Harder Qs Flashcards
Which one of the following structures separates the intervertebral disks from the spinal cord?
Anterior longitudinal liagment
Posterior longitudinal ligament
Supraspinous ligament
Inerspinous ligament
Ligamentum flavum
Which one of the following structures separates the intervertebral disks from the spinal cord?
Anterior longitudinal liagment
Posterior longitudinal ligament
Supraspinous ligament
Inerspinous ligament
Ligamentum flavum
A 43- year- old patient presents to his General practitioner complaining of fatigue and weight loss. He mentions he experiences pain around his right shoulder region and tingling sensations of his fourth and fifth fingers on his right hand. He is later diagnosed with an apical lung tumour, which presses on the C8-T1 nerve roots of the brachial plexus. Which nerve of the upper limb is primarily compromised?
Axillary nerve
Muscolskeletal nerve
Radial nerve
Ulnar nerve
Median nerve
A 43- year- old patient presents to his General practitioner complaining of fatigue and weight loss. He mentions he experiences pain around his right shoulder region and tingling sensations of his fourth and fifth fingers on his right hand. He is later diagnosed with an apical lung tumour, which presses on the C8-T1 nerve roots of the brachial plexus. Which nerve of the upper limb is primarily compromised?
Axillary nerve
Muscolskeletal nerve
Radial nerve
Ulnar nerve
Median nerve
What type of joint is A?
a) saddle
b) pivot
c) planar
d) hinge
e) condyloid
What type of joint is A?
- *a) saddle**
b) pivot
c) planar
d) hinge
e) condyloid
Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?
Pronator teres
biceps
brachialis
triceps
extensor carpi radialis longus
Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?
Pronator teres
biceps
brachialis
triceps
extensor carpi radialis longus
The brachialis inserts some of its fibres into the fibrous joint of the elbow capsule and when it contracts, it helps to flex the joint.
which muscle is the main muscle of forearm flexion?
pronator teres
flexor carpi radialis
pronator quadratus
flexor carip ulnaris
brachioradialis
which muscle is the main muscle of forearm flexion?
pronator teres
flexor carpi radialis
pronator quadratus
flexor carip ulnaris
brachioradialis
which of the following best describes botulinis toxins effect on Ach-Receptor?
- agonist
- antagonist
- depolarisng blocker
- release inhibitor
- synthesis inhibitor
which of the following best describes botulinis toxins effect on Ach-Receptor?
- agonist
- antagonist
- depolarisng blocker
- *- release inhibitor**
- synthesis inhibitor
An injury to the spinal accessory nerve will affect which of the following movements?
Lateral rotation of the arm
Adduction of the arm at the glenohumeral joint
Protraction of the scapula
Upward rotation of the scapula
Depression of the scapula
An injury to the spinal accessory nerve will affect which of the following movements?
Lateral rotation of the arm
Adduction of the arm at the glenohumeral joint
Protraction of the scapula
Upward rotation of the scapula
Depression of the scapula
The spinal accessory nerve innervates trapezius. The entire muscle will retract the scapula. However, its upper and lower fibres act together to upwardly rotate it.
What is the carpal tunnel? What is contained within it? (you’re looking for 10 items you might want to draw a simple diagram to help)
The carpal tunnel is created by a thick band of retinacula spanning between the carpal bones of the wrist, creating a tunnel. Passing through this tunnel are the tendons of
Flexor digitorum superficialis (4)
Flexor digitorum profundus (4)
Flexor pollicis longus (1)
And the Median nerve
What level do you find the iliac crest?
L1
L2
L3
L4
L5
What level do you find the iliac crest?
