Clinical Anatomy Flashcards by Austin Flick

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

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What is likely to happen during child birth

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

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

pubococcygeus

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

protrusion of pelvic viscera through pelvic floor

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What are kegel exercises

exercises done to strengthen muscles of the pelvic floor

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What are external hemorrhoids and what covers them?

varicossities of the inferior rectal veins

covered by skin

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What are internal hemorrhoids and what covers them?

varicosities of the superior rectal veins

covered by mucous membrane

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What would you feel with internal hemmorhoids and why?

Painless/nothing

mucsoa innervated by autonomic nerves

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What would you feel with external hemmorhoids and why?

extreme pain

rich sensory innervation of lower anal canal by inferior rectal nerves

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What may cause formation of a painful ischioanal abscess

infection within ischioanal fossa

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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

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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

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What is a circumcision

Removal of male prepuce

routinely performed on male infants in some societies

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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

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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

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

greater vestibular glands

undergo abscess formation

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What is an Episiotomy and where is it done

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

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Why were episiotomys originally done

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

(freq is decreasing)

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How may external genitalia be anesthetized what is it called

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

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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

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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

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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

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What may calculi within the ureter cause?

severe pain and complete or intermittent obstruction of urinary flow

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What are the 3 most common sites for calculi obstruction

junction of renal pelvis and ureter

pelvic brim

passage through bladder wall

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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 tibiotalar ```

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