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MCQ upper limb
MCQ upper limb MRCS part b
| Question | Answer |
|---|---|
| A 28 year old man lacerates the posterolateral aspect of his wrist with a knife. The ER wound is inspected and found to be located over the lateral aspect of extensor retinaculum (which is intact). Which of the structures is at greatest risk of injury? | Superficial branch of the radial nerve |
| The superficial branch of the radial nerve passes..........to extensor retinaculum (In the lateral portion) | superior |
| dorsal branch of the ulnar nerve and artery pass ............ to the extensor retinaculum (located in the medial position) | superior |
| Transection of the radial nerve at the level of the axilla will result in all of the following except: | A. Loss of elbow extension. B. Loss of extension of the interphalangeal joints. C. Loss of metacarpophalangeal extension. D. Loss of triceps reflex. E. Loss of sensation overlying the first dorsal interosseous. //// ANSWER: B (retain lumbrical futn) |
| which muscle causes abductor of shoulder? | supraspinatus (deltoid as well) |
| Dorsal venous arch drains laterally | |
| Which of the following structures is not closely related to the brachial artery? | A. Ulnar nerve B. Median nerve C. Cephalic vein D. Long head of triceps E. Median cubital vein /////////////// Answer: C |
| The following statements relating to the musculocutaneous nerve are true except? | A. arises from lateral cord of the brachial plexus B. provides cutan innervation to the lateral side of the forearm C. damaged then extension of the elbow joint will be impaired D. supplies the biceps muscle E. runs beneath biceps /// Answer C |
| Musculocutaneous nerve supplies which muscle? | biceps, brachialis and coracobrachialis |
| musculocutaneous nerve is a branch of? | lateral cord of brachial plexus |
| Which ligament keeps the head of the radius connected to the radial notch of the ulna? | A. Annular (orbicular) ligament B. Quadrate ligament C. Radial collateral ligament of the elbow D. Ulnar collateral ligament E. Radial collateral ligament // Answer: Annular ligament |
| annular ligament connects | radial head to the radial notch of the ulna. |
| At radial tuberosity which muscle is attached? | biceps brachii |
| A 38 year old man presents to the clinic with shoulder weakness. On examination he has an inability to initiate shoulder abduction. Which of the nerves listed below is least likely to be functioning normally? | Suprascapular nerve |
| suprascapular nerve arises from.......... | upper trunk of the brachial plexus |
| suprascapular nerve innervates........ | supraspinatus and infraspinatus |
| action of suprascapular nerve........ | initiates abduction of the shoulder |
| clinica feature of damaged suprascapular nerve.... | patients may be able to abduct the shoulder by leaning over the affected side and deltoid can then continue to abduct the shoulder. |
| Which of the following vessels provides the greatest contribution to the arterial supply of the breast? | Internal mammary artery |
| 60% of the arterial supply to the breast is derived from..... | internal mammary artery |
| 40% of arterial supply to the breast is derived from..... | The external mammary and lateral thoracic arteries |
| Breast itself lies on a layer of ......... fascia and .....muscles | pectoralis/// 1. Pectoralis major /2. Serratus anterior /3. External oblique |
| Nerve supply of breast | Branches of intercostal nerves from T4-T6. |
| venous drainage of breast | Superficial venous plexus to sub clavian, axillary and intercostal veins. |
| lymphatic drainage of breast | 1) 70% Axillary nodes //// 2) Internal mammary chain //////3) Other lymphatic sites such as deep cervical and supraclavicular fossa (later in disease) |
| A baby is found to have a Klumpke's palsy post delivery. Which of the following is most likely to be present? | A. Loss of flexors of the wrist B. Weak elbow flexion C. Pronation of the forearm D. Adducted shoulder E. Shoulder medially rotated////////////// Answer A |
| Features of Klumpkes Paralysis | 1) Claw hand (MCP joints extended and IP joints flexed) /////2) Loss of sensation over medial aspect of forearm and hand /////////3)Horner's syndrome//////4) Loss of flexors of the wrist |
| C8, T1 root lesion is called | Klumpkes Paralysis (caused by delivery with the arm extended) |
| with respect to the basilic vein, which statement is false? | A. Its deep anatomic location make it unsuitable for use as an AV access site in fistula surgery C. travels up medial aspect of forearm D. Halfway betn shoulder and elbow it lies deep to muscle E. join brachial to form axillary vein All true B False |
