Upper Limb ( 25% ) Flashcards
(103 cards)
1
Q
The axillary artery:
- arises from the vertebral artery.
- is divided into 3 parts by teres major.
- is clasped in its 3rd part by the cords of the brachial plexus.
- has no branches in its 3rd part.
- supplies the pectoral muscles via the superior thoracic a.
A
supplies the pectoral muscles via the superior thoracic a.
(As does the lateral thoracic)
Superior thoracic artery is the branch off first part axillary a.
Also supplies serratus anterior and subclavius
- arises from the subclavian artery
- Is divided into 3 parts by Pec Minor
- Is clasped in its2nd part by the cords of the brachial plexus
- Has Three branches in its third part
2
Q
With regard to the brachial plexus:
- the axillary n is derived from the lateral cord.
- the radial nerve is derived from C7, 8 and T1.
- the nerve to subclavius is the only branch from the trunks.
- there are 7 divisions of the trunks.
- the roots lie between the scalene muscles.
A
The roots lie between the scalene muscles
and emerge between middle and anterior scalene
- the axillary n is derived from the posterior cord
- The radial nerve is derived from C5-T1
- Three nerves off the roots: D**orsal scapular (C5), the nerve to subclavius (C5/6), and long thoracic (C5,6,7) [there is also one nerve off the trunks - suprascapular off the superior trunk. These 4 nerves are the supraclavicular branches].
- There are Six divisions of trunks (1 each ant/post for each trunk)
3
Q
Which is not a branch of the axillary artery: (>1 ANSWER)
- Thoracoacromial
- Sup thoracic
- Post CX humeral
- Dorsal scapular.
- CX scapular.
- Med thoracic
- Lateral thoracic
A
Dorsal scapular - subclavian artery
Circumflex scapular - subscapular artery (which is branch of axilla)
Med thoracic - aka internal thoracic - branch of subclavian
4
Q
1) With regard to the pectoral girdle:
- a) contains three joints, the sternoclavicular, the acromioclavicular and the glenohumeral
- b) serratus anterior, the rhomboids and subclavius attach the scapula to the axial skeleton
- c) pectoralis major and deltoid are the only muscular attachments between the clavicle and the upper limb
- d) teres major provides attachment between the axial skeleton and the girdle
A
a) Pectoral girdle is the scapula and the clavicle.
5 joints are the SC, AC, glenohumeral, scapulocostal, and suprahumeral
b) The scapula attaches to the axial skeleton by serratus anterior (medial border), pec minor, rhomboids (major and minor), levator scapulae, trapezius.
Subclavius o.1st rib i.middle third clavicle.
c) Muscles with clavicular origins are pec major (clavicular hear), deltoid (anterior), and SCM
d) teres major has origin on the lateral border of scapula, and inserts on the humerus
5
Q
2) Choose the odd muscle out as regards insertion/origin:
- a) supraspinatus
- b) subscapularis
- c) biceps
- d) teres minor
- e) deltoid
A
- a) supraspinatus
- Origin - supraspinous fossa (scapula)
- Insertion - greater tubercle humerus (superior facet)
- b) subscapularis
- O - subscapular fossa (scapula)
- I - lesser tubercle humerus
- c) biceps
- O - supraglenoid tubercle (long-head), coracoid process (shorthead)
- I - radial tuberosity / bicipital aponeurosis
- Only one that crosses two joints (shoulder and elbow), only one that inserts on forearm or has action on elbow
- d) teres minor
- O - Lateral border scapular
- I - inferior facet greater tubercle humerus
-
e) deltoid
- O - acromion + spine of scapula; clavicle lateral thrid
- I - deltoid tuberosity of humerus
- They say answer is E) - I assume because it has its insertion on two bones rather than one.
6
Q
3) Which muscle does not insert in or next to the intertubecular groove of the upper humerus?
- a) pectoralis major
- b) pectoralis minor
- c) latissimus dorsi
- d) teres major
A
a) pec major inserts into lateral lip of intertubercular groove
b) pec minor inserts into coracoid process
c) lat dorsi inserts into floor of intertubercular sulcus
d) teres maj inserts into medial lip of intertubercular sulcus
7
Q
4) Identify the incorrect pairing for testing muscles:
- a) latissimus dorsi – abduct to 60° and adduct against resistance
- b) trapezius – shrug shoulders against resistance
- c) rhomboids – place hands on hips and draw elbows back and scapulae together
- d) serratus anterior – push with arms outstretched against a wall
A
a) latissimus dorsi - abduct arm 90 degrees, then adducted against resistence
b) trapezius - shrug shoulders against resistence
c) rhomboids – place hands on hips and draw elbows back and scapulae together
d) serratus anterior – push with arms outstretched against a wall
* Sternoclavicular head of pec major -* abduct to 60° and adduct against resistance
8
Q
5) Identify the incorrect innervation:
- a) subclavius – own nerve from the brachial plexus
- b) serratus anterior – long thoracic nerve
- c) clavicular head of pectoralis major – medial pectoral nerve
- d) latissimus dorsi – dorsal scapular nerve
- e) trapezius – accessory nerve
A
- a) subclavius – nerve to subclavius (C5/6)
- Comes off superior trunk BP
- b) serratus anterior – long thoracic nerve (C5,6,7)
- From posterior aspect of anterior rami of C5,6,7
- c) clavicular head of pectoralis major – lateral pectoral nerve (C5,6,7)
- From lateral cord BP
- Note the question said medial pectoral nerve however this innervates pec minor and the sternocostal head of pec major. This comes from the medial cord (medial pectoral, medial cord; lateral pectoral, lateral cord)
-
d) latissimus dorsi – Thoracodorsal nerve (C6,7,8)
- from posterior cord
- e) trapezius – accessory nerve (XI) for motor, C3+4 for proprioception and pain
- Cranial nerve
- Note dorsal scapular nerve comes from posterior aspect of anterior ramus of C5 (+/- C4), pierces middle scalene, and innervates rhomboids +/- levator scapulae
9
Q
6) Which muscle does not extend from the posterior surface of the scapula to the greater tubercle of the humerus?
- a) teres major
- b) infraspinatus
- c) supraspinatus
- d) teres minor
A
a) teres major inserts on medial lip of intertubercular sulcus
Supraspinatus, infraspinatus, teres minor insert on the superior, middle, and inferior facets of the greater tubercle respectively
10
Q
7) With regard to action, which muscle is the odd one out?
- a) teres minor
- b) deltoid
- c) teres major
- d) subscapularis
A
a) teres minor - laterally rotates arm
Only one that does not medially rotate the arm
b) deltoid - clavicular flexes and medially rotates; acromial abducts; spinous extends and laterally rotates
c) teres major - adducts and medially rotates
d) subscapularos - medially rotates arm
11
Q
8) Which statement is INCORRECT?
- a) the muscles of the rotator cuff are deemed to be such because all their tendons fuse with the lateral part of the shoulder capsule and are attached to the humerus near the joint
- b) the capsule of the shoulder joint is attached at the line of the anatomical head except inferiorly where it extends to the level of the surgical neck
- c) the subacromial bursa lies between the tendon of supraspinatus and the coraco-acromial ligament and communicates with the shoulder joint
- d) the long tendon of biceps lies intracapsular and is sheathed by synovial membrane that allows it to slide with movement
A
c) the subacromial bursa lies between the tendon of supraspinatus and the coraco-acromial ligament and does not communicate with the shoulder joint.
It can communicate with the subdeltoid bursa however
12
Q
9) Stabilising factors of the shoulder joint include all but:
- a) a tight capsule
- b) tendons that fuse with the capsule
- c) glenohumeral and coracohumeral ligaments
- d) labrum
- e) splinting of the humeral head between the tendons of biceps and triceps
A
a) a tight capsule
The loose fibrous joint capsule of the glenohumeral joint attaches medially to the margin of the glenoid cavity and laterally at the anatomical neck of the humerus
13
Q
15) Blood supply to the upper limb, which is FALSE?
