Lower limb Flashcards
Which of the following movements occurs at the subtalar joint?
A Dorsiflexion
B Equinovarus
C Eversion
D Plantarflexion
C
Explanation
The subtalar joint is also known as the talocalcaneal joint. It allows inversion and eversion of the foot but plays no role in dorsiflexion and plantar flexion of the foot.
Which of the following muscles causes dorsiflexion and inversion of the ankle and foot?.
A Tibialis anterior
B Extensor hallucis longus
C Tibialis posterior
D Peroneus tertius
A
Explanation
Tibialis anterior causes dorsiflexion of the ankle joint and inversion of the foot. It also helps to maintain the medial longitudinal arch
EHL - dorsiflex ankle & extends digits 2-5
TP - plantarflex ankle & inverts foot
Peroneus (or fibularis) tertius - dorsiflex ankle and assist eversion
Regarding the foot interossei, which of the following statements is true?
A The plantar interossei have 2 heads
B When acting together flex metarso-phalangeal joint (MTP)
C The long axis of the foot lies along the 3rd metatarsal
D Supplied by medial plantar nerve
B
Explanation
The plantar interossei have 3 heads, are supplied by the lateral plantar nerve and the long axis lies along the second metatarsal. The lateral plantar nerve S2 S3 supplies it. From older textbooks it states that the function of the interossei are as follows: The adducting and abducting actions of the interossei are of little significance in the foot. The more important function is that they assist the lumbricals in extending the interphalangeal joints and the flex the MTP joints.
Extra:
Plantar interossei ADduct (PAD) and arise from a single metatarsal as unipennate muscles.
Dorsal interossei ABduct (DAB) and arise from two metatarsals as bipennate muscles
Regarding the medial longitudinal arch of the foot, which of the following is false?
A The most important ligament is the plantar aponeurosis
B Bones contribute little to arch stability
C The most important muscular supporting structure is the tendon of flexor hallucis longus
D The pillars of the arch are the tuberosity of the calcaneus posteriorly and the bodies of the three metatarsal bones anteriorly
D
Explanation
The pillars of the medial longitudinal arch are the tuberosity of the calcaneus posteriorly and the HEADS of the three metatarsal bones anteriorly. Bony factors do not play a significant role in maintaining the stability of the arch. Ligaments are important but unable to maintain the arch entirely on their own. Muscles are indispensable to the arch maintenance
Note: in the old prescribed text of anatomy- Bony factors do not play a significant role in maintaining the stability of the arch. in the new prescribed text it states: the shape of the united bones are passive factors involved in the forming and maintaining of the arches (especially the transverse arch) The shape of the united bones is also an important factor for forming and maintaining the arches
Also: the current TB states in order of importance for maintaining the arches: the plantar calcaneonavicular ligament (main supporter of the medial longitudinal arch), the long plantar ligament (main supporter of the lateral longitudinal arch), THEN the plantar aponeurosis followed by the plantar calcaneocuboid ligament. The old prescribed TB clearly stated that the PLANTAR APONEUROSIS IS THE MOST IMPORTANT LIGAMENT.
The old TB stated that ligaments are important, but are unable to maintain the arch entirely on their own. The most important ligament is the plantar aponeurosis. Next in importance is the spring ligament. All the other interosseous ligaments contribute towards maintaining the arch.
Muscles are indispensable to the maintenance of the medial longitudinal arch. The most important muscular supporting structure is the tendon of flexor halluci longus. It is assisted by the tendon of flexor digitoroum longus to the second and third toes, which receive a slip from the tendon of FHL
An old question- I have not removed it. I feel exposure to all types of MCQs is helpful
With regard to the femoral nerve, which of the following statements is correct?
A Deep and superficial branches of the nerve are separated by the lateral femoral circumflex artery
B It runs in the adductor canal
C It enters the thigh by passing deep to the inguinal ligament lateral to the artery in the femoral sheath.
D The nerve originates from anterior divisions of the anterior rami of the lumbar nerves
A
Explanation
The saphenous nerve and the nerve to vastus medialis run in the adductor canal. The origin of the nerve is the posterior division of the anterior rami of the lumbar nerves 2,3,4. It enters the thigh deep to the inguinal ligament, lateral to the artery but outside the femoral sheath. The lateral circumflex femoral artery passes between the branches of the femoral nerve
Regarding the ligaments of the knee, which of the following statements is correct?
A The posterior cruciate ligament is attached to the medial condyle of the femur
B The posterior cruciate stops the tibia slipping forward on the femur
C The posterior cruciate is longer and stronger than the anterior cruciate ligament
D Lateral collateral ligament makes a significant contribution to the capsule
A
Explanation
The posterior cruciate is stronger but shorter than the anterior cruciate ligament. Posterior cruciate stops the femur slipping on the tibia. The lateral collateral does not attach to the capsule of the knee joint.
From Lasts anatomy:
The anterior cruciate ligament (ACL) is attached to the anterior part of the tibial plateau between the attachments of the anterior horns of the medial and lateral menisci. The ligament ascends posterolaterally, twisting on itself, and is attached to the posteromedial aspect of the lateral femoral condyle.
The posterior cruciate ligament (PCL) is stronger, shorter and less oblique. It is attached to a smooth impression on the posterior part of the tibial intercondylar area which extends to the uppermost part of the posterior surface of the tibia. The ligament ascends anteromedially and is attached to the anterolateral aspect of the medial femoral condyle
From Clinical Moore:
The ACL, the weaker of the two cruciate ligaments., arises from the anterior intercondylar area of the tibia, just posterior to the attachment of the medial meniscus. The ACL has a relatively poor blood supply. It extends superiorly, posteriorly, and laterally to attached to the posterior part of the medial side of the lateral condyle of the femur. It limits posterior rolling (turning and traveling) of the femoral condyles on the tibial plateau during flexion, converting it to spin (turning in place). It also prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint. When the joint is flexed at a right angle, the tibia cannot be pulled anteriorly (like pulling out a drawer) because it is held by the ACL.
The PCL, the stronger of the two cruciate ligaments, arises from the posterior intercondylar area of the tibia. The PCL passes superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur. The PCL limits anterior rolling of the femur on the tibial plateau during extension., converting it to spin. It also prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint. In weight bearing flexed knee, the PCL is the main stabilising factor for the femur (e.g. When walking downhill)
Regarding the ankle joint, which of the following statements is correct?
A The capsule attaches to the articular margins of the tibia, fibula and anterior talus
B The deep part of the deltoid ligament is triangular in shape
C It has a fixed axis of rotation
D The lateral ligament attaches to talus and calcaneus
D
Explanation
The capsule is attached to the articular margins of all three bones (the current textbook says the articular surfacers of the tibia and the malleoli and inferiorly to the talus) but it is attached to the inferior part of the talus not the anterior part, and the joint does not have a fixed axis of rotation. The superficial part of the deltoid ligament is triangular.
Note:
The ankle joint is reinforced laterally by the lateral ligament of the ankle, a compound structure consisting of three completely separate ligaments
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Medially reinforced by the medial ligament of the ankle, deltoid ligament, made up of 4 parts
Tibionavicular part
Tibiocalcaneal part
Anterior tibiotalar part
Posterior tibiotalar part
Extra:
Although the lateral ligament does have attachments to the talus and calcaneus, it does not run between these two bones. Rather as above, the lateral ligament attaches the fibula (lateral malleolus) to the talus and the fibula to the calcaneus.
Which muscle takes origin from the tibia and the fibula?
A Peroneus longus
B Flexor hallucis longus
C Tibialis posterior
D Flexor digitorium longus (FDL)
C
Explanation
Tibialis posterior arises from the interosseus membrane and the adjoining surface of both bones of the leg below the origin of soleus
Note: in the current TB it states that FDL arises from the medial part of the posterior surface of the tibia inferior to the soleal line; by a broad tendon to fibula
Wed searches seems to given the origin as tibia alone
Last’s anatomy-form where the question arises: FDL arise from the posterior surface of the tibia below the soleal line
This is an old question-therefore, I will leave in current form
Which of the following muscles causes inversion of the foot?
A Extensor halliucis brevis
B Tibialis posterior
C Peroneus brevis
D Peroneus tertius
B
Explanation
Tibialis posterior acts to invert and adduct the forefoot. Because it passes behind the medial malleolus to plantarflex the ankle joint, it also contributes to maintaining the medial longitudinal arch of the foot
Which of the following bones is not part of the transverse arch of the foot?
A Cuboid
B Navicular
C Base of all the metatarsals
D Cuneiform
B
Explanation
The transverse arch of the foot runs from side to side. It is formed by the cuboid, cuneiforms and the bases of the metatarsals. The medial and lateral parts of the longitudinal arch serve as pillars fro the transverse arch. The tendons of fibularis longus and tibialis posterior cross under the sole of the foot like a stirrup and help maintain the curvature of the transverse arch.
Which of the following does not insert into the greater trochanter?
