Gross Anatomy Exam 1 - weeks 1-4 Flashcards
1
Q
What are the muscles of the 2nd layer of the sole of the foot and what do they do?
A
Quadratus plantae - assists flexor digitorum longus in flexion of 2-5 digits Lumbricals - Flex proximal phalanges, extend middle and distal and phalanges of 2-5
2
Q
What does the superficial layer of the extrinsic back muscles do?
A
It controls the upper limb. It also connects the axial skeleton with the superior appendicular skeleton.
3
Q
What innervates the posterior arm muscles?
A
The radial nerve.
4
Q
What is the blood supply of the latissimus dorsi?
A
The thoracodorsal artery.
5
Q
What is the origin and insertion of the subscapularis?
A
O: subscapular fossa I: lesser tubercle
6
Q
Where does the semitendinosus insert?
A
The medial tibia.
7
Q
What does the ischiofemoral ligament do?
A
Stabilizes the hip joint posteriorly.
8
Q
What’s more lateral, the extensor carpi radialis longus or brevis?
A
Longus is more lateral.
9
Q
What are the palpable structures on the back?
A
Vertebra prominens (C7) Scapular spine (T4) Medial border of scapula Inferior angle (T7/T8) Iliac crest (L4) Posterior superior iliac spine Acromion Greater tuberosity Ribs 6-12 Anterior superior iliac spine Sacrum Greater trochanter Ischial tuberosity
10
Q
What is Erb-Duchenne palsy and how is it caused?
A
“Waiter’s tip” deformity, shoulder medially rotated and extended and adducted, forearm pronated. Deltoid, brachialis, biceps brachii paralyzed. Caused by a separation of head and shoulder (labor dystocia) during birth. An upper brachial plexus (C5 and C6) injury.
11
Q
What is the innervation of the infraspinatus?
A
The suprascapular nerve (C5).
12
Q
What are the fascia of the breast/pectoral region?
A
Deltoid, Axillary, Pectoral, Clavipectoral.
13
Q
What is the insertion of the latissimus dorsi?
A
The intertubercular sulcus of the humerus.
14
Q
What are the nerve roots of the tibial nerve?
A
L4-S3.
15
Q
What is the insertion of the obturator internus and the superior and inferior gemellus?
A
The trochanteric fossa.
16
Q
What is the innervation of the supraspinatus?
A
the suprascapular nerve (C5).
17
Q
What is the insertion of the trapezius?
A
The acromion and spine of the scapula.
18
Q
What are some general symptoms of breast cancer?
A
Lymphedema, swelling, peau d’orange, can feel palpable nodes.
19
Q
What is psoas major innervated by?
A
The anterior rami of L1-L3. An exception to the anterior thigh muscles.
20
Q
What does the plantar reflex test?
A
The tibial nerve, roots L4-S2. The normal response is flexion - abnormal is Babinski’s sign.
21
Q
Where does breast lymph go?
A
To the subareolar lymphatic plexus.
22
Q
What can a humeral shaft fracture result in?
A
Tranverse - deltoid pulls proximal fracture laterally. Spiral - may cause shortening. Damage to the triangular interval (radial nerve and deep artery of the arm).
23
Q
What is the name of the deep fascia of the leg?
A
Crural fascia.
24
Q
What’s the only medial thigh muscle that only adducts, doesn’t flex the thigh.
A
Adductor longus - obturator externis doesn’t flex the thigh either, it laterally rotates the leg and steadies the head of femur in the acetabulum.
25
Where does the nervous innervation to the breast come from?
The anterior and lateral cutaneous branches of the 4-6th intercostal nerves.
26
What's the name of the deep fascia of the foot?
The pedal fascia.
27
Describe the terminal branches of the brachial plexus.
Axillary - posterior cord (C5,C6) Radial - posterior cord (C5-T1) Musculocutaneous - lateral cord (C5-C7) Ulnar - medial cord (C8-T1) Median - lateral and medial cord (C6-T1)
28
Which anterior thigh muscle has its own innervating branch?
The vastus medialis - has a branch of the femoral nerve called nerve to vastus medialis.
29
How many vertebral bodies are there?
33. 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused after age 30).
30
What do the carpals articulate proximally with?
The radius.
31
What is the cutaneous innervation of the radial nerve?
Basically the entire posterior compartment of the arm and the forearm.
32
Describe the ankle joint. What's another name for it?
aka the talocrural joint. Uniaxial, hinge-type joint. Made up of tibia, fibula, and trochlea of talus.
33
What is the insertion of the triceps brachii?
The olecranon process.
34
What are the dorsum intrinsic muscles and what innervates them?
Extensor digitorum brevis and extensor hallucis brevis. The deep fibular nerve.
35
What is polythelia?
Extra nipples.
36
What and where is the lumbar cistern?
An enlargement of subarachnoid space between the conus medullaris and the end of the dural sac around S2. Around L4 through this is where you do spinal anaesthesia or a lumbar puncture.
37
What are the important portions of the ulna?
Olecranon process, coronoid process, trochlear notch.
38
What are the muscles of the anterior compartment of the arm? What are they innervated by? What is their blood supply?
Biceps brachii, coracobrachialis, brachialis. Musculocutaneous nerve Brachial artery
39
What innervates the popliteus? What is its action?
The tibial nerve. Weak knee flexion / unlocks knee joint by rotating femur 5 degrees laterally on fixed tibia (or tibia 5 degrees medially on fixed femur).
40
Where are the capitulum and trochlea relative to each other?
Capitulum is lateral, trochlea is medial.
41
Tell me about the sciatic nerve.
It is the largest nerve in the body. It has L4-S3 nerve roots. divides into the tibial and common fibular nerve in the greater sciatic foramen, under the piriformis, and travels in its divisions posterior to the knee. 12% of people have nerve variations where it branches earlier or one branch travels above/through the piriformis. Damage can be be fround medial buttock injury/surgery, trauma to posterior thigh, posterior dislocation of the femural head) It also gives rise to the superior and inferior gluteal nerves.
42
What is the dorsal venous arch made of?
The small and great saphenous veins.
43
What muscles do contralateral head rotation?
Sternocleidomastoid Semispinalis capitis
44
Besides wrist flexion, what are the actions of flexor carpi radialis and flexor carpi ulnaris?
