PE sues 1, Which structure lies midway between the anterior superior |, Line from al point to adductor tubercle repre- iac spine and pubic symphysi sents: (NET Pattern 2013) (NEETPattern 2012) a. Inferior epigastric artery Femoral artery b, Femoral artery Decnnoieatiing © Superior epigasticartery x dd. Obturator arter Superior epigastric artery a Inguinal ligament EOE rt ured 1. a. Femoral artery Halfway between the anterior superior iliac spine and the pubic symphysis lies the midinguinal point. Femoral artery pulse is felt at the midinguinal point 1 cm either side (medial to lateral) Beep inguinal ring lies about | em above the inguinal ligament at the mict-inguiral point, Note:Itis mictinguinal point and not the mic:point of inguinal ligament. 2. b.Femoral artery * Insight flexion, abduction and lateral rotation of hip joint, a line drawn from the midinguinal point to the adductor tuberde represents the femoral artery.ESS eee 1. Theischial tuberosity provides attachment to: ANEET Pattern 2055) Obturator internus ‘Quadratus femoris Guteusmaximum, Adductor magnus 3. All of the following structures pass through lesser sciatic foramen except (EEF Pattern 2013} a, Pudendal nerve b. Obturator internus musde Intemal pudendal vessels di Nerve to obturator internus 5. Structures passing through lesser sciatic foramen: a, Intemal pudendal vessels Obturator intermus musde Pudendal nerve Nerve to obturator interns Pyriformis muscle PIC 2. TRUE aboutattachment at ischial tuberosity: (NEET Pattern 2015) Origin of semitendinosus from superolateral area b. Origin of semimembranosus from superolateral area Origin of lona head of biceps from inferolateral area Origin of adductor magnusfrom inferomedial area 4, Structure passing through both greater and lesser sciatic foramen are all except: (NET Pattern 2015) a. Pudendalnerve bi Internal pudendal vein Nerve to obturator intemus i Tendon of obturator interns 6. Sacrotuberous ligamentis pierced by: SI Nerve b. LSNerve © Cocaeal neve d. None (NBER Peattern.2045)EE eueR ULE Ge GUO 1, d.Adductor magnus * Posterior hamstring) part of adductor magnus takes origin from the ischial tuberosity 2. b Origin of semimembranosus from superolateral area + Semi-membranosus atisesby a long, flat tendon from a superolateral impression on the ischial tuberosity + Semitendinosus and biceps femoris long head) arises from an inferomedial impression on the upper area of the ischial tuberosity. + Hamstring part of adductor magnus originates from the inferolateral aspect of the ischial tuberosity + Infero- medial aspect of aluteal tuberosity has no muscle attachment and is covered by fibrofatty tissue and isin contact with the surface we sit upon. 3. b Obturator internusmusde + Iis the tencion (not muscle) of obturator internus, which passes through lesser sciatic natch, 4, d.Tendion of obturator internus + PIN Pudendal nerve Internal puclendal vessels and Nerve to obturator internus) structures come from pelvic cavity, pass through the greater sciaticnotch, hook behind the ischial spine (in gluteal region) and move into the lesser sciatic notch. + The tendon (and not muscle) of obturator intemus passes through the lesser sdatic notch. 5. a. Internal pudendal vessels, c. Pulendal nerve, d. Nerve to obturator internus + Pytiformis muscle pass through greater sciatic notch 6. « Coccygeal nerve + The sacrotuberous ligament is pierced by the coccygeal branches of the inferior aluteal artery, the perforating autaneous nerve and filaments of the coceygeal plexus.Bessa kee ulead 1, True about linea aspera: GIEET Pattern 2033) | 2, Wlusele attached to medial lip of linea aspera of femur, a. Formslateral border of femur QUEEF Pattern 2015) b, Formsmedial border of femur a, Short lead of biceps femoris © Continues as gluteal tuberosity b, Vastus lateralis: d. Presenton the posterior surface of femur © Vastus intermedius 4. Vastus medial 3, Lower end of femur is ossified from how many ossification | 4. Angle of theneck of femur to shaftis: centers: (NEET Pattern 2013) (MER 2007; NBEP 2013) al a 110° b2 b 125° c3 © 135° a4 4 100" Piero 1. c Continues as gluteal tuberosity » Linea asperaiis present on themiddle third of the posterior border of femur, » Superiorly the medial lip becomes continuous with the spiral line and the outer (lateral) lip becomes continuous with the gluteal tuberosity a, d. Short lead of biceps femoris, Vastus medial » From the medial lip of the linea aspera vastusmedialls originates. avait Lower end of femur has one secondary centre of ossification, which appears near the birth (@ months of intrauterine life} and fuses by 20th year 4, b. 125° » The femoral necks located between head and trechanters, * The femoral neck and the femoral diaphysis form the femoral neck angle that normally is about 125-1408 © Innormal adultitis about 125° and 135° in a child at age 3 years.ERs es CSc) 1. Allof the following are true about upper end of tibia except: {//2.) NUfient artery to tibia arises from whieh Of the following (412000) | arte (GiPMER2008) a. Ossification centre for the upper end fuses by 18 years a. Popliteal artery b. Meniscal cartilages attached to the intercondylar area b. Anterior tibial artery © Gives attachment to semimembranosus © Posterior tibial artery 4d Posterior aspect of patella articulates with upper end of tibia d.-Peronealartery laterally ANSWERS WITH EXPLANATIONS 1. d.Posterlor aspect of patella articulates with upper end of tibia laterally +) Patella hasno articulation’ is artiaulated to femur only + Upper end of tibia fuses with the shaftby 18 years, ‘+ Both medial and lateral menisd are attached to the intercondylar area on tibia, + Semi-membranosus musde is attached to the medial condyle of tibia, posterioty, 2, «Posterior tibial artery Nutrient artery is a branch of the posterior tibial artery; tay also arise at the level of the popliteal bifurcation or as a branch fram the anterior tibial artery.Eon BSS ied 1. FALSE about tibia fibula is: (NEET Pattern 2075) a. Nutrient artery of tibia is from posterior tibial artery b. Nutrient artery of ibulais from peroneal artery © Proximal end of tibia is related to common peroneal nerve dd. Tibiais the most common site of osteomyelitis ANSWER WITH EXPLANATION 1. Proximal end of ia Is related to common peroneal nerve There is no detail of common peroneal nerve relation to the proximal end of tibia in literature. Primary hematogenous osteomysiitisis more commonininfants and children, usually occurring in the long bone metaphysis, upper end of tibia being the commonest site of acute osteomyelitisEOSIN 1, Gluteofemoral bursa is in between gluteus maximus and: ¢NEET Pattern 201) Greater trochanter b. Lesser trochanter Ischial tuberosity i Vastus lateralis ANSWER WITH EXPLANATION 1.4. Vastuslateralis Gluteofemoral bursa is present between gluteus maximus and vastus lateralis,PSS eae ue 1. Regarding hip joint, which of the following statements is {//2)) Iiiofemoralligament arise from! PEI true: (NEET pattem 2012) a. Ischial tuberosity a. Retinaculum attaches femur to hip bone Anterior superior iliac spine b. Inferior gluteal nerve supplies the hip abductors € liopubic rami © Capsules attached to the intertrochantericline i Anterior inferior iliac spine dd llio-psoas causes hip abduction fe liacerest 3, Abduction of the thigh is limited by: 4, Hip flexionis done by all EXCEPT: ‘Tension in the adductors Hlio-psoas. b. Tension in the adductors and iliofemoral ligament b, Pectineus © Tension in the adductors and pubofemoral ligament © Sartorius Tension in the adductors and ischiefemaral ligament rl Semitendinosus steel Pubotemoral ligament Adductor brevis 5. Gluteofemoral bursa isin between gluteus maximus and: a. Greater trochanter (NET pattern 2014) b. Lesser trochanter © Ischial tuberosity d. Vastus lateralisESA ks au ute 1, & Capsuleis attached to the intertrochantericline + Capsule of the hip jointis attached to the intertrochantericline. + Retinaailar files are reflected capsular bres running on the neck of femur and carry arterial supply to neck and head of femur ‘They arent attached to hip bone. + Inferior gluteal nerve supplies gluteus maximus muscle, which is the chief extensor at hip joint Hip abductors are supplied by superior gluteal nerve, + Mlio-psoas musce is the chief musde for hip flexion. 2. d. Anterior inferior iliac spine ‘+ iofemoral ligament attaches to the anterior inferior iliac spine and the rim of the acetabulum, spreads obliquely downwards and lateral to attach to the intertrochanteric line on the anterior side of the femoral head Tension in the adductors and pubofemoral ligament ‘+ Pubofemoral adduicton) muscles and pubofemoral igaments pull the femur back towards pubis bone (midline), hence limiting abduction. 