BRS upper limb
10. A 35-year-old man walks in with a stab wound to the most medial side of the proximal portion of the cubital fossa. Which of the following structures would most likely be damaged? (A) Biceps brachii tendon (B) Radial nerve (C) Brachial artery (D) Radial recurrent artery (E) Median nerve
10. The answer is E. The contents of the cubital fossa from medial to lateral side are the median nerve, the brachial artery, the biceps brachii tendon, and the radial nerve. Thus, the median nerve is damaged. The radial recurrent artery ascends medial to the radial nerve.
2. A patient comes in with a gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow? (A) Acromial (B) Pectoral (C) Clavicular (D) Deltoid (E) Superior thoracic
2. The answer is E. The superior thoracic artery is a direct branch of the axillary artery. The thoracoacromial trunk has four branches: the pectoral, clavicular, acromial, and deltoid.
28. A 27-year-old man with cubital tunnel syndrome complains of numbness and tingling in the ring and little fi nger and back and sides of his hand because of damage to a nerve in the tunnel at the elbow. Which of the following muscles is most likely to be paralyzed? (A) Flexor digitorum superfi cialis (B) Opponens pollicis (C) Two medial lumbricals (D) Pronator teres (E) Supinator
28. The answer is C. The ulnar nerve innervates the two medial lumbricals. However, the median nerve innervates the two lateral lumbricals, the fl exor digitorum superfi cialis, the opponens pollicis, and the pronator teres muscles.
34. A patient bleeding from the shoulder secondary to a knife wound is in fair condition because there is vascular anastomosis around the shoulder. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? (A) Dorsal scapular artery (B) Thoracoacromial artery (C) Circumflex scapular artery (D) Transverse cervical artery (E) Suprascapular artery
34. The answer is A. The dorsal scapular artery arises directly from the third part of the subclavian artery and replaces the deep (descending) branch of the transverse cervical artery. The suprascapular and transverse cervical arteries are branches of the thyrocervical trunk of the subclavian artery. The thoracoacromial artery is a short trunk from the fi rst or second part of
35. During a breast examination of a 56-year-old woman, the physician found a palpable mass in her breast. Which of the following characteristics of breast cancer and its diagnosis is correct? (A) Elevated nipple (B) Polymastia (C) Shortening of the clavipectoral fascia (D) Dimpling of the overlying skin (E) Enlargement of the breast
35. The answer is D. Breast cancer may cause dimpling of the overlying skin because of shortening of the suspensory (Cooper's) ligaments and inverted or retracted nipple because of pulling on the lactiferous ducts. Polymastia is a condition in which more than two breasts are present.
38. A 24-year-old carpenter suffers a crush injury of his entire little fi nger. Which of the following muscles is most likely to be spared? (A) Flexor digitorum profundus (B) Extensor digitorum (C) Palmar interossei (D) Dorsal interossei (E) Lumbricals
38. The answer is D. The dorsal interossei are abductors of the fi ngers. The little fi nger has no attachment for the dorsal interosseous muscle because it has its own abductor. Therefore, the dorsal interosseous muscle is not affected. Other muscles are attached to the little fi nger, thus they are injured.
4. A 16-year-old patient has weakness flxing the metacarpophalangeal joint of the ring finger and is unable to adduct the same finger. Which of the following muscles is most likely paralyzed? (A) Flexor digitorum profundus (B) Extensor digitorum (C) Lumbrical (D) Dorsal interosseous (E) Palmar interosseous
4. The answer is E. dorsal and palmar interosseous and lumbrical muscles=flex the metacarpophalangeal joints and extend the interphalangeal joints. palmar interosseous muscles adduct the fingers, while the dorsal interosseous muscles abduct the fingers. flexor digitorum profundus flexes the distal interphalangeal (DIP) joints.
