Author: Rajesh Kumar

Nerves – Upper Limb

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Nerves – Upper Limb

Description

Short Quiz on Nerve Supply and Injuries of Nerve in Upper Limb


Instruction

1. This Test has 30 Questions 

2. Total Time = 30 Minutes

3. There is 0.25 Negative Marking for each incorrect Answer


Time Left: 30:00
Q. 1

The following hand deformity is seen in?

 A

Ulnar nerve injury

 B

Median nerve injury

 C

Klumpke’s paralysis

 D

All of the above

Q. 1

The following hand deformity is seen in?

 A

Ulnar nerve injury

 B

Median nerve injury

 C

Klumpke’s paralysis

 D

All of the above

Ans. D

Explanation:

This is a case of complete claw hand (clawing of all fingers). It is seen in:

1. Median plus ulnar nerve injury

2. Klumpke’s palsy as it involves root value of ulnar nerve & medial root of median nerve→ T1 & C8.

Q. 2

A young noy who was driving motorcycle at a high speed colllided with a tree & was thrown on his right shoulder. Thoughthere was no fracture, his right arm was medially rotated & forearm pronated. The following facts concerning this patient are correct, except-

 A

The injury was at Erb’s point

 B

A lesion of C5 & C6 was present

 C

The median & ulnar nerves were affected

 D

Supraspinatus, Infraspinatus, Subclavius & Biceps brachii were paralysed

Q. 2

A young noy who was driving motorcycle at a high speed colllided with a tree & was thrown on his right shoulder. Thoughthere was no fracture, his right arm was medially rotated & forearm pronated. The following facts concerning this patient are correct, except-

 A

The injury was at Erb’s point

 B

A lesion of C5 & C6 was present

 C

The median & ulnar nerves were affected

 D

Supraspinatus, Infraspinatus, Subclavius & Biceps brachii were paralysed

Ans. C

Explanation:

Medially rotated arm & pronated forearm after a fall on shoulder suggest the diagnosis of Erb’s palsy (C5-C6 palsy) due to traction at Erb’s point.

Ulnar nerve (C7-8 T1) & medial root of median nerve (C8 T1) are not involved.

Musclaes paralysed are biceps, deltoid, branchialis & brachioradialis.

Partly Supraspinatus, infraspinatus & supinator are also involved.

Q. 3

All of the following muscles undergo paralysis after injury to C5 & C6 nerves except?

 A

Biceps

 B

Corachobrachialis

 C

Brachialis

 D

Brachioradialis

Q. 3

All of the following muscles undergo paralysis after injury to C5 & C6 nerves except?

 A

Biceps

 B

Corachobrachialis

 C

Brachialis

 D

Brachioradialis

Ans. B

Explanation:

Muscles paralysed in C5, C6 injury (Erb’s palsy)

1. Complete paralysis: Biceps, deltoid, brachialis, brachioradialis

2. Partial: Supraspinatus, Infraspinatus, supinator

Q. 4

Upper limb deformity in Erb’s palsy?

 A

Adduction and lateral rotation of arm

 B

Adduction and medial rotation of arm

 C

Abduction and lateral rotation of arm

 D

Abduction and medial rotation of arm

Q. 4

Upper limb deformity in Erb’s palsy?

 A

Adduction and lateral rotation of arm

 B

Adduction and medial rotation of arm

 C

Abduction and lateral rotation of arm

 D

Abduction and medial rotation of arm

Ans. B

Explanation:

Deformity in Erb’s palsy (position of the limb):

  • Arm: Hanges by the side; it is adducted & medially rotated
  • Forearm: Extended and pronated
  • The deformity is known as ‘policeman’s’ tip hand or ‘porter’s tip hand’
Q. 5

Nerve lying in the spiral groove of humerus is:

 A

Musculocutaneous nerve

 B

Ulnar nerve

 C

Radial nerve

 D

Median nerve

Q. 5

Nerve lying in the spiral groove of humerus is:

 A

Musculocutaneous nerve

 B

Ulnar nerve

 C

Radial nerve

 D

Median nerve

Ans. C

Explanation:

Anatomy of radial nerve

Formed by: Axons from Roots: C5 to T1 Brachial plexus

Trunks: Superior, Medial and Inferior

Cord: Posterior

Axons pass through Spiral groove of humerus

Fibrous arch attachment of triceps to humerus

Lateral intermuscular septum below deltoid insertion

Arcade of Frohse: Above supinator and below elbow

  • Branches
  • Above elbow

– Above spiral groove (humerus)

 

Q. 6

Nerve supply to hypothenar muscles is from :

 A

Ulnar nerve

 B

Median nerve

 C

Radial nerve

 D

Musculocutaneous nerve

Q. 6

Nerve supply to hypothenar muscles is from :

 A

Ulnar nerve

 B

Median nerve

 C

Radial nerve

 D

Musculocutaneous nerve

Ans. A

Explanation:

The muscles of hypothenar eminence are:

  • Opponens digiti minimi
  • Flexor digiti minimi
  • Abductor digiti minimi
  • Palmar brevis

The intrinsic muscles of hand can be remembered using the mnemonic, “A OF A OF A (P)” for, Abductor pollicis longus, Opponens pollicis, Flexor pollicis brevis, Adductor pollicis (thenar muslces) and Opponens digiti minimi, Flexor digiti minimi, Abductor digiti minimi and Palmar brevis (Hypothenar muscles)

They are all supplied by the deep branch of the ulnar nerve.

Q. 7

Partial Claw hand is due to:      

 A

Radial nerve injury

 B

Ulnar nerve injury

 C

Median nerve injury

 D

Axillary nerve injury

Q. 7

Partial Claw hand is due to:      

 A

Radial nerve injury

 B

Ulnar nerve injury

 C

Median nerve injury

 D

Axillary nerve injury

Ans. B

Explanation:

The metacarpophalangeal joints become hyperextended because of the paralysis of the lumbrical and interosseous muscles, which normally flex these joints.

Because the first and second lumbricals are not paralyzed (they are supplied by the median nerve), the hyperextension of the metacarpophalangeal joints is most prominent in the fourth and fifth fingers.

The interphalangeal joints are flexed, owing again to the paralysis of the lumbrical and interosseous muscles, which normally extend these joints through the extensor expansion.

The flexion deformity at the interphalangeal joints of the fourth and fifth fingers is obvious because the first and second lumbrical muscles of the index and middle fingers are not paralyzed.

In long-standing cases the hand will show hollowing between the metacarpal bones caused by wasting of the dorsal interosseous muscles

True/complete claw hand involving all the fingers is produced by a combined lesion of ulnar and median nerve

Q. 8

Root value of the Radial nerve is:         

September 2005

 A

C5, C6

 B

C5, C6, C7

 C

C5, C6, C7, C8

 D

C5, C6, C7, C8, T1

Q. 8

Root value of the Radial nerve is:         

September 2005

 A

C5, C6

 B

C5, C6, C7

 C

C5, C6, C7, C8

 D

C5, C6, C7, C8, T1

Ans. D

Explanation:

BRANCHES OF THE BRACHIAL PLEXUS

There are a total of 17 branches arising from the brachial plexus that are destined to supply the upper limb of the seventeen branches of the brachial plexus; three of the branches arise from the root, one from the trunk, three from the lateral cord, five from the medial cord and five from the posterior cord.

