Lower Limb Flashcards by Donald Lester

A 42-year-old man is admitted to the emergency department after his automobile hit a tree. He is treated for a pelvic fracture and several deep lacerations. Physical examination reveals that dorsiflexion and inversion of the left foot and extension of the big toe are very weak. Sensation from the dorsum of the foot, skin of the sole, and the lateral aspect of the foot has been lost and the patellar reflex is normal. The foot is everted and plantar flexed. Which of the following structures is most likely injured?

A. The lumbosacral trunk at the linea terminalis
B. L5 and S1 spinal nerves torn at the intervertebral foramen
C. Fibular (peroneal) division of the sciatic nerve at the neck of the fibula
D. Sciatic nerve injury at the greater sciatic foramen (“doorway to the gluteal region”)
E. Tibial nerve in the popliteal fossa

A. The lumbosacral trunk at the linea terminalis

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A 23-year-old man is admitted to the emergency
department with a deep, bleeding stab wound of the pelvis. After the bleeding has been arrested, a magnetic resonance imaging (MRI) examination gives evidence that the right ventral primary ramus of L4 has been transected. Which of the following problems will most likely be seen during physical examination?

A. Reduction or loss of sensation from the medial aspect of the leg
B. Loss of the Achilles tendon reflex
C. Weakness of abduction of the thigh at the hip joint
D. Inability to evert the foot
E. Reduction or loss of sensation from the medial aspect of the leg and loss of Achilles tendon reflex

A. Reduction or loss of sensation from the medial aspect of the leg

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A 30-year-old man suffered a superior gluteal nerve injury in a motorcycle crash in which his right lower limb was caught beneath the bike. He is stabi- lized in the emergency department. Later he is exam- ined and he exhibits a waddling gait and a positive Trendelenburg sign. Which of the following would be the most likely physical finding in this patient?

A. Difficulty in standing from a sitting position
B. The left side of the pelvis droops or sags when he attempts to stand with his weight supported just by the right lower limb
C. The right side of the pelvis droops or sags when he attempts to stand with his weight supported just by the left lower limb
D. Weakened flexion of the right hip
E. Difficulty in sitting from a standing position

B. The left side of the pelvis droops or sags when he attempts to stand with his weight supported just by the right lower limb

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A 45-year-old man is treated at the hospital after he fell from his bicycle. Radiologic examination reveals fractures both of the tibia and the fibula. On physical examination the patient has a foot drop, but normal eversion (Fig. 5-1). Which of the following nerves is most likely injured?

A. Tibial
B. Common fibular (peroneal) 
C. Superficial fibular (peroneal)
D. Saphenous
E. Deep fibular (peroneal)

E. Deep fibular (peroneal)

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A 49-year-old male construction worker is admit- ted to the emergency department with a painful lump on the proximal medial aspect of his thigh. Radiologic and physical examinations reveal that the patient has a herniation of abdominal viscera beneath the inguinal ligament into the thigh. Through which of the following openings will a hernia of this type initially pass to extend from the abdomen into the thigh?

A. Femoral ring
B. Superficial inguinal ring 
C. Deep inguinal ring
D. Fossa ovalis
E. Obturator canal

A. Femoral ring

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A 37-year-old man is admitted to the hospital after an injury to his foot while playing flag football with friends on a Saturday morning. A series of radio- graphs demonstrates a fracture involving the talocrural (tibiotalar, ankle) joint. Which movements are the major ones to be affected by this injury?

A. Plantar flexion and dorsiflexion
B. Inversion and eversion
C. Plantar flexion, dorsiflexion, inversion, and eversion
D. Plantar flexion and inversion
E. Dorsiflexion and eversion

A. Plantar flexion and dorsiflexion

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After dividing the overlying superficial tissues and gluteal musculature in a 68-year-old female patient, the orthopedic surgeon carefully identified the underly- ing structures while performing a total hip arthroplasty. The key landmark in the gluteal region, relied upon in surgical explorations of this area, is provided by which of the following structures?

A. Gluteus medius
B. Obturator internus tendon 
C. Sciatic nerve
D. Piriformis muscle
E. Spine of the ischium

D. Piriformis muscle

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A 16-year-old boy received a superficial cut on the lateral side of his foot while playing football and is admitted to the emergency department where the wound is sutured. Four days later the patient returns to the hospital with high fever and swollen lymph nodes. Which group of nodes will first receive lymph from the infected wound?

A. Popliteal
B. Vertical group of superficial inguinal
C. Deep inguinal
D. Horizontal group of superficial inguinal
E. Internal iliac

A. Popliteal

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A 45-year-old man presents at the local emer- gency clinic with the complaint of a painful knee and difficulty in walking. A computed tomography (CT) scan examination reveals a very large cyst in the pop- liteal fossa compressing the tibial nerve. Which move- ment will most likely be affected?

A. Dorsiflexion of the foot 
B. Flexion of the thigh
C. Extension of the digits
D. Extension of the leg
E. Plantar flexion of the foot

E. Plantar flexion of the foot

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A 19-year-old football player was hit on the lateral side of his knee just as he put that foot on the ground. Unable to walk without assistance, he is taken to the hospital. An MRI examination reveals a torn medial collateral ligament. Which structure would most likely also be injured due to its attachment to this ligament?

A. Medial meniscus
B. Anterior cruciate ligament 
C. Lateral meniscus
D. Posterior cruciate ligament
E. Tendon of the semitendinosus

A. Medial meniscus

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A 49-year-old man underwent a coronary bypass graft procedure using the great saphenous vein. Post- operatively, the patient complains of pain and general lack of normal sensation on the medial surface of the leg and foot on the limb from which the graft was harvested. Which nerve was most likely injured during surgery?

A. Common fibular (peroneal) 
B. Superficial fibular (peroneal) 
C. Lateral sural
D. Saphenous 
E. Tibial

D. Saphenous

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A 22-year-old football player is admitted to the hospital with pain and swelling over the lateral aspect of the ankle. The emergency department doctor diag- noses an inversion sprain. Which ligament was most likely injured?

A. Plantar calcaneonavicular (spring) 
B. Calcaneofibular
C. Long plantar
D. Short plantar 
E. Deltoid

B. Calcaneofibular

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A 72-year-old woman is admitted to the hospital with a painful right foot. A CT scan examination reveals a thrombotic occlusion of the femoral artery in the proximal part of the adductor canal. Which artery will most likely provide blood supply to the leg through the genicular anastomosis?

A. Medial circumflex femoral
B. Descending branch of the lateral circumflex femoral
C. First perforating branch of the deep femoral
D. Inferior gluteal
E. Descending genicular branch of femoral

B. Descending branch of the lateral circumflex femoral

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A 75-year-old woman is admitted to the hospital after falling in her bathroom. Radiologic examination reveals an extracapsular fracture of the femoral neck. Which artery is most likely at risk for injury?

A. Inferior gluteal
B. First perforating branch of deep femoral
C. Medial circumflex femoral 
D. Obturator
E. Superior gluteal

C. Medial circumflex femoral

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A 56-year-old man with advanced bladder carcinoma suffers from difficulty while walking. Muscle testing reveals weakened adductors of the right thigh. Which nerve is most likely being compressed by the tumor to result in walking difficulty?

A. Femoral
B. Obturator
C. Common fibular (peroneal)
D. Tibial 
E. Sciatic

B. Obturator

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Upon removal of a knee-high leg cast, a 15-year- old boy complains of numbness of the dorsum of his right foot and inability to dorsiflex and evert his foot. Which is the most probable site of the nerve compression that resulted in these symptoms?

A. Popliteal fossa
B. Neck of the fibula
C. Lateral compartment of the leg
D. Anterior compartment of the leg 
E. Medial malleolus

B. Neck of the fibula

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A 32-year-old patient received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured a motor nerve in the area. Later, he had great difficulty rising to a standing position from a seated position. Which muscle was most likely affected by the injury?

A. Gluteus maximus 
B. Gluteus minimus 
C. Hamstrings
D. Iliopsoas
E. Obturator internus

A. Gluteus maximus

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During the preparation of an evening meal a female medical student dropped a sharp, slender kitchen knife. The blade pierced the first web space of her foot, resulting in numbness along adjacent sides of the first and second toes. Which nerve was most likely injured?

A. Saphenous
B. Deep fibular (peroneal)
C. Superficial fibular (peroneal)
D. Sural
E. Common fibular (peroneal)

B. Deep fibular (peroneal)

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Following an injury suffered in a soccer match, a 32-year-old woman is examined in a seated position in the orthopedic clinic. Holding the right tibia with both hands, the clinician can press the tibia backward under the distal part of her femur. The left tibia cannot be displaced in this way. Which structure was most likely damaged in the right knee?

A. Anterior cruciate ligament 
B. Lateral collateral ligament 
C. Medial collateral ligament
D. Medial meniscus
E. Posterior cruciate ligament

E. Posterior cruciate ligament

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A 22-year-old woman is admitted to the emer- gency department after another vehicle collided with the passenger side of the convertible in which she was riding. Radiologic examination reveals an avulsion frac- ture of the greater trochanter. Which of the following muscles would continue to function normally if such an injury was incurred?

A. Piriformis
B. Obturator internus 
C. Gluteus medius
D. Gluteus maximus 
E. Gluteus minimus

D. Gluteus maximus

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The news reported that the 58-year-old ambas- sador received a slashing wound to the medial thigh and died from exsanguination in less than 2 minutes. What was the most likely nature of his injury?

A. The femoral artery was cut at the inguinal ligament
B. A vessel or vessels were injured at the apex of the femoral triangle
C. The femoral vein was transected at its junction with the saphenous vein
D. The medial circumflex femoral was severed at its origin
E. The deep femoral artery was divided at its origin

B. A vessel or vessels were injured at the apex of the femoral triangle

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A 70-year-old woman suffered a hip dislocation when she fell down the steps to her garage. Which of the following is most significant in resisting hyperextension of the hip joint?

