Exam I Written Questions

Question 1

The general name for an alternate pathway of blood flow in or around an organ, around a joint, or past an obstruction is called:

Answer 1

Collateral Circulation

Question 2

When standing in the Anatomical Position the palms of the hands face:

Answer 2

Anteriorly

Question 3

While wandering around in the dark in an unfamiliar home, a visitor accidentally walks into a plate glass door. The door shatters and a shard of glass severs the posterolateral aspect of the woman’s neck. Examination reveals that the she is unable to elevate the tip of her shoulder on the injured side. The nerve injured is:

Answer 3

Spinal Accessory

Question 4

The cutaneous branch of the posterior primary ramus of C2 is called the:

Answer 4

Greater Occipital Nerve

Question 5

Loss of function, paralysis, of which muscle would result in drooping or sagging of the shoulder?

Answer 5

Trapezius

Question 6

After a penetrating wound in the area of the posterior axillary fold a patient had weakness in extension and adduction of the arm. Which muscle is likely involved?

Answer 6

Latissimus Dorsi

Question 7

The part of a spinal nerve that supplies the true back muscles and the skin overlying them is the:

Answer 7

Dorsal Primary Ramus

Question 8

A football player suffers a herniated (ruptured) intervertebral disk in his neck. The disk compresses the spinal nerve exiting through the intevertebral foramen between the 5th and 6th cervical vertebrae. Which spinal nerve is affected?

Answer 8

C6

Question 9

A man has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae. If this disk compresses the spinal nerve in the intervertebral foramen immediately posterior to this disk, which spinal nerve would be affected?

Answer 9

L5

Question 10

It is decided to image the spinal cord and spinal nerve rootlets by doing a myelogram (injection of a radio-opaque dye into the subarachnoid space followed by a radiograph). In order to inject the dye without injury to the spinal cord, the injection is usually done below what vertebral level?

Answer 10

L4

Question 11

A 45-year-old man complained to his physician that the muscles of his upper limb were weak and he felt clumsy while walking. Tests revealed that he had amyotrophic lateral sclerosis (Lou Gehrig’s disease), a disease which attacks the neurons of the voluntary motor system. Where would one expect to see atrophic or degenerated nerve cell bodies?

A. Dorsal horn of the spinal cord
B. Dorsal root ganglion
C. Lateral horn of the spinal cord
D. Sympathetic chain ganglia
E. Ventral horn of the spinal cord

Answer 11

E. Ventral Horn of the Spinal Cord

Question 12

If one does a laminectomy (removing the laminae of two adjacent vertebrae) to expose the spinal cord, which ligament must be removed?

A. Anterior longitudinal
B. Denticulate
C. Ligamentum flavum
D. Ligamentum nuchae
E. Posterior longitudinal

Answer 12

C. Ligamentum Flavum

Question 13

The clavipectoral fascia is penetrated by which artery?

Answer 13

Thoracoacromial Artery

Question 14

In the process of doing an axillary lymph node dissection in a 50 year-old patient, the surgery resident cleans the space between the pectoralis major and minor muscles, in an attempt to remove all of the lateral pectoral lymph nodes. Upon recovery it is noted that the patient’s lower pectoralis major is paralyzed. The nerve most likely injured is the:

Answer 14

Medial Pectoral Nerve

Question 15

Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection?

Answer 15

Serratus Anterior

Question 16

During a motorcycle accident, an 18-year-old male landed on the right lateral side of his rib cage with his right upper limb abducted. In the hospital he was found to have “winging” of the right scapula. Which nerve was likely damaged in the accident?

Answer 16

Long Thoracic Nerve

Question 17

During the planning of therapeutic intervention for a 54-year-old female patient with cancer of the right breast, a 3rd year medical student would need to first consider where most of the cancer cells would metastasize, which would be:

Answer 17

Axillary Lymph Nodes

Question 18

After a jarring blow to the left anterior shoulder region, a young field hockey player was told by an examining physician that she had a muscle tear that resulted directly from the superolateral distraction of a fractured coracoid process. Which muscle was torn?

