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32.
Which of the following is NOT characteristic of the third cervical vertebra?
xA.
A demifacet on the body
B.
A pedicle
C.
A bifid spinous process
D.
A foramen in the transverse process
E.
Attachment of its spinous process to the nuchal ligament
38.
A.
xE.
39.
A.
42.
The cephalic vein can sometimes be used for emergency venous access. It lies in
the__________ and drains into the _________
Deltopectoral groove; subclavian vein
B.
Deltopectoral groove; external jugular vein
C.
Intertubercular groove; axillary vein
D. Bicipital groove; brachial vein
Deltopectoral groove; axillary vein
At birth, the lower end of the conus medullaris is normally found at vertebral level
S-2
B.
C.
xD.
E.
T-12
L-1
L-3
COC-2
Which of the following statements is INCORRECT?
xA. Spina bifida most commonly occurs at the cervicothoracic junction
B.
Spina bifida occulta is the least severe variation of spina bifida
C.
Spina bifida results from failure of vertebral arches to fuse
D. Spina bifida cystica involves the meninges
E.
Spina bifida with myeloschisis is the most severe variation of the defect
59.
When performing epidural anesthesia on adults, the following landmarks are used to
ensure the spinal cord is not damaged on inserting your needle:
A.
B.
C.
xD.
E.
The umbilicus
The 12th thoracic vertebra
The xiphisternum
A horizontal line joining the highest points of the iliac crests
The subcostal margin
57.
A 14-year-old girl presents to the ER with pyrexia, stiff neck and a rash. You suspect
meningitis and decide to perform a lumbar puncture. Your needle will pass through the following
structures in which CORRECT order?
A.
Skin, ligamentum flavum, supraspinous ligament, epidural
space, dura mater, arachnoid mater
xB. Skin, supraspinous ligament, ligamentum flavum, epidural
space, dura mater, arachnoid mater
C. Skin, supraspinous ligament, ligamentum flavum, arachnoid
mater, epidural space, dura mater
D. Skin, ligamentum flavum, supraspinous ligament, arachnoid
mater, epidural space, dura mater
E. Skin, dura mater, arachnoid mater, ligamentum flavum,
epidural space, supraspinous ligament
58.
Prostate cancer often spreads to the vertebral column via the internal vertebral venous
plexus, where is this plexus found?
xA.
B.
C.
D.
E.
49.
Which of the following correlations is INCORRECT?
A.
B.
C.
D.
xE.
41.
10 Th.
12 Th.
2 Lumbar
6 Th.
8 Th.
Which of the following structures are NOT involved with the triangle of auscultation?
A.
xB.
C.
D.
E.
65.
Latissimus dorsi --- medial rotation of humerus
Occipital artery --- external carotid artery
Tendons --- attach muscles to bone
Adduction --- move limb to the body
Greater occipital nerve --- dorsal primary rami of Cl
Following a wedge fracture of the vertebral column a person complains of lack of
sensation around the umbilicus. Which vertebra was MOST LIKELY involved?
xA.
B.
C.
D.
E.
43.
Epidural space
Subarachnoid space
Subcutaneous tissue
Subdural space
Foramen transversarium
Lateral border of trapezius
Teres minor
Rhomboid major
Inferior angle of scapula
Supero-medial border of latissimus dorsi
Your 15-year-old male patient arrives at your office complaining of a "sprained
shoulder" which he reports occurred while learning to serve in tennis. His symptoms
include diffuse tenderness in the root of the neck on the right side, pain in the right
shoulder exacerbated by movement of his arm and deep breathing, and tingling and
numbness in his right arm. An x-ray of the region reveals the presence of a right cervical
rib, and you diagnose Thoracic Outlet Syndrome. What anatomical structures have been
compressed?
A.
B.
xC.
D.
E.
66.
The fascia of the neck are important in spread of infections, blood, anesthetic agents and
also in operative approaches. Among the characteristics of the superficial investing
fascia is that it ...
A.
B.
C.
D.
xE.
57.
encloses the platysma muscle
covers, and surrounds the viscera of the neck, including the larynx and pharynx
covers the ventral surface of the anterior scalene muscle and long thoracic nerve
provides the anterior boundary of the "danger space" of the neck
ensheathes (surrounds) and passes between the trapezius and
the sternocleidomastoid muscles
The patient, the manager of a small convenience store, had suffered a gunshot wound to
the right shoulder. The axillary artery was torn between the second and third parts of the
artery. To avoid excessive blood loss, vascular clamps were applied to the damaged
vessel until a vascular surgeon could arrive at the small community hospital to repair the
site of injury. While waiting for the surgical repair, arterial blood flow to the limb would
depend to a considerable extent upon anastomoses between ...
A.
B.
C.
xD.
E.
51.
