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MCQ lower limb MRCSa
MCQ lower limb MRCS part a
| Question | Answer |
|---|---|
| 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.Adductor magnus D.Sartorius E.Conjoint tendon | Answer: D |
| lateral wall of the femoral triangle formed by: | sartorius |
| Boundry of femoral triangle: Superiorly: Inguinal ligament////////// Laterally: Sartorius | Medially: Adductor longus/////////// Floor: pectineus and adductor longus muscles medially and iliopsoas muscle laterally./////////// Roof Fascia lata and Superficial fascia Superficial inguinal lymph nodes GSVein |
| superior boundry of femoral triangle: | inguinal ligament |
| medial boundry of femoral triangle: | Adductor longus |
| floor of femoral triangle formed by: | pectineus and adductor longus muscles medially and iliopsoas muscle laterally (@HAPPI) |
| Roof of the femoral triangle formed by: | Fascia lata and Superficial fascia Superficial inguinal lymph nodes GSVein |
| what are the content of femoral triangle: | From lateral to medial:NAVEL N: femoral nerve A: femoral artery V: femoral vein E: empty space (femoral canal) L: lymphatics Lateral cutaneous nerve Great saphenous vein Femoral branch of the genitofemoral nerve |
| Femoral artery-pulse palpated at: | mid inguinal point |
| 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: D |
| deep posterior compartment of leg lies anterior to | soleus |
| Muscle in the anterior compartment of leg | 1)tibialis anterior 2)extensor digitorum longus 3)peroneus tertius (fibularis tertius) 4)extensor hallucis longus |
| Nerve supply of anterior compartment of leg: | Deep peroneal nerve (supplies all the muscle of ant compartment) |
| function of tibialis anterior muscle: | Dorsiflexes ankle joint, inverts foot |
| function of extensor digitorum longus: | Extends lateral four toes, dorsiflexes ankle joint |
| function of Peroneus tertius: | Dorsiflexes ankle, everts foot |
| function of extensor hallucis longus: | Dorsiflexes ankle joint, extends big toe |
| What are the different compartments of leg: | 1) Anterior compartment 2) Posterior compartment - Superficial/ Deep 3) Peroneal compartment |
| What are the muscle in the peroneal compartment of leg: | 1) Peroneus longus 2) Peroneus brevis |
| What is the nerve supply of peroneal compartment of leg: | superficial peroneal nerve |
| What is the function of peroneus longus muscle: | Everts foot, assists in plantar flexion |
| What is the function of peroneus brevis muscle: | Plantar flexes the ankle joint |
| What are the muscle in the superficial posterior compartment of leg: | 1) Gastrocnemius 2) Soleus |
| What are the muscle in the deep posterior compartment of leg; | 1) Flexor digitorum longus (FDL) 2) Flexor hallucis longus (FHL) 3) Tibialis posterior (TP) |
| What is the nerve supply of the posterior (sup/deep) compartment of leg: | Tibial nerve |
| what is the function of gastrocnemius and soleus: | Gastrocnemius: Plantar flexes the foot, may also flex the knee Soleus: Plantar flexor |
| what is the function of FDL? | Flexes the lateral four toes |
| what is the function of FHL? | Flexes the great toe |
| what is the function of Tibialis posterior? | Plantar flexor, inverts the foot |
| A lady presents with pain on the medial aspect of her thigh. Investigations show a large ovarian cyst. Compression of which of the nerve is the most likely underlying cause? A.Sciatic B. Genitofemoral C. Obturator D.Ilioinguinal E. Femoral cutaneous | Answer: C |
| large pelvic tumours may compress which nerve: | obturator nerve |
| what is the innervation of medial thigh: | obturator nerve |
| obturator nerve arises from: | L2, L3 and L4 by branches from the ventral divisions of each of these nerve roots. (L3 forms the main contribution) |
| L2, L3 and L4 unite in the: | substance of psoas major |
| What is the course of obturator nerve: unite in the substance of psoas major>>>emerge from its medial border at lateral margin of the sacrum>>>crosses sacroiliac joint to enter lesser pelvis>>>descends on obturator internus to enter obturator groove | In the lesser pelvis the nerve lies lateral to the internal iliac vessels and ureter>>>joined by the obturator vessels lateral to the ovary or ductus deferens. |
| Obturator nerve supplies which structures: | -Medial compartment of thigh -Muscles supplied: 1) external obturator, 2) adductor longus, 3) adductor brevis, 4) adductor magnus (not the lower part-sciatic nerve), 5) gracilis -cutaneous branch is often absent. If present |
| Obturator canal connects which structure: | pelvis and thigh |
| content of obturator canal: | obturator artery, vein, nerve |
| A man suffers a compound fracture of the tibia. During attempted surgical repair the deep peroneal nerve is divided. Which muscles will not be affected ? A.Tibialis anterior B. Peroneus longus C. EHL D.Extensor digitorum longus E. Peroneus tertius | Answer: B |
