Upper Limb

Question 1

16. The following part or branch of the brachial plexus receives contributions from the C8 spinal nerve.
A. Lateral cord
B. Lateral pectoral nerve
C. Posterior cord
D. Nerve to the rhomboid muscles
E. Suprascapular nerve
F. Nerve to subclavius muscle

Answer 1

C

Question 2

17. The following part or branch of the brachial plexus has a terminal branch that supplies the skin on the medial side of the arm.
A. Musculocutaneous nerve
B. Lateralcord
C. Thoracodorsal nerve
D. Medialcord
E. Upper subscapular nerve
F. Ulnar nerve

Answer 2

D. The medial cord of the brachial plexus gives origin to the medial cutaneous nerve of the arm.

Question 3

18.
The following part of the brachial plexus is formed from the anterior divisions of two trunks.
A. Lateralcord
B. Posterior cord
C. Median nerve
D. Medialcord
E. Lowertrunk
F. None of the above

Answer 3

A

Question 4

19. The following part of the brachial plexus has branches that supply the extensor muscles of the arm.
    A. Lateralcord
    B. Medialcord
    C. Posterior cord
    D. Thoracodorsal nerve
    E. Lateral and medial cords F. None of the above

Answer 4

C. The biceps brachii is a powerful supinator of the superior and inferior radioulnar joints

Question 5

20. During its course in the upper limb, the axillary nerve lies
    A. in front of the lateral epicondyle of the humerus.
    B. against the spiral groove of the humerus.
    C. medial to the brachial artery in the cubital fossa.
    D. against the surgical neck of the humerus.
    E. behind the medial epicondyle of the humerus.
    F. in front of the medial epicondyle of the humerus.

Answer 5

D

Question 6

21. During its course in the upper limb, the ulnar nerve lies
    A. in front of the lateral epicondyle of the humerus.
    B. behind the flexor retinaculum of the wrist.
    C. against the spiral groove of the humerus.
    D. medial to the brachial artery in the cubital fossa.
    E. against the surgical neck of the humerus.
    F. behind the medial epicondyle of the humerus.

Answer 6

F

Question 7

22. During its course in the upper limb, the median nerve lies
    A. anterior to the flexor retinaculum of the wrist.
    B. in front of the lateral epicondyle of the humerus.
    C. against the spiral groove of the humerus.
    D. against the surgical neck of the humerus.
    E. within the quadrangular muscle space.
    F. medial to the brachial artery in the cubital fossa.

Answer 7

F

Question 8

23. During its course in the upper limb the radial nerve lies
    A. against the spiral groove of the humerus.
    B. in front of the medial epicondyle of the humerus.
    C. behind the flexor retinaculum of the wrist.
    D. medial to the brachial artery in the cubital fossa.
    E. against the surgical neck of the humerus.
    F. behind the medial epicondyle of the humerus.

Answer 8

A

Question 9

24. The extensor carpi radialis brevis muscle is innervated by the
A. radial nerve.
B. ulnar nerve.
C. superficial radial nerve.
D. deep branch of the radial nerve.
E. deep branch of the ulnar nerve. 
F. None of the above.

Answer 9

D

Question 10

25. The dorsal interossei muscles are innervated by the
    A. deep branch of the radial nerve.
    B. deep branch of the ulnar nerve.
    C. musculocutaneous nerve.
    D. superficial branch of the ulnar nerve.
    E. median nerve.
    F. recurrent branch of the median nerve.

Answer 10

B

Question 11

26. The extensor indicis muscle is innervated by the
A. radial nerve.
B. ulnar nerve.
C. median nerve.
D. deep branch of the radial nerve.
E. deep branch of the ulnar nerve.
F. musculocutaneous nerve.

Answer 11

D

Question 12

27. The extensor carpi ulnaris muscle is innervated by the
    A. median nerve.
    B. deep branch of the ulnar nerve.
    C. ulnar nerve.
    D. radial nerve.
    E. deep branch of the radial nerve.
    F. superficial branch of the ulnar nerve.

Answer 12

E

Question 13

28. The extensor carpi radialis longus muscle is innervated by the
A. deep branch of the ulnar nerve.
B. ulnar nerve.
C. radial nerve.
D. median nerve.
E. anterior interosseous nerve.
F. musculocutaneous nerve.

