Anatomy Ch. 7 Grays

A 25-year-old man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over his triceps brachii muscle. Which of the following nerves innervates the triceps brachii muscle? A. Radial B. Axillary C. Median D. Ulnar E. Musculocutaneous

A. Radial

A 4-year-old boy is brought to the emergency department by his mother for refusal to move his left arm. His mother recalls that he screamed out in pain after she tugged violently on her son's hand to pull him out of the way of an oncoming car this morning. Physical examination shows no swelling or bruising, but the child cannot extend his elbow. An x-ray of the upper extremity shows dislocation of the head of the radius. Which of the following ligaments is most likely associated with this injury? A. Annular B. Joint capsular C. Interosseous D. Radial collateral E. Ulnar collateral

A. Annular

The 35-year-old woman comes to the physician because of a breast lump that she noticed 1 month ago on self-breast examination. Physical examination shows a 1 cm hard nodule located just above and lateral to the areola of her right breast. A radioactive dye is injected into the tissue around the tumor, and an incision is made to expose the lymphatic vessels draining the area. Which of the following groups of lymph nodes will be first to receive the dye from the tumor? A. Anterior axillary (pectoral) nodes B. Rotter's interpectoral nodes C. Parasternal nodes along the internal thoracic artery and vein D. Central axillary nodes E. Apical axillary or infraclavicular nodes

A. Anterior axillary (pectoral) nodes

A 30-year-old man comes to the physician because of a 2-week history of dull, intermittent pain of the posterolateral right shoulder. The pain is exacerbated by overhead activities. Physical examination shows enlarged shoulder muscles that reduces the size of the quadrangular space. There is point tenderness over the quadrangular space and weakness on lateral rotation of the abducted humerus. An MRI of the shoulder shows atrophy of the teres minor. Which of the following structures would most likely be compressed? A. Axillary nerve B. Anterior circumflex humeral artery C. Cephalic vein D. Radial nerve E. Subscapular artery

A. Axillary nerve

A 32-year-old woman comes to the hospital for hemodialysis. Physical examination shows venous access in her upper limb was unexpectedly difficult as the caliber of the major vein on the lateral aspect her arm was too small. 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 of the following veins is most likely located? A. Basilic B. Lateral cubital C. Cephalic D. Median cubital E. Median antebrachial

A. Basilic

Laboratory studies in the outpatient clinic on a 24-year-old woman included assessment of circulating blood chemistry. Which of the following arteries is most likely at-risk during venipuncture in the cubital fossa? A. Brachial B. Common interosseous C. Ulnar D. Anterior interosseous E. Radial

A. Brachial

A 68-year-old woman is brought to the emergency department 3 hours after she fell on the wet bathroom floor of her home. Physical examination shows a posterior displacement of the left distal wrist and hand. An x-ray of the wrist shows an oblique fracture of the radius. Which of the following types of fracture most likely occurred in this patient? A. Colles fracture B. Scaphoid fracture C. Bennett fracture D. Volkmann ischemic contracture E. Boxer's fracture

A. Colles fracture

A 79-year-old man comes to the physician because of numbness in the medial three digits of his right hand. He has difficulty grasping objects with that hand. He retired 9 years earlier, after working as a carpenter for 50 years. Physical examination shows atrophy of the thenar eminence. Which of the following conditions is the most likely cause of the problems in his hand? A. Compression of the median nerve in the carpal tunnel B. Formation of osteophytes that compress the ulnar nerve at the medial epicondyle C. Hypertrophy of the triceps brachii muscle compressing the brachial plexus D. Osteoarthritis of the cervical spine E. Repeated trauma to the ulnar nerve

A. Compression of the median nerve in the carpal tunnel

A 21-year-old woman comes to the emergency department after she was struck in the arm by a line drive during a softball game. Physical examination shows weakness on abduction and extension of the thumb. There is also weakness on extension of the wrist and metacarpophalangeal (MCP) joints. An x-ray of the arm shows no abnormalities. An MRI shows soft tissue injury to the central aspect of the lateral humerus. Which of the following muscles is most likely spared from injury? A. Flexor carpi ulnaris B. Extensor indicis C. Brachioradialis D. Extensor carpi radialis longus E. Supinator

A. Flexor carpi ulnaris

A 20-year-old man is brought to the emergency department 2 hours after sustaining an injury to his left hand during a rugby game. The injury occurred when the athlete gripped his opponent's jersey resulting in a forceful extension of his flexed digit. Physical examination shows inability to flex the DIP joints of the fourth and fifth digits. Which of the following muscles is most likely affected? A. Flexor digitorum profundus B. Flexor digitorum superficialis C. Lumbricals D. Flexor carpi ulnaris E. Interossei

A. Flexor digitorum profundus

A 27-year-old man was brought to the emergency department after he was involved in a motor vehicle collision. An x-ray of the right shoulder shows a fracture of the lateral border of the scapula. Six weeks later, the patient comes to the physician because of pain and weakness in the right shoulder while performing his daily activities. Physical examination shows weakness and pain on medial rotation and adduction of the humerus. Which of the following nerves is most likely injured? A. Lower subscapular B. Axillary C. Radial D. Accessory E. Suprascapular

