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  • Question 1 - A 44 year old woman is brought to ED having fallen down the...

    Incorrect

    • A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:

      Your Answer: Fracture of the glenoid fossa

      Correct Answer: Surgical neck of humerus fracture

      Explanation:

      Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      3
      Seconds
  • Question 2 - The following statements are not true of the extensor carpi radialis brevis muscle,...

    Incorrect

    • The following statements are not true of the extensor carpi radialis brevis muscle, except?

      Your Answer:

      Correct Answer: It receives its blood supply from the radial artery

      Explanation:

      Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.

      The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.

      Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.

      The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).

      Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 3 - You are reviewing a patient following a fall from a horse. You suspect...

    Incorrect

    • You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Erb's palsy may result in loss of sensation of the regimental badge area.

      Explanation:

      Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 4 - The following statements are not true of the flexor digiti minimi brevis, except?...

    Incorrect

    • The following statements are not true of the flexor digiti minimi brevis, except?

      Your Answer:

      Correct Answer: It is situated on the radial border of abductor digiti minimi

      Explanation:

      Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds
  • Question 5 - Which of the following is true about the extensor carpi radialis longus? ...

    Incorrect

    • Which of the following is true about the extensor carpi radialis longus?

      Your Answer:

      Correct Answer: It assists with abduction of the hand at the wrist

      Explanation:

      The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.

      Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.

      Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.

      Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 6 - A 29 year old man presents to ED followed an alleged assault whilst...

    Incorrect

    • A 29 year old man presents to ED followed an alleged assault whilst out drinking. He received blunt trauma to his right axilla. He is complaining of difficulty abducting his right arm above the level of his shoulder, and on inspection, the inferior angle of his right scapula protrudes more than that of his left scapula. Which of the following nerves has most likely been affected:

      Your Answer:

      Correct Answer: Long thoracic nerve

      Explanation:

      Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle causing difficulty abducting the upper limb above 90 degrees and giving a ‘winged ‘ scapula appearance where the medial border, particularly the inferior angle, of the scapula moves laterally and posteriorly away from the thoracic wall (this becomes more pronounced if the patient presses the upper limb against a wall).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 7 - Regarding the extensor carpi ulnaris muscle, which of the following statements is true?...

    Incorrect

    • Regarding the extensor carpi ulnaris muscle, which of the following statements is true?

      Your Answer:

      Correct Answer: It receives its blood supply from the ulnar artery

      Explanation:

      Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.

      Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.

      Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.

      Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 8 - Regarding the flexor digitorum profundus muscle, which of the following is true? ...

    Incorrect

    • Regarding the flexor digitorum profundus muscle, which of the following is true?

      Your Answer:

      Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve

      Explanation:

      Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.

      Flexor digitorum profundus has a dual innervation:

      (1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);

      (2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 9 - A 35 year old man presents with a deep laceration to the proximal...

    Incorrect

    • A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.

      The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.

      There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.

      Which of these nerve(s) has most likely been affected?

      Your Answer:

      Correct Answer: Median nerve

      Explanation:

      A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:

      Loss of sensation to the lateral palm and the lateral three and a half fingers.

      Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.

      Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis

      Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
      Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 10 - A fracture on which of the following structures is associated with a posterior...

    Incorrect

    • A fracture on which of the following structures is associated with a posterior elbow dislocation?

      Your Answer:

      Correct Answer: Radial head

      Explanation:

      Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 11 - Which of the following muscles acts as an extensor of the shoulder joint?...

    Incorrect

    • Which of the following muscles acts as an extensor of the shoulder joint?

      Your Answer:

      Correct Answer: Teres major

      Explanation:

      The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.

      Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.

      Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.

      Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.

      External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.

      Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.

      Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds
  • Question 12 - A 25 year old man has sustained a fracture to the surgical neck...

    Incorrect

    • A 25 year old man has sustained a fracture to the surgical neck of the humerus after falling from his bike. Examination suggests an axillary nerve injury. The clinical features expected to be seen in this patient are:

      Your Answer:

      Correct Answer: Weakness of shoulder abduction

      Explanation:

      Axillary nerve injury results in:
      1. weakness of arm abduction (paralysis of deltoid),
      2. weakness of lateral rotation of the arm (paralysis of teres minor)
      3. loss of sensation over the regimental badge area.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 13 - An injury to the brachial plexus can cause Erb's palsy. The following is...

    Incorrect

    • An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:

      Your Answer:

      Correct Answer: Weakness of medial rotation of the arm

      Explanation:

      Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus.

      The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 14 - A 12-year old boy is taken to the emergency room after accidentally falling...

    Incorrect

    • A 12-year old boy is taken to the emergency room after accidentally falling off the monkey bars. Witnesses of the accident reported that, when the patient fell, he hit his right hand on a bar and a loud thump was heard. On examination, the hand is oedematous, tender and erythematous. On ultrasound, a rupture of the flexor carpi ulnaris is noted.

