Galen 53
17. A patient has a paronychia (infection of the nail bed) of the right index finger which requires removal of the nail bed. To anesthetize this region properly you should inject A. both dorsal digital nerves supplying the index finger. B. both palmar digital nerves supplying the index finger. C. the common digital nerve supplying the index and middle fingers. D. the recurrent branch of the median nerve E. the superficial radial nerve
B. both palmar (aka proper) digital nerves supplying the index finger.
26. A man awakens from a drunken stupor to find that his right hand is very weak and he is unable to actively extend his right wrist against gravity. On physical examination you find that he can oppose his thumb and can abduct and adduct his fingers without difficulty. On what part of his hand would you expect to find diminished sensation? A. central portion of palm B. dorsum of hand on radial side C. dorsum of hand on ulnar side D. tip of index finger E. tip of little finger
B. dorsum of hand on radial side saturday night palsy- radial n- superficial branch is dorsum of 3 1/2 fingers
51. All of the following muscles insert into the extensor expansion of the index finger EXCEPT for the A. extensor indicis. B. extensor carpi radialis longus. C. first dorsal interosseous. D. first palmar interosseous. E. first lumbrical.
B. extensor carpi radialis longus. the muscle doesn't go far enough!
22. The carpal bones through which force is transmitted from the hand to the radius are the A. capitate and the hamate. B. lunate and the scaphoid. C. trapezium and the trapezoid. D. trapezoid and the capitate. E. triquetral and the pisiform.
B. lunate and the scaphoid.
13. An x-ray of the hand of a male child shows ossification in all of the metacarpal bones, in all of the phalanges, and in two of the carpal bones. None of the epiphyseal centers show ossification. The child has a bone age of about A. one month. B. one year. C. three years. D. five years. E. eight years.
B. one year. only 2 of the carpal bones!!! capitate: 1-3 months hamate: 2-4 months triquetrum: 2-3 years lunate: 2-4 years scaphoid: 4-6 years trapezium: 4-6 years trapezoid: 4-6 years pisiform: 8-12 years Excluding the pisiform, a handy way to remember the order of ossification is to start at the capitate then move in a counterclockwise direction on the volar surface of the right carpus
16. The common digital arteries of the hand arise directly from the A. proper digital arteries. B. superficial palmar arch. C. deep palmar arch. D. radial artery. E. ulnar artery.
B. superficial palmar arch. (1) 2 is the common digital arteries
6. A patient who has suffered a laceration of his wrist exhibits the following signs and symptoms: inability to abduct or adduct his fingers, inability to adduct the thumb, loss of sensation on his little finger. Which of the following nerves is most likely to have been injured? A. median B. ulnar C. superficial radial D. posterior interosseous E. anterior interosseous
B. ulnar
60. Which of the following muscles is capable of BOTH flexing at the metacarpophalangeal joint and extending at the proximal interphalangeal joint of the index finger? A. Extensor digitorum B. Extensor indicis C. First lumbrical D. Flexor digitorum profundus E. Flexor digitorum superficialis
C. First lumbrical Lumbricals (1st/2nd, median; 3rd/4th, ulnar)— flex at the MCP joint, extend PIP and DIP joints.
76. Which of the following muscles inserts into the extensor expansion of the index finger? A. Extensor carpi radialis brevis B. Extensor carpi radialis longus C. First palmar interosseous D. Second dorsal interosseous E. Second lumbrical
C. First palmar interosseous
45. Which digits of the hand have palmar interossei? A. Little, ring and middle B. Ring, middle and index C. Little, ring and index D. Little, ring, middle and index E. Little, middle and index
C. Little, ring and index
65. Which digit of the hand has two dorsal interossei inserting into it? A. Thumb B. Index finger C. Middle finger D. Ring finger E. Little finger
C. Middle finger
24. An X-ray of a boy's hand shows ossification in all the metacarpals and phalanges and in the capitate and the hamate. There is no evidence of ossification in any secondary centers or in any other carpal bones. What is the approximate bone age of the child? A. Four years B. Newborn C. One year D. Three years E. Two years
C. One year only 2 of the carpal bones!!! capitate: 1-3 months hamate: 2-4 months triquetrum: 2-3 years lunate: 2-4 years scaphoid: 4-6 years trapezium: 4-6 years trapezoid: 4-6 years pisiform: 8-12 years Excluding the pisiform, a handy way to remember the order of ossification is to start at the capitate then move in a counterclockwise direction on the volar surface of the right carpus
11. Transection of the median nerve at the wrist results in all of the following EXCEPT A. loss of opposition of the thumb. B. weakness of flexion of the metacarpophalangeal joints and weakness of extension of the interphalangeal joints of the index and middle fingers. C. loss of flexion of the interphalangeal joint of the thumb. D. numbness of the skin of the palmar sides of the index finger, the middle finger, and half of the ring finger. E. numbness of the skin of the palmar side of the thumb.
