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35 Cards in this Set

  • Front
  • Back
A woman trips on an uneven sidewalk and falls hard onto her shoulder. In the emergency room, an x ray reveals that she has fractured the surgical neck of her humerus. Name the vessels that are jeopardized by such a fracture.

As the fracture heals, she notices that her skin over her shoulder is becoming numb and she complains that it is getting to be difficult to elevate her arm. Explain in anatomical terms the likely cause of her new symptoms.
anterior and posterior humeral circumflex artery

During the fracture healing process, the formation of a bony callus has entrapped the axillary n. resulting in weakness of the deltoid m. and sensory loss
Klumpe's syndrome is the name given to the disabilities associated with damage to the lower trunk of the brachial plexus, and Erb-Duchenne syndrome is the name given to the disabilities associated with damage to the upper trunk of the brachial plexus. For each of the statements below, place a K if it refers to Klumpke's syndrome, an ED if it refers to Erb-Duchenne, and an N if it refers to neither:

____ a possible injury following attempt to help promote passage of shoulders during delivery of a neonate by laterally flexing the child's neck and pulling

inability to abduct or adduct fingers

a possible injury following attempt to help deliver a neonate's trunk by pulling on an outstretched arm

wasting of the thenar and hypothenar eminences

upper limb hangs limply at the side with the arm in medial rotation and the forearm pronated

inability to shrug shoulder on affected side
ED____ a possible injury following attempt to help promote passage of shoulders during delivery of a neonate by laterally flexing the child's neck and pulling
K____inability to abduct or adduct fingers

K____a possible injury following attempt to help deliver a neonate's trunk by pulling on an outstretched arm

K___wasting of the thenar and hypothenar eminences

ED___upper limb hangs limply at the side with the arm in medial rotation and the forearm pronated

N___inability to shrug shoulder on affected side
After a brisk walk on an early spring day, a patient complains to his doctor about soreness in his leg lateral to his shin. Explain in anatomical terms the source of his discomfort.

If this condition persists, what nerve is most in jeopardy of being permanently damaged?

what sensory test could the doctor perform to determine whether this nerve has been affected?
anterior tibial compartment syd. ant. tibial comp. surrounded by non-elastic tissues. Muscle overuse leads to swelling; resulting in elevated pressure in compartment and muscle cell necrosis in periphery of compartment

deep peroneal n.

pin-prick of skin forming web between 1st and 2nd toe.
A woman arranging flowers in a vase gets a thorn stuck in her little finger. Although she washes it and applies a bandage, the finger remains sore and several days later, she complains of pain and tenderness along the entire finger and into her wrist whenever she tries to use her hand. Explain in anatomical terms the most likely cause for this conditions.
penetrating would has allowed bacteria to enter synovial tendon sheath of little finger. Since the syn. tendon sheath of little finger is commonly connected to common synovial tendon sheath, infection has spread to wrist.
When inserting a catheter into the femoral artery, why is it imperative that it not be placed into the external iliac artery by mistake?
If procedure results in bleeding from femoral artery, bleeding can be stopped by compressing artery against posteriorly positioned femoral head. There is no hard structure posterior to external iliac a. making it impossible to stop bleeding if catheter placed in external iliac a.
Why do hip fractures(fractures of femoral neck) frequently lead to necrosis of the femoral head?
the mains source of blood to femoral head, derived from medial circumflex femoral artery, passes along femoral neck. it is therefore typically damaged in hip fractures
TJ falls and breaks his ankle while skiing. His leg is put in a cast and he must use crutches to walk. Although he was told not to, he frequently leans on crutches with the tops pressing into his axillae. After a couple of weeks he notices numbness in his upper limbs and his arms feel weak. Explain what has happened
he has compressed his radial nerves as they pass through the axilla, leading to sensory loss of the posterior aspect of upper libm, and muscle weakness in dorsal muscle compartment, particularly of triceps brachii
what structures help maintain the longitudinal arch of the foot during standing?
plantar aponeurosis
short plantar lig.
long plantar lig.
spring lig.
Explain why humans are prone to suffering lateral patellar displacement.

what uniquely human anatomical features are related to preventing this tendency for lateral patellar displacement?
In order to position foot under body COM, femur is obliquely oriented (Q angle), leading to a lateral component to pull of quadriceps femoris, tending to lat. displace patella

lateral lip of patellar groove at distal end of femur is higher than the medial lip. Addition of VMO
A patient has suffered a pelvic fracture that hs injured his superior gluteal nerve. What muscles will be affected by this injury?

