Anatomy - Practice Questions
2.Which of the following structures contain the cell bodies of voluntary motor neurons? A. ventral horn of gray matter B. dorsal horn of gray matter C. intermediolateral cell columns of gray matter D. dorsal root ganglia E. paravertebral ganglia
A. ventral horn of gray matter
In this same patient, which of the following ligaments prevents posterior displacement of the tibia on the femur? A. oblique popliteal ligament B. anterior cruciate C. posterior cruciate D. lateral collateral E. medial collateral
C. posterior cruciate
2. An elderly woman fell at home and fractured the greater trochanter of her femur. Which of the following muscles would continue to function normally? A. piriformis B. obturator internus C. gluteus medius D. gluteus maximus E. gluteus minimus
D. gluteus maximus
Spondylosis
Degeneration of the spine (e.g., osteoarthritis, bone spurs)
A 42 year old man is brought to the ER complaining of intense pain in his left calf and ankle. During a tennis match he states that he heard a snap", fell to the court and could not walk. On examination, the left calf is tender with an irregular mass noted in the back of the midcalf area. What type of excessive abnormal ankle movement would be present?
Dorsiflexion of foot at ankle
5. A patient experiences weakness when abducting and medially rotating the thigh after an accident. Which of the following muscles is most likely damaged? A. piriformis B. obturator internus C. quadratus femoris D. gluteus maximus E. gluteus minimus
E. gluteus minimus
Spondylitis
Inflammation of the spine
A 7 year old boy steps on a shell while walking to the beach. He receives a tetanus shot at the hospital and the wound is cleaned and sutured. One week later, you notice that he has inflammation and pain on the lateral plantar surface of his foot. Which nerves supply sensation from this area? Which group of lymph nodes will first receive lymph from the infected wound?
Lateral plantar nerve - branch of tibial nerve Popliteal nodes - lymphatics generally follow the veins, which in this case would be the small saphenous vein. This vein empties into the popliteal vein in the popliteal fossa.
Which of the following ligaments best resists anterior dislocation of the head of the femur? A. Iliofemoral ligament B. Pubofemoral ligament C. Ischiofemoral ligament D. Ligament of the head of the femur E. Anterior cruciate ligament
A. Iliofemoral ligament
2. Name the muscle(s) that inserts into the iliotibial tract A. The tensor fascia lata muscle B. The tensor fascia lata and sartorius muscles C. The rectus femoris muscle D. The rectus femoris and sartorius muscles
A. The tensor fascia lata muscle
During a surgical procedure in the posterior compartment of the thigh, care is taken to preserve the arterial blood supply to the muscles in that region. These are branches of which of the following arteries? A. deep femoral B. femoral C. superior gluteal D. inferior gluteal E. obturator
A. deep femoral
4. A deep laceration, 2 cm in length, immediately posterior to the medial malleolus, may injure any of the following EXCEPT: A. fibular artery B. tibial nerve C. tendon of tibialis posterior D. tendon of flexor digitorum longus E. tendon of flexor hallucis
A. fibular artery
1. While paying football, a 19 year old student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred? A. tear of medial meniscus B. rupture of fibular collateral ligament C. tenderness on pressure along the fibular collateral ligament D. injury of the posterior collateral ligament E. swelling in the back of the knee joint
A. tear of medial meniscus
1. A patient experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint. Which of the following muscles was involved? A. vastus lateralis B. semimembranosus C. sartorius D. biceps femoris (long head) E. rectus femoris
A. vastus lateralis
A 42 year old diabetic woman complains of soreness of the left leg. She is moderately obese and has been recovering from surgical removal of her gall bladder two weeks ago. On examination, she has obvious swelling in the left lower leg and some tenderness of the calf that increases when the calf is gently squeezed. What structure is most likely affected?
Anterior and posterior tibial veins and fibular veins.
While skiing, a 25 year old woman falls and twists her right leg. She cannot stand on her right leg due to pain and her knee is swollen and tender. While the patient is sitting on the examination table with her knee flexed, you notice that the lower leg seems to have several centimeters of excess anterior mobility. What is the most likely diagnosis?
