Lower Limb Orthoses — MCQs
In walking, gravity tends to tilt pelvis and trunk to the unsupported side, the major factor in preventing this unwanted movement is?
All of the following are examples of traction epiphysis except which of the following?
The shown apparatus is used for
Which nerve is commonly damaged in fracture of neck of fibula?
What is the most effective management strategy for hemarthrosis?
Which of the following muscles is primarily responsible for plantar flexion?
A male patient presents with sensory loss and weakness of limbs for 3 months. He also has angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN type of lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?
A patient came with complaints of lower limb weakness. Examiner places one hand under the patient's heel and patient is asked to raise his other leg against downward resistance. What is the name of this test?
Which artery is the major supply of the medial surface of the cerebral hemisphere?
Inflammatory lesions in all of the following areas make the superficial inguinal lymph nodes enlarged and tender, EXCEPT:
Lower Limb Orthoses Indian Medical PG Practice Questions and MCQs
Question 1: In walking, gravity tends to tilt pelvis and trunk to the unsupported side, the major factor in preventing this unwanted movement is?
- A. Adductor muscles
- B. Quadriceps
- C. Gluteus medius and minimus (Correct Answer)
- D. Gluteus maximus
Explanation: ***Gluteus medius and minimus*** - The **gluteus medius** and **gluteus minimus** are essential **abductors** of the hip, primarily responsible for stabilizing the pelvis during the **single-limb support phase of gait**. - When one leg is lifted during walking, these muscles on the **stance leg side** contract to prevent the pelvis from tilting downwards on the unsupported swing leg side. *Adductor muscles* - **Adductor muscles** (adductor longus, brevis, magnus, pectineus, gracilis) primarily function to bring the thigh toward the midline of the body. - While they play a role in gait stability, their main action is not to prevent the lateral pelvic tilt described. *Quadriceps* - The quadriceps femoris group (rectus femoris, vastus lateralis, medialis, intermedius) are powerful **extensors of the knee**. - They are crucial for weight acceptance and propulsion during walking but do not directly prevent lateral pelvic tilt [1]. *Gluteus maximus* - The **gluteus maximus** is the largest and most powerful muscle of the hip, primarily responsible for **hip extension** and **external rotation**. - It is crucial for activities like climbing stairs or running, but its main role in normal walking is not to prevent lateral pelvic tilt; that function is more specific to the gluteus medius and minimus.
Question 2: All of the following are examples of traction epiphysis except which of the following?
- A. Tubercles of humerus.
- B. Posterior tubercle of talus. (Correct Answer)
- C. Trochanters of femur.
- D. Tibial tuberosity.
Explanation: ***Posterior tubercle of talus*** - The posterior tubercle of the **talus** is not typically considered a traction epiphysis because it's an integral part of the talar body, involved in joint articulation rather than being a site of significant muscle or ligament attachment pulling on a separate ossification center. - While the **flexor hallucis longus** tendon grooves its surface, its primary function and development are not driven by the tensile forces characteristic of traction epiphyses. *Tubercles of humerus* - The **greater and lesser tubercles of the humerus** are classic examples of **traction epiphyses**. - They serve as insertion sites for the **rotator cuff muscles** (supraspinatus, infraspinatus, teres minor, and subscapularis), where strong repetitive pulling forces stimulate their development. *Trochanters of femur* - The **greater and lesser trochanters of the femur** are well-known examples of **traction epiphyses**. - They provide points of attachment for powerful hip and thigh muscles, such as the **gluteal muscles** (greater trochanter) and **iliopsoas** (lesser trochanter), which exert significant traction forces during growth. *Tibial tuberosity* - The **tibial tuberosity** is a prominent example of a **traction epiphysis**. - It serves as the insertion point for the **patellar ligament**, transmitting the force of the **quadriceps femoris** muscle, making it subject to repetitive traction during growth and development.
