Clinical Anatomy Flashcards
What rarely and usually happens with injuries to the pelvic joints and why?
seldom dislcoates, instead
bony potions of adjacent pelvic rim (particularly pubic rami) usually fracture (usually both rami)
Because of strength of surrounding ligaments
What is likely to happen during child birth
stretching or tearing of levator ani muscles and or fascia of within urogenital haitus
Which of the levator ani muscles is most likely to be injured in childbirth
pubococcygeus
What can the tearing or stretching of muscles and fascia during childbirth cause
protrusion of pelvic viscera through pelvic floor
What are kegel exercises
exercises done to strengthen muscles of the pelvic floor
What are external hemorrhoids and what covers them?
varicossities of the inferior rectal veins
covered by skin
What are internal hemorrhoids and what covers them?
varicosities of the superior rectal veins
covered by mucous membrane
What would you feel with internal hemmorhoids and why?
Painless/nothing
mucsoa innervated by autonomic nerves
What would you feel with external hemmorhoids and why?
extreme pain
rich sensory innervation of lower anal canal by inferior rectal nerves
What may cause formation of a painful ischioanal abscess
infection within ischioanal fossa
Which of the following muscles is most likely to be damaged during childbirth coccygeus illiococcygeus Obturator internus piriformis pubococcygeus
pubococcygeus
most medial and anterior of muscles listed, border urogenital haitus and sweep behind vagina. Thus upon head exit may be torn
The lateral wall of the ischioanal fossa is formed partly by which of the following Piriformis levator ani ischial tuberosity anal canal sacrotuberous ligament
Ischial tuberosity
also formed by the obturator internus muscle
levator ani and anal canal form sloping superomedial border
What is a circumcision
Removal of male prepuce
routinely performed on male infants in some societies
What may rupture of the spongy urethra lead to and why
accumualtions of urine in the superficial perineal pouch
because of attachments of the superficial perineal fascia
Where would urine fill in the event of a ruptured spongy urethra (3)
scrotum
subcutaneous space of the penis
lower abdominal wall deep to superficial membranous fascia
Which glands are frequently the site of acute or chronic inflammation and what happens as a result
greater vestibular glands
undergo abscess formation
What is an Episiotomy and where is it done
Deliberate incision made posterior to the vestibule to ease dilivery of a fetus
Why were episiotomys originally done
to prevent serious damage to perineal structures (ex. anal sphincter)
(freq is decreasing)
How may external genitalia be anesthetized what is it called
infiltration of region close to pudendal nerve with local anesthetic
pudendal nerve block
Where would the needle be introduced in a pudendal nerve block
through the vagina into the area of the ischial spine palpated by a finger in the vagina
The vestibular bulbs are firmly attached to the:
Ischiopubic rami pubic symphysis perineal membrane superior pubic rami ischial tuberosities
Perineal membrane
on either side of the vagina
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
external urethral sphincter
What may calculi within the ureter cause?
severe pain and complete or intermittent obstruction of urinary flow
What are the 3 most common sites for calculi obstruction
junction of renal pelvis and ureter
pelvic brim
passage through bladder wall
What can commonly block urinary flow after middle age
benign hypertophy of the prostate
What is one of the most common tumors of older males
malignant carcinoma of the prostate
What is a common cause of female infertility and what causes it
blockage of uterine tubes caused by pelvic inflamatory disease (can be caused by chlyammidia)
What is a prolapse
protrusion of pelvic viscera through the pelvic floor to the vagina
What will usually cause a prolapse
severe stretching or tearing of the pelvic diaphragm or cervical ligaments during childbirth
How would access/drain pus fluid or blood from the rectouterine pouch.