Anterior cruciate ligament (ACL) tear
A 52 year old man reports that he develops a cramp in his left leg after walking 100 yards and you are concerned about intermittent claudication (cramping induced by exercise) in this patient because of recurring leg pain. To determine if this condition exists, you want to test your patient's posterior tibial pulse. To do this where would you place your finger? A. Between the lateral malleolus and the Achilles (calcaneal) tendon B. Between the medial malleolus and the Achilles (calcaneal) tendon C. In the popliteal fossa D. Between the gastrocnemius and the tibialis anterior on the lateral side of the leg E. On the neck of the fibula
B. Between the medial malleolus and the Achilles (calcaneal) tendon
Your 48-year-male patient has a rare condition of adductor canal syndrome that has varied clinical presentations related to compression of structures within that canal. Which of the following structures would not be involved in this syndrome because it never traverses any part of the canal? A. Superficial femoral artery B. Femoral nerve C. Femoral vein D. Nerve to vastus medialis E. Saphenous nerve
B. Femoral nerve
6. Which of the following is true of the anterior cruciate ligament? A. It becomes tight during flexion of he leg B. It resists posterior displacement of the femur on the tibia C. It inserts into the medial femoral condyle D. It helps prevent hyperflexion of the knee joint E. It is lax when the knee is extended
B. It resists posterior displacement of the femur on the tibia
A 32-year-old male cuts the medial aspect of his mid-thigh when climbing over a barbed wire fence. Five days later he reports an infected wound, high fever (102.7°), and lymphadenitis (swollen lymph nodes). Given the location of the injury, which groups of nodes would be the first to receive drainage from the infected wound? A. Popliteal B. Superficial inguinal C. Deep inguinal D. Axillary E. External iliac
B. Superficial inguinal
1. In which part of the spinal cord do motor fibers originate? A. Dorsal horns B. Ventral horns C. Intermediolateral cell colums D. Dorsal root ganglia
B. Ventral horns
5. A 34 year old woman is admitted to the emergency department after a car crash. Radiographic examination reveals a whiplash injury in addition to hyperextension of her cervical spine. Which of the following ligaments will most likely be injured? A. ligamentum flavum B. anterior longitudinal ligament C. posterior longitudinal ligament D. anulus fibrosus E. interspinous ligament
B. anterior longitudinal ligament
5. During an inversion sprain of the ankle joint, which of the following ligaments are most likely injured? A. calcaneonavicular B. calcaneofibular C. long plantar D. posterior tibial E. deltoid
B. calcaneofibular
A 54 year old man has just dislocated his right hip. You are concerned about the integrity of the joint's blood supply. Which artery is the main blood supply to the hip joint? A. lateral circumflex femoral B. medial circumflex femoral C. superficial circumflex iliac D. deep circumflex iliac E. perforating
B. medial circumflex femoral
10. An obstetrician uses caudal anesthesia during labor abd childbirth to block spinal nerves in the epidural space. Local anesthetic agents are most tlikely injected via which of the following openings? A. intervertebral foramen B. sacral lhiatus C. vertebral canal D. dorsal sacral foramen E. ventral sacral foramen
B. sacral lhiatus
7. An X-ray of a 58 year old patient reveals that the L3 vertebra has slipped anteriorly on the L4 vertebra. What is the proper name of this condition? A. spondylolysis and spondylolisthesis B. spondylolisthesis C. Hangman's fracture D. intervertebral disk herniation E. von Munchhausen fracture
B. spondylolisthesis
A patient's ankle joint will have the greatest stability when: A. the knee is flexed B. the foot is dorsiflexed C. the foot is plantarflexed D. the foot is everted E. the foot is everted
B. the foot is dorsiflexed
3. A patient exhibits a loss of sensation and paralysis of muscles on the plantar aspect of the medial side of the foot. Which of the following nerves is most likely damaged? A. common peroneal B. tibial C. superficial peroneal D. deep peroneal E. sural
B. tibial
You have examined a patient and find there is weakness in the ability to flex the knee. This indicates a problem with which of the following nerves? A. femoral B. tibial C. common fibular D. deep fibular E. superficial fibular
B. tibial
Your patient is unable to walk on her tip-toes. You immediately suspect damage to whichof the following nerves? A. sural nerve B. tibial nerve C. common fibular nerve D. superficial nerve E. deep fibular nerve
B. tibial nerve
A 25-year-old man is brought into the ER with a high fever, lethargy, and a stiff neck. After taking a history and performing a physical exam, you strongly suspect meningitis. In order to find cause of his problem, you order a lumbar puncture. At which vertebral level along the vertebral column is a needle inserted for a lumbar puncture? Which landmark can you use to find this level?