L1
L2
L3
L4
L5
On exploring the cubital fossa you would expect the brachial artery to be:
Anterior to the median nerve
Superficial to the bicipital aponeurosis
Medial to the median nerve
Lateral to the biceps tendon
Lateral to the median nerve
On exploring the cubital fossa you would expect the brachial artery to be:
Anterior to the median nerve
Superficial to the bicipital aponeurosis
Medial to the median nerve
Lateral to the biceps tendon
Lateral to the median nerve
bicep brachii, brachialis and coracobrachialis are innervated by:
a) C6, C7, C8
b) C5, C6, C7
c) C8, T1
d) C5, C6, C7, C8
e) C5, C6, C7, C8, T1
bicep brachii, brachialis and coracobrachialis are innervated by:
a) C6, C7, C8
* *b) C5, C6, C7: musculocutaneous nerve**
c) C8, T1
d) C5, C6, C7, C8
e) C5, C6, C7, C8, T1
During a game of rugby, a player is tackled and sustains a twisting injury to his knee. He is found to have a soft tissue knee injury. Which structure originates from the medial surface of the lateral femoral condyle and inserts onto the anterior intercondylar area of the tibial plateau?
Medial meniscus
Posterior cruciate ligament
Lateral collateral ligament
Anterior cruciate ligament
Popliteus
During a game of rugby, a player is tackled and sustains a twisting injury to his knee. He is found to have a soft tissue knee injury. Which structure originates from the medial surface of the lateral femoral condyle and inserts onto the anterior intercondylar area of the tibial plateau?
Medial meniscus
Posterior cruciate ligament
Lateral collateral ligament
Anterior cruciate ligament
Popliteus
Q
A 35-year-old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein
Subclavian artery
External carotid artery
Internal carotid artery
Vertebral artery
Q
A 35-year-old man falls and sustains a fracture to the medial third of his clavicle. Which vessel is at greatest risk of injury?
Subclavian vein
Subclavian artery
External carotid artery
Internal carotid artery
Vertebral artery
During a physical examination, it turns out that a patient is not able to stand on his tiptoe - which nerve lesion is most likely in the background?
common fibular nerve
femoral nerve
superficial fibular nerve
genitofemoral nerve
tibial nerve
During a physical examination, it turns out that a patient is not able to stand on his tiptoe - which nerve lesion is most likely in the background?
common fibular nerve
femoral nerve
superficial fibular nerve
genitofemoral nerve
tibial nerve
which joint permits thumb oppositon in the hand? [1]
carpo-metacarpal
Which one of the following structures separates the ulnar artery from the median nerve?
Brachioradialis
Pronator teres
Tendon of biceps brachii
Flexor carpi ulnaris
Brachialis
Which one of the following structures separates the ulnar artery from the median nerve?
Brachioradialis
Pronator teres- It lies deep to pronator teres and this separates it from the median nerve.
Tendon of biceps brachii
Flexor carpi ulnaris
Brachialis
Which one of the following muscles inserts onto the lesser tuberostiy of the the humerus?
Subscapularis
Deltoid
Supraspinatus
Teres minor
Infraspinatus
Which one of the following muscles inserts onto the lesser tuberostiy of the the humerus?
Subscapularis
Deltoid
Supraspinatus
Teres minor
Infraspinatus
Q
which is the the largest muscle of the anterior compartment of the forearm?
a) flexor digitorum profundus?
b) flexor digitorium superficialis
c) flexor carpi radialis
d) pronator teres
e) flexor capri ulnaris
A
which is the the largest muscle of the anterior compartment of the forearm?
a) flexor digitorum profundus?
* *b) flexor digitorium superficialis**
c) flexor carpi radialis
d) pronator teres
e) flexor capri ulnaris
Which one of the following represents the root values of the sciatic nerve?
L4-S3
L1-L4
L3-S1
S1-S4
L5-S1
Which one of the following represents the root values of the sciatic nerve?
L4-S3
L1-L4
L3-S1
S1-S4
L5-S1
A junior doctor sees two patients with ulnar nerve palsy in quick succession. The first patient has an injury of the wrist and presented with a severe ‘claw-like’ deformity of the hand. The second patient has an injury at the elbow and has a similar, but less severe deformity. Why is the presentation paradoxically less severe at the more proximal site of injury?
