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269 Cards in this Set

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Ptosis of the upper eyelid could be caused by what type of lesions?
Ptosis of the right upper eyelid could be caused by a lesion to either CN III or the sympathetics to the head.
What nerve fibers exit the skull through the Stylomastoid Foramen. Injury to these fibers could cause what type of symptoms?
Motor and sensory fibers of the facial nerve leave the skul through the Stylomastoid foramen. Injury to these fibers would lead to mouth drooping, inability to close the eye, inability to wrinkle the forhead, loss of the blink reflex, and hyperacusis. Motorfibers to muscles of facial expression, and cutaneous fibers tat innervate skin behind the ear pass through the stylomastoid foramen.
What are the actions of the Pectoralis major?
Adduction and internal rotation of the humerus.
What are the actions of the Deltoid?
Abduction of the humerus.
What are the actions of the Infraspinatus, teres minor, and posterior fibers of the deltoid?
External rotation of the shoulder.
What are the actions of the Biceps brachii and supinator?
Supination.
Clawing of the ring and forefinger is characteristic of a lesion to what nerve? Damage to this nerve also causes wasting of what parts of the forearm and hand? What sensation will be lost?
The Ulnar nerve. A lesion to the ulnar nerve can also produce wasting of the hypothenar eminence and dorsal interosseous muscles. Ulnar lesions also cause loss of sensation to the dorsal aspect of the little finger and half of the ring finger.
Sensation to the whole dorsal side of the hand, except for the little finger and half of the ring finger, is served by what nerve?
The Radial nerve.
Sensation to the palmar and dorsal aspects of the the little finger and one half of the ring finger is served by what nerve?
The Ulnar nerve.
Sensation to the palmar aspect of the hand, minus the little finger and half of the ring finger, is served by what nerve? What about the sensation to the tips of the first three and a half fingers?
The Median nerve supplies both of the areas described.
Wasting of the thenar eminence is associated with lesions of what nerve?
The Median nerve.
"Wrist drop" is associated with lesions to what nerve?
The Radial nerve.
Motor loss of which muscles could occur if there is damage to the ulnar nerve?
With damage to the Ulnar nerve there will likely be motor loss to the dorsal and palmar interosseus muscles, adductor pollicis, flexor digiti minimi, abductor digiti minimi, and opponens digiti minimi.
What structures make up the carpal tunnel that is thickened and causing pathology in carpal tunnel syndrome? Briefly explain the pathophysiology of this condition.
The carpal tunnel is the space bounded by the flexor retinaculum anteriorly and the carpal bone posteriorly. The 4 tendons of the flexor digitorum superficialis, the 4 tendons of the flexor digitorum profundus, the tendon of the flexor pollicis longus and the median nerve all run through the carpal tunnel. Carpal tunnel syndrome results from compression of the median nerve in the within the tunnel.
What were the medial umbilical ligaments of the adult called during fetal development? What was their purpose? What should you not confuse them with?
The paired umbilical arteries that arose from the internal iliac arteries and transported fetal (unoxygenated) blood to the placenta, become the medial umbilical ligaments after birth. DO NOT CONFUSE these with the median umbilical ligament, which is a remnant of the urachus: a structure that connects the bladder to the umbilicus.
What is the job of the Urachus in the developing fetus and what does it become after birth?
The Urachus connects the bladder to the umbilicus during fetal development. After birth this becomes the median ligament.
Where do the right and left umbilical arteries arise from in the developing fetus? What is their purpose? What do these structres become after birth?
The right and left umbilical arteries arise from the internal iliac arteries. They carry fetal (unoxygenated) blood from the fetal circulation to the placenta. After birth, these arteries obliterate and become the medial umbilical ligaments.
Which artery is the dorsalis pedis artery a continuation of? What structures does the dorsalis pedis artery pass over and between on its way to the distal parts of the lower limb?
The dorsalis pedis artery is a continuation of the anterior tibial artery after the artery crosses the ankle to reach the dorsum of the foot. ON the dorsum of the foot the pulse may be felt as the artery passes over the navicular bone, and between the extensor hallucis longus tendon and the extensor digitorum longus tendon.
Which artery passes posterior to the medial malleolus?
The Posterior Tibila artery passes into the foot posterior to the medial malleolus.
Which spinal cord segments does the phrenic nerve arise from?
The Phenic nerve arises from spinal cord segments C3 through C5
Which direction does the glenohumeral joint most often dislocate? What nerve is at most risk of being damaged in this situation? What muscles does this nerve innervate?
The most common direction for a dislocation of the Glenohumeral joint is inferior/anterior dislocation, where the joint capsule is the weakest. The Axillary nerve exits the quadrangular space immediately inferior to the GH joint. Thus, dislocation of the GH joint can stretch the axillary nerve, which innervates the deltoid muscle, and cause injury to the nerve.
What muscles does the Dorsal Scapular nerve innervate and where does it run along the scapula?
The Dorsal Scapular nerve passes along the medial border of the scapula to innervate the Rhomboid muscles.
Which nerve innervates the infraspinatus and supraspinatus muscles? What structures does this nerve run along?
The Suprascapular nerve is a branch of the upper trunk or the brachial plexus and passes over the superior border of the scapula to innervate the supraspinatus and infraspinatus muscles.
What nerve exits the Foramen Rotundum in the skull and what areas of the head does it serve?
Sensation of the midface is carried by the Maxillary Division of the Trigeminal nerve (V2), which traverses to the face through the skull via the Foramen Rotundum.
How is the Common Carotid artery transmitted through the skull?
The Common Carotid artery is transmitted into the skull through the Carotid Canal, which is located between the petrous portion of the temporal bone and the greater wing of of the sphenoid.
Damage to which cranial nerve would produce ipsilateral deviation of the tongue? Which opening in the skull does this nerve travel through?
Ipsilateral deviation of the tongue would result from damage to CN XII. This nerve travels through the hypoglossal canal in the posterior portion of the skull.
Damage to which cranial nerve would cause sensory defects to the forehead? What opening in the skill is this nerve transmitted through? What other structures are transmitted through this same opening?
Sensory defects of the forehead would result from damage to CN V1; this nerve is transmitted through the Superior Orbital Fissure. Other structures transmitted through the Superior Orbital Fissure include CN III, IV, and VI
What structures traverse the Cribiform Plate?
CN I
What structures traverse the Optic Canal?
CN II and the opthalamic artery.
What structures traverse the Superior Orbital fissure?
CN III, IV, VI, Opthalmic Nerve (V1) and Veins.
What structures traverse the Foramen Rotundum?
Maxillary nerve (V2).
What structures traverse the Foramen Ovale in the skull?
Mandibular Nerve (V3).
What structures traverse the Foramen Spinosum?
Middle Meningeal Artery.
What structures traverse the Internal Auditory Meatus?
CN VII and VIII
What structures traverse the Jugular Foramen?
CN IX, X, and XI.
What structures traverse the Hypoglossal Canal?
CN XII
What structures traverse the Foramen Magnum?
CN XI, spinal cord, vertebral arteries.
The Medial Longitudinal Fasciculus (MLF) is responsible for what coordinated function of the eyes? Which CN's does it integrate? How can you differentiate and injury to the MLF from an injury to the Oculomotor nerve (CN III)?
The MLF connects the Oculomotor (III), Trochlear (IV), and Abducens (VI) nuclei and is essential for coordinated conjugate gaze. However, a lesion of the motor fibers of the right Oculomotor nerve would also lead to the same symptoms. The way to distinguish between an Internuclear Opthalmopelgia (INO = MLF injury) from a lesion of the medial rectus muscle or a lesion of the motor fibers of CN III is to determine whether the patient can converge their eyes. In INO ability to converge the eyes is left intact.