Between the L3 and L4 or L4 and L5 vertebrae, using the iliac crest (at L4) as a guide
A 25 year-old basketball player injured his right ankle after jumping and landing on his foot in an awkward position. A physical exam reveals a severe inversion sprain of the ankle. Which of the following structures is most commonly damaged in such injuries? A. Deltoid ligament B. Tibial nerve C. Anterior talofibular ligament D. Posterior talofibular ligament E. Plantar aponeurosis
C. Anterior talofibular ligament
3. A patient presents with thrombosis in the popliteal vein. This thrombosis most likely causes reduction of blood flow in which of the following veins? A. greater saphenous B. lesser saphenous C. Femoral D. posterior tibial E. anterior tibial
C. Femoral
Your 45-year-old patient has sciatica that did not respond to initial medical treatment. MRI shows no disc herniation that would explain her symptoms. Careful clinical evaluation is now suggesting the presence of piriformis syndrome, which results from which of the following? A. Paralysis of the piriformis muscle B. Spasticity of the muscle resulting in difficulty walking C. Hypertrophy of the muscle resulting in compression of the sciatic nerve or one of its components D. Hypertrophy of the muscle resulting in compression of the pudendal nerve E. Hypertrophy of the muscle resulting in compression of the obturator nerve
C. Hypertrophy of the muscle resulting in compression of the sciatic nerve or one of its components
A 45 year old man complains of shooting pain down his right leg that worsens with sitting and coughing. He also has some numbness in the area. You test sensation on the lateral thigh region. Which of the following nerve roots is being tested? A. L1 and l2 B. L2 and l3 C. L4 and L5 D. S1 and S2 E. S3 and S4
C. L4 and L5
A 16-year-old male soccer player was brought to the ER because of the acute lower back pain he experienced after performing a high-velocity kick of the ball. The given right posterior oblique X-ray reveals pathology within the L5 vertebra that has the appearance of a "headless Scottie Dog" when outlined. Based upon the X-ray results, which of the following diagnoses is the most likely cause of his lower back pain? A. Ankylosing spondylitis B. High-grade spondylolisthesis C. Spondylolysis D. Spondylitis
C. Spondylolysis The X-ray indicates a fracture of the pars interarticularis, a.k.a spondylolysis
A patient is involved in a motor vehicle accident and subsequently experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint. Which of the following muscles is involved? A. Semimembranosus B. Sartorius C. Vastus lateralis D. Biceps femoris (long head) E. Rectus femoris
C. Vastus lateralis Rectus femoris originates on anterior inferior iliac spine
6. A 20 year old football player receives a blow on the inferolateral side of the left knee. An X-ray indicates a fracture of the head and neck of the fibula. Which of the following nerves us most likely damaged? A. sciatic B. tibial C. common peroneal D. deep peroneal E. superficial peroneal
C. common peroneal
1. A patient presents with sensory loss on adjacent sides of the big toe and second toe and impaired dorsiflexion of the foot. These signs probably indicate damage to which of the following nerves? A. superficial peroneal B. lateral plantar C. deep peroneal D. sural E. tibial
C. deep peroneal
7, After injurry to this nerve which of the followng muscles could be paralyzed? A. gastrocnemius B. popliteus C. extensor hallucis longus D. flexor digitorum longus E. tibialis posterior
C. extensor hallucis longus
4. If the acetabulum is fractured at its posterosuperior margin by dislocation of the hip joint, which of the following bones could be involved? A. pubis B. ischium C. ilium D. sacrum E. head of femur
C. ilium
9. If a person's spinal cord is crushed at the level of the 4th lumbar spinal segment, which of the following structures would most likely be spared from destruction? A. dorsal horn B. ventral horn C. intermediolateral cell column D. gray matter E. pia mater
C. intermediolateral cell column
In a patient who has a posterior dislocation of the hip, which of the following ligamentous structures would be torn? A. pubofemoral ligament B. iliofemoral ligament C. ischiofemoral ligament D. sacrotuberous ligament E. ilioinguinal ligament
C. ischiofemoral ligament
7. Injuries involving rupture of the anterior cruciate ligament (ACL) often involve which other structures associated with the knee joint A. Lateral meniscus B. Lateral collateral meniscus C. medial meniscus D. Pes anserinus
C. medial meniscus
2. A 12 year old female slips and falls on the bathroom floor. As a result, she has a posterior dislocation of the hip joint and a fracture of the neck of the femur. Rupture of the ligament of the head of the femur may head to damage to a branch of which of the following arteries? A. medial femoral circumflex B. lateral femoral circumflex C. obturator D. superior gluteal E. inferior gluteal
C. obturator
5. When one sits down in a chair from a standing position with the feet planted on the floor, the knee unlocks by having the____________________ A. popliteus muscle medially rotate the femur on the tibia B. popliteus muscle medially rotate the tibia on the femur C. popliteus muscle laterally rotate the femur on the tibia D. popliteus muscle laterally rotate the tibia on the femur E. none of the above
