PREP U - Rotator Cuff and Axillary Muscles
B) teres minor and deltoid
A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. Following this accident, the boy has weakness in rotating his arm laterally. Which of the following muscles are paralyzed? A) teres minor and infraspinatus B) teres minor and deltoid C) supraspinatus and subscapularis D) teres major and teres minor E) infraspinatus and deltoid
C) posterior humeral circumflex
A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. This accident most likely leads to damage of which of the following arteries? A) superior ulnar collateral B) deep brachial C) posterior humeral circumflex D) axillary E) scapular circumflex
A) axillary
A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal of the surgical neck of his humerus and bleeding from the point of the fracture. Which of the following nerve is most likely injured as a result of this accident? A) axillary B) musculocutaneous C) ulnar D) radial E) median
E) infraspinatus
A 16-year-old boy attempts to lift a heavy barbell in order to impress his high school football coach. During the lift, violent contraction fo the shoulder muscles causes avulsion of the greater tuberosity of the left humerus. Which of the following muscles is attached to the displaced bone fragment? A) subscapularis B) deltoid C) teres major D) pectoralis major E) infraspinatus
C) posterior circumflex humeral artery
A 17-year-old boy is taken to the emergency room after being struck on the lateral aspect of the left shoulder by a baseball bat. Examination reveals a fracture of the surgical neck of the left humerus, displaced bone fragments piercing the quadrangular space of the shoulder, and deep blood accumulation around the fracture. Which of the following blood vessels was most likely severed? A) subscapular artery B) circumflex scapular artery C) posterior circumflex humeral artery D) cephalic vein E) profunda brachii artery
C) posterior humeral circumflex
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) subscapular B) superior ulnar collateral C) posterior humeral circumflex D) lateral thoracic E) radial recurrent
E) axillary nerve
A 17-year-old male football player suffers a shoulder injury and arrives at the ER 2 hours after the injury. The physician diagnoses a shoulder dislocation, and after administration of a local anesthetic solution, the door repositions that head of the humerus into the glenoid cavity of the scapula (reduction). No fractures are seen on W-rays. However, the patient displays weakness in abduction and external rotation at the shoulder. A loss of sensation is also noted at the superior and lateral aspects of the arm. What nerve was most likely damaged in this injury? A) ulnar nerve B) median nerve C) radial nerve D) musculocutaneous nerve E) axillary nerve
A) pectoralis major
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) pectoralis major B) teres minor C) teres major D) latissimus dorsi E) subscapularis
A) infraspinatus
A 21-year-old man celebrating his birthday gets a little carried away his friends and starts a bar fight. He is stabbed with a knife that severs the roots of C5 and C6 of the brachial plexus. Which of the following muscles is likely to be paralyzed? A) infraspinatus B) palmaris brevis C) adductor pollicis D) flexor carpi ulnaris E) palmar interossei
B) latissimus dorsi
A 21-year-old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicated that she cannot adduct her arm because of paralysis of which of the following muscles? A) teres minor B) latissimus dorsi C) supraspinatus D) infraspinatus E) serratus anterior
B) accessory nerve
A 23-year-old man reports to physician due to shoulder weakness and instability. After removing his shirt, his left shoulder appears to reside lower than his right shoulder, asymmetry noted in the figure. During an examination, the patient is unable to abduct his left arm over his head and shows an inability to shrug (or elevate) his left shoulder against resistance. What nerve was most likely damaged in this patient? A) vagus nerve B) accessory nerve C) glossopharyngeal nerve D) facial nerve E) hypoglossal nerve
B) dorsal scapular
