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Year 2 - Theme A > Block 12 > Flashcards

Block 12 Flashcards

1
Q

What are the muscles of the forearm in the superficial flexor compartment? 5

A 
Pronator teres
Flexor carpi radialis
Flexor digitorum superficialis
Palmaris longus
Flexor carpi ulnaris
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2
Q

Flexor digitorum profundus

A

FOREARM - DEEP FLEXOR
Origin: upper 3/4 of anterior and medial ulnar, medial coronoid process, anterior ulnar half interosseous membrane

Insertion: palmar surfaces of base of distal phalanges

Innervation: medial (ring and little finger) = ulnar nerve. Lateral (index and middle fingers) = median C8/T1

Vascular: proximal = ulnar/common interosseous. distal = ulnar, anterior interosseous and median artery

Action: finger flexion. Only muscle to flex distal interphalangeal joint

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3
Q

Flexor pollicis longus

A

FOREARM - DEEP FLEXOR
Origin: groove in anterior radius and interosseous membrane

Insertion: palmar surface of distal phalanx of thumb

Innervation: anterior interosseous branch of median nerve C7/8

Vascular: medial = anterior interosseous artery. lateral = radial artery

Action: flexes phalanges of thumb

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4
Q

Pronator quadratos

A

FOREARM - DEEP FLEXOR
Origin: oblique ridge on anterior ulna

Insertion: distal 1/4 of anterior border and surface of radius

Innervation: anterior interosseous branch of median nerve C7/8

Vascular: anterior interosseous artery

Action: forearm pronation

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5
Q

Brachioradialis

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: proximal 2/3 of lateral supracondylar ridge of humerus

Insertion: lateral side of distal radius

Innervation: radial nerve C5/6

Vascular: radial recurrent artery and radial artery

Action: elbow flexion

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6
Q

Extensor carpi radialis longus

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: common tendon of extensors - lateral supracondylar ridge of humerus

Insertion: radial side of dorsal surface of bsae of 2nd metacarpal

Innervation: radial nerve C6/7

Vascular: radial recurrent artery and radial collateral branch

Action: extension and abductor of wrist and midcarpal joints

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7
Q

Extensor carpi radialis brevis

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: common tendon of extensors

Insertion: dorsal surface of base of 3rd metacarpal on radial side

Innervation: posterior interosseous nerve C7/8

Vascular: radial recurrent artery and radial artery

Action: extension and abduction of wrist and midcarpal joints

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8
Q

Extensor digitorum

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon

Insertion: dorsum of proximal phalanges

Innervation: posterior interosseous nerve C7/8

Vascular: proximal 1/3 = radial recurrent artery. distal 2/3 = posterior interosseous artery

Action: wrist extension, MCP, PIP and DIP extension

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9
Q

Where is the common extensor tendon?

A

lateral epicondyle of humerus

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10
Q

What are the muscles of the forearm in the deep flexor compartment? 3

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratas

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11
Q

What are the muscles of the forearm in the superficial extensor compartment? 7

A 
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Anconeous
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12
Q

What are the muscles of the forearm in the deep extensor compartment? 5

A 
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
Extensor indicis
Supinator
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13
Q

What are the names of the carpal bones?

A 
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
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14
Q

What is the contents of the carpal tunnel?

A

4 tendons of flexor digitorum profundus
4 tendond of flexor digitorum superficialis
tendon of flexor pollicis longus
median nerve

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15
Q

What forms the carpal tunnel?

A

Flexor retinaculum

Carpal arch

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16
Q

What are the intrinsic muscles of the hand? 11

A 
Flexor pollicis brevis
Abductor pollicis brevis
opponens pollicis
adductor pollicis
abductor digiti minimi
flexor digiti minimi brevis
opponens digiti minimi
palmaris brevis
palmar interossei
dorsal interossei
lumbricals
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17
Q

Pronator teres

A

FOREARM - SUPERFICIAL FLEXOR
2 heads - humeral and ulnar

Origin: common tendon for flexors (medial epicondyle of humerus) and medial side of coronoid process of ulnar

Insertion: midway along lateral surface of radial shaft

Innervation: median nerve C6/7

Vascular: humeral - inferior ulnar collateral artery and anterior ulnar recurrent artery. Ulnar - common interosseous artery

Action: pronation of forearm and weak elbow flexor

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18
Q

Flexor carpi radialis

A

FOREARM - SUPERFICIAL FLEXOR
Origin: common flexor tendon (medial epicondyle of humerus)

Insertion: base of 2nd metacarpal

Innervation: median nerve C5/6

Vascular: anterior and posterior ulnar recurrent artery branch

Action: flexes the wrist and helps abduction of the hand

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19
Q

Flexor digitorum superficialis

A

FOREARM - SUPERFICIAL FLEXOR
2 heads - humeroulnar and radial

Origin: humeroulnar - common tendon and medial coronoid process. Radial - anterial radial border and radial tuberosity

Insertion: forms 4 long tendons that pass through the carpal tunnel and attach to anterior base of intermediate phalanges 2-5

Innervation: median nerve C8/T1

Vascular: humeral: anterior ulnar recurrent. Anterior radial: ulnar and radial arteries. Posterior: ulnar and median artery

Action: flexor of PIP and MCP and wrist joint

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20
Q

Palmaris longus

A

FOREARM - SUPERFICIAL FLEXOR
Origin: common tendon (medial epicondyle of humerus)

Insertion: crosses retinaculum and is incorporated with the palmar aponeurosis

Innervation: median nerve C7/8

Vascular:anterior ulnar recurrent artery

Action: anchor for skin and fascia of hand. Carpal flexion

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21
Q

Flexor carpi ulnaris

A

FOREARM - SUPERFICIAL FLEXOR
2 heads - humeral and ulnar (connected by tendinous arch)

Origin: humeral - common tendon. ulnar - medial olecranon and 2/3 posterior border of ulna

Insertion: pisiform bone

Innervation: ulnar nerve C7/8/T1

Vascular: 3 pedicles. proximal - posterior ulnar recurrent, middle &distal - ulnar artery

Action: flexes the wrist and adducts the hand

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22
Q

Extensor digiti minimi

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon

Insertion: dorsal digital expansion of 5th digit

Innervation: posterior interosseous nerve C7/8

Vascular: radial recurrent and posterior interosseous artery

Action: extend joints of the little finger, wrist extension

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23
Q

Extensor carpi ulnaris

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon and posterior border of ulna

Insertion: tubercle on medial side of 5th metacarpal base

Innervation: posterior interosseous nerve C7/8

Vascular:proximal = radial recurrent, distally = posterior interosseous artery

Action: extension and fixation of the wrist

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24
Q

Anconeous

A

FOREARM - SUPERFICIAL EXTENSOR
Origin: posterior surface of lateral epicondyle of humerus

Insertion: lateral olecranon

Innervation: radial nerve C6/7/8

Vascular: posterior interosseous recurrent artery

Action: extending elbow

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25
Q

Abductor pollicis longus

A

FOREARM - DEEP EXTENSOR
Origin: posterior surface of ulnar shaft and middle 1/3 posterior radius

Insertion: (2) radial side of 1st metacarpal base and trapezium

Innervation: posterior interosseous nerve C7/8

Vascular: proximally = posterior interossesous artery. distally = anterior interosseous

Action: abducts the wrist and abducts the thumb radially

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26
Q

Extensor pollicis longus

A

FOREARM - DEEP EXTENSOR
Origin: lateral middle 1/3 posterior ulnar shaft

Insertion: base of distal phalanx of the thumb

Innervation: posterior interosseous nerve C7/8

Vascular: superficial = posterior interosseous. deep = anterior interosseous artery

Action: extends distal phalanx of the thumb

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27
Q

Extensor pollicis brevis

A

FOREARM - DEEP EXTENSOR
Origin: posterior surface of radius and adjacent interosseous membrane

Insertion: based of proximal phalanx of the thumb

Innervation: posterior interosseous nerve C7/8

Vascular: posterior and anterior interosseous artery

Action: extends proximal phalanx of thumb and metacarpal

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28
Q

Extensor indicis

A

FOREARM - DEEP EXTENSOR
Origin: posterior surface of ulna

Insertion: ulnar side of tendon of extensor digitorum

Innervation: posterior interosseous nerve C7/8

Vascular: superficial = posterior interosseous artery and deep = anterior interosseous artery

Action:extension of index finger and wrist

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29
Q

Supinator

A

FOREARM - DEEP EXTENSOR
Origin: lateral epicondyle of humerus and supinator crest of ulna.

Insertion: lateral surface of proximal 1/3 of radius

Innervation: posterior interosseous nerve C7/8

Vascular: superficial = radial recurrent and deep = posterior interosseous artery

Action: supination

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30
Q

What are the intrinsic muscles of the hand? (11)

A 
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis
Lumbricals
Palmar interossei
Dorsal interossei
Palmaris brevis
Adductor pollicis
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31
Q

Flexor pollicis brevis

A

INTRINSIC MUSCLE OF HAND
2 parts - superficial and deep

Origin: superficial = distal border of flexor retinaculum and distal tubercle of trapezium. deep = trapezoid and capitate bones

Insertion: both on sesamoid bone and base of 1st phalanx

Innervation: superficial = lateral terminal branch of median nerve. deep = deep branch of ulnar nerve C8/T1

Vascular: superficial palamr branch of radial artery

Action: flexes metacarpophalangeal joint of thumb

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32
Q

Abductor pollicis brevis

A

INTRINSIC MUSCLE OF HAND
Origin: flexor retinaculum

Insertion:radial side of proximal phalanx

Innervation: lateral terminal branch of median nerve C8/T1

Vascular: superficial palmar branch of radial artery

Action: draws thumb forwards (90 degrees to hand)

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33
Q

Opponens pollicis

A

INTRINSIC MUSCLE OF HAND
Origin: tubercle of trapezium and flexor retinaculum

Insertion: lateral border, palmar surface of thumb metacarpal

Innervation: lateral terminal branch of median nerve C8/T1

Vascular: superficial palmar branch of radial artery

Action: flexes metacarpal bone of thumb

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34
Q

Adductor pollicis

A

INTRINSIC MUSCLE OF HAND
2 heads - oblique and transverse

Origin: oblique = capitate and base of 2nd and 3rd metacarpal. transverse = distal 2/3 of palmar surface of 3rd metacarpal

Insertion: ulnar side of base of proximal phalanx

Innervation: deep branch of ulnar nerve C8/T1

Vascular: arteria princeps pollicis and arteria radialis indicis

Action: adduction of the thumb (thumb to palm of hand)