C. popliteus muscle laterally rotate the femur on the tibia
3. A 24-year old women comes to her physician with weakness in flexing the hip joint and extending the knee joint. Which muscle is most likely involved in this scenario? A. sartorius B. gracilis C. rectus femoris D. vastus medialis E. semimembranosus
C. rectus femoris
3. The woman undergoes hip surgery. If all of the arteries that are part of the cruciate anastamosis of the upper thigh are ligated, which of the following arteries maintains blood flow? A. medial femoral circumflex B. lateral femoral circumflex C. superior gluteal D. inferior gluteal E. first perforating
C. superior gluteal
4. A patient with a knife wound in the buttocks walks with a waddling gait that is characterized by the pelvis falling toward one side. Which of the following nerves is damaged? A. obturator nerve B. nerve to obturator internus C. superior gluteal nerve D. inferior gluteal nerve E. femoral nerve
C. superior gluteal nerve
6. A 16 year old boy suffers a stab wound to the gluteal region. If an examination of the wound reveals that the knife blade entered the pelvis above the piriformis muscle, which of the following structures is most likely to be damaged? A. sciatic nerve B. internal pudendal artery C. superior gluteal nerve D. inferior gluteal artery E. posterior femoral cutaneous nerve
C. superior gluteal nerve
2. A construction worker is hit on the leg with a concrete block and us subsequently unable to plantarflex and invert the foot. Which of the following muscles is most likely damaged? A. extensor digitorum longus B. tibialis anterior C. tibialis posterior D. peroneus longus E. peroneus brevis
C. tibialis posterior
A 42 year old man is brought to the ER complaining of intense pain in his left calf and ankle. During a tennis match he states that he heard a snap", fell to the court and could not walk. On examination, the left calf is tender with an irregular mass noted in the back of the midcalf area. What is the most likely diagnosis?
Calcaneal (Achilles) tendon rupture
During a basketball game your 25 year-old-patient severely and violently inverted his foot and now has sharp pain along the lateral margin of his foot, slightly anterior to his cuboid bone. What do you suspect? A. Fracture of the 4th metatarsal B. Fracture of the proximal phalanx of the 5th toe C. Sprain of the deltoid ligament D. Avulsion fracture of the tuberosity of the 5th metatarsal E. Fracture of the navicular bone
D. Avulsion fracture of the tuberosity of the 5th metatarsal
A 52-year-old construction worker complained of pain in his lower back that spreads down the back of his right leg. He consulted his family doctor who examined him and said that he had symptoms of a herniated IV disc. Which of the following statements about IV discs is most accurate? A. Flexion of the vertebral column compresses the posterior part of the IV discs. B. They are found between all adjacent vertebrae C. Is perforated by a needle when performing a lumbar puncture D. Herniation of the nucleus pulposus of an IV disc usually occur posterolaterally E. The water content of the nucleus pulposus increases with age
D. Herniation of the nucleus pulposus of an IV disc usually occur posterolaterally Compresses the anterior part of the disk None in sacral region Disks are found anterior to lumbar cistern Water content decreases with age
A 24-year-old football player was hit in the posterolateral aspect of the right knee. Examination of the player indicated that his right leg was unstable with widening of the medial joint space, but that there was no anterior or posterior tibial displacement. Radiographs and MRIs revealed a knee injury. Which of the following statements best describes the knee injury that most likely occurred? A. Tearing of both the medial and lateral meniscus B. Rupture of the anterior cruciate ligament C. Rupture of the posterior cruciate ligament D. Rupture of the tibial (medial) collateral ligament and tearing of the medial meniscus E. Rupture of the fibular (lateral) collateral ligament and tearing of the lateral meniscus
D. Rupture of the tibial (medial) collateral ligament and tearing of the medial meniscus The medial meniscus is often torn when the medial collateral ligament is ruptured (along with the ACL - the "Unhappy Triad") because the two structures are attached
The chief deep veins of the leg that are of concern for deep venous thrombosis are the: A. small saphenous vein B. great saphenous vein C. deep femoral vein D. anterior and posterior tibial veins E. obturator vein
D. anterior and posterior tibial veins
4. It is common for intervetebral disks to shrink in people older than 40 and it can result in spinal stenosis and herniation. At which locations are the spinal nerves most likely to be compressed? A. between the denticulate ligaments B. as they pass through the vertebral foramen C. between the superior and inferior articular facets D. between inferior and superior vertebral notches E. between the superior and interior intercostovertebral joints
D. between inferior and superior vertebral notches