40. A 49-year-old woman is diagnosed as having a large lump in her right breast. Lymph from the cancerous breast drains primarily into which of the following nodes? (A) Apical nodes (B) Anterior (pectoral) nodes (C) Parasternal (internal thoracic) nodes (D) Supraclavicular nodes (E) Nodes of the anterior abdominal wall
40. The answer is B. Lymph from the breast drains mainly (75%) to the axillary nodes, more specifi cally to the anterior (pectoral) nodes.
42. A construction worker suffers a destructive injury of the structures related to the anatomic snuffbox. Which of the following structures would most likely be damaged? (A) Triquetral bone (B) Trapezoid bone (C) Extensor indicis tendon (D) Abductor pollicis brevis tendon (E) Radial artery
42. The answer is E. The radial artery lies on the fl oor of the anatomic snuffbox. Other structures are not related to the snuffbox. The tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscles form the boundaries of the anatomic snuffbox. The scaphoid and trapezium bones form its fl oor.
43. A rock climber falls on his shoulder, resulting in a chipping off of the lesser tubercle of the humerus. Which of the following structures would most likely have structural and functional damage? (A) Supraspinatus muscle (B) Infraspinatus muscle (C) Subscapularis muscle (D) Teres minor muscle (E) Coracohumeral ligament
43. The answer is C. The subscapularis muscle inserts on the lesser tubercle of the humerus. The supraspinatus, infraspinatus, and teres minor muscles insert on the greater tubercle of the humerus. The coracohumeral ligament attaches to the greater tubercle.
44. A 22-year-old female Macarena dancer fell from the stage and complains of elbow pain and inability to supinate her forearm. Which of the following nerves are most likely injured from this accident? (A) Median and ulnar nerves (B) Axillary and radial nerves (C) Radial and musculocutaneous nerves (D) Ulnar and axillary nerves (E) Musculocutaneous and median nerves
44. The answer is C. The supinator and biceps brachii muscles supinate the forearm. The supinator is innervated by the radial nerve, and the biceps brachii is innervated by the musculocutaneous nerve.
5. A 27-year-old patient presents with an inability to draw the scapula forward and downward because of paralysis of the pectoralis minor. Which of the following would most likely be a cause of his condition? (A) Fracture of the clavicle (B) Injury to the posterior cord of the brachial plexus (C) Fracture of the coracoid process (D) Axillary nerve injury (E) Defects in the posterior wall of the axilla
5. The answer is C. pectoralis minor inserts on coracoid process -innervated by the medial and lateral pectoral nerves -depresses the shoulder
16. A patient with Bennett's fracture (a fracture of the base of the fi rst metacarpal bone) experiences an impaired thumb movement. Which of the following intrinsic muscles of the thumb is most likely injured? (A) Abductor pollicis brevis (B) Flexor pollicis brevis (superfi cial head) (C) Opponens pollicis (D) Adductor pollicis (E) Flexor pollicis brevis (deep head)
The answer is C. The opponens pollicis inserts on the fi rst metacarpal. All other intrinsic muscles of the thumb, including the abductor pollicis brevis, the fl exor pollicis brevis, and the adductor pollicis muscles, insert on the proximal phalanges.
11. The police bring in a murder suspect who has been in a gunfi ght with a police offi cer. The suspect was struck by a bullet in the arm; his median nerve has been damaged. Which of the following symptoms is likely produced by this nerve damage? (A) Waiter's tip hand (B) Claw hand (C) Wrist drop (D) Ape hand (E) Flattening of the hypothenar eminence
The answer is D. Injury to the median nerve produces the ape hand (a hand with the thumb permanently extended). Injury to the radial nerve results in loss of wrist extension, leading to wrist drop. Damage to the upper trunk of the brachial plexus produces waiter's tip hand. A claw hand and fl attening of the hypothenar eminence
12. An automobile body shop worker has his middle fi nger crushed while working on a transmission. Which of the following muscles is most likely to retain function? (A) Extensor digitorum (B) Flexor digitorum profundus (C) Palmar interosseous (D) Dorsal interosseous (E) Lumbrical
12. The answer is C. The extensor digitorum, fl exor digitorum profundus, dorsal interosseous, and lumbrical muscles are attached to the middle digit, but no palmar interosseous muscle is attached to the middle digit.
