Upper limb

Question 1

21813 – Pectoralis major
1: arises from the upper eight ribs
2: is inserted into the medial lip of the bicipital groove
3: is a powerful flexor of the gleno-humeral joint
4: is supplied by all five segments of the brachial plexus

Answer 1

FFFT
Last 9th p 54
Arises from six upper costal cartilages, (med half clavical, lat manubrium and sternum, ext oblique aponeurosis)
inserts into lateral lip of bicipital groove (and ant lip of deltoid tuberosity)
Action: clavicular head flexes and adduct arm, sternal head adducts and medially rotates arm.
Supplied by all five segments of brachial plexus - C5-6 for clavicular head and C78,8 T1 for sternocostal part
action: flexes and adducts arm, adducts and med rotates arm

Question 2

22299 – Pectoralis minor muscle
1: is supplied by fibres from C5 root
2: arises from the second, third and fourth costal cartilages
3: is an adductor of the shoulder joint
4: inserts into the medial border and upper surface of the coracoid process of the scapula

Answer 2

FFFT
Last 9th p55
Arises: anterior aspect of 3rd,4th,5th rib
Inserts: med and upper surface of corocoid process of scapula
Action: elevates ribs if scapula fixed, protracts scapula (assist serratus anterior)
Nerve: Med and lat pectoral C6,7,8 from med and lat cords.
Landmark for axillary artery and cords of brachial plexus

Question 3

24064 – The clavi-pectoral fascia is pierced by
1: the cephalic vein
2: the medial pectoral nerve
3: lymphatics passing from the infraclavicular nodes to the apical nodes of the axilla
4: the superior thoracic artery

Answer 3

TFTF
Last PAGE: 55
The clavipectoral fascia is pierced by the cephalic vein, thoracoacromial artery and vein, lymphatics, and lateral pectoral nerve

Question 4

22834 – The axillary artery
1: terminates at the inferior border of the teres major
2: lies posterior to the medial pectoral nerve
3: has its corresponding vein on its medial side
4: begins at the medial border of the pectoralis minor

Answer 4

TFTF
Last 10th Edition, page 48.
Arises: lateral margin of the first rib to lower margin of teres major
Axillary vein is medial to it

Question 5

12743 – In the axilla
1: the long thoracic nerve runs on the medial wall deep to the fascia over serratus anterior muscle
2: the axillary (circumflex) nerve leaves the axilla by passing through a space bounded by humerus, long head of triceps, subscapularis and teres major
3: the thoraco-dorsal nerve runs on the posterior wall accompanied by a vascular pedicle
4: the musculocutaneous nerve pierces the coraco-brachialis muscle

Answer 5

TTTT
The long thoracic nerve (nerve to serratus anterior) arises from the posterior aspects of the nerve roots C5, 6 and 7. The nerve emerges on the surface of scalenus medius, crosses the first rib to lie on serratus anterior in the medial wall of the axilla, deep to its fascia (A true) and runs vertically downwards behind the mid-axillary line to supply the muscle segmentally. The axillary (circumflex) nerve, from the posterior cord of the brachial plexus, gives no branches in the axilla, and leaves it immediately through the quadrangular space (B true) to run around the neck of the humerus. The thoraco-dorsal nerve (nerve to latissimus dorsi), from the posterior cord, descends through the axilla
to the posterior wall, to enter and supply latissimus dorsi. It is accompanied by the subscapular vessels, which are initially anterior to the nerves, but reverse their position in the lower axilla (C true).
The musculocutaneous nerve (C7), from the lateral cord, pierces the coracobrachialis muscle after supplying it (D true). After supplying biceps and brachialis muscles it becomes the lateral cutaneous nerve of the forearm.

Question 6

7108 – In performing an axillary dissection, you should remember that
A. the long thoracic nerve runs on the medial wall of the axilla anterior to the midaxillary line
B. the thoracodorsal nerve runs on the lateral wall of the axilla
C. the medial pectoral nerve pierces the clavipectoral fascia to supply pectoralis major muscle on its deep surface
D. the intercostobrachial nerve crosses the axilla within the axillary fat
E. the axillary sheath, an extension of the prevertebral fascia, invests both axillary artery and vein

Answer 6

D
The intercostobrachial nerve (T2) is purely sensory and supplies a variable amount of skin on the inner aspect of axilla and upper arm. It crosses the axilla after emerging from the second intercostal space in the midaxillary line. It runs within axillary fat to the upper arm, surrounded by lymph nodes of the axilla. It can be preserved during axillary clearance; but this usually involves compromising the dissection somewhat, and the nerve is usually excised with the specimen in a complete therapeutic axillary clearance. Patients should be warned to expect an area of anaesthesia, which diminishes gradually with time.

