Gross Anatomy Week 1 Flashcards
Which of the following nerves is deep to the transverse carpal ligament?
A. Radial
B. Musculocutaneous
C. Interosseous
D. Median
D. Median
List the bones of the wrist
Carpals (8 Bones)
Proximal
some lovers try positions
Distal
that they can’t handle
Proximal
Scaphoid - Lunate - Triquetrium - Pisisform
Distal
Trapezium - Trapezoid - Capitate - Hamate
Which bone receives the blood supply from distal to proximal?
A. Hamate
B. Lunate
C. Scaphoid
D. Trapezium
C. Scaphoid
Triceps deep tendon reflex (DTR) is diminished. Which of the following myotomes will be affected
A. Elbow flexion
B. Shoulder abduction
C. Wrist extension
D. Finger adduction
C. Wrist extension
C7 Myotome
Which of the following rotator cuff muscels externally rotates the shoulder joint?
A. Supraspinatus
B. Infraspinatus
C. Teres Minor
D. Subscapularis
B. Infraspinatus
What space does a lumbar puncture obtain CSF from?
A. Choroid plexus
B. Epidural
C. Subdural
D. Subarachnoid
D. Subarachnoid
Which of the following signs or symptoms would present from a deep scalp laceration?
A. Neck Abcess
B. Cellulits aof the forehead
C. Exopthalamus
D. Periorbital swelling
D. Periorbital swelling
What space do you inject drugs into the CSF at?
A. Choroid plexus
B. Epidural
C. Subdural
D. Subarachnoid
B. Epidural
Occular muscles for eye look in medially or inward?
Medial rectus
eyes look inward
look left with right eye or right with left eye
Crosseyed
Cranial nerve 3
Occular muscles for laterally or outwards
Lateral rectus
Eyes look outward or laterally
look left with left eye, look right with right eye
Cranial nerve 6
Occular muscles for looking down and in (down nose) (down and medially)
Superior Oblique
Obliques are opposite
Look down and in (medially)
look down and left with right eye or down and right with left eye
Crosseyed
Cranial nerve 4
Occular muscles for up and inwards (up & medially)
Inferior oblique
Obliques are opposite
Look up and in (medially)
look up and left with right eye or up and right with left eye
Crosseyed
Cranial nerve 3
Occular muscles for looking down and outwards (laterally)
Inferior rectus
Look down and outwards (laterally)
look down and left with left eye, look down and right with right eye
Cranial nerve 3
Occular muscles for looking up and outwards (laterally)
Superior rectus
Look up and outwards (laterally)
look up and left with left eye, look up and right with right eye
Cranial nerve 3
Cranial nerves for eye movements with muscles
3, 4, 6
Occularmotor
Trochlear
Abducens
SO4, LR6, Rest are 3
Obliques are opposite directions
What can pathology in the cavernous sinus effect
CN III, IV, V1, V2, V3
Extra ocular motion
Vision
Pupilary response
Cranial Nerve I
Number = 1
Name = Olfactory Nerve
Motor / Sensory = Sensory
Origin / Termination = Epithelium / Bulbs
Cranial exit = Foramina of cribriform plate of ethmoid bone
Brainstem location = Cortex / Midbrain / Olfactory Bulbs
Function = Transmits olfaction (smell) to the brain
(special sensory)
Cranial Nerve II
Number = 2
Name = Optic
Motor / Sensory = Sensory
Origin / Termination = Retina (ganglion cells) Cranial exit = Optic Canal Brainstem location = Retina / Midbrain Function = Vision from Retina (special sensory)
