UPPER LIMB MCQS FROM PAST PAPERS

UPPER LIMB MCQS FROM PAST PAPERS 

The cords of the brachial plexus are: 
 above the clavicle, medial to the scalenus anticus (anterior scalene).
 above the clavicle, behind the scalenus anticus (anterior scalene).
 at or below the clavicle, closely related to the axillary artery.
 at or below the clavicle, closely related to the axillary vein.

An open arterial anastomosis in the shoulder occurs between the suprascapular artery and which other artery? 
 Anterior circumflex humeral
 Circumflex scapular
 Dorsal scapular
 Thoracodorsal
 Transverse cervical

The long thoracic nerve innervates which muscle?
 Anterior scalene
 Middle scalene
 Serratus anterior
 Teres major
 Subscapularis 

A man riding a motorcycle hit a wet spot in the road, lost control, and was thrown from his bike. He landed on the right side of his head and the tip of his shoulder, bending his head sharply to the left and stretching the right side of his neck. Subsequent neurological examination revealed that the roots of the 5th and 6th cervical nerves had been torn away from the spinal cord.


Following the above injury, which of the movements of the arm at the shoulder would you expect to be totally lost? 
 adduction
 abduction
 flexion
 extension
 medial rotation

Following the above injury there would most likely be diminished cutaneous sensation over what part of the upper limb? 
 the back of the shoulder
 the pectoral region
 the top of the shoulder and the lateral side of the arm
 the medial side of the arm and forearm
 the tip of the little finger

A patient is found to have a melanoma (cancer arising in pigment cells) originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. 
Which axillary lymph nodes would not be removed by this procedure? 
 Apical
 Central
 Lateral
 Pectoral
 Subscapular

Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection? 
 Levator scapulae
 Pectoralis major
 Rhomboideus major
 Serratus anterior
 Subscapularis

During a motorcycle accident, an 18-year-old male landed on the right lateral side of his rib cage with his right upper limb abducted. In the hospital he was found to have "winging" of the right scapula. Which nerve was likely damaged in the accident?
 Accessory
 Lateral pectoral
 Long thoracic
 Phrenic
 Vagus

During an industrial accident, a sheet metal worker lacerates the anterior surface of his wrist at the junction of his wrist and hand. Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb. Branches of which nerve must have been severed? 
 Lateral antebrachial cutaneous
 Medial antebrachial cutaneous
 Median
 Radial
 Ulnar


The nerve which passes through the quadrangular space of the posterior shoulder innervates which muscle? 
 Deltoid
 Infraspinatus
 Subscapularis
 Supraspinatus
 Teres major


The surgeon next encounters a large (about 2 cm in diameter) horizontally running vein, fortunately intact, which is also retracted downward. This exposes the damaged artery. He knows that the cords of the brachial plexus are closely associated with this artery, so he carefully retracts one found superolateral and one found inferomedial to the artery and then proceeds to repair the artery itself and close the wound.

The large artery that was severed was the: 
 axillary
 brachial
 radial
 subscapular
 suprascapular


Neurological testing of a patient reveals no cutaneous sensation on the tip of the index finger. Such a finding would indicate injury to some portion of which nerve? 
 axillary
 median
 musculocutaneous
 radial
 ulnar

You are attending an axillary lymph node dissection in a patient with a melanoma in the upper limb. The surgeon says, "We are going to sample the level II lymph nodes posterior to the pectoralis minor muscle." Having excelled in anatomy, you realize that she is referring to the anatomical nodes known as 
 apical axillary nodes
 central axillary nodes 
 lateral axillary nodes
 lateral pectoral nodes
 subscapular axillary nodes

In the axilla the pectoralis minor is a landmark, being closely related to all of the following structures except: 
 cephalic vein
 cords of the brachial plexus
 lateral thoracic artery
 medial pectoral nerve
 second part of the axillary artery

In a patient with Erb-Duchenne palsy, a nerve arising from the superior trunk of the brachial plexus is nonfunctional. This nerve is the: 
 Suprascapular
 Dorsal scapular
 Long thoracic
 Lateral pectoral
 Medial pectoral

