HSC 630 -EXAM 3- LG 11
Neurological testing of a patient reveals no cutaneous sensation on the tip of the thumb. Such a finding could indicate an injury to which dermatome and peripheral nerve? a.) C6; median nerve b.) C6; ulnar nerve c.) C7; median nerve d.) C7; ulnar nerve e.) C8; median nerve f.) C8; ulnar nerve
a.) C6; median nerve
A 26-year-old construction worker was installing a new window when his arm slipped and broke through the glass. One of his fellow coworkers drove him to the emergency department while he held his shirt against his profusely bleeding arm. Examination revealed a severed tendon in his distal forearm. He has difficulty in extending and abducting his hand at the wrist. Which one of these tendons is most likely to be affected? a.) Extensor carpi radialis longus b.) Extensor carpi ulnaris c.) Extensor digitorum d.) Extensor pollicis longus e.) Extensor indicis
a.) Extensor carpi radialis longus Explanation: The extensor carpi radialis longus both extends and abducts (radially deviates) the hand at the wrist.
A 25-year-old woman sustains a deep laceration to the palmar aspect of the left index finger just proximal to the distal interphalangeal joint. On examination, she is unable to flex the tip of the index finger at the distal interphalangeal joint with the other joints of the finger held in extension. All other motions are normal. Which of the following is the most likely diagnosis? a.) Injury to the flexor digitorum profundus tendon b.) Injury to the flexor digitorum superficialis tendon c.) Injury to the palmaris longus tendon d.) Injury to the flexor pollicis longus tendon e.) Injury to the flexor carpi radialis
a.) Injury to the flexor digitorum profundus tendon Explanation: The tendon of the flexor digitorum profundus inserts on the distal phalanx. Injury to this tendon results in an isolated inability to flex the digit at the distal interphalangeal joint
An 18-year-old woman with a long-standing history of depression was brought to the emergency department after an attempted suicide by slashing horizontally across the anterior aspects of her wrists. The patient was stabilized and was put under sedatives to calm her down and to allow for repair of her wounds. During the procedure, it was noted that the median nerve was severed at the wrist. If left unrepaired, which of the following complications would likely result? a.) Loss of function of most thenar muscles and lumbricals 1 and 2 b.) Weakness in flexion of the wrist with ulnar deviation upon flexion c.) Sensory loss on the lateral part of the dorsum of the hand d.) No extension of the wrist or digits e.) Loss of abduction and adduction of the digits
a.) Loss of function of most thenar muscles and lumbricals 1 and 2 Explanation: Severing of the median nerve at the wrist would cause the loss of innervation of the median recurrent nerve, responsible for the motor function of most thenar muscles. Additionally, the median nerve is responsible for innervation of the first and second lumbricals, which would be nonfunctional if the median nerve was severed at the wrist.
A 22-year-old woman sustains a deep laceration to the hypothenar eminence just distal to the wrist crease. The cut is approximately 2 cm long and transversely oriented. Bright arterial bleeding spurts from the cut whenever pressure is released, and she has numbness of the fifth finger and lateral (ulnar) aspect of the fourth finger. A diagnosis of ulnar artery injury is made. Which of the following is the most likely associated injury? a.) Injury to the median nerve b.) Injury to the ulnar nerve c.) Injury to the medial cutaneous nerve d.) Injury to the thoracodorsal nerve
b.) Injury to the ulnar nerve Explanation: The ulnar nerve passes next to the ulnar artery and innervates the cutaneous area distal to the wrist
A 16-year-old gymnast is practicing his ring routine when he misses one of his catches and breaks his fall on outstretched arms. He complains of pain and swelling of his lateral left wrist. During the physical examination, you notice significant tenderness over the proximal aspect of his anatomical snuffbox, between the tendons of the extensor pollicis longus and extensor pollicis brevis tendons. Radiographic imaging shows a fracture of one of the carpal bones. Which of the following is most likely fractured? a.) Hamate b.) Scaphoid c.) Lunate d.) Capitate e.) Pisiform
b.) Scaphoid Explanation: The scaphoid bone is the most commonly fractured carpal bone. It is also frequently injured during falls on an outstretched hand. The scaphoid bone serves as the floor of the anatomical snuffbox, which would explain the point-tenderness in the region.
