Gray’s Anatomy Review, 3rd Edition [3 ed.] 9780323639163, 9780323639293, 0323639291

Table of contents :
Cover
IFC
Title Page
Gray’s Anatomy Review
Copyright
Dedication
Preface
Acknowledgments
Contents
1 BACK
2 THORAX
3 ABDOMEN
4 PELVIS AND PERINEUM
5 LOWER LIMB
6 UPPER LIMB
7 HEAD AND NECK
8 NEUROANATOMY
9 EMBRYOLOGY
10 QUESTION OBJECTIVES
CREDITS
INDEX
IBC

Citation preview

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2020_ME

Gray ’s

Anatomy

Review

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Gray ’s

Anatomy

THIRD

Review

EDITION

Peter H. Abrahams, MBBS, FRCS(ED),

FRCR, DO(Hon), FHEA, FRSA

Marios Loukas, MD, PhD Peter

Proessor,

Dean

St.

o

Department

Basic

George’s

Grenada,

o

Sciences;

University

West

Anatomica

Dean

o

Scoo

o

Sciences

Abraams

FHEA

Researc

Pro.

Medicine

MBBS

FRCS(ED)

FRCR

DO(Hon)

FRSA

“Emeritus”

o

Cinica

Anatomy,

Warwick

Medica

Scoo,

Indies

Nationa

T eacing

eow

&

Lie

Feow,

Girton

Coege,

Cambridge

R. Shane Tubbs, MS, PA-C, PhD Visiting

Pro.

Consutant

LKC

Brune

Scoo

o

Médica

Medicine

NTU

Singapore

Scoo

Proessor

Departments

and

Ceuar

T uane

Neurosurgery,

University

Louisiana,

United

Department

ence

o

Neuroogy

and

Structura

Stephen W. Carmichael, PhD, DSc

Bioogy

o

Institute,

Scoo

o

Medicine,

New

Oreans,

States

Mayo

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System,

Neurosci-

New

Emeritus

o

Anatomy

Rocester,

Minnesota,

United

Oreans,

Thomas Gest, PhD Louisiana,

United

Department

o

States

Anatomica

Sciences Proessor

St.

George’s

Grenada,

o

University

o

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Medicine

additional

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Indies o

Houston,

For

Anatomy

University

West

online

content

visit

T exas,

United

States

StudentConsult.com

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New

York

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Piadepia

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Love

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Dad,

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Carmicael,

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T o

my

family,

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my

students,

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a

knowledge

inspiration

Preface

Rote memorization o anatomic acts as been te cardina ea-

ture

or

o

exaustive,

many

oter

and

generations

aied

eat

exausting

o

students

science

courses

in

in

uman

medicine,

programs.

Oten,

dentistry ,

itte

6.

anatomy

Finay,

te

and

distinction

te

earning

te

in

was

in

to

Gray ’s

te

practica,

Anatomy

cinica

Review

was

appication

designed

or

o

te

use

inorma-

by

students

wo wis to test teir knowedge o cinica anatomy . he ques-

tions,

serve

1.

answers,

mutipe

his

by

various

T o

expanations

purposes

review

study

2.

and

provides

students

programs

avoid

are

students

a

in

o

pointess

questions

or

in

tis

in

various

are

preparation

gross

anatomy

witin

or

source

te

te

tat

a

he

mutipe-coice,

questions

aration

nation

4.

he

is

or

designed

te

expanations

uman

5.

o

o

simiar

te

student

Medica

review

te

prep-

Exami-

examinations.

empasize

norma

o

in

Licensing

quaiying

answers

understanding

understanding

examination

vi

and

aciitate

States

ormat

and

te

critica

dysunctiona

migt

o

be

urter

aternative,

tempted

to

enanced

incorrect

coose.

by

answers

critica

tat

stu-

majority

correated

con-

o

te

o

te

questions

wit

te

oowing

 Netter



•

 Abraams ’

A.

Wayne

Eac

ter’s

(N)

For

ca

of

and

ed

and

is

and

8,

by

Peter

Loukas,

reerenced

Abraams’

wit

W .

and

We

H.

to

7,

pages

we

by

Frank

Atlas

Abraams,

Abert

in

McMinn’s

Are

Mitce

ed

Clinical

and

capter

Before

M.

Anatomy,

McMinn ’s

embryoogy

vignettes

Adam

Human

Marios

answer

te

V og,

Atlas

Anatomy,

ave

Born:

N.

of

Jonatan

Van

Gray’s

Netter

Human

D.

Scoor

(GAS),

Net-

(ABR/McM).

correated

Essentials

of

te

cini-

Embryol-

og y and Birt Defects, ed 9, by Keit L Moore, TVN Persaud,

and

Mark

We

coor

G.

ave

T orcia.

incorporated

iustrations,

acceerate

ing

is

are

important

•

Spratt,

anatomy.

Student

dents

to

United

(USMLE)

importance

singe-best-answer

book

he

o

irrespective

o

te



in

te

coice.

medicine,

assisting

 Gray ’s Anatomy for Students, ed 4, by Ricard L. Drake,

student toward practica appications o te textua materia.

3.

review

o

distiation

anatomy,

understanding

practice

career

succinct

•

te

guide

and

a

cinica



gobe.

student,

vignettes

in

textbooks:

to

or

examinations

around

by

cinica

intended

programs.

tougt-provoking

memorization

ramed

book

tis

provides

acts

cepts

student’s

given

o

student’s

was made between te weat and te ca, and itte attention

tion.

review

petora

o

te

bot

earning

te

sources

materia

are

of

on

rom

Human

or

adapted

many

radioogica

images

process

to

anatomy

primary

Atlas

and

and

wic

and

te

we

Abraams ’and

Anatomy.”

an

enance

cinica

ave

drawings,

in

McMinn ’s

or

ed

to

understand-

appications.

drawn

u-

attempt

he

iustrative

8,

“Clinical

Acknowledgments

A

cinica

but

aso

eagues

and

ave

te

o

ave

very

and

enormousy

ter

wt

rends

board

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not

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wt

ep.

or

o

te

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hs

te

autors

and

co-

knowedge

book

woud

contrbutons

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beow.

medca

at

ony

cnca

and

not

sted

o

Socety

o

o

eac

T anya

Mark

at

te

members

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Unversty,

ts

project

capter

o

as

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troug

part

o

book.

te

Cabrto,

Cares,

Vncent

Se

Lake,

Asad

Manda,

Board

(for

Ra,

Messa

the

First

and

Second

Noe,

Rzv,

Sonja

MD

MD

Roberts,

Saandy,

Twadayo

MD

MD

Roberts,

Wasa

Advisor y

MD

MD

Annesa

Rabjot

MD

MD

Lee,

Gaurav

MD

MD

Courant,

Ed,

Sang

MD

Carrasco,

Stacey

Sasa

students,

George’s

competon

crtcsm

ts

and

Researc

te

and

work

generous

were

Scences

comments

advsory

so

group

Cnca

Anatomca

te

eedback

possbe

speca

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is

scentc

been

sgncant

been

coeagues

A

book

numerous

wo

gven

not

te

review

o

MD

MD.,

MBA

MD

Sam-Odusna,

MD

editions) Krsna

Nkos

Mea

Lann

Rana

Avarez

Cn

Monca

Guo

De

(Lower

Howard

Ipparamb

heoanns

Lee

Spro

Matur

Musoke

Georga

Sadek

Sanojan

Davd

Ryan

Uyan

Limb)

Danee

Limb)

Coey,

Du

Perineum)

Amed

Eward

Am,

part

o

very

te

ep-

advsory

(Head

and

Vd

Neck)

the Third

edition

MSc

MD,

Rames

MD

PD

Koas,

MD

MD

MD,

Obadna,

Persaud,

MD,

Petua

Rao,

MSc

MD

MBBS

PD

Pp,

Raeburn,

Rao,

MD

PD

Montabano,

Madonna

MD

MD

Marsa,

MD,

MD

MSc

MD

PD

MD Deepak

Cassandra

Anatomca

MD

Magoud,

Ouem

Neck)

Vs

Yusu

as

o

been

PD

Hargrove,

Jordan,

heoans

and

Pesss,

Hage,

Geobrna

Robert

(Back)

for

crtcsm

aso

MBBS

George,

Mcae

Board

and

ave

MD

Gbenmaco,

Kazzara

Advisor y

Department

MD

MD,

Forrester,

Robert

and

Perineum)

(Head

Patten

Burns,

Racae

(horax)

Van

Bubb,

Iketc

(Abdomen)

Brunt

te

Unversty

Antone-Frank,

Kateen

Deon

(Pelvis

and

rom

comments

Badoo,

James

(Head)

Van

ter

acuty

George’s

Emanue

Danny

(horax)

Tgue

Lndsey

Limb)

(Neck)

hyagangam

hornton

Randy

Limb)

(Head)

(Pelvis

St.

board:

Limb)

(Lower

at

Crysta

(Upper

MD

Limb)

(Upper

Neyubna

Pau

wt

Mara

(Lower

Anastasya

T ony

Koas

Mavromats

Lews

u

(Back)

Lu

Prateek

(Lower

Udoyen,

oowng

Scences

(Abdomen)

Ljo

Ova

he

(Abdomen)

(Upper

Roand

Jun

Limb)

Limb)

(Embryolog y)

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MD

Perineum)

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Hajjar

C.

and

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Dandapan

Pyumka

Rc

Casey

Ctters

Eddong

(Pelvis

Cakrabart

Ramya

Uta

(Neck)

Bargava

hakore,

Ang,

Sarma,

MD

MD Fematta

Sowa,

MD

vii

Acknowledgments

viii

Kristna

Aena

hompson,

Wade,

MD

Mr.

MD

Jon

trict

Dr. Antony D’Antoni, PD, Proessor, at Pysician Assistant

Mr.

Program,

trict

W agner

Coege,

One

Campus

Road,

Staten

Isand,

Craven,

Hospita,

Jon

ormery

Consutant

Surgeon,

York

Dis-

Consutant

Surgeon,

York

Dis-

York

Craven,

Hospita,

ormery

York

NY, as aways been a great riend and coeague. His continu-

ous

support,

tributed

comments,

enormousy

to

criticism,

te

and

entusiasm

competion

o

tis

ave

con-

project.

Proessor

ment

o

Scoo,

Dr.

Kitt

Vice

sity,

tise

Saer,

Cair

or

o

er

MD,

P.D.

Department

comments

contributed

o

and

toward

Proessor

Radioogy

criticism,

tis

o

at

and

Radioogy

Boston

Hobsey,

Studies,

ormery

he

Head

Middesex

te

Depart-

Hospita

o

Medica

London

and

Univer-

invauabe

Micae

Surgica

Mr.

Rap

Hutcings,

Mr.

Umraz

potograper

or

Imagingbody.com

exper-

project.

Kan,

Pastic

Surgeon,

Caring

Cross

Hospita,

London

We

are

vier,

he

especiay

or

er

autors

Benson

and

opmenta

troug

he

scopic,

woud

te

for

and

tank

ike

Riey,

and

a

preparation

kindly

to

te

o

Madeene

advice,

to

our

te

tis

and

tank

Hyde,

at

at

Ese-

encouragement.

Jeremy

Bowes

commissioning

team

Esevier

and

or

Kim

Jon

Unit,

Bartoomew’s

tas,

us

Dr.

o

individuals

various

Proessor

clinical,

and

St.

teir

operative,

insti-

endo-

University

J.

Spratt,

Radioogy

Dr.

Hospita,

Soutampton,

Proessor

Pau

and

Artritis

Researc

Gii

Mddesex

Bouos,

Coege

Norman

Hodder

trations

Surgeon,

London

edition,

Browse,

Arnod

rom

2005.

Vascuar

Ormond

Surgery

Street

Hospi-

Radioogist

Hospitas,

T aagt,

and

Cinica

Director

Sunderand

Radioogist,

he

Adeaide

and

Dubin

Institute

Medica

o

Emeritus

Pubisers,

Symptoms

and

or

Surgica

Scoo,

Signs

Proessor

permission

of

Surgical

Vads,

Optamoogst,

Hospta,

ormery

at

Centra

London

Campaign

Stud-

London

oogy,

o

to

Surgery,

use

ius-

Disease,

4t

Jame

Wer,

Grampan

Scotand,

Human

and

Director,

Great

London

T orreggiani,

Hospita,

Proessor

Proessor

and

Consutant

City

Wiiam

Meat

Miss

University

o

ormery

potograps:

Dr. Ray Armstrong, Reumatoogist, Soutampton Genera

ies,

Lumey,

deve-

guiding

book.

following

supplying

imaging

Ms.

insigts,

aso

Andrew

editors,

autors

tutions

tanku

invauabe

and

edtor

Anatomy,

Emertus

Unversty

ed

o

5,

Wer

Proessor

Hosptas

and

Esever.

o

Cnca

T rust,

Abraams

Rad-

Aberdeen,

Imaging

Atlas

of

Contents

Dedication,

Preface,

v

6

vi



3

4

BACK,

LIMB,

84

Questions, 286

Acknowledgments,



UPPER

vii

Answers, 312



7

HEAD

AND

NECK,

Questions, 3

Questions, 352

Answers, 20

Answers, 396

THORAX,

43

8

NEUROANATOMY ,

Questions, 43

Questions, 458

Answers, 69

Answers, 466

ABDOMEN,



9

EMBRYOLOGY ,

Questions, 110

Questions, 482

Answers, 143

Answers, 489

PELVIS

AND

PERINEUM,

95



35

QUESTION

458

48

OBJECTIVES

Questions, 195

Answers, 209 Index,

5

LOWER

LIMB,

55

36

Questions, 236

Answers, 257

ix

This

page

intentionally

left

blank

1 Back

I n t ro d u c t i o n

First

1.

Order

A

ment

30

anteror

man

mnutes

coson.

most

D.

Question

35-year-od

Pysca

musce.

key

anteror

to

s

admtted

ater

beng

be

o

njured

te

emergency

nvoved

examnaton

Wc

to

te

sows

n

a

oowng

aong

wt

a

motor

damaged

nerves

njury

to

be

atssmus

rotates

te

Second

toracc

3.

B.

Axary

ment

C.

Accessory

coson.

D.

Dorsa

anteror

E.

horacodorsa

scapuar

he

toracc

s

te

ony

nerve

tat

ner ve

nner vates

te

nnervates

detod

te

eevates

superor

ts

atera

ange

o

te

ange

or

te

dors

adducts,

extends,

and

meday

arm.

te

and

teres

Question

35-year-od

te

anteror.

axar y

A

Order

Long

ong

eevates

trapezus

serratus

musce?

serratus

B.

he

A.

he

scapuae

we

acromon.

E.

Explanation

A.

evator

scapua,

vece

serratus

woud

te

he

depart-

30

man

mnutes

Pysca

musce.

patent

most

s

admtted

ater

beng

examnaton

Wc

key

o

te

o

be

te

Retracton

B.

Eevaton

C.

Depresson

o

te

scapua

D.

Protracton

o

te

scapua

E.

Downward

rotaton

te

te

sows

emergency

n

a

a

to

depart-

motor

damaged

oowng

unabe

A.

o

to

nvoved

vece

serratus

unctons

w

perorm?

scapua

scapua

o

te

scapua

mnor.

C.

he

accessory

and

trapezus.

D.

he

dorsa

and

te

E.

he

nerve

nnervates

te

sternocedomastod

Explanation

Dferent

scapuar

ower

nerve

porton

toracodorsa

o

suppes

te

n e r ve

te

evator

rombod

musces

scapuae.

 nne r vates

te

ua

A.

2.

A

30

coson.

anteror

te

A.

man

mnutes

Pysca

musce.

s

anteror

scapua

Depresses

Protracton

D.

Eevaton

E.

Adducts,

o

to

te

emergency

nvoved

examnaton

serratus

C.

beng

Wc

Adducts

B.

admtted

ater

te

sows

n

a

a

damaged

oowng

depart-

motor

C.

vece

serratus

unctons

D.

serve?

E.

o

o

scapua

and

meday

rotates

arm

te

B.

he

C.

he

and

rombod

major

and

mnor

retract

scapua.

serratus

serratus

upward.

o

scapua

te

o

s

and

o

musces

and

scapua

o

te

evator

scap-

scapuae,

carred

out

by

te

rombods

te

out

many

by

te

tra-

musces.

s

perormed

o

musce

toracc

te

serratus

te

carred

prmary

by

te

trapezus.

anteror

on

s

scapuae

te

rotaton

rotaton

A

pus

scapua

s

te

scapua

orward

wa.

anteror

scapua

evator

Order

s

accompsed

togeter,

perormed

we

by

by

te

downward

te

rombod

scapuae.

anteror

neror

depresses

protracts

and

te

rotates

ower

te

rbs.

scapua

30

coson.

wa

posteror

Question

35-year-od

ment

trapezus

te

serratus

Upward

Second

Explanation

he

movement

trapezus,

scapua

extends,

4.

A.

te

mnor.

scapua

evator

bers

trapezus

rotaton

o

and

Depresson

he

te

to

anteror,

pectoras

o

(protracton)

rbs

and

and

Eevaton

ower

does

contrbute

serratus

trapezus.

pezus

Question

35-year-od

ment

te

Retracton

and

B.

Order

musces

as

rombods,

at ss  mus

dors.

First

suc

te

n

man

mnutes

Pysca

te

axary

oowng

A.

Levator

B.

Serratus

s

admtted

ater

beng

examnaton

regon

musces

s

to

te

nvoved

and

most

sows

wnged

key

emergency

n

a

motor

njury

to

scapua.

depart-

vece

te

cest

Wc

o

njured?

scapuae

anteror

1

2

C H A P T E R

C.

1

Back

T rapezus

D.

Rombod

E.

Serratus

major

and

posteror

mnor

superor

Explanation

A.

he

B.

he

evator

scapuae

serratus

(protracton)

pezus

to

opposed

and

keep

to

eevates

anteror

scapua.

pus

te

counterbaances

te

te

te

te

musce

costa

toracc

surace

wa,

o

scapua

pu

te

orward

o

te

scapua

preventng

tra-

cosey

wngng

o

te

scapua.

C.

Atropy

o

wngng,

but

posteror

D.

he

wngng,

he

A

te

major

musce

te

ead

traves

to

scapuar

troug

te

neck.

and

mnor

atropy

ter

may

accessory,

eevate

may

nerve,

ead

te

and

to

dorsa

retract

sgt

te

scapuar

scapuar,

traves

neck.

posteror

superor

eevates

te

2nd

troug

rbs.

Second

5.

but

te

o

ter

serratus

5t

nerve,

trange

and

troug

trapezus

ts

rombod

scapua

E.

te

Order

Question

35-year-od

ment

30

man

mnutes

s

admtted

ater

beng

to

te

emergency

nvoved

n

a

depart-

motor

vece •

coson.

wa

te

A.

n

Pysca

te

axary

oowng

Long

examnaton

regon

nerves

s

and

most

sows

njury

wnged

key

to

scapua.

te

Fig.

.

cest

Wc

o

njured?

Pysca

toracc

examnaton

sows

te

ndngs

n

Fg.

1.1.

Wc

o te oowng nerves s most key njured?

B.

Axary

A.

Long

C.

Accessory

B.

Axary

D.

Dorsa

C.

Accessory

E.

horacodorsa

scapuar

toracc

D.

Dorsa

E.

horacodorsa

scapuar

Explanation

A.

he

ong

ror

scapua.

he

axary

C.

arm

we

he

accessory

pezus

te

and

on

nerve

he

nnervates

protracts

wt

protrude

musces.

nerve

wc

Patents

scapuae

B.

toracc

musce,

njury

ter

teres

te

s

te

nerve

ke

a

sternocedomastod

w

and

lexes,

ateray

and

rotates

or

ante-

rotates

ave

te

Explanation

A.

ter

wng.

detod

responsbe

serratus

upwardy

ts

abducts,

mnor

nerve

to

back

suppes

detod

and

teres

te

and

t

tra-

traves

te

to

D.

te

opposte

zus

and

he

dorsa

neck

to

wc

ep

E.

eevates

and

upwardy

sternocedomastod

he

anteror

scapuar

suppy

are

to

sde.

serratus

te

traves

or

te

pus

o

prevents

rombod

scapuar

rotates

and

baance

nerve

responsbe

prevent

lexes

scapua

te

pu

troug

retracton

and

o

root

mnor

o

wc

adducts,

te

te

6.

Order

and

rotates,

and

extends

te

D.

he

and

Question

mnutes

ater

beng

n

a

motor

vece

coson.

E.

and

te

rotates

s

ner ve

s

rom

te

scapua

“wngng,”

scapua.

ter

scapua

detod

lexes,

te

Patents

protrud-

teres

extends

mnor

and

te

arm.

 or

s d e.

te

and

s cap u a

common y

e s on

te

tr a -

w e

te

at rop y

w ng ng,

te

he

pus

W e

s c a puar

s upp y ng

mus ce s .

rotate s

lexe s

m ore

and

and

re s p ons b  e

opp os  te

n

t

anteror

te

cn

o

te

o

te

c ause

o

scapua.

mnor

scapuar

musces

scapua.

n

te

u pw ard y

resut

serratus

ods

wng.

abducts,

ner ve

may

dorsa

te

ave

sternoc  e  d om as tod

eevates

to

rotates

w

suppes

ateray

toracc

resut

nvoved

a

te

scapua,

preventng

sternocedomas to d

ong

arm.

nerve

detod

and

te

wa

ke

nerve

accessor y

wnged

A 35-year-od man s admtted to te emergency department

30

mnor

nnervates

upwardy

ts

back

he

trape zus

o

Third

ter

upward

wngng.

meday

he

and

to

axary

pe zus

musces

scapua

on

he

trape zus

trape-

he toracodorsa nerve suppes te atssmus dors mus-

ce,

C.

wngng.

te

te

we

njury

nerve

protracts

toracc

abducts

teres

upward

between

scapuar

major

cn

te

to

musces.

troug te posteror cervca trange, not te axa. he

trapezus

cose

wt

B.

toracc

wc

ng

te

ong

musce,

and

te

arm.

suppyng

musces,

mnor

extends

he

sgt

nerve

and

Atropy

scapuar

suppes

are

o

te

rombod

responsbe

te

rombod

or

major

retracton

musces

may

wngng.

he toracodorsa nerve suppes te atssmus dors mus-

ce,

wc

adducts,

meday

rotates,

and

extends

te

arm.

CHAPTER

Fourth

7.

A

Order

Question

35-year-od

ment

ce

n

30

mnutes

coson.

Fg.

1.1.

patent

man

s

ater

beng

Pysca

Wc

most

admtted

key

te

te

emergency

nvoved

examnaton

o

be

to

to

a

sows

oowng

unabe

n

motor

te

w

durng

B.

Perormed

C.

Perormed

ve-

ndngs

unctons

perorm

depart-

major,

D.

te

pysca

examnaton?

In

A.

Latera

B.

Abducton

rotaton

C.

Fexon

D.

Extenson

E.

Abducton

o

o

te

o

o

te

arm

0

to

15

degrees

and

above

90

degrees

te

s

Explanation

A.

ror

bers

Main

te

A

coug,

sows

nto

toracc

a

teres

s

brougt

o

a

and

o

te

vertebra

“gbbus

condtons

s

sweats,

tubercuoss

te

ogc

man

because

ngt

ducng

detod

pectoras

musces.

bers,

atssmus

musces.

patent

resut

mnor,

and

ts

as

o

a

wnged

damage

musce

rotaton

90

o

done

are

te

degrees

(superor

normay

to

scapua.

te

hs

ong

usu-

toracc

by

protracton

genod

requres

rotaton

te

o

te

te

rotaton

genod

anteror

scapua

Eevatng

upward

te

serratus

o

ossa.

ossa)

and

o

tat

trapezus,

togeter.

poste-

5-day

key

te

rgt

ung,

bodes

to

o

A

o

o

severe

cest

wt

T6

Wc

be

emergency

story

emoptyss.

deormty.”

most

to

x-ray

extenson

and

te

conrmed

T7,

pro-

4.

A.

Hypertropy

o

supraspnous

B.

Hypertropy

o

nterspnous

C.

Hypertropy

o

gamentum

D.

Hypertropy

o

anteror

E.

Hypertropy

o

nuca

A

35-year-od

oowng

department

by

coson.

rado-

examnaton?

te

B.

Hyperkyposs

neck

C.

Scooss

scapua.

D.

Spna

njured

E.

Osteoartrts

bda

68-year-od

s e v e re

began

o

re c e n t

sensor y

te

tebra

L4

ver tebrae

L5.

te

a g o.

as

He

s t re n g t 

o

most

Dorsa

D.

Greater

E.

Suprascapuar

and

5.

and

ver-

sde

eve

ts

Spnous

B.

V ertebra

process

C.

T ransverse

D.

Superor

E.

Intervertebra

process

back

and

sgt

te

 owe r

 owe r

man

cana

te

 o   ow  n g

  m b.

An

stenoss

by

a

examnaton?

s

b ro u g  t

stor y

oss

mbs.

na

rmed

dsc

2 - we e k

batera

processes

n

o

P y s  c a 

o

te

condtons

o

o

te

umbar

s

te

ospta

pan

examnaton

sensaton

x-ray

magnetc

to

s e ve re

te

spne

s  ow s

most

key

ove r

sp-

Wc

to

magng

be

o

con-

(MRI)

In

wc

most

key

he

sympatetc

dorsa

root

C.

he

atera

orn

E.

A

he

posteror

o

er

as

et

mb

x-ray

o

s

o

te

most

o

te

rgt

key

4-day

are

te

ocazed

oowng

C7.

zoster

o

to

story

he

vra

te

emergency

panu

entrey

te

to

on

ras

one

dermatome

patent

was

necton

oowng

proerated

o

dag-

known

structures

cause

te

as

as

patent’s

trunk

gangon

o

ventra

o

C7

te

C7

spna

cutaneous

orn

ower

as

o

woman

experenced

and

te

spna

cord

branc

nerve

segment

o

te

dorsa

C7

45-year-od

se

border

nerves

brougt

a

nerve

erpes

he

he

An

surace

condton?

ramus

6.

spna

a

s

o

cosey

B.

D.

meda

oowng

tat

A.

te

s  ow s

skn

re g  o n .

re s o n a n c e

n

body,

te

vrus

man

because

s

wt

current

artcuar

4 5 - ye a r - o  d

o

te

bodes

sde.

dorsa

scapua

occpta

eruptons

“snges.”

A.

because

o

nosed

patent?

A

skn

o

te

te

vece

te

scapuar

64-year-od

ver -

o

te

sows

afected

to

emergency

motor

toracc

department

parts

n

A

te

njury

te

a

sde?

Long

to

 o   ow  n g

tat

C.

te

 r a c t u re d

on

to

n

examnaton

o

B.

x-ray

brougt

on

gament

gament

nvoved

racture

due

5/5

 r a c t u re s

te

key

o

a

Wc

pan

stor y

An

and

lavum

ongtudna

s

an

Axary

Pysca

o

mts.

osteopoross

Wc

no

actvtes.

c o m p re s s  o n

a re

te

sows

gament

gament

beng

ateray

neck

A.

ospta

says

norma

s e v e re

wt

o

to

patent

muscuar

wtn

s  ow s

tebrae

Te

s t re n u o u s

s  ow s

and

brougt

monts

or

ndngs

coumn,

te

4

trauma

spne

s

pan.

nsdousy

examnaton

o

man

back

man

ater

Pysca

retracted

Hyperordoss

to

3.

a

tan

scapua

A.

A

posteror

major

bers,

coracobracas

musce.

1–25

55-year-od

department

2.

nraspnatus,

detod

and

musce.

detod

Q u e st i o n s

Questions

1.

by

o

o

urter

workng

Perormed

te

te

as

superor

arm

arm

by

mage,

unctons

arm

te

anteror

brac

teres

occurs

supraspnatus

te

nerve, wc nnervates te serratus anteror musce. he

rom

arm

te

o

te

arm

bceps

and

ts

ay

te

by

Perormed

dors,

E.

by

3

Back

1

back.

te

C7

comes

spna

to

moderate

he

become

a

pan

te

pan

radates

nusance

cord

segment

pyscan

or

to

more

2

because

years

er

et

over

ower

recenty.

Se

says tat ater tng a case o sot drnks, te pan sud-

deny

became

ntense.

An

MRI

o

te

umbar

regon

4

C H A P T E R

sows

bra

s

7.

1

an

ntervertebra

eves

most

Back

L4

key

dsc

ernaton

Wc

afected

by

te

o

te

dsc

between

oowng

verte-

no

motor

nerves

on

te

ernaton?

s

ntact

on

sde

te

compresson

B.

L2

oramen

C.

L3

oowng

D.

L4

space-occupyng

E.

L5

A

3-year-od

tory

s

o

conrms

snus

A

te

and

te

s

o

anayss

o

Hs

wt

as

a

umbar

te

approprate

B.

Nuceus

C.

Posteror

D.

Anteror

s-

s

menngts

or

te

Hs

ongtudna

ater

puses

L1–L2

A.

horacodorsa

L2–L3

B.

Axary

D.

L4–L5

C.

Dorsa

E.

L5–S1

D.

Accessory

ever,

tory

etargy,

o

and

conrms

na

aboratory

te

o

s

te

he

neror

B.

he

gest

to

rgt

exter-

determne

er

te

was

s

studes

neck

wen

s

n

to

car

a

trauma

surace

o

te

oowng

te

pan

emergency

ater

was

to

was

te

a

13.

wp-

struck

cer vca

(Ldocane)

sow

te

spnes

brougt

paced

njecton

Anteror

ongtudna

B.

Lgamentum

C.

Nuca

D.

Posteror

E.

T ransverse

and

gament

cer vca

65-year-od

gament

s

most

not

bod-

key

te

department

toes.

ng

n

because

ower

mb

Pysca

on

tptoes

gament

gament

s

o

brougt

severe

motons,

examnaton

on

s

et

back

to

pan

especay

sows

eg.

te

emergency

and

pontng

weakness

Rgt

te

ower

n

mb

weak-

s

et

stand-

sows

by

by

te

umerus.

norma.

Wc

njured?

brus

se

to

o

a

er

ar

ad

a

s

most

pyscan

et

wt

to

reac

er

rgt

mastectomy

node

norma

te

nabty

dssecton

examnaton

14.

man

ater

te

te

sows

pro-

o

er

wngng

scapua.

key

top

o

b rougt

a

opposn g

Wc

damaged

te am

souder

oow ng

sow s

musc  e s

s

a

s

te

o

o

durng

e m e r ge ncy

s ou de r

dur ng

w e

te

o

to

 s

e  me t

o

abducton

an

p ay ng

d s ocat on,

arm .

tor n

most

An

e

 oo tb a.

e

MRI

musc e.

 ke y

wen

ofe ns ve

c an-

o

te

W c

d amage d

o

by

njur y?

A.

Coracobracas

B.

Long

C.

Pectoras

ead

o

te

Supraspnatus

E.

T eres

moter

or

se

not

dd

advsed

png

o

brac

major

1-year-od

was

trceps

mnor

D.

A

s

ds  oc at ng

treatmen t

 ntate

afected

lavum

man

meda

scapuar

Foowng

yng

vertebra

t

pay

admnstered.

gament

cervca

key

comes

ymp

ner ves

1 9-year-od

was

gament

ongtudna

mts.

durng

o

and

vece

norma

toracc

depar tment

rom

coar

A

te

A.

ness

oowng

horacodorsa

severe

te

ts

emergency

motor

weakness

most

ago,

and

E.

crests

dsrupted?

A

scapua

Dorsa

man

o

or

surger y?

bateray

ac

a

adducton

s

to

Pysca

Long

wt

o

breast.

D.

neror

Wc

te

n

wtn

stor y

axar y

C.

rbs

and

monts

Axary

o

sows

to

symmetrca

ead

Accessory

par

anteror

er

wt

rgt

te

spne?

o

T wo

cedure

lud

are

woman

B.

sustaned

Wc

punc-

oowng

top

and.

atus

39-year-od

es.

umbar

sgns

2-mont

A.

posteror

te

reabe

te

menngts

cerebrospna

te

s

o

scapuae

he

on

most

o

because

ac

E.

Imagng

Wc

a

39-year-od

te

owest

He

te

s-

S1.

responsbe

Rada

A

te

sacra

anestetc

o

a

temperature

bactera

wt

as

E.

12.

o

he

bend.

anayss

Hs

He

te

g

sows

ntervertebra

scapuar

o

he

njur y,

o

to

Sensaton

spne

gament

brougt

nerves

anges

D.

as

conuson.

evauaton

vertebra

moter

eadace,

oowng

ponts

C.

department

and

s

severe

dagnoss

te

L4

by

wt

nectons.

dagnoss.

A.

A

A

Furter

andmarks

poston

brougt

snus

(104.2°F).

suspected.

ture

s

maase,

mutpe

40.1°C

s

boy

numbness

gament

nvoved

are

C.

department

s

te

and

key

s

extenson,

B.

3-year-od

at

beng

vta

T12–L1

emergency

te

o

as

oot.

lavum

man

Hs

rada

L5

most

ongtudna

A.

A

o

vertebrae

examnaton

rotaton,

puncture?

MRI

eements

s

and

puposus

27-year-od

Pysca

An

patent

mb

eson?

Lgamentum

A

coson.

ver-

nerve

he

et

brosus

department

lud

oowng

ocaton

E.

11.

punc-

cerebrospna

o

te

g

a

te

structures

Annuus

temperature

bactera

te

Wc

He

o

dects.

o

rgt.

between

A.

to

eadace,

conuson.

evauaton

most

moter

severe

nectons.

dagnoss.

s

by

wt

dagnoss

Furter

aboratory

eves

umbar

brougt

maase,

mutpe

and

tebra

s

(104.2°F).

suspected.

ture

boy

department

etargy,

40.1°C

10.

strengt

atera

L1

ever,

9.

L5.

A.

emergency

8.

and

te

gr

a

s

brougt

routne

aways

to.

skn

take

Pysca

n

to

te

examnaton.

te

er

pyscan

he

prenata

vtamns

examnaton

mdne

o

by

moter

te

sows

umbar

as

a

er

says

se

dm-

regon

CHAPTER

wt

te

15.

a

tut

ar

s

growng

te

most

over

te

key

dmpe.

Wc

o

major

dagnoss?

pressure

B.

Menngocee

respratons

C.

Spna

bda

occuta

suspected

D.

Spna

bda

cystca

bar

E.

Racscss

A

26-year-od

an

ton

tc

ton

on

bte.

n

o

o

a

spnous

woman

Fve

comes

back

days

tat

ago,

Amerca

te

process

o

se

were

oowng

mosquto

bte

te

to

pyscan

to

be

te

ked

bers

back,

because

caused

returned

se

nerve

on

T4

te

appears

rom

n

a

a

tat

an

te

atera

te

vaca-

at

are

and

te

sensa-

A.

T11

and

T12

to

B.

T12

and

L1

C.

L1

and

L2

te

Somatc

aferent

D.

L2

and

L3

Somatc

eferent

E.

L3

and

L4

C.

Vscera

aferent

D.

Vscera

eferent

E.

Somatc

A

15-year-od

department

ever,

are

up

to

on

catons.

Her

pressure

s

pected.

spna

must

25/mn.

n

te

paced

In

te

B.

Between

s

not

mm

obtan

A.

and

a

say

Se

as

40.3°C

o

progressve

no

te

te

tp

o

o

s

posteror

Superca

D.

Between

E.

In

to

severe

patent

ke

or

back

sootng

MRI

man

pan.

Wc

te

o

poston

He

presson

n

as

ts

no

spne

te

was

te

oowng

are

o

up

to

date

on

a

and

upper

D.

Lower

cervca

and

upper

toracc

spna

nerves

E.

Batera

by

20.

A

accessory

69-year-od

o

neck

pan

te

past

(98.6°F),

ew

bood

and

sows

as

comes

been

weeks.

pressure

respratons

te

because

an

motor

Rombod

he

B.

Serratus

eectrc-

C.

Supraspnatus

uncton

neuro-

cord.

ernated

n

an

rom

most

A.

no

spna

w

osteopytes

to

te

pyscan

progressvey

Her

s

mm

21/mn.

An

dsc.

anatomc

drect

com-

21.

Hg,

An

37°C

puse

MRI

o

s

te

Dapragm

Latssmus

worse

or

wakng

te

tat

past

Pysca

te

woman

pan

down

2



comes

as

s

to

te

story

he

stenoss

o

oowng

emergency

A.

Anteror

progressve

B.

Dentcuate

C.

Lgamentum

D.

Nuca

E.

Crucorm

patent’s

ter

Se

o

parents

daugter

as

no

s

not

story

o

ts

condton?

two

o

te

Her

sows

upper

te

gaments

lavum

pyscan

pan

s

w

s

se

wen

bends

relexes

ower

and

mbs.

vertebra

key

An

cana.

perormed.

most

wt

gettng

worse

wen

norma

and

umbar

vertebrae

ongtudna

te

progressvey

aevated

examnaton

n

to

been

monts.

and

bateray

sows

by

dors

42-year-od

back

afected

oramen

anteror

E.

ower

be

ntervertebra

worse

s

major

D.

A

key

te

because

gettng

temperature

126/84

are

n

removed?

vaccnatons.

roots

nerves

woman

tat

amnectomy

say

o

sympatetc

sus-

o

and

toracc

roots

over.

etargy.

n

eements?

dorsa

lavum

vaccnatons

wc

ventra

neede

uggage.

as

sows

s

3-day

o

toracc

mater

neck

cord

brougt

dvson

toracc

ongtudna

eavy

gaments

o

Raynaud

symptoms

upper

gament

and

surgca

and

te

and

vasospasm.

upper

ocatons?

pyscan

a

s

cronc

rom

because

ngers

and

ongtudna

eadace,

aganst

cervca

er

sceroderma

Ree

requre

to

pyscan

o

and

Anteror

ever,

39.

neura

te

cervca

C.

gr

due

wt

o

to

cervca

MRI

because

comes

Lower

ongtudna

15-year-od

vertebra

Lower

Posteror

department

age

woud

Lower

B.

A

te

ands

sensaton

Lgamentum

sae

C.

patent?

Nuca

s

termnates

oowng

dscooraton

temperatures

te

Supraspnous

E.

o

dagnosed

at

A.

D.

te

eve

usuay

te

ensure

between vertebrae C2 and C3. Wc o te oowng

sows

spna

o

hs

to

s

um-

spne

oss

to

wc

cord

In

between

vertebrae

njured.

spna

ordered.

nserted

L5

and

menngts

dura

te

s

njury

oowng

protect

n

not

o

lavum

examnaton

or

cervca

te

to

Se

musces

to

tng

pan

Pysca

and

and

s

bood

110/mn,

B.

space

ater

te

abnormates

o

mater

comes

pan

descrbes

sensaton.

ogc

gamentum

subaracnod

59-year-od

o

te

aracnod

oten

s

woman

story

ow

92/mn,

C.

te

n

or

and

s

bers

space

anteror

s

med-

res-

lud

te

6-year

toes

A.

bood

and

menngts

oowng

a

med-

(104.5°F),

110/mn,

o

not

story

known

cerebrospna

regon,

s

gaments

A

45-year-od

dsease

parents

daugter

any

s

emergency

o

patent’s

ter

puse

o

te

he

dagnoss

wc

epdura

s

sampe

umbar

n

to

takng

Hg,

A

aferent

story

etargy.

temperature

are

tap

3-day

vaccnatons.

and

101/64

T o

be

brougt

o

and

a

nesses

pratons

s

vaccnatons

date

major

A

o

gr

eadace,

aganst

19.

because

puse

puncture

known

(104.5°F),

dagnoss

L4

te

any

40.3°C

eves?

vertebra?

vscera

A

te

cord

between

takng

s

Hg,

neede

o

adut

B.

and

mm

umbar

te

A.

eferent

a

te

dsc

not

25/mn.

spna

n

s

101/64

processes

because

ranorest.

carry

just

by

s

and

temperature

puncture,

spnous

er

Latn

Wc

18.

Her

Menngomyeocee

nsect

17.

nesses

catons.

A.

o

16.

o

oowng

5

Back

1

A

Wc

aso

be

6

C H A P T E R

22.

1

Back

A 28-year-od prmgravda woman at 40 weeks’ gesta-

ton

s

admtted

sgns

are

eart

rate

na

wtn

va

spaces

o

te

n

te

are

abor,

sacra

te

ospta

norma

montor

stages

tered

to

mts.

paced

a

sacra

A

on

cauda

atus.

cana

game

Her

vta

stfness

n

tocometer

and

eta

mts.

er

abdomen.

anestetc

Into

s

sotba

devery.

or

wc

te

o

s

te

anestetc

In

te

rgt

der.

admns-

oowng

most

key

ng

paced?

A.

V ertebra

cana

B.

V ertebra

venous

C.

Epdura

D.

Subaracnod

E.

23.

severe

s

by

s

te

24.

lud

oowng

Hs

pressure

s

o

s

are

141/91

suspected,

s

most

ever

mm

and

a

ces.

penetrated

Dorsa

D.

Greater

E.

Axary

A

ater

man

Pysca

An

MRI

ematoma.

A.

Anteror

B.

T ransverse

Lgamentum

D.

Supraspnous

E.

Nuca

A

ater

transverse

wt

o

a

te

B.

V ertebra

C.

Ascendng

D.

Deep

E.

Posteror

key

a

motor

sows

a

sows

o

arge

arteres

te

trd

s

most

vece

sows

damage

pusatng

ospta

suggs

examnaton

MRI

process

n

te

to

18-year-od

co-

no

abty

oter

tp

XI.

Wc

damaged?

29.

spna

story

o

osteopoross.

condton

o

te

pyscan

ncreasngy

examnaton

convexty

to

to

sows

te

o

te

patent’s

o

oowng

s

lex

o

major

Rombod

mnor

E.

