Anatomy Upper Extremity Class Questions

Your patient, Frank Franklin (55 year old male) comes into the clinic complaining of pain in his upper arm. He tells you that it's been hurting for awhile, but the pain has progressed significantly after this week of work. Frank is a professional light bulb cleaner and spends most of his day with his arms above his head doing repetitive motions. Physical exam shows a positive Popeye deformity. What is wrong with Frank's shoulder? Injury to the musculocutaneous nerve Rupture of the long head tendon of biceps brachii Interruption of blood flow in brachial artery Bicep tendinosis

Rupture of the long head tendon of biceps brachii

Skier's thumb occurs when the thumb is held by the ski pole while the rest of the hand hits the ground or enters the snow. In severe injuries, the head of the metacarpal has an avulsion fracture. On which metacarpal did this injury most likely occur? 1st metacarpal 2nd metacarpal 3rd metacarpal 4th metacarpal

1st metacarpal

Elly is a 24-year-old female being seen by her primary care provider for a routine exam. Her provider has ordered some routine labs to be collected via venipuncture. The phlebotomist assesses Kelly's upper extremity veins and notices the following pattern of veins: a median antebrachial vein that divides into a median basilic vein and a median cephalic vein. This pattern of veins is found in approximately what percentage of people? 10% 20% 40% 70%

20%

Dupuytren contractures typically affect what digits? 3&4 1&2 2&3 4&5

4&5

There are quite a lot of bones in the hand! The metacarpals make up how many of these bones in ONE hand? 14 10 8 5

5

A patient presents to your urgent care clinic after falling off a ladder. After getting an xray you determine the patient has a fracture and dislocation of the proximal humeral epiphysis. The patient is also complaining of some numbness in his shoulder. Which nerve should you be concerned about? A. Axillary Nerve B. Radial Nerve C. Median Nerve D. Ulnar nerve

A. Axillary nerve

The arteries of the upper limb, including digital arteries, are innervated by sympathetic nerves. Where do these nerves stem from? A. Brachial Plexus B. Spinal Nerves C. Cervical Plexus D. Digital Plexus

A. Brachial Plexus

You are a PA working in the ED, a 27-year-old male comes in complaining of right elbow pain after a fall with a visible large gross deformity of the elbow and a shortened upper limb. Plain XR films show a supra-epicondylar fracture of the right distal humerus causing displacement of the distal fragment. Which muscles of the upper arm tend to pull the distal fragment over the proximal fragment either posteriorly or anteriorly? A. Brachialis and Triceps B. Biceps and Triceps C. Biceps Brachialis and Deltoid D. Triceps and Brachioradialis

A. Brachialis and Triceps

A 28 year old pregnant female presents for an ultrasound examination. The fetus is determined to be between the 5th and 6th embryonic weeks. Which clavicular ossification developments are expected for both the mother and the fetus? A. Mother has completely fused shaft and epiphysis, fetus has begun first ossification of clavicle B. Mother has partially fused shaft and epiphysis, fetus has begun first ossification of clavicle C. Mother has completely fused shaft and epiphysis, fetus has no clavicular ossification D. Mother has partially fused shaft and epiphysis, fetus has no clavicular ossification

A. Mother has completely fused shaft and epiphysis, fetus has begun first ossification of clavicle

A 33 year old female patient presents to the emergency room stating she "fell on the bony part of her elbow". After imaging, a fracture is confirmed as she is taken to surgery for pinning, with plans for a slow healing time. What type of fracture was this? A. Olecranon fracture B. Humeral neck fracture C. Distal radius fracture D. Boxer's fracture

A. Olecranon Fracture

After an ulnar nerve injury, what will most likely happen? A. Paresthesia of the medial part of the palm and the medial one and a half fingers B. Pain and tenderness at the proximal aspect of the anterior forearm C. Hypesthesia of palmar aspect of the radial three and a half digits and adjacent palm D. Lost and weakened ability of flexion of the proximal interphalangeal joints of the 1st-3rd

A. Paresthesia of the medial part of the palm and the medial one and a half fingers

A high school baseball player threw a fast pitch which caused their injury. Symptoms are pain while throwing, especially during acceleration phase. During examination, there was a sense of popping felt in the glenohumeral joint during abduction and lateral rotation of the arm with no signs of fracture on X-ray. What is the injury? A. Tear of the fibrocartilaginous glenoid labrum B. Dislocation of the AC joint C. Pronator Syndrome D. Tendon rupture of the long head of biceps brachial E. Dislocation of elbow joint

