Chapter: Lower Limb Anatomy; Topic: Ankle & Foot Tendons; Subtopic: Tendons around the Lateral Malleolus
Keyword Definitions:
Peroneus (Fibularis) Longus: Lateral compartment muscle whose tendon passes posterior to lateral malleolus.
Lateral Malleolus Groove: Fibular groove on posterior surface of fibula guiding peroneal tendons.
Peroneal Retinacula: Bands stabilizing peroneal tendons behind lateral malleolus.
Tibialis Posterior: Medial compartment muscle passing posterior to medial malleolus.
Flexor Hallucis Longus (FHL): Posterior compartment muscle passing behind medial malleolus through separate tunnel.
1) Lead Question – 2016
Which tendon is lodged in the groove on posterior surface of lateral malleolus?
A) Peroneus longus
B) Tibialis anterior
C) Tibialis posterior
D) Flexor hallucis longus
Answer: A) Peroneus longus
Explanation: The posterior surface of the lateral malleolus features a distinct groove that accommodates the tendons of both peroneus longus and peroneus brevis. These tendons are stabilized by the superior and inferior peroneal retinacula and are essential for ankle eversion and lateral stability. Tibialis anterior runs anterior to the ankle, tibialis posterior runs behind the medial malleolus, and FHL also passes medially. Thus, the tendon lodged in the groove on the posterior aspect of the lateral malleolus is peroneus longus.
2) The tendon lying most anterior behind lateral malleolus is–
A) Peroneus longus
B) Peroneus brevis
C) FHL
D) Tibialis anterior
Answer: B) Peroneus brevis
Explanation: Peroneus brevis lies anterior to peroneus longus in the common peroneal sheath. Thus, B is correct.
3) The action of peroneus longus is–
A) Foot inversion
B) Foot eversion and plantarflexion
C) Dorsiflexion
D) Toe extension
Answer: B) Foot eversion and plantarflexion
Explanation: Peroneus longus stabilizes arch and everts foot. Thus, B is correct.
4) Peroneal tendons are stabilised by–
A) Flexor retinaculum
B) Superior peroneal retinaculum
C) Extensor retinaculum
D) Spring ligament
Answer: B) Superior peroneal retinaculum
Explanation: SPR holds both peroneal tendons behind lateral malleolus. Thus, B is correct.
5) Tibialis posterior passes behind which malleolus?
A) Lateral
B) Medial
C) Both
D) None
Answer: B) Medial
Explanation: Tibialis posterior forms part of Tom-Dick-And-Harry group behind medial malleolus. Thus, B is correct.
6) A patient with pain behind lateral malleolus likely has–
A) Peroneal tendinopathy
B) Tibialis posterior tear
C) FHL tenosynovitis
D) Achilles rupture
Answer: A) Peroneal tendinopathy
Explanation: Posterolateral ankle pain is classic for peroneal tendon injury. Thus, A is correct.
7) The muscle helping maintain transverse arch is–
A) FHL
B) Peroneus longus
C) Tibialis anterior
D) Gastrocnemius
Answer: B) Peroneus longus
Explanation: PL forms a sling with tibialis anterior across sole. Thus, B is correct.
8) Peroneus brevis inserts on–
A) Base of 1st metatarsal
B) Medial cuneiform
C) Tuberosity of 5th metatarsal
D) Navicular
Answer: C) Tuberosity of 5th metatarsal
Explanation: PB inserts on the styloid of 5th metatarsal. Thus, C is correct.
9) FHL tendon passes through–
A) Sustentaculum tali groove
B) Fibular groove
C) Tarsal tunnel
D) Cuboid fossa
Answer: A) Sustentaculum tali groove
Explanation: FHL tendon uses sustentaculum tali pulley. Thus, A is correct.
10) In eversion sprain, commonly injured structure is–
A) Lateral ligament complex
B) Deltoid ligament
C) Spring ligament
D) Peroneal retinaculum
Answer: B) Deltoid ligament
Explanation: Eversion injury stresses strong medial deltoid ligament. Thus, B is correct.
11) A patient with foot drop will have weakness of–
A) Peroneus longus
B) Tibialis anterior
C) Tibialis posterior
D) Gastrocnemius
Answer: B) Tibialis anterior
Explanation: TA is main dorsiflexor supplied by deep peroneal nerve. Thus, B is correct.
Chapter: Lower Limb Anatomy; Topic: Leg Muscles – Anterior Compartment; Subtopic: Tibialis Anterior – Actions, Nerve Supply, Relations
Keyword Definitions:
Tibialis Anterior (TA): Major dorsiflexor and inverter of the foot from anterior compartment.
Deep Peroneal Nerve: Supplies all anterior compartment muscles including TA.
Anterior Tibial Vessels: Artery and vein running deep to tibialis anterior throughout leg.
Medial Cuneiform: One of TA’s insertion sites along with base of 1st metatarsal.
Dorsiflexion: Upward movement of the foot at the ankle joint.
1) Lead Question – 2016
All of the following are true about tibialis anterior except?