Branches from the roots

  • Long thoracic nerve of bell (C5, C6, C7).
  • Dorsal scapular nerve (C5).

Branches from the trunk

  • Suprascapular Nerve (C5, C6)
  • Nerve to subclavius (C5, C6)

Branches from the lateral cord

  • Lateral pectoral nerve. (C5, C6).
  • Musculocutaneous – (C5, C6, C7)
  • Lateral root of median nerve (C5, C6, C7).

Branches from the medial cord

  • Medial pectoral nerve (C8, T1)
  • Medial cutaneous nerve of arm (C8,T1)
  • Medial cutaneous nerve of forearm (C8,T1)
  • Ulnar nerve(C7, C8, T1)
  • Medial root of median nerve (C8,T1)

Branches from the posterior cord

  • Axillary nerve (C5, C6)
  • Upper subscapular nerve (C5,C6)
  • Thoracodorsal nerve (C6, C7, C8).

Lower subscapular nerve (C5, C6)

Radial nerve (C5-T1).

Q. 9

All of the following are branches from the CORDS of brachial plexus EXCEPT:             

 A

Suprascapular nerve

 B

Upper subscapular nerve

 C

Lower subscapular nerve

 D

Lateral pectoral nerve

Q. 9

All of the following are branches from the CORDS of brachial plexus EXCEPT:             

 A

Suprascapular nerve

 B

Upper subscapular nerve

 C

Lower subscapular nerve

 D

Lateral pectoral nerve

Ans. A

Explanation:

Suprascapular nerve

Q. 10

Musculocutaneous nerve supplies all of the following EXCEPT:      

 A

Coracobrachialis

 B

Biceps brachii

 C

Brachialis

 D

Brachioradialis

Q. 10

Musculocutaneous nerve supplies all of the following EXCEPT:      

 A

Coracobrachialis

 B

Biceps brachii

 C

Brachialis

 D

Brachioradialis

Ans. A

Explanation:

Suprascapular nerve arises from the upper trunk (formed by the union of the fifth and sixth cervical nerves).

Q. 11

In a vehicle accident, the musculocutaneous nerve was completely severed, but still the person was able to weekly flex the elbow joint. All of the following muscles are responsible for this flexion, EXCEPT?

 A

Brachioradialis

 B

Flexor carpi radialis

 C

Ulnar head of Pronator teres

 D

Flexor carpi ulnaris

Q. 11

In a vehicle accident, the musculocutaneous nerve was completely severed, but still the person was able to weekly flex the elbow joint. All of the following muscles are responsible for this flexion, EXCEPT?

 A

Brachioradialis

 B

Flexor carpi radialis

 C

Ulnar head of Pronator teres

 D

Flexor carpi ulnaris

Ans. C

Explanation:

Muscles involved in elbow flexion are biceps brachii/biceps, brachialis, brachioradialis, extensor carpi radialis longus/ long radial extensor, pronator teres, palmaris longus, flexor carpi radialis and flexor carpi ulnaris.

Pronator teres has two heads a humeral and an ulnar head. The ulnar head arises from the medial border of coronoid process of ulna. And both the heads get united and the combined muscle passes obliquely across the proximal forearm for insertion into lateral surface of radius. This muscle is primarily involved in the rapid pronation movements of the forearm.

Q. 12

Froment test is positive in lesion of:

 A

Radial nerve

 B

Ulnar nerve

 C

Axillary nerve

 D

Median nerve

Q. 12

Froment test is positive in lesion of:

 A

Radial nerve

 B

Ulnar nerve

 C

Axillary nerve

 D

Median nerve

Ans. B

Explanation:

Froment sign

  • To perform the test, a patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject’s hands.
  • A normal individual will be able to maintain a hold on the object without difficulty.
  • However, with ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect.
  • Clinically, this compensation manifests as flexion of the IP joint of the thumb (rather than extension, as would occur with correct use of the adductor pollicis).
  • The compensation of the affected hand results in a weak pinch grip with the tips of the thumb and index finger, therefore, with the thumb in obvious flexion.
  • FPL is normally innervated by the anterior interosseous branch of the median nerve.
Q. 13

A 24 year old construction worker presents to his physician after an injury on the job. Physical examination is remarkable for marked flexion of the ring and little fingers of the left hand. Which of the following additional findings would most likely be found on physical examination?

 A

Loss of sensation on the back of the thumb

 B

Loss of sensation on the palmar side of the forefinger

 C

Wasting of the dorsal interosseous muscles

 D

Wasting of the thenar eminence

Q. 13

A 24 year old construction worker presents to his physician after an injury on the job. Physical examination is remarkable for marked flexion of the ring and little fingers of the left hand. Which of the following additional findings would most likely be found on physical examination?

 A

Loss of sensation on the back of the thumb

 B

Loss of sensation on the palmar side of the forefinger

 C

Wasting of the dorsal interosseous muscles

 D

Wasting of the thenar eminence

Ans. C

Explanation:

Clawing of the ring, forefinger and little fingers is characteristic of an ulnar nerve lesion. Ulnar nerve lesions can also produce wasting of the hypothenar eminence and dorsal interosseous muscles. The latter causes “guttering” between the extensor tendons on the back of the hand. Ulnar lesions also cause loss of sensation to the back of the little finger and half of the ring finger.
  • Sensation on the back of the thumb is provided by the radial nerve.
  • Sensation on the palmar side of the forefinger is provided by the median nerve. 
  • Wasting of the thenar eminence is associated with lesions of the median nerve.

 

Q. 14

A patient has a herniated intervertebral disc impinging on the right C5 nerve roots. Which of the following movements would most likely be affected?

 A

Extension of the fingers

 B

Extension of the shoulder

 C

Flexion of the elbow

 D

Flexion of the wrist

Q. 14

A patient has a herniated intervertebral disc impinging on the right C5 nerve roots. Which of the following movements would most likely be affected?

 A

Extension of the fingers

 B

Extension of the shoulder

 C

Flexion of the elbow

 D

Flexion of the wrist

Ans. C

Explanation:

C5 helps mediate flexion, abduction, and lateral rotation of the shoulder, and flexion of the elbow. Both C5 and C6 mediate extension of the elbow.
  • Extension of the fingers is mediated by C7 and 8.
  • Extension of the shoulder is mediated by C7 and 8.
  • Flexion of the wrist is mediated by C6 and 7.
Q. 15

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient?

 A

Musculocutaneous nerve

 B

Median nerve

 C

Ulnar nerve

 D

Radial nerve

Q. 15

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient?

 A

Musculocutaneous nerve

 B

Median nerve

 C

Ulnar nerve

 D

Radial nerve

Ans. B

Explanation:

Carpal tunnel syndrome is caused by swelling of the flexor digitorum superficialis, profundus, and flexor pollicis longus tendons, resulting in pressure on the median nerve. Repetitive motions of the fingers and wrist, hormonal changes, and vibration can be causes of tendon swelling. It results in tingling, numbness, and pain in the cutaneous distribution of the median nerve (lateral side). In more severe cases, atrophy of the thenar eminence may be present.
Q. 16

All of the following bony structures forms the floor of the anatomic snuff box, EXCEPT?

 A

Scaphoid

 B

Lunate

 C

Trapezium

 D

Base of first metacarpal bone

Q. 16

All of the following bony structures forms the floor of the anatomic snuff box, EXCEPT?