Question 7

21603 – The first thoracic spinal nerve
1: supplies fibres to the musculocutaneous nerve
2: supplies the parietal pleura of the first intercostal space
3: carries postganglionic sympathetic fibres to the upper limb
4: is the largest of the thoracic nerves

Answer 7

FTTT
Last 10th ed. PAGE: 50; 176; 205
T1 supplies :

divides into 2 branches,
- first branch enters the brachial plexus and supplies upper limb ulnar and median nerve. as well as med pectoral nerve, med brachial cut and med antebrachial cut
- second branch becomes the first intercostal nerve runs along first intercostal spcae supplying pleura,
- part of somatic nervous system

Question 8

21413 – Fibres from the first thoracic segment of the spinal cord supply
1: the intrinsic muscles of the hand
2: the dilator pupillae muscle of the iris
3: sweat glands on the face
4: part of the levator palpebrae superioris muscle

Answer 8

TTTT
Last PAGE: 063

Question 9

21113 – The upper trunk of the brachial plexus
1: forms behind the scalenus medius muscle
2: is covered anteriorly by the prevertebral fascia
3: gives off the dorsal scapular nerve
4: lies anterior to the cervical sympathetic trunk

Answer 9

FTFF
Last 9th p66
The roots C5 and C6 join at the lateral border of scaleunus medius to form the upper trunk and the roots C8 and T1 join behind scalene anterior to form inferior trunk.

Brachial plexus is contained in prevertebral fascia and becomes continuous with the axillary sheath.

Dorsal scapular nerve is from roots C5 not trunk

Cervical sympathetic trunk lies anterior to scalenus anterior

Question 10

20067 – S. In a lesion of the upper trunk of the brachial plexus function of levator scapulae and rhomboids may be preserved BECAUSE R. the dorsal scapular nerve arises from the root of C5

Answer 10

S is true, R is true and a valid explanation of S
Last 10th Edition, pages 50, 51, 89

Question 11

20637 – S. Division of the upper trunk of the brachial plexus will produce weakness of shoulder abduction BECAUSE R. the suprascapular, subscapular, and axillary nerves arise from the posterior cord

Answer 11

S is true and R is false
Last 10th Edition, page 50
Subscapular and axillary arise from posterior cost but suprascapular arises from upper trunk

Question 12

20799 – S. A lesion involving the C5 and C6 nerve roots does not result in loss of abduction at the shoulder BECAUSE R. the C5 and C6 nerve roots are distributed to the muscles which produce flexion at the elbow

Answer 12

S is false and R is true
Last 10th Edition, pages 50, 51
C5,6 - musculocutaneous which supplies biceps and brachialis

Question 13

22294 – Branches from the medial cord of the brachial plexus include
1: the upper subscapular nerve
2: the medial pectoral nerve
3: the medial cutaneous nerve of the forearm
4: the musculo-cutaneous nerve

Answer 13

FTTF
Last 9th p67
Branches of medial cord:
- medial pectoral n
- (median root of) median n
- medial cutaneous nerve of arm
- medial cutaneous nerve of forearm
- ulnar n

Question 14

20757 – S. Division of the lateral cord of the brachial plexus at its origin will produce some weakness of adduction of the arm Because R. division of the lateral cord of the brachial plexus at its origin results in loss of function in the medial pectoral nerve

Answer 14

S is true and R is false
Last 9th p 67
lateral pectoral nerve (from lat cord) is responsible for adduction of arm

Question 15

7748 – S: In tetraplegia sparing the C6 root but complete below that, the power of elbow extension is preserved because R: triceps is supplied by the C5 and C6 roots

Answer 15

Both S and R and false
Last 9th p67
Triceps are supplied by radial nerve which is C5-C8 however triceps supplied by C7/8

Question 16

14884 – S: The axillary vein lies external to the axillary sheath because R: the subclavian vein passes anterior to the prevertebral fascia,
from which the axillary sheath is derived

Answer 16

S is true, R is true and a valid explanation of S
Refer to Last, 10th Ed, page 323

Question 17

1948 – Scapular muscles contributing to the rotator cuff
1: are supplied by nerves arising from upper trunk and posterior cord
2: are attached to the capsule of the shoulder joint
3: are the principal muscles involved in lateral rotation at the shoulder
4: act to brace the head of the humerus against the glenoid fossa

Answer 17

TTTT
Last 10th Edition, pages 42-46.

Question 18

21138 – Lateral rotation of the arm at the glenohumeral joint is
1: an associated movement in abduction of the upper arm at the glenohumeral joint
2: produced by the contraction of muscles supplied by the fifth cervical spinal nerve
3: produced by the contraction of the infraspinatus muscle
4: produced by the contraction of the subscapularis muscle

Answer 18

TTTF
Last 10th Edition, pages 42-44
2 - dorsal scapular nerve

Question 19

21118 – The infraspinatus muscle
1: is covered, along with teres major, by a dense fascial membrane
2: is inserted anterior to the supraspinatus tendon
3: is a medial rotator of the humerus
4: is supplied by the subscapular nerve

Answer 19

FFFF
Last 10th Edition, page 43
INFRASPINATUS
Arises - medial three quarters of infraspinous fossa of scapula and fibrous intermuscular septa
inserts - Middle facet of greater tuberosity of humerus and capsule of shoulder joint.
Nerve - suprascapular nerve C56 from upper trunk
Bursa under tendon over glenoid angle, tendon forms part of rotator cuff

Question 20

19845 – The muscle pair which most often assists in elevating the arm above the head is the
A. trapezius and pectoralis minor
B. levator scapulae and serratus anterior
C. rhomboid major and serratus anterior
D. rhomboid major and levator scapulae
E. trapezius and serratus anterior