Subclavian vein, cupola of lung, and spinal accessory nerve
Anterior scalene muscle, phrenic nerve and cervical plexus
Subclavian artery and brachial plexus
Deep cervical artery, supraclavicular nerves and ansa cervicalis nerve
Supreme (highest) intercostal artery, long thoracic nerve and intercostobrachial
nerve
intercostal branches of the internal thoracic and the lateral thoracic artery
the transverse cervical artery and the suprascapular artery
the profunda brachii artery and the subscapular artery
the suprascapular artery and the circumflex scapular artery
thoracodorsal artery and the circumflex scapular artery
Shortly after an injured lineman was carried from the football field, the quarterback was
tackled by a very large second semester medical student playing the position of
linebacker. The quarterback landed heavily on his left shoulder, resulting in great pain
and his departure from the game. Upon examination, it was noted that the patient could
not abduct his left arm, nor could he rotate the arm laterally. He could not flex his elbow
strongly, either, although he could extend it, after it had been flexed by the student
health physician. He had no difficulty flexing or extending his fingers, nor performing
fine movements with his fingers. The "accident" obviously injured, or traumatized, the
A.
xB.
C.
D.
E.
radial nerve
upper trunk of the brachial plexus
lower trunk of the brachial plexus
posterior cord of the brachial plexus, independent of other structures
the medial and lateral roots of the median nerve
49.
The 10 month old daughter was brought by her mother to the pediatrician after she
discovered that when the child began to stand up, one leg appeared shorter than the
other. The physician diagnosed the child's condition as congenital dislocation of the hip.
This condition ...
xA.
B.
C.
D.
E.
67.
usually results from malformations of the acetabulum (hip socket), with
dislocation occurring after birth
is attributable to excessive tightness of the articular capsule of the hip joint, which
pulls the limb into a chronic state of abduction
always occurs in utero
is also called amelia
does not require any treatment for the child to walk normally
A young male fell and put his right hand and forearm through a window. A transverse
cut occurred across the ventral aspect of the mid forearm, extending as deep as the
osseous plane. On examination, there is-profuse arterial hemorrhage and he has
difficulty flexing the 4th and 5th fingers as well as adducting the hand. Which of the
following are NOT LIKELY findings?
A.
B.
C.
D.
E.
xThe laceration is on the lateral aspect of the ventral surface of right forearm
The ulnar nerve is cut or damaged
The flexor carpi ulnaris muscle is damaged
The ulnar artery is severed
The radial artery is intact
65.
A 40-year-old ex-convict was shot in the left forearm with the bullet entering through the
dorsal aspect, a hand's breath below the elbow arresting on the radius. Patient was subsequently
unable to extend the wrist and fingers but sensation remained normal in the entire limb. Which of
the following would NOT have occurred?
xA.
B.
C.
D.
E.
66.
A 70-year-old man developed a tumor in the distal part of the scalenus anterior muscle
with pressure on related structures. Which of the following would NOT be found at
examination of the patient?
A.
B.
C.
xD.
E.
63.
Damage to superficial branch of radial nerve
Damage to deep branch of radial nerve
Damage to extensor carpi radialis longus
Damage to extensor digitorum communis
Damage to extensor carpi radialis brevis
Prominent circumflex scapular vessels
Diminished flow in axillary vessels
Prominent suprascapular vessels
Prominent transverse cervical vessels
Prominent thoraco acromial vessels
An occlusion of the axillary artery DOES NOT usually result in total loss of blood
supply to the upper limb because of anastomoses around the scapula. Arteries which
arise from the axillary artery and contribute in a significant way to these anastomoses
include the:
A.
B.
C.
xD.
E.
64.
A fracture of the mid-portion of the shaft of the humerus resulted in injury to the nerve
lying in the spiral groove of the bone. With injury to this nerve, what would you NOT
expect to see at examination?
A.
B.
C.
D.
xE.
61.
Suprascapular artery
Deep brachial artery (profunda brachii)
Transverse cervical artery
Subscapular artery
Dorsal scapular artery
"Wristdrop" would be apparent
The triceps brachii would still be functional
There would be absence of the brachioradialis reflex
There would be weakness in the grip of the flexor muscles of the fingers
Total loss of supination of forearm and hand
A 24-year-old football player is referred to an orthopedic surgeon because of a
mid-shaft fracture of the humerus. Surgery reveals a hematoma that resulted from an
artery that was torn by a bone fragment. This artery is MOST LIKELY the:
xA. Profunda,brachii (deep brachial)
B.
Radial
C.
Axillary
D.
Brachial
E. Radial collateral
57.
A 26-year-old, muscular male had apparently traumatized his long thoracic nerve during
hiking. The next day, as a result of the paralysis of this nerve, you noticed during
examination:
xA. Weakness in protraction of scapula on affected side
B.
Paralysis of his trapezius muscle and weakness in elevating his shoulders
C.
Difficulty in breathing, because of paralysis of his diaphragm
D.
Inability to retract (or, pull back) his scapulae
E.
Inability to adduct his arms with his pectoralis major muscles
58.
A newborn had suffered a complete tear of the upper trunk of the brachial plexus by
excessive traction on its head at birth. The result of such injury would eventually
include:
A.
xB.
C.
D.
E.
Paralysis of the abductors and adductors of the fingers
Inability to abduct the arm at the shoulder joint
Paralysis of opposition of the thumb to the other digits
Loss of the triceps reflex
Loss of sensation on the medial side of the arm
56.
A patient was experiencing pain over the deltoid region extending down the lateral side
of the arm. A myelogram, injection of an opaque medium into the cerebro8pinal fluid
was performed. X-ray studies revealed that there was a compression of the fifth cervical
spinal nerve. From this, it is CORRECT to make the following assumption:
xA. The disk or bony process that is compressing the nerve lies between the fourth
and fifth cervical vertebrae
B.
