170
5 While walking to his classroom building, a fi rst-
year medical student slipped on the wet pavement and fell against the curb, injuring his right arm. Radio- graphic images showed a midshaft fracture of the hu- merus. Which pair of structures was most likely injured at the fracture site?
⃣ A. Median nerve and brachial artery
⃣ B. Axillary nerve and posterior humeral circum- fl ex artery
⃣ C. Radial nerve and deep brachial artery
⃣ D. Suprascapular nerve and artery
⃣ E. Long thoracic nerve and lateral thoracic artery
6 An 18-year-old male is brought to the emergency
department after an injury while playing rugby. Imag- ing reveals a transverse fracture of the humerus about 1 inch proximal to the epicondyles. Which nerve is most frequently injured by the jagged edges of the bro- ken bone at this location?
⃣ A. Axillary
⃣ B. Median
⃣ C. Musculocutaneous
⃣ D. Radial
⃣ E. Ulnar
7 A 52-year-old band director suffered problems in
her right arm several days after strenuous fi eld exer- cises for a major athletic tournament. Examination in the orthopedic clinic reveals wrist drop and weakness of grasp but normal extension of the elbow joint. There is no loss of sensation in the affected limb. Which nerve was most likely affected?
⃣ A. Ulnar
⃣ B. Anterior interosseous
⃣ C. Posterior interosseous
⃣ D. Median
⃣ E. Superfi cial radial
8 A 32-year-old woman is admitted to the emer-
gency department after an automobile collision. Radio- graphic examination reveals multiple fractures of the humerus. Flexion and supination of the forearm are severely weakened. She also has loss of sensation on the lateral surface of the forearm. Which of the follow- ing nerves has most likely been injured?
⃣ A. Radial
⃣ B. Musculocutaneous
⃣ C. Median
⃣ D. Lateral cord of brachial plexus
⃣ E. Lateral cutaneous nerve of the forearm
9 A 24-year-old medical student was bitten at the
base of her thumb by her dog. The wound became infected and the infection spread into the radial bursa. The tendon(s) of which muscle will most likely be affected?
⃣ A. Flexor digitorum profundus
⃣ B. Flexor digitorum superfi cialis
⃣ C. Flexor pollicis longus
⃣ D. Flexor carpi radialis
⃣ E. Flexor pollicis brevis
10 Laboratory studies in the outpatient clinic on a
24-year-old female included assessment of circulating blood chemistry. Which of the following arteries is most likely at risk during venipuncture at the cubital fossa?
⃣ A. Brachial
⃣ B. Common interosseous
⃣ C. Ulnar
⃣ D. Anterior interosseous
⃣ E. Radial
11 A 22-year-old male is diagnosed with metastatic
malignant melanoma of the skin over the xiphoid pro- cess. Which nodes receive most of the lymph from this area and are therefore most likely to be involved in metastasis of the tumor?
⃣ A. Deep inguinal
⃣ B. Vertical group of superfi cial inguinal
⃣ C. Horizontal group of superfi cial inguinal
⃣ D. Axillary
⃣ E. Deep and superfi cial inguinal
12 A 49-year-old female who had suffered a myocar-
dial infarction must undergo a bypass graft procedure using the internal thoracic artery. Which vessels will most likely continue to supply blood to the anterior part of the upper intercostal spaces?
⃣ A. Musculophrenic
⃣ B. Superior epigastric
⃣ C. Posterior intercostal
⃣ D. Lateral thoracic
⃣ E. Thoracodorsal
171
13 A 22-year-old woman is admitted to the emer-
gency department in an unconscious state. The nurse takes a radial pulse to determine the heart rate of the patient. This pulse is felt lateral to which tendon?
⃣ A. Palmaris longus
⃣ B. Flexor pollicis longus
⃣ C. Flexor digitorum profundus
⃣ D. Flexor carpi radialis
⃣ E. Flexor digitorum superfi cialis
14 A 45-year-old male is admitted to the hospital
after accidentally walking through a plate glass door in a bar while intoxicated. Physical examination shows multiple lacerations to the upper limb, with in- ability to fl ex the distal interphalangeal joints of the fourth and fi fth digits. Which of the following muscles is most likely affected?
