Arm, Hammer and Extension Cord
Which of the following is not a branch of the medial cord of the brachial plexus?
A) Brachial medial cutaneous nerve
B) Medial pectoral nerve
C) Antebrachial medial cutaneous nerve
D) Medial root of median nerve
E) Musculocutaneous nerve
F) Ulnar nerve
E - Musculocutaneous nerve
Musculocutaneous is from the lateral cord.
The medial cord outbranches in order are medial pectoral, brachial medial cutaneous, antebrachial medial cutaneous, ulnar, and medial root of median nerve
The lumbrical muscles arise from the tendons of this muscle
A) Flexor digitorum profundum
B) Flexor digitorum superficialis
C) Pronator quadratus
D) Flexor retinaculum
E) Adductor pollicis
A - Flexor digitorum profundus
The extensor pollicis longus enters the hand through this synovial sheath compartment?
A) 1
B) 2
C) 3
D) 4
C - 3
Innermost intercostals are most similar to which other muscle?
A) External intercostal
B) Internal intercostal
C) Diaphragm
D) Anterior scalene
B - Internal intercostal
They both have the same muscle fiber orientation and have the same function
These are the 2 valves that are semilunar
Pulmonary and aortic valves
A boy falls from the balcony. His physical shows no heart sounds, reduced systolic pressure, reduced cardiac output, and engorged jugular veins. Which condition is most likely characterized by these signs?
A) Hemothorax
B) Cardiac temponade
C) Hemopneumothorax
D) Pneumothorax
E) Deep vein thrombosis
B - Cardiac temponade
Cardiac temponade is the accumulation of fluid in the pericardial cavity leading to reduced filling of the heart in diastole, thus leading to reduced systolic pressure. Reduced pumping of the heart leads to reduced cardiac output, and increased venous pressure explaining the engorged jugular veins.
Deep vein thrombosis affects lower limbs and increases risk for pulmonary embolism. The other options affect pulmonary function more so than cardiac function.
Digit development is driven primarily by which of the following?
A) Hox genes
B) Sonic hedgehog
C) Bicoid
D) Caudal
A - Hox genes
Which of the following are spinotransversales muscles?
A) Iliocostalis, longissimus and spinalis
B) Rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis inferior, obliquus capitis superior
C) Rotatores, multifidus, semispinalis
D) Splenius capitis, splenius cervicis
D) Splenius capitis, splenius cervicis
Responsible for head and neck movement
Which of the following muscles are not innervated by a branch of the brachial plexus?
A) Rhomboids
B) Infraspinatus
C) Pectoralis major
D) Trapezius
D - Trapezius
Trapezius is innervated by CN XI. Rhomboids are innervated by dorsal scapular (root of C5), infraspinatus is innervated by suprascapular, and pectoralis major is by median and lateral pectoral nerves (mixture of median and lateral cords)
Damage to the posterior cord of the brachial plexus would lead to which of the following symptoms?
A) Loss of sensation in the palmar surface of the distal pinky
B) Weakened flexion of the wrist
C) Loss of sensation in the palmar surface of the proximal phalange of the middle finger
D) Loss of sensation on the index finger just below the knuckles
E) Loss of sensation on the medial dorsal side of the forearm
D - Loss of sensation on the index finger just below the knuckles -- that is part of the dermatome of the radial nerve
A is wrong because that is ulnar nerve. B is wrong because that is median and ulnar nerve. C is wrong because that is median nerve. E is wrong because that is medial antebrachial cutaneous nerve.
This muscle has two heads--one originates from the lateral epicondyle and the second from the ulna, and they both insert into the proximal radius. What muscle is this?
Supinator
This is the muscle responsible for inspiration
External intercostal muscle
Pain sensation from the pericardium is carried by which of the following structures?
