Anatomy Exam 1- Self-Study Questions (Week 2)

Front 1

What forms the medial wall of the axilla?

Back 1

thoracic wall and overlying serratus anterior

Front 2

What forms the medial wall of the anterior wall?

Back 2

Pectoralis major and minor

Front 3

At what anatomic landmark does the subclavian artery become the axillary artery?

Back 3

As it crosses the 1st rib

Front 4

What is the largest branch of the axillary artery?
What are its two major branches?

Back 4

Subscapular
Scapular circumflex & thorocodorsal

Front 5

To insure survival of the upper limb (especially the hand) where can the axillary artery be ligated during an emergency procedure following a tramatic bullet-induced tear in the axillary artery just below the clavicle?

Back 5

Any where proximal to the subscapular artery

Front 6

What cord of the brachial plexus lies deep to the axillary artery?

Back 6

Posterior cord

Front 7

Name three nerves derived from the posterior cord?

Back 7

upper and lower subscapular
thorocodorsal
radial
axillary

Front 8

What is the “M” of the brachial plexus?

Back 8

lateral cord, musculocutaneous, median, medial cord, ulnar nerves.

Front 9

What component of the brachial plexus supplies the flexor region of the arm?

Back 9

Upper roots to make up the musculocutaneous nerve

Front 10

What muscle group in the arm is innervated by the median nerve?

Back 10

None

Front 11

What muscle group in the arm is innervated by the radial nerve?

Back 11

Triceps brachii

Front 12

Where is the radial nerve in the arm most susceptible to trauma?

Back 12

Radial (spiral) groove on humerus.

Front 13

What three muscles attach to the corocoid process of the scapula?

Back 13

Pectoralis minor
corocobrachialis
short head of biceps brachii

Front 14

What is the name for the most common upper brachial plexus injury?

Back 14

Erbs Palsy

Front 15

What motions are lost that cause the final positioning of the upper limb in Erbs Palsy?

Back 15

Flexion of elbow, lateral rotation of shoulder, some supination

Front 16

What are the likely circumstances which cause upper brachial plexus injuries?

Back 16

Falls that increase the angle between neck and shoulder, or difficult baby deliveries where this same space is stretched.

Front 17

What is the name of the highest axillary lymph nodes within the axilla?

Back 17

apical

Front 18

How does lymph from the axilla enter the circulation?

Back 18

The large veins in the root of the neck – near junction of internal jugular and subclavian veins

Front 19

Introduction to Imaging Questions

Back 19

--->

Front 20

The vast majority of clinical diagnosis come from through these two non-imagery tasks?

Back 20

History & Physical Exam

Front 21

X-rays are a form of:

Back 21

ionizing radiation

Front 22

Name three imagery methods that use this type of radiation- X-rays?

Back 22

radiographic film
CT
nuclear medicine scan

Front 23

What are 2 examples of imagery modalities that use nonionizing radiation?

Back 23

Ultrasound and MRI

Front 24

Name the four types of imagery densities and give at least two examples of each.

Back 24

--air/gas: lungs, gas in intestine
--fat: adipose tissue, breasts
--soft tissues/water density: blood, solid organs, full bladder
--bone & metal: ribs, calcified bones, teeth, metal caps, bullet fragments.

Front 25

Approximately half of all radiographic studies done are what type of imaging?

Back 25

chest X-rays

Front 26

Chest x-rays are taken in which 2 views and why?

Back 26

PA & lateral. To better localize any density that may found on the films.

Front 27

Name at least three methods/substances film radiography uses to enhance the images.

Back 27

--Contrast iodine solution - angiogram
--barium swallow/enema - GI series
--Technetium-99M - nuclear bone scan.

Front 28

Describe angiography.

Back 28

An iodine solution is introduced into a vessel (artery or vein) by a catheter. Film Xray and/or CT are taken at timed intervals. The Iodine metal absorbs xrays rendering a radiopacity (white on negative film) at the location of the iodine - hopefully enhancing the vessels of interest.

Front 29

What is the advantage of CT over classical film imagery?

Back 29

3D rendering of large anatomical regions with increased resolution of soft tissues, also especially good for visualizing fine bone structure

Front 30

What methods are used to enhance CT imagery?

Back 30

oral, intravenous or intra-arterial contrast material.

Front 31

Describe what is found on a normal nuclear medicine bone scan.

Back 31

Bone is a living tissue and is constantly being remodeled so a light background of tracer deposition is normal over all the bones of the skeleton. In areas of high impact and constant movement such as joints a greater amount of deposition of tracer is seen. Tracer is also excreted from the kidney so the kidneys and urinary bladder also shows "normal" enhancement on bone scan. 13. What processes would you expect to show enhanced uptake of tracer on nuclear bone scan? Deposition of tracer at the site of increased metabolic activity and osteoblast activity (rapid turnover and formation of new bone). This is found at sites of metastatic lesions of the bone and at sites of bone healing after injury.

Front 32

What is the advantages/limitations of US?

Back 32

advantages: no exposure to ionizing radiation, relatively fast, inexpensive and reliable for screening purposes.

disadvantages: less resolution than CT, limited use on areas blocked by bone or having to discern objects filled with or surrounded by air.