3. 4, d. Semnitendinosus ‘+ Hip flexion is chiefly carried out by ille-psoas muscle and assisted by musceslike pectineus, sartorlus etc + Semitendinosus is a hamstring muscle for hip extension along with the gluteus maximus. 5. d.Vastus lateralis, Guteofemoral bursa is present between gluteus maximus and vastus lateralis.Ges sOnd 1, Pes anserinus includes following three muscles EXCEPT: 2. Clergyman’s knee is an inflammation of: a. Semitendinosus (NET Pattern 2015) a Anserine bursa b. Semimembranosus b. Pre-patellar bursa © Gadilis c Suprapatellar bursa di. Sartorius Infrapatellar bursa Pate sce urns 1. b Semimembranosus = Tendons of one muscle from each of the three compartments of the thigh: sartorius (anterior), gracilis (medial), and semitendinosus (posterior) are inserted into the upper part of the medial surface of the tibla. Anserine bursa is at thelr tibial attachment separating, each other near their insertion and also from the tibial collateral ligament. 2. d.Infrapatellar bursa ‘The popular name, deraymanes knee, indicates that it is due to a position where the patient kneels down in church while praying may develop bursitis after repeated friction between the skin and the patella,PETS) 1, WEET Pattern 2015) Anterior part of intercondylar area of tibia Medial part of medial femoral condyle Lateral part of lateral femoral condyle . A healthy young athlete sitting at table with knee at 90-degree flexion. What will happen when he fully extends the knee? (AdlMS 2010) a. Miovementof tibial tuberosity towards medialborderof patella b. iovement of tibial tuberosity towards lateral border of patella ¢ blovement of tibial tuberosity towards centre of patella No change in relationship ‘ACL prevents: a. Anterior dislocation of tibia b. Posterior dislocation of tibia © Anterior dislocation of femur Posterior dislocation of femur The blood supply of anterior cruciate ligament is primarily derived from: (APG 2008) . Superior medial genicular artery b. Descending genicular artery Middle genicular artery a Gircumflex fibular artery Medial rotation of tibia in flexed leg is brought about by: a. Popliteus (IPMIER 2000) b. Vastus medialis © Quadriceps femoris di Adductor magnus A healthy young athlete sitting at table with knee at 90-degree flexion. What will happen when he fully extends theknee? (als) a, Movement of tibial tuberosity towards lateral border of patella b. blovementof tibial tuberosity towards medialborderof patella © Movement of tibial tuberosity towards centre of patella d. No change in relationship (REP 2014; JIPMER 2016) 2. Coronary ligament of knee! situated between: 4, Physiological locking involves: 10. 12. a, Mienisc and synovium b. Two posterior horns of menisci © Meniscus and tibial condyle Meniscus and fereral condyle ‘AlPG 2008, AIIMS 2012) (AIPG 2008; NBEP 2012) a, Internal rotation of femur over stabilized tibia b. Internal rotation of tibia over stabilized femur < External rotation of tibia over stabilized femur i. External rotation of femur over stabilized tibia About posterior cruciate ligament, TRUE statement ist a. Prevent posterior displacement of tibia (APG 2007) bb. Attaches to lateral femoral condyle Intrasynovial . Inserted an medial side of medial femoral condyle Oblique popliteal ligamentis pierced by: Anterior branch of popliteal artery b. Medial inferior genvcular branch of popliteal artery. Medial superior genicular branch of popliteal artery . Middle genicular branch of popliteal artery. (NEET Pattern 2083) Physiological locking involves: (UPC; NBEP 2013} a. Internal rotation of femur overstabilized tibia b. Internal rotation of tibia over stabilized femur External rotation of tibia over stabilized fer dd. External rotation of femur over stabilized tibia Anterior cruciate ligament prevents: (EET Pattern 2015} a. Anterior dislocation of tibia bb. Pasterior dislocation af tibia & Anterior dislocation of femur 4. Posterior dlistocation of femur11. 3 15, 7 19. ai A healthy young athlete sitting at table with knee at 90-degree flexion, What will happen when he fully extends theknee? calles) a. Movement of tibial tuberosity towards lateral border of patella bb, Movementof tibial tuberosity towards medial border ofpatella Movement of tibial tuberosity towards centre of patella No change in relationship Aboy playing football received a blow to thelateral aspect of the knee and suffered a twisting fall. His medial meniscus is damaged; which other structure is most likely to be injured? a. Deltoid ligament bb. Posterior cruciate ligament Anterior crudate ligament Patellar ligament Inpolio contracture of the iliotibial tract leads to all EXCEPT: 2. Hip flexion and abduction, b, Lateral rotation of tibia Knee flexion a Yarus deformity at knee TRUE statement about posterior crudate ligamentis: (APG 2007; AIMS 2007) a. Attached to the lateral fernoral condyle b, Intrasynovial ¢ Prevents posterior distocation of tibia dl Relaxed in full exion, TRUE about medial meniscus: Made up of hyaline cartilage Injury of lateral meniscus is more frequent then medial meniscus C-shaped Fived To medal callateratigament Inner partis more avascular Posterior dislocation of tibia on femur is prevented by: Posterior cruciate ligament Anterior crudate ligament ‘Medial meniscus; Lateral meniscus Medial collateral ligament (PGK 2019) pangs b © a e 12. Anterior cruciate ligament prevents: 4, Anterior dislocation of tibia bb, Posterior dislocation of tibia © Anterior dislocation of fernur di. Posterior dislocation of femur ANEET Pattern 2015) 14, All of the following movements are possible due to contraction of tensor fascia lata except: (aig) Medial rotation of hip joint ‘Abduction of hip joint Flexion of hip joint Extension of hip joint ance 16. ique popliteal ligament attaches to: Sernimembranosus Semitendinosus Adductor magnus Sartorius Patellar anastomosis is formed by which artery: (NET Partern 2014) IPMER 2005) aoreo 18, Descending genicular Anterior tibial recurrent Posterior tibial recurrent Allof the above 'Donoghue's triad comprises of: Anterior cudate ligament tear Posterior cuciate ligament tear ‘Medial meniscus Lateral meniscus ‘Medial collateral ligament 20. PIC 2015} pangsoange PGic2011)ESA tae AU 1. b. Anterior part of intercondylar area of tibia # Anterior cuciate ligament is attached to the anteriorintercondylar area of the tibia and posterior cruciate ligament posteriorly. Note: Naming as antetior and posterior is with reference to their tibial attachments, ‘G Menisci and tibial condyle + Coronary ligamentis that part of the capsule which lies between the periphery of menisci and the tibial condyle. It attaches the lower border of both the menisci to the tibia (also called as tibio-meniscal ligament) 3, b, Movement of tibial tuberosity towards lateral border of patella + In full extension the knee gets locked, which involves lateral rotation of tibia (since foot is off the ground). Hence; tibial tuberosity moveslaterally towards the lateral border of patella + Physiological Knee locking happens in the last 30° of knee extension and involves the rotation of either bone femur oF tibia. + IRinvolves medial rotation of femur on tibia if the foot is fixed to the ground (weight bearing leg) If the foot Is off the ground (as sitting on a table) then tibia has to rotate opposite (laterally) to lock the knee joint. In either cases tibial tuberosity moves laterally towards the lateral border of patella, + Pathological knee locking: Itis an orthopedic problem where patient has some meniscal injury and he finds difficulty in carrying out knee extension fully. 4, a. Internal rotation of femur over stabilized tibia > ¢ Extemal rotation of tibia over stabilized femur + When the oot is fixed to the groundand tibia stabilized, curing the laststages of knee extension, femur rotates internally (medially) to lock the knee joint. + Ifthe foot is off the ground (as sitting on a table) then tibia rotates opposite (extermally/laterally) to lock the knee joint, 5. a, Anterior dislocation of tibia > d, Posterior dislocation of femur + Anterior cruciate ligament (ACL) prevents the anterior displacement of tibia on the bone femurs, and posterior displacement of femur on tibia as well + INACL injury anterior drawer test becomes positive, ie, tibia becomes loose and can pulled anteriorly on the bone femur 2, 6, a,Prevent posterior displacement of tibia + Posterior cruciate ligament (PCL prevents posterior displacement of + PCL attaches to the lateral surface of the medial femoral condyle. + Itisintracapsular but extrasynovial, still ined by synovial membrane almost entirely 7. © Middle genicular artery + Middle geniautar artery is a branch of popliteal artery and supplies the cruciate ligaments and the synovial membrane of knee joint. + Itteaches the interior of knee by piercing the oblique popliteal ligament of the knee. + Fibular head artery is the circumflex fibular branch given by the posterior tibial artery, which contributes towards the anastomosis around the knee joint. + Descending genicular artery is a branch of femoral artery and also contributes to the knee joint anastomosis © Sopolidr peteculér artery a Ledridll of poolibestaniersand ian innioriark baaicl int die ariceterneue around the levee pont on femur,6. 