Flexor carpi radialis abducts the hand, flexor carpi ulnaris adducts the hand.
45
What is the name of the arterial arch on the dorsum of the foot? What's it made of?
The arcuate arch. The lateral tarsal artery and the dorsalis pedis artery, both of which come from the anterior tibial artery. It anastomoses with the deep plantar arch.
46
What makes up the cutaneous innervation of the posterior thigh and knee?
The posterior cutaneous nerve of the thigh (S1-S3).
47
What is the blood supply of the levator scapulae?
The dorsal scapular artery.
48
List the intrinsic back muscles.
The paraspinous muscles and the erector spinae group.
49
What are the thenar muscles and what innervates them?
Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis The recurrent branch of tte medial nerve.
50
What do the 4 dorsal interossei do? What innervates them?
Abduct digits 2-4 and flex the metacarpophalangeal joints. The deep branch of the ulnar nerve.
51
What is the medial collateral ankle ligament made of?
AKA the deltoid ligament. The posterior and alterior tibiotalar, the tibiocalcaneal, and the tibiovanicular ligaments.
52
What is the action of the lateral leg muscles? What is the blood supply/innervation?
Eversion and weak plantarflexion. The perforating branches of the fibial and posterior tibial arteries and veins. The superficial fiibular nerve.
53
Where is a clavicular fracture most common?
At the junction of the middle and lateral 1/3 of the clavicle. The subclavian vein is just deep to the clavicle, can be affected.
54
What is special about the adductor magnus?
It has two heads and dual innervation. The hamstring division is innervated by the tibial division of the sciatic nerve. It also has an opening in its tendon called the adductor hiatus. The hamstring part originates at the ischial tuberosity and inserts on the adductor tubercle.
55
What is the innervation of the subclavius?
Nerve to subclavius (C5-6).
56
Where does the axillary artery become the brachial artery?
At the inferior border of teres minor.
57
What is genu varum?
Bowlegged
58
What is the action of serratus anterior?
Abduction of the arm and protraction of the scapular.
59
What is the facet/zygophasial joint?
Joint between two one vertebra's superior articular facet (on articular process) and another's inferior one.
60
What is the action of the coracobrachialis?
Adduct humerus, flex arm.
61
What is a hangman's fracture?
Abrupt hyperextension of the neck breaks the pedicles of C2 posterior to the superior articular facets.
62
Describe the calcaneal tendon reflex. What if it ruptures?
Normal response plantarflexion - tests S1/S2 roots of tibial nerve. Rupture - cannot rise to tiptoes, bulge in posterior leg, palpable gap where it ruptured.
63
Where is the angle of Louis?
Around the 2nd rib - at T4/T5.
64
What is the origin and insertion of the infraspinatus?
O: Infraspinous fossa I: greater tubercle
65
What does the basilic vein travel with?
The medial antebrachial cutaneous nerve.
66
What is a back sprain?
Only ligamentous tissue is involved; no dislocation or fracture. It comes from strong contractions related to movement of the vertebral column.
67
What is the path of the spinal nerves?
They emerge laterally from the intervertebral foramina and divides into anterior and posterior branches.
68
What is the action of the supraspinatus?
It abducts the arm 0-15 degrees. It also stabilizes the glenohumeral joint.
69
What does superior gluteal nerve injury result in?
Weakness of hip/thigh adduction, inability to stabilize pelvis. A positive Trendelenburg's sign is when you stand on one leg and the unsupported side pelvis drops.
70
What is special about the fibularis tertius?
Not every person has one, its belly blends in with the extensor digitorum longus, and it does weak eversion of the foot.
71
What is the axial skeleton?
The cranium, vertebral column, manubrium, sternum, and ribs. Everything else is the appendicular skeleton.
72
What nerve can a hamate fracture compress?
The ulnar nerve - runs underneath it in the Guyon's canal.
73
What is a chance fracture?
It is an anterior crush fracture and also fractures along the transverse processes of the vertebra.
74
What is the name of the anastomosis of arteries around the knee joint?
The genicular anastomosis (genicular branches of popliteal artery)
75
What is a sentinel lymph node?
The first node to drain an affected area. Radioactive particles injected at least 3-4 hours prior to surgery. If tumour is in the medial breast, the SLN may be in the sternal/internal mammary chain.
76
What are the spaces of the scapulary/arm muscles?
Triangular - circumflex scapular artery. Quadrangular - axillary nerve and posterior circumflex humeral artery. Triangular interval - radial nerve and deep artery of the arm.
77
What is the innervation of pec major?
The lateral + medial pectoral nerve (C5-7).
78
What is a Volkmann's contracture?
Sudden occlusion or laceration of the brachial artery resulting in a permanent contraction/flexion.
79
What innervates the gluteus maximus?
The inferior gluteal nerve.
80
What muscles are affected by ulnar nerve damage at the elbow?
The medial 1/2 of the flexor digitorum profundus. Cannot flex the DIPs of 4-5. Claw becomes less prominent "ulnar paradox".
81
Where does the rectus femoris originate?
Anterior inferior ilia spine, and ilium superior to the acetabulum.
82
What are the symptoms of breast cancer that has invaded the subareolar space?
Retraction and deviation of nipples caused by shortening of ducts.
83
What provides cutaneous innervation to the lateral bit of the foot?
The sural nerve.
84
Where does the popliteus originate and insert?
Origin: lateral condyle of femur Insertion: Proximal posterior tibia
85
What does the cephalic vein travel with?
The lateral antebrachial cutaneous nerve.
86
What are the nerve roots of the sciatic nerve?
L4-S3.
87
What is the innervation of the pec minor?
The medial pectoral nerve (C8-T1).
88
What does the nerve to obturator internus innervate?
The obturator internus and the superior gemellus.
89
What do the 3 palmar interossei do? What innervates them?
Adduct digits 2, 4, 5 and flex the metacarpophalangeal joints. The deep branch of the ulnar nerve.
90
What is the action of the paraspinous muscles?
They act on the vertebral column to control movements and maintain posture.
91
Describe the route of the radial nerve.
Enters the arm posterior to the brachial artery medial to the humerus, anterior to the long head of the triceps. Descends inferolaterally \*with the deep artery\* in the radial groove, between the lateral and medial heads of the triceps. When lateral to the humerus it pierces lateral intermuscular septum as it moves to the forearm anterior to the lateral epicondyle, between the brachialis and brachioradialis.
