Upper Limb Flashcards by YVETTE YONG

A 10 years old boy is admitted to the ER following a fall. On examination, there is deformity and swelling of the forearm. The ability to flex the fingers of the affected limb is impaired. However, there is no sensory impairment. Imaging confirms a displaced forearm fracture. Which of the nerve listed below is likely to have affected.

Ulnar 
Posterior interosseous. N 
Anterior Interosseous. N
Axillary 
Radial

Anterior Interosseous N
It has no sensory supply so the defect is motor alone.

its a branch of the median nerve that supplies deep muscles on the front of forearm .except ulnar half of the flexor digitorium profundus.

Innervation 2.5 muscles
- flexor pollicis longus
-pronator quadratus
- The radial half of flexor digitorum profundus (the lateral two out of four tendons)
(These muscles are in the deep level of the anterior compartment of the forearm

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Which of the following nerves supplies the majority of the skin on the palmar aspect of the thumb ?

Ulnar 
Median 
Radial 
Musculocutaneous 
None of the above

Median

The median nerve supplies cutaneous sensation to this region.

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A 63 years old lady is undergoing an axillary sentinel lymph node biopsy as part of her breast cancer treatment. Which of the structures listed below is most likely to be encountered?

Subclavian Artery 
Intercostobrachial Nerve 
Upper cord of brachial plexus 
Lower cord of the brachial plexus 
Axillary nerve

Intercostobrachial Nerve

often divided during axillary surgery. they provide cutaneous sensation to the axillary skin

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A 35 years old farm labourer injures the posterior aspect of his hand with a mechanical scythe. He severs some of his extensor tendons in this injury. How many tunnel lies in the extensor reticulum that transmit the tendons of the extensor muscles?

one 
three
four 
five 
Six

Six

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Which of the muscles listed below is not innervated by the median nerve?

Flexor Pollicis brevis 
lateral two lumbricals 
pronator teres 
opponens pollicis 
Adductor pollicis

Adductor pollicis
Adductor pollicis is innervated by the ulnar nerve.

Medial two lumbricals innervated by ulnar nerve

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A 23 years old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination he has lost extension of the fingers in his right hand. Which of the nerves listed below is most likely to have been divided ?

Median 
Musculocutaneous 
radial 
Ulnar 
Axillary

Radial nerve as it supplies to the extensor muscle groups

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An injured axillary artery is ligated between the thyrocervical trunk of the subclavian and subscapular artery. Subsequent collateral circulation is likely to result in reversal of blood flow in which of the vessels listed below ?

Circumflex scapular artery 
Transverse cervical artery 
Posterior intercostal arteries 
suprascapular arteries 
Profunda brachii artery

Circumflex scapular artery

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A 43 years old typist present with pain at the dorsal aspect of the upper part of her forearm. She also complains of weakness when extending her fingers. On examination triceps and supinator are both functioning normally. There is weakness of most of the extensor muscles. However, there is no sensory deficit. Which of the following nerves has been affected?

Anterior interosseous 
Median
Posterior interosseous 
Palmar cutaneous 
Ulnar

Posterior interosseous

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A 23 years old man falls and slips at a nightclub.
A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?

Atrophy of the first dorsal interosseous muscles

Difficulty in abduction of the 2nd, 3rd, 4th, 5th fingers

Claw like appearance of the hand

Loss of sensation on the anterior aspect of the 5th finger

Partial denervation of flexor digitorum profundus

Claw like appearance of the hand

Because injury to ulnar.N at mid to distal forearm will typically produce a claw hand.

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A 43 years old man is stabbed outside a nightclub. He suffers a transection of his median nerve just as it leaves the brachial plexus. which of these features is least likely to ensue?

Ulnar deviation of the wrist

Complete loss of wrist flexion

Loss of pronation

Loss of flexion at the thumb joint

Inability to oppose the thumb

Complete loss of wrist flexion

Loss of median nerve = loss of function of the flexor muscles.

However, flexor carpi ulnaris will still function and produce ulnar deviation and some residual wrist flexion. High median nerve lesion result in complete loss of flexion at the thumb joint.

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Which of the structures listed below articulates with the head of the radius superiorly ?

Capitulum 
Trochlea 
Lateral Epicondyle 
Ulna 
Medial Epicondyle

Capitulum

” Capital Radio” is the articulation of the radial head superiorly

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At the level of the wrist joint, which of the statements below best describes the relationship of the ulnar artery and ulnar nerve?

It lies on its radial side 
It lies deep to it 
It lies superficial to it 
it lies on its ulnar side 
None of the above

It lies on its radial side

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Which of the following anatomical structures lies within the spiral groove of the humerus ?

Median nerve 
Radial nerve 
tendon of triceps 
Musculocutaneous nerve 
Axillary Nerve

Radial nerve

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A 24 years old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply ?

From the proximal medial border

From the proximal lateral border

From the proximal posterior surface

Superficial palmar arch vessels

Dorsal Carpal branch Vessles

The dorsal carpal branch vessels supply 80% of scaphoid via retrograde flow. There is a minor supply from the superficial palmar arch vessels that supplies the distal 20% of the scaphoid.

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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 
Adductor pollicis 
Palmaris brevis 
Flexor digiti minimi brevis

Abductor pollicis brevis

Abductor pollicis brevis is innervated by the median

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Which of the nerves listed below directly responsible for the innervation of the lateral aspect of flexor digitorum profundus ?

Ulnar nerve 
Anterior interosseous nerve 
radial nerve 
Median nerve 
Posterior interosseous nerve

Anterior Interosseous nerve

AIN, branch of median nerve and responsible for innervation of the lateral aspect of the flexor digitorum profundus.

