3-Lower limp MSQs Only (2) Flashcards
1- Which of the following is not contained within the deep posterior compartment of the lower leg?
Sural nerve
The deep posterior compartment lies anterior to soleus. The sural nerve is superficially sited and therefore not contained within it.
4- At what level does the sciatic nerve usually bifurcate into the tibial and common peroneal nerves?
At the superior aspect of the popliteal fossa
The sciatic nerve passes vertically downwards over the posterior surface of the obturator internus and quadratus femoris to the hamstring compartment of the thigh, here it is crossed posteriorly by the long head of biceps femoris. In the buttock it lies under the cover of gluteus maximus. It separates into its tibial and common peroneal components at the upper aspect of the popliteal fossa.
2- Which of the following structures are at risk of direct injury following a fracture dislocation of the femoral condyles?
Popliteal artery
The heads of gastrocnemius will contract to pull the fracture segment posteriorly. The popliteal artery lies against the bone and may be damaged or compressed.
3- Which of the following structures does not pass anterior to the lateral malleolus?
Peroneus brevis
Peroneus brevis passes posterior to the lateral malleolus. Peroneus tertius is closely related to extensor digitorum and like that muscle, its tendon passes anterior to the lateral malleolus
5- During an operation for varicose veins the surgeons are mobilising the long saphenous vein. Near its point of entry to the femoral vein an artery is injured and bleeding is encountered. From where is the bleeding most likely to originate?
Deep external pudendal artery
saphenous vein near its point of union with the femoral vein. The superficial external pudendal artery lies superior to the SFJ. Neither vessel is functionally important and if injured they are best ligated.
6- A 23 year old man presents with delayed diagnosis of appendicitis. The appendix is retrocaecal and has perforated causing a psoas abscess. Into which structure does the psoas major muscle insert?
Lesser trochanter of the femur
The psoas major inserts into the lesser trochanter.
10- Which of the following structures are not closely related to the adductor longus muscle?
Long saphenous vein
Tendon of iliacus ( Right)
The profunda branch of the femoral artery
Pectineus muscle
Femoral nerve
Femoral triangle:
Adductor longus medially
Inguinal ligament superiorly
Sartorius muscle laterally
Adductor longus forms the medial border of the femoral triangle. It is closely related to the long saphenous vein which overlies it and the profunda branch of the femoral artery. The femoral nerve is related to it inferiorly. However, the tendon of iliacus inserts proximally and is not in contact with adductor longus.
8- Which of the following muscles is not within the posterior compartment of the lower leg?
Peroneus brevis
Peroneus brevis lies in the lateral compartment.
9- Which of the nerves listed below is responsible for the innervation of gluteus medius?
Superior gluteal nerve
7- The femoral nerve is transected by a rather careless surgeon during a botched femoro-popliteal bypass operation. Which of the following actions will be impaired?
Extension of the knee joint
The femoral nerve supplies the quadriceps muscle which is responsible for extension at the knee joint.
11- A 73 year old lady presents with a femoral hernia. Which of the following structures forms the lateral wall of the femoral canal?
Femoral vein
The canal exists to allow for the physiological expansion of the femoral vein, which lies lateral to it.
12- A 40-year-old man presents with pain in his lower back and ‘sciatica’ for the past three days. He describes bending down to pick up a washing machine when he felt ‘something go’. He now has severe pain radiating from his back down the right leg. On examination he describes paraesthesia over the anterior aspect of the right knee and the medial aspect of his calf. Power is intact and the right knee reflex is diminished. The femoral stretch test is positive on the right side. Which nerve or nerve root is most likely to be affected?
L3
13- Which of the following statements relating to sartorius is untrue?
It inserts into the medial femoral condyle
It inserts into the medial aspect of the upper part of the tibia.
14- A 70 year old man is due to undergo an arterial bypass procedure for claudication and foot ulceration. The anterior tibial artery will form the site of the distal arterial anastomosis. Which of the following structures is not closely related to it distally?
Tibialis posterior
As an artery of the anterior compartment, the anterior tibial artery is closely related to tibialis anterior. The tibialis posterior is related to it at its origin.
15- A 66 year old man with peripheral vascular disease is undergoing a below knee amputation. In which of the lower leg compartments does peroneus brevis lie?
Lateral compartment
The interosseous membrane separates the anterior and posterior compartments. The deep and superficial compartments are separated by the deep transverse fascia. The peroneus brevis is part of the lateral compartment.
17- Which of the muscles below does not cause lateral rotation of the hip?
Pectineus
lateral hip rotators: P-GO-GO-Q (top to bottom)
Piriformis
Gemellus superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus femoris
Pectineus adducts and medially rotates the femur.
16- A 78 year old man is undergoing a femoro-popliteal bypass graft. The operation is not progressing well and the surgeon is complaining of poor access. Retraction of which of the following structures will improve access to the femoral artery in the groin?
Sartorius
At the lower border of the femoral triangle the femoral artery passes under the sartorius muscle. This can be retracted to improve access.
18- A builder falls off a ladder whilst laying roof tiles. He sustains a burst fracture of L2. The MRI scan shows complete nerve transection at this level, as a result of the injury. Which clinical sign will not be present initially?
cid paralysis of the legs
Extensor plantar response ( Right)
Sensory loss in the legs
Incontinence
Areflexia
In lower motor neuron lesions everything is reduced
The main purpose of this question is to differentiate the features of an UMN lesion and a LMN
lesion. The features of a LMN lesion include:
· Flaccid paralysis of muscles supplied
· Atrophy of muscles supplied.
· Loss of reflexes of muscles supplied.
· Muscles fasciculation
For lesions below L1 LMN signs will occur. Hence in an L3 lesion, there will be loss of the patella reflex but there will be no extensor plantar reflex.
19- An 80 year old lady with a caecal carcinoma is undergoing a right hemicolectomy performed
through a transverse incision. The procedure is difficult and the incision is extended medially by dividing the rectus sheath. Brisk arterial haemorrhage ensues. From which of the following does the damaged vessel originate?
External iliac artery
The vessel damaged is the epigastric artery. This originates from the external iliac artery (see below).
20- Which of the following does not exit the pelvis through the greater sciatic foramen?
Obturator nerve
The obturator nerve exits through the obturator foramen.
23- Which of the following statements relating to the knee joint is false?
The posterior aspect of the patella is extrasynovial
The posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body. It may swell considerably following trauma such as ACL injury. Which may be extremely painful owing to rich innervation from femoral, sciatic and ( a smaller) contribution from the obturator nerve. During full extension all ligaments are taut and the knee is locked.
22- A 77 year old man with symptoms of intermittent claudication is due to have his ankle
brachial pressure indices measured. The dorsalis pedis artery is impalpable. Which of the following tendinous structures lies medial to it, that may facilitate its identification?
Extensor hallucis longus tendon
The extensor hallucis longus tendon lies medial to the dorsalis pedis artery.
21- A 22 year man is shot in the groin. On examination, he has weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh. Which structure has been affected?
Femoral nerve
This is a classical description of a femoral nerve injury.
24- Which of the following structures attaches periosteum to bone?
Sharpeys fibres
Periosteum is attached to bone by strong collagenous fibers called Sharpey’s fibres, which extend to the outer circumferential and interstitial lamellae. It also provides an attachment for muscles and tendons