Anatomy Part 1 Flashcards
Skeletal, Upper ext, Lower ext, Head, Nervous system, The Neck and Vertebral Column
1
Q
Normal anatomical position of the body.
A
Body erect, head directed anteriorly and forearm on sides supinated.
2
Q
Fundamental type of skeletal system.
A
Connective tissues
3
Q
Classification of clavicle as to location.
A
Appendicular
4
Q
Which of the bones is classified as short bone? A. First metatarsal B. Calcaneus C. Middle phalanx D. Distal phalanx
A
B. Calcaneus
💡phalanges are considered long bones
5
Q
End of bone, composed mostly of spongy bone.
A
Epiphysis
6
Q
Covers the surface of the epiphyses that function to decrease friction at joint surfaces.
A
Articular cartilage
💡made up of HYALINE cartilage
7
Q
Responsible for red cell formation in infants
A
Red marrow
💡yellow marrow are fats.
8
Q
Germ layer of origin of Humerus.
A
Somatic mesoderm
💡Paraxial mesoderm: bones attached to muscles
💡Splanchnic mesoderm: cardiac and smooth muscles
💡Somatic mesoderm: Limb muscles (appendicular)
9
Q
Immovable joints are also known as:
A
Synarthroses
💡Amphiarthroses: slightly movable
💡Diarthroses: freely movable
10
Q
7 types of synovial joints.
A
Plane: sternoclavicular, acromioclavicular
Hinge/Ginglymus: elbow, knee, ankle
Pivot/Trochoid: atlantoaxial, radioulnar
Condyloid: mcp/knuckles
Ellipsoidal: wrist
Saddle: carpometacarpal of thumb
Ball and socket/Enarthroses: shoulder, hip
11
Q
Contents of axilla.
A
Axillary vein
Axillary artery
Brachial plexus
12
Q
Where will you insert the needle in Brachial Nerve Plexus Block?
A
Proximal part of the sheath.
💡position verified by feeling the Pulsations of the 3rd Part of the Axillary artery.
13
Q
The following muscles are classified as "rotator cuff", except: A. Supraspinatus B. Infraspinatus C. Teres Major D. Teres Minor
A
C. Teres Major
rotator cuff muscles: ✔️supraspinatus: above ✔️inraspinatus: posterior ✔️teres minor:posterior ✔️subscapularis: anterior
14
Q
Stabilizes the shoulder joint.
A
Rotator cuff muscles
15
Q
Weakest part of the rotator cuff.
A
Inferior
💡unprotected by muscles.
16
Q
Main abductor of the shoulder.
A
Deltoid
17
Q
Initiate the abduction of shoulder.
A
Supraspinatus
18
Q
2 intrinsic muscles of shoulder supplied by Axillary nerve.
A
Teres Minor
Deltoid
19
Q
Lateral rotators of shoulder.
A
Infraspinatus
Teres minor
20
Q
Medial rotators of shoulder.
A
Subscapularis
Teres major
21
Q
Intrinsic muscles of shoulder supplied by Suprascapular nerve.
A
Supraspinatus
Infraspinatus
22
Q
Intrinsic muscle of shoulder supplied by Subrascapular nerve.
A
Subscapularis: upper
Teres major: lower
23
Q
More common dislocation of shoulder joint due to sudden violence applied to the humerus with the joint fully abducted that tilts the humeral head downward into the inferior weak part.
A
Anterior Inferior Dislocation
24
Q
Rare dislocation of shoulder, caused by direct violence to the front of the joint.
A
Posterior dislocation
25
Most commonly affected tendon in inflammation of rotator cuff.
Tendon of Supraspinatus muscle.
*pain anterior ans superior to the shoulder during ABDUCTION.
26
Contents of Quadrangular space.
```
Axillary nerve (circumflex nerve)
Posterior circumflex vessels
```
27
Boundaries of Quadrangular space.
Above: Teres minor
Below: Teres major
Medial: Long head of Triceps brachii
Lateral: Surgical neck of Humerus
28
Boundaries of Triangular space.
Above: Teres minor
Below: Teres major
Lateral: Long head of Triceps brachii
29
Contents of Triangular space.
Circumflex scapular vessels
30
Intrinsic muscles of the hand supplied by Ulnar nerve.
3 Palmar interossei: aDduct fingers
4 Dorsal interossei: aBduct fingers
"PAD-DAB"
4 Lumbricales: MEDIAL part; Flex MCP joint
31
Extrinsic muscles of hand and their actions.
Flexor digitorum superficialis: flexes the PROXIMAL IP joints (Median nerve)
Flexor digitorum profundus: flexes DISTAL IP joints (Median(lat) and Ulnar(med))
32
5 Terminal braches of Brachial plexus.
Axillary nerve: deltoid and teres minor
Musculocutaneous nerve: anterior/flexor of arm
Radial nerve: posterior/extensor of arm & forearm
Median nerve: anterior/flexor of forearm except FCU and FDP (medial part), thenar
Ulnar nerve: intrinsic muscles of hand, FCU and FDP (lateral part), hypothenar
33
Composition of brachial plexus.
5 roots
3 trunks
6 divisions
3 cords
34
Anterior division that innervate the anterior compartment of arm and forearm that act as Flexors.
```
Musculocutaneous (C5-C7)
Ulnar (C8-T1)
Median (C8-T1)
Lateral Pectoral (C5-C7)
Medial Pectoral (C8-T1)
```
35
Posterior division that innervate the posterior compartment of arm and forearm that act as Extensors.
Axillary (C5 and C6)
Radial (C5-T1)
Upper, (C5-C6), Middle ( C6-C8), Lower (C5-C6) Subscapular
36
Each trunk of the brachial plexus divides into anterior and posterior divisions. The posterior cord is formed from union of what structures?
Posterior divisions of all 3 trunks.
37
Roots of brachial plexus.
```
Dorsal scapular (C5): rhomboids
Long Thoracic (C5-C7): Serratus anterior
```
38
Muscle reflex preferred for testing involvement of the root of the 6th cervical spinal nerve with a herniation of the IVD at C5-C6.
Brachioradialis tendon reflex (C5, C6, and C7)
* supination of the radioulnar joints by tapping the insertion of the brachioradialis tendon.
39
Muscle reflex preferred for testing involvement of the root of the 5th cervical spinal nerve with a herniation of the IVD at C5-C6.
Biceps brachii tendon reflex (C5 and C6)
* flexion of the elbow joint by tapping biceps tendon.
40
Muscle reflex preferred for testing involvement of the root of the 7th cervical spinal nerve with a herniation of the IVD at C6-C7.
Triceps brachii tendon reflex (C6, C7 and C8)
* extension of the elbow joint by tapping triceps tendon.
41
Results from lesion of the C5 and C6 ventral rami in the superior trunk plexus; upper limb is adducted, extended and medially rotated; forearm pronated and the carpal flexors flex the hand at the wrist.
Erb-Duchenne Syndrome (upper brachial plexus injury)
* mainly affect the PROXIMAL musculature presenting "Waiter's tip" position.
* during difficult delivery
42
Results from lesion of the C8 and T1 ventral rami in the inferior trunk plexus; weakness of the intrinsic muscles and altered sensation of Medial hand, ring and little finger.
Klumpke Paralysis (lower brachial plexus injury)
* mainly affect the DISTAL musculature in upper limb presenting "APE hand" and a "CLAW hand".
* excessive abduction or stab or gunshot
43
The patient experience weakness in the ability to PROTRACT the scapula and difficulty in raising arm above their head. What nerve is most likely affected?
Long thoracic nerve (C5-C7)
* "winging of the scapula"
* vertebral border is unusually prominent
44
Presents with difficulty in elevating trunk (as if attempting to climb) and may have difficulty in using crutch.
Thoracodorsal nerve Lesion (C6, C7 and C8)
* Latissimus dorsi muscles is affected.
* result of surgical procedures in axilla
45
May be injured as a result of dislocation of the head of the humerus or fracture of the surgical neck of the humerus.
Axillary nerve(C5 and C6)
* weakness to aBduct the arm and lateral rotation
* deltoid and teres minor
46
Though uncommon, may be compressed through the coracobrachialis muscle; weakness in flexion of the forearm at the elbow and weak in supination.
Musculocutaneous Nerve
47
Presents as "Saturday night palsy", result of a spiral fracture in midshaft of the humerus.
Radial Nerve Lesion (C5-T1)
* "wrist drop"
* Weakness in extending the hand at the wrist and loss of extension at the MP joints of all digits
* supination weakened but not loss
* extension of the forearm spared
48
Presents with index and middle fingers remain extended when attempting to flex in making a fist; PROXIMAL lesion.
Median Nerve Lesion (C8-T1)
* "Hand of Benediction"
* SUPRACONDYLAR fracture of the Humerus
* compression between heads of pronator teres
* altered cutaneous sensation---lateral 3 1/2 digits and thenar
* wasting of THENAR muscles
49
weakness in the OPPOSITION of the thumb, so it remains aDducted and extended.
Carpal Tunnel Syndrome (Median nerve lesion)
* "APE hand"
* LUNATE dislocation
* numbness and pain over palmar aspect of thumb, index and middle fingers.
* thenar muscles spared
50
Altered sensation at medial 1 1/2 digits and hypothenar eminence; weakness in flexion of medial fingers; flexion at wrist.
Ulnar nerve lesion (C8-T1)
* FCU and FDP
* PROXIMAL lesion
* MEDIAL epicondyle fracture of Humerus
51
Altered sensation at medial aspects of hand and digits; weakness in ability to aBduct/aDduct fingers.
Ulnar nerve lesion (C8-T1)
* "CLAW hand" -- weakness of 2 lumbricals that flex the MP joints
* DISTAL lesion
* fracture of hook of HAMATE
* wasting of HYPOthenar muscles
52
The radial artery is the smaller of the terminal branches of the brachial artery, begins at the level of:
Radial neck
*cubital fossa
53
Largest branch of Axillary artery that supplies subscapularis, teres major and latissimus dorsi.
Subscapular artery (3rd part)
* can be felt in the axilla as it lies in front of teres major
54
Structure that divides the axillary artery into 3 parts.
Tendon of Pectoralis MINOR
55
Landmark of continuation of subclavian artery to axillary artery.
1st rib to teres major
56
Site for taking Radial pulse.