If not corrected, there will be sensory loss to the thoracic wall at the level of the
nipple
C.
The anterior longitudinal ligament is being pressed against the fifth thoracic nerve
and, possibly, the adjacent portion of the spinal cord
D.
The contrast medium was injected into the subdural space
E.
The outline of the subarachnoid space would be obscured at the site of the
compressed nerve
54.
xA.
50.
A 42-year-old woman presents to her doctor complaining of a sagging right shoulder
and inability to turn her head up and to the left. These symptoms are MOST LIKEY
due to injury of the:
Right spinal accessory nerve
B.
Supraclavicular nerves
C.
Vagus nerve
D. Left spinal accessory nerve
E.
C3 and C4
A patient enters your office with a posterior dislocation of the head of the humerus
putting pressure on the structures within the quadrangular space. Which nerve is in
danger of being damaged or impaired with this type of dislocation?
A.
B.
xC.
D.
E.
51.
Musculocutaneous nerve
Median nerve
Axillary nerve
Radial nerve
Ulnar nerve
A young child presents with a fracture of the clavicle at the junction of the lateral and
middle thirds. The medial and lateral fragments are tilted upward and downward,
respectively. Medial displacement of the lateral fragment is caused by contraction of
which of the following muscles?
A.
Sternocleidomastoid
B.
Trapezius
C.
Deltoid
xD. Pectoralis major
E. Subclavius
47.
A patient cannot abduct his arm. This inability results from a lesion of which of the
following nerves?
A.
xB.
C.
D.
E.
48.
46.
Inability to supinate the forearm could result from an injury to which of the following
pair of nerves?
A.
Axillary and radial
xB. Radial and musculocutaneous
C.
Suprascapular.and axillary
D.
Musculocutaneous and median
E.
Median and ulnar
Which of the following group of nerves is intimately related to a portion of the
humerus and can be affected by fracture of the humerus?
A.
B.
C.
xD.
E.
49.
ulnar
Axillary
Radial
Median
Musculocutaneous
A patient has a severely damaged radial nerve resulting from fracture of the lower third
of the humerus. The patient will experience
A.
B.
xC.
D.
E.
56.
Axillary, median, musculocutaneous
Axillary, musculocutaneous, radial
Axillary, median, ulnar
Axillary, radial, ulnar
Median, radial, ulnar
A patient complains of sensory loss over the anterior and the posterior surfaces of the
medial third of the hand and the medial one and one-half fingers. Which of the
following nerves is injured?
xA.
B.
C.
D.
E.
45.
Thoracodorsal and upper subscapular
Suprascapular and axillary
Radial and lower subscapular
Axillary and musculocutaneous
Suprascapular and dorsal scapular
a sensory loss over the ventral aspect of the base of the thumb
an inability to oppose the thumb
a loss of wrist extension, leading to wrist drop
a weakness in pronating the forearm
an inability to abduct the fingers
The position adopted by the right arm in this patient can be explained by paralysis of
which of the following groups of muscles?
A. Flexor digitorium superficialis, flexor pollicis longus, flexor carpi
radialis longus, and flexor carpi ulnaris
B. Extensor carpi ulnaris, supinator, extensor indicis, and extensor digiti
minimi
C. xxSupraspinatus, deltoid, biceps brachii, greater part of brachialis,
infraspinatus, and teres minor
D. Latissimus dorsi, triceps, anconeus, brachioradialis and supinator
E. Pectoralis major, abductor pollicis longus, extensor pollicis brevis, and
extensor pollicis longus
57.
A 30-year-old plasterer was finishing a difficult ceiling in a remodeled kitchen. He was
standing on top of a stepladder with his right arm above his head. As he moved the trowel
filled with plaster across the ceiling in his right hand, he suddenly felt an acute spasm of
pain over the tip of the right shoulder. At physical examination of the patient in the
emergency department, it was found that the pain in the right shoulder recurred in the
middle range of abduction and that there was tenderness over the greater tubercle of the
humerus.
What is the MOST LIKELY structural damage in this patient?
xxLesion of the rotator cuff
A. Fracture of the upper end of the humerus
B. Tearing of the deltoid muscle
C. Fracture of the acromion
D. Tearing of the trapezius muscle
58.
A 17-year-old girl was thrown from her horse while attempting a difficult jump. She
landed on her right shoulder and the right side of her head. It was noticed after a week of
hospitalization that she kept her right arm medially rotated and close to her side with the
forearm pronated. At physical examination, an area of anesthesia was found along the
lateral side if the upper part of the arm.
Which nerve(s) was(were) damaged during the accident?
A.
B.
C.
D.
E.
19.
Which of the following nerves DOES NOT NORMALLY have any contribution from
spinal nerve C7?
A.
B.
C.
D.
E.
59.
The axillary nerve
The radial nerve
The middle trunk of the brachial plexus
The lower trunk of the brachial plexus
xxThe C5 and C6 roots of the brachial plexus
Thoracodorsal nerve
xxMedial pectoral nerve
Musculocutaneous nerve
Long thoracic nerve
Radial nerve
A patient presents with an Erb-Duchenne palsy. Which of the following would NOT be
affected?
