Learning Assessments

Question 1

4. A 52-year-old woman suddenly lost her balance when riding her bicycle and fell on her outstretched hand. She heard a distinct cracking sound and felt sudden pain in her shoulder region. At the emergency room it was noted that the lateral part of her shoulder slumped inferomedially and that the medial portion of the clavicle was elevated. What muscle is responsible for supporting the lateral shoulder so that it does not slump?

Answer 1

Trapezius

Question 2

1. A 29-year-old male, right-handed house painter visits his family physician because of pain in his right upper limb and slight tingling and numbness in all of his digits, but especially in the fourth and fifth digits when he reaches high over his head to paint. Radiographic studies reveal the presence of a cervical rib and accessory scalene musculature. Which of the following structures is most likely compressed when he reaches high to paint?

Answer 2

Lower trunk brachial plexus (Ulnar nerve not working)

Question 3

During the difficult birth of a baby, the physician pulled on the baby’s head while the shoulder was still in the birth canal. The procedure caused a traction injury of the brachial plexus. What is the usual clinical appearance of the upper limb when this injury of the brachial plexus occurs?
What spinal nerves likely influenced?

Answer 3

C5,6

The upper limb is adducted and medially rotated

Question 4

A 36-year-old man was painting the ceiling in a large room of his home when he felt pain and tingling in his right shoulder and in the proximal part of his right arm. When being examined by his family physician, the physician raised the man’s limb above the shoulder and noted that the radial pulse decreased when examined. After holding the limb above the shoulder for several minutes, the man said he felt pain and some tingling around the shoulder. Both cyanosis and distension of the superficial limb veins was noted. Compression of what structure is responsible
for the decreased radial pulse? Compression of what structure is responsiblefor the pain and tingling around the shoulder?

Answer 4

Axillary Artery, Axillary Nerve

Question 5

During a difficult breech delivery of a large baby, strong lateral flexion of the infant’s trunk and neck was performed to deliver the head. Complete loss of sensation and complete paralysis of the right limb was evident from the time of birth. In addition, the infant’s right eyelid drooped.

What caused his right eyelid to droop?
What is right eyelid droop called?

Answer 5

Loss of sympathetic preganglionic nerve fibers

Horner syndrome

Question 6

A 19-year-old man was thrown from his motorcycle into a tree after hitting a deer. Although he appeared not to be seriously injured, his neck felt sore shortly after the accident. He came to see his family physician because his upper extremity was limp, and his forearm and hand pronated. Upon physical examination, the patient was unable to flex, abduct or laterally rotate his arm, and there was a loss of flexion at the elbow joint. A lack of sensation was detected on the lateral surface of his arm and forearm.
Which part of brachial plexus injured? (SC parts)
Which of the following muscles was probably least affected by the nerve injury?

Answer 6

C5,C6

His answer is Pectoralis Major (based on movements… but Lateral Pectoral Nerve comes off of Lateral Cord (from C5,6) and innervated Pec Major - also innervated by Medial Pec Nerve)

Question 7

Which of the following nerve fibers are located in the cervical sympathetic chain?

Answer 7

Ascending preganglionic sympathetic fibers.

Question 8

Where are preganglionic parasympathetic nuclei located?

Answer 8

Brain stem, sacral spinal cord

Question 9

What spinal nerve supplies the dermatome associated with the lateral (radial) surface of the arm and forearm?

Answer 9

C6

Question 10

What vein is found superficially on the medial surface of the arm and forearm?

Answer 10

Basilic vein

Question 11

Where is the lymphatic drainage from the medial side of the mammary gland primarily directed?

Answer 11

Parasternal Nodes

Question 12

Which of the following muscles does NOT contribute to the posterior wall of the axilla?

A. Latissimus dorsi

B. Pectoralis minor

C. Subscapularis

D. Teres major

Answer 12

Pec minor

Question 13

Which of the following arteries is NOT involved with the vascular anastomosis around the shoulder joint?

A. Dorsal scapular artery

B. Posterior circumflex humeral artery

C. Subscapular artery

D. Superior ulnar collateral artery

E. Thoracoacromial artery

Answer 13

D - SUperior Ulnar Collateral Artery

Question 14

Which statement below concerning the intercostobrachial nerve is CORRECT?

A. It is a lateral cutaneous branch of the second intercostal nerve.

B. It typically communicates with the medial antebrachial cutaneous nerve.

C. It pierces the coracobrachialis muscle.

D. It is a branch of the medial cord of the brachial plexus.

E. It contains sympathetic preganglionic fibers.

Answer 14

A - The intercostobrachial nerve is a lateral cutaneous branch of the second intercostal nerve.

Question 15

Which muscle that supinates the forearm originates from the scapula?

A. Biceps brachii muscle

B. Brachioradialis muscle

C. Latissimus dorsi muscle

D. Supraspinatus muscle

E. Teres minor muscle

Answer 15

A - Biceps Brachii

Question 16

Which muscle that helps stabilize the glenohumeral joint is innervated by the axillary nerve?