Answer 20

E
Last 10th Edition, pages 46, 47

Question 21

21108 – The serratus anterior
1: is supplied by the thoraco-dorsal nerve
2: is a retractor of the scapula
3: helps in elevating the arm above shoulder level
4: is a medial rotator of the scapula

Answer 21

FFTF
Last 10th Edition, page 40
Serratus Anterior
Arises: Upper 8 ribs and anterior intercostal membranes from midlavicular line. Lower four interdigitating with external oblique
Inserts: inner medial border of scapular. 1+2 upper angle. 3-4 lengths of costal surface. 5-8 inferior angle
Action: Laterally rotates and protracts scapula
Nerve - long thoracic nerve C567. R1+2 C5, 3-5 C6, 5-8 C7

1 - long thoracic nerve
2 - protracts scapula
3 -
4 - lateral rotation

Question 22

24034 – The deltoid muscle
1: consists of short multipennate fibres in its central part
2: has an origin which includes the upper surface of the lateral third of the clavicle
3: has the cephalic vein lying medial to its anterior edge
4: is supplied by nerve fibres from the C6 root only

Answer 22

TTTF
Last 10th Edition, page 44
DELTOID
arises - lateral third of clavicle, acromion, spine of scapula to deltoid tubercle
Inserts - Middle of lateral surface of humerus (deltoid tuberosity)
Action - abducts arm, anterior fibres flex and medially rotate, posterior fibres extend and laterally rotate
Nerve - Axillary, NC56, from posterior cord

Question 23

21133 – The deltoid muscle (or part of it) assists in
1: flexion of the arm at the glenohumeral joint
2: abduction of the arm at the glenohumeral joint
3: extension of the arm at the glenohumeral joint
4: steadying the arm in the abducted position

Answer 23

TTTT
Last 10th Edition, page 44

Question 24

22524 – The scapula
1: is raised upwards on the chest wall by the trapezius muscle
2: ossifies in membrane
3: has rhomboid major muscle attached from the inferior angle to the base of the scapular spine
4: has the glenoid fossa facing directly lateral

Answer 24

TFTF
Last 10th Edition, pages 95-97
2 - ossifies in cartilage

Question 25

21158 – The scapula
1: has the latissimus dorsi muscle attached to its inferior angle
2: is moved forwards on the chest wall by the serratus anterior muscle
3: has a glenoid angle developed from two centres of ossification
4: is rotated by the trapezius muscle so that the glenoid faces upwards

Answer 25

TTTT
Last 10th Edition, page 95

Question 26

22274 – The acromio-clavicular joint
1: lies anterior to the origin of the coraco-acromial ligament
2: is a synovial joint with a fibro cartilaginous disc
3: has a strong capsule
4: relies upon the conoid and trapezoid ligaments for stability

Answer 26

FTFT
Last 10th Edition, page 41.

Question 27

19857 – Which of the following structures is not attached to the coracoid process of the scapula
A. short head of biceps brachii muscle
B. trapezoid ligament
C. pectoralis minor muscle
D. a major anterior stabilizer of the glenohumeral joint
E. subclavius muscle

Answer 27

E
Last PAGE: 113
Corocoid
- Pec minor
- coracobracialis
- short head of biceps
- trapezoid lig
- coracoclavicular lig
- coracoacromial lig
- coracohumeral lig
- glenogoracoid ligament

Question 28

19000 – The transverse scapular ligament (transverse ligament of the scapular notch)
A. often lies above the suprascapular artery
B. usually gives partial origin to the omohyoid muscle
C. is a thickened portion of the axillary fascia
D. can be attached to the spine of the scapula
E. often lies below the suprascapular nerve

Answer 28

B
Last 10th Edition, page 44
converts the suprascapular notch into a foramen
- suprascapular nerve runs through the foramen.
- suprascapular vessels cross over

Question 29

8505 – The long thoracic nerve
1: lies on the serratus anterior muscle
2: is accompanied by the subscapular artery
3: runs behind the first part of the axillary artery
4: contains fibres from spinal segment C8

Answer 29

TFTF
Last 10th ed, Ch 2
4 - C5,6,7
descends posterior to the trunks of the plexus and the first part of the axillary artery to lie on the lateral aspect of serratus anterior on the medial axillary wall

Question 30

20571 – S. Dissection of lymph nodes near the subscapular artery may result in paralysis of the latissimus dorsi muscle BECAUSE R. the lower subscapular nerve supplies the latissimus dorsi muscle

Answer 30

S is true and R is false
Last 10th Edition, page 51
latissimus dorsi supplied by thoracodorsal n, C6,7,8

Question 31

22829 – The quadrilateral space
1: lies in the posterior wall of the axilla
2: is bounded by subscapularis and teres major
3: is bounded by the humerus laterally and the long head of triceps medially
4: transmits the axillary nerve and anterior circumflex humeral artery

Answer 31

TTTF
Last PAGE: 62
4 - posterior circumflex humeral artery

Question 32

23149 – In the arm
1: brachialis may be partly innervated by the radial nerve
2: the radial nerve pierces the lateral intermuscular septum below the origin of brachio-radialis
3: the ulnar nerve pierces the medial intermuscular septum below the insertion of coraco-brachialis
4: the lateral cutaneous nerve of the forearm is given off by the radial nerve in the spiral groove