Retained innervation of flexor digitorum profundus muscle
Retained innervation of the flexor digitorum superficialis mucle
Denervation of flexor digitorum superficialis muscle
Denervation of flexor digitorum profundus muscle
Less severe injury of ulnar nerve due to protection from surrounding muscles
A junior doctor sees two patients with ulnar nerve palsy in quick succession. The first patient has an injury of the wrist and presented with a severe ‘claw-like’ deformity of the hand. The second patient has an injury at the elbow and has a similar, but less severe deformity. Why is the presentation paradoxically less severe at the more proximal site of injury?
Retained innervation of flexor digitorum profundus muscle
Retained innervation of the flexor digitorum superficialis mucle
Denervation of flexor digitorum superficialis muscle
Denervation of flexor digitorum profundus muscle
Less severe injury of ulnar nerve due to protection from surrounding muscles
Which nerve supplies brachioradialis?
Radial nerve
Median nerve
Ulnar nerve
Long thoracic nerve
Musculocutaneous nerve
Which nerve supplies brachioradialis?
Radial nerve
Median nerve
Ulnar nerve
Long thoracic nerve
Musculocutaneous nerve
With the exception of subscapularis, the muscles of the rotator cuff insert into the where? [1]
Greater tuberosity
You are in the emergency department and a patient has just come in after falling off his motorcycle onto an outstretched hand. On examination of his hand, there is significant pain in the anatomical snuffbox. The medial border of this region is formed by the tendon of a muscle that attaches to the distal phalanx of the thumb and causes extension of the metacarpophalangeal joint and interphalangeal joints.
What is the name of this muscle and which nerve is it innervated by?
Abductor pollicis longus - radial nerve
Extensor pollicis brevis - median nerve
Extensor pollicis brevis - radial nerve
Extensor pollicis longus - median nerve
Extensor pollicis longus - radial nerve
You are in the emergency department and a patient has just come in after falling off his motorcycle onto an outstretched hand. On examination of his hand, there is significant pain in the anatomical snuffbox. The medial border of this region is formed by the tendon of a muscle that attaches to the distal phalanx of the thumb and causes extension of the metacarpophalangeal joint and interphalangeal joints.
What is the name of this muscle and which nerve is it innervated by?
Abductor pollicis longus - radial nerve
Extensor pollicis brevis - median nerve
Extensor pollicis brevis - radial nerve
Extensor pollicis longus - median nerve
Extensor pollicis longus - radial nerve
Elizabeth is a 44 year old female who felt a lump in her right breast which over a 2 month period increased in size. Examination of the breast revealed a large, irregular mass measuring 8x6cm occupying the central and upper outer quadrant of the breast. In addition there were 2 lymph nodes that could be palpated in her right axilla which were slightly tender on palpation. The left breast and axilla were unremarkable. The supracalvicular, cervical and inguinal lymph nodes were not palpable. Elizabeth underwent a radical mastectomy and axillary lymph node clearance. She also had an immediate breast reconstruction using a latissimus dorsi flap. After radiotherapy and chemotherapy there were no apparent complications until 3 days after the last radiation therapy, when she reported right shoulder pain and decreased range of movement. 2 weeks later when there was no improvement she was referred for evaluation. She had normal strength and function in the cervical and upper extremity muscles. However, she exhibited nearly complete absence of function of the serratus anterior muscle on the right side. The patient could not actively abduct the right arm more than 60 degrees. There was gross winging of the scapula on the right side most evident on forward flexion and on pushing forward against resistance.
- What are the actions of latissimus dorsi for both the upper and lower limbs (look at its insertions on both the humerus and pelvis)?*
- What does serratus anterior do? Therefore, explain sign “winging of the scapula” and the lack of abduction above the horizontal plane (note the deltoid and the supraspinatus are not affected in this case).*
Latissimus dorsi acts on the upper limb to bring about extension, and medial rotation. However is the upper limbs are in a fixed position (for example above the head holding onto a rail) latissimus dorsi pulls the trunk towards the upper limb (a pull up). It is an important climbing muscle.