92
What is Dupuytren's Contracture?
The palmar fascia of the medial hand thickens, pulling the fourth digit in flexed.
93
How does the affected limb in an acquired hip joint dislocation present?
Shorter and medially rotated.
94
What is the path of the spinal accessory nerve / CN XI?
It goes from the cranium down the neck and back deep to the trapezius. It is relatively superficial and can be easily injured with a blunt or penetrating injury.
95
What is the insertion of pec minor?
The coracoid process?
96
What is claw hand and how is it caused?
It is weak finger abduction and adduction, medial hand numbness, clawing of digits 4-5. It is caused by medial elbow and wrist trauma - specifically trauma to the ulnar nerve.
97
What makes up the deep cubital fossa?
From medial to lateral, the biceps brachii tendon, brachial artery, and medial nerve.
98
What is ankylosing spondylitis?
It is an inflammatory form of spinal arthritis where \>1 vertebral and/or sacroiliac joints fuse. It causes a hunched forward appearance and is more common in males than females.
99
What is the unhappy triad?
Torn anterior cruciate ligament, tibial collateral ligament, medial meniscus. Caused by a lateral hit to the extended knee or excessive lateral twisting of the flexed knee.
100
What makes up the sacral plexus?
The ventral rami of L4-S4. The lumbosacral trunk (L4, L5) also contributes to it.
101
What muscles are affected by ulnar nerve damage at the wrist?
Hypothenars, interossei, 3rd and 4th lumbricals. Cannot flex the metacarpophalangeal joints of 4-5, extend the IPs, or move digit 5.
102
What are the general mechanisms of the serine proteases?
Chymotrypsin: cleaves peptide after aromatic residues, small side chain that lets large hydrophobic residues bind. Trypsin: cleaves after Lys and Arg, has a negative side chain that binds with a positive side chain of the substrate. Elastase: cleaves Gly, Val, Ala, has small hydrophobic side chains that interact with also phobic residues in the substrate.
103
Which anterior arm muscles originate at the medial epicondyle?
Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Flexor carpi ulnaris
104
What is winged scapula and how is it caused?
Serratus anterior paralysis, medial scapula protrudes if patient pushes against a wall. Caused by a lesion to the thoracic nerve - often by a surgery (mastectomy) and trauma to the lateral chest.
105
What is the difference between a dermatome and cutaneous nerve areas?
The cutaneous nerve supplies an area of sin related to a peripheral nerve and can contain fibers from several individual spinal nerves. Its areas overlap with dermatomes and are generally broader and wider than a single dermatome.
106
What are important portions of the radius?
Radial head + tuberosity.
107
Where does the fibularis longus insert?
In the medial cuneiform and the base of the 5th metatarsal.
108
What muscles make up the suboccipital triangle? What margins do they make up?
Rectus capitis posterior major - superomedial. Obliquus capitis inferior - inferolateral. Obliquus capitis superior - superolateral. The greater occipital nerve (C2) is inside the triangle.
109
What happens in the case of a posterolateral disc herniation?
It may spare the nerve at the level of injury but affect the one inferior.
110
What does through the adductor hiatus?
The femoral artery and vein move through it from anterior thigh to posterior knee (popliteal fossa), and change their names to the popliteal artery and vein.
111
How does supination of the arm occur?
The head of the radius swivels inside the annular ligament, against the capitulum and radial notch of ulna.
112
What are the symptoms of breast cancer that has invaded retromammary space, pectoral fascia, or interpectoral lymph nodes.
Pectoral fascia - rock-hard, fixed nodule. The breast elevates when the pec contracts.
113
What are the types of mastectomies?
Simple/total - breast tissue. Modified radical - breast tissue + lymph nodes. Radical - breast tissue + lymph nodes + muscle.
114
Differentiate between mallet hand, swan neck, and boutonniere deformity.
Mallet hand - hyperflexed DIP. Swan neck - hyperxetended PIP, flexed DIP. Boutonniere - flexed PIP, hyperextended DIP.
115
Describe the trunks of the brachial plexus.
Superior (C5 and C6) Middle (C7) and Inferior (C8 and T1)
116
What is a prefixed and a postfixed brachial plexus?
C4-C8 and C6-T2 respectively.
117
What is the action and origin of the gastrocnemius?
Plantarflexion when knee is extended, flexes leg at knee. Origin: the lateral and medial condyles of the femur.
118
What innervates adductor pollicis?
The deep branch of the ulnar nerve.
119
Describe elbow dislocation.
The most common is posterior dislocation, where the person falls on an extended, abducted arm. It hyperextends and the radius and the ulna are dislocated posteriorly relative to the humerus.
120
How any pairs of spinal nerves are there and where do they course.
31. 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, one coccygeal. The cervical ones course superior to their vertebra (C8 above T1 vertebra), and the others course inferiorly.
121
What is the blood supply of the trapezius?
The transverse cervical artery.
122
Describe the drainage into the subclavian vein.
The basilic and brachial veins join into the cephalic vein, which joins with the axillary vein and goes into the subclavian.
123
Describe the venous drainage of the spinal cord.
3 anterior and 3 posterior spinal veins that communicate with each other and drain into the anterior and posterior medullary veins. They join the internal vertebral/epidural plexus (valveless) and communicate with the dural sinuses and then the vertebral veins. They also communicate with the external vertebral plexii on the external aspect of the vertebrae.
124
What is the adductor canal?
A fascial compartment posterior to sartorius thorugh which travel the femoral artery/vein, nerve to vastus medialis, saphenous nerve.
125
How can you identify the medial view of the foot?
The sustenaculum tali with the groove for the tendon of flexor hallucis longus. Also, the medial longitudinal arch is higher than the lateral one.
126
Quadriceps femoris is the anterior thigh. Quadratus femoris is the gluteal region.
Just a reminder!
127
What is a burst/Jefferson fracture?
4 breaks in C1 in the anterior and posterior arches. It comes from strong compression on the top of the head which drives the occipital condyles into the lateral masses of C1.
128
Where do the medial quadrants of the breast drain their lymph to?
The parasternal lymph nodes (they can also travel to the contralateral breast).
