Chapter·AnatomyUpper/Lower Limb

Muscles and movements of lower limbDownloads

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1

A 53-year-old multiparous woman is scheduled to undergo elective sling surgery for treatment of stress incontinence. She has frequent loss of small amounts of urine when she coughs or laughs, despite attempts at conservative treatment. The physician inserts trocars in the obturator foramen bilaterally to make the incision and passes a mesh around the pubic bones and underneath the urethra to form a sling. During the procedure, the physician accidentally injures a nerve in the obturator foramen. The function of which of the following muscles is most likely to be affected following the procedure?

AObturator internus

BTensor fascia latae

CAdductor longus

DSemitendinosus

ETransversus abdominis

2

A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99°F (37.2°C), blood pressure is 145/85 mmHg, pulse is 91/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patient's diagnosis?

AElectromyography

BAnkle-brachial index

CComputerized tomography myelography

DMagnetic resonance imaging

ERadiography

3

A 48-year-old male presents to his primary care provider with a two-week history of low back pain and left leg pain. He reports that his symptoms started while he was working at his job as a construction worker. He has since experienced intermittent achy pain over his lumbar spine. He has also noticed pain radiating into his left leg and weakness in left ankle dorsiflexion. On exam, he demonstrates the following findings on strength testing of the left leg: 5/5 in knee extension, 4/5 in ankle dorsiflexion, 4/5 in great toe extension, 5/5 in ankle plantarflexion, and 5/5 in great toe flexion. The patellar reflexes are 5/5 bilaterally. He is able to toe walk but has difficulty with heel walking. Weakness in which of the following compartments of the leg is most likely causing this patient’s foot drop?

ALateral compartment

BSuperficial posterior compartment

CDeep posterior compartment

DAnterior compartment

EMedial compartment

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