PROGRESSIVE EXAM SEM I 2013-14

1. After ramming the point of his shoulder into a practice dummy, a football player suffered
a severe shoulder separation. Although this is a dislocation of the acromioclavicular joint,
several structures could be torn, including the one that gives the joint its greatest strength
and stability, namely the:
A. Acromioclavicular ligament
B. Coracoacromial ligament
C. Coracoclavicular ligament
D. Supraspinatus tendon
E. Tendon of the long head of biceps
2. While doing arthrography of the shoulder joint it was noted that the contrast material
flowed into the subacromial (subdeltoid) bursa, along the tendon of the subscapularis and
along the proximal part of the tendon of the long head of the biceps. The finding of
contrast in which area was abnormal?
A. into the subacromial (subdeltoid) bursa
B. along the tendon of the subscapularis
C. along the proximal part of the tendon of the long head of the bicep
3. While performing an arthrogram to study an apparent rotator cuff injury, it was noted that
the contrast material had spread from the shoulder joint onto the anterior lateral surface of
the scapula near the joint. When asked, the first year resident responded that this was due
to an anterior tear in the cuff. Having just studied the shoulder joint you respond that the
contrast is in a normal extension of the joint cavity called the:
A. bicipital bursa.
B. olecranon bursa.
C. subacromial bursa.
D. subscapular bursa.
E. ulnar bursa.
4. A patient presented to his physician with chronic shoulder pain. It was noted that when
asked to abduct his arm, he initially leaned laterally, and then straightened up. When
iodinated contrast was injected into his shoulder joint it was found to be in the subdeltoid
bursa as well as in the joint cavity. Which structure was damaged to produce the shoulder
pain?
A. Acromioclavicular ligament
B. Long head of the biceps brachii muscle
C. Subscapularis muscle
D. Superior glenohumeral ligament
E. Supraspinatus muscle
5. The axis of rotation (pronation/supination) at the distal radioulnar joint is through the:
A. Capitate bone
B. Head of the radius
C. Head of the ulna
D. Styloid process of the radius
E. Styloid process of the ulna

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6. A two year old child will not go to take her nap. Her mother tightly holds her left hand as
she leads her to the bedroom. Refusing to go further, the child suddenly attempts to jerk
away and then sits down screaming and holding her left elbow. In a attempt to calm her
down her mother offers her a cookie, but she cannot supinate her left hand to receive it.
Which joint was dislocated?
A. the glenohumeral joint
B. the humero-ulnar joint
C. the humero-radial joint
D. the proximal radio-ulnar joint
E. the distal radio-ulnar joint
7. You are in the emergency room when a student is brought in with a shoulder injury
sustained while playing touch football. In comparing the symmetry of his two shoulders,
you notice a marked elevation of the distal end of his clavicle with respect to the
acromion on the injured side. X-ray exam reveals a grade III shoulder separation. In order
for this to have occurred, which ligament must be torn?
A. Coracoacromial
B. Coracoclavicular
C. Costoclavicular
D. superior glenohumeral
E. transverse humeral
8. A 3-year-old child walking hand-in-hand with her father screams in pain as he jerks her
quickly up onto the curb to dodge a speeding car. The examining physician calls it a case
of "pulled elbow", a dislocation sometimes seen in young children and caused by:
A. The head of the radius slipping part way out of the annular ligament
B. Tear of the common extensor tendon
C. Stretching of the radioulnar interosseous membrane
D. Tear of the ulnar collateral ligament
9. The shoulder is most often dislocated in which direction?
A. Anterior
B. Inferior
C. Posterior
D. Superolateral
E. Superomedial
10. It was determined that a football player tore his coracoclavicular ligament. This is an
example of a:
A. Pulled elbow
B. Rotator cuff tear
C. Separated shoulder
D. Dislocated shoulder
E. Colles' fracture
11. While walking to class on an icy winter morning, a student slips and falls on her
outstretched hand. The intense pain forces her to go to the emergency room. After X-rays
of her wrist are taken, the attending says," You were lucky, there is no Colles' nor
scaphoid fractures, but you have dislocated the middle carpal bone of the proximal row."
Which bone was dislocated?
A. Capitate

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 B. Lunate
C. Scaphoid
D. Trapezoid
E. Triquetrum
12. The fibrocartilaginous structure which deepens the shoulder socket is the:
A. Articular capsule
B. Articular cartilage
C. Glenoid labrum
D. Lateral meniscus
E. Superior glenohumeral ligament
13. The synovial cavity of the glenohumeral joint communicates with the subdeltoid
(subacromial) bursa after the rupture of the:
A. Infraspinatus tendon
B. Middle glenohumeral ligament
C. Subscapularis tendon
D. Supraspinatus tendon
E. Long head of the biceps brachii tendon
14. Which joint would be subject to synovitis (inflammation of the synovial membrane)?
A. epiphyseal plate
B. metacarpophalangeal
C. pubic symphysis
D. radioulnar syndesmosis
E. suture
15. Which of the following structures is unique to a synovial joint?
A. Accessory ligaments
B. Bursae
C. ligaments
D. Fibrocartilage
E. Joint cavity
16. An athlete has a knee injury, and the doctor performs a "drawer test" by pulling and
pushing on the leg with the knee flexed. If the leg translates anteriorly, i. e. "gives" or
moves anteriorly when the leg is pulled anteriorly, what joint structure is most likely
injured?
A. lateral collateral ligament
B. medial collateral ligament
C. medial meniscus
D. posterior cruciate ligament
17. In an auto accident, the patient's knee strikes the dashboard which in turn pushes the head
of the femur posteriorly out of its socket. Which ligament is most likely ruptured by this
posterior dislocation?
A. Iliofemoral
B. Ischiofemoral
C. Pubofemoral
D. transverse acetabular
18. One of the menisci of the knee is often injured in a sprain of the knee because the:
A. Anterior cruciate ligament is attached to the lateral meniscus