A) It is supplied by the superficial peroneal nerve
B) It dorsiflexes the foot
C) It is closely related to the anterior tibial vessels
D) It inserts on the medial cuneiform
Answer: A) It is supplied by the superficial peroneal nerve
Explanation: Tibialis anterior is innervated by the deep peroneal nerve, not the superficial peroneal nerve, making option A false. It is the primary dorsiflexor of the foot and also assists in inversion. It lies in close anatomical relation to the anterior tibial vessels, which run deep to it along the anterior compartment. Its insertion is on the medial cuneiform and base of the first metatarsal. Thus, all statements except A are true.
2) Tibialis anterior also contributes to–
A) Foot eversion
B) Foot inversion
C) Toe extension
D) Knee flexion
Answer: B) Foot inversion
Explanation: TA combines dorsiflexion with inversion due to its medial insertion. Thus, B is correct.
3) Deep peroneal nerve supplies all except–
A) Tibialis anterior
B) EHL
C) EDL
D) Peroneus longus
Answer: D) Peroneus longus
Explanation: Peroneus longus is supplied by superficial peroneal nerve. Thus, D is correct.
4) A patient with deep peroneal nerve palsy will have–
A) Inability to plantarflex
B) Inability to dorsiflex
C) Inability to evert
D) Inability to flex toes
Answer: B) Inability to dorsiflex
Explanation: Deep peroneal nerve supplies all dorsiflexors. Thus, B is correct.
5) In tibialis anterior tendinopathy, pain is felt over–
A) Lateral malleolus
B) Medial cuneiform
C) Calcaneus
D) Navicular tuberosity
Answer: B) Medial cuneiform
Explanation: TA inserts on medial cuneiform/base of 1st metatarsal. Thus, B is correct.
6) The artery accompanying tibialis anterior is–
A) Posterior tibial artery
B) Anterior tibial artery
C) Fibular artery
D) Medial plantar artery
Answer: B) Anterior tibial artery
Explanation: Anterior tibial artery travels deep to TA. Thus, B is correct.
7) Dorsalis pedis artery is continuation of–
A) Posterior tibial artery
B) Anterior tibial artery
C) Fibular artery
D) Popliteal artery
Answer: B) Anterior tibial artery
Explanation: ATA continues as dorsalis pedis at ankle. Thus, B is correct.
8) TA originates mainly from–
A) Fibula
B) Tibial lateral surface
C) Tibial medial surface
D) Calcaneus
Answer: B) Tibial lateral surface
Explanation: It arises from lateral tibia and interosseous membrane. Thus, B is correct.
9) A runner with foot drop has weakness of–
A) Gastrocnemius
B) Tibialis anterior
C) Tibialis posterior
D) Soleus
Answer: B) Tibialis anterior
Explanation: TA is primary dorsiflexor; weakness leads to foot drop. Thus, B is correct.
10) Superficial peroneal nerve injury affects–
A) TA
B) EHL
C) Foot eversion
D) Foot inversion
Answer: C) Foot eversion
Explanation: SPN supplies peroneus longus/brevis—main everters. Thus, C is correct.
11) Tight TA may lead to–
A) Pes cavus
B) Excessive dorsiflexion
C) Toe flexion
D) Decreased inversion
Answer: B) Excessive dorsiflexion
Explanation: Overactive TA increases dorsiflexion force at ankle. Thus, B is correct.
Chapter: Back & Pelvic Anatomy; Topic: Sacral Attachments; Subtopic: Muscular Attachments on Posterior Sacrum
Keyword Definitions:
Sacrum: Triangular bone formed by fusion of five sacral vertebrae, providing attachment to back and pelvic muscles.
Multifidus Lumborum: Deep back muscle attaching to sacrum and stabilizing vertebral column.
Piriformis: Muscle originating from anterior sacrum, exiting via greater sciatic foramen.
Iliacus: Muscle arising from iliac fossa, not the sacrum.
Coccygeus: Pelvic floor muscle attached to coccyx and ischial spine, not posterior sacrum.
1) Lead Question – 2016
Attachment on posterior surface of sacrum?
A) Multifidus lumborum
B) Iliacus
C) Coccygeus
D) Piriformis
Answer: A) Multifidus lumborum
Explanation: Multifidus lumborum is a deep intrinsic back muscle that arises from the posterior sacrum, dorsal sacroiliac ligaments, and posterior superior iliac spine. It stabilizes lumbar vertebrae and is part of the transversospinalis group. Iliacus takes origin from the iliac fossa, not the sacrum. Coccygeus attaches to the coccyx and ischial spine. Piriformis originates from the anterior, not posterior, sacral surface. Thus, the only structure clearly attached to the posterior surface of the sacrum is multifidus lumborum.
2) Piriformis arises from–
A) Posterior sacrum
B) Anterior sacrum
C) Coccyx
D) Iliac crest
Answer: B) Anterior sacrum
Explanation: Piriformis originates from anterior sacral foramina. Thus, B is correct.
3) Coccygeus inserts on–
A) Coccyx
B) L5 vertebra
C) Ilium
D) Pubis
Answer: A) Coccyx
Explanation: Coccygeus attaches to ischial spine and coccyx. Thus, A is correct.