T eres

A

by

t

s

te

owng

a

spna

te

o

te

Lgamentum

Nuca

30.

department

ng

nto

because

second

o

base

an

brougt

njury

eadrst

to

te

emergency

sustaned

durng

er

ater

sd-

company’s

odontod

uretra

to

n

njury

gaments

te

a

sows

s

emergency

roover

motor

mutpe

max-

weakness

wt

musces

n

njury

s

to

most

er

CN

key

Crucorm

Posteror

E.

Supraspnous

s

cord

woud

te

most

deat

be

most

o

a

motor

a

arrves

te

o

conrmaton

reports

racture

wc

key

oca

at

cause

oicay

was

Rupture

on

key

Upon

examner

o

(C2).

g-speed

rend

examner

njury.

o

o

te

te

o-

mpcated

n

g

stabzed,

gament

to

o

s

njured

speed

te

and

gament

gament

man

rate

brougt

lavum

ongtudna

65-year-od

a

tat

a

s

gament

D.

at

n

njury?

C.

A

ked

medca

cause

gaments

B.

s

brougt

racng

medca

axs

A.

dsc

te

patent’s

ata

was

ater

determned

autopsy,

pedces

spne?

Wen

was

te

most

man

coson

tat

stenoss

woman

te

et

x-ray

major

23-year-od

resutng

26–50

a

atas

oowng

Rombod

Spna

42-year-od

te

assocated

D.

Hyperkyposs

A

by

oowng

consderabe

C.

C.

Questions

response

sows

open-mout

cord

50

co-

toracs

B.

Lordoss

and

Iocostas

ts

Hernated

suggs

mb

sows

njured

neck,

te

Scooss

E.

vece

gament

examnaton

er

A.

D.

ospta

motor

ower

te

s

beng

Sternocedomastod

deat

ncreased

curvature

a

spna

o

B.

scene,

ambuaton.

abnormay

toracc

Wc

ts

an

panu

because

n

pevs

o

A.

gway.

comes

te

woman

ater

Wc

vece

man

patent?

afected?

o

cervca

an

gament

aceratons

to

te

and

oow-

lavum

Pysca

oaca

vertebra,

ematoma.

key

vece.

response

te

cervca

30

cervca

3-mont

posteror

nvoved

to

spna

79-year-od

rom

An

oowng

Anteror

Pysca

admtted

examnaton

sgncanty

A.

A

s

Neuroogc

abnormates.

te

man

beng

Pysca

stmu.

An

to

te

gament

department

25-year-od

to

28.

ts

cervca

te

gament

Anteror

ongtudna

o

o

a

ongtudna

Dentcuate

Posteror

o

er

sou-

torn?

C.

Nuca

o

tat

ractures

n

sows

te

Wc

B.

E.

o

and

compresson

key

admtted

examnaton

C.

D.

no

and

norma

droopng

Wc

damaged

pan

wtn

eevatng

sows

nvoved

x-ray

racture

An

s

beng

Supraspnous

ongtudna

sows

n

damage.

key

severe

are

occpta

stmu.

most

spne

as

sgns

scapuar

53-year-od

and

by

most

Accessory

process.

Wc

te

C.

sows

te

s

Se

vta

dicuty

tssue

B.

emora

A

o

sot

horacodorsa

to

puse

o

nerves

ago.

Her

examnaton

and

A.

son.

umbar

examnaton

key

and

Hg.

x-ray

sows

mnutes

temperature

19/mn,

ematopoetc

gaments

emergency

g

nta

Mcroscopc

sows

te

Pysca

A.

son.

26.

because

back.

respratons

bood

ordered.

to

neede?

mnutes

25.

s

menngts

cerebrospna

te

brougt

parents

n

and

o

puncture

o

s

was

(101.8°F),

94/mn,

dagnoss

27.

boy

stfness

38.8°C

space

space

12-year-od

department

s

space

Subdura

A

pexus

ours

neck.

souder

An

MRI

2

er

an

ts

emergency

x-ray

o

wen

s

car

a

vece

rom

department

te

spne

traveng

bend.

were

sows

tat

He

e

s

two

CHAPTER

o

s

artcuar

condton

s

scedued

ng

processes

known

regons

te

o

as

same

te

are

now

“jumped

day.

spne

In

as

ocked

acets.”

wc

ts

togeter,

Surgca

o

te

njury

a

coson

repar

An

oow-

most

o

key

o

sensaton

or

Cervca

mbs. Wc

woud

C.

Lumbar

A.

Rotaton

D.

Lumbosacra

B.

Fexon

E.

Sacra

C.

Abducton

47-year-od

back

s

40

pan.

spne

te

sows

o

Se

respratons

a

arge

s

space

a

rom

te

vece

eadace

mm

32/mn.

pexus

s

emergency

motor

severe

ematoma

oowng

te

99/78

are

venous

to

n

as

pressure

vertebra

te

brougt

nvoved

ago.

bood

and

s

beng

mnutes

Her

nterna

wc

woman

ater

122/mn,

te

Hg,

An

MRI

beedng

(o

and

most

Subaracnod

B.

Subdura

C.

Centra

o

an

In

key

Batson)

te

Aracnod

D.

Dura

oss

n

eray

because

te

been

spne

upper

o

te

an

Hs

atete

are

emergency

o

severe

rgt

and

e

norma

MRI

L4–L5

or

most

key

he

mg).

bat-

and

umbar

An

dsc.

Hs

puse

saow,

MRI

to

be

Head

B.

L4

B.

Neck

C.

L2

C.

Head

D.

L5

D.

T uberce

E.

S1

E.

Head

a

we

met

o

and

tme.

patent

te

s

because

ost

s

to

patent

toracc

spne

or

te

an

and

oowng

not

ater

depart-

a

wearng

unknown

sows

te

sows

extendng

o

tese

bendng

emergency

stran

was

examnaton

ateray

or

te

back

conscousness

Wc

to

ower

he

Pysca

ower

suppy

a

skng.

responsbe

trunk.

brougt

o

pan

trunk.

njury

to

ateray

arteres

te

o

MRI

back.

and

te

ng

bood

musces?

meda

s

T eres

B.

T rceps

Supraspnatus

Inraspnatus

E.

T eres

D.

Suprascapuar

E.

Posteror

department

unconscous

oowng

te

a

emergency

ead-to-ead

wa

n

sows

excess

beore

structures?

a

to

te

n

a

and

emergency

busy

te

s

asprn

ourt

war-

(325mg

are

112/72

costa

ntersec-

ncude

24/mn

mm

Hg.

toracc

structures

s

ver-

most

njury?

rb

rb

s

brougt

s

a

ater

back

eson

on

o

s

key

to

e

te

durng

between

te

a

te

rgt

sows

arm.

emergency

sustaned

a.

deep

trapezus

atera

weak

Wc

a

Pysca

o

sde

and

o

s

adducton

te

oow-

njured?

major

22-year-od

department

to

te

just

brac

D.

brougt

o

stop

(o

compres-

mnor

Anteror

s

sows

pexus

rb

to

most

horacodorsa

man

been

durng

spne

respratons

o

te

trd

rotaton

C.

22-year-od

te

medcatons

examnaton

B.

A

object

rb

musces

C.

ntercosta

emergency

causng

car

pressure

mnutes

A.

A

ead

rb

ker

Subscapuar

38.

n

t

sows

Pysca

a

oowng

trd

45

dors

musces

by

112/mn,

ourt

A.

ntercosta

te

avng

venous

soud

brougt

t

bood

te

wound

atssmus

o

o

aspraton

metormn,

te

te

examnaton

musces

bendng

o

s

ourt

te

20-year-od

puncture

te

o

te

o

a

e-

te

o

oowng

dsocaton

te

o

department

amount

provde

A

o

severe

wen

An

37.

MRI

neede

current

nvoved

A.

24-year-od

s

and

sows

L3

ment

to

story

unknown

Wen

beng

patent’s

A.

A

o

oss

ower

lavum

man

metoproo,

key

or

mater

ater

tebra. Wc

afected?

sows

no

mater

Lgamentum

arn,

upper

movements

vertebra

te

as

mater

65-year-od

ton.

sensory

te

A

s

ematoma

te

o

n

He

cord

department

mts.

ntervertebra

s

E.

36.

wen

ntact

o

and

tng

sesson

uy

pan

tg

was

weakness

are

mbs.

nerves

s

wtn

motor

ruptured

te

tranng

Relexes

ower

oowng

o

ntense

no

to

story

aspect

vtas

mbs.

and

a

3-our

ete

sows

ower

sows

Wc

an

durng

exam

n

o

brougt

posteror

appeared.

s

s

a

cord.

wc

Pa

man

to

spna

puncturng

An

ootba.

dsocaton

examnaton

jont.

brougt

an

sgt

afected?

2-our

wt

perormed,

C.

wegts

Pysca

te

s

s

o

nterna

eadng

B.

as

pan

o

bood

strengt

robbery.

te

space

department

eavy

space

space

32-year-od

He

o

tat

severey

man

aggravated

ruptures

Pysca

at

payng

sows

oowng

be

back

cstern

Epdura

eg.

te

Spna

Lumbar

to

n

jont.

te

we

neck

moton

because

A.

E.

radatng

42-year-od

struck

cana

D.

A

Extenson

Adducton

payer

and

motor

o

E.

A

o

key

D.

son

A.

most

department

rom

Batson).

bood

35.

puse

accumuatng?

34.

range

horacc

A

ead

atantoaxa

B.

coson

33.

anoter

te

A.

department

32.

te

o

decreased

occurred?

31.

wt

x-ray

7

Back

1

gt

tat

man

ater

te

2

e

s

was

ours

atera

brougt

trown

ago.

An

border

to

te

troug

o

x-ray

s

emergency

a

o

rgt

pate

te

gass

torax

scapua

s

8

C H A P T E R

39.

1

Back

sattered. Pysca examnaton sows dicuty rotat-

A.

L3–L4

ng

B.

L3

C.

L4

s

arm

rgt

upper

most

key

mb.

Wc

no

o

oss

te

o

sensaton

oowng

n

s

musces

s

njured?

major

D.

T12–L2

E.

T11

B.

Inraspnatus

C.

Latssmus

D.

T rapezus

ower

E.

Supraspnatus

congenta

43.

dors

Examnaton

o

s

o

spna

back.

a

3-day-od

cord

and

Wc

o

mae

mennges

te

sows

rom

oowng

a

best

ment

potopoba,

B.

Menngts

moved

C.

Spna

bda

occuta

D.

Spna

bda

wt

myeomenngocee

E.

Spna

bda

wt

menngocee

6-day

stfness

o

on

story

er

back.

campus

wo

date

vaccnatons.

er

sgns

perormed

brospna

w

or

to

lud.

penetrate

Wat

beore

Aracnod

B.

Dura

C.

Pa

D.

Lgamentum

E.

and

a

te

a

Se

reacng

s

umbar

s

structure

te

umbar

up

to

sows

puncture

n

te

te

a

oter

not

examnaton

patogen

ast

nto

one

44.

s

cere-

neede

cstern?

stf

wt

examnaton

suspected

umbar

owng

man

s

g

tat

ever,

ave

sows

a

sampe

puncture

spaces

s

was

severe

s

a

te

emergency

eadace,

or

3

days.

purpurc

A

dagnoss

o

cerebrospna

obtaned.

te

to

perssted

tere

extremtes.

and

gament

brougt

o

From

Pysca

ras

on

s

menngts

lud

wc

cerebrospna

nausea,

lud

usng

o

te

s

45.

a

o

te

es

perormed.

are

used

Vscera

Somatc

eferent

C.

Somatc

aferent

D.

Sympatetc

E.

Parasympatetc

65-year-od

b).

uses

He

an

ease

C.

Subaracnod

regon.

D.

Pretracea

caracterstc

E.

Centra

A

38-year-od

department

vece

man

ater

coson.

aceratons

aceratons

and

or

te

admtted

Pysca

to

o

oowng?

centra

o

to

te

njures

over

te

nervous

s

skn

wtn

and

sows

severa

C.

Abducton

(CNS)

by

rom

con-

wc

46.

Adducton

E.

Inverson

A

72-year-od

V entra

ram

cepton

D.

V entra

roots

computed

E.

Intercosta

se

ad

spne.

encng

sows

er

no

started

At

tumor

retan

ncontnence.

pysca

wc

most

o

sgns

te

key

pyscan

wt

a

urne

Utrasound

obstructons

are

te

recenty

to

oss

on

metastatc

dagnosed

symptoms

wt

examnaton

nerves

as

recta

drome.

te

been

Se

ment

ram

o

n

oowng

ocated?

te

conus

because

tumor

and

o

s

te

on

prmary

te

A.

badder

badder.

meduars

vertebra

er

exper-

Bot

B.

eves

s

pan

oca

oowng

pyscan

(5

t,

11

n)

or

as

needed.

s

age.

movements

oowng

Hs

He

o

s

rou-

78

sgns

tested

s

n

kg

astma

vta

or

umbar

movements

jonts

a

and

exercse-nduced

or

te

he

he

wt

o

s

et

tumors

oss

sde

n

to

te

and

s

te

most

um-

te

te

o

CT

and

te

scan

scan

te

cancer

sezures.

vbraton

beow

o

o

emergency

te

te

Pysca

ne.

bran

pevs

oowng

te

propro-

umbca

o

o

and

o

depart-

best

A

sows

sows

a

expans

bran?

venous

pexus

contans

te

ongest

body.

nterna

venous

movement

nterna

aracnod

story

to

(CT)

a

Wc

nterna

a

conscousness

tomograpy

one-way

C.

o

brougt

sows

metastass

he

s

tumor.

vens

syn-

te

ntervertebra

man

gand

C.

o

ram

te

he

lexon

D.

Dorsa

to

te

Crcumducton

s

o

stud-

sows

coccyx.

wc

m

naer

o

te

to

1.8

mts

Latera

Communcatng

comes

o

o

s

story

B.

Pan

te

MRI

s

te

regon?

prostate

woman

a

norma

Wc

B.

66-year-od

as

A.

back

o

n

pregangonc

He

motor

te

dynamc

ater

coccyx

njected

examnaton

regon

comes

lexbty

A.

A

man

a

back.

o

system

emergency

rom

examnaton

eccymoss

rrtatons

veyed

te

s

sustanng

bar

ten

nterrupt

abutero

Subdura

cord

rst

te

pregangonc

examnaton.

and

s

because

area

aferent

B.

spna

to

B.

are

te

te

pyscan

coccygea

patways?

Epdura

o

to

and

te

te

weter

Pysca

A.

A

to

n

anestetc

coccyx

papaton

s

comes

pan

determne

oca

A.

cana

T o

regon

(172

coected?

o

a

tne

o-

story

nvoved,

nerve

ongtudna

mennges

woman

brt.

anestetc

neck

and

2-week

wt

lavum

o

32-year-od

gvng

mater

department

A

o

mater

Posteror

trunk

sck.

wt

mater

19-year-od

and

ves

Pysca



s

recenty

se

been

menngts

determne

A.

A

not

eadace,

Se

were

roommate,

on

as

o

te

ts

anomay?

Avuson

a

n

descrbes

A.

wt

protruson

deect

A 20-year-od woman comes to te emergency depart-

postve

42.

as

T eres

dormtory

41.

He

A.

and

40.

ateray.

venous

space.

pexus

o

as

vaves

tat

ensure

bood.

pexus

s

ocated

n

te

sub-

CHAPTER

D.

he

nterna

venous

E.

he

nterna

venous

ra

47.

A

department

te

o

Genod

D.

Spne

E.

Acromon

to

te

be

vaveess.

te

subdu-

Questions

51.

A

a

adder

s

ouse.

abnormates.

te

te

rom

porton

gest

Wc

o

o

te

o

(98.8°F),

and

o

et

ave

been

te

ng

wc

oowng

te

scapua

scapua

Between

B.

As

C.

Between

D.

Between

E.

Between

tey

wo

s

emergency

n

sows

o

a

constructon

department

Pysca

s

ower

crused

te

a

examnaton

mbs.

spna

oowng

ater

An

MRI

cord

musces

at

worker

a

bra

rom

sows

oss

52.

A

39

vertebra

ar

te

most

weeks’

ate

ng

D.

Latssmus

epdura

E.

Detod

dors

36-year-od

sze

or

ra

te

vta

A

Feta

dagnoss

o

ts

o

vst.

n

u

Se

as

o

protrudng

oowng

congenta

term

no

ad

dev-

nerves

o

age,

An

dscs

resut-

ernaton.

most

neror

and

a

53.

sows

te

a

key

At

to

be

oramen

artcuar

superor

wegt

acets

vertebra

vca

anomay?

ca

C.

Spna

bda

cystca

o

D.

Hemotorax

E.

Cauda

regresson

gr

because

s

o

a

examnaton

superor

to

protruson

Wc

ac

s

syndrome

brougt

Pysca

te

sot

crest

te

to

te

ump

sows

deep

o

te

pyscan

above

ump

unateray

to

te

skn

oowng

on

and

s

te

s

er

buttocks.

ocated

te

et

pabe

te

by

most

just

sde.

to

te

key

dagnoss?

A.

T umor

te

B.

Hernaton

C.

Indrect

D.

Drect

E.

Femora

at

externa

te

nguna

nguna

erna

o

abdomna

umbar

erna

erna

trange

obque

(o

musce

Pett)

54.

a

cm

and

bock

Wc

used

o

to

te

or

tat

Pysca

50%

aev-

oow-

te

cauda

te

T ransverse

Latera

no

o

ad

stor y

o

to

te

s

o

to

cer vca

sows

and

spne

o

or

-

ocazed

scan

bran

parts

key

o

CT

te

pan

cs,

medca

areas

A

certan

most

pyscan

back

ever,

major

sows

te

te

any

spne.

metastass

MRI

to

persstent

cer-

conrms

te

ocated

n

cer v-

wc

ocatons?

process

process

mass

D.

Pedce

E.

Spnous

process

22-year-od

department

pan

upper

radatng

mb.

and,

He

s

brougt

et

te

ture

troug

ture

extends

a

t

upper

te

s

s

cose

mb

scapua

superory

o

n

a

back

et

to

an

te

and

mb

He

s

wt

Any

ncreases

unusua

te

emergency

down

body.

et

toward

te

tavern.

upper

s

greaty

sows

spne

nto

braw

across

supports

odng

te

o

man

oowng

severe

x-ray

not

cer vca

wt

oowng

move

as

comes

stor y

as

Metastass

C.

atus

crest

metastass

B.

An

ntervas

4

at

oramna

Se

An

Odontod

to

to

epdura

0,

regu-

oramna

examnaton

n

cancer

spne.

rgt

para

wt

strengt.

dated

commony

woman

Se

spne.

te

n

devery.

1,

ospta

12-mnute

cauda

sacra

3-mont

A.

A

te

sacra

oss.

ocazed

bda

gravda

te

oramna

sacra

Pysca

breast

at

cervx

a

most

sacra

o

tenderness

key

ntercostoverte-

bock?

eadaces.

ness.

a

vagna

s

to

ncreasng

gven

durng

Medan

neu-

o

sows

s

38-year-od

and

etus

Se

Intervertebra

A

neror

woman,

contractons

andmarks

wt

back

most

pan

because

beedng

possbe

te

n

and

comes

steady

D.

occuta

o

dsc

vertebra

and

neror

pregnant

Cornua

bda

touc.

Pysca

gaments

te

superor

C.

Cranum

he

te

Anteror

Spna

parents

te

Posteror

B.

7-year-od

Hg.

s

15/

abnormates.

because

spna

superor

B.

A.

A

mm

are

ntervertebra

and

dentcuate

A.

E.

mts.

sampe

rom

s

as

consstent

serum

ndcatve

comes

norma

utrasonograpy

te

Se

uterus

materna

s

gestaton

wtn

a

gestaton.

dscarge.

Wc

are

sows

myeomenngocee

cd.

weeks’

resutng

sgns

14-week

deect.

14

prenata

pregnancy

er

a

at

a

apa-etoproten

tube

wt

or

examnaton

vagna

g

woman,

pyscan

wt

te

sze

troug

te

examnaton

Dapragm

T oday,

te

gestaton,

been

T rapezus

Pysca

te

pass

uterne

ave

key

C.

ery.

n

stenoss

are

respratons

138/74

tat

because

temperature

jonts

B.

prevous

s

pyscan

Her

neuroogc

sows

spna

37-year-od

cer-

o

C6

w

a

s

efaced.

one

no

te

74/mn,

pressure

decreased

A.

Sternocedomastod

te

s

to

pan.

compressed?

parayzed?

to

back

puse

spne

ocatons

comes

o

sows

md

A.

A

bood

MRI

n

woman

story

examnaton

An

s

pont

1-year

mn,

ractured?

te

budng.

Wc

e

a

37.1°C

emergency

pantng

no

tat

tp,

te

51–75

74-year-od

notces

sensaton

spne

o

man

te

two-story

eve.

n

process

ange

43-year-od

vca

50.

o

sows

te

key

C.

and

sows

most

Coracod

a

genera,

to

we

ractured.

Superor

o

spped

been

B.

a

49.

s

brougt

beow

orms

as

parts

brougt

e

scapua

tat

A.

A

s

examnaton

souder

48.

man

ater

te

scapua

bony

n

ocated

o

pavement

Pysca

x-ray

s,

s

space.

26-year-od

onto

pexus

pexus

9

Back

1

te

he

superor

s

attempt

sagtta

scapua.

as

et

pan.

rac-

rac-

scapuar

10

C H A P T E R

notc.

1

Back

Wc

o

te

oowng

nerves

s

most

key L

afected?

55.

A.

Suprascapuar

B.

horacodorsa

C.

Axary

D.

Subscapuar

E.

Suprascapuar

A

5-year-od

ment

back

because

and

some

o

a

boy

webbed

o

2-day

a

An

uson

key

neck.

Hs

and

ow

to

te

story

s

symptoms.

neck.

g-rdng

most

o

toracodorsa

brougt

earng

as

abnorma

and

s

“stf”

s

steatons

te

boy

o

o

C5

o

e

upper

as

tese

examnaton

and

cervca

and

Wc

depart-

te

wt

arne

te

n

says

concerned

Pysca

te

scapua.

pan

moter

posteror

x-ray

emergency

o

C6

te

ost

con-

sows

a

sort-

spne

sows

vertebrae

and

oowng

s

a

te

dagnoss?

A.

Lordoss

B.

Kyposs

C.

Scooss

D.

Spna

E.

Kppe-Fe

bda

syndrome •

56.

A

53-year-od

3-mont

story

radatng

down

mnutes

beore

examnaton

peda

puses

o

egs

and

pan

sows

are

to

pyscan

progressve

s

te

comes

back

e

can

becomes

norma

present,

pan.

wak

Hs

or

unbearabe.

patear

and

because

tere

s

pan

s

about

6

a

Pysca

tendon

n

body

ee-

sensaton

tg.

as

An

ton

te

o

te

o

body

te

o

te

oowng

A.

Spondyoyss

B.

Spondyostess

C.

Hernaton

D.

Lordoss

E.

Scooss

A

sows

exam

boy

tabe.

s

most

upon

te

sacrum.

key

dagnoss?

dsc

mk,

o

and

te

and

abe

Wc

o

te

to

wt

arm

t

a

Pysca

s

arms

congenta

and

spna

s

of

te

Menngocee

B.

Kppe-Fe

C.

Car

D.

Hydrocepaus

E.

A

II

T etered

because

a

orward

utes.

and

Pysca

strengt

worse

key

te

o

te

zyg-

oowng

s

ernaton

wc

was

er

sows

a

te

brougt

njured

neck

struck

o

s

beng

was

rom

to

n

o

oowng

emergency

motor

vece

yperextended

bend.

racture

te

a

te

An

x-ray

odontod

structures

s

wen

o

er

process

aso

most

njured?

Anteror

Posteror

key

C.

Atantooccpta

D.

Ineror

E.

Anteror

A

o

o

vertebra

racture

woman

ater

Wc

racture

Wc

aspect

L4

syndrome

B.

60.

s

arc

o

te

tuberce

o

woman

ater

a

atas

te

atas

process

tuberce

34-year-od

o

jont

artcuar

department

examnaton

admtted

story

Se

wen

n

o

ees

te

back

reeved

se

examnaton

bateray

Kppe-Fe

spne

wt

te

spondyostess

dsc

A.

syndrome

worse.

vertebra

vece

meda

te

s

o

te

axs

atas

admtted

motor

vece

to

te

emergency

coson.

Se

rear-

ended a stopped vece at a ow rate o speed. Pysca

woman

5-mont

progressvey

E.

and

ver-

te

syndrome

cord

Intervertebra

(dens).

sows

maormaton

62-year-od

Crus

D.

cervca

te

dagnoss?

A.

C.

n

1.2).

et

sows

dagnoss?

Spondyoyss

40-year-od

te

spne

anterory,

Spondyostess

A

on

te

(Fg.

B.

er

maor-

most

key

o

A.

coson

d-

protrudng

nto

most

jont

department

s

exam

cord

are

magnum

oowng

by

weakness,

obongata

oramen

te

pyscan

strdor.

bran

medua

te

to

batera

dagnosed

troug

cana.

s

barey

MRI

cerebeum

brougt

o

s

He

An

nerory

tebra

s

swaowng

te

te

ntervertebra

boy

because

maton.

te

o

s

vertebra

59.

1-year-od

cuty

L5

.

dect

x-ray

spped

apopysa

moter

58.

sgt

te

relexes,

dicuty

Fig.

o

wakng. An MRI examnaton sows anteror dsoca-

Wc

57.

man

waks

sows

ower

to

te

pan

as

wen

or

se

ospta

a

as

gotten

se

ew

5/5

extremtes.

te

cervca

mted

range

bends

to

perorm

mn-

to

te

motor

here

s

mts

o

te

sows

and

et.

n

a

o

se

moton

task

wen

Neuroogc

te

spne

as

toracc

upper

sows

n

se

a

s

Se

axes

ower

wpas

tenderness

as

and

asked

examnaton

and

a

paraspna

regon.

to

s

se

turn

s

n

unabe

er

wtn

extremtes.

njury

n

sgncanty

ead

norma

An

MRI

addton

to

CHAPTER

yperextenson

oowng

61.

o

A.

Lgamentum

B.

Anteror

C.

Posteror

D.

Annuus

E.

Interspnous

A

and

er

upper

are

extremtes.

te

ng

MRI

cord

structures

as

wt

te

and

n

over

motor

key

50-oot

a

num-

er

n

n

er

examnatons

sows

Wc

back

strengt

upper

been

a

strengt

relex

te

et.

emergency

rom

sows

motor

spne

te

most

3/5

5/5

mts

to

te

eccymoss

and

o

to

jumpng

examnaton

Sensor y

norma

spna

admtted

and

extremtes

extremtes.

o

te

gament

ater

Pysca

extremtes

wtn

o

gament

s

mnutes

aceratons

ower

Wc

njured?

gament

woman

50

upper

spne.

key

lavum

ongtudna

watera.

o

cervca

most

brosus

department

ber

s

ongtudna

23-year-od

g

er

gaments

11

Back

1

a

and

o

torn

ower

atera

te

to

st

oow-

cause

te

devaton?

A.

Posteror

B.

T entorum

ongtudna

C.

Dentcuate

gament

cerebe •

62.

D.

Lgamentum

E.

Nuca

A

n

s

ung

lavum

boy

because

dyspnea.

he

on

te

oowng

orm

A.

one

says

soud

to

te

story

e

te

ees

eard

scapuae

te

pace

o

ke

tere

sows

most

a

by

s

cougng

s

to

to

dors,

trapezus,

meda

o

scapua

B.

Detod,

evator

C.

Latssmus

scapuae,

dors,

externa

trapezus

abdomna

obque,

ac

65.

Quadratus

obque,

E.

Rectus

A

a

neror

tesa.

s

he

pan

exacerbated

or

examnaton

wt

norma

syndrome,

o

o

te

nguna

comes

souder

as

been

wen

many

sows

e

twet

gament,

MRI

causng

te

to

te

pan

C.

L2

D.

L5

E.

S1

neror

pror.

parayss

ep-

boterng

n

n

sows

te

weakened

oowng

coege

nerves

o

or

s

Injury

B.

Injury

ete

radate

tg

an

and

MRI

o

suddeny

eg.

o

te

atete

was

tranng

Se

er

to

was

spne

oowng

t-

sesson

te

at-

brougt

was

per-

nerves

was

n

o

an

o

te

te

to

o

exbts

actvty

aneurysm

sows

hese

n

to

patent’s

o-

te

wdespread

unctons

admsson

ts

unt

eca

aortc

mbs.

pror

care

or

examnaton

cause

o

ntensve

urnary

abdomna

ower

key

o

te

contro

te

were

ospta.

current

cond-

oowng?

et

vertebra

te

great

artery

radcuar

artery

(o

Adamkewcz)

Pysca

Axa

C.

Lgaton

D.

T ransecton

o

te

o

posteror

te

spna

conus

artery

meduars

o

te

spna

cord

space

E.

movements.

afected?

man

s

to

an

ntense

afected?

norma

wc

A.

movements

key

most

ton

and

extremtes.

most

he

s

an

Wc

Pysca

o

payed

years

He

o

pares-

quadranguar

souder

s

because

arm

years.

souder

upper

sgns

m

basketba.

s

weakened

atera

were

vountary

repar

pan

rgt

1.3).

(Fg.

wo

durng

severe

er

58-year-od

days

rb

pyscan

and

pays

years

sensaton

T1-wegted

Wc

L4

owng

abdomna

o

ospta

essentay

man

severe

basketba

border

nterna

vesses

45-year-od

2-week

umborum,

abdomns,

gastrc

63.

L3

B.

A

et

probaby

A.

tte

crest

D.

te

most

ear

border

se

woman

wegts

aspect

ormed

o

sounds?

Latssmus

eavy

era

space

best

29-year-od

wen

dur-

Wc

A

ng

gass

ceary

tranguar

stetoscope

64.

and

abnorma

protracted.

borders

te

ospta

o

examnaton

auscutaton

wt

ung

2-day

Pysca

naaton

te

brougt

a

patent

ungs.

sounds

s

o

ng

were

.

gament

6-year-od

parents

Fig.

gaments

66.

A

Dvson

o

23-year-od

te

toracc

woman

Subscapuar

pan.

C.

Axary

was

D.

Rada

examnaton sows no neuroogca dects. CT o er

E.

Unar

spne

sows

a

wen

wt

cnca

a

se

story

was

muscuar

condton

8

o

emergency

B.

dagnosed

2-day

trunk

te

department

poo

a

to

Suprascapuar

ad

o

sympatetc

brougt

A.

Se

because

s

years

severe

o

dystropy.

afectng

er

back

age

and

Pysca

vertebra

12

C H A P T E R

1

coumn.

n

67.

ts

Back

Wc

o

te

oowng

s

most

key

present

resutng

patent?

sows

A.

Hyperordoss

and

B.

Hyperkyposs

te

C.

Scooss

o

D.

Spna

patent

E.

Osteoartrts

A

bda

26-year-od

pan,

weakness,

mb

or

sows

no

cervca

and

a

te

te

2

o

and

te

annuus

damaged

key

te

tngng

MRI

o

s

and

tense

te

compressng

cord.

An

nuceus

Wat

n

C.

Rombod

D.

Semspnas

E.

Latssmus

sows

nerve

a

roots

cervca

perormed.

remova

puposus

are

71.

and

most

ntervertebra

upper

B.

Eastc

ogca

C.

Fbrous

arge

Eppysa

E.

Eastc

23-year-od

n

cervca

dsc

s

remova

te

he

are

te

te

te

mb.

MRI

nuceus

puposus,

o

cord.

te

dsc

and

damaged

orgn

o

An

because

numbness,

compressng

spna

severey

pyscan

weakness,

ntervertebra

embryoogc

nuceus

to

pan,

upper

o

and

puposus

comes

o

spne

te

ACDF

s

examned

annuus

and

te

annuus

s

upon

brosus

and

Neura

C.

Scerotome

D.

Mesencyma

E.

Mesencyma ces rom scerotome and notocord

a

1-week

Se

as

ad

a

a

been

o

ces

story

and

neura

moss,

te

examnaton

sow

dranage.

parta

nlamed

o

te

wc

ce

te

notceabe

necton

conjunctva.

and

to

canges

or

te

Se

ptoss,

Pysca

o

te

o

past

n

er

recenty

tat

deveoped

and

examnaton

membrane.

oowng

neurons

ace.

73.

red-

sows

B.

Latera

C.

Posteror

D.

Spna

E.

Latera

A

gray

gray

orn

orn

gray

o

o

orn

te

te

o

spna

spna

te

by

62-year-od

department

o

man

ater

a

spna

s

cord

cord

cord

wte

to

motor

matter

te

emergency

vece

coson

74.

Latera

mass

D.

Pedce

(pars

E.

Spnous

neuro-

sows

and

a

greater

musces

w

mnor

to

Despte

as

n

o

major

severa

terapy,

cond-

a

n

er

Autopsy

resut

resutng

emergency

osptazed

erse.

a

te

epsode

o

angng.

deat

racture

sows

o

s

a

he

orcbe

wc

o

te

process

process

er

wtn

artcuars)

process

72-year-od

woman

norma

coumn

and

Scooss

C.

Hyperordoss

Norma

Prmary

65-year-od

3-day

woman

story

o

An

te

ago.

x-ray

cortca

seres

bone

w

curvature

to

group

pyscan

Her

racture

Wat

comes

a

to

days

wedge

tn

spna

B.

E.

a

canges.

abnorma

2

mts.

sows

vertebra

D.

comes

batroom

osteoporotc

a

been

angs

racture

Hyperkyposs

o

and

severe

as

years.

se

A.

A

neck

structures?

C.

o

strengt

no

normay?

brougt

a

Se

njury

Odontod

n

s

o

resutng

T ransverse

o

cord

spna

brougt

severe

o

B.

A

8

and

vertebra

toracc

ts

ganga

coumn

past

A.

type

Anteror

because

worsens,

tebra

dsease?

A.

woman

dsorder.

te

and

te

monts.

motor

wt

oowng

major

neror

36-year-od

n

ead

6

ead.

to

capts

superor

are

structures

afected

posteror

ast

suboccpta

te

capts

ang

Bopsy

o

progres-

s

weakness

te

ead

unctonng

capts

oowng

because

mont

anydross,

tympanc

bodes

pyscan

te

Obquus

mecansm

scerotome

te

emergency

o

capts

yperextenson

rom

te

E.

cervca

ectoderm

comes

o

ear

producng

bugng

woud

and

ces

myotome

woman

mdde

rgt-sded

ness

ces

and

crest

ces

55-year-od

o

neura

o

te

decreased

o

Spenus

ton

B.

A

and

sows

Obquus

tmes

respectvey?

or

D.

depressve

te

weakness

oowng

rotatng

back

C.

A

and

musce

Wc

capts

department

Wat

Notocord

crest

72.

te

story

some

MRI

be

Rectus

nuceus

posteroateray.

st

Semspnas

surgery

extendng

compressng

B.

a

o

to

1-mont

rotaton

nerves.

key

brougt

a

s

An

A.

A.

crest

dects.

o

roots

s

o

and

o

and

sows

nerve

wt

rgt

tumor

most

ernaton

porton

perormed.

s

man

story

tngng

a

brous

njury

afected?

man

because

examnaton

and

te

some

n

ram

capts

eadaces

occpta

and

3-mont

et

Wc

dorsa

mnor

musces

n

and

70.

as

st

ead

dors

weakness

He

te

ater

s

te

ractures

major

22-year-od

sve

musce.

o

scapuae

department

severey

cartage

A

a

upon

tere

examnaton

MRI

vertebra

monts

but

key

Rombod

Pysca

D.

o

most

An

arne

T wo

we,

Levator

Hyane

A

s

Pysca

mpngng

eves.

recovers

uncton

A.

a

69.

te

njury.

dects.

severa

regon

same

musces

dsc?

68.

cervca

B.

s

te

sows

A.

spne

o

o

wpas

upper

upon

o

s

anteror

type

strengt

because

a

neuroogca

examnaton

te

surgery

examned

posteroateray.

gves

pyscan

Pysca

(ACDF)

dsc

brosus

and

spna

uson

ntervertebra

te

monts.

ernaton

porton

to

numbness,

past

abnormates.

dsc

dscectomy

he

comes

neck

te

n

man

n

no

n

te

o

be

at

ater

vta

o

sgns

er

te

sowng

te

suc

most

a

sgns

key

patent?

pyscan

panu

ver-

ourt

because

bsters

over

CHAPTER

er

back

Se

n

te

notced

te

bsters

saton

se

over

75.

are

te

or

te

o

skn.

ras

ce

Dorsa

B.

Latera

C.

Dorsa

D.

Sympatetc

E.

Wte

son

An

ta

ntense

bodes

erupton

burnng

examnaton

dermatoma

zoster

dermatome.

te

(snges)

ocated

tat

made.

are

o

x-ray

n

te

responsbe

dens

and

mm

compress

Anteror

and

B.

T ransverse

C.

Interspnous

D.

Supraspnous

E.

Nuca

te

neck

a

te

spna

an

cord?

key

te

30

co-

cord.

atantoden-

o

torn

79.

odon-

ntervertebra

8

C8

B.

Dorsa

C.

C6

D.

Dorsa

E.

C7

oped

a

gaments

bood

atas

a

gament

gament

gament

A

76–100

16-year-od

tne

er

pysca

scoo

nesses

are

to

bend

77.

s

te

te

wast

rbs

oowng

to

te

story

Pysca

tan

te

te

pyscan

o

s

te

Her

er

rgt

most

rou-

vta

key

s

sgns

sows

se

toes

sde

o

medca

examnaton

touc

te

a

begnnng

oter. Wen

to

on

or

major

medcaton.

mts.

at

o

te

pror

no

no

ger

orward

o

as

receves

bugng

Wc

brougt

Se

norma

souder

teror

s

examnaton

year.

and

wtn

one

gr

80.

asked

a

A.

L1

B.

S1

C.

L3

D.

S3

E.

L5

A

pos-

days

sown.

o

bt

by

story

C6

Wc

by

nto

and

C7.

neura

te

meta-

segment

nerve

2-day

to

te

Her

to

temperature

s

Hg,

s

o

moter

100/60

mm

ends

says

se

s

he

wc

er

deve-

(104.0°F),

puse

94,

and

suspected

and

s

puncture

termnaton

at

by

eedng,

over-te-counter

Menngts

te

poor

40.0°C

perormed.

beow

pyscan

story

o

te

vertebra

must

spna

eve

n

a

o

a

age?

man

o

an

comes

tcy,

returned

n

nsects

rom

te

an

Botswana.,

we

on

because

s

back.

expedton

durng

outsde.

Sorty

e

ater

arrv-

were e was btten as become nected and puruent

C.

Lordoss

matera

D.

Spondyostess

te

E.

Scooss

tebra

30-year-od

because

and

woman

3-mont

skn

test

sgns

o

te

most

coug.

progressvey

postve



a

persstent

tng

n

o

(PPD:

ours.

tubercuoss

toracc

key

ts

48

be

n

condton

says

te

x-ray

ungs

Wc

efect

te

te

coug

studes

proten

o

te

and

o

n

te

te

ospta

back

pyng

pan

s

rom

get-

sow

are

Spondyoyss

B.

Spondyostess

C.

Hernaton

D.

V ertebra

E.

Wedge

coapse

racture

te

skn

ce

and

dervatve)

B.

V entra

orn,

C.

V entra

cest

sows

dssemnaton

oowng

toracc

In

bodes

orn

surgca

erector

perormed.

abscess.

V entra

te

o

ts

o

te

nerve

dorsa

dorsa

orn,

he

at

are

ver-

sup-

severed

structures

ocated?

orn

orn,

dorsa

musce

area

debrde

branc

oowng

branc

to

musce

nerve

underyng

wc

and

procedure

spnae

te

and

root

atera

orn

gangon,

and

atera

orn

w

D.

V entra

spne

tetc

E.

A

orn,

dorsa

paravertebra

root

gangon,

and

sympa-

gangon

V entra orn, dorsa orn, and dorsa root gangon

28-year-od

department

dsc

s

A.

81.

ntervertebra

te

te

T8

a

untreated?

A.

o

to

toracc

tat

pured

ong-term

et

o

Laboratory

An

vertebrae.

a

admtted

Se

worse.

Mantoux

ater

s

story

eve

A

te

notced

n

was

Spondyoss

dranng.

e

saar

wc

B.

nvovng

States,

hree

ng

was

Unted

oice

ras

Kyposs

abscess

te

to

red

A.

A

to

sma

pan?

spna

38/mn.

Deta

many

back

norma.

unresponsve

usuay

e

between

cord

brougt

a

s

s

are

ts

ago,

a

extendng

compressed

te

neck

norma

neuroogca

sows

regon

spna

etargy.

puncture

Okavango

dagnoss?

s

tat

26-year-od

3-day

C7

o

Her

wc

beng

or

C6

o

gr

perormed

cord

appear

no

to

s-

nerve

pressure

umbar

be

o

and

respratons

dscs

s

wtn

spne

oramen

key

because

ever

cervca

rom

are

sows

s

brougt

4-our

nerve

orn

3-day-od

sgns

s

a

nerve

spna

rrtabty,

te

te

account

orn

spna

patent

76.

most

to

spna

moter

mm.

or

s

A.

A

n

o

o

radatng

vta

MRI

cancer

because

pans

Hs

ntervertebra

mass

prostate

examnaton

An

mass

medcaton.

ongtudna

o

vece

spna

dspacement

most

gament

motor

ospta

open-mout

s

posteror

te

sows

on

mass

oowng

A.

n

to

crusng

and

atera

dens

admtted

nvoved

ead

sows

s

mb.