⃣ A. Flexor digitorum profundus
⃣ B. Flexor digitorum superfi cialis
⃣ C. Lumbricals
⃣ D. Flexor digitorum profundus and fl exor digito- rum superfi cialis
⃣ E. Interossei
15 A 24-year-old man is admitted with a wound to
the palm of his hand. He cannot touch the pads of his fi ngers with his thumb but can grip a sheet of paper between all fi ngers and has no loss of sensation on the skin of his hand. Which of the following nerves has most likely been injured?
⃣ A. Deep branch of ulnar
⃣ B. Anterior interosseous
⃣ C. Median
⃣ D. Recurrent branch of median
⃣ E. Deep branch of radial
16 A 55-year-old male is examined in a neighbor-
hood clinic after receiving blunt trauma to his right axilla in a fall. He has diffi culty elevating the right arm above the level of his shoulder. Physical examination shows the inferior angle of his right scapula protrudes more than the lower part of the left scapula. The right scapula protrudes far more when the patient pushes against resistance. Which of the following neural struc- tures has most likely been injured?
⃣ A. The posterior cord of the brachial plexus
⃣ B. The long thoracic nerve
⃣ C. The upper trunk of the brachial plexus
⃣ D. The site of origin of the middle and lower subscapular nerves
⃣ E. Spinal nerve roots C7, C8, and T1
17 A mother tugs violently on her male child’s hand
to pull him out of the way of an oncoming car and the child screams in pain. Thereafter, it becomes obvious that the child cannot straighten his forearm at the elbow.
When the child is seen in the emergency department, radiographic examination reveals a dislocation of the head of the radius. Which of the following ligaments is most likely directly associated with this injury?
⃣ A. Anular
⃣ B. Joint capsular
⃣ C. Interosseous
⃣ D. Radial collateral
⃣ E. Ulnar collateral
18 After a forceps delivery of a male infant, the baby
presents with his left upper limb adducted, internally rotated, and fl exed at the wrist. The startle refl ex is ab- sent on the ipsilateral side. Which part of the brachial plexus was most likely injured during this delivery?
⃣ A. Lateral cord
⃣ B. Medial cord
⃣ C. Roots of the lower trunk
⃣ D. Root of the middle trunk
⃣ E. Roots of the upper trunk
19 A 35-year-old patient has a small but painful tu-
mor under the nail of the little fi nger. Which of the following nerves would have to be anesthetized for a painless removal of the tumor?
⃣ A. Superfi cial radial
⃣ B. Common palmar digital of median
⃣ C. Common palmar digital of ulnar
⃣ D. Deep radial
⃣ E. Recurrent branch of median
20 A 25-year-old male athlete is admitted to the
emergency department after a bad landing in the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the fl oor of the anatomic snuffbox ( Fig. 6-1 ). Which bone has most likely been fractured?
⃣ A. Triquetral
⃣ B. Scaphoid
⃣ C. Capitate
172
⃣ D. Hamate
⃣ E. Trapezoid
21 A 36-year-old man is brought to the emergency
department because of a deep knife wound on the me- dial side of his distal forearm. He is unable to hold a piece of paper between his fi ngers and has sensory loss on the medial side of his hand and little fi nger. Which nerve is most likely injured?
⃣ A. Axillary
⃣ B. Median
⃣ C. Musculocutaneous
⃣ D. Radial
⃣ E. Ulnar
22 A 19-year-old man is brought to the emergency
department after dislocating his shoulder while playing soccer. Following reduction of the dislocation, he has pain over the dorsal region of the shoulder and cannot abduct the arm normally. An MRI of the shoulder shows a torn muscle. Which of the following muscles is most likely to have been damaged by this injury?
⃣ A. Coracobrachialis
⃣ B. Long head of the triceps
⃣ C. Pectoralis minor
⃣ D. Supraspinatus
⃣ E. Teres major
23 A 47-year-old female tennis professional is in-
formed by her physician that she has a rotator cuff in- jury that will require surgery. Her physician explains that over the years of play a shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the following ligaments is the phy- sician most likely referring?