129
What are the muscles of the quadriceps femoris? Where do they insert?
Rectus femoris, vastus medialis, vastus intermedialis, vastus lateralis. They insert on the patella via the quadriceps femoris tendon, and the tibial tuberosity via the patellar ligament.
130
What are the spinal cord meninges and spaces?
The epidural space is filled with fat and is between the dura mater and vertebral column. The subdural space is only a potential (pathological) space and is between the dura mater and the arachnoid mater. The subarachnoid space is filled with CSF and is between the arachnoid mater and the pia mater.
131
Where do breast carcinomas usually come from?
Adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the lobules.
132
What is Patellofemoral pain syndrome?
"Runner's Knee". It is pain/inflammation deep to the patella due to abnormal gliding over the femur surface. Causes: excessive downhill running, direct trauma to patella, weak vastus medialis, osteoarthritis.
133
What makes up the superficial cubital fossa?
The medial and lateral epicondyles on the top, the brachioradialis laterally, pronator teres medially.
134
What is the action of the piriformis?
It laterally rotates an extended thigh, abducts a flexed thigh. It exits through the greater sciatic foramen and so do the superior and inferior gluteal artery.
135
What is radial nerve palsy and how it caused?
Wrist drop, inability to extend wrist, loss of sensation from dorsum of thumb. Caused by trauma to the lateral albow or fracture to the midhumerus at the radial groove.
136
What is the innervation of teres minor?
The axillary nerve (C5-6) terminal branch.
137
What is a denticulate ligament?
It anchors the spinal cord to the dura mater at the midpoint between two spinal nerves.
138
What causes the hand of benediction?
Damage to the median nerve via supracondylar fracture.
139
Where do the flexor/extensor ulnaris and radialis originate?
At the base of the 5th and 2nd metacarpals respectively.
140
Where do you find the dorsalis pedis artery pulse?
Superficially over the tarsals, near the tendon of the extensor hallucis longus.
141
What is an uncinate process?
A bony lip around the rim of vertebrae C3-T1. If it grows osteophytes, it can compress the nerves and arteries with a 'mini stroke'.
142
Name the supraclavicular branches of the brachial plexus.
Long thoracic (C5-C7) Dorsal scapular (C5) Nerve to subclavius and suprascapular nerve (from the superior trunk - C5,C6)
143
What is special about the plantaris?
It is not found in all people.
144
What does inferior gluteal nerve injury result in?
Weakness of hip/thigh extension and lateral rotation. Weakness rising from a siting position and/or climbing stairs.
145
What is the general action of the muscles of the gluteal region and posterior thigh?
Laterally rotate the and abduct the thigh.
146
What are Bouchard's and Heberden's nodes?
Bouchard's is a bony bump at the PIPs and Heberden's is one at the DIPs.
147
What is special about the obturator extremis?
It laterally rotates the thigh - the other medial thigh muscles medially rotate/adduct the thigh.
148
Where are the coronoid and olecranon fossa relative to each other?
The olecranon fossa is posterior, and the coronoid fossa is anteriorly above the trochlea.
149
Describe the somatic motor pathway.
It is a 2 neuron system. First, a UMN in the primary motor cortex sends a signal down a GSE axon axon to a LMN in the ventral horn. Then the LMN sends a signal down the ventral root to a peripheral spinal nerve, which eventually innervates a muscle.
150
What is the blood supply of the medial mammary?
The internal thoracic artery.
151
What is the general blood supply and innervation of the anterior thigh?
Femoreal artery/vein/nerve (L2, L3, L4)
152
Where does the biceps femoris insert?
The head of the fibula.
153
What is tennis elbow and golfer's elbow?
Tennis - lateral epicondylitis Golfer - medial epicondylitis
154
Go over anterior/medial leg arteries/blood supply.
The common iliac artery comes from the abdominal aorta and branches into the internal and external iliac arteries. The internal iliac branches into the obturator artery. The external iliac artery branches into the femoral artery which quickly branches into the deep artery of the thigh. THe deep artery of the thigh branches into the medial circumflex femoral artery, the lateral circumflex femoral artery (in front of the femur - ascednding and descending branch), and the perforating arteries.
155
What does the ilifemoral ligament do?
Limit hyperextension.
156
What is the general action of the anterior leg muscles? What is the blood supply/innervation?
Dorsiflexion. Anterior tibial artery/vein, deep fibular nerve.
157
What does injury to the radial nerve do?
Superior to the origin of triceps = paralysis of all muscles controlled by it, sensory loss. In the radial group = paralysis of the medial head of the triceps and all posterior muscles of the forearm distal to the affected site, sensory loss. Characteristic wrist drop.
158
Where is the most frequent site of fracture in the tibia?
The shaft.
159
Describe the rupture of the tendon of the long head of the biceps brachii.
Common in men over 60 as a result of tear over the intertubercular sulcus. An audible snap/pop followed by a "popeye" deformity and pain/tenderness at the shoulder.
160
What does the musculocutaneous nerve pierce?
The coracobrachialis.
161
What are the surfaces of the hands and feet called?
Hands and feet have their own bodily planes. The top of the feet and back of the hands are called dorsal. The palm surface is called palmar and the sole surface is called plantar.
162
What makes up the anatomical snuffbox?
Anteriorly - abductor pollicis longus Posteriorly - extensor pollicis longus Floor - scaphoid + radial artery Roof - superficial branch of radial nerve + cephalic vein
163
What can be damaged in a posterior hip joint dislocation?
The sciatic nerve.
164
What muscle(s) are innervated by the superior gluteal nerve?
Gluteus minimus, gluteus medius, tensor fascia latae.
165
What's the retromammary space?
The space between breast and pectoral fascia.
166
What is arthritis?
The cartilage thins, joint rubs, and the synovial joint membrane is inflamed.
167
What does the medial pectoral nerve pierce?
Pectoralis minor.
168
What is the inertion of teres minor?
The greater tuberce.
169
What direction does the patella most commonly dislocate?
Laterally.
170
Describe somatic sensory nerve signaling.
A sensory/GSA type axon travels in the spinal nerve and reaches the dorsal root. Then it becomes a tract in the spinal cord and reaches the brain.
171
What is the action of teres major?
Adduction and medial rotation.
172
What makes up the femoral triangle?