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35
Q

Abductor digiti minimi

A

INTRINSIC MUSCLE OF HAND
Origin: pisiform bone

Insertion: ulnar side of base of proximal phalanx of little finger

Innervation: deep branch of ulnar nerve C8/T1

Vascular: deep palmar branch of ulnar artery

Action: abducts little finger

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36
Q

Flexor digiti minimi brevis

A

INTRINSIC MUSCLE OF HAND
Origin: hook of hamate and palmar surface of flexor retinaculum

Insertion: ulnar side of base of proximal phalanx of little finger

Innervation: deep branch of ulnar nerve C8/T1

Vascular: deep palmar branch of ulnar artery

Action: flexion of little finger at metacarpophalangeal joint

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37
Q

Opponens digiti minimi

A

INTRINSIC MUSCLE OF HAND
Origin: hook of hamate

Insertion: ulnar margin of 5th metacarpal bone

Innervation: deep branch of ulnar nerve C8/T1

Vascular: deep palmar branch of ulnar artery and medial deep palmar arch

Action: flexes 5th metacarpal bone (brings little finger to thumb)

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38
Q

Palmaris brevis

A

INTRINSIC MUSCLE OF HAND
Origin: flexor retinaculum and medial border of palmar aponeurosis

Insertion: dermis on ulnar border of hand

Innervation: superficial branch of ulnar nerve C8/T1

Vascular: ulnar end of superficial palmar arch

Action: secures palmar grip

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39
Q

Palmar interossei

A

INTRINSIC MUSCLE OF HAND
lies on the palmar surface of metacarpal bones

Origin: entire length of each metacarpal (not middle finger), each has one that faces the middle finger

Insertion: 1st and 2nd ulnar side, 4th and 5th radial side of metacarpal bone

Innervation: deep branch of ulnar nerve C8/T1

Vascular: deep palmar arch, princeps pollicis artery

Action: adducts fingers,metacarpophalangeal flexion and interphalangeal extension

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40
Q

Dorsal interossei

A

INTRINSIC MUSCLE OF HAND
4 bipennate muscles

Origin: adjacent sides of 2 metacarpal bones, more from the one it attaches to

Insertion: base of proximal phalanges

Innervation: deep branch of ulnar nerve C8/T1

Vascular: dorsal metacarpal arteries (1st-4th), palmar metacarpal arteries (2nd-4th) and radial artery (1st)

Action: abduction of fingers

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41
Q

What are the 2 interossei muscles and what are there actions?

A 
Palmar = ADDUCTION of fingers
Dorsal = ABDUCTION of fingers
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42
Q

Lumbricals

A

INTRINSIC MUSCLE OF HAND
4 small fasciculi from tendons of flexor digitorum profundus

Origin: 1st and 2nd from radial side palmar surface of tendons of index and middle fingers. 3rd - middle and ring and 4th - ring and little.

Insertion: lateral margin of dorsal digital expansion of extensor digitorum

Innervation: 1st and 2nd = median C8/T1. 3rd and 4th = deep ulnar nerve C8/T1

Vascular: 1st and 2nd = first and second dorsal metacarpal and dorsal digital arteries. 3rd and 4th = 2nd and 3rd common palmar digital arteries

Action: extension of interphalangeal joints, proprioception

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43
Q

What are the 3 ligaments that hold the hip in place?

A
  • Iliofemoral: from the ASIS to intertrochanteric line, inverted Y appearance, limits extension
  • Pubofemoral: iliopubic eminence to the femur, limits abduction
  • Ischiofemoral: ischium to the greater trochanter (weakest)
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44
Q

What forms the obturator canal and what passes through it?

A

a) formed by obturator membrane and the obturator foramen

b) obturator nerve and vessels

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45
Q

What forms the greater sciatic foramen and what passes through it?

A

a) margins: the greater sciatic notch, upper borders of the sacrospinous and sacrotuberous ligaments and lateral sacrum
b) above the piriformis: superior gluteal nerve artery and vein
below the piriformis:
- sciatic nerve
- inferior gluteal nerve, artery and vein
- pudendal nerve
- interal pudendal artery and vein
- posterior femoral cutaneous nerve
- nerve to obturator internus and gemellus superior muscles
- nerve to quadratas femoris and gemellus inferior muscles

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46
Q

What passes through the lesser sciatic foramen?

A

Obturator internus muscle tendon

Pudendal nerve and internal pudendal vessels

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47
Q

What passes through the gap between the inguinal ligament and the pelvic bone

A
  • psoas major, iliacus, pectineus
  • femoral artery, nerve and vein
  • lymphatics
  • femoral branch of gentiofemoral nerve
  • lateral cutaneous nerve of thigh
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48
Q

What is the fasica lata?

A

It is the thick stocking like fasica that covers the thigh and leg.

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49
Q

What are the margins of the femoral triangle?

A

Base: inguinal ligament
Medial: adductor longus muscle
Floor: pectineous
Lateral: sartorius

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50
Q

What is the contents of the femoral triangle?

A

femoral nerve, artery and vein

lymphatics

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51
Q

What is covered by the femoral sheath?

A

femoral artery, nerve and lymphatics

The femoral nerve lies lateral

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52
Q

What are the gluteal muscles? (8)

A
  • Piriformis
  • Gemellus superior
  • Gemellus inferior
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia latae
  • Obturator internus
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53
Q

What are the muscles of the thigh which lie in the anterior compartment? (8)

A
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
  • Rectus femoris
  • Sartorius
  • Psoas major
  • Psoas minor
  • Iliacus
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54
Q

What are the muscles of the thigh which lie in the medial compartment? (6)

A
  • Gracilis
  • Pectineus
  • Adductor longus
  • Adductor brevis
  • Adductor magnus
  • Obturator externus
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55
Q

What are the muscles of the thigh which lie in the posterior compartment? (3)

A
  • Biceps femoris
  • Semitendinous
  • Semimembranous
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56
Q

Piriformis

A

GLUTEAL MUSCLE
Origin: anterior surface of sacrum between the anterior sacral foramina

Insertion: medial side of superior border of greater trochanter

Innervation: Branches from L5, S1, S2

Vascular: superior gluteal and gemellar branches of the internal pudendal artery

Action: laterally rotates the extended femur at the hip and abducts flexed femur at the hip joint

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57
Q

Obturator internus

A

GLUTEAL MUSCLE
Origin: anterolateral wall of true pelvis, deep surface of obturator membrane

Insertion: medial side of the greater trochanter

Innervation: nerve to obturator internus L5, S1

Vascular: extrapelvic - gemellar branches of interal pudendal artery artery. intrapelvic - obturator artery

Action: lateral rotation of the extended femur, abduction of flexed femur

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58
Q

Gemellus superior

A

GLUTEAL MUSCLE
Origin: external surface of ischial spine

Insertion: length of superior surface of obturator internus tendon and medial side of greater trochanter

Innervation: nerve to the obturator internus L5, S1

Vascular: internal pudendal artery and gemellar branches

Action: laterally rotates the extended femur, abducts flexed femur

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59
Q

Gemellus inferior

A

GLUTEAL MUSCLE
Origin: upper aspect of ischial tuberosity

Insertion: length of inferior surface of the obturator internus tendon and medial side of the greater trochanter

Innervation: nerve to quadratas femoris L5, S1

Vascular: medial circumflex femoral artery

Action: laterally rotates extended femur and abducts flexed femur

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60
Q

Gluteus minimus

A

GLUTEAL MUSCLE
Origin: external surface of ilium between inferior and anterior gluteal lines

Insertion: linear fascet on anterolateral aspect of greater trochanter

Innervation: superior gluteal nerve L4,L5,S1

Vascular: superior gluteal and trochanteric anastamoses

Action: abducts femur, medially rotates thigh and prevents pelvic drop

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61
Q

Gluteus medius

A

GLUTEAL MUSCLE
Origin: external surface of ilium between anterior and posterior gluteal lines

Insertion: elongate fascet of lateral surface of greater trochanter

Innervation: superior gluteal nerve L4,L5,S1

Vascular: deep branch of superior gluteal artery

Action: abducts femur, medially rotates thigh, prevents pelvic drop, holds pelvis secure over stance leg

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62
Q

Gluteus maximus

A

GLUTEAL MUSCLE
Origin: fascia covering the gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spine, dorsal surface of lower sacrum, external surface of sacrotuberous ligament

Insertion: posterior aspect of iliotibial tract of fasica lata and gluteal tuberosity on the proximal femur

Innervation: inferior gluteal nerve L5, S1, S2

Vascular: inferior gluteal and superior gluteal artery

Action: powerful extensor of the flexed femur, stabiliser of the hip and knee, lateral rotation and abducts thigh

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63
Q

Tensor fascia latae

A

GLUTEAL MUSCLE
Origin: lateral aspect of crest of ilium between the ASIS and tubercle of crest

Insertion: iliotibial tract of fascia latae

Innervation: superior gluteal nerve L4,L5,S1

Vascular: lateral circumflex femoral artery

Action: stabilises the knee in extension

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64
Q

Psoas major

A

THIGH: ANTERIOR COMPARTMENT
Origin: anterior surfaces and lower borders of all lumbar vertebrae

Insertion: lesser trochanter of femur

Innervation: ventral rami of L1 and L2 (sometimes L3)

Vascular: network from lumbar, iliolumbar, obturator, external iliac and femoral

Action: acts with iliacus = iliopsoas

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65
Q

Psoas minor

A

THIGH: ANTERIOR COMPARTMENT
absent in 40%

Origin: side of bodies of T12 and L1 and their intervertebral disc

Insertion: pecten pubis and iliopectineal eminence

Innervation: branch from L1

Vascular: lumbar arteries

Action: weak flexor of the trunk

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66
Q

Iliacus

A

THIGH: ANTERIOR COMPARTMENT
Origin: iliac fossa and inner iliac crest, sacroiliac and iliolumbar ligaments and upper surface of lateral sacrum

Insertion: lesser trochanter of femur

Innervation:femoral nerve brances L2,L3

Vascular: network from lumbar, iliolumbar, obturator, external iliac and femoral arteries

Action: flexes thigh upon pelvis, bends the trunk, balancing trunk while sitting

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67
Q

What are the 4 muscles that make up the quadriceps?