Cranial Nerve III
Number = 3
Name = Occulomotor
Motor / Sensory = Motor
Origin / Termination = Nucleus of CN III (edinger westphal)
Cranial exit = Superior Orbital Fissure
Brainstem location = Midbrain
Function = Pupil Constriction, Accomodation, Eye movement
Cranial Nerve IV
Number = 4
Name = Trochlear
Motor / Sensory = Motor
Origin / Termination = Nucleus of CN IV
Cranial exit = Superior Orbital Fissure
Brainstem location = Midbrain
Function = Inferior Oblique (looks down and in
Cranial Nerve V (V1)
Number = 5
Opthalmic Division
Name = Trigeminal
Motor / Sensory = Both (sensory)
Origin / Termination = Trigeminal ganglion / spinal principle and mesecephalic nucleus of CN V
Cranial exit = Superior Orbital Fissure
Brainstem location = Pons
Function = Sensation from cornea, skin of forehead, nasal cavity and more
Cranial Nerve VI
Number = 6
Name = Abducens
Motor / Sensory = Motor
Origin / Termination = Nucleus of CN VI
Cranial exit = Superior Orbital Fissure
Brainstem location = Pons/Medulla
Function = Lateral gaze, Lateral rectus motor
Cranial Nerve VII
Number = 7
Name = Facial
Motor / Sensory = Both
Origin / Termination = Nucleus of CN VII
Cranial exit = Stylomasoid foramen
Brainstem location = Pons/Medulla
Function = facial expression
Cranial Nerve VIII
Number = 8
Name = Vestibular-Cochlear
Motor / Sensory = Sensory
Origin / Termination = Vestibular nuclei / Cochlear nuclei
Cranial exit = Internal acoustic meatus
Brainstem location = Pons/Medulla
Function = hearin, head position, balance
Cranial Nerve IX
Number = 9
Name = Glossalpharyngeal
Motor / Sensory = Both
Origin / Termination = Nuclei of soilatry/ambiguus/trigeminal
Cranial exit = Jugular Foramen
Brainstem location = Medulla
Function =Swallow, saliva, taste
Cranial Nerve X
Number = 10
Name = Vagus
Motor / Sensory = Both
Origin / Termination = Nuclei of soilatry/ambiguus/trigeminal
Cranial exit = Jugular Foramen
Brainstem location = Medulla
Function = Taste, cardiac, Digestion,
Cranial Nerve XI
Number = 11
Name = Spinal Accessory
Motor / Sensory = Motor
Origin / Termination = accessory nucleus of spinal cord
Cranial exit = Jugular foramen
Brainstem location = Medulla / spinal cord
Function = Motor muscles sternocleidomastoid, trapezius
Cranial Nerve XII
Number = 12
Name = Hypoglossal
Motor / Sensory = Motor
Origin / Termination = Nucleus of CN XII
Cranial exit = Hypoglossal canal
Brainstem location = Medulla
Function = Motor muscles of tongue
Cranial Nerve V (V2)
Number = 5 V2
Maxillary Division
Name = Trigeminal
Motor / Sensory = Both (sensory)
Origin / Termination = Trigeminal ganglion / spinal principle and mesecephalic nucleus of CN V
Cranial exit = Foramen Rotundum
Brainstem location = Pons
Function = Sensation of upper lip, mucosa of nose, maxillary sinuses, palate
Cranial Nerve V (V3)
Number = 5
Mandibular division
Name = Trigeminal
Motor / Sensory = Both
Origin / Termination = Trigeminal ganglion / spinal principle and mesecephalic nucleus of CN V and Motor nucleus of CN V
Cranial exit = Foramen Ovale
Brainstem location = Pons
Function = Muscles of mastication, sensation over mandibleTMJ, side of head etc.
