For all of the questions, select the one BEST answer. Hover the mouse over the the button to see the correct answer.
1. The distal attachment (insertion) of the triceps brachii muscle is:
  1. coronoid process of the ulna
  2. olecranon process of ulna
  3. styloid process of ulna
  4. radial notch of ulnar
  5. ulnar tuberosity
B
2. Most of the muscles that act on the shoulder girdle and upper limb joints are supplied by branches of the brachial plexus. Which of the following is not?
  1. trapezius
  2. teres minor
  3. latissimus dorsi
  4. rhomboid major
  5. levator scapulae
A
3. Increasing muscle mass and tone is the aim of many people who work out at the gym. This is done by contracting the muscle against resistance. If you want to increase the muscle mass of the latissimus dorsi muscle, which of the following actions would you be most likely to perform?
  1. depression of the scapula
  2. abduction of the arm
  3. extension of the arm
  4. flexion of the arm
  5. lateral rotation of the arm
C
4. The TRUE statement about the posterior compartment of the arm is:
  1. it receives its motor supply from the median nerve
  2. it contains the profunda brachii artery and radial nerve
  3. it contains a single elbow flexor
  4. its major artery is the brachial
  5. it contains the ulnar nerve in its distal part
B
5. The long head of the biceps brachii muscle arises from the:
  1. infraglenoid tubercle
  2. acromion process
  3. coracoid process
  4. clavicle
  5. supraglenoid tubercle
E
6. The major function of the muscles in the anterior compartment of the forearm is:
  1. abduction
  2. flexion
  3. adduction
  4. medial rotation
  5. lateral rotation
B
7. This is a radiographic image of the left shoulder. Which letter identifies the coracoid process?

    C
    8. This is a radiographic image of the wrist and hand. Which letter identifies the hook of the hamate?

      H
      9. A structure found in the deltopectoral groove is the:
      1. cephalic vein
      2. basilic vein
      3. brachial vein
      4. radial vein
      5. musculocutaneous nerve
      A
      10. In the cubital fossa, the median cubital vein is frequently used for venipuncture. This vein is separated from underlying neurovascular structures by the:
      1. investing fascia of the brachialis muscle
      2. crural fascia
      3. bicipital aponeurosis
      4. anconeus muscle
      5. tendon of the biceps brachialis muscle
      C
      11. Which of these structures passes deep to the flexor retinaculum at the wrist?
      1. tendon of the palmaris longus
      2. ulnar artery
      3. median nerve
      4. palmar branch of the ulnar nerve
      5. radial artery
      C
      12. If the dorsal rootlets of T4 are cut (dorsal rhizotomy) there will be a loss of sensation at the level of the:
      1. neck
      2. clavicle
      3. nipple
      4. umbilicus
      C
      Questions 13 and 14.