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Which of the structures listed below are most closely related to the axillary nerve within the quadrangular space?

Posterior circumflex humeral vessels

Axillary artery

Anterior circumflex humeral vessels

Radial artery

Acromiothoracic artery

Posterior circumflex humeral vessels

The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space

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Which muscle initiates abduction of the shoulder ?

Infraspinatus 
Latissimus dorsi 
Supraspinatus 
Deltoid 
Teres major

Supraspinatus
Initiate abduction of shoulder.
Damage to the tendon of supraspinatus is a common form of rotator cuff disease.

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The first root of the brachial plexus commonly aries at which of the following levels?

C6
C5
C3
C2
C8

It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)

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When the brachial plexus is injured in the axilla as a result of a crutch palsy, which of the nerve listed is the most common affected ?

Thoracodorsal nerve 
Suprascapular nerve 
Radial nerve 
Ulnar nerve 
Long thoracic nerve

Radial nerve

Common injury of radial nerve = wrist drop

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During a neck dissection, a nerve is noted to pass posterior to the medial aspect of the first rib. Which of the nerves listed below is this most likely to be ?

Median cord of brachial plexus

Long thoracic nerve

Nerve to subclavius

Medial pectoral nerve

Phrenic nerve

Phrenic nerve runs posterior to the medial aspect of the first rib.
Superiorly, it lies on the surface of scalenus anterior

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A 35 years 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

Subclavian Vein
Subclavian vein lies behind subclavius and the medial part of the clavicle.

it rest on the first rib, below and in front of the third part of the subclavian artery and then on scalenus anterior which separates it from the second part of the artery (posteriorly)

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A 56 years old man requires long term parenteral nutrition and the decision is made to insert a PICC line for long term venous access. This is inserted into the basilic vein at the region of the elbow. As the catheter is advanced, into which venous structure is the tip of the catheter most likely to pass from the basilic vein ?

Subclavian Vein 
Axillary vein 
Posterior circumflex humeral vein 
Cephalic vein 
Superior vena cava

Axillary vein

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An 8 years old boy fall onto an outstretched hand and sustains a supracondylar fracture. In addition to a weak radial pulse the child is noted to have loss of pronation of the affected hand. Which nerve is compromised?

median 
Radial 
Ulnar 
Musculocutaneous 
Axillary

median

This is a common injury in children . In this case the angulation and displacement have resulted in median nerve injury

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A 40 years old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand. Injury to which of the following nerves is most likely to account for her examination findings? ``` Ulnar Median Radial Musculocutaneous Axillary ```

Ulnar nerve because interossei are supplied by ulnar nerve

A 28 years old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus. Which of the nerves listed below is most likely to have been affected ? ``` Radial Axillary Musculocutaneous Median Subscapular ```

Axillary

A 21 years old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation, the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be ? ``` Radial Recurrent branch of median Anterior interosseous Ulnar Median ```

Median

Which of the following muscles does not attach to the radius ? ``` Pronator quadratus Biceps Brachioradialis Supinator Brachialis ```

Brachialis The Brachialis muscle inserts into the ulnar. The other muscles are all inserted onto the radius.

A 25 years old man is stabbed in the upper arm. The brachial artery is lacerated at the level of the proximal humerus, and is being repaired. A nerve lying immediately lateral to the brachial artery is also lacerated. Which of the following is the nerve most likely to be ? ``` Ulnar nerve Medial nerve Radial nerve Intercostobrachial nerve Axillary nerve ```

Median nerve

What is the course of the median nerve relative to the brachial artery in the upper arm? Medial to anterior to lateral Lateral to posterior to medial Medial to posterior to lateral Medial to anterior to medial Lateral to anterior to medial

Lateral to anterior to medial Relations of median nerve to brachial artery Lateral> Anterior> medial

The following statement relating to the musculocutaneous nerve are true except? It aries from the lateral cord of the brachial plexus It provides cutaneous innervation to the lateral side of the forearm If damaged, then extension of the elbow joint will be impaired It supplies the biceps muscles It runs beneath bisceps

If damaged, then extension of the elbow joint will be impaired It supplies biceps, brachialis and coracobrachialis. If damage then elbow flexion impaired

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 Externsor carpi radialis longus ```

Brachialis

A 32 years old rugby player is hit hard on the shoulder during a rough tackle. Clinically his arm is hanging loose on the side. It is pronated and medially rotated. Which structure is most likely to have been compromised? ``` Brachial trunks C5-6 Brachial trunks C6-7 Brachial trunks C8-T1 Anterior interosseous nerve Posterior interosseous nerve ```

Brachial trunks C5-6 The patient has an Erb palsy involing brachial trunks C5-6

A 73 years old man undergoes an excision biopsy of a lymph node that is closely applied to sternocleidomastoid. This muscle is mobilized and a nerve that is present si damaged. WHich muscle below is most likely to be affected ? ``` Trapezius Rhomboid major Deltoid Supraspinatus Rhomboid minor ```

Trapezius

A 35 years tennis player attends reporting tingling down his arm. He says that his " funny bone" was hit very hard by a tennis ball. There is weakness of abduction of his extended finger. WHich nerve has been affected ? ``` Ulnar Anterior interosseous Posterior interosseous Median Musculocutaneous ```

Ulnar

A 22 years old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. WHhich of the following structures is most likely to be injured? Palmar cutaneous branches of the median nerve Lateral tendon of flexor digitorum superficialis Ulnar artery Flexor carpi radialist tendon Lateral tendon of the flexor digitorum profundus

Ulnar artery

A motorcyclist is involved in a road traffic accident. He suffers a complex humeral shaft fracture which is plated. Post operatively he complains of an inability to extend his fingers. which of the following structures is most likely to have been injured? ``` Ulnar nerve Radial Nerve Median Nerve Axillary Nerve None of the above ```

Radial Nerve ``` Mneumonic: BEST B- brachioradialist E- extensors S- supinator T- triceps ``` Radial nerve is responsible for innervation of the extensor compartment of the forearm.