A. Lower subscapular

A 29-year-old woman is brought to the emergency department after sustaining a deep laceration in the proximal part of the forearm. Physical examination shows normal flexion of the fourth and fifth digits at the interphalangeal (IP) joints. She is unable to extend the fourth and fifth digits at the MCP joints and is unable to flex the first three digits of her right hand. Sensation is absent on the lateral side of the palm and the palmar surfaces of the first 3½ digits. Which of the following nerve(s) is most likely injured? A. Median nerve B. Ulnar and median nerves C. Ulnar nerve D. Radial and ulnar nerves E. Radial nerve

A. Median nerve

A 26-year-old man comes to the office because of a 2-week history of left shoulder pain. The pain is dull and is exacerbated when the patient lifts his arm overhead. An x-ray of the shoulder shows no abnormalities. An MRI shows tendinopathy of the long head of the biceps brachii muscle. Which of the following findings will most likely be present on physical examination? A. Pain is felt in the anterior shoulder during forced contraction B. Pain is felt in the lateral shoulder during forced contraction C. Pain is felt during abduction and flexion of the shoulder joint D. Pain is felt during extension and adduction of the shoulder joint E. Pain is felt in the lateral shoulder during flexion of the shoulder joint

A. Pain is felt in the anterior shoulder during forced contraction

A 12-year-old boy is brought to the emergency department 30 minutes after he lacerated the palmar surface of his wrist while playing with a sharp knife. His temperature is 37°C (98.6°F), pulse is 116/min, respirations are 20/min, and blood pressure is 100/70 mm Hg. Physical examination shows a 2 cm wound at the midline of the wrist. The cut ends of a tendon are exposed within the wound. The flexor retinaculum is intact. Which tendon most commonly lies in this position? A. Palmaris longus B. Flexor carpi radialis C. Abductor pollicis longus D. Flexor carpi ulnaris E. Flexor pollicis longus

A. Palmaris longus

A 25-year-old man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over his triceps brachii muscle. An x-ray of his arm shows a fracture at the mid-body of the humerus. Which of the following nerves is most likely injured? A. Radial B. Axillary C. Median D. Ulnar E. Musculocutaneous

A. Radial

A 61-year-old man is brought to the emergency department 2 hours after he was hit in the left arm by a cricket bat. His only medication is acetaminophen. He is 180 cm (5 ft 11 in) tall and weighs 82 kg (180 lb); BMI is 25 kg/m2. His vital signs are within normal limits. Physical examination shows bruising and tenderness to palpation over the mid-humeral region of the left upper limb. Upper limb pulses are palpable bilaterally. Sensation is decreased over a small area of the dorsum of the left hand proximal to the lateral two digits. The patient is unable to extend the left wrist. Which of the following nerves is most likely injured? A. Radial B. Posterior interosseous C. Lateral antebrachial cutaneous D. Medial antebrachial cutaneous E. Dorsal cutaneous of ulnar

A. Radial

A 58-year-old man is brought to the emergency department after an attempted robbery in which he sustained a bullet wound to the medial side of the elbow. His vital signs are within normal limits. A major nerve was repaired at the site where it passed behind the medial epicondyle. Bleeding was stopped from an artery which plays an important role in supplying blood supply to the nerve. Which of the following arteries was most likely repaired? A. The deep brachial artery B. The radial collateral artery C. The superior ulnar collateral artery D. The inferior ulnar collateral artery E. The anterior ulnar recurrent artery

A. The deep brachial artery

A 41-year-old woman comes to the physician for a follow-up examination. One year ago, she underwent a mastectomy of her left breast. She is scheduled for a latissimus dorsi muscle flap to cosmetically augment the site of her absent left breast. During surgery, part of the latissimus dorsi muscle is advanced to the anterior thoracic wall. Which artery forms the vascular base of this flap? A. Thoracodorsal artery B. Dorsal scapular artery C. Transverse cervical artery D. Lateral thoracic artery E. Thoracoacromial artery

A. Thoracodorsal artery

A 22-year-old man is brought to the emergency department after he sustains a penetrating injury to his left upper limb from a nail gun. His temperature is 37.6°C (99.68°F), pulse is 107/min, respirations are 22/min, and blood pressure is 108/65 mm Hg. He is unable to flex the DIP joints of the fourth and fifth digits of the left hand. An x-ray shows no fractures. What is the most likely cause of his injury? A. Trauma to the ulnar nerve near the trochlea B. Trauma to the ulnar nerve at the wrist C. Median nerve damage proximal to the pronator teres D. Median nerve damage at the wrist E. Trauma to spinal nerve root C8

A. Trauma to the ulnar nerve near the trochlea

A 25-year-old man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over his triceps brachii muscle. An x-ray of his arm shows a fracture at the mid-body of the humerus. Which of the following muscles is most likely paralyzed? A. Triceps brachii B. Biceps brachii C. Coracobrachialis D. Brachialis E. Deltoid

