Exam 2 DB Q Flashcards by Amanda Pearman

Occlusion of the radial artery at the pronator quadratus muscle will:

a. Cause ischemia in the hand
b. Only slightly diminish blood flow in the hand (most comes from the ulnar artery)
c. Increase blood flow to the hand
d. Cause diminished flow in the deep palmar branch in the ulnar artery

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The pronator quadratus

a. Is innervated by the deep branch of the radial nerve
b. Is the only muscle that pronates the hand
c. Arises from the distal ¼ of the anterior ulnar shaft
d. Generates more force when the elbow is flexed

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The anterior interosseous artery

a. Is a branch of the radial artery
b. Distally pierces the interosseous membrane to join the dorsal carpal arch
c. Supplies blood to the posterior compartment in the forearm
d. Is the source of the deep palmar arch of the hand

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The nerves most at risk during carpal tunnel release procedure are:

a. The recurrent motor branches of the median
b. The ulnar nerve at the Guyon’s canal
c. The anterior interosseous nerve
d. The medial antibrachial nerve of the forearm

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What effect would radial nerve injury have on maximum grip strength?

a. Increase
b. Decrease
c. No effect
d. Decrease thumb strength but no effect on finger strength

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Laceration of the ulnar nerve just proximal to the Guyon canal would result in:

a. Loss of flexion at the distal interphalangeal joint
b. Loss of extension at the thumb
c. Loss of flexion at the metacarpophalangeal joint of the 2nd and 3rd digits
d. Loss of abduction of the digits
e. Loss of adduction of the digits

D & E

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Which muscle flexes the interphalangeal joints of the fingers

a. The flexor digitorum profundus
b. The flexor digitorum superficialis
c. Extensor digitorum
d. Flexor pollicis longus

A & B

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The initial complaint of someone suffering from median nerve compression in the carpal tunnel should be:

a. Weakness of wrist extension
b. Paresthesias of the thumb and index finger
c. Thenar wasting
d. Weakness of thumb adduction

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The contents of the carpal tunnel includes all of the following except:

a. Tendons of the flexor digitorum superficialis
b. Tendons of the flexor pollicis longus
c. The median nerve
d. All pass though the carpal tunnel

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Carpal tunnel syndrome is associated with all of the following except:

a. Thenar weakness
b. Dropping things
c. Pregnancy
d. Proximal palmar anesthesia

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The abductor pollicis longus:

a. Is innervated by the posterior interosseous nerve
b. Forms the lateral boundary of the anatomic “snuff box”
c. Abducts and laterally rotates the carpometacarpal joint
d. All of the above

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Which of the following muscles are involved in the abduction of the wrist?

a. Flexor carpi radialis
b. Flexor carpi ulnaris
c. Extensor carpi ulnaris
d. Extensor digiti minimi
e. Extensor carpi radialis

A & E

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In the hand, the ulnar nerve supplies:

a. The deep head of the flexor pollicis brevis
b. The adductor pollicis
c. The lumbricals to digits 4 and 5
d. All of the above

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Which muscle provides fibers to support the acromioclavicular joint?

a. Trapezius
b. Biceps brachii
c. Pectoral minor
d. Corachobrachialis

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The coracoclavicular ligament serves to:

a. Anchor the clavicle to the coracoid process
b. Prevent the acromion from being driven beneath the clavicle
c. Consists of horizontal and vertical ligaments
d. All of the above

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The coracoacromial arch serves to:

a. Prevent superior dislocation of the humeral head
b. Prevent inferior dislocation of the humeral head
c. Limit lateral rotation of the humerus
d. All of the above

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The coracoacromial arch consists of:

a. The acromion
b. The coracoacromial ligament
c. The coracoid process
d. All of the above

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Glenohumeral ligaments:

a. Are formed by folds of fibrous bands radiating from the glenoid labrum
b. Completely encase the glenohumeral joint capsule strengthening it in all directions
c. Result in an extremely strong inferior joint capsule
d. All of the above

