PBL LOWER LIMB

Inferior Extremity: PBL1

70 years female was brought to OPD in the afternoon with the history of fall in the
bathroom on the same day in the morning. The old lady could not get up on her
own after that episode of fall in the bathroom.
On examination, the affected limb was laterally rotated with toes pointing laterally.
Patient did not allow further examination due to pain. She was diagnosed to be
suffering from fracture neck femur.
With knowledge of Anatomy answer the following questions.
1. What are the types of fracture neck femur in relation to the capsule of hip joint?
2. What is the blood supply of head and neck of the femur?
3. What are retinacular arteries?
4. Why the intra capsular fracture of neck of the femur is difficult to heal?
5. Why limb is laterally rotated?
6. What are the Ligaments of hip joint & which one prevent trunk from falling
back? What is other name of same?
7. How much is the normal neck-
shaft angle of femur?
8. What is Shenton’s line?

Shenton line is an imaginary

curved line drawn along the
inferior border of the superior
pubic ramus (superior border of
the obturator foramen) and along
the inferomedial border of the
neck of femur. This line should be
continuous and smooth.
Inferior Extremity: PBL 2
25 years male was brought to OPD with left swollen knee with history of fall on
flexed knee. Patient was not able to extend the knee completely and complained
of severe pain in upper and medial aspect of left knee joint. Patient was a football
player. On examination Anterior drawer’s test was positive. He was diagnosed as a
case of medical meniscal tear.
With the knowledge of Anatomy answer the following questions.
1. Which structures related to the knee joint are injured in this case?
2. What are the different varieties of meniscal tear?
3. Why is medial meniscus more commonly injured than lateral meniscus?
4. Enumerate the Intracapsular structures of knee jt.
5. Name the muscles involved in locking & unlocking
6. Classify knee joint?
7. What are the functions of ACL and PCL?
8. What is Drawer’s sign?
9. Why can’t he extend his knee?
Inferior Extremity: PBL 3
A 52 year old female patient was brought to OPD with the complaint of weakness in muscles of
anterior compartment of leg and difficulty in walking . The patient gave the history of removal of
plaster 2 days back after treatment of fracture of upper end of Fibula. She was diagnosed as a case of
foot drop.
With the knowledge of Anatomy answer the following questions.
1. What is foot drop?
2. Which nerves may be damaged in foot drop?
3. What is the most common cause of damage to these nerves?
4. Which muscles are paralyzed in case of foot drop?
5. What is the cause of high stepping gait seen in these patients?
6. What are the other associated complaints of the patients?
7. How do you differentiate between the nerves damaged in foot drop?
8. Name the branches of Common Peroneal nerve & the muscles supplied by them.
9. Give the Root value of Common Peroneal nerve.
10. Name the nerve related to the neck of fibula; and give its root value.
11. Which is the nerve of lateral compartment of leg?
Inferior Extremity: PBL 4
A 50 year old policeman with a history of chronic dull ache in both legs, came to the
hospital when he noticed dilated and tortuous veins on the medial side of his both
legs. The skin on the medial malleolus was found to be discoloured, dry and scaly.
He was diagnosed as a case of Varicose Veins.

With the knowledge of Anatomy answer the following questions

1. Name the vein(s) involved.
2. What is the relation of these veins to malleolli?
3. Name the cutaneous nerves closely related to these veins.
4. Name the veins that connect it to the deep veins of lower limb.
5. What is the direction of flow of blood in the connecting veins?
6. Name the connecting veins according to their position.
7. Name naturally tortuous arteries in our body
8.What is the anatomical reason for dilated veins?
Inferior Extremity: PBL 5
A patient was given intramuscular injection in the gluteal region. After few
weeks, she complained of difficulty while stepping on right foot while
walking. The patient experienced difficulty in dorsiflexion and eversion of
right foot.
With the knowledge of Anatomy answer the following questions
1. Name the nerve(with its root value) that is injured by the injection needle in
the gluteal region.
2. Which component of the nerve is injured based on symptoms and signs of
patient?
3. In which gluteal region is an intramuscular injection given and why?
Inferior Extremity: PBL 6
A 50 year old woman came to the hospital, when she noticed a lemon sized swelling in the
upper thigh. On examination, the swelling was found to be inferior and lateral to the pubic
tubercle. She was diagnosed with a Femoral hernia.
With the knowledge of Anatomy answer the following questions
1. What is the cause of the swelling?
2. Name the weak area through which the hernia enters the thigh.
3. Give name and boundaries of the upper opening of the passage mentioned in question 2.
4. Why is it more common in females?
5. Describe the direction of hernia and the importance of this knowledge to the surgeon.
6. What is the important bony landmark that differentiates a femoral from inguinal hernia?
7. What is abnormal obturator artery?
8. Which boundary of the femoral ring can be cut while treating the hernia surgically?
PBL 7 1. Name the condition seen in the
picture.
2. Why does it occur?
3. What is Perthe’s Test?
4. What is Trendlenberg test?
5. Name the perforator veins of
lower limb.
6. Name the longest vein of the
lower limb. What are its
tributaries?
Trendelenburg’s test:
This is done to find out the site of leak or defect in a patient with
varicose veins. Only the superficial veins and the perforating veins can
be tested, not the deep veins. The patient is made to lie down, and the
veins are emptied by raising the limb and stroking the varicose veins in
a proximal direction. Now pressure is applied with the thumb at the
saphenofemoral junction and the patient is asked to stand up quickly.
To test the superficial veins, the pressure is released. Quick filling of
the varicose veins from above indicates incompetency of the
superficial veins. To test the perforating veins, the pressure at the
saphenofemoral junction is not released, but maintained for about a
minute. Gradual filling of the varices indicates incompetency of the
perforating veins, allowing the blood to pass from deep to superficial
veins.
PBL 8

1. Name the condition seen in the

picture
2. What are the abnormalities in
this condition?
3. What are the arches of the
foot?
4. What are the factors that
maintain the medial
longitudinal arch?
1. Define a bursa
2. Name the bursa involved in Housemaid’s knee
3. Name the bursa in Clergyman’s knee
4. Name any one communicating bursa
5. Classify bursa
INFRAPATELLAR BURSITIS:
CLERGYMAN’S KNEE
PREPATELLAR BURSITIS
PBL 9
A 38 year old patient was admitted in surgery ward with gangrene of great toe
of right foot. Patient gave history of pain in lower extremity since last 3 years.
Pain increased with walking and reduced with rest. Patient was a chronic
smoker, of low socioeconomic status and had poor nutritional status. On
examination
• Lower limb was pale, had lost its normal color, loss of hair was noted and the
limb was cooler than the other side.
• Dorsalis pedis arterial pulsation was diminished on right side.
With the knowledge of Anatomy answer the following questions
1. Which arteries can be palpated in lower limb?
2. What is Peripheral vascular disease?
3. What is the cause of pain in the above case?
4. What is gangrene?
5. What is the cause of loss of color, hair, warmth?
PBL 10
A sportsman, while playing basketball twisted his foot . He
complained of severe pain on the lateral side of his right ankle. On
examination the treating physician found the ankle swollen,
movements were restricted. Pain was more on the lateral aspect of
ankle .
From your knowledge of anatomy answer the following:
1. What is the ligament injured?
2. What could be other ligament injured?
3.Which movement of the foot is likely to have caused this injury?
4. If there is also a fracture which can be the bone fractured?