- a) the subclavian artery is divided schematically by scalenus anterior
- b) usually all branches of the subclavian come from the first segment
- c) the dorsal scapular branch may arise from the third segment
- d) pectoralis major schematically divides the axillary artery into three parts
- e) the acromial branch of the thoracoacromial trunk accompanies the cephalic vein in the deltopectoral triangle
A
d) pectoralis minor schematically divides the axillary artery into three parts
* Anterior scalenus* divides subclavian into 3 parts
b) usually all branches of the subclavian come from the first two segments
First = thyrocervical trunk (->inferior thyroid, suprascapular, transverse cervical artery)
Second = costocervical trunk (-> deep cervical and superior intercostal)
Dorsal scapular artery can come from the 2nd or 3rd part, or somtimes from the deep cervical artery
14
Q
21) The clavicle:
- a) ossifies at eight weeks
- b) has atypical synovial joints at both ends
- c) articulates with the first rib
- d) is more curved in females
- e) usually fractures between deltoid tubercle and coranoid tubercle
A
b) has atypical synovial joints at each end (due to fibrous discs - complete in SC joint, incomplete in AC)
c) Articulates with the sternum and acromion of scapula
* e) Usually fractures between the medial 2/3rds and distal third.*
15
Q
24) Axillary artery:
- a) first part is separated from the cords by axillary sheath
- b) lies posterior lateral to vein – all three parts
- c) medial root of median nerve crosses behind ????? to join lateral root.
- d) leaves axillar through quadrangular space
- e) supplies the breast via thoracoacromial branch
A
a) the first part of the axillary artery is contained in the axillary sheath, which also contains the axillary vein and the three cords of brachial plexus
b) The axillary vein is initially (distally) anteromedial to the artery, terminally is anteroinferior
c) medial and lateral roots of median nerve merge to form median nerve lateral to axillary artery
d) the axillary nerve and posterior circumflex humeral artery leave through the quadrangular space
e) breast blood supply is from the internal thoracic artery, a branch of subclavian
16
Q
10) Regarding the brachial plexus, which is INCORRECT?
- a) it is derived from the anterior rami of C5-T1 after they have given off segmental supply to the prevertebral and scalene muscles
- b) the roots give off three branches including the long thoracic nerve to latissimus dorsi
- c) the trunks give off one branch
- d) the cords are divided into anterior and posterior divisions that supply the flexor and extensor compartments respectively and give off 13 branches
- e) the lateral cord supplies part of the median nerve
A
b) the roots give off three branches including the long thoracic nerve to latissimus dorsi
* Long thoracic supplies serratus anterior.*
* Latissimus dorsi is supplied by thoracodorsal nerve*
* Alternate information regarding whether nerve to subclavius comes off roots or trunks. Moores suggests it is off the superior trunk, Anatomedia + ShakEM puts it off the roots (C5,6). Knowing that Lat dorsi is suppled by thoraco dorsal, we have to assume that ‘c) one branch off the trunks’ is correct, and therefore that subclavian nerve is off the roots.*
* Three branches off roots are long thoracic, dorsal scapular, and nerve to subclavius.*
* Superior trunk gives suprascapular nerve, this is the only one off the trunks*
* The divisions are divided into anterior and posterior divisions; cords are lateral, posterior, and medial*
Median nerve has supply from lateral and medial cords
17
Q
11) Regarding lymph nodes, the lateral side of the arm and forearm is drained initially to the:
- a) supratrochlear nodes
- b) posterior axillary nodes
- c) infraclavicular nodes
- d) central axillary nodes
A
They think c) but this doesnt seem quite right. Answer should probably be apical nodes:
Posterior axillary (subscapular) nodes drain the posterior thoracic wall and scapular region
Anterior axillary (pectoral) nodes drain anterior thoracic wall and the breast
Humeral (lateral) nodes drain the upper arm
These 3 then drain into the central nodes->apical nodes
Lymph accompanying basilic vein->cubital lymph nodes (medial forearm)
Lymph accompanying cephalic vein->apical axilly nodes (lateral forearm)
Apical nodes drain to the subclavian lymphatic trunk, although some pass through the infra and supra clavicular nodes en route
18
Q
13) As it emerges from the axilla, the median nerve lies where with regards to the brachial artery?
- a) lateral
- b) anterior
- c) medial
- d) posterior
A
a) lateral
Apparently
19
Q
16) Regarding the brachial plexus, which is FALSE?
- a) the nerve to serratus anterior comes from the anterior rami of C5-C7
- b) the suprascapular nerve arises from C5 anterior ramus
- c) the divisions are at the level of the clavicle
- d) the thoracodorsal nerve arises from the posterior cord
- e) the radial nerve is the largest branch of the brachial plexus
A
They thought all were correct, but b) is false.
a) Serratus anterior supplied by long thoracic nerve, which comes from anterior rami of C5-C8
b) the dorsal scapular nerve arises from the C5 root
Suprascapular nerve arises from the superior trunk (along with nerve to subclavian
c) The divisions pass under the clavicle, and divide the plexus into supraclavicular and infraclavicular portions
d) The thoracodorsal nerve arises from the posterior cord and supplies latissimus dorsi
e) the radial nerve is the largest branch
20
Q
17) Regarding the brachial plexus:
- a) the lateral cord contains fibres from C5, 6, 7 & 8
- b) the posterior cord has fibres from C5, 6, 7, 8 & T1
- c) the medial cord has fibres from C8 and T1
- d) the suprascapular nerve arises from C5
- e) the ulnar nerve is a continuation of the medial cord
A
- They thought a) but that seems wrong. b, c, e all seem right (depending on if you distinguish ‘terminal branch’ from ‘continuation’)
- a) the lateral cord contains fibres from C5, 6, 7
- b) the posterior cord has fibres from C5, 6, 7, 8 & T1
- c) the medial cord has fibres from C8 and T1
- d) the suprascapular nerve arises from superior trunk and supplies supra and infra spinatus. The Dorsal Scapula nerve arises from C5.
- e) the ulnar nerve is a continuation of the medial cord
21
Q
19) Regarding the brachial plexus:
- a) the roots lie behind scalenus medius muscle
- b) the trunks are formed behind the clavicle
- c) at the first rib, the cords are formed
- d) the cords give branches around second part of artery
A
I think it is d), they had no answer
a) The roots run in front of scalenus medius, behind scalenus anterior
b) The divisions are formed/run behind the clavicle
c) I think the trunks are formed at the 1st rib, as they enter the cervico-axiallary canal. Then form divisions pasing under the clavicle, and cords are formed in the axilla proper.
d) The cords are named as to their location about the second part of the axillary artery. They give off multiple branches from the cords, as well as divide into the terminal branches here.
22
Q
18) Which is CORRECT?
- a) medial pectoral nerve C7 C8
- b) ulnar nerve C7 C8 T1
- c) dorsal scapular nerve C5 C6
- d) long thoracic nerve C6 C7 C8
- e) musculocutaneous C5 C6
A
a) medial pectoral nerve C8 T1 (off of medial cord)
b) ulnar nerve C7 C8 T1
c) dorsal scapular nerve C5 root
d) long thoracic nerve C5 C6 C7 C8 nerve roots
e) musculocutaneous C5 C6 C7
23
Q
5) Brachial plexus:
- a) the five roots lie in front of scalenus anterior muscle
- b) the anterior division of the central trunk runs on as the medial cord
- c) the suprascapular nerve is the only branch from the trunks
- d) the radial nerve is a branch of the lateral cord
- e) the ulna nerve is a branch of the posterior cord
A
They say C - I believe this is from an old text book
Current Moores 8th ed states that suprascapular and subclavian nerve are off the superior trunk, so 2 from trunks and 2 from roots (dorsal scapular + long thoracic)
- a) the five roots lie behind scalenus anterior muscle, in front of scalenus medius
- b) the anterior division of the inferior trunk runs on as the medial cord
- c) the suprascapular nerve and subclavian nerve are the only two branches from the trunks (both from superior trunk)
- d) the radial nerve is a branch of the posterior cord
- e) the ulna nerve is a branch of the medial cord
24
Q
6) The musculocutaneous nerve passes through which muscle?
- a) coracobrachialis
- b) short head of biceps
- c) brachialis
- d) medial head of triceps
- e) long head of biceps
A
a) coracobrachialis
25
8) Latissimus dorsi:
* a) is an accessory muscle of inspiration and expiration
* b) is supplied by the dorsal scapular nerve
* c) forms the lower border of the medially axillary fold
* d) laterally rotates the humerus
* e) lies superficial to trapezius at its upper border
* **a) is an accessory muscle of inspiration and expiration**
* **...and assists as a muscle of both forced expiration (anterior fibers) and an accessory muscle of inspiration (posterior fibers) [Wikipedia - not mentioned in the upper limb section of Moores]**
* b) is supplied by the *thoracodorsal nerve*
* *Dorsal scapular supplies rhomboids +/- levator scapulae*
* c) forms the lower border of the *posterior* axillary fold
* d) *medially* rotates the humerus
* Only infraspinatus, teres minor, and spinal portion of deltoid laterally rotate humerus
* Subscapularis, pec major, lat dorsi, teres major, clavicular portion of deltoid medially rotate it
* e) lies *deep* to trapezius at its upper border
26
9) Regarding the shoulder joint, which is INCORRECT?