A

Vastus medialis
Vastus intermedialis
Vastus lateralis
Rectus femoris

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68
Q

Vastus medialis

A

THIGH: ANTERIOR COMPARTMENT
Origin: femur - medial part of intertrochateric line, pectineal line and medial lip of linea aspera, medial supracondylar line

Insertion: quadriceps femoris tendon and medial border of patella

Innervation: femoral nerve L2,L3,L4

Vascular: superficial femoral artery

Action: extends leg at knee joint

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69
Q

Vastus intermedius

A

THIGH: ANTERIOR COMPARTMENT
Origin: femur - upper 2/3 of anterior and lateral surfaces

Insertion: quadriceps femoris tendon and lateral margin of patella

Innervation: femoral nerve L2,L3,L4

Vascular: lateral - artery of quadriceps, medial - profunda

Action: extends leg at the knee joint

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70
Q

Vastus lateralis

A

THIGH: ANTERIOR COMPARTMENT
Origin: femur - lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity and lateral lip of linea aspera

Insertion: quadriceps femoris tendon

Innervation: femoral nerve L2,L3,L4

Vascular: lateral circumflex femoral and artery of quadriceps, profunda femoris artery

Action: extends the leg at the knee joint

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71
Q

Rectus femoris

A

THIGH: ANTERIOR COMPARTMENT
Origin: straight head - ASIS, reflected head - ilium just superior to the acetabulum

Insertion: quadriceps femoris tendon

Innervation: femoral nerve L2,L3,L4

Vascular: artery of quadriceps and lateral circumflex femoral

Action: flexes thigh at hip and extends leg at knee joint

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72
Q

Sartorius

A

THIGH: ANTERIOR COMPARTMENT
Origin: ASIS

Insertion: medial surface of tibia just inferomedial to tibial tuberosity

Innervation: femoral nerve L2,L3

Vascular: femoral system - common, superficial or lateral circumflex

Action: flexes thigh at hip and flexes leg at knee

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73
Q

Gracilis

A

THIGH: MEDIAL COMPARTMENT
Origin: external surface of body of pubis, inferior pubic ramus and ramus of ischium

Insertion: medial surface of proximal shaft of tibia

Innervation: Obturator nerve L2,L3

Vascular: artery of adductors of profunda

Action: adducts thigh at hip and flexes knee

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74
Q

Pectineus

A

THIGH: MEDIAL COMPARTMENT
Origin: pectineal line and adjacent bone of pelvis

Insertion: oblique line from lesser trochanter to linea aspera

Innervation: femoral nerve L2,L3

Vascular: medial circumflex femoral and common femoral artery

Action: adducts and flexes thigh at the hip joint

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75
Q

Adductor longus

A

THIGH: MEDIAL COMPARTMENT
Origin: external surface of the body of pubis (depression inferior to the pubic crest and lateral to the pubic symphysis)

Insertion: linea aspera on middle 1/3 of femur

Innervation: obturator nerve L2,L3

Vascular: artery of adductors and profunda femoris artery

Action: adducts and medially rotates thigh at the hip

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76
Q

Adductor brevis

A

THIGH: MEDIAL COMPARTMENT
Origin: external surface of body of pubis and inferior pubic ramus

Insertion: posterior surface of proximal femur and upper 1/3 of linea aspera

Innervation: obturator nerve L2,L3

Vascular: profunda femoris and artery of adductors

Action: adducts thigh at hip

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77
Q

Adductor magnus

A

THIGH: MEDIAL COMPARTMENT
Origin: ischiopubic ramus

Insertion: linea aspera, medial supracondylar line, post proximal femur

Innervation: obturator nerve L2,L3,L4

Vascular: obturator, profunda femoris and superficial femoral artery

Action: adducts and medially rotates the thigh at the hip joint

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78
Q

Obturator externus

A

THIGH: MEDIAL COMPARTMENT
Origin: medial 2/3 of external surface of anterior pelvic wall

Insertion: trochanteric fossa of femur

Innervation: posterior branch of obturator nerve L3, L4

Vascular: obturator and medial circumflex femoral artery

Action: lateral rotation of the femur

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79
Q

Biceps femoris

A

THIGH: POSTERIOR COMPARTMENT
2 heads - long and short

Origin: long head - inferiomedial part of the upper area of ischial tuberosity. short head - lateral lip of linea aspera

Insertion: head of fibula

Innervation: sciatic nerve L5,S1,S2

Vascular: profunda femoris artery, inferior gluteal and popliteal artery

Action: flexes leg at the knee; extends and laterally rotates thigh at hip and laterally rotates the leg at the knee joint

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80
Q

Semitendinous

A

THIGH: POSTERIOR COMPARTMENT
Origin: inferiomedial part of the upper area of the ischial tuberosity

Insertion: medial surface of proximal tibia

Innervation: sciatic nerve L5,S1,S2

Vascular: profunda femoris artery, inferior gluteal and popliteal artery

Action: flexes leg at knee, extends thigh at hip and medially rotates thigh at hip and leg at the knee

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81
Q

Semimembranous

A

THIGH: POSTERIOR COMPARTMENT
Origin: superolateral imoression on ischial tuberosity

Insertion: groove and adjacent bone on medial and posterior surface of medial tibial condyle

Innervation: sciatic nerve L5, S1, S2

Vascular: posterior obturator artery

Action: flexes leg at knee and extends thigh at hip; medially rotates thigh at hip joint and leg at the knee joint

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82
Q

What muscles are responsible for flexion at the hip? [4] What spinal levels are responsible?

A

Iliopsoas
Rectus femoris
Sartorius
Pectineous

L2,L3

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83
Q

What muscles are responsible for extension at the hip? [4] What spinal levels are responsible?

A

Gluteus maximus
Biceps femoris
Semitendinous
Semimembranous

L4,L5

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84
Q

What muscles are responsible for abduction at the hip? [7] What spinal levels are responsible?

A 
Piriformis
Obturator internus
Gemellus inferior
Gemellus superior
Gluteus minimus
Gluteus medius
Gluteus maximus

L4,L5

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85
Q

What muscles are responsible for adduction at the hip? [5] What spinal levels are responsible?

A 
Gracalis
Pectineus
Adductor longus
Adductor brevis
Adductor magnus

L2,L3

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86
Q

What muscles are responsible for lateral rotation at the hip? [8]

A 
Piriformis
Obturator internus
Obturator externus
Gemellus superior
Gemellus inferior
Quadratas femoris
Gluteus maximus
Biceps femoris
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87
Q

What muscles are responsible for medial rotation at the hip? [6]

A 
Gluteus minimus
Gluteus medius
Adductor longus
Adductor magnus
Semitendinous
Semimembranous
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88
Q

What are the ligament involved in the shoulder joint [8]

A
  • Coracoacromial ligament
  • Sternoclavicular ligament
  • Costoclavicular ligament
  • Acromioclavicular ligament
  • superior transverse ligament
  • transverse humeral ligament
  • coracohumeral ligament
  • glenohumeral ligament
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89
Q

Pectoralis major

A

SHOULDER - thick fan shaped muscle

Origin: anterior sternal clavicle, anterior sternum, true rib cartilage

Insertion: greater tubercle of humerus

Innervation: medial and lateral pectoral nerves C5-T1

Vascular: thoracoacromial artery, pectoral branch from axillary

Action: adduction and medial rotation of humerus

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90
Q

Pectoralis minor

A

SHOULDER - thin triangular muscle deep to pec major

Origin: Ribs 3-5

Insertion: coracoid process of scapula

Innervation: medial and lateral pectoral nerves C5-T1

Vascular: pectoral and deltoid branches of thoracoacromial and thoracic arteries

Action: draws scapula down and dperesses point of shoulder

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91
Q

Subclavius

A

SHOULDER - small triangular muscle tucked between clavicle and first rib

Origin: junction of 1st rib and its costal cartilage

Insertion: inferior middle third of clavicle

Innervation: subclavian branch of brachial plexus C5-C6

Vascular: clavicular branch of thoracacromial artery and suprascapular artery

Action: pulls shoulder down

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92
Q

Trapezius

A

SHOULDER - large flat triangular muscle of back

Origin: occipital bone, ligamentum nuchae, spinous processes T1-T12

Insertion: Lateral third of clavicle, acromion and spine of scapula

Innervation: accessory nerve (CN11) and cervical plexus C3-C4

Vascular: upper 1/3 = transverse occipital, middle 1/3= superficial cervical, lower 1/3 = dorsal scapular

Action: steading scapula, maintaining poise. Retracts scapula and bends head backwards

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93
Q

Deltoid

A

SHOULDER - 3 heads: anterior, middle and posterior

Origin: anterior = lateral 1/3 of clavicle, middle = acromion, posterior = scapula spine

Insertion: deltoid tuberosity on lateral body of humerus

Innervation: axillary nerve C5-6

Vascular: acromio and deltoid branches of thoracoacromial artery

Action: lateral and medial rotation of humerus. Abduction of humerus.

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94
Q

Latissimus dorsi

A

SHOULDER - large flat triangular muscles of the lower back

Origin: spinous process T7-L5

Insertion: intertubercular groove of humerus

Innervation: thoracodorsal nerve from posterior cord C6,7,8

Vascular: Thoracodorsal artery

Action: medial rotation, adduction and extension of humerus

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95
Q

Serratus anterior

A

SHOULDER - large muscular sheet

Origin: upper 8 ribs

Insertion: medial border of scapula

Innervation: long thoracic nerve C5-7

Vascular: superior and lateral thoracic arteries

Action: upward rotation of scapula. Elevation of ribs when scapula fixed

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96
Q

Infraspinatus

A

SHOULDER - thick, triangular muscle in infraspinous fossa

Origin: medial 2/3 of infraspinous fossa of scapula

Insertion: middle fascet of greater tubercle of humerus

Innervation: suprascapular nerve C5&6

Vascular: suprascapular and circumflex scapular arteries

Action: lateral rotation of humerus

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97
Q

Supraspinatus

A

SHOULDER
Origin: supraspinus fossa

Insertion: greater tubercle of humerus

Innervation: suprascapular nerve C5&6

Vascular: suprascapular and dorsal scapular arteries

Action: initiates abduction of humerus. Stabilise head of humerus

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98
Q

Subscapularis

A

SHOULDER - bulky, triangular muscle that fills subscapular fossa

Origin: costal surface of scapula

Insertion: lesser tubercle of humerus

Innervation: subscapular nerve C5-6

Vascular: subscapular, axillary and suprascapular arteries

Action: medial rotation of humerus. stabilise head of humerus.

