Anatomy
A 24-year-old football player suffers an anterior shoulder dislocation. Which muscle, if paralyzed, would
most likely impair his ability to adduct and medially rotate the humerus?
A) Pectoralis minor
B) Serratus anterior
C) Subclavius
D) Pectoralis major
E) Trapezius
Answer: D – Pectoralis major
This surgical procedure targets the only places where motor and sensory fibers are segregated, allowing surgeons to cut posterior roots to relieve intractable pain or anterior roots to relieve spastic paralysis.
Answer: What is a rhizotomy?
A 22-year-old athlete presents with acute low back strain after a football tackle. On palpation, the paraspinal muscles are boggy, warm, and exquisitely tender with restricted sidebending. Which of the following describes these findings?
A. Acute somatic dysfunction with increased sympathetic tone
B. Acute somatic dysfunction with decreased sympathetic tone
C. Chronic somatic dysfunction with increased fibrosis
D. Chronic somatic dysfunction with decreased tenderness
E. Chronic somatic dysfunction with cool, dry skin
(A is the answer)
A 22-year-old male presents with numbness and tingling in his right arm following a sports injury. Imaging reveals damage to the dorsal root ganglion. Which of the following best describes the function and structure of the dorsal root ganglion?
A. Contains multipolar motor neurons; site of synaptic relay
B. Contains pseudounipolar sensory neurons; no synapses occur here
C. Contains bipolar sensory neurons; initiates motor responses
D. Contains unmyelinated axons; relays autonomic signals
E. Contains interneurons; integrate sensory and motor signals
Correct Answer: B
Explanation: The dorsal root ganglion houses pseudounipolar sensory neuron cell bodies and does not contain synapses. It relays sensory information to the CNS.
A 24-year-old football player dislocates his shoulder during a tackle. He has weakness in abduction of the arm beyond the first 15 degrees and decreased sensation over the superolateral arm. Which structure is most likely injured? What is the DISTAL attachment (insertion) of this muscle?
A. Suprascapular nerve; greater tubercle
B. Axillary nerve; Deltoid tuberosity
C. Radial nerve; deltoid tuberosity
D. Axillary nerve; greater tubercle
B. Axillary nerve – supplies deltoid & teres minor, sensation over superolateral arm; inserts at deltoid tuberosity
Which group of lymph nodes receives lymph from the majority of the upper limb?
A) Cervical nodes
B) Axillary nodes
C) Parasternal nodes
D) Supratrochlear nodes
E) Mediastinal nodes
Answer: B – Axillary nodes
These fibers of the autonomic efferent system innervate smooth muscle, cardiac muscle, and glands.
Answer: What are general visceral efferent (GVE) fibers?
A 54-year-old man has had intermittent neck stiffness for 10 years. On palpation, the cervical paraspinal muscles are ropey, cool, and fibrotic with mild tenderness. These findings are most consistent with:
A. Acute somatic dysfunction with boggy edema
B. Acute somatic dysfunction with warmth and erythema
C. Chronic somatic dysfunction with fibrotic changes
D. Chronic somatic dysfunction with moist tissue
E. Acute somatic dysfunction with spasm
(C is the answer)
Which of the following correctly contrasts myelination in the central and peripheral nervous systems?
A. CNS myelin is formed by Schwann cells; PNS myelin by oligodendrocytes
B. CNS myelin allows slower conduction due to fewer Nodes of Ranvier
C. PNS myelin is formed by Schwann cells that myelinate multiple axons
D. CNS myelin is formed by oligodendrocytes that myelinate multiple axons
E. PNS myelin is more efficient due to larger axolemma exposure
Correct Answer: D
Explanation: In the CNS, oligodendrocytes form myelin and can myelinate multiple axons. In the PNS, Schwann cells myelinate only one axon each.
A surgeon accidentally damages the long thoracic nerve during a lymph node biopsy in the axilla. Which of the following muscles, if paralyzed, would compromise the stability of the scapula against the thoracic wall, producing a “winged scapula”? What is the PROXIMAL attachment (origin) of the muscle?
A. Serratus anterior; Ribs 1-8/9
B. Latissimus dorsi; Inferior 3/4 ribs, thoracolumbar fascia
C. Serratus anterior; medial border of scapula
D. Teres major; inferior angle of scapula
A. Serratus anterior – innervated by long thoracic nerve, stabilizes scapula; originates at ribs 1-8/9
Which of the following best describes the mammary glands?
A) Modified sebaceous glands derived from dermis
B) Modified sweat glands within subcutaneous tissue
C) Exocrine glands located in the retromammary space
D) Endocrine glands embedded in pectoralis major
E) Lymphoid tissue located near axillary nodes
Answer: B – Modified sweat glands within subcutaneous tissue
When this branch of the autonomic nervous system stimulates the skin, arrector pili muscles contract causing goosebumps, peripheral blood vessels constrict leading to blanching or blue fingertips, and sweat gland activity increases.
Answer: What is the sympathetic nervous system?
A physician performs red reflex testing on the thoracic spine. In acute dysfunction, what happens?
