Keyword Definitions:
Native Aortic Valve Disease: A condition affecting the aortic valve without prior valve replacement or prosthetic material.
Right Hemiparesis: Weakness of the muscles on the right side of the body, usually due to a brain lesion or stroke.
Antiplatelet: Drugs that prevent platelet aggregation, reducing thrombus formation in arteries.
Anticoagulant: Drugs that reduce blood clotting by inhibiting clotting factors in the coagulation cascade.
Low Molecular Weight Heparin (LMWH): Injectable anticoagulant that prevents clot extension and embolization.
Dual Antiplatelet Therapy: Combination of two antiplatelet drugs (e.g., aspirin and clopidogrel) for enhanced platelet inhibition.
Stroke Prevention: Measures to reduce the risk of recurrent cerebrovascular events in at-risk individuals.
Lead Question (2012):
A patient with native aortic valve disease came with right hemiparesis. What will you do to prevent further stroke?
a) Antiplatelet only
b) Anticoagulant only
c) Both antiplatelet and anticoagulant
d) One dose of low molecular weight heparin sub-cutaneously followed by dual antiplatelet therapy
Explanation: The correct answer is b) Anticoagulant only. Native aortic valve disease with embolic stroke usually indicates a cardioembolic source, often requiring anticoagulation to prevent further events. Antiplatelets are more effective in atherosclerotic stroke, whereas anticoagulants like warfarin or DOACs are preferred for cardioembolic strokes. LMWH is used initially in certain cases but not routinely in chronic prevention.
Q2. A patient with mitral stenosis presents with sudden-onset left-sided weakness. Best drug for secondary prevention?
a) Aspirin
b) Warfarin
c) Clopidogrel
d) Dabigatran
Explanation: The correct answer is b) Warfarin. Mitral stenosis, especially with atrial fibrillation, is a high-risk source of cardioembolic stroke. Long-term anticoagulation with warfarin reduces stroke risk. Antiplatelets are insufficient for this type of embolic prevention.
Q3. Which investigation confirms cardioembolic stroke origin in aortic valve disease?
a) ECG
b) Echocardiography
c) CT Brain
d) Carotid Doppler
Explanation: The correct answer is b) Echocardiography. Echocardiography can detect valvular vegetations, thrombi, and structural abnormalities, confirming the source of embolism in cardioembolic strokes.
Q4. Which is NOT an indication for anticoagulation in valvular heart disease?
a) Prosthetic heart valve
b) Native valve with atrial fibrillation
c) Native valve with sinus rhythm but embolic stroke history
d) Native valve disease with mild regurgitation and no history of embolism
Explanation: The correct answer is d). Mild regurgitation without embolism or atrial fibrillation does not require anticoagulation.
Q5. In acute ischemic stroke within 4.5 hours, which therapy is considered?
a) Aspirin immediately
b) IV thrombolysis
c) Heparin bolus
d) Clopidogrel only
Explanation: The correct answer is b) IV thrombolysis. Alteplase is used within 4.5 hours of onset in eligible patients, improving outcomes. Antiplatelets are started after ruling out hemorrhage.
Q6. For preventing recurrent stroke in atrial fibrillation, which is preferred?
a) Aspirin
b) Apixaban
c) Ticagrelor
d) Clopidogrel
Explanation: The correct answer is b) Apixaban. Direct oral anticoagulants like apixaban reduce stroke risk in AF without the monitoring needs of warfarin.
Q7. Which side of the brain lesion causes right hemiparesis?
a) Left hemisphere
b) Right hemisphere
c) Brainstem only
d) Cerebellum
Explanation: The correct answer is a) Left hemisphere. The motor tracts decussate in the medulla, so a lesion in the left hemisphere causes contralateral (right-sided) weakness.
Q8. Which is the mainstay drug class for secondary prevention after non-cardioembolic stroke?
a) Anticoagulants
b) Antiplatelets
c) Statins
d) Beta-blockers
Explanation: The correct answer is b) Antiplatelets. Aspirin, clopidogrel, or combination therapy is standard for preventing recurrence in atherosclerotic stroke.
Q9. Which LMWH is most commonly used for initial anticoagulation?
a) Heparin sodium
b) Enoxaparin
c) Fondaparinux
d) Dalteparin
Explanation: The correct answer is b) Enoxaparin. It is widely used due to predictable pharmacokinetics and subcutaneous administration.
Q10. In a patient with recent stroke, anticoagulation should be started:
a) Immediately in all cases
b) After 1–2 weeks in large infarcts
c) Never
d) Only if carotid stenosis present
Explanation: The correct answer is b). In large infarcts, early anticoagulation increases hemorrhage risk; it’s usually delayed 1–2 weeks unless urgent indication exists.
Cervical Esophagus: The uppermost part of the esophagus, extending from the cricopharyngeus to the thoracic inlet.
Vagus Nerve: Cranial nerve X, responsible for parasympathetic control of the heart, lungs, and digestive tract.
Recurrent Laryngeal Nerve: Branch of the vagus nerve that supplies motor function and sensation to the larynx and cervical esophagus.
Esophageal Innervation: Nerve supply that controls esophageal motility and sensation.
Parasympathetic Fibers: Nerve fibers that control involuntary functions like digestion and glandular activity.
Sympathetic Fibers: Nerve fibers involved in fight-or-flight responses, also affecting smooth muscle tone in the esophagus.
Cricopharyngeus Muscle: The upper esophageal sphincter controlling the entry of food into the esophagus.
Esophageal Motility Disorders: Conditions affecting the coordinated muscle contractions of the esophagus.
Leas Question 2012
Q1. (2012) Nerve supply of cervical esophagus?
a) Vagus
b) Left recurrent laryngeal nerve
c) Right recurrent laryngeal nerve
d) All of the above
Answer: d) All of the above
Explanation: The cervical esophagus receives motor innervation from both the right and left recurrent laryngeal nerves, which are branches of the vagus nerve. These nerves provide motor supply to striated muscles and sensory innervation to the mucosa. Sympathetic fibers from the cervical sympathetic chain also contribute, controlling muscle tone. Damage to these nerves can lead to dysphagia and aspiration.
Q2. Which muscle forms the upper esophageal sphincter?
a) Cricopharyngeus
b) Thyropharyngeus
c) Inferior constrictor
d) Stylopharyngeus
Answer: a) Cricopharyngeus
Explanation: The cricopharyngeus muscle is the principal component of the upper esophageal sphincter, regulating the passage of food into the cervical esophagus. It is innervated by the recurrent laryngeal nerve. Dysfunction may lead to Zenker’s diverticulum formation.