What is the result from a lesion to the Medial Longitudinal Facsciculus?
The MLF connects CN nuclei of III, IV, and VI and is essential for conjugate gaze. A lesion in the MLF will result in the inability to medially rotate the ipsilateral eye on attempted lateral gaze.
Truncal Ataxia most likely represents a lesion in what part of the cerebellum? What type of gait does this result in?
Truncal Ataxia alone represents a lesion to the Vermis, which is located in the center of the cerebellum. This results in a wide-based, "drunken-sailor" gait.
Name the Retroperitoneal organs.
The retroperitoneal organs include:
-Most of the duodenum, most of the pancreas, ascending and descending colon, rectum, anal canal, kidneys, adrenal glands, ureter, aorta, and inferior vena cava.
Name the major Peritoneal Organs.
The major Peritoneal Organs are the stomach, liver and gallbladder, spleen, first part of the duodenum, tail of the pancreas, jejunum, appendix, transverse colon, and sigmoid colon.
Which lobes of the brain contain the Primary Sensory Cortex?
The right and left Parietal lobes are where the Primary Sensory Cortex is located.
The Primary Motor Cortex is located in which lobes of the brain?
The Primary Motor Cortex is located in the right and left Frontal Lobes of the brain.
The presence of Delta waves in a brain region indicates what?
The presence of Delta waves in a particular brain region indicates a lesion in that region of the brain.
Is Hyperreflexia a sign of a lesion to an upper or lower motor neuron?
Hyperreflexia is a sign of a lesion to an Upper motor neuron.
What is the Corneal Reflex and how does one test it? What nerves are responsible for mediating the Corneal reflex?
The corneal reflex is tested by touching the cornea of one eye with a cotton wisp; this causes both eyes to close. The afferent sensory component of the corneal reflex is mediated by the Opthalmic division (V1) of the ipsilateral Trigeminal nerve. The efferent motor component is mediated by the Facial nerve (CN VII) bilaterally.
What is the job of the Abducens Nerve (CN VI)?
The Abducens Nerve (CN VI) innervates the lateral rectus muscles, which abduct the eyes.
What is the job of the Optic Nerve (CN II)?
The Optic Nerve (CN II) is responsible for vision, and providing the afferent limb of the pupillary light reflex.
What is the job of the Trigeminal Nerve (CN V)?
The Trigeminal Nerve (CN V) is responsible for the afferent limb of the Corneal reflex. It also innervates the muscles of mastication and provides sensory innervation to the face.
What is the job of the Trochlear Nerve (CN IV)?
The Trochlear Nerve (IV) innervates the superior oblique muscles, which depress, intort and abduct the eyes.
During contraction of skeletal muscle which component of the sarcomere maintains its uncontracted length?
The A band.
What is the "unhappy triad of knee injury"?
The term "unhappy triad" is used when Medial meniscus injury is accompanied by injury to the Medial Collateral Ligament with additional involvment of the anterior cruciate ligament. It results from a blow to the lateral side of the knee with the foot planted on the ground.
With weakness of protraction of the scapula or "Winged Scapula" what is the muscle that is affected? Which ventral nerve rami potentially have a lesion? Which nerve do they feed into?
The affected muscle is the Serratus Anterior that is innervated by the C5, C6, and C7 ventral rami of the Long Thoracic nerve. A lesion of the Long Thoracic nerve or any of the rami that feed it results in protraction weakness and winging of the scapula.
A lesion to what nerve results in hoarsness and difficulty swallowing?
Weakness of the laryngeal muscles and pharyngeal muscles results from a lesion of the Vagus Nerve (CN X) or its branches and may result in hoarsness and difficulty swallowing.
A lesion to which ventral ramus may result in thenar atrophy?
The thenar muscles and the skin of the hypothenar eminence are innervated mainly by the C8 ventral ramus.
Hydrocele of the spermatic cord is caused by incomplete fusion of what structure?
The Processus Vaginalis is an evagination of the parietal peritoneum that descends through the inguinal canal before the descent of the testes. Incomplete fusion of the Processus Vaginalis leads to hydrocele formation of the spermatic cord.
Unilateral swelling associated with a suspected cancer is most likely due to what? What is the name of this sign, and what type of cancers is it most associated with?
This event would most likely be due to a migrating thrombophlebitis. This is called Trousseau's sign. It is mostly associated with tumors of the Pancreas, Lung, and Colon.
What is the most significant risk factor for pancreatic cancer?
Smoking, which is believed to double the risk.
What are the serum markers likely to be present in pancreatic carcinoma?
Carcinoembryonic antigen and CA19-9.
What are the actions of the Lateral Pterygoid muscles in the jaw?
The Lateral Pterygoid muscles consist of two heads. The Lateral Pterygoids act to pull the mandible forward in the process of opening the jaw. Other actions include protracting the mandible and moving it from side to side (as in chewing).
The Masseter, Medial Pterygoid, and Temporalis are all muscles of the jaw that help to perform what function?
These are all muscles that help to close the jaw.
What is the action of the Orbicularis oris?
The action of the Orbicularis oris is to purse the lips.
What CN innervates the Parotid gland?
The Facial Nerve (CN VII)
Which artery passes through the Parotid gland?
The External Carotid Artery.
The External Carotid artery passes through what salivary gland on the side of the face?
The Parotid gland.
Contraction of the Subscapularis muscle produces what type of rotation of the humerus?
Internal rotation.
Contraction of the Infraspinatous muscle produces what type of rotation of the humerus?
External rotation of the humerus.
Contraction of the Supraspinatous muscle produces what kind of movement of the humerus?
Abduction of the humerus.
Contraction of the Teres minor muscle produces what type of rotation of the humerus?
External Rotation of the humerus.
Erb palsy refers to motor losses assiociated with what type of nerve injury. What are the motor losses and possible sensory losses involved?
Traction injury to the upper trunk of the brachial plexus, which is served via rami of the 5th and 6th cervical nerves. Typically affected are those muscles receiving motor innervation from the 5th and 6th cervical nerves, including the deltoid and the supraspinatus muscles, the two muscles responsible for abduction of the arm at the shoulder. in addition all muscles responsible for external rotation at the should are effected. The sensory innervation of the lateral side of the arm and forearm is derived from the 5th and 6th cervical nerves as well.
What muscles does the Axillary nerve innervate? Injury to the nerve would cause what sort of motor problems? What is the space that the Axiallary nerve leaves the axilla through.
The Axillary nerve innervates the deltoid and teres minor muscles. Injury to this nerve would cause weakness in abduction and external rotation. The cutaneous sensory distribution of the axiallary nerve is limited to the region of skin on the upper arm overlying the deltoid. The Axillary nerve forms in the axilla and leaves the axilla through the quadrangular space.
The Lateral Cord of the brachial plexus contains nerve fibers that innervates what muscles. What cutaneous areas does this cord serve?
The Lateral Cord innervates muscles in the anterior compartment of the arm and forearm. The cutaneous sensory distribution of these sensory fibers is to the lateral side of the forearm and the lateral portion of the palmar aspect of the hand.
The Musculocutaneous nerve is a branch of what cord of the brachial plexus? Which muscles does it innervate?
The Musculocutaneous nerve is a branch of the lateral cord. It innervates muscles of the anterior compartment of the arm and the skin on the lateral side of the forearm.
What muscles doe the Suprascapular nerve innervate? What are the actions of these muscles?
The Suprascapular nerve arises from the superior trunk of the brachial plexus and innervates the Supraspinatus and Infraspinatus muscles. The Supraspinatus is involved in abduction of the humerus, and the Infraspinatus is involved in external rotation of the humerus.