Lateral: tendon of Brachioradialis
Medial: tendon of FCR
57
Palpated in the root of the posterior triangle of the neck as it crosses the 1st rib.
Subclavian artery
58
Choice for central venous catheterization.
Axillary vein
* Basilic vein + Brachial vein
59
1st to begin ossification during fetal development and the last one to complete at about age 21.
Clavicle
* medial 2/3: conVEX forward
* lateral 1/3: flattened
* weakest: JUNCTION
60
37/F has a fracture of the clavicle at the junction of the inner and middle 3rd. The arm is rotated medially but is not rotated laterally. Which muscle causes upward displacement of the medial fragment?
Sternocleidomastoid
* downward: deltoid and pectoralis major
61
Most commonly fractured bone;
| Fall on the shoulder or outstretched hand
Clavicle
62
A supracondylar fracture of the humerus would most likely to cause injury to what nerve?
Median
* Median: supracondylar ridge
* Ulnar: medial epicondyle
* Musculocutaneous/Axillary: surgical neck
* Radial: radial or spiral groove
63
Fracture of the distal segment and POSTERIORLY and SUPERIORLY; or distal Radial fracture (fragment dorsally displaced)
Colle / Dinner / Silver Fork Deformity
*fall on outstretched hand
64
Fracture of the distal segment and ANTERIORLY; or distal Radial fracture (fragment ventrally placed)
Smith Fracture
*fall on the back of hand
65
Most commonly fractured bone of the hand.
Scaphoid
* pain and tenderness in anatomical snuffbox after a fall on outstretched hand
* common in young adults
66
Most commonly dislocated bone of the hand.
Lunate (Distal--CTS)
*typically dislocated anteriorly
67
Radial artery, styloid process of radius and base of the 1st Metacarpal bone can be palpated.
Anatomical snuffbox
* Lat: tendon of EPB and aBd PL
* Med: tendon of EPL
* Floor: scaphoid
* Trapezium
68
Carpal bones at Proximal row.
```
(lateral to medial)
Scaphoid/Navicular
Lunate
Triquetral
Pisiform
```
69
Carpal bones at Distal row.
```
(lateral to medial)
Trapezium
Trapezoid
Capitate
Hamate
```
70
Thickening of synovial sheaths of flexor tendons or arthritic changes or carpal bones; burning pain / "pins and needles" sensation
Carpal Tunnel Syndrome
71
Localized thickening and contracture of the palmar aponeurosis; flexion of the PIP joints
Dupuytren Contracture
72
Common fractured bone among boxers.
Necks of the 4th and 5th metacarpals
* Oblique fracture
* distal segments displaced proximally
73
Fracture at the base of the 1st metacarpal bone where thumb is forcefully aBducted.
Bennett Fracture
74
What is the dermatome level at the medial aspect of the Hypothenar eminence?
C8
```
C2: back of the head
C5: tip of shoulder
C6: thumb
C7: middle finger
C8: small finger
T4-T5: nipple
T10: umbilicus
L1: inguinal
L4: knee; medial leg
L5: lateral leg; big toe
S1: small toe
S5: perinum
```
75
A patient complains of sensory loss over the anterior and posterior surfaces of the medial 1 1/2 fingers. What nerve is injured?
Ulnar (C8-T1)
76
Landmark of axillary lymphatic drainage.
Pectoralis minor
77
19/F was thrown while riding a bicycle. She attempted to break her fall with an outstretched hand and suffered a fracture. In the ER, PE revealed inability to extend the hand at the wrist. What might have been the site of fracture that caused the muscle weakness?
Midshaft of the Humerus
| radial nerve injury
78
36/F suffers traumatic injury to the upper limb that lesions a nerve. The lesion results in an inability to spread and extend her fingers, and a "clawing" of the ring and little fingers. What 2 spinal cord segments contribute to the nerve that is damaged?
C8 and T1
| ulnar nerve lesion
79
Your patient has radial deviation of the hand at the wrist when he attempts to flex the wrist and altered sensation in the skin covering the hypothenar eminence. What might account for this symptom?
fracture of the Medial epicondyle of the Humerus
80
A man who works as a cartoonist begins to develop pain and paresthesia in his right hand at night. The altered sensation is most evident on the palmar aspects of the index and middle fingers. What else might you expect to see in this patient?
Atrophy of the THENAR eminence.
81
A patient suffers a fracture on the supracondylar part of the humerus, which compresses a nerve and an accompanying artery. What might you observed in this patient?
A hand of benediction
82
Which of the structure does NOT belong to the group which forms the boundaries to the superior entrance of axilla?
a. clavicle
b. coracoid process
c. outer border of 1st rib
d. upper border of the scapula
B. coracoid process
83
Inflammation of the common extensor tendon of forearm results to what clinical condition?
Tennis elbow
*lateral epicondyle
84
Which nerve is most likely to be injured by inferior displacement of the humeral head?
a. axillary
b. musculocutaneous
c. median
d. radial
a. Axillary nerve
| * shoulder joint dislocation
85
If deep tissues of the hand are infected, which of the following group of lymph nodes will commonly be 1st to react to lymphatic dissemination of infection?
a. anterior axillary
b. central axillary
c. lateral axillary
d. infraclavicular axillary
c. Lateral axillary
86
A patient comes in with gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow?
a. acromial
b. pectoral
c. clavicular
d. deltoid
e. superior thoracic
e. superior thoracic
* acromial, pectoral, clavicular and deltoid are all branches of thoracoacromial, therefore, ligating will result to impediment of blood flow in this branches.
* superior thoracic is the highest thoracic artery
87
35/M walks in with a stab wound to the most medial side of the proximal portion of the cubital fossa. Which of he following structure would most likely be damaged?
a. biceps brachii tendon
b. radial nerve
c. brachial artery
d. radial recurrent artery
e. median nerve
e. Median nerve
88
Strongest flexor of the thigh.
Iliopsoas
89
Flexes and MEDIALLY rotates the thigh.
Tensor Fascia lata
90
Flexes and LATERALLY rotates the thigh.
Sartorius
91
Action of Anterior thigh muscles.
Flexor of the thigh
| Extensor of the Leg
92
Innervation of the Anterior thigh muscles.
Femoral nerve (L2 and L3)
* Pectineus, Iliacus and Sartorius muscles
* Tensor fascia lata: Superior gluteal nerve (L4 and L5)
93
The only muscle that extends muscle at knee joint and flexes the thigh at hip joint.
Rectus femoris
94
Common insertion of Quadriceps femoris muscles.
Patellar tendon
95
Common insertion of Iliacus and Psoas.
Lesser trochanter of femur
96
Adducts the thigh; innervated by Obturator nerve.
Medial thigh muscles
97
Common insertion of aDductor muscles of the thigh.
Linea aspera of femur
98
Common insertion of hamstring part of adductor magnus.
Adductor tubercle of femur
99
Extensors of thigh; Flexors of the leg.
| Innervated by Sciatic nerve.
Posterior thigh muscles
| L5, S1, S2
100
Hamstring muscles
Semitendinosus
Semimembranosus
Biceps femoris
Adductor magnus
101
Muscle that adducts and extends the thigh.
Adductor magnus
102
Innervation of biceps femoris.
Long head: Tibial
| Short head: Common peroneal
103
Innervation of adductor magnus.
adductor: L2, L3, L4 (anterior division of obturator nerve)
Hamstring: L4 (tibial part of sciatic nerve)
104
Common origin of Hamstring muscles.
Ischial tuberosity
105
6 month old boy needed a femoral tap for ABG determination. In what compartment of the femoral sheath will you aspirate?
a. medial
b. anterior
c. lateral
d. posterior
c. Lateral
Compartments:
Lateral: femoral artery
Intermediate: femoral vein
Medial: femoral canal
106
Funnel shaped fascial tube formed by inferior prolongation of iliopsoas and transversalis fascia of the abdomen.
Femoral Sheath
107
Femoral pulse is palpated where?
midway between ASIS and symphysis pubis
108
Supply the skin of the thigh below the inguinal ligament that is blocked with local anesthetic.
Genitofemoral nerve
| cremasteric reflex
109
Weak area in the anterior abdominal wall that normally admits the tip of 5th digit.
Femoral ring
110
A fascial tunnel in the thigh running from the apex of the femoral triangle to the aDductor hiatus in the tendon of adductor magnus muscle.
Adductor Canal / Subsartorial Canal / "Hunter's canal"
111
Contents of subsartorial canal
Femoral artery/vein
Saphenous nerve
Nerve to vastus medialis
112
Extensor group of the thigh.
Superficial group
| Gluteus maximus
113
Adductor and medial rotator group of the thigh.
Intermediate group
| Gluteus medius and minimus
114
Lateral rotator group of the thigh.
```
Deep group
(Piriformis, Obturator internus, Superior and Inferior Gemelli, Quadratus femoris)
```
115
Common origin of Gluteal muscles.
Outer surface of Ilium
116
Common insertion of Gluteal muscles.
Greater trochanter of Femur
*EXCEPT:
Gluteus maximus: gluteal tuberosity, iliotibial tract
Quadratus femoris: Quadrate tubercle
117
Muscles that act at Hip joint.
Flexion: Anterior compartment of THIGH
Extension: Posterior compartment of THIGH and Gluteus maximus
ADDuction: Medial compartment of THIGH
ABduction: Gluteus medius and minimus
Medial rotation: Gluteus medius and minimus
Lateral rotation: Piriformis, etc (deep group)
118
Formed within the Psoas major muscle by the ventral rami of L1-L4.
Lumbar plexus
119
From L1, emerges from the Lateral border of Psoas and runs in front of Quadratus lumborum that supplies the skin of the lower part of the anterior abdominal wall.
IlioHypogastric Nerve
120
From L1, emerges from the Lateral border of Psoas and runs in front of Quadratus lumborum that passes through the inguinal wall to supply the skin of the lower part of the groin and scrotum/labia.
IlioInguinal Nerve
121
From L1 and L2; emerges from the anterior surface of Psoas that is resposible for cremasteric reflex.
GenitoFemoral Nerve
```
Genital branch (Efferent): cremaster muscles
Femoral branch (Afferent): skin on the thigh
```
122
From L2 and L3, emerges from the Lateral border of crosses the Iliacus and enters the thigh behind the Inguinal ligament that supplies the skin over the lateral surface of the thigh.
