A.infraspinatusB.subscapularisc.supraspinatusD.teres majorE.teres minor59. Several deficits in muscle function of the right upper limb were noted, including inability toabduct the arm. This was caused by denervation of which muscle?A.deltoidB.infraspinatusC.latissimus dorsiD.teres minorE.trapezius60. Later, while undergoing physical therapy because of his shoulder injury, he comments that it isvery painful when hisforearm is broughtacross his chest (medial or internal rotationofthe humerus).You deduce that the pain is due to stretching of the lateral (external) rotators of the shoulder. Whichmusclewasmostlikelythesourceofhispain?A.infraspinatusB.latissimus dorsiC.rhomboideusmajorD.supraspinatusE.teres major61.An elderly patient complains of shoulder pain and has difficulty abducting his arm. Arthroscopyis done in which a dye is injected into the shoulder joint and an X-ray taken.The radiologist notesthat the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would needtoberupturedforthistooccur?A.deltoidB.infraspinatusC.latissimus dorsiD.supraspinatusE.teres minorF.latissimus dorsi62.Which movement wouldfail in caseof paralysisof thequadricepsfemoris muscle?A.Adduction at the hipB.ExtensionatthehipC.Extension at thekneeD.Flexion at the kneeE.Medial rotation at the knee63. Following a penetrating injury to the left femoral triangle, a patient related that walking wasvirtually impossible because at every step the left knee collapsed into flexion.This history suggestsparalysis of which muscle?A.Adductor magnus.B.Biceps femoris.C.Gluteus maximus.D.Quadricepsfemoris.E.Sartorius.64.An obturator hernia that compresses the obturator nerve intheobturator canal mayaffect thefunctionofallofthefollowingmusclesEXCEPTA.Adductor brevisB.Adductor longusC.GracilisD.Obturator externus11
11 A. infraspinatus B. subscapularis C. supraspinatus D. teres major E. teres minor 59. Several deficits in muscle function of the right upper limb were noted, including inability to abduct the arm. This was caused by denervation of which muscle? A. deltoid B. infraspinatus C. latissimus dorsi D. teres minor E. trapezius 60. Later, while undergoing physical therapy because of his shoulder injury, he comments that it is very painful when his forearm is brought across his chest (medial or internal rotation of the humerus). You deduce that the pain is due to stretching of the lateral (external) rotators of the shoulder. Which muscle was most likely the source of his pain? A. infraspinatus B. latissimus dorsi C. rhomboideus major D. supraspinatus E. teres major 61. An elderly patient complains of shoulder pain and has difficulty abducting his arm. Arthroscopy is done in which a dye is injected into the shoulder joint and an X-ray taken. The radiologist notes that the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would need to be ruptured for this to occur? A. deltoid B. infraspinatus C. latissimus dorsi D. supraspinatus E. teres minor F. latissimus dorsi 62. Which movement would fail in case of paralysis of the quadriceps femoris muscle? A. Adduction at the hip B. Extension at the hip C. Extension at the knee D. Flexion at the knee E. Medial rotation at the knee 63. Following a penetrating injury to the left femoral triangle, a patient related that walking was virtually impossible because at every step the left knee collapsed into flexion. This history suggests paralysis of which muscle? A. Adductor magnus. B. Biceps femoris. C. Gluteus maximus. D. Quadriceps femoris. E. Sartorius. 64. An obturator hernia that compresses the obturator nerve in the obturator canal may affect the function of all of the following muscles EXCEPT: A. Adductor brevis B. Adductor longus C. Gracilis D. Obturator externus