3. Pain from irritations of the skin of the back is conveyed to the central nervous system by which of the following? A. intercostal nerves B. ventral roots C. ventral primary rami D. dorsal primary rami E. splanchnic nerves
D. dorsal primary rami
5, A 25 year old woman is bitten by a dog on the foot, severing an artery on the dorsum of his foot just below his ankle. Which artery has been severed? A. anterior tibial B. lateral plantar C. medial plantar D. dorsalis pedis E. posterior tibial
D. dorsalis pedis
9. What is the function of the muscle at the tip of the arrow? (medial hamstring) A. medial rotation of thigh at hip B. lateral rotation of thigh at hip C. abduction of thigh at hip D. flexion of leg at knee E. extension of leg at knee
D. flexion of leg at knee
5. Which of the following structures does not lie in the adductor canal? A. superficial femoral artery B. femoral vein C. saphenous nerve D. great saphenous vein E. nerve to vastus medialis
D. great saphenous vein
2. Fracture of the neck of the femur results in avascular necrosis of the femoral head, probably resulting from lack of blood supply from which of the following arteries? A. obturator B. superior gluteal C. inferior gluteal D. medial femoral circumflex E. lateral femoral circumflex
D. medial femoral circumflex
1. During a spinal tap procedure, which of the following spaces is cerebrospinal fluid withdrawn? A. epidural space B. subdural space C. space between the spinal cord and pia mater D. subarachnoid space E. space between arachnoid and dura mater
D. subarachnoid space
You are concerned that your patient's deltoid ligament may have been torn from its proximal attachment. Which of the following would you palpate for tenderness? A. the medial aspect of the tibial shaft B. the lateral aspect of the fibular shaft C. the lateral malleolus D. the medial malleolus E. the calcaneous
D. the medial malleolus
You are concerned that your patient's medial deltoid ligament may have been torn from its proximal attachment. Which of the following would you palpate for tenderness? A. the medial aspect of the tibial shaft B. the lateral aspect of the fibular shaft C. the lateral malleolus D. the medial malleolus E. the calcaneous
D. the medial malleolus
Your patient with the hip dislocation is also exhibiting weakness of extension of the thigh at the hip. This would indicate possible damage to the: A. femoral nerve B. obturator nerve C. common fibular portion of the sciatic nerve D. tibial portion of the sciatic nerve E. saphenous nerve
D. tibial portion of the sciatic nerve
8. A 25 year old man suffers a gunshot wound to the lower part of his back and is unable to move his legs. A neurologic examination and an MRI scan reveal injury to the cauda equina. which of the following is most likely damaged? A. dorsal primary rami B. ventral primary rami C. dorsal roots of the thoracic spinal nerves D. ventral roots of the sacral spinal nerves E. lumbar spinal nerves
D. ventral roots of the sacral spinal nerves
A 42 year old diabetic woman complains of soreness of the left leg. She is moderately obese and has been recovering in bed from surgical removal of her gall bladder two weeks ago. On examination, she has obvious swelling in the left lower leg and some tenderness of the calf that increases when the calf is gently squeezed. What is the most likely diagnosis? What other signs might you observe in someone with this condition?
Deep venous thrombosis Varicose veins
While water skiing in Florida following final exams, a medical student falls and twists her ankle. Her foot is forcibly everted, which could cause a sprain of which ligament? Anterior talofibular Anterior tibiofibular Calcaneofibular Deltoid Plantar aponeurosis (spring ligament)
Deltoid
A physical examination of a 55-year-old man shows that he has lost sensation on the left side of his lower limb. Tests revealed that he has a disease which attacks the neurons of the sensory part of his nervous system. Where would one expect to see atrophic or degenerated nerve cell bodies? Dorsal horn of gray matter Dorsal root ganglia Lateral horn of spinal cord Sympathetic chain ganglia Ventral horn of gray matter
Dorsal root ganglia Cell bodies of sensory neurons are found in the dorsal root ganglia of spinal nerves. The cell bodies of motor neurons are found in the ventral horn of gray matter. The longissimus is part of the erector spinae - one of the true back muscles innervated by the dorsal primary rami. Intercostal muscles - ventral rami of thoracic nerves; Latissimus dorsi - branch of brachial plexus; trapezius - Cranial Nerve XI; Piriformis - nerve to piriformis - branch of lumbosacral plexus
A 20-year-old college student receives a severe blow on the inferolateral side of the right knee joint while playing football. Radiographic examination reveals a fracture of the head and neck of the fibula. Which of the following conditions might occur from this fracture? (Hint: which nerve(s) might be injured?) A. Inability to unlock the knee B. Loss of plantar flexion C. Trendelenburg's sign D. Total Inability to invert the foot E. Inability to evert the foot