 A

Scaphoid

 B

Lunate

 C

Trapezium

 D

Base of first metacarpal bone

Ans. B

Explanation:

The floor of anatomic snuff box is formed by the following bones in the proximal to distal order, styloid process of radius, scaphoid, trapezium and base of first metacarpal.
 
Anatomical snuff box is a hollow space which appears on the lateral side of the posterolateral side of the wrist in the fully extended position of the thumb. Radial artery passes through the anatomic snuff box to the dorsum of the hand.
 
Boundaries are formed by:
  • Ulnar side by the extensor pollicis longus tendon
  • Radial side by the tendon of abductor pollicis longus, and extensor pollicis brevis.
  • Fascial roof contains the cephalic vein and superficial branch of radial nerve.
Q. 17

A patient presents to the clinic with pain in the right hand following a fall. Xray of right upper limb reveals fracture of the medial epicondyle of humerus. Which of the following nerve is most liked to be damaged in this patient?

 A

Radial nerve

 B

Ulnar nerve

 C

Median nerve

 D

Musculocutaneous nerve

Q. 17

A patient presents to the clinic with pain in the right hand following a fall. Xray of right upper limb reveals fracture of the medial epicondyle of humerus. Which of the following nerve is most liked to be damaged in this patient?

 A

Radial nerve

 B

Ulnar nerve

 C

Median nerve

 D

Musculocutaneous nerve

Ans. B

Explanation:

Ulnar nerve is related to the posterior aspect of medial epicondyle and it is injured in case of fracture of the medial epicondyle.
  • The axillary nerve is related to the surgical neck of humerus and is damaged in fracture of the surgical neck and in anterior dislocation of the humeral head.
  • The radial nerve is related to the posterior aspect of shaft at the spiral groove, hence it is injured in fracture of mid shaft of the humerus and also following careless injection into the triceps muscle.
Q. 18

The fourth dorsal interosseous muscle is innervated by?

 A

Recurrent (motor) branch of the median nerve

 B

Deep branch of the ulnar nerve

 C

Dorsal branch of the ulnar nerve

 D

Superficial branch of the radial nerve

Q. 18

The fourth dorsal interosseous muscle is innervated by?

 A

Recurrent (motor) branch of the median nerve

 B

Deep branch of the ulnar nerve

 C

Dorsal branch of the ulnar nerve

 D

Superficial branch of the radial nerve

Ans. B

Explanation:

 
The deep branch of the ulnar nerve innervates the intrinsic muscles of the hand (with the exception of the thenar compartment). This includes the dorsal interosseous muscles, the palmar interosseous muscles, the two lumbrical muscles on the medial side of the hand, and the muscles to the 5th digit (digiti minimi). The dorsal branch of the ulnar nerve innervates the skin of the dorsal surface of the medial 1.5 digits and the skin of the medial side of the back of the hand.

The recurrent motor branch of the median nerve innervates the thenar compartment. The superficial branch of the radial nerve provides sensory innervation to the skin on the radial side of the dorsum of the hand, including the radial 3.5 digits. Finally, the superficial branch of the ulnar nerve innervates the skin of the palmar surface of the medial 1.5 digits as well as the skin of the medial side of the front of the hand. 

Q. 19

Neurological testing of a patient reveals no cutaneous sensation on the tip of the index finger. Such a finding would indicate injury to some portion of which nerve?

 A

Axillary

 B

Median

 C

Musculocutaneous

 D

Radial

Q. 19

Neurological testing of a patient reveals no cutaneous sensation on the tip of the index finger. Such a finding would indicate injury to some portion of which nerve?

 A

Axillary

 B

Median

 C

Musculocutaneous

 D

Radial

Ans. B

Explanation:

The median nerve provides cutaneous innervation to the skin of the radial half of the palm and palmar side of the lateral 3 1/2 digits. It also supplies the tips of these fingers and the nail beds on the dorsal side of the hand. So, cutaneous sensation at the tip of the index finger is supplied by the median nerve. The radial nerve supplies cutaneous innervation to the skin of the radial half of the dorsum of the hand and the dorsal side of the lateral 3 1/2 digits, stopping at the nail bed. This nerve is not innervating the tip of the finger.

The ulnar nerve supplies the skin of the medial side of the wrist and hand (on both the dorsal and palmar sides of the hand), as well as the skin of the medial 1 1/2 digits. The axillary nerve supplies some cutaneous sensation in the upper arm, and the musculocutaneous nerve supplies cutaneous sensation to the anterolateral forearm through the lateral antebrachial cutaneous nerve. 

Q. 20

In withdrawing a blood sample from the median cubital vein the needle passes slightly deep and medial; which nerve might possibly be injured?

 A

Dorsal ulnar cutaneous

 B

Lateral antebrachial cutaneous

 C

Medial antebrachial cutaneous

 D

Posterior antebrachial cutaneous

Q. 20

In withdrawing a blood sample from the median cubital vein the needle passes slightly deep and medial; which nerve might possibly be injured?

 A

Dorsal ulnar cutaneous

 B

Lateral antebrachial cutaneous

 C

Medial antebrachial cutaneous

 D

Posterior antebrachial cutaneous

Ans. C

Explanation:

The medial antebrachial cutaneous nerve is a direct branch from the medial cord of the brachial plexus. Since it provides cutaneous sensation to the medial side of the anterior forearm, it is slightly medial to the medial cubital vein and could be injured by a needle. If the needle had gone laterally, it might have injured the lateral antebrachial cutaneous nerve, which is running down the lateral side of the anterior forearm. This nerve is a branch of the musculocutaneous nerve.

The posterior antebrachial cutaneous nerve runs on the posterior surface of the arm. It comes from the radial nerve. The dorsal ulnar cutaneous nerve is the nerve which runs on the dorsal side of the hand, providing cutaneous innervation to the ulnar side of the wrist, hand, and the medial 1.5 fingers. Finally, the superficial radial nerve innervates the dorsum of the radial side of the hand. 

Q. 21

A 32 year old man visits his physician and is diagnosed with a herniated disc impinging the spinal nerve that exits inferior to the C6 vertebra. Pain from the impinged nerve would most likely radiate to which cutaneous region?

 A

Lateral shoulder

 B

Lateral surface of digit 5

 C

Medial surface of the elbow

 D

Palmar surface of digit 3

Q. 21

A 32 year old man visits his physician and is diagnosed with a herniated disc impinging the spinal nerve that exits inferior to the C6 vertebra. Pain from the impinged nerve would most likely radiate to which cutaneous region?

 A

Lateral shoulder

 B

Lateral surface of digit 5

 C

Medial surface of the elbow

 D

Palmar surface of digit 3

Ans. B

Explanation:

The C7 spinal nerve exits inferior to the C6 vertebra. The C7 dermatome is associated with digit 5, and therefore, pain would radiate to the lateral surface of digit 5.

Q. 22

A patient presented with numbness of little and ring finger, atrophy of hypothenar muscles. The nerve damaged will be?

 A

Palmar cutaneous branch of ulnar

 B

Deep branch of ulnar

 C

Ulnar nerve before division into superficial and deep branches

 D

Posterior cord of brachial plexus

Q. 22

A patient presented with numbness of little and ring finger, atrophy of hypothenar muscles. The nerve damaged will be?

