Lower.limb.Exam.questions

WINDSOR UNIVERSITY SCHOOL OF MEDICINE Anatomy- lower limb ( august 10th 2009) 1. A common peroneal nerve palsy a. b. c. d. e.

Can occur following a fracture of the neck of the fibula Causes loss of extension of the big toe Causes a characteristic foot drop Causes a loss of inversion of the foot Produces anaesthesia of the sole of the foot

2. What is the name of the muscle that inserts on the base of the 5th metatarsal bone? a. Fibularis brevis b. Flexor carpi ulnaris c. Tibialis posterior d. Abductor digiti minimi e. The 4th lumbrical 3. What is the nerve of the anterior compartment of the thigh? a. Femoral nerve b. Obturator nerve c. Saphenous nerve d. Tibial portion of sciatic nerve e. Common fibular (peroneal) portion of the sciatic nerve 4. If the sciatic nerve is injured near the greater sciatic foramen, what action at the hip will be weakened? a. Abduction b. Lateral (external) rotation c. Flexion d. Extension e. Medial (internal) rotation 5. The homolog of the median nerve in the foot is the: a. Sural nerve b. Saphenous nerve c. Deep fibular (peroneal) nerve d. Medial plantar nerve e. Lateral plantar nerve

6. Which of following muscles is innervated by the deep fibular (peroneal) nerve? a. Fibularis tertius b. Flexor digitorum brevis c. Flexor digitorum longus d. All of the above e. None of the above 7. Difficulty in standing on one’s toes is symptomatic of injury to the: a. Tibial nerve b. Common fibular (peroneal) nerve c. Superficial fibular (peroneal) nerve d. Deep fibular (peroneal) nerve e. Both A and B are correct 8. Which statements about the knee joint are true? a. The femur rotates medially on the tibia during flexion when the foot is fixed b. The medial meniscus is attached to the medial collateral ligament c. The anterior cruciate ligament limits anterior displacement of the tibia d. The anterior cruciate ligament limits lateral rotation of the femur during extension e. B and C are correct 9. Which muscle DOES NOT cross anterior to the transverse axis of the hip joint? a. Tensor fascia latale b. Psoas c. Rectus femoris d. Sartorius e. Vastus lateralis 10. Which of the following muscles is/are innervated by the superficial peroneal nerve? a. Fibularis (peroneus) longus b. Fibularis (peroneus) brevis c. Fibularis (peroneus) tertius d. A and B e. A,B and C 11. Inability to hold the pelvic girdle level while standing on one foot is symptomatic of an injury to: a. Inferior gluteal nerve b. Superficial fibular (peroneal) nerve c. Superior gluteal nerve d. Deep fibular (peroneal) nerve e. Obturator nerve

12. Difficulty in crossing the knees while sitting in a chair is symptomatic injury to: a. Femoral nerve b. Obturator nerve c. Superior gluteal nerve d. Inferior gluteal nerve e. Fibular (peroneal) division of the sciatic nerve 13. The ilioinguinal nerve is derived from: a. T10 b. T12 c. L1 d. L2-L4 e. L4-L5 14. Which statement about the psoas major muscle is FALSE? a. It originates in the thorax and inserts in the thigh, so infection can potentially spread from the thorax to the thigh by following its facial sheath b. It joins with the iliacus to form the iliiopsoas muscle, which is the chief extensor of the thigh c. Much of the lumbar plexus can be found within its belly d. It inserts on the lesser trochanter of the femur 15. While standing on one foot (right) the opposite side of the hip (left) drops. Which of the following nerve has a lesion? a. Femoral nerve b. Deep peroneal nerve c. Inferior gluteal nerve d. Tibial nerve e. Superior gluteal nerve 16. Both the avulsion fracture of the ischial tuberosity and vertical shear fracture of the pelvis will lead to weakened knee flexion and extension of the hip joint? a. True b. False 17. Varicosity of the vein in the case of lower is because of the valvular insufficiency in which of the following veins? a. Superficial b. Deep c. Perforating d. None of the above

18. During an examination of a patient, YOU notice that the person is displacing this right shoulder posteriorly during right heel strike. This displacement suggests paralysis of? a. Right Quadriceps Muscle b. Right Anterior Tibialis c. Right Gluteus Maximus d. Right Gluteus Medius e. Right Gastrocnemius 19. A patient who has had a skiing accident is brought to the emergency room. The region around his knee is swollen. The skin of his foot is pale and no dorsalis pedis pulse can be detected. An xray reveals a fracture of the femur immediately proximal to the femoral condyles. Which of the following arteries has been compressed by the displacement of this fracture? a. Anterior Tibial Artery b. Femoral Artery c. Popliteal Artery d. Posterior Tibial Artery e. Profunda Femoris Artery 20. A patient presents to YOU with torn medical collateral ligament of the right knee. Which of the following signs may be elicited during physical examination? a. Posterior Displacement of the Tibia b. Anterior Displacement of the Femur c. Abnormal passive Abduction of the extended knee d. Abnormal passive Adduction of the extended knee

Lower Limb

Second heart of body? Gastrocnemius

Pes-Planus (flat foot), foot is? Everted

Key-stone for medial longitudinal arch? Talus

Movement possible in knee joint (Tibiofemoral joints)? Flexion, Extension, Medial rotation, Lateral Rotation

Osteoarthritis (OA), the pain is due to Compression of Nerves in between the articular ends

Major muscle responsible for unlocking the knee? Popliteus

Important tarsal bone that does not have any muscle attachments? Talus

Most common complication of femur neck fracture? Avascular necrosis, Osteonecrosis, Non union, Abnormal gait due to laterally rotated limb Fracture of the femoral neck: Lower limb will be laterally rotated and shortened. This is because the gluteus maximus, piriformis, obturator internus, superior and inferior gemelli, and quadratus femoris rotate the distal fragment laterally. The rectus femoris, adductor muscles, and hamstrings draw the distal fragment proximally.

Femoral hernia can be differentially diagnosed from inguinal hernia? Neck sac always lies below & Lateral to pubic tubercle

Common action of tibialis anterior & posterior muscles? Invertion

Posterior displacement of femur on tibia is maintained by? ACL (anterior cruciate ligament)

Trendelburg sign is positive (+)? Pelvis sinks downward on unsupported leg

Femoral triangle: which is incorrect medial boundary is adductor magnus Boundaries: Inguinal Ligament Superior, Sartorius Lateral, Adductor Longus Medial (ISSLAM)

Medial Femoral Circumflex Artery: Does not send a branch with obturator canal

Femoral artery becomes Popliteal artery passing thru: Adductor hiatus

Deep (Profundus) femoral artery gives rise to perforating arteries, which supply: Post thigh muscle

Adductor tubercle: Medial condyle of femur

Which is part of Cruciate anastomosis of hip: All except inferior epigastic artery. st

Above Inf Gluteal A, Below 1 Perforating A, Medial Medial Circumflex Femoral A, Lateral Lateral Circumflex Femoral A.

Midinguinal pt: Post triangle

Adductor canal: femoral canal Contains Saphenous Nerve and Nerve to Vastus Medialis.

Main Varicose Veins Great and Small Saphenous Veins

Lat cutaneous nerve: spinal valves b L2-L3

Root value sciatic nerve: ventral rami L4, L5, S1-S3

Cutaneous supply peroneal nerve includes dorsum except: st

nd

Web b/w 1 and 2 toe

In femoral triangle: profunda femoris (deep femoral) artery originates from femoral artery, femoral nerve lies lateral to femoral artery, some inguinal lymph nodes may be found, femoral vein lies medial to femoral artery

52 year old female presents with groin pain. Immediately inferior to inguinal canal. Physician suspected that patient has femoral hernia contain a loop of small end. Which structure immediately located medial to sac of hernia: Lacunar ligament

/*******************************************************************/

Which part of the thigh can be palpated when the hip is flexed and abducted? Lateral thigh

When the greater trochanter of the femoral is fractured, which nerve is injured? a. b.