| Peroneus longus is innervated by: | superficial peroneal nerve (L4, L5, S1) |
| what is the origin of Deep peroneal nerve? | From the common peroneal nerve, at the lateral aspect of the fibula, deep to peroneus longus |
| Nerve root values of deep peroneal nerve? | L4, L5, S1, S2 |
| course of deep peroneal nerve: | Pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg Passes anteriorly down to the ankle joint, midway between the two malleoli |
| where does deep peroneal nerve terminate: | In the dorsum of the foot |
| Muscle innervated by deep peroneal nerve: | Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus tertius Extensor digitorum brevis |
| cutaneous innervation of deep peroneal nerve | Web space of the first and second toes |
| Action subtended by deep peroneal nerve: | Dorsiflexion of ankle joint Extension of all toes (extensor hallucis longus and extensor digitorum longus) Eversion of the foot |
| After its bifurcation past the ankle joint, the lateral branch of the deep peroneal nerve innervates..................... and medial branch of deep peroneal nerve innervates.............. | extensor digitorum brevis and the extensor hallucis brevis/////////web space between the first and second digits |
| Which of the following forms the medial wall of the femoral canal? A.Pectineal ligament B.Adductor longus C. Sartorius D.Lacunar ligament E. Inguinal ligament | Answer: D |
| femoral canal lies at ................... of the femoral sheath | medial aspect |
| femoral sheath contains femoral artery ................. and femoral vein ................. | laterally////////////////medially |
| femoral canal lies ............ to the femoral vein | medial |
| Boarder of femoral canal: | Laterally: Femoral vein Medially: Lacunar ligament Anteriorly: Inguinal ligament Posteriorly: Pectineal ligament |
| Contents of femoral canal: | Lymphatic vessels Cloquet's lymph node |
| Femoral canal allows the femoral vein to expand to allow for | increased venous return to the lower limbs |
| .................is the site of femoral hernias | femoral canal |
| femoral hernial have high risk of ........... | stragulation |
| You decide to take an arterial blood gas from the femoral artery. Where should the needle be inserted? | mid inguinal point |
| A man is shot in the postero- inferior aspect of his thigh. Which of the following lies at the most lateral aspect of the popliteal fossa? A.Popliteal artery B. Popliteal vein C.Common peroneal nerve D.Tibial nerve E. Small saphenous vein | Answer: C |
| contents of the popliteal fossa are (from medial to lateral): | Popliteal artery; Popliteal vein; Tibial nerve Common peroneal nerve (M>L) |
| sural nerve is a branch of..... | tibial nerve |
| sural nerve arises at: | the inferior aspect of the popliteal fossa |
| Boundry of popliteal fossa: Laterally: Biceps femoris above, lateral head of gastrocnemius and plantaris below Medially: Semimembranosus and semitendinosus above, medial head of gastrocnemius below | Floor: Popliteal surface of the femur, posterior ligament of knee joint and popliteus muscle Roof: Superficial and deep fascia |
| content of popliteal fossa: | S2P6 1) Small saphenous vein 2) Sciatic nerve branches 3) Posterior division (or genicular branch) of obturator nerve 4) Posterior cutaneous nerve of thigh 5) Popliteal artery 6) Popliteal vein 7) Popliteal lymph node 8) Pad of fat 9) Genicular |
| A old man complains of symptoms of claudication. The decision is made to measure his AnkleBrachial Index. The signal from the dorsalis pedis artery is auscultated with a hand held doppler device. This vessel is the continuation of which of the following? | Anterior tibial (dorsalis pedis is a continuation of the anterior tibial artery) |
| Foot has how many arch? | 2 arch 1) longitudional 2) transverse |
| The longitudinal arch of foot is higher on the ........... than on the ......... | medial //// lateral side |
| ................ forms a posterior pillar to support the longitudional arch of foot. | posterior part of the calcaneum |
| ..............forms summit of longitudional arch of foot | head of talus |
| summit of longitudional arch of foot located between | sustentaculum tali and the navicular bone |
| transverse arch of foot is situated on .......... | anterior part of the tarsus and the posterior part of the metatarsus |
| What contributes to the shape of transverse arch of foot: | The cuneiforms and metatarsal bases narrow inferiorly |
| Every longitudional arch of foot has: | (a) 2 Pillars, (b) a summit, and (c) joints |
| medial longitudinal arch is composed by | calcaneum, talus, navicular, 3 cuneiforms, and medial 3 metatarsals |