Answer 32

TFTF
Last 10th Edition, pages 55-60
2 - above origin of brachio-radialis
4 - musculocutaneous nerve

Question 33

19521 – Which of the following muscles is NOT a medial rotator of the humerus at the shoulder joint?
A. pectoralis major
B. latissimus dorsi
C. teres major
D. teres minor
E. subscapularis

Answer 33

D
Last 10th Edition, pages 43, 44

Question 34

21168 – The lesser tuberosity of the humerus
1: gives attachment to the coracohumeral ligament
2: is ossified from the diaphysis
3: gives attachment to the infraspinatus muscle
4: gives attachment to the transverse ligament covering the long tendon of the biceps

Answer 34

FFFT
Last 10th Edition, page 98
Lesser tuberosity of humerus
- Subscapularis
- transverse ligament of the shoulder

Question 35

21183 – With respect to the arm
1: the musculo-cutaneous nerve passes between the two heads of the biceps muscle
2: the median and ulnar nerves have no branches in the arm
3: the radial nerve supplies the brachialis, coraco-brachialis and brachio-radialis muscles in the arm
4: the median nerve crosses the brachial artery from lateral to medial

Answer 35

FTFT
Last 10th Edition, pages 56-58.
1 - passes between two heads of coracobrachialis
3 - Brachialis (MSK sometimes R) , coracobrachialis MSK, Brachioradialis - R)

Question 36

21163 – The humerus
1: has a lesser tuberosity continuous with the medial lip of the bicipital groove
2: has a greater tuberosity which projects lateral to the acromion process
3: has a medial epicondyle whose ossific centre appears around the age of 5 years
4: has a capitulum whose ossific centre appears around the age of 2 years

Answer 36

TTTT
Last 10th Edition, page 98

Question 37

12470, 19869 – The humerus has
A. a greater tuberosity located medial to the lesser tuberosity
B. the capsule of the shoulder joint attached along its entire anatomical neck
C. a capitulum which articulates with the olecranon process
D. a covering of synovial membrane over its head
E. a greater tuberosity which projects further laterally than the acromion process of the scapula

Answer 37

E
Last 10th Edition, pages 98, 99. T
he greater tuberosity lies lateral to the lesser, separated from it by the bicipital groove (A false). The capsule is not attached to the anatomical neck of the humerus inferiorly (B false). The capitulum articulates with the radial head (C false). The synovial membrane is reflected at the articular margins, and does not cover the head (D false). The greater tuberosity projects further laterally (E true) than the acromion, and can be so palpated in the living subject.

Question 38

7754 – The upper end of the humerus
1: has the subscapularis muscle attached to the greater tuberosity
2: has three epiphyses each of which fuses separately with the shaft
3: grows for a longer period than the lower end
4: has the capsular ligament of the glenohumeral joint attached to the whole of the anatomical neck

Answer 38

FFTF
Last 10th ed, Ch 2, pages 98-100
1 - lesser tuberosity
4 - The capsule is not attached to the anatomical neck of the humerus inferiorly

Question 39

21173 – The lower end of the humerus
1: develops four secondary centres of ossification
2: is cartilaginous at birth
3: has part of the pronator teres muscle attached to it
4: gives origin to the common extensor muscles from the posterior surface of the lateral epicondyle

Answer 39

TTTF
Last 10th Edition, pages 98-100
1 - med and lat epicondyle, capitulum, trochlea
4 - anterolateral surface of lateral epicondyle

Question 40

19486 – The medial intermuscular septum of the arm
A. is often pierced by the basilic vein
B. often gives part origin to the long head of triceps
C. may be pierced by the ulnar collateral artery
D. may be pierced by the radial nerve
E. may be pierced by the median nerve

Answer 40

C
Last 10th Edition, page 55
The medial intermuscular septum, extends from the lower part of the crest of the lesser tubercle of the humers below teres major and passes along medial supracondylar ridge to medial epicondyle. blended with tendon of coracobrachialis and gives attachement to the triceps brachii behind the brachialis in front. perforated by ulnar nerve and the superior ulnar collateral artery and the posterior branch of inferior ulnar collateral artery

Lateral intermuscular septum extends from lower part of crest of the greater tubercle of the humerus along the lataeral supraconduylar ridge to the lateral epicondyle. blended with the tendon of the deltoid muscle. gives attachment to triceps brachi behind, and in front: brachialis, brachioradialois, and ECRL. perforated by the radial nerve and profunda branch of the brachial artery

Question 41

0583 – S. Injury to structures running in the spiral groove of the humerus may produce sensory change on the extensor surface of the forearm proximal to the wrist BECAUSE R. this area of skin is supplied by the superficial division of the radial nerve

Answer 41

Answer: S is true and R is false
Last 10th Edition, page 53
posterior cutaneous nerve of forearm (not the superficial radial nerve which supplies dorsal hand skin and lateral 31/2 digits short of the nail beds

Question 42

19863 – Which one of the following nerves is NOT directly related to the humerus?
A. the radial nerve
B. the ulnar nerve
C. the nerve to the lateral head of the triceps muscle
D. the axillary nerve
E. the median nerve

