gross- practice q's (upper limb)

Question 1

the axillary nerve is a direct branch of which cord of the brachial plexus

Answer 1

posterior

Question 2

Which is the primary blood supply of the latissimus dorsi?

Answer 2

thoracodorsal artery

thoracodorsal nerve → innervates latissimus dorsi

Question 3

the brachial plexus is formed by the …

Answer 3

C5-T1 ventral rami

(ventral rami = anterior branches of spinal nerves)

Question 4

lateral thoracic is typically a direct branch of the _________ artery

Answer 4

axillary

Question 5

Which landmark marks the location where the subclavian artery becomes the axillary artery?

Answer 5

first rib

Question 6

the pectoralis major & minor are innervated by …

Answer 6

medial & lateral pectoral nerves

Question 7

what does the subscapularis do?

Answer 7

internally rotates arm

Question 8

what does the pectoralis major do?

Answer 8

adducts & internally rotates the arm

Question 9

the biceps brachii is innervated by the …

Answer 9

musculocutaneous nerve

Question 10

how to differentiate b/w teres major & teres minor?

Answer 10

teres major: originates from inferior angle of scapula & inserts at medial lip of bicipital groove of humerus

teres major: originates from lateral border of scapula & inserts at the greater tubercle of humerus

Question 11

which nerve supplies (innervates) the teres major muscle?

Answer 11

lower subscapular nerve

Question 12

what does the biceps brachii do?

Answer 12

flexes elbow joint & supinates the forearm

Question 13

which nerve becomes the posterior interosseous nerve?

Answer 13

radial nerve

Question 14

if a muscle has the word “carpi” in its name, it typically inserts on the __________

Answer 14

base of the metacarpal

Question 15

if your patient couldn’t pronate her forearm, you might suspect damage to which nerve?

Answer 15

median nerve

Question 16

if your patient couldn’t supinate her forearm, you might suspect damage to which nerve?

Answer 16

radial nerve

Question 17

which muscle flexes the distal phalanx of the middle finger?

Answer 17

flexor digitorum profundus

Question 18

which muscle flexes the proximal & middle phalanx of the middle finger?

Answer 18

flexor digitorum superficialis

Question 19

what does the superficial branch of the radial nerve supply

Answer 19

supplies skin of the dorsal hand (back of the hand)

Question 20

what are the primary movements that occur at the distal radio-ulnar joint?

Answer 20

pronation & supination

Question 21

which nerve is damaged if a patient cannot move his thumb, especially can’t do opposition?

Answer 21

recurrent branch of the median nerve

(oppenens pollicis not working)

Question 22

which digital sheath is continuous with the common flexor sheath?

Answer 22

5th

Question 23

where does the central band of the extensor digitorum tendon insert?

Answer 23

base of the middle phalanx (?)

Question 24

the recurrent branch of the median nerve innervates what part of the hand?

Answer 24

the thenar space

(including all the muscles of it- so no flexion or opposition in thumb if this is damaged)

Question 25

Define supination and mention the joints and muscles at which this movement takes place.

Answer 25

**supination**: movement that turns palm of hand or forearm upward (opposite of pronation) **joints**: proximal & distal radioulnar joint - radius rotates around the ulna **muscles**: - biceps brachii (most powerful supinator) - supinator muscle - brachioradialis (can assist in supination when forearm is in a neutral position)

Question 26

Give the nerves directly originating from the **upper trunk of brachial plexus** and name the muscles supplied by them.

Answer 26

upper trunk: **C5 & C6 TRUNKS not the roots** **suprascapular**: supraspinatus, infraspinatus **nerve to subclavius**: subclavius *these are the only ones from the trunks, everything else is from the roots/cords*

Question 27

Name the supporting ligaments of the shoulder joint and give their attachments.

Answer 27

1. **Glenohumeral ligaments (superior, middle, inferior)**: Attach the glenoid of the scapula to the humerus - **superior**: supraglenoid tubercle os scapula to greater tubercle of humerus - **middle**: anterior aspect of glenoid to lesser tubercle of humerus - **inferior**: inferior aspect of glenoid to neck of humerus 2. **Coracohumeral ligament**: connects coracoid process to greater tubercle of the humerus 3. **Coracoacromial ligament**: connects coracoid process to acromion. 4. **Transverse humeral ligament**: greater tubercle to lesser tubercle of humerus, covering biotic-ital groove, holds long head of biceps tendon in place 5. **Acromioclavicular ligament: acromion os scapula to clavicle, stabilizes the acromioclavicular joint

Question 28

Give boundaries and contents of mid palmer space.

Answer 28

**contents**: - 3rd & 4th lumbricals - ulnar artery & nerve branches - palmar metacarpal arteries **boundaries**: - **anterior**: palmar aponeurosis & flexor tendons - **posterior**: interosseous muscles (3-5th metacarpals) - **lateral**: medial fibrous septum

Question 29

Enlist contents of axilla that can be damaged.

Answer 29

1. Axillary artery & vein 2. All cords of brachial plexus lie in axilla: Axillary nerve, Radial Nerve, Ulnar nerve, Medial cutaneous nerves of arm and forearm, muculocutaenous nerve, lateral pectroral nerve 3. Axillary lymph nodes 4. Muscular structures: pec major & minor, teres major, latissimus dorsi, serratus anterior, subscapularis (on the walls)

Question 30

Explain an anastomosis around shoulder joint.

Answer 30

**anastomosis arteries**: 1. Suprascapular artery 2. Dorsal scapular artery 3. Circumflex scapular artery 4. Transverse cervical artery

Question 31

What will be the site of ligation of axillary artery in order to preserve blood circulation to upper limb through collateral circulation?

Answer 31

**collateral circulation**: if blockage to axillary artery, scapular anastomosis provides alternate route for blood to reach shoulder & arm **safe site of ligation**: b/w first and second part of the axillary artery, before the origin of the subscapular artery

Question 32

Following an accident, patient has no cutaneous sensation over lower half of deltoid muscle. Give reason for this sensory loss.

Answer 32

Injury to axillary nerve, specifically cutaneous branch

Question 33

Patient has a painless lump in upper lateral quadrant of left breast. Name the primary lymph nodes that will drain this quadrant and give their location. Give the other areas which are also drained by these lymph nodes.

Answer 33

primary lymph nodes draining upper lateral quadrant of breast: **axillary lymph nodes**, specifically **anterior (pectoral) group of axillary lymph nodes** **location**: along lower border of pec minor muscle in anterior wall of axilla **drainage areas**: upper lateral quadrant of breast, most of skin & parenchyma of breast, anterior thoracic wall, anterior abdominal wall above the level of the umbilicus