A. Biceps brachii muscle

B. Brachioradialis muscle

C. Latissimus dorsi muscle

D. Supraspinatus muscle

E. Teres minor muscle

Answer 16

E. Teres Minor

Question 17

Which of the following muscles flexes the forearm and is innervated by the radial nerve?

A. Biceps brachii muscle

B. Brachioradialis muscle

C. Latissimus dorsi muscle

D. Supraspinatus muscle

E. Teres minor muscle

Answer 17

B - Brachioradialis

Question 18

Which of the following muscles abducts the arm, forms part of the rotator cuff, and attaches on the greater tuberosity of the humerus?

A. Biceps brachii muscle

B. Brachioradialis muscle

C. Latissimus dorsi muscle

D. Supraspinatus muscle

E. Teres minor muscle

Answer 18

D. Supraspinatus Muscle

Question 19

Which of the following important arteries anastomose to carry blood to the upper limb following occlusion of the first part of the axillary artery?

A. Lateral thoracic and subscapular arteries

B. Posterior humeral circumflex and lateral thoracic arteries

C. Subscapular and thoracoacromial arteries

D. Suprascapular and subscapular arteries

E. Thoracoacromial trunk and lateral thoracic arteries

Answer 19

D - Subscapular and suprascapular arteries

Question 20

What clinical findings would likely be evident in an injury to the radial nerve in the radial groove of the humerus?

Answer 20

Loss of Wrist Extension

Question 21

What artery and nerve would be damaged by a penetrating wound to the posterior shoulder in the quadrangular space?

Answer 21

Axillary nerve and posterior circumflex humeral artery

Question 22

Lateral rotation of the humerus is a function of muscles innervated by which nerves?

Answer 22

Suprascapular and axillary nerves

Question 23

Following a dislocated left shoulder a patient complained of numbness around the “badge area” of the arm. What nerve may be disrupted in this patient?

A. Axillary nerve

B. Dorsal scapular nerve

C. Musculocutaneous nerve

D. Suprascapular nerve

E. Supraclavicular nerves

Answer 23

Axillary Nerve (A)

Question 24

The median nerve was severed in the arm in a farm accident. Which of the following deficits would NOT be observed on physical examination?

A. Decreased flexion of the wrist and fingers

B. Difficulty in opposing the thumb

C. Inability to abduct the fingers

D. Loss of pronation of the forearm

E. Loss of sensation on the lateral radial surface of the palm

Answer 24

C - Inability to abduct fingers (all others are from flexor muscles that median nerve affects)

Question 25

Which of the following vessels of the subclavian and axillary arteries are involved in the arterial anastomosis that occurs around the scapula?

A. Suprascapular, deep brachial and superior ulnar collateral arteries

B. Superior (supreme) thoracic, lateral thoracic and transverse cervical arteries

C. Transverse cervical, lateral thoracic, and thoracodorsal arteries

D. Transverse cervical, posterior circumflex humeral and the deep brachial arteries

E. Transverse cervical, suprascapular and circumflex scapular arteries

Answer 25

E - Transverse cervical, suprascapular, and circumflex scapular arteries

Question 26

39. A 28-year-old gymnast who had a history of biceps tendinitis and rotator cuff injury experienced vague pain in the anterior region of his shoulder joint. He said he had the sensation of popping during his parallel bar routine. During the preliminary examination, the coach noted tenderness over the bicipital groove, flexion and supination weakness of the forearm, and an abnormal bulge in the anterior part of the gymnast’s arm. During a subsequent radiographic examination, a fracture of the scapula was observed. What muscle was most likely injured?

A. Biceps brachii (long head)

B. Biceps brachii (short head)

C. Brachialis

D. Coracobrachialis

E. Triceps brachii (long head)

Answer 26

A - biceps brachii (long head)

* bicipital groove, abnormal bulge (popeye arm)

Question 27

Which of the following structures is likely to tear with a severe dislocation of the acromioclavicular joint (AC)?

Answer 27

Corococlavicular ligament

Question 28

With severe injury to the acromioclavicular joint, what ligament is injured in a “shoulder separation”?

Answer 28

Corococlavicular ligament?

Question 29

4. A 17-year-old male is brought to the emergency department following an injury while playing football. X-rays revealed a transverse fracture of the humerus 1 inch proximal to the epicondyles. What nerve is most frequently injured by the jagged edges of the broken bone at this location?

A. Axillary nerve

B. Median nerve

C. Musculocutaneous nerve

D. Radial nerve

E. Ulnar nerve

Answer 29

Radial Nerve

Question 30

12. A 50-year-old police officer presents complaining of right shoulder pain that arose 2 weeks after subduing a suspect. He recalls that the individual yanked very aggressively on his arm, but he really didn’t have much pain at the time. The arm is weak and he has pain with abduction. You find significant atrophy of the supraspinatus and infraspinatus muscles. What structure was injured in this altercation?

Answer 30

Suprascapular Nerve