C. loss of flexion of the interphalangeal joint of the thumb.
19. The most frequently dislocated carpal bone is the A. capitate. B. hamate. C. lunate. D. scaphoid. E. triquetral.
C. lunate.
41. A 75-year-old woman has numbness of the radial side of the palmar surface of the hand including the thumb, index, middle and part of the ring finger. The thenar eminence is decreased in size. A piece of paper can be held against resistance between her index and middle fingers. She can also flex the distal interphalangeal joint of her index and third fingers. Pronation and supination of the forearm is normal. The most likely site of injury is the A. common digital branches of the median nerve. B. median nerve at the elbow. C. median nerve at the flexor retinaculum. D. recurrent branch of the median nerve. E. ulnar nerve at the wrist.
C. median nerve at the flexor retinaculum.
9. An X-ray of a boy's hand shows ossification of all the phalanges and metacarpals and the capitate and the hamate. No secondary centers are present. This child's bone age is approximately A. one month. B. six months. C. one year. D. two years. E. three years.
C. one year. capitate: 1-3 months hamate: 2-4 months triquetrum: 2-3 years lunate: 2-4 years scaphoid: 4-6 years trapezium: 4-6 years trapezoid: 4-6 years pisiform: 8-12 years Excluding the pisiform, a handy way to remember the order of ossification is to start at the capitate then move in a counterclockwise direction on the volar surface of the right carpus
7. Dupuytren's contracture is a condition that usually occurs in older men in which there is progressive fibrosis and contracture of the A. flexor retinaculum. B. long flexor tendon to one of the fingers. C. palmar aponeurosis. D. extensor aponeurosis. E. extensor retinaculum.
C. palmar aponeurosis.
4. Which of the following is the earliest to begin to ossify? A. capitate B. hamate C. proximal phalanx of the thumb D. scaphoid E. lunate
C. proximal phalanx of the thumb
14. All of the following are likely to be cut in a superficial incision through the skin of the anterior surface of the wrist EXCEPT A. palmar cutaneous branch of the median nerve B. palmaris longus tendon C. superficial branch of the radial nerve. D. ulnar nerve E. ulnar artery
C. superficial branch of the radial nerve- supplies dorsum of hand
59. A 16-year-old boy cuts himself on the anterior surface of the wrist and injures his ulnar nerve. Which of the following is INTACT (still functioning)? A. Abduction of index finger B. Adduction of little finger C. Adduction of thumb D. Cutaneous sensation on dorsal surface of little finger E. Cutaneous sensation on palmar surface of little finger
D. Cutaneous sensation on dorsal surface of little finger supplied by dorsal branch of ulnar nerve, above wrist
66. The tendon of which of the following muscles passes through the carpal tunnel? A. Abductor pollicis longus B. Extensor carpi radialis longus C. Flexor carpi radialis D. Flexor pollicis longus E. Palmaris longus
D. Flexor pollicis longus
33. Transection of the ulnar nerve at the wrist would result in all of the following EXCEPT A. hyperextension of the ring and little fingers at the m-p joint. B. loss of abduction and adduction of the fingers C. loss of adduction of the thumb. D. loss of flexion at the distal interphalangeal joint of the index and middle fingers. E. loss of sensation on the palmar surface of the tip of the little finger.
