Muscles
Nerves
Innervation
Blood vessels
Foot
100
A 68 year old women is brought to the emergency department after she fell from a bicycle and landed hard on the lateral aspect of the left pelvis and thigh. Physical examination shows lateral rotation of the left leg with some shortening in the supine position. An X-ray of her thigh and pelvis show an intrascapular fracture of the neck of the femur. A total hip arthroplasty is performed. An initial division of the overlying superficial tissues and gluteal musculature is performed, and the procedure continues to reach the neck of the femur. Which of the following muscles is considered as a landmark in surgical exploration of this area?
A: Gluteus medius
B: Superior gemellus
C: Inferior gemellus
D: Piriformis
E: Quadratus femoris
D: Piriformis
100
A 22 year old women is brought to the emergency department 30 minutes after she was involved in a motor vehicle collision. She appears to be well and without major injuries. Vitals signs are within normal limits. Physical examination shows no abnormalities other than a couple lacerations over the quadriceps femoris muscle. Which of the following nerves innervates this muscle?
A: Sciatic
B: Femoral
C: Obturator
D: Saphenous
E: Tibial
B: Femoral
100
A 34 year old man comes to the physician because of difficulty walking and pain at the back of the knee. Physical examination shows that the patient has a problem initiating gait from a standing position. A muscle injury responsible for unlocking the knee joint to permit flexion of the leg is suspected, and an imaging study is ordered. Which of the following nerves innervates the affected muscle? BONUS 100 PTS for the muscle!!!!
A: common fibular
B: deep fibular
C: superficial fibular
D: tibial
E: femoral
D: tibial
The POPLITEUS muscle allows unlocking of the knee joint to initiate gait. The popliteus muscle is innervated by the tibial nerve.
100
A 75 year old women is brought to the emergency department after falling in her bathroom. The patient says that she was not able to bear weight on the affected limb after the incident. Physical examination shows an externally rotated left leg, and the left lower limb appears to be shorter than the right lower limb. A series of plain x-ray of the hip show an extracapsular fracture of the femoral neck. Which artery is most likely risk for injury?
A: inferior gluteal
B: first perforating brach of deep femoral
C: Medial circumflex femoral
D: Obturator
E: Superior gluteal
C: Medial circumflex femoral
100
A 32 year old worker is brought to the emergency department because of an ankle injury. He says that during cleanup of an old residential area of the city, he accidentally cut the back of his left ankle with the blade of a bush cutter. Examination shows that a tendon lying posterior to the medial and lateral malleoli of the right ankle is severely transected obliquely. Which of the following bones serves as an insertion for the tendons?
A: Calcaneus
B: Fibula
C: Cuboid
D: Talus
E: Navicular
A: Calcaneus
200
A 24 year old women is brought to the emergency department 30 minutes after she was involved in a motor vehicle collision. She was the unrestrained driver. Physical examination shows a large bruise and severe tenderness on the lateral aspect of her hip. An X-ray of the hip shows an avulsion of the greater trochanter. Which of the following muscles would continue to function normally if such an injury occured?
A: piriformis
B: obturator internus
C: gluteus minimus
D: gluteus medius
E: gluteus maximus
E: gluteus maximus
200
A 16 year old boy is brought to the physician by his mother because of an ankle sprain. While playing flag football, he jumped over other players and landed with his right foot over an unexpected pit. The ankle rolled outward. Since then, bearing weight on the affected foot has not been possible because of severe pain. Physical examination shows swelling of the medial aspect of the ankle with severe tenderness. If a related bone is fractured, which of the following nerves would most likely be injured?
A: superficial fibular
B: lateral sural
C: deep fibular
D: tibial
E: sural
D: tibial
200
A 45 year old man comes to the physician because of a 3 month history of posterior right knee pain and tightness, and difficulty walking. He has a long history of chronic osteoarthritis. Physical examination shows the presence of a lump in the popliteal fossa in a supine position that disappears when the knee is flexed. An ultrasound examination of the popliteal fossa shows a large pure cystic structure compressing an adjacent nerve descending the fossa vertically. Which of the following movements will most likely be affected?
A: Dorsiflexion of the foot
B: Flexion of the thigh
C: Extension of the digits
D: Extension of the leg
E: Plantar flexion of the foot
E: Plantar flexion of the foot
200
A 72 year old women comes to the physician because of a 6 week history of pain in her right foot. Physical examination shows weak dorsal pedis pulse and cold right foot. A computed tomography angiography shows a thrombotic occlusion of the femoral artery in the proximal part of the adductor canal. Which artery will most likely provide blood supply to the leg through the genticular anastomosis?
