Lower Limb A

Question 1

Question 15 of 328 The following are true of the femoral nerve, except: A. It is derived from L2, L3 and L4 nerve roots B. It supplies sartorius C. It supplies quadriceps femoris D. It gives cutaneous innervations via the saphenous

Answer 1

It supplies adductor longusAdductor longus is supplied by the obturator nerve.

Question 2

Question 19 of 328 Which of the following is true in relation to the sartorius muscle? A. Innervated by the deep branch of the femoral nerve B. Inserts at the fibula C. It is the shortest muscle in the body D. Forms the Pes anserin

Answer 2

Forms the Pes anserinus with Gracilis and semitendinous muscleIt is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.

Question 3

Question 20-22 of 328 Theme: Nerve lesionsA. Sciatic nerveB. Peroneal nerveC. Tibial NerveD. Obturator nerveE. Ilioinguinal nerveF. Femoral nerveG. None of the abovePlease select the most likely nerve injury for the scenario

Answer 3

20. A 56 year old man undergoes a low anterior resection with legs in the Lloyd-Davies position. Post operatively he complains of foot drop.You answered Sciatic nerveThe correct answer is Peroneal nervePositioning legs in Lloyd- Davies stirrups can carry the risk of peroneal nerve neuropraxia if not done carefully.21. A 23 year old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.Ilioinguinal nerveThe ilioinguinal nerve may have been entrapped in the mesh causing a neuroma.22. A 72 year old man develops a foot drop after a revision total hip replacement.You answered Tibial NerveThe correct answer is Sciatic nerveThis may be done by a number of approaches, in this scenario a posterior approach is the most likely culprit.

Question 4

Question 30 of 328 Which muscle is supplied by the superficial peroneal nerve? A. Peroneus tertius B. Sartorius C. Adductor magnus D. Peroneus brevis E. Gracilis

Answer 4

Peroneus brevis

Question 5

Question 34 of 328 Which of the following structures separates the posterior cruciate ligament from the popliteal artery? A. Oblique popliteal ligament B. Transverse ligament C. Popliteus tendon D. Biceps femoris E. Semitendinos

Answer 5

Oblique popliteal ligamentThe posterior cruciate ligament is separated from the popliteal vessels at its origin by the oblique popliteal ligament. The transverse ligament is located anteriorly.

Question 6

Question 35 of 328 How many compartments are there in the lower leg? A. 2 B. 1 C. 3 D. 5 E. 4

Answer 6

4The deep compartment of the lower leg has both superficial and deep posterior layers, together with the anterior and lateral compartments this allows for four compartments. Decompression of the deep posterior compartment during fasciotomy may be overlooked with significant sequelae.

Question 7

Question 41 of 328 A 25 year old man undergoes an excision of a pelvic chondrosarcoma, during the operation the obturator nerve is sacrificed. Which of the following muscles is least likely to be affected as a result? A. Adductor longus

Answer 7

Sartorius is supplied by the femoral nerve. In approximately 20% of the population, pectineus is supplied by the accessory obturator nerve.

Question 8

Question 46 of 328 Which nerve supplies the 1st web space of the foot? A. Popliteal nerve B. Superficial peroneal nerve C. Deep peroneal nerve D. Tibial nerve E. Saphenous nerve

Answer 8

Deep peroneal nerve

Question 9

Question 49 of 328 A man with lung cancer and bone metastasis in the thoracic spinal vertebral bodies, sustains a pathological fracture at the level of T4. The fracture is unstable and the spinal cord is severely compressed at this level. Which

Answer 9

Diminished patellar tendon reflexA thoracic cord lesion causes spastic paraperesis, hyperrflexia and extensor plantar responses (UMN lesion), incontinence, sensory loss below the lesion and ‘sensory’ ataxia.

Question 10

Question 57 of 328 Which of the following structures does not pass behind the piriformis muscle in the greater sciatic foramen? A. Sciatic nerve B. Posterior cutaneous nerve of the thigh C. Inferior gluteal artery D. Obturator nerve

Answer 10

The obturator nerve does not pass through the greater sciatic foramen.

