Question 1

A fifteen year old football player scored a goal during a teacher versus pupil match
at school. As soon as he kicked the ball he felt a sudden pain in his groin and had
painful weightbearing. He was seen in A&E soon after the injury. There was some
bruising in his groin. He had difficulty flexing his hip, but there was full range of
passive movement. X- Ray reveals a tiny bony avulsion from the Anterior Inferior Iliac
Spine. What muscle is he likely to have injured?

Sartorius

Reflected head of rectus femoris

Straight head of rectus femoris

Pectineus

None of the above

References

Straight head of rectus femoris. This is the only muscle attached to the AIIS.
Sartorius is attached to the ASIS. Reflected head of rectus femoris originates from a
shallow concavity above the acetabulum. Pectineus originates from the pectineal line
on the pubis.

Question 2
Which one of the following is not a branch of of the posterior cord of the brachial
plexus?

Radial nerve

Axillary nerve

Dorsal scapular nerve

Lower subscapular nerve

Thoracodorsal nerve

References

Dorsal Kaplan’s interval scapular (Nerve to rhomboidus) is a branch of C5 root.

Question 3
Lower limb anatomy

A : A The medial femoral circumflex artery

B : B The inferior gluteal nerve

C : C The femoral nerve

D : D The superior gluteal nerve

E : E The sciatic nerve

F : F The obturator artery

G : G The lateral femoral circumflex artery

H : H The inferior gluteal artery

I : I The superior gluteal artery

J : J The femoral artery

1 : During a direct lateral (Hardinge) approach to the hip, which neurovascular

structure may be injured by excessive retraction of the gluteus medius muscle?

Correct answer: D

2 : The artery of the ligamentumteres (foveal artery) is a branch of which vessel

Correct answer: F

3 : The anterior (Smith-Petersen) approach to the hip utilises the internervous plane
between muscles supplied by the superior gluteal nerve and which other nerve?

Correct answer: C

Question 4

Which of the following does not contribute to the blood supply of the femoral
neck/head?

Medial Femoral Circumflex Artery

Lateral Femoral Circumflex Artery

Inferior Gluteal Artery

Posterior Branch of the Obturator Artery

Internal Pudendal Artery

Question 5

Which one of the following statements is true about surgical approaches to the elbow
joint

Kaplan’s interval is between extensor carpi radialisbrevis and extensor digitorum

Kaplan’s interval can safely be extended distally to expose the proximal radius

Kocher’s approach utilises the interval between extensor carpi ulnaris and anconeus.

Olecranon osteotomy gives inadequate exposure of the distal humerus for fracture
management.

Olecranon osteotomy precludes primary arthroplasty in the treatment of distal

humeral fractures

References

Kaplan’s interval is between extensor carpi radialis longus and extensor digitorum.
The posterior interosseus nerve is at risk if Kaplan’s interval is extended distally.
Olecranon osteotomy gives good exposure of the distal humeral articular surface and
does not preclude primary arthroplasty.

Question 6

What nerve innervates the pronator quadratus muscle?

The radial nerve

The ulnar nerve

The posterior interosseous nerve

The anterior interosseous nerve

The distal motor branch of the median nerve

Question 7

The popliteus muscle receives its motor innervation from:

Peroneal branch of the sciatic nerve

Terminal branch of the obturator nerve

Saphenous nerve

Tibial branch of the sciatic nerve

Femoral nerve

Question 8

In the brachial plexus, which nerve arises from the upper trunk other than the
nerve to subclavius?

Suprascapular nerve
Thoracodorsal nerve
Axillary nerve
Upper subscapular nerve
Long thoracic nerve

A: Suprascapular nerve

Question 9

During ilioinguinal approach, actively bleeding vascular bundle crossing the

superior pubic ramus is encountered. The artery is most likely an anastomosis
between which of the following arteries?

Superior epigastric and common femoral.

Superficial femoral and profundafemoris.
Inferior gluteal and obturator.
External iliac and internal iliac.
External iliac and obturator.

A: External iliac and obturator.

Question 10

Which vessel arises from the second part of the right subclavian artery?

Internal thoracic artery

Dorsal scapular artery
Vertebral artery
Costocervical trunk
Thyrocervical trunk

A:Costocervical trunk

References

Last’s anatomy Regional and Applied. Tenth edition. CS Sinnatamby. Page 340
The only branch of the second part of subclavian artery is the costocervical
trunk

Question 11

Regarding upper limb anatomy

A : Short head of biceps

B : Long head of biceps
C : Nerve to subclavius
D :Thoracodorsal nerve
E : Upper subscapular nerve
F : Lower subscapular nerve
G :Pectoralis major
H : Long thoracic nerve
I :Scalenus anterior
J : Lateral pectoral nerve

1 : Which structure is attached to the coracoid process?

