Anatomy III Netter Clinical/ Challenge Yourself Questions Flashcards
A 56-year-old man presents with a history of pain for the last 18 months over the right buttock and radiating down the posterior aspect of the thigh and leg. A radiographic examination reveals a herniated disc between the L5 and the S1 vertebral levels. Which of the following nerves is most likely affected by this herniated disc? A. L3 B. L4 C. L5 D. S1 E. S2
S1
The nucleus pulposus of the intervertebral discs usually herniates in a posterolateral direction, where it can impinge on the nerve roots passing through the intervertebral foramen. A disc herniating at the L4-L5 level usually impinges on the L5 roots, and herniation at the L5-S1 level involves the S1 roots.
A 19-year-old man sustained an apparent cervical
spine hyperextension (“whiplash”) injury after a rear-end roller-coaster crash at a local amusement park. Radiographic examination reveals several cervical vertebral body fractures and the rupture of an adjacent vertebral ligament. Which of the following vertebral
ligaments was most likely ruptured during this hyperextension injury?
A. Anterior longitudinal ligament
B. Cruciate ligament
C. Interspinous ligament
D. Ligamentum flavum
E. Nuchal ligament
Anterior longitudinal ligament.
Hyperextension-hyperflexion (whiplash) of the cervical spine can occur when the relaxed neck is thrown backward (hyperextension), tearing the anterior longitudinal ligament. Hyperflexion is usually limited
when one’s chin hits the sternum. Properly adjusted headrests, if available, can limit the hyperextension.
A 34-year-old woman presents with a spider bite and a circumscribed area of inflammation on the back of her neck over the T4 dermatome region. Which of the following types of nerve fibers mediate this sensation? A. Somatic afferents in T4 ventral root B. Somatic afferents in T4 dorsal root C. Somatic afferents in T4 ventral ramus D. Somatic efferents in T4 ventral root E. Somatic efferents in T4 dorsal root F. Somatic efferents in T4 ventral ramus
Somatic afferents in T4 dorsal root.
Sensation from the skin is mediated by somatic afferents (fibers in dorsal root), and the cell bodies of these sensory neurons (pseudounipolar) associated with the T4 dermatome reside in the T4 dorsal root ganglion.
After an automobile crash, a 39-year-old man presents with a headache and midback pain. A radiographic exam reveals trauma to the thoracic spine and bleeding from the anterior and posterior internal vertebral venous plexus. In which of the following regions is this bleeding most likely accumulating? A. Central spinal canal B. Epidural space C. Lumbar triangle D. Subarachnoid space E. Subdural space
Epidural space. The internal vertebral venous plexus (Batson’s plexus) resides in the epidural fat surrounding
the meningeal-encased spinal cord. The epidural space lies between the bony vertebral spinal canal and the dura mater.
A high school football player receives a helmet-
to-helmet blow to his head and neck and is brought into the emergency department. A radiographic examination reveals a mild dislocation of the atlanto-axial joint. When you examine his neck, you notice his range of motion is decreased. Which of following movements of the head would most likely be affected?
A. Abduction
B. Adduction
C. Extension
D. Flexion
E. Rotation
Rotation: The atlanto-axial joint (atlas and axis) functions
in the axial rotational movements of the head. The cranium and atlas move as a unit and rotate side to side on the uniaxial synovial pivot joint between the axis (C2) and atlas (C1).
A patient is admitted to the emergency department with a sharp penetrating wound in the upper back region just lateral to the thoracic spine. Based on a quick examination, the physician concludes that several of the dorsal root ganglia are clearly damaged. Which of the following neural elements are most likely compromised by this injury? A. Postganglionic efferents B. Somatic afferents only C. Somatic afferents and efferents D. Somatic and visceral afferents E. Somatic efferents only
D. Somatic and visceral afferents.
The dorsal root ganglia between T1-L2 contain sensory neurons for both somatic and visceral (autonomic) afferent fibers, so both of these modalities would be compromised. Efferent (motor) fibers are not associated with the dorsal root ganglia.
A work-related injury results in a weakness against resistance in elevation of the scapula and atrophy of one of the lateral neck muscles. The physician suspects damage to a cranial nerve. What muscle is most likely responsible?
Trapezius (CN XI) or SCM (CN XI)
An injury results in significant weakness in extension and lateral rotation along the entire length of the spine. What muscle is most likely responsible?
