P MACQUARIE

University

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FORMAL EXAMINATION PERIOD: SESSION 2, NOVEMBER 2017

Unit Code: MEDI203

Unit Name: Musculoskeletal 1

Duration of Exam
(including reading time if applicable):
2 hours and 10 minutes reading time

Total No. of Questions: 88

Total No. of Pages
(including this cover sheet):
19

GENERAL INSTRUCTIONS TO STUDENTS:

• Students are required to follow directions given by the Final Examination Supervisor and must refrain from communicating in any way with another student once they have entered
the final examination venue.
• Students may not write or mark the exam materials in any way during reading time.
• Students may only access authorised materials during this examination. A list of authorised material is available on this cover sheet.
• All watches must be removed and placed at the top of the exam desk and must remain there for the duration of the exam. All alarms, notifications and alerts must be switched off.
• Students are not permitted to leave the exam room during the first hour (excluding reading time) and during the last 15 minutes of the examination.
• If it is alleged you have breached these rules at any time during the examination, the matter may be reported to a University Discipline Committee for determination.

EXAMINATION INSTRUCTIONS:

Answer all questions.

Part A Multiple Choice Questions - 70 marks record your answers in the Multiple Choice Answer sheet.
Part B Short-Answer Questions - 15 marks record your answers in the Booklet provided.
Part C Short-Answer/Drawing Questions - 20 marks record your answers in the Booklet provided.

AIDS AND MATERIALS PERMITTED/NOT PERMITTED:

Dictionaries: No dictionaries permitted
Calculators: No calculators permitted
Other: Closed book - No notes or textbooks permitted
 PART A: MULTIPLE-CHOICE QUESTIONS: (70 marks)

Choose the most correct answer - 1 mark each

Answer questions in General Purpose Answer Sheet provided

1. The carpal bone that articulates with the metacarpal of the thumb is the:

a) triquetrum

b) trapezium
c) trapezoid

d) capitate

2. The lateral head of the triceps muscle originates from the:

a) coracoid process of the scapula.

b) supraglenoid tubercle of the scapula.

c) infraglenoid tubercle of the scapula.

d) posterior surface of the humerus superior to the radial groove.

e) posterior surface of the humerus inferior to the radial groove.

3. The point of insertion of the flexor digitorum profundus tendon to the index finger is on

the:

a) base of the distal phalanx

b) body of the middle phalanx

c) head of the proximal phalanx

d) second metacarpal

e) trapezoid bone

4. Which of the following statements is true regarding the elbow joint?

a) The lateral collateral ligament blends distally with the anular ligament of the radius.

b) The lateral collateral ligament consists of three bands.

c) The head of the radius articulates with the trochlea of the humerus.

d) The elbow joint is classified as a synovial pivot joint.

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5. The anterior circumflex humeral artery is a branch of the:

a) first part of the axillary artery

b) second part of the axillary artery

c) third part of the axillary artery

d) brachial artery

6. In the hand:

a) the opponens policis brevis lies in the hypothenar compartment

b) the interossei muscles are innervated by the median nerve

c) the four dorsal interossei muscles adduct the digits

d) the opponens digiti minimi is innervated by the ulnar nerve

7. Which of the following muscles forms the floor of the cubital fossa?

a) Biceps brachii

b) Brachioradials

c) Brachialis

d) Pronator teres

8. The vein passing above the "anatomical snuffbox" of the upper limb is:

a) radial

b) ulnar

c) cephalic

d) basilic

9. Which of the following statements regarding cutaneous innervation of the upper limb is

true?

a) Most cutaneous nerves of the shoulder derive from the brachial plexus.

b) C6 nerve supplies forearm laterally up to the thumb.

c) C8 nerve supplies the little finger and the medial side of the hand and forearm.

d) T1 nerve supplies a small area medial side of the arm and the skin of the axilla.

