Upper & Lower Limb - BRS and Lippincotts

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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

1. A 27-year-old patient exhibits a loss of skin sensation and paralysis of muscles on the plantar aspect of the medial side of the foot. Which of the following nerves is most likely damaged? (A) Common peroneal (B) Tibial (C) Superficial peroneal (D) Deep peroneal (E) Sural

1. A physician tests the patellar tendon reflex as shown. A normal response of the involuntary contraction of the quadriceps femoris muscle is noted. This reflex confirms the integrity of what nerve? A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Obturator nerve (E) Femoral nerve

1. Physical examination of a 40-year-old man injured in an automobile accident indicates that he has suffered nerve damage affecting his left upper limb. The patient exhibits significant weakness when pronating his left forearm and flexing his left wrist. What nerve is most likely damaged? (A) Median nerve (B) Ulnar nerve (C) Superficial branch of the radial nerve (D) Deep branch of the radial nerve (E) Musculocutaneous nerve

10. A 15-year-old girl, unaware that she is pregnant, borrows her friend's Accutane (retinoic acid; vitamin A) to combat an acne problem. She uses the Accutane for about 2 months, which corresponds to weeks 7 to 15 of the embryonic development of her fetus. Which of the following skeletal elements is most likely to be absent in the newborn infant? (A) Ilium (B) Femur (C) Patella (D) Tibia (E) Phalanges

10. A 20-year-old patient cannot flex and medially rotate the thigh while running and climbing. Which of the following muscles is most likely damaged? (A) Semimembranosus (B) Sartorius (C) Rectus femoris (D) Vastus intermedius (E) Tensor fasciae latae

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 given anteroposterior (AP) X-ray depicts a humeral shaft fracture in a 22-year-old man. Given the location of the fracture, which of the following structures is most likely damaged? (A) Posterior circumflex humeral artery (B) Ulnar nerve (C) Axillary nerve (D) Profunda brachii artery (E) Median nerve

11. A 21-year-old man was involved in a motorcycle accident, resulting in destruction of the groove in the lower surface of the cuboid bone. Which of the following muscle tendons is most likely damaged? (A) Flexor hallucis longus (B) Peroneus brevis (C) Peroneus longus (D) Tibialis anterior (E) Tibialis posterior

11. A 23-year-old man was injured in a motor vehicle accident and X-rays confirmed a displaced distal radius fracture in his left forearm. Upon examination, the patient exhibits weakened pronation, weakened flexion of the index and middle fingers at the distal interphalangeal joints, and weakened flexion of the interphalangeal joint of the thumb. When asked to make the okay sign (make a circle with the thumb and index finger), the patient is unable to make a round circle, producing a col- lapsed circle on the affected hand (see photo). No areas of sen- sory loss are detected. Which nerve is most likely damaged? (A) Deep branch of the radial nerve (B) Superficial branch of the radial nerve (C) Anterior interosseous nerve (D) Median nerve, proximal to the carpal tunnel (E) Recurrent branch of the median nerve

11. A 25-year-old woman is brought to the emergency room in severe pain due to an ankle injury. She tells the attending physician she was wearing high-heel shoes, stepped off the curb into the street, lost her balance and landed awkwardly, causing her foot to turn extremely outward (eversion). Which of the following ligaments is most likely damaged? (A) Plantar calcaneonavicular (spring) ligament (B) Calcaneofibular ligament (C) Deltoid ligament (D) Anterior talofibular ligament (E) Plantar calcaneocuboid (long plantar) ligament

11. The police bring in a murder suspect who has been in a gunfight with a police officer. 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

12. A 23-year-old medical student complains of loss of sensation in the skin on the medial edge of her left hand, including the entire fifth digit. The associated motor deficit probably involves weakness in which of the following? (A) Pronation (B) Abduction of the wrist (C) Extension of the wrist (D) Abduction of the index finger (E) Flexion of the interphalangeal joints of the index finger

12. A 75-year-old female patient fell in a hospital and landed on her hip. The given AP X-ray reveals fragmentation of her proximal femur. Which of the following muscles is most likely detached in association with the fracture fragment? (A) Gluteus maximus (B) Gluteus medius (C) Iliopsoas (D) Biceps femoris (E) Sartorius

12. A construction worker falls feet first from a roof. He sustains a fracture of the groove on the undersurface of the sustentaculum tali of the calcaneus bone. Which of the following muscle tendons is most likely torn? (A) Flexor digitorum brevis (B) Flexor digitorum longus (C) Flexor hallucis brevis (D) Flexor hallucis longus (E) Tibialis posterior

12. An automobile body shop worker has his middle finger 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

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. A dermatologist performed a biopsy on a suspicious mole on the right side of the posterior neck of a 57-year-old 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) Accessory nerve (B) Axillary nerve (C) Dorsal scapular nerve (D) Long thoracic nerve (E) Thoracodorsal nerve

13. A thoracic surgeon is going to collect a portion of the greater saphenous vein for coronary bypass surgery. He has observed that this vein runs: (A) Posterior to the medial malleolus (B) Into the popliteal vein (C) Anterior to the medial condyles of the tibia and femur (D) Superficial to the fascia lata of the thigh (E) Along with the femoral artery

13. Two 11-year-old boys sneak up on their friend from behind. In surprising their friend, they shove him suddenly, which forcefully pushes his hips forward while he is standing relaxed talking to other friends. Which of the following ligaments best resists anterior dislocation of the head of the femur? (A) Iliofemoral ligament (B) Pubofemoral ligament (C) Ischiofemoral ligament (D) Lacunar ligament (E) Ligament of the head of the femur

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. A 15-year-old girl is struck by a car while crossing the street. She suffers numerous pelvic injuries, including tearing of the sacrotuberous ligament. The damage to this ligament will most likely cause direct trauma to which of the following muscles? (A) Gluteus maximus (B) Gluteus medius (C) Gluteus minimus (D) Gemelli (E) Obturator externus

14. A 52-year-old woman slipped and fell and now complains of being unable to extend her leg at the knee joint. Which of the following muscles was paralyzed as a result of this accident? (A) Semitendinosus (B) Sartorius (C) Gracilis (D) Quadriceps femoris (E) Biceps femoris

15. A 16-year-old boy making a powerful move out of the starting blocks to begin a 100-m sprint feels intense pain below his right knee and collapses to the ground, unable to straighten his leg. The given plain film of the lateral knee reveals an avulsion fracture at the area indicated by the white arrowhead, with the fracture fragment identified by the white arrow. Which of the following muscles is most likely detached? (A) Gastrocnemius (B) Tibialis anterior (C) Adductor magnus (D) Rectus femoris (E) Semitendinosus

15. A 36-year-old man broke a window with his fist to rescue his child from a house fire. The man sustained a laceration to the lateral aspect of his right forearm, but he only showed a sensory deficit (numbness and paresthesia) to the dorsolateral aspect of his hand (as denoted by the shaded area within the given photo). What nerve was most likely damaged? (A) Dorsal cutaneous branch of the ulnar nerve (B) Lateral cutaneous nerve of the forearm (C) Posterior cutaneous nerve of the forearm (D) Deep branch of the radial nerve (E) Superficial branch of the radial nerve

15. A man injures his wrist on broken glass. Which of the following structures entering the palm superficial to the flexor retinaculum may be damaged? (A) Ulnar nerve and median nerve (B) Median nerve and flexor digitorum profundus (C) Median nerve and flexor pollicis longus (D) Ulnar artery and ulnar nerve (E) Ulnar nerve and flexor digitorum superficialis

15. A patient experiences weakness in dorsiflexing and inverting the foot. Which of the following muscles is damaged? (A) Peroneus longus (B) Peroneus brevis (C) Tibialis anterior (D) Extensor digitorum longus (E) Peroneus tertius

16. A patient with Bennett's fracture (a fracture of the base of the first 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 (superficial head) (C) Opponens pollicis (D) Adductor pollicis (E) Flexor pollicis brevis (deep head)