A. Triceps brachii

A 21-year-old woman comes to the physician after sustaining an injury of her left proximal arm with a baseball bat in a fight. Physical examination shows inability to extend her hand at the wrist. An x-ray shows a fracture of the mid-body of the humerus. Injury of the radial nerve in the radial groove is suspected. Which of the following signs would be present on physical examination? A. Weakness of thumb abduction and thumb extension B. Weakness of thumb opposition C. Inability to extend the elbow D. Paralysis of pronation of the hand E. Paralysis of abduction and adduction of the arm

A. Weakness of thumb abduction and thumb extension

A 25-year-old man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over his triceps brachii muscle. An x-ray of his arm shows a fracture at the mid-body of the humerus. Which of the following will most likely be present during physical examination? A. Wrist drop B. Inability to flex his wrist and loss of pronation C. Inability to flex the index and middle fingers at the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints D. Inability to flex the ring and little fingers at DIP E. Paralysis of the lumbricals and interosseous muscles

A. Wrist drop

A 15-year-old girl was brought to the emergency department after a severe bite by a dog on the dorsolateral aspect of her right hand. She has increasingly severe pain and swelling of her right hand. Physical examination shows symmetric enlargement of the first digit with severe pain on passive extension. An x-ray of the hand shows no abnormalities. The injured tendons in this compartment would include which of the following muscles? A. Extensor carpi radialis longus and brevis B. Abductor pollicis longus and extensor pollicis brevis C. Extensor digitorum D. Extensor indicis E. Extensor carpi ulnaris

B. Abductor pollicis longus and extensor pollicis brevis

A 43-year-old woman comes to the office because she cannot hold a piece of paper between her thumb and the lateral side of her index finger without flexing the distal joint of her thumb. This is a positive Froment sign, which is consistent with ulnar neuropathy. Weakness of which specific muscle causes this sign to appear? A. Flexor pollicis longus B. Adductor pollicis C. Flexor digiti minimi D. Flexor carpi radialis E. Extensor indicis

B. Adductor pollicis

A 22-year-old man comes to the emergency department because of pain and swelling of the fifth digit of his right hand. Two hours ago, he hit a vending machine in the hospital when he did not receive his drink after inserting money twice. Physical examination shows swelling of the medial aspect of the dorsum of the hand. When the patient is asked to make a fist, one of his knuckles cannot be seen. Which of the following most likely best explains the knuckle deformity? A. Fracture of the styloid process of the ulna B. Fracture of the neck of the fifth metacarpal C. Colles fracture of the radius D. Smith fracture of the radius E. Bennett fracture of the thumb

B. Fracture of the neck of the fifth metacarpal

A 30-year-old woman comes to the physician with pain in her right wrist after falling with force onto her outstretched hand. Physical examination shows restricted movement of the wrist due to pain and decreased sensation on the palmar aspect of the lateral 3½ digits. An x-ray of the wrist shows an anterior dislocation of a carpal bone. Which of the following bones is most likely dislocated? A. Capitate B. Lunate C. Scaphoid D. Trapezoid E. Triquetrum

B. Lunate

An 18-year-old man is brought to the emergency department because of left arm pain after an injury while playing rugby. Physical examination shows significant bruising over the left arm. An x-ray of the arm shows a transverse fracture of the humerus about 1 inch proximal to the epicondyles. Which of the following nerves is most likely injured by the jagged edges of the broken bone at this location? A. Axillary B. Median C. Musculocutaneous D. Radial E. Ulnar

B. Median

A 32-year-old woman is brought to the emergency department 1 hour after a motor vehicle collision. She is awake and alert upon arrival. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 16/min, and blood pressure is 118/72 mm Hg. Physical examination shows tenderness and bruising over the left arm. Flexion and supination of the forearm are severely weakened and she has loss of sensation on the lateral surface of the forearm. An x-ray of the upper limb shows multiple fractures of the humerus. Which of the following nerves is most likely injured? A. Radial B. Musculocutaneous C. Median D. Lateral cord of the brachial plexus E. Lateral antebrachial cutaneous nerve

B. Musculocutaneous

A 34-year-old woman is brought to the emergency department with left shoulder pain for 2 hours after she struck a tree on a ski slope. Physical examination shows swelling and bruising of the left shoulder. The patent has tenderness to palpation and a "step-off" of the left clavicle is noted. An x-ray shows a high-grade left shoulder separation. Which of the following typically occurs in this type of injury? A. Displacement of the head of the humerus from the glenoid cavity B. Partial or complete tearing of the coracoclavicular ligament C. Partial or complete tearing of the coracoacromial ligament D. Rupture of the transverse scapular ligament E. Disruption of the glenoid labrum

B. Partial or complete tearing of the coracoclavicular ligament

A 22-year-old man comes to the emergency department because of wrist pain after falling on his outstretched right hand. Physical examination shows bruising of the wrist and tenderness in the anatomical snuffbox. An x-ray of the wrist shows a displaced fracture of the scaphoid bone. A surgical intervention is recommended. When the anatomical snuffbox is exposed, which artery is seen crossing the fractured bone? A. Ulnar B. Radial C. Anterior interosseous D. Posterior interosseous E. Deep palmar arch