- Serratus anterior protracts and rotates the scapula, and at rest holds the scapula flat to the back. Weakness in this muscle can therefore cause winging of the scapula.*
- Abduction of the shoulder requires rotation of the scapula, so a weakness in this muscle will result in weaker abduction.*
which of the following are sources of the axillary nerve?
- C8-T1
- C7-T1
- C5-C6
- C5-C7
- C5-T1
which of the following are sources of the axillary nerve?
- C8-T1
- C7-T1
- C5-C6
- *- C5-C7**
- C5-T1
which joint initiates shoulder elevation? [1]
which one assists after the first 30 degrees? [1]
which joint initiates shoulder elevation? [1]
glenohumeral
which one assists after the first 30 degrees? [1]
sternothoracic
Q
A 22 years old male comes to his GP and complains that he is unable to bend his left elbow. On examination, the GP notices that flexion of his left elbow and supination of his forearm has greatly weakened.
Which of the following nerves is most likely to be injured?
Radial nerve
Median nerve
Musculocutaneous nerve
Ulnar nerve
Axillary nerve
Q
A 22 years old male comes to his GP and complains that he is unable to bend his left elbow. On examination, the GP notices that flexion of his left elbow and supination of his forearm has greatly weakened.
Which of the following nerves is most likely to be injured?
Radial nerve
Median nerve
Musculocutaneous nerve - Bicep brachii is the main muscle responsible for elbow flexion and forearm supination. Elbow flexion is also assisted by brachialis.
Ulnar nerve
Axillary nerve
Which of the structures listed below articulates with the head of the radius superiorly?
Captiluum
Ulna
Medial epicondyle
Trochlea
Lateral epicondyle
Which of the structures listed below articulates with the head of the radius superiorly?
Captiluum
Ulna
Medial epicondyle
Trochlea
Lateral epicondyle
Q
A doctor is reviewing a 24 years old male who presented to the emergency department with wrist drop and weak extension of his left elbow. The doctor concludes that radial nerve has been damaged which innervates the tricep brachii.
Where does this muscle insert?
Head of the humerus
Greater tuburcle
Coracoid process
Coronoid process of the ulna
Olecranon process of the ulna
A
A doctor is reviewing a 24 years old male who presented to the emergency department with wrist drop and weak extension of his left elbow. The doctor concludes that radial nerve has been damaged which innervates the tricep brachii.
Where does this muscle insert?
Head of the humerus
Greater tuburcle
Coracoid process
Coronoid process of the ulna
Olecranon process of the ulna
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor digiti minimi
Abductor pollicis brevis
Adducot pollicis
Palmaris brevis
Flexor digiti minimi brevis
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor digiti minimi
Abductor pollicis brevis
Adducot pollicis
Palmaris brevis
Flexor digiti minimi brevis
Where does the tendon of the coracobrachialis originate?
Acromion
Greater tubercle of humerus
Supraglenoid tubercle of the scapula
Coracoid process
Infraglenoid tubercle of the scapula
Where does the tendon of the coracobrachialis originate?
Acromion
Greater tubercle of humerus
Supraglenoid tubercle of the scapula
Coracoid process
Infraglenoid tubercle of the scapula
what substance is secreted by osteocytes to indicate bone health? [1]
sclerostin
Q
Which of the following inserts onto the lesser trochanter?
Psoas minor
Psoas major
Sartorius
Obturaror externus
Gemellus
A
Which of the following inserts onto the lesser trochanter?
Psoas minor
Psoas major
Sartorius
Obturaror externus
Gemellus
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor digiti minimi
Abductor pollicis brevis
Adducot pollicis
Palmaris brevis
Flexor digiti minimi brevis
A patient sustains damage to the median nerve during a carpal tunnel release. Which of the following muscles will be affected?