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 B. Anterior cruciate ligament is attached to the medial meniscus
C. Lateral collateral ligament is attached to the lateral meniscus
D. Medial collateral ligament is attached to the medial meniscus
E. Posterior cruciate ligament is attached to the lateral meniscus
19. A soldier developed "fallen arches" from marching with a heavy pack in boots that lacked
arch support. The ligament that normally supports the head of the talus and is primarily
responsible for holding up the medial longitudinal arch of the foot is the:
A. Calcaneometatarsal
B. Deltoid
C. long plantar
D. plantar calcaneonavicular (spring)
E. short plantar
20. During a rugby match, a player is blocked from behind during a kick-off return, injuring
his medial collateral ligament. The team doctor tests his knee by pulling anteriorly on the
leg with the knee flexed. If the leg translates (moves) forward significantly, this indicates
damage to which structure?
A. Anterior cruciate ligament
B. Lateral collateral ligament
C. Medial meniscus
D. Medial collateral ligament
E. Posterior cruciate ligament
21. During a basketball game, the center of the team went up for a rebound and when coming
down, her foot landed on the foot of another player, sharply everting it. She limped off
the floor, having severely sprained the medial side of her ankle. Which ligament was
injured?
A. Calcaneofibular
B. Deltoid
C. Short plantar ligament
D. Plantar calcaneonavicular
E. Tibial collateral ligament
22. Which ligament limits extension at the hip joint?
A. Iliofemoral
B. Ligamentum capitis femoris
C. Pubofemoral
D. Zona orbicularis
23. In injuries of the knee, the medial meniscus is frequently torn because it is firmly
attached to which structure?
A. Anterior cruciate ligament
B. Fibular collateral ligament
C. Tibial collateral ligament
D. Patellar ligament
E. Patellar retinaculum

24. The axillary nerve supplies the skin over

A. Lower half of deltoid muscle
B. Upper half of deltoid muscle

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 C. Shoulder region
D. Posterior surface of arm
E. All of the above
25. The axillary vein is formed by union of
A. Cephalic and basilica veins
B. Basilic vein and venae comitantes accompanying the brachial artery
C. Cephalic vein and venae comitantes accompanying the brachial artery
D. Basilic and median cubital vein
E. Venae comitantes accompanying brachial artery
26. The musculocutaneous nerve does not supply
A. Coracobrachialis
B. Biceps brachii
C. Brachialis
D. Pronator teres
E. Skin over lateral side of foream
27. In Erb-Duchenne palsy, the lesion involves the following roots of the brachial plexus
A. C5, C6, C7
B. C5, C6
C. C8, T1
D. C5, C6, C7, C8, T1
E. C4, C5, C6
28. In Klumpke’s palsy the lesion involves
A. C5, C6, C7
B. C5, C6
C. C8, T1
D. C5, C6, C7, C8, T1
E. C4, C5, C6
29. In Erb-Duchenne palsy all of the following muscles are paralyzed except
A. Supraspinatus
B. Deltoid
C. Biceps brachii
D. Pectoralis major
D. Coracobrachialis
30. In Erb-Duchenne palsy all of the following muscles are paralyzed except
A. Supraspinatus
B. Deltoid
C. Biceps brachii
D. Pectoralis major
E. Coracobrachialis
31. In Klumpke’s palsy, the deformity seen is
A. Policeman’s or waiter’s tip position of upper limb

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 B. Claw hand
C. Ape hand
D. Wrist drop
E. Loss of rounded contour of the shoulder
32. Paralysis of the triceps muscle will occur if radial nerve is injured
A. In the axilla
B. In the spiral (radial groove)
C. Above the lateral epicondyle
D. In the cubital fossa
E. In the posterior compartment of the forearm
33. The most disabling injury to the hand is due to injury to
A. Ulnar nerve
B. Median nerve
C. Musculocutaneous nerve
D. Axillary nerve
E. Radial nerve
34. All of the following nerves come in close contact with the humerus except
A. Ulnar
B. Median
C. Axillary
D. Radial
E. The nerves to medial head of triceps and anconeus
35. In fractures of the medial epicondyle of the humerus, the nerve most likely to be injured
is
A. Ulnar
B. Median
C. Medical cutaneous nerve of forearm
D. Radial
E. Medical cutaneous nerve of arm

36. All of the following arteries take part in the cruciate anastomosis around the lesser
trochanter of the femur except
A. Medial femoral circumflex
B. Lateral femoral circumflex
C. Superficial circumflex iliac
D. Inferior gluteal
E. First perforating artery
37. The superficial inguinal group of lymph nodes drain all of the following structures except
A. Anterior abdominal wall below the umbilicus
B. Testes
C. Perineum
D. Lower half of anal canal

