Category: Quiz

Muscles of facial expression

MUSCLES OF FACIAL EXPRESSION

Q. 1

The muscles acting upon the temporomandibular joint for various actions are given below, EXCEPT?

 A

Temporalis muscle

 B

Occipitofrontalis

 C

Masseter muscle

 D

Medial pterygoid muscle

Q. 1

The muscles acting upon the temporomandibular joint for various actions are given below, EXCEPT?

 A

Temporalis muscle

 B

Occipitofrontalis

 C

Masseter muscle

 D

Medial pterygoid muscle

Ans. B

Explanation:

The muscles acting upon the TMJ are primarily the muscles that generate the various movements associated with chewing; hence, these muscles are often called the muscles of mastication.
  • Temporalis muscle: The temporalis muscle elevates the mandible.
  • Masseter muscle: It elevates the mandible. It works functionally with the temporalis and pterygoid muscles to move the mandible at the TMJ, it is a muscle of mastication.
  • Lateral pterygoid muscle: Contraction causes the mandibular condyle and the articular disc to move anteriorly, resulting in both protraction and depression of the mandible. It works synergistically with the medial pterygoid muscle to move the mandible from side to side.
  • Medial pterygoid muscle: It elevates the mandible and moves it from side to side.

Q. 2

All of the following muscles are derived from Pharyngeal Arches, Except:

 A

Tensor Tympani

 B

Levator Palpebrae superioris

 C

Palatine Tensor

 D

Orbicularis oculi

Q. 2

All of the following muscles are derived from Pharyngeal Arches, Except:

 A

Tensor Tympani

 B

Levator Palpebrae superioris

 C

Palatine Tensor

 D

Orbicularis oculi

Ans. B

Explanation:

B i.e. Lavator palpebral superioris


Q. 3

All the following muscle are innervated by the facial nerve except:

 A

Occipito-frontalis

 B

Anterior belly of digastric

 C

Risorius

 D

Procerus

Q. 3

All the following muscle are innervated by the facial nerve except:

 A

Occipito-frontalis

 B

Anterior belly of digastric

 C

Risorius

 D

Procerus

Ans. B

Explanation:

 

Facial Nerve Supplies

  Facial muscles except levator palpebrae Superioris (Which is supplied by 3rd nerve).

  • Posterior belly of Digastric
  • Stapedius
  • Auricular muscles
  • Occipto Frontalis
  • Platysma
  • Stylohyoid

 


Q. 4

Which part of orbicularis oculi is known as Horner’s muscle:

 A

Orbital

 B

Lacrimal

 C

Temporal

 D

Muller’s muscle

Q. 4

Which part of orbicularis oculi is known as Horner’s muscle:

 A

Orbital

 B

Lacrimal

 C

Temporal

 D

Muller’s muscle

Ans. B

Explanation:

Ans. Lacrimal


Q. 5

Muscle which dilates the palpebral aperture:

 A

Orbicularis oculi

 B

Orbicularis oris

 C

Levator palpebrae superioris

 D

Levator labii superioris

Q. 5

Muscle which dilates the palpebral aperture:

 A

Orbicularis oculi

 B

Orbicularis oris

 C

Levator palpebrae superioris

 D

Levator labii superioris

Ans. C

Explanation:

The levator palpebrae superioris muscle elevates and retracts the upper eyelid.


Q. 6

False about facial muscles: 

 A

Dilates and constrict facial orifices

 B

Supplied by facial nerve

 C

Develops from 3rd pharyngeal arch

 D

They develop from mesoderm

Q. 6

False about facial muscles: 

 A

Dilates and constrict facial orifices

 B

Supplied by facial nerve

 C

Develops from 3rd pharyngeal arch

 D

They develop from mesoderm

Ans. C

Explanation:

The muscles of the face are embedded in the superficial fascia, and most arise from the bones of the skull and are inserted into the skin.

  • The orifices of the face, namely, the orbit, nose, and mouth, are guarded by the eyelids, nostrils, and lips, respectively.
  • It is the function of the facial muscles to serve as sphincters or dilators of these structures.
  • A secondary function of the facial muscles is to modify the expression of the face.
  • All the muscles of the face are developed from the second pharyngeal arch and are supplied by the facial nerve.

Q. 7

Identify the Muscle as marked No 5 in the Diagram 

Facial Muscles Image based question on NEET PG

 A

Buccinator

 B

Platysma

 C

Risorius

 D

None of the above

Q. 7

Identify the Muscle as marked No 5 in the Diagram 

Facial Muscles Image based question on NEET PG

 A

Buccinator

 B

Platysma

 C

Risorius

 D

None of the above

Ans. A

Explanation:

Most buccinator fibers insert anteriorly into the buccal mucosa and around the buccal muscle node (Modiolus).  

Opposite the upper second molar the buccinator muscle is pierced by the parotid duct. Numerous buccal glands of varying size are interspersed among the muscle fibers, and a few appear on the outer surface of the muscle. The buccal nerve pierces the buccinator muscle but does not innervate it.
 

Q. 8

Muscle of fascial expression, which is not supplied by facial nerve ‑

 A

Orbicularis oris

 B

Orbicularis oculi

 C

Frontalis

 D

Levator palpebrae superioris

Q. 8

Muscle of fascial expression, which is not supplied by facial nerve ‑

 A

Orbicularis oris

 B

Orbicularis oculi

 C

Frontalis

 D

Levator palpebrae superioris

Ans. D

Explanation:

Ans. is ‘d’ i.e., Levator palpebrae superioris

Nerve supply of face

  • Each half of the face is supplied by fourteen nerves, one is motor and the rest are sensory.
  • Motor supply is derived from facial (7″) nerve which supplies all facial muscles except levator palpeprae sperioris, which is supplied by sympathetic fibers and 3rd cranial nerve.
  • Eleven sensosry nerves are derived from branches of trigeminal (5th) nerve and only two sensory are derived from great auricular nerve and transverse (anterior) cutaneous nerve of neck.


Scalp & Superficial Temporal Regiion

SCALP & SUPERFICIAL TEMPORAL REGIION

Q. 1

 Which layer of scalp is vascular?

 A

Skin

 B

Subcutaneous tissue

 C

Aponeurosis

 D

Loose connective tissue

Q. 1

 Which layer of scalp is vascular?

 A

Skin

 B

Subcutaneous tissue

 C

Aponeurosis

 D

Loose connective tissue

Ans. B

Explanation:

Subcutaneous tissue 

The following mnemonic is a useful reminder of the anatomical layers in the scalp.

  • S – Skin, thin except in the occipital region, contains many sweat and sebaceous glands and hair follicles; it has an abundant arterial supply and good venous and lymphatic drainage 
  • C – Connective tissue, forming the thick, dense, richly vascularized, subcutaneous layer, is well supplied with cutaneous nerves
  • A – Aponeurosis (epicranial aponeurosis), a strong tendinous sheet that covers the calvaria, serves as the attachment for the frontal and occipital bellies of the occipitofrontalis muscle and the superior auricular muscle; collectively these structures form the musculoaponeurotic epicranius.
  • L – ‘AKA-Danger Zone” Loose connective tissue, a sponge-like layer, has potential spaces that may distend with fluid as a result of injury or infection; this layer allows free movement of the scalp proper (the first three layers) over the underlying calvaria.
  • P – Pericranium (periosteum of skull bones), a dense layer of connective tissue, forms the external periosteum of the neurocranium; it is firmly attached but can be stripped fairly easily from the calvaria

Q. 2

Which nerves supply scalp?

 A

Auriculotemporal

 B

Zygomaticotemoral

 C

Greater occipital

 D

All

Q. 2

Which nerves supply scalp?

 A

Auriculotemporal

 B

Zygomaticotemoral

 C

Greater occipital

 D

All

Ans. D

Explanation:

B i.e., Zygomaticotemporal C i.e., Greater occipital A i.e., Auriculotemporal


Q. 3

Lacerated wound appears as incised wound in which of the following sites:

 A

Scalp

 B

Tibial shin

 C

Anterior abodominal wall

 D

a and b

Q. 3

Lacerated wound appears as incised wound in which of the following sites:

 A

Scalp

 B

Tibial shin

 C

Anterior abodominal wall

 D

a and b

Ans. D

Explanation:

A i.e. Scalp; B i.e. Tibial shin


Q. 4

Lacerated wound looks like incised wound over:

 A

Scalp

 B

Abdomen

 C

Thigh

 D

Forearm

Q. 4

Lacerated wound looks like incised wound over:

 A

Scalp

 B

Abdomen

 C

Thigh

 D

Forearm

Ans. A

Explanation:

A i.e. Scalp


Q. 5

Haemostasis in scalp wound is best achived by ‑

 A

Direct presure over the wound 

 B

Catching and crushing the bleeders by haemostats

 C

Eversion of galea aponeurotica

 D

Coagulation of bleeders

Q. 5

Haemostasis in scalp wound is best achived by ‑

 A

Direct presure over the wound 

 B

Catching and crushing the bleeders by haemostats

 C

Eversion of galea aponeurotica

 D

Coagulation of bleeders

Ans. A

Explanation:

Ans. is ‘a’ i.e., Direct presure over the wound



Ophthalmic-v1-nerve

OPHTHALMIC (V1) NERVE

Q. 1

Pain sensations from the ethmoidal sinus are carried by:

 A

Frontal Nerve

 B

Lacrimal Nerve

 C

Nasociliary Nerve

 D

Infra orbital Nerve

Q. 1

Pain sensations from the ethmoidal sinus are carried by:

 A

Frontal Nerve

 B

Lacrimal Nerve

 C

Nasociliary Nerve

 D

Infra orbital Nerve

Ans. C

Explanation:

Pain sensations from the ethmoidal sinus are carried by Nasociliary Nerve.

The nasociliary nerve carries sensory fibers from the skin of the medial aspect of the upper and lower eyelids, the lateral aspect of the nose, the nasal septum, and the ethmoid sinus mucosa.


Q. 2

A HIV patient presented with herpes zoster ophthalmicus. Which of the following nerve is MOST commonly involved?