Lateral Femoral Cutaneous
123
Largest branch of the lumbar plexus; From L2, L3 and L4, emerges from the Lateral border of Psoas that supplies the muscle of the anterior thigh and skin on the antero-medial aspect.
Femoral Nerve
124
From L2, L3 and L4, emerges from the Medial border of Psoas that supplies the medial thigh muscle and skin on the medial aspect of thigh.
Obturator nerve
125
Lies on the posterior pelvic wall in front of the Piriformis muscle, formed by anterior rami of L4 and L5 and S1-S4.
LumboSacral plexus
126
Branches of lumbosacral plexus to the lower limb that leave the Pelvis through the Greater Sciatic foramen.
Sciatic nerve (L4, L5, S1, S2, S3)
Superior Gluteal nerve (L4, L5, S1): gluteus medius and minimus
Inferior Gluteal nerve (L5, S1, S2): gluteus maximus
127
Branches of lumbosacral plexus to the lower limbPelvic muscles, Pelvic viscera and Perineum.
Pudendal nerve (S2, S3, S4)
Nerve to Piriformis
Pelvic Splanchnic nerves (S2, S3, S4)
128
Largest nerve in the body.
Sciatic nerve (L4-S3)
*supplies the skin of the foot&leg, posterior thigh muscles
129
A patient walks with waddling gait that is characterized by the pelvis falling toward one side at each step. What nerve is involved?
a. superior gluteal
b. inferior gluteal
c. obturator
d. femoral
a. Superior Gluteal (L4, L5, S1)
| * supplies the gluteus medius and minimus responsible for medial rotation of thigh.
130
Results to weakened abduction of the thigh by gluteus medius so the pelvis sags on the sign of unsupported limb.
Superior Gluteal Nerve Injury
(L4, L5, S1)
*(+) Trendelenburg sign
131
3 Factors that affect the stability of Hip joint.
* Gluteus medius and minimus must be functioning normally.
* Head of Femur must be located normally within acetabulum.
* Neck of Femur must be intact and must have normal angle with shaft of femur.
132
Presents with difficulty in extending the thigh at the hip from a flexed position, as in climbing the stairs or rising from a chair.
Inferior Gluteal Nerve Injury
(L5, S1, S2)
*weakness to LATERALLY rotate and EXTEND the thigh at hip joint.
133
Safest site for intramuscular/intragluteal injection.
Superolateral part of the buttock.
134
Common cause of Sciatic nerve lesions.
IM injection in the lower medial quadrant of the gluteus maximus muscle; or
Posterior dislocation of the femur.
135
Sensation of pain that radiates down the back of the thigh into the lower back.
Sciatica
136
A basketball player fell on his left knee resulting into swelling and pain. A fracture of the patella will result in:
a. Difficulty in extending the knee.
b. Difficulty in flexing the leg at the knee.
c. Inability to extend hip.
d. Inability to flex the hip.
a. Difficulty in extending the knee.
* extensors at the knee joint are anterior group muscles of the thigh, thus, Quadriceps femoris muscle common origin at patella.
137
May be damaged in the abdomen by an abscess of the Psoas major; diminished patellar tendon reflex.
Femoral nerve lesions
* weakness to flex the thigh at hip
* weakness to extend the leg at knee
138
May be lesioned during surgical procedures (CABG) of the leg to remove part of the great saphenous vein.
Saphenous nerve lesion
* pain and paresthesia in the skin of medial aspect of leg and foot
* no motor loss
* may be lacerated as it pierces through the adductor canal
139
Most commonly lesioned in the Pelvis.
Obturator nerve lesions
* inability to adduct the thigh at hip
* paresthesia in the skin of medial thigh
140
Neck shaft of Femur angle in young and adult.
Young: 160 degrees
Adult: 125 degrees
141
Decreased angle; may be due to fractures of the (lateral) neck of femur; ABDUCTION is limited.
Coxa VARA
142
Increased angle; may be due to congenital dislocation of the (medial) neck of femur; ADDUCTION is limited.
Coxa VALGA
143
Femoral neck fracture common in elderly women after menopause.
Subcapital
144
Femoral neck fracture due to direct trauma; common in young.
Trochanteric
145
54/M has just dislocated his right hip. The physician is concerned about the integrity of the joint's blood supply. Which artery is the main blood supply to the hip joint?
a. Lateral circumflex femoral
b. Medial circumflex femoral
c. Superficial circumflex iliac
d. Deep circumflex iliac
b. Medial circumflex femoral
* major blood supply
* Obturator artery supplies small branch to the head
146
Most commonly occur in posterior direction that ay compress the sciatic nerve resulting in weakness of muscles in the posterior thigh, leg, and foot.
Dislocation of the HEAD of Femur
* thigh is shortened and medially rotated by the gluteus medius and minimus muscles
* paresthesia over the posterior and lateral parts of the leg and dorsal and plantar surfaces of the foot.
147
Which of the following muscles dorsiflexes the foot at ankle joint?
a. Peroneus longus
b. Tibialis posterior
c. Tibialis anterior
d. Peroneus tertius
c. Tibialis anterior
* anterior: EXTENSORS
* posterior: FLEXORS
148
Dorsiflex and Extends the foot at ankle joint; supplies by Deep peroneal nerve.
Anterior Leg muscles
Muscles:
* Tibialis anterior
* Peroneus tertius
* Extensor digitorum brevis
* Extensor digitorum longus
* Extensor hallucis longus
149
Plantarflex and Flex the foot at ankle joint; supplies by Tibial nerve.
Posterior Leg muscles
Muscles:
Superficial: Gastrocnemius, Plantaris, Soleus
Deep: Popliteus, FDL, FHL, Tibialis posterior
150
Muscles of Triceps surae.
Gastrocnemius
| Soleus
151
Common insertion of leg muscles.
Achilles tendon
152
Muscle that unlocks the knee.
Popliteus
153
Most frequently injured nerve in the lower limb.
Common peroneal nerve
154
What spinal root mediates the Achilles tendon?
a. L3
b. L4
c. L5
d. S1
e. S2
d. S1
```
Tendon Reflexes
C5: Biceps brachii tendon reflex
C6: Brachioradialis
C7: Triceps brachii
L4: Patellar tendon
S1: Achilles tendon
```
155
50/M patient was noted to have cyanosis and decreased sensation of the left foot. You decided to assess the dorsalis pedis pulse. Where will you palpate for pulsation?
a. Medially to the EFL tendon.
b. Medially to the EDL tendon.
c. In front of the medial malleolus.
d. Behind the medial malleolus.
b. Medially to the EDL tendon.
Lat: tendons of EDL
Med: tendons of EHL
Landmark: between malleoli of 1st metatarsal space.
156
A dehydrated 3 y/o has only one prominent vein which is located in the ankle in front of the medial malleolus. What vein is it?
a. Anterior tibial
b. Posterior tibial
c. Small saphenous
d. Great saphenous
d. Great saphenous
157
Drainage of saphenous vein.
Great: Femoral
Small: Popliteal
158
Branch of tibial nerve that accompanies the small saphenous vein behind the lateral malleolus.
Sural nerve
159
Runs down the medial side of the leg together with the Great saphenous vein.
Saphenous nerve
160
The nerve commonly injured in "foot drop".
a. common peroneal
b. deep peroneal
c. superficial peroneal
d. tibial
a. Common Peroneal
* compression of the neck of the fibula, hip fracture, dislocation of femur
* loss of dorsiflexion of the ankle and loss of eversion
* pain and paresthesia in the lateral leg and dorsum of the foot
161
Raise is affected leg high off the ground and the foot slaps the ground when walking.
"STEPPAGE" gait
162
May be compressed in the anterior compartment of leg. May have foot drop and paresthesia in the skin of the webbed space between the great toe and 2nd toe.
Deep Peroneal nerve
| Fibular nerve lesion
163
May be injured as the nerve emerges from the lateral compartment of the leg; pain and paresthesia in the dorsal aspect of the foot.
Superficial Peroneal Nerve
*weakness in EVERSION of foot
164
Patient can't stand on tiptoes. What nerve is injured?
Tibial nerve
165
Forward sliding of the tibia on femur due to rupture of the Anterior Cruciate Ligament.
Anterior Drawing Sign
166
Backward sliding of the tibia on femur due to rupture of the Posterior Cruciate Ligament.
Posterior Drawing Sign
167
Attaches to the Anterior aspect of the Tibia and courses Posteriorly and EXternally to attach to the LATERAL condyle of femur.
Anterior Cruciate Ligament
*LAX during Flexion
168
Attaches to the Posterior aspect of the Tibia and courses Posteriorly and INternally to attach to the MEDIAL condyle of femur.
Posterior Cruciate Ligament
*LAX during Extension
169
Forced ABDUCTION of the Tibia on Femur.
Medial Collateral (Tibial)
170
Forced ADDUCTION of the Tibia on Femur.
```
Medial Collateral (Fibular)
*less common
```
171
Bones that compose the ANKLE Joint.
Tibia
Fibula
Talus
172
Tibia is twisted or bent LATERALLY; Collapse of the lateral compartment of the knee and rupture of the medial/tibial collateral ligament.
Knock Knee (Genu VALGUM)
173
Tibia is twisted or bent MEDIALLY; Collapse of the lateral compartment of the knee and rupture of the lateral/fibular collateral ligament.
Bowleg (Genu VARUM)
174
Ligament torn due to excessive inversion of the foot with plantarflexion of the ankle.
Anterior Talofibular Ligament
| Calcaneofibular Ligament
175
Ligament torn due to excessive eversion of the foot on the median ankle.
Medial or Deltoid Ligament
176
The foot is DORSI flexed at the ankle joint and everted at the midtarsal joints.
Talipes CALCANEOVALGUS
177
The foot is PLANTAR flexed at the ankle joint and inverted at the midtarsal joints.
Talipes EQUINOVARUS
178
Condition wherein a person has high longitudinal arches of the foot:
a. Pes planus
b. Pes cavus
c. Talipes equinovarus
d. Plantar fascitis
b. Pes cavus (CLAW foot)
179
A football player suffers trauma to the lateral part of the leg just distal to the head of fibula and a nerve is injured. What might the patient experience?
a. Weakness in the ability to plantar flex the foot.
b. Loss of the ability to invert the foot.
c. Altered sensation in the skin of the dorsal aspect of the foot.
d. Weakened ability to flex the toes.
c. Altered sensation in the skin of the dorsal aspect of the foot. (Common peroneal nerve injury)
180
A health worker inadvertently administers an injection to the gluteal region that results in a lesion of a nerve. The patient begins to walk with an altered gait. Upon raising the left foot off the ground during gait, the patient leans to the right, and when standing on the right foot without leaning, the left buttocks seems to sag. What muscle might have been weakened by the nerve lesion?
