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1. The general name for an alternate pathway of blood flow in or around an organ, around a joint, or past an obstruction is called: an arteriovenous anastomosis a periarticular network a perivascular plexus a venous plexus collateral circulation 2. When standing in the Anatomical Position the palms of the hands face: anteriorly laterally medially posteriorly superiorly 3. While wandering around in the dark in an unfamiliar home, a visitor accidentally walks into a plate glass door. The door shatters and a shard of glass severs the posterolateral aspect of the woman's neck. Examination reveals that the she is unable to elevate the tip of her shoulder on the injured side. The nerve injured is: accessory dorsal scapular greater occiptal spinal nerve C4 thoracodorsal 4. The regionally named layer of tissue which encloses and binds muscle groups together is the: deep fascia intermuscular septum neurovascular bundle skin subcutaneous tissue 5. The portion of the skin that serves as a barrier to water loss is the: dermis subcutaneous tissue superficial fascia epidermis deep fascia 6. Hair, nails and teeth (enamel) originate in common with what layer? deep fascia epidermis panniculus adiposis subcutaneous tissue superficial fascia 7. A person receives a laceration along the anterior border of the trapezius muscle in the neck and subsequently the point of his shoulder (scapula) sags and he has some difficulty fully abducting his arm. What nerve appears to have been severed? accessory (Cr. N. XI) axillary dorsal scapular greater occipital suprascapular 8. When people are severely burned they have great difficulty with fluid loss because the portion of the skin which is the fluid barrier is destroyed. Which layer of the skin is responsible for preventing fluid loss? dermis epidermis investing fascia panniculus adiposus subcutaneous tissue 9. The cutaneous branch of the posterior primary ramus of C2 is called the: Accessory nerve Great auricular nerve Greater occipital nerve Lesser occipital nerve Superior ramus of the ansa cervicalis 10. Interruption of cranial nerve XI would paralyze which muscle? deltoid latissimus dorsi levator scapulae rhomboideus major trapezius 11. 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. Given this scenario, answer the following: For the integument to bleed or for tissue fluid to ooze from the abrasions, what layers must be damaged? epidermis and dermis epidermis and superficial fascia epidermis and deep fascia dermis and superficial fascia dermis and deep fascia 12. Sutures (stitches) would be placed in which tough layer of the skin in order to sew up the lacerations? epidermis deep fascia dermis subcutaneous tissue superficial fascia 13. After initial examination, the patient is sent to radiology. Radiographs reveal that the portion of the scapula forming the tip or point of the shoulder has been fractured. This bone is the: acromion angle coracoid glenoid spine 14. Elevation of the tip of the patient's right shoulder was still possible indicating that which of the following nerves was intact? accessory axillary dorsal scapular suprascapular 15. thoracodorsal Panniculus adiposus refers to an abundance of fat in the: deep fascia muscular fascia skin subcutaneous tissue neurovascular bundles 16. In order to make an intramuscular injection, the needle must pass through several layers of tissue to reach the muscle. Choose the correct order of tissues the needle would pass through from superficial to deep. Epidermis, dermis, investing fascia, subcutaneous tissue, muscle Epidermis, dermis, subcutaneous tissue, investing fascia, muscle Epidermis, investing fascia, dermis, subcutaneous tissue, muscle Epidermis, subcutaneous tissue, dermis, investing fascia, muscle Epidermis, subcutaneous tissue, investing fascia, dermis, muscle 17. From your observations while removing the skin from the cadaver, in which area did you find the skin to be the thickest? Anterior surface of the forearm Anterior surface of the chest Medial surface of the arm Posterior surface of the forearm Posterior surface of the neck and scalp 18. Loss of function, paralysis, of which muscle would result in drooping or sagging of the shoulder? Erector spinae Latissumus dorsi Levator scapulae Rhomboideus major Trapezius 19. During the first day of class 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? Dermis, subcutaneous tissue, deep fascia Dermis, superficial fascia, deep fascia Epidermis, dermis Epidermis, dermis, investing fascia Epidermis, subcutaneous tissue 20. As you are sitting in a quiz, the skin immediately over the base of the spine of your scapula begins to itch. The sensation from this area is mediated through which nervous structure? Accessory nerve Dorsal primary ramus of C7 Dorsal root of T2 Ventral primary ramus C7 Ventral root of T2 21. 