Variations.—The origin is frequently moved up or down one or two vertebrae. Accessory slips are occasionally found. Nerves

• 
  trapezius muscle
  
• 
  latissimus dorsi muscle
  
• 
  rhomboid major muscle
  
• 
  levator scapulae muscle
  
• 
  serratus posterior interior muscle
  
• 
  serratus posterior superior muscle
  
• 
  erector spinae muscle
  

• 
  adductor canal
  
• 
  popliteal space
  
• 
  superior extensor retinaculum
  
• 
  superior extensor retinaculum
  
• 
  flexor retinaculum
  
• 
  superior fibular retinakulum
  
• 
  inferior extensor retinaculum
  
• 
  plantar aponevrosis
  

____________ -> prime mover of back extension; consists of 3 muscle columns

____________ -> the major spine flexor; runs vertically in front of the abdomen

____________ -> prime mover for shoulder abduction

____________ -> a single muscle below the lungs that assists with breathing

____________ -> insertion point for the pectoralis major and latissimus dorsi

____________ -> kite-shaped muscle of the upper back that raises the shoulder

____________ -> pair of deep muscles that pull the scapula to the vertebrae

____________ -> origin of both the trapezius and the latissimus dorsi

____________ -> the most external muscle on the lateral wall of the abdomen

____________ -> prime mover for shoulder flexion and adduction
Arm Muscles

____________ -> attaches to the anterior side of the hand

____________ -> twists the forearm bones so that the palm is face down

____________ -> muscle on the upper arm beneath the biceps

____________ -> prime movers when you bend the fingers to make a fist

____________ -> twists the forearm bones so that the palm is face up

____________ -> straightens out the index finger

____________ -> flexes the elbow

____________ -> extends the elbow

____________ -> found on the anterior side of the forearm

____________ -> pulls the thumb back
Leg Muscles

The ________ is superior to the gluteus maximus and is used as an injection site.

________________ is the group of 4 muscles on the anterior portion of the thigh.

________________ is the group of 3 muscles on the posterior portion of the thigh.

The __________________ is a thin, superficial muscle of the medial thigh.

The _______________ is located deep with respect to the rectus femoris.

The ____________ is located on the back of the lower leg.

II. Tests on basic theory

Exercises:

1. 
   A thyroid mass usually moves with swallowing because the thyroid gland is enclosed by which of the following fascia?
   
   1. 
      Carotid sheath
      
   2. 
      Investing layer of the deep cervical fascia
      
   3. 
      Pretracheal fascia
      
   4. 
      Prevertebral fascia
      
   5. 
      Superficial fascia
      

The correct answer is C. The pretracheal layer of the cervical fascia runs from the investing layers in both sides of the lateral neck and splits to enclose the thyroid gland. Superiorly, it attaches to the laryngeal cartilages; inferiorly, it fuses with the pericardium. As a result of these connections, the thyroid gland moves with laryngeal movements.

The carotid sheath (choice A) contains the vagus nerve, internal jugular vein, carotid artery, and lymph nodes.

The investing layer of the deep cervical fascia (choice B) splits to enclose the trapezius and sternocleidomastoid muscles.

The prevertebral fascia (choice D) covers muscles arising from the vertebrae.

The superficial fascia (choice E) is immediately deep to the platysma muscle.

2. 
   A 61-year-old Cambodian immigrant is diagnosed with spinal tuberculosis. The man develops a flocculent, red, tender bulge on one flank, with a similar bulge in the groin on the same side. This presentation is likely due to spread of infection along the fascia of a muscle with which of the following actions at the hip?
   
   1. 
      Abduction
      
   2. 
      Adduction
      
   3. 
      Extension
      
   4. 
      Flexion
      
   5. 
      Internal rotation
      

The correct answer is D. The muscle involved is the psoas major. The abscess in the groin is called a "psoas abscess," because it occurs after a spinal infection (classically tuberculosis) spreads along the psoas sheath. The principal action of the psoas muscle is to flex the thigh at the hip. It also has minimal action in external rotation of the hip.

Abductors (choice A) of the hip include the gluteus medius and gluteus maximus.

Adductors (choice B) of the hip include the adductors longus, brevis, and magnus.

Extensors (choice C) of the hip include gluteus maximus.

Internal (medial) rotators (choice E) of the hip include gluteus minimus, pectineus, and gracilis.

3. 
   A physician asks a patient to hold her right upper arm close to her lateral chest wall, and bend the arm at the elbow so that the palm is facing upward. The physician then directs the patient to turn her hand so that the palm faces downward, without bending her wrist. This maneuver causes discomfort to the patient, which the physician notes as pain on
   
   1. 
      abduction of the forearm
      
   2. 
      adduction of the forearm
      
   3. 
      flexion of the forearm
      
   4. 
      pronation of the forearm
      
   5. 
      supination of the forearm
      

The correct answer is D. When the forearm is rotated from anatomic position so that the palm faces posteriorly, the forearm is said to be pronated.

Abduction (choice A) raises the arm to a horizontal position away from the body; adduction (choice B) is the reverse.

Flexion (choice C) brings the arm or forearm forward, in front of the plane of the body.

Rotation of the forearm so that the palm faces forward (i.e., into anatomic position) is

referred to as supination (choice E).

4. 
   A 43-year-old man presents complaining of pain in the groin. On examination, his physician palpates a bulge in the region of the superficial inguinal ring, which he diagnoses as a direct inguinal hernia. The hernial sac most likely
   
   1. 
      is covered by all three layers of the spermatic fascia
      
   2. 
      passes medial to the inferior epigastric artery
      
   3. 
      passes medial to the lateral border of the rectus abdominis muscle
      
   4. 
      passes posterior to the inguinal ligament
      
   5. 
      passes through the deep inguinal ring
      

The correct answer is B. Direct inguinal hernias enter the inguinal canal by tearing through the posterior wall of that structure. The typical location for this type of hernia is through the inguinal triangle, bounded laterally by the inferior epigastric artery, medially by the lateral border of the rectus abdominis, and inferiorly by the inguinal ligament. Direct inguinal hernias pass medial to the inferior epigastric artery, whereas indirect inguinal hernias pass lateral to the inferior epigastric artery because the deep inguinal ring is lateral to the artery.