D. loss of flexion at the distal interphalangeal joint of the index and middle fingers. flexor digitorum profundum!!
5. All of the following pass through the carpal tunnel EXCEPT the A. radial artery. B. tendons of the flexor digitorum profundus. C. tendons of the flexor digitorum superficialis. D. tendon of the flexor pollicis longus. E. median nerve.
A. radial artery.
10. The carpal bone that is most commonly fractured is the A. scaphoid. B. lunate. C. capitate. D. hamate. E. fifth metacarpal.
A. scaphoid.
3. A carpal bone that articulates directly with the radius at the wrist joint is A. scaphoid. B. trapezium. C. capitate. D. hamate. E. pisiform.
A. scaphoid. wrist joint aka radiocarpal joint consists of scaphoid, lunate and triquetral carpal bones
77. Which of the following nerves contains ONLY afferents and sympathetic postganglionic efferent fibers? A. Anterior interosseous B. Dorsal branch of ulnar C. Medial plantar D. Superficial fibular E. Suprascapular
B. Dorsal branch of ulnar
28. Which of the following acts at the distal interphalangeal joint? A. Flexor carpi radialis B. Flexor digitorum profundus C. Flexor digitorum superficialis D. Flexor pollicis brevis E. Opponens pollicis
B. Flexor digitorum profundus
31. The recurrent (thenar) branch of the median nerve supplies the A. abductor pollicis longus. B. adductor pollicis. C. extensor pollicis brevis. D. flexor pollicis brevis. E. flexor pollicis longus.
D. flexor pollicis brevis.
39. A 10-year-old boy has a fracture of the medial epicondyle of the humerus. Which of the following is most likely impaired? A. Abduction of the middle finger B. Flexion of the thumb C. Pronation of the forearm D. Sensation on the lateral aspect of the forearm E. Sensation on the palmar surface of the thumb
A. Abduction of the middle finger medial epicondyle = ulnar n!! flexion of thumb & pronation of forearm → anterior interosseous branch of median nerve sensation of lateral aspect of the forearm → lateral antebrachial cutaneous nerve sensation on the palmar surface of the thumb → common/proper digital nerves of median nerve
56. Which of the following passes through the carpal tunnel? A. Common flexor synovial sheath B. Palmar cutaneous branch of median nerve C. Radial artery D. Tendon of palmaris longus E. Ulnar artery
A. Common flexor synovial sheath ???
54. The ossification center of which of the following carpal bones appears FIRST in normal development? A. Hamate B. Lunate C. Pisiform D. Scaphoid E. Trapezoid
A. Hamate capitate: 1-3 months hamate: 2-4 months triquetrum: 2-3 years lunate: 2-4 years scaphoid: 4-6 years trapezium: 4-6 years trapezoid: 4-6 years pisiform: 8-12 years Excluding the pisiform, a handy way to remember the order of ossification is to start at the capitate then move in a counterclockwise direction on the volar surface of the right carpus
50. A 27-year-old woman is being evaluated for a possible carpal tunnel syndrome of long duration. Which of the following findings is INCONSISTENT with pressure on the median nerve in the carpal tunnel? A. Inability to flex interphalangeal joint of thumb B. Numbness of skin on the palmar surface of the middlefinger C. Numbness of skin on the palmar surface of the thumb D. Weakness of abduction of the thumb E. Weakness of flexion of the thumb at the metacarpophalangeal join
A. Inability to flex interphalangeal joint of thumb
70. All of the following muscles insert into the extensor expansion of the little finger EXCEPT for A. a dorsal interosseous. B. the extensor digiti minimi. C. the extensor digitorum. D. a lumbrical. E. a palmar interosseous.
A. a dorsal interosseous. Little finger doesn't have dorsal interosseous, has own abductor
2. Structures within the carpal tunnel include the A. radial artery. B. ulnar artery. C. palmar cutaneous branch of the median nerve. D. flexor pollicis longus tendon. E. ulnar nerve.
D. flexor pollicis longus tendon. median n flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus
18. Dupuytren's contracture involves pathologic changes in the A. brachial artery. B. distal end of the radius. C. extensor retinaculum. D. extensor aponeurosis. E. palmar aponeurosis.
