2019/6/21 Answers to MCQs on Page 2

Answers to Multiple Choice Questions 11 - 20

Do NOT try to remember the answers to these questions. MCQs in the
examination may appear to be similar. Bear in mind that a single word
can change a question and therefore the answer!

11. The musculocutaneous nerve

A. is developmentally comparable to the femoral nerve in the lower limb.

B. arises from the lateral cord of the brachial plexus.
C. winds around the surgical neck of the humerus.
D. supplies the triceps brachii muscle.
E. is the only nerve in the limbs to supply both muscles and skin.

(B) : It arises from the lateral cord.

The musculocutaneous nerve is the nerve of the anterior compartment

of the arm, but NOT comparable to the femoral nerve. The femoral
nerve is a dorsal nerve supplying the extensors of the knee. Think of the
developmental rotation of the lower limb!
In this context, also note that the biceps femoris is NOT a complete
equivalent of the biceps brachii! The short head of the biceps
femoris is a dorsal muscle, supplied by the common peroneal
nerve.
The axillary nerve winds around the humerus.
The triceps is supplied by the radial nerve.
The name musculocutaneous is misleading (I would even say it is
mischievous!). There are many nerves, in both limbs, that supply
both muscles and skin - median, ulnar, radial, tibial, femoral,
obturator, peroneal... We do not need to remember the details of
their cutaneous supply, but it is important to know that the
musculocutaneous nerve just happens to named so!

12. The flexor digitorum profundus muscle can flex the

A. wrist joint
B. metacarpophalangeal joints of the fingers
C. distal interphalangeal joints
D. joints of the thumb
E : A, B and C are correct

(E)
Three key points need to be understood here :
1. A muscle acts on all the joints it crosses.
2. FDS ends at the middle phalanges, FDP reaches the distal
phalanges, so the latter can flex the distal IP joints while the former
cannot.
3. In the hand we need to distinguish between "fingers" and "thumb"!

13. If the radial nerve is totally damaged by a fracture in the spiral groove :

A. There is total loss of supination.

B. A part of the triceps brachii is spared.
C. Extensors of the wrist are paralysed.
D. Abduction of the thumb is impossible.
E. B and C are correct.

(E)
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This is one of the few questions that illustrates the effects of nerve
injuries.
Notice the movements that are produced by more than one muscle, with
different nerve supply. While supinator belongs to the extensor
compartment, the biceps can also supinate, even though the it has its
limitations. And the biceps is supplied by the musculocutaneous nerve.
Similarly, the long abductor of the thumb is supplied by the radial nerve
(through its continuation), but the thumb has a short abductor in the
thenar group (median nerve).

14. Regarding the quadriceps femoris muscle :

A. It acts on both hip and knee joints.

B. It has a double nerve supply.
C. It is developmentally dorsal muscle.
D. It has a hiatus for the passage of the femoral artery.
E. It is attached to the fibula.

(C)

This a classic example illustrating the concept of the single best answer
in MCQ.
Regarding the choice 'A' : The rectus femoris does act on both joints,
but the quadriceps as a whole does not.Therefore, that it is a
developmentally dorsal muscle is the best choice.
Regarding the other choices :
It certainly does not have a double nerve supply : major muscles with
double nerve supply are the adductor magnus and the biceps femoris.
The hiatus (opening or gap) for the femoral artery is in the adductor
magnus muscle. At this point the femoral artery continues as the
popliteal artery.
The quadriceps tendon is attached to the patella and through it, to the
tibia.

15. The hamstring group of muscles includes :

A. semimembranosus
B. short head of the biceps femoris
C. semitendinosus
D. A and C are correct
E. A, B and C are correct.

(D)
I think we have discussed the hamstrings quite extensively! Just to
recapitulate :
These are developmentally ventral muscles (rotation of the lower limb!),
supplied by the tibial division of the sciatic. They all arise from the
ischial tuberosity.
The short head of biceps femoris takes origin from the femur and is
supplied by the common peroneal nerve, therefore NOT a hamstring,
the adductor part of the adductor magnus (obturator nerve) is also NOT
a hamstring.
The "hamstring" part of the adductor magnus is a bit problematic - it
does take origin from the ischial tuberosity and is supplied by the tibial
nerve. But it does not flex the knee joint because it is attached to the
femur. (For those interested : the medial ligament of the knee joint is
considered by many to be the continuation of the adductor magnus).
Hamstrings are less powerful than the gluteus maximus in extension
of the hip joint.