Pysca

et

statc

was

sootng

upper

metastatc

wt

department

abnormates.

ganga

te

7.3

o

Questions

sarp

te

mts.

Were

te

trunk

beng

te

o

nto

A

man

emergency

tory

a

communcantes

o

70-year-od

structure

man

ater

A

te

sen-

sows

dstrbuton.

s

78.

o

he

Wc

to

a

T9

to

ganga

ram

nterva

tod

an

Pysca

n

te

orn

root

resutng

x-ray

o

pror

orn

53-year-od

mnutes

days

sensaton?

A.

A

ew

erpes

neura

pan

a

experenced

er

macuopapuar

dagnoss

dstrbuton

tat

13

Back

1

coson

Pysca

te

man

ater

s

brougt

beng

nvoved

resutng

n

examnaton

cervca

to

n

te

a

yperextenson

sows

vertebrae.

He

mdne

was

emergency

motor

o

vece

s

neck.

tenderness

paced

n

a

over

cervca

14

C H A P T E R

coar.

82.

Back

he

Wc

aged

1

o

Anteror

B.

Posteror

E.

Supraspnous

38-year-od

ee.

severe

ca

te

nerve

s

A.

Superor

B.

Lamna

C.

Ineror

D.

Pedce

E.

An

an

o

artcuar

o

wen

neck

acute

wtn

te

nerves

te

o

radatng

te

extng

and

tat

s

te

pan

e

ower

now

back

nerve

root.

accessed

te

o

rom

oowng

D.

te

n

wc

spnous

A

surg-

a

te

spnous

68-year-od

ew

ours

sensaton

nter-

Motor

extng

vertebra

he

A

bony

MRI

o

rom

te

te

process

s

o

brougt

a

45-mnute

was

extng

to

payng

emergency

story

o

ootba.

ernaton

dsc

o

wc

ntervertebra

nerve.

key

te

Wc

njury

An

MRI

te

most

s

87.

te

and

te

skn

s

anteror

o

s

C.

V ertebra

D.

Segmenta

E.

Posteror

A

er

or

vta

o

sgns

spne

spne.

Osteopoross

Scooss

E.

C5

ng

a

was

orced

no

s

durng

er

se

te

most

er

Nuca

C.

Lgamentum

curb,

e,

suc

dects

a

way

tere

gaments

stretced

to

te

anded

was

tat

Pysca

but

and

se

wear-

er

neck

s

o

neck

te

rgd-

greatest

Supraspnous

Anteror

degree

ongtudna

preparaton

papated,

a

or

and

skn

a

a

89.

umbar

ne

marker

s

to

puncture,

drawn

te

across

connect

te

ac

te

crests

patent’s

gest

ponts

35-year-od

s

neck

men

on

most

key

A.

C6

B.

C7

C.

C8

D.

T1

E.

T2

A

subaracnod

space

termnates

et.

orzonta

orzonta

te

tat

sows

te

n

o

te

artery

a

mbs.

our

mbs.

tumor

arsng

spna

cord

compressed

superory

oowng

began

decreased

ower

a

ne

emergency

by

at

by

drect

arteres?

to

te

emergency

pan

progressvey

norma

neuroogca

a

tat

gettng

mts.

been

worse.

Pysca

abnormates.

emvertebra

addtona

depart-

as

o

ndng

te

An

ower

woud

most

x-ray?

er

he

ent

e

s

o

brougt

a

was

o

to

45-mnute

payng

te

ootba.

C7–T1

Wc

o

te

te

emergency

story

o

njury

MRI

sows

ntervertebra

oowng

ora-

nerves

s

compressed?

15-mont-od

moter

gr

because

moter

says

prevousy

scedued

te

wen

te

te

wc

man

because

narrowng

started

at

te

Sacrazaton

A

o te et and rgt crests. he neede s nserted above

pont

orzonta

arge

md-back

s

te

Hyperordoss

severe

cervca

on

Spondyostess

at

lavum

E.

orzonta

te

pan

a

ormed

sows

D.

department

examnaton

he

wtn

no

C.

E.

88.

ongtudna

D.

wt

a

Atoug

njury?

B.

back

n

oowng

key

Posteror

are

anded

neuroogca

o

of

ago.

yperextenson.

A.

In

bcyce

mnutes

nto

Wc

spne

45

emet,

sows

ty.

lpped

te

over

ssure

te

or

Wc

present

B.

ace

orzonta

te

to

to

5/5

sows

brougt

are

A.

room

o

and

sows

C3

emergency

s

weeks

te

be

gr

C4

se

ends

spna

parents

examnaton

x-ray

te

key

wc

D.

er

repre-

space

spna

12-year-od

by

at

vertebra.

most

C.

to

spne

medan

te T3

rom

bateray

assessed

toracc

by

md-back

cervca

key

on

key

te

to

examnaton

meduary

toracc

brougt

acute

Pysca

Ascendng

C1

ater

to

superor

brougt

Segmenta

C2

s

to

neror

bsected

s

B.

Her

njured?

man

A.

ongong

oow-

o

tumor

ment

ocated

oramen

o

processes

wt

ago.

te

eve

te

ntervertebra

gr

neror

processes

process

strengt

B.

14-year-od

most

subaracnod

superor

processes

spnous

A.

A

processes

spnous

department

atera

te

T wo

E.

86.

removed?

e

most

oowng

te

ne

procedure

usng

(roo )

to

as

sows

oramen,

durng

margn

correspondng

compressng

ng

MRI

posteroatera

ocated

te

wc

ne

process

man

o

at

spnous

hree

because

process

because

superory

wt

ntervertebra

o

artcuar

department

an

T wo

brances

Spnous

s

pyscan

decompressed

key

35-year-od

sows

te

debtatng

oramen

Wc

most

Wc

eve

ne

C.

to

pan

so

s

te

hree

B.

superor

oramen

root.

eatures

A

s

o

ntervertebra

vertebra

A.

gament

perormed,

he

sents

ne

back

compresson

approac.

nerory.

dam-

gament

comes

ambuatng.

s

panu.

key

gament

man

pan

procedure

and

most

dsc

narrowng

causes

stf

s

lavum

ower

he

was

nerory?

ongtudna

Lgamentum

cronc

neck

structures

ongtudna

Intervertebra

A

s

pan?

D.

troube

85.

n

C.

te

84.

day

oowng

resutng

A.

o

83.

next

te

tat

and

standng

s

brougt

o

a

ts

tat

and

cdood

to

curvature

se

te

n

curvature

notced

wakng.

Se

pyscan

er

was

t

not

wen

as

mmunzatons.

ow

pres-

te

receved

Se

by

back.

gr

a

attends

CHAPTER

a

day-care

wtn

sgt

90.

te

ture

dd

spna

te

horacc

B.

Cervca

Lumbar

D.

Cervca

E.

horacc

te

comes

onto

te

umerus.

most

key

loor

o

Spnous

processes

o

T ransverse

o

processes

o

T2–T5

processes

o

C7

34-year-od

tat

er

beedng

woman,

comes

and

job

or

o

A.

Nuceus

B.

V ertebra

C.

Dorsa

woud

Spna

we

oowng

to

struc-

a

cervca

rgt

2,

a

1,

at

13

prenata

to

Se

known

as

er

no

vta

sgns

oowng

n

A

are

A

he

durng

o

underde-

structures?

ng

dscs

te

o

wt

tat

te

s

brougt

at

s

s

to

sows

key

musces,

and

s

ste

no

passes

30

mn-

o

te

96.

mmedatey

rom

drecton

crosses

upper

neuroog-

Wc

ocated

superomeda

emergency

to

constructon

abnormates.

most

processes,

te

njury

between

a

to

te

o

te

L4

C.

S2

vertebra

D.

S1

vertebra

E.

L5

attac

sows

a

zonta

radoucent

type

aspect

III

o

D.

Iocostas

B.

Superor

E.

Spnas

C.

T ransverse

He

ton

as

severe

sows

motor

ower

norma

dects.

An

back

pan.

brougt

Pysca

a

examnaton

x-ray

umbar

te

te

examna-

neuroogca

o

to

scafod.

and

spne

no

sows

97.

te

te

te

te

neror

ne

umbar

o

o

te

bot

te

snge

transverse

and

appear

to

beow

to

bone

because

n

or

te

enarge-

vertebra.

processes

te

be

t,

ave

er

spne

batera

a

enarged

appears

to

pyscan

boterng

marked

eatures

neror

artcuat-

so

muc

so

morpoogc

mmedatey

bony

area

beow

o

te

racture

on

C2

te

were

emergency

n

superor

a

body.

as

racture

a

by

o

drect

a

spne

or-

te

Wc

was

motor

cervca

demonstrated

key

te

te

njured

upper

vertebra

most

to

beng

pos-

o

te

attacment

ocated?

gament

ongtudna

gament

Ineror

story

o

band

o

ongtudna

65-year-od

gressvey

brougt

ater

x-ray

ne

gaments

Lgamentum

a

An

te

E.

o

o

was

dens

D.

A

and

nuca

been

o

are

mnutes

coson.

Apca

rom

man

45

A.

s

o

vertebra

45-year-od

to

e

ne

vertebra

Longssmus

e

to

as

mmedatey

smar

B.

Rotatores

worker

o

on

oowng?

C.

ater

nserts

vertebra

B.

constructon

musce

superor

processes

vertebra

L1

teror

department

tat

border

he snge vertebra dented on x-ray s most key

oowng

32-year-od

bony

bone

snge

Mutdus

emergency

tumor

atas

wdt

vece

vertebrae?

te

sows

vertebra

tese

department

and

n

MRI

atera

nuca

neror

x-ray

vew

atera

two

week.

eatures?

comes

tat

An

and

A.

A

pan

A.

A

o

transverse

snge

aspects

hs

neror

te

woman

weeks.

engt

ts

ast

1-cm

te

because

growng

atas

te

o

tuberce

back

o

te

sma

on

bony

o

pyscan

sowy

bone

anteroposteror

ment

or

a

between

porton

Posteror

2

te

trange.

o

bone

68-year-od

ast

verte-

woud

nes

Meda

ower

L5

vews

bone

Occpta

te

sows

process

porton

to

notced

musce

oowng

Latera

o

sows

gestaton.

resut

ntervertebra

examnaton

a

te

B.

t.

semspnas

n

o

T ransverse

E.

95.

vagna

scerotomes

key

Se

terato-

examnaton

13-week

weeks’

vst.

a

e

regon

suboccpta

occpta

para

or

tat

spne

wtn

A.

D.

penetratng

workng

orgn

te

ocated

te

mout

comes

cervca

caracterstcs

man

ater

musces

te

posteror

o

radograpc

ractures?

open

man

growt

nuca

T oday,

a

sma

wc

yper-

ganga

Pysca

spnous

our

te

o

muscuoskeeta

o

te

a

wc

24-year-od

pont

o

cord

department

Anteroposteror

45-year-od

te

ganga

Sympatetc

E.

A

s

bodes

E.

Obque

T1

destroys

most

o

puposus

root

Posteroanteror

D.

C.

Pysca

wt

wc

Latera

occpta

exposure

pans.

mts.

D.

to

oowng

tese

C.

o

hs

ntertubercuar

orgn

cemcas.

preerentay

veopment

ago.

oice

nvoves

consstent

tat

and

gravda

te

crampng

norma

embryogeness

deep

to

dangerous

uterus

or

back.

sow

ractures

oowng

B.

C1–C4

Spnous

ca

examnaton

s

key

te

Anteroposteror

te

C7–T12

processes

Spnous

utes

te

a

nterartcuars

o

A.

T7–L5

E.

back

te

o

D.

A

o

or

musce?

C.

drug

pyscan

Pysca

vertebra

B.

a

te

musce

Wc

te

o

wtn

most

curva-

observe?

to

examnaton.

processes

gens

reassured

Wc

pars

bra. Wc

o

Spnous

says

s

batera

a

94.

A.

A

moter

norma.

key

ypertroped

nserts

gestaton,

93.

most

man

arge

troped

he

was

are

sows

ordoss

pysca

o

spne.

vtas

kyposs

sows

s

te

Her

examnaton

ordoss

routne

tures

sbngs.

kyposs

24-year-od

sucus

92.

o

no

Pysca

ordoss

C.

a

as

curvature

moter

A.

A

and

mts.

curvature

tat

musce

91.

center

norma

15

Back

1

o

crucorm

gament

atas

band

o

crucorm

gament

lavum

man

comes

1-year

gettng

back

worse.

to

te

pan

Pysca

pyscan

tat

as

because

been

examnaton

pro-

sows

16

C H A P T E R

1

Back

C.

Underdeveopment

center

D.

n

E.

n

te

n

te

54-year-od

pan

tat

pan

was

et,

as

o

man

ntay

but

now

s

aevate

decreased

o

te

natng

body

rom

o

nerve

cervca

te

and

most

te

prmary

to

te

worse

e

severey

wen

e

te

o

arge

compressng

rom

ead

et

or

a

no

sows

axes.

MRI

ema-

o

te

te

he

wc

te

rgt.

osteopyte

above

t.

he

to

medcatons

n

area

mmedatey

s

neck

year.

examnaton

moton

a

or

ast

turns

Pysca

sows

emanatng

osscaton

pyscan

or

turned

posteroatera

vertebra

key

te

wen

range

spne

osscaton

arc

comes

pan.

osscaton

secondary

ant-nlammatory

te

cervca

o

ected

Over-te-counter

onger

te

gettng

ony

prmary

body

vertebra

been

te

body

vertebra

Underdeveopment

center

A

o

vertebra

Underdeveopment

center

99.

te

vertebra

C3

spna

osteopyte

o

te

s

oowng

vertebrae?

100.

A.

C2

B.

C3

C.

C4

D.

C5

E.

C1

A

38-year-od

at

40

se

weeks’

began

mnutes

Se

s

Se

njecton Fig.

or

te

te

relexes,

abdomen,

amnectomy

because

eve

te

due

to

oowng

pressed

98.

reduced

and

o

te

a

detectabe

T8

to

te

roots

s

most

Segmenta

spna

C.

Segmenta

meduary

Anteror

An

motor

vertebrae

were

dects.

at

Wc

beng

over

A

perormed

compressed

eson.

key

s

skn

tat

o

drecty

Pysca

restng

cd

ated

(Fg.

wt

1.4).

ts

brougt

to

te

pyscan

pysca

queston

bass

o

or

n

te

n

te

a

vertebra

a

or

a

we-groomed

he

gure

potograp

cd’s

o

te

best

o

assoc-

te

cd

descrbes

te

condton?

secondary

osscaton

te

process

prmary

most

beore

abortus

ospta

n

and

an

as

o

10

ntervas.

been

epdura

Wc

every

sorter

1,

ater

so

or

14

anestetc

key

t

to

reaces

be

te

te

te

ast

oowng

penetrated

epdura

by

space?

gament

gament

C.

Anteror

D.

Posteror

E.

Lgamentum

Questions

A

ongtudna

gament

ongtudna

gament

lavum

101–123

48-year-od

a

1-week

et

osscaton

wt

te

o

te

gament

occpta

te

C2

s

te

tssues.

paced

s

te

post-surgca

te

key

te

emess.

te

to

at

to

te

te

orcby

patent

dagnoss

o

o

stretced

resuted

n

on

te

open-

troug

a

te

exter-

eve

se-retanng

te

o

undergoes

neror

ended

oss

sde

at

He

Wc

drecty

and

et

ncson

A

because

and

earng

tumor

1-cm

and

made.

surgery

a

ncson

and

s

te

meatus.

recovery,

pan

pan?

on

mdne

began

pyscan

nausea,

compete

perormed.

nto

most

durng

a

te

sows

acoustc

tat

neuraga

was

sows

bran

Durng

occpta

occpta

to

vertgo,

protuberance

vertebra

tor

tors

o

wereby

na

severe

comes

emanestesa

nterna

cranotomy

nuca

man

story

examnaton

MRI

o

nerves

arc

o

spnous

dstress.

oowng

ts

Underdeveopment

center

s

te

Underdeveopment

center

B.

no

sows

s

Supraspnous

ng

examnaton

Wc

embryoogc

A.

n

ave

Interspnous

ace.

was

abor

to

B.

te

routne examnaton. Her vta sgns are wtn norma

mts.

neede

Pysca

spna

gr

n

contro.

3,

te

contractons

and

be

pan

para

to

te

com-

spna

8-year-od

stronger

agreed

A.

o

B.

Posteror

te

101.

Radcuar

E.

o

eson?

A.

D.

T9

space-occupyng

arteres

by

sensaton

no

posteror

to

4,

brougt

sustaned

gettng

as

gravda

s

.4

structures

norma

avng

and

conrmed

ours.

•

woman,

gestaton,

o

retrac-

separate

experences

postsurgca

te

by

oowng

te

ts

retrac-

patent’s

CHAPTER

102.

A.

hrd

B.

Suboccpta

Spence)

C.

Greater

ormed

D.

Lesser

E.

Accessory

A

occpta

are

a

pan

te

used

a

s

as

a

B.

Fum

C.

Conus

termnae

Posteror

Lgamentum

45

man

mnutes

compete

oter

tear

o

te

spne

undergoes

spna

o

te

cord.

anteror

sgns

Protruson

rootets

C.

was

te

rgt

o

te

a

spne

resut

o

Weak

rom

nvoved

aar

cervca

woud

sow

to

depart-

a

retracton

adducton

2-mont-od

None

spne

wc

be

anteror

sows

o

umbar

w

te

te

key

tear?

A.

L3

B.

L4

Fexon

C.

L5

D.

S1

E.

S2

Latera

E.

Abducton

A

a

lexon

107.

2-week

der.

et

upper

te

rgt

power

back

sde.

on

toward

te

te

mnor

w

A.

e

nerves

most

and

o

were

upper

to

aso

te

rotaton

back

te

and

o

aganst

arm

te

o

we

tan

bades

and

meda

Eevaton

E.

Abducton

rgt

o

te

scapua

and

neror

38-year-od

6-mont

te

rgt

woman

story

arm

comes

o

a

rom

to

ard

te

0

to

and

unctons

108.

arm

te

rotaton

15

n

te

o

because

breast.

Se as a story o carcnoma o te et breast and ad

a

umpectomy

te

axa

2

sows

years

a

3-

prevousy.

×

4-cm

Utrasonograpy

ard

mass

n

te

o

upper

most

o

di-

Wc

key

te

aganst

ever

been

(dura

a

to

o

be

et

scapua

wa

upper

mb

to

n

te

emergency

ras

tat

and

temperature

and

a

neede

At

s

39.6°C

s

s

wc

typcay

are

sgty

puncture

he

be

began

eedng

respratons

sows

sac).

te

and

rrtabe

Hs

arge

109.

brougt

cystc

embryonc

condton?

54/

bugng

perormed

nserted

nto

vertebra

eve

ound

Neura

D.

Intraembryonc

E.

Neura

n

ts

53-year-od

n

earer

bar

spne

and

norma

dented

ayers. Wc

most

key

eedng

examnaton

15

was

×

tssue

o

10

cm

removed,

rom

te

a

oow-

responsbe

or

streak

coeom

te

sows

s

day.

Spondyoyss

Spondyostess

Hernaton

D.

Lordoss

E.

Scooss

22-year-od

te

o

MRI

o

Wat

B.

C.

back

racture

agnment

sacrum.

brougt

severe

A.

to

mass

because

been

Pysca

he

prmtve

man

deny

comes

as

crest

wt

A

s

pyscan

He

ods

department

te

te

approxmatey

studes

tssues

C.

o

regon.

germ

te

to

back.

rrtabe.

mass

embryoogca

ts

A

s

sacrococcygea

ng

upon

degrees

et

a

umbar

been

v

pyscan

mass

not

o

souder

o

as

Remnants

o

A

on

Coronc

rotaton

ead.

scapuae

et

152/mn,

s

B.

arm

D.

gr

ump

A.

rgt

o

stopatoogca

tree

souder

a

te

and

musce

orzonta

hree

umerus

meduars

resstance.

te

te

and

n

scapua

o

arge

sows

te

weakness?

above

a

o

major

s

brougt

dagnoss.

neurapraxa

oowng

adducton

adducton,

and

rombod

te

o

s

examnaton

conus

removed.

(o

per-

scapua

te

ours.

s

cstern

3-day-od

sou-

arger

souder

conrms

demonstrate

rgt

rgt

decrease

back

o

because

musces

notaby

pu

te

s

te

notabe

s

wc

pyscan

movng

examnaton

In

o

Extensons,

a

a

asked

protracton

C.

o

was

key

Meda

A

was

suppyng

B.

rgt

souder

mdde

musces.

te

sows

rgt-sded

conducton

eve

to

dicuty

and

e

Abducton

te

o

here

s

wen

o

comes

examnaton

musces

Nerve

man

story

Pysca

A

o

25-year-od

24

te

s

patent?

Extenson

Rotaton

te

as

ontanee.

conrm

te

was

o

most

to

B.

D.

ast

ta

experences

border

pused

te

o

gr

puse

bot

o

o

He

Pysca

A.

C.

te

s

er

ndngs

meda

because

pror.

tumor

patent

above

axary

mastectomy

range

Weak

days

te

examnaton?

o

abducton

Weak

A

te

te

are

E.

mn.

motor

neck

gament.

movements

te

n

and

ands

nto

radca

arm

te

D.

poory

ead

upper

examnaton

cervca

as

e

o

te

te

o

15–90-degree

gament

emergency

et

protracton

wen

s

and

pysca

B.

surgery

A

addtona

durng

(103.2°F),

ater

o

oowng

department

te

er

sows

106.

brougt

MRI

rasng

Weak

structures

breast.

successuy,

A.

to

extendng

te

postoperatvey,

ound

2

s

o

sows

surgery

Durng

oowng

denty

vta

examnaton

te

nternum

gaments

Pysca

ncreased

105.

He

Hs

ower

lavum

coson.

oowng

104.

MRI

ongtudna

45-year-od

torn.

weeks.

or

meduars

E.

te

to

2

pyscan

gament

D.

a

s

wc

te

rootets?

Dentcuate

vece

o

cord.

rom

cord,

to

Pysca

dects.

spna

A.

ment

course

mts.

andmark

posteror

A

brougt

te

tumor

spna

weeks

s

norma

n

remove

o

boy

neuroogca

mass

quadrant

cuty

over

wtn

no

103.

occpta

occpta

7-year-od

back

outer

17

Back

1

o

te

s

pregnant

te

pars

body

te

o

most

woman

or

te

tat

examnaton

ntervertebra

ospta

to

pan

emergency

began

o

te

sud-

um-

nterartcuars

te

key

L5

vertebra

dagnoss?

dsc

at

devery.

40

weeks’

Her

gestaton

cervx

s

60%

18

C H A P T E R

efaced

1

Back

and

anestesa

se

te

An

back

tat

oowng

cm.

pan

MRI

epdura

nerve

5

Se

antcpaton

deveoped

weakness.

n

dated

n

o

space

exts

at

vesses

rgt

spne

resutng

eve

most

undergoes

abor.

and

er

te

s

o

ower

sows

n

o

epdura

Ater

a

key

extremty

D.

Wc

responsbe

o

te

o

te

or

te

110.

Interna

B.

Great

C.

Anteror

vertebra

radcuar

pan

spna

Posteror

E.

Externa

spna

7 1-year-od

n

s

vece

sows

cras.

te

anteror

ver tebra

A

111.

and

r upted

n

ts

E.

Intertransverse

28-year-od

eart

In

te

are

na

o

wat

L3

to

d ue

C4 –C5

re qu re d

s

B.

 nter-

to

wtn

te

ospta

norma

o

are

abor,

mmedatey

and

L4

be

paced

an

ast

devery.

er

to

te

Durng

ts

Anteror

Great

E.

Segmenta

A

pan

tumor

ng

same

te

C.

Nuceus

te

D.

Apca

E.

Cavara

A

vece

E.

Intertransverse

a

er

o

ng

deect

mbs.

at

tat

MRI

pacement

te

te

o

assocated

te

te

wt

here

umbar

L5

cana.

Compresson

B.

Compresson

o

wt

was

te

obvous

body

an

and

w

past

o

te

o

te

anteror

ds-

narrowng

most

key

cord

and

batera

mb

o

te

weakness

spna

cord

and

te

spna

cord



ow?

vertebra,

and

ntercostas,

medan

sacra

was

wt

o

te

er

struck

arteres

and

ntercos-

to

te

pyscan

te

ast

a

trauma

et

o

MRI

or

at

because

tat

nsect

nger

te

te

nger

were

structures

s

a

nter-

s

sus-

ocazed

recommended.

most

wt

as

btes.

wt

dsta

condroma

o

orgn

week

ndex

mass

excson

and

as

Pysca

a

er

cervca

Atantooccpta

Ineror

E.

Anteror

o

te

key

sar-

tumor?

Se

s

emergency

vece

secured

se

wtn

rate

sown

o

s

on

around

breat-

norma

1.5).

er

n

m-

109/mn.

(Fg.

key

co-

wen

brougt

sows

are

most

s

coar

eart

An

Wc

njured?

atas

te

atas

process

man

because

s

o

te

jont

tuberce

o

a

aso

artcuar

aspect

vtas

o

to

motor

yperextended

cervca

te

tuberce

32-year-od

department

a

bend.

spne

was

Posteror

D.

was

Her

excepton

arc

brougt

examnaton

te

oowng

s

survved

rom

C.

atera

posteror

arteres

over

recent

an

neck

B.

A

sacra

vertebra

dagnoss

se

o

ower

vertebra,

Adamkewcz)

te

sows

woman

be

unatera

temporary

anastomoses

ganga

Anteror

116.

o

arge

operated

ganga

ater

wc

neck.

A

spontaneousy.

x-ray

oowng?

spna

n

no

and

A.

weakness

ower

ts

“step-of”

weakness

sows

patoogy

o

te

an

some

spne

vertebra

hs

wc

A.

mb

vertebra

eve.

o

vertebra

L5

tenderness

abdo-

a

gament

backboard

A 38-year-od man s brougt to te pyscan because

sows

ower

s

a

puposus

40-year-od

son

as

embryoogc

root

department

examnaton

or

sows

s

te

comes

surgca

procedure,

te

back

artera

o

spna

nger

oowng

Dorsa

Interspnous

over

te

Sympatetc

D.

spne

and

o

B.

ongtudna

Pysca

An

A.

durng

ow

sows

patent

atera

we-crcumscrbed

Wc

Posteror

days.

Se

s

115.

pan

ndex

te

space?

back

te

aorta

te

(o

rom

woman

er

Her

and

artery

arteres

x-ray

ongtudna

ower

o

umbar,

posteror

examnaton

bue

C.

5

n

worse.

Lgamentum

o

and

radcuar

22-year-od

Anteror

story

and

arteres

B.

5-day

rom

and

A.

a

L5

batera

pyscan

dangerousy

rom

jont.

lavum

he

s

umbar,

pected.

by

and

abdomen

scema

epgastrc,

pro-

perorated

and

examnaton

oowng

drops

arteres

paangea

anestetc

te

repar

te

prevent

pressure

te

papaton

o

arteres

ta

abdomen.

spnous

on

aneurysm.

o

ges-

weeks’

tocometer

on

gament

epdura

A

epdura

atera

vertebrae.

te

te

or

mts.

key

to

ntercosta,

gotten

40

equna

Pysca

Segmenta

Pysca

montor

access

most

D.

o

at

equna

cauda

comes

te

Wc

C.

ds-

114.

woman

aortc

Segmenta

o

wc 

 ke y

roots

arteres

 ntu b ato n.

m os t

nerve

weakness

cauda

te

pusatons

superca

to

r up ture

o

man

durng

bood

pae

stages

woud

neede

a

e matoma

  game nts

prmgravda

rate

admnstered

cesses

and

 njur y

te

A.

s tr uck

e xam n aton

sow s

o

stop  gt

was

lavum

admtted

eta

ne ck

b ros us

a

te

te

Utrasonograpy

and

w

a

ongtudna

Lgamentum

sgns

Py s ca

p re ve r teb r a

ar w ay

at

and

n

njur y ?

Interspnous

s

a

 d ng

MRI

e m er ge ncy

 nvoved

ongtudna

D.

vta

was

te

w as

ead res ts

tr uc k .

oow  n g

C.

taton

112.

s

te

A

a

annuus

o

Posteror

He

to

e

ypere xte n s on

Wc

B.

a ter

o

examnaton.

camped.

b rougt

T2-wegte d

compromsed

Anteror

s

w tout

by

dsc

A.

on

pexus

cos on .

severe

te

men.

spna

mb

weakness

62-year-od

abdomna

mn ute s

car

bend

Adamkewcz)

artery

man

30

vntage

rom

A

te

ower

ony

notceabe

(o

artery

vertebra

depar tment

motor

pexus

artery

mb

Compresson

routne

D.

A

Compresson

E.

113.

o

unatera

ower

ematoma?

A.

Compresson

wt

ematoma

compresson

L2–L3.

C.

devery,

o

s

o

te

o

te

brougt

severe

rgt

axs

atas

tg

to

pan

and

te

emergency

radatng

eg

wen

to

e

te

was

CHAPTER

19

Back

1

B

A

C

•

tng

son.

sa,

eavy

oss

n

sows

a

MRI

o

ruptured

oowng

durng

examnaton

sensaton,

extremtes.

117.

wegts

Pysca

nerves

s

or

an

musce

te

key

no

tranng

sadde

weakness

umbar

ntervertebra

most

ntense

sows

spne

dsc.

n

(see

Fig.

1.5

ses-

CT

aneste-

s

ower

Fg.

Wc

to

1.3)

o

o

wt

s

te

te

superor

artery

te

wt

afected?

neck

and

ts

sows

racture

ractures

nes

ocated

artcuar

nerve

woud

Anteror

spna;

B.

Posteror

spna;

C1

B.

L3

C.

Posteror

spna;

C2

C.

L4

D.

V ertebra;

C1

E.

V ertebra;

C2

L5

S1

118.

utes

ment

rom

dvng

severe

pan

s

bruse

but

as

parents

because

ead-rst

nto

on

te

top

o

no

notceabe

o

an

saow

s

ead

ater

njury

sustaned

we

water.

He

wt

and

cutaneous

ntense

sensory

as

a

neck

oss.

A

o

te

greatest

atas,

atas.

rsk

o

Wat

njury

A 25-year-od man s admtted to te ospta 30 mn-

A 16-year-od boy s brougt to te emergency depart-

by

at

te

posteror

ypogossa

L2

E.

suraces

be

to

racture?

A.

A.

D.

bateray

mmedatey

ap-seat

modern

e

beng

drvng

was

cars.

nvoved

n

a

bets

Hs

wearng

rater

car

s

n

vntage

t

a

a

motor

car,

tan

tree

ap-bet,

e

vece

wc

was

souder

ead-on,

bets

and

sustaned

coson

equpped

as

n

atoug

njures.

he

20

C H A P T E R

patent

o

s

o

te

s

Back

conscous

12t

toracc

vertebra

te

neura

as

are

body,

arc

ntense

sows

vertebra.

a

pece

o

key

Wat

been

he

te

back

a

pan.

Cance

anteror

spnous

posteror

porton

o

to

A

porton

process,

te

te

CT

as

racture

o

a

and

dicuty

sows

resut

aso

vertebra

neura

notced

torax

o

eary

arc

wat

njured?

Kyposs

Lordoss

Lamna

B.

Pedce

C.

Prmary

C.

Spnous

D.

Scooss

process

Superor

E.

T ransverse

A

artcuar

70-year-od

owed

a

by

ture

te

A

o

as

te

tp

oowng

o

Dentcuate

Interspnous

Lgamentum

Nuca

E.

Posteror

weakness

cacanea

urnary

tat

se

s

n

o

and

was

an

process

o

key

a

pop

ower

unabe

avuson

C7.

o-

o

neck

to

Wc

tendon

te

Cauda

Obturator

equna

C.

Prorms

D.

Pudenda

E.

Scatca

an

tone,

past

urne

20

and

years.

s

pass-

123.

tng

urnary

spondyts

scan

more

dsease.

o

n

s

s

o

s

rgd

here

spne.

umbar

or

te

a

he

to

cuture.

tssues

second

neede

s

te

I

as

are

ts

regon,

a

o

pop

a

As

neede

te

te

structures

s

s

sampe

back,

he

a

te

resut

tssue.

key

s

rst

second

nto

te

eastc

most

A

obtan

pop.

gy

emergency

menngts.

ntroduced

rst

troug

to

suspected

perormed

lud

space.

oowng

te

brougt

o

ten

o

and

Wc

an

o

absent

te

A.

Dura

B.

Interspnous

C.

Lgamentum

D.

Posteror

E.

Supraspnous

A

pop

sub-

o

te

Wc

te

eastc

o-

wc

past

dagnosed

30

years,

wt

and

anky-

atey

s

ye a r

e

b oy

dagnosed

bone

as

to

n

wt

 a   u re

o

atera

o

but

aso

and

te

c u r va t u re

patent

brtte

n

bone

por tons

o s t e o p e t ro-

osteocasts

Te

re m o d e 

norma

 r a c t u re d

type

a

bone,

as

te

bodes

o

re s o r p t  o n .

dense

s t re s s e s

Wat

s

re s u  t

bone

ago,

gament

gament

te

ve r y

te

 a t e r a   y.

been

lavum

norma

ve r t e b r a 

te

gament

ongtudna

1 2 - ye a r - o  d

On e

pasy

te

mater

unctona

n

or

CT

reduced?

s

s

te

passng

because

dagnoss?

as

and

tat

d e ve  o p e d

numbness,

syndrome

man

et,

per orm

syndrome

67-year-od

be

troug

neede

ss,

Pysca

te

skn

mb,

severe

been

wtn

pernea

ower

as

o

erna

nerve

s

aracnod

emergency

story

Se

bateray.

key

te

ncontnence,

te

te

to

8-our

contro.

or

relex

most

brougt

eca

o

puncture

ndcates

o

te

prmary

gr

cerebrospna

pop

njured?

o

stragtenng

because

ntroduced

rac-

a

w

13-year-od

umbar

gament

retaned

recta

musces

B.

osng

or

o

A

becomng

tssue?

s

cannot

sows

poor

A.

A

woman

proessonay

badder,

ten

sows

most

et

back

we

s

T ertary

A

department

lavum

because

examnaton

owng

spnous

sustaned

He

and

neck

ongtudna

department

wegts

pato.

upper

dggng

s

e

emergency

gament

42-year-od

pan,

a

te

gament

D.

latus

te

njury

s

ower

to

gament

C.

ng

n

gaments

B.

back

was

s

an

or

pan

e

o

brougt

o

oundaton

A.

A

s

because

CT

E.

122.

man

ntense

posterory

move.

process

process

breatng.

cage

occurs

curvature

A.

n

rb

progresson

sgns

stragtenng

B.

D.

s

te

A.

dggng

121.

as

regon

mmedatey

ractured.

most

department

120.

and

toracoumbar

te

body

119.

1

bone

re s p o n s e

( Wo    ’s

o

two

bodes

dd

to

as

to

Law)

adjacent

coapsed

ts

p ro d u c e

spne?

A.

Kyposs

B.

Lordoss

C.

Prmary

D.

Scooss

E.

Secondary

E.

Osteoartrts

A n swe r s

Answers

1.

B.

1–25

Hyperkyposs

back”

ror

due

to

an

cur vature

s

c aracter ze d

abno r m a

o

te

nc reas e

tor ac c

by

n

re g on

a

“unc -

concave

afects

ante-

o

te

ver te br a

n

umbar

can

be

or

s

an

 n c re a s e

“s w a y b a c k ,”

c u r va t u re

pysoogc,

o

suc

te

as

spne.

seen

n

a

L o rd o s  s

p re g n a n t

woman.

C.

Scooss

rotaton

D.

Spna

by

s

o

a

bda

aure

atera

te

o

s

curvature

o

te

spne

wt

vertebrae.

a

neura

cosure

o

2.

B.

deect

vertebra

caracterzed

arc.

A

te

n

75;

crus

reated

entre

tat

t

N

vertebra

afects

ractures

body.

Bot

A,

162;

racture

sma

a

tube

te

a

degeneratve

cartage

to

te

o

dsorder

jonts

toracc

and

regon

tat

s

not

o

te

spne.

GAS

Hy p e r  o rd o s  s ,

s

artcuar

speccay

coumn.

A.

te

o

ABR/McM

s

body.

te

he

te

by

wedge

vertebra

around

tese

87

caracterzed

bodes,

permeter

ractures

compresson

racture

cause

but

o

s

t

te

o

smar

nvoves

vertebra

reductons

n

over-

egt.

C,

D.

Fracture

superor

o

te

artcuar

spnous,

suraces

transverse,

can

be

due

or

to

CHAPTER

an

obque,

transverse,

or

commnuted

as

racture.

E.

Intervertebra

ton,

3.

C.

o

not

dscs

GAS

78;

Te

gamentum

two

wa

adjacent

o

coce

bra

164,

te

are

168;

assocated

s

oramen.

gamentum

ABR/McM

ve r t e b r a e

n

92,

dsc

erna-

D.

and

orms

It

s

te

B.

wt

p re s e n t

E.

supraspnous

connect

D.

he

ony

te

cana

4.

C.

he

o

and

te

nterspnous

gaments

te

81–83;

dorsa

s

gament

connects

bodes

and

te

29;

posteror

above

te

ABR/McM

scapuar

nerve

responsbe

rombods,

or

retracton

extenson

eve

o

o

te

C7.

A.

te

ae

dspaced

remans

provded

tese

A.

by

oter

retracted

he

te

ventra

ramus

B.

major

C3–C4

nerves

axary

ts

due

by

te

trapezus,

scapua.

case,

to

spna

woud

rotates

nerve

C.

are

hereore,

te

evator

addtona

nerves.

not

he

te

te

detod

and

wt

to

a

detod

musce

te

D.

scapu-

D.

he

te

any

o

aso

contrbutes

spnas

nerve

E.

he

and

teres

ateray

and

GAS

te

s

te

ateray

91–92,

n

musces.

101;

N

te

468;

and

sensory

o

te

greater

dorsa

vrus

It

s

no

becomes

assocated

motor

soey

root

A.

ganga

actve

ony

o

te

he

te

but

or

as

he

ony

sensory

bers

he

and

atera

T1–L2

are

A

do

or

not

nerves

a

sem-

or

spna

natve

contans

musces.

98

regon

nerve

es

orn,

skeeta

umbar

oramen

dsc

dsc

roots.

drecty

between

Even

L4

toug

between

te

L4

L5

superor

spna

and

s

to

nerve

n

te

root

greatest

nterverte-

es

drecty

jeopardy

n

a

ernaton.

C.

suprasp-

skn

bers

s

eson.

and

coce

te

te

as

tat

s

are

sensory

efer-

E.

nerve

exts

between

L1

and

L2

nerve

exts

between

L2

and

L3

nerve

exts

between

L3

and

L4

nerve

exts

between

L4

and

L5

orns

ound

n

outlow

170,

165;

puncture

s

beow

L5

ts

te

or

ABR/McM

perormed

eve

o

te

spna

sometmes

regon

because

he

t

te

8.

B.

a

and

because

L1–L2

es

101–102

by

takng

cord)

a

sampe

between

between

te

and

te

between

he

L3

spna

dura

tese

he

te

he

verte-

and

cord

sac

areas

107,

a

he

o

L4.

It

typcay

ends

at

te

and

te

rsk

he

owest

D.

he

sacra

he

o

at

as

at

te

eve

at

te

te

L1–L2

te

eve

te

ends

ends

te

eve

spna

and

te

eve

o

o

eve

o

o

L1–

S2.

eve

o

L1–

S2.

o

L1–

S2.

cord

typcay

dura

sac

ends

S2.

N

170;

o

ocatng

ABR/McM

te

te

puncture;

te

o

ac

t

te

s

103

crests

poston

vertebra

anges

rbs

te

109,

ead

atus

o

are

te

dented

coumn

used

as

spne

o

and

(T uier

scapuae

e

at

traced

ne).

vertebra

s

one

to

ocated

T12.

ower

at

te

dsta

por-

sacrum.

posteror

GAS

te

ends

at

cauday.)

at

T7.

C.

ton

at

ends

ow

o

ponts

umbar

toward

sac

too

119;

or

ends

typcay

eve

neror

eve

E.

be

te

eve

sac

more

ends

typcay

dura

gest

meday

A.

cord

te

woud

at

sac

dura

spna

and

hs

or

cord

te

sgty

typcay

dura

spna

and

ends

cord

te

andmark

L4

cord

spna

ends

normaton.

sympatetc

N

space

and

n

at

L2

dorsa

vscera

spna

80;

GAS

wen

spna

L4

L4

L2

supraspna-

and

answer

ntermedoatera

responsbe

B.

100

panu

nerve

bers

contan

anteror

ABR/McM

te

root

te

spna

umbar

at

nnervaton

pregangonc

L5

spna

L3

he

L2

occpta

gangon.

Sympatetc

he

cdren

nraspnatus

ABR/McM

sensory

te

controng

171;

n

nerve

te

L2

done

umerus.

spna

presents

wt

nvovement.

responsbe

ent

C.

root

dorsa

and

o njurng te spna cord s mnmzed. (Remember n

neuraga.

nnervates

umerus,

rotates

te

occpta

nerve

he

skn

eve o S2. hereore, t s te saest pace to do te pro-

serratus

B. Herpes zoster s a vra dsease tat remans atent n

te

he

ends

ateray

te

many

nnervaton

addton,

nvoved

te

s

to

aracnod

teres

abducts

mnor

nnervates

nerve

nraspnatus

abducts

musce

5.

be

to

In

suprascapuar

natus

tus

capts.

can

D.

