Random Review Questions Flashcards
A person develops a primary tumor of the thyroid gland and, among other symptoms, drooping of the eyelid and constriction of the pupil on the right side of the eye are noted. What nerve fibers have been interrupted by the tumor?
postganglionic parasympathetic postganglionic sympathetic preganglionic parasympathetic the carotid nerve the cervical sympathetic trunk
Cervical Sympathetic
A surgeon doing a deep cervical lymph node dissection may encounter these structures upon the anterior surface of the anterior scalene muscle EXCEPT: Phrenic nerve Subclavian vein Middle trunk of the brachial plexus Transverse cervical artery Cervical part of the thoracic duct
Middle trunk of the brachial plexus
The middle cervical sympathetic ganglion, recurrent laryngeal nerve, and parathyroid glands are all closely related with which blood vessel? Inferior thyroid artery Inferior thyroid vein Superior thyroid artery Superior thyroid vein
Inferior Thyroid Artery
Which of the following nerves is derived from the dorsal primary rami of spinal nerves? great auricular greater occipital lesser occipital phrenic supraclavicular
GREATER OCCIPITAl = Dorsal Ramus of C2
Which muscle on the back of the neck travels obliquely at the back of the neck? Which lies under it?
Splenius Capitis (oblique) Semispinalis Capitis
Which nerve provides cutaneous innervation to the skin of the angle of the mandible? Auriculotemporal nerve Lesser petrosal nerve Buccal branches of VII Marginal mandibular nerve Great auricular nerve
Great Auricular Nerve
A deep laceration of the face in the middle of the parotid gland could affect the: External jugular vein Facial nerve Glossopharyngeal nerve Hypoglossal nerve Lingual artery
Facial Nerve
What structure lies deepest in the parotid gland? External carotid artery External jugular vein Facial artery Facial nerve Retromandibular vein
External Carotid Artery
The parotid space contains all EXCEPT: External carotid artery Facial nerve Intraparotid lymph nodes Medial pterygoid muscle Retromandibular vein
Medial pterygoid
As a result of meningitis, a patient develops Bell's palsy. One of the symptoms was hyperacusis. What nerve was involved? Facial Glossopharyngeal Oculomotor Trigeminal Vagus
Facial
innervates the stapedius
Frey's Syndrome is marked by profuse sweating over one cheek, temple, and surrounding areas of the face, precipitated by eating. The condition may be idiopathic, but often follows parotid surgery. The condition is attributable to abberant reinnervation, the redirection of autonomic fibers normally going to salivary glands being redirected to sweat glands. What is the source of the nerve fibers involved? Facial Glossopharyngeal Oculomotor Trigeminal Vagus
TRIGEMINAL
The glossopharyngeal nerve contributes to the innervation of the parotid gland by supplying preganglionic parasympathetic fibers to the otic ganglia, by way of the lesser petrosal nerve. However, these fibers are not involved with Frey’s syndrome–this condition involves the misdirection of the postganglionic parasympathetic fibers. Finally, the vagus is not involved with innervating the parotid gland.
motorcyclist lost control of his bike after hitting a wet spot on the pavement. He hit a curb and was catapulted several feet, landing on the point of his right shoulder and the right side of his head and neck, severely stretching his neck. He was taken to the emergency room with abrasions, lacerations and multiple injuries to both fleshy and bony tissues. Given this scenario, answer the following:
For the integument to bleed or for tissue fluid to ooze from the abrasions, what layers must be damaged?
epidermis and dermis
epidermis and superficial fascia
epidermis and deep fascia
dermis and superficial fascia
dermis and deep fascia
Epidermis and Dermis
Sutures (stitches) would be placed in which tough layer of the skin in order to sew up the lacerations? epidermis deep fascia dermis subcutaneous tissue superficial fascia
DERMIS
What happens if the dorsal scapulary nerve is cut?
If the dorsal scapular nerve is damaged, the rhomboids will be denervated, and the patient will not be able to retract his scapula fully.
In order to make an intramuscular injection, the needle must pass through several layers of tissue to reach the muscle. Choose the correct order of tissues the needle would pass through from superficial to deep.
