Lower Limb Practice Questions

Q: The arteries supplying the femoral head include the following except

Ligamentum teres artery. ***Ligamentum teres artery*** - While called an artery, the artery of the **ligamentum teres** (foveal artery) is an **inconsistent** and typically **insignificant** contributor to the femoral head blood supply in adults. - Its primary role, when present, is mainly during **development** and it often **obliterates** or remains a small vessel that usually provides **minimal to no significant blood supply** to the femoral head in adults. - Of all the arteries listed, this is the **least reliable** and most frequently absent or non-functional supplier. *Medial circumflex femoral artery* - The **medial circumflex femoral artery** is the **most crucial** blood supply to the adult femoral head, providing approximately **75-80%** of the blood supply, especially to the superior and posterior aspects. - It gives rise to the **retinacular arteries** that ascend along the femoral neck beneath the synovial reflection. *Profunda femoris artery* - The **profunda femoris artery** (deep femoral artery) is the main branch of the femoral artery and gives rise to the **medial and lateral circumflex femoral arteries**. - While it is the **parent vessel** of the actual suppliers, it does not **directly** supply the femoral head itself—its branches do. - In strict anatomical terms, it is a **source artery** rather than a direct supplier, but it is included here as it gives rise to the circumflex vessels. *Lateral circumflex femoral artery* - The **lateral circumflex femoral artery** also contributes to the blood supply of the femoral head, though typically to a **lesser extent** than the medial circumflex femoral artery. - It supplies the **anterior aspect** of the femoral head and neck, primarily through its ascending branch.

Q: A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?

Common peroneal nerve. **Correct: Common peroneal nerve** - The **lateral aspect of the right knee** is particularly vulnerable to direct trauma to the **common peroneal nerve** due to its superficial course around the neck of the fibula. - The unconscious state and lateral position suggest a prolonged compression or direct impact mechanism, making this nerve highly susceptible to injury. - The common peroneal nerve is the **most commonly injured nerve in the lower limb** due to its superficial location. *Incorrect: Femoral nerve* - The **femoral nerve** runs deep within the groin region and anterior thigh, making direct injury at the knee unlikely from an isolated lateral knee trauma. - Injuries to the femoral nerve typically result from pelvic fractures, abdominal surgery, or deep penetrating wounds to the groin. *Incorrect: Radial nerve* - The **radial nerve** is located in the upper limb and primarily affects the extensor muscles of the arm, forearm, and hand. - While bruises on the right arm are noted, an injury to the radial nerve would not explain the specific trauma to the lateral aspect of the knee. *Incorrect: Trigeminal nerve* - The **trigeminal nerve** is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewing. - Superficial injury to the face might affect sensory branches, but it is entirely unrelated to an injury to the lateral aspect of the knee.

Q: Nelaton's line is a line joining

Anterior superior iliac spine and ischial tuberosity. Anterior superior iliac spine and ischial tuberosity - Nelaton's line is an imaginary line drawn between the anterior superior iliac spine (ASIS) and the ischial tuberosity. - This line is clinically useful in assessing for hip dislocations or fractures of the femoral neck, where the greater trochanter may lie above or posterior to this line. Anterior superior iliac spine and umbilicus - A line joining the ASIS and the umbilicus is not a standard anatomical landmark or clinical line used for assessing hip pathology. - While these are anatomical points, their connection does not form Nelaton's line. Posterior iliac spine and umbilicus - The posterior superior iliac spine (PSIS) and the umbilicus are not used to define Nelaton's line. - This combination of landmarks does not have a recognized clinical application for hip assessment. Posterior iliac spine and ischial tuberosity - A line between the PSIS and the ischial tuberosity is not Nelaton's line. - This specific anatomical connection is not typically used as a diagnostic or assessment tool in the context of hip injuries.

Q: Foot drop occurs due to the involvement of:

Common peroneal nerve palsy. ***Common peroneal nerve palsy*** - The **common peroneal nerve** (also known as the common fibular nerve) innervates the muscles responsible for **dorsiflexion** and eversion of the foot (tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus longus and brevis). - Damage to this nerve leads to weakness or paralysis of these muscles, resulting in **foot drop**, which is the most common neurological cause. - The nerve is vulnerable at the **neck of the fibula** where it is superficial and can be compressed or injured. *Sciatic nerve* - The **sciatic nerve** divides into the tibial and common peroneal nerves. - Proximal sciatic nerve injury can cause foot drop, but it would also cause additional deficits including hamstring weakness, loss of ankle plantarflexion, and sensory loss over a wider distribution. - Isolated foot drop typically indicates **common peroneal nerve** injury, not sciatic nerve injury. *Direct injury to the dorsiflexors* - Direct trauma to the **dorsiflexor muscles** (tibialis anterior, extensor hallucis longus, extensor digitorum longus) can mechanically impair dorsiflexion. - However, the term "foot drop" typically refers to **neurological causes** rather than direct muscle injury, making common peroneal nerve palsy the more specific answer. *Obturator nerve* - The **obturator nerve** innervates the **adductor muscles of the thigh** (adductor longus, adductor brevis, adductor magnus, gracilis). - It does not innervate any muscles responsible for dorsiflexion of the foot and therefore **cannot cause foot drop**.

