Topic: Retinacula of Ankle
Subtopic: Inferior Extensor Retinaculum
Keyword Definitions:
Extensor retinaculum: Thickened bands of deep fascia at ankle that hold extensor tendons in place.
Inferior extensor retinaculum: Y-shaped band attached laterally to calcaneum and medially to medial malleolus and plantar fascia.
Calcaneum: Heel bone, provides attachment for inferior extensor retinaculum laterally.
Sole deep fascia: Thick fascial layer forming plantar aponeurosis, receives medial slip of retinaculum.
Fibula: Lateral bone of leg, superior slip does not attach here in inferior extensor retinaculum.
Lead Question - 2014
Not true about inferior extensor retinaculum?
a) Y shaped
b) Superior slip attached to lower end of fibula
c) Inferior slip attached to deep fascia of sole
d) Lateral attached to calcaneum
Explanation: Inferior extensor retinaculum is Y-shaped, laterally attached to calcaneum, with medial slips attaching to medial malleolus and plantar aponeurosis. It does not attach to the fibula. Hence option “superior slip attached to fibula” is incorrect. Correct answer: Superior slip attached to lower end of fibula.
1) The inferior extensor retinaculum is continuous with?
a) Flexor retinaculum
b) Superior extensor retinaculum
c) Peroneal retinaculum
d) Plantar aponeurosis
Explanation: Inferior extensor retinaculum is Y-shaped and related medially to the plantar aponeurosis. It is distinct from superior extensor retinaculum and flexor retinaculum. Correct answer: Plantar aponeurosis.
2) Which tendons pass deep to inferior extensor retinaculum?
a) Tibialis posterior, FDL
b) Tibialis anterior, EHL, EDL, peroneus tertius
c) Gastrocnemius, plantaris
d) Soleus, tibialis posterior
Explanation: Tendons of tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius pass beneath inferior extensor retinaculum to reach foot. Correct answer: Tibialis anterior, EHL, EDL, peroneus tertius.
3) Clinical case: A runner with anterior ankle pain is found to have inflamed tendon under inferior extensor retinaculum. Most likely tendon is?
a) Tibialis posterior
b) Extensor hallucis longus
c) Peroneus longus
d) Flexor hallucis longus
Explanation: Extensor hallucis longus runs beneath inferior extensor retinaculum and is prone to frictional tenosynovitis in athletes. Correct answer: Extensor hallucis longus.
4) The Y-shaped inferior extensor retinaculum attaches laterally to?
a) Navicular bone
b) Calcaneum
c) Talus
d) Cuboid
Explanation: The inferior extensor retinaculum is fixed laterally to upper surface of calcaneum near sinus tarsi, forming its base. Correct answer: Calcaneum.
5) Which artery passes deep to inferior extensor retinaculum?
a) Posterior tibial artery
b) Anterior tibial artery / dorsalis pedis
c) Peroneal artery
d) Popliteal artery
Explanation: The anterior tibial artery continues as dorsalis pedis artery and passes beneath inferior extensor retinaculum with deep peroneal nerve. Correct answer: Anterior tibial artery / dorsalis pedis.
6) Which nerve accompanies dorsalis pedis artery under inferior extensor retinaculum?
a) Tibial nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Sural nerve
Explanation: The deep peroneal nerve passes with dorsalis pedis artery under inferior extensor retinaculum and supplies dorsum of foot muscles and first webspace. Correct answer: Deep peroneal nerve.
7) Clinical case: Foot drop patient develops compression neuropathy under inferior extensor retinaculum. Which nerve is affected?
a) Tibial nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Sural nerve
Explanation: Compression beneath inferior extensor retinaculum can entrap deep peroneal nerve, producing pain over dorsum and webspace with foot drop. Correct answer: Deep peroneal nerve.
8) Superior vs inferior extensor retinaculum: which is Y-shaped?
a) Superior
b) Inferior
c) Both
d) None
Explanation: Superior extensor retinaculum is a simple transverse band above ankle joint. Inferior extensor retinaculum is Y-shaped below ankle joint. Correct answer: Inferior.
9) Medial limb of inferior extensor retinaculum attaches to?
a) Lateral malleolus
b) Medial malleolus and plantar aponeurosis
c) Fibula shaft
d) Tarsal tunnel
Explanation: The medial limb divides into upper band to medial malleolus and lower band to plantar aponeurosis of sole. Correct answer: Medial malleolus and plantar aponeurosis.
10) Clinical case: Ankle arthroscopy incision near inferior extensor retinaculum risks injuring?
a) Posterior tibial nerve
b) Deep peroneal nerve and dorsalis pedis artery
c) Superficial peroneal nerve
d) Tibial artery
Explanation: Structures beneath inferior extensor retinaculum include dorsalis pedis artery and deep peroneal nerve. Injury during arthroscopy incision leads to vascular and neurological deficit. Correct answer: Deep peroneal nerve and dorsalis pedis artery.
Topic: Lower Limb
Subtopic: Popliteus Muscle
Keyword Definitions:
Popliteus: Small triangular muscle at the back of the knee that unlocks the joint during flexion.
Tibial nerve: Major branch of the sciatic nerve supplying posterior leg muscles.
Intracapsular origin: Muscle origin lying within the capsule of a joint.
Knee locking: Stabilization mechanism in extension by quadriceps and ligaments.
Knee flexor: Muscles that bend the knee, e.g., hamstrings and popliteus.
Lead Question - 2014
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 unlocks the knee, not locks it. It arises intracapsularly from lateral femoral condyle, supplied by tibial nerve, and assists knee flexion. Its unique role is initiating flexion by rotating femur laterally on tibia. Thus, the incorrect statement is “causes locking of knee.” Correct answer: d) Causes locking of knee.
