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DAA III
| Question | Answer |
|---|---|
| 1. A patient is presented with an inability to extend the elbow. What nerve is involved? and what muscles are innervated by it? | • Radial N- Triceps brachii, anconeus |
| 2. A patient is presented with an inability to flex the elbow. What nerve(s) is (are) involved? and what muscles are innervated by it? | • Musculocutaneous N- Brachialis (Dual), biceps brachii, • Radial N - Brachialis (Dual), Brachioradialis • Median N- pronator teres |
| 3. A patient is presented with an inability to extend the wrist. What nerve is involved? and what muscles does it innervate? | • Radial N- Extensor carpi radialis longus, brevis, extensor carpi ulnaris |
| 4. A patient is presented with an inability to flex the wrist. What nerve(s) is (are) involved? | • Median N- Flexor carpi radialis, palmaris longus • Ulnar N- flexor carpi ulnaris |
| 5. A patient is presented with an inability to supinate the forearm. What nerve(s) is (are) involved? | • Musculocutaneous N- Biceps Brachii • Radial N- supinator |
| 6. A patient is presented with an inability to pronate the forearm. What nerve is involved? | • Median N- pronator teres, pronator quadratus |
| 1. A patient is presented with an inability to abduct the humerus. What nerve(s) is (are) involved? | • Suprascapular N- Suprapinatus • Axillary N- deltoid |
| 2. A patient is presented with an inability to adduct the humerus. What nerve(s) is (are) involved? | • Medial and Lateral Pectoral N- Pectoralis Major • Thoracodorsal N- Latissimuis Dorsi • Lower Subscapular N- Teres Major • Axillary N- Teres Minor |
| 3. A patient is presented with an inability to rotate the humerus laterally. What nerve(s) is (are) involved? | • Suprascapular N- Supraspinatus, Infraspinatus • Axillary N- Deltoid, Teres Minor |
| 4. A patient is presented with an inability to rotate the humerus medially. What nerve(s) is (are) involved? | • Upper and Lower Subscapular N- Subscapularis, Teres Major (*Only Lower) • Thoracodorsal N- Latissimus Dorsi • Medial and Lateral Pectoral N- Pectoralis Major • Axillary N- Deltoid |
| 5. A patient is presented with an inability to flex the humerus at the shoulder joint. What nerve(s) is (are) involved? | • Axillary N- Deltoid • Medial and Lateral Pectoral N- Pectoralis Major • Musculocutaneous N- Biceps brachii, coracobrachialis |
| 6. A patient is presented with an inability to extend the humerus at the shoulder joint. What nerve(s) is (are) involved? | • Axillary N- Deltoid • Thoracodorsal N- Latissimus Dorsi • Lower Subscapular N- Teres Major • Radial N- Triceps Brachii |
| 1. Loss of sensation to the skin of the thenar eminence could indicate damage to what nerve? | • Median N |
| 2. Loss of sensation to the skin of the hypothenar eminence could indicate damage to what nerve? | • Ulnar N |
| 1. What do nerves do? | Carries Signals: Efferent - Motor Afferent - Sensory |
| 2. What is a nerve? | Bundles of fibers that transmit impulses to the brain or spinal cord and impulses from these to the muscles and organs |
| 3. What is a neuron? | a nerve cell |
| 4. What components are present in every neuron? | • body (soma, contain nucleus and is processing center) • dendrite (receiving portion, contains receptors) • axon (transmitting portion) |
| 5. What is the CNS? What components of the nervous system make up the CNS? | • central nervous system- brain and spinal cord, • neuroglial cells, embryo development neural tube. |
| 6. What is the PNS? What components of the nervous system make up the PNS? | • peripheral nervous system- crainial and spinal nerves, visceral nerves and plexuses, enteric system, neuroglial cells, embryo development- neural crest |
| 7. What is myelin? How is myelin formed? | • layer around an axon, • CNS- oligodendrocytes • PNS- neurolemmocytes (schwann cells) |
| 8. What is a neurolemmocyte? What is the space between adjacent neurolemmocytes called? | • neurolemmocye- schwann cell. • Spaces- nodes of ranvier |
| 9. List the different ways neurons can be classified and give examples of each. | • functional- somatic, visceral • structure- psedounipolar, bipolar, multipolar • impulse travel- afferent or efferent |
