review

Question 1

Alpha-fetoprotein (AFP) and acetylcholinesterase (AChE) levels in amniotic fluid are elevated and AFP levels in maternal serum are elevated. Ultrasound shows increased amniotic fluid volume (polyhydramnios).

Answer 1

anencephaly

due to failed rostral neuropore closure

Question 2

Diagnosis is based on findings of a small dimple or tuft of hair in the lumbosacral region

Answer 2

Spina bifida occulta - closed NTD

vertebral arch(es) - derived from sclerotome, typically in the lumbosacral region - form incompletely while the neural tissues and meninges are intact

Question 3

In the developing spinal cord, the neuroepithelial cells of the neural tube form the _____ layer, which will become the gray matter, and the _____ layer, which will become the white matter. Additionally, the _____ layer contains the ____ plate, which develops into the sensory dorsal horn, and the _____ plate, which develops into the motor ventral horn.

Answer 3

In the developing spinal cord, the neuroepithelial cells of the neural tube form the mantle layer, which will become the gray matter, and the marginal layer, which will become the white matter. Additionally, the mantle layer contains the alar plate, which develops into the sensory dorsal horn, and the basal plate, which develops into the motor ventral horn.

[feel the Air with the Alar plate, Bust it with the Basal plate]

Question 4

risk factor for holoprosencephaly

Answer 4

alcohol consumed during pregnancy - causes defective SHH signaling

Question 5

defective closure of rostral vs caudal neuropore causes…

Answer 5

rostral —> anencephaly
caudal —> neural tube defect

this should make sense if you think of the directions !

Question 6

patient with a herniated nucleus pulpous at C5-C6 may:
feel paresthesia (tingly, prickly sensation) or numbnness in the thumb.
feel paresthesia (tingly, prickly sensation) or numbnness in the pinky finger.
lose some function in flexion of the distal interphalangeal joints.
lose some function in the ulnar nerve.
lose some function in the intrinsic muscles of the hand.

Answer 6

feel paresthesia (tingly, prickly sensation) or numbnness in the thumb.

Question 7

The ventral ramus of the C6 spinal nerve contains different nerve fiber types including:
postganglionic sympathetic.
postganglionic parasympathetic.
pregnaglionic parasympathetic.
preganglionic sympathetic.

Answer 7

postganglionic sympathetic.

Ventral rami of spinal nerves carry different fiber types, including somatic motor, somatic sensory, and POSTGANGLIONIC SYMPATHETIC. Presynaptic sympathetic neurons are only present at T1-L2 so they are not present at this level.

Question 8

A 36-year-old is being evaluated for left-hand weakness. On examination it is found that he also has numbness in the left C8 dermatome. This might indicate a lesion to the:
ventral root.
ventral ramus
dorsal root ganglia.
dorsal ramus.

Answer 8

ventral ramus

Ventral ramus is correct because it is the only choice that contains both motor and sensory components that innervate the hand. The dorsal ramus supplies sensory and motor to a limited region along the midline of the back.

Question 9

which nerve contributes to each of the following functions of the thumb?
a. 2 extensors: EPL, EPB
b. 2 flexors: FPL, FPB
c. 2 abductors: APL, APB
d. adductor pollicis
e. opponens pollicis

Answer 9

2 extensors: EPL, EPB (both radial nerve)
2 flexors: FPL, FPB (both median nerve)
2 abductors: APL, APB (radial nerve for APL, median nerve for APB)
1 adductor pollicis. (ulnar nerve)
1 opponens pollicis (median nerve)

Question 10

A fracture at the medial epicondyle of the humerus may result in the inability to:
flex the metacarpophalangeal joints with extension of the interphalangeal joints for digits 2 and 3.
adduct the fingers.
feel sensation in the 3rd digit.
flex the distal interpgalangeal joint of the index finger.
abduct the thumb.

Answer 10

adduct the fingers.

ulnar nerve may be injured at the medial epicondyle of the humerus. ulnar nerve supplies most of the intrinsic hand muscles, except the median nerve supply to 2LOAF muscles. The palmar interosseus muscles adduct the digits (PAD).

Question 11

A cyclist experiences sensory loss and motor loss in the left hand. You suspect that your patient has ulnar canal syndrome due to compression of the ulnar nerve as it courses through Guyon’s canal at the wrist. Which of the following movements may be associated with this?
inabilityto abduct the thumb
weakness in extension of metacarpophalngeal joints with flexion of interpahalngeal joints of medial four digits
inability to adduct the fingers
hypothesia in thee lateral 3-½ digits
inability to fleex the distal interphalangeal joint of digits 4 and 5

Answer 11

inability to adduct the fingers

Compression of the ulnar nerve in Guyon’s canal affects deep ulnar nerve supply to most of the intrinsic hand muscles (except 2LOAF) and superficial nerve supply to the medial 1-1/2 digits and hand. Therefore, the palmar interosseus muscles that adduct the fingers are compromised.