Superior gluteal nerve Nerve to obturator internus

Cruciate anastomoses contributes to all except Superior epigastric artery st

Above Inf Gluteal A, Below 1 Perforating A, Medial Medial Circumflex Femoral A, Lateral Lateral Circumflex Femoral A.

Which lower limb veins are most likely to become varicose? Superficial veins (great and small saphenous veins)

Factors contributing to varicose veins Multiple pregnancies, Long standing hours, Incompetent valves

Surgeon operating on popliteal aneurysm ligates Adductor Canal which begins at apex of femoral triangle and ends at the Adductor Hiatus? Lies between adductor magnus/longus, and vastus medialis muscle

Femoral triangle boundaries? ISSLAM (Inguinal Sup, Sartorius Lat, Adductor Longus Med)

Femoral sheath L- femoral artery

M- femoral canal Mid- femoral V Also, Femoral branch of genitor femoral nerve, no saphenous opening No Femoral Nerve.

Saphenous opening provide pathways for? Great saphenous vein

What is not a part of the femoral triangle? Obturator nerve

Mid inguinal point? Mid point between Anterior Superior Iliac Spine and Pubic Symphysis.

Nerve passing along great saphenous vein? Saphenous nerve.

Trauma to inguinal ligament Loss of sensation to all except Lateral Thigh

Popliteal Aneurysm operated in Adductor Canal

Adductor Canal Apex of femoral triangle ends at adductor hiatus Vastus medialis – Antero lateral boundary Contains femoral vessels, Saphenous N, Nerve to vastus medialis

Adductor Hiatus Inserted tendon of adductor magnus, allows passage of femoral vessels to popliteal fossa

Popliteal fossa All except saphenous nerve Contents: Common Peroneal, Tibial Nerve, Popliteal Vessels, Saphenous Vein.

Femoral Hernia Common in women Passes thru femoral ring and canal

Deep inguinal lymph node Femoral canal

Muscle extended leg and knee joint Quadriceps femoris

Function of muscles of Anterior of Thigh Extend leg

Femoral sheath has all except Femoral nerve

What inserts between Tibia and Fibula Soleus (Superficial Posterior Leg Muscle)

Unhappy triad ACL (ant cruciate lig.), Medial Meniscus, Tibial Collateral lig (tcl)

Anterior compartment syndrome, the ligament involved is ACL

Artery affected in Anterior Compt. Syndrome a) Anterior tibial artery b) Dosalis Pedis Artery

Hyper extension of femoral on hip is done by Ilio Femoral Ligament

Anterior drawer test Lachman’s test (other test following it is ADT)

Muscle inserts fascia lata Gluteus maximus

Profunda femoris artery does not give rise to None of the above

Foot drop Deep peroneal nerve

Pott’s Fracture Forced eversion of foot (Dupytren’s Fracture) Fracture of lower end of Fibula with medial malleolus fracture and rupture of deltoid ligament

Which nerve is vulnerable to injury around neck of fibula Common peroneal nerve (fibular nerve)

Supplying lateral side of skin and back of leg Lateral sural cutaneous nerve

Nerve less vulnerable than common peroneal nerve Superficial peroneal or musculo cutaneous nerve

Loss of skin sensation, paralysis of plantar aspect of medial side of foot Medial plantar nerve…branch of tibial nerve

Intra muscular injection injury Common peroneal nerve, branch of sciatic nerve

Medial rotator of tibia When knee is extended

Ligament supports head of talus and passes from subtant? Tali of calcenous to navicular bone Plantar calcenus ligament (spring lig)

Injury to dorsalis pedis nd

Loss of sensation to great and 2 toe

Which muscle cannot do both; extend knee and hip Semi membranous

Cannot flex thigh and knee Soleus (sartorius and gracilis do)

Muscle for abduction and flexion of knee Gracilis and sartorius

Foot drop and high stepping gate, loss of sensation to dorsum of foot and medial aspect Leads to paralysis (due to damage of DPN) of all dorsi flexors and evertor muscles

Tibialis anterior Deep peroneal nerve; dorsi-flexion and inversion

Tibialis posterior Plantar flexes and inversion

Flexor retinaculum components Tibialis posterior, flexor digitorum longus, flexor hallucis longus

Adductor magnus Obturator sciatic (tibial portion) Insertion – Linea Aspera Action – Adducts, Flexes, Extends Thighs

Pes Anserinus (goose foot)- Anserine Bursa Lies between TCL – tendons of sartorius, gracilis, semi tendonosus

Not a flexor of hip Vastus medialis (iliopsoas  great flexor)

Medial meniscus MCL Posterior Tear (both b and C)

Proximal and medial to the shaft of the femur Tibia, fibula

Palpation of greater trochantar and ischial tuberosity Sciatic nerve

Piriformis muscles Inserts into upper end of greater trochanter of femur- rotates thigh laterally

Waddling Gait Pelvis falls towards the unaffected side of each step Paralysis of gluteus medius

Trendelenburgs sign fracture of neck of femur dislocation of hip (weakness of gluteus max and med-unsupported side falls instead of rising)

Flexor digiti minimi brevis affect proximal paralysis of little toe

Sciatic nerve divides into

Tibial nerve & Common peroneal nerve

Lateral thigh supplied by Femoral nerve

Superior lateral quadrant Preferred site to give intramuscular injection

Inserts into iliac crest Tensor fasciae latae by superior gluteal nerve

Flexor retinaculum medial malleolus  holds tendons of tibialis posterior holds flexor digitorum longus holds flexor hallucis longus

Kick on lateral knee, which ligament is torn lateral collateral ligament (LCL)

Flexor hallucis longus tendon inserts into calcaneus

Ilio femoral ligament largest and most important ligament, reinforces the fibrous capsule

Posterior cruciate lig prevents anterior displacement of the femur on the tibia

Saphenous nerve Passes along with the saphenous vein

Femoral nerve Does not lie in the femoral sheath

Dural nerve Innervates the lateral side of the head and foot

Great Saphenous vein Passes thru the Saphenous opening

Structures passing thru both the greater and lesser sciatic foramen Nerve to the Obturator Internus

Gluteus maximus Extends and rotates thigh laterally

Gluteus medius and gluteus minimus Abducts and rotates thigh medially

Quadratus femoris Rotates the thigh laterally

Femoral canal site of femoral herniation

Femoral ring abdominal opening of the femoral canal

Popliteal fossa Contains popliteal vessels, common peroneal tibial nerves and the small saphenous vein

Saphenous opening provides pathway for saphenous vein

Football injuries medial meniscus ligament and lateral connected ligaments

Vastus medialis extends leg

Obturator internus rotates thigh laterally

Extensor hallucis longus extends big toe, dosiflexes and innervates foot

Extensor digitorum longus extends toes, dorsiflexes and everts foot

Flexor hallucis longus plantar flexes foot, flexes distal phalynx of big toe

Flexor digitorum longus flexes lateral four toes

Tibialis posterior plantar flexes out and inverts foot

Lateral longitudinal arch formed by cuboid bone

Spring ligament planta calcaneonavicular

Femoral nerve Arises from lumbar plexus (L2-L4)