B. Radial

A 25-year-old man is brought to the emergency department because of pain in his right wrist 2 hours after falling on an outstretched hand while performing the pole vault. Physical examination shows mild swelling on the dorsal wrist and tenderness upon palpation of the anatomical snuffbox. An x-ray of his hand shows no abnormalities. If a fracture is suspected, which bone is most likely involved? A. Lunate B. Scaphoid C. Capitate D. Hamate E. Trapezoid

B. Scaphoid

A 74-year-old woman is brought to the emergency department because of pain and swelling of her forearm after stumbling and falling over her pet dog. Physical examination of the forearm shows no open wounds and the neurovascular examination is within normal limits. The patient holds her left forearm in the pronated position and is unable to supinate the left hand. An x-ray of the right forearm shows a fracture of the upper third of the radius. The proximal end of the fracture deviates laterally. Which of the following muscles is primarily responsible for the lateral deviation? A. Pronator teres B. Supinator C. Pronator quadratus D. Brachioradialis E. Brachialis

B. Supinator

A 55-year-old man comes to the physician after receiving a blunt trauma to his right axilla during a fall. He has difficulty elevating the right arm above the level of his shoulder. Physical examination shows the inferior angle of his right scapula protrudes more than the lower part of the left scapula. The protrusion is more prominent when the patient pushes against a wall. Which of the following neural structures is most likely injured? A. The posterior cord of the brachial plexus B. The long thoracic nerve C. The upper trunk of the brachial plexus D. The site of origin of the middle and lower subscapular nerves E. Spinal nerve ventral rami C7, C8, and T1

B. The long thoracic nerve

A 45-year-old woman comes to the emergency department because of neck pain for 2 months. A computed tomography (CT) shows a single 5 × 7 cm tumor with an irregular border on the left side of her oral cavity. A radical neck surgical procedure is performed and the tumor, deep cervical lymph nodes, and related tissues are removed. Two months postoperatively the patient's left shoulder droops and she has weakness on turning her head to the right. Which of the following structures was most likely injured during the radical neck surgery? A. Suprascapular nerve B. Long thoracic nerve C. Accessory nerve D. C5 and C6 spinal nerves E. Radial nerve

C. Accessory nerve

A 60-year-old man is brought to the emergency department after he accidentally slashed his left wrist with his butcher's knife. Vital signs are within normal limits. Physical examination shows loss of sensation on the medial 1½ digits and decreased grip strength of the left hand. An x-ray of the wrist shows no other abnormalities. Which of the following actions would most likely be lost as a result of this injury? A. Flexion of the PIP joint of the fifth digit (little finger) B. Extension of the thumb C. Adduction of the fifth digit D. Abduction of the thumb E. Opposition of the thumb

C. Adduction of the fifth digit

A 52-year-old man comes to the physician because of a 3-day history of pain in his right arm after strenuous field exercise for a major athletic tournament. Physical examination shows loss of extension of the wrist at the wrist and decreased grip strength. There is no loss of sensation in the affected limb. An x-ray of the right upper limb shows no fractures. Which of the following nerves is most likely injured? A. Ulnar B. Anterior interosseous C. Deep radial D. Median E. Superficial radial

C. Deep radial

A 24-year-old woman comes to the emergency department after being bitten on her hand by a dog. She washed the wound with copious amounts of water, but the wound has progressively worsened in the last 6 hours. Physical examination shows tenderness and swelling at the base of the thumb, and difficulty with grasping and pinching movements. The infection eventually spreads to the radial bursa. The tendon(s) of which muscle will most likely be affected? A. Flexor digitorum profundus B. Flexor digitorum superficialis C. Flexor pollicis longus D. Flexor carpi radialis E. Flexor pollicis brevis

C. Flexor pollicis longus

A 27-year-old man is brought to the emergency department because of pain and swelling of his right arm after falling from a ladder. He is unable to abduct his right arm more than 15 degrees and resists lateral rotation due to pain. The patient also has a loss of sensation over the right shoulder. An x-ray of the arm shows an oblique fracture of the humerus. The most likely cause of these symptoms is a fracture affecting which of the following locations? A. Fracture of the medial epicondyle B. Fracture of the glenoid fossa C. Fracture of the surgical neck of the humerus D. Fracture of the anatomical neck of the humerus E. Fracture of the middle third of the humerus

C. Fracture of the surgical neck of the humerus

A 65-year-old woman comes to the physician for a follow-up examination. Two months ago, she was diagnosed with late-onset radial nerve palsy after closed reduction of a mid-body humeral fracture. What findings are most likely to be present during physical examination? A. Inability to abduct the digits at the MCP joint B. Inability to adduct the digits at the MCP joint C. Inability to extend the MCP joints only D. Inability to extend the MCP, PIP, and DIP joints E. Inability to extend the PIP and DIP joints

C. Inability to extend the MCP joints only

A 62-year-old woman visits her physician because of 3-year history of worsening bilateral shoulder pain. The pain worsens when the arm is lifted overhead. She has a 40-year history of rheumatoid arthritis. Physical examination of the shoulder shows a positive Yergason test of the right shoulder. An ultrasound of the right shoulder joint shows findings consistent with tendinopathy. Arthroscopic examination of the right shoulder shows an erosion of a tendon within the glenohumeral joint. Which of the following tendons was most likely observed? A. Glenohumeral B. Long head of triceps brachii C. Long head of biceps brachii D. Infraspinatus E. Coracobrachialis