 A

Palmar cutaneous branch of ulnar

 B

Deep branch of ulnar

 C

Ulnar nerve before division into superficial and deep branches

 D

Posterior cord of brachial plexus

Ans. C

Explanation:

This is a case of cubital tunnel syndrome, which is caused by compression or irritation of the ulnar nerve as it passes under the medial epicondyle before it branches to deep and superficial branches. Symptoms are usually tingling and numbness in the cutaneous distribution of the ulnar nerve. In severe cases, muscle weakness may be apparent, with atrophy of the hypothenar eminence.

Also know:
Deep branch of ulnar nerve supplies:
  • Hypothenar compartment
  • Adductor pollicis
  • Dorsal interossei
  • Palmar interossei
  • Medial lumbricals
Superficial branch of ulnar nerve supplies:
  • Palmaris brevis 
  • Surrounding skin of the digit 5 and the medial side of digit 4
Q. 23

TRUE/FALSE about peripheral nerve injuries in upper limb are:

1. Radial nerve injury cause anaesthesia over anatomical snuff box
2. Medial nerve cause wrist drop
3. Ulnar nerve causes claw hand
4. Index finger anesthesia is caused by median nerve injury
5. Thumb anesthesia is caused by ulnar nerve injury

 

 A

1,2,3 true & 4,5 false

 B

2,3,4 true & 1,5 false

 C

1,3,4 true & 2,5 false

 D

1,2 false & 3,4,5 true

Q. 23

TRUE/FALSE about peripheral nerve injuries in upper limb are:

1. Radial nerve injury cause anaesthesia over anatomical snuff box
2. Medial nerve cause wrist drop
3. Ulnar nerve causes claw hand
4. Index finger anesthesia is caused by median nerve injury
5. Thumb anesthesia is caused by ulnar nerve injury

 

 A

1,2,3 true & 4,5 false

 B

2,3,4 true & 1,5 false

 C

1,3,4 true & 2,5 false

 D

1,2 false & 3,4,5 true

Ans. C

Explanation:

Options 1 (true)
The cutaneous branch of the radial nerve supply the skin over anatomical snuff box, as such radial nerve injury causes anaesthesia over anatomical snuff box.

Option 2 (false)
Paralysis of the extensor muscles of the forearm produces wrist drop. This is usually due to the radial nerve above the level of origin of posterior interosseous nerve, e.g. in axilla and arm.
Option 3 (true)
Claw hand can be produced by many lesions, including lesions of ulnar nerve, a combined lesions of ulnar nerve and median nerves, klumpke’s paralysis, lesion of the medial cord of brachial plexus.
Option 4 (true) and 5 (false)
Lateral three and half digits (palmar aspect of middle and distal phalanges) are supplied by median nerve.
 
Lateral half of dorsum of hand including proximal phalanges of lateral two and half digits is supplied by radial nerve.
Q. 24

Deep branch of ulnar nerve supplies?

 A

Adductor Pollicis,1st lumbrical

 B

Flexor digitorum superficialis, Palmer brevis

 C

1st lumbrical, 3rd lumbrical

 D

3rd lumbrical, Adductor Pollicis

Q. 24

Deep branch of ulnar nerve supplies?

 A

Adductor Pollicis,1st lumbrical

 B

Flexor digitorum superficialis, Palmer brevis

 C

1st lumbrical, 3rd lumbrical

 D

3rd lumbrical, Adductor Pollicis

Ans. D

Explanation:

“Flexor digitorum superficialis is supplied by median nerve”

“The 1st and 2nd lumbricals are supplied by median nerve”

Ulnar nerve in hand is divided into deep and superficial terminal branches. Deep branch give further muscular branches to muscle of hypothenar eminences( abductor digiti minimi, flexor digiti minimi and opponens digiti minimi), medial two lumbrical (3rd and 4th), 8th interossei, adductor pollicis and occasionally deep head of the flexor pollicis brevis. Articular branch from deep terminal branch supplies wrist joint.

Superficial terminal branch gives muscular branch to palmaris brevis and cutaneous branches which supplies medial one and half fingers with nail beds.
Q. 25

Lesions of the musculocutaneous nerve can result in all of the following, EXCEPT?

 A

Impaired sensation on the volar aspect of forearm

 B

Weakness in flexion of pronated forearm

 C

Wasting of coracobrachialis muscle

 D

Wasting of biceps brachii muscle

Q. 25

Lesions of the musculocutaneous nerve can result in all of the following, EXCEPT?

 A

Impaired sensation on the volar aspect of forearm

 B

Weakness in flexion of pronated forearm

 C

Wasting of coracobrachialis muscle

 D

Wasting of biceps brachii muscle

Ans. B

Explanation:

Weakness of flexion of supinated forearm (not pronated) is a possibility in the nerve lesion of musculocutaneous nerve. 

Must know – Musculocutaneous nerve is a branch of the lateral cord of the brachial plexus and innervates the biceps brachii, brachialis, and coracobrachialis muscles. The origin of this nerve is from the fifth and sixth cervical roots. 

Motor: Lesions of the nerve result in wasting of these muscles and weakness of flexion of the supinated forearm. 

Sensory: Sensation may be impaired along the radial and volar aspects of the forearm (lateral cutaneous nerve). Isolated lesions of this nerve are usually the result of fracture of the humerus.

Q. 26

Which of the following is not a branch of the posterior cord of brachial plexus?

 A

Thoracodorsal nerve

 B

Axillary nerve

 C

Lower subscapular nerve

 D

Ulnar nerve

Q. 26

Which of the following is not a branch of the posterior cord of brachial plexus?

 A

Thoracodorsal nerve

 B

Axillary nerve

 C

Lower subscapular nerve

 D

Ulnar nerve

Ans. D

Explanation:

Ans:D.)Ulnar Nerve.

Cords of Branchial Plexus:

 

LATERAL CORD LATERAL PECTORAL NERVE C5,C6,C7 PECTORALIS MAJOR          –
LATERAL CORD MUSCULOCUTANEOUS NERVE C5,C6,C7

CORACOBRACHIALIS , BRACHIALIS,

         BICEPS BRACHII

LATERAL CUTANEOUS 

    OF FOREARM

LATERAL CORD

LATERAL ROOT OF

   MEDIAN NERVE

C5,C6,C7

FIBERS TO MEDIAN NERVE(Flexion muscle)

        –

POSTERIOR CORD UPPER SUBSCAPULAR NERVE C5,C6 SUBSCAPULARIS (UPPER PART)         –
POSTERIOR CORD THORACODORSAL NERVE C6,C7,C8 LATISSIMUS DORSI         –
POSTERIOR CORD LOWER SUBSCAPULAR NERVE C5,C6

SUBSCAPULARIS(LOWER PART),

TERES MAJOR

        –
POSTERIOR CORD AXILARY NERVE C5,C6

ANT. BRANCH:DELTOID

POST. BRANCH:TERES MINOR, DELTOID

 POST BRANCH – UPPER LATERAL

CUTANEOUS NERVE OF ARM

POSTERIOR CORD RADIAL NERVE C5,C6,C7,C8,T1

 TRICEPS BRACHII,SUPINATOR, ANCONEUS

EXTENSOR OF FOREARM, BRACHIORADIALIS

 POSTERIOR CUTANEOUS

     NERVE OF ARM

MEDIAL CORD MEDIAL PECTORAL NERVE C8,T1   PECTORALIS MAJOR,PECTORALIS MINOR          –
MEDIAL CORD MEDIAL ROOT OF MEDIAN NERVE C8,T1 FIBERS TO MEDIAN NERVE( Flexion muscle)