A 48 years old lady is undergoing an axillary node clearance for breast cancer. Which of the structures isted below are most likely to be encountered during axillary dissection ? Cords of the brachial plexus Thoracodorsal trunk Internal mammary artery Thoracoacromial artery none of the above

Thoracodorsal trunk Beware of damaging the thoracodorsal trunk if a latissimus dorsi flap reconstruction is planned. The thoracodorsal trunks runs through the nodes in the axilla. If injured it may compromise the function and blood supply to latissimus dorsi, which significant if it is to be used as a flap for a reconstructive procedure

A 53 years old lady is recovering following a difficult mastectomy and axillary nodal clearance for carcinoma of the breast. She complains of shoulder pain and on examination has obvious winging of the scapular. Loss of innervation to which of the following is the most likely underlying cause? ``` Latissimus dorsi Serratus anterior Pectoralis minor Pectoralis major Rhomboids ```

Serratus anterior | Winging of scapula is most common result of long thoracic nerve injury or dysfunction.

How many phalanges are there in the hand ? ``` 14 12 13 10 8 ```

14 | Each digits has 3 phalanges, the thumb has 2 total 14

Which of the following structures separates the subclavian artery from the subclavian vein? ``` Scalenus anterior Scalenus medius Sternocleidomastoid Pectoralis major Pectoralis minor ```

Scalenus anterior

A 23 years old climber falls and fractures his humerus. The surgeon decide upon a posterior approach to the middle third of the bone. Which of the following nerves is at greatest risk in this apprach? ``` Ulnar Antebrachial Musculocutaneous Radial Intercostobrachial ```

Radial The radial nerve wraps around the humerus and may be injured during a posterior approach. An IM nail may be preferred as it avoids the complex dissection needed for direct bone exposure.

What is the largest branches of the brachial artery ? ``` Radial artery Ulnar artery Profunda brachii artery Humeral nutrient artery Ulnar Collateral artery ```

Profunda brachii artery

Which of the following nerves is responsible for innervation of the triceps muscle? ``` Radial Ulnar Axillary Median None of the above ```

Radial Radial nerve innervates all three heads of triceps with a separate branch to each head. 1-2 ankle (S1-S2) 3-4 Knee (L3-L4) 5-6(C5-C6) 7-8 (C7-C8)

A patient present to the clinic following a surgical procedure. She complains that she is unable to shrug her shoulder. What is the most likely underlying nerve injury? ``` Accessory nerve Cervical plexus Anas cervicalis Long thoracic nerve Axillary nerve ```

Accessory nerve

The cords of the brachial plexus are most closely related to which of the following vessles? ``` Subclavian artery Axillary artery Axillary vein Subclavian vein Brachial artery ```

Axillary artery The trunks are related to the subclavian artery superiorly. The cords of the plexus surrounds the axillary artery, they are named according to their position relative to their structure

Which structure separates the cephalic vein and the brachial artery in the antecubital fossa? Brachioradial muscle Bicipital aponeurosis Origin of flexor digitorum profundus muscles Pronator quadratus muscles Origin of flexor digitorum superficialis muscle

Bicipital aponeurosis

A 23 years old rugby player sustains a smith fracture. On examination, opposition of the thumb is markedly weakened. which of the following nerves is least likely to be working normally ? ``` Ulnar Median Radial Musculocutaneous Palmar cutaneous ```

Median

Which of the following muscles inserts onto the lesser tuberosity of the humerus ? ``` Subscapularis Deltoid Supraspinatus Teres minor Infraspinatus ```

Subscapularis

A 73 years old lady suffers a fracture at the surgical neck of the humerus. The decision is made to operate. There are difficulties in reducing the fracture a vessel lying posterior to the surgical neck is injured. Which of the following is this vessel most likely to be ? ``` Axillary artery Brachial artery Thoracoacromial artery Transverse scapular artery Posterior circumflex humeral artery ```

Posterior circumflex humeral artery Thoracoacromial and transverse scapular arteries lie more superomedially. The posterior circumflex humeral artery is a branch of the axillary artery

Which of the following upper limb muscles is not innervated by the radial nerve ? ``` Extensor carpi ulnaris Abductor digiti minimi Anconeus Supinator Brachioradialis ```

Abductor digiti minimi is innervated by the ulnar nerve ``` Mnemonic for radial nerve muscles BEST B- brachioradialis E-extensors S-supinator T-triceps ```

Which of the following forms the floor of the anatomical snuffbox? ``` Radial artery Cephalic vein Extensor pollicis brevis Scaphoid bone Cutaneous branch of the radial nerve ```

Scaphoid bone

Which nerve supplies the skin at the medial aspect of the palm? ``` Ulnar Radial Median Musculocutaneous Anterior interosseous ```

Ulnar

Which muscle is responsible for causing flexion of the distal interphalangeal joint of the ring finger? Flexor digitorum superficialis Lumbricals Palmar interossei Flexor digitorum profundus Flexor digiti minimi brevis

Flexor digitorum profundus

A 32 years old lady complains of carpal tunnel syndrome. The carpal tunnel is explored surgically. Which of the following structures will lie in closest proximity to the hamate bone within the carpal tunnel ? The tendon of abductor pollicis longus The tendon of flexor digitorum produndus The tendons of flexor carpi radialis longus Median nerve Radial artery

