1- Upper limb MSQs Only Flashcards
(1-601) A 10 year old boy is admitted to the emergency department following a fall. On examination, there is deformity and swelling of the forearm. The ability to flex the fingers of the affected limb is impaired. However, there is no sensory impairment. Imaging confirms a displaced forearm fracture. Which of the nerves listed below is likely to have been affected?
Anterior interosseous nerve
Forearm fractures may be complicated by neurovascular compromise. The anterior interosseous nerve may be affected. It has no sensory supply so the defect is motor alone.
(2 - 601)
Which of the following nerves supplies the skin on the palmar aspect of the thumb?
Median
The median nerve supplies cutaneous sensation to this region.
( 7 of 601)
A 63 year old lady is undergoing an axillary sentinel lymph node biopsy as part of her breast cancer treatment. Which of the structures listed below is most likely to be encountered?
Intercostobrachial nerve
A particularly careless surgeon could encounter all of these. However, during a routine level 1 axillary exploration which is where the majority of sentinel nodes will be located, the nerves most commonly encountered are the Intercostobrachial nerves.
(10 of 601)
A 35 year old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnels lie in the extensor retinaculum that transmit the tendons of the extensor muscles?
Six
There are six tunnels, each lined by its own synovial sheath.
(Question 12 of 601)
Which of the muscles listed below is not innervated by the median nerve?
Adductor pollicis
Adductor pollicis is innervated by the ulnar nerve.
Medial two lumbricals innervated by the ulnar nerve
( 14 of 601 )
A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination, he has lost extension of the fingers in his right hand. Which of the nerves listed below is most likely to have been divided?
Radial
The radial nerve supplies the extensor muscle group
( 17 of 601 )
An injured axillary artery is ligated between the thyrocervical trunk of the subclavian and subscapular artery. Subsequent collateral circulation is likely to result in reversal of blood flow in which of the vessels listed below?
Transverse cervical artery
It is asking about the branches of the axillary artery and knowledge of the fact that there is an extensive collateral network around the shoulder joint
(23 of 601)
A 43 year old typist presents with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit. Which of the following nerves has been affected?
Posterior interosseous
(29 of 601)
A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?
Claw like appearance of the hand
(31 of 601)
A 43 year old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. Which of the following features is least likely to ensue?
Complete loss of wrist flexion
(33 of 601)
Which of the structures listed below articulates with the head of the radius superiorly?
Capitulum
The head of the radius articulates with the capitulum of the humerus.
39 of 601
At the level of the wrist joint, which of the statements below best describes the relationship of the ulnar artery to the ulnar nerve?
It lies on its radial side
40 of 601
Which of the following anatomical structures lies within the spiral groove of the humerus?
Radial nerve
The radial nerve lies in this groove and may be compromised by fractures involving the shaft.
41 of 601
A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphold derive the majority of its blood supply?
From the distal end
The blood supply to the scaphoid enters from a small non articular surface near its distal end. Transverse fractures through the scaphoid therefore carry a risk of non union
43 of 601
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor pollicis brevis
Of the muscles listed, only the abductor pollicis brevis is innervated by the median. In questions like this one, ensure you don’t become confused between adductor and abductor.
52 of 601
Which of the nerves listed below is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
Anterior interosseous nerve
The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.
55 of 601
Which of the structures listed below are most closely related to the axillary nerve within the quadrangular space?
Posterior circumflex humeral vessels
The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space
62 of 601
Which muscle initiates abduction of the shoulder?
Supraspinatus
The intermediate portion of the deltoid muscle is the chief abductor of the humerus. it can only do this after the movement has been initiated by supraspinatus. Damage to the te supraspinatus is a common form of rotator cuff disease.
69 of 601
The first root of the brachial plexus commonly arises at which of the following levels?
C5
It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)
72 of 601
When the brachial plexus is injured in the axilla as a result of a crutch palsy, which of the nerves listed is most commonly affected?
Radial nerve
The radial nerve is most commonly injured and results in a wrist drop. The ulnar nerve arises from the medial cord and is rarely affected as a result of this injury mechanism.
81 of 601
A 56 year old man requires long term parenteral nutrition and the decision is made to insert a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein?
Axillary vein
The basilic vein drains into the axillary vein and although PICC lines may end up in a variety of fascinating locations the axillary vein is usually the commonest site following from the basilic. The posterior circumflex humeral vein is encountered prios to the axillary vein. However, a PICC line is unlikely to enter this structure because of its angle of entry into the basilic vein
83 of 601
An 8 year old boy falls onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?
Median
This is a common injury in children. In this case the angulation and displacement have resulted in median nerve injury
84 of 601
A 40 year old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand. Injury to which of the following nerves is most likely to account for her examination findings?
Ulnar
The interossei are supplied by the ulnar nerve
98 of 601
A 28 year old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus. Which of the nerves listed below is most likely to have been affected?
Axillary