Lower Limb Practice Questions

Q: Defect in Gluteus Maximus lead to all of the following, EXCEPT:

Positive Trendelenburg's sign. ***Positive Trendelenburg's sign*** - A positive Trendelenburg's sign indicates weakness of the **gluteus medius** and **minimus** muscles, which are primarily responsible for abducting the hip and stabilizing the pelvis during gait. - A defect in the **gluteus maximus** does not directly cause this sign, as its main function is hip extension. *Extension defect* - The **gluteus maximus** is the primary extensor of the hip joint. - A defect in this muscle would indeed lead to difficulty or weakness in performing **hip extension**. *Difficulty in straightening from the bending position* - Straightening from a bending position requires powerful **hip extension**, which is a primary function of the **gluteus maximus**. - Without a functional gluteus maximus, this movement would be significantly impaired. *Difficulty rising from the sitting position* - Rising from a sitting position involves strong **hip extension** and **knee extension**, with the gluteus maximus being crucial for the hip component. - A defect would make this everyday activity much more challenging.

Q: A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?

Common peroneal nerve. **Correct: Common peroneal nerve** - The **lateral aspect of the right knee** is particularly vulnerable to direct trauma to the **common peroneal nerve** due to its superficial course around the neck of the fibula. - The unconscious state and lateral position suggest a prolonged compression or direct impact mechanism, making this nerve highly susceptible to injury. - The common peroneal nerve is the **most commonly injured nerve in the lower limb** due to its superficial location. *Incorrect: Femoral nerve* - The **femoral nerve** runs deep within the groin region and anterior thigh, making direct injury at the knee unlikely from an isolated lateral knee trauma. - Injuries to the femoral nerve typically result from pelvic fractures, abdominal surgery, or deep penetrating wounds to the groin. *Incorrect: Radial nerve* - The **radial nerve** is located in the upper limb and primarily affects the extensor muscles of the arm, forearm, and hand. - While bruises on the right arm are noted, an injury to the radial nerve would not explain the specific trauma to the lateral aspect of the knee. *Incorrect: Trigeminal nerve* - The **trigeminal nerve** is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewing. - Superficial injury to the face might affect sensory branches, but it is entirely unrelated to an injury to the lateral aspect of the knee.

Q: Lurching Gait is due to paralysis of which of the following?

Gluteus medius. ***Gluteus medius*** * Paralysis of the **gluteus medius** leads to a **Trendelenburg gait** or **lurching gait**, where the pelvis drops on the unsupported side during walking. * This muscle is crucial for **stabilizing the pelvis** during the single-limb support phase of gait. *Adductor Magnus* * Paralysis of the adductor magnus would primarily affect **thigh adduction** and extension, not directly causing a lurching gait. * Problems with this muscle might impact the ability to bring the legs together or stabilize the leg during certain movements. *Hamstrings* * The hamstrings are responsible for **knee flexion** and **hip extension**. * Paralysis would result in difficulty bending the knee and limited hip extension, potentially leading to a stiff-knee gait, but not typically a lurching gait. *Quadriceps femoris* * The quadriceps femoris is essential for **knee extension** and is critical for activities like standing, walking, and climbing stairs. * Paralysis would cause the knee to buckle, leading to a **knee-hyperflexion gait** or difficulty with weight-bearing on that leg.

Q: Which is the safest site for intramuscular (IM) injection to avoid injury to vessels and nerves?

Upper outer quadrant of buttock. ***Upper outer quadrant of buttock*** - This site, specifically the **ventrogluteal** or **dorsogluteal** region in the upper outer quadrant, avoids major nerves and blood vessels. - The **gluteus medius** and **gluteus minimus** muscles here are thick enough for medication absorption without risk of injury. *Upper inner quadrant of buttock* - This area is close to the **sciatic nerve** and major **blood vessels** like the superior gluteal artery and vein, increasing the risk of injury. - Injecting here can lead to nerve damage, pain, or hematoma formation. *Lower part of insertion of deltoid* - While deltoid injections are common, the **lower part of the deltoid** near its insertion can be inadequate for larger volumes and is closer to the **radial nerve**, increasing nerve injury risk. - The **mid-deltoid** is usually preferred for smaller volume injections. *Lower inner quadrant of buttock* - This quadrant is in close proximity to the **sciatic nerve** and the **pudendal nerve**, making it highly susceptible to nerve injury. - It also has a thinner muscle mass compared to the upper outer quadrant, increasing the risk of hitting bone or blood vessels.

