final prep u

Filum terminale externus

(filum of the dura) extends from the apex of the dura at the level of the S2 vertebra to the dorsum of the coccyx.

foot drop

Common fibular (peroneal)

Your 61-year-old female patient has varicosities of her great saphenous vein. This is associated with all of the following except?

Hypertension (is irrelevant)

51s A 21-year-old tennis player comes to an emergency room and complains of pain in the knee joint. On examination, he has an infection inside the knee joint capsule but outside the synovial cavity. Which of the following structures is preserved from this infection?

Lateral collateral ligament - extends between the lateral femoral epicondyle and the head of the fibula and is not attached to the lateral meniscus. All other ligaments lie outside the synovial cavity but within the joint capsule.

A rising second-year medical student spends his summer hiking the Appalachian Trail with a 100-lb backpack in tow. After a month of hiking 30-mi/day (48-km/day), he notices numbness, tingling, and burning sensations in the lateral aspect of his right upper thigh. His symptoms are exacerbated by his backpack pressing on the area surrounding his right anterior superior iliac spine. What nerve is most likely affected?

Lateral femoral cutaneous nerve

A 16-year-old boy falls down a rocky hillside and severely injures the superior radioulnar joint in his left arm. Which of the following movements would be most affected?

Pronation

A 10-year-old boy was running across a parking lot when he tripped and received lacerations on the base of his thumb from a broken glass bottle. On examination, his thumb was unable to oppose to his fingers, and the thumb also showed weakness when abducting and flexing. No sensory deficits were reported. What nerve was most likely severed?

Recurrent branch of median nerve

A 17-year-old boy comes to the emergency room after a hard fall onto the lateral aspect of his left shoulder during a high school basketball game. He complains of generalized pain during shoulder motion. On physical examination, the distal end of the clavicle is prominent and distinctly palpable. Radiological findings confirm the diagnosis of a severe (grade 3) shoulder separation. Which of the following features is a component of this condition?

Torn coracoclavicular ligament

27s Which of the following is a characteristic feature of the venous system?

Veins in the limbs tend to be double or multiple vessels - tightly surrounding their accompanying artery

Sural nerve

cutaneous innervation to the dorsal aspect of the lateral fifth toe and lateral malleolus of the fibula. This sensory nerve, which approximates the course of the small saphenous vein, is formed in the inferoposterior aspect of the leg by the convergence of the medial sural cutaneous nerve (off the tibial nerve) and the lateral sural cutaneous nerve (off the common fibular nerve). Damage to the sural nerve would only produce sensory deficits, so it is not responsible for plantar flexion of the foot at the ankle joint.

A 55-year-old woman recently had pelvic surgery during which cancerous lymph nodes were removed from the lateral wall of her pelvis. During a postoperative examination, she says she has been having painful muscle spasms in her thigh. Which of the following muscles is most likely involved?

gracilis - All the nerves supplying the lower limb originate within the abdominal and/or pelvic cavities, from the lumbar and/or sacral plexuses. Therefore, all these nerves must have positional relationships to and must penetrate through the abdominal or pelvic walls in order to reach the lower limb. The obturator nerve crosses the lateral wall of the pelvis on its way to the obturator canal and into the lower limb, and may be damaged in surgery or trauma to the lateral pelvic wall. Ultimately, it supplies the muscles in the medial compartment of the thigh, including the gracilis. Trauma to the efferent fibers within the obturator nerve may produce spasms or dysfunction in any of these muscles

saphenous vein

great saphenous vein originates from the medial end of the dorsal venous arch in the foot. It ascends into the leg by crossing the ankle anterior to the medial malleolus, in close company with the saphenous nerv

adductor magnus is innervated by

obturator nerve and tibial part of the sciatic nerve

supraspinatus

one of the four rotator cuff muscles, has the primary action of initiating abduction of the arm. It is the only rotator cuff member that does not have a main action of rotating the arm.

Plantaris

very small muscle originates just above the popliteus, from the lower lateral supracondylar line of the femur. However, rather than following the line of the popliteus, it descends through the leg to attach onto the posterior calcaneus. While the plantaris is generously described as participating in flexion of the knee and plantar flexion of the foot, in reality it contributes virtually no forces to those movements and may be primarily proprioceptive in function.

2m 4s Your 67-year-old female patient who fell on her hand has been diagnosed with a Colles fracture. This refers to which of the following?

