Lower Limb Practice Questions

Q: Which of the following is NOT an action of the sartorius muscle?

Extension of the leg. The **Sartorius muscle**, known as the "Tailor's muscle," is the longest muscle in the human body. It is a superficial muscle of the anterior compartment of the thigh that crosses two joints: the hip and the knee. ### **Why "Extension of the leg" is the Correct Answer** The Sartorius originates from the **Anterior Superior Iliac Spine (ASIS)** and inserts into the upper part of the medial surface of the tibia (as part of the **Pes Anserinus**). Because it passes **posterior** to the transverse axis of the knee joint, its contraction results in **flexion of the leg**, not extension. Extension of the leg is the primary function of the Quadriceps Femoris group. ### **Analysis of Other Options** * **Flexion of the thigh:** As it crosses the hip joint anteriorly, it acts as a synergist in flexing the hip. * **Flexion of the leg:** Unlike the quadriceps, the sartorius pulls the tibia backward, causing knee flexion. * **Lateral rotation of the thigh:** Due to its oblique course across the thigh, it assists in rotating the femur laterally at the hip. ### **NEET-PG High-Yield Pearls** * **The "Tailor's Position":** The sartorius performs all actions required to sit cross-legged: Hip flexion, abduction, lateral rotation, and knee flexion. * **Pes Anserinus (Goose's Foot):** This is a common insertion point on the medial tibia for three muscles: **S**artorius (Femoral n.), **G**racilis (Obturator n.), and **S**emitendinosus (Tibial n.). *Mnemonic: "Say Grace before Tea."* * **Adductor Canal (Hunter’s Canal):** The sartorius forms the **roof** of this canal, which contains the femoral artery, femoral vein, and saphenous nerve. * **Nerve Supply:** It is supplied by the **Femoral Nerve (L2, L3)**.

Q: Which of the following muscles is responsible for plantar flexion?

All of the above. **Explanation:** Plantar flexion is the movement that increases the angle between the front of the foot and the shin (pointing the toes downward). This action is primarily performed by the muscles located in the **posterior compartment of the leg**, all of which are innervated by the **tibial nerve**. 1. **Soleus (Option C):** Along with the gastrocnemius, the soleus forms the *triceps surae*. It is a powerful plantar flexor and is often called the "peripheral heart" because its venous sinuses help pump blood back to the heart. 2. **Plantaris (Option A):** This is a vestigial muscle with a long, thin tendon. While its contribution is weak, it acts across the ankle joint to assist in plantar flexion. 3. **Flexor Hallucis Longus (Option B):** Located in the deep posterior compartment, its primary action is flexing the great toe, but because it passes posterior to the transverse axis of the ankle joint, it also serves as a secondary plantar flexor. Since all three muscles cross the ankle joint posteriorly, they all contribute to the movement, making **"All of the above"** the correct choice. **High-Yield NEET-PG Pearls:** * **Prime Movers:** The Gastrocnemius and Soleus are the strongest plantar flexors. * **The "Freshman’s Nerve":** The Plantaris tendon is often mistaken for a nerve by first-year students; its tendon is commonly used for grafting. * **Clinical Correlation:** Rupture of the **Achilles tendon** (calcaneal tendon) results in a profound loss of plantar flexion and a positive **Thompson test** (Simmonds' test). * **Antagonist:** The Tibialis anterior is the primary dorsiflexor of the foot.

Q: A 34-year-old power lifter has difficulty walking and a problem unlocking the knee joint to permit leg flexion. Which of the following muscles is most likely damaged?

