Anatomy Lower limb questions

A soccer player injures his left knee when he twists the flexed knee while trying to avoid another player. While performing a knee examination, his physician pulls the flexed knee toward her (the physician's) body, as shown in the illustration. This clinical test is a check for the integrity of which of the following ligaments?

Anterior cruciate ligament (ACL)

Your athletic 23-year-old patient is being seen in the ED for a ruptured quadriceps tendon. What does this tendon do?

Attaches all four parts of the quadriceps femoris muscle to the patella

Your 22-year-old elite runner patient has severe pain in her right lower gluteal area and has difficulty walking and standing. Her hip radiograph is shown above with the black arrows pointing to the cause of her pain. What is your diagnosis?

Avulsion fracture of the ischial tuberosity

Deep venous thrombosis is a common complication from sitting in one position for a prolonged duration, such as during a long car trip or a long plane flight. The first vascular channels likely to be obstructed or occluded by an embolus from the deep veins of a lower limb are the _____________ .

Branches of the pulmonary arteries.

A 32-year-old mixed martial arts fighter could not continue his fight after receiving a side leg kick to the neck of his left fibula. The fighter reported paresthesia and numbness on the entire dorsum of his left foot. During his physical examination, the patient often stumbled with his left toes dragging on the floor during the swing phase of his gait. Asymmetry in his normal foot position was also noted by the physician (see photo) as well as weakness in eversion of the foot at the ankle joint. What nerve was damaged?

Common fibular nerve

Following surgery to repair a broken right tibia, a 22-year-old patient is placed in a short leg cast. Several hours later, she complains of extreme pain, numbness with a "pins and needles sensation," inflammation, and abnormal pressure on the anterior and lateral aspects of the affected lower leg. The cast is removed, and the physician notes weakness in dorsiflexion of the foot and toes, a weak dorsalis pedis arterial pulse, and sensory loss between the first and second toes. What nerve is most likely damaged?

Deep fibular nerve

A man interviewing for a new administrative position as hospital chief executive officer notices difficulty walking after sitting with his leg crossed for 2 hours. He was nervous during the interview but even more so now that he is attempting to stand to follow two board members for a tour of the hospital. Which of the following actions is most seriously affected by compression and temporary paralysis of the deep peroneal nerve?

Dorsiflexion of the foot

Human feet are everted so that their soles lie fully on the ground during ambulation. What muscle is developmentally unique to humans, inserts into the base of the fifth metatarsal, and assists in eversion (or pronation)?

Fibularis tertius

A 20-year-old college student receives a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the fibula. After injury to this nerve, which of the following muscles could be paralyzed?

Extensor hallucis longus

Your 57-year-old patient requires pressure from his hand on his distal thigh during walking to prevent inadvertent flexion and collapse during walking. You suspect injury to which of the following nerves?

Femoral

Loss of the knee jerk reflex could be best explained by injury to the ___________.

Femoral Nerve

A physician tests the patellar tendon reflex as shown. A normal response of the involuntary contraction of the quadriceps femoris muscle is noted. This reflex confirms the integrity of what nerve?

Femoral nerve

You find an absent patellar tendon reflex (first described by Westphal in 1875). Which of the following structures is most likely involved in the abnormal response?

Femoral nerve

Venous duplex sonography of your patient's lower limb shows a large thrombus in her popliteal vein. If this or a part of this thrombus breaks free, it would pass through which vein?

Femoral vein

A 47-year-old woman walks with difficulty into the ER and presents with pain, inflammation, and tenderness on the outside of her right foot. She reports she sprained her ankle, an inversion injury, while stepping off a sidewalk wearing 3-in. high heels. The given X-ray reveals an avulsion fracture on her lateral foot. The white arrow identifies the fracture fragment. What muscle is most likely injured, given the site of the fracture?

Fibularis brevis

The anesthesiologist is about to perform a femoral nerve block in the femoral triangle to anesthetize the anterior thigh prior to surgery to remove a small tumor. To find the femoral nerve what should she do?

Find the femoral pulse and direct the needle just lateral to that

A 14-year-old gymnastic silver medalist falls from the parallel bar and complains of pains from the knee and ankle joints. On physical examination, her physician found that the muscle responsible for flexing the leg at the knee joint and plantar flexing the foot is severely weakened. Which of the following muscles involved in both movements was most likely damaged in this accident?

Gastrocnemius

A 24-year-old woman complains of weakness when she extends her thigh and rotates it laterally. Which of the following muscles is paralyzed?

Gluteus maximus

A 72-year-old woman slips and falls on a wet floor, fracturing the neck of her right femur. Subsequent physical examination in the ER shows her right foot is laterally rotated, and the right lower extremity appears slightly shorter than the left. Which of the following muscles is mainly responsible for the rotated posture of the right limb?

Gluteus maximus

A 75-year-old female patient fell in a hospital and landed on her hip. The given AP X-ray reveals fragmentation of her proximal femur. Which of the following muscles is most likely detached in association with the fracture fragment?

