Sixth edition

APPLETON & LANGE REVIEW OF

ANATOMY
Royce Lee Montgomery, PhD
Professor
Department of Cell and Developmental Biology
School of Medicine
University of North Carolina
Chapel Hill, North Carolina

Kurt Ogden Gilliland, PhD

Department of Cell and Developmental Biology
School of Medicine
University of North Carolina
Chapel Hill, North Carolina

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Appleton & Lange Review of Anatomy, Sixth Edition
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Montgomery, Royce L.

Appleton & Lange review of anatomy / Royce L. Montgomery, Kurt Ogden

Gilliland.—6th ed.
p. ; cm.
Rev. ed. of: Appleton & Lange review of anatomy for the USMLE Step 1 / Royce L. Montgomery,
Gerald A. Montgomery. © 1995.
Includes bibliographical references.
ISBN 0-07-137727-1 (alk. paper)
1. Human anatomy—Examinations, questions, etc. 2. Physicians—Licenses—United States—Examinations—Study
guides. I. Title: Appleton & Lange review of anatomy. II. Title: Review of anatomy. III. Gilliland, Kurt Ogden. IV.
Montgomery, Royce L. Appleton & Lange review of anatomy for the USMLE Step 1. V. Title.
[DNLM: 1. Anatomy—Examination Questions. QS 18.2 M788a 2003]
QM32 .M65 2002
611′.0076—dc21
2002016672
International Edition ISBN 0-07-121248-5
Copyright © 2003. Exclusive rights by The McGraw-Hill Companies, Inc., for manufacture and export. This book cannot
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 Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

1.The Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.The Upper Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
31
3.The Thorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
4.The Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
5.The Pelvis and Perineum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
6.The Lower Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 .
109
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
132
7.The Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
141
Answers and Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
143
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

iii
 CHAPTER 2

The Upper Limb

Questions

DIRECTIONS (Questions 1 through 83): Each of (C)The acromion is superior to the glenoid
the numbered items or incomplete statements in cavity and projects anterolaterally.
this section is followed by answers or by (D)The scapula is fastened securely to the
completions of the statement. Select the ONE thoracic cage at the scapulothoracic joint.
lettered answer or completion that is BEST in each
(E)The acromioclavicular joint represents the
case.
true shoulder joint.
1. Which of the following is NOT true regarding
the clavicle? 4. Which of the following is NOT included in the
(A)Its medial end is enlarged where it condyle of the humerus?
attaches to the sternum. (A)radial, coronoid, and olecranon fossae
(B)Its lateral end is flat where it articulates (B) epicondyles
with the humerus.
(C) trochlea
(C)The medial two-thirds of the shaft are
(D) capitulum
convex anteriorly.
(E)greater tubercle
(D)The clavicle transmits shock from the
upper limb to the axial skeleton.
5. Which of the following is NOT true in respect
(E)The clavicle is a “long bone” that has no
to the ulna and radius?
medullary cavity.
(A)The brachialis attaches to the tuberosity of
2. The trapezius attaches to which of the follow- the ulna.
ing regions of the clavicle? (B)The ulnar styloid process is much larger
than the radial styloid process and
(A)lateral one-third of the clavicle
extends farther distally.
(B)conoid tubercle
(C)The head of the ulna lies distally, whereas
(C)subclavian groove the head of the radius articulates with the
(D)trapezoid line humerus.
(E)quadrangular tubercle (D)The ulna is medial to the radius in the
anatomical position.
3. Which of the following is true in respect to the (E)The bodies of these bones are firmly bound
scapula? together by the interosseous membrane.
(A)The spine of the scapula continues later-
ally as the coracoid process.
(B)The lateral surface of the scapula forms
the glenoid cavity.

11
12 2: The Upper Limb

6. Which of the following is true regarding the (D) subclavius

carpus? (E)serratus anterior
(A)The scaphoid articulates proximally with
the ulna and has a tubercle. 11. Which of the following best describes the action
(B)The lunate articulates with the ulna and is of the pectoralis minor?
broader anteriorly than posteriorly. (A)stabilizes scapula by drawing it inferiorly
(C)The triquetrum articulates proximally and anteriorly against thoracic wall
with the articular disc of the distal (B)anchors and depresses clavicle
radioulnar joint. (C)adducts and medially rotates humerus
(D)The pisiform lies on the palmar surface of (D)rotates scapula
the trapezium. (E)flexes humerus
(E)It is composed of seven bones.
12. Which of the following muscles attaches to the
7. Which of the following describes the correct coracoid process of the scapula?
order of the distal row of carpals from lateral to (A)pectoralis minor
medial?
(B)triceps brachii
(A)triquetrum, trapezoid, capitate, hamate (C) brachialis
(B)trapezoid, trapezium, capitate, hamate (D)pectoralis major
(C)trapezium, trapezoid, capitate, hamate (E) subclavius
(D)trapezium, triquetrum, capitate, hamate
(E)scaphoid, lunate, triquetrum, pisiform 13. All of the following are medial rotators of the
arm EXCEPT
8. Which of the following is actually a lateral cuta-
(A)latissimus dorsi
neous branch of an intercostal nerve, innervat-
ing the skin of the medial surface of the arm? (B)teres major
(C) subscapularis
(A)intercostobrachial nerve (D) infraspinatus
(B)superior lateral cutaneous nerve of the arm
(E)anterior part of deltoid
(C)inferior lateral cutaneous nerve of the arm
(D)medial cutaneous nerve of the arm 14. What muscles are necessary to raise the arm
(E)lateral pectoral nerve above the shoulder?
(A)first the supraspinatus, next the deltoid,
9. Which of the following is NOT a branch of the
and then the serratus anterior
radial nerve?
(B)first the deltoid, next the supraspinatus,
(A)posterior cutaneous nerve of the arm and then the serratus anterior
(B)posterior cutaneous nerve of the forearm (C)first the supraspinatus, next the serratus
(C)inferior lateral cutaneous nerve of the arm anterior, and then the deltoid
(D)superior lateral cutaneous nerve of the (D)first the serratus anterior, next the deltoid,
arm and then the supraspinatus
(E)posterior interosseous nerve (E)first the deltoid, next the serratus anterior,
and then supraspinatus
10. Which of the following is NOT an anterior tho-
racoappendicular muscle? 15. Which of the following is innervated by the
(A)pectoralis major dorsal scapular nerve?
(B)pectoralis minor (A)serratus anterior
(C) deltoid (B)rhomboid major and minor
 Questions: 6–23 13