Answer 13

C

Question 14

29. A shoulder separation that involves the lateral end of the clavicle sliding onto the superior aspect of the acromion would most likely result from damage to the
A. costoclavicular ligament.
B. sternoclavicular ligament.
C. coracoclavicular ligament.
D. glenohumeral ligament.
E. coracoacromial ligament

Answer 14

C

Question 15

30. The muscle that will compensate in part for the paralysis of the supinator muscle is the
A. extensor carpi ulnaris muscle.
B. brachialis muscle.
C. triceps brachii muscle.
D. biceps brachii muscle.
E. anconeus muscle.

Answer 15

D. The biceps brachii is a powerful supinator of the superior and inferior radioulnar joints.

Question 16

31. The synovial sheath of the flexor pollicis longus muscle forms the
    A. thenar space.
    B. radial bursa of the wrist.
    C. midpalmar space.
    D. ulnar bursa of the wrist.
    E. digital synovial sheath for the index finger.

Answer 16

B

Question 17

32. To test for trapezius muscle paralysis, you would ask the patient to
    A. flex the arm fully.
    B. adduct the arm against resistance.
    C. push against the wall with both hands. D. shrug the shoulder.
    E. abduct the arm fully.

Answer 17

D. The upper fibers of the trapezius muscle elevate the scapula and the shoulder, as in shrugging the shoulder.

Question 18

33. The lymph from the medial quadrants of the breast drain mainly into the
    A. posterior axillary (subscapular) nodes.
    B. internal thoracic nodes.
    C. anterior axillary (pectoral) nodes.
    D. lateral axillary (brachial) nodes.
    E. infraclavicular (deltopectoral) nodes.

Answer 18

B. The internal thoracic nodes lie within the thoracic cavity along the internal thoracic artery.

Question 19

34. Cutting the dorsal scapular nerve would most likely result in paralysis of the
    A. supraspinatus muscle.
    B. deltoid muscle.
    C. rhomboid major muscle. D. trapezius muscle.
    E. infraspinatus muscle.

Answer 19

C

Question 20

35. After injury to a nerve at the wrist, the thumb is laterally rotated and adducted. The hand looks flattened and apelike. The nerve that has been damaged is the
    A. anterior interosseous nerve.
    B. ulnar nerve.
    C. deep branch of the radial nerve.
    D. median nerve.
    E. superficial branch of the radial nerve.

Answer 20

D. The muscles of the thenar eminence are innervated by the recurrent branch of the median nerve. A lesion of the median nerve causes these muscles to atrophy and the eminence to flatten. The adductor pollicis muscle is supplied by the deep branch of the ulnar nerve, and adduction of the thumb is unopposed.

Question 21

36. The dermatome present over the lateral side of the wrist is
A. C8.
B. C6.
C. T1.
D. T2.
E. C5.

Answer 21

B. A dermatome is an area of skin supplied by a single segment of the spinal cord.

Question 22

37. The following statements concerning the blood vessels of the upper limb are correct except which?
    A. The pulsation of the radial artery are felt anterior to the distal third of the radius between the tendons of the brachioradialis and the flexor carpi radialis.
    B. The axillary vein is formed by the union of the venae comitantes of the brachial artery and the basilic vein.
    C. The cephalic vein arises on the palm of the hand.
    D. The axillary sheath surrounds the axillary vessels
    and the brachial plexus.
    E. The cephalic vein drains into the axillary vein.

Answer 22

C. The cephalic vein arises on the dorsum of the hand.

Question 23

38. At the wrist, the flexor retinaculum is attached to the following bones except which?
A. Thehookofthehamate
B. The ridge on the trapezium
C. The pisiform bone
D. The tubercle of the scaphoid
E. The triquetral bone

Answer 23

E.

Question 24

39. The following statements concerning the shoulder joint are correct except which?
    A. The inferior part of the capsule is the weakest.
    B. The subacromial bursa communicates with the joint cavity.
    C. The strength of the joint depends largely on the tone of the surrounding muscles.
    D. Dislocation of the shoulder joint is common.
    E. The axillary artery lies in front of the shoulder joint.

Answer 24

B. The subacromial bursa never communicates with the shoulder joint. The bursa that commonly communicates with the joint is the subscapularis bursa.