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99
Q

Teres major

A

SHOULDER - thick flat muscle

Origin: dorsal surface of inferior scapular angle

Insertion: intertuberous sulcus of humerus

Innervation: lower subscapular nerve C5-7

Vascular: thoracodorsal branch of subscapular artery

Action: draws humerus backwards. medial rotation

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100
Q

Teres minor

A

SHOULDER - narrow elongated muscle

Origin: upper 2/3 lateral border of scapula

Insertion: greater tuberosity of humerus

Innervation: axillary nerve C5-6

Vascular: circumflex scapular artery

Action: lateral rotation, weak adduction of humerus

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101
Q

Levator scapulae

A

SHOULDER

Origin: transverse process of C1-C4 in straps

Insertion: superior medial scapula spine

Innervation: direct branches of C3-5

Vascular: transverse and ascending cervical arteries (thyrocervical trunk)

Action: elevates scapula medially and upwards

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102
Q

Rhomboid major

A

SHOULDER

Origin: spinous process T2-T5

Insertion: medial border of scapula

Innervation: dorsal scapula nerve C5

Vascular: dorsal scapula artery

Action: retract medial border of scapula superiorly

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103
Q

Rhomboid minor

A

SHOULDER

Origin: spinous processes of C7-T1

Insertion: medial border of scapula

Innervation: dorsal scapula nerve C5

Vascular: dorsal scapula artery

Action: retract medial border of scapula superiorly

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104
Q

Describe the sternoclavicular joint

A

Synovial sellar joint

Between sternal end of clavicle and clavicular notch of sternum

Fibrous capsule - weak superiorly and inferiorly

Anterior and posterior sternoclavicular ligaments.
Interclavicular ligament

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105
Q

Describe the acromioclavicular joint

A

Synovial plane joint

Between acromial end of clavicle and medial acromial margin

Fibrous capsule lined by a synovial membrane

Acromioclavicular ligament
Coracoclavicular ligament (trapezoid/anterolateral and conoid/posteriomedial parts)
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106
Q

Describe the glenohumeral joint

A

Synovial multiaxial spheroidal joint

Between hemispherical head of humerus and glenoid fossa of scapula

Glenoid labrum deepens the glenoid fossa

Fibrous capsule. Hyaline cartilage.

Ligaments

  • coracohumeral ligament
  • transverse humeral ligament
  • glenohumeral ligaments (3) - superior, middle, inferior
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107
Q

What muscles are in the rotator cuff? [4]

A
  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
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108
Q

Coracobrachialis

A

UPPER ARM AND ELBOW

Origin: apex of coracoid process

Insertion: midway along medial border of humeral shaft

Innervation: musculocutaneous nerve C5-7

Vascular: axillary artery

Action: flexes arm forward and medially

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109
Q

Biceps brachii

A

UPPER ARM AND ELBOW - 2 heads (short and long)

Origin: short head = coracoid apex. long head = supraglenoid tubercle of scapula within capsule of shoulder joint

Insertion: posterior radial tuberosity

Innervation: musculocutaneous nerve C5-6

Vascular: varies between: superior/inferior ulnar collaterol, subscapular, axillary, ulnar or radail artery. Originates from brachial artery

Action: supination, elbow flexion`

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110
Q

Brachialis

A

UPPER ARM AND ELBOW

Origin: lower half of the front of humerus

Insertion: cubital articular surface

Innervation: musculocutaneous nerve C5-6 and radial nerve C7

Vascular: superior = brachial artery. inferior = superior ulnar collateral/brachial

Action: elbow flexor

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111
Q

Triceps

A

UPPER ARM AND ELBOW - 3 heads = long, lateral, medial

Origin:

  • long = infraglenoid tubercle of scapula
  • lateral = posterior surface of humeral shaft
  • medial = entire posterior surface of humeral shaft

Insertion: all converge to common tendon - upper olecranon

Innervation: radial nerve C6-8

Vascular: profunda brachii and superior ulnar collateral artery

Action: arm extensor

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112
Q

Describe the elbow joint

A

Synovial joint

2 articulations

  • humeroulnar (trochlea of humerus and ulnar trochlear notch)
  • humeroradial (capitellum of humerus and radial head)
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113
Q

Ligaments in the elbow joint

A
  • ulnar collateral ligament (3 parts - anterior, posterior and inferior)
    Connects medial epicondyle to the proximal tubercle of coronoid margin.
  • radial collateral ligament : connects lateral epicondyle to the annular ligament
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114
Q

Desribe proximal (superior) radioulnar joint

A

Uniaxial pivot joint

Articulating between the circumference of the radial head and fibro-osseous ring made by the ulnar radial notch and annular ligament

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115
Q

Describe annular ligament

A

encircles radial head, holding it against the radial notch of the ulna.

external surface of the anular ligament blends with the radial collateral ligament.

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116
Q

What are the borders of the cubital fossa

A 
Superior: imaginary line between 2 epicondyles of humerus
Medial: pronator teres
Lateral: brachioradialis
Roof: superficial fascia
Floor: brachialis and supinator
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117
Q

Define chronic pain

A

Pain lasting longer than 3 months

Often affects mood and social functioning

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118
Q

Describe neuropathic pain

A
  • Associated with abnormal sensation
  • Structural neural damage or abnormal processing
  • Responds poorly to conventional analgesics
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119
Q

Define allodynia

A

small stimulus causes a pain response

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120
Q

Define hyperalgesia

A

increase in pain from a lower stimuli

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121
Q

Define radiculopathy

A

dysfunction of spinal nerve roots/ spinal nerves causing paralysis or paresis of myotomes. Paraesthesia of dermatomes

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122
Q

Define axonotmesis

A

Disruption of nerve cell axon - only damage to the myelin sheath

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123
Q

Define neuropraxia

A

Compression of named nerve

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124
Q

Define neurotmesis

A

Cutting of entire nerve

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125
Q

Where are the common sites of nerve injury? Generic

A
  • proximity to bone
  • proximity to skin
  • tightly enclosed regions
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126
Q

Common nerve injuries to axillary nerve and what are the effects?

A

Runs behind and around the surgical neck of humerus

  • Fractures of surgical neck of humerus
  • Anterior glenohumeral dislocation

Weak lateral rotation and loss of abduction to 90 degrees

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127
Q

Common nerve injuries to radial nerve and what are the effects?

A

Sensory to posterior forearm

  • Common to injure in axilla and spiral groove
  • Midshaft humeral fracture
  • Poorly fitting crutches
  • Falling asleep over an arm chair

Wrist drop and sensory loss in posterior arm. Problems with grip due to lack of extension

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128
Q

Common nerve injuries to musculocutaneous nerve and what are the effects?

A

Supplies anterior brachial compartment

  • common to injure in midshaft of humerus
  • humeral shaft fracture
  • penetrating injury

Weakness or lack of elbow flexion.
Weakness of forearm supination
Sensory loss in lateral forearm

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129
Q

Common nerve injuries to median nerve and what are the effects?

A

Supplies all thenar muscles and 6.5 forearm flexors

  • common to injure in cubital fossa and carpal tunnel
  • supracondylar fractures
  • wrist slashing

Ulnar deviation on wrist flexion
PIP/DIP and MCP joint dysfunction in lateral 3 digits
Loss of thumb movement and thenar atrophy
Sensory loss in median nerve

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130
Q

Common nerve injuries to ulnar nerve and what are the effects?

A

Supplies all intrinsic hand muscles and some skin

  • Common injuries in medial epicondyle and Guyons canal
  • fracture of medial epicondyle
  • handlebar palsy and wrist slashing

Radial deviation.
Loss of abduction and adduction of fingers.
Loss of extension at DIP and PIP of ring and little fingers
Mild claw hand
Sensory loss over ulnar area

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131
Q

Describe Erb’s palsy

A

Loss of C5 and C6 due to violent stretch between head and shoulder

Can’t adduct shoulder
Unopposed medial rotation
Elbow extension due to loss of biceps
Pronation - loss of biceps

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132
Q

Describe the ligaments in the knee joint

A

Anterior cruciate ligament - attaches to medial surface of lateral epicondyle (stops anterior displacement)

Posterior cruciate ligament - attaches to lateral surface of medial epicondyle (stops posterior displacement)

Collateral ligaments

  • Fibular - attached to lateral femoral epicondyle and depression on lateral surface of fibular head
  • Tibial - medial epicondyle of femur and adductor tubercle
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133
Q

Describe the knee joint

A

2 femoral condyles articulate with the tibial condyles

Femoral condyles

  • curved in flexion
  • flat in extension

Surfaces covered in hyaline cartilage

Synovial membrane attaches to margins of articular surfaces

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134
Q

Descibe the locking mechanism of the knee

A

Locking the knee when standing reduces energy required

  • Change in shape and size of femoral surfaces that articulate with the tibia
  • flexion curved and extension is flat
  • Joint surfaces become larger and more stable in extension
  • medial rotation of femur on tibia
  • in extension, centre of gravity passes anterior to knee joint

Unlocked by popliteus muscle initiating lateral rotation

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135
Q

What muscles are in the posterior compartment of the leg? Superficial [3] and Deep [4]

A

Superficial

  • Gastrocnemius
  • Plantaris
  • Soleus

Deep

  • Popliteus
  • Flexor hallucis longus
  • Flexor digitorum longus
  • Tibialis posterior
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136
Q

Gastrocnemius

A

LEG - 2 heads (medial and lateral)

Origin: medial = posterior surface of distal femur just superior to medial condyle. lateral = upper posterolateral surface of lateral femoral condyle

Insertion: via calcaneal tendon, to posterior surface of calcaneus

Innervation: tibial nerve S1, S2

Vascular: popliteal artery

Action: plantar flexes foot and flexes knee

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137
Q

Plantaris

A

LEG

Origin: inferior part of lateral supracondylar line of femur and oblique popliteal ligament of knee

Insertion: via calcaneal tendon to posterior surface of calcaneus

Innervation: tibial nerve S1,S2

Vascular: sural branch of popliteal, posterior tibial and peroneal

Action: plantar flexes foot and flexes knee

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138
Q

Soleus

A

LEG

Origin: soleal line and medial border of tibia; posterior aspect of fibular head and adjacent surfaces of neck and proximal shaft; tendinous arch

Insertion: via calcaneal tendon, to posterior surface of calcaneus

Innervation: tibial nerve S1,S2

Vascular: peroneal and posterior tibial artery

Action: plantar flexes the foot

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139
Q

Popliteus

A

LEG

Origin: lateral femoral condyle

Insertion: posterior surface of proximal tibia

Innervation: tibial nerve L4,S1

Vascular: medial inferior genicular branch of popliteal artery

Action: stabilises knee joint (resists lateral rotation of tibia on femur). Unlocks knee (laterally rotates femur)

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140
Q

Flexor hallucis longus

A

LEG

Origin: posterior surface of fibula and interosseous membrane

Insertion: plantar surface of distal phalanx of big toe

Innervation: tibial nerve S2,S3

Vascular: muscular branch of peroneal and posterior tibial artery

Action: flexes great toe

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141
Q

Flexor digitorum longus

A

LEG

Origin: medial side of posterior surface of tibia

Insertion: plantar surfaces of bases of distal phalanges of the lateral 4 toes

Innervation: tibial nerve S2,S3

Vascular: muscular branch of posterior tibial artery

Action: flexes lateral 4 toes

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142
Q

Tibialis posterior

A

LEG

Origin: posterior surfaces of interosseous membrane and adjacent tibia and fibula

