UL2 - Neurovasculature (forearm, wrist & elbow)

Question 1

Where does the dorsal venous arch of the hand drain laterally?

Answer 1

cephalic vein

Question 2

Where does the cephalic vein run after formation?

Answer 2

lateral forearm
anterior to elbow
within deltopectoral groove (deltoid & pec major)
drains into axillary vein

Question 3

Where does the cephalic vein terminate?

Answer 3

drains into axillary vein at the clavipectoral triangle

Question 4

Where does the dorsal venous arch drain medially?

Answer 4

basilic vein

Question 5

What is the course of the basilic vein?

Answer 5

medial forearm
anterior surface - anterior to elbow
continues as axillary vein (at the inferior border of teres major)

Question 6

What vein connects cephalic and basilic veins within the cubital fossa?

Answer 6

median cubital vein

Question 7

Clinical significance of median cubital vein?

Answer 7

common site for venipuncture

Question 8

into which vein do deep veins of the arm ultimately drain?

Answer 8

axillary vein (via brachial or basilic vein)

Question 9

where do the palmar & superficial venous arches of the hand drain laterally?

Answer 9

radial vein

Question 10

where do the palmar & superficial venous arches of the hand drain medially?

Answer 10

ulnar vein

Question 11

what veins do the radial & ulnar veins drain into? where does this vein then drain into following this?

Answer 11

brachial vein - drains into basilic/axillary vein after

Question 12

what vein do the deep veins drain into before joining the basilic/axillary vein?

Answer 12

brachial veins (paired)

Question 13

what muscles does the cephalic vein pass between at the shoulder region? at what groove in particular?

Answer 13

deltoid & pec major muscles - within the deltopectoral groove

Question 14

A 32-year-old man has an IV cannula inserted into the vein running superficially across his cubital fossa. Which two veins does this structure connect?
a) Cephalic and radial
b) Cephalic and basilic
c) Basilic and brachial
d) Ulnar and cephalic
e) Basilic and axillary

Answer 14

b) Cephalic and basilic - describes the median cubital vein, which links the cephalic and basilic veins across the cubital fossa

Question 15

Which of the following veins is located in the deltopectoral groove?
a) Basilic
b) Axillary
c) Subclavian
d) Cephalic
e) Brachial

Answer 15

d) Cephalic - ascends in the deltopectoral groove before draining into the axillary vein at the clavipectoral triangle

Question 16

During surgery, a surgeon must be cautious not to damage the vein that receives blood from both superficial and deep venous systems of the upper limb and is located at the lower border of teres major. Which vein is this?
a) Basilic
b) Cephalic
c) Axillary
d) Subclavian
e) Brachial

Answer 16

c) Axillary vein - near axillary artery; axillary vein receives the basilic vein and tributaries from deep veins like the brachial veins

Question 17

Which deep vein accompanies the profunda brachii artery?
a) Basilic vein
b) Brachial vein
c) Cephalic vein
d) Radial vein
e) Ulnar vein

Answer 17

b) Brachial vein - profunda brachii travels with one of the paired brachial veins.

Question 18

the brachial artery ends in the ________ opposite the neck of the radius - at this point it divides into the _____ and ______ arteries

Answer 18

cubital fossa
radial & ulnar arteries

Question 19

At what point does the brachial artery bifurcate into radial and ulnar arteries?

Answer 19

neck of radius; cubital fossa

Question 20

Which branch does the ulnar artery give off early in the forearm?

Answer 20

common interosseus artery

Question 21

What does the common interosseous artery divide into?

Answer 21

anterior & posterior interosseus

Question 22

Where does the anterior interosseous artery travel?

Answer 22

along the anterior surface of the interosseus membrane - to the wrist

Question 23

Where does the posterior interosseous artery travel?

Answer 23

along posterior forearm - through interosseus membrane - to wrist/hand

Question 24

between what two muscles does the ulnar artery run between?

Answer 24

flexor carpi ulnaris
flexor digitorum profundus

Question 25

where does the ulnar artery pass at the wrist? (relative to the flexor retinaculum)

Answer 25

superficial to flexor retinaculum in Guyon's canal

Question 26

what arch does the ulnar artery primarily form in the hand?