The inguinal ligament, the sartorius, and the adductor longus.
173
What is the action of the levator scapulae?
Elevates the scapula. Inferior rotation of the glenoid cavity.
174
What provides cutaneous innervation to the dorsum of the foot (except for the skin between the first and second toes)?
The superficial fibular nerve.
175
What is the name of the arterial arch on the plantar surface of the foot? What's it made of?
The deep plantar arch. The lateral and medial plantar artery, both of which come from the posterior tibial artery. It anastomoses with the arcuate arch.
176
Which posterior arm muscles are specifically innervated by the deep branch of the radial nerve?
Extensor carpi ulnaris Extensor digiti minimi Supinator
177
What makes up the lumbar nerve plexus?
The ventral rami of L1-L4.
178
What are the causes and what is the result of tarsal tunnel syndrome?
Scar tissue, varicose veins, bone spurs, repetitive foot eversion. Results in pain/numbness at the sole of the foot, as well as weakness of the intrinsic foot muscles controlled by the tibial nerve.
179
What are the non terminal branches that come out of the medial cord of the brachial plexus?
Medial brachial cutaneous, medial antebrachial cutaneous, medial pectoral - all C8,T1
180
Where do the inferior quadrants of the breast drain their lymph to?
The subdiaphragmatic lymph nodes.
181
What is "trigger finger"?
Flexor tendinitis - the tendom becomes inflames and swells too much to pass back into the sheath, locking the finger in a flexed position. Common in diabetics and people with rheumatoid arthritis.
182
What is nursemaid's elbow?
Common in the left arm of kids 1-4. The radius comes off (subluxation and dislocation) and pinches the annular ligament against the capitulum.
183
What and where is the filum terminale?
It continues down from the conus medullaris and tethers the spinal cord to the coccyx.
184
List the extrinsic superficial back muscles and their innervations.
Trapezius (descending, middle, ascending head) - CN XI. Latissimus dorsi - thoracodorsal nerve (C6-8). Levator scapulae, rhomboid major, rhomboid minor - dorsal scapular nerve (C5). Rhomboids separate branch than levator.
185
What does the nerve to quadratus femoris innervate?
The quadratus femoris and inferior gemellus.
186
Which joint is for nodding your head and which is for shaking?
Atlanto-occipital and atlanto-axial.
187
What does the medial plantar nerve innervate?
Abductor hallucis Flexor digitorum brevis 1st foot lumbrical Flexor hallucis brevis
188
What are the deep tendon reflexes?
Biceps brachii (to test musculocutaneous), triceps brachii (to test radial nerve). Diminished means lesion at the LMNs in the peripheral nerves. Brisk means lesion at the UMNs in the CNS.
189
Where does the sartorius originate ahd insert?
O: Anterior superior iliac spine I: superior medial tibia
190
Where do the axillary lymph nodes drain to?
The humeral, subscapular, pectoral LNs -\> the central LNs -\> the apical LNs. Mostly the pectoral LNs first though.
191
What does the cephalic vein run with?
The lateral antebrachial cutaneous nerve (what the musculocutaneous nerve becomes)
192
What are the components of the elbow joint?
Humeroulnar (hinge), humeroradial (glide), and proximal radioulnar (pivot) joints.
193
What are shin splints?
Small tears in the periosteum (dense layer of vascular CT) at the attachment of the anterior compartment muscles - commonly tibialis anterior. Treat with rest.
194
What is the orientation of the fascia of the breast/pectoral region?
The pectoral becomes the axillary laterally. The clavipectoral is continuous with the axillary. The deltoid is continuous with the pectoral anteriorly.
195
What connects the cephalic and basilic veins?
The medial cubital veins.
196
What is the general blood supply and innervation of the medial thigh?
Obturator artery/vein/nerve (L2-L4).
197
What can plantar fasciitis lead to?
A calcaneal/heel spur.
198
What is the blood supply of the lateral mammary?
The lateral thoracic artery. Also posterior intercostal arteries give lateral mammary branches from the lateral cutaneous branches.
199
What is the terrible triad?
Elbow dislocation + radial head fracture + coronoid process fracture.
200
Where is spina bifida occulta seen?
In L5 and/or S1.
201
What innervates the piriformis?
Anterior rami of S1-S2.
202
Where does the fibularis brevis insert?
The tuberosity of the 5th metatarsal.
203
If a particular disc is herniated, which nerve will be affected?
The nerve going through that foramen except in the case of lumbar where it is the one above that foramen.
204
What are the innervations of the extrinsic and intrinsic muscles of the back (broadly)?
Extrinsic - anterior rami of spinal nerves and CN XI. Intrinsic - posterior rami of spinal nerves.
205
What is whiplash?
Severe hyperextension (like the hangman's) which stretches/tears the anterior longitudinal ligament. There may also be a rebound hyperflexion injury.
206
Describe the arterial blood supply of the spinal cord.
- 1 anterior spinal artery that branches from the vertebral artery - 2 posterior spinal arteries that arise directly or indirectly from vertebral arteries These are reinforced by radicular arteries, branches of segmental arteries, ascending cervical arteries, deep cervical arteries, posterior intercostal arteries, lumbar arteries, and sacral arteries.
207
What is pes planus?
Flat foot / fallen arches.
208
What kind is joint is the hip joint? What are other names for it?
Aka the coxal/acetabular joint. It is a multi-axial, ball-and-socket type joint. Blood supply to this joint is the same as blood supply to the surrounfing skin and muscles.
209
Which posterior arm muscles are specifically innervated by the posterior interosseus nerve, a continuation of the deep branch of the radial nerve?
Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis Extensor indicis
210
What is the insertion of teres major?
The medial lip of the intertubercular sulcus.
211
What is the origin and insertion of the supraspinatus?
O: supraspinous fossa I: greater tubercle
212
What is the meniscus of the knee?
A crescent shaped fibrocartilage pad that deepens the articular surface between the tibia and femur and provides shock absorption. There is a medial part firmly attached to the tibial collateral ligament and a lateral part not attached to the fibular one. The popliteus tendon also passes between the two menisci.
213
What is the action of the triceps brachii?
Long head - extends forearm, adducts and extends arm, resists inferior dislocation of humerus in adduction
214
What is the action of the subscapularis?
Medial rotation of the arm.