Erector spinae: the major extensors. Spinalis, longissimus, iliocostalis
After an automobile crash, a patient presents with radiating pain around the shoulder blades and weakness in elevating the ribs on deep breathing. What muscle is most likely responsible?
Serratus posterior superior
An injury to the back results in a weakened ability to extend and medially rotate the upper limb. What muscle is most likely responsible?
Latissimus dorsi
Sharp trauma to the back of the neck damages the suboccipital nerve, resulting in a weakened ability to extend and rotate the head to the same side against resistance. What muscle is most likely responsible?
Rectus capitis posterior major
Trauma to the lateral neck results in a lesion to the dorsal scapular nerve and a weakened ability to shrug the shoulders. What muscle is most likely responsible?
Levator scapulae (innervated by dorsal scapular nerve C5)
An elderly patient who has been minimally ambulatory is transported to the clinic with a swollen lower limb and evidence of a deep vein thrombosis. Your examination reveals a sizable clot in her small saphenous vein, and you are concerned that a thromboembolus might originate from this clot and pass to her heart and lungs. After it exits the small saphenous vein, the thromboembolus would next pass into which of the following veins on its journey to the heart? A. Deep femoral B. External iliac C. Femoral D. Great saphenous E. Popliteal
Popliteal: The small saphenous vein drains superiorly along the posterior aspect of the leg and then dives deeply to drain into the popliteal vein
deep within the knee.
The hip is a stable ball-and-socket synovial joint with several strong supporting ligaments. Hip flexion exhibits a significant range of motion, but hip extension is more limited. Which of the following hip ligaments is the strongest ligament and the one that limits hip extension? A. Iliofemoral B. Ischiofemoral C. Ligament of head of femur D. Pubofemoral E. Transverse acetabular
Iliofemoral ligament. Forms an inverted “Y” configuration and is the strongest of the hip ligaments
During a routine PE, the PA taps a patient’s patellar ligament with a reflex hammer and elicits a knee-jerk reflex. Which of the following nerves mediates this patellar reflex? A. Common fibular B. Femoral C. Obturator D. Saphenous E. Tibial
Femoral. Extension of the knee occurs w/ contraction of the quadriceps femoris group of muscles, which are innervated by the femoral nerve (L2-L4). Patellar reflex tests the L3-L4 component of the femoral nerve.
A long-distance runner is examined by her PA after c/o pain along the anteromedial aspect of her left leg, extending from just below the knee to just above the ankle. She has been running on a hard surface and notices that the pain is especially acute as she pushes off from the ground with the affected limb. Which of the following muscles of the leg is most likely affected by this stress injury? A. Extensor digitorum longus B. Fibularis longus C. Gastrocnemius D. Popliteus E. Tibialis posterior
Tibialis posterior. Most affected muscle when pushing off the ground; during the action of plantarflexion at the ankle.
A stab injury to the buttocks results in the patient’s inability to rise from a seated position without the use of his arms, as well as weakness in climbing stairs. A nerve injury is suspected. Which of the following muscles was most likely affected by this stab injury? A. Gluteus maximus B. Gluteus medius C. Obturator internus D. Piriformis E. Semitendinosus
Gluteus maximus, the most powerful extensor of the hip. Innervated by inferior gluteal nerves.
An inversion ankle injury results in the tearing of two of the three major ligaments that stabilize this joint. Which of the following pairs of ligaments are most likely injured?
A. Anterior talofibular and calcaneofibular
B. Calcaneofibular and deltoid
C. Deltoid and long plantar
D. Long plantar and posterior talofibular
E. Posterior talofibular and anterior
talofibular
Anterior talofibular and calcaneofibular. Most susceptible to inversion injuries of the ankle.
An 11 y/o boy jumps from a tree house 15 feet above the ground and lands on his feet
before rolling forward, immediately feeling extreme pain in his right ankle. RAD
exam reveals that he has broken the most frequently fractured tarsal bone in the
body. Which of the following tarsal bones is most likely fractured?
A. Calcaneus
B. Cuboid
C. Medial cuneiform
D. Navicular
E. Talus
Calcaneous. Intraarticular fracture caused by talus being driven down into the calcaneous.
A laceration across the back of the lower leg results in numbness over the site of the laceration that extends inferiorly over the heel and the lateral back of the sole. Which of the following nerves was mostly likely injured? A. Lateral plantar B. Medial plantar C. Saphenous D. Superficial fibular E. Sural
Sural
A 54 y/o man presents with an inability to fully dorsiflex his foot at the ankle, although he can invert and evert his foot. Which of the following nerves may be affected? A. Common fibular B. Deep fibular C. Medial plantar D. Superficial fibular E. Tibial
Deep fibular.