 A

Facial

 B

Ophthalmic

 C

Lacrimal

 D

Nasociliary

Q. 2

A HIV patient presented with herpes zoster ophthalmicus. Which of the following nerve is MOST commonly involved?

 A

Facial

 B

Ophthalmic

 C

Lacrimal

 D

Nasociliary

Ans. B

Explanation:

  • Varicella zoster virus lying dormant within the trigeminal ganglion can reactivate and spread through the ophthalmic division of the trigeminal nerve. 
  • While almost any ophthalmic abnormality can occur as a result, grouped vesicles in a dermatomal distribution are a classic finding. 
  • Skin lesions on the tip of the nose (Hutchinson sign) can indicate risk of ocular involvement, as this area is innervated by the nasociliary branch of the ophthalmic division of cranial nerve V.
 
Ref: Levsky M.E., DeFlorio P. (2010). Chapter 2. Ophthalmologic Conditions. In K.J. Knoop, L.B. Stack, A.B. Storrow, R.J. Thurman (Eds), The Atlas of Emergency Medicine, 3e.

Q. 3

Which of the following nerve is the largest branch of ophthalmic division of trigeminal nerve?

 A

Frontal nerve

 B

Lacrimal nerve

 C

Nasociliary nerve

 D

Long ciliary nerve

Q. 3

Which of the following nerve is the largest branch of ophthalmic division of trigeminal nerve?

 A

Frontal nerve

 B

Lacrimal nerve

 C

Nasociliary nerve

 D

Long ciliary nerve

Ans. A

Explanation:

The three branches of ophthalmic division of trigeminal nerve are lacrimal, frontal and nasociliary nerve. Frontal nerve is the largest of the three branches of ophthalmic division. It arise in the cavernous sinus just behind the superior orbital fissure through which it enters the orbit. The two branches of frontal nerve are supraorbital and supratrochlear nerve.
 
Lacrimal nerve is the smallest branch. It supplies the lacrimal gland, conjunctiva and skin of the lateral upper part of the upper lid. 
Nasociliary nerve is intermediate in size between the lacrimal and frontal nerve. Branches of it are:
  • Sensory root of sensory ganglion
  • Long ciliary nerves
  • Posterior ethmoidal nerve
  • Anterior ethmoidal nerve
  • Infratrochlear nerve
Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 346

Q. 4

Anterior ethmoidal artery closely related to which of the following structures in the anterior ethmoidal canal?

 A

Recurrent laryngeal nerve

 B

Nasociliary nerve

 C

Optic nerve

 D

Posterior ethmoidal artery

Q. 4

Anterior ethmoidal artery closely related to which of the following structures in the anterior ethmoidal canal?

 A

Recurrent laryngeal nerve

 B

Nasociliary nerve

 C

Optic nerve

 D

Posterior ethmoidal artery

Ans. B

Explanation:

The anterior ethmoidal artery accompanies the nasociliary nerve through the anterior ethmoidal canal, supplies the anterior and middle ethmoidal cells and frontal sinus, and after entering the cranium, gives off a meningeal branch to the dura mater, and nasal branches.


Q. 5

Anterior ethmoidal nerve is a branch of nasociliary nerve. All of the following areas are supplied by anterior ethmoidal nerve, EXCEPT?

 A

Maxillary sinus

 B

Interior of nasal cavity

 C

Dural sheath of anterior cranial fossa

 D

Ethmoidal air cells

Q. 5

Anterior ethmoidal nerve is a branch of nasociliary nerve. All of the following areas are supplied by anterior ethmoidal nerve, EXCEPT?

 A

Maxillary sinus

 B

Interior of nasal cavity

 C

Dural sheath of anterior cranial fossa

 D

Ethmoidal air cells

Ans. A

Explanation:

The infraorbital nerve (CN V-2) primarily innervates the maxillary sinus.

Anterior ethmoidal nerve supplies the ethmoid sinus, nasal cavity, and skin on the tip of the nose. Dura mater of anterior cranial fossa is supplied by anterior and posterior ethmoidal nerves. 


Mandibular-nerve

MANDIBULAR NERVE

Q. 1

Terminal branches of facial nerve are all EXCEPT:

 A

Mandibular nerve

 B

Marginal branch

 C

Temporal

 D

Cervical

Q. 1

Terminal branches of facial nerve are all EXCEPT:

 A

Mandibular nerve

 B

Marginal branch

 C

Temporal

 D

Cervical

Ans. A

Explanation:

After it gives off the posterior auricular nerve, the facial nerve divides within the parotid gland into its terminal branches. The terminal branches are;

  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Marginal (along the mandible)
  5. Cervical

(A traditional mnemonic device for the five terminal branches of the facial nerve is, “Ten Zebras Bit My Cat”)


Q. 2

All of the following structures pierce the buccinator muscle except?

 A

Parotid duct

 B

Molar glands of the cheek

 C

Buccal branch of facial nerve

 D

Buccal branch of the mandibular nerve

Q. 2

All of the following structures pierce the buccinator muscle except?

 A

Parotid duct

 B

Molar glands of the cheek

 C

Buccal branch of facial nerve

 D

Buccal branch of the mandibular nerve

Ans. D

Explanation:

Buccal branch of the mandibular nerve.

  • Buccinator is the muscle of the cheek. It is a thin quadrilateral muscle which occupies the interval between the maxilla and the mandible. Its upper and lower boundaries are attached to the outer surfaces of the alveolar processes of the maxilla and mandible respectively opposite the molar teeth, and the posterior border is attached to the pterygomandibular raphe. Motor nerve supply of buccinator is the buccal branch of the facial nerve.

“Buccinator muscle is pierced by the parotid duct opposite the third upper molar tooth. The duct also passes through the buccal fat pad .Beneath the fat lie a few small molar glands

`Both the buccal branch of the facial nerve and the parotid duct are at risk of injury before they pierce the buccinator muscle.”

Buccal branch of the mandibular nerve passes between the two heads of lateral pterygoid. I


Q. 3

Structure passing through Foramen Ovale is?

 A

Maxillary artery

 B

Mandibular nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Q. 3

Structure passing through Foramen Ovale is?

 A

Maxillary artery

 B

Mandibular nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Ans. B

Explanation:

Mandibular nerve


Q. 4

Branches from the Anterior division of the Mandibular nerve supplies all of the following muscles, EXCEPT?

 A

Lateral Pterygoid

 B

Medial Pterygoid

 C

Masseter

 D

Temporalis

Q. 4

Branches from the Anterior division of the Mandibular nerve supplies all of the following muscles, EXCEPT?

 A

Lateral Pterygoid

 B

Medial Pterygoid

 C

Masseter

 D

Temporalis

Ans. B

Explanation:

Branches from the anterior division of the mandibular nerve are the buccal nerve, the nerve to masseter, the deep temporal nerves to the temporalis muscle and the nerve to the lateral pterygoid. The nerve to the medial pterygoid is a branch from the main trunk of the mandibular nerve.


Q. 5

Which of the following muscles is not supplied by mandibular nerve?

 A

Masseter

 B

Buccinator

 C

Tensor veli palati

 D

Posterior belly of digastric

Q. 5

Which of the following muscles is not supplied by mandibular nerve?

 A

Masseter

 B

Buccinator

 C

Tensor veli palati

 D

Posterior belly of digastric

Ans. D

Explanation:

Mandibular nerve supplies muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani and tensor veli palati. Nerve to the medial pterygoid is a small branch of mandibular nerve that supplies the medial pterygoid muscle. It gives off two branches which pass without interruption through the otic ganglion to supply tensor tympani and tensor veli palati.


Q. 6

Foramen spinosum transmits the following?

 A

Meningeal branch of the mandibular nerve, middle meningeal artery

 B

Emissary veins from the cavernous sinus

 C

Both A and B

 D

None of the above

Q. 6

Foramen spinosum transmits the following?

 A

Meningeal branch of the mandibular nerve, middle meningeal artery

 B

Emissary veins from the cavernous sinus

 C

Both A and B

 D

None of the above

Ans. A

Explanation:

Foramen spinosum is a opening in middle cranial fossa situated immediately in front of the angular spine, posterolateral to foramen ovale. It transmits the middle meningeal artery and vein, and  surrounding the artery. 
 
The various foramens in middle cranial fossa are;
  • Foramen ovale
  • Foramen lacerum
  • Foramen spinosum
  • Foramen rotundum
  • Superior orbital fissure
 

Foramens in middle cranial fossa

Location

Content

Foramen ovale

Posteriolateral to the foramen rotumdum

Accessory meningeal artery

Mandibular nerve (V3)

Lesser petrosal nerve (occasionally)

accessory meningeal vein

Foramen spinosum

Posteriolateral to the foramen ovale

Middle meningeal artery and vein

Meningeal branch of the mandibular nerve (V3)

Sympathetic plexus

Foramen lacerum

Lies superiomedially to the foramen spinosum

Internal carotid artery,

Artery of pterygoid canal

Nerve of pterygoid canal

Superior orbital fissure

Slit like opening between the lesser and greater wings of the sphenoid

Oculomotor nerve (III)

Trochlear nerve (IV)

Lacrimal, frontal and nasociliary branches of Ophthalmic nerve (V1)

Abducent nerve (VI)

Orbital branch of middle meningeal artery

Recurrent branch of lacrimal artery

Superior orbital vein

Superior ophthalmic vein

Foramen rotundum

Below and behind the medial end of the superior orbital fissure

Maxillary nerve (V2)

 

Q. 7

Middle craninal fossa is supplied by :

 A

Maxillary nerve

 B

Mandibular nerve

 C

Anterior ethmoidal nerve

 D

A & B

Q. 7

Middle craninal fossa is supplied by :

 A

Maxillary nerve

 B

Mandibular nerve

 C

Anterior ethmoidal nerve

 D

A & B

Ans. D

Explanation:

A i.e. Maxillary nerve; B i.e. Mandibular nerve


Q. 8

Which of the following muscles is supplied by mandibular nerve:

 A

Masseter

 B

Buccinator

 C

Tensor veli palati

 D

c and a

Q. 8

Which of the following muscles is supplied by mandibular nerve:

 A

Masseter

 B

Buccinator

 C

Tensor veli palati

 D

c and a

Ans. D

Explanation:

C i.e. Tensor veli palati, A i.e. Masseter


Q. 9

All of the following are supplied by mandibular nerve except

 A

Masseter

 B

Tensor tympani

 C

Tensor palati

 D

Buccinator

Q. 9

All of the following are supplied by mandibular nerve except

 A

Masseter

 B

Tensor tympani

 C

Tensor palati

 D

Buccinator

Ans. D

Explanation:

D i.e. Buccinator


Q. 10

Structures passing through the forame ovale :

 A

Emissary vein

 B

Mandibular nerve

 C

Trigeminal nerve

 D

a & b

Q. 10

Structures passing through the forame ovale :

 A

Emissary vein

 B

Mandibular nerve

 C

Trigeminal nerve

 D

a & b

Ans. D

Explanation:

A i.e. Emissary vein, B i.e. Mandibular nerve


Q. 11

Mandibular nerve passes through following foramen:

 A

F. ovale

 B

F. rotundum

 C

F. spinosum

 D

F. lacerum

Q. 11

Mandibular nerve passes through following foramen:

 A

F. ovale

 B

F. rotundum

 C

F. spinosum

 D

F. lacerum

Ans. A

Explanation:

A i.e. Foramen ovale 

–     Vidian nerve and artery pass through pterygoid canalQ.

