Prep U - Lower Limb

Your 38-year-old patient has suffered a severe inversion ankle sprain. What structure is most commonly torn with this injury?

Anterior talofibular ligament

A 17-year-old boy was stabbed during a gang fight resulting in transection of the obturator nerve. Which of the following muscles is completely paralyzed?

Adductor longus

A 78-year-old woman receives knee surgery because her lateral meniscus is torn. Before injury, the normal lateral meniscus of the knee joint:

Lies outside the synovial cavity

A 27-year-old patient exhibits a loss of skin sensation and paralysis of muscles on the plantar aspect of the medial side of the foot. Which of the following nerves is most likely damaged?

Tibial n.

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 (peroneal) n

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?

ACL

You are working in the ED and a patient is brought in with severe knee pain from an athletic injury. Upon testing the knee you discern excessive anterior movement of the tibia on the femur. You therefore suspect which of the following?

ACL

A 6-year-old boy playing barefooted in his backyard steps on a piece of broken glass and suffers a large transverse cut on his sole, at the level of the midfoot. In the emergency room, the examining physician determines the cut is to the depth of the first layer of the plantar muscles. Which of the following structures is most likely damaged in this injury?

Abductor hallicus

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. If the lateral (fibular) collateral ligament is torn by this fracture, which of the following conditions may occur?

Abnormal passive adduction of the extended knee

Your 36-year-old patient is complaining of hip pain and a clicking sensation in his hip. An MR arthrogram of his hip is shown above. The red arrow points to a tear of which of the following?

Acetabular labrum

The obturator nerve and the sciatic (tibial portion) nerve of a 15-year-old boy are transected as a result of a motorcycle accident. This injury would result in complete paralysis of which of the following muscles?

Adductor Magnus

Which of the following is a hybrid muscle

Adductor Magnus

A 21-year-old female basketball player lands on her opponent's foot after jumping to rebound the basketball. Her foot is forcefully inverted, and when leaving the court, she tells her trainer that she twisted or sprained her ankle. After getting her ankle taped for support, she reenters the game. What ligament was most likely damaged?

Anterior talofibular ligament

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 quadriceps femoris muscles to patellar

During a basketball game your 25 year-old-patient severely and violently inverted his foot and now has sharp pain along the lateral margin of his foot, slightly anterior to his cuboid bone. What do you suspect?

Avulsion fracture to styloid process fo 5 metatarsal

you want to test your patient's posterior tibial pulse. To do this where would you place your finger?

Between the medial malleolus and the achilles (calcanean) tendon

Your 23-year-old hockey player patient received a slicing injury to the lateral side of the upper part of his leg during a game. After the wound was closed, the patient walked with a foot drop on that side. What nerve was transected during the game?

Common fibular

A 12-year-old boy was playing soccer without protective shin pads. He was kicked very hard on the anterolateral surface of his right leg. He was helped to the sidelines complaining of pain in his leg. Later he was said that his foot was numb. Several hours later the pain was so severe that his parents took him to the hospital. On examination his right leg was tender, swollen, and hard. The dorsalis pedis pulse was absent. Radiographs of his leg revealed no bone fractures. He now complained that he could not dorsiflex the toes of his right foot. Which of the following statements completely describes the most likely cause of the swelling and pain in the boy's leg?

Compartment syndrome of right leg

A 21-year-old man falls from the attic and is brought to the emergency department. Examination and radiogram reveal that the lateral longitudinal arch of his foot is flattened. Which of the following bones is displaced?

Cuboid

Choose the appropriate lettered site or structure in the following radiograph of the ankle and foot (see figure) to match the following descriptions. The peroneus longus muscle tendon is damaged in a groove of a tarsal bone by fracture. Which bone in the radiograph is most likely fractured?

Cuboid bone has a groove for the peroneal longus muscle tendon

A 47-year-old woman is unable to invert her foot after she stumbled on her driveway. Which of the following nerves are most likely injured?

Deep peroneal and tibial. The deep peroneal and tibial nerves innervate the chief evertors of the foot, which are the tibialis anterior, tibialis posterior, triceps surae, and extensor hallucis longus muscles. The tibialis anterior and extensor hallucis longus muscles are innervated by the deep peroneal nerve, and the tibialis posterior and triceps surae are innervated by the tibial nerve.