⃣ A. Acromioclavicular ligament
⃣ B. Coracohumeral ligament
⃣ C. Transverse scapular ligament
⃣ D. Glenohumeral ligament
⃣ E. Coracoacromial ligament
24 A 69-year-old man has numbness in the middle
three digits of his right hand and fi nds it diffi cult to grasp objects with that hand. He states that he retired 9 years earlier, after working as a carpenter for 50 years. He has atrophy of the thenar eminence ( Fig.
6-2 ). Which of the following conditions is the most likely cause of the problems in his hand?
⃣ A. Compression of the median nerve in the car- pal tunnel
⃣ B. Formation of the osteophytes that compress the ulnar nerve at the medial epicondyle
⃣ C. Hypertrophy of the triceps muscle compress- ing the brachial plexus
⃣ D. Osteoarthritis of the cervical spine
⃣ E. Repeated trauma to the ulnar nerve
Fig. 6-1
Fig. 6-2
173
25 A 13-year-old boy is brought to the emergency
department after losing control during a motorbike race in which he was run over by several of the other racers.
Physical examination reveals several cuts and bruises.
He is unable to extend the left wrist, fi ngers, and thumb, although he can extend the elbow. Sensation is lost in the lateral half of the dorsum of the left hand.
Which of the following nerves has most likely been injured to result in these signs, and in what part of the arm is the injury located?
⃣ A. Median nerve, anterior wrist
⃣ B. Median nerve, arm
⃣ C. Radial nerve, midhumerus
⃣ D. Ulnar nerve, midlateral forearm
⃣ E. Ulnar nerve, midpalmar region
26 A 17-year-old male has weakness of elbow fl exion
and supination of the left hand after sustaining a knife wound in that arm in a street fi ght. Examination in the emergency department indicates that a nerve has been severed. Which of the following conditions will also most likely be seen during physical examination?
⃣ A. Inability to adduct and abduct his fi ngers
⃣ B. Inability to fl ex his fi ngers
⃣ C. Inability to fl ex his thumb
⃣ D. Sensory loss over the lateral surface of his forearm
⃣ E. Sensory loss over the medial surface of his forearm
27 Following several days of 12-hour daily rehearsals
of the symphony orchestra for a performance of a Wag- nerian opera, the 52-year-old male conductor experi- enced such excruciating pain in the posterior aspect of his right forearm that he could no longer direct the musicians. When the maestro’s forearm was palpated 2 cm distal to, and posteromedial to, the lateral epicon- dyle, the resulting excruciating pain caused the con- ductor to weep. Injections of steroids and rest were recommended to ease the pain. Which of the following injuries is most likely?
⃣ A. Compression of the ulnar nerve by the fl exor carpi ulnaris
⃣ B. Compression of the median nerve by the pro- nator teres
⃣ C. Compression of the median nerve by the fl exor digitorum superfi cialis
⃣ D. Compression of the superfi cial radial nerve by the brachioradialis
⃣ E. Compression of the deep radial nerve by the supinator
28 A 54-year-old female marathon runner presents
with pain in her right wrist that resulted when she fell with force on her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone ( Fig. 6-3 ). Which of the following bones is most likely dislocated?
⃣ A. Capitate
⃣ B. Lunate
⃣ C. Scaphoid
⃣ D. Trapezoid
⃣ E. Triquetrum
29 A 45-year-old man is admitted to the hospital af-
ter a car crash. Radiographic examination reveals mild disk herniations of C7, C8, and T1. The patient pre- sents with a sensory defi cit of the C8 and T1 spinal nerve dermatomes. The dorsal root ganglia of C8 and T1 would contain cell bodies of sensory fi bers carried by which of the following nerves?
⃣ A. Medial antebrachial cutaneous nerve
⃣ B. Long thoracic nerve
⃣ C. Lateral antebrachial cutaneous nerve
⃣ D. Deep branch of ulnar nerve
⃣ E. Anterior interosseous nerve
30 A 23-year-old female maid was making a bed in a
hotel bedroom. As she straightened the sheet by run- ning her right hand over the surface with her fi ngers extended, she caught the end of the index fi nger in a fold. She experienced a sudden, severe pain over the base of the terminal phalanx. Several hours later when the pain had diminished, she noted that the end of her right index fi nger was swollen and she could not com- pletely extend the terminal interphalangeal joint. Which one of the following structures within the digit was most likely injured?