| Basilic vein is used in ...............surgery during a procedure known as a basilic vein transposition. | arteriovenous fistula |
| venous drainage for the arm and hand provided by..... | basilic and cephalic vein |
| Old man is lifting a heavy object when he feels pain in forearm and is unable to continue. Has a swelling over his upper forearm. MRI scan shows small cuff of tendon still attached to radial tuberosity consistent with recent tear. which muscle is injured? | Biceps brachii |
| Biceps inserts into....... | radial tuberosity |
| Which of the following is a branch of the third part of the axillary artery? | Posterior circumflex humeral |
| branches of axillary artery.... | Posterior cicumflex humeral//// Subscapular////Anterior circumflex humeral |
| A 23 year old rugby player sustains a Smiths Fracture. On examination opposition of the thumb is markedly weakened. Which nerve is affected? | Median nerve |
| A 45 year old lady recovering from a mastectomy and axillary node clearance notices that sensation in her armpit is impaired. Which nerve is injured? | Intercoastobrachial nerve |
| intercostobrachial nerves are frequently injured during..... | axillary dissection |
| An 8 year old boy falls 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. | Median |
| froment's test which muscle function is tested? | Adductor pollicis |
| Froment's sign assesses....... | Assess for ulnar nerve palsy |
| Phalen's test | Assess carpal tunnel syndrome |
| how to do a phalen's test for accessing carpel tunnel syndrome? | Hold wrist in maximum flexion and the test is positive if there is numbness in the median nerve distribution. |
| Tinel's sign | Assess for carpal tunnel syndrome |
| how to do a Tinel test for accessing carpel tunnel syndrome? | Tap the median nerve at the wrist and the test is positive if there is tingling/electric-like sensations over the distribution of the median nerve. |
| The skin on the palmar aspect of the thumb supplied by | Median nerve |
| The nail bed of the index finger supplied by | Median nerve |
| The skin overlying the medial aspect of the palm supplied by | ulnar nerve |
| From which of the following foramina does the opthalmic branch of the trigeminal nerve exit the skull? | Superior orbital fissure |
| Exit of branches of trigeminal nerve from the skull V1/V2/V3 | V1 -Superior orbital fissure/// V2 -foramen Rotundum/// V3 -foramen Ovale |
| opthalmic branch of the trigeminal nerve exits the skull through....... | superior orbital fissure. |
| What nerve innnervates muscle of mastication: | trigeminal nerve |
| trigeminal nerve supplies which muscle (motor supply of trigeminal nerve) | 1)Muscles of mastication 2)Mylohyoid// 3) Anterior belly of digastric// 4)Tensor tympani// 5) Tensor palati |
| trigeminal nerve supplies which region (sensory supply of trigeminal nerve) | 1)Scalp ////2)Face///3) Oral cavity (and teeth)/// 4) Nose and sinuses///5) Dura mater |
| Trigeminal nerve originates where? | Originates at the pons |
| Branches of trigeminal nerve? | Ophthalmic nerve V1=Sensory only ////////Maxillary nerve V2= Sensory only ///////////Mandibular nerve V3=Sensory and motor |
| mandibular nerve. | muscles of mastication are innervated: 1)Masseter//2) Temporalis//3) Medial pterygoid//4)Lateral pterygoid OTHERS: 1) Tensor veli palatini// 2)Mylohyoid //3)Anterior belly of digastric//4) Tensor tympani |
| old lady had an axillary node clearance for breast malignancy. Post operatively she reports weakness of shoulder. She is unable to push herself forwards from wall with right arm and scapula is pushed out medially from chest wall. What Nerve is injured? | Long thoracic nerve |
| long thoracic nerve innervates | serratus anterior |
| serratus anterior causes... | pushing out of the scapula during a punch |
| winging of the scapular laterally may indicate | trapezius muscle weakness |
| Trapezius innervated by.... | Innervated by the spinal accessory nerve. |
| A 36 year old male is admitted for elective surgery for a lymph node biopsy in the supraclavicular region. Post operatively the patient has difficulty shrugging his left shoulder. What nerve has been damaged? | Accessory nerve |
| accessory nerve lies in the........triangle | posterior |
| accessory nerve injury causes problem with | shrugging of shoulder and lifting arm above his head |
| Which of the following muscles is supplied by the musculocutaneous nerve | brachialis |