The axillary nerve arises directly from which part of the brachial plexus? 
 inferior trunk
 lateral cord
 medial cord
 middle trunk
 posterior cord
superior cord

Which of the following is not a direct branch of the axillary artery? 
 anterior circumflex humeral
 posterior circumflex humeral
 thoracoacromial
 thoracodorsal
 subscapular

While putting metal panels on the roof of a barn, one of the panels slips out of the hands of the man on the roof. During an attempt to catch the panel, a worker below is struck by its sharp edge. The panel hits across the anterior surface of his right arm at midlength and the impact severs all of the tissue to the bone. When examined in the emergency room it is noted that the patient can only weakly flex his elbow and the lateral side of his forearm is numb. In addition to the muscles, which nerve is injured? 
 axillary
 median
 musculocutaneous
 radial
 ulnar

While treating the patient (in the preceding question) the doctor observes, "You were fortunate that the panel did not sever the large artery running down the medial side of your arm." The large artery referred to lies in the neurovascular compartment and supplies most everything below the elbow; this artery is the: 
 axillary
 brachial
 deep brachial
 radial
 ulnar

In a case of Erb's palsy, where roots C5 and C6 of the brachial plexus are avulsed (torn out) which muscle is paralyzed? 
 Latissimus dorsi
 Pectoralis minor
 Supraspinatus
 Trapezius
 Triceps brachii
If the second part of the axillary artery was interrupted, collateral blood flow could pass from branches of the thyrocervical trunk into which artery? 
 Anterior humeral circumflex
 Circumflex scapular
 Deep brachial
 Posterior humeral circumflex
 Thoracoacromial

In a fracture of the surgical neck of the humerus, which artery may be injured? 
 Subscapular
 Posterior humeral circumflex
 Radial recurrent
 Deep brachial
 Circumflex scapular

While riding a bike, a patient fell against a tree and fractured the shaft of the humerus at midlength. What nerve may be injured because of its close proximity to the injury? 
 Ulnar
 Radial
 Axillary
 Medial antebrachial cutaneous
 Median

Loss of sensation from the tip of the index finger is indicative of injury to which nerve? 
 Radial
 Median
 Ulnar
 Musculocutaneous
 Medial antebrachial cutaneous
In a fracture of the midshaft of the humerus, which artery is most likely to be injured? 
 Subscapular
 Posterior circumflex humeral
 Radial recurrent
 Deep brachial
 Circumflex scapular

As an inexperienced phlebotomist (blood drawer) attempts to insert the needle to draw blood from the median cubital vein, the patient suddenly screams and complains of pain and burning in the middle and thumb side of his palm. The nerve accidentally impaled on the needle was the 
 lateral antebrachial cutaneous
 medial antebrachial cutaneous 
 median
 ulnar
 posterior antebrachial cutaneous
radial
superficial radial

In a diving accident that severed the spinal cord below the sixth cervical vertebra, which muscle would be affected? 
 Deltoid
 Infraspinatus
 Latissimus dorsi
 Levator scapulae
 Trapezius

Which muscle is the strongest medial rotator of the arm? 
 Coracobrachialis
 Infraspinatus
 Subscapularis
 Supraspinatus
 Teres minor

An elderly man complained of pain in his shoulder when he brought his forearm and hand behind his back while dressing. It was determined that the pain was caused by stretching of the lateral rotators of his arm during this motion. Which muscle was most likely involved? 
 Infraspinatus
 Latissimus dorsi
 Subscapularis
 Supraspinatus
 Teres major

A woman riding a mountain bike on a rough trail hits a rut and is thrown from the bike. Her upper arm hits a tree, fracturing the humerus just above the insertion of the teres major muscle. Later, during examination, it is noted that she cannot extend her forearm at the elbow or hand at the wrist. Which nerve must have been injured? 
 Axillary
 Median
 Musculocutaneous
 Radial
 Ulnar

