CHAPTER 5
REVIEW
Comp letion Ques tions Based on the anteroposterior radiograph of the hip region, select the phrase that best completes each s tatement.
Lower Limb
4. Structure 4 i s the A. supe rior r amu s of pubi s. B. bo dy of pu bis. C. lesser t roc han ter. D. ischi al t uber osity. E. isch ial ram us. F. Non e o f the ab ove. 5. Structure 5 i s the A. lesser sciatic foramen. B. greater sciatic foramen. C. sub pu bic an gle. D. obt urator foram en . E. fovea c ap itis. F. Non e o f the abo ve. Based on the anteroposterior radiograph of the knee joint, select the phrase that best completes each s tatement.
1. Structure 1 i s the A. ne ck of the femu r. B. mar gin of obt urator foramen. C. D. E. F.
acetabulum . iliope ctineal line. lesser t roc ha nter. Non e o f the ab ove.
2. Structure 2 i s the A. he ad of fem ur. B. iliope ctineal line. C. ischi otuber osity. D. lesser trocha nter. E. ne ck of the fem ur. F. Non e o f the ab ove. 3. Structure 3 i s the A. great er troch ant er. B. lesser trocha nter. C. ischi al t uber osity. D. E. F.
acetabu lum. isch ial ram us. Non e o f the ab ove.
6. Structure A i s the A. he ad o f the fibul a. B. medi al condy le of the femur . C. site o f the epi phy seal line. D. E. F.
lateral condy le of the ti bia. intercon dylar emi nen ce. Non e o f the ab ove.
19 5
19 6 CHAPTER 5 Lower Limb
7. Structure B i s the A. intercon dylar emi nenc e. B. medi al cond yle of tibia. C. tibial tuber osity. D. lateral m eni scu s. E. ant erior cruci ate ligament . F. Non e o f the ab ove.
11. Structure 1 is the A. calcane um. B. lateral mal leolus. C. bo dy of talus. D. na vicu lar. E. med ial ma lleo lus. F. Non e o f the ab ove.
8. Structure C i s the A. me dial me niscu s. B. lateral condy le of tibia. C. lateral condy le of femur . D. intercon dylar emi nenc e. E. site of epi phy seal line. F. Non e o f the ab ove.
12. Structure 2 is the A. cuboid. B. med ial cu ne iform. C. na vicu lar. D. he ad of talus. E. intermedi ate cu nei form. F. Non e o f the ab ove.
9. Structure D i s the A. lateral condy le of tibia. B. ne ck of the fibul a. C. super ior tibiofibul ar joint . D. co mmo n pe ron eal ne rve. E. he ad of the fibul a. F. Non e o f the ab ove.
13. Structure 3 is the A. sustent acu lum t ali. B. ne ck of the talus. C. na vicu lar. D. calcaneu m. E. lateral mal leo lus F. med ial ma lleo lus.
10. Structure E is the A. site of epi phy seal line. B. C. D. E. F.
styloid proces s of head of fibul a. lateral condy le of tibia. attachment of medial collater al ligament . articular surface of head of fibul a. Non e of the a bo ve.
Based on the la teral radiograph of t he ankle region, se lect the phrase that best completes ea ch sta tement.
14. Structure 4 is the A. med ial mal leo lus. B. C. D. E. F.
bo dy of talus. lateral mal leol us. ne ck of the talus. cuboid. Non e o f the ab ove.
15. Structure 5 is the A. na vicu lar. B. med ial cu ne iform. C. tuber osity of the nav icul ar. D. calcaneu m. E. insertion of the tendo c alcaneus . F. Non e o f the abo ve. Select the phr ase that best completes eac h statemen t.
16. Flexion of the hip j oint (with t he knee e xtende d) is limited by the A. iliofemor al ligament . B. ant erior abdo minal wall. C. ischi ofemor al ligament . D. pubo femo ral ligamen t. E. ant erior super ior iliac sp ine. F. Non e o f the ab ove. 17. Abdu ction of t he hip joint i s limited by the A. pe ctineu s mus cle. B. iliofemor al ligament . C. ischi ofemor al ligament . D. pubo femo ral ligamen t. E. ligament of the head of the femur . F. Non e o f the ab ove. 18. Extension of t he h ip joint is limited b y the A. iliofemor al ligament . B. C. D. E.
pubo femo ral ligamen t. ischi ofemor al ligament . qu adr ice ps mus cle. add uct or mag nus mu scle.
