Anatomy ?'s

[amylynn007]

Here are a few anatomy questions to test your brain. Any ideas/references?

1) A plain radiograph of a pt following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostal spaces, and displacement of the trachea to the left. You suspect:

A. hemothorax due to the blood from the wound
B. pneumothorax due to the knife penetration of the cervical pleura
C. transection of the phrenic nerve
D. transection of the sympathetic trunk
E. pleurisy

I am trying to decide between A and C. The elevation of the hemidiaphragm makes me lean toward C, but I do not know if transection of the phrenic will cause the other 2 findings.

2) The semispinalis capitis:
A. is part of the erector spinae group of muscles
B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side.
C. when acting bilaterally, flexes the neck
D. is innervated by cervical and upper thoracic posterior rami
E. is superficial to the splenius capitis

I think it is B, but some of my classmates think it is D. However, I think it is only innervated by the cervical posterior rami, not the thoracic.

3) In examining a newly pregnant woman, you notice that the spinous process of the L5 vertebra is abnormally prominent compared to the spinous processes of the superior lumbar vertebrae. You suspect:
A. fracture of the body of L5
B. spondylolisthesis
C. a vertebral canal tumor
D. spina bifida
E. kyphosis

I am not really sure on this one. Best guess is B. I know that causes anterior displacement of the vertebral body, but I do not know if it affects the SP.

4) Which of the following is incorrect pertaining to the scaphoid?
A. It articulates with the radius.
B. it is the most frequently fractured carpal bone.
C. Fracture is accompanied by pain along the lateral side of the wrist.
D. A complication associated with fracture is avascular necrosis.
E. It attaches to the flexor retinaculum.

These answers seem like they all are correct, but I think the least correct is C. There is pain when pressure is placed on the anatomical snuff box, and it usually feels like a deep discomfort on the lateral side of the wrist.

5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head
C. it provides sensory innervation to some of the face
D. it provides sensory innervation to some of the scalp
E. it provides sensory innervation to some of the shoulder.

I have found references that indicate all of these choices as correct, unless if the skin over the parotid gland is not considered part of the face?

If anyone has any ideas, I would greatly appreciate it!

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[Southpawz]

1) A plain radiograph of a pt following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostal spaces, and displacement of the trachea to the left. You suspect:

A. hemothorax due to the blood from the wound
B. pneumothorax due to the knife penetration of the cervical pleura
C. transection of the phrenic nerve
D. transection of the sympathetic trunk
E. pleurisy

I am trying to decide between A and C. The elevation of the hemidiaphragm makes me lean toward C, but I do not know if transection of the phrenic will cause the other 2 findings.

A pneumothorax due to the penetration of the cervical pleura is probably what I would choose. Remember the apex of the lungs is just about 2cm below the clavicle, so it isnt too hard to perforate on a stab wound there.

 

[Iwy Em Hotep]

A pneumothorax due to the penetration of the cervical pleura is probably what I would choose. Remember the apex of the lungs is just about 2cm below the clavicle, so it isnt too hard to perforate on a stab wound there.

Yep. Pneumothorax will also cause tracheal deviation towards the affected side, while hemothorax will cause tracheal deviation away from the affected side.

 

[Krazykritter]

This question is addressed in Moore and Dalley's Clinically Oriented Anatomy. My answer and the one provided in the book is B.

 

[humuhumu]

Here are a few anatomy questions to test your brain. Any ideas/references?

1) A plain radiograph of a pt following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostal spaces, and displacement of the trachea to the left. You suspect:

A. hemothorax due to the blood from the wound
B. pneumothorax due to the knife penetration of the cervical pleura
C. transection of the phrenic nerve
D. transection of the sympathetic trunk
E. pleurisy

I am trying to decide between A and C. The elevation of the hemidiaphragm makes me lean toward C, but I do not know if transection of the phrenic will cause the other 2 findings.

2) The semispinalis capitis:
A. is part of the erector spinae group of muscles
B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side.
C. when acting bilaterally, flexes the neck
D. is innervated by cervical and upper thoracic posterior rami
E. is superficial to the splenius capitis

I think it is B, but some of my classmates think it is D. However, I think it is only innervated by the cervical posterior rami, not the thoracic.

