Anatomy Booklet Questions

Question 1

How does contraction of pectoralis major assist in breathing?

Answer 1

The 2 pectoralis muscles form part of a ring of muscles which encircle the thoracic cage; the other muscles forming the ring are SCAPULA muscles. When the ring contracts the thoracic pressure rises to assist exhalation. (This only occurs in disease and during exercise, normal exhalation is a passive process)

Question 2

Which bony structures lie subcutaneously in the anterior chest wall?

Answer 2

Clavicles

Sternum (manubrium, body, xiphi-sternum)

Question 3

What are the articulations of the clavicle?

Answer 3

At the medial end to the manubrium of the sternum; the sternoclavicular joint and at the lateral end to the acromion of the scapula; the acromioclavicular joint.

Question 4

What forms the anterior axillary fold?

Answer 4

The lower edge of the pectoralis major muscle

Question 5

What lies deep to the pectoralis minor muscle?

Answer 5

The axilla

Question 6

The majority of breast tissue is in the upper outer quadrant of the breast. Where does lymph from this part of the breast drain?

Answer 6

To the axillary lymph noes

Question 7

Which costal cartilage connects to the sternum at the sternal angle? (angle of Louis)

Answer 7

2nd costal cartilage

Question 8

Which nerves carry sensation from the parietal and visceral pleura?

Answer 8

The parietal pleura lines the inside of the thoracic wall and is supplied by the same nerves as the tissue of the thoracic wall; the spinal nerves, T1 and T2. The visceral pleura covers the surface of the lung and is supplied by the same nerves as the lung; the vagus and sympathetic nerves.

Question 9

What is a bronchopulmonary segment?

Answer 9

A bronchopulmonary segment has a feeding artery and bronchus which run together through the centre of the segment and repeatedly branch to reach all parts of the segment. The veins which drain the segment run on the surface of the segment rather than through the centre. The ten segments on each side are separate dby layers of connective tissue and the fissures. Each segment is anatomically and functionally seperate and this influences how diseases may spread throughout the lungs.

Question 10

What structures pass through the hilum of the lung?

Answer 10

Main bronchus
Pulmonary artery 
Two pulmonary veins
Bronchial artery
Lymphatic vessels
branches of the vagus and sympathetic nerves

Question 11

How does contraction of the diaphragm assist in returning blood to the heart?

Answer 11

Contraction of the diaphragm decreases intra-thoracic pressure and increases intra-abdominal pressure. The net effect is for blood to flow from the abdomen into the chest.

Question 12

What is the sensory and motor nerve supply to the diaphragm?

Answer 12

Sensory and motor supply are both from the phrenic nerve which arises from the spinal chord at C3, 4, 5 (C345 keeps the diaphrahm alive)

Question 13

What is the surface markings of the lowest extent of the lungs?

Answer 13

At the midclavicular line to lowest part of the lung lies at the tip of the 6th rib, at the mid-axillary line the 8th rib and posteriorly the 10th rib.

Question 14

What is intercostal recession?

Answer 14

When a patient is having difficulty taking a breath in and is having to create very negative pressure in the thorax the intercostal muscles get ‘sucked in’.

Question 15

What is the developmental significance of the ligamentum arteriosum?

Answer 15

It is the remnant of a shunt between the pulmonary artery and aorta. The shunt carries all the blood from the pulmonary artery into the aorta before the lungs have developed and most of the blood after the lungs have developed. At birth it closes so that all the right ventricular blood passes to the lungs.

Question 16

What are the main branches of the following arteries and what organs/tissues do these vessels supply:
1 - left common carotid artery
2 - left subclavian artery

Answer 16

Left common carotid artery
- Internal and external carotid arteries
External -> left side of the face and head
Internal -> most of the cerebral hemispheres

Left subclavian arteries
- Vertebral, thyro-cervical, axillary

Vertebral; cerebellum, brain stem, occipital lobe and the interior temporal lobe

Thyro-cervical; thyroid gland and neck

Axillary; upper limb

Question 17

What are the nerve roots of the phrenic nerve? Why is this clinically important?