Guessed Questions for NEET PG
1) Popliteus muscle originates from?
a) Medial femoral condyle
b) Lateral femoral condyle
c) Tibial tuberosity
d) Medial tibial condyle
Explanation: Popliteus originates intracapsularly from the lateral condyle of the femur and attaches to posterior tibia. This unique origin helps it unlock the knee joint during flexion. Therefore, the correct answer is b) Lateral femoral condyle.
2) Which nerve supplies popliteus?
a) Common peroneal nerve
b) Femoral nerve
c) Tibial nerve
d) Obturator nerve
Explanation: The tibial nerve, a division of the sciatic nerve, supplies the popliteus muscle. It provides both motor innervation and contributes to proprioceptive function of the knee. Hence, the correct answer is c) Tibial nerve.
3) Clinical: A patient cannot unlock his knee while walking. Which muscle is most likely weak?
a) Popliteus
b) Gastrocnemius
c) Quadriceps
d) Biceps femoris
Explanation: Unlocking of the knee during flexion initiation is specifically performed by the popliteus muscle. Weakness leads to difficulty starting knee flexion, especially from extended position. Hence, the correct answer is a) Popliteus.
4) Popliteus muscle action includes all EXCEPT?
a) Unlocking knee
b) Lateral rotation of femur
c) Assisting knee flexion
d) Locking knee
Explanation: Popliteus functions to unlock knee by rotating femur laterally on tibia, enabling flexion. It never locks the knee, which is done by quadriceps and ligaments. Therefore, the incorrect action is d) Locking knee.
5) Clinical: Injury to tibial nerve affects which popliteus function?
a) Knee extension
b) Knee locking
c) Knee unlocking
d) Plantarflexion
Explanation: The tibial nerve supplies popliteus, essential for unlocking knee. Nerve injury causes inability to initiate flexion due to failure in unlocking. Therefore, the correct answer is c) Knee unlocking.
6) Popliteus inserts on?
a) Posterior tibia above soleal line
b) Posterior tibia below soleal line
c) Medial tibial condyle
d) Tibial tuberosity
Explanation: The popliteus inserts on the posterior surface of tibia above the soleal line. This anatomical feature stabilizes posterior tibia during knee flexion. Hence, correct answer: a) Posterior tibia above soleal line.
7) Clinical: A football player suffers knee trauma, causing difficulty unlocking knee. Likely structure injured?
a) Popliteus
b) Vastus medialis
c) Anterior cruciate ligament
d) Gastrocnemius
Explanation: Inability to unlock knee strongly suggests popliteus muscle injury, as it is the only muscle initiating flexion by lateral femoral rotation. Therefore, the correct answer is a) Popliteus.
8) Popliteus acts by?
a) Medial rotation of tibia
b) Lateral rotation of tibia
c) Extension of knee
d) Abduction of tibia
Explanation: During open-chain movement, popliteus medially rotates tibia on femur; during closed-chain, it laterally rotates femur on tibia. This dual action helps in unlocking knee. Correct answer: a) Medial rotation of tibia.
9) Clinical: Patient with posterior knee pain and locking difficulty shows MRI lesion in muscle behind knee joint capsule. Which is most affected?
a) Popliteus
b) Biceps femoris
c) Semimembranosus
d) Gastrocnemius
Explanation: The only small intracapsular muscle at posterior knee capsule is popliteus. Lesion here causes pain and locking difficulties. Correct answer: a) Popliteus.
10) Popliteus forms relation with?
a) Floor of popliteal fossa
b) Roof of popliteal fossa
c) Medial wall of knee
d) Lateral wall of knee
Explanation: Popliteus forms the floor of popliteal fossa, along with posterior femur and posterior capsule of knee. This anatomical relation is crucial for surgical approaches. Correct answer: a) Floor of popliteal fossa.
Topic: Lower Limb
Subtopic: Semitendinosus Muscle
Keyword Definitions:
Semitendinosus: A hamstring muscle located in the posterior thigh, important for knee flexion and hip extension.
Sciatic nerve: Largest nerve in the body, supplying the hamstring muscles through tibial and common peroneal divisions.
Pes anserinus: Combined tendon insertion of sartorius, gracilis, and semitendinosus on the medial tibia.
Knee flexion: Bending of the knee joint, performed by hamstring muscles.
Hip extension: Backward movement of the thigh, primarily performed by hamstrings and gluteus maximus.
Lead Question - 2014
True regarding semitendinosus ?
a) Supplied by common peroneal part of sciatic nerve
b) Proximal flashy distal thin
c) Distal flashy proximal thin
d) Proximal and distal thin middle fleshy
Explanation: Semitendinosus is supplied by tibial division of sciatic nerve, not common peroneal. The muscle is fleshy proximally and becomes thin distally before insertion at pes anserinus. Its unique structure helps in knee flexion and hip extension. Correct answer: b) Proximal flashy distal thin.
Guessed Questions for NEET PG
1) Semitendinosus inserts at?
a) Fibular head
b) Tibial tuberosity
c) Pes anserinus
d) Lateral tibial condyle
Explanation: Semitendinosus inserts with sartorius and gracilis as part of pes anserinus on the medial surface of the upper tibia. This insertion stabilizes the medial knee during walking. Correct answer: c) Pes anserinus.
2) Which nerve supplies semitendinosus?
a) Femoral nerve
b) Tibial division of sciatic
c) Common peroneal division
d) Obturator nerve
Explanation: Semitendinosus is innervated by the tibial division of the sciatic nerve, which supplies most hamstring muscles. This ensures both hip extension and knee flexion functions. Correct answer: b) Tibial division of sciatic.
