Unit 7 Question Bank
Sourcing: items tagged TMU 2021–22 come from the real final paper. Items tagged
Slide come from the TMU lecture. Items tagged Gray's are built from the textbook to cover
examinable content. Nothing here is invented; answers are verifiable against the cited page — check against
the official marking scheme where one exists.
0 / 20 answered
1The contents of the cubital fossa from LATERAL to MEDIAL are ( ).
Answer: C
M-A-N from lateral to medial: Muscle tendon (biceps), Artery (brachial), Nerve (median). The radial nerve lies deep and lateral and is a relation, not a classical content.TMU Lecture 8 Slide 7 · Gray's 4e p.766
2The medial boundary of the cubital fossa is the ( ).
Answer: D
Medially the lateral border of pronator teres; laterally the medial border of brachioradialis; the base is a line between the two epicondyles.TMU Lecture 8 Slide 7
3At the front of the wrist, the median nerve lies between the tendons of ( ).
Answer: A
Between palmaris longus and flexor carpi radialis. Clench the fist and flex the wrist and both tendons stand up — the nerve is in the gap, which is where a median nerve block is placed and what a wrist laceration divides.TMU Lecture 8 Slide 15
4Which structure is NOT contained within the carpal tunnel?
Answer: B
The ulnar nerve and artery pass superficial to the flexor retinaculum, in Guyon's canal — which is why they are spared in carpal tunnel syndrome and why the little finger is normal.Gray's 4e p.797 · TMU Lecture 8 Slide 13
5Which muscles of the anterior forearm are supplied by the ULNAR nerve?
Answer: C
The one-and-a-half rule: flexor carpi ulnaris and the medial (ulnar) half of flexor digitorum profundus. Everything else in the compartment is median.Gray's 4e p.775
6The brachial artery divides into radial and ulnar arteries at the level of the ( ).
Answer: D
In the cubital fossa, at about the level of the neck of the radius.TMU Lecture 8 Slide 10
7The three muscles of the anterior compartment of the arm are supplied by the ( ).
Answer: A
The musculocutaneous nerve supplies biceps brachii, brachialis and coracobrachialis, then continues as the lateral cutaneous nerve of the forearm.TMU Lecture 8 Slide 6
8Which muscle lies in the anterior forearm but is supplied by the RADIAL nerve?
Answer: B
Brachioradialis is anterior by position but posterior by innervation — a classic compartment exception, mirroring pectineus in the thigh.Gray's 4e p.775 · Snell's 10e Ch.3
9Carpal tunnel syndrome spares sensation over the thenar eminence because ( ).
Answer: C
The palmar cutaneous branch of the median nerve arises proximal to the flexor retinaculum and passes superficial to it, so it escapes compression. Numbness of the whole hand is therefore not carpal tunnel syndrome.Gray's 4e p.797
10How many tendons pass through the carpal tunnel?
Answer: D
Nine — four of flexor digitorum superficialis, four of flexor digitorum profundus, and one of flexor pollicis longus — plus the median nerve.Gray's 4e p.797
11At the front of the wrist, the structure immediately LATERAL to the tendon of flexor carpi radialis is the ( ).
Answer: A
Lateral to medial the order is brachioradialis tendon · radial artery · FCR tendon · median nerve · palmaris longus tendon · ulnar artery · ulnar nerve · FCU tendon. The radial pulse is felt here.TMU Lecture 8 Slide 15
12The most powerful supinator of the forearm is ( ).
Answer: B
Biceps brachii, because it inserts on the radial tuberosity. Supinator is the dedicated but weaker muscle; biceps supplies the power, which is why screws are tightened clockwise for right-handers.Snell's 10e Ch.3
13The ulnar artery terminates as the ( ).
Answer: C
The ulnar artery forms the superficial palmar arch; the radial artery forms the deep palmar arch.TMU Lecture 8 Slides 10–11
14The roof of the cubital fossa is formed by ( ).
Answer: D
Deep fascia reinforced by the bicipital aponeurosis, with the median cubital vein lying on it. Brachialis and supinator form the floor.Gray's 4e p.766
15Allen's test is performed to assess ( ).
Answer: A
Both arteries are compressed, the hand blanches, then the ulnar is released and colour return is timed. It confirms collateral supply before radial artery cannulation or harvest.Snell's 10e Ch.3 (clinical)
16The common interosseous artery is a branch of the ( ).
Answer: B
It arises from the ulnar artery near its origin and divides into anterior and posterior interosseous arteries on either side of the interosseous membrane.TMU Lecture 8 Slide 11
17The median nerve enters the forearm by passing between the two heads of ( ).
Answer: C
Between the two heads of pronator teres, then running on the deep surface of flexor digitorum superficialis. Compression there is called pronator syndrome.TMU Lecture 8 Slide 12
18Which vein is most commonly used for venepuncture at the elbow?
Answer: D
The median cubital vein, which slants between cephalic and basilic veins and lies on the bicipital aponeurosis — the sheet that separates it from the brachial artery and median nerve beneath.TMU Lecture 8 Slide 3 · Gray's 4e p.695
19A supracondylar fracture of the humerus threatens which vessel, risking Volkmann's contracture?
Answer: A
The brachial artery lies in the cubital fossa immediately in front of the distal humerus. Injury causes forearm flexor ischaemia and the fixed flexion deformity known as Volkmann's ischaemic contracture.Snell's 10e Ch.3 (clinical)
20The deep layer of the anterior forearm consists of ( ).
Answer: B
The deep layer is flexor pollicis longus, flexor digitorum profundus and pronator quadratus. Flexor digitorum superficialis forms an intermediate layer of its own.TMU Lecture 8 Slide 14
1 Cubital fossa — draw a figure · 4′+
A triangular depression on the anterior aspect of the elbow.
Base (superiorly): an imaginary line between the medial and lateral epicondyles of the humerus.
Medially: lateral border of pronator teres.
Laterally: medial border of brachioradialis.
Floor: brachialis and supinator.
Roof: deep fascia reinforced by the bicipital aponeurosis, with the median cubital vein on it.
Contents, lateral → medial: tendon of biceps brachii · brachial artery and veins · median nerve. The radial nerve lies deep and lateral as a relation.TMU Lecture 8 Slide 7 · Gray's 4e p.766
Base (superiorly): an imaginary line between the medial and lateral epicondyles of the humerus.
Medially: lateral border of pronator teres.
Laterally: medial border of brachioradialis.
Floor: brachialis and supinator.
Roof: deep fascia reinforced by the bicipital aponeurosis, with the median cubital vein on it.
Contents, lateral → medial: tendon of biceps brachii · brachial artery and veins · median nerve. The radial nerve lies deep and lateral as a relation.TMU Lecture 8 Slide 7 · Gray's 4e p.766
2 Arrangement at the front of the wrist — homework · 4′+
From lateral to medial:
1. Tendon of brachioradialis
2. Radial artery
3. Tendon of flexor carpi radialis
4. Median nerve
5. Tendon of palmaris longus
6. Ulnar artery
7. Ulnar nerve
8. Tendon of flexor carpi ulnarisTMU Lecture 8 Slide 15
1. Tendon of brachioradialis
2. Radial artery
3. Tendon of flexor carpi radialis
4. Median nerve
5. Tendon of palmaris longus
6. Ulnar artery
7. Ulnar nerve
8. Tendon of flexor carpi ulnarisTMU Lecture 8 Slide 15
3 Carpal tunnel — 3′+
An osteofibrous tunnel at the wrist.
Floor and sides: the arched carpal bones. Roof: the flexor retinaculum.
Contents: nine tendons — four of flexor digitorum superficialis, four of flexor digitorum profundus, one of flexor pollicis longus — and the median nerve.
The ulnar nerve and artery pass superficial to the retinaculum and are not in the tunnel.Gray's 4e p.797
Floor and sides: the arched carpal bones. Roof: the flexor retinaculum.
Contents: nine tendons — four of flexor digitorum superficialis, four of flexor digitorum profundus, one of flexor pollicis longus — and the median nerve.
The ulnar nerve and artery pass superficial to the retinaculum and are not in the tunnel.Gray's 4e p.797
4 Bicipital aponeurosis — 2′+
A flat triangular sheet spreading medially from the tendon of biceps brachii to blend with the deep fascia over the flexor muscles of the forearm.
It forms part of the roof of the cubital fossa and separates the median cubital vein superficially from the brachial artery and median nerve beneath — which is what makes venepuncture at the elbow safe.Gray's 4e p.766
It forms part of the roof of the cubital fossa and separates the median cubital vein superficially from the brachial artery and median nerve beneath — which is what makes venepuncture at the elbow safe.Gray's 4e p.766
5 Carpal tunnel syndrome — 3′+
Compression of the median nerve within the carpal tunnel.
Symptoms: tingling and numbness of the lateral three and a half fingers, worse at night; later thenar wasting and weak thumb abduction.
Two diagnostic anatomical points: sensation over the thenar eminence is spared (the palmar cutaneous branch passes over the retinaculum), and the little finger is normal (ulnar territory).TMU Lecture 8 Slide 13 · Gray's 4e p.797
Symptoms: tingling and numbness of the lateral three and a half fingers, worse at night; later thenar wasting and weak thumb abduction.
Two diagnostic anatomical points: sensation over the thenar eminence is spared (the palmar cutaneous branch passes over the retinaculum), and the little finger is normal (ulnar territory).TMU Lecture 8 Slide 13 · Gray's 4e p.797
6 Median cubital vein — 2′+
A superficial vein crossing the cubital fossa obliquely, connecting the cephalic vein laterally with the basilic vein medially.
It lies on the bicipital aponeurosis and is the vein of choice for venepuncture at the elbow.TMU Lecture 8 Slide 3
It lies on the bicipital aponeurosis and is the vein of choice for venepuncture at the elbow.TMU Lecture 8 Slide 3
1
Describe the boundaries and contents of the cubital fossa, and its clinical importance.
8′
Set as a drawing homework in TMU Lecture 8.
Boundaries
- Base (superior): imaginary line between the medial and lateral epicondyles
- Medial: lateral border of pronator teres
- Lateral: medial border of brachioradialis
- Floor: brachialis and supinator
- Roof: deep fascia reinforced by the bicipital aponeurosis
Contents, lateral to medial
- Tendon of biceps brachii
- Brachial artery and its venae comitantes
- Median nerve
Mnemonic M-A-N. The radial nerve lies deep and lateral under brachioradialis, dividing into superficial and deep branches — a relation rather than a classical content. The median cubital vein lies superficially on the roof.
Clinical importance
- Blood pressure measurement — stethoscope over the brachial artery, medial to the biceps tendon
- Venepuncture from the median cubital vein, protected from the artery by the bicipital aponeurosis
- Supracondylar fracture of the humerus may injure the brachial artery → Volkmann's ischaemic contracture
Marking guide: three boundaries 2 · floor and roof 1.5 · three contents in order 2 · radial nerve relation 0.5 · two clinical points 2.
2
Describe the arrangement of structures at the front of the wrist.
6′
Set as homework in TMU Lecture 8.
From lateral to medial, eight structures lie side by side immediately deep to the skin:
- Tendon of brachioradialis
- Radial artery
- Tendon of flexor carpi radialis
- Median nerve
- Tendon of palmaris longus
- Ulnar artery
- Ulnar nerve
- Tendon of flexor carpi ulnaris
How to remember it
The two arteries occupy positions 2 and 6 and the two nerves positions 4 and 7. The median nerve lies between the tendons of palmaris longus and flexor carpi radialis — both of which stand up when the fist is clenched and the wrist flexed.
Clinical relevance
- The radial pulse is felt lateral to the flexor carpi radialis tendon
- A median nerve block is placed between palmaris longus and flexor carpi radialis
- A wrist laceration may divide the median nerve, the ulnar nerve, or both arteries — the order predicts what is cut
Marking guide: eight structures in correct order 4 (½ each) · median nerve landmark 1 · one clinical application 1.
3
Describe the carpal tunnel and explain the clinical features of carpal tunnel syndrome.
7′
Boundaries
- Floor and sides: the carpal bones, arched into a concavity
- Roof: the flexor retinaculum, attached to the scaphoid and trapezium laterally and the pisiform and hook of hamate medially
Contents
Nine tendons and one nerve: four tendons of flexor digitorum superficialis, four of flexor digitorum profundus, one of flexor pollicis longus, and the median nerve.
Not in the tunnel: the ulnar nerve and ulnar artery, which pass superficial to the retinaculum in Guyon's canal, and the tendon of palmaris longus.
Carpal tunnel syndrome
- Cause: any increase in pressure in a tunnel that cannot expand — tenosynovitis, pregnancy, hypothyroidism, rheumatoid arthritis, repetitive use
- Sensory: tingling and numbness of the lateral three and a half fingers, classically worse at night
- Motor: weakness of thumb abduction and opposition, with wasting of the thenar eminence
Two anatomical points that make the diagnosis
- Sensation over the thenar eminence is spared — the palmar cutaneous branch of the median nerve arises proximal to the tunnel and passes over the retinaculum
- The little finger is normal, because it is ulnar territory. Numbness of the whole hand excludes the diagnosis
Marking guide: boundaries 2 · nine tendons and median nerve 2 · what is excluded 1 · symptoms 1 · thenar sparing explained 1.
4
Give the nerve supply of the anterior compartment of the forearm, including the exceptions.
6′
General rule
The median nerve supplies the anterior (flexor) compartment of the forearm.
Muscles by layer
- Superficial: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris (and brachioradialis by position)
- Intermediate: flexor digitorum superficialis
- Deep: flexor pollicis longus, flexor digitorum profundus, pronator quadratus
The exceptions — where the marks are
- Flexor carpi ulnaris — ulnar nerve
- Medial (ulnar) half of flexor digitorum profundus — ulnar nerve
- Brachioradialis — radial nerve, despite lying in the anterior forearm
The deep muscles flexor pollicis longus, the lateral half of flexor digitorum profundus and pronator quadratus are supplied by the anterior interosseous branch of the median nerve.
The pattern mirrors the hand, where the ulnar nerve supplies all the intrinsic muscles except the thenar group and the two lateral lumbricals.
Marking guide: general rule 1 · layers named 2 · two ulnar exceptions 2 · brachioradialis exception 1.
5
Describe the arteries of the forearm.
6′
Division
The brachial artery divides in the cubital fossa, at the level of the neck of the radius, into the radial and ulnar arteries.
Radial artery
- Runs down the lateral side of the forearm, relatively superficial, lying on bone at the wrist
- The radial pulse is palpated lateral to the tendon of flexor carpi radialis
- Passes through the anatomical snuffbox and enters the palm to form the deep palmar arch
Ulnar artery
- Runs down the medial side deep to the flexor muscles, with the ulnar nerve on its medial side
- Gives off the common interosseous artery near its origin, which divides into the anterior and posterior interosseous arteries on either side of the interosseous membrane
- Passes superficial to the flexor retinaculum and forms the superficial palmar arch
Clinical point
Because the two arteries anastomose through the palmar arches, either can usually supply the whole hand. Allen's test confirms this before radial artery cannulation or harvest for coronary bypass.
Marking guide: division and level 1 · radial course and arch 2 · ulnar course and arch 2 · Allen's test or interosseous branches 1.