Indirect inguinal hernias are covered by all three layers of the spermatic fascia (choice A). Direct inguinal hernias are covered by fewer than all three layers because the direct inguinal hernia tears through one or more layers of fascia as it emerges though the abdominal wall.

The lateral border of the rectus abdominis muscle (choice C) forms the medial border of the inguinal triangle. All inguinal hernias pass lateral to the rectus abdominis.

Femoral hernias pass posterior to the inguinal ligament (choice D). Inguinal hernias emerge through the superficial inguinal ring, which is superior to the inguinal ligament. Inguina hernias that descend below the inguinal ligament pass anterior to the ligament.

Indirect inguinal hernias pass through the deep inguinal ring (choice E); direct inguinal hernias do not. Both types of inguinal hernias pass through the superficial inguinal ring.

5. 
   To evaluate hypoglossal nerve function, a neurologist asks her patient to protrude his tongue. On doing so, his tongue deviates to the right side. This finding results from paralysis of which of the following muscles?
   
   1. 
      Left genioglossus
      
   2. 
      Left hyoglossus
      
   3. 
      Left palatoglossus
      
   4. 
      Right genioglossus
      
   5. 
      Right hyoglossus
      
   6. 
      Right palatoglossus
      

The correct answer is D. The genioglossus muscle is innervated by the hypoglossal nerve. The function of the genioglossus muscle is to pull the tongue forward (protrude) and toward the opposite side. When the right genioglossus muscle is paralyzed, the left genioglossus muscle pulls the tongue forward and to the right.

If the left genioglossus muscle were paralyzed (choice A), the tongue would deviate toward the left on protrusion because of the unopposed action of the right genioglossus muscle. The left genioglossus muscle is innervated by the left hypoglossal nerve.

The hyoglossus muscles (choices B and E) are innervated by the hypoglossal nerves. The function of these muscles is to retract the tongue. These muscles are not active during protrusion of the tongue.

The palatoglossus muscles (choices C and F) are innervated by the vagus nerves, rather than the hypoglossal nerves. Their function is to pull the tongue back (retract) and upward toward the palate.

6. 
   A 51-year-old supermarket cashier begins to have difficulty working, sometimes ringing up the wrong amount because her right hand feels "weak." She also notes that her right hand sometimes feels numb after working for long periods of time. Physical examination reveals loss of sensation on the palmar aspect of her thumb and first two fingers, as well as atrophy of the thenar eminence on her right hand. The nerve most likely injured in this patient also innervates which of the following muscles?
   
   1. 
      Adductor pollicis
      
   2. 
      Extensor digitorum
      
   3. 
      Extensor pollicis longus
      
   4. 
      Flexor carpi ulnaris
      
   5. 
      Flexor digitorum superficialis
      

The correct answer is E. The nerve is the median nerve, which can be damaged by repetitive minor trauma (e.g., typing or using a cash register) as it passes under the flexor retinaculum. Inflammation causes tissue swelling, producing "carpal tunnel syndrome," and entrapping the nerve. The median nerve supplies sensation to the anterior forearm and the palmar aspect of the thumb and adjacent 2-and-one-half fingers. It supplies motor function to all of the anterior forearm muscles (including the flexor digitorum superficialis) except the flexor carpi ulnaris (supplied by the ulnar nerve) and one half of the flexor digitorum profundus (supplied by the ulnar nerve). The median nerve also supplies the thenar muscles and the lateral lumbricals.

The adductor pollicis (choice A) is supplied by the ulnar nerve.

The extensors digitorum (choice B) are supplied by the radial nerve.

The extensor pollicis longus (choice C) is supplied by the radial nerve.

The flexor carpi ulnaris (choice D) is supplied by the ulnar nerve.

7. 
   A hunter got his foot caught in a bear trap. The emergency room physician evaluating the patient notes that a tendon that inserts onto the plantar surface of the base of the distal 3rd phalanx has been severed. The patient is no longer able to plantar flex that toe. This tendon arises from a muscle that originates from which of the following structures?
   
   1. 
      Distal 1/3 of the anterior surface of the fibula
      
   2. 
      Distal 2/3 of the lateral surface of the fibula
      
   3. 
      Head and proximal 2/3 of the lateral surface of the fibula
      
   4. 
      Middle 1/2 of the anterior surface of the fibula
      
   5. 
      Posterior surface of the middle 3/5 of tibia
      

The correct answer is E. The muscle is the flexor digitorum longus. This muscle arises from the posterior surface of the middle 3/5 of the tibia, passes under the medial aspect of the ankle, and forms four tendons in the sole of the foot that insert into the bases of the distal phalanges of the 2nd-5th toes. This muscle acts to flex the toes and foot, and to invert the foot at the ankle.

Choice A describes the origin of peroneus tertius. This muscle acts to extend the foot at the ankle joint, and evert the foot at the subtalar and transverse tarsal joints.

Choice B describes the origin of peroneus brevis. This muscle acts to plantar flex the foot at the ankle joint, and evert the foot at the subtalar and transverse tarsal joints.

Choice C describes the origin of peroneus longus. This muscle acts to plantar flex the foot at the ankle joint, and evert the foot at the subtalar and transverse tarsal joints.

Choice D describes the origin of extensor hallucis longus. This muscle acts to extend the great toe and extend the foot at the ankle.

8. 
   One week following a sexual encounter at a ski resort in Colorado, a young woman develops a painful, swollen knee joint. The emergency room doctor suspects gonococcal arthritis and wants to confirm this by sending joint fluid for bacterial culture. He uses the standard suprapatellar approach and passes a needle from the lateral aspect of the thigh into the region immediately proximal to the patella. Through which of the following muscles does the needle pass?
   