Thumb abduction is not affected because of recurrent median nerve supply to the APB and deep posterior interosseus nerve supply to the APL. The medial half of the FDP is supplied by the ulnar proximal to Guyon’s canal, so flexion of DIP still occurs in all digits.

Question 12

which of the rotator cuff muscles is a medial rotator?

Answer 12

subscapularis

Question 13

Sign of benediction is associated with a _____ nerve injury.

Answer 13

Sign of benediction is associated with a median nerve injury.

Question 14

In evaluating your patient’s hand you ask him to hold a piece of paper between his index and middle fingers while you pull on the paper. Which of the following nerve/muscle combinations are you assessing with this test?
ulnar nerve and 1st dorsal interosseous muscle
median nerve and 1st lumbrical muscle
ulnar nerve and 1st palmar interosseous muscle
anterior interosseous nerve and flexor digitorum profundus of the index finger
median nerve and adductor pollicis muscle

Answer 14

ulnar nerve and 1st palmar interosseous muscle

Keeping the paper between the index and middle fingers requires the patient to adduct (palmar interossei muscles PAD) the index finger and abduct (dorsal interossei muscles DAB) the middle finger. Both muscle groups are Ulnar nerve innervated and the 1st palmar interosseous muscle adducts the index finger.

Question 15

Following a surgical procedure in the axilla, your patient complains of reduced sensation along the lateral border of the forearm indicating inadvertent damage to the lateral cord of the brachial plexus. Which of the following functional deficits would this patient most likely present with?
weakness of abduction of the arm at the glenohumeral joint
weakness of lateral rotation of the arm at the glenohumeral joint
weakness of supination of the forearm
weakness of opposition of the thumb
weakness of extension of the forearm at the elbow

Answer 15

weakness of supination of the forearm

LATERAL CORD lesion resulting in reduced sensation from the lateral forearm indicates damage to nerve fibers traveling in the MUSCULOCUTANEOUS NERVE. SUPINATION of the forearm is the only action involving a muscle (biceps) innervated by the musculocutaneous nerve.

Question 16

Examination of your patient reveals that he is unable to abduct his arm at the shoulder to a full 180 degrees. Injury of which of the following nerves might cause this finding?
medial pectoral nerve
dorsal scapular nerve
upper subscapular nerve
long thoracic nerve
musculocutaneous nerve

Answer 16

The LONG THORACIC NERVE supplies the SERRATUS ANTERIOR, which is involved in full abduction at the shoulder.

Question 17

A patient presents due to low back pain. Your examination includes the sit-to-stand test, which reveals left quadriceps femoris weakness. This test is consistent with a diagnosis of:
compression of the ventral ramus of a sacral spinal nerve by a herniated nucleus pulposus.
stenosis of the vertebral canal at the level of the L5 vertebra.
a herniated nucleus pulposus at the lateral border of the anterior longitudinal ligament.
a herniated nucleus pulposus of the L4-5 intervertebral disc.
an arthritic bone spur narrowing the L3-4 intervertebral foramen.

Answer 17

an arthritic bone spur narrowing the L3-4 intervertebral foramen.

A weakness in the quadriceps femoris muscle may result with compression/injury to the femoral nerve or any of the spinal nerve segments (L2-L4) that comprise the femoral nerve. An arthritic bone spur narrowing the L3-L4 intervertebral foramen would impact the L4 spinal nerve that exits through this opening. Since L4 contributes to the femoral nerve this is the correct choice. An HNP of the L4-5 intervertebral disc would impinge on the L5 nerve so no effect on the femoral nerve or the muscles it innervates.

Question 18

ANTERIOR LEG MUSCLES are innervated by the ______ and cause foot DORSIFLEXION. LATERAL LEG MUSCLES are innervated by the ______ and cause foot EVERSION.

Answer 18

ANTERIOR LEG MUSCLES are innervated by the DEEP FIBULAR NERVE and cause foot DORSIFLEXION. LATERAL LEG MUSCLES are innervated by the SUPERFICIAL FIBULAR NERVE and cause foot EVERSION. The COMMON FIBULAR NERVE divides into the deep and superficial below the knee. Injury to the common fibular nerve would compromise both foot dorsiflexion and eversion.

Question 19

You are evaluating your patient’s gait in order to evaluate the integrity of the nerve supply to the lower limbs. You note that your patient enters the right stance phase with a toe strike. This finding is consistent with a lesion of his…

Answer 19

right deep fibular nerve

A toe strike when entering the stance phase of the gait cycle occurs when a patient can’t dorsiflex the foot. Since this case involves the patient’s right foot a right deep fibular nerve injury would weaken the right anterior leg muscles responsible for dorsiflexion.