| 10. Show how the above classifications can overlap and give examples of each. 11. Give examples of where the different classifications of neurons are found in the body. | GSA - General Somatic Afferent; somatic sensory, from skin, bones, joints GSE - General Somatic Efferent; motor to skeletal muscle GVA - General Visceral Afferent; sensory, pain & stretch from viscera & blood vessels GVE - General Visceral Effere |
| 1. What is the distal end of the spinal cord called? | conus medullaris |
| 2. What is the name of the pia mater filament that anchors the spinal cord to the coccyx? | filum terminale |
| 3. What is the relationship of white matter to gray matter in the spinal cord? | • brain- G-outside, W-inside • spinal cord- G-inside W-surrounds gray |
| 4. What type of information do ascending tracts carry in the white matter of the spinal cord? | sensory information |
| 5. What type of information do descending tracts carry in the white matter of the spinal cord? | Motor information |
| 6. What are the names of the horns of the gray matter of the spinal cord and what kinds of neurons are found in each? | • dorsal (posterior) horn- sensory • ventral (anterior) horn- motor neurons |
| 7. What is the cauda equina? | is a collection of spinal nerve roots distal to termination of spinal cord |
| 8. What are denticulate ligaments, what are they made of and what is their function? | - Extensions of the piam mater- 20-22 sawtooth like attachments of the pia to dura. - They suspend the spinal cord within the dural sack from foamen magnum- T12-L2 |
| 1. What neurological components form the spinal nerve at the IVF? | junction of the dorsal and ventral roots in the neural canal. Once exits branches |
| 2. What kind of information is carried in the dorsal root of a spinal nerve? | sensory |
| 3. What kind of information is carried in the ventral root of a spinal nerve? | motor |
| 4. What is a spinal segment? | cross area of spinal cord that gives rise to a single pair of spinal nerves |
| 5. Explain the dis-relationship that exists between spinal segments and vertebral bodies. | • The spinal cord ends at L1 so all spinal segments are from L1 superior, so its not a 1:1 association of spinal segments to vertebral body |
| 6. How are spinal nerves numbered? | • C1-7 exit above the vertebra they are named for • C8-Col – exit below the vertebra they are named for |
| 7. What are the 4 branches of a spinal nerve? | • recurrent meningeal nerve (meningeal ramus, sinuvertebral nerve) • posterior (dorsal) ramus • anterior (ventral) ramus • rami communicantes |
| 8. What does each branch of a spinal nerve do? | • RMN- innervates: posterior aspect of IVD, posterior longitudinal ligament, anterior epidural veins, anterior aspect of the dura, periosteum of posterior aspect of vertebral bodies • PR- (2) branches medial and lateral- innervates: skin and intrinsic |
| 9. What are the branches of a dorsal ramus? What is significant about T6? | • medial – SUPERIOR TO T6- sensory INFERIOR- motor • lateral- SUPERIOR TO T6- motor INFERIOR- sensory |
| 10. What branch forms the plexuses we studied in class? | Ventral ramus |
| 1. What spinal nerves contribute to the formation of the cervical plexus? | ventral rami of spinal nerves C1-4(5) |
| 2. What are the branches of the cervical plexus? | • SENSORY- o lessor occipital nerve o greater auricular nerve o transverse cervical nerve o supraclavicular nerve • MOTOR- o ansa cervicalis o phrenic nerve |
| 3. Which spinal nerves contribute to the formation of each branch of the cervical plexus? | • LON- C2(3) • GAN- C2,3 • TCN- C2,3 • SN- C3,4 • AC- C1,2,3 • PN-C3,4,5 |
| 4. What is the relationship of the SCM muscles to the cutaneous sensory branches of the cervical plexus? | • They all emerge from its posterior border |
| 5. What are the areas of skin innervated by the 4 sensory branches of the cervical plexus? | • LON- skin posterior to the auricle and lateral portion of the occipital region • GAN- (ant) skin over parotid salivary gland (post) over mastoid process and ear lob • TCN- skin over anterior neck • SCN- (m) skin from clavicle to midline (int) anteri |