A fracture of the distal radius in which the distal fragment is angulated dorsally

A 48-year-old bartender complained to his physician about a globular swelling in his left groin. He said the swelling became smaller when he lay down but never completely disappeared. He also complained that the swelling occasionally became very large and formed a bulge under the skin on the anterior aspect of his thigh. When asked to pinpoint the location of the swelling, he put his fingers over the region of the femoral triangle. He later said he felt pain along the inside of his thigh. When the physician inserted his finger in the patient's superficial inguinal ring and asked him to cough, the physician did not feel a protruding mass. However he noted that the mass in his thigh increased in size. Which of the following statements best describes the most likely cause of the swelling in the man's thigh?

A hernial sac that descended through the femoral canal within the femoral sheath, causing a globular swelling in the thigh.

21s A 17-year-old boy was stabbed during a gang fight resulting in transection of the obturator nerve. Which of the following muscles is completely paralyzed?

Adductor longus

A 17-year-old boy was stabbed during a gang fight resulting in transection of the obturator nerve. Which of the following muscles is completely paralyzed?

Adductor longus

Due to torsioning of the lower limb and merging of separate premuscle masses during development, certain adult lower limb muscles are supplied by two separate nerves. These interneural fusions are termed "hybrid muscles". Which of the following is a hybrid muscle?

Adductor magnus

51s A 52-year-old man was helping a friend lift a piano when he suddenly felt a severe pain in his lower back and buttock that radiated down the posterior aspect of his thigh into his leg, including the dorsum of his foot. Which of the following statements best describes the most likely cause of the man's back pain?

An acute herniated intervertebral (IV) disc between L5 and S1 vertebrae

A soccer player injures his left knee when he twists the flexed knee while trying to avoid another player. While performing a knee examination, his physician pulls the flexed knee toward her (the physician's) body, as shown in the illustration. This clinical test is a check for the integrity of which of the following ligaments?

Anterior cruciate ligament (ACL)

You are working in the ED and a patient is brought in with severe knee pain from an athletic injury. Upon testing the knee you discern excessive anterior movement of the tibia on the femur. You therefore suspect which of the following?

Anterior cruciate ligament tear

A 10-year-old boy falls off his bike, has difficulty in moving his shoulder, and is brought to an emergency department. His radiogram and angiogram reveal fracture of the surgical neck of his humerus and bleeding from the point of the fracture. Following this accident, the damaged nerve causes difficulty in abduction, extension, and lateral rotation of his arm. Cell bodies of the injured nerve involved in movement of his arm are located in which of the following structures?

Anterior horn of the spinal cord

Idling at a stoplight in his vintage car without headrests, a 71-year-old-man's car is struck from behind by a truck going approximately 30 mph (48 kph). The man is brought to the ER suffering from a severe hyperextension neck injury due to the crash. The given T2-weighted MRI shows a rupture of the anterior anulus of the C4-5 intervertebral disc, inflammation of that disc (the white appearance), and a prevertebral hematoma, which compromised his airway and required intubation. Which of the following ligaments is disrupted in this injury?

Anterior longitudinal ligament

A 3-year-old girl is brought to the emergency room holding her right arm with the elbow flexed and the forearm pronated. She refuses to move her arm and complains her elbow "hurts a lot." Her mother reports they were holding hands and running in the park when the child tripped. The mother pulled on the child's hand to prevent her from hitting the ground. Given the nature of this injury and the age of the patient, what structure is most likely damaged?

Anular ligament of radius

Your athletic 23-year-old patient is being seen in the ED for a ruptured quadriceps tendon. What does this tendon do?

Attaches all four parts of the quadriceps femoris muscle to the patella

1m 4s You are concerned about intermittent claudication in your 67-year- old female 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?

Between the medial malleolus and the Achilles (calcaneal) tendon

A 22-year-old man is brought to the ER with severe back pain and lower limb weakness after falling off the top of a 16-ft ladder and landing on his feet. The ER physician orders a CT scan, and the given midsagittal CT directs the physician toward making which of the following diagnoses?

Burst fracture of T12 vertebral body

fter several months of engaging in a vigorous exercise program, a 28-year-old woman experiences periodic pain and muscle spasms in her left upper limb. Thorough physical and radiographic examinations by her primary care physician and a consulting surgeon determine that she suffers a posterolateral herniation of the C5-6 intervertebral disc. Which of the following structures is this herniation most likely impinging?

