JPJ - Questions submitted to MSK – August 2008

OBA 1

A patient who sustained injuries in a motorcycle accident found that he was not able to abduct or laterally rotate his arm on
the injured side. The clinical symptoms can be attributed to loss of innervation which of the following sets of muscles?

a. Deltoid, teres major and latissimus dorsi

b. Supraspinatus, deltoid and teres major
c. Deltoid, teres minor and supraspinatus
d. Pectoralis major, infraspinatus and teres major
e. Deltoid, teres minor and pectoralis major

Answer: c

OBA 2

Following a brutal assault by a criminal group, a University student was informed that his spinal cord was injured at the level
of the upper thoracic region. Which of the following nerves is most likely to be affected in injuries to the T1 segment of the
spinal cord?

a. Axillary nerve
b. Dorsal scapular nerve
c. Subcostal nerve
d. Suprascapular nerve
e. Ulnar nerve

Answer: e

OBA 3

A patient presented with progressive hollowing of the tip of the shoulder and was informed by his doctor that it was the
effect of a chronic nerve lesion. The most likely nerve to be involved is

a. Axillary nerve
b. Dorsal scapular nerve
c. Long thoracic nerve
d. Median nerve
e. Musculocutaneous nerve

Answer: a

OBA 4
A doctor examining a patient whose forearm remained in supination concluded that it was a result of loss of function of a
particular nerve. The nerve that has lost its function is most likely to be
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 a. Axillary nerve
b. Median nerve
c. Musculocutaneous nerve
d. Radial nerve
e. Ulnar nerve

Answer: b

OBA 5
The skin has a dual embryonic origin. Which of the following is a common developmental pattern shared by sebaceous
glands, sweat glands, mammary glands, hair follicles, and nails of the skin?

a. Development from neural crest cells

b. Derivation from mesenchyme
c. Differentiation influenced by steroids
d. Invagination of epidermal cells into the dermis
e. Development from neuroectoderm

Answer: d

OBA 6
A paediatrician examining a child observed that the child was not able to initiate abduction, but with a little assistance was
able to fully abduct the shoulder. Which of the following muscles was most likely injured in this case?

a. Deltoid
b. Supraspinatus
c. Trapezius
d. Serratus anterior
e. Infraspinatus

Answer: b

OBA 7
In the extended position, the knee becomes rigid and stable because the medial femoral condyle rides posteriorly and on
the tibial plateau, rotating the femur medially or the tibia laterally and achieving a configuration that effectively "locks" the
knee. The process of "unlocking" the knee in preparation for flexion requires initial contraction of the

a. Gastrocnemius, soleus, and plantaris muscles

b. Hamstring muscles
c. Popliteus muscle
d. Quadriceps femoris muscle
e. Sartorius muscle and short head of the biceps femoris muscle

Answer: c
OBA 8
In a patient, normal extension was observed at the elbow, but supination of the forearm was weak. The nerve lesion can be
localised to which of the following points?

a. Posterior cord of the brachial plexus in the axilla

b. Posterior division of brachial plexus
c. Radial nerve at distal third of humerus
d. Radial nerve in the mid forearm
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e. Radial nerve in vicinity of the head of the radius

Answer: c

OBA 9
The skeletal and connective tissue structures of the lower portion of the face and anterior neck are derived from neural crest
cells in the branchial arches. All the following structures are derived from the second branchial arch EXCEPT the

a. Lesser horn of the hyoid bone

b. Malleus
c. Stapes
d. Styloid process of the temporal bone
e. Stylohyoid ligament

Answer: b

OBA 10
Articulation of the talus with the malleoli and lower tibia forms the ankle, or talocrural, joint. Factors that contribute to the
stability of this joint include all the following EXCEPT the

a. Calcaneonavicular ligament
b. Deltoid ligament
c. Lateral ligament
d. Posterior tibiofibular ligament
e. Trapezoidal shape of the talar articular surface that is wider anteriorly than posteriorly

Answer: a

OBA 11
Extenstion of the wrist is caused by superficial and deep extensor muscles. The muscles of the deep extensor group of the
forearm arise from which of the following site/sites?

a. Medial epicondyle of the humerus and oblique line of the radius

b. Dorsal surfaces of the radius, ulna and interosseous membrane
c. Medial intermuscular septum and the distal end of the humerus
d. Lateral epicondyle of the humerus and the dorsal surface of the ulna
e. Posterior surface of the olecranon process of the humerus

Answer: b

OBA 12

Muscles of the anterior and posterior compartments of the forearm may be affected by compartment syndromes. Which of
the following is located in the posterior compartment of the forearm?

a. Abductor pollicis longus muscle

b. Flexor carpi ulnaris muscle
c. Common interosseous artery
f. Flexor digitorum profundus muscle
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g. Pronator quadratus muscle

Answer: a

OBA 13

Tennis elbow results from abrupt pronation during extension at the elbow. Which of the following ligaments are most likely
to be affected in this condition?

