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Anatomy Block 4 > Clinical Anatomy > Flashcards

Clinical Anatomy Flashcards

1
Q

What rarely and usually happens with injuries to the pelvic joints and why?

A

seldom dislcoates, instead

bony potions of adjacent pelvic rim (particularly pubic rami) usually fracture (usually both rami)

Because of strength of surrounding ligaments

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2
Q

What is likely to happen during child birth

A

stretching or tearing of levator ani muscles and or fascia of within urogenital haitus

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3
Q

Which of the levator ani muscles is most likely to be injured in childbirth

A

pubococcygeus

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4
Q

What can the tearing or stretching of muscles and fascia during childbirth cause

A

protrusion of pelvic viscera through pelvic floor

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5
Q

What are kegel exercises

A

exercises done to strengthen muscles of the pelvic floor

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6
Q

What are external hemorrhoids and what covers them?

A

varicossities of the inferior rectal veins

covered by skin

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7
Q

What are internal hemorrhoids and what covers them?

A

varicosities of the superior rectal veins

covered by mucous membrane

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8
Q

What would you feel with internal hemmorhoids and why?

A

Painless/nothing

mucsoa innervated by autonomic nerves

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9
Q

What would you feel with external hemmorhoids and why?

A

extreme pain

rich sensory innervation of lower anal canal by inferior rectal nerves

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10
Q

What may cause formation of a painful ischioanal abscess

A

infection within ischioanal fossa

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11
Q 
Which of the following muscles is most likely to be damaged during childbirth
coccygeus
illiococcygeus
Obturator internus
piriformis
pubococcygeus
A

pubococcygeus

most medial and anterior of muscles listed, border urogenital haitus and sweep behind vagina. Thus upon head exit may be torn

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12
Q 
The lateral wall of the ischioanal fossa is formed partly by which of the following 
Piriformis
levator ani
ischial tuberosity
anal canal
sacrotuberous ligament
A

Ischial tuberosity

also formed by the obturator internus muscle
levator ani and anal canal form sloping superomedial border

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13
Q

What is a circumcision

A

Removal of male prepuce

routinely performed on male infants in some societies

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14
Q

What may rupture of the spongy urethra lead to and why

A

accumualtions of urine in the superficial perineal pouch

because of attachments of the superficial perineal fascia

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15
Q

Where would urine fill in the event of a ruptured spongy urethra (3)

A

scrotum

subcutaneous space of the penis

lower abdominal wall deep to superficial membranous fascia

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16
Q

Which glands are frequently the site of acute or chronic inflammation and what happens as a result

A

greater vestibular glands

undergo abscess formation

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17
Q

What is an Episiotomy and where is it done

A

Deliberate incision made posterior to the vestibule to ease dilivery of a fetus

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18
Q

Why were episiotomys originally done

A

to prevent serious damage to perineal structures (ex. anal sphincter)

(freq is decreasing)

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19
Q

How may external genitalia be anesthetized what is it called

A

infiltration of region close to pudendal nerve with local anesthetic
pudendal nerve block

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20
Q

Where would the needle be introduced in a pudendal nerve block

A

through the vagina into the area of the ischial spine palpated by a finger in the vagina

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21
Q

The vestibular bulbs are firmly attached to the:

Ischiopubic rami
pubic symphysis
perineal membrane
superior pubic rami
ischial tuberosities
A

Perineal membrane

on either side of the vagina

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22
Q

Which of the following structures is located in the deep perineal pouch

Perineal body
Bulb of penis
greater vestibular glands
external urethral sphincter
ischiovavernosus muscle
A

external urethral sphincter

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23
Q

What may calculi within the ureter cause?

A

severe pain and complete or intermittent obstruction of urinary flow

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24
Q

What are the 3 most common sites for calculi obstruction

A

junction of renal pelvis and ureter

pelvic brim

passage through bladder wall

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25
Q

What can commonly block urinary flow after middle age

A

benign hypertophy of the prostate

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26
Q

What is one of the most common tumors of older males

A

malignant carcinoma of the prostate

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27
Q

What is a common cause of female infertility and what causes it

A

blockage of uterine tubes caused by pelvic inflamatory disease (can be caused by chlyammidia)

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28
Q

What is a prolapse

A

protrusion of pelvic viscera through the pelvic floor to the vagina

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29
Q

What will usually cause a prolapse

A

severe stretching or tearing of the pelvic diaphragm or cervical ligaments during childbirth

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30
Q

How would access/drain pus fluid or blood from the rectouterine pouch.

