Lower Limb Practice Questions

Q: Consider the following structures in the femoral triangle: 1. Femoral canal 2. Femoral Nerve 3. Femoral artery 4. Femoral vein What is the correct sequence of the above from medial to lateral ?

1, 4, 3, 2. The correct order from medial to lateral within the femoral triangle is **Femoral canal (lymphatics)**, **Femoral vein**, **Femoral artery**, and **Femoral nerve**. A common mnemonic for this order is **NAVEL** read from lateral to medial: **N**erve, **A**rtery, **V**ein, **E**mpty space/**L**ymphatics (femoral canal). Therefore, from medial to lateral, the sequence is: Canal (1), Vein (4), Artery (3), Nerve (2). *1, 2, 3, 4* - This sequence incorrectly places the Femoral nerve (2) second from medial and the Femoral vein (4) most lateral, which contradicts the anatomical arrangement. The **Femoral nerve** is the most lateral structure, and the **Femoral canal** is the most medial component. *4, 3, 1, 2* - This order incorrectly positions the Femoral canal (1) second from lateral instead of being the most medial structure. The **Femoral canal** must be the most medial, followed by vein, artery, and nerve. *3, 4, 2, 1* - This sequence incorrectly places the **Femoral artery** as the most medial and the **Femoral canal** as the most lateral, which is completely reversed. The correct medial-to-lateral order is Canal (1), Vein (4), Artery (3), Nerve (2).

Q: Sprain of the ankle joint results from an injury to:

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the **most commonly injured ligament** in ankle sprains, especially those resulting from **inversion injuries**. - It lies on the lateral aspect of the ankle and connects the **fibula to the talus**, stabilizing the **ankle joint** against anterior displacement and internal rotation of the talus. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is part of the lateral collateral ligament complex but is **rarely injured in isolation** or as the primary site in an ankle sprain. - It is typically involved only in **severe ankle sprains** with significant joint instability. *Deltoid ligament* - The **deltoid ligament** is located on the **medial side of the ankle** and is very strong, making it less prone to injury compared to the lateral ligaments. - Injury to the deltoid ligament usually occurs with **eversion injuries** of the ankle, which are less common than inversion injuries. *Spring Ligament* - The **spring ligament (plantar calcaneonavicular ligament)** supports the **medial longitudinal arch of the foot** and is not directly involved in stabilizing the ankle joint against sprains. - Injury to the spring ligament can lead to a **flatfoot deformity** but is not the primary cause of an ankle sprain.

Q: Which ligament connects medial cuneiform to the base of the 2nd metatarsal?

Lisfranc. ***Lisfranc*** - The **Lisfranc ligament** specifically connects the medial cuneiform to the base of the second metatarsal, forming a crucial part of the **tarsometatarsal joint complex**. - Its strength and integrity are vital for **midfoot stability**, and injury to this ligament can lead to significant functional impairment. *Chopart* - The **Chopart joint** (transverse tarsal joint) involves the talonavicular and calcaneocuboid articulations. - While it is a significant midfoot joint, it does not directly connect the medial cuneiform to the second metatarsal. *Deltoid* - The **deltoid ligament** is located on the medial side of the ankle, connecting the tibia to the talus, calcaneus, and navicular bones. - It primarily provides stability to the **ankle joint** and is not involved in hindfoot-to-midfoot connections. *Spring* - The **spring ligament** (plantar calcaneonavicular ligament) connects the calcaneus to the navicular bone. - It plays a crucial role in supporting the **medial longitudinal arch** of the foot, but does not connect the cuneiform to the metatarsals.

Q: Which of the following structures is supplied by the superior gluteal nerve?

Gluteus minimus. ***Gluteus minimus*** - The **superior gluteal nerve** provides motor innervation to the gluteus medius, gluteus minimus, and tensor fasciae latae muscles. - This nerve originates from the sacral plexus **(L4, L5, S1)** and exits the pelvis through the greater sciatic foramen, superior to the piriformis muscle. *Gluteus maximus* - The gluteus maximus muscle is innervated by the **inferior gluteal nerve**, not the superior gluteal nerve. - The inferior gluteal nerve also arises from the sacral plexus **(L5, S1, S2)** and is crucial for hip extension and external rotation. *Piriformis* - The piriformis muscle receives its own direct branches from the sacral plexus **(S1, S2)** via the nerve to piriformis, distinct from the superior or inferior gluteal nerves. - It plays a key role in hip external rotation and abduction when the hip is flexed. *All of the options* - This option is incorrect because gluteus maximus is innervated by the inferior gluteal nerve, and piriformis has its own specific nerve supply. - The superior gluteal nerve specifically innervates only the gluteus medius, gluteus minimus, and tensor fasciae latae.