Inferior gluteal nerve Innervates the gluteus maximus

Sciatic nerve Largest nerve in the body

Superior gluteal artery Arises from internal iliac artery

Obturator nerve Arises from the internal iliac artery

Femoral artery continuation of the external iliac artery

Popliteal artery continuation of the femoral artery

Femoral vein Passes thru Saphenous opening

Femoral hernia common in women

Potts fracture caused by forces eversion of the foot

Damage to the femoral nerve paralysis of quadriceps femoris

Damage to obturator nerve weakness of adduction

Damage to DPN (Deep Peroneal Nerve) Results in foot drop

Damage to SPN (Superficial Peroneal Nerve) Loss of eversion of the foot

Adductor longus innvervates the obturator nerve

Vastus lateralis extends leg

Indirect inguinal hernia occurs on right side

Xiphoid process…..attaches via its pointed causal end to the linea alba

Internal spermatic fascia derives from transversalis fascia

Cremasteric fascia originated in the internal oblique muscle

Processes vaginalis may result in congenital indirect inguinal hernia

Gubernaculum testis homologus to the round ligament of the uterus

Hip Flexion cannot be produced by: Vastus Medialis

Individual right gluteus medius muscle will: demonstrate lowering of left side of Pelvis

Foot drop is: Deep peronial nerve

Sartoris, Gracilis and Semi tendonosus muscle: medial shaft of tibia

All produce movement on Hip and Knee joint : Adductor Magnus

Potts Fracture involve Fracture of Fibula and Rupture of Deltoid ligament produced by: forced Eversion of foot

38yr old woman brought to woman by fork lift operator. Examation revels loss of sensation of dorsum of left foot. Dorsiflexion against resistance is not possible. Inversion of subtalar joints on left limb. Diagnosis is trauma to: Common peroneal nerve and neck of Fibula

Palpation at point equidistant between Ischial tuberosity and greater trochanter of femur reveals what: Sciatic nerve

Which ligament involved in clipping Injury: ACL, MCL, MM

/*********************************************************/

Test 1 1. Femoral triangle: which is incorrect medial boundary is adductor magnus 2. Medial femoral circumflex Artery: d/n send a branch with obturator canal 3. Femoral triangle: deep femoral artery originiates from femoral artery: Nerve lateral to artery; Inginual lymph Vein medial to artery 4. Femoral artery becomes popliteal artery passing thru: adductor hiatus 5. Deep (Profundus) femoral artery gives rise to perforating arteries, which supply: post thigh muscle 6. Adductor tubercle: medial condyle of femur 7. which is directly beside Femoral Hernia: medial to lacunar ligament 8. Which is part of Cruciate anastomis of hip: all except inferior epigastic artery 9. Trendleburg’s sign: pelvis will sink downwards on unsupported leg side 10. Post displacement of femur on tibia is maintained by: anterior Cruciate ligament 11. Common action of tibialis ant and post: inversion 12. Femoral hernia differentially diagnosed from inginual by: neck of sac below and lateral to pubic tubercle 13. Fracture of neck femur: Osteonecrosis, avascular necrosis, abnormal gait due to laterally rotated limb, non union

14. Tarsal bone with no muscle attachments: talus 15. Unlocking knee: Popliteus 16. Osteoarthritis, pain due to: compression of nerve b/w articular ends 17. Key stone for medial longitudinal arch: talus 18. Movements in knee joint (Tibio- femoral joints): flexion, extension, medial and lateral rotation 19. Flat foot: foot is everted 20. 2nd heart of body: Gastrocnemius

Test 2: 1. 2. 3. 4. 5. 6. 7. 8.

Midinguinal pt: post triangle Adductor canal: femoral canal Saphenous nerve: small saphenous is false Saphenous nerve art is medial side of foot: e varicose veins lat cutaneous nerve: spinal valves b L2-L3 Root value sciatic nerve: ventral rami L4, L5, S1-S3 Cutaneous supply peroneal nerve includes dorsum except: web b/w 1st and 2nd toe

Test 1: 1. In respect to femoral triangle, select incorrect: Medial boundary in adductor magnus 2. Which of the following statement about medial femoral circumflex a is false: it sends a branch with obturator canal 3. In femoral triangle: profunda femoris (deep femoral) artery originates from femoral artery, femoral nerve lies lateral to femoral artery, some inguinal lymph nodes may be found, femoral vein lies medial to femoral artery 4. femoral artery: becomes popliteal artery after passing thru adductor hiatus 5. Profunda femoris a (deep femoral a): gives perforating arteries which supply post thigh muscle 6. Adductor tubercle is located in: medial condyle femur

7. 52 year old female presents with groin pain. Immediately inferior to inguinal canal. Physician suspected that patient has femoral hernia contain a loop of small end?…which structure immediately located medial to sac of hernia: lacunar ligament 8. Cruciate anastomosis is of hip joint receives primary contribution from following arteries except: inf epigastric artery 9. Which of following statements regarding postive trendelburg’s sign is correct: pelvis sinks downwards on unsupported leg side

Lower Limb Review Questions

2. Which part of the thigh can be palpated when the hip is flexed and abducted?  lateral thigh 3. When the greater trochanter of the femoral is fractured, which nerve is injured? a. Superior gluteal nerve b. Nerve to obturator internus 4. Cruciate anastomoses contributes to all except  Superior epigastric artery 5. Which lower limb veins are most likely to become varicose?  superficial veins (great and small saphenous veins) 6. Factors contributing to varicose veins a. Multiple pregnancies b. Long standing hours c. Incompetent valves 7. Surgeon operating on popliteal aneurysm ligates Adductor Canal which begins at apex of femoral triangle and ends at the Adductor Hiatus  lies between adductor magnus/longus, and vastus medialis muscle 8. Femoral triangle boundaries  ISSLAM (Inguinal Sup, Sartorius Lat, Adductor Longus Med) 9. Femoral sheath L- femoral artery M- femoral canal Mid- femoral V Also, Femoral branch of genitor femoral nerve, no saphenous opening 10. Saphenous opening provide pathways for  great saphenous vein

11. What is not a part of the femoral triangle?  obturator nerve 12. Mid inguinal point?  mid pt between Ant Sup Iliac Spine and Pubic Symphysis 13. Nerve passing along great saphenous vein  saphenous nerve 14. Trauma to inguinal ligament  loss of sensation to all except Lateral Thigh 15. Popliteal Aneurysm operated in  Adductor Canal 16. Adductor Canal  Apex of femoral triangle ends at adductor hiatus Vastus medialis – Antero lateral boundary Contains femoral vessels, Saphenous N, Nerve to vastus medialis 17. Adductor Hiatus  inserted tendon of adductor magnus, allows passage of femoral vessels to popliteal fossa 18. Popliteal fossa  all except saphenous nerve 19. Femoral Hernia  common in women  passes thru femoral ring and canal 20. Deep inguinal lymph node  femoral canal 21. Muscle extended leg and knee joint  Quadriceps femoris 22. Function of muscles of Anterior of Thigh  extend leg 23. Femoral sheath has all except  femoral nerve 24. What inserts between Tibia and Fibula  Soleus 25. Unhappy triad  ACL (ant cruciate lig.), Medial Meniscus, tibial collateral lig (tcl)

26. Anterior compartment syndrome, the ligament involved is  ACL 27. Artery affected in Anterior Compt. Syndrome a) Anterior tibial artery b) Dosalis Pedis Artery 28. Hyper extension of femoral on hip is done by  Ilio Femoral Ligament 29. Anterior drawer test  Lachman’s test (other test following it is ADT) 30. Muscle inserts fascia lata  Gluteus maximus 31. Profunda femoris artery does not give rise to  none of the above 32. Foot drop  deep peroneal nerve 33. Pott’s Fracture  forced eversion of foot (Dupytren’s Fracture)  fracture of lower end of Fibula with medial malleolus fracture and rupture of deltoid ligament 34. Which nerve is vulnerable to injury around neck of fibula  commen peroneal nerve (fibular nerve) 35. Supplying lateral side of skin and back of leg  Lateral surreal cutaneus nerve 36. Nerve less vulnerable than common peroneal nerve  superficial peroneal or musculo cutaneous nerve 37. Loss of skin sensation, paralysis of plantar aspect of medial side of foot  medial plantar nerve…branch of tibial nerve 38. Intra muscular injection injury  common peroneal nerve, branch of sciatic nerve 39. Medial rotator of tibia  when knee is extended 40. Ligament supports head of talus and passes from subtant? Tali of calcenous to navicular bone  plantar calcenus ligament (spring lig) 41. Injury to dorsalis pedis  loss of sensation to great and 2nd toe