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Which nerve is involved with innervation of the sternoclavicular joint?

a. Nerve to the subclavius
b. The axillary nerve
c. Lateral pectoral nerve
d. Medial pectoral nerve

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The law of Hilton states:

a. The vascular supply to a joint also supplies muscles proximal to the joint
b. Joints are innervated by the nerves to the muscles moving that joint
c. Joints are supplied by the nerves innervating muscles located only distal to that joint
d. If you are “hot” you can get paid to party

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Shoulder dislocations occur most often in which direction?

a. Superior
b. Inferior
c. Lateral
d. Distal

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Which structure plays a major role in force transmission from the hand to the humerus?

a. Subtendinous olecranon bursae
b. Interosseous membrane
c. Piso-hamate ligament
d. The sacciform recess of the proximal radioulnar joint
e. Scapho-radial articulation

B & E

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What structure limits wrist adduction?

a. Ulnar styloid process
b. Radial styloid process
c. Proximal radio-ulnar joint
d. Pisohamate ligament

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The costoclavicular ligament of the sternoclavicular joint joins the proximal clavicle to:

a. The manubrium
b. The 1st costal cartilage
c. The angle of the 1st rib
d. The body of the sternum

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The hook grip involves: a. Isolated engagement of the wrist flexors & extensors b. Engagement of the dorsal interossei c. The flexor digitorum superficialis & flexor digitorum profundus d. All of the above

Forearm muscles involved in wrist extension are located in which compartment: a. Anterior b. Posterior c. Medial d. Both anterior and posterior

The palmar aponeurosis: a. Is continuous with the Palmaris longus tendon b. Invests the dorsal and palmar surfaces of the hand c. Is thickest over the thenar eminence d. All of the above

A Fyi other parts of the palmar apneurosis: a. Invests the palmar surface of the hand b. Is thickest over the 2-4 metacarpals c. Passes superficially to the flexor retinaculum

With the respect to the palmar aponeurosis of the following are accurate except: a. Is continuous with the palmaris longus tendon b. Passes superficially to the flexor retinaculum c. Is thickest over the thenar eminence d. All are accurate

The central compartment of the hand contains: a. Flexor tendons and sheaths b. Lumbrical muscles c. The superficial palmar arch d. All of the above

Which of the following muscles is not involved in wrist flexion? a. Flexor carpi ulnaris b. Flexor digitorum superficialis c. Brachioradialis d. Flexor carpi radialis e. None of the above

Dupuytren’s fascitis/contracture: a. Involves the thumb and index finger most often b. Rarely impairs hand function c. Often begins in the teen years d. Involves unknown factors that cause inflammation of the palmar fascia

The power grip involves: a. Isolated engagement of the finger & wrist flexors b. Engagement of the wrist extensors c. Flexor digitorum superficialis but not flexor digitorum profundus d. All of the above

B FYI, power grip also involves: a. Contraction of the extensor carpi radialis longus b. Contraction of the extensor carpi radialis brevis c. Contraction of the FDS and FDP

The pollical carpometacarpal joint: a. Has an impressive freedom of movement b. Is a saddle joint that acts like a ball and socket joint c. Is involved in opposition of the thumb and 5th digit d. All of the above

Which thenar muscle is not innervated by the recurrent branch of the median nerve? a. Abductor pollicis brevis b. Opponens pollicis c. Superficial head of the flexor pollicis brevis d. Deep head of the flexor pollicis brevis

Inability to flex the distal phalanx of the middle finger indicates injury to which of these muscles? a. Dorsal interosseous b. Flexor digitorum profundus c. Flexor digitorum superficialis d. Lumbricals

Motor changes that would accompany an ulnar nerve injury at the wrist would involve all of these EXCEPT: a. Abduction of the 5th finger b. Adduction of the 4th digit c. Abduction of the thumb d. Adduction of the thumb

