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Pectoral Girdle, Shoulder and Arm1. The stability of the shoulder jointa. Is primarily due to the strong capsule – musculotendinous rotator cuffb. Is assisted by the rotator cuff muscles <= correct, SSIT: sub, supra, infra, tminorc. Is aided by the splinting effect of short head of biceps – shunt (not splint) muscles: deltoid, long head triceps, coracobrachialis, short head of bicepsd. Is weakest posteriorly - inferiorlye. Is reliant on the deep glenoid cavity - shallow2. In the upper arma. The musculocutaneous nerve pierces and supplies the triceps muscle – radial passes between lat and med heads and pierces lateral intermuscular septum, musculocutaneous pierces coracobrachialisb. The axillary nerve arises from the medial cord of the brachial plexus – post c. The median nerve crosses in front of the brachial artery <= starts lat, crosses ant, ends medd. The ulnar nerve passes between the 2 heads of pronator teres – median, ulnar between FCU, radial between supinatore. The radial nerve spirals around the front of the humerus - back3. The axillary arterya. Becomes the brachial artery at the lower border of teres minor – teres majorb. Is anteromedial to the axillary vein – the vein is anteromedial to the arteryc. Runs with branches of the brachial plexus in the 2nd part - cordsd. Gives off the subscapular artery from the third part <= 1st: superior thoracic, 2nd: thoraco-acromial and lateral thoracic, 3rd: subscapular, anterior and posterior circumflex humeral (S,TL,SAP)e. Commences at the medial border of the clavicle – the medial border 1st rib4. The trunks of the brachial plexus are founda. Between the scalene muscles – the rootsb. In the posterior trianglec. Around the second part of the axillary artery – the cordsd. Behind the clavicle – the divisionse. Immediately after the intervertebral foramina -?roots5. The brachial plexusa. Is formed from fibres from C4 to T1b. Gives off 2 branches from the trunks <= suprascapular and nerve to c. Gives off the radial nerve from the lateral cord - postd. Has the ulnar nerve as the largest branch of the medial cord <= it ise. Gives off the suprascapular nerve from the lateral cord – superior trunk6. Biceps brachiia. Is supplied by the axillary nerveb. Has no action on the shoulder jointc. Arises from the infraglenoid tubercled. Has a short head attached in common with brachialis - coracobrachialise. Inserts into both radius and ulna <= debatable in Moore’s7. Tricepsa. Is supplied by three branches of the radial nerve – In Moore’s it is, by a study in 2004 showed long head is really spplied by axillaryb. Arises via its medial head from the lateral side of the radial groove – superior to radial groovec. May be weakened by mid humeral fractures – radial supply comes off proximallyd. Arises via the long head from the infraglenoid tubercle - truee. Assists in supination of the forearm – only extension (+ long head as shunt)8. Regarding the brachial plexus, all of the following are true EXCEPT:a. The roots forming the plexus originate from the anterior rami of C5, 6, 7, 8 and T1b. The roots lie between the scalenus medius and scalenus posterior muscles <= anterior/mediusc. The trunks lie in the lower part of the posterior triangled. The divisions are formed behind the claviclee. The cords are formed at the outer border of the 1st rib9. The axillary arterya. Becomes the brachial artery at the upper border of teres major - lowerb. Gives rise to the thoracoacromial artery as its largest branch - c. Lies medial to the axillary vein – the vein is antero medial to the arteryd. Gives rise to the superior thoracic artery which supplies latissimus dorsi – superior thoracic supplies 1st/snd intercostal spaces and upper slips serratus anterior. thoracodorsal a. -> lat. dorsie. Is the continuation of the third part of the subclavian artery <= true10. The brachialis muscle:a. Arises from the upper third of the humerus – distal halfb. Inserts into the coronoid process and tuberosity of ulna <= truec. Is suppled exclusively by the medial nerve - musculocutaneousd. Is a powerful supinator of the forearm – chief flexore. Adducts the arm – doesn’t cross the GHJ11. Paralysis of which nerve results in inability to initiate abduction of the arma. Axillary nerve – continue abduction via deltoidb. Suprascapular nerve <= to supraspinatous thus truec. Subscapular nerve – upper and lower to subscap, lower to teres majord. Dorsal scapular nerve – to rhomboids and lev scape. Thoracodorsal nerve – to lat dorsi12. The axillaa. Communicates with the anterior triangle of the neck – no posterior via cervicoaxillary canalb. Contains lymph nodes draining the upperlimb and lateral chest wall <= truec. Has an anterior wall made up by the serratus anterior muscle – medial, anterior is pec