Exam review Flashcards
piano key deformity
Acromioclavicular tear
rupture of the glenohumeral ligaments
Anterior shoulder dislocation
A 55-year-old woman was submitted to surgery to remove her left breast and afterwards she noticed that she was experiencing weakness in her left shoulder and had considerable difficulty raising her left arm above her head, even two months after her surgery. Her husband also noticed that her left scapula seemed to protrude posteriorly to a greater extent than the one on her right side. This phenomenon is called a “winged scapula”. Which muscle was affected and which nerve supplies it? Why was this patient’s ability to raise her arm above her head affected?
Serratus anterior- supplied by long thoracic nerve Serratus anterior helps to rotate scapula superiorly
A football player fell on his elbow and fractured the surgical neck of the humerus, producing an elevation and adduction of the distal fragment. Which of the following muscles would most likely cause the adduction of the distal fragment? Brachialis Teres minor Pectoralis major Supraspinatus Pectoralis minor
Pectoralis major Pectoralis major inserts below the surgical neck of humerus
Which muscle allows abduction after 15 degrees?
deltoid
A 65-year-old male slips on his outstretched hands while walking on the ice. He arrives in the ER complaining of right shoulder pain. His physical exam shows inability to abduct the arm from approximately 15o and insensitivity of the overlying skin to touch. Which of the following injuries is most likely responsible? A. Anterior and inferior dislocation of the humerus B. shoulder separation C. fracture of coracoid process D. spiral fracture of the humerus midshaft E. fracture of the hook of the hamate
A. Anterior and inferior dislocation of the humerus An anterior and inferior dislocation of the humerus may damage the axillary nerve with paralysis of the deltoid, teres minor and loss of sensation from the upper lateral part of the shoulder
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 normally gives rise to this artery? A. First part of axillary artery B. Second part of axillary artery C. Third part of axillary artery D. Third part of subclavian artery E. First part of brachial artery
B. Second part of axillary artery
A 38 year old female patient is found to have a hard nodule in the upper lateral portion of her right breast. The physician injects dye into the tissue around the tumor so that it can be taken up by the lymphatic vessels around the area. Which of the following nodes will most likely first encounter the lymph from the tumor? Apical axillary nodes Central axillary nodes Anterior axillary (pectoral) nodes Parasternal nodes Subscapular (posterior) axillary nodes
Anterior axillary (pectoral) nodes
A 32 year old female patient is placed on dialysis and a suitable vein in the upper limb was needed for venipuncture. A vein was found on the medial side of the arm that passed through the superficial and deep fascia to join veins beside the brachial artery. Which vein was this? Basilic Cephalic Median cubital Medial antebrachial
Basilic
While attempting to collect a sample of blood from the medial cubital vein a phlebotomist inserts the needle too deeply and enters the cubital fossa. 1. Which structure forms the roof of the cubital fossa? 2. Which structures may be damaged by venipuncture or a stab wound in the cubital fossa?