A) Vagus nerve
B) Phrenic nerve
C) Sympathetic trunks
D) Parasympathetic trunks
B - Phrenic nerve
This is the most commonly fractured carpal bone
Scaphoid
The tricuspid and mitral valves develop from
A) Septum primi
B) Muscular portion of the interventricular septum
C) Septum secundum
D) Membraneous portion of the interventricular septum
D - Membraneous portion of the interventricular septum
These become fibrous giving rise to the valves
This superficial muscle is well developed in athletes, aids in respiration, and is innervated by the anterior rami of T1-T4
Serratus posterior posterior
These are the muscles of the anterior compartment of the forearm that are not innervated by the median nerve
Flexor carpi ulnaris, and medial half of the flexor digitorum profundus
This muscle inserts in the palmar aponeurosis
Palmaris longus
Damage to which of the following nerves would damage wrist extension the most?
A) Anterior interosseous nerve
B) Posterior interosseous nerve
C) Musculocutaneous nerve
D) Medial antebrachial nerve
B - Posterior interosseous nerve
Which of the following best encompasses all true ribs?
A) I - V only
B) II - IX only
C) II - VI only
D) I - VII only
D - I - VII only
The coronary arteries arise from this structure
A) Aortic sinuses
B) Pulmonary trunk
C) Coronary sinuses
D) Pectinate muscles
A - Aortic sinuses
A football player suffered a wrist injury while falling with force on his outstretched hand. When the anatomic snuffbox is exposed during surgery, an artery is visualized crossing the fractured bone that provides a floor for this space. What is that artery?
Radial artery
Heart progenitor cells arise from
A) Paraxial mesoderm layer
B) Hypoblast
C) Somites
D) Epiblast
D - Epiblast
This is the only rotator cuff muscle that abducts
Supraspinatus
A boy breaks his olecranon. Which of the following structures would be mostly affected?
A) Triceps
B) Supinator
C) Anconeus
D) Biceps
A - Triceps
Olecranon is the point of insertion of the triceps
Which of the following describes a function of the anconeus?
A) Flexion of the the forearm
B) Pronation
C) Adduction of the distal ulna
D) Maintains hands at the central axis during pronation
D - maintains hands at the central axis during pronation
These are the 8 carpal bones
Scaphoid, lunate, triquetrium, pissiform, hamate, capitate, trapezoid, trapezium
A perforation of the intercostal space would most likely damage which of the following structures?
A) Intercostal artery
B) Intercostal vein
C) Intercostal nerve
D) Juxta-esophageal lymph nodes
C - Intercostal nerve
Nerves are somewhat protected by the costal groove, but they are not fully behind it like the arteries and veins
Which of the following structures is most likely to develop clots?
A) Right atrium
B) Left atrium
C) Right auricle
D) Left ventricle
C - Right auricle
During transophageal echocardiography (TEE), an ultrasound transducer is placed through the nose or mouth to lie directly behind the heart. The closer the transducer is, the best the structure can be visualized. In TEE, which heart valve is best visualized?
A) Tricuspid
B) Pulmonary
C) Mitral
D) Aortic
E) Valve of the inferior vena cava
C - Mitral
The esophagus is closer to the posterior side of the heart, and that would be the mitral valve.
Which of the following structures arise from the secondary heart field?
A) Left ventricle
B) Right ventricle
C) Dorsal aorta
D) Umbilical vein
B - Right ventricle
Left ventricle and dorsal aorta come from the primary heart field, and the umbilical vein comes from the allantois
A patient has pinched their anterior rami of C5 spinal nerve. Which of the following muscles would be affected?
A) Latissimus Dorsi
B) Subscapularis
C) Longissimus
D) Flexor digiti minimi brevis
B - Subscapularis
Subscapularis is innervated by the superior subscapular (C5-C6). Latissimus dorsi is innervated by the thoracodorsal nerve (C6-C8), longissimus is innervated by the posterior rami, and flexor digiti minimi brevis is innervated by the ulnar nerve (C7-T1)
Basilic and cephalic veins are joined by this structure
Median cubital vein
A boy breaks his lateral epicondyle of the humerus. Which pronator muscle in his forearm would be unaffected by this fracture?
Both pronators would be unaffected
Pronator teres arises from the medial epicondyle of the humerus, and the pronator quadratus is by the distal radio-ulnar joint, not the proximal one.
People who lack the tendon of the branch of the extensor digitorum to the pinky relies on this muscle to extend their pinky?