Question 20

A baseball player was hit by a pitch in the back of the thigh resulting in a large hematoma over the middle aspect of the semimembranosus muscle. The most likely source of the bleeding was from injury to branches of the…

Answer 20

profunda femoral artery (and its branches) is the chief blood supply to the entire thigh. The posterior thigh is supplied by perforating branches of the profunda femoral artery.

Question 21

Excessive inversion of the foot is resisted by ligaments on the _____ side of the ankle. The _______ is on the _____ side of the ankle/foot and it is the most commonly torn ligament during an INVERTED ANKLE SPRAIN.

Answer 21

Excessive inversion of the foot is resisted by ligaments on the lateral side of the ankle. The ANTERIOR TALOFIBULAR LIGAMENT is on the LATERAL side of the ankle/foot and it is the most commonly torn ligament during an INVERTED ANKLE SPRAIN.

Question 22

Ultrasonography indicates an obstruction in the posterior tibial vein of your patient. A thrombus in this vein is at risk of detaching and traveling to the lungs. The most direct course of the embolus through the lower limb would be from the: posterior tibial vein to the
fibular vein to the popliteal vein to the internal iliac vein.
great saphenous vein to the profunda femoral vein to the external iliac vein.
lesser saphenous vein to the great saphenous vein to the femoral vein.
popliteal vein to the femoral vein to the external iliac vein.
anterior tibial vein to the popliteal vein to the femoral vein.

Answer 22

popliteal vein to the femoral vein to the external iliac vein.

Question 23

Immediately after intragluteal injection, a patient complains of foot drop and numbness, tingling, burning in the right leg down to the toes. Which nerve or division of the nerve is most likely affected?

Answer 23

The SCIATIC NERVE may be damaged during an intragluteal injection. Divisions of the sciatic nerve are tibial and common fibular nerve.

Question 24

During a physical exam you have your patient stand on his right leg only and notice his pelvis tilts to the left. If the cause of your findings was a lesion of one of the collateral nerves of the lumbosacral plexus, which of the following other functional deficits would you expect to find with a lesion of that same collateral nerve?
weakened medial rotation at the hip joint
weakened extension at the hip joint
complete loss of flexion at the hip joint
complete loss of lateral rotation at the hip joint
weakened adduction at the hip joint

Answer 24

weakened medial rotation at the hip joint

Presentation indicates a weakness in HIP ABDUCTOR muscles, which are innervated by the SUPERIOR GLUTEAL NERVE. Those same muscles also are responsible for medial rotation at the hip.

Question 25

A 40-year old presents with numbness over the posterior thigh and calf. Your evaluation indicates compression of nerve tissue by the piriformis muscle. Which of the following muscles may also be affected by compression of this nerve?
adductor magnus muscle
iliopsoas muscle
obturator externus muscle
pectineus muscle
tensor fascia latae muscle

Answer 25

adductor magnus muscle

Piriformis compression of sciatic nerve and/or its tibial and common fibular components. Adductor magnus is the only muscle in this list innervated by the tibial nerve portion of the sciatic nerve.

Question 26

_____ is the only medial thigh muscle which cross both the hip and knee joints.

Answer 26

Gracilis is the only medial thigh muscle which cross both the hip and knee joints.

Question 27

Pt complains of knee locking prematurely when walking… what kind of injury is this caused by?

Answer 27

indicates meniscal tear

Question 28

A kick to the shin resulted in hemorrhaging that occurred within the associated compartment. Which nerve is most likely affected?

Answer 28

deep fibular nerve

Question 29

After a game, a 13-year-old soccer player with a previous diagnosis of Osgood Schlatter’s disease experienced pain on the anterior aspect of the knee. This pain is most likely a result of inflammation of the attachment site for the patellar ligament and a still developing ossification center at the…

Answer 29

tibial tuberosity

Question 30

Your patient suffered a penetrating knife wound in the neck that has paralyzed the right half of his diaphragm. Which of the following blood vessels was most likely lacerated with this injury?
transverse cervical artery
internal carotid artery
superior thyroid artery
external jugular vein
axillary vein

Answer 30

transverse cervical artery

The phrenic nerve (C3C4C5) lies posterior to the prevertebral layer of deep cervical fascia and is crossed anteriorly by the transverse cervical and suprascapular vessels.

Question 31

The _____ is a suprahyoid that depresses the mandible when the hyoid is stabilized by contraction of the infrahyoids. When the hyoid is not fixed by contraction of the infrahyoids, the ______ raises the floor of the mouth during the beginning of deglutition (swallowing) and elevates the hyoid bone.

Answer 31

The mylohyoid is a suprahyoid that depresses the mandible when the hyoid is stabilized by contraction of the infrahyoids. When the hyoid is not fixed by contraction of the infrahyoids, the mylohyoid raises the floor of the mouth during the beginning of deglutition (swallowing) and elevates the hyoid bone.

