29-year-old male, right-handed house painter visits his family physician because

of pain in his right upper limb and slight tingling and numbness in all of his
digits, but especially in the fourth and fifth digits when he reaches high over his
head to paint. Radiographic studies reveal the presence of a cervical rib and
accessory scalene musculature. Which of the following structures is most likely
compressed when he reaches high to paint?
A. Axillary artery
B. Brachiocephalic artery
C. Lower trunk of the brachial plexus
D. Subclavian artery
E. Superior trunk of the brachial plexus

C. Lower trunk of the brachial plexus

A 44-year-old man is admitted to the hospital after a bar fight in which his right
arm was severely injured. Radiographic examination of the arm reveals an
oblique fracture of the humerus. Physical examination of the patient revealed he
was unable to extend his forearm or wrist. The damaged nerve was composed of
nerve fibers from what spinal cord segments?
A. C5,C6
B. C5, C6, C7
C. C5, C6, C7, C8, T1
D. C7, C8, T1
E. C8, T1

C. C5, C6, C7, C8, T1

A 32-year-old woman complains of pain in her right wrist after falling on some
rocks when climbing up from a river bed. Radiographic studies indicate an
anterior dislocation of a carpal bone in the proximal row. Which of the following
bones is most commonly dislocated?
A. Capitate
B. Hamate
C. Lunate
D. Triquetrum
E. Scaphoid

C. Lunate

A 35-year-old woman is brought to the emergency room following a car accident.

Physical examination reveals severe pain in the flexor muscles of the forearm;
fixed flexion position of the fingers; and swelling, cyanosis, and anesthesia of the
fingers. Which of the following is the most likely diagnosis?
A. Bennett's fracture
B. Boxer's fracture
C. Colles' fracture
D. Scaphoid fracture
E. Volkmann's ischemic contracture

E. Volkmann's ischemic contracture

A 48-year-old woman is being examined for cosmetic breast surgery because the
breasts sag considerably. Which breast structure has become stretched leading to
the sagging of the breasts?
A. Axillary fascia
B. Clavipectoral fascia
C. Deep cervical fascia
D. Pectoralis major muscle
E. Suspensory (Cooper's) ligaments

E. Suspensory (Cooper's) ligaments

A 52-year-old female medical school secretary is examined for symptoms of

carpal tunnel syndrome. Which muscles most typically become weakened in this
condition?
A. Flexor muscles of the forearm
B. Hypothenar muscles
C. Lumbrical muscles III and IV
D. Palmar interossei
E. Thenar muscles

E. Thenar muscles

A 32-year-old male is brought to the emergency room with injuries to his right
elbow after falling while rock climbing. X-rays of the right elbow revealed a
fracture of the medical epicondyle. Which of the following nerves was likely
injured in this fall?
A. Anterior interosseous nerve
B. Deep branch of the radial nerve
C. Median nerve
D. Superficial branch of the median nerve
E. Ulnar nerve

E. Ulnar nerve
A 32-year-old male is brought to the emergency room with injuries to his right
elbow after falling while rock climbing. X-rays of the right elbow revealed a
fracture of the medical epicondyle. Which of the following muscles would most
likely be paralyzed?
A. Flexor carpi superficialis
B. Flexor carpi ulnaris
C. Pronator quadratus
D. Pronator teres
E. Thenar muscles

B. Flexor carpi ulnaris

An 85-year-old woman fell when attempting to cross the street and injured her
left arm when hitting the curb. X-rays showed a midshaft fracture of the
humerus. Which pair of structures was most likely injured at the fracture site?
A. Axillary nerve midposterior humeral circumflex artery
B. Median nerve and brachial artery
C. Radial nerve and deep brachial artery
D. Suprascapular nerve and suprascapular artery
E. Thoracodorsal nerve and thoracodorsal artery

C. Radial nerve and deep brachial artery

A 17-year-old male is brought to the emergency room following an injury while

playing football. X-rays revealed a transverse fracture of the humerus 1 inch
proximal to the epicondyles. What nerve is most frequently injured by the jagged
edges of the broken bone at this location?
A. Axillary nerve
B. Median nerve
C. Musculocutaneous nerve
D. Radial nerve
E. Ulnar nerve

