Lower Limb Practice Questions

Q: Superficial epigastric artery is a branch of?

Femoral artery. ***Femoral artery*** - The **superficial epigastric artery** is one of the initial branches that arises directly from the **femoral artery** in the femoral triangle, just below the inguinal ligament. - It supplies the **skin** and **superficial fascia** over the lower part of the anterior abdominal wall and the superficial inguinal lymph nodes [1]. *Internal pudendal artery* - The **internal pudendal artery** is a branch of the **internal iliac artery** and primarily supplies structures in the perineum and genitalia. - It does not supply the anterior abdominal wall. *External pudendal artery* - The **external pudendal artery** is also a branch of the **femoral artery**, but it supplies the skin of the external genitalia (scrotum/labia majora) and adjacent thigh. - It does not supply the superficial epigastric region. *Internal iliac artery* - The **internal iliac artery** primarily supplies the pelvic organs, gluteal region, and medial thigh. - While it has many branches, the superficial epigastric artery is not one of them.

Q: Which muscle plays a key role in preventing lateral dislocation of the patella?

Vastus medialis. ***Vastus medialis*** - The **vastus medialis obliquus (VMO)** fibers pull the patella medially, counteracting the natural lateral pull exerted by the quadriceps femoris. - Its strength and proper activation are crucial in maintaining **patellar tracking** and preventing lateral subluxation or dislocation. *Rectus femoris* - The **rectus femoris** primarily acts as a hip flexor and knee extensor, with its pull being largely in the superior-inferior direction. - While it contributes to knee extension, its role in **medial stabilization** of the patella is minimal. *Vastus intermedius* - The **vastus intermedius** lies deep to the rectus femoris and primarily contributes to knee extension. - Its fibers run predominantly in the superior-inferior direction, offering little direct lateral-to-medial pull on the patella for stability. *Vastus lateralis* - The **vastus lateralis** pulls the patella in a superior and lateral direction, increasing the tendency for **lateral patellar dislocation**. - An imbalance where the vastus lateralis is significantly stronger or more active than the vastus medialis often contributes to patellar instability.

Q: Locking of the knee involves which of the following?

Internal rotation of the femur with the foot on the ground. ***Internal rotation of the femur with the foot on the ground*** - When the foot is on the ground (closed kinematic chain), the **femur rotates internally on the tibia** during the end stages of knee extension. This creates a more stable, "locked" position of the knee. - This **terminal rotation of the femur** increases the contact area and tension in the cruciate ligaments, enhancing joint stability for weight-bearing. *Internal rotation of the tibia with the foot on the ground* - This describes the action of the **popliteus muscle** when "unlocking" the knee from full extension, not the locking mechanism itself. - With the foot on the ground, the tibia is fixed, and internal rotation would typically be a movement for unlocking, not locking. *Contraction of the popliteus muscle* - The **popliteus muscle** is primarily responsible for **unlocking the knee** from full extension, by causing internal rotation of the tibia (or external rotation of the femur). - Its contraction would lead to initial flexion of the knee, releasing the locked position, not establishing it. *External rotation of femur with the foot off the ground* - With the foot off the ground (open kinematic chain), **external rotation of the tibia** occurs during the final degrees of extension to lock the knee, not external rotation of the femur. - The locking mechanism requires specific relative rotation between femur and tibia; external rotation of the femur alone would not achieve the screw-home mechanism necessary for knee locking.

Q: Which artery is primarily responsible for supplying the head and neck of the femur?

Medial circumflex artery. ***Medial circumflex artery*** - The **medial circumflex artery** is the primary blood supply to the **femoral head and neck** in adults. - Its branches, particularly the **retinacular arteries**, ascend along the femoral neck to perfuse the head. *Lateral circumflex artery* - The **lateral circumflex artery** supplies the **vastus lateralis muscle** and contributes to the supply of the **greater trochanter**. - While it anastomoses with the medial circumflex artery, its direct contribution to the femoral head is minimal. *Profunda femoris artery* - The **profunda femoris artery**, or deep femoral artery, is the main arterial supply to the **thigh muscles**. - It gives rise to the medial and lateral circumflex femoral arteries but does not directly supply the femoral head. *Obturator artery* - The **obturator artery** primarily supplies the **adductor muscles** of the thigh and contributes branches to the hip joint capsule. - While it has a small branch (artery to the head of the femur) that may contribute to the femoral head in children, it is not the main source in adults.

