Lower Limb Practice Questions

Q: Which of the following structures is supplied by the superior gluteal nerve?

Gluteus minimus. ***Gluteus minimus*** - The **superior gluteal nerve** provides motor innervation to the gluteus medius, gluteus minimus, and tensor fasciae latae muscles. - This nerve originates from the sacral plexus **(L4, L5, S1)** and exits the pelvis through the greater sciatic foramen, superior to the piriformis muscle. *Gluteus maximus* - The gluteus maximus muscle is innervated by the **inferior gluteal nerve**, not the superior gluteal nerve. - The inferior gluteal nerve also arises from the sacral plexus **(L5, S1, S2)** and is crucial for hip extension and external rotation. *Piriformis* - The piriformis muscle receives its own direct branches from the sacral plexus **(S1, S2)** via the nerve to piriformis, distinct from the superior or inferior gluteal nerves. - It plays a key role in hip external rotation and abduction when the hip is flexed. *All of the options* - This option is incorrect because gluteus maximus is innervated by the inferior gluteal nerve, and piriformis has its own specific nerve supply. - The superior gluteal nerve specifically innervates only the gluteus medius, gluteus minimus, and tensor fasciae latae.

Q: An MRI of a patient with low back pain reveals compression of the L5 nerve root. Which of the following muscles would most likely show weakness during physical examination?

Tibialis anterior. ***Tibialis anterior*** - The **L5 nerve root** primarily innervates muscles responsible for **dorsiflexion** of the foot, with the **tibialis anterior** being the primary dorsiflexor. - Weakness of the tibialis anterior would manifest as difficulty lifting the front of the foot, potentially leading to a **foot drop** gait. *Tibialis posterior* - The **tibialis posterior** is primarily innervated by the **tibial nerve** (S1-S2) and is responsible for **plantarflexion** and **inversion** of the foot. - Weakness in this muscle would not be the most likely presentation of L5 nerve root compression. *Gastrocnemius* - The **gastrocnemius** muscle is primarily innervated by the **tibial nerve** (S1-S2) and is a powerful **plantarflexor** of the foot. - Weakness in this muscle would indicate an S1 or S2 nerve root issue, not typically L5. *Quadriceps femoris* - The **quadriceps femoris** is innervated by the **femoral nerve**, predominantly originating from the **L2, L3, and L4 nerve roots**. - Weakness would manifest as difficulty extending the knee, which is not characteristic of L5 compression.

Q: During a physical examination, a physician tests the strength of hip adduction against resistance. Which of the following nerves innervates the primary muscles responsible for this action?

Obturator nerve. ***Obturator nerve*** - The **obturator nerve** primarily innervates the **adductor muscles** of the thigh, including the adductor longus, adductor brevis, adductor magnus (adductor part), gracilis, and pectineus (variable innervation). - These muscles are responsible for **adducting the hip**, which is the action tested when a physician checks hip adduction strength against resistance. *Sciatic nerve* - The **sciatic nerve** innervates the **hamstring muscles** (semitendinosus, semimembranosus, biceps femoris) and all muscles below the knee. - It does not significantly contribute to the innervation of the primary hip adductors. *Superior gluteal nerve* - The **superior gluteal nerve** mainly innervates the **gluteus medius**, **gluteus minimus**, and **tensor fasciae latae** muscles. - These muscles are primarily involved in **hip abduction** and medial rotation, not adduction. *Femoral nerve* - The **femoral nerve** innervates the **quadriceps femoris muscles** (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) and the sartorius. - Its primary actions are **knee extension** and hip flexion, with no direct role in hip adduction.

Q: A 25-year-old woman presents with shooting pain along the lateral aspect of her right thigh. The pain is exacerbated by standing or walking for long periods. Physical examination reveals tenderness at the anterior superior iliac spine. Which of the following nerves is most likely affected?