In old age, the supraspinatus tendon is sometimes ruptured where it blends with the capsule of the shoulder joint. Following this kind of injury one might expect 
 difficulty in adducting the arm
 difficulty in flexing the arm
 difficulty in abducting the arm
 difficulty in extending the arm
 difficulty in medially rotating the arm

During a strenuous game of tennis a 55 year old woman complained of severe shoulder pain that forced her to quit the game. During physical examination it was found that she could not initiate abduction of her arm, but if her arm was elevated to 45 degrees from the vertical (at her side) position, she had no trouble fully abducting it. Injury to which muscle was responsible? 
 deltoid
 infraspinatus
 supraspinatus
 teres major
 trapezius 

A man is in an auto accident and sustains several injuries, among them are:
Skin lacerations: 
on the back of his head in the occipital area,
on his chest just above the nipple,
on the lateral side of his arm,
lateral forearm at midlength,
dorsal hand between his thumb and index finger.
Abrasions and contusions (bruises) about his right shoulder
A fractured right radius near its distal end

Later, while undergoing physical therapy because of his shoulder injury, he comments that it is very painful when his forearm is brought across his chest (medial or internal rotation of the humerus). You deduce that the pain is due to stretching of the lateral (external) rotators of the shoulder. Which muscle was most likely the source of his pain? 
 infraspinatus
 latissimus dorsi
 rhomboideus major
 supraspinatus
 teres major

An elderly patient complains of shoulder pain and has difficulty abducting his arm. Arthroscopy is done in which a dye is injected into the shoulder joint and an X-ray taken. The radiologist notes that the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would need to be ruptured for this to occur? 
 deltoid
 infraspinatus
 latissimus dorsi
 supraspinatus
 teres minor

A person riding a mountain bike on a rustic trail hits a rut, the fork of the bike breaks and the person is thrown into a tree, severely fracturing the upper end of his humerus. During the repair the surgeon ties off the artery traveling through the quadrangular space to stop the hemorrhage. Which artery did he ligate? 
 dorsal scapular
 posterior circumflex humeral
 scapular circumflex
 subscapular 
 suprascapular

After initial examination, a patient is sent to radiology. Radiographs reveal that the portion of the scapula forming the tip or point of the shoulder has been fractured. This bone is the 
 acromion
 angle
 coracoid 
 glenoid 
 spine

Several deficits in muscle function of the right upper limb were noted, including inability to abduct the arm. This was caused by denervation of which muscle? 
 deltoid
 infraspinatus
 latissimus dorsi
 teres minor
 trapezius

The rotator cuff is composed of all of the following muscles except: 
 infraspinatus
 subscapularis
 supraspinatus
 teres major
 teres minor

Following a gunshot wound to the shoulder, a patient is unable to abduct the arm between 0 and 15 degrees, with reduced lateral rotation of the humerus. What nerve is probably injured? 
 Accessory (CN XI)
 Axillary
 Median
 Suprascapular
 Ulnar 


During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals that the vertebral (medial) border of the patient's scapula projects posteriorly and is closer to the midline on the injured side. On return visit the patient complains that he cannot reach as far forward (such as to reach for a door knob) as he could before the injury. The nerve injured which caused these symptoms is the: 
 axillary
 long thoracic
 musculocutaneous
 radial
 suprascapular

A man suffers a penetrating wound through the anterior axillary fold, with resulting damage to one of the main terminal branches of the brachial plexus. Among the effects is a significant weakening of flexion of the elbow. One or more other effects to be expected is (are): 
 Loss of cutaneous sensation on the tips of several fingers
 Only loss of cutaneous sensation on the anterolateral surface of the forearm
 Only weakening of flexion at the shoulder
 Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the arm
 Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the forearm

A person sustains a left brachial plexus injury in an auto accident. After initial recovery the following is observed: 1) the diaphragm functions normally, 2) there is no winging of the scapula, 3) abduction cannot be initiated, but if the arm is helped through the first 45 degrees of abduction, the patient can fully abduct the arm. From this amount of information and your knowledge of the formation of the brachial plexus where would you expect the injury to be: 
 axillary nerve
 posterior cord
 roots of plexus
 superior trunk
 suprascapular nerve