D. Radial nerve

A 48-year-old male office worker, while on vacation one day, played numerous
games of tennis. The following day he went to the orthopedic clinic because of
difficulty in using his right hand. Examination revealed wrist drop and weakness
of grasp, but normal extension of the elbow joint. No loss of sensation was noted
in the right limb. Which nerve is most likely affected?
A. Anterior interosseous nerve
B. Median nerve
C. Posterior interosseous nerve
D. Radial nerve
E. Superficial radial nerve

C. Posterior interosseous nerve

A blood sample is obtained from the cubital fossa for an assessment of

circulating blood chemistry. Which of the following arteries is most likely at risk
during venipuncture of the cubital fossa?
A. Anterior interosseous artery
B. Brachial artery
C. Common interosseous artery
D. Radial artery
E. Ulnar artery

B. Brachial artery

A 17-year-old male athlete comes to the emergency room after a bad landing
when running the hurdles. Severe pain is felt when placing pressure in the
anatomical snuff box. X-rays of the hand revealed a fractured carpal bone.
Which bone has most likely been fractured?
A. Capitate
B. Hamate
C. Levate
D. Scaphoid
E. Trapezoid

D. Scaphoid

While sliding into second base, a 22-year-old baseball player jammed his right
index finger into the base pad. He experienced a sudden, severe pain over the
base of the terminal phalanx. Several hours later the right index finger was
swollen and he could not completely extend the terminal interphalangeal joint.
Which one of the following structures related to the digit was most likely injured.
A. Fibrous digital sheath
B. Insertion of the tendon of the extensor digitorum onto the base of the distal
phalanx
C. Insertion of the flexor digitorum profundus tendon
D. Insertion of the flexor digitorum superficialis tendon
E. Insertion of the vincula into the flexor tendons

B. Insertion of the tendon of the extensor digitorum onto the base of the distal phalanx
A 23-year-old male sustained a deep laceration in the proximal forearm from a
knife during a brawl. After the injury was surgically closed, a neurology resident
noted that digits 1-3 extended and could not be flexed. Digits 4 and 5 are
partially flexed at the metacarpophalangeal joints and noticeably more flexed at
the distal interphalangeal joints. Sensation is absent in the lateral side of the
palm and the palmar surfaces of digits 1-3 and the radial side of digit 4. Which of
the following nerves has (have) most likely been injured?
A. Median nerve
B. Radial nerve
C. Radial and ulnar nerves
D. Ulnar nerve
E. Ulnar and median nerves

A. Median nerve

A 34-year-old carpenter is brought to the emergency room following a

penetrating injury to his left upper limb near the elbow from the accidental
firing of a nail gun when climbing a ladder. After removing the nail, the patient
was unable to flex the distal interphalangeal joints of digits 4 and 5. What is the
most likely cause of the injury?
A. Median nerve damage near the elbow
B. Medial nerve damage at the wrist
C. Radial nerve damage near the elbow
D. Ulnar nerve damage near the elbow
E. Ulnar nerve damage near the wrist

D. Ulnar nerve damage near the elbow

During a yearly physical exam, a 54-year-old construction worker complained of

pain over the right shoulder. Abduction of the right upper extremity caused
considerable discomfort, and palpation of the deltoid muscle produced pain.
Imaging studies of the shoulder revealed intermuscular inflammation extending
over the head of the humerus. Which of the following structures was inflamed?
A. Axillary sheath
B. Glenohumeral joint cavity
C. Subacromial bursa
D. Subscapular bursa
E. Teres minor muscle

C. Subacromial bursa
A 16-year-old girl attempted to slash her wrists with a sharp knife. She was
rushed to the emergency room, and the cut end of a tendon could be seen near
the midline of the wrist. Which tendon lies near the midline in most people?
A. Abductor pollicis longus tendon
B. Flexor carpi radialis tendon
C. Flexor carpi ulnaris tendon
D. Flexor pollicis longus tendon
E. Palmaris longus tendon