A. Pubofemoral ligament 
B. Ischiofemoral ligament 
C. Iliofemoral ligament
D. Negative pressure in the acetabular fossa 
E. Gluteus maximus muscle

C. Iliofemoral ligament

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A 75-year-old man is transported to the emer- gency department with severe pain of his right hip and thigh. A radiologic examination reveals avascular necrosis of the femoral head (Fig. 5-2). Which of the following conditions most likely occurred to produce avascular necrosis in this patient?

A. Dislocation of the hip with tearing of the ligament of the head of the femur
B. Intertrochanteric fracture of the femur
C. Intracapsular femoral neck fracture
D. Thrombosis of the obturator artery
E. Comminuted fracture of the extracapsular femoral neck

C. Intracapsular femoral neck fracture

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A 58-year-old male farmer was accidentally struck with a scythe (a long, curved cutting blade) by another worker while they were cutting wheat. He was admit- ted to the county hospital with severe bleeding. During physical examination the doctor noted that the patient had a foot drop; sensation was present over the dorsum of the foot and the skin of the posterior calf. Which of the following nerves was injured?

A. Femoral nerve
B. Sciatic nerve
C. Superficial fibular (peroneal) nerve
D. Deep fibular (peroneal) nerve
E. Common fibular (peroneal) nerve

D. Deep fibular (peroneal) nerve

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A 45-year-old man is admitted to the emergency department after experiencing a sharp pain while lifting a box of books. He told the physician that he “felt the pain in my backside, the back of my thigh, my leg, and the side of my foot.” During physical examination it is observed that his Achilles tendon jerk is weakened on the affected side. Which is the most likely cause of injury? ``` A. Disc lesion at L3-4 B. Disc lesion at L4-5 C. Disc lesion at L5-S1 D. Disc lesion at S1-2 E. Gluteal crush syndrome of the sciatic nerve or piriformis syndrome ```

C. Disc lesion at L5-S1

A 55-year-old woman is admitted to the emergency department after an automobile crash. Physical examination reveals that the patient’s foot is everted and she cannot invert it. A weakness in dorsiflexion and inversion of the foot is noted. Her ipsilateral patel- lar reflex is reduced in quality, although the Achilles tendon reflex is brisk. Knee extension is almost normal, as are all hip movements and knee flexion. Sensation is greatly reduced on the medial side of the leg. Which of the following nerves is most likely injured? ``` A. Femoral nerve B. L4 spinal nerve C. L4 and L5 spinal nerves D. Common fibular (peroneal) nerve E. Tibial nerve ```

B. L4 spinal nerve

A 46-year-old woman stepped on a broken wine bottle on the sidewalk and the sharp glass entered the posterior part of her foot. The patient was admitted to the hospital, and a physical examination concluded that her lateral plantar nerve had been transected (cut through). Which of the following conditions will most likely be confirmed by further physical examination? A. Loss of sensation over the plantar surface of the third toe B. Paralysis of the abductor hallucis C. Paralysis of the interossei and adductor hallucis D. Flexor hallucis brevis paralysis E. Flexor digitorum brevis paralysis

C. Paralysis of the interossei and adductor hallucis

A 22-year old male martial arts competitor was examined by the clinician because of pain and serious disability suffered from a kick to the side of his knee. Physical examination revealed a dark bruise just distal to the head of the fibula. Which of the following muscles will most likely be paralyzed? A. Tibialis anterior and extensor digitorum longus B. Tibialis posterior C. Soleus and gastrocnemius D. Plantaris and popliteus E. Flexor digitorum longus and flexor hallucis longus

A. Tibialis anterior and extensor digitorum longus

A 61-year-old female immigrant had been diag- nosed with spinal tuberculosis. The woman had devel- oped a fluctuant, red, tender bulge on one flank, with a similar bulge in the groin on the same side. This presentation is likely due to spread of disease process within the fascia of a muscle with which of the follow- ing actions at the hip? ``` A. Abduction B. Adduction C. Extension D. Flexion E. Internal rotation ```

D. Flexion

In an accident during cleanup of an old residential area of the city, the Achilles tendon of a 32-year-old worker was cut through by the blade of a brush cutter. The patient is admitted to the hospital and a laceration of the Achilles tendon is diagnosed. Which of the following bones serves as an insertion for the Achilles tendon? ``` A. Calcaneus B. Fibula C. Cuboid D. Talus E. Navicular ```

A. Calcaneus

A 27-year-old female tennis pro injured her ankle during the quarterfinal match. A physical examination at the outpatient clinic revealed a severe inversion sprain of the ankle. Which of the following structures is most commonly damaged in such injuries? ``` A. Medial plantar nerve B. Tibial nerve C. Anterior talofibular ligament D. Posterior talofibular ligament E. Deltoid ligament ```

C. Anterior talofibular ligament

A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiologic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What would be the most likely cause in this case? A. Tearing of the plantar calcaneonavicular (spring) ligament B. Fracture of the cuboid bone C. Interruption of the plantar aponeurosis D. Sprain of the anterior talofibular ligament E. Sprain of the deltoid ligament

A. Tearing of the plantar calcaneonavicular (spring) ligament

During a football game a 21-year-old wide receiver was illegally blocked by a linebacker, who threw himself against the posterolateral aspect of the runner’s left knee. As he lay on the ground, the wide receiver grasped his knee in obvious pain. Which of the following struc- tures is frequently subject to injury from this type of force against the knee? A. Fibular collateral ligament B. Anterior cruciate ligament C. Lateral meniscus and posterior cruciate ligament D. Fibular collateral and posterior cruciate ligament E. All the ligaments of the knee will be affected

B. Anterior cruciate ligament

Lower limb angiography of an 82-year-old woman reveals a possible cause for her limb pain during her workout routines in the health spa. The artery that was occluded is one that should have been demonstrable passing between the proximal part of the space between the tibia and fibula. Which of the following arteries is most likely affected? ``` A. Deep femoral B. Popliteal C. Posterior tibial D. Fibular (peroneal) E. Anterior tibial ```

E. Anterior tibial

A 43-year-old man visits the outpatient clinic with a painful, swollen knee joint. The patient’s history reveals chronic gonococcal arthritis. A knee aspiration is ordered for bacterial culture of the synovial fluid. A standard suprapatellar approach is used, and the needle passes from the lateral aspect of the thigh into the region immediately proximal to and deep to the patella. Through which of the following muscles would the needle pass? ``` A. Adductor magnus B. Short head of biceps femoris C. Rectus femoris D. Sartorius E. Vastus lateralis ```

E. Vastus lateralis

A 34-year-old male power lifter visits the outpa- tient clinic because he has difficulty walking. During physical examination it is observed that the patient has a problem unlocking the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged? ``` A. Biceps femoris B. Gastrocnemius C. Popliteus D. Semimembranosus E. Rectus femoris ```

C. Popliteus

A 32-year-old male basketball player comes down hard on his ankle. He is admitted to the outpatient clinic, and radiologic examination reveals a Pott’s frac- ture. What ligament is most likely injured? ``` A. Calcaneofibular ligament B. Deltoid ligament C. Spring ligament D. Plantar ligament E. Long plantar ligament ```

B. Deltoid ligament

A 23-year-old man is admitted to the emergency department with pain and cyanosis of his right lower limb. Doppler ultrasound studies reveal deficiency in development of his femoral artery, which appears to terminate midthigh. A thrombotic occlusion is seen in an unusual, rather tortuous, large vessel in the poste- rior compartment of the thigh, arising in the gluteal area and continuous inferiorly with a normal appearing popliteal artery. It is decided that a vascular graft should be placed from the femoral artery to the popli- teal artery. What is the identity of the aberrant artery? A. A large, fifth perforating branch of the femoral B. An sciatic branch of the inferior gluteal artery C. Descending branch of the medial circumflex femoral D. Descending branch of the superior gluteal artery E. An enlarged descending lateral circumflex femoral artery

B. An sciatic branch of the inferior gluteal artery

When he attempted to lift one side of his new electric automobile from the ground to demonstrate his strength, a 51-year-old man felt a sharp pain in his back and quickly dropped the vehicle. Upon examination, it is observed that the patient has deficits in sensation on the dorsum and sole of his foot and marked weakness in abduction and lateral rotation of the lower limb. What was the nature of his injury? ``` A. Piriformis syndrome, with entrapment of the sciatic nerve B. Disc lesion at L3-4 C. Disc lesion at L4-5 D. Disc lesion at L5-S1 E. Posterior hip dislocation ```

C. Disc lesion at L4-5

A 43-year-old woman is examined by a neurolo- gist, to whom she complains of pain in her lower limb of 6 months’ duration. She has pain in the gluteal area, thigh, and leg. The neurologist observes reduced sensa- tion over the dorsum and lateral side of the involved foot and some weakness in foot dorsiflexion and ever- sion. A diagnosis of a piriformis entrapment syndrome is made, with compression of the fibular (peroneal) division of the sciatic nerve. Which of the following conditions did the neurologist also most likely find during her physical examination of the patient? A. Paralysis of plantar flexion B. Instability of the knee, due to paralysis of the quadriceps femoris C. Foot drop D. Spasm or clonic contractures of the adductor musculature of the thigh E. Loss of sensation in the gluteal area, by paralysis of anterior cluneal nervesD. Spasm or clonic contractures of the adductor musculature of the thigh

C. Foot drop

Three years following a 62-year-old’s hip replace- ment, the man’s CT scans indicated that two of his larger hip muscles had been replaced by adipose tissue. The opinion is offered that his superior gluteal nerve could have been injured during the replacement proce- dure, and the muscles supplied by that nerve had atro- phied and been replaced by fat. Which of the following muscles receives its innervation from the superior gluteal nerve? ``` A. Tensor fasciae latae B. Rectus femoris C. Gluteus maximus D. Piriformis E. Quadratus femoris ```