muscles and clavipectoral fasciad. Has an apex bounded by the humerus, clavical and scapula – apex is outer 1st rib, clavical and scapular, humerus w/ intertubercular groove is the medial walle. Has no medial wall – as above it does13. The brachial artery:a. Crosses anterior to the median nerve in the arm – is crossed anteriorly by the median nerveb. Gives off the nutrient artery to the humerus <= truec. Lies deep to bicepsd. Has the ulnar nerve on its medial side – posteriomedial?e. Gives muscular branches to triceps14. The major stabilising factor of the sternoclavivular joint ita. The acromioclavicular ligamentb. The costoclavicular ligament <= not detailed in Moore’sc. The interclavicular ligamentd. The sternoclavicular ligamente. The coracoclavicular ligament15. The Musculocutaneous nerve:a. Supplies brachioradialis – by radiusb. Terminates as the posterior interosseous nerve – there is no posterior interosseusc. Supplies all of the brachialis muscle – no, the radial does also…d. Contains fibres from C5, C6, C7 and C8 – C5,6e. Arises from the lateral cord of the brachial plexus <= true16. An injury to the posterior cord of the brachial plexus will result in which of the following?a. Winging of the scapula – roots 5,6,7 -> long thoracicb. Paralysis of supraspinatus and infraspinatus – superior trunk -> suprascapularc. Paralysis of the clavicular part of pectoralis major – lat cord -> lateral pectorald. Numbness along the posterior part of the upper arm – SsTAR: upper posterolat via axiallary -> superior lateral cutaneous nerve, and radial to inferior lateral cutaneous nerve of arme. Numbness along the medial part of the upper arm – medial 17. Which statement regarding the brachial plexus is true?a. It is formed by the posterior rami of C5, 6, 7, 8, T1 - anteriorb. The roots unite to form the trunks behind the clavicle – the trunks are in the (post) triangle, divisions behind the claviclec. The only branch from the trunks is thoracodorsal nerve to supra and infraspinatus – the suprascapluar nerve (and possibly the nerve to subclavius), the dorsal scapular spplies rhomboids and levator scapulaed. The cords are formed at the outer border of the first rib <=e. The ulnar nerve receives a branch from the lateral cord which carries fibres to flexor carpi ulnaris18. Fracture of the humerus can commonly result in which of the following lesions?a. Paralysis of tricepsb. Numbness over posterior part of upper armc. Numbness over 1st dorsal interosseous <=d. Numbness over posterior forearm and lateral upper arme. Paralysis of long flexors of fingers19. The posterior compartment of the arm hasa. The lateral head of triceps arising from the infraglenoid tubercle of the scapulab. The radial nerve occupying the whole of the spiral groovec. Triceps being innervated by three branches of the radial nerved. Radial nerve giving off lower lateral cutaneous nerve of arm and lateral cutaneous nerve of forearme. The medial head of triceps also inserts into the elbow joint capsule20. The actions of deltoid include:a. Abduction of the arm with supraspinatusb. Extension of the arm with latissimus dorsic. Flexion and medial rotation of the arm with pectoralis majord. Steadying the arm in abduction (anterior and posterior fibres)e. All of the above <=21. The triangular space below teres major in the axilla transmits the profunda brachii vessels anda. Musculocutaneous nerveb. Ulnar nervec. Median nerved. Radial nerve <=e. Axillary nerve – via quad w/ posterior circumflex humeral22. The nerve supply of teres major isa. Thoracodorsal nerveb. Dorsal scapular nervec. Axillary nerved. Lower subscapular nerve <=e. Suprascapular nerve23. The second part of the axillary artery gives rise to thea. Superior thoracic artery – 1stb. Subscapular artery – 3rdc. Suprascapular artery – from subclavian (via thyrocervical trunk usually, tITS)d. Circumflex humeral arteries – 3rde. Thoracoacromial artery <= S,TL,SAP, 2nd: thoracoacromial and lateral thoracic24. The axillary nerve contains fibres froma. C5, 6 <=b. C5, 6, 7c. C6, 7d. C7e. C8, T125. The radial nervea. Passes out of the axilla below the lower edge of teres major <= the triangular space is lower border teres major, humerus and long head of triceps, so correctb. Supplies the shoulder joint – suprascapluar, axillary and lateral pectoral nervesc. Supplies a small patch of skin on lateral surface of arm – a large strip posterolaterally and supplies skin on dorsum of handd. Is motor to flexor muscles of forearm - mediane. Is cutaneous to dorsal surface of tips of index and middle fingers - median26. Infraspinatusa. Medially rotates the shoulder joint – subscap pect majorb. Laterally rotates the shoulder joint – correct, main actionc. Inserts into the lower facet on greater tuberosity of humerus – middle, S#SITd. Is supplied by the