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 Triangle of auscultation Inguinal triangle Triangle of Calot Greater sciatic foramen 22. If the right dorsal scapular nerve were cut near its origin, what would result: Skin of the upper back on the right side would be numb The point of the right shoulder would droop Scapular retraction on the right would be weakened Extension of the right arm would be weakened Inability to adduct the right arm 23. The transverse cervical artery is severed in an auto accident. What muscle would be affected the most? Levator scapulae Rhomboideus minor Rhomboideus major Trapezius Latissimus dorsi 24. During a triathalon biking accident, a rider fell and landed with the handle bar of her bike forced upward into her right axilla. Subsequently while swimming in another triathalon event she found that her right arm tired so badly during the swimming portion that she could barely finish the event. During examination it was found that movements involving adduction, medial rotation and extension of her arm were particularly weak and affected her swimming stroke. The nerve injured was the: Accessory Dorsal scapular Lateral pectoral Medial pectoral Thoracodorsal 25. In order for a skin abrasion to bleed, the lesion must penetrate at least into the: Dermis Deep fascia Epidermis Muscular fascia Subcutaneous tissue 26. After a penetrating wound in the area of the posterior axillary fold a patient had weakness in extension and adduction of the arm. Which muscle is likely involved? Latissimus dorsi Pectoralis major Levator scapulae Rhomboideus major Trapezius 1. The correct answer is: collateral circulation When the body moves, vessels in certain locations may become constricted. Collateral circulation allows blood to flow around potential constrictions, such as at moveable joints. An arteriovenous anastomosis is a shunt between arterioles and venules that can divert blood away from a capillary bed. A periarticular network sounds good, and is pretty much descriptive of collateral circulation, but it's not the winner. A perivascular plexus is a collection of autonomic nerve fibers that follow blood vessels to reach a target to innervate (including the vessels themselves). A venous plexus is a network of small veins - the internal vertebral plexus around the dural sac is a good example. 2. The correct answer is: anteriorly In the anatomical position, the body stands erect, upper limbs at the sides, palms facing forward or anteriorly, thumbs pointing away from the body. 3. The correct answer is: accessory nerve The accessory nerve innervates the trapezius which is the muscle responsible for elevating the acromion of the scapula, also known as the tip of the shoulder. If a patient has damaged her accessory nerve, she will be unable to elevate her acromion. The dorsal scapular nerve innervates three muscles: rhomboideus major, rhomboideus minor, and the lower portion of levator scapulae. The rhomboids and trapezius retract the scapula toward the midline. So, if the dorsal scapular nerve is injured and rhomboids are paralyzed, retraction of the scapula on the affected side will be weakened. The greater occipital nerve supplies upper deep neck muscles and cutaneous sensation to the posterior scalp. Spinal nerve C4 refers to the nerve formed by the dorsal and ventral roots of C4. This nerve does not innervate the trapezius. Although branches from the ventral primary rami of C3 and C4 combine with the accessory nerve to form the subtrapezial plexus, C3 and C4 provide only proprioception and are not involved with the motion of the trapezius. Finally, the thoracodorsal nerve innervates latissimus dorsi. The latissimus dorsi is the muscle used to extend the arm or raise the trunk to the arms, as if climbing or doing chin-ups. If the thoracodorsal nerve was injured, a patient would be unable to complete these motions. 4. The correct answer is: deep fascia Deep fascia is a dense layer of connective tissue that invests structures such as the muscles. Intermuscular septae are specific fascial planes that separate groups of muscles into different compartments, a concept that will be very important for understanding the limbs. A neurovascular bundle is a combination of a nerve and vasculature (arteries, veins, and lymphatics) which may travel together in a packet. These bundles may vary in size and do not always contain all of these elements. Skin is the most superficial structure of the body, and it is comprised of the epidermis and dermis. The subcutaneous tissue, also known as the hypodermis or superficial fascia, is the mostly fat filled layer which lays directly underneath the skin. Although skin and subcutaneous tissue cover the muscles, these layers do not directly invest and enclose regional muscle groups--that's the job of the deep fascia. 