Epidermis, dermis, investing fascia, subcutaneous tissue, muscle
Epidermis, dermis, subcutaneous tissue, investing fascia, muscle
Epidermis, investing fascia, dermis, subcutaneous tissue, muscle
Epidermis, subcutaneous tissue, dermis, investing fascia, muscle
Epidermis, subcutaneous tissue, investing fascia, dermis, muscle
Epidermis, dermis, subcutaneous tissue, investing fascia, muscle
As you are sitting in a quiz, the skin immediately over the base of the spine of your scapula begins to itch. The sensation from this area is mediated through which nervous structure? Accessory nerve Dorsal primary ramus of C7 Dorsal root of T2 Ventral primary ramus C7 Ventral root of T2
Dorsal Primary Ramus of C7
What are the functions of pec minor and pec major?
Medial rotation and flexion
After a penetrating wound in the area of the posterior axillary fold a patient had weakness in extension and adduction of the arm. Which muscle is likely involved? Latissimus dorsi Pectoralis major Levator scapulae Rhomboideus major Trapezius
Latissimus Dorsi
The part of a spinal nerve that supplies the true back muscles and the skin overlying them is the: dorsal primary ramus dorsal root ventral primary ramus ventral root
Dorsal Primary Ramus
It is decided to image the spinal cord and spinal nerve rootlets by doing a myelogram (injection of a radio-opaque dye into the subarachnoid space followed by a radiograph). In order to inject the dye without injury to the spinal cord, the injection is usually done below what vertebral level? L 1 L 2 L 3 L 4 L 5
L4
It was noted that after the injury the patient’s face on the right side was flushed due to dilation of the blood vessels. The lack of vasoconstriction was due to interruption of what fibers somewhere along their course?
somatic afferent
somatic efferent
parasympathetic
Sympathetic
Dorsal Root explanation
The dorsal root ganglia is the location of the cell bodies of somatic sensory neurons. Cells from the dorsal root ganglia transmit somatic sensation from areas like the skin to the central nervous system. A neuron with a cell body in the dorsal root ganglia might be involved in conveying sensory information from the skin overlying the trapezius.
Motor neurons have their cell bodies in the ventral horn of the spinal cord. They leave the spinal nerve through the ventral root, join a spinal nerve, and then divide into the ventral and dorsal primary rami. The dorsal primary rami innervate the deep back muscles, while the ventral primary rami innervate other muscles, including pectoralis major (which is innervated via the brachial plexus).
The cell bodies of preganglionic sympathetic fibers are found in the lateral horn of the spinal cord. Finally, visceral afferent sensation is not carried on somatic sensory neurons–instead, the sensation from the stomach is carried on special visceral afferent nerves which accompany sympathetic nerves.
A neuron with a cell body in the dorsal root ganglia could convey what type of fibers?
motor to the deep back muscles
motor to the pectoralis major muscle
sensory from the skin overlying the trapezius
sympathetic preganglionics to the suprarenal medulla
visceral efferents to the stomach
Sensory from skin overlaying the back muscles
The denticulate ligament: is a modification of pia mater is found between all dorsal and ventral roots attaches to the dural sac continuously has its terminal attachment at S2 holds the radicular arteries in place
Is a modification of pia mater
A patient is suspected of having bacterial meningitis. As part of the diagnostic procedure, a lumbar puncture is to be performed. The attending physician asks you where she should insert the spinal needle to withdraw CSF. You answer, "just below the spine of the 4th lumbar vertebra." What reference point would you use to identify the spine? Crest of the ilium Ischial tuberosity Pubic symphysis Umbilicus Xiphoid process
Crest of the Ilium
The number of vertebrae and number of spinal cord segments are the same in each region except: Cervical Thoracic Lumbar Sacral
Cervical
Quasimoto, the "Hunchback of Notre Dame," suffered from an abnormal thoracic curvature called kyphosis. In this condition the accentuated convexity of the curvature is: Anterior Caudal Lateral Medial Posterior
Posterior
A patient is suspected of having bacterial meningitis. A lumbar puncture is performed to remove cerebrospinal fluid (CSF) for analysis. The fluid would be removed from the:
Epidural space at the level of L3
Intervertebral foramen at the level of L2
Spinal canal at level of L 3
Subdural space at the level of L4
Subarachnoid space at the level of L4
Subarachnoid Space at L4
In the lumbar spine, the L4 nerve root sleeve exits:
above the pedicle of L4 and at the top of the intervertebral foramen
above the pedicle of L4 and at the bottom of the intervertebral foramen
below the pedicle of L4 and at the top of the intervertebral foramen
below the pedicle of L4 and at the bottom of the intervertebral foramen
The correct answer is: Below the pedicle of L4 and at the top of the intervertebral foramen
Remember, in the lumbar region, spinal nerves exit below the vertebra with the same number. So, the L4 nerve exits below the L4 vertebra. The spinal nerves also exit at the top of the intervertebral foramen.
