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1. What are the two main systems of veins in the lower limb?
→ The superficial system (in superficial fascia) and the deep system (accompanying arteries). They communicate via perforating veins.
2. What are the main superficial veins of the lower limb?
→ Long (great) saphenous vein and short (small) saphenous vein.
3. What is the course of the long saphenous vein?
→ Begins at the medial end of the dorsal venous arch, passes anterior to the medial malleolus, ascends along the medial side of leg and thigh, and drains into the femoral vein through the saphenous opening.
4. What is the course of the short saphenous vein?
→ Begins at the lateral end of the dorsal venous arch, passes behind the lateral malleolus, ascends along the back of the leg, and drains into the popliteal vein.
5. Which vein is commonly used for coronary artery bypass grafting (CABG)?
→ Long (great) saphenous vein — due to its length, accessibility, and wall thickness.
6. What is the direction of venous flow in perforating veins?
→ From superficial → deep veins only, due to the presence of valves.
7. What are the major named perforating veins of the leg?
→ Cockett’s (lower leg), Boyd’s (upper leg), and Dodd’s (thigh).
8. What is a varicose vein?
→ A dilated, tortuous vein due to valvular incompetence in superficial or perforating veins.
9. Where are venous ulcers commonly seen?
→ Just above the medial malleolus due to chronic venous stasis.
10. What is a saphenous varix?
→ Localized dilatation of the terminal part of long saphenous vein at the saphenous opening, often confused with a femoral hernia.
11. What are the factors aiding venous return from the lower limb?
→ Muscle pump, venous valves, deep fascia compression, arterial pulsation, and respiratory suction.
12. What is deep vein thrombosis (DVT)?
→ Thrombus formation in deep veins (usually in calf veins) due to stasis or hypercoagulability, with risk of pulmonary embolism.
13. What are the groups of inguinal lymph nodes?
→ Superficial (horizontal and vertical) and deep groups.
14. What does the horizontal group of superficial inguinal lymph nodes drain?
→ Lower anterior abdominal wall, gluteal region, perineum, and external genitalia (except testis).
15. What does the vertical group of superficial inguinal lymph nodes drain?
→ Superficial lymphatics from the lower limb via the long saphenous vein.
16. What is the node of Cloquet (Rosenmüller)?
→ The highest deep inguinal lymph node, located in the femoral canal beneath the inguinal ligament.
17. Where does the lymph from the lateral side of foot drain first?
→ Into popliteal lymph nodes, then to deep inguinal nodes.
18. What is the lymphatic drainage of the glans penis or clitoris?
→ Directly into deep inguinal lymph nodes.
19. What is the clinical significance of lymphadenopathy in the groin?
→ Indicates infection or malignancy in the lower limb, perineum, or external genitalia.
20. What are the sympathetic functions in the lower limb?
→ Vasomotor (vessel tone), sudomotor (sweat secretion), and pilomotor (hair erection).
21. What is the spinal origin of sympathetic fibers to the lower limb?
→ T10–L2 spinal segments.
22. What are the effects of lumbar sympathectomy?
→ Warm, dry skin due to loss of vasomotor and sudomotor tone.
23. What is the dermatome of the great toe?
→ L4.
24. What is the dermatome of the little toe?
→ S1.
25. Which nerve root is tested by the knee jerk reflex?
→ L3–L4.
26. Which nerve root is tested by the ankle jerk reflex?
→ S1–S2.
27. Which nerve root is responsible for dorsiflexion of the foot?
→ L4–L5 (Tibialis anterior).
28. Which nerve root is responsible for plantar flexion?
→ S1–S2 (Gastrocnemius, Soleus).
29. Why are dermatomes of the lower limb spiral in arrangement?
→ Due to medial rotation of the limb buds during embryonic development.
30. What is the difference in rotation between upper and lower limbs during development?
→ Upper limb rotates laterally, lower limb rotates medially.
31. What is the preaxial and postaxial border of the lower limb?
→ Preaxial: Medial (great toe side); Postaxial: Lateral (little toe side).
32. What are the main differences between upper and lower limbs?
→ Upper limb is for mobility and manipulation, lower limb for support and locomotion.
33. What is the commonest nerve lesion of lower limb?
→ Common peroneal nerve injury, producing foot drop.
34. What are the spinal segments for plantar reflex?
→ L5–S1.