A 27-year-old intoxicated male presents by ambulance after an altercation at a local tavern. Paramedics note an apparent stab wound to the right posterolateral neck (posterior to the sternocleidomastoid muscle). There was minimal blood noted at the scene and there is no active bleeding at this time. The patient is on no regular medications and has no known medication allergies. His stated weight is 195 lbs and he quit smoking 1 year ago. Although his speech is slurred and he has the odor of alcohol on his breath, he is somewhat cooperative and polite. The airway appears to be clear and breath sounds are equal. Initial vital signs include a blood pressure of 155/95, pulse of 105, and respiratory rate of 22. After removing his jacket and shirt, the nurse notices the right scapula is laterally displaced. Which of the following nerve injuries would most likely explain this finding? A) spinal accessory B) dorsal scapular C) long thoracic D) thoracodorsal E) axillary
A) fracture of the coracoid process
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 coracoid process B) fracture of the clavicle C) axillary nerve injury D) defects in the posterior wall of the axilla E) injury to the posterior cord of the brachial plexus
A) roots
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) roots B) lower trunk C) posterior cord D) medial cord E) upper trunk
A) supraspinatus
A 35-year-old left-handed baseball pitcher experiences a severe spasm of pain while abducting his left arm in beginning to throw a pitch, and is unable to continue playing. Subsequently, he cannot initiate abduction of the left arm. However, if that arm is passively elevated through the first 15 degrees of abduction. he can complete bringing the arm up to a right angle. The tendon of which of the following muscles is most likely torn? A) supraspinatus B) teres minor C) teres major D) subscapularis E) infraspinatus
B) deltoid muscle and gravity
A 37-year-old female patient has a fracture of the clavicle. The junction of the middle and lateral thirds of the bone exhibits overriding of the medial and lateral fragments. The arm is rotated medially, but it is not rotated laterally. The lateral portion of the fractured clavicle is displaced downward by which of the following? A) trapezius and pectoralis minor muscles B) deltoid muscle and gravity C) pectoralis minor muscle and gravity D) deltoid and trapezius muscles E) pectoralis major and deltoid muscles
B) acute rupture of the supraspinatus part of the rotator cuff
A 38-year-old baseball pitcher felt a sharp pain in his shoulder when he threw the ball very hard. After a visit by the pitching coach, he threw another pitch but he told the catcher that the pain was unbearable. He left the game and went to the dressing room where he was examined by the team's orthopedic surgeon, who detected tenderness near the greater tubercle of the humerus. An MRI taken the next day revealed a tear in the pitcher's rotator cuff. Which of the following statements is most likely based on this finding? A) acute rupture of the subscapular tendon B) acute rupture of the supraspinatus part of the rotator cuff C) acute tear of latissimus dorsi tendon D) acute tear of teres major tendon
E) anterior axillary lymph nodes
A 48-year-old woman is diagnosed with a malignant tumor in the superolateral quadrant of the right breast, including the axillary tail. If it metastasizes, this cancer will most likely spread first to which of the following locations? A) parasternal lymph nodes B) deep cervical lymph nodes C) lateral axillary lymph nodes D) contralateral breast lymph nodes E) anterior axillary lymph nodes
B) latissimus dorsi
A 65-year-old man is brought to the emergency room after being attacked in his office by a disgruntled co-worker. The attacker reportedly used a long, narrow-bladed letter-opener to inflict multiple stab wounds to the man's back. Physical examination shows a puncture wound in the posterior axillary fold. The patient presents with weakness in extension, adduction, and medial rotation of his arm. Which of the following muscles is most likely cut in this injury? A) pectoralis minor B) latissimus dorsi C) levator scapulae D) serratus anterior E) teres minor
E) extension of the arm
A ballet dancer falls to the floor and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements? A) adduction of the scapula B) elevation of the scapula C) lateral rotation of the arm D) abduction of the arm E) extension of the arm
E) accessory nerve
A dermatologist performed a biopsy on a suspicious mole on the right side of the posterior neck of a 57-yearold male construction worker. Pathology confirmed a malignant melanoma, so the physician excised a substantial amount of tissue surrounding the mole. After the procedure, the patient experienced difficulty elevating his right shoulder and lifting his right arm over his head. No sensory deficits were seen. What nerve was most likely damaged in this patient? A) thoracodorsal nerve B) long thoracic nerve C) axillary nerve D) dorsal scapular nerve E) accessory nerve