   1. 
      Adductor magnus
      
   2. 
      Gracilis
      
   3. 
      Iliacus
      
   4. 
      Sartorius
      
   5. 
      Vastus lateralis
      

The correct answer is E. This route passes through the vastus lateralis to penetrate the knee joint via the suprapatellar bursa, allowing aspiration of joint fluid for culture. The vastus lateralis, together with the vastus medialis, vastus intermedius and rectus femoris, form the quadriceps muscle.

The adductor magnus (choice A) is on the inner and anterior aspect of the upper thigh.

The gracilis (choice B) is on the inner aspect of the thigh.

The iliacus (choice C) is on the lateral, proximal aspect of the thigh.

The sartorius (choice D) passes diagonally from the lateral hip to the medial knee.

9. 
   An inflammatory process in the temporal bone has resulted in a swelling of the facial nerve within the facial canal. Which muscle may be paralyzed as a result of this compression?
   
   1. 
      Anterior belly of the digastric
      
   2. 
      Geniohyoid
      
   3. 
      Stapedius
      
   4. 
      Stylopharyngeus
      
   5. 
      Masseter
      

The correct answer is C. The stapedius muscle is innervated by the facial nerve. This muscle is located in the middle ear and attaches to the neck of the stapes. Contraction of the stapedius reduces the amplitude of oscillation of the stapes and thus reduces the perceived loudness of a sound. Paralysis of this muscle may result in hyperacusis.

The anterior belly of the digastric muscle (choice A) is a muscle in the floor of the mouth that is innervated by the mandibular division of the trigeminal nerve.

The geniohyoid muscle (choice B) is one of the suprahyoid muscles in the neck. This muscle is innervated by C1 spinal nerve fibers that travel for a short distance with the hypoglossal nerve.

The stylopharyngeus muscle (choice D) is one of the longitudinal muscles of the pharynx that acts to elevate the pharynx. It is innervated by the glossopharyngeal nerve.

The masseter muscle (choice E) is one of the muscles of mastication. All of the muscles of mastication are innervated by the mandibular division of the trigeminal nerve.

10. 
    A 68-year-old hypertensive man suffers a small stroke and is hospitalized. After discharge, he is seen by a neurologist. On physical examination, the man is unable to touch the tip of his tongue to the roof of his mouth. Dysfunction of which of the following muscles would be most likely to produce this result?
    
    1. 
       Buccinator
       
    2. 
       Geniohyoid
       
    3. 
       Palatoglossus
       
    4. 
       Palatopharyngeus
       
    5. 
       Tensor palati
       

The correct answer is C. Elevation of the tongue is carried out by the styloglossus (innervated by the hypoglossal nerve, CN XII) and the palatoglossus (innervated by the pharyngeal plexus).

The buccinator (choice A) functions in storing, filling, and emptying the vestibule.

The geniohyoid (choice B) moves the hyoid anteriorly to open the pharynx.

The palatopharyngeus (choice D) produces a "stripping wave" on the posterior pharyngeal wall.

The tensor palati (choice E) tenses the soft palate.

11. 
    A 24-year-old construction worker presents to his physician after an injury on the job. Physical examination is remarkable for marked flexion of the ring and little fingers of the left hand. Which of the following additional findings would most likely be found on physical examination?
    
    1. 
       Loss of sensation on the back of the thumb
       
    2. 
       Loss of sensation on the palmar side of the forefinger
       
    3. 
       Wasting of the dorsal interosseous muscles
       
    4. 
       Wasting of the thenar eminence
       
    5. 
       Wrist drop
       

The correct answer is C. Clawing of the ring, forefinger and little fingers is characteristic of an ulnar nerve lesion. Ulnar nerve lesions can also produce wasting of the hypothenar eminence and dorsal interosseous muscles. The latter causes "guttering" between the extensor tendons on the back of the hand. Ulnar lesions also cause loss of sensation to the back of the little finger and half of the ring finger.

Sensation on the back of the thumb (choice A) is provided by the radial nerve.

Sensation on the palmar side of the forefinger (choice B) is provided by the median nerve.

Wasting of the thenar eminence (choice D) is associated with lesions of the median nerve.

"Wrist drop" (choice E) is associated with lesions of the radial nerve.

1. 
   All of the following muscles take origin from the lateral epicondyle of the humerus, EXCEPT:
   
   1. 
      extensor digitorum
      
   2. 
      *extensor digiti minimi
      
   3. 
      extensor carpi ulnaris
      
   4. 
      extensor carpi radialis brevis
      
   5. 
      extensor carpi radialis longus
      
2. 
   The following muscles originate within the pelvis, EXCEPT:
   
   1. 
      piriformis
      
   2. 
      obturator internus
      
   3. 
      iliacus
      
   4. 
      *sphincter urethrae
      
   5. 
      coccygeus
      
3. 
   Structures contained within the submandibular triangle include all of the following, EXCEPT:
   
   1. 
      lingual N
      
   2. 
      *common carotid A
      
   3. 
      facial A
      
   4. 
      submandibular gland
      
   5. 
      hypoglossal N
      
4. 
   All of the following attach to the atlas, EXCEPT:
   
   1. 
      levator scapulae M
      
   2. 
      obliquus capitis inferior M
      
   3. 
      rectus capitis posterior minor M
      
   4. 
      rectus capitis anterior M
      
   5. 
      *scalenus posterior M
      
5. 
   Which muscle is not a medial rotator of the arm?
   
   1. 
      pectoralis major
      
   2. 
      latissimus dorsi
      
   3. 
      subscapularis
      
   4. 
      deltoid
      
   5. 
      *supraspinatus
      
6. 
   Which of the following statements is true for the pectoralis major muscle?
   
   1. 
      arises from the humerus
      
   2. 
      inserts into the bony ribs
      
   3. 
      abducts the arm
      
   4. 
      innervated by the median nerve
      
   5. 
      *none of the above
      
7. 
   All of the following muscles extend the wrist, EXCEPT:
   
   1. 
      extensor carpi radialis longus
      
   2. 
      extensor carpi radialis brevis
      
   3. 
      extensor carpi ulnaris
      
   4. 
      extensor digitorum
      
   5. 
      *brachioradialis
      
8. 
   A radiograph of a young child shows a fracture of the clavicle at the junction of the lateral and middle thirds. The medial and lateral fragments are tilted upward and downward, respectively. Upward displacement of the medial half is caused by which of the following muscles?
   