Foramen spinosum pass MEN i.e. Middle meningeal artery, Emissary vein & Nervous spinosus (meningeal br. of mandibular nerve).

–    Foramen ovale pass MALE i.e. Mandibular nerveQ, Accessory meningeal artery, Lesser petrosal nerve and Emissary vein.


Q. 12

Which of the following regarding mandibular nerve is correct-           

 A

Branch of facial nerve

 B

Purely motor

 C

Passes through foramen ovale

 D

Related to sphenopalatine ganglion

Q. 12

Which of the following regarding mandibular nerve is correct-           

 A

Branch of facial nerve

 B

Purely motor

 C

Passes through foramen ovale

 D

Related to sphenopalatine ganglion

Ans. C

Explanation:

C i.e. Passes through foramen ovale


Q. 13

Which of the following is not supplied by the anterior division of mandibular nerve (V3)?

 A

Temporalis

 B

Medial pterygoid

 C

Lateral pterygoid

 D

Masseter

Q. 13

Which of the following is not supplied by the anterior division of mandibular nerve (V3)?

 A

Temporalis

 B

Medial pterygoid

 C

Lateral pterygoid

 D

Masseter

Ans. B

Explanation:

B i.e. Medial pterygoid

Temporalis, messeter and lateral pterygoid musclesQ are supplied by anterior division of mandibular nerve whereas medial pterygoid muscleQ is supplied by the main trunk of mandibular nerve.


Q. 14

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Q. 14

Sensory nerve supply of pinna is :

 A

Mandibular nerve

 B

Maxillary nerve

 C

Facial nerve

 D

Abducent nerve

Ans. A

Explanation:

Auriculotemporal nerve, a branch of mandibular nerve (V3)(2 supplies the external acoustic meatus, external surface of auricle above this, skin of temporal region and TM joint.


Q. 15

Mandibular nerve does not supply:‑

 A

Buccinator

 B

Masseter

 C

Tensor tympani

 D

Temporalis

Q. 15

Mandibular nerve does not supply:‑

 A

Buccinator

 B

Masseter

 C

Tensor tympani

 D

Temporalis

Ans. A

Explanation:

A. i.e. Buccinator 


Q. 16

Nerve which loops around submandibular duct‑

 A

Mandibular nerve

 B

Lingual nerve

 C

Hypoglossal nerve

 D

Recurrent laryngeal nerve

Q. 16

Nerve which loops around submandibular duct‑

 A

Mandibular nerve

 B

Lingual nerve

 C

Hypoglossal nerve

 D

Recurrent laryngeal nerve

Ans. B

Explanation:

Submandibular duct

  • It is 5 cm long duct and runs forwards on hyoglossus, between lingual and hypoglossal nerves.
  • At the anterior border of the hyoglossus muscle it is crossed by lingual nerve which loops around it.
  • It opens into the floor of mouth, on the summit of the sublingual papilla at the side offrenulum of tongue.

Q. 17

Mandibular nerve passes through ‑

 A

Formanen rotundum

 B

Foramen lacerum

 C

Stylomastoid foramen

 D

Foramen ovale

Q. 17

Mandibular nerve passes through ‑

 A

Formanen rotundum

 B

Foramen lacerum

 C

Stylomastoid foramen

 D

Foramen ovale

Ans. D

Explanation:

Foramen ovale



Maxillary nerve

MAXILLARY NERVE

Q. 1

Middle superior alveolar nerve is a branch of:

 A

Infra orbital nerve

 B

Nasal branch of maxillary nerve

 C

Mandibular branch of trigeminal nerve

 D

None of the above

Q. 1

Middle superior alveolar nerve is a branch of:

 A

Infra orbital nerve

 B

Nasal branch of maxillary nerve

 C

Mandibular branch of trigeminal nerve

 D

None of the above

Ans. A

Explanation:

Middle superior alveolar nerve is a branch of infra orbital nerve. It supplies the lateral wall of maxillary sinus, gingiva, mesial buccal root of the first molar, and all the root of the bicuspids.
 
Another nerve arising from the infra orbital nerve is anterior superior alveolar nerve. It innervates the anterior maxillary sinus, gingiva, cuspids, laterals and central incisors.
 
The 4 branches of the maxillary nerve are zygomatic, infraorbital, posterior superior alveolar and pterygopalatine. The pterygopalatine branch divides into greater palatine, lesser palatine and nasopalatine nerve.
 
Ref: Delmar’s Dental Assisting: A Comprehensive Approach  By Donna J. Phinney 2nd edn page 84.

Q. 2

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Q. 2

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Ans. D

Explanation:

Nerves providing sensory innervation of the nasopharynx are :
Maxillary nerve innervates nasopharynx, glossopharyngeal nerve innervates the oral pharynx and laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve.
 

Q. 3

All of the following are structures associated with pterygopalatine fossa, EXCEPT:

 A

Pterygopalatine ganglion

 B

Mid third of maxillary artery

 C

Maxillary nerve

 D

Greater petrosal nerve

Q. 3

All of the following are structures associated with pterygopalatine fossa, EXCEPT:

 A

Pterygopalatine ganglion

 B

Mid third of maxillary artery

 C

Maxillary nerve

 D

Greater petrosal nerve

Ans. B

Explanation:

The pterygopalatine fossa is the region between the pterygomaxillary fissure and the nasal cavity. 

  • The fossa accommodates branches of the maxillary nerve [cranial nerve (CN) V-2], the pterygopalatine ganglion, the terminal branches of the maxillary artery, and greater superficial petrosal nerve.
 

Q. 4

Middle superior alveolar nerve supplies upper premolar teeth. It is a branch of?

 A

Infraorbital portion of Maxillary nerve

 B

Palatine division of maxillary nerve

 C

Anterior nasal division of maxillary nerve

 D

Infraorbital nerve

Q. 4

Middle superior alveolar nerve supplies upper premolar teeth. It is a branch of?

 A

Infraorbital portion of Maxillary nerve

 B

Palatine division of maxillary nerve

 C

Anterior nasal division of maxillary nerve

 D

Infraorbital nerve

Ans. A

Explanation:

Ans:A.)Infraorbital portion of Maxillary nerve.

The middle superior alveolar nerve is a nerve that drops from the infraorbital portion of the maxillary nerve to supply the sinus mucosa, the roots of the maxillary premolars, and the mesiobuccal root of the first maxillary molar.

Branches of Maxillary Nerve
Its branches may be divided into four groups, depending upon where they branch off: in the cranium, in the pterygopalatine fossa, in the infraorbital canal, or on the face.

  • In the cranium
    • Middle meningeal nerve in the meninges
  • From the pterygopalatine fossa
    • Zygomatic nerve (zygomaticotemporal nerve, zygomaticofacial nerve), through the Zygomatic foramen
    • Nasopalatine nerve, through the sphenopalatine foramen
    • Posterior superior alveolar nerve
    • Greater and lesser palatine nerves
    • Pharyngeal nerve
  • In the infraorbital canal
    • Middle superior alveolar nerve
    • Anterior superior alveolar nerve
    • Infraorbital nerve
  • On the face
    • Inferior palpebral nerve
    • Superior labial nerve

Q. 5

Which of the following structure is passing through foramen rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Q. 5

Which of the following structure is passing through foramen rotundum?

 A

Maxillary artery

 B

Maxillary nerve

 C

Middle meningeal artery

 D

Spinal accessory nerve

Ans. B

Explanation:

Foramen rotundum located posterior to the medial end of the superior orbital fissure. The foramen rotundum transmits the maxillary nerve (CN V-2) en route to the pterygopalatine fossa. CN V-2 supplies the skin, teeth, and mucosa associated with the maxillary bone.

Q. 6

Middle craninal fossa is supplied by :

 A

Maxillary nerve

 B

Mandibular nerve

 C

Anterior ethmoidal nerve

 D

A & B

Q. 6

Middle craninal fossa is supplied by :

 A

Maxillary nerve

 B

Mandibular nerve

 C

Anterior ethmoidal nerve

 D

A & B

Ans. D

Explanation:

A i.e. Maxillary nerve; B i.e. Mandibular nerve



Trigeminal neuralgia

TRIGEMINAL NEURALGIA

Q. 1

 Drug of choice for trigeminal neuralgia is?

 A Chlorpromazine
 B

 Carbamezapine

 C Gabapentine
 D

Fluoxetine

Q. 1

 Drug of choice for trigeminal neuralgia is?