42. Which muscle cannot do both; extend knee and hip  semi membranous 43. Cannot flex thigh and knee  soleus (satorius and gracilis do) 44. Muscle for abduction and flexion of knee  gracilis and satorius 45. Foot drop and high stepping gate, loss of sensation to dorsum of foot and medial aspect  leads to paralysis (due to damage of DPN) of all dorsi flexors and evertor muscles 46. Tibialis anterior  deep peroneal nerve ; dorsiflexion and inversion 47. Tibialis posterior  plantar flexes and inversion 48. Flexor retinaculum components  tibialis posterior, flexor digitorum longus, flexor hallucis longus 49. Adductor magnus  obturator sciatic (tibial portion)  Insertion – Linea Aspera  Action – Adducts, Flexes, Extends Thighs 50. Pes Anserinus (goose foot)- Anserine Bursa  lies between TCL – tendons of sartorius, gracilis, semi tendonosus 51. Not a flexor of hip  Vastus medialis (iliopsoas  great flexor) 52. Medial meniscus MCL  Posterior Tear (both b and C) 53. Proximal and medial to the shaft of the femur  tibia, fibula 54. Palpation of greater tochantar and ischial tuberosity  sciatic nerve 55. Piriformis muscles  inserts into upper end of greater trochanter of femur- rotates thigh laterally 56. Waddling Gait  Pelvis falls towards the unaffected side of each step  paralysis of gluteus medius

57. Trendelenburgs sign  fracture of neck of femur  dislocation of hip (weakness of gluteus max and med-unsupported side falls instead of rising) 58. Flexor digiti minimi brevis  affect proximal paralysis of little toe 59. Sciatic nerve divides into  tibial, common peroneal nerve 60. Lateral thigh supplied by  femoral nerve 61. Superior lateral quadrant  preffered site to give instramuscular injection 62. Inserts into iliac crest  tensor fascia lata by superior gluteal nerve 63. Flexor retinaculum  medial malleolus  holds tendons of tibialis posterior  holds flexor digitorum longus  holds flexor hallucis longus 64. Kick on lateral knee, which ligament is torn  lateral collateral ligament (LCL) 65. Flexor hallucis longus tendon  inserts into calcaneus 66. Ilio femoral ligament  largest and most important ligament, reinforces the fibrous capsule 67. Posterior cruciate lig  prevents anterior displacement of the femur on the tibia 68. Saphenous nerve  passes along with the saphenous vein 69. Femoral nerve  does not lie in the femoral sheath 70. Dural nerve  invervates the lateral side of the head and foot 71. Great saphenous vein  passes thru the saphenous opening

72. Structures passing thru both the greater and lesser sciatic foramen  nerve to the obturator internus 73. Gluteus maximus  extends and rotates thigh laterally 74. Gluteus medius and gluteus minimus  abducts and rotates thigh medially 75. Quadratus femoris  rotates the thigh laterally 76. Femoral canal  site of femoral herniation 77. Femoral ring  abdominal opening of the femoral canal 78. Femoral sheath  does not contain femoral nerve 79. Popliteal fossa  contains popliteal vessels, common peroneal tibial nerves and the small saphenous vein 80. Saphenous opening  provides pathway for saphenous vein 81. Football injuries  medial meniscus ligament and lateral connected ligaments 82. Vastus medialis  extends leg 83. Obturator internus  rotates thigh laterally 84. Extensor hallucis longus  extends big toe, dosiflexes and innervates foot 85. Extensor digitorum longus  extends toes, dorsiflexes and everts foot 86. Flexor hallucis longus  plantar flexes foot, flexes distal phalynx of big toe 87. Flexor digitorum longus  flexes lateral four toes 88. Tibialis posterior

 plantar flexes out and inverts foot 89. Lateral longitudinal arch formed by  cuboid bone 90. Spring ligament  planta calcaneonavicular 91. Femoral nerve  arises from lumbar plexus (L2-L4) 92. Inferior gluteal nerve  innvervates the gluteus maximus 93. Sciatic nerve  is the largest nerve in the body 94. Superior gluteal artery  arises from internal iliac artery 95. Obturator nerve  arises from the internal iliac artery 96. Femoral artery  continuation of the external iliac artery 97. Popliteal artery  continuation of the femoral artery 98. Femoral vein  passes thru saphenous opening 99. Femoral hernia  common in women 100. Potts fracture  caused by forces eversion of the foot 101. Damage to the femoral nerve  paralysis of quadriceps femoris 102. Damage to obturator nerve  weakness of adduction 103. Damage to DPN  results in foot drop

104. Damage to SPN  loss of eversion of the foot 105. Adductor longus  innvervates the obturator nerve 106. Vastus lateralis  extends leg 107. Indirect inguinal hernia  occurs on right side 108. Xiphoid process…..attaches via its pointed causal end to the linea alba 109. Internal spermatic fascia  derives from transversalis fascia 110. Cremasteric fascia  originated in the internal oblique muscle 111. Processes vaginalis  may result in congenital indirect inguinal hernia 112. Gubernaculum testis  homologus to the round ligament of the uterus

Abdomen

1. Thin fatty layer  Campers Fascia 2. Scarpas Fascia  deep membranous layer 3. Pretineal ligaments ????????  Coopers Ligament 4. Inguinal triangle

 common site of direct inguinal hernia 5. Inguinal triangle (Hasselbach’s triangle) is bounded laterally by  inferior epigastric vessels 6. Transversalis fascia  gives rise to spermatic fascia 7. Median umbilical ligament  remnant of urachus 8. Superior epigastric artery  arises from internal thoracic artery 9. Superior and inferior epigastric arteries anastomoses within  rectus abdominus 10. Inferior epigastric arteries  arise from external iliac artery 11. Indirect inguinal hernia  common than direct inguinal hernia 12. Greater omentum  abdominal policeman 13. Central veins  does not form portal system 14. Falciform ligament  connects the liver to the diaphragm 15. Ligamentum teres hepatic  round ligament of liver 16. Coronary ligament  round bare area of the liver 17. Ligamentum venosus  remant of ductus venosus 18. Epiploic foramen  Winslow’s Foramen 19. Stomach bed  Pancreas, spleen, left kidney, left supra renal gland, transverse colon, diaphragm 20. Acidic area  lesser curvature

21. Jejunum  has lung plicae circularis 22. Ileum  has Peyer’s Patches 23. Enteric division ?????????????????  consists of Auerbach’s Plexus 24. Ileum  short vasa recta and plicae circularis 25. Mc Burney’s Point  lateral one third of a line between right anterior superior iliac spine and umbilicus 26. Mc Burney’s Point  site of acute appendicitis 27. Liver  coronary and falciform ligaments 28. Meisners Valves  present in gallbladder 29. Ampulla of Voter  Duct of w…………..????????????? 30. Sartorius duct????????????  accessory pancreactic duct 31. Sphincter ani  muscle in lower part??????????????? 32. Left gastric artery gives rise to  esophageal branch 33. Meckels diverticulum  occurs in about 2% of population 34. Liver Cirrhosis????????  portal hypertension, esophageal v, hemorrhoid, caput medusa 35. Common bile duct  obstructs bile flow leading to jaundice 36. Supra renal gland empties into  inferior vena cava …………………….

