Upper Limb Flashcards
A 45-year-old woman is being examined as a candidate for cosmetic breast surgery. The surgeon notes that both of her breasts sag considerably. Which structure(s) has most likely become stretched to result in this condition?
A. Scarpa’s fascia B. Pectoralis major muscle C. Pectoralis minor muscle D. Suspensory (Cooper’s) ligaments E. Serratus anterior muscle
D. Suspensory (Cooper’s) ligaments
A 27-year-old man was admitted to the emer- gency department after an automobile collision in which he suffered a fracture of the lateral border of the scapula. Six weeks after the accident, physical examination reveals weakness in medial rotation and adduction of the humerus. Which nerve was most likely injured?
A. Lower subscapular B. Axillary C. Radial D. Spinal accessory E. Ulnar
A. Lower subscapular
A 48-year-old female court stenographer is admitted to the orthopedic clinic with symptoms of carpal tunnel syndrome, with which she has suffered with for almost a year. Which muscles most typically become weakened in this condition?
A. Dorsal interossei B. Lumbricals III and IV C. Thenar D. Palmar interossei E. Hypothenar
C. Thenar
A 45-year-old man arrived at the emergency department with injuries to his left elbow after he fell in a bicycle race. Plain radiographic and magnetic resonance imaging (MRI) examinations show a fracture of the medial epicondyle and an injured ulnar nerve. Which of the following muscles will most likely be paralyzed?
A. Flexor digitorum superficialis B. Biceps brachii C. Brachioradialis D. Flexor carpi ulnaris E. Supinator
D. Flexor carpi ulnaris
While walking to his classroom building, a first- year medical student slipped on the wet pavement and fell against the curb, injuring his right arm. Radiographic images showed a mid-shaft fracture of the humerus. Which pair of structures was most likely injured at the fracture site?
A. Median nerve and brachial artery
B. Axillary nerve and posterior circumflex
humeral artery
C. Radial nerve and deep brachial artery
D. Suprascapular nerve and artery
E. Long thoracic nerve and lateral thoracic artery
C. Radial nerve and deep brachial artery
An 18-year-old man is brought to the emergency department after an injury while playing rugby. Imaging reveals a transverse fracture of the humerus about 1 inch proximal to the epicondyles. Which nerve is most frequently injured by the jagged edges of the broken bone at this location?
A. Axillary B. Median C. Musculocutaneous D. Radial E. Ulnar
B. Median
A 52-year-old female band director suffered problems in her right arm several days after strenuous field exercises for a major athletic tournament. Examination in the orthopedic clinic reveals wrist drop and weakness of grasp but normal extension of the elbow joint. There is no loss of sensation in the affected limb. Which nerve was most likely affected?
A. Ulnar B. Anterior interosseous C. Posterior interosseous D. Median E. Superficial radial
C. Posterior interosseous
A 32-year-old woman is admitted to the emergency department after an automobile collision. Radiologic examination reveals multiple fractures of the humerus. Flexion and supination of the forearm are severely weakened. She also has loss of sensation on the lateral surface of the forearm. Which of the following nerves has most likely been injured?
A. Radial B. Musculocutaneous C. Median D. Lateral cord of brachial plexus E. Lateral cutaneous nerve of the forearm
B. Musculocutaneous
A 24-year-old female medical student was bitten at the base of her thumb by her dog. The wound became infected and the infection spread into the radial bursa. The tendon(s) of which muscle will most likely be affected?
A. Flexor digitorum profundus B. Flexor digitorum superficialis C. Flexor pollicis longus D. Flexor carpi radialis E. Flexor pollicis brevis
C. Flexor pollicis longus
Laboratory studies in the outpatient clinic on a 24-year-old woman included assessment of circulating blood chemistry. Which of the following arteries is most likely at risk during venipuncture at the cubital fossa?
A. Brachial B. Common interosseous C. Ulnar D. Anterior interosseous E. Radial
A. Brachial
A 22-year-old man is diagnosed with metastatic malignant melanoma of the skin over the xiphoid process. Which lymph nodes receive most of the lymph from this area and are therefore most likely to be involved in metastasis of the tumor?
A. Deep inguinal
B. Vertical group of superficial inguinal
C. Horizontal group of superficial inguinal
D. Axillary
E. Deep and superficial inguinal
D. Axillary
A 49-year-old woman who had suffered a myocardial infarction must undergo a bypass graft procedure using the internal thoracic artery. Which vessels will most likely continue to supply blood to the anterior part of the upper intercostal spaces?
A. Musculophrenic B. Superior epigastric C. Posterior intercostal D. Lateral thoracic E. Thoracodorsal
C. Posterior intercostal
A 22-year-old woman is admitted to the emergency department in an unconscious state. The nurse takes a radial pulse to determine the heart rate of the patient. This pulse is felt lateral to which tendon?