A

Through the posterior fornix of the vagina

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31
Q

Which of the following structures would a sperm cell pass through on ts way from the testis to the ampulla of the uterine tube

prostatic utricle
infundibulum of uterine tube
prostate
uterine ostium
seminal gland
A

Uterine ostium

sperm enters uterine cavity through uterine ostium and finally reaches ampulla of uterine tube

infundibulum is after ampulla
prostatic utricle is a bind recess of male prostatic urethra
seminal gland and prostate provide secretion but are not contiguous with sperm course

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32
Q

What lymph nodes should be monitored in the case of testicular cancer

A

para aortic

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33
Q

Where in the pelvic region can tumors frequently occur and who are they most commonly seen in

A

testis

young males

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34
Q

What is extremely vunerable during hyserectomy and why

A

ureter

due to close proximity of ureter and uterine artery at base of broad ligament

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35
Q

What controls bladder emptying

A

parasympathetic fibers of the pelvic splanchnic nerves

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36
Q

What may be injured in rectal surgery and what can it lead to

A

parasympathetic fibers of the pelvic splanchnic nerves

leads to retention of urine

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37
Q

in general how does visceral pain from pelvic organs travel back to the spinal cord

A

the reverse of the pathway that brought parasympatheic supply to the organs (namely S2,S3,S4)

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38
Q

What is the exception to the general rule about pelvic visceral pain/where do they travel

A

fibers from uterine fundus and body (and superior part of bladder)

Travel with sympathetic fibers in inferior hypgastric plexus, hypogastric nerves, and superior hypogastric plexus

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39
Q

What can be a treatment to relieve exessive uterine pain associated with menstruation (dysmenorrhea)

A

division of the superior hypogastric plexus (presacral neurectomy)

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40
Q

What could occur when placing arterial grafts in the common iliac arteries

A

interuption of hypogastric plexus

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41
Q

What would interruption of hyposgastric plexus cause in males and why

A

Sensation of ejaculation but nothing comes out

symp innerv to involuntary internal urethral sphincter has been cut
causes retrograde ejaculation into urinary bladder

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42
Q

Which branch of the internal iliac arty is most appropriate to the discription:

Arises below inferior gluteal artery as a parietal branch of the internal illiac:

Superior gluteal artery
Lateral sacral artery
obturator artery
umbilical artery
internal pudendal artery
A

Internal pudendal artery

superioor gluteal inferior gluteal and pudendal arteries always arise in order but any 2 or 3 could be from a common stem

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43
Q

Which branch of the internal iliac arty is most appropriate to the discription:

Gives rise to superior vesical artery(ies) as well as the artery of the ductus deferns in males:

Superior gluteal artery
Lateral sacral artery
obturator artery
umbilical artery
internal pudendal artery
A

Umbilical artery

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44
Q

Which branch of the internal iliac arty is most appropriate to the discription:

May frequently arise as a branch of the external iliac or inferior epigastric artery:

Superior gluteal artery
Lateral sacral artery
obturator artery
umbilical artery
internal pudendal artery
A

Obturator artery

45
Q

What are the visceral branches of the internal iliac artery (3)

A

Umbilical
inferior vesical
middle rectal

46
Q

What are the parietal branches of the internal iliac artery (6)

A 
iliolumbar 
lateral sacral
obturator
internal pudendal
superior gluteal
inferior gluteal
47
Q

What is the order from superior to inferior of A, N, V in the obturator foramen

A

Above: Obturator nerve
Middle: Obturator artery
Below: Obturator vein

48
Q

What passes over the obturator artery

A

ureters and either ductus deferens or round ligament of uterus

49
Q

A woman presents to her physician with extreme low back pain during menstruation. This low back pain is probably referred from the pelvic region. The pathways that convey this pain sensation to the CNS involve the:

Pudendal nerve to S2 to S4
Pelvic splanchnic nerves to S2 to S4
Lumbosacral trunk to L4 L5
Hypogastric nerve to L1 L2
Parasympathetic fibers to S2 to S4
A

Hypogastric nerve to L1 L2

50
Q

Where would pain from a diseased hip joint be referred to and why

A

Medial surface of knee joint

because femoral, obturator, and tibial nerves supply articualr branches to both hip and knee

51
Q

During late stages of pregnancy (fetal head descended into pelvis) where might a mother feel discomfort or pain and why?

A

extending down one or both lower limbs

due to babies head putting pressure on sacral plexus

52
Q

How might nerves of the the sacral plexus get invaded by tumors

A

malignant tumors extending from neighboring viscera

53
Q

What would tumors invading the nerves of the sacral plexus cause

A

severe pain down the lower limbs

54
Q 
Which of the following muscles lies posterior to the sacral plexus of nerves
Obturator internus
Piriformis
Levator Ani
Coccygeus
Ilioccygeus
A

Piriformis

55
Q 
Which of the following groups of segmental nerves usually are contained within the femoral nerve
S1-S4
L5-S3
L4,L5,S1,S2,S3
L2,L3,L4
L1,L2,L2
A

L2, L3, L4

L1 only goes to iliohypogastric and ilioinguinal nerves

56
Q

A quick start (sprint) or extreme stretching (gymnastics) may cause what? What is this injury called?