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10. The axillary vein:

a) lies on the lateral side of the axillary artery

b) is formed by union of the brachial veins and the cephalic vein

c) ends at the inferior border of the midpoint of the clavicle to become the subclavian vein

d) commences at the inferior border of the teres major muscle

11. A hockey player has been hit hard by a hockey stick in the mid-humeral region of his arm.

On physical examination, you may find all of the following EXCEPT:

a) inability to extend the wrist

b) loss of extension at the interphalangeal joints

c) sensory loss on the skin on the dorsum of the hand proximal to first two digits

d) weakened extension of the elbow

12. If the medial epicondyle of the humerus is fractured and the nerve passing dorsal to it is

injured, which muscle would be most affected?

a) Extensor carpi ulnaris

b) Extensor digitorum

c) Flexor carpi ulnaris

d) Flexor digitorum profundus

e) Flexor digitorum superficialis

13. The nerve passing between the pisiform and the hook of the hamate is:

a) posterior interosseous

b) median

c) ulnar

d) palmar cutaneous branch of median nerve

14. An inability to protract the scapula indicates lesion of the:

a) Dorsal scapular nerve

b) Long thoracic nerve

c) Lower subscapular nerve

d) Suprascapular nerve

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15. Lateral rotator of the gleno-humeral joint is:

a) teres major muscle

b) infraspinatus muscle

c) latissimus dorsi muscle

d) subscapularis muscle

16. The axillary nerve innervates the deltoid muscle and:

a) latissimus dorsi muscle

b) rhomboid major

c) levator scapulae

d) teres minor muscle

17. Injury to the CN XI (accessory nerve) would paralyse which muscle?

a) Sternocleidomastoid muscle

b) Serratus posterior superior

c) Subscapularis

d) Infraspinatus

18. Which of the following statements regarding the brachial plexus is correct?

a) The roots enter the axilla with the subclavian vein.

b) The anterior rami of the C5, C6 and C7 spinal nerves unite to form the superior trunk.

c) The roots pass through the gap between the middle and posterior scalene muscles.

d) The anterior divisions of the superior and middle trunks unite to form the lateral cord.

19. Which of the following muscles passes through the carpal tunnel?

a) Palmaris longus

b) Flexor carpi radialis

c) Flexor pollicis longus

d) Flexor carpi ulnaris

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20. The radial artery:

a) commences in the arm opposite to the medial epicondyle of the humerus

b) leaves the forearm winding around the lateral aspect of the wrist

c) is the main contributor to the superficial palmar arch

d) in the cubital fossa lies above the bicipital aponeurosis

21. The biceps brachii reflex involves the spinal nerves:

a) C5 and C6

b) C6 and C7

c) C7 and C8

d) C8 and T1

22. In an auto accident, the patient's knee strikes the dashboard which in turn pushes the

head of the femur posteriorly out of the socket. Which ligament is most likely ruptured by

this injury?

a) Iliofemoral

b) Ischiofemoral

c) Pubofemoral

d) Transverse acetabular

23. The ligament that extends between the calcaneus and the cuboid and is primarily

responsible for maintaining the lateral longitudinal arch is the:

a) calcaneometatarsal

b) long plantar

c) short plantar

d) plantar calcaneonavicular (spring)

24. The following muscles are abductors of the hip joint EXCEPT:

a) gluteus medius

b) gluteus minimus

c) obturator externus

d) tensor of fascia lata

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25. After an obturator nerve injury, some adduction of the thigh is still possible because of

double innervation to the:

a) Gracilis

b) Adductor magnus

c) Sartorius

d) Adductor longus

e) Adductor brevis

26. The nerve most commonly injured after the fracture of the neck of the fibula is:

a) Tibial nerve

b) Superficial fibular nerve

c) Common fibular nerve

d) Saphenous nerve

27. The following muscles attach to the linea aspera of the femur EXCEPT:

a) Vastus lateralis

b) Vastus intermedius

c) Adductor brevis

d) Adductor magnus

28. Excessive anterior movement of the tibia when pulling forward on the leg with the knee

flexed would indicate damage to this ligament of the knee:

a) medial collateral

b) lateral collateral

c) anterior cruciate

d) posterior cruciate

e) oblique popliteal

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29. The saphenous nerve is a sensory branch of the:

a) common fibular and tibial nerve

b) sciatic nerve

c) femoral nerve

d) obturator nerve

30. The biceps femoris muscle:

a) forms the medial superior boundary of the popliteal fossa

b) forms the lateral superior boundary of the popliteal fossa

c) forms the floor of the popliteal fossa

d) gives rise to the oblique popliteal ligament

31. The vein found within the tarsal tunnel is the:

a) small saphenous vein

b) posterior tibial vein

c) greater saphenous vein

d) fibular vein

32. The following statements regarding the superficial veins of the lower limb are true

EXCEPT:

a) communicating/perforating veins direct blood from superficial to deep veins

b) the great saphenous vein lies posterior to the medial malleolus

c) the small saphenous vein is accompanied by the sural nerve

d) the small saphenous vein lies posterior to the lateral malleolus

33. Each of the following matchings of the thigh muscles with points of origin is correct

EXCEPT:

a) gracilis —body and inferior ramus of pubis

b) rectus femoris—anterior inferior iliac spine

c) pectineus—superior ramus of pubis

d) semitendinosus—linea aspera of femur

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34. Absent dorsalis pedis artery pulse indicates occlusion of all arteries listed below, EXCEPT:

a) external iliac artery

b) internal iliac artery

c) femoral artery

d) popliteal artery

35. In the foot:

a) the plantar aponeurosis arises posteriorly from the calcaneus

b) the extensor digitorum brevis muscle is innervated by the superficial fibular nerve

c) the spring ligament is primarily responsible for holding up the transverse foot arch

d) the cuboid is the most medial bone in the distal row of the tarsus

36. The extensor digitorum longus muscle is innervated by:

a) femoral nerve

b) tibial nerve

c) superficial fibular nerve

d) deep fibular nerve

37. The posterior compartment of the leg contains which one of the following structures?

a) Pectineus muscle

b) Superficial fibular/peroneal nerve

c) Popliteus muscle

d) Sural nerve

38. Regarding the muscles of the gluteal region:

a) Piriformis muscle leaves the pelvis through the lesser sciatic foramen

b) Obturator externus lies between superior and inferior gemelli muscles

c) Obturator internus laterally rotates the tight

d) Gluteus minimus is innervated by the inferior gluteal nerve

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39. Which one of the following statements regarding the ligaments of the hip joint is correct?

a) The iliofemoral ligament particularly prevents hyperextension of the hip joint during standing.

b) The ligament of the head of the femur conducts nerves supplying the hip joint.

c) The ischiofemoral ligament reinforces the anterior aspect of the fibrous membrane.

d) Pubofemoral ligament prevents over adduction of the hip joint.

40. The area below the pelvic inlet, bordered by the muscle in front and bone along the sides

and back is called:

a) pelvic brim

b) false pelvis

c) true pelvis

d) pelvic girdle

41. Regarding the joints of the vertebral column:

a) the joints of the vertebral bodies are primary cartilaginous joints

b) the uncovertebral joints are found between C3 - C6/7 vertebrae

c) the nucleus pulposus of the intervertebral disc is highly vascular

d) the intervertebral discs are thickest in the superior thoracic region

42. The intercostal nerves in the intercostal space:

a) run deep to the innermost intercostal muscle

b) run between innermost and internal intercostal muscles

c) run along the superior margin of the rib below

d) give off accessory branches that run along the middle of the intercostal space

43. The lateral sacral crest of the sacrum represents fused:

a) articular processes

b) transverse processes

c) laminae

d) pedicles

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44. On a physical examination of the vertebral column:

a) the spinous process of C5 cannot be palpated as it lies deep to the posterior longitudinal

ligament

b) the root of the spine of the scapula is at the same level as the spinous process of T4

vertebra

c) the inferior angle of the scapula is at the same level as the spinous process of T9 vertebra

d) the horizontal line between the highest points of the iliac crests corresponds to the spinous

process of L4 vertebra

45. The first rib:

a) has two facets for articulation with T1 and T2 vertebrae

b) has a tubercle for the anterior scalene muscle attachment anterior to the groove for the

subclavian artery

c) has a tubercle for the posterior scalene muscle attachment posterior to the groove for the

subclavian artery and vein

d) has a costal groove for the neurovascular bundle on its inferior surface

46. Which muscle is innervated by posterior primary rami of the spinal nerves?

a) Levator scapulae

b) Rhomboid major

c) Iliocostalis

d) Serratus posterior superior

47. At birth, the spinal cord ends inferiorly at the level of:

a) the coccyx

b) L1/L2

c) L2/L3

d) L3/L4

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48. A 25-year-old pregnant woman asked her obstetrician about options to reduce pain during

childbirth. The obstetrician suggested a caudal epidural block. The following are true,

when performing a caudal epidural block on an adult EXCEPT:

a) an in-dwelling catheter is inserted through the sacral hiatus

b) the sacral hiatus represents an absence of the laminae and S5 spinous process

c) the sacral cornua are the bony landmarks used in locating sacral hiatus

d) the anaesthetic spreads subdurally and acts on S2 through the coccygeal nerves