A Gluteus maximus
B Superior gemellus
C Piriformis
D Obturator externus
A
Explanation
Obturator externus inserts on the medial surface of the greater trochanter into a deep pit, the trochanteric fossa. The deep half of the lower portion of gluteus maximus is inserted into the gluteal tuberosity of the femur.The remaining three-quarters of the muscle is inserted into the upper end of the iliotibial tract
Which is true as regards the layers of the foot?
A The fourth layer contains the tendons of tibialis posterior and peroneus brevis
B The 2nd layer comprises the long tendons and the lumbricals
C The third layer comprises the flexor digitorum brevis
D The plantar aponeurosis can be regarded as the 5th layer
B
Explanation
The plantar aponeurosis does not feature in any of the layers. Flexor digitorum brevis is in the 1st layer. The 4th layer does not contain peroneus brevis
An important question fro the MCQs and the VIVAs
First layer: flexor digitorum brevis, abductor hallucis and abductor digiti minimi
Second layer: tendon of flexor hallucis longus, tendon of flexor digitorum longus, quadratus plantae and lumbricals
Third layer: flexor hallucis brevis, adductor hallucis and flexor digiti minimi breivs
Fourth layer: interosseous muscles (dorsal and plantar), tendon of peroneus longus and tendon of tibialis posterior
Regarding the menisci of the knee, which of the following statements is correct?
A The posterior cruciate ligament (PCL) extends anteromedially and is attached to the anterolateral aspect of the medial femoral condyle
B A fold of synovium lies posterior to anterior cruciate
C The medial meniscus is vascular
D The anterior horn of medial meniscus is attached to medial tibial condyle
A
Explanation
The medial meniscus is avascular. The fold of synovium does not lie posterior to the anterior cruciate and the anterior horn of the medial meniscus is attached to the anterior intercondylar area of the tibia.
Note: a way to remember the PCL and ACL details is that each of them needs to have an anterior, posterior, medial and lateral element to it. i.e. PCL attaches to anterolateral part of the medial femoral condyle. ACL attaches to the posteromedial aspect of the lateral femoral condyle.
Current TB: the PCL passes superiorly and anteriorly on the medial of the ACL to attached to the anterior part of the lateral surface of the medial epicondyle of the femur.
Extra: From a previous question.
The anterior cruciate ligament (ACL) is the weaker of the two ligaments. It arises from the anterior intercondylar area of the tibia, posterior to the attachment of the medial meniscus. It extends superiorly, posteriorly and laterally to attach to the posterior part of the medial side of the lateral condyle of the femur. It limits posterior rolling of the femoral condyles on the tibial plateau during flexion and it prevents hyperextension of the knee joint and posterior displacement of the femur on the tibia. It has a relatively poor blood supply.
The posterior cruciate ligament (PCL)- stronger of the two ligaments, arises form the posterior intercondylar area of the tibia and extends superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur. The PCL limits anterior rolling of the femur on the tibial plateau during extension. It helps prevent hyperflexion of the knee joint and prevents anterior displacement of the femur on the tibia or posterior displacment of the tibia on the femur. The PCL is the main stabilizing factor for the femur when in the weight bearing flexed knee
Regarding the adductor canal, which of the following statements is correct?
A The nerve to vastus lateralis passes through it
B The femoral artery lies between the saphenous nerve and femoral vein
C The vein is medial to the artery throughout
D Adductor longus forms the roof
B
Explanation
The adductor canal (~15cm) is bounded:
Anteriorly and laterally by the vastus medialis
Posteriorly by the adductors longus and magnus
Medially by the sartorious, which overlies the groove between the above muscles, forming the roof of the canal
Contents of the canal: femoral artery, femoral vein, saphenous nerve and nerve to vastus medialis
At all levels on the thigh the femoral artery lies between the saphenous nerve and femoral vein
In the distal part of the canal the femoral vein is posterior-lateral to the artery
All of the following make up the medial arch of the foot except?
A The first three metatarsals
B Navicular
C Calcaneous
D Cuboid
D
Explanation
The bones of the medial longitudinal arch (MLA) of the foot are calcaneus, talus, navicular, the three cuneiform bones and their three metatarsals. The pillars of the arch are the tuberosity of the calcaneus posteriorly and the heads of the three metatarsals anteriorly. The keystone of the medial longitudinal arch is the talar head. Tibialis anterior attaching to the first metatarsal and medial cuneiform helps strengthen the MLA. The fibularis longus tendon passing from lateral to medial, also helps support this arch
All of the following drain into the great saphenous vein except?
A Superficial epigastric
B Deep external pudendal
C Superficial circumflex iliac
D Deep circumflex iliac
D
Explanation
A number of tributaries may be expected to join the great saphenous vein in the region of the saphenous opening. There are usually four veins that correspond to the four cutaneous branches of the femoral artery- superficial circumflex iliac, superficial epigastric, superficial and deep external pudendal. In addition there may be a deep vein that pierces the fascia lata over adductor longus
All of the following are branches of the femoral artery except?
A Obturator
B Profunda femoris
C Superficial circumflex iliac
D Superficial epigastric
A
Explanation
The following are the branches of the femoral artery
Superficial epigastric,
Superficial circumflex iliac
Superficial external pudendal
Deep external pudendal
Profunda femoris
Superior genicular
Muscular
Note: the latest text says: sometimes the femoral artery gives off the deep circumflex iliac artery. The lateral and medial circumflex femoral arteries arise form the profunda femoris BUT may arise from the femoral artery
Which of the following passes through the lesser sciatic foramen?
A The superior gemellus
B Internal pudendal artery
C Superior gluteal artery
D Piriformis
B
Explanation
It transmits the following structures:
The tendon of obturator internus
Internal pudendal artery
Internal pudendal veins
Pudendal nerve
Nerve to obturator internus
Current TB: the internal pudendal artery enters the gluteal region through the greater sciatic foramen; descends posterior to the ischial spine; enters perineum through the lesser sciatic foramen.
Superior and inferior gluteal arteries enter through the greater sciatic foramen.
Nerves
Sciatic-enters gluteal region via the greater sciatic foramen
Posterior cutaneous nerve of the thigh- enters gluteal region via the greater sciatic foramen
Superior gluteal- enters gluteal region via the greater sciatic foramen
Inferior gluteal- enters gluteal region via the greater sciatic foramen
Nerve to quadratus femoris- enters gluteal region via the greater sciatic foramen
Pudendal- EXISTS pelvis via the greater sciatic foramen; descends posterior to the sacrospinous ligament-enters perineum through the lesser sciatic foramen
Nerve to obturator internus- EXITS pelvis via the greater sciatic foramen inferior to piriformis; descends posterior to the sacrospinous ligament-enters perineum through the lesser sciatic foramen
Which of the following statements concerning the femoral triangle is false?
A Adductor longus is a medial boundary
B The lateral border is the medial border of sartorius
C Femoral vein receives the great saphenous and the deep femoral vein
D It contains superficial inguinal lymph nodes and associated lymphatic vessels
D
Explanation
The following structures are contained within the femoral triangle (from lateral to medial):
Terminal part of the femoral nerve and its branches
Femoral sheath
Femoral artery and its branches
Femoral veins and its tributaries
Femoral canal, containing the deep inguinal lymph nodes and associated lymphatic vessels
It is bounded by:
(superiorly) the inguinal ligament
(medially) the medial border of the adductor longus muscle
(laterally) medial border of the Sartorius muscle
CONFLICT- OLD TEXTBOOK AND WED SOURCES REPORT THE MEDIAL BORDER OF THE FEMORAL TRIANLGE IS: MEDIAL BORDER OF ADDUCTOR LONGUS. THE CURRENT TEXTBOOK REPORTS: MEDIAL BORDER IS THE LATERAL BORDER OF ADDUCTOR LONGUS
Its floor is provided laterally by iliopsoas, medially by pectineus and adductor longus
The roof is formed by the fascia lata
The femoral triangle is shaped like the sail of a ship.
Its boundaries can be remembered using the mnemonic “SAIL” for Sartorius, Adductor longus and Inguinal Ligament.
Which of the following structures is NOT in the 3rd layer of the sole?
A Flexor hallucis brevis
B Flexor digiti minimi brevis
C Adductor hallucis
D Peroneus longus
D
Explanation
Peroneus longus is in the 4th layer.
According to Last’s anatomy and various web sources, peroneus (fibularis) longus is included in the fourth layer. Tibialis posterior is also included.
Regarding the medial side of the ankle, which of the following statements is correct?
A The deltoid ligament is continuous with the spring ligament
B The anterior talo-fibular ligament strengthens the joint
C The great saphenous vein runs posterior to the malleolus
D The posterior tibial artery runs anterior to the malleolus
A
Explanation
The great saphenous runs anterior to the malleolus. The posterior tibial artery runs posterior to the malleolus and the anterior talo-fibular ligament (one of the three ligaments forming the lateral ligament of the ankle). The other two: posterior talofibular ligament and the calcaneofibular ligament) strengths the lateral side of the joint. The medial side is strengthened by the deltoid ligament.