C6 spinal nerve roots - Classic posterolateral herniation of the nucleus pulposus of the intervertebral disc occurs most often within the C4-5 and L4-5 intervertebral discs. A herniated nucleus pulposus may displace or disrupt the posterior longitudinal ligament and extend into the vertebral canal and impinge upon spinal nerve roots either within the vertebral canal or as they traverse the intervertebral foramen (or both). When dealing with such cases in the cervical and lower lumbar regions, remember the formula "N+1." That is, N = the number of the intervertebral disc; +1 = the number of the spinal nerve roots primarily contacted by the herniation. Thus, the herniated C5-6 disc will most likely impinge upon the C6 spinal nerve roots.

31s A 26-year-old woman experiences severe back pain from an automobile accident. A CT scan reveals that the L5 vertebral foramen is completely obliterated by a collapsed L5 laminae and pedicles. In this injury, which of the following structures is crushed?

Cauda equina - is formed by dorsal and ventral roots of the lumbar and sacral spinal nerves. Thus, it is crushed at the level of the L5 vertebra, whereas the other structures are not.

You are examining a 61-year-old patient who has generalized back pain and stiffness. In trying to determine which part of the spine the physical therapist should concentrate on to relieve stiffness you are aware that, of the presacral part of the vertebral column, the region that permits the most rotation is:

Cervical

1m Your 23-year-old hockey player patient received a slicing injury to the lateral side of the upper part of his leg during a game. After the wound was closed, the patient walked with a foot drop on that side. What nerve was transected during the game?

Common fibular (peroneal)

Your 23-year-old hockey player patient received a slicing injury to the lateral side of the upper part of his leg during a game. After the wound was closed, the patient walked with a foot drop on that side. What nerve was transected during the game?

Common fibular (peroneal) - traverses superficial to the neck of the fibular and is frequently injured in this location. If cut, the patient cannot dorsiflex his foot and walks with a footdrop in which the foot is raised higher than normal during swing phase and "flops" when it hits the ground.

4m 39s Following surgery to repair a broken right tibia, a 22-year-old patient is placed in a short leg cast. Several hours later, she complains of extreme pain, numbness with a "pins and needles sensation," inflammation, and abnormal pressure on the anterior and lateral aspects of the affected lower leg. The cast is removed, and the physician notes weakness in dorsiflexion of the foot and toes, a weak dorsalis pedis arterial pulse, and sensory loss between the first and second toes. What nerve is most likely damaged?

Deep fibular nerve

patient presents with sensory loss on adjacent sides of the great and second toes and impaired dorsiflexion of the foot. These signs probably indicate damage to which of the following nerves?

Deep peroneal

In examining a radiograph of the right shoulder of a 32-year-old male car accident victim, the radiologist identifies the head of the humerus located below the coracoid process of the scapula in a subcoracoid position. Which of the following terms best describes the condition of the humerus?

Dislocated

Yergason's test is a test for which a positive sign is likely to indicate rupture of the transverse humeral ligament. Such a rupture would be associated with which of the following?

Dislocation of the tendon of the long head of the biceps brachii (holds the tendon in the groove)

Cervical spine CT scanning of a young adult ED patient brought in after automobile trauma is reported to show "jumped facets." What does this refers to?

Displaced and locking facets (dislocation) in the cervical regio

Question 9 See full question 32s A 23-year-old man complains of numbness on the medial side of the arm following a stab wound in the axilla. On examination, he is diagnosed with an injury of his medial brachial cutaneous nerve. In which of the following structures are the cell bodies of the damaged nerve involved in numbness located?

Dorsal root ganglion

A man interviewing for a new administrative position as hospital chief executive officer notices difficulty walking after sitting with his leg crossed for 2 hours. He was nervous during the interview but even more so now that he is attempting to stand to follow two board members for a tour of the hospital. Which of the following actions is most seriously affected by compression and temporary paralysis of the deep peroneal nerve?

Dorsiflexion of the foot

35s You find an absent patellar tendon reflex (first described by Westphal in 1875). Which of the following structures is most likely involved in the abnormal response?

Femoral nerve

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?

Femoral nerve

1m 6s A 17-year-old man has pain and moderate swelling over the dorsomedial aspect and in the hypothenar area of his right hand after punching a locker over a dispute with his girlfriend. What is the most likely finding on an X-ray of his hand?