Extensor digiti minimi
This is the function of the retromammary space
Allows for movement of the breast over the pectoral muscle
Which of the following is not true about the cardiac skeleton?
A) Electrically isolates the atria and ventricles
B) Helps maintain cardiac structures
C) The left fibrous trigone is between the aortic ring and right AV ring
D) The interconnecting parts of the cardiac skeleton are called annulus fibrosus
C - The left fibrous trigone is between the aortic ring and left AV ring
A boy sustained a chest injury upon impact with the steering wheel during a car crash. A radiograph revealed an uncommon fracture at the sternomanubrial joint. Which rib would be most affected?
A) First
B) Second
C) Third
D) Fourth
E) Fifth
B - Second
The superior demifacet of the second rib joins at the manubrium while the inferior demifacet joins at the body of the sternum
The lung fully matures at this time point
8 years old
Which of the following statements is true?
A) The vertebral venous plexus of Batson is a network of veins that provide a route for metastatic cancer from the pelvis to the lungs
B) The posterior interosseous artery branches from the radial artery while the posterior interosseous nerve branches from the median nerve
C) The supinator is the strongest supinator muscle of the forearm
D) The posterior rami of spinal nerves innervate deep and intermediate muscles of the back, while the anterior rami innervate superficial muscles of the back
A) The vertebral venous plexus of Batson is a network of veins that provide a route for metastatic cancer from the pelvis to the lungs
B is wrong because the posterior interosseous artery arises from the ulnar artery, and the posterior interosseous nerve arises from the radial nerve. C is wrong because the biceps is the strongest supinator. D is wrong because the intermediate back muscles are innervated by the anterior rami of spinal nerves
A pre-fixed brachial plexus has contributions from roots from this spinal cord level
C4
Post-fixed has from T2
Inflammation and swelling of the flexor pollicis longus would lead to which of the following symptoms?
A) Inability to pronate the wrist
B) Loss of sensation on the dorsal side of the distal phalanx of the middle finger
C) Loss of sensation on the dorsal side of the thumb
D) Loss of sensation on the skin over the anatomical snuffbox
B - Loss of sensation on the dorsal side of the distal phalanx of the middle finger
Inflammation of the flexor pollicis longus would compress the median nerve leading to carpal tunnel. B is the only option that is innervated by the median nerve.
Most of the deep extensor muscles of the posterior compartment are perfused by which of the following vessels?
A) Radial artery
B) Recurrent interosseous artery
C) Anterior interosseous artery
D) Posterior interosseous artery
C - Anterior interosseous artery
It sends multiple perforating branches to most extensor muscles
Which of the following is a true statement
A) Extrinsic intercostal muscles connect superior margins of the rib above to the superior margins of the rib below
B) Intrinsic intercostal muscles run obliquely posteriorly between ribs
C) Extrinsic intercostal muscles rub obliquely posteriorly between ribs
D) Intrinsic intercostal muscles connect superior margins of the rib above to the inferior margins of the rib below
B - Intrinsic intercostal muscles run obliquely posteriorly between ribs
Extrinsic intercostal muscles run obliquely anteriorly, and both intrinsic and extrinsic connect inferior margin of superior rib to superior margin of inferior rib
These are the 3 specialized trabeculae cordinae that attach ventricular surface to the tricuspid valve
Anterior, posterior and septal papillary muscles
With which of the following bones does the ulna normally articulate at the wrist?
A) Triquetrum
B) Hamate
C) Radius and lunate
D) Radius
E) Pisiform and triquetrum
D - Radius
The ulna normally does not articulate with any of the carpal bones at hand, and only the radius. The ulna is separated from the triquetrum and lunate by the triangular fibrocartilage complex between the ulna itself and the radius
The ostium secundum rises in the atrium septum by
A) Incomplete attachment of the septum primum outgrowth into the AV
B) Enlargement of the ostium primum towards the septum primum
C) Apoptosis of the upper septal cells
D) Incomplement attachment of the osteum secundum to the endothelial cushion
C - Apoptosis of the upper septal cells
A girl has a broken spinoglenoid notch, and the parents claim she has fallen from her skateboard. Which of the following would be a symptom that is consistent with the fall?