10, n. 2, 2B. a. Prevent posterior displacement of tibia + Posterior cruciate ligament (P.} prevents posterior displacement of tibia on femur. ‘+ PL attachesto the lateral surface of the medial femoral condyle + _Itisintracapsular but extrasynovial, stil ined by synovial membrane almost entirely. . c Middle genicular artery ‘= Middle geniaular artery is abranch of popliteal artery and supplies the cruciate ligaments and the synovial membrane of knee joint. ‘* Itreaches the interior ef knee by piercing the oblique popliteal ligament af the knee. ‘+ Fibularhead artery is the circumflex fibular branch given by the posterior tibial artery, which contributes towards the anastomosis around the knee joint, + Descending denicular artery s a branch of femoral artery and also contributes to the knee joint anastomosis. + Superior genicular artery isa branch of popliteal artery andis an important branch in the anastomosis around the knee joint 4, Middle genicular branch of popliteal artery + Oblique popliteal ligaments an expansion from the tendon of semimemibranosus musde, running upward! and laterally superficial to the capsule to be attached to the interconeylar line of the femur, strengthens the capsule of knee joint posteriorly + [tis intimately related to the popliteal artery and pierced by: Middle genicular nerve, middle genicular vessels, and posterior division of the obturator nerve, . a. Popliteus ‘= Medial rotation of the flexed legis produced by popliteus, semimembranosus and semitendinosus, assisted by sartorius and gracilis. a. Internal rotation of femur over stabilized tibia > c. External rotation of tibia over stabilized femur ‘= When the footis fixed on the graund conjunct medial rotation of the femur on the tibia in the later stages of extension is part of a ‘Tocking’ mechanism, ‘= Locking of knee joint involves lateral rotation of tibia, if the foot is not fixed to the ground and is free in the ait. This statement is mentioned by fevy authors, hence answer of second preference. a. Movement of tibial tuberosity towards lateral border of patella = Thismanoeuvre leadstolocking of knee joint, with lateral rotation of tibia, and the tibial tuberosity moving towards|ateral border of patella. a. Anterior dislocation of tibia > d. Posterior dislocation of femur © Anterior cuciate ligament prevents anterior dislocation of tibia is mentioned by most of the authors, = Few other mention ACL prevents posterior dislocation of femur on fixed tibia, Anterior cruciate ligament © Thisis a case of terible (triple) triad and leads to damage of three ligaments: TC. (Tibial Collateral Ligament), medial meniscus and ACL (Anterior Cruciate Ligament). Lachman test becomespositive.12. 1B. 4, a.Anterlor dislocation of tibia > d. Posterior dislocation of femur Anterior auciate ligament prevents anterior dislocation of tibiais mentioned by most of the authors + Few other mention ACL prevents posterior dislocation of femur on fixed tibia, Anterior cruclateligament + Thisisa case of terrible (tiple) triad and leads to damage of three ligaments: TCL (Tibial Collateral Ligament, medial meniscus and ACL (interior Crudate Ligament). Lachman test becomes positive 4. Extension of hip joint ‘Tensor fasciae latae is one of the anterior thigh muscles It originates from the external lip ofthe iliac crest & descends to insert into the iliotibial tract + The iliotibal tract inserts into the anterolateral surface of the lateral tibial condyle. + Innervation is provided by the superior gluteal nerve L4, L5) = Itsactions are varied: = Abduction, flexion and medial rotation at hip ~ Weakextension of knee joint ~_ Stabilize the pelvis during walking Counters the pull of gluteus maximus on the iliotibial tract15. 16. v7, 18. 19. d.Varus deformity atknee ‘The typical contractures of polio = Ilio-tibial tractis the insertion of 2 muscles into the lateral tibial condyle. ‘+ The musdes are: gluteus maximus & tensor fascia lata. = In polio contracture it leads to flexion, abduction & lateral rotation at both the hip & knee joint. ‘+ Itleads to genu valgus ¬ varusatknee, sinceitis attached Callus on knee Flexion-Abduction i \ rom craw (nthe lateral tibial condyle) ean 9 a. Semimembranosus * Oblique popliteal ligamentis an expansion from the tendon Flagion: conleacue-of knoe, ay of semimembranosus muscle, runs upward and laterally and leg ( superficial to the capsule to be attached to the intercondylar ‘Varus and Vaigus \/ Enuinus deformity line ofthe femur. deformity of Foot of ankle Prevents posterior dislocation of tibia ‘+ Posterior cruciate ligament is attached to the posterior most impression on the intercondylar area on the tibia + Itruns in the forward and upward direction to reach the medial condyle of femur + When the knee is flexed, it resists the forces pushing tibia posteriorly in relation to fernut. Therefore itis important while acing downstairs or downhill Itrestricts anterior femoral dislocation on fixed tibia ‘+ Guciate ligaments ie within the capsule but are not inside the synovial cavity ¢, they are intracapsular and extrasynovial. #Itiswell relaxed in mid flexion. 4d. All of the above + Arnetwork of vessels is present around and above the patella and on the contiguous ends of the femur and tibia, forming a superficial and a deep plexus. C-shaped d, Fixed to medial collateral ligament ‘+ Menisci are crescenticC shape fibrocartlaginous structures, ‘The peripheries are vascularized by capillay loops from the fibrous capsule and synovial membrane, while their inner regions are avascular, {eniscal tears mostly occur in inner zone and seldom heal spontaneously (poor vascularity) Peripheral zone have the potential to heal spontaneously, due to good vascular supply. ‘+ Medial meniscusis more vulnerable to injury than lateral because of is fixity tothe tibial collateral ligament and areater excursion during rotatory movernent. + Lateral meniscus is pulled and protected by popliteus muscle. a. Anterior cruciate ligament tear; c, Medial meniscus; ¢. Medial collateral ligament = O'Donoghue’ triad may ocaur wien a football players dleated shoe is planted fly inthe turf and the knee is struck rom the lateral side, + [tis characterized by the {a} rupture of the tibial collateral igament, as a result of excessive abduction: (b} tearing of the anterior udate ligament, as a result of forward displacement of the tibia; and (@) injury to the medial meniscus, as a result of the tibial eolsicral aeaneneuttechenent21. b. Anterior cruciate ligament + PCL prevents posterior translation of the tibia (and posterior dislocation of tibia on femur) to limit hyperflexion of the knee.esse ake suite 1. The stability of the ankle joint is maintained by all of the 2, Deltold ligament isnotattached to: (AuiNMS 2009) following except: ‘Allis. 2003) ‘Medial cuneiform a. Plantar calcaneonavicular (spring) ligament b. Medial malleolus b. Deltoid ligament © Sustentaculum tali © Lateral igament 4 Spring ligament Shape of the superior talar articular surface 3. Stability of ankle joint is maintained by all except: 4, Deltoid ligament has all the following components except: a Collateral ligaments (Aili’S 2002) Anterior tibiotalar b. Cruciate ligaments b Tibionavicular Tendon of muscles crossing the joint © Tibiocalcaneal Close apposition of articular surfaces of bones a. Caleaneonavicular 5. Plantar flexion is brought about by which of these muscles: (PG#2002) a. Plantaris b FHL © Tibialis anterior Peroneus brevis SoleusPSE see nen 1. a. Plantar calcaneonaviailar (spring) ligament + Spring ligament works for the maintenance of medial longitudinal arch, 2. a, Medial cuneiform + Deltoid ligamentisa triangular (delta shaped ligament on the medial side of the ankle attached to tibia (Medial malleolus) + No partis attached to medial cuneiform bone. 3. bh Crudate ligaments + Guciate ligaments are present in the knee (ane not ankle) joint 4, 4, Calcaneonavicular + Deltoid ligament attaches to medial malleolus of tibia and calcaneonaviaular (spring) ligament has no such attachment. 