Gluteus medius
| superior gluteal nerve lesion
181
A piece of wood fell on the head of a medical student while passing by the building construction site. He suffered a lacerated wound on the scalp which was bleeding profusely and gaping. What involved layer was responsible for gaping wound?
a. Superficial fascia
b. Galea aponeurotica
c. Loose areolar connective tissue
d. Periosteum
b. Galea aponeurotica
* tendinous sheet covering the calvaria
Loose connective tissue: allows free movement of the scalp; danger area, emissary veins are located
182
Medulla oblongata is a derivative of what secondary brain vesicle?
a. Myelencephalon
b. Telencephalon
c. Metencephalon
d. Diencephalon
a. Myelencephalon
* Telencephalon: Cerebrum
* Metencephalon: Pons, Cerebellum
* Diencephalon: Thalamus
* Mesencephalon: Midbrain
183
3 primary brain vesicles.
Forebrain / Procencephalon
Midbrain / Mesencephalon
Hindbrain / Rhombencephalon
(5th week of development)
Procencephalon: Telencephalon & Diencephalon
Mesencephalon: Remained
Rhombencephalon: Metencephalon & Myelencephalon
184
Gives rise to the cells that forms the PNS and ANS; cranial, spinal and autonomic ganglia.
Neural crest
185
Differentiates into the CNS.
Neural tube
186
Located above the tentorium cerebella.
Supratentorial level
*cerebrum, basal ganglia, thalamus, hypothalamus, CN Iand II
187
Located below the tentorium cerebelli but above the foramen magnum.
Infraratentorial level
*cerebellum, brainstem (midbrain, pons, and medulla), CN III to XII.
188
Located below the foramen magnum but contained within the vertebral column.
Spinal level
*spinal cord, spinal nerves within the vertebral column.
189
Located outside the skull and vertebral column.
Peripheral level
*neuromuscular structures located outside the skull and vertebral column including CN ad spinal nerves and their peripheral branches.
190
Layer where periosteum cover the inner surface of the skull bones.
Endosteal layer
191
Dura mater proper; dense strong fibrous membrane covering the brain and is continuous through the foramen magnum with the dura mater of the spinal cord.
Meningeal layer
192
Function is to restrict the displacement of brain associated with acceleration and deceleration, when the head is moved.
Septa
193
Most convenient approach in the skull.
Transphenoid
194
Sickle-shaped fold of Dura mater that lies in the midline between two cerebral hemispheres. Narrow anterior end is attached to the Frontal crest and Crista galli.
Falx Cerebri
195
Crescent-shaped fold of Dura mater that roof over the posterior cranial fossa; covers the upper surface of the Cerebellum and supports the Occipital lobes of the cerebral hemispheres.
Tentorium cerebelli
196
Small, sickle-shaped fold of Dura mater that attached to the internal occipital crest between two cerebral hemispheres.
Falx Cerebelli
197
Small, circular fold of Dura mater that forms the roof of the Sella turcica (sphenoid bone).
Diaphragma sella
198
Innervation of Dura matter ABOVE the tentorium.
Trigeminal nerve
* Headache referred to the forehead and face.
199
Innervation of Dura matter BELOW the tentorium.
Cervical nerves
* Headache referred to the back of the head and neck..
200
Innervation of Dura matter.
Trigeminal and the 1st 3 Cervical nerves.
201
Delicate, impermeable membrane covering the brain and lying between the Pia mater internally and Dura mater externally.
Arachnoid mater
202
Separates the Dura and Arachnoid mater.
Subdural space
203
Separates the Arachnoid and Pia mater.
Sub arachnoid space
*filled with CSF
204
Vascular membrane covered by flattened mesothelial cells; closely invests the brain covering the Gyri and descending into the deepest Sulci.
Pia mater
205
Relationship of Gyrus functional area:
a. Precentral gyrus: Primary sensory cortex
b. Postcentral gyrus: Primary motor cortex
c. Heschl gyrus: Primary auditory cortex
d. Inferior frontal gyrus: Wernicke area
c. Heschl gyrus: Primary auditory cortex
206
Described according to numbered areas based on Broadmann classification.
Functional areas
207
Described according to lobes (frontal, parietal, temporal, occipital, limbic and insular).
Anatomical areas
Frontal: motor area; seat of mental activities
Parietal: somesthetic area
Occipital: visual center
Temporal: hearing center
208
Perceives sensations, command skilled movements, provides awareness of emotions and is necessary for memory, thinking, language abilities.
Higher center
209
Brocas area 4
Precentral gyrus
| Primary MOTOR area
210
Brocas area 3, 1, 2
Postcentral gyrus
| Primary SOMESTHETIC area
211
Brocas area 17
Primary VISUAL area
212
Brocas area 41, 42
Primary AUDITORY area
213
Brocas area 44, 45
Inferior Frontal gyrus
| *MOTOR aphasia
214
Brocas area 22 (Wernicke area)
Superior Temporal gyrus
| *SENSORY aphasia
215
Language function is involved; motor or sensory language disturbances.
Aphasia
216
Patient hears but does not understand.
Wernicke aphasia
* B.A. 22 (sensory)
* receptive
217
Patient knows what he wants to say but speech is slow, deleting many words.
Broca's aphasia
* B.A. 44, 45 (motor)
* expressive
218
58/M with atherosclerosis suffers from embolic stroke that leaves him with a left leg paresis. PE reveals Babinski sign on the left and diminished sensation over his left leg. Blockade of which of the following vessels is responsible for his symptoms?
a. Left anterior cerebral artery
b. Right anterior cerebral artery
c. Left middle cerebral artery
d. Right cerebral artery
b. Right anterior cerebral artery
| * ALL areas are supplied by middle cerebral artery EXCEPT the leg area.
219
Where is the location of the decussation of the Costicospinal tract:
a. Midbrain
b. Pons
c. Upper medulla
d. Lower medulla
d. Lower medulla
220
Descending pathways of corticospinal tract.
Upper motor neuron
221
Motor cells in the Anterior gray horn of the SC and motor nuclei of the cranial nerves are the final common pathways for the control of skeletal muscle activity.
Lower motor neuron
222
The following are Signs and Symptoms of an Upper motor neuron lesion, except:
a. Hyperreflexia
b. (+) Pathologic reflex
c. Spastic paralysis
d. (+) Fasciculation
d. (+) Fasciculation
| * LMN lesion: flaccid, (+) atrophy, decreased muscle tone
223
Maintain coordination of limb movements while the movements are being executed; regulation of muscle tone.
Paleocerebellum or Spinocerebellum
(Anterior Lobe)
*limbs via spinal connections
224
Main lobe for coordination of voluntary movements.
Neocerebellum or Cerebrocerebellum
(Posterior Lobe)
*cerebral cortex
225
Responsible for coordination of the paraxial muscles associated with equilibrium.
Archicerebellum or Vestibulocerebellum
(Floculonodular Lobe)
*vestibular apparatus
226
Heel to shin test is done to check the integrity of what lobe of cerebellum?
a. anterior
b. posterior
c. lateral
d. floculonodular
a. anterior lobe
227
Loss of coordination of voluntary movements; rate, range, and force of movements are abnormal resulting to intention tremor.
Ataxia
228
Overshoots or undershoots when attempting to touch a target.
Dysmetria
229
Inability to perform rapid alternating movements.
Dysdiadochokinesia
230
Patient presents with ataxia, dysmetria, dysdiadochokinesia, and intention tremor.
Posterior Lobe Syndrome
231
Loos of coordination chiefly in lower limbs, thus, patient presents with marked instability.
Anterior Lobe Syndrome
232
Truncal ataxia is evident.
Flocculonodular Lobe Syndrome
| "wide based gait"
233
Rate of production of CSF.
0.5 ml/min
234
Normal pressure of CSF.
60 to 150 mm of water
235
Total volumes of CSF.
130 to 150 ml
236
Produce mainly the CSF.
Choroid plexus of the lateral, 3rd and 4th ventricle.
*main: lateral ventricle
237
Clear, colorless fluid located in subarachnoid space; some originates from the ependymal cells lining the ventricles.
Cerebrospinal fluid
238
Where will you aspirate when doing Lumbar puncture?
Usually done at level L3-L4 or L4-L5
239
Finding that would suggest inflammation of the meninges or encephalitis.
Increase in WBCs in CSF.
*Normal: 0-3 lymphocytes/cu mm
240
Finding that implies a change in vascular permeability.
Increase in protein content.
*Normal protein: 15-45mg / 100ml
241
Finding that usually indicates the presence of PMNs or an excessive quantity of protein.
Cloudy CSF
242
Presents with tremor, rigidity, akinesia, bradykinesia, and abnormal posture also known as Paralysis agitans.
Parkinson's Disease
* degeneration of substancia nigra (midbrain)
243
Hesitancy in starting movement.
Akinesia
244
Flexion of limbs and trunk is associated with the failure to make quick postural adjustments to correct balance.
Postural disturbance
245
Actions the patient does not want to perform but cannot prevent.
Positive signs
*e.g. pill rolling
246
Actions that the patient wants to perform but cannot.
Negative signs
247
Irregular, repetitive, jerking movements.
Chorea
* autosomal dominant disorder
* degeneration of striatal neurons
* dementia and athetosis
248
Irregular, repetitive, writhing movement.
Athetosis
249
Slow, sustained, abnormal movements.
Dystonia
250
Explosive, violent movement.
Ballismus
* results from damage of subthalamic nucleus (diencephalon)
* usually results from strokes of the PCA
251
All the cranial nerves have parasympathetic component, except:
a. trigeminal
b. oculomotor
c. facial
d. vagus
a. trigeminal
```
Nerves with Parasympathetic component
CN III: Oculomotor
CN VII: Facial
CN IX: Glossopharyngeal
CN X: Vagus
```
252
Patient presents with slowed/involuntary movement, rigidity, "lead-pipe", no weakness, no paralysis, normal muscle tone and normal reflexes.
