A patient with arm lymphedema following a mastectomy will be advised to avoid which of the following? a.
iv insertions in the affected arm b.
avoid injuries to the skin c.
avoid constrictive items d.
carry heavy packages e.
all of the above
E
Which of the following muscles may be removed in radical mastectomy? a)Latissimus dorsi b)pectoralis major c)serratus anterior d)serratus posterior inferior e)subclavius
B- pec major- also could be pec minor
Branches of which of the following vessels is (are) ligated in radical mastectomy? a)lateral thoracic b)thoracoacromial c)brachial d)internal thoracic e)subscapular
Alateral thoracic artery- runs with long thoracic nerve
Bthoracoacromial- superior
Cinternal thoracic- medial
Which of the following group of spinal segments receives pain impulses from breast following mastectomy? a)T2-T5 b)T8-T12 c)T10-T12 d)T5-T9 e)C8-T1
A

A ballet dancer falls to the floor and hurts herself during a practice session before opening night. She sustains an injury to thoracodorsal nerve which would probably affect which of the following movements? a)extension of the arm b)adduction of the scapula c)extension of the scapula d)abduction of the arm
Affects extension of the arm
Which of the following bony landmarks serves as a site of attachment for the infraspinatus and teres minor?
Greater tubercle – attaches supraspinatus, infraspinatus, and teres minor- lesser tubercle attaches subscapularis
Lateral rotation of the arm is an important mechanical component of
“bringing the arm back” when preparing to throw an object. What muscles act to produce lateral rotation of the arm?
Infraspinatus and teres minor
Which of the following arm movements is shared by the supraspinatus and the deltoid?
Abduction
Which of the following nerves courses with the same named artery?
Transverse cervical artery- superficial runs with accessory and deep runs with dorsal scapular
Dorsal scapular
Thoracodorsal (aka middle subscapular)
Which of the following lies directly deep to the trapezius muscle?
Infraspinatus and supraspinatus
What makes up the triangle of auscultation?
-latissimus dorsi, trapezius, and scapula (medial border)
What makes up the lumbar triangle?
-iliac crest, lat dorsi, and external oblique abdominal muscles- site of hernia
Comp Exam

1.
A young man is brought to the ED after being mugged. He was stabbed in the shoulder after refusing to give his wallet to his assailant. If the stab wound lacerates the posterior humeral circumflex artery passing through the quadrangular space on the shoulder region, which of the following nerves might be injured? #1
A)radial b)axillary c)thoracodorsal d)suprascapular e)accessory
B
2.
A 47-year old woman has had a lumpectomy and axillary dissection to check for metastasis. She has come in for her follow up appointment, and her physician notices on her physical examination that the medial part of her scapula protrudes from her back and that she is not able to raise her arm above the horizontal level. Which of the following nerves has been damaged during her surgery? a) median b) ulnar c) thoracodorsal d) long thoracic e) radial
D
Back
1.
After a 26 year old man’s car was broadsided by a large truck, he is brought to the ED with multiple fractures of the transverse processes of the cervical and upper thoracic vertebrae. Which of the following muscles might be affected? #6
(a) Trapezius
(b) Levator scapulae
(c) Rhomboid major
(d) Serratus posterior superior
(e) Rectus capitis posterior major
B- others are attached to the spinous processes
2.
During a domestic dispute, a 16-year-old boy receives a stab wound around the superior angle of the scapula near the medial border, which injures both

the dorsal scapular and spinal accessory nerves. Such an injury could result in paralysis or weakness of which of the following muscles? #10
B
(a) trapezius and serratus posterior superior
(b) rhomboid major and trapezius
(c) rhomboid minor and lat dorsi
(d) splenius cervicis and SCM
(e) levator scapulae and erector spinae
3.
A 25-year old man with congenital abnormalities at birth has a lesion of the dorsal scapular nerve, making him unable to adduct (retract) his scapula.
Which of the following muscles is most likely paralyzed? #22 a) semispinalis capitis b) rhomboid major c) multifidus d) rotator longus e) iliocostalis
B- rhomboids and trapezius retract the scapula
4.
After an automobile accident, a back muscle that forms the boundaries of the triangle of auscultation and lumbar triangle receives no blood. Which of the following muscles might be ischemic? #23 a) levator scapulae b) rhomboid minor c) latissimus dorsi d) trapezius e) splenius capitis
C
5.
A 38-year old woman with a long history of shoulder pain is admitted to a hospital for surgery. Which of the following muscles becomes ischemic soon after ligation of the superficial or ascending branch of the transverse cervical artery? #24 a) latissimus dorsi b) multifidus c) trapezius d) rhomboid major e) longissimus capitis
C- trapezius receives blood from superficial branch of transverse cervical artery. Lat dorsi receives blood from the thoracodorsal artery (runs with