(C)erector spinae (C)teres major

(D) subscapularis (D) subscapularis
(E) supraspinatus (E)levator scapulae

16. Which of the following is an extrinsic shoulder 21. Which of the following is NOT contained in the
muscle? axilla?
(A) deltoid (A)axillary blood vessels
(B)teres major (B)lymph nodes
(C)levator scapulae (C)trunks and divisions of the brachial
(D)teres minor plexus
(E) supraspinatus (D)axillary nerve
(E)lymph nodes
17. Which of the following is true in respect to the
trapezius? 22. Which of the following is most correct?
(A)It is innervated by the dorsal scapular (A)The subscapular artery arises from the
nerve. third part of the axillary artery and
(B)Its superior fibers retract the scapula. contributes to blood supply of muscles
(C)Its middle fibers elevate the scapula. near the scapula and humerus.
(D)Its inferior fibers retract the scapula. (B)The second part of the axillary artery typi-
cally contains two branches—the thora-
(E)Its superior and inferior fibers act together
coacromial artery and the superior
in rotating the scapula on the thoracic
thoracic artery.
wall.
(C)The first part of the axillary artery lies
18. A patient is asked to place the hands posteriorly posterior to the pectoralis minor.
on the hips and to push the elbows posteriorly (D)The thoracoacromial artery supplies the
against resistance. Which muscle is being tested? pectoral muscles, axillary lymph nodes,
and most importantly the lateral part of
(A)levator scapulae the mammary gland in women.
(B) rhomboid (E)The lateral thoracic artery divides into
(C) trapezius four branches, the acromial, deltoid, pec-
(D)latissimus dorsi toral, and clavicular.
(E)serratus anterior
23. Which of the following is NOT correct?
19. Which rotator cuff muscle does NOT rotate the
(A)The brachial plexus is formed by the union
humerus? of the ventral rami of C5 through T1.
(A) supraspinatus (B)The roots of the brachial plexus and the
(B) infraspinatus subclavian artery pass through the gap
(C)teres minor between the anterior and middle scalene
(D) subscapularis muscles.
(C)Gray rami contribute sympathetic fibers
(E)teres major
to each root.
20. The axillary nerve innervates which of the fol- (D)Each of the three trunks of the brachial
plexus divide into anterior and posterior
lowing muscles?
divisions.
(A) coracobrachialis
(E)The cords of the brachial plexus surround
(B)teres minor the brachial artery.
14 2: The Upper Limb

24. Which of the following is NOT a supraclavicu- (D)It is primarily innervated by the musculo-
lar branch of the brachial plexus? cutaneous nerve, but some of its lateral
part is innervated by a branch of the
(A)dorsal scapular nerve
radial nerve.
(B)lateral pectoral nerve
(E)It crosses two joints.
(C)long thoracic nerve
(D)nerve to the subclavius 29. A patient is asked to abduct the arm 90 degrees
(E)suprascapular nerve and then to extend the flexed forearm against
resistance. Which muscle is being tested?
25. Which of the following is true regarding the
(A)triceps brachii
quadrangular space?
(B) brachialis
(A)It is bounded superiorly by the teres
(C) coracobrachialis
major.
(D)biceps brachii
(B)It is bounded inferiorly by the subscapu-
(E) supinator
laris and teres minor.
(C)It is bounded medially by the humerus 30. The deep artery of the arm accompanies which
and laterally by the long head of the
of the following before passing around the
triceps.
body of the humerus?
(D)It contains the posterior circumflex
humeral artery and the axillary nerve. (A)radial nerve
(E)Brachial plexus herniations occur here. (B)musculocutaneous nerve
(C)median nerve
26. Which of the following is NOT innervated by (D)ulnar nerve
the suprascapular nerve? (E)axillary nerve
(A) supraspinatus
31. Which muscle assists in extension of the fore-
(B) infraspinatus
arm, resists abduction of the ulna during prona-
(C)glenohumeral joint
tion of the forearm, and tenses the capsule of
(D)skin over superior part of scapula
the elbow joint so that it is not pinched when
(E)shoulder joint the joint is extended?

27. Which of the following is NOT a branch of the (A) anconeus

(B)triceps brachii
posterior cord of the brachial plexus?
(C) coracobrachialis
(A)upper and lower subscapular nerves
(D) brachialis
(B)thoracodorsal nerve
(E)biceps brachii
(C)axillary nerve
(D)radial nerve 32. Which of the following is a branch of the brachial
(E)long thoracic nerve artery?
(A)anterior and posterior circumflex humeral
28. Which of the following is NOT true in respect
arteries
to the brachialis?
(B)deltoid artery
(A)Its origin is the distal half of the anterior
(C)superior and inferior ulnar collateral
surface of the humerus. arteries
(B)Its insertion is the coronoid process and (D)thoracoacromial artery
tuberosity of the ulna.
(E)anterior and posterior ulnar recurrent
(C)It flexes the forearm in all positions. arteries
 Questions: 24–42 15

33. Which of the following nerves supply NO 38. Which muscle does NOT cross the elbow joint?
branches to the arm?
(A)flexor pollicis longus
(A)musculocutaneous and median (B)pronator teres
(B)radial and ulnar (C)flexor carpi radialis
(C)median and ulnar (D)flexor carpi ulnaris
(D)median and radial (E)flexor digitorum superficialis
(E)musculocutaneous and radial
39. The ulnar nerve innervates which of the fol-
34. Which of the following nerves is correctly paired lowing muscles in the flexor compartment?
with its cutaneous branch? (A)the medial part of the flexor digitorum
(A)median nerve and medial antebrachial superficialis
cutaneous nerve (B)flexor carpi radialis
(B)musculocutaneous nerve and lateral ante- (C)pronator quadratus
brachial cutaneous nerve (D)pronator teres
(C)ulnar nerve and posterior antebrachial (E)the medial part of flexor digitorum
cutaneous nerve profundus
(D)median nerve and medial brachial cuta-
neous nerve 40. The radial artery lies just lateral to the tendon of
(E)radial nerve and superior lateral brachial which muscle?
cutaneous nerve
(A)pronator teres
35. The cubital fossa does NOT contain which of the (B)flexor carpi radialis
following? (C)palmaris longus
(D)flexor carpi ulnaris
(A)terminal part of the brachial artery
(E)flexor digitorum superficialis
(B)deep accompanying veins of the arteries
(C)median nerve 41. The palmaris longus tendon is a useful guide to
(D)biceps brachii tendon which nerve at the wrist?
(E)ulnar nerve (A)anterior interosseous nerve
36. A patient is unable to flex the arm and forearm. (B)posterior interosseous nerve
Where is the lesion likely to be? (C)median nerve
(D)ulnar nerve
(A)ventral rami of C3–C4
(E)radial nerve
(B)ventral rami of C5–C6–C7
(C)dorsal rami of C6–C7–C8 42. To pronate the forearm, which of the following
(D)ventral rami of C8–T1 must occur?
(E)dorsal rami of T1 (A)The pronator quadratus initiates prona-
tion, assisted later by the pronator teres.
37. The radial nerve innervates muscles in the exten-
(B)The pronator teres initiates pronation,
sor compartment of the forearm, but it also in-
assisted later by the pronator quadratus.
nervates the following flexor:
(C)The anconeus initiates pronation, assisted
(A) brachioradialis later by the pronator teres.
(B)pronator teres (D)The pronator quadratus initiates prona-
(C)palmaris longus tion, assisted later by the anconeus.
(D)pronator quadratus (E)The ulnar nerve must be used.
(E)palmaris longus
16 2: The Upper Limb