Question 11

Question 67 of 328 A 78 year old lady falls over in her nursing home and sustains a displaced intracapsular fracture of the femoral neck. A decision is made to perform a hemi arthroplasty through a lateral approach. Which of these vessels will be div

Answer 11

ransverse branch of the lateral circumflex arteryDuring the Hardinge style lateral approach the transverse branch of the lateral circumflex artery is divided to gain access. The vessels and its branches are illustrated below:

Question 12

Question 80 of 328 A 72 year old lady with osteoporosis falls and sustains an intracapsular femoral neck fracture. The fracture is completely displaced. Which of the following vessels is the main contributor to the arterial supply of the femoral

Answer 12

Circumflex femoral arteriesThe vessels which form the anastomoses around the femoral head are derived from the medial and lateral circumflex femoral arteries. These are usually derived from the profunda femoris artery

Question 13

Question 93 of 328 The following statements relating to the ankle joint are true except? A. Three groups of ligaments provide mechanical stability B. The sural nerve lies medial to the Achilles tendon at its point of insertion C. Eversion

Answer 13

The sural nerve lies medial to the Achilles tendon at its point of insertionThe sural nerve lies behind the distal fibula. Inversion and eversion are sub talar movements. The structures passing behind the medial malleolus from anterior to posterior include: tibialis posterior, flexor digitorum longus, posterior tibia vein, posterior tibial artery, nerve, flexor hallucis longus.

Question 14

Question 96 of 328 A 19 year old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which of the following muscle groups is most likely to have been injured? A. Semimembranosus B. Semi

Answer 14

Long head of biceps femorisThe biceps femoris is the laterally located hamstring muscle. The semitendinosus and semimembranosus are located medially. Rupture of gastrocnemius and soleus may occur but is less common.

Question 15

Question 107 of 328 A 22 year old man is involved in a fight and is stabbed in the posterior aspect of his right leg. The knife passes into the popliteal fossa. He sustains an injury to his tibial nerve. Which muscle is least likely to be compromised

Answer 15

Peroneus tertiusPeroneus tertius is innervated by the deep peroneal nerve

Question 16

Question 112 of 328 At which of the following anatomical locations does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves? A. Immediately anterior to the linea aspera B. At the lateral aspect of the neck of the

Answer 16

At the lateral aspect of the neck of the fibulaThe common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).

Question 17

Question 113 of 328 A 48 year old motor cyclist sustains a complex lower limb fracture in a motor accident. For a time the popliteal artery is occluded and eventually repaired. Subsequently he develops a compartment syndrome and the anterior and

Answer 17

PlantarisMuscles of the deep posterior compartment: Tibialis posterior Flexor hallucis longus Flexor digitorum longus PopliteusThe plantaris muscle lies within the superficial posterior compartment of the lower leg.

Question 18

Question 114 of 328 A 23 year old lady is undergoing a trendelenberg procedure for varicose veins. During the dissection of the saphenofemoral junction, which of the structures listed below is most liable to injury? A. Superficial circumflex ili

Answer 18

Deep external pudendal arteryTheme from September 2011 examThe deep external pudendal artery runs under the long saphenous vein close to its origin and may be injured. It is at greatest risk of injury during the flush ligation of the saphenofemoral junction. Provided an injury is identified and vessel ligated, injury is seldom associated with any serious adverse sequelae.

Question 19

Question 117 of 328 A 52 year female post hysterectomy attends clinic. She reports pain and reduced sensation over the medial aspect of her thigh. Clinically thigh adduction is weak. What is the most likely nerve injury? A. Obturator nerve B.

Answer 19

Obturator nerveThe obturator nerve supplies sensation to the medial aspect of the thigh and causes adduction and internal rotation of the thigh.Injury occurs during pelvic or abdominal surgery.L3 cord compression is unlikely.

Question 20

Question 124 of 328 With regard to the sciatic nerve which statement is false? A. It is derived from L4 to S3 B. It contains nerve roots from the posterior division of the lumbosacral plexus only C. It divides to give the tibial nerve and

Answer 20

It contains nerve roots from the posterior division of the lumbosacral plexus onlyIt is derived from both anterior and posterior divisions of the lumbosacral plexus. The sciatic nerve is the longest and widest nerve in the human body. It is particularly susceptible to trauma in the posterior approach to the hip.