Gluteus medius

A 23-year-old female medical student notices she was gaining weight due to a sedentary lifestyle and compulsive studying. Therefore, she decides to run in a marathon and starts her training by running 6 miles each morning before class. After 2 weeks, she presents with right lateral knee pain and inflammation, specifically in the area of the lateral femoral epicondyle. This pain intensifies throughout her morning jogs, especially

Iliotibial band syndrome (ITBS)

A physician performs some simple muscle tests on a 35-year-old male patient when he complains of weakness in his lower limbs. In the physical test illustrated below, the patient is asked to touch his buttocks with his heel while working against resistance. What muscle group is being tested?

Hamstrings

Your patient is having difficulty walking and you suspect weakness in his gluteus medius and minumus. To test these muscles in the right limb, what would you do?

Have the patient lay on his left side and abduct his right limb against resistance

Following a complicated hip replacement surgery, your 77-year-old patient is having difficulty walking up stairs although he can walk fairly normally on flat surfaces. You suspect the surgery likely injured which of the following nerves?

Inferior gluteal

An 83-year-old woman reports an inability to stand up from a seated position and to climb stairs. Further examination also reveals weakness in lateral rotation at the hip joint. What nerve is most likely compromised in this patient?

Inferior gluteal nerve

A 12-year-old girl suffers from a type of neural tube defect called tethered cord syndrome, a congenital anomaly that results from defective closure of the neural tube. This syndrome is characterized by an abnormally low conus medullaris, which is tethered by a short, thickened filum terminale, leading to progressive neurologic defects in the legs and feet. This girl has strong muscle function of the flexors of the thigh, but she has weakness of the extensors (hamstrings). A lesion has occurred at which of the following spinal cord levels?

L5

A 32-year-old woman, who has gained 50 pounds during her first 36 weeks of pregnancy while carrying twins, presents with numbness, tingling, and burning sensations in the lateral aspect of her right upper thigh. Her symptoms are exacerbated when her physician applies pressure near her right anterior superior iliac spine. What nerve is most likely affected?

Lateral femoral cutaneous nerve

A rising second-year medical student spends his summer hiking the Appalachian Trail with a 100-lb backpack in tow. After a month of hiking 30-mi/day (48-km/day), he notices numbness, tingling, and burning sensations in the lateral aspect of his right upper thigh. His symptoms are exacerbated by his backpack pressing on the area surrounding his right anterior superior iliac spine. What nerve is most likely affected?

Lateral femoral cutaneous nerve

An elderly man falls on an icy sidewalk outside his home and cannot get up. He tells the attending paramedics that he has a lot of pain in his right hip. Following inconclusive analysis of an AP X-ray, the given coronal MRI reveals a nondisplaced fracture of the right femoral neck, as noted by the black arrow. Branches of which of the following arteries are most likely to be damaged in this injury?

Medial circumflex femoral artery

A 62-year-old woman slips and falls on the bathroom floor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. Fracture of the neck of the femur results in avascular necrosis of the femoral head, probably resulting from lack of blood supply from which of the following arteries?

Medial femoral circumflex

Following a femoral neck fractures in a 76-year-old woman, her femoral head underwent avascular necrosis. This occurred because the fracture likely tore which of the following arteries?

Medial femoral circumflex

Your 87-year-old osteoporotic female patient fell and fractured her femur. What part of the femur is most likely to be fractured in such injuries?

Neck

Your 17-year-old male athletic patient is complaining of chronic recurring pain over his tibial tuberosity. What is your preliminary diagnosis?

Osgood-Schlatter disease

A 41-year-old man was involved in a fight and felt weakness in extending the knee joint. On examination, he was diagnosed with a lesion of the femoral nerve. Which of the following symptoms would be a result of this nerve damage?

Paralysis of the vastus lateralis muscle

A 22-year-old patient is unable to "unlock" the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged?

Popliteus

While standing upright, a 40-year-old man moves his knees in a locked position by moving his femurs into a slight hyperextended and medial rotated position on the tibial plateaus. With his knees in this locked position, which of the following muscles would contract to unlock the knee joint and permit its flexion?

Popliteus

An 18-year-old man hurts his left knee while playing rugby. During the knee examination, his physician is able to push the tibia of his flexed left knee posteriorly, and this displacement is more significant than what was seen in the unaffected (right) knee. Based upon the results of this clinical test, what knee ligament is most likely damaged?

Posterior cruciate ligament

A 52-year-old woman slipped and fell and now complains of being unable to extend her leg at the knee joint. Which of the following muscles was paralyzed as a result of this accident?

Quadriceps femoris

A 24-year-old woman presents to her physician with weakness in flexing the hip joint and extending the knee joint. Which muscle is most likely involved in this scenario?

Rectus femoris

A young man suffers a dislocation of the right hip in a car accident. During recovery, he finds he has an abnormal gait in which his left hip sinks when he lifts that foot to take a step, as shown in the right frame (C) of the given diagram. The problem may be the result of damage to which of the following structures?