Q: Which is the largest nerve that exits the pelvis through the greater sciatic foramen?

Sciatic nerve. ***Sciatic nerve*** - The **sciatic nerve** is the largest nerve in the human body, formed from the sacral plexus, and it is indeed the largest structure that passes through the **greater sciatic foramen** as it descends into the posterior thigh. - It supplies motor and sensory innervation to the posterior thigh, lower leg, and foot. *Superior gluteal artery* - The superior gluteal artery exits the pelvis through the **greater sciatic foramen** above the piriformis muscle. - While significant, it is an artery and not a nerve, and it is not the largest structure passing through this foramen. *Inferior gluteal artery* - The inferior gluteal artery also exits the pelvis via the **greater sciatic foramen**, inferior to the piriformis muscle. - Like the superior gluteal artery, it is an arterial structure and not a nerve, and it is not the largest structure in the foramen. *Piriformis muscle* - The **piriformis muscle** originates inside the pelvis and passes through the **greater sciatic foramen** to insert on the greater trochanter of the femur. - Although it occupies a significant portion of the foramen, it is a muscle, not a nerve, and the sciatic nerve is the largest nerve exiting this aperture.

Q: Inversion and eversion of foot occurs at which joint

Subtalar. ***Subtalar*** - The **subtalar joint** (talocalcaneal joint) is primarily responsible for **inversion** and **eversion** movements of the foot. - **Inversion** involves tilting the sole of the foot medially (turning inward), while **eversion** involves tilting the sole laterally (turning outward). - This joint allows the foot to **adapt to uneven surfaces** and plays a crucial role in the biomechanics of walking and running. - The subtalar joint is essential for shock absorption and balance during gait. *Ankle* - The **ankle joint** (talocrural joint) is a hinge joint primarily responsible for **dorsiflexion** and **plantarflexion** of the foot. - It allows moving the foot up and down but has minimal contribution to inversion and eversion. *Tarso-metatarsal* - The **tarso-metatarsal joints** (Lisfranc joints) connect the tarsal bones to the metatarsal bones. - These joints contribute primarily to the **stability and arch integrity** of the foot, with minimal movement capacity. - They allow slight gliding movements but not significant inversion or eversion. *None of the options* - This option is incorrect because the **subtalar joint** is indeed the primary joint responsible for inversion and eversion of the foot. - Understanding foot joint biomechanics is essential for diagnosing gait abnormalities, ankle sprains, and foot pathologies.

Q: Which of the following muscles is not supplied by the femoral nerve?

Obturator externus. ***Obturator externus*** - The **obturator externus** muscle is primarily supplied by the **obturator nerve** (L3-L4), which arises from the lumbar plexus, not the femoral nerve. - Its main function is the **lateral rotation of the thigh** at the hip joint. *Pectineus* - The **pectineus** muscle receives dual innervation, typically from both the **femoral nerve** (L2-L4) and the obturator nerve. - It aids in **adduction**, **flexion**, and **medial rotation** of the thigh. *Sartorius* - The **sartorius** muscle is entirely supplied by the **femoral nerve** (L2-L3). - It is responsible for **flexing, abducting, and laterally rotating the thigh** at the hip, and flexing the leg at the knee. *Vastus medialis* - The **vastus medialis** is one of the four muscles forming the quadriceps femoris group, all of which are exclusively supplied by the **femoral nerve** (L2-L4). - This muscle is crucial for **extending the leg** at the knee joint.

Q: Which of the following statements about the femoral triangle is NOT true?