3) Clinical: A patient with tibial division injury of sciatic nerve will lose which function of semitendinosus?
a) Knee extension
b) Hip flexion
c) Knee flexion
d) Plantarflexion
Explanation: Tibial division injury compromises hamstring function, including semitendinosus, leading to weakness of knee flexion and hip extension. Correct answer: c) Knee flexion.
4) The semitendinosus muscle lies?
a) Superficial to semimembranosus
b) Deep to semimembranosus
c) Lateral to biceps femoris
d) Between sartorius and gracilis
Explanation: Semitendinosus lies superficial to semimembranosus and medial to biceps femoris. Its tendon descends to form part of pes anserinus. Correct answer: a) Superficial to semimembranosus.
5) Clinical: Athlete presents with pain at medial tibial insertion after overuse. Which hamstring tendon is commonly involved?
a) Biceps femoris
b) Semitendinosus
c) Semimembranosus
d) Rectus femoris
Explanation: Overuse injury at medial tibial surface often involves pes anserinus tendons, especially semitendinosus. Pain occurs with resisted knee flexion and climbing. Correct answer: b) Semitendinosus.
6) Which of the following is NOT a hamstring muscle?
a) Biceps femoris (long head)
b) Semitendinosus
c) Semimembranosus
d) Adductor longus
Explanation: True hamstrings are biceps femoris long head, semitendinosus, and semimembranosus. Adductor longus is a medial thigh muscle, not a hamstring. Correct answer: d) Adductor longus.
7) Clinical: Semitendinosus harvesting is commonly used for?
a) Rotator cuff repair
b) ACL reconstruction
c) Meniscal repair
d) Tendon Achilles repair
Explanation: The semitendinosus tendon is frequently used in ACL reconstruction grafts due to its length and strength. This provides stability in anterior knee surgeries. Correct answer: b) ACL reconstruction.
8) Primary action of semitendinosus?
a) Knee extension
b) Knee flexion
c) Plantarflexion
d) Hip adduction
Explanation: Semitendinosus flexes the knee and extends the hip. Its tendon at pes anserinus also contributes to medial rotation of tibia. Correct answer: b) Knee flexion.
9) Clinical: A footballer sustains a hamstring tear with tenderness at ischial tuberosity. Which semitendinosus attachment is injured?
a) Pes anserinus
b) Lateral tibial condyle
c) Fibular head
d) Ischial tuberosity
Explanation: Semitendinosus originates from ischial tuberosity. Trauma here often results in proximal hamstring tear. Correct answer: d) Ischial tuberosity.
10) Semitendinosus assists in?
a) Lateral rotation of tibia
b) Medial rotation of tibia
c) Abduction of hip
d) Plantarflexion
Explanation: Through its pes anserinus insertion, semitendinosus assists medial rotation of tibia on femur during knee flexion, stabilizing the medial side. Correct answer: b) Medial rotation of tibia.
Topic: Lower Limb Muscles
Subtopic: Dorsiflexors of Foot
Keyword Definitions:
Dorsiflexion: Movement of the foot upward at the ankle joint, bringing the toes closer to the shin.
Tibialis anterior: Primary dorsiflexor of the foot, also inverts the foot.
Tibialis posterior: Muscle that plantarflexes and inverts the foot.
Peroneus brevis: Muscle that everts and weakly plantarflexes the foot.
Extensor digitorum brevis: Muscle on the dorsum of the foot, extends toes but does not dorsiflex significantly.
Lead Question - 2014
Which of the following dorsiflexes the foot?
a) Tibialis posterior
b) Tibialis anterior
c) Peroneus brevis
d) Extensor digitorum brevis
Explanation: Tibialis anterior is the chief dorsiflexor of the foot. It originates from the lateral tibia and inserts on the medial cuneiform and first metatarsal, allowing dorsiflexion and inversion. Other muscles listed do not act as strong dorsiflexors. Correct answer: b) Tibialis anterior.
Guessed Questions for NEET PG
1) Tibialis anterior inserts on?
a) Calcaneum
b) Navicular
c) Medial cuneiform and base of 1st metatarsal
d) Cuboid
Explanation: Tibialis anterior inserts on the medial cuneiform and base of the first metatarsal. This allows it to dorsiflex and invert the foot effectively. Correct answer: c) Medial cuneiform and base of 1st metatarsal.
2) Clinical: A patient with foot drop most likely has paralysis of?
a) Tibialis posterior
b) Tibialis anterior
c) Peroneus longus
d) Soleus
Explanation: Foot drop occurs due to paralysis of dorsiflexors, particularly tibialis anterior, commonly from damage to the common peroneal nerve. Correct answer: b) Tibialis anterior.
3) Which nerve innervates tibialis anterior?
a) Tibial nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Femoral nerve
Explanation: Tibialis anterior is supplied by the deep peroneal nerve, a branch of the common peroneal nerve. This ensures dorsiflexion of the foot. Correct answer: b) Deep peroneal nerve.
4) Clinical: Weak dorsiflexion with sensory loss between first and second toe suggests injury to?
a) Tibial nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Sural nerve
Explanation: The deep peroneal nerve supplies tibialis anterior and provides cutaneous sensation to the web between the first and second toes. Its injury causes weakness of dorsiflexion and sensory loss. Correct answer: b) Deep peroneal nerve.
5) Which movement is opposed by tibialis anterior?
a) Plantarflexion
b) Inversion
c) Eversion
d) Dorsiflexion
Explanation: Tibialis anterior causes dorsiflexion and inversion of the foot. It works against plantarflexion and eversion. Correct answer: a) Plantarflexion.