16. Regarding the nerves of the foot :

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A. The lateral plantar nerve enters the foot from the lateral side.
B. The medial plantar nerve is comparable to the ulnar nerve in the hand.
C. Both lateral and medial plantar nerves are branches of the tibial nerve.
D. The lateral plantar nerve also supplies the peroneal muscles.
C. Both lateral and medial plantar nerves are purely cutaneous nerves.

(C)
This question may sound like it is testing too much detail, but really it
just illustrates a bit of terminology and some developmental principles.
Compare the hand and the foot. In the hand we have median and ulnar
nerves, in the foot, medial and lateral plantar. Both the plantar nerves
are branches of the tibial nerve - the tibial nerve is the single, large
ventral nerve in the leg and the foot. Both plantar nerves enter the foot
from the medial side along with tendons of the ventral muscles (flexor
digitorum &c).
Because the peroneal muscles are on the lateral side, it is tempting to
think that they are supplied by the lateral plantar nerve. They are NOT,
the peroneal muscles are dorsal muscles, and have their own peroneal
nerve!
The medial plantar nerve, being medial goes towards the great toe
which is a preaxial structure. The ulnar nerve goes towards the little
finger.
The choice E just tests the fact that their are muscles in the foot
comparable to thenar, hypothenar and interosseous muscles!

17. The psoas major muscle

A. is a lateral rotator of the femur IF the femoral neck is fractured.
B. is attached to the greater trochanter.
C. is an extensor of the vertebral column.
D. receives nerve supply from the obturator nerve.
E. None of the above is true.

(A)
Think of the femur. The normal axis for rotation passes between the
head and the medial epicondyle. If the neck of the femur is fractured,
the shaft of the femur rotates around its own long axis. Therefore in
such a case the psoas, pulling on the lesser trochanter from the front,
becomes a lateral rotator. If you find this explanation difficult, let us
eliminate the other choices! :
The greater trochanter is lateral, for the attachment (mainly) of the
gluteus medius.
The psoas is in front of the vertebral column, cannot extend the column.
Acting singly, it is a lateral flexor.
It is anterior to the hip, obturator is the nerve of the adductors which are
medial.

18. The ankle joint

A. is formed by the tibia, fibula and the talus.

B. has the deltoid ligament on the lateral side.
C. is the joint for the movements of inversion and eversion.
D. is a saddle type of joint.
E. All of the above are true.

(A)

The participation of the fibula in the ankle joint is of tremendous

importance for holding the talus in a vicelike grip!
The deltoid ligament is pretty thick and strong and is on the medial side.
Movements of the ankle are dorsiflexion and plantarflexion - inversion

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and eversion take place at a lower joint.

It is mainly a uniaxial joint.

19. Preaxial structures in the limbs include :

A. The fibula in the lower limb

B. The radius in the upper limb
C. The basilic vein in the upper limb.
D. The short saphenous vein in the lower limb.
E. All of the above are true.

(B)
The concept of pre- and post-axial structures began in 212 and has
been emphasised in 213!
Remember the rotation of the limbs. Comparable preaxial structures in
the limbs are : radius/tibia, thumb/great toe. Postaxial structures are
ulna/fibula, little finger/little toe.
In the upper limb the basilic vein runs on the medial (ulnar) side and is
cutaneous for a shorter distance, cephalic vein is longer and runs on the
lateral (radial) side.
The short saphenous vein begins on the lateral (fibular) side, the long
("great") saphenous runs on the medial (tibial) side.
In this context, also bear in mind some other developmental
considerations :
Special terms used for movements of ankle joint (dorsiflexion and
plantarflexion), the reversal of compartments of the thigh (ventral is
posterior) and suchlike.

20. The posterior cruciate ligament of the knee joint

A. prevents the femur from slipping forwards on the tibia.

B. divides the knee joint into two completely separate compartments.
C. is attached to the femur on the posterior side.
D. is a part of the popliteus tendon.
E. is also known as the meniscofemoral ligament.

(A)

Some basic concepts regarding the intra-articular structures in the knee

joint :
The cruciate ligaments help in the anteroposterior stability of the knee
joint. They are named by their attachments to the tibia. The posterior is
attached to the posterior side of the tibial plateau. Since the ligaments
cross each other (cruciate : cross-like), on the femur their attachments
are reversed.
They divide the knee joint into two prts, but incompletely.
The popliteus tendon is partly intra-articular, but is an independent
structure, as are the menisci.

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