   1. 
      deltoid
      
   2. 
      trapezius
      
   3. 
      subclavius
      
   4. 
      *sternocleidomastoid
      
   5. 
      pectoralis major
      
9. 
   All the following are true concerning the adductor canal, EXCEPT:
   
   1. 
      it begins at the apex of the femoral triangle
      
   2. 
      it is bounded by the sartorius M. anteriorly
      
   3. 
      it is bounded by the vastus medialis M. laterally
      
   4. 
      it is bounded by the adductor longus M. medially
      
   5. 
      *it transmits only structures found within the femoral sheath
      
10. 
    Arrange the following structures of the plantar surface of the foot from superficial to deep.
    

1. 
   adductor hallucis M. (transverse head)
   
2. 
   plantar aponeurosis
   
3. 
   interossei muscles
   
4. 
   abductor hallucis M.
   
5. 
   quadratus plantae M.
   

1. 
   2-5-4-3-1
   
2. 
   *2-4-5-1-3
   
3. 
   5-2-4-1-3
   
4. 
   4-2-5-3-1
   
5. 
   5-2-4-3-2
   
1. 
   All the following muscles have an insertion on the radius, EXCEPT:
   
   1. 
      supinator
      
   2. 
      pronator quadratus
      
   3. 
      pronator teres
      
   4. 
      biceps brachii
      
   5. 
      *brachialis
      
2. 
   A patient is found to have pus in the midpalmar space. The space is
   
   1. 
      the space around the hypothenar muscles
      
   2. 
      the space around the thenar muscles
      
   3. 
      the synovial sheath for the flexor pollicis longus tendon
      
   4. 
      the ulnar bursa
      
   5. 
      *a space lying medial to a fibrous septum attaching the palmar
      
   6. 
      aponeurosis to the third metacarpal bone
      
3. 
   All of the following muscles are attached to the medial border of the scapula,EXCEPT:
   
   1. 
      *levator scapulae
      
   2. 
      rhomboideus major
      
   3. 
      teres major
      
   4. 
      serratus anterior
      
   5. 
      rhomboideus minor
      
4. 
   Based on their bony attachments, all the following back muscles are part of a transverse-spinalis group, EXCEPT:
   
   1. 
      multifidi
      
   2. 
      rotatores
      
   3. 
      semispinalis cervicis
      
   4. 
      obliquus capitis inferior
      
   5. 
      *splenius capitis
      
5. 
   Which statement is true about the scapula?
   
   1. 
      The root of the spine (spina scapulae) is located at T-5 vertebral level.
      
   2. 
      The superior angle is located at T-1 vertebral level.
      
   3. 
      *The suprascapular artery passes through the scapular notch below the superior transverse scapular ligament.
      
   4. 
      The infraglenoid tubercle is a point of attachment for the long head of the biceps M.
      
   5. 
      The subscapular fossa is on the dorsal surface.
      
6. 
   Which muscle is not a contributor to the "rotator" cuff of the shoulder?
   
   1. 
      teres major
      
   2. 
      teres minor
      
   3. 
      infraspinatus
      
   4. 
      *supraspinatus
      
   5. 
      subscapularis
      
7. 
   The distal phalanx of the middle finger is flexed by:
   
   1. 
      lumbrical
      
   2. 
      dorsal interosseous
      
   3. 
      flexor digitorum superficialis
      
   4. 
      *flexor digitorum profundus
      
   5. 
      palmar interosseous
      
8. 
   All the following muscles have their origin from the spinous processes of the cervical vertebrae, EXCEPT:
   
   1. 
      rectus capitis posterior major
      
   2. 
      splenius capitis
      
   3. 
      *obliquus capitis superior
      
   4. 
      obliquus capitis inferior
      
   5. 
      splenius cervicis
      
9. 
   The muscle attached to the whole length of the caudal (inferior) lip of the scapular spine is the:
   
   1. 
      trapezius
      
   2. 
      serratus anterior
      
   3. 
      rhomboideus major
      
   4. 
      *deltoid
      
   5. 
      infraspinatus
      
10. 
    All of the following muscles act across two or more joints EXCEPT:
    
    1. 
       long head of triceps brachii
       
    2. 
       biceps brachii
       
    3. 
       flexor carpi radialis
       
    4. 
       *brachioradialis
       
    5. 
       flexor carpi ulnaris
       
11. 
    All of the following muscles originate, at least in part, from the medial epicondyle of the humerus, EXCEPT:
    
    1. 
       flexor carpi ulnaris
       
    2. 
       flexor digitorum superficialis
       
    3. 
       *flexor pollicis longus
       
    4. 
       pronator teres
       
    5. 
       flexor carpi radalis
       
12. 
    All of the following statements about the diaphragm are correct EXCEPT:
    
    1. 
       The crura attach to bodies of lumbar vertebrae.
       
    2. 
       *The azygos vein passes through the esophageal opening.
       
    3. 
       The medial arcuate ligament bridges the psoas major M.
       
    4. 
       The inferior phrenic arteries are branches of the abdominal aorta.
       
    5. 
       Venous drainage is into the inferior vena cava, internal thoracic, and azygos veins.
       
13. 
    All of the following muscle(s) attach to the calcaneus, EXCEPT:
    
    1. 
       extensor digitorium brevis M.
       