⃣ A. The proper palmar digital branch of the me- dian nerve
Fig. 6-3
174
⃣ B. The vinculum longa
⃣ C. The insertion of the tendon of the extensor digitorum onto the base of the distal phalanx
⃣ D. The insertion of the fl exor digitorum profun- dus tendon
⃣ E. The insertion of the fl exor digitorum superfi - cialis tendon
31 A 45-year-old patient had fallen upon his out-
stretched hand, resulting in a Smith fracture of the distal end of the radius. The fractured bone displaced a carpal bone in the palmar direction, resulting in nerve compression within the carpal tunnel. Which of the following carpal bones will most likely be dislocated?
⃣ A. Scaphoid
⃣ B. Trapezium
⃣ C. Capitate
⃣ D. Hamate
⃣ E. Lunate
32 A 15-year-old girl was brought to the emergency
department with a tear of the tendons in the fi rst dorsal compartment of the wrist from a severe bite by a pit bull dog. The injured tendons in this compartment would include which of the following muscles?
⃣ A. Extensor carpi radialis longus and brevis
⃣ B. Abductor pollicis longus and extensor pollicis brevis
⃣ C. Extensor digitorum
⃣ D. Extensor indicis proprius
⃣ E. Extensor carpi ulnaris
33 As she fell from the uneven parallel bars, the 17-
year-old female gymnast grasped the lower bar briefl y with one hand but then fell painfully to the fl oor. An MRI examination reveals an injury to the medial cord of the brachial plexus. Which of the following spinal nerve levels would most likely be affected?
⃣ A. C5, C6
⃣ B. C6, C7
⃣ C. C7, C8
⃣ D. C7, C8, T1
⃣ E. C8, T1
34 A 21-year-old female softball pitcher is examined
in the emergency department after she was struck in the arm by a line drive (a ball hit very hard and low).
Radiographic and MRI studies show soft tissue injury to the region of the spiral groove, with trauma to the radial nerve. Which of the following muscles would be intact after this injury?
⃣ A. Flexor carpi ulnaris
⃣ B. Extensor indicis
⃣ C. Brachioradialis
⃣ D. Extensor carpi radialis
⃣ E. Supinator
35 Examination of a 21-year-old female athlete with
an injury of the radial nerve in the spiral groove would typically demonstrate which of the following physical signs?
⃣ A. Weakness of thumb abduction and thumb extension
⃣ B. Weakness of thumb opposition
⃣ C. Inability to extend the elbow
⃣ D. Paralysis of pronation of the hand
⃣ E. Paralysis of abduction and adduction of the arm
36 The 58-year-old convenience store operator had
received a superfi cial bullet wound to the soft tissues on the medial side of the elbow in an attempted robbery. A major nerve was repaired at the site where it passed behind the medial epicondyle. Bleeding was stopped from an artery that accompanied the nerve in its path toward the epicondyle. Vascular repair was performed on this small artery because of its important role in sup- plying blood to the nerve. Which of the following arter- ies was most likely repaired?
⃣ A. The profunda brachii
⃣ B. The radial collateral artery
⃣ C. The superior ulnar collateral artery
⃣ D. The inferior ulnar collateral artery
⃣ E. The anterior ulnar recurrent artery
37 A 60-year-old male butcher accidentally slashed
his wrist with his butcher knife, partially dividing the ulnar nerve. Which of the following actions would most likely be lost as a result of this injury?
⃣ A. Flexion of the proximal interphalangeal joint of the fi fth digit (little fi nger)
⃣ B. Extension of the thumb
⃣ C. Adduction of the fi fth digit
⃣ D. Abduction of the thumb
⃣ E. Opposition of the thumb
38 A 23-year-old male medical student fell asleep in
his chair with Netter’s Atlas wedged into his axilla.