A. Skin blanches and fades quickly
B. Skin remains erythematous longer than normal
C. Skin immediately returns to baseline color
D. No change in skin tone
E. Skin cools rapidly
(B is the answer)
Which of the following best describes a key difference between the somatic and autonomic nervous systems?
A. Somatic system controls involuntary functions; autonomic controls voluntary movement
B. Somatic system uses unmyelinated axons; autonomic uses myelinated axons only
C. Somatic system involves one neuron from CNS to effector; autonomic involves two
D. Autonomic system innervates skeletal muscle; somatic innervates smooth muscle
E. Autonomic system has no ganglia; somatic system has multiple ganglia
Correct Answer: C
Explanation: The somatic nervous system uses a single neuron from the CNS to the effector (skeletal muscle), while the autonomic system uses a two-neuron chain (preganglionic and postganglionic).
A 42-year-old construction worker falls directly onto his shoulder. Radiographs reveal separation at the acromioclavicular joint with tearing of the coracoclavicular ligament. Which function of this ligament is primarily lost?
A. Preventing superior displacement of the clavicle
B. Deepening the glenoid cavity
C. Preventing anterior dislocation of the humeral head
D. Supporting the sternoclavicular joint
A. Preventing superior displacement of clavicle – coracoclavicular ligament anchors clavicle
The basilic vein drains the medial aspect of the forearm and arm. Which deep vein does it eventually join
to form the axillary vein?
A) Radial vein
B) Ulnar vein
C) Brachial veins
D) Cephalic vein
E) Subclavian vein
Answer: C – Brachial veins
Outnumbering neurons by about 10 to 1, these non-excitable support cells maintain the environment, provide structural and metabolic support, and in some cases form myelin.
Answer: What are neuroglia (glial cells)?
A 29-year-old female presents to your office with back pain. On palpation, you identify muscle resistance and tightness when moving in a superior, lateral, and clockwise approach. When using DMFR technique, how would you treat this?
A. Do not use DMFR. Use another form of treatment.
B. Move the area of resistance in the superior, lateral, and clockwise approach.
C. Move the area of resistance in the inferior, medial, and counterclockwise direction.
D. Move the area of resistance in the inferior, lateral, and counterclockwise direction.
E. IDK, maybe try icing it or something?
(C is the answer)
During a preparticipation physical exam, a physician identifies a history of asthma in a collegiate athlete. What is the primary purpose of this evaluation?
A. To determine eligibility for scholarship
B. To diagnose chronic conditions unrelated to sports
C. To assess overall health and identify conditions that may predispose to injury
D. To provide treatment for acute injuries
E. To evaluate academic performance and mental health
Correct Answer: C
Explanation: The sports physical aims to assess general health, identify life-threatening or disabling conditions, and detect issues that may predispose to injury or illness.
A patient presents with mid-shaft humeral fracture. On exam, he is unable to extend his wrist and fingers, and sensation is lost on the posterior forearm. Which artery travels with the nerve most likely injured? What is the space called where this artery and nerve pop out at?
A. Circumflex scapular artery; quadrangular space
B. Posterior circumflex humeral artery; triangular interval
C. Profunda brachii artery; triangular interval
D. profunda brachii artery; triangular space
C. Profunda brachii artery – runs with radial nerve in radial groove; pops out at triangular interval between long head and lateral head of tri's
A cutaneous nerve is best defined as which of the following?
A) A nerve that carries sensory input from multiple dermatomes
B) A branch of a spinal nerve root that supplies a specific dermatome
C) The motor nerve to a muscle of the skin
D) A cranial nerve branch that carries cutaneous sensation
E) A nerve that carries only autonomic fibers
Answer: A – A nerve that carries sensory input from multiple dermatomes
These deep mechanoreceptors detect heavy, prolonged touch and pressure, as well as joint rotation during stretch.
Answer: What are Ruffini endings?
Which of the following best defines somatic dysfunction?
A. Disruption of normal neuromuscular junction transmission
B. Impaired or altered function of skeletal, arthrodial, and myofascial structures with related vascular, lymphatic, and neural elements
C. Permanent fibrotic replacement of normal tissue due to injury
D. Inflammatory swelling of muscle and connective tissue
E. Loss of bone density with increased fracture risk
(B is the answer)
A patient is diagnosed with Guillain-Barré syndrome. Is this a PNS or CNS demyelination disorder and what type of cells does it affect?
Correct Answer: PNS demyelination affecting Schwann cells
Explanation: Guillain-Barré syndrome is a peripheral nervous system disorder involving demyelination of Schwann cells, leading to motor and sensory deficits.
A 60-year-old man with chronic shoulder pain is diagnosed with inflammation of the subacromial bursa. This condition most directly interferes with the movement of which tendon? What deficit/weakness would you find upon examination?
A. Long head of biceps brachii; arm extension
B. Supraspinatus; Initial abduction of shoulder (up to 15º)
C. Infraspinatus; lateral rotation of shoulder
D. Supraspinatus; flexion of shoulder
B: Supraspinatus
subacromial bursa reduces friction under coracoacromial arch; would see a weakness of initial shoulder abduction if supraspinatus was affected