Q: Trendelenberg sign is positive in paralysis of all except:

Gluteus maximus. ***Gluteus maximus*** - The **gluteus maximus** is primarily responsible for **hip extension** and **external rotation**, and its paralysis would lead to a different gait pattern (e.g., gluteus maximus lurch) but not a positive Trendelenburg sign. - The **Trendelenburg sign** specifically assesses the strength and function of the **hip abductors**, which are not the primary role of the gluteus maximus. *Tensor fascia lata* - The **tensor fascia lata** is a hip abductor and internal rotator, contributing to the stability of the pelvis during gait. - Paralysis of the **tensor fascia lata** would weaken hip abduction, contributing to a positive Trendelenburg sign. *Gluteus medius* - The **gluteus medius** is a primary **hip abductor** and is crucial for stabilizing the pelvis when standing on one leg. - Weakness or paralysis of the **gluteus medius** directly leads to a positive Trendelenburg sign, where the unsupported side of the pelvis drops. *Gluteus minimus* - The **gluteus minimus** is also a primary **hip abductor** and works synergistically with the gluteus medius to maintain pelvic stability during gait. - Paralysis of the **gluteus minimus** would impair hip abduction strength, resulting in a positive Trendelenburg sign.

Q: A patient was on DVT prophylaxis. All of the following have perforators which connect superficial veins to the deep veins, except:

Mid-shaft of tibia. The mid-shaft of the tibia is primarily composed of bone and muscle, and it lacks the significant perforating veins found in other regions of the lower limb. Perforating veins are most prevalent where superficial veins are close to deep veins and require connection to aid venous return against gravity, such as in the ankle, calf, and thigh [1]. *Ankle* - The **ankle** region has several perforating veins (e.g., **Cockett’s perforators**) that connect the **great saphenous vein** to the **posterior tibial veins**, which are crucial for venous return [1]. - These perforators are clinically significant in the development of **venous stasis ulcers** [1]. *Mid Calf* - The **mid-calf** has numerous perforating veins, including **Boyd’s perforator** and perforators connecting the **small saphenous vein** to deep calf veins [1]. - These veins play a vital role in pumping blood from the superficial system into the deep system during muscle contraction [1]. *Lower Thigh* - The **lower thigh** contains perforating veins such as **Dodd’s perforator**, which connects the **great saphenous vein** to the **femoral vein** [1]. - These perforators are important for efficient venous drainage from the superficial to the deep venous system in this region [1].

Q: Which ligament is involved in pes planus of foot?

Spring ligament. ***Spring ligament*** - The **spring ligament** (plantar calcaneonavicular ligament) is crucial in maintaining the **medial longitudinal arch** of the foot by supporting the head of the talus. - Insufficiency or rupture of this ligament leads to a flattening of the arch, characteristic of **pes planus**. *Deltoid ligament* - The **deltoid ligament** is a strong medial collateral ligament of the ankle joint, preventing excessive eversion. - While it plays a role in ankle stability, its primary function is not directly supporting the **longitudinal arch** of the foot, and thus it is not the main ligament involved in pes planus. *Deep transverse ligament* - The **deep transverse metatarsal ligament** connects the heads of the metatarsals, stabilizing the forefoot. - Its involvement is more related to conditions affecting the forefoot, such as splayfoot or bunions, rather than the **medial longitudinal arch** central to pes planus. *Long and short plantar ligament* - The **long and short plantar ligaments** support the lateral longitudinal arch of the foot and connect the calcaneus to the cuboid and metatarsals. - While these ligaments are important for general foot arch integrity, the **spring ligament** is specifically critical for the medial longitudinal arch, which is primarily flattened in pes planus.

Q: Which of the following group of lymph nodes does NOT receive direct lymphatic drainage from the perineum?