| 6. What do the two muscular branches of the cervical plexus innervate? | • ansa cervicalis- motor to omohyoid, sternohyoid, sternothyroid • phrenic- motor to diaphragm |
| 7. If you peeled away the skin from the back of the head, list the superficial nerves you would see from medial to lateral. | • 3rd occipital • greater occipital • lesser occipital • greater auricular |
| 8. What does the dorsal ramus of C1 spinal nerve innervate? | motor to SOT muscles (no cutaneous sensory branch- reason for only 30 dermatomes) |
| 9. What does the dorsal ramus of C2 spinal nerve innervate? | Sensory to the posterior scalp, splenius muscle |
| 1. What spinal nerves contribute to the formation of the brachial plexus? | Ventral ramus – C5,6,7,8 T1 |
| 2. What are the branches of the brachial plexus? List the supraclavicular separate from the infraclavicular branches. | • SUPRACLAVICULAR- dorsal scapular, long thoracic, nerve to the sublclavius, suprascapular nerve • INTRACLAVICULAR- lateral cord , medical cord, posterior cord |
| 3. Which spinal nerves contribute to the formation of each branch of the brachial plexus? | • DS: C5 - LP: C5-7 -MP: C8-T1 -R: C5-T1 • LT: C5-7 -USS: C5-6 -MBC: C8-T1 -MC: C5-7 • SS: C5-6 -TD: C6-8 -MABC: C8-T1 -M: C5-T1 • SC: C5-6 -LSS: C5-6 -AX: C5-6 -U: C8-T1 |
| 4. Describe the formation of the trunks, the divisions and the cords of the brachial plexus. | roots --> trunks (3) --> divisions (2) --> cords (3) --> Branches? |
| 5. If the long thoracic nerve in a patient is cut, what clinical signs would be seen in that patient? | winging- serratus anterior issues |
| 6. Differentiate the clinical signs seen in a patient with carpal tunnel syndrome and a patient with pronator teres syndrome. | • PTS the patient will have decreased feeling in the thenar eminence because it affects the entire length of the median nerve. No night pain- wrist position doesn’t effect- pain is experience when elbow is extended • CTS the patient will not experience |
| 7. What does the evidence based research on carpal tunnel syndrome show as far as likely cause, diagnostics and treatment? | • Cause: repetitive stress injuries- typing, house painting, hammering, oral contraceptives, pregnancy, hypothyroidism, arthritis • Diagnostics: Katz hand diagram (A), phalens and tinnels (B) for CTS not present- thumb abduction weakness (A) and hypal |
| 8. Know the different pathologies involving the brachial plexus and the nerves involved in each, know the common names of the conditions as well. | • Erb-Duchenne Palsy (C5,6) excessive displacement of head to opposite side and depression of shoulder (waiters tip, bellmans tip) • Klumpke’s Palsy (C8,T1) excessive traction or abduction of arm • Horner’s Syndrome (T1) caused by damage to SNS (claw h |
| 1. A patient is presented with an inability to flex the knee. What nerve(s) is (are) involved? | • Femoral N- Sartorius • Tibial N- Semitendinous, semimenbranous, Biceps femoris (LH)(hamstrings), plantaris, popliteus, gastrocnemius • Common Peroneal N- Biceps femoris (SH) • Obturator N- Gracilis |
| 2. A patient is presented with an inability to extend the knee. What nerve(s) is (are) involved? | • Femoral N- Quadriceps Femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) |
| 3. A patient is presented with an inability to flex the thigh. What nerve(s) is (are) involved? | • Femoral N- Sartorius, Iliopsoas, Quadriceps Femoris (4), Pectineus • Superior Gluteal N- Tensor Fasciae Latae • Obturator N- Adductor mm., Gracilis, pectineus |
| 4. A patient is presented with an inability to extend the thigh. What nerve(s) is (are) involved? | • Tibial N- hamstring mm, adductor magnus • Branches of the sacral plexus (S1,2,3,4) - Piriformis • Inferior Gluteal N- Gluteus Maximus |
| 5. What nerve innervates the "hands in pockets" area of cutaneous distribution? | The Ilionguinal Nerve (L1) |
| 6. If the sciatic nerve was cut, what could a patient not do? | Basically anything from the knee down |
| 7. A patient is presented with an inability to dorsiflex the foot. What nerve(s) is (are) involved? | • Deep (common) Peroneal N- tibialis anterior, extensor digitorm longus, extensor hallicus longus, peroneous tertius |