A) The girl feels numbness on her entire superior lateroposterior region
B) The girl feels numbness on the infraspinous fossa region, but can feel touch on the supraspinous fossa region
C) The girl has difficulty abducting her arm
D) The girl has difficulty with external rotations of her shoulder
B) The girl feels numbness on the infraspinous fossa region, but can feel touch on the supraspinous fossa region
C would be true if she had broken the suprascapular notch and damaged the suprascapular nerve before it branched.
Which of the following statements is true?
A) The roots of the brachial plexus receives axons from the white rami communicantes of the spinal cord
B) In the brachial plexus, the posterior division of the middle trunk feeds into the inferior trunk, while the anterior division of the superior trunk feeds into the middle trunk
C) The superior trunk is the only trunk of the brachial plexus that has small branches directly from it
D) The axillary and radial nerves are the main nerves responsible for innervating the posterior compartment of the forearm
C- The superior trunk is the only trunk of the brachial plexus that has small branches directly from it -- that is the suprascapular nerve
A is wrong because brachial plexus receives axons from the post-ganglionic fibers (gray rami).
B is wrong because the posterior division of the middle trunk feeds into the posterior cord, and the anterior division of the superior trunk feeds into the lateral cord
D is wrong because the axillary nerve feeds the deltoid and teres minor, not the forearm
Our wrist has much more limited abduction capabilities compared to our adduction capabilities because of this structure
Radial styloid
Radial styloid is much bigger than the ulnar styloid, and is the site of brachioradialis insertion
A boy breaks his pisiform, which of the following would be a possible symptom?
A) Weakened flexion of the thumb
B) Weakened flexion of the wrist
C) Weakened flexion of the pinky
D) Loss of sensation on the nail bed of the pinky
B - Weakened flexion of the wrist
Flexor carpi ulnaris attaches to the pisiform and is the strongest flexor of the wrist
A patient has suffered an accident, and they cannot start abduction of their arm. What is the next thing you should check for immediately?
Breathing
Onset of abduction is the myotome test for C5 function, and phrenic nerve root starts in C4-C6
This is the name of the smooth walled outflow of the right ventricle
Infundibulum
A boy lacerated his palmar surface of the wrist. The cut ends of the tendon could be seen within the wound in the exact midline of the wrist. Which tendon lies in that position in most people?
A) Palmaris longus
B) Flexor carpi radialis
C) Abductor pollicis longus
D) Flexor carpi ulnaris
E) Flexor pollicis longus
A - Palmaris longus
This is the reason why babies born at 32 weeks old have much higher success rate at survival than 24 weeks old babies
A boy comes in complaining of severe shoulder pain. Upon examination, you see that the boy's subscapularis muscle is atrophied due to a large blockage in the subscapular artery. Which of the following muscles would you also expect to have poor perfusion?
A) Pectoralis Minor
B) Supraspinatus
C) Latissimus Dorsi
D) Infraspinatus
C) Latissimus Dorsi
Thoracodorsal artery comes from the subscapular artery
The teres major is innervated by this branch of the brachial plexus
Mainly by lower subscapular nerve
It also receives some innervation by the thoracodorsal nerve
Which of the following statements is true?
A) Damage to the anatomical snuffbox can lead to damage to the basilic vein
B) Damage to the flexor carpus radialis will lead to motor problems in the middle and ring fingers
C) Pinching of the T1 posterior ramus will lead to weakened flexion of the wrist
D) The flexor digitorum profundus is the only muscle capable of flexing the distal interphalangeal joints
E) Damage to the palmaris longus can lead to serious functional complications in the elderly
D- The flexor digitorum profundus is the only muscle capable of flexing the distal interphalangeal joint
A is wrong because damage to the anatomical snuffbox would impair the cephalic vein. B is wrong because flexor carpus radialis connects to metacarpals II and III, not IV. C is wrong because posterior rami innervates cutaneous back and deep back muscles. E is wrong because palmaris longus is missing in 15% of the population and leads to no functional problems.
