CHAPTER 5 Lower Limb 195

REVIEW 4. Structure 4 is the

A. superior ramus of pubis.
B. body of pubis.
Completion Questions C. lesser trochanter.
D. ischial tuberosity.
Based on the anteroposterior radiograph of the hip region, E. ischial ramus.
select the phrase that best completes each statement. F. None of the above.
5. Structure 5 is the
A. lesser sciatic foramen.
B. greater sciatic foramen.
C. subpubic angle.
D. obturator foramen.
E. fovea capitis.
F. None of the above.

Based on the anteroposterior radiograph of the knee joint,

select the phrase that best completes each statement.

1. Structure 1 is the
A. neck of the femur.
B. margin of obturator foramen.
C. acetabulum.
D. iliopectineal line.
E. lesser trochanter.
F. None of the above.
2. Structure 2 is the
A. head of femur.
B. iliopectineal line.
C. ischiotuberosity.
D. lesser trochanter.
E. neck of the femur.
F. None of the above.
3. Structure 3 is the 6. Structure A is the
A. greater trochanter. A. head of the fibula.
B. lesser trochanter. B. medial condyle of the femur.
C. ischial tuberosity. C. site of the epiphyseal line.
D. acetabulum. D. lateral condyle of the tibia.
E. ischial ramus. E. intercondylar eminence.
F. None of the above. F. None of the above.

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7. Structure B is the 11. Structure 1 is the

A. intercondylar eminence. A. calcaneum.
B. medial condyle of tibia. B. lateral malleolus.
C. tibial tuberosity. C. body of talus.
D. lateral meniscus. D. navicular.
E. anterior cruciate ligament. E. medial malleolus.
F. None of the above. F. None of the above.
8. Structure C is the 12. Structure 2 is the
A. medial meniscus. A. cuboid.
B. lateral condyle of tibia. B. medial cuneiform.
C. lateral condyle of femur. C. navicular.
D. intercondylar eminence. D. head of talus.
E. site of epiphyseal line. E. intermediate cuneiform.
F. None of the above. F. None of the above.
9. Structure D is the 13. Structure 3 is the
A. lateral condyle of tibia. A. sustentaculum tali.
B. neck of the fibula. B. neck of the talus.
C. superior tibiofibular joint. C. navicular.
D. common peroneal nerve. D. calcaneum.
E. head of the fibula. E. lateral malleolus
F. None of the above. F. medial malleolus.
10. Structure E is the 14. Structure 4 is the
A. site of epiphyseal line. A. medial malleolus.
B. styloid process of head of fibula. B. body of talus.
C. lateral condyle of tibia. C. lateral malleolus.
D. attachment of medial collateral ligament. D. neck of the talus.
E. articular surface of head of fibula. E. cuboid.
F. None of the above. F. None of the above.
15. Structure 5 is the
Based on the lateral radiograph of the ankle region, select the A. navicular.
phrase that best completes each statement. B. medial cuneiform.
C. tuberosity of the navicular.
D. calcaneum.
E. insertion of the tendo calcaneus.
F. None of the above.

Select the phrase that best completes each statement.

16. Flexion of the hip joint (with the knee extended) is lim-
ited by the
A. iliofemoral ligament.
B. anterior abdominal wall.
C. ischiofemoral ligament.
D. pubofemoral ligament.
E. anterior superior iliac spine.
F. None of the above.
17. Abduction of the hip joint is limited by the
A. pectineus muscle.
B. iliofemoral ligament.
C. ischiofemoral ligament.
D. pubofemoral ligament.
E. ligament of the head of the femur.
F. None of the above.
18. Extension of the hip joint is limited by the
A. iliofemoral ligament.
B. pubofemoral ligament.
C. ischiofemoral ligament.
D. quadriceps muscle.
E. adductor magnus muscle.