- The bicipital aponeurosis 2. Brachial artery and median nerve
Which of the following structures do not travel or run parallel or generally go, together? Axillary nerve and anterior circumflex humeral artery (through quadrangular space) Radial nerve and deep brachial artery (in lateral triangular space) Anterior interosseous nerve and artery Thoracodorsal nerve and artery Brachial artery and median nerve (in arm) Peanut butter and jelly
The axillary nerve and posterior circumflex artery pass through the quadrangular space together
After a difficult delivery through the birth canal, a baby presents with his left upper limb adducted, internally rotated, extended at the elbow and flexed at the wrist. Which part of the brachial plexus was most likely injured during this delivery? A. lateral cord B. medial cord C. roots of the lower trunk D. roots of the upper trunk E. roots of the middle trunk
roots of upper trunk This is an example of an upper brachial plexus injury (Erb-Duchenne palsy), affecting the lateral rotators of the humerus, the flexors of the elbow, and the abductors of the shoulder
A 27-year-old patient presents with an inability to draw the scapula forward and downward because of dysfunction of the pectoralis minor. Which of the following would most likely be a cause of his condition? A. Injury to the thoracodorsal nerve B. Axillary nerve injury C. Fracture of the coracoid process D. Fracture of the clavicle E. Injury to the posterior cord of the brachial plexus
C. Fracture of the coracoid process Pectoralis minor inserts on the coracoid process and is supplied by medial pectoral n. from medial cord
An ice skater falls to the ice and hurts herself during a practice session before opening night. She sustains an injury to the thoracodorsal nerve that would probably affect the strength of which of the following movements? A. Adduction of the scapula B. Elevation of the scapula C. Extension of the arm D. Abduction of the arm E. Lateral rotation of the arm
C. Extension of the arm The thoracodorsal nerve supplies the latissimus dorsi muscle which extends the arm (along with adduction and medial rotation)
A 20 year old man is brought to the ER after dislocating his shoulder while playing football. He has pain over the lateral region of his shoulder and cannot abduct the arm normally. An MRI of the shoulder shows a torn muscle. Which of the following muscles is most likely to have been damaged by this injury? Coracobrachialis Long head of triceps Pectoralis major Supraspinatus Teres major
Supraspinatus- initiates abduction
Lateral rotation of the arm is an important mechanical component of “bringing the arm back” (i.e, laterally rotating the arm) when preparing to throw an object. What muscle acts to produce lateral rotation of the arm? A. Supraspinatus B. Teres major C. Teres minor D. Subscapularis E. Latissimus dorsi
C. Teres minor The teres minor, one of the rotator cuff muscles, is a lateral rotator of the humerus (along with the infraspinatus)
An orthopedic surgeon exposed the muscle in the supraspinous fossa so that she could move it laterally, in repair of an injured rotator cuff. As she reflected the muscle, an artery was exposed crossing the ligament that bridges the notch in the superior border of the scapula. Which artery was this? Subscapular Transverse cervical Dorsal scapular Posterior circumflex humeral Suprascapular
Suprascapular The suprascapular artery goes over the ligament while the suprascapular nerve goes under
A 27 year old man falls off a ladder onto his shoulder. An X-ray shows a fracture of the surgical neck of the humerus and you suspect there may be some nerve damage to the nerve which passes around this area. How would you test for the status of this nerve? A. have the patient push against a wall to assess if he has winged scapula B. test for normal sensation over the lateral part of the forearm C. test for sensation over the lateral part of the shoulder D. have the patient extend his forearm against resistance E. have the patient shrug the shoulders
Correct answer is: C. test for sensation over the lateral part of the shoulder The axillary nerve passes around the surgical neck of the humerus. Superior lateral cutaneous n. of arm is branch of axillary n. Incorrect: A. Long thoracic nerve. B. Musculocutaneous n D. Radial N E. Spinal accessory n
The right shoulder of a 51 year old chemistry teacher had become increasingly painful over the past year. Abduction of the right arm caused him to wince from discomfort. An MRI revealed inflammation extending over the head of the humerus. Which structure was inflamed? Subscapular bursa Infraspinatus muscle Subacromial bursa Pectoralis minor Teres minor muscle