6) Clinical: Steppage gait is seen in lesions of?
a) Superficial peroneal nerve
b) Tibial nerve
c) Common peroneal nerve
d) Femoral nerve
Explanation: Steppage gait occurs in common peroneal nerve injury, due to paralysis of dorsiflexors like tibialis anterior. The patient lifts the leg high to prevent toe dragging. Correct answer: c) Common peroneal nerve.
7) Which of the following is NOT a dorsiflexor?
a) Extensor digitorum longus
b) Extensor hallucis longus
c) Tibialis posterior
d) Tibialis anterior
Explanation: Tibialis posterior is a plantarflexor and invertor, not a dorsiflexor. Other listed muscles dorsiflex the foot. Correct answer: c) Tibialis posterior.
8) Clinical: Which muscle is tested when patient is asked to dorsiflex and invert the foot against resistance?
a) Tibialis anterior
b) Tibialis posterior
c) Peroneus tertius
d) Soleus
Explanation: Dorsiflexion with inversion specifically tests tibialis anterior function, as it is the main muscle performing these combined actions. Correct answer: a) Tibialis anterior.
9) Clinical: Trauma to the lateral aspect of the knee may cause loss of dorsiflexion due to injury to?
a) Femoral nerve
b) Common peroneal nerve
c) Tibial nerve
d) Obturator nerve
Explanation: The common peroneal nerve winds around the neck of fibula, making it vulnerable to trauma. Its injury leads to foot drop from dorsiflexor paralysis. Correct answer: b) Common peroneal nerve.
10) Main action of tibialis anterior?
a) Plantarflexion and eversion
b) Dorsiflexion and inversion
c) Plantarflexion and inversion
d) Dorsiflexion and eversion
Explanation: Tibialis anterior produces dorsiflexion and inversion. It pulls the foot upwards and medially, crucial for normal gait. Correct answer: b) Dorsiflexion and inversion.
Topic: Knee Joint Anatomy
Subtopic: Oblique Popliteal Ligament and Related Arteries
Keyword Definitions:
Oblique Popliteal Ligament: Broad ligament at the posterior knee, reinforcing the joint capsule.
Middle Genicular Artery: Branch of popliteal artery, supplies cruciate ligaments and synovium.
Genicular Arteries: Vascular branches forming an anastomosis around the knee joint.
Popliteal Artery: Continuation of femoral artery through the popliteal fossa.
Lead Question - 2014
Artery piercing the oblique popliteal ligament of knee -
a) Superior genicular
b) Inferior genicular
c) Middle genicular
d) Popliteal
Explanation: The middle genicular artery, a branch of the popliteal artery, pierces the oblique popliteal ligament to supply cruciate ligaments and synovium. Other genicular arteries form periarticular anastomoses but do not pierce the ligament. Thus, the correct answer is option (c) Middle genicular artery.
1) The popliteal artery is a direct continuation of which artery?
a) Anterior tibial
b) Posterior tibial
c) Femoral
d) Peroneal
Explanation: The popliteal artery is a continuation of the femoral artery after it passes through the adductor hiatus. It supplies the knee joint and leg branches. Options anterior tibial and posterior tibial are its terminal branches, not its origin. Correct answer: (c) Femoral artery.
2) A patient sustains injury to the popliteal artery. Which structure is most at risk due to its proximity?
a) Tibial nerve
b) Sciatic nerve
c) Saphenous vein
d) Common peroneal nerve
Explanation: The tibial nerve lies posterior and superficial to the popliteal artery, making it most vulnerable in popliteal injuries. Sciatic nerve terminates proximal to popliteal fossa, while saphenous vein and peroneal nerve lie more laterally. Correct answer: (a) Tibial nerve.
3) Which artery is most important in supplying cruciate ligaments of the knee?
a) Middle genicular
b) Superior genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery directly pierces the posterior knee capsule and oblique popliteal ligament to supply cruciate ligaments. Superior, inferior, and descending genicular arteries mainly contribute to periarticular anastomoses. Thus, the correct answer is (a) Middle genicular artery.
4) During posterior knee surgery, which vessel pierces the posterior capsule and must be preserved?
a) Middle genicular
b) Anterior tibial
c) Femoral
d) Inferior gluteal
Explanation: The middle genicular artery pierces the posterior capsule through the oblique popliteal ligament and supplies intra-articular structures. Injury can cause intra-articular bleeding and compromise cruciate ligament nutrition. Correct answer: (a) Middle genicular artery.
5) Which branch of the popliteal artery does NOT contribute significantly to the knee joint anastomosis?
a) Superior genicular
b) Middle genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery does not participate in periarticular anastomosis. Instead, it directly supplies cruciate ligaments and synovial membrane. Superior, inferior, and descending genicular arteries form the vascular ring around the knee joint. Correct answer: (b) Middle genicular artery.
6) A 30-year-old man with posterior knee trauma develops hemarthrosis. Which artery is most likely damaged?
a) Superior genicular
b) Middle genicular
c) Inferior genicular
d) Popliteal
Explanation: Posterior capsule trauma often injures the middle genicular artery, as it pierces the oblique popliteal ligament to enter the joint. This leads to bleeding into the joint cavity (hemarthrosis). Correct answer: (b) Middle genicular artery.
7) Which ligament is reinforced by expansion from the semimembranosus tendon?
a) Anterior cruciate ligament
b) Oblique popliteal ligament
c) Posterior cruciate ligament
d) Lateral collateral ligament
Explanation: The oblique popliteal ligament is formed partly by an expansion of the semimembranosus tendon. This structure strengthens the posterior knee capsule. Correct answer: (b) Oblique popliteal ligament.