Popliteus. ### Explanation **Correct Option: C. Popliteus** The **Popliteus** is known as the **"Key to the knee"** because of its essential role in initiating flexion from a fully extended position. * **The Mechanism:** When the knee is fully extended, it is "locked" in a position of maximum stability due to the medial rotation of the femur on the tibia. To initiate flexion, the knee must first be "unlocked." * **The Action:** The popliteus muscle accomplishes this by **laterally rotating the femur** on the fixed tibia (in a weight-bearing position, like a powerlifter standing) or medially rotating the tibia on the femur (in a non-weight-bearing position). This rotation relaxes the ligaments and allows flexion to proceed. --- ### Why the other options are incorrect: * **A. Biceps femoris:** This is a lateral hamstring muscle. While it is a flexor of the knee and a lateral rotator of the leg when the knee is flexed, it does not perform the initial "unlocking" required to start flexion from full extension. * **B. Gastrocnemius:** This muscle acts as a weak flexor of the knee and a strong plantarflexor of the ankle. It helps maintain the stability of the knee but does not have a rotatory component to unlock the joint. * **D. Semimembranosus:** This is a medial hamstring muscle. It assists in knee flexion and medial rotation of the leg when the knee is already flexed, but it is not the primary initiator of the unlocking mechanism. --- ### High-Yield Clinical Pearls for NEET-PG: * **Origin:** Lateral condyle of the femur (intracapsular but extrasynovial). * **Insertion:** Posterior surface of the tibia, above the soleal line. * **Innervation:** Tibial nerve (L4, L5, S1). * **The "Locking" Mechanism:** Occurs during the last 30° of extension; it is a passive movement (medial rotation of femur) that requires no muscle power. * **The "Unlocking" Mechanism:** An active process initiated by the **Popliteus**.

Q: Which of the following muscles is located in the first layer of the sole of the foot?

Flexor digitorum brevis. The sole of the foot is organized into **four distinct layers** of muscles and tendons, a high-yield topic for NEET-PG. ### **Explanation of the Correct Answer** The **first (most superficial) layer** consists of three muscles that originate primarily from the calcaneal tuberosity and act as the "intrinsic stabilizers" of the foot. These are: 1. **Abductor hallucis** 2. **Flexor digitorum brevis (FDB)** (The correct answer) 3. **Abductor digiti minimi** The FDB lies centrally in the first layer. It inserts into the middle phalanges of the lateral four toes and is responsible for flexing the proximal interphalangeal joints. ### **Analysis of Incorrect Options** * **Adductor hallucis (Option A):** This muscle belongs to the **third layer**. It has two heads (oblique and transverse) and is crucial for maintaining the transverse arch of the foot. * **Flexor digiti minimi brevis (Option C):** This is also a **third layer** muscle, located on the lateral side of the foot, acting on the little toe. * **Flexor hallucis longus (Option D):** This is an **extrinsic muscle** (originates in the posterior compartment of the leg). Its tendon passes through the **second layer** of the sole, where it is crossed by the tendon of the flexor digitorum longus. ### **NEET-PG High-Yield Pearls** * **Nerve Supply:** All muscles of the first layer are supplied by the **Medial Plantar Nerve**, *except* for the Abductor digiti minimi, which is supplied by the **Lateral Plantar Nerve**. * **Layer 2 Shortcut:** Remember "2 Tendons, 2 Muscles." Tendons: FDL and FHL. Muscles: Quadratus plantae and Lumbricals. * **Master Rule:** Most intrinsic muscles of the foot are supplied by the **Lateral Plantar Nerve** (S2, S3), which is analogous to the Ulnar nerve in the hand. Only four muscles are supplied by the Medial Plantar Nerve (LAFF: 1st **L**umbrical, **A**bductor hallucis, **F**lexor hallucis brevis, and **F**lexor digitorum brevis).

Q: Which structure passes deep to the medial malleolus?