Abductor digiti minimi
Abductor pollicis brevis
Adducot pollicis
Palmaris brevis
Flexor digiti minimi brevis
During a block dissection of the groin, the sartorius muscle is identified. What is the nerve supply to this muscle?
Obturator nerve
Posterior division of the femoral nerve
Anterior division of the femoral nerve
Sciatic nerve
Genitofemoral nerve
During a block dissection of the groin, the sartorius muscle is identified. What is the nerve supply to this muscle?
Obturator nerve
Posterior division of the femoral nerve
Anterior division of the femoral nerve
Sciatic nerve
Genitofemoral nerve
A 24-year-old female is rushed to the emergency department after sustaining an injury during training. She is a competitive powerlifter and her training involves rapid, explosive movements with heavy weights.
On examination, weakness of knee flexion, and some localised knee swelling is noted. The emergency doctor is concerned about the detachment of the biceps femoris from the site of insertion and requests an orthopaedic review.
Which of the following is the site of insertion of the long and short head of biceps femoris?
Medial surface of proximal tibia
Tibial tuberosity
Head of the fibula
Medial tibial condyle
Lesser trochanter
A 24-year-old female is rushed to the emergency department after sustaining an injury during training. She is a competitive powerlifter and her training involves rapid, explosive movements with heavy weights.
On examination, weakness of knee flexion, and some localised knee swelling is noted. The emergency doctor is concerned about the detachment of the biceps femoris from the site of insertion and requests an orthopaedic review.
Which of the following is the site of insertion of the long and short head of biceps femoris?
Medial surface of proximal tibia
Tibial tuberosity
Head of the fibula
Medial tibial condyle
Lesser trochanter
which substance inactivates osteoclasts to maintain Ca2+ levels at an appropriate level?
a) PTH
b) sclerostin
c) 1,25-dihydroxyvitamin D
d) calcitonin
e) RANK
which substance inactivates osteoclasts to maintain Ca2+ levels at an appropriate level?
a) PTH
b) sclerostin
c) 1,25-dihydroxyvitamin D
* *d) calcitonin**
e) RANK
which of the following tightens the interaction between vesicle and presynaptic membrane complexes at the presynaptic membrane, causing them to merge?
- syntaxin
- SNAP25
- synaptobrevin
- synaptotagmin
which of the following tightens the interaction between vesicle and presynaptic membrane complexes at the presynaptic membrane, causing them to merge?
- syntaxin
- SNAP25
- synaptobrevin
- *- synaptotagmin**
Andy, a 22-year-old male, presents to the emergency department following a fall on an outstretched hand during a rugby match. He complains of pain in his right shoulder.
The emergency doctor proceeds to check the neurovascular status and then orders an x-ray which shows a surgical neck fracture of the right humerus.
Considering the nerve most likely to be affected by this fracture, which muscles are likely to have reduced movement?
Teres minor and trapezius
Teres minor and deltoid
Teres major and deltoid
Teres major, trapezius and deltoid
Teres minor, trapezius and deloid
Andy, a 22-year-old male, presents to the emergency department following a fall on an outstretched hand during a rugby match. He complains of pain in his right shoulder.
The emergency doctor proceeds to check the neurovascular status and then orders an x-ray which shows a surgical neck fracture of the right humerus.
Considering the nerve most likely to be affected by this fracture, which muscles are likely to have reduced movement?