E. Palmaris longus tendon

An 18-year-old male was hit on the end of his right middle finger when
attempting to catch a football. After the swelling that occurred had subsided, he
noted that he could not straighten the distal joint of the finger. What injury did
the player suffer?
A. Boutonniere deformity
B. Clawhand deformity
C. Dupuytren contracture
D. Mallet finger
E. Trigger finger

D. Mallet finger

A 21-year-old male suffered a severe laceration of his proximal hand at the distal
crease of the wrist, cutting the ulnar nerve and artery. Which of the following
would most likely occur?
A. The patient could not touch the tip of the thumb to the tips of the other digits.
B. There would be loss of sensation on the dorsum of the medial side of the hand.
C. The patient would be unable to flex the interphalangeal joints.
D. There would be decreased ability to extend the interphalangeal joints.
E. There would be atrophy of the thenar muscles.

D. There would be decreased ability to extend the interphalangeal joints

On physical examination, a 66-year-old patient reveals weakness of ulnar

deviation of the wrist (adduction), loss of sensation on the medial side of the
hand, and clawing of the fingers. What is the most likely site of nerve injury?
A. Compression of a nerve passing between the humeral and ulnar heads of
origin of the flexor
carpi ulnaris.
B. Compression of a nerve passing in Guyon's canal between the pisiform bone
and the flexor
retinaculum
C. Compression of a nerve passing through the carpal tunnel.
D. Compression of a nerve passing between the ulnar and radial heads of origin
of flexor
digitorum superficialis.
E. Compression of a nerve passing deep to the brachioradialis muscle.

A. Compression of a nerve passing between the humeral and ulnar heads of origin of the flexor
carpi ulnaris.

A 64-year-old woman arrives at the emergency room after falling on an icy

sidewalk. X-rays of the distal forearm and hand reveal a Colles' fracture and
osteoporosis. Which of the following carpal bones are often fractured or
dislocated with a Colles' fracture?
A. Lunate and capitate
B. Lunate and scaphoid
C. Lunate, scaphoid and triquetrum
D. Scaphoid and triquetrum
E. Triquetrum and pisiform

B. Lunate and scaphoid

A 33-year-old woman arrives at the emergency room after falling when climbing
onto a farm machine. X-rays revealed a fracture of the humerus involving the
spiral groove. A cast is placed to stabilize the upper extremity, and 3 days later
the patient complains of severe pain over the length of the upper extremity. The
forearm and hand appear swollen, pale and cool. Radial pulse is absent, and any
movement of the extremity causes severe pain. Which of the following conditions
will most likely be responsible for the clinical findings with the exam?
A. Compartment syndrome
B. Dupuytren's contracture
C. Radial nerve injury
D. Raynaud's disease
E. Thoracic outlet syndrome

A. Compartment syndrome

A 29-year-old woman visits the walk-in clinic after falling from her 4-wheeler.
When asked to clench her fist, the second and third fingers remain partially
extended. She is unable to bring her thumb over to touch the tip of her other
digits. Which of the following is the most likely diagnosis?
A. Injury to the median nerve
B. Injury to the median and radial nerves
C. Injury to the median and ulnar nerves
D. Injury to the ulnar nerve
E. Injury to the ulnar, median and radial nerves

A. Injury to the median nerve

A 10-year-old boy fell from his bicycle and fractured his humerus. A nerve was
lesioned by the fracture that resulted in weakness in the ability to extend the
hand at the wrist. There was also numbness in the skin over the anatomical
snuffbox. Which of the following arteries that course with the affected nerve may
have been lacerated by the fracture?
A. Axillary artery
B. Deep brachial artery
C. Lateral thoracic artery
D. Posterior circumflex humeral artery
E. Subscapular artery

B. Deep brachial artery

A 10-year-old boy fell from his bicycle and suffered shoulder trauma that
stretches the upper trunk of the brachial plexus. Which of the following signs or
symptoms would the boy most likely have as a result of the injury?
A. Inability to shrug the shoulder against resistance
B. Weakness in the ability to abduct and adduct the fingers
C. Weakness in the ability to flex the forearm at the elbow
D. Weakness in the ability to protract the scapula
E. Wrist drop