* a) full abduction requires medial rotation
* b) the long head of biceps is intracapsular
* c) the subacromial bursa is attached to the coracoacromial ligaments
* d) flexion involves pec major, deltoid, coracobrachialis and biceps
* e) supraspinatus initiates abduction
a) full abduction requires *lateral* rotation
27
11) What structure does NOT pierce the clavipectoral fascia?
* a) cephalic vein
* b) lymphatics
* c) lateral thoracic artery
* d) lateral pectoral nerve
* e) thoracoacromial artery
c) lateral thoracic artery
Coming in = cephalic vein + lymphatics
Going out = thoracoacromial artery + lateral pectoral nerve
28
14) Teres major:
* a) receives its nerve supply from the lateral cord of the brachial plexus
* b) is part of the medial wall of the axilla
* c) forms the medial border of the triangular space
* d) is separated from teres minor by the long head of triceps
* e) has the same nerve supply as teres minor
a) Nerve supply is lower subscapular nerve (off posterior cord)
b) is part of the *posterior* wall of axilla
c) forms the *inferior* border of the triangular space
**d) d) is separated from teres minor by the long head of triceps**
e) Nerve supply to teres minor is the axillary nerve
29
15) Regarding the brachial plexus:
* a) the dorsal scapular nerve is the only branch from the trunks
* b) the axillary nerve is derived from C5, 6, 7, 8, T1
* c) the ulnar nerve is the largest branch of the whole plexus
* d) the axillary nerve passes below teres major
* e) the thoracodorsal nerve supplies lateral dorsi
a) the dorsal scapular nerve + *subclavian nerve are* the only branch from the trunks (both from superior trunk)
b) the axillary nerve is derived from C5 + 6 (from posterior cord)
c) the *radial nerve* is the largest branch of the plexus
d) Axillary nerve exits the axilla through the quadrangular space (along wtih post cx humeral artery)
Below teres minor, above teres major
**e) the thoracodorsal nerve supplies lateral dorsi**
30
25) With respect to the brachial plexus:
* a) it consists of the entire anterior rami of C5 → T1
* b) there are five roots, three trunks, five divisions and three cords
* c) there are two branches from the divisions
* d) there are a total of 13 branches from the cords
* e) there are three branches from the roots
**d) there are a total of 13 branches from the cords**
**3 from lateral, 5 each post and medial**
* a) it *does not* consist of the entire anterior rami of C5 → T1
* Some of the fibres -\> cervical plexus off C5 (eg phrenic nerve)
* b) there are five roots, three trunks, *six* divisions (1 ant and 1 post each trunk), and three cords
* c) there are *no* branches from divisions. (2 from roots, 2 from trunks, 13 from cords)
* e) there are *two* branches from the roots: Long thoracic (C5,6,7) and dorsal scapular (C5)
* Subclavian nerve and suprascapular nerve come off the superor trunk = 4 supraclavicular branches
* Note there are differing opinions here depending on source, but this is how Moores see's it.
31
26) With respect to the brachial plexus:
* a) the lateral cord lies in the axilla
* b) the median nerve is the largest branch of the whole plexus
* c) the roots lie within the posterior triangle of the neck
* d) the ulnar nerve is a branch of the lateral cord
* e) the musculocutaneous nerve is a branch of the medial cord
* **a) the lateral cord lies in the axilla (as do all the cords)**
* b) the median nerve is the largest branch of the whole plexus radial
* c) the *trunks* lie within the posterior triangle of the neck (*roots are between anterior and middle scalene)*
* d) the ulnar nerve is a branch of the *medial* cord
* e) the musculocutaneous nerve is a branch of the *lateral* cord
32
24) With respect to the axilla:
* a) the thoracodorsal nerve runs posterior to the mid axillary line on serratus anterior, which it supplies
* b) the axillary artery is divided into three parts by scalenus anterior
* c) the lateral wall is made up of latissimus dorsi tendon, subscapularis, teres major
* d) the lateral thoracic vein is connected by the thoracoepigastric vein to the superficial epigastric vein, therefore bypassing the IVC in its obstruction
* e) the axillary vein commences at the upper border of teres major as a continuation of the basilic vein
* a) the thoracodorsal nerve runs posterior to the mid axillary line on serratus anterior, *and supplies latissimus dorsi*
* *Serratus anterior is supplied by long thoracic nerve*
* b) the axillary artery is divided into three parts by *pec minor*
* c) the lateral wall is made up of *humerus/intertubercular sulcus (posterior wall is* made up of latissimus dorsi tendon, subscapularis, teres major)
* **d) the lateral thoracic vein is connected by the thoracoepigastric vein to the superficial epigastric vein, therefore bypassing the IVC in its obstruction**
* e) the axillary vein commences at the *lower* border of teres major as a continuation of the basilic vein
33
23) The clavipectoral fascia is pierced by all but one of the following structures:
* a) lymphatic drainage from the infraclavicular nodes to apical axillary nodes
* b) cephalic vein
* c) lateral pectoral nerve
* d) thoracoacromial artery
* e) pectoralis minor
* a) lymphatic drainage from the infraclavicular nodes to apical axillary nodes - IN
* b) cephalic vein - IN
* c) lateral pectoral nerve - OUT
* d) thoracoacromial artery - OUT
* **e) pectoralis minor**
34
21) Regarding the clavicle, which is false?
* a) the clavicle is longer and its curvatures more pronounced in the male
* b) the articulating sternal end is covered by fibrocartilage
* c) it is the first bone to ossify in the foetus
* d) it has four named ligaments attached to it
* e) fractures of the clavicle tend to occur between the costoclavicular and the coracoclavicular ligaments
d) it has four named ligaments attached to it
2: costoclavicular, corococlavicular
35
22) Which is true of muscles of the pectoral girdle?
* a) “direct” muscles are inserted into the clavicle or scapula from the axial skeleton, eg pectoralis major
* b) “indirect” attachment to the axial skeleton is represented by serratus anterior
* c) the sternocostal fibres of pectoralis major from the 6th costal cartilage are inserted higher on the laterallip of the intertubecular soleus than the fibres from the first cartilage
* d) biceps muscle gives no stability to the shoulder joint
* e) trapezius is the only muscle to be supplied by all five segments of the brachial plexus
**c) the sternocostal fibres of pectoralis major from the 6th costal cartilage are inserted higher on the lateral lip of the intertubecular soleus than the fibres from the first cartilage**
d) biceps muscle *short head resists dislocation of the shoulder joint*
e) trapezius is *innervated by the spinal accessory nerve (XI), a cranial nerve, and not the brachial plexus*
* Cannot find anything on direct/indirect attachments, but pec major inserts on the humerus and serratus on the scapula, so their distinctions are likely to be reversed.*
36
17) Which nerve supplies serratus anterior?
* a) axillary nerve (C5, C6)
* b) long thoracic nerve (C5, C6, C7)
* c) musculocutaneous nerve (C5, C6)
* d) thoracodorsal nerve (C6, C7, C8
* e) suprascapular nerve (C5, C6)
* a) axillary nerve (C5, C6) *-\> deltoid + teres minor*
* **b) long thoracic nerve (C5, C6, C7)**
* c) musculocutaneous nerve (C5, C6) *-\> biceps, brachialis, coracobrachialis*
* d) thoracodorsal nerve (C6, C7, C8) *- latissimus dorsi*
* e) suprascapular nerve (C5, C6) *- supraspinatus and infraspinatus. (*Nerve passes through the suprascapular notch)
37
12) Which of the following has some nerve supply from the radial nerve?
* a) long head of biceps
* b) coracobrachialis
* c) short head of biceps
* d) brachialis
**d) brachialis**
O: Distal half anterior humerus
I: Ulnar tuberosisty and coronoid process
Inn: Like all anterior compartment flexors (along with biceps brachii and coracobrachilis) is mainly supplied by musculocutenous nerve. However it receives its sensory supply from radial nerve, and is the only anterior compartment muscle to do so.