37. Portal hypertension can cause venous blood of the portal system to be shunted through the anastomatic connections with the systemic venous system. Clinical sign produced due to portal hypertension around the umbilical is Caput Medusa 38. The conjoint tendon (falx inguinalis) is formed by the a) rectus abdominis muscle or its aponeurosis b) external oblique muscle or its aponeurosis c) both a and b d) neither a or b 39. The following facts are true for inguinal ligament a) It is an aponeurosis of the external abdominal oblique muscle b) It dorms the flood of inguinal canal c) It extends from the anterior superior iliac spine to pub tubercle d) All of the above 40. Omental bursa is communicated to greater sac via  foramen of winslow 41. An indirect hernia  passes thru the deep inguinal ring 42. Tunica vaginalis is the remnant of  processus vaginalis 43. A CT scan reveals that a loop of gait exits the abdominal cavity by passing medial to the inferior epigastric artery. This type of hernial would be called  direct inguinal hernia 44. In reference to the covering layers of the spermatic cord and testis  the cremaster muscle is innervated by the genital branch of the genitofemoral nerve 45. The inguinal canal a) Begins at the deep inguinal ring b) Has the inf. Oblique forming part of its roof c) Has the inguinal lig forming its floor d) Has the ilio inguinal nerve coursing through the superficial ring e) All of the above 46. A 10 year old boy brought to your office…boy is asked to cough…the most likely diagnosis is the presence of a(n)  indirect inguinal hernia 47. In this case, which of the following layers of the abdominal wall would not contribute to the wall of the hernial sac  transverse abdominus muscle 48. Hydrocele is the collection of fluid between the layers of  tunica vaginalis 49. Ventra root of spinal nerve carries

 motor fibres 50. The nerves of the abdominal wall  in the mid axillary line are located between transverse abdominis and internal oblique 51. Which abdominal structure gives rise to (is continuous with) the tunica vaginalis following descent of testes during development  peritoneum 52. The left inguinal hernia is made more common than right  FALSE 53. Left testicular vein drains into  left renal vein 54. Trans pyloric plane passes at the  upper border of L3 vertebra 55. Direct inguinal hernia passes the  inguinal triangle 56. Sinus of testes lies  laterally

1) Mc Burneys point: Max tenderness felt in appendicites and point in right spine umblical line 2) Following vein form imp. Portal systemic anastomoses except: Superior Rectal vein and IVC 3) Mostly vermiform appendix directly lie on top of cecum and also know to be tucked into: Meso appendix 4) Patient in cirrhosis in liver venous hypertension might be found in the: Short Gastric vein 5) Portal hypertension can cause venous blood of Portal system to be shunted through anastomic connection of systemic venous system. Examples of clinical signs are: External Hemmoriods 6) Bare area of Liver is linked by Limenia of: Corornary Ligaments 7) All are features are of Portal tract area Except: Hepatic Vein

8) Correct statement: Root of mesentry is found to Transverse obquiley from the body of 2nd lumbar vertebra to right sacro iliac joint 9) Correct statement: Interior aspect of duodenum is crossed by Transverse Mesocolin Mesentery 10) Houstans valves are Konlvansh fold are known as: Semilunar folds of colon 11) Muscle resulting from thickening of circular smooth musculature of anal canal is: Sphincter ani internus muscle 12) Which is not moveable: Desending colon 13) Which structure is not present in Stomach bed: Splenic vein 14) Appendix is supplied by: T10 15) Not true in relation to Stomach: Cardiac notch is an incisura found at most dependent point of lesser curvature 16) Surgical mobilization of descending colon from posterior abdominal wall can be accomplished by restablizing mesentery for this section of bowel restablished portion of mesentery could contain: Left lumbar artery 17) Which abdominal structures give rise to tunica vaginalis following descend of testis during development: Peritoneum 18) Correct statement: Falciform ligament actively suspends liver 19) Short numerous vasa recta are contain within: Ileum 20) Concerning Inf Mesentric artery which is false: gives off Inf pancreatico duodenal artery 21) Which structures not present within lesser omentum: IVC 22) Ligamentum vinosum is remnant of: Ductus Venosus 23) Ligamentum Teres is remnant of: Obulaterated Left Umblical artery 24) Transversalis Fascia: Both a and b 25) Conjoint Tendon formed by: Neither a nor b 26) Following facts are true for Inguinal Ligament: All of the above 27) Notch and Lesser curvature of stomach is: Insura Angularis 28) Following are structures which form stomach bed except: Splenic vein 29) Gastric ulcers are common in: Lesser curvatures

30) Omental bursa is communicated to Greater sac via: Foramen of Winslow 31) Arteries supply stomach except: Gastro duodenal 32) Litters Hernias content is: Meckels diverticulum 33) Indirect Hernia: passes through deep inguinal ring 34) Tunica vaginalis is remnant of: Process vaganilis 35) Not correct about Meckels diverticulum: All of the above 36) Congential Inguinal hernia is due to: Persistent Process vaginalis 37) Direct Inguinal hernia is medial to: stem of inferior epigastric artery 38) Structures form medial boundary of Inguinal Triangle: Inferior Epigastric artery 39) Due to rupture appendix duodenal ulcer and gallbladder disease subphrenic access is likely to occur on: Right side 40) Porta Hepatis is where: All of the above 41) Circular Muscle around distal end of bile duct form the: Sphincter of Oddi 42) Duct leading out of the Gallbladder is the: Cystic duct 43) Surgeon making incision for appendectomy: over Mc Burney’s point 44) Appendix represents: Lymphoid Tissue 45) Which peritoneal pouch is most dependent in female Pelvis: Recto Utherine Pouch or Douglas pouch

1) Hip Flexion cannot be produced by: Vastus Medialis 2) Tibial nerve injury slightly below mid thigh level will modify gait because he less able to: Both A and B 3) Individual right gluteus medius muscle will: demonstrate lowering of left side of Pelvis 4) Foot drop is: Deep peronial nerve 5) Sartoris, Gracilis and Semi tendonosus muscle: medial shaft of tibia

6) All produce movement on Hip and Knee joint : Adductor Magnus 7) Potts Fracture involve Fracture of Fibula and Rupture of Deltoid ligament produced by: forced Eversion of foot 8) 38yr old woman brought to woman by fork lift operator. Examation revels loss of sensation of dorsum of left foot. Dorsiflexion against resistance is not possible. Inversion of subtalar joints on left limb. Diagnosis is trauma to: Common peroneal nerve and neck of Fibula 9) Palpation at point equidistant between Ischial tuberosity and greater trochanter of femur reveals what: Sciatic nerve 10) Which ligament involved in clipping Injury: ACL, MCL, MM

Anatomy Exam- Lower Limb (Hip & Thigh) TEST I

1. Regarding femoral triangle; incorrect statement is: Medial boundary is adductor magnus (B) 2. Regarding femoral circumflex artery; false statement is: It sends branch through obturator canal (E) 3. In relation to femoral triangle: All the above 4. Femoral artery becomes: Popliteal artery (D) 5. Profunda femoris artery (deep femoral artery) gives rise to: Perforating arteries which supply posterior thigh muscles (C) 6. Adductor tubercle located: Medial epicondyle of femur (C) 7. Groin pain, bulge in groin area, inferior to inguinal canal; femoral hernia with intestinal group- what is immediately medial to it? Lacunar ligament (E) 8. Cruciate anatomosis of hip joint gets supply from all arteries except:

Inferior epigastric artery (C) 9. Positive Tredenberg sign: Pelvis will sink downwards on unsupported leg side (C) 10. Femoral hernia is different from inguinal hernia: Neck of sack lies below pubic tubercle (B) 11. Common result of femoral fracture: All of the above (C) 12. Trauma to right buttock, difficulty in extending right hip but strength of right knee flexion is similar to left knee, hip does not sink (no + tredenburg sign), abnormal cutaneous sensation in thigh; nerve to be damaged: Inferior gluteal nerve (C) 13. Nerve supply to anterior thigh Femoral nerve (A) 14. Lateral rotator of thigh except: Tensor fascia lata 15. Not a true hamstring muscle: Short head of femoris biceps (D) 16. Difficulty crossing leg, indicates damage in: Femoral nerve 17. Inguinal ligament: Between A.S.I.S. and Pubic ligament AND in lower abdominal quadrant ((E) A & D) 18. Name of socket of hip joint Acetabulum (D) 19. Piriformis muscle in pelvis travels to gluteal region via:

Greater sciatic foramen (A) 20. Mid-Ingunal point: Femoral artery immediately posterior to it (D) 21. Incorrect statement regarding adductor canal: Contains femoral nerve (E) 22. Regarding saphenous opening; the false statement is: Pierced by small saphenous vein (C) 23. Great saphenous vein: Longest vein in body (A) 24. Root value of lateral femoral cutaneous nerve: L2, L3 (B) 25. Root value of sciatic nerve: Ventral Rami of L4-S3

Anatomy-Knee and Leg

1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.) 11.) 12.)