 A Chlorpromazine
 B

 Carbamezapine

 C Gabapentine
 D

Fluoxetine

Ans. B

Explanation:

Carbamezapine REF: Harrison’s 17th ed chapter 371

  • Drug of choice for trigeminal neuralgia – Carbamezapine
  • If drug treatment fails, surgical therapy should be offered. The most widely applied procedure creates a heat lesion of the trigeminal (gasserian) ganglion or nerve, a method termed radiofrequency thermal rhizotomy.
  • Gamma knife radiosurgery is also utilized for treatment
  • A third surgical treatment, microvascular decompression to relieve pressure on the trigeminal nerve as it exits the pons, requires a suboccipital craniotom

Q. 2

Which statement is true about carbamazepine ?

 A

Used in trigeminal neuralgia

 B

Carbamazepine is an enzyme inhibitor

 C

Can cause megaloblastic anemia

 D

It is the drug of choice for status epilepticus

Q. 2

Which statement is true about carbamazepine ?

 A

Used in trigeminal neuralgia

 B

Carbamazepine is an enzyme inhibitor

 C

Can cause megaloblastic anemia

 D

It is the drug of choice for status epilepticus

Ans. A

Explanation:

Used in trigeminal neuralgia [Ref K.D.T. 6thie p 406-407]

  • Trigeminal neuralgias are characterized by attacks of high intensity electric shock like stabbing pain, set off by even trivial stimulation of certain trigger zones in the mouth or on the face.
  • Carbamazepine is not an analgesic but has a specific action in these neuralgias. It acts by interrupting temporal summation of afferent impulses (by a selective action on high frequency nerve impulses).
  • “Carbamazepine has become the drug of choke for Trigeminal neuralgias”.
  • Other antiepileptics such as phenytoin and Baclofen are less efficacious alternatives.

More on carbamazepine

  • The most important action of carbamazepine is blockade of voltage dependent sodium ion channels, reducing membrane excitability.
  • It is considered the drug of choice for partial seizures

Pharamacokinetics

  • Carbamazepine is an extensively metabolized drug.
  • One of the notable property of carbamazepine is its ability to induce microsomal enzymes (Paso)
  • The t1/2 of carbamazepine decreases from 36 hrs, seen initially, to as short as 8-12 hrs due to its enzyme inducing property (it induces its own metabolism).
  • Due to its enzyme inducing property, carbamazepine effects the metabolism of other drugs too.

Toxicity:-

  • The most cocoon dose related adverse effects of carbamazepine are diplopia and ataxia.
  • It may also cause hyponatretnia and water intoxication.
  • One more important adverse effect is idiosyncratic blood dyscrasias which may cause aplastic anemia and agranulocytosis.

Q. 3

A Patient presents with recurrent episodes of sharp pain over his right cheek that is precipitated on chewing. Between attacks patient is otherwise normal. The most probable diagnosis is?

 A

Preherpetic neuralgia

 B

Trigeminal neuralgia

 C

Mumps

 D

Thalamic syndrome

Q. 3

A Patient presents with recurrent episodes of sharp pain over his right cheek that is precipitated on chewing. Between attacks patient is otherwise normal. The most probable diagnosis is?

 A

Preherpetic neuralgia

 B

Trigeminal neuralgia

 C

Mumps

 D

Thalamic syndrome

Ans. B

Explanation:

Answer is B (Trigeminal Neuralgia):

Recurrent attacks of sharp pain over the cheek precipitated .from trigger areas or trigger factors such as chewing with the patient being normal in the interval period strongly suggests a diagnosis of Trigeminal Neuralgia. Trigeminal Neuralgia is typically characterized by Paroxysmal attacks of brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve lasting for a brief period from a fraction of a second to 2 minutes. The most common division of the trigeminal nerve involved in trigeminal neuralgia is the Maxillary division (V2) followed by the mandibular division (V3). The ophthalmic Division (VI) is rarely involved

The pain often evokes spasm of the muscle of the face on the affected side. The clinical association between Trigeminal Neuralgia and hemifacial spasm is called Tic Douloureux.

Typical Features of Trigeminal Neuralgia (Prosopalgia, Fothergill’s disease)

  • Sudden/ Abrupt onset and termination
  • Sharp superficial, stabbing or burning in quality
  • Severe in intensity
  • Brief in duration (lasting for a brief period from a fraction of a second to 2 minutes)
  • Intermittent (Between paroxysms the patient is usually asymptomatic. Following a painful paroxysm there is usually a refractory period during which pain cannot be triggered)
  • Unilateral (The pain never crosses to the opposite side but it may rarely occur bilaterally in which case a central cause such as multiple sclerosis must be considered)
  • Precipitated from trigger areas or by trigger factors in the trigeminal area such as eating or chewing, washing the face, shaving, smoking, talking or brushing the teeth
  • There is no clinically evident neurological deficit

Note :

Trigeminal Neuralgia is More common with advancing age

Trigeminal Neuralgia is More common in women

Trigeminal Neuralgia is More common on right side

Trigeminal Neuralgia attacks are most frequent during the day (but may awaken the patient at night) Trigeminal Neuralgia most frequently arises from the maxillary division of Trigeminal nerve (V2)


Q. 4

All of the following statements about Trigeminal Neuralgia are true Except:

 A

Most commonly involves Ophthalmic Division (V3) of Maxillary Nerve

 B

Attacks most commonly occur during the day

 C

Affects women more than men

 D

More common on the Right Side

Q. 4

All of the following statements about Trigeminal Neuralgia are true Except:

 A

Most commonly involves Ophthalmic Division (V3) of Maxillary Nerve

 B

Attacks most commonly occur during the day

 C

Affects women more than men

 D

More common on the Right Side

Ans. A

Explanation:

Answer is A (Most commonly involves Ophthalmic Division (V3) of Maxillary Nerve):

The most common division of the trigeminal nerve involved in trigeminal neuralgia is the Maxillary division (V2) followed by the mandibular division (V3). The maxillary division (V2) is the most common site ofpain either alone or in combination with the mandibular division (V3). The ophthalmic Division (VI) is rarely involved (<5%). Pain arising from the maxillary division is usually referred to the upper lip nose and cheek while the pain arising from the mandibular division is often referred to the lower lip.

Features of Trigeminal Neuralgia

  • The most common division of the trigeminal nerve involved in trigeminal neuralgia is the Maxillary division (V2)
  • More common with advancing age
  • More common in women
  • More common on right side
  • Attacks are most frequent during the day (but may awaken the patient at night)

Q. 5

Most common cause of trigeminal neuralgia ‑

 A

Infection

 B

Trauma

 C

Vascular compression

 D

Iatrogenic

Q. 5

Most common cause of trigeminal neuralgia ‑

 A

Infection

 B

Trauma

 C

Vascular compression

 D

Iatrogenic

Ans. C

Explanation:

Ans. is ‘c’ i.e., Vascular compression

  • Trigeminal neuralgia (tic douloureux) is characterized by intermittent, shooting pain in the face.
  • It is due to involvement of trigeminal nerve.
  • 95% of causes of trigeminal neuralgia are due to pressure on trigeminal nerve close to where it enters the brain stem, past the Gasserian ganglion. In most cases, this pressure seems to be caused by an artery or vein compressing trigeminal nerve.
  • Other causes are tumor, cysts, AV malformation and multiple sclerosis.
  • Most commonly used drugs for treatment of trigeminal neuralgia are carbamazepine, gabapentin and valproate.


Trigeminal (v) nerve

 

TRIGEMINAL (V) NERVE

Q. 1

Which of the following nerve constitute the afferent component of corneal reflex?

 A Vagus nerve
 B Facial nerve
 C Trigeminal nerve
 D Glossopharyngeal nerve

Q. 1

Which of the following nerve constitute the afferent component of corneal reflex?

 A Vagus nerve
 B Facial nerve
 C Trigeminal nerve
 D Glossopharyngeal nerve
Ans.C

Explanation:

The afferent component of corneal reflex is mediated by trigeminal nerve and efferent component is mediated by facial nerve which innervates the orbicularis oculi muscle. In this reflex, touching the cornea from the side while the subject looks forward evokes blinking.

Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 292-3; Color Atlas of Neurology By Reinhard Rohkamm, Page 26.


Q. 2

Which of the following nerve innervates the anterior belly of the digastric muscle?

 A Facial nerve
 B Trigeminal nerve
 C Vagus nerve
 D Abducens nerve

Q. 2

Which of the following nerve innervates the anterior belly of the digastric muscle?

 A Facial nerve
 B Trigeminal nerve
 C Vagus nerve
 D Abducens nerve
Ans.B

Explanation:

The anterior belly of the digastric muscle is innervated by the mandibular division of the trigeminal nerve.

  • The inferior alveolar nerve which give rise to the mylohyoid nerve innervates the mylohyoid muscle. 

Q. 3

The tensor tympani muscle is inserted to the handle of malleus. The nerve supply to tensor tympani is?

 A Vagus nerve
 B Glossopharyngeal nerve
 C Trigeminal nerve
 D Facial nerve

Q. 3

The tensor tympani muscle is inserted to the handle of malleus. The nerve supply to tensor tympani is?

 A Vagus nerve
 B Glossopharyngeal nerve
 C Trigeminal nerve
 D Facial nerve
Ans.C

Explanation:

The motor pure branches of mandibular division of trigeminal nerve:

  • Masseteric nerve (masseter muscle)
  • Deep temporal nerves (temporalis muscle)
  • Pterygoid nerves (pterygoid muscles)
  • Nerve of the tensor tympani muscle
  • Nerve to the tensor veli palatini muscle

Q. 4

Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve?

 A Foramen ovale
 B Foramen lacerum
 C Foramen magnum
 D Foramen spinosum

Q. 4

Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve?

 A Foramen ovale
 B Foramen lacerum
 C Foramen magnum
 D Foramen spinosum
Ans.A

Explanation:

Foramen ovale is an opening at the base of the lateral pterygoid plate. It transmits the third branch of the trigeminal nerve, the accessory meningeal artery, and occasionally the superficial petrosal nerve.
  • Foramen lacerum transmits the internal carotid artery.
  • Foramen magnum transmits the medulla and its membranes, the spinal accessory nerves, the vertebral arteries, and the anterior and posterior spinal arteries.

Q. 5

Which is the nucleus of Masseteric Reflex?