Insertion: tuberosity of navicular and adjacent region of medial cuneform

Innervation: tibial nerve L4,L5

Vascular: posterior tibial artery

Action: inversion and plantar flexion of foot; support of medial arch of foot during walking

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143
Q

What are the muscles in the lateral compartment of the leg? [2]

A

Fibularis longus

Fibularis brevis

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144
Q

Fibularis longus

A

LEG - lateral

Origin: upper lateral surface of fibula, head of fibula and occasionally the lateral tibial condyle

Insertion: undersurface of lateral sides of distal end of medial cuneform and base of metatarsal 1

Innervation: superficial fibular nerve L5,S1,S2

Vascular: fibular (peroneal) artery

Action: eversion and plantar flexion of foot; supports arches of foot

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145
Q

Fibularis brevis

A

LEG

Origin: lower 2/3 of lateral fibula shaft

Insertion: lateral tubercle at base of metatarsal 5

Innervation: superficial fibular nerve L5,S1,S2

Vascular: fibular (peroneal) and anterior tibial artery

Action: eversion of the foot

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146
Q

What are the muscles in the anterior compartment of the leg? [4]

A

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius

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147
Q

Tibialis anterior

A

LEG

Origin: lateral surface of tibia and adjacent interosseous membrane

Insertion: medial and inferior surfaces of medial cuneiform and adjacent surface on base of metatarsal 1

Innervation: deep fibular nerve L4,L5

Vascular: anterior tibial artery

Action: dorsiflexion of foot at ankle, inversion of foot, dynamic support of medial arch of foot

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148
Q

Extensor hallucis longus

A

LEG

Origin: middle 1/2 of medial surface of fibula and adjacent 10 membrane

Insertion: dorsal surface of distal phalanx of great toe

Innervation: deep fibular nerve L5,S1

Vascular: anterior tibial artery

Action: extension of great toe and dorsiflexion of foot

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149
Q

Extensor digitorum longus

A

LEG

Origin: proximal 1/2 of medial surface of fibula and related surface of lateral tibial condyle

Insertion: via dorsal digital expansions into bases of distal and middle phalanges of lateral 4 toes

Innervation: deep fibular nerve L5,S1

Vascular: anterior tibial artery

Action: extension of lateral 4 toes and dorsiflexion of the foot

150
Q

Fibularis tertius

A

LEG

Origin: distal part of medial surface of fibula

Insertion: dorsomedial surface of base of metatarsal 5

Innervation: deep fibular nerve L5,S1

Vascular: anterior tibial artery

Action: dorsiflexion and eversion of foot

151
Q

Name the tarsal bones [7]

A

Proximal: talus and calcaneus

Intermediate: navicular

Distal: cuboid, cuneiform (lateral, medal and intermediate)

152
Q

Describe talocrural joint

A

Ankle joint - synovial

Involves the talus, tibia and fibula

153
Q

What are the 3 lateral ligaments in the ankle?

A

Anterior talofibular
Posterior talofibular
Calcaneofibular

154
Q

What forms the tarsal tunnel?

A

Formed on posteromedial side of ankle by:

  • depression formed by medial malleolus of tibia, medial and posterior surfaces of talus and medial surface of calcaneus
  • overlying flexor retinaculum
155
Q

What are the contents of the tarsal tunnel?

A 
Tendon of flexor hallucis longus
Tibial nerve
Posterior tibial artery
Tendon of flexor digitorum longus
Tendon of tibialis posterior
156
Q

What methods are used to maintain postural control?

A

Ankle strategy
Hip strategy
Stepping strategy

157
Q

What is involved in sensing the position of the centre of gravity?

A

Somatosensory (60-70%)
Proprioceptive
Visual (10-20%)
Vestibular (10-20%)

158
Q

What is acupuncture and how effective is it?

A

Acupuncture is a traditional Chinese medicine technique where fine needle are inserted into trigger points.

Control of underlying life energy called qi “chi”

Effectiveness 5/5 - 31 trials

159
Q

What is osteopathy and how effective is it?

A

It is a strengthening of the musculoskeletal network through manipulation. Relieves muscle tension and increase blood supply.

Effectiveness 3/5 - Amber safety

160
Q

What are the CAMs recommended by NICE for back pain?

A

Acupuncture
Spinal manipulation
Spinal mobilisation
Massage

161
Q

What is the nervous supply to the auricle?

A

The centre is supplied by the vagus nerve.

The outer edge is supplied by the facial nerve.

162
Q

What is the blood supply to the external ear?

A

Posterior auricular artery - from external carotid

Anterior auricular artery - from superficial temporal artery

163
Q

Describe external ear?

A

Covered with skin and hair
Covered in modified sweat glands that produce cerumen (earwax)

Wider laterally

Sensory innervation from mandibular V3 and vagus X, minor from facial VII

164
Q

Describe the tympanic membrane

A

Sloped medially from top to bottom

Outside lined with connective tissue
Inside lined with mucous membrane

Fibrocartilaginous ring attaches it to the surrounding temporal bone

Concavity produced by attachment of handle of malleus - point of attachment is umbo of tympanic membrane

Sensory innervation to outer surface = mandibular V3 with some vagus
To inner surface = glossopharyngeal IX

165
Q

What are the boundaries of the middle ear?

A
  • Roof: thin layer of bone that separates from middle cranial fossa (tegmen tympani)
  • Floor: thin layer of bone that separates from internal jugular vein
  • Lateral: bont lateral wall of epitympanic recess
  • Posterior: partially complete. Bony partition between tympanic cavity and mastoid air cells+ aditus to mastoid antrum
  • Anterior: partially complete, bone separating tympanic cavity from internal carotid
166
Q

What is the pharynotympanic tube and what is its function?

A

Connect middle ear with nasopharynx

Equalises pressure on both sides of tympanic membrane

Outer 1/3 is bony, inner is cartilaginous

Innervated from tympanic plexus and glossopharyngeal nerve

167
Q

What are the 3 auditory ossicles in the middle ear?

A

Malleus
Incus
Stapes

168
Q

What are the 2 muscles found in the middle ear?

A

Tensor tympani

Stapedius

169
Q

Tensor tympani

A

EAR

Origin: cartilaginous part of phayngotympanic tube; greater wing of sphenoid

Insertion: part of handle of malleus (upper)

Innervation: branch of mandibular nerve V3

Function: contraction pulls handle of malleus medially

170
Q

Stapedius

A

EAR

Origin: attached to inside of pyramidial eminence

Insertion: neck of stapes

Innervation: branch of facial nerve VII

Function: contraction

171
Q

What are the 2 components of the inner ear?

A 
Bony cavities (labyrinth)
Membranous ducts and sacs (membranous labyrinth)
172
Q

What are the components of the bony labyrinth?

A

Vestibule
3 semicircular canals
Cochlea

Lined with periosteum and contains a clear fluid called perilymph

173
Q

What are the components of the membranous labyrinth?

A

semicircular ducts, cochlear duct, utricle and saccule

Filled with endolymph

174
Q

What are the 3 canals formed from the cochlear duct?

A

Scala vestibuli
Scala tympani
Scala media

175
Q

What is the organ of corti?

A

On the surface of the basiliar membrane

Contains a series of electromechanically sensitive hair cells that generate nerve impulse in response to vibration

176
Q

Describe the basiliar membrane

A

Fibrous membrane in the inner ear
Contains 20000-30000 basiliar fibres that project from the centre of the cochlea

  • fibres are stiff and free at one end to vibrate
  • length increases to the tip of cochlea
  • thick short fibres = very high frequency at base
  • long thin fibres = low frequency at tip of cochlea
177
Q

Outline the physiology of hearing

A
  • vibrations of tympanic membrane transmits sound to ossicles
  • malleus and incus act as single lever
  • articulation of incus with stapes causes the stapes to push forward on the oval window and cochlear fluid on other side
  • causes basilar membrane to bend in direction of round window
  • organ of corti senses vibration in basilar membrane and generates nerve impulses
  • synapse with cochlea nerve endings
  • spiral ganglion of corti
  • cochlear nerve
178
Q

What is the central auditory path for hearing?

A
  • cochlear nerve
  • medulla (trapezoid body)
  • pons (superior olivary nuclei & nucleus of lateral lemniscus)
  • Midbrain (inferior colliculus and medial geniculate nucleus)
  • Brain - primary auditory cortex
179
Q

At what points in the central auditory path does decussation occur?

A
  • in trapezoid body
  • between 2 nuclei of lateral lemniscus
  • in commissure connecting inferior colliculi

Transmission is greater contralaterally

180
Q

What are the 2 parts to the auditory cortex and what excites these areas?

A

Primary auditory cortex - directly excited by projections from medial genticulate

Auditory association cortex - excited by primary and thalamic association areas

181
Q

How is sound frequency determined?

A

Place principle

Different sound frequencies are detected by determining position of excitation along the basilar membrane

182
Q

How is loudness determined?

A

Spacial summation

As the sound becomes louder, the amplitude of vibration of the basilar membrane increases.
Hairs excite nerve endings more rapidly

183
Q

What is the role of the stereocilia?

A

Stereocilia project up from hair cells and touch the tectorial membrane.
Bending stereocilia one way depolarises and hyperpolaries the other way - excites auditory nerves

184
Q

How is sound attenuated?

A

When a loud sound is transmitted - reflex causing contraction of stapedius and to a lesser extent tensor tympani

Stapedius pulls stape outwards
Tensor tympani pulls malleus inwards

Causes rigidity to reduce ossicular conduction of low frequencies

Protects cochlea from damaging vibrations
Masks low frequency noise in background

185
Q

How is sound direction determined?

A

Time lag between ear entry and differences in intensities

Starts in superior olivary nuclei (medial and lateral)
Medial detects time lag
Lateral detects intensity

186
Q

What are the 2 types of deafness and define?

A

Nerve/ sensorineural deafness - caused by an impairment of the cochlea or auditory nerve

Conduction deafness - caused by an impairment of physical structures of the ear

187
Q

Causes of sensorineural deafness?

A 
Age
Loud noises
Viral infections of inner ear (measles, mumps)
Viral infections of auditory nerve (mumps, rubella)
Menieres
Meningitis
Encephalitis
MS
Stroke
Chemotherapy
188
Q

Causes of conductive deafness?

A

Perforated ear drum
Otosclerosis - abnormal bone growth, decreases mobility
Injury/trauma
Cholesteatoma - abnormal skin cell collection
Otitis media or externa with effusion
Excess ear wax

189
Q

Describe Rinne’s test and what is shows

A

Tuning fork in front of ear and on mastoid process - determining which is louder

POSITIVE - air louder than bone - sensorineural or normal
NEGATIVE - bone louder than air - conductive

190
Q

Describe Weber’s test and what is shows

A

Tuning fork in middle of forehead, which is louder

NORMAL - same in both ears
SENSORINEURAL - louder in unaffected ear
CONDUCTIVE - louder in affected ear

191
Q

What are the 3 layers of the eye?

