Download Questions in Anatomy of the Upper Limb

Questions in Anatomy of the Upper Limb
Course 101 Medicine (Anat 101)
By
Prof. M. Fawzi Gaballah
Head of the Anatomy Department
These are objective questions especially prepared to function as a guide to study anatomy in a
better and critical way. These are also meant to be examples for questions that may be
encountered in the assessment, midterm and final anatomy exams. All the "true –false" questions
are presented here as only true statements. However, any of these statements can be made false
by just changing one or more words.
Students should answer these objective questions and present their written answers to the staff of
the department by the end of the course to be evaluated.
It is to be noted that, in addition to the objective questions, all the anatomy exams will include
short or/and long essay questions.
Contents
Unit (1): Pectoral region
Unit (2): Axilla
Unit (3): Scapular region
Unit (4): Upper arm
Unit (5): Front of forearm
Unit (6): Back of forearm
Unit (7): Nerves of upper limb
Unit (8): Arteries of upper limb
Unit (9): Hand & joints
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Answers Added By : HeMa Jaser
Unit(1)
Pectoral Region
Mammary Gland (Breast)
True statements:
1. It extends from the 2nd rib to the 6th rib.
2. It lies on the pectoralis major and pectoralis minor.
3. The nipple lies opposite the 4th intercostal space.
4. The axillary tail passes upwards and laterally along the lower border of pectoralis major.
5. It is supplied by branches from the lateral thoracic artery & from the internal thoracic artery.
6. An incision of the gland should be in a radial direction.
7. Its medial part drains its lymph into the parasternal nodes.
8. Normally, the mammary gland moves easily on the underlying muscle bed.
9. The gland lies in the superficial fascia
10. The lobes are separated from each other by fibrous septa called suspensory ligaments of
Cooper.
11. The lobes of the gland are arranged in a radial direction radiating from the nipple.
Matching:
A) Parts (quadrants) of mammary gland:
1. lateral part
2. medial part
3. upper part
4. lower part
B) Lymph drainage into:
- parasternal nodes ( 2 )
-
pectoral nodes ( 1 )
- subdiaphragmatic lymph plexus ( 4 )
apical nodes ( 3 )
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Clavipectoral Fascia
True statements:
1. It extends from the pectoralis minor muscle to the clavicle.
2. It is pierced by the cephalic vein.
3. The axillary vein lies deep to it.
4. It lies deep to the clavicular part of the pectoralis major.
5. It encloses the subclavius muscle.
Complete:
- It extends between a muscle called Pectoralis
minor muscle
& Subclavius muscle.
- It is pierced by Cephalic vein, Thoraco-acromial artery
& Lateral
Pectoral nerve.
- Deep to it lie the Axillary artery, apical lymph nodes & cords of
Brachial Plexus
Pectoralis Major Muscle
True statements:
1. The clavicular head is separated from the deltoid by the deltopectoral groove.
2. Forms part of the anterior wall of the axilla.
3. It is inserted by a bilaminar tendon into lateral lip of bicipital groove.
4. As a whole the muscle is a flexor, adductor and medial rotator of the arm.
5. It is supplied by the lateral and medial pectoral nerves.
Complete:
-
The muscle is separated from the deltoid by Delto-Pectoral groove which contains
Deltoid branch of Thoraco-Acromial artery.
-
The clavicular part is supplied by Lateral
Pectoral nerve which arises from Lateral
cord of the brachial plexus.
-
It is inserted into Lateral
-
It rotates the arm Medially
-
It lies over Pectoralis
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lip of bicipital groove.
Minor muscle and Clavipectoral fascia.
Answers Added By : HeMa Jaser
Pectoralis Minor Muscle
True statements:
1. It is inserted into the coracoid process.
2. It arises from the 3rd, 4th and 5th ribs.
3. It is supplied by the medial pectoral nerve.
4. It lies deep to the pectoralis major.
5. It draws the scapula downwards and forwards.
Complete:
-
The muscle crosses over 2
-
It arises from 3
-
It is supplied by Medial
rd
nd
part of axillary artery.
, 4th , 5th ribs.
Pectoral nerve which is a branch from Medial cord of
brachial plexus.
-
It kies under cover of the Pectoralis
Major muscle.