Q3. Injury to the left recurrent laryngeal nerve during thyroid surgery may cause?
a) Hoarseness
b) Dysphagia
c) Loss of gag reflex
d) Loss of taste sensation
Answer: a) Hoarseness
Explanation: The left recurrent laryngeal nerve supplies motor fibers to most intrinsic laryngeal muscles. Injury results in vocal cord paralysis, causing hoarseness, weak cough, and aspiration risk. This nerve also contributes to the cervical esophageal motor function.
Q4. Which nerve passes under the arch of the aorta before ascending to the larynx?
a) Left recurrent laryngeal nerve
b) Right recurrent laryngeal nerve
c) Vagus nerve
d) Glossopharyngeal nerve
Answer: a) Left recurrent laryngeal nerve
Explanation: The left recurrent laryngeal nerve loops under the aortic arch, while the right loops under the subclavian artery. This anatomical difference explains why left-sided nerve palsy may occur in thoracic diseases affecting the aorta or mediastinum.
Q5. Sympathetic innervation of the cervical esophagus arises from?
a) Stellate ganglion
b) Cervical sympathetic chain
c) Thoracic sympathetic chain
d) Both a and b
Answer: d) Both a and b
Explanation: Sympathetic fibers from the cervical sympathetic chain, including the stellate ganglion, provide vasomotor and smooth muscle tone control to the cervical esophagus. These fibers complement parasympathetic vagal input for coordinated swallowing.
Q6. Which cranial nerve is responsible for parasympathetic innervation of the cervical esophagus?
a) Glossopharyngeal
b) Vagus
c) Accessory
d) Hypoglossal
Answer: b) Vagus
Explanation: The vagus nerve (cranial nerve X) carries parasympathetic fibers to the esophagus, facilitating peristalsis and glandular secretions. Recurrent laryngeal branches of the vagus provide the direct motor supply to the cervical portion.
Q7. A tumor compressing the left recurrent laryngeal nerve can present with all EXCEPT?
a) Stridor
b) Hoarseness
c) Dysphagia
d) Hyperacusis
Answer: d) Hyperacusis
Explanation: Hyperacusis is due to facial nerve (CN VII) involvement. Compression of the left recurrent laryngeal nerve by tumors such as lung carcinoma or mediastinal masses leads to hoarseness, stridor, and dysphagia but not auditory hypersensitivity.
Q8. Clinical sign most suggestive of bilateral recurrent laryngeal nerve injury?
a) Aphonia
b) Inspiratory stridor
c) Dysphagia
d) Nasal regurgitation
Answer: b) Inspiratory stridor
Explanation: Bilateral injury to recurrent laryngeal nerves causes vocal cord adduction, narrowing the airway and producing inspiratory stridor. This is a surgical emergency often seen after thyroidectomy complications.
Q9. The cervical esophagus transitions from striated to smooth muscle at approximately what vertebral level?
a) C4
b) C6
c) T1
d) T4
Answer: b) C6
Explanation: At the C6 vertebral level, the pharyngoesophageal junction marks the start of the esophagus. The upper part contains striated muscle fibers, gradually transitioning to smooth muscle in the thoracic portion.
Q10. Which nerve is most vulnerable during anterior cervical spine surgery?
a) Hypoglossal
b) Recurrent laryngeal
c) Vagus
d) Glossopharyngeal
Answer: b) Recurrent laryngeal
Explanation: Anterior cervical spine approaches risk injury to the recurrent laryngeal nerve due to its proximity to the tracheoesophageal groove. Injury can lead to hoarseness, aspiration, and swallowing difficulties.
Q11. The esophageal plexus is primarily formed by?
a) Glossopharyngeal and hypoglossal
b) Vagus and sympathetic fibers
c) Facial and trigeminal
d) Phrenic and accessory
Answer: b) Vagus and sympathetic fibers
Explanation: The esophageal plexus is formed by branches from the vagus nerve and sympathetic chain, integrating parasympathetic and sympathetic control of motility and glandular secretions along the esophagus.
Keyword Definitions:
Tibial Nerve: A branch of the sciatic nerve that innervates the posterior compartment of the leg and plantar surface of the foot.
Palsy: Weakness or paralysis of a muscle group due to nerve damage.
Plantar Flexion: Movement of the foot downward at the ankle joint.
Dorsiflexion: Upward movement of the foot at the ankle joint.
Anterior Compartment of Leg: Muscles responsible for dorsiflexion of the foot and extension of the toes.
Posterior Compartment of Leg: Muscles responsible for plantar flexion and toe flexion.
Sciatic Nerve: Largest nerve in the body, branching into tibial and common peroneal nerves.
Medial Plantar Nerve: Branch of the tibial nerve supplying the medial aspect of the sole.
Lateral Plantar Nerve: Branch of the tibial nerve supplying the lateral aspect of the sole.
Clinical Examination: Bedside evaluation of nerve injury using motor, sensory, and reflex testing.
Chapter: Neuroanatomy Topic: Peripheral Nervous System Subtopic: Tibial Nerve Injury
Lead Question (2012):
Tibial nerve injury/palsy causes:
a) Dorsiflexion of foot at ankle joint
b) Plantar flexion of the foot at ankle joint
c) Loss of sensation of dorsum of foot
d) Paralysis of muscles of anterior compartment of leg
Explanation: The tibial nerve supplies the posterior compartment of the leg, responsible for plantar flexion and toe flexion. Injury leads to loss of plantar flexion, weakened inversion, and sensory loss over the sole. Dorsiflexion is performed by the anterior compartment (deep peroneal nerve). The dorsum of the foot is supplied mainly by the superficial peroneal nerve.
Q1. Which of the following muscles is innervated by the tibial nerve?
a) Tibialis anterior
b) Gastrocnemius
c) Peroneus longus
d) Extensor digitorum longus
Explanation: The gastrocnemius muscle is part of the posterior compartment of the leg, innervated by the tibial nerve, and functions in plantar flexion. Tibialis anterior and extensor digitorum longus are supplied by the deep peroneal nerve. Peroneus longus is supplied by the superficial peroneal nerve.
Q2. Damage to the tibial nerve at the popliteal fossa results in loss of:
a) Dorsiflexion
b) Plantar flexion
c) Knee extension
d) Hip abduction
Explanation: Tibial nerve injury at the popliteal fossa causes loss of plantar flexion and toe flexion, as the posterior compartment muscles are denervated. Dorsiflexion is controlled by anterior compartment muscles. Knee extension is mediated by the femoral nerve, and hip abduction by the gluteal nerves.