A

Outer fibrous layer - sclera posteriorly and cornea anteriorly

Middle vascular layer - choroid posteriorly and ciliary body & iris anteriorly

inner layer - optic retina

192
Q

What are the 2 muscles in the iris and what is the innervation?

A

Sphincter pupillae - fibres in circular pattern - contraction constrict the opening. Parasympathetic innervation (oculomotor)

Dilator pupillae - fibres in radial pattern - contaction increases the opening - sympathetic innervation (superior cervical ganglion T1)

193
Q

What is the optic disc?

A

Where optic nerve leaves the retina, no light receptor cells in this area - blind spot

194
Q

What is the macula lutea?

A

Lateral to the optic disc with a hint of yellow colouration.
Central depression is the fovea centralis.
Higher visual sensitivity due to fewer rods, more cones

195
Q

What is the ciliary body?

A

extended from anterior border of choroid and forms a complete ring around the eyeball

Ciliary muscles are controlled by parasympathetics (oculomotor) and contraction decreases the size of the ring formed by the ciliary body.

Ciliary processes are longitudinal ridges projected from the inner surface of ciliary body

Collectively forms the suspensory ligament of the lens
Contaction = decreased ring size = decreased tension = more rounded lens

196
Q

What are the extrinsic muscles of the eye? [7]

A 
Levator palpebrae superioris
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
197
Q

Levator palpebrae superioris

A

EYE

Origin: lesser wing of sphenoid anterior to optic canal

Insertion: anterior surface of tarsal plate; a few fibres to skin and superior conjunctival fornix

Innervation: oculomotor nerve III (superior branch)

Function: elevation of upper eyelid

198
Q

Superior rectus

A

EYE

Origin: superior part of common tendinous ring

Insertion: anterior half of eyeball superiorly

Innervation: oculomotor nerve III (superior branch)

Function: elevation, adduction, medial rotation of eyeball

199
Q

Inferior rectus

A

EYE

Origin: inferior part of tendinous ring

Insertion: anterior half of eyeball inferiorly

Innervation: oculomotor branch (superior branch)

Function: depression, adduction, lateral rotation of eyeball

200
Q

Medial rectus

A

EYE

Origin: medial part of common tendinous ring

Insertion: anterior half of eyeball medially

Innervation: oculomotor nerve (inferior branch)

Function: adduction of the eyeball

201
Q

Lateral rectus

A

EYE

Origin: lateral part of common tendinous ring

Insertion: anterior half of eyeball laterally

Innervation: abducent nerve VI

Function: abduction of eyeball

202
Q

Superior oblique

A

EYE

Origin: body of sphenoid, superior and medially to optic canal

Insertion: outer posterior quadrant of eyeball (superior surface)

Innervation: trochlear nerve IV

Function: depression, abduction, medial rotation of eyeball

203
Q

Inferior oblique

A

EYE

Origin: medial floor of orbit posterior rim, maxilla lateral to nasolacrimal duct

Insertion: outer posterior quadrant of eye (superior surface)

Innervation: oculomotor nerve III (inferior branch)

Function: elevation, adduction, lateral rotation

204
Q

How is aqueous humor produced and what is the flow pattern?

A

Secreted by ciliary processes - formed by active secretion

Begins with active transport of Na+ into spaces between cells

Na+ pulls Cl- and HCO3- ions along to maintain neutrality

Water follows

From ciliary processes –> canals of Schlemm

Outflow is controlled by resistance in the trabeculae

205
Q

What are the 7 layers of the retina?

A 
Stratum opticum
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
Pigmented layer
206
Q

What are the different cells in the retina?

A 
Amacrine cells
Ganglion cells
Horizontal cells
Bipolar cells
Rods 
Cones
207
Q

Describe rods and cones

A

Rods are narrower and longer than cones.

Each has membrane cells in the outer segment
Mitochondria are found in the inner segment

Light sensitive photochemical is found in outer segment

Rods = rhodopsin
Cones - 1 of 3 colour proteins

208
Q

Causes of cataracts

A 
Galactosemia
Wilson disease
Corticosteroids
Trauma
Diabetes
Atopic dermatitis 
Radiation
209
Q

Define cataracts

A

Lenticular opacities that can be congential or acquired

210
Q

Define open angle glaucoma

A

Aqueous humor has complete physical access to trabecular meshwork and elevation in intraocular pressure is from increased resistance to aqueous outflow

211
Q

Define angle-closure glaucoma

A

Peripheral zone of iris adheres to trabecular meshworks and physically impedes the egress of humor from the eye

212
Q

What causes secondary open angle glaucoma?

A

Particulate material:

  • proteins from phogolysis
  • red cells after trauma
  • iris epithelial pigment granules
  • necrotic tissues

Can clog trabecular meshwork

213
Q

What is the most common type of glaucoma?

A

Primary open angle

214
Q

What can cause primary closed angle glaucoma?

A

eyes with shallow anterior chambers - hyperopia
apposition of iris to anterior lens - pupillary block

continues aqueous humor production elevates pressure
Can damage lens epithelium
Minute anterior subcapsular opacities
Can produce corneal oedema

215
Q

What are the risk factors for glaucoma?

A 
Females (4x increase)
aged 60+ years
Chinese and south asian
Family history
Myopia
Retinal disease
hypertension
diabetes
216
Q

What are the symptoms of glaucoma?

A 
Progressive pain in eye
Blurred vision -> vision loss
Nausea and vomiting
Headache
Coloured halos around lights
217
Q

Define stroke

A

Acute episode of focal loss of cerebral function due to vascular disease lasting more than 24 hours

218
Q

Define TIA

A

transient ischaemic attack
Acute episode of focal loss of cerebral or monocular function due to embolic or thromboting vascular disease lasting less than 24 hours

219
Q

Define primary prevention

A

avoidance of disease, no signs or symptoms

220
Q

Define secondary prevention

A

Avoidance of progression, signs and symptoms present

221
Q

Risk factors for stroke

A 
Age (older)
Gender (female)
Race (afrocarribean)
Family history
Hypertension
Diabetes
AF
Smoking
Obesity
Hyperlipidaemia
222
Q

What is the CHAD 2 Score?

A

Measures the risk of getting a stroke

Congestive heart failure =1
Hypertension =1
Age >75 = 1
Diabetes = 1
Prior stroke/TIA = 1
223
Q

What are the 2 ascending tracts?

A

Spinothalamic

Dorsal column medial lemniscus

224
Q

Describe the path and function of the spinothalamic tract

A

Pain, temperature and crude touch

  • 1st order neuron enters dorsal horn
  • Decussates at spinal level
  • Fibres run contralaterally
  • 2nd order synapse in ventral posterior nucleus of thalamus
  • 3rd order synapse in primary somatosensory area
225
Q

Describe the path and function of the DCML tract

A

Fine touch, proprioception, vibration

  • 1st order neuron enters dorsal horn
  • Above T6 = cuneate
  • Below T6 = gracalis
  • Fibres run ipsilaterally to medulla
  • 2nd order decussate in medulla - thalamus via medial lemniscus of midbrain
  • 3rd order from thalamus to cerebrum
226
Q

What are the names of the ventromedial descending tracts? What is the function?

A
  • pontine reticulospinal
  • tectospinal
  • vestibulospinal

postural and girdle muscles

227
Q

What are the names of the dorsolateral descending tracts? What is the function?

A

Corticospinal
Rubrospinal

distal muscles and fine movement

228
Q

Describe the path of the pontine reticulospinal

A

IPSILATERAL
Motor cortex - pontine reticulospinal - spinal cord

Large movements of trunk and limbs, excites extensors, inhibits flexors

Runs in genu of internal capsule

229
Q

Describe the path of the tectospinal tract

A

CONTRALATERAL

superior colliculus - anterior horn of cervical spinal cord

Orientation and navigation - turn head to stimuli

230
Q

Describe the pathway of vestibulospinal tract

A

IPSILATERAL

Vestibular nuclei (pons and medulla) - spine

Keeps upright, balance and quick movements

231
Q

What happens if you damage the ventromedial tracts?

A 
loss of righting reaction
no navigational control
forward slump
can't reach
can flex elbow and digits
232
Q

Describe the corticospinal tract

A

85% CONTRALATERAL 15% IPSILATERAL

  • premotor, motor and primary sensory -> contralateral anterior horn

Independent flexion of distal joints and skilled motor

Runs through posterior limb of internal capsule

233
Q

Describe the rubrospinal tract

A

CONTRALATERAL

Mesencephalic red nuclei (midbrain) and decussates

Control and coordination of movement

234
Q

What happens if you injure the dorsolateral descending tracts?

A

Reach by shoulder circumduction
Fingers flex together
Arms hang limply

235
Q

Define traumatic brain injury

A

non-degenerative, noncongenital insult to the brain from an external mechanical force which can lead to permanent or temporary impairment of cognitive, physical or psychosocial functions

236
Q

Mechanisms of primary TBI

A 
Impact Loading
Impulsive loading
skull fracture
auditory/vestibular dysfunction
intracranial haemorrhages
coup and contrecoup contusions
concussion
diffuse axonal injury
237
Q

What is secondary injury in TBI and examples of how it occurs?

A

Further cellular damage from effects of primary injury

  • elevated excitatory amino acids that cause swelling, vasodilation and neuronal death
  • endogenous opioid peptides can exacerbate neuronal damage by modulating the presynapitic release of EAA neurotransmitters (inflammation)
  • increased ICP
  • hydrocephalus
238
Q

What are the different types of brain herniation? [5]

A
  • supratentorial
  • subfalcine: frontal lobe is pushed beneath falx cerebri (MOST COMMON)
  • Central transtentorial: midbrain through tentorial notch, cerebral hemispheres downward
  • Uncal: displacement of uncus over ipsilateral edge of tentorium cerebelli foramen - midbrain compression
  • Cerebellar: cerebellum pushed through foramen magnum
239
Q

Define dysphasia - what are the 2 types?

A

Impaired ability to understand or use the spoken word.

Due to a lesion of dominant hemisphere and can include impaired ability to read and write

Receptive and expressive

240
Q

Define receptive dysphasia

A

language fluent with normal rhythm and articulation but meaningless - Wernickes

241
Q

Define expressive dysphasia

A

language not fluent, difficulty forming words, difficulty finding the right words but understand what is being said.

Broca’s

242
Q

Define dysarthria

A

Caused by upper motor neuron lesions of the cerebral hemispheres or lower motor neuron lesions of brain stem

difficult or unclear articulation of speech that is otherwise linguistically normal

243
Q

Symptoms of head injury

A 
Seizures and fitting
Altered level of consciousness
Post traumatic amnesia
Vomiting
Pain
Dizziness
244
Q

What is the Cushing reflex?