PART OF HAND NOT SUPPLIED

BY ULNAR OR RADIAL

MEDIAL CORD MEDIAL CUTANEOUS NERVE OF ARM C8,T1              – FRONT AND MEDIAL SKIN OF ARM
MEDIAL CORD MEDIAL CUTANEOUS NERVE OF ARM C8,T1              – MEDIAL SKIN OF FOREARM
MEDIAL CORD ULNAR NERVE C8,T1

FLEXOR CARPII ULNARIS, 2 MEDIAL BELLIES

OF FLEXOR DIGITORUM PROFUNDUS,INTRINSIC

HAND MUSCLE EXCEPT THENAR,2 LATERAL 

MOST LUMBRICUS

SKIN OF MEDIAL SIDE OF HAND

MEDIAL 1/2 FINGERS ON 

PALMAR SIDE, MEDIAL 21/2

FINGER ON DORSAL SIDE


Q. 27

A 23 year old man involved in a RTA and is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in his both arms as well as the inability to move part of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal.Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?

 A

Biceps

 B

Extensor carpi radialis longus

 C

Flexor carpi radialis

 D

Flexor carpi ulnaris

Q. 27

A 23 year old man involved in a RTA and is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in his both arms as well as the inability to move part of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal.Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?

 A

Biceps

 B

Extensor carpi radialis longus

 C

Flexor carpi radialis

 D

Flexor carpi ulnaris

Ans. B

Explanation:

  • The radial nerve innervates the triceps, brachioradialis, wrist and finger extensors, and supinator. The extensor carpi radialis longus is a wrist extensor and is innervated by the radial nerve.
  • The biceps muscles are innervated by the musculocutaneous nerve.
  • The flexor carpi radialis is innervated by the median nerve. 
  • The flexor carpi ulnaris is innervated by the ulnar nerve.
Q. 28

A 57 year old woman presents to her family physician complaining of numbness and tingling in her right thumb, index and long finger for the past four weeks. She reports that she wakes up in the middle of the night with these symptoms and needs to shake her hands to “wake” them up. She denies numbness or tingling in her other hand or either leg. She has no neck or upper arm pain. On physical examination, her symptoms are reproduced by Tinel testing. Her symptoms are also exacerbated by hyperflexion of the wrist. There is decreased sensation over the palmar aspects of the thumb, index and middle fingers. There is no apparent motor weakness. Which of the following is the most likely diagnosis?

 A

C5 cervical nerve root compression

 B

Carpal tunnel syndrome

 C

Cubital tunnel syndrome

 D

Radial tunnel syndrome

Q. 28

A 57 year old woman presents to her family physician complaining of numbness and tingling in her right thumb, index and long finger for the past four weeks. She reports that she wakes up in the middle of the night with these symptoms and needs to shake her hands to “wake” them up. She denies numbness or tingling in her other hand or either leg. She has no neck or upper arm pain. On physical examination, her symptoms are reproduced by Tinel testing. Her symptoms are also exacerbated by hyperflexion of the wrist. There is decreased sensation over the palmar aspects of the thumb, index and middle fingers. There is no apparent motor weakness. Which of the following is the most likely diagnosis?

 A

C5 cervical nerve root compression

 B

Carpal tunnel syndrome

 C

Cubital tunnel syndrome

 D

Radial tunnel syndrome

Ans. B

Explanation:

The patient’s symptoms are classic for carpal tunnel syndrome. Carpal tunnel syndrome is the most common compressive neuropathy in the upper extremity. It is caused by compression of the median nerve in the carpal tunnel. The median nerve provides sensation to the palmar side of the thumb, index finger, long finger and radial half of the ring finger. The floor of the tunnel is formed by the carpal bones; the roof is formed by the transverse carpal ligament.

  • A patient with a C5 nerve cervical nerve root compression would have weakness in their deltoids and biceps with sensory changes in the lateral arm.
  • Cubital tunnel syndrome is compression of the ulnar nerve at the elbow. Symptoms include pain and paresthesias over the medial forearm and hand as well as weakness in the ulnar nerve distribution.
  • Radial tunnel syndrome is compression of a branch of the radial nerve at the forearm. It is a pain-only problem without motor or sensory changes. 
Q. 29

All of the following features can be observed after the injury to axillary nerve, EXCEPT?

 A

Atrophy of deltoid muscle

 B

Loss of overhead abduction

 C

Loss of rounded contour of shoulder

 D

Loss of sensation along lateral side of upper arm

Q. 29

All of the following features can be observed after the injury to axillary nerve, EXCEPT?

 A

Atrophy of deltoid muscle

 B

Loss of overhead abduction

 C

Loss of rounded contour of shoulder

 D

Loss of sensation along lateral side of upper arm

Ans. B

Explanation:

Axillary nerve originates from the posterior cord of brachial plexus C5,6. It supplies deltoid and teres minor muscles, shoulder joint and a patch of skin in the so called regimental badge area of the arm. Deltoid helps in abduction of the arm above 15 degree, Teres minor helps in the lateral rotation of the arm at the glenohumeral joint.

Most common cause of axillary nerve injury is traction on the nerve during an anterior shoulder dislocation or during surgery in the shoulder joint region. Axillary nerve damage result in atrophy of deltoid muscle resulting in loss of rounded contour of the shoulder, inability to abduct arm above 15 degree and loss of sensation along lateral side of upper arm.

Q. 30

Injury to radial nerve in lower part of spiral groove result in which of the following?

 A

Weakens pronation movement

 B

Results in paralysis of anconeus muscle

 C

Leaves extension at the elbow joint intact

 D

Spares nerve supply to extensor carpi radialis longus

Q. 30

Injury to radial nerve in lower part of spiral groove result in which of the following?

 A

Weakens pronation movement

 B

Results in paralysis of anconeus muscle

 C

Leaves extension at the elbow joint intact

 D

Spares nerve supply to extensor carpi radialis longus

Ans. B

Explanation:

Ans:B.)Results in paralysis of anconeus muscle.

RADIAL NERVE

(1) Before entering the spiral groove, radial nerve supplies the long and medial heads of the triceps.
(2) In the spiral groove, it supplies the lateral and medial heads of the triceps and the anconeus. 
(3) Below the radial groove, on the front of the arm, it supplies the brachialis with proprioceptive fibres, the brachioradialis, and the extensor carp radialis longus.
The radial nerve is very commonly damaged in region of the radial (spiral) groove. The common causes of injury are: (i) intramuscular injections in the arm (triceps), (ii) sleeping in an armchair with the limb hanging by the side of the chair (Saturday night palsy), or even the pressure by crutch (crutch paralysis), and (iii) fractures of the shaft of the humerus. This results in the weakness or loss of power of extension at the wrist (wrist drop) and sensory loss over a narrow strip on the back of forearm, and on the lateral side of the dorsum of the hand.


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Description

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. 


Instruction

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. Keep the following in mind:

  • Multiple Attempts – You will have three attempts for this quiz with your highest score being recorded in the grade book.
  • Timing – You will need to complete each of your attempts in one sitting, as you are allotted 30 minutes to complete each attempt.
  • Answers – You may review your answer-choices and compare them to the correct answers after your final attempt.

