0MEDICAL GROSS ANATOMY

TLE - limbs

Choose the single best answer.

1. In order to test the action of the flexor digitorum profundus m. the examiner should
stabilize in
extension which joint of the patient's limb?

1- DIP of digit 3
2- PIP of digit 3
3- MP of digit 3
4- Sellar joint of thumb
5- Wrist

2. While using a hand-held hook to grab bales of straw from a wagon, a farmer missed
the bale and embedded the hook in his leg immediately lateral to his shin bone in
the upper part of his leg. Which deep structure did the hook most likely enter?

1- Fibularis longus m.
2- Common fibular (peroneal) n.
3- Deep fibular n./anterior tibial a.
4- Extensor hallucis longus m.
5- Tibialis anterior m.

3. After a weekend of manually trimming the hedges surrounding his house with
garden shearers, a 35-y.o.man visits his physician complaining of pain over the
back of his forearm above the wrist. Examination reveals edema on the dorsum of
the distal radius, and the overlying skin area is reddened and hot to the touch. The
patient complains of pain when extending and abducting his thumb, and
crepitations (vibrations/bubbling noise) can be felt and heard by the physician
during these movements. Passive adduction of the wrist and flexion of the thumb
also produce intense pain.The likely diagnosis is

1- tenosynovitis of the 1st dorsal tendon compartment.

2- fracture of the scaphoid bone.
3- tenosynovitis involving the radial bursa.
4- acute carpal tunnel syndrome.
5- inflammation of thenar compartment.

4. A 16-y.o. member of a street gang sustained a laceration of his hand in knife fight.
The transverse wound was on the palmar surface at the level of the heads of the
metacarpals. The patient maintained ability to flex the DIP and PIP joints of digits 2-
5. The profuse bleeding was principally due to injury to the

1- common palmar digital aa. 4- deep palmar arch.

 2- superficial palmar arch. 5- superficial palmar branch,
radial a.
3- princeps pollicis a.

5. The characteristic, medially rotated position of the arm in Erb (Erb-Duchenne)

paralysis is
principally due to denervation of which muscle(s)?

1- Those supplied by terminal branches of the medial cord.

2- Latissimus dorsi
3- Those supplied by the lower trunk of brachial plexus
4- Subscapularis
5- Those supplied by C5,6

6. While in-line skating along Lake Shore Drive, a 24-y.o. woman was cut-off by a
cyclist and fell
forward on the palm of her abducted right hand. Examination in the St. Joseph
Hospital ER revealed abrasions of her palm (she was not wearing protective gear)
and pain upon palpation in the proximal portion of the anatomic snuffbox but not in
its floor. The most likely diagnosis is
1- fracture of the 1st metacarpal.
2- fracture of the trapezium.
3- Colles fracture.
4- fracture of the radial styloid process.
5- fracture of the scaphoid bone.

7. A 42-y.o. laboratory technician felt an unusual pull and immediate pain in her right
shoulder upon lifting a heavy shipment box. Her physician ordered MRI studies
with contrast media injected into the joint
cavity. These revealed, among other findings, communication between the
subacromial bursa and the
joint cavity, suggesting injury to the

1- labrum.
2- superior glenohumeral ligament.
3- supraspinatus tendon.
4- coracoclavicular ligament.
5- coracoacromial ligament.

8. The preferred site to administer anesthetic (peripheral nerve block) to block

selectively sensation from the majority of the sole of the foot is the

1- peroneal (fibular) retinaculum.

2- compartment of the great toe.
3- inferomedial quadrant of the gluteal region.
4- popliteal fossa.
 5- posterior to the medial malleolus

9. While playing a game of basketball to relax following her gross anatomy exams, a
23-y.o. medical student suffered an inversion injury to her left ankle. She self-
diagnosed it as a 3rd degree sprain because there was a great deal of laxity and
edema. However, after a few days with no resolution and increasing pain and
edema, she was treated at Health Services. X-ray suggested that the talus had
fractured another bone during the displacement occasioned by the sprain. The
most likely candidate for this fracture is the

1- cuboid. 3- lateral malleolus.

2- medial malleolus. 4- navicular.

10. Due to the presence of a "cervical" rib a patient suffers from partial obstruction of
the main arterial
trunk to the upper limb at the level of the first thoracic rib. Angiography
demonstrates that the scapular
anastomosis is the major collateral route for supply of the affected limb.
Anterograde supply to this
anastomosis in this patient would include the

1- lateral thoracic a.
2- posterior humeral circumflex a.
3- subscapular a.
4- anterior humeral circumflex a.
5- suprascapular a.

11. A 40-y.o. farmer sustained a penetrating injury to the upper portion of his popliteal
region. Blood loss was quickly controlled in the community hospital's ER.
Neurological testing identified, among other findings, diminished cutaneous
sensation over most of the dorsum of the foot. The injured nerve most likely was
the

1- common peroneal (fibular).

2- lateral sural cutaneous.
3- saphenous.
4- medial sural cutaneous.
5- tibial.