43. The extensor carpi radialis longus tendon is 47. Which of the following is true in respect to the
crossed by which two muscles? anatomical snuff box?
(A)abductor pollicis longus and extensor pol- (A)It is bounded anteriorly by the tendons of
licis longus the extensor pollicis longus.
(B)extensor indicis and extensor digitorum (B)It is bounded posteriorly by the tendons
(C)extensor digitorum and extensor pollicis of the abductor pollicis longus and exten-
brevis sor pollicis brevis.
(D)abductor pollicis longus and extensor pol- (C)The radial artery lies in the floor of the
licis brevis snuff box.
(E)extensor indicis and extensor carpi radi- (D)The scaphoid and triquetrum can be pal-
alis brevis pated within the snuff box.
(E)The snuff box is visible when the thumb is
44. Which of the following is true in respect to the fully flexed.
supinator?
48. Which of the following does NOT abduct the
(A)It is innervated by the ulnar nerve.
hand at the wrist joint?
(B)It supinates the forearm by rotating the
ulna. (A)flexor carpi radialis
(C)It forms the floor of the cubital fossa along (B)extensor carpi radialis longus
with the brachioradialis. (C)extensor carpi radialis brevis
(D)It supinates the forearm when the forearm (D)abductor pollicis longus
is already flexed. (E)palmaris longus
(E)It rotates the radius to turn the palm ante-
riorly. 49. Which of the following is derived from the
radial artery?
45. Which of the following does NOT take an ori-
(A)dorsal and palmar carpal arteries
gin from the lateral epicondyle of the humerus?
(B)common interosseous artery
(A)extensor carpi radialis brevis (C)anterior interosseous artery
(B)extensor carpi ulnaris (D)poster interosseous artery
(C)abductor pollicis longus (E)ulnar recurrent artery
(D) supinator
(E)extensor digiti minimi 50. The median nerve does which of the following?
(A)innervates the elbow joint with articular
46. Which of the following is correctly paired with
branches
its nerve?
(B)innervates the medial half of the flexor
(A)flexor pollicis longus and anterior digitorum profundus
interosseous nerve (C)innervates the hypothenar muscles
(B)flexor digitorum profundus and anterior (D)innervates lumbricals 3 and 4
interosseous nerve
(E)innervates the skin of the dorsum of the
(C)extensor carpi radialis longus and poste- hand
rior interosseous nerve
(D)brachioradialis and posterior interosseous 51. The ulnar nerve does NOT do which of the fol-
nerve lowing?
(E)abductor pollicis longus and anterior
(A)innervate the elbow joint with articular
interosseous nerve
branches
(B)innervate the flexor carpi ulnaris
 Questions: 43–59 17

(C)innervate the skin on the lateral part of (B)adductor pollicis

the palm and dorsum of the hand (C)flexor pollicis brevis
(D)innervate the adductor pollicis (D)opponens pollicis
(E)innervate the dorsal and palmar interossei (E)The recurrent branch of the median nerve
The radial nerve does NOT do which of the fol- innervates all of the above.
52.
lowing?
56. Which of the following muscles is correctly
(A)give a superficial branch that innervates
matched with the accompanying description?
the dorsum of the hand (A)lumbricals 1 and 2 ... bipennate
(B)innervate the brachioradialis and extensor (B)lumbricals 3 and 4 ... unipennate
carpi radialis longus (C)dorsal interossei 1–4 ... bipennate
(C)give a deep branch that innervates the (D)palmar interossei 1–3 ... bipennate
extensor carpi radialis brevis and (E)deltoid ... bipennate
supinator
(D)give a posterior interosseous branch that 57. The deep branch of the ulnar does NOT inner-
innervates all remaining extensor muscles
vate which of the following?
in the posterior compartment of the fore-
arm (A)abductor digiti minimi
(E)innervate the glenohumeral joint (B)flexor digiti minimi brevis
(C)lumbricals 1 and 2
53. Which of the following is NOT true in respect (D)dorsal interossei 3 and 4
to the flexor pollicis brevis? (E)palmar interossei 1 and 2
(A)It is located medial to the abductor polli-
cis brevis. 58. The carpal tunnel does NOT contain which of
(B)It flexes the thumb at the carpometacarpal the following?
joint. (A)median nerve
(C)It flexes the thumb at the metacarpopha- (B)four tendons of the flexor digitorum
langeal joint. superficialis
(D)Its tendon typically contains a sesamoid (C)four tendons of the flexor digitorum pro-
bone. fundus
(E)It is innervated by C5–C6. (D)the tendon of the flexor pollicis longus
(E)ulnar nerve
54. Which of the following is true in respect to the
palmaris brevis? 59. The sternoclavicular joint ...
(A)It aids the palmaris longus in tightening (A)... is a saddle-type synovial joint but
the palmar aponeurosis. functions as a ball-and-socket joint.
(B)It is innervated by the median nerve. (B)... is supplied by lateral thoracic and
(C)It is in the hypothenar compartment. thoracoacromial arteries.
(D)It covers and protects the radial artery. (C)... is innervated by the lateral and medial
(E)It wrinkles the skin of the hypothenar pectoral nerves.
eminence and deepens the hollow of the (D)... is the articulation of the clavicle and
palm. gladiolus of the sternum.
(E)... dislocates easily.
55. The recurrent branch of the median nerve does
NOT innervate which of the following?
(A)abductor pollicis brevis
18 2: The Upper Limb