Answer 26

superficial palmar arch

Question 27

what are the branches of the superficial palmar arch?

Answer 27

3 **common palmar digital arteries** - anastomose with palmar metacarpal arteries - form **proper palmar digital arteries**

Question 28

what arch does the radial artery form?

Answer 28

deep palmar arch

Question 29

How does the radial artery reach the deep palmar space?

Answer 29

passes within anatomical snuff box pierces 1st dorsal interossei muscle returns to palmar aspect

Question 30

What are the branches of the deep palmar arch?

Answer 30

palmar metacarpal arteries - anastomose with common palmar digital arteries

Question 31

what does the anastomoses of the palmar metacarpal arteries of the radial artery & common palmar digital arteries of the ulnar artery give rise to? - what does this supply?

Answer 31

proper palmar digital artery - supplies fingers

Question 32

What clinical test assesses collateral circulation of radial & ulnar arteries?

Answer 32

Allen's test

Question 33

what is the purpose of the Allen's test?

Answer 33

assesses the collateral blood flow between the radial and ulnar arteries via the palmar arch

Question 34

A 60-year-old woman is undergoing a radial artery cannulation for arterial blood gas sampling. To ensure collateral flow, an Allen’s test is performed. Which arteries are involved in this test? a) Radial and brachial b) Ulnar and radial c) Radial and interosseous d) Ulnar and axillary e) Radial and deep palmar branch

Answer 34

b) Ulnar and radial

Question 35

Which artery primarily supplies the deep muscles of the hand? a) Ulnar artery via superficial palmar arch b) Anterior interosseous artery c) Posterior interosseous artery d) Radial artery via deep palmar arch e) Brachial artery

Answer 35

d) Radial artery via deep palmar arch

Question 36

A surgeon ligates the ulnar artery just before it enters the hand through Guyon's canal. Which structure would still allow blood to reach the superficial palmar arch? a) Anterior interosseous artery b) Deep palmar arch via radial artery c) Common interosseous artery d) Posterior interosseous artery e) Brachial artery

Answer 36

b) Deep palmar arch via radial artery - due to the anastomosis between superficial and deep palmar arches

Question 37

The anterior interosseous artery is a branch of which artery? a) Radial b) Posterior interosseous c) Common interosseous d) Brachial e) Superficial palmar arch

Answer 37

c) Common interosseous - which arises from the ulnar artery

Question 38

Which artery runs superficial to the radius and is used for palpating the radial pulse? a) Ulnar artery b) Radial artery c) Brachial artery d) Common interosseous artery e) Anterior interosseous artery

Answer 38

b) Radial artery - runs superficially along the radius, lateral to the flexor carpi radialis tendon

Question 39

Which structure does the radial artery pierce to enter the deep palm and contribute to the deep palmar arch? a) Flexor retinaculum b) Thenar muscles c) 1st dorsal interosseous muscle d) Adductor pollicis e) Palmar aponeurosis

Answer 39

c) 1st dorsal interosseous muscle

Question 40

A patient has a laceration damaging the ulnar artery before it gives off its deep palmar branch. Which part of the hand’s blood supply is at most risk? a) Superficial palmar arch b) Deep palmar arch c) Proper digital arteries d) Dorsal carpal network e) Palmar metacarpal arteries

Answer 40

b) Deep palmar arch - deep palmar branch of the ulnar artery contributes to the deep palmar arch

Question 41

Which artery lies deep to pronator teres? a) Radial artery b) Ulnar artery c) Brachial artery d) Posterior interosseous artery e) Palmar arch

Answer 41

b) Ulnar artery - deep to pronator teres, then runs along medial side of forearm

Question 42

The palmar metacarpal arteries, which help anastomose with the common palmar digital arteries, arise from which arterial structure? a) Superficial palmar arch b) Anterior interosseous artery c) Deep palmar arch d) Posterior interosseous artery e) Digital branches of ulnar artery

Answer 42

c) Deep palmar arch

Question 43

During decompression of Guyon's canal for ulnar nerve entrapment, which artery is at risk due to its location? a) Radial artery b) Deep palmar arch c) Ulnar artery d) Superficial palmar arch e) Anterior interosseous artery