5. Ans. a, Plantatis, b. FHL, e. Soleus Calf muscles carry out the movement of plantar flexion.ESS 1, Allare branches of lumbar plexus except: 2. Whatistheroot value of sciatic nerve: (NEETPattern 2012) . liohypogastricnerve (sbErPattern2015) a S1,52,83. b, ilioinguinal nerve b, L4L5;51,52,53 © Obturatornerve © L123, i. Subcostal nerve L234 3. Rootvalue of theposterior autaneousnerve ofthe thigh: 4, Nerve root of pudendal nerves: IREET Pattern 2014} a. SUS2 (NEETPattern2012) a S1,S2S3. b, $2583 b, $283.54 © S1,S253 © S354 $253.54 52583 PSs une 1. d. Subcostal nerve ‘+ Subcostal nerve arises from the anterior division of the twelfth thoracic nerve, is larger than the others: runs alona the lower border of the twelfth rib, often gives a communicating branch to the first lumbar nerve, and passes under the lateral lumbocostal arch. ‘+ Itinnervates the Transversus, and passes forward between it and the Obliquusinternus to be distributed in the same manner as the lowerintercostal nerves, + It communicates with the liohypogastric nerve of the lumbar plexus, and gives a branch to the Pyramidalis, It also gives off a lateral cutaneous branch that suppliessensory innervation to the skin over the hip. 2. bL4Ls}$15253 ‘+ Sciaticnerve arises from the ventral divisions of L-4,5 and $-1,2.3, 2 61/5253 = Posterior cutaneous nerve of thigh arises from the sacral plexus with root value $-1,2.3 4, b$2,53,54 + Pudendal nerve arises from the ventral primary rami of $-2.2.ESS es 1. Dermatomal supply ofthe perianal skin is: 2. Marked dermatome i asl (NEETPattern2012) a. Lt b. 12 bbs ‘ be Sd ad s2u. Posterior cutaneous nerve of thigh supplies skin | 4, overlying: (PGHC-2012) Lateral aspect of thigh Posterior inferior aspect of buttock Scrotum Back af thigh Popliteal fossa Meraigia paresthesia is due to involvement of: 6. a. Lateral cutaneous nerve of thigh (Alli’S-2015) b. lic-inguinal nerve © Genitofemoral nerve dl. Saphenous nerve Medial aspect of great toes supplied a. Saphenous nerve b, Deep peroneal nerve Superficial peroneal nerve id. Sural nerve Postero-lateral herniation of nucleus pulposus at 10. L5-S1 vertebrae level will result in pain located along the: a. Anterior aspect of the thigh b. Medial aspect of the thigh Antero-medial aspectof the leg d. Lateral side of the foot Deep peroneal nerve sensory innervation: a. Ist web space b. Sthweb space © Antero lateral dorsum of foot di Lateral partof leg During laparoscopic hernia repair a tack was acddently placed below and lateral to the illopubic tract. Post-operatively the patient com- plained of pain in the thigh. ‘due to the involvement of: a. Lateral cutaneous nerve of thigh (AiMS-2085) b. Mlio-inguinal nerve & Genite-femoral nerve id. Obturator nerve Root value of medial cutaneous nerve of thigh: a Lil2 (NET Pattern 2014) b 13,13 Superficial peroneal nerve di. Saphenous nerve ‘The skin overlying the region where a venesection is made to access the great saphenous vein is supplied by: (APG 2008) a. Femoral nerve b. Suralnerve Tibialnerve d_ Superficial peroneal nerve Knowledge of the segmental cutaneous innervation of the skin of the lower extremity is importantin determining thelevel of intervertebral disk disease. Thus, 51 nerve root irritation will result in pain located along the: a. Anterior aspect of the thigh ‘ativas 2004) b. Medial aspect of the thigh Anteromedial aspect of the leg, d. Lateral side of the foot (Alivas 2009)ANSWERS WITH EXPLANATIONS 1. asa + Perianal skins supplied by S4 root value of the pudendal nerve. 2, Ans.d.S-2 + Posterior calf and thigh region has $2 dermatome, 3. b Posterior inferior aspect of buttock, c. Scrotum, d. Back of thigh, e. Popliteal fossa «The root value of posterior cutaneous nerve of thighs S~ 1, 2,3, ‘+ Itsupplies the cutaneous region of posterior thigh and popliteal fossa. + Italso covers the cutaneous region on posterior inferior aspect of buttock region and saotum 4, a, Lateral cutaneous nerve of thigh + liopubic tract runs parallel and deeper to inguinal ligament. The nerve damaged in this scenarios lateral cutaneous nerve of thigh. + Lateral femoral cutaneous nerve arises from the lumbar plexus (L2-13) passes under the inguinal ligament near the anterior supetiorilac spine and supply skin on the anterolateral aspect of thigh. 5. a,Lateral cutaneous nerve of thigh + Inmeralgia paresthesia there is constant pain and abnormal perception in the outer side of the thigh, occasionally extending to the knee. + Thenerve invalvedislateral autaneous nerve of thigh 6. L213 ‘+ edial cutaneous nerve of the thigh 12, |3)isa branch of the anterior division of the femoral nerve + Itivides into anterior and posterior branches, which run medially across the femoral vessels, pierce the fascia lata at the mid-thigh, and supply the skin on the medial side of the thigh. 7. © Superficial peroneal nerve + lost of the dorsum of foot is supplied by superficial peroneal nerve, including medial side of areat toe. + Saphenousnerve supplies the medial side of the dorsum of foot, only tll the ball of areat toe, + Lateral side of the areat toe is supplied by the deep peroneal nerve. Itsupplies the Istweb space on the dorsum of foot 8, a. Femoral nerve +The nerve injured is saphenousnerve (branch of femoral nerve) + Great saphenous vein anterior to medial malleolusis the most preferred site of venesection (cut-down) in emergency. +The saphenous nerve accompanying the vein should be identified and secured, curing the procedure 9. d.Lateral side of the foot + Thenerve rootinvalvedlin this case of sip discis $1, and the corresponding dermatome irvolvedis the lateral side ofthe foot andlittle toe 10. d.Lateral side of the foot + Suralnerve supplies the skin over little toe and lateral margin of foot, bearing the dermatome SI.aw. a. Ist web space Peroneal nerve has 2 branches: superfidal and deep. The superficial peroneal nerve supplies almost the entire dorsum of foot whereas, deep peroneal nerve supplies the dorsum of first web space (inteidigital deft). The area over the great saphenous vein is supplied by the branches of femoral nerve, mainly the medial cutaneous branch of thigh and the saphenous nerve in the leg, Allered sensation aver the atea of great saphenous vein in leg may occur secondary to damaged saphenous nerve, as might occur during venae-section of great saphenous vein, Tibial nerve supplies the sensations over the back of the leg and the sole of the foot Sural nerve isa brand) of tibial nerve and runs along the short saphenous vein and supplies the dorsum of foot along its lateral border Gnduding the little toe).Eater 1, Following are the nerves and muscles of the leg. Choose the correct pair: a, Superficial peroneal: Soleus bb, Deep peroneal: Peroneus brevis © Tibial nerve: Tibialis anterior d. Common fibular nerve: Short head of biceps PSErenuns eeu 1. d. Common fibular nerve: Short head of biceps ® Short head of biceps is supplied by the common peroneal nerve. © Soleusis calf muscle supplied by posterior tibial nerve, * Petoneus brevis is a lateral leg muscles innervated by superficial peroneal nerve. © Tibialis anterior is supplied by deep peroneal nerve.1. Which nerve does NOT supply gluteal region? (AilifS 20/2) 2. Superior gluteal nerve acts at hip joint for: 4, Superior gluteal nerve a. Abdluction and lateral rotation b. Sdaticnerve b. Abduction and medial rotation Nerve to quadrates femoris © Adeluction and medial rotation Nerve to obturator intemus 1 Adeluction and lateral rotation, 3, Superior gluteal nerve supplies all EXCEPT: aitAs 2070) a. Gluteusminimus b. Gluteusmedius ¢ Tensor fascia lata d Gluteusmaximus Lower Limb Pn ue 1. b.Sdaticnerve + Sciatic nerve supplies back of thigh, the leg and footregion. + Itpasses through the gluteal region, but doestvt supply the area. 2. b, Abduction and medial rotation * Superior gluteal nerve supplies three musdes: gluteus medius, gluteus minimus and tensor fascia lata, which act at the hi abduction, medial rotation and pelyicrotation. 