Q: During a physical examination, a physician tests the strength of hip adduction against resistance. Which of the following nerves innervates the primary muscles responsible for this action?

Obturator nerve. ***Obturator nerve*** - The **obturator nerve** primarily innervates the **adductor muscles** of the thigh, including the adductor longus, adductor brevis, adductor magnus (adductor part), gracilis, and pectineus (variable innervation). - These muscles are responsible for **adducting the hip**, which is the action tested when a physician checks hip adduction strength against resistance. *Sciatic nerve* - The **sciatic nerve** innervates the **hamstring muscles** (semitendinosus, semimembranosus, biceps femoris) and all muscles below the knee. - It does not significantly contribute to the innervation of the primary hip adductors. *Superior gluteal nerve* - The **superior gluteal nerve** mainly innervates the **gluteus medius**, **gluteus minimus**, and **tensor fasciae latae** muscles. - These muscles are primarily involved in **hip abduction** and medial rotation, not adduction. *Femoral nerve* - The **femoral nerve** innervates the **quadriceps femoris muscles** (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) and the sartorius. - Its primary actions are **knee extension** and hip flexion, with no direct role in hip adduction.

Q: A 25-year-old woman presents with shooting pain along the lateral aspect of her right thigh. The pain is exacerbated by standing or walking for long periods. Physical examination reveals tenderness at the anterior superior iliac spine. Which of the following nerves is most likely affected?

Lateral femoral cutaneous nerve. ***Lateral femoral cutaneous nerve*** - This presentation is classic for **meralgia paresthetica**, caused by compression of the **lateral femoral cutaneous nerve** as it passes under the inguinal ligament, leading to pain and numbness on the **lateral thigh**. - Tenderness at the **anterior superior iliac spine** points to the inguinal ligament region where this nerve is most vulnerable to compression. *Common peroneal nerve* - Injury to the common peroneal nerve typically causes **foot drop** and sensory deficits over the **dorsum of the foot** and **lateral leg**, not the lateral thigh. - It is often compressed at the **fibular head**, which is anatomically distinct from the anterior superior iliac spine. *Obturator nerve* - The obturator nerve innervates the **medial thigh muscles** and provides sensation to the medial thigh; its compression would cause pain in this region, not the lateral thigh. - Injury often leads to **adductor weakness** and is typically associated with pelvic trauma or surgery. *Sciatic nerve* - Sciatic nerve pain typically radiates down the **posterior aspect of the leg** into the foot (**sciatica**), often associated with lumbar disc herniation. - Sensory deficits would follow the dermatomal distribution of its branches (**tibial** and **common peroneal nerves**).

Q: Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Medial circumflex femoral artery. ***Medial circumflex femoral artery*** - The **medial circumflex femoral artery** is the primary blood supply to the **femoral head** and **neck**, particularly through its retinacular branches. - Interruption of this blood flow, often due to trauma or other conditions, is the most common cause of **avascular necrosis** of the femoral head. *Lateral circumflex femoral artery* - The **lateral circumflex femoral artery** primarily supplies the **vastus lateralis muscle** and parts of the greater trochanter. - It contributes minimally and indirectly to the blood supply of the femoral head. *Obturator artery* - The **obturator artery** primarily supplies structures in the medial compartment of the thigh and makes a small contribution to the femoral head via the **artery of the ligamentum teres**, which is generally insufficient to prevent avascular necrosis alone. - This artery is most significant in children, but by adulthood, its contribution to femoral head vascularity is minor. *Profunda femoris artery* - The **profunda femoris artery** (deep femoral artery) is the largest branch of the femoral artery and gives rise to the circumflex femoral arteries. - Its direct contribution to the femoral head blood supply is generally through its branches (like the circumflex arteries), rather than directly.

Q: Dorsum of first webspace is supplied by which nerve?