Basal Ganglia Lesion
* Cerebral hemispheres: corpus striatum
* Diencephalon: subthalamic nucleus
* Midbrain: substancia nigra
253
Patient presents with weakness, spastic paralysis, spasticity, "clasp-knife", hypertonia, and hyper reflexia.
UMN Lesion
254
Innervation of parotid gland.
Glossopharyngeal nerve (CN IX)
255
Glands innervated by Facial nerve.
Submandibular, Sublingual and Lacrimal gland
| CN VII
256
Cranial nerves that are purely sensory.
Olfactory, Optic, and Vestibulocochlear
| CN I, II, VIII
257
Cranial nerves that are purely motor.
Oculomotor, Trochlear, Abducens, Accessory, Hypoglossal
| CN III, IV, VI, XI, XII
258
Cranial nerves that are both motor and sensory.
Trigeminal, Facial, Glossopharyngeal, and Vagus
| CN V, VII, IX, X
259
Largest cranial nerve.
Trigeminal nerve
260
Longest cranial nerve.
Vagus nerve
261
During a game, a 25y/o basketball player received a severe blow to the head that fracture his Optic canal. Which of the following pairs of structures are most likely to be damaged?
a. Optic nerve and Ophthalmic vein
b. Ophthalmic nerve and Ophthalmic vein
c. Optic nerve and Ophthalmic artery
d. Ophthalmic nerve and Ophthalmic vein
c. Optic nerve and Ophthalmic artery
Optic canal: Optic nerve, Ophthalmic artery
Superior orbital fissure: CN III, IV, VI; ophthalmic nerve (V1), ophthalmic vein
Foramen rotundum: Maxillary nerve (V2)
Foramen ovale: Mandibular nerve (V3)
Jugular formen: CN IX, X, XI cranial roots
Hypoglossal canal: CN XII
Internal acoustic meatus: CN VII and VIII
Foramen magnum: Medulla, meninges, vertebral arteries, CN XI spinal roots
262
A 25/F was brought to ER with continuous dripping of clear fluid from her nose associated will loss of the sense of smell. The most likely injury is:
a. Fracture of frontal sinus
b. Fracture of the bridge of the nose
c. Fracture of the cribriform plate
d. Laceration of frontal lobe
c. Fracture of the cribriform plate
| * Foramina of Cribriform plate of Ethmoid: CN I
263
Diplopia with eye turned down & out; ptosis and dilated and fixed pupil is caused by injury of what cranial nerve?
CN III / Oculomotor
264
Diplopia with extorsion of the eye and weakness of downward gaze is caused by injury of what cranial nerve?
CN IV / Trochlear
| Superior oblique muscle injury
265
Diplopia with medial deviation and abductor paralysis caused by injury of what cranial nerve?
CN VI / Abducens
| Lateral Rectus muscle injury
266
TRUE regarding Bell's palsy:
a. absence of lacrimation
b. inability to open eyelid
c. loss of common sensation of anterior 2/3 of the tongue
d. aota
a. absence of lacrimation
Bell's Palsy: Facial paralysis, Loss of corneal/blink reflex (inability to close eyes), Hyperacusis, Dry mouth, Loss of lacrimation, loss of taste of anterior 2/3 of the tongue (special sensation)
267
Level of bifurcation common carotid to become external and internal carotid.
Level of C4
*superior cartilage of thyroid cartilage
268
Union of 2 vertebral arteries at the level of pons.
Basilar artery
269
Divides the 3 parts of subclavian arteries.
Scalenius anterior
270
The oculomotor nerve passes between which two arteries at the base of the brain and may be affected by an aneurysm of either of these two arteries?
a. Middle cerebral - Anterior cerebral
b. Posterior cerebral - Posterior communicating
c. Basilar - Vertebral
d. Anterior cerebral - Anterior communicating
b. Posterior cerebral - Posterior communicating (midbrain)
| * c. Basilar - Vertebral: Pons
271
Saccular dilatations of the walls of the arteries, most common in anterior part of Circle of Willis; may experience an acute explosive "worst headache of his life".
Berry aneurysm
* Anterior communicating, Posterior communicating or MCA
* worst headache: caused by blood leaking from the aneurysm which irritates the meninges
272
Where is the dangerous area of the face?
a. Root of the nose and 2 angles of the mouth.
b. Tip of the nose and 2 angles of the mouth.
c. Root of the nose and 2 angles of the jaw.
d. Tip of the nose and 2 angles of the jaw.
a. Root of the nose and 2 angles of the mouth.
Dangerous triangle of the Face
* drained by Facial veins with communication to Cavernous sinus
273
Develop from mesoderm in the 2nd pharyngeal arches.
Facial muscles
274
"Kissing muscle"
Orbicularis oris
Smiling muscle: Zygomaticus
Grinning muscle / Sarcodonic: Risorius
"Trumpeeter's muscle: Buccinator
Chin muscle: mentalis
275
Formed by union of Superficial temporal and Maxillary veins.
Retromandibular vein
276
Septic thrombosis of the cavernous sinus could cause secondary injury to the following structures, except:
a. Maxillary division of the Trigeminal nerve
b. Mandibular division of the Trigeminal nerve
c. Trochlear nerve
d. Internal carotid artery
b. Mandibular division of the Trigeminal nerve
Cavernous sinus boundaries:
Ant: extends into the medial end of superior orbital fissure
Post: up to the apex of petrous temporal bone
Med: pituitary above and sphenoid bone
Lat: temporal lobe and uncus
Sup: optic chiasm
Inf: endosteal dura mater, greater wing of sphenoid
277
Results from infections in the orbit, nasal sinuses and superior part of the face.
Cavenous Sinus Thrombosis
* CN III, IV, VI
* Ophthalmic, Maxillary division of Trigeminal nerve
* Internal carotid artery
278
Terminal Branches of Facial nerve from Parotid plexus.
```
Temporal
Zygomatic
Buccal
Mandibular
Cervical
```
279
Muscles of mastication that closes the jaw.
Temporalis
Masseter
Medial pterygoid
280
Muscles of mastication that opens the jaw.
Lateral pterygoid
281
A teenager had a habit of picking blemishes on her face. One of the blemishes above the upper lip on the left became infected and spread from the face to the cavernous sinus where the infection formed a thrombolytic lesion of nerves that traverse the sinus. Which of the following will not be affected by lesion?
a. sensation in the skin of the forehead
b. pupillary light reflex
c. ability to elevate the upper eyelid
d. lacrimal gland secretions
e. ability to abduct the eye
d. lacrimal gland secretions (facial nerve)
Cavenous Sinus Thrombosis
* CN III, IV, VI
* Ophthalmic, Maxillary division of Trigeminal nerve
* Internal carotid artery
282
The Great cerebral vein of Galen drains directly into which of the following sinuses?
a. Superior sagittal sinuses
b. Inferior sagittal sinus
c. Straight sinus
d. Transverse sinus
e. Cavernous sinus
c. Straight sinus
```
Venous Blood Sinuses
Superior sagittal: at upper Falx cerebri
Inferior sagittal: at lower Falx cerebri
Straight: at junction of falx cerebri with tentorium cerebelli; formed by union of inferior sagittal and great cerebral vein
Right transverse: from superior sagittal
Left transverse: from straight sinus
Sigmoid: from transverse sinuses to IJV
```
283
Skin on the side of the nose is supplied by what nerve?
a. Maxillary division of Trigeminal
b. Mandibular division of Trigeminal
c. Ophthalmic division of Trigeminal
d. Zygomatic branch of Facial
a. Maxillary division of Trigeminal
284
Episodes of sharp, stabbing pain that radiates over the areas innervated by sensory branches of maxillary or mandibular division of CN V.
Tic Douloureux (Trigeminal Neuralgia)
* triggered by moving the mandible, smiling or yawning, or by cutaneous stimulation
* may be caused by pressure on or interruption of the blood supply of the trigeminal ganglion
285
The following muscles of the head are derivatives from the Pharyngeal arches, except:
a. Muscles of Mastication
b. Muscles of Facial expression
c. Muscles of the Eyeball
d. Muscles od Deglutition
c. Muscles of the Eyeball
```
Pharyngeal/Branchial Apparatus
1: Mastication
2: Facial expression
3: Deglutition
4& 6: Phonation
```
286
Alter the SHAPE of the tongue innervated by Hypoglossal nerve.
Intrinsic muscles of the tongue
*4 muscles: superior and inferior longitudinal, transverse and vertical
287
Alter the POSITION of the tongue innervated by Hypoglossal nerve except Palatoglossus which is innervated by Vagus nerve.
Extrinsic muscles of the tongue
```
Muscles of the Tongue
Palatoglossus: Elevation
Styloglossus: Retraction
Hyoglossus: Depression
Genioglosus: Protrusion
```
288
The only extrinsic muscle of the tongue that is innervated by Vagus nerve.
Palatoglossus muscle
289
After injury of CN III, what can you expect with eye movement?
Abducted and Depressed
290
In a patient with Oculomotor nerve paralysis, he can still perform:
a. Upward movement of eyeball.
b. Downward movement of eyeball.
c. Inward movement of eyeball.
d. Lateral movement of eyeball.
d. Lateral movement of eyeball.
291
Internal strabismus results as a consequence of an injury to what cranial nerve?
a. Optic
b. Oculomotor
c. Abducens
d. Trochlear
c. Abducens
* located beneath the facial colliculus in the floor of 4th ventricle in the caudal pons
* medial deviation or ESOTROPIA and paralysis of abduction of the ipsilateral eye
292
Slight extorsion or outward rotation of the superior part of the eye; compensated by tilting of the head.
Trochlear nerve injury
*located at the ventral border of the periaqueductal gray of the midbrain at the level of inferior colliculus.
