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Anatomy Shelf Exam Q&A: Musculoskeletal System and Clinical Correlations, Exams of Anatomy

A comprehensive set of questions and answers related to anatomy, focusing on musculoskeletal structures, nerve and artery pathways, and common injuries. It covers topics such as lumbar punctures, herniated discs, fractures of various bones, rotator cuff muscles, and conditions like carpal tunnel syndrome and sciatica. The material is presented in a question-and-answer format, making it useful for students preparing for exams or seeking a quick review of key anatomical concepts. It also includes clinical correlations, such as the causes and effects of specific nerve injuries and fractures, enhancing its practical value for medical education. Designed to help students understand and recall important anatomical information through targeted questions and concise answers, facilitating effective learning and exam preparation.

Typology: Exams

2024/2025

Available from 05/14/2025

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nbme anatomy shelf|Questions With Correct
Answers|Verified
Where and why are lumbar punctures performed? - Spinal Block -> Anesthetic (into
epidural space)
Spinal Tap -> CSF extraction (into subarachnoid space)W
B/W L3/L4 or L4/L5
NB: Posterior to this is *cauda equina*
Where does a *herniated intervertebral* disk occur? What causes it? - Occurs b/w
L4/L5 or *L5/S1* and C5/C6 or C6/C7
NB: affects lower spinal nerve #
Degeneration of annulus fibrosis followed by *sudden compression* of nucleus
pulposus
What is the difference b/w *retrolisthesis* and *spondylolisthesis*? - Retro -
backwards movement of vertebral bone
Spondylo - forward movement of bone
What is *lordosis*? - exaggerated *L*umbar curvature
What is *kyphosis*? - exaggerated thoracic curvature (can be seen w/osteoporosis)
What structures will be affected by a fracture of the *surgical neck*? - axillary nerve
and posterior humeral circumflex artery
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nbme anatomy shelf|Questions With Correct

Answers|Verified

Where and why are lumbar punctures performed? - ✔Spinal Block - > Anesthetic (into epidural space) Spinal Tap - > CSF extraction (into subarachnoid space)W B/W L3/L4 or L4/L NB: Posterior to this is cauda equina Where does a herniated intervertebral disk occur? What causes it? - ✔Occurs b/w L4/L5 or L5/S1 and C5/C6 or C6/C NB: affects lower spinal nerve # Degeneration of annulus fibrosis followed by sudden compression of nucleus pulposus What is the difference b/w retrolisthesis and spondylolisthesis? - ✔Retro - backwards movement of vertebral bone Spondylo - forward movement of bone What is lordosis? - ✔exaggerated Lumbar curvature What is kyphosis? - ✔exaggerated thoracic curvature (can be seen w/osteoporosis) What structures will be affected by a fracture of the surgical neck? - ✔axillary nerve and posterior humeral circumflex artery

What structures will be affected by a fracture at midshaft of humerus? - ✔radial nerve and profunda brachii artery What structures will be affected by a fracture at supracondylar region of humerus? - ✔median nerve and brachial artery What are differences b/w Colles' and Smith's Fractures? - ✔Both are distal radial fractures Smith's - flexion fracture (distal segment anterior) Colles' - extension fracture (distal segment posterior/dorsal) - incl. avulced ulnar styloid process What are the carpal bones? - ✔Some Lovers Try Positions That They Can't Handle Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Which carpal bone is most often fractured during a fall (symptoms)? - ✔Scaphoid "deep tenderness in anatomical snuff box" What is a boxer's fracture? - ✔Fracture of necks of metacarpals What are the 4 muscles of the rotator cuff? - ✔Supraspinatus Infraspinatus Teres Minor Subscapularis

brachial a. median n. What two muscles form borders of cubital fossa? - ✔Pronator Teres (medial) and Brachioradialis (lateral) What are subcutaneous structures of cubital fossa? - ✔From lateral to medial: cephalic v. median cubital v. (connects the two; over bicipital aponeurosis) basilic v. What are causes/symptoms of carpal tunnel syndrome? - ✔Causes: lesion that ↓ size of carpal tunnel (dislocation of lunate bone, fluid retention, infection), repetitive movement Effect: median n. affected

  • "pins and needles lateral 3.5 digits"
  • palm sensation not affected What causes Upper Brachial Palsy? - ✔AKA Erb-Duchenne Palsy Trauma during fall (head away from shoulder) Pulling arm of child Lesion of C5/C6 or Upper Trunk What results from upper brachial palsy? - ✔Waiter's tip hand

Medially rotated arm Adducted shoulder Extended elbow Loss of sensation in lateral upper limb What are the cause/result of klumpke's paralysis? - ✔a. injury of lower root (C8/T1); "grabbing a tree limb"; thoracic outlet syndrome b. combination lesions of ulnar (claw hand) and median nerve (ape hand) What results from lesion to musculocutaneous nerve? - ✔Cause: lesion of lateral cord Effect: weak elbow flexion (biceps/brachialis) and forearm supination (biceps) What are main innervations of arm? - ✔1. biceps brachii, brachialis, coracobrachialis musculocutaneous n.