Extra:
The joint capsule is strengthened medially by the strong deltoid ligament made up of 4 adjacent and continuous parts. It is continuous with the spring ligament.
Tibionavicular.
Tibiocalcaneal
Anterior and Posterior Tibiotalar.
Laterally 3 separate ligaments strengthen the joint:
Anterior talofibular ligament;
Posterior talofibular ligament;
Calcaneofibular ligament.
Some important structures pass POSTERIOR to medial malleolus under the flexor retinaculum: (ant to post) Tibial posterior; flexor digitorum longus tendon; post tibial artery; tibial Nerve; flexor hallucis longus tendon (Mnemonic: Tom, Dick and Nervous Harry or Tall Doctors Are Never Hungry).
Great saphenous vein runs ANTERIOR to medial malleolus.
All of the following make up the lateral longitudinal arch except?
A Calcaneus
B lateral two metatarsals
C Talus
D Cuboid
C
Explanation
The bones of the medial longtitudinal arch of the foot are calcaneus, talus, navicular, the three cuneiform bones and their three metatarsals. The pillars of the arch are the tuberosity of the calcaneus posteriorly and the heads of the three metatarsals anteriorly.
The lateral longitudinal arch is much flatter than the medial part of the arch and rests on the ground during standing. It is made up of the calcaneus, cuboid and the lateral two metatarsals
In relation to the plantar aponeurosis, which of the following statements is correct?
A Is not attached to the skin of the sole
B Covers the abductors of the big and little toe
C It forms the central compartment of the sole
D Arises from the talus
C
Explanation
The plantar aponeurosis (PA) is composed of dense collagen fibres. It forms the central compartment of the sole. It arises from the medial process of calcaneous and fans out over the sole. The PA becomes broader and thinner in front, and divides near the heads of the metatarsal bones into five processes, one for each toe. At the anterior end of the sole, inferior to the heads of the metatarsals, the aponeurosis is reinforced by transverse fibres forming the superficial transverse metatarsal ligament. In the mid and forefoot, vertical intermuscular septa extend deeply from the margins of the plantar aponeurosis toward the first and fifth metatarsals forming three compartments of the sole- the medial, lateral and central. Fibrous septa anchor the skin to the underlying aponeurosis and limit the mobility of the skin. The medial and lateral plantar nerves supply the muscles and skin of the sole of the foot. These two nerves are the terminal branches of the tibial nerve. The four muscle layers of the foot begin with the superficial or first layer beneath the PA. The abductors of the big and little toes are covered by a deep fascia that is much thinner than the central aponeurosis.
The skin over the femoral triangle is supplied by which of the following nerves?
A Ilio-inguinal
B Medial femoral cutaneous
C Obturator
D Genito-femoral
D
Explanation
Please note:
Last’s= the genitofemoral nerve is the described nerve which supplies the skin of the femoral triangle.
CM= genitofemoral nerve, its femoral part supplies the skin over the lateral part of the femoral triangle and the genito part supplies the anterior scrotum or the labia majora. Ilioinguinal supplies the skin over the medial part of the femoral triangle
Web source= genitofemoral nerve supplies the skin over the femoral triangle
Latest recommended text (Moore, pg 537) has both ilio-inguinal and genito-femoral as supplying the skin over the femoral triangle. The former supplies the medial and the latter the lateral areas of femoral triangle.
With respect to the great saphenous vein, which of the following is true?
A It is a continuation of the lateral marginal vein of the foot
B It pierces the cribriform fascia covering the saphenous opening
C It runs between the two heads of gastrocnemius
D It does not communicate directly with the superficial vein varicosities
B
Explanation
The great saphenous vein is a continuation of the medial marginal vein of the foot. It does not run between the 2 heads of gastrocnemius, and does communicate directly with the superficial vein varicosities.
All the following ligaments in the knee joint are extra-capsular except?
A Oblique popliteal ligament
B Patellar ligament
C Transverse ligament
D Tibial collateral ligament
C
Explanation
Patella Ligament: From inferior border of patella to tibial tuberosity; is the continuation of quadriceps tendon.
Tibial collateral ligament: Broad flat band attached on medial epicondyle of femur (below adductor tubercle) - runs downward and forward to the medial condyle of the tibia - is crossed by the tendons of sartorius, gracilis and semitendinosus - attaches to meniscus.
Fibular collateral ligament: Round cord from lateral epicondyle of femur (above groove of popliteus), runs downward and backward to head of fibula - is primarily covered by the tendon of biceps femoris
Obliques popliteal ligament: Extension of semimembranosus - attached above the lateral condyle of femur - forms the floor of popliteal fossa and is in contact with popliteal artery.
Arcuate popliteal ligament: Y-shaped - from the posterior border of the intercondylar area of tibia and the lateral epicondyle of femur to the area below the head of fibula.
Transverse ligament - is an intra-capsular ligament. Slender fibrous band that joins anterior edges of menisci, crossing the anterior intercondylar area and tethering the menisci to each other during knee movement.
Which of the following is not a branch of the common peroneal nerve?
A Superior genicular
B Recurrent genicular
C Lateral cutaneous nerve of the calf
D Medial sural cutaneous nerve
D
Explanation
the common peroneal nerve gives off the following branches
Sural communicating nerve
Lateral cutaneous nerve of the calf
Superior and inferior genicular nerves
The recurrent genicular nerve
The common peroneal nerve ends by dividing, in the substance of peroneus longus, into the deep and superficial peroneal nerves
The medial sural cutaneous nerve is a branch of the tibial nerve which joins the sural communicating branch of the common fibular (peroneal nerve)
All of the following structures pass deep to the superior extensor retinaculum with the exception of?
A Deep peroneal nerve
B Peroneus tertius
C Superficial peroneal nerve
D Extensor digitorum longus
C
Explanation
Deep to the superior extensor retinaculum lie the tendons of tibialis anterior, extensor hallucis longus, extensor digitorium longus and peroneus tertius, in that order from medial to lateral, in front of the lower end of the tibia. The anterior tibial artery and deep peroneal nerves are also deep to the retinaculum, lying between extensor hallucis longus and extensor digitorium longus, with the vessels medial to the nerve.
Extra:
Mnemonic (medial to lateral) Timothy Has A Very Nasty Disease, Fungal Toe. (Tibialis anterior tendon, extensor hallucis longus, tibial anterior Artery, tibial anterior Vein, deep fibular Nerve, extensor digitorium longus and peroneus tertius)
In the lateral compartment of the leg, which of the following statements is correct?
A The muscles are supplied by the deep peroneal nerve
B The blood supply is the anterior tibial artery
C The peroneus longus arises only from the fibula
D The peroneal muscle tendons share the same tendon sheath as they pass the lateral malleolus
D
Explanation
The muscles are supplied by the superficial peroneal nerve (L5, S1, S2). Peroneus longus arises from the head and superior two thirds of the lateral surface of the fibula-and attaches to the base of the first metatarsal and medial cuneiform and the intermuscular septum (note: Older textbook state that the peroneus (fibularis) longus also arises from the intermuscular septa. This point should be removed if the question is to be used as the answer must come from the most current TB only). I have left the question as is because it is an older question-likely written using the older textbooks.
Peroneus brevis from the inferior two thirds of the lateral surface of the fibula. There is no official blood supply to the lateral compartment of the leg. The peroneal muscles evert the foot and weakly plantarflexes the ankle. The lateral compartment ends inferiorly at the superior fibular retinaculum. Here the tendons of the two muscles enter a common synovial sheath to accommodate their passage between the superior fibular retinaculum and the lateral malleolus. Peroneus tertius is a muscle of the anterior compartment. It aids in dorsiflexion of the ankle and eversion of the foot.
The peroneal muscle tendons share the same tendon sheath from above the lateral malleolus to the peroneal trochlea. The peroneal trochlea is distal to the lateral malleolus
Peroneus is the same as fibulairs
In relation to popliteus, which of the following statements is correct?
A It arises from the tibia above the condyles
B It acts to lock the knee in full extension
C It has attachments to the lateral meniscus
D It is innervated by a branch of the common peroneal nerve
C
Explanation
Popliteus arises on the posterior surface of the tibia above the soleal line (below the tibia condyles). It slopes upwards and laterally and it acts to unlock the knee in full extension. It is innervated by the tibial nerve.
Origin: Lateral surface of lateral condyle of femur and lateral meniscus
Insertion: Posterior surface of tibia, superior to soleal line
Nerve: Tibial nerve (L4, L5, S1)
Action: Weakly flexes knee and unlocks it by rotating femur 5° on flexed tibia; medially rotates tibia of unplanted limb
According to Hilton’s law, the hip joint is supplied by the following nerves EXCEPT
A Sciatic
B Obturator
C Femoral
D Gluteal
A
Explanation
Current textbook
Hilton’s law states that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin covering the distal attachments of those muscles
Articular rami arise from the intermuscular rami of the muscular branches or directly from named nerves. A knowledge of the nerve supply of the muscles and their relationships to the joints can allow one to deduce the nerve supply of many joints. Possible deductions regarding the hip joint and its muscular relationships include:
Flexors innervated by the femoral nerve pass anterior to the hip joint; the anterior aspect of the hip joint is innervated by the femoral nerve.