Answer 43

c) Ulnar artery

Question 44

Which artery directly gives rise to the common interosseous artery? a) Brachial b) Radial c) Ulnar d) Deep palmar arch e) Posterior interosseous

Answer 44

c) Ulnar

Question 45

A patient loses the radial artery due to trauma. What anatomical factor allows continued perfusion of the thumb and index finger? a) Collateral flow via posterior interosseous artery b) Anastomosis from ulnar artery through deep palmar arch c) Direct branch from brachial artery d) Involvement of dorsal carpal arteries e) Branches from superficial palmar arch

Answer 45

b) Anastomosis from ulnar artery through deep palmar arch

Question 46

the ulnar artery passes infero-medilally deep to the ________ _______ muscle to reach the __________ side of the forearm

Answer 46

pronator teres medial side

Question 47

early in its course - the ulnar artery gives off the ______ _________ artery - splits into anterior & posterior interosseus arteries

Answer 47

common interosseus artery

Question 48

the radial artery passes inferolaterally deep to the _____________ muscle - reaches the ________ side of the forearm

Answer 48

brachioradialis lateral

Question 49

the ulnar artery passes ____________ to the flexor retinaculum through a space called the __________ - then gives off a __________ branch

Answer 49

anterior/superficial Guoyan's canal superficial palmar branch

Question 50

the superficial palmar arch is formed by the distal end of the ____________ artery

Answer 50

ulnar artery

Question 51

the deep palmar arch is formed by the distal end of the ____________ artery

Answer 51

radial artery

Question 52

What are the nerve roots of the radial nerve?

Answer 52

C5-T1

Question 53

Where does the radial nerve split into superficial and deep branches?

Answer 53

at the cubital fossa - anterior to the lateral epicondyle

Question 54

What does the deep branch of the radial nerve become after piercing the supinator?

Answer 54

posterior interosseus nerve

Question 55

What area of skin is supplied by the superficial branch of the radial nerve?

Answer 55

dorsal lateral 3 and a half fingers (not the tips)

Question 56

course of the radial nerve: a) emerges from _____________ nerve roots; ______________ cord b) passes __________ to the lateral epicondyle c) reaches cubital fossa where it divides into its ____________ and __________ branches d) superficial branch of the radial nerve runs down the medial forearm - enters the ______________ = supplies the dorsal lateral 3 and a half fingers e) the deep branch of the radial nerve pierces the __________ muscle f) enters the posterior compartment of the forearm & continues as the _____________ nerve

Answer 56

a) CT-1 nerve roots; posterior cord b) passes **anterior** to the lateral epicondyle C) **superficial** and **deep** branches d) enters the **anatomical snuff box** e) pierces the **supinator** muscle f) **posterior interosseus nerve**

Question 57

radial nerve - nerve root? cord?

Answer 57

C5-T1 roots posterior cord

Question 58

course of the ulnar nerve: a) emerged from _______ nerve roots; _________ cord b) passes __________ to the medial epicondyle of the humerus c) runs between 1._____________ and 2. __________ d) provides motor innervation to the whole ___________ and _______ half of flexor digitorum profundus e) at the wrist is passes _______ to the flexor retinaculum within __________

Answer 58

a) C8-T1 nerve roots; medial cord b) passes **posterior** to the medial epicondyle c) runs between **flexor carpi ulnaris** and **flexor digitorum profundus** d) **flexor carpi ulnaris** & **medial** half of flexor digitorum profundus e) **superficial** to the flexor retinaculum within **Guoyan's canal**

Question 59

Where is the ulnar nerve most superficial and vulnerable at the elbow

Answer 59

behind/posterior to the medial epicondyle in the cubital tunnel

Question 60

What muscles does the ulnar nerve supply in the forearm?

Answer 60

flexor carpi ulnaris medial half of flexor digitorum profundus

Question 61

what is Guyon’s canal? what nerve travels through this?

Answer 61

passage at the wrist where **ulnar nerve** travels superficial to flexor retinaculum

Question 62

What sensation does the dorsal branch of the ulnar nerve provide?