4) Multifidus is part of–
A) Erector spinae
B) Transversospinalis group
C) Pelvic diaphragm
D) Abdominal wall
Answer: B) Transversospinalis group
Explanation: Multifidus belongs to deep intrinsic back muscles. Thus, B is correct.
5) A patient with sacral back pain may have strain of–
A) Multifidus
B) Rectus femoris
C) Vastus medialis
D) Soleus
Answer: A) Multifidus
Explanation: Multifidus attaches on posterior sacrum; strain causes localized pain. Thus, A is correct.
6) Iliacus joins which muscle to form iliopsoas?
A) Psoas major
B) Rectus femoris
C) Sartorius
D) Pectineus
Answer: A) Psoas major
Explanation: Iliacus + psoas major form iliopsoas. Thus, A is correct.
7) Piriformis exits pelvis through–
A) Lesser sciatic foramen
B) Greater sciatic foramen
C) Obturator canal
D) Inguinal canal
Answer: B) Greater sciatic foramen
Explanation: Piriformis divides the greater sciatic foramen. Thus, B is correct.
8) Multifidus function includes–
A) Hip extension
B) Vertebral stabilization
C) Shoulder abduction
D) Knee flexion
Answer: B) Vertebral stabilization
Explanation: Multifidus stabilizes spine during posture. Thus, B is correct.
9) Coccygeus helps form–
A) Pelvic diaphragm
B) Thoracic diaphragm
C) Urogenital diaphragm
D) Lumbar plexus
Answer: A) Pelvic diaphragm
Explanation: Coccygeus with levator ani forms pelvic diaphragm. Thus, A is correct.
10) A tight piriformis may compress–
A) Femoral nerve
B) Sciatic nerve
C) Pudendal nerve
D) Genitofemoral nerve
Answer: B) Sciatic nerve
Explanation: Piriformis syndrome results from sciatic nerve compression. Thus, B is correct.
11) Posterior sacral foramina transmit–
A) Dorsal rami
B) Ventral rami
C) Sacral plexus
D) Femoral nerve
Answer: A) Dorsal rami
Explanation: Posterior foramina transmit dorsal rami supplying back muscles including multifidus. Thus, A is correct.
Chapter: Spine & Nervous System Anatomy; Topic: Sacrum – Foramina & Hiatus; Subtopic: Structures Passing Through Sacral Hiatus
Keyword Definitions:
Sacral Hiatus: An opening at the inferior end of sacral canal formed due to failure of laminae fusion of S4–S5.
Sacral Canal: Continuation of vertebral canal containing cauda equina and sacral nerves.
Sacral Nerve Roots: Ventral and dorsal roots emerging from sacral segments S1–S5.
Filum Terminale: Fibrous extension from conus medullaris that exits via sacral hiatus.
Caudal Epidural:** Site for caudal epidural anesthesia through sacral hiatus.
1) Lead Question – 2016
Structures passing through sacral hiatus are?
A) S4 nerve root
B) S2 nerve root
C) S3 nerve root
D) S5 nerve root
Answer: D) S5 nerve root
Explanation: The sacral hiatus is formed due to the non-fusion of the laminae of S4 and S5 vertebrae. It transmits the S5 nerve root, coccygeal nerve, and the filum terminale externum. Nerve roots S1–S4 exit through separate sacral foramina and do not pass through the sacral hiatus. Clinically, the sacral hiatus is used for caudal epidural anesthesia, making familiarity with its contents essential. As only the S5 nerve root passes through the sacral hiatus, the correct answer is option D.
2) Sacral hiatus is formed due to failure of fusion of–
A) S1 laminae
B) S2 laminae
C) S4–S5 laminae
D) S3 laminae
Answer: C) S4–S5 laminae
Explanation: Non-fusion of S4–S5 laminae creates sacral hiatus. Thus, C is correct.
3) The filum terminale externum attaches to–
A) L5 vertebra
B) Coccyx
C) Sacral promontory
D) Ilium
Answer: B) Coccyx
Explanation: Filum terminale anchors spinal cord to coccyx. Thus, B is correct.
4) Caudal epidural anesthesia is given through–
A) Sacral promontory
B) Sacral hiatus
C) Posterior sacral foramina
D) Intervertebral foramina
Answer: B) Sacral hiatus
Explanation: Sacral hiatus gives access to epidural space. Thus, B is correct.
5) Posterior sacral foramina transmit–
A) Ventral rami
B) Dorsal rami
C) Sympathetic chain
D) Lumbosacral trunk
Answer: B) Dorsal rami
Explanation: Dorsal rami exit posterior foramina to supply back muscles. Thus, B is correct.
6) Anterior sacral foramina transmit–
A) Cauda equina
B) Ventral rami
C) Dorsal rami
D) Ilioinguinal nerve
Answer: B) Ventral rami
Explanation: Ventral rami forming sacral plexus exit anteriorly. Thus, B is correct.
7) Coccygeal nerve emerges through–
A) Sacral hiatus
B) L5/S1 foramen
C) S2 foramen
D) Obturator canal
Answer: A) Sacral hiatus
Explanation: Coccygeal nerve exits via sacral hiatus. Thus, A is correct.