38
14) With regards to the posterior compartment of the arm, which is FALSE?
* a) the medial head of triceps lies deep to the long and lateral heads
* b) triceps inserts onto the upper surface of the olecranon
* c) midshaft fracture of the humerus can damage the radial nerve resulting in paralysis of triceps
* d) the medial intermuscular septum divides it from the anterior compartment and runs from the axilla to the elbow
c) midshaft fracture of the humerus can damage the radial nerve *resulting in paralysis of triceps*
I think this is wrong because by this stage, the radial nerve has already supplied at least the long and lateral heads.
The medial head inserts inferiorly to the radial groove.
39
26) Regarding triceps:
* a) lateral head arises from humerus below radial groove
* b) midshaft humerus fractures may paralyse triceps
* c) has an insertion into the elbow joint capsule
* d) aids in adduction of shoulder
* e) is pierced by ulnar nerve
* a) *Medial* head arises from humerus below radial groove
* b) midshaft humerus fractures may *not* paralyse triceps
* Innervation to long and lateral heads is proximal to this
* Will paralyse extensor muscles of forearm
* c) has an insertion into the elbow joint capsule
* Anconeus does
* **d) aids in adduction of shoulder**
* **Long head aids adduction and extension of arm, and stabilises glenohumeral joint**
* e) Ulnar nerves pierces the *medial intermuscular septum*
* musculocutaneous nerve pierces coracobrachialis
40
20) In the cubital fossa
* a) median nerve lies lateral to the biceps tendon
* b) radial nerve and interosseous branch lies beneath the brachialis
* c) radial artery passes between heads of pronator teres
* d) brachial artery lies beneath biceps aponeurosis
* e) radial nerve leaves fossa between heads of supinator
* a) median nerve lies *medial* to the biceps tendon
* TAN lat-\>med: tendon, artery, nerve
* b) radial nerve and interosseous branch lies *above* the brachialis, *below brachioradialis*
* c) *Median nerve* passes between heads of pronator teres, *then runs between FDS and FDP, below palmaris longus tendon, enters wrist in carpal tunnel*
* Radial artery runs under brachioradialism lateral to FCR tendon in distal forearm, winds around lateral radius and crosses floor of snuffbox
* **d) brachial artery lies beneath biceps aponeurosis**
* e) *Deep branch of radial nerve (posterior Interosseus) penetrates supinator to enter posterior compartment of forearm*
41
1) At the elbow joint:
* a) the tilt of the trochlear of the humerus is the main cause for the carrying angle of the elbow
* b) the capsule is not attached to the radius
* c) the annular ligament is attached to the head and neck of the radius
* d) the middle band is the strongest of the three bands that make up the ulnar collateral ligament
* e) the carrying angle is the angle between the extended ulna and the vertical
* a) the tilt of the trochlear of the humerus *improves degree of flexion available*
* **b) the capsule is not attached to the radius - *it attaches to the annular ligament***
* c) the annular ligament is *not* attached to the head and neck of the radius, *it is attached to the ulnar and merely surrounds the radius but does not attach*
* d) the *anterior* band is the strongest of the three bands that make up the ulnar collateral ligament
* anterior, posterior, oblique bands (no middle band). Anterior is the strongest, posterior weakest
* e) the carrying angle is the angle between the extended ulna and the *humerus*
42
4) Regarding the nerves and vessels of the arm:
* a) the circumflex vessels and the axillary nerve enter the extensor compartment in the axilla through the triangular space
* b) the ulnar nerve pierces the lateral intermuscular septum in the lower third of the arm
* c) the median nerve crosses obliquely in front of the radial artery in the arm
* d) supratrochlear lymph nodes lie in the subcutaneous tissue just above the medial epicondyle
* e) the basilic vein is lateral to the cephalic vein
* a) the *posterior humeral* circumflex vessels and the axillary nerve enter the *scapular region* through the *quadrangular* space
* b) the ulnar nerve pierces the *medial* intermuscular septum *about the middle of the arm*
* c) the median nerve crosses obliquely in front of the *brachial* artery in the arm (medial-\>lateral)
* **d) *cubital* lymph nodes lie in the subcutaneous tissue just above the medial epicondyle**
* **Supratrochlar lymph nodes arent mentioned in Moores, Wikipedia identifies them as being distinct but in the same location**
* e) the basilic vein is medial to the cephalic vein
43
13) Which artery is the main supply of triceps?
* a) dorsal scapular artery
* b) brachial artery
* c) profunda brachii artery
* d) radial artery
* e) posterior circumflex humeral artery
c) profunda brachii artery
44
18) At the elbow joint:
* a) there is no communication with the proximal radioulnar joint
* b) the capsule is attached to the neck of the radius
* c) the radial collateral ligament is made up of three bands
* d) the ulnar nerve passes between the anterior and posterior bands of the ulnar collateral ligament
* e) the carrying angle is greater in men
* a) there **is** communication with the proximal radioulnar joint
* They share a joint cavity
* b) the capsule is attached to the *annular ligament, it does not have any attachment to the* neck of the radius
* c) the *ulnar* collateral ligament is made up of three bands
* Anterior (stongest), posterior (weakest), oblique
* Radial collateral ligament is fanshaped and blends with the annular ligament distally
* **d) the ulnar nerve passes between the anterior and posterior bands of the ulnar collateral ligament**
* **Runs between the two heads of FCU as it moves distally**
* e) the carrying angle is greater in *women (15 vs 10 degrees)*
* *Because they got big fat hips they dont want to bump with their arms*
I cant find anything specific on d) being right, and the one picture i can find shows it doesnt really pass there, but everything else is definitely wrong
45
20) Which nerve does NOT make contact with periosteum?
* a) radial nerve
* b) axillary nerve
* c) median nerve
* d) ulnar nerve
* e) anterior interosseous nerve
* a) radial nerve - in radial groove - humeral shaft
* b) axillary nerve - humerus as it passes quadrangular space
* **c) median nerve**
* d) ulnar nerve - in ulnar groove- elbow
* e) anterior interosseous nerve - runs on interosseus membrane and presumably touches periosteum at some point
46
27) The blood supply to the breast involves all but one of the following:
* a) lateral thoracic artery
* b) long thoracic artery
* c) internal thoracic artery
* d) posterior intercostal artery
* e) thoracoacromial artery
b) long thoracic artery
Blood supply to breast comes from 3 sources
1. Axillary artery branches laterally: superior thoracic, thoracoacromial trunk, lateral thoracic, subscapular
2. Internal thoracic branches medially
3. Perforating branches of 2nd, 3rd, 4th intercostal arteries
'Long thoracic' artery does not exist (but the nerve does -\> serratus anterior)
47
28) Which muscle takes origin (in part) from both the medial and lateral intermuscular septa?
* a) biceps
* b) brachioradialis
* c) extensor carpi radialis longus
* d) supinator
* e) triceps
e) triceps
Not in Moores or Anatomedia, but as per Wikipedia
48
23) At the wrist / carpal tunnel:
* a) flexor retinaculum attaches to scaphoid and trapezoid laterally
* b) all superficial and deep flexors, except flexor pollicis longus, share a common flexor sheath
* c) the ulnar nerve lies medial to pisiform
* d) tendons of flexor digitorum remain attached until they reach the palm
* e) median nerve lies beneath flexor retinaculum between flexor digitorum superficialis and flexor pollicis longus
* a) flexor retinaculum attaches to scaphoid (*tubercle)* and _trapez*ium*_ laterally
* Medially to pisiform and hook of hamate
* b) all superficial and deep flexors, except flexor pollicis longus, share a common flexor sheath
* Common flexor sheath is for FDS and FDP flexors
* Palmaris longus passses over flexor retinaculum.
* All other flexors act at the wrist or RUJ (FCU, FCR, pronator teres and quadratus)
* c) the ulnar nerve lies *lateral* to pisiform
* In Guyons canal, between pisiform and hook of hamate, superficial to flexor retinaculum
* d) tendons of flexor digitorum remain attached until they reach the palm
* ?attached to what, but they seem to divide into individual tendons before the wrist
* **e) median nerve lies beneath flexor retinaculum between flexor digitorum superficialis and flexor pollicis longus**
* **Seems best answer - betweem tendons of these two muscles, and superficial to FDP**
49
25) All the following arise from the common extensor origin EXCEPT:
* a) extensor carpi radialis brevis
* b) extensor carpi radialis longus
* c) extensor digitorum
* d) extensor digitorum minimi
* e) extensor carpi ulnaris
**b) extensor carpi radialis longus**
**From lateral supraepicondylar ridge of humerus (just distal to brachioradialis)**
**ECO is ECRB, ED, EDM, heads of ECU and supinator**
50
28) Which joint is the odd one out with regard to degrees of freedom?