16. An anesthesiologist administers an anesthetic solution into the axillary sheath of a 19-year-old college baseball player in preparation for repair of the ulnar collateral ligament of the elbow. After 5 minutes, the patient experiences numbness and paresthesia distal to the middle aspect of the arm; however, the medial aspect of the arm and elbow remain sensitive to pain. What nerve provides sensory innervation to the sensitive area and was not blocked by the anesthetic solution? (A) Long thoracic nerve (B) Median nerve (C) Medial cutaneous nerve of the arm (D) Intercostobrachial nerve (E) Ulnar nerve

16. Rupture of the ligamentum teres capitis femoris may lead to damage to a branch of which of the following arteries? (A) Medial circumflex femoral (B) Lateral circumflex femoral (C) Obturator (D) Superior gluteal (E) Inferior gluteal

16. When standing upright, the femur moves into the locked position by slightly hyperextending, gliding posteriorly, and medially rotating on the tibial plateaus. Which of the following muscles acts to initiate the unlocking of the knee? (A) Biceps femoris (B) Gastrocnemius (C) Popliteus (D) Sartorius (E) Plantaris

17. 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 doctor repositions the head of the humerus into the glenoid cavity of the scapula (reduction). No fractures are seen on X-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) Axillary nerve (B) Median nerve (C) Ulnar nerve (D) Radial nerve (E) Musculocutaneous nerve

17. A 27-year-old pianist with a known carpal tunnel syndrome experiences difficulty in finger 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. A roofing installer falls off a high ladder and lands with the sole of his right foot hitting the ground first. He suffers a fracture and inferior displacement of the sustentaculum tali of the calcaneus. Which of the following structures is most likely torn? (A) Tendon of the tibialis posterior muscle (B) Tendon of the flexor hallucis longus (FHL) muscle (C) Tendons of the flexor digitorum brevis muscle (D) Small saphenous vein (E) Plantar arterial arch

17. Fracture of the neck of the femur results in avascular necrosis of the femoral head, probably resulting from lack of blood supply from which of the following arteries? (A) Obturator (B) Superior gluteal (C) Inferior gluteal (D) Medial femoral circumflex (E) Lateral femoral circumflex

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 flexor carpi ulnaris (B) Tendon of the flexor pollicis longus (C) Tendon of the flexor digitorum profundus (D) Tendon of the flexor carpi radialis (E) Tendon of the palmaris longus

18. A physician tests the myotatic biceps reflex as shown. A normal response of involuntary contraction of the biceps brachii muscle is noted. This reflex confirms the integrity of what nerve? (A) Axillary nerve (B) Median nerve (C) Ulnar nerve (D) Radial nerve (E) Musculocutaneous nerve

18. A soccer player injures his left knee when he twists the flexed knee while trying to avoid another player. While performing a knee examination, his physician pulls the flexed knee toward her (the physician's) body, as shown in the illustration. This clinical test is a check for the integrity of which of the following ligaments? (A) Tibial (medial) collateral ligament (TCL) (B) Fibular (lateral) collateral ligament (FCL) (C) Anterior cruciate ligament (ACL) (D) Posterior cruciate ligament (PCL) (E) Patellar ligament

18. If the acetabulum is fractured at its posterosuperior margin by dislocation of the hip joint, which of the following bones could be involved? (A) Pubis (B) Ischium (C) Ilium (D) Sacrum (E) Head of the femur

19. A 21-year-old male college student reports to the student health clinic on Monday morning, the day after the Super Bowl. He explains that he was intoxicated and lost consciousness with his upper limbs draped over the back of a couch. He complains of numbness and paresthesia over the dorsum of his hand on the radial side and is unable to support the weight of his left hand when the hand is placed in a pronated position (see photo). What nerve was most likely damaged in this individual? (A) Axillary nerve (B) Median nerve (C) Ulnar nerve (D) Radial nerve (E) Musculocutaneous nerve

19. A veteran infantry soldier develops painful flat feet after several years of service including hundreds of miles of marches. The pain is particularly acute on the medial aspect of his sole. Which of the following structures is most likely strained in this condition? (A) Calcaneal (Achilles) tendon (B) Plantar calcaneocuboid (long plantar) ligament (C) Extensor retinaculum (D) Tendon of the fibularis (peroneus) longus muscle (E) Plantar calcaneonavicular (spring) ligament

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 woman experiences weakness when abducting and medially rotating the thigh after this accident. Which of the following muscles is most likely damaged? (A) Piriformis (B) Obturator internus (C) Quadratus femoris (D) Gluteus maximus (E) Gluteus minimus

2. A 50-year old man falls off a ladder while cleaning his windows, landing on the ground as seen in the given drawing. He does not seek medical aid, believing his general soreness will go away with time. However, after several months, he develops a postural deformity of his left upper limb that includes an adducted, medially rotated, and extended shoulder, extended elbow, and pronated forearm. The injury and subsequent condition reflect damage to what structure? (A) Upper trunk of the brachial plexus (B) Lower roots of the brachial plexus (C) Posterior divisions of the brachial plexus (D) Medial cord of the brachial plexus (E) Lateral root of the median 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. A patient with a deep knife wound in the buttock walks with a waddling gait that is characterized by the pelvis falling toward one side at each step. Which of the following nerves is damaged? (A) Obturator nerve (B) Nerve to obturator internus (C) Superior gluteal nerve (D) Inferior gluteal nerve (E) Femoral nerve

2. On the given radiograph, a fractured tarsal bone is identified by the black arrow with accompanying impaction of the tarsometatarsal joint. What bone, articulating with the fourth and fifth metatarsal bones, is fractured? (A) Navicular (B) Cuboid (C) Talus (D) Calcaneus (E) Lateral cuneiform

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 circumflex (D) Superior ulnar collateral (E) Radial recurrent

20. A 50-year female equestrian is thrown from a startled horse and dragged by the reins, which were wrapped around her left wrist, for some distance. At the ER, she is experiencing pain and paresthesia in the axilla and medial aspect of her upper limb. Despite being left-handed, she has marked weakness in the movements of her dominant hand, especially abduction and adduction of the fingers. What structure was most likely damaged in this woman? (A) Upper trunk of the brachial plexus (B) Lower trunk of the brachial plexus (C) Posterior cord of the brachial plexus (D) Lateral cord of the brachial plexus (E) Long thoracic nerve

20. A 62-year-old man recently had coronary bypass surgery in which the great saphenous vein was harvested for reestablishing coronary blood flow. Following the procedure, he complained of loss of sensation in the cutaneous area noted in the given photo in the limb from which the vein was harvested. Which of the following nerves was most likely damaged during the surgery? (A) Sural nerve (B) Obturator nerve (C) Saphenous nerve (D) Deep fibular (peroneal) nerve (E) Superficial fibular (peroneal) nerve

20. The woman undergoes hip surgery. If all of the arteries that are part of the cruciate anastomosis of the upper thigh are ligated, which of the following arteries maintains blood flow? (A) Medial femoral circumflex (B) Lateral femoral circumflex (C) Superior gluteal (D) Inferior gluteal (E) First perforating

21. A 23-year-old woman who receives a deep cut to her ring finger 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. A 34-year-old woman sustains a deep cut on the dorsum of the foot just distal to her ankle joint by a falling kitchen knife. A physician in the emergency department has ligated the dorsalis pedis artery proximal to the injured area. Which of the following conditions most likely occurs as a result of the injury? (A) Ischemia in the peroneus longus muscle (B) Aneurysm in the plantar arterial arch (C) Reduction of blood flow in the medial tarsal artery (D) Low blood pressure in the anterior tibial artery (E) High blood pressure in the arcuate artery

21. A child is born to a young woman who had utilized thalidomide to help relieve her morning sickness early in her pregnancy. The infant suffers the congenital defects shown here. She is missing the proximal segments of both upper and lower limbs. The hands and feet that are present are attached to the trunk of the body and resemble small seal's flippers. Which of the following is the correct term for this malformation? (A) Adysplasia (B) A duplication defect (C) Micromelia (D) Meromelia (E) Amelia

21. A young man suffers a dislocation of the right hip in a car accident. During recovery, he finds he has an abnormal gait in which his left hip sinks when he lifts that foot to take a step, as shown in the right frame (C) of the given diagram. The problem may be the result of damage to which of the following structures? (A) Right gluteus maximus and inferior gluteal nerve (B) Left gluteus maximus and superior gluteal nerve (C) Left gluteus medius and inferior gluteal nerve (D) Right gluteus medius and superior gluteal nerve (E) Right gluteus minimus and inferior gluteal nerve