Through the posterior fornix of the vagina
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
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
What lymph nodes should be monitored in the case of testicular cancer
para aortic
Where in the pelvic region can tumors frequently occur and who are they most commonly seen in
testis
young males
What is extremely vunerable during hyserectomy and why
ureter
due to close proximity of ureter and uterine artery at base of broad ligament
What controls bladder emptying
parasympathetic fibers of the pelvic splanchnic nerves
What may be injured in rectal surgery and what can it lead to
parasympathetic fibers of the pelvic splanchnic nerves
leads to retention of urine
in general how does visceral pain from pelvic organs travel back to the spinal cord
the reverse of the pathway that brought parasympatheic supply to the organs (namely S2,S3,S4)
What is the exception to the general rule about pelvic visceral pain/where do they travel
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
What can be a treatment to relieve exessive uterine pain associated with menstruation (dysmenorrhea)
division of the superior hypogastric plexus (presacral neurectomy)
What could occur when placing arterial grafts in the common iliac arteries
interuption of hypogastric plexus
What would interruption of hyposgastric plexus cause in males and why
Sensation of ejaculation but nothing comes out
symp innerv to involuntary internal urethral sphincter has been cut
causes retrograde ejaculation into urinary bladder
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
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
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
Umbilical artery
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
Obturator artery
What are the visceral branches of the internal iliac artery (3)
Umbilical
inferior vesical
middle rectal
What are the parietal branches of the internal iliac artery (6)
iliolumbar lateral sacral obturator internal pudendal superior gluteal inferior gluteal
What is the order from superior to inferior of A, N, V in the obturator foramen
Above: Obturator nerve
Middle: Obturator artery
Below: Obturator vein
What passes over the obturator artery
ureters and either ductus deferens or round ligament of uterus
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
Hypogastric nerve to L1 L2
Where would pain from a diseased hip joint be referred to and why
Medial surface of knee joint
because femoral, obturator, and tibial nerves supply articualr branches to both hip and knee
During late stages of pregnancy (fetal head descended into pelvis) where might a mother feel discomfort or pain and why?
extending down one or both lower limbs
due to babies head putting pressure on sacral plexus
How might nerves of the the sacral plexus get invaded by tumors
malignant tumors extending from neighboring viscera
What would tumors invading the nerves of the sacral plexus cause
severe pain down the lower limbs
Which of the following muscles lies posterior to the sacral plexus of nerves Obturator internus Piriformis Levator Ani Coccygeus Ilioccygeus
Piriformis
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
L2, L3, L4
L1 only goes to iliohypogastric and ilioinguinal nerves
A quick start (sprint) or extreme stretching (gymnastics) may cause what? What is this injury called?
stretching or tearing of the proximal attachments of the adductor muscles
Groin injury or pulled groin
What would damage to the femoral nerve result in
inability to extend the knee and impairs normal gait
What would tapping the patellar ligament of the quadriceps femoris test? What is this reflex called?
Tests the integrity of the femoral nerve
knee jerk reflex
When placing a needle or catheter in the femoral vein how is the correct placement found?
by finding the femoral pulse
Where will the femoral vein lie in relation to the femoral artery
medial and parallel to the artery
What would present as a mass in the proximal thigh
femoral hernia
What is a femoral hernia
loop of gut or mesentery passes deep to inguinal ligament and through the femoral ring
Presents as mass in proximal thigh
In which gender are femoral hernias more common
females
Which of the following structures is associated with both the femoral triangle and adductor canal adductor magnus pectineus adductor longus inguinal ligament
adductor longus
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
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
Which of the folowing medial femoral muscles is attached to the tibia Gracilis Pectineus Adductor longus Adductor brevis Adductor magnus
Gracilis
What is are frequent sites of inflammation in the gluteal region and what is the name for the inflammation
Trochanteric and Ischial Bursas
Bursitis
What muscles are commonly pulled or torn in strenuous running or kicking activites (football or soccer)
Hamstring muscles
What would damage to the superior gluteal nerve from trauma or disease cause
disabling of the major abductors of the hip
drastically hamper gait
How would you test for damage to the superior gluteal nerve
patient standing on one foot, opposite pelvis drops downward
trendelenburg test
What nerve is vunerable during intamuscular injections
sciatic nerve due to poisition in gluteal region
what quadrant of the gluteal region should you aim for during intramuscular injections and why
superolateral quadrant
to avoid damaging the sciatic nerve
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
Short head of biceps femoris
Which of the following structures exits the pelvis through the lesser sciatic foramen Pudendal nerve Inferior Gluteal artery Obturator internus tendon Sciatic Nerve Piriformis
Obturator internus tendon
Which of the folowing muscles is a medial rotator of the thigh Gluteus Maximus Gluteus Minimus Obturator internus piriformis Inferior gemellus
Gluteus minimus
What are shin splints
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
What would rupture of the calcaneal tendon cause and is it common
inability to plantar flex
it is fairly common
Where is the common fibular nerve vunerable
vunerable to trauma as it passes around head of femur
it is just deep to the skin here
What would damage to the common fibular nerve cause
loss of dorsiflexion and eversion of the foot
called: foot drop
What may deep wounds to the popliteal fossa injure and what would result?
