Upper Limb

Author: brenda4paID: 56698Filename: Upper LimbUpdated: 2010-12-21 22:00:04Description:Gross Anatomy

A 21 year old patient has a lesion of the upper trunk of the brachial plexus(Erb-Duchenne paralysis). Which of the following is the most likely diagnosis?

A. Paralysis of the rhomboid major

B. Inability to elevate the arm above the horizontalC. Arm tending to lie medial rotationD. Loss of sensation on the medial side of the armE. Inability to adduct the thumbC. Arm tending to lie medial rotation

1.

A patient comes in with a gunshot wound and requires surgery in which histhoracoacromial trunk needs to be ligated. Which of the following arterial brancheswould maintain normal blood flow?

A. AcromialB. PectoralC. ClavicularD. DeltoidE. Super thoracicE. Super thoracic

2.

A 29 year old man comes in with a stab wound, cannot raise his arm abovehorizontal, and exhibits a condition known as "winged scapula". Which of thefollowing structures of the brachial plexus would most likely be damaged?

A. Medial cordB. Posterior cordC. Lower trunkD. RootsE. Upper trunkD. Roots

3.

A 16 year old patient has weakness flexing the metacarpophalangeal joint of the ringfinger and is unable to adduct the same finger. Which of the following muscles ismost likely paralyzed?

4.

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A. Flexor digitorum profundusB. Extensor digitorumC. LumbricalD. Dorsal InterosseousE. Palmar InterosseousE. Palmar Interosseous

A 27 year old patient presents with an inability to draw the scapula forward anddownward because of paralysis of the pectoralis minor. Which of the following wouldmost likely be a cause of his condition?

A. Fracture of the clavicleB. Injury to the posterior cord of the brachial plexusC. Fracture of the coracoid processD. Axillary nerve injuryE. Defects in the posterior wall of the axillaC. Fracture of the coracoid process

5.

A 22 year old patient received a stab wound in the chest that injured theintercostobrachial nerve. Which of the following conditions results from the describedlesion the nerve?

A. Inability to move the ribsB. Loss of tactile sensation on the lateral aspect of the armC. Absence of sweating on the posterior aspect of the armD. Loss of sensory fibers from the second intercostal nerveE. Damage to the sympathetic preganglionic fibersD. Loss of sensory fibers from the second intercostal nerve

6.

A 16 year old boy fell from a motorcycle, and his radial nerve was severly damagedbecause of a fracture of the midshaft of the humerus. Which of the followingconditions would most likely result from this accident?

A. Loss of wrist extension leading to wrist dropB. Weakness in pronating the forearmC. Sensory loss over the ventral aspect of the base of the thumbD. Inability to oppose the thumbE. Inability to abduct the fingersA. Loss of wrist extension leading to wrist drop

7.

A patient comes in complaining that she cannot flex her proximal interphalangealjoints. Which of the following muscles appear(s) to be paralyzed on furtherexamination of her finger?

8.


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A. Palmar interosseiB. Dorsal interosseiC. Flexor digitorum profundusD. Flexor digitorum superficialisE. LumbricalsC. Flexor digitorum profundus

A 21 year old woman walks in with a shoulder and arm injury after falling duringhorseback riding. Examination indicates that she cannot adduct her arm because ofparalysis of which of the following muscles?

A. Teres minorB. SuprasinatusC. Latissimus dorsiD. InfraspinatusE. Serratus anteriorC. Latissimus dorsi

9.

A 35 year old man walks in with a stab would to the most medial side of the proximalportion of the cubital fossa. Which of the following structures would most likely bedamaged?

A. Biceps brachii tendonB. Radial nerveC. Brachial arteryD. Radial recurrent arteryE. Mediam nerveE. Median nerve

10.

The police bring in a murder suspect who has been in a gunfight with a police officer.The suspect was struck by a bullet in the arm; his median nerve has been damaged.Which of the following symptoms is likely produced by this nerve damage?

A. Waiter's tip handB. Claw handC. Wrist dropD. Ape handE. Flattening of the hypothenar eminenceD. Ape hand

11.

An automobile body shop worder has his middle finger crushed while working on atransmission. Which of the following muscles is most likely to retain function?