E.Pectineus65. What muscle passes through the lesser sciatic foramen?A.Gluteus minimusB.Obturator internusc.PiriformisD.Quadratus femorisE.Superior gemellus66. When, in approximately 12%, the common fibular nerve passes through the piriformis muscle,the nervemay be compressed.This would affect part of which muscle?A.AdductormagnusB.Biceps femorisc.Gluteus maximusD.SemimembranosisE.Semitendinosis67.Apatient with painful swelling in the distal calf cannot plantar flex at the ankle with any power.Which tendonwas likely ruptured?A.CalcanealB.Extensordigitorum longusc.Extensor hallucis longusD.PlantarisE.Tibialis anteriorIL.Definition1. sternal angle:2. thoracic outlet3.palmaraponeurosis4. carpal tunnel5.tibial collateral ligament:III. Short question.1 .List and describe the various types of moveable joints and give examples of each type.2.Listthe characteristics of and identify the parts of a typical synovial joint.3.Describe the structure of the joints of thelower limb and thefunctional capabilities andlimitations of eachbased on theirbony structure and ligaments.AnswerI. Single choice:9C3D4 B1A2A5 B6 C7B8 B10B15E16 D19 D20E11E12 B13 C14 B17D18C21 D22 A23 A29 A30 B24 A25A26 C27D28D31E32D33D34D35A36E37B38A39C40A49C41 A42A43E44C45 B46 D47E48D50C51E52 A53 D54 B55 A56 D57A58D59 A60 A61 D62C63 D64 E65 B66 B67AII. Definition:1. sternal angle: aprotrusion on the anterior thoracic wall at the junction of the manubrium andbodyof the sternum (manubriosternal symphysis).Sternal angle is thelocation of the attachmentofthe costal cartilage ofthe 2nd rib to the sternum; an imaginary horizontal plane through the sternalanglepasses through the T4/T5 intervertebral disc and marks the inferior boundary ofthe superiormediastinum12
12 E. Pectineus 65. What muscle passes through the lesser sciatic foramen? A. Gluteus minimus B. Obturator internus C. Piriformis D. Quadratus femoris E. Superior gemellus 66. When, in approximately 12%, the common fibular nerve passes through the piriformis muscle, the nerve may be compressed. This would affect part of which muscle? A. Adductor magnus B. Biceps femoris C. Gluteus maximus D. Semimembranosis E. Semitendinosis 67. A patient with painful swelling in the distal calf cannot plantar flex at the ankle with any power. Which tendon was likely ruptured? A. Calcaneal B. Extensor digitorum longus C. Extensor hallucis longus D. Plantaris E. Tibialis anterior II. Definition 1. sternal angle： 2. thoracic outlet 3. palmar aponeurosis 4. carpal tunnel 5. tibial collateral ligament： III. Short question. １．List and describe the various types of moveable joints and give examples of each type. ２．List the characteristics of and identify the parts of a typical synovial joint. ３．Describe the structure of the joints of the lower limb and the functional capabilities and limitations of each based on their bony structure and ligaments. Answer I. Single choice： 1 A 2 A 3 D 4 B 5 B 6 C 7 B 8 B 9C 10B 11 E 12 B 13 C 14 B 15 E 16 D 17 D 18 C 19 D 20 E 21 D 22 A 23 A 24 A 25 A 26 C 27 D 28 D 29 A 30 B 31 E 32 D 33 D 34 D 35 A 36 E 37 B 38 A 39 C 40 A 41 A 42 A 43 E 44 C 45 B 46 D 47 E 48 D 49 C 50 C 51 E 52 A 53 D 54 B 55 A 56 D 57 A 58 D 59 A 60 A 61 D 62 C 63 D 64 E 65 B 66 B 67 A II. Definition： 1. sternal angle：a protrusion on the anterior thoracic wall at the junction of the manubrium and body of the sternum (manubriosternal symphysis)．Sternal angle is the location of the attachment of the costal cartilage of the 2nd rib to the sternum; an imaginary horizontal plane through the sternal angle passes through the T4/T5 intervertebral disc and marks the inferior boundary of the superior mediastinum
2.thoracic outlet:theopeningattheinferiorend oftheribcagethroughwhichthoracic structuresexit the thorax, it is bounded by the T12 vertebral body, both 12th ribs, the costal cartilages of ribs7-12, and the xiphisternal joint thoracic outlet is closed by the respiratory diaphragm which isattached at its boundary, also known as: inferior thoracic aperture3.palmar aponeurosis : a thick aponeurotic layer overlying the central compartment of the palmthepalmarislongus inserts intoit4.carpal tunnel :formed bythe carpal bones and the flexor retinaculum,transmits theflexorpollicis longus, flexor digitorum superficialis & profundus, and the median n.5.tibial collateral ligament:capsular ligament of theknee joint connecting medial epicondyle offemur with medial surface of medial tibial condyle; its attachment to the medial meniscus