E. Inability to evert the foot The common peroneal nerve may be injured, paralyzing muscles in the lateral (superficial peroneal n.) and anterior (deep peroneal n.) compartments. The patient might also have foot-drop due to injury to deep peroneal n. Popliteus - tibial n. Gastrocs, soleus - tibial n. Gluteus medius, minimus - sup. gluteal n. Tibialis anterior - deep peroneal n., tibialis posterior - tibial n
6. An X-ray of a patient with severe back pain that radiates to her left lower limb reveals disk herniation between vertebral levels L4 and L5. Which of the following nerves was most likely affected by the disk herniation? A. L1 B. L2 C. L3 D. L4 E. L5
E. L5
6. An obturator hernia that compresses the obturator nerve in the obturator canal may affect the function of all of the following muscles EXCEPT: A. Adductor brevis B. Adductor longus C. Gracilis D. Obturator externus E. Pectineus
E. Pectineus
A 45-year-old male patient has painful swelling over his left patella. You learn that he is often kneeling while at his job installing carpeting. The swelling is fluctuant, directly superficial to the patellae, and there does not appear to be a knee joint effusion. The rest of the physical exam is normal. What is your initial diagnosis? A. Quadriceps tendonitis B. Torn ACL C. Popliteal aneurysm D. Baker's cyst E. Prepatellar bursitis
E. Prepatellar bursitis
7. Following surgical opening of the adductor canal, a patient experienced a loss of cutaneous sensation of the medial side of the leg. Which nerve was cut? A. Ilioinguinal B. Femoral C. Obturator D. sciatic E. Saphenous
E. Saphenous
Your patient has sustained an external force to the knee, Which of the following ligaments has prevented abduction of the leg at the knee? A. oblique popliteal ligament B. anterior cruciate C. posterior cruciate D. lateral collateral E. medial collateral
E. medial collateral
A patient has sustained lower limb trauma that has damaged the posterior tibial artery. You are therefore concerned about the blood supply to the: A. posterior thigh only B. lateral compartment only C. posterior compartment only D. sole of the foot only E. posterior compartment of the leg and the sole of the foot
E. posterior compartment of the leg and the sole of the foot
4. A 52 year old woman is admitted to the emergency room after severely injuring her right lower limb when she fell from a ladder. An X-ray reveals a trimalleolar fracture of the ankle involving the lateral malleolus, medial malleolus and posterior process of the tibia. Which of the following bones will also most likely be affected? A. navicular B. calcaneus C. cuneiform D. cuboid E. talus
E. talus
1. A 20 year old patient cannot flex and medially rotate the thigh while running and climbing. Which of the following muscles is most likely damaged? A. semimembranosus B. sartorius C. rectus femoris D. vastus lateralis E. tensor fascia lata
E. tensor fascia lata
While skiing, a 25 year old woman falls and twists her right leg. She cannot stand on her right leg due to pain and her knee is swollen and tender. While the patient is sitting on the examination table with her knee flexed, you notice that the lower leg seems to have several centimeters of excess anterior mobility. What is the mechanism of the injury?
Excessive rotational force strains or ruptures the ligament.
A physician tests the patellar tendon reflex as shown. A normal response of the involuntary contraction of the quadriceps femoris muscle is noted. This reflex confirms the integrity of what nerve? Sciatic nerve Obturator nerve Femoral nerve Common peroneal nerve Nerve to iliopsoas
Femoral nerve
Spondylolysis
Fracture of a vertebra at the pars interarticularis
A skydiver was taken to the hospital complaining of bad pain in the right foot caused by improper and forceful landing on her heel. Upon arrival at the hospital her injured foot was swollen, deformed and held rigid. Plain-film X-rays showed an undisplaced fracture of the talar neck. How would the talus be fractured as a result of a fall on the heel? What other bones may fracture from such trauma?
From force exerted on it by calcaneus The tibia and fibula
A 7 year-old boy received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured a motor nerve in this area. Later he had difficulty rising to a standing position from a seated position. Which muscle was most likely affected by the injury? Obturator internus Gluteus minimus Hamstrings Gluteus maximus Piriformis
Gluteus maximus The gluteus maximus extends the thigh at the hip (the power-extender, such as when getting up from a chair) and is innervated by the inferior gluteal nerve which may be damaged by a badly placed gluteal injection
A middle-aged anatomy professor plays in a charity softball game and suddenly develops intense pain in the posterior thighs while running the bases. The pain persists for several days and becomes worse when he flexes his hips. What is the nature of his injury?
Hamstring injury
A 54-year old man complains of lower back pain that radiates down the back of his right leg. He states that the pain is worsened by coughing or lifting but relieved by lying down. He denies trauma to his back. During the examination, while the patient is lying on his back, he complains of severe pain when his right leg is raised. What is the most likely diagnosis?