60. Which of the following is true in respect to the (A)proximal and distal radioulnar joints ...
acromioclavicular joint? condyloid type of synovial joint
(A)It is a saddle-type synovial joint. (B)radiocarpal joint ... pivot type of synovial
joint
(B)It is strengthened by the coracohumeral
and transverse humeral ligaments. (C)intercarpal joints ... plane type of syn-
ovial joints
(C)It is supplied by the lateral thoracic
arteries. (D)metacarpophalangeal joints ... hinge type
of synovial joints
(D)It is innervated by the nerve to the sub-
clavius. (E)interphalangeal joints ... condyloid type
of synovial joints
(E)When dislocated, it is often referred to as
a “separated shoulder.”
65. All carpometacarpal and intermetacarpal joints
61. Which of the following flexes the arm at the are plane types of synovial joints EXCEPT for
glenohumeral joint? (A)the carpometacarpal joint of the thumb.
(A)deltoid (posterior part) (B)the carpometacarpal joint of the fifth
metacarpal.
(B)pectoralis major
(C)the carpometacarpal joint of the third
(C)latissimus dorsi
metacarpal.
(D) subscapularis
(D)the intermetacarpal joint of the 4th and
(E) infraspinatus 5th metacarpals.
(E)the intermetacarpal joint of the 1st and
62. In respect to movement of the arm at the gleno-
2nd metacarpals.
humeral joint, which of the following move-
ments is correctly paired with its prime mover? 66. Which of the following is NOT true in respect
(A)extension ... deltoid (posterior part) to the clavicle?
(B)abduction ... pectoralis major and latis- (A)The clavicle varies more in shape than
simus dorsi most other long bones.
(C)adduction ... deltoid (D)medial (B)The clavicle can be pierced by a branch of
rotation ... infraspinatus (E)lateral the supraclavicular nerve.
rotation ... subscapularis (C)The clavicle is thicker and more curved in
manual workers.
63. Which of the following is true in respect to the (D)The right clavicle is stronger than the left
elbow joint? and is usually shorter.
(A)It is a plane type of synovial joint. (E)The clavicle is a compact bone.
(B)It is strengthened by the radial and ulnar
cruciate ligaments. 67. Fractures of the scapula typically involve
(C)It is supplied by the cephalic and basilic (A)the acromion.
arteries. (B)the coracoid process.
(D)It is innervated by the median and axil- (C)the spine.
lary nerves.
(D)the inferior angle.
(E)It is surrounded by the intratendinous ole-
(E)the suprascapular notch.
cranon bursa, the subtendinous olecranon
bursa, and the subcutaneous olecranon
68. Which of the following parts of the humerus is
bursa.
matched correctly with the nerve with which it
64. Which of the following joints is paired correctly is in direct contact?
with its type?
 Questions: 60–76 19

(A)distal end of humerus ... radial nerve (A)The teres major atrophies.
(B)surgical neck ... musculocutaneous nerve (B)The rounded contour of the shoulder dis-
(C)radial groove ... musculocutaneous nerve appears.
(D)medial epicondyle ... ulnar nerve (C)A loss of sensation may occur in the
(E)scapular notch ... suprascapular nerve lateral forearm.
(D)The patient may lose the ability to adduct
69. “Winging” of the scapula is most likely caused the arm.
by which of the following? (E)The patient may exhibit “wrist-drop.”
(A)a lesion to the long thoracic nerve
(B)a lesion to the thoracodorsal nerve 74. Which of the following is true regarding rotator
(C)injury to the suprascapular nerve cuff injuries?
(D)damage to the dorsal scapular nerve (A)Injury or disease may damage the rotator
(E)damage to the upper and lower subscapu- cuff, causing instability of the acromio-
clavicular joint.
lar nerves
(B)The supraspinatus tendon is the most
commonly torn part of the rotator cuff.
70. Which of the following is correct regarding the
(C)The teres major takes the longest to reha-
triangle of auscultation?
bilitate of the rotator cuff muscles.
(A)Its borders are the latissimus dorsi,
(D)The injuries occur when the muscles pull
scapula, and trapezius. away from their origin on the acromion.
(B)It is a good location to hear heart murmurs. (E)Acute tears are common in young persons.
(C)The 8th and 9th ribs and the 8th inter-
costal space are subcutaneous here. 75. A patient has been thrown from a motorcycle,
(D)It is a location of back trauma. landing on the shoulder such that the neck and
(E)It is a location for dorsal rami to pass to shoulder are widely separated. You suspect an
the superficial back. upper brachial plexus injury. What signs do you
expect?
71. A patient cannot raise the trunk (as in climb- (A) “clawhand”
ing). What is most likely the problem? (B)paralysis of flexor carpi ulnaris, flexor
(A)damage to the ventral rami of C5–C6–C7 digitorum superficialis, and flexor digito-
(B)paralysis of the latissimus dorsi rum profundus
(C)injury to the dorsal scapular nerve (C)adducted shoulder, medially rotated arm,
(D)damage to the dorsal rami of C8–T1 and extended elbow
(E)injury to the axillary nerve (D)loss of sensation in the medial forearm
(E) “wrist-drop”
72. The scapula on one side of a patient is located
farther from the midline than that on the nor- 76. A patient exhibits “clawhand.” What might
mal side. What might be the problem? have happened?
(A)paralysis of the rhomboids on one side (A)upper brachial plexus injury
(B)injury to the long thoracic nerve (B)acute brachial plexus neuritis
(C)a lesion of C7–C8 (C)compression of the cords of the brachial
(D)dislocated shoulder plexus
(E)separated shoulder (D)lower brachial plexus injury
(E)damage to dorsal rami that send fibers to
73. The axillary nerve is damaged. What is the the brachial plexus
likely result?
20 2: The Upper Limb