2 : Injury to which nerve will cause Loss of function of latissimusdorsi muscle?

3 : In preganglionic upper trunk brachial plexus injury scapular winging is

caused by loss of which nerve function?

Correct answer:
1. A 2. D 3. H

References

Last’s Anatomy – Regional and Applied. Tenth edition. C.S Sinnatamby.

Brachial plexus injuries are not common in everyday practice but common in
exam situations! Brachial plexus arises from anterior primary rami of C5,6,7,8
and T1. In a pre-fixed plexus, contribution from C4 is large and T1 is reduced.
In a post-fixed plexus, C5 is always present and T1 is large. Roots – Trunks –
Divisions – Cords – Branches

Question 12

With regards to hand anatomy

A : Dorsal interosseous muscles

B :Opponenspollicis
C : 2nd and 3rd lumbricals
D : 1st and 2nd lumbricals
E : Abductor pollicisbrevis
F : 4th and 5th lumbricals
G : Adductor pollicis
H : Extensor pollicisbrevis
I : Flexor pollicisbrevis
J : Palmar interosseous muscles

1 : The ulnar nerve is the sole supply to which thenar muscle

2 : The single muscle in the hand to have dual nerve supply is

3 : Which of the intrinsic muscles of the hand other than thenar muscles are
supplied by the median nerve?

Correct answer:
1. G 2. I 3. D

References

Campbell's Operative Orthopaedics

In the forearm, the ulnar nerve supplies flexor carpi ulnaris, the ulnar half of flexor
digitorum profundus, abductor digiti minimi, opponens digiti minimi, Palmaris brevis,
flexor digiti minimi, the 3rd and 4th lumbricals, interossei, adductor pollicis and the
deep head of flexor pollicis brevis.
The median nerve supplies the pronator teres, flexor carpi radialis, Palmaris longus,
flexor digitorum superficialis, abductor pollicisbrevis, the supinator head of flexor
pollicis brevis, opponens pollicis, 1st and 2nd lumbricals. The anterior interosseus
nerve supplies the lateral half of flexor digitroum profundus, flexor pollicis longus
and pronator quadratus.
Question 13

Lower limb neurology

a) Sural nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Saphenous nerve
e) Posterior tibial
f) Medial plantar
g) Lateral plantar

1. Skier with numbness in the dorsal first web space after removing boots
2. Paraesthesia of the lateral border of the foot after nailing of the fibula
3. Pain on inversion and plantarflexion of the foot

1.b
2. a
3 . will dwmrbing

Question 14

Upper limb neurology

a) Ulnar nerve
b) Axillary nerve
c) Median Nerve
d) Thoraco-dorsal nerve
e) Musculocutaneous nerve
f) Dorsal scapular nerve
g) Radial nerve
h) Long thoracic nerve

4. Nerve supply to short head of biceps

5. Between Brachoradialis and brachialis
6. Between pronator teres and Brachoradialis

10 e
11 g
12 c
Question 15

Approaches to the hip

a) Charnely
b) Southern
c) Ludloff
d) Hardinge
e) Fergusson
f) Watson-Jones
g) Smith-Peterson

6. Between sartorius and rectus femoris

7. Between gluteus medius and tensor fascia lata
8. one third of gluteus medius and Vastuslateralis

13 g
14 f
15 d

Question 16
Root supply

a) C6
b) C7
c) C8
d) T1
e) T6
f) T7
g) T8
h) T9
i) T10
j) T11

36. Biceps
37. Supinator
38. Abdominal reflex

1. a
2. a
3 . ?willdwmrbalain
Question 17
Which of the following nerves does NOT innervate any of the rotator cuff muscles?
a. Axillary nerve
b. Dorsal scapular nerve
c. Upper subscapular nerve
d. Lower subscapular nerve
e. Suprascapular nerve

References
Miller MD, Review of Orthopaedics, 4th edition, pg602
Dorsal scapular nerve supplies the rhomboids and levator scapulae which are not part of the
rotator cuff.
Ans; b

Question 18
Trapezius is supplied by which of the following nerves?
Suprascapular
Thoracodorsal
Dorsal Scapular
Spinal accessory
Axillary

Trapezius is supplied by the spinal root of the accessory nerve (CNXI). Thoracodorsal nerve
supplies latissimusdorsi. Dorsal Scapula nerve supplies the Rhomboids and levator scapulae.
Suprascapular nerve supplies Supraspinatus and Infraspinatus. Axillary nerve supplies
Deltoid and Teres minor.
Ans; d, spinal acc

Question 19
Which of the following option is TRUE of the gluteus medius muscle:
a. Has an L5 nerve root innervation
b. Inserts onto the lesser trochanter of the femur.
c. Is an adductor of the hip joint.
d. Is an internal rotator of the hip joint.
Ie.s innervated by the inferior gluteal nerve.