Herniated lumbar disk
A 37 year old male is involved in a motor vehicle accident in which his car is struck head-on and he is thrown forward by the sudden deceleration. His left knee strikes the dashboard and he feels a painful pop in his left hip. He has great pain in his left hip region and, compared to his right leg, his left leg is shortened, adducted and medially rotated. There is a painful mass in his lateral gluteal region. What are the structures involved in this injury?
Hip joint, including the femoral head, joint capsule and ligaments and acetabulum.
Because of their structure and interconnections, which veins are especially important in the metastatic spread of prostate or other pelvic cancer? Great saphenous vein Lesser saphenous vein Superior gluteal vein Internal vertebral venous plexus Femoral vein
Internal vertebral venous plexus
A 55 year old mailman complains of numbness and pain in his right lower leg and foot after walking his route. Upon examination, you notice that his leg and foot are cold with diminished posterior tibial and pedis dorsalis pulses. What could be the source of his problem?
It is likely that this patient has peripheral vascular disease which is occluding his femoral or popliteal artery. Confirmation should come from an arteriogram of his leg.
A man has a posterolateral herniation of the intervertebral disk between the third and fourth lumbar vertebrae. If this disk compresses the spinal nerve in the intervertebral foramen which spinal nerve would most likely be affected? L2 L3 L4 L5 L5, S1, S2
L4
A 40 year old female is diagnosed with constriction of the lumbar vertebral canal. A laminectomy of two vertebrae is performed. Which of the following ligaments will most likely also be cut? Anterior longitudinal Denticulate Ligamentum flavum Posterior longitidinal Supraspinous
Ligamentum flavum
Your patient is in the first stage of labor and has requested anesthesia to block pain during delivery. How could you administer a caudal epidural nerve block? Which nerves would be affected by this block?
Locate the sacral hiatus at the base of the sacrum by palpating the sacral cornua The sacral nerves would be blocked (S1 - S5). These would affect the pudendal nerve (S2 - S4) - which provides sensation to the perineum (area around external genitalia) Part of the sciatic (L4 - S3) nerve might also be blocked, depending on how much anesthetic is injected
An obturator hernia that compresses the obturator nerve in the obturator foramen may affect the function of all of the following muscles EXCEPT Adductor longus Adductor brevis Adductor magnus Gracilis Obturator internus
Obturator internus The obturator internus is supplied by its own nerve - the "nerve to obturator internus"
A patient is suspected of having bacterial meningitis. A midline lumbar puncture is performed to remove cerebrospinal fluid (CSF) for analysis. If done properly, the needle used for the tap would penetrate all layers except: Arachnoid mater Epidural fat Dura mater Pia mater Supraspinous ligament
Pia mater
If a CT scan of a patient reveals a large Baker's cyst in the postero-medial aspect of the popliteal fossa, which movement would most likely be affected? Dorsiflexion of the foot Eversion of the foot Extension of the toes Extension of the leg Plantar flexion of the foot Where might the patient lose sensation?
Plantar flexion of the foot The cyst would put pressure on the tibial nerve. This would affect the plantar flexors of the foot and toes, as well as sensation on the plantar surface of the foot. On the plantar surface of the foot
A 43-year male comes to the ER with a pulsatile mass in the back of the knee. What clinical condition might explain this? Would your diagnosis be the same if there were no pulse in this area?
Popliteal aneurysm This could be a popliteal (Baker's) cyst
While collecting money for the Salvation Army, a sidewalk Santa stumbles and lands on the pavement, hyperflexing his right knee.. Following this incident he complains of intense pain in his right knee. A physical examination shows that the right tibia can be displaced backwards under the distal part of the femur. Which structure was most likely damaged in the right knee? Anterior cruciate ligament Lateral collateral ligament Medial collateral ligament Medial meniscus Posterior cruciate ligament
Posterior cruciate ligament
A 37 year old male is involved in a motor vehicle accident in which his car is struck head-on and he is thrown forward by the sudden deceleration. His left knee strikes the dashboard and he feels a painful pop in his left hip. He has great pain in his left hip region and, compared to his right leg, his left leg is shortened, adducted and medially rotated. There is a painful mass in his lateral gluteal region. What is the most likely diagnosis?
Posterior hip dislocation, with or without acetabular fracture.
A 37 year old male is involved in a motor vehicle accident in which his car is struck head-on and he is thrown forward by the sudden deceleration. His left knee strikes the dashboard and he feels a painful pop in his left hip. He has great pain in his left hip region and, compared to his right leg, his left leg is shortened, adducted, medially rotated and flexed. There is a painful mass in his lateral gluteal region. What is the most likely diagnosis? What is the structure that normally prevents this type of injury? What clinically important structures are at potential risk?