| 8. A patient is presented with an inability to plantar flex the foot. What nerve(s) is (are) involved? | • Tibial N- Gastrocnemius, Soleus, Plantaris, Tibialis Posterior, Flexor Hallicus longus, Flexor Digitorum Longus • Superficial Peroneal N- Peroneus Longus, Peroneus Brevis |
| 9. What are the branches of the lumbar plexus? | L1, 2, 3, 4 |
| 10. What do the branches of the lumbar plexus innervate? | • Ilioinguinal Nerve (L1) o M: internal and external obliques and transverse abdominis o S: skin of upper medial aspect of the thigh, genitalia • Iliohypogastric Nerve (L1) o M: muscles of the anteriolateral abdominal wall o S: skin of the lower ab |
| 11. What are the branches of the sacral plexus? | • L4, 5, S1, 2, 3, 4 |
| 12. What do the branches of the sacral plexus innervate? | • Superior Gluteal Nerve (L4, 5, S1) o M: motor to gluteus minimus, medius, & tensor fasciae late o No sensory • Inferior Gluteal Nerve (L5, S1, 2) o M: gluteus maximus o No sensory • Sciatic Nerve (L4, 5, S1, 2, 4) o 2 nerves in 1 neural she |
| 13. What spinal nerve roots form the branches of the sacral plexus? | • L4, 5, S1, 2, 3, 4 |
| 14. What spinal nerve roots form the branches of the lumbar plexus? | • L1, 2, 3, 4 |
| 15. To anesthetize the skin of the perineum, what spinal nerves must be blocked? | The Pudendal Nerve (S2, 3, 4) |
| 16. How do the nerves of the nerves of the lumbar plexus relate anatomically to the psoas major m. | The nerves run posterior to the psoas major |
| 17. Know the pathologies of the lumbar and sacral plexuses, the nerves involved and the common names of the maladies. | • Femoral Nerve Neuropathy • Sciatic Nerve Neuropathy • Sciatica o Vague term • Peroneal Nerve Palsy o Tight stockings, casts, crossed legs, foot drop • Meralgia Paresrgesia |
| 1. What is a dermatome? | Areas of skin innervated by a spinal nerve or spinal segment |
| 2. List the dermatomes of the hand. | C6, 7, 8 |
| 3. List the dermatomes of the foot. | L4, 5, S1 |
| 4. List the components of a reflex arch. | Receptor, sensory neuron, association neuron, motor neuron, effector organ |
| 5. How do you determine which component of a reflex arch is affected in a patient with a diminished reflex. | Touch the area and feel sensory loss? |
| 1. If I cut C5 nerve root what peripheral nerves would be more affected? What could the patient not do? | C5 – dorsal scapular Levator and rhomboids Elevate and retract scapula, lateral flexion |
| 2. If I cut C5, 6 nerve root what peripheral nerves would be more affected? What could the patient not do? | dorsal scap, suprasc, upper and lower subsc, axillary, musculocut, rad – Erbs P Supraspin, infraspin, subscap, teres maj and min, deltoid No lat rot |
| 3. If I cut C5, 6, 7 nerve root what peripheral nerves would be more affected? What could the patient not do? | lateral pectoral, musculocutaneous Pec major, arm flexors Flex humerus, adduct, medial rotation |
| 4. If I cut C8, T1 nerve root what peripheral nerves would be more affected? What could the patient not do? | Klum Pal - Pec maj and minor, flex of pinky Flex and add humerus, med rot, protract/depress scap, flex digits 4,5 Paresis of hand ext, atrophy of hypothenar m, short muscles of hand affected, sensory loss on ulnar aspect, Horner’s syndrome “Claw Hand” |
| 5. If I cut L2, 3 nerve root what peripheral nerves would be more affected? What could the patient not do? | L2,3: lateral cutaneous femoral (Meralgia Pparesthesia) Skin over lateral anterior thigh Disturbing sensations over the thigh or loss of sensation Possible entrapment of inguinal ligament, Pelvic Compression Test |
| 6. If I cut L2, 3, 4 nerve root what peripheral nerves would be more affected? What could the patient not do? | L2,3,4: femoral, obturator Knee extensors, adductors |
| 7. If I cut L4, 5, S1, 2 nerve root what peripheral nerves would be more affected? What could the patient not do? | L4,5,S1,2: Common Peroneal n. (Peroneal nerve Palsy) From knee down No dorsiflexion or eversion Will cause forcible foot inversion, foot drop, sensory loss over dorsolateral foot and shin |
| 8. If I cut L4, 5, S1, 2, 3 nerve root what peripheral nerves would be more affected? What could the patient not do? | L4,5,S1,2,3: tibial n (from sciatic) Back of leg (flexors) except biceps short head |