Posterior displacement of femur on tibia maintained by Anterior Cruciate Ligament (ACL) Common action of tibialis anterior and posterior is inversion Major muscle responsible for unlocking of knee is the popliteus Movements possible in knee joint (tibio-fibular jt) are: flexion, extension, medial and lateral rotation 2nd heart of the body is the gastrocnemius muscle b/c it pumps impure blood against gravity to the heart Saphenous nerve is the cutaneous nerve of the medial side of leg and foot 35 year old female with pain in leg that aggrevates upon standing and is alleviated when propped up, what is wrong?  Varicose Veins Muscles innervated by deep fibular nerve (AKA deep peroneal nerve)  dorsiflexors of foot In the knee joint, medial meniscus is attached to the medial collateral ligament Inability to do plantar flexion of foot due to tibial nerve Player hit lateral side of knee-medial collateral ligament and the ACL are damaged Rupture of a long slender tendon that rolls up between the gastrocnemius and the soleus, what tendon rolls up?  plantaris

13.) Nerve that carries both efferent and afferent sensors when the knee is tapped is the femoral nerve 14.) Root values of the tibial nerve are L4-S3 15.) Football triad clipping injury  lateral side of the knee is injured, rupture of the medial collateral ligament and meniscus 16.) Plantar flexors unopposed and dorsiflexors are damaged so there is damage to the deep peroneal nerve 17.) Tibialis anterior responsible for the dorsiflexion of the foot 18.) Not found the popliteal fossa-the lesser saphenous vein 19.) Potts fracture involves fracture of the tibia, rupture of the deltoid ligament, what movement is affected?  inversion 20.) Supracondylar fracture of distal femur-in order to avoid injury to the popliteal artery, the knee has to be maintained in a flexed position

Test 1 Test 1- Lower Limb 1. Femoral triangle: which is incorrect medial boundary is adductor magnus 2. Medial femoral circumflex Artery: d/n send a branch with obturator canal 3. Femoral triangle: deep femoral artery originiates from femoral artery: Nerve lateral to artery; Inginual lymph Vein medial to artery 4. Femoral artery becomes popliteal artery passing thru: adductor hiatus 5. Deep (Profundus) femoral artery gives rise to perforating arteries, which supply: post thigh muscle 6. Adductor tubercle: medial condyle of femur 7. which is directly beside Femoral Hernia: medial to lacunar ligament 8. Which is part of Cruciate anastomis of hip: all except inferior epigastic artery 9. Trendleburg’s sign: pelvis will sink downwards on unsupported leg side 10. Post displacement of femur on tibia is maintained by: anterior Cruciate ligament

11. Common action of tibialis ant and post: inversion 12. Femoral hernia differentially diagnosed from inginual by: neck of sac below and lateral to pubic tubercle 13. Fracture of neck femur: Osteonecrosis, avascular necrosis, abnormal gait due to laterally rotated limb, non union 14. Tarsal bone with no muscle attachments: talus 15. Unlocking knee: Popliteus 16. Osteoarthritis, pain due to: compression of nerve b/w articular ends 17. Key stone for medial longitudinal arch: talus 18. Movements in knee joint (Tibio- femoral joints): flexion, extension, medial and lateral rotation 19. Flat foot: foot is everted 20. 2nd heart of body: Gastrocnemius

Test 2-Lower Limb: 9. 10. 11. 12. 13. 14. 15. 16.

Midinguinal pt: post triangle Adductor canal: femoral canal Saphenous nerve: small saphenous is false Saphenous nerve art is medial side of foot: e varicose veins lat cutaneous nerve: spinal valves b L2-L3 Root value sciatic nerve: ventral rami L4, L5, S1-S3 Cutaneous supply peroneal nerve includes dorsum except: web b/w 1st and 2nd toe

Test 1- Lower Limb: 10. In respect to femoral triangle, select incorrect: Medial boundary in adductor magnus

11. Which of the following statement about medial femoral circumflex a is false: it sends a branch with obturator canal 12. In femoral triangle: profunda femoris (deep femoral) artery originates from femoral artery, femoral nerve lies lateral to femoral artery, some inguinal lymph nodes may be found, femoral vein lies medial to femoral artery 13. femoral artery: becomes popliteal artery after passing thru adductor hiatus 14. Profunda femoris a (deep femoral a): gives perforating arteries which supply post thigh muscle 15. Adductor tubercle is located in: medial condyle femur 16. 52 year old female presents with groin pain. Immediately inferior to inguinal canal. Physician suspected that patient has femoral hernia contain a loop of small end?…which structure immediately located medial to sac of hernia: lacunar ligament 17. Cruciate anastomosis is of hip joint receives primary contribution from following arteries except: inf epigastric artery 18. Which of following statements regarding postive trendelburg’s sign is correct: pelvis sinks downwards on unsupported leg side Lower Limb Review Questions

100.

Which part of the thigh can be palpated when the hip is flexed and abducted?  lateral thigh

101.

When the greater trochanter of the femoral is fractured, which nerve is injured? a. Superior gluteal nerve b. Nerve to obturator internus 102. Cruciate anastomoses contributes to all except  Superior epigastric artery 103. Which lower limb veins are most likely to become varicose?  superficial veins (great and small saphenous veins) 104.

Factors contributing to varicose veins a. Multiple pregnancies b. Long standing hours c. Incompetent valves 105. Surgeon operating on popliteal aneurysm ligates Adductor Canal which begins at apex of femoral triangle and ends at the Adductor Hiatus  lies between adductor magnus/longus, and vastus medialis muscle 106. Femoral triangle boundaries  ISSLAM (Inguinal Sup, Sartorius Lat, Adductor Longus Med) 107.

Femoral sheath L- femoral artery M- femoral canal

Mid- femoral V Also, Femoral branch of genitor femoral nerve, no saphenous opening 108. Saphenous opening provide pathways for  great saphenous vein 109. What is not a part of the femoral triangle?  obturator nerve 110. Mid inguinal point?  mid pt between Ant Sup Iliac Spine and Pubic Symphysis 111. Nerve passing along great saphenous vein  saphenous nerve 112. Trauma to inguinal ligament  loss of sensation to all except Lateral Thigh 113. Popliteal Aneurysm operated in  Adductor Canal 114. Adductor Canal  Apex of femoral triangle ends at adductor hiatus Vastus medialis – Antero lateral boundary Contains femoral vessels, Saphenous N, Nerve to vastus medialis 115. Adductor Hiatus  inserted tendon of adductor magnus, allows passage of femoral vessels to popliteal fossa 116. Popliteal fossa  all except saphenous nerve 117. Femoral Hernia  common in women  passes thru femoral ring and canal 118. Deep inguinal lymph node  femoral canal 119. Muscle extended leg and knee joint  Quadriceps femoris 120. Function of muscles of Anterior of Thigh  extend leg 121.