Answer 18

Pectoralis Minor

Question 19

After being thrown from a motorcycle moving at high speed, a 16-year-old female was found to have a paralyzed right pectoralis major muscle. Which set of movements at the shoulder joint would be found greatly weakened?

Answer 19

Adduction and Flexion

Question 20

In the process of escaping from T. rex in Jurassic Park the heroine punctures the skin on the medial side of her wrist on a spiny bush. A few days later, due to the toxin, an infection is seen spreading up the medial side of her arm along the large cutaneous vein extending from the dorsum of her hand to the medial side of her arm. The vein involved is the:

A. Basilic
B. Brachial
C. Cephalic
D. Median cubital
E. Ulnar

Answer 20

A. Basilic Vein

Question 21

The lateral antebrachial cutaneous nerve comes from the:

Answer 21

Musculocutaneous Nerve

Question 22

In withdrawing a blood sample from the median cubital vein the needle passes slightly deep and medial; which nerve might possibly be injured?

Answer 22

Medial Antebrachial Cutaneous

Question 23

While you are stitching up a man’s hand, he notes that you did not have to give him an anesthetic since the area between his thumb and index finger on the dorsal side was already numb. Which nerve must have been injured (most likely by the fracture of his wrist) for this area to be numb?

Answer 23

Superficial Radial Nerve

Question 24

A sixteen-year-old boy receives a superficial cut on the thumb side of his forearm. The superficial vein most likely affected is the:

Answer 24

Cephalic Vein

Question 25

After trying to throw a curve ball, a pitcher lost sensation from the tip of the little finger. This indicates injury to which nerve?

Answer 25

Ulnar Nerve

Question 26

A man suffers a penetrating wound through the anterior axillary fold, with resulting damage to one of the main terminal branches of the brachial plexus. Among the effects is a significant weakening of flexion of the elbow. What nerve was damaged?

Answer 26

Musculocutaneous Nerve

Question 27

A person sustains a left brachial plexus injury in an auto accident. After initial recovery the following is observed: 1) the diaphragm functions normally, 2) there is no winging of the scapula, 3) abduction cannot be initiated, but if the arm is helped through the first 45 degrees of abduction, the patient can fully abduct the arm. From this amount of information and your knowledge of the formation of the brachial plexus where would you expect the injury to be:

Answer 27

Suprascapular Nerve

Question 28

The cords of the brachial plexus are:

A. above the clavicle, medial to the scalenus anticus (anterior scalene).
B. above the clavicle, behind the scalenus anticus (anterior scalene).
C. at or below the clavicle, closely related to the axillary artery.
D. at or below the clavicle, closely related to the axillary vein.

Answer 28

C. at or below the clavicle, closely related to the axillary artery.

Question 29

An open arterial anastomosis in the shoulder occurs between the suprascapular artery and which other artery?

Answer 29

Circumflex Scapular

Question 30

The femur is derived from :

A. Sclerotome tissue
B. Dermatome tissue
C. Intermediate mesoderm
D. Neuralcrestcells
E. Lateral plate mesoderm

Answer 30

E. Lateral plate mesoderm

Question 31

A man riding a motorcycle hit a wet spot in the road, lost control, and was thrown from his bike. He landed on the right side of his head and the tip of his shoulder, bending his head sharply to the left and stretching the right side of his neck. Subsequent neurological examination revealed that the roots of the 5th and 6th cervical nerves had been torn away from the spinal cord.

Following the above injury, which of the movements of the arm at the shoulder would you expect to be totally lost?

Answer 31

Abduction

Question 32

During an industrial accident, a sheet metal worker lacerates the anterior surface of his wrist at the junction of his wrist and hand. Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb. Branches of which nerve must have been severed?

Answer 32

Median

Question 33

The nerve which passes through the quadrangular space of the posterior shoulder innervates which muscle?