Fracture of the fifth metacarpal bone

A 19-year-old man was rollerblading when he caught his skate in a wide crack in the cement sidewalk. He said he fell on his open hand with his wrist extended and abducted. As his hand was very painful and slightly swollen, he went to the emergency department of a hospital. On examination, the physician noted that all wrist movements were painful, and there was tenderness in his anatomical snuffbox, but no unusual features were palpable. Radiographs of his wrist did not reveal a fracture. Because wrist movements were painful, the physician applied a light plaster cast. When the cast was removed 3 weeks later, wrist movements were still painful and the pain in the snuffbox was severe when the floor of the box was compressed with the thumb. A repeat radiograph revealed a decrease in the bone density of part of a carpal bone. The reduced bone density made the proximal part of the bone appear dark relative to the distal part of the bone and other carpal bones. Which of the following statements best describes the most likely cause of the man's continuing wrist pain?

Fracture of the scaphoid

19s A 24-year-old woman complains of weakness when she extends her thigh and rotates it laterally. Which of the following muscles is paralyzed?

Gluteus maximus

An elderly woman fell at home and fractured the greater trochanter of her femur. Which of the following muscles would continue to function normally?

Gluteus maximus - inserted into the gluteal tuberosity of the femur and the iliotibial tract. All of the other muscles insert on the greater trochanter of the femur, and their functions are impaired.

Which of the following veins in the lower limb is commonly used in arterial bypasses?

Great saphenous vein - largest, longest superficial, etc

A 27-year-old mountain climber falls from a steep rock wall and is brought to the emergency department. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the upper thoracic vertebrae. The fractured body of the T4 vertebra articulates with which of the following parts of the ribs?

Head of the fifth rib

A 52-year-old construction worker complained of pain in what he called the "small of his back." As he moved slowly down a ladder, he felt pain that spread 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 herniation of IV discs is most accurate?

Herniation of the nucleus pulposus of an IV disc usually occur posterolaterally because the anulus fibrosus is relatively thin at this site.

Young Johnny was playing on the playground at school when he fell and struck his arm against the swing set. He ran to the school nurse, complaining of which of the following conditions as a result of injuring the radial nerve in the spiral groove of the humerus?

Inability to extend the hand

1m 18s You feel the greater trochanter superior to the Nélaton line in a 79-year-old female patient. This line is an imaginary line running from the anterior superior iliac spine to the ischial tuberosity. Feeling the trochanter superior to this line indicates which of the following?

Indicates a dislocated hip or fractured femoral neck - Normally, the greater trochanter should be felt along this line

A 32-year-old man was lifting a very heavy box into a van when it slipped out of his hands and hit his upper lateral right leg. He fell to the ground and complained of severe pain and loss of sensation on the entire dorsal surface of his foot. He was taken to a hospital where a physician examined him and noticed footdrop when he lifted his right foot off the ground. The physician knew that the patient had a peripheral nerve injury. Imaging revealed severe bruising to the proximal right fibula. Which of the following most likely explains the patient's complete condition?

Injury of the right common fibular (peroneal) nerve (not deep fibular because it would nto cause sensory changes)

our 45-year-old patient is showing weak hand pronation, especially in initiating the movement. You suspect a problem with the pronator quadratus. Which of the following is incorrect about this muscle?

It can be palpated from the dorsal aspect with deep pressure

Your 37-year-old athletic patient is in the ED with a Pott fracture. Which of the following is not correct about this fracture?

It involves a fracture of the talus

A developmental biologist studying the derivatives of the somites and somitomeres treats the epimeres in a mouse embryo with a toxin that kills all of their cells. If the mouse develops to full term, which of the following muscles is most likely to be absent?

Longissimus

Following a femoral neck fractures in a 76-year-old woman, her femoral head underwent avascular necrosis. This occurred because the fracture likely tore which of the following arteries?

Medial femoral circumflex

1m 4s A 64-year-old man with a history of liver cirrhosis has been examined for hepatitis A, B, and C viruses. In an attempt to obtain a blood sample from the patient's median cubital vein, a registered nurse inadvertently procures arterial blood. During the procedure, the needle hits a nerve medial to the artery. Which of the following nerves is most likely damaged?

Median

34s You are about to insert a catheter into the vein of your 33-year-old patient that runs diagonally across the anterior surface of the elbow joint (cubital fossa). What is this vein?