Question 25

40. The following statements concerning the lymphatic drainage of the upper limb are correct except which?
    A. Lymph from an infected nail bed of the little finger drains into the supratrochlear lymph node.
    B. Lymph from infected cut of the index finger drains into the infraclavicular nodes.
    C. Lymph from an infected graze over the medial side of the elbow joint drains into the anterior (pectoral) group of axillary nodes.
    D. Lymph from the upper lateral quadrant of the
    breast drains into the anterior (pectoral) group of axillary nodes.
    E. Lymph from a boil on the back over the inferior angle of the scapula drains into the posterior (sub- scapular) nodes.

Answer 25

C. The lymphatic drainage of the skin on the medial side of the elbow ascends the upper limb in lymph vessels that accompany the basilic vein and drain into the medial group of axillary lymph nodes.

Question 26

41. The following structures pass superficial to the flexor retinaculum at the wrist except which?
    A. Palmar cutaneous branch of the median nerve
    B. Ulnar nerve
    C. Flexor pollicis longus tendon
    D. Ulnar artery
    E. Palmar cutaneous branch of the ulnar nerve

Answer 26

C. The flexor pollicis longus tendon passes into the palm beneath the lateral part of the flexor retinaculum.

Question 27

42. Collateral circulation around the shoulder joint would involve the following except which?
    A. The subscapular artery
    B. The superficial cervical artery
    C. The suprascapular artery
    D. The anterior circumflex humeral artery
    E. The lateral thoracic artery

Answer 27

E

Question 28

43. The proximal row of carpal bones includes all the fol- lowing carpal bones except which?
A. The pisiform
B. The capitate
C. The lunate
D. The triquetral
E. The scaphoid

Answer 28

B

Question 29

44. Regarding a “winged scapula,” the following facts are correct except which?
    A. The spinal part of the accessory nerve is damaged.
    B. The inferior angle of the scapula projects
    backward.
    C. The serratus anterior muscle may be wasted.
    D. The long thoracic nerve is damaged.
    E. The scapula can no longer be pulled anteriorly around the chest wall (as in thrusting the upper limb anteriorly when reaching).

Answer 29

A. The spinal part of the accessory nerve supplies the sternocleidomastoid and the trapezius muscles.

Question 30

45. The following statements concerning the rotator cuff are correct except which?
    A. It adds stability to the shoulder joint.
    B. It is formed by the tendons of the short muscles around the shoulder joint.
    C. The muscle tendons are fused to the capsule of the shoulder joint.
    D. Degeneration or tearing of the cuff will cause severe pain in the shoulder region.
    E. All the muscle tendons associated with the cuff are innervated by the suprascapular nerve.

Answer 30

E. The rotator cuff is formed by the tendons of the short muscles that cover the anterior, the superior, and the posterior surfaces of the shoulder joint. These muscles are the subscapularis muscle, supplied by the upper and lower subscapular nerves; the supraspinatus muscle, supplied by the suprascapular nerve; the infraspinatus muscle, supplied by the suprascapular nerve; and the teres minor muscle supplied by the axillary nerve.

Question 31

46. The quadrangular space in the region of the shoulder transmits the following structures except which?
    A. The axillary nerve
    B. The posterior circumflex humeral artery
    C. The lymphatic vessels
    D. The radial nerve
    E. The posterior circumflex humeral vein

Answer 31

D

Question 32

47. The following statements concerning the lateral cord of the brachial plexus are true except which?
    A. It contains sympathetic nerve fibers
    B. It has a branch that supplies the pectoralis major muscle
    C. It has a branch that supplies the skin on the lateral
    side of the forearm
    D. It has a branch that supplies the skin on the lateral
    side of the upper arm
    E. It lies lateral to the second part of the axillary artery

Answer 32

D. The skin on the lateral side of the upper arm covering the upper half of the deltoid muscle is innervated by the supraclavicular nerves (C3 and 4), and the skin covering the lower half of the deltoid muscle is innervated by the upper lateral cuta- neous nerve of the arm (C5 and 6) from the axil- lary nerve.

Question 33

48. An examination of a patient with carpal tunnel syn- drome may reveal all the following symptoms and signs except which?
    A. Atrophy of the muscles of the thenar eminence
    B. Weakness in opposition of the thumb
    C. Loss of skin sensation on the medial part of the
    palm
    D. Loss of skin sensation on the anterior surface of the index finger
    E. Normal skin sensation on the anterior surface of the little finger

Answer 33

C. Carpal tunnel syndrome results from compression of the median nerve as it passes beneath the flexor retinaculum. The median nerve innervates the op- ponens pollicis muscle, and it gives off digital nerves to the lateral three and a half fingers on the palmar aspect. The muscles of the hypothenar eminence are supplied by the deep branch of the ulnar nerve. The skin of the medial part of the palm is supplied by the palmar cutaneous branch of the ulnar nerve.