22. A 23-year-old competitive weight lifter goes to his physician complaining of pain in his proximal forearm. During his examination, the pain is exacerbated by flexion of the elbow and supination of the forearm against resistance. A lateral radiograph shows chronic microtrauma to the proximal radius, marked by the black arrows. Which of the following muscles attaches to, and most likely damaged, this osteological process? (A) Supinator (B) Brachialis (C) Pronator teres (D) Biceps brachii (E) Brachioradialis

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 floor 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. A 72-year-old woman slips and falls on a wet floor, fracturing the neck of her right femur. Subsequent physical examination in the ER shows her right foot is laterally rotated, and the right lower extremity appears slightly shorter than the left. Which of the following muscles is mainly responsible for the rotated posture of the right limb? (A) Semitendinosus (B) Adductor longus (C) Gluteus maximus (D) Rectus femoris (E) Gracilis

22. A patient experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint. Which of the following muscles is involved? (A) Vastus lateralis (B) Semimembranosus (C) Sartorius (D) Biceps femoris (long head) (E) Rectus femoris

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. A 36-year-old woman injured in an automobile accident tells the paramedics at the scene that her upper thigh hurts badly and she can barely flex her hip. A plain film of the hip joint reveals an avulsion fracture of the proximal femur, indicated by the open white arrow, and a fracture fragment identified by the solid white arrow. Which of the following muscles is most likely detached? (A) Adductor magnus (B) Iliopsoas (C) Rectus femoris (D) Biceps femoris (E) Sartorius

23. 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

23. A patient is involved in a motorcycle wreck that results in avulsion of the skin over the anterolateral leg and ankle. Which of the following structures is most likely destroyed with this type of injury? (A) Deep peroneal nerve (B) Extensor digitorum longus muscle tendon (C) Dorsalis pedis artery (D) Great saphenous vein (E) Superficial peroneal nerve

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. A knife wound penetrates the superficial vein that terminates in the popliteal vein. Bleeding occurs from which of the following vessels? (A) Posterior tibial vein (B) Anterior tibial vein (C) Peroneal vein (D) Great saphenous vein (E) Lesser saphenous vein

24. A rugby player injures his left extended knee when hit from the lateral side by a defender trying to tackle him. While performing a knee examination, his physician applies pressure to his lateral thigh and medial leg (as shown in the illustration). This clinical test is a check for the integrity of which of the following ligaments? (A) Tibial (medial) collateral ligament (TCL) (B) Fibular (lateral) collateral ligament (FCL) (C) Anterior cruciate ligament (ACL) (D) Posterior cruciate ligament (PCL) (E) Patellar ligament

24. Physical examination of a 45-year-old man who had been stabbed in the back of the shoulder 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) Lateral cord of the brachial plexus (C) Radial nerve (D) Axillary nerve (E) Medial cutaneous nerve of the arm

25. A 10-year-old boy falls from a tree house. The resultant heavy compression of the sole of his foot against the ground caused a fracture of the head of the talus. Which of the following structures is unable to function normally? (A) Transverse arch (B) Medial longitudinal arch (C) Lateral longitudinal arch (D) Tendon of the peroneus longus (E) Long plantar ligament

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 fingers. 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. A 55-year-old woman recently had pelvic surgery during which cancerous lymph nodes were removed from the lateral wall of her pelvis. During a postoperative examination, she says she has been having painful muscle spasms in her thigh. Which of the following muscles is most likely involved? (A) Sartorius (B) Biceps femoris (C) Tensor muscle of fascia lata (D) Vastus medialis (E) Gracilis

25. 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 lateral cord of the brachial plexus lies lateral to the muscle (B) The clavipectoral triangle lies lateral to the muscle (C) The anterior axillary lymph nodes lie along the medial border of the muscle (D) The lateral wall of the axillary fossa includes the muscle (E) The second part of the axillary artery lies deep to the muscle

26. A 24-year-old woman complains of weakness when she extends her thigh and rotates it laterally. Which of the following muscles is paralyzed? (A) Obturator externus (B) Sartorius (C) Tensor fasciae latae (D) Gluteus maximus (E) Semitendinosus

26. A 6-year-old boy playing barefooted in his backyard steps on a piece of broken glass and suffers a large transverse cut on his sole, at the level of the midfoot. In the emergency room, the examining physician determines the cut is to the depth of the first layer of the plantar muscles. Which of the following structures is most likely damaged in this injury? (A) Plantar arterial arch (B) Tendons of the flexor digitorum longus muscle (C) Tendon of the fibularis (peroneus) longus muscle (D) Abductor hallucis muscle (E) Superficial fibular (peroneal) nerve

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 superficialis (E) Flexor pollicis brevis and pronator quadratus

26. 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) Supraspinatus (B) Teres major (C) Latissimus dorsi (D) Subscapularis (E) Teres minor

27. A 29-year-old patient comes in; he cannot flex the distal interphalangeal (DIP) joint of the index finger. 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 flex the DIP joint of the ring finger (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. A man working in a junkyard trips and falls into a pile of scrap metal, suffering a deep cut immediately posterior to the lateral malleolus. Which of the following is most likely to be injured? (A) Saphenous nerve (B) Tendon of the fibularis (peroneus) tertius (C) Tendon of the fibularis (peroneus) longus (D) Posterior tibial artery (E) Great saphenous vein

27. A patient with hereditary blood clotting problems presents with pain in the back of her knee. An arteriogram reveals a blood clot in the popliteal artery at its proximal end. Which of the following arteries will allow blood to reach the foot? (A) Anterior tibial (B) Posterior tibial (C) Peroneal (D) Lateral circumflex femoral (E) Superior medial genicular

27. The lateral cord of the brachial plexus is named because it lies immediately lateral to which of the following structures? (A) Long head of the biceps brachii muscle (B) Axillary artery (C) Subclavian vein (D) Surgical neck of the humerus (E) Pectoralis minor muscle

28. A 27-year-old man with cubital tunnel syndrome complains of numbness and tingling in the ring and little finger 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 superficialis (B) Opponens pollicis (C) Two medial lumbricals (D) Pronator teres (E) Supinator

28. A 72-year-old woman complains of a cramp-like pain in her thigh and leg. She was diagnosed as having a severe intermittent claudication. Following surgery, an infection was found in the adductor canal, damaging the enclosed structures. Which of the following structures remains intact? (A) Femoral artery (B) Femoral vein (C) Saphenous nerve (D) Great saphenous vein (E) Nerve to the vastus medialis

28. A physician performs some simple muscle tests on a 35-year-old male patient when he complains of weakness in his lower limbs. In the physical test illustrated below, the patient is asked to touch his buttocks with his heel while working against resistance. What muscle group is being tested? (A) Quadriceps femoris (B) Hamstrings (C) Adductors (D) Tricepssurae (E) Plantar flexors

28. Pronator teres syndrome is a condition in which one of the following nerves is excessively compressed where it passes between the two heads of the pronator teres muscle. Which of the following nerves is entrapped? (A) Deep branch of radial nerve (B) Median Nerve (C) Deep branch of ulnar nerve (D) Superficial branch of ulnar nerve (E) Musculocutaneous nerve

29. A basketball player was hit in the thigh by an opponent's knee. Which of the following arteries is likely to compress and cause ischemia because of the bruise and damage to the extensor muscles of the leg? (A) Popliteal (B) Deep femoral (C) Anterior tibial (D) Posterior tibial (E) Peroneal

29. A patient presents with extreme pain due to arterial insufficiency in the posterior femoral compartment. This compartment of the thigh receives its blood supply mainly from the perforating arteries. An arteriogram confirms partial occlusion of the artery that gives rise to these perforating arteries. What artery is occluded in the arteriogram? (A) Femoral artery (B) Profunda femoris artery (C) Obturator artery (D) Popliteal artery (E) Medial femoral circumflex artery

