anatomy revision.pptx

Anatomy Revision

Question 1

A patient present to hospital with a suspected fracture of their humerus. Where is the fracture most likely to be?A. Along the radial grooveB. At the surgical neckC. At the anatomical neckD. At the physiological neckE. Along the supracondylar line

Question 2

What structures are most at risk in a patient presenting with a fracture of the surgical neck of humerus?A. Brachial artery and musculocutaneous nerveB. Profunda brachii artery and radial nerveC. Basilic vein and median nerveD. Posterior circumflex humeral artery and axillary

nerveE. Anterior circumflex humeral artery and

suprascapular nerve

Question 3

How best would to assess a patient to determine if the axillary nerve has been damaged?A. Assess sensation over the regimental badgeB. Assess power of abductionC. Assess biceps tendon reflexD. Assess sensation of the C7 dermatomeE. Assess power of medial rotation

Question 4

If the axillary nerve were damaged, which of the following muscles would be most affected?A. Teres majorB. InfraspinatusC. SupraspinatusD. ScapularisE. Teres minor

Question 5

A patient present to hospital with a suspected dislocated shoulder. In which direction does the shoulder typically dislocate?A. Posterior inferiorlyB. Posterior superiorlyC. Anterior inferiorlyD. Anterior superiorlyE. Directly posteriorly

Question 6

An x-ray confirms the patients shoulder is dislocated. What structure or structures are at risk?A. Brachial arteryB. Basilic veinC. Axillary nerveD. Radial nerveE. Cephalic vein

Question 7

The musculocutaneous nerve is a terminal branch of the brachial plexus. What muscle does it pierce as it enters the anterior compartment of the arm?A. CoracobrachialisB. Biceps brachiiC. BrachialisD. DeltoidE. Triceps brachii

Question 8

A man presents after attempting to lift a heavy crate and feeling a pain in his left arm. Is unable to properly flex or supinate his arm. What structure is most likely to have ruptured?

A. Insertion of biceps brachii tendon

B. Tendon of long head of biceps

C. Tendon of short head of biceps

D. Tendon of triceps

E. Common flexor tendon

Question 9

A patient present with difficult abducting their arm in the first 15° of motion. Is could be due to damage of which nerve?A. Suprascapular nerveB. Lower subscapular nerveC. Upper subscapular nerveD. Axillary nerveE. Radial nerve

Question 10

Following a complicated birth, a neonate presents with a medially rotated arm, extended elbow and wrist and fingers flexed. Which of the following nerves is least likely to be affected?A. Suprascapular nerveB. Axillary nerveC. Ulna nerveD. Musculocutaneous nerve

Axillary Nerve innervates….

• T minor, deltoid• Skin over regimental badge• C5 and C6

Musculocutaneous Nerve innervates

• Anterior/flexor forearm compartment• Skin of lateral aspect of forearm• C5-7

• Pierces coracobrachilais• Becomes lateral cutaneous nerve

Radial nerve innervates

• C5-T1• Posterior compartment of arm – triceps and

aconeus• All posterior compartment of forearm• Sensory to posterior forearm, lateral 2/3 of

hand dorsum

Median Nerve innervates….

• C5-T1• All forearm compartment muscles EXCEPT

ulnar part of FDP• Adductor policis brevis, opponens pollicis,

superior head of FPB• Sensation to area of carpal tunnel

Ulnar nerve innervates….

• Flexor carpi ulnaris, medial half of FDP• Sensation over palarma distal dorsal 5th digit

and proximal side of 4th digit• Adductor pollicis, deep head of flexor pollicis

brevis

Most common spot for clavical fracture

Middle 1/3 on the lateral end

Winged scapula?

Injury to serratus anterior (long thoracic nerve)

Severed lower trunk of brachial plexus?

Klumpke Palsy

• Mostly ulnar and medial nerve intrinsic hand muscles affected

• Eg breech birth, catching a fall

Severed upper trunk of brachial plexus?

• Erb’s Palsy• Eg MVA• No abduction (axillary), forearm flexion (musc

cut), lateral rotation, supination

Thoracodorsal nerve injury?

• Lattisimus dorsi paralysis – cant raise trunk with lower limbs

• Eg surgery to axilla

Nerve that innervates rhomboids?

Dorsal scapular nerve

Which rotator cuff muscle most likely to be injured?

Supraspinatus

• Cant adduct limb slowly to 15 deg

Wrist drop?

