Lower Limb and Thorax Lecture Notes and Review Questions

Core Lectures

Radiology - Study Questions

Clinical Correlates - Study Questions

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Subinguinal Region - Study Guide

These questions were not submitted by the lecturer.

True/False

1. Flexing the hip causes the knee to move anterior.
2. Extendingf the knee causes the foot to move anterior.
3. A midsaggital view of the lower extremity may include a mid-shaft view of both the femur and the tibia.
4. A coronal view of the lower extremity may include a mid-shaft view both the femur and the tibia.
5. A horizontal view of the lower extremity may include a mid-shaft view of both the a mid-shaft view.
6. Tela subcutanea condenses to form the investing fascia of the thigh.
7. The investing fascia is deep to the skin and superficial to the tela subcutanea.
8. Abduction of both thighs will cause the knees to move together.
9. The intertrochanteric line is posterior to the intertrochanteric crest.
10. The adductor tubercle is continuous with the lateral epicondyle.
11. The femur is the largest bone of the leg.
12. The falciform edge of the saphenous hiatus is immediately anterior to the femoral vein.
13. The inferior cornu of the saphenous hiatus is immediately anterior the the femoral vein and posterior to the great saphenous vein.
14. The external pudendal artery, but not the external pudendal vein passes through the saphenous hiatus.
15. The medial region of the saphenous hiatus is marked by a well defined edge of the fascia lata.
16. The superior cornu of the saphenous hiatus is crossed by the superficial epigastric vein.
17. The rectus femoris, but not the vastus intermedius, flexes the hip and flexes the knee.
18. The femoral nerve, at the level of the inguinal ligament, lies deep to the iliacus fascia.
19. The medial extent of the femoral sheath is opposed to the lacunar ligament.
20. The lateral extent of the femoral sheath is opposed to the iliopectineal arch.
21. The femoral sheath is a prolongation of the iliacus fascia that surrounds the femoral nerve.
22. A femoral hernia passes through the femoral canal to then enter the femoral canal.
23. The lateral border of the femoral triangle is marked by the medial border of the sartorius muscle.
24. The femoral artery, withing the femoral triangle, crosses to the posterior side of the femoral vein.
25. The lateral, medial, and posterior intermuscular septae define three compartments for the thigh.
26. The transverse branch of the later femoral circumflex artery passes deep to sartorius and anterior to rectus femoris
27. The external pudendal vein, but not the external pudendal artery, passes through the saphenous hiatus.

Definition and Short Answer

1. Femoral ring and canal
2. What is the significance of knowing about fascial layers?
3. What is the relationship between investing fascia, epimysium, and perimysium?
4. Blood flow in veins is from superficial to deep. Thus, veins are said to "travel" from superficial to deep. What about the anatomy of veins when stated in proximal to distal terminology?
5. The adductor canal provides a communication between what two named regions?
6. The dorsal surface of the foot faces the ventral surface of the trunk. How can this be?
7. A projectile enters the ventrum of the trunk, passes through the abdominopelvic cavity, and exits from the dorsum of the trunk. At what point did the direction of the penetration change from superficial/deep to deep/superficial? Was the projectile always passing from anterior to posterior?
8. In light of the previous question, discuss the ambiguity of "behind," "in front of," "below," "on top of," "over," "roof," and "floor."
9. Why might a radiologist become annoyed if a colleague is imprecise in using (or failing to use) the terms thigh, leg, foot, and lower extremity?
10. During flexion of the hip the thigh moves anterior whereas during flexion of the knee the leg moves posterior. Thus, it appears that flexion denotes movement that is in the opposite direction at these joints. Is there an organising principle that makes sense of this?
11. Whenever a muscle crosses a joint it acts at that joint. The sartorius muscle crosses two joints; the hip joint and the knee joint. Discuss the primary, secondary, and tertiary actions of sartorius at the hip joint and the primary action of sartorius at the knee joint. Sartorius is known as the "tailor's muscle." Why?
12. Bony tubercles are shaped during life by the mechanical stresses applied to the bone. What might be inferred about the life of an individual with a large lesser trochanter compared to the life of an individual with a small lesser trochanter? A small tibial tuberosity versus a large tibial tuberosity?
13. Flexion has been defined as the approximation of two ventral surfaces. Does flexion of the hip and flexion of the knee agree with this "embryological" definition of flexion? Explain?
14. Discuss the lateral and medial relations of the iliopectineal arch. Be prepared to account for the ant/post and sup/inf relations.
15. How might a chronic femoral hernia promote the formation of varicose veins?
16. Discuss the immediate relations of the femoral ring. Account for 6 directions - ant/post, med/lat, and sup/inf. Your discussion of relations should start with the most salient relations and then elaborate a bit further. Relate sup/inf to named spaces (cavities and canals in this case).
17. Discuss the relations (6 directions) of the apex of the femoral triangle. Similar to the femoral ring, the most salient relations for sup/inf are argueably a space and a canal.
18. The femoral ring provides a communication between the ___________ cavity and the _________ canal. The adductor canal provides a communication between the ________ triangle and the __________ fossa.
19. What artery(s) leave the femoral triangle passing between the iliopsoas and the pectineus? Between pectineus and adductor longus? Between rectus femoris and vastus intermedius (after passing deep to sartorius)? Through the adductor canal? What artery enters the femoral triangle through the vascular lacuna?

Essay

1. Discuss the boundaries, contents, and relationships of femoral sheath
   • superior -
   • inferior -
   • anterior -
   • posterior -
   • lateral -
   • medial -
2. The femoral ring is two dimensional. There are lateral, medial, anterior, and posterior boundaries. What about superior and inferior? Why, based on your knowledge of the boundaries for the femoral ring, is a femoral hernia prone to strangulation? What are the boundaries?
3. Provide a general discussion of the femoral triangle. What boundaries of the femoral triangle are crossed by each content of the femoral triangle?
4. What are the relationships as the femoral, deep femoral, medial femoral circumflex, and lateral femoral circumflex arteries leave the femoral triangle?
5. Discuss the adductor canal and hiatus. What structures pass through each?
6. Relationships of the anterior superior iliac spine.
7. Medial compartment of the femoral sheath.
8. Structures crossing each of the six boundaries of the femoral triangle.
9. Relationships of adductor brevis.
10. Cruciate anastomosis

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Gluteal Region and the Ischio Rectal Fossa - Study Guide

These questions were not submitted by the lecturer.

True/False Questions

1. The spinal cord ends at the vertebral level of L2(3) whereas the spinal canal continues to the level of S2.
2. The sacrospinous ligament contributes the superior border of the of the lesser sciatic foramen.
3. The sacrotuberous ligament contributes the superior border of the lesser sciatic foramen.
4. The gluteus maximus muscle takes insertion, in part, from the sacrotuberous ligament.
5. In addition to the iliotibial tract, the gluteus maximus muscle inserts onto the linea aspera.
6. The gluteus maximus muscle receives the inferior gluteal artery but not the inferior gluteal nerve.
7. The gluteus maximus muscle receives the superior gluteal artery but not the superior gluteal nerve.
8. When standing with just one lower extremity planted (on one foot), the gluteus medius is an adductor of the free (un-planted) lower extremity.
9. The quadratus femoris muscle, by virtue of inserting onto the intertrochanteric line, is a medial rotator of the hip joint.
10. The superior and inferior gemelli insert onto the trochanteric fossa by way of the obturator externus tendon.
11. The superior gluteal nerve, but not the superior gluteal artery, enter the gluteus maximus muscle.
12. The pudendal nerve, as it crosses the posterior surface of the ischial spine, is accompanied by the the external pudendal artery.
13. The posterior cutaneous nerve of the thigh, within the gluteal region is located immediately medial to the peroneal portion of the sciatic nerve.
14. The lumbar plexus, by way of the lumbosacral trunk, communicates (connects) with the sacral plexus.
15. The ventral ramus of the L5 spinal nerve does not contribute to the lumbar plexus.
16. The ventral ramus of the L4 spinal nerve contributes both to the lumbar plexus and to the sacral plexus.
17. The sciatic nerve consists of a peroneal portion that innervates original dorsal musculature and a tibial portion that innervates original ventral musculature.
18. The lateral femoral cutaneous nerve contributes to the L2, L3, and L4 dermatome.
19. The lateral femoral cutaneous nerve, by way of the lumbar plexus, receives contributions from the ventral rami of spinal nerves L1, L2, L3.

Bony Overview

1. The greater and lesser trochanters are related on the anterior femur by the introchanteric crest.
2. The two innominate bones are joined at their anterior extents by the sacroiliac joints.
3. Intermediate between the greater and lesser sciatic notches is the ilial spine.
4. The greater sciatic foramen, an osseofibrous foramen, has the sacrospinous ligament contributing to its superior boundary.
5. The lesser sciatic foramen provides a communication between the gluteal region and the ischiorectal fossa.
6. The spinal cord ends at the level of L2 but the spinal canal extends to sacral level 2.

Muscles

1. The gluteus maximus is vacularized by both the superior and inferior gluteal arteries but its motor innervation is by the inferior gluteal nerve only and not the superior gluteal nerve.
2. The gluteus medius lies deep to the the gluteus maximus and superficial to the gluteus minimus.
3. The gluteus medius lies anterior to the gluteus maximus and posterior to the gluteus minimus.
4. The inferior gemellus originates from the ischial spine and inserts onto the tendon of the obturator externus and then the fovea of the femur.
5. The superior gemellus arises from the ischial spine and inserts on the the tendon of the obturator internus and then the fovea of the femur.
6. The superior gluteal nerve travels transversely deep to the gluteus medius and superficial to gluteus minimus toward the tenser fascia lata.
7. The piriformis, superior gemellus, obturator internus, inferior gemullus, and quadratus femoris make up 5 short lateral rotators of the hip.
8. The origins of the superior and inferior gemeli are interrupted by the greater sciatic notch.
9. Both the superior gluteal nerve and the sciatic nerve enter the gluteal region by passing superior to the piriformis.
10. The lumbar plexus receives ventral rami, but not dorsal rami, from spinal nerves.

Lumbar and Sacral Plexuses

1. The lumbar plexus, a somatic plexus, elaborates the femoral and obturator nerves (non-exhaustive).
2. The sacral plexus, a somatic plexus, elaborates the sciatic nerve, superior gluteal nerve, and inferior gluteal nerve (non-exhaustive)..

Dermatomes

1. A peripheral nerve derived from a plexus typically contributes to more than one dermatome.
2. A spinal nerve contributes to one dermatome only.
3. A dermatomal region of anesthesia indicates spinal nerve damage (eg. herniated disc).
4. A cross-dermatomal region of anesthesia indicates damage to a peripheral nerve derived from a plexus (eg. nerve entrapment).