Question 21

Question 129 of 328 Which of the following is a content of the adductor canal? A. Saphenous nerve B. Sural nerve C. Femoral nerve D. Profunda branch of the femoral artery E. Saphenous vein

Answer 21

It contains the saphenous nerve and the superficial branch of the femoral artery.

Question 22

Question 135 of 328 A 34 year old man is injured by farm machinery and sustains a laceration at the superolateral aspect of the popliteal fossa. The medial aspect of biceps femoris is lacerated. Which of the following underlying structures is at grea

Answer 22

Common peroneal nerveThe common peroneal nerve lies under the medial aspect of biceps femoris and is therefore at greatest risk of injury. The tibial nerve may also be damaged in such an injury (but is not listed here). The sural nerve branches off more inferiorly.

Question 23

Question 137 of 328 Which of the nerves listed below is at greatest risk of injury with a laceration to the upper lateral margin of the popliteal fossa? A. Common peroneal nerve B. Sural nerve C. Sciatic nerve D. Saphenous nerve E. T

Answer 23

Common peroneal nerveThe sural nerve exits at the lower latero-medial aspect of the fossa and is more at risk in short saphenous vein surgery. The tibial nerve lies more medially and is even less likely to be injured in this location.

Question 24

Question 148 of 328 An 18 year old athlete attends orthopaedic clinic reporting pain and swelling over the medial aspect of the knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there

Answer 24

Pes Anserinus BursitisPes anserinus: GOOSE’S FOOTCombination of sartorius, gracilis and semitendinous tendons inserting into the anteromedial proximal tibia.Pes Anserinus Bursitis is common in sportsmen due to overuse injuries. The main sign is of pain in the medial proximal tibia. As the McMurray test is negative, medial meniscal injury is excluded.

Question 25

Question 158 of 328 Which of the following bones is related to the cuboid at its distal articular surface? A. All metatarsals B. 5th metatarsal C. Calcaneum D. Medial cuneiform E. 3rd metatarsal

Answer 25

5th metatarsalTheme from April 2012 ExamThe cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.

Question 26

Question 166 of 328 Which of the following is not a content of the rectus sheath? A. Pyramidalis B. Superior epigastric artery C. Inferior epigastric vein D. Internal iliac artery E. Rectus abdominis

Answer 26

Internal iliac arteryThe rectus sheath also contains:superior epigastric veininferior epigastric artery

Question 27

Question 169 of 328 A 25 year old man is stabbed in the groin and the area, which lies within the femoral triangle is explored. Which structure forms the lateral wall of the femoral triangle? A. Adductor longus B. Pectineus C. Adducto

Answer 27

The sartorius forms the lateral wall of the femoral triangle (see below).

Question 28

Question 175 of 328 Onto which of the following structures does the anterior cruciate ligament insert? A. Posterolateral aspect of the lateral femoral condyle B. Posteromedial aspect of the lateral femoral condyle C. Posterolateral aspect

Answer 28

Posteromedial aspect of the lateral femoral condyleThe anterior cruciate ligament is attached to the anterior intercondylar area of the tibia. Is then passes posterolaterally to insert into the posteromedial aspect of the lateral femoral condyle.

Question 29

Question 185 of 328 A 40 year old lady presents with varicose veins, these are found to originate from the short saphenous vein. As the vein is mobilised close to its origin which structure is at greatest risk of injury? A. Sciatic nerve B. S

Answer 29

The sural nerve is closely related and damage to this structure is a major cause of litigation. The other structures may all be injured but the risks are lower.

Question 30

Question 188 of 328 A 72 year old man with non reconstructible arterial disease is undergoing an above knee amputation. The posterior compartment muscles are divided. Which of the following muscles does not lie in the posterior compartment of the thi

Answer 30

Quadriceps femorisThe quadriceps femoris lies in the anterior compartment.

Question 31

Question 191 of 328 Which of the following structures is not closely related to the posterior tibial artery? A. Soleus posteriorly B. Tibial nerve medially C. Deep peroneal nerve laterally D. Flexor hallucis longus postero-inferiorl

Answer 31

Deep peroneal nerve laterallyThe deep peroneal nerve lies in the anterior compartment. The tibial nerve lies medially. At its termination it lies deep to the flexor retinaculum.