12. A severely depressed 14-y.o. boy who had stopped taking his anti-depressant
medication for a month attempted suicide by slashing his wrist with a kitchen knife.
Examination in the ER revealed that the only tendinous injury was to that of the
palmaris longus m. The boy was able to oppose his thumb normally. One
neurological deficit was, however, detected. This most likely was loss of

1- ability to flex the MP joints of digits 2 & 3.

2- cutaneous sensation on the lateral dorsal aspect of the hand.
 3- ability to flex the wrist.
4- cutaneous sensation to the central, proximal palm.
5- cutaneous sensation to the lateral 3 1/2 digits.

13. While enjoying a weekend away from your practice, you receive a telephone call
from a friend whose 15-y.o. son has twisted his ankle while playing
basketball. You tell him to have some x-rays done at the local urgent care center
but reassure your friend that it’s most likely an ankle sprain. The ligament most
likely affected is the

1- deltoid.
2- calcaneofibular.
3- “spring”.
4- plantar calcaneonavicular.
5- long plantar.

14. A force most likely to damage the medial meniscus is one that

1- places a varus stress on the knee.

2- is directed posteriorly against the patella.
3- places a valgus stress on the knee.
4- displaces the tibia posteriorly relative to the femur.

15. Two or three days following removal of a subcutaneous wood splinter from the
medial aspect of her
right leg, a 16-y.o. track and field runner develops swelling of lymph nodes in the
inguinal region.
The lymph from these inflamed nodes returns to the venous system via the

1- thoracic duct.
2- deep inguinal lymph nodes.
3- right lymphatic duct.
4- popliteal lymph nodes.
5- left lymphatic duct.

16. A 45-y.o. female postal worker is found to have a mass palpable in her
anteromedial thigh that is
suspected to be an early stage femoral hernia. If this diagnosis is correct, the mass
should be located

1- immediately medial to the femoral sheath.

2- adjacent to a deep inguinal lymph node.
3- lateral to the pulsations in the femoral triangle.
 4- external to the transversalis fascia.
5- in the adductor canal.

17. Within the distal extent of the adductor canal the structure that is most anterior is
the

1- femoral a.
2- femoral n.
3- femoral v.
4- profunda femoris a.
5- tibial n.

18. A 25-y.o. construction worker sustained a deep laceration in his cubital fossa.
The arterial bleeding
was controlled during the ambulance run by compression in the arm. During
surgery the biceps tendon
was observed in the lateral aspect of the wound. Potential injury to which nerve
may be expected?

1- Ulnar
2- Deep radial
3- Lateral antebrachial cutaneous
4- Median
5- Superficial radial

19. A 45-y.o. victim of domestic abuse presents in the ER with a mid-shaft fracture of
the right humerus.
The posterior aspect of the arm has become distended and firm to palpation. The
ER physician suspects that the distension is due to fluid accumulation. The most
likely source of the fluid is the

1- brachial a.
2- right lymphatic duct.
3- profunda brachii v.
4- cephalic v.
5- superior ulnar collateral a.

20. In earlier centuries prisoners of war were sometimes prevented from attempting
escape by "hamstringing" (cutting their Achilles tendons). While walking was
rendered virtually impossible,
some degree of plantarflexion was possible by the action of the

1- plantaris m.
 2- quadratus plantae m.
3- flexor hallucis longus m.
4- soleus m.
5- tibialis anterior m.

21. The elements of the rotator (musculotendinous) cuff of the shoulder reinforce the
joint capsule such that
the weakest capsular region is that on which aspect?

1- Superior
2- Anterior
3- Posterior
4- Inferior

22. While assembling a bookcase to hold all of her textbooks and notes, a left-handed
M1 is attempting to
tighten the screws anchoring the shelves. She notes that, in contrast to her right-
handed roommate, she
must use which muscle to apply maximal force to the screws?

1- Supinator
2- Pronator quadratus
3- Biceps brachii
4- Brachioradialis
5- Pronator teres

23. The cell bodies of the alpha motor neurons supplying the major flexors of the digits
of the hand are
principally located in the

1- dorsal root ganglion of C8.

2- ventral horn of C8.
3- ventral primary ramus of C8,T1.
4- spinal nerve of C8,T1.
5- brainstem.

24. At her annual physical exam a patient complained of progressive symptoms in her
right upper limb.
 A radiologic exam identified a "cervical" rib. A likely symptom described by the
patient was

1- paresthesia of the lateral forearm.

2- atrophy of the posterior axillary fold.
3- weakened adduction of the digits.
4- weakness of elbow flexion.
5- inability to initiate abduction of the shoulder.

25. A 30-y.o. man presents in the ER with multiple nodular swellings in the groin
region of both sides.
The nodules are subcutaneous, pea-sized and parallel the inguinal ligament. The
examining physician
identifies no skin wounds on the lower limbs. The physician should next
determine whether there is any evidence of

1- lower limb fractures.

2- family history of bone cancer.
3- deep vein inflammation
4- sexually transmitted infections.
5- inflammation near the lateral malleolus.

26. A 23-y.o. medical student is diagnosed with paronychia (septic inflammation of

the skin fold adjacent the fingernail) of all digits of her right hand. Because of
the advanced infection, it is decided to drain each one of pus by incisions.
Rather than multiple injections of anesthetic, the physician opts for a nerve
block. The minimum number of nerves to block at the wrist to accomplish
appropriate anesthesia is

1- one.
2- two.
3- three.
4- four.