Both the pinky and thumb have muscles that are specialized in making them oppose. What two structural differences between the pinky and thumb allows the thumb to oppose to a higher degree?
The thumb lacks the deep transverse metarcapal ligament, and the thumb has a saddle joint with trapezium allowing greater mobility
Which of the following statements is true about the right and left pulmonary arteries?
A) The right pulmonary artery is shorter than the left pulmonary artery and passes anteriorly to the ascending aorta
B) The left pulmonary artery is longer than the right pulmonary artery and passes posteriorly to the ascending aorta
C) The left pulmonary artery is shorter than the right pulmonary artery and passes anteriorly to the ascending aorta
D) The right pulmonary artery is shorter than the left pulmonary artery and passes posteriorly to the ascending aorta
C - The left pulmonary artery is shorter than the right pulmonary artery and passes anteriorly to the ascending aorta
This is the structure that determines the dominance of the heart
The side that originates the posterior descending artery
A 2-day newborn swallows milk and becomes cyanotic. After 3 days, he develops pneumonia. A trachoesophageal fistula is suspected. Failure of development has occurred most specifically in which of the following structures?
A) Esophagus
B) Trachea
C) Tongue
D) Tracheoesophageal septum
E) Pharynx
D - Tracheoesophageal septum
Blood in the embryo enters through the right atrium and passes through the _____________ and ____________ to enter the left atrium
A) ostium primum; ostium secundum
B) atrioventricular ridge; foramen ovale
C) ostium secundum; ostium primum
D) foramen ovale; ostium secundum
D - foramen ovale; ostium secundum
Which of the following is a true statement?
A) Nucleus pulposus is made of type I and type II collagen
B) The rhomboids are innervated by nerves from C6-C8 spinal nerves
C) Thenar muscles are innervated by the superior branch of the radial nerve
D) The meninges are made from a mixture of cells derived from neuroectoderm and endoderm
A) Nucleus pulposus is made of type I and type II collagen
Nucleus pulposus is made of fibrocartilage.
B is wrong because the rhomboids are innervated by the dorsal scapular nerve (C5 root). C is wrong because thenar muscles are primarily innervated by the median nerve. D is wrong because the meninges is a mixture of neuroectoderm and mesoderm
These are the two specific points of insertion of the biceps
Bicipital aponeurosis and tuberosity of the radius
The ulnar nerve enters the hand by passing through this structure
Guyon's canal (ulnar canal)
These muscles originate from the hook of hamate
Opponens digiti minimi and flexor digiti minimi
This what separates the medial lobe from the superior lobe
Horizontal fissure
The right coronary artery travels down the heart on this anatomical landmark
Coronary sulcus
A boy choked on his car toy. Where in the tracheobronchial tree is the most common site for a foreign object to be lodged in?
A) Right primary bronchus
B) Left primary bronchus
C) Carina
D) Beginning of the trachea
E) Left tertiary bronchus
A - Right primary bronchus
The right primary bronchus is shorter, wider and more vertical, and the most common site for objects to be lodged in.
What is the order of digits appearance?
A) 4, 2, 3, 5, 1
B) 3, 5, 4, 1, 2
C) 1, 2, 3, 4, 5
D) 3, 4, 2, 5, 1
E) 1, 2, 4, 3, 5
A - 4, 2, 3, 5, 1
This is the structure that keeps the dens of the axis in contact with the anterior arch of the atlas
Transversal ligament of the atlas
The brachial artery branches into radial and ulnar arteries at the distal end of this anatomical landmark
Cubital fossa
Someone cut the ventral side of their wrists completely severing the two most superficial tendons of the flexor digitorum superficialis. What movement would be most effected?
A) Flexion of the MP and IP joints of the thumb
B) Flexion of the PIP joints of digits 2 and 5
C) Flexion of the PIP joints of digits 3 and 4
D) Flexion of the DIP joints of digits 2 and 5
E) Flexion of the DIP joints of digits 3 and 4
C- Flexion of the PIP joints of digits 3 and 4
Deeper tendons of the flexor digitorum superficialis connects 2 and 5
A patient has an infection on their flexor pollicis brevis. To which of the following muscles would this most likely spread next if left untreated?