The pulse of the radial artery at the wrist is felt immediately lateral to which tendon? a.) flexor carpi ulnaris b.) flexor carpi radialis c.) flexor digitorum profundus d.) flexor digitorum superficialis e.) palmaris longus
b.) flexor carpi radialis
A 59 year old man is having difficulty using his thumb. The patient has no difficulty when drawing his thumb across the palm of the hand in the frontal plane. He can also move his thumb perpendicularly within the sagittal plane such that his thumb is pointed forward, away from his palm. However, he is unable to return his thumb back to his palm against resistance. Based on this presentation, what nerve do you suspect is impacted? a.) anterior interosseous nerve b.) ulnar nerve c.) median nerve d.) radial nerve e.) posterior interosseous nerve
b.) ulnar nerve
What superficial vein of the arm is located on the medial side?
basilic vein
A 22 year old man sustained multiple deep lacerations of the anterior surface of the palm and wrist. During examination, a piece of paper is put between adjacent sides of the patient's index and middle fingers and found hum unable to squeeze them together with sufficient force to hold the paper. What muscles are being tested? a.) 1st dorsal interosseous; 1st palmar interosseous b.) 1st dorsal interosseous; 2nd palmar interosseous c.) 2nd dorsal interosseous; 1st palmar interosseous d.) 2nd dorsal interosseous; 2nd palmar interosseous
c.) 2nd dorsal interosseous; 1st palmar interosseous
Neurological testing of a patient reveals no cutaneous sensation on the tip of the middle finger. Such a finding could indicate an injury to which dermatome and peripheral nerve? a.) C6; median nerve b.) C6; ulnar nerve c.) C7; median nerve d.) C7; ulnar nerve e.) C8; median nerve f.) C8; ulnar nerve
c.) C7; median nerve
You are called to see a 16-year-old girl who has slashed her inner left wrist in a suicide attempt. There is a linear cut 3 cm in length just proximal to the wrist crease. Testing reveals excellent radial and ulnar pulses, no neurological deficits, and full active and passive range of motion of all digits and the wrist. As you explore the wound before closure, you find the proximal and distal ends of a tendon. What is the most likely diagnosis? a.) Division of a tendon of flexor digitorum profundus b.) Division of a tendon of flexor digitorum superficialis c.) Division of palmaris longus tendon d.) Division of the tendon of flexor carpi radialis e.) Division of the tendon of flexor pollicis longus
c.) Division of palmaris longus tendon Explanation: The only tendon that can be divided without causing a defect in active range of motion is the tendon of palmaris longus. This is also the most superficial tendon in this location and so most likely to be injured
A 22-year-old man fell off his bicycle and fractured the medial epicondyle of his humerus. The physician must determine the integrity of the ulnar nerve. Which pair of muscles would allow the patient to hold a dollar bill between the fingers against resistance? a.) Abductor digiti minimi-dorsal interossei b.) Adductor pollicis-lumbricals c.) Dorsal interossei-palmar interossei d.) Lumbricals-palmar interossei
c.) Dorsal interossei-palmar interossei Explanation: To hold a dollar bill between any two adjacent digits (2 and 5), one digit must abduct, while the adjacent digit must adduct to press against its neighbor. The palmar interossei, which insert into the proximal phalanges on the ulnar side of the index finger and the radial sides of the ring and little fingers, adduct digits 2, 4, and 5 (PAD = palmar adduct). The dorsal interossei, which insert into the proximal phalanges on the radial side of the index finger, on both sides of the middle finger, and on the ulnar side of the ring finger, abduct digits 2 and 4 (DAB = dorsal abduct). The thumb and the fifth digit each has its own abductor. The ulnar nerve innervates all interossei via its deep branch.