77. A patient receives a knife wound to the axilla. (D)amelia ... long bones are absent, and
What problems do you expect? small hands or feet are attached to the
trunk by short, irregular bones
(A)damage to the axillary nerve
(E)cleft hand (lobster claw deformity) ...
(B)paralysis of the coracobrachialis, biceps,
absent third metacarpal, fusion of digits
and brachialis
1–2 and 4–5
(C)inability to extend the wrist and digits at
the metacarpophalangeal joints 81. Syndactylyl involves
(D)loss of sensation on the medial surface of
the arm (A)extra fingers or toes.
(E) “clawhand” (B)absence of a digit or limb.
(C)abnormal fusion of fingers and toes.
78. A patient tries to make a fist, but digits 2 and (D)small hands or feet being attached to trunk
3 remain partially extended. What nerve is by short bones instead of long bones.
injured? (E)congenital dislocation of glenohumeral
joint.
(A)ulnar nerve
(B)radial nerve
82. Which of the following is NOT correct?
(C)median nerve
(D)musculocutaneous nerve (A)During development, dorsal cells orga-
nize as the epimere and ventral cells orga-
(E)axillary nerve
nize as the hypomere.
79. Which of the following is true in respect to ulnar (B)Dorsal rami innervate muscles derived
from the epimere.
nerve injuries?
(C)Ventral rami innervate muscles derived
(A)The injury often occurs where the nerve
from the hypomere.
passes posterior to the medial epicondyle
(D)Myoblasts of the hypomere form the
of the humerus.
extensor muscles of the vertebral column.
(B)The patient experiences numbness and
(E)Somites and somitomeres form the mus-
tingling on the lateral part of the palm
culature of the limbs.
and the thumb.
(C)The patient may exhibit “waiter’s tip 83. A patient in surgery has no pectoralis major.
hand.”
What do you suspect?
(D)Patients have difficulty because they can-
not flex their first, second, and third digits (A) trauma
at the DIP joints. (B)dominant pectoralis minor
(E)Power of abduction is impaired, and (C)drug-induced muscle hypoplasia
when the patient attempts to flex the (D)atrophy of the muscle
wrist, the flexor carpi ulnaris brings the (E)congenital absence of the muscle
hand to the medial side.

80. Which limb defect is correctly matched with its

definition?
(A)meromelia ... complete absence of one or
more extremities
(B)phocomelia ... all segments of extremities
are present but abnormally short
(C)micromelia ... partial absence of one or
more extremities
 Questions: 77–93 21

DIRECTIONS (Questions 84 through 88): Identify the anatomical features indicated on the art below.

DIRECTIONS (Questions 89 through 93): Identify the anatomical features indicated on the art below.
22 2: The Upper Limb

DIRECTIONS (Questions 94 through 98): Identify the anatomical features indicated on the art below.
 Answers and Explanations

1. (B)The lateral end of the clavicle is flat where it 7. (C)From lateral to medial, the four bones of the
articulates with the acromion at the acromio- distal row of carpals are the trapezium, trape-
clavicular (AC) joint (Moore, pp 665–666). zoid, capitate, and hamate (Moore, p 674).
(A)The trapezius attaches to the lateral third of (A)The intercostobrachial nerve is the lateral
2. 8.
the clavicle, acromion, and spine of the cutaneous branch of the second intercostal
scapula. nerve
The deltoid attaches to the deltoid tubercle, the from T2, innervating the skin of the medial sur-
conoid ligament attaches to the conoid face of the arm (Moore, p 684).
tubercle,
the subclavius attaches to the subclavian (D)The posterior cutaneous nerve of the arm,
9.
posterior cutaneous nerve of the forearm, and
groove,
inferior lateral cutaneous nerve of the arm are
and
trape-the trapezoid ligament attaches to the branches
lateral of the radial nerve. The superior
3.
zoid line (Moore, pp 666, 691).
cutaneous nerve is a branch of the axillary
(B)The lateral surface of the scapula forms the (Moore, p 684).
nerve
glenoid cavity, superior to which the coracoid
10. (C)
The pectoralis major, pectoralis minor, sub-
process projects anterolaterally. The glenohum-
clavius, and serratus anterior are anterior tho-
eral
joint,joint itself represents the true shoulder racoappendicular muscles. The deltoid is a
whereas the scapulothoracic joint, which is a scapulohumeral (shoulder) muscle (Moore, pp
(Moore, pp 668–669).
con- 688, 691).
ceptual joint, is a location where the scapula
4. (E)
The condyle
moves of the
easily on the thoracic
humerus (theThe
wall. distal
spineend)
of 11. (A)
The pectoralis minor stabilizes the scapula
includes the epicondyles, trochlea, capitulum,
the scapula continues laterally as the acromion by drawing it inferiorly and anteriorly against
and the three fossae (radial, coronoid, and the thoracic wall (Moore, p 688).
radial)
(Moore, p 670).
(A)The pectoralis minor, biceps brachii (short
12.
5. (B) The radial styloid process is much larger head), and coracobrachialis attach to the cora-
than the ulnar styloid process and extends far- coid process of the scapula (Moore, p 688).
ther distally (Moore, p 671–672).
(D)The latissimus dorsi, teres major, and sub-
13.
(C)The scaphoid articulates proximally with scapularis medially rotate the arm. The infra-
6.
the radius and has a large tubercle. The lunate spinatus and teres minor rotate the arm laterally.
articulates with the radius and is broader anteri- The deltoid is unique in that its anterior part
orly than posteriorly. The triquetrum articulates rotates the arm medially, and its posterior part
proximally with the articular disc of the distal rotates the arm laterally (Moore, p 691).
radioulnar joint. The pisiform lies on the palmar (A)The supraspinatus initiates abduction of
surface of the triquetrum (Moore, p 674). 14. the arm. The deltoid becomes fully effective as