The tendon of flexor digitorum produndus

Which nerve supplies the interossei of the fourth finger? ``` Radial Median Superficial ulnar Deep ulnar Posterior interosseous ```

Deep ulnar Mneuomonic PAD and DAB Palmer interossei ADduct Dorsal interossei Abduct

A 45 years man present with hand weakness. He is given a piece of paper to hold between his thumb and index finger. When the paper is pulled, the patient has difficulty maintaining a grip. Grip pressure is maintained by flexing the thumb at the interphalangeal joint. What is the most likely nerve lesion? Posterior interosseous nerve Deep branch of ulnar nerve Anterior interosseous nerve Superficial branch of ulnar nerve Radial nerve

Deep branch of ulnar nerve

A 22 years old man is involved in a flight and sustains a stab wound in his upper forearm. On examination there is a small, but deep laceration. There is an obvious loss of pincer movement involving the thumb and index finger with minimal loss of sensation. The most likely nerve injury is to the: ``` Ulnar nerve Radial nerve Anterior interosseous nerve Axillary nerve Median nerve ```

Anterior interosseous nerve AIN, motor branch of median nerve just below elbow When damage - pain in the forearm - loss of pincer movement of the thumb and index finger - minimal loss of sensation due to lack of a cutaneous branch

A 32 years old attends neurology clinic complaining of tingling in his hands. He has radial deviation of his wrist and there is mild clawing of his finger, with the 4th and 5th digits being relatively spared. What is the most likely lesion? Ulnar nerve damage at the wrist Ulnar nerve damage at the elbow radial nerve damage at the elbow Median nerve damage at the wrist Median nerve damage at the elbow

Ulnar nerve damage at the elbow The ulnar paradox- the higher the lesion, the less the clawing of the finger