 A Superior sensory nucleus of trigeminal nerve
 B Spinal nucleus of trigeminal nerve
 C Mesencephalic nucleus of trigeminal nerve
 D Dorsal nucleus of vagus nerve

Q. 5

Which is the nucleus of Masseteric Reflex?

 A Superior sensory nucleus of trigeminal nerve
 B Spinal nucleus of trigeminal nerve
 C Mesencephalic nucleus of trigeminal nerve
 D Dorsal nucleus of vagus nerve
Ans.C

Explanation:

The reflex arc of masseteric reflex involves two nuclei of the trigeminal nerve, namely, the mesencephalic nucleus and the motor nucleus of trigeminal nerve .


Q. 6

False statement about trigeminal nerve:

 A Carries sensation from face and scalp
 B Has motor branch
 C Arise from C8 nerve root
 D Composed of spinal nucleus

Q. 6

False statement about trigeminal nerve:

 A Carries sensation from face and scalp
 B Has motor branch
 C Arise from C8 nerve root
 D Composed of spinal nucleus
Ans.C

Explanation:

C i.e. Arise from C8 nerve root


Q. 7

Identify the Nerve Marked as Nerve A in the Diagram ?

Trigeminal nerve

 A Facial Nerve 
 B Trigeminal Nerve
 C Occulomotor Nerve
 D None of the Above

Q. 7

Identify the Nerve Marked as Nerve A in the Diagram ?

Trigeminal nerve

 A Facial Nerve 
 B Trigeminal Nerve
 C Occulomotor Nerve
 D None of the Above
Ans.B

Explanation:

The Image shows Trigeminal Nerve



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Muscles of pectoral region

MUSCLES OF PECTORAL REGION

Q. 1

Protractor of scapula is? 

 A

Serratus anterior

 B

Rhomboidis major 

 C

Deltoid

 D

Pectoralis major

Q. 1

Protractor of scapula is? 

 A

Serratus anterior

 B

Rhomboidis major 

 C

Deltoid

 D

Pectoralis major

Ans. A

Explanation:

Serratus anterior

Movements of scapula:

Movement

Muscles

Elevation

Trapezius and Levator scapular

Protraction

Serratous anterior and Pectoralis minor

Retraction

Rhomboids and Trapezius

Lateral rotation

upper trapezius and lower serratous

Medial rotation

Levator scapulae , Rhomboids and Pectoralis minor


Q. 2

During breast reconstruction surgery which of the following structure is preserved?

 A Pectoralis minor
 B

Pectoralis major

 C Serratus anterior
 D

Nipple areola complex

Q. 2

During breast reconstruction surgery which of the following structure is preserved?

 A Pectoralis minor
 B

Pectoralis major

 C Serratus anterior
 D

Nipple areola complex

Ans. B

Explanation:

Pectoralis major REF: Oncoplastic and Reconstructive Surgery for Breast Cancer: By A. Fitoussi, M. G. Berry, B. Couturaud, R. J. Salmon Page 45

“As the breast implant is mostly placed beneath the pectoralis major muscle, it is never dissected. A complete musculofascial pocket is created by lateral and inferolateral dissection of the pectoralis minor and serratus anterior. If indicated, mastectomy is performed with preservation of skin envelop, but nipple areola complex is included in the resection with fusiform incision that is more oblique inferiorly”

The four surgical approaches to emplacing a breast implant to the implant pocket are described in anatomical relation to the pectoralis major muscle.

  1. Subglandular — the breast implant is emplaced to the retromammary space, between the breast tissue (the gland) and the pectoralis major muscle, which most approximates the plane of normal breast tissue, and affords the most aesthetic results. Yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the capsular contracture incidence rate is slightly greater with subglandular implantation.
  2. Subfascial- the breast implant is emplaced beneath the fascia of the pectoralis major muscle; this is a variant of the subglandular position. The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position.
  3. Subpectoral (dual plane) — the breast implant is emplaced beneath the pectoralis major muscle, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane.
  4. Submuscular — the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall — either the serratus muscle or the pectoralis minor muscle, or both — and suturing it, or them, to the pectoralis major muscle. In breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants.

Q. 3

Boundary of triangle of auscultation is not formed by:

 A >Serratus anterior
 B >Scapula
 C >Trapezius
 D >Latissimus dorsi
Q. 3

Boundary of triangle of auscultation is not formed by:

 A >Serratus anterior
 B >Scapula
 C >Trapezius
 D >Latissimus dorsi
Ans. A

Explanation:

Serratus anterior [Ref: B.D.C. Anatomy 4/e vol. 1 p64]Repeat.from Nov 08

The triangle of auscultation is a small triangular space on the back where the relatively thin musculature allows for respiratory sounds to be heard more clearly with a stethoscope.

It has the following boundaries:

  • medially, by the Trapezius
  • laterally by the scapula
  • inferiorly by the Latissimus dorsi

The floor is formed by

–      7th rib

–      6th & 7th intercostal spaces

–     Rhomboideus major

On the left side, the cardiac orifice of the stomach lies deep to the triangle, and in days before X-rays were discovered the sounds of swallowed liquids were auscultated over this triangle.



Q. 4

Muscle most commonly affected by congenital absence is?

 A

Pectoralis major

 B

Semi membranosus

 C

Teres minor

 D

Gluteus maximus

Q. 4

Muscle most commonly affected by congenital absence is?

 A

Pectoralis major

 B

Semi membranosus

 C

Teres minor

 D

Gluteus maximus

Ans. A

Explanation:

Pectoralis major and minor muscles are the most common congenitally absent muscles in humans.

Ref: Ultrasound of the Musculoskeletal System, 2007, Pages 51, 285; Principles of Neurology By Allan H. Ropper, Raymond Delacy Adams, Maurice Victor, Robert H. Brown, Page 1245; Clinical Pediatric Urology By A. Barry Belman, Lowell R. King, Stephen Alan Kramer, Page 947


Q. 5

A day after a left-sided lumpectomy and axillary dissection, a 63-year-old woman is experiencing difficulty elevating her left arm. She cannot fully raise her upper arm from the side of her body. The median border and inferior angle of the left scapula become unusually prominent when she pushes against the wall with both hands. The innervation of which of the following muscles was most likely injured during the surgery?

 A

Deltoid

 B

Latissimus dorsi

 C

Pectoralis major

 D

Serratus anterior

Q. 5

A day after a left-sided lumpectomy and axillary dissection, a 63-year-old woman is experiencing difficulty elevating her left arm. She cannot fully raise her upper arm from the side of her body. The median border and inferior angle of the left scapula become unusually prominent when she pushes against the wall with both hands. The innervation of which of the following muscles was most likely injured during the surgery?

 A

Deltoid

 B

Latissimus dorsi

 C

Pectoralis major

 D

Serratus anterior

Ans. D

Explanation:

This patient most likely sustained an injury to the long thoracic nerve (C5-C7), which innervates the serratus anterior muscle.

This muscle is located on the lateral portion of the thorax, attaching to the external surface of the lateral parts of the 1st – 8th ribs proximally and the anterior surface of the medial border of the scapula distally.

It is responsible for keeping the scapula applied to the thoracic wall, and protracts and rotates the scapula.

Other muscles and bones rely on the scapula to be “fixed”, as they use it as an anchor when producing movements of the humerus.

Injury to the long thoracic nerve, which lies on the medial wall of the axilla, can occur during weight lifting, thoracic or axillary surgery, or from a stab wound. The clinical features of a long thoracic nerve injury include a “winged” scapula (the protrusion of the scapula as the patient presses against a wall) and an inability to abduct the arm.

The deltoid and teres minor muscles are innervated by the axillary nerve (C5-C6), which winds around the humeral neck, and may be injured during the dislocation of the shoulder or a fracture to the neck of the humerus.

Injuries to this nerve present with weakness of shoulder abduction, and atrophy of the shoulder.

“Winging” of the scapula is not a prominent clinical feature of an axillary nerve injury.

The latissimus dorsi muscle is innervated by the thoracodorsal nerve (C6-C8), and is a large, fan-shaped muscle that extends, adducts, and medially rotates the humerus, and helps raise the body toward the arms during climbing and performing chin-ups.

Injury to the nerve that innervates this muscle can occur during surgical operations in the axilla, and makes the patient unable to perform a chin-up or go climbing.

The patient’s clinical findings in this case are inconsistent with an injury to the thoracodorsal nerve.

The pectoralis major muscle, which is innervated by the medial and lateral pectoral nerves, is involved in the adduction and medial rotation of the arm.

Injury to the nerves that innervate this muscle does not typically result in any disability, however the anterior axillary fold is absent on the affected side.


Q. 6

All of the following forms the boundaries of the lower triangular space of arm, EXCEPT?

 A

Teres major

 B

Shaft of humerus

 C

Pectoralis major

 D

Long head of triceps

Q. 6

All of the following forms the boundaries of the lower triangular space of arm, EXCEPT?

 A

Teres major

 B

Shaft of humerus

 C

Pectoralis major

 D

Long head of triceps

Ans. C

Explanation:

Boundaries of lower triangular space of arm are: medially it is bounded by long head of triceps, laterally by medial border of humerus and superiorly by teres major. Radial nerve and profunda brachii vessels are the contents of the lower triangular space.


Q. 7

Cord of brachial plexus are named as per their relation with the axillary artery behind which muscle?

 A

Deltoid

 B

Subclavius

 C

Teres major

 D

Pectoralis minor

Q. 7

Cord of brachial plexus are named as per their relation with the axillary artery behind which muscle?

 A

Deltoid

 B

Subclavius

 C

Teres major

 D

Pectoralis minor

Ans. D

Explanation:

Pectoralis minor crosses in front of axillary artery and divides it into three parts. The anterior relation of each part are; First part lies behing the pectoralis major muscle, second part lies behind the pectoralis minor and major muscle and third part lies behind pectoralis major.

The cords of brachial plexus are named according to their relation with the second part of  axillary artery, lateral cord runs lateral to the axillary artery, as well the medial and posterior cord lies medially and posterior to the axillary artery. Thus the muscle anteriorly to second part is pectoralis minor and major.