C. Long head of biceps brachii

A 31-year-old man is brought to the emergency department 1 hour after falling onto his elbow during a hockey game. He has a restricted range of motion of his left arm due to pain. His temperature is 37°C (98.6°F), pulse is 90/min and regular, respirations are 18/min, and blood pressure is 128/76 mm Hg. Physical examination shows swelling and ecchymosis at the proximal shoulder. An x-ray of the shoulder shows a fracture of the surgical neck of the humerus with elevation and adduction of the distal fragment. Which of the following muscles most likely caused the adduction of the distal fragment? A. Brachialis B. Teres minor C. Pectoralis major D. Supraspinatus E. Pectoralis minor

C. Pectoralis major

A 44-year-old man comes to the physician after sustaining a penetrating wound to his shoulder from a crossbow bolt. Physical examination shows a deep, 4 cm laceration of the anterior shoulder and asymmetry of the radial artery. A compress is placed on the wound and deep pressure is applied. An angiogram shows transection of the axillary artery just distal to the origin of the subscapular artery. What collateral arterial pathways are available to bypass the site of injury? A. Suprascapular with circumflex scapular artery B. Dorsal scapular with thoracodorsal artery C. Posterior circumflex humeral artery with deep brachial artery D. Lateral thoracic with brachial artery E. Superior thoracic artery with thoracoacromial artery

C. Posterior circumflex humeral artery with deep brachial artery

A 23-year-old man comes to the emergency department because he is unable to move his arm after he fell asleep in his chair with a book wedged into his axilla. Physical examination shows inability to extend his wrist and fingers and numbness of the lateral side of the dorsal aspect of the affected hand. Which of the following nerves is most likely compressed? A. Lateral cord of the brachial plexus B. Medial cord of the brachial plexus C. Radial nerve D. Median nerve E. Lateral and medial pectoral nerves

C. Radial nerve

A 24-year old woman is brought to the emergency department after she slipped on wet pavement and fell against the curb, injuring her right arm. Physical examination shows loss of sensation of the posterior forearm and dorsal hand. An x-ray of the right upper limb shows a mid-body fracture of the humerus. Which pair of structures is most likely injured at the fracture site? A. Median nerve and brachial artery B. Axillary nerve and posterior circumflex humeral artery C. Radial nerve and deep brachial artery D. Suprascapular nerve and artery E. Long thoracic nerve and lateral thoracic artery

C. Radial nerve and deep brachial artery

A 20-year-old man is brought to the emergency department after a motorbike collision. He is awake, alert, and oriented and his vital signs are within normal limits. Physical examination shows several cuts and bruises on his body. He is unable to extend the left wrist. Extension of the elbow is normal bilaterally. Sensation is lost in the lateral half of the dorsum of the left hand. Which of the following nerves is most likely injured, and in what part of the arm is the injury located? A. Median nerve, anterior wrist B. Median nerve, arm C. Radial nerve, mid humerus D. Radial nerve, mid lateral forearm E. Ulnar nerve, midpalmar region

C. Radial nerve, mid humerus

A 48-year-old woman comes to the physician because of a 1-month history of intermittent numbness and tingling in her right hand. The symptoms awake her from sleep at night and are relieved by shaking her hand. A diagnosis of nerve compression in the carpal tunnel was made, and the patient underwent an endoscopic nerve release. Two weeks postoperatively, the patient has weakness in the thumb, with loss of thumb opposition. Sensation to the hand is normal. Which of the following nerves was injured during the operation? A. The first common palmar digital branch of the median nerve B. The second common palmar digital branch of the median nerve C. Recurrent branch of median nerve D. Deep branch of the ulnar nerve E. Anterior interosseous nerve

C. Recurrent branch of median nerve

A 35-year-old man comes to the physician because of a 2 cm, red, blanchable nodule under the nail of his fifth digit. The patient has sudden severe attacks of pain localized to the area of the lesion, that are exacerbated by cold temperatures and pressure. Total surgical excision is recommended. Which of the following nerves would have to be anesthetized for painless removal of the tumor? A. Superficial radial B. Common palmar digital branch of median C. Superficial branch of ulnar D. Deep radial E. Recurrent branch of median

C. Superficial branch of ulnar

A 29-year-old man is brought to the emergency department after a painful fall against a rocky ledge. His temperature is 37.5°C (99.5°F), pulse is 95/min, respirations are 18/min, and blood pressure is 118/70 mm Hg. He has dull pain in the lateral shoulder with radiation to the proximal arm. An x-ray of the arm shows a hairline fracture of the surgical neck of the humerus. Which of the following tests is best for assessing the status of the nerve associated with this injury? A. Have the patient abduct the limb while holding a 4.5 kg (10-lb) weight B. Have the patient shrug the shoulders C. Test for presence of skin sensation over the lateral side of the shoulder D. Test for normal sensation over the medial skin of the axilla E. Have the patient push against an immovable object like a wall and assess the position of the scapula

