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  • Question 1 - A 27-year-old man presents with a laceration of his forearm that severed the...

    Correct

    • A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer: The median nerve

      Explanation:

      Flexor carpi radialis is innervated by the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      56.9
      Seconds

  • Question 2 - Due to a traffic accident, a male patient was unable to lift his...

    Incorrect

    • Due to a traffic accident, a male patient was unable to lift his arm, indicating an injury at the glenohumeral joint. Based on the patient’s current condition, which nerve or nerves are may likely damaged?

      Your Answer: Axillary and long thoracic nerve

      Correct Answer: Axillary and suprascapular nerve

      Explanation:

      A suprascapular nerve injury causes numbness in the shoulder, as well as weakness in abduction and external rotation.

      Damage to the axillary nerve can result in shoulder or arm muscle weakness, as well as difficulty lifting the arm. This is because the deltoid and supraspinatus muscles, which are innervated by the axillary and suprascapular nerves, are responsible for abduction of the arm at the shoulder joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      85.1
      Seconds

  • Question 3 - Regarding the abductor pollicis longus, which of the following statements is true? ...

    Incorrect

    • Regarding the abductor pollicis longus, which of the following statements is true?

      Your Answer: It forms part of the thenar eminence

      Correct Answer: It extends the thumb at the carpometacarpal joint

      Explanation:

      Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.

      Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.

      Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.

      Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.

      Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      48
      Seconds

  • Question 4 - A man presents to the emergency department with an injury that has damaged...

    Incorrect

    • A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.

      Which of the following statements regarding the opponens pollicis muscle is considered correct?

      Your Answer: It is innervated by a branch of the radial nerve

      Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint

      Explanation:

      Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.

      Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.

      It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      60.6
      Seconds

  • Question 5 - Which of the following is most likely affected in De Quervain's tenosynovitis? ...

    Incorrect

    • Which of the following is most likely affected in De Quervain's tenosynovitis?

      Your Answer: Extensor carpi radialis brevis

      Correct Answer: Extensor pollicis brevis

      Explanation:

      De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.

      The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      57.8
      Seconds

  • Question 6 - 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: Erb's palsy classically results from sudden excessive abduction of the arm.

      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
      9.3
      Seconds

  • Question 7 - 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: Weakness of supination of the forearm

      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
      36.2
      Seconds

  • Question 8 - Which of the following nerves is most likely associated with an anterior shoulder...

    Correct

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

      Your 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
      17.1
      Seconds

  • Question 9 - A 24-year-old waiter cuts his hand on a dropped plate that smashed and...

    Incorrect

    • A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.
      The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: The superficial branch of the ulnar nerve

      Correct Answer: The deep branch of the ulnar nerve

      Explanation:

      Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.
      Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.
      Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      53.5
      Seconds

  • Question 10 - Which of the following muscles acts as an extensor of the shoulder joint?...

    Correct

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

      Your 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
      104.3
      Seconds

  • Question 11 - A newborn baby girl is delivered vaginally to a 19-year old female, however...

    Incorrect

    • A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.

      What is the most probable diagnosis of the case above?

      Your Answer: Axillary nerve palsy

      Correct Answer: Klumpke’s palsy

      Explanation:

      Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.

      The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.

      The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      33.1
      Seconds

  • Question 12 - Fracture of the medial epicondyle would result to the following, except ...

    Incorrect

    • Fracture of the medial epicondyle would result to the following, except

      Your Answer: Weakness of adduction of the fingers

      Correct Answer: Weakness of abduction of the thumb

      Explanation:

      Thumb abduction is mediated by the abductor pollicis longus and brevis, which are innervated by the radial and median nerves, respectively.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      58.5
      Seconds

  • Question 13 - 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: Olecranon

      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
      23.2
      Seconds

  • Question 14 - 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: The median nerve

      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
      25.8
      Seconds

  • Question 15 - 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: Axillary nerve and axillary artery

      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
      71.5
      Seconds

  • Question 16 - 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: It is absent in approximately 50% of the population

      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
      57.6
      Seconds

  • Question 17 - 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: Median and radial nerve

      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
      84.5
      Seconds

  • Question 18 - A 25-year-old man suffers from a shoulder injury that damaged the nerve that...

    Incorrect

    • A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.

      Which of the following nerves may most likely be affected?

      Your Answer: The dorsal scapular nerve

      Correct Answer: The suprascapular nerve

      Explanation:

      The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      88.6
      Seconds

  • Question 19 - A patient was diagnosed with Erb's palsy as a result of a brachial...

    Incorrect

    • A patient was diagnosed with Erb's palsy as a result of a brachial plexus injury sustained in a car accident and, as a result, suffers from left arm paralysis. The following muscles are affected by the injury, except

      Your Answer: Biceps brachii

      Correct Answer: Trapezius

      Explanation:

      Damage to the C5 and C6 nerve roots causes Erb’s palsy.

      The spinal accessory nerve (CN XI) innervates the trapezius muscle, thus you would not expect this muscle to be impacted.

      The trapezius is a muscle that runs from the base of the neck across the shoulders and into the centre of the back.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      42
      Seconds

  • Question 20 - A 22 year old male has been stabbed and is brought to the...

    Incorrect

    • A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?

      Your Answer: Median nerve at elbow

      Correct Answer: Ulnar nerve at elbow

      Explanation:

      The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger.
      Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve.
      The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      72.3
      Seconds

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Anatomy (3/20) 15%
Upper Limb (3/20) 15%
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