🤔 MEDIUM

The musculoskeletal system is a fascinating topic. The quiz is about the bones, muscles and their associated arterial and nervous supply. Good luck!

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Musculoskeletal anatomy - Part 4

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Question 1

STEM 1 OF 4

Read the following vignette: A 45 year old lady complains to her GP that she is experiencing pain and numbness in the thumb and digits that is severe enough to wake her during her sleep. These symptoms seem to be worse in the mornings and gradually subside throughout the day. You suspect the lady is suffering from carpal tunnel syndrome. The carpal tunnel is formed by a concave arch on the palmar side. Which of the following bony structure is not a border of this arch?
A
Hook of hamate
B
Lunate
C
Pisiform
D
Tubercle of scaphoid
E
Tubercle of trapezium
Question 2

STEM 2 OF 4

Which of the following is not a content of the carpal tunnel?
A
Flexor carpi radialis
B
Flexor digitorum profundus
C
Flexor digitorum superficialis
D
Flexor pollicis longus
E
Median nerve
Question 2 Explanation: 
Sometimes you may hear that the carpal tunnel contains the flexor carpi radialis tendon but it is a misconception. It is located within the flexor retinaculum and not within the carpal tunnel itself.
Question 3

STEM 3 OF 4

Which of the following muscles is not supplied by the median nerve in the hand?
A
Abductor pollicis brevis
B
Flexor pollicis brevis
C
Lateral two lumbricals
D
Medial two lumbricals
E
Opponens pollicis
Question 3 Explanation: 
The median nerve gives rise to two motor branches in the hand, one supplies all the thenar muscles that control movement of the thumb while the other branch supplies the lateral two lumbricals. The rest of the muscles in the hand are supplied by the ulnar nerve.
Question 4

STEM 4 OF 4

Regarding the sensory distribution to the hand by the median nerve, which area of the hand is spared in carpal tunnel syndrome?
A
Central palm
B
Dorsal surface of the tip of the 2nd digit
C
Palmar surface of the thumb
D
Palmar surface of the 2nd digit
E
Palmar surface of the 3rd digit
Question 4 Explanation: 
Cutaneous sensation to central palm is supplied by the palmar cutaneous branch of the median nerve and it descends superficial to the flexor retinaculum hence it is not affected in carpal tunnel syndrome.
Question 5
In the cubital fossa:
A
pronator teres forms the floor of the fossa
B
the biceps tendon separates the brachial artery from the median nerve
C
the medial cutaneous nerve of the forearm runs deep to the bicipital aponeurosis
D
the median nerve is medial to the brachial artery
E
the radial artery leaves the brachial artery at right angles
Question 6
Regarding the radial nerve, which of the following is INCORRECT?
A
It divides into a superficial and deep branch anterior to the lateral epicondyle of humerus
B
It gives rise to the posterior interosseous nerve which pierces the supinator muscle to reach posterior forearm
C
Injury to the radial nerve usually causes wrist drop deformity
D
The superficial branch of the radial nerve runs superficial to the area of the anatomical snuffbox
E
The radial nerve supplies the supinator muscle directly
Question 6 Explanation: 
Bit of a tricky one because the supinator muscle is supplied by the posterior interosseous nerve, which is a branch of the radial nerve so the innervation is indirect
Question 7
Regarding the brachial plexus:
A
Erb's palsy occurs due to a lesion to the lower trunk
B
The anterior divisions merge together to form the posterior cord
C
The infraspinatus, subscapularis and supraspinatus muscles are all supplied by the suprascapular nerve
D
The long thoracic nerve arises from the roots
E
The thoracodorsal nerve supplies the serratus anterior muscle
Question 7 Explanation: 
Erb's palsy is due to lesion to the upper trunk (C5, C6). The posterior divisions merge to form the posterior cord. The suprascapular nerve supplies the infraspinatus and supraspinatus only. The thoracodorsal nerve supplies the latissimus dorsi muscle.
Question 8
Paralysis of which nerve results in inability to perform shoulder retraction?
A
Axillary nerve
B
Dorsal scapular nerve
C
Long thoracic nerve
D
Subscapular nerve
E
Suprascapular nerve
Question 8 Explanation: 
Shoulder retraction is performed by trapezius (spinal accessory nerve), rhomboid major, rhomboid minor (dorsal scapular nerve) and latissimus dorsi (thoracodorsal nerve)
Question 9
Regarding the musculocutaneous nerve
A
All of the brachialis muscle is supplied by it
B
Injury of the nerve causes weakness of forearm supination
C
It contains fibres from C5, 6, 7 and 8
D
It supplies the brachioradialis
E
Its terminal branch is the lateral cutaneous nerve of arm
Question 9 Explanation: 
The musculocutaneous nerve supplies the biceps brachii which contributes to forearm supinator
Question 10
The lunate articulates with all of the following EXCEPT:
A
Capitate
B
Radius
C
Scaphoid
D
Trapezoid
E
Triquetral
Question 11
The pectoralis major muscle inserts to
A
Floor of the intertubercular groove
B
Greater tubercle
C
Medial lip of the intertubercular groove
D
Lateral lip of the intertubercular groove
E
Lesser tubercle
Question 12
Which tendon is affected in De Quervain's tenosynovitis?
A
Extensor carpi radialis brevis
B
Extensor carpi radialis longus
C
Extensor carpi ulnaris
D
Extensor indicis
E
Extensor pollicis brevis
Question 12 Explanation: 
This condition is usually caused by inflammation of the tendon sheath enclosing the extensor pollicis brevis and abductor pollicis longus tendons.
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