  1. back of arm - radial n.
  2. forearm muscles (8) - median n. Exception: f. digitorum profundus/f. carpi ulnaris ulnar n. What are the eight flexor muscles of the forearm? - ✔Think 4 - 1 = 3 (superficial to deep)
  1. FPFP (f. carpi ulnaris, palmaris longis, f. carpi ulnaris, pronator teres)
  2. F. Digitorum Superficialis
  1. avascular necrosis of femoral head What is the unhappy triad for knee joint injuries? - ✔Cause: lateral trauma to knee
  2. Tibial Collateral Ligament
  3. Medial Meniscus
  4. Anterior Cruciate Ligament What is the function/structure of the fibular/lateral collateral ligament? - ✔b/w lateral epicondyle of femur/head of fibula does not blend w/joint capsule or attach to lateral meniscus limits extension/adduction of knee What is a sign of ACL rupture? - ✔anterior drawer sign excess forward movement of tibia What is a sign of PCL rupture? - ✔posterior drawer sign excess backward movement of tibia [less common] What does the patellar reflex test? - ✔"knee jerk reflex" both limbs carried by femoral nerve Tests spinal nerves L2 - > L

What structures are injured in a lateral ankle sprain? - ✔"inversion injury" lateral ligament ("anterior talofibular ligament*) is injured severe cases - > fracture of lateral malleolus of fibular bone What structures are injured in a medial ankle sprain? - ✔"eversion injury"; abduction of foot medial ligament injured What does the ankle jerk reflex test? - ✔"achilles tendon reflex" tap calcaneal tendon both limbs carried by tibial nerve tests spinal nerve S1 - > S What causes piriformis syndrome? - ✔inflammation/spasm of piriformis muscle produces pain like that of sciatica Func'n of Piriformis: supination of hip What are cause/effect of injury to sciatic n.? - ✔c: posterior hip dislocation/bad butt injection e: weak hip extension/knee flexion; foot drop or flail foot What causes hip drop? - ✔posterior hip dislocation, surgery, polio

Prevents plantar flexion What is result of lesion to tibial n. in popliteal fossa? - ✔Loss of plantar flexion of foot (triceps surae), weakened inversion (tibialis post. m.) What are effects of fibular neck fracture? - ✔injury to common peroneal n. paralysis of ant/lat compartment muscles (dorsiflexors/evertors) foot drop What is the origin of breast carcinomas? - ✔typically adenocarcinomas - from epithelial cells of lactiferous ducts in mammary glands What causes dimpling of skin in breast cancer? - ✔attachment of cancer to cooper's (suspensory) ligaments What is a common neural complication of radical mastectomy? - ✔Lesion to long thoracic n. - > leads to winged scapula and a difficulty in abducting above the horizontal (paralysis to serratus anterior) loss of sensation to medial arm due to lesion of intercostobrachial nerve (from T2) What are cause/effect of hemiparalysis to diaphragm*? - ✔Ipsilateral lesion to phrenic n. paradoxical mvmnt - dome of injured diaphragm pushed up during inspiration by abdominal viscera instead of down What are effects of mitral valve failure? - ✔Results in left atrial enlargement - > compression of esophagus (dysphagia)

Where is the esophagus constricted? - ✔1. where laryngopharynx meets w/esophagus behind the cricoid cartilage

  1. crossed in front by left main bronchus and aortic arch
  2. esophageal hiatus in the diaphragm at T10 What are the areas of auscultation? - ✔a. aortic valve - > 2nd right ICS PSL b. pulmonary valve - > 2nd left ICS PSL c. tricuspid valve - > 4th left ICS PSL d. mitral valve - > 5th left ICS MCL What are sites of auscultation for mitral and aortic murmurs? - ✔a. aortic stenosis (systolic) right 2nd ICS/PSL b. mitral insufficiency (systolic) right 3rd ICS/MAL c. tricuspid insufficiency (systolic) left 5th ICS/PSL d. mitral stenosis/aortic insufficiency (diastolic) right 5th ICS/MCL NB: areas of stenosis are the same as normal auscultation What does right coronary artery supply and what are its branches? - ✔right atrium/ventricle branches: a. anterior cardiac branches - > right atrium b. nodal branch - > SA/AV nodes c. marginal a. - > right ventricle d. post. interventricular a. - > diaphragmatic surface of both ventricles

early metastasis to thoracic lymph nodes persistent, productive cough at apex = pancoast tumour What is open pneumothorax? - ✔pleural cavity open to outside inspiration - air enters chest wall - > mediastinum shifts to opposite side (compress other lung) expiration - air exits wound - > mediastinum shifts back What is innervation of the parietal pleura? - ✔paint, temp, touch, pressure a. costal - > intercostal n. b. mediastinal - > phrenic n. c. diaphragmatic - > phrenic n. (over domes); intercostal n. around periphery What is innervation of visceral pleura? - ✔sensitive to stretch only autonomic nerve supply from pulmonary plexus What organs are in the right upper quadrant? - ✔liver, gallbladder What organs are in the left upper quadrant? - ✔spleen, stomach What organs are in the right lower quadrant? - ✔appendix, cecum What organs are in the left lower quadrant? - ✔descending colon, sigmoid colon