Question 32

Question 198 of 328 A 30 year old man presents with back pain and the surgeon tests the ankle reflex. Which of the following nerve roots are tested in this manoeuvre? A. S3 and S4 B. L4 and L5 C. L3 and L4 D. S1 and S2 E. S4 only

Answer 32

S1 and S2(2012 exam)

Question 33

Question 201 of 328 A 77 year old man with symptoms of intermittent claudication is due to have his ankle brachial pressure indices measured. The dorsalis pedis artery is impalpable. Which of the following tendinous structures lies medial to it,

Answer 33

The extensor hallucis longus tendon lies medial to the dorsalis pedis artery.

Question 34

Question 209 of 328 Which of the following structures attaches periosteum to bone? A. Sharpeys fibres B. Peripheral lamellae C. Elastic fibres D. Fibrolamellar bundles E. Purkinje fibres

Answer 34

Sharpeys fibresPeriosteum is attached to bone by strong collagenous fibers called Sharpey’s fibres, which extend to the outer circumferential and interstitial lamellae. It also provides an attachment for muscles and tendons.

Question 35

Question 215 of 328 The integrity of which muscle is assessed by the Trendelenburg test? A. Sartorius B. Quadratus femoris C. Semimembranosus D. Gluteus medius E. Piriformis

Answer 35

Gluteus medius(2011 Exam)

Question 36

Question 216 of 328 A 52 year old female renal patient needs a femoral catheter to allow for haemodialysis. Which of the structures listed below is least likely to be encountered during its insertion? A. Great saphenous vein B. Deep circu

Answer 36

Deep circumflex iliac arteryFemoral access catheters are typically inserted in the region of the femoral triangle. Therefore the physician may encounter the femoral, vein, nerve, branches of the femoral artery and tributaries of the femoral vein. The deep circumflex iliac artery arises above the inguinal ligament and is therefore less likely to be encountered than the superficial circumflex iliac artery which arises below the inguinal ligament.

Question 37

Question 222 of 328 Which of the following statements relating to the knee joint is false? A. It is the largest synovial joint in the body B. When the knee is fully extended all ligaments of the knee joint are taut C. Rupture of the anteri

Answer 37

The posterior aspect of the patella is extrasynovialThe posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body. It may swell considerably following trauma such as ACL injury. Which may be extremely painful owing to rich innervation from femoral, sciatic and ( a smaller) contribution from the obturator nerve. During full extension all ligaments are taut and the knee is locked.

Question 38

Question 224 of 328 Which of the following does not exit the pelvis through the greater sciatic foramen? A. Superior gluteal artery B. Internal pudendal vessels C. Sciatic nerve D. Obturator nerve E. Inferior gluteal nerve

Answer 38

Obturator nerveThe obturator nerve exits through the obturator foramen.

Question 39

Question 231 of 328 A 78 year old man is undergoing a femoro-popliteal bypass graft. The operation is not progressing well and the surgeon is complaining of poor access. Retraction of which of the following structures will improve access to the femor

Answer 39

SartoriusAt the lower border of the femoral triangle the femoral artery passes under the sartorius muscle. This can be retracted to improve access.

Question 40

Question 234 of 328 A 66 year old man with peripheral vascular disease is undergoing a below knee amputation. In which of the lower leg compartments does peroneus brevis lie? A. Lateral compartment B. Anterior compartment C. Superficia

Answer 40

Lateral CompartmentThe interosseous membrane separates the anterior and posterior compartments. The deep and superficial compartments are separated by the deep transverse fascia. The peroneus brevis is part of the lateral compartment.

Question 41

Question 235 of 328 A 70 year old man is due to undergo an arterial bypass procedure for claudication and foot ulceration. The anterior tibial artery will form the site of the distal arterial anastomosis. Which of the following structures is not

Answer 41

Tibialis posteriorAs an artery of the anterior compartment, the anterior tibial artery is closely related to tibialis anterior.

Question 42

Question 236 of 328 Which of the muscles below does not cause lateral rotation of the hip? A. Obturator internus B. Quadratus femoris C. Gemellus inferior D. Piriformis E. Pectineus

Answer 42

PectineusMnemonic lateral hip rotators: P-GO-GO-Q (top to bottom)PiriformisGemellus superiorObturator internusGemellus inferiorObturator externusQuadratus femorisPectineus adducts and medially rotates the femur.