Subacromial bursa
A 24 year old hotel porter is lifting a heavy box and suddenly hears a “pop” in his left arm. In the ER, physical examination reveals a rupture of the long head of biceps brachii. Which of the following is the most-likely location of the rupture? Bony insertion of the muscle Midportion of the biceps Intertubercular groove Junction with the short head of biceps Proximal end of the combined muscle
Intertubercular groove Rupture of the tendon results from wear and tear of an inflamed tendon as it moves back and forth in the intertubercular groove of the humerus
A 17 year old male has weakness of elbow flexion and supination of the left hand after sustaining a knife wound in a fight. Examination in the ER indicates that a nerve has been severed. What other conditions will also most likely be seen during physical examination? A. inability to adduct and abduct the fingers B. Inability to flex his fingers C. Inability to flex his thumb D. Sensory loss over the lateral surface of his forearm E. Sensory loss over the medial surface of his forearm
D. Sensory loss over the lateral surface of his forearm Musculocutaneous nerve ends as the lateral cutaneous nerve of forearm
A mother tugs forcefully on her child’s arm to pull him out of the way of an oncoming car and the child screams in pain. It then becomes obvious that the child cannot straighten his forearm at the elbow. An X-ray taken in the ER shows a dislocation of the head of the radius. Which of the following ligaments or membranes is most likely directly associated with this injury? A mother tugs forcefully on her child’s arm to pull him out of the way of an oncoming car and the child screams in pain. It then becomes obvious that the child cannot straighten his forearm at the elbow. An X-ray taken in the ER shows a dislocation of the head of the radius. Which of the following ligaments or membranes is most likely directly associated with this injury? A. Annular B. Interosseous C. Radial collateral D. Ulnar collateral
A. Annular Nursemaid’ elbow
Your 67-year-old female patient who fell on her hand has been diagnosed with a Colles fracture. This refers to which of the following? A. A fracture of the lunate B. A fracture of the scaphoid C. A fracture of the distal radius in which the distal fragment is angulated dorsally D. A fracture of the radial styloid process in which the separated segment overrides the scaphoid E. A fracture of the distal radius in which the distal fragment is angulated ventrally
C. A fracture of the distal radius in which the distal fragment is angulated dorsally
You are treating a patient in the ED who has a severe cut on the proximal dorsal surface of the middle of her forearm. The profuse bleeding is derived primarily (directly) from which of the following? A. Ulnar artery B. Radial artery C. Deep brachial artery D. Ulnar recurrent artery E. Posterior interosseous artery
E. Posterior interosseous artery
Your 45-year-old patient is showing weak hand pronation, especially in initiating the movement. You suspect a problem with the pronator quadratus. Which of the following is INCORRECT about this muscle? A. It is innervated by the anterior interosseous branch of the median nerve B. It is the only muscle that is attached to the ulna at one end the radius at the other C. It supports the interosseous membrane between the radius and ulna D. It is the deepest muscle in the forearm E. It can be palpated from the dorsal aspect with deep pressure
E. It can be palpated from the dorsal aspect with deep pressure
A 74 y.o. Maine lobster fisherman visits the clinic because of a deep penetrating injury of a fish hook to the anterior forearm. The patient is asked to make the “OK” sign between thumb and forefinger, but can only make a “pinch”. Which nerve has most likely been injured?
Patient cannot make an “O” between thumb and forefinger due to paralysis of flexor pollicis longus and radial half of flexor digitorum longus, both of which supplied by anterior interosseous nerve
In preparation for a nerve conduction test on your 56-year-old patient, you want to locate the median nerve at the wrist. Where is this nerve located? A. Just lateral to the radial artery B. Superficial to the flexor retinaculum C. Just lateral to the tendon of the flexor carpi radialis D. Just lateral to the tendon of palmaris longus in those patients with this muscle E. Just medial to the ulnar artery
D. Just lateral to the tendon of palmaris longus in those patients with this muscle
