Download FORM A

Systemic Anatomy Exam IV
Prepared especially for the trimester one class, Summer 2003
Please place the single best answer in the space provided (unless designated by the letters MACA, which in this
case mark all correct answers that apply) on your scantron sheet. The faculty will not answer any of your
questions (unless you find a typo) once the exam begins, as interpretation of the question is a part of the
examination. This test has sections of questions that relate back to a specific case scenario. Good luck.
FORM A
A 32 year old male is presented to your clinic with the history of being involved in an automobile accident
3 weeks prior. He was broad sided by a large truck and sustained a midshaft fractured left humerus that
according to him “injured his nerve that runs in the groove in the middle of the arm bone”. He has come
to your clinic to see if you can help him rehabilitate the injured arm and get normal function back.
(Q’s 1-5)
1) What nerve is most likely involved in the above injury?
a) axillary nerve
b) median nerve
c) radial nerve
d) thoracodorsal nerve
e) suprascapular nerve
2) Damage to the nerve referred to would manifest clinically as an inability to _______.
a) abduct the arm at the should joint
b) flex the hand at the carpus
c) rotate the humerus medially
d) extend the carpus and digits
e) rotate the humerus laterally
3) What area would you detect a cutaneous hypoesthesia?
a) posterior forearm
b) anterior forearm
c) lateral side of trunk
d) area over the shoulder joint
e) anterior superior chest wall
4) The above referenced nerve is derived from which of the following spinal nerve roots? (MACA)
a) C5
b) C6
c) C7
d) C8
e) T1
5) The above referenced nerve is derived from what cord of the brachial plexus?
a) lateral cord
b) medial cord
c) posterior cord
page 1, SA Exam IV, Q. # 1-5
A 13 year old female presents to your clinic with a history of being on her roller blades when she feel,
sustaining an injury to her neck. You review the emergency room report she brought with her and you
see she had a contusion to the left side of her neck affecting cervical nerves C5 and 6. She has some
pronounced neurological deficits. (Q’s. 6-10)
6) Which of the following would she have the most difficulty doing?
a) adducting the hand at the carpus
b) lateral rotation of the humerus
c) medial rotation of the humerus
d) abduction of the fingers
e) flexion of the carpus and digits
7) Could this female patient still abduct her humerus at the shoulder joint?
a) yes
b) no
8) Which of the following clinical signs would be seen in this patient?
a) scapula on left side would fall laterally
b) shoulder on left side would be higher than shoulder on right side
c) arm would be rotated laterally
d) both arms would show same strength on flexion of elbow
e) she could not extend the hand at the carpus
9) The clinical signs seen in this patient’s injury are very similar to those seen in _____.
a) Klumpke’s palsy
b) Erb-Duchenne Palsy
c) Carpal Tunnel syndrome
d) drunkard paralysis
e) patients who have had damage to the long thoracic nerve
10) Which one of the following nerves WOULD NOT be affected in the above patient?
a) ulnar nerve
b) musculocutaneous nerve
c) axillary nerve
d) suprascapular nerve
e) dorsal scapular nerve
A 16 year old male is presented to your clinic with the history of having recently been involved in a motor
cycle crash. He was hit broad sided by a car and suffered a crushing injury to the proximal lateral aspect
of the leg at the knee that crushed the head of the fibula and severed the nerve in this area. He is now in
your clinic for nerve deficits.
(Q’s 11-14)
11) What nerve is most likely involved in the above patient?
a) obturator nerve
b) lateral cutaneous femoral nerve
c) common peroneal nerve
d) superior gluteal nerve
e) tibial nerve
page 2, SA Exam IV, Q. # 6-11
12) Which one of the following clinical signs would you expect to see in this patient?
a) inability to plantar flex the foot
b) inability to dorsiflex the foot
c) inability to flex the knee
d) inability to extend the knee
e) inability to abduct the femur
13) Which of the following muscles would be most affected by this type of nerve injury?
a) gastrocnemius m.
b) tibialis posterior m.
c) gluteus maximus m.
d) gracilis m.
e) peroneus longus m.
14) Where would you expect to see sensory loss in this patient?
a) posterior crural area and plantar aspect of the foot
b) lateral aspect of the thigh
c) anterior crural area and dorsum of the foot
d) posterior aspect of the thigh
e) medial aspect of the thigh
A 21 year old man falls through a plate glass window and suffers a deep gash in the posterolateral aspect
of the left side of the neck. Examination at the ER reveals that the level of the left shoulder is lower than
the right shoulder and the patient has difficulty in shrugging the left shoulder against resistance as
compared to the right. C5 spinal nerve root was severed. (Q’s 15-17)
15) What muscle is involved in the above patient accounting for the drop in the left shoulder?
a) deltoid m.
b) supraspinatus m.
c) levator scapulae m.
d) long head, triceps brachii m.
e) teres minor m.