A.

occpta

skn.

o

o cerebrospna lud rom te umbar cstern (te sub-

scapua.

greater

or

or

N

wereas

L1

GAS

7.

anteror, wc unctons to protract and upwardy

rotate

he

cedure

nerve

back

dorsa

brances

vertebrae.

umerus.

toracc

te

secton

te

vertebrae.



nnervaton

Injury

present

nnervates

prmary,

ong

dsc,

brae

musces.

umerus

he

In

to

sma

n

sensory

vertebrae.

scapua.

mnor

B.

scapua.

unctona

resde

vertebrae.

ts nerve s damaged, ndvduas present wt a ater-

ay

parasympatetc

back.

te

spna

not

cutaneous

vrus

a

ernaton

posteroatera

103

(rom

asssted

o

112;

does

ts

orn,

ntervertebra

bra

and mnor and usuay te ower porton o te evator

he

te

afects

L4

te

nter-

o C5) s responsbe or nnervatng rombods

scapuae.

or

and L5 vertebrae, t exts rom te spna cana troug

vertebra

a

gament

N

L5

te

neurons

61,

Dsc

posteror

gament

supraspnous

GAS

E.

o

ventra

GAS

6.

dscs.

nuca

S2–S4

vrus

nnervate

motor

processes.

ongtudna

porton

vertebra

he

spnous

anteror

anteror

E.

he

ve r t e -

spna

transmt

musces

a n s we r

te

o

as

zoster

atoug

and

he

eves

Herpes

ram

posteror

ony

 y p e r t ro p  y

woud

amnae

stenoss.

A,

at

ramus,

w

te

te

contact

T  e re  o re

113

connects

cana.

d  re c t

avum

wt

ractures.

avum

ve r t e b r a 

tat

as

outlow.

compresson

N

we

21

Back

1

neror

117–118;

ac

N

spnes

161;

e

beow

ABR/McM

S2.

103

22

C H A P T E R

9.

A.

he

te

1

Back

anteror

vertebra

B.

he

two

adjacent

C.

he

nuca

te

he

spnous

(GAS

GAS

B.

Fgs.

81;

troug

te

a

A.

A

o

te

o

te

C.

nto

he

193;

or

not

amnae

contnuaton

C7,

o

wc

at

te

o

o

wa.

con-

s

a

not

s

asso-

A.

98,

102

B.

A

dsc

ernaton

nuceus

oramen.

responsbe

s

D.

or

nto

tor

E.

te

annuus

commony

o

te

bro-

ver tebra

bodes.

he

gament

traverses

te

a

he

p oster or

asp e ct

p os te r or

 e ngt

anteror

he

o

GAS

A.

he

dors,

and

ary

80;

one

te

B.

N

o

nerve

28,

te

ces,

164,

te

te

but

s

te

te

tat

umerus.

te

detod

he

ower

o

nerve

rotate

prmary

ABR/McM

nnervates

umerus,

rotators

can

168;

nerve

umerus.

axary

wc

te

amnae

o

he

dorsa

and

t

meda

D.

he

te

he

te

and

atera

nerve

can

te

o

te

as

a

n

te

91,

he

o

trceps

arm

he

eter

drecton

o

te

s

and

teres

trapezus

and

or

sometmes,

nner-

te

eva-

te

atssmus

T eres

not

C.

te

by

te

and

stes

teres

o

s

o

musces

mnor,

perormed

detod

dam-

ncude

abducton

rom

serratus

ossa

to

to

move

and

o

te

by

te

15

to

90

s

turn

above

anteror

mus-

superory

90

responsbe

and

degrees.

or

adducton

arm.

s

responsbe

mnor

s

adducton

or

extenson

o

not

responsbe

o

te

nvoved

or

umerus.

n

meda

hs

abducton

mus-

at

te

jont.

s

responsbe

o

te

or

umerus.

nvoved

n

meda

hs

rotaton

musce

abducton

at

te

s

and

tere-

genou-

jont.

711–712,

Spna

rom

hese

orearm.

and

major

144–149

common

degrees)

brac

and

are

orzonta, te scapua s upwardy

tereore

McM

14.

15

pectoras

mera

musce

abductor

course

responsbe

Intaton

coracobracas

GAS

detod

te

nraspnatus,

umerus

lexon

ore

nerve

suppes

musces

te

wc

rombods

eevate

and

and

o

101;

nnervates

and

s

depresses

skn

orearm.

N

te

responsbe

and

te

ents

717;

N

180,

409,

412–413;

ABR/

138

bda

s

ncompete

a

deveopmenta

uson

over

ebow,

414;

te

or

te

hese

trapezus

te

and

ABR/McM

are

dgts.

144,

146

Spna

CNS

aspect

neary

suc

ogc

B.

as

a

bda

terzed

nnervaton

musces

wrst,

wc

scapua.

posteror

asymptomatcay

stgmata

A.

nerve

nerve

extensors

GAS

te

adducton

te

scapua.

musces

arm

E.

or

pecto-

suppy

tora-

not

detod

nnervates

njures.

genod

genoumera

ax-

extend

s

and

ABR/McM

trapezus

te

te

te

umerus

known

scapuae

eevates,

rada

o

he

te

te

rotaton

umerus.

suppes

scapuar

accessory

retracts,

E.

Above

Wereas

subscapuar

te

C.

atssmus

wc

nerve

oowed

ce

not

te

nnervates

musces

rst

adducts,

musce

and

do

musces.

nerve

(SITS).

extends,

does

mastectomy

o

te

condton

vertebra

resutng

arces

wtn

te umbar regon. Spna bda occuta commony pres-

evator

retract

B.

103

te

umerus.

C.

A.

189;

cuf

(te

by

and

connect

musces

rotates

and

meda

he

traverses

N

souder

causng

te

nnervates

te

gament

a

ong

toracc

wa.

rombods

supraspnatus,

rotated

ve r teb r a

cana.

lavum

major

rotate

nerves

oter

durng

degrees.

vertebrae.

meday

adduct

ongtudna

vertebra

toracodorsa

meday

ra

te

gamentum

adjacent

11.

726;

supraspnatus,

on g tud  na

o

nerve

scapuar

te

subscapuars

o ny

o

o

rotator

aowng

engt

E.

he

te

cana.

D.

D.

age

pupo-

te

toracc

te

te

toracc

nerves

suppes

toracodorsa

umerus

s

toracc

aong

durng

remanng

te

nerve,

eve

scapuae.

GAS

cana.

 gamen t

aganst

ong

pro-

orzonta

dors.

com-

causng

nuceus

njury

te

serratus

and

musces.

dorsa

he

afected

te

to

nerve

accessory

he

te

poston

te

eevaton

toracodorsa

rom

te

atera

vaton

13.

o

dsc,

te

nerves,

or

supercay

subject

Asde

nnervates

beyond

sternocedomastod

genera,

be

ts

te

runs

axary

he

puposus

In

may

wt

s

te

he

ora-

scapua

nerve

and

nerve

responsbe

mantanng

Aong

aong

s

te

procedure.

coumn

roots.

ong tud  n a

spannng

spna

posteroateray

rupture

vertebra

o

toracc

te

toracc

wc

codorsa

gament

gament

dspacement

posteror

on

ntervertebra

te

brosus

nerve

s

es

ong

tracton

bodes.

te

ABR/McM

ntervertebra

dsc

he

anteror,

mnor

ernaton.

but

C.

2.38).

ntervertebra

gament

te

gament

(cardna)

and

nerves

spna

te

12.

wa

protruson

posteroatera

sus

above

vertebra

ongtudna

ernated

sus

and

dsc

ernaton

presson

te

annuus

cana

posteror

te

a

o

o

by

torn

spna

te

by

29,

ndcates

caracterzed

posteror

gament

uterus

2.35

Compresson

men

to

we

a

cervca

te

N

s

ongtudna

surace

wt

connects

anteror

coumn.

processes.

transverse

cated

es

vertebra

vertebrae.

gament

posteror

posteror

gament

te

lavum

supraspnous

he

E.

aong

gamentum

nects

D.

10.

ongtudna

bodes

by

tut

wt

o

wt

and

and

a

umbar,

sma

s

o

bot

oten

te

cutaneous

skn

myeomenngocee

protruson

tssues

mdne,

ar,

dmpe.

s

carac-

mennges

assocated

wt

and

neuro-

dects.

Menngocee

troug

te

mony

due

cyst

a

or

sac

s

te

sku

to

a

or

protruson

te

spna

deveopmenta

ed

wt

o

te

coumn,

deect,

cerebrospna

mennges

most

com-

ormng

lud.

a

CHAPTER

D.

Spna

bda

mennges

E.

Racscss,

wt

te

to

use

aso

spna

GAS

72;

and

cord

N

presents

te

or

164;

as

resuts

s

wt

unused

known

myeoscss,

ods

15.

cystca

troug

protruson

vertebra

spna

rom

a

spna

nerves

ABR/McM

bda

aure

caracterzed

by

and

o

te

18.

arces.

cord

neura

protruson

te

touc,

CNS.

temperature,

Aferent

B.

Somatc

C.

Vscera

bers

o

mennges.

eferent

bers

aferents

regardng

te

proprocepton

convey

motor

generay

pysoogc

sensory

canges

to

B.

stmu.

te

D.

to

dac

eferents

tree

musce,

nervous

and

s

o

nterna

wereas

E.

wt

musce,

to

cardac

te

tree

car-

Somatc

and

o

te

16.

E.

nterna

nto

A.

and

and

o

and

te

ts-

te

ganduar

B.

anteror

C.

he

two

adjacent

D.

he

subdura

dura

GAS

107,

ament

dsc

he

o

te

o

te

te

o

te

um

conus

o

L1

te

and

termnae

conus

L2

n

te

nternum

meduars.

at

te

eves

o

T11

and

cord

s

present

at

te

eves

o

T11

and

meduars

s

oten

stuated

at

L3

n

meduars

s

oten

stuated

at

L3

n

pexus

(o

ongtudna

vertebra

te

Batson).

te

119;

ony

N

as

170;

te

a

aracnod

potenta

D.

A.

o

aspect

s

B.

and

o

Wt

puposus

te

ony

C.

g-

he

vertebra

te

te

spnous

nterver-

vertebra

bodes

tus

te

woud

supraspnous

runs

to

te

81–82;

N

s

a

externa

near

te

contnuaton

te

occpta

ABR/McM

to

to

oss

o

woud

ead

to

oss

o

spna

artera

nerves

but

suc

woud

are

constrcton

not

and

ave

reated

te

pan-

dgts.

o

te

accessory

nerves

and

woud

trapezus

N

175;

s

C3

major

ramus

o

ABR/McM

nnervated

to

s

by

prenc

nerve,

C5.

nnervated

C5

100–101

te

wc

by

a

branc

contrbutes

to

o

te

te

bra-

pexus.

anteror

ram

o

s

nnervated

C5,

6,

and

7

by

brances

wc

o

te

contrbute

to

pexus.

ram

s

nnervated

o

C5

and

by

C6

brances

rom

te

o

te

braca

dors

ventra

ram

s

o

nnervated

C7

and

C8

by

brances

rom

te

o

braca

he

ments

to

161–162;

N

gamentum

ound

te

n

anteror

greaty

te

196

lavum

aspect

o

tckened

smutaneousy

s

vertebra

te

n

one

o

cana

vertebra

spna

removed

te

and

upon

s

two

ga-

aderent

arces

patoogy.

excson

and

It

o

s

te

amna.

posteror

gaments

30;

connect

vertebrae.

gament

ganga,

outlow

ead

sternocedomastod

rom

braca

GAS

C.

he

adjacent

woud

roots

o

te

te

Latssmus

E.

o

n

Supraspnatus

tus

gaments

trunk

sympatetc

roots

consequences,

36–37;

Serratus

he

lavum

ner-

vasoconstrc-

pexus.

processes

traverses

and

dorsa

dvson

arses

te

21.

gament

or

pexus.

E.

posteroateray.

connects

101

autonomc

sympatetc

te

ventra

o

Rombod

D.

nuca

o

dapragm

ventra

ntervertebra

o

seected

dvson

Surgca

ventra

103

te

responsbe

decrease

ncreased

ventra

mater

space

te

actvty.

scema

te

ABR/McM:

dscs.

protrudes

te

te

wc

lud.

gament

posteror

nuceus

gamentum

o

ABR/McM

o

mbs.

Surgca

ca

ongtudna

o

prmary

Separaton

GAS

20.

gaments

amnae

169–170;

dvson

musces.

at

vertebrae.

sde

E.

bodes.

connects

cerebrospna

te

s

Separaton

u

dura

contans

165,

woud

upper

oten

GAS

and

Atoug

eve

present

N

Dvson

to

te

ventrces

between

vertebrae,

between

exsts

te

anteror

amnae

101;

system

not protect te spna cord rom drect compresson.

and

te

a

spna

sensaton.

subarac-

ventrces

rom

venous

ongtudna

usuay

anteror

te

equna

sympatetc

denervate

te

lavum

supraspnatus

he

o

ntervertebra

adjacent

lows

te

postoned

space,

109,

ernaton,

tebra

C.

and

C.

canges

vertebrae.

contan

spannng

wtn

wt

posteror

engt

posteror

bodes

dsc

and

mater,

not

normaton

space).

vertebra

gamentum

does

he

A.

te

motor

pysoogc

D.

ound

lud

space,

he

and

s

perosteum

B.

convey

transmt

contnuous

nterna

traverse

he

unwanted

lud

s

epdura

and

at

meduars,

termna

s

conus

owever,

6

subaracnod

he

he

ton.

dever

vscera.

N

(cerebrospna

te

mater

B.

bers

aferent

31–33;

space

bran

17.

eferent

cerebrospna

nod

te

cord

conus

motor

vscera

GAS

conus

o

termnaton.

rests

beyond

spna

he

vous

autonomc

types

A.

epteum.

E.

he

GAS

19.

Vscera

eferents

musce,

unc-

musce,

epteum.

vscera

uncton

motor

smoot

ganduar

motor

smoot

autonomc

tssue:

assocated

system,

autonomc

dever

types

nnervaton

sue:

cauda

spna

te

newborns.

Vscera

ton

neror

usuay

beow

he

o

projecton

newborns.

vscera.

D.

ocaton

T12.

normaton

o

te

T12.

normaton.

carry

ts

te

extend

A.

ony

at

adut,

93

and

carry

s

conca

meduars

A. Somatc aferents are responsbe or conveyng pan,

pressure,

hs

tapered

cystca

o

C.

23

Back

1

98

C7

o

vertebrae

protuberance.

A.

he

anteror

ongtudna

anteror-most

C1

to

ected

te

by

a

aspect

sacrum

o

and

gament

te

woud

amnectomy.

runs

vertebra

aong

coumn

tereore

be

te

rom

una-

24

C H A P T E R

B.

1

Back

Dentcuate

rom

te

to

D.

te

gam e n ts

pa

mater

aracnod

he

at

gament

eve

and

he

to

s

N

not

29;

 orame n

posteror

rom

C7

te

to

A.

ongtudna

externa

s

a

an

ga-

anteror

be

to

nvoved

space

at-ed

s

n

spna

cord,

extendng

to

C1

extends

troug

mennges,

hs

cana

te

te

spna

answer

s

vertebrae,

cord,

coce

ongtudna

and

does

cana

contanng

assocated

not

tat

te

descrbe

a

he

A.

nterna

vaveess

nay

D.

he

network

aong

does

vertebra

not

te

he

te

he

te

nterspnous

adjacent

B.

he

C.

he

te

most

and

can

eve

o

ment

w

be

ormed

body

E.

he

or

to

GAS

24.

B.

he

CNS

mater.

te

space

pressure

drected

and

te

te

to

are

o

te

because

ateray.

extends

vertebra



n

ts

at

ongtudna

vertebra

te

extends

gament

o

transverse

29,

n

165,

arteres

cervca

most

Answers

26.

te

processes.

167;

run

vertebrae

cosey

176;

s

rom

ga-

s

were

te

te

eve

procedure

case,

cranay

dened

to

not

as

eter

drecty

spna

to

te

w t

cur va -

convex ty) .

torac c

t s

111

pr  mar y

and

p ate nt’s

s acr a

c n ca

a

atera

devaton

o

te

sp-

sde.

o

assocated

wt

a

dspacement

coumn.

s

an

ncreased

posterory)

secondary

afectng

te

curvature

cervca

and

regons.

ernated

te

nto

he

(CN

dsc

s

a

rupture

ntervertebra

te

75;

N

vertebra

162;

o

dsc,

dspacement

accessor y

XI)

resuts

but

per-

ema-

te

ony

and

n

te

annuus

commony

o

te

bro-

causng

nuceus

a

pupo-

cana.

ABR/McM

ne r ve

trape zus,

musce

to

to

can

te

te

test

patent

resstance

ng

s

87

te

o

te

wos e

te

cn  c a

sr ug

er

p o nt

o

or

os s

o

due

o

to

XI

p aray s s

te

soude r.

te

MRI,

ne r ve

as

and

CN

by

soude r s

tr ap e z  us ),

ne r ve

re p re se nt

te

t s

e r

aga n st

c r an a

tra p e z us

b er s

o

nd ngs

 s

te

ead

he

s up er or

te

te

s ou de r

nner vat on

to

e e ve nt

bot

m us c es .

rase

(testng

or

s

nner vate s

droopng

addton

we 

res  stan ce

In

o ne

as k ng

aga ns t

as

turn-

(te s t ng

te

sternocedomastod ) .

A.

vertebra

rom

cervca

ABR/McM

troug

C6

98–99,

(poste r or

  ke y

tat

cervca

he

toracodorsa

dors,

wc

as

nerve

no

nnervates

drect

acton

te

on

atssmus

te

souder

grde.

ower

assocated

te

aderent

nc reas ed

c o um n

o

costo-

cord.

ABR/McM

an

te

artery

musces.

are

spna

artery,

26–50

B.

te

C.

regon

te

troug

wt

102,

103

transverse

C1

njury

and

to

are

te

he

dorsa

musces

D.

N

te

very

rom

vertebrae.

sma

aspect

neck

asso c  ate d

posteroatera

gament.

gament

vertebra

tereore

A

sus

o

aong

bodes

perormed

correct

asprated

te

ocated

gament

posteror

as

correct

ventray.

ony

were

o

te

rom

very

arteres

a

artery

spnous

connectng

not

generay

te

E.

tese

GAS

structure

eve

are

and

he

at

s

te

sus



s

(concave

101

neede,

ts

deep

mos t

Hyperordoss

cerebro-

te

s

a

usuay

subcavan

o

arses

aso

spna

spna

te

posteror

sternocedomastod

ony

s

D.

space.

connects

ts

o

assocated

Spna stenoss s a narrowng o te vertebra cana

and

between

Normay,

te

29,

s

o

s

tyrod

aspect

artery

s

suppy

N

coumn

and

contanng

te

sku.

81–83;

oramna

L5.

ces

nuca

space

wtn

he

aspect

ncorrecty

anteror

te

at

T12

punctured

supraspnous

true

ABR/McM

ongtudna

present

topoetc

to

gaments

reaced

C.

coce

o

potenta

penetrate

at

na

ongtud-

answer

anterory

drecty

artery

trunk

and

aspect

and

umbar

gament

puncture

L4

s

a

subaracnod

anteror

be

Lumbar

hs

to

cur vature

Scooss

mosty

processes.

termnate

anteror

a

vertebrae.

spnous

extendng

ound

due

gament

te

S2.

s

166;

w

dentcuate

tey

D.

te

N

supraspnous

o

s

s

space.

aracnod

used

n

s

o

space

104;

mdne,

It

pexus

cana.

specc

eve

te

are

lud

57,

processes

te

and

ayers

GAS

n

te

vens

space

lud

subdura

spna

A.

to

dura

two

23.

a

subaracnod

extends

E.

o

vertebra

descrbe

cerebrospna

venous

ocated

not

condton.

space.

B.

aong

te

regons

s

s

neror

anteror

cervca

102;

o

hs

specc

te

Hype rkyposs

ture

gaments.

te

posteror

GAS

B.

cervca

o

trunk

posteror

25.

vertebra

deep

he

te

rom

on

vertebrae

E.

and

vertebrae.

branc

courses

artery

cord

tyrocervca

he

amnectomy.

superca

te

ascendng

cervca

103

ound

space

te

wt

runnng

answer

spna

spna

he

te

occpta

ncorrect

te

sma

D.

s

anteror

aong

magnum

sacrum.

he

he

troug

supraspnous

te

ABR/McM

epdura

It

a

gament

woud

spna

o

ocated

81–83;

mater.

te

A.

t

tus

GAS

dura

te

e x te ns ons

mate r

(non).

crucorm

because

s

contnung

te

protuberance

he

C.

 rom

ate ra

d ur a

C.

nuca

ment

22.

mater

te

T12.

extenson

E.

are

to

he

greater

nerve

E.

he

scapuar

and

axary

and

te

nerve

It

s

not

GAS

101;

N

nnervates

evator

nerve

a

te

140,

rombod

prmary

aspect

detod

n

te

scapuae

branc

nvoved

138,

s

posteror

s

nnervates

musces.

89,

te

occpta

nnervatng

pexus

nerve

usuay

o

o

te

and

souder

183;

musce.

a

sensory

te

scap.

braca

teres

mnor

eevaton.

ABR/McM

100

CHAPTER

27.

B.

he

dens

transverse

anterory

ment

o

te

gament

ateray

dens.

hs

to

o

te

prevent

gament

atas

ancors

posteror

as

been

te

B.

It

dspace-

torn

n

ts

C.

he

C.

he

anteror

anteror

o

he

E.

he

te

A.

paced

68,

N

s

o

cana

te

s

and

contracton)

n

and

not

te

does

te

te

afected.

not

ocated

D.

not

back

and

above

te

musce

lexon

C.

Rombod

D.

Rombod

E.

T eres

nerve

uar

nerve

and

toracs

wt

major

and

extenson

eve

s

o

o

31.

C7.

nnervated

rotaton

(batera

s

to

by

woud

A.

(un-

to

by

te

dorsa

GAS

89,

he

ment

dorsa

B.

s

rotate

scap-

C.

scap-

ound

te

at

pedces

A.

be

101,

sku

and

N

base

and

te

s

ABR/McM

te

a

te

It

dens.

spna

39,

transverse

stabzng

C1/C2.

stabze

severs

171;

caed

gament

eps

oten

122;

(aso

atas)

te

gament

can

91,

Rupture

cord

and

138

to

o

are

vertebra

arces

mentum

lavum

te

vertebra

ated

wt

bony

to

te

runs

cana

te

structures

te

L5

ts

he

nuca

vertebra

on

and

amnae

te

s

body.

posteror

more

tan

to

he

B.

o

o

s

a

ongtudna

C.

te

extenson

D.

he

and

30.

A.

or

s

o

te

meda

te

te

most

posteror

spnous

to

te

aspect

o

te

processes.

ongtudna

anteror

nous

processes

GAS

68;

N

ocked

tons

gament

aspect

o

te

extends

vertebra

te

cana

acets,

tan

oter

condton

te

Due

te

ockng

te

te

to

more

cervca

vertebrae.

o

known

as

te

rom

C7

orzontay

vertebrae

hs

can

dspaced

“jumped

are

E.

ead

to

acets.”

dsoca-

o

artcuar

tey

sacra

vertebrae

because

tey

ABR/McM

epdura

91,

space;

ematoma

space,

n

113

ence

ts

te

beed-

space.

contanng

emorrage

te

woud

ntracerebra

woud

rom

superor

cana

cerebrosp-

a

most

resut

torn

sagtta

key

aneurysm.

most

key

cerebra

snus

ven

wtn

te

be

L2,

L2,

N

L2,

S1

ext

L3,

w

as

L4

te

te

gray

o

conus

cauda

end

matter

te

sub-

meduars

o

te

sub-

descends

te

L5

ext

vertebrae.

te

L5

te

In

verte-

an

spna

between

L4

L4,

nerve

and

L5

eve.

nerves

ave

aready

exted

ave

aready

exted

ave

aready

exted

ernaton.

spna

o

L4

102

nerves

named

spna

L4

eve

spna

ernaton,

t

o

eve

ext

ter

dsc

eve

and

te

te

enargement

ABR/McM

regon

beow

and

te

an

and

175;

and

L3,

s

between

cord

beow

te

wtn

space.

afected

L3,

ocated

cstern

space

umbar

to

s

cord.

spna

coumn

A.

80,

Posteror

nerves

ernaton.

spna

o

nerves

ernaton.

beow

n

111;

te

te

musces

atera

he

N

164,

ntercosta

extendng

oter

L4,

L5

ntervertebra

dsc

toracc

and

regon,

ateray

sted

lexon

170

arteres

are

o

subscapuar

not

te

suppy

wc

bendng

te

are

te

responsbe

deep

back

responsbe

trunk.

or

he

extenson

trunk.

artery

suppes

te

subscapuars

musce.

he

toracodorsa

artery

suppes

te

atssmus

dors.

C.

tgty

processes

te

ts

because

beed

te

ntervertebra

or

one

orented

ess

artcuar

o

o

to

eves

vertebrae

ematoma

spna

104;

te

GAS

33.

B.

dspacement

anges

ower

ernaton.

nerory.

98

anteror

In

and

vertebrae

at

sacra

ruptured

umbar

musces

pedces.

ABR/McM

s

vertebrae.

wt

o

30;

Spondyoyss

more

he

above

o

he supraspnous gament s ocated aong te sp-

artcuar

a

aong

posteror

engt

E.

on

te

venous

centra

te

above

assoc-

pedces

167;

te

a

enters

above

ga-

aspect

cosey

te

te

E.

gament

runnng

vertebrae

rom

a

vertebrae

te supraspnous gament rom C7 to te occput,

bot

t

woud

tereore

connectng

n

subdura

he

bra

vertebrae.

B.

D.

A.

pedces

te

subaracnod

GAS

32.

ata.

he

A

o

gament

attaces

n

N

cause

aracnod

te

ga-

susceptbe

pressures

sagtta

te

subaracnod

o

E.

adduct

somewat

te

vertebrae

rbs.

sku.

subscapuar

and

toracc

te

togeter.

mater

rom

scapuae.

ower

n

seen

aracnod

crucorm

o

he

A

te

It

o

na lud s ocated between pa and aracnod mater.

scapuae.

te

te

te

meday

te

by

adduct

nnervated

serves

n

posture.

te

te

togeter.

83–84;

dura

umerus.

C.

not

ng

as

by

adduct

to

ound

seen

used

te

lexon.

nnervated

serves

s

and

are

o

n

actor

D. he nterna vertebra pexus (o Batson) surrounds

contracton)

mantan

nnervated

serves

and

s

musce

to

neck

s

mnor

major

nerve

s

are

98

contraatera

unctons

assocated

uar

It

te

not

GAS

ongtudna

because

used

resut

ocostas

deep

29.

vertebrae

spne

s

are

neck.

he

It

contact

aong

common

stabzng

acets.

posteror

E.

s

ABR/McM

unctons

s

on

on

vertebrae.

a

sternocedomastod

XI

and

runs

dens.

gament

30;

and

ound

gament

gament

69;

gament

vertebrae

vertebra

supraspnous

he

te

te

lavum

processes

nuca

GAS

o

o

supraspnous

spnous

atera

te

anterory

D.

CN

aspect

gamentum

aspect

te

ongtudna

ess

te

probem

A.

B.

muc

to

Lumbar

njury.

28.

s

due

25

Back

1

he

anteror

ntercosta

D.

he

tus

suprascapuar

and

GAS

ntercosta

suppes

te

upper

nne

te

supraspna-

spaces.

artery

nraspnatus

102–103;

N

suppes

musces.

168,

197

26

C H A P T E R

34.

A.

1

he

sbe

Back

atantoaxa

or

rotaton

extenson,

B.

Te

n

or

jont

o

te

s

a

synova

ead,

not

jont

lexon,

respon-

exon

and

D.

jont

s

extenson

prmary

o

te

ead

on

toaxa

D.

he

lexon

jont

and

GAS

D.

he

na

to

rate

69;

te

were

te

he

spna

B.

he

pa

C.

he

na

26,

by

atan-

s

s

te

wc

aracnod

woud

es

(o

nvoved

te

te

n

not

to

112

pass

reac

T o

te

te

wtn

te

asp-

te

dura

ocated

o

te

E.

he

gamentum

GAS

E.

he

o

te

he

o

te

te

te

rb.

own

on

te

ead

he

39.

sp-

A.

dura

ts

our t

body

to

jont)

s

unt,

te

nto

te

rb

as

ton

wt

T4.

he

neck

o

a

o

te

T3

C.

he

D.

he

acet

te

ead

artcuates

 or ms

ve r teb ra,

ve r te b ra

 t

rb

o

w t

o

he

wt

nod

so

and

as

a

A.

ead

GAS

he

meda

o

te

ourt

trd

o

w e n

te

move

one

at-

as

rb

w

a

not

te

rb

w

trd

key

rb

not

w

be

A.

he

B.

he

o

te

te

N

major

rotaton

teres

lud

not

o

192;

s

te

mnor

s

ABR/McM

he

na

responsbe

or

te

adducton

and

responsbe

atera

rotaton

ebow.

brac

responsbe

or

extenson

o

adducton,

scapua

and

o

te

pane.

or

s

te

rst

15

104–106

per ormed,

gamentum

te

Te

w  e re

umbar

te

avum,

aracnod

space

subaracnod

pexus

mater

s

n

te

aderent

lavum

mater

te

c e re -

cstern

space

(o

s

b e  ow

Batson)

epdura

to

s

te

a

te

es

exter-

space.

spna

ocated

ongtudna

o

te

N

cord.

deep

space

gament

vertebra

174;

space,

ocated

to

te

ep-

and

s

ABR/McM

te

lud

can

attaced

pa

103

te

and

crcuates

be

to

bodes.

contanng

between

space

epdura

nterna

cerebro-

te

arac-

wtn

asprated

ony

te

rom

and

s

te

does

not

space

vertebra

ste

to

contan

contans

venous

nject

an

cerebrospna

te

epdura

pexus

anestetc

at

(Batson

or

ep-

anestesa.

subdura

he

space

does

subdura

te

dura

pretracea

not

space

and

space

s

contan

ony

aracnod

does

not

a

cerebrospna

potenta

space

mater.

contan

cerebrosp-

lud.

te

centra

substance

GAS

s

and

rom

o

te

lud

ts

cana,

spna

contaned

cord,

extracton

space

woud

does

o

resut

wtn

contan

cerebrospna

n

spna

cord

njur y.

umerus.

trceps

te

cerebrospna

he

te

lud

or

te

ABR/McM

nay

aspect

cerebrospna

umerus.

a

umerus.

abducton

p u n c t u re

117–119;

Atoug

102

o

or

te

responsbe

vertebra

epdura

lud.

D.

not

ocaton.

he

be

o

durng

ocated.

dura

s

mater.

dura

njured.

key

rotaton

mnor,

adducton

responsbe

422;

te

mater

109,

vens)

be

atera

or

rotaton

eevator

s

subaracnod

and

ar t cua-

key

te

space.

lud.

E.

126–127;

teres

te

between

tuberce

o

posteror

he

cos to tr ans-

r b

ony

ts

ve r teb r a

s

posteror

he

B.

te

ud

pa

spna

ar tcuat on

te

o

105–107

or

teres

orzonta

and

gamentum

C.

te

subaracnod

he

GAS

njured.

E.

m a t e r,

nterna

to

te

40.

413,

he

E.

s

an

te

D.

vertebra).

supe-

s

C.

ourt

te

15

umerus.

penetrate

te

dura

neror

(te

wt

pon ts

T4

te

acet

jo nt

te

te

wt

rotator

ABR/McM

responsbe

te

umbar

subaracnod

tub e rc  e

njured,

wereas

artcuates

wt

na

acets.

body

rst

meduars.

he

ead

te

above

artcuates

rb

on

two

on

consderaton,

tw o

orms

rb

and

neror

rb.

as

acet

te

s

o

scapua

N

a

must

dura

conus

wt

te

abducton.

contnuaton

njured.

37.

717;

re a c 

B.

rb

vertebra

neror

t

te

te

ourt

te

te

space.

superor

vertebra)

o

vertebra

ead

and

verse

T4

and

te

rb

(te

wtn

atera

wt

meda

above

o

Wen

te

te

or

umerus.

responsbe

supraspnatus

neede

102

artcuates

o

te

vertebra

rb

o

(te

ead

wt

wt

ocated

epdura

vertebra

body

s

ABR/McM

he

acet

T4

o

ourt

te

vertebra

te

acet

ter

to

lavum

175;

artcuates

artcuates

ror

B.

N

toracc

t

T akng

A.

deep

superor

acet

rb

sac

104;

T4

rb

ts

he

degrees

sac.

wtn

te

umerus

neede

sac.

a

413;

s

dors

and

trapezus

GAS

surace

major

rotaton

rotates

epdura

dura

te

s

(aong

atssmus

he

exter-

accumuate.

te

teres

he

D.

es

responsbe

o

ere).

he

C.

180,

umerus

meda

s

N

extenson,

space.

must

717;

nraspnatus

b ro s p  n a 

dura

36.

te

A.

sac.

D.

o

neck.

ead

Batson)

wtn

on

s

o

epdura

ocated

mater

on

ABR/McM

lavum

ocated

he

dsocaton.

pyscan

bood

cord

prmary

pexus

n

te

mater

cord,

afected

ead

jont

28–29;

gamentum

A.

s

te

reducton)

mater

bood,

te

o

vertebra

dura

excess

troug

space

22,

nterna

te

not

s

abducton

nraspnatus

GAS

B.

coce

jont

atantoaxa

N

s

o

umerus.

dsocaton.

(atera

by

ead

extenson

Adducton

afected

35.

te

atantooccpta

lexon

E.

o

supraspnatus

he

 n vo  ve d

38.

Latera

he

degrees

adducton.

atantooccpta

neck.

C.

C.

abducton,

41.

A.

109;

Genera

te

skn

o

N

120;

somatc

te

back

ABR/McM

aferent

va

te

101

bers

dorsa

are

conveyed

ram.

rom

CHAPTER

B.

Communcatng

eferent

aferent

C.

mbs

D.

bers

V entra

nerves

he

ram

(sympatetc)

o

ram

te

to/rom

a

ventra

mxed

oter

te

roots

genera

and

autonomc

convey

excudng

contan

bers

nervous

sensory

parts

vscera

genera

o

B.

In

aow

system.

and

te

45.

vscera

A.

o

and

C.

ony

eferent

(motor)

GAS

42.

D.

L2

he

A.

regon

L3–L4

o

te

ABR/McM

s

te

s

a

s

D.

s

te

ram

o T1–T11.

subcosta

E.

GAS

any

ocated

coce

at

tat

te

L1–

46.

contans

ocaton

cauda

to

to

te

perorm

apex

o

umbar

te

L3

s

cauda

to

te

conus

meduars.

C.

L4

s

cauda

to

te

conus

meduars.

E.

T11

GAS

D.

superor

101;

N

Because

ncuded

ton

s

a

to

169,

te

n

n

ocated

n

tass

te

conus

170;

te

and

protr uson,

cassc

Avuson

truson

B.

101

B.

o

cord

patent’s

spna

are

bda

C.

tants

o

cord

by

A

nvove

pro-

It

or

does

resut

o

te

mennges

numerous

not

n

cause

oter

rr-

deormaton

protruson

o

occuta

n

wc

te

tut

s

a

te

normay

vertebra

durng

o

ar

afected

s

embryoogc

commony

regon

spna

(usuay

a

tssue,

contans

t

s

ony

known

as

spna

bda

Somatc

cay

A.

rom

w

D.

aferent

body

bers

wa

aferents

present

convey

as

du

and

bers

pan,

typ-

C.

Pan

rom

nervous

tese

and

do

bers

not

are

bers

vscera

eferents

normaton.

GAS

31–33;

due

to

te

orentaton

o

te

to

te

orentaton

o

te

ABR/McM

a

can

(Batson)

vaveess

space

o

provde

rom

low

87

venous

te

o

network

te

a

route

s

vens

vertebra

prostate

bood

venous

o

or

or

te

cana.

metas-

breast

to

bdrectona

te

due

o

te

s

nterna

rreevant

ncorrect

because

pexus,

one-way

vertebra

to

te

te

n

nterna

genera,

movement

o

venous

queston.

vertebra

does

not

ave

bood.

te

he

epdura

nterna

wtn

104;

N

te

o

te

not

te

venous

epdura,

175;

acromon

part

space,

vertebra

not

ABR/McM

(te

gest

scapua

tat

subaracnod.

(Batson)

te

pexus

subdura

s

space.

102

pont

orms

o

te

te

souder)

“pont”

o

te

superor

he

near

genod

ead

he

A

C.

o

te

be

te

o

to

te

scapua

s

back.

scapua

artcuates

orm

ocated

192,

nerves

atssmus

ntact

w

and

te

wt

genou-

and

ossae.

409

rom

be

posterory

nraspnous

C6

and

nerve

beow

w

(C7–C8)

be

wc

ost.

sternocedomastod

because

tey

are

musces

nnervated

by

te

nerve.

ntact

and

sternocedomastod

because

tey

are

musces

nnervated

by

te

nerve.

dapragm

nerve

36,

s

and

toracodorsa

trapezus

be

scapua

N

spna

trapezus

he

te

te

umerus

supraspnous

te

so

he

o

ange

o

jont.

accessory

sensor y

te

702–711;

he

meda)

mdne

ossa

o

spne

o

w

(or

te

suppy

s

w

work

derved

propery

rom

te

as

ts

prenc

motor

nerve

(C3–C5).

Parasympatetc

vscera

he

w

nnervaton

contan

s

(Batson)

accessory

pregangonc

bers

162;

pexus

or

nnervates

B.

motor

te

he nterna vertebra venous (Batson) pexus s ocated

GAS

D.

sys-

dfuse.

convey

vaves

separates

normaton.

E.

s

mera

musce.

Sympatetc

hs

te

A.

autonomc

o

due

epdura

engt

afected,

ocazed

orentaton

pressures.

ocated

wt

mbs.

te

he coracod process s ocated more neromeday.

but

93

convey

and

normaton.

eferent

skeeta

eferent

ABR/McM

to

he

to

48.

164;

sensory

Somatc

to

N

te

Vscera

tem

B.

72;

orentaton

B.

umbar

mennges

te

A.

growng

mdne

to

souder.

deveop-

seen

due

due

vertebra

te

he

te

D.

protruson

CNS

GAS

C.

s

asymptomatc

amnae

E.

N

because

GAS

47.

mted

(e.g.,

ocated

menngocee.

44.

E.

poston).

te

no

vra,

or

not

cord.

nlammaton

competey

over

I

an

bood).

bda

ment.

E.

s

vertebrae

condton

n

spna

woud

contents.

Spna

use

mennges

s

te

o

wtn

bactera,

(e.g.,

te

te

mted

cancer

vaves

wt

s

genera,

venous

cond -

vertebrae

acets.

(Batson)

spna

te

presentaton

te

Menngts

caused

C.

o

o

o

oca

A.

meduars.

ABR/McM

mennges

to

myeomenngocee.

A.

ack

mted

umbar

rotaton.

acets.

nterna

pexus,

s

te

and

acets.

mted

62–69;

he

bran)

B.

s

D.

he

conus

meduars.

43.

Adducton

artcuar

99

s

lexon,

acets.

Inverson

nerve.

answer.

common

t

s

usuay

tereore

correct

but

ventra

T12

meduars

eve;

puncture,

are

ramus

31–33;

conus

vertebra

ts

nerves

ventra

atera

extenson,

artcuar

artcuar

Intercosta

he

te

artcuar

contan

to

lexon,

Abducton

back.

bers.

E.

or

Crcumducton

motor

trunk

addton

27

Back

1

pregangonc

and

do

not

bers

contan

are

aso

sensory

E.

he

detod

motor

rom

N

6

GAS

w

suppy

C5

91,

and

101;

not

s

C6.

N

be

rom

414

afected

te

because

axary

ts

nerve

nerve

derved

28

C H A P T E R

49.

C.

1

Spna

Back

bda

menngocee

cystca

or

reers

to

spna

myeomenngocee

bda

and

s

wt

te

a

E.

Intercostovertebra

correct

tebra

answer.

A.

GAS

Cranum

n

B.

te

sku,

back.

Spna

but

bda

s

a

deect

and

be

n

does

cord,

regresson

and

o

te

menngocee

GAS

72;

N

bood

ocated

n

te

not

te

ormaton

usuay

te

ower

ower

or

52.

o

o

obque,

Pett

A.

hs

and

s

Cauda

and

o

and

ABR/McM

(o

te

space

te

s

wt

oss

spne,

not

reated

n

or

A.

ts

not

by

ormed

s

a

te

to

by

a

possbe

best

ste

answer

crest.

C.

D.

a

tumor,

An

ndrect

na

cana

A

drect

as

tumors

nguna

o

te

nterna

o

D.

loor

(Hessebac)

to

be

s

o

ocated

te

n

te

anteror

A

erna

occurs

beow

ngu-

areas

nguna

or

abdomna

te

N

161,

180;

ABR/McM

nguna

51.