215
Which vertebra has a vertebra prominens?
C7.
216
What is the rotator cuff made of?
The supraspinatus, infraspinatus, teres minor, and subscapularis.
217
What does a blood pressure cuff do?
Compress the brachial artery against the humeral shaft.
218
Where does the iliopsoas insert?
Lessert trochanter of femur.
219
What is the innervation of the deltoid?
The axillary nerve (C5-6).
220
What are the carpals?
Laterally to medially and proximally to distally Scaphoid Lunate Triquetum Pisiform (not visible dorsally) Trapezium (tubercle anteriorly) Tapezoid Capitate Hamate (hook anteriorly)
221
Where do you find the posterior tibial artery pulse?
Inferior to the medial malleolus in the tarsal tunnel.
222
Where does the "true hamstring"/posterior thigh compartment originate? What are the innervations?
The ischial tuberosity and the tibial division of the sciatic nerve. Biceps femoris short head = origincates on lateral lip of linea aspera and is innervated bu fibular division of sciatic nerve.
223
What is a crush/compression fracture?
A fraction of the body due to a sudden forceful flexion. It can be accompanied with the dislocation/fracture of the articular facets between two vertebrae and/or the rupture of interspinous ligaments.
224
Where do you do an epidural?
Around L4 in the lumbar cistern or in the sacral hiatus. You do it in the epidural space.
225
What provides cutaneous innervation between the first and second toes dorsally?
The deep fibular nerve.
226
What is the cutaneous innervation of the axillary nerve?
The skin over the deltoid.
227
What are the medial and lateral and inferior borders of the popliteal fossa?
Lateral - biceps femoris Medial - semimembranosus/semitendinosus Inferior - Heads of the gastrocnemius
228
What provides cutaneous innervation to the sole of the foot?
The tibial nerve (medial/lateral plantar nerve, medial calcaneal nerve).
229
What are deep posterior neck muscles responsible for?
Extension and lateral flexion.
230
What's a way to treat lumbar stenosis?
Decompressive laminectomy.
231
What does the brachial artery run with?
The median nerve.
232
What is the action of tibialis posterior?
Plantarflexion and inversion of the foot.
233
What makes up the cutaneous innervation to the buttocks?
The superior/middle/inferior cluneal nerves.
234
What is the path of the dorsal scapular nerve?
It goes down the neck and along the medial border of the scapula then emerges between the anterior and middle scalene muscles/
235
What exits the greater sciatic foramen and enters the lesser sciatic foramen?
The pudendal nerve, internal pudendal artery/vein, nerve to obturator internus.
236
What and where is the conus medullaris?
The ending point of the spinal cord around L1/L2. In neonates, it is L3/L4.
237
What is the origin of the biceps brachii?
Long head - supraglenoid tubercle, short head - coracoid process.
238
Where does the semimembranosus insert?
The posterior medial condyle of the tibia.
239
What is the non terminal branch that comes out of the lateral cord of the brachial plexus?
The lateral pectoral nerve (C5-C7)
240
What does the intrinsic layer of back muscles do?
It acts on the axial skeleton only. It acts on the vertebral column to control movements and maintain posture.
241
What is the action of the anconeus?
Assists in forearm extension, stabilizes the elbow.
242
What is the insertion of the levator scapulae?
The medial border of the scapula - superior to the root of the scapular spine.
243
What are the branches of the axillary artery?
The superior thoracic, the thoracoacromial (clavicular, acromial, deltoir, pectoral), the lateral thoracic, the subscapular (thoracodorsal, circumflex scapular, etc), the posterior circumflex humeral, the anterior circumflex humeral.
244
What is the most common carpal fracture?
A fracture of the scaphoid - pain in th snuffbox, risk of avascular necrosis.
245
What is the dermatome of the nipple?
T4.
246
What is Klumpke Palsy and how is it caused?
Claw hand from ulnar nerve involvement, ape hand ith median nerve involvement. Can be associated with Horner syndrome (myosis). Caused by upper limb trauma during birth. A lower brachial plexus injury (C8 and T1).
247
What are the non terminal branches that come out of the posterior cord of the brachial plexus?
Upper subscapular (C5), lower subscapular (C6), Thoracodorsal (C6-C8)
248
What is the action of the subclavius?
It anchors and depresses the clavicle.
249
What's inside the breast?
Secretory ligaments, fat, and suspensory ligaments holding it up.
250
Where do the flexor/extensor ulnaris and radialis originate?
At the base of the 5th and 2nd metacarpals respectively.
251
What muscles do ipsilateral head rotation?
Obliquus capitis inferior Rectus capitis posterior (major and minor) Longissimus capitis Splenis capitis
252
What is Carpal Tunnel Syndrome and how is it caused?
Ape hand, sometimes loss of sensation on the lateral 3 1/2 digits. Wrist flexion hurts, wrist extension relieves pain. Symptoms worse at night. Caused by repetitive wrist motion (swelling within the flexor retinaculum compresses the median nerve).
253
What are the muscles of the posterior compartment of the arm? What are they innervated by? What is their blood supply?
Triceps brachii, anconeus The radial nerve and deep artery of the arm (triangular interval)
254
What is the lateral collateral ankle ligament made of?
The posterior and anterior talofibular, and the calcaneofibular ligaments.
255
What is the action of the serratus posterior superior and inferior?
They control respiratory and proprioceptive movements.
256
What is the action of the erector spinae group?
They extend the vertebral column, give some rotation tot he vertebral column, and act on the vertebral column to control movements and maintain posture.
257
What anterior thigh muscle has dual innervation?
The pectineus - femoral nerve and also obturator nerve.
258
What is the action of the rhomboid major + minor?
Retract and inferiorly rotate the scapula. Fix scapulae to thoracic wall.
259
What are the bursae of the knee?
Fluid filled sacs that act as cushions. Suprapatellar (between femur and quadriceps frmoris tendon) Subcutaneous prepatellar (between skin and anterior patella) Subcutaneous infrapatellar (between skin and tibial tuberosity) Deep infrapatellar (between patellar ligament and tibia)
260
What is inside the femoral triangle?
The femoral nerve, artery, vein, an empty space, and the lacunar ligament. NAVEL
261
What is the action of the trapezius?