A: medial circumflex femoral
B: descending branch of the lateral circumflex femoral
C: first perforating branch of deep femoral
D: inferior gluteal
E: descending genticular branch of femoral
B: descending branch of the lateral circumflex femoral
200
A 32 year old man comes to the physician because of an ankle sprain. Yesterday, the patient a basketball player, came down hard on his ankle during the match. Physical examination shows soft tissue swelling and severe tenderness on the medial aspect of the ankle. The patient is not able to put weight on the affected leg. An X-ray shows a bimalleolar fractures. Which of the following ligaments is most likely injured?
A: Talonavicular
B: Medial collateral (deltoid)
C: Spring
D: Plantar
E: Long Plantar
B: Medial collateral (deltoid)
300
A 24 year old women comes to the physician because of swelling in her groin and persistent low grade fever. She was diagnosed with tuberculosis a year ago but has not been compliant with medicine. Physical examination shows non-tender, fluctuant swelling in her left groin. A CT scan shows a spread of a large abscess at lumbar vertebrae within the fascia of a muscle with which of the following actions at the hip?
A: Abduction
B: Adduction
C: Extension
D: Flexion
E: Median Rotation
D: Flexion
Iliopsoas muscle which main action is flexion of the hip
300
A 45 year old man is brought to the emergency department 40 minutes after he was involved in a motor vehicle collision. Physical examination shows he is not able to bare weight on the affected limb. In a supine position, the left foot is plantarflexed. Eversion of the affected foot is intact. An X-ray examination of his left leg shows a fracture distal to the fibula. Which of the following nerves is most likely injured?
A: tibial
B: common fibular
C: superficial fibular
D: saphenous
E: deep fibular
E: deep fibular
300
A 30 year old man is brought to the emergency department 20 minutes after he was involved in a motor vehicle collision with his right hip caught beneath the motorcycle at the scene. Physical examination shows a deep laceration of the upper part of the right hip. A few days later stabilization and treatment, the patient is asked to walk, and he exhibits a waddling gait and the inability to perform abduction and medial rotation of the right thigh. The patient is most likely to show which of the following?
A: Difficulty in standing from a sitting position
B: Sagging of the left pelvis while standing only on the right lower limb
C: Drooping of the right pelvis while standing only on the left limb
D: Weakened flexion at the right hip joint
E: Difficulty in sitting from a standing position
B: Sagging of the left pelvis while standing only on the right lower limb
300
An 82 year old man comes to the physician because of a 3 month history of pain in her right leg below the knee. She says that her limb pain gets worse during her workout routines in the health spa. An angiography of the lower limbs shows minimal flow through the artery passing through the aperture present in the proximal part of the leg, between the tibia and fibula. Which of the following arteries is most likely affected?
A: deep femoral
B: popliteal
C: posterior tibial
D: fibular
E: anterior tibial
B: popliteal
300
A 7 year old girl is brought to the physician after she accidentally stepped on a sharp snail shell while walking to the beach. She receives a tetanus shot, and the wound is cleaned throughly and sutured. One week later, during a follow up examination, she has a great difficulty in flexing her great toe, even though there is no inflammation present in the sole of the foot. Which of the following nerves is most likely damaged by the piercing of the shell?
A: lateral plantar
B: medial plantar
C: sural
D: superficial fibular
E: deep fibular
B: medial plantar
400
A 43 year old man comes to the physician because of a painful, swollen knee joint. The patient's history shows chronic gonococcal arthritis. A knee aspiration is ordered for bacterial culture of the synovial fluid. A standard suprapatellar approach is used, and the needle passes from the lateral aspect of the thigh into the region immediately proximal to and deep to patella. Through which of the following muscles would the needle pass?
A: Adductor magnus
B: Short head biceps femoris
C: Rectus femoris
D: Sartorius
E: Vastus lateralis
E: Vastus lateralis
400
Three years following a 62 year old man's hip replacement, his CT scans indicated that two of his larger hip muscles had been replaced by adipose tissue. The opinion is offered that his superior gluteal nerve could have been injured during the replacement procedure, and the muscles supplied by that nerve had atrophied and been replaced by fat. Which of the following muscles receives innervation from the superior gluteal nerve?