Question 43

Question 245 of 328 Which of the following statements relating to sartorius is untrue? A. It is supplied by the femoral nerve B. It forms the lateral boundary of the femoral triangle C. The middle third forms the roof of the adductor

Answer 43

It inserts into the medial femoral condyleIt inserts into the medial aspect of the upper part of the tibia.

Question 44

Question 252 of 328 Which of the following structures are not closely related to the adductor longus muscle? A. Long saphenous vein B. Tendon of iliacus C. The profunda branch of the femoral artery D. Pectineus muscle E. Femoral nerv

Answer 44

B. Tendon of iliacus Femoral triangle:Adductor longus mediallyInguinal ligament superiorlySartorius muscle laterallyAdductor longus forms the medial border of the femoral triangle. It is closely related to the long saphenous vein which overlies it and the profunda branch of the femoral artery. The femoral nerve is related to it inferiorly. However, the tendon of iliacus inserts proximally and is not in contact with adductor longus.

Question 45

Question 255 of 328 A 73 year old lady presents with a femoral hernia. Which of the following structures forms the lateral wall of the femoral canal? A. Pubic tubercle B. Femoral vein C. Femoral artery D. Conjoint tendon E. Femoral n

Answer 45

Femoral veinThe canal exists to allow for the physiological expansion of the femoral vein, which lies lateral to it.

Question 46

Question 257 of 328 Which of the following muscles is not within the posterior compartment of the lower leg? A. Peroneus brevis B. Flexor digitorum longus C. Soleus D. Popliteus E. Flexor hallucis longus

Answer 46

Peroneus brevisTheme from 2007 ExamPeroneus brevis lies in the lateral compartment.

Question 47

Question 266 of 328 The femoral nerve is transected by a rather careless surgeon during a botched femoro-popliteal bypass operation. Which of the following actions will be impaired? A. Extension of the great toe B. Adduction of the thigh

Answer 47

The femoral nerve supplies the quadriceps muscle which is responsible for extension at the knee joint.

Question 48

Question 271 of 328 A 23 year old man presents with delayed diagnosis of appendicitis. The appendix is retrocaecal and has perforated causing a psoas abscess. Into which structure does the psoas major muscle insert? A. Greater trochanter of

Answer 48

Theme based on 2011 examThe psoas major inserts into the lesser trochanter.

Question 49

Question 275 of 328 As it exits the axilla the radial nerve lies on which of the following muscles? A. Supraspinatus B. Infraspinatus C. Teres major D. Deltoid E. Pectoralis major

Answer 49

Teres majorThe radial nerve passes through the triangular space to leave the axilla. The superior border of this is bounded by the teres major muscle to which the radial nerve is closely related.

Question 50

Question 295 of 328 During an operation for varicose veins the surgeons are mobilising the long saphenous vein. Near its point of entry to the femoral vein an artery is injured and bleeding is encountered. From where is the bleeding most likely to or

Answer 50

Deep external pudendal arteryTheme from 2011 ExamThe deep external pudendal artery is a branch of the SFA and it runs medially under the long saphenous vein near its point of union with the femoral vein. The superficial external pudendal artery lies superior to the SFJ. Neither vessel is functionally important and if injured they are best ligated.

Question 51

Question 300 of 328 Which of the following is not contained within the deep posterior compartment of the lower leg? A. Tibialis posterior muscle B. Posterior tibial artery C. Tibial nerve D. Sural nerve E. Flexor hallucis longus

Answer 51

The deep posterior compartment lies anterior to soleus. The sural nerve is superficially sited and therefore not contained within it.

Question 52

Question 302 of 328 Which of the following structures are at risk of direct injury following a fracture dislocation of the femoral condyles? A. Popliteal artery B. Sciatic nerve C. Plantaris muscle D. Tibial artery E. Tibial nerv

Answer 52

Popliteal arteryThe heads of gastrocnemius will contract to pull the fracture segment posteriorly. The popliteal artery lies against the bone and may be damaged or compressed.

Question 53

Question 325 of 328 Which of the following structures does not pass anterior to the lateral malleolus? A. Anterior tibial artery B. Extensor digitorum longus C. Tibialis anterior D. Peroneus brevis E. Peroneus tertius

Answer 53

Peroneus brevis passes posterior to the lateral malleolus.