13. A 14-year-old boy falls on his outstretched hand and has a fracture of the scaphoid bone. The fracture is most likely accompanied by a rupture of which of the following arteries? (A) Brachial artery (B) Ulnar artery (C) Deep palmar arterial arch (D) Radial artery (E) Princeps pollicis artery
13. The answer is D. The scaphoid bone forms the fl oor of the anatomic snuffbox, through which the radial artery passes to enter the palm. The radial artery divides into the princeps pollicis artery and the deep palmar arch.
14. A 12-year-old boy walks in; he fell out of a tree and fractured the upper portion of his humerus. Which of the following nerves are intimately related to the humerus and are most likely to be injured by such a fracture? (A) Axillary and musculocutaneous (B) Radial and ulnar (C) Radial and axillary (D) Median and musculocutaneous (E) Median and ulnar
14. The answer is C. The axillary nerve passes posteriorly around the surgical neck of the humerus, and the radial nerve lies in the radial groove of the middle of the shaft of the humerus. The ulnar nerve passes behind the medial epicondyle, and the median nerve is vulnerable to injury by supracondylar fracture of the humerus, but these nerves lie close to or in contact with the lower portion of the humerus. The musculocutaneous nerve is not in direct contact with the humerus.
15. A man injures his wrist on broken glass. Which of the following structures entering the palm superfi cial to the fl exor retinaculum may be damaged? (A) Ulnar nerve and median nerve (B) Median nerve and fl exor digitorum profundus (C) Median nerve and fl exor pollicis longus (D) Ulnar artery and ulnar nerve (E) Ulnar nerve and fl exor digitorum superfi cialis
15. The answer is D. Structures entering the palm superfi cial to the fl exor retinaculum include the ulnar nerve, ulnar artery, palmaris longus tendon, and palmar cutaneous branch of the median nerve. The median nerve, the fl exor pollicis longus, and the fl exor digitorum superfi cialis and profundus run deep to the fl exor retinaculum.
17. A 27-year-old pianist with a known carpal tunnel syndrome experiences diffi culty in fi nger movements. Which of the following intrinsic muscles of her hand is paralyzed? (A) Palmar interossei and adductor pollicis (B) Dorsal interossei and lateral two lumbricals (C) Lateral two lumbricals and opponens pollicis (D) Abductor pollicis brevis and palmar interossei (E) Medial two and lateral two lumbricals
17. The answer is C. The median nerve innervates the abductor pollicis brevis, opponens pollicis, and two lateral lumbricals. The ulnar nerve innervates all interossei (palmar and dorsal), the adductor pollicis, and the two medial lumbricals.
18. A 31-year-old roofer walks in with tenosynovitis resulting from a deep penetrated wound in the palm by a big nail. Examination indicates that he has an infection in the ulnar bursa. This infection most likely resulted in necrosis of which of the following tendons? (A) Tendon of the fl exor carpi ulnaris (B) Tendon of the fl exor pollicis longus (C) Tendon of the fl exor digitorum profundus (D) Tendon of the fl exor carpi radialis (E) Tendon of the palmaris longus
18. The answer is C. The ulnar bursa, or common synovial fl exor sheath, contains the tendons of both the fl exor digitorum superfi cialis and profundus muscles. The radial bursa envelops the tendon of the fl exor pollicis longus. The tendons of the fl exor carpi ulnaris and the palmaris longus are not contained in the ulnar bursa.