C. Test for presence of skin sensation over the lateral side of the shoulder

A 25-year-old man is brought to the emergency department because of excruciating pain in his right shoulder and proximal arm after a wrestling match. Physical examination shows that the arm is slightly abducted and externally rotated. The patient resists when passive medial rotation is attempted. Radial pulses are palpated bilaterally. An x-ray of the shoulder shows a dislocation of the humerus at the glenohumeral joint. Which of the following is the most likely mechanism of injury? A. The head of the humerus is displaced laterally B. The head of the humerus is displaced posteriorly C. The head of the humerus is displaced inferiorly D. The head of the humerus is displaced superiorly E. The head of the humerus is displaced medially

C. The head of the humerus is displaced inferiorly

A 23-year-old woman comes to the physician because of sudden severe pain over the base of the terminal phalanx of the index finger. Two days ago, she was making a bed in a hotel and caught the end of the index finger in a fold as she straightened the sheet. Physical examination shows the right index finger is swollen and she is unable to completely extend the DIP joint. Which one of the following structures within the digit was most likely injured? A. The proper palmar digital branch of the median nerve B. The vinculum longum C. The insertion of the tendon of extensor digitorum onto the base of the distal phalanx D. The insertion of the flexor digitorum profundus tendon E. The insertion of the flexor digitorum superficialis tendon

C. The insertion of the tendon of extensor digitorum onto the base of the distal phalanx

A 15-year-old boy is brought to the emergency department 30 minutes after sustaining a gunshot wound to the ventral surface of the upper limb. Three months after the injury, the patient comes to the physician for a follow-up examination. Physical examination shows a complete clawing of the digits of his left hand, but the patient is able to extend his wrist. He has severe paresthesia of all five digits of the affected hand. Which of the following mechanisms is most likely responsible for these findings? A. The ulnar nerve has been severed at the wrist. B. The median nerve has been injured in the carpal tunnel. C. The median and ulnar nerves are damaged at the wrist. D. The median and ulnar nerves have been injured at the elbow region. E. The median, ulnar, and radial nerves have been injured at mid-humerus.

C. The median and ulnar nerves are damaged at the wrist.

A 48-year-old woman comes to the physician because of a 1-year history of pain and paresthesia in her right hand that has increased in severity during the past month. The pain has been persistent after falling on her outstretched hand one year ago. Physical examination shows loss of sensation in the radial 3½ digits of her right hand. Her left hand shows no abnormalities. Which muscle(s) is most likely weakened in this condition? A. Dorsal interossei B. Lumbricals III and IV C. Thenar D. Palmar interossei E. Hypothenar

C. Thenar

A 19-year-old man is brought to the emergency department after falling painfully onto his right shoulder in a soccer game. A diagnosis of a dislocated right shoulder is made. After reduction of the shoulder dislocation, he has persistent pain over the dorsal region of the shoulder. Physical examination shows no obvious bone deformities but he is unable to abduct the arm normally. A magnetic resonance imaging (MRI) of the shoulder shows a torn muscle. Which of the following muscles is most likely damaged by this injury? A. Coracobrachialis B. Long head of the triceps brachii C. Pectoralis minor D. Supraspinatus E. Teres major

D. Supraspinatus

A 17-year-old girl is brought to the emergency department after falling from uneven parallel bars during a gymnastic routine. Neurologic examination finds altered sensation of the medial 1½ digits of her right hand. An MRI examination finds an injury to the medial cord of the brachial plexus. Which of the following spinal nerve levels is most likely affected? A. C5, C6 B. C6, C7 C. C7, C8 D. C7, C8, T1 E. C8, T1

D. C7, C8, T1

A 19-year-old man is brought to the emergency department after sustaining a deep laceration of his right upper limb when he stumbled and fell onto a broken bottle. His temperature is 37°C (98.6°F), pulse is 92/min, respirations are 18/min, and blood pressure is 128/75 mm Hg. Neurological examination finds he is able to extend the MCP joints of all his fingers in the right limb. He is unable to extend the IP joints of the fourth and fifth digits, and extension of the IP joints of the second and third digits is weak. Sensation of the hand is normal. Which of the following nerves is most likely injured? A. Radial nerve at the elbow B. Median nerve at the wrist C. Ulnar nerve in the mid forearm D. Deep branch of ulnar nerve E. Recurrent branch of the median nerve

D. Deep branch of ulnar nerve

A 22-year-old woman is brought to the emergency department 30 minutes after a motor vehicle collision. On arrival, she is unconscious. Her respirations are 30/min, and blood pressure is 100/50 mm Hg. The radial pulse is checked to determine the heart rate of the patient. This pulse is felt lateral to which of the following tendon? A. Palmaris longus B. Flexor pollicis longus C. Flexor digitorum profundus D. Flexor carpi radialis E. Flexor digitorum superficialis

D. Flexor carpi radialis

A 23-year-old woman is brought to the emergency department 4 hours after she had a painful injury to her hand in a dry ski-slope competition. The patient caught her thumb in the matting as she fell. Physical examination shows pain and swelling at the ulnar aspect of the MCP joint of the first digit. Lidocaine is injected into the MCP joint and increased laxity of the thumb is noted during flexion and extension at the MCP joint. An MRI shows a rupture of the ulnar collateral ligament. She is scheduled for surgical repair. Which of the following is the most likely diagnosis? A. De Quervain syndrome (tenosynovitis) B. Navicular bone fracture C. Boxer's thumb D. Gamekeeper's thumb E. Bennett thumb

