Exam 1 13 April 2015, questions and answers PDF

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Student 1 Student name: Section A: Direct palpation (3 marks) (2 minutes maximum) Precise palpation required QUESTION

ANSWER

1

the lateral epicondyle of the humerus (½)

2

the olecranon fossa (½)

3

the shaft of the radius (1/2)

Correctly identifies most lateral bony point at level of elbow on humerus with model and student in appropriate positions (½) Correctly identifies the sulcus between posterior aspects of elbow condyles with model and student in appropriate positions (elbow 90 degrees flexion) (½) Correctly identifies lower 2/3 of shaft proximal to radial styloid at wrist with model and student in appropriate position (1/2)

4

ON THE MODEL INDICATE THE POSITION AND TRACE THE SHAPE of the cubital fossa NAME the structure of the lateral border (1½)

MARKS AVAILABLE

MARKS AWARDED

COMMENTS

½ ½ ½

Correctly indicates position with model and student in appropriate positions (½) 

Triangular region on the anterior aspect of elbow

½

Correctly names and indicates the following structure: (1) 

Lateral border = brachioradialis

1 Palpation Section Mark

(3)

Section D: Nerve and Blood Supply (9 marks) (4 minutes maximum)

1

QUESTION

ANSWER

a) ON THE SKELETON OUTLINE the course of the ulnar nerve from the cervical spine to the elbow STATING main anatomical relations (3)

a) Accurately describes and indicates the course of the nerve (3) CM

   

Arises from the ventral rami of C8 and T1 (and occasionally C7), the inferior trunk (anterior division) and the medial cord. It enters the arm medial to the axillary artery and descends down the arm medial to the brachial artery and anterior to triceps. Half way down the arm the ulnar nerve passes posteriorly, piercing the medial intermuscular septum to enter the posterior compartment of arm. At the elbow it passes behind the medial epicondyle of the humerus in the ulnar groove (funny bone) before entering the forearm.

b) What forearm muscles are supplied by this nerve? (1)

b) FCU and medial ½ FDP (1)

c) What is the sensory supply of this nerve and its branches? (1)

c) Articular branches to the elbow and wrist, skin on the medial third of the palmar and dorsal surfaces of the hand and the palmar and dorsal surfaces of the medial 1½ digits (2)

d) Name another nerve that arises from anterior divisions of the brachial plexus (1)

MARKS AVAILABLE

3

1

2

d) Median or Musculocutaneous (1)

1

MARKS AWARDED

COMMENTS

2

QUESTION

ANSWER

a) IDENTIFY the brachial pulse in the mid arm (1)

a) Verbally describes and accurately locates the pulse. Examiner to confirm by simultaneously palpating alternative pulse (1)

 

MARKS AVAILABLE

MARKS AWARDED

COMMENTS

1

Palpate pulse on the medial side of upper arm in the cleft between biceps brachii and triceps brachii muscles Avoid palpating through clothing

b) Which artery does the brachial artery arise from? (½)

b) Correctly identifies the axillary artery (½)

c) Name a branch of the brachial artery in the arm? (½)

c) Deep brachial artery (profunda brachii) (½)

½ ½

Nerve and Blood Supply Section Mark

(9)

Student 2 Student name: Section B: Joint question (17 marks) (6 minutes maximum)

1

2

3

4

QUESTION

ANSWER

a) What is the joint classification of the inferior radio-ulnar joint? (1)

a) Gives correct joint classification (1)  Synovial (1/2)  Pivot (1/2)

1

b) Name the physiological movements available at the inferior radioulnar joint? (1)

b) Gives all available physiological movements (1)  Supination/pronation

1

ON THE MODEL INDICATE THE POSITION OF the inferior radio-ulnar joint using direct palpation and describe how you palpate it (1)

Indicates position on posterior aspect distal forearm (½)

a) USING THE SKELETON IDENTIFY the articular surfaces of the inferior radio-ulnar joint (2)

Describes how to palpate joint (½) Direct palpation:  Palpated posteriorly, vertical line between the radius and head of ulna a) Identifies correctly crescent shaped notch on lateral aspect distal ulna (1) and ulnar notch on medial aspect distal radius (1)

b) COMMENT ON TWO FEATURES of the radial articular surface (1)

b) Correctly describes 2 features (1) Ulnar notch of radius (any of the following)  Covered in hyaline cartilage  Biconcave  Faces medially  Provides point of attachment for base of articular disc

a) USING THE SKELETON INDICATE the position of

a) For the following 2 structures, correctly points to position on skeleton and describes attachments

