Lower Limb Practice Questions

Q: What is the action of the muscle marked in the image?

Hip abduction. ***Hip abduction*** - The image displays the **gluteus medius** muscle, whose primary action is to **abduct** the thigh at the hip joint. - This muscle is crucial for stabilizing the pelvis during the gait cycle; weakness leads to a positive **Trendelenburg sign**. ***Internal rotation*** - While the anterior fibers of the **gluteus medius** contribute to internal rotation, it is not its primary function. - The primary internal rotators of the hip are the **gluteus minimus** and the **tensor fasciae latae**. ***Knee extension*** - The **gluteus medius** does not cross the knee joint and therefore has no action on knee extension. - Knee extension is the primary function of the **quadriceps femoris** muscle group, located in the anterior thigh. ***Knee flexion*** - The **gluteus medius** does not act on the knee joint, so it cannot cause knee flexion. - Knee flexion is primarily performed by the **hamstring muscles** (biceps femoris, semitendinosus, and semimembranosus) located in the posterior thigh.

Q: Which muscles are supplied by the superficial peroneal nerve?

Peroneus longus & Brevis. ***Peroneus longus & Brevis*** - The **superficial peroneal nerve** (superficial fibular nerve) supplies **only two muscles**: **Peroneus longus** and **Peroneus brevis** - These muscles form the **lateral compartment of the leg** - They function primarily in **ankle eversion** and contribute to **plantar flexion** - The superficial peroneal nerve is a terminal branch of the **common peroneal nerve** that arises at the neck of the fibula *Incorrect - Both A & C* - This option incorrectly combines different muscle groups - Option C refers to muscles supplied by the **deep peroneal nerve**, not the superficial peroneal nerve *Incorrect - Extensor hallucis longus* - This muscle is located in the **anterior compartment** of the leg - It extends the great toe and assists in ankle dorsiflexion - It is innervated by the **deep peroneal nerve**, NOT the superficial peroneal nerve *Incorrect - Peroneus tertius* - This muscle belongs to the **anterior compartment** despite its name - It acts as a dorsiflexor and evertor of the foot - It is supplied by the **deep peroneal nerve**, NOT the superficial peroneal nerve - The superficial peroneal nerve only supplies the lateral compartment muscles (Peroneus longus and brevis)

Q: A patient presents with meralgia paresthetica. Based on the diagram, identify the nerve involved in this condition.

C. ***C (Lateral Femoral Cutaneous Nerve)*** - Meralgia paresthetica is an entrapment neuropathy caused by compression of the **Lateral Femoral Cutaneous Nerve (LFCN)**, which corresponds to C in the diagram and arises from **L2 and L3** roots. - Compression usually occurs as the nerve passes under the **inguinal ligament**, resulting in pain, numbness, and tingling over the **anterolateral thigh**. *A (Ilioinguinal/Iliohypogastric Nerve)* - Nerve A, usually the Ilioinguinal or Iliohypogastric nerve (T12, L1), innervates the **inguinal region** and lower abdominal wall. - Entrapment of these nerves results in pain radiating towards the **groin** or superior thigh, not the characteristic distribution of meralgia paresthetica. *B (Genitofemoral Nerve)* - Nerve B is the **Genitofemoral nerve** (L1, L2), which supplies sensation to the superior medial thigh and genitalia. - Injury results in loss of the **cremasteric reflex** and sensory changes in the scrotal/labial and proximal anterior thigh area. *D (Femoral Nerve)* - Nerve D is the large **Femoral Nerve** (L2-L4), responsible for motor supply to the **quadriceps** and sensation to the anterior thigh and medial leg. - Compression typically causes prominent **quadriceps weakness** (difficulty extending the knee) in addition to sensory loss, unlike the purely sensory presentation of meralgia paresthetica.

Q: The image shows left hip bone lateral surface. Name the muscles attached at X and Y sites respectively:

X= Gluteus medius and Y= Piriformis. ***X= Gluteus medius and Y= Piriformis*** - X indicates the attachment site for the **gluteus medius** muscle on the lateral surface of the ilium, specifically between the anterior and posterior gluteal lines. - Y indicates the region of the **greater sciatic notch** through which the **piriformis** muscle exits the pelvis. The piriformis originates from the anterior surface of the sacrum (S2-S4) and inserts on the greater trochanter of the femur, passing through the greater sciatic notch as a key anatomical landmark. *X= Gluteus minimus and Y= Gluteus maximus* - The **gluteus minimus** attaches to the ilium anterior to the gluteus medius (between anterior and inferior gluteal lines), not at site X which is positioned for gluteus medius. - The **gluteus maximus** attaches primarily to the posterior gluteal line of the ilium and the sacrum/coccyx, not at the greater sciatic notch region marked as Y. *X= Gluteus maximus and Y= Piriformis* - The **gluteus maximus** attaches posterior to site X; X represents the gluteus medius attachment area between the anterior and posterior gluteal lines. - While Y is correctly associated with the **piriformis** muscle and greater sciatic notch, the identification of X is incorrect. *X= Quadratus femoris and Y= Gluteus maximus* - The **quadratus femoris** attaches to the lateral border of the ischial tuberosity and the intertrochanteric crest of the femur, not at site X on the ilium's lateral surface. - The **gluteus maximus** does not attach at the greater sciatic notch region marked as Y; this area is associated with the piriformis muscle's passage.