29. A secretary comes in to your office 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 finger (B) Inability to flex the DIP joint of the ring finger (C) Flattened thenar eminence (D) Loss of skin sensation of the medial one and one-half fingers (E) Atrophied adductor pollicis muscle

29. The pulse of the radial artery is readily palpable where the vessel passes which of the following structures? (A) Across the anterior aspect of the lateral epicondyle of the humerus (B) Between the tendons of the palmaris longus and flexor carpi ulnaris (C) Lateral to the tendon of the flexor carpi radialis (D) Superficial to the tendons of the extensor pollicis brevis and abductor pollicis longus (E) Superficial to the carpal tunnel

3. A 21-year-old man goes to his college campus health clinic complaining of soreness in his left wrist after falling on an outstretched hand during a basketball game the previous day. He is supporting his left wrist and indicates that the pain worsens with movement and is minimized with inactivity. There is no loss of feeling in his hand, nor does he have trouble grasping or holding objects. The physician exacerbates the wrist pain by applying pressure to the base of the thumb in the anatomical snuffbox (see photo). Radiographic imaging will confirm a break of which carpal bone? (A) Capitate (B) Scaphoid (C) Hamate (D) Trapezium (E) Pisiform

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. A patient is unable to prevent anterior displacement of the femur on the tibia when the knee is flexed. Which of the following ligaments is most likely damaged? (A) Anterior cruciate (B) Fibular collateral (C) Patellar (D) Posterior cruciate (E) Tibial collateral

3. Despite slamming on her brakes, a 23-year-old female driver crashes into the back of a car that stopped suddenly. During impact, her foot is severely dorsiflexed resulting in severe pain. At the ER, she explains to the attending physician that she thinks she has broken her foot. A lateral plain film of the foot reveals the fracture indicated by the white arrow. Which of the following bones is fractured in this patient? (A) Navicular (B) Sustentaculum tali (C) Talus (D) Calcaneus (E) Cuboid

30. A 25-year-old man suffers a gunshot wound to the calf that severs the posterior tibial artery at its origin. Which of the following vessels will not receive blood flow immediately following the injury? (A) Anterior tibial artery (B) Inferior medial genicular artery (C) Dorsalis pedis artery (D) Popliteal artery (E) Fibular (peroneal) artery

30. A 74-year-old man complains of pain in his right hand and fingers when he works with his hands for a while. Thorough testing reveals insufficient blood flow into the deep palmar arch. Occlusion of which of the following arteries is the most likely cause of this condition? (A) Posterior interosseous artery (B) Ulnar artery (C) Anterior interosseous artery (D) Radial artery (E) Inferior ulnar collateral artery

30. A man is unable to hold typing paper between his index and middle fingers. Which of the following nerves was likely injured? (A) Radial nerve (B) Median nerve (C) Ulnar nerve (D) Musculocutaneous nerve (E) Axillary nerve

30. An elderly woman fell at home and fractured the greater trochanter of her femur. Which of the following muscles would continue to function normally? (A) Piriformis (B) Obturator internus (C) Gluteus medius (D) Gluteus maximus (E) Gluteus minimus

31. A 65-year-old man with a history of heavy smoking visits his physician complaining of intermittent pain in his feet, accompanied by pallor and coldness of his feet. The physician suspects vascular insufficiency and takes a pulse of the dorsalis pedis artery. That pulse is best palpated at which of the following locations? (A) Immediately anterior to the medial malleolus (B) Immediately anterior to the lateral malleolus (C) Between the tendons of the extensor hallucis longus and extensor digitorum longus muscles (D) Between the tendons of the extensor digitorum longus and fibularis (peroneus) tertius muscles (E) Immediately lateral to the tendon of the fibularis (peroneus) tertius muscle

31. 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) Radial vein (B) Ulnar vein (C) Brachial vein (D) Basilic vein (E) Cephalic vein

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. Which of the following nerves is damaged? (A) Sciatic (B) Tibial (C) Common peroneal (D) Deep peroneal (E) Superficial peroneal

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. After injury to this nerve, which of the following muscles could be paralyzed? (A) Gastrocnemius (B) Popliteus (C) Extensor hallucis longus (D) Flexor digitorum longus (E) Tibialis posterior

32. An elderly man falls on an icy sidewalk outside his home and cannot get up. He tells the attending paramedics that he has a lot of pain in his right hip. Following inconclusive analysis of an AP X-ray, the given coronal MRI reveals a nondisplaced fracture of the right femoral neck, as noted by the black arrow. Branches of which of the following arteries are most likely to be damaged in this injury? (A) Femoral artery (B) Obturator artery (C) Lateral circumflex femoral artery (D) Medial circumflex femoral artery (E) Inferior gluteal artery

32. 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) Posterior circumflex humeral artery (B) Brachial artery (C) Deep brachial (profunda brachii) artery (D) Subscapul arartery (E) Superior ulnar collateral artery

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. During an attempted suicide, a depressed young woman slashes the front of her wrist with a razor blade. However, she cuts only to the depth of the superficial aspect of the flexor retinaculum before passing out at the sight of her own blood. Which of the following muscle tendons may be severed? (A) Flexor digitorum superficialis (B) Brachioradialis (C) Flexor pollicis longus (D) Abductor pollicis longus (E) Flexor carpi radialis

33. If the lateral (fibular) collateral ligament is torn by this fracture, which of the following conditions may occur? (A) Abnormal passive abduction of the extended leg (B) Abnormal passive adduction of the extended leg (C) Anterior displacement of the femur on the tibia (D) Posterior displacement of the femur on the tibia (E) Maximal flexion of the leg

33. The relative positions of blood vessels can sometimes be explained in terms of rotation of the limbs during development. For example, upon entering the femoral triangle the femoral artery resides ____ to the femoral vein, whereas in the popliteal fossa the popliteal artery lies ____ to the popliteal vein. (A) medial...posterior (B) lateral...deep (C) lateral...posterior (D) medial...superficial (E) anterior...lateral

34. A 17-year-old man has pain and moderate swelling over the dorsomedial aspect and in the hypothenar area of his right hand after punching a locker over a dispute with his girlfriend. What is the most likely finding on an X-ray of his hand? (A) Dislocation of the fifth metacarpophalangeal joint (B) Fracture of the triquetral bone (C) Fracture of the proximal phalanx of the ring finger (D) Fracture of the proximal phalanx of the little finger (E) Fracture of the fifth metacarpal bone

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. Due to torsioning of the lower limb and merging of separate premuscle masses during development, certain adult lower limb muscles are supplied by two separate nerves. These interneural fusions are termed hybrid muscles. Which of the following is a hybrid muscle? (A) Adductor magnus (B) Gastrocnemius (C) Rectus femoris (D) Semimembranosus (E) Tibialis anterior

34. Which of the following arteries could also be damaged by this fracture? (A) Popliteal (B) Posterior tibial (C) Anterior tibial (D) Peroneal (E) Lateral inferior genicular

35. A 23-year-old female medical student notices she was gaining weight due to a sedimentary lifestyle and compulsive studying. Therefore, she decides to run in a marathon and starts her training by running 6 miles each morning before class. After 2 weeks, she presents with right lateral knee pain and inflammation, specifically in the area of the lateral femoral epicondyle. This pain intensifies throughout her morning jogs, especially when her right foot strikes the ground or when she is running downhill. What is most likely diagnosis in this patient? (A) Sprained fibular (lateral) collateral ligament (FCL) (B) Patellofemoral pain syndrome (C) Iliotibial band syndrome (ITBS) (D) Torn lateral meniscus (E) Pes anserinus bursitis

35. 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 experiences sharp pain in the range of 80 to 150 degrees of abduction at the glenohumeral joint. What is the most likely diagnosis? (A) Infraspinatus tendonitis (B) Supraspinatus tendonitis (C) Acromioclavicular (AC) joint arthritis (D) Degenerative arthritis of the shoulder (E) Broken clavicle

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. Which of the following conditions would occur from this fracture? (A) Ischemia in the gastrocnemius (B) Loss of plantar flexion (C) Trendelenburg's sign (D) Anterior tibial compartment syndrome (E) Flat foot