Lateral rotators pass inferior and posterior to the hi[ joint; the inferior aspect of the joint is innervated by the obturator nerve and the posterior aspect is innervated by branches from the nerve to the quadratus femoris.
Abductors innervated by the superior gluteal nerve pass superior to the hip joint; the superior aspect of the joint is innervated by the superior gluteal nerve
Other sources
The nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and twigs of the sciatic nerve
A difficult question, but important to be aware of!
Which of the following muscles of the lower leg can initiate dorsiflexion and inversion of the foot?
A Tibialis posterior
B Peroneus tertius
C Tibialis anterior
D Peroneus longus
C
Explanation
Tibialis posterior causes inversion
Peroneus tertius causes eversion and dorsiflexion
Peroneus longus gives rise to eversion.
Regarding the femoral artery, which of the following statements is correct?
A It is separated from the hip joint capsule by fat only
B It is found at the mid-inguinal point.
C It enters the adductor canal by piercing sartorius
D It gives off the medial femoral cutaneous as its major branch
B
Explanation
The femoral artery is separated from the hip joint by psoas major. It enters the femoral triangle deep to sartorius. The profunda branch is its major offshoot
Extra:
The femoral artery is a continuation of the external iliac artery distal to the inguinal ligament. It is the primary artery of the lower limb. It enters the femoral triangle deep to the inguinal ligament midway between the ASIS and the pubic symphysis, between the femoral nerve laterally and the femoral vein medially.
Definitions:
Mid-inguinal point – halfway between the pubic symphysis and the anterior superior iliac spine. The femoral pulse can be palpated here. Midpoint of the inguinal ligament – halfway between the pubic tubercle and the anterior superior iliac spine (the two attachments of the inguinal ligament)
Source NIH
Which of the following statements is correct in relation to gluteus maximus?
A It is the deepest of the gluteal muscles
B It medially rotates and extends the hip
C It is supplied by L5, S1 and S2
D It forms the skin crease of the gluteal fold
C
Explanation
It is the most superficial of the gluteal muscles. It laterally rotates and extends the hip. It does not form the crease of the gluteal fold.
The fold of the buttock is the transverse skin crease for the hip joint and is not caused by the lower border of gluteus maximus, which crosses the line of the fold obliquely
The current text book says: The gluteal fold (sulcus) coincides with the inferior border of the gluteus maximus and indicates the separation of the buttock from the thigh. Coincides-but does not say form.
Web search: The gluteal sulcus (also known as the gluteal fold, fold of the buttock or horizontal gluteal crease) is an area of the body of humans described by a horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh. The gluteal sulcus is formed by the posterior horizontal skin crease of the hip joint and overlying fat, and is not formed by the lower border of the gluteus maximus muscle, which crosses the fold obliquely
In relation to the hip joint, which of the following statements is correct?
A It is limited in full extension by the pubofemoral ligament
B It has the ischiofemoral as its strongest ligament
C The nerve supply is via the obturator and sciatic nerves only
D It derives stability largely from its articular surfaces
D
Explanation
The hip joint is limited in full extension by the iliofemoral ligament. . The ischiofemoral is the weakest ligament.
Note (in some sources): the hip joint is innervated by the femoral nerve (flexors + anterior aspect of hip joint), obturator nerve (lateral rotators + inferior aspect of hip joint), the nerve to quadratus femoris (posterior aspect of hip joint) and superior gluteal (adductors + superior aspect of the hip joint). There is no mention of the sciatic nerve
In other sources: The nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and twigs of the sciatic nerve
A difficult question, but important to be aware of
In relation to the popliteal fossa, which of the following is correct?
A The infero-medial border is soleus muscle
B The roof is formed by biceps femoris
C The popliteal vein lies between the popliteal artery and tibial nerve
D The sural nerve branches from the common peroneal nerve only
C
Explanation
Infero-lateral/medial border: gastrocnemius
Superolateral: biceps femoris
Superolateral: semimembranosus, semitendinosus
Roof: fascia lata
Floor: popliteal surface of femur, post joint capsule, popliteal fascia over popliteus
Contents:
Termination of small saphenous vein
Popliteal arteries and veins and branches/tributaries
Tibial and common fibular nerves
Posterior cutaneous nerve of thigh
Popliteal lymph nodes and lymphatic vessels
The sural nerve is a branch of the tibial nerve and the common peroneal nerve.
Regarding tibialis anterior, which of the following statements is correct?
A It platarflexes and everts the foot
B It inserts into the medial cuneiform and the adjacent first metatarsal bone
C It arises from the upper two thirds of the fibula
D It shares its site of insertion with peroneus tertius
B
Explanation
Tibialis anterior dorsiflexes and inverts the foot. It arises from the upper 2/3 of the tibia. It does not share its site of origin with peroneus tertius (PT or fibularis tertius). PT inserts into the dorsum of base of the 5th metatarsal. PT shares a sheath with extensor digitorium longus (EDL)
Note:
An older question, in older textbook it is clear TA arises from the upper two thirds of the extensor surface of the tibia, from the interosseous membrane and from the deep fascia overlying it. PT arises from the lower third of the fibula.
Current textbook:
TA-proximal attachment- lateral condyle and superior half of the lateral surface of tibia and interosseous membrane. Distal attachment-Medial and inferior surfaces of medial cuneiform and base of first metatarsal.
PT-proximal attachment-inferior third of anterior surface of the fibula and interosseous membrane. Distal attachment- dorsum of base of 5th metatarsal.
Under the extensor retinaculum, which is the most lateral structure?
A The sural nerve
B Extensor halucis longus
C The anterior tibial artery
D Peroneus tertius
D
Explanation
Deep to the superior extensor retinaculum lie the tendons of tibialis anterior, extensor hallucis longus, extensor digitorium longus and peroneus tertius, in that order from medial to lateral, in front of the lower end of the tibia. The anterior tibial and deep peroneal nerve are also deep to the retinaculum, lying between extensor hallucis longus and extensor digitorium longus, with the vessels medial to the nerve
A good mnemonic to remember the structures behind the superior extensor retinaculum (from medial to lateral) is: “Timothy Has A Very Nasty Disease, Paratyphoid.” -
T = Tibialis anterior
H = extensor Hallucis longus
A = Artery
V = Vein
N = Nerve
D = extensor Digitorum longus
PT = Peroneus tertius
With regard to cutaneous innervation of the lower limb, which of the following statements is correct?
A The medial plantar nerve supplies a greater area than the lateral
B The sural nerve supplies the medial malleolus
C The deep peroneal nerve supplies the 3rd digital cleft
D The superficial peroneal nerve supplies the 1st inter-digital cleft
A
Explanation
The medial plantar nerve supplies the skin of the medial side of the sole of foot and sides of the first three digits.
The lateral plantar supplies skin on the sole lateral to a line splitting the 4th digit.
The sural nerve supplies the extensors on the lateral side of the foot and little toe.
The deep peroneal nerve supplies the first inter-digital cleft.
The superficial peroneal nerve supplies the third inter-digital cleft
Which dermatome usually supplies the great toe?
A L3
B L5
C S1
D L4
B
Explanation
L3= anterior and medial thigh and knee
L4= medial leg, medial ankle and side of foot
L5= lateral leg, dorsum of foot, medial sole, 1-3 toes
S1= lateral ankle, lateral side of dorsum and sole of foot, 4-5 toes
S2= Posterior leg, posterior thigh, buttocks and penis
In relation to Hiltons law, which nerve does not supply the hip joint?
A Femoral
B Inferior gluteal
C Nerve to quadratus femoris
D Obturator
B
Explanation
Hilton’s law;
A nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles
Nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and the superior gluteal nerve.
Note: some older texts report that there are articular twigs from the sciatic nerve which supply the hip joint
Interestingly, in the current textbook, the movement of the hip joint encompasses: flexors, adductors, lateral rotators, extensors, abductors and medial rotators. Lateral rotators include gluteus maximus. This muscle is supplied by the inferior gluteal nerve. This nerve however, is not part of the nerves supplying the hip joint which seems in contrary to Hilton’s law. I have asked a few anatomists and the general response is that the law holds true but with some exceptions. See the next quote and source- “one OFTEN finds that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles”. I-Hilton, J. (1863). However, Hilton’s law is actually an axiom, not a law. In general, axioms are generally true and therefore not always law. In his 13 lectures he further expounds on this. It is an AXIOM, not a dictum. A dictum creates a LAW (truth).
Another websource: https://www.physio-pedia.com/Hip_Anatomy
The hip joint receives innervations from the femoral, obturator and superior gluteal nerves.
Which ligament of the knee forms part of the capsule?
A Medial collateral
B Posterior cruciate
C Anterior cruciate
D Popliteus tendon
A
Explanation
The medial collateral ligament of the knee (also called the tibial collateral ligament), has its posterior apex of the triangular ligament blended with the capsule of the knee and attaches to the medial meniscus.