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A. Extensor digitorumB. Flexor digitorum profundusC. Palmar interosseousD. Dorsal interosseousE. LumbricalC. Palmar interosseous

A 14 year old boy falls on his outstretched hand and has a fracture of the scaphoidbone. The fracture is most likely accompanied by a rupture of which of the followingarteries?

A. Brachial arteryB. Ulnar arteryC. Deep palmar arterial archD. Radial arteryE. Princeps pollicis arteryD. Radial artery

13.

A 12 year old boy walks in; he fell out of a tree and fractured the upper portion of hishumerus. Which of the following nerves are intimately related to the humerus and aremost likely to be injured by such a fracture?

A. Axillary and musculocutaneousB. Radial and ulnarC. Radial and axillaryD. Median and musculocutaneousE. Median and ulnarC. Radial and axillary

14.

A man injures his wrist on broken glass. Which of the following structures entering thepalm superficial to the flexor retinaculum may be damaged?

A. Ulnar nerve and median nerveB. Median nerve and flexor digitorum profundusC. Median nerve and flexor pollicis longusD. Ulnar artery and ulnar nerveE. Ulnar nerve and flexor digitorum superficialisD. Ulnar artery and ulnar nerve

15.

A patient with Bennett's fracture (a fracture of the base of the first metacarpal bone)experiences an impaired thumb movement. Which of the following intrinsic muscles ofthe thumb is most likely injured?

A. Abductor pollicis brevis

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B. Flexor pollicis brevis (superficial head)C. Opponens pollicisD. Adductor pollicisE. Flexor pollicis brevis (deep head)C. Opponens pollicis

A 27 year old pianist with a known carpar tunnel syndrome experiences difficulty infinger movements. Which of the following intrinsic muscles of her hand is paralyzed?

A. Palmar interossei and adductor pollicisB. Dorsal interossei and lateral two lumbricalsC. Lateral two lumbricals and opponens pollicisD. Abductor pollicis brevis and palmar interosseiE. Medial two and lateral two lumbricalsC. Lateral two lumbricals and opponens pollicis

17.

A 31 year old roofer walks in with tenosynovitis resulting from a deep penetratedwound in the palm by a big nail. Examination indicates that he has an infection in theulnar bursa. This infection most likely resulted in necrosis of which of the followingtendons?

A. Tendon of the flexor carpi ulnarisB. Tendon of the flexor pollicis longusC. Tendon of the flexor digitorum profundusD. Tendon fo the flexor carpi radialisE. Tendon of the palmaris longusC. Tendon of the flexor digitorum profundus

18.

An 18 year old boy involved in an automobile accident presents with arm that cannotabduct. His paralysis is caused by damage to which of the following nerves?

A. Suprascapular and axillaryB. Thoracodorsal and upper subscapula C. Axillary and musculocutaneousD. Radial and lower subscapularE. Suprascapular and dorsal scapularC. Axillary and musculocutaneous

19.

A 17 year old boy with a stab wound received multiple injuries on the upper part of thearm and required surgery. If the brachial artery were ligated at its origin, which of thefollowing arteries would supply blood to the profunda brachii artery?

A. Lateral thoracicB. SubscapularC. Posterior humeral circumflex

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D. Superior ulnar collateralE. Radial recurrentC. Posterior humeral circumflex

A 23 year old woman who receives a deep cut to her ring finger by a kitchen knife isunable to move the metacarpophalangeal joint. Which of the following pairs of nerveswas damaged?

A. Median and ulnarB. Radial and medianC. Musculocutaneous and ulnarD. Ulnar and radialE. Radial and axillaryD. Ulnar and radial

21.

A 27 year old baseball player is hit on his forearm by a high-speed ball during theWorld series, and the muscles that form the floor of the cubital fossa appear to be torn.Which of the following groups of muscles has lost thier functions?

A. Brachioradialis and supinatorB. Brachialis and supinatorC. Pronator teres and supinatorD. Supinator and pronator quadratusE. Brachialis and pronator teresB. Brachialis and supinator

22.

A 23 year old man complains of numbness on the medial side of the arm following astab wound in the axilla. On examination, he is diagnosed with an injury of his medialbrachial cutaneous nerve. In which of the following structures are the cell bodies of thedamaged nerve involved in numbness located?