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 CHAPTER 5 Lower Limb 197

19. Flexion of the hip joint (with the knee flexed) is limited D. internal iliac nodes
by the E. vertical group of superficial inguinal nodes.
A. hamstring muscles.
28. The lateral meniscus of the knee joint
B. iliofemoral ligament.
A. has a thick inner border.
C. adductor magnus muscle.
B. is strongly attached around its circumference to
D. pubofemoral ligament.
the tibia.
E. anterior abdominal wall.
C. is more frequently torn than the medial meniscus.
F. ischiofemoral ligament.
D. is strongly attached to the lateral collateral
20. The long head of the biceps femoris muscle is inner- ligament.
vated by the E. is attached by its anterior horn to the tibia in front
A. obturator nerve. of the intercondylar eminence.
B. tibial portion of the sciatic nerve.
29. Lymph from the skin of the lateral side of the foot drains
C. femoral nerve.
into the
D. common peroneal nerve.
A. popliteal nodes.
E. sural nerve.
B. internal iliac nodes.
21. The gracilis muscle is innervated by the C. vertical group of superficial inguinal nodes.
A. femoral nerve. D. horizontal group of superficial inguinal nodes.
B. common peroneal nerve. E. subsartorial nodes.
C. sural nerve.
D. obturator nerve. 30. Lymph from the skin of the medial side of the knee
E. tibial portion of the sciatic nerve. drains into the
A. popliteal nodes.
22. The gluteus maximus muscle is innervated by the B. vertical group of superficial inguinal nodes.
A. inferior gluteal nerve. C. medial group of the horizontal superficial inguinal
B. nerve to quadratus femoris. nodes
C. obturator nerve. D. internal iliac nodes.
D. superior gluteal nerve. E. lateral group of horizontal inguinal nodes.
E. nerve to obturator internus.
31. Lymph from the skin around the anus drains into the
23. The sartorius muscle is innervated by the A. internal iliac nodes.
A. obturator nerve. B. inferior mesenteric nodes.
B. femoral nerve. C. lateral group of horizontal superficial inguinal
C. nerve to vastus medialis. nodes.
D. superior gluteal nerve. D. medial group of horizontal superficial inguinal
E. lateral cutaneous nerve of the thigh. nodes.
24. The hamstring portion of the adductor magnus muscle E. vertical group of inguinal nodes.
is innervated by the
A. common peroneal nerve.
B. tibial portion of the sciatic nerve. Multip le-Ch oice Questions
C. obturator nerve.
D. femoral nerve.
Select the best answer for each question.
E. nerve to the pectineus muscle.
32. The sciatic nerve enters the gluteal region through
25. The adductor longus muscle is innervated by the
which foramen?
A. femoral nerve.
A. Posterior sacral
B. common peroneal nerve.
B. Greater sciatic
C. tibial portion of the sciatic nerve.
C. Anterior sacral
D. anterior division of the obturator nerve.
D. Lesser sciatic
E. posterior division of the obturator nerve.
E. Obturator
26. A malignant melanoma (cancer) of the skin covering
33. The common peroneal nerve can be palpated in which
the buttock is likely to spread via lymphatics to the
region of the knee?
A. horizontal group of superficial inguinal nodes.
A. As it winds around the medial side of the neck of
B. vertical group of superficial inguinal nodes.
the fibula.
C. posterior axillary nodes.
B. As it passes around the medial condyle of the tibia.
D. popliteal nodes.
C. As it winds around the lateral side of the neck of
E. internal iliac nodes.
the fibula.
27. Lymph from the nail bed of the big toe drains into the D. As it passes forward b etween the tibia and the
A. horizontal group of superficial inguinal nodes. fibula.
B. presacral nodes. E. As it crosses the lateral side of the head of the
C. popliteal nodes. fibula.

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34. If the dorsalis pedis artery is severed just proximal to its 41. The femoral nerve arises from which of the following
medial and lateral tarsal branches, blood can still reach segments of the spinal cord?
the dorsum of the foot through which vessel(s)? A. L2 and 3
A. The peroneal artery. B. L4 and 5 and S1, 2, and 3
B. The posterior tibial artery. C. L2, 3, and 4
C. The medial plantar artery. D. L1 and 2
D. The lateral plantar artery. E. L5 and S1, 2, and 3
E. All of the above. 42. The dermatome present over the lateral side of the foot
35. In children, the chief arterial supply to the head of the is which of the following?
femur is derived from which artery or arteries? A. S5
A. The obturator artery. B. L3
B. The internal pudendal artery. C. S1
C. Branches from the medial and lateral circumflex D. L4
femoral arteries. E. L5
D. The deep circumflex iliac artery. 43. The femoral sheath is formed by which of the following
E. The superficial circumflex iliac artery. layer(s) of fascia?
36. Which statement is correct concerning the femoral ring? A. The pectineus fascia
A. It is the opening in the deep fascia of the thigh for B. The fascia iliaca and the fascia transversalis
the great saphenous vein. C. The fascia lata and the membranous layer of the
superficial fascia
B. It is the opening in the adductor magnus muscle
D. The psoas fascia and the fatty layer of superficial
for the femoral artery.
fascia
C. It is the proximal opening in the femoral canal.
E. The processus vaginalis
D. It is the compartment in the femoral sheath for the
femoral artery. 44. Which of the following muscles everts the foot?
E. It is the compartment in the femoral sheath for the A. The tibialis posterior muscle
femoral nerve. B. The flexor hallucis longus muscle
C. The peroneus longus muscle
37. To lift the left foot off the ground while walking, which of D. The tibialis anterior muscle
the following muscles plays an important role? E. The flexor digitorum longus muscle
A. The left gluteus medius muscle
B. The left gluteus maximus muscle 45. Injury to the common peroneal nerve results in which
C. The right adductor longus muscle condition?
D. The right gluteus medius muscle A. Inability to invert the foot
E. None of the above. B. Inability to plantar flex the ankle
C. Inability to feel skin sensation on the medial side of
38. Rupture of the tendo calcaneus results in an inability to the leg
do what? D. Inability to plantar flex the big toe
A. Dorsiflex the foot E. Inability to evert the foot
B. Evert the foot
C. Invert the foot 46. After a lesion of the tibial part of the sciatic nerve, some
D. Plantar flex the foot active flexion may still be possible at the knee joint; the
muscles responsible for this remaining flexion include
E. None of the above.
which?
39. A sprained ankle resulting from excessive eversion most A. The short head of the biceps femoris muscle
likely demonstrates that which structure is torn? B. The gastrocnemius muscle
A. The talofibular ligament C. The plantaris muscle
B. The tendo calcaneus D. The popliteus muscle
C. The deltoid ligament E. The long head of the biceps femoris muscle
D. The interosseous ligament 47. A patient in the supine position with the hip and knee
E. The peroneal retinaculum joints extended is asked to abduct the lower limb
40. If the foot is permanently dorsiflexed and everted, against resistance provided by the physician; this exer-
which nerve might be injured? cise tests which of the following muscles?
A. The deep peroneal nerve A. The semitendinosus muscle
B. The superficial peroneal nerve B. The gluteus medius muscle
C. The common peroneal nerve C. The pectineus muscle
D. The tibial nerve D. The gracilis muscle
E. The obturator nerve E. The semimembranosus muscle