49. A middle-aged man felt a severe lower back pain while lifting a heavy weight at the gym.

MRIs revealed that he had protruding intervertebral disc at L5/S1 vertebral level. Which of

the following statements is INCORRECT?

a) The herniated disc usually protrudes posterolaterally.

b) The posterior longitudinal ligament is weaker and narrower than anterior longitudinal

ligament.

c) The lower back pain will radiate to the back of his thigh, leg and dorsum of the foot.

d) The spinal nerve L5 was compressed by protruded intervertebral disc.

50. The alar ligaments:

a) connect the body of the axis to the occipital condyles

b) are integral part of the cruciate ligament

c) restrict side to side movements

d) hold the dens of the axis against the anterior arch of the atlas

51. Which of the following statements regarding the muscles of the antero-lateral abdominal

wall is INCORRECT?

a) The muscles are innervated by anterior rami of lower 6 thoracic spinal nerves (T7-T12) and

L1.

b) The rectus sheath is formed by decussation of their aponeuroses.

c) The muscles move the trunk and help maintain the posture.

d) The rectus abdominis muscle is most important in compressing the abdominal content.

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52. When contracted the splenius capitis will:

a) extend the head or turn the head on the same side

b) flex the head or turn the head to the same side

c) extend the head or turn the head to the opposite side

d) laterally flex the head

53. The structural classification of a costochondral joint is:

a) synchondroses

b) synovial

c) syndesmoses

d) synarthrosis

54. The multifidus muscles:

a) are the most superficial muscles in the transversospinales group

b) span the length of the vertebral column

c) are best developed in the thoracic region

d) are supplied by the anterior rami of the spinal nerves

55. A direct inguinal hernia involves the:

a) peritoneal sac entering the inguinal canal under the inguinal ligament

b) peritoneal sac entering the inguinal canal through a weakened area in the abdominal wall

medial to the inferior epigastric vessels

c) peritoneal sac entering the inguinal canal through the superficial inguinal ring

d) peritoneal sac entering the inguinal canal through the deep inguinal ring

56. The ligamenta flava:

a) consist predominantly of dense regular connective tissue

b) form the part of the anterior surface of the vertebral canal

c) run between the pedicles of the adjacent vertebrae

d) resist separation of the lamina in flexion

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57. The structure passing through the vena cava opening on the diaphragm is the:

a) right vagus nerve

b) right phrenic nerve

c) thoracic duct

d) azygos vein

58. The skeletal muscle of the erector spinae muscles is primarily derived from:

a) hypaxial muscle precursors in the ventrolateral region of the myotome

b) epaxial muscle precursors in the dorsomedial region of the myotome

c) mesenchymal cells of the lateral plate mesoderm

d) mesenchymal cells of the dermatome

59. The costal processes:

a) In the cervical region fuse to form uncinate processes

b) In the thoracic region form spinous processes

c) In the lumbar region fuse with the transverse process

d) In the upper sacral region fuse and form ventral portion of the ala of the sacrum.

60. The illustration below shows developmental abnormality in the lumbar region.

an

t f,

J7 -S

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 The congenital anomaly is known as:

a) spina bifida oculta

b) meningomyelocele

c) meningocele

d) teratoma

61. Regarding limb growth and patterning:

a) limb buds appear at about 6 weeks of development

b) epiphyseal plate is the portion of the long bone where growth in diameter occurs

c) limb outgrowth is initiated by the apical ectodermal ridge

d) much of the basic structures of the limbs are established by 12 weeks

62. A newborn baby has been taken for a further testing as at birth the blue discoloration of

sclerae and tendency to bleed were noticed. Attending paediatrician suspect that the

newborn has osteogenesis imperfecta. The osteogenesis imperfecta occurs as a result of:

a) inheritance as an autosomal dominant disorder affecting differentiation of osteoprogenitor