A. Palmaris longus B. Flexor pollicis longus C. Flexor digitorum profundus D. Flexor carpi radialis E. Flexor digitorum superficialis
D. Flexor carpi radialis
A 45-year-old man is admitted to the hospital after accidentally walking through a plate glass door in a bar while intoxicated. Physical examination shows multiple lacerations to the upper limb, with inability to flex the distal interphalangeal joints of the fourth and fifth digits. Which of the following muscles is most likely affected?
A. Flexor digitorum profundus B. Flexor digitorum superficialis C. Lumbricals D. Flexor digitorum profundus and flexor digitorum superficialis E. Interossei
A. Flexor digitorum profundus
A 24-year-old man is admitted with a wound to the palm of his hand. He cannot touch the pad of his index finger with his thumb but can grip a sheet of paper between all fingers and has no loss of sensation on the skin of his hand. Which of the following nerves has most likely been injured?
A. Deep branch of ulnar B. Anterior interosseous C. Median D. Recurrent branch of median E. Deep branch of radial
D. Recurrent branch of median
A 55-year-old man is examined in a neighborhood clinic after receiving blunt trauma to his right axilla in a fall. He has difficulty elevating the right arm above the level of his shoulder. Physical examination shows that the inferior angle of his right scapula protrudes more than the lower part of the left scapula. The right scapula protrudes far more when the patient pushes against the examiner’s hand with resistance. Which of the following neural structures has most likely been injured?
A. The posterior cord of the brachial plexus
B. The long thoracic nerve
C. The upper trunk of the brachial plexus
D. The site of origin of the middle and lower subscapular nerves
E. Spinal nerve ventral rami C7, C8, and T1
B. The long thoracic nerve
A mother tugs violently on her 4-year-old boy’s hand to pull him out of the way of an oncoming car and the child screams in pain. Thereafter, it becomes obvious that the child cannot straighten his forearm at the elbow. When the child is seen in the emergency department, radiographic examination reveals a dislocation of the head of the radius. Which of the following ligaments is most likely directly associated with this injury?
A. Anular B. Joint capsular C. Interosseous D. Radial collateral E. Ulnar collateral
A. Anular
After a forceps delivery of an infant boy, the baby presents with his left upper limb adducted, internally rotated, and flexed at the wrist. The startle reflex is not seen on the ipsilateral side. Which part of the brachial plexus was most likely injured during this difficult delivery?
A. Lateral cord B. Medial cord C. Ventral rami of the lower trunk D. Ventral ramus of the middle trunk E. Ventral rami of the upper trunk
E. Ventral rami of the upper trunk
A 35-year-old man has a small but painful tumor under the nail of his little finger. Which of the following nerves would have to be anesthetized for a painless removal of the tumor?
A. Superficial radial B. Common palmar digital of median C. Common palmar digital of ulnar D. Deep radial E. Recurrent branch of median
C. Common palmar digital of ulnar
A 25-year-old male athlete is admitted to the emergency department after a bad landing while performing the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the floor of the anatomic snuffbox (Fig. 6-2). Which bone has most likely been fractured?
A. Triquetral B. Scaphoid C. Capitate D. Hamate E. Trapezoid
B. Scaphoid
A 36-year-old man is brought to the emergency department because of a deep knife wound on the medial side of his distal forearm. He is unable to hold a piece of paper between his fingers and has sensory loss on the medial side of his hand and little finger. Which nerve is most likely injured?
A. Axillary B. Median C. Musculocutaneous D. Radial E. Ulnar
E. Ulnar
A 19-year-old man is brought to the emergency department after dislocating his shoulder while playing soccer. Following reduction of the dislocation, he has pain over the dorsal region of the shoulder and cannot abduct the arm normally. An MRI of the shoulder shows a torn muscle. Which of the following muscles is most likely to have been damaged by this injury?
A. Coracobrachialis B. Long head of the triceps brachii C. Pectoralis minor D. Supraspinatus E. Teres major
D. Supraspinatus
A 47-year-old female tennis professional is informed by her physician that she has a rotator cuff injury that will require surgery. Her physician explains that over the years of play, a shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the following ligaments is the physician most likely referring?
A. Acromioclavicular ligament B. Coracohumeral ligament C. Transverse scapular ligament D. Glenohumeral ligament E. Coracoacromial ligament
E. Coracoacromial ligament
A 79-year-old man has numbness in the middle three digits of his right hand and finds it difficult to grasp objects with that hand. He states that he retired 9 years earlier, after working as a carpenter for 50 years. He has atrophy of the thenar eminence (Fig. 6-3). Which of the following conditions is the most likely cause of the problems in his hand?