| 1. What is the spinal origin of sympathetic preganglion neurons and the tissues the innervate? T1-T3 | |
| 2. What is the spinal origin of sympathetic preganglion neurons and the tissues the innervate? T1-T4 | |
| 3. What is the spinal origin of sympathetic preganglion neurons and the tissues the innervate? T8-L1 | |
| 4. What is the spinal origin of sympathetic preganglion neurons and the tissues the innervate? T3-T6, T4-T9, T11-L2, T10-L2, T7-L1 | T3-T6 - upper limbs T4-T9 - abdominal viscera T11-L2 - urinary bladder and prostate T10-L2 pelvic viscera and reproductive organs T7-L1 - lower limbs |
| 1. What are the dermatomal landmarks? C6 | Thumb |
| 2. What are the dermatomal landmarks? C7 | Middle Finger |
| 3. What are the dermatomal landmarks? C8 | Little Finger |
| 4. What are the dermatomal landmarks? T4 | Breast Nipple |
| 5. What are the dermatomal landmarks? T10 | Umbilicus |
| 6. What are the dermatomal landmarks? L3 | Medial Knee |
| 7. What are the dermatomal landmarks? L4 | Medial Ankle |
| 8. What are the dermatomal landmarks? L5 | Web space, great toe |
| 9. What are the dermatomal landmarks? S1 | Little toe |
| 0. What innervates eccrine and apical sweat glands? What type of receptor is at the tissue? | ALL sweat glands = sympathetic Apocrine = adrenergic Eccrine = muscarinic (cholinergic) |
| 1. Know the holes of the skull and what runs through them - Cribriform Plate | CN I |
| 1. Know the holes of the skull and what runs through them - Optic Canal | CN II |
| 1. Know the holes of the skull and what runs through them - Superior Orbital Fissure (SOF) | CN III, IV, V (V1), VI CN 3, 4, 5-1, 6 |
| 1. Know the holes of the skull and what runs through them - Foramen Rotundum | CN V (V2) |
| 1. Know the holes of the skull and what runs through them - Foramen Ovale | CN V (V3) |
| 1. Know the holes of the skull and what runs through them - Internal Acoustic Meatus | CN VII (Exits Ext. Acoustic Meatus?) |
| 1. Know the holes of the skull and what runs through them - Jugular Foramen | CN IX, X, XI |
| 1. Know the holes of the skull and what runs through them - Hypoglossal Canal | CN XII |
| 2. Bones of the skull, and which form what structures - pterion | Frontal, parietal, sphenoid, temporal |
| 2. Bones of the skull, and which form what structures - jugular foramen | Temporal, occipital |
| 2. Bones of the skull, and which form what structures - clivius | Sphenoid and occipital -- from dorsum sellae to foramen magnum |
| 2. Bones of the skull, and where structures are - inion | Occipital |
| 2. Bones of the skull, and where structures are - glabella | Frontal |
| 3. What muscles attach to the scapula? Actions? | Elevation: Trapezius, Levator Scaplulae, rhomboid major and minor mm. Depression: Trapezius, pectoralis minor mm. Retract/Adduction: Trapezius, Rhomboid major/minor, Latissimus dorsi mm. Protract/Abd: Serratus anterior and Pectoralis minor mm |
| 4. What muscles move the elbow? | |
| 4. Where does this muscle insert? Innervated by? Biceps Brachii | Radial Tuberosity |
| 4. Where does this muscle insert? Innervated by? Brachialis | Coronoid Process of Ulna Ulnar Tuberosity |
| 4. Where does this muscle insert? Innervated by? Brachioradialis | Distal Aspect of Radius, Proximal to Styloid |
| 4. Where does this muscle insert? Innervated by? Triceps Brachii | Olecranon of Ulna (with ancon) |
| 4. Where does this muscle insert? Innervated by? Anconeus | Olecranon of Ulna (with tri) |
| 4. Where does this muscle insert? Innervated by? Pronator Teres | Middle of lateral surface of radius |
| 4. Where does this muscle insert? Innervated by? Pronator Quadratus | Distal Aspect of Anterior Radius |
| 4. Where does this muscle insert? Innervated by? Supinator | Proximal 1/3 of radius |
| 4. Where does this muscle insert? Innervated by? Flexor Carpi Radialis | Base of Mc 2 and 3 |
| 4. Where does this muscle insert? Innervated by? Palmaris Longus | Palmar aponeurosis |
| 4. Where does this muscle insert? Innervated by? Flexor Carpi Ulnaris | Pisiform, hamulus, Mc5 |
| 4. Where does this muscle insert? Innervated by? Supinator | Proximal 1/3 of radius |
| 4. Where does this muscle insert? Innervated by? |
Created by:
DrJLH