cells

b) gene mutation and impairment in collagen maturation

c) alcohol consumption in early pregnancy and toxic effect on neural crest cells

d) inheritance as an autosomal dominant disorder affecting chondrocytes

63. The connective tissue wrapping around a muscle that is continuous with tendons is the:

a) epimysium

b) endomysium

c) perimysium

d) ectomysium

64. Growth hormone stimulates bone growth by:

a) stimulating synthesis of bone matrix

b) stimulating osteoclastic activity

c) promoting calcium ion absorption from the digestive system

d) promoting phosphate ion absorption from the digestive system

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65. The stiffness of muscle tissue in rigor mortis partially results from:

a) excessive acetylcholine activity on muscle

b) excessive calcium release in muscle

c) excessive lactic acid build up

d) excessive contraction of the fibres

66. The oxygen depth of a muscle is:

a) demand for oxygen prior to strenuous exercise

b) demand for oxygen during the strenuous exercise

c) demand for oxygen for conversion of lactate to pyruvate

d) demand for oxygen to restore normal pre-exertion conditions

67. Parathyroid hormone secretion is stimulated when:

a) Ca++ blood concentration increases

b) Ca++ blood concentration decreases

c) Na+ blood concentration increases

d) Na+ blood concentration increases

68. During the first 15 second of intensive exercise, such as sprinting or power lifting, most of

the energy is provided by:

a) Carbohydrate oxidation

b) ATP in muscle fibre

c) Phosphocreatine

d) A and C

e) B and C

69. Which of the following statements is true regarding properties of the fast-twitch muscle

fibers?

a) The fast-twitch fibers have a small cross-sectional diameter.

b) The fast-twitch fibers take prolonged time to peak tension.

c) The fast-twitch fibers contain many mitochondria.

d) The fast-twitch fibers contain high concentration of glycolytic enzymes in the sarcoplasm.

16
70. As he was riding his bike, Charles was sideswiped by a lorry. He suffered multiple bruises

and fractured pelvis and tibia. Several months later he still had an area of numbness on the

medial side of his thigh and walked with a lateral swing to his gate. Which muscle was

affected by his injury?

a) Gluteus medius

b) Gluteus maximus

c) Semimembranosus

d) Adductor longus

PART B: Short answer Questions: (15 marks)

Answer in the separate booklet provided - clearly label your questions

(1 mark per correct answer)

1. Sensory loss of the area of the skin on continuous sides of the 1st and 2nd toes indicates

lesion of the nerve.

2. Positive (normal) response when performing Achille tendon reflex, confirms the integrity of

the spinal segment_____________ .

3. Extension of the vertebral column is the greatest in the region.

4. pulse is best felt on the dorsum of the foot just laterally to the extensor

hallucis longus.

5. The serratus posterior superior muscle is innervated by

6. The four muscles of the suboccipital region are innervated by

7. The most common cause of the "foot drop" is paralysis of muscle.

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8. The nerve root value for the sciatic nerve is

9. The lymph drainage of the skin of the upper limb is to group of axillary

lymph nodes.

10. Inability to stand on one's toes indicates injury to which nerve around the knee joint?

11. The increase of the total mass of a muscle is called muscle

12. When the extracellular fluid concentration of calcium ions falls below normal it causes

muscle

13. The hormone secreted when Ca++ blood level decreases is

14. Inactive vitamin D is produced in the skin, and then modified to its active form in two steps,

first in the , then in the . (liver, kidney)

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 PART C: Short answers/Drawing an annotated diagram 20 marks

Answer in the separate booklet provided - clearly label your questions.

1. A) Draw an annotated diagram showing the phases of a skeletal muscle twitch (contraction).

(3 marks)

B) For each phase briefly explain the sequence of events leading to muscle contraction.

(3 marks)

2. The muscle contractions can be classified as isotonic and isometric on the basis of their

pattern of tension production.

For each type of muscle contraction, explain how the muscle changes and give an example.

(3 marks)

3. List three organs/tissues (draw an annotated diagram - optional) and explain how they

contribute in restoring the normal blood calcium level after hypercalcaemia (high Ca++ blood

level).

(8 marks)

4. Copy the photograph of the palm of the hand in the separate booklet provided and annotate

it to show cutaneous innervation. (3 marks)

TOTAL MARK FOR THE PAPER 105

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