8) A patient with PCL injury undergoes reconstruction. Which artery provides major vascular supply to the PCL?
a) Middle genicular
b) Superior genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery supplies both cruciate ligaments (ACL and PCL). Its preservation during surgery is vital for graft healing and ligament nutrition. Correct answer: (a) Middle genicular artery.
9) Which of the following arteries passes anterior to the interosseous membrane into the anterior compartment?
a) Middle genicular
b) Anterior tibial
c) Posterior tibial
d) Popliteal
Explanation: The anterior tibial artery arises from the popliteal artery, pierces the interosseous membrane, and supplies the anterior compartment of the leg. Middle genicular is intra-articular, not related to anterior compartment. Correct answer: (b) Anterior tibial artery.
10) A 40-year-old athlete has persistent posterior knee pain after ligament injury. Which small artery damage may compromise ligament healing?
a) Popliteal artery
b) Middle genicular artery
c) Inferior genicular artery
d) Anterior tibial artery
Explanation: Damage to the middle genicular artery compromises blood supply to cruciate ligaments, delaying healing. Popliteal is main trunk, while inferior genicular and anterior tibial supply periarticular structures. Correct answer: (b) Middle genicular artery.
Topic: Knee Joint Stabilization
Subtopic: Muscular Control of Patellar Tracking
Keyword Definitions:
Patella: A sesamoid bone within quadriceps tendon that improves leverage of knee extension.
Lateral Dislocation: Common displacement of patella, usually toward the outer side of knee.
Vastus Medialis: Medial quadriceps muscle with oblique fibers preventing lateral patellar displacement.
Quadriceps Femoris: A group of four muscles extending the leg at the knee joint.
Lead Question - 2014
Lateral dislocation of patella is prevented by ?
a) Rectus femoris
b) Vastus intermedius
c) Vastus lateralis
d) Vastus medialis
Explanation: The vastus medialis oblique (VMO) fibers pull the patella medially and prevent its lateral dislocation. Rectus femoris aids flexion at hip and extension at knee, vastus lateralis tends to pull patella laterally, while intermedius acts centrally. Thus, the correct answer is (d) Vastus medialis.
1) Which muscle provides dynamic medial stabilization of the patella?
a) Vastus lateralis
b) Vastus intermedius
c) Vastus medialis
d) Rectus femoris
Explanation: The vastus medialis oblique provides dynamic medial stabilization by counteracting the lateral pull of vastus lateralis. Its oblique fibers are critical for proper patellar tracking. Correct answer: (c) Vastus medialis.
2) A 20-year-old athlete has recurrent patellar dislocation laterally. Weakness of which muscle predisposes to this?
a) Vastus medialis
b) Vastus lateralis
c) Biceps femoris
d) Sartorius
Explanation: Weakness of the vastus medialis reduces medial stabilization of patella, leading to recurrent lateral dislocation. Lateral muscles instead accentuate lateral pull. Correct answer: (a) Vastus medialis.
3) Which structure acts as a passive restraint against lateral patellar dislocation?
a) Medial patellofemoral ligament
b) Iliotibial band
c) Rectus femoris tendon
d) Lateral meniscus
Explanation: The medial patellofemoral ligament (MPFL) is the primary passive restraint against lateral patellar displacement. It works along with vastus medialis for stabilization. Correct answer: (a) Medial patellofemoral ligament.
4) A patient with lateral patellar dislocation most likely has tightness of which structure?
a) Iliotibial band
b) Vastus medialis
c) Semitendinosus
d) Gracilis
Explanation: Tightness of the iliotibial band laterally pulls the patella outward, favoring lateral dislocation. Vastus medialis provides medial correction, whereas gracilis and semitendinosus are not major stabilizers. Correct answer: (a) Iliotibial band.
5) Which quadriceps muscle inserts into the base of the patella without significant role in patellar tracking?
a) Vastus medialis
b) Rectus femoris
c) Vastus lateralis
d) Vastus intermedius
Explanation: The vastus intermedius inserts centrally into the base of the patella, contributing to extension but not significantly influencing patellar tracking. Correct answer: (d) Vastus intermedius.
6) A 19-year-old basketball player develops lateral patellar dislocation after a sudden pivot. Which muscle failure contributes most?
a) Vastus medialis
b) Vastus lateralis
c) Rectus femoris
d) Popliteus
Explanation: Failure of vastus medialis oblique to stabilize patella allows lateral displacement during dynamic sports. Vastus lateralis increases lateral pull, rectus femoris acts mainly on hip and knee extension. Correct answer: (a) Vastus medialis.
7) Which factor increases the risk of lateral patellar dislocation?
a) Shallow trochlear groove
b) Strong vastus medialis
c) Weak iliotibial band
d) Medial patellofemoral ligament thickening
Explanation: A shallow trochlear groove predisposes to lateral patellar dislocation as the patella cannot seat firmly during knee flexion. Other factors like vastus medialis strength and MPFL integrity provide stabilization. Correct answer: (a) Shallow trochlear groove.
8) Which imaging is best to assess trochlear dysplasia predisposing to patellar dislocation?
a) X-ray AP knee
b) CT scan
c) Ultrasound
d) MRI
Explanation: MRI provides best assessment of trochlear morphology, cartilage, ligaments, and dynamic alignment, useful for patellar instability evaluation. CT helps with bony detail but MRI offers comprehensive view. Correct answer: (d) MRI.
9) Which surgical procedure realigns patella in recurrent dislocations due to vastus medialis weakness?
a) MPFL reconstruction
b) ACL reconstruction
c) Meniscectomy
d) High tibial osteotomy
Explanation: Medial patellofemoral ligament (MPFL) reconstruction restores medial restraint in recurrent lateral patellar dislocations, often combined with strengthening of vastus medialis. Correct answer: (a) MPFL reconstruction.
