Anatomy Quiz 1

The regionally named layer of tissue which encloses and binds muscle groups together is the:
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A motorcyclist lost control of his bike after hitting a wet spot on the pavement. He hit a curb and was catapulted several feet, landing on the point of his right shoulder and the right side of his head and neck, severely stretching his neck. He was taken to the emergency room with abrasions, lacerations and multiple injuries to both fleshy and bony tissues. For the integument to bleed or for tissue fluid to ooze from the abrasions, what layers must be damaged?
Panniculus adiposis refers to an abundance of fat in the:Subcutaneous tissue.From your observations while removing the skin from the cadaver, in which area did you find the skin to be the thickest?Posterior surface of the neck and scalp.Loss of function, paralysis, of which muscle would result in drooping or sagging of the shoulder?Trapezius.During the first day of class a student a student lacerated his finger while putting a new blade on his scalpel. The cut penetrated the skin and it was necessary for him to go to the emergency room to have it stitched up. Which layers would the ER physician include in the stitches in order to close only the skin?Epidermis, dermis.A patient complains of pain on the lower left side of her back. A radiograph confirms a hernia passing posterolaterally immediately superior to the iliac crest. This hernia passes through the:Lumbar triangle.If the right dorsal scapular nerve were cut near its origin, what would result:Scapular retraction on the right would be weakened.The part of the spinal nerve that supplies the true back muscles and the skin overlying them is the:Dorsal primary ramus.Which is not a function of the skin?Vitamin C conversion.Which is an incorrect statement regarding the skin?Surgical incisions are perpendicular to tension lines to minimize scarring.Which of the following is not a sign of melanoma?Brown color.Between which two layers does a blister form?Dermis and epidermis.A 16-year-old 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. 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.Latissimus dorsi does what?Adducts.Extrinsic muscles:Trapezius, Latissimus Dorsi, Serratus muscles, Rhomboids.Which curves are different in the adult vs the newborn?Cervical and Lumbar.What nerve in the neck is a motor nerve?Suboccipital.The part of the spinal nerve that supplies the true back muscles and the skin overlying them is the:Dorsal primary nerve.Which is a source of axons found in the dorsal primary ramus of the 4th thoracic spinal nerve?Afferent neurons arising from the skin overlying the trapezius muscle.A football player suffers a herniated (ruptured) intervertebral disc in his neck. The disc compresses the spinal nerve exiting through the intervertebral foramen between the 5th and 6th cervival vertebrae. Which spinal nerve is affected?C6.A man has a herniated intervertebral disc between the 4th and 5th lumbar vertebrae. If the disc compresses the spinal nerve in the intervertebral foramen immediately posterior to this disc, which spinal nerve would be affected?L5.Kyphosis is an accentuated or abnormal curvature of which region of the spine?Thoracic.Both the dural sac and the subarachnoid space end at which vertebral level?S2.It is decided to image the spinal cord and spinal nerve rootlets by doing a pyelogram (injection of radio-opaque dye into the subarachnoid space followed by a radiograph). In order to inject the dye without injury to the spinal cord, the injection is usually done below what vertebral level?L4.The pyelogram revealed that the dye had leaked out along the spinal nerves in the mid cervical region on the right side. For the dye to leak out, what layer must have been torn or ruptured?Arachnoid.The pyelogram also revealed that the dorsal and ventral rootlets of the 5th and 6th cervical nerves had been avulsed (torn or pulled out) from the spinal cord on the right side. Which nerve fibers would not be damaged by the avulsion?Postganglionic sympathetic.It was noted that after the injury the patient's face on the right side was flushed due to dilation of the blood vessels. The lack of vasoconstriction was due to interruption of what fibers somewhere along their course?Sympathetic.The intervertebral disc:Adds about 1/4th to entire length of vertebral column.The conus medullaris:Gives origin to most of the caudal equina.A neuron with a cell body in the dorsal root ganglia could convey what type of fibers?Sensory from the skin overlying the trapezius.The denticulate ligament:Is a modification of Pia mater.A patient is suspected of having bacterial meningitis. As part of the diagnostic procedure, a lumbar puncture is to be performed. The attending physician asks you where she should insert the spinal needle to withdraw CSF. You answer, "just below the spine of the 4th lumbar vertebrae". What reference point would you use to identify the spine?Crest of the ilium.As the spinal needle in the above question is being inserted, which ligament would it pass through on its way to the subarachnoid space?Supraspinous.Because of their structures and interconnections, which veins are especially important in the metastatic spread of cancer?Internal vertebral venous plexus.The number of vertebrae and number of spinal cord segments are the same in each region except:Cervical.The subtrapezial plexus of nerves includes:C3, C4, and the accessory nerve.If in the process of doing a lumbar puncture a spinal needle was inserted posteriorly in the midline until it had just penetrated the posterior longitudinal ligament, would the needle have entered the subarachnoid space?Yes.While moving into a new apartment a student lifting a heavy box of books experiences a sharp pain in his back, radiating down