8) The sacral cornua represent–
A) Transverse processes
B) Inferior articular processes of S5
C) Fused spinous processes
D) Superior articular facets
Answer: B) Inferior articular processes of S5
Explanation: Cornua flank sacral hiatus. Thus, B is correct.
9) Caudal epidural block anesthetizes–
A) L2 dermatome
B) Sacral nerve roots
C) Brachial plexus
D) Cervical roots
Answer: B) Sacral nerve roots
Explanation: Local anesthetic spreads to S2–S5 levels. Thus, B is correct.
10) The sacral canal contains all except–
A) Cauda equina
B) Filum terminale
C) Coccygeal nerve
D) Sympathetic trunk
Answer: D) Sympathetic trunk
Explanation: Sympathetic trunk lies anterior to sacrum. Thus, D is correct.
11) Sacral hiatus is clinically palpated between–
A) Sacral cornua
B) Posterior superior iliac spines
C) Coccygeal tip
D) Ischial tuberosities
Answer: A) Sacral cornua
Explanation: Sacral cornua guide needle placement for caudal block. Thus, A is correct.
Chapter: Spine & Nervous System Anatomy; Topic: Sacrum – Foramina & Hiatus; Subtopic: Structures Passing Through Sacral Hiatus
Keyword Definitions:
Sacral Hiatus: An opening at the inferior end of sacral canal formed due to failure of laminae fusion of S4–S5.
Sacral Canal: Continuation of vertebral canal containing cauda equina and sacral nerves.
Sacral Nerve Roots: Ventral and dorsal roots emerging from sacral segments S1–S5.
Filum Terminale: Fibrous extension from conus medullaris that exits via sacral hiatus.
Caudal Epidural:** Site for caudal epidural anesthesia through sacral hiatus.
1) Lead Question – 2016
Structures passing through sacral hiatus are?
A) S4 nerve root
B) S2 nerve root
C) S3 nerve root
D) S5 nerve root
Answer: D) S5 nerve root
Explanation: The sacral hiatus is formed due to the non-fusion of the laminae of S4 and S5 vertebrae. It transmits the S5 nerve root, coccygeal nerve, and the filum terminale externum. Nerve roots S1–S4 exit through separate sacral foramina and do not pass through the sacral hiatus. Clinically, the sacral hiatus is used for caudal epidural anesthesia, making familiarity with its contents essential. As only the S5 nerve root passes through the sacral hiatus, the correct answer is option D.
2) Sacral hiatus is formed due to failure of fusion of–
A) S1 laminae
B) S2 laminae
C) S4–S5 laminae
D) S3 laminae
Answer: C) S4–S5 laminae
Explanation: Non-fusion of S4–S5 laminae creates sacral hiatus. Thus, C is correct.
3) The filum terminale externum attaches to–
A) L5 vertebra
B) Coccyx
C) Sacral promontory
D) Ilium
Answer: B) Coccyx
Explanation: Filum terminale anchors spinal cord to coccyx. Thus, B is correct.
4) Caudal epidural anesthesia is given through–
A) Sacral promontory
B) Sacral hiatus
C) Posterior sacral foramina
D) Intervertebral foramina
Answer: B) Sacral hiatus
Explanation: Sacral hiatus gives access to epidural space. Thus, B is correct.
5) Posterior sacral foramina transmit–
A) Ventral rami
B) Dorsal rami
C) Sympathetic chain
D) Lumbosacral trunk
Answer: B) Dorsal rami
Explanation: Dorsal rami exit posterior foramina to supply back muscles. Thus, B is correct.
6) Anterior sacral foramina transmit–
A) Cauda equina
B) Ventral rami
C) Dorsal rami
D) Ilioinguinal nerve
Answer: B) Ventral rami
Explanation: Ventral rami forming sacral plexus exit anteriorly. Thus, B is correct.
7) Coccygeal nerve emerges through–
A) Sacral hiatus
B) L5/S1 foramen
C) S2 foramen
D) Obturator canal
Answer: A) Sacral hiatus
Explanation: Coccygeal nerve exits via sacral hiatus. Thus, A is correct.
8) The sacral cornua represent–
A) Transverse processes
B) Inferior articular processes of S5
C) Fused spinous processes
D) Superior articular facets
Answer: B) Inferior articular processes of S5
Explanation: Cornua flank sacral hiatus. Thus, B is correct.
9) Caudal epidural block anesthetizes–
A) L2 dermatome
B) Sacral nerve roots
C) Brachial plexus
D) Cervical roots
Answer: B) Sacral nerve roots
Explanation: Local anesthetic spreads to S2–S5 levels. Thus, B is correct.
10) The sacral canal contains all except–
A) Cauda equina
B) Filum terminale
C) Coccygeal nerve
D) Sympathetic trunk
Answer: D) Sympathetic trunk
Explanation: Sympathetic trunk lies anterior to sacrum. Thus, D is correct.
11) Sacral hiatus is clinically palpated between–
A) Sacral cornua
B) Posterior superior iliac spines
C) Coccygeal tip
D) Ischial tuberosities
Answer: A) Sacral cornua
Explanation: Sacral cornua guide needle placement for caudal block. Thus, A is correct.