    2. 
       flexor digitorium brevis M.
       
    3. 
       *flexor hallucis brevis M.
       
    4. 
       quadratus plantae M.
       
    5. 
       abductor hallicus M.
       
14. 
    The most anterior of the tendons passing behind the medial malleolus at the ankle is the:
    
    1. 
       tibialis anterior
       
    2. 
       *tibialis posterior
       
    3. 
       flexor digitorum longus
       
    4. 
       flexor hallucis longus
       
    5. 
       extensor hallucis longus
       
15. 
    Agenesis of which muscle is often associated with major clinical anomalies:
    
    1. 
       plantaris
       
    2. 
       psoas minor
       
    3. 
       *pectoralis major
       
    4. 
       palmaris longus
       
    5. 
       adductor minimus (thigh)
       
16. 
    Which of the following is TRUE of the flexor reticulum?
    
    1. 
       it is attached to the medial malleolus and the calcaneus
       
    2. 
       the deep peroneal nerve travels deep to the reticulum and posterior to the tendon of the flexor hallicus longus muscle
       
    3. 
       the tendon of the tibialis posterior lies deep to it
       
    4. 
       *a and c
       
    5. 
       a, b, and c
       
17. 
    The tendon of the peroneus longus muscle lies between bone and
    
    1. 
       transverse head of the adductor hallucis muscle
       
    2. 
       flexor digitorum brevis muscle .
       
    3. 
       long plantar ligament
       
    4. 
       short plantar ligament
       
    5. 
       *b and c
       
18. 
    All of the following muscles insert on the humerus EXCEPT:
    
    1. 
       pectoralis major muscle
       
    2. 
       latissimus dorsi muscle
       
    3. 
       *c. brachialis muscle
       
    4. 
       deltoid muscle
       
    5. 
       supraspinatus muscle
       
19. 
    Which of the following are involved in the shoulder joint and its movement?
    
    1. 
       tendon of the long head of the biceps brachii tendon
       
    2. 
       subscapularis muscle
       
    3. 
       C. coracohumeral ligament
       
    4. 
       infraspinatus muscle
       
    5. 
       *all of the above
       
20. 
    The digastric muscle:
    
    1. 
       *has a dual innervation
       
    2. 
       bounds the muscular triangle in the neck
       
    3. 
       arises from the mastoid process and the mandible
       
    4. 
       is attached to the thyroid cartilage via an intermediate tendon
       
    5. 
       none of the above
       
21. 
    The buccinator muscle:
    
    1. 
       is pierced by the buccal nerve
       
    2. 
       is supplied by the facial nerve
       
    3. 
       is covered by mucosa innervated by branches of the mandibular nerve
       
    4. 
       has origin from the pterygomandibular raphe
       
    5. 
       *all of the above are true
       
22. 
    Which of the following muscles does NOT contribute directly to the stability of the knee joint?
    
    1. 
       *soleus muscle
       
    2. 
       semimembranosus muscle
       
    3. 
       sartorius muscle
       
    4. 
       biceps femoris muscle
       
    5. 
       gastrocnemius muscle
       
23. 
    The quadratus plantae and the lumbrical muscles are associated with the:
    
    1. 
       abductor hallucis
       
    2. 
       flexor digitorum brevis
       
    3. 
       *c. flexor digitorum longus
       
    4. 
       flexor hallucis longus
       
    5. 
       flexor hallucis brevis
       
24. 
    The first plantar interosseous muscle acts on the:
    
    1. 
       1 st toe
       
    2. 
       2nd toe
       
    3. 
       *3rd toe
       
    4. 
       4th toe
       
    5. 
       5th toe
       
25. 
    The deep muscles of the back:
    

1. 
   are innervated segmentally by dorsal primary rami
   
2. 
   extend, laterally flex and rotate the spine
   
3. 
   vary in length from one to many spinal segments
   
4. 
   have some attachments to the scapula
   

1. 
   *1, 2 and 3 are correct
   
2. 
   1 and 3 are correct
   
3. 
   2 and 4 are correct
   
4. 
   4 is correct
   
5. 
   all are correct
   
1. 
   The scalenus anterior muscle:
   
   1. 
      lies anterior to the roots of the brachial plexus
      
   2. 
      lies anterior to the subclavian artery
      
   3. 
      is located immediately posterior to the phrenic nerve
      
   4. 
      separates the subclavian artery from the subclavian vein
      
   5. 
      *all of the above are correct
      
2. 
   Although most dislocations of the shoulder joint are inferior, the muscle in the best position to protect against inferior dislocation is the
   
   1. 
      coracobrachiali
      
   2. 
      infraspinatus
      
   3. 
      *long head of the triceps
      
   4. 
      pectoralis minor
      
   5. 
      teres minor
      
3. 
   The anterolateral muscles of the abdominal wall are NOT prime movers during
   
   1. 
      defecation
      
   2. 
      expiration
      
   3. 
      *inspiration
      
   4. 
      micturition
      
   5. 
      parturition
      
4. 
   Choose the most appropriate answer concerning statements I and 2.
   
   1. 
      *statement I is true only
      
   2. 
      statement 2 is true only
      
   3. 
      statement I and 2 are true
      
   4. 
      statement I and 2 are false
      

Statement 2: Layers of a direct hernia include peritoneum, internal spermatic fascia, cremaster muscle