Radial nerve palsy

• Saturday night palsy/honeymoon palsy• Handcuff neuropathy

Medial epicondylitis

Golfer’s elbow

• Hurts to flex forearm

Lateral epicondylitis?

Tennis elbow

• Injury to the forearm extensors

Mallet finger

• Avulsion of extensor tendon – cant extend distal IP

• Baseball finger

Median Nerve Injury

• Hand of benediction – only present when trying to make a fist

• Can’t do OK sign ‘pinch sign’

Ulnar nerve injury

• Claw hand• Injury looks less bad the higher up it is

Colles’ Fracture

Dinner Fork Deformity

• Fracture of distal end of radius, displaced dorsally

• Proximal radial fragment has posterior angulation

Scaphoid fracture

• Avascular necrosis risk due to poor blood supply

• Eg in FOOSH

Question 14

A positive Trendelenburg test indicatesA. Inferior gluteal nerve palsy of the raised legB. Inferior gluteal nerve palsy of the fixed legC. Superior gluteal nerve palsy of the raised legD. Superior gluteal nerve palsy of the fixed legE. Both inferior and superior gluteal nerve palsy

of the raised leg

Which drug for glaucoma?

A. α1-adrenoceptor agonists

B. α1-adrenoceptor antagonists

C. α2-adrenoceptor agonists

D. α2-adrenoceptor antagonists

E. β1-adrenoceptor agonists

α2-adrenoceptor agonists

Question 16

What is the sensitivity of the following screening test?

A. 40/55B. 35/45C. 40/50D. 35/50E. 50/100

Biopsy positive

Biopsy negative

Screening test positive 40 15 55

Screening test

negative10 35 45

50 50 100

Question 16

What is the sensitivity of the following screening test?

A. 40/55B. 35/45C. 40/50 true positive/positive test resultsD. 35/50E. 50/100

Biopsy positive

Biopsy negative

Screening test positive 40 15 55

Screening test

negative10 35 45

50 50 100

Question 44

Following a neurological examination of the lower limb, a patient presents with a + knee jerk reflex, decreased power of knee extension and is unable to feel vibration or pain sensation on the lateral aspect of their thigh. What structure is most likely to be affected?

A. Sciatic nerveB. Obturator nerveC. Femoral nerveD. Tibial nerveE. Common fibular nerve

Question 45

When completing an eye examination, an enlarged optic disc indicates

A. Clouding of the lensB. Altered curvature of the corneaC. Optic nerve atrophyD. Angiogenesis of the vessels of the eyeE. Increased intraocular pressure

Question 1

An elderly lady presents with osteoarthritis of her right hip. She is asked to stand on her right leg and her left hip drops. This is most likely due to weakness ofA. Left gluteus mediusB. Left gluteus minimusC. Right gluteus mediusD. Right gluteus minimusE. Left gluteus maximus

Question 2

A patient presents with a below the knee cast and complains that it is too tight. You are worried it might be compressing the common fibular nerve. Which of the following is most likely to be affectedA. Flexor digitorum longusB. Tibialis anteriorC. Flexor hallicus longusD. GastrocnemiusE. Soleus

Question 3

The lateral collateral ligament

A. Is longer than the medial collateral ligamentB. Is weaker and more likely to tear than the medial meniscusC. Is attached to the head of fibulaD. Is attached to the lateral meniscus

Question 4

A football player presents after being tackled and hearing a pop from his right knee. On examination there is significant forward sliding of the tibia on the femur. Which structure is most likely to have ruptured?A. MCLB. LCLC. PCLD. ACL

Question 5

A ballerina presents with an inversion injury. She has swelling and tenderness around the base of the 5th metatarsal. What structure is most likely to be damaged?A. Rupture of tibialis anterior tendonB. Rupture of tibialis posterior tendonC. Rupture of fibularis longus tendonD. Rupture of fibularis brevis tendonE. Rupture of flexor hallicus longus

Question 6

A elderly female patient presents with a fracture neck of femur and requires a hemiarthroplasty. Which artery most likely been damaged?A. Medial circumflex femoral arteryB. Lateral circumflex femoral arteryC. Superior gluteal arteryD. Inferior gluteal arteryE. Artery of ligament of head of femur

Question 7

A surgeon needs to insert a catheter into the femoral artery to perform an angiogram. The femoral artery can be found?A. At the mid-inguinal pointB. At the mid-point of the inguinal ligamentC. Medial to the femoral nerveD. Lateral to the femoral nerveE. A and CF. A and DG. B and CH. B and D