You feel the greater trochanter superior to the Nélaton line in a 79-year-old female patient. This line is an imaginary line running from the anterior superior iliac spine to the ischial tuberosity. Feeling the trochanter superior to this line indicates which of the following?

Dislocated hip or fractures femoral head

A 72-year-old man is brought to the ER after being struck by a car. Radiographic imaging reveals a rotationally unstable pubic ramus fracture, which is depicted in the given figure. Which of the following structures is most likely damaged specifically by the fracture of the superior pubic ramus?

Ductus deferens

You are evaluating your 60-year-old patient for peripheral artery disease. You cannot palpate a dorsalis pedis pulse in either foot. Although this likely supports a diagnosis of peripheral artery disease, this artery is sometimes replaced by which of the following?

Enlarged perforating fibular artery

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 hallicus longus

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

As part of a physical examination to evaluate lower limb function, a physician asks a patient to abduct her second through fifth toes. What specific nerve is the doctor testing?

Lateral plantar nerve

A 63-year old woman goes to an emergency room with acute abdominal pain, nausea, and vomiting after moving heavy furniture in her house. On examination, the doctor discovers a painful, globular mass located below and lateral to the pubic tubercle. Given her presentation, what is the most likely diagnosis?

Femoral hernia

After spending 2 days moving heavy furniture out of her house, a 56-year-old woman goes to an emergency room in acute pain. The patient reports nausea, vomiting, and severe abdominal pain. On examination, the doctor discovers a painful, globular mass located inferior and lateral to the pubic tubercle. Given her presentation and history, what is the most likely diagnosis?

Femoral hernia

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

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 nerve

A 25-year-old man suffers a gunshot wound to the calf that severs the posterior tibial artery at its origin. Which of the following vessels will not receive blood flow immediately following the injury?

Fibular (peroneal) artery

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 femoral pulse and inject needle directly lateral to that

A roofing installer falls off a high ladder and lands with the sole of his right foot hitting the ground first. He suffers a fracture and inferior displacement of the sustentaculum tali of the calcaneus. Which of the following structures is most likely torn?

Flexor hallicus longus

Your 34-year-old patient has been diagnosed with inflammation of her iliotibial tract (band). Which of the following is not correct about this structure?

Forms insertion fo rectus femoris

You are examining a newborn male patient with talipes equinovarus. This is associated with all of the following except?

Foto eversion and dorsiflexion - it is strongly inverted

The woman experiences weakness when abducting and medially rotating the thigh after this accident. Which of the following muscles is most likely damaged?

GLut minimis

A 15-year-old girl is struck by a car while crossing the street. She suffers numerous pelvic injuries, including tearing of the sacrotuberous ligament. The damage to this ligament will most likely cause direct trauma to which of the following muscles?

Gluteus maximus

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

An elderly woman fell at home and fractured the greater trochanter of her femur. Which of the following muscles would continue to function normally?

Gluteus maximus bc it inserts on the gluteal tuberosity on femur instead of greater trochanter

A 55-year-old woman recently had pelvic surgery during which cancerous lymph nodes were removed from the lateral wall of her pelvis. During a postoperative examination, she says she has been having painful muscle spasms in her thigh. Which of the following muscles is most likely involved?

Gracilis

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 patient lay on left side and abduct right leg against resistance

Your 61-year-old female patient has varicosities of her great saphenous vein. This is associated with all of the following except?

Hypertension

Your 45-year-old patient has sciatica that did not respond to initial medical treatment. MRI shows no disc herniation that would explain her symptoms. Careful clinical evaluation is now suggesting the presence of piriformis syndrome, which results from which of the following?

Hypertrophy of the muscle causing compression of the nerve

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. If the acetabulum is fractured at its posterosuperior margin by dislocation of the hip joint, which of the following bones could be involved?

Ilium

Following a severe compound fracture of the shafts of the tibia and fibula in your 46-year-old patient, you are concerned about damage to the deep fibular (peroneal) nerve. You can test the function of this nerve by testing for cutaneous sensation where?

In the web spaces between 1st and 2nd toe

A 22-year-old man stabbed himself in the thigh with a skinning knife, approximately four centimeters superior to the base (superior border) of the patella. To control the spurting of blood, he compressed the wound area with a handkerchief and the bleeding stopped in approximately 15 minutes. Later he covered the wound with a bandage. A few days later the inferior part of the anterior region of his thigh was swollen and painful and there was some swelling of his knee. He went to an ambulatory care clinic where he was examined and the wound was cleansed and bandaged. An oral antibiotic agent was prescribed. Which of the following statements best describes the most likely cause of the pain and swelling in the man's distal thigh and knee regions?