C. Weakness in the ability to flex the forearm at the elbow

A 55-year-old woman with a history of severe depression cut herself deeply with
a razor blade on the volar (palmar) surface of her wrist at the level of the carpal
tunnel. A friend found her shortly thereafter and rushed her to the emergency
room. After the hemorrhage was controlled, a neurologic examination revealed
that she could no longer flex or abduct her thumb. She could not extend her
index or middle fingers, and she had no sensation on the palmar and dorsal
aspects of the middle and index fingers and half of the ring finger. Which of the
following structures has been compromised?
A. Flexor carpi radialis tendon
B. Median nerve
C. Palmaris longus tendon
D. Radial nerve
E. Ulnar nerve

B. Median nerve

A 52-year-old woman suddenly lost her balance when riding her bicycle and fell
on her outstretched hand. She heard a distinct cracking sound and felt sudden
pain in her shoulder region. At the emergency room it was noted that the lateral
part of her shoulder slumped inferomedially. Which of the following injured
structures was likely responsible for the clinical appearance of her shoulder?
A. Acromion of the scapula
B. Clavicle
C. Head of the humerus
D. Humeral shaft
E. Scapular spine

B. Clavicle

A 52-year-old woman suddenly lost her balance when riding her bicycle and fell
on her outstretched hand. She heard a distinct cracking sound and felt sudden
pain in her shoulder region. At the emergency room it was noted that the lateral
part of her shoulder slumped inferomedially and that the medial portion of the
clavicle was elevated. At what site does the clavicle commonly fracture?
A. Acromioclavicular joint
B. Junction of the middle and lateral third
C. Junction of the middle and medial third
D. Midclavicular region
E. Sternoclavicular joint

B. Junction of the middle and lateral third

A 52-year-old woman suddenly lost her balance when riding her bicycle and fell
on her outstretched hand. She heard a distinct cracking sound and felt sudden
pain in her shoulder region. At the emergency room it was noted that the lateral
part of her shoulder slumped inferomedially and that the medial portion of the
clavicle was elevated. What muscle is responsible for supporting the lateral
shoulder so that it does not slump?
A. Infraspinatus
B. Rhomboid
C. Supraspinatus
D. Teres major
E. Trapezius
E. Trapezius

A 78-year-old woman attempted to open a stuck double-hung window by lifting

the lower window frame. She experienced a sudden pain in her shoulder,
suggesting involvement of the rotator cuff. Which of the following muscles is
NOT part of the rotator cuff?
A. Infraspinatus muscle
B. Subscapularis muscle*
C. Supraspinatus muscle
D. Teres minor muscle
E. Teres major muscle

E. Teres major muscle

A 78-year-old woman attempted to open a stuck double-hung window by lifting

the lower window frame. She experienced a sudden pain in her shoulder,
suggesting involvement of the rotator cuff. Which muscle usually tears in rotator
cuff injuries?
A. Infraspinatus muscle
B. Subscapularis muscle
C. Supraspinatus muscle
D. Teres minor muscle
E. Teres major muscle

C. Supraspinatus muscle

A 78-year-old woman attempted to open a stuck double-hung window by lifting

the lower window frame. She experienced a sudden pain in her shoulder,
suggesting involvement of the rotator cuff. What movement of the upper
extremity produces pain in rotator cuff injuries?
A. Adduction
B. Abduction
C. Extension
D. Flexion
E. Lateral rotation

B. Abduction

A 35-year-old baseball pitcher told his catcher and manager that he felt a
gradual onset of shoulder pain. He continued to pitch but had to stop because of
pain and weakness. A MRI revealed a tear in the pitcher's rotator cuff. What
part of the rotator cuff usually tears?
A. Biceps (long head) muscle
B. Infraspinatus muscle
C. Coracobrachialis muscle
D. Subscapularis muscle
E. Supraspinatus muscle

E. Supraspinatus muscle

A 44-year-old woman's husband noticed that his wife's right scapula protruded
abnormally when she pushed against the wall during her stretching exercises.
Several weeks earlier she had had surgical dissection of her right axilla for the
removal of lymph nodes for staging and treatment of breast cancer. She also had
difficulty raising her right arm above her head. What nerve was probably
injured?
A. Intercostobrachial nerve
B. Long thoracic nerve
C. Pectoral nerves
D. Suprascapular nerve
E. Thoracodorsal nerve