Posterior tibial artery. The structures passing deep to the flexor retinaculum (behind the medial malleolus) are organized in a specific anteroposterior sequence. This is a classic high-yield topic for NEET-PG, often remembered by the mnemonic: **"Tom, Dick, And Very Nervous Harry."** 1. **T**ibialis posterior tendon (Most anterior) 2. **D**igitorum longus (Flexor digitorum longus tendon) 3. **A**rtery (Posterior tibial artery) 4. **V**ein (Posterior tibial vein) 5. **N**erve (Tibial nerve) 6. **H**arry (Flexor hallucis longus tendon - Most posterior/deep) **Explanation of Options:** * **A. Posterior tibial artery (Correct):** As per the mnemonic, the artery lies between the flexor digitorum longus and the tibial nerve behind the medial malleolus. * **B. Great saphenous vein:** This structure passes **anterior** to the medial malleolus, accompanied by the saphenous nerve. It is a superficial structure, not deep to the retinaculum. * **C. Tibialis anterior tendon:** This is a structure of the anterior compartment of the leg and passes anterior to the **ankle joint**, medial to the extensor hallucis longus. * **D. Peroneus tertius tendon:** This is also an anterior compartment muscle that inserts onto the base of the 5th metatarsal; it passes anterior to the **lateral malleolus**. **Clinical Pearls for NEET-PG:** * **Tarsal Tunnel Syndrome:** Compression of the tibial nerve as it passes deep to the flexor retinaculum. * **Pulsations:** The posterior tibial artery pulse is best felt midway between the medial malleolus and the medial tubercle of the calcaneus. * **Order:** Tibialis posterior is the first structure encountered immediately behind the medial malleolus and is the most commonly injured tendon in this region.

Q: Which is the most commonly injured nerve in the leg?

Common peroneal nerve. **Explanation:** The **Common Peroneal Nerve (CPN)**, also known as the common fibular nerve, is the most commonly injured nerve in the lower limb. The primary reason for its vulnerability is its **superficial anatomical course**. As it winds around the **neck of the fibula**, it lies directly against the bone, covered only by skin and fascia. This makes it highly susceptible to compression (e.g., tight casts, prolonged leg crossing) and direct trauma (e.g., fibular neck fractures). **Analysis of Options:** * **Common Peroneal Nerve (Correct):** Its exposed position at the fibular neck makes it the most frequent site of peripheral nerve entrapment in the leg, typically presenting as **foot drop** due to paralysis of the anterior and lateral compartment muscles. * **Femoral Nerve:** Located deep within the femoral triangle and protected by the inguinal ligament, it is rarely injured except during pelvic fractures or iatrogenic surgical trauma. * **Sciatic Nerve:** While it is the largest nerve, it is well-protected by the gluteus maximus and posterior thigh muscles. It is most commonly injured by posterior hip dislocations or misplaced intramuscular injections, but less frequently than the CPN. * **Tibial Nerve:** This nerve is deeply situated in the popliteal fossa and the posterior compartment of the leg. It is generally protected from external trauma, though it can be compressed in the tarsal tunnel. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Injury leads to **Foot Drop** (loss of dorsiflexion) and **Equinovarus** deformity. * **Sensory Loss:** Occurs on the dorsum of the foot and the lateral aspect of the leg. * **High-Yield Association:** Often associated with **Stryker's position** (lithotomy) or "Strawberry picker’s palsy" due to prolonged squatting.

Q: Eversion is:

Sole of the foot outward. **Explanation:** **Eversion** is a complex movement of the foot where the **sole of the foot is turned outward**, away from the median plane. This movement occurs primarily at the **subtalar** and **transverse tarsal joints**. * **Why Option B is Correct:** During eversion, the lateral border of the foot is raised, and the sole faces laterally. This movement is primarily executed by the muscles in the lateral compartment of the leg: the **Peroneus (Fibularis) longus** and **Peroneus brevis**, both of which are supplied by the **superficial peroneal nerve**. * **Why Other Options are Incorrect:** * **Option A (Upward):** This describes **Dorsiflexion**, which occurs at the ankle joint (talocrural joint). * **Option C (Inward):** This describes **Inversion**, where the sole faces the midline. This is the opposite of eversion and is performed mainly by the Tibialis anterior and Tibialis posterior. * **Option D (Downward):** This describes **Plantarflexion**, occurring at the ankle joint. **High-Yield Clinical Pearls for NEET-PG:** 1. **Joints Involved:** Remember that Inversion and Eversion occur at the **Subtalar joint** (between talus and calcaneus) and the **Midtarsal/Transverse tarsal joints**, *not* the ankle joint. 2. **Stability:** The foot is more stable in eversion than inversion. Consequently, **Inversion injuries** (sprains) are much more common, often damaging the **Anterior Talofibular Ligament (ATFL)**. 3. **Nerve Supply:** A lesion of the **Common Peroneal Nerve** leads to "Foot Drop" and a loss of eversion, as it supplies both the anterior and lateral compartments.