Definition and Short Answer

1. What is a key difference between the distribution of the superior gluteal artery and the superior gluteal nerve?
2. How does nerve to obturator externus enter the gluteal region?
3. Somatic nerve plexus. What is the difference between a dermatome and a peripheral nerve distribution?
4. The tibial and common peroneal parts of the sciatic nerve reflect what about development of the lower extremity?
5. What is a key difference, other than distribution, between the superior and inferior clunial nerves?
6. What dermatomal levels equate to peripheral nerve distributions? What key anatomical structures are not found at these levels?
7. The greater sciatic foramen provides an osseofibrous communication between the (blank) cavity and the (blank) region. The lesser sciatic foramen provides an osseofibrous communication between the (blank) region and the (blank) fossa.
8. The superior gluteal nerve leaves the (blank) cavity passing throught the (blank) foramen opposed to the superior surface of the (blank) muscle. Within the (blank) region, the superior gluteal nerve courses laterally on the anterior surface of the (blank) muscle and on the posterior surface of the (blank) muscle. Extending further laterally, the superior gluteal nerve provides its most distal innervation to the (blank) muscle. Discuss a key anatomical difference between the distribution of the superior gluteal nerve and the distribution of the superior gluteal artery.
9. The pudendal nerve leaves the (blank) cavity passing through the (blank) foramen inferior to the (blank) muscle. In the gluteal region the pudendal nerve courses inferior along the posterior surfaces of the (blank) muscle, (blank) ligament, and (blank) spine. The pudendal nerve leaves the (blank) region passing through the (blank) foramen to the (blank) fossa. Within the (blank) fossa, the pudendal nerve courses along the (blank) edge on the medial wall of the (blank) tuberosity in an osseofibrous passageway known as the (blank) canal.
10. The greater sciatic foramen shares its inferior boundary with the superior boundary of the lesser sciatic foramen by way of the (blank) ligament.
11. The embryological determination of origin and insertion relies on proximal/distal anatomy. What is the embryological origin of the gluteus medius? What is the functional origin of the gluteus medius when the opposite lower limb is not planted during standing or walking?
12. The obturator internus has an origin within the (blank) cavity and a tendinous projection that enters the (blank) region passing through the (blank) foramen inferior to the (blank) muscle. Together, these three muscles insert on the (blank) crest and act to (blank) rotate the (blank) joint.
13. There are five short lateral rotators in the gluteal region. In order, from superior to inferior, these are the (blank), (blank), (blank), (blank), and (blank) muscles.
14. Three nerves enter the gluteal region crossing the anterior/inferior surface of the (blank) muscle and the posterior/superior surface of the (blank) muscle and/or the (blank) ligament and/or the (blank) spine. From medial to lateral these nerves are the (blank), (blank), and (blank) nerves. The two most medial of these nerves leave the gluteal region by way of the (blank) foramen to enter the (blank) fossa whereas the most lateral of these three nerves courses inferiorly to enter the posterior (blank) as the nerve crosses anterior to the (blank) fold.
15. A probe passed from the superficial gluteal region to a deeper location about 1/4" anterior to the interval between the inferior gemellus and the quadratus femoris. The tip of the probe is in contact with the (blank) muscle and branches of the (blank) artery.
16. What is the difference between a dermatome and a peripheral nerve distribution. You will understand this difference when you know why a sensory deficit that maps a dermatome indicates a nerve lesion proximal to a nerve plexus whereas a sensory deficit that maps a peripheral nerve distribution indicates a lesion distal to a nerve plexus. In the former case the lesion might be caused by a herniated disk compressing a spinal nerve whereas in the latter case the lesion might be caused by entrapment compressing a peripheral nerve (e.g., lateral femoral nerve entrapment at the inguinal ligament).
17. Arterial supply to the superior aspect of the sciatic nerve is provided by the (blank) artery, a branch of the (blank) artery. Be prepared to know the arterial supply to the middle and inferior portions of the sciatic nerve. See Grant's Atlas.
18. Compare the distribution of the superior gluteal artery to the distribution of the superior gluteal nerve.

Essay

1. Reversal of origin and insertion? Discuss the anatomy and function of gluteus medius and minimus.
2. Insertion by way of an intervening tendon from another muscle?
3. Innervation by one nerve (inferior gluteal nerve) but supplied by two arteries (superior and inferior gluteal arteries)?
4. Five short lateral rotators?
5. Discuss why the superior lateral gluteal quadrant is preferable for an injection site relative to each of the remaining 3 quadrants.
6. What structures traverse the lessor sciatic foramen? What are the regions that communicate by way of the lessor sciatic foramen?
7. An injection into the upper medial quadrant of the gluteal region could cause both pelvic sag and foot drop. Explain.

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Questions for the Thigh and Popliteal Fossa

These questions were not submitted by the lecturer.

True/False - August 10, 2011

1. Despite a total lesion of the tibial portion of the sciatic nerve, flexion of the knee remains possible.
2. Despite a total lesion of the sciatic nerve; flexion of the knee remains possible.
3. Despite total lesions of the sciatic nerve and the femoral nerve; flexion of the knee remains possible.
4. Despite total lesions of the sciatic nerve, femoral nerve, and obturator nerve; flexion of the knee remains possible.
5. The first perforating artery supplies, in part, the upper part of the posterior thigh.
6. The popliteal artery supplies, in part, the lower region of the posterior thigh.
7. The inferior gluteal artery supples the sciatic nerve.
8. The perforating arteries supply the sciatic nerve.
9. The popliteal artery supplies the sciatic nerve.
10. The posterior surface of the distal femur contributes to the anterior boundary of the popliteal fossa.
11. The superior medial genicular artery circles the femur at a location superior to the adductor tubercle and deep the tendon of the posterior adductor magnus.
12. The inferior lateral genicular artery crosses the anterior surface of the popliteus muscle.
13. The oblique popliteal ligament, derived from the tendon of insertion of the semimembranosus, crosses the posterior knee capsule from inferior lateral to superior medial.
14. The fibular circumflex artery crosses the medial surface of the neck of the fibular and the anterior tibial artery crosses the lateral surface of the neck of the fibula.
15. The middle genicular artery enters the intercondyler fossa from the posterior joint capsule of the knee.
16. The pes anserinus can be linked to 3 motor nerves, three compartments of the thigh, and one sensory nerve.
17. Lymph from the dorsal lateral region of the foot drains, in part, to the popliteal lymph nodes.

True/False - August 11, 2010

1. The short head of the biceps femoris is innervated by the common peroneal part of the sciatic nerve.
2. The posterior part of the adductor magnus arises from the ischial tuberosity, inserts on the adductor tubercle, and is innervated by the obturator nerve.
3. The semitendinosus has a long tendon of origin.
4. The semitendinosus provides a membranous tendon of insertion.
5. The short head of the biceps femoris, unlike the hamstring muscles, can flex the knee despite that the hip is fully extended.
6. The sciatic nerve at the mid-thigh is posterior to the hamstrings.
7. Only one nerve arises from lateral side of the sciatic nerve and this nerve innervates the long head of biceps femoris.
8. The short head of the biceps femoris flexes the knee, laterally rotates the knee, and extends the hip.
9. The femoral vein, within the adductor canal, is deep to the femoral artery and the popliteal vein, within the popliteal fossa, is superficial to the popliteal artery.
10. The femoral vein, within the adductor canal, is posterior to the femoral artery and the popliteal vein, within the popliteal fossa, is posterior to the popliteal artery.
11. The transverse branch of the lateral femoral circumflex artery contributes to the genicular anastomosis.
12. The superior medial genicular artery passes through the adductor hiatus.
13. The superior medial genicular artery passes deep to the tendon of insertion from the posterior adductor magnus.
14. The descending genicular artery passes through the adductor hiatus.
15. The inferior lateral genicular artery crosses the posterior surface of the popliteus muscle.
16. The peroneal communicating branch of the lateral cutaneous sural nerve converges onto the medial sural cutaneous nerve to from sural nerve.
17. Despite total destruction of the sciatic nerve, flexing the knee is still possible.
18. Despite total destruction of the femoral nerve, flexing the knee is still possible.
19. Despite total destruction of the obturator nerve, flexing the knee is still possible.
20. Despite total destruction of the sciatic and femoral nerves, flexing the knee is still possible.
21. Despite total destruction of the obturator and femoral nerves, flexing the knee is still possible.
22. Despite total destruction of the obturator and sciatic nerves, flexing the knee is still possible.
23. Despite total destruction of the obturator, sciatic, and femoral nerves, flexing the knee is still possible.
24. Each of the three muscles that insert at the pes anserinus have a different innervation.

Definitions and Short Answer

1. Pes anserinus
2. The tibial portion of the sciatic nerve is lesioned. Is flexion at the knee possible? If so, by what muscles?
3. The tibial and peroneal portion of the sciatic nerve is lesioned. Is flexion at the knee possible? If so, by what muscles?
4. The sciatic nerve and the obturator nerve are entirely lesioned. Is flexion at the knee possible? If so, by what muscles?
5. The sciatic nerve, obturator nerve, and femoral nerve are entirely lesioned. Is flexion at the knee possible? If so, by what muscles?
6. Why is the short head of the biceps not a hamstring. Why is the posterior adductor magnus not a hamstring? Why is tensor fascia lata not a hamstring?
7. What is the relationship of the superior medial genicular artery to the tendon of insertion of the posterior adductor magnus?
8. What is the relationship of the inferior lateral genicular artery to the popliteus muscle?
9. Thus far, we have discussed the cruciate anastomosis and the genicular anastomosis. Take note that these anastomoses occur in regions of high mobility. What may be the advantage for these anastomotic arterial networks?
10. From anterior/lateral to posterior/medial the insertions of the pes anserinus are the (blank), (blank), and (blank) muscles. The muscles are, in the above order, located in the (blank), (blank), and (blank) compartments of the (blank). In order, they are innervated by the (blank), (blank), and (blank) nerves. In order, the primary actions at the hip joint are (blank), (blank), and (blank). In order, the primary actions at the knee joint are (blank), (blank), and (blank). This anatomy has been referred to as an inverted (blank).
11. The inferior lateral genicular artery crosses the posterior tibial condyle immediately posterior to the (blank) ligament and the (blank) muscle and immedately anterior to the (blank) muscle.
12. Be prepared to discuss specific arterial routes that blood could follow from the thigh to the leg without involving the middle 1/3 of the popliteal artery. This discussion requires knowledge of the (blank) anastomsis.
13. Use superficial/deep terminology to complete the following sentence. Within the adductor canal the femoral artery is (blank) to the femoral vein whereas within the popliteal fossa the popliteal artery is (blank) to the popliteal vein. Use anterior/posterior terminology to complete the following sentence. Within the adductor canal the femoral artery is (blank) to the femoral vein whereas within the popliteal fossa the popliteal artery is (blank) to the popliteal vein. When might you prefer to use superficial/deep terminology and when might you prefer to use anterior/posterior, medial/lateral, and superior/inferior terminology?
14. The most superior aspect of the hamstrings receive arterial supply from the (blank) artery, a branch of the (blank) artery. The most inferior aspect of the hamstrings receive arterial supply form the (blank) artery, a continuation of the (blank) artery. The middle aspect of the hamstrings receive arterial supply from the (blank) arteries, branches of the (blank) artery.
15. The is a small longitudinal artery that passes the entire length of the posterior compartment of the thigh. The upper 1/3 of this artery is augmented by the (blank) branch of the (blank) artery. The middle 1/3 of this artery is augmented the (blank) branches of the (blank) artery. The lower 1/3 of this artery is augmented by unnamed branches of the (blank) artery. The artery that is the focus of this question forms an arterial complex around the (blank)(blank).
16. What muscle(s) would be involved in flexion of the knee when the hip is extended?
17. What is the primary source of blood to the posterior compartment of the thigh?

Essay

1. What is the primary nerve supply to the anterior, medial, and posterior compartment of the thigh?
2. What is the primary vascular supply to the anterior, medial, and posterior compartment of the thigh?
3. Discuss contents of the popliteal fossa as they enter/leave the boundaries of the fossa.
   • superior lateral:
   • superior medial:
   • inferior lateral:
   • inferior medial:
   • superior:
   • inferior:
   • anterior:
   • posterior:
   • Note: Structures passing the posterior boundary may challenge you. Think about lymphatic vessels and veins.
4. Discuss the anatomy of the popliteal fossa. Include a statement of the boundaries (6 in number) and anatomical relations of each boundary. Discuss structures entering and leaving the popliteal fossa. Include the relations of these structures both within the fossa and at the boundaries of the fossa.
5. What is the arterial supply to the sciatic nerve? Consider superior, intermediate, and inferior
6. What is the vascular supply to the hamstrings. Discuss the parent vessels, key relations, and fascial barriers that are involved.
7. Discuss the contribution (if any) of each compartment of the thigh to flexion of the knee.
8. Discuss the arterial supply to the sciatic nerve. Discuss the arterial supply to the posterior compartment of the thigh.

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Questions for the Leg

These questions were not submitted by the lecturer.

True/False for Leg - August 11, 2011

1. The fiber direction of the interosseous membrane resists proximal displacement of the fibula.
2. The tendon of flexor digitorum longus crosses superficial to the tendon of flexor hallucis longus.
3. The tendon of the flexor hallucis longus, within the foot, is superior to the tendon of flexor digitorum longus.
4. The anterior tibial artery enters the anterior compartment of the leg by passing lateral to the neck of the fibula.
5. The deep peroneal nerve enters the anterior compartment of the leg by passing the superior free edge of the interosseous membrane.
6. The talocural joint in primarily a joint of extension and flexion.
7. The talocalcaneonavicular (subtalar) joint is primarily a joint of eversion and inversion.
8. The transverse tarsal joint is primarily a joint of flexion and extension.
9. The tendon of extensor hallucis brevis blends into the lateral side of the tendon of extensor hallucis longus.
10. The tendons of extensor digitorum brevis blend into the medial side of the tendons of extensor digitorum longus except for digits 2-4.
11. The tendons of flexor hallucis brevis bifurcate at a location that is inferior to the tendons of flexor digitorum longus.
12. The flexor digitorum longus flexes the distal interphalangeal joint but not the proximal interphalangeal joint.
13. The superior ramus of the "Y" of the inferior extensor retinaculum extends superior to the medial malleolus.
14. The patella is a sesamoid bone.
15. The anterior medial malleolar artery circlets the medial side of the tibia at a location that is superior to the medial malleolus.
16. The peroneal artery enters the anterior compartment of the leg.
17. The lateral calcaneal artery arises from the peroneal artery.
18. Immediately inferior to the sustentaculum tali is the tendon of flexor hallucis longus.
19. Immediately medial (superficial) to the sustentaculum tali is the posterior tibial artery and the tibial nerve.
20. Immediately superior to the sustentaculum tali is the tendon of flexor digitorum longus.
21. Attaching to the anteror surface of the sustentaculum tali is the plantarcalcaneonavicular (spring) ligament.
22. Attaching to the superior surface of the sustentaculum tali is the deltoid ligament.
23. The anterior tibial arterial pulse can be palpated between the skin and the lateral surface of the sustentaculum tali.