23
24 2: The Upper Limb

an abductor following the initial 15 degrees of pass through the gap between the anterior and
abduction. The serratus anterior rotates the middle scalene muscles. Gray rami contribute
scapula, elevating its glenoid cavity so that the sympathetic fibers to each root. The roots of the
arm can be raised above the shoulder (Moore, brachial plexus form three trunks, each of
which divides into anterior and posterior
pp 695, 696, 689).
divisions. The cords of the brachial plexus
15. (B) The dorsal scapular nerve innervates the surround the axillary artery (Moore, p 708).
levator scapulae, rhomboid major, and rhom- (B)The dorsal scapular nerve, long thoracic
boid minor (Moore,
(C)The trapezius,
p 691). latissimus dorsi, 24. nerve, nerve to the subclavius, and supra-
levator scapulae, and rhomboids are extrinsic scapular nerve are supraclavicular branches of
16. shoulder muscles. The deltoid, teres major, the brachial plexus, whereas the lateral
supraspinatus, infraspinatus, teres minor, and pectoral nerve is an infraclavicular branch,
subscapularis are intrinsic shoulder muscles originating from the lateral cord (Moore, pp
(Moore, pp 691–692). (E)The trapezius, 708–709). (D)The quadrangular space is
innervated by the spinal root of the accessory bounded superi- orly by the subscapularis and
nerve (XI), is composed of three types of fibers. 25. teres minor, infe- riorly by the teres major,
17. Its superior fibers elevate the scapula, its medially by the long head of triceps, and
middle fibers retract the scapula, and its laterally by the humerus. It contains the
inferior fibers depress the scapula. Its superior axillary nerve and the posterior cir- cumflex
and inferior fibers act together in rotating the humeral artery (Moore, p 711). (D)The
scapula on the thoracic wall (Moore, p 694). suprascapular nerve innervates the
(B)To test the rhomboids, the patient is asked supraspinatus, infraspinatus, and
to place the hands posteriorly on the hips and 26. glenohumeral (shoulder) joint (Moore, p 710).
to push the elbows posteriorly against (E)The posterior cord gives rise to the upper
and lower subscapular nerves, thoracodorsal
18. resistance
nerve, axillary nerve, and radial nerve. The
(Moore, p 695). long tho- racic nerve originates from C5–C6–C7
27.
(Moore,
pp 711).
19. The
(A) supraspinatus is the only rotator cuff
muscle that does not rotate the humerus
(Moore,
28. (E)
The brachialis originates from the distal half of
pp 697–698).
20. (B) The axillary nerve innervates both the del- the anterior surface of the humerus and inserts
toid and the teres minor (Moore, p 691). on the coronoid process and tuberosity of the
(C)The axilla contains axillary blood vessels, ulna. It crosses one joint, flexing the forearm in
21. lymph nodes, the cords and branches of the all positions. While it is primarily innervated
brachial plexus, and the axillary nerve. The by the musculocutaneous nerve, some of its
trunks and divisions are found superior to the lateral part is innervated by a branch of the
axilla in the neck (Moore, p 699). (A)The radial nerve
subscapular artery arises from the third part of
(Moore, p 722).
the axillary artery and contributes to blood 29. (A)
To test the triceps brachii, the arm is abducted
22. supply of muscles near the scapula and 90 degrees and then the flexed forearm is extended
humerus (Moore, p 701). (E)The brachial against resistance (Moore, p 724).
plexus is formed by the union of the ventral (A)The deep artery of the arm accompanies
rami of C5 through T1. The roots of the brachial 30. the radial nerve through the radial groove and
plexus and the subclavian artery passes around the body of the humerus (Moore,
23. p 728).
 Answers and Explanations: 15–44 25

31. (A)The anconeus assists in extension of the 36. (B)A patient who is unable to flex the arm and
fore- arm, resists abduction of the ulna during forearm is likely to have a lesion in the ventral
prona- tion of the forearm, and tenses the rami of C5, C6, and C7. The biceps brachii and
capsule of the elbow joint so that it is not brachialis receive fibers from C5 and C6, and
pinched when the joint is extended (Moore, p the coracobrachialis receives fibers from C5,
724). (C)The axillary artery gives rise to the C6, and C7. C6 is the main source of fibers for
32. superior thoracic, thoracoacromial, lateral each
(Moore, p 722).
thoracic, sub- scapular, and anterior and
posterior circumflex humeral arteries. The 37. (A)
The brachioradialis is a flexor of the forearm,
brachial artery gives rise to the deep artery of but it is located in the extensor compartment and
the arm, the nutrient humeral artery, and the is innervated by the radial nerve (Moore, p 734).
superior and inferior collateral arteries. The (A)The superficial muscles (pronator teres,
ulnar artery gives rise to the anterior and 38. flexor carpi radialis, palmaris longus, flexor
posterior ulnar recurrent, common inter- carpi ulnaris, and flexor digitorum superficialis)
osseous, anterior and posterior interosseous, cross the elbow joint. The deep muscles (flexor
and dorsal and palmar carpal branch arteries digitorum profundus, flexor pollicis longus, and
(Moore,
pp 699, 727–728, 750). pronator quadratus) do not (Moore, p 734).
(E)All muscles in the anterior compartment
33. (C) The median and ulnar nerves supply no of the forearm are innervated by the median
branches to the arm (Moore, p 730).nerve gives
(B)The median 39. nerve, except for the flexor carpi ulnaris and the
rise to a palmar cutaneous branch; the ulnar medial part of the flexor digitorum profundus,
34. nerve as well has a palmar cutaneous branch. which are innervated by the ulnar nerve (Moore,
The radial nerve gives rise to the posterior
brachial cutaneous nerve, the posterior
antebrachial cutaneous nerve, the inferior pp 736–737).
lateral brachial cutaneous nerve, and a
superficial branch that innervates the dorsum 40. (B) The radial artery lies lateral to the tendon of
of the hand and the digits. The the flexor carpi radialis (Moore, p 737).
musculocutaneous nerve continues as the
lateral antebrachial cuta- neous nerve. The 41. (C)
The palmaris longus tendon is a guide for
axillary nerve gives rise to the superior lateral locating the median nerve at the wrist
brachial cutaneous nerve. The medial cord of (Moore,
p 737).
the brachial plexus gives rise to the medial
brachial cutaneous nerve and the medial 42. (A)
To pronate the forearm, the pronator quad-
antebrachial cutaneous nerve. The supra- ratus initiates pronation, assisted later by the
clavicular nerves (from C3–C4) and the inter- pronator teres (Moore, p 741).
costobrachial nerve (from T2) also contribute to (D)The extensor carpi radialis longus tendon
the cutaneous innervation of the arm (Moore, 43. is crossed by the abductor pollicis longus and
pp 684, 758–759). extensor pollicis brevis (Moore, p 745).
(E)The supinator, which forms the floor of the
35. (E) The cubital fossa contains the terminal part cubital fossa along with the brachioradialis, is
of the brachial artery (and the beginning of the 44. innervated by the deep branch of the radial
ulnar and radial arteries), deep accompanying nerve. It supinates the forearm by rotating the
veins, the median nerve, and the biceps brachii radius. The biceps brachii also supinates the
tendon. In the tissue superficial to the fossa are forearm when the forearm is already flexed
the median cubital vein and medial and lateral
antebrachial cutaneous nerve. The deep and
superficial branches of the radial nerve are (Moore, p 746).
within the floor of the fossa (Moore, pp 731–732).
26 2: The Upper Limb