| ....creates posterior column of the medial longitudinal arch of foot | medial half of the calcaneum |
| ....creates anterior column of the medial longitudinal arch of foot | heads of the medial 3 metatarsals |
| ateral longitudinal arch is composed of... | calcaneum cuboid and lateral 2 metatarsals |
| posterior column of the lateral longitudinal arch is composed of............and anterior column is composed of.................... | lateral tubercle of the calcaneum///////heads of the lateral 2 metatarsals |
| learn difference between medial and lateral longitudional arches from table | |
| learn anatomy of following muscle from this website: 1)Abductor Hallucis 2)Flexor digitorum brevis 3)Abductor digiti minimi 4)Flexor hallucis brevis 5)Adductor hallucis 6)Extensor digitorum brevis | |
| Lateral plantar nerve course | Passes anterolaterally towards the base of the 5th metatarsal between flexor digitorum brevis and flexor accessorius>>>>>At the base of the 5th metatarsal it splits into superficial and deep branches |
| Medial plantar nerve course | Passes forwards with the medial plantar artery under the cover of the flexor retinaculum to the interval between abductor hallucis and flexor digitorum brevis on the sole of the foot. |
| Plantar arteries | Arise under the cover of the flexor retinaculum, midway between the tip of the medial malleolus and the most prominent part of the medial side of the heel. |
| medial plantar artery located between.... | between abductor hallucis and flexor digitorum brevis. |
| Medial plantar artery ends by uniting with ............ | branch of 1st plantar metatarsal artery. |
| Dorsalis pedis artery is a direct continuation of the ............... | anterior tibial artery |
| Dorsalis pedis artery gives off ........... artery and continues as first dorsal metatarsal artery | arcuate artery |
| Dorsalis pedis artery is crossed by: | extensor hallucis brevis |
| A man is due to undergo a revisional THR by posterior approach. After dividing gluteus maximus in the line of its fibres there is brisk arterial bleeding. Which is responsible? | Inferior gluteal artery |
| Which artery runs on deep surface of the gluteus maximus muscle? | Inferior gluteal artery |
| Inferior gluteal artery is branch of.......... | Internal Iliac artery |
| Internal Iliac artery is commonly divided during which procedure? | posterior approach to hip joint (esp during THA) |
| Head of femur articulates with | acetabulum of the pelvis |
| Head of femur AND acetabulum of the pelvis covered by: | articular hyaline cartilage |
| acetabulum forms at the union of .... | ilium, pubis, and ischium |
| ............separates the pelvic bones | triradiate cartilage (Y-shaped growth plate) |
| acetabulum holds the femoral head by.......... | acetabular labrum |
| Normal angle between femoral head and femoral shaft.......... | 130 |
| How many ligament of hip joint: | two 1)Transverse ligament 2)Head of femur ligament (ligamentum teres) |
| Head of femur ligament (ligamentum teres) contains: | arterial supply to head of femur in children |
| what are different Extracapsular ligaments of hip joint: | 1) Iliofemoral ligament : 2) Pubofemoral ligament 3) Ischiofemoral ligament |
| Iliofemoral ligament is which type of shape? | inverted Y shape |
| Blood supply to hip joint? | Medial circumflex femoral and lateral circumflex femoral arteries |
| Medial circumflex femoral and lateral circumflex femoral arteries are branches of | profunda femoris |
| pubofemoral ligament connects | acetabulum to lesser trochanter |
| Ileofemoral ligament connects | Anterior iliac spine to the trochanteric line |
| Ischiofemoral ligament connects | Ischium to greater trochanter |
| 2 anastomosis of hip joint: | Cruciate and the trochanteric anastomoses (provides most of the blood to the head of the femur) |
| why need for hemiarthroplasty when there is a displaced femoral head fracture? | because Cruciate and the trochanteric anastomoses (provides most of the blood to the head of the femur) |
| Cruciate and the trochanteric anastomoses exist between | femoral artery or profunda femoris and the gluteal vessels. |
| Which of the following nerves passes through the greater and lesser sciatic foramina? A. Pudendal nerve B. Sciatic nerve C. Superior gluteal nerve D. Inferior gluteal nerve E. Posterior cutaneous nerve of the thigh | Answer: A |
| Structures passing through the lesser and greater sciatic foramina (medial to lateral): | PIN Pudendal nerve Internal pudendal artery Nerve to obturator internus |
| pudendal nerve originates from | ventral rami of the second, third, and fourth sacral nerves (S2, S3, S4). |