5. The correct answer is: epidermis The keritinized epidermis, which is the most superficial layer of skin, is responsible for serving as a barrier to water loss. The dermis, found directly below the epidermis, contains collagen and elastin, fibers which provide the skin with tensile strength and tone. The dermis also contains hair follicles, sweat glands, and sebaceous glands. The subcutaneous tissue (hypodermis, superficial fascia) is a loose and fatty connective tissue. It protects the skin from bony protuberances and helps with thermal regulation. The subcutaneous tissue also contains sweat glands and cutaneous nerves. The deep fascia is a dense layer of connective tissue that invests structures such as the muscles. 6. The correct answer is: epidermis Ectoderm is the embryonic layer that gives rise to skin, nails, hair, and the enamel of teeth, as well as some nervous and connective tissues, and even a type of endocrine tissue (suprarenal medulla). 7. The correct answer is: accessory nerve (CN XI) If the accessory nerve is damaged and the trapezius is denervated, a person will no longer be able to raise the acromion of the shoulder. The dorsal scapular nerve innervates rhomboideus major, rhomboideus minor, and levator scapulae. If the dorsal scapular nerve is damaged, the rhomboids will be denervated, and retraction of the scapula will be weakened. An injury to the greater occipital nerve will result in a loss of sensation on the posterior scalp and denervation of the upper deep neck muscles on the affected side. The axillary nerve and suprascapular nerve will be covered with the upper limb, but for completeness, note that the axillary nerve innervates the deltoid muscle. If this nerve is damaged, the deltoid may atrophy, and the person will be unable to abduct the arm. If the suprascapular nerve is injured, lateral rotation of the humerus will be severely weakened. 8. The correct answer is: epidermis Once again, remember that the epidermis is responsible for serving as a barrier to water loss. The dermis sits below the epidermis and helps give the skin strength. The panniculus adiposus/ subcutaneous tissue/ superficial fascia is the layer of fat that sits beneath the skin. Investing fascia is the deep fascia which covers muscle groups and binds them together. 9. The correct answer is: Greater occipital nerve The greater occipital nerve is the dorsal primary ramus of spinal nerve C2--it provides cutaneous innervation to the skin of the back of the head. The accessory nerve is cranial nerve XI--it innervates trapezius. The great auricular nerve, the lesser occipital nerve, and ansa cervicalis are all structures from the cervical plexus, which is made of ventral primary rami. They will be studied with the head and neck. 10. The correct answer is: trapezius Cranial nerve XI is another name for the accessory nerve, which innervates the trapezius. The deltoid muscle is innervated by the axillary nerve. (More to come with the upper limb.) Latissimus dorsi is innervated by the thoracodorsal nerve. Levator scapulae and rhomboidus major are both innervated by the dorsal scapular nerve, with the upper part of levator scapulae receiving some branches of C3 and C4. 11. The correct answer is: epidermis and dermis The epidermis is the layer of the skin which serves as a barrier to water loss, and the dermis is the layer of skin directly below the epidermis. For fluid to ooze from the abrasions, both of these layers must be damaged. Damaging other layers, such as the subcutaneous tissue or deep fascia, would not necessarily lead to fluid loss. 12. The correct answer is: dermis The dermis is filled with collagen and elastic fibers which account for the strength and tone of the skin. Therefore, this layer of skin is strong enough to hold the sutures used to sew up the lacerations. The epidermis is thin and weak, so it would not be able to hold sutures by itself. Superficial fascia/ subcutaneous tissue is the loose and fatty connective tissue below the dermis, and not an appropriate location for sutures. The deep fascia invests muscles or groups of muscles, and it would be too deep to place sutures. 