To start, click the “Take the Quiz” button. When finished, click the “Submit Quiz” button.


Time Left: 30:00
Q. 1

Characteristic features of Rokitansky — Kuster Hauser syndrome are all of the following except :

 A

Absent uterus

 B

Absent vagina

 C

Anovulation

 D

46 — XX

Q. 1

Characteristic features of Rokitansky — Kuster Hauser syndrome are all of the following except :

 A

Absent uterus

 B

Absent vagina

 C

Anovulation

 D

46 — XX

Ans. C

Explanation:

Anovulation

Mayer Rokitansky Kuser Syndrome (MRKH) is the complete failure in the development of the mullerian ducts resulting in absence of the fallopian tubes, uterus and most of vagina° (as of vagina is formed by Mullerian duct).

Mayer Rokitansky-Kuster Hauser syndrome

Karyotype = 46 XX°

Phenotype = Female

Associated abnormalities are :

  • Renal ectopy and agenesis (Horse shoe shaped kidney)°
  • Skeletal abnormalities° (most common – scoliosis)
  • Cardiac anomalies.°

Clinical features :

  • Patient present between 15-18 years of age with primary amenorrhoea.° (eugonadotropic amenorrhea).
  • Secondary sexual characteristics are normal° as ovaries are normal (because of their separate embryonic origin, so ovulation is also normal.)
  • P/V = Vagina is felt like a blind pouch and uterus is absent.°
  • Findings are confirmed by USG.°
  • Ideal method for demonstrating Uterine malformations is MRI.°

Management :

  • Repair of vaginal agenesis done either by frank dilatation or vaginoplasty.
  • Vaginoplast should onl be performed when the girls is just married or about to be marripri  

Frank Dilatation :

This non-surgical procedure consists of a woman applying gradual pressure with progressively increasing dilators over the mullerian pit for 15 minutes twice a day. An indentation is created by the end of 3 to 6 month. Some have satisfactory intercourse, but in many, vaginal size is inadequate and they need a surgical procedure eventually.

Surgical management : Vaginoplasty either by Mc Indoe operation

Differential Diagnosis :

  • Testicular feminization syndrome.
  • Mayer Rokitansky-Kuster Hauser syndrome can be differentiated from testicular feminizing syndrome on the basis of :
Q. 2

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Q. 2

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Ans. D

Explanation:

None

Q. 3

The Colposcopic features suggestive of malig­nancy are all except :

 A

Condyloma

 B

Vascular atypia

 C

Punctation

 D

White epithelium

Q. 3

The Colposcopic features suggestive of malig­nancy are all except :

 A

Condyloma

 B

Vascular atypia

 C

Punctation

 D

White epithelium

Ans. D

Explanation:

White epithelium

Q. 4

Metropathica hemorrhagica is best treated by :

 A

Curettage of uterus

 B

Progestogen

 C

Estrogen

 D

Clomiphene

Q. 4

Metropathica hemorrhagica is best treated by :

 A

Curettage of uterus

 B

Progestogen

 C

Estrogen

 D

Clomiphene

Ans. B

Explanation:

Ans. is b i.e. Progestogen    

Metropathia hemorrhagica is a specialised form of DUB. Mostly seen in premenopausal women.

Maximum age incidence : between ages 40 – 45 years.

Pathology :

Changes in the Uterus : Symmetrical enlargement of the uterus to a size of 8 – 10 weeks due to hypertrophy of muscles.

Changes in Endometrium : Naked eye appearance : Endometrium looks thick, congested and often polypoidal.

Microscopic appearance :

  • Hyperplasia of all endometrial components.
  • Intense cystic glandular hypertrophy.
  • Some glands are small and some large giving appearance of “swiss cheese°.
  • Glands are empty and lined by columnar epithelium.
  • Secretory changes are absent.°
  • Follicular cysts containing estrogen present on ovaries.

Sign and Symptom : Patient complains of excessive painless bleeding (Anovular bleeding).

Treatment :

  • In DUB due to anovular causes : Progesterones are the mainstay of therapy.
  • They diminish the effects of estrogen on target cells by inhibiting oestrogen receptors.

To stop Acute severe bleeding :

  • Norethisterone (5 mg tab.) is given thrice daily till bleeding stops. Then norethisterone is stopped resulting in withdrawl bleeding (after 2-4 day). This is called as Medical curettage.
  • Thereafter cyclical progesterone – MPA (Medroxy Progesterone Acetate) 10 mg or Norethisterone 5 mg is given from day 5 – day 25 of the cycle for 3 cycles.
Q. 5

First site to be affected in genital tuberculosis :

 A

Ovary

 B

Cervix

 C

Fallopian tube

 D

Vagina

Q. 5

First site to be affected in genital tuberculosis :

 A

Ovary

 B

Cervix

 C

Fallopian tube

 D

Vagina

Ans. C

Explanation:

Fallopian tube

Q. 6

Transverse vaginal septum corresponds to :

 A

External Os

 B

Vesical neck

 C

Bladder base

 D

Hymen

Q. 6

Transverse vaginal septum corresponds to :

 A

External Os

 B

Vesical neck

 C

Bladder base

 D

Hymen

Ans. A

Explanation:

External Os

If there is a disorder in fusion of downgrowing Mullerian duct and upgrowing derivative of urogenital sinus. It results in Transverse vaginal septum which causes imperforate vagina (or vaginal agenesis).

In a series reported :

–       46% septa were located in upper part.° Ott ti2v-a        

–       40% septa were located in middle part.°

–       14% septa were located in lower part.°

The upper part corresponds to external os therefore it is the option of choice.

Transverse vaginal septum can present either  in :

A. Neonatal age group ?

  • The placental transfer of estrogen results in stimulatin the •lands of the endocervix which results in formation of Mucocolpos it can present as :
  1. abdominal tumour.°
  2. can compress the ureter resulting in hydroureter followed by hydronephrosis.°
  3. can compress the rectum resultina in obstioation / intestinal obstruction.°

B. At puberty ?

  • Patient can present with Primary amenorrhea (actually called as Cryptomenorrheaa as uterus menstruates normally but blood does not come out due to outflow Tract obstruction).°
  • Secondary sexual characteristics are normal.°
  • Due to Cryptomenorrhoea, blood gradually collects and distends first the vagina (hematocolpos)° then cervix uterus (hematocervix and hematometra) and finally the tube (hematosaipinx)°. All these present as pelvic/ abdominal tumour.
  • The abdominal tumour can irritate the bladder followed by compression of internal urinary meatus leading to

complete retention of urine (This occurs 3 – 4 years after the onset of hidden menstruation and therefore patient is generally aged 15 – 18 years°).

  • Patient may complain of monthly cyclic pain (backache I lower abdomen pain).°

Management ?

  • Once the diagnosis of cryptomenorrhea is made, surgical treatment is urgently required° since every menstrual episode further dilates the genital tract and threatens permanent impairment of reproductive function.
  • Obstruction at the level of the cervix is managed by uterovaginoplasty. If uterovaginoplasty is unsuccessful hysterectomy is performed.
  • When the outflow menstrual blood is prevented by a thick vaginal membrane at any level, incision followed

by covering the deficiency with either vaginal epithelium or skin grafting is done.