lower subscapular nerve - suprascapulare. Extends the shoulder joint – deltoid, teres major, lat dorsi, long head triceps27. Regarding tricepsa. The long head lies lateral to the medial head - medialb. The lateral head arises from the lateral intermuscular septum – lateral head in proximal to the radial groovec. The medial head receives 3 branches of the radial nerved. Damage to the radial nerve at the midshaft of the humerus will interrupt supply to triceps – no branches arise high (in axilla)e. The long head arises from the infraglenoid tubercle of the scapula <= true28. Pectoralis minor inserts intoa. Coracoid process <= superior and medial ascpectb. Medial lip of intertubercular groovec. Lateral lip of intertubercular grooved. Anterior lip of deltoid tuberositye. Infraglenoid tubercle29. Regarding subclaviusa. Its nerve supply is from the medial trunk of the brachial plexus (C5, 6) – superior trunkb. It lies on top of the clavipectoral fascia - withinc. It arises from the angle of the first rib – the costochondral margind. It inserts into the subclavian groove on the inferior surface of the clavicle – insert into middle thirde. It can prevent damage to the subclavian artery from a fractured clavicle <=30. Regarding pectoralis majora. It provides direct attachment of pectoral girdle to the axial skeletonb. It forms part of the posterior wall of the axilla - anteriorc. Its insertion into the scapula is to the lateral lip of the intertubercular groove - humerusd. The humeral insertion extends distally to deep fascia of arm - ?e. Its sternocostal head arises from manubrium, sternum, external oblique and upper 6 costal cartilages <= true31. Regarding pectoralis major, all are true EXCEPT:a. It may have rectus sternalis accompanying itb. The medial pectoral nerve pierces pectoralis minor to reach pectoralis majorc. The laterl pectoral nerve pierces the clavipectoral fascia to reach pectoralis major <=d. Its actionis medial rotation and abduction – medial rotation and aDductione. Fibres from the posterior leaf of the trilaminar tendon insert into the shoulder joint capsule32. The clavipectoral fascia has all but one of the following featuresa. Encloses pectoralis minor and subclavius - trueb. Forms the costocoracoid ligament at the lower border of pectoralis minor <= upperc. Forms the suspensory ligament of the axilla - trued. Is pierced by lymphatics and the cephalic vein - truee. Is pierced by thoracoacromial vessels and the lateral pectoral nerve - true33. Regarding pectoralis minor, all are true excepta. It arises from ribs 3, 4, 5 deep to pectoralis major - trueb. It is supplied by both medial and lateral pectoral nerves – mostly the medial, but some lateral pectoral nerve fibers pass to it via the medial pectoral nervec. It acts to protract the scapula – it doesd. It is used as a landmark to divide the axillary artery into 3 parts <= truee. It inserts into medial and lower border of the coracoid process – medial and superior surface34. Trapeziusa. Has an extensive midline origin from superior nuchal line to spinous process of T12 - trueb. Inserts into lateral 1/3 of clavicle, acromion and all of the spine of the scpula - truec. Supplied by the spinal part of the accessory nerve - trued. Acts to rotate the scapula – upward rotatione. Is antagonised by the rhomboids and levator scapulae – downward rotation35. Regarding the muscles of the upper limba. Latissimus dorsi is not supplied by the brachial plexus – thoracodorsal n. from post cord (SsTar)b. The triangle of auscultation is bounded by the lateral border of trapezius, the upper border of latissimus dorsi and the vertebral border of the scapula – lateral border of scapulac. Damage to the thoracodorsal nerve results in winging of the scapula – long thoracicd. The rhomboid muscles are supplied by the suprascapular nerve – dorsal scapular (C5)e. Serratus anterior is the only muscle of the upper limb supplied by all segments of the brachial plexus – it is via long thoracic c5,6,7. Pect major is supplied by all36. Regarding the cutaneous nerve supply to arm and forearma. C3/4 supply pectoral and upper shoulderb. Branches of the brachial plexus supply arm and forearmc. C4/5/6/T1 supply the majority of the armd. ?e. ?37. Regarding the brachial plexusa. Serratus anterior is supplied by C6, 7, 8b. All branches originate from roots, divisions or cords – none from divisions, 2 from trunks, 2 from rootsc. Suprascapular nerve comes off the posterior cord – superior trunkd. Dorsal scapular nerve comes off C5 <=e. ?38. Which does not pass through the clavipectoral fasciaa. Lymph vesselsb. Cephalic veinc. Medial pectoral nerve <=d. Thoracoacromial arterye. Lateral pectoral nerve39. Which is incorrect regarding the lateral intermuscular septuma. Medial head of triceps arises from it <=b. It has brachioradialis