The following statements regarding lumbricals are accurate EXCEPT: a. Flex the MCP joint b. Extend the interphalangeal joints c. Arise from the tendons of the FDP d. All are innervated by the ulnar nerve

The following statements about interossei muscles of the hand are true EXCEPT: a. They are innervated by the ulnar nerve b. Palmar interosseous muscles adduct digits to the midline c. Dorsal interosseous muscles abduct digits from the midline d. Muscles to the 2nd and 3rd digits are innervated by the median nerve

The radialis indicis & princes pollicis arteries are branches of: a. The deep palmar arch b. The superficial palmar arch c. The superficial palmar branch d. The deep palmar branch

Which thenar muscle is innervated completely by the ulnar nerve? a. Adductor pollicis b. Flexor pollicis longus c. Flexor pollicis brevis d. Abductor pollicis brevis

The ulnar nerve in the forearm: a. Passes between the two heads of the flexor carpi ulnaris b. Lies between the Flexor digitorum profundus and Flexor digitorum superficialis c. Occasionally receives branches from the radial nerve d. Pierces the interosseous membrane to form the posterior interosseous nerve

Which of the following muscles does not have an origination from the medial epicondyle of the humerus? a. Flexor digitorum superficialis b. Flexor pollicis longus c. Palmaris longus d. Flexor carpi radialis

The brachioradialis muscle is an “exceptional” forearm muscle because: a. It is a flexor innervated by the median nerve b. It is an anterior compartment muscle c. It is a flexor supplied by the radial nerve d. It supinates the forearm as well as flexing the forearm

Which of these forearm muscles arises from the lateral epicondyle of the humerus? a. Extensor digiti minimi b. Extensor digitorum c. Extensor carpi radialis brevis d. All of the above

Identify the accurate statement regarding the pronator teres and pronator quadratus? a. Both originate only from the ulna b. The pronator quadratus alone produces quick and powerful pronation c. Both assist in forearm flexion d. Both may be impaired by a comminuted medial epicondyle humerus fracture

Abduction of the arm is limited by contact of the coracoacromial arch with the: a. Lesser tubercle of the humerus b. Greater tubercle of the humerus c. Deltoid tubercle of the humerus d. Humeral head

The strongest hand supinator with the elbow extended is the: a. Biceps brachii b. Supinator c. Brachioradialis d. Supinator quadratus

The strongest hand supinator with the elbow bent 90 is the: a. Biceps brachii b. Supinator c. Brachioradialis d. Supinator quadratus

Which of the following muscles is not innervated by the deep branch of the ulnar nerve? a. Superficial head of the flexor pollicis brevis b. Transverse head of the adductor pollicis c. Oblique head of the adductor pollicis d. All are innervated by the deep ulnar nerve e. Lumbrical to the third digit

A & E

During a DIY home demolition reality show, the host is struck on the posterior proximal forearm by an errant hammer blow; in addition to soft tissue injury the host suffers a radial head dislocation. On examination the host will most likely exhibit: a. A loss of sensation over the lateral aspect of the dorsum of the hand b. Weakness in extending the distal phalanx of the 1st digit c. An inability to extend the proximal interphalangeal joint of the 3rd digit d. An inability to flex the metacarpophalangeal joint of the 2nd digit

A bricklayer complains of an aching in his proximal right forearm (he is right handed), he notes it is worse at the end of a long day at work and seems to get progressively worse through the week. You suspect supinator syndrome, what finding would not be consistent with the diagnosis? a. Normal sensation on the dorsum of the hand b. Deviation to the radial side with wrist extension c. Deviation to the ulnar side with wrist extension d. All are consistent with supinator syndrome

The presence of anatomic snuffbox tenderness after a fall creates a concern for which pathologic process? a. Radial artery dissection b. Avascular necrosis c. Flexor pollicis brevis rupture d. Lunate bone fracture

What anatomic structure would be at most risk of injury during the most common type of shoulder dislocation? a. Axillary artery b. Radial nerve c. Profunda brachii artery d. Axillary nerve