thoracodorsal nerve). The rhomboid major receives blood from the dorsal scapular artery (aka the deep branch of the transverse cervical artery).
Upper Limb/Axilla
1) A patient comes in with a gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow? #2 a) acromial b) pectoral c) clavicular d) deltoid e) superior thoracic
Ddirect branch of axillary, rest are branches of thoracoacromial deltoid branch runs alongside the cephalic vein
2) A 27-year old patient presents with an inability to draw the scapula forward and downward because of the paralysis of the pectoralis minor. Which of the following would most likely be the cause his condition? a) fracture of the clavicle b) injury to the posterior cord of the brachial plexus c) fracture of the coracoid process d) axillary nerve injury e) defects in the posterior wall of the axilla
C- where it inserts
3.
A 21-year old woman walks in with a shoulder and arm injury after falling during horseback riding. Examination indicates that she cannot adduct her arm because of paralysis of which of the following muscles? a)teres minor b) supraspinatus c) latissimus dorsi d) infraspinatus e) serratus anterior
C- main muscle of adduction
4.
An 18-year old boy involved in an automobile accident presents with an arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? #19
A)suprascapular and axillary b)thoracodorsal and upper subscapular c)axillary and musculocutaneous d) radial and lower subscapular e)suprascapular and dorsal scapular

Asupraspinatus and deltoid muscles are innervated by these
5.
A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident. Which of the following muscle tendons is intact and has normal function? a)suprasinatus b)subscapularis c)teres major d)teres minor e)infraspinatus
Bteres major- the rest are part of the rotator cuff
6.
A patient is bleeding form the shoulder secondary to a knife wound in fair condition because there is vascular anastomosis around the shoulder. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? #34 a) dorsal scapular b) thoracoacromial c) circumflex scapular d) transverse cervical e) suprascapular
A
-thoracoacromial comes from axillary artery
7.
During a breast examination of a 56-year old woman, the physician found a palpable mass in her breast. Which of the following characteristics of breast cancer and its diagnosis is correct?#35 a)elevated nipple b)polymastia c)shortening of clavipectoral fascia d)dimpling of the overlying skin e)enlargement of the breast
Cpeau d’orange + inverted nipple due to shortening of suspensory ligaments
8.
A rock climber falls on his shoulder, resulting in a chipping off of the lesser tubercle of the humerus. Which of the following structures would most likely have structural and functional damage? #43 a)supraspinatus b)infraspinatus c)subscapularis d)teres minor e)coracohumeral ligament

DA, B, and D insert in greater tubercle
A 37-year old female patient has a fracture of the clavicle. The junction of the middle and lateral thirds of the bone exhibits the overriding of the medial and lateral fragments. The arm is rotated medially, but it is not rotated laterally.
45. The lateral portion of the fracture clavicle is displaced downward by which of the following? a)deltoid and trapezius b)pectoralis major and deltoid muscles c)pectoralis minor and gravity d)trapezius and pectoralis minor e)deltoid muscle and gravity
E
46. Which of the following muscles causes upward displacement of the medial fragment? a)pectoralis major b)deltoid c)trapezius d)sternocleidomastoid e)scalenus anterior
47. Which of the following conditions is most likely to occur secondary to the fractured clavicle? a)fatal hemorrhage from the brachiocephalic vein b)thrombosis of the subclavian vein, causing a pulmonary embolism c)thrombosis of the subclavian artery, causing an embolism in ascending aorta d)damage to the upper trunk of the brachial plexus e)damage to the long thoracic nerve, causing winged scapula
B
A 10-year old boy falls off his bike, has difficulty in moving his shoulder, and is brought to the ED. His radiograph and angiograph reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture.
51. Which of the following nerves is most likely injured as a result of this accident? a)musculocutaneous b)axillary c)radial d)median e)ulnar