Q3. Sensory loss in tibial nerve injury typically occurs over:
a) Dorsum of foot
b) Lateral leg
c) Sole of foot
d) Medial thigh
Explanation: The tibial nerve provides sensory innervation to the sole of the foot via the medial and lateral plantar nerves. The dorsum of the foot is innervated by the superficial peroneal nerve. Lateral leg sensation comes from the superficial peroneal and sural nerves; medial thigh is via femoral nerve branches.
Q4. Which reflex may be lost in tibial nerve injury?
a) Knee jerk
b) Ankle jerk
c) Biceps jerk
d) Plantar reflex
Explanation: The ankle jerk (Achilles tendon reflex) tests the S1-S2 roots via the tibial nerve. Tibial nerve injury abolishes this reflex. Knee jerk involves L2-L4 via femoral nerve, biceps jerk involves C5-C6 via musculocutaneous nerve, and plantar reflex tests corticospinal tract integrity.
Q5. The tibial nerve is a terminal branch of which nerve?
a) Femoral nerve
b) Obturator nerve
c) Sciatic nerve
d) Common peroneal nerve
Explanation: The sciatic nerve divides into the tibial and common peroneal nerves at the apex of the popliteal fossa. The tibial nerve continues downward to supply the posterior leg and sole of the foot. Femoral and obturator nerves are separate lumbar plexus branches.
Q6. In tarsal tunnel syndrome, which nerve is compressed?
a) Common peroneal nerve
b) Tibial nerve
c) Deep peroneal nerve
d) Sural nerve
Explanation: Tarsal tunnel syndrome is due to compression of the tibial nerve beneath the flexor retinaculum, causing pain, tingling, and numbness in the sole of the foot. The common and deep peroneal nerves are involved in anterior/lateral leg innervation; sural nerve supplies the posterolateral leg and lateral foot.
Q7. A patient with tibial nerve injury will have difficulty in:
a) Standing on toes
b) Standing on heels
c) Knee extension
d) Hip extension
Explanation: Standing on toes requires plantar flexion, which is mediated by the tibial nerve. Tibial nerve injury makes this action weak or impossible. Standing on heels requires dorsiflexion (deep peroneal nerve). Knee and hip extension are controlled by femoral and gluteal nerves respectively.
Q8. Which artery accompanies the tibial nerve in the posterior compartment of the leg?
a) Anterior tibial artery
b) Posterior tibial artery
c) Popliteal artery
d) Fibular artery
Explanation: The posterior tibial artery runs with the tibial nerve in the posterior compartment. Anterior tibial artery runs with deep peroneal nerve. Popliteal artery is above the split, and fibular artery is a branch of the posterior tibial artery.
Q9. Which muscle is spared in tibial nerve injury at the ankle?
a) Flexor hallucis longus
b) Flexor digitorum longus
c) Tibialis posterior
d) Gastrocnemius
Explanation: Injury at the ankle spares proximal muscles like gastrocnemius, tibialis posterior, and long toe flexors because they are innervated higher up. Only intrinsic foot muscles supplied by tibial nerve branches are affected.
Q10. Clinical feature of complete tibial nerve transection at popliteal fossa includes:
a) Foot drop
b) Clawing of toes
c) Loss of knee jerk
d) Loss of hip abduction
Explanation: Complete tibial nerve injury causes inability to plantar flex and invert foot, loss of sole sensation, absent ankle jerk, and clawing of toes due to intrinsic foot muscle paralysis. Foot drop is from common peroneal nerve injury. Knee jerk and hip abduction are unrelated to tibial nerve.
Keywords & Definitions:
Popliteus muscle: A small muscle located at the back of the knee joint, playing a role in unlocking the knee from a fully extended position.
Knee joint: A hinge-type synovial joint connecting the femur, tibia, and patella, allowing flexion and extension.
Intracapsular origin: A muscle origin point located within the fibrous capsule of a joint.
Tibial nerve: A branch of the sciatic nerve supplying motor and sensory innervation to parts of the leg and foot.
Knee locking: A mechanism that stabilizes the knee in extension by medial rotation of the femur on the tibia.
Flexor muscles of knee: Muscles that bend the knee joint, reducing the angle between the thigh and leg.
Posterior cruciate ligament: A ligament inside the knee joint that prevents posterior displacement of the tibia.
Meniscus: C-shaped fibrocartilage structures that provide cushioning and stability in the knee joint.
Lateral rotation of femur: Outward movement of the femur around its longitudinal axis, important in knee biomechanics.
Bursitis: Inflammation of the bursa, a small fluid-filled sac reducing friction between tissues.
Chapter: Locomotor System – Lower Limb Anatomy
Topic: Muscles of the Leg
Sub-topic: Popliteus Muscle Anatomy and Function
Lead Question – NEET PG 2012:
True about popliteus are all except?
a) Flexor of knee
b) Intracapsular origin
c) Supplied by tibial nerve
d) Causes locking of knee
Explanation:
The popliteus muscle is a flexor of the knee, originates intracapsularly from the lateral femoral condyle, and is supplied by the tibial nerve. However, it causes unlocking of the knee by laterally rotating the femur on the tibia during initiation of flexion. The locking function is opposite to its role. Correct answer: d) Causes locking of knee.
Guess Question 1:
Which nerve injury can lead to weakness in unlocking the knee?
a) Common peroneal nerve
b) Tibial nerve
c) Femoral nerve
d) Obturator nerve
Explanation: The tibial nerve innervates the popliteus muscle, crucial for unlocking the knee. Injury to this nerve impairs flexion initiation from a fully extended position, causing difficulty in walking downstairs or on slopes. Correct answer: b) Tibial nerve.
Guess Question 2:
The popliteus muscle primarily acts by:
a) Medially rotating the tibia
b) Laterally rotating the femur
c) Abducting the tibia
d) Extending the knee
Explanation: The popliteus muscle unlocks the knee by laterally rotating the femur on the tibia when the foot is fixed, or medially rotating the tibia when the foot is free. This breaks the 'screw-home' mechanism of knee locking. Correct answer: b) Laterally rotating the femur.
Guess Question 3:
Which structure is located anterior to the popliteus muscle?
a) Lateral meniscus
b) Posterior cruciate ligament
c) Medial meniscus
d) Patellar ligament
Explanation: The posterior cruciate ligament lies anterior to the popliteus muscle within the knee joint capsule. This anatomical relationship is important during knee surgeries to avoid injury. Correct answer: b) Posterior cruciate ligament.
Guess Question 4:
Popliteus muscle origin is:
a) Medial femoral condyle
b) Lateral femoral condyle
c) Tibial plateau
d) Fibular head
Explanation: The popliteus originates from the lateral femoral condyle and adjacent lateral meniscus. Its tendon passes inferomedially through the capsule to insert on the posterior tibia. Correct answer: b) Lateral femoral condyle.