Floor is formed by adductor longus. ***Floor is formed by adductor longus*** - The floor of the femoral triangle is actually formed by the **iliopsoas** laterally and the **pectineus** medially. - The **adductor longus** forms part of the medial boundary of the femoral triangle, not its floor. - This is the INCORRECT statement (correct answer for a "NOT true" question). *Contains the femoral vessels* - The femoral triangle is a crucial anatomical space containing the **femoral artery**, **femoral vein**, and **femoral nerve**. - These structures are organized from lateral to medial as nerve, artery, vein (NAVY). *Lateral margin is formed by sartorius* - The **sartorius muscle** forms the lateral boundary of the femoral triangle. - Its medial border defines one of the triangle's sides. *Medial margin is formed by adductor longus* - The **adductor longus** does form the medial boundary of the femoral triangle. - This is anatomically correct along with the inguinal ligament (superior boundary) and sartorius (lateral boundary).

Q: The structure which lies outside the femoral sheath is:

Femoral nerve. ***Femoral nerve*** - The **femoral nerve** lies lateral to the femoral artery and is therefore situated outside the **femoral sheath**, which encloses the femoral artery, femoral vein, and lymphatic vessels [2]. - It originates from the lumbar plexus (L2-L4) and provides motor innervation to the quadriceps femoris and sensory innervation to the anterior thigh and medial leg. *Femoral artery* - The **femoral artery** is a primary content of the **femoral sheath**, occupying the most lateral compartment. - It is a continuation of the external iliac artery and is a major blood supply to the lower limb. *Femoral vein* - The **femoral vein** lies within the **femoral sheath**, positioned medial to the femoral artery. - It is the primary vein responsible for draining blood from the lower limb and eventually becomes the external iliac vein. *Genitofemoral nerve* - The **genitofemoral nerve** typically emerges on the anterior surface of the psoas major muscle and then usually divides into genital and femoral branches [1]. - While its femoral branch supplies sensory innervation to the skin over the femoral triangle, it does not course within the femoral sheath itself but rather anterior to it or outside its immediate vicinity [1].

Question 1

Superficial epigastric artery is a branch of?

Accepted Answer

Femoral artery

Answer

Internal pudendal artery

Answer

External pudendal artery

Answer

Internal iliac artery

Question 2

Which muscle plays a key role in preventing lateral dislocation of the patella?

Accepted Answer

Vastus medialis

Answer

Rectus femoris

Answer

Vastus intermedius

Answer

Vastus lateralis

Question 3

Locking of the knee involves which of the following?

Accepted Answer

Internal rotation of the femur with the foot on the ground

Answer

Internal rotation of the tibia with the foot on the ground

Answer

Contraction of the popliteus muscle

Answer

External rotation of femur with the foot off the ground

Question 4

Which artery is primarily responsible for supplying the head and neck of the femur?

Accepted Answer

Medial circumflex artery

Answer

Obturator artery

Answer

Lateral circumflex artery

Answer

Profunda femoris artery

Question 5

Which is the largest nerve that exits the pelvis through the greater sciatic foramen?

Accepted Answer

Sciatic nerve

Answer

Superior gluteal artery

Answer

Inferior gluteal artery

Answer

Piriformis muscle

Question 6

Inversion and eversion of foot occurs at which joint

Accepted Answer

Subtalar

Answer

Ankle

Answer

Tarso-metatarsal

Answer

None of the options

Question 7

Which of the following muscles is not supplied by the femoral nerve?

Accepted Answer

Obturator externus

Answer

Pectineus

Answer

Sartorius

Answer

Vastus medialis

Question 8

Which of the following statements about the adductor muscles of the thigh is correct?

Accepted Answer

The adductor magnus has two parts: adductor and hamstring portions.

Answer

Adductor magnus is the largest muscle of the thigh.

Answer

The adductor magnus originates entirely from the pubic ramus.

Answer

The main blood supply to the adductor muscles is the obturator artery.

Question 9

Which of the following statements about the femoral triangle is NOT true?

Accepted Answer

Floor is formed by adductor longus

Answer

Contains the femoral vessels

Answer

Lateral margin is formed by sartorius

Answer

Medial margin is formed by adductor longus

Question 10

The structure which lies outside the femoral sheath is:

Accepted Answer

Femoral nerve

Answer

Genitofemoral nerve

Answer

Femoral vein

Answer

Femoral artery

Lower Limb — MCQs

Lower Limb — MCQs

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