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48. A femoral hernia has the following characteristics ex-
cept which?
A. It is more common in women than in men.
B. The swelling occurs below and lateral to the pubic
tubercle.
C. It descends through the femoral canal.
D. Its neck is related immediately laterally to the
femoral artery.
E. Its neck is related medially to the sharp edge of the
lacunar ligament.
49. The gastrocnemius and the soleus muscles have all the
following features in common except which?
A. They are supplied by the tibial nerve.
B. They are found in the posterior compartment of
the leg.
C. They arise from the femoral condyles and flex the
knee joint.
D. They insert via the tendo calcaneus.
E. They plantar flex the ankle joint.
50. All the following statements about the sartorius muscle
are correct except which?
A. It flexes the leg at the knee joint.
B. It flexes the thigh at the hip joint.
C. It laterally rotates the thigh at the hip joint.
D. It adducts the thigh at the hip joint.
E. It attaches to the anterior superior iliac spine.
51. The following structures are transmitted through the
lesser sciatic foramen except which?
A. The tendon of the obturator internus muscle
B. The internal pudendal vessels
C. The nerve to the obturator internus muscle
D. The pudendal nerve
E. The inferior gluteal artery
52. The following statements regarding the great saphenous
vein are correct except which?
A. It arises on the dorsum of the foot.
B. It enters the leg by passing anterior to the medial
malleolus.
C. It drains into the femoral vein approximately 1.5 in.
(3.8 cm) below and lateral to the pubic tubercle.
D. It is accompanied by the saphenous nerve.
E. It has no communication with the deep veins of
the leg.
53. The following statements regarding the obturator nerve
are correct except which?
A. It originates from the lumbar plexus.
B. It enters the thigh immediately beneath the
inguinal ligament.
C. It innervates the adductor muscles of the thigh.
D. It divides into an anterior and a posterior division.
E. It supplies the skin on the medial side of the thigh.
CHAPTER 5 Lower Limb 199
Read the case histories and select the best answer to the
question following them.
Afte r a fo o tb a ll in ju ry, a n o rth o p e d ic s u rg e o n
n o te d th a t th e rig h t tib ia o f th e p a tie n t co u ld b e
m o ve d a n te rio rly w ith e xce s s ive fre e d o m w h e n
th e kn e e w a s fle xe d .
54. In this patient, which ligament is most likely to be torn?
A. The lateral collateral ligament
B. The posterior cruciate ligament
C. The anterior cruciate ligament
D. The medial collateral ligament
E. The patellar ligament
A 69-ye a r-o ld m a n w a s w a lkin g d o w n a flig h t o f
s te p s w h e n h e s lip p e d a n d fe ll. On im p a ct, h is
le ft fo o t h it th e g ro u n d a n d w a s fo rcib ly in ve rte d
a n d m e d ia lly ro ta te d . He s ta te d th a t h e fe lt
s o m e th in g g ive o n th e la te ra l s id e o f th e d o rs u m
o f th e fo o t. Th o u g h s h o cke d b y th e fa ll a n d th e
re s u ltin g fo o t p a in , h e w a s a b le to w a lk h o m e .
With in 2 h , th e le ft fo o t a n d a n kle h a d s w o lle n
co n s id e ra b ly, w h ich m a d e e xa m in a tio n b y h is
p h ys icia n d ifficu lt. Mo ve m e n ts o f th e a n kle w e re
cle a rly p o s s ib le , b u t in ve rs io n w a s e xtre m e ly
p a in fu l. On s ta n d in g , th e p a tie n t co u ld b e a r h is
b o d y w e ig h t w ith o u t to o m u ch d is co m fo rt. Th e
p h ys icia n o rd e re d a n a n te ro p o s te rio r a n d a la t-
e ra l ra d io g ra p h o f th e a n kle re g io n , b o th o f
w h ich s h o w e d n o th in g a b n o rm a l. Th is p a tie n t
w a s d ia g n o s e d a s h a vin g a n a cu te s p ra in o f th e
la te ra l a n kle .
55. Which ligament is most likely to have been damaged?
A. The deltoid ligament
B. The anterior talofibular ligament
C. The plantar calcaneonavicular ligament
D. The anterior ligament of the inferior tibiofibular
joint
E. The posterior talofibular ligament
A 29-ye a r-o ld w o m a n w a s in vo lve d in a n a u to -
m o b ile a ccid e n t. He r ca r s kid d e d in to a tre e , a n d
s h e w a s th ro w n fo rw a rd , s trikin g h e r rig h t kn e e
o n th e d a s h b o a rd . At e xa m in a tio n in th e e m e r-
g e n cy d e p a rtm e n t, s h e w a s fo u n d to h a ve a p o s -
te rio r fra ctu re d is lo ca tio n o f h e r rig h t h ip jo in t.
56. What bone or bones are likely to have been fractured?
A. The greater tuberosity of the femur
B. The floor of the acetabulum
C. The posterior rim of the acetabulum and fracture
of the femoral head
D. The lesser trochanter of the femur
E. The anterior inferior iliac spine
57. What anatomic structure is likely to be compromised in
a hip dislocation of this type?
A. The tendon of obturator internus
200 CHAPTER 5 Lower Limb