Which muscle extends the interphalangeal joint? a. Flexor digitorium profundus b. Flexor digitorium superficialis c. Palmar interosseous muscles d. Lumbricals e. None of these

C & D

Interruption of blood flow to the hand may be reliably produced by occlusion of: a. The profunda brachii artery at its origin and the brachial artery just proximal to the bifurcation of the brachial artery b. The distal ulnar and radial arteries c. The brachial artery just proximal to the radial artery and ulnar artery bifurcation and common interosseous trunk d. The brachial artery just proximal to the origin of the profunda brachii artery

You examine a patient with complaints indicative of median nerve compression in the carpal tunnel, which of the following findings indicates the diagnosis of carpal tunnel syndrome is incorrect? a. Intact sensation over the medial thenar eminence b. Weakness of the opponens pollicis c. Absent flexor pollicis brevis function d. Muscle wasting lateral to the 2nd and 3rd metacarpals

Which of the following injuries doesn’t result in disconnecting the upper extremity appendicular skeleton from the axial skeleton? a. Disruption of the SC joint and costoclavicular ligament b. Transverse fracture of the clavicle c. Complete disruption of the intrinsic AC ligament d. All 3 disarticulate the upper extremity appendicular skeleton from the axial skeleton

D FYI, Other joints with articular joints include (but not limited to): a. The sternoclavicular joint b. The distal radio-ulnar joint c. The acromionclavicular joint

Which of the following joints lacks a sacciform recess? a. The SC joint b. The distal radio-ulnar joint c. The proximal radio-ulnar joint d. All have articular discs

An intoxicated anatomy student falls from a street light while celebrating a football victory. He severely injuries his left knee in the fall and while being well anesthetized, his gait instability results in a fall in which he shatters a store window and suffers a deep gash on the anterior aspect of his forearm. While waiting for the doctor, he begins a self-examination of his injury. Because he is able to flex the distal phalangeal joints in his 4 fingers and thumb, he concludes the following are not completely severed: a. Flexor carpi radialis b. FDS c. FDP d. Palmaris longus

He also concludes from this finding that the following nerve(s) must be intact: a. Musculocutaneous b. Axillary c. Ulnar d. Radial

Further inspection reveals an inability to flex the proximal interphalangeal joints of his 4 fingers. He concludes from this finding he has injured his: a. Median nerve b. FDS muscle c. Extensor digitorium d. AIN

The risk of avascular necrosis in scaphoid fracture is increased with: a. The location of the fracture, the more distal the greater the risk b. Displacement of the fracture fragments, the greater the displacement the greater the risk c. Both a & b d. Neither

B FYI: The risk also includes (may not be limited to..): a. the location of the fractior, the more PROXIMAL the greater the risk

Which carpometacarpal joint shows the greatest range of motion? a. Digit 1 b. Digit 2 c. Digit 3 d. Digit 5

With respect to the scaphoid bone all of the following statements are accurate except: a. It has major articular interaction with the distal radius b. It has minor articular interaction with the distal ulna c. Its vascular supply is from a branch of the radial artery d. All are accurate

The strongest component of the medial (ulnar) collateral ligament is the: a. Anterior cord b. Posterior cord c. Oblique cord d. All are approximately equal in strength

Injury of the median nerve as its traverse the carpal tunnel would result in weakness of: a. Thumb extension b. Thumb flexion c. Both d. Neither

B FYI, also includes (may not be limited to:) a. thumb opposition b. thumb abduction

Placing a screw with a screwdriver would be most impaired by an injury to the: a. Deep branch of the radial nerve b. Superficial branch of the radial nerve c. Axillary nerve d. Musculocutaneous nerve

A FYI, also includes median nerve

Radial nerve injury would most impair which thumb (digit 1) function: a. Abduction b. Adduction c. Extension d. It would have no effect on thumb function