Guess Question 5:
Which artery supplies the popliteus muscle?
a) Femoral artery
b) Popliteal artery
c) Anterior tibial artery
d) Posterior tibial artery
Explanation: The popliteal artery, a continuation of the femoral artery, gives muscular branches to the popliteus. Adequate blood supply is essential for muscle function and healing post-injury. Correct answer: b) Popliteal artery.
Guess Question 6 (Clinical):
A patient with a posterior knee stab wound presents with difficulty in initiating knee flexion. Which muscle is likely injured?
a) Gastrocnemius
b) Popliteus
c) Semitendinosus
d) Biceps femoris
Explanation: The popliteus initiates flexion from full extension by unlocking the knee. Injury here causes functional impairment despite intact hamstrings. Correct answer: b) Popliteus.
Guess Question 7:
Which of the following is NOT an action of the popliteus muscle?
a) Unlocking the knee
b) Assisting knee flexion
c) Lateral rotation of femur
d) Knee extension
Explanation: The popliteus assists in flexion and unlocking the knee but does not extend the knee. Extension is achieved mainly by the quadriceps femoris. Correct answer: d) Knee extension.
Guess Question 8 (Clinical):
Damage to which ligament may impair popliteus function due to its attachment?
a) Anterior cruciate ligament
b) Posterior cruciate ligament
c) Lateral meniscus
d) Patellar ligament
Explanation: The popliteus has a fibrous attachment to the lateral meniscus. Damage here may affect both structures, leading to locking symptoms. Correct answer: c) Lateral meniscus.
Guess Question 9:
In a weight-bearing knee, the popliteus unlocks the joint by:
a) Medial rotation of femur
b) Lateral rotation of femur
c) Lateral rotation of tibia
d) Hyperextension
Explanation: In a fixed-foot condition, the popliteus laterally rotates the femur to unlock the knee. This movement is reversed when the tibia is free. Correct answer: b) Lateral rotation of femur.
Guess Question 10 (Clinical):
A patient recovering from knee arthroscopy has pain and weakness during the first 10° of flexion. Which muscle is primarily responsible for this movement?
a) Gastrocnemius
b) Hamstrings
c) Popliteus
d) Quadriceps femoris
Explanation: The popliteus is critical for initiating knee flexion from a locked position. Weakness here manifests as difficulty in starting flexion. Correct answer: c) Popliteus.
Chapter: Anatomy – Lower Limb
Topic: Ankle Joint & Ligaments
Sub-topic: Medial (Deltoid) Ligament of Ankle
Keyword Definitions:
Deltoid Ligament: Strong triangular ligament on the medial side of the ankle, preventing eversion.
Medial Malleolus: Bony prominence on inner side of ankle, part of tibia.
Medial Cuneiform: Tarsal bone in midfoot, articulates with first metatarsal.
Spring Ligament: Plantar calcaneonavicular ligament supporting medial arch.
Sustentaculum Tali: Medial projection of calcaneus supporting talus.
Plantar Ligaments: Support arches of foot, prevent excessive dorsiflexion.
Ankle Joint: Synovial hinge joint between tibia, fibula, and talus.
Foot Arches: Medial and lateral longitudinal arches, transverse arch.
Tibialis Posterior: Muscle supporting medial arch and inverting foot.
Eversion Injury: Outward twisting of foot, commonly involving deltoid ligament injury.
Q1 (2012 NEET PG): Deltoid ligament is attached to all except:
Medial malleolus
Medial cuneiform
Spring ligament
Sustentaculum tali
Explanation: The deltoid ligament originates from the medial malleolus and fans out to attach to the talus, sustentaculum tali, and navicular via the spring ligament. It is not directly attached to the medial cuneiform. Therefore, the correct answer is Medial cuneiform. Its function is to resist eversion and maintain medial ankle stability.
Q2: Which component of the deltoid ligament attaches to the navicular bone?
Tibiocalcaneal
Tibionavicular
Tibiotalar anterior
Tibiotalar posterior
Explanation: The tibionavicular part of the deltoid ligament extends from the medial malleolus to the navicular bone. It helps support the medial longitudinal arch by linking with the spring ligament and prevents excessive eversion.
Q3: In an eversion ankle injury, which ligament is most likely torn first?
Anterior talofibular ligament
Calcaneofibular ligament
Deltoid ligament
Bifurcate ligament
Explanation: Eversion injuries stress the medial side of the ankle. The deltoid ligament is often injured first due to its strong attachment to the medial malleolus and tarsal bones. Severe force may cause medial malleolar fracture instead of ligament rupture.
Q4: Which tarsal bone does not receive direct attachment from the deltoid ligament?
Talus
Calcaneus
Navicular
Cuboid
Explanation: The deltoid ligament attaches to talus, calcaneus, and navicular but not to the cuboid. The cuboid is located laterally, away from the ligament’s medial orientation.
Q5: The spring ligament connects the sustentaculum tali to which bone?
Talus
Navicular
Medial cuneiform
First metatarsal
Explanation: The plantar calcaneonavicular ligament (spring ligament) runs from the sustentaculum tali of the calcaneus to the navicular. It supports the head of the talus and the medial arch.
Q6: A patient with posterior tibial tendon dysfunction is likely to have attenuation of which ligament?
Spring ligament
Long plantar ligament
Deltoid ligament
Interosseous talocalcaneal ligament
Explanation: Posterior tibial tendon dysfunction leads to collapse of the medial arch and stretching of the spring ligament. This reduces ankle stability and causes flatfoot deformity.
Q7: Which part of the deltoid ligament attaches to the sustentaculum tali?
Tibionavicular
Tibiocalcaneal
Tibiotalar anterior
Tibiotalar posterior
Explanation: The tibiocalcaneal portion of the deltoid ligament connects the medial malleolus to the sustentaculum tali of the calcaneus, resisting valgus tilt of the ankle.
Q8: In a trimalleolar fracture, which ligament is most often associated with medial injury?
Anterior talofibular ligament
Deltoid ligament
Bifurcate ligament
Long plantar ligament
Explanation: In a trimalleolar fracture (medial, lateral, and posterior malleoli), the deltoid ligament is commonly damaged on the medial side, contributing to ankle instability.
Q9: Which ligament is important for preventing abduction of the foot at the ankle?
Deltoid ligament
Calcaneofibular ligament
Interosseous ligament
Bifurcate ligament
Explanation: The deltoid ligament is the primary restraint to abduction (eversion) of the foot at the ankle joint. Its medial location counteracts outward tilting.
Q10: Which is the strongest medial ankle ligament?