3. d. Gluteus maximus ® Gluteus maximus is supplied by the inferior gluteal nerve. © Superior gluteal nerve supplies the trio ~ Gluteus medius, Gluteus minimus and Tensor fascia latae.Gesu eu 1. Obturator nerve enters thigh (EET Pattein 2014) 2, Obturator nerve innervates all of the following muscles except: a. Adductor canal a. Adductor longus (NEET Pattern 2014) b. Obturator canal b. Pectineus © Superficial inguinal ring © Obturatorinternus Femoral canal A Obturator externus 3. A patient present with defective adduction of thehip joint and painsin the hip and knee joint. Which nerveis involved? a. Obturator nerve (AliMS 2000) b, Femoral nerve © Saphenous nerve 4. Sdaticneve ANSWERS WITH EXPLANATIONS 1. b, Obturator canal = Obturator canal isa passage way formedin the obturator foramen by part of the obturator membrane. + Iteonnects the pelvis ta the thigh and lets pass the obturator neurovascular bundle throudh it 2. © Obturatorinternus ‘© Obturator internus is supplied by the nerve to obturatorinternus 3. a, Obturator nerve = Thenerve working for hip adduction is obturator nerve by supplying medial thigh muscles. © Itgives articular branch to hip as well the knee joint, hence explains pain at both during a lesion, 1, $2).a special nerve from the sacal plexus.Eee 1. Tibial nerve injury causes: a. Darsiflexion of foot at ankle joint b. Plantar flexion of the foot at ankle joint Loss of sensation of dersum of foot Paralysis of muscles of anterior compartment of leg ¢. Loss of sensation over the medial border of foot (PGIC 2012} Phra seo nue 1. a, Dorsiflexion of foot at ankle joint + In tibial nerve injury posterior leg (calf) muscles and sole muscle are paralysed and there is sensory loss on the posterior calf region, lateral footand sole skin, © The patient is unable to do plantar flexion and the foot remainsin dorsifiexion.PSone) 1. Injury of common peroneal nerve at the lateral aspect of head of 2, Deep peronealnerve sensory innervation: (AlIMS2009) fibula result in al of the following EXCEPT: (alias 2008 a Ist web space a, Weakness of ankle dorsiflexion, b. Sthweb space b. Foot drop. cc Anterolateral dorsum of foot Loss of ankle reflex d. Lateral part of leg d. Sensory impairment on lateral aspect of leg extending to the dorsum of foot 3. An personisunableto dorsiflex the foot and therelslossof sensations 4. Features seen in common peroneal nerve injury: ‘on dorsal foot Possiblenerve injury ist (PGIC2013) a, Inversion inal (PGIE2010) a, Damage to common peroneal nerve at neck of fibula b. Loss of sensation of sole b, Damage to common peroneal at medial malleolus © Footdrop. Compression of anterior tibial nerve at ankle 1d Loss of extension of great toe dd, Damage to superficial peroneal nerve fe. Seen in fibular neck fracture © Damage of deep peroneal nerve 5, Which of the following may occur in common peroneal nerve injury? PGIC2015) Loss of dorsiflexion of toe Foot drops High stepping of foot Eversion of foot affected Loss of sensation over salle ANSWERS WITH EXPLANATIONS 1. GLoss ofankle reflex + Triceps surae muscles work for plantar flexion in ankle reflex are supplied by tibial nerve, which is not lesioned in this patient. 2, a.Istweb space + Peroneal nerve has 2 branches: superficial and deep. The superficial peroneal nerve supplies almost the entire dorsum of foot whereas, deep peroneal nerve supplies the dorsum of firstwel— space dinterdigital deft) +The afea over the great saphenous vein is supplied by the branches of femoral nerve, mainly the medial cutaneous brandh of thigh and the saphenous nervein the lea + Tibial nerve supplies the sensations over the back of the leg and the sole of the foot, + Sural nerveisa branch of tibial nerve and runsalona the short saphenous vein and supplies the dorsum of foot along its lateral border induding the litle toe). 3. c Compression of anterior tibial nerve at ankle, e. Damage of deep peroneal nerve ‘+ Isolated injury to the deep fibular nerve may result from compartment syndrome, from an intraneural ganglion cyst etc. + Individuals with lesionsof the deep fibular nerve have weakness of ankle dorsiflexion and extension ofall toes but normal foot eversion Sensory impairmentis confined to the first interdigital web space.3. c Compression of anterior tibial nerve at ankle, e. Damage of deep peroneal nerve ‘= Isolated injury to the deep fibular nerve may result from compartment syndrome, from an intraneural ganglion cyst ete, ‘= Individualswith lesionsof the deep fibular nerve have weakness of ankle dorsiflexion and extension of all toes but normal oot eversion. = Sensory impalimentis confined ta the first interdigital web space. —____§_ Lower Limb Foot drop, d. Loss of extension of great toe, e, Seen in fibular neck fracture * Fracture neck of fibula results in common peroneal nerve injury, leading to loss of dorsiflexion at the ankle (foot drop) and toes, alongwith inability of foot eversion (and not inversion). + There sloss of sensation on the dorsum of the foot and not sole). 5. a.Loss of dorsiflexion of toe; b. Foot drop; c. High stepping of foot; d. Eversion of foot affected = Commen peroneal nerve injury leads toloss of dorsiflexion at the ankle (foot drop) and toes, alongwith inal © There isloss of sensation on the dorsum of the foot (and not sole). ty of foot eversionPES 1. Apersonis unable to dorsiflex the foot and there is loss of 2. An altered sensation over the area of great saphenous vein sensations on dorsal foot. Possible nerve injury is: In leg Is seen due to injury to which of the following nerve: (PGIC-2012) (APG 2008) a, Damage to common peroneal nerve at neck of fibula, a. Femoral b, Damage to common peroneal at medial malleolus b. Tibial Compression of anterior tibial nerve at ankle © Sural d. Damage to superficial peroneal nerve 4. Peroneal e. Damage of deep peroneal nerve ——— Lower Limb 3. In L5 root involvement, which among the following is NOT 4. Injury to nerve which passes superior to piriformis and affected: (AiPG-2011) winds around greater sciaticnotch paralyzes: (NBEP-2012) a, Thigh abduction a. Gluteus medius b. Knee flexion b. Gluteus maximus: cc Knee extension © Obturato d. Toe extension . PiriformisPOA ure 1, a, Damage to common peroneal nerve at neck of fibula + Common peroneal nerve is prone to injury asit winds around the neck of fibula +The patient presents with features of foot drop (loss of dorsiflexion at ankle} and problems of foot eversion, alongwith sensory loss ‘on the dorsum of foot. 2. a, Femoral + The area over the great saphenous vein is supplied by the branches of femoral nerve, mainly the medial cutaneous branch of thigh and the saphenous nerve in the lea. + Altered sensation over the area of great saphenous veit during venaesection of great saphenous vein. + Tibial nerve supplies the sensations over the back of the leg and the sole ofthe foot + Sural nerve runs along the short saphenous vein and supplies the dorsum of foot along its lateral border (inducing the little toe). + Peroneal nerve has 2 branches: superficial and deep. The superficial peroneal nerve supplies almost the entire dorsum of foot, ‘whereas, deep peroneal nerve supplies the dorsum of frst interdigital lft, 3. «Knee extension + Knee extension is carried out by L-2, 3 and 4 (Femoral nerve). + Injury at the level of 5, doesnt affect knee extension, + Knee flexionis carried outby the root value: LS and $-1 (Tibial nerve). + Toe extension requires L-5 (deep peroneal nerve) 4, a. Gluteus medius + Superior gluteal nerve passes through the greater scaticforamen (above the piriformis muscle) to supply three muscles: gluteus medius, gluteus minimus and tensor fascia lata. ‘+ Superior gluteal nerve passes through the grazer sciatic foramen (above the piriformis muscle} to supply three muscles: gluteus ‘medius, gluteus minimus and tensor fasda lata. in leg may occur secondary to damaged saphenous nenre, as might occurES ONES 1, Lateral dislocation of patella is prevented by: 2, Strongest flexor of the hip join (NEET Pattern: 2012) a. Rectus femoris (NEST Patter 2015) a. Sartorius b, Vastus intermedi b. Gluteus maximus . Vastus lateralis © Hliopsoas aL Vastus medialis, dh Pectineus 3. Rectus femoris is part of quadriceps femoris causes: A, Action of sartorius muscles indudes all except: a. Hip fledion and knee extension a. Flexion of thigh (NEEF Pattern 2015) b. Hip and knee flexion b. Flexion of leg © Hip and knee extension © Extension ofleg d_ Hip extension and knee flexion d. Lateral rotator of thigh, EOS ence rend 1, d.Vastusmedialis = Vastus mer izes patella bone and prevents its lateral dislocation on femur. jopsoas + lliopsoasis the chief flexor at hip joint, assisted by sartorius and pectineus as the accessory muscles. © Gluteus maximus is the chief extensor at hip joint, assisted by hamstrings as the accessory muscles,.Hip flexion and knee extension + Rectus femoris. a part of quadriceps femoris pulls the tibia anterior for knee extension, + Rectus femorisalso act at the hip joint along with iliopsoas for hip flexion. Extension ofleg + Sartorius muscle help to attain the sartor (tailor) posture, + Itcauses flexion at both the hip and knee + Italso causesabduction and lateral rotation at Action of rectus femoris at hip and Sartor (tailor posture) attained by the activity of knee joints sartorius muscle: Flexion at both hip and knee joints and abduction & lateral retation at hip joint.1. Whatis TRUE about adductors of thigh: |. Ischial head of aclductor magnusis an adductor Profunda femoris artery is the main blood supply Ischial head of adductor magnus originates from adductor tubercle ‘Adductor magnus is the largest muscle ern 2015) b, « a 1. d. Adductor magnusis the largest muscle, > b. Profunda femoris artery is the main blood supply ‘Adductor magnus isthe largest muscle and is a hybrid muscle having two parts, Posterior ischial head of adductor magnus, takes origin from ischial tuberosity and is a hamstring part not adductor). Profunda femoris artery pravides major supply to all the three compartments of thigh including medial (adductor) compartment.Pee essen 1, The following arepart of hamstrings: (PGIC2014,15) 2, TRUE regarding semitendinosus: (MEET Pattern 2015) a. Semitendinosus Supplied by common peroneal part of siaticnerve a b. Semimembranosus bb. Proximal flashy distal thin, & Graclis Distal Mashy proximal thin 1d. Shorthead of biceps femoris 4, Proximal and distal thin micllle festy. ©. Sartorius: 3. Biceps femoris, a hamstring muscle causes: a. Hip flexion and knee extension b. Hip and knee flexion © Hip and knee extension AL Hip extension and knee flexion EOS ue 1. a. Semitendinosus, b. Semimembranosus = Hamstrings are: semitendinosus, semimembranosus, long head of biceps femoris and posterior part of adductor magnus, 2, b. Proximal flashy distal thin ‘= Semitendinosusisieshy in the upper part and formsa cordblike tendon in the lower part which ies posterior to semimembranosusmusde. + Itisa hamstring musde supplied by the tibial part of sciatic nerve. 3. d. Hip extension and knee flexion + Biceps femoris is one of the hamstring muscles along with semitendinosys, semimembranosus, and ischial head of the adductor ‘magnus, which extend the thigh al the hip and flex the leg atthe knee.eee 11. Gluteus maximusisinserted on: (NEETPatzem 2014) 2, TRUEregarding origin and insertion of piriformis: a, Lesser trochanter (NEET Pattern 2015) b. Greater trochanter Origin from sacrum and ilium andinsertion on LT Spiral line b. Origin from sacrum and ilium and insertion on GT . liotibial tract © Origin from ischial tuberosity and insertion on LT 4, Origin from ischial tuberosity and insertion on GT 3. Muscle attached to lateral surface of greater trochanter: 4, Gluteus mediusis supplied by the nerve: (A1PG-2010), a, Guteus maximus (NEETPattern 2014) a. Superior luteal b. Guteusmedius b. Inferior gluteal © Guteusminimus, Femoral Piriform 1d. Sciatic ANSWERS WITH EXPLANATIONS 1, di tliotibial tract + For aluteus maximus insertion, most fibers end in iliotibial tract, which inserts into lateral condyle of tibia; some fibers insert on luteal tuberosity 2. b. Origin from sacrum and ilium and insertion on GT. + Fitiformis musde takes its origin from anterior surface of sacrum, gluteal surface of ium and sacrotuberous ligament + Itsround tendon inserts on the medial side of the greater trochanter 3. b, Gluteus medius + Gluteus medius attaches to the lateral surface of greater trochanter. + Gluteus minimus attaches to the anterior surface of greater trochanter. + Gluteus maximus attaches on posterior aspect of femur bone at gluteal tuberosity 4, a, Superior gluteal + Gluteus medius is supplied by superior gluteal nerve. Supetior gluteal nerve supplies three muscles: gluteus medius, gluteus minimus and tensor fascia lata. + Inferior gluteal nerve supplies gluteus maximus musde (chief muscle forhip extension). + Femoral nerve supplies the anterior thigh muscles like quadriceps femoris. + Sciatic Gibial and peroneal) nerve supplies the posterior thigh musdes and the muscles of the leq and sole.FESS eeu) 1. Anterior compartment of leg contains all musdeEXCEPT: 2. Action of tibialis anterior: (NEET Pattern 2015) a. Peroneus brevis (NET Pattern 2012) a. Plantar flexion of foot b. Peroneus tertius b. Adduction of foot Extensor halluds longus Inversion of foot 4 Tibialis anterior d. None of the above 3. Alll are true about anterior compartment of leg EXCEPT: 4, Violent inversion of the foot will lead to avulsion of tendon (NEETPatiemn 2015) of the following muscle attached to the tuberosity of the Sth a. Tibialis anterior causes dorsiflexion of foot metatarsal: (altisS 2002) b. EHL causes extension of MTP joint of big toe a, Peroneus brevis, Peronaus longus causes eversian of foot b. Peroneus longus 4. Nerve supply is through deep peroneal nerve © Peroneus tertius d. Extensor digitorum brevis 5. Peroneus longus a. Invertor of foot b. Supplied by deep peroneal nerve _ Wiaintains arches of foot 4. Atises from tibia Pie esau 1. a.Peroneus brevis ‘+ Peroneus longus and brevis belong to lateral leg compartment, ‘= Peroneus tertiusis present in anterior leg compartment with extensors Tom, Dick & Harty (I-Tibials anterior, D- Extensor digitorum longus, H- Extensor Halluds longus. INEET Pattern 2015) 2. cinversion of foot ‘+ Tibialis anterior is a muscle of anterior (extensor) lea compartment for extension (dorsiflexion) at the ankle joint. ‘+ _Itworks with tibialis posterior for movement of inversion aswell. 3. GPeroneus longus causes eversion of foot 4, a, Peroneusbrevis ‘+ Peroneus longus and brevis cause eversion of foot at subtalar joint. ‘+ Tibialis anterior and posterior cause inversion of foot at subtalar joint, 5. & Maintains arches of foot ‘= Peroneus longus causes foot eversion andl maintains lateral longitudinal and transverse arches of foot + Ittakes its origin from fibula and is supplied by superficial peroneal nerve.ESS See ues 1. Which of the following tendonsmore likely torupture during violent dorsiflexion of the foot: (NEET Pattern 2033) a. EHL b, EDL c FHL 1. Plantaris 3, All are true about popliteus EXCEPT: a. Flexes the knee b. Unlodks the knee © Inserted on medial meniscus 4, Isintracapsular 5. Which muscle originates from both Interosseus membrane: a. Popliteus Flexor digitorum longus Flexor hallucis lonqus 1. Tibialis posterior 7. Tibialis posterior is inserted in all the tarsal bones EXCEPT: a. Galeaneus b. Intermediate cuneiform < Guboid d. Talus (NBEP-2013) ja and fibula and ANEEF Patter 2014) 2, Muscle acting both at knee and ankle jointis/are: a. Gastromemius (PCIC-2014, 15) b Soleus Plantaris A. Tibialis posterior @. Flexor hallucis longus 4, Which of the following muscles 4 Gastroonemius b. Popliteus. © Extensor hallucis longus 4. Extensor digitorum longus 6. INCORRECT statement regarding popliteus is: a. Intracapsular origin b. Attaches to medial lemniscus © Supplied by tibial nerve Causes flexion and medial rotation atknee joint Triceps surae: (BEP-2034)POSTE 1, d Plantaris + Plantarisis a muscle of calf region which get stretched in dorsiNexion, and might get ruptured 2. a, Gastrocnemius,, Plantaris +The only musdeswhich cross the knee joint as well as ankle joint are gastrocnemius & plantaris, «They both cause flexion atknee joint and plantar flexion at ankle joint. 3. c Inserted on medial meniscus + Popliteus muscle is inserted to lateral meniscus of knee joint 4, a, Gastrocnemius + Triceps surae indude three muscle (GPS): Gastrocnemius, plantaris and soleus. 5. d. Tibialis posterior 6, b. Attaches to medial meniscus. + Popliteus musde has intracapsular origin from the lateral condyle of femur, has attachment with the lateral lemnniscus énot medial) and insertsinto the postetior surface of tibia floor of popliteal fossa). + _Itissupplied by tibial nerve and unlocks the knee joint by medial rotation of tibia inunplanted foot}. Italso works with hamstring muscles for knee flexion, 7. d.Talus ‘+ Tibialis posterior muscle has extensive attachments on the foot bones, but is not attached to talus bone. Talus bone in the foot and Incus bone in the middle ear cavity has nohasno muscle attachments,PESseeee sue 1. True aboutiliotibial tract all EXCEPT: a. Receives insertion of gluteus maximus b. Derived from fascia lata Inserted on tibial tuberosity 4. Supports knee in semiflexed and extended position (NEET Pattern 2015) >) Lower Limb ANSWER WITH EXPLANATION 1. cInserted on tibial tuberosity © lliotibial tractis inserted on the Gerdy’s tubercle, on anterolateral surface of the lateral tibial condyle,ESS Seen) 1. In walking, gravity tends to tilt pelvis and trunk to the _ 2, Wrong about Trendelenburg testis: unsupported side, major factor in preventing this unwanted a. Contraction of gluteus maximusis assessed movement is b. Positive in superior gluteal nerve damage 2, Adductor muscles Right pelvis drops down in left superior aluteal nerve lesion, b. Quadriceps dd. Bilateral damage resultsin Waddling gait © Gluteusmaximus . Gluteus medius and minimus 3, Trendelenburg test is positive due to injury to thenerv 4, An 83-year-old man has trouble walking. At his physicians (alts 2008) office, he is asked to stand on his right foot and his left hip a. Inferior gluteal drops. Which of the following nervesismostlikely damaged, b. Superior gluteal ‘causing his problem: © Obturator a. Leftinferior gluteal Tibial b. Left superior gluteal © Right inferior gluteal dd Right superior gluteal 5, Inability to maintain pelvis position while standing on one leg, nerve paralysed: (IPMER-2016) a, Superior gluteal nerve bb. Inferior aluteal nerve & Tibial part of sdaticnerve L_ Common peroneal nerve OE mse uns 1. d.Gluteus medius and minimus * During walking, gravity tends to tlt pelvis and trunk to the unsupported side, these muscles prevent this unwanted movement, by counteracting gravity from the opposite side, 2. a, Contraction of gluteus maximusis assessed. + Trendelenburg testis to check the gluteus medius and minimus muscle (not the gluteus maximus} Superior gluteal nervelesion. paralyses gluteus medius and minimus, which leads to fall of contralateral pelvis during swing phase of walking cycle. © Ifthe nerve injury is bilateral, it leads to bilateral lurching (waddling gait)3. b. Superior gluteal ‘= Superior gluteal nerve, if to Trendelenberg test positive. injured, paralyses the 3 musdes: gluteus medius, gluteus minimus and tensor fascia latae and hence lead + These 3 muscles, espedally the gluteus medius raises the unsupported hip during walking, which otherwise will be pulled down by the gravity. + InTrendslenberg test this action of gluteus medius (superior pelvic tilt of contralateral hip) is absent and we actually observe that there is a downward drop of the unsupported hip -due to unoppased action of gravity. «This leadsto Lurching gait in the patient |. Right superior gluteal = ee job being performed by gluteus mecius, 3. Superior gluteal nerve In this patient the right superior gluteal nerve is damaged, leading to failure of abductor mechanism of gluteus medius, ‘Thereis also the failure of muscle to cause an upward lift of left ‘Normally the superior gluteal nerve leads to pelvicstability while a person stands on a single foot, by elevating the opposite hip- the ip. when the patientis asked to stand on his right foot When a person who has suffered a lesion of the superior gluteal nerve is asked to stand on one lea, the pelvis on the unsupported side descends, indicating that the gluteus medius and minimus on the supported side are weak or nonfunctional This sign is referred to clinically as a pesitive Trendelenburg test. Pee ue 1, Hybrid muscles are all EXCEP a. Peatineus b. Adductor magnus Tensor fascia lata d. Biceps femoris 3. Which of the following muscle sinvolved in movement from sitting to standing position: (MEET Pattern-2014) a. Gluteusmaximus b. Obturator intemus cc Gluteusmedius d. Gluteusminimus 2. Identify the marked mus¢le in the gluteal region: a Oblurator externus b, Obturatorintemus © Quadratus femoris d. Piriformis 4, Which of the following muscle has intracapsular origin: ‘Anconeus Coracobrachialis Long head of biceps femoris Popliteus Peroneus longus, (PaIC-2012) paoseBOSS ae sue 1, Hybrid muscles areal EXCEPT: 2, Identify the marked musde in the gluteal 59 a. Pectineus region: i b. Adductor magnus a, Obturator externus i Tensor fascialata b. Obturator intermus Biceps femoris © Ouadratus femoris 4 Piiformis 3. Which of the following muscles involved in movement 4, Which of the following muscle has intracapsular ori from sitting to standing position: (NEFTPattern-2014) Anconeus: (PGIC-2012) a. Guteusmaximus Cotacobrachialis b. Obturator internus Long head of biceps femoris Guteusmedius Popliteus d. Guteus minimus Peroneus longus eaoge 5. With foot off the ground and knee flexed, medial rotation of ti a. Popliteus bb. Vastus medialis, & Gastrocnemius i. Adductor magnus is broughtabout by: (PER 2007) ee nue 1, G Tensor fascia lata + Tensor fascia latais supplied by a single nerve - superior gluteal nerve, 2. G Quadratus femoris + Under cover of gluteus maximus, a quadrangular musde, attached to bone femur is called quadratus femoris 3. a. Gluteus maximus © Gluteusmaximus worksas an extensor of trunk on thigh, when raising the trunk from sitting, acting from the pelvis it an extend the flexed thigh and bring it in ine with the trunk. 4. 4, Popliteus. + Long head of biceps brachii and the popliteus muscle has intracapsular origin. 5. a.Popliteus + Popliteus muscle causes unlocking of knee joint, when footisin the air, by rotating ia medially.Pee sue 1 The superficial extemal pudendal artery is a branch oft a. Femoral artery (NEET Pattern 2015) External liac artery Internal iiacartery di Aorta The blood supply to femoral head is mostly by: a. Lateral epiphyseal artery (NEETR Pattern 2013) b. Medial epiphyseal artery © Ligamentum teres artery L_Profunda femoris In the following nutrient arteries to bones, choose the WRONG pair: a. Humerus: Profunda brachit b. Radius: Anterior interosseous Fibula: Peroneal Tibia: Anterior tibial Popliteal artery is difficult to palpate because: a. Itisnot superficial b. Does not pass over prominent bony structure c Superficial but does net pass over prominent bony structure 2. Superficial epigastricartery is a branch of HFETPatzern 2015) a. Internal pudendal artery b. External pudendal artery © Intetnaliliacartery Femoral artery 4, Theblood supply to femoral head a. Obturator artery b._ Internal puclendal artery Lateral Groumtflex femoral artery dL Femoral artery fe. Profunda femoral artery 6. Middle genicular artery is. branch oft Femoral artery Popliteal artery Anterior tibial artery Posterior tibial artery (PGIC2014, 2003) (AG 2009} d._ Not superficial and does not pass aver prominent bony structurePSA an ue! 1. a.Femoral artery + Superficial external pudendal artery is one of the three puclendal arteries. + Deep external pudendal artery i also. branch of femoral artery whereas, Internal pudendal artery isa branch ofintemal iliac artery {anterior division}, 2. d.Femoral artery + Superficial epigastric arteryis a branch of femoral artery. + Inferior epigastric artery arises from external iliac artery. Superior epigastric artery is a branch of internal thoracic artery. 3. a, Lateral epiphyseal artery + The lateral epiphyseal artery (the terminal branch of the medial ciraumflex femoral artery) isthe primary blood supply and runs along the postero-superior aspect of the femoral neck before terminating into 2-4 retinacular arteries that enter the femoral head + The femoral head receives blood supply mostly from the MFCA (medial circumflex femoral artery) ~_ Alsofrom the anastomoses that contribute te the blood supply ofthe femoral head, the most importantis the anastomosis with the IGA Gnferior gluteal artery) via the piriformis branch, which can also be a dominant vessel supplying the femoral head. ~The anteriornutrient artery ofthe femoral neck—originating from the lateral circumflex artery—and the obturator artery, via the artery of the ligamentum teres, constitute a minor component of the blood supply to the femoral head 4, a, Obturator artery, c Lateral ciraimflex femoral artery, d, Femoral artery, e, Profunda femoral artery + Femoral heads supplied by branch of obturator artery, meciial &lateral circumflex arteries and inferior & superior aluteal arteries + Medial circumflex artery may be a direct branch of femoral artery occasionally. + _Itisalso supplied by Tstperforating branch of profunda femoral artery. 5. d.Tibia: Anterior tibial * Nutrient artery to tibia is a branch of posterior tibial artery 6. b Popliteal artery. * Five genicular arteries are aiven by popliteal artery induding middle genicutar artery) to supply knes joint. + There ate two superior (medial &lateral} and two inferior (medial & lateral 7. 4.Not superficial and doesnot pass over prominent bony structure + Popliteal arteryis the most difficult ofthe peripheral pulses to feel because it ies deep in the popliteal fossa and does nat pass over oreient be arcrmetare:io 11. TRUE regarding saphenous vein: (PGIC2014) a. Long saphenous vein formed as continuation of medial side of deep venous arch, bb. _Longsaphenous vein — situated posterior tomedial malleolus Long saphenous vein— closely related to saphenous nerve «L_ Short saphenous vein— open into great saphenous vein Short saphenous vein assodated with sural nerve 3, All are true about short saphenous vein EXCEPT: a, Runs behind lateral malleolus (NEET Pattern 2015) b. Runs on lateral side of leg Accompanied by sural nerve Achilles tenclon is medial to vein 5. Hunterian perforators are seen in: a, Upper thigh b. Lower thigh © Calf dl Mic-thigh The direction of the flow of venous blood in conditions of valve Incompetence affecting perforating veins of lower limb is: (AUMS 2005) a, Along aravity b. Superficial todeep © Along osmotic gradient Deep to superticial attern 2013} 2. TUR 2. TRUE statement about great saphenous vein (INEET Pattern 2015) a. Itbeginsat lateral end of dorsal venous arch bb Itruns anterior to medial malleclus <_Itis accompanied by sural nerve Terminates into popliteal vein 4. A patient was on DVT prophylaxis. All of the following has perforators which connect superficial veins to the deep veins EXCEPT: ‘ALIMS 2007) a. Ankle b_Belowringuinal ligament < Mid-calf Lower thigh 6 All areValveless EXCE a, Dural venous sinus b. Hepatic veins © Inferior vena cava Femoral vein 8 Inferior epigastric vein drainsinto: a, Femoral vein b. External iiacyein Internaliliacvein 4. Internal pudendal vein (REEF Pattern 2035)9. TRUE about saphenous opening: (EET Pattern 2014) a, Transmits saphenousnerve b. Lies cmlateral and superior to pubic tubercle & Covered by crbriform fascia 4. Opening in eribriform fascia Waele anaes 1, a, Long saphenous vein formed as continuation of medial side of deep venous arch; c. Long saphenous vein- closely related to saphenous nerve; e. Short saphenous vein associated with sural nerve + Long saphenous veinis formed by the union of the medial end of dorsal venous arch with the medial marginal vein which drains the ‘medial se of areat toe. It passes upwards anterior (not posterior) to the medial malleolus, +The saphenous nerve has a course aleng with the long saphenous vein. ‘Short saphenous vein is accompanied by the sural nerve and opens into the popliteal vein (not great saphenous vein), bb. Itruns anterior to medial malleolus + Great saphenousyein beginsat the medial end of dorsal venous arch, runs anterior te medial malleolus isaccompaniedby saphenous nerve and terminates into femoral vein + Short saphenousnerve begins at the lateral end of dorsal venous arch, runs posterior to lateral malleolus is accompanied by sural nerve and terminates into popliteal vein, 3. b Runs on lateral side of leg + Short saphenous nerve begins at the lateral end of dorsal venous arch, runs superiorly behind the lateral malleolus, along the lateral edge of tendocalcaneus, and is accompanied by the sural nerve on its lateral side + Itkeeps ascending in the middle of the back of the leg eventually terminates into popliteal vein b. Below inguinal ligament + Thereis no perforater veins below the inguinal ligament. 5. 4.Mid-thigh + Hunterian perforatoris present in mic! thigh at the lower part of adductor (Hunterian) canal. ‘+ Itconneets great saphenous vein with the femoral vein, in the mid-thigh, 6. d.Femoral w + Femoral veins contain between one and six valves, and popliteal veins contain between zero and four valves. + Deep veinvalvesare consistently located in the common femoral vein (within 5 cm of the inguinal ligament), the femoral vein (within 3.om of the deep femoral vein tributary) and in the popliteal vein near the adductor hiatus 7. d.Deep to superficial + Incompetent valves affecting perforating veins of lower limb makes the blood flow from deep to superficial direction, + Thismakes the superficial veins overfiled with blood and they become dilated, elongated and tortuous — varicose veins. + Normally the venous blood flows from the superficial to deep veins via the perforating veins, which have valves to make sure this unidirectional flow of blood.. Deep to superficial Incompetent valves affecting perforating veins of lover limb makes the blood flow from deep to superficial direction. This makes the superficial veins overfilled with bload and they become dilated, elongated and tortuous varicose veins, Normally the venous blood flows from the superficial to deep veins via the perforating veins, which have valves to make sure this unidirectional low of blood. b. Externalilliacvein Inferior epigastricvein drains into the external iiac vein and anastomoses from the superior epigastric vein. Itis accompanied by the inferior epigastiic artery, which itself is a branch of external iliac artery. Covered by cribriform fascia Saphenous openingis an oval defect in the fascia lata in frontof the thigh, for the passage of great saphenous vein into the femora vein, The centre of the opening is about 4 cm inferolateral to the pubictuberde. The saphenous openingis closed by a membrane of ateolar tissue — the cribriform fascia whichis pierced by great saphenous vein, sup- erficial epigastric and superficial external pudendal vessels and Iymph vessels connecting superfidal and deep inguinal lymph nodes.Pee sien 1, Skin and fascia of great toe drains into: (NET Pattern 2075) 2. Skin and facia covering the ball of the big toe drain the Superficial inguinal lymph nodes lymphatics into: (NEET Patter 2015) b. Externaliliacnodes a. Vertical group of superfidal inguinal lymph nodes Internal liacnodes Horizontal group of superfidal inguinal lymph nodes d._ Deep inguinal nodes i b, cPopliteal lymph nodes Deep inguinal lymph nodes ere cue 1. a, Superficial inguinal lymph nodes © Skin and fascia of drain into the superfidal lymphatics, most of which end in superfidal inguinal lymph nodes. 2. a.Vertical group of superficial inguinal lymph nodes » Lymphatics from skin and superfidal fascia of great toe accompany great saphenous vein and drain inte superficial inguinal lymph. nodes (vertical group).Petey 1, Whats most medial in the femoral triangle? _(Alii#S 2009) {//2./ All are Contents of femoral triangle EXCEPT: a, Lymphatics (NEED Pattern 2015) bo Nene a. Femoral artery © vain b. Femoral vein di. Artery © Superfidal inguinal lymph nodes d._ Nerve to pectineus 3, All are contents of femoral sheath EXCEPT: (PIMER 200%, 4; NET Pattern 2012) a. Femoral artery b. Femoral nerve Femoral vein d. Genitofemoral nerve 1. a.lymphatic + Femoral triangle has the deep inguinal lymph nodes in the medial most region + Femoral trianale is present in the anterior thigh and is bounded by superior - inguinal ligament; medial - medial marain of the adductor longus musde and lateral - medial margin of the sartorius muscle. The contents (lateral to medial) are: Lateral cutaneous nerve of thigh; terminal part of the femoral nerve and its branches; the femoral branch of genitofemoral nerve; femoral sheath having three compartments with contents dateral to medial): Femoral artery and its branches; femoral vein and its tributaries and femoral canal, which contains lymphatic vessels and deep inguinal lymph nodes. 2. © Superficial inguinal lymph nodes * The superficial inguinal lymph nodes are found deep to Camper’sfascia and superficial to fascia lata + Since femoral triangle isa sub-tasclal space (fascia lata being the roof}, itis only the deep inguinal lymph nodes, which are contents of femoral triangle, 3. b.Femoral nerve © Femoral nerve is a content of femoral triangle, but is not covered by femoral sheath,Eos reiaeesuened 1. All of the following pairs regarding adductor canal are true | 2. Which of the following structure(s) pass through adductor EXCEPT: GIPMER 2010) | magnus? (PGIC 2015) a, Roof: Sartoriusmuscle a. Femoral vessels Contents: Femoral nerve b b. Femoral nerve ¢ Floor: Adductor longus and magnus Femoral sheath dL. Anteto-lateral boundary: Vastus medialis, Saphenous nerve Tibial nerve Wate nnlsae uur 1. b Contents: Femoral nerve = Femoral nerve ismot.a content of adductor canal 2. a. Femoral vessels ‘= Adductor magnus has a hiatus through which pass the femoral artery and vein from the adductor canal to enter the popliteal fossa. = Femoralartery,vein and nerve are presentinfemoral triangle, artery and vein inside thefemoral sheath (nerve being outside the sheath). Saphenous nerveisa branch of femoral nervein femoral triangle, enters the adductor canal, but does not leave through the acductor hiatus instead penetrates superficially halfway through the adductor canal Tibial nerve is located in the posterior thigh and descend inferiorly to become a content of popliteal fossa.