A. Compression of the median nerve in the carpal tunnel
B. Formation of the osteophytes that compress the ulnar nerve at the medial epicondyle
C. Hypertrophy of the triceps brachii muscle compressing the brachial plexus
D. Osteoarthritis of the cervical spine
E. Repeated trauma to the ulnar nerve
A. Compression of the median nerve in the carpal tunnel
A 13-year-old boy is brought to the emergency department after losing control during a motorbike race in which he was hit by several of the other racers. Physical examination reveals several cuts and bruises. He is unable to extend the left wrist, fingers, and thumb, although he can extend the elbow. Sensation is lost in the lateral half of the dorsum of the left hand. Which of the following nerves has most likely been injured to result in these signs, and in what part of the arm is the injury located?
A. Median nerve, anterior wrist B. Median nerve, arm C. Radial nerve, midhumerus D. Ulnar nerve, midlateral forearm E. Ulnar nerve, midpalmar region
C. Radial nerve, midhumerus
A 17-year-old boy has weakness of elbow flexion and supination of the left hand after sustaining a knife wound in that arm in a street fight. Examination in the emergency department indicates that a nerve has been severed. Which of the following conditions will also most likely be seen during physical examination?
A. Inability to adduct and abduct his fingers
B. Inability to flex his fingers
C. Inability to flex his thumb
D. Sensory loss over the lateral surface of his forearm
E. Sensory loss over the medial surface of his forearm
D. Sensory loss over the lateral surface of his forearm
Following several days of 12-hour daily rehearsals of the symphony orchestra for a performance of a Wagnerian opera, the 52-year-old male conductor experienced such excruciating pain in the posterior aspect of his right forearm that he could no longer direct the musicians. When the maestro’s forearm was palpated 2 cm distal and posteromedial to the lateral epicondyle, the resulting excruciating pain caused him to grimace. Injections of steroids and rest were recommended to ease the pain. Which of the following injuries is most likely?
A. Compression of the ulnar nerve by the flexor carpi ulnaris
B. Compression of the median nerve by the pronator teres
C. Compression of the median nerve by the flexor digitorum superficialis
D. Compression of the superficial radial nerve by the brachioradialis
E. Compression of the deep radial nerve by the supinator
E. Compression of the deep radial nerve by the supinator
A 54-year-old female marathon runner presents with pain in her right wrist that resulted when she fell with force on her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone (Fig. 6-4). Which of the following bones is most likely dislocated?
A. Capitate B. Lunate C. Scaphoid D. Trapezoid E. Triquetrum
B. Lunate
A 45-year-old man is admitted to the hospital after a car crash. Radiographic examination reveals mild disc herniations of C7, C8, and T1. The patient presents with a sensory deficit of the C8 and T1 spinal nerve dermatomes. The dorsal root ganglia of C8 and T1 would contain cell bodies of sensory fibers carried by which of the following nerves?
A. Medial antebrachial cutaneous nerve B. Long thoracic nerve C. Lateral antebrachial cutaneous nerve D. Deep branch of ulnar nerve E. Anterior interosseous nerve
A. Medial antebrachial cutaneous nerve
A 23-year-old female maid was making a bed in a hotel bedroom. As she straightened the sheet by running her right hand over the surface with her fingers extended, she caught the end of the index finger in a fold. She experienced a sudden, severe pain over the base of the terminal phalanx. Several hours later when the pain had diminished, she noted that the end of her right index finger was swollen and she could not completely extend the terminal interphalangeal joint. Which one of the following structures within the digit was most likely injured?
A. The proper palmar digital branch of the median nerve
B. The vinculum longa
C. The insertion of the tendon of the extensor
digitorum onto the base of the distal phalanx
D. The insertion of the flexor digitorum profundus tendon
E. The insertion of the flexor digitorum superficialis tendon
C. The insertion of the tendon of the extensor
digitorum onto the base of the distal phalanx
A 45-year-old man had fallen on his outstretched hand, resulting in Smith’s fracture of the distal end of the radius. The fractured bone displaced a carpal bone in the palmar direction, resulting in nerve compression within the carpal tunnel. Which of the following carpal bones will most likely be dislocated?
A. Scaphoid B. Trapezium C. Capitate D. Hamate E. Lunate
E. Lunate
A 15-year-old girl was brought to the emergency department with a tear of the tendons in the first dorsal compartment of the wrist from a severe bite by a pit bull dog. The injured tendons in this compartment would include which of the following muscles?
A. Extensor carpi radialis longus and brevis
B. Abductor pollicis longus and extensor pollicis brevis
C. Extensor digitorum
D. Extensor indicis proprius
E. Extensor carpi ulnaris
B. Abductor pollicis longus and extensor pollicis brevis
