Exam review Flashcards
piano key deformity
Acromioclavicular tear
rupture of the glenohumeral ligaments
Anterior shoulder dislocation
A 55-year-old woman was submitted to surgery to remove her left breast and afterwards she noticed that she was experiencing weakness in her left shoulder and had considerable difficulty raising her left arm above her head, even two months after her surgery. Her husband also noticed that her left scapula seemed to protrude posteriorly to a greater extent than the one on her right side. This phenomenon is called a “winged scapula”. Which muscle was affected and which nerve supplies it? Why was this patient’s ability to raise her arm above her head affected?
Serratus anterior- supplied by long thoracic nerve Serratus anterior helps to rotate scapula superiorly
A football player fell on his elbow and fractured the surgical neck of the humerus, producing an elevation and adduction of the distal fragment. Which of the following muscles would most likely cause the adduction of the distal fragment? Brachialis Teres minor Pectoralis major Supraspinatus Pectoralis minor
Pectoralis major Pectoralis major inserts below the surgical neck of humerus
Which muscle allows abduction after 15 degrees?
deltoid
A 65-year-old male slips on his outstretched hands while walking on the ice. He arrives in the ER complaining of right shoulder pain. His physical exam shows inability to abduct the arm from approximately 15o and insensitivity of the overlying skin to touch. Which of the following injuries is most likely responsible? A. Anterior and inferior dislocation of the humerus B. shoulder separation C. fracture of coracoid process D. spiral fracture of the humerus midshaft E. fracture of the hook of the hamate
A. Anterior and inferior dislocation of the humerus An anterior and inferior dislocation of the humerus may damage the axillary nerve with paralysis of the deltoid, teres minor and loss of sensation from the upper lateral part of the shoulder
The lateral thoracic artery provides the main blood supply to the lateral side of the chest wall, including much of the breast. To deter excessive blood loss during a surgical procedure involving the breast, a surgeon can clamp the lateral thoracic artery near its origin. Which of the following arteries normally gives rise to this artery? A. First part of axillary artery B. Second part of axillary artery C. Third part of axillary artery D. Third part of subclavian artery E. First part of brachial artery
B. Second part of axillary artery
A 38 year old female patient is found to have a hard nodule in the upper lateral portion of her right breast. The physician injects dye into the tissue around the tumor so that it can be taken up by the lymphatic vessels around the area. Which of the following nodes will most likely first encounter the lymph from the tumor? Apical axillary nodes Central axillary nodes Anterior axillary (pectoral) nodes Parasternal nodes Subscapular (posterior) axillary nodes
Anterior axillary (pectoral) nodes
A 32 year old female patient is placed on dialysis and a suitable vein in the upper limb was needed for venipuncture. A vein was found on the medial side of the arm that passed through the superficial and deep fascia to join veins beside the brachial artery. Which vein was this? Basilic Cephalic Median cubital Medial antebrachial
Basilic
While attempting to collect a sample of blood from the medial cubital vein a phlebotomist inserts the needle too deeply and enters the cubital fossa. 1. Which structure forms the roof of the cubital fossa? 2. Which structures may be damaged by venipuncture or a stab wound in the cubital fossa?
- The bicipital aponeurosis 2. Brachial artery and median nerve
Which of the following structures do not travel or run parallel or generally go, together? Axillary nerve and anterior circumflex humeral artery (through quadrangular space) Radial nerve and deep brachial artery (in lateral triangular space) Anterior interosseous nerve and artery Thoracodorsal nerve and artery Brachial artery and median nerve (in arm) Peanut butter and jelly
The axillary nerve and posterior circumflex artery pass through the quadrangular space together
After a difficult delivery through the birth canal, a baby presents with his left upper limb adducted, internally rotated, extended at the elbow and flexed at the wrist. Which part of the brachial plexus was most likely injured during this delivery? A. lateral cord B. medial cord C. roots of the lower trunk D. roots of the upper trunk E. roots of the middle trunk
roots of upper trunk This is an example of an upper brachial plexus injury (Erb-Duchenne palsy), affecting the lateral rotators of the humerus, the flexors of the elbow, and the abductors of the shoulder
A 27-year-old patient presents with an inability to draw the scapula forward and downward because of dysfunction of the pectoralis minor. Which of the following would most likely be a cause of his condition? A. Injury to the thoracodorsal nerve B. Axillary nerve injury C. Fracture of the coracoid process D. Fracture of the clavicle E. Injury to the posterior cord of the brachial plexus
C. Fracture of the coracoid process Pectoralis minor inserts on the coracoid process and is supplied by medial pectoral n. from medial cord
An ice skater falls to the ice and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements? A. Adduction of the scapula B. Elevation of the scapula C. Extension of the arm D. Abduction of the arm E. Lateral rotation of the arm