B. Long thoracic nerve

A 38-year-old man was slammed to the ground during a pickup game of football
on artificial turf. On physical examination he felt moderate pain that became
worse when he attempted to raise his arm. The acromial end of the clavicle was
raised and tender to the touch, and some mobility of the clavicle where it
articulates with the acromion was noted. Abduction of the arm beyond 90o
caused severe pain. What part of the shoulder was most likely injured in this
individual?
A. Acromion
B. Acromioclavicular joint
C. Clavicle
D. Coracoclavicular ligament
E. Sternoclavicular joint

B. Acromioclavicular joint

A 38-year-old man was slammed to the ground during a pickup game of football
on artificial turf. On physical examination he felt moderate pain that became
worse when he attempted to raise his arm. The acromial end of the clavicle was
raised and tender to the touch, and some mobility of the clavicle where it
articulates with the acromion was noted. Abduction of the arm beyond 90o
caused severe pain. If the player had fumbled the ball and landed on his open
hand, what bone would have probably been fractured?
A. Clavicle
B. Humerus
C. Radius
D. Scapula
E. Ulna

A. Clavicle

A 28-year-old woman beginning tennis lessons practiced daily for several weeks.
She mentioned to her coach that she felt pain over the lateral region of her elbow
that radiated down her forearm. On physical examination by her family
physician, it was noted that she felt intense pain over the lateral epicondyle when
he resisted extension of her hand. What injury has this woman sustained?
A. Fracture of the distal humerus
B. Fracture of the proximal radius
C. Lateral epicondylitis
D. Medial epicondylitis
E. Radial nerve compression

C. Lateral epicondylitis

A 28-year-old woman beginning tennis lessons practiced daily for several weeks.
She mentioned to her coach that she felt pain over the lateral region of her elbow
that radiated down her forearm. On physical examination by her family
physician, it was noted that she felt intense pain over the lateral epicondyle when
he resisted extension of her hand. What group of muscles moving the hand are
affected in this individual?
A. Abductors of the hand
B. Adductors of the hand
C. Extensors of the hand
D. Flexors of the hand
E. Pronators and supinators of the hand

C. Extensors of the hand

A 68-year-old man consulted his family physician about a dull ache in his right
shoulder that often awakened him at night. During the physical examination, it
was noted that he kept his right upper extremity adducted. Pressing firmly on
the shoulder just lateral to the acromion, extreme tenderness was noted. When
abducting the upper extremity, the patient felt extreme pain when the limb
reached approximately 50o of abduction. What tendon of the rotator cuff was
likely involved?
A. Infraspinatus tendon
B. Pectoralis major tendon
C. Subscapularis tendon
D. Supraspinatus tendon
E. Teres minor tendon

D. Supraspinatus tendon

A 68-year-old man consulted his family physician about a dull ache in his right
shoulder that often awakened him at night. During the physical examination, it
was noted that he kept his right upper extremity adducted. Pressing firmly on
the shoulder just lateral to the acromion, extreme tenderness was noted. When
abducting the upper extremity, the patient felt extreme pain when the limb
reached approximately 50o of abduction. Inflammation of what bursa is
responsible for the pain in this patient?
A. Anconeal bursa
B. Bicipitoradial bursa
C. Olecranon bursa
D. Subacromial bursa
E. Subscapular bursa

C. Olecranon bursa

During the difficult birth of a baby, the physician pulled on the baby's head
while the shoulder was still in the birth canal. The procedure caused a traction
injury of the brachial plexus. What spinal nerves were most likely affected?
A. C2 and C3
B. C3 and C4
C. C4 and C5
D. C5 and C6
E. C6 and C7

D. C5 and C6

During the difficult birth of a baby, the physician pulled on the baby's head
while theshoulder was still in the birth canal. The procedure caused a traction
injury of the brachial plexus. What is the usual clinical appearance of the upper
limb when this injury of the brachial plexus occurs?
A. The upper limb is abducted and laterally rotated
B. The upper limb is abducted and medially rotated
C. The upper limb is adducted and medially rotated
D. The upper limb is adducted and laterally rotated
E. The arm is extended and forearm flexed