Q. 8

All of the following structures forms the border of Quadrangular space, EXCEPT?

 A

Teres major

 B

Teres minor

 C

Pectoralis minor

 D

Long head of the triceps brachii muscle

Q. 8

All of the following structures forms the border of Quadrangular space, EXCEPT?

 A

Teres major

 B

Teres minor

 C

Pectoralis minor

 D

Long head of the triceps brachii muscle

Ans. C

Explanation:

Structures forming the borders of Quadrangular space are teres major and teres minor muscles, long head of the triceps brachii muscle, and the humerus. 
 
Contents of this space are: axillary nerve and the posterior circumflex humeral artery.
 
Structures forming the border of triangular space are:
  • Teres major and teres minor muscles and the long head of the triceps brachii muscle.
  • Its contents is Circumflex scapular artery.

Q. 9

Which of the following is the only shoulder girdle muscle which is not inserted on the bone in free upper limb?

 A

Coracobrachialis

 B

Pectoralis major

 C

Pectoralis minor

 D

None of the above

Q. 9

Which of the following is the only shoulder girdle muscle which is not inserted on the bone in free upper limb?

 A

Coracobrachialis

 B

Pectoralis major

 C

Pectoralis minor

 D

None of the above

Ans. C

Explanation:

Pectoralis minor is the only shoulder girdle muscle which is not inserted on the bone in free upper limb. It arises from the 3rd to 5th ribs and is inserted on the coracoid process. It lowers and rotates the scapula. It is innervated by pectoral nerves (C6-8).
 
Coracobrachialis: It arise from the coracoid process together with the short head of the biceps brachii. It is inserted on the medial surface of the humerus on the continuation of the crest of the lesser tubercle. It is innervated by musculocutaneous nerve.
 
Pectoralis major: The three parts of the muscle get inserted on the crest of the greater tubercle of humerus. It forms the muscular basis of the anterior axillary fold. 

Q. 10

Axillary artery is divided into 3 parts. Which of the following muscle divides axillary artery into 3 parts?

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Q. 10

Axillary artery is divided into 3 parts. Which of the following muscle divides axillary artery into 3 parts?

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Ans. D

Explanation:

Axillary artery is divided into 3 parts by pectoralis minor muscle. Axillary artery extends from the outer border of the first rib to inferior border of teres major muscle where it becomes the brachial artery. 
 
Branches of the axillary artery:
 
First part:
  • Superior thoracic artery
Second part:
  • Thoracoacromial artery
  • Lateral thoracic artery
Third part:
  • Subscapular artery
  • Anterior humeral circumflex artery
  • Posterior humeral circumflex artery

Q. 11

A male patient presented with winging of scapula following a trauma. Nerve involved in this lesion is?

 A

Nerve supplying serratus anterior

 B

Pectoral nerve

 C

Subscapular nerve

 D

Ulnar nerve

Q. 11

A male patient presented with winging of scapula following a trauma. Nerve involved in this lesion is?

 A

Nerve supplying serratus anterior

 B

Pectoral nerve

 C

Subscapular nerve

 D

Ulnar nerve

Ans. A

Explanation:

Long thoracic nerve (C5–C7) descends posteriorly to the roots of the plexus and the axillary artery and along the lateral surface of the serratus anterior muscle, with the lateral thoracic artery, while supplying the muscle. Injury to the long thoracic nerve results in paralysis of the serratus anterior muscle. This presents with the medial border of the scapula sticking straight out of the back (winged scapula).

Q. 12

Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection?

 A

Levator scapulae

 B

Pectoralis major

 C

Rhomboideus major

 D

Serratus anterior

Q. 12

Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection?

 A

Levator scapulae

 B

Pectoralis major

 C

Rhomboideus major

 D

Serratus anterior

Ans. D

Explanation:

Serratus Anterior, innervated by the long thoracic nerve, draws the scapula forward. If it is denervated, there is no muscle to oppose the motion of the trapezius which is elevating and retracting the scapula. The medial border of the scapula falls away from the posterior chest wall and begins to look like an angel’s wing. This is termed a “winged scapula.” A winged scapula commonly occurs after an injury to the long thoracic nerve, which runs on the superficial surface of serratus anterior and is particularly vulnerable to trauma. The long thoracic nerve contains contributions from C5, 6, and 7, so remember the saying “C5, 6, and 7 keep the wings from heaven.”


Q. 13

Which of the following DOES NOT form boundary of triangle of auscultation?

 A

Serratus anterior

 B

Scapula

 C

Trapezius

 D

Latissimus dorsi

Q. 13

Which of the following DOES NOT form boundary of triangle of auscultation?

 A

Serratus anterior

 B

Scapula

 C

Trapezius

 D

Latissimus dorsi

Ans. A

Explanation:

The triangle of auscultation is a small triangular space on the back where the relatively thin musculature allows for respiratory sounds to be heard more clearly with a stethoscope. It has the following boundaries:

  • Medial wall is formed by lateral border of trapezius
  • Lateral wall is formed by medial border of scapula
  • Inferiorly by the upper border of latissimus dorsi
  • Floor is formed by: 7th rib, 6th and 7th intercostal spaces, rhomboids major
 
On the left side, the cardiac orifice of the stomach lies deep to the triangle, and in days before X-rays were discovered the sounds of swallowed liquids were auscultated over this triangle.

Q. 14

Which of the following arteries supply pectoralis major muscle?

1. Pectoral branches of thoracoacromial artery
2. Intercostal artery
3. Lateral thoracic artery
4. Subclavian artery
5. Internal mammary artery
 
 A

1, 2 & 3

 B

2, 3 & 4

 C

1, 2 & 5

 D

1, 2, 4 & 5

Q. 14

Which of the following arteries supply pectoralis major muscle?

1. Pectoral branches of thoracoacromial artery
2. Intercostal artery
3. Lateral thoracic artery
4. Subclavian artery
5. Internal mammary artery
 
 A

1, 2 & 3

 B

2, 3 & 4

 C

1, 2 & 5

 D

1, 2, 4 & 5

Ans. C

Explanation:

Blood supply of pectoralis major:

  • Pectoralis major derives it blood supply mainly from pectoral branch of the thoracoacromial artery.
  • Other arteries supplying the muscle are: First perforating branch of the internal thoracic artery (Internal mammary artery) and intercostal artery.

Q. 15

A 24 year old college student presented with ‘winged scapula’ after a fall. Winging of the scapula is due to injury to?

 A

Nerve supplying serratus anterior

 B

Pectoral nerve

 C

Subscapular nerve

 D

Ulnar nerve

Q. 15

A 24 year old college student presented with ‘winged scapula’ after a fall. Winging of the scapula is due to injury to?

 A

Nerve supplying serratus anterior

 B

Pectoral nerve

 C

Subscapular nerve

 D

Ulnar nerve

Ans. A

Explanation:

Branches off the C5–C7 roots, descends posteriorly to the roots of the plexus and the axillary artery and along the lateral surface of the serratus anterior muscle, with the lateral thoracic artery, while supplying the muscle.
 
Injury to the long thoracic nerve results in paralysis of the serratus anterior muscle. This presents with the medial border of the scapula sticking straight out of the back (winged scapula).

Q. 16

Which is the muscle that draws the scapula forward ?

 A

Trapezuis

 B

Rhomboides

 C

Serratus anterior

 D

Levator scapulae

Q. 16

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. 17

What is the root value of long thoracic nerve which supplies serratus anterior muscle?

 A

C 3,4,5

 B

C 5,6,7

 C

C 7,8 & T1

 D

C 2,3,4

Q. 17

What is the root value of long thoracic nerve which supplies serratus anterior muscle?

 A

C 3,4,5

 B

C 5,6,7

 C

C 7,8 & T1

 D

C 2,3,4

Ans. B

Explanation:

Long thoracic nerve (C5–C7). Branches off the C5–C7 roots, descends posteriorly to the roots of the plexus and the axillary artery and along the lateral surface of the serratus anterior muscle, with the lateral thoracic artery, while supplying the muscle. 

Injury to the long thoracic nerve results in paralysis of the serratus anterior muscle. This presents with the medial border of the scapula sticking straight out of the back (winged scapula).

Q. 18

After a jarring blow to the left anterior shoulder region, a young field hockey player was told by an examining physician that she had a muscle tear that resulted directly from the superolateral distraction of a fractured coracoid process. Which muscle was torn?

 A

Deltoid

 B

Pectoralis major

 C

Pectoralis minor

 D

Serratus anterior

Q. 18

After a jarring blow to the left anterior shoulder region, a young field hockey player was told by an examining physician that she had a muscle tear that resulted directly from the superolateral distraction of a fractured coracoid process. Which muscle was torn?

 A

Deltoid

 B

Pectoralis major

 C

Pectoralis minor

 D

Serratus anterior

Ans. C

Explanation:

Of the muscles listed, pectoralis minor is the only one which is attached to the coracoid process. The deltoid originates from the clavicle, acromion and scapular spine and inserts on the deltoid process of the humerus. Pectoralis major originates from the clavicle, sternum, and ribs and inserts on the crest of the greater tubercle of the humerus. Serratus anterior originates on the ribs and inserts on the medial border of the costal surface of the scapula. So, none of these other muscles would be detached by a fracture of the coracoid process. 

NOTE:
Coracobrachialis and the short head of biceps are attached to the coracoid process.

Q. 19

Which of the following arteries supply pectoralis major muscle:

 A

Pectoral branches of thoracoacromial artery

 B

Intercostal artery

 C

Lateral thoracic artery

 D

All

Q. 19

Which of the following arteries supply pectoralis major muscle:

 A

Pectoral branches of thoracoacromial artery

 B

Intercostal artery

 C

Lateral thoracic artery

 D

All

Ans. D

Explanation:

A i.e. Pectoral branches of thoracoacromial artery; B i.e. Intercotal artery; C i.e. Lateral thoracic artery

  • Pectoralis major muscle is supplied by one dominant vascular pedicle from pectoral branch of thoraco-acromial artery, supplied by several smaller secondary segmental vessels from deltoid & clavicular branches of thoracoacromial artery, and perforating branches of, intercostal, internal thoracic/internal mammary, superior thoracic and lateral thoracic arteries.
  • Intercostal arteries supply blood to intercostal muscle, pectoral muscles, breast, skin, (by both anterior & posterior intercostal, arteries); spinalis, longissimus thoracic, iliocostalis, medial aspects of latissimus dorsi & trapezius (by dorsal branch of posterior intercostal artery) and serratus anterior (by muscular branch of posterior intercostal artery).