C. Extension of the arm The thoracodorsal nerve supplies the latissimus dorsi muscle which extends the arm (along with adduction and medial rotation)
A 20 year old man is brought to the ER after dislocating his shoulder while playing football. He has pain over the lateral region of his shoulder and cannot abduct the arm normally. An MRI of the shoulder shows a torn muscle. Which of the following muscles is most likely to have been damaged by this injury? Coracobrachialis Long head of triceps Pectoralis major Supraspinatus Teres major
Supraspinatus- initiates abduction
Lateral rotation of the arm is an important mechanical component of “bringing the arm back” (i.e, laterally rotating the arm) when preparing to throw an object. What muscle acts to produce lateral rotation of the arm? A. Supraspinatus B. Teres major C. Teres minor D. Subscapularis E. Latissimus dorsi
C. Teres minor The teres minor, one of the rotator cuff muscles, is a lateral rotator of the humerus (along with the infraspinatus)
An orthopedic surgeon exposed the muscle in the supraspinous fossa so that she could move it laterally, in repair of an injured rotator cuff. As she reflected the muscle, an artery was exposed crossing the ligament that bridges the notch in the superior border of the scapula. Which artery was this? Subscapular Transverse cervical Dorsal scapular Posterior circumflex humeral Suprascapular
Suprascapular The suprascapular artery goes over the ligament while the suprascapular nerve goes under
A 27 year old man falls off a ladder onto his shoulder. An X-ray shows a fracture of the surgical neck of the humerus and you suspect there may be some nerve damage to the nerve which passes around this area. How would you test for the status of this nerve? A. have the patient push against a wall to assess if he has winged scapula B. test for normal sensation over the lateral part of the forearm C. test for sensation over the lateral part of the shoulder D. have the patient extend his forearm against resistance E. have the patient shrug the shoulders
Correct answer is: C. test for sensation over the lateral part of the shoulder The axillary nerve passes around the surgical neck of the humerus. Superior lateral cutaneous n. of arm is branch of axillary n. Incorrect: A. Long thoracic nerve. B. Musculocutaneous n D. Radial N E. Spinal accessory n
The right shoulder of a 51 year old chemistry teacher had become increasingly painful over the past year. Abduction of the right arm caused him to wince from discomfort. An MRI revealed inflammation extending over the head of the humerus. Which structure was inflamed? Subscapular bursa Infraspinatus muscle Subacromial bursa Pectoralis minor Teres minor muscle
Subacromial bursa
A 24 year old hotel porter is lifting a heavy box and suddenly hears a “pop” in his left arm. In the ER, physical examination reveals a rupture of the long head of biceps brachii. Which of the following is the most-likely location of the rupture? Bony insertion of the muscle Midportion of the biceps Intertubercular groove Junction with the short head of biceps Proximal end of the combined muscle
Intertubercular groove Rupture of the tendon results from wear and tear of an inflamed tendon as it moves back and forth in the intertubercular groove of the humerus
A 17 year old male has weakness of elbow flexion and supination of the left hand after sustaining a knife wound in a fight. Examination in the ER indicates that a nerve has been severed. What other conditions will also most likely be seen during physical examination? A. inability to adduct and abduct the fingers B. Inability to flex his fingers C. Inability to flex his thumb D. Sensory loss over the lateral surface of his forearm E. Sensory loss over the medial surface of his forearm
D. Sensory loss over the lateral surface of his forearm Musculocutaneous nerve ends as the lateral cutaneous nerve of forearm
A mother tugs forcefully on her child’s arm to pull him out of the way of an oncoming car and the child screams in pain. It then becomes obvious that the child cannot straighten his forearm at the elbow. An X-ray taken in the ER shows a dislocation of the head of the radius. Which of the following ligaments or membranes is most likely directly associated with this injury? A mother tugs forcefully on her child’s arm to pull him out of the way of an oncoming car and the child screams in pain. It then becomes obvious that the child cannot straighten his forearm at the elbow. An X-ray taken in the ER shows a dislocation of the head of the radius. Which of the following ligaments or membranes is most likely directly associated with this injury? A. Annular B. Interosseous C. Radial collateral D. Ulnar collateral
A. Annular Nursemaid’ elbow
Your 67-year-old female patient who fell on her hand has been diagnosed with a Colles fracture. This refers to which of the following? A. A fracture of the lunate B. A fracture of the scaphoid C. A fracture of the distal radius in which the distal fragment is angulated dorsally D. A fracture of the radial styloid process in which the separated segment overrides the scaphoid E. A fracture of the distal radius in which the distal fragment is angulated ventrally
C. A fracture of the distal radius in which the distal fragment is angulated dorsally
You are treating a patient in the ED who has a severe cut on the proximal dorsal surface of the middle of her forearm. The profuse bleeding is derived primarily (directly) from which of the following? A. Ulnar artery B. Radial artery C. Deep brachial artery D. Ulnar recurrent artery E. Posterior interosseous artery
E. Posterior interosseous artery