Answer 42

E
Last 10th Edition, page 57

Question 43

21153 – Division of the radial nerve in the spiral groove of the humerus will produce
1: inability to extend the wrist
2: loss of sensation on the dorsum of the radial three and a half digits and the web of the thumb
3: inability to extend the interphalangeal joint of the thumb
4: inability to extend the interphalangeal joints of the fingers

Answer 43

TFTF
Last 9th Ed., p126.
4 - the interphalangeal joints can still be straightened by the action of the interossei and lumbricals

Question 44

24274 – Division of the musculocutaneous nerve may result in
1: weakness of supination
2: anaesthesia of the lateral side of the forearm extending to the interphalangeal joint of the thumb
3: weakness of elbow flexion
4: weakness of adduction at the shoulder

Answer 44

TFTT
Last 9th p126
musculocutaneous - supplying biceps and brachialis, becomes the lateral cutaneous nerve of forearm
1 - due to weakness of brachialis
2 - lateral cutaneous nerve supplies by radial n also hence no weakness
3 - long and short head of biceps

Question 45

12763 – The brachial artery
1: lies medial to the biceps tendon in the cubital fossa
2: is crossed in the mid-upper arm from medial to lateral side by the median nerve
3: divides at the level of the radial tuberosity into its terminal branches
4: has the basilic vein lateral to it

Answer 45

TFTF
The brachial artery is palpable in the cubital fossa medial to the tendon of biceps (A true). In the midupper arm the median nerve crosses the artery from the lateral to medial side (B false). The artery usually divides at the level of the radial tuberosity (C true). The basilic vein is medial to the artery and pierces the deep fascia to run with the artery from mid-arm level (D false).

Question 46

21818 – The cephalic vein
1: in the distal arm, lies medial to the muscle belly of biceps
2: in the forearm, runs in the superficial fascia along the pre-axial border of the limb
3: in the proximal arm, lies under the deep fascia in the delto-pectoral groove
4: ends by joining the subclavian vein

Answer 46

FTTF
Last 10th Edition, page 68.
- runs radially in distal anterior arm
- Communicates with the median cubital vein at the elbow.
- Located in the superficial fascia along the anterolateral surface of the biceps.
- passes between the deltoid and pectoralis major in the deltopectoral groove, through the clavipectoral triangle and empties into the axillary vein.

Question 47

22289 – Muscles arising from the radial collateral ligament of the elbow joint include
1: the flexor digitorum superficialis
2: the brachio-radialis
3: the anconeus
4: the supinator

Answer 47

FFFT
Last 10th Edition, pages 70, 72

Question 48

21027 – S. Division of the median nerve in the cubital fossa will produce weakness of supination of the forearm BECAUSE R. supinator is supplied by the anterior interosseous division of the median nerve

Answer 48

Answer: both S and R and false
Last 10th Edition, page 94
supplied by posterior interosseous which is a branch of the radial nerve
- passes between two heads of supinator three fingers breadth below radial head passing to the posterior compartment where it breaks into terminal branches between deep and superficial muscles

Question 49

18838 – Concerning the ulna
A. the majority of growth takes place at the distal epiphyseal plate
B. ossification of the distal epiphyseal centre occurs in foetal life
C. the deep head of pronator teres arises from the medial border of the olecranon
D. the inferior articular facet articulates directly with the triquetrum
E. the annular ligament is attached to the ulnar shaft just below the radial notch

Answer 49

A
Last’s 9th Ed., p139.

Question 50

25973 – The brachioradialis
1: arises from the lateral epicondyle of the humerus
2: is a weak pronator of the supinated forearm
3: is supplied by the posterior interosseous nerve
4: is inserted into the base of the styloid process of the radius

Answer 50

FTFT
Last 10th Edition, page 70
Arises - lateral supracondylar ridge of humerus and lateral intermuscular septum.
inserts - base of styloid process of radius
action - flexes arm at elbow and brings forearm into midprone position (weak pronator)
nerve - radial
- overlies radial nerve and artery as they lie on supinator

Question 51

20013 – The flexor carpi radialis muscle
A. often arises from the lateral epicondyle of the humerus
B. may be inserted into the scaphoid
C. often has a tendon which lies lateral to the radial artery
D. can be supplied by the anterior interosseous nerve
E. may have a tendon that lies in its own tunnel in the flexor retinaculum

Answer 51

E
Last 10th Edition, page 61.
common flexor origin - medial epicondyle of humerus
inserts - base of second and third MC’s via groove in trapezium.
action - flexes and abducts wrist
nerve - median nerve (median and lateral cords)

Question 52

7829 – The extensor carpi radialis longus
1: is supplied by the posterior interosseous nerve
2: is inserted into the base of the third metacarpal bone
3: lies superficial to the tendon of abductor pollicis longus
4: arises from the lateral epicondyle of the humerus

Answer 52

FFFF
Last 10th ed, Ch 2, page 71
arises - lateral supracondylar ridge and lateral intermuscular septum
inserts - posterior base of second metacarpal
action - extends and abducts hand at wrist
nerve - radial N

Question 53

2768 – Extensor carpi ulnaris
1: originates partly from the subcutaneous border of the ulna
2: is inserted into the fifth metacarpal bone
3: is supplied by the posterior interosseous nerve
4: is inserted partly into the triquetrum

Answer 53

TTTF
Extensor carpi ulnaris is supplied by the posterior interosseous nerve (C true). It has a humeral and an ulnar origin via an aponeurosis from the posterior subcutaneous border of the ulna (A true). It is inserted into the base of the fifth metacarpal bone (B true). It is not inserted into the triquetrum (D false).