A. Sympathetic chain ganglionB. Dorsal root ganglionC. Anterior horn of the spinal cordD. Lateral horn of the spinal cordE. Posterior horn of the spinal cordB. Dorsal root ganglion

23.

A 38 year old homebuilder was involved in an accident and is unable to supinate hisforearm. Which of the following nerves are most likely damaged?

A. Suprascapular and axillaryB. Musculocutaneous and medianC. Axillary and radial

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D. Radial and musculocutaneousE. Median and ulnarD. Radial and musculocutaneous

A 31 year old patient complains of sensory loss over the anterior and posterior surfacesof the medial third of the hand and the medial on and one-half fingers. He is diagnosedby a physician as having "funny bone" symptoms. Which of the following nerves isinjured?

A. AxillaryB. RadialC. MedianD. UlnarE. MusculocutaneousD. Ulnar

25.

A patient with a deep stab wound in the middle of the forearm hias impaired movementof the thumb. Examination indicates a lesion of the anterior interosseous nerve. Whichof the following muscles is paralyzed?

A. Flexor pollicis longus and brevisB. Flexor pollicis longus and opponens pollicisC. Flexor digitorum profundus and pronator quadratusD. Flexor digitorum profundus and superficialisE. Flexor pollices brevis and pronator quadratusC. Flexor digitorum profundus and pronator quadratus

26.

A 29 year old patient comes in; he cannot flex the distal interphalangeal joint of tehindex finger. His physician determines that he has never damage from a supracondylarfracture. Which of the following conditions is also a sympton of this nerve damage?

A. Inability to flex the distal interphalangeal (DIP) joint of the index fingerB. Atrophy of the hypothenar eminenceC. Loss of sensation over the distal part of the second digitD. Paralysis of all the thumb musclesE. Loss of supinationC. Loss of sensation over the distal part of the second digit

27.

A 27 year old man with cubital tunnel syndrom complains of numbness and tingling inthe ring and little finger and back and sides of his hand because of damage to a nerve inthe tunnel at the elbow. Which of the following muscles is most likely to be paralyzed?

A. Flexor digitorum superficialisB. Opponens pollicis

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C. Two medial lumbricalsD. Pronator teresE. SupinatorC. Two medial lumbricals

A secretary comes in to your office complaining of pain in her wrist from typing allday. You determine that she likely has carpal tunnel syndrome. Which of the followingconditions would help you to determine the diagnosis?

A. Inability to adduct the little fingerB. Inability to flex the distal interphalangeal joint of the ring fingerC. Flattened thenar eminenceD. Loss of skin sensation of the medial one and one-half fingersE. Atrophied adductor pollicis muscleC. Flattened thenar eminence

29.

A man is unable to hold typing paper between his index and middle fingers. Which ofthe following nerves was likely injured?

A. Radial nerveB. Median nerveC. Ulnar nerveD. Musculocutaneous nerveE. Axillary nerveC. Ulnar nerve

30.

The victim of an automobile accident has a destructive injury of the proximal row ofcarpal bones. Which of the following bones is most likely damaged?

A. CapitateB. HamateC. TrapeziumD. TriquetrumE. TrapezoidD. Triquetrum

31.

A patient has a torn rotator cuff of the shoulder joint as the result of an automobileaccident. Which of the following muscle tendons is intact and has normal function?

A. SuprasinatusB. SubscapularisC. Teres majorD. Teres minorE. Infraspinatus

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C. Teres major

A patient complains of having pain with repeated movements of his thumb(claudication). His physician performs the Allen test and finds an insuffiency of theradial artery. Which of the following conditions would be a result of the radial arterystenosis?

A. A marked decrease in the blood flow in the superficial palmar arterial archB. Decreased pulsation in the artery passing superficial to the flexor retinaculumC. Ischemia of the entire extensor muscles of the forearmD. A marked decrease in the blood flow in the princeps pollicis arteryE. A low blood pressure in the anterior interosseous arteryD. A marked decrease in the blood flow in the princeps pollicis artery

33.