Since the man can evert and invert but cannot fully dorsiflex at the ankle, he most likely has injured his deep fibular nerve. If he had lost eversion alone, he would have injured the superficial fibular nerve and if dorsiflexion and eversion were weakened, then one would suspect an injury of the common fibular nerve.
A man is seen in the clinic waiting room who enters with a “shuffling” gait and a weakened ability to plantarflex his foot. Which of the following nerve-muscle combinations is most likely involved?
A. Deep fibular and tibialis anterior muscle
B. Deep fibular and tibialis posterior muscle
C. Superficial fibular and fibularis longus
muscle
D. Tibial and tibialis anterior muscle
E. Tibial and tibialis posterior muscle
Tibial and tibialis posterior muscle
A first-year medical student is asked to demonstrate the location of the dorsalis pedis pulse. Which of the following landmarks would be a reliable guide for finding this artery?
A. Lateral to the extensor hallucis longus tendon
B. Medial to the extensor digitorum longus tendons
C. Over the intermediate cuneiform bone
D. Over the second metatarsal bone
E. Web space between toes 1 and 2
Lateral to the extensor hallucis longus tendon
Irritation of the knee in a cleaning lady who scrubs floors on her knees results in septic bursitis and “housemaid’s knee.” Which of the following bursae is most likely involved? A. Anserine B. Deep infrapatellar C. Prepatellar D. Subcutaneous infrapatellar E. Suprapatellar
Prepatellar
A dipping of the pelvis during the stance phase of walking may occur if there is an injury to the nerves innervating this important abductor of the femur at the hip. What muscle most likely responsible/ affected?
Gluteus medius. Gluteal dip aka positive Trendelenburg sign. Usually denotes injury to the superior gluteal nerves innervating the medius and minimus.
Weakened flexion of the thigh and abduction at the hip, and flexion of the leg at the knee would suggest an injury to this muscle or to the nerves innervating this muscle.
Sartorius.
The sartorius (“tailor’s”) muscle flexes and abducts the hip and flexes the knee (think about the action of sitting in a chair with one thigh crossed over the other, as a “tailor” might do while stitching). Thus, it acts on both joints and is innervated by branches of the femoral nerve.
An elderly woman falls on her outstretched hand and fractures the surgical neck of her humerus. Several weeks later she presents with significant weakness in abduction of her arm and some weakened extension and flexion. Which of the following nerves is most likely injured? A. Accessory B. Axillary C. Radial D. Subscapular E. Thoracodorsal
Axillary
Cancer spreading via the lymphatics passes into the axillary group of lymph nodes. Which of these axillary groups of nodes is most likely to receive this lymph first? A. Anterior (pectoral) B. Apical (subclavian) C. Central D. Lateral (brachial) E. Posterior (subscapular)
Anterior (pectoral)
During a routine physical examination, the physician notes an absent biceps tendon reflex. Which spinal cord level is associated with this tendon reflex? A. C4-C5 B. C5-C6 C. C6-C7 D. C7-C8 E. C8-T1
C5-C6
A patient with a midshaft compound humeral fracture presents with bleeding and clinical signs of nerve entrapment. Which of the following nerves is most likely injured by the fracture? A. Axillary B. Median C. Musculocutaneous D. Radial E. Ulnar
Radial. This nerve innervates all the extensory muscles of the upper limb (posterior compartments of the arm and forearm)
A baseball pitcher delivers a 97-mph fastball to a batter and suddenly feels a sharp pain in
his shoulder on release of the ball. The trainer examines the shoulder and concludes that the pitcher has a rotator cuff injury. Which muscle is most vulnerable and most likely torn by this type of injury?
A. Infraspinatus
B. Subscapularis
C. Supraspinatus
D. Teres major
E. Teres minor
Supraspinatus
A fall on an outstretched hand results in swelling and pain on the lateral aspect of the wrist. Radiographic examination confirms a Colles’ fracture. Which of the following bones is most likely fractured? A. Distal radius B. Distal ulna C. Lunate D. Scaphoid E. Trapezium
Distal radius.
The Colles’ fracture (a fracture of the distal radius) presents with a classic dinner fork deformity with the dorsal and proximal displacement of the distal fragment. This is an extension-compression fracture.
