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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STEM 1 OF 4Read 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?
Hook of hamate
Tubercle of scaphoid
Tubercle of trapezium
STEM 2 OF 4Which of the following is not a content of the carpal tunnel?
Flexor carpi radialis
Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
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.
STEM 3 OF 4Which of the following muscles is not supplied by the median nerve in the hand?
Abductor pollicis brevis
Flexor pollicis brevis
Lateral two lumbricals
Medial two lumbricals
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.
STEM 4 OF 4Regarding the sensory distribution to the hand by the median nerve, which area of the hand is spared in carpal tunnel syndrome?
Dorsal surface of the tip of the 2nd digit
Palmar surface of the thumb
Palmar surface of the 2nd digit
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.
In the cubital fossa:
pronator teres forms the floor of the fossa
the biceps tendon separates the brachial artery from the median nerve
the medial cutaneous nerve of the forearm runs deep to the bicipital aponeurosis
the median nerve is medial to the brachial artery
the radial artery leaves the brachial artery at right angles
Regarding the radial nerve, which of the following is INCORRECT?
It divides into a superficial and deep branch anterior to the lateral epicondyle of humerus
It gives rise to the posterior interosseous nerve which pierces the supinator muscle to reach posterior forearm
Injury to the radial nerve usually causes wrist drop deformity
The superficial branch of the radial nerve runs superficial to the area of the anatomical snuffbox
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
Regarding the brachial plexus:
Erb's palsy occurs due to a lesion to the lower trunk
The anterior divisions merge together to form the posterior cord
The infraspinatus, subscapularis and supraspinatus muscles are all supplied by the suprascapular nerve
The long thoracic nerve arises from the roots
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.
Paralysis of which nerve results in inability to perform shoulder retraction?
Dorsal scapular nerve
Long thoracic 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)
Regarding the musculocutaneous nerve
All of the brachialis muscle is supplied by it
Injury of the nerve causes weakness of forearm supination
It contains fibres from C5, 6, 7 and 8
It supplies the brachioradialis
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
The lunate articulates with all of the following EXCEPT:
The pectoralis major muscle inserts to
Floor of the intertubercular groove
Medial lip of the intertubercular groove
Lateral lip of the intertubercular groove
Which tendon is affected in De Quervain's tenosynovitis?
Extensor carpi radialis brevis
Extensor carpi radialis longus
Extensor carpi ulnaris
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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