A. Tear of the fibrocartilaginous glenoid labrum

Linda, a 56-year-old female, presents to the ER with right shoulder pain and weakness. Linda explains that she fell with her right hand outstretched while walking. Linda states that she is unable to move her right arm without pain. The PA suspects a rotator cuff injury and tests one of the tendons by first adducting the arm and then attempts to abduct the arm against resistance. Given the test the PA is performing and the most commonly ruptured tendon in a rotator cuff injury, where is the PA palpating while attempting to abduct the arm during this test? A. The muscle superior to the scapula spine B. The muscle inferior to the scapula spine C. The muscle medial to the scapula spine D. The muscle lateral to the scapula spine

A. The muscle superior to the scapula spine

The surgical treatment for carpal tunnel syndrome is called carpal tunnel release. Why is the incision made toward the medial wrist when performing the procedure? A. To avoid injuring the median nerve recurrent branch B. To avoid injury to the median vein and/or artery C. To avoid injury to the flexor tendons D. To avoid injury to the palmaris longus tendon

A. To avoid injuring the median nerve recurrent branch

A fracture of the hamate bone may result in damage to which of the following nerves? A. Ulnar nerve B. Radial nerve C. Musculocutaneous nerve D. Median nerve

A. Ulnar nerve

A 40-year-old male presents to the Emergency Department with right shoulder pain, decreased mobility and swelling after getting driven into the boards during an ice hockey game. Upon physical exam you notice the acromion is more prominent and the clavicle is more superior to the process in comparison to the left shoulder. What do you suspect is injured? Conoid ligament Trapezoid ligament Transverse humeral ligament Acromioclavicular ligament

Acromioclavicular ligament

______________ is a plane type of synovial joint, which is located 2-3 cm from the "point" of the shoulder formed by the lateral part of the acromion. Trapezoid ligament Acromioclavicular ligament Transverse humeral ligament Conoid ligament

Acromioclavicular ligament

A 17-year-old male baseball player presents to the Emergency Department complaining of severe pain and restriction of movement of the right shoulder. The patient states he heard his shoulder "pop" as he was extending his arm back in order to throw a fastball. On examination, the patient is holding his right shoulder in abduction and external rotation. There is limited and painful range of motion. Which of the following is the most likely diagnosis? Acromioclavicular joint injury Posterior glenohumeral joint dislocation Midshaft fracture of the humerus Anterior glenohumeral joint dislocation

Anterior glenohumeral joint dislocation

A 72 year old man who recently was hospitalized for a stroke 2 weeks ago came in for a follow up and presents with slight numbness and weakness in his right arm. He states it has felt like this since he was in the hospital. His primary provider informs him that his axillary artery was suddenly occluded during his stroke which is why he is having these symptoms. What provides the patient with partial sensation of his upper limb when his axillary artery unable to provide sufficient circulation? Arterial anastomoses around the scapula The axillary nerve The jugular Teres major

Arterial anastomoses around the scapula

A young adult patient presents to the ED after they were stabbed by a knife in the shoulder region. Hemostatic gauze is ineffective and there continues to be perfuse bleeding. As the ER provider you want to compress the ________artery in order to stop the bleeding. Radial Deep palmar arch Ulnar Axillary

Axillary

The intertubercular sulcus is also known as the: A) Radial groove B) Bicipital groove C) The greater tubercle D) The lesser tubercle

B) Bicipital groove

Kirk Cousins, the Vikings Quarterback, presents with complaint of fumbling the football and infuriating his teammates (and fans). Notably, he has a painful mass in the right axilla that has been present for several months. Over the last couple weeks it has been causing an increase in discomfort as well as a loss of sensation in his arm and fingers. On exam, the mass feels as if it is pulsating. What is the most likely diagnosis? A. Rupture of axillary lymph nodes B. Aneurysm of the axillary artery C. Compression of the axillary artery D. Air emboli in the blood from injury to the axillary vein

B. Aneurysm of the axillary artery

Which of the following nerve branches originates distally off of the median nerve? A. Posterior Interosseous Nerve B. Anterior Interosseous Nerve C. Dorsal Cutaneous Branch D. Lateral Cutaneous Nerve

B. Anterior Interosseus Nerve

A 46 year old male presents to your clinic with loss of sensation over the right lateral side of the proximal arm. Two months ago, he was diagnosed with a right proximal humeral fracture involving the surgical neck. During physical exam, you notice the right deltoid muscle is atrophied, showing a flattened appearance of the shoulder and a slight hollow inferior to the acromion. Which nerve is most likely injured? A. Radial nerve B. Axillary nerve C. Musculocutaneous nerve D. Thoracodorsal nerve E. Spinal accessory nerve

B. Axillary nerve

Chad Jackson is a 24 year old male who presents to urgent care for left thumb pain. He reports he was at a bar with some friends and they dared him to ride the mechanical bull. Pain to the lateral aspect of his thumb and decreased mobility have been present since falling off the bull. What is the most likely diagnosis? A. Skier's thumb B. Bull Rider's thumb C. Gamekeeper's thumb D. Buck thumb