A. Tensor fasciae latae

A popliteal arterial aneurysm can be very fragile, bursting with great loss of blood and the potential loss of the leg if it is not dealt with safely and effectively. In the 18th century, Dr. John Hunter (1728-1793) dis- covered that if a primary artery of the thigh is tempo- rarily compressed, blood flow in the popliteal artery can be reduced long enough to treat the aneurysm in the popliteal fossa surgically, with safety. What structure is indicated in Fig. 5-3 that is related to his surgical procedure? ``` A. Sartorius B. Femoral vein C. Femoral artery D. Gracilis E. Adductor brevis ```

B. Femoral vein

A 49-year-old male worker fell from a ladder, with his weight impacting on the heels of his feet. Radiologic examination reveals comminuted calcaneal fractures. After the injury the contraction of which one of the following muscles could most likely increase the pain in the injured foot? ``` A. Flexor digitorum profundus B. Gastrocnemius C. Tibialis posterior D. Tibialis anterior E. Fibularis (peroneus) longus ```

B. Gastrocnemius

A 24-year-old woman received a small-caliber bullet wound to the popliteal fossa from a drive-by assailant. The patient was admitted to the emergency department, where the surgeons recognized that the bullet had severed the tibial nerve. Such an injury would most likely result in which of the following? A. Inability to extend the leg at the knee B. Foot drop C. A dorsiflexed and everted foot D. A plantar flexed and inverted foot E. Total inability to flex the leg at the knee joint

C. A dorsiflexed and everted foot

An 82-year-old grandmother slipped on the pol- ished floor in her front hall and was transported to the emergency department and admitted for examination with a complaint of great pain in her right lower limb. During physical examination it is observed by the resi- dent that the right lower limb is laterally rotated and noticeably shorter than her left limb. Radiologic exami- nation reveals an intracapsular fracture of the femoral neck. Which of the following arteries supplies the head of the femur in early childhood but no longer in a patient of this age? ``` A. Superior gluteal B. Lateral circumflex femoral C. A branch of the obturator artery D. Inferior gluteal E. Internal pudendal ```

C. A branch of the obturator artery

A 19-year-old patient is admitted to the orthope- dic service with a complaint of severe pain in his very swollen and discolored foot. He states that he hurt the foot when jumping from his girlfriend’s bedroom window to the concrete driveway below. Plain film radiographic studies reveal that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What would be the most likely, serious problem in such a case? A. Tearing of the plantar calcaneonavicular (spring) ligament B. Fracture of the cuboid bone C. Interruption of the plantar aponeurosis D. Sprain of the anterior talofibular ligament E. Disruption of the distal tibiofibular ligament

A. Tearing of the plantar calcaneonavicular (spring) ligament

A 24-year-old male police officer is examined in a neighborhood clinic, with a complaint of discomfort in the lateral thigh. The physician observes that the policeman is rather overweight and that he is wearing a heavy leather belt, to which numerous objects are attached, including his empty holster. After a thorough physical examination a diagnosis of meralgia pares- thetica is confirmed. Which of the following nerves is most likely involved? ``` A. Superior gluteal B. Femoral C. Obturator D. Fibular (peroneal) division of sciatic E. Lateral femoral cutaneous ```

E. Lateral femoral cutaneous

The swollen and painful left foot of a 23-year-old female long distance runner is examined in the univer- sity orthopedic clinic. She states that she stepped on an unseen sharp object while running through the park several days earlier. Emergency surgery is ordered to deal with her tarsal tunnel syndrome. The tarsal tunnel is occupied normally by tendons, vessels, and nerves that pass beneath a very strong band of tissue (flexor retinaculum) on the medial side of the ankle. What is the most anterior of the structures that pass through this tunnel? ``` A. Flexor hallucis longus tendon B. Plantaris tendon C. Tibialis anterior tendon D. Tibialis posterior tendon E. Tibial nerve ```

D. Tibialis posterior tendon

A 42-year-old male sign painter is admitted to the emergency department after falling to the sidewalk from his ladder. Radiologic examination reveals a fracture of the proximal femur. Which of the following arteries supplies the proximal part of the femur? ``` A. Deep circumflex iliac B. Acetabular branch of obturator C. Lateral circumflex femoral D. A branch of profunda femoris E. Medial circumflex femoral ```

D. A branch of profunda femoris

A 22-year-old man is admitted to the emergency department after falling from his bicycle. Radiologic examination reveals a fracture of the tibia above the ankle. MRI and physical examination reveal that the tibial nerve is severed on the posterior aspect of the tibia. Which of the following signs will most likely be present during physical examination? A. Sensory loss of the dorsum of the foot B. Sensory loss on the sole of the foot C. Foot drop D. Paralysis of the extensor digitorum brevis E. Sensory loss of the entire foot

B. Sensory loss on the sole of the foot

A 24-year-old man is admitted to the emergency department after a car collision. Radiologic examina- tion reveals a fracture at the junction of the middle and lower thirds of the femur. An MRI examination provides evidence that the popliteal vessels were injured when the distal fragment of the fracture was pulled posteri- orly. Which of the following muscles is most likely to displace the distal fracture fragment? ``` A. Soleus B. Gastrocnemius C. Semitendinosus D. Gracilis E. Tibialis anterior ```

B. Gastrocnemius

A 65-year-old man is admitted to the hospital after falling from his roof while cleaning leaves and pine needles from the gutters. Among other injuries suffered in his fall, radiologic examination reveals a fracture of the talus bone in one foot. Much of the blood supply of this bone can be lost in such an injury and can result in osteonecrosis. From what artery does this bone receive its primary vascular supply? ``` A. Medial plantar B. Lateral plantar C. Dorsalis pedis D. Anterior tibial E. Posterior tibial ```

E. Posterior tibial

A 58-year-old female dancer presented to the orthopedic clinic with a complaint of pain during her work because of bilateral bunions. She was referred to a podiatric surgeon who scheduled her for surgery. The protruding bony and soft tissues of the toe were excised, and a muscle was reflected from the lateral side of the proximal phalanx, together with a sesamoid bone, upon which the muscle also inserted. What muscle was this? ``` A. Adductor hallucis B. Abductor hallucis C. First dorsal interosseous D. First lumbrical E. Quadratus plantae ```

A. Adductor hallucis

A 34-year-old male long-distance runner com- plained to the team physician of swelling and pain of his shin. Skin testing in a physical examination showed normal cutaneous sensation of the leg. Muscular strength tests showed marked weakness of dorsiflexion and impaired inversion of the foot. Which nerve serves the muscles involved in the painful swelling? ``` A. Common fibular (peroneal) B. Deep fibular (peroneal) C. Sciatic D. Superficial fibular (peroneal) E. Tibial ```

B. Deep fibular (peroneal)

A 7-year-old girl accidentally stepped on a sharp snail shell while walking to the beach. She was admit- ted to the hospital, where she received a tetanus shot, and the wound was cleaned thoroughly and sutured. One week later, during a return visit to her physician, it is seen that she has great difficulty in flexing her big toe, even though there is no inflammation present in the sole of the foot. Which nerve was most likely damaged by the piercing of the shell? ``` A. Lateral plantar nerve B. Medial plantar nerve C. Sural nerve D. Superficial fibular (peroneal) nerve E. Deep fibular (peroneal) nerve ```

B. Medial plantar nerve

A 49-year-old man is admitted to the emergency department with a cold and pale foot. Physical exami- nation reveals that the patient suffers from peripheral vascular disease; duplex ultrasound studies indicate possible occlusion of his popliteal artery, and the pulse of the posterior tibial artery is absent. What is the most common location for palpation of the pulse of the pos- terior tibial artery? A. Lateral to the muscular belly of the abductor hallucis B. Posteroinferior to the medial femoral condyle C. Groove midway between the lateral malleolus and the calcaneus D. Groove midway between the medial malleolus and the calcaneus E. Medially, between the two heads of the gastrocnemius

D. Groove midway between the medial malleolus and the calcaneus

Young parents were concerned that their 14-month- old daughter had not yet begun walking. Their pediatri- cian reassured them, saying that one of the muscles of the leg, the fibularis (peroneus) tertius, had to complete its central neurologic development before the child could lift the outer corner of the foot and walk without stumbling over her toes. What is the most common nerve supply of this muscle? ``` A. Sural B. Lateral plantar C. Deep fibular (peroneal) D. Superficial fibular (peroneal) E. Tibial ```

C. Deep fibular (peroneal)

A 22-year-old woman is admitted with high fever and vaginal discharge. Physical and laboratory exami- nations reveal gonorrheal infection. A series of intra- muscular antibiotic injections are ordered. Into which of the following parts of the gluteal region should the antibiotic be injected to avoid nerve injury? A. Anterior and superior to a line between the posterior superior iliac spine and the greater trochanter B. In the middle of a line between the anterior superior iliac spine and the ischial tuberosity C. Inferolateral to a line between the posterior superior iliac spine and the greater trochanter D. Inferomedial to a line between the posterior superior iliac spine and the greater trochanter E. Halfway between the iliac tuberosity and the greater trochanter

A. Anterior and superior to a line between the posterior superior iliac spine and the greater trochanter

A 45-year-old intoxicated man was struck by a tour bus while walking in the middle of the street. The man was admitted to the emergency department and during physical examination was diagnosed with “adductor gait,” in which an individual crosses one limb in front of the other, due to powerful hip adduction. Which of the following nerves was most likely involved in this condition? ``` A. Tibial B. Obturator C. Inferior gluteal D. Superior gluteal E. Femoral ```