CHAPTER 5
19. Flexion of t he h ip joint (with the knee flexed) by th e A. hams tring mus cles. B. iliofemor al ligament . C. add uc tor m agnu s mu scle. D. pubo femor al ligamen t. E. ant erior abdo minal wall. F. ischi ofemo ral l igamen t.
is limited
20. The long head of the b iceps f emoris muscl e is innervated by the A. obt urator ne rve. B. tibial port ion of the sciatic nerv e. C. fem oral ne rve. D. co mmo n pe ron ea l ner ve. E. sural ne rve. 21. The gracili s muscle is innervated by the A. fem oral ne rve. B. co mmo n pe ron ea l ne rve. C. sural ne rve. D. obt urator ne rve. E. tibial port ion of the sciatic nerv e. 22. The gluteus maximus muscle is innervated by t he A. inferior gluteal ner ve. B. C. D. E.
ner ve to qua dra tus femor is. obt urator ne rve. super ior gluteal ner ve. ner ve to obtu rator internus .
23. The sartori us muscle is innervated by the A. obt urator ne rve. B. fem oral ne rve. C. ner ve to vastus medi alis. D. super ior gluteal ner ve. E. lateral cu tan eous ner ve of the thi gh. 24. The ha mstring port ion of t he a dductor magnus muscle is inne rvated by the A. co mmo n pe ron ea l n erve. B. tibial port ion of the sciatic nerv e. C. obt urator ne rve. D. E.
femo ner veral to tne herve. pec tineu s mu scle.
25. The ad ductor longus mus cle is i nnervat ed b y the A. fem oral ne rve. B. co mmo n pe ron ea l ne rve. C. tibial port ion of the sciatic nerv e. D. anter ior division of the obtu rator ner ve. E. post erior di vision of the obt urat or ner ve. 26. A malig nant melanoma (ca ncer) of the sk in cover ing the b uttock is li kely to sprea d via lymphatics to the A. hori zont al group of super ficial inguinal nodes. B. vertical group of s uperf icial inguinal nodes. C. pos terior axillary nodes . D. po plitea l no des . E. internal iliac node s. 27. Lymph from the na il be d of the b ig toe drains into t he A. hori zont al group of super ficial inguinal nodes. B. presac ral no de s. C. po plitea l n od es.
D. E.
Lower Limb
19 7
internal iliac node s vertical group of s uperf icial inguinal nodes.
28. The lateral menis cus of t he knee joint A. has a thick inner bor der . B. is strong ly attached around it s circumf erence to the tibia. C. is more f requent ly torn t han the medi al meni scus . D. is strong ly att ached to the l ater al col lat eral ligament. E. is attached by it s ant erior hor n to the t ibia in f ront of the intercondylar eminence. 29. Lymph from the skin of the lateral si de o f the foot drains into the A. po pliteal no des . B. internal iliac n odes . C. vertical group of s uperf icial inguinal nodes. D. hori zont al g roup of s uperf icial inguinal nodes. E. subs artorial n od es. 30. Lymph fr om the skin of t he m edial side of t he kne e drains into the A. po pliteal no des . B. vertical group of s uperf icial inguinal nodes. C. medial g roup of t he horiz ontal s uperf icial ingu inal nodes D. internal iliac no des . E. later al group of hori zont al inguinal nodes . 31. Lymph f rom the ski n around the anus d rains int o the A. internal iliac no des . B. inferior mes ent eric no des . C. lat eral g roup of hor izontal s uperf icial i ngui nal nodes. D. medial g roup of hori zont al s uperf icial i ngui nal nodes. E. vertical g roup of i nguinal no des .
Multiple-Choice Questions Select the best answer for each questi on.