36. A 47-year-old woman walks with difficulty into the ER and presents with pain, inflammation, and tenderness on the outside of her right foot. She reports she sprained her ankle, an inversion injury, while stepping off a sidewalk wearing 3-in. high heels. The given X-ray reveals an avulsion fracture on her lateral foot. The white arrow identifies the fracture fragment. What muscle is most likely injured, given the site of the fracture? (A) Extensor digitorum longus (B) Fibularis brevis (C) Fibularis longus (D) Fibularis tertius (E) Flexor digiti minimi brevis

36. A 56-year-old woman was stopped at a light when her car was rear-ended by another car. She had her right arm on the steering wheel, and the impact caused forced flexion at her elbow. Several months later, she comes to her physician complaining of numbness and a pins and needles sensation in her right little finger when she talks on the phone, rests her head on her right hand at work, or spends most of her day typing at work. She also notices the quality of her typing and her ability to play the violin have diminished. Which nerve is compressed at what location? (A) Ulnar nerve in the elbow (B) Ulnar nerve in the wrist (C) Median nerve in the wrist (D) Median nerve in the elbow (E) Median nerve in the axilla

36. A construction worker is hit on the leg with a concrete block and is subsequently unable to plantar flex and invert his foot. Which of the following muscles is most likely damaged? (A) Extensor digitorum longus (B) Tibialis anterior (C) Tibialis posterior (D) Peroneus longus (E) Peroneus 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

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. A 32-year-old male farmer cuts the medial aspect of his midthigh when climbing over a barbwire fence. Though he bandages the wound, he reports to the ER 5 days later with an infected wound, high fever (102.7°), and lymphadenitis (swollen lymph nodes). Given the location of the injury, which groups of nodes would be the first to receive drainage from the infected wound? (A) Popliteal (B) External iliac (C) Deep inguinal (D) Horizontal group of superficial inguinal (E) Vertical group of superficial inguinal

37. As part of a physical examination to evaluate intrinsic hand muscle function, a physician holds three fingers in the extended position, and instructs the patient to flex the proximal interphalangeal joint of the free finger, as shown. Which of the following muscles is the doctor specifically testing? (A) Flexor digitorum profundus (FDP) (B) Extensor digitorum (C) Second lumbrical (D) Dorsal interosseous (E) Flexor digitorum superficialis (FDS)

37. The obturator nerve and the sciatic (tibial portion) nerve of a 15-year-old boy are transected as a result of a motorcycle accident. This injury would result in complete paralysis of which of the following muscles? (A) Rectus femoris (B) Biceps femoris, short head (C) Pectineus (D) Adductor magnus (E) Sartorius

38. A 24-year-old carpenter suffers a crush injury of his entire little finger. 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. A 24-year-old woman presents to her physician with weakness in flexing the hip joint and extending the knee joint. Which muscle is most likely involved in this scenario? (A) Sartorius (B) Gracilis (C) Rectus femoris (D) Vastus medialis (E) Semimembranosus

38. As part of a physical examination to evaluate lower limb function, a physician places her hands on the dorsum of the patient's foot and asks the patient to dorsiflex the ankle joint against resistance, as shown. What nerve is the doctor testing? (A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Medial plantar nerve (E) Lateral plantar nerve

38. Because of repeated bad needle sticks, a heroin addict develops an infected abscess in the floor of the cubital fossa. Which of the following structures is the abscess most likely to invade first? (A) Brachioradialis muscle (B) Pronator teres muscle (C) Brachialis muscle (D) Head of the radius (E) Olecranon fossa of the humerus

39. A 17-year-old boy was stabbed during a gang fight resulting in transection of the obturator nerve. Which of the following muscles is completely paralyzed? (A) Pectineus (B) Adductor magnus (C) Adductor longus (D) Biceps femoris (E) Semimembranosus

39. A 35-year-old male prisoner received a right gluteal intramuscular (IM) injection during a visit to the infirmary. Following the injection, the man experienced a painful, swollen right leg. Within a month, he complained that his right leg started to shrink. Examination revealed muscle wasting with fasciculations in the L4-S1 distribution and marked weakness in dorsiflexion, inversion, and eversion at the ankle joint. He also exhibited a typical high-steppage gait indicating right foot drop. What nerve was most likely damaged during the gluteal IM injection? (A) Superior gluteal nerve (B) Common fibular nerve (C) Tibial nerve (D) Inferior gluteal nerve (E) Sciatic nerve

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 traditional radical mastectomy includes removal of the pectoralis major muscle. Which of the following movements is most affected postoperatively by this surgical procedure? (A) Adduction of the arm (B) Abduction of the arm (C) Extension of the arm (D) Lateral rotation of the arm (E) Depression of the arm

4. A 16-year-old patient has weakness flexing 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. A 41-year-old man was involved in a fight and felt weakness in extending the knee joint. On examination, he was diagnosed with a lesion of the femoral nerve. Which of the following symptoms would be a result of this nerve damage? (A) Paralysis of the psoas major muscle (B) Loss of skin sensation on the lateral side of the foot (C) Loss of skin sensation over the greater trochanter (D) Paralysis of the vastus lateralis muscle (E) Paralysis of the tensor fasciae latae

4. A 70-year-old man reports an inability to climb stairs and stand up from a sitting position. Further examination also shows weakness when laterally rotating the thigh against resistance. What nerve is most likely compromised in this patient? (A) Femoral nerve (B) Obturator nerve (C) Sciatic nerve (D) Superior gluteal nerve (E) Inferior gluteal nerve

4. 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 abduction of the upper limb. Which of the following muscles was involved in this fracture? (A) Supraspinatus (B) Long head of biceps brachii (C) Long head of triceps (D) Subscapularis (E) Infraspinatus

40. A 22-year-old soldier is injured from shrapnel from an improvised explosive device in the right upper thigh, below the midpoint of the inguinal ligament. Though he received field dressings from a medic, he arrives at the military hospital having lost copious amounts of blood. What sign and/or symptom would accompany this patient's presentation? (A) Increased pulse in the right dorsalis pedis artery (B) Tachycardia (C) Warm right foot (D) Increased hematocrit (E) Hypertension

40. A 32-year-old carpenter fell from the roof. The lateral longitudinal arch of his foot was flattened from fracture and displacement of the keystone for the arch. Which of the following bones is damaged? (A) Calcaneus (B) Cuboid bone (C) Head of the talus (D) Medial cuneiform (E) Navicular bone

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 lateral thoracic artery provides the main blood supply to the lateral side of the chest wall, including much of the breast. To deter excessive blood loss during a surgical procedure involving the breast, a surgeon can clamp the lateral thoracic artery near its origin. Which of the following arteries gives rise to this artery? (A) First part of the axillary artery (B) Second part of the axillary artery (C) Third part of the axillary artery (D) Third part of the subclavian artery (E) First part of the brachial artery

41. A 17-year-old boy fell from his motorcycle and complains of numbness of the lateral part of the arm. Examination reveals that the axillary nerve is severed. Which of the following types of axons is most likely spared? (A) Postganglionic sympathetic axons (B) Somatic afferent axons (C) Preganglionic sympathetic axons (D) General somatic efferent axons (E) General visceral afferent axons

41. A rising second-year medical student spends his summer hiking the Appalachian Trial with a 100-lb backpack in tow. After a month of hiking 30-mi/day (48-km/day), he notices numbness, tingling, and burning sensations in the lateral aspect of his right upper thigh. His symptoms are exacerbated by his backpack pressing on the area surrounding his right anterior superior iliac spine. What nerve is most likely affected? (A) Femoral branch of genitofemoral nerve (B) Saphenous nerve (C) Anterior cutaneous branches of femoral nerve (D) Lateral femoral cutaneous nerve (E) Iliohypogastric nerve

41. 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) Long thoracic nerve (B) Intercostobrachial nerve (C) Medial pectoral nerve (D) Thoracodorsal nerve (E) Axillary nerve

41. While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred? (A) Tear of the medial meniscus (B) Ruptured fibular collateral ligament (C) Tenderness on pressure along the fibular collateral ligament (D) Injury of the posterior cruciate ligament (E) Swelling on the back of the knee joint