De Quervain syndrome is a painful idiopathic tenosynovitis that typically involves two of the tendons on the thumb side of the wrist. Although the cause is not known, repetitive activity involving these tendons responsible for abduction and extension of the thumb can exacerbate the pain, swelling, and inflammation seen in this area of the wrist. Additionally, this pair of parallel tendons forms the anterior border of the anatomical snuffbox. Based on this information, which of the following pairs of tendons are likely the tendons implicated in de Quervain syndrome? a.) Flexor pollicis longus and flexor pollicis brevis b.) Abductor pollicis longus and flexor pollicis brevis c.) Extensor pollicis brevis and abductor pollicis longus d.) Extensor pollicis longus and extensor pollicis brevis e.) Abductor pollicis longus and extensor pollicis longus
c.) Extensor pollicis brevis and abductor pollicis longus Explanation: The extensor pollicis brevis and the abductor pollicis longus muscle tendons together form one of the major boundaries of the anatomical snuffbox and are two major muscles utilized during abduction and extension of the thumb at the wrist. Chronic overuse of these muscles can cause irritation of the synovial sheaths that wrap around these tendons near the anatomical snuffbox, causing the significant pain and discomfort associated with de Quervain syndrome.
A 17-year-old high school wrestler visits his family doctor due to pain in his left hand. After a series of tests the doctor sends him to get an MRI of the wrist. The imaging confirms that a structure passing through the carpal tunnel is damaged. Which of the following structures is most likely affected in this patient? a.) Radial artery b.) Tendons of the extensor digitorum c.) Tendon of the flexor pollicis longus d.) Ulnar artery e.) Palmar branch of the median nerve
c.) Tendon of the flexor pollicis longus Explanation: The tendon of the flexor pollicis longus muscle does pass through the carpal tunnel along with the median nerve and eight other tendons (i.e., four tendons each of the flexor digitorum superficialis and profundus muscles).
A 28 year old man sustained a severe neck injury in which his spinal cord was severed at the C7 spinal level. Which of the following would be most affected in this scenario? a.) abduction of arm b.) extension of arm c.) adduction of digits 2-5 d.) flexion of forearm e.) supination of forearm
c.) adduction of digits 2-5 ulnar nerve injured --> palmar interossei muscles
The abductor pollicis brevis acts in which anatomical plane? a.) frontal b.) transverse c.) sagittal
c.) sagittal
What superficial vein of the arm is located on the lateral side?
cephalic vein
A 43-year-old carpenter is using a pneumatic nail gun to install crown molding when he slips on his stepladder and fires a nail through the center of his hand. The emergency department physician removes the nail, and on physical exam she notices the patient has lost some function of his thumb. After her careful exam she hypothesizes that the nail severed the deep branch of the ulnar nerve. Which of the following muscles is most likely affected? a.) Extensor pollicis brevis b.) 2nd lumbrical c.) Abductor pollicis brevis d.) Adductor pollicis e.) Opponens pollicis
d.) Adductor pollicis Explanation: The adductor pollicis muscle is innervated by the deep branch of the ulnar nerve.