Chapter: Knee Anatomy; Topic: Posterior Knee Structures; Subtopic: Oblique Popliteal Ligament
Keyword Definitions:
Oblique Popliteal Ligament: Strong posterior ligament of knee derived from semimembranosus tendon.
Semimembranosus: Hamstring muscle whose expansions stabilize posterior knee.
Popliteal Fossa: Diamond-shaped space behind knee containing major vessels and nerves.
Posterior Capsule: Fibrous layer reinforcing knee joint from the back.
Biceps Femoris: Lateral hamstring inserting on fibular head, not forming this ligament.
1) Lead Question – 2016
Oblique popliteal ligament is derived from?
A) Semitendinosus
B) Biceps femoris
C) Adductor magnus
D) Semimembranosus
Answer: D) Semimembranosus
Explanation: The oblique popliteal ligament is a key reinforcement of the posterior knee capsule and is derived from the reflected fibers of the semimembranosus tendon. It reinforces the posterior capsule, supports the knee during extension, and forms part of the floor of the popliteal fossa. Semitendinosus does not form this structure, while biceps femoris inserts laterally onto the fibular head. Adductor magnus inserts at the adductor tubercle and does not contribute to posterior capsule formation. Therefore, semimembranosus is the correct origin of the oblique popliteal ligament.
2) The posterior oblique ligament helps resist–
A) Valgus stress
B) Varus stress
C) Posterior tibial translation
D) Anterior tibial translation
Answer: C) Posterior tibial translation
Explanation: The posterior oblique ligament prevents posterior tibial movement, complementing PCL. Thus, C is correct.
3) Semimembranosus inserts mainly on–
A) Lateral tibial condyle
B) Medial tibial condyle
C) Fibular head
D) Patella
Answer: B) Medial tibial condyle
Explanation: Semimembranosus inserts posteriorly on medial condyle of tibia. Thus, B is correct.
4) A tear of the posterior capsule would most likely affect which structure?
A) Oblique popliteal ligament
B) LCL
C) ACL
D) Medial meniscus
Answer: A) Oblique popliteal ligament
Explanation: Oblique popliteal ligament reinforces the posterior capsule. Thus, A is correct.
5) The popliteal fossa contains all except–
A) Popliteal artery
B) Tibial nerve
C) Peroneal artery
D) Popliteal vein
Answer: C) Peroneal artery
Explanation: Peroneal artery lies deep in leg, not popliteal fossa. Thus, C is correct.
6) Which muscle forms the superomedial border of popliteal fossa?
A) Semimembranosus
B) Sartorius
C) Rectus femoris
D) Biceps femoris
Answer: A) Semimembranosus
Explanation: Semimembranosus forms upper medial boundary. Thus, A is correct.
7) The oblique popliteal ligament attaches to–
A) Lateral femoral condyle
B) Medial epicondyle
C) Fibular head
D) Iliac crest
Answer: A) Lateral femoral condyle
Explanation: It runs from semimembranosus to lateral femoral condyle. Thus, A is correct.
8) Posterior knee pain during extension suggests injury to–
A) Popliteus
B) Oblique popliteal ligament
C) ACL
D) Quadriceps
Answer: B) Oblique popliteal ligament
Explanation: Posterior capsule stretch stresses oblique popliteal ligament. Thus, B is correct.
9) The ligament reinforcing posterolateral knee is–
A) Arcuate ligament
B) MCL
C) ACL
D) PCL
Answer: A) Arcuate ligament
Explanation: Arcuate ligament stabilizes posterolateral complex. Thus, A is correct.
10) Semitendinosus forms part of–
A) Pes anserinus
B) IT band
C) Quadriceps tendon
D) Patellar retinaculum
Answer: A) Pes anserinus
Explanation: Semitendinosus with sartorius and gracilis forms pes anserinus. Thus, A is correct.
11) Popliteus muscle unlocks knee by rotating–
A) Tibia internally
B) Tibia externally
C) Femur laterally
D) Patella medially
Answer: C) Femur laterally
Explanation: Popliteus externally rotates femur on tibia to unlock knee. Thus, C is correct.
Chapter: Peripheral Nerve Anatomy; Topic: Cutaneous Nerve Supply of Foot; Subtopic: Sensory Innervation of Lateral Border of Foot
Keyword Definitions:
Sural Nerve: Sensory nerve supplying posterolateral leg and lateral border of foot.
Saphenous Nerve: Longest cutaneous nerve, supplying medial leg and medial foot.
Deep Peroneal Nerve: Supplies 1st web space sensation and dorsiflexors of foot.
Superficial Peroneal Nerve: Sensory to dorsum of foot except 1st web space.
Cutaneous Dermatomes: Sensory distribution areas of peripheral nerves in the limb.
1) Lead Question – 2016
Lateral border of the foot receives its sensory supply from?