Front 33

What are some indications for the use of MRI?

Back 33

brain disease such as infarction & tumors, body cavity tumors, soft tissue injuries that produce edema, spinal cord injuries.

Front 34

What are some contraindications for MRI?

Back 34

--ferrous containing objects such as metal surgical staples & aneurysm clips,
--pace maker
-- implanted medication pumps
--some IUDs
--nerve stimulator devices

Front 35

On T1 weighted MRI what tissue in general is displayed as bright white?

Back 35

fat

Front 36

What are best visualized as enhanced signal (bright white) using T2 weighted MRI?

Back 36

CSF and edema

Front 37

The subspecialty of modern imagery that can directly treats disease through minimally invasive percutaneous access to internal structures is?

Back 37

interventional radiology.

Front 38

What results in a Colles’ fracture?

Back 38

is the most common fracture of the forearm in adults >50 years due to forced dorsiflexion of the hand (e.g., trying to ease a fall by outstretching the upper limb). This fracture results in the distal 2 cm of the radial styloid process having a complete transverse fracture, with the fragment being displaced dorsally and often comminuted (broken into pieces). Essentially, Colles’ fracture shortens the radius at the distal end in reference to the ulna, forming a characteristic “dinner fork” deformity

Front 39

What vein is commonly used for venipuncture? Where is it located?

Back 39

median cubital vein
located in the superficial to cubital fossa

Front 40

What is the primary (and most powerful) supinator of the forearm?

Back 40

biceps brachii is the primary and most powerful supinator of the flexed forearm; the supinator muscle supinates the forearm in the absence of resistance

Front 41

Name the main flexor of the forearm.

Back 41

Brachialis

Front 42

Name the divisions of the brachial artery where it splits at the region of the cubital fossa.

Back 42

radial and ulnar arteries

Front 43

List the nerves and their neuromuscular relationships in the forearm.

Back 43

Median nerve = 6 ½ flexor muscles ( ½ refers to FDP of the lateral 2 digits—index and middle fingers) Ulnar nerve = 1 ½ flexor muscles ( ½ refers to FDP of the medial 2 digits—ring and little fingers) Radial nerve = all extensors plus the brachioradialis

Front 44

What is the characteristic clinical sign of a radial nerve injury at the level of the radial groove of the humerus?

Back 44

Wrist drop

Front 45

What muscle(s) flex the middle phalanges?…the distal phalanges?

Back 45

flexor digitorum superficialis; flexor digitorum profundus

Front 46

Which muscle is the prime mover in pronation?

Back 46

pronator quadratus

Front 47

What nerve(s) is/are compromised when a person has trouble pronating his/her forearm?

Back 47

median nerve

Front 48

List the muscles that extend and abduct or adduct the hand at the wrist joint. Identify their main functions.

Back 48

extensor carpi radialis longus & brevis (extend and abduct hand at wrist), extensor carpi ulnaris (extend and adduct hand at wrist)

Front 49

List the muscles that extend the medial four digits.

Back 49

extensor digitorum, extensor digiti minimi, extensor indicis

Front 50

List the muscles that extend or abduct the 1st digit, or thumb.

Back 50

extensor pollicis longus & brevis, abductor pollicis longus

Front 51

What prevents bowstringing of the extensor tendons when the hand is hyperextended?

Back 51

extensor retinaculum

Front 52

Tingling sensations and pain on the lateral side of the hand is due to the compression of what nerve? Where does this nerve pass through to enter the hand?

Back 52

median nerve; carpal tunnel

Front 53

What structures accompany the median nerve through the carpal tunnel?

Back 53

tendons of the FDS, FDP, & FPL

Front 54

List the main arteries supplying the forearm muscles.

Back 54

radial and ulnar arteries

Front 55

What nerve is at risk when the “funny bone” is hit or injured?

Back 55

ulnar nerve

Front 56

A knife wound on the palm at the level of the extended thumb injures what artery on the palm? This artery is the terminal continuation of what artery?

Back 56

superficial palmar arch ; ulnar artery

Front 57

Where is the radial pulse taken?

Back 57

lateral to the tendon of the flexor carpi radialis

Front 58

In terms of motor innervations of the flexor tendons traveling to the nonthumb digits what nerve innervates the flexor digitorum superficialis and the lateral half (digits 2 & 3) of the flexor digitorum profundus?

Back 58

the median nerve

Front 59

Which nerve innervates the medial half (digits 4 & 5) of the flexor digitorum profundus?

Back 59

Ulnar nerve

Front 60

With sensory innervations of the hand, which nerve supplies the skin of 3 ½ digits (palmar side—digits 1-3 and lateral half of digit 4; dorsal side—tips of thumb, index and middle fingers)?

Back 60

The median nerve

Front 61

Which nerve supplies the skin of 1 ½ digits (palmar—little finger and medial half of ring finger; dorsal—medial half of dorsum of hand at the same territories as palmar side)?

Back 61

The ulnar nerve

Front 62

Which nerve supplies the skin of the dorsolateral part of the hand?

Back 62

The radial nerve