B. Bull Rider's thumb

A patient presents to the ER with difficulty making a fist. He cannot flex the 4th and 5th digits of the distal interphalangeal joints when trying to make a fist. He also cannot extend the 4th and 5th digits of the distal interphalangeal joints when trying to straighten his fingers. What type of condition does the patient most likely have? A. Cubital Tunnel Syndrome B. Claw Hand C. Pronator Syndrome D. Mallet Finger

B. Claw Hand

What is the most common fracture in the forearm? A. Smith Fracture B. Colles Fracture C. Barton Fracture D. Chauffeur Fracture

B. Colles Fracture

Neonates with broad shoulders have an increased risk of breaking their clavicle during delivery. Due to the lack of rigidity and overall development of the neonate's skeletal system, this type of fracture would likely be encountered if the clavicle sustained injury. A. Rotational B. Greenstick C. Strain D. Translocation

B. Greenstick

Which of the following is most likely to result in a baseball finger injury? A. Hyperextension B. Hyperflexion C. Lateral bending D. Medial bending

B. Hyperflexion

The triangle of auscultation is formed by the medial border of the scapula and which muscles? A. Teres major and rhomboids B. Latissimus dorsi and trapezius C. Rhomboids and trapezius D. Latissimus dorsi and teres major

B. Latissimus dorsi and trapezius

A 14 year old male presents to the Emergency Room with right hand pain. The patient reports he was playing baseball and jammed his finger while diving into 2nd base. Upon examination, he cannot extend the distal interphalangeal joint of his right 3rd finger. What is the most likely diagnosis? A. Boxers Fracture B. Mallet Finger C. Trigger Finger D. Median Nerve Injury

B. Mallet Finger

Which head of the triceps brachii is considered the "workhorse" of forearm extension? A. Long head B. Medial head C. Lateral head D. Distal head

B. Medial Head

Synovial cysts aka ganglion cysts are the most common soft tissue tumors of the hand and wrist. They most commonly occur on the dorsal side of the wrist, but occasionally develop on the anterior aspect of the wrist connected to the common flexor synovial sheath. Which nerve is most at risk of impingement if this occurs? A. Radial nerve B. Median nerve C. Ulnar nerve D. Ganglion cysts do not grow large enough to compress nerves.

B. Median nerve

What is the most commonly absent muscle with Poland syndrome? A. Bicep B. Pectoralis Major C. Deltoid D. Sternocleidomastoid

B. Pectoralis Major

What is a common injection sites for a brachial plexus block? A. Sternoclavicular Joint B. Supraclavicular C. Antecubital region D. Ulnar groove

B. Supraclavicular

Which tendon is most commonly ruptured in a rotator cuff injury? A. Infraspinatus tendon B. Supraspinatus tendon C. Subscapularis tendon D. Teres minor tendon

B. Supraspinatus tendon

Excision and pathological analysis of axillary lymph nodes are necessary for staging and determining appropriate treatment of cancer. During a dissection there are 2 nerves that are at risk of injury. They are: A. Radial Nerve and Ulnar Nerve B. Thoracic Nerve and Thoracodorsal Nerve C. Axillary Nerve and Facial Nerve D. C1 and C2 Spinal Nerves E. Supraclavicular Nerve and Musculocutaneous Nerve

B. Thoracic Nerve and Thoracodorsal Nerve

What nerve is responsible for sensory innervation in the pinkie finger? A. Radial Nerve B. Ulnar Nerve C. Median Nerve D. Musculocutaneous Nerve

B. Ulnar Nerve

Which of the following peripheral nerves is affected by Guyon canal syndrome? A. Median nerve B. Ulnar nerve C. Radial nerve D. Musculocutaneous nerve

B. Ulnar nerve

Suzy, a 40 year old female patient, recently underwent right-sided mastectomy surgery. She returns to your office 2 days later for a follow up appointment, where you notice a strange new abnormality on her back. When she puts her arms up, her right scapula comes out, typical of a winged scapula. What is causing this abnormality? A. injury to the spinal accessory nerve B. injury to the long thoracic nerve C. injury to the trapezius D. injury to the levator scapulae E. Injury to the subscapularis

B. injury to the long thoracic nerve

Mary, a 45 year old female, recently underwent right axillary dissection so her lymph node could be examined for breast cancer suspicions. After the surgery, she says she feels shooting pain in her upper right back. When she went to the climbing gym yesterday (a part of her normal routine), she could not pull herself up with her arms. What is the most likely diagnosis? A. trapezius injury B. injury to the thoracodorsal nerve C. rotator cuff injury D. Injury to the musculocutaneous nerve

B. injury to thoracodorsal nerve

A 57 year old male comes into your office complaining of chronic shoulder pain which has gotten increasingly worse over the last couple of months. He was a major league baseball player for the Yankees for 15 seasons. You ordered an MRI which was negative for any fractures or tears. What is the most likely diagnosis? SLAP injury Torn bicep tendon Bursitis Bicep Tendinitis