Teres minor and trapezius
Teres minor and deltoid - surgical neck fractures damage the axillary nerve. supplies these two muscles
Teres major and deltoid
Teres major, trapezius and deltoid
Teres minor, trapezius and deloid
during periods of low Ca2+ serum, what does release of parathyroid hormone cause to occur at the kidney?
a) increases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & increases P04 reabsobtion
b) decreases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & increases P04 reabsobtion
c) decreases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & decreases P04 reabsobtion
d) decreases Ca2+ excretion in urine, increases P04 excretion in urine; decreases Ca2+ reabsorbtion & increases P04 reabsobtion
e) decreases Ca2+ excretion in urine, increases P04 excretion in urine; decreases Ca2+ reabsorbtion & increases P04 reabsobtion
during periods of low Ca2+ serum, what does release of parathyroid hormone cause to occur at the kidney?
a) increases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & increases P04 reabsobtion
b) decreases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & increases P04 reabsobtion
c) decreases Ca2+ excretion in urine, increases P04 excretion in urine; increases Ca2+ reabsorbtion & decreases P04 reabsobtion
d) decreases Ca2+ excretion in urine, increases P04 excretion in urine; decreases Ca2+ reabsorbtion & increases P04 reabsobtion
e) decreases Ca2+ excretion in urine, increases P04 excretion in urine; decreases Ca2+ reabsorbtion & increases P04 reabsobtion
Quick rhyme to remember the nerve roots:
?
Quick rhyme to remember the nerve roots:
S1,2: tie my shoe - ankle reflex.
L3,4: kick the door - knee reflex.
C5,6: pick up sticks - biceps reflex.
C7,8: lay them straight - triceps reflex.
Mnemonic for radial nerve muscles? [4]
Mnemonic for radial nerve muscles: BEST
B rachioradialis
E xtensors
S upinator
T riceps
Q
Which muscle initiates abduction of the shoulder?
Infraspinatus
Latissimus dorsi
Supraspinatus
Deltoid
Teres major
A
Which muscle initiates abduction of the shoulder?
Infraspinatus
Latissimus dorsi
Supraspinatus
Deltoid
Teres major
which is the only rotator cuff muscle to cause internal rotation? [1]
subscapularis
which is the strongest ligament around the hip joint articular capsule, which strengthens the joint? [1]
anterior iliofemoral ligament - makes anterior side more stable than posterior
endochondral ossification is characterised by the production of which type of collagen?
a) type I
b) type 2
c) type 3
d) type 4
e) type 5
endochondral ossification is characterised by the production of which type of collagen?
a) type I
* *b) type 2**
c) type 3
d) type 4
e) type 5
Q
A young man presents with a left-sided winged scapula following a fight in a pub. On examination he is found to have difficulty performing a certain movement with his left arm. Which movement is this most likely to be?
Extension
Flexion
Abdtuction
Adduction
Supination and pronation
A
A young man presents with a left-sided winged scapula following a fight in a pub. On examination he is found to have difficulty performing a certain movement with his left arm. Which movement is this most likely to be?
Extension
Flexion
Abduction
Adduction
Supination and pronation
ID B, C, E & F?
B: corocoid process
C: glenoid fossa
E: acromion
F: biciptial groove (inbetween the tubercles) for long head of bicep tendon
Which one of the following fingers is not a point of attachment for the palmar interossei?
Middle finger
Little finger
Ring finger
Index finger
None of the above
Which one of the following fingers is not a point of attachment for the palmar interossei?
Middle finger
Little finger
Ring finger
Index finger
None of the above
The middle finger has no attachment of the palmar interosseous.
what type of joint is A?
a) saddle
b) ball and socket
c) planar
d) hinge
e) condyloid
what type of joint is A?
a) saddle
b) ball and socket
* *c) planar**
d) hinge
e) condyloid
which ligament stops abrupt flexion & extends from the lamina above to lamina below of adjacent vertebra
- anterior longitudinal ligament
- posterior longitudinal ligament
- ligamentum flavum
- interspinous ligament
which ligament stops abrupt flexion & extends from the lamina above to lamina below of adjacent vertebra
- anterior longitudinal ligament
- posterior longitudinal ligament
- *- ligamentum flavum**
- interspinous ligament
Which one of the following muscles does not attach to the radius
Pronater quadratus
Biceps
Brachioradialis
Supinator
Brachialis
Which one of the following muscles does not attach to the radius
Pronater quadratus
Biceps
Brachioradialis
Supinator
Brachialis
