S1 Practice Questions for Lab Practical

1. What is the location of the common hamstring origin?

Greater Trochanter

Lesser Trochanter

Ischial Tuberosity

Inferior Pubic Ramus

Ischial Spine

All posterior thigh muscles (except the short head of biceps femoris) originate on
ischial tuberosity. This is one of the criteria that must be satisfied in order for a
muscle to be considered a True Hamstring.

Explanation

All posterior thigh muscles (except the short head of biceps femoris) originate on
ischial tuberosity. This is one of the criteria that must be satisfied in order for a
muscle to be considered a True Hamstring.

2. A 4-year-old patient comes into your office for a routine checkup accompanied by his mother. At one point during the physical exam, you ask the boy to sit on the ground and then stand up. He succeeds without difficulty. Along with ruling out a potentially debilitating muscular disease, you have also correctly tested the proper functionality of which nerve acting on muscle(s) of the hip joint?

Common fibular branch of the sciatic nerve

Inferior gluteal nerve

Femoral nerve

Superior gluteal nerve

Nerve to the quadratus femoris

Gower's sign is when the patient walks their hands up their legs to stand rather
than using their weakened gluteal and thigh muscles. The gluteus maximus is the
primary muscle used for standing from a sitting position and is innervated by the
inferior gluteal nerve.

Explanation

Gower's sign is when the patient walks their hands up their legs to stand rather
than using their weakened gluteal and thigh muscles. The gluteus maximus is the
primary muscle used for standing from a sitting position and is innervated by the
inferior gluteal nerve.

3. You are volunteering at a track tournament held at a local high school. One of the athletes has injured themselves during the hurdling competition. You do a quick assessment of the injured limb, and determine that the ischial tuberosity has been avulsed. Which muscle of the posterior thigh is not affected by this injury?

Semitendinosus

Long head of the biceps femoris

Semimembranosus

Short head of the biceps femoris

The short head of the biceps femoris has two distinct differences from the other
posterior thigh muscles. First, it originates from the linea aspera of the femur, not the
ischial tuberosity (thus, it is still functional in this patient). And second, the muscle is
innervated by the common fibular nerve, not the tibial nerve. Because of this, short
head of biceps femoris is not a true Hamstring.

Explanation

The short head of the biceps femoris has two distinct differences from the other
posterior thigh muscles. First, it originates from the linea aspera of the femur, not the
ischial tuberosity (thus, it is still functional in this patient). And second, the muscle is
innervated by the common fibular nerve, not the tibial nerve. Because of this, short
head of biceps femoris is not a true Hamstring.

4. An elderly female complains of having trouble getting up from a chair. As you observe her in your exam room, you notice that she must use her upper limbs to help herself up from a seated position. What nerve is likely to have a lesion in this patient?

Nerve to Piriformis

Common Fibular Nerve

Superior Gluteal Nerve

Inferior Gluteal Nerve

Clunial Nerves

Inferior gluteal nerve supplies the gluteus maximus. This muscle extends the
thigh, which is necessary to lift oneself from a seated position. The hamstring
muscles are also extensors of the thigh (but the tibial n. is not an answer option
here).

Explanation

Inferior gluteal nerve supplies the gluteus maximus. This muscle extends the
thigh, which is necessary to lift oneself from a seated position. The hamstring
muscles are also extensors of the thigh (but the tibial n. is not an answer option
here).

5. Which muscle, other than Quadratus Femoris, does the Nerve to Quadratus Femoris innervate?

None

Superior Gemellus

Inferior Gemellus

Obturator Internus

Piriformis

The Nerve to Quadratus Femoris innervates the Inferior Gemellus muscle.

Explanation

The Nerve to Quadratus Femoris innervates the Inferior Gemellus muscle.

6. The great saphenous vein is often used for coronary artery bypass graft surgery. The nerve that runs with a portion of this vein is vulnerable to injury when the vein is harvested surgically. What is the name of this nerve?

Sural nerve

Femoral nerve

Saphenous nerve

Obturator nerve

Tibial nerve

Saphenous nerve, a terminal branch of femoral nerve, supplies cutaneous
innervation to the medial leg. This nerve lies next to the great saphenous vein as it
passes posteromedial to the knee, and may be damaged as the vein is harvested at
this location.

Explanation

Saphenous nerve, a terminal branch of femoral nerve, supplies cutaneous
innervation to the medial leg. This nerve lies next to the great saphenous vein as it
passes posteromedial to the knee, and may be damaged as the vein is harvested at
this location.

