Flashcards in Test Deck (61):
Which finger only has attachment of one lumbrical, one adductor interosseous muscle, and no abductor interossei?
The pinky has no abductor interossei because it has the abductor digit minimi brevis.
Which can cause foramen stenosis
Hypertrophy of Ligamentum flavin.
Bone spurs (osteophytes)
Bulging of the nucleus pulposus
Dislocation of the zygapophysial joint
Where would you enter for right side catherization?
Where would you enter for left side catherization?
Right side: femoral vein (makes sense)
Left side: femoral artery.
How would you palate a brachial artery in the cubital fossa?
It is superficial to the brachialis.
What does the saphenous nerve supply?
The saphenous nerve supplies sensation to the medial side of the ankle (medial malleolus).
What anastomosis will create circumscapular collateral flow?
Of four vessels.
1. Thoracoacromial artery
2. Transverse cervical
3. Suprascapular artery
4. Transverse cervical
The lumbar puncture...
Doesn't pass through the posterior longitudinal ligament.
During surgery of the axilla to remove malignant cells of the axillary lymph nodes
Surgeon does not enter the axillary sheath since the lymph nodes are outside it. Axillary vein is not in the sheath btw and is medial to it.
The long thoracic nerve is vulnerable to damage
The axillary lymph nodes on the right side normally drain into the right lymphatic duct.
Lymphatics are part of the vascular circulation.
Lymphatic drainage of the more distal parts of upper limb will be affected.
What is the key result of 4th week C folding and lateral folding?
To have the heart progenitor driven centrally to take its correct place in the thorax and develop into a heart.
Patient stands on right leg and pelvis tilts to the left, if the lesion is one of the collateral nerves of the lumbrosacral plexus, which other functional deficit would you find?
Pelvic tilt is caused by a weakness in the hip abductors. Hip abductors are innervated by the superior gluteal nerve. These muscles also medially rotate the hip
There is compression of the nerve by the piriformis muscle. Which special muscle would be affected?
Adductor magnus. Its a tricky one. Its medial but also has a posterior component
Which is the only medial thigh muscle that crosses both the hip and knee joints
Gracillis (groin muscle)
What would a tear of the iliotibial tract and medial meniscus cause?
Pain on the lateral side of the knee and her knee locks prematurely and knee locking is a meniscal tear
How does the anterior tibial artery enter the anterior compartment
It enters through a gap in the superior part of the interosseous membrane.
Which compartment of the leg does the fibular artery descend?
The posterior compartment
Where does the dorsalis pedis artery lie?
Between the tendon of the extensor hallucis longus and extensor digitorum longus muscle.
Where does the posterior tibial artery lie relative to the flexor digitorum longus tendon
Tom dick and very nervous harry.
Artery would lie posterior.
A women has abnormally thin trabeculae, why?
What is the primary product of osteoclasts
Diminished osteoblast activity
Secretes cathespsin K
Describe the order of muscles in full abduction
Supraspinatus> deltoids > trapezius > serratus anterior
A patient is unable to oppose the thumb and abduct digits 2-5. What likely nerve injury?
Injury to lower trunk because intrinsic hand muscles are all c8-T1
What is the most likely skeletal injury for radial nerve injury?
Fracture of the midshaft of the humerus
What is the name of channels that facilitate osteocyte communication within the osteon?
Which levels would you do lumbar puncture in an infant?
The conus medullaris is higher in adults so although L3-L4 is fine for adult, you need to go lower for a babe
What do each of these give rise to?
Neuroepithelium of neural tube
Neuroepithelium = neurons and neuroglia of the CNS
Neural crest=neurons and neuroglia of PNS
Nucleus pulposis = notochord
Myotome = skeletal muscle
Hyaline cartilage = epiphysis of long bones in newborn
Bone= diaphysis of long bones in newborn
What are tissues with polydactyl coming from?
Limb buds are derived from somatic mesoderm.
What would happen from a laceration of the peripheral nerve
Polyribosomes and ser in cell body would be redistributed
patient displaces shoulder posteriorly at time of right heel strike, what can you infer?
paralysis or paresis of the gluteus maximus and/or hamstrings
Patient enters right stance phase with a toe strike, this suggests...
Lesion of deep fibular nerve
Patient has knee fully extended and locked during midstance phase of gait. This suggests
Lesion of femoral nerve and weak quadriceps. You would want to hyperextend to knee to shift the axis of rotation at the knee closer to the force vector. You can't shift center of mass forward since hip wants to flex.
Patient has displacement of trunk toward right during right midstance phase of gait, what does this mean?
Weakness of abductor muscles on the right side. (Lesion of inferior gluteal nerve.
During heel strike of right lower limb, which muscle is relaxed?
On the other limb, you have the toe off. You are trying to put everything into plantar flexion so the thing relaxing is the dorsiflexors.
How would you identify a nerve as myelinated by electron microscopy?
Presence of basal lamina
A man has left hand weakness. He also has loss of sensation in the C8 dermatome, what was lesioned?
Sensory and motor loss so lesion of the ventral ramus
In a laminectomy, which ligament attaches to the laminae and needs to be partially removed.