The gluteus medius originates from the ilum and inserts into the greater trochanter. It is
supplied by the superior gluteal nerve with a predominantly L5 nerve root in addition to S1. Its
action is to abduct the hip. Ans; a, has L5 nv root innervation NB SOME BOOKS SAY GLUT
MEDIUS IS AN INTERNAL ROTATOR

Question 20
Anterior approach to the hip utilises which of the following deep muscular planes to
gain access to the joint capsule.
Sartorius and adductor longus
Sartorius and rectus femoris
Tensor fascia lata and rectus femoris
Rectus femoris and gluteus medius
Rectus femoris and gluteus minimus
References
The deep internervous muscular plane lies between rectus femoris (femoral nerve) and
gluteus medius (superior gluteal nerve). The superficial plane lies between Sartorius (femoral
nerve) and tensor facialata (superior gluteal nerve).

Question 21
The Anterior Interosseous Nerve:
Originates as a branch of the radial nerve
Runs on the volar surface of Flexor digitorum profundus
Innervates pronator teres
Provides cutaneous supply to the anterolateral surface of the forearm
Innervates flexor pollicisbrevis
References
Last's anatomy
Arises from median nerve, 5 cm above medial epicondyle; runs on volar surface of FDP and
along interosseous membrane between ulna & radius; supplies FPL, lateral half of FDP, &
pronator quadratus; may supply sensory branches to distal radio-ulnar and carpal joints.
Martin Gruber anastomosis occurs in 10-15% of all forearms and in half of these cases, the
nerve communication arises from the AIN branch; hence palsy of the AIN could lead to palsy
of the hand intrinsics normally supplied by the ulnar nerve

Question 22
Regarding lower limb fasciotomy for compartment syndrome. Which of the following is
NOT in the anterior compartment?
Deep peroneal nerve
Extensor digitorumlongus
Extensor hallucislongus
Peroneus brevis
Peroneus tertius
References
Surgical Exposures in Orthopaedics, 3rd Ed. Hoppenfeld&deBoer

The anterior compartment consists of the following- Tibialis anterior, extensor

digitorumlongus, extensor hallucis longus, peroneus tertius, deep peroneal nerve and anterior
tibial artery. Peroneus brevis is a content of the lateral compartment

Question 23

The nerve supplying teres minor is a branch of which nerve?

Suprascapular nerve (C5,C6)

Lower subscapular nerve (C5,C6)

Upper subscapular nerves (C5,C6)

Axillary nerve (C5,C6)

Medial supraclavicular nerves (C3,C4)

Question 24

Which nerve supplies the inferior gemellus?

Inferior gluteal nerve

Nerve to obturatorinternus

Nerve to quadratusfemoris

Obturator nerve

Superior gluteal nerve

References

Whittaker RH and Borley NR. Instant Anatomy. Blackwell Science

Moore KL and Dalley AF. Clinically oriented anatomy. Lippincott, Williams and Wilkins.

Nerve to quadratus femoris supplies quadratus femoris and the inferior gemellus, as
well as a sensory branch to the hip joint. The superior gemellus is supplied via the
nerve to obturator internus. The superior gluteal nerve supplies gluteus medius and
minimus, while the inferior gluteal nerve supplies gluteus maximus. The obturator
nerve supplies obturator externus, the thigh adductors and sensory branches to hip,
knee and skin of the medial thigh

Question 25

The second web space on the dorsum of the foot is supplied by

Deep peroneal nerve

Common peroneal nerve

Superficial peroneal nerve

Sural nerve
 Saphenous nerve

Question26
With respect to nerves of the lower limb

A : Common digital nerve

B : Lateral plantar nerve

C : Medial plantar nerve

D :Sural nerve

E : Deep peroneal nerve

F : Superficial peroneal nerve

G :Tibial nerve

H : Saphenous nerve

1 : This is the main innervator of extensor digitorum brevis

2 : This is in danger at the proximal portion of the lateral approach to calcaneal

fracture fixation

3 : This supplies the skin over the dorso-medial part of the great toe

4 : This pierces the deep fascia 10-15 cm proximal to the lateral malleolus

Answers; E, D, F, F

Question 27
Concerning the muscle layers of the sole of the foot

A : Layer 1

B : Layer 2

C : Layer 3

D : Layer 4

E : Layer 1+3
F : Layer 2+4

G : Layer 4+5

H : Layer 3+5

I : Between first and the second layer underneath flexor digitorumbrevis.