A) Saphenous nerve
B) Sural nerve
C) Deep peroneal nerve
D) Sciatic nerve
Answer: B) Sural nerve
Explanation: The sural nerve is responsible for sensory innervation of the posterolateral aspect of the leg and the lateral border of the foot including the little toe. It is formed by contributions from the tibial nerve (medial sural cutaneous nerve) and the common peroneal nerve (sural communicating branch). The saphenous nerve supplies the medial foot, not the lateral side. The deep peroneal nerve supplies only the first web space. The sciatic nerve does not supply direct cutaneous sensation to the foot. Hence, the sural nerve is the correct answer.
2) The deep peroneal nerve supplies sensation to–
A) Lateral foot
B) First web space
C) Medial arch
D) Heel
Answer: B) First web space
Explanation: Deep peroneal nerve innervates only the first dorsal web space. Thus, B is correct.
3) Saphenous nerve supplies–
A) Posterior leg
B) Lateral foot
C) Medial foot
D) Sole of foot
Answer: C) Medial foot
Explanation: Saphenous nerve is sensory to medial leg and medial foot. Thus, C is correct.
4) Sural nerve is formed by branches of–
A) Femoral + tibial
B) Tibial + common peroneal
C) Obturator + tibial
D) Superficial + deep peroneal
Answer: B) Tibial + common peroneal
Explanation: Medial sural cutaneous + sural communicating branch join to form sural nerve. Thus, B is correct.
5) A patient with injury behind the lateral malleolus may lose sensation over–
A) First web space
B) Medial malleolus
C) Lateral border of foot
D) Heel
Answer: C) Lateral border of foot
Explanation: Sural nerve runs behind lateral malleolus; injury reduces lateral foot sensation. Thus, C is correct.
6) The tibial nerve gives rise to which sensory branch in the foot?
A) Sural nerve component
B) Superficial peroneal nerve
C) Deep peroneal nerve
D) Saphenous nerve
Answer: A) Sural nerve component
Explanation: Tibial nerve contributes medial sural cutaneous branch. Thus, A is correct.
7) Sensory loss over the 5th toe indicates lesion of–
A) Deep peroneal nerve
B) Sural nerve
C) Saphenous nerve
D) Tibial nerve
Answer: B) Sural nerve
Explanation: The sural nerve supplies lateral foot and little toe. Thus, B is correct.
8) Heel sensation is supplied by–
A) Medial plantar nerve
B) Lateral plantar nerve
C) Medial calcaneal branch of tibial nerve
D) Deep peroneal nerve
Answer: C) Medial calcaneal branch of tibial nerve
Explanation: Tibial nerve gives calcaneal branches to heel. Thus, C is correct.
9) The superficial peroneal nerve supplies–
A) Medial foot
B) Heel
C) Most of dorsum of foot
D) Lateral border of foot
Answer: C) Most of dorsum of foot
Explanation: SPN supplies dorsum except 1st web space. Thus, C is correct.
10) A clinical sign of sural nerve injury is–
A) Weak dorsiflexion
B) Loss of medial foot sensation
C) Loss of lateral foot sensation
D) Loss of heel reflex
Answer: C) Loss of lateral foot sensation
Explanation: Sural nerve is purely sensory to lateral foot; injury leads to sensory deficit. Thus, C is correct.
11) Which nerve is purely sensory?
A) Deep peroneal nerve
B) Tibial nerve
C) Common peroneal nerve
D) Sural nerve
Answer: D) Sural nerve
Explanation: Sural nerve has no motor fibers and is purely sensory, supplying lateral foot. Thus, D is correct.
Chapter: Thorax Anatomy; Topic: Thoracic Cage; Subtopic: Components of the Chest Wall
Keyword Definitions:
Chest Wall: Bony and muscular protective enclosure of thoracic organs, composed of ribs, sternum, thoracic vertebrae, and intercostal muscles.
Thoracic Vertebrae: Twelve vertebrae forming posterior boundary of the thoracic cage.
Sternum: Flat bone forming anterior midline support of thorax.
Ribs: Curved bones forming major structural component of thoracic cage.
Lumbar Vertebrae: Lower back vertebrae not included in chest wall formation.
1) Lead Question – 2016
All of the following is included in chest wall except?
A) Ribs
B) Thoracic Vertebrae
C) Sternum
D) Lumbar vertebrae
Answer: D) Lumbar vertebrae
Explanation: The chest wall consists of the ribs, costal cartilages, sternum, and thoracic vertebrae. These structures collectively protect thoracic organs such as the heart and lungs and provide attachment for respiratory muscles. Lumbar vertebrae are located below the thoracic region and are not part of the thoracic cage. They do not contribute to chest wall formation or respiratory mechanics. Therefore, the only option that is not included in the chest wall is the lumbar vertebrae, making option D correct.
2) True ribs are defined as those that–
A) Attach directly to sternum
B) Do not attach to sternum
C) Attach to vertebrae only
D) Are floating
Answer: A) Attach directly to sternum
Explanation: True ribs (1–7) connect directly to sternum via costal cartilage. Thus, A is correct.
3) Floating ribs are–
A) 1–2
B) 3–5
C) 11–12
D) 7–8
Answer: C) 11–12
Explanation: Ribs 11–12 do not attach anteriorly. Thus, C is correct.