A.
B.
C.
D.
xE.
60.
Infraspinatus muscle
Biceps brachii muscle
Subclavius muscle
Teres minor muscle
Pectoralis minor muscle
A patient presents to the office with a loss of sensation over the lateral portion of the
palm and the lateral three digits. The patient has difficulty with fine motor movements of
the hand (i.e. buttoning her shirt or making the "OK" sign). Which of the following
nerves is affected?
B.
C.
D.
E.
F.
20.
An occlusion of the axillary artery does not usually result in total loss of blood supply to
the upper limb because of anastomoses around the scapula. Arteries which arise from the
axillary artery and contribute in a significant way to these anastomoses include the:
A.
B.
C.
D.
E.
21.
Suprascapular artery
Deep brachial artery (profunda brachii)
xxSubscapular artery
Transverse cervical artery
Dorsal scapular artery
A fracture of the mid-portion of the shaft of the humerus had resulted in injury to the
nerve lying in the spiral groove of the bone. With injury to this nerve, what effects would
be expected in the functions of the affected limb?
A.
B.
C.
D.
E.
22.
Musculocutaneous nerve
Ulnar nerve
xxMedian nerve
Radial nerve
Thoracodorsal nerve
"Wristdrop" would occur
The triceps brachii would still be functional
There would be absence of the brachioradialis reflex
There would be weakness in the grip of the flexor muscles of the fingers
xxAll of the responses listed would be expected
A third year medical student was asked to perform venipuncture on a patient's right arm.
He is initially unsuccessful, and he changes the site of puncture to a slightly more medial
one. The patient experiences pain radiating down the ventral surface of the forearm and
hand, including the thumb, index finger and middle finger. The nerve penetrated is
MOST LIKELY:
A.
B.
C.
D.
E.
The medial antebrachial cutaneous nerve
xxThe median nerve
The radial nerve
A branch of the musculocutaneous nerve
The ulnar nerve
23.
A 24-year-old football player is referred to an orthopedic surgeon because of a mid-shaft
fracture of the humerus. Surgery reveals a hematoma that resulted from an artery that was
torn by a bone fragment. This artery is MOST LIKELY the:
A.
B.
C.
D.
E.
80.
E.
xxProfunda brachii (deep brachial)
Radial
Axillary
Brachial
Radial collateral
The 44 YO female patient, a computer software engineer, pomplained that she was
awakened frequently at night by pain in her right hand, particularly in the lateral portions
of her hand, and the palmar surfaces of the thumb, index and long finger. Her right thenar
eminence was reduced in size, compared with that of the contralateral hand. Among the
structures that pass through the carpal tunnel, wherein the median nerve is often
compressed, is the...
A. superficial palmar branch of the radial artery
B. deep ulnar nerve and deep branch of the ulnar artery
C. deep palmar branch of the radial artery
xxD. tendon of the flexor pollicis longus
tendon of the palmaris longus
78.
As he was examined in the clinic, it became obvious that the patient had several problems
in his left leg. These included the following: anesthesia limited to the medial aspect of his
leg; absence of his patellar reflex; weakness in dorsiflexion of his foot;near-total paralysis
of inversion of the foot. The MOST LIKELY cause of this cluster of problems would be
xxA.
compression of the L4 spinal nerve root by disk herniation
B.
compression of the L5 spinal nerve root by disk herniation
C.
a tumor of the psoas sheath involving the lumbosacral trunk
D.
lesion of the sciatic nerve just proximal to the popliteal fossa
E.
compression of the tibial nerve between the gastrocnemius and soleus muscles
76.
A 32 YO man had taken a fall when his motorcycle hit a rock in the road from adjacent
sidewalk construction. He complains of numbness and tingling along the anterolateral
surface of his leg and the dorsum of his foot. He cannot elevate his foot (dorsiflexion) nor
extend his toes. He cannot evert the foot, either. X-Ray imaging reveals a fracture of the
neck of the fibula. Which nerve has been injured in the accident?
74.
xxA. common fibular (peroneal) nerve
B.
deep fibular (peroneal) nerve
C.
tibial nerve
D.
saphenous nerve
E.
superficial peroneal (fibular) nerve
The 52 YO patient presented a complaint of impotence. Physical examination revealed
atrophy of the musculature of his lower limbs and reduced pulses in the groin, popliteal
fossa, ankles and feet. The patient admitted that his lower limbs tired easily.
Gastrointestinal, renal and respiratory functions appeared within normal limits. The
probable diagnosis in this case:
xxA.
LeRiche syndrome, thrombus at the aortic bifurcation
B.
Embolic occlusion of-the "Critical Point of Sudeck".
C.
Aortic occlusive stenosis at the median arcuate ligament of the diaphragm
D.
Bilateral femoral arterial atherosclerotic occlusion
E.
Aortic aneurysm and intimal dissection proximal to renal arteries
72.