Promary headache types
Migraine
Tension
Trigeminal autonomic cephalalgias (cluster)
Horner syndrome
Horner syndrome = Nerve interruption, can result from stroke, small pupil, drooping Eyelid
Trigeminal neuralgia
Trigeminal neuralgia = chronic, over 50 in women, pain in face
Upper Motor Neuron vs Lower Motor Neuron
eyebrows
Raise eye brows
If both raise, it is upper motor neuron problem
(Stroke) Involves brain
If only one raises, it is a lower motor neuron problem
(bells palsy) involves brain
Bells palsey (UMN vs LMN)
Lower motor neuron problem
ipsilateral problem
Problem is on the same side
This involves the Nerve, not the brain
Stroke (UMN vs LMN)
Upper motor neuron problem
Crosses hemispheres
Oppostie side problem
This involves the brain, not the nerve
Location of LMN problem
Lower Motor Neuron
Anterior horn to The affected organ system (end plate) This is ipsilateral side Lose motor on ipsilateral side Affects the entire side of face Only one eye brow moves
Location of UMN problem
Upper Motor Neuron
Affects the lower face
Contralateral side
Both eyebrows move
What cranial nerve inervates the parotid gland
CN IX
glossalpharyngeal
salvary juices
swallowing
What cranial nerve can get cut in thyroid disease and cause permanent hoarseness
Vagus Nerve
CN X
What cranial nerve gives taste and sensation in back of throat
Vagus
CN X
What cranial nerve gives taste in the back 3rd (posterior 3rd) of tongue
Glossalpharyngeal
CN IX
What cranial nerve gives taste for front 2/3s (anterior 2/3s) of tongue
Facial
CN VII
Tongue Cranial nerves Posterior 1/3
Posterior 1/3 =
Taste and sensation = Glossalpharyngeal CN IX
Motor = Hypoglossal CN XII
Tongue Cranial nerves Anterior 2/3
Anterior 2/3 =
Taste = Facial CN VII
Sensation = Trigeminal 3 CN V3
Motor = Hypoglossal CN XII
What cranial nerve is motor in the back 3rd (posterior 3rd) of tongue
Motor = Hypoglossal CN XII
What cranial nerve gives sensation in the back 3rd (posterior 3rd) of tongue
sensation = Glossalpharyngeal CN IX
What cranial nerve is motor for front 2/3s (anterior 2/3s) of tongue
Motor = Hypoglossal CN XII
What cranial nerve gives sensation for front 2/3s (anterior 2/3s) of tongue
Sensation = Trigeminal 3
CN V3
Saying Ah tests which Cranial Nerve
A. Vagus
B. Hypoglossal
C. Trigeminal V3
D. Facial
A. Vagus
The OD has a loss of all visual fields. Where is the defect?
A. Optic tract
B. Lateral geniculate nucleus
C. Optic nerve
D. Optic radiations
C. Optic Nerve
Patient has a Cranial nerve VI lesion. Which of the following is affected?
A. Visual acuity
B. Facial sensation
C. Hearing
D. Convergence
D. Convergence
Where is the lesion for teh Old man with the stroke symptoms (both eyebrows raise, lip droop.
A. Middle cerebral artery
B. Facial nerve
C. Trigeminal Nerve
D. Internal carotid artery
A. Middle cerebral artery
The effernet pupilary response is controlle by which nerve?
A. CN II
B. CN III
C. CN V1
D. CN IV
B. CN III
Efferent
Motor Nerves
Outgoing
Afferent
Sensory Nerves
In coming
What are the cranial nerves responsible for pupil constriciotn and dialation
Incoming (afferent) light = CN II Optic nerve
Sensory
Pupil constriction (efferent) = CN III oculomotor Motor
Pupil Dialation (efferent) = CN V1 Trigeminal 1 Motor
Lower Motor Neuron Attributes
Loss of muscle tone Same sided weakness Flaccidity atrophy tendon reflexes impaired or gone fasciculations
From anterior horn to the effector plate
Upper Motor Neuron Attributes
Chorea
Dystonia
Athetosis
increased muscle tone, reflexes
rigidity
spacticity
Babinsky
Brain cross over (opposite side)
Bulbocavernosa reflex
Squeeze clitoris or penis and anus contracts
DTR Deep tendon reflexes
Biceps C5/C6
Brachioradialis C6
Triceps C7
Distal Finger Flexors C8
Patellar L4
Ankle Jerk S1
Jaw Jerk CN V
Basillar skul fracture symptoms
Raccoon eyes (periorbital eccymosis)
Battle signs (Postauricular eccymosis)
Hemotympanum
CSF otorrhea
Pterion
The pterion is the region where the frontal, parietal, temporal, and sphenoid bones join together. It is located on the side of the skull, just behind the temple.
Scalp infection can result in what
Periorbital swelling
What do we worry about in a Pterion fracture
Middle meningeal artery tearing
Which can lead to epidural hematoma
Layers of meninges from deep to superficial
Pia Subarachnoid space Arachnoid space Subdural space Dura
Where does CSF go into the venus system
Archnoid granulations
Three ways to have hydrocephalus
Back up of CSF (communicating or non communicating)
Choroid plexus over production
Arachnoid granulation isn’t reabsorbing CSF and putting it into the venus space
What feeds almost the entire dura
Middle meningeal artery
What is faux cerebri
Dura that seperates the brain into left and right hemispheres
What is the tentorium cerebelli (tentorium)
Seperates the cerebellum from the crebrum
superior sagital sinus
runs down the top center of skull
a venous sinus of dura mater
Main reabsorption site of CSF
What is the danger area of the scalp for infection and laceration
Loose areola tissue
Infection in this layer can pass into the cranial cavity through emissary veins, which pass through parietal foramina in the calvaria and reach intracranial structures such as the meninges.