Which structure does NOT contain efferent autonomic nerve fibers? Dorsal ramus of C4 Dorsal root of T6 Ventral root of T3 Ventral ramus of L2
The correct answer is: Dorsal root of T6
The dorsal root of a spinal nerve contains afferent sensory nerve fibers and no efferent autonomic nerve fibers. The efferent autonomic nerve fibers, which originate in the lateral horn of the spinal nerve, travel out of the spinal cord through the ventral root of the spinal nerve. As the ventral and dorsal roots join to form the spinal nerve, the fibers from both roots intermingle, and the dorsal and ventral primary rami take a mix of fibers, including afferent sensory fibers from the dorsal root, and efferent motorfibers from the ventral root. Postganglionic sympathetic efferent fibers join each spinal nerve via a gray ramus communicans. So, all of the other nerves listed do contain efferent autonomic fibers.
In an adult, the conus medullaris of the spinal cord is normally positioned at which vertebral body levels: T10-T12 T12-L2 L2-L4 L5-S1
T12-L2
In the final stages of labor a caudal anesthetic is sometimes given via a needle inserted into the sacral hiatus. The anesthetic is thus placed around the outside of the sacral spinal nerve roots and into the: Central canal Dural sinus Epidural space Subarachnoid space Subdural space
Epidural Space
In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes? Central axillary Deltopectoral Lateral axilllary Parasternal Subscapular
Central Axillary
In the axilla the pectoralis minor is a landmark, being closely related to all of the following structures except: cephalic vein cords of the brachial plexus lateral thoracic artery medial pectoral nerve second part of the axillary artery
Cephalic
In a fracture of the surgical neck of the humerus, which artery may be injured? Subscapular Posterior humeral circumflex Radial recurrent Deep brachial Circumflex scapula
Posterior Humeral Circumflex
In a diving accident that severed the spinal cord below the sixth cervical vertebra, which muscle would be affected? Deltoid Infraspinatus Latissimus dorsi Levator scapulae Trapezius
The correct answer is: latissimus dorsi
If the spinal cord was severed beneath the 6th cervical vertebra, all nerve roots below C6 would be affected. So, latissimus dorsi, which is innervated by the thoracodorsal nerve (C6, C7, C8) would be affected.
Deltoid is suplied by the axillary nerve (C5, C6). Infraspinatus is supplied by the suprascapular nerve (C5, C6). Levator scapulae is supplied by the dorsal scapular nerve (C5). Trapezius is supplied by the accessory nerve (CN XI). All of these nerves would be intact, so these muscles would not be affected after the accident.
Which muscles are strong medial rotators of the arm?
There are four muscles which are strong medial rotators of the arm: subscapularis, pectoralis major, teres major, and latissimus dorsi.
An elderly man complained of pain in his shoulder when he brought his forearm and hand behind his back while dressing. It was determined that the pain was caused by stretching of the lateral rotators of his arm during this motion. Which muscle was most likely involved? Infraspinatus Latissimus dorsi Subscapularis Supraspinatus Teres major
Infraspinatus and teres minor are the two lateral rotators of the arm. These were probably the muscles that this patient had strained. Latissimus dorsi, teres major, subscapularis and pectoralis major are all important medial rotators of the arm. Supraspinatus is the muscle that initiates abduction of the arm through the first 15 degrees.
An elderly patient complains of shoulder pain and has difficulty abducting his arm. Arthroscopy is done in which a dye is injected into the shoulder joint and an X-ray taken. The radiologist notes that the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would need to be ruptured for this to occur? deltoid infraspinatus latissimus dorsi supraspinatus teres minor
Supraspinatus
When the C5 spinal nerve was severed were any preganglionic sympathetic fibers cut?