* a) 1st carpometacarpal joint
* b) radiohumeral joint
* c) sternoclavicular joint
* d) acromioclavicular joint
* e) radiocarpal joint
* **a) 1st carpometacarpal joint - saddle**
* b) radiohumeral joint - ?rotates/indirect joint
* c) sternoclavicular joint - saddle
* d) acromioclavicular joint - few
* e) radiocarpal joint - few
Need to clarify answer
51
3) Which is NOT an origin of supinator
* a) radial tuberosity
* b) radial collateral ligament
* c) lateral epicondyle of humerus
* d) supinator crest of ulnar
* e) aponeurosis overlying supinator muscle
**a) radial tuberosity**
***Inserts* onto radius, cannot have origin there**
Lateral epicondyle of humerus
Radial collateral and annular ligaments
Supinator fossa
Crest of ulna
52
7) What structure does NOT lie in the anatomical snuff box?
* a) cephalic vein
* b) radial artery
* c) radial styloid
* d) first metacarpal bone
* e) extensor pollicis longus
* a) cephalic vein - content
* b) radial artery - content
* c) radial styloid - floor
* d) first metacarpal bone - base is floor
* **e) extensor pollicis longus - makes up ulnar border**
53
10) In the forearm:
* a) the median nerve passes between the two heads of pronator teres
* b) the ulnar nerve lies deep to flexor digitorum profundus
* c) superficial fibres of flexor digitorum superficialis gives rise to the tendons for index and middle fingers
* d) the radial artery is on the lateral side of the radial nerve
* e) the fibres of the interosseous membrane run obliquely down from ulna to radius
* **a) the median nerve passes between the two heads of pronator teres**
* b) the ulnar nerve lies *superficial* to flexor digitorum profundus, *deep to FCU*
* c) superficial fibres of flexor digitorum superficialis gives rise to the tendons for index and middle fingers
* ??but likely the lateral fibres
* d) the radial artery is on the lateral side of the radial nerve
* ??answer
* e) the fibres of the interosseous membrane run obliquely down from *radius to ulna*
54
16) Flexor pollicis longus:
* a) is a bipennate muscle
* b) arises from the common flexor origin
* c) pierces the flexor retinaculum at the wrist
* d) inserts into the radial border of the proximal phalanx
* e) has fleshy fibres to a point, just above the wrist
* a) is a *unipennate* muscle
* b) arises from the *anterior surface of radius and adjacent IOM*
* **Is a deep muscle of forearm
* c) pierces the flexor retinaculum at the wrist
* Traverses flexor retinaculm lateral to FDS/FDP in its own synovial sheath
* d) inserts into the *base of distal phalanx*
* **e) has fleshy fibres to a point, just above the wrist**
55
19) Which structure does NOT insert into the flexor retinaculum?
* a) abductor pollicis brevis
* b) flexor digiti minimi brevis
* c) palmaris longus
* d) opponens pollicis
* e) flexor pollicis brevis
**c) palmaris longus**
**o. common flexor**
**i. flexor retinaculum and palmar aponeurosis**
* flexor digiti minimi brevis
* o. FR + hook of hamate
* i. medial side of base of PP of 5th digit
* opponens pollicis, Abductor pollicis brevis, flexor pollicis brevis
* i. flexor retinaculum + *tubercles of scaphoid and trapezium*
*Unclear what the answer is - they think C which inserts into FR, everything else has an origin there*
56
9) Pectoralis major:
* a) is innervated laterally by the lateral pectoral nerve
* b) inserts into the medial lip of the intertubercular sulcus
* c) receives its arterial supply via the thoracoacromial artery
* d) can act as an accessory muscle of inspiration
* e) acts with latissimus dorsi and teres minor to adduct the arm
* a) is innervated laterally by the lateral pectoral nerve ( + *medial pectoral nerve)*
* b) inserts into the *lateral* lip of the intertubercular sulcus
* c) receives its arterial supply via the thoracoacromial artery
* Blood supply from pectoral branch of thoracoacromial artery, lateral thoracic +/- superior thoracic
* **d) can act as an accessory muscle of inspiration**
* e) acts with latissimus dorsi and teres minor to adduct the arm
* Teres minor laterally rotates the arm - it does not adduct
57
24) The nerve supply of serratus anterior is:
* a) axillary nerve
* b) C4
* c) dorsal scapular nerve
* d) thoracodorsal nerve
* e) long thoracic nerve
**e) long thoracic nerve**
58
25) Which muscle arises from both the radius and ulna:
* a) extensor pollicis longus
* b) extensor pollicis brevis
* c) abductor pollicis longus
* d) extensor indicis
* e) extensor digitorum
* a) extensor pollicis longus - posterior surface middle third of ulna + IOM
* b) extensor pollicis brevis - post surface distal third of radius + IOM
* **c) abductor pollicis longus - posterior surface of proximal half radius, ulna, IOM**
* d) extensor indicis - distal third ulna + IOM
* e) extensor digitorum - common extensor origin
59
27) At the cubital fossa:
* a) the median nerve is medial to the brachial artery
* b) the biceps tendon separates the brachial artery from the median nerve
* c) the radial artery leaves the brachial artery at right angles
* d) the medial cutaneous nerve of the forearm runs deep to the bicipital aponeurosis
* e) pronator teres forms the floor of the fossa
* **a) the median nerve is medial to the brachial artery**
* b) the biceps tendon separates the brachial artery from the median nerve
* Tendon-Artery-Nerve from Lat-\>medial
* c) the radial artery leaves the brachial artery at right angles
* ??? no
* d) the medial cutaneous nerve of the forearm runs s*uperficial* to the bicipital aponeurosis
* from median cord in brachial plexus, veers off at mid-arm and pierces deep fascia with basilic vein to supply median foreaarm
* e) *brachialis and supinator* forms the floor of the fossa
* Pronator teres forms the medial border
60
26) Which lymphatics do not drain the breast?
* a) subscapular nodes
* b) infraclavicular nodes
* c) lateral axillary nodes
* d) parasternal nodes
* e) pectoral nodes
**c) lateral axillary nodes (aka humeral nodes)**
**Receive lymph from upper arm**
**Subscapular drains posterior trunk and subscapular region**
**Infraclavicular, parasternal, pectoral are all involved in various facets of anterior thoracic wall drainage**
61
23) Which is the smallest branch of the medial cord of the brachial plexus?