35. What are the spinal segments for anal reflex?
→ S3–S5.
36. What is saddle anesthesia?
→ Loss of sensation over perineum (S3–S5 dermatomes) → seen in cauda equina syndrome.
37. Which reflex tests corticospinal tract integrity?
→ Plantar reflex — Babinski’s sign indicates upper motor neuron lesion.
38. What does the term "musculovenous pump" mean?
→ Calf muscle contraction squeezes deep veins, forcing blood upward — aided by valves preventing backflow.
39. Why is the long saphenous vein prone to varicosity?
→ Because it runs a long superficial course and has multiple tributaries with valves that can become incompetent.
40. Why is the foot often swollen in lymphatic obstruction?
→ The tight deep fascia of leg restricts upward lymph flow, leading to distal accumulation.
1. The long (great) saphenous vein begins at:
A. Lateral end of dorsal venous arch
B. Medial end of dorsal venous arch
C. Behind lateral malleolus
D. Popliteal fossa
→ Answer: B
2. The short (small) saphenous vein ends in:
A. Femoral vein
B. External iliac vein
C. Popliteal vein
D. Posterior tibial vein
→ Answer: C
3. The long saphenous vein passes:
A. Behind the medial malleolus
B. Anterior to the medial malleolus
C. Behind the lateral malleolus
D. Between tibia and fibula
→ Answer: B
4. The short saphenous vein passes:
A. In front of lateral malleolus
B. Behind lateral malleolus
C. In front of medial malleolus
D. Behind medial malleolus
→ Answer: B
5. The vein commonly used for coronary artery bypass grafting (CABG) is:
A. Short saphenous vein
B. Long saphenous vein
C. Popliteal vein
D. Femoral vein
→ Answer: B
6. Perforating veins connect:
A. Arteries and veins
B. Deep veins and superficial veins
C. Lymphatics and veins
D. Deep arteries and superficial arteries
→ Answer: B
7. Valves in veins of lower limb prevent:
A. Backward flow of blood
B. Venous collapse
C. Arterial reflux
D. Varicose ulcers
→ Answer: A
8. In varicose veins, the most common site is:
A. Short saphenous vein
B. Long saphenous vein and its tributaries
C. Deep femoral vein
D. Perforators only
→ Answer: B
9. Cockett’s perforators are located in:
A. Thigh
B. Upper leg
C. Lower leg near ankle
D. Groin
→ Answer: C
10. The saphenous varix is:
A. Dilatation of popliteal vein
B. Dilatation of terminal part of long saphenous vein
C. Dilatation of femoral vein
D. Dilatation of deep vein
→ Answer: B
11. The node of Cloquet is located in:
A. Popliteal fossa
B. Cribriform fascia
C. Femoral canal
D. Saphenous opening
→ Answer: C
12. Lymph from the lateral side of foot drains first into:
A. Superficial inguinal nodes
B. Deep inguinal nodes
C. Popliteal nodes
D. External iliac nodes
→ Answer: C
13. Lymph from glans penis drains into:
A. Superficial inguinal nodes
B. Deep inguinal nodes
C. External iliac nodes
D. Lumbar nodes
→ Answer: B
14. Superficial inguinal lymph nodes receive lymph from all except:
A. Lower abdominal wall
B. Perineum
C. Testis
D. External genitalia
→ Answer: C
15. Popliteal lymph nodes drain into:
A. Superficial inguinal nodes
B. Deep inguinal nodes
C. External iliac nodes
D. Common iliac nodes
→ Answer: B
16. Sympathetic supply to lower limb arises from:
A. T1–T5
B. T6–T9
C. T10–L2
D. L3–S2
→ Answer: C
17. Which of the following functions is not sympathetic?
A. Vasomotor
B. Sudomotor
C. Pilomotor
D. Voluntary movement
→ Answer: D
18. The dermatome of the great toe corresponds to:
A. L3
B. L4
C. L5
D. S1
→ Answer: B
19. The dermatome of the little toe corresponds to:
A. L3
B. L4
C. L5
D. S1
→ Answer: D
20. Dorsiflexion of foot tests which spinal segment?
A. L2
B. L3
C. L4–L5
D. S1
→ Answer: C
21. Plantar flexion of foot depends mainly on:
A. L2–L3
B. L3–L4
C. L4–L5
D. S1–S2
→ Answer: D
22. Knee jerk reflex tests integrity of:
A. L2–L3