A 23 years old man is involved in a fight and is stabbed in his upper arm. The ulnar nerve is transected. Which of the following muscle will not demonstrate compromised function as a result ? Flexor carpi ulnaris Medial half of flexor digitorum profundus Palmaris brevis Hypothenar muscles Pronator teres

``` pronator teres MAFIA M- medial lumbricals A-dductor pollicis F- flexor digitorum profundus/ Flexor digiti minimi I- interossei A- abductor digiti minimi and opponens ``` Innervates all intrinsic muscle of the hand excep 2 - thenar muscle & first 2 lumbricals

A 22 years old man is involved in a fight. He sustains a laceration to the posterior aspect of his wrist. In the emergency department the wound is explored and the laceration is found to be transversely orientated and overlies the region of the extensor retinaculum, which is infact. Which of the following structures is least likely to be injured in this scenario? Doral cutaneous branch of the ulnar nerve Tendon of extensor indicis Basilic vein Superficial branch of the radial nerve Cephalic vein

Tendon of extensor indicis

A man has an incision sited that runs 8cm from the deltopectoral groove to the midline of the chest. which of the following is not at risk of injury ? ``` Cephalic vein Shoulder joint capsule Axillary artery Pectoralis major Trunk of the brachial plexus ```

Shoulder joint capsule

Which of the following nerves does not contribute to the innervation of the elbow joint ? ``` Median Musculocutaneous Radial Posterior interosseous Ulnar ```

Posterior interosseous

A 23years old man is injured during a game of rugby. He suffers a fracture of the distal third of his clavicle, it is compound fracture and there is evidence of arterial haemorrhage. Which of the following vessels is most likely to be encountered first during subsequent surgical exploration? Posterior circumflex humeral artery Axillary artery Thoracoacromial artery Sub Scapular artery Lateral thoracic artery

Thoracoacromial artery - arises from second part of the axillary artery. - It is a short, wide trunk, which pierces the clavipectoral fascia, and ends, deep to pectoralis major by dividing into 4 branches.

A 38 years oldman falls onto an outstretched hand. Following the acccident he is examined in the emergency department. On palpating his anatomical snuffbox there is tenderness noted in the base. Which is the most likely injury in this scenario? Rupture of tendon of flexor pollicis Scaphoid fracture Distal radius fracture Rupture of flexor carpi ulnaris tendon None of the above.

Scaphoid fracture -suspected and common on fall onto outstretched hand and tenderness at base of anatomical snuffbox. _ if tendon rupture = bony tenderness

Which of the following structures passes through the quadrangular space near the humeral head ? ``` Axillary artery Radial artery Axillary nerve Median nerve Transverse scapular artery ```

Axillary nerve

Which is the first branch of the axillary artery? ``` Subscapular artery Lateral thoracic artery Thoraco acromial artery Superior thoracic artery Anterior circumflex humeral artery ```

Superior thoracic artery -first branch of first part 2 branches from 2nd part - thoraco acromal & lateral thoracic 3 branches from 3rd part - subscapular artery, anterior and posterior circumflex humeral arteries Mnemonic for axillary artery branches Screw The Lawyer, Save A Patient

Which of the following structures separates the ulnar artery from the median nerve? Brachioradialis Pronator teres Tendon of biceps brachii Flexor carpi ulnaris Brachialis

Pronator teres It lies deep to ronator teres and this separates it from the median nerve

A 32 years old motorcyclist is involved in a road traffic accident. His humerus is fractured and severely displaced. At the time of surgical repair the surgeon notes that the radial nerve has been injured. Which of the following muscles is least likely to be affected by an injury at this site ? Extensor Carpi radialis brevis Brachioradialis Abductor pollicis longus Extensor pollicis brevis None of the above

None of the above ``` BEST B-brachioradialis E-Extensors S-supinator T- Triceps ``` Radial nerve supplies the extensor muscles, abductor pollicis longus and extensor pollicis brevis (the latter two being innervated by posterior interosseous branch of the radial nerve)

Which muscle is responsible for causing flexion of the interphalangeal joint of the thumb ? Flexor pollicis longus Flexor pollicis brevis Flexor digitorum superficialis Flexor digitorum profundus Adductor pollicis

Flexor pollicis longus

An 18 years old man is stabbed in the axillary during a fight. His axillary artery is lacerated and repaired. However, the surgeon neglects to repair an associated injury to the upper trunk of the brachial plexus. Which of the following muscles is least likely to demonstrate impaired function as a result ? ``` Palmar interossei Infraspinatus Brachialis Supinator brevis None of the above ```

Palmar interossei The palmar interossei are supplied by the ulnar nerve. Which lies inferiorly and is therefore less likely to be injured.

A 23 years old man is involved in a fight, during the dispute he sustains a laceration to the posterior aspect of his right arm, approximately 2cm proximal to the olecronon process. On assessment in the emergency department he is unable to extend his elbow joint. Which of the following tendons is most likely to have been cut ? ``` Triceps Pronator teres Brachioradialis Brachialis Biceps ```

Triceps | Triceps muscles extends the elbow joint. The other muscles listed all produce flexion of the elbow joint.

Which of the following is not an intrinsic muscle of the hand? ``` Opponens pollicis Palmaris longus Flexor pollicis brevis Flexor digiti minimi brevis Opponens digiti minimi ```

Palmaris longus ``` Mneumonic for intrinsic hand muscle A OF A OF A A- Abductor pollicis brevis O -opponens pollicis F- flexor pollicis brevis A- adductor pollicis (thenar muscles) O- opponens digiti minimi F-Flexor digiti minimi brevis A-abductor digiti minimi (hypothenar muscles) ```

A 28 years old man lacerates the posterolateral aspect of his wrist with a knife in an attempted suicide. On arrival in the emergency department the wound is inspected and found to be located over the lateral aspect of the extensor retinaculum (which is intact). which of the following structures is at the greatest risk of injury? Superficial branch of radial nerve Radial nerve Dorsal branch of ulnar nerve Tendon of extensor carpi radialis brevis Tendon of extensor digiti minimi

Superficial branch of radial nerve

Transection of the radial nerve at the level of the axilla will result in all of the following except: Loss of elbow extension Loss of extension of the interphalangeal joints Loss of metacarpophalangeal extension Loss of triceps reflex Loss of sensation overlying the first dorsal interosseous

Loss of extension of the interphalangeal joints

Which of the following muscles does not adduct the shoulder ? ``` Teres major Pectoralis major Coracobrachialis Supraspinatus Latissimus dorsi ```

Supraspinatus supraspinatus is an abductor of the shoulder

Which of the following structures is not closely related to the brachial artery ? ``` Ulnar nerve Median nerve Cephalic Vein Long head of triceps Median Cubital vein ```

Cephalic Vein