Right gluteus medius and superior gluteal nerve

A 35-year-old male prisoner received a right gluteal intramuscular (IM) injection during a visit to the infirmary. Following the injection, the man experienced a painful, swollen right leg. Within a month, he complained that his right leg started to shrink. Examination revealed muscle wasting with fasciculations in the L4-S1 distribution and marked weakness in dorsiflexion, inversion, and eversion at the ankle joint. He also exhibited a typical high-steppage gait indicating right foot drop. What nerve was most likely damaged during the gluteal IM injection?

Sciatic nerve

A 32-year-old man was lifting a very heavy box into a van when it slipped out of his hands and hit his right knee. He fell to the ground and complained of severe knee pain and loss of sensation in the sole of his foot. He was taken to a hospital where a physician examined him. A peripheral nerve injury was detected. Radiographs of his knee revealed a comminuted fracture of the proximal tibia. Which of the following statements best describes the most likely cause of the peripheral nerve injury?

Severance of the tibial nerve by fragments of the comminuted fracture of the tibia

A thoracic surgeon is going to collect a portion of the greater saphenous vein for coronary bypass surgery. He has observed that this vein runs ____________.

Superficial to the fascia lata of the thigh.

A patient experiences weakness in dorsiflexing and inverting the foot. Which of the following muscles is damaged?

Tibialis Anterior

A 7-year-old boy has walked with an abnormal "dipping" gait since being born with a congenital dislocation of the right hip. When his physician asks him to stand on his right leg and lift his left leg off the ground, the left-side of his pelvis sinks below horizontal causing him to stumble to his left. Which of the following nerve was most likely damaged due to his congenital hip dislocation?

Superior gluteal nerve

A patient with a deep knife wound in the buttock walks with a waddling gait that is characterized by the pelvis falling toward one side at each step. Which of the following nerves is damaged?

Superior gluteal nerve

A 76-year-old man recently had coronary bypass surgery in which the small saphenous vein was harvested to establish coronary blood flow. Following the procedure, he complained of numbness and paresthesia in the limb from which the vein was removed. The given photo highlights the cutaneous area affected in the patient. No motor loss was noted. What nerve was most likely damaged during harvesting of the vein for transplantation?

Sural nerve

A 35-year-old man has difficulty in dorsiflexing the foot. Which of the following muscles is most likely damaged?

Tibialis anterior

While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?

Tear of the medial meniscus

Following major pelvic surgery your 59-year-old patient's right iliopsoas muscle was paralyzed. Which of the following muscles typically hypertrophies in these patients to compensate for the loss of the powerful hip flexor?

Tensor fascia latae

A 21-year-old soccer player is tackled via a high-impact sweeping injury about the right knee, causing a posterior knee dislocation. Soon after, he is unable to plantar flex his right ankle or flex his toes. He also experiences loss of sensation on the sole of his right foot. Which of the following nerves is most likely injured?

Tibial Nerve

As part of a physical examination to evaluate lower limb function, a physician asks a 10-year-old boy to stand on his tiptoes. What nerve is the doctor testing?

Tibial Nerve

A physician tests the calcaneal tendon (ankle jerk) reflex as shown. A normal response of plantar flexion of the ankle joint is noted. This myotatic (deep tendon) reflex confirms the integrity of what nerve?

Tibial nerve

As part of a physical examination to evaluate lower limb function, a physician asks her patient to stand on his tiptoes, as shown. What nerve is the doctor testing?

Tibial nerve

Injury to muscles in the deep posterior compartment of the leg resulted in a compartment syndrome. What are the three muscles within this compartment that affect the ankle joint?

Tibialis posterior, flexor hallucis longus, flexor digitorum longus

A 67-year-old patient has been given a course of antibiotics by gluteal intramuscular injections after a major abdominal surgery. To avoid damaging the sciatic nerve during an injection, the needle should be inserted into which of the following areas?

Upper lateral quadrant of the gluteal region

You are treating a 34-year-old elite runner with pain deep to her patella. You believe she is developing patellofemoral syndrome and recommend she perform exercises to strengthen which of the following muscles?

Vastus Medialis

An overweight woman participates in her first rugby match without proper training and conditioning. Upon catching the opening kickoff, she awkwardly twists her right knee, screams in pain, and falls to the ground. The team manager notes her patella is dislocated, residing on the lateral side of her knee. After straightening the woman's knee, the patellar dislocation is reduced (goes back into place). To prevent future dislocation of the patella, what specific muscle should be targeted during rehabilitation?

Vastus medialis

Anterior drawer sign is an indication of damage to the ____________.

anterior cruciate ligament.

Damage to the deep fibular nerve will have the greatest affect on the__________.

dorsiflexion of the ankle.

The pulse taken between the medial malleolus and the calcaneal tendon is that of the ______________.

posterior tibial artery.

Lesion of the inferior gluteal nerve will have the greatest affect on _____________.

thigh extension