Answer 17

C3, 4, 5
Painful diseases affecting the diaphragm are felt by the patient in the side of the neck and onto the shoulder tip which is the dermatome supplied by C345.

Question 18

What structures are supplied by the vagus nerve?

Answer 18

• Pharynx
• Larynx
• Heart
• Lungs
• Fore gut
• Mid gut

Question 19

What are the vessels which connect the heart to other structures?

Answer 19

Aorta
Pulmonary artery 
Four pulmonary veins
Superior vena cava
Inferior vena cava

Question 20

What is the surface marking for the apex of the heart?

Answer 20

5th intercostal space

midclavicular line

Question 21

How may the fibrous pericardium contribute to a reduction in ventricular filling?

Answer 21

Fibrous tissue is resistant to stretching, and so restricts the maximum end diastolic volume. Diseases which ‘take up volume’ in the pericardial sac (E.g. fluid, muscle, hypertrophy etc.) whill reduce diastolic filling and therefore reduce stroke volume. Cardiac output can then only increase by increasing the heart rate. Disease which progress very slowly (over years rather than days) can stretch the pericardium.

Question 22

Describe the anatomy of the tricuspid and mitral valves. What happens if they are incompetent?

Answer 22

Both of these valves have a similar structure with the tricuspid having 3 cusps and the mitral having 2 cusps. The cusps are made of fibrous tissue covered with endothelium and are very flexible. The cusps are attached to a ring of fibrous tissue which forms the orifice between the atrium and ventricle, the myocardium is also attached to this fibrous ring. The free edge of the cusp has multiple tendinous cords attached, the cordi tendini; for each cusp these cords attach to a cylinder of myocardium, the papillary muscle, which contracts during systole to keep the cordi tendini taught.

Question 23

Describe the anatomy of the aortic and pulmonary valves. What happens if they are incompetent?

Answer 23

Both of these valves have a similar structure with both having three cusps. The cusps are made of fibrous tissue covered with endothelium and are very flexibile. The cusps are attached to a ring of fibrous tissue which form the orifice between the ventricle and artery. The free edge of the cusps have a thickening, like a baton in a sail, which helps to shape the valve when it is closed.

Question 24

At what phase of the cardiac cycle do the coronary arteries fill? Why?

Answer 24

Blood flows through the coronary arteries during ventricular dystole. Blood flows from high pressure to low pressure. During ventricular systole the highest pressure is in the ventricular lumen and in the myocardium surrounding the lumen. Pressure in the coronary arteries on the surface of the heart is initially lower so these fill with blood. However, most of the coronary arteries are inside the myocardium where the pressure is highest so these will be squeezed so that they are empty. Blood cannot flow from the surface arteries into the myocardium so there is no flow. During ventricular diastole, pressure in the aorta is high, pressure in the myocardium drops to zero; now the coronary arteries inside the muscle can fill and blood flow occurs.

Question 25

Describe the conducting system of the heart and its function.

Answer 25

The 4 fibrous rings which support the four heart valves form a complete electrical isolation of the ventricles from the atria. In order for the ventricles to contract there has to be a system of carrying the electrical impulse across this barrier. Furthermore, the ventricles need to contrat from the apex towards the aortia and pulmonary valve for maximum efficiency. As a result, the conducting system starts at the atrio-ventricular node, which is positioned in the atrial septum close to the fibrous rings. From the atrio-ventricular node modified myocardium (purkinje fibres) extends into the ventricular septum and travels down to the apex of the heart. In the ventricular septum it divides twice to provide a right bundle to the right ventricle and two bundles (an anterior and posterior) for the left ventricle. The right bundle crosses the lumen of the ventricle as the moderator band.

Question 26

What is the blood supply of the sinoatrial node and the atrioventricular node?

Answer 26

The sino-atrial node is supplied by the right coronary artery in 60% of hearts and the left in 40%. The atrioventricular node is supplied by the posterior intraventricular artery in all hearts. However, in 90% of hearts the posterior intraventricular artery arises from the right coronary artery and in 30% of hearts from the left coronary artery. In 20% of hearts there are 2 posterior intraventricular arteries, one from the left and one from the right.