E. palmar aponeurosis.
25. A man presents with a swollen, red, hot, tender, left hand. There is an open, red wound on the palmar surface of the left index finger between the proximal and distal interphalangeal joints. He says that he punctured the index finger with a thorn three days previously, and the swelling and tenderness in the palm have developed over the past day. The swelling in the hand is probably due to an infection in the thenar (Moore's lateral midpalmar) space, which is located A. anterior to the adductor pollicis. B. in the carpal tunnel. C. in the hypothenar eminence. D. in the thenar eminence. E. posterior to the adductor pollicis.
A. anterior to the adductor pollicis.
36. The flexor retinaculum of the wrist has direct attachment to all of the following bones EXCEPT for the A. capitate. B. hamate. C. pisiform. D. scaphoid. E. trapezium.
A. capitate.
49. The flexor retinaculum has direct connection to all of the following carpal bones EXCEPT for the A. hamate. B. pisiform. C. scaphoid. D. trapezium. E. triquetral.
E. triquetral. Trap Pieces of Ham Scraps
75. A 37-year-old woman has a nerve injury. When asked to hold a piece of paper tightly between the index and middle finger, the examiner can easily pull it away. She has no deficits of cutaneous sensation on her hand. Which of the following is the most likely site of nerve injury? A. Deep branch of ulnar nerve B. Median nerve in carpal tunnel C. Median nerve in cubital fossa D. Radial nerve immediately distal to posterior antebrachial cutaneous branch E. Ulnar nerve immediately distal to dorsal branch
A. Deep branch of ulnar nerve All of the other answer choices would have deficits in cutaneous sensation The test is testing abduction and adduction which is innervated by the deep branch of ulnar nerve. Deep branch of ulnar nerve also innervates hypothenar muscles, 3rd and 4th lumbricals, and adductor pollicis Dorsal interossei (ulnar)—abduct the fingers. Palmar interossei (ulnar)—adduct the fingers.
73. A 41-year-old man has wrist drop due to a nerve injury. To help determine the site of injury of the involved nerve, which of the following areas of skin on the hand is tested? A. Dorsal webspace between first and second metacarpals B. Palmar tip of index finger C. Palmar tip of little finger D. Palmar tip of thumb E. Proximal palm
A. Dorsal webspace between first and second metacarpals tests radial nerve!!
47. A 25-year-old man has a deep laceration on the lateral side of his distal arm. At which site on the hand does sensitivity to pin prick best test the integrity of the radial nerve? A. Dorsum of hand between first and second metacarpals B. Dorsum of hand between fourth and fifth metacarpals C. Tip of the index finger D. Tip of the little finger E. Tip of the middle finger
A. Dorsum of hand between first and second metacarpals
30. Which of the following passes deep (posterior) to the flexor retinaculum at the wrist? A. Flexor pollicis longus tendon B. Palmar cutaneous branch of median nerve C. Palmaris longus tendon D. Ulnar artery E. Ulnar nerve
A. Flexor pollicis longus tendon
20. Which of the following does NOT pass through the carpal tunnel A. flexor digitorum profundus B. flexor digitorum superficialis C. flexor pollicis longus D. median nerve E. ulnar nerve
E. ulnar nerve
67. A 60-year-old man has had untreated carpal tunnel syndrome for 5 years. At rest, which of the following descriptions is most likely true of the joints of his index finger? (MP = metacarpophalangeal, PIP = proximal interphalangeal, DIP = distal interphalangeal) A. Flexed at MP, flexed at PIP, flexed at DIP B. Flexed at MP, flexed at PIP, extended at DIP C. Flexed at MP, extended at PIP, extended at DIP D. Hyperextended at MP, flexed at PIP, flexed at DIP E. Hyperextended at MP, extended at PIP, extended at DIP
D. Hyperextended at MP, flexed at PIP, flexed at DIP Hyperextended at mp joint due to weakness of flexion Flexed at ip joints due to weakness of extension (both from lumbricals)] Lumbricals (1st/2nd, median; 3rd/4th, ulnar)— flex at the MCP joint, extend PIP and DIP joints.