  • When the obstructing membrane is thin and low down, the membrane is merely excised.°
Q. 7

All of the following are features of mullerian agenesis except :

 A

46 XX karyotype

 B

Normal breast development

 C

Absent vagina

 D

Ovarian agenesis

Q. 7

All of the following are features of mullerian agenesis except :

 A

46 XX karyotype

 B

Normal breast development

 C

Absent vagina

 D

Ovarian agenesis

Ans. D

Explanation:

Ans:D.)Ovarian agenesis

Mullerian agenesis

  • It is Mayer Rokitansky-Kuster Hauser syndrome. .
  • Müllerian agenesis is a congenital malformation characterized by a failure of the Müllerian duct to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. Müllerian agenesis (including absence of the uterus, cervix and/or vagina) is the cause in 15% of cases of primary amenorrhoea.
  • Because ovaries do not develop from the Müllerian ducts, affected women might have normal secondary sexual characteristics but are infertile due to the lack of a functional uterus.

Signs and Symptoms:

  • An individual with this condition is hormonally normal; that is, the person will enter puberty with development of secondary sexual characteristics including thelarche and adrenarche (pubic hair). The person’s chromosome constellation will be 46,XX. At least one ovary is intact, if not both, and ovulation usually occurs. Typically, the vagina is shortened and intercourse may, in some cases, be difficult and painful. Medical examination supported by gynecologic ultrasonography demonstrates a complete or partial absence of the cervix, uterus, and vagina.

Classification:

  • Typical MRKH – Isolated uterovaginal aplasia/hypoplasia
    • Prevalence – 64 percent
  • Atypical MRKH – Uterovaginal aplasia/hypoplasia with renal malformation or uterovaginal aplasia/hypoplasia with ovarian dysfunction
    • Prevalence – 24 percent
  • MURCS syndrome – Uterovaginal aplasia/hypoplasia with renal malformation, skeletal malformation, and cardiac malformation
    • Prevalence – 12 percent
Q. 8

Find the wrong match :

 A

Brenner’s tumor – puffed wheat nuclei

 B

Krukenberg tumor – Signet ring appearance

 C

Granulosa cell tumor – Cell exner bodies

 D

Gonadoblastoma – Reinke’s crystals

Q. 8

Find the wrong match :

 A

Brenner’s tumor – puffed wheat nuclei

 B

Krukenberg tumor – Signet ring appearance

 C

Granulosa cell tumor – Cell exner bodies

 D

Gonadoblastoma – Reinke’s crystals

Ans. D

Explanation:

Gonadoblastoma – Reinke’s crystals

Q. 9

In menopause, not seen is :

 A

↓ FSH

 B

Cholestsrol

 C

 Androgen

 D

↓ Cholesterol

Q. 9

In menopause, not seen is :

 A

↓ FSH

 B

Cholestsrol

 C

 Androgen

 D

↓ Cholesterol

Ans. A

Explanation:

↓ FSH

Q. 10

Ovulation occurs due to :

 A

Midcycle FSH surge

 B

High prolactin level

 C

Midcycle LH surge

 D

a and c both

Q. 10

Ovulation occurs due to :

 A

Midcycle FSH surge

 B

High prolactin level

 C

Midcycle LH surge

 D

a and c both

Ans. D

Explanation:

a and c both

Q. 11

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Q. 11

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Ans. A

Explanation:

FSH

Initiated by the release of FSH (From Anterior pituitary)
FSH stimulates the Growth of Multiple Follicles (Folliculogenesis)

Selection of a dominant Follicle (Graffian Follicle), by day 5-7.
Graffian Follicle acquires FSH receptors on Granulosa cells and LH receptors on Theca cell.
Under the influence of FSH, Graffian follicle secretes 178 estradiol (Day 7)
178 estradiol causes

4,                                                                   i                                                                    4,

Proliferative changes              Negative feedback on FSH                    Positive feedback on LH therefore

in the endometrium                                                                                      LH increases in amount.

Decreased Amount of FSH                      Increased LH leads to :

 

 

Production of androgen from Theca cells

which is converted peripherally to estrogen therefore Estrogen peak occurs (48 hours before ovulation)

LH surge (32-36 hours before ovulation) & LH peak (10-16 hours before ovulation) 1

Ovulation Occurs (14 days prior to next cycle)

Formation of corpus luteum & 2nd phase of ovulatory cycle i.e. Luteal Phase begins.

Secretes Progesterone

 

Stimulates Endometrium to undergo secretory changes 1.

In absence of Fertilisation corpus luteum degenerates

 

Oestradiol                          Progesterone                         Inhibin

(inhibin      FSH production)

(Leads to menstruation in menstrual

cycle) & will release the negative                         Increased FSH as

feedback on GnRH, therefore                               compared to LH increases GnRH pulses

L

Another follicular phase begins


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renu

Question.1

Structure derived from first pharyngeal arch:

NEET PG Jan-2019
A. Levator palatini
B. Buccinator
C. Stylohyoid
D. Anterior belly of digastric
Correct Ans: D
Explanation

Answer D.  Anterior belly of digastric

MESODERMAL DERIVATIVES OF PHARYNGEAL ARCHES


Scapula

SCAPULA


SCAPULA

  • Flat triangular bone overlapping second to seventh rib of the upper part of posterolateral chest wall.
  • Important features are:
  1. Inferior angle overlaps seventh rib or seventh intercostal space & lies opposite to tip of T7 spinous process.
  2. Superior angle lies opposite to tip of T2 spinous process.
  3. Lateral angle corresponds to glenoid fossa.
  4. Junction of medial (vertebral) border corresponds to tip of T3 spine.
  • The medial border, inferior angle and part of the lateral border of scapula can be palpated on a patient as can the spine and acromian.
  • The superior border and angle of the scapula are deep to soft tissue and are not readly palpable.
  • Triangle of Auscultation bounded by trapezius, lattismus dorsi and medial border of scapula, lies just medial to lower half of medial border.
  • Congenital high scapula is known as sprengel’s deformity. It is due to failure of normal descent of scapula during development.
 
MUSCLES ATTACHED TO SCAPULA:
 
  1. Coracoid process:  Tip of the coracoid process gives origin to coracobrachialis (medially) and short head of the biceps laterally.  The upper surface receives insertion of pectoralis minor.
  2. Spine of scapula and acromian process: There is origin of Deltoid and insertion of trapezius.
  3. Glenoid tubercle:  Supraglenoid tubercle gives origin to the long head of biceps and infra glenoid tubercle gives origin to long head of triceps.
  4. Lateral border:  Origins of teres minor & teres major.
  5. Medial border: Insertion of serratus anterior (anteriorly); & rhomboideus major, rhomboideus minor & levator scapulae (posteriorly).
  6. Costal (anterior) surface (origin): Subscapularis.
  7. Dorsal surface (origins): Supraspinatus, infraspinatus and at inferior angle latissimus dorsi.
 
 
MOVEMENTS OF SCAPULA:
 

MOVEMENTS OF SCAPULA

MUSCLES CAUSING MOVEMENTS

Elevation

  • Trapezius (upper part)
  • Levator scapulae

Depression

  • Pectoralis minor
  • Serratus anterior

Protraction

  • Serratus anterior
  • Pectoralis minor

Retraction

  • Rhomboideus major
  • Rhomboideus minor
  • Trapezius

Forward rotation of inferior    angle (for overhead abduction)

  • Trapezius (upper fibers)
  • Serratus anterior (lower fibers)

Backward rotation

  • Levator scapulae
  • Rhomboideus major & minor

 

Exam Question

  • Congenital elevation of scapula is called Sprengel shoulder.
  • Winging of scapula is seen in paralysis of Serratus anterior muscle.
  • Superior angle of scapula lies at T2 level.
  • Inferior angle of scapula lies at T7.
  • Superior border of scapula is non palpable.
  • Protractor of scapula is Serratus anterior.
Don’t Forget to Solve all the previous Year Question asked on SCAPULA

Scapula

SCAPULA

Q. 1

The muscles of scapula which function as retractors are given below, EXCEPT?