You place a sheet of paper vertically between 2nd and 3rd digits of non-dominant hand and ask the subject to hold onto the paper as you remove it. Failure to successfully retain the paper indicates a defect in which nerve? a. Deep radial b. Median recurrent branches c. Median nerve d. Ulnar nerve

Which of the following structures is most suitably located to afford protection to the brachial artery from inadvertent injury by an inexperienced phlebotomist trying to puncture the median cubital vein? a. Brachialis tendon b. Biceps tendon c. Bicipital aponeurosis d. None of the above

Testing the extension of the distal interphalangeal of the fingers (digits 2-5) tests which of the following nerves? a. Ulnar nerve b. Median nerve c. PIN d. All of the above

Identify the muscle inserting on the carpal bone a. Flexor carpi radialis b. Flexor carpi ulnaris c. Extensor carpi ulnaris d. Flexor pollicis longus

Identify the muscle whose tendon inserts on a carpal bone a. Flexor carpi radialis b. Flexor carpi ulnaris c. Extensor carpi ulnaris d. Flexor pollicis longus

A 52 year old male is recovering from a two-story fall. He suffered a displaced comminuted lateral epicondyle fracture and dislocated olecranon with an injury to a single neurovascular bundle requiring an emergent open reduction with internal fixation. Pre-operatively, he had intact elbow extension (although painful), elbow flexion was slightly diminished, wrist flexion is intact, additional deficits would include the following except: a. Decreased wrist adduction b. Diminished grip strength c. Radial deviation on wrist extension d. Absent supination with elbow extended

Posterior cord injury would most severely impair: a. MCP extension at digits 1-3 b. PIP extension at digits 3-5 c. DIP extension at digits 2-4 d. All would be equally affected

On his second day on the job, Sidney Whipsnead suffers both a medial and lateral cord injury (brachial plexus). Which of the following movements would be least affected? a. Extension of the PIP joint of 4th digit b. Extension of DIP joint of 3rd digit c. Extension of IP joint of 1st digit d. All would be equally affected

Which of the following muscles is not involved in elbow flexion? a. FDP b. FDS c. FCR d. Pronator teres

Injury to both the medial and lateral cords of the BP would result in: a. Severely weakened elbow flexion b. Moderately weakened elbow flexion c. Minimally weakened elbow flexion d. Have no effect on elbow flexion

Oliver Wendell Holmes suffers a sharp penetrating injury from an errant piece of bailing wire to the medial margin of the thenar eminence. An injury to this area would likely result in impaired: a. Extension of the proximal interphalangeal joint of the 3rd digit b. Flexion of the metacarpal-phalangeal joint of the 2nd digit independent of DIP flexion c. Impaired abduction of the 3rd digit d. Both a & b would occur

D FYI, impairment would also include, not limited to: a. Flexion of the metacarpal-phalangeal joint independent of DIP flexion b. Extension of the proiximal interphalangeal joint of the 3rd digit

Which of the following muscles is not involved in wrist abduction? a. Abductor pollicis longus b. Extensor carpi radialis brevis c. Flexor carpi radialis d. Brachioradialis

Concerning the abductor pollicis longus, which of the following is inaccurate (all the following are accurate except? a. Innervated by PIN b. Forms the lateral boundary of anatomic “snuff box” c. Abducts and laterally rotates the carpometacarpal joint d. All are accurate

Which of these forearm muscles does not arise from the lateral epicondyle of the humerus? a. Extensor digiti minimi b. Extensor digitorum c. Extensor carpi radialis brevis d. All arise from the lateral epicondyle

Ace reliever for the Montgomery Biscuits Dave Heaverlo was a knuckleball specialist, the knuckleball is notoriously difficult to control much to the chagrin of hitters, catchers and home plate umpires. Heaverlo’s main claim to fame is.. blah blah blah… He was struck in the distal third of the forearm by a dart thrown by local dart legend Andy “The Pieman” Smith. The projectile lacerated a forearm nerve ending Dave’s career. Injury to which forearm nerve would most impair Heaverlo’s ability to throw his signature pitch? a. Median nerve b. Ulnar nerve c. Anterior interosseous nerve d. Deep branch of the radial nerve