Question 32

The internal laryngeal nerve and superior laryngeal artery enter the _______ membrane.

Answer 32

The internal laryngeal nerve and superior laryngeal artery enter the thyrohyoid membrane.

Question 33

________ hemorrhage results from torn bridging veins.

Answer 33

subdural hemorrhage results from torn bridging veins.

cortical/bridging veins drain from brain cortex across subarachnoid space, penetrate arachnoid and dura, empties to dural venous sinus (primarily superior sagittal sinus); bleeding from torn veins will separate arachnoid from dura; onset of symptoms is slower than epidural hematoma because of slower leaking of blood from lower pressure veins; radiographically crosses suture lines because arachnoid not directly attached to bone of skull

Question 34

what type of brain bleed does this describe?

associated with fracture of pterion > unconsciousness > lucid interval after regaining consciousness > rapid demise; radiographically seen as not crossing suture lines

Answer 34

epidural hematoma due to rupture of middle meningeal artery

Question 35

A patient who suffered a penetrating wound to the gluteal region years ago leans his torso to the right when in midstance during support on the right lower limb while walking. This gate indicates injury to the…

Answer 35

… right superior gluteal nerve

Question 36

what are the major everters of the lateral leg? what are they supplied by?

Answer 36

fibularis longus + brevis, supplied by superficial fibular nerve

Question 37

with which postsynaptic parasympathetic cranial ganglia does the lesser petrosal nerve of CN IX synapse?

Answer 37

otic ganglion in infratemporal fossa

Question 38

with which postsynaptic parasympathetic cranial ganglia does the chorda tympani synapse?

Answer 38

submandibular ganglion in the oral cavity

Question 39

Which muscle lies inferior to the levator scapulae muscle and has the same innervation?

Answer 39

rhomboids

Both innervated by dorsal scapular nerve (C5)!

Question 40

what makes up the cauda equina?

Answer 40

roots of spinal nerves

Question 41

Which of the following is the more lateral superficial vein in the upper limb?
basilic vein
radial vein
axillary vein
cephalic vein
median cubital vein

Answer 41

cephalic vein

Question 42

The gastrocnemius, soleus, and plantaris are in the superficial layer of the posterior leg and work to move the foot in
eversion.
inversion.
plantarflexion.
dorsiflexion.

Answer 42

plantarflexion

Question 43

what is the function of the saphenous nerve?

Answer 43

skinny superficial branch of femoral nerve, provides cutaneous innervation to the medial surface of the leg.

Question 44

Which structure passes immediately medial to the lateral collateral ligament (LCL)?
popliteus tendon
anterior cruciate ligament.
medial meniscus
posterior cruciate ligament.
lateral meniscus.

Answer 44

popliteus tendon

Question 45

An arteriogram of the external carotid artery would show which of the following branches?
facial artery
ophthalmic artery
subclavian artery
inferior thyroid artery
vertebral artery

Answer 45

facial artery

Question 46

The contents of the carotid sheath include the
phrenic nerve.
vagus nerve (CN X).
spinal accessory nerve (XI).
subclavian artery.
external jugular vein.

Answer 46

vagus nerve (CN X).

Question 47

The dural venous sinuses drain eventually into the…

Answer 47

internal jugular vein.

Question 48

Which of the following travels to the foramen spinosum, through a split of the auriculotemporal nerve?
inferior alveolar artery
chorda tympani
inferior alveolar nerve
lingual nerve
middle meningeal artery

Answer 48

middle meningeal artery

Question 49

Which of the following courses with the lingual nerve in the infratemporal fossa to reach the anterior tongue?
inferior alveolar artery
chorda tympani
maxillary nerve
lingual artery
inferior alveolar nerve

Answer 49

chorda tympani

Question 50

The piriform recess is located in the
oral cavity.
nasopharynx.
oropharynx.
nasal cavity.
laryngopharynx.
larynx.

Answer 50

laryngopharynx.

Question 51

What is incised in a cricothyorotomy?

Answer 51

cricothyoid membrane

Question 52

The palatine tonsils are located between the ______ and _____ folds

Answer 52

between the palatoglossal and palatopharyngeal folds.

Question 53

The opening to the maxillary sinus can be found in the
middle nasal meatus.
inferior nasal meatus.
sphenoethmoidal recess.
oral cavity.
superior nasal meatus.

Answer 53

middle nasal meatus.

Question 54

within the parotid gland, the facial nerve divides into 5 terminal branches:

Answer 54

1. temporal
2. zygomatic
3. buccal
4. mandibular
5. cervical

Question 55

Weakness of the deltoid and infraspinatus muscles, biceps, and wrist extensors leads to opposing muscles holding the affected limb in adduction and internal rotation with the forearm pronated and the wrist flexed.