Median cubital - traverses the cubital fossa, connecting the cephalic and basilic veins.

31s Your 67-year-old patient has fecal incontinence due to a nonfunctioning external anal sphincter. His surgeon is going to transplant the gracilis muscle to create a replacement. The patient will then have to train the repositioned muscle to act as a sphincter. Because the muscle retains its original innervation, what nerve will the patient have to learn to use during defecation?

Obturator

24s A 25-year-old gladiator sustains a penetrating injury that severs the superficial peroneal nerve. This will most likely cause paralysis of which of the following muscles?

Peroneus brevis

25-year-old gladiator sustains a penetrating injury that severs the superficial peroneal nerve. This will most likely cause paralysis of which of the following muscles?

Peroneus brevis

2m 41s A motorcyclist falls from his bike in an accident and gets a deep gash that severs the superficial peroneal nerve near its origin. Which of the following muscles is paralyzed?

Peroneus longus

A veteran infantry soldier develops painful flat feet after several years of service including hundreds of miles of marches. The pain is particularly acute on the medial aspect of his sole. Which of the following structures is most likely strained in this condition?

Plantar calcaneonavicular (spring) ligament

12s When standing upright, the femur moves into the locked position by slightly hyperextending, gliding posteriorly, and medially rotating on the tibial plateaus. Which of the following muscles acts to initiate the unlocking of the knee?

Popliteus

30s A 22-year-old patient is unable to "unlock" the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged?

Popliteus

A physician discovers that his 72-year-old patient is leaking blood from a vessel that normally carries oxygen-depleted blood. Which of the following vessels is most likely damaged?

Pulmonary trunk

34s A 38-year-old homebuilder was involved in an accident and is unable to supinate his forearm. Which of the following nerves are most likely damaged?

Radial and musculocutaneous

A 74-year-old man complains of pain in his right hand and fingers when he works with his hands for a while. Thorough testing reveals insufficient blood flow into the deep palmar arch. Occlusion of which of the following arteries is the most likely cause of this condition?

Radial artery - the superficial palmar arch is formed mainly by the ulnar artery, whereas the deep palmar arch is formed primarily by the radial artery.

32s A performer at the traveling circus for the state fair has injured her shoulder during a routine. When she fell off the trapeze, she struck the ground on her back, and most of the blunt force was directed toward her shoulders. A crush injury of the suboccipital nerve would result in paralysis of which of the following muscles?

Rectus capitis posterior major of the back

A young man suffers a dislocation of the right hip in a car accident. During recovery, he finds he has an abnormal gait in which his left hip sinks when he lifts that foot to take a step, as shown in the right frame (C) of the given diagram. The problem may be the result of damage to which of the following structures?

Right gluteus medius and superior gluteal nerve

A 33-year-old tennis player initially experienced vague pain in the anterior region of her glenohumeral joint during a game. Then, she had the sensation of something popping during her third set. During the preliminary examination by her trainer, he noted tenderness over the intertubercular groove in the humerus, flexion and supination weakness of the forearm, and an abnormal bulge in the distal part of the anterior part of her arm. Radiographs of the shoulder and arm did not reveal skeletal abnormalities. Which of the following statements best describes the most likely cause of the symptoms and signs in this case?

Rupture of the tendon of the long head of the biceps

After moving his parents' heavy furniture out of their house, a 38-year-old man experiences lower back pain and presents to his doctor with tingling numbness radiating down his right lower limb to the lateral part of his foot. A thorough physical examination reveals weakness when standing on the toes of his right foot. A T1-weighted MRI revealed an intervertebral disc herniation, as indicated by the white arrow. Which of the following structures is most likely impinged by this disc herniation?

S1 spinal nerve roots - intervertebral disc herniations occur toward the bottom of the spine at the L4-5 or L5-S1 segments. This T1-weighted MRI reveals posterolateral herniation of the nucleus pulposus of the L5-S1 intervertebral disc, as indicated by the white arrow. Remember that a herniated nucleus pulposus may displace or disrupt the posterior longitudinal ligament and extend into the vertebral canal and impinge upon spinal nerve roots either within the vertebral canal or as they traverse the intervertebral foramen (or both). When dealing with such cases in the lower lumbar regions, remember the formula "N+1.

The lateral thoracic artery provides the main blood supply to the lateral side of the chest wall, including much of the breast. To deter excessive blood loss during a surgical procedure involving the breast, a surgeon can clamp the lateral thoracic artery near its origin. Which of the following arteries gives rise to this artery?