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. A patient has weakness when flexing both her thigh and leg. Which of the following muscles is most likely injured? (A) Rectus femoris (B) Semitendinosus (C) Biceps femoris (D) Sartorius (E) Adductor longus

42. After spending 2 days moving heavy furniture out of her house, a 56-year-old woman goes to an emergency room in acute pain. The patient reports nausea, vomiting, and severe abdominal pain. On examination, the doctor discovers a painful, globular mass located inferior and lateral to the pubic tubercle. Given her presentation and history, what is the most likely diagnosis? (A) Indirect inguinal hernia (B) Direct inguinal hernia (C) Femoral hernia (D) Lymphadenitis of superficial inguinal nodes (E) Fractured hip

42. 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) Suspensory ligaments (C) Lactiferous ducts (D) Retromammary space (E) Pectoralis major

43. A 16-year-old boy was fishing barefoot in a muddy river when the plantar surface of his foot was cut by unseen debris. He suffers a large transverse cut, penetrating the first two layers of his plantar musculature, in the area of the first cuneiform bone. In the emergency room, his physician notes a complete inability to flex and abduct the big toe and numbness on the plantar aspect of the three medial toes. Which of the following nerves is most likely damaged? (A) Medial plantar nerve (B) Lateral plantar nerve (C) Sural nerve (D) Deep fibular nerve (E) Superficial fibular nerve

43. A 35-year-old man has difficulty in dorsiflexing the foot. Which of the following muscles is most likely damaged? (A) Tibialis posterior (B) Flexor digitorum longus (C) Tibialis anterior (D) Peroneus longus (E) Peroneus brevis

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. As part of a physical examination to evaluate intrinsic hand muscle function, a physician asks the patient to assume the Z-position (seen in photo) with his hand, which involves flexion of the metacarpophalangeal joints and extension of the interphalangeal joints of the fingers. Which of the following nerves is being tested in assuming this position? (A) Deep branch of radial nerve (B) Superficial branch of radial nerve (C) Recurrent branch of median nerve (D) Deep branch of ulnar nerve (E) Superficial branch of ulnar nerve

44. A 10-year-old boy was running across a parking lot when he tripped and received lacerations on the base of his thumb from a broken glass bottle. On examination, his thumb was unable to oppose to his fingers, and the thumb also showed weakness when abducting and flexing. No sensory deficits were reported. What nerve was most likely severed? (A) Deep branch of radial nerve (B) Superficial branch of radial nerve (C) Recurrent branch of median nerve (D) Deep branch of ulnar nerve (E) Superficial branch of ulnar nerve

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. A tall 17-year-old man is crammed into the front passenger seat of an automobile when the speeding car slides off a wet road and slams its front bumper into a road guardrail. The passenger's left shin slams against the dashboard with an impact just below the knee. He reports to the emergency room with considerable knee pain, tenderness, and a pronounced limp during walking. With the patient lying supine, his hips flexed at 45 degrees, knees flexed at 90 degrees, and feet flat on the table, the physician notes a widened space, or sag, in the sulcus between the tibia and the femur. When the physician pushes the left tibia posteriorly, as noted in the photo, a pronounced laxity is noted in the left knee when compared to the right. What structure is most likely damaged? (A) Anterior cruciate ligament (ACL) (B) Posterior cruciate ligament (PCL) (C) Tibial (medial) collateral ligament (TCL) (D) Fibular (lateral) collateral ligament (FCL) (E) Patellar ligament

44. An injury to the leg of a golfer results in loss of the ability to invert the foot. Which of the following muscles is most likely paralyzed? (A) Tibialis posterior (B) Peroneus longus (C) Peroneus brevis (D) Peroneus tertius (E) Extensor digitorum longus

45. 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) Lateral axillary lymph nodes (B) Anterior axillary lymph nodes (C) Deep cervical lymph nodes (D) Parasternal lymph nodes (E) Contralateral breast lymph nodes

45. An orthopedic surgeon ligates the posterior tibial artery at its origin. Which of the following arteries has no blood flow immediately after the ligation? (A) Peroneal (B) Dorsalis pedis (C) Superior medial genicular (D) Anterior tibial (E) Descending genicular

45. An overweight woman participates in her first rugby match without proper training and conditioning. Upon catching the opening kickoff, she awkwardly twists her right knee, screams in pain, and falls to the ground. The team manager notes her patella is dislocated, residing on the lateral side of her knee. After straightening the woman's knee, the patellar dislocation is reduced (goes back into place). To prevent future dislocation of the patella, what specific muscle should be targeted during rehabilitation? (A) Vastus intermedius (B) Vastus lateralis (C) Vastus medialis (D) Rectus femoris (E) Tibialis anterior

45. The lateral portion of the fractured clavicle is displaced downward by which of the following? (A) Deltoid and trapezius muscles (B) Pectoralis major and deltoid muscles (C) Pectoralis minor muscle and gravity (D) Trapezius and pectoralis minor muscles (E) Deltoid muscle and gravity

46. A 32-year-old mixed martial arts fighter could not continue his fight after receiving a side leg kick to the neck of his left fibula. The fighter reported paresthesia and numbness on the entire dorsum of his left foot. During his physical examination, the patient often stumbled with his left toes dragging on the floor during the swing phase of his gait. Asymmetry in his normal foot position was also noted by the physician (see photo) as well as weakness in eversion of the foot at the ankle joint. What nerve was damaged? (A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Common fibular nerve (E) Sciatic nerve

46. A 48-year-old woman falls on an icy sidewalk and lands on her right elbow. She suffers a midshaft humeral fracture, as seen on the given X-ray. The attending physician wants to assess whether the nerve residing in the spiral groove of the humerus is damaged. What sign or symptom would confirm damage to this nerve? (A) Numbness on the lateral (radial) aspect of the forearm (B) Numbness of the medial aspect of the upper arm (C) Numbness over the superolateral aspect of the upper arm (D) Weakness extending the wrist and fingers (E) Weakness in grip strength

46. Before knee surgery, a surgeon ligates arteries participating in the anastomosis around the knee joint. Which of the following arteries is most likely spared? (A) Lateral superior genicular (B) Medial inferior genicular (C) Descending branch of the lateral femoral circumflex (D) Saphenous branch of the descending genicular (E) Anterior tibial recurrent

46. Which of the following muscles causes upward displacement of the medial fragment? (A) Pectoralis major (B) Deltoid (C) Trapezius (D) Sternocleidomastoid (E) Scalenus anterior

47. A 25-year-old gladiator sustains a penetrating injury that severs the superficial peroneal nerve. This will most likely cause paralysis of which of the following muscles? (A) Peroneus tertius (B) Peroneus brevis (C) Flexor hallucis longus (D) Tibialis anterior (E) Tibialis posterior

47. A 35-year-old male recreational basketball player heard a loud pop in his left knee while pivoting in a squatted position. He finished playing several more games, but 3 days later he went to an orthopedic surgeon reporting persistent pain, inflammation, and stiffness in his knee, and he admitted it felt like his knee was going to give out when he descended stairs. During a knee examination, the physician noted tenderness along the joint line and a clicking sound while placing a valgus stress on the lateral side of the flexed left knee. During a deep knee bend, the patient experienced pain in the bottom of the motion as shown in the figure. An MRI would confirm damage to what knee structure? (A) Tibial (medial) collateral ligament (TCL) (B) Fibular (lateral) collateral ligament (FCL) (C) Anterior cruciate ligament (ACL) (D) Meniscus (E) Patella

47. 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) Serratus anterior (E) Subscapularis

47. Which of the following conditions is most likely to occur secondary to the fractured clavicle? (A) A fatal hemorrhage from the brachiocephalic vein (B) Thrombosis of the subclavian vein, causing a pulmonary embolism (C) Thrombosis of the subclavian artery, causing an embolism in the ascending aorta (D) Damage to the upper trunk of the brachial plexus (E) Damage to the long thoracic nerve, causing the winged scapula

48. A 37-year-old factory worker fractures multiple bones distal to the elbow when his hand and forearm are crushed by equipment dropped by a faulty hydraulic lift. Which of the following bones, if fractured, would most likely develop avascular necrosis? (A) Distal radius (B) Midshaft ulna (C) Fifth metacarpal (D) Lunate (E) Scaphoid