Q: Nelaton's line is a line joining

Anterior superior iliac spine and ischial tuberosity. Anterior superior iliac spine and ischial tuberosity - Nelaton's line is an imaginary line drawn between the anterior superior iliac spine (ASIS) and the ischial tuberosity. - This line is clinically useful in assessing for hip dislocations or fractures of the femoral neck, where the greater trochanter may lie above or posterior to this line. Anterior superior iliac spine and umbilicus - A line joining the ASIS and the umbilicus is not a standard anatomical landmark or clinical line used for assessing hip pathology. - While these are anatomical points, their connection does not form Nelaton's line. Posterior iliac spine and umbilicus - The posterior superior iliac spine (PSIS) and the umbilicus are not used to define Nelaton's line. - This combination of landmarks does not have a recognized clinical application for hip assessment. Posterior iliac spine and ischial tuberosity - A line between the PSIS and the ischial tuberosity is not Nelaton's line. - This specific anatomical connection is not typically used as a diagnostic or assessment tool in the context of hip injuries.

Q: Foot drop occurs due to the involvement of:

Common peroneal nerve palsy. ***Common peroneal nerve palsy*** - The **common peroneal nerve** (also known as the common fibular nerve) innervates the muscles responsible for **dorsiflexion** and eversion of the foot (tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus longus and brevis). - Damage to this nerve leads to weakness or paralysis of these muscles, resulting in **foot drop**, which is the most common neurological cause. - The nerve is vulnerable at the **neck of the fibula** where it is superficial and can be compressed or injured. *Sciatic nerve* - The **sciatic nerve** divides into the tibial and common peroneal nerves. - Proximal sciatic nerve injury can cause foot drop, but it would also cause additional deficits including hamstring weakness, loss of ankle plantarflexion, and sensory loss over a wider distribution. - Isolated foot drop typically indicates **common peroneal nerve** injury, not sciatic nerve injury. *Direct injury to the dorsiflexors* - Direct trauma to the **dorsiflexor muscles** (tibialis anterior, extensor hallucis longus, extensor digitorum longus) can mechanically impair dorsiflexion. - However, the term "foot drop" typically refers to **neurological causes** rather than direct muscle injury, making common peroneal nerve palsy the more specific answer. *Obturator nerve* - The **obturator nerve** innervates the **adductor muscles of the thigh** (adductor longus, adductor brevis, adductor magnus, gracilis). - It does not innervate any muscles responsible for dorsiflexion of the foot and therefore **cannot cause foot drop**.

Q: Trendelenberg sign is positive in paralysis of all except:

Gluteus maximus. ***Gluteus maximus*** - The **gluteus maximus** is primarily responsible for **hip extension** and **external rotation**, and its paralysis would lead to a different gait pattern (e.g., gluteus maximus lurch) but not a positive Trendelenburg sign. - The **Trendelenburg sign** specifically assesses the strength and function of the **hip abductors**, which are not the primary role of the gluteus maximus. *Tensor fascia lata* - The **tensor fascia lata** is a hip abductor and internal rotator, contributing to the stability of the pelvis during gait. - Paralysis of the **tensor fascia lata** would weaken hip abduction, contributing to a positive Trendelenburg sign. *Gluteus medius* - The **gluteus medius** is a primary **hip abductor** and is crucial for stabilizing the pelvis when standing on one leg. - Weakness or paralysis of the **gluteus medius** directly leads to a positive Trendelenburg sign, where the unsupported side of the pelvis drops. *Gluteus minimus* - The **gluteus minimus** is also a primary **hip abductor** and works synergistically with the gluteus medius to maintain pelvic stability during gait. - Paralysis of the **gluteus minimus** would impair hip abduction strength, resulting in a positive Trendelenburg sign.