a. Annular ligament
b. Anterior ligament
c. Posterior ligament
d. Radial collateral ligament
e. Ulnar collateral ligament

Answer: d

OBA 14

An elderly lady sustained a fracture of the upper end of the femur after having slipped in the toilet. The doctors feared a
complication of avascular necrosis. Which of the following vessels is the main source of supply to the upper end of the
femur?

a. artery of the ligament of the head of the femur

b. inferior gluteal artery
c. medial femoral circumflex artery
d. superior gluteal artery
e. superficial iliac circumflex artery

Answer: c

OBA 15

The gluteus maximus which is the largest muscle in the body is often used as the site for intramuscular injections. Which of
the following statements accurately describes the gluteus maximus muscle?

a. it passes through the greater sciatic foramen

b. it inserts into the head of the femur
c. it is innervated by the superior gluteal nerve
d. it is the chief abductor of the hip joint
e. it arises partly from the sacrotuberous ligament

Answer: e

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OBA 16

Which of the following is the primary movement that occurs at the talocrural joint?

a. Inversion and eversion

b. Flexion and extension
c. Eversion and abduction
d. Inversion and adduction
e. Eversion and adduction

Answer: b

OBA 17

Which of the following muscles is a dorsiflexor of the foot?

a. Gastrocnemius
b. Soleus
c. Peroneus longus
d. Peroneus brevis
e. Peroneus tertius

Answer: e

OBA 18
The knee joint is frequently involved in injuries. Which of the following structures lies between the lateral meniscus and the
fibular collateral ligament?

a. Inferior genicular blood vessels

b. Anterior tibial artery
c. Popliteus tendon
d. Posterior meniscofemoral ligament
e. Biceps femoris tendon

Answer: c

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OBA 19

A brachial plexus injury resulted in a child’s hand showing a claw hand deformity. The doctor diagnosed it as a Klumpke’s
paralysis. Which of the following statements most accurately describes Klumpke’s paralysis?

a. It mainly involves T1 spinal segment

b. It mainly involves the junction of C5 and C6 roots.
c. The radial nerve is the main nerve affected
d. There is flexion at the metacarpophalangeal joints and extension at the interphalangeal joints
e. It results in wasting of the thenar muscles.

Answer: a

OBA 20

A student whose humerus was dislocated in a football match was informed that the lateral cord of the brachial plexus was
injured. Which of the following nerves is likely to be affected the most?

a. Axillary nerve
b. Radial nerve
c. Median nerve
d. Musculocutaneous nerve
e. Ulnar nerve

Answer: d

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EMQ 1
Theme: Nerves of the upper limb.

Options
A. Axillary nerve.
B. Long thoracic nerve.
C. Lower subscapular nerve.
D. Median nerve.
E. Musculocutaneous nerve.
F. Radial nerve.
G. Suprascapular nerve.
H. Thoracodorsal nerve.
I. Ulnar nerve.
J. Upper subscapular nerve.

For each statement described below, choose the SINGLE most appropriate choice from the above list of
options. Each option may be used once, more than once, or not at all.
Statements

1. Which is the nerve that innervates a muscle, the paralysis of which results in a condition called
‘winging of the scapula’ ?

2. Which is the nerve most likely to be affected if a patient presents with thenar muscle wasting?

3. A patient is unable to extend his elbow. What is the nerve that is most likely to have been affected?

4. What is the nerve that is most likely to be injured in inferior dislocations of the shoulder joint?
5. During a venepuncture in the cubital fossa, a trainee doctor accidentally injured a large nerve. Which
is the important nerve found medial to the brachial artery in the cubital fossa?

Answers:
1. B
2. D
3. F
4. A
5. D

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EMQ 2
Theme: Muscles related to the shoulder joint.
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 Options
A. Deltoid.
B. Infraspinatus
C. Latissimus dorsi.
D. Pectoralis major.
E. Serratus anterior.
F. Subscapularis.
G. Supraspinatus.
H. Teres major.
I. Teres minor.
J Trapezius.

For each statement described below, choose the SINGLE most appropriate muscle from the above list of
options. Each option may be used once, more than once, or not at all.
Statements

1. Supplied by the axillary nerve, this muscle is responsible for shoulder abduction until 90.

2. Inserted into the floor of the intertubercular sulcus, this broad muscle is supplied by the thoracodorsal
nerve.

3. This muscle may be affected by injuries to the C 5, 6,& 7 roots of the brachial plexus.

4. This muscle is supplied by a cranial nerve.

5. The principal action of this rotator cuff muscle is adduction and medial rotation of the humerus.

Answers:
1. A
2. C
3. E
4. J
5. F
[NEW – JPJ]

EMQ 3
Theme: Structures related to the knee joint.

Options
A. Anterior cruciate ligament
B. Arcuate popliteal ligament.
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 C. Coronary ligament.
D. Lateral collateral ligament.
E. Lateral meniscus.
F. Ligamentum patellae.
G. Medial collateral ligament.
H. Medial meniscus.
I. Posterior cruciate ligament.
J. Transverse ligament.

