misc C+M Flashcards

1
Q

A patient is concerned with their hearing and sometimes fails to recognise familiar tastes. He is also unstable when he gets out of bed. If cranial nerves are responsible for these symptoms, where is the most likely location?

A

Lateral pontomedullary junction

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2
Q

how would you describe flexion and extension of the shoulder

A

same direction as flexion and extension of the hip!

flexion = swinging arm forward (eg while walking)

extension = swinging arm back

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3
Q

latissimus dorsi muscle:

  • origin
  • insertion
  • actions 3
  • innervation
A

origin:
- broad: spinous processes of T6 to T12, illiac crest, thoracolumnar fascia + inferior 3 ribs

insertion:
- intertubercular sulcus of the humerus

actions:

  • extends shoulder
  • adducts shoulder
  • medially rotates shoulder

innervation:
- thoracodorsal nerve

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4
Q

trapezius:

  • origin?
  • insertion?
  • action of upper fibres? 2
  • action of middle fibres? 1
  • action of lower fibres? 1
  • innervation?
A

origin:

  • skull
  • nuchal ligament
  • spinous processes of C7 - T12

insertion:

  • clavicle
  • acromion
  • spine of scapula

upper fibres:

  • elevate scapula
  • rotate scapula (during abduction of arm))

middle fibres:
- retract scapula

lower fibres:
- pull scapula inferiorly (depress)

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5
Q

what are the possible movements of the scapula?

A
  • elevation
  • depression
  • protraction (hunch shoulders forward)
  • retraction (pull shoulders back, shoulder blades closer together)
  • upwards rotation (seen when arm is aBducted)
  • downwards rotation (seen when arm is aDucted)
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6
Q

levator scapulae:

  • origin?
  • insertion?
  • action?
  • innervation?
A

origin:
- TRANSVERSE processes of the C1-C4 vertebrae

insertion:
- medial border of scapula

action:
- elevates scapula (clue’s in the name)

innervation:
- dorsal scapula nerve

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7
Q

rhomboid major + minor:

  • origins?
  • insertions?
  • actions? 2
  • innervation?
A

rhomboid major:

  • origin = spinous processes of T2-T5
  • insertion = medial border of scapula, between scapula spine + inferior angle

rhomboid minor:

  • origin = spinous processes of C7-T1
  • insertion = medial border of scapula, at level of scapula spine

nb rhomboid minor sits superior to rhomboid major

actions:

  • retracts scapula
  • rotates scapula

innervation:
- dorsal scapula nerve

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8
Q

what are the three groups of muscles of the back?

what could each be said to mainly control?

A

superficial
- associated with movements of the shoulder

intermediate
- associated with movements of thoracic cage

deep
- associated with movements of the vertebral column

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9
Q

list the superficial back muscles? 5

A
  • trapezius
  • levator scapulae
  • rhomboid minor
  • rhomboid major
  • lat dorsi

nb all innervqated by dorsal scapula nerve (except trapezius is innervated by accessory nerve CN11)

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10
Q

what structure is cut through in a laryngotomy?

A

cricothyroid cartilage

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11
Q

what is the difference between ulnar claw and hand of benediction?

incl nerve damaged and muscles paralysed

A

lnar claw: paralysis of the medial 2 lumbricals means that, when your hand is RESTING, your pinky and ring finger are flexed at IP and extended at MCP

Hand of benediction: paralysis of all extrinsic flexors in forearm EXCEPT flexor carpi ulnaris and medial half of flexor digitorum profundus! Therefore, when the person tries to make a fist they can flex the MCP + IP joints of the pinky and ring but CANT flex the index and middle finger!

So basically you get the same ‘claw’ in both pathologies but you see it at rest in ulnar claw and when asked to make a fist in hand of benediction!

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12
Q

what movement is the scapula unable to perform if the long thoracic nerve is damaged?

what may cause this damage?

A

unable to PROtract the scapula

-> winging of the scapula

eg axillary lymph node clearance for breast carcinoma

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13
Q

what branch of the median nerve passes through the carpal tunnel + supplies the thenar eminence?

A

recurrent branch of the median nerve

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14
Q

what is the innervation of the lumbricals?

A

median 2 lumbricals = ulnar nerve

lateral 2 lumbricals
= median nerve

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15
Q

what is the arterial blood supply to the:

  • internal capsule + basal ganglia?
  • thalamus?
A

internal capsule + basal ganglia:
- striate arteries (branch off the medial cerebral artery)

thalamus:
- branches of the posterior cerebral artery

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16
Q

what two muscles are likely to be injured due to a laceration of the webspace between the 1st + 2nd digits?