7. Before Ned was a poor medical student he was filthy rich. He liked to flaunt it, so he carried copious amounts of cash in his wallet, which he kept in his back pocket. After prolonged sitting in the Annex, he developed Sciatica, which would resolve itself upon standing for a short while. In this case, what is the most likely cause of his symptoms?

Piriformis Syndrome

Herniated Disc in Lumbar Region

Cauda Equina Syndrome

Sectioned Sciatic Nerve

Tumor in the Greater Sciatic Foramen

Sciatica refers to pain or paresthesia along the regions supplied of the sciatic
nerve. Piriformis syndrome is a cause of sciatica when the sciatic nerve is
compressed as it passes through or deep to the piriformis muscle. Sitting on a thick
wallet can induce this syndrome by applying extra pressure on the piriformis muscle
causing it to temporarily compress the nerve. The other causes could result in
similar symptoms, but would not be relieved by standing up.

Explanation

Sciatica refers to pain or paresthesia along the regions supplied of the sciatic
nerve. Piriformis syndrome is a cause of sciatica when the sciatic nerve is
compressed as it passes through or deep to the piriformis muscle. Sitting on a thick
wallet can induce this syndrome by applying extra pressure on the piriformis muscle
causing it to temporarily compress the nerve. The other causes could result in
similar symptoms, but would not be relieved by standing up.

8. Your patient has a spider bite on the right buttocks, within the superior medial quadrant. After three days, the bite becomes swollen and inflamed. What lymph nodes will be the first to receive the majority of the lymph from this infected bite?

Sacral

Superficial Inguinal, horizontal group

Superficial Inguinal, vertical group

Deep Inguinal

External Iliac

superficial inguinal, horizontal group

Explanation

superficial inguinal, horizontal group

9. Your patient presents to the emergency room with a swollen, painful knee. You determine that the patient suffers from a dislocated patella. What muscle, when weakened, is unable to resist a lateral patella dislocation?

Vastus medialis

Vastus lateralis

Rectus femoris

Vastus intermedius

Popliteus

vastus medialis weakness may allow for lateral subluxation of the patella, which
may lead to dislocation of the patella out of the patellar notch of the femur. This
occurs because the Q-angle (quadriceps pull angle) is putting more lateral force on
the patella (especially in females, who tend to have a greater Q-angle).

Explanation

vastus medialis weakness may allow for lateral subluxation of the patella, which
may lead to dislocation of the patella out of the patellar notch of the femur. This
occurs because the Q-angle (quadriceps pull angle) is putting more lateral force on
the patella (especially in females, who tend to have a greater Q-angle).

10. Which muscle tendon exits the pelvic cavity through the lesser sciatic foramen?

Obturator Internus

Obturator Externus

Piriformis

Gluteus Minimus

Quadratus femoris

The muscle tendon that exits the pelvic cavity through the lesser sciatic foramen is the Obturator Internus. This muscle is located in the pelvic region and helps with the rotation of the hip joint. It passes through the lesser sciatic foramen, which is a small opening in the pelvis, to reach its insertion point on the femur.

Explanation

The muscle tendon that exits the pelvic cavity through the lesser sciatic foramen is the Obturator Internus. This muscle is located in the pelvic region and helps with the rotation of the hip joint. It passes through the lesser sciatic foramen, which is a small opening in the pelvis, to reach its insertion point on the femur.

11. You decide to participate in the diabetic clinic hosted by Ross Emergency Medicine Association (REMA). You are instructed by the attending physician to check for a dorsalis pedis pulse. Where will you place your fingers in order to take this pulse, and what is the origin of this artery?

Medial to extensor hallucis longus tendon; posterior tibial artery.

Lateral to extensor digitorum longus tendon; anterior tibial artery.

Lateral to extensor hallucis longus tendon; anterior tibial artery.

Lateral to extensor hallucis longus tendon; posterior tibial artery.

Dorsalis pedis is a branch of the anterior tibial artery and it is palpable lateral to
the tendon of the extensor hallucis longus, or between the tendons of extensor
hallucis longus and extensor digitorum longus, especially with the foot held in
dorsiflexion.

Explanation

Dorsalis pedis is a branch of the anterior tibial artery and it is palpable lateral to
the tendon of the extensor hallucis longus, or between the tendons of extensor
hallucis longus and extensor digitorum longus, especially with the foot held in
dorsiflexion.

12. What structure passes through a gap in the interosseous membrane of the leg?

Common Fibular Nerve

Posterior Tibial Artery

Anterior Tibial Artery

Fibular Artery

Tibial nerve

The popliteal artery divides into anterior and posterior tibial arteries. The anterior
tibial artery passes through a gap at the superior end of the interosseous membrane
to move to the anterior compartment of the leg, which it supplies.