B) dorsal scapular artery
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) thoracoacromial artery B) dorsal scapular artery C) suprascapular artery D) circumflex scapular artery E) transverse cervical artery
B) teres major
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) teres minor B) teres major C) supraspinatus D) infraspinatus E) subscapularis
B) supraspinatus tendonitis
A right-handed 21-year-old college student visits his physician because of pain in his right shoulder that developed after starting a summer job on a construction crew 2 weeks ago. He explains that on his job site he regularly lifts heavy construction materials over his head. During physical examination, the patient experienced sharp pain in the range of 80 to 150 degrees of abduction at the glenohumeral joint. What is the most likely diagnosis? A)acromioclavicular (AC) joint arthritis B) supraspinatus tendonitis C) infraspinatus tendonitis D) degenerative arthritis of the shoulder E) broken clavicle
D) subscapularis muscle
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) coracohumeral ligament B) teres minor muscle C) infraspinatus muscle D) subscapularis muscle E) supraspinatus muscle
D) axillary nerve
A young man is brought to the emergency department after being mugged. He was stabbed in the shoulder after refusing to give his wallet to the assailant. If the stab wound lacerated the posterior humeral circumflex artery passing through the quadrangular space on the shoulder region, which of the following nerves might be injured? A) radial nerve B) accessory nerve C) thoracodorsal nerve D) axillary nerve E) suprascapular nerve
B) infraspinatus
An 11-year-old boy falls down the stairs. A physician examines a radiograph of the boy's shoulder region (see figure). If the structure indicated by the letter A is calcified, which of the following muscles is most likely paralyzed? A) teres major B) infraspinatus C) subscapularis D) deltoid E) teres minor
A) long thoracic nerve
An 18-year-old boy is cut severely on the lateral wall of his right chest. Following healing, his scapula moves away from the thoracic wall when he leans on his right hand, giving the appearance indicated in the given photo. Which of the following nerves is likely damaged? A) long thoracic nerve B) dorsal scapular nerve C) axillary nerve D) suprascapular nerve E) thoracodorsal nerve
C) suspensory ligaments
An 80-year-old woman comes to the physician because of a lump in her right breast. Physical examination shows a 2-cm mass in the right breast with dimpling of the overlying skin and peau d'orange (edema of the breast with the skin assuming the appearance of an orange peel). Examination of a biopsy specimen confirms a diagnosis of carcinoma. Involvement of what structure is the most likely cause of this patient's skin dimpling? A) clavipectoral fascia B) pectoralis major C) suspensory ligaments D) retromammary space E) lactiferous ducts
D) suprascapular and axillary
An18-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 dorsal snapular B) axillary and musculocutaneous C) thoracodorsal and upper subscapular D) suprascapular and axillary E) radial and lower subscapular
D) supraspinatus
As a result of chronic stress associated with an intense high school weight-lifting program, a 15-year-old boy suffers an avulsion fracture of the greater tubercle of the humerus. In the ER, he displays difficulty initiating abductiong of the upper limb. Which of the following muscles was involved in this fracture? A) subscapularis B) long head of triceps C) infraspinatus D) supraspinatus E) long head of biceps brachii
A) the knife pierced the pectoralis minor muscle to reach the cords of the brachial plexus
During an attempted robbery, a 20-year-old man of average body build is stabbed once with a long, narrow knife. Initial examination in the emergency room indicates the knife penetrated the anterior wall of the right axilla and reached approximately the center of the axillary space. Which of the following is most likely true of this injury? A) the knife pierced the pectoralis minor muscle to reach the cords of the brachial plexus B) the man will likely develop a "winged scapula" condition C) the suprascapular nerve is probably lesioned D) the knife probably struck one of the trunks of the brachial plexus E) the knife penetrated the teres major muscle