What test could a doctor perform to look for weakness or paralysis of these muscles?

What role do these muscles play during normal walking?

Describe the walking gait of a person with a damaged superior gluteal nerve.
gluteus medius, minimus, and tensor fascia latae

ask patient to abduct lower limb

prevent supporting side hip from collapsing into adduction during single limb support.

during stance phase of affected side, unaffected side hip will drop and trunk will laterally flex toward affected side.
For each of the following symptoms or signs, name the nerve that is most likely to be damaged and the muscles that have been paralyzed:

a)weakness in hip adduction

b)severe weakness in foot eversion

c)person tends to lean backwards at heel strike during walking
a)weakness in hip adduction
obturator n. adductor longus, brevis and magnus, and gracilis

b)severe weakness in foot eversion
superficial peroneal n. Peroneus longus and brevis
c)person tends to lean backwards at heel strike during walking

either inferior gluteal n. and gluteus maximus,
or
tibial n. and hamstrings
Ligaments help prevent or limit undesirable motions at joints. For each undesirable motions listed below, indicate what ligaments help prevent it from happening:

a)abduction of the ankle
b)upward displacement of the caudal sacrum during standing
c)rotation of the knee
a)deltoid lig.
b)sacrotuberous lig
c)medial and lateral collateral and anterior cruciate
A man slips on some ice and hits his elbow on a nearby railing fracturing the medial epicondyle of his humerus. What nerves are in jeopardy from this fracture?

If this nerve damage has in fact occurred, describe what would happen when he attempts to do the following?
a)extend his fingers
b)flex his wrist
c)extend his elbow
ulnar n.

a)extend his fingers
ring and little fingers would assume a claw appearance (hyperextension at MP joint, flexion at both IP jts. Other fingers would extend normally

b)flex his wrist
Although wrist would flex, motion might seem weak and hand would radially deviate slightly
c)extend his elbow
elbow extension would be normal
Froments sign?
grip paper by flexor pollicus longus and brevis because adductor pollicis is paralyzed
The coracoclavicular ligaments help prevent motion at what joint?

describe what type of motion they are designed to resist, and the resulting configuration of the joint should they fail
acromioclavicular joint

shoulder separation-medial and inferior displacement of the acromion relative to the lateral end of the clavicle.
What major nerve is in jeopardy from a retractor pressing laterally on the psoas major?

what muscles does this nerve innervate?

what is the role of these muscles during walking?

describe the gait of an individual in whom these muscles were paralyzed
femoral nerve

innervates quadriceps femoris, sartorius and pectineus

quadriceps femoris prevent the knee from collapsing under the weight of the body during the first half of stance phase

person will tend to lean forward at touch-down so that body COM will be in front of knee joing. May also place hand on thigh to push knee into extension
Describe where you would feel for a pulse in the following vessels:

a)brachial artery
b)radial artery
c)dorsalis pedis artery
a)brachial artery
-on medial side of upper arm, just above cubital fossa, posterior to belly of biceps brachii
b)radial artery
-just proximal to wrist, lateral to tendon of flexor carpi radialis
c)dorsalis pedis artery
-on dorsum of foot, at base of metatarsals lateral to tendon of EHL
Name the artery and/or nerve that would be in jeopardy by a fracture of the following bony structures:

a)neck of the fibula
b)neck of the radius
c)distal femur
a)common peroneal n.
b)deep radial n,
c)popliteal a.
if a patient suffered damage to the inferior gluteal nerve, what muscle(s) would be affected?

describe a motor test to determine the integrity of the inferior gluteal nerve
gluteus maximus

with patient lying prone on a table with their knee flexed, ask them to lift thigh off of the table while examiner palpates gluteus maximus
If a person's eyeballs are too short for light to converge on the foveae centrales when the lenses are at their maximum flatness, will this person by myopic (near sighted) or hyperopic (far sighted)?

why?
hyperopic

because distant objects can be brought into focus by contracting the ciliary m. which causes the lens to get rounder and the focal point to move forward onto the fovea. Objects that are close cannot be in focus because the lens has reached limit of roundness.
a patient presents with hoarse and breathy voiceYour workup eventually reveals cancer of the thoracic esophagus. How has this led to the presenting symptoms?

You perform a laryngoscopy and ask the person to say "aah". Describe the positions and states of tension of the two vocal cords.

What is the state of the patients ability to cough?

