Select the one best response to each question!
Fractures of the scapula typically involve
Fractures of the scapula typically involve the protruding subcutaneous acromion. The remainder of the scapula is well protected by muscles and the thoracic wall itself
Which of the following parts of the humerus is matched correctly with the nerve with which it is in direct contact?
The surgical neck of the humerus is in direct contact with the axillary nerve, the radial nerve runs in the radial groove, the distal end of the humerus is in direct contact with the median nerve, and the medial epicondyle is in contact with the ulnar nerve
“Winging” of the scapula is most likely caused by which of the following?
Damage to the long thoracic nerve results in “winging” of the scapula
Which of the following is correct regarding the triangle of auscultation?
The triangle of auscultation, a good place to examine lung sounds, is bounded by the superior horizontal border of the latissimus dorsi, the medial border of the scapula, and the inferolat eral border of the trapezius. The 6th and 7th ribs and the 6th intercostal space is subcutaneous
. A patient cannot raise the trunk (as in climbing). What is most likely the problem?
With paralysis of the latissimus dorsi, the patient is unable to raise the trunk as necessary for climbing. The cause could be injury to the thoracodorsal nerve
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The scapula on one side of a patient is located farther from the midline than that on the normal side. What might be the problem?
Injury to the dorsal scapular nerve (C4–C5) can paralyze the rhomboids, causing the scapula on one side to be located farther from the midline than that on the normal side
The axillary nerve is damaged. What is the likely result?
The deltoid atrophies when the axillary nerve (C5–C6) is damaged. Therefore, the rounded contour of the shoulder often disappears. A loss of sensation may occur on the lateral side of the proximal part of the arm
Which of the following is true regarding rotator cuff injuries?
Please select 2 correct answers
Injury or disease may damage the rotator cuff, causing instability of the glenohumeral joint. The supraspinatus tendon is the most commonly torn part of the rotator cuff. Acute tears are uncommon in young persons
A patient has been thrown from a motorcycle, landing on the shoulder such that the neck and shoulder are widely separated. You suspect an upper brachial plexus injury. What signs do you expect?
In an upper brachial plexus injury causing Erb-Duchenne palsy, one would expect damage to C5–C6, resulting in “waiter’s tip position” (adducted shoulder, medially rotated arm, and extended elbow). This results from paralysis of the deltoid, biceps, brachialis, and brachioradialis. The lateral aspect of the upper limb also experiences loss of sensation
A patient exhibits “clawhand.” What might have happened?
Damage to the inferior trunks of the brachial plexus (C8–T1) affects the short muscles of the hand, resulting in “clawhand.” The patient might have grabbed a tree limb to catch himself while falling to cause this injury. “Clawhand” may also be caused by an injury to the ulnar nerve
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A patient receives a knife wound to the axilla. What problems do you expect?
A knife wound to the axilla would damage the musculocutaneous nerve and result in paralysis of the coracobrachialis, biceps, and brachialis. Therefore, flexion of the elbow joint and supination of the forearm would be weak ened. The patient would also lose sensation on the lateral surface of the forearm
A patient tries to make a fist, but digits 2 and 3 remain partially extended. What nerve is injured?
When the median nerve is injured, the patient often exhibits the “hand of benediction.” When the patient tries to make a fist, digits 2 and 3 remain partially extended because flexion of the PIP joints is lost in digits 1–3 and weakened in digits 4–5. Flexion of the DIP joints is lost in digits 2–3 but maintained in digits 4–5 (since the ulnar nerve controls the medial part of the flexor digitorum profundus). Flexion of the MCP joints of digits 2-3 will also be affected due to a loss of the lumbricals 1 and 2
Which of the following is true in respect to ulnar nerve injuries?
Which limb defect is correctly matched with its definition?
Amelia is the complete absence of one or more extremities while meromelia is the partial absence of one or more extremities. All segments of extremities are present but abnormally short in micromelia. In phocomelia, long bones are absent, and small hands or feet are attached to the trunk by short, irregular bones. In cleft hand (lobster claw deformity), the third metacarpal is absent and digits 1–2 and 4–5 are fused
Syndactylyl involves
Syndactyly involves abnormal fusion of fingers and toes. Cleft hand (lobster claw deformity) consists of an abnormal cleft between the 2nd and 4th metacarpal bones, with the 3rd metacarpal and phalangeal bones being absent and with digits 1–2 and 4–5 being fused. Polydactyly involves extra fingers or toes, while ectrodactyly involves the absence of a digit. Mutations in HOXA13 result in hand-foot-genital syndrome, where carpals and short digits are fused and the genitalia have altered structures
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Which of the following is NOT correct?
During development, dorsal cells organize as the epimere and ventral cells organize as the hypomere. Dorsal rami innervate muscles derived from the epimere, whereas ventral rami innervate muscles derived from the hypomere. Myoblasts of the epimere form the extensor muscles of the vertebral column, and those of the hypomere give rise to muscles of the limbs and body wall. Somites and somitomeres form the musculature of the limbs
A patient in surgery has no pectoralis major. What do you suspect?