| PUDENDAL NERVE passes between the .... muscles and exits the pelvis through....Then crosses the spine of the ischium and reenters the pelvis through... then passes through the pudendal canal.....Then pudendal nerve gives off .......terminates into: | piriformis and coccygeus///// greater sciatic foramen//// lesser sciatic foramen////////////inferior rectal nerves////terminates into: perineal nerve, and the dorsal nerve of the penis or the dorsal nerve of the clitoris |
| Structure that pass through greater sciatic foramen | PIN and PINS Posterior cutaneous nerve of thigh Inferior gluteal vessels and nerves Nerve to quadratus femoris Pudendal nerve Internal pudendal vessels Nerve to obturator internus Sciatic nerve |
| ....is landmark for identifying structures passing out of the sciatic notch | piriformis |
| Above piriformis what passes: Below piriformis what passes: | Above piriformis:Superior gluteal vessels//////// Below piriformis: Inferior gluteal vessels, sciatic nerve and posterior cutaneous nerve of the thigh |
| Greater sciatic foramen boundaries | Anterolaterally: Greater sciatic notch of the ilium//// Posteromedially: Sacrotuberous ligament//// Inferior: Sacrospinous ligament and the ischial spine///// Superior: Anterior sacroiliac ligament |
| Contents of the lesser sciatic foramen: | PINTO P: pudendal nerve I: internal pudendal artery and vein N: nerve to obturator internus TO: tendon of obturator internus |
| old man with long standing AF develops an embolus to the lower leg. The decision is made to perform an embolectomy, utilising a trans popliteal approach. ... continue nxt page | After incising the deep fascia, which structures will the surgeons encounter first on exploring the central region of the popliteal fossa? Tibial nerve |
| ............lies superior to the vessels in the inferior aspect of the popliteal fossa | tibial nerve |
| The ................ is the deepest structure in the popliteal fossa. | popliteal artery |
| lady presents with varicose veins and undergoes a saphenofemoral disconnection, long saphenous vein stripping to the ankle and isolated hook phlebectomies. Post op she notices an area of numbness superior to her ankle. what is the cause? | Saphenous nerve injury |
| saphenous nerve is related to..... | LONG SAPHENOUS VEIN so full length stripping of the vein is no longer advocated |
| sural nerve is related to...... | short saphenous vein |
| ...........vein may be harvested for triple or quadruple bypass surgery | Long saphenous vein |
| origin of long saphenous vein..... | Originates at the 1st digit where the dorsal vein merges with the dorsal venous arch of the foot |
| termination of long saphenous vein..... | joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction |
| course of long saphenous vein | Passes anterior to the medial malleolus and runs up the medial side of the leg >>>At knee, it runs over posterior border of medial epicondyle of the femur>>>laterally to lie on anterior surface of thigh before entering saphenous opening then terminates |
| Tributaries of long saphenous vein: | Medial marginal, superficial epigastric, superficial iliac circumflex and superficial external pudendal veins |
| origin of short saphenous vein | Originates at the 5th digit where the dorsal vein merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein. |
| course of short saphenous vein | It passes around the lateral aspect of the foot (inferior and posterior to the lateral malleolus) and runs along the posterior aspect of the leg (with the sural nerve) |
| termination of short saphenous vein | Passes between the heads of the gastrocnemius muscle, and drains into the popliteal vein, approximately at or above the level of the knee joint. |
| A 34 year old man undergoes excision of a sarcoma from the right buttock. During the procedure the sciatic nerve is sacrificed. Which of the following will not occur as a result of this process? | A.Loss of extension at the knee joint// B. Foot drop// C. Inability to extend extensor hallucis longus// D.Loss of sensation to the posterior aspect of the thigh// E. Loss of sensation to the posterior aspect of the lower leg |
| Extension of the knee joint is caused by | obturator and femoral nerves. |
| origin of sciatic nerve | Spinal nerves L4 - S3 |
| muscle supply of sciatic nerve in upper leg: | Semitendinosus// Semimembranosus// Biceps femoris// Part of adductor magnus |
| cutaneous sensation supplied by sciatic nerve | Posterior aspect of thigh// Gluteal region// Entire lower leg (except the medial aspect) |
| termination of sciatic nerve | At the upper part of the popliteal fossa by dividing into the tibial and peroneal nerves |
| girl stabbed in the buttock. wound is sutured in the emergency department. 8weeks later as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. O/E- buttock muscle wasting. which nerve is injured? | superior gluteal nerve |
| Damage to the superior gluteal nerve will result in a........ | Trendelenberg gait. |