55. In an ulnar nerve palsy, inability to extend the interphalangeal joints of the little finger is due primarily to denervation of which of the following muscles? A. Dorsal interosseous B. Extensor digitorum C. Flexor digitorum profundus D. Lumbrical E. Palmar interosseous
D. Lumbrical
68. Which of the following muscles inserts into the extensor expansion of the little finger? A. Abductor digiti minimi B. Dorsal interosseous C. Flexor digiti minimi brevis D. Lumbrical E. Opponens digiti minimi
D. Lumbrical Little finger doesn't have dorsal interosseous, has own abductor
40. When the metacarpophalangeal joint of the index finger is extended which of the following muscles is most responsible for extension at the interphalangeal joints? A. Dorsal interosseous B. Extensor digitorum C. Extensor indicis D. Lumbrical E. Palmar interosseous
D. Lumbrical Lumbricals (1st/2nd, median; 3rd/4th, ulnar)— flex at the MCP joint, extend PIP and DIP joints.
29. A young man suffers a skin laceration on the dorsal aspect of the radial side of his wrist that transects the superficial branch of the radial nerve. Which of the following is he most likely to experience on the affected extremity? A. Inability to adduct and abduct his fingers B. Loss of opposition of the thumb C. Numbness of the nail bed of his index finger D. Numbness of the skin of the lateral side of the dorsum of his hand E. Wrist drop
D. Numbness of the skin of the lateral side of the dorsum of his hand
71. Which of the following structures separates the midpalmar from the thenar space? A. Adductor hallucis B. Lateral septum C. Medial septum D. Oblique septum E. Palmar aponeurosis
D. Oblique septum
72. A patient is asked to tightly grip a sheet of paper between the ring and little fingers and resist the attempt of the examiner to pull it from this position. Which of the following muscles are being tested? A. Abductor digiti minimi and palmar interosseous of the ring finger B. Abductor digiti minimi and dorsal interosseous of ring finger C. Flexor digiti minimi brevis and dorsal interosseous of ring finger D. Palmar interosseous of little finger and dorsal interosseous of ring finger E. Palmar interosseous of little finger and palmar interosseous of ring finger
D. Palmar interosseous of little finger and dorsal interosseous of ring finger DAB = Dorsals ABduct. PAD = Palmars ADduct.
35. A 15-year-old girl cut the anterior surface of her left wrist in a suicide attempt and injured the ulnar nerve. Where on the skin of the left hand would sensation most likely be impaired? A. Dorsal surface of proximal little finger B. Dorsal surface of proximal middle finger C. Dorsal webspace between thumb and index finger D. Palmar surface of little finger E. Palmar surface of thumb
D. Palmar surface of little finger
58. Which fingers of the hand have BOTH a palmar and dorsal interosseous muscle which can act on them? A. Little and ring B. Little and index C. Little and middle D. Ring and index E. Ring and middle
D. Ring and index Dorsal interossei (ulnar)—abduct the fingers. Palmar interossei (ulnar)—adduct the fingers. DAB = Dorsals ABduct. PAD = Palmars ADduct
27. Which of the following carpal bones has the most direct contact with the radius at the wrist joint? A. Capitate B. Hamate C. Pisiform D. Scaphoid E. Triquetral
D. Scaphoid
21. A patient who has received a gunshot wound to the arm is brought to the emergency room. On physical examination you find that both radial and ulnar pulses are present, that the patient is unable to extend his wrist and metacarpophalangeal joints on the side of the injury, but he can flex and extend his interphalangeal joints. He can adduct and abduct his fingers, but he is unable to extend his thumb. He can also extend and flex his elbow, although motion is limited because of pain at the site of the injury. Sensation to pin prick appears to be intact except for a small area on the radial side of the dorsum of the hand. The bullet has probably damaged which nerve? A. axillary B. median C. musculocutaneous D. radial E. ulnar
D. radial
12. Which of the following pairs correctly match an injured nerve and an appropriate sign of that nerve injury? A. axillary nerve - weakness of supination B. median nerve - hyperextension of the medial two metacarpophalangeal joints C. musculocutaneous nerve - loss of sensation on the medial side of the forearm D. radial nerve - anesthesia of the skin overlying the first dorsal interosseous muscle E. ulnar nerve - loss of flexion of the distal interphalangeal joint of the index finger
D. radial nerve - anesthesia of the skin overlying the first dorsal interosseous muscle superficial branch of radial n is dorsum of 3 1/2 fingers!