The painter had fallen from his scaffold for a considerable distance before managing to
grasp a rope and arrest his fall. As a result, however, the lower trunk of the brachial
plexus was injured because of the tension to the nerve trunk where it crossed over the
first rib. Sensory deficits and motor paralysis resulted. Among the resultant problems,
one should be able to anticipate…
A.
paralysis of all interossei + loss of sensation over the
lateral aspect of the dorsum of the hand
B.
inability to extend the elbow or MP joints + loss of
sensation over the lateral aspect of the ventral surface of the forearm
xxC. paralysis of opposition of thumb to other digits + absence
of sensation over the medial aspect of the forearm and hand
D.
loss of ability to flex the elbow, whether supinated or
pronated + anesthesia on the medial aspect of the dorsum of the hand
E.
All of the above
73.
The 24 YO patient, a medical student, presented in clinic complaining of burning pain
and tingling sensations down the lateral aspects of both thighs. It was noted by the well
trained nurse that the patient's bluejeans were very, very tight; in fact, it took
considerable effort and a significant amount of time for the student to remove this article
of clothing so that careful examination could be performed to exclude more serious
diagnostic possibilities. Meralgia paresthetica often results from compression of a
cutaneous nerve beneath the lateral extremity of the inguinal ligament. This nerve
contains sensory fibers which are derived usually just from spinal nerve levels ....
A.
70.
T12
B.
L1
C.
L1, L2
xxD.
L2, L3
The 60 YO woman had a marked lurch (a type of limp) when she walked. She would lean
over her right hip to swing the left limb forward, thus balancing the weight of her upper
body over the right lower limb. She could advance the right limb without severe
difficulty. A very likely diagnosis in this case would be Trendelenburg gait. This
dysfunction of ambulation results from weakness or paralysis principally of the ...
xxA.
B.
C.
D.
gluteus medius
gluteus maximus
tensor fasciae latae
"short lateral rotator group" of the gluteal region
E.
71.
67.
E.
quadriceps femoris
A hard mass in the ostium of the patient's appendix had led to local infection appendicitis, with a slightly elevated temperature and moderate increase in WBC count.
The initial pain from the infection was dull and difficult to localize, but the patient placed
his hand in the periumbilical area to indicate the general area of discomfort. The region of
the umbilicus receives its sensory supply, classically, from spinal nerve level ...
A.
T7
B.
T8
xxC. T10
D.
T12
The 29 YO woman had been suffering increased difficulty in her morning run before
class at the medical school. On examination, it was found that the muscle group of the
medial side of her left thigh was obviously weaker and smaller than that on the
contralateral limb. The conclusion was that her left obturator nerve was being
compressed at the obturator foramen and required surgical release. Among the muscles
that were suffering paralytic weakness would be the ...
A.
rectus femoris
xxB. gracilis
C.
vastus medialis
D.
tensor fasciae latae
sartorius
63.
The young man's hand was caught between the automobile and the pavement
when the vehicle overturned. The tendons in the second compartment of the dorsum of
his hand were torn severely. These tendons would include the...
A.
xxB.
C.
D.
E.
61.
54.
extensor pollicis longus and brevis
extensor carpi radialis longus and brevis
abductor pollicis longus and extensor pollicis brevis
extensor digitorum and extensor digiti minimi
extensor carpi ulnaris and extensor indicis
Because of the size of the baby, excessive traction on the head and neck was used to
assist in its delivery from the birth canal. It was observed thereafter that the baby could
not abduct, flex, nor laterally rotate the right arm; elbow flexion also seemed to be absent.
The baby's hand seemed to function normally. What neural structure(s) was (were)
injured at birth?
A.
the musculocutaneous and median nerves
B.
the lower trunk of the brachial plexus
C.
the posterior cord of the brachial plexus
xxD. the upper trunk of brachial plexus, at Erb's point
E.
the ulnar, suprascapular and axillary nerves
The femoral artery is often used when it is necessary to thread a catheter into the heart.
The artery is located within the femoral triangle of Scarpa. The lateral boundary of the
femoral triangle is provided by the ...
A.
B.
C.
xxD.
E.
rectus femoris
adductor longus
pectineus
sartorius
iliopsoas
53.
When it is not possible to find superficial veins for insertion of a catheter in the upper
limbs of an infant, it is usually possible to identify and utilize the great saphenous vein.
This vessel is located...
A.
anterior to the lateral malleolus
xxB. anterior to the medial malleolus
C.
posterior to the lateral malleolus
D.
posterior to the medial malleolus
E.
just posterior to the lateral femoral condyle
49.
Volkmann's ischemic contracture is MOST OFTEN attributable to a ...
A.
fracture of the surgical neck of the humerus
B.
midshaft fracture of the humerus
C.
Colles' fracture of the wrist
D.
midshaft fracture of the radius
xxE. supracondylar fracture of the humerus
46.
The patient had been experiencing pain in the buttock and posterior thigh because part of
his sciatic nerve passed through the muscle that forms the "key" of the gluteal region, and
was being compressed. The muscle that was compressing the nerve was the...
A.
B.
xxC.
D.
E.
42.
B.
43.
A 50 YO woman discovered that the cause of her carpal tunnel syndrome was the
dislocation of a carpal bone. The MOST LIKELY bone involved would be the…
xxA. lunate
pisiform.
C.
scaphoid
D.
hamate
E.
capitate
A 60 YO butcher accidently slashed his wrist, injuring his ulnar nerve. Which of the
following actions would be lost as a result of the injury?