injure the tibial nerve
result in loss of plantar flexion of the foot and flexion of the toes
What may result from damage to the politeal artery and veins and why
Damage may result in arteriovenosus shunt of blood
Popliteal artery and veins bound tightly together by connective tissue
Loss of the popliteal pulse would be diagnostic of what?
occluded femoral artery
What is the normal floow of lood in the lower limbs (veins) and what does it depend on ?
from superficial veins to deep ones
depends on the competnecy of the venous valves
What would damage to the venous valves of the lower limb or impession of flow in deep veins cause
distension of the superficial veins and eventual varicosity
Which of the following is a major dorsiflexor of the foot Tibialis Anterior Fibularis Brevis Soleus Plantaris Flexor digitorum longus
Tibialis anterior
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
Fibular artery
What is plantar fasciitis
inflammation of the plantar fascia
What may cause plantar fasciitis
running or high impact activites
or growth of a bony spur from the calcaneus
What is used to record the pulse in a recumbent patient
dorsalis pedis
posterior tibial artery
Which of the following muscles is innervated by the medial plantar nerve? abductor digiti minimi Flexor Digitorum brevis Quadratus plantae Second Lumbrical Plantar interossei
Flexor digitorum brevis
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
Great saphenous vein
Which section of the femur is common for fractures? in who moreso
neck of the femur
common in older individulas especially women
What is often torn during fracture of the femoral neck and what resuts?
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
Are acquired dislocations of the hipjoint common or uncommon
uncommon
What are 2 misalignments of the knee joint ? what can lead to them
Genu varum (bowlegs) Genu Valgum (knock-knee)
injury or osteoarthritis can lead to them
When can the condition of the cruciate ligaments be assessed
When the knee is flexed
What are the tests for a tear in the posterior or anterior cruciate ligaments
Anterior or Posterior drawer tests
What will be seen in a positive anterior drawer test and what does that mean
tibia can be pulled anterior relative to the femur
tear of anterior cruciate ligament
What will be seen in a positive posterior drawer test and what does that mean
TIbia can be pushed posterior to the femur
tear of posterior cruciate ligament
What makes up the unhapy triad
tibial collateral ligament
medial meniscus
anterior cruciate ligament
What would a blow to the posterolateral aspect of the knee (with the foot fixed) possibly cause
posible tear to
tibial collateral ligament
medial meniscus
anterior cruciate ligament
Why is the unhappy triad associated with one another
- 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)
A sprain of the ankle joint usually involves what?
tearing of ligaments, most frequently on the lateral side
What almost always causes a sprained ankle
an inversion injury
Why is one side of the ankle more frequently damaged in a sprain then the other?
Lateral ligaments usually torn in sprain because lateral ligaments are much weaker than medial ones
What does flat feet involve and what are the 3 possible causes of it
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)
Loss of muscle tone or fatigue in which muscles is most likely to cause flat feet
fibularis longus and tibialis posterior
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
Anterior Cruciate ligament
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 tibiotalarAnterior 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