Question 8

A patient present with a positive Trendelenburg’s sign when raising their right leg. Which nerve is most likely affected?A. Right superior gluteal nerveB. Right inferior gluteal nerveC. Left superior gluteal nerveD. Left inferior gluteal nerveE. Sciatic nerve

Question 9

A patient complains of paraesthesia down the lateral side of their leg to their foot. It is found that the sciatic nerve is compressed. To exit the pelvis, the sciatic nerveA. Runs through the lesser sciatic foramenB. Runs through the greater sciatic foramen superior to

piriformisC. Runs through the greater sciatic foramen inferior to

piriformisD. Runs through the obturator foramenE. Runs deep to the inguinal ligament

Question 10

A footballer sustains an avulsion fracture to their semimembranosus of their right leg. Semimembranosus originates fromA. Ischial tuberosityB. Lateral lip of linea asperaC. Gluteal line of femurD. Great trochanterE. Ischiopubic ramus

Question 1

A footballer gets his index finger caught in an opponent’s jumper when attempting to tackle. There is no apparent deformity but he cannot flex the distal phalange of his index finger. This injury is most likely aA. Rupture of the flexor digitorum profundusB. Rupture of the flexor digitorum superficialisC. Rupture of extensor indicisD. Rupture of the distal collateral ligamentE. Rupture of the extensor hood

Question 2

Which of the following bones is not connected to the flexor retinaculum? A. ScaphoidB. LunateC. TrapeziumD. HamateE. Pisiform

Question 3

Which of the carpal bones is mostly commonly fractured on a fall on an out stretched hand?A. 1B. 2C. 3D. 4E. 5 12

3 54

Question 4

A patient presents with pain and paraesthesia in their thumb, index and middle fingers. What nerve is mostly likely affected?A. Ulna nerveB. Radial nerveC. Median nerve D. Superficial branch of the radial nerveE. Superficial branch of the ulna nerve

Question 5

The patient is diagnosed with carpal tunnel syndrome. Which of the following structures does not pass through the carpal tunnel?A. Tendons of flexor digitorum profundusB. Tendons of flexor digitorum superficialisC. Median nerveD. Tendon of flexor pollicis longusE. Tendon of flexor carpi radialis

Question 6

The patient later admits to experiencing some weakness in their hand too. Which muscles are most likely to be affected?A. Dorsal interosseiB. Palmar interosseiC. Hypothenar muscleD. Thenar musclesE. Palmaris brevis

Question 7

A doctor wishes to insert a short-term IV cannula into the cephalic vein. Where can it be easily found and accessed?A. Lateral to the styloid process of the ulnaB. Between the index and middle fingers on the

dorsum of the handC. Over the anatomical snuffboxD. Medial to the styloid process of the radius

Question 8

A patient presents with a spiral fracture of the humerus. Which of the following actions is most likely to be affected?A. Flexion of the wristB. Extension of the wristC. PronationD. SupinationE. Flexion of the elbow

Surgical neck of humerus, what nerve?

Axillary nerve

Radial groove on humerus, which nerve, what fracture?

• in spiral fracture• Radial groove radial nerve

Distal end of humerus, what nerve is affected?

Median nerve

Medial epicondyle; what nerve is affected

Ulnar nerve

Nerve roots in brachial reflex?

Which part of the brachial plexus is endangered if the clavicle is fractured?

Divisions

Femoral nerve injury

• How• Motor and sensory deficits?

• Hip/pelvic fracture• Stab/gunshot

• Motor: knee extension and thigh flexion• Sensory: anterior and medial thigh & lower leg

Obturator nerve injury

• How• Motor/sensory deficits

• Anterior hip dislocation

• Motor: thigh adduction• Sensory: medial thigh

Lateral cutaneous nerve of thigh injury


Meralgia paraesthesia

• Compression near ASIS

• Sensory: lateral and posterior thigh

LL reflexes….