Question 27

What is the location of the sinoatrial node?

Answer 27

The sinoatrial node is located on the crista terminalis (a ridge of tissue on the inside between the right atrium and right atrial appendage) just where the superior vena cava enters the right atrium.

Question 28

On a chest X-ray, which chambers and vessels form the right and left borders of the cardiac shadow?

Answer 28

Right heart border; right atrium | Left heart border; left auricular appendage superiorly and the left ventricle.

Question 29

What is the thoracic duct and where does it join the vascular system?

Answer 29

The thoracic duct is the main lymphatic channel draining lymph from the lower half of the body and the bowel back to the bloodstream. The bowel component is important because fat is absorbed into the lymphatics so this is the only route for fat absorption. It joins the vascular system at the confluence of the left subclavian and left internal jugular vein.

Question 30

What structures are supplied by the three splanchnic nerves and where does a patient appreciate pain felt by these nerves?

Answer 30

The greater splanchnic nerve supplies the foregut and pain is felt in the epigastrium. The lesser splanchnic nerve supplies the midgut and pain is felt round the umbilicus. The least splanchnic nerve supplies the hindgut and pain is felt in the suprapubic area.

Question 31

What structure lies immediately behind the trachea in the upper thorax and the left atria in the lower thorax?

Answer 31

Oesophagus

Question 32

What structures drain blood into the azygous system?

Answer 32

The lateral and posterior chest wall and the lateral and posterior abdominal wall

Question 33

Why is the left recurrent laryngeal nerve at risk from thoracic disease, but not the right?

Answer 33

The LRL passes into the thorax, round the aortic arch and back into the neck. The RRL does not pass through the thorax.

Question 34

Where do the sympathetic nerves attach to the CNS?

Answer 34

T1 - T12 L1 L2

Question 35

What happens if the sympathetic nerves to the head and neck are damaged?

Answer 35

There will be no sweating on the face (anhidrosis) The eye lid will droop (ptosis) The pupil will be constricted (miosis) Slightly withdrawn eye ball (enopthalmos) Horner's syndrome

Question 36

What is the function of the extrinsic laryngeal muscles? (sternothyroid, thyrohyoid?)

Answer 36

They move the larynx up and down the neck and support its central position, this is particularly important for swallowing.

Question 37

Where may you create an emergency airway?

Answer 37

Between the thyroid and cricoid cartilage, through the cricothyroid membrane.

Question 38

Why does the thyroid gland have such a good blood supply?

Answer 38

Iodine is present in very low conc. in the blood so the gland needs a high blood flow to ensure adequate delivery of iodine.

Question 39

Which structure may be compressed by an enlarged thyroid gland?

Answer 39

trachea

Question 40

What is the location of the parathyroid glands and how many are there?

Answer 40

They are positioned on the posterior surface of the thyroid gland. There are four.

Question 41

What is the only complete cartilage ring around the airway?

Answer 41

The cricoid cartilage.

Question 42

A patient may develop hypocalcaemia after thyroid surgery, why?

Answer 42

The parathyroid glands may be accidentally or deliberately removed during thyroid surgery which will cause acute hypoparathyroidism.

Question 43

What forms the ganglia on the sympathetic chains and vagus nerves?

Answer 43

A collection of neuron cell bodies.

Question 44

What is the name of the fused first thoracic and lower cervical sympathetic ganglia?

Answer 44

The stellate ganglion

Question 45

What structures are supplied by the superior laryngeal nerve?

Answer 45

Sensation to the inside of the larynx down to the vocal cords and the cricothyroid muscle.

Question 46

Which special sensation is carried in the glossopharyngeal nerve

Answer 46

Taste from the posterior 1/3rd of the tongue

Question 47

What is the location of the carotid sinus and what sensation does it detect?

Answer 47

The origin of the internal carotid artery; blood pressure.

Question 48

Which structures lie immediately behind the pharyngeal wall?

Answer 48

A thin layer of loose areolar tissue and then the cervical vertebral bodies.

Question 49

Which parts of the pharynx lie below the lower border of the mandible?

Answer 49

The hypopharynx

Question 50

Which structure stops liquid refluxing into the back of the nose during swallowing?