16) What peripheral nerve is most involved in the above injury?
a) dorsal scapular nerve
b) long thoracic nerve
c) median nerve
d) axillary nerve
e) nerve to the subclavius m.
17) The above nerve is derived directly from which component of the brachial plexus?
a) posterior cord
b) middle trunk
c) C5 spinal nerve root
d) superior trunk
e) lateral cord
page 3, SA Exam IV, Q. # 12-17
A bicycle rider is presented to your clinic with complaints of spasms in his hip and shooting pain down
the back of his left thigh. Upon examination you find he has a subluxated sacrum. (Q’s 18-20)
18) What muscle originates from the anterior surface of S2, 3 and 4 vertebra?
a) biceps femoris m.
b) rectus femoris m.
c) gluteus maximus m.
d) piriformis m.
e) gracilis m.
19) Spasm of the above muscle, as is seen in subluxation of the sacrum, could compress which of the following
spinal nerves accounting for the clinical signs seen in the above mentioned patient.
a) obturator nerve
b) superior gluteal nerve
c) sciatic nerve
d) femoral nerve
e) lateral cutaneous femoral nerve
20) The muscle involved in this patient’s condition is a(n) ______________________.
a) medial rotator of the hip joint
b) lateral rotator of the hip joint
c) flexor of the hip joint
d) adductor of the hip joint
e) extensor of the knee joint
_____________________________________the end of the case senarios_______________________________
21) Choose the INCORRECT match.
a) presbycusis – deafness in geriatric patients
b) mydriasis – constriction of the pupil
c) syncope – fainting
d) tinnitus – ringing sound in the ears
e) arboreal – to branch like a tree
22) Choose the INCORRECT match.
a) empirical – by trial and error
b) febrile – an elevation in body temperature above the normal range
c) iatrogenic – caused by a doctor
d) idiopathic – a disease of unknown cause
e) cynophobia – a fear of things of the color blue
23) Choose the INCORRECT match.
a) cicatrix – a scar
b) crepitation – the slow steady advance of a disease process
c) bruit – a murmur
d) claudication – limping or lameness
e) dysplasia – abnormal growth or formation
24) Choose the INCORRECT match.
a) spinal nerves – 31pair
b) cranial nerves – 12 pair
c) dermatomes – 31
d) oligodendrocytes - CNS
e) astrocytes – CNS
page 4, SA Exam IV, Q. # 18-24
25) Where is the cell body of the second GVE neuron in the two neuron chain of the autonomic nervous system
located?
a) in the ventral horn of the spinal cord
b) in the dorsal root ganglia
c) in the lateral horn of the spinal cord
d) in the ventral root
e) in a peripheral ganglia
26) The information carried in an axon of a sensory neuron would be classified as ___ in relationship to the
soma.
a) afferent
b) efferent
27) If I cut the dorsal root of a spinal nerve, what would I be cutting?
a) axons
b) dendrites
c) both a and b
28) Choose the INCORRECT match of functional component to tissue supplied or action.
a) GSE – contract a skeletal muscle
b) SSA – smell a rose
c) GVE – contract urinary bladder
d) GSA – feel the pain of touching a hot stove
e) GVA – feels the pains of intestinal cramping
29) Which one of the following classifications of neurons would NOT be found in the ventral ramus of C5
spinal nerve?
a) GSE
b) SVA
c) GSA
d) GVA
e) GVE
30) The sodium potassium pump pumps sodium ___ the neuron to establish polarization of the cell.
a) into
b) out of
31) The internal voltage at which a cells will spontaneously depolarize is called?
a) action potential
b) resting membrane potential
c) polarization
d) threshold
e) all or none principle
32) The spinal cord ends at what vertebral level?
a) T12
b) L1
c) S1
d) S5
e) coccyx
page 5, SA Exam IV, Q. # 25-32
33) Where would I find the spinal segment that gives rise to L5 spinal nerve?
a) between L4 and L5
b) between L5 and S1
c) between T5 and T6
d) between T11 and T12
e) between L2 and L3
34) Ascending tracts in the spinal cord carry __ information.