Infection to the suprapatellar bursa

An 80-year-old histologist complained to his physician about attacks of lameness and pain in his right leg, chiefly in the calf muscles. The physician noted that he had a slight limp when he entered his office. The man told his physician that these symptoms occurred when he walked a block or so and that he stopped when the intensity of the pain forced him to rest. After about 7 minutes, the pain disappeared, but it recurred when he walked another block. The physician also noted an absent right posterior tibial pulse. The patient had no other neurological signs (e.g., no paresthesia). Which of the following statements best describes the likely cause of the limp and pain in his right leg?

Intermittent claudication (ischemia) of calf muscles

A radical prostatectomy was scheduled. Before surgery, his physician wants to rule out possible metastases of the cancer. Which group of lymph nodes should be checked in the first instance to rule out metastases?

Internal iliac

Choose the appropriate lettered site or structure in the radiograph of the hip and pelvis (see figure) to match the following descriptions. Which fractured structure is likely to cause paralysis of the adductor magnus?

Ischiopubic ramus and ischial tuberosity are attachment post for adductor Magnus

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 knife wound penetrates the superficial vein that terminates in the popliteal vein. Bleeding occurs from which of the following vessels?

Lesser saphenous vein

A 'groin pull' refers to a straining of muscles in the ____________.

Medial compartment of thigh

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

During a knee examination, the physician noted tenderness along the joint line and a clicking sound while placing a valgus stress on the lateral side of the flexed left knee. During a deep knee bend, the patient experienced pain in the bottom of the motion as shown in the figure. An MRI would confirm damage to what knee structure?

Meniscus

Your patient is very unstable when supporting weight on her left limb. One possible cause of this is weakness in the triceps coxae muscles. These consist of which of the following muscles?

Obturator internus ad gemelli

Your 67-year-old patient has fecal incontinence due to a nonfunctioning external anal sphincter. His surgeon is going to transplant the gracilis muscle to create a replacement. The patient will then have to train the repositioned muscle to act as a sphincter. Because the muscle retains its original innervation, what nerve will the patient have to learn to use during defecation?

Obturator n

A patient is unable to prevent anterior displacement of the femur on the tibia when the knee is flexed. Which of the following ligaments is most likely damaged?

PCL

Which of the following muscles may be innervated by the femoral or the obturator nerves?

Pectineus

A 18-year-old male skateboarder presents at the emergency room with a straddle injury after impacting his perineum on the hand railing of the local library. During an examination, he presents with signs of extravasation of urine due to swelling and discoloration in the penis and scrotum. Which of the following structures is most likely compromised?

Penile urethra

A 25-year-old gladiator sustains a penetrating injury that severs the superficial peroneal nerve. This will most likely cause paralysis of which of the following muscles?

Peroneus brevis

A 21-year-old man was involved in a motorcycle accident, resulting in destruction of the groove in the lower surface of the cuboid bone. Which of the following muscle tendons is most likely damaged?

Peroneus longus

A motorcyclist falls from his bike in an accident and gets a deep gash that severs the superficial peroneal nerve near its origin. Which of the following muscles is paralyzed?

Peroneus longus

A 40-year-old woman who runs marathons complains of plantar foot pain after first walking to the bathroom in the morning. The pain dissipates after 5 to 10 minutes of activity. She has not had any recent foot trauma. The patient has point tenderness on the medial surface of her calcaneus. You suspect:

Plantar fasciitis

Your 78-year-old patient presented with symptoms of left lower limb ischemia. During physical examination, you palpate a swelling in the left popliteal fossa associated with "thrills". A bruit can be detected when you listen with a stethoscope. What is your preliminary diagnosis?

Popliteal artery aneurism

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

You are examining a 36-year-old patient in the ED who has a hip dislocation after a severe motor vehicle accident. Which direction of dislocation and associated nerve injury is most likely?