Explanation

The popliteal artery divides into anterior and posterior tibial arteries. The anterior
tibial artery passes through a gap at the superior end of the interosseous membrane
to move to the anterior compartment of the leg, which it supplies.

13. A 60-year-old male presents to the clinic with difficulty walking. You observe the patient's right hip drops down when he stands on his left leg. What is the most likely location of the lesion?

Right Superior Gluteal Nerve

Right Inferior Gluteal Nerve

Left Superior Gluteal Nerve

Left Inferior Gluteal Nerve

This patient has the Trendelenberg sign: his hip drops to the opposite side when
he is balancing on one leg. The superior gluteal nerve innervates the gluteus medius
and minimus muscles, which stabilize the pelvis during walking by abducting the
thigh on the supporting (balancing) leg. The lesion always occurs on the side of the
balancing leg, NOT the side to which the hip drops.

Explanation

This patient has the Trendelenberg sign: his hip drops to the opposite side when
he is balancing on one leg. The superior gluteal nerve innervates the gluteus medius
and minimus muscles, which stabilize the pelvis during walking by abducting the
thigh on the supporting (balancing) leg. The lesion always occurs on the side of the
balancing leg, NOT the side to which the hip drops.

14. Which muscle tendon passes inferior to the lateral malleolus and inserts at the plantar surface of the base of the first metatarsal?

Tibialis Anterior

Tibialis Posterior

Fibularis Longus

Fibularis Brevis

Fibularis Tertius

Fibularis longus tendon has a long course posterior then inferior to the lateral
malleolus (this acts like a pulley), then inserting on the 1st metatarsal plantar surface.

Explanation

Fibularis longus tendon has a long course posterior then inferior to the lateral
malleolus (this acts like a pulley), then inserting on the 1st metatarsal plantar surface.

15. For his Behavioral Science mandatory Personal Improvement Project, Ned decides his goal is to run a marathon. He hasn't jogged since he arrived in Dominica 1 year ago. He runs 5 miles on the first day and develops pain and swelling in his leg. What is the root cause of his symptoms?

Repetitive microtrauma to Tibialis Anterior muscle

Repetitive microtrauma to Extensor Digitorum Longus

Common Fibular Nerve entrapment

Tibial Nerve entrapment

Repetitive microtrauma to Plantar Fascia

Ned suffers from ‘shin splints’. This is commonly due to microtears of the tibialis
anterior muscle, usually from overuse in poorly conditioned individuals. This muscle
is a strong dorsiflexor and inverter of the foot, both of which are required when you
jog.

Explanation

Ned suffers from ‘shin splints’. This is commonly due to microtears of the tibialis
anterior muscle, usually from overuse in poorly conditioned individuals. This muscle
is a strong dorsiflexor and inverter of the foot, both of which are required when you
jog.

16. Your patient fractures the head of his fibula when he was side-swiped while playing hockey. He presents with footdrop and cutaneous sensory deficits. What area of skin is supplied by the deep fibular nerve?

Dorsum of foot including 1st interdigital cleft

Just dorsum of foot

1st interdigital cleft

Sole of foot

Heel of foot

Common fibular nerve runs posterior to the head of the fibula and wraps around
the fibular neck, and so is prone to injury if a fracture occurs at this location. The
deep fibular nerve supplies cutaneous innervation to the web of skin between the 1st
and 2nd digits (1st interdigital cleft), while the superficial fibular nerve supplies the
distal 1/3 of the lateral leg and the rest of the dorsum of the foot; thus, sensory
deficits occurs across the entire dorsum of the foot including the web between 1st-2nd
toes with a Common Fibular N. injury since this happened prior to the split into its
two terminal branches.

Explanation

Common fibular nerve runs posterior to the head of the fibula and wraps around
the fibular neck, and so is prone to injury if a fracture occurs at this location. The
deep fibular nerve supplies cutaneous innervation to the web of skin between the 1st
and 2nd digits (1st interdigital cleft), while the superficial fibular nerve supplies the
distal 1/3 of the lateral leg and the rest of the dorsum of the foot; thus, sensory
deficits occurs across the entire dorsum of the foot including the web between 1st-2nd
toes with a Common Fibular N. injury since this happened prior to the split into its
two terminal branches.

17. Mr. Johnson comes to your office complaining of loss of sensation to the lateral aspects of his thigh. Recalling your knowledge of anatomy and cutaneous nerves to that region, you determine that there is likely a lesion to the:

Anterior division, L2-L4

Posterior division, L2-L4

Posterior division, L2-L3

Posterior division, L3-L4

Anterior division, L2-L3

Lateral cutaneous nerve (from posterior division of L2-L3) supplies the lateral
thigh, it is separate from the femoral nerve, unlike the anterior cutaneous branches
of femoral nerve that supply the anterior thigh.

