Download Fall 2003 4a

Systemic Anatomy Exam IV
Prepared especially for the trimester one class, Fall 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. Good luck.
FORM A
A 58 year old man suffers an injury to the right shoulder during a biking accident. An AP radiograph of
the left shoulder reveals a complete dislocation of the shoulder joint. The head of the humerus lies
inferior and medial to the glenoid fossa. You perform a physical exam and determine the axillary nerve
has been damaged as a result of this injury.
1) This nerve is derived from which spinal nerve roots?
a) C 2,3
b) C 3,4,5
c) C 5,6
d) C 6,7,8
e) C 8, T1
2) Which of the following muscles are innervated by this nerve? (MACA)
a) teres major m.
b) teres minor m.
c) deltoid m.
d) supraspinatus m.
e) infraspinatus m.
3) Damage to this nerve could produce which of the following motor deficits?
a) weakness in extension of the forearm at the elbow against resistance
b) weakness in flexing the forearm at the elbow against resistance
c) weakness in flexion of the carpus and digits
d) weakness in lateral rotation of the humerus against resistance
e) weakness in pronation of the forearm against resistance
4) Injury to the above nerve would cause this patient to have the most difficulty _______.
a) adducting the arm at the shoulder joint
b) abducting the arm at the shoulder joint
c) flexing the carpus and digits
d) extending the carpus and digits
5) The above mentioned nerve is derived from the ___ cord of the brachial plexus?
a) medial
b) lateral
c) posterior
page 1, SA Exam IV, Q.# 1-5
A 36 year old woman suffers an injury to the left arm during a fall during an ice storm. She had slipped
while walking down some stairs in her apartment complex. You are the only doctor open as it is a
holiday and you decided to stay open to make some extra money to buy the kids Christmas presents. She
walks through your front door and you shoot radiographs of her arm. You pop the film up on the view
box and you see an oblique fracture through the mid-shaft of the humerus.
6) Which nerve is most likely to be injured by the mid-shaft fracture of the humerus?
a) axillary nerve
b) radial nerve
c) median nerve
d) musculocutaneous nerve
e) ulnar nerve
7) Why is the above nerve most susceptible to damage with this type of injury?
a) it lies in the groove on the posterior aspect of the medial epicondyle of the humerus
b) is lies in the quadrangle space
c) it pierces the heads of the pronator teres muscles just past the origin of this muscle
d) it lies in the musculospiral groove
e) it pierces the belly of the biceps brachii m.
8) Injury to this nerve could result in WHICH of the following motor deficits? (MACA)
a) weakness in extending the hand at the wrist against resistance
b) weakness in flexing the hand at the wrist against resistance
c) weakness in abducting the hand at the wrist against resistance
d) weakness in adducting the hand at the wrist against resistance
e) weakness in pronating the forearm against resistance
9) The above mentioned nerve is derived from what cord of the brachial plexus?
a) lateral cord
b) medial cord
c) posterior cord
10) Which of the following muscles of the forearm are innervated by the above mentioned nerve?
a) pronator teres m.
b) brachioradialis m.
c) flexor carpi ulnaris m.
d) palmaris longus m.
e) two of the above
page 2, SA Exam IV, Q.# 6-10
A 17 year old male suffers an injury after a fall while he was roller blading down by the lake. His parents
rush him to your clinic. He is in a great deal of pain and holding his left elbow very close to his body and
does not want you to touch it. You convince him that you need to take an XRAY and he very reluctantly
allows you to do so. Radiographs reveal a displaced fracture of the medial epicondyle of the humerus.
11) Which nerve is most likely involved in the patient with a displaced fracture of the medial epicondyle of the
humerus?
a) axillary nerve
b) radial nerve
c) musculocutaneous nerve
d) ulnar nerve
e) median nerve
12) Injury to the above nerve could result in WHICH of the following deficits?
a) loss of sensation to the skin of the hypothenar eminence
b) difficulty abducting the hand at the wrist against resistance
c) atrophy of the muscles of the posterior forearm
d) difficulty in flexing the forearm at the elbow
e) loss of sensation of the skin of the thenar eminence
13) The above mentioned nerve is derived from what cord of the brachial plexus?
a) medial cord
b) lateral cord
c) posterior cord
d) two of the above
14) Which of the following muscles are innervated by the above nerve?
a) palmaris longus m.
b) deltoid m.
c) biceps brachii m.
d) extensor carpi ulnaris m.
e) flexor carpi ulnaris m.