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Q. 1

The muscles of scapula which function as retractors are given below, EXCEPT?

 A

Trapezius

 B

Rhomboid major

 C

Rhomboid minor

 D

Levator scapulae

Ans. D

Explanation:

Three muscles make up of retractors of the scapula. They are,

  • Rhomboid major

  • Rhomboid minor (The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction)

  • Middle fibers of trapeziuscourse horizontally from the lower nuchal ligament and thoracic vertebrae to the scapula, causing scapular retraction.

 These muscles primarily tug the shoulder blade back toward the vertebral column. The levator scapula muscle is located deep to the trapezius muscle and superior to the rhomboids causing elevation and downward rotation of the scapula.


Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Q. 2

All of the following muscles elevate scapula, EXCEPT?

 A

Trapezius

 B

Levator scapulae

 C

Latissimus dorsi

 D

Rhomboid major

Ans. C

Explanation:

The latissimus dorsi acts on the humerus causing powerful adduction, extension, and medial rotation of the arm.

  • Superior fibers of the trapezius cause scapular elevation and upward rotation. Middle fibers causes scapular retraction. Inferior fibers causes scapular depression and upward rotation.
  • The levator scapula muscle attaches to the cervical vertebrae and the superior angle of the scapula, causing elevation and downward rotation of the scapula.
  • The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction also also helps in elevation of scapula.

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Q. 3

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Ans. C

Explanation:

Serratus anterior protracts the scapula, it acts as a main muscle in reaching and pushing movements. It also helps in raising the arm fully. The muscular digitations of serratus anterior can be seen and felt when the outstretched hand pushes against resistance. In case of paralysis, the lower angle of the scapula stands out prominently, there is projection of scapula also termed as winging of scapula.

Must know:

Seratus anterior is innervated by the long thoracic nerve also known as nerve of bell.

Good to know:

Dropped shoulder occurs as a result of paralysis of the trapezius muscle. With paralysis of the trapezius muscle a drop shoulder with rotation of the angle of the scapula towards the midline and restricted abduction of the arm is caused. Trapezius is supplied by accessory nerve.


Q. 4

All of the following muscles are used for the retraction of scapula, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 4

All of the following muscles are used for the retraction of scapula, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

The levator scapula muscle attaches to the cervical vertebrae and the superior angle of the scapula, causing elevation and downward rotation of the scapula.

 Trapezius elevates, retracts, depresses, and rotates scapula. The rhomboid muscles attach to the spinous processes of C7–T5 and the medial border of the scapula, resulting in scapular retraction. 

Q. 5

The spine of the scapula can be palpated at which of the following level of vertebrae?

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Q. 5

The spine of the scapula can be palpated at which of the following level of vertebrae?

 A

T 1

 B

T 3

 C

T 5

 D

T 7

Ans. B

Explanation:

Spine of the scapula lies at the level of T3 vertebrae. Scapular spine is seen on the posterior surface of the scapula and it expands into a terminal process called acromion process.

The scapulae overlie the posterior portion of the thoracic wall, and cover the upper seven ribs. The superior angle of scapula can be palpated at the T1 vertebral level and the inferior angle lies  at the level of T7 vertebrae.


Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Q. 6

Inferior angle of scapula lies at –

 A

T6

 B

T7

 C

T3

 D

T12

Ans. B

Explanation:

Important landmarks of scapula

i) Inferior angle overlaps seventh rib or seventh intercostal space and lies opposite to tip of T7 spinous process.

ii) Superior angle lies opposite to tip of T2 spinous process.

iii) Lateral angle corresponds to glenoid fossa.

iv) Junction of medial (vertebral) border corresponds to tip of T3 spine.


Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Q. 7

Which border of scapula is not palpable ‑

 A

Medial

 B

Lateral

 C

Inferior

 D

Superior

Ans. D

Explanation:

“The medial border, inferior angle and part of the lateral border of scapula can be palpated on a patient as can the spine and acromian. The superior border and angle of the scapula are deep to soft tissue and are not readly palpable”


Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Q. 8

Superior angle of scapula lies at which level ‑

 A

T7

 B

T12

 C

T2

 D

C5

Ans. C

Explanation:

Ans. is ‘c’ i.e., T2


Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Q. 9

Winging of scapula is seen in paralysis of which muscle‑

 A

Serratus anterior

 B

Supraspinatus

 C

Pectoralis major

 D

Infraspinatus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Serratus anterior


Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Q. 10

Congenital elevation of scapula is called ‑

 A

Sprengelshouder

 B

Bouchard

 C

Boutennier

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sprengel shoulder

Congenital high scapula (sprengel’s shoulder)

  • Congenital high scapula is an uncommon congenital deformity characterized by an abnormally high position and relative fixity of scapula.
  • The anomaly represents a failure of the scapula to descend during development to its normal thoracic position.

Q. 11

Patient presented with this condition of scapula in the clinic ,it is due involvement of?

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Q. 11

Patient presented with this condition of scapula in the clinic ,it is due involvement of?

 A

Medial pectoral nerve palsy

 B

Lateral pectoral nerve palsy

 C

Nerve to serratus anterior palsy

 D

Nerve to Latissimus dorsi palsy

Ans. C

Explanation:

Winging of scapula

  • The most common cause of scapular winging is serratus anterior paralysis.
  • This is typically caused by damage to the long thoracic nerve.
  • This nerve supplies the serratus anterior, which is located on the side of the thorax and acts to pull the scapula forward

Q. 12

All of the following muscles are used for this action of scapula as seen in image, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Q. 12

All of the following muscles are used for this action of scapula as seen in image, EXCEPT?

 A

Trapezius

 B

Rhomboideus major

 C

Rhomboideus minor

 D

Levator scapula

Ans. D

Explanation:

This action is retraction of scapula

  


Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Q. 13

Which muscle causes retraction of scapula ‑

 A

Serratus anterior

 B

Levator scapulae

 C

Rhomboideus major 

 D

Supraspinatus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rhomboideus major

Movements of scapula Muscles causing movements
Elevation Trapezius (upper part), levator scapulae
Depression Pectoralis minor, serratus anterior
Protraction Serratus anterior, pectoralis minor
Retraction Rhomboideus major Rhomboideus minor, Trapezius
Forward rotation of inferior angle(for overhead abduction) Trapezius (upper fibers), serratus anterior (lower fibers) 
Backward rotation Levator scapulae, rhomboideus major and minor

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Q. 14

Winging of scapula is due to which of these conditions?

 A

Long thoracic nerve pals

 B

Thoraco-dorsal nerve palsy

 C

Erb’s palsy

 D

Klumpke’s palsy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Long thoracic nerve palsy 



Image Based Question – 65941

Question

In the picture shown below, ligature mark is an example of ?

A. Contusion

B. Pressure abrasion.

C. Laceration

D. Burn

 

Show Answer

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