A

Increase in blood pressure to maintain cerebral perfusion pressure

245
Q

What is the Monroe-Kellie doctrine?

A

There is a degree of compensation within the skull for increased ICP.

This is due to movement of CSF into spine and venous blood into JVP

Works up to a point

246
Q

After a head injury what causes the progressive damage?

A
  • Damage to lipid bilayer
  • ATP pump failure
  • Movement of Ca2+ ions
  • Free oxygen radical formation
  • This causes cellular damage
247
Q

What are the different methods for imaging the brain? [6]

A
  • CT (computerised tomography)
  • EEG (electroencephalography)
  • MRI (magnetic resonance imaging)
  • MEG (magnetoencephalography)
  • PET (positron emission tomography)
  • TMS (transcranial magnetic stimulation)
248
Q

What are the causes of a stroke?

A
  • Embolisation 25%
  • Occlusion 50%
  • Haemorrhage 20%
  • Other 5% (venous infarction, demyelination)
249
Q

If there is a blockage to the posterior inferior cerebellar artery - what happens?

A

Ipsilateral ataxia and horners syndrome

Contralateral hemiparesis and spinothalamic sensory loss

250
Q

If there is a large vessel occulation to the carotid artery - what happens?

A

Contralateral hemiplegia and hemisensory disturbance

Gaze palsy - eyes deviate to side of lesion

If in the dominant hemisphere - global aphasia

251
Q

What is involved in the rehabilitation service for stroke?

A 
Assessment
Goal setting
Education
Speech and language therapy
Psychologist
Physio
OT
MDT
Nutrition
Swallowing assessment
Medication and therapies to prevent a reoccurence
252
Q

What is cranial nerve 1?
Where does it exit the skull?
What is its function?

A

Olfactory nerve
Exits skull at cribiform plate of ethmoid bone
Function = smell
Afferent fibres

253
Q

What is cranial nerve 2?
Where does it exit the skull?
What is its function?

A

Optic nerve
Exits skull at the optic canal
Function = vision
Afferent fibres

254
Q

What is cranial nerve 3?
Where does it exit the skull?
What is its function?

A

Oculomotor nerve
Exits skull at superior orbital fissure
Functions:
- innervates levator palpebrae superioris, superior rectus, inferior rectus, medial rectus, inferior oblique
- innervates sphincter pupillae and ciliary muscle

Efferent fibres

255
Q

What is cranial nerve 4?
Where does it exit the skull?
What is its function?

A

Trochlear nerve
Exits skill at superior orbital fissure
Function = innervates superior oblique muscle
Efferent fibres

256
Q

What is cranial nerve 5?
Where does it exit the skull?
What is its function?

A

Trigeminal
1 - opthalmic
2 - maxillary
3 - mandibular

Exits skull at:
1 - superior orbital fissure
2- foramen rotundum
3 - foramen ovale

Functions=
1 - sensory to eyes, nasal cavity, orbit, upper eye lid and anterior scalp
2- sensory to nasopharynxc, palate, nasal cavity, upper teeth, maxillary sinus, lower eyelid, cheek, upper lip
3 - sensory to skin of lower face and lip, tongue, external acoustic meatus, lower teeth

Innervates temporalis, masseter, pterygoids, tensory tympani, mylohyoid

257
Q

What is cranial nerve 6?
Where does it exit the skull?
What is its function?

A

Abducens
Exits skull at superior orbital fissure
Function: innervates lateral rectus muscle

Efferent fibres

258
Q

What is cranial nerve 7?
Where does it exit the skull?
What is its function?

A

Facial nerve
Exits skull through stylomastoid foramen, leaves through internal acoustic meatrus and branches in the facial canal

Functions

  • sensory from exteral acoustic meatus and deep auricle
  • taste from anterior tongue
  • innervates lacrimal and salivary glands (not parotid), palate and mucous membrane in nose
  • innervates facial muscles, stapedius and stylohyoid muscles

Efferent and afferent

259
Q

What is cranial nerve 8?
Where does it exit the skull?
What is its function?

A 
Vestibulocochlear
Exits skull through internal acoustic meatus
Function
- vestibular = balance
- cochlear = hearing

afferent

260
Q

What is cranial nerve 9?
Where does it exit the skull?
What is its function?

A

Glossopharyngeal
Exits skill through jugular foramen

Function

  • sensory from carotid body and sinus
  • innervation to posterior tongue, tonsils and oropharynx
  • taste from posterior tongue
  • innervates parotid salivary gland

Afferent and efferent

261
Q

What is cranial nerve 10?
Where does it exit the skull?
What is its function?

A

Vagus nerve
Exits skull through jugular foramen

Functions:

  • sensory from larynx, deep auricle, external acoustic meatus, aotic body and baroreceptors, oesophagus, bronchi, lungs, heart, abdominal viscera
  • taste from epiglottis and pharynx

Efferent and afferent

262
Q

What is cranial nerve 11?
Where does it exit the skull?
What is its function?

A

Accessory nerve
Exits skull at jugular foramen
Function: innervates sternocleidomastoid and trapezius muscle

Efferent

263
Q

What is cranial nerve 12?
Where does it exit the skull?
What is its function?

A

Hypoglossal
Exits skull through hypoglossal canal
Function: innervates tongue muscles

Efferent

264
Q

What are the symptoms of Alzheimers?

A

Early - insidious impairment of higher intellectual function, alterations in mood and behaviour

Later

  • progressive disorientation
  • memory loss
  • aphasia
  • severe cortical dysfunction

Even later

  • profoundly disabled
  • mute and immobile
265
Q

What are the different types of dementia?

A

Alzheimers 50%
Vascular 15%
Dementia with lewy bodies 5-10%
Frontotemporal 2-5%

266
Q

In dementia what changes occur in the brain?

A
  • Decreased brain volume
  • Ventricular enlargement (compensatory)
  • Neuritic plaque
  • Neurofibrillary triangles
  • Neuronal loss
267
Q

What are the 5A’s of clinical features of dementia?

A 
Amnesia
Aphasia
Apraxia
Agnosia
Associated features
268
Q

Describe the neuritic plaques in dementia

A

spherical collections of neuritic processes often centred around an amyloid core

found in hippocampus, amygdala and neocortex

relative sparing of primary motor and sensory cortices

269
Q

Pathogenesis of plaques in demenia

A

APP - amyloid precursor protein undergoes cleavage

If at the beta secretase site = pathogenic
alpha secretase = normal

Formed A beta peptides which aggregate, cause inflammation and cause neurotoxic dysfunction

270
Q

Why are people with Downs syndrome at higher risk of getting dementia?

A

Amyloid precursos protein gene is found on chromosome 21

271
Q

What are the clinical features of frontotemporal dementia?

A 
Lose inhibitions
Lose motivation
Lose sympathy/empathy
Repetitive/compulsive behaviour
Craving for sweet or fatty food
272
Q

What are the clinical features of vascular dementia?

A 
Problems with speed of thinking, concentration and communication
Memory problems
Symptoms of stroke
Seizures
Confusion
Depression
Anxiety
273
Q

What are the clinical features of dementia with lewy bodies?

A 
Subtle initial symptoms
Some from Alzheimers
Some from Parkinsons
Attention alters
Visual hallucinations
274
Q

Define epilepsy

A

Condition in which seizures recur, usually spontaneously

275
Q

Define seizure

A

abnormal paroxysmal discharge of cerebral neurons sufficient to cause clinically detectable intermittent disturbance of consciousness, behaviour, emotion, motor or sensory function

276
Q

What are the 4 types of generalised seizures - describe them

A

Tonic clonic -
Tonic phase - all muscles contract, breathing patterns change, loss of consciousness
Clonic phase - limbs jerk as muscles relax and contract in turn, loss of bladder control

Absence - unconscious for a few seconds e.g. day dreaming

Myoclonic - muscle jerking in arms/head.Very brief. Unconscious briefly. Happen in morning

Atonic - lose all muscle tone and drop to the floor. Very brief, no confusion

277
Q

When does limb development begin and when does it end?

A

Day 26 to week 12

278
Q

Which limb bud appears fist in embryological development?

A

Upper limb appears first

279
Q

What embryonic tissues contribute to the developing limb?

A

somatic lateral mesoderm covered by ectoderm

280
Q

What is the apical ectodermal ridge?

A

Forms at apex of each limb
Ectodermal thickening
Multilayered epithelial structure induced by mesochyme

Influences limb mesenchyme
Initiates growth and development in proximo-distal axis

281
Q

What embryonic tissues give rise to muscles of developing limb?

A

Mesenchyme

282
Q

Describe rotation of limbs in development

A

Upper - rotate laterally by 90 degrees

Lower - rotate medially by 90 degrees

283
Q

What ligaments contribute to the stability at the acromioclavicular joint?

A

Acromioclavicular (superior and inferior)
Coracoacromial
Coracoclavicular

284
Q

What muscle tendons pass under the acromion?

A

rotator cuff muscles

285
Q

Which is the most common direction of dislocation of the shoulder? Why?

A

Anterior

Weaker anterior ligaments

286
Q

What are the different lymph nodes in the axilla?

A 
Anterior
Lateral
Central
Posterior
Apical
287
Q

Where do the axillary lymph nodes drain?

A

Subclavian lymph trunk (from apical)

Right jugular trunk or thoracic duct

288
Q

Where do finger flexor tendons insert?

A

Flexor digitorum superficialis - intermediate phalanges

Flexor digitorum profundus - distal phalanges

289
Q

What is the function of the lumbricals?

A

Flex MCP and extend IP joints simultaneously

290
Q

Describe the superficial palmar arch

A

Formed from the ulnar artery
Splits into common palmar digital arteries
Splits into proper palmar digitial arteries (one down each side of finger)

291
Q

Describe the deep palmar arch

A

Formed mainly from the radial artery with some input from ulnar
Forms palmar metacarpal arteries
Also forms princeps pollicis to thumb and radialis indicis to finger

292
Q

What bone can be felt in the depths of the snuff box?

293
Q

What is common complication of #FOOSH?

A

Scaphoid fracture

Avascular necrosis of scaphoid

294
Q

What artery traverses the anatomical snuff box?

295
Q

What effects would paralysis of lumbricals and interossei have on the hand?

A

Proximal phalanges are hyperextended
Distal and middle phalanges are hyperflexes
Claw hand (ulnar nerve damage)

296
Q

What is mallet finger?

A

Extensor damage
Hyperflexion of extensor digitorum tendon
Hyperflexion of DIP

297
Q

What is a boutonniere deformity?

A

PIP flexion with DIP hyperextension

Interruption to central slip of extensor tendon

298
Q

What does limb development begin and end?