An 18 year old man is thrown from a pick-up truck during a roll over accident and sustains injuries to
his left neck, shoulder and upper limb. Examination in the emergency room does not reveal any cuts,
fractures or dislocations and he is sent home. The following day he is suffering several maladies and seeks
help from you at your clinic. You do your exam and find the patient has suffer a lateral traction injury to
the superior roots of the brachial plexus.
15) Which of the following signs WOULD be seen in this patient?
a) left shoulder retracted upwards toward the neck
b) left scapula pulled medially
c) loss of lateral rotators of the humerus
d) paresis of muscles of the posterior aspect of left arm
e) left forearm is supinated due to loss of biceps brachii m.
16) Muscles innervated by which cord of the brachial plexus would be MOST affected by this injury?
a) lateral cord
b) medial cord
c) posterior cord
page 3, SA Exam IV, Q.# 11-16
17) Which of the following nerves WOULD be most involved in the patient with the above injury? (MACA)
a) suprascapular nerve
b) musculocutaneous nerve
c) axillary nerve
d) ulnar nerve
e) dorsal scapular nerve
18) This type of injury is also commonly seen in which of the following scenarios?
a) a baby being jerked by one arm by an angry parent
b) during birth when the baby’s head to being pulled by an over vigorous obstetrician
c) when someone is falling and grabs a stationary object with their hand to brake their fall
d) when someone is found sleeping with their arm draped over a park bench
e) suicide attempts by slashing the wrist with a knife
A middle aged woman has been a typist for the past 30 years. She presents to your clinic complaining of
a problem with her right forearm and hand. You do your exam and find signs and symptoms consistent
with carpal tunnel syndrome.
19) What nerve is involved in this condition?
a) ulnar nerve
b) axillary nerve
c) median nerve
d) radial nerve
e) musculocutaneous nerve
20) This patient described above would most likely be complaining of a burning pins and needles pain where?
a) posterior hand
b) lateral aspect of the palmar surface
c) medial aspect of the palmar surface
d) anterior forearm
e) posterior forearm
21) The above mentioned nerve is derived from what component(s) of the brachial plexus?
a) posterior cord
b) lateral cord
c) medial cord
d) two of the above
22) The above nerve is derived from contributions of which components of the brachial plexus?
a) anterior divisions
b) posterior divisions
c) both a and b
23) The above nerve is derived from the dorsal rami of which of the following spinal nerve roots?
a) C5,6
b) C5,6,7
c) C5,6,7,8
d) C5,6,7,8,T1
e) none of the above
page 4, SA Exam IV, Q.# 17-23
A 35 year old man sustains a severe nerve compression injury to his left upper leg when he is hit by a car
while riding his motorcycle. Examination of this patient at your office reveals a contusion with hematoma
formation surrounding the head and neck of the fibula.
24) Which of the following nerve is most susceptible to direct injury by a severe compression force applied to
the lateral aspect of the head and neck of the fibula?
a) common peroneal nerve
b) tibial nerve
c) obturator nerve
d) saphenous nerve
e) femoral nerve
25) Injury to this nerve would result in which one of the following deficits?
a) inability to extend the knee joint
b) inability to flex the knee joint
c) inability to dorsiflex the foot
d) inability to plantar flex the foot
e) inability to flex the toes
-------------------------------------------------------------end of case studies--------------------------------------------------26) Does the femoral nerve innervate muscles which flex the knee joint or extend the knee joint or both?
a) flex
b) extend
c) both
27) Muscles that adduct the thigh are innervated by the _____.
a) inferior gluteal nerve
b) superior gluteal nerve
c) obturator nerve
d) common peroneal nerve
e) iliohypogastric nerve
28) Muscles that extend the thigh are innervated by the _____. (MACA)
a) inferior gluteal nerve
b) superior gluteal nerve
c) obturator nerve
d) tibial nerve
e) common peroneal nerve
29) All of the following muscles are innervated by the tibial nerve EXCEPT:
a) tibialis posterior m.
b) gastrocnemius m.
c) short head of biceps femoris m.
d) flexor hallucis longus m.
e) hamstring portion of the adductor magnus m.