105

to

hs

queston

dsc

te

ernatons

nto

cana.

he

eray,

were

te

and

tebra

dsc

te

te

posteror

wen

annuus

so

nuceus

s

te

puposus

te

oramen

protruson

s

s

gament.

most

or

vertebra

renorced

he

te

key

neror

ocaton

he

pa

mater

mantan

B.

ancor

spna

space.

he

oramen

vertebra

spna

pace

o

o

are

te

atera

dura

n

extensons

mater,

poston

and

s

passes;

te

cana

we

t

s

ts

not

te

troug

may

most

a

aso

be

a

ste

acets

processes

o

te

te

ocatons

vertebrae

were

artcuate

te

artcu-

wt

eac

by

anestes-

and

to

cdbrt.

te

opens

sp-

epdura

between

te

are

and

ocated

are

not

on

te

papabe

ram

are

o

te

sacra

openngs

nerves

ext

oramna

nerves

are

ext

te

n

openngs

cervca,

to-

regons.

sacra

he

B.

s

N

crest

s

166;

crana

to

ABR/McM

te

55,

te

njecton

95

typca

o

he

o

66;

o

metastass

o

metastass

o

metastass

N

27,

and

deep

hs

scapuar

he

o

to

nerve

spne

n

te

cervca

spne

n

te

cervca

spne

n

te

cervca

spne

as

te

s

passes

most

afected

te

te

supe-

transverse

n

queston.

bend

to

be

key

n

te

ax-

subscapuars

protected.

posterory

s

te

superor

runs

wc

89

troug

descrbed

tereore

space,

o

te

dsta

troug

to

te

te

superor

nerve

orgnates

braca

pexus,

rom

wc

te

s

poste-

dsta

to

racture.

suprascapuar

combnaton

bend

wt

te

to

te

be

protected.

GAS

cervca

notc.

cord

he

te

ABR/McM

superca

nerve

subscapuar

ste

te

n

passes

nerve

es

woud

quadranguar

164;

nerve

scapua

and

axary

n

pedces.

metastass

toracodorsa

he

bran

metastass

pedces.

notc,

artery

o

recenty

eter

pedces.

pace

te

pace

wo

to

pedces.

pace

gament.

women

pedces.

pace

60,

n

metastass

vertebra

pace

vertebra

musce

E.

he

vertebra

scapuar

te

suggests

suprascapuar

ary

D.

tenderness

vertebra

typca

te

runs

are

wc

sacra

perneum.

andmarks.

spna

vertebra

racture

wc

key

te

te

used

abor

oramna

dorsa

papabe

spne.

typca

scapuar

o

te

he

ror

o

ernaton.

oter.

A.

ep

wtn

bock

rom

sacrum

sacra

cancer

typca

te

ror

compresson,

Artcuar

ar

cord

to

cord

subaracnod

te

C.

tat

te

gaments

to

oramna

te

umbar

typca

GAS

54.

C.

dentcuate

ABR/McM

approac.

wc

spne

te

he

s

nterver-

compresson.

A.

E.

o

annuus

posteroat-

not

rame

reatng

Intervertebra

troug

notces

ts

cord.

brosus

ongtudna

vertebra

oramen,

te

protrudes

common

te

knowedge

spna

ntervertebra

most

superor

anatomc

and

occur

ntervertebra

brosus

by

tests

vertebra

o

ocazed

te

he

s

typca

o

he

s

51–75

D.

164;

anestetc

atus,

sacra

109–113;

breast

s

C.

Answers

not

and

cervca

B.

87–88;

oca

wc

medan

cervca

gament.

GAS

ver-

D. Patents wt persstent eadace or back pan wt

A.

emora

used

durng

ntervertebra

GAS

53.

wa.

E.

he

ad

te

were

ste.

wa.

n

o

dorsa

are

he

s

masses.

28,

commony

sacra

surace

a

racc,

E.

ump

ard

ocated

abdomna

erna

trange

s

te

troug

abdomna

ts

N

sensaton

pan

posteror

and

ernaton.

because

tend

erna

anteror

nguna

s

anteror

he

meday

he

ocatons

rbs.

cornua.

rom

B.

genera.

bordered

ac

te

va

s

carry

reeve

troug

s

te

s

pevc

descrbed as sot and pabe, wc woud not key

ndcate

to

he

spna

93

Pett)

nerory

s

tat

procedure

sacra

presents

part

mbs

n

111–112;

anestesa

nerves

oogsts

ungs.

myeomenngocee,

trange

trange

obque,

C.

hs

by te atssmus dors, ateray by te externa abdom-

na

101–103,

are

wt

103

present

accumuaton

syndrome

te

164;

umbar

to

surroundng

deormaton

he

not

menngocee

jonts

artcuate

Admnstraton

reers

space

Cauda

B.

wt

menngocee.

peura

50.

present

woud

arces

Hemotorax

E.

t

occuta

vertebra

wt

coud

na

ower

te

D.

bda

bodes

nerve

te

axary

subscapuars

717–718;

s

artery

musce

N417,

correct,

toracodorsa

468

and

and

but

nerve,

es

not

n

wc

superca

woud

tereore

CHAPTER

55.

E.

Kppe-Fe

wc

or

tere

more

sort,

A.

s

a

syndrome

s

a

reducton,

or

extensve

cervca

stf

neck

vertebrae.

wt

Hyperordoss

s

It

mted

an

congenta

oten

deect

uson

o

manests

n

B.

one

as

between

a

ets

moton.

abnorma

ncrease

n

umbar

C.

Scooss

D.

Spna

ncrease

GAS

A.

te

a

N

te

curvature

present

s

arc

wc

pacement

s

spne.

and

condton

and

o

not

o

te

nuceus

deormtes

n

te

us

neror

te

L5

te

case

s

or ward

n

ts

s

L4

rater

acets

s

(on

n

(and

te

E.

ds-

ante-

suc

tat

sometmes

beng

L3)

restraned

troug

cated

te

wt

a

protruson

annuus

Hyperordoss

E.

Scooss

s

an

te

brosus,

vertebra

D.

o

nuceus

and

ts

not

asso-

A.

he

ory

n

B.

he

te

C.

umbar

curvature.

an

abnorma

atera

curvature

o

te

wc

s

te

L5

not

te

racture

o

GAS

C.

83–84;

Car

II

N

167;

ABR/McM

maormaton

91,

ncudes

a

e r n  atons

protr ud e s

te

m os t

w e re

by

te

o

syndrome

cervca

and

cerebeum

verms

beow

te

o

occur

troug

te

Menngocee

wc

B.

ony

Kppe-Fe

number

D.

o

s

te

a

syndrome

cervca

Hydrocepaus

low,

or

sma

deect

mennges

N

te

arc

o

te

posteror

on

167;

resuts

resuts

te

te

o

or

te

rom

an

rom

te

axs

91,

dens,

and

obstructon

tuberce

o

te

surace

o

atas

te

T etered

caused

tube.

hs

A.

syndrome

nternum.

a

congenta

cosure

oten

o

he

atantooccpta

lexon

and

jo n t

s

exte n s  on

o

te

he

ates

neror

wt

artcuar

te

C3

acet

vertebra

s

were

(GAS

and

a

on

ar ticular

lateral

mass

facet

of

CI

n

ts

neura

tckened

by

an

coumn

sometmes

racture

te

at

te

pars

suc

L3)

an

n

anteror

te

tat

a

um

te

and

protrude

nterartcuars.

hs

s

known

margn

te

here

ncudng

condton

anteror

as

cre-

o

te

overyng

orward.

jont

Addtonay,

vertebrae

dspacement

anteror

L5

zygapopysea

spondyoyss.

o

s

rreguarty

s

te

L4

s

a

area

known

dspace-

spondyostess. Superior

ar ticular Dens

hereore,

n

ts

spondyostess.

patent,

a

spondyoyss

as

ed

to

a

b ro s us

abnorma

113

s

super-

wt

a

bony

te

em-

arc

o

 nvo ve d

ead

facet

of

CII

•

GAS

Fig.

.

te

Fg.

lud

caracterzed

an

pr m ar  y

anomay

te

or

protr us on

atas.

117

by

ment

s

meduars

Spondyostess

(and

s

deectve

termnae

vertebra

as

a

conus

ated

o

syndrome

by

ow-yng

N

58.

cord

oten

a nnu -

 oram en

posteror

absorpton.

E.

te

projects

te

o

w en

te

artcuates

abnorma

cerebrospna

ver-

ong  tud n a

rom

bodes.

wt

o

atas.

outer

oramen

cranum

ts

bodes.

ABR/McM

process,

body

resuts

ernate.

vertebra

ntererence

n

s

n

annuus

p oster or

magnum.

A.

case

coapse

comm on

vertebra

Inferior

branstem

ac-

vertebra)

 n te r ver te br a

he

renorced

s

113

ernaton

regon

trauma.

spne.

57.

te

artcuar

on

t e

neck.

D.

s

nto

83–84;

rom

n

ncrease

dsc

cana.

odontod

anteror

dsocaton.

abnorma

o

wc

resut

puposus

Kppe-Fe

GAS

59.

puposus

s

a

posteroateray,

not

nence

s

n

neror

arc

vertebra

as

brosus

number

ver tebra

and

gament.

or

exampe.

coumn

tan

regon

damaged

rreguarty

ver tebra

te

artcuar

anteror

an

overyng

wc

vertebra)

an

by

te

n

S1.

Hernaton

bodes

Inter ver tebra

s

a

created

margn

protr ude

by

wt

te

condton

mssng,

Compresson

tebra

BP19

Spondyostess

L5

abnorma

D.

o

a

posteror

or

ver tebra

superor

posteror

ror

an

curvature.

atera

can

s

regon.

76;

mssng,

C.

toracc

Spondyoyss

between

B.

s

bda

umbar

56.

n

(“uncback”)

te

s

superor

exampe.

C.

Hyperkyposs

(on

te

damaged

curvature.

B.

Spondyoyss

29

Back

1

axs

2.21).

artcu-

30

C H A P T E R

1

Back

Posterior

longitudinal

ligament

Ligamentum

flavum

Supraspinous

ligament

Interspinous

Anterior

•

GAS

Fig.

longitudinal

ligament

Ligamentum

2.35

•

E.

he

anteror

nence

te

60.

tuberce

te

outer

he

anteror

brous

son.

N

band

aspect

dscs;

te

atas

o

te

s

a

bony

anteror

em-

arc

o

t

It

BP34;

o

can

covers

te

be

by

and

vertebra

torn

stabty

by

gamentum

posture

ABR/McM

ongtudna

tat

mantans

he

gament

and

cervca

te

112

connects

bodes

lavum

connectng

89,

he

te

o

vertebra

D.

he

E.

he

s

te

and

a

strong

anteroat-

cana

mantan

amnae

o

two

gament

s

and

te

te

posteror

prevents

outer

gament

part

o

an

193;

adjacent

sp-

he

he

98,

102

Fig.

2.38

gaments

to

roots

tougt

to

te

o

ligament

are

atera

dura

te

spna

uncton

extensons

mater

n

between

nerves.

keepng

hese

te

o

te

g-

spna

posteror

ongtudna

aspect

o

te

gament

vertebra

supports

bodes

wtn

te

te

cana.

tentorum

supports

cerebe

te

and

gamentum

by

s

occpta

covers

te

lavum

connectng

te

a

ayer

obes

o

o

dura

te

mater

cerebra

cerebeum.

eps

mantan

amnae

o

two

uprgt

adjacent

vertebrae.

E.

he

son

nuca

o

te

te

gament

s

supraspnous

C7

vertebra

to

a

posteror

gaments

te

exten-

extendng

externa

occpta

protuberance.

GAS

ABR/McM

Supraspinous

stabzed.

he

rom

connects

ventra

are

posture

aspect

GAS

attac

emsperes

wtn

yperlexon.

brous

processes.

N

and

tat

adjacent

runs

tat

vertebra

B.

flavum

dentcuate

mater

posteror

uprgt

dsc.

nterspnous

81;

A.

yperexten-

yperextenson.

supportng

bodes

brosus

ntervertebra

GAS

he

cord

ntervertebra

prevents

eps

ongtudna

vertebra

annuus

nous

pa

D.

posteror

te

C.

aments

vertebrae.

C.

61.

dorsa

69;

era

o

surace

atas.

GAS

B.

A.

on

ligament

106–107;

100,111

N

174–175;

ABR/McM

98,

CHAPTER

62.

A.

he

regon

atssmus

and

te

meda

trange

most

o

he

te

border

rom

ts

between

detod,

not

by

orm

o

te

skn

s

because

o

o

te

te

te

o

can

as

be

mnma

back

and

and

te

te

B.

he

te

spna

noted

tssue

n

ungs.

A.

auscutaton.”

C.

he

D.

externa

abdomna

obque,

C.

(o

as

te

quadratus

and

te

neror

umbar

umborum,

neror

border

o

nterna

border

te

trange

o

Pett).

abdomna

te

superor

o

twet

umbar

D.

rb

trange

he

rectus

neror

nguna

GAS

he

abdomns,

epgastrc

trange

87,

90;

N

weakness

o

ary

wc

nerve,

(o

te

orm

257;

border

and

o

E.

te

movement

mnor

passes

and

resuts

detod

troug

te

by

rom

te

ax-

quadranguar

artery

to

can

and

be

resut

(oss

neror

s

posteror

soud

t

parapega

movement

vertebra

ts

artery

ocaton

posteror

o

not

L2

te

eves

vertebra

cana.

Dvson

o

be

and

o

at

a

te

to

spna

protected

woud

te

not

surgca

artery

woud

ocaton

be

ste.

not

nsde

te

cana.

woud

te

key

parayss,

conus

occur

and

as

s,

te

meduars

ts

agan,

toracc

as

woud

N

te

protected

sympatetc

dsrupton

102–103;

o

structure

symptoms

wc

sympatetc

GAS

66.

te

o

o

s

nsde

trunk

descrbed

not

be

(GAS

a

Fg.

spna

ocated

te

woud

ncude

consequence

2.55A).

176

C. Scooss can be a secondary condton n suc dsor-

ders

as

muscuar

musces

tat

border

te

quadran-

n

contact

te

detod

ca

A.

wt

musce

cutaneous

he

nerve.

may

branc

suprascapuar

natus

tus

and

T eres

te

ateray

major

nerve

and

Numbness

resut

o

s

te

musces.

and

te

nnervated

te

nerve

nnervates

umerus,

to

o

superor

axary

nerve

rotates

serves



te

nraspnatus

abducts

musce

B.

te

atera

s

te

he

te

skn

A.

over

by

te

back

afected.

B.

suprasp-

te

he

anguated

subscapuar

adduct

D.

te

o

te

te

E.

nerve

musces

arm

Unar

and

GAS

718;

responsbe

and

skn

on

or

te

te

nnervaton

posteror

aspect

damage

o

n

manest

wt

and

67.

te

an

L5

L4–L5

nerve

L5

exsts.

vertebra

414

In

wc

vertebrae

be

to

ext

Compresson

B.

Compresson

ness

on

te

over

te

Compresson

E.

Compresson

ness

GAS

beow

o

on

te

te

80;

N

o

nerve

o

t

regon,

ter

dsc

as

beow

anteror

C.

ness

umbar

afected

A.

ness

te

coumn

spna

named

ernaton,

descends

nerves

te

L5

between

spna

L4

o

nerve

te

L5

L3

woud

produce

numb-

woud

produce

numb-

L4

165;

L2

abnor-

he

S1

anke

numb-

produce

numb-

tg.

woud

and

74;

ABR/McM

101–102

N

brosus

s

a

o

most

eson

to

tear.”

tubercuoss,

resuts

n

ste.

and

woud

presents

It

o

uncback

dystropy

commony

and

curvature

a

wc

deect

muscuar

ABR/McM

dsc

nner

rom

between

s

or

not

poo.

wt

gy

age

unkey

cartage

synova

jonts

s

and

cartage

nuceus

te

87

conssts

o

an

outer

puposus.

annuus

he

brosus,

annu-

tense

wc

m-

vertebrae.

Hyane

Eastc

te

pregnancy .

woman.

162;

and

secondary

deormty,”

at

“wear

ate

prmary

produces

congenta

resut

comes

rotaton

D.

he

E.

Eastc

68.

E.

eppysa

derved

A.

bers

79;

N

Notocord

centrc

oot.

a

and

be

kyposs

ntervertebra

GAS

produce

agnment

ound

on

eppysa

s

ound

artcuar

suraces

n

pates.

n,

or

exampe,

te

epgotts.

eve.

woud

can

norma

puposus

anteror

nerve

atera

B.

and

tg.

nerve

upper

A.

In

knee.

o

ts

ext

vertebrae.

norma

durng

ncreased

“gbbus

23-year-od

strengt

ntervertebra

woud

C.

us

D. In ts MRI a posteroatera ernaton between L4

and

a

GAS

woud

It

a

bda

as

common

s

regons

Osteoartrts

rom

abnormates.

N

Spna

present

orearm.

nerve

movement

s

qute

toracc

producng

E.

rada

s

deormty.

umerus.

D.

and

Hyperkyposs

supraspna-

and

te

Hyperordoss s ncreased secondary curvature o te

nraspnatus

ower

rotate

keep

umbar regon. It can be caused by stress on te ower

bra-

umerus.

meday

not

n

o te vertebra coumn and resuts n a atera curvature.

te

does

poo

s

o

acton

and

ma

ypertropy

musce

dystropy

space. Quadranguar space syndrome occurs wen tere

guar space or bross o portons o te musces tat are

64.

o

et

because

L1,

ts

damage

ncudng

superor

T ransecton

not

105–106

ts

cord

mb

ABR/McM

souder

teres

gament,

te

Hessebac).

161,

n

denervaton

nguna

vesses

te

due

Lgaton

at

Grynett).

Adamkewcz)

njury).

vertebra

known

(o

anteror

o

because

vountary

to

(aso

orm

C.

te

occur

obque,

63.

o

Injury

to

ocaton

surgery

and

and ac crest orm te border o te umbar trange

he

E.

dors,

he

artery

suppy

consequences,

key

atssmus

bood

arteres.

dre

eve

o

radcuar

or

durng

sensaton

do

“trange

great

mportant

eard

trapezus

so-caed

65.

trapezus,

known

sounds

scapuae,

borders

border

o

scapua

ocaton

te

upper

border

Lung

evator

te

te

atera

auscutaton.

ceary

ntervenes

B.

bounded

dors,

31

Back

1

and

rom

rngs

Nuceus

and

ces

164,

168;

remnant

te

te

o

ts

s

s

a

ound

type

n

te

adjacent

te

no

a

drect

yane

te

103

geatnous

mesencyme

orms

nuceus

wc

te

s

con-

brosus.

remnant

o

nvovement

deveopment.

cartage.

epgotts.

scerotome

annuus

s

o

ABR/McM

orms

surroundng

puposus

tere

n

pate

are

te

o

notocord,

neura

crest

32

C H A P T E R

1

Back

B.

here s no drect neura crest or ectoderm nvove-

C.

he

ment

n

deveopment

scerotome

annuus Posterior

spinal

but

n

tere

deveopment

s

no

o

te

scerotome

nvovement

n

te

deveopment

o

or

te

puposus.

ar ter y

D.

We

ment

Segmental

eter.

ar ter y

nuceus spinal

o

nvoved

brosus,

myotome

Anterior

s

o

crest

medullar y

te

scerotome

te

ce

s

annuus

nvoved

brosus,

nvovement

n

te

n

te

tere

s

deveop-

no

neura

deveopment

o

te

ar teries

nuceus

GAS Ver tebral

puposus.

79;

N

164,

168;

ABR/McM

103

ar ter y

69. Ascending

B.

Horner

syndrome

s

caracterzed

by,

among

oter

cer vical

tngs,

constrcted

pups,

sunken

eyes,

partay

ar ter y

droopng Deep

cer vical

skn Costocer vical

on

Subclavian

trunk

era

to

ar ter y

te

te

A.

ar teries

It

s

caused

from

C.

patways

Horner

by

and

dryness

probems

bodes

spna

cord

anteror

gray

bers.

Ces

te

orn

as

a

te

n

upper

posteror

s

o

ocated

te

eferent

n

suppy

are

n

suc

syndrome

sympatetc

ce

he

medullar y

(branch

segmental

(beparoptoss),

ace.

autonomc

orn.

aptc

Segmental

te

n

o

te

sympa-

trunk

tetc

Thyrocer vical

eyed

ar ter y

damage

resut

ead

te

gray

ce

te

at-

presyn-

gray

orn

o

regon.

bodes

orn

to

dsrupton

wose

atera

toracc

as

o

or

receve

somatc

te

sgnas

spinal

rom

sensory

bers

wose

ce

bodes

are

ocated

ar ter y)

n

D.

te

here

spna

are

no

ganga.

sympatetc

nerve

ce

bodes

ocated

nerve

ce

bodes

ocated

Segmental

spinal

n

ar ter y

E.

Posterior

te

here

intercostal

spna

are

n

te

N

172;

no

wte

ganga.

sympatetc

matter

ABR/McM

o

te

spna

cord.

100

ar ter y

70.

D.

Semspnas

coces

nerves.

ventra

Ar ter y

of

(branch

Adamkiewicz

A.

tat

A

capts

s

o

s

te

supped

te

oter

ony

by

musce

dorsa

musces

among

ram

are

o

te

cervca

supped

by

te

ram.

he

rombod

major

s

nnervated

by

te

dorsa

from

scapuar

nerve,

a

branc

o

te

ventra

ramus

o

segmental

C5. spinal

ar ter y)

B.

he

evator

brances

o

scapuae

C3

and

s

C4,

oten

as

we

nnervated

as

rom

by

brances

Segmental

o spinal

te

dorsa

scapuar

nerve.

ar ter y

C.

he

rombod

scapuar

mnor

nerve,

a

s

nnervated

branc

o

te

by

te

ventra

dorsa

ramus

o

C5.

E.

he

atssmus

codorsa

ventra

GAS Lateral

sacral

ram

95;

dors

nerve,

N

o

s

wc

C7

184;

and

nnervated

contans

by

te

bers

tora-

rom

te

C8.

ABR/McM

110

arter y

71.

C.

o

he

C3

A.

spenus

and

Rectus

are

capts

s

supped

by

te

dorsa

ram

C4.

capts

posteror

nnervated

by

major

brances

and

o

mnor

te

musces

suboccpta

nerve.

B.

he

s

•

GAS

Fig.

greater

occpta

nerve

suppes

te

semspna-

capts.

2.55A

D.

he

obquus

brances

pes

te

o

capts

te

rectus

musces

suboccpta

capts

are

nerve

posteror

nnervated

wc

major

aso

and

by

sup-

mnor.

CHAPTER

E.

he

obquus

brances

72.

D.

pes

te

GAS

95,

Wt

racture

C2

capts

te

rectus

100;

te

s

a

hs

In

and

crucorm

upper

te

odontod

A.

he

B.

here

C.

he

s

he

s

process

o

torn

s

te

te

a

C2

E.

he

te

mnor.

most

GAS

key

o

te

Answers

76.

E.

are

a

ractured

resuts

crused

n

by

s

“rb-ump”

A.

be

no

s

105;

process

not

atera

spnous

toracc

curvature,

ractured

n

N

convex

necessary

mass

process

26

(T able

vertebrae

nvoved

B.

so

nvovement.

2.1);

to

Wedge

necton,

or

Scooss

tebrae

C.

on

one

113

C.

prmary

racture

ere

eads

aso

D.

woud

not

ead

woud

not

ead

es

A.

75;

Somatc

are

N

and

te

he

C.

he

bers

GAS

he

dens

ment

A.

s

orn

not

ram

cur-

n

te

to

a

N

te

te

171;

are

C.

to

o

prevent

as

te

te

sympa-

because

te

been

98

he

n

gament

vertebra

ancors

posteror

torn

nous

processes

sacrum.

spnous

D.

he

tps

It

gaments

to

restrcts

processes

spnous

eac

te

attac

oter

degree

durng

supraspnous

o

E.

te

runs

on

s

te

C2

separaton

to

o

o

s

ocated

B.

vertebrae.

te

sp-

wt

bendng

curvature

coumn.

toracc

and

patent’s

term

coumn

hs

sacra

cnca

meanng

or

or

162;

typca

s

an

any

degen-

number

secondary

afectng

anteror

te

o

curva-

cervca

case

n

more

dsease,

spne.

te

toracc

coapse

s

racture

a

o

racture

a

o

wc

hs

s

vertebra

o

te

te

ds-

eventuay

bodes

vertebrae.

neura

coumn

arc.

typcay

bodes.

s

or

o

vertebra

an

vertebrae,

arc

vertebra

te

and

te

a

87

Pott

dscs

o

to

(spondyoyss).

o

o

dspacement

consequent

ABR/McM

vertebra

neura

Wedge

In

anteror

oten

dspacement

oowng

spondyoyss.

coumn

o

typcay

77;

racture

T ubercuoss

afects

te

o

o

o

vertebra

te

dorsa

From

by

te

nerves

te

named

te

nerves

he

te

orn

dorsa

by

o

orn

not

usuay

a

resut

o

yper-

porton

o

ver-

osteopoross.

N

and

te

spna

te

170

verte-

te

beow

regon,

cord

woud

sp-

ter

spna

cervca

not

be

oramen.

beow,

coumn

spna

te

te

vertebrae.

and

named

te

at

beow,

ntervertebra

regon

n

ext

coumn

cervca

vertebra

but

o

nerves

vertebrae.

named

te

ter

mass

111–112;

n

te

at

te

above

spna

regon

toracc

a

to

vertebra

but

mass

ext

te

anteror

named

ter

vertebrae,

ext

afected

GAS

ter

above

a

s

162

vertebrae,

ext

te

reated

toracc

ext

dscs

necton.

typcay

o

regon,

above

nerves

are

oten

N

cervca

coumn

he

tubercuoss

crusng

bodes,

From

ntervertebra

o

ractures

and

73,

te

na

sp-

te

ncreased

vertebra

tubercuoss

afected

D.

aong

a

N

te

nerves

not

lexon.

gament

processes

adjacent

rom

o

wen

prmary

ts

genera

te

destructon

named

njury.

and

te

Hernaton

na

dspace-

ts

bodes

te

Spondyostess

GAS

78.

C.

nterspnous

s

lexon

A.

atas

o

assocated

spna

key

spna

Spondyoyss

bra

ABR/McM

o

C7.

regons.

consequence

pregangonc

white

te

wt

nterartcuars

74;

tebra

carry

o

bodes.

autonomc

te

o

pars

to

te

and

E.

caed

o

not

s

te

ntervertebra

one

body.

ongtudna

o

B.

normaton.

dever

devaton

oten

ncreased

assocated

T ubercuoss

eves

receve

myen.

wc

A.

bod-

afected.

C.

o

umbar

hs

eads

typ-

ce

cord

tat

an

Spondyostess

te

presynaptc

ganga

gament

aspect

pan,

spna

nuce

eve

98

examnaton

posterory)

semnated

neurons.

and

ateray

anteror

anteror

at

sensory

more

dens,

D.

curvature.

te

extenson

te

toes.

s

s

s

s

GAS

ganga.

communcantes

112;

and

s

(concave

afects

mbs,

root

trunk

bers

contan

35,

and

on

te

atera

and

Hyperordoss

te

curvature.

spna

ocazed

somatosensory

nnervaton

anterory

he

te

ver-

87

convey

ound

o

sensory

transverse

o

secondary

spna

prmary

comprses

sympatetc

Wte

o

te

accentuated

norma

a

dorsa

orn

sympatetc

B.

te

wa

ncomng

atera

tetc

s

ABR/McM

comprsed

neurons,

D.

n

to

to

bers

body

dorsa

s

process

B.

162;

aferent

ound

he

te

a

ture

and

hs

rom

wen

posterory,

hs

cay

o

regon.

E.

GAS

curvature

rotaton

77.

occurs

D.

C.

atera

nvoves

as

posterory)

Spondyoss

and

to

anoter.

concave

umbar

75.

abnorma

Hyperordoss

vature,

74.

an

wc

above

ABR/McM

sde

seen

and

porton

s

vertebrae,

ongtudna

reasons.

te

trauma

as

Hyperkyposs

eraton

ABR/McM

contrbute

a

condton.

nvovement.

posterory.

osteopoross,

nvovement.

eter

touc

curvature

yperkyposs.

B.

to

(convex

not

30;

dened

to

regons

transverse

no

84,

s

coumn

orward

person.

typcay

N

s

gaments

76–100

na

beng

gament

68-69;

Scooss

“angman’s”

wc

nuca

supraspnous

109

(pedce)

as

juncton

kng

vertebra

may

here

rom

process,

no

C1

GAS

A.

pedces

and

by

sup-

cases.

tere

E.

te

known

gament

spnomeduary

odontod

descrbed,

aso

aso

ABR/McM

nterartcuars

s

nnervated

wc

major

3.2–3.3;

njury

angng,

te

are

nerve

posteror

T able

pars

racture.

te

capts

o

te

musces

suboccpta

N

type

o

vertebrae.

suc

73.

o

33

Back

1

te

beow

regon,

sp-

ter

spna

vertebrae.

cord

woud

ntervertebra

not

be

oramen.

34

C H A P T E R

79.

C.

1

Back

Lumbar

eve

o

puncture

L4–L5.

L1–L2

n

he

aduts

s

generay

spna

and

oten

cord

at

perormed

ends

te

at

eve

te

o

at

te

82.

he

n

cord

typcay

aduts

but

ends

may

at

L2–L3

n

gn

te

extend

to

eve

L3

n

o

he

L2

D.

he

dura

spna

E.

he

L2

D.

sa

he

te

109;

are

bodes

N

ce

adjacent

hs

o

o

we

n

te

eve

te

eve

o

o

L1–

beow,

newborn.

sa

S2,

Eac

so

te

answer

te

te

at

te

L3

n

eve

te

supped

sensory,

motor

ce

dorsa

o

L1–

A.

bodes

are

we

not

te

dor-

tetc

S2–S4

outlow

atera

account

ganga.

o

ound

te

ganga.

n

sympatetc

or

are

te

orns

responsbe

or

B.

or

te

ce

te

ce

C.

te

ce

outlow

hs

o

n

te

or

n

E.

does

95–97;

he

anteror

brous

era

son.

B.

band

aspect

dscs;

t

It

he

N

can

tat

o

not

we

be

n

83.

outlow

C.

he

dsc

parasympa-

are

S2–S4

outlow

n

are

te

te

be

or

wc

te

are

ce

bodes

ound

n

A.

E.

he

torn

by

and

stabty

by

connects

bodes

and

cervca

cana

ver teb r a

s

te

and

a

te

o

te

by

te

vertebra

zygapopy-

processes.

neror

vertebra

adjacent

rom

te

wt

te

vertebrae.

amnae

o

o

n

bone

te

tat

mdne

extend

to

orm

arc.

process

process

artcuates

o

project

adjacent

rom

te

wt

te

vertebrae.

amnae

o

N

163–164;

te

C2

s

rom

te

te

ste

mdne

or

C3

a

C3

ner ves

vertebrae

C3

ABR/McM

postoned

and

spna

he

by

and

superory

te

and

projects

amnae

gament

attacment.

62–70;

most

C2

and

ner ve

102

nter vertebra

vertebrae.

ext

take

nter vertebra

In

superor

a

cer-

ter

somewat

or-

exts

oramen

dsc

te

to

tereore

posteroatera

between

and

ernaton

woud

at

ts

anteroat-

bod es

r uns

D.

w  t n

E.

lavum

te

eps

mantan

amnae

o

two

uprgt

adjacent

E.

s

te

outer

brous

part

o

an

dsc.

connects

adjacent

processes.

N

sp-

ABR/McM

98

te

C1

cranum

69;

N

vertebra

and

and

woud

not

surace

o

te

dscs

sku

sacrum.

he

anterory

coumn

te

and

ts

second

verte-

ernated

dsc

te

ts

restrct

te

and

vertebra

ernated

dsc

and

aong

ts

nerory

99–100

movement.

courses

vertebra

bodes

way.

to

he

downward

It

te

stretces

anteror

gament

extenson.

on

anteror

te

attacng

ongtudna

postoned

ts

dsc

correspondng

o

ABR/McM

to

vertebra

ernated

afected.

anteror

mts

a

correspondng

o

eve

be

gament

ntervertebra

o

170;

te

by

afected.

to

te

not

serve

to

afected

eve

be

superor

tereore

superor

be

to

te

not

beow

ongtudna

most

167–168;

s

Lgaments

te

te

C3.

superor

beow

exts

base

gament

s

not

and

C5

ror

brosus

C2

tereore

w

84.

between

o

passes

woud

w

wc

pre ve nts

exsts

bone

nerve

exts

GAS

nterspnous

81–84;

C4

wc

p os te r or

an d

C2

and

between

yperexten-

te

nerve

afected.

bra

yperextenson.

 game nt

C1

occpta

he

strong

ntervertebra

prevents

s up p or t ng

connectng

ntervertebra

GAS

vertebra

process

two

pat.

te

B.

gament

ongtud  n a

te

annuus

nous

jon

artcuar

between

he

te

vertebrae.

he

te

artcuates

o

seets

to

processes

o

afected

be

vertebra

gamentum

posture

D.

and

project

lat

artcuar

regon

zonta

yperlexon.

he

s

vca

responsbe

eves

are

te

musce

GAS

174

ver tebra

o

account

bers,

covers

te

posteror

aspect

C.

o

correspondng

T1–L2

ongtudna

mantans

te

o

artcuar

process

process

pedces

spnous

and

ganga.

GAS

A.

te

neror

he

te

ound

sympatetc

parasympatetc

sympatetc

paravertebra

81.

by

bodes

(loor)

o

te

eve.

answer

te

margn

by

vertebrae.

pevs.

n

pedce

superor

processes

superor

bodes

ound

orns

responsbe

ound

te

margn

adjacent

artcuar

artcuar

roo

he

para-

bodes

ound

are

atera

or

te

contans

amnae

rom

pevs.

E.

he

n

sensory

he

n

te

are

wc

he

o

margn

vertebra

mar-

notc

vertebrae.

autonomc

are

ound

wc

bers,

o

te

oramen

superor

vertebra

anteror

neror

notc

te

neror

between

te

ntervertebra

te

posteror

superor

unon

responsbe

eves

te

neror

ganga.

does

are

account

bers,

dsc

jont

pedce

he

newborn.

by

and

part

root

bers

not

sympatetc

T1–L2

and

te

vertebra,

vertebra

(acet)

by

an

oowng:

notces.

to

s

a

vertebrae,

Artcuar

does

sympatetc

te

or

n

ganga.

te

he

motor,

sympatetc

paravertebra

C.

te

o

o

te

ormed

Artcuar

carry

answer

hs

te

ends

extend

musce

bodes

paravertebra

B.

at

at

L3

ger.

typcay

may

to

170

orn,

te

ends

end

spnae

ound

o

vertebra

o

but

ends

extend

usuay

cord

wc

he

typcay

may

must

erector

anteror

bers

A.

cord

aduts

ram,

bers.

but

sac

spna

n

GAS

80.

cord

aduts

s

pedce

superor

spna

n

(roo )

ncude

ntervertebra

te

newborn.

B.

boundares

(cockwse)

te

spna

L1–L2

he

o

newborns.

A.

D.

eve

rom

te

te

surace

gament

o

ante-

to

te

s

o

te

vertebra

CHAPTER

A.

he

posteror

posteror

to

te

ment

he

o

te

ntervertebra

serves

tebra

B.

ongtudna

surace

to

coumn

nuca

dscs

prevent

and

aong

way.

lexon

rom

mts

traves

bodes

te

excessve

extends

gament

gament

vertebra

C2

to

excessve

on

te

87.

B.

Hemvertebra

attacng

more

hs

causes

o

ga-

te

te

ver-

umn

sacrum.

lexon

o

A.

he

o

gamentum

adjacent

tem

D.

he

rom

tay,

termed

GAS

C.

A

81–82;

te

ac

o

te

L4

he

S2

rory

rom

A.

spnous

woud

be

spna

ends

D.

T wo

C.

te

cord

spnous

at

to

spna

ends

he

marked

eve

tereore

te

L1,

te

not

above

eve

tereore

drawn

wc

nerory

pa

be

drawn

170;

ssure

hs

ABR/McM

spna

and

artery

s

key

ormed

spnous

E.

he

a

te

vertebra

he

es

be

n

te

ascendng

te

compressed

superory

by

te

ses

to

and

suppy

ses

and

suppy

o

te

aong

te

te

atera

not

te

ory

unon

arse

spna

to

rom

spna

dorsa

aspect

o

te

E.

cord.

A.

cd

once

and

ave

GAS

ony

sma

102–103;

N

brances

176;

te

to

te

ABR/McM

posteror

drect

98

aspect

area.

B.

n

o

by

an

o

te

an

n

become

ractures

ncrease

n

umbar

or

ncrease

tckness

anteror

n

tck-

posteror,

dspacement

consequent

to

a

o

racture

a

o

(spondyoyss).

te

t

ABR/McM

cervca

Nerves

umbar

vertebra

87

vertebrae

C1–C7

vertebrae,

and

ext

wereas

egt

(8)

superor

nerve

C8

to

exts

vertebra.

ext

superor

to

ter

correspond-

ext

superor

to

ter

correspond-

toracc

to

ter

te

ter

s

born,

od

cd

are

54;

o

a

a

None

stes

and

te

are

n

te

s

curvatures

convex

orms

wc

Durng

n

anter-

response

cervca

sttng

spne;

and

com-

wak.

te

norma

o

be

be

ts

ABR/McM

to

musce

te

ac

oter

musces

wen

ts

woud

cd

te

o

curvature

wt

te

baby

begns

consdered

crest

abnorma

age.

consdered

abnorma

age.

87

s

te

spnous

ntertubercuar

o

or

to

woud

cd

162;

attaced

te

s

cd

deveops

ypertroped

s

rst

present

up.

ordoss

N

s

kyposs.

addtona

and

te

s

curvature,

born.

neck

n

regons

vertebrae.

curvature

wc

he

starts

kyposs

horacc

one

termed

ead

kyposs

n

regons

vertebrae.

subsequent

prmary

two

ordoss.

ordoss

Cervca

and

ony

te

curvatures,

ts

ts

subsequent

correspondng

and

once

we

and

correspondng

toracc

to

tng

Cervca

he

te

orms

te

loor

on

162;

(7)

coumn,

termed

brae T7–L5

sucus

an

deveopment

n

posteroatera

bones

resut

170

secondary

here are two posteror spna arteres; eac s ocated

te

s

anterory

horacc

wc

o

vertebra

GAS

90.

o

N

curvatures

ves-

roots

co-

rota-

bodes.

C7

cd

curvatures

spna

ventra

spna

D.

cord.

te

meduary

and

ves-

roots

N

neror

second

to

resut

wen

C1–C7

a

wc

spna

ventra

oow

segmenta

te

A.

B.

te

meduary

and

te

arteres

wtn

contrbute

te

111;

and

te

te

cord.

oow

dorsa

o

ound

oten

segmenta

aspect

aong

s

not

arteres

te

spna

provde

does

te

spna

atera

run

artery

and

provde

run

te

wc

cervca

suppy

segmenta

nerves

to

bood

wc

he

by

orm,

a

decrease

nerves.

nerves

C. Wen

petes

cana

segmenta

nerves

anteror

arteres.

vertebra

he

process

spna

ncude

sacrum.

neror

ext

GAS

89.

101

artery

woud

te

were

mater.

s

a

s

seven

nerves

ext

postnata

N

anteror

wt

pa

ne

woud

or

hs

vertebrae.

he

a

one

vertebrae.

ng

D.

te

aso

were

may

curvature

vertebra

C1–C7

Nerves

enoug.

wc

ocaton

te

B.

te

mater.

ow

te

L2,

ng

woud

te

to

Nerves

ne

were

It

correspondng

GAS

to

E.

crests

and

caracterzed

or

te

spna

concave

te

D.

ter

o

may

condton

nterartcuars

are

s

101;

ntersects

cervca

ne-

o

73–77;

here

A.

ocaton

approxmate

and

ac

to

C.

s

vertebra

to

GAS

88.

o

traumas.

spnes.

pars

uses

ne).

subarac-

part

competey.

bendng

wc

anteror

Sacrazaton

process

processes

te

E.

processes.

above

vertebra

te

a

Spondyostess

te

ponts

(T uier

te

o two anteror spna brances tat drecty

B.

on

D.

o te L4 vertebra. he dura sac ends at te S2 eve.

tumor.

A.

sagt-

were

deveop

atera

dense

anteror,

te

medan

te

ness

n

he

ne

cervca

correspondng

between

woud

convex

te

and

s

ess

mnor

te

98

gest

spnous

spnous

approxmate

and

te

te

eve

spnous

processes

correspond

cord

ne

vertebra

te

te

nterspace

hree

n

porton

represents

te

processes

spnous

be

at

S2

te

o

to

tranguar

ABR/McM

processes

to

woud

86.

at

to

correspond

T wo

L4–L5

drawn

hree

B.

E.

te

tps

C7

not

scooss,

Hyperordoss

te

broadens

and

bsects

wc

process.

correspond

te

rom

gament

connects

typcay

termnates

C.

gament.

tat

or

attaces

as

condton

deormtes.

even

prevent

a

abnorma

graduay

suraces

and

s

does

Osteopoross

lexon.

oter

dstnct

167–168;

ne

cstern,

spnous

woud

N

vertebra

space,

te

more

nterna

oter

durng

eac

nuca

crests

umbar

nod

te

te

orzonta

o

to

te

eac

apart

Superory

becomng

attac

to

gament

processes

sacrum.

85.

pung

supraspnous

spnous

s

lava

amnae

an

known

tona

te

cervca spne and serves as an attacment or musces.

C.

vertebrae

35

Back

1

and

atssmus

processes

ten

o

attaces

dors,

verte-

to

te

sucus.

optons

attacng

descrbes

to

te

attacments

upper

mb.

36

C H A P T E R

C.

1

Back

None

stes

D.

o

or

None

stes

E.

o

or

None

stes

te

te

or

te

optons

attacng

oter

musces

o

GAS

oter

musces

optons

attacng

oter

musces

86–92;

descrbes

to

attacng

180

attacments

upper

descrbes

to

optons

N

te

te

te

(T able

he

ror.

mb.

3.2);

ta

mb.