True/False - August 12, 2010

1. The superior tibiofibular joint is a synovial joint and the inferior tibiofibular joint is a syndesmosis joint.
2. The great toe has one less phalangeal bone than the remaining four toes.
3. The transverse and subtalar joints mediate movements of inversion and eversion.
4. Eversion injuries of the ankle joint may rupture ligaments the lateral side of the ankle.
5. With regard to the definition of ligaments and tendons; the quadriceps tendon is said to insert on the fibula.
6. The extensor hallucis longus extends the IP and MP joint of the great toe and also extends (dorsiflexes) the ankle.
7. Dorsiflexion refers to extension of the ankle only and does not apply to the toes.
8. Retinacula are specializations of deep fascia the secure tendons and prevent "bowstringing."
9. The common peroneal nerve crosses the lateral aspect of the neck of the fibula.
10. The tendon of flexor digitorum longus crosses the inferior surface of the tendon of flexor hallucis longus.
11. The popliteus muscle medially rotates the femur when the foot is planted and laterally rotates the tibia when the foot is free.
12. The anterior intermuscular septum separates the lateral compartment of the leg from the posterior compartment.
13. The posterior intermuscular septum separates the posterior compartment of the leg from the anterior compartment.
14. The interosseous membrane, posterior intermuscular septum, tibia, and fibula separate the deep compartment of posterior leg from the anterior compartment.
15. The circumflex fibular artery contributes blood supply to the superior part of the lateral compartment of the leg.
16. Arteries derived from the malleolar anastomosis contribute to the blood supply of the inferior part of the lateral compartment of the leg.
17. The peroneal artery contributes blood supply to lateral compartment of the leg.
18. The triceps surae make up much of the mass of the posterior thigh.
19. The extensor hallucis longus dorsiflexes the foot and extends the fifth toe
20. Damage to the entire common peroneal nerve is expected to cause loss of toe extension at the MP joint but not at the IP joints of the lateral four toes.
21. Damage to the entire superficial peroneal nerve is expected to cause loss of eversion of the foot.
22. Damage to the entire deep peroneal nerve is expected to weaken but not eliminate inversion of the foot.
23. Damage to the entire common peroneal nerve is expected to cause a loss of dorsiflexion.
24. The sustentaculum tali is part of the calcaneus bone.
25. The anterior tibial arterial pulse can be palpated at the sustentaculum tali.
26. The tendon of flexor hallucis longus is crosses the inferior surface of the sustentaculum tali.
27. The plantar calcaneonavicular ligament (spring) is, in part, attached to the sustentaculum tali.
28. The anterior medial and lateral maleolar arteries are from the anterior tibial artery.
29. The medial and lateral tarsal arteries are from the dorsalis pedis artery.
30. The anterior and posterior, lateral and medial, malleollar arteries form an arterial ring located superior to the medial and lateral malleoli (bones).

Definitions and Short Answer

1. retinaculum
2. extensor hood
3. sesamoid bone and developmental history
4. tendon of flexor hallucis longus
5. What is the relationship of the lateral tarsal artery to the tendons of extensor digitorum longus and brevis?
6. What is the relationship of the dorsal venous arch to the tendons of extensor digitorum longus and brevis?
7. What is the relationship of the short saphenous vein to the posterior boundary of the popliteal fossa?
8. You observe the top of your foot and see that the tendons of extensor digitorum brevis approach the extensor hood from the left side. Which foot are you observing; the left or the right?
9. How is the arterial supply to the lateral compartment of the leg similar to the arterial supply to the posterior compartment of the thigh?
10. The artery of the anterior compartment of the leg is the (blank) artery. This artery branches from the (blank) artery within the (blank) compartment of the leg. This artery courses anterior to arrive in the anterior compartment by passing superior to the superior free edge of the (blank) membrane and inferior to the (blank) ligament. The nerve of the anterior compartment is the (blank) nerve. This nerve branches from the (blank) nerve near the head of the (blank). Unlike the artery of the anterior compartment, this nerve courses anterior by passing lateral (superficial) to the (blank) of the (blank). Before arriving in the anterior compartment, this nerve must first penetrate the (blank) septum, the (blank) muscles, and then the (blank) septum.
11. The soleus muscle has two heads of origin. The lateral heard arises from the (blank) whereas the medial head arises from the (blank). Between the two heads of origin there is a superior free edge known as the (blank). Passing from the popliteal fossa into the leg immediately anterior to the superior free edge of the soleus muscle is the (blank) nerve and the (blank) artery as they enter the (blank) compartment of the (blank) compartment of the leg.
12. The tibia is limited in superior displacement by the femoral condyles. The fibula is limited in superior displacement by attachments to the tibia. Does this observation reflect the direction of fiber orientation in the interosseous membrane? Beginning with attachment at the tibia, fiber orientation of the interosseous membrane starts (blank) and courses (blank) in a (blank) direction toward the fibula. (The last two blanks are interchangeable).

Essay

1. Discuss the vascularization of the upper, middle, and lower thirds of the lateral compartment of the leg.
2. Discuss the vascularization of the upper, middle, and lower thirds for the three compartments of the leg.
3. Discuss the vascularization of the upper, middle, and lower thirds for the three compartments of the thigh.
4. Discuss the vascularization of the upper, middle, and lower thirds of the gluteal region.
5. Discuss why flexion of the toes is more precise than extension?
6. Extensor digitorum longus extends the toes but dorsiflexes the ankle. Does this bother you? "Dorsiflexion" is a relatively recent term. The term "dorsiflexion" discards the development of the lower limb. The lower limb undergoes a 180 degree medial rotation during development. What anatomical observations become more understandable when considered in the light of development?
7. What is the arterial supply to the lateral compartment of the leg? Consider superior, intermediate, and inferior regions. Discuss the parent vessels and fascial barriers that are involved.
8. Discuss the relations of the superior free edge of the interosseous membrane.
9. Discuss the relations of the pes anserinus
10. How would you assess damage to the common peroneal nerve and its branches?
11. Contrast the course of the blood supply and the nerve supply to the anterior compartment of the leg.
12. What are the relations of the anterior tibial a. as it leaves the posterior compartment of the leg to enter the anterior compartment of the leg? What are the relations of the common peroneal nerve as it leaves the popliteal fossa? what are the relations of the deep peroneal nerve as it enters the lateral compartment and then the anterior compartment? Discussed named fascial barriers. What is the relation of the deep peroneal nerve to the anterior tibial artery when both stuctures reside on the interosseous membrane?
13. The tibial nerve is lesioned at the superior free edge of the soleus. Can the ankle still be flexed (plantar-flexed)? Explain?

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Questions for the Foot, Arches, and Gate

These questions were not submitted by the lecturer.

True/False - August 12, 2011

1. The plantar aponeurosis contributes support to the medial, lateral, and transverse plantar arches.
2. Both the plantar aponeurosis and the tendon of flexor hallucis longus contribute to the lateral longitudinal arch.
3. The plantar interossei adduct digits 1,3,4,5 toward digit 2.
4. The dorsal interossei abduct digits 1, 3, 4, 5 away from digit 2.
5. The first and second dorsal interosseous muscles attach to digit 2.
6. The plantar interossei, but not the dorsal interossei, flex the metacarpophalangeal joint.
7. The dorsal and plantar interossei extend the proximal and distal interphalangeal joints.
8. The tendon of flexor hallucis longus crosses the inferior surface of the flexor digitorum longus.
9. The longitudinal plantar arches extend distally to the bases of the distal phalanges.
10. The plantarcalcaneonavicular (spring) ligament stabilizes both the medial plantar arch and the subtalar joint.
11. The spring ligament attaches to the anterior surface of the sustentaculum tali.
12. The deltoid ligament attaches to the superior surface of the sustentaculum.
13. The tendon of the flexor hallucis longus is applied to the inferior surface of the sustentaculum tali.
14. The peroneus longus muscle provides suspension support to the lateral longitudinal arch, tie beam support to the transverse arch, and staple support to the medial longitudinal arch. in
15. The plantar arch crosses the superior parts of the adductor hallucis and the inferior surfaces of the plantar and dorsal interossei.

Definition and Short Answer

1. talocalcaneonavicular joint
2. The plantar aponeurosis predominately contributes support to which arches?
3. Crossing transversely across the sole of the foot between flexor digitorum brevis and quadratus plantae are what structures?
4. What observations distinguish whether an injury is to the common, superfical, or deep peroneal nerves?
5. Both plantar and dorsal interosseous muscles can be viewed for a dissection of the plantar (inferior) side of the foot. Dorsal interosseoi, but not plantar interosseoi, can be viewed from the dorsal (superior) side of the foot. This is because the dorsal interosseoi are (blank) whereas the the plantar interosseoi are monopennate.
6. The primary "staple" to the medial longitudinal arch is the (blank) ligament. This ligament extends from the sustentaculum tali of the (blank) to the (blank) bone. Immediately superior to this ligament is the (blank) of the (blank) known as the "keystone" of the medial longitudinal arch. Immediately inferior the to this ligament is a long tendon providing a "tie-beam" for the medial longitudinal arch. This is the tendon of (blank). Another tie-beam is provided by an intrinsic muscle of the foot. This muscle is the (blank). In addition to the aforementioned muscular "tie-beams," fascial tie-beams are provided by the (blank) and even the (blank) of the sole of the foot. The major "suspension" support of the medial longitudinal arch is provided by the (blank). This muscle, in addition to suspending the arch also provides a "staple" because of the splaying out of the tendonous insertions near the base of the (blank).
7. The (blank) provides a "staple" for the medial longitudinal arch (due to a splaying out of tendonous insertions near the (blank)), a "tie-beam" for the transverse arch, and a "suspension" for the lateral longitudinal arch.
8. The superior aspect of the sustentaculum tali provides a site of attachment for the (blank) ligament. The anterioinferior aspect of the sustentaculum tali provides a site of attachment for the (blank) ligament. The inferior aspect of the sustentaculum tali provides a groove for the (blank). Immediately medial (superficial) to the sustentaculum tale are the (blank), (blank), and (blank). The sustentaculum tali is a bony process derived from the (blank).
9. The dorsalis pedis has as its terminal branches the (blank) and (blank) arterys. The (blank) artery crosses the superior aspects of the base of the metatarsals whereas the other terminal branch passes inferiorly between the heads of origin of the (blank) to from the medial aspect of the (blank).
10. The lateral plantar artery is a terminal branch of the (blank) artery. From its origin at the flexor retinaculum of the ankle the lateral plantar artery passes superior and then deep (lateral) to the (blank) muscle to enter the sole of the foot. The lateral plantar artery crosses the sole obliquely in a fascial plane immediately superior to (blank) and inferior to (blank). Upon reaching the lateral side of the sole the lateral plantar artery passes superiorly toward the base of the 5th (blank). At this location, the lateral plantar artery becomes the (blank) and lies superior to the (blank) head of the adductor hallucis and inferior to the (blank) muscles.
11. The tendon of peroneus longus crosses the lateral aspect of the sole through an osseofibrous canal. The superior wall of this canal is the (blank). The inferior wall of this canal is the (blank).
12. What structures arise from the dorsal venous arch? What are their relations to the malleoli?
13. A dorsal expansion has insertions as follows. Which toe of which foot is involved? * a long tendon inserts along a longitudinal path * a short tendon inserts along a transverse path from the right * a tendon crossing anterior the mp joint inserts on the medial side * a tendon from a monopennate muscle inserts on the medial side * a tendon from a bipennate muscle inserts on the lateral side

Essay

1. What branch of the dorsalis pedis artery contributes blood supply to the plantar aspect of the foot? Explain the relations of this arterial branch.
2. Discuss why flexion of the toes is more controlled than extension. Which digit has the most overall control and why?
3. Discuss the support of the medial longitudinal arch. Please be systematic in your answer by working from the deepest structures outward.
4. Does a strong pulse of the dorsalis pedis artery guarantee that the anterior compartment of the leg is receiving an adequate blood supply? Explain your answer. (hint: no it doesn't)
5. What arterial branches course distally (anterior) from the plantar arch? What are the relations of these arteries. What arterial branches course proximal (posterior) from the plantar arch. What are the relations of these arteries? What arterial branches course superior (toward dorsum of foot)? What are the relations of these arteries?
6. Consider that some unfortunate person steps on a nail. The nail penetrates straight into the sole of the foot. Ultimately the spring ligament is pierced and the penetration is arrested. What structures (fascia, muscles, neurovascular, bone) were possibly damaged. What finally stopped the penetration?
7. In accord with the "bridge" analogy, can you think of a structure that participates as a staple for the medial longitudinal arch, a tie-beam for the transverse arch, and a suspension for the lateral longitudinal arch? Explain.