Question 3: The shown apparatus is used for
- A. Ankle knee stabilizer
- B. Thomas splint
- C. Knee brace
- D. Patella tendon bearing brace (Correct Answer)
Explanation: ***Patella tendon bearing brace*** - This orthotic device is designed to **transfer weight-bearing load through the patella tendon**, reducing stress on the lower extremity during ambulation. - It features a **molded cuff** that fits snugly below the patella and distributes weight through the **patellar tendon bearing area**, commonly used in **prosthetic applications** and **below-knee amputees**. *Ankle knee stabilizer* - This device provides **combined support to both ankle and knee joints** simultaneously, typically used for **multi-joint injuries** or instability. - It features **dual bracing systems** with straps and supports extending from ankle to knee, unlike the focused patellar tendon bearing design. *Thomas splint* - A **rigid metal-framed splint** used primarily for **femur fracture stabilization** and maintaining **skeletal traction** in emergency situations. - It consists of a **ring that fits around the upper thigh** with extending metal bars, designed for **fracture immobilization** rather than weight distribution. *Knee brace* - A general **knee joint support device** used for **ligament injuries**, **post-surgical recovery**, or **osteoarthritis management**. - Available in various forms (**sleeve, hinged, or wraparound designs**) but lacks the specific **weight-bearing transfer mechanism** of a patella tendon bearing brace.
Question 4: Which nerve is commonly damaged in fracture of neck of fibula?
- A. Tibial
- B. Common peroneal (Correct Answer)
- C. Superficial peroneal
- D. Deep peroneal
Explanation: ***Common peroneal*** - The **common peroneal nerve** (also known as the **common fibular nerve**) wraps superficially around the **neck of the fibula**, making it highly vulnerable to injury in fractures of this region. - Damage to this nerve typically results in **foot drop** and sensory loss over the dorsum of the foot and lateral leg, due to impaired dorsiflexion and eversion. *Tibial* - The **tibial nerve** lies in the posterior compartment of the leg and is generally well-protected, making it less susceptible to injury from a fibular neck fracture. - Injury to the tibial nerve would primarily affect plantarflexion of the foot and sensation to the sole. *Superficial peroneal* - The **superficial peroneal nerve** is a branch of the common peroneal nerve that descends along the lateral compartment of the leg. - While it originates from the common peroneal, a direct fracture of the fibular neck is more likely to injure the main common peroneal trunk rather than just this specific branch, leading to a broader deficit. *Deep peroneal* - The **deep peroneal nerve** is another branch of the common peroneal nerve that runs through the anterior compartment of the leg. - Similar to the superficial peroneal nerve, a fracture at the fibular neck is more likely to affect the main **common peroneal nerve** directly.
Question 5: What is the most effective management strategy for hemarthrosis?
- A. Immobilization with a P.O.P. cast
- B. Application of a compression bandage
- C. Needle aspiration to remove excess blood (Correct Answer)
- D. All of the options
Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.
Question 6: Which of the following muscles is primarily responsible for plantar flexion?
- A. Tibialis posterior
- B. Soleus
- C. Plantaris
- D. Gastrocnemius (Correct Answer)
Explanation: ***Gastrocnemius*** - The **gastrocnemius** is a powerful superficial muscle of the calf that, along with the soleus, forms the triceps surae. - It is primarily responsible for **plantar flexion of the ankle** and also assists in knee flexion. *Plantaris* - The **plantaris** is a small, slender muscle that aids weakly in plantar flexion and knee flexion. - Its contribution to overall plantar flexion strength is **minimal** compared to the gastrocnemius and soleus. *Tibialis posterior* - The **tibialis posterior** primarily functions in **inversion of the foot** and also contributes to plantar flexion. - It plays a crucial role in maintaining the **medial longitudinal arch** of the foot. *Soleus* - The soleus is a broad, flat muscle located deep to the gastrocnemius, and it is a major contributor to **plantar flexion**. - Unlike the gastrocnemius, the soleus only crosses the ankle joint, making its action **independent of knee position**.
Question 7: A male patient presents with sensory loss and weakness of limbs for 3 months. He also has angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN type of lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?