Partial or complete absence of one or more muscles is rather common. One of the bestknown examples is total or partial absence of the pectoralis major (Poland anomaly). Similarly, the palmaris longus, serratus anterior, and quadratus femoris may be partially or entirely absent
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| 66. Which of the following is NOT true in respect to the clavicle? (A) The clavicle varies more in shape than most other long bones. (B) The clavicle can be pierced by a branch of the supraclavicular nerve. (C) The clavicle is thicker and more curved is manual workers. (D) The right clavicle is stronger than the left and is usually shorter. (E) The clavicle is a compact bone. |
| 67. Fractures of the scapula typically involve (A) the acromion. (B) the coracoid process. (C) the spine. (D) the inferior angle. (E) the suprascapular notch. |
| 68. Which of the following parts of the humerus is matched correctly with the nerve with which it is in direct contact?
(A) distal end of humerus . . . radial nerve |
| 69. “Winging” of the scapula is most likely caused by which of the following? (A) a lesion to the long thoracic nerve (B) a lesion to the thoracodorsal nerve (C) injury to the suprascapular nerve (D) damage to the dorsal scapular nerve (E) damage to the upper and lower subscapular nerves |
| 70. Which of the following is correct regarding the triangle of auscultation? (A) Its borders are the latissimus dorsi, scapula, and trapezius. (B) It is a good location to hear heart murmurs. (C) The 8th and 9th ribs and the 8th intercostal space are subcutaneous here. (D) It is a location of back trauma. (E) It is a location for dorsal rami to pass to the superficial back. |
| 71. A patient cannot raise the trunk (as in climbing). What is most likely the problem? (A) damage to the ventral rami of C5–C6–C7 (B) paralysis of the latissimus dorsi (C) injury to the dorsal scapular nerve (D) damage to the dorsal rami of C8–T1 (E) injury to the axillary nerve |
| 72. The scapula on one side of a patient is located farther from the midline than that on the normal side. What might be the problem? (A) paralysis of the rhomboids on one side (B) injury to the long thoracic nerve (C) a lesion of C7–C8 (D) dislocated shoulder (E) separated shoulder |
| 73. The axillary nerve is damaged. What is the likely result?
(A) The teres major atrophies. |
| 74. Which of the following is true regarding rotator cuff injuries? (A) Injury or disease may damage the rotator cuff, causing instability of the acromioclavicular joint. (B) The supraspinatus tendon is the most commonly torn part of the rotator cuff. (C) The teres major takes the longest to rehabilitate of the rotator cuff muscles. (D) The injuries occur when the muscles pull away from their origin on the acromion. (E) Acute tears are common in young persons. |
| 75. A patient has been thrown from a motorcycle, landing on the shoulder such that the neck and shoulder are widely separated. You suspect an upper brachial plexus injury. What signs do you expect? (A) “clawhand” (B) paralysis of flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus (C) adducted shoulder, medially rotated arm, and extended elbow (D) loss of sensation in the medial forearm (E) “wrist-drop” |
| 76. A patient exhibits “clawhand.” What might have happened? (A) upper brachial plexus injury (B) acute brachial plexus neuritis (C) compression of the cords of the brachial plexus (D) lower brachial plexus injury (E) damage to dorsal rami that send fibers to the brachial plexus |
| 77. A patient receives a knife wound to the axilla. What problems do you expect? (A) damage to the axillary nerve (B) paralysis of the coracobrachialis, biceps, and brachialis (C) inability to extend the wrist and digits at the metacarpophalangeal joints (D) loss of sensation on the medial surface of the arm (E) “clawhand” |
| 78. A patient tries to make a fist, but digits 2 and 3 remain partially extended. What nerve is injured? (A) ulnar nerve (B) radial nerve (C) median nerve (D) musculocutaneous nerve (E) axillary nerve |
| 79. Which of the following is true in respect to ulnar nerve injuries? (A) The injury often occurs where the nerve passes posterior to the medial epicondyle of the humerus. (B) The patient experiences numbness and tingling on the lateral part of the palm and the thumb. (C) The patient may exhibit “waiter’s tip hand.” (D) Patients have difficulty because they cannot flex their first, second, and third digits at the DIP joints. (E) Power of abduction is impaired, and when the patient attempts to flex the wrist, the flexor carpi ulnaris brings the hand to the medial side. |
| 80. Which limb defect is correctly matched with its definition? (A) meromelia . . . complete absence of one or more extremities (B) phocomelia . . . all segments of extremities are present but abnormally short (C) micromelia . . . partial absence of one or more extremities(D) amelia . . . long bones are absent, and small hands or feet are attached to the trunk by short, irregular bones (E) cleft hand (lobster claw deformity) . . . absent third metacarpal, fusion of digits 1–2 and 4–5 |
| 81. Syndactylyl involves (A) extra fingers or toes. (B) absence of a digit or limb. (C) abnormal fusion of fingers and toes. (D) small hands or feet being attached to trunk by short bones instead of long bones. (E) congenital dislocation of glenohumeral joint. |
| 82. Which of the following is NOT correct? (A) During development, dorsal cells organize as the epimere and ventral cells organize as the hypomere. (B) Dorsal rami innervate muscles derived from the epimere. (C) Ventral rami innervate muscles derived from the hypomere. (D) Myoblasts of the hypomere form the extensor muscles of the vertebral column. (E) Somites and somitomeres form the musculature of the limbs. |
| 83. A patient in surgery has no pectoralis major. What do you suspect? (A) trauma (B) dominant pectoralis minor (C) drug-induced muscle hypoplasia (D) atrophy of the muscle (E) congenital absence of the muscle |