Extracapsular ligaments of the knee joint
Fibular (lateral) collateral ligament
Tibial (medial) collateral ligament
Oblique collateral ligament
Arcuate popliteal ligament
Intra-articular ligaments of the knee joint
Cruciate ligaments- anterior and posterior
The menisci-medial and lateral
Transverse ligament of the knee
In relation to the lateral compartment of the leg, which of the following statements is correct?
A Peroneus longus lies in the groove on the posterior ridge of the cuboid bone
B Contains the deep peroneal nerve and the superficial peroneal nerve
C Contains peroneus longus, brevis and tertius
D Peroneus brevis passes above the peroneal trochlea to be inserted into the tubercle at the base of the 5th metatarsal
D
Explanation
Peroneus tertius and the deep peroneal nerve lies in the anterior compartment of the leg. Peroneus longus passes through the inferior compartment - inferior to the fibular trochlea on the calcaneus - and enters a groove on the anterior inferior aspect of the cuboid bone
Extra:
The muscles are supplied by the superficial peroneal nerve (L5, S1, S2). Peroneus longus arises from the fibula and the intermuscular septum and peroneus brevis from the inferior two thirds of the lateral surface of the fibula. There is no official blood supply to the lateral compartment of the leg. The peroneal muscles evert the foot and weakly plantarflexes the ankle. The lateral compartment ends inferiorly at the superior fibular retinaculum. Here the tendons of the two muscles enter a common synovial sheath to accommodate their passage between the superior fibular retinaculum and the lateral malleolus. Peroneus tertius is a muscle of the anterior compartment. It aids in dorsiflexion of the ankle and eversion of the foot.
Peroneus is the same as fibulairs
Note: Peroneus=Fibularis
The deep peroneal nerve travels through the lower leg with which artery?
A Posterior tibial
B Deep peroneal
C Common peroneal
D Anterior tibial
D
Explanation
The deep peroneal nerve reaches the anterior tibial artery from the lateral side, runs in front of it in the crowded space of the middle of the leg and returns to its lateral side below. The anterior tibial artery is accompanied by 2 anterior tibial veins running on either side.
Injury to the common fibular nerve is associated with all the following EXCEPT?
A Sensory loss over dorsum of the foot
B Foot drop
C Eversion of the foot
D Fibular fracture
C
Explanation
The common fibular nerve in the nerve most often injured in the lower limb due to its superficial position. It winds around the fibular neck making it very vulnerable to trauma. The nerve may be injured during fracture of the fibular neck or severely stretched when the knee joint is dislocated or fractured. Injury results in flaccid paralysis of all the muscles in the anterior and lateral compartment of the lower limb (dorsiflexion and evertors of the foot). The loss of dorsiflexion causes foot drop. This is further exacerbated by the unopposed inversion of the foot, causing a high stepping gait to avoid the toes hitting the ground during the swing phase of walking. Sensory loss extends over the lower lateral part of the leg and the dorsum of the foot.
Extra:
If the common fibular nerve is damaged, the patient may lose the ability to dorsiflex, evert the foot, and extend the digits.
Source: physio -pedia
Injury to L5 will cause the following clinical signs
A Inability to dorsiflex the big toe
B Numbness along the medial border of the leg
C Loss of lateral rotation of the hip
D Eversion of the foot only
A
Explanation
L5- dermatome involves the lateral part of the leg, dorsum of the foot and the medial sole. L5 is involved in hip extension, knee flexion, foot eversion (and inversion according to CM) and big toe dorsiflexion. The lateral rotators of the hip consists of the externus and internus obturator muscles, piriformis, superior and inferior gemelli and quadratus femoris.
Obturator externus: obturator nerve (L3, L4)
Obturator internus: nerve to obturator internus (L5 S1)
Piriformis: Branch of anterior rami (S1, S2)
Superior gemelli: nerve to obturator internus (L5 S1)
Inferior gemelli: nerve to quadratus femoris (L5, S1)
Quadratus femoris: nerve to quadratus femoris (L5, S1)
Note: Bold denotes the main segmental innervation. (Therefore lateral rotation will not be lost completely). I feel that “Inability to dorsiflex the big toe” is the most correct answer. Also, the old textbook displays L5 as foot eversion only and L4 foot inversion. The current textbook reads that L5 does both inversion and eversion of the foot.
Regarding the sacroiliac joint, which is true?
A Both bones are covered by articular cartilage at the joint surface
B The SI joint does not allow any movment
C The joint surfaces are smooth
D They are saddle joints
A
Explanation
The sacroiliac joints are strong weight baring compound joints, consisting of a anterior synovial joint (between the articular surfaces of the sacrum and ilium, covered by articular cartilage) and a posterior syndesmosis (between the tuberosities of the same bones). The articular surfaces have irregular but congruent elevations and depressions that interlock. The SI joint differs form other synovial joint as it limited mobility is allowed, a consequence of their role in transmitting the weight of most of the body to the hip bones. The sacroiliac joints like all spinal joints (except the atlanto-axial) are bicondylar joints, meaning that movement of one side corresponds to a correlative movement of the other side.
Which is incorrect about the plantar aponeurosis?
A Is attached firmly to the skin
B Is found in the second layer of the foot
C Arises from the calcaneous
D Is supplied by the tibial nerve
B
Explanation
The plantar aponeurosis (PA) is composed of dense collagen fibres. It forms the central compartment of the sole. It arises from the medial process of calcaneous and fans out over the sole. The PA becomes broader and thinner in front, and divides near the heads of the metatarsal bones into five processes, one for each toe. At the anterior end of the sole, inferior to the heads of the metatarsals, the aponeurosis is reinforced by transverse fibres forming the superficial transverse metatarsal ligament. In the mid and forefoot, vertical intermuscular septa extend deeply from the margins of the plantar aponeurosis toward the first and fifth metatarsals forming three compartments of the sole- the medial, lateral and central. Fibrous septa anchor the skin to the underlying aponeurosis and limit the mobility of the skin. The medial and lateral plantar nerves supply the muscles and skin of the sole of the foot. These two nerves are the terminal branches of the tibial nerve. The four muscle layers of the foot begin with the superficial or first layer beneath the PA. The abductors of the big and little toes are covered by a deep fascia that is much thinner than the central aponeurosis.
Which is true regarding the cruciate ligaments of the knee?
A The anterior cruciate ligament prevents hyperextension of the knee
B The posterior cruciate helps prevent posterior displacement of the femur on the tibia
C The anterior cruciate is stronger than the posterior cruciate ligament
D The posterior cruciate attaches to the posterior part of the lateral surface of the medial condyle of the femur
A
Explanation
The anterior cruciate ligament (ACL) is the weaker of the two ligaments. It arises from the anterior intercondylar area of the tibia, posterior to the attachment of the medial meniscus. It extends superiorly, posteriorly and laterally to attach to the posterior part of the medial side of the lateral condyle of the femur. It limits posterior rolling of the femoral condyles on the tibial plateau during flexion and it prevents hyperextension of the knee joint and posterior displacement of the femur on the tibia. It has a relatively poor blood supply. The posterior cruciate ligament (PCL)- stronger of the two ligaments, arises form the posterior intercondylar area of the tibia and extends superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur. The PCL limits anterior rolling of the femur on the tibial plateau during extension. It helps prevent hyperflexion of the knee joint and prevents anterior displacement of the femur on the tibia or posterior displacment of the tibia on the femur. The PCL is the main stabilizing factor for the femur when in the weight bearing flexed knee
Which is TRUE regarding the extracapsular ligaments of the knee?
A The arcuate popliteal ligament arises from the posterior aspect of the tibia
B The tibial collateral is stronger than the fibular collateral ligament
C The patellar ligament receives the medial and lateral retinacula
D The extracapsular ligaments of the knee comprise of 4 ligaments
C
Explanation
The extracapsular ligaments of the knee comprise the 1-patellar ligament, 2-fibular collateral ligament, 3-tibial collateral ligament, 4-oblique popliteal ligament and the 5-arcuate popliteal ligament.
PL: it is the anterior ligament of the knee. It is the distal part of the quadriceps tendon. Laterally it receives the medial and lateral retinacula. The PL inserts into the tibial tuberosity
FCL: a cord like ligament extending inferiorly form the lateral epicondyle of the femur to the lateral surface of the fibular head. The tendon of biceps femoris is split in two by this ligament
TCL: flat, intrinsic band that extends from the medial epicondyle of the femur to the medial condyle and superior part of the medial surface of the tibia. TCL is weaker than the FCL and is more damaged
OPL: arises posterior to the medial tibial condyle and passes superolaterally toward the lateral femoral condyle, blending with the central part of the posterior aspect of the joint capsule.
APL: arises from the posterior aspect of the fibular head, passes superomedially over the tendon of popliteus and spreads of the posterior surface of the knee joint
Clinical features found following a fibular neck fracture/injury include the following EXCEPT?
