Upper Limb Flashcards
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
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.
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
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
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
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
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
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
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.
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.
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
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
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
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
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.
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
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.
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
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.
The first root of the brachial plexus commonly aries at which of the following levels?
C6 C5 C3 C2 C8
C5
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)
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
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
Phrenic nerve runs posterior to the medial aspect of the first rib.
Superiorly, it lies on the surface of scalenus anterior
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)
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
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
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