Q. 20

True about serratus anterior is/are:

 A

Laterally rotates the scapula

 B

It is attached to the medial side of scapula

 C

protects scapula

 D

All

Q. 20

True about serratus anterior is/are:

 A

Laterally rotates the scapula

 B

It is attached to the medial side of scapula

 C

protects scapula

 D

All

Ans. D

Explanation:

A i.e. Laterally rotates the scapula B i.e. It is attached to the medial side of scapula C i.e. protects scapula


Q. 21

True about the Serratus anterior muscle is

 A

Originates from the lower four ribs

 B

Bipennate muscle

 C

Supplied by the subscapular nerve

 D

Helps in forced inspiration

Q. 21

True about the Serratus anterior muscle is

 A

Originates from the lower four ribs

 B

Bipennate muscle

 C

Supplied by the subscapular nerve

 D

Helps in forced inspiration

Ans. D

Explanation:

Serratus anterior helps in vertical overhead abductionQ (assisted by trapezius), forward punchQ (assisted by pectoralis minor) & forced inspirationQ; it’s paralysis leads to winging of scapulaQ


Q. 22

Which of these muscles is not cut in postero lateral thoractomy :

 A

Serratus anterior

 B

Pectoralis major

 C

Latissimus dorsi

 D

Intercostals

Q. 22

Which of these muscles is not cut in postero lateral thoractomy :

 A

Serratus anterior

 B

Pectoralis major

 C

Latissimus dorsi

 D

Intercostals

Ans. B

Explanation:

B. i.e. Pectoralis major


Q. 23

In patients with breast cancer, chest wall involvement means involvement of any one of the following structures except

 A

Serratus anterior

 B

Pectoralis major

 C

Intercoastal musclesBreast / 3

 D

Ribs

Q. 23

In patients with breast cancer, chest wall involvement means involvement of any one of the following structures except

 A

Serratus anterior

 B

Pectoralis major

 C

Intercoastal musclesBreast / 3

 D

Ribs

Ans. B

Explanation:

Ans. is ‘b’ i.e. Pectoralis major 

The chest wall includes ribs, intercostal muscles and serratus anterior muscle, but not the pectoral muscles.


Q. 24

In Patey’s mastectomy the step not done is

 A

Nipple and areola removed

 B

Surrounding normal tissue of tumor is removed.

 C

Pectoralis major removed

 D

Pectoralis minor removed

Q. 24

In Patey’s mastectomy the step not done is

 A

Nipple and areola removed

 B

Surrounding normal tissue of tumor is removed.

 C

Pectoralis major removed

 D

Pectoralis minor removed

Ans. C

Explanation:

Ans. is ‘c’ i.e. (Pectoralis major removed) 

Lets see the nomenclature of various surgeries on breast

  • Simple or Total mastectomy

– it removes all breast tissue, the nipple-areola complex, and skin.

  • Extended simple mastectomy

– Simple mastectomy + removal of level I axillary lymph nodes.

  • Modified radical mastectomy

it removes all breast tissue, the nipple-areola complex, skin and the level I and level II axillary lymph nodes.

  • Halstead’s Radical mastectomy

removes all breast tissue and skin, the nipple areola complex, the pectoralis major and minor muscles and the level I, II and III axillary lymph nodes.

  • Modified Radical Mastectomy
  • Two forms of modified radical mastectomy are in use
  • Auchincloss (pronounced as ‘aushincloss’) procedure

Here both the pectoralis major and minor muscles are preserved with removal of level I and II axillary lymph nodes

Patey’s Procedure

here the pectoralis minor muscle is removed to allow complete dissection of level III axillary lymph nodes

  • Scanlon’s modification of Patey’s procedure

here the pectoralis minor muscle is divided instead of removing. Division of pectoralis minor muscle allows complete removal of level III lymph nodes

  • Halstead Radical Mastectomy
  • In this operation following structures are removed.

i)         the whole breast

ii)       the portion of skin overlying the tumor, which includes the nipple-areola complex.

iii)    the subcutaneous fat and the deep fascia vertically from the lower border of the clavicle upto the upper quarter of the sheath of the rectus abdominis and horizontally from the strenum to the anterior border of lattissimus dorsi

iv)     pectoralis major muscle

v)       pectoralis minor muscle and clavipectoral fascia

vi)     upper part of the aponeurosis of the external oblique and anterior parts of a few digitations of the serratus anterior muscle

vii)    all fatty and loose areolar tissue along with level I, II & III axillary lymph nodes

  • Structures saved are :

i)         the axillary vein and the cephalic vein

ii)       the long thoracic nerve of Bell (Nerve to serratus anterior). The nerve to latissimus dorsi may be sacrified if required.

  • Also know
  • Extended Radical Mastectomy – Radical mastectomy + removal of internal mammary lymph nodes

Super Radical Mastectomy – Radical mastectomy + removal of internal mammary, mediastinal and supraclavicular lymph nodes.


Q. 25

All of the following are used for reconstruction of breast except –

 A

Transverse rectus abdominis myocutaneous flap

 B

Latissimus dorsi myocutaneous flap

 C

pectoralis major myocutoneous flap

 D

Transversus rectus abdominis free flap

Q. 25

All of the following are used for reconstruction of breast except –

 A

Transverse rectus abdominis myocutaneous flap

 B

Latissimus dorsi myocutaneous flap

 C

pectoralis major myocutoneous flap

 D

Transversus rectus abdominis free flap

Ans. C

Explanation:

Ans. is ‘c’ Pectoralis major myocutaneous flap 


Q. 26

All form the posterior wall of axilla EXCEPT:

 A

Subscapularis

 B

Subclavius

 C

Teres major

 D

Latissimus dorsi

Q. 26

All form the posterior wall of axilla EXCEPT:

 A

Subscapularis

 B

Subclavius

 C

Teres major

 D

Latissimus dorsi

Ans. B

Explanation:

Subclavius forms the anterior wall of axilla


Q. 27

Insertion of pectoralis major is at:         

 A

Lateral lip of bicipital groove of humerus

 B

Medial lip of bicipital groove of humerus

 C

In the bicipital groove of humerus

 D

Clavicle

Q. 27

Insertion of pectoralis major is at:         

 A

Lateral lip of bicipital groove of humerus

 B

Medial lip of bicipital groove of humerus

 C

In the bicipital groove of humerus

 D

Clavicle

Ans. A

Explanation:

Pectoralis major arises from the anterior surface of the sternal half of the clavicle; from breadth of the half of the anterior surface of the sternum, as low down as the attachment of the cartilage of the sixth or seventh rib; from the cartilages of all the true ribs, with the exception, frequently, of the first or seventh and from the aponeurosis of the abdominal external oblique muscle. From this extensive origin the fibers converge in a flat tendon, about 5 cm in breadth, which is inserted into the lateral lip of the bicipital groove of the humerus.


Q. 28

Structure preserved in Modified radical [Patey] mastectomy is:      

September 2006, 2009

 A

Axillary vein

 B

Pectoralis major muscle

 C

Nerves to serratus anterior

 D

All of the above

Q. 28

Structure preserved in Modified radical [Patey] mastectomy is:      

September 2006, 2009

 A

Axillary vein

 B

Pectoralis major muscle

 C

Nerves to serratus anterior

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above


Q. 29

Anterior axillary fold is due to which muscle ‑

 A

Pectoralis major

 B

Pectoralis minor

 C

Subscapularis

 D

Teres major

Q. 29

Anterior axillary fold is due to which muscle ‑

 A

Pectoralis major

 B

Pectoralis minor

 C

Subscapularis

 D

Teres major

Ans. A

Explanation:

Anterior axillary fold is rounded in shaped and is formed by pectoralis major (lower border). Posterior axillary fold is formed by teres major and latisimus dorsi.


Q. 30

True about serratus anterior ‑

 A

Causes protraction

 B

Causes lateral rotation

 C

Supplied by thoracodorsal nerve

 D

Forms lateral boundary of axilla

Q. 30

True about serratus anterior ‑

 A

Causes protraction

 B

Causes lateral rotation

 C

Supplied by thoracodorsal nerve

 D

Forms lateral boundary of axilla

Ans. A

Explanation:

Serratus anterior causes protraction of scapula.

  • It is supplied by long thoracic nerve (Nerve of Bell).
  • It forms medial boundary of axilla.

Serratus anterior

  • Origin : Outer surface of upper 8 ribs by 8 digitations (multipennate muscles).
  • Insertion : Medial border of scapula and inferior angle.
  • Nerve supply : Long thoracic nerve (nerve of bell).
  • Actions : Action of serratus anterior are –
  • Rotates the scapula so that glenoid cavity is raised upward & forward – Helps in Vertical over head abduction (in this action assisted by trapezius).
  • Draws the scapula forward around the throcic wall so paralysis leads to winging of scapula.°
  • Also used when arm is pushed forward in horizontal position as in forward punch (helped by Pectoralis minor in this action)e.
  • Steadies the scapula during weight carrying.
  • Helps in forced inspiration.2 (Accessory muscle of inspiration).
  • Because of greater pull exerted on the inferior angle, inferior angle passes laterally and forward and the glenoid cavity is raised upward & forward; in this action the muscle is assisted by trapezius.

Q. 31

Artery which is shown by arrow  is divided into 3 parts. Which of the following muscle divides this artery into 3 parts

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Q. 31

Artery which is shown by arrow  is divided into 3 parts. Which of the following muscle divides this artery into 3 parts

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Ans. D

Explanation:

Axillary artery is divided into 3 parts by pectoralis minor muscle. Axillary artery extends from the outer border of the first rib to inferior border of teres major muscle where it becomes the brachial artery. 
 