External iliac. ***External iliac*** - The external iliac lymph nodes do **NOT receive direct lymphatic drainage** from the perineum. - They primarily receive lymph from the **deep inguinal nodes**, pelvic organs (bladder, upper vagina), and lower anterior abdominal wall [1]. - Perineal lymphatics drain to superficial inguinal, deep inguinal, or internal iliac nodes first, making external iliac a **secondary or tertiary drainage station** rather than a direct recipient. *Superficial inguinal* - These are the **primary drainage site** for lymph from the superficial perineum. - They receive direct lymphatic vessels from the **vulva, distal vagina, labia majora**, scrotum, and skin of the perineum. - This is the main first-line drainage pathway for superficial perineal structures. *Internal iliac* - Internal iliac lymph nodes receive **direct lymphatic drainage** from the deep perineum, including the **male urethra, prostate**, and deep structures [2], [3]. - They serve as primary drainage for pelvic visceral structures and deep perineal tissues [3]. *Deep inguinal* - Deep inguinal lymph nodes receive lymph from the **superficial inguinal nodes** and from deep structures of the lower limb. - They are part of the drainage pathway from the perineum via the superficial inguinal nodes.

Q: Which structure is closely associated with the fibular collateral ligament?

Biceps femoris. ***Biceps femoris*** - The **biceps femoris tendon** passes superficial and lateral to the fibular collateral ligament before inserting onto the head of the fibula. - These two structures run parallel to each other and are anatomically closely related at the lateral aspect of the knee joint. - The **intimate relationship** between the biceps femoris tendon and the fibular collateral ligament makes them key anatomical landmarks for understanding lateral knee anatomy. *Peroneus longus* - The **peroneus longus** muscle is located in the lateral compartment of the leg and its tendon courses around the lateral malleolus, but it does not have a direct anatomical association with the fibular collateral ligament at the knee joint. - Its primary role is in **eversion and plantarflexion of the foot**, not direct knee joint stabilization. *Semimembranosus* - The **semimembranosus** muscle is a hamstring muscle located in the posterior compartment of the thigh, inserting predominantly on the medial tibial condyle. - It strengthens the medial aspect of the knee joint and has no direct anatomical relationship with the lateral fibular collateral ligament. *Adductor magnus* - The **adductor magnus** is a large muscle of the medial compartment of the thigh, involved in adduction of the hip. - It inserts on the femur and its tendinous attachments are far removed from the lateral knee structures like the fibular collateral ligament.

Question 1

The arteries supplying the femoral head include the following except

Accepted Answer

Ligamentum teres artery

Answer

Medial circumflex artery

Answer

Profunda femoral artery

Answer

Lateral circumflex artery

Question 2

A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?

Accepted Answer

Common peroneal nerve

Answer

Femoral nerve

Answer

Radial nerve

Answer

Trigeminal nerve

Question 3

Nelaton's line is a line joining

Accepted Answer

Anterior superior iliac spine and ischial tuberosity

Answer

Anterior superior iliac spine and umbilicus

Answer

Posterior iliac spine and umbilicus

Answer

Posterior iliac spine and ischial tuberosity

Question 4

Foot drop occurs due to the involvement of:

Accepted Answer

Common peroneal nerve palsy

Answer

Obturator nerve

Answer

Sciatic nerve

Answer

Direct injury to the dorsiflexors

Question 5

Trendelenberg sign is positive in paralysis of all except:

Accepted Answer

Gluteus maximus

Answer

Tensor fascia lata

Answer

Gluteus medius

Answer

Gluteus minimus

Question 6

A patient was on DVT prophylaxis. All of the following have perforators which connect superficial veins to the deep veins, except:

Accepted Answer

Mid-shaft of tibia

Answer

Ankle

Answer

Mid Calf

Answer

Lower Thigh

Question 7

Which ligament is involved in pes planus of foot?

Accepted Answer

Spring ligament

Answer

Deltoid ligament

Answer

Deep transverse ligament

Answer

Long and short plantar ligament

Question 8

Which of the following group of lymph nodes does NOT receive direct lymphatic drainage from the perineum?

Accepted Answer

External iliac

Answer

Superficial inguinal

Answer

Internal iliac

Answer

Deep inguinal

Question 9

Not true about anterior cruciate ligament -

Accepted Answer

It begins just behind the anterior horn of lateral meniscus on tibia

Answer

It provides proprioceptive inputs to knee

Answer

It is taut in extension

Answer

It is extrasynovial

Question 10

Which structure is closely associated with the fibular collateral ligament?

Accepted Answer

Biceps femoris

Answer

Peroneus longus

Answer

Semimembranosus

Answer

Adductor magnus

Lower Limb — MCQs

Lower Limb — MCQs

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