Spring ligament
Deltoid ligament
Long plantar ligament
Bifurcate ligament
Explanation: The deltoid ligament is the strongest medial ligament of the ankle, made of superficial and deep fibers, providing strong stability against eversion and rotational forces.
Q11: Which ligament maintains the head of the talus in position?
Spring ligament
Deltoid ligament
Long plantar ligament
Bifurcate ligament
Explanation: The spring ligament supports the head of the talus, preventing it from dropping and maintaining the medial longitudinal arch of the foot.
Chapter: Lower Limb Anatomy
Topic: Femoral Triangle & Related Structures
Sub-topic: Structures Passing Behind Inguinal Ligament
Keyword Definitions:
Inguinal Ligament: A fibrous band from the anterior superior iliac spine to the pubic tubercle, forming the base of the inguinal canal.
Femoral Vein: A major deep vein of the thigh, located medial to the femoral artery in the femoral triangle.
Psoas Major: A large muscle of the posterior abdominal wall, important for hip flexion.
Genitofemoral Nerve: A mixed nerve of lumbar origin, with genital and femoral branches.
Femoral Triangle: An anatomical space in the upper thigh containing femoral nerve, artery, vein, and lymphatics.
Retroinguinal Space: Area beneath the inguinal ligament containing vessels, nerves, and muscles passing into the thigh.
Iliacus Muscle: A hip flexor muscle passing beneath the inguinal ligament along with the psoas major.
Lymphatics of Lower Limb: Vessels and nodes draining lower extremities, passing through femoral canal.
Lead Question – NEET PG 2012:
Which structure(s) passes behind the inguinal ligament?
a) Femoral branch of genitofemoral nerve
b) Femoral vein
c) Psoas major
d) All
Explanation: The inguinal ligament forms the lower boundary of the abdomen. Structures passing beneath it include muscles (psoas major, iliacus), vessels (femoral artery, femoral vein), nerves (femoral nerve, femoral branch of genitofemoral nerve, lateral femoral cutaneous nerve), and lymphatics. Since all listed options pass behind it, the correct answer is d) All.
Q2. Which nerve passes lateral to the femoral artery beneath the inguinal ligament?
a) Obturator nerve
b) Femoral nerve
c) Sciatic nerve
d) Pudendal nerve
Explanation: The femoral nerve lies lateral to the femoral artery beneath the inguinal ligament within the muscular compartment of the retroinguinal space. This anatomical relationship is key in femoral catheterization and nerve blocks. The correct answer is b) Femoral nerve.
Q3. The femoral vein lies in relation to the femoral artery as:
a) Lateral
b) Medial
c) Posterior
d) Anterior
Explanation: In the femoral triangle, the femoral vein lies medial to the femoral artery. Clinically, this helps in identifying vascular structures during catheterization. Remember the order from lateral to medial: Nerve – Artery – Vein – Lymphatics (NAVL). The correct answer is b) Medial.
Q4. Which structure occupies the muscular lacuna beneath the inguinal ligament?
a) Femoral artery
b) Femoral vein
c) Psoas major
d) Femoral canal
Explanation: The muscular lacuna is the lateral compartment beneath the inguinal ligament, containing the psoas major, iliacus, and femoral nerve. Vessels pass through the vascular lacuna. The correct answer is c) Psoas major.
Q5. In femoral hernia, the hernial sac passes through:
a) Muscular lacuna
b) Femoral canal
c) Obturator canal
d) Inguinal canal
Explanation: Femoral hernia occurs when abdominal contents protrude through the femoral canal, which lies medial to the femoral vein beneath the inguinal ligament. It is more common in females due to a wider pelvis. The correct answer is b) Femoral canal.
Q6. The lateral femoral cutaneous nerve passes beneath the inguinal ligament:
a) Medial to ASIS
b) Lateral to ASIS
c) Through femoral canal
d) Through obturator canal
Explanation: The lateral femoral cutaneous nerve passes beneath the inguinal ligament about 1 cm medial to the anterior superior iliac spine (ASIS) to supply sensation to the lateral thigh. Compression here may cause meralgia paresthetica. The correct answer is a) Medial to ASIS.
Q7. Which vessel lies directly medial to the femoral artery beneath the inguinal ligament?
a) Femoral vein
b) Femoral nerve
c) Deep femoral artery
d) Great saphenous vein
Explanation: The femoral vein lies immediately medial to the femoral artery in the femoral sheath beneath the inguinal ligament. This arrangement is vital for femoral venous access. The correct answer is a) Femoral vein.
Q8. In retroperitoneal hemorrhage, which muscle passing under the inguinal ligament may become tender?
a) Rectus femoris
b) Psoas major
c) Sartorius
d) Tensor fasciae latae
Explanation: Psoas major lies retroperitoneally and passes under the inguinal ligament into the thigh. Retroperitoneal bleeding can cause irritation and tenderness in the psoas muscle, leading to difficulty in hip flexion. The correct answer is b) Psoas major.
Q9. Which structure does NOT pass beneath the inguinal ligament?
a) Femoral artery
b) Femoral vein
c) Obturator nerve
d) Psoas major
Explanation: The obturator nerve passes through the obturator canal in the pelvis and does not cross beneath the inguinal ligament. The others listed are retroinguinal structures. The correct answer is c) Obturator nerve.
Q10. Which artery lies lateral to the femoral vein beneath the inguinal ligament?
a) Femoral artery
b) Deep femoral artery
c) Popliteal artery
d) Superficial epigastric artery
Explanation: The femoral artery lies lateral to the femoral vein beneath the inguinal ligament. This relationship is consistent in anatomical positioning and is clinically relevant for surgical approaches. The correct answer is a) Femoral artery.
Locking of Knee Joint – A condition where the knee becomes stuck in one position due to mechanical obstruction, usually caused by meniscus injury or loose bodies.
Osgood Schlatter Disease – An overuse injury causing pain and swelling at the tibial tuberosity, common in adolescents.
Loose Body in Knee – Small fragments of bone or cartilage floating inside the joint, often causing locking or catching.
Tuberculosis of Knee – A chronic infection of the knee joint caused by Mycobacterium tuberculosis, leading to pain, swelling, and restricted movement.
Meniscal Tear – Injury to the cartilage in the knee, a common cause of locking.
Patellofemoral Pain Syndrome – Pain in the front of the knee, often from overuse or malalignment, not typically causing locking.
Anterior Cruciate Ligament (ACL) Injury – Damage to the ACL causing instability, swelling, and reduced movement.
Synovial Chondromatosis – A joint disorder where cartilage nodules form in the synovium, which may break off and cause loose bodies.