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Questions for the Joints of the Lower Extremity

These questions were not submitted by the lecturer.

True/False - August 15, 2011

1. The ankle is more stable in extension than in flexion.
2. The acetabular fossa receives contributions from the pubis, ischium, and illium.
3. The hip joint is considered to the the most movable joint of the body.
4. The fovea of the head of the femur is not covered by hyaline cartilage.
5. The artery of the ligament of the head of the femur (ligamentum capitus) is, in children, an end artery.
6. The articular cartilage of the acetabular fossa is covered by a synovial membrane (synovium).
7. The transverse acetabular ligament is a cartilaginous extension of the acetabular articular cartilage.
8. The articular capsule of the hip joint attaches to the intertrochanteric crest.
9. The inferior stem of the "Y ligament of Bigalow" (iiofemoral ligament) extends to the lesser trochanter.
10. The pubofemoral ligament interdigitates with the iliofemoral ligament in the area of the intertrochanteric line.
11. The ischiofemoral ligament has anterior attachments at the intertrochanteric line.
12. The ligamentus specializations of the hip articular capsule are relaxed during quiet standing.
13. The line of gravity falls anterior to the hip joint during quiet standing.
14. The oblique popliteal contributes to the posterior joint capsule of the knee.
15. The synovium of the knee joint covers the deep surface of the patela.
16. The suprapatellar bursa communicates with the intrapatellar bursa and with the synovial joint cavity.
17. The medial collateral ligament attaches, in part, at the neck of the fibula
18. The cruciate ligaments are intracapsular and extrasynovial and the tendon of orgin of the popliteus muscle is both intrasynovial and intracapsular.
19. The lateral meniscus is typically torn when the lateral collateral ligament of the knee ruptures.
20. The anterior cruciate ligament is attached to the anterior region of the intercondylar space.
21. The anterior and posterior ligaments are so named for their relative attachments to the tibia.
22. The crossing of the cruciate ligaments tighten as the femur medially rotates on the tibial plateau.
23. The popliteus tendon intervenes between the medial meniscus and the medial collateral ligament.
24. The tibiocalcaneal ligament of the medial ankle joint is continuous at its calcaneal attachments with the spring ligament.
25. The long plantar ligament form the inferior boundary of a osseofibrous tunnel that transmits the tendon of the peroneus longus to the medial side of the foot.
26. The tendon of flexor hallucis longus is applied to the groove of the cuboid bone.

True/False - August 16, 2010

1. Articular cartilage is typically covered by a synovial membrane.
2. Joint ligaments can, at once, be inside the joint capsule but outside the joint synovial cavity.
3. Included in the intrasynovial space is synovial fluid.
4. The "screw home" mechanism is a carpentry referent applied to the final turn that firmly seats a screw and, thus, stabilizes the joint.
5. The line of force of gravity, anterior to the knee joint, contributes to the "screw home" stability of the knee in extension while standing.
6. The popliteus muscle "unscrews" the extended knee of the planted lower limb by medially rotating the femur.
7. The ligamentum capitis together with the artery to the head of the femur, enters the acetabular fossa, by way of the acetabular notch.
8. The trochanteric fossa receives attachment of the ligamentum capitis.
9. The hip joint is most stable in flexion.
10. The acetabular labrum is interrupted by the acetabular notch.
11. Intervening between the intertrochanteric line and the iliopsoas tendon is the iliofemoral ligament.
12. The iliopsoas tendon crosses the anterior surface of the pubofemoral ligament.
13. Maximum tension of the ischiofemoral, iliofemoral, and pubofemoral ligaments occurs during flexion of the hip joint.
14. That part of the adductor magnus that extends the hip inserts on the adductor tubercle.
15. The posterior part of adductor magnus extends the hip and is innervated by the obturator nerve.
16. The semimembranosus, semitendinosus, biceps femoris, posterior adductor magnus, and the superior all arise from the ischial tuberosity.
17. The oblique popliteal ligament is a thickening of the inner surface of the patellar tendon.
18. The suprapatellar bursa is continuous with the synovial cavity of the knee joint.
19. The prepatellar bursa does not typically communicate with synovial joint cavity.
20. The lateral meniscus, but not the medial meniscus, is attached to the tibial collateral ligament of the knee.
21. The tendon of origin of the popliteus muscle is attached to the fibular collateral ligament.
22. The posterior joint capsule provides a surgical approach to the cruciate ligaments that does not disrupt the synovial joint cavity.1
23. The anterior cruciate ligament resists anterior displacement of the tibia.
24. The posterior cruciate ligament resists posterior displacement of the tibia.
25. Forced abduction of the leg may rupture the medial collateral ligament and, thus, tear the medial meniscus.
26. A blow to the lateral side of the knee joint (football clip) generates a forced abduction of the leg and a forced adduction of the thigh.
27. The deltoid ligament, at the level of the flexor retinaculum, is deep the the plantar vessels and nerves.
28. The long plantar ligament extends distally beyond the groove of the cuboid bone.
29. The short plantar ligament "stops short" of the groove of the cuboid bone.
30. The tendon of the peroneus longus muscle crosses the superior surface of the long plantar ligament.
31. The tendon of flexor hallucis longus crosses the inferior surface of the spring ligament (plantar calcaneonavicular ligament).
32. Inversion injuries of the ankle may disrupt the lateral ligaments of the ankle.

Definition and Short Answer

1. What intervenes between the lateral collateral ligament and the lateral meniscus?
2. Are the menisci of the knee joint intrasynovial? Or, instead do they face into the synovial cavity?
3. The artery of the ligament of the head of the femur is a branch of what artery?
4. Crossing the anterior surface of the iliofemoral ligament and the pubofemoral ligament is the tendon of ________?
5. What is the relative stability of the hip joint while seated in a car? While standing?
6. Is the patella within the quadraceps tendon, or instead, is the patella between the quadraceps tendon and the patella ligament?
7. What was the surgical approach to the cruciate ligaments before arthroscopic surgery? Why avoid invasion of the synovial cavity?
8. Why is it handy to discuss limitations of movement by the cruciate ligaments in terms of the tibia?
9. What are the bony and fibrous components that make up the osseofibrous tunnel for the peroneus longus tendon.
10. As the inferior lateral genicular artery proceeds anterior having crossed the posterior surface of the popliteus muscle, it crosses the medial (deep) surface of the (blank) ligament and the lateral surface of the (blank) meniscus and the medial surface (deep) of the blank tract.
11. The center of gravity, when standing, is (blank) to the hip joint, (blank) to the knee joint, and (blank) to the ankle joint. Minimal muscle activity is required at the hip largely due to support provided by the (blank) ligament. Minimal muscle activity is required at the knee because of the "screw home" mechanism that brings the joint into a "close packed" position due to a (blank) rotation of the (blank) condyles on the (blank) plateau. Considerable muscle activity is required across the ankle joint and is provided by the (blank) muscles.
12. The lateral plantar arthery crosses the sole of the foot starting medial to lateral: 1) (blank) to abductor hallucis, (blank) to flexor hallucis brevis, and (blank) to quadratus plantae.

Essay

1. What are the relationships of the sustentaculum tali to the spring ligament, deltoid ligament, medial/lateral plantar nerves and arteries, flexor hallucis longus, medial longitudinal arch, and whatever else is adjacent?
2. What nerve distributions contribute to flexion of the knee? Mention key muscles for each distribution. What is the action of these muscles at the hip?
3. Discuss the anatomy of Trandelenberg's gate. Include possible causes for this particularly nerve injury. Consider origins and insertions and the mechanics of compensation (explain the appearance of the gait).
4. Discuss the "screw home" mechanism of the hip joint. When is the hip joint maximally stable? How does this relate to the line of gravity at the hip?
5. What is the significance of the infrapatellar synovial fold in understanding that a structure (anterior cruciate ligament) can be both intracapsular and extrasynovial?
6. Discuss the muscles and nerves that contribute to movement at the hip.
7. Discuss the relations of the fibular collateral ligament of the knee.
8. The tibial portion of the sciatic nerve is lesioned within the middle third of the thigh. Can you still flex the knee using muscles of the posterior compartment on the thigh? The tibial portion of the sciatic nerve is lesioned in the gluteal region. Can you still flex the knee using muscles of the posterior compartment? The tibial and peroneal portions of the sciatic nerve are lesioned in the distal third of the thigh. Can you still flex the knee using muscles of the posterior compartment of thigh? The tibial portion of the sciatic nerve is lesioned in the gluteal region and the peroneal portion is lesioned in the lower third of the thigh. Can you still flex at the knee using muscles of the posterior compartment of the thigh? The tibial and peroneal portions of the sciatic nerve are lesioned in the gluteal region. Can the knee still be flexed by any muscle regardless of compartment?
9. What are the functions of the popliteus muscle?

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Questions for the Introduction to Thorax

These questions were not submitted by the lecturer.

True/False - August 16, 2011

1. The lactiferous ducts are a specialization of cutis retinacula.
2. The anterior thoracic artery is applied to the posterior surface of the brachiocephalic vein.
3. The first rib and the clavicle both articulate with the xiphoid process.
4. The jugular notch defines, in part, the thoracic outlet.
5. The body of the sternum, on an A/P projection, is superimposed on the the apex of the heart.
6. The jugular notch is at the A/P projection to T4.
7. The costal margin consists of cartilage that articulates with the distal ends of rib 7-10.
8. The most inferior extent of the costal margin is at the same S/I level as the third lumbar vertebra.
9. The fiber direction of the external intercostal membrane is from superior/lateral to inferior/medial.
10. The fiber direction of the internal intercostal muscle at the chondral cartilages is superior/medial to inferior/lateral.
11. The deep surface of the innermost intercostal muscles are lined by endothoracic fascia.
12. Despite blockage of the aorta at the ligamentum arteriosum (coarctation), blood continues to flow in the descending aorta.
13. Posterior intercostal arteries arise from the internal intercostal artery.
14. Anterior intercostal arteries arise from the ascending aorta.
15. The collateral circulation of the thoracic wall defines an arterial shunt across the thoracic descending aorta.
16. The hilum of the lung is a point of invagination "into" the pleural cavity.
17. The lung is located in the thoracic cavity, but not in the pleural cavity.
18. Endothoracic fascia provides adherence of the diaphragmatic parietal pleura to the suprapleural membrane.
19. The mesothelial layer of parietal pleura faces into the pleural cavity.
20. The visceral layer of pleura has a mesothelial layer, but not a fibrous layer.
21. A pneumothorax happens when the endothoracic fails to secure the visceral pleura to the thoracic wall.
22. The parietal pleura becomes redundant at the costodiaphragmatic recess.
23. The subcostal muscles define, in part, the inner (deep) surface of the neurovascular plane for the intercostal vessels and nerves.
24. The posterior intercostal veins drain directly into the inferior vena cava.
25. The subcostal muscles, innermost intercostal muscles, and transversus thoracis muscles define the deep wall of the neurovascular plane.
26. The internal intercostal muscle defines the superficial wall of the neurovascular plane.
27. False ribs connect directly to the xiphoid process..
28. Costochondral joints are syndesmoses and sternochondral joints are synovial.
29. Intervening between the left and right pleural cavities is the mediastinum.
30. The costomediastinal recess defines a location where paracentesis (access to the pericardial sac with a hypodermic needle) avoids puncturing the pleural cavity.
31. The A/P projection from the sternal angle to the L4 vertebra defines the inferior boundary of the superior mediastinum.
32. A projection from the sternal angle to the T1 vertebra defines the superior boundary of the superior mediastinum.