Answer 50

the soft palate

Question 51

Which nerve carries sensation from the larynx below the vocal cords?

Answer 51

The recurrent laryngeal nerves

Question 52

Describe the histology of the mucosa of the trachea

Answer 52

Simple ciliated pseudostratified columnar | + goblet cells

Question 53

Which nerve travels through the parotid gland?

Answer 53

Facial nerve C7

Question 54

Where do the parotid and submandibular ducts enter the mouth?

Answer 54

Parotid; from the cheek adjacent to the second upper premolar Submandibular; under the tongue

Question 55

Which nerve supplies the muscles of the tongue?

Answer 55

Hypoglossal nerve | C12

Question 56

What is the upper extent of the abdominal cavity?

Answer 56

Anteriorly the undersurface of the diaphragm reaches the 5th intercostal space.

Question 57

Describe the 9 regions of the abdominal wall

Answer 57

Two vertical lines down from the midclavicular line. A horizontal line across the lowest point on the thoracic cage. A horizontal line across the tubercules of the iliac crest. Three areas down the midline are; epigastrium, umbilical and suprapubic from top down. The three lateral areas are hypochondrium, flank and iliac fossa from top down.

Question 58

Describe the nerve supply to the skin of the abdominal wall

Answer 58

The dermatomes of the abdominal wall start at T5 in the upper epigastrium, with T10 being at the umbilicus and T12 being just above the hair bearing area in the lower suprapubic area. Each dermatome starts at the back at the level of the name vertebra; the dermatomes run towards as they pass round the trunk to the front.

Question 59

How is the rectus sheath formed?

Answer 59

In the upper 2/3 of the abdomen, the aponeurosis of the external oblique muscle passes in front of the rectus abdominus and the aponeurosis of the transversus abdominus passes behind. The aponeurosis of internal oblique sends fibres both in front and behind rectus abdominus. In the lower 1/3 of the abdomen all three aponeuroses pass in front of the rectus abdominus.

Question 60

What is the surface marking of the aortic bifurbication?

Answer 60

The level of the umbilicus

Question 61

In which regions of the abdomen is pain from the 3 parts of the bowel felt?

Answer 61

Foregut - epigastrium Midgut - umbilicus Hindgut - suprapubic

Question 62

Describe the anatomy of a 'six pack'?

Answer 62

The rectus abdominus muscle runs vertically from the pubis up to the costal margin. Along its length there are 3 places where is becomes a tendon. When exercised the muscle hypertrophies (becomes bigger) but the tendinous part stays the same. The result is three bulges of muscle between the tendons. This occurs on either side of the midline; six bulges in all.

Question 63

With the patient in a supine position, where might fluid collect in the abdomen?

Answer 63

Posterior to the liver

Question 64

What embryological structure forms the ligamentum teres?

Answer 64

The umbilical vein, returning blood from the placenta to the liver.

Question 65

Where does the base of the appendix lie? (surface marking and internally)

Answer 65

2/3 of the way from the umbilicus to the anterior superior iliac spine, McBurnie's point.

Question 66

Which parts of the bowel have a mesentery?

Answer 66

The first 1cm of the duodenum, all of the jejunum and ileum, the transverse and sigmoid colon and the appendix.

Question 67

What structures form the portal triad?

Answer 67

Hepatic portal vein Bile duct Hepatic artery

Question 68

What is the (greater and lesser) omentum?

Answer 68

They are sheets of tissue covered on both surfaces with peritoneum and containing fat, blood vessels, lymphatics and nerves. The greater omentum attaches to the greater curve of the stomach and the posterior abdominal wall. The lesser omentum connects to the lesser curve of the stomach and the liver. The lesser omentum also contains the portal triad entering the porta hepatis.

Question 69

At what vertebral level does the oesophagus pass through the diaphragm?

Answer 69

T10

Question 70

Which structures pass through the diaphragm alongisde the oesophagus?

Answer 70

The vagal trunks, inferior oesophageal artery and vein.