4) Manubriosternal joint is a–
A) Synovial joint
B) Secondary cartilaginous joint
C) Primary cartilaginous joint
D) Fibrous joint
Answer: B) Secondary cartilaginous joint
Explanation: Manubrium + body of sternum join by symphysis. Thus, B is correct.
5) Which rib articulates with the sternal angle?
A) 1st
B) 2nd
C) 3rd
D) 5th
Answer: B) 2nd
Explanation: The second rib attaches at manubriosternal junction. Thus, B is correct.
6) The intercostal neurovascular bundle lies between–
A) Internal & innermost intercostals
B) External & internal intercostals
C) Rib & external intercostals
D) Sternum & costal cartilage
Answer: A) Internal & innermost intercostals
Explanation: VAN lies in intercostal groove protected by these muscles. Thus, A is correct.
7) A stab wound at midaxillary line affecting the 5th intercostal space may injure–
A) Lung
B) Diaphragm
C) Liver
D) Spleen
Answer: A) Lung
Explanation: Midaxillary 5th ICS corresponds to lung field. Thus, A is correct.
8) Rib notching on X-ray indicates enlargement of–
A) Intercostal arteries
B) Internal mammary artery
C) Aorta
D) Pulmonary artery
Answer: A) Intercostal arteries
Explanation: Seen in coarctation of aorta from dilated intercostals. Thus, A is correct.
9) Typical rib contains all except–
A) Head
B) Neck
C) Tubercle
D) Manubrium
Answer: D) Manubrium
Explanation: Manubrium is part of sternum, not rib. Thus, D is correct.
10) Upper thoracic vertebrae are unique due to–
A) Costal facets
B) Transverse foramina
C) Bifid spinous processes
D) Large vertebral body
Answer: A) Costal facets
Explanation: Thoracic vertebrae articulate with ribs via costal facets. Thus, A is correct.
11) Intercostal spaces are widest at–
A) Upper thorax
B) Lower thorax
C) Mid-thorax
D) Apex
Answer: C) Mid-thorax
Explanation: Widest around 6–7th ribs allowing better expansion. Thus, C is correct.
Chapter: Respiratory System Anatomy; Topic: Lower Respiratory Tract; Subtopic: Bronchiolar Division & Respiratory Bronchioles
Keyword Definitions:
Terminal Bronchioles: Final purely conducting airways before gas-exchanging units begin.
Respiratory Bronchioles: First structures in lung where gas exchange begins due to presence of alveoli.
Bronchioles: Airways lacking cartilage and glands; lined by simple cuboidal epithelium.
Alveolar Ducts: Distal passages lined almost entirely by alveoli.
Pulmonary Acinus: Functional unit starting from respiratory bronchiole to alveoli.
1) Lead Question – 2016
Respiratory bronchioles are formed from?
A) Principal bronchus
B) Terminal bronchioles
C) Tertiary bronchus
D) Lobar bronchioles
Answer: B) Terminal bronchioles
Explanation: Respiratory bronchioles are the first segment of the respiratory zone and arise directly from terminal bronchioles. The terminal bronchiole is the last purely conducting airway and divides into two or more respiratory bronchioles, which possess alveoli in their walls, allowing the start of gas exchange. Principal, lobar, and tertiary bronchi belong to the larger conducting airways and do not give rise directly to respiratory bronchioles. Thus, the correct answer is option B, as respiratory bronchioles are derived only from terminal bronchioles.
2) The first part of lung involved in gas exchange is–
A) Terminal bronchiole
B) Respiratory bronchiole
C) Primary bronchus
D) Alveolar duct
Answer: B) Respiratory bronchiole
Explanation: Gas exchange begins where alveoli appear—respiratory bronchioles. Thus, B is correct.
3) Terminal bronchioles are lined by–
A) Stratified squamous cells
B) Simple cuboidal epithelium
C) Pseudostratified ciliated epithelium
D) Simple squamous
Answer: B) Simple cuboidal epithelium
Explanation: Terminal bronchioles contain Clara cells and cuboidal epithelium. Thus, B is correct.
4) Presence of alveoli in bronchiolar wall indicates–
A) Terminal bronchiole
B) Respiratory bronchiole
C) Cartilage
D) Bronchus
Answer: B) Respiratory bronchiole
Explanation: Alveoli begin at respiratory bronchioles. Thus, B is correct.
5) A patient with emphysema shows destruction mainly of–
A) Terminal bronchioles
B) Alveoli and acini
C) Lobar bronchi
D) Principal bronchus
Answer: B) Alveoli and acini
Explanation: Emphysema involves distal airspaces including respiratory bronchioles. Thus, B is correct.
6) The conducting zone includes all except–
A) Terminal bronchioles
B) Lobar bronchi
C) Trachea
D) Respiratory bronchioles
Answer: D) Respiratory bronchioles
Explanation: Respiratory bronchioles begin gas exchange; not part of conducting zone. Thus, D is correct.
7) Clara cells are found in–
A) Trachea
B) Bronchi
C) Terminal bronchioles
D) Alveoli
Answer: C) Terminal bronchioles
Explanation: Clara cells detoxify and secrete surfactant-like substances. Thus, C is correct.