B. Obturator

The baby was quite large, and the pelvis of the mother-to-be was somewhat narrow, causing her con- siderable difficulty and pain during the delivery. At her specific request, it was decided to inject local anesthetic into the perineum. The genitofemoral and ilioinguinal nerves were infiltrated anteriorly, and a deep injection was made medial to the ischial tuberosity to anesthe- tize the pudendal nerve, which supplies much of the perineum in most cases. A few minutes later, it became very obvious to those in attendance that the injection had not been effective enough in the central and pos- terior parts of the perineum. A separate injection was therefore inserted lateral to the ischial tuberosity. What other nerve(s) can provide much of the sensory supply to the perineum in some individuals? ``` A. Posterior femoral cutaneous B. Inferior cluneal nerves C. Iliohypogastric nerve D. Inferior gluteal nerve E. Middle cluneal nerves ```

A. Posterior femoral cutaneous

A 55-year-old man is admitted to the hospital for an iliofemoral bypass. The operation is performed suc- cessfully and the blood flow between the iliac and femoral arteries is restored. During rehabilitation which of the following arteries should be palpated to monitor good circulation of the lower limb? ``` A. Anterior tibial B. Deep fibular (peroneal) C. Deep plantar D. Dorsalis pedis E. Dorsal metatarsal ```

D. Dorsalis pedis

A 55-year-old woman is bitten by a dog in the dorsum of the foot and is admitted to the emergency department. The wound is cleaned thoroughly, during which it is seen that no tendons have been cut, but the dorsalis pedis artery and the accompanying nerve have been injured. Which of the following conditions would be expected during physical examination? ``` A. Clubfoot B. Foot drop C. Inability to extend the big toe D. Numbness between the first and second toes E. Weakness in inversion of the foot ```

D. Numbness between the first and second toes

A 31-year-old woman presents to the department of surgery with a complaint of facial paralysis (Bell’s palsy), which had appeared a year earlier and had resulted in paralysis of muscles of one side of her face. The chief of plastic surgery recommends a nerve graft, taking a cutaneous nerve from the lower limb to replace the defective facial nerve. The surgery is successful. Six months after the procedure, there is restoration of func- tion of previously paralyzed facial muscles. There is an area of skin on the back of the leg laterally and also on the lateral side of the foot that has no sensation. What nerve was used in the grafting procedure? ``` A. Superficial fibular (peroneal) B. Tibial C. Common fibular (peroneal) D. Sural E. Saphenous ```

D. Sural

A 10-year-old girl is admitted to the emergency department after falling from a tree in which she was playing with her friends. Radiologic and physical exam- inations reveal Osgood-Schlatter disease (Fig. 5-4). Which of the following bony structures is chiefly affected? ``` A. Medial condyle of tibia B. Posterior intercondylar area C. Intercondylar eminence D. Tibial tuberosity E. Anterolateral tibial tubercle (Gerdy’s tubercle) ```

D. Tibial tuberosity

An 81-year-old man is admitted to the emergency department with severe pain in his knees. The patient has a long history of osteoarthritis. Radiologic examina- tion reveals degeneration of the joints of his lower limbs. The degeneration is more severe on the medial side of the knees, which causes his knees to be bowed outward when he stands upright. Which of the following terms best describes the condition of his knees? ``` A. Genu varus B. Genu valgus C. Coxa varus D. Coxa valgus E. Hallux valgus ```

A. Genu varus

The patellar reflex appears to be markedly reduced in a 33-year-old diabetic female patient, due to deficient vascular supply of the nerves of her lower limb. The tendon of which of the following muscles is stretched during the patellar reflex? ``` A. Quadriceps femoris B. Quadratus femoris C. Sartorius D. Pectineus E. Biceps femoris ```

A. Quadriceps femoris

A 52-year-old woman is admitted to the emer- gency department after severely injuring her right lower limb when she fell from a trampoline. Radiologic exam- ination reveals a trimalleolar fracture of the ankle involving the lateral malleolus, medial malleolus, and the posterior process of the tibia. Which of the follow- ing bones will also most likely be affected? ``` A. Navicular B. Calcaneus C. Cuneiform D. Cuboid E. Talus ```

E. Talus

A 72-year-old man visits the outpatient clinic with a complaint of severe pain when walking. Physical examination reveals the problems in his feet as shown in Fig. 5-5. What is the most likely diagnosis? ``` A. Coxa varus B. Coxa valgus C. Genu valgus D. Genu vara E. Hallux valgus ```

E. Hallux valgus

A 63-year-old woman visits the outpatient orthopedic clinic with the complaint of pain in herexaminations give evidence of constant extension at the metatarsophalangeal joints, hyperflexion at the proximal interphalangeal joints, and extension of distal interphalangeal joints (Fig. 5-6). Which of the following terms is most accurate to describe the signs of physical examination? ``` A. Pes planus B. Pes cavus C. Hammertoes D. Claw toes E. Hallux valgusl ```

C. Hammertoes

A 58-year-old man is admitted to the hospital with pain in his lower limb for the past 2 months. Physical examination reveals point tenderness in the region of his greater sciatic foramen, with pain radiating down the posterior aspect of his thigh. An MRI examination reveals that the patient suffers from piriformis entrap- ment syndrome. He is directed to treatment by a physi- cal therapist for stretching and relaxation of the muscle. Entrapment of which of the following nerves can mimic piriformis entrapment syndrome? ``` A. L4 B. L5 C. S1 D. S2 E. S3 ```

C. S1

A 22-year-old woman is found in a comatose condition, having lain for an unknown length of time on the tile floor of the courtyard. She is found in pos- session of cocaine. The patient is transported to the hospital while EMT personnel receive instructions for treatment of drug overdose. During the physical exami- nation the patient’s gluteal region shows signs of ischemia. After regaining consciousness, she exhibits paralysis of knee flexion and dorsal and plantar flexion and sensory loss in the limb. What is the most likely diagnosis? ``` A. Tibial nerve loss B. S1-2 nerve compression C. Gluteal crush injury D. Piriformis entrapment syndrome E. Femoral nerve entrapment ```

C. Gluteal crush injury

A 75-year-old man is admitted to the emergency department with severe pain at his right hip and thigh. An MRI examination reveals avascular necrosis of the femoral head (Fig. 5-7). Which of the following arteriesis most likely injured, resulting in avascular necrosis? A. Deep circumflex iliac B. Acetabular branch of obturator C. Descending branch of lateral circumflex femoral D. First perforating branch of profunda femoris E. Ascending branch of medial circumflex femoral

E. Ascending branch of medial circumflex femoral

A 27-year-old woman had suffered a penetrating injury in the popliteal region by an object thrown from a riding lawnmower. She was admitted to the emer- gency department for removal of the foreign object. After making a midline incision in the skin of the pop- liteal fossa, the surgical resident observed a vein of moderate size in the superficial tissues. What vein would be expected at this location? ``` A. Popliteal vein B. Perforating tributary to the deep femoral vein C. Great saphenous vein D. Lesser (short) saphenous vein E. Superior medial genicular vein ```

D. Lesser (short) saphenous vein

A 58-year-old diabetic patient is admitted to the hospital with a painful foot. Physical examination reveals that the patient suffers from peripheral vascular disease. There is no detectable dorsalis pedis arterial pulse, but the posterior tibial pulse is strong. Which of the following arteries will most likely provide adequate collateral supply from the plantar surface to the toes and dorsum of the foot? ``` A. Anterior tibial B. Fibular (peroneal) C. Arcuate D. Medial plantar E. Lateral plantar ```

E. Lateral plantar

A 32-year-old man is admitted to the emergency department after an injury to his foot while playing football with his college friends. An MRI examination reveals multiple tendinous tears (Fig. 5-8). Which of the following bones is associated with the muscle tears? ``` A. Navicular B. Cuboid C. Calcaneus D. Sustentaculum tali E. Talus ```

Calcaneus

An 18-year-old professional tennis player fell when she leaped for an overhead shot and landed with her foot inverted. Radiologic examination in the hospi- tal revealed an avulsion fracture of the tuberosity of the fifth metatarsal. Part of the tuberosity is pulled off, producing pain and edema. Which of the following muscles is pulling on the fractured fragment? ``` A. Fibularis (peroneus) longus B. Tibialis posterior C. Fibularis (peroneus) brevis D. Extensor digitorum brevis E. Adductor hallucis ```

C. Fibularis (peroneus) brevis

A 58-year-old female employee of a houseclean- ing business visits the outpatient clinic with a com- plaint of a constant burning pain in her knees. Clinical examinations reveal a “housemaid’s knee” condition (Fig. 5-9). Which of the following structures is most likely affected? ``` A. Prepatellar bursa B. Infrapatellar bursa C. Posterior cruciate ligament D. Patellar retinacula E. Lateral meniscus ```

A. Prepatellar bursa

A 42-year-old mother of three children visits the outpatient clinic complaining that her youngest son cannot walk yet even though he is 4 years old. Radio- logic and physical examinations reveal an unstable hip joint. Which of the following ligaments is responsible for stabilization of the hip joint in childhood? ``` A. Iliofemoral B. Pubofemoral C. Ischiofemoral D. Ligament of the head of the femur E. Transverse acetabular ligament ```

D. Ligament of the head of the femur

A 45-year-old is admitted to the hospital after his left leg impacted a fence post when he was thrown from a powerful four-wheel all-terrain vehicle. Radio- logic examination reveals posterior displacement of the tibia upon the femur. Which of the following structures was most likely injured? ``` A. Anterior cruciate ligament B. Posterior cruciate ligament C. Lateral collateral ligament D. Lateral meniscus ligament E. Patellar ligament ```