Answer 62

dorsal medial 1 and a half fingers

Question 63

course of the median nerve: a) emerges from _________ nerve roots; ______ and _____ cords b) enters forearm medial to ________ artery c) passes between the two heads of the __________ muscle - anterior interosseus nerve branches off d) runs distally between the _____________ & __________ muscles e) at the level of the wrist - passes _________ to the flexor retinaculum within a space called the ___________

Answer 63

a) **C5/6-T1** roots; **medial & lateral** cords b) medial to **brachial** artery c) two heads of **pronator teres** d) **flexor digitorum superficialis** & **flexor digitorum profundus** muscles e) **deep** the flexor retinaculum; within the **carpal tunnel**

Question 64

median nerve - nerve roots? cords?

Answer 64

C5/6-T1 nerve roots medial & lateral cords

Question 65

where does the anterior interosseous nerve branch off the median nerve?

Answer 65

between the two heads (humeral & ulnar heads) of the pronator teres

Question 66

Which muscles are innervated by the recurrent branch of the median nerve?

Answer 66

abductor pollicis brevis flexor pollicis brevis opponens pollicis (thenar muscles)

Question 67

What area of sensation is supplied by the median nerve in the hand?

Answer 67

palmar lateral 3 and a half fingers (+tips and lateral palm)

Question 68

What causes carpal tunnel syndrome?

Answer 68

compression of the median nerve due to swelling of tendons/sheaths

Question 69

contents of the carpal tunnel?

Answer 69

median nerve tendons of flexor digitorum superficialis, flexor digitorum profundus & flexor pollicis longus

Question 70

what runs superficial to the flexor retinaculum in Guyan's canal?

Answer 70

ulnar nerve, vein and artery

Question 71

what is ulnar canal syndrome? causes?

Answer 71

compression of the ulnar nerve within Guyon's canal - caused by ganglionic cyst, trauma, lipoma

Question 72

Which nerve passes between the two heads of pronator teres? a) Radial b) Median c) Ulnar d) Anterior interosseous e) Musculocutaneous

Answer 72

b) Median - common entrapment site for the median nerve in pronator syndrome

Question 73

A patient has lost sensation over the dorsal surface of the lateral 3.5 fingers but retains sensation at the fingertips. Which nerve is affected? a) Median b) Superficial radial c) Posterior interosseous d) Ulnar e) Lateral cutaneous nerve of forearm

Answer 73

b) Superficial radial - radial nerve supplies dorsum of lateral fingers; tips innervated by median nerve

Question 74

Which nerve runs posterior to the medial epicondyle and is vulnerable to trauma at the elbow? a) Median b) Radial c) Ulnar d) Axillary e) Musculocutaneous

Answer 74

c) Ulnar

Question 75

A patient presents with wasting of the thenar eminence, inability to oppose the thumb, and numbness of the lateral 3.5 fingers including the tips. Which structure is most likely compressed? a) Ulnar nerve in Guyon’s canal b) Posterior interosseous nerve c) Superficial radial nerve d) Median nerve in carpal tunnel e) Anterior interosseous nerve

Answer 75

d) Median nerve in carpal tunnel

Question 76

Which nerve runs superficial to the flexor retinaculum and is at risk of compression in Guyon’s canal? a) Median nerve b) Ulnar nerve c) Radial nerve d) Posterior interosseous nerve e) Anterior interosseous nerve

Answer 76

b) Ulnar nerve

Question 77

Which branch of the median nerve supplies most of the anterior forearm muscles? a) Superficial branch b) Anterior interosseous nerve c) Deep branch d) Recurrent branch e) Posterior interosseous nerve

Answer 77

b) Anterior interosseous nerve

Question 78

A laceration to the palmar base of the hand spares the thenar muscles but causes numbness over the lateral 3.5 fingers. Which branch of the median nerve is likely intact? a) Recurrent branch b) Palmar cutaneous branch c) Common palmar digital nerves d) Anterior interosseous nerve e) Deep branch

Answer 78

a) Recurrent branch - supplies thenar muscles but not skin

Question 79

what pollicis/thumb muscle does the median nerve not innervate? a) abductor pollicis brevis b) flexor pollicis brevis c) flexor pollicis longus d) adductor pollicis e) opponens pollicis

Answer 79

d) adductor pollicis - innervated by deep branch of ulnar nerve; rest innervated by recurrent branch of median nerve