40. 
    All the following pass through the-pelvic inlet EXCEPT the
    
    1. 
       abnormal obturator artery
       
    2. 
       ductus deferens
       
    3. 
       obturator nerve
       
    4. 
       round ligament of the uterus
       
    5. 
       *e. psoas major muscle
       
41. 
    The most powerful flexor of the thigh is
    
    1. 
       sartorius
       
    2. 
       pectineus
       
    3. 
       *iliopsoas
       
    4. 
       rectus femoris
       
    5. 
       tensor fascia lata
       
42. 
    The safest place to give an intramuscular injection into the gluteal region is in the
    
    1. 
       inferolateral quadrant
       
    2. 
       inferomedial quadrant
       
    3. 
       *superolateral quadrant
       
    4. 
       superomedial quadrant
       
43. 
    Which of the following muscles does NOT contribute directly to the stability of the knee joint?
    
    1. 
       *soleus muscle
       
    2. 
       semimembranosus muscle
       
    3. 
       sartorius muscle
       
    4. 
       biceps femoris muscle
       
    5. 
       gastrocnemius muscle
       
44. 
    Posterior percutaneous renal biopsy is an accepted method to obtain renal tissue for diagnosis. On the posterior surface of either kidney choose the correct structural relationships from lateral to medial edges:
    
    1. 
       quadratus lumborum > psoas major> transversus abdominus
       
    2. 
       psoas major > transversus abdominus > quadratus lumborum
       
    3. 
       transversus abdominus > psoas major > quadratus lumborum
       
    4. 
       *transversus abdominus > quadratus lumborum > psoas major
       
    5. 
       none of the above relationship sequences are correct
       
45. 
    The trapezius muscle
    
    1. 
       *a. originates from the occipital bone and spinous processes
       
    2. 
       b. is innervated by the thoracodorsal nerve
       
    3. 
       inserts on the ligamentum nuchae
       
    4. 
       is supplied by the ascending cervical artery
       
    5. 
       all of the above are true
       
46. 
    The tibialis anterior muscle
    
    1. 
       *arises from the anterolateral aspect of the tibia
       
    2. 
       is innervated by the superficial peroneal nerve
       
    3. 
       everts the foot
       
    4. 
       a and b
       
    5. 
       a, b, and c
       
47. 
    Forming the musculotendinous "sling" of the arch are the:
    
    1. 
       tendons of peroneus brevis and tertius and tibialis anterior and posterior
       
    2. 
       b tendons of tibialis anterior and peroneus longus
       
    3. 
       *c tendons of tibialis posterior and peroneus brevis
       
    4. 
       tendon of tibialis anterior, the "spring" ligament and quadratus plantae
       
    5. 
       long plantar ligament and the anterior and posterior tibialis tendons
       
48. 
    AU of the following muscles insert on the humerus EXCEPT:
    
    1. 
       pectoralis major muscle
       
    2. 
       latissimus dorsi muscle
       
    3. 
       *brachialis muscle
       
    4. 
       deltoid muscle
       
    5. 
       supraspinatus muscle
       
49. 
    In a patient with no palmaris longus muscle, the median nerve can be located just above the wrist by palpating the area between the flexor carpi radialis and the tendon of the flexor digitorum superficialis muscle to the:
    
    1. 
       index finger
       
    2. 
       little finger
       
    3. 
       *middle finger
       
    4. 
       ring finger
       
50. 
    An infection deep to the dorsal tendon plate of the extensor digitorum will spread to the dorsal antebrachial osteofascial compartment through the:
    
    1. 
       1st compartment of the extensor retinaculum
       
    2. 
       2nd compartment of the extensor retinaculum
       
    3. 
       3rd compartment of the extensor retinaculum
       
    4. 
       *4th compartment of the extensor retinaculum
       
    5. 
       5th compartment of the extensor retinaculum
       
51. 
    Depression of the jaw (opening the mouth) is accomplished by contraction of which of the following muscles?
    
    1. 
       lateral pterygoids
       
    2. 
       *geniohyoids
       
    3. 
       mylohyoid
       
    4. 
       digastrics
       
    5. 
       all of the above
       

1. 
   Young man felt sharp pain in the back during active tightening on the horizontal bar. Objectively: pain while moving of upper extremity, limited pronation and adduction functions. Sprain of what muscle is presented?
   
   1. 
      *М. latissimus dorsi
      
   2. 
      М. romboideus major
      
   3. 
      М. levator scapulae
      
   4. 
      М. trapezius
      
   5. 
      М. subscapularis
      
2. 
   A 45-year-old man applied to the trauma unit because of domestic shoulder trauma. Objectively: flexibility, reduction and pronation functions of the shoulder are absent. What muscle was injured?
   
   1. 
      *Teres major muscle
      
   2. 
      Supraspinous muscle
      
   3. 
      Infraspinous muscle
      
   4. 
      Teres minor muscle
      
   5. 
      Subscapular muscle
      
3. 
   A 7-year-old child can't abduct the arm, raise it to the horizontal level. He can raise the hand to the face only with dorsal side with abduction of the arm (with help of supraspinous muscle ) - "bugler" arm. Active function of what muscle is absent?
   
   1. 
      Teres major
      
   2. 
      *Deltoid
      
   3. 
      Infraspinous
      
   4. 
      Teres minor
      
   5. 
      Pectoral major
      
4. 
   A 45-year-old man with domestic apper arm injuiry applied to the trauma unit. The objective data are: no extension, adduction and pronation functions of the arm. What muscle damage caused this condition?
   
   1. 
      Teres minor
      
   2. 
      Subspinous
      
   3. 
      Subscapular
      
   4. 
      Supraspinous
      
   5. 
      *Teres major
      
5. 
   A 55-year-old patien was hospitalized in result of the trauma of the medial group of femoral muscles. What kind of movements is the patient unable to do?
   
   1. 
      Flexion of femur
      
   2. 
      Abduction of femur
      
   3. 
      Extension of femur
      
   4. 
      Suppination of femur
      
   5. 
      *Adduction of femur
      
6. 
   A physician examined a patient and found inguinal hernia. Through what anatomic formation does it penetrate into the skin?
   
   1. 
      Anulus femoralis
      
   2. 
      Canalis adductorius
      
   3. 
      Lacuna musculorum
      
   4. 
      Hiatus saphenus
      
   5. 
      *Anulus inguinalis superficialis
      
7. 
   A patient was admitted to an intensive therapy department with heavy poisoning. To provide holiatry it is necessary to catheterize the patient and inject medicines into subclavian vein. In what topographical place is it localized?
   