B. Posterior cruciate ligament

A 55-year-old man visits the outpatient clinic complaining that he cannot walk more than 5 minutes without feeling severe pain in his feet. An image of the feet of this patient is shown in Fig. 5-10. What is the most common cause of this condition? A. Collapse of medial longitudinal arch, with eversion and abduction of the forefoot B. Exaggerated height of the medial longitudinal arch of the foot C. Collapse of long plantar ligament D. Collapse of deltoid ligament E. Collapse of plantar calcaneonavicular ligament

A. Collapse of medial longitudinal arch, with eversion and abduction of the forefoot

A 55-year-old cowboy is admitted to the emer- gency department after he was knocked from his feet by a young longhorn steer. MRI examination reveals a large hematoma in the knee joint. Physical examination reveals that the patient suffers from the “unhappy triad” (of O’Donoghue). Which of the following struc- tures are involved in such an injury? A. Medial collateral ligament, medial meniscus, and anterior cruciate ligament B. Lateral collateral ligament, lateral meniscus, and posterior cruciate ligament C. Medial collateral ligament, lateral meniscus, and anterior cruciate ligament D. Lateral collateral ligament, medial meniscus, and anterior cruciate ligament E. Medial collateral ligament, medial meniscus, and posterior cruciate ligament

A. Medial collateral ligament, medial meniscus, and anterior cruciate ligament

A 32-year-old man is admitted to the emergency department after a car collision. Radiologic examina- tion reveals a distal fracture of the femur. The patient is in severe pain, and a femoral nerve block is admin- istered. What landmark is accurate for localizing the nerve for injection of anesthetics? A. 1.5 cm superolateral to the pubic tubercle B. 1.5 cm medial to the anterior superior iliac spine C. 1.5 cm lateral to the femoral pulse D. 1.5 cm medial to the femoral pulse E. Midway between the anterior superior iliac spine and pubic symphysis

C. 1.5 cm lateral to the femoral pulse

A 39-year-old woman is admitted to the emergency department with a painful foot. Radiologic examination reveals a Morton’s neuroma. What is the most typical location of this neuroma? A. Between the third and fourth metatarsophalangeal joints B. Between the second and third metatarsophalangeal joints C. Between the first and second metatarsophalangeal joints D. Between the fourth and fifth metatarsophalangeal joints E. In the region of the second, third, and fourth metatarsophalangeal joints

A. Between the third and fourth metatarsophalangeal joints

A 34-year-old male distance runner visits the out- patient clinic with a complaint of pain he has suffered in his foot for the past week. The clinical examination indicates that the patient has an inflammation of the tough band of tissue stretching from the calcaneus tothe ball of the foot. Which of the following conditions is most characteristic of these symptoms? ``` A. Morton’s neuroma B. Ankle eversion sprain C. Tarsal tunnel syndrome D. Plantar fasciitis E. Inversion sprain of the ankle ```

D. Plantar fasciitis

A 5-month-old baby boy is admitted to the pedi- atric orthopedic clinic. During physical examination it is noted that the baby has inversion and adduction of the forefoot relative to the hindfoot and plantar flexion. Which of the following terms is diagnostic for the signs observed on physical examination? ``` A. Coxa vara B. Talipes equinovarus C. Hallux valgus D. Hallux varus E. Plantar fasciitis ```

B. Talipes equinovarus

A 71-year-old man is admitted to the orthopedic clinic with difficulties walking. The patient has a past history of polio. Physical and radiologic examinations reveal extension at the metatarsophalangeal joints with flexion of both the proximal and distal interphalangeal joints. Which of the following descriptions is most appropriate for this patient’s condition? ``` A. Hallux valgus B. Pes planus C. Hammertoes D. Claw toes E. Pes cavus ```

D. Claw toes

A 62-year-old man is admitted to the emergency department. Radiologic examination and the available data indicate the likelihood of a transient ischemic attack. During physical examination the ankle jerk reflex is absent. Which of the following nerves is most likely responsible for the reflex arc? ``` A. Common fibular (peroneal) B. Superficial fibular (peroneal) C. Deep fibular (peroneal) D. Tibial E. Superficial and deep fibular (peroneal) ```

D. Tibial

Following the insertion of a prosthetic hip joint in a 72-year-old man, it was observed that the patient had greatly diminished sensation in the region of distribu- tion of the posterior femoral cutaneous nerve. Which of the following is characteristic of this nerve? A. Cutaneous supply of the superior aspect of the gluteal region B. Arises from sacral spinal nerve levels S1, S2, S3 C. Motor innervation of the obturator internus and gemelli muscles D. Injury results in meralgia paresthetica E. Provides origin of the sural nerve

B. Arises from sacral spinal nerve levels S1, S2, S3

A 34-year-old woman has a direct blow to the patella by the dashboard of the vehicle during an automobile crash. The woman is admitted to the emergency department and radiologic examination reveals patellofemoral syndrome. This type of syndrome is characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening by physical rehabilitation to prevent future dislocation of the patella? ``` A. Vastus lateralis B. Vastus medialis C. Vastus intermedius D. Rectus femoris E. Patellar ligament ```

B. Vastus medialis

A 34-year-old man visits the outpatient clinic for an annual checkup. A radiographic examination of his knees is shown in Fig. 5-11. Physical examination reveals no pathology or pain to his knees. The patient has no past history of any knee problems. What is the most likely diagnosis? ``` A. Enlarged prepatellar bursa B. Osgood-Schlatter disease C. Normal intercondylar eminence D. Bipartite patella E. Injury to lateral meniscus ```

D. Bipartite patella

A 48-year-old woman is admitted to the hospital with severe abdominal pain. Several imaging methods reveal that the patient suffers from intestinal ischemia. An abdominopelvic catheterization is ordered for ante- grade angiography. A femoral puncture is performed. What is the landmark for femoral artery puncture? ``` A. Halfway between anterior superior iliac spine and pubic symphysis B. 4.5 cm lateral to the pubic tubercle C. Midpoint of the inguinal skin crease D. Medial aspect of femoral head E. Lateral to the fossa ovalis ```

D. Medial aspect of femoral head

A 23-year-old man is admitted to the emergency department after injuring his knee while playing foot- ball. During physical examination there is pain and swelling of the knee, in addition to locking of the knee in full extension. Radiologic examination reveals a bucket handle meniscal tear (Fig. 5-12). Which of the following ligaments is most likely injured? ``` A. Posterior cruciate B. Medial collateral C. Lateral collateral D. Anterior cruciate E. Coronary ```

D. Anterior cruciate

A 27-year-old male triathlon competitor com- plained that he frequently experienced deep pains in one calf that almost caused him to drop out of a regional track-and-field event. Doppler ultrasound studies indi- cated, and surgical exposure confirmed, the existence of an accessory portion of the medial head of the gas- trocnemius that was constricting the popliteal artery. Above the medial head of the gastrocnemius, the superior medial border of the popliteal fossa could be seen. Which of the following structures forms this border? ``` A. Tendon of biceps femoris B. Tendons of semitendinosus and semimembranosus C. Tendon of plantaris D. Adductor hiatus E. Popliteus ```

B. Tendons of semitendinosus and semimembranosus

The neurosurgeon had removed a portion of the dense tissue (dura mater) covering the brain of the patient when she removed the tumor that had invaded the skull. To replace this important tissue covering of the brain, she took a band of the aponeurotic tissue of the lateral aspect of the thigh, covering the vastus lateralis muscle. What muscle, supplied by the inferior gluteal nerve, inserts into this band of dense tissue as part of its insertion? ``` A. Gluteus medius B. Gluteus minimus C. Gluteus maximus D. Tensor fasciae latae E. Rectus femoris ```

C. Gluteus maximus

In the radiographs of the knee of a male 28-year- old basketball player, who had apparently suffered a tear in a medial ligament of the knee, the tubercle on the superior aspect of the medial femoral condyle could be seen more clearly than in most individuals. What muscle attaches to this tubercle? ``` A. Semimembranosus B. Gracilis C. Popliteus D. Adductor magnus E. Vastus medialis ```

D. Adductor magnus

In preparing to isolate the proximal portion of the femoral artery, the vascular surgeon gently sepa- rated it from surrounding tissues. Posterior to the femo- ral sheath, what muscle forms the lateral portion of the floor of the femoral triangle? ``` A. Adductor longus B. Iliopsoas C. Sartorius D. Pectineus E. Rectus femoris ```

B. Iliopsoas

A 37-year-old woman had been suffering for months from piriformis entrapment syndrome, which was not relieved by physical therapy. Part of the sciatic nerve passed through the piriformis, and a decision was made for surgical resection of the muscle. When the area of entrapment was identified and cleared, a tendon could be seen emerging through the lesser sciatic foramen, at first hidden by two smaller muscles and several nerves and vessels destined for the region of the perineum. The tendons of which of the following muscles pass through this opening? ``` A. Obturator internus B. Obturator externus C. Quadratus femoris D. Gluteus minimus E. Gluteus medius ```

A. Obturator internus

A 67-year-old woman has been suffering from osteoporosis for the past year. During her annual check- up, radiologic examination reveals an angle of 160 degrees made by the axis of the femoral neck to the axis of the femoral shaft. Which of the following conditions is associated with these examination findings? ``` A. Coxa vara B. Coxa valga C. Genu valgum D. Genu varum E. Hallux valgus ```

B. Coxa valga

A 34-year-old male runner visits the outpatient clinic complaining of pain in his foot for the past week. Physical examination reveals inflammation of the tough band of tissue stretching from the calcaneus to the ball of the foot. Which of the following conditions is characteristic of these symptoms? ``` A. Pott’s fracture B. Dupuytren fracture C. Tarsal tunnel D. Plantar fasciitis E. Rupture of spring ligament ```