      A 52-year-old man was brought to the emergency room after being found in the park where he had apparently lain overnight after a fall. He complained of severe pain in the left arm. Physical examination suggested a broken humerus, which was confirmed radiologically. The patient was able to extend the forearm at the elbow, but supination appeared somewhat weak; the hand grasp was very weak when compared with the uninjured arm. Neurologic examination revealed an inability to extend the wrist ("wrist drop"). Since these findings pointed to apparent nerve damage, the patient was scheduled for a surgical reduction of the fracture.
      13. The observations that extension at the elbow appeared normal, but supination of the forearm weak, warrants localization of the nerve to the:
      1. posterior division of the brachial plexus
      2. posterior cord of the brachial plexus in the axilla
      3. radial nerve at the distal third of the humerus
      4. radial nerve injury in the vicinity of the head of the radius
      5. radial nerve in the mid-forearm
      E
      14. In this patient, paralysis of the supinator muscle only slightly affects the ability to supinate due to the unimpaired action of the:
      1. pronator teres
      2. brachioradialis
      3. pronator quadratus
      4. biceps brachii
      5. triceps brachii
      D
      15. The thumb action that is totally affected by radial nerve trauma is:
      1. abduction
      2. adduction
      3. extension
      4. flexion
      5. opposition
      C
      16. The supraglenoid tubercle serves as an attachment for:
      1. the long head of the biceps
      2. long head of the triceps
      3. medial head of the triceps
      4. subscapularis
      5. short head of triceps
      A
      17. The extensor expansion of the fingers is formed by the tendon of the:
      1. extensor carpi radialis longus
      2. extensor pollicis longus
      3. extensor digitorum
      4. extensor pollicis brevis
      5. interossei
      C
      18. Which of the following muscles is innervated by the ulnar nerve?
      1. flexor pollicis longus
      2. extensor pollicis longus
      3. abductor pollicis brevis
      4. adductor pollicis
      5. opponens pollicis
      D
      19. If you slide a piece of paper between a patients fingers and asked the patient to hold onto the paper when you try to pull it from the fingers, and the patient is unable to perform this action, which nerve is suspected to be nonfunctional?
      1. radial
      2. median recurrent
      3. ulnar
      4. deep radial
      5. superficial radial
      C
      20. Which of the following muscles does NOT rotate the arm medially (or internally)?
      1. subscapularis
      2. supraspinatus
      3. latissimus dorsi
      4. pectoralis major
      5. anterior fibers of the deltoid
      B
      21. Damage to the coracobrachialis muscle and its nerve supply would weaken which motion of the arm and forearm?
      1. extension
      2. rotation
      3. flexion
      4. supination
      5. abduction
      C
      Match the lettered item on the diagram to the numbered structure:

      22. trochlea
      F

      23. deltoid tuberosity
      C

      24. greater tuberosity
      B

      25. The uppermost part of the rotator cuff of the shoulder is the tendon of the:
      1. deltoid
      2. teres minor
      3. teres major
      4. subscapularis
      5. supraspinatus
      E
      26. Which of the following muscles is a lateral rotator of the arm?
      1. infraspinatus
      2. subscapularis
      3. latissimus dorsi
      4. teres major
      5. anterior fibers of the deltoid
      A
      27. Which of the following wrist bones is found in the proximal row?
      1. trapezium
      2. trapezoid
      3. capitate
      4. hamate
      5. scaphoid
      E
      28. Which of these muscles of the forearm has a double innervation?
      1. flexor digitorum profundus
      2. flexor digitorum superficialis
      3. pronator teres
      4. flexor pollicis longus
      5. pronator quadratus
      A
      29. The muscle that forms the bulk of the anterior axillary fold is the:
      1. latissimus dorsi
      2. pectoralis major
      3. subscapularis
      4. teres minor
      5. teres major
      B
      30. The infraglenoid tubercle serves as an attachment for the:
      1. long head of biceps
      2. long head of triceps
      3. medial head of triceps
      4. coracobrachialis
      5. subscapularis
      B
      31. The ulnar nerve is a branch of which cord of the brachial plexus?
      1. medial
      2. lateral
      3. posterior
      A
      32. Muscles of the hypothenar eminence are innervated by the:
      1. median nerve
      2. ulnar nerve
      3. radial nerve
      4. median and radial nerves
      5. median and ulnar nerves
      B
      33. Numbness to the skin on the lateral half of the palm of the hand would be caused by a lesion to which nerve?
      1. ulnar
      2. radial
      3. median
      4. superficial radial
      5. anterior interosseous
      C
      34. The nerve most likely to be injured in fractures of the medial epicondyle is the:
      1. radial
      2. axillary
      3. ulnar
      4. median
      5. musculocutaneous
      C
      35. Which nerve is probably damaged if a patient cannot abduct the arm beyond 25 degrees?
      1. axillary
      2. radial
      3. musculocutaneous
      4. median
      5. ulnar
      A
      36. Identify the nerve of the brachial plexus that supplies the muscles of the posterior compartment of the arm.

