Lachmans TEST REVIEW (PERSONAL Upper Limb) (Part 2)

Question 1

Which forearm muscles are not innervated by the median nerve?

Answer 1

Flexor carpi ulnaris

Medial half of flexor digitorum profundus (ulnar half)

Question 2

What are the main motor actions of muscles innervated by the median nerve?

Answer 2

Pronation of the forearm

Flexion of the wrist

Flexion of the digits

Question 3

What does the median nerve innervate in the hand?

Answer 3

Thenar muscles

1st and 2nd lumbricals

Sensory to lateral 3½ digits on the palmar surface

Question 4

Why do sensory symptoms typically appear before motor deficits in median nerve compression?

Answer 4

Sensory fibers are more susceptible to compression, leading to earlier symptoms

Question 5

What are the two main categories of veins?

Answer 5

Superficial veins: in the superficial fascia, not accompanied by arteries, drain into deep veins

Deep veins: located deep to the deep fascia

Question 6

Name examples of superficial veins in different body regions.

Answer 6

Upper limb: Cephalic & Basilic

Lower limb: Long (great) & Short (small) Saphenous

Neck: External & Anterior Jugular

Abdomen: Thoracoepigastric

Question 7

What is the course and drainage of the cephalic vein?

Answer 7

Arises from the lateral dorsal venous network of the hand

Travels through the deltopectoral groove and triangle, pierces the clavipectoral fascia

Drains into the axillary vein

Question 8

What is the course of the basilic vein?

Answer 8

Arises from medial dorsal venous network of the hand

Ascends anteromedial forearm, pierces deep fascia in the arm

Joins brachial vein to form the axillary vein

Question 9

What is the median cubital vein, and where is it located?

Answer 9

Communication between cephalic and basilic veins

Crosses the cubital fossa obliquely

Lies lateral to the biceps brachii tendon

Question 10

What lies medial to the biceps brachii in the cubital fossa?

Answer 10

Brachial artery

Median nerve (both deep to the bicipital aponeurosis)

Question 11

What is the course of the long (great) saphenous vein?

Answer 11

Arises from medial dorsal venous arch

Ascends anteromedially, enters the saphenous hiatus

Drains into the femoral vein via the femoral triangle

Question 12

What is the path of the short (small) saphenous vein?

Answer 12

Arises from lateral dorsal venous arch

Ascends posterolaterally, pierces crural fascia

Drains into the popliteal vein

Question 13

What is the role of valves in saphenous veins?

Answer 13

Reduce hydrostatic pressure in upright posture

Prevent backflow and pooling

Valve failure can cause varicose veins

Question 14

What do perforating veins and deep veins do?

Answer 14

Perforating veins: allow flow from superficial to deep

Deep veins: use a musculovenous pump to assist venous return

Question 15

What forms the external jugular vein and where does it drain?

Answer 15

Formed by posterior auricular vein + branch of retromandibular vein

Descends superficially on SCM, drains into subclavian vein

Question 16

Where does the anterior jugular vein drain?

Answer 16

Drains into external jugular vein or directly into subclavian vein

Jugular venous arch connects the R and L anterior jugular veins

Question 17

What visible sign might indicate raised central venous pressure?

Answer 17

Engorgement of the external jugular vein

Question 18

Where do thoracoepigastric veins drain and what are their clinical connections?

Answer 18

Drain inferiorly into femoral vein via superficial epigastric and circumflex iliac veins

Anastomose superiorly with axillary vein tributaries

Form part of the SVC-IVC anastomosis

Connected to portal venous system via paraumbilical veins

Question 19

What condition causes thoracoepigastric vein enlargement?

Answer 19

Portal hypertension, due to backflow from the portal to systemic venous systems

Question 20

What is the proximal row of carpal bones (lateral to medial)?

Answer 20

Scaphoid, Lunate, Triquetrum

Question 21

What is the distal row of carpal bones (lateral to medial)?

Answer 21

Trapezium, Trapezoid, Capitate, Hamate

Question 22

What type of bone is the pisiform, and where is it located?

Answer 22

A sesamoid bone in the tendon of the flexor digitorum ulnaris

Lies on the anterior surface of the triquetrum

Question 23

What bones does the scaphoid articulate with?

Answer 23

Distally: with the trapezium (which articulates with the 1st metacarpal)

Proximally: with the radius

Question 24

Where is the scaphoid located anatomically for physical examination?

Answer 24

Lies in the floor of the anatomical snuffbox

Bordered by the extensor pollicis longus and extensor pollicis brevis tendons

Question 25

What artery supplies the scaphoid, and which part has the best blood supply?

Answer 25

Supplied by branches of the radial artery Distal pole: good blood supply Proximal pole: poor supply

Question 26

Which nerve fibers are more affected in sensory deficiencies: large myelinated or small unmyelinated?

Answer 26

Large, myelinated fibers (for voluntary muscle control and tactile discrimination) are more affected than small, unmyelinated fibers (which carry pain).

Question 27

What motor deficits result from carpal tunnel syndrome?

Answer 27

Loss of motor function of the abductor pollicis brevis and opponens pollicis.

Question 28

What forms the roof of the carpal tunnel and where does it attach?

Answer 28

The flexor retinaculum Laterally: attaches to the scaphoid and trapezium Medially: attaches to the pisiform and hook of hamate

Question 29

What are the contents of the carpal tunnel?

Answer 29

Tendon of flexor pollicis longus (with radial bursa) Tendons of flexor digitorum superficialis & profundus (with ulnar bursa) Median nerve

Question 30

Which structures pass superficial to the flexor retinaculum and must be protected during surgery?

Answer 30

Ulnar artery, superficial branch of the radial artery (they form the superficial palmar arch) Superficial branch of the ulnar nerve Recurrent motor branch of the median nerve

Question 31

Where is the ulnar nerve commonly entrapped?

Answer 31

At the wrist (between the pisiform & hook of hamate) In the ulnar groove behind the medial epicondyle

Question 32

Which nerve can be compressed as it passes through the supinator muscle?

Answer 32

The posterior interosseous branch of the radial nerve

Question 33

Where can the suprascapular nerve become entrapped?

Answer 33

Between the transverse scapular ligament and the scapular notch

Question 34

What other peripheral nerves are susceptible to entrapment?

Answer 34

Common fibular nerve, superficial fibular nerve, and the tibial nerve (beneath the flexor retinaculum)