Q: A patient was on DVT prophylaxis. All of the following have perforators which connect superficial veins to the deep veins, except:

Mid-shaft of tibia. The mid-shaft of the tibia is primarily composed of bone and muscle, and it lacks the significant perforating veins found in other regions of the lower limb. Perforating veins are most prevalent where superficial veins are close to deep veins and require connection to aid venous return against gravity, such as in the ankle, calf, and thigh [1]. *Ankle* - The **ankle** region has several perforating veins (e.g., **Cockett’s perforators**) that connect the **great saphenous vein** to the **posterior tibial veins**, which are crucial for venous return [1]. - These perforators are clinically significant in the development of **venous stasis ulcers** [1]. *Mid Calf* - The **mid-calf** has numerous perforating veins, including **Boyd’s perforator** and perforators connecting the **small saphenous vein** to deep calf veins [1]. - These veins play a vital role in pumping blood from the superficial system into the deep system during muscle contraction [1]. *Lower Thigh* - The **lower thigh** contains perforating veins such as **Dodd’s perforator**, which connects the **great saphenous vein** to the **femoral vein** [1]. - These perforators are important for efficient venous drainage from the superficial to the deep venous system in this region [1].

Q: Which ligament is involved in pes planus of foot?

Spring ligament. ***Spring ligament*** - The **spring ligament** (plantar calcaneonavicular ligament) is crucial in maintaining the **medial longitudinal arch** of the foot by supporting the head of the talus. - Insufficiency or rupture of this ligament leads to a flattening of the arch, characteristic of **pes planus**. *Deltoid ligament* - The **deltoid ligament** is a strong medial collateral ligament of the ankle joint, preventing excessive eversion. - While it plays a role in ankle stability, its primary function is not directly supporting the **longitudinal arch** of the foot, and thus it is not the main ligament involved in pes planus. *Deep transverse ligament* - The **deep transverse metatarsal ligament** connects the heads of the metatarsals, stabilizing the forefoot. - Its involvement is more related to conditions affecting the forefoot, such as splayfoot or bunions, rather than the **medial longitudinal arch** central to pes planus. *Long and short plantar ligament* - The **long and short plantar ligaments** support the lateral longitudinal arch of the foot and connect the calcaneus to the cuboid and metatarsals. - While these ligaments are important for general foot arch integrity, the **spring ligament** is specifically critical for the medial longitudinal arch, which is primarily flattened in pes planus.

Question 1

Defect in Gluteus Maximus lead to all of the following, EXCEPT:

Accepted Answer

Positive Trendelenburg's sign

Answer

Extension defect

Answer

Difficulty in straightening from the bending position

Answer

Difficulty rising from the sitting position

Question 2

A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?

Accepted Answer

Common peroneal nerve

Answer

Femoral nerve

Answer

Radial nerve

Answer

Trigeminal nerve

Question 3

Lurching Gait is due to paralysis of which of the following?

Accepted Answer

Gluteus medius

Answer

Adductor magnus

Answer

Hamstrings

Answer

Quadriceps femoris

Question 4

Which is the safest site for intramuscular (IM) injection to avoid injury to vessels and nerves?

Accepted Answer

Upper outer quadrant of buttock

Answer

Upper inner quadrant of buttock

Answer

Lower part of insertion of deltoid

Answer

Lower inner quadrant of buttock

Question 5

Nelaton's line is a line joining

Accepted Answer

Anterior superior iliac spine and ischial tuberosity

Answer

Anterior superior iliac spine and umbilicus

Answer

Posterior iliac spine and umbilicus

Answer

Posterior iliac spine and ischial tuberosity

Question 6

Foot drop occurs due to the involvement of:

Accepted Answer

Common peroneal nerve palsy

Answer

Obturator nerve

Answer

Sciatic nerve

Answer

Direct injury to the dorsiflexors

Question 7

Trendelenberg sign is positive in paralysis of all except:

Accepted Answer

Gluteus maximus

Answer

Tensor fascia lata

Answer

Gluteus medius

Answer

Gluteus minimus

Question 8

A patient was on DVT prophylaxis. All of the following have perforators which connect superficial veins to the deep veins, except:

Accepted Answer

Mid-shaft of tibia

Answer

Ankle

Answer

Mid Calf

Answer

Lower Thigh

Question 9

Which ligament is involved in pes planus of foot?

Accepted Answer

Spring ligament

Answer

Deltoid ligament

Answer

Deep transverse ligament

Answer

Long and short plantar ligament

Question 10

Not true about anterior cruciate ligament -

Accepted Answer

It begins just behind the anterior horn of lateral meniscus on tibia

Answer

It provides proprioceptive inputs to knee

Answer

It is taut in extension

Answer

It is extrasynovial

Lower Limb — MCQs

Lower Limb — MCQs

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