When he awoke in the morning, he was unable to ex- tend the forearm, wrist, or fi ngers. Movements of the ipsilateral shoulder joint appear to be normal. Which of
175 the following nerves was most likely compressed, pro-
ducing the symptoms described?
⃣ A. Lateral cord of the brachial plexus
⃣ B. Medial cord of the brachial plexus
⃣ C. Radial nerve
⃣ D. Median nerve
⃣ E. Lateral and medial pectoral nerves
39 The fact that the kidneys of a 32-year-old female
patient were failing required that she be placed on di- alysis. However, the search in her upper limb for a suitable vein was unexpectedly diffi cult. The major vein on the lateral side of the arm was too small; others were too delicate. Finally, a vein was found on the me- dial side of the arm that passed through the superfi cial and deep fascia to join veins beside the brachial artery.
Which of the following veins was this?
⃣ A. Basilic
⃣ B. Lateral cubital
⃣ C. Cephalic
⃣ D. Medial cubital
⃣ E. Medial antebrachial
40 A 29-year-old female had sustained a deep lacera-
tion in the proximal part of the forearm. After the wound is closed, the following functional defi cits are observed by the neurologist on the service: The fi rst three digits are in a position of extension and cannot be fl exed. Digits 4 and 5 are partially fl exed at the meta- carpophalangeal joints and noticeably more fl exed at the distal interphalangeal joints. Sensation is absent in the lateral side of the palm and the palmar surfaces of digits 1 to 3 and half of the fourth digit. Which of the following nerves has (have) most likely been injured?
⃣ A. Median nerve
⃣ B. Ulnar and median nerve
⃣ C. Ulnar nerve
⃣ D. Radial and ulnar nerve
⃣ E. Radial nerve
41 A 35-year-old male wrestler is admitted to the
emergency department with excruciating pain in his right shoulder and proximal arm. During physical ex- amination the patient clutches the arm at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint.
Which of the following conditions is the most likely?
⃣ A. The head of the humerus is displaced anteriorly.
⃣ B. The head of the humerus is displaced posteriorly.
⃣ C. The head of the humerus is displaced inferiorly.
⃣ D. The head of the humerus is displaced superiorly.
⃣ E. The head of the humerus is displaced medially.
42 The 35-year-old female patient has a hard nodule
about 1 cm in diameter slightly above and lateral to her right areola. A specifi c dye is injected into the tissue around the tumor, and an incision is made to expose the lymphatic vessels draining the area, for the lym- phatic vessels take up the dye—which is visible to the eye. The vessels can then be traced to surgically expose the lymph nodes receiving the lymph from the tumor.
Which of the following nodes will most likely fi rst en- counter the lymph from the tumor?
⃣ A. Anterior axillary (pectoral) nodes
⃣ B. Rotter interpectoral nodes
⃣ C. Parasternal nodes along the internal thoracic artery and vein
⃣ D. Central axillary nodes
⃣ E. Apical or infraclavicular nodes
43 During a fi ght in a tavern, a 45-year-old male con-
struction worker received a shallow stab wound from a broken beer bottle at a point near the middle of the left posterior triangle of his neck. Upon physical examina- tion it is observed that the left shoulder is drooping lower than the right shoulder, and the superior angle of the scapula juts out slightly. Strength in turning the head to the right or left appears to be symmetric. Which of the following nerves is most likely injured?
⃣ A. Suprascapular nerve in the supraspinous fossa
⃣ B. The terminal segment of the dorsal scapular nerve
⃣ C. The upper trunk of the brachial plexus
⃣ D. The spinal accessory nerve in the posterior cervical triangle
⃣ E. The thoracodorsal nerve in the axilla
44 A 44-year-old woman is diagnosed with radial
nerve palsy. When muscle function is examined at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, what fi ndings are most likely to be present?
⃣ A. Inability to abduct the digits at the MCP joint
⃣ B. Inability to adduct the digits at the MCP joint
⃣ C. Inability to extend the MCP joints only
⃣ D. Inability to extend the MCP, PIP, and DIP joints
⃣ E. Inability to extend the PIP and DIP joints