* a) medial pectoral nerve
* b) medial root of the median nerve
* c) medial cutaneous nerve of the arm
* d) medial cutaneous nerve of the forearm
* e) ulnar nerve
c) medial cutaneous nerve of the arm
Supplies only upper, inner, medial arm
62
22) The following are true about flexor carpi radialis EXCEPT:
* a) it arises from the common flexor origin at the humerus
* b) it has its own compartment in the flexor retinaculum
* c) the radial artery lies laterally to it at the wrist
* d) flexor pollicis longus lies medially
* e) it is supplied by the median nerve
* f) it inserts into the base of the 2nd and 3rd metacarpals
f) it inserts into the base of the 2nd and 3rd metacarpals
**2nd only**
d) flexor pollicis longus lies *laterally*
* Seems to be the muscle bulk does, but tendon seems to run medially to FCR at the carpal tunnel*
* They think (d) only*
63
18) Regarding the brachial plexus:
* a) the medial cord has three branches
* b) the lateral cord has fibres from C7, C8 and T1
* c) the musculocutaneous nerve is a branch of the medial cord
* d) the five roots are found from the posterior rami and C5 – T1 nerves
* e) none of the above
**e) none of the above**
* a) the *lateral* cord has three branches
* Lateral pectoral n, musculocutaneous nerve, lateral root median nerve
* b) the lateral cord has fibres from C5,6,7
* c) the musculocutaneous nerve is a branch of the *lateral* cord
* d) the five roots are found from the *anterior* rami and C5 – T1 nerves
* e) none of the above
64
22) Regarding innervation of hand muscles:
* a) opponens pollicis may be supplied by ulnar nerve
* b) opponens digiti minimi may be supplied by median nerve
* c) two radial interossei are usually supplied by median nerve
* d) nail beds are supplied 31⁄2 to 11⁄2 by branches of radial and ulnar nerves
* e) adductor pollicis is supplied by muscular (recurrent) branch of median nerve
**None appear to be right, no answer given**
* a) opponens pollicis may be supplied by *median* nerve (*along with all thenar muscles except deep head of FPB)*
* b) opponens digiti minimi may be supplied by *ulnar* nerve (*along will all hypothenar muscles)*
* c) two radial *lumbricals* are usually supplied by median nerve
* All interossei are supplied by ulnar
* d) nail beds are supplied 31⁄2 to 11⁄2 by branches of *median* and ulnar nerves
* e) adductor pollicis is supplied by *deep branch of ulnar nerve*
65
2) Regarding palmar spaces:
* a) the hypothenar space contains the long tendon of abductor digiti minimi
* b) the midpalmar space is deep to the common synovial sheath and flexor tendons
* c) the midpalmar space is not continuous with the three ulnar lumbrical canals
* d) the thenar space is open at the wrist
* e) prevent spread of infection
* a) the hypothenar space contains the *muscle belly* abductor digiti minimi - *intrinsic muscle of the hand, does not have a long tendon*
* **b) the midpalmar space is deep to the common synovial sheath and flexor tendons**
* c) the midpalmar space is not continuous with the three ulnar lumbrical canals (wrong, but ?why)
* d) the *midpalmar space* is open at the wrist *and is continuous with the anterior compartment of the forearm via the carpal tunnel*
* e) prevent spread of infection - *can help spread of infection from one finger to another*
66
12) Regarding the thumb:
* a) abductor pollicis longus originates from both radius and ulna
* b) opponens pollicis rotates the first metacarpal on the triquetral
* c) adductor pollicis inserts on to the radial sesamoid of the thumb, then the base of the proximal phalanx
* d) nerve supply is by the median nerve (C7, C8)
* e) adductor pollicis lies superficial to the thenar space
* **a) abductor pollicis longus originates from both radius and ulna**
* **inserts on base of first MC, part of outcropping section of deep extensors of forearm**
* b) opponens pollicis rotates the first metacarpal on the *trapezium*
* c) adductor pollicis inserts on to the radial sesamoid of the thumb, then the base of the proximal phalanx
* I don't know if sesamoid bones count as an insertion, but adductor pollicis usually has one
* d) nerve supply is *primarily* by the median nerve *to the thenar space* (C7, C8)
* proximal dorsal aspect sensation is radial; deep head of FPB is ulnar; APL, EPL, EPB are PION (off radial n)
* e) adductor pollicis lies *deep* to the thenar space
67
29) The carpus:
* a) there are five extensor tunnel compartments
* b) the extensor expansion attaches to the anterolateral border of the radius above the styloid process, and distally to the pisiform and trapezoid bones
* c) the radiocarpal joint is an uniaxial synovial joint
* d) there are no muscular attachments to the extensor surface of the carpus
* e) the bones palpable in the anatomical snuff box are the radial styloid, triquetral, scaphoid and base of first metacarpal
* a) there are *six* extensor tunnel compartments
* b) the extensor *retinaculum* attaches to the anterolateral border of the radius above the styloid process, and distally to the pisiform and trapezoid bones
* *extensor expansion is covering the dorsal aspect of fingers*
* c) the *distal radioulnar* joint is an uniaxial synovial *pivot* joint
* radiocarpal joint is synovial condyloid joint
* **d) there are no muscular attachments to the extensor surface of the carpus**
* e) the bones palpable in the anatomical snuff box are the radial styloid, *trapezium*, scaphoid and base of first metacarpal
68
30) Which is true?
* a) the flexor synovial sheath is only continuous from wrist to distal phalanx in the thumb
* b) the medial cutaneous nerve is the smallest nerve branch of the brachial plexus
* c) the capitate bone within the carpus is the last of these to ossify
* d) the pisiform bone is the first bone of the carpus to ossify
* e) superficial lymphatics lie with arteries, deep lymphatics with veins
* a) the flexor synovial sheath is only continuous from wrist to distal phalanx in the thumb
* **b) the medial cutaneous nerve is the smallest nerve branch of the brachial plexus**
* c) the capitate bone within the carpus is the last of these to ossify
* d) the pisiform bone is the first bone of the carpus to ossify
* e) superficial lymphatics lie with arteries, deep lymphatics with veins
69
10) Regarding the brachial plexus:
* a) the suprascapular nerve arises from the anterior C5, 6 division
* b) ulnar nerve often carries fibres from C7
* c) the radial nerve leaves the axilla via the quadrangular space
* d) the radial artery lies anterior to the medial and lateral roots of the median nerve
* e) the long thoracic nerve arises from the C5 nerve root only
* a) the suprascapular nerve arises from the anterior C5, 6 division
* Superior trunk (C5/6)
* **b) ulnar nerve often carries fibres from C7**
* **C7,8,T1**
* c) the *axillary* nerve leaves the axilla via the quadrangular space
* Radial nerve leaves via the triangular interval
* d) the radial artery lies anterior to the medial and lateral roots of the median nerve
* Just...no. Axillary artery if anything
* e) the *dorsal scapular* nerve arises from the C5 nerve root only
* Long thoracic nerve is C5,6,7
70
11) The subacromial bursa:
* a) communicates with the shoulder joint
* b) does not extend beyond the lateral aspect of the acromion
* c) innervated in part by the dorsal scapular nerve
* d) attached superiorly to the conoid trapezoid and conoid ligaments
* e) attached inferiorly to the tendon of supraspinatus
* a) communicates with the shoulder joint - *the _subscapular bursa_ does*
* **e) attached inferiorly to the tendon of supraspinatus**
71
12) The subclavius muscle:
* a) arises from the costochondral junction of the second rib
* b) passes in the subclavian groove on the inferior aspect of the clavicle to attach to the acromion
* c) is enclosed by the upper attachment of the clavipectoral fascia
* d) is supplied by C7 and C8
* e) assists shoulder adduction
* a) arises from the costochondral junction of the *first* rib
* b) *Attaches to the inferior surface of the medial third of clavicle*
* **c) is enclosed by the upper attachment of the clavipectoral fascia**
* **Splits to enclose subclavius and pec minor, reforms below**
* d) is supplied by C5,6 (nerve to subclavius, off the C5/6 junction aka Erbs point aka is it a fucking trunk or root who knows? - Moores latest edition states superior trunk)
* e) assists shoulder adduction
* Anchors and depresses clavicle
72
13) Pectoralis minor:
* a) inserts into the lateral tip of the intertubecular groove of the humerus
* b) is a rectangular muscle
* c) is a guide for the underlying subclavian artery
* d) is superior to the suspensory ligament of the axilla
* e) is supplied by the subclavian nerve
* a) inserts into the lateral tip of the intertubecular groove of the humerus - *pec major*
* b) is a *triangular* muscle
* c) is a guide for the underlying *axillary* artery
* **d) is superior to the suspensory ligament of the axilla**
* e) is supplied by the *medial pectoral* nerve
73
14) Teres major:
* a) is separated from subscapularis by the quadrangular space in the posterior wall of the axilla
* b) is supplied by the lateral subscapular nerve
* c) inserts into the lateral lip of the intertubecular groove of the humerus
* d) acting alone, it abducts and medially rotates the humerus at the shoulder joint
* e) arises from the lateral side of the inferior angle of the ventral aspect of the scapula
* a) is separated from subscapularis by the quadrangular space in the posterior wall of the axilla
* b) is supplied by the lateral subscapular nerve
* c) inserts into the lateral lip of the intertubecular groove of the humerus
* d) acting alone, it abducts and medially rotates the humerus at the shoulder joint
* e) arises from the lateral side of the inferior angle of the ventral aspect of the scapula
74
15) The shoulder joint:
* a) subscapularis, supraspinatus, infraspinatus and teres minor all have rotatory action on the humerus and their tendons form the rotator cuff with the lateral part of the shoulder capsule
* b) the subacromial bursa rolls inwards under the acromion when the arm is adducted
* c) the joint capsule is attached to the surgical neck of the humerus inferiorly
* d) the articular surface of the head of the humerus is five times the area of the glenoid cavity
* e) upward thrust on the humerus will preferentially fracture the coracoacromial arch
No answer given, I'm not sure either. Maybe b)
* a) subscapularis, supraspinatus, infraspinatus and teres minor all have rotatory action on the humerus and their tendons form the rotator cuff with the *(?anterior, posterior, and superior)* part of the shoulder capsule
* b) the subacromial bursa rolls inwards under the acromion when the arm is adducted ??