- A. Subacute combined degeneration of cord (Correct Answer)
- B. Extradural compression of the spinal cord
- C. Progressive muscular atrophy
- D. Cervical spondylotic myelopathy
Explanation: ***Subacute combined degeneration of cord*** - The combination of **sensory loss (proprioception, vibration)**, **UMN weakness**, **absent ankle reflex** (suggesting LMN involvement or peripheral neuropathy), and **angular stomatitis** (a sign of nutritional deficiency) is highly characteristic of **vitamin B12 deficiency**, leading to subacute combined degeneration. - This condition affects the **posterior and lateral columns of the spinal cord**, explaining the broad neurological symptoms. *Extradural compression of the spinal cord* - While it can cause sensory loss and weakness, **extradural compression** typically presents with a more localized deficit and would not explain the **angular stomatitis** or the specific pattern of combined UMN/LMN signs without a clear lesion level. - Would primarily cause symptoms related to the compressed spinal cord segments, often with **radicular pain** or a **sensory level**, which are not explicitly described. *Progressive muscular atrophy* - This is a form of **motor neuron disease** characterized by **pure lower motor neuron (LMN) degeneration**, leading to **muscle weakness, atrophy, and fasciculations**. - It would not typically present with **UMN signs** (like UMN type weakness) or **sensory loss** (proprioception, vibration), nor angular stomatitis. *Cervical spondylotic myelopathy* - This condition involves **compression of the cervical spinal cord** due to degenerative changes, leading to **UMN signs below the level of compression** and sometimes LMN signs at the level of compression. - It would not typically cause widespread **proprioception and vibration loss** in a diffuse pattern or **angular stomatitis**, and the absent ankle reflex without other LMN signs is less typical for isolated cervical involvement.
Question 8: A patient came with complaints of lower limb weakness. Examiner places one hand under the patient's heel and patient is asked to raise his other leg against downward resistance. What is the name of this test?
- A. O'Donoghue test
- B. McBride test
- C. Waddell's test
- D. Hoover test (Correct Answer)
Explanation: ***Hoover test*** - This specific maneuver is used to detect **malingering or non-organic weakness** in the lower limbs [1]. The examiner expects an involuntary downward thrust from the heel of the seemingly weak leg when the patient attempts to lift the contralateral leg. - Absence of this expected downward pressure on the examiner's hand when the patient is asked to lift the "strong" leg suggests the patient is not genuinely attempting to lift the affected leg. *O'Donoghue test* - The O'Donoghue test assesses for **meniscal or ligamentous injury** in the knee joint by combining passive and resisted motions of the knee. - It involves motions like resisted flexion, extension, and rotation to elicit pain, which is different from the described procedure. *McBride test* - The McBride test is used to evaluate the integrity of the **collateral ligaments of the knee**, particularly after injury. - It involves specific manipulations of the knee and ankle to assess stability and pain, which is not what the question describes. *Waddell's test* - Waddell's signs are a set of five physical signs that indicate **non-organic or psychological components to low back pain**. - These signs include superficial tenderness, simulated axial loading pain, distraction signs, regional weakness/sensory disturbance, and overreaction during examination, none of which involve the specific maneuver for detecting lower limb motor weakness described in the question.
Question 9: Which artery is the major supply of the medial surface of the cerebral hemisphere?
- A. Anterior cerebral artery (Correct Answer)
- B. Posterior cerebral artery
- C. Middle cerebral artery
- D. Posterior inferior cerebellar artery
Explanation: ***Anterior cerebral artery*** - The **anterior cerebral artery (ACA)** is a primary branch of the internal carotid artery and is responsible for supplying blood to the **medial surface** of the frontal and parietal lobes of the cerebral hemispheres [1]. - It also supplies the **corpus callosum**, the superior aspect of the frontal and parietal lobes, and parts of the basal ganglia [1]. *Posterior cerebral artery* - The **posterior cerebral artery (PCA)** primarily supplies the **occipital lobe** and the inferior part of the **temporal lobe** [1]. - It also provides blood to parts of the midbrain and the **thalamus** [1]. *Middle cerebral artery* - The **middle cerebral artery (MCA)** is the largest cerebral artery and supplies most of the **lateral surface** of the cerebral hemispheres [1]. - It is crucial for the blood supply to the **motor and sensory cortices** for the face and upper limb, as well as language areas (Broca's and Wernicke's). *Posterior inferior cerebellar artery* - The **posterior inferior cerebellar artery (PICA)** is a branch of the **vertebral artery** and exclusively supplies the **cerebellum** and the lateral medulla. - It is not involved in the blood supply to the cerebral hemispheres.
Question 10: Inflammatory lesions in all of the following areas make the superficial inguinal lymph nodes enlarged and tender, EXCEPT:
- A. Spongy Urethra
- B. Big Toe
- C. Lower part of Anal Canal
- D. Isthmus of Uterine Tube (Correct Answer)
Explanation: No changes were made to the original explanation because the provided references did not contain relevant information regarding the lymphatic drainage of the isthmus of the uterine tube, the spongy urethra, the lower limb (big toe), or the anal canal below the pectinate line. Each reference was evaluated and found to be unrelated to the specific anatomical question asked.
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