A.
B.
xxC.
D.
E.
41.
C.
30.
flexion of the distal phalanx of the fifth digit (little finger)
extension of the thumb
adduction of the fifth digit
abduction of the thumb
opposition of the thumb
A 24 YO football player is referred to an orthopedic surgeon because of a mid-shaft
fracture of the humerus. Surgery reveals a hematoma on the posterior aspect of the arm
that resulted from bleeding from an artery that was torn by a bone fragment. This artery is
MOST LIKELY the…
A. radial
B. axillary
brachial
xxD. profunda brachii (deep brachial)
E.
radial recurrent
If a lumbar puncture is performed in this individual, what would you expect the CSF to
show?
A.
B.
xxC.
D.
E.
31.
gluteus medius
obturator internus
piriformis
obturator externus
quadratus femoris
increased protein, increased glucose
increased protein, increased white blood cells
increased protein, but not white blood cells
increased glucose, but not white blood cells
increased glucose, increased white blood cells
After having a mastectomy for the removal of an extensive breast cancer, the
44-year-old patient tells her physician that she has great difficulty abducting her arm
above the level of her shoulder. Physical examination reveals that she has a "winged"
scapula when she pushes against the wall. What structure has been injured during her
breast surgery to result in this problem?
A.
B.
C.
xxD.
E.
34.
In preparation for delivery of the baby, the anesthesiologist elects to inject a suitable
quantity of anesthetic into the CSF and then so position the patient that the anesthetic
will have its principal effect upon the lower portion of the body including the pelvic
region. Where should the anesthetic be injected to achieve the desired result?
A.
B.
C.
xxD.
E.
58.
A.
43.
Axillary nerve
Pectoralis major muscle
Deltoid muscle
Long thoracic nerve
Lateral pectoral nerve
Into the epidural space at the sacral hiatus
Into the extradural space at L3
Into the subarachnoid space at T12/L1
Into the subarachnoid space at L3/L4
Into the subdural space at Ll/L2
As you examine the baby who was delivered two weeks earlier at Princess Margaret
Hospital (Roseau) you note that the left upper limb is rotated medially and that the infant
is seemingly unable to move the limb at the shoulder. Finger movements of the ipsilateral
limb indicate that distal muscles are functional. From this, you conclude CORRECTLY
that an injury has occurred at birth to the.
lower trunk of the brachial plexus
B.
axillary nerve
xxC. upper trunk of the brachial plexus
D.
musculocutaneous nerve
E.
C7 ventral primary ramus
She had suffered a severe knife wound to the upper lateral portion of her pectoral region,
with entry of the knife at the deltopectoral groove. Pressure applied to the wound had
prevented further profuse bleeding. In the Emergency Department, vascular clamps were
applied to the axillary artery, proximal and distal to the site of injury which had occurred
between the second and third parts of the axillary artery. The vascular surgeon knew that
he would have adequate time to repair the wound of the artery because of the rich
collateral pathway provided by the anastomoses between the ...
xxA.
B.
C.
D.
E.
suprascapular and circumflex scapular arteries
supreme (superior) thoracic and thoracoacromial
transverse cervical and suprascapular arteries
posterior humeral circumflex and profunda brachii arteries
lateral thoracic and suprascapular arteries
78.
Following an infection in the left hallus, (big toe), a patient developed pain in the left
groin. Likely reason for the pain is:
A.
xxB.
C.
D.
E.
76.
74.
Following a fracture of the neck of the fibula, a patient noticed that he could dorsiflex
but not evert his foot. Which of the following nerves was injured?
xxA. The superficial peroneal (fibular)
B.
The common peroneal (fibular) nerve
C.
The deep peroneal (fibular) nerve
D. The sural nerve
E.
Tibial nerve
A policeman was stabbed in the antero-medial third of the left thigh. At exploration, the
knife was found to pass through the middle of the sartorius into the adductor canal.
Which of the following is likely to be entered first in the path of the knife?
xxA.
B.
C.
D.
E.
75.
Ulnar nerve
Anterior interosseous nerve
Median nerve
Superficial radial nerve
Radial nerve
An example of a nerve innervating a group of related muscles is:
A.
B.
C.
D.
xxE.
73.
The femoral artery
The profunda femoris artery
The profunda femoris vein
The femoral vein
The popliteal artery
Inability to hold a piece of paper between the second and third digits would result from
damage to the:
xxA.
B.
C.
D.
E.
72.
Referral of pain via the obturator nerve
Lymphatic spread from the leg
Referral of pain via the femoral nerve
Referral of pain via the saphenous nerve
Venous spread from the leg
Obturator nerve to obturator internus and obturator externus
Femoral nerve to adductors of thigh
Sciatic nerve to gluteal muscle
Superior gluteal nerve to lateral rotators of hip
Tibial nerve to all intrinsic muscles on sole of the foot
If the entire greater tubercle of the humerus was broken away as a result of an injury,
which of the following movements of the humerus would be affected?
A.
B.
Extension and medial rotation
Flexion and abduction
xxC. Abduction and lateral rotation
D. Flexion and medial rotation
E.
Flexion, abduction and adduction
69.