True/False - August 17, 2010

1. The lactiferous ducts are 15-20 in number for both the male and the female.
2. Retinacula cutis is a differentiated part of the tela subcutanea that provides support to the female breast.
3. The right and left internal thoracic arteries are from the right and left subclavian arteries.
4. The jugular notch is part of the manubrium.
5. Intervening between the right and left clavicular notches is the jugular notch.
6. The manubrium refers to a shield whereas the xiphoid process refers to a sword.
7. The jugular notch, in part, defines the thoracic outlet.
8. The sternal angle is formed, in part, by the inferior extent of the manubrium.
9. The costochondral cartilage connects the ribs to the vertebral bodies.
10. The external intercostal membrane is located superficial to the external intercostal muscle.
11. The lateral extent of the external intercostal membrane is at the costochondral joint.
12. The internal intercostal membrane lies deep to the innermost intercostal membrane.
13. The subcostal muscles located on the anterior thoracic wall and the transversus thoracis muscles located on the posterior thoracic wall span a rib.
14. The intercostal vein, artery, and nerve lie along a groove at the superior border of a rib.
15. The upper anterior intercostal spaces have anterior intercostal arteries from the internal thoracic artery.
16. The subcostal muscles are observed in the paravertebral region of the thoracic wall; the internal intercostal muscles are observed at the midaxillary line; and the transversus thoracis muscles are observed in the parasternal region.
17. The contents of the pleura cavities include the lungs.
18. The contents of the pleural cavities, under non-pathological conditions, include a film of pleural fluid.
19. The parietal pleura has a single mesothelial cell layer.
20. The visceral pleura has both a mesothelial cell layer and a fibrous layer.
21. The endothoracic fascia "glues" the visceral pleura to the lung.
22. The mediastinum separates the thoracic cavity from the abdominal cavity.
23. The pulmonary ligament is known as a visceral ligament and consists of a reflection of visceral pleura.
24. Simpson's fascia (suprapleural membrane) is a thickening of visceral pleural at the apex of the lung.
25. A reflection of costal parietal pleura to become diaphragmatic parietal pleura defines, in part, the infer extent of the costodiaphragmatic recess.
26. The pleural cavity, under non-pathological conditions, is at negative atmospheric pressure.
27. An equalization of pleural cavity pressure and atmospheric pressure causes the lung to collapse - pneumothorax.
28. A needle that passes through the costodiaphragmatic recess will penetrate costal parietal pleura to enter the recess and then diaphragmatic parietal pleura to leave the recess.
29. A needle that passes through the pleural cavity along the midaxillary line at the 4th intercostal space will pierce costal parietal pleura to enter the pleural cavity and visceral pleura to leave the pleura cavity.
30. The mediastinum is a partition that separates the two pleural cavities.

Definition and Short Answer

1. The deepest layer of intercostal muslces is represented by the __________ muscles anteriorly, the ________ muscles at the midaxillary line, and the ________ muscles posteriorly.
2. Which of the following questions is a nightmare?. 1) Discuss the contents of the thoracic cavity. 2) Discuss the contents of the pleural cavity.
3. The endothoracic fascia is immediately applied to what layer of pleura?
4. What is the pulmonary ligament. Is there a fibrous layer of this ligament?
5. The internal thoracic arteries branch from the (blank) arteries. The left of these arteries is a branch of the (blank) artery whereas the right of these arteries is a branch of the (blank) artery. There is a conditional known as coarctation of the aorta. The aorta becomes occluded at a location distal to the parent arteries of the internal thoracic arteries and proximal to the branching of the posterior intercostal arteries. Thus, there is blood flow in the normal direction within the internal thoracic arteries. Despite near total occlusion of the aorta proximal to the branching of the posterior intercostals from the descending aorta, the descending aorta fills with blood and there is blood flow to the entire body. Explain the pattern of blood flow in the case of coarctation of the aorta. Where is the normal direction of flow reversed? Where is blood pressure apt to be elevated and where is it apt to be lowered? What radiographic findings are expected? What might you hear, to your initialize surprise, when attempting to listen to he heart with a stethoscope?
6. The heart position causes the left anterior costomediastinal pleural reflection to deviate to the left side. This provides the opportunity to perform pericardiocentesis without entering either pleural cavity. Thus, a needle is passed through the fatty contents of the (blank) ligament. Provide a brief account of the procedure.
7. A pleural tap of the costodiaphragmatic recess requires that a needle through the (blank) intercostal space at the (blank) line. The fascial barriers penetrated are: 1) skin, 2) (blank), 3) investing fascia, 4) (blank), 5) (blank), 6) (blank), 7) endothoracic fascia, 8) (blank), 9) (blank), 10) pleural cavity. If the needle continued through the pleural cavity on the right side the next fascial barrier would be: 11) visceral layer of (blank), 12) blank, 13) (blank), 14) diaphragm.
8. The intercostobrachial nerve is derived from the (blank) cutaneous branch of the (blank) ramus of the (blank) spinal nerve. The left intercostobrachial nerve is of great clinical importance. Be prepared to briefly discuss "referred pain" along the distribution of the left intercostobrachial nerve.
9. The cutaneous innervation of the skin overlying the xiphoid process is provided by the medial branch of the (blank) cutaneous nerve derived from the (blank) intercostal nerve. The vertebral projection of the xiphoid process projects to the (blank) thoracic vertebrae. The (blank) rib articulates at the xiphisternal junction.
10. The internal thoracic vessels are secured to the posterior surface of the anterior thoracic wall. These vessels lie immediately posterior (deep) to the (blank) muscles and immediately anterior (superficial) to the (blank) muscles. Are the internal thoracic vessels within the same neurovascular plane as the intercostal vessels? Explain?
11. The innermost intercostal fascial plane has been described as representing three muscles. The (blank) muscles anterior; the (blank) muscles are intermediate (mid-axillary); the (blank) muscles are posterior.
12. The thorax is to the pleural cavity as the capsule of the knee joint is to the _____.

Essay

1. Collateral circulation of the thoracic cage. Discuss the flow of blood in the case of coarctation of the aorta. Where is blood flow reversed from normal.
2. What fascial planes are penetrated by wound that begins at the right mid-axilary line at the eighth intercostal space and proceeds into the liver.
3. Pleurisy may cause adhesions that, in turn, lead to newly formed lymph channels. How might these channels be different from the typical lymphatic drainage of the lungs?
4. A stab wound penetrates straight into the right side of the thorax in the mid-axillary line at the 8th intercostal space. What are the facial layers and spaces are penetrated? Limit your answer to structures of the thorax.
5. What bony landmark would be useful to identify the terminal branching of the internal thoracic artery? What are the distributions of these terminal branches?
6. What relation could you rely upon to unequivocably identify the internal intercostal muscle from a posterior view of the anterior chest wall?
7. What relations could you rely upon to unequivocalbly ID the transversus thoracis from an anterior view?
8. What nerve branches provide innervation to the skin overlying the xiphoid process? These nerves are derived from what spinal nerve. What is the vertebral projection of the xiphoid process?
9. Discuss the boundaries of the visceral and parietal pleura. Provide approximate vertebral levels in defining the boundaries.

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Questions for the Lungs and Anterior/Middle Mediastinum

These questions were not submitted by the lecturer.

True/False Questions - August 17, 2011

1. The trachea bifurcates into secondary main bronchi on the posterior surface of the second thoracic vertebra.
2. The right main bronchus is more vertical than the left main bronchus owing to the positioning of the heart.
3. The oblique fissure of the right lung has surface projections to T3 T5 6th rib.
4. The horizontal fissure of the right lung has surface projections to T4 and to rib 4.
5. In general, the A/P topography is artery, vein, bronchi for the lungs.
6. Cradled by the leaflets of the pulmonary ligament at the inferior extent is a pulmonary vein.
7. The arch of the azygos vein is impressed upon the left lung.
8. Primary bronchi define the bronchopulmonary segments.
9. The second order bronchus, pulmonary vein, and lung tissue define a bronchopulmonary segment.
10. The bronchial arteries carry deoxygenated blood to the lungs.
11. The pulmonary veins carry deoxygenated blood to the right atrium of the heart.
12. The lungs are said to follow expansion of the thoracic wall by the properties of surface tension.
13. Air rushing into the thoracic cavity, but not the pleural cavity, leads to pneumothorax.
14. The costotranverse joints of the upper ribs are cup shaped and the constotransverse joints of the lower ribs are p lanar.
15. The true ribs articulate DIRECTLY with the sternum.
16. The movement of the upper six ribs is similar to the movements of a pump handle with the sternum being the pump handle.
17. During inspiration the lower ribs slide laterally at the costotransverse joint.
18. The vertical movement of thoracic expansion is mediated by the diaphragm.
19. The vertical movement of thoracic expansion is limited by pregnancy.
20. A costovertebral joint includes two vertebral bodies, an intervertebral disc, and the head of a rib.
21. The costochondral joint is fibrous and the sternochondral joint is synovial.
22. The lingula is a tongue like projection of the upper lobe of the right lung that lies immediately deep to the sternochondral joint of the right 6th rib.

True/False - August 18, 2010

1. The level of the T4 vertebra marks the location of the tracheal bifurcation.
2. The deviation of the heart to left side provides a mneumonic for knowing that the left bronchus is longer and more transverse than the right bronchus.
3. The horizontal fissure is unique to the left lung.
4. The lingula provides the inferior border of the cardiac notch.
5. Posteriorly, the oblique fissure is at the level of T3 vertebra, mid-axillary at 5th rib, mid-clavicular at 6th rib.
6. Horizontal fissure marks the 7th rib.
7. The hilum of the lung is cradles by the suprapleural membrane.
8. The pulmonary ligament is formed by pleural reflections beginning at the hilum of the lung and extending inferior toward the diaphragmatic surface.
9. The segmental bronchi are known as tertiary bronchi.
10. Each bronchopulmonary segment has a segmental pulmonary artery and a lobar bronchus.
11. Lung tissue proper is not perfused by either the pulmonary artery or vein.
12. The upper 7 ribs mediate an increase in the anterior/posterior dimension of the thorax on inspiration.
13. The lower 5 ribs mediate an increase in the transverse dimension of the thorax on inspiration.
14. The pump handle movement of respiration refers the movements of the sternum whereas the bucket handle movement refers to movements of the costal margin.
15. The vertical dimension of the thorax increases when the diaphragm contracts.
16. The costotransverse joints allow rotation (cup shaped) for the upper 7 ribs and sliding (planar) for the lower 5 ribs.
17. The costochondral and sternochondral joints participate in the movements of respiration.
18. The lungs receive oxygenated blood from the pulmonary arteries
19. Relaxed breathing is primarily mediated by the upper 7 ribs.
20. Cup shaped articulations of the costotransverse joint permit transverse movement of the lower ribs.
21. The arterial supply to the left lung is derived directly from the aortic arch

Definition and Short Answer

1. Contrast the anatomy of the pulmonary arteries and veins in regard to a bronchopulmonary segment
2. The anterior and posterior lamina of the pulmonary ligament (a visceral ligament) diverge superiorly near the (blank) of the lung. At this location the anterior and posterior lamina of the pulmonary ligament reliably embrace a (blank). This relation can be used to unequivocably identify a (blank) and, thus, judge differences in wall thicknesses between (blank) and (blank). In general, structures easily observed at the root of the lung from anterior to posterior, are the (blank), (blank), and (blank).
3. The left phrenic nerve enters the thoracic inlet crossing the anterior surface of the (blank) artery and the posterior surface of the (blank) vein (Grants 1.44). The phrenic nerve descends through the (blank) fascia of the (blank) mediastinum passing (blank) to the root of the lung. As the phrenic nerve travels along the mediastinum the fascia immediately medial to it is the (blank) fascia and the fascia immediately lateral to it is the (blank) fascia.
4. The costotransversal joints have (blank) shaped articulations at the transverse process for the upper 7 ribs. These articulations allow upward (blank) at the neck of the rib during (blank). The costotransverse joints have (blank) shaped articulations at the transverse process for the lower 5 ribs. These articulations allow outward (blank) at the neck of the rib during (blank).
5. Visible impessions of the left lung include the (blank) of the aorta whereas visible impessions of the right lung includes (blank) of the azygos vein.
6. It can be argued that the poor esophagus is "bullied" about through out its course through the thorax. The (blank) of the trachea at the (blank) of the (blank) lung is said to force the esophagus to a (blank) position and possibly restrict the flow of contents. The aorta is said to force the esophagus to remain to the (blank) of the midline of the anterior vertebral bodies and thus, deny the esophagus any social interactions with the (blank) lung. Nearing the inferior aspect of the thorax the esophagus, fed up with being pushed around, deviates to the left and leaves a positive impression on its new found friend -- the (blank) lung.