Describe the borders of the Femoral ring? What does the mneumonic NAVEL describe?
The femoral ring is bounded medially by the lacunar ligament, anteriorly by the inguinal ligament, posteriorly by the pubis, and laterally by the femoral vein. NAVEL describes the structures that we encounter in the groin moving lateral to medial: femoral Nerve, femoral Artery, femoral Vein, Empty space, Lacunar ligament.
What is the Inferior epigastric artery used for in the diagnosis of hernias in men?
The Inferior Epigastric Artery is on the anterior abdominal wall and passes immediately medial to the Deep inguinal ring. Indirect inguinal hernias pass lateral to this artery and direct inguinal hernias pass medial to this artery.
Is it more common for women to present with femoral hernias or inguinal hernias?
Femoral hernias.
Is the Femoral canal medial or lateral to the Inguinal Canal?
The Femoral Canal is lateral to the Inguinal Canal, making the Inguinal Canal the more medial of the two.
How doe Femoral hernias present with respect to the Inguinal Ligament?
Femoral Hernias classically present posterior and inferior to the Inguinal Ligament.
The Lacunar ligament is an inferior extension of what higher structure?
The Inguinal Ligament.
Does an indirect inginal hernia protrude through the deep inguinal ring or the superficial inguinal ring? Will this hernia be medial or lateral to the inferior epigastric artery?
The Deep Inguinal Ring. This will present lateral to the inferior epigastric artery.
Which spinal nerve anterior rami make up the Lumbosacral plexus?
The anterior rami of spinal nerves L1 through S4.
Innervation of the lower limb arises from which segments of the Lumbosacral plexus?
The innervation of the lower limb arises from segments L2 through S4.
Which nerves travel together through the gluteal region and thigh in a common connective tissue sheath to make up what is called the Sciatic nerve?
The Tibial Nerve (anterior divisions of L4-S3) and the Common Peroneal Nerve (posterior divisions of L4-S2).
The Femoral Nerve supplies what parts of the lower limb? Damage to the Femoral Nerve results in what type of motor loss and what type of sensory loss?
The Femoral nerve supplies the anterior compartment of the thigh and is involved in extension at the knee. Damage results in weakened hip flexion, loss of extension at the knee and sensory loss on the anterior thigh, medial leg, and foot.
The Inferior Gluteal Nerve supplies what parts of the lower limb? Damage to the Inferior Gluteal Nerve results in what type of motor loss?
The Inferior Gluteal nerve is a collateral nerve of the lumbosacral plexus. It originates from the posterior divisions of L5-S2, and supplies the Gluteus Maximus. Damage produces weakened hip extension and difficutly in rising from a seated position or in climbing stairs.
The Obturator Nerve supplies what parts of the lower limb? Damage to the Obturator Nerve results in what type of motor loss?
The Obturator nerve arises from the anterior divisions of L2-L4 and supplies the anterior compartment of the thigh. Damage leads to weakened thigh adduction and medial rotation of the thigh.
The Superior GlutealNerve supplies what parts of the lower limb? Damage to the Superior Gluteal Nerve results in what type of motor loss and what type of sensory loss?
The Superior Gluteal nerve is also a collateral nerve of the Lumbosacral plexus. It arises from the posterior divisions of L4-S1.. and supplies the gluteus medius, gluteus minimus, and the tensor fasciae latae. Damage causes loss of abduction of the limb and results in a gait impairment. (Trendelenburg gait).
Describe the motor and sensory losses most associated with Sciatica.
Signs and symptoms of compression of the Sciatic Nerve would include weakened extension of the thigh, loss of flexion of the knee, and loss of function below the knee. Pain and/or sensory loss on the posterior thigh, the leg, and the foot are also common.
Where does the Common Peroneal Nerve run along the leg? What two branches does the Common Peroneal Nerve split into?
The Common Peroneal nerve courses by the neck of the fibula, where it is susceptible to injury. It subsequently divides into two main branches, the superficial peroneal nerve and the deep peroneal nerve.
What muscles and sensory function does the Superficial Peroneal Nerve supply?
The Superficial Peroneal nerve supplies most of the skin of the dorsum of the foot (in addition to lateral muscles that evert the foot).
What muscles and sensory function does the Deep Peroneal Nerve supply?
The Deep Peroneal Nerve supplies muscles that dorsiflex the foot, extend the toes, and assist in foot inversion. It also supplies a small patch of skin in the first web space.
At what level of the spine does the IMA arise from the aorta? What is another anatomical marker using the Duodenum?
The IMA arises from the aorta at about the level of the L3. You can also use the 3rd part of the duodenum that crosses the midline at the same level and passes anterior to the aorta at the origin of the IMA.
What are the tissues that the IMA supplies?
The IMA supplies the distal colon from the distal third of the transverse colon all the way to the upper portion of the anal canal.
A positive Psoas sign suggests what disease process?
Appendicitis.
What is hemianopsia? What is the test used to diagnose hemianopsia? Describe the most common cause of hemianopsia.
The Goldmann visual field test reveals a bitemporal hemianopsia, which is defined as a loss of peripheral vision in both eyes. The most common cause of this unique pattern of visual field loss is a mass in the sella turcica, such as a pituitary adenoma, craniopharyngioma, or neurosarcoid lesion. The most common type of pituitary adenoma is a prolactinoma, which secrete prolactin and leads to galactorrhea. Patients often complain of a milky discharge, which may precede the onset of visual changes.
Discuss the signs and symptoms associated with a Prolactinoma?
Hyperprolactinemia is caused by the pituitary adenoma (prolactinoma). Bitemmporal hemianopsia is cause by compression of the optic chiasm. It presents in women as glactorrhea and/or amenorrhea. It presentsin men as galactorrhea and/or infertility.
What type of sensation is the Dorsal Column/Medial Lemniscus system responsible for?
Concious proprioception, discriminative touch (two-point discrimination), and vibrational sense.
The Anteriolateral system is responsible for what type of sensation?
Light touch and painful stimuli.
What neruonal system is the Fasciculus gracilis a part of? Does it recieve input from the lower limbs or the upper limbs? Where to the fibers of the Fasciculus cuneatus come from?
The Fasciculus gracilis is part of the Dorsal Column/Medial Lemniscus system. The lower limbs. The fibers from the Fasciculus cuneatus come from the upper limbs. They are part of the same system.
What is the most commonlyl dislocated carpal bone? When is dislocates anteriorly which nerve is at risk of being compressed?
The lunate is the most commonlly dislocated carpal bone. It dislocates anteriorly into the carpal tunnel and may compress the only nerve that traverses the tunnel, the Median nerve.
The Posterior Cerebral Artery (PCA) supplies what region of the brain? What sensory region does this include? What type of lesion will infarction of this region produce? What will be spared?
The PCA supplies the occipital cortex, where the primary visual cortex is located. Infarction of this region in one hemosphere will produce a homonymous hemianopsia. However, unlike injury to the lateral geniculate nucleus or the optic radiaitons, the blood supply in the most posterior region of the occipital cortex, where the macular is represented, is bilaterally redundant. As a result, occipital lobe strokes/infarctions often spare the macula and hence visual acuity is preserved.
What kind of visual lesion would an anuerysm of the Anterior Communicating Artery Produce?
the Anterior Commmunicating Artery is located in the vicinity of the optic chiasm. Aneurysms in this blood vessel may impinge on crossing fibers to cause a Bitemporal Hemianopsia.
Occlusion or infarction of the opthalmic artery would result inf what type of vision loss?
The Opthalmic artery perfuses the optic nerve as well as the retina, and an occlusion of this artery would lead to monocular blindness, not just a visual field defect.
How would an aneurysm of the Posterior Communicating Arteries affect vision?