Question 71

Name the parts of the stomach

Answer 71

``` Fundus cardia body pylorus pyloric sphincter duodenum greater curvature (bottom curve) lesser curvature (top curve) ```

Question 72

From where does the stomach receive its nerve supply?

Answer 72

Parasympathetic from the vagus nerves, C10 Sympathetic from the greater splanchnic nerves, T5-T9

Question 73

What structure attaches the stomach to the liver?

Answer 73

The lesser omentum

Question 74

Which structures lie in front ofthe stomach?

Answer 74

Left lobe of the liver | Anterior abdominal wall

Question 75

Which structures lie behind the stomach?

Answer 75

The lesser sac, behind the lesser sac is the pancreas and diaphragm

Question 76

What is portosystemic anastomosis?

Answer 76

It is a vein which joins to the hepatic portal system (so can carry blood to the liver) to the systemic system. It can take blood from the bowel and bypass the liver to return the blood to the heart.

Question 77

Which bein drains blood from the colon and where does it flow to?

Answer 77

Inferior mesenteric vein drains into the splenic vein.

Question 78

Where does lymph from the small bowel drain?

Answer 78

Into the cisterna chyli and to the thoracic duct.

Question 79

Which foodstuffs are absorbed through the lymphatic system?

Answer 79

Lipids

Question 80

What 4 anatomical features ensure the small bowel has a high surface area for absorption of nutrients?

Answer 80

Length Mucosal folds (plicae circularis) Villi Microvilli

Question 81

Where is the junction between the midgut and the hindgut

Answer 81

2/3 of the way along the transverse colon

Question 82

How do you distinguish a loop of large intestine from that of small intestine?

Answer 82

Large intestine has appendices epiploicae and tenia coli. The small bowel is centrally located and the colon is round the sides.

Question 83

Which part of the bowel is supplied by sacral nerves 2, 3 and 4.

Answer 83

The hind gut.

Question 84

Which artery is the cystic artery a branch of?

Answer 84

Usually the right hepatic artery but it can be the left hepatic artery or the hepatic artery.

Question 85

Which structure degenerates to form the ligamentum venosum?

Answer 85

The ductus arteriosis; an embryological bypass for the liver which exists before the liver has fully formed.

Question 86

Where is the bare area of the liver?

Answer 86

Under the central tendom of the right side of the diaphragm.

Question 87

What is the surface marking of the fundus of the gall bladder?

Answer 87

The tip of the ninth costal cartilage. Where the midclavicular line crosses the costal margin. The most lateral attachment of the rectus abdominus onto the costal margin.

Question 88

Where do the hepatic veins drain?

Answer 88

Directly into the inferior vena cava

Question 89

Can the spleen be palpated during abdominal examination?

Answer 89

No, it needs to be considerably enlarged or displaced by a large mass to be palpable.

Question 90

What structures might a tumour of the head of the pancreas involve?

Answer 90

The hepatic portal vein, bile duct or pancreatic duct

Question 91

What structures join to form the common bile duct and what is its course?

Answer 91

The common hepatic and cystic duct. The common bile duct runs in the free edge of the lesser omentum and behind the first part of the duodenum, onto the posterior or the pancreas where it enters the pancreas to run alongside the pancreatic duct before opening into the duodenum.

Question 92

What structures join to form the common bile duct and what is its course?

Answer 92

The common hepatic and cystic duct. The common bile duct runs in the free edge of the lesser omentum and behind the first part of the duodenum, onto the posterior or the pancreas where it enters the pancreas to run alongside the pancreatic duct before opening into the duodenum.

Question 93

Where is the sphincter of Oddi located?

Answer 93

On the medial wall of the duodenum between the 2nd and 3rd parts

Question 94

Which artery lies behind the first part of the duodenum?

Answer 94

Gastroduodenal artery

Question 95

What lies between the pancreas and the stomach?

Answer 95

The lesser sac

Question 96

How many pancreatic ducts are there? What is the embryological significance?

Answer 96

Two | One from the ventral pancreatic bud and one from the dorsal pancreatic bud

Question 97

What is the function of the eustachian tube?

Answer 97

To equalize the air pressure either side of the tympanic membrane

Question 98