| Injury or division of the superior gluteal nerve results in....... | (1) weakened abduction of the thigh by gluteus medius//// (2) disabling gluteus medius limp /// (3)compensatory list of the body weakened gluteal side |
| When a person is asked to stand on one leg the gluteus medius usually........... as soon as the contralateral leg leaves the floor | contracts |
| When a person is asked to stand on one leg the gluteus medius usually contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from....... | dipping towards the unsupported side |
| When a person with paralysis of the superior gluteal nerve is asked to stand on one leg, pelvis on the unsupported side ............, indicating that the .......... on the affected side is weak or non functional | descends////gluteus medius |
| When a person with paralysis of the superior gluteal nerve is asked to stand on one leg, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non functional. It is known as ......... | positive trendelenberg test |
| A 73 year old lady presents with symptoms of faecal incontinence. On examination she has weak anal sphincter muscles. What are the main nerve root values of the nerves supplying the external anal sphincter? | S2,3,4 |
| external anal sphincter is innervated by | inferior rectal branch of the pudendal nerve |
| what is the root value of inferior rectal branch of the pudendal nerve? | S2,3,4 |
| Internal anal sphincter composed of .... muscle | smooth muscle continuous with the circular muscle of the rectum |
| External anal sphincter is composed of...muscle | striated muscle |
| nerve supply of the external anal sphincter is | inferior rectal branch of the pudendal nerve (S2 and S3) and the perineal branch of the S4 nerve roots. |
| An old man has a fall. He fractured neck of femur and undergoes left hip hemiarthroplasty. Two months post operatively he is found to have an odd gait. When standing on his left leg his pelvis dips on right side. There is no foot drop. What is cause? | Superior gluteal nerve damage absence of a foot drop excludes the possibility of polio of L5 radiculopathy in this case |
| Gluteus maximus insertion | gluteal tuberosity of the femur and iliotibial tract |
| Gluteus medius attachment | lateral greater trochanter |
| Gluteus minimis attachment | anterior greater trochanter |
| Gluteus muscle function | All extend and abduct the hip |
| Deep lateral hip rotators | Piriformis// Gemelli// Obturator internus// Quadratus femoris |
| Superior gluteal nerve (nerve root and supply) | (L5, S1) Gluteus medius// Gluteus minimis// Tensor fascia lata |
| Inferior gluteal nerve supplies | Gluteus maximus |
| see video of trendelenberg gait | |
| Which of the following structures lies posterior to the femoral nerve in the femoral triangle? A. Adductor longus B. Pectineus C. Psoas major D. Iliacus E. None of the above | Answer D |
| iliacus lies posterior to... | femoral nerve in femoral triangle |
| femoral sheath lies anterior to ....... | iliacus and pectineus muscles |
| root value of femoral nerve | L2-4 |
| femoral nerve INNERVATES | Pectineus// Sartorius// Quadriceps femoris// Vastus lateralis/medialis/intermedius |
| Branches of femoral nerve: | Medial cutaneous nerve of thigh// Saphenous nerve// Intermediate cutaneous nerve of thigh |
| Pnemonic for femoral nerve supply/branches | @(don't) M I S V Q Scan for PE M edial cutaneous nerve of the thigh I ntermediate cutaneous nerve of the thigh S aphenous nerve V astus Q uadriceps femoris S artorius PE ectineus |
| Which of the following ligaments contains the artery supplying the head of femur in children? | A.Transverse ligament// B.Ligamentum teres// C.Iliofemoral ligament// D.Ischiofemoral ligament// E.Pubofemoral ligament////// Answer: B |
| A old man with critical limb ischaemia is undergoing a femoro-distal bypass graft. During mobilisation of the proximal part of the posterior tibial artery which structure is at greatest risk of injury? | tibial nerve |
| tibial nerve is closely related to the....... | posterior tibial artery |
| The ........... crosses the post tibial vessel posteriorly approximately 2.5cm distal to its origin. | tibial nerve |
| Posterior tibial artery branch of .......... | popliteal artery |
| post tibial artery terminates by dividing into... | medial and lateral plantar arteries |
| relation of posterior tibial artery: | Anterior: Tibialis posterior// Flexor digitorum longus//post surface of tibia.............Posteriorly: tibial nerve 2.5cm distal to origin/fascia overlying deep muscular layer/proximal part covered by gastrocnemius and soleus/ distal part covered by skin |
| Which structure lies deepest in the popliteal fossa? | popliteal artery |
| superficial to deep structure in popliteal fossa? | 1)common peroneal nerve// 2)tibial nerve// 3)popliteal vein// 4)popliteal artery |
Created by:
sarthaknepal1