D. Plantar fasciitis

A 50-year-old man is admitted to the emergency department after a car crash. An MRI examination reveals an injured anterior cruciate ligament. Physical examination reveals a positive drawer sign. Which of the following signs is expected to be present during physical examination? A. The tibia can be slightly displaced anteriorly B. The tibia can be slightly displaced posteriorly C. The fibula can be slightly displaced posteriorly D. The fibula can be slightly displaced anteriorly E. The tibia and fibula can be slightly displaced anteriorly

A. The tibia can be slightly displaced anteriorly

A 23-year-old male basketball player injured his foot during training and is admitted to the emergency department. An MRI examination reveals a hematoma around the medial malleolus. Upon physical examina- tion the patient shows excessive eversion of his foot. Which of the following ligaments most likely has a tear? ``` A. Plantar calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid ```

E. Deltoid

A 5-year-old boy is admitted to the emergency department after a car collision. Radiologic examina- tion reveals a fracture of the head of the femur. An MRI examination reveals a large hematoma. Which of the following arteries is most likely injured? A. Deep circumflex iliac B. Acetabular branch of obturator C. Descendingbranchoflateralcircumflexfemoral D. Medial circumflex femoral E. Radicular branches of circumflex artery

B. Acetabular branch of obturator

A 72-year-old woman is admitted to the emer- gency department after an episode of stroke. During neurologic examination the patient shows no response to the ankle reflex test. Which of the following nerve roots is responsible for this reflex? ``` A. L2 B. L3 C. L4 D. L5 E. S1 ```

E. S1

A 20-year-old man visits the family physician complaining of difficulty to flex and medially rotate his thigh while running and climbing. Which of the following muscles is most likely damaged in this individual? ``` A. Rectus femoris B. Tensor fasciae latae C. Vastus intermedius D. Semimembranosus E. Sartorius ```

B. Tensor fasciae latae

A 49-year-old man is admitted to the emergency department with a cold and pale foot. Physical exami- nation reveals that the patient suffers from peripheral vascular disease; his popliteal artery is occluded and no pulse is felt upon palpation. What is the landmark to feel the pulse of the femoral artery? ``` A. Adductor canal B. Femoral triangle C. Popliteal fossa D. Inguinal canal E. Pubic symphysis ```

B. Femoral triangle

A 49-year-old man is admitted to the emergency department complaining that he has difficulties walking. Physical examination reveals that the patient suffers from peripheral vascular disease. An ultrasound exami- nation reveals an occlusion of his femoral artery at the proximal portion of the adductor canal. Which of the following arteries will most likely provide collateral circulation to the thigh? A. Descending branch of the lateral circumflex femoral B. Descending genicular C. Medial circumflex femoral D. First perforating branch of deep femoral E. Obturator artery

A. Descending branch of the lateral circumflex femoral

A 34-year-old man is lifting heavy weights while doing squats. Unfortunately, while making a maximal effort, he drops the weight and immediately grabs at his upper thigh, writhing in pain. The man is admitted to the emergency department and during physical examination is diagnosed with a femoral hernia. What reference structure would be found immediately lateral to the herniated structures? ``` A. Femoral vein B. Femoral artery C. Pectineus muscle D. Femoral nerve E. Adductor longus muscle ```

A. Femoral vein

A 25-year-old man, an intravenous drug abuser, had been injecting himself with temazepam (a power- ful intermediate acting drug in the same group as diaz- epam (Valium) and heroin for 5 years, leaving much residual scar tissue over points of vascular access. The patient is admitted to the emergency department for a detoxification program requiring an intravenous infu- sion. The femoral veins in his groin are the only acces- sible and patent veins for intravenous use. Which of the following landmarks is the most reliable to identify the femoral veins? A. The femoral vein lies medial to the femoral artery. B. The femoral vein lies within the femoral canal. C. The femoral vein lies lateral to the femoral artery. D. The femoral vein lies directly medial to the femoral nerve. E. The femoral vein lies lateral to the femoral nerve.

A. The femoral vein lies medial to the femoral artery.

A 42-year-old man is bitten on his posterior thigh by a dog. The superficial wound is sutured in the emer- gency department. Four days later the patient returns to the hospital with high fever and swollen lymph nodes. Which group of nodes first receives lymph from the infected wound? A. External iliac B. Vertical group of superficial inguinal C. Deep inguinal D. Horizontal group of superficial inguinal E. Internal iliac

B. Vertical group of superficial inguinal

During a battle, a 19-year-old soldier is shot in the lateral aspect of the right foot by a bullet that rico- cheted off a building. The soldier is taken to a field hospital. A radiograph of the foot reveals that the base of the fifth metatarsal was completely obliterated. Which of the following muscles is most likely affected by this injury? ``` A. Tibialis anterior B. Fibularis (peroneus) longus C. Gastrocnemius D. Fibularis (peroneus) brevis E. Extensor hallucis longus ```

D. Fibularis (peroneus) brevis

A 29-year-old woman is involved in a car crash and is taken to the emergency department. Radiographs reveal a fracture of her pelvis. During healing of the pelvic fracture, a nerve becomes entrapped in the bone callus. Musculoskeletal examination reveals an inability to adduct the thigh. Which of the following nerves is most likely affected? ``` A. Obturator B. Femoral C. Inferior gluteal D. Superior gluteal E. Tibial ```

A. Obturator

A 29-year-old man is brought to the physician for removal of a cast from his left leg. He had sustained a fracture of the left lower extremity 6 weeks prior which was immobilized in a cast that extended from just below the knee to the foot. At the time of injury, there was severe pain but normal strength in the extremity. When the cast was removed, physical examination showed a pronounced left foot drop with paresthesia and sensory loss over the dorsum of the left foot and lateral leg. Injury to which nerve is the most likely cause? ``` A. Common fibular (peroneal) B. Superficial fibular (peroneal) C. Deep fibular (peroneal) D. Sciatic E. Tibial ```

A. Common fibular (peroneal)

A 12-year-old boy is brought to the physician by his father because of redness and swelling of his left foot for 24 hours. Three days earlier he had scraped his foot while wading in a drainage ditch. Examination of the foot shows a purulent abrasion with edema, ery- thema, and tenderness on the lateral side. Infection will most likely spread from the lateral side of the foot to the regional lymph nodes in which area? ``` A. Lateral surface of the thigh B. Medial malleolus, posteriorly C. Popliteal fossa D. Sole of the foot E. Superficial inguinal area ```

C. Popliteal fossa

A 22-year-old soccer player collides with one of her teammates. During examination on the field, the posterior drawer test was performed and the tibia moved backward in relation to her femur. Injury to which structure is confirmed by performing this test? ``` A. Anterior cruciate ligament B. Lateral collateral ligament C. Medial collateral ligament D. Medial meniscus E. Posterior cruciate ligament ```

E. Posterior cruciate ligament

A 16-year-old boy presents to the emergency department with a fracture of the first and second toes of his right foot. He received an anesthetic injection in the first web space of his foot, to permit easy manipula- tion and correction. Which nerve was blocked by the anesthesia? A. Saphenous B. Cutaneous branch of deep fibular (peroneal) C. Cutaneous branch of superficial fibular (peroneal) D. Sural E. Common fibular (peroneal)

B. Cutaneous branch of deep fibular (peroneal)

During an interview, a 30-year-old man who is a psychiatric patient suddenly becomes aggressive. In order to calm him down, the patient is given an intra- muscular injection in the upper lateral quadrant of the buttock. The injection is given at this specific location to prevent damage to which of the following nerves? ``` A. Lateral femoral cutaneous B. Sciatic C. Superior gluteal D. Obturator E. Inferior gluteal ```

B. Sciatic

A lateral blow to the knee during a tackle in a football game injures a 24-year-old woman. Field exam- ination reveals an “anterior drawer sign.” An MRI dem- onstrates injury to several structures of the knee, including her medial meniscus. Which structure might also have been injured by the tackle? ``` A. Medial collateral ligament B. Lateral collateral ligament C. Lateral meniscus D. Posterior cruciate ligament E. Tendon of the semitendinosus ```

A. Medial collateral ligament

A 58-year-old woman presents to the outpatient surgery clinic for removal of varicose veins on the medial aspect of her foot. The operation was successful however, one month later she reports loss of sensation over the medial aspect of her leg and foot. Which of the following nerves was most likely injured during the procedure? ``` A. Saphenous B. Obturator C. Lateral femoral cutaneous D. Tibial E. Femoral ```

A. Saphenous

A 16-year-old teenage girl suffered an inversion sprain of her ankle during dance class. Physical exami- nation in the clinic most likely reveals severe tender- ness over which ligament? A. Calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid

B. Calcaneofibular

A 58-year-old man visited his physician for his annual check-up. Physical examination reveals a hyper reflexive patellar reflex. Which muscle(s) contribute(s) to the tendon that is struck when testing this reflex? ``` A. Quadriceps femoris B. Quadratus femoris C. Sartorius D. Pectineus E. Biceps femoris ```

A. Quadriceps femoris

A 37-year-old unconscious man is rushed to the emergency department after being retrieved from a motor vehicle crash. On physical examination bruising and obvious deformity is seen over his left knee joint. Radiological studies showed a posteriorly dislocated supracondylar fracture with severe compression of the popliteal artery. Which of the following arteries would ensure adequate blood supply to the leg and foot in this patient? ``` A. Medial femoral circumflex B. Lateral femoral circumflex C. Anterior tibial artery D. Posterior tibial artery E. Fibular (peroneal) artery ```

B. Lateral femoral circumflex

After a revascularization procedure involving the common iliac artery, a 68-year-old man has difficulty walking. Nerve conduction studies reveal decreased activity in the nerve that innervates the adductors of the thigh. Which nerve is this? A. Femoral B. Obturator C. Common fibular (peroneal) D. Tibial E. Sciatic