Which of the following are innervated by the ulnar nerve? a.) 3rd palmar interosseous b.) 4th lumbrical c.) 1st dorsal interosseous d.) all of the above e.) a and c only
d.) all of the above
To produce local anesthesia before draining a paronychia (nail bed infection) of a patient's left fourth digit (ring finger), you wish to create a digital nerve block. Where should you inject the local anesthetic? a.) At the base of the hypothenar eminence b.) In the anatomical snuffbox at the base of the thumb c.) Medial and lateral surfaces of digit four, targeting dorsal branches of superficial radial nerve d.) Medial and lateral surfaces of digit four, targeting dorsal branches of superficial radial and median nerves e.) Medial and lateral surfaces of digit four, targeting dorsal branches of palmar branches of median and ulnar nerves
e.) Medial and lateral surfaces of digit four, targeting dorsal branches of palmar branches of median and ulnar nerves Explanation: The digital nerves are found at the medial and lateral aspect of each finger. By targeting the medial and lateral surfaces of digit four the dorsal branches of palmar branches of median and ulnar nerves can be anesthetized. This will allow for a pain-free surgery of the nail bed of finger four
An 18-year-old boy is brought to the emergency department by his father after the boy cut his hand while slicing a bagel. The boy was holding the bagel in his left hand and using a knife with his right hand to make the cut. The blade passed through the bagel and cut him along the medial border of the thenar eminence, just distal to the flexor retinaculum. The cut was pretty superficial, but the doctored worried he may have cut his recurrent branch of the median nerve. Which of the following functions would you test to rule out this possibility? a.) Sensation over the proximal palm of the hand b.) Flexion of the thumb c.) Abduction of the thumb d.) Adduction of the thumb e.) Opposition of the thumb toward little finger
e.) Opposition of the thumb toward little finger Explanation: Opposition of the thumb toward little finger is the best test because the recurrent (motor) branch of the median nerve innervates the opponens pollicis muscle and is the only muscle that allows for opposition of the thumb. If the patient can accomplish this motion he most likely has an intact recurrent (motor) branch of the median nerve.
A construction worker suffers an injury to his hand when a nail gun accidentally discharges and drives a nail into his anatomical snuffbox. Which of the following would most likely be damaged? a.) radial artery b.) ulnar artery c.) scaphoid bone d.) trapezoid bone e.) a and c f.) b and d
e.) a and c
Compression of the median nerve at the level of the carpal tunnel will affect which of the following hand muscles? a.) Abductor pollicis brevis b.) Palmar interossei c.) Lumbrical 2 d.) Lumbrical 4 e.) a and c f.) b and d
e.) a and c
Your patient comes into your office for overuse of her right wrist, which has resulted in sensory and motor deficits due to carpal tunnel syndrome. Which of the following are symptoms she may be experiencing? a.) weakness of the thenar muscles b.) weakness of the hypothenar muscles c.) loss of thumb opposition d.) loss of abduction of digits 2-5 e.) a and c f.) b and d
e.) a and c
A lesion just proximal to the common palmar digital nerves would result in which of the following deficits? a.) loss of sensation to tip of index finger b.) loss of sensation over thenar eminence c.) weakness of thumb flexion d.) all of the above e.) a and c only
e.) a and c only
The adductor pollicis acts on which of the following joints? a.) 1st MCP b.) 1st IP c.) 1st CMC d.) all of the above e.) a and c only
e.) a and c only
Which of the following acts on the 3rd metacarpophalangeal (MCP) joint? a.) 2nd lumbrical b.) 3rd palmar interosseous c.) 2nd dorsal interosseous d.) all of the above e.) a and c only
e.) a and c only
Which of the following is an action of the lumbrical muscles? a.) extension of DIP joints b.) flexion of PIP joints c.) flexion of MCP joints d.) all of the above e.) a and c only
e.) a and c only also does extension of PIP joints
Neurological testing of a patient reveals no cutaneous sensation on the tip of the pinky finger. Such a finding could indicate an injury to which dermatome and peripheral nerve? a.) C6; median nerve b.) C6; ulnar nerve c.) C7; median nerve d.) C7; ulnar nerve e.) C8; median nerve f.) C8; ulnar nerve
f.) C8; ulnar nerve
Which of the following pass through the carpal tunnel? a.) flexor pollicis longus tendon b.) median nerve c.) flexor digitorum superficialis tendon d.) flexor digitorum profundus tendon e.) a and c f.) b and d g.) all of the above
g.) all of the above
What is the special movement of the thumb across the palm that permits grasping and holding of an object?
opposition
What vessels form an anastomosis in the hand to ensure it gets enough oxygen?
the radial and ulnar artery