Which ligaments keeps the head of the radius connected to the radial notch of the ulna ? Annular (orbicular) ligament Quadrate ligament Radial collateral ligament of the elbow Ulnar collateral ligament Radial collateral ligament

Annular (orbicular) ligament

A 38 years old man presents to the clinic with shoulder weakness. On examination he has an inability to initiate shoulder abduction. Which of the nerves listed below is least likely to be functioning normally ? ``` Suprascapular nerve Medial pectoral nerve Axillary nerve Median nerve Radial nerve ```

Suprascapular nerve

Which of the following is not a branch of the subclavian artery ? ``` Superior thyroid artery Vertebral artery Thyrocervical trunk Internal thoracic artery Dorsal scapular artery ```

Superior thyroid artery ``` Mneumonic for branches of subclavian artery VIT C & D V - vertebral artery I- internal thoracic T-thyrocervical trunk C-costalcervical trunk D- dorsal scapular ```

Which of these vessels provide the greatest contribution to the arterial supply of the breast? ``` External mammary artery Thoracoacromial artery Internal mammary artery Lateral thoracic artery Subclavian artery ```

Internal mammary artery 60% of the arterial supply to the breast is derived from the internal mammary artery. The external mammary and lateral thoracic arteries also make a significant but lesser contribution.

A baby is found to have a Klumpke palsy post delivery. Which of the following is most likely to be present ? ``` Loss of flexors of wrist Weak elbow flexion Pronated forearm Adducted shoulder Shoulder medially rotated ```

Loss of flexors of wrist Features of Klumpkes Paralysis - claw hand (MCP joints extended and IP joints flexed) - Loss of sensation over medial aspect of forearm and hand - Horner's syndrome - Loss of flexor of the wrist C8-T1 root lesion = klumpke's paralysis and is caused by delivery with the arm extended

Through which of the structures listed below does the axillary nerve pass? ``` Quadrangular space Triangular space Subclavicular space Sub Pectoral space Intercostal space ```

Quadrangular space

Which of the following is a branch of the third part of the axillary artery ? ``` Superior thoracic Lateral thoracic Dorsal Scapular Thoracoacromial Posterior circumflex humeral ```

Posterior circumflex humeral Superior thoracic artery -first branch of first part 2 branches from 2nd part - thoraco acromal & lateral thoracic 3 branches from 3rd part - subscapular artery, anterior and posterior circumflex humeral arteries Mnemonic for axillary artery branches Screw The Lawyer, Save A Patient

Which respect to the basilic vein, which statement is false ? Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgery It originates from the dorsal venous network on the hand It travels up the medial aspect of the forearm Halfway between the shoulder and the elbow it lies deep to muscle It is joined by the brachial vein t form the axillary vein

Its deep anatomical location makes it unsuitable for use as an arteriovenous access site in fistula surgery It is used in arteriovenous fistula surgery during a procedure known as a basilic vein transposition.

The Anterior interosseous nerve is a branch of which of the following ? ``` Ulnar nerve Superficial branch of the radial nerve Axillary nerve Deep branch of the radial nerve Median nerve ```

Median nerve

In fromen's test which muscle function is tested? ``` Flexor pollicis longus Abductor pollicis longus Abductor pollicis brevis Adductor pollicis Opponens pollicis ```

Adductor pollicis Froment's Sign - assess for ulnar. N palsy - adductor pollicis muscle function tested - Hold a piece of paper between their thumb and index finger. The object is then pulled away. - If ulnar nerve palsy, unable to hold the paper and will flex the flexor pollicis longus to compensate (flexion of thumb at interphalangeal joint)

A 42 years old lady has had an axillary node clearance for breast malignancy. Post-operatively she reports weakness of the shoulder. She is unable to push herself forwards from a wall with the right arm and scapula is pushed out medially from the chest wall. What is the most likely nerve injury ? ``` C5,C6 C8,T1 Axillary N Long thoracic Nerve Spinal accessory nerve ```

Long thoracic Nerve

A 36 years old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What is the most likely reason? ``` Phrenic nerve lesion Axillary nerve lesion C5, C6 root lesion C8, T1 root lesion Accessory nerve lesion ```

Accessory nerve lesion - located in posterior triangle may be injured in this region.

A 20 years old man presents to the emergency department with a stab injury to the thenar eminence. On examination, he is found to have a 2 cm long laceration with loss of sensation in the thumb and index finger and weakness of the thenar muscle. Which of the following structures is most likely to have been injured? Anterior interosseous nerve Recurrent branch of the median nerve Sensory and motor branches of the median nerve Sensory and motor branches of the radial nerve Sensory and motor branches of the ulnar nerve

Sensory and motor branches of the median nerve

Which of these muscles is supplied by the musculocutaneous nerve? ``` Brachialis Latissimus dorsi Flexor carpi ulnaris Teres minor Triceps ```

Brachialis Muscle innnervated by the musculocutaneous nerve BBC Biceps brachii Brachialis Coracorachialis

A 17 years old male present to the clinic. He complains of difficulty using his left hand. It has been a presistent problem since he sustained a distal humerus fracture as a child. On examination, there is diminished sensation overlying the hypothenar eminence and medial one and half fingers. Which is the most likely nerve lesion? ``` Anterior interosseous nerve Posterior interosseous nerve Ulnar nerve Median nerve Radial nerve ```

Median nerve

A 72 years old male with end stage critical ischaemia is undergoing an axillo-femoral bypass. What structure is not closely related to the axillary artery ? Posterior cord of the brachial plexus Scalenus anterior muscle Pectoralis minor muscle Axillary Vein Lateral cord of the brachial plexus

Scalenus anterior muscle

Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris ? ``` Triquetrum Lunae Pisiform Scaphoid Capitate ```

Pisiform

A 43 years old woman is due to undergo an axillary node clearance following a positive sentinel node biopsy. Which of the nerves below is at greatest risk? ``` Accessory nerve Thoracodorsal Upper trunk of the brachial plexus Medial pectoral Axillary ```

Thoracodorsal

A 70 years old man fall and fractures his scaphoid bone. The fracture is displaced and the decision is made to inert a screw to fix the fracture. Which of the following structures lies directly medial to the scaphoid ? ``` Lunate Pisiform Trapezoid Trapezium None of the above ```

Lunate | - Fractures of the scaphoid that are associated with high velocity injuries may cause associated lunate dislocation.

Which of the muscles listed below would be affected if the radial nerve were injured in a humeral shaft fracture ? ``` Supinator Flexor digitorum profundus Brachialis Abductor pollicis brevis Abductor digiti minimi ```

Supinator

A 73 years old lady is hit by a car. She suffers a complex fracture of the distal aspect of her humerus with associated injury to the radial nerve. Which of the following movement will be most impaired as a result? ``` Elbow extension Elbow flexion Shoulder abduction wrist extension none of the above ```

wrist extension