Lateral femoral cutaneous nerve. ***Lateral femoral cutaneous nerve*** - This presentation is classic for **meralgia paresthetica**, caused by compression of the **lateral femoral cutaneous nerve** as it passes under the inguinal ligament, leading to pain and numbness on the **lateral thigh**. - Tenderness at the **anterior superior iliac spine** points to the inguinal ligament region where this nerve is most vulnerable to compression. *Common peroneal nerve* - Injury to the common peroneal nerve typically causes **foot drop** and sensory deficits over the **dorsum of the foot** and **lateral leg**, not the lateral thigh. - It is often compressed at the **fibular head**, which is anatomically distinct from the anterior superior iliac spine. *Obturator nerve* - The obturator nerve innervates the **medial thigh muscles** and provides sensation to the medial thigh; its compression would cause pain in this region, not the lateral thigh. - Injury often leads to **adductor weakness** and is typically associated with pelvic trauma or surgery. *Sciatic nerve* - Sciatic nerve pain typically radiates down the **posterior aspect of the leg** into the foot (**sciatica**), often associated with lumbar disc herniation. - Sensory deficits would follow the dermatomal distribution of its branches (**tibial** and **common peroneal nerves**).

Q: Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Medial circumflex femoral artery. ***Medial circumflex femoral artery*** - The **medial circumflex femoral artery** is the primary blood supply to the **femoral head** and **neck**, particularly through its retinacular branches. - Interruption of this blood flow, often due to trauma or other conditions, is the most common cause of **avascular necrosis** of the femoral head. *Lateral circumflex femoral artery* - The **lateral circumflex femoral artery** primarily supplies the **vastus lateralis muscle** and parts of the greater trochanter. - It contributes minimally and indirectly to the blood supply of the femoral head. *Obturator artery* - The **obturator artery** primarily supplies structures in the medial compartment of the thigh and makes a small contribution to the femoral head via the **artery of the ligamentum teres**, which is generally insufficient to prevent avascular necrosis alone. - This artery is most significant in children, but by adulthood, its contribution to femoral head vascularity is minor. *Profunda femoris artery* - The **profunda femoris artery** (deep femoral artery) is the largest branch of the femoral artery and gives rise to the circumflex femoral arteries. - Its direct contribution to the femoral head blood supply is generally through its branches (like the circumflex arteries), rather than directly.

Q: Dorsum of first webspace is supplied by which nerve?

Deep peroneal. ***Deep peroneal*** - The **deep peroneal nerve** innervates the **first dorsal webspace** of the foot, which is a classic sensory test area for this nerve. - Damage to this nerve can result in **foot drop** and loss of sensation in this specific area. *Superficial peroneal* - The **superficial peroneal nerve** supplies the majority of the **dorsum of the foot**, excluding the first webspace and the ankle. - It handles sensation for the **anterolateral aspect** of the distal leg and most of the dorsal foot. *Sural* - The **sural nerve** provides sensation to the **posterolateral aspect of the leg** and the **lateral border of the foot**. - It is often used for **nerve grafting** due to its superficial course. *Posterior tibial* - The **posterior tibial nerve** provides sensation to the **sole of the foot** via its medial and lateral plantar branches. - It also innervates most of the **intrinsic muscles of the foot**, affecting motor function.

Q: Tibial and common peroneal nerves supply which of the following muscles?

Biceps femoris. **Biceps femoris** - The **long head** of the biceps femoris is supplied by the **tibial nerve**. - The **short head** of the biceps femoris is supplied by the **common peroneal nerve**. *Gracilis* - The gracilis muscle is solely innervated by the **obturator nerve**. - It participates in **hip adduction** and **knee flexion**, but its innervation is distinct. *Adductor longus* - The adductor longus muscle is innervated exclusively by the **obturator nerve**. - Its primary function is **adduction of the thigh**. *Adductor magnus* - The adductor magnus has a dual innervation, but not by the tibial and common peroneal nerves. - Its **adductor part** is innervated by the **obturator nerve**, while its **hamstring part** is supplied by the **tibial nerve**.