      Which of the following statements is true regarding the flexor carpi ulnaris?

      Your Answer:

      Correct Answer: It acts to adduct the hand at the wrist joint

      Explanation:

      Flexor carpi ulnaris is a fusiform muscle located in the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, along with pronator teres, palmaris longus, flexor digitorum superficialis and flexor carpi radialis. Flexor carpi ulnaris is the most medial of the superficial flexors.

      Innervation of the flexor carpi ulnaris muscle is from the brachial plexus via the ulnar nerve (C7-T1).

      Flexor carpi ulnaris receives its arterial blood supply via three different routes. Proximally, a branch of the posterior ulnar recurrent artery supplies the muscle as it passes between the humeral and ulnar heads. Branches of the ulnar artery supply the middle and distal parts of the muscle, with an accessory supply also present distally via the inferior ulnar collateral artery.

      Due to its position and direction in the forearm, flexor carpi ulnaris can move the hand sideways as well as flexing it. Contracting with flexor carpi radialis and palmaris longus, flexor carpi ulnaris produces flexion of the hand at the wrist joint. However, when it contracts alongside the extensor carpi ulnaris muscle in the posterior compartment, their counteracting forces produce adduction of the hand at the wrist, otherwise known as ulnar deviation or ulnar flexion

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 15 - A patient presents with a laceration on his hand and wrist that has...

    Incorrect

    • A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.
      The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: The recurrent branch of the median nerve

      Explanation:

      Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.
      Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.
      The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 16 - A 35-year-old man suffers an open fracture of his forearm. The nerve that...

    Incorrect

    • A 35-year-old man suffers an open fracture of his forearm. The nerve that innervates the pronator quadratus muscle is damaged as a consequence of this injury.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer:

      Correct Answer: The anterior interosseous nerve

      Explanation:

      Pronator quadratus is a small, square-shaped muscle that lies in the anterior compartment of the forearm. It arises from the distal fourth of the anterior surface of the ulna and inserts into the distal fourth of the anterior surface of the radius.
      Pronator quadratus is innervated by the anterior interosseous nerve. It receives its blood supply from the anterior interosseous artery, which is a branch of the common interosseous artery, which in turn is a branch of the ulnar artery.
      The main action of pronator quadratus is to assist pronator teres with pronation of the forearm. The deep fibres bind the radius and ulna together.
      The pronator quadratus muscle highlighted in blue (adapted from Gray’s Anatomy)

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds
  • Question 17 - A 25-year old male is brought to the emergency room after a traffic...

    Incorrect

    • A 25-year old male is brought to the emergency room after a traffic accident. Upon examination, there was tenderness and erythema on the right acromioclavicular joint, with notable step deformity. On radiographic imaging, there is a superior elevation of the clavicle, a twice than normal coracoclavicular distance, and absence of fracture.

      Which of the following structure/s is/are likely to have ruptured?

      Your Answer:

      Correct Answer: Acromioclavicular ligament, coracoclavicular ligament and joint capsule

      Explanation:

      Acromioclavicular joint injuries account for more than forty percent of all shoulder injuries. Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.

      The AC joint is a diarthrodial joint defined by the lateral process of the clavicle articulating with the acromion process as it projects anteriorly off the scapula. The joint is primarily stabilized by the acromioclavicular ligament, which is composed of an anterior, posterior, inferior, and superior component. Of note, the superior portion of the AC ligament is the most important component for the stability of the AC joint. Supporting structures include two coracoclavicular ligaments (trapezoid and conoid ligaments), which provide vertical stability, as well as the coracoacromial ligament.

      Patients with an AC joint injury typically present with anterosuperior shoulder pain and will describe a mechanism of injury of blunt trauma to the abducted shoulder or landing on an outstretched arm, suggestive of this type of injury. They may describe pain radiating to the neck or shoulder, which is often worse with movement or when they try to sleep on the affected shoulder. On examination, the clinician may observe swelling, bruising, or a deformity of the AC joint, depending on the degree of injury. The patient will be tender at that location. They may have a restriction in the active and passive range of motion secondary to pain. Piano key sign may be seen, with an elevation of the clavicle that rebounds after inferior compression.

      Standard X-rays are adequate to make a diagnosis of acromioclavicular joint injury and should be used to evaluate for other causes of traumatic shoulder pain.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 18 - What kind of function loss do you anticipate in a 22-year-old guy who...

    Incorrect

    • What kind of function loss do you anticipate in a 22-year-old guy who had a laceration to his arm, resulting in nerve damage in the antecubital fossa?

      Your Answer:

      Correct Answer: Opposition of thumb

      Explanation:

      The symptoms of median nerve injury include tingling or numbness in the forearm, thumb, and three adjacent fingers, as well as gripping weakness and the inability to move the thumb across the palm.