Question 54

20277 – S. The extensor digitorum is a comparatively weak extensor of the inter-phalangeal joints of the fingers when the interossei are paralysed BECAUSE R. most of the pull of the extensor digitorum is expended in hyperextension of the metacarpophalangeal joints when the interossei are paralysed

Answer 54

S is true, R is true and a valid explanation of S
Last 8th ed. PAGE: 120

Question 55

19851 – The posterior interosseous nerve
A. does not contain afferent fibres
B. winds around the medial side of the radial neck
C. does not supply extensor carpi ulnaris
D. usually supplies brachioradialis
E. supplies the supinator

Answer 55

E
Last 10th Edition, page 74

Question 56

20577 – S. Division of the posterior interosseous nerve at its origin causes weakness of extension of the wrist BECAUSE R. the posterior interosseous nerve supplies the extensor carpi radialis longus muscle

Answer 56

Answer: S is true and R is false
Last 10th Edition, page 74
ECRL supplied by radial nerve but not PIN
PIN supplies
ECRB, ED, EDM, ECU, Abd pol long, EPB, EPL extensor indices

Question 57

20643 – S. Grip deteriorates after division of the posterior interosseous nerve BECAUSE R. no extension of the wrist is possible after division of the posterior interosseous nerve

Answer 57

S is true and R is false
Last 10th Edition, page 74
Most extension/abd pollucis longus, supplied by PIN but not all grip related.

Question 58

12758 – The radial nerve
1: supplies extensor carpi radialis longus and brevis above the elbow joint
2: gives off the posterior cutaneous nerve of the forearm in the axilla
3: gives off the posterior interosseous nerve which is entirely muscular
4: passes deep to the tendon of brachio-radialis and superficial to the tendons of the anatomical snuff box

Answer 58

FFFT
The extensor carpi radialis brevis is supplied by the posterior interosseous nerve (A false). The posterior cutaneous nerve of the forearm is given off in the spiral groove (B false). The posterior interosseous nerve is sensory to the interosseous membrane, periosteum of radius and ulna and the wrist and carpal joints on their extensor surfaces (C false). The radial nerve lies to the radial side of the radial artery under cover of brachioradialis, and passes backwards under the tendon 5 cm above the radial styloid. Its terminal branches run superficial to the tendons of the anatomica snuff box and can be rolled over the taut tendon of extensor pollicis longus (D true).

Question 59

19527 – Division of the median nerve above the elbow often causes total loss of active
A. flexion of the wrist
B. flexion of all proximal interphalangeal joints
C. abduction of the index finger
D. flexion of the interphalangeal joint of the thumb
E. extension of the thumb

Answer 59

D
Last 10th Edition, page 94
A - doesn’t do all flexion (ulnar),
B- doesn’t do all,
C - PAD, DAB, dorsal interossei - ulnar
D- median nerve does flex pol long and brev
E.- extension is radial nerve

Question 60

12753 – The ulnar nerve
1: often picks up fibres of the seventh cervical spinal nerve from the lateral cord of the brachial plexus in the axilla
2: enters the forearm by passing between the two heads of the extensor carpi ulnaris muscle
3: runs parallel and medial to the ulnar artery in the forearm
4: has a terminal superficial branch which is entirely sensory

Answer 60

TFTF
The ulnar nerve arises from the medial cord of the brachial plexus (C8, T1) and in 90% of cases receives a branch in the axilla from the lateral cord (C6, 7) which supplies the motor branch to flexor carpi ulnaris (A true). The nerve enters the forearm by passing between the two heads of the flexor carpi ulnaris muscle (B false). It gives no branches in the arm; in the forearm it supplies flexor carpi ulnaris and part of flexor digitorum profundus. The ulnar artery inclines medially to join the nerve and runs parallel to it an on its lateral side on flexor digitorum profundus (C true). The terminal superficial branch supplies palmaris brevis as well (D false).

Question 61

22073 – During the surgical exposure of the ulnar nerve in Guyon’s canal (at the wrist)
1: a slender band of fascia over the flexor retinaculum must be divided
2: division of the nerve does not affect sensation in the little finger
3: the ulnar artery lies on the radial aspect
4: the nerve lies on the ulnar border of the pisiform

Answer 61

TFTF
Last 10th Edition, page 93

Question 62

22284 – Division of the ulnar nerve at the level of the pisiform will produce
1: weakness of adduction of the fingers
2: loss of sensation on the dorsal skin of little and half ring fingers, over the proximal phalanx
3: loss of sensation on the volar skin of little and half ring fingers, over the proximal phalanx
4: weakness of abduction of the thumb

Answer 62

TFTF
Last 10th Edition, page 69
2 - sensation on the dorsum is unaffected because the dorsal branch of the ulnar nerve passes on to the dorsal aspect proximal to the head of the ulna