Bicep Tendinitis

Farmer Bob presents to the emergency room after falling off a ladder while trimming apple tree branches with a chainsaw. He has a large laceration beginning at the lateral epicondyle of his left arm and wraps posteriorly and medially upwards around the arm, ending at the bicipital groove. Which artery can be compressed at its origin at the lateral border of the first rib by exerting downward pressure in the angle between the clavicle and the inferior attachment of the sternocleidomastoid muscle in an effort to control bleeding? A. Subclavian artery B. Suprascapular artery C. Axillary artery D. Subscapular artery E. Thoracodorsal artery

C. Axillary artery

Sandy, a 34 year old female, enjoys sewing and cross stitch, which requires many fine hand movements. She spends all her free time sewing and doing other crafts. She has noticed lately that she has more tingling and numbness in her index and middle finger. She has also noticed that her thumb isn't gripping her sewing needle as well and is getting very frustrated. What is her most likely diagnosis? A. Cubital Tunnel Syndrome B. Posterior Interosseous Syndrome C. Carpal Tunnel Syndrome D. Finger Flexor tendonitis

C. Carpal Tunnel Syndrome

Harry Potter, a 12 year old male, arrives at the emergency department after being knocked off his broom by a rogue bludger from a height of 20 feet while playing Quidditch. He fell on his right hand with his elbow flexed and complains of numbness in his little finger and is unable to flex or adduct his wrist. You determine that he has an ulnar nerve injury which is most likely secondary to which injury? A. Torn ulnar collateral ligament B. Fracture of the olecranon process C. Dislocation of the elbow joint D. Subluxation of the radial head

C. Dislocation of the elbow joint

Who is most at risk for a fracture-dislocation of the proximal humeral epiphysis? A. Men B. Women C. Kids D. Elderly

C. Kids

Dwayne "The Rock" Johnson, a 50 year old male, comes into the clinic for his annual physical checkup. You notice that he is a heavily muscled individual and therefore are unable to hear specific organ sounds from your stethoscope on his anterior side. You ask him to fold his arms across his chest and flex his trunk so that his triangle of auscultation enlarges. Which organ are you now able to properly listen to? A. Heart B. Kidneys C. Lungs D. Large intestines

C. Lungs

A patient presents to the ED following direct trauma to the anterior portion of his right forearm. On physical exam, the attending Physician Assistant notices that the patient is unable to make a fist with his right hand, keeping the thumb, 2nd digit, and 3rd digit extended while being able to flex the 4th and 5th digit. Which of the following nerves is most likely to have been injured as a result of the accident? A. Ulnar Nerve B. Radial Nerve C. Median Nerve D. Musculocutaneous Nerve

C. Median Nerve

A patient, a 13 year old male, presents to the ER with pain and tenderness at the wrist after catching his fall with his hand. After ordering an X-ray, you see a fracture at the distal end of the radius that extends through the distal epiphyseal plate. What are you most concerned about during the healing process? A. Bony union due to blood supply to the distal end of the radius B. Avascular necrosis occurrence C. Misalignment of the epiphyseal plate and disturbance of radial growth D. Nonunion of the fractured bony parts

C. Misalignment of the epiphyseal plate and disturbance of radial growth

A 34 year old male requires surgery on his upper arm. He has a past medical history of having adverse reactions to general anesthesia including hyperthermia, nausea, and tachycardia. The patient has requested to not be put under general anesthesia for these reasons. What is the best option for this patient? A. Give an anti-nausea and beta blocker medication before surgery B. Inject pain medication into the cervical subarachnoid space C. Perform a brachial plexus block and apply a tourniquet D. There is no other anesthesia options for this patient

C. Perform a brachial plexus block and apply a tourniquet

A common mechanism of injury which leads to a dislocation of the elbow may result from hyperextension or a blow that drives the ulna in which direction? A. Anterolateral B. Anteromedial C. Posterolateral D. Posteromedial

C. Posterolateral

A high school soccer player came into contact with another players' shoulder resulting in a direct blow and causing a shoulder injury. This produces an X-ray that shows a fracture and a dislocation of the same bone. What is most likely to be affected? A. Scapula and nerves surrounding the area B. Radius and Ulnar with ulnar nerve being affected. C. Proximal humeral epiphysis D. Scaphoid epiphysis E. Olecranon

C. Proximal humeral epiphysis

Which nerve can be injured with a midhumeral shaft fracture? A. Ulnar Nerve B. Musculotaneous Nerve C. Radial Nerve D. Median Nerve

C. Radial Nerve

During a routine examination, your patient tells you they've had a difficult time scooping ice cream at work lately. They report some numbness in their fingers, and state that sometimes the tips of their fingers turn white. What is the most likely diagnosis given the patient's history and symptoms? A. Carpal Tunnel Syndrome B. Trigger Finger C. Raynaud's Syndrome D. Ulnar Canal Syndrome