A
  • the first dorsal interosseous

- adductor pollicis

17
Q

substantia gelatinosa:

  • function?
  • located in which rexed laminae of the spinal cord grey matter?
A

an area in the dorsal horn of the spinal cord where afferent pain fibres synapse
- it is important in the gate-control mechanism of pain sensation

rexed laminae number II

“the pain is not TWO bad”

18
Q

on an ultrasound of the leg, do muscles appear lighter or darker when they are tensed?

A

darker (as get more dense!)

dense stuff appears darker on ultrasound (opposite to x-ray) as echowaves can’t pass through it

19
Q

where do the lateral and medial circumflex arteries of the hip normally arise from?

A

the profunda femoris artery

only rarely from the femoral

20
Q

which artery supplies an acetabular branch to the head of the femur?

A

obturator artery

21
Q

what causes night blindness?

A

absense/loss of rod cells

can be congenital or acquired through infection etc

22
Q

What are the boundaries of the deltopectoral (clavipectoral) triangle?

What structure lies in this triangle?

A
Mediosuperior = clavicle
Superolateral = deltoid
Inferomedial = pec major

Cephalic vein

23
Q

What are the actions of pec major?

A

Together:
- adducts + medially rotates humerus

Just clavicular head:
- flexes humerus

Just sternocostal head: extends humerus

24
Q

What is the action of pec minor?

A

Stabilises scapula by drawing anteroinferiorly against thoracic wall

25
What is the insertion of serratus anterior?
Costal (rib facing) surface of medial border of scapula
26
What form the borders of the axilla?
Anterior: pec major + minor Posterior: scapularis, teres major, lat dorsi Lateral: intertubercular sulcus of humerus Medial: serratus anterior + thoracic wall
27
What are the 5 sections of the brachial plexus?
- roots - trunks - divisions - cords - terminal branches
28
Which cords of the brachial plexus contribute to the: - musculocutaneous nerve? - axillary nerve? - radial nerve? - median nerve? - ulnar nerve?
Musculocutaneous: - lateral cord Axillary: - posterior cord Radial: - posterior cord Median: - lateral AND medial cord Ulnar: medial cord Nb the cords are named for their position around the axillary artery
29
Biceps brachii: - proximal attachments? - insertion? - actions? 3
Proximal attachments - short head: coracoid process of scapula - long lead: supraglenoid tubercle of scapula Insertion - radial tuberosity (on radius) + fascia of forearm ``` Actions - supination of forearm - flex arm at shoulder - flex arm at elbow Nb especially during supination ```
30
brachialis: - origin? - insertion? - action?
origin: - medial + lateral surfaces of humeral shaft insertion: - ulna tuberosity (on ulna) action: - flexion of elbow (esp during pronation) nb biceps brachii flexes elbow during supination, brachialis during pronation
31
coracobrachialis: - origin? - insertion? - action?
origin: - coracoid process of the scapula insertion: - medial surface of humeral shaft (at level of deltoid tubercle) action: - flexion of arm at shoulder (+ weak adduction)
32
what is quadrilateral space syndrome?
compression of the axillary nerve in the quadrilateral space -> paralysis + atrophy of deltoid
33
what causes a 'painful arc'?
sub acromial bursitis basically the tendons compress the inflammed bursa -> pain during this 'arc' between 60-120 deg rotation of shoulder
34
what is frozen shoulder? aka?
adhesive capsulitis pain + stiffness in shoulder due to swollen + thickened capsule
35
teres major: - origin? - insertion? - actions? 2 - innervation?
origin: - post surface of the inferior angle of the scapula insertion: - intertubercular groove of the humerus actions: - adducts shoulder - medially rotates arm innervation: - lower subscapular nerve
36
what are the 4 rotator cuff muscles | - which nerve is each innervated by?
supraspinatus - suprascapular nerve infraspinatus - suprascapular nerve subscapularis - upper + lower subscapular nerve teres minor - axillary nerve nb sub scapularis is on costal (anteroinferior) side of scapula, the others are on the posterosuperior side
37
where do the rotator cuff muscle insert? what is the action of each of them, individually?
supraspinatus, infraspinatus + teres minor all insert at GREATER tuberosity and are LATERAL rotators subscapularis inserts aat LESSER tuberosity and is a MEDIAL rotator supraspinatus ALSO initiates ABDUCTION of the arm and does first 0-15 degs (then deltoid takes over!)
38
what is the name of the canal in the wrist through which the ulnar nerve travels?
Guyon's canal
39
which epicondyle is affected in: - golfers elbow? - tennis elbow?
golfers = medial tennis = lateral "in golf you hold club close to body whereas tennis racket is held away from your body"