Answer 55

Erb-Duchenne upper brachial plexus palsy

upper limb placed in “waiter’s tip” position

Question 56

Injury of the ________ nerve may occur during mastectomy and result in weakened ability to extend, adduct, and medially rotate the arm as a result of compromised latissimus dorsi muscle function on the affected side

Answer 56

Injury of the thoracodorsal nerve may occur during mastectomy and result in weakened ability to extend, adduct, and medially rotate the arm as a result of compromised latissimus dorsi muscle function on the affected side

note Injury of the long thoracic nerve may also occur during mastectomy procedures.

Question 57

When a patient pushes their hands against the wall in front of them, the medial border of their scapula protrudes posteriorly. What additional function would be compromised in this patient?

Answer 57

injury of long thoracic nerve innervating serratus anterior - would also see weakness of abduction of the arm above horizontal (90+ degrees)

long thoracic nerve may be injured during mastectomy

Question 58

Injury to the medial and lateral pectoral nerves that supply the pectoralis muscle results in weakness while…

Answer 58

Injury to the medial and lateral pectoral nerves that supply the pectoralis muscle results in weakness while adducting and medially rotating the arm.

Question 59

most frequently injured nerve during axillary lymph node dissection in mastectomy procedures, sensory to the skin of the axilla and medial upper arm

Answer 59

intercostobrachial nerve is a purely sensory nerve that originates from the second intercostal nerve and traverses the axilla to innervate the skin of the axilla and medial upper arm

Question 60

injury of the thoracodorsal nerve results in inability to…

Answer 60

Paralysis of the latissimus dorsi through injury of the thoracodorsal nerve results in the inability to raise the body with the upper limbs, as in climbing or crawling. Use of an axillary crutch, which requires active depression of the scapula, is not possible because the latissimus dorsi cannot counteract the shoulder being pushed superiorly by the crutch.

Question 61

Injury of the ________ nerve may weaken the rhomboid muscles and be seen as a lateral deviation of the scapula that is further away from the midline on the injured side compared to the uninjured side.

Answer 61

Injury of the dorsal scapular nerve may weaken the rhomboid muscles and be seen as a lateral deviation of the scapula that is further away from the midline on the injured side compared to the uninjured side.

Question 62

Fracture of the humeral surgical neck or inferior shoulder dislocation may cause injury of the _____ nerve

Answer 62

Fracture of the humeral surgical neck or inferior shoulder dislocation may cause injury of the axillary nerve. The deltoid and teres minor muscles are supplied by the axillary nerve, whose injury can weaken abduction and lateral rotation of the arm. The deltoid is a frequent site for intramuscular injection and may also result in axillary nerve injury.

The lateral cutaneous nerve of the arm is a branch of the axillary nerve. Sensation may be lost to lateral arm.

Question 63

Of the rotator cuff muscles, the ______ is most vulnerable to inflammation and injury with shoulder pain due to a relatively avascular area in its tendon and repeated trauma from impingement between the ______ and the ______ during abduction.

Answer 63

Of the rotator cuff muscles, the supraspinatus is most vulnerable to inflammation and injury with shoulder pain due to a relatively avascular area in its tendon and repeated trauma from impingement between the head of the humerus and the acromion during abduction.

Question 64

three rotator cuff muscles that attach at the greater tubercle and laterally/externally rotate the humerus:

Answer 64

three rotator cuff muscles (on the posterior surface of the shoulder) that attach at the greater tubercle and laterally/externally rotate the humerus: supraspinatus, infraspinatus, and teres minor.

may be weakened by avulsion fracture of the humerus

Question 65

the deep ulnar nerve supplies motor fibers to the intrinsic hand muscles except… (5)

Answer 65

2-LOAF:
- 1st and 2nd lumbricals
- opponens pollicis
- abductor pollicis brevis
- flexor pollicis brevis

these are supplied by the median nerve!

Question 66

which intrinsic hand muscles are supplied by the median nerve, NOT the ulnar nerve?

Answer 66

2-LOAF:
- 1st and 2nd lumbricals
- opponens pollicis
- abductor pollicis brevis
- flexor pollicis brevis

Question 67

what is the cause of pronator teres syndrome?

Answer 67

Pronator teres syndrome is caused by a compression of the median nerve by the pronator teres muscle in the anterior forearm.

Question 68

Intragluteal injections are intramuscular injections commonly performed in the superior lateral quadrant of the gluteal region to avoid injury to the ______ nerve

Answer 68

Intragluteal injections are intramuscular injections commonly performed in the superior lateral quadrant of the gluteal region to avoid injury to the superior gluteal nerve

Question 69

what is the consequence of an intragluteal infection into the super medial quadrant vs the inferior medial or lateral quadrant?