Second part of the axillary artery - The lateral thoracic artery, along with the thoracoacromial trunk, typically branches from the second part of the axillary artery, deep to the pectoralis minor. It descends along the lateral border of the pectoralis minor to supply the lateral aspect of the chest wall, including much of the breast and the serratus anterior muscle. However, this vessel is variable and may originate from other source points. Remember, arteries are often named for the regions they supply, not necessarily for their branching patterns

A 15-year-old active boy was sent to an orthopedist for a physical examination by his hockey coach. The physician observed a dimple covered by a hairy patch on the inferior part of his back and suspected the boy had a pathologic condition (see figure). What condition did the physician likely suspect?

Spina bifida occulta

Bones are often classified according to their shape and/or developmental pattern. Which of the following choices is an example of a flat bone?

Sternum

26s An 18-year-old boy involved in an automobile accident presents with arm that cannot abduct. His paralysis is caused by damage to which of the following nerves?

Suprascapular and axillary - abductors of the arm are the deltoid and supraspinatus muscles

A 35-year-old left-handed baseball pitcher experiences a severe spasm of pain while abducting his left arm in beginning to throw a pitch, and is unable to continue playing. Subsequently, he cannot initiate abduction of the left arm. However, if that arm is passively elevated through the first 15° of abduction, he can complete bringing the arm up to a right angle. The tendon of which of the following muscles is most likely torn?

Supraspinatus

Which of the following is true pertaining to the tension lines in the skin?

Surgical incisions should be made parallel to these lines to minimize scarring

11s You are treating a patient in the ED with a fracture of the proximal end of the humerus. Most of these fractures occur at which of the following?

Surgical neck

While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?

Tear of the medial meniscus (part of unhappy triad MMA)

You are testing the reflexes of a newborn child and stroke the lateral aspect of her foot from the heel to the base of the hallux. The infant responds with slight fanning of the lateral four toes and dorsiflexion of the hallux. What is your conclusion?

The baby is showing a normal response for her age - Babinski sign and, although indicative of corticospinal tract/motor cortex disorders in adults, it is a normal response in infants and children up to the age of 4.

Gastrocnemius

The gastrocnemius attaches to the femoral condyles, crosses the posterior side of the knee, and inserts onto the posterior calcaneus via the calcaneal tendon (tendo calcaneus; Achilles tendon). It flexes the knee after unlocking and plantar flexes the foot.

axis of rotation malleolus

The tendons of the fibularis (peroneus) longus and brevis muscles pass tightly against the posterior side of the lateral malleolus as they leave the lateral compartment of the leg and cross the ankle. Therefore, both muscles act to produce plantar flexion of the foot and may be injured in trauma posterior to the lateral malleolus.

The radiologic report on your 75-year-old patient with left neck pain indicated the development of bone spurs at the C5/6 uncovertebral joints (of Luschka). Which of the following is correct about these joints?

They involve the uncinate processes of the bodies of most of the cervical vertebrae

A 16-year-old girl who spends 18 hours a week on her gymnastic routine complained of lower back pain. She was examined by a pediatric orthopedist. The physical examination of her back revealed an abnormal protrusion of the L5 vertebra. A radiograph showed that the posterior vertebral arch of the L5 vertebra was separated from the vertebral body. The anterior part of the vertebra (body, pedicles, and superior articular processes) had moved anteriorly on the sacrum (see figure). Which of the following statements best describes this abnormality?

This degenerative condition typically results from a fracture of the portion of the vertebra known as the pars interarticularis.

Third part of the axillary artery

This part typically gives rise to three branches: the subscapular artery and the anterior and posterior circumflex humeral arteries. The lateral thoracic and subscapular arteries may originate as a common trunk

A rugby player injures his left extended knee when hit from the lateral side by a defender trying to tackle him. While performing a knee examination, his physician applies pressure to his lateral thigh and medial leg (as shown in the illustration). This clinical test is a check for the integrity of which of the following ligaments?

Tibial (medial) collateral ligament (TCL)

49s Your 23-year-old patient is having heel pain subsequent to an eversion ankle injury. The medial side of her foot posterior and inferior to the medial malleolus is swollen and you suspect tarsal tunnel syndrome. This syndrome is associated with compression of which of the following nerves?