D. Gamekeeper's thumb

A 24-year-old man comes to the emergency department with a wound to the palm of his hand. On physical examination, he cannot touch the pad of his index finger with his thumb but can grip a sheet of paper between all fingers and has no loss of sensation on the skin of his hand. Which of the following nerves is most likely injured? A. Deep branch of ulnar B. Anterior interosseous C. Median D. Recurrent branch of median E. Deep branch of radial

D. Recurrent branch of median

A 17-year-old is brought to the emergency department after sustaining a knife wound to his left arm in a street fight. Physical examination shows a 4 cm wound on the proximal medial arm. He has weakness of elbow flexion and supination of the left hand. Extension at the elbow and wrist is normal. Which of the following additional findings would be present on physical examination? A. Inability to adduct and abduct his 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

A 68-year-old woman is brought to the emergency department after falling on a flexed wrist in an attempt to break her fall when she missed the last step of her motorhome. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 138/75 mm Hg. Physical examination shows a deformity of the distal wrist. An x-ray of the wrist shows a fracture of the distal radius with volar angulation of the distal fragment. Which of the following is the most likely type of fracture in this patient? A. Colles fracture B. Scaphoid fracture C. Bennett fracture D. Smith fracture E. Boxer's fracture

D. Smith fracture

A 78-year-old woman comes to the physician with worsening right shoulder pain over the past 6 months. She has severe pain when placing books on the overhead bookshelf at work and pain in her shoulder while combing her hair. Abduction of the right arm and palpation of the deltoid muscle produces exquisite pain. An MRI of the upper limb shows hyperintense focal lesions of intermuscular inflammation extending over the head of the humerus. Which of the following structures is most likely inflamed? A. Subscapular bursa B. Infraspinatus muscle C. Glenohumeral joint cavity D. Subacromial bursa E. Teres minor muscle

D. Subacromial bursa

A 29-year-old woman is brought to the emergency department 2 hours after falling from her balcony. Physical examination shows noticeable swelling and bruising over the clavicle. There is tenderness, crepitus on palpation, and decreased range of motion of her left upper limb. An x-ray of the left shoulder shows a fracture of the clavicle and internal bleeding is strongly suspected. Which of the following vessels is most likely to be injured in a clavicular fracture? A. Subclavian artery B. Cephalic vein C. Lateral thoracic artery D. Subclavian vein E. Internal thoracic artery

D. Subclavian vein

A 17-year-old boy suffered the most common of fractures of the carpal bones when he fell on his outstretched hand. Which bone would this be? A. Trapezium B. Lunate C. Pisiform D. Hamate E. Scaphoid

E. Scaphoid

A 45-year-old woman comes to the physician for a cosmetic breast surgery consultation. Physical examination shows that the areola falls below the inframammary fold at the level of the T8 dermatome. There is no erythema, fluctuance, swelling, dimpling, or lumps on either breast. The integrity of which of the following structure(s) is compromised? A. Scarpa fascia B. Pectoralis major muscle C. Pectoralis minor muscle D. Suspensory (Cooper) ligaments E. Serratus anterior muscle

D. Suspensory (Cooper) ligaments

A 45-year-old man comes to the emergency department 1 hour after sustaining a shallow stab wound in the neck. He has neck pain that radiates to the left shoulder and upper back. Physical examination shows a 4 cm laceration located in the posterior triangle of the left side of his neck. Asymmetry of the shoulders is noted. The superior angle of the left scapula protrudes slightly. Neurologic examination finds 5/5 power bilaterally when turning the head. Which of the following nerves is most likely injured? A. Suprascapular nerve in the supraspinous fossa B. The terminal segment of the dorsal scapular nerve C. The upper trunk of the brachial plexus D. The accessory nerve in the posterior cervical triangle E. The thoracodorsal nerve in the axilla

D. The accessory nerve in the posterior cervical triangle

A 54-year-old man comes to the emergency department because of a penetrating injury to his forearm from a baling hook while farming. His temperature is 37°C (98.6°F), pulse is 117/min, respirations are 22/min, and blood pressure is 100/70 mm Hg. Physical examination of the upper limb shows the patient is unable to oppose the tip of the thumb to the tip of the index finger. He is able to touch the tips of the ring and little fingers to the pad of his thumb. Which of the following nerves is most likely injured? A. Median B. Deep branch of radial C. Radial D. Recurrent median E. Anterior interosseous

E. Anterior interosseous

A 52-year-old man comes to the emergency department with excruciating pain in the posterior aspect of his right forearm. For the past several days he has been rehearsing with the symphony orchestra as a conductor. Physical examination shows excruciating pain upon palpation 2 cm distal and posteromedial to the lateral epicondyle. Intramuscular steroids are administered. Which of the following is the most likely mechanism of injury? A. Compression of the ulnar nerve by the flexor carpi ulnaris B. Compression of the median nerve by the pronator teres C. Compression of the median nerve by the flexor digitorum superficialis D. Compression of the superficial radial nerve by the brachioradialis E. Compression of the deep radial nerve by the supinator