32. The sciat ic nerve enters the gluteal r which foramen? A. Posterior s acr al B. Grea ter sciatic C. Anterior sac ral D. Lesser sciatic E. Obturator
egion through
33. The comm on peroneal nerv e can be palpated in w hich region o f the knee ? A. As it winds around t he medial side of the neck of the fibula. B. As it pas ses around t he medial condyl e of t he ti bia. C. As it winds around t he lat eral side of t he neck of the fibula. D. E.
As it pas ses forw ard betw een the t ibi a and the fibula. As it cr oss es t he lat eral side of t he head of t he fibula.
19 8 CHAPTER 5 Lower Limb
34. If the dorsalis pedis artery i s severed just proxi mal to its med ial and lateral tarsal branc hes, blood ca n still reach the d orsum of the foot through which vess el(s)? A. The p erone al artery. B. The post erior t ibial ar tery. C. The medi al plant ar artery. D. The lat eral pl ant ar ar tery. E. All of the abo ve. 35. In children, the chief art erial supply to the hea d of the femur is derived from which artery or arteries? A. The obt urator ar tery. B. The i nternal pudendal artery. C. Branches from t he medial and lat eral circumf lex femoral arteries. D. The deep ci rcumf lex iliac artery. E. The superf icial cir cumf lex i liac arter y. 36. Which statement is corr ect con cerning t he femoral ri ng? A. It is the opening in the deep fas cia of the t high for the great saphenous vein. B. It is the openi ng in the adductor magnus muscl e for the femoral artery. C. It is the prox imal opening in the femoral canal. D. It is the compart ment i n the f emoral sheat h for the femoral artery. E. It is the compart ment i n the f emoral sheat h for the femo ral nerve. 37. To lift the left foot o ff the groun d wh ile walking, which of the following muscles plays an imp ortant role? A. The lef t gluteus med ius mus cle B. The lef t gluteus max imus mus cle C. The ri ght add uct or long us mu scle D. The right gluteus medius muscl e E. Non e o f the ab ove. 38. Rupture of t he tend o calca neu s results in an inabilit y to do what? A. Dorsiflex the foot B. Evert the foo t C. Invert the foo t D. Plant ar flex t he f oot E. Non e o f the ab ove. 39. A sprained a nkle result ing from exce ssive evers ion mo st likely demo nstrates that which structure is torn? A. The t alofibul ar ligament B. The t en do c alca ne us C. The del toid ligamen t D. The i nterosseous ligament E. The p erone al retinacu lum 40. If the foot is permane ntly dorsi flexed and which ne rve might be injured? A. The d eep per onea l ner ve B. The sup erficial per oneal ner ve C. The c ommo n pe rone al ner ve D. E.
The ibial ner ve The tob turator ne rve
evert ed,
41. The femoral ne rve arises f rom which o f the following segments of t he spina l cord? A. L2 and 3 B. L4 and 5 and S 1, 2, and 3 C. L2, 3, an d 4 D. L1 and 2 E. L5 an d S1, 2, an d 3 42. The d ermatome p resent over the later al side of the foot is which o f the following? A. S5 B. L3 C. S1 D. L4 E. L5 43. The femoral sheath is f ormed by which of the following layer(s) of fascia? A. The pe ctineus fascia B. The fas cia i liaca and the f asci a trans versalis C. The fascia lat a and the membr anous l ayer of the supe rficial fascia D. The psoas f ascia and the fatt y layer of superf icial fascia E. The proces sus vaginal is 44. Which o f the followi ng muscles everts the foot? A. The tibialis post erior muscl e B. The flexor hallucis long us muscl e C. The per oneu s long us m uscle D. The ti bialis ant erior mus cle E. The flexor digitorum l ongus muscl e 45. Injury to the comm on p eroneal nerve res ults in whi ch condition? A. Inabil ity to invert the foot B. Inabil ity to pl antar flex the ankl e C. Inabil ity to feel skin sens ation on the medial side of the leg D. Inabil ity to plant ar flex the big toe E. Inabi lity to e vert the foot 46. After a lesion of the tibial part of t he sciatic ne rve, some active flexion may still be possible at the knee joint; the muscles respon sible for this remaining fl exion inc lude which? A. The shor t head of the bi ceps f emori s mus cle B. The g astrocne mius mu scle C. The p lant aris mus cle D. The p opl iteus mus cle E. The long head of the bi ceps femori s muscl e 47. A patient i n the supine posit ion wi th the hip and knee join ts e xte n d e d is a ske d to ab d uc t th e low e r lim b against resi stance provided b y the ph ysician; this exercise tests which of the following muscles? A. The semitendi nos us mus cle B. The g luteus medi us mu scle C. The pe ctineu s m uscle D. The g raci lis mus cle E. The s emi membr anos us mus cle