C. The upper limb is adducted and medially rotated

During the difficult birth of a baby, the physician pulled on the baby's head
while the shoulder was still in the birth canal. The procedure caused a traction
injury of the brachial plexus. Which of the following muscles was least affected
or paralyzed in this individual?
A. Biceps brachii
B. Deltoid
C. Brachialis
D. Brachioradialis
E. Triceps brachii

E. Triceps brachii

A 54-year-old farmer with a history of biceps tendinitis and rotator cuff injury
experienced vague pain in the anterior region of his glenohumeral joint. While
attempting to lift a heavy piece of equipment, he felt a sudden popping in his
arm. Examination by the family physician noted tenderness over the bicipital
groove, flexion and supination weakness of the forearm, and an abnormal bulge
in the anterior part of the farmer's arm. What muscle was most likely injured?
A. Biceps brachii (long head)
B. Biceps brachii (short head)
C. Brachialis
D. Coracobrachialis
E. Triceps brachii (long head)

A. Biceps brachii (long head)

A 66-year-old man recently retired from his office job consulted his family
physician about anaching pain in his elbow and along the anterior surface of his
forearm after playing every other day 18 holes of golf. The physician detected
extreme tenderness in the region of the medial epicondyle and some pain when
the forearm flexor-pronator group of muscles was compressed. The patient said
the pain gradually subsided after he finished playing, but that it was gradually
becoming more severe and constant. A X-ray of the elbow showed no
abnormalities. What injury to the elbow has this patient sustained?
A. Lateral epicondylitis
B. Medial epicondylitis
C. Olecranon bursitis
D. Olecranon fracture
E. Radial head subluxation

B. Medial epicondylitis

A 52-year-old male carpenter visited his family physician concerning severe

"pins and needles"sensations in his right hand that involved the palmar surface
of his thumb and lateral two and one half fingers. He told the physician that the
pain was becoming progressively worse and often awakened him during the
night. He also said he was having difficulty using hand tools and buttoning his
shirt. Physical examination showed weakness of the thenar muscles and impaired
sensation in the hand. What structure was responsible for the clinical signs and
symptoms?
A. Flexor pollicis longus muscle
B. Lumbrical muscles
C. Median nerve
D. Radial nerve
E. Ulnar nerve

C. Median nerve

A 52-year-old male carpenter visited his family physician concerning severe

"pins and needles"sensations in his right hand that involved the palmar surface
of his thumb and lateral two and one half fingers. He told the physician that the
pain was becoming progressively worse and often awakened him during the
night. He also said he was having difficulty using hand tools and buttoning his
shirt. Physical examination showed weakness of the thenar muscles and impaired
sensation in the hand. What is the entrapment syndrome described for this
individual?
A. Carpal tunnel syndrome
B. Cubital tunnel syndrome
C. Ischemic compartment syndrome
D. Pronator syndrome
E. Raynaud syndrome

A. Carpal tunnel syndrome

A 25-year-old woman while skiing severely fractured her right tibia at the boot
line. Because it was a comminuted fracture, a metal plate was surgically placed
in her leg to stabilize the fracture. After frequent faulty use of crutches for
approximately 6 weeks, she experienced pain and paresthesia in the posterior
aspect of her right forearm and dorsum of her hand. Compression of what nerve
produced pain and paresthesia in her right forearm and hand?
A. Axillary nerve
B. Median nerve
C. Musculocutaneous nerve
D. Radial nerve
E. Ulnar nerve

D. Radial nerve

A 36-year-old man was painting the ceiling in a large room of his home when he
felt pain and tingling in his right shoulder and in the proximal part of his right
arm. When being examined by his family physician, the physician raised the
man's limb above the shoulder and noted that the radial pulse decreased when
examined. After holding the limb above the shoulder for several minutes, the
man said he felt pain and some tingling around the shoulder. Both cyanosis and
distension of the superficial limb veins was noted. Compression of what structure
is responsible for the decreased radial pulse?
A. Axillary artery
B. Deep brachial artery
C. Radial artery
D. Suprascapular artery
E. Ulnar artery