19. An 18-year-old boy involved in an automobile accident presents with arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? (A) Suprascapular and axillary (B) Thoracodorsal and upper subscapular (C) Axillary and musculocutaneous (D) Radial and lower subscapular (E) Suprascapular and dorsal scapular
19. The answer is A. The abductors of the arm are the deltoid and supraspinatus muscles, which are innervated by the axillary and suprascapular nerves, respectively. The thoracodorsal nerve supplies the latissimus dorsi, which can adduct, extend, and rotate the arm medially. The upper and lower subscapular nerves supply the subscapularis, and the lower subscapular nerve also supplies the teres major; both of these structures can adduct and rotate the arm medially. The musculocutaneous nerve supplies the fl exors of the arm, and the radial nerve supplies the extensors of the arm. The dorsal scapular nerve supplies the levator scapulae and rhomboid muscles; these muscles elevate and adduct the scapula, respectively.
20. A 17-year-old boy with a stab wound received multiple injuries on the upper part of the arm and required surgery. If the brachial artery were ligated at its origin, which of the following arteries would supply blood to the profunda brachii artery? (A) Lateral thoracic (B) Subscapular (C) Posterior humeral circumfl ex (D) Superior ulnar collateral (E) Radial recurrent
20. The answer is C. The posterior humeral circumfl ex artery anastomoses with an ascending branch of the profunda brachii artery, whereas the lateral thoracic and subscapular arteries do not. The superior ulnar collateral and radial recurrent arteries arise inferior to the origin of the profunda brachii artery.
21. A 23-year-old woman who receives a deep cut to her ring fi nger by a kitchen knife is unable to move the metacarpophalangeal joint. Which of the following pairs of nerves was damaged? (A) Median and ulnar (B) Radial and median (C) Musculocutaneous and ulnar (D) Ulnar and radial (E) Radial and axillary
21. The answer is D. The metacarpophalangeal joint of the ring figer is fl exed by the lumbrical, palmar, and dorsal interosseous muscles, which are innervated by the ulnar nerve. The extensor digitorum, which is innervated by the radial nerve, extends this joint. The musculocutaneous and axillary nerves do not supply muscles of the hand. The median nerve supplies the lateral two lumbricals, which can fl ex metacarpophalangeal joints of the index and middle fi ngers.
22. A 27-year-old baseball player is hit on his forearm by a high-speed ball during the World Series, and the muscles that form the fl oor of the cubital fossa appear to be torn. Which of the following groups of muscles have lost their functions? (A) Brachioradialis and supinator (B) Brachialis and supinator (C) Pronator teres and supinator (D) Supinator and pronator quadratus (E) Brachialis and pronator teres
22. The answer is B. The brachialis and supinator muscles form the fl oor of the cubital fossa. The brachioradialis and pronator teres muscles form the lateral and medial boundaries, respectively. The pronator quadratus is attached to the distal ends of the radius and the ulna.
23. A 23-year-old man complains of numbness on the medial side of the arm following a stab wound in the axilla. On examination, he is diagnosed with an injury of his medial brachial cutaneous nerve. In which of the following structures are the cell bodies of the damaged nerve involved in numbness located? (A) Sympathetic chain ganglion (B) Dorsal root ganglion (C) Anterior horn of the spinal cord (D) Lateral horn of the spinal cord (E) Posterior horn of the spinal cord
23. The answer is B. The medial brachial cutaneous nerve contains sensory (general somatic afferent [GSA]) fi bers that have cell bodies in the dorsal root ganglia, and an injury of these GSA fi bers causes numbness of the medial side of the arm. It also contains sympathetic postganglionic fi bers that have cell bodies in the sympathetic chain ganglia. The anterior horn of the spinal cord contains cell bodies of skeletal motor (general somatic efferent [GSE]) fi bers, and the lateral horn contains cell bodies of sympathetic preganglionic fi bers. The posterior horn contains cell bodies of interneurons.
24. A 38-year-old homebuilder was involved in an accident and is unable to supinate his forearm. Which of the following nerves are most likely damaged? (A) Suprascapular and axillary (B) Musculocutaneous and median (C) Axillary and radial (D) Radial and musculocutaneous (E) Median and ulnar
24. The answer is D. The supinator and biceps brachii muscles, which are innervated by the radial and musculocutaneous nerves, respectively, produce supination of the forearm. This is a question of two muscles that can supinate the forearm.