MARKS AVAILABLE

1

2

1

MARKS AWARDED

COMMENTS

QUESTION

ANSWER

the following structures and describe the attachments in detail (4) Triangular fibrocartilaginous articular disc (2)

(4)

CM

Triangular fibrocartilaginous articular disc (2) Attachments:  apex at root ulna styloid  base at inferior edge ulnar notch on radius

Interosseous membrane (2)

Interosseous membrane (2)  Strong fibrous sheet between interosseous borders of radius and ulna

b) DESCRIBE how each structure contributes to joint structure and function (2)

b) For the following 2 structures, correctly describes how each structure contributes to joint structure and function (2) Triangular fibrocartilaginous articular disc (1)  Inferiorly participates in radiocarpal joint  Prevents displacement between radius and ulna

5

a) What is the normal ROM for forearm supination? (1) b) Describe supination at the inferior radio-ulnar joint (1) c) Describe supination at the superior radio-ulnar joint with reference to spin, roll and glide (1) d) For supination, state the axis of movement

Interosseous membrane (1)  Transmits forces from hand to radius, to ulna, to humerus  Prevents displacement between radius and ulna a) States correct ROM + 5 degrees (1) 

MARKS AVAILABLE

2

2

1

1 1

180° (from full pronation) or 90° (from mid pronation)

b) States correct accessory movements (1) 

Rotation (spin) of the lower end of radius around the head of ulna

c) States correct accessory movements (1) Rotation (spin) of head of radius within annular ligament and radial notch of ulna d) Gives correct axis (1)  Vertical axis (running along middle finger)

1

1



1

MARKS AWARDED

COMMENTS

QUESTION

ANSWER

MARKS AVAILABLE

MARKS AWARDED

COMMENTS

(1) e) Identifies both of the following (1) e) Name two structures that limit supination (1)



Passive resistance from opposing muscles (names both pronator teres and pronator quadrates)

1

Joint Section Mark

(17)

Student 3 Student name: Section C: Muscle question (20 marks) (7 minutes maximum)

1

QUESTION:

ANSWER:

IDENTIFY ON THE SKELETON and DESCRIBE the attachments and direction of fibres of pronator teres (4) and pronator quadratus (4)

Describes arrangement in detail and accurately indicate location using skeleton (8) CM Pronator teres O: Humeral head: lower part of medial supracondylar ridge & adjacent intermuscular septum & CFT on medial epicondyle Ulnar head: pronator ridge inferior to coronoid process on ulna R: Down & laterally I: middle of lateral surface of radius Pronator quadratus O: Lower ¼ anterior surface of ulna R: Transversely I: Lower ¼ anterior surface of radius (Some deeper fibres insert into triangular area above ulnar notch of radius)

2

ASK THE MODEL TO DEMONSTRATE 2 actions of pronator teres acting as a prime mover (1)

Identifies correct movement and facilitates model to perform 2 active movements using layman’s terminology (1)  

Pronation Assists with elbow flexion

MARKS AVAILABLE

4

4

1

MARKS AWARDED

COMMENTS

QUESTION: 3 ON THE MODEL PALPATE the ORIGIN of the humeral head (½) and MUSCLE BELLY (1½) of pronator teres

4

5

ASK THE MODEL TO DEMONSTRATE a functional activity of pronator teres, STATING range and type of muscle work (3)

ANSWER:

MARKS AVAILABLE

MARKS AWARDED

COMMENTS

Accurately palpate in an appropriate position the muscle contraction during an active / resisted movement (2) Pronator teres  Model seated  ORIGIN: medial supracondylar ridge & CFT on medial epicondyle  MUSCLE BELLY: Active/resisted pronation - Palpate along the medial border of cubital fossa between medial epicondyle and the middle of the radius Identifies an appropriate functional movement and describes muscle work and range (3) ▪ ▪ ▪

Correct demonstration of function using layman’s terminology (e.g. using screw driver) Stating correct range Type of muscle work

1½

3

DEFINE an antagonist. IDENTIFY for the above function an antagonist muscle and explain your reasoning

Defines correctly (1) and selects an appropriate example and gives correct rationale (1)

ASK THE MODEL TO DEMONSTRATE pronator teres working concentrically in inner range (2)

Facilitates the model using correct terminology into correct action. Correct range (1) and muscle work (1)

STATE the nerve supply and root values of pronator teres (2)

Correctly state nerve and root values (2)

▪ 

½

Directly opposes the movement of a prime mover/agonist Eg. Supinator, biceps brachii

1 1

6

7



 

e.g. end range pronation against resistance

Median nerve C5,6,7, 8,T1

2

2 Muscle Section Mark

(20)...