What are the three regions for referred abdominal pain? - ✔a. foregut structures - epigastric b. midgut structures - umbilical c. hindgut structures - hypogastric Which fascia make up layers of abdominal hernias? - ✔innermost - > outermost a. transversalis fascia b. internal oblique fascia c. external oblique fascia Where does the indirect inguinal hernia pass through? - ✔lateral to inferior epigastric vessels congenital deep inguinal ring - > inguinal canal - > superficial inguinal ring - > scrotum Where does the direct inguinal hernia pass through? - ✔medial to inferior epigastric vessels acquired through hesselbach's triangle inguinal canal - > superficial inguinal ring What are the contents of the lesser omentum - ✔portal triad (portal v., bile duct, proper hepatic a.) - hepatoduodenal ligament R./L. Gastric Vessels What two ligaments make up the lesser omentum? - ✔a. hepatogastric b. hepatoduodenal

What will a gastric ulcer of the distal lesser curvature affect? - ✔corrosion of left gastroepiploic a. branch of splenic a. What will be the effect of a penetrating gastric ulcer of the posterior wall? - ✔corrosion of splenic a. What area is affected in a congenital diaphragmatic hernia? - ✔posterolateral How does a sliding hiatal hernia occur? - ✔hernia of stomach cardia through esophageal hiatus (T10) can cause damage to vagal trunk How does meckel's diverticulum develop? - ✔congenital; remember "story of 2's" persistent portion of vitelline duct forming fistula can cause inflammation if contains ectopic, pancreatic, gastric, endometrial tissue Describe first pain of appendicitis? - ✔referred pain around umbilicus afferent fibers to T10 (dermatome) Describe second pain of appendicitis? - ✔sharp, localized pain at mcburney's point occurs when pain shifted to parietal peritoneum What is the cause of hirschsprung's disease? - ✔failure of neural crest cells to migrate congenital absence of parasympathetic postganglionic neurons dilation occurs proximal to affected region

What are branches of aorta (include vertebral level) - ✔Celiac Trunk - T SMA - L Renal A. - L IMA - L Common Iliac A. - L Where does the celiac trunk emerge near? - ✔passes above superior border of pancreas three branches

  1. left gastric a.
  2. splenic a.
  3. common hepatic a. What is the origin of the cystic a.? - ✔right hepatic artery What are branches of gastroduodenal artery? - ✔descends behind 1st part of duodenum branches to form:
  4. right gastroepiploic a.
  5. superior pancreaticoduodenal a. What is a complication of cholecystectomy? - ✔mistakenly ligate right hepatic a. leads to right lobe necrosis What is the liver's collateral circulation when hepatic a. is ligated? - ✔left/right gastric a. left/right gastroepiploic a.

leads to obstructive jaundice What forms posterior to the neck of the pancreas? - ✔portal vein What happens when ventral/dorsal pancreatic buds form ring around duodenum? - ✔annular pancreas What ribs must fracture to cause laceration of spleen? - ✔Left 9th/10th ribs What are contents of gastrosplenic ligament? - ✔-connects spleen to upper/greater curvature

  • contains short gastric & left gastroepiploic vesels What are contents of splenorenal ligament? - ✔-connects left kidney/spleen
  • contains tail of pancreas, splenic vessels, lymph/nerve What are the two main types of kidney stones? - ✔1. calcium oxalate
  1. calcium phosphate What are staghorn calculi? - ✔renal stones that develop in the calyx gives impression of antlers from magnesium ammonium phosphate (MAP) result from recurrent urinary tract infection Left Renal Vein - > Anterior/Posterior to aorta? - ✔Anterior What causes varicocele? - ✔Engorgement of pampiniform plexus

Leads to left testicular vein What causes internal hemorrhoids? - ✔dilation of tributaries of superior rectal veins (above pectinate line) not painful; visceral afferent fibers What causes external hemorrhoids? - ✔dilation of tributaries of inferior rectal veins (below pectinate line) painful; somatic afferent fibers What are contents of deep perineal pouch? - ✔think "such a deeb bouch"

  1. sphincter urethrae muscle
  2. deep transverse perineal muscle
  3. bulbourethral glands What are contents of superficial perineal pouch? - ✔all muscle (think: irritable bowel syndrome)
  4. ischocavernosus
  5. bulbospongiosus
  6. superficial transverse perineal What facilitates bladder emptying? - ✔a. parasympathetic (pelvic splanchnic n.) (+) detrusor m. contraction and internal sphincter relaxation b. pudendal nerve causes voluntary relaxation of external sphincter What inhibits bladder emptying? - ✔sympathetic fibers (sacral splanchnic n.) inhibit detrusor muscle and stimulate internal sphincter