3) In examining a newly pregnant woman, you notice that the spinous process of the L5 vertebra is abnormally prominent compared to the spinous processes of the superior lumbar vertebrae. You suspect:
A. fracture of the body of L5
B. spondylolisthesis
C. a vertebral canal tumor
D. spina bifida
E. kyphosis

I am not really sure on this one. Best guess is B. I know that causes anterior displacement of the vertebral body, but I do not know if it affects the SP.

4) Which of the following is incorrect pertaining to the scaphoid?
A. It articulates with the radius.
B. it is the most frequently fractured carpal bone.
C. Fracture is accompanied by pain along the lateral side of the wrist.
D. A complication associated with fracture is avascular necrosis.
E. It attaches to the flexor retinaculum.

These answers seem like they all are correct, but I think the least correct is C. There is pain when pressure is placed on the anatomical snuff box, and it usually feels like a deep discomfort on the lateral side of the wrist.

5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head
C. it provides sensory innervation to some of the face
D. it provides sensory innervation to some of the scalp
E. it provides sensory innervation to some of the shoulder.

I have found references that indicate all of these choices as correct, unless if the skin over the parotid gland is not considered part of the face?

If anyone has any ideas, I would greatly appreciate it!

1. C Injuring the phrenic nerve would elevate the hemidiaphragm (because the phrenic nerve normally depresses it). I don't know if the other signs would really be obvious on a CXR, but the opposite happens in pneumothorax (i.e., depression of hemidiaphragm, widening of intercostal spaces, deviation of the mediastinum towards the contralateral side). Hemothorax would also tend to depress the hemidiaphragm because of the pooling of blood.

2. D Semispinalis capitis is attached inferiorly at the transverse processes of thoracic vertebrae, so it's not hard to imagine some thoracic posterior rami innervating it. The fibers of the semispinalis capitis run nearly straight up and down, so I can see how it would be hard to get head rotation. Still, this is a really nitpicky question.

3. B Check out this animation of spondylolisthesis: http://www.spine-health.com/dir/spondy.html

4. They're all correct unless you don't consider the anatomical snuffbox to be part of the lateral wrist. In that case, C is the correct answer. Again, nitpicky.

5. C is probably the best answer, since the face is almost entirely innervated by branches of V. But the question is not as "clean" as it could be, because technically "some of the face" can indeed be innervated by the great auricular nerve.


How's that for my 500th post?

 

[ms1finally]

1) A plain radiograph of a pt following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostal spaces, and displacement of the trachea to the left. You suspect:

A. hemothorax due to the blood from the wound
B. pneumothorax due to the knife penetration of the cervical pleura
C. transection of the phrenic nerve - elevated hemidiaphragm is a CLASSIC sympton of damage to the phrenic nerve (http://www.rcsed.ac.uk/journal/vol46_3/4630015.htm)
D. transection of the sympathetic trunk
E. pleurisy

2) The semispinalis capitis:
A. is part of the erector spinae group of muscles - nope, part of the deep layer of the intrinsic back muscles
B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side. - nope, it rotates them contraleterally
C. when acting bilaterally, flexes the neck - really can't isolate action of these muscles, they work together
D. is innervated by cervical and upper thoracic posterior rami - all of the deep epaxial back muscles are
E. is superficial to the splenius capitis - nope, deep to it

I think it is B, but some of my classmates think it is D. However, I think it is only innervated by the cervical posterior rami, not the thoracic.



4) Which of the following is incorrect pertaining to the scaphoid?
A. It articulates with the radius.
B. it is the most frequently fractured carpal bone.
C. Fracture is accompanied by pain along the lateral side of the wrist.
D. A complication associated with fracture is avascular necrosis.
E. It attaches to the flexor retinaculum.

- Sorry, I think you are off here. Snuffbox tenderness is a classic sign of scaphoid fracture. By process of elimination it has to be E

5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head - I think this one is wrong
C. it provides sensory innervation to some of the face
D. it provides sensory innervation to some of the scalp
E. it provides sensory innervation to some of the shoulder.

I highly recommend Essential Clinical Anatomy by Keith Moore.

 

[amylynn007]

Thank you, everyone, for your responses!

Here are a few references to what I have found:

B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side. - nope, it rotates them contraleterally

Gray's Anatomy for Students by Drake p. 60 says "unilateral contraction pulls the head posteriorly and turns it, causing the chin to move superiorly and turn toward the side of the contracting muscle."