B. The sciatic nerve 38. D. The soleus and the gastrocnemius muscles are at-
C. The quadratus femoris muscle tached to the calcaneum via the tendo calca-
D. The gluteus maximus muscle neus. These muscles plantar flex the ankle joint.
E. The superior gluteal nerve The plantaris is only a weak plantar flexor
muscle.
39. C 41. C 43. B
ANSWERS TO REVIEW QUESTIONS 40. D 42. C 44. C
45. E. The plantar flexors of the ankle joint and the in-
vertors of the foot are mainly supplied by the tibial
1. C 6. B 11. C nerve. The skin on the medial side of the leg is sup-
2. E 7. A 12. C plied by the saphenous nerve, which is a branch of
3. B 8. B 13. F the femoral nerve.
4. D 9. E 14. C 46. A. The short head of the biceps femoris muscle is
5. D 10. A 15. D supplied by the common peroneal nerve.
16. F. With the knee joint extended, the hamstring mus- 47. B. The gluteus medius muscle is a strong abductor of
cles are stretched and limit the degree of flexion of the hip joint.
the hip joint. 48. D. The neck of the femoral hernia is related immedi-
17. D 20. B 23. B ately laterally to the femoral vein.
18. A 21. D 24. B 49. C. The soleus does not arise from the femoral
19. E 22. A 25. D condyles.
26. A. Remember that the skin of the back below the 50. D. The sartorius muscle is an abductor of the hip
level of the iliac crests drains into the horizontal joint.
group of superficial inguinal lymph nodes 51. E. The inferior gluteal artery emerges from the
27. E 28. E 29. A greater sciatic foramen.
30. B 52. E. The great saphenous vein has numerous commu-
31. D. Remember that the mucous membrane of the nications with the deep veins of the leg through
lower half of the anal canal has the same lym- the valved perforating veins.
phatic drainage as the skin around the anus— 53. B. The obturator nerve enters the thigh through the
namely, into the medial group of horizontal su- obturator canal.
perficial inguinal nodes. 54. C
32. B 33. C 34. E 55. B. The anterior talofibular ligament is very com-
35. A. The nutrient artery, which is a branch of the obtu- monly damaged, more so than those ligaments on
rator artery, reaches the femoral head in children the medial side of the joint. Excessive inversion of
along the ligament of the head and enters the bone the foot with plantar flexion of the ankle or at-
at the fovea capitis. The femoral head is separated tempted medial rotation of the ankle is the com-
from the arteries supplying the neck of the femur mon cause.
by the epiphyseal cartilage. 56. C. The head of the femur is driven backward by the
36. C force of the accident through the posterior rim of
37. D. The right gluteus medius and the right gluteus min- the acetabulum that is fractured. The head of the
imus tilt the pelvis so that the left lower limb is femur may also be fractured.
raised, thus permitting the left foot to be advanced 57. B. The sciatic nerve is commonly damaged in this
forward clear of the ground. type of fracture dislocation.