Epidural hematoma cause
Test question
Tear of middle meningeal artery
CT w/o contrast
Blood is white
Acute process (Rapid, abrupt bleeding) Lens like shape (Swelling out of scalp)
Is there midline shift?
Subarachnoid hemorrhage cause
Active bleeding from within that Is white on CT
(diffuse white blood on the CT)
see blood in all different spaces
Caused by aneurysm that gives out
Ventricles are black
Blood is white
Acute onset
Subdural hematoma Cause
Bridging veins torn
Ventricles are black
(white is new blood)
Balloon shape
layering
bleeding under balloon
Venous bleed, slower
CSF Purpose
Protection, waste removal, nutrient transport
Differnece in communicating and non communicating (CSF)
In communicating, there is no blockage. Every thing is open and flowing.
All ventricles will be dialated
In non communicating, there is a blockage somwhere. one or more ventricels are dialated while others are not.
What is Normal pressure hydrocephalus a cause of
Normal pressure hydrocephalus is reversible cause of dementia
Which sinues can you palpate
Frontal sinuses (can palpate)
Ethmoid sinuses (cannot palpate)
Sphenoid sinuses (cannot palpate) behind ethmoid
Maxillary sinuses (can palpate)
What sinus is behind the sphenoid sinus
cavernous sinus
Best way to image sinuses
Sinus CT Scan
cavitating
the layer of the sinus now has fluid behind it and is expanding and is pressuring the eyeball
Nerves in and around cavernous sinus
CN III oculomotor CN IV trochlear CN VI abducens CN V1 Trigeminal opthalmic CN V2 Trigeminal maxillary
internal carotid
surounds the pituitary
How far does nuchal ligament go
c1 - c7
What is most posterior ligament in cervical spine
Nuchal
List ligaments in cervical spine from anterior to posterior
Anterior longitudinal Posterior longitudinal ligamentum flavum interspinal ligament Nuchal ligament
What makes the popo on a lumbar puncture
Punching through the ligamentum flavum
Where does the nerve exit on each cervical vertebrae
Nerve exits above each vertebrae
C1 nerve root is above C1
reason we have C8 nerve but no C8 vertebrae
Where does the nerve exit on each vertebrae other than cervical
Below the vertebrae
T1 nerve root exits below T1, between T1 and T2
What view on x ray allows us to see the nerve exit
Oblique view
Where does the spinal cord usually terminate
L1 or L2
Cauda equina
MRI T1 vs T2
T1 fluid is not white
T2 fluid is white
What attaches the upper limb to the axial skeleton
Sternoclavicular joint
Shoulder Joint
Glenohumeral joint
glenoid is shallow socket
Because of its freedom of movement and instability, the glenohumeral joint is commonly dislocated by direct or indirect injury.
Most common downward (inferior) direction
Rotator cuff muscles
SITS
Suprapinatous (abductor) Infraspinatus (external rotators) Teres minor (external rotators) (Superior to major) Subscapularis (internal rotation)
Rotator Cuff Muscles
Subscapularis
Large flat muscle on anterior (inside) of scapula
internal rotation
Rotator Cuff Muscles
Infraspinatus
Large muscle on posterior of flat portion of scapula, sits below spine of scapula, above teres minor
(external rotators)
Rotator Cuff Muscles
Teres minor
sits on the bottom margin posterior of scapula under inferior to the infraspinatus
(external rotators) (Superior to major)
Rotator Cuff Muscles
Suprapinatous
Sits above the spine of the scapula at the top of the scapula on the posterior side
(abductor)
Injectionsite in shoulder
Subacromial bursa
groove of superior humerous
long head of biceps runs through groove of humerous and attaches to the superior portion of the glenoid
Short head of bicep attaches to
Short head of bicep attaches to the coracoid process
Long head of bicep attaches to
Long head of bicep attaches to transverse humeral ligament
What does volar mean
Dorsal
Typically used for forearm
What does the radial nerve innervate
All muscles of the posterior compartment of arm and forearm
What does the ulnar nerve innervate
flexor carpi ulnaris and ulnar half of the flexor digitorum profundus in the forearm
the hypothenar and interosseous muscles of the hand
the lumbricals to digits 3 and 4
and 1½ thenar muscles (adductor pollicis and the deep head of the flexor pollicis brevis).