Why is the maxillary sinus more prone to infection?

Answer 98

The opening into the nasal cavity is at the top of the sinus so it does not drain easily.

Question 99

What is the nerve supply to the anterior 2/3 of the tongue?

Answer 99

General sensation: mandibular branch of the trigeminal nerve Taste sensation: facial nerve (C7) Muscles: hypoglossal nerve (C12)

Question 100

Where do the ducts for the submandibular salivary glands open into the mouth?

Answer 100

Below the tongue

Question 101

Why may disease in the maxillary sinus cause numbness of the cheek?

Answer 101

The nerve which gives sensation to the cheek passes in the roof of the maxillary sinus

Question 102

What are the attachments of the muscles of the tongue?

Answer 102

The hyoid bone

Question 103

What structure stops reflux of liquid into the nose during swallowing?

Answer 103

The soft palate

Question 104

Which muscles are responsible for abduction of the shoulder?

Answer 104

Initiation = supraspinatus and then it is assisted by deltoid Rotation of the scapula is by the trapezius

Question 105

Describe the movements of the scapula and humerus during abduction of the shoulder

Answer 105

Supraspinatus initiates abduction and after 10-15 degrees it is assisted by deltoid. As the arm rises the humerus externally rotates to keep the articular surfaces in contact. At full abduction the humerus has externally rotated 90 degree (Arm vertical above head).

Question 106

Which nerve supplies trapezius?

Answer 106

spinal accessory nerve (CN XI)

Question 107

Which nerve is damaged by posterior dislocation of the shoulder and what sensory and motor loss is experienced?

Answer 107

Axillary nerve; sensory loss in skin over the insertion of deltoid muscle and paralysis of deltoid.

Question 108

What structures stabilise the shoulder joint?

Answer 108

The rotator cuff muscles; supraspinatus, infraspinatus, teres minor and subscapularis

Question 109

Which bony parts of the shoulder girdle lie subcutaneously and can be palpated easily?

Answer 109

Manubrium sternum, clavicle, spine of the scapula and acronium

Question 110

Will 'Saturday night palsy' result in weakness of triceps, explain your answer?

Answer 110

No. Saturday night palsy is loss of function of the radial nerve as it runs against the mid-shaft of the humerus in the spiral groove. Although the posterior compartment of the arm, which is formed by triceps, is supplied by the radial nerve the branches leave the nerve before the spiral groove.

Question 111

How does blood reach the right axillary artery from the left ventricle?

Answer 111

It passes through aorta, then brachiocephalic artery, subclavian artery, axillary artery

Question 112

Outline the arrangement of cords of the brachial plexus around the second part of the axillary artery.

Answer 112

The chords of the brachial plexus lie lateral, medial and posterior to the axillary artery (immediately behind pectoralis minor muscle)

Question 113

Which muscles for the rotator cuff, where are they inserted?

Answer 113

Supraspinatus; superior facet on the greater tuberosity of the humerus Infraspinatus; middle facet on the greater tuberosity of the humerus Teres minor; inferior facet on the greater tuberosity of the humerus Subscapularis; lesser tuberosity of the humerus

Question 114

What parts of the body drain lymph directly to the axillary lymph nodes?

Answer 114

Ipsilateral upper limb and body wall above the umbilicus

Question 115

What structures lie along the medial border of the biceps in the middle of the arm?

Answer 115

Median nerve, ulna nerve, medial cutaneous nerve of the forearm, brachial artery and basilar vein

Question 116

What are the 3 superficial veins of the forearm and where do they run?

Answer 116

The cephalic vein arises from the lateral end of the dorsal venous arch on the back of the hand. It runs more or less over the radius up to antecubital fossa where it gives the antecubital vein. It continues in the groove between triceps and biceps on the lateral side of the arm until it reaches deltoid where it passes up in the delto-pectoral groove to just below the clavicle. Just below the clavicle it passes deep into the axillary vein. The basilic vein arises from the medial end of the dorsal venous arch on the back of the hand. It passes up the forearm over the ulna to pass medial to the elbow joint where it is joined by the antecubital vein. It passes halfway up the medial side of the arm in the groove below triceps and biceps. Half way up the arm it passes deep to become the brachial vein.