B.

deveop

and,

te



nto

he

ABR/McM

D.

he

w

dorsa

D.

he

neura

E.

he

sympatetc

A.

as

GAS

65

root

tube

a

B.

s

transverse

processes

he

bone

and

tat

neror

cartage

E.

he

o

te

remnant

are

te

te

te

te

noto-

95.

annuus

by

neura

deveop

perpera

te

neura

and

a

deep

crest

usuay

rotatores

crosses

wc

cord.

crest

our

to

on

segments.

te

and

peope

sacrum

vertebra.

and

hs

wen

s

owever

panu

sacrum

bot

ess

sep-

competey

caed

ts

hs

wt

transverse

or

or

vertebra

wc

sacrum.

more

party

L5

L4–L5

producng

s

te

o

s

process

te

strong;

S1

vertebra

popuaton.

o

wdt

te

L5

te

s

umbar-

sacrazed,

puts

pressure

eventuay

degen-

symptoms.

nvoved

n

sacrazaton.

nvoved

n

sacrazaton.

processes

C.

he

S2

vertebrae

s

not

nvoved

n

sacrazaton.

D.

he

S1

vertebrae

s

not

nvoved

n

sacrazaton.

one

not

or

deep

two

to

segments

beow.

semspnas

but

s

GAS

s

not

deep

to

semspnas

but

s

96.

s

not

97–98;

deep

to

N

182;

semspnas

seen;

were

te

In

te

atera

te

y

seen.

In

te

he

pars

vew,

GAS

84;

te

to

s

26;

but

s

may

te

te

see

76;

he

nserts

o

te

capts

porton

o

and

on

“Scotte

pars

vertebra

to

B.

nterartcu-

vertebra

are

so

t

C.

he

be

vertebra

s

a

E.

hese

trange.

musces

orm

te

runs

o

o

te

crucorm

transverse

gament

aspect

(C2).

rom

te

te

tp

oramen

band

superory

bodes

wc

o

orms

trange.

nserts

nuca

ne

on

and

te

te

ne

o

meda

te

occpta

border

o

te

odng

te

bra

cana

to

o

te

dens

magnum.

o

te

attac

cruc-

onto

te

and

o

te

atas

meda

aspects

dens

pace.

lavum

connects

n

s

spans

o

ocated

te

n

amnae

te

te

te

o

ds-

atera

verte-

adjacent

vertebrae.

97.

A.

he

68–70;

radcuar

arteres.

oow

process

te

gamentum

GAS

radograpc

gament

between

and

posteror

presses

te

es

tat

B.

he

es

and

30;

A

roots

every

suppy

w

spna

renorce

arse

n

at

to

aso

o

te

segmenta

vertebra

te

eve

anteror

eson

tat

compress

te

and

and

com-

arter-

tem.

te

torax,

te

occur

98

brances

space-occupyng

segmenta

and

are

bood

posteror

suppy

ABR/McM

arteres

provde

tat

te

N

hey

roots.

arteres

bone.

axs

runs

95

posterosuperor

ongtudna

transverse

cord

nuca

te

te

te

margn

he

spna

neror

major

he

masses,

eas-

nterartcuars.

suboccpta

neror

to

o

gament

gament

porton

te

body

anteror

rectus capts posteror mnor nserts on te meda

o

rom

attaces

superor

tance

supermposed

cannot

transverse

neror

apca

te

orm

bodes

113

te

and

93,

band

occput.

regon.

capts

te

he

ABR/McM

ongtudna

nerory

o

te

dog”

runs

atas

nterartcuars.

te

pars

posteror

te

te

pars

mout

cervca

sow

166;

te

seen.

vew,

te

a

to

N

neror

o

A.

dea

te

pedces

open

obquus

border

rectus

be

s

vew,

see

107

s

projecton

dog

ABR/McM

tat

te

neror

atera

upper

N

musce

vew

nterartcuars

dicut

o

he

to

anteroposteror

atas

te

posteroanteror

t

vew

he

ts

o

racture

dicut

on

make

In

neck

anteroposteror

t

te

te

ABR/McM

radograpc

nterartcuars.

be

D.

gament

obque

make

B.

o

te

wt

not

In

te

uses

not

ars,

te

engt

rom

109–110

were

5%

orgnates

s

pars

A.

te

s

GAS

94.

te

atas.

ABR/McM

process

at

on

vertebrae

he

E.

mnor

te

caracterstcs

are

rom

nserts

vertebrae

superca.

C.

te

arses

and

L1

s

between

te

above

oten

o

about

te

eves

eve

posteror

184;

a

n

T ypcay,

L5–S1

N

s

mnor

atas

meday.

tuberce

oter

L5

te

L4

Spnas

B.

wt

erates,

superca.

A.

nuca

he

Iocostas

can

occp-

neror

he

D.

D.

rom

te

superca.

93.

and

transverse

te

B.

vertebra

attac

te

onto

te

supe-

A.

Longssmus

typcay

sx

te

n

In

o

ncompetey

adapts

ncrease

arated

spnous

or

pace

processes.

attaces

to

superor

o

capts

sp-

o

musces

musce,

border

rom

nserts

posteror

ne

capts

99–100;

takes

used

superomeday

atera

obquus

nous processes or amnae o vertebrae and transverse

C.

E.

rectus

vertebra

ganga.

back

processes

and

te

capts

Sacrazaton

an

spna

rom

E.

hs

deveopment.

or

te

te

orgnates

tuberce

nuca

competey

scerotome.

ormed

precursor

ganga

o

wtn

rom

durng

s

a

s

atas

between

posteror

zaton.

Mutdus

rom

somtes

underdeveopment

encased

ganga

mgrate

do

s

deveops

he

ces,

ke

n

o

te

rectus

GAS

becomes

wc

tat

tssues

resut

puposus

C.

ces

dervatves

coumn.

It

bross,

te

connectve

nuceus

cord.

92.

are

emnated,

vertebra

A.

bone

orms

trange

musce

o

posteror

Scerotomes

tat

nes.

105–107

91.

hs

process

attacments

upper

musce

suboccpta

attacments

upper

descrbes

to

C.

mb.

rom

arteres

bood

te

neck,

te

atera

te

vertebra

te

umbar

sacra

are

and

posteror

arteres

arteres

eeder

suppy

n

n

te

to

te

deep

arter-

spna

cervca

ntercostas

te

n

abdomen,

pevs.

CHAPTER

C.

he segmenta meduary arteres are aso brances o

on

wt

ng

D.

he

E.

he

te

and

hs

vertebra

ters

soud

one

one

ary

n

te

n

and

o

superor

here

ton

hree

n

(to

o

centers

at

te

rms

are

no

cord

tp

o

te

ony

arc.

n

te

and

s

spnous

no

prmary

processes,

batera

secondary

n

bda

body

D.

cord

occuta,

V ertebra

GAS

A.

In

vertebra

bodes

osscaton,

wc

ts

s

not

reated

to

72;

te

bodes

o

possess

prmary,

not

N

164;

te

he

te

te

trd

dorsa

meday

B.

he

spna

vertebra

C.

secondary,

D.

E.

nerve

exts

n

B.

vertebrae

In

te

te

named

nerve

exts

In

te

te

te

named

exts

te

te

beow

te

te

named

exts

beow

A.

te

te

GAS

C3

regon,

he

C2

102.

A.

mater

correspond-

spna

and

C3

es

spna

above

te

hereore

vertebrae

nerve

spna

te

drecty

exts

te

C3

es

spna

above

hereore

vertebrae

nerve

te

n

te

C3

es

te

C3

spna

above

te

hereore

vertebrae

spna

D.

170;

ABR/McM

te

C3

es

87;

t

not

hs

e

te

ga-

cana.

gament

anteror

w

spna

n

spna

drecty

It

to

be

te

es

spna

punctured

103

nerve

pa

te

he

E.

end

he

he

D.

he

surace

A.

tat

te

to

te

atera

n

to

ts

Fg.

md-

patent.

te

ear

and

patent.

te

and

te

ts

trapezus

as

no

and

cutane-

2.52).

108

s

an

on

te

extenson

eter

dura

between

rootets

sde

mater.

te

servng

o

pa

o

te

Meday,

orgn

as

a

o

te

andmark

tem.

nternum

connects

spna

meduars

dura

s

te

s

te

an

extenson

conus

o

meduars

sac.

termna

end

o

te

cord.

ongtudna

vertebra

o

o

es

posteror

lavum

connects

te

amna

o

vertebrae.

106–107;

aar

gament

bodes.

gamentum

rotaton

(GAS

es

pro-

suppes

bend

n

suppes

t

between

posteror

te

e

ABR/McM

gament

o

es

musces

gament

occpta

regon.

and

afected

nerves

neck

ts

o

musce

trange.

ongtudnay

mater

adjacent

103.

te

184;

be

o

branc

trapezus

wtn

afected

termnae

conus

to

nerve

posteror

um

es

meda

te

externa

skn

ner ve

key

be

te

te

te

connectng

and

s

perces

suboccpta

to

n

N

N

gament

te

te

174;

ABR/McM

connects

occpta

te

condyes.

atantoaxa

100

dens

It

to

te

mts

meda

excessve

jonts.

Fexon o te upper cervca spne occurs at te atan-

tooccpta

89

not

connects

vertebra

es

nerve

occpta

key

cord,

he

to

drecty

exts

adjacent

does

bodes.

ABR/McM

occpta

ess

dentcuate

to

C.

n

correspond-

and

vertebrae.

N

nerve

passes

cana.

between

gament

te

t

beow

dentcuate

GAS

te

s

runnng

te

correspond-

and

and

vertebra

es

ongtudna

and

C3.

neck

dferentate

B.

drecty

exts

te

vertebra

cana,

168;

o

te

suppy

spna

te

N

accessory

anteror

correspond-

and

o

esser

ess

he

n

te

exts

to

te

oramen

vertebrae.

above

112;

vertebrae.

nerve

te

te

vertebrae.

ntervertebra

nerve

vertebrae

oramen

vertebrae.

cervca

ngy

C3

regon,

above

C2

above

above

ts

epdura/

anestetc.

gament

wtn

sternocedomastod

vertebrae.

cervca

named

te

te

ntervertebra

exts

C2

spna

hereore

oramen

vertebrae.

C2

nerve

In

regon,

above

ngy

C3

te

exts

te

te

cana.

te

suppes

greater

he

te

vertebrae.

cervca

nerve

te

E.

C2

te

nerve

beow

te

oramen

vertebrae.

above

ngy

In

drecty

regon,

ntervertebra

beow

D.

es

ntervertebra

ngy

beow

C.

and

cervca

spna

te

and

and

GAS

C3

n

he

ous

C3

hs

occpta

ne

vertebrae.

te

wtn

sac

suboccpta

ntervertebra oramen above te correspondngy named

hereore

connect-

procedure.

ramus

musces

93

spna

e

dura

81–83;

101–123

A.

are

ABR/McM

regon,

nto

connects

gament

posteror

spna

te

Answers

osscaton.

cervca

e

o

not

te

and

101.

prmary

exbts

o

arces

Puncturng

te

osscaton

possess

cd

enter

ongtudna

aspect

te

durng

deveopment.

centers

99.

te

o

to

njecton

vertebra

does

tuberance

Atoug

centers

te

wtn

te

ossca-

center

vertebra

vertebrae.

gament

processes.

Atoug

ater

n

te

not

anteror

ment

D.

centers.

C.

he

GAS

centers

or

does

anteror

neror

prmary

osscaton

ony

C.

and

centers.

here

wtn

body.

osscaton

two

o

second-

te

te

neede

nterspnous

spnous

cen-

processes,

te

space

o

adjacent

supraspnous

he

week:

body)

Fve

on

B.

resutng

vertebrae

spnous

vertebra

secondary

arc,

vertebra

aows

gament

egt

o

aong te tps o te vertebra spnous processes. hs

bda

uson

aspect

amna

he

98

spna

te

A.

drecty.

o

anteror

te

gament

verte-

osscaton

by

te

processes,

te

as

aure

vertebra

o

cord

te

extradura

te

condton

and

deveop

vertebra

drecty.

ABR/McM

above

etus

orm

te

rom

spna

prmary

te

te

transverse

vertebra

B.

a

one

gure

osscaton

centrum

te

te

arteres.

rom

arses

deveopmenta

present

osscaton

tps

a

spna

176–177;

te

arces.

be

eac

puberty:

A.

s

ncompete

te

N

n

spna

arses

artery

suppes

102–104;

occuta.

te

spna

and

patent

posteror

artery

suppes

artery

GAS

and

spna

posteror

he

rom

anteror

anteror

bra

E.

E. he gamentum lavum es wtn te vertebra cana

te segmenta spna arteres tat anastomose drecty

artery

98.

100.

37

Back

1

jonts

and

te

zygapopesa

jonts.

hese

are not mted by te aar gaments (GAS Fg. 2.20B).

Splenius

Semispinalis

capitis

capitis

Obliquus

Rectus

capitis

posterior

Vertebral

artery

Posterior

ramus

capitis

Semispinalis

posterior

major

Splenius

of

C2

cer vicis

capitis

Longissimus

capitis

capitis

•

GAS

Atlas

Atlas

tubercle

(CI

Fig.

(CI

2.52

vertebra)

and

Axis

(CII

vertebra)

Anterior for

capitis

process

Semispinalis

Facet

C1

inferior

Spinous

Anterior

of

superior

minor

Rectus

Obliquus

capitis

ver tebra)

T ransverse

ligament

of

atlas

arch

dens

Lateral

mass

T ransverse

process

Impressions

for

alar

ligaments Foramen

transversarium

Facet

Posterior

for

occipital

condyle

arch

Posterior

tubercle

Superior Superior

view

view T ectorial

membrane

(upper

par t Apical

of

posterior

longitudinal

of

T ransverse

ligament

of

ligament

ligament) dens

atlas

Atlas Dens

Inferior

(CI

longitudinal vertebra)

Axis

(CII

vertebra)

band

of

crucifor m and

Axis

ligament (CII

vertebra)

Dens

and

of

Facets

for

attachment

alar

of

ligaments

Alar

ligaments

Posterior

longitudinal

ligament

B

Superior

view

Posterior

view

•

GAS

Posterosuperior

Fig.

2.20B

view

base

skull

CHAPTER

B.

Extenson

te

o

te

upper

atantooccpta

cervca

jonts

and

spne

te

occurs

at

106.

zygapopysa

lexon

s

a

uncovertebra

lexon

s

not

combnaton

jonts

mted

(o

by

te

movement

Luscka).

aar

at

at

Latera

gament

Abducton

s

a

uncovertebra

by

te

GAS

104.

D.

by

te

uncton

rotaton

o

o

te

ormed

smus

C.

smus

te

many

B.

vates

ts

te

o

and

by

N

ateray

suc

w

not

be

he

ng

and

wen

wa,

serratus

arm

toracc

and

wa

o

degrees)

owed

by

s

Retracton

E.

Adducton

s

s

te

major,

n

D.

S1

E.

S2

A.

s

cauda

s

te

to

te

eve

arm

at

15

s

a

conus

meduars

wc

te

te

s

to

te

aduts.

aduts.

n

dura

D.

to

he

N

108.

s

A.

A

s

pro-

B.

by

te

aduts.

sac

normay

not

tse

rse

ods

to

are

to

ods

o

te

contrbute

but

te

structure

mesoderm

dsc

wc

to

te

and

con-

ormaton

membranes

not

germ

contan

o

te

ces

tat

ayers.

rom

ectoderm

and

gves

ces.

coeom

a

ormed

crest

te

does

tereore

are

neura

101

epbast

tramnar

ormed

crest

s

te

ayers.

do

ntraembryonc

orms

te

embryonc

space.

rom

ectoderm

and

gves

ces.

153

racture

pacement

supped

n

tereore

neura

Neura

per-

v

and

s

deveopment

germ

gve

cavtes

E.

te

and

ABR/McM

streak

embryo

Neura

rse

169–170;

resutng

tree

woud

arm.

degrees

or

embryo

are

ats-

N

prmtve

Coronc

o

nerves

and

101;

he

B.

ats-

o

o

te

te

pars

vertebra

nterartcuars

vertebrae

Spondyostess

te

106

to

nerve

ts

s

to

or

u

te

s

s

s

E.

a

s

responsbe

tereore

wen

or

odng

workng

protract-

t

aganst

togeter

wt

Lordoss

s

s

termed

wen

dspaced

te

te

wtout

anteror

ater

ds-

spondyoyss.

racture

porton

o

te

o

pars

A.

An

s

te

s

wen

te

te

nuceus

annuus

norma

puposus

brosus.

curvature

o

te

cervca

spne.

an

wc

abnorma

usuay

aso

atera

as

a

curvature

degree

o

o

te

rotaton

o

vertebrae.

GAS

109.

s

Scooss

dsc

troug

umbar

spne

er

caed

ernated

and

damaged

puses

wat

D.

ee-

above

A

protrudes

musce.

aow

ted

patent

n

dam-

anteror

musce

te

was

anteror

serratus

and

wen

C.

detod

o

te

te

by

rom

scapua

major,

s

o

te

15

s

mnor,

dors,

(te

supraspnatus,

to

90

many

and

accompsed

atssmus

umerus

te

by

teres

rst

83–84;

epdura

epdura

vertebra

woud

N

(Batson)

te

164;

ABR/McM

anestetc

space

cause

possby

(Upper

Limb

B.

o-

wc

pexus.

spna

cord

113

procedure

contans

compresson

trapezus.

major,

C.

N

417;

he

and

ocated

he

T12,

A

at

s

te

resutng

perormed

and

ematoma

on

medan

n

ocated

n

arteres

spna

te

te

artery

o

epdura

spna

ssures

and

ger

ssure

posteror

teroatera

meduary

te

n

n

regon

nerves

severe

n

nterna

ts

spna

artery

Adamkewcz)

muc

anteror

ror

ABR/McM

(o

segmenta

pectora-

te

anteror

artery

around

D.

Chapter);

great

spna

accompsed

te

he

uar

degrees.

subscapuars.

106

n

meduars

rse

te

scapuae

te

perormed

rombod

GAS

meduars

conus

per-

hese

major

te

serratus

abducton

te

D.

by

te

ends

and

pan

and

dects.

Intaton

15

conus

te

and

trapezus.

C.

te

trape-

and

arm.

wc

resutng

anteror

cord

poston

to

te

scapua

ver-

o

wc

to

te

toracc

pectora

o

toracc

arm,

suppy

te

nterartcuars.

ong

te

ts

dsc,

cauda

endoderm,

pro-

to

and

major

atera

ABR/McM

te

o

canges

ntervertebra

cauda

nerve.

te

te

s

respectvey.

troug

graduay

L1–L2

cord,

s

responsbe

neror

due

te

te

extends

It

spna

s

growt

eve.

GAS

107.

he

scapua.”

te

te

aso

aceved

te

o

pectoras

te

cord

L5

C.

adducton

rotates

nerve

ong

extends

and

te

468;

as

degrees

pectoras

arm

suppes

te

“wnged

te

supraspnatus,

surgery

aganst

by

nerve,

te

te

I

ands

te

meda

abducton

and

and

anteror

adducton

aso

wc

90–92;

abducton,

ead.

and

by

many

wc

Durng

aso

scapuae.

possbe

serratus

nant.

o

te

spna

dferenta

C.

supped

respectvey.

wc

rotaton

by

Durng

aged

A.

by

o

are

supped

suprascapuar

GAS

105.

are

dors,

duced

are

sometmes

eevaton

90

an

and

to

termnates.

mnor

above

scapua

nerves,

Abducton

mted

coumn

te

Due

L4

tans

arm

toracodorsa

ormed

E.

te

actons

dors,

Meda

not

2.20B).

evator

s

s

te

entrey.

B.

85

wc

o

scapuae

rotaton

supped

Fg.

and

nerve

porton

te

wc

Meda

(GAS

ABR/McM

It

at

scapua.

o

o

accessory

movement

Luscka).

major

evator

combned

zus,

(o

scapuar

Abducton

and

23;

ower

tracton

B.

N

rombod

dorsa

suppes

A.

jonts

gaments

68–69;

he

te

aar

combnaton

n

eve

adut

(GAS

Fg.2.20B).

E.

L3

te

deveopment,

cana

vertebra

Latera

te

Durng

tebra

jonts.

C.

A.

39

Back

1

te

s

te

or

great

argest

usuay

radc-

o

te

ocated

at

L2–L3.

ocated

spna

n

cord,

te

and

ante-

s

not

space.

te

epdura

s

tan

arteres

o

s

are

spna

space.

ocated

cord,

n

te

and

pos-

are

not

40

C H A P T E R

E.

he

1

Back

externa

vertebra

pexus

s

ocated

externa

to

C.

Narrowng

te vertebra coumn and a ematoma o ts pexus

w

not

GAS

110.

A.

produce

102–104;

Lgaments

ongtudna

ror

serve

o

ntervertebra

te

o

te

most

restrct

and

courses

ts

anteror

ts

patent.

he

downward

bodes

way.

to

ower

It

te

on

te

stretces

anteror

gament

rom

o

te

surace

gament

te

ower

te

s

GAS

113.

o

te

vertebra

extenson.

ng

to

surace

te

gament

o

te

vertebra

to

dscs

prevent

coumn

and

Lgamentum

o

adjacent

tem

D.

he

rom

bodes

aong

excessve

extends

processes

sacrum;

spnous

111.

he

A.

t

to

anteror

and

te

B.

way.

C2

restrcts

processes

eac

te

ntertransverse

hs

o

and

attac

to

dura

procedure

supraspnous

gamentum

gap

o

degree

sted.

termed

te

o

n

te

he

te

C.

s

skn,

gament,

lavum

gamentum

anteror

vertebra

he

te

beow

te

o

py

te

bodes

connect

posteror

adjacent

durng

nterspnous

s

tere

an

tssue,

ep-

musce,

gament,

s

oten

a

E.

cannot

be

s

reaced

by

to

ts

processes

spnous

L2

as

be

te

o

81–83;

spna

cauda

o

te

N

cord

he

end

cana

nerves

s

posteror

be

reaced

114.

te

eson

o

D.

to

to

but

beow

ts

te

te

beow

at

te

C2

sp-

to

separaton

o

are

te

descrbed

spna

s

cord.

atera

o

nerves

As

L5

a

Dorsa

B.

Sympatetc

and

C.

resutng

L1–

n

on

batera

te

L5

eve,

beow

te

te

L5

eve,

beow

te

root

N

not

cord

te

and

mutpe

s

usuay

arses

at

te

arteres

to

te

do

spna

addtona

course

rom

not

cord

sup-

mutpe

canne

cord,

t

s

or

not

te

ow-

te

crcuaton

ony

to

te

to

te

spna

aong

not

cord

te

s

entre

smpy

n

provded

engt

te

neck

o

and

176–177

s

typcay

wc

a

s

s

bengn

tumor

encapsuated.

mesoderm

wc

as

te

consdered

brocar tage

crest

Nuceus

he

o

ganga

deveop

paravertebra

It

apca

as

a

o

as

ga-

r udmen-

derved

rom

te

rom

neura

ganga

arse

crest

ces.

rom

neu-

ces.

puposus

te

bones

s

derved

rom

te

mesoderma

notocord.

o

te

unsegmented

crana

paraxa

vaut

deveop

mesoderm

rom

and

crana

neura

crest

ces.

nar-

mpact

do

spna

vesses

receve

coatera

rom

atas

A.

contnue

resut,

w

rom

spna

ter

coumn,

orgn,

te

E.

te

and

vesses

nter ver tebra

ces

between

te

regon.

suppy

spna

suppy

orgn

te

GAS

115.

A.

he

rom

B.

101–104

odontod

te

he

C.

he

body

arc

on

process,

o

o

te

posteror

nence

at

do

sacra

regons.

te

cord.

descrbed

spna

at

medan

arteres

tese

anastomotc

te

102–104;

o

anteror

s

te

tese

scerotome.

103

eve.

eve

too

o

posteror

provde

vertebra

same

ra

spna

ts

vertebra

resuppy

but

or

to

course

umbar

bood

aong

condroma

ment

tecnque.

eve

eve

ts

rom

o

ABR/McM

at

adjacent

o

segmenta

A

te

lexon.

by

101

te

to

Adamkewcz

eves

mportant

GAS

by

weakness.

eson

o

ends

dsc

oter

gaments

168;

equna

te

mb

he

not

attac

degree

durng

perorated

ntervertebra

end

B.

processes

eac

te

not

ower

A.

to

restrcts

ntertransverse

rowng

a

t

may

he

aso

gaments

he

GAS

D.

gament

ts

upper

and

cervca

porton

te

tar y

nterspnous

sacrum;

112.

an

by

mdne

anteror

or

segmentay

cest

gament

can

pan.

o

spna

suppy

argest

o

suicent

Anastomotc

and

procedure.

he

nous

E.

and

w

cord.

lavum).

ongtudna

bodes

L5

batera

We te great radcuar arter y (o Adamkewcz)

102

subcutaneous

and

w

sources.

D.

perced

ongtudna

back

arteres,

posteror

aong

artery

anteror

car tagnous

vertebra

ts

D.

he

sp-

to

separaton

ABR/McM

(atoug

o

n

ABR/McM

epgastrc

L5

batera

weakness.

resutng

eves

spna

o

n

eve

brances

bood

he

toracc

provde

approac.

C.

segmentay

ower

prevents

C2

and

suicent

sources

lexon.

structures

te

ony

a

superca

py

vesse

order

at

170;

at

posteror

te

unatera

not

N

eve

resutng

nerves

anastomotc

te

suraces

adjacent

rom

gaments

167–168;

te

121;

te

beow cervca eves and w receve addtona sup-

GAS

N

not

cana

arteres

te

est

81;

o

at

nerves

weakness,

anteror

provde

lexon.

oter

durng

nterna

oter

durng

gaments

to

ncude

he

attac-

lexon

rom

te

eac

apart

a

mb

transverse processes and prevent excessve rotaton.

he

B.

attaces

amnae

pung

nterspnous

nous

E.

lavum

te

108–111,

send

sacrum.

C.

o

on

coumn

cana

te

artery.

vertebra

nter vertebra

ser ves

o

weakness,

Segmenta

not

he posteror ongtudna gament traves on te

posteror

A.

te

a

mb

mpact

ante-

to

o

on

Narrowng

anteror

attacng

ongtudna

postoned

mts

ts

movement.

vertebra

aong

o

E.

nerory

he

anterory

coumn

B.

sku

sacrum.

to

te

dscs

symptoms

178

gament

surace

base

te

N

mpact

ts

te

and

dens,

and

projects

superory

artcuates

wt

te

atas.

tuberce

posteror

atantooccpta

lexon

or

axs

o

jont

extenson

te

atas

s

a

bony

em-

arc.

o

s

te

prmary

ead

on

nvoved

te

neck.

n

CHAPTER

D.

he

to

E.

neror

te

he

C3

anteror

nence

A,

on

te

x-ray

C2

s

body

te

In

ter

nerve

te

N

ts

s

a

bony

n

s

118.

em-

s

1.5,

pass

crosses

umbar

te

produce

B,

s

C.

to

vertebrae,

to

odontod

n

wc

te

t

w

L4

ext

case

o

nerves

symptoms

ernaton.

be

dsc

to

and

As

ext

compressed

L4

L2,

L3,

dferent

L4,

to

and

tose

S1

seen

produce

o

nerves

symptoms

119.

D.

L2,

L3,

dferent

L4,

to

and

tose

S1

seen

produce

o

nerves

symptoms

L2,

L3,

dferent

L4,

to

and

tose

S1

seen

woud

produce

o

nerves

symptoms

L2,

L3,

dferent

L4,

to

and

tose

S1

seen

D.

he

te

ar

C.

E.

ts

te

n

as

t

165;

type

o

artery

C1

Bot

wc

ABR/McM

passes

he

atas.

ts

N

vertebra

atas

o

on

tese

ts

es

s

and

a

may

typca

posteror

surace

superor

beneat

structures

hs

anteror

to

nerve

superor

be

t,

artcu-

aganst

njured

Jeferson

arces

o

he

o

sac

ay

B.

he

na

not

he

na

cord

he

s

C2

ess

te

n

a

n

n

te

racture

a

key

te

racture

spna

to

s

be

ypogossa

posteror

wtn

not

occpta

posteror

wtn

pared

cord

te

njured

pared

njured

E.

be

artery

woud

he

above

njured

C.

and

racture.

eray

spna

nerve

be

an

te

dura

te

and

and

69,

ts

usu-

e

on

te

woud

be

sac

and

e

on

te

woud

not

dects

o

te

wt

N

176–177

neu-

body

rom

meet

te

n

and

attac

te

ne-

to

te

sde,

te

te

and

bodes.

90

extenson

It

eabo-

attaces

process

An

o

aong

avuson

C7

s

oten

racture.

s

a

dura

ter

eac

vertebrae.

gaments

not

rom

on

gament.

gament

atera

extenson

o

sac.

connect

adjacent

sp-

tps.

lavum

and

connects

adjacent

29;

am-

ABR/McM

because

cauda

te

es

anteror

vertebra

bod-

nvoves

dsc,

o

by

or

spna

oss

108–109

nvoved

equna

a

wde-rangng

compresson

a

mass

tumor.

roots

radcuar

or

reduced

he

L2

pan,

suc

It

o

as

a

typcay

and

beow.

absent

urnary

treatment

knee

badder

nvoves

sterods.

erna

may

musces

nerve,

t

contro.

and

to

dscs.

syndrome

and

gament

posteror

unatera

tg

but

cause

due

t

to

woud

weakness

compresson

not

afect

n

te

o

te

structures

perneum.

Prorms

syndrome

mon

buar

neve

passes

We

not

nerve

n

compresson

nstances

te

pernea

pudenda

neve

structures

mb

s

troug

afect

prorms

te

part

com-

o

ts

musce.

It

structures.

pasy

afected,

nvovement

o

were

n

mgt

tere

ts

expan

woud

type

o

not

te

be

ner ve

njur y.

C1

C1,

and

C2

wc

and

es

on

E.

Scatca

te

s

pat

GAS

121

a

o

perneum.

102–104;

N

obturator

ower

atas.

tan

te

ateray

posteror

spnous

ntervertebra

pernea

be

a

Soveer’s

spncter

woud

sp-

s

ongtudna

sac

surgery

te

not

amna

ABR/McM

te

wtn

relex,

ana

n

C.

D.

arteres

es

obturator

sp-

not

o

vertebra

superory

project

cervca

compresson

meda

anteroat-

woud

te

do

vertebra

ntervertebra

emergent

sort

o

Cay

equna

anke

An

te

tp

a

81–81;

presents

te

atas.

atas.

GAS

n

runs

and

arteres

between

njured

wtn

as

dura

nerves

and

o

posteror

nvoves

racture.

sac

spna

es

nerve

atas

dura

o

damaged

condyes

spna

o

ocated

con-

njured

vertebrae.

ernated

It

te

163;

gamentum

te

and

and

supraspnous

te

Cauda

B.

anteror

dura

A.

to

N

processes,

o

GAS

120.

racture

are

tat

part

amnae

project

processes

pedce

nterspnous

he

and

C1

arc

te

posterory

pared

amnae

dentcuate

he

n

o

s

porton

projects

te

gament

a

and

he

te

te

posteror

spna

racture.

te

es

99

ractured.

A.

he

to

woud

ts

o

nous

woud

te

unctona

80;

acet.

tps

pa

ts

patent.

117.

nuca

to

A.

te

attac

o

woud

n

t

contact

processes

te

66–67;

o

es

Compresson

neura

bodes.

o

reerred

ts

n

te

and

posteror

not

process

transverse

racture

patent.

GAS

he

te

te

n

te

were

rom

not

nae

Compresson

E.

he

raton

patent.

C.

arc,

artcuar

GAS

beow

n

o

body,

does

spnous

he

do

te

by

s

and

vertebra

B.

Compresson

he

rory

beow

te

part

mdne.

D.

reconstructon

nerves

ntervertebra

vertebra

arc

te

racture.

amna

neura

racture

vertebrae

spna

s

vertebra

Cance

he

unon

between

superor

te

drecty.

at

19).

posterory.

he

open-mout

CT

p.

pedce

to

ra

patent.

B.

a

E.

regon

te

Compresson

he

n

ernaton.

A.

B.

ony

reatve

anged

racture.

as

centered

Fg.

posterory

and

a

patent

wc

Sagtta

dsc

umbar

woud

t

jons

BP34–BP35

correspondng

nerve

on

C,

ernated

te

axs

racture.

66–71;

he

te

A.

dspaced

subte

sows

atas

arrowheads

ndcate

(arrows).

L5.

were

te

tat

(arrow)

x-ray

D.

o

sweng,

(see

ndngs

extremey

GAS

s

arc.

sows

prevertebra

hese

L5

tuberce

odontod

te

acet

nects

anteror

odontod

he

116.

ts

Latera

md

s

artcuar

vertebra.

41

Back

1

term

te

used

scatc

oosey

ner ve

or

and

pan

not

aong

n

te

42

C H A P T E R

121.

B.

1

Lordoss

cave

to

craw

and

ts

produce

a

a

a

type

ten

o

tebra

ung

o

te

tat

dsease

use

because

o

te

and

and

togeter,

can

nto

cause

o

te

may

te

costover-

restrctve

cest

wa

to

s

a

prmary

convex

posteror

curvature

n

te

curvature

toracc

tat

and

s

sacra

regons.

C.

he

prmary

anterory.

cervca

and

curvature

ordoss,

ten

as

As

a

o

te

te

vertebra

nant

secondary

wakng

begns,

begns

coumn

to

curvature,

a

umbar

craw,

s

a

deveops,

ordoss

s

acqured.

Scooss

son

E.

o

here

GAS

122.

C.

he

cause

nto

A.

o

te

N

an

abnorma

162;

rst

o

pop

te

curvature

ABR/McM

lavum

two

bendng

and

tor-

ts

et

s

pops

n

te

87

he

and

wt

nner

n

a

puncturng

aracnod

bone

bones

as

a

eastc

neede

s

and

s

bone

sow

acdc

surace,

D.

te

Once

or

umbar

a

water

a re

ed

p u n c t u re ,

baoon,

wt

ary

gament

contnuous

supraspnous

gament.

s

wt

not

te

more

eastc

superca

hs

spaces

crana

nerve

and

s

Kyposs

tat

a

by

due

te

tps

not

woud

o

gy

smpy

t.

103

aure

o

osteocasts

to

a

and

norma

uncton.

mutaton

as

produces

o

and

creates

oramna

sceross

bone.”

a

are

n

te

curvature

dense

tat



susceptbty

nvoved

and

aso

to

patents

pases.

known

extrameduary

deects

and

bones

Laboratory

congenta

resut,

tck

cortca

compresson

atera

a

te

a

s

s

X-rays

as

bone-

studes

sow

ematopoess.

o

te

spne

condton

or

tat

may

trauma

to

n

te

posterory

toracc

convex

and

sacra

curva-

regons

spne.

a

secondary,

acqured

begns

te

prmary,

ound

adut

tat

he

s

s

Lordoss

wen

C.

c e re b r o s p  n a 

gy

are

t

s

beneat

ABR/McM

deectve

symmetrc

rom

nant

because

t

anteror

vertebra

spne.

ture

te

because

troug

overgrowt

“stone

Scooss

o

o

crana

ture

mater

produces

to

aong

and

gament

envronment

marrow

dfuse

n-bone

ntroduced

aracnod

due

es

processes,

caracterzed

osteocasts

because

exbt

B.

te

168;

es

te

dscs.

passng

resorpton.

ractures.

to

cd

prmary

n

craw,

begns

concave

te

and

to

curvature

posteror

cervca

n

regon

te

curva-

wen

umbar

an

regon

wak.

o

te

spne

s

convex

posterory.

E.

nterspnous

s

deectve

generate

te

A.

gy

N

s

resorpton

te

ud.

B.

neede

to

gene or carbonc anydrase II tat mpars ter abty

spne.

space.

m a t e r,

aganst

ke

atera

spnous

gament

posteror

gament

nterspnous

81–83;

resut

tertary

dura

second

and

he

spne.

subaracnod

yng

s

no

75;

Te

t

s

gamentum

te

GAS

A

te

Osteopetross

bone

and

ntervertebra

vertebra

pancytopena

te

s

and

sac,

supraspnous

enter

123.

ongtudna

dura

eastc.

te

concave

D.

te

to

Kyposs

he

n

expand.

A.

E.

Typca

pro-

posteror

te

bodes

even

resutng

he

to

stfness.

Furtermore,

nabty

D.

spondyts

spne.

spondyts

jonts

con-

begns

spondyts

regon

pan

spne.

ankyosng

person

Ankyosng

afects

bamboo

costosterna

dsease

cur vature,

te

umbar

ncude

eventuay

or

as

Ankyosng

n

kyposs.

te

te

and

secondar y

acqured

wak.

artrts

o

spne

gresson

s

cur vature

vertebrae

rgd

norma

tat

umbar

symptoms

he

s

posterory,

reverse

s

Back

he

spne

cervca

craw

GAS

and

74

acqures

and

umbar

ater

to

secondary

regons

wak.

as

curvatures

te

nant

n

te

begns

to

2 Thorax

Q u e st i o n s

Questions

1.

A

4.

1–25

31-year-od

norma

spontaneous

pications

te

boy

unt

woman

during

is

Wc

o

wt

dogram

sows

o

to

te

2

he

s

ater

pregnancy

prmary

te

was

An

great

nto

com-

on

2.

Septum

secundum

B.

Septum

prmum

C.

Bubar

D.

Aortcopumonary

E.

Endocarda

32-year-od

surgca

at

30

nata

weeks’

vst.

mts.

n

sze

py

T oday,

Pysca

wt

sows

nverted

a

a

3.

er

etus

wt

dapragm,

consstent

wt

Laryngea

B.

T racea

C.

Poyydramnos

B.

Umbca

arteres

C.

Umbca

ven

D.

Coarctaton

E.

Pumonary

Lung

sowed

norma

or

no

wtn

uterus

Feta

pre-

norma

sows

a

routne

wt

ungs,

no

te

and

murmur.

te

a

Prevous

moter

wt

no

he

cd

Wc

anomaes

Membranous

B.

T etraogy

o

C.

Muscuar

ventrcuar

D.

Ostum

secundum

E.

Ostum

prmum

od,

ventrcuar

septa

septa

deect

deect

deect

a

u-term

ater

oud,

brt

snge

gr.

sows

S2

sound

ecocardogram

sows

te

T ransposton

Pumonary

E.

ventrcuar

6-day-od

bue

te

we

o

ts

s

because

sows

a

ars

An

an

deect

x-ray

and

o

te

condton

o

va

vag-

brt.

At

emergency

skn

appeared

we

systoc

eedng.

murmur

ecocardogram

overrdng

ypertropy

cest

s

ts

te

er

border.

sows

most

key

cnca

aorta,

o

a

te

boot-

respon-

pcture?

Faot

o

te

great

vesses

atresa

s

he

artery

septa

Wc

Superor

to

stenoss,

septa

most

brougt

gr

durng

dscooraton

deect

brougt

moter

deect

o

te

te

o

says

An

stenoss,

key

o

to

because

breasteedng.

custer

newborn

artery

moter

bue.

pumonary

ansms

perormed?

deect

gr

er

ventrce.

most

o

septa

a

sterna

Wc

D.

by

s

deveopment

C.

turnng

devers

compcatons

moter

An

T etraogy

ment

s

aorta

gr

septa

eart.

or

maormaton

bus

upper

ventrce.

as

o

er

Atra

deect

Faot

et

ventrcuar

no

by

sgt

B.

A

no

te

A.

A.

A.

a

An

to

days

stenoss

woman

wt

ventrcuar

sbe

te

examnaton

exam-

occurs

commony?

ad

com-

a

o

artery

pumonary

saped

s

to

te

rgt

oter

brougt

Pysca

condtons.

cardac

s

dever y

pregnancy.

medca

congenta

cd

ave

sows

an

condtons

examnaton.

vagna

cardac

assocated

oowng

a

devery

monts

at

indngs?

abnormates

durng

29-year-od

Pysca

consstent

ecogenc

asctes

a

utrasonogra-

oowng

Amercan

spontaneous

pcatons

A

to

6.

Arcan

pyscan

oter

eta

te

or

0,

ypopasa

2-year-od

naton

o

oce

are

a

aborta

atresa

Ogoydramnos

a

sgns

sows

enarged,

tese

E.

vsts

te

and

eart.

te

te

atresa

D.

te

to

gestaton.

and

Wc

A.

A

vta

examnaton

30-week

abnormates.

most

comes

2

arterosus

department

0,

o

great

or

cusons

gestaton,

correcton

Ductus

6

para

te

A.

septum

1,

tacypnea,

o

brt

gr

structures must reman patent or te gr to survve unt

na

gravda

te

com-

5.

woman,

cyanoss,

auscutaton

gves

o

transposton o te great arteres. Wc o te oowng

septum

A

woman

examnaton

care

ar teres?

A.

27-year-od

centra

ar teres.

te

A

Pysca

ecocar-

responsbe

ar terosus

via

deiver y

intensive

metus.

o

boy

witout

neonata

dabetes

tr uncus

u-term

ours

transposton

te

a

deiver y

T wo

cyanoss.

type

str ucture

dvson

vagina

bir t.

admitted

because

pcated

deivers

and

emergency

a

sudden

te

gr’s

depart-

epsode

ps

ecocardogram

overrdng

o

ypertropy

oowng

responsbe

te

o

or

te

sows

aorta,

te

embryoogc

o

turned

rgt

mec-

deveopment

anomaes?

maagnment

o

te

subpumonary

nundbuum

B.

Deect

C.

Endocarda

n

te

aortcopumonary

D.

T ota

E.

Atroventrcuar

cuson

anomaous

septum

deect

pumonary

(AV)

cana

venous

connectons

maormaton

43

44

C H A P T E R

7.