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Unit (2)
Axilla
Walls of the Axilla
True statements:
1. Its anterior wall is formed of 3 muscles and clavipectoral fascia.
2. The posterior fold of axilla is formed of teres major and latissimus dorsi.
3. Its apex communicates with the neck through a triangular gap deep to the clavicle.
4. Its base (floor) is formed by the axillary fascia.
5. Its medial wall is wider than the lateral wall.
Matching:
A) Walls of the axilla:
1. anterior wall
2. posterior wall
3. medial wall
4. lateral wall
B) Muscles in the walls of the axilla:
- Subclavius ( 1 )
- teres major ( 2 )
- serratus anterior ( 3 )
- coracobrachialis ( 4 )
Contents of the Axilla
True statements:
1. The axillary vessels cross the axilla from medial to lateral.
2. The axilla contains branches of the 3 cords of the brachial plexus.
3. The axillary vein runs medial to the axillary artery.
4. There is a group of lymph nodes related to each wall of the axilla.
5. The axilla contains a large quantity of fat.
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Axillary Artery
True statements:
1. The artery is the continuation of the subclavian artery.
2. It ends at the lower border of the teres major.
3. It begins at the outer border of the 1st rib.
4. It is divided into 3 parts by the pectoralis minor.
5. It lies deep to the clavipectoral fascia.
1st Part of Axillary Artery
True statements:
1. It is related above to the cords of the brachial plexus.
2. It is covered by clavicular head of pectoralis major and clavipectoral fascia.
3. It is related posteriorly to 1st digitations of serratus anterior.
4. It gives off the superior thoracic artery.
5. The axillary vein lies directly medial to it.
Matching:
A) Relations:
1. anterior relation
2. posterior relation
3. medial relation
4. lateral relation.
B) Related structures:
- 1st digitations of serratus anterior ( 2 )
- axillary vein ( 3 )
- clavicular head of pectoralis major ( 1 )
- posterior cord of brachial plexus ( 4 )
2nd Part of Axillary Artery
True statements:
1. It is covered by the pectoralis minor and major muscles.
2. It is separated from subscapularis muscle by the posterior cord of brachial plexus.
3. The axillary vein is separated from it by the medial cord of brachial plexus.
4. The lateral cord separates the artery from coracobrachialis muscle.
5. It gives off the thoraco-acromial and lateral thoracic branches.
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2nd Part of Axillary Artery
Complete:
-
The posterior cord separates the artery from Subscapularis muscle.
-
The medial cord separates the artery from Axillary vein.
-
The Lateral cord lies lateral to the artery, separating it from Coracho-Brachialis
muscle.
3rd Part of Axillary Artery
True statements:
1. It can be felt pulsating in its lower 1/2.
2. It is related to branches of the 3 cords of brachial plexus.
3. It is separated from the subscapularis muscle by the axillary nerve.
4. It is separated from the axillary vein by 2 nerves.
5. It is separated from insertion of latissimus dorsi and teres major by radial nerve.
Complete:
-
It is separated from the axillary vein by Ulnar & Medial
cutanous nerve of
forearm nerves.
-
It is separated from the posterior fold of the axilla by Radial nerve.
-
It is related laterally to Musculocutanous nerve & Lateral
root of median nerve.
Branches of Axillary Artery
True statements:
1. The superior thoracic artery ramifies on the upper part of the chest.
2. The lateral thoracic arises from the 2nd part of axillary artery.
3. The thoracoacromial artery pierces the clavipectoral fascia.
4. The subscapular artery runs in company with the thoracodorsal nerve.
5. The posterior circumflex humeral artery passes through the quadrangular space.
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Answers Added By : HeMa Jaser
Complete:
-
The subscapular artery is a branch of 3
rd
part of the axillary artery and is accompanied by
Thoraco-Dorsal nerve.
-
The thoracoacromial artery is a branch of 2
nd
part of the axillary artery and pierces the
Clavipectoral fascia.
-
st
The superior thoracic artery is a branch of 1 part of axillary artery and supplies Upper
Lateral part of the chest wall.
-
The posterior circumflex humeral artery passes through the Quadrangular space & is
accompanied by Axillary nerve.
Anastomosis Around the Scapula
True statements:
1. This anastomosis communicates 1st part of subclavian with 3rd part of axillary artery.
2. The subscapular artery runs along the lateral border of the scapula.
3. The suprascapular artery arises from the 1st part of subclavian artery
4. The deep branch of transverse cervical (dorsal scapular) runs along the medial border of the
scapula.
