Upper Limb
As a result of chronic stress associated with an intense high school weight-lifting program, a 15-year-old boy suffers an avulsion fracture of the greater tubercle of the humerus. In the ER, he displays difficulty initiating abduction of the upper limb. Which of the following muscles was involved in this fracture?
(A) Supraspinatus
(B) Long head of biceps brachii
(C) Deltoid
(D) Subscapularis
(E) Infraspinatus
(A) Supraspinatus
A soccer player injures his left knee when he twists the flexed knee while trying to avoid another player. While performing a knee examination, his physician pulls the flexed knee toward her (the physician’s) body, as shown in the illustration. This clinical test is a check for the integrity of which of the following ligaments?
(A) Tibial (medial) collateral ligament (TCL)
(B) Fibular (lateral) collateral ligament (FCL)
(C) Anterior cruciate ligament (ACL)
(D) Posterior cruciate ligament (PCL)
(E) Patellar ligament
(C) Anterior cruciate ligament (ACL)
An elderly man falls on an icy sidewalk outside his home and cannot get up. He tells the attending paramedics that he has a lot of pain in his right hip. Following inconclusive analysis of an AP X-ray, the given coronal MRI reveals a nondisplaced fracture of the right femoral neck, as noted by the black arrow. Branches of which of the following arteries are most likely to be damaged in this injury?
(A) Femoral artery
(B) Obturator artery
(C) Lateral circumflex femoral artery
(D) Medial circumflex femoral artery
(E) Inferior gluteal artery
(D) Medial circumflex femoral artery
A 74-year-old man complains of pain in his right hand and fingers when he works with his hands for a while. Thorough testing reveals insufficient blood flow into the deep palmar arch. Occlusion of which of the following arteries is the most likely cause of this condition?
(A) Posterior interosseous artery
(B) Ulnar artery
(C) Anterior interosseous artery
(D) Radial artery
(E) Inferior ulnar collateral artery
(D) Radial artery
A 25-year-old woman comes to the physician because of pain and weakness in her left leg that started 2 days ago while running a marathon. Physical examination shows impaired flexion of the left knee joint and impaired extension of the left hip joint. An MRI of the left lower extremity shows injury to the long head of the biceps femoris muscle and the semitendinosus muscle. Which of the following is the most likely origin of the injured muscles?
A.Superior pubic ramus
B.Ischial tuberosity
C.Anterior superior iliac spine
D.Greater trochanter
E.Linea aspera
F.Medial tibial condyle
B.Ischial tuberosity
A 52-year-old retired professional cyclist, who still rides his bike 400 miles per week, comes to his physician complaining of hand problems. The physician notes hyperextension of the ring and little fingers at the metacarpophalangeal joints and flexion at the interphalangeal joints within the same fingers at rest (see photo). During examination, the patient has no weakness in flexion or adduction of the wrist. What nerve is compressed at what location?
(A) Ulnar nerve in the elbow
(B) Ulnar nerve in the wrist
(C) Median nerve in the wrist
(D) Median nerve in the elbow
(E) Median nerve in the axilla
(B) Ulnar nerve in the wrist
A 20-year-old man fell from the parallel bar during the Olympic trials. A neurologic examination reveals that he has a lesion of the lateral cord of the brachial plexus. Which of the following muscles is most likely weakened by this injury?
(A) Subscapularis
(B) Teres major
(C) Latissimus dorsi
(D) Teres minor
(E) Pectoralis major
(E) Pectoralis major
A young man suffers a dislocation of the right hip in a car accident. During recovery, he finds he has an abnormal gait in which his left hip sinks when he lifts that foot to take a step, as shown in the right frame (C) of the given diagram. The problem may be the result of damage to which of the following structures?
(A)Right gluteus maximus and inferior gluteal nerve
(B)Left gluteus maximus and superior gluteal nerve
(C)Left gluteus medius and inferior gluteal nerve
(D)Right gluteus medius and superior gluteal nerve
(E)Right gluteus minimus and inferior gluteal nerve
(D)Right gluteus medius and superior gluteal nerve
A 25-year-old man suffers a gunshot wound to the calf that severs the posterior tibial artery at its origin. Which of the following vessels will not receive blood flow immediately following the injury?
(A) Anterior tibial artery
(B) Inferior medial genicular artery
(C) Dorsalis pedis artery
(D) Popliteal artery
(E) Fibular (peroneal) artery
(E) Fibular (peroneal) artery
The lateral thoracic artery provides the main blood supply to the lateral side of the chest wall, including much of the breast. To deter excessive blood loss during a surgical procedure involving the breast, a surgeon can clamp the lateral thoracic artery near its origin. Which of the following arteries gives rise to this artery?
(A) First part of the axillary artery
(B) Second part of the axillary artery
(C) Third part of the axillary artery
(D) Third part of the subclavian artery
(E) First part of the brachial artery
(B) Second part of the axillary artery
A 45-year-old man comes to the office because of progressively worsening pain in his left heel over the past 3 months. The pain is worse in the morning when he gets up from the bed but decreases as he starts walking. He started jogging daily and working out in an attempt to lose weight. He does not take any medications. BMI is 31 kg/m2. His vital signs are within normal limits. Physical examination shows tenderness over the medial aspect of the left heel's inferior surface and worsening of the pain with passive dorsiflexion of the toes. The pain is not reproduced upon squeezing the sides of the heel. An x-ray of the foot shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?
(A) Achilles tendinopathy
(B) Plantar fasciitis
(C) Retrocalcaneal bursitis
(D) Tarsal tunnel syndrome
(E) Stress fracture of the calcaneus
(B) Plantar fasciitis
A 21-year-old female basketball player lands on her opponent’s foot after jumping to rebound the basketball. Her foot is forcefully inverted, and when leaving the court, she tells her trainer that she twisted or sprained her ankle. After getting her ankle taped for support, she reenters the game. What ligament was most likely damaged?
(A) Calcaneofibular ligament
(B) Anterior talofibular ligament
(C) Posterior talofibular ligament
(D) Plantar calcaneonavicular ligament
(E) Medial (deltoid) ligament
(B) Anterior talofibular ligament
The given anteroposterior (AP) X-ray depicts a humeral shaft fracture in a 22-year-old man. Given the location of the fracture, which of the following structures is most likely damaged?
SHOW PICTURE
(A) Posterior circumflex humeral artery
(B) Ulnar nerve
(C) Axillary nerve
(D) Profunda brachii artery
(E) Median nerve
(D) Profunda brachii artery
A 26-year-old woman comes to the physician because of painful paresthesia in her right foot. Examination shows decreased sensation in the first interdigital space and a hallux valgus deformity. This patient's paresthesia is most likely caused by compression of which of the following nerves?
(A)Superficial peroneal nerve
(B)Tibial nerve
(C)Deep peroneal nerve
(D)Sural nerve
(E)Saphenous nerve
(F)Medial plantar nerve
(C)Deep peroneal nerve
A 21-year-old man injures his right arm in an automobile accident. Radiographic examination reveals a fracture of the medial epicondyle of the humerus. After this injury, the patient is unable to do which of the following?
(A) Flex the proximal interphalangeal joint of his ring finger
(B) Flex the DIP joint of his index finger
(C) Feel sensation on his middle finger
(D) Abduct his thumb
(E) Adduct his index finger
(E) Adduct his index finger