For each statement described below, choose the SINGLE most appropriate structure from the above list of
options. Each option may be used once, more than once, or not at all.
Statements

1. This structure may be damaged in a rotational strain during the flexion of the knee.

2. This structure may be torn in forced hyperextension of the knee.

3. This structure is attached to the tibial tuberosity.

4. This structure has an attachement to the popliteus tendon.

5. This structure is attached to the head of the fibula

Answers:
1. H
2. A
3. F
4. E
5. D

[NEW – JPJ]

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SAQ 1
1. Name TWO movements of the wrist and ONE principal muscle that produces each of those movements. (4 marks)

Flexion – FCU, FCR, PL FDS and FDP

Extension – ECU, ECRL, ECRB and ED
Adduction – ECU
Abduction – FCR, FCRL, FCRB, APL, EPB

2. Name the bone involved in a person who has suffered a “Colle’s fracture”. Where does the bone fracture and what is the
characteristic external appearance of the affected wrist? (3 marks)

Radius (lower end)

Transverse fracture at the lower end of the radius
Dinner fork deformity

3. Name the carpal bones that take part in the formation of the wrist joint. (3 marks)
Scaphoid
Lunate
Triquetral

[NEW – JPJ]

SAQ 2
1. Define “locking” of the knee joint. How is it brought about? (3 marks)

Locking of the knee joint permits standing upright with little expenditure of energy in the form of muscle
contraction. It is brought about by medial rotation of the femur on the tibia during final stages of extension. It
makes the ligaments taut which in turn maintain the joint in the stable (extended) position.

2. Name the muscle that unlocks the knee joint and the mechanism by which it does it. (3 marks)

Unlocking involves lateral rotation of the femur on the tibia. It is brought about by action of the popliteus muscle.
It arises from the lateral femoral condyle and inserts into the posterior part of the tibia. It pulls the lateral condyle
posteriorly thereby laterally rotating the femur. This loosens the tension on the collateral and cruciate ligaments.

3. Name THREE bursae related to the knee joint and ONE clinical condition involving any of them. (4 marks)
Prepatellar bursa
Suprapatellar bursa
Infrapatellar bursa
Semimebranosus bursa
Anserine bursa etc
(any three)

Baker’s cyst
Suprapatellar bursitis
Prepatellar bursitis
(any one)

[NEW – JPJ]

SAQ 3

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1. Define supination. Name the joint/s permitting this movement and name TWO muscles that produce supination.
(5 marks)

Supination is a rotary movement of the forearm around a vertical axis. In supination, the radius and ulna are
parallel to each other. In a semiflexed elbow, the palm is turned ventrally in supination.

Superior and inferior radioulnar joints.

Biceps brachii and Supinator

2. Write briefly on the superior radioulnar joint under the following headings: (5 marks)

a. Type (1 mark)
b. Articular surfaces (2 marks)
c. Ligaments (2 marks)

The superior radioulnar joint is a pivot type of synovial joint. The circumference of the head of the radius, the
osseofibrous ring formed by the radial notch of the ulna and the annular ligament form the articular surfaces. The
annular ligament and the quadrate ligament are two important ligaments of this joint.

[NEW – JPJ]

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OSPE 1

Provided: Model of the knee joint.

1. Identify the structure labelled A. Name the structures attached to its proximal and distal parts.
(3 marks)

A – Patella
Proximal – Quadriceps tendon
Distal – Ligamentum patellae

2. Identify the structure labelled B. Name the ligament which is anatomically attached to it and the clinical condition in
which it is torn / injured.
(3 marks)

B – Medial meniscus
Medial (tibial) collateral ligament
Bucket handle tear or injury

3. Identify the structure labelled C. Name its proximal and distal attachments. (3 marks)

C – Lateral (fibular) collateral ligament

Proximal attachment: Lateral epicondyle of femur
Distal attachment: Head of the fibula

4. Name the movement of the knee joint that makes structure D taut. (1 mark)

(D – Anterior cruciate ligament)

Extension of the knee joint

[NEW – JPJ]

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OSPE 2

Provided: Model of the elbow joint.

1. Identify the part of the bone labelled A. Name the muscle attached to it and its primary action.
(3 marks)

A – Coranoid process of the ulna

Muscle attached – Brachialis
Action – Flexion of the elbow

2. Identify the part of the bone labelled B. Name the muscle attached to it and its primary action.
(3 marks)

B – Olecranon process of the ulna

Muscle attached – Triceps brachii
Action – Extension of the elbow

3. Name the ligament labelled C. Name its proximal and distal attachments. (3 marks)

C – Ulnar collateral ligament

Medial epicondyle of the humerus
Coranoid process of the ulna

4. Name the type of joint that the elbow belongs to. (1 mark)

Synovial joint, hinge variety

[NEW – JPJ]

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