48. A patient presents with a thrombosis in the popliteal vein. This thrombosis most likely causes reduction of blood flow in which of the following veins? (A) Greater saphenous (B) Lesser saphenous (C) Femoral (D) Posterior tibial (E) Anterior tibial

48. As part of a physical examination to evaluate lower limb function, a physician asks a patient to abduct her second through fifth toes. What specific nerve is the doctor testing? (A) Sural nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Medial plantar nerve (E) Lateral plantar nerve

48. Which of the following nerves is most likely injured as a result of this accident? (A) Axillary (B) Musculocutaneous (C) Radial (D) Median (E) Ulnar

49. A 21-year-old tennis player comes to an emergency room and complains of pain in the knee joint. On examination, he has an infection inside the knee joint capsule but outside the synovial cavity. Which of the following structures is preserved from this infection? (A) Anterior cruciate ligament (B) Posterior cruciate ligament (C) Lateral meniscus (D) Lateral collateral ligament (E) Medial meniscus

49. As part of a physical examination to evaluate muscle function in the hand, a physician holds the four fingers (digits 2 through 5) and asks the patient to spread their fingers, as shown below. What muscle(s) is/are the doctor testing? (A) Lumbrical muscles (B) Palmar interosseous muscles (C) Dorsal interosseous muscles (D) Flexor digitorum superficialis (E) Flexor digitorum profundus

49. Following surgery to repair a broken right tibia, a 22-year-old patient is placed in a short leg cast. Several hours later, she complains of extreme pain, numbness with a pins and needles sensation, inflammation, and abnormal pressure on the anterior and lateral aspects of the affected lower leg. The cast is removed, and the physician notes weakness in dorsiflexion of the foot and toes, a weak dorsalis pedis arterial pulse, and sensory loss between the first and second toes. What nerve is most likely damaged? (A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Medial plantar nerve (E) Lateral plantar nerve

49. Which of the following muscles is most likely paralyzed as a result of this accident? (A) Extensor pollicis brevis (B) Abductor pollicis longus (C) Abductor pollicis brevis (D) Adductor pollicis (E) Opponens pollicis

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. A 47-year-old woman is unable to invert her foot after she stumbled on her driveway. Which of the following nerves are most likely injured? (A) Superficial and deep peroneal (B) Deep peroneal and tibial (C) Superficial peroneal and tibial (D) Medial and lateral plantar (E) Obturator and tibial

5. A physician tests the calcaneal tendon (ankle jerk) reflex as shown. A normal response of plantar flexion of the ankle joint is noted. This myotatic (deep tendon) reflex confirms the integrity of what nerve? (A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Medial plantar nerve (E) Lateral plantar nerve

5. During an attempted suicide, a depressed young woman slashes her wrist with a straight razor. She cuts just proximal to the pisiform bone to the depth of the superficial aspect of the flexor retinaculum before passing out at the sight of her own blood. As a result of this wound, she may suffer a neuromuscular deficit that results in which of the following? (A) Weakness in pronation (B) Inability to abduct the thumb (C) Weakness in flexion of the thumb (D) Weakness in opposition of the thumb (E) Inability to adduct the thumb

50. A 14-year-old gymnastic silver medalist falls from the parallel bar and complains of pains from the knee and ankle joints. On physical examination, her physician found that the muscle responsible for flexing the leg at the knee joint and plantar flexing the foot is severely weakened. Which of the following muscles involved in both movements was most likely damaged in this accident? (A) Tibialis posterior (B) Gastrocnemius (C) Soleus (D) Peroneus longus (E) Flexor digitorum longus

50. A 52-year-old retired professional cyclist, who still rides his bike 400 miles per week, comes to his physician complaining of hand problems. The physician notes hyperextension of the ring and little fingers at the metacarpophalangeal joints and flexion at the interphalangeal joints within the same fingers (see photo). During examination, the patient has no weakness in flexion or adduction of the wrist. What nerve is compressed at what location? (A) Ulnar nerve in the elbow (B) Ulnar nerve in the wrist (C) Median nerve in the wrist (D) Median nerve in the elbow (E) Median nerve in the axilla

50. After this injury, the patient is unable to do which of the following? (A) Flex the proximal interphalangeal joint of his ring finger (B) Flex the DIP joint of his index finger (C) Feel sensation on his middle finger (D) Abduct his thumb (E) Adduct his index finger

50. As part of a physical examination to evaluate lower limb function, a physician asks her patient to stand on his tiptoes, as shown. What nerve is the doctor testing? (A) Tibial nerve (B) Deep fibular nerve (C) Superficial fibular nerve (D) Sural nerve (E) Saphenous nerve

51. A 28-year-old basketball player falls while rebounding and is unable to run and jump. On physical examination, he has pain and weakness when extending his thigh and flexing his leg. Which muscle involved in both movements is most likely injured? (A) Short head of biceps femoris (B) Adductor magnus (C) Semitendinosus (D) Sartorius (E) Gracilis

51. A 3-year-old girl is brought to the emergency room holding her right arm with the elbow flexed and the forearm pronated. She refuses to move her arm and complains her elbow hurts a lot. Her mother reports they were holding hands and running in the park when the child tripped. The mother pulled on the child's hand to prevent her from hitting the ground. Given the nature of this injury and the age of the patient, what structure is most likely damaged? (A) Interosseous membrane of forearm (B) Quadrate ligament (C) Radial collateral ligament of elbow (D) Ulnar collateral ligament of elbow (E) Anular ligament of radius

51. Which of the following nerves is most likely injured as a result of this accident? (A) Musculocutaneous (B) Axillary (C) Radial (D) Median (E) Ulnar

52. A 52-year-old woman comes to an orthopedic surgeon complaining of an uncomfortable feeling in her knee and ankle joints. After a thorough examination, she is diagnosed as having arthritis with mild discomfort with passive movements. The muscles acting at the ankle joint appear normal with good strength. Which muscle can both dorsiflex and invert her foot? (A) Peroneus longus (B) Peroneus brevis (C) Peroneus tertius (D) Extensor hallucis longus (E) Extensor digitorum longus

52. Following this accident, the damaged nerve causes difficulty in abduction, extension, and lateral rotation of his arm. Cell bodies of the injured nerve involved in movement of his arm are located in which of the following structures? (A) Dorsal root ganglion (B) Sympathetic chain ganglion (C) Anterior horn of the spinal cord (D) Lateral horn of the spinal cord (E) Posterior horn of the spinal cord

53. Rupture of the tendon superior to this structure would most likely cause an inability to extend the knee joint.

53. The damaged nerve causes numbness of the lateral side of the arm. Cell bodies of the injured nerve fibers involved in sensory loss are located in which of the following structures? (A) Anterior horn of the spinal cord (B) Posterior horn of the spinal cord (C) Lateral horn of the spinal cord (D) Dorsal root ganglia (E) Sympathetic chain ganglia

54. Fracture of this structure would most likely cause weakness in adduction, flexion, and extension of the thigh.

54. This accident most likely leads to damage of which of the following arteries? (A) Axillary (B) Deep brachial (C) Posterior humeral circumflex (D) Superior ulnar collateral (E) Scapular circumflex

55. A knife penetrating through this point would most likely cause muscle ischemia in the anterior compartment of the leg.

55. Following this accident, the boy has weakness in rotating his arm laterally. Which of the following muscles are paralyzed? (A) Teres major and teres minor (B) Teres minor and deltoid (C) Infraspinatus and deltoid (D) Supraspinatus and subscapularis (E) Teres minor and infraspinatus

56. Fracture of this structure would most likely cause a lesion of the common peroneal nerve, resulting in paralysis of the muscles in the anterior and lateral compartments of the leg.

56. The blood most likely comes from which of the following arteries? (A) Brachial (B) Radial (C) Ulnar (D) Common interosseous (E) Superior ulnar collateral

57. During the procedure, the needle hits a nerve medial to the artery. Which of the following nerves is most likely damaged? (A) Radial (B) Median (C) Ulnar (D) Lateral antebrachial (E) Medial antebrachial

57. Which structure in this radiograph may be fractured, resulting in loss of the chief flexor of the thigh?

58. Fracture of which structure may destroy the site of insertion of the muscle that can rotate the thigh laterally and its tendon that passes through the lesser sciatic foramen?