A well toned weight lifter attends clinic reporting weakness of his left arm. There is weakness of flexion and supination of the forearm. Which of the following nerves is likely to have been affected ? ``` Axillary Suprascapular Median Radial Musculocutaneous ```

Musculocutaneous

An 18 years old man develops a severe spreading sepsis of the hand. The palm is explored surgically and the flexor digiti minimi brevis muscle is mobilised to facilitate drainage of the infection. Which of the following structures is not closely related to this muscle? The hook of hamate Median nerve Superficial palmar arterial arch Digital nerve arising from the ulnar nerve None f the above

Median nerve

A 22 years old man develops an infection in the pulp of his little finger. What is the most proximal site to which this infection may migrate? The metacarpophalangeal joint The distal interphalangeal joint The proximal interphalangeal joint Proximal to the flexor retinaculum Immediately distal to the carpal tunnel

Proximal to the flexor retinaculum The 5th tendon sheath extends from the little finger to the proximal aspect of the carpal tunnel. This carries a significant risk of allowing infection to migrate proximally.

Which of the following muscles is not innervated by the deep branch of the ulnar nerve ? Adductor pollicis Hypothenar muscles All the interosseous muscles Opponens pollicis Third and fourth lumbricals

Opponens pollicis

During an arch aortogram the brachiocephalic artery is entered with an angiography catheter. The radiologist continues to advance the catheter. Into which of the following vessels is it likely to enter? ``` Left subclavian artery Left axillary artery Right subclavian artery Right axillary artery None of the above ```

Right subclavian artery

Which of the following structures lies between the lateral and medial heads of triceps muscles? ``` Radial nerve Median Nerve Ulnar nerve Axillary nerve Median cutaneous nerve of forearm ```

Radial nerve

Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert ? The surgical neck of the humerus The body of the humerus The bicipital groove Immediately distal to the greater tuberosity The anatomical neck of the humerus

The anatomical neck of the humerus

The cephalic vein pierces the clavipectoral fascia to terminate in which of the veins listed below? ``` External jugular Axillary Internal jugular Azgos Brachial ```

Axillary

A woman develops wing of the scapula following a patey mastectomy. What is the most likely cause? Division of pectoralis minor to access level 3 axillary nodes Damage to the brachial plexus during axillary dissection Damage to the long thoracic nerve during axillary dissection Division of the thoracodorsal trunk during axillary dissection Damage to the thoracodorsal trunk during axillary dissection

Damage to the long thoracic nerve during axillary dissection

Which of the following is not closely related to the capitate bone ? ``` Lunate bone Scaphoid bone Ulnar nerve Hamate bone Trapezoid bone ```

Ulnar nerve

Which nerve supplies sensation to the nail bed of the index finger? ``` Median Ulnar Radial Musculocutneous Axillary ```

Median

An injury to the spinal accessory nerve will have the greatest effect on 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

Upward rotation of the scapula

A 28 years teacher report difficulty with writting. There is no sensory loss. She is known to ahve an aberrant Gantzer muscle. Which of the following nerves has been affected ? ``` Posterior interosseous Anterior interosseous Median Ulnar Musculocutaneous ```

Anterior interosseous

A 23 years old man falls over whilst intoxicated and a shard of glass transects his median nerve at the proximal border of the flexor retinaculum. His tendon escape injury. Which of the following features is least likely to be present ? Weakness of thumb abduction Loss of sensation on the dorsal aspect of the thenar eminence Loss of power of opponens pollicis Parasthesia of the palmar aspect of the second digit Loss of power of abductor pollicis brevis

Loss of sensation on the dorsal aspect of the thenar eminence

A 23 years old man falls and injures his hand. There are concerns that he may have a scaphoid fractures as there is tenderness in his anatomical snuffbox on clinical examination. Which of the following forms the medial border of this structure ? ``` Basilic vein Radial artery Extensor pollicis brevis Abductor pollicis longus Extensor pollicis longus ```

Extensor pollicis longus

A 44 years old lady who works as an interior decorator has undergone a mastectomy and axillary node clearance to treat breast cancer. Post operatively, she comments that her arm easily becomes fatigued when she is painting walls. What is most likely explanation? Injury to the axillary nerve Injury to the long thoracic nerve Injury to the intercostobrachial nerve Injury to the thoracodorsal nerve Injury to the median pectoral nerve

Injury to the thoracodorsal nerve

A 28 years old man is stabbed outside a nightclub in the upper arm. The median nerve is transected. Which of the following muscles will demonstrate impaired function as a result ? ``` palmaris brevis Second and third interossei Adductor pollicis Abductor pollicis longus Abductor pollicis brevis ```

Abductor pollicis brevis

In the distal third of the upper arm, where is the musculocutaneous nerve located ? Between the biceps brachii and brachialis muscle Between the brachialis and brachioradialis muscles Between the brachioradialis and triceps muscles Between the brachial and triceps muscles Between the humerus and brachialis muscles

Between the biceps brachii and brachialis muscle

Which of the following is not a branch of posterior cord of the brachial plexus ? ``` Thoracodorsal nerve Axillary nerve Radial nerve Lower subscapular nerve Musculocutaneous nerve ```

Musculocutaneous nerve ``` Mneumonic for posterior cord STAR S- subscapular (upper and lower) T- Thoracodorsal A- Axillary R- Radial ```

A 56 years old machinist has his arm entrapped in a steel grinder and is brought to the emergency department. On examination, he is unable to extend his metacarpophalangeal joints and abduct his shoulder. He has weakness of his elbow and wrist. what has been injured? Ulnar nerve Axillary nerve Medial cord of brachial plexus Lateral cord of brachial plexus Posterior cord of brachial plexus

Posterior cord of brachial plexus Posterior cord give rise to - Radial nerve - Axillary nerve - Upper subscapular nerve - Lower subscapular nerve - Thoracodorsal nerve

A motor cyclist is involved in a RTA causing severe right shoulder injuries. He is found to have an adducted, medially rotated shoulder. The elbow is fully extended and the forearm pronated. Which is the most likely diagnosis ? C8,T1 root lesion C5,C6 root lesion Radial nerve lesion Ulnar nerve lesion Axillary nerve lesion

C5,C6 root lesion Erbs palsy

A man sustains a laceration between the base of the little finger and wrist. Several weeks after the injury there is loss of thumb adduction power. Which nerve is most likely to have been injured? ``` Superficial ulnar nerve Deep ulnar nerve Median nerve Radial nerve Recurrent branch of median nerve ```

Deep ulnar nerve

A 23 years old man has a cannula inserted into his cephalic vei. through which structure does the cephalic vein pass? ``` Interosseous membrane Triceps Pectoralis major Clavipectoral fascia Tendon of biceps ```

Clavipectoral fascia