5. The posterior intercostal arteries share in the anastomosis by their lateral branches.
Axillary Vein
True statements:
1. It begins at the lower border of teres major.
2. It is formed by union of the basilic vein and venae comitantes of brachial artery.
3. It is closely related to the lateral and apical groups of lymph nodes.
4. It ends by becoming the subclavian vein.
5. It receives the cephalic vein just below the clavicle.
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Brachial Plexus
True statements:
1. Its roots are the anterior primary rami of C5, 6, 7, 8 and T.1.
2. The lower trunk is formed by C.8 and T.1.
3. The posterior cord is formed by union of the posterior divisions of the 3 trunks.
4. The lower trunk lies in contact with the 1st rib.
5. The 3 cords & their branches lie in the axilla.
Matching:
A) Parts of the brachial plexus:
1. roots
2. upper trunk
4. medial cord
5. posterior cord
3. lateral cord
B) Branches of the plexus:
- axillary n. ( 5 )
- musculocutaneous n. ( 3 )
- suprascapular n. ( 2 )
- ulnar n. ( 4 )
- long thoracic n. ( 1 )
Branches of Brachial Plexus
True statements:
1. The long thoracic nerve arises in the neck from the roots of the plexus.
2. Lesion of the upper trunk results in Erb's paralysis.
3. The lateral cord gives origin to the lateral pectoral nerve
4. The ulnar nerve arises from the medial cord.
5. The posterior cord gives origin to the subscapular nerves.
Axillary Lymph Nodes
True statements:
1. The lateral lymph nodes lie along the axillary vessels.
2. The pectoral or anterior nodes receive lymph from the lateral part of breast.
3. The central group of lymph nodes sends its efferents to the apical nodes.
4. The apical nodes receive afferents from all other groups of axillary nodes.
5. The apical nodes lie deep to the clavipectoral fascia just below the clavicle.
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Unit (3)
Scapular Region
True statements:
Muscles connecting the scapula to the trunk (ribs & vertebrae)
1. Serratus anterior: to the front of the medial margin of the scapula.
2. Trapezius: to the acromion and spine of scapula.
3. Rhomboids: to the back of the medial margin of the scapula.
4. Levator scapulae: to the back of the medial margin of the scapula.
5. Pectoralis minor: to the coracoid process.
Muscles connecting the scapula to the humerus
1. Deltoid: from the acromion and spine of the scapula.
2. Supraspinatus: from the supraspinous fossa.
3. Infraspinatus: from the infraspinous fossa.
4. Subscapularis: from the subscapular fossa.
5. Teres major: from the back of the lateral margin of the scapula
6. Coracobrachialis: from the coracoid process.
Matching:
A) Muscles attached to the scapula:
1. serratus anterior
2. trapezius
3. rhomboids
4. pectoralis minor
B) Site of attachment:
- coracoid process ( 4 )
- anterior aspect of medial margin of the scapula ( 1 )
- spine of scapula ( 2 ).
- posterior aspect of medial margin of scapula ( 3 )
Matching:
A) Muscles of the scapula:
1. teres minor
2. supraspinatus
3. teres major
4. trapezius
B) Nerve supply:
- suprascapular nerve ( 2 )
- axillary nerve ( 1 )
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- subscapular nerve ( 3 )
- spinal root of accessory nerve ( 4 )
Answers Added By : HeMa Jaser
True statements:
Serratus anterior
1. It arises from the outer surfaces of the upper 8 ribs
2. Its 1st digitation is inserted into the 1st and 2nd ribs.
3. Its lower 5 digitations are inserted into the inferior angle of the scapula.
4. It takes its nerve supply from the long thoracic nerve (C.5,6,7).
5. Its lower 5 digitations rotate the scapula upward in raising the arm above the head.
Trapezius
1. It forms a part of the 1st layer of the back.
2. It takes origin from the medial 1/3 of the superior nuchal line.
3. Its middle fibers are inserted into the medial border of the acromion and the crest of the spine
of the scapula.