A patient presents with an arrow embedded in the carotid triangle. Which of the
following is NOT LIKELY to be involved?
xxA.
B.
C.
D.
E.
70.
Which of the following muscles would NOT be affected by compression of the median
nerve in the carpal tunnel?
A.
B.
C.
D.
xxE.
71.
Digital branch of the median nerve
Superficial branch of the radial nerve
Digital branch of the ulnar nerve
Digital branch of the radial nerve
Anterior interosseous branch of the median nerve
A 10-year-old boy is playing at a construction site when he falls backward onto a nail
protruding from a piece of wood which pierces into the medial half of his right gluteal
region. In the Emergency Department he is found to have intact thigh extension, knee
flexion, and foot movement, but when he tries to walk his hip collapses toward the left
side when he takes a step with his left leg. What nerve was damaged?
A.
B.
C.
xxD.
E.
60.
Abductor pollicis brevis
Second lumbrical
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis
A large splinter, deeply embedded adjacent to the nail on the medial side of the ring
finger develops into an abscess. Prior to lancing to remove the fragment and drain the
abscess, the surgeon blocked with anesthetic the appropriate:
A.
B.
xxC.
D.
E.
57.
Brachial plexus
Cervical sympathetic trunk
Internal jugular vein
Vagus nerve
Carotid arteries
Superior cluneal nerve
Inferior gluteal nerve
Sciatic nerve
Superior gluteal nerve
Inferior cluneal nerve
A 32-year-old man fell from his motorbike and received a hard blow to the lateral side of
the upper part of his leg. He complains of numbness and tingling along the lower
anterolateral surface of his leg and the dorsum of his foot. X-ray reveals a fracture of the
neck of the fibula. Physical examination shows that he is unable to dorsiflex his foot.
Which nerve is MOST LIKELY to be injured by a fracture of the neck of the fibula?
A.
B.
C.
D.
xxE.
54.
51.
A football player had been hit hard on the lateral side of his knee, with the ipsilateral foot
planted on the ground and bearing his full weight, resulting in tearing of three structures
in the joint. The "anterior drawer sign" was present upon examination. The structures
injured would therefore MOST LIKELY include the:
A.
Fibular collateral and posterior cruciate ligaments
xxB. Medial collateral and anterior cruciate ligaments
C.
Posterior cruciate ligament and lateral meniscus
D.
Lateral meniscus and fibular collateral ligament
E.
Ligamentum patellae
A convenient site for insertion of an intravenous line in the great saphenous vein is:
xxA.
B.
C.
D.
E.
52.
49.
Tibial nerve
Lateral sural nerve
Deep fibular (peroneal) nerve
Saphenous nerve
Common fibular (peroneal) nerve
Anterior to the medial malleolus
Inferior to the inguinal ligament
Posterior to the lateral malleolus
Medial to the popliteal vein
Dorsal venous arch of foot
A patient presented with swelling of the entire left lower limb due to venous occlusion.
The pelvic viscera remained normally drained. Likely site of obstruction will be:
xxA. External iliac vein
B.
Common iliac vein
C.
Popliteal vein
D.
Inferior vena cava
E.
Great saphenous vein
A patient walks with a waddling gait that is characterized by the pelvis falling toward the
side of the raised foot. Which of the following nerves is damaged?
A.
B.
xxC.
D.
E.
Obturator nerve
Nerve to obturator internus
Superior gluteal nerve
Inferior gluteal nerve
Femoral nerve
50.
An industrial accident produced a fracture of the upper third of the shaft of the femur.
The proximal fragment was abducted and laterally rotated. Which of the following
muscles was NOT INVOLVED in producing the above?
A.
Piriformis
B.
Obturator internus
xxC. Iliopsoas
46.
D.
Gluteus minimus
E.
Gluteus medius
Which of the following is the CORRECT sequence from lateral to medial?
A.
B.
C.
D.
xxE.
47.
Following an infection in the left hallux, a patient developed pain in the left groin. Likely
reason for the pain is
A.
B.
C.
xxD.
E.
48.
A.
Femoral vein, femoral artery, femoral ring, femoral nerve
Femoral artery, femoral ring, femoral vein, femoral nerve
Femoral artery, femoral nerve, femoral vein, femoral ring
Femoral ring, femoral vein, femoral artery, femoral nerve
Femoral nerve, femoral artery, femoral vein, femoral ring
referral of pain via the femoral nerve
referral of pain via the saphenous nerve
referral of pain via the obturator nerve
lymphatic spread from the foot
venous spread from the foot
To avoid damaging the sciatic nerve during an intramuscular injection in the right gluteal
region, the clinician should insert the needle
in the area over the sacrospinous ligament
B.
midway between the ischial tuberosity and the lesser trochanter
C.
at the midpoint of the gemelli muscles
D.
Xx in the upper right outer quadrant of the gluteal region
in the lower right quadrant of the gluteal region
E.
45.