Question 63

20061 – S. When the ulnar nerve is divided at the level of the pisiform bone, sensation on the dorsum of the hand is unaffected BECAUSE R. the dorsal branch of the ulnar nerve passes on to the dorsal aspect proximal to the head of the ulna

Answer 63

S is true, R is true and a valid explanation of S
Last PAGE: 109

Question 64

21178 – In relation to the carpus
1: the carpal bones are all ossified at birth
2: the flexor retinaculum is attached medially to the pisiform and hamate
3: the range of extension at the radiocarpal joint is greater than the range of flexion
4: the tubercle of the scaphoid lies medial to the tendon of the flexor carpi radialis

Answer 64

FTTF
Last 10th Edition, page 103

Question 65

20223 – S. A fracture across the waist of the scaphoid bone may result in
avascular necrosis of the proximal fragment BECAUSE R. the blood vessels to the scaphoid bone from its dorsal surface are more numerous distally than proximally

Answer 65

S is true, R is true and a valid explanation of S
Last 10th Edition, page 103

Question 66

27402 – A 27-year-old man presents to the Emergency Department with a wound of the flexor aspect of the left wrist due to a slash from a knife in a brawl, and the appearance is as illustrated.
1: Inability to flex the terminal joint of the index finger will confirm that the median nerve has been divided.
2: Inability to flex the terminal joint of the little finger will confirm that the ulnar nerve has been divided.
3: Transection of the median nerve would render it impossible to demonstrate on clinical examination whether flexor carpi radialis tendon has been divided.
4: The deformities of index and middle fingers are due to division of the median nerve.
5: Absence of sweating over the radial three digits on their volar surfaces would suggest median nerve injury.

Answer 66

FFFFT
median and ulnar n give off branches to supply muscles before reaching wrist - 1, 2 and 3 not relevant
test for nerve injury by sensation +/- sweating as stated in 5

Question 67

20517 – S. A penetrating wound of the wrist at the level of the distal wrist crease just to the radial side of the median nerve, and entering the scaphoid bone may result in weakness of pinch grip BECAUSE R. adductor pollicis is supplied by the deep branch of the ulnar nerve

Answer 67

S is true, R is true but not a valid explanation of S
Last 10th Edition, page 83

Question 68

21738 – Flexor pollicis longus
1: derives its nerve supply directly from the median nerve
2: has some fibres of origin from the coronoid process of the ulna
3: passes through the carpal tunnel superficial to the median nerve
4: has some origin from the interosseous membrane

Answer 68

FTFT
Last’s 10th Ed., p91.
Arises anterior surface of radius below anterior oblique line and adjacent interosseous membrane
inserts - base of distal phalanx of thumb.
Nerve - ant interosseous

Question 69

14122 – The abductor pollicis longus
1: arises partly from the ulna
2: is inserted into the base of the first metacarpal
3: may send a slip to the abductor pollicis brevis at its insertion
4: is supplied by the posterior interosseous nerve

Answer 69

TTTT
Refer to Last, 10th Ed, page 73
Abductor pollicis longus
Arises - upper post surface of ulnar and middle third of posterior surface of radius, and interosseous membrane between
inserts - over tendons of radial extensors and brachioradialis to base of first MC and trapezium
nerve PIN
forms radial side of snuffbox

Question 70

12578, 21021 – S: The head of the ulna articulates with bones of the proximal row of the carpus because R:the cavity of the wrist joint is usually continuous with the cavity of the inferior radio-ulnar joint

Answer 70

: both S and R and false
Last 10th Edition, page 75.
The head of the ulna articulates with the proximal surface of the triangular fibrocartilage, or articular disc, which is normally a complete, intact structure although it may become perforated in the elderly. The inferior radio-ulnar joint is thus normally quite separate from the wrist joint.

Question 71

7640 – The surface marking of the radio carpal joint is often
A. at the distal skin crease of the wrist
B. at the proximal skin crease of the wrist
C. 1cm proximal to the proximal skin crease of the wrist
D. 1cm distal to the distal skin crease of the wrist
E. midway between the proximal skin crease of the wrist and the hook of the hamate

Answer 71

Answer: B
Last 10th ed, Ch 2

Question 72

14952 – To demonstrate the surface marking of the flexor retinaculum it would be relevant to seek the position of the
1: proximal flexion crease of wrist
2: styloid process of ulna
3: styloid process of radius
4: pisiform bone

Answer 72

FFFT
Refer to Last, 10th Ed, page 78
On the ulnar side, the flexor retinaculum attaches to the pisiform bone and the hook of the hamate bone.
On the radial side, it attaches to the tubercle of the scaphoid bone, and to the medial part of the palmar surface and the ridge of the trapezium bone (crest of trapezium)

Question 73

20973 – S. Compression of structures within carpal tunnel results in the weakness of the adductor pollicis muscle BECAUSE R. the oblique head of the adductor pollicis muscle is supplied by the median nerve

Answer 73

both S and R and false
Last PAGE: 96
adductor pollicis
Arises - oblique head is the base of second and third metacarpals, trapezoid and capitate.
Transverse head - palmar border and shaft of third metacarpal
- nerve - Deep branch of ulnar to both heads