C. Raynaud's Syndrome

John, a 50-year-old male, presents to the ER with right wrist pain. John says he was working at a construction site when he tripped over some debris and landed on his right hand. The ER PA completes an orthopedic exam and notes tenderness while palpating the anatomical snuff box of John's right hand. Initial X-ray was completed, but did not show a fracture so the patient was misdiagnosed with a sprained wrist. 2 weeks later repeat X-rays were completed that showed a scaphoid fracture. What is the most likely reason this was not seen on the initial X-ray? A. Radiologist missed the fracture on the first X-ray B. X-ray was taken in lateral view C. Resulting bone resorption is not visible initially D. MRI should have been taken instead of an X-ray

C. Resulting bone resorption is not visible initially

A 22-year-old male presents to the emergency department with complaints of pain in his left forearm and hand. On examination his arm appears swollen and his fingers are purple to black in color. He admits to IV drug use within the last two weeks. He is referred to orthopedic surgery, and amputation is necessary. What anatomical variation does he most likely have to cause this complication of IV drug use? A. High division of brachial artery B. Noncommunicating radial and ulnar arteries C. Superficial ulnar artery D. Variation in origin of radial artery

C. Superficial ulnar artery

Which of the following muscles involved in shoulder elevation is innervated by the spinal accessory nerve (CN XI)? A. Trapezius and levator scapulae B. Levator scapulae and latissimus dorsi C. Trapezius and sternocleidomastoid D. Sternocleidomastoid and serratus anterior E. Teres minor and supraspinatus

C. Trapezius and Sternocleidomastoid

Which nerve in the arm is easy to palpate and is often referred to as the "funny bone"? A. Musculocutaneous nerve B. Radial nerve C. Ulnar nerve D. Median nerve

C. Ulnar nerve

An 18 year old boy arrives to the Emergency Department after suffering an injury during a dirt biking competition. He states he took a turn to sharply and landed hard on his left side where his bike forcefully drove him into the dirt from above. In addition to general upper body discomfort and pain, X-ray confirms both shoulders have been dislocated. Post shoulder reduction, the patient continues to complain of pain to his sternoclavicular region. His upper chest, close to midline, is warm and swollen upon palpation. To rule out any additional skeletal trauma in this area, what imaging test would you order? MRI Angiography CT Percussion Test

CT

Anterior dislocation of the lunate is an uncommon but serious injury that usually results from a fall on the dorsiflexed wrist. The displaced lunate may compress the median nerve. Which of the following syndrome is most likely to occur from this injury? Carpal Tunnel Syndrome Compartment Syndrome Radial Nerve Syndrome Tarsal Tunnel Syndrome

Carpal Tunnel Syndrome

In the biceps reflex deep tendon test, a positive response confirms the integrity of the musculocutaneous nerve and the C5 and C6 spinal cord segments. Excessive, diminished, or prolonged (hung) responses MAY be indicative of ________ central nervous system disease peripheral nervous system disease Central nervous system disease or peripheral nervous system disease, or metabolic disorders. Metabolic disorders or peripheral nervous system disease

Central nervous system disease or peripheral nervous system disease, or metabolic disorders.

Injury to the inferior brachial plexus may result in what physical deformity? Dislocated shoulder Claw Hand Waiter's tip Popeye deformity

Claw Hand

A fracture of the distal end of the radius with dorsal angulation, most common fracture in people >50 years of age and is a result of FOOSH. Greenstick fracture Scaphoid fracture Colles fracture Smith fracture

Colles fracture

A 73 year old female with history of left bicep tendonitis presents to your clinic with pain near the left proximal humerus. During physical exam, you palpate along the intertubercular sulcus. This produces pain. You also hear popping and crackling noises in the same area during ROM rotational exercises. What is the most likely cause of this pain with popping and crackling noises? A) Rupture to the supraspinatus of the rotator cuff B) Lateral condyle fracture of the humerus C) Injury to the radial nerve near the midhumeral shaft D) Dislocation of tendon of long head of biceps brachii

D) Dislocation of tendon of long head of biceps brachii

Which portion of the scapula directly articulates with the clavicle? A. Scapular spine B. Coracoid process C. Deltoid Tubercle D. Acromion

D. Acromion

A 13-year-old boy arrives to the Emergency Department stabilizing his left arm alongside his torso with the opposite hand. He states that while practicing a new trick at the skatepark, he landed backwards on his left arm and felt a pop in his upper chest. His left shoulder and neck region is swollen and deformed, and painful when the patient tries to move his arm. After ordering an x-ray, you secure his left arm in a sling that seems to provide some relief. Based on the mechanism of injury, his presentation, and the initial treatment, what common fracture are you suspecting? A. Humeral head B. Deltoid C. Hangman's fracture D. Clavicle