B. L3–L4
C. L5–S1
D. S1–S2
→ Answer: B
23. Absence of ankle jerk indicates lesion at:
A. L3–L4
B. L5–S1
C. S1–S2
D. T12–L1
→ Answer: C
24. Plantar reflex is mediated through:
A. L2–L3
B. L3–L4
C. L5–S1
D. S2–S4
→ Answer: C
25. Babinski sign indicates:
A. Lower motor neuron lesion
B. Sensory loss
C. Upper motor neuron lesion
D. Peripheral neuropathy
→ Answer: C
26. Dermatomes of the lower limb are arranged:
A. Longitudinally
B. Spirally
C. Horizontally
D. Randomly
→ Answer: B
27. The upper limb rotates _______ during development, while the lower limb rotates _______.
A. Laterally, medially
B. Medially, laterally
C. Anteriorly, posteriorly
D. Posteriorly, anteriorly
→ Answer: A
28. Preaxial border of the lower limb is:
A. Lateral
B. Medial
C. Posterior
D. Anterior
→ Answer: B
29. Postaxial border of the lower limb is:
A. Medial
B. Lateral
C. Posterior
D. Anterior
→ Answer: B
30. The most common nerve injury in the lower limb causing foot drop involves:
A. Tibial nerve
B. Common peroneal nerve
C. Femoral nerve
D. Obturator nerve
→ Answer: B
31. The arches of the foot are maintained by all except:
A. Plantar aponeurosis
B. Peroneus longus tendon
C. Adductor longus
D. Spring ligament
→ Answer: C
32. Functionally, the upper limb is specialized for:
A. Stability
B. Locomotion
C. Manipulation
D. Weight bearing
→ Answer: C
33. Functionally, the lower limb is specialized for:
A. Fine movement
B. Weight bearing
C. Grasping
D. Rotation
→ Answer: B
34. The commonest deformity after common peroneal nerve injury is:
A. Foot drop
B. Claw foot
C. Flat foot
D. Club foot
→ Answer: A
35. The reflex testing integrity of corticospinal tract is:
A. Knee jerk
B. Ankle jerk
C. Plantar reflex
D. Cremasteric reflex
→ Answer: C
36. The dermatome of the posterior thigh corresponds mainly to:
A. L4
B. L5
C. S1
D. S2
→ Answer: D
37. The lymph from testis drains into:
A. Superficial inguinal nodes
B. Deep inguinal nodes
C. Para-aortic (lumbar) nodes
D. Internal iliac nodes
→ Answer: C
38. The horizontal group of superficial inguinal nodes lies:
A. Below the inguinal ligament
B. Along femoral vein
C. Around saphenous opening
D. Over the adductor canal
→ Answer: A
39. The node receiving lymph from glans penis is:
A. Superficial inguinal
B. Deep inguinal
C. External iliac
D. Popliteal
→ Answer: B
40. Loss of vasomotor and sudomotor tone after sympathectomy leads to:
A. Pale, cold limb
B. Warm, dry limb
C. Blue, moist limb
D. Cold, cyanotic limb
→ Answer: B
1. What are the two systems of veins in the lower limb?
→ Superficial and deep venous systems, interconnected by perforating veins.
2. What is the function of perforating veins?
→ They connect superficial veins to deep veins and contain valves that allow flow only from superficial to deep.
3. Name the major superficial veins of the lower limb.
→ Long (great) saphenous vein and short (small) saphenous vein.
4. Where does the long saphenous vein terminate?
→ In the femoral vein at the saphenous opening.
5. Where does the short saphenous vein terminate?
→ In the popliteal vein in the popliteal fossa.
6. Which vein passes in front of the medial malleolus?
→ Long saphenous vein.
7. Which vein passes behind the lateral malleolus?
→ Short saphenous vein.
8. What are Cockett’s perforators?
→ Perforating veins connecting the posterior arch vein with posterior tibial veins in the lower leg.
9. What causes varicose veins?
→ Incompetence of venous valves, leading to reversal of blood flow and venous dilation.
10. Why are venous ulcers common near the medial malleolus?
→ Due to chronic venous stasis and poor tissue oxygenation in varicose veins.
11. What is a saphenous varix?
→ A localized dilation of the terminal part of the long saphenous vein at the saphenous opening.