A

2

Thorax

5 -year-od

depar tment

ness

he

o

naton

ixed

key

says

sows

a

o

an

Atra

septa

T etraogy

E.

o

Aortc

u

or

 ear t.

e xam-

a

term

proie,

w de ,

contrast

occur

n

T etraogy

B.

T ransposton

C.

Atra

D.

T runcus

E.

Coarctaton

pumonary

s

te

mo st

aorta.

septa

oter

examnaton

o

te

and

great

o

te

boy

or

s

a

sows

a

sows

te

snge

a

s

septa

severe

boy

s

papebra

most

congenta

Wc

most

key

wt

o

be

Pysca

and

an

cardac

a

te

eon-

ow-set

10.

A.

T etraogy

B.

T ransposton

Atra

D.

Coarctaton

septa

E.

Aortc

28-year-od

at

32

weeks’

department

vta

es

sgns

sow

irmng

o

te

key

Faot

o

and

o

and

te

at

oowng

assocated

truncus

great

te

ma-

wt

because

o

wtn

arterosus

septa

deects

14.

gravda

wt

T etraogy

B.

T ransposton

C.

Atra

D.

T runcus

E.

Coarctaton

septa

2,

brougt

dzzness

serum

o

eta

A.

s

norma

dagnoss

oowng

o

and

sows

key

nto

te

n

te

arc

expanaton

A

te

et

o

or

te

ts

or

mts.

gucose

1,

te

aborta

severa

days.

Laboratory

dabetes.

maormatons

moter’s

condton?

Faot

o

and

te

great

ductus

arterosus

venosus

E.

ventrcuar

A

3-year-od

o

te

aorta

Her

stud-

con-

Wc

s

most

septa

or

septa

boy

a

s

deect

brougt

routne

sows

spt

a

S2

eart

septa

systoc

An

and

deect.

ncompete

to

te

pyscan

examnaton.

oud

sound.

rgt

atra

A.

Foramen

B.

Lgamentum

C.

Ductus

murmur

x-ray

te

o

te

patent

hs

cosure

Cardac

s

wc

o

a

usuay

te

wde,

an

wt

resuts

oowng

Snus

E.

Coronary

venarum

A

2-our

s

brougt

a

snus

premature

to

te

boy,

o

dstress

type

s

n

va

boy

he

boy

or

24

s

weeks

he

cesarean

sows

syndrome.

responsbe

at

department

breatng.

moter

te

gruntng.

tory

born

emergency

dcuty

17-year-od

and

arterosum

arterosus

boy

dagnosed

Wc

o

was

devery.

tacypnea,

te

synteszng

gestaton,

because

o

born

Pysca

nasa

wt

ar-

respra-

oowng

suractant

n

A.

Aveoar

B.

Bronca

mucous

C.

Bronca

respratory

D.

T ype

I

E.

T ype

II

An

ce

ts

admtted

dever y

o

gastrc

te

nto

rgt

o

cest

sows

te

te

torax

oowng

te

sows

n

s

te

et

ntensve

o

a

et

ypopastc

nspraton,

most

et

1

ung

Pysca

ascend-

we

normay.

key

unt

dstress.

emtorax.

contracts

te

care

resprator y

emdapragm

durng

emdapragm

te

to

because

contents

examnaton

ng

epteum

aveoar

s

ater

x-ray

and

endotea

aveoar

nant

An

capary

cause

te

Wc

o

ts

o

te

condton?

A.

Absence

B.

Absence

o

a

peuropercarda

o

muscuature

n

od

one

a

dapragm

deects

s

sows

dagnosed

condton

o

and

cest

by

exam-

ovae

D.

arteres

ventrcuar

arterosus

0,

emergency

concentratons

gestatona

cardac

te

para

to

deect

syndrome?

ts

aorta

woman,

assocated

most

examna-

murmur.

mmedatey

reeased

ductus

our

eevated

te

vsbe

Patent

ng,

arteres

ventrcuar

te

gestaton,

are

Cardac

Pysca

abdom-

stenoss

examnaton

eco-

atresa

A

be

arng,

perormed

Patent

to

ears.

maor-

deeton

septa

progressve

condton?

C.

s

wen

te

nasa

department

breat.

structures?

pyscan

issures,

and

ypocacema

dagnosed

cromosome.

te

examnaton.

mcrognata,

sows

o

to

o

macnery-ke

D.

rom

13.

routne

cardogram

w

emergency

breatng.

C.

an

o

deects

to

Mtra

enarged

murmur.

indng

Atra

B.

ixed,

pa-

dagnoss

A.

naton

a

arteres

brougt

narrow

eatures,

he

s

to

sortness

tacypnea,

durng

artery

Wat

moter

Pysca

aorta

sow

ormatons

and

12.

born

macrogossa,

cardac

ventrcuar

studes

22q11

s

condton?

Laborator y

matons.

by

was

devery.

brdge,

conirms

Wat

cd

ods,

examnaton

ts

pyscan

he

vagna

epcantc

nasa

te

arterosus

moter

aca

to

Faot

3-mont-od

gated

brougt

anayss

o

o

contnuous

medum

c e s t

arteres

examnaton.

Cardac

A.

s

great

spontaneous

syndrome.

to

s

depressed

crease.

brougt

cateterzaton

te

Wat

s

because

sows

a

o

deect

te

sows

Cromosoma

Down

o

boy

va

sows

cardac

Faot

routne

examnaton

by

and

x-ray

boy

moter

retractons

ton

stenoss

3-mont-od

A

mur mur

An

s

na

os p ta-

Pys ca

2-year-od

examnaton

 at gued

p r o r

A

by

r ie nd s .

eas y

no

 ne ss .

s y s to c

wit

11.

s or t-

deect

T ransposton

moter

9.

s

as

e m er gency

se vere

indng?

D.

key

s occe r

c d

He

sound.

r  gt

septa

C.

mar

te

m ajor

2

te

o

dagnoss?

B.

at

S

enarged

ventrcuar

at

o

oud

te

A.

A

tat

to

b ec ause

p  ay ing

actv t e s .

stor y

spt

sows

8.

or

b rougt

m ote r

wen

pysca

zatons

is

is

breat

moter

durng

boy

by

C.

Faure

o

mgraton

D.

Faure

o

te

E.

Absence

o

a

o

septum

dapragm

transversum

peuropertonea

od

to

deveop

CHAPTER

15.

A

35-year-od

department

ening

tion

eadace

sows

a

extremities,

murmur

Wic

o

ikey

A.

Bubus

B.

Ductus

E.

Rgt

cardna

ourt,

5-day-od

s

emergency

weekend.

Pysica

upper

puses,

anterior

body,

and

cest

tese

a

a

a

wors-

septa

ower

oud

and

and

et

boy

sxt

orns

o

vena

s

to

because

o

Ostum

secundum

prmum

C.

AV

Common

E.

Snus

A

depart-

droong

4

and

te

at

(7

and

5

cardac

te

cest

rax

wt

sows

ar

a

swaowng

nasogastrc

bubbes

structures

n

te

aed

tube

mk.

cong

stomac.

to

An

deveop

n

x-ray

te

Wc

n

ts

o

to-

o

te

patent?

embryoogc

Fauty

B.

T racea

era

C.

T ongue

D.

T raceoesopagea

E.

Parynx

s

born

te

durng

o

te

torax

oowng

ts

s

brougt

eedng.

cest

he

a

bubbes

istua

(TEF)

condtons

o

te

s

emergency

excessve

moter

wen

sows

ar

to

because

cyanotc

wt

esopagea

wt

boy

moter

became

x-ray

n

s

says

swaowng

nasogastrc

te

stomac.

key

te

new-

A

be

21.

An

cong

o

D.

Interrupton

E.

Fauty

A

2-day-od

n

unt

was

te

born

Pysca

assocated

and

and

gr

er

brougt

parents

dscooraton

o

o

1

er

te

gr

breatng,

was

o

ts

a

te

ater

and

tey

at

u

Pysca

was

term

depart-

a

bus

and

severe

uncomp-

va

oowng

s

key

o

and

examna-

Despte

ater

te

rom

oow-

responsbe

sternum

and

uson

or

percar-

o

te

paryngea

magnetc

wt

at-

arc

magng

s

at

he

te

u

arng,

An

boy

term.

gruntng,

ecocardogram

(MRI)

connectons.

events

and

devery

nasa

ntensve

tacypnea.

sow

Wc

responsbe

macne-ke

septaton

deveopment

o

te

septum

C.

Abnorma

deveopment

o

te

et

D.

Abnorma

deveopment

o

te

coronary

E.

Abnorma

deveopment

o

common

A

3-day-od

breatng.

dur-

ng

eart

w

Abnorma

Abnorma

and

most

by

er

abdomen

sows

totay

o

te

or

ts

o

Varcea

C.

Septum

E.

T reponema

brougt

requent

breat.

to

te

pyscan

epsodes

Cardac

o

by

s

atgabty

examnaton

sows

23.

Cervca

E.

Dorsa

o

orn

snus

cardna

to

te

because

o

dcuty

upon

scan

te

sows

o

centra

oowng

ven

emergency

wt

nasa

ar-

nspraton.

er

cest

tendon

structures

o

A

and

te

aed

ods

ods

transversum

myotomes

mesentery

30-year-od

easy

secundum

snus

normay?

D.

A

o

te

venosus

brougt

(CT)

absence

Wc

D.

s

s

snus

retractons

Peuropercarda

padum

te

examnaton

B.

vrus

gr

tomograpy

dapragm.

deveop

o

moter

Pysca

abdomna

computed

anomay?

newborn

Cytomegaovrus

o

neonata

and

B.

C.

sortness

deveopment

A.

to

o

te

vagna

sows

embryoogc

Peuropertonea

because

to

arc

venosus

breatng.

resonance

A.

boy

snus

uncompcated,

pumonary

T oxopasmoss

5-year-od

paryngea

cyanoss

examnaton

Rubea

and

te

brougt

B.

moter

days

Wc

most

o

spontaneous

retractons

department

sows

retractons

nectons

22.

sponta-

examnaton

abdomna

congenta

noted

abdomen

contnuous

te

emergency

pregnancy

born

arng,

and

Wc

to

he

devery.

nasa

to

our

cest

breat.

vagna

it

A.

A

3

was

5

maormaton?

exposure

s

boy

va

T oxopasmoss

2-day-od

o

was

E.

ead

des

ourt

course

pregnancy

hadomde

key

Pysca

ncompete

o

o

Poyydramnos

murmur.

were

condtons?

o

to

because

D.

ng

s

suc

brougt

abnormates.

newborn

deveopment

C.

tacypnea,

o

scores

s

wegt

Interrupton

oowng

and

Apgar

respectvey.

events

cords

brt

Interrupton o trd paryngea arc deveopment

Rubea

neous

sep-

C.

B.

cated,

superor

atra

B.

care

traceo-

Wc

to

and

mk.

tube

suspected.

most

depart-

droong

condton?

sortness

2

ods

anomaous

by

and

deveopment

Ogoydramnos

ment

te

o

S

atra

descrpton?

Hs

ypoxema.

secondary

A.

A

ts

spt

an

deveopment

5-day-od

by

o

types

ectopa

cardac

te

and

deveopment

dum,

A

care,

te

Esopagus

wt

11oz),

ng

A.

or

department.

mnutes,

aure

A.

septum

newborn

mutpe

became

wen

openng

oowng

ixed,

sows

atrum

b,

sows

approprate

cyanotc

te

caracterstc

emergency

kg

1

wde,

venosus

1-our-od

ton

a

cana

D.

to

emergency

at

Ostum

20.

are

and

examnaton

te

B.

arces

deects

o

A.

is

symptoms?

excessve

ocated

Wc

back.

venosus

te

murmur

utrasound

deect

cava.

3500

brougt

An

ta

ven

moter

systoc

mid-

structure(s)

paryngea

snus

oud

sound.

examina-

cod

wa

embryoogic

produce

and

cokng durng eedng. he moter says te newborn

cokng

19.

to

te

arteriosus

and

ment

18.

is

to

nosebeed

cordis

hrd,

oowng

17.

aected

Rgt

by

te

emora

on

D.

ment

severe

oowing

C.

A

brougt

a

deveoped

absent

te

is

o

over

more

systoic

most

16.

man

because

45

Thorax

2

man

atgabty.

o

te

comes

esopagus

to

Pysca

te

pyscan

examnaton

because

sows

te

46

C H A P T E R

2

bracia

arteria

emora

puses

artery

are

arteria

Thorax

deayed.

low

Wic

pressure

pressure

o

in

He

te

te

is

is

is

markedy

decreased,

diagnosed

proxima

oowing

part

increased,

and

wit

o

te

structures

te

a

te

bockage

toracic

aied

examnaton

emora

to

x-ray

o

toracc

24.

Second

B.

hrd

C.

Fourt

D.

Ft

E.

Ductus

A

aortic

aortc

aortc

aortc

n

sterna

because

te

oogc

25.

Let

B.

Rgt

C.

Let

D.

Rgt

E.

Let

sxt

are

An

pyscan

o

breat.

n

te

does

te

and

ductus

pat-

embry-

s

gr

s

39.4°C

29.

arc

arc

brougt

ater

because

to

o

(102.9°F).

norma

mts.

murmur

cest

arc

arc

aortc

a

he

Cardac

eard

sows

Ecocardograpy

te

on

g

a

Laryngotracea

E.

Foregut

and

depart-

An

pumonary

vaves

to

bunde

coronary

C.

T rcuspd

D.

Let

E.

Aortc

5-day-od

o

dcuty

and

vertebra

cardac

brougt

rada

abnormates.

dvson

o

te

portons

o

s

te

made.

maormatons

septa

B.

T etraogy

o

Pyorc

D.

Congenta

dapragmatc

Faot

E.

Esopagea

istua

Coarctaton

Patent

ductus

o

E.

Aortc

atresa

te

expans

tese

indngs?

aorta

30.

arterosus

A

A

ton

26–50

3-day-od

ta

ntensve

cyanoss

bue.

dd

boy

care

because

were

he

not

u-term

boy

oowng

type

o

was

mprove

examnaton

te

unt

te

boy’s

gven

s

sows

s

brougt

ace

o

an

and

epsode

suppementa

w

o

most

severe

Interatra

septa

B.

Interventrcuar

njury

C.

Patent

D.

Corrected

E.

Common

ductus

because

o

key

produce

ts

D.

Prenc

E.

horacc

A

great

arteres

and

sows

cest

cyanoss.

ntensve

Pysca

ror

sows

te

spne

ecocardogram

dagnoss

nto

o

ncom-

respratory

o

te

tract

s

and

oowng

assocated

erna

unconscous

s

vece

Hg,

88%.

s

most

to

te

emer-

coson.

puse

Hs

s

105/mn,

Pysca

examna-

on

te

cest

perormed.

commony

wa.

Wc

at

g

o

An

te

rsk

o

ven

carotd

artery

duct

woman

wtn

cear

to

an

o

procedure?

because

te

by

a

s

mts.

to

to

Pysca

te

nerve

resut

te

n

emergency

breatng.

bateray.

nvadng

Wc

tumor

brougt

dcuty

sounds

tumor

um.

te

o

norma

breat

sows

pressed

x-ray

nerve

45-year-od

are

because

nerve

department

arterosus

dyspnea

ts

Vagus

A 2-day-od boy s brougt nto te neonata

unt

structures

durng

C.

sgns

te

traceostomy

bracocepac

31.

o

s

common

o

A

aceratons

Let

Wc

and

mm

saturaton

mutpe

Let

sunt.

An

motor

62/30

B.

deect

transposton

a

A.

arterosus

truncus

s

brougt

ater

wc

deect

septa

oxygen

sows

oowng

turned

oxygen,

pressure

emergency

sunt?

A.

care

neona-

s

Ecocardograpc

rgt-to-et

condtons

te

extremtes

symptoms.

a

nto

boy

department

bood

artery

stenoss

2-year-od

gency

pyscan

gastrontestna

C.

D.

key

wen

deect?

examnaton

Wc

deect

C.

most

struc-

surgeon

syndrome?

ta

Atra

a

subpumo-

descendng)

te

oregut

atresa

A.

to

abnormates

acaasa

and

sows

sows

oowng

te

Pysca

apasa.

Esopagea

aureus

and

27.

s

eedng.

Esopagea

Questions

26.

boy

B.

Stapyococcus

te

te

o

(anteror

A.

sows

te

by

ste

o

er

eed-

artery

antb-

cuture

examnaton

area

o

by

durng

vave

otc terapy s ntated. Wc o te oowng congen-

Bood

te

pyscan

branc

wt

atresa

ts

te

careuy

at

te

vave

A

wt

at

nterventrcuar

condtons

norma.

paced

Rgt

dgestve

arteres.

be

are

to

ecocardogram

Wc

avoded

Rgt

pete

x-ray

be

B.

sows

a

et

propery?

breatng

Pysca

An

deect

A.

sgns

sows

septa

nundbuum.

vta

te

embryoogca

deveop

brougt

atgue.

must

remanng

examnaton

nto

An

and

septum

murmur.

tures

sows

to

dcuty

nary

tem-

ntestnes

oowng

ung

membrane

s

o

excessve

oosystoc

ana

te

retractons.

groove

gr

because

sutures

o

and

ypopastc

transversum

3-mont-od

Her

auscutaton.

te

D.

ever.

promnent

sows

emergency

T raceoesopagea

A

et

aed

Peuropertonea

te

arterosus

key

C.

ventrcuar

arc

aortc

most

arng

a

abdomna

Wc

B.

a

rgt

a

te

Septum

ng

mur-

o

nasa

sows

A.

moter

upper

sows

oowng

te

s

Pysca

et

arrytmas

angogram

o

by

macne-ke

space

sows

Wc

aortc

aortc

er

ars

te

ECG

aortc

ourt

wtn

o

sortness

structures

ourt

by

oud,

te

contnuous

ntercosta

An

sxt

it

perature

a

arterosus.

4-year-od

ment

severe

to

rom?

A.

A

brougt

ypertropy.

artera

orgnate

o

sows

border.

ductus

28.

s

second

ventrcuar

ent

arc

boy

examnaton

mur

arc

venosus

1-year-od

moter

aorta

arc

cest

cavty.

structures

deveop

sows

te

ernaton

aorta.

normay?

A.

o

s

An

ung

Her

vta

examnaton

x-ray

o

surace

most

key

dyspnea?

te

ante-

com-

CHAPTER

32.

A.

Prenic

B.

Vagus

department

C.

Intercosta

ke

D.

Recurrent

E.

Cardiopumonary

A

36.

aryngea

62-year-od

man

3-mont

istory

signs

witin

are

s

to

te

progressive

norma

pysician

voice

imits.

because

sotening.

Pysica

o

A

CT

te

aortic

artery.

Wic

compressed

33.

to

cause

prenic

Esopagea

C.

Let

recurrent

D.

Let

vagus

E.

Let

sympatetic

Vita

2-mont

se

ago,

se

just

beyond

most

90

patient’s

structure

is

canges

a

growt

te

in

et

most

te

tra

Least

D.

horacc

E.

T5–T9

o

er

a

sows

tons

to

being

ead

te

unabe

due

to

mastectomy

weakness

in

er

damaged

o

rigt

during

pysician

to

reac

pain. T wo

procedure.

souder

arm.

to

a

Hg.

pan-

s

nerve

in

Greater

Prenc

C.

Vagus

condition?

s

D.

Intercosta

B.

Spina

E.

Lesser

C.

Long

D.

Radia

gency

E.

horacodorsa

2-mont

A

41-year-od

department

zed

pan

sows

ung

ieds.

An

bodes

te

centra

Dorsa

root

B.

Sympatetc

C.

Dorsa

D.

Latera

E.

V entra

brougt

s

or

cest

ocaton

te

nerve

nervous

n

te

te

ibers

to

ower

rgt

peu-

neurona

tat

cest

carry

d ow.

orn

o

orn

o

orn

te

te

o

te

spna

norma

ung

Vagus

Prenc

ts

C.

Let

D.

Rgt

E.

Greater

39.

A

o

cord

10-day

Hg,

and

ton

sows

o

te

nvoved

115/mn,

respratons

brusng

pregangonc

ncreasng

te

eart

cardac

are

o

cord

a

ng

motor

vece

pressure

25/mn.

te

cest.

neurona

coson.

120/78

Pysca

Wat

ce

s

s

bodes

mm

te

examna-

te

te

ocaton

nvoved

A.

n

rate?

A.

Deep

B.

Dorsa

C.

Latera

orn

T5–T9

D.

Latera

orn

T1–T4

E.

Ineror

motor

n

bood

pexus

nuceus

cervca

o

ganga

oowng

to

te

cen-

te

2-our

110/mn,

pressure

s

nnervaton

o

oowng

o

mm

expratory

dagnoss

te

s-

respra-

120/80

dfuse

A

o

emergency

o

te

acute

nerves

bronca

s

by

o

mass

te

brougt

er

oarseness.

Pysca

te

te

emer-

because

V t a 

sgns

examnaton

b   a t e r a   y.

at

to

usband

A

CT

s  ow s

scan

o

aortcopumonar y

 o   ow  n g

ner ves

s

o

a re

most

te

wn-

key

aryngea

aryngea

toracc

spancnc

woman

story

o

comes

to

te

dysestesa

n

pyscan

te

nner

because

aspect

o

te arm and axa. Se ad a tota mastectomy ncud-

excson

ago.

beng

s

s

sows

Wc

mts.

o

42-year-od

ment

ater

te

spancnc

recurrent

dagnosed

puse

a

to

because

puse

bood

woman

recurrent

A 23-year-od man s brougt to te emergency depart-

Hs

o

eart

and

conirm-

spancnc

sounds

Wc

B.

cord

spna

Her

te

stor y

s  ow s

brougt

auscutaton.

department

A.

system?

spna

ST -eevatons

te

s

ces?

toracc

ce

ganga

puse

pressure

c o m p re s s e d ?

ganga

trunk

s

made.

or

42-year-od

norma

percus-

rgt

A

wtn

oca-

examnaton

sows

o

emergency

poory

duness

remtus

te

te

but

Pysca

sounds,

o

te

to

sarp,

wa.

tacte

x-ray

Wat

A.

s

severe,

breat

responsbe

to

o

cest

decreased

efuson.

pan

te

decreased

and

ra

woman

because

on

son,

38.

bood

troponns

Wc

boyrend

toracc

Axiary

toracic

and

pressure-

Hs

(cardopumonary)

and

ung

A.

accessory

arm.

ram

er

musce

B.

et

sows

rom

examnaton

on

A.

emergency

spancnc

dyspnea.

attack

te

te

spancnc

35/mn,

was

s

eevated

ibers

gr

by

responsbe

smoot

to

substerna,

30/mn,

narcton.

vscera

Pysca

astma

Pysica

resut

are

to

ECG

sow

ventra

severe

weezng

monts

abduction

Wic

surgery

because

are

An

toracc

17-year-od

o

radates

pan

toracc

department

trunk

istory

degrees

A

brougt

severe,

system?

C.

nerve

comes

te

nervous

tory

woman

carry

Vagus

voice?

Hg.

myocarda

Greater

patient’s

tat

studes

B.

37.

aryngea

mm

A.

being

s

o

respratons

ocated

ikey

man

because

pan

pumonary

pexus

underwent

ikey

to

a

nerves

nerve

above

examination

sows

90/70

ng

examination

nerve

39-year-od

a

cest

adjacent

te

B.

A

te

neura

Let

try

35.

o

arc

A.

o

34.

scan

witin

cest

aboratory

sows cear ung sounds biateray and no murmurs are

eard.

55-year-od

110/mn,

comes

o

A

47

Thorax

2

vagus

40.

Vta

o

te

wt

sgns

oowng

axary

(o

Spence)

o

are

norma

wtn

nerves

was

te

most

breast

mts.

key

ater

two

beng

weeks

Wc

njured

o

durng

procedure?

Unar

B.

Long

C.

Intercostobraca

D.

Latera

E.

Axary

A

ta

carcnoma

toracc

cutaneous

39-year-od

department

svey

sarp

nerve

o

T4

nerve

man

because

s

o

retrosterna

brougt

3-day

pan

to

te

story

tat

emergency

o

radates

progres-

to

te

et

48

C H A P T E R

2

souder.

worse

or

41.

he

wt

mts.

ton

Thorax

pan

Pysca

rub.

te

s

reeved

nspraton.

o

radatng

te

pan

Intercostobraca

B.

Prenc

C.

Long

D.

Greater

E.

horacc

retc

toracc

man

percarda

nerves

s

o

rc-

s

o

A.

te

An

sow

pan

ECG

wa

sarp,

sows

te

a

s

arm

A

and

or

on

a

myocarda

15

kg

(33

Prenc

oarseness.

a

Intercostobraca

esopagus.

D.

Greater

key

E.

Suprascapuar

o

1-week

axa.

and

o

He

over

e

sustaned

sensaton

Wc

ne.

n

te

a

te

axa

were

Dorsa

B.

V entra

wre

and

severa

key

oss

o

wounds.

damaged

to

o

dorsa

o

ventra

E.

Ram

46.

resut

department

patent

because

radatng

and

150/100

are

to

ram

aortc

endovascuar

oowng

Let

Greater

E.

Prenc

A

a

ram

A

a

a

sensaton

a

s

a

Hs

urgent

s

o

apex

o

dated

et

resut

n

47.

A

o

o

te

sows

a

or

te

A

scan

CT

sows

Sympatetc

postgangoncs

expected

D.

Sympatetc

pregangoncs

stomac?

E.

Parasympatetc

2-mont

n

te

story

nppes

enancement.

and

Wat

o

oss

areoae

Pysca

to

o

te

sensaton

oowng

examnaton

comes

Vta

by

and

severe

se

o

dys-

as

and

been

as

cougng

swaow

te

ost

se

as

and

sow

toracc

nerves

s

most

nerve

to

te

um

o

te

s

nerve

nerve

te

are

a

wtn

scan

o

te

structure

o

wt

s

m-

murmur

cest

et

at

sows

most

te

o

swa-

norma

dastoc

expanson

key

atrum

symptoms?

cava

woman

s

masses

needs

ast

te

a

woman

o

n

ste

at

wt

te

te

Paryngoesopagea

bateray

C.

Posteror

to

D.

Posteror

to

E.

Esopagea

superor

ungs

te

oarse

and

and

tube

s

resstance

rom

te

toracc

aortc

te

et

man

te

broncus

dapragm

voce.

abdomen

ver.

For

nser ted.

woud

nose

aperture

arc

ospta

examnaton

juncton

te

o

a

cest

wc

passes

to

Pysca

nasogastrc

tube

atus

admtted

cancer.

examnaton

te

because

dcuty

cava

ar yngea

as

pyscan

ung

vena

te

o

to

Wc

te

Leve

breast

o

emergency

o

weeks,

oowng

sgns

A

B.

reducton

te

monts

progressve

A.

eectve

sows

to

barum

spancnc

because

pyscan

a

posteror

patent’s

mutpe

horacc

comes

ramus

second

compressng

aryngea

eart.

vena

nutrtona

woman

and

te

tn-appearng

C.

o

te

o

B.

22-year-od

te

69-year-od

because

Somatc

A

o

atrum.

Ineror

aferents

te

attacks

CT

Superor

aferents

o

severa

te

compressed

A.

vscera

te

(ntercostobra-

dyspaga

sows

E.

back?

durng

o

ood.

D.

aferents

o

examnaton

T racea

respra-

Wc

responsbe

sod

Pysca

Root

an

ventra

story

2

past

aryngea

man

C.

o

past

te

nerve,

story

B.

cest

o

nerve

cest

te

te

tracea

toracc

yper-

pressure

and

te

Wc

Esopagus

pacement

perormed.

to

o

trd

afected?

A.

tearng

bood

100/mn,

key

emergency

story

examnaton

An

most

radatng

as

day.

s

scan

stent-grat

are

He

pack

aneurysm.

nerves

te

n

35-year-od

beng

sudden-onset,

puse

CT

to

njury?

and

brances

te

brougt

5-our

Fuoroscopy

recurrent

4-mont

to

brougt

back.

Hg,

22/mn.

an

o

te

smokes

mm

s

s

because

Over

recurrent

D.

a

communcantes

62-year-od

second

nerves

brances

For

det

vagus

C.

te

brances

tearng

eang

et

roots

brances

sows

sows

oowng

ung

week

te

Let

ts.

Cutaneous

tons

ast

aong

Rgt

B.

te

o

o

spna

o

sputum

be

A.

owng

Cutaneous

s

n

roots

D.

tenson

ence

examnaton

C.

pan

andross

aceratons

most

because

sgns?

A.

A

pyscan

and

barbed

deep

Pysca

et

to

numbness

severa

structures

tese

comes

story

mdaxary

n

man

te

atrogenc

cutaneous

brances

woman

b).

mass

C.

43-year-od

o

to

nc-

nerves

because

boody

to

to

and

nerves

toracc

anxety.

Vagus

spancnc

ateray

nerves

cutaneous

qud

4-cm

Wc

brances

atera

ntercosta

32-year-od

pnea

areoae

erytema

nerves)

Latera

B.

et

44.

second

A.

A

and

ntercosta

department

troponns.

responsbe

durng

45.

no

nerves

pectora

trd

ventrce.

te

s

subject

cutaneous

cutaneous

dapo-

myocarda

et

eang.

Latera

E.

rom

here

key

Latera

ad

toracc

and

D.

ca

to

skn

nes.

C.

sub-

radates

cardac

nerves

te

o

pan

te

most

Anteror

te

narcton?

43.

dry

were

Anteror

emergency

sows

o

eevated

to

te

he

examnaton

oowng

o

to

story

pan.

posteror

studes

o

30-mn

dyspnea.

te

radaton

brougt

cest

Pysca

o

are

nerves

souder?

o

mdaxary

sons

responsbe

(cardopumonary)

because

Laboratory

42.

sensaton

te

ntercosta

man

wt

narcton

te

and

norma

spancnc

vscera

arm.

Wc

te

a

orward

wtn

ourt

pressure-ke

et

sows

oowng

to

are

B.

department

s

eanng

toracc

72-year-od

sterna

by

sgns

examnaton

Wc

A.

A

Vta

to

be

te

CHAPTER

48.

A

59-year-od

department

brougt

to

sortness

te

o

emergency

breat.

52.

Pysica

A

55-year-od

department

was

ago

brougt

wt

to

cest

te

pan.

emergency

Cardac

cat-

juguar

venous

et

edema.

A

te

or

can

it

ntercosta

be

seen.

Rgt

B.

Let

C.

Aortc

D.

Apex

E.

Mtra

was

trauma

Pysca

te

be

space

part

o

n

te

on

and

te

te

pitting

cest

wa

o

s

responsbe

te

eart

vave

man

ater

a

s

brougt

ead-on

an

unrestraned

to

s

anteror

key

Rgt

B.

Apex

C.

Let

D.

Rgt

and

rom

te

to

sows

wa.

be

part

by

eart

et

wee.

Anteror

C.

Crcumex

D.

Artery

E.

Posteror

as

woud

a

o

mpact?

te

s

et

atrum

brougt

to

te

emergency

department because se ees er eart beatng. Se expe-

rences sortness o breat wt exerton, ortopnea, and

te

man

wt

Rgt

B.

AV

s

systoc

mtra

cck

vave

perormed

and

ecocardograpc

proapse.

at

Let

B.

Rgt

ower

C.

Rgt

second

D.

Drecty

E.

Let

der

der

it

wc

A.

o

te

o

te

te

o

o

oowng

space,

te

beow

o

space

vave

severe

noda

Ineror

D.

Snuatra

s

Anteror

best

ts

te

near

sternum

te

atera

te

bor-

wat

s

noss

o

A.

mdde

ntercosta

o

te

space

manubrum

near

te

man

A

bor-

A

B.

cest

sure

s

te

by

brougt

we

he

pan

rest.

Hs

130/80

mm

Hg,

angograpy

artery.

bypass

s

s

wt

crcumex

nary

man

pan.

Coronary

artery

Wen

procedure,

protected

te

tat

emergency

s

worse

wt

It

s

s

te

s

rgt

aortc

coronary

vave.

mnma.

wc

key

Hs

Assumng

to

o

st

te

ave

artery

most

a

o

Coronar y

to

be

proxma

to

et

et

surgca

expanaton

ts

precudng

w

and

Havng

no

emergency

arter y

ponts

crcumex

and

te

pan.

coronar y

tree

arteres.

key

to

cest

et

at

te

or

anteror

domnant

nter venton,

or

a

poor

prog-

patent?

te

te

coronary

cance

artery

tat

are

end

anastomotc

occur.

tat

musces

artery

brougt

te

brances

probabe

artery

o

te

anteror

te

and

trcuspd

posteror

vave

ave

pap-

been

damaged.

51–75

mproves

(L AD)

recover y

te

n

o

most

severe

nto

connectons

sternum

48-year-od

department

o

to

nterventrcuar

s

crcuaton

te

ary

Questions

con-

artery

occuded

arteres,

atera

most

node

domnant,

be

nterventrcuar

burcaton

coronar y

nppe

snus

margna

noda

55-year-od

descendng

te

he

bypass

artery

(posteror)

70%–80%

ocatons?

just

body

ntercosta

ts

sows

md-

sternum

over

second

o

Auscutaton

ntercosta

part

studes

a

coronary

ow?

sows

wt

brances

bocked.

surgeon

pan

occuson

coronary

angograpy

murmur

a

brougt

cest

woud

ts.

a

(SA)

crcuaton

wt

sows

s

rgt

rgt

(acute)

C.

A

te

arteres

bood

A.

E.

54.

to

department

examnaton

te

be

nterventrcuar

severe

an ntermttent coug. Vta sgns are wtn norma m-

Pysca

s

snuatra

(neror)

cardac

patent

norma

te

to

sgnicant

coatera

ventrce

woman

undergo

artery

bunde

to

nterventrcuar

dsta

oowng

margn

et

margna

58-year-od

artery,

atrum

Anteror

Rgt

B.

e

on

ventrce

54-year-od

Wc

to

and

system

exerton. Upon cardac cateterzaton, t s ound tat

ventrce

o

rgt

wt?

A.

A

te

conducton

scedued

department

bunt

eccymoses

te

53.

coson.

steerng

o

te

emergency

sustaned

extensve

Wat

njured

te

vece

drver

sternum

cest

to

motor

s

operaton.

arc

and

cardac

patent

mdcavcuar

eart

ventrce

te

cerned

examnaton

most

E.

gaop,

atrum

o

A.

A

S3

atrum

42-year-od

He

Wat

an

pusation

pusaton?

A.

A

rytmic

et

ts

distention,

sigt

department

51.

man

5-days

eterzaton sowed te vesse tat suppes muc o te

ne

50.

is

o

examination sows crackes at te ung bases, increased

at

49.

man

because

49

Thorax

2

rom

ts

because

s

worse

puse

and

ts

o

wt

neary

s

tota

exposed

njury?

bood

are

and

to

must

a

he

E.

he

55.

A

a

routne

promnent

Great

cardac

ntercosta

C.

Sma

cardac

ne.

Ts

D.

Anteror

ton

or

E.

Posteror

te

et

ventrce

o

te

efectve

and

w

suppy

neror

not

be

o

snuatra

node

s

coatera

crcuaton

(posteror)

nterven-

possbe.

te

vaves?

woman

S1

s

AV

brougt

examnaton.

mts.

B.

o

arteres

35-year-od

or

Mdde

ven

anteror

bood

A.

cardac

o

node

w

be

nadequate.

norma

cardac

suppy

deveopment

trcuar

o

be

bood

between

coro-

perorm

ven

D.

25/mn.

et

he

nadequate.

pres-

bockage

te

C.

story

exerton

rom

accompanyng

emergency

5-day

98/mn,

orgn

artery

wat

s

te

respratons

sows

near

to

Pysca

eart

space

best

auscutaton

o

to

te

sgns

pyscan

a re

examnaton

sound

aong

ocaton

V t a 

ocated

te

et

n

o

te

et

a

t

md-cavcuar

c o r re s p o n d s

wc

wtn

s  ow s

to

te

te

oca-

 o   ow  n g

50

C H A P T E R

A.

Mitra

B.

Aortic

Thorax

vave

Pumonary

D.

Aortic

was

te

boy

des

perormed

eart

o

te

unexpectedy

and

boy .

It

man

is

because

brougt

o

severe

to

cest

te

pain

emergency

wit

aby

radia-

te

a

ata

arrytma.

conducton

tssue

Rgt

B.

he

bunde

C.

he

et

bunde

branc

D.

he

AV

bunde

o

E.

he

posteror

o

te

tum.

w

he

be

and

sows

ECG

ower

part

respirations

a

o

te

o

severey

are

diaporetic

sows

uncton

most

severe

man

in

Pysica

severe

myocardia

muscuar

wc

30/min.

inarction

interventricuar

o

te

dis-

oowng

sep-

vaves

61.

afected?

A

department

Pumonary

taned

B.

Aortc

wee

C.

T rcuspd

mm

D.

Mtra

mnutes.

E.

Eustacan

department

s

95

ton

because

pressure

sows

ECG

te

sows

a

oowng

Pumonary

C.

Aortc

T rcuspd

T rcuspd

gr

B.

Let

C.

AV

D.

Posteror

AV

gr

s

te

bunde

bunde

u

s

and

eart

2

Rgt

B.

Obtuse

C.

Rgt

o

term

wt

T wo

te

te

va

spontaneous

membranous

neror

days

arrytmas

o

a

a

cardac

to

te

ven-

repar.

noncoro-

postoperatvey,

s

A

afectng

conducton

(o

was

s

te

margn

wa

most

Crcumex

B.

Anteror

C.

Ineror

D.

Artery

E.

Rgt

s

and

porton

to

be

o

te

cest

te

Se

te

pressure

sows

s

most

75/55

are

muled

Utrasound

Wc

key

o

be

sus-

steerng

22

eart

exam-

te

o-

njured?

et

ventrce

pan.

wt

ventrce

because

Pysca

crackes

s

brougt

o

severe

examnaton

n

te

ventrcuar

narcton

te

n

septum

to

ung

et

sows

bases.

septa

anteror

and

te

emergency

substerna,

a

An

ECG

musce,

two-trds

anteror

o

“crusng”

daporetc

sows

myocarda

te

nterven-

ventrcuar

wa.

A

te

oowng

arteres

rgt

Proxma

et

D.

Proxma

anteror

E.

Ineror

A

most

key

occuded?

coronary

coronary

nterventrcuar

(posteror)

49-year-od

s

woman

because

o

artery

nterventrcuar

s

brougt

severe,

to

crusng,

artery

te

emergency

retrosterna

pan

te

myocarda

ventrce

te

o te oowng arteres s te most key to be occuded?

te

A.

Artery

ven-

B.

Rgt

oowng

C.

Crcumex

artery

64.

artery

coronary

Rgt

E.

Dagona

A

te

te

patent

s

conus

coronary

D.

artery

margna

75-year-od

md

artery

o

and

o

musce.

coronary

rgt

perormed,

aspect

papary

ound to ave et domnant coronary crcuaton. Wc

artery

s

posteror

A

te

angogram

n

posteromeda

and

tat

coronary

narcton

and

and

o

rgt

et

ECG

anteror

Wc

acute

er

narcton

Emergency

sows

te

w

by

respratons

dstenton.

ypoknetc

to

o

bood

and

tamponade.

te

man

Proxma

emergency

pan.

nterventrcuar

branc

et

C.

conus

margna

sternum

Her

emergency

atrum

B.

occuded?

nterventrcuar

(posteror)

te

o

occuded.

key

to

myocarda

regurgtaton.

te

coson.

or te ast our. An ECG sows tat se s suferng rom

brougt

a

o

ven-

patway

severe

o

atrum

most

procedure?

perormed

upper

A.

o

sow

parts

ventrce

department

s

oowng

nterrupted?

to

vece

er

structures

Crcumex

Hs)

man

ven

cardac

69-year-od

o

63.

nternoda

vave

o

o

patway

examnaton

A.

bot

tssue

te

key

brougt

105/mn,

te

branc

because

ree

Apex

an

angograpy

porton

et bunde branc bock s aso noted on ECG. Wc

branc

ecocardograpy

suppyng

Let

E.

trcuar

node

pumonary

D.

to

cras.

s

a

s

motor

juguar

cardac

A.

Wc

te

sows

and

An

a

Pysca

examna-

sound.

bock.

owng

deectve?

undergoes

patced

durng

bunde

department

arteres

born

aorta.

part

62-year-od

trcuar

breats/mn,

Pysca

branc

key

dagnosed

severe

njured

Rgt

E.

S

puse

cest

deect

Wc

A.

A

most

er

Her

aortc

deect

o

deveops

key

a

An

taken

Hs

nternoda

woman

puse

and

naton

man

and

septa

septa

trces.

bunde

breat.

21

Hg.

emergency

mtra

devery

cusp

n

o

te

62.

3-mont-od

nary

tat

seep.

were

Bacmann

trauma

durng

Hg,

department

and

E.

he

spttng

s

are

mm

to

vave

D.

trcuar

brougt

sortness

120/80

rgt

B.

vagna

o

vaves

Mtra

s

respratons

s

wde

A.

A

woman

beats/mn,

bood

s

branc

o

ater

bunt

sounds

35-year-od

bunde

42-year-od

A.

A

n

sampes

ound

o

most

A.

Hg,

An

was

Wc

was

90/60

mm

tssue

te conducton tssue tat penetrates te rgt ibrous tr-

tion to te jaw. His puse is 105/min, bood pressure is

comort.

59.

3-mont-od

gone ad become necrotc. he cause o deat was prob-

72-year-od

examination

58.

pumonary

T ricuspid

A

A

rom

and

department

57.

60.

autopsy

C.

E.

56.