8. The carpal bones that articulate directly with the radius are the A. capitate and hamate. B. trapezoid and trapezium. C. pisiform and the triquetral. D. scaphoid and the lunate. E. ulna and the humerus.
D. scaphoid and the lunate.
15. The midpalmar space of the hand lies immediately anterior to the A. adductor pollicis muscle. B. first dorsal interosseous muscle. C. first palmar interosseous muscle. D. second and third palmar interosseous muscles. E. tendons of the flexor digitorum profundus muscle.
D. second and third palmar interosseous muscles.
32. The palmar lumbrical muscles originate from A. adjacent metacarpal bones. B. the carpal bones. C. the medial epicondyle of the humerus. D. the tendons of the flexor digitorum profundus. E. the tendons of the flexor digitorum superficialis.
D. the tendons of the flexor digitorum profundus.
23. A bone that articulates directly with the first metacarpal bone is the A. capitate. B. proximal phalanx of the index C. scaphoid. D. trapezium. E. trapezoid.
D. trapezium.
43. A 7-year-old girl has a cut on the distal aspect of one of the digits of her left hand. Infection quickly spreads to the common flexor synovial sheath in the palm. Which digit is most likely injured? A. Thumb B. Index finger C. Middle finger D. Ring finger E. Little finger
E. Little finger only one continuous with the flexor synovial sheath!
34. A 55-year-old woman is diagnosed with a carpal tunnel syndrome that has been untreated for three years. Which of the following movements within the hand is most likely impaired? A. Adduction of the thumb B. Flexion of distal phalanx of the ring finger C. Flexion of distal phalanx of the thumb D. Opposition of the little finger E. Opposition of the thumb
E. Opposition of the thumb
52. A 75-year-old man has his ring finger drawn into flexion at the metacarpophalangeal and proximal interphalangeal joints and presents with a thickened longitudinal band across the palm. This patient most likely demonstrates pathology of which of the following structures? A. Common flexor synovial sheath B. Dorsal interosseous muscle C. Lumbrical muscle D. Oblique septum of the hand E. Palmar aponeurosis
E. Palmar aponeurosis
53. Pressure on the ulnar artery at the wrist is most likely to FIRST cause reduced blood flow in which of the following arteries? A. Common digital B. Deep palmar arch C. Palmar metacarpal D. Proper digital E. Superficial palmar arch
E. Superficial palmar arch
62. The septum which separates the midpalmar and thenar spaces of the hand is attached to which of the following bones? A. Fifth metacarpal B. First metacarpal C. Hamate D. Scaphoid E. Third metacarpal
E. Third metacarpal
63. Pulsations in which of the following arteries can be palpated immediately lateral to the pisiform bone? A. Anterior interosseous B. Deep palmar arch C. Posterior interosseous D. Radial E. Ulnar
E. Ulnar
38. Which of the following structures passes anterior to the flexor retinaculum? A. Common flexor synovial sheath B. Dorsal branch of ulnar nerve C. Median nerve D. Tendon of flexor pollicis longus E. Ulnar artery
E. Ulnar artery
48. A 37-year-old man with no previous access to health care has scars on his left upper extremity from severe lacerations which occurred three years ago. His left hand is "clawed" (most pronounced in the ring and little fingers). He is insensitive to pin prick on the palmar surface of the tip of his little finger. However, sensation is intact on most of the dorsum of the little finger. A laceration of which of the following nerves is most likely? A. Deep branch of ulnar nerve B. Superficial branch of ulnar nerve C. Ulnar nerve at medial epicondyle D. Ulnar nerve in proximal forearm E. Ulnar nerve at wrist
E. Ulnar nerve at wrist
1. The first bones to ossify in the hand are the A. capitate and the hamate. B. scaphoid and the lunate. C. lunate and the triquetral. D. capitate and the trapezium. E. metacarpals and the phalanges.
E. metacarpals and the phalanges.