E. It attaches to the flexor retinaculum.
By process of elimination it has to be E[/I]

Hollinshead Textbook of Anatomy p. 245 says that the tubercles of the scaphoid attach to the flexor retinaculum.

5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head - I think this one is wrong

I'm not quite so sure on B. My lecture notes say that longus colli is innervated by the anterior primary rami of cervical spinal nerves C2-C7 and branches from cervical and brachial plexuses. One of its actions listed is "slight rotation to the opposite side."

I highly recommend Essential Clinical Anatomy by Keith Moore.[/QUOTE]

Yes, I agree! I wish I would have gotten it at the beginning of the semester (I still have to get it).

Thanks again,
Amy

 

[ms1finally]

Thank you, everyone, for your responses!

Here are a few references to what I have found:

B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side. - nope, it rotates them contraleterally
p. 297 of little Moore (Essential Clinical Anatomy) attributes contralateral rotation to the semispinalis - NOT ipsilateral. Also, if you think about the structure of the deep back muscles, they are going to have thoracic innervation. (I refer you to the "muscle table", I've never found it to be wrong: www.ptcentral.com/muscles)


5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head - I think this one is wrong

"Big Moore" (aka Clinically Oriented Anatomy) does list "torsion to opposite side if acting unilaterally," but it seems like its primary function is flexion of the neck. This is a poorly written question and it really depends on what the author means by "face." If face doesn't include the area around the parotid, then I guess that statement would work. However, that seems like a narrow definition of "face."

 

[humuhumu]

5) Which of the following is incorrect pertaining to the cervical plexus?
A. it innervates the omohyoid, sternohyoid, and sternothyroid
B. it innervates a muscle that turns the head
C. it provides sensory innervation to some of the face
D. it provides sensory innervation to some of the scalp
E. it provides sensory innervation to some of the shoulder.

For this question I ruled out "B" because the cervical plexus helps innervate the sternocleidomastoid, which obviously turns the head. However, some sources indicate that cervical ventral rami provide only afferent innervation (i.e. proprioception) to the SCM, while XI is solely responsible for the efferent (motor) innervation. If "B" is referring to motor innervation only, then it may be the best answer because none of the other muscles innervated by the cervical plexus have anything to do with turning the head (in general they act on the hyoid or flex the neck and/or head). Again, not a very well written question.

 

[PiccoloPlaya82]

Maybe I should study over winter break?

 

[subtle1epiphany]

Just to help out here...I attend the same school as AmyLynn
The profs have announced that pertaining to the scaphoid fracture, there is no correct answer due to all of them being correct and the question asking for the incorrect one.
In addition, with respect to the hemidiaphragm elevation/intercostal narrowing/tracheal deviation to the same side, the answer has been confirmed as pneumothorax. It comes down to either phrenic nerve severing or pneumo, as hemothorax would require an extreme amount of blood. Evidently there are a couple of types of pneumothorax (which I wouldn't know as a first year) but in one the affected lung completely deflates and the other is able to increase further, therefore causing the trachea to move to the side of the deflated lung. Evidence for this is provided in Moore & Dalley text - page 118, and is refered to as a Complete Pneumothorax (when contrasted with a tension pneumothorax which I had assumed). This has been substantiated by Dr. Fitzsimmons, course coordinator of Medical Gross Anatomy. Hope this helps with understanding of above questions and posts.

 

[Southpawz]

Just to help out here...I attend the same school as AmyLynn
The profs have announced that pertaining to the scaphoid fracture, there is no correct answer due to all of them being correct and the question asking for the incorrect one.
In addition, with respect to the hemidiaphragm elevation/intercostal narrowing/tracheal deviation to the same side, the answer has been confirmed as pneumothorax. It comes down to either phrenic nerve severing or pneumo, as hemothorax would require an extreme amount of blood. Evidently there are a couple of types of pneumothorax (which I wouldn't know as a first year) but in one the affected lung completely deflates and the other is able to increase further, therefore causing the trachea to move to the side of the deflated lung. Evidence for this is provided in Moore & Dalley text - page 118, and is refered to as a Complete Pneumothorax (when contrasted with a tension pneumothorax which I had assumed). This has been substantiated by Dr. Fitzsimmons, course coordinator of Medical Gross Anatomy. Hope this helps with understanding of above questions and posts.

Tension Pneumothorax vs. Pneumothorax