Question 34

49. The following movements are expected to be normal after a complete section of the medial cord of the brachial plexus except which?
    A. Extension of the wrist
    B. Flexion of the elbow
    C. Abduction of the shoulder joint
    D. Metacarpophalangeal flexion and interphalangeal
    extension of the medial four fingers
    E. Metacarpophalangeal flexion and interphalangeal
    extension of the thumb

Answer 34

D. Flexion of the metacarpophalangeal joints is produced by the flexor digitorum superficialis, the flexor digitorum profundus, and the lumbricals and interossei muscles, all of which receive nerve fibers from the medial cord via the median and the ulnar nerves. The interphalangeal joints are extended by the lumbricals and the interos- sei muscles, which are assisted by the extensor digitorum. The lumbricals and the interossei are innervated by the median and the ulnar nerves, which have many nerve fibers that originate in the medial cord of the brachial plexus.

Question 35

50. The following statements regarding the sympathetic innervation of the upper limb are correct except which?
    A. There are preganglionic nerve fibers originating in
    spinal cord segments T2 to 8.
    B. It causes vasoconstriction of the arteries and veins
    of the skin.
    C. There are preganglionic nerve fibers synapsing in
    the middle cervical, the inferior cervical, and the first thoracic ganglia.
    D. Many of the postganglionic fibers are distributed within the branches of the brachial plexus.
    E. The sympathetic nerves do not innervate the sweat glands.

Answer 35

E. The sweat glands of the upper limb are innervated by sympathetic postganglionic nerve fibers.

Question 36

51. During an automobile accident, a patient fractured the neck of her right radius and damaged a closely related nerve. At physical examination, the patient exhibited the following except which?
    A. Weakness in extending the terminal phalanx of the thumb.
    B. A loss of skin sensation on the lateral part of the dorsum of the hand.
    C. An inability to extend the metacarpophalangeal joint of the index finger.
    D. A normal ability to adduct the thumb at the car- pometacarpal joint.
    E. Normal skin sensation down the medial border of the hand.

Answer 36

B. The deep branch of the radial nerve lies within the supinator muscle and is closely related to the neck of the radius. The extensor pollicis longus and extensor digitorum muscles are innervated by the deep branch of the radial nerve. The sensory nerve supply of the skin on the lateral side of the dorsum of the hand is the superficial branch of the radial nerve.

Question 37

52. Diminished sweating and increased warmth and vasodilation of the skin vessels over the hypothenar eminence as well as the ring and the little fingers could result from the following except which?
    A. A lesion of the posterior cord of the brachial plexus.
    B. Ulnar nerve damage behind the medial epicondyle of the humerus.
    C. A lesion of the medial cord of the brachial plexus.
    D. A lesion of the eighth cervical nerve.
    E. Ulnar nerve damage over the front of the wrist

Answer 37

A. The sweat glands and the blood vessels of the skin over the hypothenar eminence and the palmar surface of the medial one and a half fingers are innervated by sympathetic postganglionic nerve fibers. These fibers travel in the eighth cervical and first thoracic spinal nerves, the medial cord of the brachial plexus, and the ulnar nerve and its palmar cutaneous and digital branches.

Question 38

A 14-year-old boy fell off a wall and fractured his right humerus at midshaft. The wrist joint immediately assumed a flexed position that the patient was unable to correct. Extension and supination of the forearm was weakened but not abolished, and skin sensation over the lateral side of the dorsum of the hand was diminished.

53. Which damaged peripheral nerve could account for these symptoms and signs?
A. The ulnar nerve 
B. The median nerve 
C. The radial nerve 
D. The axillary nerve
E. The musculocutaneous nerve

Answer 38

C. The radial nerve was damaged in the spiral groove on the posterior surface of the shaft of the humerus.
The supraspi

Question 39

On examination of a 53 y/o woman, it was
found that she could abduct her left shoulder to only a 15° position. She told her physician that 10 years ago she had fallen on ice outside her front door and had dislocated her left shoulder joint. It was noted that the head of the humerus was in its normal position relative to the scapula on the left side. Her left shoulder when compared with the right shoulder, however, showed flattening and had lost most of the normal curvature.