12. What factors help venous return from the lower limb?
→ Muscle pump, venous valves, deep fascia compression, arterial pulsation, and respiratory movements.
13. What is the musculovenous pump?
→ Action of calf muscles compressing deep veins during walking, forcing blood upward toward the heart.
14. Which lymph nodes drain the superficial tissues of the lower limb?
→ Superficial inguinal lymph nodes.
15. Which lymph nodes drain the deep structures of the lower limb?
→ Deep inguinal lymph nodes.
16. Into which lymph nodes does the lateral side of foot drain first?
→ Popliteal lymph nodes.
17. Which is the highest deep inguinal lymph node?
→ Node of Cloquet (Rosenmüller) — located in the femoral canal.
18. What is the drainage of the glans penis or clitoris?
→ Directly into deep inguinal lymph nodes.
19. Lymph from the testis drains into which nodes?
→ Para-aortic (lumbar) lymph nodes.
20. What are the sympathetic root levels supplying the lower limb?
→ T10–L2.
21. What structures receive sympathetic supply in the lower limb?
→ Blood vessels, sweat glands, and arrector pili muscles.
22. What are the effects of lumbar sympathectomy?
→ Warm, dry limb due to loss of vasomotor and sudomotor tone.
23. What are the components of sympathetic function in the limb?
→ Vasomotor, sudomotor, and pilomotor.
24. Which dermatome corresponds to the medial side of leg and great toe?
→ L4.
25. Which dermatome corresponds to the lateral side of foot and little toe?
→ S1.
26. Which spinal segment controls dorsiflexion of the foot?
→ L4–L5.
27. Which spinal segment controls plantar flexion?
→ S1–S2.
28. What is the root value of knee jerk reflex?
→ L3–L4.
29. What is the root value of ankle jerk reflex?
→ S1–S2.
30. What is the root value of plantar reflex?
→ L5–S1.
31. What does a positive Babinski sign indicate?
→ Upper motor neuron lesion of the corticospinal tract.
32. Why are dermatomes of the lower limb spiral in arrangement?
→ Due to medial rotation of the limb buds during development.
33. Which border of the lower limb is preaxial and which is postaxial?
→ Preaxial: Medial (great toe side)
Postaxial: Lateral (little toe side)
34. How does the development of upper and lower limbs differ?
→ Upper limb rotates laterally, lower limb rotates medially.
35. What is the functional difference between upper and lower limbs?
→ Upper limb: Mobility and manipulation.
Lower limb: Support and locomotion.
36. Which muscle corresponds to the flexor digitorum superficialis of hand?
→ Flexor digitorum brevis of foot.
37. Which muscle corresponds to the flexor digitorum profundus of hand?
→ Flexor digitorum longus of foot.
38. Which deformity occurs after common peroneal nerve injury?
→ Foot drop.
39. Which deformity occurs after tibial nerve injury?
→ Calcaneovalgus deformity — loss of plantar flexion.
40. Which is the commonest site for varicose ulcer?
→ Above the medial malleolus.
41. What causes lymphoedema of the lower limb?
→ Obstruction of lymphatic drainage due to filariasis, surgery, or malignancy.
42. What is elephantiasis?
→ Gross thickening and enlargement of the limb due to chronic filarial lymphatic obstruction.
43. Which reflex tests the integrity of S3–S5 segments?
→ Anal reflex.
44. What is saddle anesthesia?
→ Loss of sensation over perineum (S3–S5 dermatomes), seen in cauda equina syndrome.
45. Which nerve lesion is tested by loss of dorsiflexion of the foot?
→ Common peroneal nerve lesion.
46. Which nerve lesion causes loss of plantar flexion?
→ Tibial nerve lesion.
47. What maintains the longitudinal arches of the foot?
→ Tibialis posterior, plantar aponeurosis, spring ligament, and flexor tendons.
48. What maintains the transverse arch of the foot?
→ Peroneus longus tendon, adductor hallucis (transverse head), and deep transverse metatarsal ligament.
49. What are the homologous arteries of the upper and lower limbs?
→ Brachial artery ↔ Femoral artery.
50. What are the homologous nerves of the upper and lower limbs?
→ Median nerve ↔ Medial plantar nerve; Ulnar nerve ↔ Lateral plantar nerve.
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