A patient bleeding from the should secondary to a kinfe wound is in fair conditionbecause there is vascular anastomsis around the shoulder. Which of the followingarteries is most likely a direct branch of the subclavian artery that is involved in theanastomosis?

A. Dorsal scapular arteryB. Thoracoacromial arteryC. Circumflex scapular arteryD. Transverse cervical arteryE. Suprascapular arteryA. Dorsal scapular artery

34.

During a breast examination of a 56 year old woman, the physician found a palpablemass in her breast. Which of the following characterisitics of breast cancer and itsdiagnosis is correct?

A. Elevated nippleB. PolymastiaC. Shortening of the clavipectoral fasciaD. Dimpling of the overlying skinE. Enlargement of the breastD. Dimpling of the overlying skin

35.

A patient with a stab wound receives a laceration of the musculocutaneous nerve.Which of the following conditions is most likely to have occurred?

A. Lack of sweating on the lateral side of the forearmB. Inability to extend the forearmC. Paralysis of brachioradialis muscleD. Loss of tactile sensation on the arm

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E. Constriction of blood vessels on the handA. Lack of sweating on the lateral side of the forearm

A 20 year old man fell from the parallel bar during the Olympic trail. A neurologicexamination reveals that he has a lesion of the lateral cord of the brachial plexus.Which of the following muscles is most likely weakened by his injury?

A. SubscapularisB. Teres majorC. Latissimus dorsiD. Teres minorE. Pectoralis majorE. Pectoralis major

37.

A 24 year old carpenter suffers a crush injury of his entire little finger. Which of thefollowing muscles is most likely to be spared?

A. Flexor digitorum profundusB. Extensor digitorumC. Palmar interosseiD. Dorsal interosseiE. LumbricalsD. Dorsal interossei

38.

A 7 year old boy falls from a tree house and is brought to the emergency room of alocal hospital. On examination, he has weakness in rotating his arm laterally because ofan injury of a nerve. Which of the following conditions is most likely to cause a loss ofthis nerve function?

A. Injurt to the lateral cord of the brachial plexusB. Fracture of the anatomic neck of the humerusC. Knife wound on the teres major muscleD. Inferior dislocation of the head of the humerusE. A tumor in the triangular space in the shoulder regionD. Inferior dislocation of the head of the humerus

39.

A 49 year old woman is diagnosed as having a large lump in her right breast. Lymphfromt he cancerous breast drains primarily into which of the following nodes?

A. Apical nodesB. Anterior (pectoral) nodesC. Parasternal (internal thoracic) nodesD. Supraclavicular nodesE. Nodes of the anterior abdominal wall

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B. Anterior (pectoral) nodes

A 17 year old boy fell from his motorcycle and complains of numbness of the lateralpart of the arm. Examination reveals that the axillary nerve is severed. Which of thefollowing types of axons is most likely spared?

A. Postganglionic sympathetic axonsB. Somatic afferent axonsC. Preganglionic sympathetic axonsD. General somatic efferent axonsE. General visceral afferent axonsC. Preganglionic sympathetic axons

41.

A construction worker suffers a destructive injury of the structures related to theanatomic snuffbox. Which of the following structures would most likely be damaged?

A. Triquetral boneB. Trapezoid boneC. Extensor indicis tendonD. Abductor pollicis brevis tendonE. Radial arteryE. Radial artery

42.

A rock climber falls on his shoulder, resulting in a chipping off the lesser tubercle ofthe humerus. Which of the following structures would most likely have structural andfunctional damage?

A. Supraspinatus muscleB. Infraspinatus muscleC. Subscapularis muscleD. Teres minor muscleE. Coracohumeral ligamentC. Subscapularis muscle

43.

A 22 year old female Macarena dancer fell fromthe stage and complains of elbow painand inability to supinate her forearm. Which of the following nerves are most likelyinjured from this accident?

A. Median and ulnar nervesB. Axillary and radial nervesC. Radial and musculocutaneous nervesD. Ulnar and axillary nervesE. Musculocutaneous and median nervesC. Radial and musculocutaneous nerves

44.


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Scenario: A 37 year old female patient has a fracture of the clavicle. The junction of themiddle and lateral thirds of the bone exhibits overriding of the medial and lateralfragments. The arm is rotated medially, but it is not rotated laterally.