8) Alveolar ducts arise from–
A) Terminal bronchioles
B) Respiratory bronchioles
C) Tertiary bronchi
D) Lobar bronchi
Answer: B) Respiratory bronchioles
Explanation: Respiratory bronchioles lead to alveolar ducts. Thus, B is correct.
9) The acinus begins at the–
A) Terminal bronchiole
B) Respiratory bronchiole
C) Lobar bronchus
D) Tertiary bronchus
Answer: B) Respiratory bronchiole
Explanation: Acinus includes respiratory bronchiole onward. Thus, B is correct.
10) In chronic bronchitis, which structure is primarily affected?
A) Respiratory bronchioles
B) Terminal bronchioles
C) Alveoli
D) Alveolar ducts
Answer: B) Terminal bronchioles
Explanation: Chronic bronchitis is a disease of conducting airways including terminal bronchioles. Thus, B is correct.
11) Smooth muscle extends maximally up to–
A) Alveoli
B) Terminal bronchioles
C) Respiratory bronchioles
D) Alveolar sacs
Answer: C) Respiratory bronchioles
Explanation: Smooth muscle persists into respiratory bronchioles but not alveoli. Thus, C is correct.
Chapter: Respiratory Anatomy; Topic: Bronchial Tree; Subtopic: Generations of Bronchi
Keyword Definitions:
Primary Bronchi: First branches of trachea supplying each lung.
Secondary Bronchi (Lobar): Branches of primary bronchi supplying each lobe of lung.
Tertiary Bronchi: Segmental bronchi supplying bronchopulmonary segments.
Terminal Bronchioles: Last conducting airways with no alveoli.
Respiratory Bronchioles: Bronchioles giving rise to alveoli and starting gas exchange.
1) Lead Question – 2016
Segment of bronchi distal to primary bifurcation?
A) Primary bronchi
B) Terminal bronchiole
C) Respiratory bronchiole
D) Secondary bronchi
Answer: D) Secondary bronchi
Explanation: After the trachea divides at the carina into right and left primary bronchi, each primary bronchus further divides into secondary (lobar) bronchi. These secondary bronchi specifically correspond to lung lobes—three on the right and two on the left. Terminal and respiratory bronchioles occur far later in the bronchial tree and are part of the smaller airway system. Therefore, the segment immediately distal to the primary bifurcation is the secondary (lobar) bronchi, making option D correct.
2) Secondary bronchi supply–
A) Bronchopulmonary segments
B) Lung lobes
C) Alveolar sacs
D) Terminal bronchioles
Answer: B) Lung lobes
Explanation: Secondary bronchi are lobar bronchi supplying each lung lobe. Thus, B is correct.
3) Tertiary bronchi are also known as–
A) Respiratory bronchioles
B) Segmental bronchi
C) Lobar bronchi
D) Bronchial ducts
Answer: B) Segmental bronchi
Explanation: Tertiary bronchi supply bronchopulmonary segments. Thus, B is correct.
4) First airway with alveoli present–
A) Terminal bronchiole
B) Respiratory bronchiole
C) Secondary bronchus
D) Primary bronchus
Answer: B) Respiratory bronchiole
Explanation: Alveoli begin at respiratory bronchioles; gas exchange starts here. Thus, B is correct.
5) Terminal bronchioles are lined by–
A) Stratified squamous epithelium
B) Simple cuboidal epithelium
C) Pseudostratified epithelium
D) Simple squamous epithelium
Answer: B) Simple cuboidal epithelium
Explanation: Terminal bronchioles contain Clara cells and cuboidal lining. Thus, B is correct.
6) A carcinoma obstructing secondary bronchus causes collapse of–
A) Entire lung
B) One lobe
C) One segment
D) Alveoli only
Answer: B) One lobe
Explanation: Each secondary bronchus supplies one lobe; obstruction collapses that lobe. Thus, B is correct.
7) Smooth muscle persists maximally up to–
A) Terminal bronchioles
B) Respiratory bronchioles
C) Tertiary bronchi
D) Alveolar ducts
Answer: B) Respiratory bronchioles
Explanation: Smooth muscle extends into respiratory bronchioles. Thus, B is correct.
8) Largest airway without cartilage–
A) Bronchus
B) Terminal bronchiole
C) Respiratory bronchiole
D) Segmental bronchi
Answer: B) Terminal bronchiole
Explanation: Terminal bronchioles have no cartilage and are purely conducting. Thus, B is correct.
9) The carina is located at–
A) T2
B) T4–T5
C) T6
D) T8
Answer: B) T4–T5
Explanation: Carina lies at sternal angle corresponding to T4–T5. Thus, B is correct.
10) A foreign body most commonly enters–
A) Left primary bronchus
B) Right primary bronchus
C) Lobar bronchus left
D) Terminal bronchioles
Answer: B) Right primary bronchus
Explanation: Right bronchus is wider, shorter, and more vertical. Thus, B is correct.
11) Pulmonary acinus begins at–
A) Terminal bronchiole
B) Respiratory bronchiole
C) Secondary bronchus
D) Tertiary bronchus
Answer: B) Respiratory bronchiole
Explanation: Acinus includes structures distal to respiratory bronchioles. Thus, B is correct.