J : Between second and third layer protected by quadratusplantae

1 : In what layer do medial and lateral plantar nerves lie

2 : Flexor digitorum longus and lumbricals are part of

3 : Peroneus longus and interossei are part of

Knowing layers of foot is important for those involved in foot surgery.

First layer consists (from lateral to medial) of the ADM, FDB, & abductor hallucis.

Medial and lateral Plantar nerve and artery lies between First and second layer.

Second layer (from medial to lateral) tendon of FHL, tendon of FDL,

quadratusplantae&lumbricalsin

Third layer has adductor hallucis, & FHB

Fourth layer has Palmer and Dorsal interossei.

First two layers originate from calcaneal tuberosity and the other two from the
metatarsal shafts.

Lateral release of first MTP joint in an integral part of Bunion surgery. It involves
release of Adductor hallucis which lies in the third layer and often surgeon ends up
just releasing the dorsal interossei which from the dorsal side is superficial to
adductor hallucis and is in layer 4. Flexor digitorum longus is used for tendon transfer
in acquired flat foot correction.

Answers; I, B, D

Question 28
With regards to the nerve supply to the foot choose the nerve that innervates
each of the structures below.

A : Common peroneal

B : Deep Peroneal Nerve

C : Lateral Plantar nerve

D : Medial plantar nerve

E : Posterior tibial

F : Superficial peroneal nerve

G :Sural nerve

H :Tibial nerve

1 : Flexor digitorumbrevis

2 : Abductor Hallucis

3 : First web space sensation

The nerve supply to the foot is essential knowledge. The cutaneous supply of the
nerves running through each compartment of the leg is also essential knowledge for
the assessment of the patient presenting with a compartment syndrome.

Flexor digitorumlongus (FDL) is in the second plantar layer of the foot and enters the
sole on the medial side of the tendon of flexor hallucislongus (FHL), it divides into
four tendons as it crosses superficial to the FHL tendon.The four tendons pass
forward on the sole deep to those of flexor digitorumbrevis (FDB) and after giving off
the lumbricals they enter the fibrous sheaths of the lateral four toes. Each tendon
perforates the tendon of FDB and inserts into the base of the distal phalanx. Its
function is to flex the lateral four toes in any position of the ankle joint. FDB is
supplied by the medial plantar nerve.

Abductor hallucis arises from the medial process of the calcaneus and from the flexor
retinaculum. It runs along the medial border of the foot before inserting into the
medial side of the base of the proximal phalanx of the great toe, Its function is to
abduct the great toe. Its nerve supply is the medial plantar nerve.

The deep peroneal nerve runs through the anterior compartment of the leg and
supplies sensation to the first web space.

Answers: D, D, B

Question 29

The nerve supplying teres minor is a branch of which nerve?

Suprascapular nerve (C5,C6)

Lower subscapular nerve (C5,C6)

Upper subscapular nerve (C5,C6)

Axillary nerve (C5,C6)

Medial supraclavicular nerve (C3,C4)

The nerve supplying teres minor originates from the posterior branch of
axillary nerve

Question 30

The rectus femoris is innervated by which one of the following?

Anterior division of the femoral nerve

Posterior division of the femoral nerve

Anterior division of the obturator nerve

Posterior division of the obturator nerve

Muscular branch of the sciatic nerve

Question 31
The following muscles are innervated by:

A : Anterior interosseous nerve

B : Median nerve

C : Posterior interosseous nerve

D : Radial nerve

E : Superficial radial nerve

F : Ulnar nerve

G : Axillary nerve

H : Upper subscapular nerve

I : Lower suscapular nerve

1 : Extensor Carpi ulnaris

Correct answer:C

2 : Triceps

Correct answer: D

3 :Interossei of the hand

Correct answer: F

4 : Pronator quadratus

Correct answer: A

Question 32

The rotator cuff is a group of muscles which originate from the scapula and stabilises
the shoulder. It consists of supraspinatus, infraspinatus, teres minor and subscapularis.
Which nerve supplies the teres minor?
1. Axillary nerve
2. Lower subscapular
3. Suprascapular
4. Thoracodorsal
5. Upper subscapular
Question 33

