Upper Limb — MCQs

Upper Limb Indian Medical PG Practice Questions and MCQs

Question 731: Pulp of the index finger is supplied by

A. Median nerve (Correct Answer)
B. Radial nerve
C. Ulnar nerve
D. Axillary nerve

Explanation: ***Median nerve*** - The **median nerve** innervates the **radial side of the hand**, including the palmar surface of the thumb, index finger, middle finger, and the radial half of the ring finger [1]. - Sensation to the **pulp of the index finger** is specifically provided by the **median nerve** [1]. *Radial nerve* - The **radial nerve** primarily supplies the **dorsum of the hand** and fingers, except for the distal phalanges. - It does not provide sensory innervation to the palmar surface or pulp of the index finger. *Ulnar nerve* - The **ulnar nerve** innervates the **ulnar side of the hand**, specifically the palmar and dorsal surfaces of the little finger and the ulnar half of the ring finger [1]. - It plays no role in the sensation of the index finger pulp. *Axillary nerve* - The **axillary nerve** innervates the **deltoid muscle** and provides sensation to the skin over the deltoid region, often referred to as the "regimental badge area." - It is located in the shoulder region and has no sensory distribution in the hand.

Question 732: Which muscle acting on the thumb is the only one among the options that has dual nerve supply?

A. Flexor Pollicis Longus
B. Adductor Pollicis
C. Opponens Pollicis
D. Flexor Pollicis Brevis (Correct Answer)

Explanation: ***Flexor Pollicis Brevis (FPB)*** - The **Flexor Pollicis Brevis** is unique among thumb muscles because it commonly has a **dual nerve supply**. [1] - Its superficial head is innervated by the **median nerve**, while its deep head is innervated by the **ulnar nerve**. *Flexor Pollicis Longus (FPL)* - The **Flexor Pollicis Longus** is solely innervated by the **anterior interosseous nerve**, a branch of the **median nerve**. [1] - It does not receive any neural input from the ulnar nerve. *Adductor Pollicis* - The **Adductor Pollicis** muscle is exclusively innervated by the **deep branch of the ulnar nerve**. - It plays a crucial role in **adduction of the thumb** and does not share innervation with the median nerve. *Opponens Pollicis* - The **Opponens Pollicis** is primarily supplied by the **recurrent branch of the median nerve** (also known as the thenar motor branch). - Its function is **opposition of the thumb**, and it does not have dual innervation.

Question 733: What movements does the coracoacromial ligament resist?

A. Upward displacement of humeral head (Correct Answer)
B. Abduction of shoulder
C. Inferior displacement of humerus
D. External rotation

Explanation: Upward displacement of humeral head - The **coracoacromial ligament** extends from the coracoid process to the acromion, forming the **coracoacromial arch** which acts as a protective roof over the humeral head. - This anatomical position allows it to act as a **passive restraint against superior migration** or upward displacement of the **humeral head**, especially important when the rotator cuff (particularly supraspinatus) is deficient. - It prevents **superior subluxation** of the humerus and protects the joint from impingement against the acromion. *Abduction of shoulder* - **Abduction** of the shoulder is primarily limited by the **inferior capsule** and **adductor muscles** (latissimus dorsi, pectoralis major, teres major). - The coracoacromial ligament does not play a significant role in limiting the range of abduction movements. *Inferior displacement of humerus* - **Inferior displacement** of the humerus is primarily resisted by the **superior capsule**, the **supraspinatus tendon**, and the **coracohumeral ligament**. - The coracoacromial ligament is positioned superiorly and therefore does not prevent downward movement of the humeral head. *External rotation* - **External rotation** of the shoulder is limited by the **anterior capsule**, **anterior glenohumeral ligaments**, and the **subscapularis muscle**. - The coracoacromial ligament's orientation and function do not contribute to resisting rotational movements of the humerus.

Question 734: Where does the flexor carpi radialis insert?