4. It takes its nerve supply mainly from the spinal root of accessory nerve.
5. Its lower fibers rotate the scapula upward.
Latissimus dorsi
1. It arises from the lower 4 ribs.
2. It is inserted into the floor of the intertubercular (bicipital) groove.
3. Near the humerus, its tendon lies in front of the teres major.
4. It gets its nerve supply from the thoracodorsal nerve (C.6,7,8).
5. It extends the arm and rotates it medially.
Deltoid muscle
1. It arises from the clavicle, acromion and spine of scapula.
2. It is inserted into the deltoid tuberosity of the humerus.
3. It is supplied by the axillary nerve (C.5,6).
4. Its middle fibers abduct the arm from 15° to 90°.
5. Deep to it lies the capsule of the shoulder joint and the rotator muscle cuff.
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Rotator muscle cuff
1. It consists of the supraspinatus, infraspinatus, teres minor and subscapularis.
2. The supraspinatus is supplied by the suprascapular nerve (C.5,6).
3. The infraspinatus is inserted into the back of the greater tubercle of the humerus.
4. The teres minor adducts the arm and rotates it laterally.
5. The subscapularis is inserted into the lesser tubercle of the humerus.
Nerve supply of muscles of the scapula
Complete:
-
The infraspinatus is supplied by the Suprascapular nerve.
-
The teres minor is supplied by the Axillary nerve.
-
The subscapularis is supplied by the Upper
-
The teres major is supplied by lower the Lower
-
The levator scapulae is supplied by the Dorsal
Of Lower Subscapular nerves.
Subscapular nerve.
Scapular nerve.
Complete:
-
The 1st layer of the muscles of the back consists of Trapezius & Lattismus
Dorsi
muscles.
st
& 2nd ribs
-
The 1st digitation of serratus anterior arises from 1
-
The lower 5 digitations of serratus anterior are inserted into Inferior
Angle Of
Scapula.
-
The upper part of the trapezius is inserted into Posterior
Border Of Lateral 1/3 Of
Clavicle
-
The lower part of the trapezius rotates the scapula Upwards
-
The latissimus dorsi is inserted into Floor
-
The nerve that lies deep to the deltoid muscle is the Axillary
Shoulder
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Of Bicipital Groove
nerver & supplies
joint.
Answers Added By : HeMa Jaser
Attachments of Muscles of the Scapula
True statements:
1. Supraspinatus: inserted into the greater tubercle of humerus.
2. Teres minor: arises from the upper 2/3 of the back of lateral border of scapula.
3. Subscapularis: inserted into the lesser tubercle of humerus.
4. Teres major: inserted into the medial lip of intertubercular (bicipital)groove.
5. Rhomboid major: inserted into the back of the medial border of scapula.
Quadrangular Space of the Arm
True statements:
1. It lies below the lateral border of the scapula.
2. The teres major forms its lower boundary.
3. The surgical neck of the humerus forms its lateral boundary.
4. The long head of the triceps forms its medial boundary.
5. The axillary nerve & posterior circumflex humeral artery pass through the space.
Axillary Nerve
True statements:
1. It is a branch of the posterior cord of the brachial plexus (C.5,6).
2. It winds round the surgical neck of the humerus.
3. It supplies the shoulder joint by a branch from its trunk.
4. It supplies the deltoid and teres minor.
5. Its injury leads to failure of abduction of the arm from 15° to 90°.
6. It is accompanied by the posterior circumflex humeral artery.
Complete:
-
Its root value is C5 & C6
-
It winds round Surgical
-
Its cutaneous branch is called Lateral
-
Its articular branch supplies the Shoulder
-
It is a branch from Posterior
13
neck of the humerus.
Cutanous Nerve Of Arm
Joint.
Cord of brachial plexus.
Answers Added By : HeMa Jaser
Suprascapular Nerve
True statements:
1. It arises in the neck from the upper trunk of the brachial plexus (C.5,6).
2. It supplies the supraspinatus and infraspinatus muscles.
3. It enters the supraspinous fossa from uner cover of the suprascapular ligament.
4. It passes through the spinoglenoid notch to reach the infraspinous fossa.
5. It gives articular branch to the shoulder joint.
Unit (4)
Upper Arm
Muscles
Coracobrachialis
True statements:
1. It arises by a common tendon with the short head of biceps brachii.
2. It is inserted into the middle of the medial border of the humerus.
3. It gets its nerve supply from the musculocutaneous nerve.
4. It is pierced by the musculocutaneous nerve.
5. At its insertion, the median nerve crosses the brachial artery from lateral to medial.
Complete:
At the insertion of the coracobrachialis:
-
The median nerve crosses the Brachial artery.