A Inability to dorsiflex the foot
B Weakness of the muscles of the anterior and lateral compartment of the leg
C Inability to evert the foot
D Loss of sensation of the dorsum of the foot with sparing of the first web space
D
Explanation
Clinical features found following a fibular neck fracture/injury include the following:
Inability to dorsiflex ankle- foot drop, Inability to evert foot- you get unopposed inversion, weakness of the muscles of the anterior and lateral compartment-flaccid paralysis. Loss of sensation over the dorsum of the foot and the anterolateral aspect of the leg-the common fibular nerve-superficial branch innervates the web spaces 2, 3, 4 and the deep branch innervates the 1 web space
Three compensatory actions occur: a waddling gait (lean to the opposite side-hiking the hip up), a swing out gait and a high stepping (steppage) gait (to ensure that the toes clear the ground)
Extra:
The common fibular (peroneal) nerve forms as the sciatic bifurcates at the apex of the popliteal fossa; descends through the popliteal fossa and follows the medial border of biceps femoris and its tendon; passes over posterior aspect of the head of fibula and then winds around neck of fibula deep to fibularis longus, where it divides into deep and superficial fibular (peroneal) nerves.
Which is INCORRECT regarding the sciatic nerve?
A The sciatic nerve receives the sciatic artery, a branch of the superior gluteal artery
B The sciatic nerve is the most lateral nerve entering the greater sciatic foramen
C The sciatic nerve runs inferolateraly under the gluteus maximus muscle
D The sciatic nerve is the largest nerve in the body
A
Explanation
The sciatic nerve is the largest nerve in the body. It is a continuation of the sacral plexus. The sciatic nerve is the most lateral nerve entering the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels and the pudendal nerve. The sciatic nerve runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles. Due to its size, the sciatic nerve receives the sciatic artery, a branch of the inferior gluteal artery. It supplies no structures in the gluteal region. It supplies the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. All the articular branches to the joints are supplied by the sciatic nerve.
Not a great question. Remember, some of the questions are old and are unlikely to be repeated. However, it is important to keep all questions in the bank and use them as learning tools.
Which is true of the biceps femoral muscle?
A The main blood supply is form the inferior gluteal artery
B The long head of biceps femoris is innervated by the tibial division of the sciatic nerve
C Biceps femoris’s two head together with the semitendinosus and semimembranosus muscle form the hamstrings
D The hamstring’s proximal attachment is from the body of ischium
B
Explanation
The biceps femoral (BF) muscle consists of two heads- a long and short head. The long head together with the semitendinosus and semimembranosus muscle form the hamstring muscles. The hamstring muscles have a common nerve supply- the tibial division of the sciatic nerve, The short head of biceps is innervated by the fibular division of the sciatic nerve. The main blood supply is form the perforating branches of the profunda femoris artery. The upper part of the hamstrings are supplied by the inferior gluteal artery and the popliteal artery. The main action of the BF is flexion of the leg, lateral rotation of leg when the knee is flexed and extension of the thigh (e.g. when starting to walk). The hamstring muscle’s proximal attachment arises form the ischial tuberosity.
Extra:
For Clarity: Definition of Hamstring Muscle includes: (1) must cross the knee and insert below to either tibia or fibula (2) must attach to ischial tuberosity (short head does not fulfil this) (3) must flex the knee AND extend the hip (short head does not extend the hip) (4) must be innervated by the tibial nerve (which short head does not fulfil)
Which myotome causes big toe abduction?
A S2
B L5
C L3
D L4
B
Explanation
NOTE:
I am not sure of the answer. But it seems the closest
abductor hallucis is innervated by S2 S3 (medial plantar nerve) this muscle abducts and flexes great toe. So, I think the more appropriate answer should be S2.
Other thoughts: MTP and phalangeal dorsiflexion and plantarflexion Great toe used as example in diagram. L5S1 dorsiflexion; S1S2 plantarflexion The terms abduction and adduction of the toes are used with reference to an axis through the second toe. Thus, abduction of the big toe is a medial movement, away from the second toe as which occurs in dorsiflexion. Therefore L5,S1.
Extra from a user: agree with the initial explanation, don’t think the movement away from the second toe in dorsiflexion is in the right plane to count as abduction
Which is FALSE regarding the course of the sciatic nerve?
A The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles
B The sciatic nerve runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity
C It descends in posterior thigh deep to biceps femoris
D The sciatic nerve is the most medial nerve entering the greater sciatic foramen
D
Explanation
The sciatic nerve is the largest nerve in the body. It is a continuation of the sacral plexus. The sciatic nerve is the most lateral nerve entering the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels and the pudendal nerve. The sciatic nerve runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles. It descends in the posterior thigh deep to biceps femoris, bifurcates into tibial and common fibular nerves at the apex of popliteal fossa. Due to its size, the sciatic nerve receives the sciatic artery, a branch of the inferior gluteal artery. It supplies no structures in the gluteal region. It supplies the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. All the articular branches to the joints are supplied by the sciatic nerve.
What is true of the biceps femoris muscle?
A It is involved in flexion of the knee and hip joint
B Receives dual supply from tibia (long head) and common fibular (short head) part of sciatic nerve
C Distally the single tendon of biceps femoris muscle inserts into the upper end of the tibia
D Arterial supply is provided by the femoral artery
B
Explanation
The biceps femoris muscle has two heads of origin. Long head-arises from the ischial tuberosity in common with semitendinosus. Short head-has a long origin, from the whole length of the linea aspera and the upper part of the lateral supracondylar line of the femur. Note: the short head origin in the old prescribed TB says the whole length of the linea aspera and the upper part of the lateral supracondylar line of the femur. In the current TB it arises from the lateral lip of the inferior third of the linea aspera and supracondylar ridge of the femur. Distally the single tendon of biceps femoris muscle inserts into the head of the fibula
Biceps femoris receives dual supply from tibia (long head) and common fibular (short head) part of sciatic nerve.
The blood supply comes from the profunda femoris and its perforating branches
Actions: The hamstrings (thus including semimembranosus and semitendinosus) flex the knee joint and extend the hip joint. In the semiflexed knee the biceps femoris laterally rotates the knee and the semimembranosus and semitendinosus medially rotate it
Extra: The biceps femoris is innervation by which two nerves? (similar way to ask this question)
Which is CORRECT regarding the anatomy of the ankle joint?
A The lateral ligament reinforcing the ankle is a single ligament made up of three parts
B The tibia and fibula have single articulations with the talus
C The ankle is the most unstable in the dorsiflexion position
D The tibia flares outwards at both ends to provide an increased area for articulation and weight transfer.
D
Explanation
The distal ends of the tibia and fibular form a malleolar mortise into which the pulley shaped trochlea of the talus fits.
The joint formed is a hinge type synovial joint.
The medial surface of the lateral malleolus articulates with the lateral surface of the talus. The tibia articulates with the talus in two places. The tibia’s inferior surface forms the roof of the malleolar mortise and the tibia’s medial malleolus articulates with the medial surface of the talus. The tibia flares outwards at both ends to provide an increased area for articulation and weight transfer.
The ankle joint is quite unstable during plantarflexion because the trochlear is narrower posteriorly and, therefore lies loosely within the mortise. It is during plantar flexion that most ankle injures occur.
The ankle is reinforced by the lateral ligament of the ankle-made of three separate ligament (anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament) and medially by the medial ligament of the ankle (deltoid ligament)-made of four parts (tibionavicular part, tibiocalcaneal part, anterior and posterior tibiotalar parts)
Regarding the perforating veins of the lower limb, which is CORRECT?
A They do not add to the musculovenous pump of the lower limb
B They pierce the superficial and deep fascia of the lower limb
C They do not contain valves
D They ensure bloods flows from the superficial to the deep veins only
D
Explanation
The perforating veins penetrate the deep fascia and contain valves that allow blood to flow only from the superficial veins to the deep veins. They pass through the deep fascia at an oblique angle so that when muscles contract and the pressure increases inside the deep fascia, the perforating veins are compressed. Compression of the perforating veins also prevents blood from flowing from the deep to the superficial veins. This pattern of blood flow, from superficial to deep, is important for complete and proper venous retrun from the lower limb because it enables muscular contractions to propel blood towards the heart against the pull of gravity
Which of the following muscles is the main flexor of the thigh?
A Pectineus
B Quadriceps femoris
C Iliopsoas
D Iliacus
C
Explanation
Iliopsoas is the chief flexor of the thigh. It is the most powerful of the hip flexors with the longest range. Of the thigh flexors, it is the only muscle attached to the vertebral column, pelvis and femur. It is able to produce stability as well as movement.
The flexors of the hip joint: pectineus, iliopsoas, psoas minor, iliacus and sartorius
Note:
The iliopsoas refers to the joined psoas and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. As such, they are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter, and acts as the strongest flexor of the hip.
Clinical orientated anatomy refers to the muscle as one: iliopsoas- its broad lateral part (iliacus), and its long medial part (psoas major) arise from the iliac fossa and lumbar vertebrae respectively. Thus it is the only muscle attached to the vertebral column, pelvis and femur
What is the main nerve of the lateral compartment of the leg?