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 E. External genitalia and urethra in both sexes
38. Regarding the sapheous opening all of the following statements are true except
A. It is a gap in the superficial fascia of the thigh, just below the inguinal ligament
B. It transmits the great sapheous vein, some branches of the femoral artery and lymph
vessels
C. It is situated 4 cm below and lateral to the public tubercle
D. It is filled with loose connective tissue called the cribriform fascia
E. The falciform margin is the lower lateral border of the opening
39. Tingling or painful sensations in the lateral region of the thigh may occur in the older,
overweight individual as a result of a bulging abdomen, compressing a nerve beneath the
linguinal ligament. Which of the following nerves is most likely to be involved?
A. Anterior femoral cutaneous
B. Femoral branch of genitofemoral
C. Genital branch of genitofemoral
D. Ilioinguinal
E. Lateral femoral cutaneous
40. Meniscal tears in the knee joint usually result from which of the following
circumstances?
A. Compression of the menisci
B. Hyperflexion of the knee joint (undue increased flexion)
C. Rotation of the knee joint in partial flexion
D. Rotation of the knee joint in full extension
E. None of the above
41. All of the following actions occur during the final phase of extension of the knee joint
except
A. The anterior and posterior cruciate ligaments become taut
B. There medial rotation of the femur on the tibia
C. The popliteus muscle contracts
D. The lateral and medial collateral ligaments are twisted and tightened
E. The oblique popliteal ligament is taut
42. A man was hit in the leg by a baseball bat producing a fracture of the head and neck of
the fibula and damaging a major nerve to the leg. Physical findings that would be found
is/are:
A. inability to plantar flex his foot
B. inability to dorsiflex his foot
C. the foot would be everted
D. flexion of the leg is lost
E. extension of the leg is lost
43. Which of the following runs through a groove underneath the sustentaculum tali?
A. peroneus longus tendon
B. tibialis posterior artery
C. flexor hallucis longus tendon
D. tibialis nerve

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 E. flexor digitorum longus tendon
44. In the following list what is the main invertor of the foot is the:
A. peroneus brevis
B. tibialis posterior
C. flexor hallucis longus
D. flexor digitorum longus
E. peroneus longus
45. If a patient cannot stand on his heal, which nerve is not functioning?
A. tibial nerve
B. femoral nerve
C. medial plantar nerve
D. peroneal nerve
E. obturator nerve
46. A misplaced intramuscular injection into the gluteal region infiltrated the sciatic nerve
and its surroundings, giving rise to temporary paralysis of the muscles supplied by that
nerve. All of the following would be involved EXCEPT for the:
A. tibialis anterior
B. soleus
C. peroneus brevis
D. gracilis
E. popliteus
47. In a fracture of the midshaft of the humerus, which artery is most likely to be injured?
A. Subscapular
B. Posterior circumflex humeral
C. Radial recurrent
D. Deep brachial
E. Circumflex scapular
48. As an inexperienced phlebotomist (blood drawer) attempts to insert the needle to draw
blood from the median cubital vein, the patient suddenly screams and complains of pain
and burning in the middle and thumb side of his palm. The nerve accidentally impaled on
the needle was the
A. lateral antebrachial cutaneous
B. medial antebrachial cutaneous
C. median
D. ulnar
E. posterior antebrachial cutaneous
49. The extensor expansion of the ring finger receives tendons from all of the following
EXCEPT:
A. Dorsal interosseus
B. Extensor carpi ulnaris
C. Extensor digitorum
D. Lumbrical
E. Palmar interosseus
50. A girl playing softball cuts the palm of her hand as she scoops up a piece of glass along
with the ball. If the only nerve damaged is the recurrent branch of the median nerve, she
would lose what movement of the thumb?

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 A. Abduction
B. Adduction
C. Flexion of the distal phalanx
D. Opposition

Section B

1. Following a major operation, a patient was placed on a course of antibiotics which were
to be delivered via intramuscular injection to the buttocks. After one of these injections,
the patient complained of more pain than usual in the region of the injection. Later, as the
patient was taking his afternoon walk in the hall, the nurse noticed that he was walking
with a limp that had not been present before--his left hip dropped every time he lifted his
left foot off the floor, but on the right side, his pelvis remained level when he lifted up his
right foot. The doctor was called, and after a brief examination, she concluded that the
injection had damaged a nerve that resulted in muscle weakness, which caused the
patient's unusual limp. (10 Marks)

a) Based on the vignette above, which muscles are affected and on which side? Give a
reason for your answer

b) If these muscles are affected, which nerve must be damaged? Where is this nerve located
in the buttock and where does it originate?

c) What other structures in the posterior hip/buttocks region might be damaged by an

inappropriately administered intramuscular injection or other penetrating injury?

d) What is the clinical name given to the symptoms the patient displayed following the
injury and what other conditions might cause it?

2. Describe the attachments of the palmer carpal ligament? (5 marks)

a) Name the muscles which lie within the fascial plane of the palmar carpal ligament?

b) Which vessels and nerves lie within the palmer carpal ligament?

c) List the muscles that lie deep to the fascial plane of the palmar carpal ligament?