Question: The lateral portion of the fractured clavicle is displaced downward by whichof the following?

A. Deltoid and trapezius musclesB. Pectoralis major and deltoid musclesC. Pectoralis minor muscle and gravityD. Trapezius and pectoralis minor musclesE. Deltoid muscle and gravityE. Deltoid muscle and gravity

45.


Question: Which of the following muscles causes upward displacement of the medialfragment?

A. Pectoral majorB. DeltoidC. TrapeziusD. SternocleidomastoidE. Scalenus anteriorD. Sternocleidomastoid

46.


Question: Which of the following conditions is most likely to occur secondary to thefractured clavicle?

A. A fatal hemorrhage from the brachiocephaic veinB. Thrombosis of the subclavian vein, causing a pulmonary embolismC. Thrombosis of the subclavian artery, causing an embolism in the ascending aortaD. Damage to the upper trunk of the brachial plexusE. Damage to the long thoracic nerve, causing the winged scapulaB. Thrombosis of the subclavian vein, causing a pulmonary embolism

47.

Scenario: A 21 year old man injures his right arm in an automobile accident.48.


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Radiographic examination reveals a fracture of the medial epicondyle of the humerus.

Question: Which of the following nerves is most likely injured as a result of thisaccident?

A. AxillaryB. MusculocutaneousC. RadialD. MedianE. UlnarE. Ulnar

Scenario: A 21 year old man injures his right arm in an automobile accident.Radiographic examination reveals a fracture of the medial epicondyle of the humerus.

Question: Which of the following muscles is most likely paralyzed as a result of thisaccident?

A. Extensor pollicis brevisB. Abductor pollicis longusC. Abductor pollicis brevisD. Adductor pollicisE. Opponens pollicisD. Adductor pollicis

49.

Scenario: A 21 year old man injures his right arm in an automobile accident.Radiographic examination reveals a fracture of the medial epicondyle of the humerus.

Question: After this injury, the patient is unable to do which of the following?

A. Flex the proximal interphalangeal joint of his ring fingerB. Flex the distal interphalangeal joint of his index fingerC. Feel sensation on his middle fingerD. Abduct his thumbE. Adduct his index fingerE. Adduct his index finger

50.

Scenario: A 10 year old boy falls off his bike, has difficulty in moving his shoulder, andis brought to an emergency room. His radiogram and angiogram reveal fracture of thesurgical neck of the humerus and bleeding from the point of the fracture.

Question: Which of the following nerves is most likely injured as a result of thisaccident?

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A. MusculocutaneousB. AxillaryC. RadialD. MedianE. UlnarB. Axillary


Question: Following the accident, the damaged nerve causes difficulty in abduction,extension, and lateral rotation of his arm. Cell bodies of the injured nerve involved inmovement of his arm are located in which of the following structures?

A. Dorsal root ganglionB. Sympathetic chain ganglionC. Anterior horn of the spinal cordD. Lateral horn of the spinal cordE. Posterior horn of the spinal cordC. Anterior horn of the spinal cord

52.


Question: The damaged nerve causes numbness of teh lateral side of the arm. Cellbodies of th injured nerve fibers involved in sensory loss are located in which of thefollowing structures?

A. Anterior horn of the spinal cordB. Posterior horn of the spinal cordC. Lateral horn of the spinal cordD. Dorsal root ganglionE. Sympathetic chain gangliaD. Dorsal root ganglion

53.


Question: The accident most likely leads to damage of which of the following arteries?

A. Axillary

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B. Deep brachialC. Posterior humeral circumflexD. Superior ulnar collateralE. Scapular circumflexC. Posterior humeral circumflex


Question: Following the accident, the boy has weakness in rotating his arm laterally.Which of the following muscles are paralyzed?

A. Teres major and teres minorB. Teres minor and deltoidC. Infraspinatus and deltoidD. Spraspinatus and subscapularisE. Teres minor and infraspinatusB. Teres minor and deltoid

55.

Scenario: A 64 year old man with a history of liver cirrhosis has been examined forhepatitis A, B, and C viruses. In an attempt to obtain a blood sample from the patient'smedian cubital vein, a registered nurse inadvertently procures arterial blood.