54.  Which of the following muscles was likely to have been paralyzed by the dislocation of the shoulder joint 10 years ago?
A. The rhomboid minor B. The deltoid
D. The supraspinatus 
E. The teres minor
F. The subscapularis

Answer 39

B. The supraspinatus muscle is mainly responsible for approximately the first 15° of abduction by the shoulder joint. From approximately 15° to 90°, the deltoid muscle is largely responsible. Remember that for someone to raise an arm above 90°, the scapula needs to rotate, thus involving contraction of the trapezius and the serratus anterior muscles.

Question 40

An 19 Y/O girl was seen in the emergency
department and found to have a knife wound to the front of her left wrist. A careful examination revealed that two superficial tendons on either side of the median nerve had been severed.

55. Which of the following tendons were likely to have been cut?
    A. The flexor pollicis longus and the pronator quadratus tendons
    B. The flexor carpi ulnaris and the flexor digitorum profundus tendons
    C. The flexor digitorum superficialis and the flexor carpi radialis tendons
    D. The brachioradialis and the pronator teres tendons
    E. The abductor pollicis longus and the extensor pollicis brevis tendons

Answer 40

C

Question 41

A 17-year-old girl was thrown from her horse while attempting a difficult jump. She landed on her right shoulder and the right side of her head. It was noticed after a week of hospitalization that she kept her right arm medially rotated and close to her side with the forearm pronated. At physical examination, an area of anesthesia was found along the lateral side of the upper part of the arm.

56. Which of the following was damaged during the accident?
    A. The lower trunk of the brachial plexus
    B. The axillary nerve
    C. The radial nerve
    D. The middle trunk of the brachial plexus
    E. The C5 and C6 roots of the brachial plexus

Answer 41

E

Question 42

57. The position adopted by the right arm in this patient can be explained by paralysis of which of the following groups of muscles?
    A. Supraspinatus, deltoid, biceps brachii, greater part of brachialis, infraspinatus, and teres minor
    B. Latissimus dorsi, triceps, anconeus, brachioradialis, and supinator
    C. Flexor digitorum superficialis, flexor pollicis longus, flexor carpi radialis longus, and flexor
    carpi ulnaris
    D. Extensor carpi ulnaris, supinator, extensor indicis, and extensor digiti minimi
    E. Pectoralis major, abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus

Answer 42

A.
This patient has a right-sided Erb-Duchenne palsy—that is, a lesion of the fifth and the sixth roots of the brachial plexus. The suprascapular nerve, the nerve to subclavius, and the musculo- cutaneous and axillary nerves all possess nerve fibers derived from C5 and C6 roots and therefore will be functionless. Consequently, the following muscles are paralyzed: The supraspinatus (abduc- tor of shoulder), the subclavius, the biceps brachii (flexor of elbow and strong supinator of forearm), the greater part of the brachialis and coraco- brachialis, and the deltoid (abductor of shoulder), and the teres minor (lateral rotator of shoulder). The right upper limb will hang limply by the side (adducted) and be rotated medially by the unop- posed sternocostal part of the pectoralis major; the forearm will be pronated through loss of the action of the biceps. The position of the upper limb in this condition has been likened to that of a waiter hint- ing for a tip. In addition, there will be loss of sensa- tion down the lateral side of the right arm.

Question 43

A 30-year-old plasterer was finishing a difficult ceiling in a remodeled kitchen. He was standing on top of a stepladder with his right arm above his head. As he used his right hand to move the trowel, loaded with plaster, across the ceiling, he suddenly felt an acute spasm of pain over the tip of the right shoulder. At physical examination of the patient in the emergency department, it was found that the pain in the right shoulder recurred in the middle range of abduction and that there was extreme tenderness over the greater tuberosity of the humerus.

58. What is the most likely structural damage in this patient?
    A. Fracture of the upper end of the humerus
    B. Tearing of the deltoid muscle
    C. Fracture of the acromion
    D. Lesion of the rotator cuff
    E. Tearing of the trapezius muscle

Answer 43

D. This patient has supraspinatus tendinitis. During the middle range of abduction, the tendon of the supraspinatus impinges against the outer border of the acromion. Normally, the large subacromial bursa intervenes and ensures that the movement is painless and relatively free of friction. In this condition, however, the bursa has degenerated, and the supraspinatus tendon exhibits a localized area of degeneration.