Q: Which of the following muscles has an attachment on the capsule of the hip joint?

Rectus femoris. **Explanation:** The **Rectus femoris** is a unique component of the Quadriceps femoris muscle because it is the only one that crosses two joints (hip and knee). It arises via two heads: 1. **Straight head:** Originates from the Anterior Inferior Iliac Spine (AIIS). 2. **Reflected head:** Originates from a groove above the acetabulum and the **capsule of the hip joint**. This attachment to the joint capsule is clinically significant as it helps pull the capsule away from the joint space during hip flexion, preventing impingement. **Analysis of Incorrect Options:** * **Sartorius (A):** Originates from the Anterior Superior Iliac Spine (ASIS). It is the longest muscle in the body but has no capsular attachments at the hip. * **Vastus lateralis (C) & Vastus medialis (D):** These muscles originate from the femur (linea aspera, intertrochanteric line, etc.) and only cross the knee joint. They do not have an origin or attachment related to the hip joint capsule. **High-Yield Clinical Pearls for NEET-PG:** * **The "Kick" Muscle:** Rectus femoris is often called the "kicking muscle" because it simultaneously flexes the hip and extends the knee. * **Nerve Supply:** All muscles listed are supplied by the **Femoral Nerve (L2-L4)**. * **Capsular Attachments:** Other muscles with hip capsule attachments include the **Gluteus minimus** (anteriorly) and the **Obturator externus** (inferiorly). * **Avulsion Fracture:** In young athletes, a forceful contraction of the rectus femoris can lead to an avulsion fracture of the **AIIS**.

Question 1

A 72-year-old woman presents with a painful right foot. A CT scan reveals a thrombotic occlusion of the femoral artery in the proximal part of the adductor canal. Which artery will most likely provide blood supply to the leg through the genicular anastomosis?

Accepted Answer

Descending branch of the lateral circumflex femoral

Answer

Medial circumflex femoral

Answer

First perforating branch of the deep femoral

Answer

Inferior gluteal

Question 2

Which of the following is NOT an action of the sartorius muscle?

Accepted Answer

Extension of the leg

Answer

Flexion of the thigh

Answer

Flexion of the leg

Answer

Lateral rotation of the thigh

Question 3

Which of the following muscles is responsible for plantar flexion?

Accepted Answer

All of the above

Answer

Plantaris

Answer

Flexor hallucis longus (FHL)

Answer

Soleus

Question 4

Injury to the medial meniscus is rather impossible when the knee joint does not:

Accepted Answer

Flex

Answer

Extend

Answer

Rotate

Answer

Abduct or adduct

Question 5

A 34-year-old power lifter has difficulty walking and a problem unlocking the knee joint to permit leg flexion. Which of the following muscles is most likely damaged?

Accepted Answer

Popliteus

Answer

Biceps femoris

Answer

Gastrocnemius

Answer

Semimembranosus

Question 6

Which of the following muscles is located in the first layer of the sole of the foot?

Accepted Answer

Flexor digitorum brevis

Answer

Adductor hallucis

Answer

Flexor digiti minimi brevis

Answer

Flexor hallucis longus

Question 7

Which structure passes deep to the medial malleolus?

Accepted Answer

Posterior tibial artery

Answer

Great saphenous vein

Answer

Tibialis anterior tendon

Answer

Peroneus tertius tendon

Question 8

Which is the most commonly injured nerve in the leg?

Accepted Answer

Common peroneal nerve

Answer

Femoral nerve

Answer

Sciatic nerve

Answer

Tibial nerve

Question 9

Eversion is:

Accepted Answer

Sole of the foot outward

Answer

Sole of the foot upward

Answer

Sole of the foot inward

Answer

Sole of the foot downward

Question 10

Which of the following muscles has an attachment on the capsule of the hip joint?

Accepted Answer

Rectus femoris

Answer

Sartorius

Answer

Vastus lateralis

Answer

Vastus medialis

Lower Limb — MCQs

Lower Limb — MCQs

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