B. Obturator

A 23-year-old woman was taken to the emergency department after being involved in a head-on collision with a truck. On physical examination a hematoma was seen in the medial thigh. A CT scan revealed a fracture of the femur with a ruptured femoral artery. She was taken to the operating room for repair of the damaged structures. Two days postoperatively during physical examination the patient has loss of sensation to the anterior medial thigh and medial side of her leg and foot. Branches of which of the following nerves were most likely injured in the repair of the fracture? ``` A. Femoral B. Saphenous C. Obturator D. Tibial E. Fibular (peroneal) ```

A. Femoral

A 27-year-old man has had increasing difficulty walking and complained of an area of numbness on the dorsum of his right foot. Examination reveals a hard mass at the anterolateral aspect of his right leg just below the knee. Imaging studies reveal a large bone tumor between the fibula and tibia that is compressing a nerve, accounting for his neurological symptoms. Which of the following is the most likely description of abnormalities on neurological examination? A. Decreased/absent knee jerk reflex and decreased sensation on the medial aspect of the leg B. Weakness of flexion at the knee and decreased sensation of the plantar aspect of the foot C. Weakness of eversion at the ankle and decreased sensation between the first and second toes D. Weakness of inversion, dorsiflexion at the ankle, and decreased sensation between the first and second toes E. Weakness of plantar flexion at the ankle, weakness of toe flexion, decreased sensation of the plantar aspect of the foot

D. Weakness of inversion, dorsiflexion at the ankle, and decreased sensation between the first and second toes

A 60-year-old retired male marathon runner com- plains to his primary care physician that during his daily morning jog he experiences bouts of numbness and tingling on the medial aspect of his heel. Upon further examination the doctor discovers the patient has trouble tiptoeing and shows a positive Tinel’s sign. Which of the following conditions is most characteristic of these symptoms? ``` A. Plantar fasciitis B. Ankle inversion sprain C. Morton’s neuroma D. Lateral ligament E. Tarsal tunnel syndrome ```

E. Tarsal tunnel syndrome

A 50-year-old diabetic man presents for a routine wellness checkup. During physical examination it is noted that he has paraesthesia in a classic glove and stocking distribution. The physician decides on a com- plete peripheral vascular system examination, which includes palpating the pulse of the dorsalis pedis. Where can the dorsalis pedis pulse be palpated? A. Between the tendons of extensor hallucis and extensor digitorum longus on the dorsum of the foot B. Superior to flexor hallucis longus just distal to the tarsal tunnel C. Inferolateral to the pubic symphysis and medial to the deep dorsal vein of the penis D. 2 cm anterior to the medial malleolus E. 2 cm posterior to the medial malleolus

A. Between the tendons of extensor hallucis and extensor digitorum longus on the dorsum of the foot

A 43-year-old victim of a drunk driving car crash is undergoing reconstructive arm surgery. The surgeon performs an autograft using a weak adductor of the leg located superficially on the medial side of the thigh. Which muscle is most likely being harvested to perform this reconstruction? ``` A. Gracilis B. Sartorius C. Rectus femoris D. Vastus lateralis E. Vastus medialis ```

A. Gracilis

A 39-year-old woman who is a school teacher unwittingly sits on a thumbtack a student placed on her chair. Her left buttock becomes painful and inflamed. Which group of nodes will first receive lymph from the infected wound? ``` A. Superficial horizontal group B. Superficial vertical group C. Superior and inferior gluteal nodes D. External iliac E. Deep inguinal ```

A. Superficial horizontal group

During a 100-meter sprint a 25-year-old male Olympic athlete suddenly pulls up in discomfort and is seen to be clutching the back of his left thigh in agony. Upon further examination the athlete describes the pain as a “tearing” sensation and is unable to flex his knee. Based on these symptoms which of the following actions are affected due to this injury? A. Flexion of the hip and extension of the knee B. Extension of the hip and dorsiflexion C. Medial rotation of the hip D. Lateral rotation of the hip E. Hip extension and knee flexion

E. Hip extension and knee flexion

During a gymnastic session, a 24-year-old woman suddenly developed pain and swelling on the right buttock. This happened following a forceful thigh movement. There is severe weakness of right hip exten- sion and knee flexion. Adduction of the thigh is also slightly weak. An avulsion fracture of the ischial tuber- osity is found on a radiograph. Which of the following group of muscles has most likely involved in this process? A. Adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis B. Biceps femoris, semimembranosus, semitendinosus, and adductor magnus C. Iliacus and psoas major D. Gluteus medius and gluteus minimus E. Gluteus maximus and adductor magnus F. Iliacus, psoas major, rectus femoris and sartorius

B. Biceps femoris, semimembranosus, semitendinosus, and adductor magnus

A 6-year-old boy with a family history of muscu- lar disease leading to wheelchair dependency in his maternal uncles presents with difficulty in standing from the seated position. He bends forward, uses his hands to help him push up from the floor, and then straightens his knees to stand. Which of the following muscles is most likely involved by this disease process? ``` A. Tibialis posterior and gastrocnemius B. Quadratus femoris C. Gluteus medius and gluteus minimus D. Gluteus maximus E. Hamstrings F. Iliopsoas ```

D. Gluteus maximus

A 22-year-old male professional football player is admitted to the emergency department with acute right knee pain after sustaining a kick injury to an extended leg. A radiograph and a subsequent MRI revealed that the trauma caused anterior displacement of the tibia with respect to her femur. Which of the following ligaments was most likely injured? ``` A. Fibular (lateral) collateral B. Tibial (medial) collateral C. Patellar D. Anterior cruciate E. Posterior cruciate F. Oblique popliteal ```

D. Anterior cruciate

A 51-year-old immigrant with tuberculosis is found to have large flocculent masses over the lateral lumbar spine. There is a similar mass located in the ipsilateral groin. Physical examination reveals increased tenderness just medial to the ipsilateral anterior supe- rior iliac spine on palpation. This pattern of involve- ment most likely suggests an abscess tracking along which of the following muscles? ``` A. Piriformis B. Psoas major C. Adductor longus D. Gluteus maximus E. Obturator internus ```

B. Psoas major

A 23-year-old man is taken to the emergency department because of anorexia, nausea, vomiting, and severe abdominal pain in the right lower quadrant. On examination, he has tenderness in the right lower quad- rant with rebound tenderness. The physician suspects appendicitis. To confirm this diagnosis, the physician attempts to straighten the patient’s flexed thigh. This causes the patient to wince with pain. Which of the following muscles most likely caused this symptom? ``` A. Adductor magnus B. Psoas major C. Biceps femoris D. Obturator internus E. Gluteus maximus ```

B. Psoas major

A 60-year-old man presents with pain on the medial aspect of his thigh. During physical examination he describes the pain to be constant, nonradiating and he also complains of numbness on the medial aspect of his leg and medial plantar arch. The nerve involved in this patient’s numbness is closely associated with a structure with which of the following characteristics? A. Empties into the popliteal vein B. In its ascent in the medial aspect of the leg, it travels posterior to the medial condyle of the femur C. In its ascent in the medial aspect of the leg, it travels anterior to the medial condyle of the femur D. Arches posterior to the medial malleolus E. Is associated with nodes that drain to the horizontal group of inguinal nodes

B. In its ascent in the medial aspect of the leg, it travels posterior to the medial condyle of the femur

A 56-year-old diabetic man complains of repeated injury and ulcers to his right big toe. He also complains that he finds it difficult maintaining his shoes because the tips of the shoes around the toe area easily wear down. He also complains that for a while now, his first two toes “feel funny.” He used to enjoy playing soccer on weekends but has found it difficult to be involved. Which of the following nerves is most likely affected? A. Superior gluteal nerve injury B. Inferior gluteal nerve injury C. Deep fibular (peroneal) nerve injury D. Superficial fibular (peroneal) nerve injury E. Common fibular (peroneal) nerve injury

C. Deep fibular (peroneal) nerve injury

A 30-year-old man who is a bodybuilder presents to the physician’s office complaining of pain and tin- gling sensation radiating down the inside of his thigh that was exacerbated upon thigh movement. A hernia through which opening would most likely cause this presentation? ``` A. Femoral ring B. Superficial inguinal ring C. Deep inguinal ring D. Fossa ovalis E. Obturator canal ```

E. Obturator canal

After suffering a deep stab wound to her posterior thigh, a 22-year-old woman presents to the emergency department. The wound is closed but the patient devel- ops a subsequent wound infection. Which group of lymph nodes first receives drainage from this deep wound area, and would most likely be enlarged in this patient? ``` A. External iliac B. Superficial inguinal C. Deep inguinal D. Common iliac E. Internal iliac ```

C. Deep inguinal

A 29-year-old construction worker falls onto some rusty wire mesh and suffers a deep laceration to his right buttock. When the ambulance arrives to transport him to the emergency department and it is noted that he has difficulty stepping up into the ambulance with his right leg. Which nerve has probably been damaged? ``` A. Superior gluteal B. Tibial C. Common fibular (peroneal) D. Inferior gluteal E. Nerve to piriformis ```

D. Inferior gluteal

A 69-year-old woman, who fell down the stairs, presents to the emergency department. Radiologic imaging reveals a fracture of the talocrural (tibiotalar) joint. Which movements take place at this joint? ``` A. Plantar flexion and dorsiflexion B. Inversion and eversion C. Plantar flexion, dorsiflexion, inversion, and eversion D. Plantar flexion and inversion E. Dorsiflexion and eversion ```

A. Plantar flexion and dorsiflexion

Afterbeingstruckfrombehindbyamotorvehicle, a 55-year-old man presents to the hospital with a swell- ing of his right knee. Imaging reveals a large hematoma of the popliteal artery compressing his tibial nerve. Upon neurologic examination which movement would likely be diminished in strength? ``` A. Dorsiflexion of the foot B. Flexion of the thigh C. Extension of the digits D. Extension of the leg E. Plantar flexion of the foot ```