   1. 
      Spatium interscalenum.
      
   2. 
      *Spatium anterscalenum.
      
   3. 
      Spatium retrosternocleidomastoideus.
      
   4. 
      Spatium interaponeuroticum suprasternale.
      
   5. 
      Trigonum omotrapezoideum.
      
8. 
   Little finger felon was complicated by the phlegmon of hand and forearm. Purulent process has spread over:
   
   1. 
      *Vagina communis tendinum mus culorum flexorum.
      
   2. 
      Vagina tendinis musculi flexoris pollicis longi.
      
   3. 
      Canalis carpalis.
      
   4. 
      Vagina tendinis musculi flexoris carpi radialis.
      
   5. 
      Interfascial compartments.
      
9. 
   During physical training a 15-year-old pupil felt pain in the hip joint area after the lower extremity internal rotation. Traumatologist detected an injury of a muscle tendon. What muscle is it?
   
   1. 
      M. piriformis.
      
   2. 
      M. obturatorius internus.
      
   3. 
      M. obturatorius externus.
      
   4. 
      *M. gluteus medius.
      
   5. 
      M. quadratus femoris.
      
10. 
    A man, 30 years old, appealed to a dentist complaining of mastication disorder: painful backward movement of the mandible. The doctor detected the inflammation of a masticatory muscle. Which muscle exactly is it?
    
    1. 
       *Temporal (posterior fibres).
       
    2. 
       Temporal (anterior fibres).
       
    3. 
       Medial pterygoid.
       

5. 
   Lateral pterygoid.
   
6. 
   Masticatory.
   

11. 
    A mother appealed to a pediatriacian complaining of her 1-year-old child's neck always turned to the left. What neck muscle is underdeveloped?
    
    1. 
       *Sternocleidomastoid.
       
    2. 
       Platysma.
       
    3. 
       Digastric.
       
    4. 
       Long muscle of neck.
       
    5. 
       Thyrohyoid.
       
12. 
    During a game a basketball-player injured his right leg in consequence of which he couldn't bend the right foot. A doctor detected that tendons were injured. The tendon of what muscle was injured?
    
    1. 
       *Triceps surae.
       
    2. 
       Extensor hallucis longus.
       
    3. 
       Tibialis anterior.
       
    4. 
       Biceps femoris.
       
    5. 
       Sartorius.
       
13. 
    A man, 30 years old, appealed to a traumatologist with an incised wound of the left foot plantar region. The injured had problems with lifting the lateral border of the foot. What muscle function was affected?
    
    1. 
       Triceps surae.
       
    2. 
       Tibialis anterior.
       
    3. 
       Flexor hallucis longus.
       
    4. 
       *Peroneus longus.
       
    5. 
       Soleus.
       
14. 
    A 45-year-old man was admitted to a traumatology center after a shoulder home accident. Examination has shown the absence of extension, adduction and pronation functions of the shoulder. What muscle has been injured?
    
    1. 
       Supraspinatus.
       
    2. 
       Subscapularis.
       
    3. 
       Teres minor.
       
    4. 
       Infraspinatus.
       
    5. 
       *Teres major.
       
15. 
    A child, 8 years old, was admitted to a clinic with an incised wound of the right leg sole. Debridement has shown a deep wound with tendon tear in the plantar region near the lateral border of the foot. Lifting of the lateral border of the foot is limited. The function of what muscle has been affected?
    
    1. 
       M. tibialis anterior.
       
    2. 
       *M. peroneus longus.
       
    3. 
       M. extensor digitorum longus.
       
    4. 
       M. quadriceps femoris.
       
    5. 
       M. triceps surae.
       
16. 
    A boy, 8 years old, cannot put lips round,the angles of the mouth are pulled out and up, and oral fissure is stretched aside. What muscle is injured?
    
    1. 
       Risorius.
       
    2. 
       Greater zygomatic.
       
    3. 
       Buccinator.
       
    4. 
       *Orbicular muscle of mouth.
       
    5. 
       Masticatory.
       
17. 
    Examination of a patient's facial expression has shown that he can not put his lips, round, whistle, the oral fissure is stretched to sides. What muscle's atrophy do these symptoms indicate?
    
    1. 
       Risorius muscles.
       
    2. 
       Greater zygomatic.
       
    3. 
       Cheek muscle.
       
    4. 
       *Orbicular muscle of mouth.
       
    5. 
       Masticatory.
       
18. 
    During an operation on crural hernia the lateral wall of the internal crural ring was touched. What anatomic formation was damaged?
    
    1. 
       Inguinal ligament.
       
    2. 
       Femoral vein.
       
    3. 
       *Femoral artery.
       
    4. 
       Iliopectineal arch.
       
    5. 
       Pectineal ligament.
       
19. 
    An X-ray examination has shown a comminuted fracture of the infraglenoid tubercle of a patient with a trauma in the shoulder joint area. Tendon of what muscle head beginning in this place has been damaged?
    
    1. 
       *A long head of m. tricepitis brachii.
       
    2. 
       A long head of m. bicepitis brachii.
       
    3. 
       A medial head of m. tricepitis brachii.
       
    4. 
       A lateral head of m. tricepitis brachii.
       
    5. 
       A short head of m. bicepitis brachii.
       
20. 
    A 38-year-old man with a right hand trauma has been taken to a traumatology center. Examination has shown an incised wound in the region of the right hand thumb eminence; the distal phalanx of the I finger does not bend. What muscle has been damaged?
    
    1. 
       *Long flexor of thumb.
       
    2. 
       Short flexor of thumb.
       
    3. 
       Short abductor muscle of thumb.
       
    4. 
       Opposer muscle of thumb.
       
    5. 
       Adductor of thumb.
       
21. 
    A 39-year-old man has been taken to a traumatology center with a left hand trauma. Examination has shown an incised wound in the region of the left hand thumb eminence; the proximal phalanx of the I finger does not bend. What muscle has been damaged?
    