the anterior thigh and medial side of his leg. After several days of misery, he finally goes for treatment and is told that he has a herniated intervertebral disc at the L4 level which is compressing a spinal nerve where it exits the vertebral column. The point of compression is the:Intervertebral foramen.Which muscle is innervated by posterior primary rami?Erector spinae.The spinal cord is segmented like the vertebral column, but in contrast to the vertebrae there are only ______ cord segments.31.A patient is suspected of having bacterial meningitis. A 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:Pia mater.Quasimoto, the "hunchback of Notre Dame," suffered from an abnormal thoracic curvature called kyphosis. In this condition the accentuated convexity of the curvature is:Posterior.A patient is suspected of having bacterial meningitis. A lumbar puncture is performed to remove CSF for analysis. The fluid would be removed from the:Subarachnoid space at the level of L4.A 60-year-old male presented with a number of unusual signs and symptoms in the facial region. Among others, it was found that the right side of his face was flushed (red). Further testing revealed a lack of ability to sweat in the same cutaneous region. Which nervous structures were most likely implicated in this set of clinical abnormalities?Sympathetic nerve fibers.In the lumbar spine, the L4 nerve root sleeve exits:Below the pedicle of L4.Which structures does NOT contain efferent autonomic nerve fibers?Dorsal root of T6.In order to expose the spinal cord from the posterior side, it is necessary to remove the:Laminae, spinous processes and ligament flavum.In an adult, the conus medullar is of the spinal cord is normally positioned at which vertebral body levels:T12-L2.Inserting a spinal tap needle in the lumbar region, in the midline, you hear and feel a "pop" at the needle tip. What structure was perforated to cause the "pop"?Dura mater.Prostate cancer is diagnosed in an 82-year-old male. Thereafter a malignant brain tumor of prostatic origin is found. He subsequently dies. An autopsy reveals tumor sites in the prostate, and brain, but no other organs. By what vascular pathway did the cancerous cells get to the brain:Vertebral venous plexus.Which of the following statements about the artery of Adamkiewicz is not correct?It is also known as the artery of the lumbar enlargement?A 45-year-old man complained to his physician that the muscles of his upper limb were weak and he felt clumsy while walking. Tests revealed that he had amyotrophic lateral sclerosis (Lou Gehrig's disease), a disease which attacks the neurons of the voluntary motor system. Where would one expect to see atrophic or degenerated nerve cell bodies?Ventral horn of the spinal cord.A patient is diagnosed as having a venous anomaly of the posterior spinal veins which have enlarged, putting pressure on the spinal cord. In order to expose the veins, the surgeon will have to pass through the skin, subcutaneous tissue, deep back muscles and then, in order, the:Laminae and ligament flava, epidural space, dura, subdural space, arachnoid, subarachnoid space, pia.A university student comes to the emergency room with a high fever, lethargy, and a stiff neck. After further examination, meningitis is suspected and a lumbar puncture is ordered. What landmark could be used to insert the spinal needle between the 4th and 5th lumbar vertebral spines?Iliac crest.If one does a laminectomy (removing the laminae of two adjacent vertebrae) to expose the spinal cord, which ligament must be removed?Ligamentum flavum.In the final stages of labor a caudal anesthetic is sometimes given via a needle inserted into the sacral hiatus. The anesthetic is thus placed around the outside of the sacral spinal nerve roots and into the:Epidural space.What are the 4 risks for spinal immobilization in the ED listed in the article?Decrease functional capacity Compromise vascular function Increase risk of pressure ulcers Can confound emergency department assessment of traumatic injuries by causing pain.Spinal immobilization is always indicated in these 5 findings, what are they?Blunt trauma Altered mental status Midline spinal pain or tenderness Nuerologic complaints or findings Anatomic deformity of spineA spinal immobilization is indicated when a high mechanism of injury occurs with any of these 3 comorbidities. Pick the three concurrent conditions:Drug or alcohol intoxication Inability to communicate Distracting injuryWhat 5 conditions must all be present for spinal immobilization to NOT be indicated?Normal level of consciousness (e.g. Glasgow Coma Score of 15) No spine tenderness or anatomic abnormality No neurologic findings or complaints No distracting injuries No intoxicationT or F: There are some contraindications to performing a spinal immobilization.True.Which part of the spine are you mostly trying to keep aligned?Cervical.To clear a patient of spinal trauma what items must you check per the NEXUS rules?No midline tenderness: you must put your fingers on the c-spine and palpate all the way down No evidence of intoxication The patient has a normal level of alertness No neurological deficit is detected No distracting injury is presentWhat is the imaging of choice?CT.When should you refer?CT of CS demonstrates an injury or there is a neurologic deficit referable to a CS injury.What are the ABCs of cervical spine imaging?A - Alignment & Anatomy B - Bony integrity C - Cartilage (Joint) spaces S - Soft tissuesWhat are you looking for when evaluating "C"?Widened or narrowed disc space/floats.What are the 4 anatomic lines to evaluate when looking at a C-spine image X-rays?Spinolaminar line Posterior cortex line Anterior cortex line Pervertebral lineSpinal immobilization is always indicated in these 5 findings, what are they?Anatomic deformity of spine.