13. The correct answer is: acromion The acromion is the point of the scapula that corresponds to the tip of the shoulder. Because most of the scapula is protected by muscles and the thoracic wall, most scapular fractures involve the protruding acromion. The angles of the scapula are inferior to the acromion and not involved with the tip of the shoulder. The coracoid process is a beaklike process on the anterior face of the scapula. It is inferior to the acromion and projects anteriorly. The glenoid cavity is on the lateral side of the scapula. It articulates with the head of the humerus. The spine of the scapula is the ridge of bone on the posterior face of the scapula. Although it continues laterally to become the acromion, it is not the same as the acromion, which specifically refers to the tip of the shoulder. 14. The correct answer is: accessory The accessory nerve (CN XI) is responsible for innervating the trapezius which lifts the tip of the shoulder, or acromion. The axillary nerve, which will be covered with the upper limb, innervates the deltoid muscle. The dorsal scapular nerve innervates rhomboideus major, rhomboideus minor, and levator scapulae. If the dorsal scapular nerve is damaged, the rhomboids will be denervated, and the patient will not be able to retract his scapula fully. The suprascapular nerve, which will also be covered during the upper limb, innervates the supraspinatus and infraspinatus muscles. Finally, the thoracodorsal nerve innervates latissimus dorsi. If this nerve is injured and latissimus dorsi is denervated, the patient will not be able to raise his trunk to his arms (the motion associated with pull-ups). Noticing lots of questions about the accessory nerve, the trapezius, and lifting the acromion? It's important to remember this relationship! 15. The correct answer is: subcutaneous tissue Of all the answer choices, the subcutaneous tissue is the only tissue where large amounts of fat may be deposited. The muscular fascia and deep fascia are tighter types of connective tissue that invest muscles or muscle groups. The skin, composed of the epidermis and dermis, is not the site of abundant fat deposition. Instead, fat collects under the skin in the subcutaneous tissue. Finally, a neurovascular bundle, composed of some combination of an artery, vein, lymphatics, and nerve, is not a site for fat deposition. 16. The correct answer is: investing fascia, muscle Epidermis, dermis, subcutaneous tissue, The first layer through which the needle must cross is the skin, composed of the superficial epidermis and deeper dermis. Then comes the subcutaneous tissue--it's filled with fat and fairly loose. Finally, the investing fascia covers the muscle. Remember this sequence to keep yourself oriented when thinking about the different layers of skin and fascia! 17. The correct answer is: posterior surface of the neck and scalp Other than the palms of the hands and the soles of the feet, skin is thickest on the upper back, posterior neck and scalp. Why is a good question - perhaps it's an evolutionary adaptation for defense against back stabbing. 18. The correct answer is: trapezius The trapezius, innervated by the accessory nerve (CN XI), is the muscle responsible for elevating the tip of the shoulder. Erector spinae, which is innervated by the dorsal primary rami of C1-S5, extends and laterally bends the trunk, head and neck. Latissimus dorsi, innervated by the thoracodorsal nerve, allows the trunk to be lifted up to the arms (like with climbing or pull-ups). Levator scapulae, innervated by the dorsal scapular nerve, elevates the scapula. Rhomboidus major and minor are both innervated by the dorsal scapular nerve and aid trapezius in retracting the scapula. 19. The correct answer is: epidermis, dermis. The epidermis and the dermis are the two layers that comprise the skin. The subcutaneous tissue/superficial fascia and the deep or investing fascia are all below the skin. As long as sutures are crossing through the thick dermis, the skin will be able to hold the sutures, and the wound will be repaired. 