10) A young woman presents with patellofemoral pain and lateral patellar tilt. Strengthening which muscle helps rehabilitation?
a) Vastus medialis
b) Vastus lateralis
c) Rectus femoris
d) Gluteus medius
Explanation: Strengthening the vastus medialis oblique is the primary rehabilitation strategy for lateral patellar tilt and anterior knee pain, as it restores medial stability. Correct answer: (a) Vastus medialis.
Topic: Femoral Vessels and Related Structures
Subtopic: Adductor Canal (Hunter’s Canal)
Keyword Definitions:
Hunter’s Canal: Also called the adductor canal, it is an intermuscular passage in the middle third of thigh transmitting femoral vessels.
Femoral Artery: Major blood supply to lower limb passing through Hunter’s canal before becoming popliteal artery.
Saphenous Nerve: Largest cutaneous branch of femoral nerve traveling in Hunter’s canal.
Adductor Magnus: Muscle forming the posterior boundary of Hunter’s canal with opening for femoral vessels.
Lead Question - 2014
Hunter's canal is seen in?
a) Cubital fossa
b) Popliteal fossa
c) Thigh
d) Calf
Explanation: Hunter’s canal, or adductor canal, lies in the middle third of the thigh. It transmits femoral artery, femoral vein, saphenous nerve, and nerve to vastus medialis. It begins at apex of femoral triangle and ends at adductor hiatus. Correct answer: (c) Thigh.
1) Hunter’s canal begins at which landmark?
a) Apex of femoral triangle
b) Base of femoral triangle
c) Adductor tubercle
d) Popliteal fossa
Explanation: The Hunter’s canal begins at the apex of the femoral triangle and continues downward until it ends at adductor hiatus. Correct answer: (a) Apex of femoral triangle.
2) Which artery continues as popliteal artery after passing through Hunter’s canal?
a) Profunda femoris artery
b) Femoral artery
c) Anterior tibial artery
d) Posterior tibial artery
Explanation: The femoral artery passes through Hunter’s canal and exits via adductor hiatus to become the popliteal artery in the popliteal fossa. Correct answer: (b) Femoral artery.
3) Which nerve accompanies femoral artery in Hunter’s canal?
a) Saphenous nerve
b) Tibial nerve
c) Obturator nerve
d) Common peroneal nerve
Explanation: The saphenous nerve, a cutaneous branch of femoral nerve, accompanies femoral artery in Hunter’s canal but leaves before adductor hiatus. Correct answer: (a) Saphenous nerve.
4) A patient with thigh surgery has numbness along medial leg. Which structure was likely injured in Hunter’s canal?
a) Tibial nerve
b) Saphenous nerve
c) Sciatic nerve
d) Obturator nerve
Explanation: Injury to saphenous nerve in Hunter’s canal causes sensory loss along medial side of leg and foot. It is the only nerve passing through this canal. Correct answer: (b) Saphenous nerve.
5) Which muscle forms the posterior boundary of Hunter’s canal?
a) Adductor longus
b) Sartorius
c) Adductor magnus
d) Vastus medialis
Explanation: The posterior boundary of Hunter’s canal is formed by adductor longus and adductor magnus, while sartorius forms its roof. Correct answer: (c) Adductor magnus.
6) A 55-year-old with femoral artery occlusion undergoes bypass grafting. Which canal must surgeon access to reach distal femoral artery?
a) Inguinal canal
b) Hunter’s canal
c) Popliteal fossa
d) Femoral triangle
Explanation: The Hunter’s canal is accessed for surgical exposure of distal femoral artery before it enters popliteal fossa. Correct answer: (b) Hunter’s canal.
7) Which structure leaves Hunter’s canal before femoral vessels exit through adductor hiatus?
a) Femoral artery
b) Femoral vein
c) Saphenous nerve
d) Nerve to adductor magnus
Explanation: The saphenous nerve exits Hunter’s canal before adductor hiatus to follow great saphenous vein along medial leg. Correct answer: (c) Saphenous nerve.
8) Which nerve to quadriceps muscle is found in Hunter’s canal?
a) Nerve to vastus lateralis
b) Nerve to rectus femoris
c) Nerve to vastus medialis
d) Nerve to vastus intermedius
Explanation: The nerve to vastus medialis, a branch of femoral nerve, travels in Hunter’s canal alongside femoral vessels. Correct answer: (c) Nerve to vastus medialis.
9) A patient with arterial injury in Hunter’s canal presents with absent popliteal pulse. Which artery is affected?
a) Popliteal artery
b) Femoral artery
c) Anterior tibial artery
d) Profunda femoris artery
Explanation: Damage to the femoral artery in Hunter’s canal results in absent popliteal pulse and distal ischemia. Correct answer: (b) Femoral artery.
10) Which muscle forms the roof of Hunter’s canal?
a) Vastus medialis
b) Sartorius
c) Adductor longus
d) Pectineus
Explanation: The sartorius muscle forms the roof of Hunter’s canal by crossing over the femoral vessels. Correct answer: (b) Sartorius.
Topic: Fascia and Muscular Insertions
Subtopic: Iliotibial Tract
Keyword Definitions:
Iliotibial tract: Thickened lateral band of fascia lata extending from iliac crest to lateral condyle of tibia.
Gluteus maximus: Largest gluteal muscle inserting partly into iliotibial tract, aiding hip extension and lateral stability.
Fascia lata: Deep fascia of thigh enclosing muscles and forming iliotibial tract laterally.
Lateral tibial condyle: Outer condyle of tibia where iliotibial tract inserts, providing lateral knee stabilization.