293
26/F has been back and forth to her physician complaining of frontal headaches that are resistant to medication. The patient has irregular menstrual cycles and notes that she seems to be losing her peripheral vision bilaterally. MRI reveals a tumor in the cranial cavity. What structure might the tumor be compressing?
a. Optic tract
b. Optic nerve
c. Lateral aspects of Optic chiasma
d. Crossing fibers of Optic chiasm
e. Structures passing through the superior orbital fissure
d. Crossing fibers of Optic chiasm
Optic nerve: Blindness
Optic chiasm: Bitemporal hemianopsia
Angle of chiasm: Nasal heminanopsia (aneurysm of ICA)
Optic tract: Homonymous hemianopsia (vascular)
294
A patient examined to have Right Nasal Hemianopsia. Where is the most probable site of the lesion?
a. Right optic nerve
b. Uncrossed fibers of the right optic chiasm
c. Right optic radiation
d. Optic chiasm
b. Uncrossed fibers of the right optic chiasm
295
5/F is brought to her pediatrician because her mother says she is frequently bumping into stationary objects while playing. Visual field examination shows bilateral peripheral vision defects. CT scan of the head reveals calcifications in the pituitary fossa. Which of the following is the most likely origin of this child's brain tumor?
a. 4th ventricle neuroectoderm
b. Rathke's pouch
c. Adenohypophyseal lastotrophs
d. Ventricular lining
b. Rathke's pouch
Development of Pituitary Gland
Hypophyseal Pouch / Rathke: upgrowth from ROOF of primitive mouth - ANTERIOR PITUITARY
Neurohypophyseal bud: downgrowth from the forebrain (diencephalon) - POSTERIOR PITUITARY
296
3 layers of tympanic membrane.
Outer: cutaneous
Intermediate: fibrous
Inner: mucous
297
Cone of light from UMBO is seen in:
anteroinferior quadrant
298
Contained within the Petrous part of the Temporal bone.
Tympanic cavity
299
Covered with skin and is innervated by the auriculotemporal branch of Trigeminal nerve and auricular branches of Facial, Vagus, and Glossopharyngeal nerve.
External / Lateral concave surface
300
Covered by mucous membrane and is innervated by the tympanic branch of the Glossopharyngeal nerve.
Internal / Medial surface
301
What membrane separates the Scala media and Scala tympani?
a. Basilar membrane
b. Reissner's membrane
c. Tectorial membrane
d. Vestibular membrane
a. Basilar membrane
* Reissner's/Vestibular membrane: between scala vestibuli and media.
Scala Media: endolymph, Organ of corti
Scala Tympani: perilymph
302
Muscle that is responsible for hyperacusis.
Stapedius muscle
303
Abnormal bone formation around stapes and oval window that causes conduction deafness.
Otosclerosis
304
Filled with ENDOLYMPH and contains sensory organs.
Membranous Labyrinth
305
Contains PERILYMPH with 3 parts: vestibule, 3 semicircular canals and cochlea (upper scala vestibuli and lower tympani)
Bony Labyrinth
306
Sensory organs for Linear acceleration.
Maculae utricle and Saccule
307
Sensory organs for Angular acceleration.
Ampullae of Semicircular ducts
308
The thyroid gland is invested by what structure?
a. Carotid sheath
b. Pretracheal fascia
c. Prevertebral fascia
d. Superficial layer of deep cervical fascia
b. Pretracheal fascia
| * forms the fascial floor of the posterior triangle
309
Thin layer that is attached above the laryngeal cartilages that forms a false capsule of the thyroid gland.
Pre tracheal fascia
310
Thick layer that passes like septum across the neck behind the Pharynx and Esophagus and in front of the Prevertebral muscles and vertebral column.
Prevertebral Fascia
| *forms the fascial floor of the posterior triangle
311
Investing layer that encircles the neck and splits to enclose the Trapezius and Sternocleidomastoid.
Superficial Cervical Fascia
312
Which cranial nerve descends through the neck in the Carotid sheath?
a. Vagus
b. Hypoglossal
c. Accessory
d. Glossopharyngeal
a. Vagus
CAROTID SHEATH- local condensation of prevertebral, pretracheal, and investing layers of deep cervical fascia.
Lateral: IJV
Medial: Common and ICA
Posterior: Vagus nerve
313
67/M developed dental abscess that he ignored for 2 weeks. At that time, he began to have severe chest pain due to infection of the mediastinum. Through which pathway did the infection spread to the mediastinum?
a. Masticator space
b. Preteacheal space
c. Retropharyngeal space
d. Suprasternal space
c. Retropharyngeal space
314
24/M was involved in a knife fight in a bar. A 2cm laceration was noted in the anterolateral aspect of the neck. The wound was superficial but the physician observed muscle fibers just deep to the superficial fascia. Which muscle was observed?
a. platysma
b. sternocleidomastoid
c. omohyoid
d. trapezius
a. Platysma --- broad, thin sheet of muscle in the subcutaneous tissue of the neck.
315
The hyoid bone approximately lies at what level of cervical vertebra?
a. C 2
b. C 3
c. C 4
d. C 5
b. C 3
C3-C4: Hyoid bone; bifurcation of common carotid artery
C5: Thyroid cartilage; Carotid Pulse palpated
C6: Cricoid cartilage; start of Trachea; start of Esophagus
T2: Sternal notch; Arch of Aorta
T4: Sternal angle; Junction of Superior and Inferior Mediastinum; bifurcation of Trachea
T5-T7: Pulmonary hilum
T8: IVC hiatus
T9: Xiphisternal joint
T10: Esophageal hiatus
T12: Aortic hiatus; Celiac artery; Upper pole of Left Kidney
T12-L1: Duodenum
316
The only bone that does not articulate with another bone and serves as a moveable base for the tongue.
Hyoid bone
317
What triangle od the neck is bounded by the posterior belly of digastric, superior belly of omohyoid and the anterior border of the sternocleidomastoid?
a. Muscular
b. Digastric
c. Carotid
d. Submental
c. Carotid
Anterior: Digastric, Carotid, Muscular
Posterior: Supraclavicular, Occipital
Submental: Ant. belly of Digastric, Hyoid bone and Mylohyoid
Muscular: Superior belly of omohyoid, Ant. belly of digastric, Ant. border of SCM
Digastric/Submandibuar: Ant and Post bellies of Digastric, Inferior border of mandible
318
An 18/M was stabbed in the neck and was hit in front of the right sternocleidomastoid and superior omohyoid muscles and below the hyoid bone. What triangle is involved?
a. Digastric
b. Submental
c. Carotid
d. Muscular
d. Muscular
| * Superior belly of omohyoid, Ant. belly of digastric, Ant. border of SCM
319
The contents of the upper portion of the carotid sheath are crossed obliquely and anteriorly by the:
a. Omohyoid
b. Anterior belly of Digastric
c. Mylohyoid
d. Posterior belly of Digastric
d. Posterior belly of Digastric
320
A deep gash in the Posterior triangle of the neck can cut the:
a. External carotid artery
b. Internal carotid artery
c. External jugular vein
d. Internal jugular vein
c. External jugular vein
321
Superficial landmark of supraclavicular fossa.
Supraclavicular triangle (aka subclavian triangle)
322
How much the Thyroid gland weighs?
20 grams
323
Fibrous or muscular band frequently connects the pyramidal lobe to the hyoid bone.
Levator Glandulae Thyroidea
324
45/F is undergoing thyroid surgery for suspected thyroid cancer. The surgeon has taken a midline approach and encounters significant bleeding below the isthmus of the thyroid gland. Which of the following is the likely cause of the bleeding?
a. Superior thyroid artery
b. Inferior thyroid artery
c. Thyroidea ima artery
d. Inferior laryngeal artery
c. Thyroidea ima artery
* midline artery
* arises from the aortic arch or brachiocephalic trunk
325
When a low tracheostomy is performed below the isthmus of the thyroid, which of the following vessels may be encountered?
a. Inferior thyroid vein
b. Inferior thyroid artery
c. Superior thyroid artery
d. Costocervical trunk
a. Inferior thyroid vein
326
First endocrine gland to develop; 24 days after fertilization.
Thyroid gland
327
Painless, progressively enlarging movable mass; asymptomatic unless become infected.
Thyroglossal duct cyst
328
Caner cells in thyroid malignancy will metastasize first to this group of cervical lymph nodes:
a. Cervical LN II
b. Cervical LN VI
c. Cervical LN III
d. Cervical LN V
d. Cervical LN V
* Primary tumors within the Oral cavity and Lip: to level I, II and III
* Oropharynx, Hypopharynx, and Larynx: to Level II, III and IV
* Nasopharynx and Thyroid: level V
329
Larynx lies at what level of the cervical vertebra?
4th, 5th, and 6th cervical vertebrae
| *situated below the tongue and hyoid bone
330
What cartilage forms the laryngeal prominence in the neck?
a. Cricoid cartilage
b. Thyroid cartilage
c. Epiglottis
d. Arytenoid cartilage
b. Thyroid cartilage
* aka Adam's apple
* largest
* 2 laminae of hyaline cartilage that meet at the midline
331
3 UNPAIRED laryngeal cartilages.
Thyroid
Cricoid: signet ring; hyaline cartilage
Epiglottis: leaf shaped lamina of elastic cartilage
332
3 PAIRED laryngeal cartilages.
Arytenoid: pyramid shaped; at the back of larynx
Cuneiform: small rod shaped
Corniculate: small conical shaped
333
Connects the upper margin of the thyroid cartilage to the hyoid bone; pierced on each side by the superior laryngeal vessels and internal laryngeal nerve.
ThyroHyoid membrane
*midline is thickened to form the Thyrohyoid ligament
334
Connects the cricoid cartilage to the first ring of the trachea.
CricoTracheal ligament
335
Extends between the epiglottis and arytenoid cartilages.
Quadrangular membrane
*thickened inferior margin forms the Vestibular ligament (interior of vestibular folds)
336
Lower margin is attached to the upper border of the cricoid cartilage; superior margin ascends on the medial surface of the thyroid cartilage; forms vocal ligaments on each side.
CricoThyroid ligament
337
Forms the interior of the Vocal folds/cords.
Vocal ligament
338
An emergency cricothyroidotomy is done due to airways collapse and severe laryngoedema. Which of the following is the most accurate description of the location of the cricothyroid membrane?
a. immediately superior to thyroid cartilage
b. immediately inferior to thyroid cartilage
c. immediately inferior to cricoid cartilage
d. immediately inferior to hyoid bone
b. immediately inferior to thyroid cartilage
* Cricothyroid membrane--located INFERIOR to the Thyroid cartilage and SUPERIOR to the Cricoid cartilage;
* True vocal cords lie SUPERIOR to it.
339
Structures you will see in vertical incision of Cricothyroidotomy.