Deep peroneal. ***Deep peroneal*** - The **deep peroneal nerve** innervates the **first dorsal webspace** of the foot, which is a classic sensory test area for this nerve. - Damage to this nerve can result in **foot drop** and loss of sensation in this specific area. *Superficial peroneal* - The **superficial peroneal nerve** supplies the majority of the **dorsum of the foot**, excluding the first webspace and the ankle. - It handles sensation for the **anterolateral aspect** of the distal leg and most of the dorsal foot. *Sural* - The **sural nerve** provides sensation to the **posterolateral aspect of the leg** and the **lateral border of the foot**. - It is often used for **nerve grafting** due to its superficial course. *Posterior tibial* - The **posterior tibial nerve** provides sensation to the **sole of the foot** via its medial and lateral plantar branches. - It also innervates most of the **intrinsic muscles of the foot**, affecting motor function.

Q: Foot eversion is caused by

Peroneus longus. ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.

Q: Which of the following is an intra-articular tendon?

Popliteus. ***Popliteus*** - The **popliteus tendon** originates within the knee capsule (intra-articular) before emerging to insert onto the posterior tibia. - It plays a crucial role in **unlocking the knee joint** from full extension and contributes to posterior stability. *Anconeus* - The **anconeus muscle** is located on the posterior aspect of the elbow, extending from the lateral epicondyle of the humerus to the ulna. - It is an **extra-articular muscle** that assists in elbow extension and stabilization. *Semitendinosus* - The **semitendinosus** is one of the hamstring muscles, located in the posterior thigh. - Its tendon contributes to the **pes anserinus**, inserting on the medial aspect of the tibia distal to the knee joint, making it an extra-articular tendon. *Sartorius* - The **sartorius** is the longest muscle in the body, running obliquely across the anterior aspect of the thigh. - Its tendon also contributes to the **pes anserinus**, inserting medially to the knee joint, and is considered extra-articular.

Question 1

Consider the following structures in the femoral triangle:

1. Femoral canal
2. Femoral Nerve
3. Femoral artery
4. Femoral vein

What is the correct sequence of the above from medial to lateral ?

Accepted Answer

1, 4, 3, 2

Answer

1, 2, 3, 4

Answer

4, 3, 1, 2

Answer

3, 4, 2, 1

Question 2

Sprain of the ankle joint results from an injury to:

Accepted Answer

Anterior talofibular ligament

Answer

Posterior talofibular ligament

Answer

Deltoid ligament

Answer

Spring Ligament

Question 3

Which ligament connects medial cuneiform to the base of the 2nd metatarsal?

Accepted Answer

Lisfranc

Answer

Chopart

Answer

Deltoid

Answer

Spring

Question 4

Which of the following structures is supplied by the superior gluteal nerve?

Accepted Answer

Gluteus minimus

Answer

Gluteus maximus

Answer

Piriformis

Answer

All of the options

Question 5

During a physical examination, a physician tests the strength of hip adduction against resistance. Which of the following nerves innervates the primary muscles responsible for this action?

Accepted Answer

Obturator nerve

Answer

Sciatic nerve

Answer

Superior gluteal nerve

Answer

Femoral nerve

Question 6

A 25-year-old woman presents with shooting pain along the lateral aspect of her right thigh. The pain is exacerbated by standing or walking for long periods. Physical examination reveals tenderness at the anterior superior iliac spine. Which of the following nerves is most likely affected?

Accepted Answer

Lateral femoral cutaneous nerve

Answer

Common peroneal nerve

Answer

Obturator nerve

Answer

Sciatic nerve

Question 7

Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Accepted Answer

Medial circumflex femoral artery

Answer

Lateral circumflex femoral artery

Answer

Obturator artery

Answer

Profunda femoris artery

Question 8

Dorsum of first webspace is supplied by which nerve?

Accepted Answer

Deep peroneal

Answer

Superficial peroneal

Answer

Sural

Answer

Posterior tibial

Question 9

Foot eversion is caused by

Accepted Answer

Peroneus longus

Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Extensor digitorum

Question 10

Which of the following is an intra-articular tendon?

Accepted Answer

Popliteus

Answer

Anconeus

Answer

Semitendinosus

Answer

Sartorius

Lower Limb — MCQs

Lower Limb — MCQs

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