Tibial -passes deep to the flexor retinaculum as it exits the posterior compartment and as such it is susceptible to compression when there is inflammation and swelling in the tarsal tunnel deep to the retinaculum. Heel pain is a common symptom.

A physician tests the calcaneal tendon (ankle jerk) reflex as shown. A normal response of plantar flexion of the ankle joint is noted. This myotatic (deep tendon) reflex confirms the integrity of what nerve?

Tibial nerve

As part of a physical examination to evaluate lower limb function, a physician asks her patient to stand on his tiptoes, as shown. What nerve is the doctor testing?

Tibial nerve - supplies the posterior muscles of the knee joint and leg, including the three muscles of the superficial compartment (gastrocnemius, soleus, and plantaris) and four muscles of the deep compartment (popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior).

A 35-year-old man has difficulty in dorsiflexing the foot. Which of the following muscles is most likely damaged?

Tibialis anterior

Injury to muscles in the deep posterior compartment of the leg resulted in a compartment syndrome. What are the three muscles within this compartment that affect the ankle joint?

Tibialis posterior, flexor hallucis longus, flexor digitorum longus

12s Your 25-year-old patient has a fracture of the hook of her hamate bone. She is also showing a decrease in grip strength. You are concerned about damage to which of the following nerves?

Ulnar

16s After winning a boxing match, a 24-year-old man is unable to abduct his fingers. Which of the following nerves is injured?

Ulnar nerve

A 52-year-old retired professional cyclist, who still rides his bike 400 miles per week, comes to his physician complaining of hand problems. The physician notes hyperextension of the ring and little fingers at the metacarpophalangeal joints and flexion at the interphalangeal joints within the same fingers (see photo). During examination, the patient has no weakness in flexion or adduction of the wrist. What nerve is compressed at what location?

Ulnar nerve in the wrist

An overweight woman participates in her first rugby match without proper training and conditioning. Upon catching the opening kickoff, she awkwardly twists her right knee, screams in pain, and falls to the ground. The team manager notes her patella is dislocated, residing on the lateral side of her knee. After straightening the woman's knee, the patellar dislocation is reduced (goes back into place). To prevent future dislocation of the patella, what specific muscle should be targeted during rehabilitation?

Vastus medialis - inserts into the patella and the tibial tuberosity through the common quadriceps tendon and patellar ligament. This muscle helps extend the leg at the knee joint, but it also maintains a medial pull on the patella, reducing the lateral, dislocating force. The patella is stabilized by the vastus medialis muscle and the prominent femoral condyles, which usually prevent lateral dislocation during flexing of the leg at the knee joint.

Denticulate ligament

a lateral extension of the pia between the dorsal and ventral roots of the spinal nerves, consists of 21 pairs of processes, the last one lying between the T12 and L1 spinal nerves.

Subscapularis

another rotator cuff muscle, acts mainly to medially rotate the arm

femoral nerve path

anterior compartmnet - oes not cross the lateral pelvic wall in its path to the lower limb. Instead, it runs lateral and parallel to the psoas major muscle, outside the true pelvic cavity.

Anterior drawer sign is an indication of damage to the ____________.

anterior cruciate ligament

Vertebral artery

arises from the subclavian artery, ascends through the transverse foramina of the upper six cervical vertebrae.

Iliohypogastric nerve

arises primarily from the ventral ramus of L1, with possible contributions from T12. This nerve runs above the anterior superior iliac spine within the anterolateral muscular wall of the abdomen. The iliohypogastric nerve supplies the suprapubic region of the abdomen

epidural space

between the walls of the vertebral canal and the dura mater

pectineus is innervated by

both the obturator and femoral nerves.

Inferior ulnar collateral artery

branches off the brachial artery just above the elbow. It passes distally across the anterior side of the medial epicondyle of the humerus to form a collateral connection with the anterior ulnar recurrent branch of the ulnar artery. This vessel is far removed from the hand.

posterior interosseous artery

branches off the common interosseous artery, which is derived from the ulnar artery in the proximal forearm. - supplies the posterior compartment of the forearm.

Anterior interosseous artery

branches off the common interosseous artery, which is derived from the ulnar artery in the proximal forearm. The anterior interosseous artery supplies the anterior compartment of the forearm as well as the distal posterior forearm via its posterior terminal branch.

foot drop

defect to common fibular nerve - traverses superficial to the neck of the fibular and is frequently injured in this location. If cut, the patient cannot dorsiflex his foot and walks with a footdrop in which the foot is raised higher than normal during swing phase and "flops" when it hits the ground.