Femoral sheath has all except

 femoral nerve 122. What inserts between Tibia and Fibula  Soleus 123. Unhappy triad  ACL (ant cruciate lig.), Medial Meniscus, tibial collateral lig (tcl) 124. Anterior compartment syndrome, the ligament involved is  ACL 125.

Artery affected in Anterior Compt. Syndrome a) Anterior tibial artery b) Dosalis Pedis Artery 126. Hyper extension of femoral on hip is done by  Ilio Femoral Ligament 127. Anterior drawer test  Lachman’s test (other test following it is ADT) 128. Muscle inserts fascia lata  Gluteus maximus 129. Profunda femoris artery does not give rise to  none of the above 130. Foot drop  deep peroneal nerve 131. Pott’s Fracture  forced eversion of foot (Dupytren’s Fracture)  fracture of lower end of Fibula with medial malleolus fracture and rupture of deltoid ligament 132. Which nerve is vulnerable to injury around neck of fibula  commen peroneal nerve (fibular nerve) 133.

Supplying lateral side of skin and back of leg

 Lateral surreal cutaneus nerve 134.

Nerve less vulnerable than common peroneal nerve

 superficial peroneal or musculo cutaneous nerve 135. Loss of skin sensation, paralysis of plantar aspect of medial side of foot  medial plantar nerve…branch of tibial nerve 136. Intra muscular injection injury  common peroneal nerve, branch of sciatic nerve

137. Medial rotator of tibia  when knee is extended 138. Ligament supports head of talus and passes from subtant? Tali of calcenous to navicular bone  plantar calcenus ligament (spring lig) 139.

Injury to dorsalis pedis

 loss of sensation to great and 2nd toe 140. Which muscle cannot do both; extend knee and hip  semi membranous 141. Cannot flex thigh and knee  soleus (satorius and gracilis do) 142. Muscle for abduction and flexion of knee  gracilis and satorius 143. Foot drop and high stepping gate, loss of sensation to dorsum of foot and medial aspect  leads to paralysis (due to damage of DPN) of all dorsi flexors and evertor muscles 144. Tibialis anterior  deep peroneal nerve ; dorsiflexion and inversion 145. Tibialis posterior  plantar flexes and inversion 146. Flexor retinaculum components  tibialis posterior, flexor digitorum longus, flexor hallucis longus 147. Adductor magnus  obturator sciatic (tibial portion)  Insertion – Linea Aspera  Action – Adducts, Flexes, Extends Thighs 148. Pes Anserinus (goose foot)- Anserine Bursa  lies between TCL – tendons of sartorius, gracilis, semi tendonosus 149. Not a flexor of hip  Vastus medialis (iliopsoas  great flexor) 150. Medial meniscus MCL  Posterior Tear (both b and C) 151.

Proximal and medial to the shaft of the femur

 tibia, fibula 152. Palpation of greater tochantar and ischial tuberosity  sciatic nerve 153. Piriformis muscles  inserts into upper end of greater trochanter of femur- rotates thigh laterally 154. Waddling Gait  Pelvis falls towards the unaffected side of each step  paralysis of gluteus medius 155. Trendelenburgs sign  fracture of neck of femur  dislocation of hip (weakness of gluteus max and med-unsupported side falls instead of rising) 156. Flexor digiti minimi brevis  affect proximal paralysis of little toe 157. Sciatic nerve divides into  tibial, common peroneal nerve 158. Lateral thigh supplied by  femoral nerve 159. Superior lateral quadrant  preffered site to give instramuscular injection 160. Inserts into iliac crest  tensor fascia lata by superior gluteal nerve 161. Flexor retinaculum  medial malleolus  holds tendons of tibialis posterior  holds flexor digitorum longus  holds flexor hallucis longus 162.

Kick on lateral knee, which ligament is torn

 lateral collateral ligament (LCL) 163. Flexor hallucis longus tendon  inserts into calcaneus 164. Ilio femoral ligament  largest and most important ligament, reinforces the fibrous capsule 165.

Posterior cruciate lig

 prevents anterior displacement of the femur on the tibia 166. Saphenous nerve  passes along with the saphenous vein 167. Femoral nerve  does not lie in the femoral sheath 168.

Dural nerve

 invervates the lateral side of the head and foot 169. Great saphenous vein  passes thru the saphenous opening 170. Structures passing thru both the greater and lesser sciatic foramen  nerve to the obturator internus 171. Gluteus maximus  extends and rotates thigh laterally 172. Gluteus medius and gluteus minimus  abducts and rotates thigh medially 173. Quadratus femoris  rotates the thigh laterally 174. Femoral canal  site of femoral herniation 175. Femoral ring  abdominal opening of the femoral canal 176. Femoral sheath  does not contain femoral nerve 177. Popliteal fossa  contains popliteal vessels, common peroneal tibial nerves and the small saphenous vein 178. Saphenous opening  provides pathway for saphenous vein 179.

Football injuries

 medial meniscus ligament and lateral connected ligaments 180. Vastus medialis  extends leg 181. Obturator internus  rotates thigh laterally

182. Extensor hallucis longus  extends big toe, dosiflexes and innervates foot 183. Extensor digitorum longus  extends toes, dorsiflexes and everts foot 184. Flexor hallucis longus  plantar flexes foot, flexes distal phalynx of big toe 185. Flexor digitorum longus  flexes lateral four toes 186. Tibialis posterior  plantar flexes out and inverts foot 187. Lateral longitudinal arch formed by  cuboid bone 188.

Spring ligament  planta calcaneonavicular

189. Femoral nerve  arises from lumbar plexus (L2-L4) 190. Inferior gluteal nerve  innvervates the gluteus maximus 191. Sciatic nerve  is the largest nerve in the body 192. Superior gluteal artery  arises from internal iliac artery 193.

Obturator nerve

 arises from the internal iliac artery 194.

Femoral artery

 continuation of the external iliac artery 195. Popliteal artery  continuation of the femoral artery 196. Femoral vein  passes thru saphenous opening 197. Femoral hernia  common in women 100. Potts fracture

 caused by forces eversion of the foot 101. Damage to the femoral nerve  paralysis of quadriceps femoris 102. Damage to obturator nerve  weakness of adduction 103. Damage to DPN  results in foot drop 104. Damage to SPN  loss of eversion of the foot 105. Adductor longus  innvervates the obturator nerve 106. Vastus lateralis  extends leg 107. Indirect inguinal hernia

 occurs on right side 108. Xiphoid process…..attaches via its pointed causal end to the linea alba 109. Internal spermatic fascia  derives from transversalis fascia 110. Cremasteric fascia  originated in the internal oblique muscle 111. Processes vaginalis  may result in congenital indirect inguinal hernia 112. Gubernaculum testis  homologus to the round ligament of the uterus ------------------------------------------------------------------------------------------

11) Hip Flexion cannot be produced by: Vastus Medialis 12) Tibial nerve injury slightly below mid thigh level will modify gait because he less able to: Both A and B 13) Individual right gluteus medius muscle will: demonstrate lowering of left side of Pelvis 14) Foot drop is: Deep peronial nerve 15) Sartoris, Gracilis and Semi tendonosus muscle: medial shaft of tibia 16) All produce movement on Hip and Knee joint : Adductor Magnus 17) Potts Fracture involve Fracture of Fibula and Rupture of Deltoid ligament produced by: forced Eversion of foot 18) 38yr old woman brought to woman by fork lift operator. Examation revels loss of sensation of dorsum of left foot. Dorsiflexion against resistance is not possible. Inversion of subtalar joints on left limb. Diagnosis is trauma to: Common peroneal nerve and neck of Fibula 19) Palpation at point equidistant between Ischial tuberosity and greater trochanter of femur reveals what: Sciatic nerve 20) Which ligament involved in clipping Injury: ACL, MCL, MM