C FYI, similar Q Same as above BUT… The projectile lacerated a forearm nerve 12 cms from the proximal wrist crease. Injury to which forearm nerve would least impair Heaverlo’s ability to throw his signature pitch? a. Median nerve b. Ulnar nerve (summer ’16 right answer choice) c. AIN d. Deep branch of the radial nerve (A & B)

Which of the following muscles is innervated by a recurrent branch of the median nerve? a. Superficial head of the flexor pollicis brevis b. Transverse head of the adductor pollicis c. Oblique head of the adductor pollicis d. All are innervated by the deep ulnar nerve

Impaired distal interphalangeal joint extension of the second digit would occur following interruption of which of the following nerves? a. Posterior interosseous nerve b. Median nerve c. Ulnar nerve d. All of the above

The insertional complex of the extensor carpi ulnaris includes: a. The medial side of the base of the 5th metacarpal b. The pisiform bone c. Both d. Neither

Elbow flexion would minimally be affected by cutting which of the following nerves? a. Radial b. Ulnar c. Anterior interosseous d. Median e. Interruption of any of these nerves would at least moderately affect elbow flexion

Which muscle has an insertional complex involving two metacarpal bones? a. Flexor carpi radialis b. Flexor carpi ulnaris c. Extensor carpi ulnaris d. All have an insertional complex involving two metacarpals

The adductor pollicis is located within the a. Thenar compartment b. Central compartment c. Adductor compartment d. Interosseous compartment

Which nerve has a proximal cutaneous branch forming proximal to its passage over the metacarpal region? a. Median b. Ulnar c. Both d. Neither

Which digit receives motor innervation from the largest number of named nerves? a. Digit #3 b. Digit #4 c. Digit #5 d. All three are served by an equal number of named nerves

Impaired distal interphalangeal joint extension of the second digit would occur following interruption of which of the following nerves? a. Posterior interosseous nerves b. Median nerve c. Ulnar nerve d. All of the above

Which of the following statements is accurate with respect to the posterior interosseous nerve? a. It runs on the posterior surface of the interosseous membrane b. It is a branch of the interosseous nerve c. It supplies all the extensors of the 1st digit d. None are accurate e. All of the above

The insertion of the extensor carpi radialis brevis is located on a. The base of the second metacarpal b. The base of the third metacarpal c. The radial styloid process d. None of the above

The supinator has an origin on all of the following structures except: a. Humerus b. Radius c. Ulna d. It has an origin on all of the above

Hyperextension at rest (no active movement of the hand) of the proximal phalanges of the 5th and 4th digits can result from damage to which nerve? a. Median b. Radial c. Ulnar d. Posterior interosseous nerve

An injury of the type described in the above question could be produced by a lesion of the , which other additional findings. a. Posterior division of the middle trunk b. Anterior division of the middle trunk c. Posterior division of the middle trunk d. Anterior division of the lower trunk

Sensation to the dorsal surface of the 4th digit is supplied by the a. Ulnar nerve b. Radial nerve c. Both d. Neither

Elmer Fudd is a 53 yo avid hunter of lagomorphs, while out in the woods in pursuit of his nefarious prey he steps on to a camouflaged pit. As he falls he wildly grasps with his left hand to grab on overlying tree branch. His grasp only transiently delays his fall to the bottom of the pit which is littered with carrots. His plaintive cries for help are answered and he is rescued and evaluated in a local urgent care facility. He has evidence of contusions of the left axilla and medial arm and complains of left arm weakness and decrease sensation. What findings would indicate a nerve root injury rather than a trunk, cord, or nerve injury? a. Impaired left arm abduction past 15-20* b. Weakened abduction of the extended left arm c. Pupillary asymmetry d. Impaired medial rotation of the left arm