25. A 31-year-old patient complains of sensory loss over the anterior and posterior surfaces of the medial third of the hand and the medial one and one-half fi ngers. He is diagnosed by a physician as having "funny bone" symptoms. Which of the following nerves is injured? (A) Axillary (B) Radial (C) Median (D) Ulnar (E) Musculocutaneous
25. The answer is D. The ulnar nerve supplies sensory fi bers to the skin over the palmar and dorsal surfaces of the medial third of the hand and the medial one and one-half fi ngers. The median nerve innervates the skin of the lateral side of the palm; the palmar side of the lateral three and one-half fi ngers; and the dorsal side of the index fi nger, the middle fi nger, and one-half of the ring fi nger. The radial nerve innervates the skin of the radial side of the hand and the radial two and one-half digits over the proximal phalanx.
26. A patient with a deep stab wound in the middle of the forearm has impaired movement of the thumb. Examination indicates a lesion of the anterior interosseous nerve. Which of the following muscles is paralyzed? (A) Flexor pollicis longus and brevis (B) Flexor pollicis longus and opponens pollicis (C) Flexor digitorum profundus and pronator quadratus (D) Flexor digitorum profundus and superfi -cialis (E) Flexor pollicis brevis and pronator quadratus
26. The answer is C. The anterior interosseous nerve is a branch of the median nerve and supplies the fl exor pollicis longus, half of the fl exor digitorum profundus, and the pronator quadratus. The median nerve supplies the pronator teres, fl exor digitorum superfi cialis, palmaris longus, and fl exor carpi radialis muscles. A muscular branch (the recurrent branch) of the median nerve innervates the thenar muscles.
27. A 29-year-old patient comes in; he cannot fl ex the distal interphalangeal (DIP) joint of the index fi nger. His physician determines that he has nerve damage from a supracondylar fracture. Which of the following conditions is also a symptom of this nerve damage? (A) Inability to fl ex the DIP joint of the ring fi nger (B) Atrophy of the hypothenar eminence (C) Loss of sensation over the distal part of the second digit (D) Paralysis of all the thumb muscles (E) Loss of supination
27. The answer is C. The fl exor digitorum profundus muscle fl exes the DIP joints of the index and middle fi ngers and is innervated by the median nerve, which also supplies sensation over the distal part of the second digit. The same muscle fl exes the DIP joints of the ring and little fi ngers but receives innervation from the ulnar nerve, which also innervates the hypothenar muscles. The median nerve innervates the thenar muscles. The radial nerve innervates the supinator, abductor pollicis longus, and extensor pollicis longus and brevis muscles. The ulnar nerve innervates the adductor pollicis. The musculocutaneous nerve supplies the biceps brachii that can supinate the arm.
29. A secretary comes in to your offi ce complaining of pain in her wrists from typing all day. You determine that she likely has carpal tunnel syndrome. Which of the following conditions would help you determine the diagnosis? (A) Inability to adduct the little fi nger (B) Inability to fl ex the DIP joint of the ring fi nger (C) Flattened thenar eminence (D) Loss of skin sensation of the medial one and one-half fi ngers (E) Atrophied adductor pollicis muscle
29. The answer is C. The carpal tunnel contains the median nerve and the tendons of fl exor pollicis longus, fl exor digitorum profundus, and fl exor digitorum superfi cialis muscles. Carpal tunnel syndrome results from injury to the median nerve, which supplies the thenar muscle. Thus, injury to this nerve causes the fl attened thenar eminence. The middle fi nger has no attachment for the adductors. The ulnar nerve innervates the medial half of the fl exor digitorum profundus muscle, which allows fl exion of the DIP joints of the ring and little fi ngers. The ulnar nerve supplies the skin over the medial one and one-half fi ngers and adductor pollicis muscle.