Yes
No
Preganglionic sympathetic fibers come from the lateral horn of the spinal cord between T1 and L2. They leave the spinal cord through the ventral root before entering the sympathetic chain. Since this injury happened at C5, there are no preganglionic sympathetic fibers coming through the spinal nerve at this level.
Supination of the hand and forearm would be diminished by loss of radial nerve function. But one very powerful supinator would remain intact and unaffected, namely: Brachialis Brachioradialis Biceps brachii Flexor carpi radialis Supinator
Muscolocutaneous
nterruption of the median nerve in the cubital fossa affects what movement(s) of the thumb? Flexion Opposition Both Neither
Both
A patient is severely limited in extension at the wrist joint after several months in a cast following a Colles fracture. Which joint would be especially important in therapy to regain full extension? carpometacarpal distal radioulnar midcarpal radiocarpal ulnocarpal
Radiocarpal
The function of the posterior interosseous nerve is:
motor to the brachioradialis
motor to the extensor carpi ulnaris
parasympathetic to the dorsum of the forearm
sensory from the wrist joint
sensory from the dorsum of the forearm
Sensory from the wrist joint
Development of "tennis elbow" (lateral epicondylitis) involves the origin of which muscle? Abductor pollicis longus Anconeus Brachioradialis Extensor carpi radialis brevis Triceps brachii
Extensor Carpi Radialis Brevis
What arterial vessel accompanies the deep branch of the ulnar nerve across the palm? Deep palmar arterial arch Radial Radialis indicis Superficial palmar arterial arch Ulnar
deep palmar arterial arch
The most specific nerve branch to these muscles is the:
Deep branch of the ulnar nerve
Median nerve
Recurrent (motor) branch of the median nerve
Superficial branch of the ulnar nerve
Ulnar nerve
Deep branch of the Ulnar Nerve
The triangle in which the superior branch of the ansa cervicalis separates from the hypoglossal nerve is the: Carotid Muscular Subclavian Submental Occipita
Carotid
One of the motor components of the cervical plexus, the ansa cervicalis, innervates all of the following muscles except the: Omohyoid Sternohyoid Sternothyroid Stylohyoid Thyrohyoid
Stylohyoid
These structures are all located in the superficial fascia of the neck EXCEPT External jugular vein Platysma muscle Cervical branch of the facial nerve Omohyoid muscle Transverse cervical nerve
Omohyoid Muscle
Superficial Facia is all muscles, fat, and cutaneous nerves including the PLATYSMA
Investing Facia = all the muscles
Which structure or area receives NO nerve fibers from the cervical plexus?
Diaphragm
Skin over the angle of the mandible
Skin over the external occipital protuberance
Thyrohyoid muscle
Skin over the occipital Protuberance
Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that seems (to the patient) to originate in the area atop the shoulder. This is due to the fact that the phrenic nerve shares spinal segments with what cutaneous nerve in the shoulder region? Dorsal scapular Lesser occipital nerve Long thoracic nerve Supraclavicular nerve Suprascapular nerve
Supraclavicular Nerve
Which of the following statements about the cervical plexus is true?
It comprises spinal segments C1-C3
It consists solely of cutaneous nerves
It consists solely of ventral rami of spinal nerves
It supplies motor innervation to platysma
Consists solely of ventral rami of Spinal Nerves
An elderly man presented with severe pain beneath the left eye, radiating into the lower eyelid, lateral side of the nose and upper lip. What nerve was involved? Buccal Infraorbital Mental Supratrochlear Zygomatic
Infraorbital
Ganglia
Axillary nerve contains GSE, GSA, GVA, and sympathetic postganglionic
GVE fi bers. Cell bodies of GSA and GVA fi bers are located in the dorsal root ganglia. Cell
bodies of GSE fi bers are located in the anterior horn of the spinal cord. Cell bodies of
sympathetic postganglionic GVE fi bers are located in the sympathetic chain ganglia, but
cell bodies of sympathetic preganglionic GVE fi bers lie in the lateral horn of the spinal cord.