| 17 yr presents to clinic. Complains- difficulty using left hand. Has persistent problem since sustained a distal humerus fracture as a child. PE- There is diminished sensation overlying hypothenar eminence and medial one and half fingers. Nerve lesion? | Ulnar nerve |
| A 72 year old male with end stage critical ischaemia is undergoing an axillo-femoral bypass. What structure is not closely related to the axillary artery? | Scalenus anterior muscle |
| axillary artery is the continuation of | subclavian artery |
| Which of the following carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris? | Pisiform |
| A 70 year old man falls and fractures his scaphoid bone. The fracture is displaced and the decision is made to insert a screw to fix the fracture. Which of the following structures lies directly medial to the scaphoid? | Lunate |
| A 73 year old lady is hit by a car. She suffers a complex fracture of the distal aspect of her humerus with associated injury to the radial nerve. Which of the following movements will be most impaired as a result? | Wrist extension (The triceps will not be affected so elbow extension will be preserved) |
| An 18 year old man develops a severe spreading sepsis of the hand. The palm is explored surgically and the flexor digiti minimi brevis muscle is mobilised to facilitate drainage of the infection. Which is not closely related to this muscle? | =Median nerve (On undersurface lies the ulnar contribution to the superficial palmar arterial arch and digital nerves derived from the ulnar nerve)////////////////// =median nerve overlies the flexor tendons. |
| flexor digiti minimi brevis originates from | hamate |
| A 22 year old man develops an infection in the pulp of his little finger. What is the most proximal site to which this infection may migrate? | Proximal to the flexor retinaculum |
| Which of the following muscles is not innervated by the deep branch of the ulnar nerve? | A. Adductor pollicis B. Hypothenar muscles C. All the interosseous muscles D. Opponens pollicis E. Third and fourth lumbricals Answer : D |
| deep branch of the ulnar nerve innervate which muscles? | Hypothenar muscles/// All the interosseous muscles ////Third and fourth lumbricals ///Adductor pollicis/// Medial head of the flexor pollicis brevis |
| Which of the following structures lie between the lateral and medial heads of the triceps muscle? | Radial nerve |
| Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert? | The anatomical neck of the humerus |
| fibrous capsule attaches to the anatomical neck .......... and the surgical neck ............... | superiorly/ inferiorly |
| Damage to the posterior cord of the brachial plexus will not result in any of the following except: | A. Klumpkes palsy B. Anaesthesia overlying the lateral aspect of the forearm C. A warm sweaty hand on the affected side D. Loss of flexion of the arm E. Anaesthesia overlying the posterior surface of the arm ////// Answer: E |
| radial nerve gives cutaneous branches which supply the forearm..... and arm.............. | posteriorly/ laterally |
| Loss of sympathetic function would not result in | sweaty hand |
| A woman develops winging of the scapula following a Patey mastectomy. What is the most likely cause? | Damage to the long thoracic nerve during axillary dissection |
| The serratus anterior muscle is supplied by | long thoracic nerve |
| Which of the following is not closely related to the capitate bone? | A. Lunate bone B. Scaphoid bone C. Ulnar nerve D. Hamate bone E. Trapezoid bone ///////// Answer: Ulnar nerve |
| The ulnar nerve and artery lie adjacent to the | pisiform bone |
| The capitate bone articulates with | lunate, scaphoid, hamate and trapezoid bones |
| largest of the carpal bones | capitate |
| In capitate bone, rounded head set into the cavities of the ............... AND Flatter articular surfaces are present for the ............medially and the................. laterally | lunate and scaphoid bones//////hamate-medially/ trapezoid-laterally |
| An injury to the spinal accessory nerve will affect which of the following movements? | Upward rotation of the scapula |
| Function of trapezius | Entire muscle will retract the scapula. The upper and lower fibers act together to upwardly rotate it. |
| A 23 year old man falls over whilst intoxicated and a shard of glass transects his median nerve at the proximal border of the flexor retinaculum. His tendons escape injury. Which of the following features will not be present? | Loss of sensation on the dorsal aspect of the thenar eminence |