Answer 33

Deltoid

Question 34

Neurological testing of a patient reveals no cutaneous sensation on the tip of the index finger. Such a finding would indicate injury to some portion of which nerve?

Answer 34

Median Nerve

Question 35

The axillary nerve arises directly from which part of the brachial plexus?

Answer 35

Posterior Cord

Question 36

While putting metal panels on the roof of a barn, one of the panels slips out of the hands of the man on the roof. During an attempt to catch the panel, a worker below is struck by its sharp edge. The panel hits across the anterior surface of his right arm at midlength and the impact severs all of the tissue to the bone. When examined in the emergency room it is noted that the patient can only weakly flex his elbow and the lateral side of his forearm is numb. In addition to the muscles, which nerve is injured?

Answer 36

Musculocutaneous Nerve

Question 37

In a case of Erb’s palsy, where roots C5 and C6 of the brachial plexus are avulsed (torn out) which muscle is paralyzed?

Answer 37

Supraspinatus

Question 38

In a fracture of the surgical neck of the humerus, which artery may be injured?

Answer 38

Posterior Circumflex Humeral

Question 39

While riding a bike, a patient fell against a tree and fractured the shaft of the humerus at midlength. What nerve may be injured because of its close proximity to the injury?

Answer 39

Radial Nerve

Question 40

Loss of sensation from the tip of the index finger is indicative of injury to which nerve?

Answer 40

Median Nerve

Question 41

In a diving accident that severed the spinal cord below the sixth cervical vertebra, which muscle would be affected? 
A. Deltoid
B. Infraspinatus
C. Latissimus dorsi
D. Levator scapulae
E. Trapezius

Answer 41

Latissimus Dorsi

Question 42

Which muscle is the strongest medial rotator of the arm?

Answer 42

Subscapularis

Question 43

A person riding a mountain bike on a rustic trail hits a rut, the fork of the bike breaks and the person is thrown into a tree, severely fracturing the upper end of his humerus. During the repair the surgeon ties off the artery traveling through the quadrangular space to stop the hemorrhage. Which artery did he ligate?

Answer 43

Posterior Circumflex Humeral

Question 44

Due to bleeding, the surgeon ligated (tied off) the suprascapular artery as it crossed the top of the scapula. There was no concern however, as she knew that direct collateral branches of which artery would supply the normal distribution of the supra scapular artery?

Answer 44

Scapular Circumflex Artery

Question 45

The patient was unable to retract his scapula because of paralysis of the trapezius and:

Answer 45

Rhomboids

Question 46

During an intramural baseball game a player is hit in the side of the head, between the eye and the ear. He immediately loses consciousness, wakes up momentarily and then becomes comatose. He is rushed to the ER and is immediately given a CT scan. The scan shows a skull fracture and an accumulation of blood between the dura and the cranial bone on the side of his head, compressing his cerebrum. He is rushed to surgery where a hole is bored into his skull to relieve the pressure. After a few tense hours, he regains consciousness and has an uneventful recovery. The hemorrhage from the fracture would be described as:

Answer 46

Epidural

Question 47

A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIIIth cranial nerve) where it entered the temporal bone. What other cranial nerve might also be affected since this nerve uses the same foramen as the VIIIth in its course?

Answer 47

Facial

Question 48

The presence of blood in a spinal tap taken from an individual with a closed head injury signals arterial bleeding into the:

Answer 48

Subarachnoid Space

Question 49

The most likely source of blood in a patient with an epidural hemorrhage is:

Answer 49

Middle Meningeal Artery

Question 50

All of the following nerves exit the cranial cavity by way of bony openings located in the middle cranial fossa EXCEPT:

A. Abducens
B. Trochlear
C. Oculomotor
D. Trigeminal
E. Facial

Answer 50

Facial

Question 51

Supination of the hand and forearm would be diminished by loss of radial nerve function. But one very powerful supinator would remain intact and unaffected, namely:

Answer 51

Biceps

Question 52

A worker doing repetitive lifting develops an inflammation in the tendon of origin of the extensor carpi radialis brevis muscle, commonly called “tennis elbow”. The focal point of pain would most likely be near which palpable bony landmark?