Answer 69

superior medial quadrant - superior gluteal nerve would be at risk of injury, which may result in the inability to abduct the thigh. This would result in “Trendelenburg’s gait” or sinking of the contralateral pelvis during the stance phase of gait because of the inability of the hip abductors to stabilize the joint.

inferior medial or lateral quadrants - sciatic nerve would be at risk of injury, which would result in motor loss to the posterior thigh and the entire leg and foot plus loss of cutaneous innervation to a large portion of the leg and foot

injections must be superior lateral!

Question 70

_______ may be a landmark during a pudendal nerve block which is sometimes used for vaginal delivery, vaginal repair, hemorrhoidectomies, chronic pain from pudendal neuralgia, and other potential circumstances.

Answer 70

ischial spine may be a landmark during a pudendal nerve block which is sometimes used for vaginal delivery, vaginal repair, hemorrhoidectomies, chronic pain from pudendal neuralgia, and other potential circumstances.

Question 71

with which leg injuries is the sciatic nerve most vulnerable?

Answer 71

The sciatic nerve is posterior to the hip joint and vulnerable to injury with posterior hip dislocation.

Question 72

what are the structures posterior to the medial malleolus, from anterior to posterior? (hint, memory trick)

Answer 72

Tibialis posterior tendon
flexor Digitorum longus tendon
posterior tibial Artery & Vein and tibial Nerve
flexor Hallucis longus tendon

To remember the structures posterior to the medial malleolus, from anterior to posterior use the phrase:“Tom (TP), Dick (FDL), And Very (posterior tibial artery and vein) Nervous (tibial nerve) Hal (FHL)”

Question 73

________ artery provides the main blood supply to the femoral head. Fractures of the femoral neck (for example, in osteoporotic patients who have fallen) may disrupt this blood supply and result in avascular necrosis of the femoral head.

Answer 73

medial circumflex femoral artery provides the main blood supply to the femoral head. Fractures of the femoral neck (for example, in osteoporotic patients who have fallen) may disrupt this blood supply and result in avascular necrosis of the femoral head.

Question 74

______ is a common site for atherosclerosis of the popliteal artery.

Answer 74

adductor hiatus is a common site for atherosclerosis of the popliteal artery.

Question 75

explain the primary cause of shin splints

Answer 75

Shin splits, common in athletes, cause pain along the inner distal two thirds of the tibial shaft. The primary cause of shin splits is repetitive pulling of the tibialis anterior muscle along its attachments on the anterior tibia and interosseous membrane during dorsiflexion of the foot. The muscles in the anterior compartment swell from overuse and the edema and muscle-tendon inflammation reduces blood flow to the muscles, causing them to be painful and tender to pressure. This is a common injury for “weekend warriors”.

Question 76

the major segmental innervation for the extensor hallucis longus and flexor hallucis longus muscles is _____, respectively. Bilateral testing against resistance for these muscles is a good test for those spinal cord segments.

Answer 76

major segmental innervation for the extensor hallucis longus and flexor hallucis longus muscles is L5 and S1, respectively. Bilateral testing against resistance for these muscles is a good test for those spinal cord segments.

Question 77

how is a mandibular nerve block performed?

Answer 77

Anesthetic is injected into the infratemporal fossa to anesthetize the inferior alveolar nerve

Question 78

Which artery travels to the posterior compartment of the arm with the radial nerve?

Answer 78

Profunda brachial artery (branch of brachial in upper arm which dives deep)

Question 79

Which muscle does the musculocutaneous nerve pierce?

Answer 79

Coracobrachialis

Then runs between coracobrachialis and biceps brachii muscles

Question 80

Which head of the biceps brachii is medial vs lateral

Answer 80

Short head - medial
Long head - Lateral

Question 81

Which of the following is innervated by the glossopharyngeal nerve?
A. Pharyngeal muscles, except Stylopharyngeus.
B. Laryngeal muscles.
C. Parotid gland.
D. Sensation to anterior tongue.
E. Muscles of facial expression.

Answer 81

C. Parotid gland.

Glossopharyngeal nerve is associated with pharyngeal arch 3 and innervates the Stylopharyngeus muscle, parotid gland for salvation (lesser petrosal nerve as presynaptic parasympathetic), posterior tongue for sensation

Question 82

Which of the following is innervated by the vagus nerve?
A. Muscles of mastication.
B. Tensor palati muscle.
C. Parotid gland.
D. Cricothyroid membrane.
E. Taste to anterior tongue.