| median nerve may be injured ........... to the flexor retinaculum | proximal |
| When the patient is asked to close the hand slowly there is a lag of the index and middle fingers reflecting the impaired ..............muscle function. | lumbrical |
| Abductor pollicis longus will contribute to .......... | thumb abduction |
| Abductor pollicis longus innervated by......... | posterior interosseous nerve, deep branch of radial nerve |
| A 23 year old man falls and injures his hand. There are concerns that he may have a scaphoid fracture as there is tenderness in his anatomical snuffbox on clinical examination. Which of the following forms the posterior border of this structure? | Extensor pollicis longus |
| boundry of anatomical snuff box | boundaries are extensor pollicis longus, medially (posterior border) and laterally (anterior border) by the tendons of abductor pollicis longus and extensor pollicis brevis. |
| A 28 year old man is stabbed outside a nightclub in the upper arm. The median nerve is transected. Which of the following muscles will demonstrate impaired function as a result? | Abductor pollicis brevis |
| What nerve supplies each??????? Palmaris brevis - ........................Palmar interossei- Adductor pollicis - ..................Abductor pollicis longus - ...............Abductor pollicis brevis - ................ | Palmaris brevis - Ulnar nerve ...................Palmar interossei- Ulnar nerve............ Adductor pollicis - Ulnar nerve ...............Abductor pollicis longus - Posterior interosseous nerve ...........Abductor pollicis brevis - Median nerve |
| Palmaris and the interossei are innervated by the................. | ulnar nerve |
| The median nerve innervates all the short muscles of the thumb except................ | adductor and the deep head of the short flexor |
| Mnemonic branches off the posterior cord...... | STAR (S ubscapular (upper and lower) T horacodorsal A xillary R adial) |
| musculocutaneous nerve is a branch off | lateral cord |
| A 56 year old machinist has his arm entrapped in a steel grinder and is brought to the emergency department. On examination, he is unable to extend his MCPJ and abduct his shoulder. He has weakness of his elbow and wrist. What has been injured? | Posterior cord of brachial plexus |
| Thoracodorsal nerve innervate | lattisimus dorsi |
| Lower subscapular nerve innervate | teres major and subscapularis |
| Upper subscapular nerve | innervates subscapularis |
| innervates deltoid and teres minor innervated by | Axillary nerve |
| A motor cyclist is involved in a road traffic accident causing severe right shoulder injuries. He is found to have an adducted, medially rotated shoulder. The elbow is fully extended and the forearm pronated. Which is the most likely diagnosis? | C5, C6 root lesion |
| Erbs Palsy | C5, C6 lesion The features include: |
| Erbs palsy: A) Loss of shoulder abduction (deltoid and supraspinatus paralysis) B) Loss of external rotation of the shoulder (paralysis of infraspinatus and teres major) C) Loss of elbow flexion (paralysis of biceps, brachialis and brachioradialis) | D) Loss of forearm supination (paralysis of Biceps) |
| birth injury when a baby has a shoulder dystocia. What lesion? | Erbs palsy |
| A 23 year old man has a cannula inserted into his cephalic vein. Through which structure does the cephalic vein pass? | Clavipectoral fascia |
| .................is a favored vessel for arteriovenous fistula formation | cephalic vein |
| ...............should be preserved in patients with end stage renal failure | cephalic vein |
| Which of the following is not a muscle of the rotator cuff | A. Subscapularis B. Teres minor C. Supraspinatus D. Infraspinatus E. Deltoid //////////// Answer: E |
| A 32 year old man is stabbed in the neck and the inferior trunk of his brachial plexus is injured. Which of the modalities listed below is least likely to be affected? | Initiating abduction of the shoulder |
| As it exits the axilla the radial nerve lies on which of the following muscles? | Teres Major |
| A 62 year old man presents with arm weakness. On examination he has a weakness of elbow extension and loss of sensation on the dorsal aspect of the first digit. What is the site of the most likely underlying defect? | Radial nerve |
| The long head of the triceps muscle may be innervated by the ................... and therefore complete loss of triceps muscles function may not be present even with ......... | axillary nerve/ proximally sited nerve lesions |
