Block 1 practice questions

Question 1

what is a crush fracture vs a wedge fracture vs oblique, transfers, or communicated fraction

Answer 1

compression of the entire vertebral BODY

• wedge fraction compresses the perimeter of the vertebral body
• both cause reduction in overall height

oblique fracture : fraction of the spinal process

transverse fracture: fracture of the transverse process
communicated fracture: fracture of the superior articular process

-the intervertebral discs are associated with hernias, not fractures

Question 2

spinal stenosis involves which ligament and why?

Answer 2

ligamentum flavum because it connects the lamina of 2 adjacent vertebrae and is the only choice in direct contact with the vertebral foramen.

hypertrophy of the ligamentum flavum would present as spinal stenosis

Question 3

patient presents with scapula retracted laterally. which nerve has been injured?

greater occipital?
suprascapular?
axillary nerve?
long thoracic nerve? 
dorsal scapular?

Answer 3

dorsal scapular because it innervates rhomboids major and minor which are responsible for medial retraction (adduction ) of the scapula

Question 4

The primary action at the atlanto-axial joint is:

Answer 4

The atlanto-axial joint is a complex joint with multiple articulations between the atlas (C1 vertebra) and the axis (C2 vertebra). The primary action at this joint is rotation of the head on the neck.

Question 5

At what level does the spinal cord usually terminate in the adult?
why is this important?

Answer 5

The adult spinal cord terminates at the L1-L2 vertebral level. Remember this important relationship! This is the reason why adult lumbar punctures are typically performed between the L3-L4 level to avoid damaging the spinal cord.

Question 6

The spinal nerve emerges from the vertebral canal by passing through an intervertebral foramen. The foramen is formed (or bounded) by the superior and inferior vertebral notches on adjacent pedicles and the intervertebral disc. To view the circumference of a lumbar intervertebral foramen on a radiograph, which of the following views would be best?

Answer 6

The intervertebral foramina are oriented such that the spinal nerves can emerge laterally to access the body. The best view of these foramina would therefore be achieved with a lateral x-ray.

Question 7

Ventral and dorsal roots of the spinal nerves in the upper two-thirds of the vertebral canal are separated from each other bywhat structure?

Answer 7

The dentate ligaments separate ventral from dorsal roots in the upper two-thirds of the spinal canal. These roots must penetrate arachnoid and dura mater to exit the cord and canal to access the body wall musculature. The internal vertebral plexus of veins travels within the spinal canal but within the epidural space (i.e. outside the dura mater) and does not function to separate the ventral and dorsal spinal nerve roots.

Question 8

What dermatome segment includes the skin around the umbilicus?

Answer 8

T-10

Question 9

Nerve impulses resulting from light touch on the skin enter the spinal cord:

Answer 9

via dorsal roots

Somatic afferent impulses enter the cord via dorsal roots. Ventral roots contain efferent fibers. Gray rami communicans contain postganglionic sympathetic fibers. White rami communicants contain preganglionic sympathetic fibers and some general visceral afferents.

Question 10

which part of vertebrae forms joints with the next

Answer 10

The superior articular processes of each vertebral bone form zygapophyseal joints (aka “Z joints”) with adjacent vertebrae.

Question 11

A small herniation of the intervertebral disc into the intervertebral foramen between the L-4 and L-5 vertebrae would pinch which nerve(s)?

Answer 11

Although Lumbar spinal nerves are named for the vertebra ABOVE them (i.e., nerve emerging between L4-L5 is the L4 spinal nerve), the orientation of the cord causes symptomatic herniations in this region to affect the spinal nerve emerging at the next intervertebral foramen down. Therefore, an L4-L5 disk herniation will impinge on the L5 spinal nerve. In contrast, cervical spinal nerves are named for the vertebra BELOW them, so a symptomatic herniation between, e.g., C5-C6 will impinge on the C6 spinal nerve.

Question 12

How many muscles attach to the coracoid process of the scapula?

Answer 12

3 muscles attach to the coracoid process: pectoralis minor, coracobrachialis, and biceps brachii (short head).

Question 13

Denticulate (dentate) ligaments are extensions of the

Answer 13

The denticulate (dentate) ligaments are saw-tooth shaped extensions of pia mater traveling between the anterior (ventral) and posterior (dorsal) spinal nerve roots as they exit the spinal cord.

Question 14

Several tissues contribute to the structural ability of the vertebral column. Which one of these would be pierced by a syringe needle in a properly placed lumbar puncture?

Answer 14

ligamentum flavum

A properly placed lumbar puncture needle penetrates the ligamentum flavum, which runs between the laminae of adjacent vertebrae, before penetrating the dura. The anterior/posterior longitudinal ligaments run along the anterior/posterior surfaces of the vertebral bodies, and should not be pierced by the needle. The nucleus pulposus and annulus fibrosus comprise the intervertebral disks, which should not be pierced by the needle.

Question 15

The vertebra prominens, the easily palpated spinous process of the ________ vertebra, marks the inferior extent of the _______.