A young mountain climber had fallen some distance before managing to
grasp a safety line with one hand. The quick upward pull of the line on the weight
of his body caused severe injury to the lower trunk of the brachial plexus. As a
result of the lower trunk injury, one would CORRECTLY expect:
xxA. Loss of function of the intrinsic muscles of the hand, with anesthesia along the
medial aspect of his forearm and hand
B. Loss of extension of the elbow and anesthesia on the dorsum of his arm and forearm
C. Paralysis of the deltoid and the "SIT" group of muscles and anesthesia over the
proximal, lateral side of the arm
D. Inability to flex the elbow and anesthesia on the lateral side of the ventral surface of
the forearm
E. Paralysis of the serratus anterior and scapular winging, without sensory loss
42.
A 50-year-old woman was recently diagnosed with carpal tunnel syndrome. Which of the
following is LEAST LIKELY to be a predisposing factor in this condition?
A.
B.
C.
xxD.
E.
43.
Which of the following group of nerves is intimately related to a portion of the humerus
and can be affected by fractures of the humerus?
A.
B.
xxC.
D.
E.
44.
pairs
Dislocated lunate
Thickened flexor retinaculum
Tenosynovitis of long flexor tendons
Compression of ulnar nerve
Paresthesia or lack of sensation over thenar eminence
Axillary, musculocutaneous, radial
Axillary, median, ulnar
Axillary, radial, ulnar
Axillarv, median, musculocutaneous
Median, radial, ulnar
Inability to supinate the forearm could result from an injury to which of the following
of nerves?
A.
Suprascapular and axillary
B.
Musculocutaneous and median
C.
Axillary and radial
xxD. Radial and musculocutaneous
E.
Median and ulnar
41.
A 21-year-old football player is referred to an orthopedic surgeon because of a
fracture of the surgical neck of the humerus. Surgery reveals a hematoma that resulted
from an artery that was torn by a bone fragment. This artery is MOST LIKELY the:
A.
B.
C.
D.
xxE.
57.
A 10-year-old boy is playing at a construction site when he falls backward onto
a nail protruding from a piece of wood which pierces into the medial half of his
right gluteal region. In the Emergency Department he is found to have intact
thigh extension, knee flexion, and foot movement, but when he tries to walk his
hip collapses toward the left side when he takes a step with his left leg. What
nerve was damaged?
A.
B.
C.
xxD.
77.
The inferior hemorrhoidal (rectal) nerves
The superior hypogastric nerve
The inferior hypogastric nerve
The pelvic splanchnic nerve
The vagus nerve
Following an infection in the left hallus, (big toe), a patient developed pain in
the left groin. Likely reason for the pain is:
A.
xxB.
C.
D.
E.
76.
Superior cluneal nerve
Inferior gluteal nerve
Sciatic nerve
Superior gluteal nerve
A tourist accidentally swallowed a bone while eating and the bone eventually
got impacted in the anal canal below the dentate line. He suffered severe pain
from this impaction. The pain experienced is mediated via:
xxA.
B.
C.
D.
E.
78.
Radial
Axillary
Brachial
Profunda brachii (deep brachial)
Posterior humeral circumflex
Referral of pain via the obturator nerve
Lymphatic spread from the leg
Referral of pain via the femoral nerve
Referral of pain via the saphenous nerve
Venous spread from the leg
Following a fracture of the neck of the fibula, a patient noticed that he could
dorsiflex but not evert his foot. Which of the following nerves was injured?
xxA. The superficial peroneal (fibular)
B.
The common peroneal (fibular) nerve
74.
C.
The deep peroneal (fibular) nerve
D.
The sural nerve
E.
Tibial nerve
A policeman was stabbed in the antero-medial third of the left thigh. At
exploration, the knife was found to pass through the middle of the sartorius into
the adductor canal. Which of the following is likely to be entered first in the path
of the knife?
xxA.
B.
C.
D.
E.
75.
Inability to hold a piece of paper between the second and third digits would
result from damage to the:
xxA.
B.
C.
D.
E.
73.
71.
The femoral artery
The profunda femoris artery
The profunda femoris vein
The femoral vein
The popliteal artery
Ulnar nerve
Anterior interosseous nerve
Median nerve
Superficial radial nerve
Radial nerve
If the entire greater tubercle of the humerus was broken away as a result of an
injury, which of the following movements of the humerus would be affected?
A. Extension and medial rotation
B. Flexion and abduction
xxC. Abduction and lateral rotation
D. Flexion and medial rotation
E.
Flexion, abduction and adduction
A large splinter, deeply embedded adjacent to the nail on the medial side of the
ring finger develops into an abscess. Prior to lancing to remove the fragment and
drain the abscess, the surgeon blocked with anesthetic the appropriate:
A.
B.
xxC.
D.
E.
Digital branch of the median nerve
Superficial branch of the radial nerve
Digital branch of the ulnar nerve
Digital branch of the radial nerve
Anterior interosseous branch of the median nerve
SEMESTER TWO
B
72.
MINI THREE
APRIL 9, 2002
An example of a nerve innervating a group of related muscles is:
Form
A.
B.
C.
D.
xxE.
70.
Obturator nerve to obturator internus and obturator externus
Femoral nerve to adductors of thigh
Sciatic nerve to gluteal muscle
Superior gluteal nerve to lateral rotators of hip
Tibial nerve to all intrinsic muscles on sole of the foot
Which of the following muscles would NOT be affected by compression of the
median nerve in the carpal tunnel?
A.
B.
C.
D.
xxE.
Abductor pollicis brevis
Second lumbrical
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis