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Human Anatomy MSc Sheffield - trunk and limb > 1st year medicine anatomy questions > Flashcards

1st year medicine anatomy questions Flashcards

1
Q

<p>How do we count inter-costal spaces in the living?</p>

A

<p>Feel for the ridge between the manubrium and body of the sternum. feel laterally and you will feel a costal cartilage, this is the second cartilage. Count the ribs up and down from here.</p>

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2
Q

<p>What happens if the valves are incompetent?</p>

A

<p>During ventricular systole blood some of the blood flow backwards through the valve into the atria. This will make a noise heard as a heart murmer and can over load the atria.</p>

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3
Q

<p>What is the purpose of having cartilage in the trachea and bronchi?</p>

A

<p>In the trachea above the first rib – it stops the airway collapsing on inspiration.</p>

<p>In the airways below the first rib (in the chest), it stops the airways collapsing on forced expiration.</p>

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4
Q

<p>Do the trachea and bronchi have muscle in them?</p>

A

<p>Yes, to alter the calibre of the airways.</p>

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5
Q

<p>Where would you listen to theupper lobe of a lung?</p>

A

<p>Anteriorly high up on the chest wall.</p>

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6
Q

<p>Where would you listen to the right middle lobe?</p>

A

<p>5th intercostal space just to the right of the sternum.</p>

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7
Q

<p>Name three of the abdominal organs that the lung overlaps</p>

A

<p>Liver, spleen, upper poles of the kidneys (just), adrenal glands, stomach</p>

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8
Q

<p>How do you distinguish between the vessels at the hilum of the lung?</p>

A

<p>Bronchus has cartilage in the wall. The pulmonary artery is thicker walled and usually superior. The pulmonary veins are thinner walled and tend to be posterior.</p>

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9
Q

<p>How many pairs of ribs are there?</p>

A

<p>12</p>

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10
Q

<p>What are the contents of the intercostal space?</p>

A

<p>Intercostal artery, vein and nerve.</p>

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11
Q

<p>What connects the ribs to each other?</p>

A

<p>The intercostals muscles.</p>

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12
Q

<p>What bones do the ribs articulate with?</p>

A

<p>The sternum at the front and the thoracic vertebrae at the back</p>

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13
Q

<p>Do bronchioles have cartilage in their walls?</p>

A

<p>NO</p>

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14
Q

<p>What happens to the vertical diameter of the thoracic cavity when the diaphragm contracts?</p>

A

<p>It increases because the diaphragm is pulled downwards.</p>

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15
Q

<p>What happens to the transverse diameter of the thoracic cavity when the intercostals muscles contract?</p>

A

<p>It increases by lifting the lower ribs upwards towards the first rib which is fixed.</p>

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16
Q

<p>Which morphology has the greatest power?</p>

A

<p>Multipennate muscles</p>

<p></p>

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17
Q

<p>Which morphology can pull the furthest distance?</p>

A

<p>Strap muscles</p>

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18
Q

<p>Where does the pectoralis major muscle insert?</p>

A

<p>The humerus</p>

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19
Q

<p>Describe the terms origin and insertion in muscle?</p>

A

<p>Origin is where the muscle starts, usually it does not move when the muscle contracts (eg. the ribs for pectoralis major). Insertion is where the muscle ends, it usually does move when the muscle contracts (eg. humerus for pectoralis major).</p>

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20
Q

<p>Where does the lymphatics of the breat drain into?</p>

A

<p>Lateral half to the axillary lymph nodes, medial half to internal mammary lymph nodes (in the chest).</p>

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21
Q

<p>What are accessory muscles of respiration?</p>

A

<p>Muscles which are not usually used in respiration (breathing) but which can be used during respiratory distress, such as asthma.</p>

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22
Q

<p>What is the ligamentum arteriosum?</p>

A

<p>It is the reminant of the embryological shunt between the pulmonary artery and the aorta.</p>

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23
Q

<p>Does the vagus nerve enter the abdomen?</p>

A

<p>Yes, passing through the oesophageal hiatus in the diaphragm.</p>

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24
Q

<p>What are the surface markings of the heart (right border and the apex)?</p>

A

<p>a) right border of the heart – right sternal edge</p>

<p>b) the apex of the heart 5th intercostals space mid-clavicular line.</p>

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25
Q

<p>Where is the SAN?</p>

A

<p>A ‘large’ crescent shaped area on the crista terminalis at the superior border of the right atrium (the crista terminalis is where the smooth and trabeculated parts of the right venous chamber meet.</p>

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26
Q

<p>Where is the AV node?</p>

A

<p>Small nodule just above the septal cusp of the trisuspid valve in the inter-atrial septum.</p>

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27
Q

<p>What is the thoracic duct? Where does it join the CVS?</p>

A

<p>The channel draining all the lymph from the Gastrointestinal tract back to the blood stream. The left subclavian vein.</p>

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28
Q

<p>Which is the lowermost palpable costal cartilage?</p>

A

<p>T10</p>

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29
Q

<p>Where is the subcostal plane?</p>

A

<p>Horizontally from the lower border of the tenth costal cartilage.</p>

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30
Q

<p>What is the transpyloric plane?</p>

A

<p>A horizontal plane through L1 vertebra. On the anterior abdominal wall it passes through the ninth costal cartilage which is also where the lateral border of the rectus sheath crosses the costal margin.</p>

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31
Q

<p>What lies in the transpyloric plane?</p>

A

<p>Gall bladder, hilum of the right kidney, second part of the duodenum, head of the pancreas, pylorus, body of the pancreas, hilum of the spleen.</p>

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32
Q

<p>What are the dermatomes of the anterior abdominal wall?</p>

A

<p>T6-T12, T10 round the unbilicus</p>

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33
Q

<p>What is the surgical importance of the tendinous intersections?</p>

A

<p>They allow the rectus muscle to be divided (to allow operations on the abdominal contents) with out the muscle completely retracting to its each end of the rectus sheath.</p>

<p></p>

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34
Q

<p>What are the contents of the rectus sheath?</p>

A

<p>Rectus muscle, inferior epigastric artery and vein, superior epigastric artery and vein, sympathetics nerves (with the arteries), lymphatics (follow the arteries backwards), terminal branches of spinal nerves.</p>

<p></p>

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35
Q

<p>What structures are supplied by the internal thoracic artery?</p>

A

<p>Anterior chest wall as far laterally as the midclavicular line, the medial breast, the anterior abdominal; wall down to the umbilicus and as far laterally as the lateral edge of the rectus sheath.</p>

<p></p>

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36
Q

<p>Where does the inferior epigastric artery come from?</p>

A

<p>External iliac artery</p>

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37
Q

<p>What is the arcuate line?</p>

A

<p>The lower limit of the posterior rectus sheath</p>

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38
Q

<p>What travels in the free border of the lesser omentum?</p>

A

<p>Common bile duct, hepatic artery, portal vein.</p>

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39
Q

<p>What is pringles manoeuvre?</p>

A

<p>Passing a finger into the lesser sac through the epiploic foramina and compressing the portal trad to stop blood flowing into the liver.</p>

<p></p>

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40
Q

<p>With a patient in the supine position, where would fluid collect in the abdomen?</p>

A

<p>Right retrohepatic space.</p>

<p></p>

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41
Q

<p>What did the ligamentum teres used to be?</p>

A

<p>Umbilical vein</p>

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42
Q

<p>What structures surround the epiploic foramen?</p>

A

<p>Anteriorly; the free edge of the lesser omentum</p>

<p>Posteriorly; Inferior vena cava</p>

<p>Inferiorly; duodenum</p>

<p>Superiorly; caudate lobe of the liver</p>

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43
Q

<p>What connects the jejunum to the posterior abdominal wall?</p>

A

<p>Small bowel mesentry</p>

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44
Q

<p>What parts of the large bowel and in mesentery?</p>

A

<p>Transverse colon and sigmoid colon</p>

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45
Q

<p>What is the arrangement of the vessels in the liver hiatus?</p>

A

<p>Hepatic ducts, hepatic arteries, portal vein (at the back)</p>

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46
Q

<p>What are the sides of Calot's triangle?</p>

A

<p>Side one; right hepatic and common hepatic duct</p>

<p>Side two; gall bladder and cystic duct</p>

<p>Side three; the liver</p>

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47
Q

<p>What are the contents of Calot's triangle?</p>

A

<p>A lymph node</p>

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48
Q

<p>What does the cystic artery come from?</p>

A

<p>A lymph node</p>

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49
Q

<p>What structures are in the porta hepatis?</p>

A

<p>Hepatic arteries, hepatic ducts, portal vein, lymphatics, sympathetic nerves (follow the artery)</p>

<p></p>

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50
Q

<p>Where is the bare area of the liver?</p>

A

<p>Under the tendinous part of the right hemidiaphragm.</p>

<p></p>

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51
Q

<p>What is the surface marking of the fundus of the gall bladder?</p>

A

<p>Tip of the ninth costal cartilage, where the lateral edge of the rectus sheath joins the costal margin</p>

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52
Q

<p>Where do the hepatic veins drain?</p>

A

<p>Inferior vena cava</p>

<p></p>

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53
Q

<p>Where is the coronary ligament?</p>

A

<p>It is where the visceral peritoneum reflects onto the diaphragm at the bare area of the liver.</p>

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54
Q

<p>How do you identify the pylorus?</p>

A

<p>Thickenned, has a small artery running across it.</p>

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55
Q

<p>Which nerve lies in front of the abdominal oesophagus and which one behind?</p>

A

<p>Left vagus in front, right vagus behind.</p>

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56
Q

<p>What is the blood supply of the stomach?</p>

A

<p>Coelic axis; left gastric (lesser curve from oesophagus down), right gastric (lesser curve from duodenum up), right gastroepiloic (greater curve duodenum up), left gastroepiploic (greater curve spleen down), short gastrics (fundus)</p>

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57
Q

<p>Which structure goes through the diaphragm with the oesophagus?</p>

A

<p>Right and left vagus and inferior oesophageal artery and vein.</p>

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58
Q

<p>Which structures does the left gastric artery supply?</p>

A

<p>Superior part of the lesser curve of the stomach and the lower 1/3 of the oesophagus.</p>

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59
Q

<p>What is the nerve supply of the stomach?</p>

A

<p>Somatic; none</p>

<p>Parasympathetic; vagus</p>

<p>Sympathetic; greater splanchnic nerve, from T5 to T9.</p>

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60
Q

<p>Which structure attaches the stomach to the liver?</p>

A

<p>Lesser omentum</p>

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61
Q

<p>Which structure lies in front of the stomach?</p>

A

<p>Left lobe of the liver, abdominal wall.</p>

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62
Q

<p>Which structures lie behind the stomach?</p>

A

<p>Pancreas, splenic artery and vein, diaphragm.</p>

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63
Q

<p>Where does the jejunum and ileum blood supply drain?</p>

A

<p>Superior mesenteric vein</p>

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64
Q

<p>What structures does the root of the small bowel mesentery cover?</p>

A

<p>Aorta, inferior vena cava, right ureter, right gonadal vein and artery.</p>

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65
Q

<p>How do the arterial arcades of the jejunum and ileum differ?</p>

A

<p>Jejunum, long and single; ilium, short and multiple</p>

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66
Q

<p>What food is absorbed through the lymphatic system?</p>

A

<p>Fats</p>

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67
Q

<p>What is the innervation of the small bowel?</p>

A

<p>Somatic; None</p>

<p>Sympathetic; lesser splanchnic nerve from T10-T11,</p>

<p>Parasympathetic; vagus (cranial nerve X)</p>

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68
Q

<p>Which four mechanisms ensure a high surface area of the bowel for maximum absorption?</p>

A

<p>Coiled length, plicae circularis, Villi, micrvilli.</p>

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69
Q

<p>Which artery normally supplies the descending colon?</p>

A

<p>Left colic branch of the middle colic superiorly and left colic branch of the inferior mesenteric inferiorly.</p>

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70
Q

<p>What is the significance of the wandering artery of Drummond?</p>

A

<p>It is an anastomosis between the middle colic and sigmoid arteries, if the inferior mesenteric artery occludes slowly (eg. With atheroma) then the superior mesenteric artery takes over the blood supply of the hind gut through this artery.</p>

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71
Q

<p>What is the blood supply of the appendix?</p>

A

<p>Appendicular artery; a branch of the ileal artery.</p>

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72
Q

<p>How do you distinguish large intestine from small intenstine?</p>

A

<p>Large bowel has teniae coli, appendices epiploicae, position, haustrations, calibre (but not reliable in disease).</p>

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73
Q

<p>Which artery lies behind the first part of the duodenum?</p>

A

<p>The gastro-duodenal artery</p>

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74
Q

<p>What are the sites of porto-systemic anastomosis? What is their clinical importance?</p>

A

<p>Between tributaries of the left gastric vein and the azygos vein in the lower third of the oesophagus (forms oesophageal varices), between tributaries of the superior rectal vein and the anal veins (drain to the internal iliac veins) in the anal canal (form haemorrhoids).</p>

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75
Q

<p>How is the common bile duct formed and what is its course?</p>

A

<p>From the confluence of the cystic duct and the common hepatic duct. It runs in the free border of the lesser omentum, passes posterior to the first part of the duodenum and into the substance of the pancreas, it curves to the right to enter the duodenum at the Ampulla of Vater along side the pancreatic duct.</p>

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76
Q

<p>Where is the sphincter of Oddi?</p>

A

<p>Between the second and third parts of the duodenum on the left wall, about 5cm distal to the pylorus in the adult.</p>

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77
Q

<p>Where does the splenic vein join the superior mesenteric vein?</p>

A

<p>Behind the neck of the pancreas.</p>

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78
Q

<p>What is the duodenal cap?</p>

A

<p>The highest part of the duodenum, the first part.</p>

<p></p>

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79
Q

<p>How many pancreatic ducts are there?</p>

A

<p>Two; the pancreas forms from an anterior and posterior bud from the gut tube, each bud has its own duct. During development the buds rotate and fuse, trapping the superior mesenteric artery between the two.</p>

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80
Q

<p>What is the difference between a male and female pelvis?</p>

A

<p>Female, Thinner bone and lighter, Oval inlet, wide shallow true pelvis, outlet large, ishial spines point parallel to outlet, wide angle at inferior pubic symphysis. Male, thicker bone heaver build, heart shaped inlet, small outlet with ishial spines pointing into outlet, narrow angle at inferior pubic symphysis.</p>

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81
Q

<p>What makes the sacroiliac joint strong?</p>

A

<p>High contact area between the bones. Interlocking surfaces. Fibrous connection between the bones within the joint space. Strong surrounding ligaments.</p>

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82
Q

<p>What is the perineum?</p>

A

<p>The area below (superficial to) the levator ani muscle.</p>

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83
Q

<p>What is an epidural and how does it differ from a lumbar puncture?</p>

A

<p>An epidural involves the injection of a substance (analgesia/anaesthesia etc) into the epidural space anywhere along the vertebral column. Whereas in a lumbar puncture a hollow needle is inserted below the level of the spinal cord into the subarachnoid space in order to remove Cerebro-Spinal Fluid for diagnostic purposes.</p>

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84
Q

<p>Does the subarachnoid space end where the spinal cord does?</p>

A

<p>NO! It extends down to the lower sacrum</p>

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85
Q

<p>What does the ligamentum flavum do?</p>

A

<p>Connects adjacent laminae</p>

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86
Q

<p>What fibres does the dorsal ramus contain?</p>

A

<p>It carries visceral motor, somatic motor, and sensory information to and from the skin and deep muscles of the back</p>

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87
Q

<p>Why are the articular surfaces of the cervical facets horizontal?</p>

A

<p>The articular surfaces of the cervical facet joints are horizontal so that dislocation can occur without fracture.</p>

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88
Q

<p>Where does radicular arteries enter the vertebral canal?</p>

A

<p>They enter the vertebral canal through the intervertebral foramina.</p>

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89
Q

<p>What is a dermatome?</p>

A

<p>A dermatome is that area of skin supplied by a single spinal nerve, there will be two dermatomes for each vertebral level, one on each side! </p>

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90
Q

<p>What is the dermatome of the thumb?</p>

A

<p>C6</p>

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91
Q

<p>What is the dermatome of the nipple line?</p>

A

<p>T4</p>

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92
Q

<p>What is the dermatome of the knee?</p>

A

<p>L3</p>

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93
Q

<p>What is the dermatome of the big toe?</p>

A

<p>L5</p>

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94
Q

<p>What is the arterial supply of the spinal cord?</p>

A

<p>The blood supply of the spinal cord is derived from the anterior and posterior spinal arteries. The anterior spinal arteries supply the cord in front of the posterior grey column. The posterior spinal arteries supply the posterior grey columns and the dorsal columns.</p>

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95
Q

<p>What are the two parts of the intervertebral disc?</p>

A

<p>The two parts are the annulus fibrosus and nucleus pulposus. The nucleus pulposus is at the center of the disc and has a jelly consistency, the annulus fibrosus is formed from dense fibrous tissue and hyaline cartilage and surround the nucleus pulposus.</p>

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96
Q

<p>What structures make up the intervertebral foramina?</p>

A

<p>The intervertebral foramina are on the lateral aspect of the vertebral column and lie between the pedicles of adjoining vertebrae. They are bounded anteriorly by the vertebral bodies and the disc and posteriorly by the facet joints.</p>

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97
Q

<p>A stroke where would causeataxia (lack of control over voluntary movement)?</p>

A

<p>Cerebellar ataxia can arise from a posterior circulation stroke. Thestroke will affect the vertebral or basilar arteries. The Superior cerebellar arteries and the anterior inferior cerebellar arteries stem from the basilar artery, and the posterior inferior cerebellar arteries originate from the vertebral arteries.</p>

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98
Q

<p>A stroke where would cause hemianopia?</p>

A

<p>An Hemianopia would occur from a stroke affecting the visualpathways from the optic chiasm onwards to the occipital lobe. The most likely type would be a homonymous hemianopia which wouldoccur from an occlusion of the Posterior cerebral artery, therefore aposterior circulation stroke would be more likely.</p>

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99
Q

<p>A stroke where would cause motor weakness?</p>

A

<p>Motor weakness can occur from any stroke that affects the motor cortex or motor tracts of the brain and spinal cord. The anterior and middle cerebral arteries supply the primary motor cortex, this means that strokes of the anterior circulation will produce motor weakness. However, as the corticospinal tracts have to through the brainstem and spinal cord, a stroke affecting the brainstem could also produce weakness, therefore as the basilar arteries supply the brainstem a posterior circulation stroke could also produce motor weakness</p>

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100
Q

<p>A stroke where would make you unable to speak words?</p>

A

<p>Expressive aphasia will occur from a stroke of the artery supplyingBrocca’s area in the frontal lobe of the brain. In right handed people Brocca’s area is almost always on the left so is supplied by the Left middle cerebral artery, so it is an anterior circulation stroke. In left handed people Brocca’s area is on the right in about 60% and left in 40%.</p>

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101
Q

<p>A stroke where would make you unable to understand speech?</p>

A

<p>Receptive aphasia occurs in strokes involving Wernicke’s area, whichis also supplied by the middle cerebral artery, so this is also in theanterior circulation</p>

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102
Q

<p>A stroke where would cause cranial nerve impairment?</p>

A

<p>Cranial nerve involvement will occur in strokes affecting the midbrain, pons and medulla, which are supplied by the posterior circulation.</p>

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103
Q

<p>What lobe is the hippocampus in?</p>

A

<p>Temporal lobe</p>

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104
Q

<p>What lobe is the amygdala in?</p>

A

<p>Temporal lobe</p>

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105
Q

<p>Where do headaches arise from?</p>

A

<p>Pain can arise from the Meninges, head and neck muscles and cranial/spinal nerves. Although the brain itself does not have any pain receptors, the large blood vessels of the brain do carry sympathetic nerve fibers which may transmit pain.</p>

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106
Q

<p>How does the internal carotid artery enter the brain?</p>

A

<p>Enters the skull via the carotid canal then travels horizontally through the temporal bone to enter the cranium through the foramen lacerum.</p>

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107
Q

<p>What bone does the optic nerve come through to enter the brain?</p>

A

<p>Enters through the optic canal in the lesser wing of the sphenoid bone.</p>

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108
Q

<p>Where does the facial nerve exit the cranium?</p>

A

<p>Exits the cranium through the internal acoustic meatus in the petrous part of the temporal bone and emerges from the skull through the stylomastoid foramina.</p>

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109
Q

<p>How does the oculomotor nerve enter the brain?</p>

A

<p>Enters the orbit via the superior orbital fissure between the greater and lesser wings of the sphenoid bone.</p>

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110
Q

<p>Which artery supplies the visual cortex?</p>

A

<p>The visual cortex is located in the occipital lobe of the brain. The occipital lobe is supplied by the posterior cerebral arteries.</p>

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111
Q

<p>How would the eye look if there was a lesion on the oculomotor nerve?</p>

A

<p>The oculomotor nerve supplies all extraocular muscles except superior oblique and lateral rectus. A lesion to the oculomotor nerve would result in unopposed action of superior oblique and lateral rectus forcing the eye to look downwards and outwards. The eye will be fixed in this position.</p>

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112
Q

<p>What do the suspensory ligaments do in the accomodation reflex (looking at a near object)?</p>

A

<p>They would weaken because the lens needs to be more convex to shorten its focal length.</p>

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113
Q

<p>What do the pupils do during the accomodation reflex?</p>

A

<p>The pupils constrict to prevent divergent light rays from hitting the periphery of the retina and producing a blurred image.</p>

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114
Q

<p>Do the eyes converge during the accomodation reflex?</p>

A

<p>YES</p>

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115
Q

<p>What happens to the accomodation reflex if there is a lesion to the oculomotor nerve?</p>

A

<p>It is abolished because we losemotor control</p>

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116
Q

<p>Where do the majority of the fibres in the corticospinal tract decussate?</p>

A

<p>80% of the corticospinal tract decussate in the medullary pyramids and travel in the lateral corticospinal tract. 10% join the ipsilateral lateral corticospinal tract and 10% travel in the anterior corticospinal tract and cross in the spinal cord.</p>

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117
Q

<p>What fibres do the superior peduncles carry?</p>

A

<p>Efferent fibres from the dentate, emboliform and globose nuclei. These axons send feedback to the motor cortex in the frontal lobe.</p>

<p>Afferent fibres from the ventrospinocerebellar tract take ‘unconscious proprioceptive’ information from the lower body.</p>

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118
Q

<p>What fibres are carried in the middle peduncles?</p>

A

<p>Corticopontocerebellar information. A copy of the information from the primary motor cortex which the pyramidal tract is carrying down to lower motor neurons.</p>

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119
Q

<p>What fibres does the inferior peduncle carry?</p>

A

<p>Vestibulocerebellar tract (vestibular impulses from labyrinths, directly and via the vestibular nucleus. Also ‘unconcious proprioceptive’ information from the dorsospinocerebellar tract.</p>

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120
Q

<p>What is the blood supply to the cerebellum?</p>

A

<p>Posterior inferior cerebellar arteries from the vertebral arteries</p>

<p>Anterior inferior cerebellar arteries from the basilar artery</p>

<p>Superior cerebellar arteries from the basilar artery</p>

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121
Q

<p>What is the function of the dentate nucleus? Where do it's fibres go?</p>

A

<p>The dentate nucleus is responsible for the planning, initiation and control of voluntary movements.<br></br>Efferent fibres travel via the superior cerebellar peduncles through the red nucleus to the thalamus.</p>

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122
Q

<p>What fibres does the vermis receive?</p>

A

<p>It receives fibres from the dorsal and ventral spinocerebellar tracts carrying information from muscle, joint and cutaneous receptors through the inferior and superior cerebellar peduncles respectively.</p>

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123
Q

<p>What term do we use for the white matter that connects the cortex of the cerebral hemisphere to other structures?</p>

A

<p>This particular white matter is known as the internal capsule.</p>

124
Q

<p>What makes up the papez circuit and what does it do?</p>

A

<p>The papez circuit consists of the hippocampus, fornix, mammillarybodies, cingulate gyrus, thalamus, singulum and parahippocampalgyrus.</p>

<p>The papez circuit is involved in memory, emotions or emotional memory</p>

125
Q

<p>Would a direct inguinal hernia be medial or lateral to the inferior epigastric artery?</p>

A

<p>Medial to the inferior epigastric artery</p>

126
Q

<p>How many layers of spermatic fascia cover an indirect hernia?</p>

A

<p>Three once it is through the superficial inguinal ring.</p>

127
Q

<p>Where would you palpate the ductus deferens? By palpation alone, how would you identify the ductus deferens?</p>

A

<p>In the spermatic cord between the upper pole of the testis and the superficial inguinal ring. Hard, incompressible cord.</p>

128
Q

<p>What is a varicocele?</p>

A

<p>Dilated veins in the pampiniform plexus.</p>

129
Q

<p>What anatomical feature would you use to distinguish between inguinal and femoral hernias?</p>

A

<p>Inguinal hernias pass above and medial to the pubic tubercle and down into the scrotum. Femoral hernias arise below and lateral to the pubic tubercle and pass vertically down into the thigh, they are entirely below the inguinal ligament.</p>

130
Q

<p>Where would you try to palpate lymph nodes to assess the spread of testicular cancer?</p>

A

<p>In the epigastrium. Remember that as a rule lymphatics follow the arteries backwards, hence the lymphatics from the testis follow the testicular artery back to theupper abdominal aorta in the epigastrium.</p>

131
Q

<p>Testicular pain may radiate to the loin. Why?</p>

A

<p>The nocioceptive (nasty sensation) nerve fibers to the testis are sympathetic and follow the testicular artery from the aortic sympathetic plexus which is formed from the T11 and T12 nerve roots.</p>

132
Q

<p>Where might you look for an undescended testis? Is it worth surgically correcting this anomaly?</p>

A

<p>It may be found anywhere along the line of descent from the lower pole of the kidney, down the posterior abdominal wall, through the inguinal canal. It must be corrected if sperm production is to occur normally.</p>

133
Q

<p>What anatomical structure in the glans penis might impede the progress of a catheter?</p>

A

<p>Navicular fossa</p>

134
Q

<p>Which nerves provide sensory innervation to the scrotal skin?</p>

A

<p>Anterior 1/3 – ilioinguinal nerve<br></br>Posterior 2/3 – perineal nerves and branches from the posterior nerve of the thigh</p>

135
Q

<p>Renal tumors can become very large before they invade adjacent structures. What anatomical features explain this?</p>

A

<p>Fibrous capsule (inner layer) closely applied to the renal substance, perirenal fat, renal fascia (encloses the kidney and adrenal glands together), pararenal fat. So the tumor has to grow through multiple tough layers before invading adjacent structures.</p>

136
Q

<p>Describe at least two common variations in the anatomy of the renal pelvis and ureter.</p>

A

<p>Duplex system, pelvoureteric junction obstruction.</p>

137
Q

<p>What veins do the right and left gonadal veins drain into?</p>

A

<p>Right into the Inferior vena cava, left into the left renal vein</p>

138
Q

<p>What is a polar artery? Explain why polar arteries exist.</p>

A

<p>An accessory renal artery usually supplying the lower pole of the kidney. Thekidney develops as a number of separate kidneys which fuse together during development, if this fusion is incomplete duplex kidney can occur or part of the kidney can have a separate blood supply.</p>

139
Q

<p>Where would you palpate an abdominal aortic aneurysm?</p>

A

<p>In the epigastrium (above the umbilicaus).</p>

140
Q

<p>What features of the ureter aid its identification at operation?</p>

A

<p>Position, writhes like a worm when touched</p>

141
Q

<p>At what sites does the ureter narrow (sites where renal stones may arrest)?</p>

A

<p>Pelvoureteric junction, over iliac vessels, entering the bladder</p>

142
Q

<p>Why is the ureter in danger of being damaged during a hysterectomy (removal of the uterus)?</p>

A

<p>The ureter runs immediately under the uterine artery which needs to be ligated during hysterectomy. (Water under the bridge)</p>

143
Q

<p>Give a brief account of the nervous control of micturition (urination).</p>

A

<p>Sensory input from bladder to spinal cord through parasympathetic nerves toS2,3,4, tells the cord and brain that the bladder if filling. Spinal reflex passes some of these signals to the motor parasympathetic nerves which supply the detrusor muscle and inhibit the internal urethral sphincter. If it is not socially convenient to urinate brain inhibits these impulses. When in toilet (hopefully) brain stops inhibition and parasympathetic motor nerves via s2,3,4 cause detrusor muscle to contract and internal sphincter to relax.</p>

144
Q

<p>Where does the arterial blood supply to the bladder come from?</p>

A

<p>Internal iliac arteries</p>

145
Q

<p>Explain why inflammation of the ovary may cause pain along the medial aspect of the thigh.</p>

A

<p>The ovary sits along side the lateral pelvic side wall where the obturator nerve runs, irritation of the nerve leads to medial thigh pain as a REFERRED pain.</p>

146
Q

<p>What is a retroverted uterus?</p>

A

<p>The uterus normally lies tilted forwards over the bladder, retroversion is when itlies backwards impinging on the anterior wall of the rectum.</p>

147
Q

<p>What factors maintain the normal position of the uterus?</p>

A

<p>Tone in the levator ani muscles</p>

<p>Transverse cervical ligaments (cardinal)</p>

<p>Pubocervical ligaments</p>

<p>Sacrocervical ligaments Broad ligaments</p>

148
Q

<p>To which lymph nodes would cervical cancer spread?</p>

A

<p>Internal iliac</p>

149
Q

<p>What structures are palpable during vaginal examination?</p>

A

<p>Anteriorly, base of bladder, urethra, lower ureters (if they contain a stone)</p>

<p>Laterally, ureter, levator ani muscle, ovary by bimanual palpation</p>

<p>Posteriorly, rectum, Pouch of Douglas, perineal body.</p>

150
Q

<p>Outline the signs and symptoms produced by an enlarged prostate gland. How would you determine that the prostate was enlarged?</p>

A

<p>Symptoms, poor stream, terminal dribbling, hesitancy, nocturia, frequency.</p>

<p>Signs, large prostate on rectal examination</p>

151
Q

<p>What are the lobes of the prostate gland? Which lobes are more prone to malignant tumours? Is this the same for benign tumours?</p>

A

<p>Malignant - lateral lobes</p>

<p>Benign – median lobe</p>

152
Q

<p>Would urine from a ruptured penile urethra enter the superficial or deep perineal pouch?</p>

A

<p>Superficial perineal pouch</p>

153
Q

<p>List in sequence the tubular structures along which spermatozoa pass to the exterior following onset of ejaculation.</p>

A

<p>Epididymis, vas deferens, ejaculatory duct, prostatic urethra, membrinous urethra, penile urethra.</p>

154
Q

<p>What nerve supplies the anterior compartment of the thigh?</p>

A

<p>Femoral nerve</p>

155
Q

<p>What does the obturator nerve supply:</p>

<p>a) adductor longus</p>

<p>b) sartorius</p>

<p>c) obturator internus</p>

<p>d) piriformis</p>

A

<p>The adductor longus</p>

156
Q

<p>Which part of the quadriceps femoris muscle is related to the suprapatellar bursa?</p>

A

<p>The lower part</p>

157
Q

<p>What is the function of the adductor brevis?</p>

A

<p>Prevents forced abduction of the thigh</p>

158
Q

<p>What is the surface marking of the saphenous opening?</p>

A

<p>Two finger breadths (4cm in adults) below and lateral to the pubic tubercle. 4cmbelow the inguinal ligament just medial to the femoral pulse</p>

159
Q

<p>What are the tributaries of the great saphenous vein in the saphenous opening?</p>

A

<p>Thesuperficial epigastric vein, superficial external pudendal vein, superficial circumflex iliac vein.</p>

160
Q

<p>What is the iliotibial tract?</p>

A

<p>A thickened lateral aspect of the deep fascia of the leg, the tensor facia lata muscle is inserted into its deep surface. (the fascia lata)</p>

161
Q

<p>What are the function of the iliotibial tract?</p>

A

<p>When standing up straight tension on the iliotibial tract keeps the knee locked straight.</p>

162
Q

<p>What are the boundaries of the femoral triangle?</p>

A

<p>Superiorly-inguinal ligament</p>

<p>Laterally-medial border of sartorius muscle</p>

<p>Medially- lateral border of adductor longus muscle.</p>

163
Q

<p>What are the contents of the femoral sheath?</p>

A

<p>Femoral artery and vein, lymphatics</p>

164
Q

<p>Is the femoral artery pulsation palpable? If so, where do you feel the pulsation?</p>

A

<p>Yes, below the mid-inguinal point</p>

165
Q

<p>What is the surface marking of the femoral artery?</p>

A

<p>2cm below the mid-inguinal point in the adult</p>

166
Q

<p>How does the blood reach the femoral artery from the aorta?</p>

A

<p>Common iliac artery -> external iliac artery -> femoral artery</p>

167
Q

<p>Name the branches of the femoral artery?</p>

A

<p>Profunda femoris (deep femoral), superficial femoral, (superficial epigastric artery, superficial external pudendal artery, superficial circumflex iliac artery)</p>

168
Q

<p>Which vein becomes the common femoral vein?</p>

A

<p> Superficial femoral and profunda femoris veins joint to form the common femoral vein</p>

169
Q

<p>How does blood from the femoral vein reach the heart?</p>

A

<p>External iliac vein ->common iliac vein ->inferior vena cava</p>

170
Q

<p>If you do a femoral puncture to take blood from the femoral vein, do you introduce the needle lateral to the femoral artery pulsation or medially?</p>

A

<p>Medially</p>

171
Q

<p>How do you distinguish between the femoral and great saphenous beins when you do a cut down?</p>

A

<p>Great saphenous has valves and lies outside the deep fascia</p>

172
Q

<p>What is the femoral canal?</p>

A

<p>A potential space medial to the femoral vein</p>

173
Q

<p>What does the femoral canal contain?</p>

A

<p>A lymph node and sometimes a hernia</p>

174
Q

<p>What are the boundaries of the femoral canal?</p>

A

<p>Superficial-inguinal ligament</p>

<p>Medial-lacuna ligament</p>

<p>Deep-pectinate line on the superior pubic ramus</p>

<p>Lateral-femoral vein</p>

175
Q

<p>What is a femoral hernia?</p>

A

<p>Protrusion of bowel through the femoral canal</p>

176
Q

<p>Why do femoral hernias often get obstructed or strangulated?</p>

A

<p>The walls of the femoral canal are rigid and do not dilate so the neck of the hernia is tight</p>

177
Q

<p>How is the femoral nerve formed?</p>

A

<p>Femoral plexus, L2-L4 nerve roots</p>

178
Q

<p>What is the motor and sensory supply of the femoral nerve?</p>

A

<p>Medial cutaneous nerve of the thigh -intermediate cutaneous nerves, nerve to sartoriusand pectineus. Saphenous nerve -rectus femoris, sensory to hip and knee.</p>

179
Q

<p>Does the femoral nerve supply joints? If so, which ones?</p>

A

<p>Yes, hip and knee. (RULE: If a nerve supplies a muscle it also supplies the joint thatthe muscle moves, this is true for all nerves)</p>

180
Q

<p>What are the boundaries of the adductor canal?</p>

A

<p>Hamstring part of adductor magnus medially, femur medially, adductor part ofadductor magnus superiorly</p>

181
Q

<p>What passes through the adductor canal?</p>

A

<p>Popliteal vein, to form the superficial femoral vein. Superficial femoral artery, to formthe politeal artery. Posterior division of the obturator nerve</p>

182
Q

<p>What are the functions of the quadriceps?</p>

A

<p>Flex the hip, extend the knee</p>

183
Q

<p>What are the problems produced by a weak quadriceps?</p>

A

<p>Difficulty going DOWN stairs</p>

184
Q

<p>Where is the obturator nerve formed?</p>

A

<p>Femoral plexus, L2-L4 (NB same as femoral nerve)</p>

185
Q

<p>What is referred pain?</p>

A

<p>Pain arising in one area but felt in another area</p>

186
Q

<p>Give some exmples of referred pain in the leg?</p>

A

<p>Sciatica. Pain in medial thigh caused by inflammation of the ovary irritating obturatornerve</p>

187
Q

<p>Where does the bieps femoris muscle insert?</p>

A

<p>Into the head of the fibula</p>

188
Q

<p>What is the function of the hamstring muscles?</p>

A

<p>Extend the thigh at the hip joint</p>

189
Q

<p>What does the sciatic nerve split into?</p>

A

<p>The common perineal and the tibial nerves</p>

190
Q

<p>How do you examine the hamstrings in the living?</p>

A

<p>Active flexion of the knee</p>

191
Q

<p>What muscles insert into the condyle?</p>

A

<p>The semitendinosus, sartorius, semi-membrinosis, gracilis</p>

192
Q

<p>Is the head of the fibula palpable?</p>

A

<p>Yes</p>

193
Q

<p>What is the effect of injury to the common perineal nerve?</p>

A

<p>Failure to extend the ankle joint on the lateral side of the foot, ie. Foot drop</p>

194
Q

<p>What is the relation of the nerve artery and vein in the popliteal fossa?</p>

A

<p>Artery medial, vein lateral</p>

195
Q

<p>How does the popliteal artery reach the popliteal fossa?</p>

A

<p>Through the adductor canal</p>

196
Q

<p>How do you examine the pulsation of the popliteal artery?</p>

A

<p>Knee flexed at 90 degrees finger wrapped round the gastrocnemius muscle, pressingthe artery against the back of the tibia</p>

197
Q

<p>Which superficial vein drains into the popliteal vein?</p>

A

<p>Short saphenous vein</p>

198
Q

<p>Which area of the leg is drained by the superficial short saphenous vein?</p>

A

<p>Back of the calf, lateral side of the foot</p>

199
Q

<p>What are the extensors of the hip joint?</p>

A

<p>Gluteus maximus, medius, hamstrings</p>

200
Q

<p>When do the extensors of the hip joint act?</p>

A

<p>climbing stairs</p>

201
Q

<p>What are the structures passing through the greater sciatic foramen?</p>

A

<p>Sciatic nerve, pudendal nerve, superior and inferior gluteal nerves, posteriorcutaneous nerve of the thigh. Piriformis muscle</p>

202
Q

<p>Wht structures pass through the lesser sciatic foramen?</p>

A

<p>Pudendal nerve, internal pudendal artery and vein, tendon and nerve of obturatorinternus</p>

203
Q

<p>Is the ischial spine palpable in the living? If so, how do you palpate it?</p>

A

<p>Yes, either trans rectally of trans vaginally.</p>

204
Q

<p>When do you abduct the hip joint?</p>

A

<p>When walking</p>

205
Q

<p>What is the usual function of the abductors of the hip joint?</p>

A

<p>To hold the pelvis level when you take one leg off the ground</p>

206
Q

<p>What is Trendelenburg's test?</p>

A

<p>To test if the pelvis remains level (or raises slightly) when the ipsilateral leg is lifted off the ground</p>

207
Q

<p>What is the importance of knowing the surface marking of the sciatic nerve?</p>

A

<p>To avoid it when giving injections into the buttocks</p>

208
Q

<p>What nerve winds round the neck of the fibula?</p>

A

<p>The common peroneal nerve</p>

209
Q

<p>What does complete transection of the common peroneal nerve cause?</p>

A

<p>Foot drop</p>

210
Q

<p>Where does the Achilles tendon insert into?</p>

A

<p>The gastrocnemius, the plateris and thesoleus</p>

211
Q

<p>Does the long saphenous vein cross in front or behind the medial malleolus?</p>

A

<p>In front</p>

212
Q

<p>Give the surface marking of the long saphenous vein until it drains into the femoral vein?</p>

A

<p>Up the medial leg medial to the knee, up the medial thigh onto the anteromedial thighto the sapheno-femoral junction</p>

213
Q

<p>What are the tributaries of the long saphenous veins?</p>

A

<p>All the superficial vein from the foot, leg and thigh EXCEPT the posterior leg andlateral foot which drain into the short saphenous vein</p>

214
Q

<p>What is the venous drainage of the leg?</p>

A

<p>Superficial via the short and long saphenous vein which drain into the popliteal andfemoral veins respectively. The deep veins follow the arteries. The superficial veins communicate with the deep veins via ‘perforators’ which pass through (perforate) the deep fascia. There are multiple valves which only allow blood to flow from the bottom of the leg to the top and from the outside to the inside.</p>

215
Q

<p>Where does the superficial peroneal nerve supply skin sensation?</p>

A

<p>Lower 1/3 anterolateral leg onto the dorsum of the foot,</p>

216
Q

<p>Where does the deep peroneal nerve supply skin sensation?</p>

A

<p>Dorsum of first web space on foot,</p>

217
Q

<p>Where does the saphenous nerve supply skin sensation?</p>

A

<p>Medial side of leg</p>

218
Q

<p>Where does the sural nerve supply skin sensation?</p>

A

<p>Back of leg onto lateral border and sole of foot</p>

219
Q

<p>Where does the posterior cutaneous nerve of the thigh supply skin sensation?</p>

A

<p>Popliteal fossa</p>

220
Q

<p>Where does the tibial nerve supply skin sensation?</p>

A

<p>Medial sole of the foot</p>

221
Q

<p>What is compartment syndrome?</p>

A

<p>Bleeing ,oedema or infection within a compartment causes swelling which results in the pressure in the compartment increasing. Eventually the pressure will exceed venous pressure and blood flow will cease and the compartment will become ischaemic.</p>

222
Q

<p>How do you test for the tibialis anterior?</p>

A

<p>Dorsiflexion at the ankle</p>

223
Q

<p>How do you test for the extensor digitorum longus?</p>

A

<p>Extension of the toes</p>

224
Q

<p>How do you test for the extensor hallucis longus?</p>

A

<p>Extension of the big toe</p>

225
Q

<p>How does the deep peroneal nerve reach the anterior compartment?</p>

A

<p>Between the tibia and fibula above the upper extent of the intercostals membrane</p>

226
Q

<p>What muscle compartment is supplied by the deep peroneal nerve?</p>

A

<p>Anterior compartment of the leg</p>

227
Q

<p>Does the deep peroneal nerve supply skin? If so, where?</p>

A

<p>Yes, first web space on foot</p>

228
Q

<p>What is the anterior tibial artery a branch of?</p>

A

<p>Popliteal artery</p>

229
Q

<p>How does the anterior tibial artery reach the anterior compartment from the lower part of the popliteal fossa?</p>

A

<p>Between the tibia and fibula above the upper extent of the intercostal membrane</p>

230
Q

<p>Where do you palpate the pulsation of the dorsalis pedis artery?</p>

A

<p>Between the first and second metatarsal</p>

231
Q

<p>What are the actions of the peroneii muscles?</p>

A

<p>Eversion of the foot</p>

232
Q

<p>How do you test for the peroneii muscles in the living?</p>

A

<p>Eversion against resistance</p>

233
Q

<p>How does a bone get it's blood supply?</p>

A

<p>A nutrient artery and from any muscles attached to it</p>

234
Q

<p>Which leg bone has more muscle attached to it?</p>

A

<p>Fibula</p>

235
Q

<p>Why is the blood supply to the shaft of the ribia relatively poor?</p>

A

<p>Very little muscle attachment</p>

236
Q

<p>Why do fractures of the tibia take longer to heal?</p>

A

<p>Poor blood supply</p>

237
Q

<p>Why are compound fractures more common in the tibia?</p>

A

<p>It is subcutaneous so a little displacement risks piercing the skin in an ‘inside out’ compound fracture.</p>

238
Q

<p>How do you test for the gastrocnemius?</p>

A

<p>Stand on your tip toes</p>

239
Q

<p>What is an ankle jerk?</p>

A

<p>Hit the Achilles tendon with a patellar hammer to acutely stretch the gastrocnemious muscle, this should result in a reflex contraction of the muscle.</p>

240
Q

<p>Which segments of the spinal cord are you testing when you elicit the ankle jerk reflex?</p>

A

<p>S1 and S2</p>

241
Q

<p>Which segments of the spinal cord are you testing when you do the knee jerk reaction?</p>

A

<p>L2, L3 and L4</p>

242
Q

<p>Which muscle compartment is supplied by the tibial nerve?</p>

A

<p>The posterior leg</p>

243
Q

<p>Which do you feel the pulsation of the posterior tibial artery?</p>

A

<p>Just posterior to the tibia at the ankle (back of the medial malleolus)</p>

244
Q

<p>Which muscles support the pelviswhen standing on only one leg?</p>

A

<p>The gluteus medius and minimus</p>

245
Q

<p>In posterior dislocations of the hip which nerve is liable to injury?</p>

A

<p>The sciatic nerve</p>

246
Q

<p>What does the sciatic nerve supply?</p>

A

<p>All the muscles below the knee</p>

247
Q

<p>What accompanies the ligament of the head of the femur in children?</p>

A

<p>The blood supply to the femoral head epiphsis</p>

248
Q

<p>Describe the arterial supply of the head of the femur?</p>

A

<p>In adults comes along the femoral neck from the arteries in the joint capsule. In children from the nutrient artery of the epiphysis</p>

249
Q

<p>What is the usual cause of avascular necrosis of the head of the femur in adults and children?</p>

A

<p>Adults - displaced fracture neck of femur, Children – splipped epiphysis</p>

250
Q

<p>A child with a hip joint disease has pain in the knee joint. Why?</p>

A

<p>Sciatic nerve supplies hip and knee joint, referred pain</p>

251
Q

<p>Describe the bony compartments of the knee joint:</p>

A

<p>Femoral condyles – markedly curved, tibial plateux – almost flat, patella – sesamoid bone within quadriceps muscle.</p>

252
Q

<p>Name the extracapsular ligamentof the hip:</p>

A

<p>Lateral collateral ligament</p>

253
Q

<p>Give the attachments of the tibial and fibrular collateral ligaments</p>

A

<p>Tibial – medial femoral EPIcondyle, medial tibial condyle. Fibula – lateral femoral EPIcondyle, head of the fibula</p>

254
Q

<p>Which collateral ligament of more prone to injury?</p>

A

<p>Medial</p>

255
Q

<p>Outline the functions of the popliteus:</p>

A

<p>It twists the tibia on the femur to unlock the knee joint so that it can be flexed</p>

256
Q

<p>What are the functions of the quadriceps?</p>

A

<p>Extension of the knee (as in kicking a ball), NB rectus femoris also flexes the hip joint, Vastus medialis also stabilizes the patella.</p>

257
Q

<p>List the intracapsular structures of the knee joint?</p>

A

<p>Medial and lateral meniscii, anterior and posterior cruciate ligaments, blood vessels on the cruciate ligaments (these can bleed INTO the joint when the cruciate’s rupture)</p>

258
Q

<p>What are the functions of the cruciate ligaments?</p>

A

<p>Stabilise the knee in the anterior and posterior direction, particularly when the knee is flexed</p>

259
Q

<p>Describe the attachments of the anterior cruciate ligament?</p>

A

<p>Anteriorly on the TIBIA on the intercondylar ridge. Posteriorly on the medial side of the lateral condyle of the femur.</p>

260
Q

<p>Describe the attachments of the posterior cruciate ligament?</p>

A

<p>Posteriorly on the TIBIA on the intercondylar ridge. Anteriorly on the lateral side of the medial condyle of the femur</p>

261
Q

<p>Which is meniscus is more prone to injury? Why?</p>

A

<p>Medial, it is attached to the medial collateral ligament which means it is less able to move within the knee joint. Extreme forces placed through the joint may be transmitted through the meniscus causing a tear, the lateral meniscus, being more mobile can move more freely to avoid damage</p>

262
Q

<p>What the functions of the menisci?</p>

A

<p>They sit on the relatively flat surface of the tibia and conform to the curves of the femoral condyles. They allow some rotation of the joint which would not be possible if the tibia and femur fitted together perfectly</p>

263
Q

<p>What are Bakers cyst, house maids knee and clergy mans knee?</p>

A

<p>They are all clinical presentations of inflammation in different bursae around the knee joint. Bakers; behind the knee, can communicate with the knee joint. Clergymans; infrapatella bursa, from praying. Housemaids; prepatella, from scrubbing floors.</p>

264
Q

<p>Describe the movements of the knee and list the muscles producing them?</p>

A

<p>Flexion; biceps femoris, gracilis, semimembranosis, sartorius, gastrocnemius, plantaris. Extension; quadriceps femoris. Rotation during extension; passive. Rotation during flexion; popliteus to initiate.</p>

265
Q

<p>What is the function of the patella?</p>

A

<p>To transfer the force produced by Quadraceps over the bent knee to the tibia. (If the tendon ran directly over the bone it would be damaged</p>

266
Q

<p>What are the attachments of the patella?</p>

A

<p>Superiorly to the quadriceps and inferiorly to the infrapatella tendon (ligament)</p>

267
Q

<p>how does blood reach the right axillary artery from the left ventricle?</p>

A

<p>Ascending aorta ->brachio-cephalic ->right subclavian ->right axillary artery</p>

268
Q

<p>Outline the arrangement of the cords of the brachial plexus around the second part of the axillary artery?</p>

A

<p>Lateral cord is above and lateral to the artery, posterior cord is behind the artery and the medial cord is below and medial to the artery.</p>

269
Q

<p>What is lymphatic drainage?</p>

A

<p>It is the path lymph takes, along microscopic lymphatic channels, from the bodies tissues back to enter the circulation.</p>

270
Q

<p>Describe the various lymph node groups in the acilla and their clinical significance:</p>

A

<p>Anterior, posterior, medial, apical: anterior sits just deep to the anterior axillary fold which is formed by the pectoralis major, posteriorsits just deep to the posterior axillary fold which is formed by the latissimus dorsii tendon, Medialsits on the chest wall on the medial expent of the axilla, Apical sits just under the vessels and brachial plexus at the apex of the axilla.</p>

271
Q

<p>What parts of the body drain lymph directly into the axillary lymph nodes?</p>

A

<p>The arm, the breast, the body wall below the clavicle as far down as the umbilicus anteriorly and the mid lumbar area posteriorly.</p>

272
Q

<p>In full abduction of the upper limb what happens to the scapula?</p>

A

<p>It rotates forward</p>

273
Q

<p>What are the bony points which are palpable in the region of the shoulder?</p>

A

<p>Subcutaneous clavicle throughout its length, acromian, spine of the scapula, the headof the humerus can be felt deep to deltoid if the muscle is not over developed</p>

274
Q

<p>What are the factors stabilising the shoulder joint?</p>

A

<p>The rotator cuff muscles, biceps tendons, superiorly acromian and its ligaments.</p>

275
Q

<p>Name the muscles forming the rotator cuff. Where are they inserted?</p>

A

<p>Subscapularis – lesser tuberosity of the humerus, infraspinatus – middle facet of thegreater tuberosity of the humerus, supraspinatus – upper facet of the greater tuberosity,teres minor – lower facet of the greater tuberosity.</p>

276
Q

<p>How may the axillary nerve be damaged?</p>

A

<p>Posterior dislocation of the shoulder, fracture of the surgical neck of the humerus</p>

277
Q

<p>What is the extent of damage to the axillary nerve? How do you test for it?</p>

A

<p>Numb patch over the lateral side of the arm adjacent to the insertion of deltoid,paralysis of deltoid and teres minor.</p>

278
Q

<p>Briefly outline the mechanism of abduction of the shoulder?</p>

A

<p>Initiated by Supraspinatus which abducts the humerus on the scapula. Action ofdeltoid then assists supraspinatus and trapezius and the lower fibers of serratus anterior rotate the scapula. For every 2 degree of abduction at the shoulder joint there is one degree of rotation of the scapula.</p>

279
Q

<p>Why should paralysis of CN 11 limit abduction?</p>

A

<p>The trapezius will be paralysed and therefore there will be limited rotation of the scapula.</p>

280
Q

<p>Name 3 muscles supplied by the musculocutaneous nerve?</p>

A

<p>Coracobrachialis, biceps, brachialis.</p>

281
Q

<p>What is the clinical significance of nerves lying close to bones?</p>

A

<p>Fracture of the bones may cause nerve damage or external pressure onto the bone maycause nerve damage.</p>

282
Q

<p>Name 3 nerves closely related to the humerus?</p>

A

<p>Axillary, radial, ulna</p>

283
Q

<p>What is the relation of the median nerve to the brachial artery?</p>

A

<p>In the upper third of the arm nerve lateral to artery. In the anticubital fossa – nervemedial to artery.</p>

284
Q

<p>Name 3 superficial veins of the forearm:</p>

A

<p>Cephalic, Basilic, anticubital.</p>

285
Q

<p>What is the common flexor origin?</p>

A

<p>The medial epicondyle of the humerus where a number of flexors take origin.</p>

286
Q

<p>List the muscles in the superficial group of the forearm and the joint on which they act?</p>

A

<p>Pronator teres – radius, flexor carpi radialis – base of second and third metacarple andthe adjacent carpal bones, palmaris longus – palma fascia, flexor carpi ulnaris,pisiform bone</p>

287
Q

<p>Name three major nerves entering the forearm?</p>

A

<p>Radial, median and ulna</p>

288
Q

<p>Which muscles aresupplied by the median nerve?</p>

A

<p>Supinator, pronator teren and flexor carpi ulnaris respectively.</p>

289
Q

<p>Briefly describe the course of the ulna artery?</p>

A

<p>It arises from the brachial artery superficial to the flexor digitorumprofundus muscle, runs down the forearm between the superficialis and profundus muscles. Distally passes from under the superficial muscle at the wrist to lie between the flexor digitorum superficialis and flexor carpi ulnaris. </p>

290
Q

<p>Describe the course of the radial artery:</p>

A

<p>Itarises from the brachial artery in the anticubital fossa passes superficial to the superficial flexors just under the brachoradialis. Where the brachoradialis terminates on the radius the artery lies on the distal radius.</p>

291
Q

<p>What are the joints between the radius and the ulna?</p>

A

<p>Proximally the synovial radioulna joint communicating with the elbow joint. Distallyalso a synovial joint communicating with the wrist joint.</p>

292
Q

<p>Define pronation:</p>

A

<p>Rotating the forearm from the anatomical position so that the palm of the hand facesbackwards.</p>

293
Q

<p>Define supination:</p>

A

<p>Rotating the forearm so that the palm faces forwards</p>

294
Q

<p>Which muscles produce supination and pronation?</p>

A

<p>Pronation – Pronator teres, pronator quadratus, brachoradialis to the midprone point.</p>

<p>Supination – biceps, supinator, brachoradialis to the midprone point.</p>

295
Q

<p>What is the working postition of the forearm - supinated or pronated?</p>

A

<p>Midprone</p>

296
Q

<p>Which carpal bone is most prone to injury?</p>

A

<p>Scaphoid</p>

297
Q

<p>What is the complication of a scaphoid fracture?</p>

A

<p>Avascular necrosis of the proximal part</p>

298
Q

<p>What structures lie superficial to the flexor retinaculum?</p>

A

<p>Flexor carpi ulnaris tendon ending in the pisiform bone, ulnar nerve, ulna artery, palmar cutaneous nerve of the ulnar nerve, palmaris logus tendon, palmar cutaneous branch of the median nerve.</p>

299
Q

<p>What is the carpal tunnel? What nerve travels through it?</p>

A

<p>An enclosed “tunnel” at the wrist formed from the carpal bones and the flexor retinaculum, any swelling in the carpal tunnel will cause a great increase in pressure here and affect the function of the median nerve which passes through the tunnel.</p>

300
Q

<p>What is the cutaneous distribution of the median and ulnar nerves in the hand?</p>

A

<p>Median; lateral three and a half digits on the palmar side extending onto the dorsal surface of the distal phalanx only and the adjacent palm. Ulna; medial one and a half digits on the palmar and dorsal side extending and the adjacent palm.</p>

301
Q

<p>What are the thenar muscles?</p>

A

<p>The muscles in the hand which act on the thumb: abductor pollicis brevis, flexor pollicis brevis, adductor pollicis, opponens pollicis.</p>

302
Q

<p>What is the nerve supply of the thenar muscles?</p>

A

<p>Median nerve (use your LOAF) First and second Lumbrical, Opponens, Abductor, Flexor. Adductor is supplied by the ulnar nerve</p>

303
Q

<p>How are the lumbricals innervated?</p>

A

<p>Lateral two median nerve, medial two ulnar nerve.</p>

304
Q

<p>Which muscles flexes the distal interphalangeal joint?</p>

A

<p>Flexor digitorum profundus</p>

305
Q

<p>List the muscles supplied by the deep branch of the ulnar nerve?</p>

A

<p>Hypothenar muscles, medial two lumbricals, adductor pollicis, interossei.</p>

Human Anatomy MSc Sheffield - trunk and limb (13 decks)

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