B
55. This accident most likely leads to damage of which of the following arteries? a)axillary b)deep brachial c)posterior humeral circumflex d)superior ulnar collateral e)scapular circumflex
C
There is a radiograph of a boy’s shoulder region indicating calcification of the scapular notch (a) and the surgical neck of the humerus (b). Which muscle would be paralyzed in A and which structure would be injured in B?
Ainfraspinatus- suprascapular nerve
Bposterior humeral circumflex artery
Select the single best answer.
I. Anatomical Directions and Movements
1 Which of the following is true of the anatomical position?
(A) The humerus is proximal to the scapula.
(B) The radius is medial to the ulna.
(C) The vertebral arch is ventral to the vertebral body.
(D) The femur is superior to the fibula.
(E) The phalanges of the foot are cranial to the metatarsals.
D
2 If the body were sectioned along a ___ plane, it would be divided into ___ portions.
(A) sagittal…anterior and posterior
(B) sagittal…superior and inferior
(C) coronal…superior and inferior
(D) coronal…right and left
(E) horizontal…superior and inferior
E
3 Which of the following is true of a median plane of the hand?
(A) It becomes a horizontal plane when the hand is medially rotated 90 degrees.
(B) It becomes a coronal plane when the brachium (upper arm) is laterally rotated 90 degrees and abducted
90 degrees.
(C) It is the same as a frontal plane.
(D) It remains a median plane regardless of limb or body

position.
(E) It is oriented mediolaterally.
D
4 A radiologist wishes to image the body in a plane parallel to both scapulae. Which of the following choices best describes the desired sectioning?
(A) Horizontal section
(B) Transverse section
(C) Frontal section
(D) Sagittal section
(E) Oblique section
C
5 A young boy uses his right hand to screw-in a new light bulb.
Which of the following terms best describes the screw-home movement of his forearm?
(A) Flexion
(B) Abduction
(C) Pronation
(D) Adduction
(E) Supination
E
Medical Imaging
27 Assuming normal health and imaging conditions, which of the labeled structures in the given posteroanterior (PA) radiograph of the chest is the most radiopaque?

C-coracoid process
28 Which of the following medical imaging techniques utilizes a beam of X-rays to transilluminate the body?
(A) Computerized tomography (CT)
(B) Magnetic resonance imaging (MRI)
(C) Positron emission tomography (PET)
(D) Ultrasonography
(E) X-ray glasses
A
29 )Which of the following statements is true regarding the resultant imagery in standard CT (computerized tomography) fi lms?
(A) Air appears white
(B) Muscle appears black
(C) Bone appears white
(D) Fluids appear black
(E) Fat appears white
C
30 A radiologist orders a posteroanterior (PA) plain fi lm of the chest. This image should provide the greatest resolution of which of the following structures?
(A) Transverse processes of vertebrae

(B) Heart
(C) Esophagus
(D) Primary bronchi
(E) Descending aorta
B- it’s most anterior
Back
9 An internal medicine attending physician asks a medical student to place the bell of her stethoscope on the triangle of auscultation to hear a patient’s breathing sounds. Which of the following structures make up the boundaries of this triangle?
(A) Deltoid, latissimus dorsi, scapula
(B) Trapezius, scapula, latissimus dorsi
(C) Latissimus dorsi, ilium, external abdominal oblique
(D) Rhomboids, levator scapulae, splenius capitis
(E) Longissimus, rhomboids, vertebral spinous processes
B
21 A 17-year-old gymnast grips a high bar with his arms outstretched and begins to pull himself straight upward to the level of the bar, as in doing a chin-up. Which of the following muscles is the prime agonist in this action?
(A) Serratus posterior superior
(B) Rhomboid major
(C) Levator scapulae
(D) Latissimus dorsi
(E) Longissimus
D
Upper Limb and Axilla
4 As a result of chronic stress associated with an intense high school weight-lifting program, a 15-year-old boy suffers an avulsion fracture of the greater tubercle of the humerus. In the ER, he displays difficulty initiating abduction of the upper limb. Which of the following muscles was involved in this fracture?
(A) Supraspinatus
(B) Long head of biceps brachii
(C) Long head of triceps
(D) Subscapularis
(E) Infraspinatus
A
8 An 18-year-old boy is cut severely on the lateral wall of his right chest during a knife fight. Following healing, his scapula moves away from the thoracic wall when he leans on his right hand, giving the appearance indicated in the given photo.
Which of the following nerves is likely damaged?
(A) Axillary nerve
(B) Thoracodorsal nerve
(C) Long thoracic nerve