* c) the joint capsule is attached to the surgical neck of the humerus *medially*
* d) the articular surface of the head of the humerus is *3-4* times the area of the glenoid cavity
* e) upward thrust on the humerus will preferentially fracture the coracoacromial arch
* Coracoacromial arch very strong, more likely to fracture humeral neck
75
16) Regarding the nerves and vessels of the arm:
* a) the circumflex vessels and the axillary nerve enter the extensor compartment in the axilla through the triangular space
* b) the ulnar nerve pierces the lateral intermuscular septum in the lower third of the arm
* c) the median nerve crosses obliquely in front of the radial artery in the arm
* d) supratrochlear lymph nodes lie in the subcutaneous fat just above the medial epicondyle
* e) the basilic vein is lateral to the cephalic vein
No answer given
* a) the circumflex vessels and the axillary nerve enter the extensor compartment in the axilla through the *quadrangular* space
* b) the ulnar nerve pierces the *medial* intermuscular septum in the lower third of the arm
* c) the median nerve crosses obliquely in front of the *brachial* artery in the arm
* **d) *Cubital* lymph nodes lie in the subcutaneous fat just above the medial epicondyle**
* Somewhere I read that supratrochlear lymph nodes are seperate but in the same place as cubital nodes, Moores does not mention them
* e) the basilic vein is *medial* to the cephalic vein
76
17) Regarding triceps:
* a) the long head is lateral to the medial head
* b) it inserts into the posterior aspect of the radial tuberosity
* c) attachment to the olecranon is by a tendon only
* d) the long head receives two branches of the radial nerve
* e) the medial head has origins in both lateral and medial intermuscular septums
No answer given
* a) the long head is lateral to the medial head
* Origin is medial, but seems to run more posterior than to either side, but medial to it if anything
* b) it inserts into the *tip of olecranon on ulna*
* c) attachment to the olecranon is by a tendon *and to fascia of forearm*
* d) the long head receives two branches of the radial nerve
* Not mentioned - innervation is radial nerve C6,7,8 for all heads
* Long and medial heads receive their branches about the triangular interval or so, lateral head in the radial groove
* e) the medial head has origins in both lateral and medial intermuscular septums
* Seems wrong, nothing is mentioned about this.
77
19) At the carpal tunnel:
* a) the flexor tendon synovial sheath is incomplete on the ulnar side
* b) the superficial tendons lie in the same plane
* c) the four profundus tendons have not yet separated
* d) the median nerve lies lateral to flexor digitorum superficialis
* e) median nerve compression causes anaesthesia over the thenar eminence
* a) the flexor tendon synovial sheath is incomplete on the *radial* side
* I assume they mean which side is open, and pictures show it this way
* b) the superficial tendons lie in *two* planes
* 2,5 deep, 3,4 superficially
* c) the four profundus tendons have not yet separated
* Certainly seem to have in the pictures
* **d) the median nerve lies lateral to flexor digitorum superficialis**
* **M-\>L: FDP, FDS, MN, FPL, FCR**
* e) median nerve compression causes ?*paraesthesia/pain* over the thenar eminence
78
20) What structure pierces the flexor retinaculum?
* a) ulnar nerve
* b) flexor carpi radialis tendon
* c) palmar branch of median nerve
* d) flexor pollicis longus tendon
* e) ulnar artery
b) flexor carpi radialis tendon
Passes through a canal in the lateral part of the flexor retinaculum and through a vertical groove in the trapezium in its own synovial *tendinous sheath of the FCR*
79
21) The lumbrical muscles:
* a) arise from the four superficial tendons
* b) are all bicipital muscles
* c) pass along the ulnar side of the metacarpophalangeal joint
* d) flex the metacarpophalangeal joint
* e) attach directly to the first phalanx
* a) arise from the four *profunda* tendons
* b) are *not* all bicipital muscles
* Lateral two are unipennate, medial two are bipennate
* c) pass along the *radial* side of the metacarpophalangeal joint
* **d) flex the metacarpophalangeal joint**
* **And extend IPJs**
* e) attach *to lateral sides of extensor expansions*
80
14) Regarding the intrinsic muscles of the hand, which of the following is NOT true?
* a) the palmar and dorsal interossei are supplied by the deep branch of the median nerve
* b) the intrinsic muscles of the thumb are abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, adductor pollicis, first palmar and first dorsal interossei
* c) opponens pollicis acts only on the carpometacarpal joint
* d) their motor supply is derived from segment T1 of the spinal cord
* e) the thenar muscles are supplied by the recurrent branch of the median nerve
* Terrible question - lots of these are not true. Listed answer is a, though b and e also wrong
* **a) the palmar and dorsal interossei are supplied by the deep branch of the *ulnar* nerve (*along with the medial 2 lumbricals)***
* b) the intrinsic muscles of the thumb are abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and adductor pollicis.
* Lumbricals and interossei do not attach to the thumb (and dorsal interossei do not attch to the little finger - PAD / DAB)
* Noted as correct as the first dorsal interosseus attaches to the thumb (though palmar does not)
* c) opponens pollicis acts only on the carpometacarpal joint
* d) their motor supply is derived from segment T1 of the spinal cord
* e) the thenar muscles are supplied by the recurrent branch of the median nerve
* Except adductor pollicis and deep head of FPB which are supplied by deep br. of ulnar
81
15) Regarding the synovial flexor sheaths, which of the following is NOT true?
* a) three synovial sheaths are found on the front of the wrist
* b) a common synovial sheath envelops all the superficialis and profundus tendons
* c) the sheath around flexor pollicis longus tendon extends almost to its insertion
* d) the flexor carpi ulnaris tendon has a short sheath
* e) the ring, middle and index fingers have digital sheaths that do not extend to the common sheath
d) the flexor carpi ulnaris tendon has a short sheath
I dont think it has a sheath, as it inserts on pisiform and extends to hook of hamate and 5th metacarpal (ie inserts at the wrist)
* a) three synovial sheaths are found on the front of the wrist
* Common flexor (FDS + FPD), FPL, and FRC
* b) a common synovial sheath envelops all the superficialis and profundus tendons
* c) the sheath around flexor pollicis longus tendon extends almost to its insertion
* e) the ring, middle and index fingers have digital sheaths that do not extend to the common sheath
82
16) The recurrent branch of the median nerve supplies:
* a) opponens digiti minimi
* b) first dorsal interosseous
* c) adductor pollicis
* d) first lumbrical
* e) abductor pollicis brevis
Iisted as c) but is:
**e) abductor pollicis brevis**
All interossei are supplied by deep br. ulnar n.
First lumbrical is medial n (not recurrent branch)
Adductor pollicis and opponens digiti minimi are deep branch of ulnar
83
17) The corocobrachialis muscle:
* a) is functionally important
* b) origin = apex of acromion
* c) insertion = lateral border of humerus
* d) nerve supply = C4, C5
* e) is pierced by the musculocutaneous nerve
* a) is functionally important - *implied that this is not true but it probably can do something if you believe in it enough.*
* b) origin = *tip of coracoid*
* c) insertion = *middle third of medial* of humerus
* d) nerve supply = *C5,6,7*
* **e) is pierced by the musculocutaneous nerve**
84
18) Which structure lies in the deltopectoral groove?
* a) median pectoral nerve
* b) lateral pectoral nerve
* c) cephalic vein
* d) basilic vein
* e) axillary vein
**c) cephalic vein**
85
19) Which lymph nodes drain the ulnar side of the forearm?
* a) infratrochlear
* b) supratrochlear
* c) infraclavicular
* d) anterior axillary
* e) ulnar trochlear
b) supratrochlear
86
20) Which does NOT enter posterior compartment of the arm?
* a) radial nerve
* b) profunda brachii artery
* c) ulnar nerve
* d) posterior cutaneous nerve of forearm
* e) superior ulnar collateral artery
Question seems to be wrong, as per Moores.
They have said: e) superior ulnar collateral artery
As per Moores 'the ulnar nerve...around the middle of the arm, it pierces the medial intermuscular septum with the superior ulnar collateral artery and descends between the septum and the medial head of triceps'. Then they both pass posterior to the medial epicondyle.