| From which of the following structures does the long head of the triceps muscle arise? | Infraglenoid tubercle |
| insertion of triceps? | Both heads (fleshy lateral and medial) heads are attached to the posterior aspect of the humerus between the insertion of the teres minor and the olecranon fossa. |
| Nipple retraction may occur as a result of ............ | Tumour infiltration of Coopers Ligaments that run through the breast and surround the lobules |
| Majority of blood supply to breast..... | Internal mammary artery |
| The internal mammary artery is a branch of | subclavian artery |
| Up to 70% of lymphatic drainage is to ............ | Ipsilateral axillary nodes |
| Nipple retraction is a feature of | breast malaignancy |
| A typist presents with pain at the dorsal aspect of the upper part of her forearm. Complains of weakness when extending her fingers. PE- triceps and supinator - Normal. There is weakness of most of the extensor muscle. No sensory deficit. lesion? | Posterior interosseous nerve |
| ............may become entrapped in the "arcade of Frohse" which is a superficial part of the supinator muscle | Radial nerve |
| ..............gives branches to extensor carpi radialis brevis and supinator. | Posterior interosseous nerve |
| A 28 year teacher reports difficulty with writing. There is no sensory loss. She is known to have an aberrant Gantzer muscle. Lesion? | Anterior interosseous nerve |
| The Gantzer muscle is an aberrant accessory of ........ | flexor pollicis longus (and is a risk factor for anterior interosseous nerve compression) |
| loss of pincer grip and normal sensation indicates | interosseous nerve lesion |
| A 35 year 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 and adduction of his extended fingers. lesion? | Ulnar nerve |
| A 53 year old lady presents with pain and discomfort in her hand. She works as a typist and notices that the pain is worst when she is working. She also suffers symptoms at night. Her little finger is less affected by the pain. Which nerve is affected? | Median |
| Median nerve supplies in hand......... | L ateral 2 lumbricals O pponens pollicis A bductor pollicisbrevis F lexor pollicis brevis |
| A 24 year female is admitted to A&E with tingling of her hand after a fall. She is found to have a fracture of the medial epicondyle. What is the most likely nerve lesion? | Ulnar nerve |
| A 43 year old lady is undergoing an axillary node clearance for breast cancer. The nodal disease is bulky. During clearance of the level 3 nodes there is suddenly brisk haemorrhage. The most likely vessel responsible is: | Thoracoacromial artery |
| A 73 year old lady with long standing atrial fibrillation develops a cold and pulseless white arm. A brachial embolus is suspected and a brachial embolectomy is performed. What structure is greatest risk of injury during this procedure? | Median nerve |
| median nerve lies close to the brachial artery in.... | antecubital fossa |
| ............. usual site of surgical access to the brachial artery for an embolectomy procedure | antecubital fossa |
| Which of the following fingers is not a point of attachment for the palmar interossei? | Middle finger |
| The middle finger has no attachment of......... | palmar interossei |
| A 6 year old sustains a supracondylar fracture of the distal humerus. There are concerns that the radial nerve may have been injured. What is the relationship of the radial nerve to the humerus at this point? | Anterolateral |
| radial nerve lies.......... to the humerus in the ............... | anterolateral/supracondylar area |
| The following are true of the ulnar nerve except: | A. It innervates the palmar interossei B. Derived from the medial cord of the brachial plexus C. Supplies the muscles of the thenar eminence D. Supplies the medial half of flexor digitorum profundus ///////////////// Answer: C |
| Which muscle is responsible for causing flexion of the distal interphalangeal joint of the ring finger? | Flexor digitorum profundus |
| superficialis tendons insert on the bases of | middle phalynx |
| profundus tendons insert on the bases of | distal phalanges |
| ................. tendon flex the wrist, MCP and PIP joints | Flexor digitorum superficialis and flexor digitorum profundus |
| only the .............. tendons flex the DIP joints | profundus |
| Which of the following muscles lies medial to the long thoracic nerve | A. Serratus anterior B. Latissimus dorsi C. Pectoralis major D. Pectoralis minor E. None Answer: find it out yourself :p |
Created by:
sarthaknepal1