Question 117

What are the 3 major nerves entering the forearm and what do they supply?

Answer 117

Radial; motor to the posterior compartment and skin on the lateral part of the back of the hand Median; motor to all muscles in flexor forearm except flexor carpi ulnaris and ulna half of flexor digitorum profundus (both ulna nerve). Motor to the LLOAF muscles of the hand; lateral lumbricles, opponese pollicis, abductor pollicis brevis, flexor pollicis brevis, skin on lateral 3.5 digits of hand Ulna nerve ; motor flexor carpi ulnaris and ulna half of flexor digitorum profundus. Motor all muscles EXCEPT LLOAF. Skin - medial 1.5 digits on palm of hand

Question 118

What is the common flexor origin?

Answer 118

Medial epicondyle of the humerus

Question 119

How do you test the muscles supplied by the median nerve?

Answer 119

Flexion of the thumb and lateral two fingers. Movement of the thenar muscles

Question 120

Where does the brachial artery and median nerve pass into the forearm?

Answer 120

Medial to the biceps aponeurosis

Question 121

What is pronation and supination; which muscles perform these movements/

Answer 121

Supination is position both the radius and ulna parallel to each other; the hand faces forwards in the anatomical position or upwards with the elbow flexed. Supinator (in any position of the elbow) and biceps (with the elbow flexed) produce supination. Pronation is positioning the radius and ulna crossing each other; the hand faces backwards in the anatomical position or downwards with the elbow flexed. Pronator teres and prontator quadratus (in any position of the elbow) produces pronation.

Question 122

Which carpal bone is most prone to injury?

Answer 122

Scaphoid; it is in direct contact with the radius so putting your hand out to stop yourself falling over will put all the force directly through the scaphoid.

Question 123

What is the cutaneous distribution of the median and ulnar nerves in the hand?

Answer 123

Median; palmar lateral 3.5 digits and extending over the finger tips up to the nail bed Ulna; palmar medial 1.5 digits and extending over the finger tips up to the nail bed

Question 124

What are the thenar muscles? What is their nerve supply?

Answer 124

The thenar muscles are at the base of the thumb on the palmar side of the hand (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis). They are supplied by the MEDIAN nerve

Question 125

If infection occurs in the synovial flexor tendon sheath how far will it spread in the: middle finger? thumb? little finger?

Answer 125

middle finger = to the distal skin crease on the palm of the hand thumb = into the forearm little finger = into the forearm

Question 126

How do you test the interrossei muscles?

Answer 126

Test abduction and adduction of the fingers

Question 127

How does division of the median nerve at the elbow differ from one at the wrist?

Answer 127

Sensory loss will be the SAME. Motor at the wrist will paralyse the LLOAF muscles (lateral lumbricles, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis) Motor at the elbow will paralyse the long flexor to the thumb, both flexors to the index and middle fingers and the superficial flexors to the ring and little finger. (and LLOAF)

Question 128

What is the nerve supply of the extensor compartment of the forearm and what area of skin does this nerve also supply?

Answer 128

Radial nerve; skin on the dorsal aspect of the the lateral 3.5 digits up to the distal interphalangeal joint.

Question 129

Which bone lies in the base of the anatomical snuff box?

Answer 129

Scaphoid

Question 130

Which nerve and vein cross the anatomical snuff box superficially?

Answer 130

Radial nerve | cephalic vein

Question 131

If the T1 nerve root is damaged which group of muscles will be paralysed and which area of skin will be anaesthetic?

Answer 131

All the muscles in the hand are paralysed and the skin over the medial arm is anaesthetic

Question 132

Which muscle is the most powerful supinator and what position does the elbow need to be in to maximise its force?

Answer 132

Biceps, with the elbow flexed to 90 degrees

Question 133

Which fingers have two extensor muscles?

Answer 133

Index | little finger

Question 134

Describe how the radius moves during pronation and supination

Answer 134

The proximal radius roatates about its own axis, the distal radius rotates round the ulna

Question 135

What is the surface marking of the femoral artery and saphenous opening?

Answer 135