D. Clavicle

A 22 y/o male presents to a clinic complaining of wrist and hand pain after playing golf. The patient describes the pain started after striking the ground with his golf club after he missed an easy putt. Upon exam, you note the pain to be localized to the hypothenar area of his right hand. Which of the following bones did this patient most likely fracture? A. Scaphoid B. Trapezium C. Distal ulna D. Hamate

D. Hamate

You are on your OB-GYN rotation and are examining a newborn and notice an absence of the axillary skin fold on their right side, their right nipple is inferior on their chest compared to the left, and that two rib segments feel absent. Your preceptor chose to order a CT to further assess the situation. What diagnosis does the newborn most likely have? A. Thoracic outlet syndrome B. Ectrodactyly C. Shoulder Dystocia D. Poland Syndrome

D. Poland Syndrome

Bull Rider's thumb refers to a sprain of _______ ligament and to an avulsion fracture of the lateral part of the proximal phalanx of the _____? A. Ulnar Collateral ligament, Index finger B. Ulnar Collateral ligament, Thumb C. Radial Collateral ligament, Index finger D. Radial Collateral ligament, Thumb

D. Radial Collateral ligament, Thumb

Carl, a 26 y.o. male, was hiking in Banning State Park last weekend where he slipped and fell while attempting to cross a creek, falling down and ultimately injuring the left side of his neck. He presents to the ER with a dropped left shoulder. The attending physician notices weakness in the shoulder, especially when shrugged against resistance. Which of the following nerves is most likely to have been injured as a result of his injury? A. Vagus Nerve B. Thoracodorsal Nerve C. Axillary Nerve D. Spinal Accessory Nerve E. Valgus Nerve

D. Spinal Accessory Nerve

What carpal bone articulates with the thumb? A. Scaphoid B. Hamate C. Pisiform D. Trapezium E. Capitate

D. Trapezium

A patient with a ganglion cyst on their wrist has been complaining of paresthesias in their medial 4th and 5th digits for the past several weeks. Upon physical exam, you note that their 4th and 5th digits are hyperextended at the MCP joints and flexed at the PIP joints. However, they are able to flex these fingers when instructed. This presentation is most associated with which of the following conditions? A. Ulnar nerve injury B. Carpal tunnel syndrome C. Median nerve injury D. Ulnar canal syndrome

D. Ulnar canal syndrome

Which of the following motions would most likely cause pain in someone with lateral epicondylitis? Knitting Drinking a glass of water Washing their hair Petting their dog

Drinking a glass of water

A 53 year old male presents to clinic stating he "can't extend his 4&5th fingers" of both hands. Upon examination, there are palpable nodules extending from the proximal aspect of the hand to the base of the 4&5th digits. The 4th and 5th digits are flexed at the MCP and PIP joints, and are unable to extend actively or passively. What is the patient's most likely diagnosis? Carpal Tunnel Syndrome Dupuytren Contracture Trigger Finger Raynaud Syndrome

Dupuytren Contracture

In which patient population are fractures of the surgical neck of the humerus most common? Adults in motor vehicle accidents Elderly people with osteoporosis Infants due to their small features Teenagers in collision sports

Elderly people with osteoporosis

Which intrinsic shoulder muscle is innervated by C5 and C6 (axillary nerve) and is a common site for intramuscular drug injections? A. Supraspinatus B. Teres minor C. Infraspinatus D. Subscapularis E. Deltoid

E. Deltoid

A condition showing red, warm, and tender streaks in limbs caused by infections in little organ clusters found throughout the body in areas like the axillary, abdomen, and the breasts is called what? A. Cancer B. Tendinitis C. Pronator Syndrome D. Dupuytren contracture E. Lymphangitis

E. Lymphangitis

Dislocations of the sternoclavicular joint are often the result of fractures at this specific area of the clavicle, which does not close on most people until their mid 20's. Coracoid process Epiphyseal plate Sternum Acromioclavicular ligament

Epiphyseal plate

Your patient comes in after getting their hand crushed between two helmets at a hockey game. They are complaining of pain in the upper palm of their hand, below the knuckles. Their 2nd (pointer) and 3rd (middle) fingers will not bend with the rest of their hand. These fingers appear much shorter than the corresponding fingers on the opposite hand. What are you most suspicious of? Boxer's Fracture Fracture of the Scaphoid Fracture of the Metacarpals Fracture of the Phalanges

Fracture of the Metacarpals

This joint has more freedom of movement than any other joint within the body. This joint allows movement around three axes and permits flexion-extension, abduction-adduction, rotation (medial and lateral) of the humerus and circumduction. Sternoclavicular joint Acromioclavicular joint Glenohumeral joint Elbow joint