A: Tensor fasciae latae
B: Rectus femoris
C: Gluteus maximus
D: Piriformis
E: Quadratus femoris
A: Tensor fasciae latae
Superior gluteal nerve innervates the gluteus minimus, gluteus medius, and tensor fasciae lata
400
A 42 year old man is brought to the emergency department 30 minutes after he was involved in a motor vehicle collision. He is treated for a pelvic fracture and several deep lacerations. Physical examination shows that dorsiflexion and inversion of the left foot and extension of the great toe are very weak. Sensation from the dorsum of the foot, skin of the sole, and the lateral aspect of the foot has been lost and the patellar reflex is normal. The foot is everted and plantar flexed. Which of the following structures is most likely injured?
A: the lumbosacral trunk at the linea terminalis
B: L5 and S1 spinal nerves torn at the intervertebral formaina
C: Fibular (peroneal) division of the sciatic nerve at the neck of the fibula
D: Sciatic nerve injury at the greater sciatic foramen
E: Tibial nerve in popliteal fossa
A: the lumbosacral trunk at the linea terminalis
L5 is responsible for cutaneous innervation of the dorsum of the foot. L4 affects inversion by tibialis anterior
400
A 42 year old man is brought to the emergency department after falling to the sidewalk from his ladder. Physical examination shows the patient is not able to put weight on his left leg. There is a swelling and bruises around the left midthigh, as well as multiple lacerations on his left arm and leg. An X-ray of the femur shows a fracture of the proximal shaft of the left femur. Which od the following arteries supplies the affected part of the femur?
A: deep circumflex iliac
B: acetabular brach of obturator
C: lateral circumflex femoral
D: medial circumflex
E: A brach of deep femoral
E: A brach of deep femoral
400
A 22 year old man is brought to the emergency department after falling from his bicycle. During physical examination, the patient is not able to put weight on the right leg and is unable to perform certain movements. An X-ray of the leg shows a fracture of the right tibia above the ankle. An MRI shows that the major nerve in the posterior compartment of the leg is severed by the fracture. Which of the following signs would have been most likely found during the physical examination?
A: sensory loss of the dorsum of the foot
B: sensory loss on the sole of the foot
C: Foot drop
D: Paralysis of the extensor digitorum brevis
E: sensory loss of entire foot
B: sensory loss on the sole of the foot
500
A 22 year old man who practices martial arts comes to the physician because of left knee pain and serious disability that took place from a kick to the side of his left knee in a competition a week ago. Physical examination shows a large bruise just distal to the head of the fibula. An X-ray of the leg shows a comminuted fracture. Which of the following muscles will most likely be paralyzed?
A: Tibialis anterior and extensor digitorum longus
B: Tibialis posterior
C: Soleus and gastrocnemius
D: Plantaris and popliteus
E: Flexor digitorum longus and flexor hallucis
A: Tibialis anterior and extensor digitorum longus
500
Young parents are concerned that their 14 month old daughter has not yet begun to walking. Their pediatrician reassures them, saying that one of the muscles of the leg, the fibularis tertitus, has to complete its central neurological development before the child could lift the outer corner of the foot and walk without stumbling over her toes. What is the most common nerve supply of this muscle?
A: sural
B: lateral plantar
C: deep fibular
D: superficial fibular
E: tibial
C: deep fibular
500
A 23 year old man is brought to the emergency department with a deep, bleeding stab wound of the pelvis. After the bleeding has been stopped, MRI of his pelvis shows the right ventral ramus of L4 has been transected. Which of the following will most likely be seen during physical examination?
A: reduction or loss of sensation from the medial aspect of the leg
B: Loss of sensation over the right little toe
C: Loss of sensation over the upper middle thigh
D: Loss of sensation over the middle toe
E: Loss of sensation over the posterior aspect of the knee
A: reduction or loss of sensation from the medial aspect of the leg
500
A 65 year old man is brought to the emergency department after falling from his roof while cleaning leaves and pine needles from the gutters. An X-ray of the right foot shows a fracture of the talus. Much of the blood supply of this bone can be lost in such an injury and can result in osteonecrosis. From what artery does this bone receive its primary vascular supply?
A: Medial plantar
B: Lateral Plantar
C: Dorsalis pedis
D: Anterior tibial
E: Posterior tibial
E: Posterior tibial
500
A 58 year old women comes to the physician because of 6 month history of pain during her work because of bilateral bunions. Physical examination shows swelling, redness, and calluses at the lateral base of the proximal phalanx of the great toes. During the operation, the protruding bony and soft tissues of the toe are excised, and the muscle is reflected from the lateral side of the proximal phalanx, together with a sesamoid bone, upon which the muscle also inserts. What muscle is it?
A: adductor hallucis
B: Abductor hallucis
C: First dorsal interosseous
D: first lumbrical
E: quadratus plantae
A: adductor hallucis