      B
      37. The middle trunk of the brachial plexus is formed by anterior rami of which spinal cord segments?
      1. C7
      2. C6 and C7
      3. C6
      4. C5 and C6
      5. C7 and T1
      A
      38. Loss of pronation of the hand suggests a lesion of the:
      1. median nerve
      2. radial nerve
      3. ulnar nerve
      4. intercostobrachial nerve
      5. musculocutaneous nerve
      A
      39. After a time, when a motor nerve to a muscle is sectioned, the muscles will atrophy (get smaller). If you notice that the thenar muscles are atrophied, which nerve would you suppose has been injured?
      1. musculocutaneous
      2. ulnar
      3. radial
      4. median
      5. thoracodorsal
      D
      40. A physical sign known as "winged scapula" suggests the loss of function to which of the following muscles?
      1. rhomboid major
      2. levator scapulae
      3. latissimus dorsi
      4. serratus anterior
      5. trapezius
      D
      41. If a tumor grows into the quadrangular space of the axillary region, which structures would be in danger?
      1. anterior humeral circumflex artery and axillary nerve
      2. posterior humeral circumflex artery and radial nerve
      3. posterior humeral circumflex artery and axillary nerve
      4. radial nerve and profunda brachii artery
      5. profunda brachii artery and axillary nerve
      C
      42. The medial wall of the axilla is formed by which of the following muscles?
      1. teres major
      2. serratus anterior
      3. pectoralis major
      4. subscapularis
      5. pectoralis minor
      B
      43. A branch of the axillary artery is the:
      1. costocervical
      2. vertebral
      3. dorsal scapular
      4. suprascapular
      5. subscapular
      E
      44. At the front of the elbow, which of the following lies superficial to the bicipital aponeurosis?
      1. median cubital vein
      2. brachial artery
      3. median nerve
      4. ulnar nerve
      5. cephalic vein
      A
      45. The lateral boundary of the cubital fossa is formed by the:
      1. flexor carpi radialis muscle
      2. tendon of the biceps muscle
      3. brachialis muscle
      4. brachioradialis muscle
      5. pronator teres muscle
      D
      46. Which artery accompanies the radial nerve to supply the posterior compartment of the arm?
      1. axillary
      2. brachial
      3. ulnar
      4. profunda brachii
      5. radial
      D
      47. The artery that may be palpated deep in the "anatomical snuff box" is the:
      1. superficial ulnar
      2. posterior interosseous
      3. cephalic
      4. radial
      5. deep ulnar
      D
      48. All of these arteries may contribute to the anastomoses around the scapula EXCEPT the:
      1. subscapular
      2. transverse cervical
      3. suprascapular
      4. intercostal
      5. lateral thoracic
      E
      49. When taking the blood pressure, the stethoscope is usually paced on which artery?
      1. ulnar
      2. profunda brachii
      3. axillary
      4. brachial
      5. radial
      D
      50. The superficial vein that runs up the ulnar side of the upper limb is the:
      1. radial
      2. median forearm
      3. axillary
      4. cephalic
      5. basilic
      E
      51. The deep palmar arterial arch is formed primarily by the:
      1. deep radial artery
      2. superficial radial artery
      3. ulnar artery
      4. anterior interosseous artery
      5. posterior interosseous artery
      A
      55. The clavicle is one of the most fractured bones. In the diagram, the clavicle has been fractured at about the junction of the middle and distal thirds. Notice that the proximal end has been pulled upward. Which of the following muscles is responsible for this?
      1. anterior deltoid fibers
      2. trapezius
      3. subclavius
      4. sternocleidomastoid
      5. pectoralis major
      D
      56. Which muscle is innervated by both the ulnar and median nerves?
      1. flexor digitorum superficialis
      2. pronator quadratus
      3. flexor digitorum profundus
      4. supinator
      5. none of the above
      C
      57. Which of the following muscles does NOT extend the wrist?
      1. extensor carpi radialis longus
      2. extensor carpi radialis brevis
      3. extensor carpi ulnaris
      4. extensor digitorum
      5. brachioradialis
      E
      58. Which of the following nerves sends branches to the muscles of the arm?
      1. median
      2. ulnar
      3. dorsal scapular
      4. musculocutaneous
      5. long thoracic
      D
      59. The filum terminale is a continuation of the:
      1. denticulate ligament
      2. coccygeal ligament
      3. dura mater
      4. arachnoid
      5. pia mater
      E
      60. Abduction of the thumb is when it is moved:
      1. laterally from the palm
      2. at right angles to the palmar surface
      3. along side the index finger
      4. straight across the palm
      5. none of the above
      B