Answer 82

D. Cricothyroid membrane.

Vagus nerve is associated with arches 4 and 6, and innervates the intrinsic muscles of larynx and pharynx (except Stylopharyngeus – CN IX), sensation to laryxn, levator palati, parasympathetic presynaptic to thorax and some abdominal viscera

Question 83

Presynaptic parasympathetic, fibers innervating the lacrimal gland are in the ______ nerve, a branch of CN ____

Answer 83

Presynaptic parasympathetic, fibers innervating the lacrimal gland are in the GREATER PETROSAL nerve, a branch of CN VII (facial)

Question 84

During the process of deglutition, the laryngeal pharynx is elevated and moves anteriorly – which of the following muscles is most responsible for this movement?
A. Anterior belly of the digastric.
B. Geniohyoid
C. Hypoglossus
D. Stylohyoid.
E. Thyrohyoid.

Answer 84

A. Anterior belly of the digastric.

Question 85

During the active swallowing, the tongue is raised in the bolus of food is passed up against the hard palate, and then back into the oropharynx. Which of the following muscles is primarily responsible for keeping food from entering the nasopharynx?
A. Levator palatini
B. Hypoglossus
C. Genioglossus.
D. Styloglossus.
E. Geniohyoid.

Answer 85

A. Levator palatini

Styloglossus raises the tongue during swallowing. The other muscles listed protrude or depress the tongue. The levator palatini elevates the palate. The geniohyoid is a suprahyoid muscle.

Question 86

In order to generate speech, the vocal folds must be approximated. Which of the following muscles is primarily responsible for adducting the vocal folds?
A. Thyroarytenoid
B. Posteiror cricoarytenoid
C. vocalis
D. Lateral cricoarytenoid
E. Cricothyroid

Answer 86

D. Lateral cricoarytenoid - adduct

Posterior cricoarytenoids - abduct
Cricothyroid - tenses
Vocalis - shortens vocal chord

Question 87

Where does drainage of the maxillary sinus occur?
A. Middle meatus.
B. Superior meatus.
C. Inferior meatus.
D. Sphenoethmoidal recess.

Answer 87

A. Middle nasal meatus.

Question 88

Which of the following artery supplies the posterior nasal cavity?
A. Facial.
B. Infraorbital
C. Descending Palatine.
D. Ophthalmic.
E. Sphenopalatine.

Answer 88

E. Sphenopalatine artery - branch of third part of maxillary artery that reaches the nasal cavities

Question 89

Absence of sweating on one side of the face may result from a lesion of:
A. Ventral ramus of C1.
B. Ventral ramus of T1.
C. White ramus communicans of C1.
D. Gray ramus communicans of T1
E. Gray ramus communicans of C1

Answer 89

B. Ventral ramus of T1.

Presynaptic sympathetic -> T1 lateral horn -> ventral root -> spinal nerve -> ventral ramus -> white ramus communicans -> ascend sympathetic chain -> synapse on postsynaptic sympathetics in superior cervical ganglion -> carotid plexus of nerve going to sweat glands of face

Question 90

Which cranial nerves contain parasympathetic fibers as they exits from the brain stem?

Answer 90

Cranial nerves 3, 7, 9, 10

Question 91

A lesion of which of the following structures would most likely result in denervation of sweat glands in the forehead?
A. Gray ramus communicans at T1.
B. Lesser petrosal nerve.
C. White ramus communicans at T1
D. Dorsal horn of the T1 spinal cord segment.
E. CN V2.

Answer 91

C. White ramus communicans at T1

Presynaptic sympathetic from T1 to synapse at superior cervical ganglion and postsynaptic sympathetics as plexus on carotid

Question 92

The ventral ramus of the C6 spinal nerve contains different nerve fiber types including
preganglionic parasympathetic.
special sensory.
postganglionic parasympathetic.
preganglionic sympathetic.
postganglionic sympathetic.

Answer 92

postganglionic sympathetic.

Ventral rami of spinal nerves carry different fiber types, including somatic motor, somatic sensory, preganglionic sympathetic, and postganglionic sympathetic.

Parasympathetic neurons originate in craniosacral regions of the CNS and synapse on cranial or intramural autonomic motor ganglia.

Special sensory neurons are found in the head.

Question 93

what artery supplies the rhomboid muscles?

Answer 93

dorsal scapular artery

Question 94

Your patient presents with low back pain due to a bulging intervertebral disc that has been unresponsive to conservative treatment. You recommend she undergo a laminectomy to surgically treat her pain. Which of the following ligaments attaches to the lamina and will most likely be partially removed in this procedure?
supraspinous ligament
anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
ligamentum nuchae

Answer 94

Ligamentum flavum attaches to the deep surface of lamina.