3. A 29-year-old man comes in with a stab wound, cannot raise his arm above horizontal, and exhibits a condition known as "winged scapula." Which of the following structures of the brachial plexus would most likely be damaged? (A) Medial cord (B) Posterior cord (C) Lower trunk (D) Roots (E) Upper trunk
3. The answer is D. Winged scapula is caused by paralysis of the serratus anterior muscle that results from damage to the long thoracic nerve, which arises from the roots of the brachial plexus (C5-C7).
30. A man is unable to hold typing paper between his index and middle fi ngers. Which of the following nerves was likely injured? (A) Radial nerve (B) Median nerve (C) Ulnar nerve (D) Musculocutaneous nerve (E) Axillary nerve
30. The answer is C. To hold a typing paper, the index fi nger is adducted by the palmar interosseous muscle, and the middle fi nger is abducted by the dorsal interosseous muscle. Both muscles are innervated by the ulnar nerve.
31. The victim of an automobile accident has a destructive injury of the proximal row of carpal bones. Which of the following bones is most likely damaged? (A) Capitate (B) Hamate (C) Trapezium (D) Triquetrum (E) Trapezoid
31. The answer is D. The proximal row of carpal bones consists of the scaphoid, lunate, triquetrum, and pisiform bones, whereas the distal row consists of the trapezium, trapezoid, capitate, and hamate bones.
32. A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which of the following muscle tendons is intact and has normal function? (A) Supraspinatus (B) Subscapularis (C) Teres major (D) Teres minor (E) Infraspinatus
32. The answer is C. The rotator cuff consists of the tendons of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. It stabilizes the shoulder joint by holding the head of the humerus in the glenoid cavity during movement. The teres major inserts on the medial lip of the intertubercular groove of the humerus.
33. A patient complains of having pain with repeated movements of his thumb (claudication). His physician performs the Allen test and finds an insufficiency of the radial artery. Which of the following conditions would be a result of the radial artery stenosis? (A) A marked decrease in the blood flow in the superficial palmar arterial arch (B) Decreased pulsation in the artery passing superficial to the flexor retinaculum (C) Ischemia of the entire extensor muscles of the forearm (D) A marked decrease in the blood flow in the princeps pollicis artery (E) A low blood pressure in the anterior interosseous artery
33. The answer is D. The radial artery divides into the princeps pollicis artery and the deep palmar arterial arch. Thus, stenosis of the radial artery results in a decreased blood fl ow in the princeps pollicis artery. The superfi cial palmar arterial arch is formed primarily by the ulnar artery, which passes superfi cial to the fl exor retinaculum. The extensor compartment of the forearm receives blood from the posterior interosseous artery, which arises from the common interosseous branch of the ulnar artery. However, the radial and radial recurrent arteries supply the brachioradialis and the extensor carpi radialis longus and brevis.
36. A patient with a stab wound receives a laceration of the musculocutaneous nerve. Which of the following conditions is most likely to have occurred? (A) Lack of sweating on the lateral side of the forearm (B) Inability to extend the forearm (C) Paralysis of brachioradialis muscle (D) Loss of tactile sensation on the arm (E) Constriction of blood vessels on the hand
36. The answer is A. The musculocutaneous nerve contains sympathetic postganglionic fi bers that supply sweat glands and blood vessels on the lateral side of the forearm as the lateral antebrachial cutaneous nerve. The musculocutaneous nerve does not supply the extensors of the forearm and the brachioradialis. This nerve also supplies tactile sensation on the lateral side of the forearm but not the
37. A 20-year-old man fell from the parallel bar during the Olympic trial. A neurologic examination reveals that he has a lesion of the lateral cord of the brachial plexus. Which of the following muscles is most likely weakened by this injury? (A) Subscapularis (B) Teres major (C) Latissimus dorsi (D) Teres minor (E) Pectoralis major
37. The answer is E. The pectoralis major is innervated by the lateral and medial pectoral nerves originating from the lateral and medial cords of the brachial plexus, respectively. The subscapularis, teres major, latissimus dorsi, and teres minor muscles are innervated by nerves originating from the posterior cord of the brachial plexus.