as an anterior relationc. It is pierced by the radial nerve - trued. It extends along the lateral supracondylar linee. ?40. Regarding the shoulder jointa. The humeral head is twice the area of the glenoid cavity – 3xb. The short head of biceps is intracapsular – long headc. It often communicates anteriorly with subscapularis bursa <= trued. It is reinforced by important glenohumeral ligaments -?e. It is only supplied by the axillary nerve – suprascapular and lateral pectoral41. The upper brachial plexus suppliesa. The medial rotators of the shoulder – C 6,7,8b. The adductors of the shoulder – C6,7,8c. The extensors of the elbow – C7,8d. Small muscles of the hand – T1e. Sensation of the lateral side of arm and forearm <=42. Regarding subclaviusa. Its nerve supply is from the medial trunk of the brachial plexus (C5, 6)b. It lies on top of the clavipectoral fascia - withinc. It arises from the angle of the first rib – 1st costochondral cart -> inferior mid 1/3 clavicled. It inserts into the subclavian groove on the inferior surface of the clavicle <= also truee. It can prevent damage to the subclavian artery from a fractured clavicle <=43. Pectoralis majora. Is quadrilateral in shape – fan shapedb. Has a head that arises from the posterior surface of the claviclec. Inserts into the medial lip of the bicipital grooved. Lies between biceps and the humeral shafte. Is supplied by all five segments of the brachial plexus <= true, by lateral pectoral (C5,6,7) and medial pectoral (C8, T1) nn.44. Latissimus dorsia. Arises from the spinous processes of T2 to L5 –inferior 6 thoracic, thoracolumbar fascia, iliac crest and lower 3-4 ribsb. Spirals around the upper border of teres major – lower borderc. Arises from the iliac crest <= trued. Inserts in the lesser tuberosity of the humerus – inserts into base of intertubercular groovee. Externally rotates the humerus - internally45. The sternoclavicular jointa. Communicates with the manubriosternal jointb. Is mostly stabilised by the costoclavicular ligament <=c. Is the fulcrum of movements at the sternoclavicular jointd. Contains two fibrocartilaginous discse. Is supplied by nerve branches from C8 and T146. teres majora. arises from the medial border of the scapula – mid lateralb. forms the lower border of the quadrandular space <=c. forms the lateral border of the triangular space - humerusd. is supplied by the axillary nervee. largely acts to extend the arm – adduct and medially rotate47. the axillary arterya. arises from the vertebral arteryb. is divided into 3 parts by teres major – pect minorc. is clasped in its parts by the cords of the brachial plexus <=d. has no branches in its 3rd parte. supplies the pectoral muscles via the superior thoracic artery – superior thoracic doesn’t supply much (subclav, upper slips of serratus ant and 1st and 2nd intercostals), the pectoral mm. are supplied by the lateral thoracic a.48. with regard to the brachial plexusa. the axillary nerve is derived from the lateral cord - postb. the radial nerve is derived from C7, C8, T1 – C5-T1c. the nerve to subclavius is the only branch from the trunks – suprascapular nd. there are seven divisions of the trunkse. the roots lie between the scalene muscles <=49. an injury to the middle trunk of the brachial plexusa. would mean that C8 sensation is alteredb. will manifest in the medial cordc. will affect the median nerve <=d. will affect the long thoracic nervee. all of the above50. the rotator cuff is formed from all of the following EXCEPT:a. subscapularisb. supraspinatusc. infraspinatusd. teres minore. teres major <=51. the subacromial bursaa. is strengthened anteriorly by the glenohumeral ligamentsb. lies under the coracoacromial ligament <= true, between the supraspinatus and the ligamentc. envelopes the distal end of the coracoid processd. if inflamed will be more tender when abducted – there will be a painful arc 60-90deg, then reliefe. all of the above52. with regard to the biceps brachii musclea. the long head arises from the greater tuberosity of the humerusb. the short head arises from the acromionc. it is a supinator of the forearm <=d. it is supplied by branches of the median nervee. the two heads merge in the upper arm53. the brachial arterya. lies lateral to the basilic vein <=b. lies anterior to the cephalic veinc. is crossed posteriorly by the median nerved. runs parallel but deep to the profunda brachii arterye. is the continuation of the subclavian artery54. the triceps musclea. is a misnomer because it only has two headsb. is supplied by the radial nerve <=c. stabilises the shoulder in adduction <=d. will often have its nerve supply compromised by humeral shaft fracturese. derives its blood supply from the posterior interosseous artery ................
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