A Lateral fibular nerve
B Superficial fibular nerve
C Deep fibular nerve
D Common fibular nerve
B
Explanation
Superficial fibular nerve. It is a terminal branch of the common fibular nerve.
Deep fibular nerve - supplies anterior compartment of the leg
What is the function(s) of the lumbricals of the foot?
A Adduction of the lateral four toes
B Adduct digits and flex metatarsophalangeal joints
C Flexion of the lateral four toes
D Extension of middle and distal phalanges of the lateral four digits
D
Explanation
They are found in the second layer of the foot. They perform the following functions: flex proximal phalanges, extend middle and distal phalanges of the lateral four digits (toes)
Flexion of the lateral four toes=flexor digitorium brevis
Abduct digits (2-4) and flex metatarsophalangeal joints (MTPJs)=dorsal interossei
Adduct digits (3-5) and flex MTPJs= plantar interossei
In review of this question, I don’t think it is a great one. The answers semms to come form the table in CM textbook. However if you do a web search on the function of the foot lumbricals, you get the following answer:
By pulling the medial base of the proximal phalanx, the lumbrical muscles flex and adduct the toes at the metatarsophalangeal (MTP) joints. Conversely, by pulling the extensor expansions of the phalanges, the lumbricals extend the toes at the interphalangeal (IP) joints.
These actions of the lumbrical muscles provide a balancing function to the foot. Flexion and adduction at the MTP joints oppose the extension of the long and short extensor of the toes and prevent hyperextension of the toes during the propulsive phase of gait. The extension at IP joints prevents clawing during gait as it opposes to the flexion produced by the long and short flexors of the toes.
Source: kenhub.com
I would keep to the textbook’s answer, but I can see why it may be confusing everyone
Which muscles is not supplied by the tibial component of the sciatic nerve?
A Short head of biceps femoris
B The hamstring part of adductor magnus
C Semimembranosus
D Semitendinosus
A
Explanation
The tibial division of the sciatic nerve does not supply the short head of bicep femoris, but rather the long head. The common fibular division of the sciatic nerve supplies the short head of biceps femoris
Adductor magnus is the largest, most powerful, and most posterior muscle in the adductor group. It has an adductor part and a hamstring part. The adductor part is supplied by the obturator nerve and the hamstring part by the tibial component of the sciatic nerve
Which nerve root would be affected if there was numbness to the anterior lower leg and medial three toes?
A L3
B L5
C L4
D S1
B
Explanation
Looking at the dermatomal distribution of the lower limb in the prescribed textbook. Dermatome L5 would be responsible.
Which of the folllowing is FALSE regarding femoral hernias?
A Femoral hernias are small and do not enlarge as they are contained within the wall of the femoral canal
B A femoral hernia appears as a mass in the femoral triangle, inferolateral to the pubic tubercle
C The A femoral hernia is bounded by the femoral vein laterally and the lacunar ligament medially
D Femoral hernias are more common in females because of their wider pelvises.
A
Explanation
The femoral ring is a weak area in the anterior abdominal wall and is the usual site of the origin of a femoral hernia-a protrusion of abdominal viscera (often a loop of small intestine) through the femoral ring into the femoral canal. A femoral hernia appears as a mass, often tender, in the femoral triangle, inferolateral to the pubic tubercle. The hernia is bounded by the femoral vein laterally and the lacunar ligament medially. The hernia sac (although initially small and contained within the wall of the canal) can enlarge by passing inferiorly through the saphenous opening into the subcutaneous tissues of the thigh. Femoral hernias are more common in females because of their wider pelvises.
Which is true regarding venous drainage of the lower limb?
A The superficial veins have more valves than the deep veins
B Passage of flow in the deep veins of the lower limbs is: from the the deep veins to the popliteal vein to the femoral vein to the internal iliac vein
C The deep veins lie in the deep fascia
D The deep veins are contained within a vascular sheath with the artery, whose pulsations also help compress and move blood in the veins.
D
Explanation
The superficial veins are located in the subcutaneous tissue and the deep veins are located beneath (deep) to the deep fascia and accompany all major arteries. Superficial and deep veins have valves, which are more numerous in the deep veins. The two major superficial veins in the lower limb are the great and small saphenous veins. Perforating veins penetrate the deep fascia close to their origin from the superficial veins and contain valves that allow blood to flow only form the superficial veins to the deep ones. The deep veins are contained within a vascular sheath with the artery, whose pulsations also help compress and move blood in the veins. The anterior tibial vein (anterior leg) and the posterior tibial and fibular veins (formed by the medial and lateral plantar veins of the foot) are all deep veins. The three deep veins drain into the popliteal vein which becomes the femoral vein in the thigh. The femoral vein passes deep to the inguinal ligament to become the external iliac vein
A patient suffers a fracture of the femoral neck. Which of the following features of the fractures are false?
A Aseptic avascular necrosis of the femoral head is a common complication of a neck of femur fracture
B Most of the blood supply to the head and neck of the femur is via the medial circumflex femoral artery
C Fractures of the femoral neck results in medial rotation of the lower limb
D Femoral neck fractures (NOF) are common in people >60yrs old,
C
Explanation
Femoral neck fractures (NOF) are common in people >60yrs old, and more common in women (because they have weaker and more brittle bones at this age due to osteoporosis). Fractures of the femoral neck are often intracapsular. NOF fractures result in lateral rotation of the lower limb. Most of the blood supply to the head and neck of the femur is via the medial circumflex femoral artery and is disrupted by a NOF fracture. Following a NOF fracture, the artery to the ligament of the femoral head may be the only remaining artery which is often inadequate resulting in aseptic avascular necrosis of the femoral head
Which is true of the dorsalis pedis artery?
A The dorsali pedis artery runs superficial to the extensor retinaculum on the dorsum of the foot
B It begins above the malleoli and runs between extensor hallucis longus and extensor digitorium longus tendons on the dorsum of the foot
C The dorsalis pedis is a branch of the posterior tibial artery
D The dorsalis pedis forms part of (contributes to) the deep plantar arch
D
Explanation
The dorsalis pedis (DP) artery is a major source of blood supply to the forefoot. The DP is a direct continuation of the anterior tibial artery. The DP begins midway between the malleoli and runs anteromedially, deep to the inferior extensor retinaculum between the extensor halluces longus and the extensor digitorum longus tendons on the dorsum of the foot.
The DP passes to the first interosseous space, where it divides into the first metatarsal artery and a deep planter artery. The deep plantar artery joins the lateral plantar artery to form the DEEP PLANTAR ARCH.
Which of the following factors is the most important in stabilizing the patella?
A The forward prominence of the lateral femoral condyle
B The ligamentous tension of the medial patella retinaculum
C The lowest fibres of the vastus medialis
D The pull of the of the quadriceps muscles
C
Explanation
The patella is a sesamoid bone in the quadriceps tendon. The patellar ligament is vertical, but the pull of the of the quadriceps is oblique, in the line of the shaft of the femur, and when the muscle contracts it tends to draw the patella laterally.
Factors preventing lateral dislocation include: the forward prominence of the lateral femoral condyle, the ligamentous tension of the medial patella retinaculum and the lowest fibres of the vastus medialis. These fibres hold the patella medially when the quadriceps contracts and are indispensable to the stability of the patella
Following an urgent saphenous vein cut down, a patient complains of numbness to the medial border of the foot. Which of the following nerves has been compromised?
A Medial plantar nerve
B Sural nerve
C Saphenous nerve
D Tibial nerve
C
Explanation
The saphenous nerve accompanies the great saphenous vein anterior to the medial malleolus. It can be damaged during a venous cut down or by a ligature following closing of a surgical wound
Which of the knee bursae is the most likely to lead to a septic arthritis?
A Popliteus
B Gastrocnemius
C Anserine
D Suprapatellar
D
Explanation
There are about 12 bursa around the knee joint
Four bursae communicate with the synovial cavity of the knee joint.
Suprapatellar, popliteus, anserine and gastrocnemius bursa.
The large suprapatellar bursa is the most likely to lead to a septic joint infection. Although it develops separately for the knee joint, the bursa becomes continuous with it.
Which nerve supplies sensation to the dorsum of the foot, between the 1st and 2nd toes?
A Tibial nerve
B Deep fibular nerve
C Superficial fibular nerve
D Saphenous nerve
B
Explanation
The deep fibular nerve supplies sensation to the dorsal webspace between the 1st and 2nd toes.
The superficial fibular nerve supplies sensation to the remainder of the dorsum of the foot.
Branches of the tibial nerve, including the medial and lateral plantar nerves distally, and the medial calcaneal branches proximally, supply sensation to the plantar aspect of the foot.
The saphenous nerve supplies sensation to the medial aspect of the foot and lower leg.
Which myotome is responsible for plantar flexion of the ankle?