``` Which of the following is not a carpal bone ? Trapezium Triquetrum Trapezoid Trapezius Lunate ```

Trapezius

Which of thee muscles is not a component of rotator cuff ? ``` Subscapularis Teres minor Supraspinatus Infraspinatus Deltoids ```

Deltoids ``` SITS S-subscapularis S-supraspinatus I-Infraspinatus T- Teres minor ```

A 32 years old man is stabbed in the neck and the inferior trunk of his brachial plexus is injured. Which of the modalities listed below is least likely to be affected? ``` Initiating abduction of the shoulder Abduction of the fingers Flexion of the little finger Sensation on the palmar aspect of the little finger Gripping a screwdriver ```

Initiating abduction of the shoulder

A 42 years old teacher is admitted with a fall. An X-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk ? ``` Median Radial Axillary Musculocutaneous Subscapular ```

Axillary

As it exits the axilla the radial nerve passes over the inferior border which of the muscles listed below ? ``` Supraspinatus Infraspinatus Teres major Deltoid Pectoralis major ```

Teres major

A 62 years old man presents with arm weakness. On examination he has a weakness of elbow extension and loss of sensation on the dorsal aspect of the first digit. What is the site of the most likely underlying defect ? ``` Axillary nerve Median nerve Ulnar nerve Radial nerve Musculocutaneous nerve ```

Radial nerve

From which of the following structures does the long head of the triceps muscles aries? ``` Coracoid process Acromion Infraglenoid tubercle Coraco-acromial ligament Coraco-humeral ligament ```

Infraglenoid tubercle | - long head aries from infraglenoid tubercle.

A 58 years old lady present with a mass in the upper outer quarant of the right breast. Which of the following statement relating to the breast is untrue? The internal mammary artery provides the majority of its arterial supply Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia The internal mammary artery is a branch of the subclavian artery Up to 70% of lymphatic drainage is to the ipsilateral axillary node None of the above

Nipple retraction may occur as a result of tumour infiltration of the clavipectoral fascia

A 78 years old man is lifting a heavy object when he feels a pain in his forearm and is unable to continue. He has a swelling over his upper forearm. An MRI scan shows a small cuff of tendon still attached to the radial tuberosity consistent with a recent tear. Which of the following muscles has been injured? ``` Pronator teres Supinator Aconeus Brachioradialis Biceps brachii ```

Biceps brachii

A 53 years old lady present with pain and discomfort in her hand. She works as a typist and notices that the pain is worst when she is working. She also suffers symptoms at night. Her little finger is less affected by the pain. Which of the nerves listed below is most likely to be affected ? ``` Radial Median Ulnar Anterior interosseous nerve Posterior interosseous nerve ```

Median ``` LOAF L- Lateral 2 lumbricals O-Opponens pollicis A-abductor pollicisbrevis F-Flexor pollicis brevis ```

Which of the following muscles lies medial to the long thoracic nerve ? ``` Serratus anterior Latissimus dorsi Coracobrachialis Pectoralis minor None of the above ```

Serratus anterior

During a patey mastectomy, the pectoralis minor muscle is divided to gain access to the level III axillary nodes. What is the nerve supply to this structure ? ``` Axillary nerve Medial pectoral nerve Lateral pectoral nerve Long thoracic nerve Thoracodorsal nerve ```

Medial pectoral nerve pectoralis minor is supplied by the medial pectoral nerve

A 24years female is admitted to A&E with tingling of her hand after a fall. She is found to have a fracture of the medial epicondyle. What is the most likely nerve lesion? ``` Ulnar nerve Radial nerve Median nerve Axillary nerve Cutaneous nerve ```

Ulnar nerve The radial nerve is located near the lateral epicondyle

A 44 years old lady has undergone a mastectomy and axillary node clearance. Post operatively, she notices a patch of anaesthesia of her axillary skin when she applies an underarm deodorant. Which nerve has most likely been affected? ``` Axillary Intercostobrachial Long thoracic Thoracodorsal Accessory ```

Intercostobrachial

A 43 years old lady is undergoing an axillary node clearance for breast cancer. The nodal disease is bulky. During clearance of the level 3 nodes there is suddenly brisk haemorrhage. The most likely vessel responsible is: ``` Thoracoarcromial artery Cephalic vein Thoracodorsal trunk Internal Mammry artery Posterior circumflex artery ```

Thoracoarcromial artery

A 73 years old lady with long standing atrial fibrillation develops a cold and pulseless white arm. A brachial embolus is suspected and a brachial embolectomy is performed. Which of the following structures is at greatest risk of injury during this procedure? ``` Radial nerve Cephalic vein Ulnar nerve Median nerve None of the above ```

Median nerve

Which 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 ```

Middle finger

A 33 years old man sustains an injury to his forearm and wrist. When examined in clinic he is unable to adduct his thumb. What is the most likely underlying nerve lesion ? Radial nerve Superficial branch of the ulnar nerve Median nerve Posterior interosseous nerve Deep branch of the ulnar nerve

Deep branch of the ulnar nerve

A 6 years old sustains a supracondylar fracture of the distal humerus. There are concerns that the radial nerve may have been injured. What is the relationship of the radial nerve to the humerus at this point ? ``` Anterolateral Anteromedial Posterolateral Posteromedial Immediately anterior ```

Anterolateral The radial nerve lies anterolateral to the humerus in the supracondylar area

The following are true of the ulnar nerve except: It innervates the palmar interossei Derived from the medial cord of the brachial plexus Supplies the muscles of the thenar eminence Supplies the medial half of flexor digitorum profundus Passes superficial to the flexor retinaculum

Supplies the muscles of the thenar eminence The muscles of the thenar eminence are supplied by the median nerve and atrophy these is a feature of carpal tunnel syndrome