A. Base of 5th metacarpal
B. Base of 2nd and 3rd metacarpal (Correct Answer)
C. Scaphoid and trapezium
D. Capitate and hamate

Explanation: ***Base of 2nd and 3rd metacarpal*** - The **flexor carpi radialis** muscle, as its name suggests, is a powerful wrist flexor and **radial deviator**. - Its tendon typically inserts onto the **palmar aspect of the base of the second and third metacarpal bones**. *Base of 5th metacarpal* - The **5th metacarpal** is located on the **ulnar side** of the hand, which is not the insertion site for the flexor carpi radialis. - Muscles inserting near the 5th metacarpal include the **flexor carpi ulnaris** and the **extensor carpi ulnaris**. *Scaphoid and trapezium* - The **scaphoid** and **trapezium** are **carpal bones** of the wrist, but they do not serve as the direct insertion point for the flexor carpi radialis [1]. - These bones form part of the **carpal tunnel** and are involved in complex wrist movements [1]. *Capitate and hamate* - The **capitate** and **hamate** are also **carpal bones** located in the distal row of the wrist. - While they are functionally involved in wrist movements, they are not the primary insertion site for the flexor carpi radialis.

Question 735: Which muscle protects the brachial plexus in case of clavicle fractures?

A. Subclavius (Correct Answer)
B. Supraspinatus
C. Subscapularis
D. Teres Minor

Explanation: ***Subclavius*** - The **subclavius muscle** lies inferior to the clavicle, between the clavicle and the first rib, acting as a **cushion** during trauma. - Its strategic position provides a **protective barrier** for the underlying neurovascular structures, including the **brachial plexus** and subclavian vessels, against clavicular fragments. *Supraspinatus* - The **supraspinatus muscle** is located in the **supraspinous fossa** of the scapula, superior to the spine of the scapula. - Its primary role is in **shoulder abduction** and stabilization of the glenohumeral joint, not providing direct protection to the brachial plexus during clavicle fractures. *Subscapularis* - The **subscapularis muscle** is situated in the **subscapular fossa** on the anterior surface of the scapula. - It functions in **internal rotation** of the humerus and stabilization of the shoulder joint, and does not lie in a position to protect the brachial plexus from clavicular trauma. *Teres Minor* - The **teres minor muscle** is one of the rotator cuff muscles, located on the **posterior aspect of the scapula**, inferior to the infraspinatus. - Its main actions are **external rotation** and adduction of the humerus, and it is anatomically distant from the clavicle and brachial plexus in this context.

Question 736: Infraspinous fossa of scapula contains which of the following muscles?

A. Subscapularis
B. Infraspinatus (Correct Answer)
C. Teres major
D. Supraspinatus

Explanation: ***Infraspinatus*** - The **infraspinous fossa** is a large depression on the posterior surface of the scapula, inferior to the spine. - As its name suggests, it is the origin for the **infraspinatus muscle**, which is a key component of the rotator cuff. - This muscle is responsible for **external rotation** of the humerus at the shoulder joint. *Subscapularis* - The **subscapularis muscle** originates from the **subscapular fossa**, which is on the anterior (costal) surface of the scapula. - This muscle is responsible for internal rotation of the humerus. *Teres major* - The **teres major muscle** originates from the inferior angle and lower part of the lateral border of the scapula. - It works to extend, adduct, and internally rotate the humerus, acting synergistically with the latissimus dorsi. *Supraspinatus* - The **supraspinatus muscle** originates from the **supraspinous fossa**, which is located above the spine of the scapula. - This muscle is primarily responsible for the initiation of abduction of the arm.

Question 737: Posterior interosseous artery is a branch of?

A. Radial artery
B. Median artery
C. Brachial artery
D. Common interosseous artery (Correct Answer)

Explanation: ***Common interosseous artery*** - The **common interosseous artery** is a short branch of the **ulnar artery** that quickly divides into the anterior and posterior interosseous arteries. - The **posterior interosseous artery** then supplies muscles in the posterior compartment of the forearm. *Radial artery* - The **radial artery** is one of the two terminal branches of the **brachial artery** and primarily supplies the lateral side of the forearm and hand. - It does not directly give off the posterior interosseous artery. *Median artery* - The **median artery** is a small artery that runs with the **median nerve** and is often a branch of the **anterior interosseous artery**. - It does not give rise to the posterior interosseous artery itself. *Brachial artery* - The **brachial artery** is the main artery of the upper arm, branching into the **radial** and **ulnar arteries** in the forearm. - While it's an upstream vessel, it does not directly give off the posterior interosseous artery; that branch comes from the common interosseous artery, which is a branch of the ulnar artery.