E. Compression of the deep radial nerve by the supinator

A 32-year-old man comes to the physician because of a 3-day history of right shoulder pain after taking part in a tennis competition. An MRI in the oblique sagittal plane shows thickening and hypertrophy of a shoulder ligament. The physician explains that over the years of playing tennis, a shoulder ligament has gradually caused severe damage to the underlying muscle. Which of the following ligaments is the physician most likely referring to? A. Acromioclavicular (AC) ligament B. Coracohumeral ligament C. Transverse scapular ligament D. Glenohumeral ligament E. Coracoacromial ligament

E. Coracoacromial ligament

A 16-year-old man is brought to the emergency department with pain and swelling of his right wrist after falling from his bike onto a flexed, outstretched hand. An x-ray of the forearm shows a fracture of the distal radius. The fractured bone displaced a carpal bone in the palmar direction, resulting in nerve compression within the carpal tunnel. Which of the following carpal bones is most likely dislocated? A. Scaphoid B. Trapezium C. Capitate D. Hamate E. Lunate

E. Lunate

A 27-year-old-man is brought to the emergency department after he was hit on a fingertip while attempting to catch a ball bare-handed. Physical examination shows that the ballplayer cannot straighten the DIP joint of the middle finger of his right hand. Which of the following is the most likely diagnosis? A. Claw hand deformity B. Boutonnière deformity C. Swan-neck deformity D. Dupuytren contracture E. Mallet finger

E. Mallet finger

A 60-year old woman comes to the physician because of intermittent numbness and tingling sensation of her right hand, which often wakes her up at night. Physical examination shows flexion of the wrist for 60 seconds reproduces the painful symptoms. A 3-month trial of wrist splinting and non-steroidal anti-inflammatory drugs therapy did not relieve the pain. During surgery, an anesthetic injection into the axillary sheath is administered. The axillary sheath takes its origin from which of the following structures? A. Superficial fascia of the neck B. Superficial cervical investing fascia C. Buccopharyngeal fascia D. Clavipectoral fascia E. Prevertebral fascia

E. Prevertebral fascia

A 26-year-old man comes to the physician because of a 1-week history of pain and weakness in the right shoulder after a tennis match. The pain is exacerbated by movement. He is referred to an orthopedic surgeon. During surgery, the supraspinatus muscle is reflected from its bed. Which artery was seen crossing the ligament that bridges the notch of the superior border of the scapula? A. Subscapular B. Transverse cervical C. Dorsal scapular D. Posterior circumflex humeral E. Suprascapular

E. Suprascapular

A 14-year-old girl is brought to the physician because of difficulty holding a pen in her right hand. The patient is unable to perform opposition of the thumb, abduction and adduction of the digits, and IP joint extension of the right hand. There is notable anesthesia of the skin on the medial side of the forearm. Long flexor and extensor muscles of the hand and wrist appear to be functioning within normal limits. An x-ray shows marked elevation of the right first rib due to scoliosis. Which of the following neural structures is most likely impaired? A. Median nerve B. Middle trunk of the brachial plexus C. Radial nerve D. Lower trunk of the brachial plexus E. T1 ventral ramus

E. T1 ventral ramus

A 27-year-old man is brought to the emergency department after a motorcycle collision. Vitals are within normal limits. Physical examination shows bruising on the upper body and loss of the soft tissue on the dorsum of his left hand. The functions of the left extensor carpi radialis longus and brevis tendons are lost. An x-ray of the upper limbs shows no other abnormalities. A decision to replace those tendons with the palmaris longus tendons of both forearms is made. Postoperatively, sensation is absent on the lateral palm and palmar surfaces of the first three digits bilaterally. There is also paralysis of thumb opposition. What is the most likely cause of the sensory and motor deficits? A. Bilateral loss of spinal nerve T1 with fractures of first rib bilaterally B. Lower plexus (lower trunk) trauma C. Dupuytren contracture D. Left radial nerve injury in the posterior compartment of the forearm E. The palmaris

E. The palmaris longus was absent bilaterally; the nerve normally deep to it looked like a tendon and was cut

A 36-year-old man is brought to the emergency department after sustaining a deep knife wound on the medial side of his distal forearm in a fight. Neurologic examination finds that he is unable to hold a piece of paper between his fingers and has a loss of sensation on the medial aspect of his hand and medial 1½ digits. The site of injury is extremely tender on palpation. Which of the following nerves is most likely injured? A. Axillary B. Median C. Musculocutaneous D. Radial E. Ulnar

E. Ulnar

A 28-year-old nulligravida woman gives birth to a 3500 g (7 lb 11 oz) baby boy by forceps delivery. The pregnancy was complicated by gestational diabetes. Physical examination of the neonate finds an adducted, medially rotated left arm that is flexed at the wrist. Which part of the brachial plexus was most likely injured during the delivery? A. Lateral cord B. Medial cord C. Ventral rami of the lower trunk D. Ventral ramus of the middle trunk E. Ventral rami of the upper trunk

E. Ventral rami of the upper trunk