What does the median nerve innervate
muscles of the anterior compartment of the forearm
(with 1½ exceptions that are innervated by the ulnar nerve)
the lumbricals to digits 2 and 3
and the intrinsic muscles of the thumb (thenar muscles).
What does the musculocutaneous nerve innervate
all the muscles of the anterior compartment of the arm.
Dermatome C5
Upper arm (lateral)
Dermatome C6
Trigger finger
thumb
lateral forearm
Dermatome C7
Middle finger
Dermatome C8
Pinkie finger
Ring finger
Dermatome T1
medial forearm
Dermatome T2
Medial upper arm
axilla
Phrenic Nerve
Diaphragm
C3,4,5 keeps the diaphragm alive
Brachial plexus nerves
C5 -T1
C5, C6, C7, C8, T1
Myotome Elbow flexion
C5/C6
Myotome Elbow extension
C6/C7
Myotome Wrist Flexion
C6/C7
Myotome Wrist extension
C6/C7
Myotome Finger Flexion
C7/C8
Myotome Finger extension
C7/C8
Myotome Shoulder Flexion
C5
Myotome Shoulder extension
C6/C7/C8
Myotome C5/C6
Elbow flexion
Myotome C7/C8
Finger flexion/extension
wrist pronation
Myotome C6/C7
Wrist extension/flexion
Elbow extension
Myotome wrist supination
C6
Myotome wrist pronation
C7/C8
Lines of demarcation of brachial plexus
First rib and teres major
Brachial Plexus C5
Musculocutaneous
Axillary
Radial
Brachial Plexus C6
Musculocutaneous
Axillary
Median
Radial
Brachial Plexus C7
Musculocutaneous
Median
Radial
Brachial Plexus C8
Median
Radial
Ulnar
Brachial Plexus T1
Median
Radial
Ulnar
Brachial Plexus Musculocutaneous Nerve
C5
C6
C7
Brachial Plexus Axillary Nerve
C5
C6
Brachial Plexus Median Nerve
C6
C7
C8
T1
Brachial Plexus Radial Nerve
C5 C6 C7 C8 T1
ALL
Brachial Plexus Ulnar Nerve
C8
T1
What runs between the scalene muscles
Brachial plexus nerves
Where does the subclavian artery become the axillary artery
At the outer border of the first rib
Where does the axillary artery become the brachial artery
as it crosses teres major
What are the 3 forearm compartments
Volar
Mobile
Dorsal
Contents of Volar Compartment
ulnar nerve
median nerve
superficial branch of the radial nerve
anterior interosseous nerve
ulnar artery
radial artery
anterior interosseous artery
Muscles = flexor of hands and wrist, including policis longus flexor digitorum superficialis flexor carpi radialis flexor pollicis longus flexor digitorum profundus flexor carpi ulnaris
Contents of the Mobile Compartment
AKA mobile WAD
Muscles=
extensor carpi radialis brevis
longus muscles
brachioradialis
Contents of the Dorsal Compartment
Posterior interosseous artery (PIA),
posterior interosseous nerve
Muscles= finger extensors and the long thumb abductor abductor pollicis longus extensor digiti minimi extensor carpi ulnaris extensor pollicis longus extensor digitorum communis
Volkmanns Contracture
Failure to recognize compartment syndrome
Volar
Compartment syndrome
supracondylar fx, radial fx, crush injury
What is TFCC
Pad between the ulna and triquetrum
What articulates with 1st metacarpal (thumb)
Trapezium
What tendon does only 50% of population have
Palmaris longus
What is radial artery lateral to
Flexor Carpi radialis tendon
What is cut in carpal tunnel surgery
Transverse carpal ligament
Hand compartments
Thenar = thumb side Hypothenar = pinkie side Central = middle palmar side
Where does the musculocutaneous nerve terminate
about the elbow
