Review Questions

1. A patient experiences radial deviation of the hand at the wrist when he flexes the wrist and altered sensation in the skin covering the hypothenar eminence. What is the most likely cause of these symptoms?

(A) Fracture of the scaphoid bone

(B) Fracture of the medial epicondyle of the humerus

(C) Fracture of surgical neck of the humerus

(D) Fracture of the distal end of the radius

(E) Anterior and inferior dislocation of the head of the humerus

2. A patient develops a significant clawing of the fourth and fifth digits secondary to nerve injury. Which muscle has been weakened and therefore results in the clawing?

(A) Extensor digitorum

(B) Lumbrical

(C) Flexor digitorum superficial

(D) Dorsal interosseous

(E) Flexor digiti minimi

3. A patient has suffered a fracture of the surgical neck of the humerus. Which muscle is most likely to have been weakened?

(A) Deltoid

(B) Supraspinatus

(C) Biceps brachii

(D) Teres major

(E) Latissimus dorsi

4. A 39-year-old man has suffered for many years from pains in his right arm. Recently, after moving to a new job that requires carrying heavy parcels, the pain has worsened, and occasional tingling and numbness is felt in the little finger and ring finger of the right hand. The area of pain in the limb is localized to the medial side of the arm and forearm and the ulnar side of the hand. General muscle strength in the right extremity is less than in the left, and there is particular weakness of opposition and adduction of the right thumb. Wasting of the right hypothenar and thenar eminence is evident, and the patient cannot hold a piece of paper between his index and middle fingers. The most likely site of the injury is

(A) lower trunk of the brachial plexus

(B) upper trunk of the brachial plexus

(C) posterior cord of the brachial plexus

(D) ulnar nerve

(E) median nerve

5. A man who uses hand tools for a living begins to develop pain and paresthesia in his right hand at night. The altered sensation is most evident on the palmar aspects of the index and middle fingers. What else are you most likely to see in this patient?

(A) Atrophy of the thenar eminence

(B) Weakness in extension of the thumb

(C) Radial deviation of the hand at the wrist during wrist flexion

(D) Altered sensation in skin over die anatomic snuffbox

(E) Inability to spread the fingers

6. A 20-year-old man stated that he was unable to raise his right arm. Questioning revealed that he had been involved in a motorcycle accident, at which time he had been thrown from die motorcycle and had hit his shoulder against a tree. The patient held his upper limb limply at his side, with the arm medially rotated and the hand pronated. Muscles covering the shoulder joint showed significant wasting. The most likely site of the injury is the

(A) lower trunk of the brachial plexus

(B) upper trunk of the brachial plexus

(C) posterior cord of the brachial plexus

(D) axillary nerve

(E) radial nerve

7. The axillary artery has become progressively occluded deep to the pectoralis minor muscle. Which pair of blood vessels would most likely provide a significant collateral circulation around the blockage?

(A) Posterior humeral circumflex artery and anterior humeral circumflex artery

(B) Subscapular artery and posterior humeral circumflex artery

(C) Subscapular artery and suprascapular artery

(D) Lateral thoracic artery and supreme thoracic artery

(E) Posterior humeral circumflex artery and profunda brachial artery

8. Your patient has fallen on his outstretched hand and has dislocated a carpal bone. The patient does not seek treatment, and several weeks later he begins to exhibit signs of nerve compression. The patient is most likely to present with which of the following conditions?

(A) Wrist drop

(B) Clawing of ring and index fingers

(C) Inability to spread and oppose the fingers

(D) Weakness in the ability to oppose the thumb

(E) Pain on the palmar aspects of the ring and little fingers

(A)

A

(B)

B

(C)

C

(D)

D

(E)

E

(F)

F

(G)

G

(H)

H

10. A humeral fracture results in wrist drop in your patient. Which letter in the figure above identifies the injured neural structure?

(A)

A

(B)

B

(C)

C

(D)

D

(E)

E

(F)

F

(G)

G

(H)

H

Questions 9 and 10 are based on the figure below.

A rock hits a 10-year-old child on the chest wall just below the axilla. Several days later, during gym class, the child has difficulty doing push-ups. Which letter in the figure above identifies the injured neural structure?

11. In the cross-section below, a lesion of a nerve at "A" wouJd result in

Cross section of the wrist

(A) paresthesia of the lateral aspect of the palm

(B) wrist drop

(C) paresthesia in skin over the anatomic snuffbox

(D) inability to press the pulp of die thumb against the pulp of the index finger

(E) inability to spread the fingers

12. Referring to the figure below, extension of the interphalangeal joints of the digit indicated by "E" is controlled by the

(A) ulnar nerve

(B) radial nerve

(C) median nerve

(D) axillary nerve

(E) musculocutaneous nerve

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Responses

  • Ulla-Maj
    Which pair of blood vessels would provide a collateral circulation around occluded axillary artey?
    3 years ago

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