Answer 52

Lateral Epicondyle of the Humerus

Question 53

The anterior interosseous is a branch of which nerve?

Answer 53

Median Nerve

Question 54

During an industrial accident, a sheet metal worker lacerates the anterior surface of his wrist at the junction of his wrist and hand. Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb. Branches of which nerve must have been severed?

Answer 54

Median Nerve

Question 55

A middle-aged woman comes to you complaining of pain on the lateral side of her right elbow, so severe that she holds her eating utensils in her left hand to eat. She says that she spent the weekend putting in a new garden plot and that it involved loosening and turning over a large area of grass sods with a garden fork. You find that the region just proximal to the lateral epicondyle of her humerus is painful to the touch. There is no sensory loss in her forearm or hand. You suspect a localized tearing of the origin of a muscle producing the equivalent of “tennis elbow.” The muscle most likely involved is the:

Answer 55

Brachioradialis

Question 56

A boy fell onto a sharp object and cut his deep radial nerve as it emerged from the supinator muscle. The artery joining it at this point was also injured. The injured artery is the:

Answer 56

Posterior Interosseus

Question 57

The tendons on the dorsal side of the wrist are held in place by a thickening of the antebrachial fascia called the:

Answer 57

Extensor Retinaculum

Question 58

In an industrial accident, the artery passing lateral to the pisiform bone is cut. This artery is the

Answer 58

Ulnar Artery

Question 59

When falling on an outstretched hand, the most commonly dislocated carpal bone is the:

Answer 59

Lunate

Question 60

If the musculocutaneous nerve is severed at its origin from the brachial plexus, flexion at the elbow is greatly weakened but not abolished. What muscle remains operative and can contribute to flexion?

Answer 60

Brachioradialis

Question 61

In order to check the pulse of a child whose forearm is in a cast, the pediatrician presses her finger into the depth of the “anatomical snuffbox”. The tendon lying immediately medial (ulnar) to the physician’s finger belongs to what muscle?

Answer 61

Extensor Pollicis Longus

Question 62

What muscle tendon is enclosed within its own synovial sheath in the carpal canal?

Answer 62

Flexor Pollicis Longus

Question 63

The point of insertion of the flexor digitorum superficialis tendon to the index finger is on the:

Answer 63

Middle Phalange

Question 64

The point of insertion of the flexor digitorum profunda tendon to the index finger is on the:

Answer 64

Distal Phalange

Question 65

The fourth dorsal interosseous muscle is innervated by the:

Answer 65

Deep Branch of the Ulnar Nerve

Question 66

A patient sustained multiple deep lacerations on the palm of his hand and anterior surface of his wrist. During examination, the physician put a piece of paper between adjacent surfaces of the patient’s index and middle fingers and found him unable to squeeze them together with sufficient force to hold the paper. What muscles are being tested?

A. First dorsal and first palmar interosseous muscles
B. First dorsal and second palmar interosseous muscles
C. First lumbrical and second dorsal interosseous muscles
D. Second dorsal and first palmar interosseous muscles

Answer 66

Second dorsal and first palmar interosseous muscles

When you are thinking about abducting and adducting digits in the hand, remember that the midline extends through the middle digit. So, this patient is trying to adduct his index finger by pulling it towards the midline and abduct his middle finger by pulling it away from the midline.

Question 67

Bleeding from a superficial cut in the middle of the palm of the hand near the proximal transverse crease comes mainly from what vessel?

Answer 67

Superficial Palmar Arch

Question 68

After suffering a cut deep to the hypothenar eminence, the patient is unable to hold a sheet of paper between the second and third digits. The nerve most likely injured was the:

Answer 68

Deep Ulnar Nerve

Question 69

After ramming the point of his shoulder into a practice dummy, a football player suffered a severe shoulder separation. Although this is a dislocation of the acromioclavicular joint, several structures could be torn, including the one that gives the joint its greatest strength and stability, namely the:

Answer 69

Coracoclavicular Ligament

Question 70

A two year old child will not go to take her nap. Her mother tightly holds her left hand as she leads her to the bedroom. Refusing to go further, the child suddenly attempts to jerk away and then sits down screaming and holding her left elbow. In a attempt to calm her down her mother offers her a cookie, but she cannot supinate her left hand to receive it. Which joint was dislocated?

Answer 70

Proximal Radioulnar Joint

Question 71

A 3-year-old child walking hand-in-hand with her father screams in pain as he jerks her quickly up onto the curb to dodge a speeding car. The examining physician calls it a case of “pulled elbow”, a dislocation sometimes seen in young children and caused by:

Answer 71

The head of the radius slipping part way out of the annular ligament

Question 72

The fibrocartilaginous structure which deepens the shoulder socket is the:

Answer 72

Glenoid Labrum

Question 73

The interosseous membrane between the radius and ulna is the uniting structure in a type of fibrous joint classified as a:

Answer 73

Syndesmosis

Question 74

A person receives a shallow knife wound just behind the sternocleidomastoid muscle and about 1 1/2 inches above the clavicle. There is an immediate numbness of the skin below the wound and over the acromion and clavicle. The nerve most likely severed was the

Answer 74

Supraclavicular

Question 75

The triangle in which the superior branch of the ansa cervicalis separates from the hypoglossal nerve is the:

Answer 75

Carotid

Question 76

You are called on to do a venous catheterization to measure central venous pressure in the heart. Which muscle of the neck would provide the best area of approach to the internal jugular vein?

Answer 76

Sternocleidomastoid

Question 77

The superior belly of the omohyoid forms the anterior border of which cervical triangle?

Answer 77

Carotid

Question 78

A six-year-old child, whose medical history includes a rather difficult birth, has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was very likely damaged during birth?

Answer 78

Sternocleidomastoid

Question 79

Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that seems (to the patient) to originate in the area atop the shoulder. This is due to the fact that the phrenic nerve shares spinal segments with what cutaneous nerve in the shoulder region?

Answer 79

Supraclaviculars

Question 80

A muscular patient who regularly lifts weights presents with pain and weakness in his right upper limb that has been slowly developing over time. His limb is cool and there is an obvious vascular insufficiency in his upper extremity. Subsequent tests show that a large vessel passing between the anterior and middle scalene muscles is being occluded by hypertrophy (enlargement) of the muscles due to the excercise. The artery involved is the:

Answer 80

Subclavian

Question 81

A 27-year-old man who is a professional weight lifter comes to his physician complaining of recent weakness in his left arm and frequent tingling in his hand and fingers during exercise sessions which subsides with rest. He is diagnosed as having vasuclar insufficiency due to scalenus anticus syndrome and as a remedy it is decided to transect the anterior scalene muscle where it inserts on the first rib. During surgery, which structure in contact with the anterior surface of the muscle must the surgeon be careful of sparing?

Answer 81

Phrenic Nerve

Question 82

Which structure lies immediately anterior to the right anterior scalene muscle at its costal attachment?

Answer 82

Subclavian Vein

Question 83

A person develops a primary tumor of the thyroid gland and, among other symptoms, drooping of the eyelid and constriction of the pupil on the right side of the eye are noted. What nerve fibers have been interrupted by the tumor?

Answer 83

Cervical Sympathetic Trunk

Question 84

An abscess was surgically removed from the middle of the posterior triangle on the right side. During recovery the patient noticed that her shoulder drooped and she could no longer raise her right hand above her head to brush her hair. Which nerve has been cut?

Answer 84

Accessory Nerve