D) dimple of the overlying skin
During fa 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) polymastia B) enlargement of the breast C) elevated nipple D) dimple of the overlying skin E) shortening of the clavipectoral fascia
D) thoracodorsal nerve
Following a radical mastectomy procedure, a surgeon plans to conduct a breast reconstruction utilizing a latissimus dorsi muscle flap. What nerve will the surgeon need to keep intact during the surgical dissection of the chest wall to prevent atrophy of the muscle flap? A) axillary nerve B) intercostobrachial nerve C) long thoracic nerve D) thoracodorsal nerve E) medial pectoral nerve
B) cephalic vein
In both the upper and lower limbs, the superficial veins begin in a dorsal cutaneous arch that drains into medial and lateral cutaneous veins aligned mainly along the first and fifth digit sides of the limb. Which of the following veins in the upper limb is the equivalent of the great saphenous vein in the lower limb? A) ulnar vein B) cephalic vein C) radial vein D) brachial vein E) basilic vein
E) at the lateral side of the clavipectoral (deltopectoral) triangle
In order to test the activity of the long head of the biceps brachii, you want to palpate the coracoid process in your 24-year-old patient. Where would you find this structure? A) at the lateral aspect of the acromion B) along the medial border of the scapula C) overlying the lateral aspect of the clavicle D) at the neck of the scapula E) at the lateral side of the clavipectoral (deltopectoral) triangle
C) subscapular and dorsal scapular
In viewing an upper limb angiogram of your 76-year-old patient, you are surprised to see that all but the most distal part of her right axillary artery is totally occluded yet her entire upper limb remains healthy. You suspect blood is reaching her upper limb via an anastomosis between which of the following? A) lateral thoracic and posterior humeral circumflex B) thoracoacromial and dorsal scapular C) subscapular and dorsal scapular D) supreme thoracic and 1st intercostal E) posterior humeral circumflex and 3rd intercostal artery
E) teres minor
Lateral rotation of the arm is an important mechanical component of "bringing the arm back" when preparing to throw an object. What muscle acts to produce lateral rotation of the arm? A) teres major B) subscapularis C) supraspinatus D) latissimus dorsi E) teres minor
A) retraction of the scapula
Lesion of the dorsal scapular nerve will have the greatest effect of the ________________. A) retraction of the scapula B) sensation over the shoulder C) abduction of the humerus D) elevation of the clavicle E) sensation over the anterior arm
B) winging scapula
Lesion of the long thoracic nerve causes ________________________. A) loss of sensation over the posterior arm B) winging scapula C) inability to abduct the arm over 90 degrees D) loss of sensation over the scapula E) inability to initiate abduction of the arm.
A) pectoralis minor
Organization of the axillary lymph nodes into Levels I, II, and III for breast cancer treatment is based on the location of the nodes relative to which of the following muscles? A) pectoralis minor B) pectoralis major C) latissimus dorsi D) subscapularis E) serratus anterior
E) axillary nerve
Physical examination of a 45-year-old man who had been stabbed shows a deep wound penetrating into the quadrangular space of the shoulder, causing bleeding from the severed blood vessels there. Which of the following neural structures is most likely damaged as well? A) musculocutaneous nerve B) radial nerve C) lateral cord of the brachial plexus D) medial cutaneous nerve of the arm E) axillary nerve
D) deltoid
The PT is testing the action of one of your patient's muscles by bringing the patients upper limb away from her side and then asking to abduct against resistance. What is the muscle being tested? A) latissimus dorsi B) pectoralis major C) serratus anterior D) deltoid E) pectoralis minor
E) posterior circumflex humeral artery
The given X-ray reveals a fracture of the proximal humerus, indicated by the black arrow. Given the location of the fracture, what artery is most likely damaged in this patient? A) superior ulnar collateral artery B) subscapular artery C) deep brachial (profunda brachii) artery D) brachial artery E) posterior circumflex humeral artery
C) axillary artery