Question 95

A 40-year-old man was cleaning his gutters and fell off the roof. Reflexively, he tried to catch himself from falling by grabbing onto the gutter. In doing so he hyperabducted his arm at the glenohumeral joint which resulted in a loss of sensation over the hypothenar emminence but no other sensory findings. Which of the following motor findings would you expect to find with this injury?
inability to flex his thumb at the interphalangeal joint
ulnar deviation of hand during wrist flexion
weakness in flexion at the elbow
clawing of digits IV and V
arm medially rotated at the glenohumeral joint

Answer 95

clawing of digits IV and V

lower trunk injury / motor to intrinsic hand muscles / C8-T1

Question 96

A 28-year-old male comes into the emergency department with a laceration on the posterior aspect of his right thumb. His thumb is bent in flexion at the interphalangeal joint but the rest of the forearm and hand are fully functional. These findings indicate that the forced flexion of the thumb is the result of a laceration of the
median nerve.
radial nerve.
extensor pollicis longus tendon.
deep radial nerve.
flexor pollicis longus tendon.

Answer 96

extensor pollicis longus tendon.

The EPL tendon was injured at the posterior aspect of the thumb. There was no motor nerve injury because the radial nerve injury supplies the posterior arm and forearm and there was no wrist drop.

Question 97

A boy fell while running with a drinking glass, which broke and lacerated his wrist. Which of the following structures passing superficial to the flexor retinaculum may have been damaged?
radial artery
flexor digitorum superficialis tendons
flexor pollicis longus tendon
median nerve
ulnar nerve

Answer 97

ulnar artery and ulnar nerve, and the cutaneous branches of the median and ulnar nerves, pass on top of the flexor retinaculum.

Question 98

where can the dorsalis pedis artery pulse vs posterior tibial pulse be palpated?

Answer 98

The dorsalis pedis artery pulse can be palpated readily lateral to the extensor hallucis longus tendon on the dorsal surface of the foot.

The posterior tibial pulse may be palpated posterior to the medial malleolus.

Question 99

A 50-year-old man has difficulty breathing through his nose and a toothache. On examination his physician finds he has swelling of the mucous membranes of the middle nasal meatus. Which opening of the paranasal sinuses is most likely plugged and causing his symptoms?

Answer 99

Maxillary sinus is close to roots of maxillary teeth and drains to middle nasal meatus.

Frontal and anterior-middle ethmoidal sinuses drain to middle meatus too. Posterior ethmoidal air cells drain to superior meatus and sphenoidal sinus drains to sphenoethmoidal recess.

Question 100

Imaging reveals your patient has a space-occupying lesion in the facial canal immediately distal to the geniculate ganglion. Which of the following combinations of physical findings on the effected side would most likely result from this lesion?
A. facial paralysis, reduced submandibular gland secretion, reduced lacrimation
B. normal lacrimation, facial paralysis, reduced taste from the anterior 2/3rds of the tongue
C. hyperacusis, normal submandibular gland secretion, reduced lacrimation
D. normal facial tone, reduced submandibular secretion, hyperacusis
E. conductive hearing loss, numbness of the anterior 2/3rds of the tongue, reduced lacrimation

Answer 100

B. normal lacrimation, facial paralysis, reduced taste from the anterior 2/3rds of the tongue

geniculate ganglion and greater petrosal would not be affected by this lesion, so there is normal lacrimation. The nerve to the stapedius is affected, so there would be hyperacusis. The somatic motor fibers to the muscles of facial expression would be affected, so there would be facial paralysis with this facial nerve palsy. The chorda tympani would be affected so anterior 2/3 of ipsilateral tongue would experience taste loss and there would be reduced secretion of submandibular and sublingual glands on the ipsilateral side leading to dry mouth.

Question 101

An infection can reach the cavernous could directly through the
transverse sinus
straight sinus
superior ophthalmic vein
confluence of sinuses
inferior sagittal sinus

Answer 101

superior ophthalmic vein

Question 102

A newborn presents with a midline cleft palate. The cleft palate deformity is the result of incomplete fusion of
nasolacrimal groove.
mandibular prominences.
palatine shelves of the maxillary prominences.
lateral nasal prominence with medial nasal prominence.
lateral nasal prominence with maxillary prominence.

Answer 102

palatine shelves of the maxillary prominences —> secondary cleft palate

[Defective fusion of MEDIAL NASAL PROMINENCES with each other in the midline or with MAXILLARY PROMINENCE(S) laterally can result in midline anterior cleft deformities of the primary palate, anterior to the incisive foramen]

Question 103

benign mass located along the anterior border of the sternocleidomastoid may be the result of
incomplete fusion of mesenchyme of pharyngeal arches during embryogenesis.
incomplete obliteration of endodermal remnants of an epithelial tract formed during migration of glandular tissue during embryogenesis.
defective migration of endodermal cells from pharyngeal pouches during embryogenesis.
incomplete obliteration of ectodermal remnants of pharyngeal clefts during embryogenesis.

Answer 103

incomplete obliteration of ectodermal remnants of pharyngeal clefts during embryogenesis.

LATERAL CERVICAL CYSTS form along the anterior border of the SCM from incomplete obliteration of ectodermal cervical sinus remnants of pharyngeal clefts 2-4 during embryogenesis.