```
Skin
Superficial fascia
Investing layer of Deep cervical fascia
Pretracheal fascia
Larynx
```
340
Fixed, False and is Formed by mucous membrane covering the vestibular ligament.
Vestibular Fold
| *Vascular (Pink in color)
341
True, Mobile, concerned with voice production and is Formed by mucous membrane covering the vocal ligament.
Vocal Fold/Cord
| *Avascular (White in color)
342
In Thyroidectomy, what nerve may be injured during the ligation of superior thyroid artery?
a. internal laryngeal
b. superior laryngeal
c. external laryngeal
d. inferior laryngeal
c. external laryngeal
343
Innervates the muscles of phonation (motor).
Inferior LN/Recurrent Laryngeal nerve
| *except cricothyroid; sensory below vocal cord area
344
Supplies cricothyroid.
External laryngeal nerve
345
Supplies the sensory above vocal cord area.
Internal laryngeal nerve
346
Chief tensor of the vocal cords.
Cricothyroid muscle
347
If a patient is unable to abduct the vocal cords during quiet breathing, which of the following muscles is paralyzed?
a. Posterior Cricoarytenoid
b. Lateral Cricoarytenoid
c. Cricothyroid
d. Thyroarytenoid
a. Posterior Cricoarytenoid --- aBductor
Lateral Cricoarytenoid: aDductor
Cricothyroid: Tensor
Thyroarytenoid: Relaxor
348
In partial surgical resection of the Thyroid gland, the paralysis of the Cricothyroid muscle may be a result of:
a. Trauma to the muscle during surgery
b. Secondary infection after surgery
c. Severing the Inferior Laryngeal Nerve
d. Severing the Superior Laryngeal Nerve
d. Severing the Superior Laryngeal Nerve
349
Usually asymptomatic because fibers are mainly sensory; may experience mild hoarseness or monotonous speech. (if external nerve lesion)
Superior Laryngeal nerve lesion
350
Injury to this nerve may result in fixed vocal cord and transient hoarseness.
Recurrent Laryngeal nerve lesion
* Left injured more commonly--hooks around the aorta
* Right--hooks around the right subclavian artery
351
Which of the following muscles is the most important to allow air movement through the larynx?
a. Posterior Cricoarytenoid
b. Lateral Cricoarytenoid
c. Cricothyroid muscle
d. Infrahyoid muscles
a. Posterior Cricoarytenoid
352
A male teenager is admitted with a stab wound in the neck which is several inches inferior from the mastoid process, just posterior to SCM. The patient complains of weakness in the ability to shrug his shoulder on the side of injury. What else might be observed in this patient?
a. weakness in the ability to protract the scapula
b. weakness in the ability to aBduct his arm above his head to comb hair
c. weakness in the ability to depress the hyoid bone
d. weakness in the ability to turn his face to the opposite side of injury
e. weakness in the ability to depress the mandible
b. weakness in the ability to aBduct his arm above his head to comb hair.
* lesion on the spinal accessory nerve
353
Your patient is stabbed to the neck that lacerates structures entering the pharynx through the thyrohyoid membrane. Which of the following symptoms might the patient have?
a. b. weakness in the ability to aDduct vocal cords
b. decreased ability to detect a foreign body in contact with the mucosa below the vocal cord
c. b. weakness in the ability to tense the vocal ligament
d. hoarseness
e. decreased ability to detect a foreign body in contact with the mucosa above the vocal cord
e. decreased ability to detect a foreign body in contact with the mucosa above the vocal cord
354
A 15/M is eating fish dinner and inadvertently has a bone "caught in his throat". He complains of significant pain above the vocal cords. Which of the following nerves is responsible in carrying the sensation of pain?
a. Superior Laryngeal nerve
b. Recurrent Laryngeal nerve
c. Spinal accessory nerve
d. Hypoglossal nerve
e. Glossopharyngeal nerve
a. Superior Laryngeal nerve
355
Ovoid bodies, measuring about 6mm long in diameter; closely related to the posterior border of the thyroid gland lying within its fascial capsules.
Parathyroid gland
356
Constant in position, lie at the level of the middle of the posterior border of the thyroid gland.
Superior Parathyroid Gland
357
Lie close to the inferior poles of the Thyroid gland.
Inferior Parathyroid Gland
358
The activity of osteoclast in releasing Calcium from bones is a result of stimulation of what hormone?
a. Calcitonin
b. TSH
c. Thyroxine
d. PTH
d. PTH
- -stimulates osteoclastic activity in bones, thus mobilizing the bone calcium and increasing the calcium levels in the blood
* produced by chief cells
359
Close relationship between inferior parathyroid and thymus frequently seen in the superior mediastinum.
Ectopic Parathyroid
360
Derived from 3rd pharyngeal pouch.
INFERIOR parathyroid
361
Derived from 4th pharyngeal pouch.
SUPERIOR parathyroid
362
Abnormal communication between the trachea and esophagus; results from improper division of foregut by the tracheoesophageal septum.
Tracheoesophageal Fistula
363
True regarding ANSA cervicalis, except:
a. derived from branches of cervical nerves
b. usually lies across the internal jugular vein
c. innervates the infrahyoid muscles
d. encircles the subclavian artery
d. encircles the subclavian artery
364
Formed by the anterior rami of the first four cervical nerves; lie in from of the origins of levator scapula and scalenus medius muscle
Cervical plexus
* Cutaneous branches: Lesser occipital (C2), Greater auricular (C2 and C3), Transverse cutaneous (C2 and C3), and supraclavicular (C3 and C4)
* Muscular branches: Neck muscles
365
Formed by fibers from union of Hypoglossal and C1 nerves (descending branch) unites with descending cervical (C2 and C3)
Ansa cervicalis
366
Only motor nerve supply to diaphragm
Phrenic nerve (C3, C4, and C5)
367
Key muscle; deeply placed and descends almost vertically from the vertebral column to the 1st rib
Scalenus Anterior
368
17/M receives an injury of the Phrenic nerve by a knife wound on the neck. The damaged nerve passes by which of the following structures in the neck?
a. Anterior to the Subclavian vein
b. Posterior to the Subclavian artery
c. Deep to the Brachial plexus
d. Medial to Common carotid artery
e. Superficial to the Anterior Scalene muscle
e. Superficial to the Anterior Scalene muscle
369
A 28y/o tricycle driver was brought to the ER due to stab wound on the lateral aspect of the left neck at the level slightly above the clavicle. On PE, there was an expanding hematoma with pulsation on the Left supraclavicular area. According to penetrating neck injuries, the injury is at what zone?
a. Zone I
b. Zone II
c. Zone III
d. Zone IV
a. Zone I
* includes the root of the neck and extends from clavicles and manubrium to the level of INFERIOR border of the CRICOID cartilage
* cervical pleurae, apices of the lungs, thyroid and parathyroid glands, trachea, esophagus, common carotid artery, jugular veins and cervical region of the vertebral column
370
Area that extends from the cricoid cartilage to the level of ANGLE of the MANDIBLE.
Zone II
*most common, but is easily visualized and treated
371
ABOVE the level of ANGLE of the MANDIBLE.
Zone III
* salivary glands, oral and nasal cavities, oropharynx, nasopharynx
* can obstruct airway and have greatest risk of morbidity and mortality.
372
69/M has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is most likely diagnosis?
a. Lordosis
b. Spina bifida
c. Meningomyelocele
d. Meningocele
e. Kyphosis
e. Kyphosis
LORDOSIS: LUMBAR; increase in weight of the abdominal contents
SCOLIOSIS: lateral deviation; common in THORACIC
373
Primary curvature of the vertebral column corresponds to what segments?
Thoracic and Sacral
*conCAVE ventrally
374
Secondary curvature of the vertebral column corresponds to what segments?
Cervical and Lumbar
*conVEX ventrally
375
Which of the following is a characteristic feature of the first cervical vertebra?
a. absent body
b. odontoid process
c. absent foramen transversarium
d. massive body
e. long spinous process
a. absent body
Cervical 1:
* also known as ATLAS
* NO body
* atypical
376
Which of the following is a characteristic feature of the second cervical vertebra?
a. absent body
b. odontoid process
c. absent foramen transversarium
d. massive body
e. long spinous process
b. odontoid process
Cervical 2:
* also known as AXIS
* presence of odontoid process or DENS
* atypical
377
The seventh cervical vertebra is characterized by:
a. long spinous process
b. an odontroid process
c. a large foramen transversarium
d. a massive body
e. a heart shaped body
a. long spinous process
Cervical 7:
* long spinous process and not bifid
* vertebral prominence
* atypical
378
When a person's neck and trunk is flexed, as in preparation for a spinal tap, the spinous process of C7 becomes visible and it is for the reason that is called:
a. Spina bifida
b. Atlas
c. Vertebral prominence
d. Axis
c. Vertebral prominence
Cervical 7:
* long spinous process and not bifid
* vertebral prominence
* atypical
379
First part of the subclavian artery.
Vertebral : brain
Thyrocervical : thyroid
Internal thoracic : anterior chest wall, breast area
380
Transverse processes possess a Foramen Transversarium; Spines are small and bifid; Body is small and broad; Vertebral foramen is large and TRIANGULAR; Superior articular processes have facets that face posteriorly and superiorly, inferior and anteriorly.
TYPICAL Cervical Vertebra
*C3 to C6
381
The sixth thoracic vertebra is characterized by:
a. its bifid spinous process
b. its thick lamina
c. having the superior articular processes face medially and those of the inferior articular processes face laterally
d. its massive body
e. its heart shaped body
e. its heart shaped body
THORACIC vertebra:
* heart-shaped body
* facets on their Bodies for articulation with head of Ribs
* facets on their Transverse processes for articulation with the Tubercles
* Long spinous processes
382
Body is medium size and Heart shaped; Vertebral foramen is small and circular; Spines are long.
Typical THORACIC Vertebra
Costal facets - BODIES - with Head of Ribs
Costal facets - TRANSVERSE PROCESS - with Tubercle of Ribs
383
The characteristic feature of the fifth lumbar vertebra is its:
a. short and thick transverse process
b. rounded vertebral foramen
c. small pedicles
d. massive body
e. heart-shaped body
d. massive body
| * large and kidney shaped body
384
Body is large and kidney shaped; Pedicles are strong and directed backward; Laminae are short in vertical dimension; Vertebral foramina is triangular; Transverse processes are long and slender; Spinous process are short, flat and quadrangular; project posteriorly.