a) sensory
b) motor
c) both a and b
35) What kind of information is found in the ventral horn of T10 spinal nerve?
a) GSE, GVE
b) GSA, GVA
c) GVE, GVA
d) GSE, GSA
36) Choose the INCORRECT match.
a) rami communicantes – outside of the neural canal
b) dorsal root – inside of the neural canal
c) ventral ramus – carries GVE information to the upper and lower extremities
d) dorsal ramus – medial branch sensory superior to T6
e) sinuvertebral nerve – same as spinal nerve root
37) Choose the INCORRECT match.
a) lesser occipital nerve – derived from C2, 3 spinal nerves
b) transverse cervical nerve – innervates skin of anterior neck
c) ansa cervicalis – motor to omohyoid m.
d) greater auricular nerve – derived from dorsal rami of C2, 3 spinal nerves
e) phrenic nerve – innervates the diaphragm m.
38) On the posterior aspect of the scalp, which nerve listed is most lateral and which one is most medial?
1) lesser occipital nerve
3) greater occipital n.
2) greater auricular n.
4) third occipital n.
a) 2; 4
b) 1; 4
c) 2; 3
d) 2; 1
e) 3; 4
39) The brachial plexus is derived from the dorsal rami of spinal nerves?
a) C2, 3, 4
b) C4, 5, 6
c) C5, 6, 7, 8, T1
d) C7, 8, T1, 2, 3
e) none of the above
page 6, SA Exam IV, Q. # 33-39
40) Choose the INCORRECT statement concerning the brachial plexus.
a) all nerves derived from the lateral cord contain contributions from C5, 6, 7 spinal nerve roots
b) the ulnar nerve is derived from the medial cord
c) nerves derived from the posterior cord innervate muscles which are mostly flexors
d) the lateral cord is formed by the convergence of the anterior divisions of the upper and middle trunks
e) the thoracodorsal nerve is derived from the posterior cord
41) What nerves would I have to cut to prevent lateral rotation of the humerus? (MACA)
a) axillary n.
b) musculocutaneous n.
c) suprascapular n.
d) thoracodorsal n.
e) medial and lateral pectoral nn.
42) What is affected in pronator teres syndrome that is not affected in carpal tunnel syndrome?
a) the nerve to the palmaris longus m.
b) the palmar branch of the median nerve
c) the skin of the hypothenar eminence
d) the medial aspect of the hand
e) none of the above
43) In femoral nerve paralysis, what could the patient NOT do?
a) flex the thigh is a supine position
b) flex the knee joint
c) extend the thigh
d) extend the knee
e) plantar flex the foot
44) Abnormal sensation to the skin of the perineum, could indicate spinal nerve compression in which of the
following spinal nerves?
a) S2, 3, 4
b) L4, 5, S1
c) L1, 2, 3
d) L2, 3, 4
e) S4, 5 Cy1
45) Choose the INCORECT match of nerve to tissue innervated.
a) tibialis anterior m. – tibial n.
b) sartorius m. – femoral n.
c) short head of biceps femoris m. – common peroneal n.
d) adductor magnus m. – tibial and obturator n.
e) brachialis m. – radial and musculocutaneous n.
46) If I cut the sciatic nerve, could the patient still flex the knee joint?
a) yes
b) no
47) A simple reflex arc will not function with any one of its components absent.
a) true
b) false
page 7, SA Exam IV, Q. # 40-47
48) Which of the following nerves innervate muscles that will extend the hip joint? (MACA)
a) inferior gluteal nerve
b) superior gluteal nerve
c) tibial division of the sciatic nerve
d) common peroneal division of the sciatic nerve
e) femoral nerve
49) A patient presents with decreased cutaneous sensation of the skin which covers the 5th digit of the hand.
Compression of the spinal nerve that exits between which two of the following vertebra may be the cause.
a) C5, 6
b) C6, 7
c) C7, T1
d) T1, T2
e) none of the above
50) Choose the INCORRECT match or action to nerves that innervate the muscles that result in that action.
The list may not be all inclusive but the nerves must all innervate muscles that do result in the action listed.
a) medial rotation of the humerus – medial and lateral pectoral nn, thoracodorsal n., lower subscapular n.
b) flex carpus – median n., ulnar n.
c) flex elbow – musculocutaneous n., radial n., median n.
d) flex hip – femoral n.
e) flex arm – radial n., axillary n.
The end of the fourth exam. Grades will be posted as soon as I get them graded.
page 8, SA Exam IV, Q. # 47-50