30) Articular cartilage is typically hyaline cartilage. Which of the following joints have one or more of their
articular surfaces covered with hyaline cartilage? (MACA)
a) the temporomandibular joint
b) the acromioclavicular joint
c) the sternoclavicular joint
d) the sacroiliac joint
e) the glenohumeral joint
page 5, SA Exam IV, Q. # 24-30
31) If I cut the tibial nerve, could I still plantar flex the foot?
a) yes
b) no
32) Denticulate ligaments are made of ______.
a) dura mater
b) pia mater
c) arachnoid
33) The spinal cord typically ends at what vertebral level in the human?
a) T1
b) T6
c) L1
d) L6
e) S1
34) According to Bell Magendie law the ventral root carries ____ information.
a) motor
b) sensory
c) both sensory and motor
35) In the brachial plexus, spinal nerve roots directly form ____ which then for ____
a) divisions, trunks
b) terminal branches, cords
c) trunks, divisions
d) cords, terminal branches
e) cords, trunks
36) At the level of T2 the medial branch of the dorsal ramus carries predominately sensory information.
a) true
b) false
37) What would I find in the greatest concentration in the ventral horn of the spinal cord?
a) pseudounipolar neuron cell bodies
b) multipolar neuron cell bodies
c) bipolar neuron cell bodies
38) The sciatic nerve would contain neurons which carried which of the following types of information?
(MACA)
a) GSE
b) GSA
c) GVE
d GVA
e) SSA
39) The majority of sodium ions are found ___ the cell.
a) inside of
b) outside of
page 6, SA Exam IV, Q.# 31-39
40) The influx of sodium ions into a neuron cell will result in a stimulus of ___ strength being required to cause
that neuron to depolarize.
a) greater
b) lesser
41) The dural sac ends at the level of _____.
a) T6
b) L1
c) L3
d) S3
e) there is no such thing as a dural sac
42) Choose the INCORRECT match.
a) depurant – cleansing or purifying
b) edentulous – loose of teeth
c) iatrogenic – of unknown origin
d) fremitus – a palpable vibration
e) juxtaspinal – next to the spine
43) Choose the INCORRECT match.
a) jaundice – icterus
b) melena – a black tar like stool
c) epistaxis – nose bleed
d) enuresis – urea in the blood stream
e) palsy – paralysis
44) Ascending tracts in the posterior funiculus of the spinal cord carry __ information.
a) sensory
b) motor
45) If I was looking for the specific segment of the spinal cord that gives rise to the spinal nerve that exits the
IVF formed between S1 and S2 vertebrae, at what vertebral level would I look?
a) T1
b) T6
c) T10
d) L1
e) S1
46) The branch of the spinal nerve that carries GSE and GSA information from the medial aspect of the palmer
surface of the hand is the _____.
a) rami communicantes
b) dorsal ramus
c) ventral ramus
d) meningeal ramus
e) rami gigglimano
47) The nerve which is motor to the diaphragm is derived from spinal nerves ____.
a) C2,3,4
b) C3,4,5
c) C5,6,7
d) C6,7,8
e) none of the above
page 7, SA Exam IV, Q.# 40-47
48) Looking at a superficial view of the muscles of the posterior scalp, which nerve is most lateral?
a) lesser occipital nerve
b) greater auricular nerve
c) greater occipital nerve
d) third occipital nerve
e) suboccipital nerve
49) To prevent flexion of the elbow, I would have to cut which of the following nerves? (MACA)
a) radial nerve
b) axillary nerve
c) median nerve
d) ulnar nerve
e) musculocutaneous nerve
50) The skin over the thumb is located at what dermatomal level?
a) C4
b) C5
c) C6
d) C7
e) C8
page 8, SA exam IV, Q.# 47-50
The end of exam 4. I will have your grades out by the close of the day today.