E. Plantar flexion of the foot

A lateral blow to the knee during a tackle in a football game injures a 24-year-old woman. Field examination reveals an “anterior drawer sign.” An MRI demonstrates injury to several structures of the knee, including her medial meniscus. Which structure might also have been injured by the tackle? ``` A. Medial collateral ligament B. Lateral collateral ligament C. Lateral meniscus D. Posterior cruciate ligament E. Tendon of the semitendinosus ```

A. Medial collateral ligament

A 50-year-old woman is admitted to the emer- gency department complaining of painful swelling to the left leg, fever, and malaise for 2 days. The patient has a history of type 2 diabetes mellitus, and she was bitten on the left leg by an insect a week before pre- sentation. She scratched the pruritic area and applied alcohol to the site when the swelling increased; a puru- lent fluid began to drain from it 2 days later. During physical examination, the patient was febrile (40° C) with 5 × 5 cm tender, fluctuant swelling over the anterolateral aspect of the middle third of the left leg, which drained copious amounts of purulent fluid. Which of the following findings is most likely to be also present during physical examination of this patient? A. Tender vertical group of superficial inguinal lymph nodes B. Enlarged horizontal group of superficial inguinal lymph nodes C. Enlarged group of deep inguinal lymph nodes D. Enlarged popliteal lymph nodes E. Enlarged iliac nodes

C. Enlarged group of deep inguinal lymph nodes

A 30-year-old woman was admitted to the emer- gency department after being involved in a motor vehicle crash. The patient complained of pain to the right hip and knee. During physical examination, there is no deformity of the lower limb, but there is tender- ness over the right ischiopubic ramus. Pelvic radiographs revealed an inferiorly displaced fracture of the right superior and inferior pubic rami with dislocation of the right sacroiliac joint and pubic symphysis. The patient was referred to the orthopedics team, which had a high suspicion of rupture of the right obturator membrane. What clinical findings are most likely to be present in this patient? A. Urinary and fecal incontinence and diminished sensation over the perineum B. Weak adduction of the hip and diminished sensation over the upper medial thigh C. Weak abduction of the hip and positive Trendelenburg sign D. Weak flexion of the hip and diminished sensation over the anterior thigh and medial leg E. Weak extension of the hip and diminished sensation over the posterior thigh

B. Weak adduction of the hip and diminished sensation over the upper medial thigh

A 32-year-old man is brought to the emergency department with complaints of pain to the left ankle and knee. The patient recalls that during a football game, his left foot landed in a hole as he was running on an uneven dirt field. The ankle was externally rotated and everted while the knee twisted medially. He was unable to bear weight subsequently. During physical examination, the right ankle is swollen and there is exquisite tenderness over the right medial malleolus and the proximal lateral leg. Radiologic examination of the right lower limb reveals a displaced fracture of the neck of right fibula and a comminuted fracture of the tibial plafond and medial malleolus. Which of the following describes the most likely con- sequences of this injury? A. Weak “push-off” while walking and numbness over the posteromedial leg B. Weak ankle eversion and numbness over the dorsum of the foot C. High stepping gait and numbness over the dorsum and first web space of the foot D. Waddling gait and inability to feel a pin prick over the anterolateral leg E. Swing-out gait and numbness over the medial leg

C. High stepping gait and numbness over the dorsum and first web space of the foot

A 40-year-old man was brought to the emergency department after being struck by a car. He complained of pain to the left knee and leg and inability to bear weight on the affected limb. On examination, there was a joint effusion of the left knee, and tenderness over the medial and lateral side of the joint. A valgus stress test was positive while the varus stress test was nega- tive. An MRI of the left knee showed complete disrup- tion of multiple ligament support structures of the knee. What other symptoms are most likely possible in this patient? A. Inability to extend the knee B. Inability to flex the knee C. Instability of the knee when walking down a flight of stairs D. Instability of the knee when walking up a flight of stairs E. Excessive extension of the knee and difficulty walking down stairs

D. Instability of the knee when walking up a flight of stairs

A 19-year-old woman is admitted to the emer- gency department with complaints of pain and swelling to the right ankle. In a recent volleyball game she jumped to spike the ball then landed on the opponent’s shoe with her right foot. She recalls hearing a loud “pop” and felt immediate pain to the ankle. She was unable to bear weight subsequently. On examination, the right ankle was swollen, with maximal tenderness inferior and anterior to the lateral malleolus. Radio- graphs of the ankle showed no fractures. Which of the following structures were most likely injured? ``` A. Posterior talofibular ligament B. Interosseous ligament between the tibia and fibula C. Tibionavicular ligament D. Anterior tibiofibular ligament E. Calcaneofibular ligament ```

E. Calcaneofibular ligament

A 30-year-old woman is admitted to the emer- gency department with complaints of pain to the ante- rior left thigh. While participating in a 100-meter race, she felt a sudden onset of pain in the anterior midthigh area and could only limp to the finish line. Physical examination revealed a swollen, tender right thigh anteriorly. Extension of the knee was limited due to pain. Ultrasonography of the area revealed a defect in the fibers of the quadriceps muscle, confirmed by CT scan of the limb. Which of the following is the embryologic origin of the affected structure? A. Lateral plate mesoderm B. Dorsolateral migration of neural crest cells C. Preceded the development of chondrification centers D. Intermediate mesoderm E. Migration of cells from paraxial mesoderm

E. Migration of cells from paraxial mesoderm

A 23-year-old woman delivered a live male infant at 37 weeks’ gestation after an uneventful pregnancy. Examination of the infant revealed the right second and third toes were fused. Radiographs of the right foot indicated 14 phalanges in their correct position. After review by the pediatric orthopedic surgeon, corrective surgery for the deformity was scheduled. Which of the following embryologic conditions explains the infant’s condition? A. The digital ray for the third toe did not develop B. Excessive neural crest cell migration into the foot C. Incomplete apoptosis of tissue between digital rays D. Lack of signal from the zone of polarizing activity (ZPA) E. Faulty development of chondrification centers

C. Incomplete apoptosis of tissue between digital rays

A 30-year-old man was brought to the emergency department after his involvement in a motor vehicle crash. He complained of pain in the right knee and an inability to bear weight. On examination, there were minor abrasions about his body, in addition to a deep, 5 cm oblique laceration over the anterior right knee, which exposed the patella. He was unable to extend the right knee. Radiographs revealed a displaced trans- verse fracture of the inferior pole of the patella. The superior fragment of the patella appeared to be “high riding” over the anterior surface of the femur. Which of the following most likely occurred? A. Blood and fat from the injury can enter the popliteus bursa B. Blood and fat from the injury can enter the suprapatellar bursa C. Joint fluid can enter the subcutaneous infrapatellar bursa D. The deep infrapatellar bursa will be affected E. The gastrocnemius bursa will not be affected

B. Blood and fat from the injury can enter the suprapatellar bursa

A 53-year-oldwomanreportsdifficultyinwalking. Physical examination showed a positive Trendelenburg sign when she is asked to stand on her right leg. Which nerve has been compromised to produce the positive sign? ``` A. Sciatic B. Right superior gluteal C. Left inferior gluteal D. Left superior gluteal E. Right inferior gluteal ```

B. Right superior gluteal

A 45-year-old man is admitted to the emergency department after a fall and subsequent leg injury. On physical examination the patient has a foot drop but eversion is unaffected. Which nerve is most likely injured? ``` A. Tibial B. Common fibular (peroneal) C. Superficial fibular (peroneal) D. Saphenous E. Deep fibular (peroneal) ```

E. Deep fibular (peroneal)

A 48-year-old man comes to the physician because of severe back pain for 2 days. The pain radiates down to the buttock, posterior thigh, and posterolateral leg. He also has numbness on the lateral side of his left foot. On physical examination sensation to pain is decreased over the lateral side of the left foot. Deep tendon reflexes are absent at the left ankle, and there is a weakness of dorsiflexion of the left foot. Compres- sion of which of the following nerve roots is the most likely cause of these findings? ``` A. T12 B. L2 C. L4 D. S1 E. S3 ```

D. S1

A 45-year-old man after being diagnosed with a posterior acetabular fracture is taken to the operating room to repair the fracture. During the neurological examination the physician notices loss of sensation to the skin of the inferior half of the buttocks, posterior, and upper medial thigh. The patient had a normal neurovascular examination preoperatively. Which of the following nerves was mostly likely damaged during the operation? ``` A. Posterior femoral cutaneous B. Obturator nerve C. Sciatic D. Femoral E. Lateral femoral cutaneous ```

A. Posterior femoral cutaneous

E. Migration of cells from paraxial mesoderm

A 32-year-old man was brought to the emergency with complaints of pain to the left ankle and leg. During a game of football, his left foot landed in a hole as he was running on an uneven dirt field. He was unable subsequently bear weight on his left limb. On examina- tion, the right ankle was swollen, with exquisite tender- ness over the right medial malleolus and over the distal third of the lateral right leg. Radiographs of the right lower limb revealed an inferiorly displaced fracture of the right medial malleolus and a spiral fracture of the distal third of the right fibula. Which of the following describes the most likely mechanism of this injury? A. Forceful inversion of the ankle B. Direct upward force from the talus into the tibial plafond C. Forceful external rotation and eversion of the ankle D. Forceful dorsiflexion of the foot E. Extreme plantar flexion of the foot

C. Forceful external rotation and eversion of the ankle

A 15-year-old boy falls and injures his ankle while skateboarding. Examination in the emergency depart- ment leads to the conclusion that the ankle is mildly sprained, and it is wrapped with an elastic bandage. The boy still complains of pain in his ankle. Which of the following peripheral nerves is involved in carrying pain sensation from the ankle? ``` A. Deep fibular (peroneal) B. Femoral C. Obturator D. Posterior femoral cutaneous E. Sural ```

A. Deep fibular (peroneal)