Chapter: Orthopaedics
Topic: Knee Joint Disorders
Sub-topic: Mechanical Locking of the Knee
Q1 (Lead Question – 2012): Locking of knee joint can be caused by:
a) Osgood Schlatter
b) Loose body in knee joint
c) Tuberculosis of knee
d) a and b both
Explanation: The correct answer is b) Loose body in knee joint. Knee locking occurs when something physically obstructs joint movement, most often due to meniscus tears or loose bodies (osteochondral fragments). Osgood Schlatter disease affects the tibial tuberosity in growing adolescents and does not cause locking. Tuberculosis of the knee leads to chronic swelling and stiffness, but locking is uncommon.
Q2: A 22-year-old athlete reports sudden locking of the knee after a twisting injury. Which structure is most likely injured?
a) ACL
b) Medial meniscus
c) Lateral collateral ligament
d) Patellar tendon
Explanation: Correct answer: b) Medial meniscus. Meniscal tears, especially bucket-handle tears, can mechanically block knee extension, leading to locking. The medial meniscus is more frequently injured due to its firm attachment to the tibia and medial collateral ligament, making it less mobile.
Q3: Which imaging modality is best for detecting a meniscal tear?
a) X-ray
b) MRI
c) CT scan
d) Ultrasound
Explanation: Correct answer: b) MRI. MRI provides detailed images of soft tissue, making it the investigation of choice for diagnosing meniscal injuries. X-rays can detect bony pathology but not cartilage tears. CT is less sensitive for soft tissue, and ultrasound is rarely used for intra-articular injuries.
Q4: In knee tuberculosis, the most common X-ray finding is:
a) Sunburst appearance
b) Phemister’s triad
c) Onion-skin periosteal reaction
d) Ground-glass opacity
Explanation: Correct answer: b) Phemister’s triad – periarticular osteoporosis, marginal erosions, and gradual joint space narrowing. TB of the knee is a slowly progressive monoarthritis that rarely causes acute locking.
Q5: Which of the following can present with intermittent locking due to cartilage nodules?
a) Synovial chondromatosis
b) Gout
c) Rheumatoid arthritis
d) Osteoporosis
Explanation: Correct answer: a) Synovial chondromatosis. This rare condition produces loose cartilage nodules in the synovial membrane, which may detach and cause locking or catching sensations in the joint.
Q6: The most common site of Osgood Schlatter disease is:
a) Tibial tuberosity
b) Patella
c) Femoral condyle
d) Fibular head
Explanation: Correct answer: a) Tibial tuberosity. Osgood Schlatter is an apophysitis caused by repetitive strain from the patellar tendon, especially in adolescents during sports activities.
Q7: The “bucket handle” tear is associated with:
a) Cruciate ligament rupture
b) Meniscal tear
c) Patellar fracture
d) Quadriceps tendon rupture
Explanation: Correct answer: b) Meniscal tear. In this injury, a portion of the torn meniscus flips into the joint, causing mechanical blockage and locking.
Q8: A patient with a locked knee cannot perform which movement?
a) Flexion
b) Extension
c) Abduction
d) Internal rotation
Explanation: Correct answer: b) Extension. Locking typically prevents full extension, as the obstructing structure (like a torn meniscus) blocks the femoral condyle from gliding forward.
Q9: Which treatment is preferred for a young patient with symptomatic loose body in the knee?
a) Arthroscopic removal
b) Plaster cast immobilization
c) Long-term NSAIDs
d) Heat therapy
Explanation: Correct answer: a) Arthroscopic removal. Surgery removes the mechanical obstruction, restoring movement and preventing further cartilage damage.
Q10: Meniscal tears heal poorly because:
a) Meniscus has no nerve supply
b) Meniscus has limited blood supply
c) Meniscus is made of bone
d) Meniscus is too thick
Explanation: Correct answer: b) Meniscus has limited blood supply. The inner two-thirds of the meniscus is avascular, limiting healing potential. Only peripheral tears in the vascular zone may heal with conservative treatment.
Chapter: Musculoskeletal Anatomy
Topic: Lower Limb Anatomy
Sub-topic: Gluteal Region – Muscles, Nerves, and Safe Injection Sites
Keyword Definitions:
Gluteus maximus: The largest muscle in the buttock, responsible for hip extension and external rotation.
Gluteus medius: A muscle important for hip abduction, covering part of the safe injection site.
Sciatic nerve: Major nerve running through the posterior thigh, can be injured by improper injection.
Safe injection site: The superolateral quadrant of the buttock to avoid nerve or vascular injury.
Trendelenburg gait: Abnormal gait caused by injury to the superior gluteal nerve.
Superior gluteal nerve: Nerve that supplies gluteus medius, gluteus minimus, and tensor fasciae latae.
Inferior gluteal nerve: Supplies the gluteus maximus muscle.
Intramuscular injection: Administration of drugs into the muscle tissue for rapid absorption.
Quadrants of buttock: Divisions used to identify safe anatomical injection sites.
Ischial tuberosity: Bony prominence of pelvis, landmark for hamstring muscle attachment.
1. Site of injection in the gluteus? (2012)
a) Inferomedial
b) Superomedial
c) Superolateral
d) Superomedial
Explanation: The correct answer is c) Superolateral. Intramuscular injections in the gluteal region should be given in the superolateral quadrant to avoid injury to the sciatic nerve and major vessels. This quadrant lies over the gluteus medius, which has good muscle bulk and minimal risk of nerve damage. Choosing other quadrants risks nerve injury or hematoma formation.
2. Which nerve is most at risk if a gluteal intramuscular injection is given in the inferomedial quadrant?
a) Femoral nerve
b) Sciatic nerve
c) Obturator nerve
d) Pudendal nerve
Explanation: The correct answer is b) Sciatic nerve. The sciatic nerve passes through the lower and medial portions of the gluteal region. Improper injections here can cause severe neuropathic pain, weakness in the leg, and even permanent paralysis in severe cases. Hence, the inferomedial quadrant is strictly avoided for injections.
3. A patient develops Trendelenburg gait after hip surgery. Which nerve was likely injured?
a) Superior gluteal nerve
b) Inferior gluteal nerve
c) Sciatic nerve
d) Femoral nerve
Explanation: The correct answer is a) Superior gluteal nerve. This nerve innervates gluteus medius and minimus. Injury leads to weakness in hip abduction, causing the pelvis to drop on the opposite side during walking. This is commonly tested clinically and can occur after injections or surgery near the greater sciatic foramen.
4. Which muscle is primarily used for safe gluteal intramuscular injections?
a) Gluteus maximus
b) Gluteus medius
c) Piriformis
d) Tensor fasciae latae
Explanation: The correct answer is b) Gluteus medius. The muscle has a thick bulk in the superolateral quadrant, providing a safe site for intramuscular injections while avoiding important neurovascular structures. Gluteus maximus is avoided due to the underlying sciatic nerve pathway.