A

Day 26- week 12

299
Q

Which limb develops first?

300
Q

What embryonic tissues contribute to developing limb?

A

Parietal (somatic) mesoderm

Covered by ectoderm

301
Q

What is the apical ectodermal ridge?

A 
Forms at the apex of the limb
Ectodermal thickening
Multilayered epitherlial structure
Directs limb growth via various fibroblast growth factors
Especially in proximodistal axis
302
Q

What are the 3 axis in the developing limb?

A

Proximodistal (shoulder to hand)
Dorsoventral (back of hand to palm)
Pre/post axial (thumb to pinky)

303
Q

Describe limb rotation in embryological development?

A

Upper limb rotates 90 degrees laterally
Lower limb rotates 90 degree medially
Week 7

304
Q

Outline embryological formation of limbs

A

Day 26 - week 12
Upper limb first, lower limb 2-10 days later
parietal (somatic) layer of lateral plate mesoderm
covered by ectoderm
Apical ectodermal ridge
Apoptosis for digit formation
90 rotation at week 7

305
Q

What is the intracapsular ligament of the hip?

A

Ligament of the head of femur
Acetabular fossa to fovea
Contains obturator artery

306
Q

What are the factors the stabilise the hip?

A

Ligaments
Muscles
Acetabulum
Acetabular labrum

307
Q

What is the blood supply to the femoral head?

A

Media circumflex femoral artery (some lateral)
branches of profunda femoris artery
Forms an anastamoses
Fracture can cause avascular necrosis

308
Q

What is the saphenous opening?

A

Oval opening in supramedial fascia lata
3-4cm inferolateral to pubic tubercle

Transmits great saphenous vein and other small vessels & gentiofemoral nerve

309
Q

Why is the saphenofemoral valve clinically important?

A

A failed valve can contribute to varicose veins

310
Q

What are the boundaries of the popliteal fossa?

A

Lateral

  • Upper = biceps femoris
  • Lower = gastrocnemius (lateral) and plantaris

Medial

  • Upper = semimembranous
  • Lower = gastrocnemius (medial)

Floor - popliteus muscle

311
Q

What are the contents of the popliteal fossa from superficial to deep?

A 
Tibial nerve
Popliteal vein
Popliteal artery
Small saphenous vein
Common fibular nerve
Popliteal lymph node
312
Q

Describe the process of fracture healing

A 
Haematoma 
Inflammation
Granulation
Soft callus formation (cartilage)
Hard callus formation (calcium and phosphate production)
Bone remodelling
313
Q

What is a pathological fracture?

A

Caused by disease

Weakness of bone structure

314
Q

Which tumours commonly metastasise to bone?

A

prostate
breast
lung

315
Q

What helps to keep the patella on track during flexion and extension?

A

Prominence of anterior femoral condyles
Retinacular fibres of patella
Vastus lateralis and medialis

316
Q

What is Osgood Schlatter’s disease?

A

Irritation of patellar ligament at the tibial tuberosity.

Painful lumps just below the knee.

317
Q

Which collateral ligament attaches to the meniscus?

A

Tibial/ medial collateral

318
Q

Describe the attachments of the anterior cruciate ligament

A

Attaches to a fascet on anterior part of intercondylar area of tibia and attaches to lateral wall of intercondylar fossa of femur

Stops anterior displacement

319
Q

Describe the attachments of the posterior cruciate ligament

A

Posterior aspect of intercondylar area and attaches to the medial wall of intercondylar wall of fossa

Stops posterior displacement

320
Q

What are the 2 openings between middle and inner ear?

A

Oval window - plugged by stapes

Round window - covered by fibrous tissue

321
Q

What is the pars flaccida?

A

Lies above malleolar folds attached to the petrous bone

Thin superior part of the membrane

322
Q

What is the chorda tympani?

A

Runs from taste buds through the middle ear and carries taste messages

323
Q

Histology of the middle ear and auditory tube?

A

Simple squamous

Gradually becomes ciliated pseudostratified columnar

324
Q

What is the role of hair cells in the organ of Corti?

A

Electromechanically sensitive and generate nerve impulses in response to vibration

325
Q

How does the organ of corti function?

A

Hairs move due to movement of endolymph

Hair cells synapse with cochlea nerve endings

Stereocilia project from hair cells and touch tectorial membrane

Bending of hair cells causes depolarisation or hyperpolarisation

Excites auditory nerve fibres

326
Q

What are the saccule and utricle?

A

part of balancing apparatus located in bony labyrinth

327
Q

What is the macula (ear)?

What is its function?

A

Thickening in wall of saccule and utricle

Contains vestibular hair cells

Perceive changes in longitudinal acceleration as well as effects of gravity

328
Q

What are the otoliths and where are they found?

A

Structure in saccule or utricle in vestibular labyrinth

Sensitive to gravity and linear acceleration

329
Q

What is the crista ampullaris?

What is its function?

A

Sensory organ of rotation in semicircular canal

It senses angular acceleration ad deceleration

330
Q

What is the microscopic anatomy of crista ampullaris?

A

Hair cells covered by gelatinous mass called the cupula

Rotation causes endolymph to deflect cupula against the hair cells
This causes nerve stimulation

331
Q

What movements are possible at the ankle proper?

A

Dorsiflexion and plantar flexion

In plantar flexion (some rotation, abduction and adduction)

332
Q

What ligaments are likely to be injured in forced ankle inversion?

A

Anterior talofibuar

Calcaneofibular if very severe

On the lateral side of ankle

333
Q

What ligaments are likely to be injured in forced ankle eversion?

334
Q

How do you test the integrity of the calcaneal tendon?

A

Thompson test
Prone patent. Leg flexed to 90 degrees
Squeeze gastrocnemius
Plantar flexion

335
Q

What are the 3 arches in the foot?

A

Transverse
Medial longitudinal
Lateral longitudinal

336
Q

What bones are involved in the medial longitudinal arch of foot?

A 
Calcaneous
Talus
Navicular
Cuneiforms
MT1-3
337
Q

What bones are involved in the lateral longitudinal arch of foot?

A

calcaneous
cuboid
MT 4 5

338
Q

What nerves are involved in the cutaneous innervation of the sole of the foot?

A 
Medial plantar
Lateral plantar
Sural
Saphenous
Medial calcaneal
339
Q

What is Morton’s neuralgia?

A

Affects common plantar digital nerves (commonly between 4th and 5th MT) and causes pain, numbness and tingling

340
Q

What are the layers of the scalp?

A 
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium
341
Q

What is intramembranous ossification?

A

No cartilage formed in the formation of bones
Skull repair and suture fusing

Formation of bone spicules
Fuse to become trabeculae

342
Q

Which parts of the neurocranium ossify in cartilage?

A

Sphenoid

Ethmoid

343
Q

Where would you feel the pain if frontal and maxillary sinusitis?

A

Maxillary - cheeks, teeth, headache

Frontal - behind eyes, headache

344
Q

What are the surface marking of the middle meningeal artery?

A

Midway between frontozygomatic suture and zygomatic arch

345
Q

What nerves and vessels are related to the cavernous sinus?

A

Internal carotid

Cranial nerve 3 4 5(1&2) 6

346
Q

What are the dural sinuses?

A 
Cavernous
Inferior petrosal
Superior petrosal
Transverse
Inferior sagittal
Superior sagittal
Straight
Occipital
Sigmoid
347
Q

Where do the dural sinuses drain?

A

Cavernous into inferior and superior petrosal

Inferior sagittal into straight

Superior petrosal, straight, occipital and superior sagittal into transverse

Transverse into sigmoid

348
Q

What are the different layers of the meninges?

A

Periosteal layer of dura
Meningeal layer of dura
Arachnoid
Pia

349
Q

What is hydrocephalus?

A

Excess and abnormal accumulation of CSF in the ventricles raising ICP

350
Q

How would damage to the left optic tract present?

A

Homonymous hemianopia

Loss of vision on right hand side of both eyes

351
Q

If the cervical sympathetic trunk is damaged, what will the effect of the eye be?

A

Miosis - constriction of the pupil
Ptosis - drooping of eyelid
Anhydrosis

352
Q

If the oculomotor nerve is damaged what effects will it have on the pupil an eye lid?

A

Eyes down and out

Pupil dilation
Ptosis

353
Q

What nerves are responsible for the pupil reflex?

A

CN2 optic

CN3 oculomotor

354
Q

What are the branches of the facial nerve?

A 
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
355
Q

What are the 6 eye muscles?

A 
Medial rectus
Lateral rectus
Superior rectus
Inferior rectus
Superior oblique
Inferior oblique
356
Q

Medial rectus
Action?
Innervation?

A

Adduction

Oculomotor

357
Q

Lateral rectus
Action?
Innervation?

A

Abduction

Abducens

358
Q

Superior rectus
Action?
Innervation?

A

Elevation
Adduction
Oculomotor

359
Q

Inferior rectus
Action?
Innervation?

A

Depression
Adduction
Oculomotor

360
Q

Superior oblique
Action?
Innervation?

A 
Intorsion
Depression
Abduction
DOWN AND OUT
Trochlear
361
Q

Inferior oblique
Action?
Innervation?

A

Extortion
Elevation
Adduction

UP AND IN

Oculomotor

362
Q

What is the sensory innervation to the eyelid?

A 
Infratrochlear
Supratrochlear
Supraorbital
Lacrimal
Opthalmic

Inferior lid
Infratrochlear
Infraoribital
Maxillary

363
Q

What are the layers of the eye lid?

A 
Skin
Subcutaneous tissue
Orbicularis oculi
Orbital septum
Tarsal plates
Palpebral conjunctiva
364
Q

What is the palpebral fissure?

A

Elliptical space between medial and lateral canthi of 2 open lids

365
Q

Describe the pathway of a tear

A 
Lacrimal gland
Punctum
Canaliculi
Lacrimal sac
Nasolacrimal duct
Inferior meatus
366
Q

What is the canal of Schlemm?

A

Channel in eye that collects aqueous humour from anterior chamber and drains it

367
Q

If there is a nerve 3 palsy, what effect would it have on accommodation?

A

Blurred vision for near objects, unable to focus the eye

368
Q

What happens in accommodation of the eye?

A

Oculomotor nerve

Constricts cilliary body
Relaxes tension on lens
Round lens
Accomodation for near vision

369
Q

What is the optic disc?

A

Blind spot, where axons exit eye as optic nerve

370
Q

What is the fovea?

A

Centre of macula
High percentage of cone cells
Sharp central vision

371
Q

What are the 3 layers of the lens?

A

capsule
epithelium
fibres

372
Q

What type of epithelium lies over the cornea?

A

Columnar (deep)
Wing cells (middle)
Squamous (superficial)

Year 2 - Theme A (7 decks)

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