Answer 15

7th cervical; neck

Question 16

After a penetrating wound in the area of the posterior axillary fold a patient had weakness in extension and adduction of the arm. Which muscle is likely involved?

Answer 16

he correct answer is: Latissimus dorsi
Latissimus dorsi makes the posterior axillary fold, so it’s easy to see why that should be the muscle injured following a wound to the posterior axillary fold. Latissimus dorsi is the muscle important for medial rotation, extension, and adduction of the arm; the patient’s symptoms fit with an injury to this structure.

Pectoralis major medially rotates and flexes the arm–this muscle makes the anterior axillary fold. Levator scapulae elevates the scapula, while rhomboideus major retracts the scapula. Trapezius elevates and depresses the scapula (depending on which part of the muscle contracts), rotates the scapula superiorly, and retracts the scapula. It also helps raise the tip of the shoulder, or acromion.

Question 17

In order for a skin abrasion to bleed, the lesion must penetrate at least into the:

Answer 17

The correct answer is: Dermis
The epidermis is the most superficial layer of the skin, and it’s not vascularized. But the dermis, sitting immediately below the epidermis, is very vascular and will bleed following an injury. So that’s the answer.

If an abrasion goes to the deep fascia, muscular fascia, or subcutaneous tissue, it will definitely bleed, but this question is asking you to choose the first layer to bleed after a skin wound, and that’s the dermis.

Question 18

During a triathalon biking accident, a rider fell and landed with the handle bar of her bike forced upward into her right axilla. Subsequently while swimming in another triathalon event she found that her right arm tired so badly during the swimming portion that she could barely finish the event. During examination it was found that movements involving adduction, medial rotation and extension of her arm were particularly weak and affected her swimming stroke. The nerve injured was the:

Answer 18

The correct answer is: Thoracodorsal
The thoracodorsal nerve innervates latissimus dorsi, which is an important muscle for adducting, medially rotating, and extending the arm. This is the muscle that is used when swimming the crawl. Since she can’t do these motions, the triathelete must have injured her thoracodorsal nerve. Another indication of this injury is that the thoracodorsal nerve is particularly vulnerable following trauma to the axilla.

The accessory nerve innervates trapezius. If this nerve was injured, the patient could not raise the tip of her shoulder. The dorsal scapular nerve innervates the rhomboids and levator scapulae. If this nerve was injured, the patient would have problems elevating or retracting her scapula. The lateral and medial pectoral nerves innervate pectoral major, a medial rotator and flexor of the arm. An injury to this nerve would cause a problem with flexion, not extension, of the arm.

Question 19

The transverse cervical artery is severed in an auto accident. What muscle would be affected the most?

Answer 19

The correct answer is: trapezius
The transverse cervical artery supplies blood to trapezius. Levator scapulae and the rhomboids receive blood from the dorsal scapular artery. Latissimus dorsi receives blood from the thoracodorsal artery.

Question 20

As you are sitting in a quiz, the skin immediately over the base of the spine of your scapula begins to itch. The sensation from this area is mediated through which nervous structure?

Answer 20

The correct answer is: dorsal primary ramus of C7
Dorsal and ventral primary rami are the first branches off of spinal nerves. Dorsal rami provide sensory innervation to the skin over the back and give motor innervation to the true back muscles; ventral rami supply sensory innervation to the skin over the limbs and the skin over the ventral side of the trunk. Ventral rami also give motor innervation to the skeletal muscles of the neck, trunk, and extremities. So, if the skin over the spine of your scapula began to itch, the sensation of that area would be transmitted by the dorsal primary rami of C7. The accessory nerve, which innervates the trapezius, is not responsible for any sensory innervation. The dorsal and ventral roots of spinal nerves are not directly responsible for any sensory innervation to the skin. Dorsal and ventral rootlets emerge from the spinal cord to form the dorsal and ventral roots. The ventral roots contain efferent motor fibers to skeletal muscles, while the dorsal roots contain afferent sensory fibers. These roots combine to form the spinal nerve, which then gives off the primary rami.

Question 21

During the first day of class a student lacerated his finger while putting a new blade on his scalpel. The cut penetrated the skin and it was necessary for him to go to the emergency room to have it stitched up. Which layers would the ER physician include in the stitches in order to close only the skin?

Answer 21

The correct answer is: epidermis, dermis.
The epidermis and the dermis are the two layers that comprise the skin. The subcutaneous tissue/superficial fascia and the deep or investing fascia are all below the skin. As long as sutures are crossing through the thick dermis, the skin will be able to hold the sutures, and the wound will be repaired.

Question 22

Loss of function, paralysis, of which muscle would result in drooping or sagging of the shoulder?