Descending head - elevation of the scapula. Ascending head - depression of the scapula. D+A=superior rotation of the scapula. Middle head - retraction of scapula.
262
What is the normal reaction to the patellar reflex? What does it test?
The patellar nerve - should extend knee.
263
Where is the most frequent site of fracture in the fibula?
Proximal to the lateral malleolus.
264
What is the main flexor of the thigh at the hip joint?
Iliopsoas.
265
What is the innervation of the serratus anterior?
The long thoracic nerve (C5-7).
266
What and where is the cauda equina?
The bottom of the spinal cord where nerves begin to taper out and travel to the intervertebral canal exit. It is surrounded by a dural sac.
267
What is the action of the plantar interossei?
Adduct 3-5 digits and flex metatarsophalangeal joints.
268
What travels inside the popliteal fossa?
From superficial -\> deep Tibial nerve, popliteal vein, politeal artery
269
What are the nerve roots of the common fibular nerve? How does it travel?
L4-S2. It moves posteriorly to anteriorly by winding around the head and neck of the fibula - it is very superficial.
270
What is the insertion of the serratus anterior?
The anterior surface of the medial border of the scapula.
271
What innervates the anterior arm muscles?
The median nerve except for flexor carpi ulnarus and the 4-5 digits of flexor digitorum profundus, which are innervated by the ulnar nerve.
272
What is the innervation of the subscapularis?
The upper and lower subscapular nerve (C5-6).
273
What are colles and smith fractures?
Colles is a fracture where you fall on the palm - radius displaces dorsally. "Dinner fork deformity". Can come with median and ulnar nerve injury, carpal fracture, radioulnar joinr dislocation. Smith is a reverse Colles fracture - radius displaces ventrally. Can come with acute carpal tunner, ischemia, compressive neuropathy.
274
What is the most common sense of breast cancer metastasis?
The axillary lymph nodes.
275
Describe upper trunk (brachial plexus) injuries.
Caused by excessive angle increase between the neck and shoulder. Muscle paralysis depends on the location of injury. Loss of sensation on the lateral arm/forearm.
276
What are the ligaments of the knee?
Patellar (continuation of quadriceps femoris tendon to the tibial tuberosity). Tibial and Fibular collateral. Anterior and posterior cruciate.
277
How many dermatomes are there?
30. 7 cervical (C1 doesn't have one, it's just motor), 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal.
278
What is the action of pec major?
The clavicular head flexes the humerus, the sternocostal head extends it from the flexed position. Both heads adduct and medially rotate.
279
How do you recognize the atlas?
It has no body and a transverse ligament.
280
How can you identify a cervical vertebra?
It has transverse foramina.
281
What does the basilic vein run with?
The medial antebrachial cutaneous nerve.
282
What is the cutaneous innervation of the ulnar nerve?
The medial 1 1/2 fingers and the skin below them on the palm and back.
283
What is the acetabulum made of? At what age does it fuse?
The ilium, ischium, and pubis. Fuses at 25.
284
What is the innervation of teres major?
The lower subscapular nerve (C6).
285
What is the action of the lumbar interossei?
Abduct 2-4 digits and flex metatarsophalangeal joints.
286
What is the insertion of the superficial posterior leg muscles?
The calcaneus via calcaneal tendon.
287
Which posterior arm muscles originate at the lateral epicondyle?
Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Supinator
288
What can a distal humerus fracture result in?
Can be inter or supracondylar. Can result in damage to the medial nerve and brachial artery.
289
What is hallux valgus?
Bunions - lateral deviation of the big toe at the metatarsophalangeal joint. Caused by degenerative joint disease, wearing pointed shoes.
290
What travels between the heads of the gastrocnemius?
The small saphenous vein and the sural nerve.
291
What is genu valgum?
Knock-kneed
292
What is the action of the deltoid?
Abducts the arm \>15 degrees.
293
What is the action of teres minor?
Lateral rotation
294
Describe the costal facets of the thoracic vertebrae.
The superior and inferior ones articulate with the head of the rib, and the transverse ones (on the edge of the transverse processes) articulate with the costal tubercle.
295
Describe leg lymph drainage.
It follows the route of the great saphenous vein then goes to the superficial inguinal LNs, then the deep inguinal, external iliac, and lumbar/aortal.
296
What is the insertion od the deltoid?
The deltoid tuberosity of the humerus.
297
What are the secondary spinal curves?
The newborn spine is kyphotic. Lordosis forms in the cervical and lumbar vertebrae with the child starts holding her head up and standing respectively.
298
Where do the lateral quadrants of the breast drain their lymph to?
The axillary lymph nodes (they get 75% from these areas).
299
What is the insertion of the biceps brachii?
Radial tuberosity and forearm fascia via biccipital aponeurosis.
300
What exits through the greater sciatic foramen?
Piriformus, superior and inferior artery/vein/nerve, nerve to quadratus femoris, sciatic nerve, posterior and cutaneous nerve of thigh.
301
Describe the cords of the brachial plexus.
The posterior cord is all the posterior divisions of the trunks. The lateral cord is the anterior divisions of the superior and middle trunk. The medial cord is the anterior division of the inferior trunk.
302
What are the parenchyma?
At puberty, the lactiferous ducts form 15-20 lobules of mammary glands, which constitute the parenchyma.
303
What is the action of the lumbricals? What innervates them?
Flex the metacarpophalangeal joints, extend the interphalangeal joints of digits 2-5. 1+2 - the median nerve (medial and lateral branches) 3+4 - the deep branch of the ulnar nerve
304
What is the cutaneous innervation of the median nerve?
The lateral 3 1/2 fingers on the palmar side and their tips on the dorsal side.
305
What nerves pass superior and inferior to the inferior extensor retinaculum of the foot?
Superior - superficial fibular nerve. Inferior - deep fibular nerve.
306
Which is lateral between the flexor hallucis longus and the flexor digitorum longus? Besides plantarflexion, which action do they share?
The flexor hallucis longus. They both support the arch of the foot.
307
What joint does inversion and eversion happen at?
The subtalar joint. It has a talocalcaneal ligament.
308
The flow of what vessel can be damaged by a femoral neck fracture?
Medial circumflex femoral artery. Common complication is necrosis of the femoral head.
309
What is a disc herniation? Where does it most frequently happen?