      62. Which of the following statements is TRUE for the pectoralis major muscle?
      1. it arises from the humerus
      2. it inserts into the bony ribs
      3. it abducts the arm
      4. it is innervated by the median nerve
      5. there is no true statement
      E
      63. The nerve most likely to be traumatized with a fracture of the surgical neck of the humerus is the:
      1. median
      2. axillary
      3. radial
      4. ulnar
      5. profunda brachii
      B
      64. With an injury to the right upper trunk of the brachial plexus (Erb Duchenne paralysis), the patient's right upper extremity would be:
      1. abducted
      2. adducted
      3. medially rotated
      4. laterally rotated
      5. flexed
      C
      65. At the wrist, the long slender tendon of which muscle serves as a guide to the median nerve, which is deep and lateral to it:
      1. flexor carpi radialis
      2. flexor carpi ulnaris
      3. flexor digitorum superficialis
      4. palmaris longus
      5. flexor digitorum profundus
      D
      66. Which joint serves as the only bony attachment of the superior limb to the axial skeleton?
      1. glenohumeral
      2. acromioclavicular
      3. scapulothoracic
      4. sternoclavicular
      5. costoclavicular
      D
      67. The only rotator cuff muscle that does not contribute to rotation of the arm is the:
      1. teres minor
      2. infraspinatus
      3. supraspinatus
      4. subscapularis
      C
      68. The dermatome of the thumb is innervated by nervous elements arising from which spinal cord segment?
      1. C5
      2. C6
      3. C7
      4. C8
      5. T1
      B
      69. A large muscle that arises from two heads flexes and medially rotates the arm. It is innervated by nerves arising from different cords of the brachial plexus. This is the:
      1. latissimus dorsi
      2. trapezius
      3. deltoid
      4. subscapularis
      5. pectoralis major
      E
      70. Loss of opposition of the thumb is a symptom associated with lesion of which nerve?
      1. radial
      2. ulnar
      3. musculocutaneous
      4. median
      5. posterior interosseous
      71. Which carpal bone articulates with the radius?
      1. trapezoid
      2. scaphoid
      3. hamate
      4. capitate
      5. trapezium
      B
      72. All of the following bony landmarks are visible on a skeleton when viewed directly from behind (posterior view), EXCEPT:
      1. medial epicondyle
      2. greater tubercle
      3. spiral groove
      4. lesser tubercle
      5. olecranon process
      D
      73. Inability to flex the distal phalanx of the middle finger indicates injury to which of these muscles?
      1. lumbrical
      2. dorsal interosseous
      3. flexor digitorum superficialis
      4. flexor digitorum profundus
      5. palmar interosseous
      D
      74. The anterior wall of the vertebral canal is formed by:
      1. ligamenta flava
      2. interspinal ligaments
      3. posterior longitudinal ligament
      4. anterior longitudinal ligament
      5. ligamentum nuchae
      C
      75. The muscle attached to the whole length of the scapular spine is the:
      1. trapezius
      2. serratus anterior
      3. rhomboideus major
      4. deltoid
      5. infraspinatus
      A
      76. You are to perform a venipuncture of the median cubital vein. Which of the following structures is most suitably located to afford protection against your inadvertently entering the brachial artery rather than the veins?
      1. the tendon of the biceps brachii muscle
      2. the bicipital aponeurosis
      3. the tendon of the brachialis
      4. the brachioradialis muscle
      5. the medial epicondyle of the humerus
      B
      77. The subarachnoid space ends inferiorly in the adult at the level of:
      1. the coccyx
      2. S2
      3. S5
      4. promontory
      5. the lower border of L1
      E
      78. All of the following muscles attach to the medial border of the scapula, EXCEPT the:
      1. levator scapulae
      2. rhomboideus major
      3. teres major
      4. serratus anterior
      5. rhomboideus minor
      C
      79. Which nerve-artery pair do not run together?
      1. radial nerve, profundus brachii artery
      2. axillary nerve, posterior humeral circumflex artery
      3. ulnar nerve, superior ulnar collateral artery
      4. median nerve, posterior interosseous artery
      5. anterior interosseous nerve, anterior interosseous artery
      D
      80. Following a cervical injury, a patient is unable to abduct the arm above the horizontal plane. This would be a result of an injury to the:
      1. spinal accessory nerve
      2. long thoracic nerve
      3. axillary nerve
      4. all of the above
      5. none of the above
      Bones can fracture or be displaced from their normal anatomical position at any of several locations. Each of these injuries may traumatize a nerve passing close to the bone in question at that location. Match the nerve most likely to be injured with the problem:

      81.Fracture of the medial epicondyle of the humerusC
      82. Fracture of the surgical neck of the humerusB
      83. Mid-shaft humeral fractureA
      84. Anterior dislocation of the lunateD
      1. radial nerve
      2. axillary nerve
      3. ulnar nerve
      4. median nerve
      5. medial brachial cutaneous nerve
      Match the following muscles with their appropriate innervation.

      85. supraspinatus muscleE
      86. latissimus dorsi muscleC
      87. teres minor muscleB
      88. serratus anterior muscleD
      1. lower subscapular nerve
      2. axillary nerve
      3. thoracodorsal nerve
      4. long thoracic nerve
      5. suprascapular nerve
      89. The four chief bony attachments of the flexor retinaculum are:
      1. hamate, pisiform, trapezium, scaphoid
      2. hamate, capitate, trapezoid, scaphoid
      3. lunate, hamate, capitate, scaphoid
      4. lunate, pisiform, trapezoid, hamate
      5. trapezium, trapezoid, capitate, hamate
      A
      90. Select the correct match to the structure at the end of the arrow
      1. tendon of the extensor digitorum muscle
      2. flexor digitorum superficialis muscle
      3. lumbrical muscle
      4. vincula longus

      C
      This is an anterior view of the left elbow. Match the lettered items with the following:

      91. trochleaD
      92. insertion of brachialis muscleE
      93. insertion of biceps brachii muscleB
      94. capitulumA
      95. common origin of flexor muscles of handC
      96. Match the lettered items with the numbered statements.

      96. With a lesion of this nerve elbow flexion is severely weakenedC

      97. One indication of a lesion of this nerve: the patient is unable to hold a piece of paper tightly between the fingersA

      98. All postaxial musculature of the upper extremity would be denervated by a lesion at this siteD

      99. This nerve may be damaged by a deep cut over the anterolateral chest wallE

      100. This nerve is traumatized in Carpal Tunnel SyndromeB
      101. drains into subclavian veinA (cephalic vein)
      102. innervates muscles of the handE (median nerve)
      103. drains into the brachial veinD (basilic vein)
      104. biceps brachii muscleB
      Questions 105 - 107 refer to the diagrams. The diagrams on the right show an area of anesthesia occurring after a cut (shown by the red arrow and dotted line) in the lower left figure). Nerve regeneration over a period of 4 (left column) to 93 (right column) weeks indicates a reduced area of anesthesia as shown. Assume only nerves are cut and not any tendons.
      105. The injured nerve is the:
      1. radial
      2. median
      3. musculocutaneous
      4. ulnar
      5. median recurrent

      D

      106. Motor changes that would acccompany this lesion would include all of these EXCEPT:
      1. adduction of the fifth finger
      2. abduction of the fifth finger
      3. adduction of the fourth finger
      4. abduction of the thumb
      5. adduction of the thumb

      D

      107. In most patients, accompanying initial motor changes would include some weakness in thumb
      1. abduction
      2. adduction
      3. opposition
      4. extension
      5. flexion

      B
                




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