A

stretching or tearing of the proximal attachments of the adductor muscles

Groin injury or pulled groin

57
Q

What would damage to the femoral nerve result in

A

inability to extend the knee and impairs normal gait

58
Q

What would tapping the patellar ligament of the quadriceps femoris test? What is this reflex called?

A

Tests the integrity of the femoral nerve

knee jerk reflex

59
Q

When placing a needle or catheter in the femoral vein how is the correct placement found?

A

by finding the femoral pulse

60
Q

Where will the femoral vein lie in relation to the femoral artery

A

medial and parallel to the artery

61
Q

What would present as a mass in the proximal thigh

A

femoral hernia

62
Q

What is a femoral hernia

A

loop of gut or mesentery passes deep to inguinal ligament and through the femoral ring

Presents as mass in proximal thigh

63
Q

In which gender are femoral hernias more common

A

females

64
Q 
Which of the following structures is associated with both the femoral triangle and adductor canal
adductor magnus
pectineus
adductor longus
inguinal ligament
A

adductor longus

65
Q 
A lesion of the obturator nerve would impair
extension of the thigh
abduction of the thigh
extension of the knee
adduction of the thigh
flexion of the knee
A

Adduction of the thigh

extension primarily gluteal and posterior thigh (innerv by sup inf gluteal and sciatic)

abduction primarily gluteus medius minimus and tensor fascia latae (iiner by sup gluteal)

Extension primarliy quadriceps (innerv by femoral)

Flexion primarily posterior thigh

66
Q 
Which of the folowing medial femoral muscles is attached to the tibia
Gracilis
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
A

Gracilis

67
Q

What is are frequent sites of inflammation in the gluteal region and what is the name for the inflammation

A

Trochanteric and Ischial Bursas

Bursitis

68
Q

What muscles are commonly pulled or torn in strenuous running or kicking activites (football or soccer)

A

Hamstring muscles

69
Q

What would damage to the superior gluteal nerve from trauma or disease cause

A

disabling of the major abductors of the hip

drastically hamper gait

70
Q

How would you test for damage to the superior gluteal nerve

A

patient standing on one foot, opposite pelvis drops downward

trendelenburg test

71
Q

What nerve is vunerable during intamuscular injections

A

sciatic nerve due to poisition in gluteal region

72
Q

what quadrant of the gluteal region should you aim for during intramuscular injections and why

A

superolateral quadrant

to avoid damaging the sciatic nerve

73
Q 
A lesion of the common fibular nerve would affect which of the following muscles
Semimembranousus
Semitendinosus
Long head of Biceps femoris
Adductor magnus
Short head of Biceps femoris
A

Short head of biceps femoris

74
Q 
Which of the following structures exits the pelvis through the lesser sciatic foramen
Pudendal nerve
Inferior Gluteal artery
Obturator internus tendon
Sciatic Nerve
Piriformis
A

Obturator internus tendon

75
Q 
Which of the folowing muscles is a medial rotator of the thigh
Gluteus Maximus
Gluteus Minimus
Obturator internus
piriformis
Inferior gemellus
A

Gluteus minimus

76
Q

What are shin splints

A

overxertion of anterior leg muscles (in athletic events or sedentery individuals) resuting in tearing of muslce fibers and swelling and pain

especially in tibialis anterior

77
Q

What would rupture of the calcaneal tendon cause and is it common

A

inability to plantar flex

it is fairly common

78
Q

Where is the common fibular nerve vunerable

A

vunerable to trauma as it passes around head of femur

it is just deep to the skin here

79
Q

What would damage to the common fibular nerve cause

A

loss of dorsiflexion and eversion of the foot

called: foot drop

80
Q

What may deep wounds to the popliteal fossa injure and what would result?

A

injure the tibial nerve

result in loss of plantar flexion of the foot and flexion of the toes

81
Q

What may result from damage to the politeal artery and veins and why

A

Damage may result in arteriovenosus shunt of blood

Popliteal artery and veins bound tightly together by connective tissue

82
Q

Loss of the popliteal pulse would be diagnostic of what?

A

occluded femoral artery

83
Q

What is the normal floow of lood in the lower limbs (veins) and what does it depend on ?