What structure is deep to the semitendinosis at the level of the knee joint
1. Gracilis
2. Iliotibial tract
3. Pesanserinus bursa
4. Sartorius
5. Semimembranosus

Question 34

What is the most lateral structure in the superior portion of the popliteal fossa?
1. Common peroneal nerve
2. Long saphenous vein
3. Popliteal vein
4. Short saphenous vein
5. Tibial nerve

Question 35

Injury to which nerve can commonly lead to paraesthesia lateral to a midline incision
over the knee?
1. Lateral sural cutaneous nerve
2. Common peroneal nerve
3. Obturator nerve
4. Lateral cutaneous nerve of the thigh
5. Infrapatellar branch of the saphenous nerve

Question 36

Which ONE of the following muscles is supplied by the FIRST branch of the lateral
plantar nerve?
1- Abductor digitiminimi
2- Abductor hallucis
3- Adductor hallucis
4- First lumbrical
5- Flexor hallucisbrevis
Question 37

Which ONE of the following tendons lies in the groove on the plantar surface of the
cuboid?

1. Flexor digitorumlongus
2. Peroneus tertius
3. Peroneus brevis
4. Peroneus longus
5. Tibialis posterior

Question 38

In the Smith-Peterson approach to the hip the superficial dissection exploits the
internervous plane between sartorius and tensor fasciae latae. Tensor fasciae latae is
innervated by?

1. Femoral nerve
2. Inferior gluteal Nerve
3. Lateral femoral cutaneous nerve
4. Sciatic nerve
5. Superior gluteal nerve

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Regarding the muscles of the rotator cuff, which of the following is correctly matched to its
innervation?

Question Correct Answer

Supraspinatus – Axillary nerve Incorrect

Infraspinatus – Infrascapular nerve Incorrect

Teres minor – Axillary nerve Correct

Question Correct Answer

Subscapularis – Medial and lateral pectoral nerves Incorrect

Teres major – Infrascapular and subscapular nerve Incorrect

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The medial circumflex femoral artery is a direct branch of which artery?

Question Correct Answer

Femoral artery Incorrect

External iliac artery Incorrect

Internal iliac artery Incorrect

Profundafemoris artery Correct

Common femoral artery Incorrect

The major blood supply to the femoral head in the adult is derived from the medial and lateral
circumflex arteries (medial is more important). These arise from the profunda femoris artery
which in turn arises from the femoral artery

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Which of the following muscles is situated in the anterior compartment of the thigh and
innervated by the femoral nerve?

Question Correct Answer

Gracillis Incorrect

Tensor fascia lata Incorrect

Vastus medialis Correct

Adductor longus Incorrect

Semi-membranosus Incorrect

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patient presents with a complete transection of the posterior cord of the brachial plexus after a
stabbing incident. This injury would affect all of the following muscles EXCEPT:

Question Correct Answer

Teres major Incorrect

Deltoid Incorrect

Subscapularis Incorrect

Triceps Incorrect

Supraspinatus Correct

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Select the artery from which each of these is a direct branch.

Correct Answer

Artery of the ligamentum teres

Obturator artery

Correct Answer

Anterior part of extra capsular arterial ring

Lateral femoral circumflex artery

Correct Answer

Superior gluteal artery

Internal iliac artery

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Select the correct anatomical compartment in which you would find the following anatomical
structures.

Correct Answer

The location of peroneus tertius

Antero-lateral compartment of the lower leg

Correct Answer

The nerve which supplies peroneus longus

Peroneal compartment of the lower leg

Correct Answer

The nerve which supplies gastrocnemius

Deep posterior compartment of the lower leg

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With regard to the anatomy of the upper limb, match each stem to

its most appropriate answer.

Correct Answer

Adductor pollicis
The deep branch of the radial artery passes
between the two heads of which muscle?
Your Answer

Adductor pollicis

Correct Answer

Anconeus

This muscle is supplied by the radial nerve

Your Answer

Anconeus

Correct Answer

Clinical examination of this muscle may help

distinguish between a proximal and distal Flexor digitorum profundus
ulnar nerve lesion

Your Answer
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Regarding innervation of structures around the knee please select the most appropriate
response for the following

Correct Answer

Tibial nerve

Popliteus is innervated by

Your Answer

Tibial nerve

Correct Answer

Infra patella branch of saphenous nerve

Cutaneous anaesthesia on the lateral aspect
of the knee following TKR is most likely due
to division of
Your Answer

Infra patella branch of saphenous nerve

Correct Answer

Superficial branch of femoral nerve

Sartorius is innervated by

Your Answer

Superficial branch of femoral nerve

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