Q: Foot eversion is caused by

Peroneus longus. ***Peroneus longus*** - The **peroneus longus** muscle (fibularis longus) is a primary evertor of the foot. - It originates from the head and upper lateral surface of the fibula, inserts into the medial cuneiform and first metatarsal, and its contraction pulls the foot outwards and downwards. *Tibialis anterior* - The **tibialis anterior** is the primary dorsiflexor and invertor of the foot. - It pulls the foot upwards and inwards, which is the opposite action of eversion. *Tibialis posterior* - The **tibialis posterior** is a strong invertor and plantar flexor of the foot. - It contributes to maintaining the arch of the foot and does not cause eversion. *Extensor digitorum* - The **extensor digitorum longus** primarily extends the toes and assists in dorsiflexion of the ankle. - While it may have a slight eversion component, it is not the primary muscle responsible for foot eversion.

Q: Which of the following is an intra-articular tendon?

Popliteus. ***Popliteus*** - The **popliteus tendon** originates within the knee capsule (intra-articular) before emerging to insert onto the posterior tibia. - It plays a crucial role in **unlocking the knee joint** from full extension and contributes to posterior stability. *Anconeus* - The **anconeus muscle** is located on the posterior aspect of the elbow, extending from the lateral epicondyle of the humerus to the ulna. - It is an **extra-articular muscle** that assists in elbow extension and stabilization. *Semitendinosus* - The **semitendinosus** is one of the hamstring muscles, located in the posterior thigh. - Its tendon contributes to the **pes anserinus**, inserting on the medial aspect of the tibia distal to the knee joint, making it an extra-articular tendon. *Sartorius* - The **sartorius** is the longest muscle in the body, running obliquely across the anterior aspect of the thigh. - Its tendon also contributes to the **pes anserinus**, inserting medially to the knee joint, and is considered extra-articular.

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.

Question 1

Which of the following structures is supplied by the superior gluteal nerve?

Accepted Answer

Gluteus minimus

Answer

Gluteus maximus

Answer

Piriformis

Answer

All of the options

Question 2

An MRI of a patient with low back pain reveals compression of the L5 nerve root. Which of the following muscles would most likely show weakness during physical examination?

Accepted Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Gastrocnemius

Answer

Quadriceps femoris

Question 3

During a physical examination, a physician tests the strength of hip adduction against resistance. Which of the following nerves innervates the primary muscles responsible for this action?

Accepted Answer

Obturator nerve

Answer

Sciatic nerve

Answer

Superior gluteal nerve

Answer

Femoral nerve

Question 4

A 25-year-old woman presents with shooting pain along the lateral aspect of her right thigh. The pain is exacerbated by standing or walking for long periods. Physical examination reveals tenderness at the anterior superior iliac spine. Which of the following nerves is most likely affected?

Accepted Answer

Lateral femoral cutaneous nerve

Answer

Common peroneal nerve

Answer

Obturator nerve

Answer

Sciatic nerve

Question 5

Avascular necrosis of the femoral head most commonly occurs due to disruption of which of the following arteries?

Accepted Answer

Medial circumflex femoral artery

Answer

Lateral circumflex femoral artery

Answer

Obturator artery

Answer

Profunda femoris artery

Question 6

Dorsum of first webspace is supplied by which nerve?

Accepted Answer

Deep peroneal

Answer

Superficial peroneal

Answer

Sural

Answer

Posterior tibial

Question 7

Tibial and common peroneal nerves supply which of the following muscles?

Accepted Answer

Biceps femoris

Answer

Gracilis

Answer

Adductor longus

Answer

Adductor magnus

Question 8

Foot eversion is caused by

Accepted Answer

Peroneus longus

Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Extensor digitorum

Question 9

Which of the following is an intra-articular tendon?

Accepted Answer

Popliteus

Answer

Anconeus

Answer

Semitendinosus

Answer

Sartorius

Question 10

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

Lower Limb — MCQs

Lower Limb — MCQs

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