Q: Identify the bone marked as X.

Cuboid. ***Cuboid*** - The cuboid bone is a **tarsal bone** located on the **lateral side of the foot**, distal to the calcaneus and proximal to the fourth and fifth metatarsals, which matches the position of X in the image. - It articulates with the **calcaneus**, **lateral cuneiform**, and the bases of the **fourth and fifth metatarsal bones**. *Navicular* - The navicular bone is located on the **medial side of the foot**, distal to the talus and proximal to the three cuneiform bones. - The bone marked X is on the lateral side of the foot, making the navicular an incorrect identification. *Cuneiform* - There are three cuneiform bones (**medial, intermediate, and lateral**), located between the navicular and the first, second, and third metatarsals on the medial aspect of the foot. - The bone marked X is more lateral and articulates with the fourth and fifth metatarsals, not the first three. *Calcaneus* - The calcaneus is the **largest tarsal bone**, forming the **heel** of the foot and lying posterior to the cuboid and navicular bones. - The bone marked X is positioned in the midfoot region, distinctly anterior to where the calcaneus would be.

Q: Femoral hernias are more common in females because :

femoral canal is wide. ***femoral canal is wide*** - Females tend to have a **wider pelvis** to accommodate childbirth, which consequently leads to a proportionally wider and shorter femoral canal. - A wider femoral canal provides less structural support, making it easier for abdominal contents to herniate through the **femoral ring** [1]. *femoral canal is long* - The length of the femoral canal is not the primary factor influencing the predisposition to femoral hernias in females. - A longer canal might theoretically offer more resistance to herniation if its diameter were consistent. *ligaments of femoral canal neck are weak* - While ligamentous laxity can contribute to hernia formation, the primary anatomical reason for the increased incidence in females is the **wider canal**, not inherently weaker ligaments specific to the femoral canal neck. - The **inguinal ligament** forms the anterior boundary of the femoral ring, and its integrity is important, but its weakness isn't the direct cause of female predisposition. *weakness of posterior inguinal wall* - Weakness of the posterior inguinal wall is more directly associated with **direct inguinal hernias**, which are distinct from femoral hernias [1]. - Femoral hernias protrude below the inguinal ligament, through the femoral canal, rather than through the inguinal canal itself.

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.

Question 1

What is the action of the muscle marked in the image?

Accepted Answer

Hip abduction

Answer

Internal rotation

Answer

Knee flexion

Answer

Knee extension

Question 2

Which muscles are supplied by the superficial peroneal nerve?

Accepted Answer

Peroneus longus & Brevis

Answer

Both A & C

Answer

Extensor hallucis longus

Answer

Peroneus tertius

Question 3

A patient presents with meralgia paresthetica. Based on the diagram, identify the nerve involved in this condition.

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 4

Which is correct about the markings shown on the left popliteal fossa? (Recent NEET Pattern 2016-17)

Accepted Answer

1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semimembranosus

Answer

1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semitendinosus

Answer

1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semitendinosus

Answer

1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semimembranosus

Question 5

The image shows left hip bone lateral surface. Name the muscles attached at X and Y sites respectively:

Accepted Answer

X= Gluteus medius and Y= Piriformis

Answer

X= Gluteus minimus and Y= Gluteus maximus

Answer

X= Gluteus maximus and Y= Piriformis

Answer

X= Quadratus femoris and Y= Gluteus maximus

Question 6

Identify the bone marked as X.

Accepted Answer

Cuboid

Answer

Navicular

Answer

Cuneiform

Answer

Calcaneus

Question 7

Femoral hernias are more common in females because :

Accepted Answer

femoral canal is wide

Answer

femoral canal is long

Answer

ligaments of femoral canal neck are weak

Answer

weakness of posterior inguinal wall

Question 8

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 9

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 10

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

Accepted Answer

Lisfranc

Answer

Chopart

Answer

Deltoid

Answer

Spring

Lower Limb — MCQs

Lower Limb — MCQs

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