Posterior dislocation and sciatic nerve injury

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

Posterior tibial

A 45-year-old male patient has painful swelling over both of his patellae. You learn that he is often kneeling while at his job installing carpeting. The swelling is fluctuant, directly superficial to the patellae, and there does not appear to be a knee joint effusion. The rest of the physical exam is normal. What is your initial diagnosis?

Prepatellar bursitis

A patient presents with extreme pain due to arterial insufficiency in the posterior femoral compartment. This compartment of the thigh receives its blood supply mainly from the perforating arteries. An arteriogram confirms partial occlusion of the artery that gives rise to these perforating arteries. What artery is occluded in the arteriogram?

Profunda femoris artery

Your 65-year-old patient has signs of lower limb deep venous thrombosis. Which of the following is the major clinical concern with this condition?

Pulmonary thromboembolism

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

After a very strong kick while playing soccer your 35-year-old male patient complained of severe pain in his hip and points to the location of his anterior inferior iliac spine as the location of the most acute pain. You suspect which of the following caused an avulsion fracture?

Rectus femoris

A patient has weakness when flexing both her thigh and leg. Which of the following muscles is most likely injured?

SARTORIUS

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

After repair of a ruptured diverticulum, a 31-year-old patient begins to spike with fever and complains of abdominal pain. An infection in the deep perineal space would most likely damage which of the following structures?

Sphincter urethrae

A 16-year-old boy, who was riding his skateboard down a stair railing, falls and impacts his perineum on the railing, causing a straddle injury. He presents in the ER with discoloration and swelling in the scrotum, penis, and anterior abdominal wall, which is characteristic of extravasation of urine. Which of the following structures is most likely compromised?

Spongey urethra

A veteran infantry soldier develops painful flat feet after several years of service including hundreds of miles of marches. The pain is particularly acute on the medial aspect of his sole. Which of the following structures is most likely strained in this condition?

Spring ligament

Your 56-year-old patient, who has had recurrent lateral ankle sprains, is now complaining of numbness and paresthesia along the lateral side of his leg and dorsum of his foot and ankle. What do you initially suspect?

Stretch of the superior fibular nerve (peroneal)

A patient is involved in a motorcycle wreck that results in avulsion of the skin over the anterolateral leg and ankle. Which of the following structures is most likely destroyed with this type of injury?

Superficial fibularis (peroneal) nerve

Your 58-year-old female patient has a painful bunion. This is a friction bursitis of which of the following?

Superficial to first metatarsal-phalangeal joint

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 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 left buttock walks with a waddling gait that is characterized by the pelvis descending toward the right side at each step. Which of the following nerves is most likely 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 22-year-old soldier is injured from shrapnel from an improvised explosive device in the right upper thigh, below the midpoint of the inguinal ligament. Though he received field dressings from a medic, he arrives at the military hospital having lost copious amounts of blood. What sign and/or symptom would accompany this patient's presentation?

Tachycardia

A 24-year-old football player was illegally blocked by a defensive back that drove his shoulder into the posterolateral aspect of the man's knee. The trainer who rushed to examine the player noted that his right leg was unstable but that there was no anterior or posterior tibial displacement. The injured player was carefully taken to the sidelines by the trainers and later was taken to a hospital. Radiographs and MRIs revealed a knee injury. Which of the following statements best describes the knee injury that most likely occurred?

Tear of Mcl and medial meniscus

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 medial meniscus

A man working in a junkyard trips and falls into a pile of scrap metal, suffering a deep cut immediately posterior to the lateral malleolus. Which of the following is most likely to be injured?

Tendon of the fibularis longus

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 lata

A rugby player injures his left extended knee when hit from the lateral side by a defender trying to tackle him. While performing a knee examination, his physician applies pressure to his lateral thigh and medial leg (as shown in the illustration). This clinical test is a check for the integrity of which of the following ligaments?

Tibial (MCL) collateral ligament

you suspect tarsal tunnel syndrome. This syndrome is associated with compression of which of the following nerves?

Tibial n

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

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 hallicus longus, flexor digitorum longus

An injury to the leg of a golfer results in loss of the ability to invert the foot. Which of the following muscles is most likely paralyzed?

Tibilais posterior

An orthopedic surgeon is about to perform a femoral head replacement procedure. Regardless of which approach he takes, which of the following structures is the surgeon least likely to need to transect to perform this surgery?

Transverse acetabular ligament

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

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 pulmonary arteries

A femoral hernia passes through the ____________.

femoral ring/canal