A. Axillary artery

A 36-year-old man was painting the ceiling in a large room of his home when he
felt pain and tingling in his right shoulder and in the proximal part of his right
arm. When being examined by his family physician, the physician raised the
man's limb above the shoulder and noted that the radial pulse decreased when
examined. After holding the limb above the shoulder for several minutes, the
man said he felt pain and some tingling around the shoulder. Both cyanosis and
distension of the superficial limb veins was noted. Compression of what structure
is responsible for the pain and tingling around the shoulder?
A. Axillary nerve
B. Dorsal scapular nerve
C. Radial nerve
D. Suprascapular nerve
E. Thoracodorsal nerve

A. Axillary nerve
During a difficult breech delivery of a large baby, strong lateral flexion of the
infant's trunk and neck was performed to deliver the head. Complete loss of
sensation and complete paralysis of the right limb was evident from the time of
birth. In addition, the infant's right eyelid drooped. What part of the brachial
plexus was likely injured?
A. Cords
B. Divisions
C. Dorsal rami
D. Trunks
E. Terminal branches

D. Trunks

During a difficult breech delivery of a large baby, strong lateral flexion of the
infant's trunk and neck was performed to deliver the head. Complete loss of
sensation and complete paralysis of the right limb was evident from the time of
birth. In addition, the infant's right eyelid drooped. What caused his right eyelid
to droop?
A. Loss of parasympathetic nerve fibers
B. Loss of somatic motor nerve fibers
C. Loss of somatic sensory nerve fibers
D. Loss of sympathetic postganglionic nerve fibers
E. Loss of sympathetic preganglionic nerve fibers

E. Loss of sympathetic preganglionic nerve fibers

During a difficult breech delivery of a large baby, strong lateral flexion of the
infant's trunk and neck was performed to deliver the head. Complete loss of
sensation and complete paralysis of the right limb was evident from the time of
birth. In addition, the infant's right eyelid drooped. What is the name of the
eyelid syndrome?
A. Horner syndrome
B. Kleinfelter syndrome
C. Poland syndrome
D. Raynaud syndrome
E. Thoracic outlet syndrome

A. Horner syndrome

A 19-year-old man was thrown from his motorcycle into a tree after hitting a
deer. Although he appeared not to be seriously injured, his neck felt sore shortly
after the accident. He came to see his family physician because his upper
extremity was limp, and his forearm and hand pronated. On physical
examination the patient was unable to flex, abduct or laterally rotate his arm,
and there was a loss of flexion at the elbow joint. A lack of sensation was detected
on the lateral surface of his arm and forearm. What part of the brachial plexus
was injured in this man?
A. C4 and C5
B. C5 and C6
C. C6 and C7
D. C7 and C8
E. C8 and T1

B. C5 and C6

A 19-year-old man was thrown from his motorcycle into a tree after hitting a
deer. Although he appeared not to be seriously injured, his neck felt sore shortly
after the accident. He came to see his family physician because his upper
extremity was limp, and his forearm and hand pronated. Upon physical
examination, the patient was unable to flex, abduct or laterally rotate his arm,
and there was a loss of flexion at the elbow joint. A lack of sensation was detected
on the lateral surface of his arm and forearm. Which of the following muscles
was probably least affected by the nerve injury?
A. Biceps brachii
B. Brachialis
C. Infraspinatus
D. Pectoralis major
E. Supinator

D. Pectoralis major

A 34-year-old sheet metal worker sustained a deep cut across the palmar aspect
of his middle finger at his site of employment. The injury bled profusely but was
not reported to his employer. On the third day following the accident, the finger
became inflamed, tightly swollen, and very tender to touch or motion. An
infection was suspected. What is the most likely site of the infection?
A. Fibrous digital sheath
B. Radial bursa
C. Synovial tendon sheath
D. Transverse carpal ligament
E. Ulnar bursa

C. Synovial tendon sheath

A 17-year-old male received a deep cut on his little finger when he was filleting a
fish. Considerable bleeding occurred and he washed the wound with running
water. Several days later his little finger and the palm of his hand were swollen
and painful. His family physician suspected an infection. What is the most likely
site of the infection?
A. Fibrous digital sheath
B. Radial bursa
C. Synovial tendon sheath
D. Transverse carpal ligament
E. Ulnar bursa