A

from superficial veins to deep ones

depends on the competnecy of the venous valves

84
Q

What would damage to the venous valves of the lower limb or impession of flow in deep veins cause

A

distension of the superficial veins and eventual varicosity

85
Q 
Which of the following is a major dorsiflexor of the foot
Tibialis Anterior
Fibularis Brevis
Soleus
Plantaris
Flexor digitorum longus
A

Tibialis anterior

86
Q 
The vascular supply to the lateral compartment of the leg is the 
Popliteal artery
Fibular artery
Posterior tibial artery
Anterior tibial artery
Dorsalis pedis artery
A

Fibular artery

87
Q

What is plantar fasciitis

A

inflammation of the plantar fascia

88
Q

What may cause plantar fasciitis

A

running or high impact activites

or growth of a bony spur from the calcaneus

89
Q

What is used to record the pulse in a recumbent patient

A

dorsalis pedis

posterior tibial artery

90
Q 
Which of the following muscles is innervated by the medial plantar nerve?
abductor digiti minimi
Flexor Digitorum brevis
Quadratus plantae
Second Lumbrical
Plantar interossei
A

Flexor digitorum brevis

91
Q 
Which of the following structures passes anterior to the medial malleolus?
Flexor digitorum longus
posterior tibial artery
great saphenous vein
flexor hallucis longus
tibial nerve
A

Great saphenous vein

92
Q

Which section of the femur is common for fractures? in who moreso

A

neck of the femur

common in older individulas especially women

93
Q

What is often torn during fracture of the femoral neck and what resuts?

A

medial femoral circumflex (supplying most of the blood to the femoral head and neck is torn)

Artery from obturator traveling with ligament to the head is often inadequate and aseptic necrosis of femoral head occurs

94
Q

Are acquired dislocations of the hipjoint common or uncommon

A

uncommon

95
Q

What are 2 misalignments of the knee joint ? what can lead to them

A 
Genu varum (bowlegs)
Genu Valgum (knock-knee)

injury or osteoarthritis can lead to them

96
Q

When can the condition of the cruciate ligaments be assessed

A

When the knee is flexed

97
Q

What are the tests for a tear in the posterior or anterior cruciate ligaments

A

Anterior or Posterior drawer tests

98
Q

What will be seen in a positive anterior drawer test and what does that mean

A

tibia can be pulled anterior relative to the femur

tear of anterior cruciate ligament

99
Q

What will be seen in a positive posterior drawer test and what does that mean

A

TIbia can be pushed posterior to the femur

tear of posterior cruciate ligament

100
Q

What makes up the unhapy triad

A

tibial collateral ligament
medial meniscus
anterior cruciate ligament

101
Q

What would a blow to the posterolateral aspect of the knee (with the foot fixed) possibly cause

A

posible tear to
tibial collateral ligament
medial meniscus
anterior cruciate ligament

102
Q

Why is the unhappy triad associated with one another

A
  • posterolateral force causes rupture of TCL (MCL)
  • MCL is attached to medial meniscus and often tears it or detaches it from capusle
  • Shearing force exerted on the acl results in tearing of its attachment to the lateral femoral condyle

(further epanded to incluede either menisci)

103
Q

A sprain of the ankle joint usually involves what?

A

tearing of ligaments, most frequently on the lateral side

104
Q

What almost always causes a sprained ankle

A

an inversion injury

105
Q

Why is one side of the ankle more frequently damaged in a sprain then the other?

A

Lateral ligaments usually torn in sprain because lateral ligaments are much weaker than medial ones

106
Q

What does flat feet involve and what are the 3 possible causes of it

A

Involves the arches of the foot

Due to:
Malformation of the tarsal bones
Stretching or elongation of supporting ligaments
Fatigue or loss of tonicity of muscles (especially fibularis longus and tibialis posterior)

107
Q

Loss of muscle tone or fatigue in which muscles is most likely to cause flat feet

A

fibularis longus and tibialis posterior

108
Q 
Cam Newton is sacked by a low tackle from his left and is unable to walk off the field. Upon examining his knee the doctor discovers Cam's leg can be moved excessively anterior to the thigh when the knee is flexed. What has been injured?
Tibial collateral ligament
Anterior Cruciate ligament
Fibular Collateral ligament
Medial meniscus
Contract negotiations
A

Anterior Cruciate ligament

109
Q 
A forcible eversion of the foot will cause a sprain of which of the following ligaments 
Anterior Talofibular
Posterior Talofibular
Plantar Cacanonavicular ("spring")
Calcanofibular
Anterior tibiotalar
A

Anterior tibiotalar

is a component of deltoid ligament which resists eversion of the foot

Plantar calcanonavicular : helps maintain longitudinal arch of foot

Others: lateral ligaments of the ankle to resist inversion

Anatomy Block 4 (16 decks)

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