You examine a patient who has weakness of medial deviation (adduction) of the wrist, loss of sensation on the medial palmar side of the hand, and clawing of the 4th & 5th digits. Where is the most likely place of injury? A. Compression of a nerve passing behind the medial epicondyle (Cubital Tunnel) B. Compression of a nerve passing at Guyon’s canal between the pisiform and flexor retinaculum C. Compression of a nerve passing through the carpal tunnel D. Compression of a nerve passing through the supinator E. Compression of a nerve passing deep to brachioradialis muscle
A. Compression of a nerve passing behind the medial epicondyle (Cubital Tunnel)
A 39 year old female tennis player comes to the clinic with pain over the right lateral epicondyle of her elbow. Physical examination reveals she has lateral epicondylitis. Which of the following tests should be performed during physical examination to confirm the diagnosis? Evaluation of pain experienced during flexion and extension of the elbow joint Observing the presence of pain when the wrist is extended against resistance Observing the presence of numbness and tingling in the ring and little fingers when the wrist is flexed against resistance Evaluation of pain over the styloid process of the radius during brachioradialis contraction
Observing the presence of pain when the wrist is extended against resistance
This is an image of a cat bite. Which of the following is NOT true of such infections? A. they often spread to the distal forearm B. they may pass to the little finger C. they normally spread to the 2nd, 3rd or 4th fingers D. they affect muscles that are supplied by a branch of the median nerve E. they are serious infections that need prompt attention
C. they normally spread to the 2nd, 3rd or 4th fingers
As part of a physical examination to evaluate intrinsic hand muscle function, a physician asks the patient to assume the Z-position with his hand, which involves flexion of the metacarpophalangeal joints and extension of the interphalangeal joints of the 4th and 5th fingers. Which of the following nerves is being tested in assuming this position? A. Deep (or posterior interosseous) 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
A. Deep (or posterior interosseous) branch of radial nerve and D. Deep branch of ulnar nerve
A baseball player attempted to catch a ball barehanded and was hit on the tip of the index finger. He then found that he could not extend the distal interphalangeal joint of this finger. What type of injury did the player suffer?
Mallet finger
A 26 year old man comes to the ER with a wound to the palm of his hand. He cannot touch the pads of his fingers with his thumb but can grip a sheet of paper between his fingers and has no loss of sensation on the skin of his hand. Which of the following nerves has most likely been injured? Deep branch of ulnar Anterior interosseous Median Recurrent branch of median nerve Deep branch of radial
Recurrent branch of median nerve
Your 61-year-old patient has a fracture of the medial epicondyle of the humerus injuring the nerve which passes around this bony prominence. Which of the following would not be consistent with such an injury? A. Weakness in abduction of fingers B. Weakness in adduction of fingers C. Inability to flex the distal interphalangeal joints of the 2nd and 3rd digits D. Loss of sensation in medial 1 and a half digits E. Weakness in adducting the thumb
The anterior interosseous nerve, the deep branch of the median nerve, supplies the medial portion of the FDP (which flexes the 2nd and 3rd DIP joints). The ulnar nerve (which passes behind the medial epicondyle) is responsible for the other motor and sensory functions
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
C. Dorsal interosseous muscles
coarcatation of the aorta
dislocation of ulna
left hemidiaphragm- injury to phrenic nerve
Medial epicondyle fracture
nursemaid’s elbow
olecranon fracture
osteoarthritis
pleural effusion on left side
rheumatoid arthritis
subacromial bursitis
supraspinatus tear
most common humerus dislocation
anterior and inferior to the glenoid fossa
glenoid labrum
deepens the glenoid labrum
prevents upward displacment
coracoclavicular and acromialclavicular ligaments
serratus anterior helps to
rotate scapula
long thoracic nerve runs
on top of the serratus muscles
pectoralis major aattaches to the
lateral lip of the intertubercular groove
quadrangular space
axillary nerve and post/ curcumflex artery
upper lateral lymp drain
pectoral anterior nodes
medial quadrant of lymph
what is so important of this?
parasternal
cross over to the other side of the breast
arterial anastomose of the scapula
circumflex scapular artery and suprascapular artery
deep plmar branch supplied mostly by
radial artery
erb’s palsy
roots of upper trunk
teres minor inserts into the
coracoid process
T2
fluid is white
Tranverse ligament of the scapular
what is important?