Question: The blood most likely comes from which of the following arteries?

A. BrachialB. RadialC. UlnarD. Common intersosseousE. Superior ulnar collateralA. Brachial

56.

Scenario: A 64 year old man with a history of liver cirrhosis has been examined forhepatitis A, B, and C viruses. In an attempt to obtain a blood sample from the patient'smedian cubital vein, a registered nurse inadvertently procures arterial blood.

Question: During the procedure, the needle hits a nerve medial to the artery. Which ofthe following nerves is most likely damaged?

A. RadialB. MedianC. UlnarD. Lateral antebrachial

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E. Medial antebrachialB. Median

Scenario: A 17 year old boy is injured in an automobile accident. He has a fracture ofthe shaft of the humerus.

Question: Which of the following nerves is most likely damaged?

A. Axillary nerveB. Radial nerveC. Musculocutaneous nerveD. Median nerveE. Ulnar nerveB. Radial nerve

58.


Question: As a result of this fracture, the patient shows lack of sweating on the back ofthe arm and forearm. Cell bodies of the damaged nerve fibers involved in sweating arelocated in which of the following structures?

A. Anterior horn of the spinal cordB. Posterior horn of the spinal cordC. Lateral horn of the spinal cordD. Sympathetic chain ganglionE. Dorsal root ganglionD. Sympathetic chain ganglion

59.


Question: Following the accident, the patient has no cutaneous sensation in which ofthe following areas?

A. Medial aspect of the armB. Lateral aspect of the forearmC. Palmar aspect of the second and third digitsD. Area of the anatomic snuffboxE. Medial one and one-half fingersD. Area of the anatomic snuffbox

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Question: Which of the following arteries may be damaged?

A. Brachial arteryB. Posterior humeral circumflex arteryC. Profunda brachii arteryD. Radial arteryE. Radial recurrent arteryC. Profunda brachii artery


Question: After this accident, supination is still possible through contraction of whichof the following muscles?

A. SupinatorB. Pronator teresC. BrachioradialisD. Biceps brachiiE. SuprasinatusD. Biceps brachii

62.

Scenario: An 11 year old boy falls down the stairs. A physician examines a radiographof the boy's shoulder region.

Question: If the structure indicated by the letter A is calcified, which of the followingmuscles is most likely paralyzed?

A. DeltoidB. Teres majorC. Teres minor

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D. InfraspinatusE. SubscapularisD. Infraspinatus

Scenario: An 11 year old boy falls down the stairs. A physician examines a radiographof the boy's shoulder region.

Question: If the structure indicated by the letter B is fractured, which of the followingstructures is most likely injured?

A. Musculocutaneous nerveB. Radial nerveC. Deep brachial arteryD. Posterior humeral circumflex arteryE. Scapular circumflex arteryD. Posterior humeral circumflex artery

64.

Radiograph of the elbow joint.

Destruction of this area would most likely cause weakness of supination and flexion ofthe forearm.

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B.


Destruction of this area would most likely cause weakness of pronation of the forearmand flexion of the wrist joints.

E.

66.


A lesion of the radial nerve would most likely cause paralysis of muscles that areattached to this area.

D.

67.

Radiograph of the wrist and hand.

Destruction of the structure indicated by the letter E most likely causes weakness ofwhich of the following muscles?

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A. Flexor carpi radialisB. Palmaris longusC. Flexor carpi ulnarisD. BrachioradialisE. Flexor digitorum superficialisC. Flexor carpi ulnaris

Radiograph of the wrist and hand.

If the floor of the anatomic snuffbox and origin of the abductor pollicis brevis aredamaged, which of the following bones is most likely to be involved?

B.

69.

MRI scan through the middle of the palm of a woman's right hand.

The patient is unable to abduct her middle finger because of paralysis of this structure.

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D.


A lesion of the median nerve causes paralysis of this structure.

A.

71.


The patient is unable to adduct her little finger because of paralysis of this structure.

G.

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Atrophy of this structure impairs extension of both the metacarpophalangeal andinterphalangeal joints.

E.

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Upper Limb

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