isclinically relevantIl. Short questions:1. List and describe the various types of moveable joints and give examples of each type.Thethreemajortypes of joints,alongwith subtypesand examples, arelisted here:Fibrous joints:the simplest joints.They are only connected byfibrousligaments.a suture is a fibrousjoint that eventuallyfuses, forming one bone from two (a synostosis), likein the skull ofa growinginfant.a gomphosis is the joint between a tooth and the jaw.A syndesmosis is afibrous membraneor ligamentthat jointstwobones.Thetibiaandfibula have an interosseous ligaments ormembrane,as do the radius and ulna.Cartilaginous joints: joined by cartilage only.These joints are avascular or anervous, except at theirmargins.Synchondroses are temporary joints present in growing bones.The epiphyseal plate(growthplate)will later ossify into solid bone.Theepiphysis has hyaline cartilage and the extensionofossification from the diaphysis side converts it tobone.a symphysis is a permanent cartilaginousunion.They always have hyaline cartilage on the bony surfaces concerned, and these cartilaginoussurfaces are joinedbyfibrous tissue orfibrocartilage.Synovial joints: "diarthroses" (freely moveable joints). These joints are joined by a fluid-filledcapsule and accessory ligaments. Examples include the knee, ankle, and hip.2. List the characteristics of and identify the parts of a typical synovial joint.Synovial joints consist of:Hyaline cartilage: covers the full weight-bearing surface, providing a smooth yet resilient surfaceJoint capsule:a cavitymade ofaccessory ligaments,with synovial fluid inside.This reinforcesthesynovial membrane.Synovial membrane lining: secretes synovial fluid and covers the synovial cavity.It reaches to theedges ofthehyalinecartilage.Accessory structures: accessory ligaments ("intracapsular" and"extracapsular"), articular discs ormenisci, which are pads offibrous cartilage, muscles and tendons, and subsynovial fat.3.Describe the structure of the joints of the lower limb and the functional capabilities andlimitations ofeachbased ontheirbonystructure and ligamentsThe knee joint is basically a hinge type of joint, allowing flexion and extension. The hingemovements arecombinedwithsomeglidingandrollingand with somerotationaboutavertical axis.This allows freemotion in one primaryplanecombined withdecent stability.Thefibrous capsule isdeficient ina fewareas to allowtendons topass throughtothe outside.The synovial membranelinesthefibrouscapsuleandattachestotheperipheryofthepatellaandtheedgesofthemenisci(Latin, patella = shallow dish, Greek, meniskos = moon, crescent). It reflects onto the cruciateligamentsandalso reflectsbetweenthetibiaandfibulacoveringtheinfrapatellarfatpad.Thistechnicallyseparatesthefat padand thecruciate ligamentsfromthejoint cavity.Theknee joint isrelatively weak and depends on several things to strengthen it. First, its area of weight distributionis two or three times larger than either the tibia or the femur, which reduces the overall pressure.Furthermore,a strongfibrous capsule,the medial patellar and lateral patellarretinacula, patellartendon, iliotibial tract (lateral side), and longitudinal fibers offascia lata (medial side) all serve tostrengthen the joint.Finally,two groups of important ligaments help add stability13
13 2. thoracic outlet ：the opening at the inferior end of the rib cage through which thoracic structures exit the thorax; it is bounded by the T12 vertebral body, both 12th ribs, the costal cartilages of ribs 7-12, and the xiphisternal joint thoracic outlet is closed by the respiratory diaphragm which is attached at its boundary; also known as: inferior thoracic aperture 3. palmar aponeurosis ：a thick aponeurotic layer overlying the central compartment of the palm the palmaris longus inserts into it 4. carpal tunnel ：formed by the carpal bones and the flexor retinaculum ，transmits the flexor pollicis longus, flexor digitorum superficialis & profundus, and the median n. 5.tibial collateral ligament：capsular ligament of the knee joint connecting medial epicondyle of femur with medial surface of