Branches of the axillary artery:
 
First part:
  • Superior thoracic artery
Second part:
  • Thoracoacromial artery
  • Lateral thoracic artery
Third part:
  • Subscapular artery
  • Anterior humeral circumflex artery
  • Posterior humeral circumflex artery


Axillary artery

AXILLARY ARTERY

Q. 1

Axillary artery occlusion affects all EXCEPT:

 A

Post circumflex humeral.

 B

Suprascapular artery

 C

Subscapular artery

 D

Superior thoracic artery

Q. 1

Axillary artery occlusion affects all EXCEPT:

 A

Post circumflex humeral.

 B

Suprascapular artery

 C

Subscapular artery

 D

Superior thoracic artery

Ans. B

Explanation:

Suprascapular artery 

“Suprascapular artery is a branch of thyrocervical trunk of the subclavian artery, not axillary artery”

Branches of axillary artery:

The branches of the axillary artery are superior thoracic, thoraco-acromial, lateral thoracic, subscapular, anterior and posterior circumflex humeral. The Suprascapular artery usually arises from the thyrocervical trunk of the subclavian artery


Q. 2

Cord of brachial plexus are named as per their relation with the axillary artery behind which muscle?

 A

Deltoid

 B

Subclavius

 C

Teres major

 D

Pectoralis minor

Q. 2

Cord of brachial plexus are named as per their relation with the axillary artery behind which muscle?

 A

Deltoid

 B

Subclavius

 C

Teres major

 D

Pectoralis minor

Ans. D

Explanation:

Pectoralis minor crosses in front of axillary artery and divides it into three parts. The anterior relation of each part are; First part lies behing the pectoralis major muscle, second part lies behind the pectoralis minor and major muscle and third part lies behind pectoralis major.

The cords of brachial plexus are named according to their relation with the second part of  axillary artery, lateral cord runs lateral to the axillary artery, as well the medial and posterior cord lies medially and posterior to the axillary artery. Thus the muscle anteriorly to second part is pectoralis minor and major.


Q. 3

Which of the following is least likely to be involved in a collateral anastomosis which bypasses an obstruction of the first part of the axillary artery?

 A

Suprascapular artery

 B

Subscapular Artery

 C

Dorsalscapular Artery

 D

Posterior humeral circumflex artery

Q. 3

Which of the following is least likely to be involved in a collateral anastomosis which bypasses an obstruction of the first part of the axillary artery?

 A

Suprascapular artery

 B

Subscapular Artery

 C

Dorsalscapular Artery

 D

Posterior humeral circumflex artery

Ans. D

Explanation:

The suprascapular, dorsal scapular, subscapular, and scapular circumflex arteries participate in a potential collateral anastomoses around the scapula. The suprascapular and dorsal scapular arteries arise, directly or indirectly, from the subclavian artery while the subscapular and scapular circumflex arteries are from the third part of the axillary artery, thus providing a bypass for obstructions of the first or second parts of the axillary artery.


Q. 4

Which of the following artery is a branch of the first part of axillary artery?

 A

Lateral thoracic artery

 B

Superior thoracic artery

 C

Subscapular artery

 D

Thoracoacromial artery

Q. 4

Which of the following artery is a branch of the first part of axillary artery?

 A

Lateral thoracic artery

 B

Superior thoracic artery

 C

Subscapular artery

 D

Thoracoacromial artery

Ans. B

Explanation:

Superior thoracic artery is the only branch from the first part of the axillary artery. The axillary artery is a continuation of the subclavian artery and is divided into three parts. 
 
Branches from the second part of the axillary artery are:
  • Lateral thoracic artery
  • Thoracoacromial artery
Branches from the third part of the axillary artery are:
  • Subscapular artery
  • Anterior circumflex humeral artery
  • Posterior circumflex humeral artery

Q. 5

Axillary artery is divided into 3 parts. Which of the following muscle divides axillary artery into 3 parts?

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Q. 5

Axillary artery is divided into 3 parts. Which of the following muscle divides axillary artery into 3 parts?

 A

Teres major

 B

Teres minor

 C

Pectoralis major

 D

Pectoralis minor

Ans. D

Explanation:

Axillary artery is divided into 3 parts by pectoralis minor muscle. Axillary artery extends from the outer border of the first rib to inferior border of teres major muscle where it becomes the brachial artery. 
 
Branches of the axillary artery:
 
First part:
  • Superior thoracic artery
Second part:
  • Thoracoacromial artery
  • Lateral thoracic artery
Third part:
  • Subscapular artery
  • Anterior humeral circumflex artery
  • Posterior humeral circumflex artery

Q. 6

Axillary artery give rise to 6 main branches. Which of the following is the largest branch of axillary artery?

 A

Lateral thoracic artery

 B

Subscapular artery

 C

Superior thoracic artery

 D

Thoracoacromial artery

Q. 6

Axillary artery give rise to 6 main branches. Which of the following is the largest branch of axillary artery?

 A

Lateral thoracic artery

 B

Subscapular artery

 C

Superior thoracic artery

 D

Thoracoacromial artery

Ans. B

Explanation:

Subscapular artery is the largest branch of the axillary artery. It arise at the lower border of the subscapularis muscle and descend along the axillary border of the scapula. It give rise to two branches thoracodorsal artery and circumflex scapular artery.

Q. 7

A 42 year old man in Mumbai is being treated for Atrial Fibbrillation (AF). You suspect thromboembolism on further investigatins. Thromboembolism of axillary artery can affect all of the following vessels, EXCEPT:

 A

Post circumflex humeral

 B

Suprascapular artery

 C

Subscapular artery

 D

Superior thoracic artery

Q. 7

A 42 year old man in Mumbai is being treated for Atrial Fibbrillation (AF). You suspect thromboembolism on further investigatins. Thromboembolism of axillary artery can affect all of the following vessels, EXCEPT:

 A

Post circumflex humeral

 B

Suprascapular artery

 C

Subscapular artery

 D

Superior thoracic artery

Ans. B

Explanation:

Suprascapular artery is a branch of thyrocervical trunk of the subclavian artery, not axillary artery.

The axillary artery has several smaller branches.

First part (1 branch)

  • Superior thoracic artery

Second part (2 branches)

  • Thoraco-acromial artery
  • Lateral thoracic artery
Third part (3 branches)
  • Subscapular artery
  • Anterior humeral circumflex artery
  • Posterior humeral circumflex artery
It continues as the brachial artery past the inferior border of the teres major.

Q. 8

In case of occlusion occurs at the 2nd part of Axillary artery, blood flow is maintained by collateral/ anastomosis between:

 A

Anterior and posterior circumflex humoral artery

 B

Suprascapular and posterior circumflex artery

 C

Deep branch of the transverse cervical artery and Subscapular artery

 D

Anterior circumflex artery and subscapular artery

Q. 8

In case of occlusion occurs at the 2nd part of Axillary artery, blood flow is maintained by collateral/ anastomosis between:

 A

Anterior and posterior circumflex humoral artery

 B

Suprascapular and posterior circumflex artery

 C

Deep branch of the transverse cervical artery and Subscapular artery

 D

Anterior circumflex artery and subscapular artery

Ans. C

Explanation:

C i.e., Deep branch of the transverse cervical artery and subscapular artery

Axillary artery is a continuation of subclavian artery from lateral border of 1st rib to lateral border of teres major muscle(2 after which it becomes brachial artery. Because of extensive collateral circulation between thyrocervical trunk of subclavian artery and subscapular artery, which is branch distal axillary artery. Ligation, thrombosis or trauma of axillary artery anywhere between origins of thyrocervical trunk & sub scapular arteries will not lead to compromise of flow to distal arm.



Brachial artery

BRACHIAL ARTERY

Q. 1

In a fracture shaft humerus, which of the following complication requires immediate surgery?

 A

Compound fracture

 B

Nerve injury

 C

Brachial artery occlusion

 D

Comminuted fracture

Q. 1

In a fracture shaft humerus, which of the following complication requires immediate surgery?

 A

Compound fracture

 B

Nerve injury

 C

Brachial artery occlusion

 D

Comminuted fracture

Ans. C

Explanation:

C i.e. Brachial artery occulsion

The absolute indications for immediate operative management of fracture shaft humerus are – associated vascular injuryQ (eg. branchial artery rupture, occlusion etc) and associated higher grade (not all) open woundsQ


Q. 2

Bicipital aponeurosis lies over which structure in cubital fossa‑

 A

Ulnar nerve

 B

Radial nerve

 C

Brachial artery

 D

Anterior interosseous artery

Q. 2

Bicipital aponeurosis lies over which structure in cubital fossa‑

 A

Ulnar nerve

 B

Radial nerve

 C

Brachial artery

 D

Anterior interosseous artery

Ans. C

Explanation:

 

  • Bicipital aponeurosis  passes superficial to the brachial artery and median nerve. It lies deep to superficial veins.
  • During venipuncture, the bicipital aponeurosis provides limited protection for brachial artery and median nerve.

Q. 3

BP is measured in ‑

 A

Axillary artery

 B

Carotid artery

 C

Brachial artery

 D

Radial artery

Q. 3

BP is measured in ‑

 A

Axillary artery

 B

Carotid artery

 C

Brachial artery

 D

Radial artery

Ans. C

Explanation:

Ans. is ‘c’ i.e., Brachial artery

The standard location for noninvasive blood pressure measurement is the brachial artery, although there are several other sites where it can be done.


Q. 4

 

 

Bicipital aponeurosis lies over which structure in the triangle as shown in this picture

 A

Ulnar nerve

 B

Radial nerve

 C

Brachial artery

 D

Anterior interosseous artery

Q. 4

 

 

Bicipital aponeurosis lies over which structure in the triangle as shown in this picture

 A

Ulnar nerve

 B

Radial nerve

 C

Brachial artery

 D

Anterior interosseous artery

Ans. C

Explanation:

  • Bicipital aponeurosis  passes superficial to the brachial artery and median nerve. It lies deep to superficial veins.
  • During venipuncture, the bicipital aponeurosis provides limited protection for brachial artery and median nerve.


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