Review Session
12/16/2009 5:59:00 PM
*These questions are not indicative of format (first thing he said… yet some
of these are from the quiz)
A 52 year old band director suffered problems in her right arm. Physical
exam reveals wrist drop and weakness of grasp but normal elbow extension.
There is no loss of sensation in the affected limb. Which is most likely
affected?
 Ulnar
o Adduction abduction of fingers affected (interossei, adductor
pollicis- weak grip


Anterior interosseous
o Deep branch of median nerve (deeper flexors: pronator
quadratus
Posterior interosseous
o Branch of radial n.; enters forearm through the lateral side of
cubital fossa. Just proximal to CF, find radial n. in between
brachialis and brachioradialis; branches to superficial and
deep; deep branch will dive through the supinator posterior to
interosseous membrane, known as posterior interosseous
o For our intents- know that extensors are innervated by deep
radial
 In lab, be able to ID superficial radial, deep radial, and
if you see a ‘teensy’ little nerve in the extensors, call it
the posterior interosseous n.
 Median
 Superficial Radial
o No motor supply, this is all sensory to back of hand
A 22 year old woman is admitted to the ED in an unconscious state. The
nurse takes a radial pulse to determine the HR of the patient. This pulse is
felt lateral to which tendon?
 Palmaris longus
o Not always there; also runs more median
 Flexor pollicis longus
o Not a ‘bad answer’; however it would run deeper than FCR
 Flexor digitorum profundus
 Flexor carpi radialis
o Flex wrist against resistance, it’s the tendon on the lateral
side
 Flexor digitorum superficialis
Which ligament(s) contribute(s) to the anterior wall of the vertebral canal?
 Ligamenta flava
 Anterior longitudinal
 Posterior longitudinal
 All of the above
 None of the above
A 24 year old man is admitted with a wound to the palm of his hand.
Physical exam reveals that he 1: cannot touch the pads of his fingers with
his thumb, 2: can grip a sheet of paper between all fingers, and 3: has no
loss of sensation from the skin of his hand. Which nerve has most likely
been injured?
*Clarification: Gripping a sheet of paper shows adduction, letting us know
that the ulnar n. is fine
 Deep branch of ulnar
 Anterior interosseous
 Median (in the hand)
o After it gives off anterior interosseous, you find the median
nerve deep to FDS, above profundus. It goes through the
carpal tunnel, immediately branches (recurrent goes to
Thenar m.) and innervates lumbricals 1&2 (deep) and
cutaneous (superficial)
 Recurrent branch of median
o Thenar muscle function is compromised
 Deep branch of radial
*Note: consider FPB innervated by the MEDIAN Nerve, despite Sean Figy’s
best efforts
A 55 year old male is examined in a neighborhood clinic after receiving blunt
trauma to his right axilla in a fall. He has difficulty elevating the right arm
above the level of his shoulder. Physical exam shows inferior angle of his
right scapula protrudes more than the lower part of the left scapula. The
right scapula protrudes far more when the patient pushes against resistance.
What is most likely injured?
 Posterior cord of brachial plexus


Long thoracic nerve
o This is a long-winded explanation of winging of the scapula,
controlled by the long thoracic nerve
o Also, serratus anterior is involved in abduction past 90
degrees
Upper trunk of the brachial plexus
o C5, C6: Does share something with Long thoracic.. however
this nerve comes straight from the roots, not the trunk
o If this were in the upper trunk, you would see issues with
suprascapular n
 Site of origin of the middle and lower subscapular nerves
 Spinal nerve roots C7, C8, T1
A quarterback is hit by the left tackle while passing the ball. His arm is
forced backward, resulting in shoulder dislocation. Which structure does
NOT contribute to stability of the glenohumeral joint?
 Inferior glenohumeral joint
o Fibrous capsule
 Coraco-acromial ligament
o Part of coracoacromial arch; prevents superior dislocation

Coracohumeral ligament
o
 Supraspinatus
o SITS… Rotator cuff muscle
 Coracoclavicular ligament
o Has two parts; more medial than G-H joint
After a forceps delivery of a male infant, the baby presents with his left
upper limb adducted, internally rotated, and flexed at the wrist. Which part
of the brachial plexus was most likely injured during this delivery?





Lateral cord
Medial cord
Roots of lower trunk
Roots of middle trunk
Roots of upper trunk
o Erb’s Palsy… classic waiter’s tip position
o By definition, an upper brachial plexus injury
o If you don’t remember the palsy; think about what is affected
Adduction indicates that aBduction is affected
(Supraspinatus (Suprascapular C5-C6, Deltoid (Axillary
C5-C6))
 Flexion indicates that extensors can not counteract
During shoulder surgery on a 56 year old woman the vascular bundle along
the medial border of the scapula is damaged. Which artery will most likely
compensate for the blood supply to the scapula that was lost during the
procedure?
 Dorsal scapular
o Normally supplies the medial border (rhomboids and levator


scapulae)
o Generally found deep to rhomboid minor, typically not found
in lab
o If you see a structure on the medial border of the scapula,
please label it “dorsal scapular”
o FYI also contributing to this anastamoses would be the
circumflex scapular
Suprascapular
o On the “superior border” of the scapula
 Posterior circumflex humeral
 Lateral thoracic
 Thoracodorsal
A 17 year old male has weak elbow flexion and supination of the left forearm
after sustaining a knife wound in that arm in a street fight. Examination in
the ED indicates that a nerve has been severed. Which condition will also
most likely be seen during physical examination?
 Inability to adduct and abduct his fingers
 Inability to flex his fingers