45. (C)The abductor pollicis longus originates from ulnaris and medial half of the flexor digitorum
the posterior surfaces of the ulna, radius, and profundus. The palmar cutaneous branch
interosseous membrane. The following muscles inner- vates the skin of the medial part of the
take at least one of their origins from the lateral palm, and the dorsal cutaneous branch
epicondyle of the humerus: extensor carpi radi- innervates the pos- terior surface of the medial
alis brevis, extensor digitorum, extensor digiti part of the hand and digits. The deep branch
minimi, extensor carpi ulnaris, and supinator innervates the hypo- thenar muscles, adductor
(Moore, p 742). pollicis, interossei, and the 3rd and 4th
lumbricals (Moore, pp 759–760). (E)The
46. (A) The flexor pollicis longus is innervated by 52. radial nerve gives a superficial branch that
the anterior interosseous nerve from the median innervates skin on the dorsum of the hand. The
nerve (Moore,
(C)The snuff box is bounded
pp 736–737, 742–743).anteriorly radial nerve itself innervates the brachiora-
by the tendons of the abductor pollicis longus dialis and extensor carpi radialis longus. It then
47. and ex- tensor pollicis brevis. Posteriorly it is gives a deep branch that innervates the
bounded by the tendon of the extensor pollicis extensor carpi radialis brevis and the supinator
longus. The radial artery can be felt in the floor, before continuing as the posterior interosseous
along with the radial styloid process, first nerve, which innervates the extensor
metacarpal, scaphoid, and trapezium (Moore, digitorum, ex- tensor digiti minimi, extensor
p 749). (E)The hand is abducted at the wrist carpi ulnaris, ab- ductor pollicis longus,
joint by the flexor carpi radialis, abductor extensor pollicis brevis, extensor pollicis
pollicis longus, extensor carpi radialis longus, longus,
(Moore,andpp extensor indicis
742, 761).
48. and extensor carpi radialis brevis (Moore, pp
736, 742). (A)The radial artery gives rise to 53. (E)
The flexor pollicis brevis is located medial to
the radial recurrent artery as well as dorsal and the abductor pollicis brevis. It flexes the thumb
palmar carpal branches. The ulnar artery gives at the carpometacarpal and metacarpophalan-
rise to the common interosseous artery, geal joints and assists in opposition. Its tendon
49. anterior and poste- rior interosseous arteries, typically contains a sesamoid bone. It is inner-
anterior and posterior ulnar recurrent arteries, vated by the recurrent branch of the median
and dorsal and palmar carpal branches nerve (C8–T1) (Moore, p 767).
(Moore, p 750). (A)The median nerve assists (E)The palmaris brevis, innervated by the ulnar
in the innervation of the elbow joint and gives 54. nerve, wrinkles the skin of the hypothenar emi-
muscular branches to pronator teres, flexor nence and deepens the hollow of the palm, assist-
carpi radialis, palmaris longus, and flexor ing the palmar grip. The muscle actually covers
digitorum superficialis. The median nerve also and protects the ulnar artery and the ulnar nerve,
has an anterior interosseous branch that which innervates it. The muscle is not by defi-
50.
innervates the lateral part of the flexor nition in the hypothenar compartment. The pal-
digitorum profundus, flexor pollicis longus, maris longus, on the other hand, flexes the hand
and pronator quadratus. The recurrent branch at the wrist and tightens the palmar aponeuro-
of the median nerve innervates the thenar sis (Moore, p 768).
muscles, and the palmar cutaneous branch (B)The recurrent branch of the median nerve
innervates the skin of the lateral part of the innervates the abductor pollicis brevis, flexor
palm (Moore, pp 757–759). (C)The ulnar
55. pollicis brevis, and opponens pollicis, but the
nerve gives rise to articular branches that deep branch of the ulnar nerve innervates adduc-
innervate the elbow joint and mus- cular tor pollicis (Moore, pp 769–770).
branches that innervate the flexor carpi (C)Lumbricals 1–2 and palmar interossei 1–3
are unipennate muscles. Lumbricals 3–4 and dor-
sal interossei 1–4 are bipennate muscles. The del-
toid is multipennate (Moore, p 770).
51. 56.
 Answers and Explanations: 45–70 27

57. (C)The deep branch of the ulnar nerve inner- anastomosis around the elbow and is inner-
vates the adductor pollicis, abductor digiti vated by the musculocutaneous, radial, and
min- imi, flexor digiti minimi brevis, opponens ulnar nerves. It is surrounded by the
digiti minimi, lumbricals 3 and 4, dorsal intratendi- nous olecranon bursa, the
interossei 1–4, and palmar interossei 1–3. The subtendinous olec- ranon bursa, and the
median nerve innervates lumbricals 1 and 2 subcutaneous olecranon bursa (Moore, pp
(Moore, p 770). (E)The carpal tunnel contains 795–798). (C)The proximal and distal
58. the median nerve, the four tendons of the 64. radioulnar joints are pivot-type synovial
flexor digitorum superfi- cialis, the four joints. The radiocarpal (wrist) joint is a
tendons of the flexor digitorum profundus, and condyloid type of synovial joint. Intercarpal
the tendon of the flexor pollicis longus joints are plane-type synovial joints.
(Moore, p 774). (A)The sternoclavicular joint, Metacarpophalangeal joints are condyloid
which does not dislocate easily, is a saddle- types of synovial joints. Interphalangeal
59. type synovial joint but functions as a ball-and- joints are hinge-type synovial joints
socket joint. It is the articulation of the sternal (Moore,
807, 809).pp 800, 803,
end of the clavicle with the manubrium of the
sternum. The joint is sup- plied by the internal 65. All
(A) carpometacarpal and intermetacarpal
thoracic and suprascapular arteries and is joints are the plane-type synovial joints except
innervated by branches of the medial for the carpometacarpal joint of the thumb,
supraclavicular nerve and the nerve to the which is a saddle joint (Moore, p 809).
subclavius (Moore, pp 781–782). (E)The (E)The clavicle varies more in shape than most
acromioclavicular joint is a plane-type synovial 66. other long bones and is thicker and more curved
joint and is strengthened by the AC lig- ament in manual workers. The right clavicle is stronger
and the coracoclavicular ligament, which is than the left and is usually shorter. The clavicle
60.
composed of the conoid and trapezoid liga- can also be pierced by a branch of the supracla-
ments. It is supplied by the suprascapular and vicular nerve. The clavicle is a long bone with no
thoracoacromial arteries and is innervated by medullary cavity. It consists of spongy (cancel-
the supraclavicular, lateral pectoral, and lous) bone with a shell of compact bone (Moore,
axillary nerves. When dislocated, it is referred
to as a “separated shoulder” (Moore, pp 784,
787). (B)The pectoralis major (clavicular head) p 667).
and deltoid (anterior part) flex the arm at the
gleno- humeral joint. The coracobrachialis and 67. (A)
Fractures of the scapula typically involve the
the bi- ceps brachii assist (Moore, p 792). protruding subcutaneous acromion. The remain-
61. (A)The posterior portion of the deltoid causes der of the scapula is well protected by muscles
extension of the arm at the glenohumeral joint. and the thoracic wall itself (Moore, p 669).
The deltoid (as a whole, but especially the cen- (D)The surgical neck of the humerus is in direct
tral part) causes abduction, whereas the pec- 68. contact with the axillary nerve, the radial nerve
toralis major and latissimus dorsi cause adduc- runs in the radial groove, the distal end of the
62. tion. The subscapularis causes medial rotation, humerus is in direct contact with the median
whereas the infraspinatus causes lateral rota- nerve, and the medial epicondyle is in contact
tion (Moore, p 792). (E)The elbow is a hinge with the ulnar nerve (Moore, p 670).
type of synovial joint, strengthened by radial (A)Damage to the long thoracic nerve results
and ulnar collateral liga- ments. It is supplied in “winging” of the scapula (Moore, p 689).
by arteries derived from the 69. (A)The triangle of auscultation, a good place to
examine lung sounds, is bounded by the supe-
rior horizontal border of the latissimus dorsi, the
70. medial border of the scapula, and the inferolat-
63.
28 2: The Upper Limb