Explanation

Lateral cutaneous nerve (from posterior division of L2-L3) supplies the lateral
thigh, it is separate from the femoral nerve, unlike the anterior cutaneous branches
of femoral nerve that supply the anterior thigh.

18. What is the insertion of the Biceps Femoris muscle?

Tibial Head

Fibular Head

Medial Femoral Condyle

Lateral Femoral Condyle

Patella

The biceps femoris inserts on the fibular head. The other hamstring muscles:
semitendinosus inserts as part of pes anserinus on the proximal medial tibia, and
semimembranous inserts on the medial condyle of tibia. These muscles act as
‘splints’ along both sides of the knee, and help stabilize the knee by resisting knee
rotation.

Explanation

The biceps femoris inserts on the fibular head. The other hamstring muscles:
semitendinosus inserts as part of pes anserinus on the proximal medial tibia, and
semimembranous inserts on the medial condyle of tibia. These muscles act as
‘splints’ along both sides of the knee, and help stabilize the knee by resisting knee
rotation.

19. The femoral artery can be safely ligated proximal to the profunda femoris artery without compromising blood supply to thigh because of continued blood supply through which artery?

Inferior Gluteal

Medial Circumflex Femoral

Lateral Circumflex Femoral

1st Perforating branch of Profunda Femoris

Popliteal

Ligation of femoral artery proximal to profunda femoris is possible because of
continued blood flow through inferior gluteal artery (a branch of internal iliac artery),
which anastomoses with medial and lateral circumflex femoral arteries and the first
perforating a. (branches of profunda femoris); blood can thus pass through this
collateral network and return through the profunda femoris to the femoral a. distal to
the ligature.

Explanation

Ligation of femoral artery proximal to profunda femoris is possible because of
continued blood flow through inferior gluteal artery (a branch of internal iliac artery),
which anastomoses with medial and lateral circumflex femoral arteries and the first
perforating a. (branches of profunda femoris); blood can thus pass through this
collateral network and return through the profunda femoris to the femoral a. distal to
the ligature.

S1 Practice Questions For Lab Practical

1. What is the location of the common hamstring origin?

2.

What first name or nickname would you like us to use?

4. An elderly female complains of having trouble getting up from a chair. As you observe her in your exam room, you notice that she must use her upper limbs to help herself up from a seated position. What nerve is likely to have a lesion in this patient?

5. Which muscle, other than Quadratus Femoris, does the Nerve to Quadratus Femoris innervate?

6. The great saphenous vein is often used for coronary artery bypass graft surgery. The nerve that runs with a portion of this vein is vulnerable to injury when the vein is harvested surgically. What is the name of this nerve?

8. Your patient has a spider bite on the right buttocks, within the superior medial quadrant. After three days, the bite becomes swollen and inflamed. What lymph nodes will be the first to receive the majority of the lymph from this infected bite?

9. Your patient presents to the emergency room with a swollen, painful knee. You determine that the patient suffers from a dislocated patella. What muscle, when weakened, is unable to resist a lateral patella dislocation?

10. Which muscle tendon exits the pelvic cavity through the lesser sciatic foramen?

11. You decide to participate in the diabetic clinic hosted by Ross Emergency Medicine Association (REMA). You are instructed by the attending physician to check for a dorsalis pedis pulse. Where will you place your fingers in order to take this pulse, and what is the origin of this artery?

12. What structure passes through a gap in the interosseous membrane of the leg?

13. A 60-year-old male presents to the clinic with difficulty walking. You observe the patient's right hip drops down when he stands on his left leg. What is the most likely location of the lesion?

14. Which muscle tendon passes inferior to the lateral malleolus and inserts at the plantar surface of the base of the first metatarsal?

15. For his Behavioral Science mandatory Personal Improvement Project, Ned decides his goal is to run a marathon. He hasn't jogged since he arrived in Dominica 1 year ago. He runs 5 miles on the first day and develops pain and swelling in his leg. What is the root cause of his symptoms?

16. Your patient fractures the head of his fibula when he was side-swiped while playing hockey. He presents with footdrop and cutaneous sensory deficits. What area of skin is supplied by the deep fibular nerve?

17. Mr. Johnson comes to your office complaining of loss of sensation to the lateral aspects of his thigh. Recalling your knowledge of anatomy and cutaneous nerves to that region, you determine that there is likely a lesion to the:

18. What is the insertion of the Biceps Femoris muscle?

19. The femoral artery can be safely ligated proximal to the profunda femoris artery without compromising blood supply to thigh because of continued blood supply through which artery?