    1. 
       Adductor of thumb.
       
    2. 
       Long flexor of thumb.
       
    3. 
       Short abductor muscle of thumb.
       
    4. 
       Opposer muscle of thumb.
       
    5. 
       *Short flexor of thumb.
       
22. 
    As a result of tibia fracture the anterior muscle of leg was injured. The function of what muscle is affected?
    
    1. 
       *Extensor hallucis longus.
       
    2. 
       Flexor digitorum longus.
       
    3. 
       Peroneus longus.
       
    4. 
       Soleus.
       
    5. 
       Extensor digitorum brevis.
       
23. 
    A patient complains of pain in the left part of the neck while moving. The best painless position is bending the neck to the left with simultaneous rais­ing of the chin and rotation of the face to the opposite side. What muscle is injured?
    
    1. 
       Right trapezius.
       
    2. 
       Right sternocleidomastoid.
       
    3. 
       Left trapezius.
       
    4. 
       *Left sternocleidomastoid.
       
    5. 
       Sternohyoid.
       
24. 
    A patient complains of impossible external rotation caused by a shoulder trauma in the great tubercle of humeri area. What muscles are injured?
    
    1. 
       Supraspinatus and teres major.
       
    2. 
       *Infraspinatus and teres minor.
       
    3. 
       Subscapular and coracobrachial.
       
    4. 
       Deltoid and supraspinatus.
       
    5. 
       Teres major and teres minor.
       
25. 
    A man can not bend his arm in the elbow joint because of a wound of anterior shoulder surface. Which muscle is injured?
    
    1. 
       Anconeus.
       
    2. 
       Deltoid.
       
    3. 
       Pectoral major.
       
    4. 
       Triceps brachial.
       
    5. 
       *Biceps brachial.
       
26. 
    A basketball-player complains of pain in the calcaneal region, which intensifies while walking. What muscle tendon is injured?
    
    1. 
       Long peroneal muscle.
       
    2. 
       Posterior tibial muscle.
       
    3. 
       Long flexor muscle of toes.
       
    4. 
       *Triceps muscle of calf.
       
    5. 
       Short peroneal muscle.
       
27. 
    A patient has complications of hand movements. Inflammation of common synovial sheath for flexor tendons has been diagnosed. According to anamnesis, a week before the patient got a punctured wound of a finger. Which finger is injured?
    
    1. 
       *Little finger.
       
    2. 
       Thumb.
       
    3. 
       Middle finger.
       
    4. 
       Index finger.
       
    5. 
       Ring finger.
       
28. 
    After an injury a patient can not raise his hand to the horizontal level. Which muscle is injured?
    
    1. 
       Triceps muscle of arm.
       
    2. 
       Biceps muscle of arm.
       
    3. 
       *Deltoid.
       
    4. 
       Trapezius.
       
    5. 
       Broadest muscle of back.
       
29. 
    During a traffic accident a driver got multiple injuries of the lateral face area including jugal bridge fracture. Which muscle function is affected?
    
    1. 
       *Masseter.
       
    2. 
       Orbicular muscle of mouth.
       
    3. 
       Buccinator.
       
    4. 
       Procerus.
       
    5. 
       Risorius.
       
30. 
    After an accident a patient has severe painfullness and anterior leg surface edema, dorsal flexion of the foot is difficult. Which muscle functions are damaged?
    
    1. 
       Long peroneal muscle.
       
    2. 
       Long flexor muscle of toes.
       
    3. 
       Long flexor muscle of great toe.
       
    4. 
       *Anterior tibial.
       
    5. 
       Short peroneal muscle.
       
31. 
    Right palpebral fissure of a patient is noticeably bigger than the left one. Which facial muscle function is damaged?
    
    1. 
       *Orbicular muscle of eye.
       
    2. 
       Procerus.
       
    3. 
       Corrugator.
       
    4. 
       Occipitofrontal (frontal belly).
       
    5. 
       Greater zygomatic.
       
32. 
    A 37-year-old patient had a cough, then asphyxia because a foreign body got into the respiratory tracts. Tracheotomy was made in the neck region limited by the superior belly of omo­hyoid muscle, sternocleidomastoid muscle and the median neck line. In what triangle of neck was the operation performed?
    
    1. 
       Carotid.
       
    2. 
       *Omotracheal.
       
    3. 
       Submandibular.
       
    4. 
       Omotraperoid.
       
    5. 
       Omoclavicular.
       
33. 
    A patient complains of pain in the left part of the neck, which intensifies with head movements. The best position is bending the neck to the left and rotating the face to the right. Which muscle is injured?
    
    1. 
       *Left sternocleidomastoid.
       
    2. 
       Right sternocleidomastoid.
       
    3. 
       Right platysma.
       
    4. 
       Left platysma.
       
    5. 
       Long muscle of neck.
       
34. 
    A patient has a fissure of the shaft of humerus posterior surface diagnosed. Symptoms of the radial nerve injury in the region of canal is hume-romuscularis are observed. What is this canal limited by?
    
    1. 
       *Posterior surface of humerus and triceps muscle of arm.
       
    2. 
       Anterior surface of humerus and biceps muscle of arm.
       
    3. 
       Anterior surface of humerus and coracobrachial.
       
    4. 
       Anterior surface of humerus and brachial.
       
    5. 
       Posterior surface of humerus and anconeus.
       
35. 
    Usually the intravenous injection is done into median cubital vein because it is slightly movable due to fixation by the soft tissues. What is it fixed in the cubital fossa by?
    
    1. 
       Anconeus muscle
       
    2. 
       Brachioradial muscle
       
    3. 
       *Aponeurosis of biceps muscle
       
    4. 
       Brachial muscle
       
    5. 
       Tendon of the triceps muscle