3. A 48 year old lady presented to the breast clinic with a 3 weeks history of a bloody
discharge from the right breast. She also gave a history of noticing a mass in the same
breast 2 years previously but had ignored it. On examination, she had a peau d’ orange
appearance of the skin of the right breast, had a mass in the breast which was mobile. The
regional lymph nodes were enlarged. The left breast was normal, however she had
supernumerary nipples. After further investigations a diagnosis of carcinoma breast was
made. She underwent radical mastectomy and radiotherapy.

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 a. During mastectomy which blood vessels would the surgeon have to look out for?

b. The lymph nodes were enlarged, describe the lymphatic drainage of the breast?

c. Why did the surgeon have to examine the opposite breast?

d. She had supernumerary nipples, describe the embryological development of the

breast.

4. Describe the compartments of the foot including their contents and, nerve and vascular
supply. (15 Marks)

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PROGRESSIVE EXAM SEM1 2010-11

1. The developing mammary glands show which of the following characteristics?

A. Multiple hormones control their development
B. They have lactiferous sinuses derived from mesenchyme
C. They have ductal epithelium derived from mesenchyme
D. They have mesodermally derived myoepithelial cells
E. They can differentiate to a lactogenic state without oestrogen
2. Somite derivatives include which of the following?
A. Vertebral ligaments
B. Bodies of vertebrae
C. Intercostals muscles
D. Dermal connective tissue fobroblasts
3. A serious complication of fractures of the femoral neck is a vascular necrosis of the
femoral head. This usually results from rupture of which artery?
A. Acetabular branch of obturator
B. Deep circumflex iliac
C. Descending branch of lateral circumflex femoral
D. Medial circumflex femoral
E. Second perforating branch of lateral circumflex
4. Blood flow around an occlusion of the femoral (superficial femoral) artery at apex of the
femoral triangle could be provided by:
A. Anterior tibial recurrent
B. Descending branch of the lateral circumflex femoral
C. Descending genicular
D. Medial circumflex femoral
E. Perforating branches of the deep femoral
5. During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does
not enter the chest cavity. Physical examination reveals that the vertebral (medial) border
of the patient’s scapula projects posteriorly and is closer to the midline on the injured
side. On return visit the patient complains that he cannot reach as far forward (such as to
reach for a door knob) as he could before the injury. The nerve injured which caused
these symptoms is the:
A. Axillary
B. Long thoracic
C. Musculocutaneous
D. Radial
E. Suprascapular

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6. A man suffers a penetrating wound through the anterior axillary fold, with resulting
damage to one of the main terminal branches of the brachial plexus. Among the effects is
a significant weakening of flexion of the elbow. One or more other effects to be expected
is (are)
A. Loss of cutaneous sensation on the tips of several fingers
B. Only loss of cutaneous sensation on the anterolateral surface of the forarm
C. Only weakening of flexion at the shoulder
D. Weakening of flexion at the shoulder and loss of cutaneous sensation on the
anterolateral surface of the arm
7. A person sustains a left brachial plexus injury in an auto accident. After initial s
observed: 1) the diaphragm normally,2) there is no winging of the scapula, 3) abduction
cannot be initiated, but if the arm is helped through the first 45 degrees of abduction, the
patient can fully abduct the arm. From this amount of information and your knowledge of
the formation of the brachial plexus where would you expect the injury to be:
A. Axillary nerve
B. Posterior cord
C. Roots of plexus
D. Superior trunk
E. Suprascapular nerve
A man riding a motorcycle hit a wet spot in the road, lost control , and was thrown from
his bike. He landed on the right side of his head and the tip of his shoulder, bending his
head sharply to the left and stretching the right side of his neck. Subsequent neurological
examination revealed that the roots of the 5th and 6th cervical nerves had been torn away
from the spinal cord.
8. Following the above injury there would most likely be diminished cutaneous sensation
over what part of the upper limb?
A. The back of the shoulder
B. The pectoral region
C. The top of the shoulder and the lateral side of the arm
D. The medial side of the arm and forearm
E. The tip of the little finger
9. The surgeon next encounters a large (about 2 cm in diameter) horizontally running vein,
fortunately intact, which is also retracted downward. This exposes the damaged entry. He
knows that the cords of the brachial plexus are closely associated with this artery, so he
carefully retracts one found superolateral and one found inferomedial to the artery and
then proceeds to repair the artery itself and close the wound.

The large artery that was severed was the:

A. Axilary
B. Brachial
C. Radial
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 D. Subscapular
E. Suprascapular
10. Later when you see the patient it is clear that he has pronounced neurological deficits.
There is lack of cutaneous sensation between his thumb and index finger on the dorsal
side, diminished sensation on the dorsal surface of the forearm, arm, and lateral side of
the shoulder. he has “wrist drop” (inability to extend the wrist), lack of extension at the
elbow, and although abduction can be initiated, it cannot be completed. Flexion,
extension, medial and lateral rotation of the arm are not significantly affected. There is no
“winging of the scapula.” Later exploration by a neurosurgeon reveals that a single large
nerve bundle posterior to the artery was also severed, accounting for the neurological
findings
The large nerve bundle lying posterior to the artery which was also severed was the:
A. C 7 root
B. Middle trunk
C. Posterior division
D. Radial nerve
11. Neurological testing of a patient reveals no cutaneous sensation on the tip of the index
finger. Such a funding wound indicates injury to some portion of which nerve?
A. Axillary
B. Median
C. Musculocutaneous
D. Radial
E. Ulnar
12. A worker doing repetitive lifting develops an inflammation in the tendon of origin of the
extensor carpi radialis brevis muscle, commonly called “tennis elbow”. The focal point of
pain would most likely be near which palpable bony landmark?
A. Coronoid process of ulna
B. Lateral epicondyle of humerus
C. Lateral supracodylar ridge of humerus
D. Medial epicondyle of humerus
E. Medial supracondylar ridge of humerus
13. In an attempt to commit suicide by slashing the ventral side of the wrist, the two tendons
e the flexor digitorum superficialis located most superficially were completely severed.
What movement would be affected?
A. Flexion of the MP and IP joints of the thumb
B. Flexion of the PIP joints of digits 2 and 5
C. Flexion of the PIP joints of digits 3 and 4
D. Flexion of the DIP joints of digits 2 and 5
E. Flexion of the DIP joints of digits 3 and 4
14. Compression of the median nerve in the carpal tunnel affects which hand muscle(S)?
A. Dorsal interossei
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 B. Flexor pollicis longus
C. Opponens digiti minimi
D. Palmar interossei
15. The victim shrapnel wounds to the upper limb must have his forearm amputated at
midlength. Because of concomitant damage in the patient’s arm, the surgeon must ligate
the main artery at some point. The best chance of saving collateral circulation to the
stump of the forarm would be when the ligature is placed just below which of the
following?
A. Beginning of the brachial artery
B. Origin of the deep brachial artery
C. Origin of the superior ulnar collateral artery
D. Origin of the inferior ulnar collateral artery
E. Bifurcation of the brachial artery
16. During an industrial accident, a sheet metal worker lacerates the anterior surface of his
wrist at the junction of his wrist and hand. Examination reveals no loss of hand function,
but the skin on the thumb side of his palm is numb. Branches of which nerve must have
been severed?
A. Lateral antebranchial cutaneous
B. Medial antebranchial cutaineous
C. Median
D. Radial
E. Ulnar
17. The extensor expansion of the ring finger receives tendons from all the following
EXCEPT:
A. dorsal interosseus
B. Extensor carpi ulnaris
C. Extensor digitorum
D. Lumbrical
E. Palmar interosseus
18. A girl playing softball cuts the palm of her hand as she scoops up a piece of glass along
with the ball. If the only nerve damaged is the recurrent branch of the median nerve, she
would lose what movement of the thumb?
A. Abduction
B. Adduction
C. Flexion of the distal phalanx
D. Opposition
19. In order to check the pulse of a child whose forearm is in a cast, the pediatrician presses
her finger into the depth of the “anatomical snuffbox”. The tendon lying immediately
medial (ulnar) to the physician’s finger belongs to what muscle?
A. Branchioradialis
B. Extensor carpi radialis brevis
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 C. Extensor carpi radialis longus
D. Extensor pollicis brevis
E. Extensor pollicis longus
20. While watching her boyfriend split wood, a teenager was struck on the back of her
carpals by a sharp –edged flying wedge. Her extensor digitorum tendons were exposed,
though not severed, indicating that surrounding synovial sheath had been opened.
What other muscle has its tendon surrounded by the same synovial sheath?
A. Extensor carpi radialis brevis
B. Extensor carpi radialis longus
C. Extensor digiti minimi
D. Extensor indicis
E. Extensor pollicis longus
21. During recovery from a gunshot wound of the right pelvis, the patient notices a lurch in
his gait. When he lifts his left foot off of the ground, his pelvis dips down on the left side.
The nerve that appears to have been injured is the:
A. Nerve to piriformis
B. Nerve to obturator internus
C. Sciatic nerve
D. Femoral nerve
E. Superior gluteal nerve
22. The team doctor tells a football player that he has “muscle. This results from a tearing of
the origin of the origin from the:
A. Sacrum
B. Posterior gluteal line
C. Ischial tuberosity
D. Obturator membrane
E. Iliac tubercle
23. What muscle passes through the lesser sciatic foramen?
A. Gluteus minimus
B. Obturator internus
C. Piriformis
D. Quadratus femoris
E. Superior gemellus
24. When the femur is fractured, the broken distal end often turns posteriorly to enter the
popliteal fossa due to muscle traction. Because of its position deepest in the fossa, which
structure is most vulnerable to laceration?
A. Common fibular n.
B. Lesser saphenous v.
C. Popliteal a.
D. Popliteal v.
E. Tibial n.
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25. When, in approximately 12% of people, the common fibular nerve passes through the
piriformis muscle, the nerve may be compressed. This would affect part of which
muscle?
A. Adductor mugnus
B. Biceps femoris
C. Gluteus maximus
D. Semimembranosus
E. Semitendinosus
26. During surgical repair of a popliteal artery aneurism, ligation of the femoral artery at
mid-thigh would not interrupt supply to the hamstring muscles because the
A. Genicular anastomosis ensures blood supply to posterior thigh
B. Cruciate anastmosis ensures blood supply to the posterior thigh
C. Perforating branches of the deep femoral artery supply posterior thigh
D. Obturator artery supplies the posterior thigh
E. Anterior and posterior femoral circumflex arteries anastomose with the inferior
gluteal artery
27. A worker falls from a height and lands on his feet. Radiographs reveal a fracture of the
sustentaculum tali. The muscle passing immediately beneath it that would be adversely
affected is the:
A. Fibularis longus
B. Flexor digitorum longus
C. Flexor hallucis longus
D. Tibialis anterior
E. Tibialis posterior
28. A patient has stepped on a board with a long nail sticking up from it, and the nail
penetrated the patient’s foot between the bases of the first and second metatarsals. What
artery is most likely injured at this location?
A. Arcuate
B. Deep plantar
C. Dorsalis pedis
D. Lateral plantar
E. Medial plantar
29. A deep laceration, 2 cm in length, immediately posterior to the medial malleolus, may
injure any of the following EXCEPT:
A. Fibular artery
B. Tibial nerve
C. Tendon of flexor digitorum longus m.
D. Tendon of flexor hallucis longus m.
E. Tendon of tibialis posterior m.
30. A soldier complains of foot pain following a 50 mile hike. Upon examination, the
physician diagnoses tendonitis of the fibularis longus tendon. Because the tenderness is
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 located deeply on the foot, it appears that the irritation occurred where the tendon lies
against bone, covered by a structure called the:
A. Long plantar ligament
B. Plantar aponeurosis
C. Short plantar ligament
D. Spring ligament
E. Tendon of tibialis posterior
31. While walking barefoot on the beach in Entebbe following final exams, a medical student
steps on a sharp shell which punctures the sole of her foot. She notices that she can
nolonger spread her toes apart (without using her hands). Which nerve must have been
injured?
A. Deep fibular
B. Lateral plantar
C. Medial plantar
D. Sural
E. Tibial
32. The lateral antebranchial cutaneous nerve comes from the:
A. Axillary nerve
B. Medial cord nerve
C. Musculocutaneous nerve
D. Radial nerve
E. Ulnar nerve
33. In withdrawing a blood sample from the median cubital vein the needle passes slightly
deep and medial; which nerve might possibly be injured?
A. Dorsal ulnar cutaneous
B. Lateral antebrachial cutaneous
C. Posterior antebrachial cutaneous
D. Medial antibranchial cutaneous
E. Superficial radial
34. After X-ray examination, you are called upon to sature his lacerations in the emergency
room. Which laceration (from your observations in the gross anatomy lab) would you
expect to be the most difficult to suture because of thick skin?
A. Back of his head in the occipital area
B. Chest, just above the nipple
C. Lateral side of arm
D. Lateral forearm
E. Dorsal side of hand
35. While you are stitching up his hand, he notes that you did not have to give him an
anesthetic since the area between his thumb and index finger on the dorsal side was
already numb. Which nerve must have been injured (most likely by the fracture of his
wrist) for this area to be numb?
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 A. Lateral antebrachial cutaneous
B. Medial antebranchial cutaneous
C. Median
D. Superficial radial
E. Superficial ulnar
36. The injured nerve (from the skin of his hand) contains afferent nerve fibers that travel
through which of the following parts of a spinal nerve?
A. Dorsal primary ramus
B. Dorsal root
C. Gray ramus communicans
D. Posterior cutaneous branch
E. Ventral root
37. During insertion of an IV cannula in the median cubital vein, the patient suddenly lost
feeling on the radial side of the forearm. What nerve was injured?
A. Lateral antebranchial cutaneous
B. Medial antebranchial cuneous
C. Musculocutaneous
D. Posterior antbranchial cutaneous
E. Superficial radio nerve
38. After trying to throw a curve ball, a pitcher lost sensation from the tip of the little finger.
This indicates injury to which nerve?
A. Radial
B. Median
C. Ulnar
D. Musculocuteneous
E. Medial antebranchial cutaneous
39. After rammings the point of his shoulder into a practice dummy, a football player
suffered a severe shoulder separation. Although this is a dislocation of the
acromioclavicular joint, several structures could be torn, including the one that gives the
joint its greatest strength and stability, namely the:
A. Acromioclavicular ligament
B. Coracoacromial ligament
C. Coracoclavicular ligament
D. Suspraspinatus
E. Tendon of the long head of biceps
40. While doing arthrography of the shoulder joint it was noted that the contrast material
flowed into the subacromial (subdeltoid) bursa, along the tendon of the subscapularis and
along the proximal part of the tendon of the long head of the biceps. The finding of
contrast in which area was abdormal?
A. Into the subacrmial (subdeltoid) bursa
B. Along the tendon of the subscapularis
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 C. Along the proximal part of the tendon of the long head of the biceps
41. A patient presented to his physician with chronic shoulder pain. I was noted that when
asked to abduct his arm, he initially leaned laterally, and then straightened up. When
iodinated contrast was injected into his shoulderjoint it was found to be in the subdeltoid
bursa as well as in the joint cavity. Which structure was damaged to produce the shoulder
pain?
A. Acromioclavicular ligament
B. Long head of the biceps branchii muscle
C. Subscapularis muscle
D. Superior glenohumeral ligament
E. Supraspinatus muscle
42. A two year old child will not go to take her nap. Her mother tightly holds her left hand as
she leads her to the bedroom. Refusing to go further, the child suddenly attempts to jerk
away and then sits down screaming and holding her left elbow. In an attempt to calm her
down her mother offers her a cookie, but she cannot supinate her left hand to receive it.
Which joint was dislocated?
A. The glenohumeral joint
B. The humero-ulnar joint
C. The proximal radio-ulnar joint
D. The distal radio-ulnar joint
43. It was determined that a football player tore his coracoclavicular ligament. This is an
example of a:
A. Pulled elbow
B. Rotator cuff tear
C. Separated shoulder
D. Disocated shoulder
E. Colles’ fracture
44. Which joint would be subject to synovitis (inflammation of the synovial membrane)?
A. Epiphyseal plate
B. Metacacarpophalangeal
C. Pubic symphysis
D. Radioulnar syndesmosis
E. Suture
45. An anthlete has a knee injury, and the doctor performs a “drawer test” by pullin and
pushing on the leg with knee flexed. If the leg translates anteriorly, i.e. “gives” or moves
anteriorly when the leg is pulled anteriorly, what joint structure is most likely injured?
A. Anterior cruciate ligament
B. Lateral collateral ligament
C. Medial collateral ligament
D. Medial meniscus
E. Posterior cruciate ligament
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46. In an auto accident, the patient’s knee strikes the dashboard which in turn pushes the head
of the femur posteriorly out of its socket. Which ligament is most likely ruptured by this
posterior dislocation?
A. Iliofemoral
B. Ischiofemoral
C. Pubofemoral
D. Transverse acetabular
47. A woman with breast cancer subsequently develops mestastases in her verbral column.
The most direct route for spread of the tumor to the vertebral column was via:
A. Branches of the cephalic vein
B. Branches of the lateral thoracicvein
C. Branches of the thoracoacromial veins
D. Lymphatic vessels draining into the axilla
E. Branches of the intercostals veins
48. The clavipectoral fascia is penetrated by which artery?
A. Anterior circumflex humeral
B. Axillary
C. Subscapular
D. Thoracoacromial
E. Thoracodorsal
49. In the process of doing an axillary lymph node dissection in a 50 year –old patient, the
surgery resident cleans the space between the pectoralis major and minor muscles. In an
attempt to remove all the lateral pectoral lymph nodes. Upon recovery it is noted that the
patient’s lower pectoralis major is paralysed. The nerve most likely injured is the:
A. Axillary
B. Lateral pectoral
C. Medial pectoral
D. Suprascapular
E. thoracodorsal
50. In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into
which group of nodes?
A. Central axillary
B. Deltopectoral
C. Lateral axillary
D. Parasternal
E. Subscapular
51. 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 coracoids process. Which muscle was torn?
A. Deltoid
B. Pectoralis major
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 C. Pectoralis minor
D. Serrats anterior
E. Subclavius
52. Fracture of the femoral neck may lead to a vascular necrosis of the femoral head due to
the interruption of which artery?
A. First perforating branch of the deep femoral
B. Inferior epigastric
C. Internal pudendal
D. Lateral circumflex femoral
E. Medial circumflex femoral
53. Following surgical opening of the abductor canal, a patient experienced a loss of
cutaneous sensation of the medial side of the leg. Which nerve was cut?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Medial sural cutaneous
E. Saphenous
54. Following a gunshot wound to the shoulder, a patient is unable to abduct the arm between
0 and 15 degrees with reduced lateral rotation of the humerus. What nerve is probably
injured?
A. Accessory (CN XI)
B. Axillary
C. Median
D. Suprascapular
E. Ulnar