Femoral artery (within 1.5cm of) the point half way between the pubic tubercle and the anterior superior iliac spine. Saphenous opening, 3cm below and lateral to the pubic tubercle. Medial to the femoral artery 3cm below the inguinal ligament.

Question 136

What is the order of the femoral artery, vein and nerve in the groin?

Answer 136

Nerve lateral and vein medial (artery between them)

Question 137

Which vein becomes the superficial femoral vein?

Answer 137

Popliteal vein as it passes through the adductor canal

Question 138

What is the motor and sensory supply of the femoral nerve?

Answer 138

Motor, anterior compartment of the thigh Sensory, anterior thigh skin, hip and knee joint

Question 139

What are the attachments of the adductor muscles?

Answer 139

All have an origin on the pubis, all insert onto the femur

Question 140

Which nerve supplies the adductor muscles?

Answer 140

Obturator nerve

Question 141

What passes through the adductor canal?

Answer 141

Superficial femoral artery, popliteal vein

Question 142

What is the function of the hip extensors, and which is the most powerful?

Answer 142

Gluteus maximus is the most powerful hip extensor, and it is used for climbing up hill/stairs.

Question 143

Which muscles abduct the hip and when is abduction vital to normal function?

Answer 143

Gluteus minimus and medius. They hold the pelvis horizontal during walking when one leg is off the ground.

Question 144

What structures pass through the greater sciatic foramen?

Answer 144

Sciatic nerve Piriformes muscle Superior and inferior gluteal vessels Pudendal nerves

Question 145

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

Answer 145

Yes | through the vagina or rectum

Question 146

Where is the surface marking of the sciatic nerve and why is it important?

Answer 146

Lower inner quadrant of the buttock. | Drug injection into muscle is common, injection into the nerve can completely destroy it.

Question 147

If the sciatic nerve is completely cut, which parts of the lower limb will still have a nerve supply?

Answer 147

Anterior and medial muscle compartments of the thigh. Sensation from the medial dorsum of the foot up the anteromedial calf (saphenous vein, branch of femoral). Sensation from anterior and medial thigh (femoral and obturator nerves).

Question 148

Which major vessels supply the buttock with blood?

Answer 148

The superior and inferior gluteal arteries, both branches from the posterior branch of the internal iliac artery.

Question 149

Which nerves supply the anterior and lateral compartments of the leg? (knee to ankle)

Answer 149

Anterior compartment = deep branch of the common peroneal and lateral = superficial branch

Question 150

Where are the deep and superficial branch of the common peroneal at risk of damage?

Answer 150

Where they run against the neck of the fibula just under the skin

Question 151

Which artery supplies the anterior compartment of the leg?

Answer 151

Anterior tibial artery

Question 152

How many extensor tendons are there to each of the toes? Where do they originate?

Answer 152

Two tendons to each of the toes, a longus tendon from a muscle in the anterior leg (Which is attached to the fibula and interrouseous membrane) and a brevis tendon from a muscle in the foot (Attached to the dorsum of the calcanium and surrounding ligaments in the lateral foot). The brevis tendon to the little toe is often absent.

Question 153

Why is the tibia prone to poor fracture healing?

Answer 153

Bones have nutrient arteries to supply the marrow but also receive a significant amount of blood from blood vessels which run fro mthe muscles which are attached to the bone. The tibia is relatively devoid of muscle attachment (none on subcutaneous surface) which means it has a poor blood supply and poor healing.

Question 154

Describe the movements at the ankle joint?

Answer 154

The ankle joint is between the tibia/fibula mortice and the talus. The only movement possible at this joint = dorsi flexion and plantar flexion.

Question 155

What would be the effect of damage to the common peroneal nerve?

Answer 155

Paralysis of all muscles in the anterior and lateral compartments of the leg. Loss of sensation down the lateral leg from the knee to the ankle and onto the dorsum of the foot including the dorsum of the medial four toes.

Question 156

Which muscles attach to the Achilles tendon?

Answer 156

Gastrocnemius soleus plantaris

Question 157

What is the nerve supply of the posterior compartment?

Answer 157

Tibial nerve; a branch of the sciatic nerve