CHAPTER 5
48. A femo ral hernia has the foll owing charac teristics except which? A. It is mor e common i n wo men t han i n men. B. The sw elling occurs below and lat eral to the pubic tubercle. C. It des cends through the f emor al ca nal . D. Its neck is rel ated immediat ely lat eral ly to the femoral artery. E. Its neck i s relat ed medial ly to the shar p edge of the lacunar ligament. 49. The gastr ocnem ius and the soleus muscles hav e all the following features in comm on except which? A. They are s uppl ied by the t ibial nerv e. B. They are found in t he post erior compa rtment of the leg. C. They ar ise from the f emoral condyl es and f lex the knee joint. D. They insert via the tendo cal caneus. E. They plantar flex the ankl e joint . 50. All the followi ng statements ab out the sartorius muscle are correct exc ept which? A. B. C. D. E.
It flexes flexes the the thi leggh at at thethe knee oint .. It hi pj joint It lateral ly rotat es the thi gh at the hip joint. It adduct s the thi gh at the hi p joint. It attaches to the anter ior super ior iliac s pine.
51. The foll owing s tructures are transmit ted through the lesser sciati c forame n except which? A. The tendon of the obtur ator internus muscl e B. The i nternal pudenda l vessels C. The nerv e to the obtur ator internus muscl e D. The pu den dal ne rve E. The inf erior g luteal ar tery 52. The following statements reg arding the g reat sapheno us vein are correct exc ept which? A. B. C. D. E.
It arises on t he dors um of the foot. It ent ers the l eg by pass ing anter ior to the medial malleolus. It drains into the femoral v ein approxi mately 1.5 in. (3.8 cm) below and lateral t o the p ubic tubercle. It is acc ompani ed by t he sap henous ner ve. It has no communi cat ion wi th the deep v eins of the leg.
53. The following s tatemen ts regarding t he o bturator nerve are correct exc ept which? A. It originat es from t he lumbar plex us. B. It ent ers the thi gh i mmedi ate ly beneat h the inguinal lig ame nt. C. It innerv ates the adductor muscl es of the t high. D. E.
It suppl divides anteri ormedial and a post division. It iesinto the san kin on the s ideerior of the t high.
Lower Limb
19 9
Read the cas e histor ies and se lect the best answer to the ques tion following them.
After a football injury, an orthopedic surgeon noted that the right tibia of the patient could be m oved a nteri orl y wit h excessive f reedom when the knee wa s flexed. 54. In this patient, whi ch ligament is most li kely to be torn? A. The later al collater al ligament B. The pos terior cr uci ate ligament C. The ant erior cruci ate ligament D. The medi al co llateral ligament E. The pat ellar ligamen t A 69-year-ol d m an was walk ing dow n a flight of steps when he slipped and fell. On impact, his left foot hit the gro und and was forcibl y inverted and medially rotated. He stated that he felt som ethi ng g ive on the lateral side of the dorsum of the foot. Though shocked by the fall and the resulting foot pain, he was able to walk home. Within 2 h, the left foot and ankle had swollen considerably, which made examination by his p h ys icia n d ifficu lt. M o ve m e n ts o f th e a n kle w e re clearly possible, but inversion was extremely 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 teral radiograph of the ankle region, both of which showed nothing abnormal. This patient was d iagno sed a s having an acute sprain of t he lateral ankle. 55. Which li gament is most likely to ha ve been dama ged? A. The de ltoid ligamen t B. The ant erior talofibul ar ligament C. The plant ar cal caneon avicul ar l igament D. The anterior ligament of the inf erior ti biofibul ar joint E. The post erior talofibul ar ligament A 29-year-old woman was involved in an autom obil e a cciden t. Her car ski dde d into a tree , and she was thrown forward, striking her right knee on the dashboard. At examination in the emergency departme nt, she wa s found to have a pos terior fracture dislocation of her right hip joint. 56. What bone or bones are lik ely to have been fractur ed? A. The gr eater tuber osity of the femur B. The floor of the acet abul um C. The post erior rim of the acet abulum and f ract ure of the femoral hea d D. The lesser trochanter of the femur E. The anter ior inferior iliac spi ne 57. What ana tomic st ructure is likely to be com promised in a h ip dislocation of this ty pe? A. The t endon of obt urator internus