A scafford falls on the right shoulder of a construction worker lacerating the side of his
neck and suprascapular area, severing C5 spinal nerve just lateral to the verterbral
column. Subsequent to the injury, the patient could not elevate the tip of his shoulder or
retract it and had difficulty fully abducting his arm. Given this scenario answer the
following questions.

55. Due to the bleeding, the surgeon legated (tied off) the suprascapular artery as it crossed
the top of the scapula. There was no concern however, as she knew that direct collateral
branches of which artery would supply the normal distribution of the suprascapular
artery.
A. Anterior circumflex humeral
B. Posterior circumflex humeral
C. Scapular circumflex
D. Subscapular
E. Thoracordosal

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56. The pulse of radial artery at the wrist is felt immediately lateral to which tendon?
A. Abductor pollicis longus
B. Extensor pollicis longus
C. Flexor carpi radialis
D. Flexor digitorum profundus
E. Palmaris longus
57. If the medial epicondyle of the humerus is fractured and the nerve passing dorsal to it is
injured, which muscle would be most affected?
A. Extensor carpi ulnaris
B. Extensor digitorum
C. Flexor carpi ulnaris
D. Flexor digitorum profundus
E. Flexor digitorum superficialis
58. While on vacation in Zanzibar following her final exams, a scuba diving medical student
is accidentally speared by her diving partner. The end of the spear passes medial to
lateral, posterior to the medial malleolus. It severs an artery there, which is the:
A. Anterior tibial
B. Dorsalis pedis
C. Fibular
D. Medial plantar
E. Posterior tibial
59. A patient has been diagnosed with bone cancer in the fibula that necessitates its removal.
Which of the following muscles would be least affected following removal of the fibula?
A. Biceps femoris
B. Extensor digitorum longus
C. Flexor digitorum longus
D. Flexor hallucis longus
E. Peroneus tertius
60. In the axilla the pectoralis minor is a landmark, being closely related to all of the
following structures except:
A. Cephalic vein
B. Cords of the brnchial plexus
C. Lateral thoracic artery
D. Medial pectoral nerve
E. Second part of the axillary artery