A) Extensor indiciis
B) Adductor policis
C) Extensor expansions of the index finger
D) Opponens digiti minimi
E) Palmar interosseus of the middle finger
D - Opponens digiti minimi
Radial and ulnar bursae have the same synovial sheath
The carina is located in this structure
This is the lowest ring structure of the trachea and is hook shaped--responsible for coughing if food and water enters the trachea
The left descending artery marks the superficial separation of these two heart chambers
A woman is found unconscious and has absent biceps flex. What is the spinal level of the afferent component of this reflex?
A) C5
B) C6
C) C7
D) C8
E) T1
B - C6
Biceps is innervated by C5 and C6, where C5 is responsible for the motor component and C6 is responsible for the afferent component of the reflex arc
What is true about limb development?
A) Hindlimb development is driven by Tbx5
B) Forelimb development is driven by Tbx4
C) Interdigital necrotic zones appear before chondrogenesis
D) The apical ectodermal ridge secretes FGF8, and it is maintained by FGF10
D - The apical ectodermal ridge secretes FGF8, and it is maintained by FGF10
AER defines anterior-posterior and dorsal-ventral axes, and is maintained by the FGF10 secretion by the mesenchyme
A patient with Marfan's Syndrome would have which of the following structures to be most compromised?
A) Nucleus pulposus
B) Ligamentum flavum
C) Annulus fibrosus
D) Glenohumeral labrum
B) Ligamentum flavum
This is a highly elastic structure with lots of elastic fibers (elastin + fibrillin)
These are the three fossae of the distal humerus
Radial, coronoid and olecranon fossae
Radial is superior to capitulum, coronoid is adjacent to radial fossa and superior to trochlea, and olecranon is superior to trochlea on the posterior side
The radial nerve bifurcates into its deep (motor) and superficial (sensory) branches between these two muscles
Brachialis and brachioradialis
What is the difference in the actions of the flexor digitorum profundus, flexor digitorum superficialis, and lumbricals and interossei
Lumbrical and interossei flex the MPs while extending PIPs and DIPs. FDS flexes MPs and PIPs, but not DIPs. FDPs flexes all three (MPs, PIPs and DIPs)
Ribs I, X, XI and XII are different from the typical rib. How so?
Rib I and rib X lack superior facet, so they only articulate with the vertebra at its own level. Ribs XI and XII also articulate only with their own vertebral bodies and lack a tubercle
These are the structures that make up the conduction of the system of the heart, in order of the propagation of the electrical signal
SA Node > AV node > AV bundle > Subendocardial plexus
A man is admitted to the hospital because of severe nosebleed and headache that has worsened during the weekend. His upper body is mucho more developed than his lower body. He has a midsystolic murmur, his lower extremities are cold, and has no femoral pulse. Which of the following embryologic structures has been most likely affected to produce such symptoms?
A) Bulbus cordis
B) Ducturs arteriosus
C) Third, fourth and sixth pharyngeal arches
D) Right and left horns of sinus venosus
E) Right cardinal vein
C - Third, fourth, and sixth pharyngeal arches
The anomalies are due to aortic coarctation, and the part of the aorta being affected arises from third, fourth and sixth pharyngeal arches. Bulbis cordis is part of the ventricular system, and the ductus arteriosus gives rise to the ligamentum arteriosum.
This is the reason the aortic arch and pulmonary trunk intertwine, and the aorta rises posteriorly while the pulmonary artery arises anteriorly?
A) Intertwining of the aortic arches
B) Heart looping
C) 180 degree spiraling of the endocardical cushion during septation
D) Migration of the neural crest cells
C - 180 degree spiraling of the endocardical cushion during septation
A patient suffered from spinal stroke, and they can't adduct or abduct their index, middle and ring fingers. Which spinal cord level was mostly affected by this stroke?
T1
This is the myotome test specific to assess T1 function.
Abduction of the arm is to test C5, flexion of the arm is to test C6, extension of the arm at elbow joint is for C7, and finger flexion is for C8.