      Because the thenar muscles and the flexor pollicis longus are paralyzed, flexion, abduction, and opposition of the thumb at the MCPJ and IPJ are gone.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds
  • Question 19 - Regarding the abductor digiti minimi, which of the following statements is false? ...

    Incorrect

    • Regarding the abductor digiti minimi, which of the following statements is false?

      Your Answer:

      Correct Answer: It assists with flexion of the fifth finger at the middle phalanx

      Explanation:

      Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.

      The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.

      Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.

      Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 20 - A patient has suffered a nerve injury that has caused weakness of the...

    Incorrect

    • A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.
      Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Medial pectoral nerve

      Explanation:

      Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.
      The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.
      The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 21 - A 64-year-old woman had a humerus midshaft fracture due to tripping on a...

    Incorrect

    • A 64-year-old woman had a humerus midshaft fracture due to tripping on a curb and falling on her left arm. She might also have damaged which of the following structures?

      Your Answer:

      Correct Answer: Radial nerve and deep brachial artery

      Explanation:

      The radial nerve and brachial artery are most likely to be damaged in humerus fractures. They are tethered together to the bone and cannot withstand the forces applied to it as a result of the displacement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 22 - If a patient dislocated his right shoulder and has been referred to the...

    Incorrect

    • If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?

      Your Answer:

      Correct Answer: Arm at 90 degrees to side with palm up

      Explanation:

      The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.
      The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 23 - During bedside rounds, an 82-year old female in the Medicine Ward complains of...

    Incorrect

    • During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.

      Which of the following is expected to undergo atrophy in carpal tunnel syndrome?

      Your Answer:

      Correct Answer: The thenar eminence

      Explanation:

      Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.

      The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
      L– lateral two lumbricals
      O– Opponens pollicis
      A– Abductor pollicis
      F– Flexor pollicis brevis

      In the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.

      Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 24 - A man working as a waiter cuts his arm on a glass while...

    Incorrect

    • A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.

      Which of the following statements regarding the palmaris longus muscle is considered correct?

      Your Answer:

      Correct Answer: It receives its blood supply from the ulnar artery

      Explanation:

      The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.

      The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.

      The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 25 - You have been asked to give a tutorial on common upper limb neurology...

    Incorrect

    • You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:

      Your Answer:

      Correct Answer: Weakness of forearm pronation

      Explanation:

      Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 26 - A patient with a stab wound to the axilla arrives to the emergency...

    Incorrect

    • A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:

      Your Answer:

      Correct Answer: Musculocutaneous nerve

      Explanation:

      The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 27 - Which of the following nerves supplies the abductor pollicis brevis? ...

    Incorrect

    • Which of the following nerves supplies the abductor pollicis brevis?

      Your Answer:

      Correct Answer: The recurrent branch of the median nerve

      Explanation:

      Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 28 - A 30-year old male is brought to the emergency room after a terrible...

    Incorrect

    • A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.

      Which of the following nerves is most likely injured in the case above?

      Your Answer:

      Correct Answer: The anterior interosseous nerve

      Explanation:

      Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 29 - Which of the following nerves is most likely associated with an anterior shoulder...

    Incorrect

    • Which of the following nerves is most likely associated with an anterior shoulder dislocation?

      Your Answer:

      Correct Answer: Axillary nerve

      Explanation:

      In an anterior dislocation, the arm is an abducted and externally rotated position. In the externally rotated position, the posterosuperior aspect of the humeral head abuts and drives through the anteroinferior aspect of the glenoid rim. This can damage the humeral head, glenoid labrum, or both. An associated humeral head compression fracture is described as a Hill Sach’s lesion. If large enough, it can lead to locked dislocations that may require open reduction. The glenoid labrum is a fibrocartilaginous structure that rings the circumference of the glenoid fossa. Bankart lesions are injuries to the anteroinferior glenoid labrum complex and the most common capsulolabral injury. A bony Bankart lesion refers to an associated fracture of the glenoid rim. These capsulolabral lesions are risk factors for recurrent dislocation.

      Axillary nerve injury is identified in about 42% of acute anterior shoulder dislocations. Nerve transection is rare, and traction injuries are more common. Arterial injury has also been described. The subclavian artery becomes the axillary artery after passing the first rib. The distal portion of the axillary artery is anatomically fixed and, therefore, susceptible to injury in anterior dislocations. Ischemic injury, including pseudoaneurysm and arterial laceration, is rare but carries marked morbidity if not quickly identified.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 30 - Where on the body is the radial artery pulsation best palpated? ...

    Incorrect

    • Where on the body is the radial artery pulsation best palpated?

      Your Answer:

      Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon

      Explanation:

      The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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