Lead Question - 2014
True about iliotibial tract all except?
a) Receives insertion of gluteus maximus
b) Derived from fascia lata
c) Inserted on lateral tibial condyle
d) None
Explanation: The iliotibial tract is a thickened lateral band of fascia lata. It receives insertion from both gluteus maximus and tensor fasciae latae and inserts on the lateral tibial condyle (Gerdy’s tubercle). All statements are true, so the correct answer is d) None. Clinical importance lies in stabilizing the lateral knee.
Guessed Questions for NEET PG
1) Iliotibial tract inserts at:
a) Medial tibial condyle
b) Lateral tibial condyle
c) Femoral condyle
d) Patella
Explanation: The iliotibial tract inserts on the lateral tibial condyle at Gerdy’s tubercle, stabilizing the knee joint laterally. Correct answer: b) Lateral tibial condyle.
2) Muscle contributing to iliotibial tract is:
a) Gluteus medius
b) Sartorius
c) Tensor fasciae latae
d) Pectineus
Explanation: Tensor fasciae latae contributes fibers to the iliotibial tract, helping in hip abduction and medial rotation. Correct answer: c) Tensor fasciae latae.
3) Iliotibial band syndrome commonly affects:
a) Swimmers
b) Cyclists
c) Runners
d) Weightlifters
Explanation: Iliotibial band syndrome is an overuse injury commonly affecting runners due to repetitive friction over the lateral femoral condyle. Correct answer: c) Runners.
4) Iliotibial tract is a thickening of:
a) Crural fascia
b) Fascia lata
c) Scarpa’s fascia
d) Camper’s fascia
Explanation: The iliotibial tract is a specialized thickened band of fascia lata along the lateral thigh. Correct answer: b) Fascia lata.
5) Iliotibial tract stabilizes which joint?
a) Hip
b) Knee
c) Ankle
d) Shoulder
Explanation: The iliotibial tract stabilizes both hip and knee joints, particularly the lateral knee during walking and running. Correct answer: b) Knee.
6) A marathon runner complains of lateral knee pain, most likely diagnosis?
a) Meniscal tear
b) Iliotibial band syndrome
c) ACL injury
d) PCL injury
Explanation: Lateral knee pain in long-distance runners is often due to iliotibial band friction syndrome. Correct answer: b) Iliotibial band syndrome.
7) Iliotibial tract extends from:
a) Iliac crest to medial tibial condyle
b) Iliac crest to lateral tibial condyle
c) Ischium to patella
d) Femoral shaft to tibia
Explanation: Iliotibial tract extends from iliac crest to lateral tibial condyle (Gerdy’s tubercle). Correct answer: b) Iliac crest to lateral tibial condyle.
8) Which test assesses iliotibial band tightness?
a) Lachman test
b) Ober’s test
c) McMurray test
d) Thompson test
Explanation: Ober’s test is used clinically to check iliotibial band tightness. Correct answer: b) Ober’s test.
9) The iliotibial tract is thickest at:
a) Thigh
b) Leg
c) Foot
d) Knee joint line
Explanation: The iliotibial tract is thickest along the lateral thigh where it descends to insert on the tibia. Correct answer: a) Thigh.
10) Iliotibial tract aids gluteus maximus in:
a) Hip flexion
b) Hip extension
c) Knee flexion
d) Ankle plantarflexion
Explanation: The iliotibial tract transmits the action of gluteus maximus for hip extension and lateral stabilization. Correct answer: b) Hip extension.
Topic: Foot Joints and Ligaments
Subtopic: Support of Talus
Keyword Definitions:
Talus: A tarsal bone of the ankle articulating with tibia, fibula, calcaneus, and navicular for weight transfer.
Spring ligament: Plantar calcaneonavicular ligament supporting head of talus and medial longitudinal arch.
Deltoid ligament: Strong medial ankle ligament preventing talar eversion, arising from medial malleolus.
Lateral collateral ligament (LCL): Group of three ligaments supporting lateral ankle joint, preventing inversion injuries.
Cervical ligament: Connects calcaneus and talus, stabilizing subtalar joint during inversion and eversion.
Lead Question - 2014
Ligament supporting the talus is ?
a) Spring ligament
b) Deltoid ligament
c) LCL
d) Cervical ligament
Explanation: The spring ligament (plantar calcaneonavicular ligament) forms a sling under the talus, supporting its head and maintaining the medial longitudinal arch of the foot. It is essential for weight transmission and stability. Thus, the correct answer is a) Spring ligament, with clinical importance in flatfoot deformity if weakened.
Guessed Questions for NEET PG
1) Which ligament prevents talar eversion?
a) Deltoid ligament
b) Spring ligament
c) LCL
d) Cervical ligament
Explanation: The deltoid ligament on the medial side prevents excessive talar eversion and stabilizes the ankle joint. Correct answer: a) Deltoid ligament.
2) Ligament most often injured in ankle inversion sprain?
a) Anterior talofibular
b) Deltoid
c) Cervical
d) Spring
Explanation: The anterior talofibular ligament, part of the lateral collateral ligament complex, is most commonly injured in inversion sprains. Correct answer: a) Anterior talofibular.
3) Ligament maintaining medial longitudinal arch?
a) Deltoid
b) Spring
c) Cervical
d) Plantar aponeurosis
Explanation: The spring ligament is key in maintaining the medial longitudinal arch by supporting the head of talus. Correct answer: b) Spring.
4) Which ligament connects calcaneus to talus in subtalar joint?
a) Spring
b) Cervical
c) Deltoid
d) LCL
Explanation: The cervical ligament lies between talus and calcaneus, stabilizing subtalar joint during inversion and eversion. Correct answer: b) Cervical.