• Knee L3/4 (femoral)

• Ankle S1/S2 (sciatic)

• Babinski L5/S1

Tibial Nerve Injury


• Posterior knee dislocation• Rare – popliteal laceration

• Motor: foot plantar flexion and inversion• Sensory: sole of foot

Common peroneal nerve injury


• Injury at neck of fibula• Tightly applied lower limb plaster case

• FOOT DROP• Motor – foot dorsiflexion and eversion, great

toe extension• Sensory – dorsum of foot and lower lateral

part of leg

Superior gluteal nerve injury


• Misplaced IM injection• Hip surgery, pelvic #• Posterior hip dislocation

• Motor: hip abduction• Positive trendelenburg sign

Inferior gluteal nerve injury


• In association with sciatic nerve injury

• Can’t jump or climb stairs• Can’t rise from seated position

• Motor: hip extension an lateral rotation

Superficial vs deep fibular nerves

• Deep foot drop; does sensory between 1st and 2nd toes

• Superficial can’t evert foot, does sensory for dorsum of foot except between 1st and 2nd toes

Effect of cutting B? Function of E? Action of D?

• B – sensory loss to medial 1.5 digits = ulnar nerve

• E = abductor pollciis brevis – abducts thumb at 1st MP joint

• D – lumbricals. Flex MP, extend IP via insertion into dorsal digital expansion

Effect of severance of the nerves?

• A – axillary nerve. Loss of deltoid, loss of sensation over lateral aspect of shoulder/upper arm

• B – radial nerve. Loss of power in triceps (not all of it). Loss of all forearm extensors, snesation on dorsum of forearm and part of hand (snuffbox)

• C – ulnar nerve. Loss of sensation to medial forearm and medial 1.5 digits. Loss of FCU, ½ of FDP and intrinsic hand muscles

What are C, D, E?

• C = talus neck• D = navicular• E = cuneiforms (intermediate)

What dermatomes?

• 10: L5• 11: S1

Borders and clinical importance of the femoral triangle

• Inguinal ligament superiorly• Meidal border or sartorius laterally• Medial border of adductor longus medially• Floor: pectineus

• Importance:– Placement of femoral nerve blocks– Femoral artery puncture– Femoral hernias

• Contents; NAVY– Nerve– Artery– Vein– Y (between the legs)

Mid inguinal point vs mid point of inguinal ligament

• Mid inguinal point: halfway between ASIS and pubic symphysis– Femoral ARTERY

• Mid point of inguinal ligament– Femoral NERVE

Where can you inject in the LL (2 spots)

• Gluteal upper outer quadrant• Middle third of vastus lateralis in the thigh

Three mechanisms for ACL injury

• Lead, land (+/- hyperextension) and collapse• Running, change direction and collapse• Collision

• ‘Pop sound’• Swelling in < 2 hours

Haemarthrosis in knee injury

ACL tear

Mechanism of injury to PCL?

Big hit to anterior aspect of proximal tibia

• MVA, knee hits dashboard• Ruck contest• Knee bangs onto hard ground

• O/E – medial joint line, tibia sunk backards

Knee unhappy triad?

• MCL• Medial meniscus tear• ACL

Most common ligament for ankle sprain

Anterior talo-fibular ligament

• What comes out of each of the pelvic foramen?

• Greater sciatic – sciatic nerve, piriformis, pudendal nerve

• Lesser sciatic - pudendal nerve (S2-4), obtruator internus

• Obturator – obturatory nerve, artery

Differences between above and below the pectinate/dentate line?

• Above:– Columnar epithelium– IMA derived B.S, portal venous– Visceral motor with no pain fibres– Internal iliac LN

• Below:– Keratinised, stratified epithelium– IIA derived BS, systemic venous– Somatic motor nerves– Superficial inguinal LN

• A 14 year-old male presents to his GP one- week following internal fixation of an ankle fracture. He complains of the plaster cast being tight, and suffers anaesthesia and paraesthesia in the leg and foot. Upon removal of the cast you notice an inability to extend the ankle to any degree. Which nerve is most likely involved?

• Common fibular (peroneal) • Tibial • Superficial fibular • Deep fibular • Sural

Common fibular (peroneal)

• A patient has a restricted ability to invert the foot. You suspect that the patient has a peripheral neuropathy, but affecting which nerve?

• Sural • Tibial • Superficial fibular • Deep fibular • Common fibular

Tibial Nerve

• Which of the following muscle attaches distally to the 1st metatarsal?

• Tibialis posterior • Flexor digitorum longus • Fibularis longus • Fibularis tertius • Flexor hallicus longus

Fibularis longus

anatomy revision.pptx

Documents

humeral artery

patient present

suspected fracture

suspected dislocated

surgical neckat

axillary nerveanterior

brachial plexus

patients shoulder