39. A 7-year-old boy falls from a tree house and is brought to the emergency department of a local hospital. On examination, he has weakness in rotating his arm laterally because of an injury of a nerve. Which of the following conditions is most likely to cause a loss of this nerve function? (A) Injury to the lateral cord of the brachial plexus (B) Fracture of the anatomic neck of the humerus (C) Knife wound on the teres major muscle (D) Inferior dislocation of the head of the humerus (E) A tumor in the triangular space in the shoulder region
39. The answer is D. Inferior dislocation of the head of the humerus may damage the axillary nerve, which arises from the posterior cord of the brachial plexus, runs through the quadrangular space accompanied by the posterior humeral circumfl ex vessels around the surgical neck of the humerus, and supplies the deltoid and teres minor, which are lateral rotators of the arm.
6. A 22-year-old patient received a stab wound in the chest that injured the intercostobrachial nerve. Which of the following conditions results from the described lesion of the nerve? (A) Inability to move the ribs (B) Loss of tactile sensation on the lateral aspect of the arm (C) Absence of sweating on the posterior aspect of the arm (D) Loss of sensory fibers from the second intercostal nerve (E) Damage to the sympathetic preganglionic fibers
6. The answer is D. The intercostobrachial nerve arises from the lateral cutaneous branch of the second intercostal nerve and pierces the intercostal and serratus anterior muscles. It may communicate with the medial brachial cutaneous nerve, and it supplies skin on the medial side of the arm. It contains no skeletal motor fi bers but does contain sympathetic postganglionic fi bers, which supply sweat glands.
7. A 16 year-old boy fell from a motorcycle, and his radial nerve was severely damaged because of a fracture of the midshaft of the humerus. Which of the following conditions would most likely result from this accident? (A) Loss of wrist extension leading to wrist drop (B) Weakness in pronating the forearm (C) Sensory loss over the ventral aspect of the base of the thumb (D) Inability to oppose the thumb (E) Inability to abduct the fingers
7. The answer is A. Injury to the radial nerve results in loss of wrist extension, leading to wrist drop. The median nerve innervates the pronator teres, pronator quadratus, and opponens pollicis muscles and the skin over the ventral aspect of the thumb. The ulnar nerve innervates the dorsal interosseous muscles, which act to abduct the fi ngers.
8. A patient comes in complaining that she cannot flex her proximal interphalangeal joints. Which of the following muscles appear(s) to be paralyzed on further examination of her fi nger? (A) Palmar interossei (B) Dorsal interossei (C) Flexor digitorum profundus (D) Flexor digitorum superfi cialis (E) Lumbricals
8. The answer is D. The flexor digitorum superficialis muscle flexes the proximal interphalangeal joints. The flexor digitorum profundus muscle flexes the DIP joints. The palmar and dorsal interossei and lumbricals can flex metacarpophalangeal joints and extend the interphalangeal joints. The palmar interossei adduct the fingers, and the dorsal interossei abduct the fi ngers.
9. A 21-year-old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which of the following muscles? (A) Teres minor (B) Supraspinatus (C) Latissimus dorsi (D) Infraspinatus (E) Serratus anterior
9. The answer is C. The latissimus dorsi adducts the arm, and the supraspinatus muscle abducts the arm. The infraspinatus and the teres minor rotate the arm laterally. The serratus anterior rotates the glenoid cavity of the scapula upward, abducts the arm, and elevates it above a horizontal position.
1. A 21-year-old patient has a lesion of the upper trunk of the brachial plexus (Erb- Duchenne paralysis). Which of the following is the most likely diagnosis? (A) Paralysis of the rhomboid major (B) Inability to elevate the arm above the horizontal (C) Arm tending to lie in medial rotation (D) Loss of sensation on the medial side of the arm (E) Inability to adduct the thumb
C upper trunk leision= waiters tip hand arm= -medial rotates long thoracic innervates serratus anterior = elevates arm above horizontal Dorsal scapular innervates rhomboid major The adductor pollicis is innervated by the ulnar nerve.