Abdomen

57. Thin fatty layer  Campers Fascia 58. Scarpas Fascia  deep membranous layer 59. Pretineal ligaments ????????  Coopers Ligament 60. Inguinal triangle  common site of direct inguinal hernia 61. Inguinal triangle (Hasselbach’s triangle) is bounded laterally by  inferior epigastric vessels 62. Transversalis fascia  gives rise to spermatic fascia

63. Median umbilical ligament  remnant of urachus 64. Superior epigastric artery  arises from internal thoracic artery 65. Superior and inferior epigastric arteries anastomoses within  rectus abdominus 66. Inferior epigastric arteries  arise from external iliac artery 67. Indirect inguinal hernia  common than direct inguinal hernia 68. Greater omentum  abdominal policeman 69. Central veins  does not form portal system 70. Falciform ligament  connects the liver to the diaphragm 71. Ligamentum teres hepatic  round ligament of liver 72. Coronary ligament  round bare area of the liver 73. Ligamentum venosus  remant of ductus venosus 74. Epiploic foramen  Winslow’s Foramen 75. Stomach bed  Pancreas, spleen, left kidney, left supra renal gland, transverse colon, diaphragm 76. Acidic area  lesser curvature 77. Jejunum  has lung plicae circularis 78. Ileum  has Peyer’s Patches 79. Enteric division ?????????????????

 consists of Auerbach’s Plexus 80. Ileum  short vasa recta and plicae circularis 81. Mc Burney’s Point  lateral one third of a line between right anterior superior iliac spine and umbilicus 82. Mc Burney’s Point  site of acute appendicitis 83. Liver  coronary and falciform ligaments 84. Meisners Valves  present in gallbladder 85. Ampulla of Voter  Duct of w…………..????????????? 86. Sartorius duct????????????  accessory pancreactic duct 87. Sphincter ani  muscle in lower part??????????????? 88. Left gastric artery gives rise to  esophageal branch 89. Meckels diverticulum  occurs in about 2% of population 90. Liver Cirrhosis????????  portal hypertension, esophageal v, hemorrhoid, caput medusa 91. Common bile duct  obstructs bile flow leading to jaundice 92. Supra renal gland empties into  inferior vena cava ……………………. 93. Portal hypertension can cause venous blood of the portal system to be shunted through the anastomatic connections with the systemic venous system. Clinical sign produced due to portal hypertension around the umbilical is Caput Medusa 94. The conjoint tendon (falx inguinalis) is formed by the

a) rectus abdominis muscle or its aponeurosis b) external oblique muscle or its aponeurosis c) both a and b d) neither a or b 95. The following facts are true for inguinal ligament a) It is an aponeurosis of the external abdominal oblique muscle b) It dorms the flood of inguinal canal c) It extends from the anterior superior iliac spine to pub tubercle d) All of the above 96. Omental bursa is communicated to greater sac via  foramen of winslow 97. An indirect hernia  passes thru the deep inguinal ring 98. Tunica vaginalis is the remnant of  processus vaginalis 99. A CT scan reveals that a loop of gait exits the abdominal cavity by passing medial to the inferior epigastric artery. This type of hernial would be called  direct inguinal hernia 100. In reference to the covering layers of the spermatic cord and testis  the cremaster muscle is innervated by the genital branch of the genitofemoral nerve 101.

The inguinal canal a) Begins at the deep inguinal ring b) Has the inf. Oblique forming part of its roof c) Has the inguinal lig forming its floor d) Has the ilio inguinal nerve coursing through the superficial ring e) All of the above 102. A 10 year old boy brought to your office…boy is asked to cough…the most likely diagnosis is the presence of a(n)  indirect inguinal hernia 103. In this case, which of the following layers of the abdominal wall would not contribute to the wall of the hernial sac  transverse abdominus muscle 104. Hydrocele is the collection of fluid between the layers of  tunica vaginalis 105. Ventra root of spinal nerve carries  motor fibres 106. The nerves of the abdominal wall  in the mid axillary line are located between transverse abdominis and internal oblique

107. Which abdominal structure gives rise to (is continuous with) the tunica vaginalis following descent of testes during development  peritoneum 108. The left inguinal hernia is made more common than right  FALSE 109. Left testicular vein drains into  left renal vein 110. Trans pyloric plane passes at the  upper border of L3 vertebra 111. Direct inguinal hernia passes the  inguinal triangle 112. Sinus of testes lies  laterally

46) Mc Burneys point: Max tenderness felt in appendicites and point in right spine umblical line 47) Following vein form imp. Portal systemic anastomoses except: Superior Rectal vein and IVC 48) Mostly vermiform appendix directly lie on top of cecum and also know to be tucked into: Meso appendix 49) Patient in cirrhosis in liver venous hypertension might be found in the: Short Gastric vein 50) Portal hypertension can cause venous blood of Portal system to be shunted through anastomic connection of systemic venous system. Examples of clinical signs are: External Hemmoriods 51) Bare area of Liver is linked by Limenia of: Corornary Ligaments 52) All are features are of Portal tract area Except: Hepatic Vein 53) Correct statement: Root of mesentry is found to Transverse obquiley from the body of 2nd lumbar vertebra to right sacro iliac joint 54) Correct statement: Interior aspect of duodenum is crossed by Transverse Mesocolin Mesentery 55) Houstans valves are Konlvansh fold are known as: Semilunar folds of colon

56) Muscle resulting from thickening of circular smooth musculature of anal canal is: Sphincter ani internus muscle 57) Which is not moveable: Desending colon 58) Which structure is not present in Stomach bed: Splenic vein 59) Appendix is supplied by: T10 60) Not true in relation to Stomach: Cardiac notch is an incisura found at most dependent point of lesser curvature 61) Surgical mobilization of descending colon from posterior abdominal wall can be accomplished by restablizing mesentery for this section of bowel restablished portion of mesentery could contain: Left lumbar artery 62) Which abdominal structures give rise to tunica vaginalis following descend of testis during development: Peritoneum 63) Correct statement: Falciform ligament actively suspends liver 64) Short numerous vasa recta are contain within: Ileum 65) Concerning Inf Mesentric artery which is false: gives off Inf pancreatico duodenal artery 66) Which structures not present within lesser omentum: IVC 67) Ligamentum vinosum is remnant of: Ductus Venosus 68) Ligamentum Teres is remnant of: Obulaterated Left Umblical artery 69) Transversalis Fascia: Both a and b 70) Conjoint Tendon formed by: Neither a nor b 71) Following facts are true for Inguinal Ligament: All of the above 72) Notch and Lesser curvature of stomach is: Insura Angularis 73) Following are structures which form stomach bed except: Splenic vein 74) Gastric ulcers are common in: Lesser curvatures 75) Omental bursa is communicated to Greater sac via: Foramen of Winslow 76) Arteries supply stomach except: Gastro duodenal 77) Litters Hernias content is: Meckels diverticulum

78) Indirect Hernia: passes through deep inguinal ring 79) Tunica vaginalis is remnant of: Process vaganilis 80) Not correct about Meckels diverticulum: All of the above 81) Congential Inguinal hernia is due to: Persistent Process vaginalis 82) Direct Inguinal hernia is medial to: stem of inferior epigastric artery 83) Structures form medial boundary of Inguinal Triangle: Inferior Epigastric artery 84) Due to rupture appendix duodenal ulcer and gallbladder disease subphrenic access is likely to occur on: Right side 85) Porta Hepatis is where: All of the above 86) Circular Muscle around distal end of bile duct form the: Sphincter of Oddi 87) Duct leading out of the Gallbladder is the: Cystic duct 88) Surgeon making incision for appendectomy: over Mc Burney’s point 89) Appendix represents: Lymphoid Tissue 90) Which peritoneal pouch is most dependent in female Pelvis: Recto Utherine Pouch or Douglas pouch