-
The radial nerve comes out of the Spiral groove.
-
The ulnar nerve pierces the Medial
-
The nutrient artery enters the Nutrient foramen of the humerus.
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Intermuscular septum.
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Biceps Brachii
True statements:
1. Its short head arises from the tip of the coracoid process.
2. Its long head arises from the supraglenoid tubercle.
3. Its long head passes inside the shoulder joint.
4. It is a powerful supinator of the forearm.
5. Its tendon is inserted into the radial tuberosity.
6. It is inserted into the deep fascia by the bicipital aponeurosis.
Complete:
-
The short head arises from Coracoid-Process
-
The long head passes through the cavity of Bicipital
-
In the cubital fossa its tendon lies lateral to Brachial artery.
-
The bicipital aponeurosis intervenes between Median
Groove
Cubital vein superficially &
Brachial artery deeply.
Brachialis
True statements:
1. It lies deep to the biceps muscle.
2. It is inserted into the ulnar tuberosity.
3. It is supplied by the radial and musculocutaneous nerves.
4. It is the main flexor of the elbow joint.
5. It arises from the lower 1/2 of the front of the humerus.
Complete:
-
It is inserted into Tuberosity of the ulna.
-
It is supplied by Musculocutanous & Radial nerves.
-
It is the main flexor of Elbow
-
The Musculocutanous nerve runs between it and the biceps.
-
The Radial nerve runs on its lateral side between it and brachioradialis.
-
It crosses in front of the Elbow joint.
15
Joint
Answers Added By : HeMa Jaser
Triceps
True statements:
1. It has 3 heads of origin: long, medial and lateral.
2. The medial head is deeper to the other 2 heads.
3. It is inserted into the summit of the olecranon process.
4. The lateral head forms the roof of the spiral (radial) groove.
5. Each head has a separate branch from the radial nerve.
Complete:
-
Its long head arises from Infraglenoid
Tubercle.
-
Its lateral head forms the roof Spiral groove.
-
It is the main Extensor of the elbow joint.
-
Its deepest head is the Medial head.
-
Its long head forms the Medial boundary of the quadrangular space.
Brachial Artery
True statements:
1. It ends in the cubital fossa opposite the neck of the radius.
2. It runs on the medial side of the upper 1/2 of arm but comes in front of its lower 1/2.
3. The median nerve crosses in front of its upper part at the insertion of coracobrachialis.
4. The tendon of biceps is lateral to its lowermost part.
5. The profunda brachii arises close to its beginning and enters the spiral groove.
6. Its nutrient branch enters the humerus opposite the insertion of coracobrachialis.
7. Its superior ulnar collateral branch runs in company with the ulnar nerve.
8. Its inferior ulnar collateral branch arises 5 cm above its end.
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Answers Added By : HeMa Jaser
Complete:
-
Its branch that enters the spiral groove is called Profunda
-
The branches that arise in the cubital fossa are Radial& Ulnar arteries.
-
The branches which accompany the ulnar nerve are Superior
& Inferior
Brachii artery.
Ulnar Collateral
Ulnar Collateral arteries
-
The nerve that crosses the artery from lateral to medial is the Median
Nerve
-
The tendon lateral to the artery in the cubital fossa is that of Bicips muscle.
-
In the cubital fossa it is separated from the medial cubital vein by the
Bicipital
aponeurosis.
Musculocutaneous Nerve
True statements:
1. It arises from the lateral cord of brachial plexus.
2. It pierces the coracobrachialis muscle.
3. It runs between the biceps and the brachialis.
4. It supplies the coracobrachialis, biceps and brachialis.
5. It ends by becoming the lateral cutaneous nerve of forearm.
Complete:
-
It pierces the Coraco-Brachialis muscle which arises from Coracoid process.
-
Its cutaneous branch supplies the skin of the Lateral side of forearm.
-
It passes between 2 muscles Bicips muscle & Brachialis muscle.
-
It is a branch from the Lateral
-
At its origin, it lies lateral to the (
Cord of brachial plexus.
3rd part of ) Axillary artery.
********************************
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Answers Added By : HeMa Jaser