Glenohumeral joint

As Janis was breaking it down on the dance floor at her favorite hip-hop club, she fell and landed directly on her flexed elbow. Which humeral fracture would this most likely result in? Oblique fracture of the humeral shaft Transverse fracture of the humeral shaft Avulsion fracture of the greater tubercle of the humerus Intercondylar fracture of the humerus

Intercondylar fracture of the humerus

A 40-year-old male present with pain over the outside of his elbow and down the posterior side of his forearm. He describes that the pain started gradually, and he first noticed it when he drinks his coffee in the morning. He says he loves to throw the tennis ball for his dog every day for about 30 minutes. What is his most likely diagnosis? Fracture of the olecranon Pronator Syndrome Lateral Epicondylitis Carpal tunnel syndrome

Lateral Epicondylitis

Which vein is the most common site for a blood specimen collection? median cubital vein basilic vein of arm cephalic vein of arm cephalic vein of forearm

Median cubital vein

Sarah is a 15 year old female who has recently started high school. She has a history of depression, anxiety, and sucidal ideations. She recently experienced bullying at school which has led her to slash her wrists. When she slashes her wrists which nerve is she most likely to injure as this nerve is relatively close to the surface? Radial nerve Ulnar nerve Median nerve Musculocutaneous nerve Axillary nerve

Median nerve

Frank Franklin, a 62 year old male, is seen at your clinic for a follow up appointment after a stabbing injury that occurred when he got into a fight a few weeks ago. He was struck with a knife in the shoulder and can no longer complete shoulder flexion without extreme effort. He states that his arm feels weak. Elbow flexion and supination are also extremely difficult for him to complete. Frank, a professional lightbulb cleaner, is concerned that this will begin to affect his ability to work. What nerve was injured when he was stabbed? Musculocutaneous Nerve Radial Nerve Ulnar Nerve Olecranon Nerve

Musculocutaneous Nerve

When measuring the radial pulse rate, the pulp of the thumb should ______ because it ______ A) Be used, has the most sensitive touch receptors amongst the distal phalanges B) NOT be used, has its own pulse C) Be used, has the largest surface area amongst the distal phalanges D) NOT be used, is more likely to obstruct blood flow

NOT be used, has its own pulse

A 56-year-old male presents to the emergency room after suffering a direct trauma at the wrist; he is unable to oppose his thumb but does not have complete paralysis to any of his fingers. Should a median nerve lesion be ruled out? Yes, he does not have complete paralysis No, there is communication between median and ulnar nerves preventing paralysis. Yes, it has to be related to the radial nerve in the thumb. No, we need an X-ray

No, there is communication between median and ulnar nerves preventing paralysis.

When the median nerve is severed at the wrist or the forearm which function is the thumb unable to do? Flexion Extension Abduction Adduction Opposition

Opposition

A 45 year old patient presents to the ED with neurovascular symptoms in their upper limb. WIth the use of imaging, you find that the inferior trunk of their brachial plexus is being compressed by the first rib. What is the most likely brachial plexus variation of this patient? Postfixed brachial plexus Inferior brachial plexus Superior brachial plexus Prefixed brachial plexus

Postfixed brachial plexus

Gregory, a 27 y/o man, has come into your clinic with complaint of swelling and redness in his right palm along with a fever of 101.1 which has been progressively worsening over the past week following a cat bite in his palmar region. Due to the duration of his symptoms, where can you expect his infection to spread? Distally throughout his fingers, except for his thumb Proximally through his carpal tunnel into his forearm Proximally, stopping distal to his carpal tunnel Distally until stopping at his MCP joint

Proximally through his carpal tunnel into his forearm

Which nerve innervates the extensor muscles of the forearm? Ulnar nerve Radial nerve Median nerve Brachial nerve Axillary nerve

Radial nerve

A fracture to which carpal bone carries an increased risk of avascular necrosis and is most likely to occur after a fall onto an outstretched hand while the thumb is abducted? Scaphoid Triquetrum Trapezoid Hamate Lunate

Scaphoid

A 30 y.o. male presents to the emergency department for evaluation of right wrist pain and swelling after falling onto his outstretched right hand earlier in the day. His pain onset immediately at the time of the injury and his swelling has progressively worsened. On exam, he has edema and tenderness over the anatomic snuff box of the right hand with no numbness or weakness of the right hand or fingers. His pain is exacerbated with circumduction of the wrist. X-ray imaging (A-P and lateral views) of the wrist was obtained and didn't demonstrate any clear and obvious signs of fracture. A fracture to which bone is most likely in this setting? Radial fracture Scaphoid fracture 1st metacarpal fracture Ulnar fracture

Scaphoid fracture

What is one of the many arterial anastomoses around the scapula? Superior thoracic artery Subscapular artery Thoracodorsal artery Brachial artery