27. During physical examination of a patient an M3 student ascertains strong

arterial pulsations both
in the femoral triangle and lateral to the course of the extensor hallucis longus
tendon in the foot. She
reasons that there should also be a strong pulse

1- posterior to the knee.

2- posterior to the lateral malleolus.
 3- lateral to the neck of the fibula.
4- anterior to the medial malleolus.
5- posterior to the medial malleolus.

28. A patient being seen for an unrelated problem relates that six months earlier he
had suffered a knife-
wound to the armpit area. He now has atrophy of the posterior axillary fold, the
acromion is very prominent, and the shoulder region is angular in appearance.
He also is unable to extend his forearm
and has wrist drop. The probable site of injury was the

1- axillary n.
2- lateral cord of the brachial plexus.
3- posterior cord of the brachial plexus.
4- radial n.
5- proximal end of the radial groove of the humerus.

29. Lymphatic channels from the breast that lead directly to an intrathoracic
location are those
tributary to the

1- subscapular nodes
2- central nodes.
3- superficial inguinal nodes.
4- pectoral nodes.
5- parasternal nodes.

30. A 35-y.o. computer programmer with intractable carpal tunnel syndrome is

scheduled for surgery in which the flexor retinaculum is to be released (incised to
relieve pressure). The longitudinal incision
is made along the lateral side of the retinaculum. Post-operatively the patient
exhibits some deficits most likely caused by injury to the
1- recurrent branch of the median n.
2- flexor pollicis longus tendon.
3- deep branch of the ulnar n.
4- the ulnar n. in Guyon’s canal.
5- tendons of the flexor digitorum superficialis m. for digits 2 and 5.
31. A former police officer seen in clinic for an unrelated problem is observed to
have a deformity of
his right hand at rest in which the medial four MP joints are hyperextended.
When attempting to
make a fist, the IP joints of all five digits are flexed, while the MP joints remain
unchanged (slight
flexion for digits 2 & 3) and the thumb remains abducted as it was at rest. The
patient reports that
10 years ago he suffered a gunshot wound to the limb in the line of duty.

You may expect to find a scar near the

1- midline of the forearm at the wrist.

2- medial epicondyle of the humerus.
3- midpoint of the medial side of the arm.
4- lateral epicondyle of the humerus.
5- medial side of the wrist.

32. While playing tennis you note a player in the adjacent court has collapsed
while returning a serve
and now complains of severe knee pain. With the player supine on the court
and with the injured
knee flexed ~30º you determine that you can displace the leg anteriorly
(relative to thigh) much more
than on the uninjured side. Varus and valgus stress tests of the knee appear
normal. The most likely
diagnosis is a disrupted

1- ACL.
2- PCL.
3- TCL (MCL).
4- FCL (LCL).
5- lateral meniscus.

33. What triggers the second meiotic division of the oocyte?

1- Increased estrogen secretion associated with the proliferative phase of

the
menstrual cycle
2- Fusion of the male and female pronuclei
3- The luteinizing hormone surge
4- Penetration of the sperm into the oocyte
5- The acrosome reaction
Questions 34 & 35 refer to the following figure:

34. Which embryonic rudiment is the source of skeletal muscle of the upper limbs?

1- A
2- B
3- C
4- D
5- E

35. Which embryonic rudiment is the source of all bone, cartilage and joints of the
upper limbs?

1- A
2- B
3- C
4- D
5- E
36. Embryologic failure of fusion of the lumbosacral vertebral arches as a
consequence of the failure of the neural tube to close is termed

1- spina bifida occulta.

2- rachischisis.
3- spina bifida cystica with meningocele.
4- spina bifida cystica with meningomyelocele.
5- scoliosis.

37. Malignant mesothelioma is a rare form of cancer which most commonly forms in
the lining of the
pleural cavities. What is the most likely embryonic origin of this cancer?

1- Neural crest
2- Sclerotome
3- Intermediate mesoderm
4- Branchiomeric mesoderm
5- Lateral plate mesoderm

38. Ultrasound examination of a pregnant 24-y.o. woman showed twins with separate
placentae,
chorions and amnions. Such twins

1- are monozygotic.
2- are dizygotic.
3- may be either monozygotic or dizygotic.
4- possess fetal membrane arrangements impossible with either type
 MEDICAL GROSS ANATOMY
TLE - limbs

ANSWER KEY

1. (2) 11. (1) 21. (4) 31. (5)

2. (5) 12. (4) 22. (5) 32. (1)
3. (1) 13. (2) 23. (2) 33. (4)
4. (1) 14. (3) 24. (3) 34. (2)
5. (5) 15. (1) 25. (4) 35. (1)
6. (4) 16. (2) 26. (2) 36. (2)
7. (3) 17. (1) 27. (1) 37.
(5) 8. (5) 18. (4) 28. (3) 38.
(3)
9. (2) 19. (3) 29. (5)
10. (5) 20. (3) 30. (1)