medial tibial condyle; its attachment to the medial meniscus is clinically relevant III. Short questions: 1. List and describe the various types of moveable joints and give examples of each type. The three major types of joints, along with subtypes and examples, are listed here: Fibrousjoints: the simplest joints. They are only connected by fibrous ligaments. a suture is a fibrous joint that eventually fuses, forming one bone from two (a synostosis), like in the skull of a growing infant. a gomphosis is the joint between a tooth and the jaw. A syndesmosis is a fibrous membrane or ligament that joints two bones. The tibia and fibula have an interosseous ligaments or membrane, as do the radius and ulna. Cartilaginous joints: joined by cartilage only. These joints are avascular or anervous, except at their margins. Synchondroses are temporary joints present in growing bones. The epiphyseal plate (growth plate) will later ossify into solid bone. The epiphysis has hyaline cartilage and the extension of ossification from the diaphysis side converts it to bone. a symphysis is a permanent cartilaginous union. They always have hyaline cartilage on the bony surfaces concerned, and these cartilaginous surfaces are joined by fibrous tissue or fibrocartilage. Synovial joints: "diarthroses" (freely moveable joints). These joints are joined by a fluid-filled capsule and accessory ligaments. Examplesinclude the knee, ankle, and hip. 2. List the characteristics of and identify the parts of a typical synovial joint. Synovial joints consist of: Hyaline cartilage: covers the full weight-bearing surface, providing a smooth yet resilient surface Joint capsule: a cavity made of accessory ligaments, with synovial fluid inside. This reinforces the synovial membrane. Synovial membrane lining: secretes synovial fluid and covers the synovial cavity. It reaches to the edges of the hyaline cartilage. Accessory structures: accessory ligaments ("intracapsular" and "extracapsular"); articular discs or menisci, which are pads of fibrous cartilage; muscles and tendons; and subsynovial fat. 3. Describe the structure of the joints of the lower limb and the functional capabilities and limitations of each based on their bony structure and ligaments The knee joint is basically a hinge type of joint, allowing flexion and extension. The hinge movements are combined with some gliding and rolling and with some rotation about a vertical axis. This allows free motion in one primary plane combined with decent stability. The fibrous capsule is deficient in a few areas to allow tendons to pass through to the outside. The synovial membrane lines the fibrous capsule and attaches to the periphery of the patella and the edges of the menisci. (Latin, patella = shallow dish, Greek, meniskos = moon, crescent). It reflects onto the cruciate ligaments and also reflects between the tibia and fibula, covering the infrapatellar fat pad. This technically separates the fat pad and the cruciate ligaments from the joint cavity. The knee joint is relatively weak and depends on several things to strengthen it. First, its area of weight distribution is two or three times larger than either the tibia or the femur, which reduces the overall pressure. Furthermore, a strong fibrous capsule, the medial patellar and lateral patellar retinacula, patellar tendon, iliotibial tract (lateral side), and longitudinal fibers of fascia lata (medial side) all serve to strengthen the joint. Finally, two groups of important ligaments help add stability:
Collateral ligaments:capsular and extracapsular.They become taut in extension and preventhyperextension, also prevent abduction and adduction.The medial collateral ligament, at itsmidpoint, firmly attaches to the medial meniscus. It is the weaker of the two, so injuries are morecommonhere and,moreover,will usually involvethe medial meniscus.The lateral collateralligament is separated from the lateral meniscus by the tendon of the popliteus. Other extracapsularligaments that strengthen the knee are the patellar ligament, the oblique popliteal ligament and thearcuatepopliteal ligament.Cruciate ligaments: intracapsular. The anterior cruciate ligament (acl) is weaker than the posteriorcruciateligament (pcl).Theybothpreventmovement of thetibiaforward orbackward underthefemoral condyles.They become taut in all positions of flexion but mostly with full extension andfullflexion.(cruciate=cross-shaped)。14