5) Injury of spring ligament leads to?
a) High arch foot
b) Flatfoot
c) Clubfoot
d) In-toeing
Explanation: Weakening of spring ligament causes collapse of medial longitudinal arch, resulting in flatfoot deformity. Correct answer: b) Flatfoot.
6) A child presents with painful flatfoot and medial foot collapse. Likely structure involved?
a) Spring ligament
b) Deltoid ligament
c) Cervical ligament
d) LCL
Explanation: Pediatric flatfoot with medial arch collapse is most commonly due to weakened spring ligament support. Correct answer: a) Spring ligament.
7) The deltoid ligament arises from?
a) Lateral malleolus
b) Medial malleolus
c) Talus head
d) Navicular tuberosity
Explanation: The deltoid ligament originates from medial malleolus and spreads to talus, calcaneus, and navicular. Correct answer: b) Medial malleolus.
8) Which ligament supports talus during walking?
a) Cervical ligament
b) Spring ligament
c) LCL
d) Interosseous ligament
Explanation: The spring ligament forms a sling for the head of talus, supporting weight during walking. Correct answer: b) Spring ligament.
9) Ligament stabilizing lateral ankle against inversion?
a) Spring ligament
b) Lateral collateral ligament
c) Deltoid ligament
d) Cervical ligament
Explanation: Lateral collateral ligament complex stabilizes the ankle against inversion forces. Correct answer: b) Lateral collateral ligament.
10) A football player develops medial ankle swelling after forced eversion. Injured ligament?
a) Deltoid
b) Spring
c) Cervical
d) ATFL
Explanation: Forced eversion injuries stretch or tear the deltoid ligament on the medial ankle. Correct answer: a) Deltoid.
Topic: Tibia and Fibula
Subtopic: Blood Supply and Relations
Keyword Definitions:
Tibia: The larger medial bone of the leg, weight-bearing, articulates with femur and talus.
Fibula: The slender lateral bone of the leg, non-weight-bearing, provides muscle attachment.
Nutrient artery: Artery supplying marrow and cortex of long bones, usually from main neighboring artery.
Common peroneal nerve: Branch of sciatic nerve, winds around fibular neck, prone to injury.
Osteomyelitis: Infection of bone and marrow, tibia commonly involved due to poor soft tissue cover.
Lead Question - 2014
False about tibia-fibula is ?
a) Nutrient artery of tibia is from posterior tibial artery
b) Nutrient artery of fibula is from peroneal artery
c) Proximal end of tibia is related to common peroneal nerve
d) Tibia is the most common site of osteomyelitis
Explanation: The nutrient artery of the tibia is from the posterior tibial artery, while the fibula receives from the peroneal artery. The common peroneal nerve relates to the fibula, not tibia. Tibia is the most common site for osteomyelitis. Thus, the false statement is c.
Guessed Questions for NEET PG
1) Nutrient artery of fibula arises from?
a) Anterior tibial artery
b) Peroneal artery
c) Posterior tibial artery
d) Popliteal artery
Explanation: The nutrient artery of the fibula usually comes from the peroneal artery, a branch of the posterior tibial artery. Correct answer: b.
2) Which nerve winds around neck of fibula?
a) Tibial nerve
b) Common peroneal nerve
c) Sural nerve
d) Saphenous nerve
Explanation: The common peroneal nerve winds around the lateral aspect of the fibular neck, making it vulnerable to injury in fractures. Correct answer: b.
3) Most common site of osteomyelitis in long bones?
a) Tibia
b) Femur
c) Fibula
d) Radius
Explanation: The tibia is the most common site for osteomyelitis because of subcutaneous position and limited soft tissue covering. Correct answer: a.
4) A patient with fracture neck of fibula develops foot drop. Likely nerve injured?
a) Tibial nerve
b) Sural nerve
c) Common peroneal nerve
d) Saphenous nerve
Explanation: Common peroneal nerve injury at fibular neck leads to foot drop due to loss of dorsiflexion. Correct answer: c.
5) Nutrient artery of tibia arises from?
a) Popliteal artery
b) Anterior tibial artery
c) Posterior tibial artery
d) Peroneal artery
Explanation: The nutrient artery of tibia is a branch of the posterior tibial artery, supplying the shaft and marrow. Correct answer: c.
6) In open tibial fractures, complication seen commonly is?
a) Osteomyelitis
b) Osteosarcoma
c) Pseudarthrosis
d) Fat embolism
Explanation: Due to poor soft tissue cover, open tibial fractures are highly prone to chronic osteomyelitis. Correct answer: a.
7) Which part of tibia is subcutaneous and vulnerable to injury?
a) Lateral border
b) Posterior border
c) Anterior border
d) Superior surface
Explanation: The anterior border and medial surface of tibia are subcutaneous and commonly injured in trauma. Correct answer: c.
8) Proximal tibiofibular joint is what type?
a) Synovial plane
b) Syndesmosis
c) Cartilaginous
d) Fibrous
Explanation: The proximal tibiofibular joint is a synovial plane type of joint allowing slight gliding movements. Correct answer: a.
9) Commonest site of stress fractures in tibia?
a) Proximal end
b) Middle third
c) Lower third
d) Upper epiphysis
Explanation: Stress fractures of tibia are most often seen in lower third region due to repetitive strain in athletes. Correct answer: c.
10) A child presents with swelling over tibia, fever, and bone pain. Most likely diagnosis?
a) Osteosarcoma
b) Osteomyelitis
c) Fibrous dysplasia
d) Ewing’s sarcoma
Explanation: In a child, fever, localized pain, and swelling over tibia typically indicate acute osteomyelitis. Correct answer: b.