58. Which of the following nerves is most likely damaged? (A) Axillary nerve (B) Radial nerve (C) Musculocutaneous nerve (D) Median nerve (E) Ulnar nerve

59. As a result of this fracture, the patient shows lack of sweating on the back of the arm and forearm. Cell bodies of the damaged nerve fibers involved in sweating are located in which of the following structures? (A) Anterior horn of the spinal cord (B) Posterior horn of the spinal cord (C) Lateral horn of the spinal cord (D) Sympathetic chain ganglion (E) Dorsal root ganglion

59. Which fractured structure is likely to cause paralysis of the adductor magnus?

6. A 21-year-old female basketball player lands on her opponent's foot after jumping to rebound the basketball. Her foot is forcefully inverted, and when leaving the court, she tells her trainer that she twisted or sprained her ankle. After getting her ankle taped for support, she reenters the game. What ligament was most likely damaged? (A) Calcaneofibular ligament (B) Anterior talofibular ligament (C) Posterior talofibular ligament (D) Plantar calcaneonavicular ligament (E) Medial (deltoid) ligament

6. A 22-year-old patient is unable to unlock the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged? (A) Rectus femoris (B) Semimembranosus (C) Popliteus (D) Gastrocnemius (E) Biceps femoris

6. As part of a physical examination to evaluate muscle function in the hand, a physician holds the proximal interphalangeal joint of his patient's index finger in the extended position and instructs him to try to flex the distal interphalangeal joint, as shown below. Which of the following muscles is the doctor testing? (A) Flexor digitorum profundus (FDP) (B) Extensor indicis (C) First lumbrical (D) First dorsal interosseous (E) Flexor digitorum superficialis (FDS)

60. Following this accident, the patient has no cutaneous sensation in which of the following areas? (A) Medial aspect of the arm (B) Lateral aspect of the forearm (C) Palmar aspect of the second and third digits (D) Area of the anatomic snuffbox (E) Medial one and one-half fingers

60. Which structure becomes necrotic after the medial femoral circumflex artery is severed?

61. The flexor hallucis longus tendon is damaged in a groove on the posterior surface of a tarsal bone. Which bone in the radiograph is likely fractured?

61. Which of the following arteries may be damaged? (A) Brachial artery (B) Posterior humeral circumflex artery (C) Profunda brachii artery (D) Radial artery (E) Radial recurrent artery

62. After this accident, supination is still possible through contraction of which of the following muscles? (A) Supinator (B) Pronator teres (C) Brachioradialis (D) Biceps brachii (E) Supraspinatus

62. The tibialis anterior and peroneus longus muscles are weakened. Which bone in the radiograph is most likely fractured?

63. If the structure indicated by the letter A is calcified, which of the following muscles is most likely paralyzed? (A) Deltoid (B) Teres major (C) Teres minor (D) Infraspinatus (E) Subscapularis

63. The medial longitudinal arch of the foot is flattened because the spring ligament is torn. Which bone in the radiograph is most likely fractured?

64. If the structure indicated by the letter B is fractured, which of the following structures is most likely injured? (A) Musculocutaneous nerve (B) Radial nerve (C) Deep brachial artery (D) Posterior humeral circumflex artery (E) Scapular circumflex artery

64. The peroneus longus muscle tendon is damaged in a groove of a tarsal bone by fracture. Which bone in the radiograph is most likely fractured?

65. Destruction of this area would most likely cause weakness of supination and flexion of the forearm.

66. Destruction of this area would most likely cause weakness of pronation of the forearm and flexion of the wrist joints.

67. A lesion of the radial nerve would most likely cause paralysis of muscles that are attached to this area.

68. Destruction of the structure indicated by the letter E most likely causes weakness of which of the following muscles? (A) Flexor carpi radialis (B) Palmaris longus (C) Flexor carpi ulnaris (D) Brachioradialis (E) Flexor digitorum superficialis

69. If the floor of the anatomic snuffbox and origin of the abductor pollicis brevis are damaged, which of the following bones is most likely to be involved? (A) A (B) B (C) C (D) D (E) E

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. A 17-year-old boy comes to the emergency room after a hard fall onto the lateral aspect of his left shoulder during a high school basketball game. He complains of generalized pain during shoulder motion. On physical examination, the distal end of the clavicle is prominent and distinctly palpable. Radiological findings confirm the diagnosis of a severe (grade 3) shoulder separation. Which of the following features is a component of this condition? (A) Dislocated head of the humerus (B) Torn coracoclavicular ligament (C) Fractured clavicle (D) Dislocated sternal end of the clavicle (E) Torn anterior glenohumeral (GH) ligament

7. A 76-year-old man recently had coronary bypass surgery in which the small saphenous vein was harvested to establish coronary blood flow. Following the procedure, he complained of numbness and paresthesia in the limb from which the vein was removed. The given photo highlights the cutaneous area affected in the patient. No motor loss was noted. What nerve was most likely damaged during harvesting of the vein for transplantation? (A) Sural nerve (B) Saphenous nerve (C) Superficial fibular nerve (D) Deep fibular nerve (E) Lateral plantar nerve

7. A patient presents with sensory loss on adjacent sides of the great and second toes and impaired dorsiflexion of the foot. These signs probably indicate damage to which of the following nerves? (A) Superficial peroneal (B) Lateral plantar (C) Deep peroneal (D) Sural (E) Tibial

70. The patient is unable to abduct her middle finger because of paralysis of this structure.

71. A lesion of the median nerve causes paralysis of this structure.

72. The patient is unable to adduct her little finger because of paralysis of this structure.

73. Atrophy of this structure impairs extension of both the metacarpophalangeal and interphalangeal joints.

8. A 36-year-old man arrives at the ER unconscious and with a suspected spinal cord injury after being involved in a motor vehicle accident. If the physician wants to localize the spinal cord lesion, what reflex would test the integrity of the L1-2 spinal cord segment? (A) Anocutaneous reflex (B) Patellar reflex (C) Plantar reflex (D) Calcaneal reflex (E) Cremasteric reflex

8. A motorcyclist falls from his bike in an accident and gets a deep gash that severs the superficial peroneal nerve near its origin. Which of the following muscles is paralyzed? (A) Peroneus longus (B) Extensor hallucis longus (C) Extensor digitorum longus (D) Peroneus tertius (E) Extensor digitorum brevis

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 finger? (A) Palmar interossei (B) Dorsal interossei (C) Flexor digitorum profundus (D) Flexor digitorum superficialis (E) Lumbricals

8. An 18-year-old boy is cut severely on the lateral wall of his right chest during a knife fight. 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) Axillary nerve (B) Thoracodorsal nerve (C) Long thoracic nerve (D) Dorsal scapular nerve (E) Suprascapular nerve

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. A 67-year-old patient has been given a course of antibiotics by gluteal intramuscular injections after a major abdominal surgery. To avoid damaging the sciatic nerve during an injection, the needle should be inserted into which of the following areas? (A) Over the sacrospinous ligament (B) Midway between the ischial tuberosity and the lesser trochanter (C) Midpoint of the gemelli muscles (D) Upper lateral quadrant of the gluteal region (E) Lower medial quadrant of the gluteal region

9. Human feet are everted so that their soles lie fully on the ground during ambulation. What muscle is developmentally unique to humans, inserts into the base of the fifth metatarsal, and assists in eversion (or pronation)? (A) Extensor digitorum longus (B) Extensor digitorum brevis (C) Fibularis longus (D) Fibularis tertius (E) Flexor digiti minimi brevis

9. On his downswing, an amateur golfer strikes the hard earth with his club and feels pain in his right wrist. During a subsequent physical examination, he complains of wrist pain that is exacerbated by gripping, displays point tenderness in his medial wrist, and complains of numbness and weakness in his pinky finger (fifth digit). What carpal bone, identified by the white arrow on the given X-ray, is most likely fractured in this patient? (A) Capitate (B) Hamate (C) Lunate (D) Pisiform (E) Scaphoid

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