Typical LUMBAR Vertebra
385
The spinal cord in adult ends inferiorly at the level of the:
a. L 5 vertebra
b. L 3 vertebra
c. S 2 - S 3 vertebra
d. T 12 vertebra
d. L 1 vertebra
d. L 1 vertebra
L1: SMA; Upper pole of R Kidney; Conus medullaris; Pia mater
L2: Renal artery
L3: End of SC in NB; IMA; umbilicus
L4: Iliac crest; bifurcation of aorta
S1: Sacral promontory
S2: end of Dural sac, Dura, Arachnoid, Subarachnoid space and CSF
S3: end of Sigmoid colon
386
The subarachnoid space ends inferiorly in the adults at what vertebral level?
a. coccyx
b. lower border of L1
c. S 2 - S 3 vertebra
d. S 5
d. promontory of sacrum
c. S 2 - S 3 vertebra
387
What is the term that refers to the collection of posterior and anterior roots that occupy the lumbar cistern?
a. Cauda equina
b. Conus medularis
c. Denticulate ligament
d. Filum terminale externum
e. Filum terminale internum
a. Cauda equina
388
A 27y/o stuntman is thrown out of his vehicle. His spinal cord is crushed at the level of the 4th sacral spinal segment. Which of the following structures would most likely be spared from destruction?
a. Dorsal horn
b. Ventral horn
c. Lateral horn
d. Gray mater
e. Pia mater
c. Lateral horn
*only in upper segment
*thoracic and lumbar
*
389
Ascending tracts.
Dorsal/Posterior column
* position sense
* 2 pt discrimination
* fine, discriminate
* vibratory sense
* steriognosis
Spinothalamic tract : contralateral
* ASTT - touch/pressure
* LSTT - pain & temp
390
Descending tract
Lateral Corticospinal : ipsilateral
* Rubrospinal
* Lateral reticulospinal
* Medial reticulospinal
* Vestibuspinal
* Tectospinal
* Anterior corticospinal
391
Spinal hemisection, that presents with Contralateral loss of pain and temperature; Ipsilateral loss of proprioception; Ipsilateral manifestations of UMN and LMN motor loss
Brown-Sequard Syndrome
392
Progressive cavitation around the central canal; loss of pain and temperature sensations in hands & forearm (common in cervical).
Syringomyelia
393
Attacks the anterior horn cells leading to Lower motor neuron loss; motor loss.
Poliomyelitis
394
Caused by neurosyphilis; dorsal root involvement with secondary degeneration of dorsal columns (loss of vibration and position senses).
Tabes dorsalis
395
Pure motor disease involving degeneration of anterior horn cells (LMNL) and corticospinal tract (UMNL); NO sensory loss.
Amyotrophic Lateral Sclerosis or Lou Gehrig syndrome
396
Caused by vitamin B12 deficiency; degeneration of posterior and lateral columns (loss of position sense and vibration in legs associated with UMNL).
Subacute Combined Degeneration
397
Presents with inability to recognize limb position, astereognosis, loss of 2 point discrimination, loss of vibration sense, and (+) Romberg sign.
Injury to Lemniscal Pathway
* eyes closed, swaying: sensory
* eyes open, swaying: cerebellar lesion
398
11/F brought to the ER because the girl cut her little finger but did not realize it until she saw blood. Examination reveals a bilateral loss of pain and thermal sensations on the upper extremities and shoulder. Which of the following is the likely deficit:
a. Brown sequard
b. Tabes dorsalis
c. Syringomyelia
d. PICA syndrome
e. ALS
c. Syringomyelia
* Progressive cavitation around the central canal;
* loss of pain and temperature sensations in hands & forearm
* common in cervical
399
Examination reveals hemiplegia on the left, a loss of vibratory sense on the left and loss of pain and thermal sensation on the right involving the upper and inner extremities. These deficits are seen in what syndrome?
a. Millard gubler
b. Brown sequard
c. Calude
d. Wallenberg
e. Weber
b. Brown sequard
Wallenberg-Lateral medullary/PICA syndrome: alternating sensory losses
Millard Gubler: Pons
Claude & Weber: Midbrain
400
A 23y/o is brought to the ER from the site of an automobile collision. Neuro exam reveals weakness of the right lower extremity and loss of pain and thermal sensation on the left side beginning at the level of the umbilicus. Damage to which of the following tracts would correlate with weakness of the lower extremity in this man?
a. Left Lateral Corticospinal tract
b. Left Fasciculus Gracilis
c. Right Lateral Corticospinal tract
d. Right Fasciculus Gracilis
c. Right Lateral Corticospinal tract
401
Presents with loss of pain and thermal sensation on the left side beginning at the level of the umbilicus and reveals weakness of right lower extremity. Which of the following represents the most likely damage to the spinal cord resulting from the fracture to the vertebral column in this man?
a. T8 on the Left
b. T8 on the Right
c. T10 on the Left
d. T10 on the Right
b. T8 on the Right
| * loss of PAIN/TEMPERATURE at T10 dermatome on the Left,
402
Bilateral cervical spinal cord damage C4-C6 may result in paralysis of all four extremities.
Quadriplegia
403
Unilateral spinal cord lesions in the thoracic levels that result in paralysis of the IPSILATERAL lower extremities.
Monoplegia
404
The thoracic spinal cord damage is bilateral, both lower extremities may be paralyzed.
Paraplegia
405
An elderly man at nursing home is known to have degenerative brain disease. When CSF is withdrawn by lumbar puncture, which of the following structures is most likely penetrated by the needle?
a. Pia mater
b. Filum terminale
c. Posterior longitudinal ligament
d. Ligamentum flavum
e. Annulus fibrosis
d. Ligamentum flavum
Lumbar Puncture (Spinal Tap)
* lies within imaginary line between highest points on iliac crest
* Skin, Superficial fascia, Supraspinous ligament, Interspinous ligament, Ligamentum flavum, Epidural space, Dura mater, Arachnoid, Subarachnod space that contains CSF
406
A herniation of a cervical intervertebral disc is most likely to occur between:
a. C1 - C2
b. C2 - C3
c. C3 - C4
d. C4 - C5
e. C5 - C6
e. C5 - C6
407
Which muscle reflex would be diminished with a lesion of the fifth cervical spinal root?
a. Biceps brachii
b. Brachioradialis
c. Triceps brachii
d. Deltoid
e. Supraspinatus
a. Biceps brachii
```
Intervertebral Disc Herniation
CERVICAL Region: between C5-C6 or C6-C7
C5: Biceps brachii - lateral arm
C6: Brachioradialis - lateral forearm
C7: Triceps brachii - digits 2, 3, 4
```
408
Which muscle reflex is preferred for testing involvement of the root of the sixth cervical spinal nerve with herniation of the IVD at C5-C6?
a. Biceps brachii
b. Brachioradialis
c. Triceps brachii
d. Brachialis
e. Flexor carpi radialis
b. Brachioradialis
```
Intervertebral Disc Herniation
CERVICAL Region: between C5-C6 or C6-C7
C5: Biceps brachii - lateral arm
C6: Brachioradialis - lateral forearm
C7: Triceps brachii - digits 2, 3, 4
```
409
Herniation of the IVD between the fifth and sixth cervical vertebrae will compress the:
a. fourth cervical nerve root
b. sixth cervical nerve root
c. fifth cervical nerve root
d. seventh cervical nerve root
e. seventh and eight cervical nerve root
b. sixth cervical nerve root
| * 1st cervical nerve root above 1st cervical vertebra
410
Which spinal roots mediates the Achilles tendon reflex?
a. L3
b. L4
c. L5
d. S1
e. S2
d. S1
Intervertebral Disc Herniation
LUMBAR Region: between L4-L5 or L5-sacrum
L4: Patellar tendon - Medial aspect of the Leg
S1: Achilles tendon - Lateral aspects of Foot
411
Which spinal roots mediates the Patellar tendon reflex?
a. L3
b. L4
c. L5
d. S1
e. S2
b. L4
Intervertebral Disc Herniation
LUMBAR Region: between L4-L5 or L5-sacrum
L4: Patellar tendon - Medial aspect of the Leg
S1: Achilles tendon - Lateral aspects of Foot
412
A patient was examined and neurologic exam revealed strong muscle function of the flexors of the thigh but with weakness of the hamstrings. A lesion has occurred at which of the following spinal cord levels?
a. T 12
b. L 1
b. L 3
d. L 5
e. S 5
d. L 5
Intervertebral Disc Herniation
LUMBAR Region: between L4-L5 or L5-sacrum
L4: Patellar tendon - Medial aspect of the Leg
S1: Achilles tendon - Lateral aspects of Foot
413
What two vertebral levels are most frequently involved in Spina bifida occulta?
a. L1 and L2
b. L2 and L3
c. L3 and L4
d. L4 and L5
e. L5 and S1
e. L5 and S1
Spina Bifida Occulta
* no clinical manifestations
* presence of small dimple with a tuft of hair
414
A newborn presented with a cyst-like sac in the lumbar region of the vertebral column. The cyst contained meninges and spinal cord. What is the most likely diagnosis?
a. Spina bifida occulta
b. Spina bifida with meningomyelocele
c. Spina bifida with meningocele
d. Spina bifida with myeloschisis
b. Spina bifida with meningomyelocele
Spina Bifida CYSTICA: severe type
Spina Bifida with MENINGOCELE: meninges & CSF
Spina Bifida with MENINGOMYELOCELE: Spinal cord &/or nerve roots included
Spina Bifida with MYELOSCHISIS: most severe type; spinal cord in the affected area is OPEN because neural folds failed to fuse
415
After an automobile accident, a back muscle that forms the boundaries of the triangle of auscultation and the lumbar triangle receives no blood. Which of the following muscles might be ischemic?
a. Levator scapulae
b. Rhomboid major
c. Latissimus dorsi
d. Trapezius
e. Splenius capitis
c. Latissimus dorsi
Triangle of AUSCULTATION - heart sounds best heard
* latissimus dorsi
* trapezius
* medial border of scapula
Lumbar Triangle of PETIT - site of lumbar hernia
* external oblique muscles
* latissimus dorsi
* iliac crest
416
Point of boundary for Superior nuchal line.
External Occipital protuberance
Spine of scapula: acromion process
Vertebral spines
Iliac crest
Sacrum