Inability to flex his thumb
Sensory loss over lateral surface of forearm
o Musculocutaneous nerve damage (flexion and supination from
biceps brachii)
o Brachioradialis is still intact (radial n.)
o Musculocutaneous n. continues as lateral cutaneous n. of
forearm
Sensory loss over medial surface of forearm
Review session
12/16/2009 5:59:00 PM
He calls Dr. Hankin “Dr. Supinator,” which is awesome
A 35 year old woman complains of a progressive facial flushing, headaches,
dyspnea, edema of the upper extremities, pain, dysphagia, and several
episodes of syncope. MRI revealed a tumor compressing the base of the
superior vena cava to the brachiocephalic v. Which of the following
mediastinum is this tumor located?
 Superior
 Anterior
 Middle
 Posterior


1 and 2
1 and 3
o Remember divisions of mediastinum. Base of the great veins
and arteries are in the MIDDLE, which is why the answer is
both 1 and 3
o Question: Where is arch of azygous?
 Sternal angle contains
 Arch of aorta
 Pericardial extent


Arch of azygous: Superior
Bifurcation of trachea (carina)


Clinical

2 and 4
All
vignette about carotid artery… The carotid artery formed by:
Aortic arch 1
o Maxillary
 Aortic arch 2
o Stapedial




Aortic arch 3
o Carotid artery
Aortic arch 4
o Arch of aorta
Aortic arch 5
o OBLITERATES
Aortic arch 6
o Pulmonary
*Talks for a while about the cardinal, vitelline and umbilical veins. Cardinal
forms most of the veins of the body, including SVC and MOST of the IVC.
Vitelline forms all of the digestive veins of the body, and the stump of the
IVC that comes from the liver. IF he tags the IVC in the thorax… that is
VITELLINE. Umbilical veins; Right obliterates, Left enlarges to form ductus
venosus, which closes after birth.
Clinical vignette…. Shortness of breath, ECG revealed absence of P wave.
Which of the following is probably affected?
 Atria






Ventricle
AV node
o PR segment. Problem here will increase P R segment
His bundle
Purkinje fibers
SA Node
o P wave absence indicates problem with SA node, and possibly
the atria as well
Right Bundle Branch
*SA node gets 55% of blood supply from the RCA, 45% from the LCA
*Lots of discussion about dominance vs % supply
Clinical vignette introducing cardiac tamponade… The first layer of
pericardium cut by the surgeon is
 Parietal serous
 Parietal fibrous
 Fibrous
o Two types of pericardium, fibrous and serous. Fibrous is
outer layer. Serous is parietal and visceral/epicardium
 Serous fibrous
 Serous visceral
 Epicardium
Questions on Transposition of Great Arteries: Aorta goes to the body FROM
the Right Ventricle, so no oxygenated blood is circulated (Same problem
with pulmonary circulation; oxygenated blood keeps going to lungs and back
Micro Review
12/16/2009 5:59:00 PM
ID structure in box
 Bronchus
 Trachea
 Arteriole
 Muscular Artery
 Bronchiole
o No cartilage cap
ID vessel contained within the red box
 Muscular artery
 Capillary

Arteriole
o <5 layers of smooth muscle, internal elastic lamina visible
 Venule
 Bronchiole
ID the bracketed layer. Be specific!
 Thick Skin
 Dermis
 Reticular Layer
o Deeper layer of the dermis.
 Papillary Layer
 Hypodermis
ID the indicated cells. Be specific!
 Melanocytes
 Keratinocytes
o Darkly stained cells
 Langerhans Cells
 Merkel Cells
 Clara Cells
What sensory modality does the indicated structure respond to?
 Light touch
o Meissner’s Corpuscle (Horizontal cells)
 Pain
 Temperature
 Moisture
 Deep Touch
ID the structure indicated by the arrows. Be specific




Valscular Plexus of olfactory epithelium
Olfactory acini
Lamina propria
Bowman’s glands
o Clear lumen, deeper
 Olfactory epithelium
The basic tissue type of the indicated cells is:
 Simple squamous epithelium
 Cardiac muscle
 Endothelium


Smooth muscle
Epithelium
o This was the simple squamous epithelium of the
endocardium, and a bullshit question… key word is “basic”
and not “specific”
The features shown in the electron micrograph are diagnostic for which cell?
 Basophils
 Neutrophils
 Eosinophils
o Key in the electron micrograph were the granules (hamburger
looking) which is indicative of eosinophilic granules
 Reticulocytes
ID the structure indicated by the black arrow. Be specific
 Tunica adventitia
 Vaso vasorum
o Blood supply to an artery
 Tunica media
 Elastic lamellae
 Tunica
ID the bracketed layer
 Thin skin
 Tunica granulosum
 Stratum epineurium
 Stratum hallucinum
 Stratum corneum
o Outermost layer, no nuclei, clear
ID the structure indicated by the arrows
 Tracheal cartilage ring
 Lamina propria
 Trachealis muscle
o Muscle tissue in between the cartilage ring
 Hyaline muscle
 Elastic lamina
Of the following choices, what could account for an increase in indicated cell
type?
 Low oxygen tension


Climbing mount everest
Fall into a crevasse on Mt. Everest and get injured
o Indicated cells are neutrophils, which I suppose would
respond when bacteria infiltrate a wound if you fell off of a
fucking mountain. Dumb question.
 All of the above
ID the structure enclosed in the brackets
 Alveoli
 Lymph node



Respiratory bronchiole
Alveolar sac
Alveolar Duct
o Respiratory bronchiole will have additional CT. The duct is all
pneumocyte tissue. The sacs are “dead ends.”
Cells in the indicated area are killed by HIV
 True
o This is the T cell region
 False
What happened here?
 Antigen presentation
 Red blood cell formation
 Red cell destruction
 Plasma cell differentiation
o Activated area of white pulp, B cell proliferation, B cells
become PLASMA CELLS!