eral border of the trapezius. The 6th and 7th ened. The patient would also lose sensation on
ribs and the 6th intercostal space is the lateral surface of the forearm (Moore, p
subcutaneous 731).
78.
(Moore, p 693). (C)When the median nerve is injured, the pa-
71. With
(B) paralysis of the latissimus dorsi, the
patient is unable to raise the trunk as necessary tient often exhibits the “hand of benediction.”
for climbing. The cause could be injury to the When the patient tries to make a fist, digits 2
thoracodorsal nerve (C6–C7–C8) (Moore, p 693). and
(A)Injury to the dorsal scapular nerve (C4–C5) 3 remain partially extended because flexion of
72. can paralyze the rhomboids, causing the scapula the PIP joints is lost in digits 1–3 and weakened
on one side to be located farther from the midline in digits 4–5. Flexion of the DIP joints is lost in
than that on the normal side (Moore, p 695). digits 2–3 but maintained in digits 4–5 (since
(B)The deltoid atrophies when the axillary
nerve (C5–C6) is damaged. Therefore, the the
ulnar
73. rounded contour of the shoulder often dis- flexor nerve controls the medial part of the
appears. A loss of sensation may occur on the 79. digitorum profundus). Flexion of the MCP
lateral side of the proximal part of the arm
joints
(Moore, pp 696–697). of
of digits 2-3 will also be affected due to a loss
the lumbricals 1 and 2 (Moore, pp 757, 774,
776).
74. Injury
(B) or disease may damage the rotator
cuff, causing instability of the glenohumeral (A)The ulnar nerve is often injured where it
joint. The supraspinatus tendon is the most
commonly torn part of the rotator cuff. Acute passes posterior to the medial epicondyle of
the
tears are uncommon in young persons humerus. The patient experiences loss of sensa-
(Moore, tion in the medial part of the palm as well as in
80. Amelia
the
(E) medial is 11⁄2digits.
the complete absencehand
Most intrinsic of one
mus-or
pp 698–699).
75. In
(C)an upper brachial plexus injury causing more extremities while meromelia
cles are paralyzed, and the patient loses the is the
Erb-Duchenne palsy, one would expect damage partial
ability toabsence of one
adduct the handorat more extremities.
the wrist. Patients
to C5–C6, resulting in “waiter’s tip position” All segments
cannot make a of fistextremities areunable
since they are present but
to flex
the
(adducted shoulder, medially rotated arm, and abnormally short in micromelia. In
4th and 5th digits at the DIP joints. The result-
extended elbow). This results from paralysis of phocomelia, long bones are absent, and small
ing deformity is known as “clawhand”
the deltoid, biceps, brachialis, and brachioradi- (Moore,or feet are attached to the trunk by
hands
alis. The lateral aspect of the upper limb also short,
pp 761,irregular
776–777). bones. In cleft hand (lobster
experiences loss of sensation (Moore, p 716). claw deformity), the third metacarpal is
(D)Damage to the inferior trunks of the brachial absent and digits 1–2 and 4–5 are fused
76. plexus (C8–T1) affects the short muscles of the (Sadler,
hand, resulting in “clawhand.” The patient might 81. (C)
Syndactyly involves abnormal fusion of fin-
p 179).
have grabbed a tree limb to catch himself while gers and toes. Cleft hand (lobster claw defor-
falling to cause this injury. “Clawhand” may also mity) consists of an abnormal cleft between the
be caused by an injury to the ulnar nerve (Moore, 2nd and 4th metacarpal bones, with the 3rd
pp 716–717, 761). metacarpal and phalangeal bones being absent
and with digits 1–2 and 4–5 being fused. Poly-
dactyly involves extra fingers or toes, while
77. (B) A knife wound to the axilla would dam- ectrodactyly involves the absence of a digit.
age the musculocutaneous nerve and result in Mutations in HOXA13result in hand-foot-
paralysis of the coracobrachialis, biceps, and geni- tal syndrome, where carpals and short
brachialis. Therefore, flexion of the elbow joint digits are fused and the genitalia have altered
and supination of the forearm would be weak- structures
(Sadler, p 181).
 Answers and Explanations: 71–98 29

82. (D)During development, dorsal cells organize 87. brachial artery

as the epimere and ventral cells organize as the
hypomere. Dorsal rami innervate muscles de- 88. median nerve
rived from the epimere, whereas ventral rami
innervate muscles derived from the hypomere. 89. lateral cord
Myoblasts of the epimere form the extensor
muscles of the vertebral column, and those of 90. musculocutaneous nerve
the hypomere give rise to muscles of the limbs
and body wall. Somites and somitomeres form 91. medial antebrachial cutaneous nerve
the musculature of the limbs (Sadler, pp 189–
190). (E)Partial or complete absence of one or 92. ulnar nerve
83. more muscles is rather common. One of the
best- known examples is total or partial 93. lateral pectoral nerve
absence of the pectoralis major (Poland
anomaly). Similarly, the palmaris longus, 94. coracobrachialis
serratus anterior, and quad- ratus femoris may
be partially or entirely absent 95. brachialis
(Sadler, p
96. ulna
192).
84.
biceps brachii 97. long head of triceps brachii
85.
cephalic vein 98. lateral head of triceps brachii
86.
radial nerve
 Questions: 111–130 59

DIRECTIONS (Questions 121 through 125): Identify the anatomical features indicated on the art below.

DIRECTIONS (Questions 126 through 130): Identify the anatomical features indicated on the art below.