20. The correct answer is: dorsal primary ramus of C7 Dorsal and ventral primary rami are the first branches off of spinal nerves. Dorsal rami provide sensory innervation to the skin over the back and give motor innervation to the true back muscles; ventral rami supply sensory innervation to the skin over the limbs and the skin over the ventral side of the trunk. Ventral rami also give motor innervation to the skeletal muscles of the neck, trunk, and extremities. So, if the skin over the spine of your scapula began to itch, the sensation of that area would be transmitted by the dorsal primary rami of C7. The accessory nerve, which innervates the trapezius, is not responsible for any sensory innervation. The dorsal and ventral roots of spinal nerves are not directly responsible for any sensory innervation to the skin. Dorsal and ventral rootlets emerge from the spinal cord to form the dorsal and ventral roots. The ventral roots contain efferent motor fibers to skeletal muscles, while the dorsal roots contain afferent sensory fibers. These roots combine to form the spinal nerve, which then gives off the primary rami. 21. The correct answer is: Lumbar triangle The lumbar triangle is the site of a lumbar hernia. It is a triangle defined by the border of the latissimus dorsi medially, the external abdominal oblique laterally and the iliac crest inferiorly. This is the exact site of the hernia that is described here, so that's the answer. The triangle of auscultation is a triangle located below the inferior angle of the scapula, bounded by the trapezius medially, rhomboideus major superiorly and the latissimus dorsi inferiorly. This is a place where you can place your stethoscope and auscultate the lungs. The inguinal triangle is bounded medially by rectus abdominis, inferiorally by the inguinal ligament, and superolaterally by the inferior epigastric artery. It is the site of a direct inguinal hernia. The triangle of Calot is a triangle found near the gall bladder. It is bounded by the cystic artery, cystic duct, and common hepatic duct, Finally, the greater sciatic foramen is a pelvic structure created by the sacrospinous ligament and the sacrotuberous ligament. 22. The correct answer is: be weakened Scapular retraction on the right side would The dorsal scapular nerve is a motor nerve off the C5 nerve root that innervates the rhomboids and levator scapula. These muscles help to retract and elevate the scapula, so these motions would be weakened following that damage. The skin of the upper back on the right side is innervated by the dorsal primary rami of a spinal nerve. The point of the right shoulder, the acromion, is elevated by trapezius. Trapezius is innervated by the accessory nerve, so the point of the shoulder would droop if the accessory nerve was damaged. Latissimus dorsi, innervated by the thoracodorsal nerve, allows for extension and adduction of the arm. 23. The correct answer is: trapezius The transverse cervical artery supplies blood to trapezius. Levator scapulae and the rhomboids receive blood from the dorsal scapular artery. Latissimus dorsi receives blood from the thoracodorsal artery. 24. The correct answer is: Thoracodorsal The thoracodorsal nerve innervates latissimus dorsi, which is an important muscle for adducting, medially rotating, and extending the arm. This is the muscle that is used when swimming the crawl. Since she can't do these motions, the triathelete must have injured her thoracodorsal nerve. Another indication of this injury is that the thoracodorsal nerve is particularly vulnerable following trauma to the axilla. The accessory nerve innervates trapezius. If this nerve was injured, the patient could not raise the tip of her shoulder. The dorsal scapular nerve innervates the rhomboids and levator scapulae. If this nerve was injured, the patient would have problems elevating or retracting her scapula. The lateral and medial pectoral nerves innervate pectoral major, a medial rotator and flexor of the arm. An injury to this nerve would cause a problem with flexion, not extension, of the arm. 25. The correct answer is: Dermis The epidermis is the most superficial layer of the skin, and it's not vascularized. But the dermis, sitting immediately below the epidermis, is very vascular and will bleed following an injury. So that's the answer. If an abrasion goes to the deep fascia, muscular fascia, or subcutaneous tissue, it will definitely bleed, but this question is asking you to choose the first layer to bleed after a skin wound, and that's the dermis. 26. The correct answer is: Latissimus dorsi Latissimus dorsi makes the posterior axillary fold, so it's easy to see why that should be the muscle injured following a wound to the posterior axillary fold. Latissimus dorsi is the muscle important for medial rotation, extension, and adduction of the arm; the patient's symptoms fit with an injury to this structure. Pectoralis major medially rotates and flexes the arm--this muscle makes the anterior axillary fold. Levator scapulae elevates the scapula, while rhomboideus major retracts the scapula. Trapezius elevates and depresses the scapula (depending on which part of the muscle contracts), rotates the scapula superiorly, and retracts the scapula. It also helps raise the tip of the shoulder, or acromion.