Answer 22

The correct answer is: trapezius
The trapezius, innervated by the accessory nerve (CN XI), is the muscle responsible for elevating the tip of the shoulder. Erector spinae, which is innervated by the dorsal primary rami of C1-S5, extends and laterally bends the trunk, head and neck. Latissimus dorsi, innervated by the thoracodorsal nerve, allows the trunk to be lifted up to the arms (like with climbing or pull-ups). Levator scapulae, innervated by the dorsal scapular nerve, elevates the scapula. Rhomboidus major and minor are both innervated by the dorsal scapular nerve and aid trapezius in retracting the scapula.

Question 23

In order to make an intramuscular injection, the needle must pass through several layers of tissue to reach the muscle. Choose the correct order of tissues the needle would pass through from superficial to deep.

Answer 23

The correct answer is: Epidermis, dermis, subcutaneous tissue, investing fascia, muscle
The first layer through which the needle must cross is the skin, composed of the superficial epidermis and deeper dermis. Then comes the subcutaneous tissue–it’s filled with fat and fairly loose. Finally, the investing fascia covers the muscle. Remember this sequence to keep yourself oriented when thinking about the different layers of skin and fascia!

Question 24

After initial examination, the patient is sent to radiology. Radiographs reveal that the portion of the scapula forming the tip or point of the shoulder has been fractured. This bone is the:

Answer 24

The correct answer is: acromion
The acromion is the point of the scapula that corresponds to the tip of the shoulder. Because most of the scapula is protected by muscles and the thoracic wall, most scapular fractures involve the protruding acromion. The angles of the scapula are inferior to the acromion and not involved with the tip of the shoulder. The coracoid process is a beaklike process on the anterior face of the scapula. It is inferior to the acromion and projects anteriorly. The glenoid cavity is on the lateral side of the scapula. It articulates with the head of the humerus. The spine of the scapula is the ridge of bone on the posterior face of the scapula. Although it continues laterally to become the acromion, it is not the same as the acromion, which specifically refers to the tip of the shoulder.

Question 25

Sutures (stitches) would be placed in which tough layer of the skin in order to sew up the lacerations?

Answer 25

The correct answer is: dermis
The dermis is filled with collagen and elastic fibers which account for the strength and tone of the skin. Therefore, this layer of skin is strong enough to hold the sutures used to sew up the lacerations. The epidermis is thin and weak, so it would not be able to hold sutures by itself. Superficial fascia/ subcutaneous tissue is the loose and fatty connective tissue below the dermis, and not an appropriate location for sutures. The deep fascia invests muscles or groups of muscles, and it would be too deep to place sutures.

Question 26

A motorcyclist lost control of his bike after hitting a wet spot on the pavement. He hit a curb and was catapulted several feet, landing on the point of his right shoulder and the right side of his head and neck, severely stretching his neck. He was taken to the emergency room with abrasions, lacerations and multiple injuries to both fleshy and bony tissues. Given this scenario, answer the following:
For the integument to bleed or for tissue fluid to ooze from the abrasions, what layers must be damaged?

Answer 26

The correct answer is: epidermis and dermis
The epidermis is the layer of the skin which serves as a barrier to water loss, and the dermis is the layer of skin directly below the epidermis. For fluid to ooze from the abrasions, both of these layers must be damaged. Damaging other layers, such as the subcutaneous tissue or deep fascia, would not necessarily lead to fluid loss.

Question 27

7) What would be the most likely nerve damaged if a person had difficulty abducting their shoulder joint to the horizontal plane

Answer 27

a. Axillary nerve
i. Deltoid and teres minor
ii. But in clinical world: when knock out suprascapular- they pop it out
iii. Best clinical answer

Question 28

5) Which muscle would be the one most indicated if pt had difficulty with shoulder girdle retraction

Answer 28

Rhomboid major- pulls back scapula bc shoulder girdle

Question 29

3) What muscle attaches to lateral border of clavicle?

Answer 29

a. Answer: Teres minor

Question 30

2) Second polar body contains __ chromosomes

Answer 30

23, 1n

Question 31

1) when moving upper limb from anat position to the L what movement?

Answer 31

Elbow flexion

Question 32

The first axis of polarity n the embryo is

Answer 32

dorsal-ventral axis, formation of the epiblast and hypoblast

Question 33

the first site of blood formation is the
allantois
amnion
chroion
extraembryonic mesoderm
yolk sac

Answer 33

answer:
yolk sac
and a little later in the

Question 34

which of the following layers is the only one that fails to undergo an epithelial mesenchymal transformation during the second week of development?

Answer 34

ectoderm

3 layers come from epiblast
ectoderm- other 2 layers develop so it stays put

Question 35

woman has acute onset of pain in the lower left quad of abdomen. 2 months pregnant you suspect

Answer 35

tubal pregnancy

Question 36

molar pregnancy. due to fusion of 2 male pronuclei what tissues revealed?

Answer 36

absent embryo and large grape cluster placenta

males contribute to the placenta

Question 37

which button to increase gain on ultrasound keyboard? on the superficial side

Answer 37

A

Question 38

t1 MRI

Answer 38

H20- water opaque in T2

opposite for T1