Posterior tibial artery

descends through the tibial side of the posterior compartment of the leg and crosses the ankle posterior to the medial malleolus before it terminates by dividing into the medial and lateral plantar arteries.

Spinal cord

ends at the level of the L2 vertebra.

Tendon of the fibularis (peroneus) tertius

fibularis tertius is a member of the anterior compartment of the leg. Its tendon crosses the anterior aspect of the ankle, bound by the extensor retinaculum. It is the most lateral tendon from the anterior compartment but does not have a particularly close relation to the lateral malleolus. Because it does pass anterior to the malleoli, the tendon of the fibularis tertius muscle participates in dorsiflexion of the foot at the ankle joint and eversion of the foot at the subtalar and transverse tarsal joints

First part of the axillary artery

gives rise to one branch: the superior (or supreme) thoracic artery, which has a small distribution to the superolateral chest wall

flat-foot" (pes planus; talipes planus; "fallen arch")

he medial longitudinal arch of the foot significantly lowers or collapses altogether. This collapse may cause pain due to stretching of the plantar muscles and ligaments, and eversion and abduction of the forefoot leading to excessive wear on the medial side of the soles of shoes. - The medial longitudinal arch of the foot is higher and more mechanically significant than the lateral longitudinal arch.

tensor muscle of fascia lata

innervated by the superior gluteal nerve

The musculocutaneous nerve continues into the forearm as the _______________.

lateral cutaneous nerve of the forearm.

Teres minor

laterally rotate the arm.

internal vertebral venous plexus

located in the spinal epidural space. The vertebral artery and vein occupy the transverse foramina of the upper six cervical vertebrae

Sartorius

muscle crosses the anterior thigh from lateral (anterior superior iliac spine) to medial (proximal medial tibia). Because of its oblique course, it contributes to flexion, lateral rotation, and abduction of the hip and flexion of the knee. While it does participate in flexion of the knee, it does not unlock the knee, but acts after the popliteus has unlocked the knee joint.

Anterior cutaneous branches of femoral nerve

nerve supply the upper medial aspect of the thigh. These nerves are derived from L2-4

20s Your 67-year-old patient has fecal incontinence due to a nonfunctioning external anal sphincter. His surgeon is going to transplant the gracilis muscle to create a replacement. The patient will then have to train the repositioned muscle to act as a sphincter. Because the muscle retains its original innervation, what nerve will the patient have to learn to use during defecation?

obturator

The posterior cord of the brachial plexus is formed by the ________________.

posterior divisions of all 3 cords.

23s The pulse taken between the medial malleolus and the calcaneal tendon is that of the ______________.

posterior tibial artery - passes into the sole of the foot by passing between the medial malleolus and the calcaneal tendon with the tibialis posterior, flexor digitorum, posterior tibial vein, tibial nerve, and flexor hallucis.

Teres major

primary actions are to medially rotate and adduct the arm

Ulnar artery

primary supply into the superficial palmar arterial arch

Infraspinatus

rotator cuff muscles- primary action is to laterally rotate the arm

thoracodorsal nerv

supplies the latissimus dorsi, which can adduct, extend, and rotate the arm medially

upper and lower subscapular nerves

supply the subscapularis, and the lower subscapular nerve also supplies the teres major; both of these structures can adduct and rotate the arm medially

A man working in a junkyard trips and falls into a pile of scrap metal, suffering a deep cut immediately posterior to the lateral malleolus. Which of the following is most likely to be injured?

tendon of the fibularis (peroneus) longus.

Deep fibular nerve

terminal branch of the common fibular nerve that supplies motor innervation to the four muscles of the anterior compartment of the leg: (1) tibialis anterior, (2) extensor digitorum longus, (3) extensor hallucis longus, and (4) fibularis (peroneus) tertius. These four muscles are responsible for dorsiflexion of the ankle.

Saphenous nerve

terminal sensory branch of the femoral nerve, which traverses medially through the adductor canal in the thigh to supply the medial side of the leg and foot, including the medial malleolus of the tibia. Due to the location of the sensory deficits in the upper lateral thigh, this nerve is not involved in this patient's presentation.

Lesion of the inferior gluteal nerve will have the greatest affect on _____________.

thigh extension.