14 Collateral ligaments: capsular and extracapsular. They become taut in extension and prevent hyperextension, also prevent abduction and adduction. The medial collateral ligament, at its midpoint, firmly attaches to the medial meniscus. It is the weaker of the two, so injuries are more common here and, moreover, will usually involve the medial meniscus. The lateral collateral ligament is separated from the lateral meniscus by the tendon of the popliteus. Other extracapsular ligaments that strengthen the knee are the patellar ligament, the oblique popliteal ligament and the arcuate popliteal ligament. Cruciate ligaments: intracapsular. The anterior cruciate ligament (acl) is weaker than the posterior cruciate ligament (pcl). They both prevent movement of the tibia forward or backward under the femoral condyles. They become taut in all positions of flexion but mostly with full extension and full flexion. (cruciate = cross-shaped)
Chapter2DigestivesystemI Single choice1. The terminal (end) portion of the small intestine is the:A.ileumB.cecumC.duodenumD.jejunumE.ascending colon2.The bulk of a tooth is composed ofA.dentineB.enamelC.cementD.dental pulpE.alveolar bone3.Which of the following is not considered part of the digestive system?A.pancreasB.spleenC.tongueD.cecumE.vermiform appendix4.Thepalatinetonsil isplaced at the lateral wall of theA.nasopharynxB.oropharynxc.laryngopharynxD.oral cavityE.laryngeal cavity5.Pyloric stenosis will interferemost directly withthe passage of materialsfrom theA.esophagus into the stomachB.pharynxintotheesophagusC.ileum into the cecumD.stomach into the duodenumE.duodenumintothececum6. Which of thefollowing statements concerning the stomach is false?A.it is the most dilated part of the digestive tubeB.lies inthe left hypochondriac and epigastric regions of the abdomenC.the cardiac orificecommunicates with theesophagusD.thepyloric orificecommunicates with theduodenumE.consists ofthefundus and body of thestomach7. Mesentery, lesser omentum, and greater omentum are all directly associated with the:A.Peritoneum.B.liverC.esophagusD.mucosa of the alimentary canaE.commonbileduct8.If an incision had to be made in the small intestine to remove an obstruction, which layer of tissuewould be cut first?A.muscularisB.mucosac.serosaD.submucosa15
15 Chapter 2 Digestive system I. Single choice 1. The terminal (end) portion of the small intestine is the: A. ileum B. cecum C. duodenum D. jejunum E. ascending colon 2. The bulk of a tooth is composed of A. dentine B. enamel C. cement D. dental pulp E. alveolar bone 3. Which of the following is not considered part of the digestive system? A. pancreas B. spleen C. tongue D. cecum E. vermiform appendix 4. The palatine tonsil is placed at the lateral wall of the A. nasopharynx B. oropharynx C. laryngopharynx D. oral cavity E. laryngeal cavity 5. Pyloric stenosis will interfere most directly with the passage of materials from the A. esophagus into the stomach B. pharynx into the esophagus C. ileum into the cecum D. stomach into the duodenum E. duodenum into the cecum 6. Which of the following statements concerning the stomach is false? A. it is the most dilated part of the digestive tube B. lies in the left hypochondriac and epigastric regions of the abdomen C. the cardiac orifice communicates with the esophagus D. the pyloric orifice communicates with the duodenum E. consists of the fundus and body of the stomach 7. Mesentery, lesser omentum, and greater omentum are all directly associated with the: A. Peritoneum. B. liver C. esophagus D. mucosa of the alimentary cana E. common bile duct 8. If an incision had to be made in the small intestine to remove an obstruction, which layer of tissue would be cut first? A. muscularis B. mucosa C. serosa D. submucosa