Posteriorly-dislocated hip ischio-femoral ligament Sciatic nerve, gluteal muscles
A 37 year old male is involved in a motor vehicle accident in which his car is struck head-on and he is thrown forward by the sudden deceleration. His left knee strikes the dashboard and he feels a painful pop in his left hip. He has great pain in his left hip region and, compared to his right leg, his left leg is shortened, adducted and medially rotated. There is a painful mass in his lateral gluteal region. What clinically important structures are at potential risk?
Sciatic nerve.
A 54-year old man complains of lower back pain that radiates down the back of his right leg. He denies trauma to his back. During the examination, while the patient is lying on his back, he complains of severe pain when his right leg is raised. What is the most likely diagnosis?
Sciatica - impingement of nerve roots of lumbar plexus contributing to sciatic nerve or impingement of the sciatic nerve itself
Spondylolisthesis
Slippage of a vertebra anterior to an inferior one
You've been given the task of inserting the catheter for a patient scheduled for angioplasty. Which bony anatomical landmarks in the groin are you looking for to guide you? What other structures can you potentially palpate in this area?
The ASIS and pubic tubercle - the attachment points of the inguinal ligament - one of the boundaries of the femoral triangle The femoral artery, superficial inguinal lymph nodes are found in the femoral triangle Also - femoral hernias!
An elderly woman falls and fractures the neck of her right femur. After reviewing the films, the surgeon inserts a pin through the femoral neck and into the femoral head. Although the operation is a success, the surgeon worries that he may still have to go back and do a hemi-arthroplasty (partial hip replacement). Why?
The blood supply to the head of the femur, from the medial (and lateral) circumflex femoral arteries, may have been damaged by the neck fracture
A 65 year old woman underwent coronary bypass graft surgery using the great saphenous vein. Postoperatively the patient complains of pain and general lack of sensation on the medial surface of the leg and foot on the limb from which the graft was harvested. Which nerve was most likely injured during surgery?
The saphenous nerve
A 15-year-old girl on the cross-country team runner is diagnosed with "shin splints". Dorsiflexion of the foot and toes was severely limited. The dorsalis pedis pulse was weak, and sensory loss was noted between the first and second toes. An intracompartmental pressure measurement was made of the anterior compartment of her leg, which was found to be alarmingly high. What do you think happened to the girl's leg in this case? How do you explain the sensory loss on the foot?
This condition is an example of anterior compartment syndrome of the leg. Her anterior tibial artery and deep peroneal nerve were compressed, causing the loss of sensation and weak pulse.
A 57-year-old man undergoes surgery to repair an abdominal aortic aneurysm. This procedure involves clamping the aorta proximally and distally in the abdomen. Following the surgery the patient is unable to walk and has lost sensation in the both lower limbs. What could be the cause of his condition?
This patient most-likely has ischemia of the lower part of the spinal cord. The blood supply to this part of the cord comes from branches of lumbar arteries which unite to give the anterior and posterior spinal arteries
Hyper-kyphosis is an accentuated or abnormal curvature of which region of the spine? Cervical Thoracic Lumbar Sacral coccygeal
Thoracic
A 42 year old man is brought to the ER complaining of intense pain in his left calf and ankle. During a tennis match he states that he heard a snap", fell to the court and could not walk. On examination, the left calf is tender with an irregular mass noted in the back of the midcalf area. What is the most likely diagnosis? Could he plantarflex his foot at all?
Torn Achille's tendon Yes, weakly, because his tibialis posterior, flexor hallucis longus and flexor digitorum longus (as well as peroneus longus and brevis) can help to plantarflex the foot
After recuperating from a gunshot wound to the buttocks resulting from a hunting accident, you notice that a patient was walking with a limp that had not been present before--his left hip dropped every time he lifted his left foot off the floor, but on the right side, his pelvis remained level when he lifted up his right foot. 1. What is the clinical name given to the symptoms the patient displayed following the injury? Based on the sign given above, which muscles are affected? On which side? 3. What other structures in the posterior hip/buttocks region might be damaged by this penetrating injury or by an inappropriately administered intramuscular injection?
Trendelenburg sign Right gluteus medius and minimus Inferior/superior gluteal nerve/artery, sciatic nerve, gluteal muscles
A 48 year old man whose daily exercise routine includes 45 minutes on the stationary bike and rowing machine develops progressively worse pain over his greater trochanter and gluteal region. What is the nature of his injury?
Trochanteric/gluteal bursitis
A 42 year old diabetic woman complains of soreness of the left leg. She is moderately obese and has been recovering from surgical removal of her gall bladder two weeks ago. On examination, she has obvious swelling in the left lower leg and some tenderness of the calf that increases when the calf is gently squeezed. What is the most likely diagnosis?
deep venous thrombosis