All others definitely do have a major course or origin in the posterior compartment.
posterior cutaneous nerve of forearm arises from radial nerve in the posterior compartment
87
21) The annular ligament of the elbow:
* a) has minimal usefulness
* b) is attached to margins of the radial notch of the ulna
* c) is attached to the head and neck of the radius
* d) has common attachment with ulnar collateral ligament
* e) is attached to the lateral epicondyle
b) is attached to margins of the radial notch of the ulna
88
22) Extensor pollicis brevis:
* a) origin – radius and interosseous membrane
* b) lies on ulnar side of snuffbox
* c) inserts into the base of the first distal phalanx
* d) nerve supply = ulnar nerve
* e) joins extensor digitorum tendon at metacarpophalangeal joint
**a) origin – radius and interosseous membrane**
Radial side of snuffbox
Inserts intom proximal phalanx
Nerve supply is posterior interosseus nerve (C7,8)
89
23) Extensor pollicis longus – which is INCORRECT?
* a) origin = ulnar just distal to adductor pollicis longus
* b) insertion = base of first distal phalanx
* c) tendon hooks around Lister’s tubercle (radius)
* d) forms radial boundary of snuffbox
* e) nerve supply – posterior interosseous nerve (C7, 8)
**d) forms *Ulnar* boundary of snuffbox**
90
24) Extensor indicis:
* a) origin = radius
* b) shares a common synovial sheath with E.D. (?extensor digitorum)
* c) tendon lies on radial side of E.D. tendon index finger
* d) separate insertion from dorsal expansion E.D.
* e) nerve supply = median nerve
b) shares a common synovial sheath with E.D. (?extensor digitorum)
91
25) The extensor retinaculum attaches between:
* a) radius and ulna
* b) scaphoid and ulna
* c) radius and triquetral and pisiform
* d) radius and lunate
* e) trapezium and ulnar
**c) radius and triquetral and pisiform**
92
26) All the following statements concerning the scaphoid bone are true EXCEPT:
* a) it articulates with radius proximally in abduction
* b) it is the most susceptible of the carpal bones to fracture
* c) it participates in the midcarpal joint
* d) it receives an attachment for the transverse carpal ligament
* e) fracture of the scaphoid is a common cause for median nerve compression in carpal tunnel syndrome
e) fracture of the scaphoid is a common cause for median nerve compression in carpal tunnel syndrome
Usually overuse and shit, not fractures
93
27) All of the following structures pass deep to the transverse carpal ligament EXCEPT the:
* a) flexor digitorum superficialis tendon
* b) flexor digitorum profundus tendon
* c) flexor pollicis longus tendon
* d) median nerve
* e) ulnar artery
e) ulnar artery
Transverse carpal ligament seems to be a synonym for the flexor retinaculum
Ulnar artery passes through Guyons canal along with ulnar nerve
94
28) Laceration of the recurrent branch of the median nerve results in paralysis of all the following muscles of the thumb EXCEPT:
* a) abductor pollicis brevis
* b) deep head of flexor pollicis brevis
* c) opponens pollicis
* d) superficial head of flexor pollicis brevis
b) deep head of flexor pollicis brevis
Median recurrent branch innervates opponens pollicis, abductor pollicis brevis, and superficial head of flexor pollicis brevis
Ulnar nerve innervates deep head of FPB and adductor pollicis
95
29) Which muscle is the odd one out?
* a) pronator teres
* b) flexor carpi radialis
* c) first lumbrical of the hand
* d) fourth lumbrical of the hand
* e) flexor pollicis longus
d) fourth lumbrical of the hand - supplied by ulnar nerve
All others are supplied by median nerve
Ulnar supplies all interossei, medial 2 lumbricals (3+4)
96
30) Infection in the volar aspect of the little finger can spread to all EXCEPT:
* a) distally to the ring finger via the tendon sheath
* b) to the flexor sheath of the thumb
* c) to the distal forearm through the carpal tunnel
* d) rupture of the sheath and spread to deep spaces of the palm
* e) ischaemic necrosis may occur to the flexor tendon involved
a) distally to the ring finger via the tendon sheath
97
31) Wrist:
* a) the flexor retinaculum runs between the styloid process of the radius and the pisiform and hook of hamate
* b) the median nerve passes beneath the flexor retinaculum between flexor digitorum superficialis and flexor carpi ulnaris
* c) the ulnar nerve lies on the flexor retinaculum with the ulnar artery on its ulnar side
* d) the wrist joint involves the radius, ulna, scaphoid, lunate and triquetral bones
* e) the radiocarpal joint is separated from the distal radioulnar joint by a triangular fibrocartilage
**e) the radiocarpal joint is separated from the distal radioulnar joint by a triangular fibrocartilage**
* a) the *extensor* retinaculum runs between the styloid process of the radius and the pisiform and hook of hamate
* Flexor runs from scaphoid tubercle/trapezium to hook of hamate/pisiform (no radioulnar attachemnets)
* b) the median nerve passes beneath the flexor retinaculum between *flexor digitorum superficialis/flexor carpi ulnaris* *and FPL*
* c) the ulnar nerve lies on the flexor retinaculum with the ulnar artery on its *radial* side (ie the nerve is medial, same pattern as TAN in cubital fossa)
* d) the wrist joint involves the radius, ulna, scaphoid, lunate and triquetral bones - *dont think it involves the ulna*
98
32) Hand:
* a) palmar brevis lies across the base of the thenar eminence
* b) abductor pollicis brevis and opponens pollicis both arise from the flexor retinaculum and adjacent trapezium
* c) flexor pollicis brevis lies to radial side of abductor pollicis brevis
* d) the muscles of the thenar eminence are usually supplied by the recurrent branch of the median nerve
* e) opponens pollicis inserts into the whole of the ulnar border of the first metacarpal
* a) palmar brevis lies across the base of the *hypothenar* eminence
* b) abductor pollicis brevis and opponens pollicis both arise from the flexor retinaculum and adjacent trapezium *and scaphoid tubercle*
* c) flexor pollicis brevis lies to *ulnar* side of abductor pollicis brevis
* **d) the muscles of the thenar eminence are usually supplied by the recurrent branch of the median nerve - except deep head of FBP**
* e) opponens pollicis inserts into the whole of the *radial* border of the first metacarpal
99
33) Trapezius inserts into:
* a) vertebral border scapula
* b) scapula spine
* c) proximal humerus
* d) medial clavicle
* e) none of the above
b) scapula spine
Also the *lateral clavicle / acromion*
100
34) Myotome of elbow flexion:
* a) C5,6
* b) C6,7
* c) C7,8
* d) C5
* e) C6
a) C5,6
101
35) Vincula:
* a) papillary ridges of skin that form finger prints
* b) superficial fibres of palmar aponeurosis that insert into the skin
* c) remnant fibres of palmar interossei inserting into the proximal phalanx at the thumb
* d) communication between common flexor sheath and sheath of pollicis longus present in 50% of people
* e) vascular synovial folds of flexor tendons
e) vascular synovial folds of flexor tendons
"In anatomy, a vinculum (pl. vincula) is a band of connective tissue, similar to a ligament, that connects a flexor tendon to a phalanx bone. They contain tiny vessels which supply blood to the tendon."
102
36) Of the hand joints, which is INCORRECT?
* a) the midcarpal joint is S shaped
* b) joint between hamate and fifth metacarpal is most mobile at four digits
* c) the first carpometacarpal joint is reinforced by the medial and palmar ligaments
* d) palmar ligaments of metacarpophalangeal joints limit extension of joint
* e) interphalangeal joints ????have to obliquely place collateral ligaments as a mechanism of tightening re flexion and extension
c) the first carpometacarpal joint is reinforced by the *anterior oblique ligament, ulnar collateral ligament, and first intermetacarpal ligament*
103
37) Which is true of brachial plexus?
* a) the trunks lie behind scalene muscle
* b) accessory phrenic nerve fibres run to superior mediastinum with long thoracic nerve
* c) median nerve divides at the carpal tunnel, lateral branch supplies thenar muscles and medial branch supplies lumbricals (2)
* d) ulnar nerve in 95% of cases picks up C7 fibres from lateral cord
* e) branches of radial nerve rise just proximal to their destination
d) ulnar nerve in 95% of cases picks up C7 fibres from lateral cord
Per Moores: 'larger terminal branch of the medial cord, receiving fibres from C8-T1, and often C7'