SECTION B

1. A 28 year old dentist consults her physician, complaining that she feels tingling and
slight pain in her right hand. The symptoms are localized to her thumb, index, middle
and lateral side of her ring finger. The sensations are more intense at night or if she

22
 overworks. Recently, she has experienced some weakness in her grasp and finds it
more difficult to hold her instruments. Also, movements of her right thumb are not as
strong as before.

On examination, there is loss of power on certain movements of the thumb. She has
impaired appreciation of light touch and pin pricks to the thumb, index, middle and
lateral side of her ring finger, but sensation to her palm is not affected. Pressure and
tapping over the flexor retinaculum causes tingling. After a complete examination,
the patient is diagnosed with carpal tunnel syndrome.
a) Describe the carpal tunnel. What is contained in it?
b) Name two muscles that are affected by a carpal tunnel syndrome. How
would you test their function?
c) Physicians used to think this kind of pain was caused by a deficiency
in the brachial plexus. if this was the case, what roots or trunks would
have to be involved and why is this unlikely to be the caand why is
this unlikely to be the cause of the problem?(consider both sensory and
motor deficiencies that this patient has.)
d) What causes symptoms of carpal tunnel syndrome?
e) Although this patient recovered with rest and physical therapy, some
patients do not improve with conservative treatment and opt for
surgery. What structures might be endangered by surgery and need to
be avoided?
2. Following a major operation, a patient was placed on a course of antibiotics which
were to be delivered via intramuscular injection to the buttocks. After one of these
injections, the patient complained of more pain than usual in the region of the
injection. Later, as the patient was taking his afternoon walk in the hall, the nurse
noticed that he was walking with a limp that had not been present before- his left hip
dropped every time he lifted his left foot off the floor. But on the right side, his pelvis
remained level when he lifted up his right foot. The doctor was called, and after a
brief examination, she concluded that the injection had damaged a nerve that resulted
in muscle weakness, which caused the patient’s unusual limp.
Based on the vignette above,
a) Which muscles are affected? On which side? Why does his left hip
drop?
b) If this muscles are affected, which nerve must be damaged? Where is
this nerve located in the buttock and where does it originate?
c) What other structures in the posterior hip/buttocks region might be
damaged by an inappropriately administered intramuscular injection or
other penetrating injury?

23
 d) Based on your knowledge of the anatomy of this region, where is the
best location for administering intramuscular injections to avoid
damaging ny important structures?
e) What is the clinical name given to the symptoms the patient displayed
following the injury and what other conditions might cause it?
3. Describe the walls of the boundaries of the axilla.
b) describe the lymphatic drainage of the upper limb and the major lymphatic node
groups of the axilla.
4. describe the attachments of the palmer carpal ligament?
a.Name the muscles which lie within the fascial plane of the palmar carpal ligament?
b. which vessels and nerves lie within the palmer carpal ligament?
c. list the muscles that lie deep to the facial plane of the palmar carpal ligament?
5. describe the blood supply, nerve supply and the lymphatic drainage of the breast.

5. Describe the arches of the foot

Describe the supporting mechanisms of these arches.

61. The lymph from the upper lateral upper lateral quadrant of the breast drains mainly into
the
A. Internal thoracic nodes
B. Posterior axillary nodes
C. Anterior axillary nodes
D. Lateral axillary nodes
E. Apical group of nodes
62. The nerve supply of pectoralis major muscle is
A. Medical pectoral
B. Lateral pectoral
C. Both medial and lateral pectoral
D. Long thoracic nerve
E. Thoracodorsal nerve
63. The clavipectoral fascia is pierced by all except
A. Cephalic vein
B. Lateral pectoral nerve
C. Lymphatics from infraclavicular nodes
D. Medical pectoral nerve
E. Thoracoacromial branch of axillary artery
64. The following is true about the clavicle except that it
A. Ossifies in membrane
B. Ossifies from two primary members
C. Has a medullary cavity
D. Is the only long bone that is horizontal
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 E. Is subcutaneous throughout
65. The main function of the clavicle is to
A. Act as a strut that holds the upper limb away from the trunk
B. Transmit weight/force from the upper limb to axial skeleton
C. Protect the brachial plexus
D. Form one of the boundaries of the apex of the axilla
E. Protect the subclavian vessels
66. All of the following are true about the clavipectoral fascia except
A. Encloses the subclavius and pectoralis minor muscles
B. Pierced by the axillary vein
C. Continues as the susensory ligament of the axilla
D. Responsible for raising the skin of the armpit
E. Protects the contents of the axilla
67. All of the following are the contents of the axilla except
A. Axillary artery and its branches
B. Brachial artery
C. Axillary vein and its tributes
D. Brachial plexus
E. Axillary lymph nodes

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