The Posterior Communicating Arteries overlie CN III. Therefore, aneurysm of these arteries can often lead to a third-nerve palsy, resulting in strabismus with the affected eye primarily pointed downward and outward on primary gaze.
Calcification of the Internal Carotid Artery in the vacinity of the optic chiasm could produce what type of visual field defect?
This could lead to binasal hemianopsia.
Contrast the difference of drainage and anatomical relationship of the Left and Right Adrenal Veins to the corresponding Renal Veins. Explain the same for the Left and Right Gonadal Veins.
The Left Adrenal Vein and the Left Gonadal Vein (either testicular or ovarian) drain into the Left Renal Vein (which then drains into the IVC). In, contrast the Right Adrenal Vein and RIght Gonadal Vein Drain directly into the IVC.
Where do the Azygous and Hemiazygous veins receive drainage from?
The Hemiazygous vein receives the venous drainage from the body wall on the left side of the thorax and abdomen. No visceral organs drain directly to the azygous or hemiazygous veins.
On which side of the abdomen does the Inferior Vena Cava (IVC) sit?
The IVC is on the right side of the abdomen.
Does the Splenic vein receive drainage from just the spleen or other organs as well? What special venous system is it a part of?
The Splenic vein receives the venous drainage from the spleen and part of the pancreas and stomach. The Splenic vein is part of the portal system.
What is the job of the Superior Mesenteric vein? What other veins does it join up with?
The Superior Mesenteric Vein receives venous drainage from much of the intestinal tract. It is part of the portal venous system and joins with the splenic vein to form the portal vein.
What is a Babinski sign? Describe what it indicates.
A Babinski sign is an abnormal reflex in adults. A normal plantar response is downward contraction of the toes. An upgoing big toe and fanning outward of the other toes is characteristic of a Babinski sign, which indicates upper motor neuron lesions anywhere along the corticospinal tract.
Explain the course of the Corticospinal tract. Where does it originate and where does it terminate?
The Corticospinal tract originates in the cerebral cortex, descends through the posterior limb of the internal capsule, then continues down through the midbrain cerebral peduncles, the base of the pons, and the medullary pyramids. In the caudal medulla, 90% of the fibers decussate in the pyramidal decussation and descend in the spinal cord as the lateral Corticospinal tracts, terminating in the ventral horn of the spinal cord.
How does a Babinski sign relate to the Corticospinal tract? Where does this tract decussate?
A Babinski sign is an abnormal reflex that occurs with damage to the Corticospinal tract. The majority of the Corticospinal tract decussates in the Caudal Medullla.
Where does the Median Nerve enter the carpal tunnel and between which tendons in order to inject aneshtesia to numb the cutaneous palmar region supplied by the Median Nerve?
At the distal forearm, before the Median Nerve enters the carpal tunnel, it lies in a superficial position between the tendons of the Palmaris longus and the Flexor carpi radialis.
Between which tendons of the forearm do we find the Radial Artery?
The region between the Abductor Pollicis Longus tendon and the Flexor Carpi Radialis is the location of the radial artery.
Between which tendons of the forearm do we find the Ulnar Nerve and Ulnar Artery?
The region between the Flexor Carpi Ulnaris tendon and the Flexor Digitorum Profundus tendon is the location of the Ulnar Nerve and Ulnar Artery.
Which muscles does the Median Nerve innerrvate? What aspects of the brachial plexus does it arise from?
The Median Nerve innervates all of the muscles of the anterior compartment of the forearm except one and one-half muscles (the Flexor Carpi Ulnaris and half of the Flexor Digitorum Profundus). The Median Nerve arises from the combination of the Medial and Lateral cord.
How can one tell the difference between Vertebral Artery impingement and Cervical Spinal nerve compression?
Vertebral areteries enter at the level of C6 and then travel in the transverse foramina. Any external compression can lead to decreased blood flow to the brain stem with consequent cranial nerve and/or cerebellar abnormalities. In contrast, a spinal nerve compression at the cervical level presents as pain, burning or tingling sensation, and weakness or numbness in the shoulder, arm, or hands.
Sensory-neglect syndrome results from lesions to what part of the brain? What is another sensory syndrome produced by a lesion to this part of the brain?
Sensory-neglect syndrome is usually due to damage to the Parietal Lobe. Another symptom produced by a lesion to the Parietal Lobe is extinguishing to double simultaneous stimuli. This is the ability for a patient to detect the presence of two stimuli independently, but not simultaneously.
What sort of symptoms are found in patients with lesions of the Frontal Lobe?
Patients with lesions of the Frontal Lobe can present with a variety of signs and symptoms depending on the location of the lesion. These include a decrease in spontaneous behavior, social inappropriateness, an inability to deal in abstraction, difficulty changing strategies, and perseveration.
Which intercerebral arteries are prone to rupture during uncontrolled hypertension? What part of the brain is at risk of ishcemia?
The Lenticulostriate arteries are prone to rupture in uncontrolled hypertension. These blood vessels supply the Internal Capsule which is an area of white matter in the brain that separates the Caudate Nucleus and the Thalamus from the Lenticular Nucleus.
Which parts of the Internal Capsule carry what type of nerve fibers?
The Anterior limb of the Internal Capsule (IC) conveys the Frontopontine fibers, the Genu conducts Corticobulbar fibers, and the Posterior Limb of the IC conveys Corticospinal Fibers to the Contralateral arm and leg. (e.g. hemorrhage of the left internal capsule results in right-sided dense hemipelgia in which paralysis of the arm and leg are of the same intensity.
The Lenticulostriate arteries arise from what main cerebral artery branch? Which region of the brain is supplied by these arteries? Describe the effect that a lesion of these arteries would have.
The Lenticulostriate arteries arise from the Middle cerebral artery. The Lenticulostriate arteries supply the Internal Capsule and a lesion such as a hemorrhage of the Internal Capsule can be the result of uncontrolled hypertension, mainfesting as contralateral dense hemipelgia.
Which muscles are supplied by the Deep Peroneal Nerve? Which are supplied by the Superficial Peroneal nerve?
The Anterior Compartment muscles of the leg (dorsiflexion) and the Lateral Compartment muscles (eversion) of the leg are supplied b the Deep Peroneal nerve and Superficial Peroneal nerve respectively. Both of these nerves are branches of the Common Peroneal nerve. Also the Superficial and Deep Peroneal nerves provide sensory innervation to the dorsum of the foot.
Which nerve is susceptible to injury because it is superficially located at the neck of the fibula?
The Common Peroneal Nerve.
Which muscles does the Femoral Nerve supply?
The Femoral nerve innervates the muscles and the skin of the Anterior Thigh
Which muscles does the Obturator nerve supply?
The Obturator nerve innerrvates the muscles of the medial thigh and the skin in this region.
What two nerve does the Sciatic nerve become? Which of these two nerves is responsible for supplying the muscles of the calf and the skin of the sole of the foot?
The Sciatic nerve divides to become the Tibial nerve and the Common Peroneal nerve. The Tibial nerve innervates the muscles of the calf and the skin of the sole of the foot.
What is the syndrome that can be caused by compression from a Pineal tumor? Describe the signs and symptoms that are caused and why they occur.
The clinical syndrome that can be caused by a Pineal tumor is called Parinaud's syndrome. It occurs due to the enlarged Pineal gland compressing the Superior colliculi and pretectal area of the dorsal midbrain, the region that contains the vertical gaze center which can cause paralysis of upward gaze. Pineal tumors can also cause compression of the cerebral aqueducts, resulting in noncommunicating hydrocephalus.
During surgery, through what sinus is the Pituitary gland approached transnasally?
The Sphenoid sinus is located in the Shenoid bone under the Pituitary gland. Therefore, the Pituitary gland can be approached transnasaly via the sphenoid sinus for hypophysectomy.
The Ethmoid sinus borders the bony wall of what space?
The Ethmoid sinus is related to the medial wall of the Orbit.
Which sinus does the Frontal lobe lie behind?
The Frontal lobe lies behind the Frontal sinus.
The Mastoid sinus lies within what bone and communicates with what space?
The Mastoid sinus lies within the Temporal bone and communicates with the middle ear.
Which spinal nerves are responsible for the Knee (quadriceps) stretch reflex test?
Knee (L2 to L4), especially L4.
Which spinal nerves are responsible for the Ankel (Gastroc) stretch reflex test?
Ankle (S1).
Which spinal nerves are responsible for the Biceps stretch reflex test?
Biceps (C5 to C6).
Which spinal nerves are responsible for the Triceps stretch reflex test?
Triceps (C7 to C8).
Left Atrial enlargement may impinge on what posterior lying structure?
The esophagus lies posterior to the left atrium. Therefore, left atrial enlargement can compress the esophagus, resulting in dysphagia.
Which type of inguinal hernia, direct or indirect, passes through the deep inguinal ring? What portion of the fascia must be weakened in order for such a hernia to occur?
Only an Indirect Hernia passes through the deep inguinal ring. It passes laterally to the inferior epigastric vessels and then courses through the inguinal canal. The posterior wall of the inguinal canal is formed by the tranversalis fascia laterally and the conjoined tendon medially. It is the transversalis fascia that is weak.
Name the components of the inguinal canal (externally to internally).
External oblique fascia > External spermatic fascia > Internal oblique muscle > Cremaster muscle and fascia >Transversalis fascia > Internal spermatic fascia
Compare and contrast direct and indirect inguinal hernias. Which one is due to a failure of embryonic closure of the processus vaginalis?
Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.
What two Secondary Vesicles does the Forebrain develop into? What are the CNS structures and ventricles that each of these Secondary vesicles develops into?
Forbrain --> Telencephalon, Diencephalon

1) Telencephalon: Cerebral hemispheres and Lateral ventricle

2) Diencephalon: Thalamus and Third Ventricle
What two Secondary Vesicles does the Midbrain develop into? What are the CNS structures and ventricles that each of these Secondary vesicles develops into?
Midbrain --> Mesencephalon

3) Mesencephalon: Midbrain and Cerebral aqueduct
What two Secondary Vesicles does the Hindbrain develop into? What are the CNS structures and ventricles that each of these Secondary vesicles develops into?
Hindbrain --> Metencephalon, Myelencephalon

4) Metecephalon: Pons and Cerebellum, and 4th ventricle

5) Myelencephalon: Medulla and 4th ventricle
Which muscles does the Axillary nerve innervate?
The Teresminor and Deltoid muscles.
Which muscles does the Dorsal Scapular nerve innervate?
The Rhomboideus major and Rhomboideus minor muscles.
Which muscles does the Suprascapular nerve innervate?
The Supraspinatus and Infraspinatus muscles.
Which muscle does the Thoracodorsal nerve innervate?
The Latissimus Dorsi muscle.
The Pryiform cortex is responsible for transmitting which type of message?
Sense of smell from olfactory nerves.
The Insula is thought to be responsible for what type of sense?
The Insula is thought to contain the Primary Gustatory (taste) cortex.
The Nucleus Ambiguus provides the special visceral efferent fibers carried by which Cranial Nerves?
The Nucleus Ambiguus provides the special visceral efferent fibers carried by the Glossopharyngeal and Vagus Nerves.
The Postcentral Gyrus is responsible for what type of message relaying?
The Postcentral Gyrus contains the Primary Sensory cortex.
The Precentral Gyrus is responsible for what type of message relaying?
The Precentral Gyrus contains the Primary Motor cortex.
Which two sinuses border the orbit of the eye? Where do they line?
The Ethmoid air cells are medial to the orbit. The floor of the orbit is also the roof of the Maxillary sinus. A "blowout" in which hydrostatic pressure shatters the floor of the orbit (the roof of the maxillary sinus) allows for subsequent bleeding into the Maxillary sinus that can result in blood draining from the sinus into the nasal cavity.
Which ventricle does the Cerebellum overlie?
The Cerebellum overlies the 4th ventricle.
Which ventricle is adjacent to the Hippocampus?
The Hippocampus is adjacent to the inferior (temporal) horn of the Lateral Ventricle.
Which ventricle is the Pons next to?
The Pons forms part of the floor of the 4th Ventricle.
Which ventricle does the Hypothalamus abut?
The Hypothalamus abuts the 3rd Ventricle.
Which portion of the brain is thought to be the satiety center? What happens when there is a lesion to this region of the brain?
The Ventromedial nucleus. Bilateral destruction leads to hyperphagia, obesity, and savage behavior. Stimulation inhibits the urge to eat.
What symptoms would destruction of the Lateral Nucleus result in?
Destruction of the Lateral Nucleus results in starvation, whereas stimulation of this nucleus induces eating.
What symptoms would destruction of the Septal Nucleus produce?
Destruction of the Septal Nucleus produces aggressive behavior.
What "rhythm" is the Suprachiasmatic Nucleus responsible for controlling?
The Suprachiasmatic Nucleus receives direct input from the retina and plays a role in controlling circadian rhythms.
What is the job of the Supraoptic Nucleus? What other nucleus does it work in conjunction with? Which hormone does it regulate?
The Supraoptic Nucleus, along with the Periventricular Nucleus, regulates water balance and produces ADH and Oxytocin.
Explain what the jobs of these hypothalamic nuclei are. List the function, and then the lesion of each.
1) Lateral Nucleus
2) Ventromedial Nucleus
3) Septal Nucleus
4) Suprachiasmatic Nucleus
5) Supraopotic Nucleus
1) Lateral Nucleus- Fxn: Hunger/Lsn: Starvation
2) Ventromedial Nucleus- Fxn: Satiety/Lsn: Hyperphagia
3) Septal Nucleus- Fxn: Sexual behavior, docility/Lsn: Agressive behavior
4) Suprachiasmatic- Fxn: Circadian rhythm/Lsn: Disrupted circadian rhythm
5) Supraoptic nucleus- Fxn: Synthesis of ADH and Oxytocin/Lsn: Diabetes insipidus (polydypsia and polyuria)
Which muscles of the leg does the Deep Peroneal nerve innervate? What actions of the foot are these muscles responsible for?
The Deep Peroneal nerve supplies the anterior compartment of the leg, i.e. the tibialis anterior, extensor hallucis, extensor digitorum, and peroneus tertius. The prrimary action of these innervated muscles is to dorsiflex the foot, extend the digits, and invert the foot.
What muscle does the Common Peroneal nerve innervate? Which nerve roots does it arise from?
The Common Peroneal nerve supplies the short head of the Biceps Femoris, whose action is to flex the knee. The Common Peroneal nerve arises from the posterior divisions of the nerve roots of L4 to S2.
Which muscles are supplied by the Obturator Nerve and from which nerve roots does it arise?
The Obturator Nerve supplies the muscles of the medial compartment of the thigh, i.e. the gracilis, the adductor longus, the adductor brevis, and the anterior portion of the adductor magnus. The action of these muscles is to adduct and medially rotate the thigh. The Obturator nerve arises from the anterior divisions of the nerve roots of L2 through L4.
Which compartment of the leg does the Superficial Peroneal nerve supply? Which muscles are associated with this compartment?
The Superficial Peroneal nerve supplies the lateral compartment of the leg. The muscles included are the Peroneus Longus, and Peroneus Brevis. The action of these muscles is to evert the foot.
The Tibial nerve is responsible for much of the innervation of the posterior compartment of the thigh and the posterior compartment of the leg. Which muscles does it supply and which nerve roots does it arise from?
Posterior compartment of the thigh:
-Semimembranosus, Semitendinosus, Long Head of the Biceps Femoris, and Posterior part of the Adductor Magnus.

Posterior compartment of the Leg:
-Gastrocnemius, Soleus, Flexor Digitorum Longus, Flexor Hallucis Longus, Tibilais posterior (also the plantar muscles of the foot).

The Tibial nerve arises from the anterior divisions of the L4 through S3 nerve roots.
Which artery and nerve pass anterior to the elbow?
The Brachial Artery and the Median Nerve pass anterior to the elbow.
Which muscles of the forearm does the Ulnar Nerve supply? What symptoms would the patient exhibit if the Ulnar nerve were damaged?
The Ulnar Nerve supplies the Flexor Carpi Ulnaris, half of the Flexor Digitorum Profundus (the Ulnar side). Therefore the patient would have weakened wrist flexion, loss of abduction and adduction of the digits, loss of the hypothenar muscles and lumbricals 3 and 4, and weakened flexion of the 4th and 5th digits.
Which muscles of the hand doe the Ulnar Nerve supply? What symptoms would the patient exhibit if the Ulnar nerve were damaged?
The Ulnar Nerve supplies all the muscles of the hand except for the three thenar comparmtment muscles and the 1st and 2nd lumbricals. Therefore the patient would have weakened wrist flexion, loss of abduction and adduction of the digits, loss of the hypothenar muscles and lumbricals 3 and 4, and weakened flexion of the 4th and 5th digits.
What type of functional loss of the muscles of the forearm and hand might occur from damage to the Median Nerve?
Weakened wrist flexion, LOSS OF PRONATION, loss of function of lumbricals 1 and 2, decreased flexion of the digits and thenar muscles.
Loss of sensation of the lateral aspect of the forearm would indicate a lesion to what nerve?
Loss of sensation of the lateral aspect of the forearm would occur with a Musculocutaneous Nerve injury.
Injury to which nerve would cause loss of wrist extension, as well loss of extensors of the digits and sensory loss of the posterior forearm and hand?
This collection of symptoms would occur after injury to the Radial Nerve.
The Lateral Ventricles of the brain communicate with the Third Ventricle via what channel?
The interventricular Foramen of Monroe.
The Lateral Ventricles connect with the Third ventricle via the Foramen of Monroe, but how does the Third ventricle communicate with the Fourth Ventricle?
The Third Ventricle communicates with the Fourth Ventricle via the Cerebral Aqueduct of Sylvius.
What are the exits for CSF at the level of the Fourth ventricle? Where does the CSF go?
The Foramen of Magendie and the Foramina of Luschka are the exits for the CSF at the level of the Fourth ventricle. These are the Median and Lateral Apertures respectively, and they allow the CSF to flow into the subarachnoid space around the cerebellum and cerebral hemispheres, and around the spinal cord.
How is CSF recycled and returned to the Venous system?
Almost all of the CSF returns to the venous system by draining through the arachnoid granulations, into the superior sagittal dural venous sinus.
Track the flow of CSF from its production by the Choroid Plexus to its reabsorption into the venous blood.
CSF is produced by the Chorid Plexus and is secreted into the Lateral Ventricles --> exits via the interventricular foramina of Monro into the 3rd ventricle --> cerebral aqueduct of sylvius --> 4th Ventricle, which exits through the two Lateral Foramina of Luschka and the Median Foramen of Magendie --> Subarachnoid space --> Arachnoid granulations into the superior sagittal sinus (venous blood)
Name the three boundaries of the Inguinal triangle. Which type of hernia is most commonly found here?
The Inguinal Triangle is bounded laterally by the inferior epigastric artery, medially by the lateral border of the rectus abdominis, and inferiorly by the inguinal ligament. Direct Hernias enter the inguinal canal by tearing through the posterior wall of that structure, the fascia transversalis. The typical location for this type of hernia is through the inguinal triangle.
The presentation of diploplia with a demylinating central nervous system lesion identified on MRI is strongly suggestive of what disease?
Multiple Sclerosis.
Disconjugate gaze is pathognomonic for a CNS lesion to what structure?
Disconjugate gaze is pathognomonic for Internuclear Opthalmopelgia (INO). INO is cause by damage to the Medial Longitudinal Fasciculus (MLF), which links the Abducens Nucleus of CN VI with the contralateral oculomotor CN III nucleus during lateral gaze. This allows for conjugate gaze.
What are the differences between where the testicular arteries and veins originate/drain?
The testicular arteries both arise from the aorta, whereas the right testicular vein drains into the inferior vena cava and the left testicular vein usually drains into the left renal vein.
At what vertebral level does the Inferior Mesenteric Artery arise from the aorta? What structures does it supply?
The IMA arises from the anterior aorta at the level of the body of L3, and gives rise to the Left Colic and Sigmoid Arteries before it terminates as the Superior Rectal Artery. These branches supply the distal transverse colon, descending colon, and superior and mid rectum.
Which arteries are derived from the Celiac Trunk?
The Celiac Trunk gives rise to the Common Hepatic, Splenic, and Left Gastric Arteries; the components of the embryonic foregut.
What vessel does the External Iliac Artery arise from and what does it become?
The External Iliac Artery arises from the common iliac artery and supplies circulation to the lower extremity. It becomes the femoral artery at the inguinal ligament.
What vessel does the Internal Iliac Artery arise from and what structures does it supply?
The Internal Iliac Artery arises from the Common Iliac Artery and supplies blood to a myriad of pelvic organs.
At what vertebral level does the Superior Mesenteric Artery arise from the Anterior Aorta? Which arterial branches does it give rise to? What structures does it supply?
The SMA arises from the anterior aorta at the level of L2. It gives rise to Ileal and Jejunal branches, as well as RIght Colic, Middle Colic, and Ileocolic arteries. The SMA supplies the ileum, jejunum, right colon. and proximal transverse colon; the components of the embryonic midgut.
The Median nerve is subject to entrapment neuropathy by which muscle because it passes through this muscle in the region of the elbow, entering the forearm?
The Median Nerve is subject to entrapment neuropathy as it passes between the two heads of the Pronator Teres muscle.
Which muscle of the anterior compartment of the arm does the Musculocutaneous Nerve pierce? Which muscles does this nerve supply? What is the distal continuation of this nerve and what cutaneous regions does it supply?
The Musculocutaneous Nerve pierces the Coracobrachialis muscle in the anterior compartment of the arm. The Musculocutaneous nerve provides motor innervation to the muscles of the anterior compartment of the arm (coracobrachialis, brachialis, and biceps brachii). The distal continuation of this nerve is the lateral Antebrachial Cutaneous nerve, which provides cutaneous innervation to the skin of the lateral portion of the forearm.
What are the sacral nerve roots that supply the Pudendal Nerve?
The Pudendal Nerve originates from S2,S3,and S4.
What "spine" and ligament creates and separates the greater sciatic foramen from the lesser sciatic foramen? What nerve wraps around these structures? Palpation of which structure allows you to find this nerve in order to perform a nerve block?
The ischial spine and the sacrospinous ligament separates the greater sciatic foramen from the lesser sciatic foramen. The Pudendal nerve leaves the pelvis through the greater sciatic foramen, then wraps around the ischial spine and sacrospinous ligament to enter the lesser sciatic foramen and eventually reach the perineum. Palpation of the ischial spine allows the physician to locate the pudendal nerve in order to perform a pudendal nerve block.
Which lobe of the brain would be responsible for a right lower quadrantic anopsia? Which lobe of the brain would be responsible for a right upper quadrantic anopsia?
A lesion to the Left Parietal Lobe will cause a right lower quadrantic anopsia. A lesion to the Left Temporal Lobe would cause a right upper quadrantic anopsia.
Which arteries form as the Popliteal artery ends and trifurcates?
The Anterior Tibial, Posterior Tibial, and Peroneal arteries form as the Popliteal artery terminates in the trifurcation.
Which artery becomes the Popliteal artery?
The Superficial Femoral artery becomes the popliteal artery as it exits the adductor hiatus in the distal midthigh.
The Femoral artery has three branches, what are they? Which branch supplies the most blood to the head of the femur, such that if this artery is occluded there will necrosis of the head of the femur? When the lesion spontaneously occurs in children and has an unknown etiology, what is the condition called?
The Femoral artery has three branches: the Profunda Femoris artery, and the Medial and Lateral Circumflex Femoral arterues. Most of the blood supply to the head of the femur arises from the Medial Femoral Circumflex artery. Idiopathic avascular necrosis of the femoral head is called Legg-Calve-Perthes disease.
Which branch of the Common Iliac artery becomes the Femoral Artery?
The Femoral Artery is a continuation of the External Iliac Artery, which comes off of the Common Iliac Artery.
Varicosties of which veins leads to external hemorrhoids?
Varicosities in the Inferior rectal veins produce external hemorrhoids.
Varicosities of which vein produce internal hemorrhoids?
Varicosities of the Superior Rectal Vein produce internal hemorrhoids.
What is the difference between where the Superior and Inferior Rectal veins drain?
The Inferior Rectal vein drains into the Inferior Vena Cava, while the Superior Rectal vein drains into the Portal System.
A blow to the Temporal region of the head would most likely injure which artery?
A blow to the Temporal region, would most likely result in injury to the Middle Meningeal Artery.
A tear of the Middle Meningeal Artery (located in the Temporal Region of the head) results in blood entering which potential space? What does this look like on CT scan? What treatment is necessary?
The Middle Meningeal artery is in the interior of the lateral portion of the cranial covity, embedded in the periosteal (outer) layer of the dura. A tear of this artery results in blood entering the potential space betweeen the outer dural layer and the skull (epidural space), causing an epidural hematoma. The high-pressure arterial blood causese a dissection between the dura and bone, which is seen as a biconvex fluid collection on CT scan. Measures must be taken immediately to decrease the intracranial pressure and the hematoma must be evacuated surgically.
A tear in either the Anterior Cerebral or Middle cerebral artery would result in blood entering what space?
The Anterior Cerebral and Middle Cerebral artery lie on the surface of the brain. A tear in either of these arteries would result in blood entering the subbarachnoid space (subarachnoid hemorrhage).
Which muscles are responsible for extended the digits of the hand at the IP joints?
The Lumbricals muscles and the Interossei muscles.
Which muscles of the hand are not innervated by the Ulnar nerve, but are instead innervated by the Median nerve?
The 3 Thenar compartment muscles and the 1st and 2nd lumbricals.
Compression of the Femoral Nerve would cause weakness in what function and sensation of the leg?
Compression of the Femoral Nerve would cause weakness in extension of the knee, as well as paresthesia of the anterior thigh and medial leg.
Compression of the Tibial Nerve would cause what symptoms in the foot?
Compression of the Tibial Nerve would cause weakness in flexion of the toes and loss of sensation from the plantar surface of the foot.
Compression of the Superficial Peroneal Nerve would cause what motor and sensation symptoms of the foot?
Compression of the Superficial Peroneal nerve would cause weakness in eversion of the foot and decreased sensation over most of the dorsum of the foot except the first web space.
Obsessive compulsive disorder is associated with what region(s) of the brain?
OCD is associated with increased activity in the Caudate Nucleus, a component of the basal ganglia, as well as the prefrontal cortex.
The Amygdala is associated with what features of behavior and personality?
The Amygdala is associated with emotion and affect.
What type of memory is the hippocampus associated with? Injuries to this region have what result?
The Hippocampus is best associated with short-term memory. Lesions to the area result in defects in short-term memory and memory consolidation.
What sensory function is the Occipital lobe responsible for? What is the result of a lesion to the Occipital lobe?
The Occipital lobe of the cerebral cortex is involved in various functions, but most notably is the location of the visual cortex. Lesions of the Occipital cortex cause cortical blindness.
Which sensory functions does the temporal lobe play a part in? Are there any other roles that it has?
The Temporal lobe of the cerebral cortex is also involved in various functions, including hearing, language, and higher-order visual processing as well as episodic/declarative memory.
What would the clinical manifestations of the eye be if there were a lesion to the Occulomotor nerve? Why?
A patient with a lesion to the Occulomotor nerve (CN III), would present with Ptosis, mydriasis, and the eye looking down and out. This occurs because the Occulomotor nerve innervates the levator palpebbrae superioris, which elevates the eyelid. It also contains preganglionic parasympathetic fibers that synapse, in the ciliary ganglion, on postganglionic parasympathetic nerve fibers that innervate the sphincter pupillary muscle, which constricts the pupil.
What would the clinical manifestations of the eye be if there were a lesion to the Trigeminal nerve? Why?
The Trigeminal nerve provides sensory innervation to much of the head. A lesion of this nerve may interfere with the afferent limb of the corneal reflex.
What would the clinical manifestations of the eye be if there were a lesion to the Facial nerve? Why?
A lesion of the facial nerve would cause a loss of the efferent limb of the corneal reflex. The Facial nerve innervates the muscles of facial expression, including the orbicularis oculi muscle. A lesion of this nerve may therefore also result in the inability to close the eye.
Which muscle is responsible for closing the eye?
The Orbicularis oculi muscle.
What are the main actions that are supplied by the Radial Nerve?
Extension of the fingers, wrist, and elbow, and supination of the at the arm.
What are the main action that are supplied by the Axillary nerve?
Abduction and lateral rotation of the shoulder.
What are the main actions that are supplied by the Median nerve?
Flexion of the fingers, wrist, opposition of the thumb and pronation.
What are the main actions supplied by the Musculocutaneous nerve?
Flexion at the elbow and supination.
What are the main actions supplied by the Ulnar nerve?
Wrist flexion and adduction, adduction of the thumb, adduction and abduction of digits 2 through 5.
Which portion of the diaphragm does the thoracic duct enter through? Which portion of the mediastinum enter through?
The Thoracic duct, which is the largest lymphatic vessel in the body, enters the thorax through the aortic hiatus of the diaphragm. At this point it lies in the posterior mediastinum, the region posterior to the pericardium. As it ascends through the thorax and passes the level of the fourth thoracic vertebra, it enters the superior mediastinum.
What are the structures located in the anterior mediastinum?
The Anterior mediastinum contains the thymus and fatty connective tissue.
What are the structures located in the middle mediastinum?
The Middle mediastinum contains the heart and the roots of the great vessels.
What structures, in addition to the Thoracic duct, are located in the Superior Mediastinum?
The Superior mediastinum contains the thoracic duct, ascending aorta, aortic arch, branches of the aortic arch, descending aorta, superior vena cava, brachiocephalic veins, thymus, trachea and esophagus.
In addition to the Thoracic duct, what structures does the Posterior Mediastinum contain?
The Posterior Mediastinum contains the thoracic duct, the descending aorta, the azygous vein, the hemiazygous vein, and the esophagus.
The Opponens pollicis muscle is innervated by what nerve?
The Median nerve.
The Abductor pollicis longus, extensor indicis, and the extensor pollicis longus are innervated by what nerve that is a branch of which terminal nerve of the brachial plexus?
These muscles are innervated by the posterior interosseous nerve, which is a branch of the radial nerve.
The Adductor policis is innervated by what nerve?
The Ulnar nerve.
What are the hand muscles innervated by the Median nerve?
Opponens pollicis, flexor pollicis brevis, abductor pollicis brevis, 1st and 2nd lumbricals.
What are the hand muscles innervated by the Ulnar nerve?
Adductor pollicis, all interosseous muscles, all digiti minimi muscles.
Which muscles of the hand are innervated by the Radial nerve?
Abductor pollicis longus, extensor indicis, extensor pollicis longus.
What is the difference between Klumpke paralysis and Erb palsy?
Klumpke paralysis results from an injury to the lower part of the brachial plexus, derived from C8-T1. The result is paralysis of the intrinsic hand muscles (e.g. the thumb and little finger cannot be opossed) and numbness along the inner aspect of the hand. Erb palsy is caused by damage to the upper part of the brachial plexus (C5-C6), causing a "waiter's tip" arm position.
What trauma usually causes the Klumpke paralysis lesion?
Klumpke paralysis is a brachial plexus injury that can occur during delivery. the baby is usually a breech delivery with the arms delivered in an extended position after the head.
Which cranial nerves emerge from the brain stem at the cerebellopontine angle?
The cerebellopontine angle is a triangular area formed by the cerebellum, upper medulla, and middle cerebellar peduncle. The Facial nerve (CN VII) and the Vestibulocochlear nerve (CN VIII) emerge from the brain stem at the cerebellopontine angle.
Which cranial nerves emerge from the brainstem aat the post-olivary sulcus? Where does this lie in relation to the cerebellopontine angle?
The Glossopharyngeal and Vagus nerves (CNs IX, and X) emerge from the brain stem at the postolivary sulcus. This is caudal to the cerebellopontine angle.
The Styloglossus and Palatoglossus are extrinsic muscles of the tongue that are responsible for what actions? Which nerve are responsible for the innervation of these muscles?
The muscles are responsible for the action of elevating the tongue to touch the roof of the mouth. The Syloglossus is innervated by the Hypoglossal nerve, CN XII, and the Palatoglossus is innervated by the pharyngeal plexus.
What is the function of the Geniohyoid muscle?
The Geniohyoid moves the hyoid anteriorly to open the pharynx.
What is the function of the Tensor palati?
The Tensor palati tenses the soft palate.
What is the association with venous drainage of the Right and Left Gonadal and Adrenal veins?
Drainage of the right gonad differs from that of the left gonad in that the left gonadal vein enters the renal vein before merging with the IVC. The right gonadal vein drains directly into the IVC. These same relationships exists for the Right and Left Adrenal veins.
Which parts of the leg have lymphatic drainage that drains to the Superficial Inguinal lymphnodes?
The lateral and medial sides of the thigh, the medial side of the leg below the knee, and the medial side of the sole of the foot all drain to the Superficial Inguinal nodes.
Most of the venous drainage of the skin of the lower extremity is to the long saphenous vein, the accompanying lymphatics of which drain into the superficial group of the inguinal lymph nodes. What is the exception to this rule of drainage in the lower extremity?
The skin drained by the short saphenous vein, including that of the lateral aspect of the dorsum of the foot, is an exception to this rule. Lymphatic fluid from this area drains into lymphatics accompanying the short saphenous vein, then drains into the lymph nodes behind the knee in the popliteal fossa.
Lymphatics accompanying which vein drain into lymph nodes behind the knee in the popliteal fossa?
The Short Saphenous vein.
Elevation of the tongue is tests the function of what muscle and what cranial nerve?
Elevation of the tongue is carried out by the styloglossus (innervated by CN XII, the hhypoglossal nerve), and the palatoglossus (innervated bythe pharyngeal plexus).
Paralysis of what muscles results in the inability to elevate the tongue?
The styloglossus and palatoglossus.
What are the two cranial nerves that would be affected by a tumor in the cerebellopontine angle?
CN VII an CN VIII
Where do the Glossopharyngeal and Vagus nerve emerge from the brain stem?
The Glossopharyngeal nerve (CN XII) and the Vagus nerve (CN X) emerge from the brain stem at the post-olivary sulcus.
Where does the Optic nerve exit from the brain?
The Optic nerve exits from the optic chiasm on the ventral surface of the diencephalon.
Where does the Trigeminal nerve emerge from the brain stem?
The Trigeminal nerve emerges from the brain stem at the anterolateral surface of the pons.
How does drainage of the right ovary differ from that of the left ovary? What are the main veins that are responsible for the drainage and which structures do they feed into?
The right gonadal vein drains the right ovary directly into the IVC, whereas drainage of the left ovary occurs via the left gonadal vein entering the left renal vein before it merges with the IVC.
Describe the path of venous drainage of the uterine cervix.
Cervical vein --> Uterine vein --> Internal iliac vein.
Which superficial vein of the leg drains into the Inguinal Lymph nodes? What part of the leg does this drain, and which side can it be found on?
The Long Saphenous vein drains into the Inguinial lymph nodes. The Long Saphenous vein drains and runs on the medial side of the leg.
Which superficial vein of the leg drains into the Popliteal Fossa lymph nodes? What part of the leg does this drain, and which side can it be found on?
The Short Saphenous vein drains into the Popliteal Fossa lymphnodes. The Short Saphenous vein drains the lateral side of the dorsum of the foot and runs on the posterior side of the leg.
Most of the venous drainage of the skin of the lower extremity is due to the Long Saphenous vein with the accompanying lymphatics draining into the superficial group of the Inguinal lymph nodes. Which vein is the exception to this rule? What part of the lower extremity does it drain and which lymph nodes does it contribute to?
The skin of the lateral aspect of the dorsum of the foot is an exception to the rule as it is drained by the Short Saphenous vein. The lymphatics accompanying the Short Saphenous vein, then drain into lymph nodes behind the knee in the Popliteal Fossa.
The Serratus Anterior is innervated by what nerve?
The Long Thoracic nerve.
The SITS muscles of the rotator cuff perform what functional job?
They approximate the head of the humerus in the glenoid cavity.
The coracobrachialiis, biceps brachii, and brachialis muscles are all innervated by what nerve?
The Musculocutaneous nerve.
The Subscapularis and Teres minor major are innervated by what nerve? What about the Supraspinatus and Infraspinatus?
The Lower Subscapular Nerve; the Suprascapular nerve.
Which cranial nerve is responsible for receiving information from the carotid sinus and body?
CN IX
What are the sensory functions of the Hypoglossal Nerve?
None. All of the functions of the CN XII are motor functions that involve the intrinsic muscles of the tongue (except for the palatoglossus muscle).
In what peritoneal structure is the cystic artery located?
The hepatoduodenal ligament.
Which structures are found in the Hepatoduodenal Ligament?
Within the Hepatoduodenal ligament are found the proper hepatic artery and its branches, the common bile duct and its branches, and the portal vein.
What fetal structure is the falciform ligament an adult structure of?
The Falciform ligament is an adult remnant of the umbilical vein.
What is the arrangement of the three important structures in the arm near the cubital fossa?
TAN: Tendon of the biceps brachii, brachial Artery, and median Nerve.
Fibromyalgia is a musculoskeletal disorder pain disorder that most commonly presents how? What are some of the key clinical findings? How is the treated?
Fibromyalgia is most commonly seen in women between the ages of 20-50, and is associated with widespread chronic musculoskeletal pain that improves with exercise, chronic fatigue, and sometimes severe headaches. Examination typically reveals painful trigger points produced by palpation of the trapezius and the lateral epicondyle of the elbow. One of the most effective treatments of this disorder is TCA's.