A L2-3
B L4-5
C L3-4
D S1-2
D
Explanation
Mytomes of ankle:
Dorsiflexion: L4-5
Plantarflexion: S1-2
Inversion L4-5
Eversion L5-S1
A patient is noted to have a drop in their contralateral, unsupported hip when standing on one leg. Injury to which nerve could be responsible for this deficit?
A Inferior gluteal nerve
B Femoral nerve
C Superior gluteal nerve
D Obturator nerve
C
Explanation
Trendelenburg gait is an abnormal gait resulting from defective hip abductor mechanism. Weakness of the gluteus medius and minimus muscles causes drooping of the pelvis of the contralateral side whilst walking. It can occur as a result of damage to the superior gluteal nerve.
A soccer player suffers an avulsion fracture of his anterior inferior iliac spine whist kicking a ball. Which muscle is likely to be affected?
A Sartorius
B Vastus lateralis
C Adductor longus
D Rectus femoris
D
Explanation
Structures attaching to the AIIS include the rectus femoris and the iliofemoral ligament.
Which best describes the location of a femoral hernia in relation to the pubic tubercle
A Inferior and medial
B Super and lateral
C Inferior and lateral
D Super and medial
C
Explanation
Femoral hernias are masses located in the femoral triangle, inferolateral to the pubic tubercle, They are bounded by the femoral vein laterally, and lacunar ligament medially. More common in females because of wider pelvis. Initially small, but can enlarge by passing inferiorly through the saphenous opening into subcut tissue of the thigh.
Which of the following is correct regarding femoral hernias?
A They are bounded laterally by the lacunar ligament and medially by the femoral vein
B They are located inferolaterally to the pubic tubercle
C They are more common in men
D They can descend into the scrotum
B
Explanation
Femoral hernias are masses located in the femoral triangle, inferolateral to the pubic tubercle, They are bounded by the femoral vein laterally, and lacunar ligament medially. More common in females because of wider pelvis. Initially small, but can enlarge by passing inferiorly through the saphenous opening into subcut tissue of the thigh.
An elderly lady suffers a subcapital neck of femur fracture. She is at risk of avascular necrosis of the femoral head. Injury to which artery is responsible for this disease?
A Medial circumflex artery
B Descending branch of superior gluteal artery
C Artery to head of femur
D Descending branch of inferior gluteal artery
A
Explanation
The blood supply to the neck and head of the femur is primarily via retinacular branches of the medical Cx artery, which is a branch of the profunda femoris artery. The obturator artery also gives some supply via the artery to the head of the femur.
What is the primary movement that occurs at the sub-talar joint?
A Flexion and extension
B Flexion and inversion
C Inversion and eversion
D Eversion and extension
C
Explanation
Inversion and eversion occur at the subtalar (talocalcaneal) and transverse tarsal (calcaneocuboid and talonavicular joints)
You are having difficulty obtaining venous accessing on a patient in a resuscitation situation and decide to perform a venous cutdown. The great saphenous vein is located relative to which structure in the lower limb?
A Anterior to the medial malleolus
B Anterior to the lateral malleolus
C Posterior to the medial malleolus
D Posterior to the lateral malleolus
A
Explanation
Structures running posterior to the medial malleolus include the tibialis posterior, FDL, posterior tibial artery and vein, tibial nerve, FHL tendon. The small saphenous vein ascends on the lateral side of the foot.
Contents (“Tom, Dick and A Very Nervous Harry”)
Tibialis posterior tendon
Flexor Digitorium longus tendon
Posterior tibial Artery
Posterior tibial Vein
Tibial Nerve
Flexor Hallucis longus tendon
Femoral nerve blocks are performed commonly in the emergency department. In the femoral triangle, the femoral nerve sits lateral to which structure?
A Femoral vein
B Deep lymph nodes
C Femoral artery
D Femoral canal
C
Explanation
The location of structures in the femoral triangle, from lateral to medial, is femoral nerve, artery, vein, empty space, and lymph nodes.
Extra:: acronym NAVEL helps: Nerve, Artery, Vein, empty space, and Lymph nodes
Which ligament prevents anterior rolling of the femur on the extended knee?
A Anterior cruciate ligament
B Medial collateral ligament
C Posterior cruciate ligament
D Lateral collateral ligament
C
Explanation
Functions of the PCL include: Limits anterior rolling of femur on tibial plateau during extension Prevents posterior displacement of tibia on femur Prevents hyperflexion of knee joint Main stabilising factor for femur in weight bearing knee
A patient develops infection on the medial aspect of his foot. Which group of lymph nodes will react?
A Superficial inguinal lymph nodes
B Popliteal lymph nodes
C Deep inguinal lymph nodes
D External iliac lymph nodes
A
Explanation
The medial superficial lymphatic vessels, larger and more numerous than the lateral ones, drain the medial side of the dorsum and sole of the foot. These vessels converge on the great saphenous vein and accompany it to the vertical group of superficial inguinal lymph nodes, and then to the deep inguinal lymph nodes.
What branch from the internal iliac supplies the psoas and quadratus lumborum?
A Iliolumbar artery
B Lateral sacral artery
C Internal pudendal artery
D Obturator artery
A
Explanation
Iliolumbar artery (posterior division of internal iliac artery) supplies psoas major, iliacus, quadratus lumborum, cauda equina in vertebral canal.
Internal iliac artery
[Anterior divisions]
Umbilical
Obturator - (ant branch) supplies obturator externus, pectineus, thigh adductors, and gracilis; (post branch) supplies muscles attached to ischial tuberosity
Inferior vesical
Artery to ductus deferens
Prostatic branches
Uterine
Vaginal
Internal pudendal - supplies external genitalia & perineal m.
Middle rectal
Inferior gluteal - supplies glut maximus, obturator internus, quat femoris and superior parts of hamstrings
[Posterior divisions]
Iliolumbar - supplies psoas and quad lumborum
Lateral sacral (superior and inferior)
Superior gluteal - (superficial) glut maximus, (deep) glut medius/ minimus and TFL
Following a fracture of a bone in the lower limb, you notice a patient has a high stepping gait. A fracture of which structure would most likely be responsible for this?
A Femur
B Mid-shaft fibula
C Proximal fibula
D Proximal tibia
C
Explanation
Because of its superficial position, the common fibular nerve is the nerve most often injured in the lower limb, mainly because it winds subcutaneously around the fibular neck, leaving it vulnerable to direct trauma. Severance of the common fibular nerve results in flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors of ankle and evertors of foot). The loss of dorsiflexion of the ankle causes footdrop, which is further exacerbated by unopposed inversion of the foot.
Therefore, patient has high-stepping gait secondary to foot drop indicating common fibular nerve injury – the fibular neck (proximal fibula) is most likely affected
Following infiltration around the knee with local anaesthetic, a patient reports weakness to eversion. Which nerve has most likely been affected?
A Posterior tibial nerve
B Saphenous nerve
C Superficial fibular nerve
D Sural nerve
C
Explanation
The superficial fibular nerve supplies the fibularis longus and brevis which both evert the foot and weakly plantar flex the ankle (fibularis tertius dorsiflex and ankles and aids in eversion of the foot).
Tibial nerve supplies posterior muscles of leg and knee joint.
Sural nerve supplies skin on posterior and lateral aspects of leg and lateral foot.
Saphenous nerve supplies skin on medial side of ankle and foot.
The biceps femoris is innervation by which two nerves
A Sciatic nerve (L5, S1, S2)
B Fibular division of sciatic nerve (L5, S1, S2)
C Tibial division of sciatic nerve (L5, S1, S2)
D Long head- fibular division and short head-tibial division of the sciatic nerve
A
Explanation
The long head of the biceps femoris is innervated by the tibial division of the sciatic nerve (L5, S1, S2). The short head of the biceps femoris is innervated by the common fibular division of the sciatic nerve (L5, S1, S2). The adductor magnus also has two innervations – the adductor part supplied by obturator nerve, and hamstring part supplied by tibial part of sciatic nerve.
Note: the sciatic nerve comprises both the tibial and fibular divisions. Therefore “2” nerves.
Shin splints is characterised by tenderness over the anterior distal tibia, following repeated trauma. Which muscle does this represent?
A Tibialis anterior
B Fibularis longus
C Extensor digitorum longus
D Extensor hallucis longus
A
Explanation
Shin splints—oedema and pain in the area of the distal two thirds of the tibia— result from repetitive microtrauma of the tibialis anterior, which causes small tears in the periosteum covering the shaft of the tibia and/or of fleshy attachments to the overlying deep fascia of the leg. Shin splints are a mild form of the anterior compartment syndrome. Shin splints commonly occur during traumatic injury or athletic overexertion of muscles in the anterior compartment, especially TA, by untrained persons. Often, persons who lead sedentary lives develop shin splints when they participate in long-distance walks.
The dermatome that typically involves the medial knee?
A L2
B L4
C L3
D L5
C
Explanation
L1 – inguinal region.
L2 – lateral thigh.
L3 – medial thigh/knee.
L4 – medial leg.
L5 – lateral leg/medial dorsum of foot.
S1 = lateral foot.
S2 = posterior thigh