Whys is the person at greater risk of pneumonia (independent of any general effects of the cancer?)
the cancer, or nodes to which it has metastasized, are compressing the left recurrent laryngeal n.

the left cord will be in the intermediate position and flaccid. the right cord will have crossed the midline to approach the left cord and will be tight

weak

because the inability to oppose two tight cords, and the diminished sensation on the left, predisposes to aspiration
What is the medical term for the most likely visual defect to arise in the case of a pituitary tumor?
damage to what structure causes this condition?

what symptoms might the patient describe that would lead to suspicion of this visual disturbance?
bitemporal hemianopia

optic chiasm

bumping into objects
Name the structures with the following relationships, or name the contents of the following spaces:

a)on the superior surface of the first rib, posterior to the subclavian artery
b)in the posterior chamber of the eye
c)in the anterior chamber of the eye
d)in the canal of Schlemm
e)embedded in the medial wall of the tympanic cavity superior to the footplate of the stapes and inferior to the bulge produced by the lateral semicircular canal
f)embedded in the outer later of the cranial dura deep to the squamous portion of the temporal bone
a)on the superior surface of the first rib, posterior to the subclavian artery
inferior trunk brachial plexus

b)in the posterior chamber of the eye- aqueous humor
c)in the anterior chamber of the eye- aqueous humor
d)in the canal of Schlemm- aqueous humor
e)embedded in the medial wall of the tympanic cavity superior to the footplate of the stapes and inferior to the bulge produced by the lateral semicircular canal
-facial nerve
f)embedded in the outer later of the cranial dura deep to the squamous portion of the temporal bone
-middle meningela a.
At what site are the glossopharyngeal n, vagus n and accessory n. most likely to suffer simultaneous injury?
in vicinity of the jugular foramen
what muscle is being tested and what nerve innervates it?

a)ask patient to shrug her shoulders while you press down on them
trapezius
accessory n.
what muscle is being tested and what nerve innervates it?


b)in a patient who can follow your finger with his eyes as you move it toward the bridge of his nose, you then ask him to follow it as you move it to his left and then downward, with you looking at his right eye.
superior oblique
trochlear n
what muscle is being tested and what nerve innervates it?
if right side paralysis?
ask the patient to open her mouth
lateral pterygoid
mandibular (V3)
if right side paralysis: lower jaw will deviate to patient's right
what muscle is being tested and what nerve innervates it?
if right side paralysis?
ask the patient to say "aah" while you look in her mouth
levator veli palatini
vagus
uvula will shift to the left
what muscle is being tested and what nerve innervates it?
if right side paralysis?
ask the patient to puff out his cheeks
orbicularis oris
facial
air will escape from right side of mouth
what muscle is being tested and what nerve innervates it?
if right side paralysis?
ask the patient to stick out his tongue
genioglossus
hypoglossal
tongue will deviate to patient's right side
If a person reports he hears a tuning fork louder when it is placed on his mastoid process than when it is placed by his external auditory meatus, what is not working properly?

how will the results of this test be affected by paralysis of the tensor tympani?
ossicular chain, or air conduction mechanism

not at all
What abnormality, not visible externally, will an x ray show in a two year old with scaphocephaly?


what abnormality, not visible externally, will an x ray show in a two year old with trigonocephaly?
fused sagittal suture

fused metopic suture
The patient shown on the right has either an abnormally high left upper eyelid or an abnormally low right eyelid.

Weakness of what one muscle, innervated by what nerve, could lead to an abnormally elevated left upper eyelid?

weakness of what two muscles, innervated by what nerves could lead to an abnormally depressed right upper eyelid?
orbicularis oculi, facial n.

1)levator palpebrae superioris, oculomotor n.
2)Muller's m. sympathetic n
a routine blood test of R. A. reveals she has an abnormally high serum calcium level. Sestamibi-technetium subtraction scintigraphy identifies an adenoma in the left inferior parathyroid gland. Where is this gland normally located?

What artery supplies the left inferior parathyroid gland?

What nerve is at greatest risk of injury during surgery on the left parathyroid gland and where does it lie in relation to other structures in your surgical field?

you remove hyperplastic parathyroid glands. you firmly tap the skin of the cheek immediately anterior to the earlobe. What would you observe if the nerve starts to fire?
on posterior surface of inferior lobe of thyroid gland

inferior thyroid a.

left recurrent laryngeal n., which lies in the lateral part of the groove between the trachea and the esophagus

facial mm will twitch
In 15% of trigeminal neuralgia cases, symptoms are limited to the area innervated by V3. If only V3 is involved, where will pain be felt?
fleshy cheek, skin over anterior half of mandible, upper region of auricle, mandible and its teeth, anterior 2/3 of tongue