5. The piriformis muscle exits the pelvis through which structure?
a) Lesser sciatic foramen
b) Greater sciatic foramen
c) Obturator canal
d) Inguinal canal
Explanation: The correct answer is b) Greater sciatic foramen. The piriformis muscle is a key landmark in the gluteal region, dividing the greater sciatic foramen into superior and inferior parts for neurovascular structures. Its relationship is clinically important in avoiding nerve injury during injections.
6. Which artery accompanies the sciatic nerve in the gluteal region?
a) Inferior gluteal artery
b) Superior gluteal artery
c) Obturator artery
d) Femoral artery
Explanation: The correct answer is a) Inferior gluteal artery. This artery, along with the sciatic nerve, exits the pelvis below the piriformis. Injury to this artery during wrong injection placement can cause significant hematoma formation.
7. Which nerve passes above the piriformis muscle?
a) Sciatic nerve
b) Superior gluteal nerve
c) Inferior gluteal nerve
d) Pudendal nerve
Explanation: The correct answer is b) Superior gluteal nerve. It exits the pelvis above piriformis and is at risk in superomedial injections, leading to Trendelenburg gait. This is why even the superomedial quadrant is avoided for injections.
8. A patient complains of buttock pain radiating down the thigh after a fall. Which nerve is most likely injured?
a) Sciatic nerve
b) Femoral nerve
c) Obturator nerve
d) Pudendal nerve
Explanation: The correct answer is a) Sciatic nerve. This nerve supplies the posterior thigh and all muscles below the knee. Injury causes pain, weakness, and sensory loss along its distribution. It is the most commonly injured nerve in the gluteal region from trauma or improper injections.
9. Which muscle is innervated by the inferior gluteal nerve?
a) Gluteus maximus
b) Gluteus medius
c) Gluteus minimus
d) Piriformis
Explanation: The correct answer is a) Gluteus maximus. This muscle is important for hip extension, especially in rising from sitting or climbing stairs. Injury to its nerve reduces hip extension power but does not affect walking significantly.
10. Which landmark is used to locate the superolateral gluteal injection site?
a) Anterior superior iliac spine and greater trochanter
b) Ischial tuberosity and coccyx
c) Pubic symphysis and femoral head
d) Sacrum and iliac crest
Explanation: The correct answer is a) Anterior superior iliac spine and greater trochanter. Drawing an imaginary line between these two landmarks and selecting the upper outer quadrant ensures safe injection placement.
Keyword Definitions:
Pelvic Stability: Ability to maintain pelvis alignment during walking or standing to prevent tilting.
Gluteus Medius & Minimus: Hip abductor muscles crucial for stabilizing pelvis during gait.
Trendelenburg Gait: Abnormal gait caused by weakness of gluteus medius/minimus.
Hip Abduction: Movement of the leg away from the midline, important in walking stability.
Gait Cycle: The sequence of motions during walking, divided into stance and swing phases.
Quadriceps: Group of thigh muscles involved in knee extension and stabilization during walking.
Adductors: Muscles bringing the thigh towards the body's midline.
Pelvic Tilt: Movement of the pelvis in the sagittal or frontal plane affecting gait mechanics.
Chapter: Locomotion and Movement
Topic: Gait and Muscle Actions
Sub-topic: Pelvic Stability During Walking
Lead Question (2012):
42. In walking, gravity tends to tilt pelvis and trunk to the unsupported side, major factor in preventing this unwanted movement is?
a) Adductor muscles
b) Quadriceps
c) Gluteus maximus
d) Gluteus medius and minimus
Explanation: The gluteus medius and minimus are primary hip abductors that stabilize the pelvis during the stance phase of gait. When one leg is lifted, these muscles on the opposite side contract to prevent pelvic drop. Weakness results in Trendelenburg gait. Adductors, quadriceps, and gluteus maximus have other roles in walking but do not provide primary pelvic stability in this context. Correct Answer: d) Gluteus medius and minimus
1. A patient presents with a waddling gait and difficulty maintaining pelvic level while walking. Which muscle weakness is most likely responsible?
a) Gluteus medius
b) Rectus femoris
c) Sartorius
d) Iliopsoas
Explanation: Waddling gait and pelvic drop point to gluteus medius weakness. This muscle functions as a pelvic stabilizer during the stance phase. Rectus femoris is mainly for knee extension and hip flexion, sartorius assists in flexion/abduction, and iliopsoas is the primary hip flexor. Correct Answer: a) Gluteus medius
2. Trendelenburg test is used to assess the integrity of which nerve?
a) Femoral nerve
b) Obturator nerve
c) Superior gluteal nerve
d) Inferior gluteal nerve
Explanation: The superior gluteal nerve innervates the gluteus medius and minimus. Damage causes positive Trendelenburg sign due to pelvic drop on the contralateral side during single-leg stance. The femoral nerve supplies anterior thigh muscles, obturator nerve supplies adductors, and inferior gluteal nerve supplies gluteus maximus. Correct Answer: c) Superior gluteal nerve
3. During walking, in which phase do the gluteus medius and minimus contract most strongly?
a) Swing phase
b) Stance phase
c) Toe-off phase
d) Double support phase
Explanation: Hip abductors like gluteus medius and minimus are most active during the stance phase when the opposite leg is in the swing phase. This activity prevents pelvic drop toward the unsupported side. In the swing phase, these muscles are less active. Correct Answer: b) Stance phase
4. A clinical student notes that a patient’s pelvis drops to the left during right leg stance. This indicates weakness in:
a) Left gluteus medius
b) Right gluteus medius
c) Right gluteus maximus
d) Left gluteus maximus
Explanation: Pelvic drop occurs on the side opposite to the weak muscle. If pelvis drops to the left, the right gluteus medius is weak. This is because the right hip abductors should hold the pelvis level when the right leg bears weight. Correct Answer: b) Right gluteus medius
5. Which of the following muscles assists the gluteus medius in pelvic stabilization?
a) Tensor fasciae latae
b) Biceps femoris
c) Semitendinosus
d) Gastrocnemius
Explanation: The tensor fasciae latae assists the gluteus medius in hip abduction and pelvic stabilization during gait. Biceps femoris and semitendinosus are hamstring muscles, while gastrocnemius is a calf muscle. Correct Answer: a) Tensor fasciae latae
6. In a patient with a superior gluteal nerve injury, which gait abnormality is most expected?
a) Steppage gait
b) Antalgic gait
c) Trendelenburg gait
d) Ataxic gait
Explanation: Superior gluteal nerve injury weakens the gluteus medius and minimus, leading to Trendelenburg gait — characterized by pelvic drop on the unsupported side during walking. Steppage gait is seen in foot drop, antalgic gait in pain, and ataxic gait in cerebellar disorders. Correct Answer: c) Trendelenburg gait
7. Which muscle is primarily responsible for preventing excessive pelvic tilt in the coronal plane during single-leg stance?
