Gross Anatomy Questions That Should be Answerable After October 27, 2017

Transcription

1 Gross Anatomy Questions That Should be Answerable After October 27, The inferior angle of the scapula of a woman who was recently in an automobile accident seems to protrude making a ridge beneath the skin of her back. Paralysis of either of two muscles can produce this condition known as winging of the scapula. Name these two muscles and the nerves that innervate them: Describe what test(s) you could perform to determine which muscle has been affected, including how the result(s) would indicate one muscle or the other. 2. Trace one alternative route of blood flow around an obstruction located between the second and third parts of the subclavian artery 3. The following are motor symptoms of nerve damage. In each case, name the single nerve that has most likely been damaged and the muscle(s) whose paralysis has(have) produced the symptom: (a) weakness of abduction and flexion of the arm 4. What are the borders of the quadrangular space? What important structures pass through this space? 5. The so-called "waiters-tip" position of upper limb (medially rotated arm with extended and pronated forearm) is associated with damage to what structure? Explain the specific underlying reasons for two of the symptoms associated with condition. 6. An angiogram of the vasculature of a patient s upper limb reveals plaque build up that completely obstructs the first part of the axillary artery, yet he suffers no symptoms associated with ischemia of the limb. Trace one alternative route of blood flow by-passing the obstruction.

2 7. Due to a fall from her bicycle, a young woman suffers a fracture of the surgical neck of her humerus. What nerve is in jeopardy from the fracture? If this nerve was injured, what muscles would be affected? What motor test could you perform to test for damage to this nerve? 8. For the following symptoms or signs, name the nerve and muscle(s) that are most likely to be associated with the following deficits: (a) Marked weakness of lateral rotation of the upper arm 9. Label the 17 indicated parts of the right brachial plexus. Place the letter A on the portion of the plexus that could be injured by an attempt to help promote passage of the shoulders of a neonate during delivery by laterally flexing the child s neck and pulling Place the letter B on the portion of the plexus that could be injured by an attempt to help deliver a neonate s trunk by pulling on an outstretched arm Using the letters A and B again, indicate which, if either, of these injuries would result in the following symptoms: wasting of the thenar and hypothenar eminences paralysis of abduction and lateral rotation of the upper arm weakness of supination of the forearm sensory loss over the lateral side of the forearm sensory loss over the medial side of the forearm

3 10. The inferior angle of the right scapula of a woman who had undergone a right radical mastectomy protrudes making a ridge beneath the skin of her back. The ridge gets more pronounced when she flexes her arm, but seems to diminish when she abducts her arm. What nerve(s) and muscle(s) have been damaged? What motor test could you perform to verify your diagnosis? 11. Name the nerve (specifying the branch if that has its own specific name) and muscle(s) associated with the following deficits: a) weakness when attempting to extend and medially rotate the upper limb (as in swimming) b) arm hangs in an adducted, medially rotated position with elbow extended and forearm pronated 12. Following a fracture of the proximal end of her humerus, a woman complains of difficulty in raising her arm, and upon examination her physician notes a flattened appearance to her shoulder and a slight hollow inferior to the acromion. What is the most likely explanation for her condition? What motor test could you perform to test the validity of your diagnosis? 13. Trace one alternative route of blood flow around an obstruction at second part of the axillary artery. 14. The man in the image below has been asked to lean against the wall on his hands. What is the name of the symptom he displays? Name the nerve that has been damaged and the muscle that has been paralyzed: If after lowering his arms he abducted his right arm at the shoulder, would his condition likely get better or worse?

4 15. Trace one alternative route of blood flow around an obstruction of the brachial artery just proximal to the cubital fossa. 16. The following are motor symptoms of nerve damage. In each case, name the single nerve that has most likely been damaged and the muscle(s) whose paralysis has(have) produced the symptom: (a) severe weakness of forearm flexion (c) inability to pronate forearm 17. If the musculocutaneous nerve was damaged at the point were it comes off of the brachial plexus, what muscles would be affected? Describe the motor deficits you would expect to see. Where would you test for loss of sensation due to damage of the musculocutaneous nerve? 18. A man stumbles and falls breaking the medial epicondyle of his humerus. What nerve is in jeopardy from this fracture? What impact would this injury have on the man s ability to flex his elbow? What impact would this injury have on the man s ability to flex his wrist? 19. For the following symptoms or signs, name the nerve and muscle(s) that are most likely to be associated with the following deficits: (a) Inability to extend the elbow against resistance 20. Name the nerve (specifying the branch if that has its own specific name) and muscle(s) associated with the following deficits: a) inability to extend the elbow except by gravity 21. Name a nerve and artery in close proximity to each of the following osteological structures: a) medial epicondyle of the humerus c) humeral midshaft

5 22. A nurse has been instructed to give a patient a venous injection. She palpates the cubital fossa of the patient s right arm. What vessel suitable for injection is she looking for? She detects a pulse in the vessel she has felt, so she switches to the left arm. What anatomical anomaly has she identified causing her to switch to the left side? Explain why a potentially serious injury could have resulted if she had proceeded with the injection into the patient s right arm. 23. Match the following muscles with the correct attachment sites: (There may be more than one correct answer, and answers can be used more than once) biceps brachii A. humeral greater tuberosity I. acromion coracobrachialis B. humeral lesser tuberosity J. supraglenoid tubercle triceps brachii C. head of the radius K. infraglenoid tubercle subscapularis D. olecranon process L. clavicle supraspinatus E. head of the ulna M. proximal phalanges flexor carpi radialis F. radial tuberosity N. middle phalanges pronator teres G. medial epicondyle O. distal phalnges deltoid H. coracoid process FDP FDS 24. Name the nerve and artery located in the cubital fossa. 25. What muscle(s) attaches to the following bony elements? (a) ventral surface of the scapular blade (b) radial tuberosity (c) olecranon process (d) greater tubercle of the humerus (e) deltoid tuberosity (f) ventral surface of distal phalanx of the thumb 26. For each of the following, name the nerve and artery related to the indicated structure or space: (b) the medical epicondyle of the humerus 27. For the following symptoms or signs, name the nerve and muscle(s) that are most likely to be associated with the following deficits: (a) marked weakness of flexion of the forearm at the elbow

6 28. Why should you always feel for a pulse prior to performing an injection into the medial cubital vein? What potentially serious injury could result from failing to do so? 29. While horseback riding, a girl falls onto her right out-stretched hand. In the emergency room, she complains severe pain in her shoulder, and the ER physician notes that the distal end of her right clavicle is quite prominent. What is the most likely explanation for her condition? What structures had to have been damaged for this condition to develop? 30. From the list below, circle the names of those structures that contribute to glenohumeral joint stability: (All must be correct to receive credit) negative atmospheric pressure rotator cuff tendons glenohumeral ligaments subacromial bursa interlocking bony articular surfaces coracoacromial ligaments 31. What anatomical structures are most important in helping to prevent shoulder separation (dislocation of acromioclavicular joint)? 32. During a game of touch football, a player pushes backward on the quarterback s arm just as he is about to throw the ball. He screams in pain, clutching his shoulder. What injury has he probably suffered? Explain in reference to anatomy why the quarterback was prone to this injury in this circumstance. 33. While ice-skating, a girl loses her balance and falls sideways onto her outstretched left hand. In the emergency room, she complains of pain and swelling around the shoulder, and the ER physician notes that the distal end of her left clavicle is quite prominent. What is the most likely explanation for her condition? What structures had to have been damaged for this condition to develop? 34. What is meant by the term shoulder separation? What anatomical structures are most important in preventing this undesirable event?