E. Ulnar bursa

A 12-year-old boy fell off his skateboard and hit his right elbow on the roadway.
Because of the elbow pain and numbness on the side of his hand, the mother
brought him to their family physician. Physical examination showed no response
to pinpricks in his right little finger and the medial border of his palm. He was
unable to grip a piece of paper placed between his fingers. A x-ray of the elbow
showed considerable displacement of the epiphysis of the medial epicondyle.
What nerve was injured in the fall?
A. Medial antebrachial cutaneous nerve
B. Medial nerve
C. Musculocutaneous nerve
D. Radial nerve
E. Ulnar nerve

E. Ulnar nerve

A 17-year-old boy came to the emergency room after being hit hard by a hockey
stick in the midhumeral region of his right arm. He presented with signs of
tenderness, swelling, deformity, and abnormal movements in the extremity.
Physical examination revealed an inability to extend the wrist and digits, and loss
of sensation on a small area of his right hand. Extension of the IP joints was
weak. A x-ray of the arm showed a transverse fracture of the humerus just distal
to its midpoint. What peripheral nerve was damaged and which artery may have
been torn?
A. Median nerve and brachial artery
B. Radial nerve and deep brachial artery
C. Radial nerve and superior ulnar collateral artery
D. Ulnar nerve and deep brachial artery
E. Ulnar nerve and superior ulnar collateral artery
B. Radial nerve and deep brachial artery

An 18-year-old male college student playing touch football fell on his open hand
with his wrist hyperextended and abducted (laterally deviated). Thinking his
wrist was only sprained, he did not seek medical attention, but two weeks later he
sought medical advice because the wrist pain was still present and getting worse.
When the family physician deeply palpated the student's anatomical snuff box,
localized tenderness was evident. A x-ray of the hand showed an undisplaced
hairline fracture of one of the carpal bones. Which carpal bone lies in the floor of
the anatomical snuff box?
A. Capitate
B. Hamate
C. Scaphoid
D. Trapezium
E. Triquetrum

C. Scaphoid

A depressed 16-year-old girl who slashed her left wrist with a razor blade was
rushed to the emergency room of a hospital. Small spurts of blood were coming
from the lateral side of her wrist. After the bleeding was stopped, physical
examination of her left wrist and hand showed that she could adduct her thumb
but was unable to oppose it. She had lost control of some fine movements of her
second and third digits, and she had anesthesia over the lateral half of her palm
and digits. What nerve had been severed?
A. Median nerve
B. Lateral antebrachial cutaneous nerve
C. Radial nerve
D. Recurrent median nerve
E. Ulnar nerve

A. Median nerve

A depressed 16-year-old girl who slashed her left wrist with a razor blade was
rushed to the emergency room of a hospital. Small spurts of blood were coming
from the lateral side of her wrist. After the bleeding was stopped, physical
examination of her left wrist and hand showed that she could adduct her thumb
but was unable to oppose it. She had lost control of some fine movements of her
second and third digits, and she had anesthesia over the lateral half of her palm
and digits. What muscles are responsible for the loss of the fine movements of
her second and third digits?
A. First and second lumbricals
B. First and second dorsal interossei
C. First and second palmar interossei
D. Flexor digitorum profundus
E. Flexor digitorum superficialis

A. First and second lumbricals

A depressed 16-year-old girl who slashed her left wrist with a razor blade was
rushed to the emergency room of a hospital. Small spurts of blood were coming
from the lateral side of her wrist. After the bleeding was stopped, physical
examination of her left wrist and hand showed that she could adduct her thumb
but was unable to oppose it. She had lost control of some fine movements of her
second and third digits, and she had anesthesia over the lateral half of her palm
and digits. What artery was probably responsible for blood spurting from her
left wrist?
A. Anterior interosseous artery
B. Deep palmar branch of the ulnar artery
C. Radial artery
D. Superficial palmar branch of the radial artery
E. Superficial palmar arterial arch

D. Superficial palmar branch of the radial artery