suprascapular nerve uner adn suprascapular artery above it
biceps brachi supinator in the
flex
colle’s fracture
angulated dorsally
nightstick
ulnar and scaphoid bone
ok sign
anterior interosseous
wrist drop
radial nerve damage leading to no extension of the wrist
lateral epicondylitis muscle
extensor carpi radialis brevis
mallet finger
lateral band
Boutonniere
central band tear
Phrenic nerve from
C3- C5
sympathetic nerves from
T1- L2
parasympathetic nerves from
S2- S3
left lower lobe lymphatic drainage
can go to the right side
which type of pleura has somatic innervation
parietal pleura
Achille’s heel of the heart
Purkinje fibers
water-bottle
pericarditis
visceral layer
insensitive to pain
coronary artery perfusion occurs during
diastole
cranio-sacral
parasympathetic
intermediolateral cell colums of T5 to T9
Splanchnic nerves
The fetal right atrium is mainly derived from the:
A.Primordial pulmonary vein
B.Right pulmonary vein
C.Primordial atrium
D.Sinus venarum
E.Right horn of sinus venosus
E.Right horn of sinus venosus
The fetal left atrium is mainly derived from the:
A.Primordial pulmonary vein
B.Right pulmonary vein
C.Primordial atrium
D.Left horn of sinus venosus
E.Right horn of sinus venosus
A.Primordial pulmonary vein
A failure of the atrioventricular (endocardial) cushions to fuse will lead to which of the following malformations?
A.Persistent truncus arteriosus
B.A single ventricle
C.Transposition of the great arteries
D.Aortic valve stenosus
E.Persistent common atrioventricular canal
E.Persistent common atrioventricular canal
Closure of the foramen (ostium) primum results from fusion of the:
A.Septum primum and septum secundum
B.Septum primum and endocardial cushions
C.Septum secundum and endocardial cushions
B.Septum primum and endocardial cushions
Excessive resorption of the septum primum or septum secundum will lead to:
A.Persistent truncus arteriosus
B.Patent foramen ovale (atrial septal defect)
C.Transposition of the great arteries
D.Tetralogy of Fallot
E.Persistent common atrioventricular canal
B.Patent foramen ovale (atrial septal defect)
Neural crest cells contribute to
conotruncal septation
A partial development of the aorticopulmonary septum will lead to which of the following malformations?
A. a persistent truncus arteriosus
B. a single ventricle
C. transposition of the great arteries
D. aortic valve stenosis
E. persistent common atrioventricular canal
A. a persistent truncus arteriosus
A non-spiral development of the aorticupulmonary septum may lead to which of the following?
A. a persistent truncus arteriosus
B. ostium secundum defect
C. transposition of the great arteries
D. Tetralogy of Fallot
E. persistent common atrioventricular canal
C. transposition of the great arteries
A misaligned development of the aorticopulmonary septum will lead to:
A.Persistent truncus arteriosus
B.Ostium secundum defect
C.Transposition of he great arteries
D.Tetralogy of Fallot
E.Persistent common atrioventricular canal
D.Tetralogy of Fallot
transposition of the great vessel needs what for survivial
patent ductus arteriousis or patent foramen ovale
A patient is diagnosed with blockage of arterial flow in the proximal part of the thoracic aorta. Brachial pressure is markedly increased, femoral pressure is decreased. Which of the following structures failed to develop normally?
A.Second aortic arch
B.Third aortic arch
C.Fourth aortic arch
D.Fifth aortic arch
E.Sixth aortic arch
C.Fourth aortic arch
Which of the following structures is derived from the 3rd aortic arch?
A. Common carotid aa
B. External carotid aa
C. Left subclavian a
D. Right subclavian a
E. Pulmonary trunk
A. Common carotid aa
A 9-month-old girl was admitted to the children’s hospital with tachypnea (fast breathing) and shortness of breath. Physical examination further exhibits a patent ductus arteriosus. Which of the following embryonic arterial structures is most likely responsible for the origin of the patent ductus arteriosus?
A. Right sixth arch
B. Left sixth arch
C. Right fourth arch
D. Left 5th arch
E. Right 5th arch
A. Right sixth arch