a) Piriformis
b) Gluteus maximus
c) Gluteus medius
d) Iliacus
Explanation: The gluteus medius is the primary stabilizer preventing excessive pelvic tilt in the coronal plane during single-leg stance. Piriformis assists in lateral rotation, gluteus maximus in hip extension, and iliacus in hip flexion. Correct Answer: c) Gluteus medius
8. A 45-year-old patient has difficulty climbing stairs after hip surgery. Which muscle weakness is most likely if pelvic stability is also compromised?
a) Quadriceps femoris
b) Gluteus medius
c) Adductor magnus
d) Sartorius
Explanation: Gluteus medius weakness affects both stair climbing and pelvic stability. Quadriceps mainly extend the knee, adductor magnus brings the leg toward midline, and sartorius flexes the hip and knee but does not stabilize pelvis effectively. Correct Answer: b) Gluteus medius
9. Which muscle group counteracts gravity’s tendency to tilt the pelvis during the gait cycle?
a) Hip abductors
b) Hip adductors
c) Knee extensors
d) Ankle plantarflexors
Explanation: Hip abductors (mainly gluteus medius and minimus) counteract gravity’s pull, keeping pelvis level during stance phase. Adductors, knee extensors, and ankle plantarflexors serve other roles in gait mechanics. Correct Answer: a) Hip abductors
10. A physiotherapist is retraining a stroke patient’s gait. To strengthen pelvic stability, which exercise is most appropriate?
a) Side-lying hip abduction
b) Leg press
c) Calf raises
d) Hamstring curls
Explanation: Side-lying hip abduction specifically targets the gluteus medius and minimus, enhancing pelvic stability during walking. Leg press works mainly quadriceps, calf raises target gastrocnemius/soleus, and hamstring curls strengthen posterior thigh muscles. Correct Answer: a) Side-lying hip abduction
Chapter: Lower Limb Anatomy
Topic: Femur
Sub-topic: Blood Supply of Femur
Nutrient artery: A major artery entering the shaft of a long bone to supply the inner two-thirds of the cortex and marrow.
Profunda femoris artery: Deep artery of the thigh; gives branches to thigh muscles and nutrient artery to femur.
Femoral artery: Main artery supplying the lower limb, continuation of external iliac artery.
Popliteal artery: Continuation of femoral artery behind the knee, supplies knee joint and leg muscles.
Middle circumflex femoral artery: Branch of profunda femoris artery supplying the head and neck of femur.
Medial circumflex femoral artery: Branch of profunda femoris artery supplying femoral head and neck.
Femoral triangle: Anatomical space in upper thigh containing femoral nerve, artery, vein, and lymphatics.
Osteomyelitis: Infection of bone, commonly via bloodstream.
1. The nutrient artery to the femur is? 2012 Lead Question
a) Profunda femoris artery
b) Femoral artery
c) Popliteal artery
d) Middle circumflex femoral artery
Correct answer: a) Profunda femoris artery. The nutrient artery to the femur mainly arises from the profunda femoris artery. It enters the nutrient foramen on the femur's posterior surface and supplies the inner two-thirds of the cortical bone and marrow, essential for bone nourishment and repair.
2. Which branch of the profunda femoris artery supplies the head and neck of the femur?
a) Lateral circumflex femoral artery
b) Medial circumflex femoral artery
c) Nutrient artery
d) Descending genicular artery
Correct answer: b) Medial circumflex femoral artery. This artery arises from the profunda femoris and mainly supplies the head and neck of the femur, which is critical for femoral head viability, especially after fractures.
3. Injury to which artery is most likely to cause avascular necrosis of the femoral head in femoral neck fractures?
a) Lateral circumflex femoral artery
b) Medial circumflex femoral artery
c) Profunda femoris artery
d) Popliteal artery
Correct answer: b) Medial circumflex femoral artery. This artery is the primary blood supply to the femoral head. Damage during femoral neck fractures can cause avascular necrosis leading to joint dysfunction.
4. The profunda femoris artery typically arises from the femoral artery at which location?
a) At the inguinal ligament
b) Just below the inguinal ligament
c) At the adductor hiatus
d) At the popliteal fossa
Correct answer: b) Just below the inguinal ligament. The profunda femoris artery arises about 3-4 cm below the inguinal ligament and passes posteriorly to supply deep thigh structures.
5. Which artery provides important collateral circulation around the thigh in cases of femoral artery occlusion?
a) Profunda femoris artery
b) Popliteal artery
c) Middle circumflex femoral artery
d) Dorsalis pedis artery
Correct answer: a) Profunda femoris artery. Its perforating branches form collateral pathways that maintain blood flow when the femoral artery is occluded.
6. Damage to the nutrient artery during femoral shaft fracture may result in:
a) Muscle ischemia
b) Delayed bone healing
c) Joint dislocation
d) Nerve injury
Correct answer: b) Delayed bone healing. The nutrient artery supplies the inner cortical bone and marrow; damage reduces blood supply, impeding bone repair and potentially causing nonunion.
7. In the femoral triangle, the femoral artery lies _______ to the femoral vein.
a) Medial
b) Lateral
c) Posterior
d) Anterior
Correct answer: b) Lateral. The femoral artery is lateral to the femoral vein in the femoral triangle, an important consideration during vascular access.
8. The nutrient artery primarily supplies which part of the femur?
a) Outer cortex
b) Inner two-thirds of cortex and marrow
c) Joint capsule
d) Surrounding muscles
Correct answer: b) Inner two-thirds of cortex and marrow. The nutrient artery enters via the nutrient foramen and nourishes the bone marrow and inner cortex essential for bone vitality.
9. Hematogenous osteomyelitis of the femur commonly involves spread via which artery?
a) Popliteal artery
b) Medial circumflex femoral artery
c) Nutrient artery
d) Lateral circumflex femoral artery
Correct answer: c) Nutrient artery. Bacteria enter via the nutrient artery to infect the marrow cavity, causing osteomyelitis.
10. During femoral artery cannulation, the puncture site is ideally located:
a) 1 cm below the inguinal ligament
b) 2-3 cm below the inguinal ligament
c) At the midpoint of femoral triangle
d) At the adductor hiatus
Correct answer: a) 1 cm below the inguinal ligament. This site allows safe access to the femoral artery while avoiding the femoral vein and minimizing complications.