Question 738: Coracohumeral ligament inserts on?

A. Greater tuberosity
B. Lesser and greater tuberosities (Correct Answer)
C. Bicipital groove
D. Anatomical neck of humerus

Explanation: ***Lesser and greater tuberosities*** - The **coracohumeral ligament** originates from the **lateral border of the coracoid process** and inserts onto **both the greater and lesser tuberosities** of the humerus. - It divides into two bands: one inserts on the **greater tuberosity** and the other on the **lesser tuberosity**, effectively bridging across the **bicipital groove**. - This ligament strengthens the **superior part of the joint capsule** and limits inferior translation and external rotation of the humeral head. *Greater tuberosity* - While the coracohumeral ligament does insert partially on the **greater tuberosity**, this option is incomplete as it omits the insertion on the **lesser tuberosity** as well. - The greater tuberosity also serves as the attachment site for **supraspinatus**, **infraspinatus**, and **teres minor** muscles (rotator cuff). *Bicipital groove* - The **bicipital groove** (intertubercular sulcus) houses the **long head of the biceps tendon**. - The **transverse humeral ligament** spans this groove, holding the biceps tendon in place. - The coracohumeral ligament bridges across the groove but does not insert into it. *Anatomical neck of humerus* - The **anatomical neck** is the constriction below the humeral head, representing the old epiphyseal line. - The **joint capsule** attaches to the anatomical neck, but the coracohumeral ligament specifically inserts on the **tuberosities**, not the neck itself.

Question 739: Inability to pronate forearm is due to injury to which nerve ?

A. Ulnar
B. Radial
C. Median (Correct Answer)
D. Musculocutaneous

Explanation: Median nerve - The median nerve innervates the pronator teres and pronator quadratus muscles, which are the primary muscles responsible for forearm pronation. - Damage to the median nerve would therefore lead to an inability or significant difficulty in performing this action. Ulnar - The ulnar nerve primarily controls most intrinsic muscles of the hand and some forearm flexors, but it does not play a direct role in forearm pronation. - Injury to the ulnar nerve would typically manifest as weakness in finger adduction/abduction and wrist flexion, not pronation issues. Radial - The radial nerve innervates the supinator muscle and the extensors of the forearm and hand, facilitating forearm supination and wrist/finger extension. - Damage to the radial nerve would impair supination and extension, not pronation. Musculocutaneous - The musculocutaneous nerve innervates the biceps brachii, brachialis, and coracobrachialis muscles, which are primarily involved in flexion of the elbow and supination of the forearm (biceps). - Injury to this nerve would compromise flexion and supination, but not pronation directly.

Question 740: Which muscle primarily forms the posterior wall of the axilla?

A. Latissimus dorsi
B. Teres major
C. Subscapularis (Correct Answer)
D. Pectoralis major

Explanation: ***Subscapularis*** - The **subscapularis** muscle forms the **largest and superior part of the posterior wall of the axilla**. - It arises from the subscapular fossa on the anterior surface of the scapula and its broad surface creates the majority of the posterior axillary wall. - It is a key component of the rotator cuff and passes through the axilla to insert on the lesser tubercle of the humerus. *Latissimus dorsi* - The **latissimus dorsi** contributes to the **inferior part of the posterior wall** of the axilla [1]. - Along with teres major, it forms the lower border of the posterior wall, but does not form the primary or largest component [1]. *Teres major* - The **teres major** also forms part of the **inferior portion of the posterior wall**, lying superior to latissimus dorsi. - Together with latissimus dorsi, it contributes to the lower aspect of the posterior wall. *Pectoralis major* - The **pectoralis major** forms the **anterior wall of the axilla**, not the posterior wall [1]. - It is a large, fan-shaped muscle essential for adduction and medial rotation of the humerus [1].

Practice by Chapter

Pectoral Region and Axilla

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Arm and Cubital Fossa

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Forearm and Hand

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Joints of Upper Limb

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Nerves of Upper Limb

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Arterial Supply and Venous Drainage

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Lymphatic Drainage

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Muscles and Their Actions

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Applied Anatomy and Clinical Correlations

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Surface Anatomy and Landmarks

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Upper Limb — MCQs

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