Question 74

23139 – Structures passing deep to the flexor retinaculum include
1: the ulnar artery
2: the palmar branch of the median nerve
3: the tendon of flexor carpi radialis
4: the dorsal branch of the ulnar nerve

Answer 74

FFTF
Last 10th Edition, page 78

Question 75

12773, 24284 – The digitations of the palmar aponeurosis are attached to the
1: deep transverse ligaments of the palm
2: fibrous flexor sheaths of the fingers
3: bases of the proximal phalanges of the fingers
4: common flexor synovial sheath

Answer 75

TTTF
Last 10th Edition, page 77.
Each digitation of the palmar aponeurosis divides into two bands over the proximal end of the fibrous flexor sheath. They are inserted into the deep transverse ligaments of the palm, into the fibrous flexor sheath of the fingers, and into the sides of the proximal phalanges of the fingers (A,B,C true). The synovial sheath is not attached to the palmar aponeurosis (D false).

Palmar aponeurosis (palmar fascia) invests the muscles of the palm and consists of central, lateral and medial portions.
Central - receives the palmaris longus
apex - continuous with lower margin of transverse carpal ligament
base - sends four slips one for each finger. superficial fibres to skin of palm and finger. at furrow corresponding to MCP articulation.
deeper part subdivides into two processes inserting into fibrous sheaths of flexor tendons. and to transverse metacarpal ligament.

Question 76

21143 – The palmar aponeurosis
1: is continuous with the palmaris longus
2: overlies the adductor pollicis brevis
3: sends a slip to each of the four fingers
4: is crossed by the ulnar artery

Answer 76

TFTF
Last 10th Edition, pgs 77 & 81.

Question 77

21148 – The midpalmar space
1: is covered superficially by fascia lying deep to common synovial sheath and flexor tendons
2: has sides formed by septa dipping in from the margins of the palmar aponeurosis
3: connects distally with the ulnar three lumbrical canals
4: is floored by the interossei and metacarpals of the third and fourth spaces

Answer 77

TTTT
Last 10th Edition, page 86. This
midpalmar space containes the 2nd 3rd and 4th lumbrical muscles and lies posterior to the long flexor tendons to the middle, ring and little fingers.
it lies in front of the interossei and the 3rd 4th and 5th metacarpal bone

Question 78

15212 – Which of the following is NOT a property of the first dorsal interosseous muscle in the hand?
A. it is usually supplied by the ulnar nerve
B. it extends the proximal interphalangeal joint of the index finger
C. it passes in front of the deep transverse metacarpal ligament
D. it abducts the index finger
E. it is dorsal to the transverse head of the adductor pollicis muscle

Answer 78

C
Refer to Last, 10th Ed, Ch 2, page 83-84

Question 79

7349 – S Hyperextension of the metacarpophalangeal joint of the little finger occurs in ulnar nerve lesions at the wrist Because R the interosseous and lumbrical muscles which go to the little finger are supplied by the ulnar nerve

Answer 79

S is true, R is true and a valid explanation of S
Last 10th Edition, pages 82 & 94.
The ‘ulnar claw hand’ is a deformity developing some time after an ulnar nerve lesion at the wrist (or at a higher level); and involves clawing of the little and ring finger with hyper-extension at the metacarpophalangeal joints. All the interossei muscles, including those to the little finger, together with the lumbrical muscles to the little and ring fingers, are supplied by the
ulnar nerve. The weakness of flexion of the metacarpophalangeal joint due to paralysis of the fourth lumbrical and of the interossei to the little finger causes hyperextension of the metacarpophalangeal
joint due to unopposed action of the extensor digitorum communis and extensor digiti minimi.

Question 80

15302 – With regard to movements of the fingers
1: flexion at the distal interphalangeal joints of all the digits is lost if the ulnar nerve is cut at the elbow
2: movement of the index finger in a radial direction is produced by the first dorsal interosseous muscle
3: extension at the metacarpophalangeal joints is effected by the dorsal interosseous muscles
4: flexion at the metacarpophalangeal joints, while there is extension at the interphalangeal joints, is produced by the interossei muscles

Answer 80

FTFT
Last’s 9th Ed., p120.
In ulnar palsy all the interossei are paralysed but the lumbricals of only the little and ring fingers are out of action. The claw hand of ulnar paralysis affects these fingers most, index and middle fingers being less affected because their lumbrical muscles are intact (median nerve).

Question 81

12464 – The sharp borders of the middle phalanx of the index finger give attachment to
A. the tendon of flexor digitorum profundus muscle
B. the oblique retinacular ligaments
C. the fibrous flexor sheath
D. the long vinculum of the flexor digitorum profundus tendon
E. the short vinculum of the flexor digitorum profundus tendon

Answer 81

C
The tendon of flexor digitorum profundus muscle, which is inserted into the base of the distal phalanx on its flexor aspect, has no attachment to the middle phalanx (A false). The oblique retinacular ligaments pass from the palmar aspect of the fibrous flexor sheath to join the lateral band of the extensor expansion (B false). The sheath itself takes part of its origin from the sharp borders of the middle phalanx (C true). The vinculum longum of the flexor digitorum profundus tendon is attached to the palmar surface of the proximal phalanx just proximal to the proximal interphalangeal joint, and the vinculum breve to the capsule of the distal interphalangeal joint (D and E false).