(D) Dorsal scapular nerve
(E) Suprascapular nerve
C
13 A dermatologist performed a biopsy on a suspicious mole on the right side of the posterior neck of a 57-year-old male construction worker. Pathology confirmed a malignant melanoma, so the physician excised a substantial amount of tissue surrounding the mole. After the procedure, the patient experienced difficulty elevating his right shoulder and lifting his right arm over his head. No sensory deficits were seen. What nerve was most likely damaged in this patient?
(A) Accessory nerve
(B) Axillary nerve
(C) Dorsal scapular nerve
(D) Long thoracic nerve
(E) Thoracodorsal nerve
A
23 A 65-year-old man is brought to the emergency room after being attacked in his office by a disgruntled co-worker. The attacker reportedly used a long, narrow-bladed letter-opener to infl ict multiple stab wounds to the man’s back. Physical examination shows a puncture wound in the posterior axillary fold. The patient presents with weakness in extension, adduction, and medial rotation of his arm. Which of the following muscles is most likely cut in this injury?
(A) Pectoralis minor
(B) Latissimus dorsi
(C) Levator scapulae
(D) Serratus anterior
(E) Teres minor
B
24 Physical examination of a 45-year-old man who had been stabbed in the back of the shoulder shows a deep wound penetrating into the quadrangular space of the shoulder, causing bleeding from the severed blood vessels there. Which of the following neural structures is most likely damaged as well?
(A) Musculocutaneous nerve
(B) Lateral cord of the brachial plexus
(C) Radial nerve
(D) Axillary nerve
(E) Medial cutaneous nerve of the arm
D
25 The pectoralis minor muscle is an important landmark in identifying and describing neighboring structures in the chest and axillary regions. Which of the following relationships of the pectoralis minor is correct?
(A) The lateral cord of the brachial plexus lies lateral to the muscle
(B) The clavipectoral triangle lies lateral to the muscle
(C) The anterior axillary lymph nodes lie along the medial

border of the muscle
(D) The lateral wall of the axillary fossa includes the muscle
(E) The second part of the axillary artery lies deep to the muscle
E
26 Lateral rotation of the arm is an important mechanical component of “bringing the arm back” when preparing to throw an object. What muscle acts to produce lateral rotation of the arm?
(A) Supraspinatus
(B) Teres major
(C) Latissimus dorsi
(D) Subscapularis
(E) Teres minor
E
32 The given X-ray reveals a fracture of the proximal humerus, indicated by the black arrow. Given the location of the fracture, what artery is most likely damaged in this patient?- arrow points to surgical neck
A) Posterior circumfl ex humeral artery
(B) Brachial artery
(C) Deep brachial (profunda brachii) artery
(D) Subscapular artery
(E) Superior ulnar collateral artery
A
39 The traditional radical mastectomy includes removal of the pectoralis major muscle. Which of the following movements is most affected postoperatively by this surgical procedure?
(A) Adduction of the arm
(B) Abduction of the arm
(C) Extension of the arm
(D) Lateral rotation of the arm
(E) Depression of the arm
A
40 The lateral thoracic artery provides the main blood supply to the lateral side of the chest wall, including much of the breast.
To deter excessive blood loss during a surgical procedure involving the breast, a surgeon can clamp the lateral thoracic

A artery near its origin. Which of the following arteries gives rise to this artery?
(A) First part of the axillary artery
(B) Second part of the axillary artery
(C) Third part of the axillary artery
(D) Third part of the subclavian artery
(E) First part of the brachial artery
B
41 Following a radical mastectomy procedure, a surgeon plans to conduct a breast reconstruction utilizing a latissimus dorsi muscle flap. What nerve will the surgeon need to keep intact during the surgical dissection of the chest wall to prevent atrophy of the muscle flap?
(A) Long thoracic nerve
(B) Intercostobrachial nerve
(C) Medial pectoral nerve
(D) Thoracodorsal nerve
(E) Axillary nerve
D
42 An 80-year-old woman comes to the physician because of a lump in her right breast. Physical examination shows a 2-cm mass in the right breast with dimpling of the overlying skin and peau d’orange (edema of the breast with the skin assuming the appearance of an orange peel). Examination of a biopsy specimen confi rms a diagnosis of carcinoma. Involvement of what structure is the most likely cause of this patient’s skin dimpling?
(A) Clavipectoral fascia
(B) Suspensory ligaments
(C) Lactiferous ducts
(D) Retromammary space
(E) Pectoralis major
B
47 Organization of the axillary lymph nodes into Levels I, II, and
III for breast cancer treatment is based on the location of the nodes relative to which of the following muscles?
(A) Pectoralis minor
(B) Pectoralis major
(C) Latissimus dorsi
(D) Serratus anterior
(E) Subscapularis