Essay

1. How is the pulmonary ligament similar to the venous mesocardium? Consider function and anatomy.
2. What left lung impressions are most noticeably differ from the right? Is there any anatomical significance to the lingula?
3. Could a stab wound penetrating into the thoracic cavity from the anterior chest wall do so without creating pneumothorax? If so, exactly where might this wound occur? Is there clinical significance to this?
4. Contrast the relations (6 directions) of the pulmonary ligaments for the left and right lung.
5. Where might you find two layers of serous parietal pleura in contact with each other?

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Questions for the Heart and Great Vessels - A Partial Study Guide

These questions were not submitted by the lecturer.

True/False - August 19, 2011

1. The pericardiacophrenic artery is on the same parasaggital plane as the chondral cartilages.
2. The phrenic nerve crosses anterior to the hilum of the lung.
3. The fibrous coat of the pericardium has endothoracic fascia on its external surface.
4. The parietal layer serous paricardium is directly adhered to the fibrous coat without a layer of endothoracic fascia.
5. The visceral pericardium secretes fluid into the pericardial cavity but not into the pericardial sac.
6. The blending of the fibrous coat with the great vessels is known as arterial mesocardium.
7. The blending of the fibrous coat with the pulmonary and caval veins is known as the venous mesocardium.
8. The pulmonary veins access the fibrous coat at the posterior lateral wall of the pericardial sac.
9. The venous and arterial mesocardia are immediately continuous with the parietal pericardium and the epicardium.
10. The superior boundary of the oblique sinus is contributed by the fibrous coat.
11. The pericardiophrenic artery, as it passes inferior to the root of the lung, lies within endothoracic fascia.
12. The periphery of the diaphragm is vascularized by the pericardiacophrenic artery and the central tendon is vascularized by the intercostal arteries.
13. The pericardiacophrenic artery, despite the name, does not supply the pericardial sac.
14. The right ventricle, despite the name, is primarily posterior to the left ventricle.
15. The apex of the heart is deviated to the left side at the level of the 4th rib.
16. The atria have little ears and the left lung has a little tongue.
17. The caval veins open into the left atrium.
18. The anatomy of the left atrioventricular valve is similar to that of the aortic valve.
19. Asymmetries between the left and right ventricles reflects the aortic arterial tree compared to the pulmonary arterial tree.
20. The valve of the inferior vena cava and the valve of the coronary sinus are located in the anterior wall of the right atrium.
21. The crista terminalis is on the inside of the right ventricle and the sulcus terminalis is located of the outside wall of the pericardial sac.
22. The fossa ovalis, if patent, allows blood to travel from the right atrium to the left atrium.
23. The tricuspid valve is a characteristic of the left ventricle.
24. The septomarginal trabecula is continuous with the posterior papillary muscle.
25. The chorda tendonae of a single papillary muscle attach to a single cusp.
26. The infundibulum, near the pulmonary valve, becomes membranous.
27. The chorda tendinae actively close the aortic valve.
28. The aortic valve, but not the pulmonary valve, has a noncoronary valve.
29. Nodules and lunules provide attachment sites for the chorda tendinae.
30. The coronary arteries perfuse the myocardium during systole.
31. The aortic sinuses fill with blood during diastole.
32. The lunules diverge during systole and converge during diastole.
33. The skeleton of the heart consists of fibrocartilage.
34. The conduction system of the heart is intrinsic and, thus, the heart can beat without influence from an exogenous source of neural commands.
35. The inferior extent of the sulcus terminalis marks the subepicardial location of the sinuatrial node.
36. The interventricular septum hosts purkinje fibers from the atrioventricular node that travel to the anterior papillary muscle of the right atrium.
37. A blockage of the proximal left coronary artery is expected to disrupt the conduction system of the heart.
38. The right coronary artery provides the primary blood supply to the anterior part of the interventricular septum.
39. The left coronary artery provides the primary blood supply to the anterior part of the interventricular septum.
40. Branches of the right and left coronary arteries, to a varying degree, anastomose at the apex of the heart.
41. The anterior cardiac veins drain directly into the left ventricle and the coronary sinus drains directly into the right atrium.
42. The great cardiac vein drains into (becomes) the coronary sinus.
43. The middle cardiac vein drains directly into the right atrium.

Questions for the Heart and Great Vessels - A Partial Study Guide

These questions were not submitted by the lecturer.

True/False

August 20, 2010

1. The pericardial sac is contained within the pericardial cavity.
2. The heart is outside the pericardial sac and inside the pericardial cavity.
3. The anterior surface of the pericardial is stabilized by the sternopericardial ligaments.
4. The base of the heart is secured at the central tendon of the diaphragm.
5. The posterior pericardial sac is stabilized by the pulmonary arteries.
6. Deep to the visceral pericardium is the epicardium.
7. The pulmonary veins drain into the right atrium.
8. The arterial mesocardium marks a reflection of
9. The arterial and venous mesocardia are analogous to the pleural reflections at the hilum of the lung.
10. Reflections of parietal serous pericardium defines the boundaries of the oblique sinus.
11. An infection that erodes through the pericardial cavity into the pleural cavity invades the endothoracic fascia and puts the phrenic nerve at risk.
12. The bicuspid valve passes deoxygenated blood whereas the tricuspid valve passes oxygenated blood.
13. The crista terminalis marks the location of the sulcus terminalis.
14. Pectinate muscles line the right ventricle.
15. The fossa ovalis marks a fetal communication between the right atrium and the left ventricle.
16. Chordae tendineae arising from a single papillary muscle attach to more than one cusp.
17. Perfusion by the coronary arteries occurs during diastole.
18. Blood fills the coronary sinus during systole.
19. The tricuspid valve has three nodules, three lunules, and three cusps.
20. The fibrocartilaginous skeleton of the heart provides
21. The heart's intrinsic nervous system can cause the heart to beat without extrinsic nervous influence.
22. The sinoatrial node is immediately deep to the endocardium.
23. The atrioventricular node is immediately superficial to the endocardium.
24. The atrioventricular bundle conveys nervous impulses to the papillary muscles.
25. The ostia of the right coronary artery is at the coronary sinus of the right coronary cusp of the pulmonary semilunar valve.
26. The anterior interventricular artery is supplied by the right coronary artery and the posterior interventricular artery is supplied by the left coronary artery.
27. The anterior cardiac veins first drain into the small cardiac vein and then the coronary sinus.
28. The middle cardiac vein lies in the anterior interventricular sulcus.

August 2009

1. The internal thoracic, but not the phrenic nerve passes along the margin of the mediastinum.
2. The internal thoracic artery is lateral to the sternocostal joint and medial to the costochondral joint.
3. The sternopericardial ligaments contribute to the stability of the heart.
4. The inferior border of the pericardial sac is adhered to the central tendon of the diaphragm by way of the endothoracic fascia.
5. The outermost layer of the the pericardium, the fibrous coat, is adhered to the fibrous layer of parietal pleura.
6. The parietal layer of serous pericardium is redundant with, and continuous with the visceral pericardium.
7. The heart is within the pericardial sac and outside the pericardial cavity.
8. The epicardium (visceral pericardium) lines the outside of the myocardium while the endocardium lines the inner surface of the myocardium..
9. The fibrous coat of the pericardium is attached to the great vessels, the diaphragm, the inferior vena cava, and the pulmonary veins.
10. The fibrous pericardium, by way of the sternopericardial ligaments is tethered to the sternum.
11. Which of the following questions is a nightmare? Discuss the contents of the pericardial cavity. Discuss the contents of the pericardial sac. Ans: the latter.
12. The pericardiacophrenic vessels and the phrenic nerve are both located within the endothoracic fascia.
13. The oblique sinus is bounded superiorly by reflections of parietal pericardium known as the arterial mesocardium.
14. The transverse sinus is located between the venous mesocardium and the arterial mesocardium.
15. The pericardiacophrenic artery is derived the right subclavian artery on the right and the brachiocephalic artery on the left.
16. The internal thoracic arteries branch from the subclavian arteries.
17. The apex of the heart is oriented inferior, anterior, and to the left.
18. The base of the heart, relative to the apex, is oriented superior, posterior, and to the right.
19. The auricle is part of the ventricle.
20. The tricuspid valve leads to the left ventricle and the bicuspid valve leads to the right ventricle.
21. The pulmonary arteries carry oxygenated blood to the lungs.
22. The pulmonary veins carry de-oxygenated blood to the right atrium.
23. The left ventricle has thicker walls than does the right ventricle.
24. The arch of the aorta is at the level of T4.
25. The valve of the inferior vena cava is immediately to the right of the ostia for the coronary sinus.
26. The fossa ovale is a remnant of the foramen ovalis.
27. The crista terminalis, resembling the crown of a rooster, is easily demonstrated on the external margin of the right ventricle.
28. Pectinate muscles are unique to the right ventricle.
29. Trabeculae carne are unique to the right atrium.
30. Papillary muscles actively close the tricuspid valve.
31. Backflow closes the tricuspid valve and the papillary muscles prevent eversion of the tricuspid valve.
32. The chordae tendinae of a single papillary muscle extend to a single tricuspid valvule.
33. The pulmonary semilunar valve passes blood to the left atrium.
34. The left atrium, like the right atrium, contains pectinate muscles.
35. The septomarginal trabecula is within the left ventricle.
36. The heart is perfused during diastole.
37. The papillary muscles actively open the bicuspid valve.
38. The semilunar valves, at the center of each lunule, has three nodules.
39. The aortic semilunar valve closes at the beginning of diastole.
40. Arterial elasticity distal to the aortic semilunar valve partly mediates perfusion of the heart.
41. The fibrocartilagenous skeleton of the heart supports the bases of the heart valves.
42. The heart has an intrinsic nervous system that, nevertheless, is modulated by an extrinsic nervous system.
43. Intimately applied to the epicardium is the sinoatrial node.
44. Intimately appled to the endocardium is the atrioventricular node.
45. Purkinje fibers from the AV node follow the septomarginal trabecula to the posterior papillary muscle.
46. The sinuatrial artery is typically the first branch of the left coronary artery.
47. The marginal artery, a branch of the right coronary, follows the anterior margin of the heart.
48. The left coronary artery gives rise to the anterior interventricular artery and the circumflex artery.
49. The circumflex artery typically continues as the posterior interventricular artery.
50. The coronary sinus is located in the atrioventricular groove between the left atrium and left ventricle.
51. The great cardiac vein is along the anterior interventricular sulcus.
52. The small cardiac vein is along the right margin of the heart.
53. The anterior cardiac veins drain directly into the left atrium.
54. The middle cardiac vein is along the posterior interventricular sulcus.
55. The ligamentum venosum is a vestige of the ductus venosus that, in turn, was shunt between the umbilical vein and the left hepatic vein.
56. The ductus arteriosus, a vestige of the ligamentum arteriosum, provided a shunt between the pulmonary trunk and the right pulmonary vein.
57. The foramen ovale, in fetal life, provides a shunt between the atria.

Definition and Short Answer

1. What nerve contributes to pain sensation of both the diaphragm and the pericardium?
2. What specific vascular damage would lead to an irregular heart rate?

Essay

1. A stab wound penetrates straight into the right side of the thorax in the mid-axillary line at the 4th intercostal space. What facial layers and spaces are penetrated? Consider that the wound penetrates into a ventrical of the heart.
2. The cardiac cycle may show disrupted timing of atrial and ventricle contractions. What regions may be damaged? What is the typical blood supply to each of these regions?
3. A fatal condition results when the cusps of the tricuspid valve evert into the atrium. Discuss the relevant anatomy.
4. Discuss stabilization of the heart within the middle mediastinum.
5. Discuss the conduction system of the heart.

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Questions for the Superior and Posterior Mediastinum, and the Autonomic Nervous System

These questions were not submitted by the lecturer.

True/False - August 22, 2011

1. Collectively, the central nervous system plus the peripheral nervous system equals the nervous system.
2. The autonomic nervous system includes a preganglionic neuron located in the central nervous system and postganglionic neuron located in the peripheral nervous system.
3. Afferent nerves are said to affect the contraction of muscles and efferent neurons are said to effect our sensations and perceptions.
4. Neural circuits in the spinal cord may effect reflexive movement without volitional control.
5. Reflexively withdrawing your hand from a hot stove minimizes tissue damage relative to if you had to "think" about withdrawing your hand of your own volition.
6. The autonomic nervous system operates outside of volition.
7. Despite that autonomic reflexes are common, the afferent side of the reflex arc is not, by definition, part of the autonomic nervous system.
8. The parasympathetic division of the autonomic nervous system has shorter postganglionic fibers than does the sympathetic division of the autonomic system.
9. The thoracic sympathetic trunk ganglia host cell bodies belonging to the parasympathetic division of the autonomic nervous system.
10. The splanchnic nerves of the posterior mediastinum pass from the thorax into the abdominopelvic cavity.
11. The dorsal root ganglion hosts preganglionic cell bodies of the parasympathetic division of the autonomic nervous system.
12. Dorsal and ventral roots of the spinal cord converge to from a spinal nerve.
13. The distal termination of a spinal nerve is into ventral and dorsal rami.
14. Communicating between the sympathetic trunk ganglia and the intercostal nerves are ventral and dorsal rami.
15. Surgical disruption of the gray rami communicantes of thoracic sympathetic trunk ganglia is a treatment for excessive sweating of the hands.
16. Surgical disruption of the white rami communicantes of thoracic sympathetic trunk disrupts autonomic functions to viscera of the abdominopelvic cavity.
17. The greater, lesser, and least splanchnic nerves terminate at the celiac, superior mesenteric, and inferior mesenteric ganglia.
18. The proximal to distal orientation of the greater splanchnic nerve is inferior, medial and anterior.
19. The vagus nerve conveys preganglionic neuronal fibers into the thorax and abdominopelvic cavity.
20. The craniosacral division of the autonomic nervous system refers to the sympathetic division of the autonomic nervous system.
21. The thoracic and abdominal viscera have parasympathetic postganglionic cell bodies located in intrinsic ganglia.
22. The deep cardiac plexus is located on the anterior surface of the trachea at the bifurcation into main bronchi.
23. The superficial cardiac plexus is applied to the arch of the aorta near to the ligamentum arteriosum.
24. Diaphragmatic breathing is controlled by the autonomic nervous system.
25. The parietal pleura, but not the visceral pleura, has sensation mediated by the somatic nervous system.
26. Pleurisy irritates both visceral and somatic afferent nerve fibers.
27. The cell bodies the serve visceral pain of the heart are located in the dorsal root ganglia of T1-4. (This is true)
28. Embarrassment of the heart activates visceral fibers that share the same dorsal root ganglia as somatic fibers that provide sensation of the medial arm.
29. Visceral "pain" refers along dermatomal representations.
30. The azygous system mediates venous drainages of the thoracic cavity.
31. Right posterior intercostal spaces 1-2 drain into the arch of the azygous.
32. The left superior intercostal vein drains into the arch of the azygous.
33. The ductus arteriosus shunts the pulmonary and aortic arteries during fetal development and, post-partum, obliterates as the ligamentum arteriosum.
34. The thoracic duct crosses the posterior surface of the right posterior intercostal arteries.
35. In the case of coarctation of the aorta there is a reversal of blood flow in the left subclavian artery.

True/False - August 23, 2010

1. The dorsal and ventral horns are named parts for the gray matter of the spinal cord.
2. The dorsal and ventral roots are nerve branches arising directly from the spinal cord.
3. The dorsal and ventral roots combine to form a nerve plexus.
4. The dorsal root and the ventral root has a ganglion within the spinal canal.
5. The dorsal root and the ventral root combine to form a spinal nerve.
6. A spinal nerve terminates distally by elaborating a dorsal ramus and a ventral ramus.
7. Dorsal rami, but not ventral rami, enter into somatic plexuses.
8. Afferent fibers make up the dorsal roots and efferent fibers make up the ventral roots.
9. The interneuron within a reflex arc relays information from afferent fibers to efferent fibers.
10. Dropping an unexpectedly hot potato involves rapid extension of the fingers brought about by the interplay of afferent neurons, interneurons, and efferent neurons.
11. Efferent fibers of the somatic nervous system innervate skeletal muscle.
12. Efferent fibers of the autonomic nervous system innervate skeletal.
13. Tradition includes visceral afferent fibers as part of the autonomic nervous system.
14. The autonomic nervous consists of three efferent neurons.
15. The preganglionic neuron of the autonomic nervous system is located in nuclei within the central nervous system.
16. Sympathetic trunk ganglia are known as paravertebral ganglia.
17. Collateral ganglia of the autonomic nervous system are located at the lateral margins of arteries.
18. Intrinsic ganglia of the autonomic nervous system are located in enteric ganglia of the target organ.
19. The thoracolumbar part of the autonomic nervous system refers to the sympathetic division of the autonomic nervous system.
20. The craniosacral part of the autonomic nervous system refers to the parasympathetic division of the nervous system.
21. Visceral afferent information passes through two sensory cell bodies before arriving at the spinal cord.
22. Preganglionic fibers derived from the sympathetic division of the autonomic nervous system enter the sympathetic trunk ganglia.
23. Preganglionic fibers enter the sympathetic trunk by way of a white ramus communicans.
24. Gray rami communicantes convey postganglionic fibers.
25. The sympathetic trunk elaborates gray rami from the upper cervical region to the lower sacral region.
26. The sympathetic trunk elaborates white rami from the 1st thoracic cord level to the 2nd lumbar cord level.
27. The S3 cord level is at the L2 vertebral level.
28. Splanchnic nerves branch from the anterior margin of the sympathetic trunk and rami communicantes branch from the posterior margin of the sympathetic trunk.
29. Splanchnic nerves derived from the T5-9 cord levels combine to form the greater splanchnic nerve.
30. The viscera are dual innervated - part from the autonomic nervous system and part from the somatic nervous.
31. The viscera receive postganglionic fibers from the sympathetic nervous system and preganglionic fibers from the parasympathetic nervous system.
32. The superficial cardiac plexus is located on the anterior surface of the bifurcation of the trachea.
33. The superficial cardiac plexus is located on the arch of the aorta near the ligamentum arteriosum.
34. The deep cardiac plexus supplies fibers to the atrioventricular node.
35. Aneurysm of the aortic arch may damage the right recurrent laryngeal nerve.
36. The intercostobrachial cutaneous nerve (lateral branch of T2) is said the mediate referred pain from the heart.
37. Visceral afferent high threshold ("pain") fibers from the epicardium project to the T2 cord level.
38. Dermatomal charts show the distribution of afferent fibers projecting to a specific cord level.
39. The afferent fibers of a particular spinal nerve represent the distribution of a single dermatome.
40. The upper lateral quadrant of the right breast drains lymph into the left lymphatic duct.
41. Coarctation of the aorta causes retrograde blood flow in the posterior intercostal arteries.

True/False - August 2009

1. The parasympathetic division of the autonomic nervous system generally has postganglionic cell bodies in intrinsic ganglia at the target organ.
2. Intermediolateral cell columns are identified from spinal levels T1-12 and and S1-3.
3. Dorsal and ventral rami belong the the autonomic nervous system whereas gray and white rami are uniquely belong to the somatic nervous system.
4. The sympathetic trunk extends the entire length of the vertebral column.
5. Nerve fibers derived from gray rami typically travel within the sympathetic trunk.
6. Fibers derived from white rami travel anterior, medial, and inferior from the sympathetic trunk within the splanchnic nerves.
7. The esophageal plexus receives postganglionic fibers derived from the vagus nerve.
8. The greater, lesser, and least splanchnic nerves leave the thorax by passing through the esophageal plexus.
9. The thorax receives parasympathetic fibers nearly entirely, if not entirely, from the vagus nerve.
10. The cardiac nerves carry sympathetic nerves from the cervical region into the supericial and deep cardiac plexuses.
11. Intermediolateral cell colums host preganganglionic sympathetic cell bodies at thoracic spinal levels and parasympathetic postganglionic cell bodies at sacral spinal levels.
12. The vertebral projection of the xiphoid process is to T10 and the spinal nerve that provides sensory innervation to skin overlying the xiphoid is T10.
13. The superficial cardiac plexus is applied to the lateral margin of the aorta near the ligamentum arteriosum and the deep cardiac plexus is located on the anterior surface of the bifurcation of the trachea.
14. The cardiac plexuses receive both sympathetic and parasympathetic postganglionic fibers.
15. For the most part, the parasympathetic nervous system mediates homeostatic processes.
16. The sympathetic nervous system directly strengthens muscle contractions during stressful events.
17. Dilation of deep vasculature and contraction of peripheral vasculature is mediated by the parasympathetic nervous system.
18. Sensory fibers that follow pathways hosting sympathetic fibers tend to mediate high threshold (pain) sensation and sensory fibers that follow parasympathetic pathways tend to mediate low threshold (homeostatic) sensation.
19. Arising from the posterior margin of sympathetic trunk ganglia are splanchnic nerves and from the anterior margin are gray and white rami.
20. Spinal nerves convey autonomic, somatic, and viscerosensory fibers.
21. Visceral sensation, relative to somatic sensation, is dull, aching, and poorly localized.
22. Crosstalk between the viscerosensory and somatosensory systems is thought to occur in the dorsal root ganglia and, thus, explains referred pain.
23. Viscerosensation from the heart projects to spinal level T2 along cardiac nerves and the intercostobrachial cutaneous nerve is derived from spinal nerve T2.
24. The fibrous coat of the pericardium of innervated by the somatic nervous system whereas the epicardium is innervated by the viscerosensory system.
25. The diaphragm muscle is innervated by parasympathetic postganglionic fibers conveyed by the phrenic nerve.
26. Posterior intercostal spaces 2-4 on the right drain into the superior intercostal vein, a tributary of the arch of the azygos vein.
27. Posterior intercostal spaces on the left generally drain into the accessory hemiazygos vein.
28. The 9th anterior intercostal space drains into the internal thoracic vein.
29. Branches from musculophrenic artery anastomoses with the 10th posterior intercostal artery.
30. Posterior intercostal spaces 1-2 are derived from the costocervical trunk on the left and the brachiocephalic artery on the right.
31. The inferior and superior vena cava are shunted by veins that fun along the vertebral column.
32. The right recurrent laryngeal nerve ascends on the medial surface of the aortic arch.
33. The left recurrent laryngeal nerve passes the posterior margin of the ligamentum venosum.
34. The thoracic duct passes through both the posterior and superior mediastinum.
35. The thoracic duct drains into the subclavian vein on the left and into the brachiocephalic vein on the right.
36. The lymphatic drainage of the upper lateral quadrant of the right breast drains into the right lymphatic duct.

Definition and Short Answer

1. What is the difference between a spinal level and a vertebral level?
2. Splanchnic nerve

Essay

1. Cardiac embarrassment may provoke pain along the medial aspect of the left upper limb. Explain.
2. Discuss the course of the left vagus nerve though the thorax. Include key relations at several locations (e.g. mediastinal regions).
3. Explain the mechanism leading to pain of the left shoulder and medial arm during cardiac embarrassment.
4. What structures lie immediately to the left of the arch of the azygos vein?
5. Follow the course of the esophagus in the thoracic cavity. Identify 4 areas of constrictions of the esophagus in the thorax.
6. Discuss the pattern of blood flow when there is coarctation of the aorta.
7. What fascial layers compromised by a breast cancer that directly invades into the lung.

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Questions for the Radiology of the Lower Limb, Susann E. Schetter, DO

These questions were not submitted by the lecturer.

True/False

August 19. 2010

1. The base of the first two metatarsals articulate with the navicular bone.
2. Bony trabeculations reflect the particular stresses placed upon a bone.
3. The profunda femoral artery, within the femoral triangle, lies lateral to the femoral artery.
4. The transverse genicular ligament attaches the posterior horns of the medial and lateral menisci.
5. The medial meniscus is "C" shaped whereas the lateral meniscus is "O" shaped.
6. The medial femoral condyle is larger than the lateral femoral condyle.
7. The transverse genicular ligament crosses the anterior surface of the anterior cruciate ligament and the posterior surface of the alar synovial fold.
8. The head of the talus articulates with the posterior surface of the navicular bone and the anterior surface of the calcaneus bone.
9. The most anterior chamber of the heart is the right atrium.
10. The left atrium is the most posterior and superior chamber of the heart.
11. The main pulmonary artery is inferior to the aortic arch.
12. The costophrenic angles, in part, define the costodiaphragmatic recess.
13. The inferior margin of the left ventricle is opposed to the diaphragm.
14. The carina is at the level of the T4 vertebra.
15. The right pulmonary artery is longer than the left owing to the position of the heart to the left side.
16. The left hilum of the lung is superior to the right hilum owing to the position of the heart to the left inferior side.
17. The left and right common carotid arteries are branches of the left and right brachiocephalic arteries respectively.
18. The arch of the azygos vein cradles the superior surface of the left main bronchus.
19. The bifurcation of the trachea lies on the anterior surface of the esophagus.
20. The left brachiocephalic vein crosses the anterior margin of the left common carotid artery and the anterior surface of the brachiocephalic artery.
21. The left pulmonary artery cradles the superior surface of the right main bronchus.
22. The pulmonary trunk is anterior to the aortic root.

August, 2009

1. The talus articulates with the calcaneous at the subtalar joint and at the talocalcaneonavicular joint.
2. Trabeculae line up along direction of stress.
3. The external pudendal artery, but not the external pudendal vein, passes though the saphenous openning.
4. The superficial femoral artery enters the adductor canal along with the superficial femoral vein. (not to be asked on your examination)
5. The posterior lateral genicular crosses the lateral part of the leg deep to the tendon of insertion of the biceps femoris.
6. The first branch of the anterior tibial artery is apt to be the anterior recurrent tibial artery.
7. The anterior tibial artery enters the anterior compartment after crossing the lateral surface of the neck of the fibula.
8. The genicular anastomosis mediates the flow of blood across the knee in the case of popliteal artery occlusion.
9. The transverse genicular ligament is extrasynovial and extracapsular.
10. The menisci mediate shock absorption and stability.
11. The anterior cruciate ligament crosses to the posterior surface of the posterior cruciate ligament.
12. The posterior cruciate ligament attaches proximally to the medial femoral condyle.
13. The anterior cruciate ligament attaches proximally to the medial side of the lateral femoral condyle within the intercondylar space.
14. The quadriceps insert onto the tibial tuberosity (multiple interpretations).
15. The coronary ligaments secure the menisci to the femoral condyles.

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Questions for the Radiology of the Thorax, Susann E. Schetter, DO

These questions were not submitted by the lecturer.

True/False

1. The superior vena cava enters the left atrium.
2. Most anterior is the left ventricle.
3. The atria contribute to the lateral margins of the heart.
4. The superior vena cava contributes to the right margin of the mediastinum.
5. The carina is located anterior to the 4 thoracic vertebra.
6. Immediately posterior to the sternum is the right ventricle.
7. The phrenic nerve follows the lateral margin of the anterior mediastinum.
8. The pericardiacophrenic artery is located with endothoracic fascia.
9. Middle lobe syndrome is caused by enlarged lymph nodes at the root of the left lung.
10. In general, within the root of the lung the veins are most anterior followed by the bronchi and then pulmonary arteries.
11. The pulmonary arteries cross the anterior surfaces of the bronchi.
12. The right pulmonary artery is longer than the left and the right bronchus is shorter than left.
13. There are two brachiocephalic veins but only one brachiocephalic artery.
14. From anterior to posterior within the superior mediastinum are the left brachiocephalic vein, bracchiocephalic a. left common carotid a., left subclavian a., trachea, and esophagus.
15. The arch of the azygos vein cradles the right main bronchus.
16. The brachiocephalic veins cross anterior to he branches of the arotic arch (the great vessels).
17. The right main bronchus is cradled by the arch of the azygos.
18. The left pulmonary artery passes anterior to the left main bronchus.
19. The ligamentum arteriosus attaches the aortic arch to the right pulmonary artery.
20. The root of the main pulmonary artery is anterior to the aortic bulb.
21. The pulmonary artery crosses the anterior surface of the left coronary artery and the posterior surface of the right coronary artery.
22. The most posterior aspect of the heart is the right atrium.
23. The most inferior margin of the paricardium is applied the the central tendon of the diaphragm.
24. A dilated aortic arch may lead to hoarseness.
25. A catheter passed from the femoral vein to the pulmonary artery must pass through the bicuspid (mitral) valve.
26. The brachiocephalic veins are anterior to the aortic arch branches.
27. The right brachiocephalic artery is longer than the left brachiocephalic artery.
28. The arch of the azygos vein is celebrated for arching over the superior border of the left main bronchus.
29. The right pulmonary artery passes anterior to the right main bronchus.
30. The left pulmonary artery passes anterior to the left main bronchus.
31. The pulmonary artery is the most anterior of the heart vessels.

Lower Extremity Review

1. The popliteal artery descends inferior to the inferior border of the popliteal fossa.
2. The popliteal artery terminates into the posterior tibial and peroneal arteries
3. The anterior tibial artery is a branch of the peroneal artery.

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Questions for the Lower Limb Clinical Correlate - Eric Greensmith, PhD MD

These questions were not submitted by the lecturer.

True/False

1. The lateral calcaneal nerve branches from the saphenous nerve near the lateral malleolus.
2. The common peroneal nerve crosses the medial part of the leg immediately superior the the head of the fibula.
3. Immediately anterior to the distal attachment of the anterior cruciate ligament is the transverse genicular ligament.
4. The skin overlying the posterior border of the popliteal fossa (a redundancy) receives innervation from the lateral femoral cutaneous nerve.
5. Osteotomes refer to the distribution of peripheral nerves to the bone.
6. Does it make sense to refer to the dermatomal distribution of a non-segmental peripheral nerve?
7. The inferior lateral genicular artery crosses the lateral side of the tendon of origin of the popliteus muscle.
8. The lateral femoral cutaneous nerve enters the anterior thigh by passing deep to the inguinal ligament.
9. The midline of the inguinal ligament is located anterior to the femoral artery.
10. The saphenous nerve is generally the first branch (most proximal) of the femoral nerve.
11. The sartorius muscle flexes and laterally rotates the knee.
12. The sartorius muscle (Tailor's muscle) flexes, laterally rotates, and abducts at the hip.
13. It is the tibial part of the sciatic nerve that sometimes passes through the piriformis.
14. The inferior gluteal nerve has a motor branch that extends superior to the level of piriformis.
15. A posterior branch of the superior gluteal artery is NOT accompanied by a branch of the superior gluteal nerve.
16. The inferior clunial nerves branch from the tibial portion of the sciatic nerve
17. The pudendal nerve, within the gluteal region, is located medial to the sciatic nerve.
18. Electrical stimulation of the sciatic nerve that causes knee flexion without hip extension indicates stimulation of the peroneal part but not the tibial part.
19. The obturator nerve enters the medial thigh by way of the obturator foramen.
20. The obturator nerve divides into anterior and posterior divisions within the obturator externus muscle, but distal to the obturator canal.

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Questions for the Clinical Correlate: Lower Extremity - E. R. Bollard, MD, DDS, FACP

These questions were not submitted by the lecturer.

True/False

August 18, 2010

1. A crushing injury to the sustentaculum tali damage the tendon of flexor hallucis longus, spring ligament, deltoid ligament, tibial nerve, lateral plantar nerve, medial plantar nerve, posterior tibial artery, lateral plantar artery, and the medial plantar artery.
2. The anterior cruciate ligament resists anterior displacement of the femur on the tibia.
3. An area of burning numbness that defines the distribution of the lateral femoral cutaneous nerve is expected to cross dermatomes.
4. The lateral femoral cutaneous nerve crosses the anterior surface of the sartorius muscle immediately inferior to the anterior superior iliac spine.
5. Nerve entrapment is expected to cause cross dermatomal numbness.
6. Radiating pain caused by herniated disc is expected to be dermatomal.
7. Varicella (shingles) is expected to be dermatomal.
8. The horizontal and vertical group of superficial inguinal lymph nodes receive lymphatic vessels following with the external pudendal, superficial circumflex iliac, superficial epigastric, and great saphenous veins.

August 2009

1. The anterior drawer sign assesses the integrity of the posterior cruciate ligament.
2. The anterior cruciate ligament limits anterior displacement of the tibia..
3. The anterior cruciate ligament limits anterior displacement of the femur
4. Valgus stress mimics abduction of the leg.
5. Varus stress mimics adduction of the leg.
6. Forced abduction of the leg may lead to injury of the medial collateral ligament, anterior cruciate ligament, and the medial meniscus.
7. A patient draws an oval area of paraesthesia along the lateral aspect of the thigh. This is apt to be a spinal nerve injury because multiple dermatomes are crossed.
8. Shingles has dermatomal cutaneous representation. Thus, the virus migrates along a spinal nerve distribution, not a peipheral nerve distribution.
9. The superficial inguinal lymph nodes drain into lymph channels that pass through the femoral canal.
10. Lymph channels that travel with the short saphenous vein drain into the popliteal lymph nodes.
11. A superficial infection of the lateral dorsal foot may lead to a weak posterior tibial pulse as well as a weakened dorsalis pedis pulse.
12. The hip is "easier" to become dislocated when in a seated position (auto accident).

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Questions for the Clinical Correlate on Cardiothoracic Surgery, Sanjay M. Mehta, MD

These questions were not submitted by the lecturer.

True/False

1. An aneurysm of the aortic arch may lead to hoarseness.
2. Retrograde blood flow in the coronary sinus is used to perfuse the heart. Thus, the great, middle, and small coronary veins are valveless.
3. Redirecting the internal thoracic arteries for coronary bypass leads to retrograde blood flow in the anterior intercostal arteries.
4. The anterior and posterior papillary muscles of the mitral valve pull the leaflets closed. - FALSE
5. The tertiary bronchus begins at the carina.
6. A lesion of the gray ramus for the 10th spinal nerve is expected to reduce sweating along the corresponding dermatome including the paraumbilical region.

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1. Discuss the superior mediastinum. Include speculation of symptoms that may be observed due to compression of the superior mediastinum by an aneurysm of the aortic arch.

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Questions for the Applied Anatomy of Posture and Gait, Jeff C. Conforti, DPT

These questions were not submitted by the lecturer.

True/False

1. The line of gravity, when standing passes anterior to the hip joint, posterior to the knee joint, and anterior to the ankle joint.
2. The hamstrings decelerate the ending of the swing phase.
3. The gastrocnemius have a role in flexing the knee during the gate cycle.
4. Anterior compartment syndrome of the leg weakens planter flexion.
5. Compression of the common peroneal nerve at the fibular neck is expected to cause foot drop.
6. Mobility comes at the expense of mobility.

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Questions for the Clinical Correlate: Lower Extremity, Spence Reid, MD

These questions were not submitted by the lecturer.

True/False

August 25th, 2010

1. Pain resulting from perturbation of the hip proper is felt in the groin whereas trochanteric bursitis is felt over the lateral aspect of the hip.
2. Injury to the superior gluteal nerve can be assessed by testing the integrity of a cutaneous distribution.
3. While standing on one foot the center of gravity passes through the planted foot.
4. While standing on one foot the lower extremity is adducted to correct the center of gravity.
5. Decreasing the normal distance between the origin and insertion of a muscle (shorten) decreases the power of contraction.

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Questions for the Clinical Correlate: Thorax - E. R. Bollard, MD, DDS, FACP

These questions were not submitted by the lecturer.

True/False

1. A forced abduction of the leg (adduction of the thigh) stresses the medial collateral ligament.
2. The inferior anastomotic ring of the genicular anastomosis crosses deep to the patella ligament part of the quadraceps tendon.
3. Venous drainage from the lung tissue proper is largely by way of the pulmonary veins.
4. The bronchial arteries are not accompanied by bronchial veins.
5. The majority of the heart is perfused by the left coronary artery.
6. Ischemia of the sinuatrial node may lead to decreased heart rate.
7. Perfusion of the coronary arteries during diastole relies on elastic recoil of the arterial system.
8. Cardiac tamponade results when a space occupying event occurs within the pericardial cavity.
9. The sternochondral joint is a synovial joint and the costochondral joint is a syndesmosis joint.

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-- LorenEvey - 12 Aug 2009

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