The nucleus pulposus slipping out and compressing the spine. It happens mostly posterolaterally, the risk increases with age, and most commonly it is at L4/L5 and L5/S1.
310
What is the blood supply of rhomboid major and minor?
The dorsal scapular artery.
311
What is special about the sartorius?
It flexes at the knee unlike most anterior thigh muscles - it also produces the cross legged position.
312
What are the 1st layer of the muscles of the sole of the foot and where do they originate?
Abductor hallucis Flexor hallucis brevis Abductor digiti minimum Calcaneus
313
What arises from the brachiocephalic trunk?
The subclavian artery from which emergent he vertebral artery (moves superiorly), and the thyrocervical trunk.
314
What is special about the tibialis anterior?
It is the most superficial muscle of the anterior compartment, and it also does foot inversion.
315
What are the tarsals?
Talus, calcaneus, cuboid, navicular, lateral/medial/intermediate cuneiform.
316
Describe the venous drainage to the vertebal column.
The spinal veins form internal and external venous plexii. Both the external and internal plexii have anterior and posterior components, and the internal plexii is valveless (a potential path for metastasis). There are also basivertebral veins within the vertebral bodies. They all end up draining into the vertebral veins.
317
What exits through the lesser sciatic foramen?
The tendon of the obturator internus.
318
What is talipes equinovorus?
"clubfoot" - a congenital defect more common in boys, treated by braces/casts of surgery.
319
Name the ligaments of the vertebral column.
Anterior&posterior longitudinal ligaments - surround the vertebral bodies, A is broader than P, prevent hyperextenson/flexion. Ligamentum flavum - connects the laminae, is yellow and elastic and limits flexion. Nuchal ligament - thick and broad from the external occipital protuberance to the C7 spinous process. It lets the back muscles attach. Intertraverse, interspinous, and supraspinous ligaments. Supraspinous takes over for nuchal from C7 downwards.
320
What is the general action of the posterior leg muscles? What are their blood supply/innervation?
Plantarflexion. The posterior tibial, fibular, popliteal arteries/veins. The tibial nerve (L4-S3).
321
What are the intrinsic shoulder muscles? Also kind of serratus anterior.
The supraspinatus, infraspinatus, deltoid, teres major and minor, and the subscapularis.
322
Describe the blood flow to the scapular/upper arm region.
The subclavian artery branches into the dorsal scapular, axillary, and thyrocervical trunk (transverse cervical and suprascapular artery). The axillary continues down and branches into the subscapular and circumflex arteries, and the subscapular branches into the thoracodorsal. The thoracodorsal, circumflex, and subscapular all connect to the dorsal scapular from the other direction. Also there are posterior intercostal arteries coming into the dorsal scapular.
323
What are the hypothenar muscles and what innervates them?
Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi brevis The deep branch of the ulnar nerve.
324
What are flexion and extension?
They decrease the angle and increase the angle between bodily parts respectively.
325
What is the action of the biceps brachii?
Supinates, flexes supine forearm, helps hold humeral head in glenoid fossa.
326
What muscles does the suboccipital nerve (C1) innervate?
rectus capitis posterior major/minor and obliquus capitis superior/inferior.
327
What is the action of the latissimus dorsi?
Extends, adducts, medially rotates the humerus. Lifts the body when climbing.
328
What does the pubofemoral ligament do?
Prevents hyperabduction.
329
Describe the route of the musculocutaneous nerve.
It pierces the coracobrachialis, travels distally between the biceps and brachialis, then emerges lateral to the biceps as the lateral cutaneous nerve of the forearm.
330
Where does the subclavian artery turn into the axillary artery?
At the lateral border of the first rib.
331
What happens if you damage the median nerve at the wrist?
Thenar damage, loss of thumb opposition, weakened abduction and flexion, "Ape hand".
332
What provides sensory innervation to the back?
The cutaneous branches of the posterior rami.
333
What is the action of the infraspinatus?
Lateral rotation of the arm and to stabilize the glenohumeral joint.
334
What is the arrangement of the posterior thigh muscles?
Medial to lateral: semimembranosus, semitendinosus, biceps femoris.
335
What provides cutaneous innervation to the medial leg and bit of the foot?
The saphenous nerve (a branch of the femoral nerve).
336
What is the general action of the anterior thigh?
Extension at the knee, flexion at the thigh.
337
What is the general action of the medial thigh?
Adduction at the hip.
338
What is the action of the brachialis?
Flexes the forearm in all positions.
339
What does the intermediate layer of the extrinsic back muscles do?
It controls only the axial skeleton. It helps with respiratory and proprioceptive movements (and the serratus posterior muscles)?
340
Describe the knee/tibiofemoral joint.
A biaxial modified hinge joint. It has articulations at the lateral and medial condyles of the tibia with the femur, and at the patella with the femur.
341
How does lymph drainage of the palm go?
Palm to dorsal.
342
What is the action of pec minor?
It stabilizes the scapula against the thoracic wall.
343
What is a back strain?
Stretching and/or microscopic tearing of muscle fibers caused by overly strong contraction. Often the erector spinae are involved and spasms may be in response to inflammation. This is a common sports injury.
344
What are the symptoms of breast cancer that has invaded glandular tissue?
Large dimples caused by shortening / traction of the suspensory ligament.
345
What does the lateral thoracic artery run with?
The long thoracic nerve.
346
What is the path of the vertebral artery? What happens when blood flow is restricted (e.g. atherosclerosis).
It is a branch of the subclavian artery, it travels through the C6-C1 transverse foramina, goes medially along the C1 posterior branch and then passes superiorly through the foramen magnum to the brain. In the event of reduced blood flow, prolonged turning of the head can reduce blood flow to the brain.
347
Where is the tarsal tunnel? What is inside it?
Posterior to the medial malleolus between calcaneus and flexor retinaculum. Tibialis posterior tendon Flexor digitorum longus tendom Posterior tibial artery + vein Posterior tibial nerve Flexor hallucis longus tendon
348
What can a surgical neck fracture result in?
Injury to the quadrangular space (the axillary nerve and posterior humeral artery). Damage to the axillary nerve results in loss of innervation to the deltoid, sensory loss of skin over the deltoid. You can feel a palpable depression under the acromion.
349
What is coccydynia?
Coccyx pain from injury, childbirth, straining.