The lateral cord of the brachial plexus is named because it lies immediately later to which of the following structures? A) subclavian vein B) longhead of the biceps brachii muscle C) axillary artery D) surgical neck of the humerus E) pectoralis minor muscle
D) the second part of the axillary artery lies deep to the muscle
The pectoralis minor muscle is an important landmark in identifying and describing neighboring structures in the chest and axillary regions. Which of the following relationships of the pectoralis minor is correct? A) the anterior axillary lymph nodes lie along the medial border of the muscle B) the clavipectoral triangle lies lateral to the muscle C) the lateral wall of the axillary fossa includes the muscle D) the second part of the axillary artery lies deep to the muscle E) the lateral cord of the brachial plexus lies lateral to the muscle
B) adduction of the arm
The traditional radical mastectomy includes removal of the pectoralis major muscle. Which of the following movements is most affected postoperatively by this surgical procedure? A) abduction of the arm B) adduction of the arm C) extension of the arm D) depression of the arm E) lateral rotation of the arm
B) superior thoracic
Which of the following branches of the axillary artery is given off proximal to the pectoralis minor? A) subscapular B) superior thoracic C) anterior circumflex humeral D) thoracoacromial E) lateral thoracic
C) lateral pectoral nerve
Which of the following is found in the deltopectoral triangle? A) dorsal scapular vein B) suprascapular artery C) lateral pectoral nerve D) basilic vein E) thoracic duct
A) it is a weak joint that is frequently dislocated
You are examining a patient with pain in her sternoclavicular joint and you suspect osteoarthritic changes in this joint. Which of the following is not correct about it? A) it is a weak joint that is frequently dislocated B) it has an articular disk C) it allows anterior-posterior movement of the clavicle D) it is allows some rotation of the clavicle E) it allows elevation and depression of the clavicle
C) axillary
You are treating a 37-year-old male wrestler who dislocated his glenohumeral joint. He now also has some loss of sensation over the lateral side of his proximal arm. You are concerned that he may have sustained damage to which of the following nerves? A) dorsal scapular B) thoracodorsal C) axillary D) long thoracic E) spinal accessory
E) surgical neck
You are treating a patient in the ED with a fracture of the proximal end of the humerus. Most of these fractures occur at which of the following? A) anatomical neck B) greater trochanter C) lesser trochanter D) deltoid tuberosity E) surgical neck
A) serratus anterior
You are working in the ED treating a 34-year-old patient who was in a knife fight and has a wound under his right axilla. He seems unable to fully abducts his arm above horizontal. When you ask him to press against the wall you notice that he has a "winged scapula". Which muscle is likely paralyzed? A) serratus anterior B) latissimus dorsi C) rhomboid major D) trapezius E) pectoralis major
C) axillary
You suspect your 49-year-old patient has quadrangular space syndrome. What nerve would be compressed in this syndrome? A) dorsal scapular B) spinal accessory C) axillary D) thoracodorsal E) long thoracic
B) serratus anterior
Your 12-year-old male patient is interested in a career in boxing and wants to learn exercises that specifically strengthen his "boxer's muscles" which is most important when reaching or punching anteriorly. What is this muscle? A) latissimus dorsi B) serratus anterior C) subclavius D) sternocostal head of pectoralis major E) trapezius
A) teres major
Your 45-year-old patient has frequent humeral dislocation. You refer him to a physical therapist for exercises to strengthen his rotator cuff muscles. Which of the following is not part of this group of muscles? A) teres major B) supraspinatus C) teres minor D) subscapularis E) infraspinatus
E) the supraspinatus tendon and/or subacromial bursa
Your 67-year-old patient has a very painful shoulder upon abduction. You order radiography that reveals the calcification where? A) the deltoid muscle B) the subscapularis tendon C) the long bicep tendon D) ac joint E) the supraspinatus tendon and/or subacromial bursa
C) latissimus dorsi
Your young patient is interested in becoming the "chin-up" champion of his school. You instruct him that the muscle most important to develop to achieve his goal is which of the following? A) trapezius B) deltoid C) latissimus dorsi D) serratus anterior E) levator scapula