Subscapular artery

A 58 year old male presents to the ED immediately after falling from his motorcycle. He states he landed directly onto his left shoulder, stating that his shoulder was widely separated from his neck. The patient endorses numbness and paresthesias in the entire left upper extremity. He is also presenting with his left upper extremity in a "waiter's tip" position. What structure was damaged in the accident? Inferior brachial plexus Rotator cuff Superior brachial plexus Dorsal scapular nerve

Superior brachial plexus

What would be the most likely treatment for a severe Skier's thumb ligament rupture? Opioids RICE NSAIDs Surgery

Surgery

What is degeneration within the tendon's collagen causing disorganization of the collagen? Tendinosis Tendinitis Tenosynovitis Bursitis

Tendinosis

Where is swelling in the hand due to fascia infections typically seen due to the thickness of it's fascia? The palmar surface The thenar eminence The hypothenar eminence The dorsal surface

The dorsal surface

A 75 year old female presents to the emergency department after a MVA with a broken right humerus at the mid shaft. X-ray shows a displaced oblique fracture of the humerus. She complains of lower arm paralysis and is unable to flex her arm. What structure got injured with her fracture given the patients symptoms? The radial artery The median nerve The brachialis The brachial artery

The median nerve

The brachial artery may divide at a more proximal level than usual. What structure may run between the ulnar and radial arteries if there is this higher division of the two on the upper arm? The biceps The Ulnar nerve The radial nerve The median nerve

The median nerve

Which muscle would NOT be affected in a musculocutaneous nerve injury? Coracobrachialis Biceps brachii Brachialis Triceps brachii

Triceps brachii

A patient presents to your urgent care clinic after finishing a seven-hour continuous bicycle ride and whose chief complaint is that fingers just do not feel right. From past knowledge, you are able to recall that this extensive time spent in the bicycling position places pressure on the hooks of their hamate. What nerve is most likely involved and where is the loss of sensation in the fingers most likely to occur? A) Median nerve, affecting the 1st, 2nd, and one-half of the 3rd finger B) Ulnar nerve, affecting the 5th, 4th, and one-half of the 3rd finger C) Radial nerve, affecting the 1st, 2nd, and 3rd finger D) Ulnar nerve, affecting the 5th finger and one-half of the 4th finger

Ulnar nerve, affecting the 5th finger and one-half of the 4th finger

In some cases, there can be variations in the origin of the radial artery. What is a risk of these variations? More protection Vulnerability to laceration Vulnerability to impingement Hard to find pulse

Vulnerability to laceration

Rupture of the biceps tendon may be the result of forceful flexion of the arm against resistance. Which of the following athletes is at the highest risk for this injury? Long distance runner Downhill skier Gymnast Weightlifter

Weightlifter

The patient is a 29 year old female who recently took up skateboarding. She fell down with her wrist in a flexed position. Ever since she has been unable to extend her wrist or fingers. She denies any neurological symptoms. What is the most likely diagnosis? Arm drop Forearm drop Wrist drop Nerve entrapment

Wrist drop

Which phalanx is most commonly injured with a fracture? a. Distal b. Middle c. Proximal d. Carpal e. Metacarpal

a. distal

What it is called when the brachial plexus has a superior most root of C4 and inferior root of C8? a. Prefixed brachial plexus b. Superior brachial plexus c. Postfixed brachial plexus d. Inferior brachial plexus

a. prefixed brachial plexus

A patient presents to the emergency department with pain and a hematoma developed after crushing their finger in the car door. What is the most likely phalanx that is fractured? a. Middle b. Proximal c. Carpal d. Distal e. Metacarpal

d. distal

A 38 year old female presents to the ED for evaluation of pain and weakness after a stick punctured her posterior forearm. She is having difficulty extending the thumb and digits at the metacarpal joints against resistance. Wrist drop testing is negative. X-ray is negative for fracture. Sensation to light touch is intact in the hand. This presentation is most consistent with an injury to which nerve? superficial branch of the radial nerve common radial nerve deep branch of the radial nerve median nerve ulnar nerve

deep branch of the radial nerve

Injury to this nerve would limit the ability of the patient to perform extension of the thumb and digits at the metacarpal joints without significantly impacting cutaneous sensation of the hand? superficial branch of the radial nerve deep branch of the radial nerve common radial nerve median nerve

deep branch of the radial nerve

Steve is a 54-year-old male being seen by his primary care provider. Steve is a professional piano player and states his index finger is often stuck in the bent position. He states that he has to extend his finger using his other hand. When he extends his finger, he hears a snap. What is likely causing Steve's finger issue? infection of the digital synovial sheath Quervain tenovaginitis stenosans fracture of the digit digital stenosing synovitis (trigger finger)

digital stenosing synovitis (trigger finger)

Which of the following is the term or phrase used when inflammation of the tendon and synovial sheath occurs? tendonitis tendinosis tenosynovitis tendon atrophy

tenosynovitis