What is the sequence of lumbar puncture to retrieve CSF
Skin, subcutaneous, supraspinous ligament, interspinous ligament, dura mater, arachnoid mater
Injury to middle trunk will affect which muscles?
Middle trunk only contains C7 so you would get weakness of lats and serratus anterior
where is the relative position of the tibialis posterior?
It is deep and in between the flexor digitorum longus and the flexor hallucis longus. Its tendon is what goes anterior to the posterior medial malleolus bundle.
What embryonic tissue gives rise to the notochord and what are the adult derivatives of the notocord?
It derives from the cells of the primitive pit.
It becomes the nucleus purposes of the intervertebral discs.
You ask a patient to make a fist, The patient flexes at digits 4 and 5 but is unable to flex at joints in digits 1-3
This is hand of benediction so thats injury to the median nerve in the distal arm.
When the lower limb enters the stance phase of gait she had heel strike followed by foot slap. A nerve injury could be?
Total lesion of L4 ventral root in the vertebral canal.
This man is having muscular dystrophy of his proximal thigh muscles. He is shifting his weight posteriorly, what is happening at his hip
It means he is relying more on his iliofemoral and ischiofemoral ligaments.
Not his quads obviously because he is having dystrophy and not swaying.
What is a nerve that carries innervation to muscle but not sensation?
The medial pectoral nerve (it has the medial brachial cutaneous nerve)
Which phase of gait is the quads the least active?
Deceleration of swing
Where is the radial nerve in the arm relative to muscles?
It is between the brachialis and brachioradialis muscles.
What proximal arterial occlusion would interfere with arterial supply to the posterior forearm?
The common interosseous artery because the occlusion is the posterior interosseous artery.
What muscles would further decrease flow in the anterior tibial vessels?
It is between the extensor hallucis and extensor digitorum muscles so dorsiflexion could compress the artery further.
A patient sprained her ankle by forcible inversion of her foot. What movements are involved in the mechanism of injury
Movement at the subtalalr and transverse tarsal joints.
Surgical neck fracture will result in movement of the distal fragment... what direction?
Medially (not inferiorly somehow. Ohhh delts?)
What could a fractured pisiform or hamate result in?
Radial deviation with flexion at the wrist. Abduction and adduction of fingers. And have clawing at fingers 4 and 5.
Adduct the thumb.
Which vessels contribute most to the thermal countercurrent mechanism.
The radial veins and veins in cubital fossa.
What is the correct steps in performing a lumbar puncture?
Between spinous processes, through the interspinous ligament, through the ligamentum flavum, past the epidural venous plexus, through the dura mater, the arachnoid mater and into the subarachnoid space
What would happen from a herniated C6/C7 disk?
Impingement of C7 nerve and radiating pain within the C7 dermatome and muscle weakness in the distal musculature of the forearm.
What does the dorsal mass of myoblast from the somitic mesoderm become in the limb bud and what is its innervation?
extensor muscles innervated by ventral rami of spinal nerves.
Where is the posterior tibial artery relative to the medial malleolus
Where is the dorsalis pedis artery relative to the extensor hallucis tendon?
Where is the radial artery relative to the flexor carpi radialis tendon?
Where is the ulnar artery relative to the flexor carpi ulnaris tendon?
Posterior tibial artery is POSTERIOR the medial malleolus
The dorsalis pedis artery is LATERAL to the extensor hallucis tendon (between that and the extensor digitorum)
Radial artery is LATERAL to the flexor carpi radialis tendon but medial to the nerve.
*The ulnar artery is lateral to the flexor carpi ulnaris tendon but the nerve is most medial. (Ulnaris is super lateral)
If the lateral chord is lesioned, what functional loss would not occur?
Intrinsic hand muscle actions because lateral chord only contains C5-C7. Anything else would be affected. DAYUM.
Which vein and artery run the closest to one another in the upper limb for artery to vein anastomosis?
Brachial artery and basilic vein.
If you had a fracture of the distal end of the humerus, where would the distal fragment get pulled?
It will get pulled posteriorly by the trapezius muscles.
Describe the path of the arteries in the lower limb
Common aorta then branches into the external and internal illiac arteries. The superior, inferior gluteal and obturator artery will branch off of the internal iliac artery
Then the external branch becomes the femoral branch and the deep femoral artery comes off of it.
Then the lateral and medial circumflex come off the deep femoral.
Next the femoral artery goes through the adductor canal and wraps medially behind the knee and becomes the popliteal artery. The popliteal artery branches and becomes the anterior and posterior tibial arteries. Then the fibular artery branches off the POSTERIOR tibial to go laterally.
The posterior tibial continues medially and becomes the lateral and medial plantar arteries. The anterior becomes the dorsalis pedis which runs medially inbetween the tendon of the extensor hallucis longus and the muscle of the extensor digitorum .
What happens during a femoral hernia?
-the hernia is within the femoral sheath and occurs in the femoral canal, the most medial shit.
-it enter the thigh by passing posterior to the inguinal ligament
-the hernia passes through an opening in the fascia lata used by the great saphenous vein.
What would occur from a T1/T2 herniation?
Impingement of T1 on left side
Pain in the T1 dermatome
Left pupil is much smaller than her right eye, can't reach the paravertebral vertebrae for sympathetic autonomic response.