20 0 CHAPTER 5 Lower Limb
B. C. D. E.
The s ciatic ner ve The quadr atus femor is mus cle The g luteus max imus mus cle The s uper ior gluteal ner ve
ANSWERS TO REVIEW QUESTIONS 1. 2. 3. 4. 5. 16.
27.
6. B 11. C 7. A 12. C 8. B 13. F 9. E 14. C 10. A 15. D With the kn ee j oint ex tended, the hams tring mu scles are stretched a nd limit t he d egree of f lexion o f the h ip joint. D 20. B 23. B A 21. D 24. B E 22. A 25. D A. Remember th at th e skin of the back bel ow th e level of the iliac crests drains into the horizontal group of superf icial inguinal ly mph nod es E 28. E 29. A
30. 31.
B D.
17. 18. 19. 26.
C E B D D F.
32. 35.
B A.
36. 37.
C D.
Rememb er that th e muc ous membr ane o f th e lower half of the anal canal has the same lymp ha tic d ra ina ge as th e skin ar ou nd th e a nu s— namely, into the medial group of horizontal supe rficia l inguin al n od es. 33. C 34. E The nut rient a rtery, which is a branch of the obturator art ery, reache s the femoral head in children along the li gament of t he h ead a nd e nters the b one at the fovea capitis. The femoral head is separated from the arteries supplying the neck of the femur by the ep iph yseal c artilage .
38.
D.
39. 40. 45.
C D E.
46. 47. 48. 49. 50. 51.
vertors of the foot are m ainly s upp lied by the tibial nerve. T he skin on the m edial side of the leg is s upplie d by the sap he no us ne rve, which is a bra nc h of the femoral nerve. A. The s hort head of the biceps femori s muscl e is suppli ed b y the c ommon peroneal nerve. B. The g luteus medi us m uscle is a strong a bduct or of the h ip joint. D. The neck o f the femor al h ernia is related im medi ately laterally to the femoral vein. C. The s oleus does not ari se fro m the f emor al condyles. D. The s arto rius mus cle is a n abduct or of th e hi p joint. E. The inf erio r glutea l ar te ry emer ges from t he greater sciati c foramen .
52.
E.
53.
B.
54. 55.
C B.
56.
C.
57.
B.
The right gluteus medius and the right gluteus minimus tilt the pelvis so that the left lower limb is raised, thus permitti ng the left f oot to b e ad vanced forward clear of the ground .
The s oleus and t he g astrocnemi us mus cle s are at tached to the calcaneum via the tendo calcaneus. These muscles plantar flex the ankle joint. The plantaris is only a weak plantar flexor muscle. 41. C 43. B 42. C 44. C The pl antar flexors of the ankl e joint and the in-
The great sapheno us vein ha s numer ous communications with the deep veins of the leg through the valved perforating veins. The obt urator ne rve ent ers the th igh thr oug h the obturator canal. The anter io r talofibu la r liga ment i s very common ly dam aged, more so than those lig ame nts on the medial side of the joint. Excessive inversion of the foot with plantar flexion of the ankle or attempted medial rotation of the ankle is the common cause. The head of the femur is driven back ward by t he force of the accident through the posterior rim of the acetabulum that is fractured. The head of the femu r may also be fractured. The s ciatic ner ve is commonl y damag ed i n this type of fracture dislocation.