2

man

sortness

swoen

o

egs.

comes

breat

Vta

Ecocardogram

to

and

sgns

sows

a

te

an

are

pyscan

nabty

wtn

arge,

because

to

wak

norma

mobe

o

due

mts.

structure

n

CHAPTER

te

rigt

cava

atrium

dentied

Wc

o

resembe

65.

te

a

B.

Eustacan

C.

hebesan

D.

Septum

E.

Fossa

septa

68.

most

boy

ment because o acute onset cest pan. ECG sows ST

key

eevaton

ocaton?

he

da

wt

a

o

te

te

A.

Crsta

B.

Pectnate

C.

T rcuspd

D.

Eustacan

E.

Coronary

te

sde

ncson

te

s

Wc

to

te

o

protect

and

ascendng

trunk

and

superor

69.

oowng

durng

A

48-year-od

department

te

because

o

myocarda

sows

Mdde

bood

B.

Great

cardac

cardac

ven

resp-

cardac

ven

E.

Coronary

ade

s

a

suspected

perormed.

te

A.

myocarda

neede

Rgt

At

be

and

an

wc

sevent

emergency

o

nserted

narcton.

te

to

ECG

Cardac

sows

ntercosta

te

70.

tampon-

percardocentess

oowng

reeve

ocatons

s

n

te

mdaxary

Let

C.

Rgt

it

D.

Let

E.

T range

ntercosta

trd

space

ntercosta

at

te

space,

1

sterna

nc

border

atera

to

sxt

ntercosta

space

n

te

mdcavcuar

ne

o

auscutaton

55-year-od

department

pressure

s

rreguar.

wt

ater

beedng

orceps

njury

o

to

he

and

te

vece

Hg

te

bood

ibrous

te

A.

Aurcuar

B.

Coronary

C.

Anteror

D.

Let

prenc

E.

Let

sympatetc

puse

o

A

te

trunk

s

to

be

s

artery

and

nterna

to

te

aorta

preserve

s

cere-

eevated

ongtudna

made

to

structures?

et

bood

98/mn

taken

mdne,

snus

nerve

Hs

toracc

and

woud

nterventrcuar

s

percardum

oowng

appendage

emergency

sows

patent

oss

punctured.

o

te

coson.

descendng

percardum

wc

and

to

examnaton

and

he

mnmze

ow.

brougt

motor

mm

room.

to

bood

ncson

a

s

Utrasound

operatng

camped

man

70/55

abdomna

bra

conirmng

(posteror)

rgt

atrum

prevent

71.

a

s

neror

patent

bypass.

te

vesse

ECG

arterog-

te

he

artera

perorm

o

ave

te

Anteror

et

part

s

Wen

bypass

most

Dapragmatc

D.

Latera

E.

Posteror

began

crusng

sows

a

o

part

70-year-od

proce-

susceptbe

new

rgt

s

o

severe

ago.

rgt

to

cest

Se

down

artery

te

Rgt

B.

Snuatra

C.

AV

D.

Latera

E.

Anteror

s

bocked

artery

Wc

key

be

node

te

et

occuded?

ventrce

nterventrcuar

septum

te

emergency

pan.

he

wt

just

n

o

septum

te

arm.

a

a

symp-

pan

An

as

ECG

ventrcu-

sows

dsta

tat

to

rgt

te

afected

node

o

myocar-

crcumex

septum

angograpy

atrum

wa

ne-

rom

ventrce

et

bockade?

A.

te

te

descrbes

narcton

margna

most

o



te

arses

becomes

brougt

crcuaton.

woud

part

suppy

te

I

branc

sows

tropo-

ventrce

Coronary

rgt

domnant

structures

narcton.

artery

o

emergency

ECG

eevated

nterventrcuar

ours

coronary

te

et

te

myocarda

te

nary

te

radaton

arrytma.

o

sow

wc

surace

o

ew

wt

abs

te

pan.

nterventrcuar

woman

ar

orgn

te

because

a

to

cest

bood

coronary

Inundbuum

toms

artery,

o

C.

department

and

reduced

wa

brougt

severe

myocarda

B.

A

o

arter y.

nterventrcuar

coronary

w

s

o

eevatons

ror

A.

sternum

man

nns

branc

te

Coronar y

ven

because

segment

dum

B.

pan.

snus

54-year-od

te

ne

A

A

ST

soud

emergency

cest

ven

cardac

department

tamponade?

space

to

cava

te

njur y?

eart

conirmng

arter y

Hs

and

to

bockage

coronar y

A.

Anteror

dstenton.

a

camp.

aorta

vena

substerna

tota

emergency

100/mn,

brougt

accompanyng

Sma

ven

s

ts

wc

D.

juguar

puse

pan.

ave

C.

and

Hg,

cest

to

vascuar

cava

narcton.

neary

he

percar-

arteres

nter ventrcuar

ratons are 22/mn. Pysca examnaton sows muled

sounds

mm

severe

te

o

rapy

to

to

because

a

dure,

snus

s

surgery.

vens

vena

coronary

man

sows

exposng

vave

et

a

cor-

artery.

camped?

trunk

correct

pumonary

o

are

Pumonary

scedued

brougt

vesses

Pumonary

are

and

(posteror)

s

pacement

neror

Cardac

et

transverse

E.

te

and

te

bypass

te

D.

n

et

n

Rgt

atrum?

patent

easy

oowng

and

coronary

C.

vave

90/60

te

a

ingers

nterven-

to

te

aowng

o

or

er

o

nterventrcuar

Rgt

ST segment eevatons and abs sow eevated troponns

67.

snus

taken

pace

anteror

Superor

made

vave

s

can

te

narcton.

bockage

B.

musces

52-year-od

s

patent

and

myocarda

severe

A.

termnas

department

artery

a

sows

or

room

Instruments

trcuspd

cruca

o

irst

atrum.

deect.

nterventrcu-

operatng

rgt

rgt

most

rgt

muscuar

to

te

wde

septa

te

sma

access

troug

ventrcuar

s

a

taken

conirmng

cateterzaton

surgeon

s

o

nserted

A 45-year-od man s brougt to te emergency depart-

Wc

surace

pressure

vena

eart.

prmum

septum,

A

woud

te

vave

deect

structures

66.

ts

inerior

o

vave

trcuar

openng

structures

n

te

onary

repar. T o

te

o

component

vave

surgca

ten

opening

ovas

4-year-od

anteror

te

norma

trombus

T rcuspd

ar

a

oowng

A.

A

near

as

51

Thorax

2

te

coro-

oowng

ater

suc

a

52

C H A P T E R

72.

A

2

Thorax

43-year-od

o

sortness

witin

norma

mid-diastoic

opening

gram

73.

te

eart

irst

imits.

mitra

vaves

eart

to

and

te

an

eard

vave

are

pysician

atigue.

Pysica

wit

sound

a

comes

breat

rumbe

snap

sows

owing

o

woman

o

Vita

because

signs

examination

abnormay

ater

S2.

stenosis.

responsibe

S1

a

te

o

Ineror

E.

Rgt

te

o-

Questions

76.

production

A

sound?

voent

and

mtra

mm

and

trcuspd

mn.

T rcuspd

Mtra

E.

T rcuspd

A

and

and

pan

and

eart

s

radatng

o

to

narcton

Pysca

sound.

responsbe

Wc

te

te

et

and

o

te

substerna,

a

te

arm.

rgt

examnaton

or

to

A.

Aortc

and

pumonary

B.

Aortc

and

trcuspd

T rcuspd

D.

Mtra

E.

T rcuspd

A

and

and

ECG

oowng

o

sows

a

oud

eart

te

3-mont-od

department

sve

n

er

vaves

n

are

C.

ra

te

gr

des

ormed

ducton

tssue

sows

te

vave.

to

key

o

Snuatra

C.

Atroventrcuar

D.

Frst

uar

o

te

rest

area

o

eaet

o

te

te

te

o

con-

te

eart

te

department

an

a

at

radates

epsode

systoc

te

to

o

brougt

cest

pan,

antng.

to

second

carotds.

njured

sortness

C.

Let

D.

Margna

E.

Rgt

Pysca

ntercosta

o

te

te

examnaton

murmur

space

and

Ecocardogram

n

te

nterna

te

ventrces

a

te

a

arte-

sounds

carotd

as

to

arteres

detected

w

bend

ospta

surgca

rgt

tat

bock

most

and

te

key

a

o

coronary

pyscan

resuts

severe

s

angogra-

usuay

hs

by

repar

domnant

procedure,

vesse

was

te

Pre-operatve

system.

suppes

n

nter-

arrytma.

drect

branc

o

arteres?

nterventrcuar

artery

artery

artery

woman

because

sows

it

s

o

a

brougt

sortness

oosystoc

ntercosta

radaton

severe

vave

dastoc

artery

to

mtra

oowng

mtra

te

et

vave

structures

cusps

space

nto

te

et

Crsta

termnas

wc

B.

Crsta

supraventrcuars

C.

Pectnate

D.

Cordae

E.

T rabecuae

emergency

breat.

murmur

at

te

axa.

prevents

te

to

o

Pysca

best

eard

mdcavcuar

Ecocardogram

regurgtaton.

A.

te

o

and

scedued

as

AV

coronary

et

eart

dstnct,

best

sows

and

artery

coronary

wt

boy

o

anteror

42-year-od

sows

breat,

per-

key

sgnicanty

anomay.

oowng

most

systoc

brougt

Durng

artery

te

unre-

emergency

te

most

mandbe

s

te

perods

o

te

njured

was

at

35/

cammy

decrease

juguar

nterna

conducton

was

nterventrc-

te

crescendo-decrescendo

rgt

te

o

te

Dsta

ne

because

tat

system.

o

te

cardac

examnaton

anteror

n

w

a

70/55

are

and

ud

papabe

ncrease

prevousy

Crcumex

artery

s

a

department

o

coo

enargement

dmnsed

boy

B.

artery

s

respratons

sows

or

between

w

n

o

A.

A

durng

pressure

oowng

externa

gradua

be

o

artery

man

or

sows

wc

trcus-

narcton

arteres

he

78.

noda

anges

mttent

body,

emergency

cest

examnaton?

vsbe

te

bood

and

te

s

sows

te

ncreasngy

congenta

part

necrotc

ibrous

sowed

oowng

o

be

w

accdentay

per-

a

o

puses

artera

efort,

s

o

to

to

ven

15-year-od

py

cardac

autopsy

centra

septa

he

te

perorator

75-year-od

eard

he

a

doctor’s

An

porton

te

unrespon-

ad

conus

noda

septa

he

a

occuded?

B.

sows

and

tssue.

Artery

and

to

examnaton

A.

A

necrotc.

emergency

er

gr

te

arrva.

sgnicant

septum,

Wc

ound

te

Despte

neror

Furter

surroundng

markabe.

ago,

ater

a

be

ocated

membranous

pd

moter

days

corrected.

tssue

was

er

T en

sorty

and

here

E.

parents

te

Hs

115/mn,

dference

D.

A

brougt

wound

pysca

be

pressures

te

to

ven

dastoe

he

eart

77.

brougt

s

Wc

w

become

s

atrum

examnaton

w

here

s

stab

dspute.

durng

juguar

B.

pumonary

because

maormaton

here

mtra

gr

crb.

ound

second

second

et

Ecocardogram

space.

A.

a

branc

pumonary

and

puse

Pysca

dmensons

sound?

C.

Hg,

be

pressure-ke

bunde

sows

producton

emergency

a

domestc

carda

brougt

man

ater

extremtes.

pumonary

woman

because

myocarda

bock.

mtra

pumonary

75-year-od

te

atrum

department

Aortc

D.

o

pumonary

76–100

Aortc

C.

wa

rgt

42-year-od

B.

cest

75.

Posteror

D.

A.

department

74.

C.

and

ecocardio-

Wic

or

sows

oud

An

are

Wc

regurgtaton

atrum

durng

o

o

te

systoe?

musces

2

aortc

vave

stenoss.

area

Patent

ment.

As

snus,

wc

wt

te

to

te

tps

A.

Ineror

B.

Superor

be

o

te

te

vena

cm

undergoes

surgeon

o

0.7

an

expores

oowng

ingers?

cava

vena

conirmng

cava

aortc

te

s

aortc

vave

obque

not

vave

repace-

percarda

drecty

papabe

79.

A

tendneae

58-year-od

department

degree

maker

te

carneae

woman

because

eart

bock

pacement.

pacemaker

o

s

and

he

must

be

brougt

antng.

se

s

te

emergency

sows

scedued

eectrca

passed

to

ECG

conductng

nto

te

a

or

a

trd-

pace-

eads

eart.

o

Wc

CHAPTER

o

te

oowing

passage

A.

B.

o

vena

atrium,

because

s

126/78

o

cava,

vave,

vave,

superior

o

mm

te

vave

Regurgtaton

Hg.

A

vave

Occuson

o

E.

Occuson

o

te

emergency

22/mn,

barum

Hs

bood

swaow

sows

department

most

ypertro-

key

o

te

te

te

bood

conirmng

specazed

cause

s

nterventrcuar

(posteror)

brougt

artery

nterventrcu-

te

s

mm

ibraton.

conductng

At

te

rgt

C.

At

o

82.

tssue

te

Between

In

Hg,

batera

te

te

an

ower

woud

o

et

a

te

and

tat

rgt

s

P-waves

te

mass

te

and

85.

o

vena

wc

o

te

vena

cava

rgt

and

cava

and

pyscan

sweng.

best

te

pan

contro.

ayer

tat

A

exam-

Ecocardogram

o

an

sows

ncompetent

te

bood

oowng

ow

n

ts

at

tr-

areas

cardac

Let

trunk

C.

Ascendng

D.

Rgt

E.

Let

remtus

te

ne

dran

cest

ange

s

te

con-

wc

t

most

efuson

86.

boy

earer

object

rgt

te

a

o

tenson

te

cest

necessary

s

te

oca

or

deepest

anestetc

peura

s

brougt

started

to

s

prmary

he

carna

begnnng

E.

he

et

o

suspected

s

o

Wc

o

sma

te

ago.

toy

breat

suspected.

most

he

cars.

n

common

was

Pysca

sounds.

Were

and

boy

A

te

ste

or-

tra-

or

a

broncus

te

s

brougt

a

te

a

emergency

sudden

astma

and

oowng

ncreasng

te

s

gven

te

onset

sows

retractons.

severe

oxygen

o

examnaton

ntercosta

on

to

because

Pysca

avng

te

tracea

ater

and

paced

s

our

broncus

breat.

weezng

an

tracea

o

cd

by

a

depart-

breatng

broncus

te

tertary

3-year-od

emergency

odge?

he

department

s

te

dcuty

decreased

prmary

o

to

or

wt

tree

D.

n

s

oowng

wt

dstended

at

C.

s

tube

Hg,

sows

asca

sows

et

patent

te

and

sows

anestesa

cest

sort-

mm

anestesa?

aspraton

he

s

o

86/52

sde

cest

oca

a

s

examnaton

rgt

te

nitrated

payng

he

use

te

o

o

moter

wc

sortness

pressure

emergency

severe

peura

B.

A

on

te

and

musces

s

body

to

pan

d-

he

boy

attack.

he

broncoda-

most

ntratoracc

mportant

capacty

n

nspraton?

aorta

A.

ande

movement”

o

anteror-posteror

te

rbs—tereby

dmensons

o

te

torax

man

because

“Pump

ncreasng

ventrce

34-year-od

be

pareta

A.

atrum

department

to

Pysca

Adequate

adequate

by

actor

atrum

tube

breat.

sounds,

hroug

mdaxary

brougt

x-ray

Wc

must

5-year-od

tors.

B.

An

ceobronca

te

eard

o

costoprenc

cest

bood

nserton

examnaton

because

Pysca

murmur

and

to

aceve

s

o

sounds

vens.

cougng

atra

to

border.

atrum

Into

Pumonary

breat

pror

ment

cardac

te

tacte

x-ray

efuson.

cest

115/mn.

Vscera

respratons

absent

septum

comes

regurgtaton

s

E.

and

snus

superor

extremty

rgt

A.

A

puse

Costa

abnormaty?

83.

and

Hs

Subcutaneous

ntates

neror

oosystoc

sterna

vave.

te

breat.

oregn

ower

enarged

cuspd

te

woman

sows

et

o

D.

Were

coronary

nterventrcuar

45-year-od

naton

o

juncton

E.

o

ness

man

because

C.

rreguar,

atrum

D.

A

51-year-od

gteadedness,

sows

te

An

o

breat

T wet

A

Endotoracc

and

a

sortness

decreased

ieds.

rgt

aong

and

decreased

peura

nsert

Intercosta

atrum

te

T ent

egn

juncton

te

rgt

Egt

D.

seen

juncton

to

B.

120/mn

examnaton

atra

C.

to

atrum

B.

space

A.

te

te

sded

emergency

to

paptatons,

puse

130/80

ECG

Sxt

wa

aorta

s

o

Fourt

B.

absent

ocated?

At

rgt

and

ung

o

pneumotorax.

anteror

Her

pressure

25/mn.

buntng

juguar

neror

because

ower

department

stenoss

woman

weakness.

percusson,

rgt

A.

E.

84.

compresson.

cardac

te

ood.

and

to

sgnicant

s

cava,

artery

35-year-od

to

te

coug,

sows

ud?

ventrice

to

secondary

oowng

vena

swaowng

are

cava,

stenoss

D.

duness

ntercosta

ventrice

superior

rigt

dcuty

vena

wa,

examnaton

sows

dyspaga?

C.

A.

mitra

tricuspid

rigt

brougt

sows

Pumonary

cyce

vein,

vave,

is

constrcton

B.

are

atrium,

respratons

Mtra

and

rigt

mitra

A.

A

vena

toracc

Pysca

approprate

man

patent’s

ar

81.

cava,

vein,

Wc

te

anteror

irmng

braciocepaic

Ecocardogram

o

atrium,

vave,

esopagea

py.

superior

tricuspid

85/mn,

pressure

or

n

rigt

braciocepaic

atrium,

department

s

structures

ventrice

cava,

vena

68-year-od

puse

vein,

o

ventrice?

ventrice

Rigt

rigt

rigt

order

rigt

ventrice

Rigt

rigt

A

te

braciocepaic

rigt

E.

correct

into

vave,

Superior

D.

te

mitra

Superior

C.

is

eads

Rigt

rigt

80.

te

53

Thorax

2

s

o

a

brougt

sarp,

to

te

ocazed

emergency

pan

over

te

B.

“Bucket

ng

te

ande

movement”

transverse

dameter

o

o

te

te

rbs—ncreas-

torax

54

C H A P T E R

C.

2

Thorax

Straigtening

racic

spine,

sions

D.

o

te

Descent

te

te

A

Hg,

a

puse

Pysca

expansion

woman

igt.

s

is

o

Her

o

te

vertica

wit

to-

oowng

dimen-

be

increasing

o

in

te

a

a

stab

and

ribs

to

te

wound

Superor,

B.

Apca,

vertica

C.

Posteror,

D.

Apca,

E.

Anteror,

baby,

91.

emergency

s

are

25/mn.

mogram

ymp

sounds.

metastaszed

o

ts

te

oowng

pumonary

A.

he

orzonta

issure

o

te

et

B.

he

orzonta

issure

o

te

rgt

C.

he

obque

D.

he

apex

E.

he

root

A

o

55-year-od

a

panu

dscarge

ton

te

n

Wc

o

A.

o

rgt

et

woman

ump

er

te

te

ung

ung

ung

er

92.

to

te

rgt

rgt

o

upper

oowng

te

skn

because

a

(peau

o

te

te

o

te

eta

and

nante

state

o

Apca

D.

Anteror

E.

Posteror

An

Intraducta

C.

Retracton

D.

Obstructon

o

edema

skn

A

by

ng

o

te

te

and

te

sbe

or

gaments

o

te

93.

man

as

s

puses

sgns

te

o

most

B.

Cor

o

Dssectng

o

s

carna

s

group

ympatcs,

wt

te

o

eptea

s

nng

Pumonary

A

o

te

nppe

Hg,

35/mn.

ymp

to

te

sortness

mm

dstorted

and

tat

o

breast.

te

key

to

to

te

atgue,

severa

braca

deayed.

irst

to

contan

emergency

and

days.

artery

a

ead-

Pysca

pressure

he

patent

Wc

o

sows

te

s

and

no

oow-

dagnoss?

te

aorta

puse

s

wdened.

s

most

no

76/mn,

Broncoscopy

nodes

and

Her

as

o

te

sows

x-ray

rgt

respon-

Ineror

D.

Superor

traceobronca

E.

Paratracea

72-year-od

ound

wt

condtons

common

ac

Fa

Pneumotorax

department

dcuty

aspratng

sows

wt

s

partay

rgt

A

rom

breatng.

unc.

dgested

superor

dsease

obar

a

s

brougt

nursng

An

our

Broncoscopc

ood

bockng

ome

ago,

e

exam-

te

broncus. Wc

o

or-

te

ca

pan

o

beng

wc

are

artery

deayed.

most

emergency

and

days.

pressure

nammaton.

w

te

key

he

ead-

pressure

s

s

decreased,

patent

Wc

be

a

Pysca

o

sows

te

observed

o-

on

an

te

condton?

te

wt

dagnosed

wen

p re s e n t s

we a k n e s s

ago,

P y s  c a 

o

rbs

woman

mastectomy

scapua

severa

braca

emora

te

st

and

we e k s

b re a s t .

over

to

atgue,

cest

5 6 - ye a r - o  d

ater

cava

cest?

B.

wt

Parknson

o

A.

T wo

man

emergency

o

94.

traceobronca

brougt

tat

puses

Medastna

C.

carna?

sows

sgns

te

vena

nosebeed,

worsened

emora

o

superor

s

o

ncreased,

externa

owng

Enargement

key

te

te

man

E.

te

are

because

examnaton

emergency

breat.

o

Broncopumonary

o

te

s

wt

mam-

embosm

22-year-od

markedy

brougt

severe

120/80

te

Obstructon

E.

department

ypoderms

are

o

aterng

cutaneous

D.

B.

gn

over

aneurysm

Hydrotorax

naton

o

A

pumonae

Notcng

was

brougt

nosebeed,

tat

key

D.

te

nodes

most

nammaton.

C.

because

s

o

sows

Pumonary

to

and

breast,

axa.

carcnoma

ymp

worsened

A.

A

rgt

ces?

because

Coarctaton

ace

woman

pressure

wc

er

(subscapuar)

A.

C.

tumor

suspensory

te

because

respratons

tat

te

underyng

58-year-od

bood

90.

o

cancer

o

department

o

cancerous

Inammaton

and

n

because

examnaton

artery

B.

E.

pyscan

(pectora)

emora

externa

nppe

breast

tat

te

Pysca

psatera

conirm

dranage

18-year-od

te

a

nppe?

Retenton

Centra

C.

te

basa

markedy ncreased, emora pressure s decreased,

breast.

nverson

B.

to

mass

n

axary

tumor

examnaton

an

sows

Latera

ace

d’orange)

Mammogram

expans

boody

wt

A.

department

examna-

nppe

quadrant

best

and

Pysca

o

te

areoa.

pyscan

breast

nppe.

nverson

te

rgt

et

ung

ung

appearance

o

te

comes

n

unatera

vcnty

tumor

er

te

rom

sows

orange-pee

n

issure

te

o

structures

ste?

o

basa

atera

breast.

ixed

nodes

bopsy

receve

o

89.

and

comes

rgt

and

ourt costa cartage wt assocated decreased breat

at

te

irm

w

atera

atera

meda,

woman

ymp

meda

superor,

meda,

er

group

Wc

n

a

swoen

atera,

superor,

n

segments

posteror

anteror,

atera,

mass

sows

mm

meda,

Wc

present

aceraton

a

broncopumonary

obstructon?

anteror,

35-year-od

o

sustained

90/60

A

o

ts

rgt

s

a

te

se

pressure

by

A.

directions

respratons

sows

in

groups

afected

o

protrusion

cavity

brougt

bood

105/mn,

examnaton

te

tereby

toracic

lexibiity

because

bar

curvature

cavity

wa,

te

and

aowing

54-year-od

ater

88.

o

Orientation

department

orward

increasing

diapragm,

abdomina

tus

87.

te

toracic

o

dimensions

E.

o

tereby

n

patent

puses

 o   ow  n g

pyscan

s  o u  d e r.

axar y

c a rc  n o m a

examnaton

se

te

rgt

u n d e r we n t

e x t e n s  ve

wt

to

te

s  ow s

aganst

n e r ve s

te

a

o

te

wngng

wa.

woud

rad-

dssecton

rgt

o

te

In j u r y

re s u  t

n

to

ts

CHAPTER

B

A.

Muscuoprenc

B.

Superor

C.

Posteror

D.

Latera

E.

horacodorsa

55

Thorax

2

epgastrc

ntercosta

toracc

A

98.

A

10-year-od

boy

o

retrosterna

o

cancer.

opment

scan

te

by

Pysca

and

sows

no

a

brougt

to

te

here

examnaton

gross

mdne

oowng

te

s

dscomort.

vens

woud

o

o

te

most

no

story

norma

te

deve-

neck.

tymus.

key

because

amy

sows

deormtes

tumor

pyscan

s

be

A

CT

Wc

o

compressed

tumor?

C

D

E

95.

B.

Let

nterna

nterna

C.

Rgt

D.

Let

E.

Rgt

juguar

juguar

bracocepac

bracocepac

subcavan

A

B.

B

ment ater sustanng a gunsot wound n te neck. Hs

C.

C

temperature

D.

D

bood

E.

E

A

99.

sows

te

ing

te

is

steering

wee

woud

most

aso

te

during

o

motor

cest

o

te

o

te

rgt

key

An

A.

Costa

sternum

B.

Cupua

in

oow-

suc

an

Rgt

manstem

Rgt

upper

E.

Medastna

C.

hrd

o

D.

Fourt

Se

E.

Ft

ntractabe

47-year-od

examnaton

barum

severe

man

because

sows

sows

nammaton

atus

key

cause

rom

o

a

te

brougt

dcuty

sweng

swaow

agea

s

o

due

severe

B.

horacc

duct

bockage

C.

Superor

vena

cava

Aortc

Femora

nar y

and

nterna

ar ter y

puse

Hg.

esop-

te

ower

s

120/mn,

Pysca

and

examnaton

mbs?

A.

te

dab e te s .

gated.

Wc

provde

trd

o

te

Dur ng

ar ter y

gr a t.

to

te

he

s  xt

s

a

te

us ed

s up p y

ar ter e s

tes e

D.

o

t e

E.

coro-

structures

tenson

severe

te

te

cest

pneu-

was

most

pneumotorax?

cest

o

to

pan.

two

duness

are

sows

te

te

Se

emergency

as

oroparyngea

days

vomtng.

Crackes

Wc

o

o

sows

ied.

o

brougt

cest

cemoterapy

he

ung

rgt

he

to

ago

a

and

on

afectng

ad

over

te

auscutaton.

pneumona

s

as

examna-

percusson

eard

story

dyspaga.

Pysca

oowng

pneumona

he

he

age

vascuar

tan

o

te

te

te

most

rgt

key

rgt

ower

man

te

resstance

et

s

ger

n

te

te

et

ung

broncus

s

stragter

tan

broncus

rgt

man

broncus

s

narrower

tan

te

broncus

rgt

man

p roce d ure ,

anter or

to

to

s tor y

as

 ntercosta

 o  ow ng

coate r a

p ys c an

as

o

tenson

peura

s

o

and

Pumonary

man

He

a

obe?

man

to

te

x-ray

and

broncus

woman

cest

obe.

rgt

byp ass .

An

oowng

n

pareta

epsodes

ung

x-ray

ung

B.

c om es

tor ac  c

te

rb.

ung

broncus

obe

tumor

expanaton

most

C.

ar te r y

o

irst

rgt

te

because

receved

ower

dsease

bypass

n

spaces?

te

te

s

An

wt

occuson

man

coronar y

ar teres

key

o

at

bran

rgt

extremtes.

Wat

51-year-od

ton

Pysca

daton

A

constrcton

artery

yper tenson

et

emergency

aneurysm

49-year-od

undergo

ower

constrcton

edema

horacc

E.

te

poma.

A.

D.

aorta

te

esopagea

to

arge

o

to

swaowng.

o

resut

D.

department

department

to

and

te

C.

Second

te

mm

peura

B.

100.

o

Wc

First

A

(98.6°F),

85/45

cavce

njured

A.

A

37°C

s

coapse

motorax.

swe-

injury?

A

s

pressure

sows

veice

wa.

te

invoved

o

upon

prouse

te

Wic

be

emergency

injury

a

sows

racture

joint.

ikey

to

cest

deormation

uncommon

manubriosterna

ribs

a

examination

and

an

brougt

sustaining

Pysica

erytema,

x-ray

at

woman

ater

wit

coision.

ing,

A 25-year-od man s brougt to te emergency depart-

sows a buet wound n te neck just above te mdde

22-year-od

impact

97.

Rgt

A.

department

96.

A.

man

broncus

s

onger

as

poorer

tan

te

et

broncus

rgt

tan

ower

te

ung

oter

obe

venous

dran-

obes

 nterc os ta

sp aces

w  

are

m os t

n te rcos ta

Questions

101.

A

101–125

41-year-od

department

dzzness,

man

wt

and

s

brougt

compants

sarp

cest

o

pan.

to

te

sortness

Patent

emergency

o

as

breat,

a

ong

56

C H A P T E R

istory

ture

are

is

o

smoking

37°C

arge

regon

o

and

B.

Rgt

C.

Let

vena

Arc

Pumonary

o

te

42-year-od

a

n

te

by

Durng

n

structure?

B.

n

he

n

rgt

er

te

nppe.

nverson

o

to

rgt

o

te

s

o

and

Pysca

te

skn

quadrant

pyscan

breast

rgt

over

te

most

a

because

a

mass

breast.

and

o

a

104.

tssue

Wc

A

sde

ste

sde

department

o

nvoved

caracterzed

s

37°C

D.

Obstructon

breast,

curasse

cancerous

o

te

wt

Inammaton

department

coson.

110/mn,

and

te

te

o

dranng

te

skn

o

skn

eptea

nng

o

te

nppe

ypoderms

s

beng

brougt

nvoved

temperature

bood

cest

te

s

pressure

sows

our

n

37°C

s

to

a

te

emergency

motor

(98.6°F),

115/85

broken

mm

rbs

o

vece

puse

105.

s

Hg.

An

te

et

a

s

te

te

procedure

rbs

A.

Penetraton

B.

Injury

o

Hg.

te

s

A



a

o

o

te

superor

te

et

E.

Impaement

sows

an

A

presence

trd

o

nodes

te

w

CT

o

vagus

s

o

B.

Broncopumonary

T raceobronca

E.

Superor

A

a

Wc

be

te

man

wt

smoked

sow

emergency

ater

beng

temperature

and

bood

ne

s

oowng

pres-

paced

njures

centra

venous

artery

cava

carotd

artery

nerve

a

to

te

A

at

te

et

te

as

n

a

swaow

eve

urter

cancer

o

emergency

Patent

barum

bopsy

afected

and

20

o

te

ndcate

te

oowng

dsta

ymp

irst?

gastrc

te

brougt

cgarettes

and

irst

s

retrosterna

bopsy

magnant

o

Hs

oppo-

traceobronca

department

Endoscopy

te

te

traceobronca

42-year-od

as

on

njures

swaowng.

and

medastna

Ineror

on

smokng.

be

Posteror

D.

afected

vena

Wc

A.

C.

be

aso

te

esopagea

key

w

constrcton

esopagus.

most

on

to

brougt

scan

an

afected

common

panu

esopagea

dapragm.

te

te

story

be

nerve

o

ong-standng

not

be

venous

subcavan

Penetraton

man

w

perormed?

Penetraton

wt

rbs

subcavan

D.

50-year-od

moves

w

115/mn,

C.

A

segment

te

and

centra

prenc

o

o

moves

wa

wa

coson.

ncorrecty

o

te

a

brougt

vece

occur

s

most

rbs

resusctaton. Wc

to

segment

cest

cest

traumatc

puse

mm

a

te

dapragm

severe

motor

key

department

106.

te

(98.6°F),

ud

te

o

dapragm

broken

man

wt

89/39

most

ne

ympatcs

woman

ater

Her

tumor

edema

o

underyng

25-year-od

s

s

n

te

o

be

ractures

broken

te

33-year-od

or

Intraducta

o

rb

o

te

as

w

examnaton?

movements”

te

descent

te

oowng

nspraton,

ande

o

drecton

drecton

descent

te

pysca

nspraton,

deep

same

by

o

durng

deep

sde

he

examnaton

nppe

key

E.

boody

d’orange

C.

o

comes

Wc

opposte

“Pump

sure

en

te

te

condtons

Peau

te

Durng

indngs?

Cancer

x-ray

ts

A.

te

D.

ump

upper

B.

A

s

Hg.

wa.

observed

afected

texture

oowng

tese

and

Wat

mm

ndcates

C.

er

A.

E.

100/65

cest

key

cava

woman

rom

rgt

te

2.1).

(Fg.

is

te

toracc

aorta

unatera

woody

te

o

tempera-

respirations

artery

panu

dscarge

ard,

pressure

x-ray

His

120/min,

ventrce

E.

sows

te

is

ventrce

D.

as

ypertension.

puse

bood

n

patoogy

Superor

A

and

(96.8°F),

arrow

A.

se

103.

Thorax

24/min,

he

102.

2

to

pan

day

te

or

or

te

examnatons

growt

oowng

at

te

ymp

nitrated

by

6

rgt

nodes

cancerous

emergency

monts.

past

o

20

te

man

w

tracea

broncus.

most

ces

He

years.

key

rom

te

magnancy?

A.

Ineror

B.

Paratracea

C.

Broncomedastna

D.

Broncopumonary

E.

107.

A

horacc

scan

sows

toracc

Fig.

.

man

wt

a

s

brougt

severe

pan

dssectng

aorta.

aneurysm

trunk

duct

60-year-od

department

•

traceobronca

Durng

ruptured

and

n

to

s

aneurysm

s

e

ospta

was

te

emergency

mdsecton.

o

te

stay,

te

transerred

A

CT

descendng

or

patent’s

surgery.

CHAPTER

Postoperativey,

gia.

Wic

injured

108.

o

te

te

during

te

Rigt

B.

Let

C.

Rigt

subcavian

D.

Great

radicuar

E.

Esopagea

A

coronary

in

er

enarged

ment

benign

most

te

resut

in

te

ikey

paraysis?

(o

Adamkiewicz)

woman

gand

tracea.

tumor.

on

An

to

to

te

et

rigt

o

te

compressed

te

pysician

examination

x-ray

te

Wic

be

comes

Pysica

A.

Let

braciocepaic

B.

Let

interna

C.

Let

subcavian

D.

Vagus

E.

Prenic

A

side

o

te

and

a

by

te

and

80/min,

centra

te

rect

cest

Let

B.

Site

wi

C.

Rigt

tyroid

110.

invoved

o

is

pressure

is

as

a

te

37°C

is

paced.

a

emergency

motor

Superior

D.

Let

E.

Rigt

Wic

to

mm

o

ine

inerior

B.

superior

oowing

C.

aorta

in

te

te

tip

cor-

artery

vena

42-year-od

cava

man

pain.

comes

He

as

gands,

secondary

o

te

is

a

sows

ikey

an

tis

to

te

pysician

diagnosed

resut

o

resut

o

cinica

wit

o

is

or

iver

acooism.

enargement

oowing

describe

raes

costa

space

is

an

rigt

and

to

obar

ung.

be

does

te

not

sow

oowing

is

compressed

any

signs

cavity.

o

conditions

by

te

externa

wi

most

rom

s

te

ng

voume

A.

Rgt

B.

Let

Wic

o

tis

cest

wit

B.

Empysema

paradoxica

respiration

116.

ange.

te

te

is

cest

o

most

er

ikey

is

ung

ung

brougt

ever.

cest

An

te

x-ray

neede

neede

percardum

by

pain,

efuson.

he

te

to

o

te

te

Wen

s

and

cest

too

up

sows

rom

deepy,

enterng

cambers

tacy-

percardocen-

nserted

passes

emergency

dyspnea,

woud

te

be

te

perc-

eart.

te

irst

neede?

ventrce

ventrce

C.

Rgt

D.

Let

atrum

he

cardac

A

rigt

oowng

penetrated

o

E.

Fai

obes

inter-

sounds

ung

rigt

severe

and

vscera

o

examination

describe

man

wit

rigt

te

te

perormed,

te

be

te

o

o

o

pneumonia?

percarda

nrasterna

case?

A.

o

ungs

obe

sixt

obes

ungs

injuries.

ikey

oowing

te

et

a

great

Pysica

te

x-ray

o

because

du

et

to

peura

o

An

one

te

and

and

x-ray o te cest sows tat er rigt ung is coapsed

ung

percussion.

in

o

ine,

and

tess

rigt

eve

rigt

Wc

et

te

midaxiary

rigt

emergency

te

examination

te

uneven parae bars during er gymnastic practice. An

er

at

pysician

Pysica

te

Amastia

te

te

o

E.

o

to

days.

o

sgnicant

in

4

obes

Gynecomastia

air

by

coug,

er

o

compressed?

obes

D.

and

or

during

35-year-od

wen

Wic

Lower

cardia,

a

Hg.

Upper

A

examina-

supine,

E.

most

Poymastia

ater

ikey

preg-

because

artery

crackes

Wic

department

dyspnea

mm

is

D.

wi

breast

severe

most

patient

obe

C.

wit

90/50

o

norma

Lower

Supernumerary

department

te

is

C.

process.

B.

te

Pysica

Midde

disease

to

days.

B.

conditions

brougt

is

trimester

department

mammary

115.

is

to

vein

Upper

case?

woman

tird

pressure

Wen

pneumonia

obe

te

severa

comes

te

invoved

vein

vein

A.

Poyteia

21-year-od

in

braciocepaic

Pysica

A.

A

gir

at

o

veins

ever

and

produced

sows

disease

a

sows

most

pacement

braciocepaic

bood

carotid

and

was

is

cy-

cava

juguar

17-year-od

are

examination

Wic

interna

dyspnea

atrium

as

common

E.

a

cava

vena

D.

A

or

drops

vena

te

ine

sows

structures

during

emergency

er

structures

A.

tat

is

pressure

a

and

rigt

sitting.

is

Hg,

te

veriy

venous

puse

or

venous

cest

tem-

bood

vein

et

juguar

te

tat

centra

His

and

vein

woman

to

emergency

90/min,

te

oowing

te

o

dizziness

sows

oowing

atrium

pancreatic

comes

severe

o

part

te

ine?

externa

28-year-od

bood

veice

(96.8°F),

119/89

andmark

centra

in

te

114.

Subcavian

A

being

to

pace?

abdomina

111.

used

C.

Proxima

o

te

is

A

o

damaged

subcavian

Rigt

Hg.

to

unconscious.

puse

x-ray

juguar

origin

E.

nancy

mm

o

venous

externa

o

brougt

ound

(96.8°F),

120/90

D.

A

is

being

subsequent

centra

A.

enarged

37°C

Wic

a

structures

man

ater

accidentay

a

113.

brougt

ine

cateter

B.

is

A

sows

vein

temperature

Carina

pressure

sows

vein

is

bood

A.

is

te

artery

man

venous

is

perature

standing

ater

His

structures

o

juguar

pneumotorax

34-year-od

ikey

nerve

and

T ension

A

tion

33-year-od

coision.

Cyotorax

otorax.

an

dispace-

biopsy

oowing

wit

sows

nerve

department

Hemotorax

D.

department

gand?

109.

C.

E.

112.

carotid

deviation

ikey

to

parape-

most

artery

neck.

tyroid

o

tracea

rom

was

paced.

47-year-od

pain

suers

arteries

operation

A.

common

patient

oowing

57

Thorax

2

atrum

45-year-od

department

apex

man

wt

s

severe

brougt

cest

to

pan

te

emergency

radatng

to

s

58

C H A P T E R

et

2

arm

Thorax

and

myocardia

Wic

most

117.

o

et

te

ikey

receive

T1,

T2,

T3

B.

T1,

T2,

T3,

C.

T1,

T2

D.

T4,

T5,

T6

E.

T5,

T6,

T7

55-year-od

department

o

te

nation

deep

o

ECG

inerior

spina

o

sows

an

acute

A.

Hemotorax

wa.

B.

Cardac

woud

C.

Hemopneumotorax

ventricuar

cord

sensations

segments

pain

in

tis

case?

121.

coug

sows

sows

is

and

an

is

severe

te

emergency

dyspnea.

An

Pysica

o

te

oowing

caracteristic

or

x-ray

Increase

B.

Increase

o

te

o

transverse

te

diameter

anteroposterior

o

Increase

D.

Decrease

E.

Decrease

o

te

o

vertica

te

anteroposterior

o

te

15-year-od

department

te

o

be

he

expratory

to

Pysca

eart

2

indngs.

C.

Aortc

o

\

te

torax

o

te

122.

te

torax

T rcuspd

T rcuspd

o

te

o

te

o

are

o

indngs.

astma

C.

Aortc

te

nerves

123.

smoot

T rcuspd

T rcuspd

department

Prenc

Pysca

encng

Vagus

T1–T4

E.

Recurrent

aryngea

34-year-od

racc

wa.

percusson

efuson.

son

wt

a

and

A

an

cest

an

brougt

x-ray

tube

s

to

ocazed

examnaton

o

s

te

te

te

pan

cest

space.

cest

\

to

At

tube

emergency

over

sows

nserted

ntercosta

ocatons

sbe

nerve

s

sarp,

Pysca

troug

owng

man

ibers

te

to-

duness

sows

dran

wc

most

a

peura

te

o

on

efu-

te

key

124.

o-

to

Superor

B.

Ineror

C.

At

D.

Between

to

to

te

te

mdde

te

upper

ower

o

te

border

border

o

o

te

ntercosta

nterna

and

te

rb

rb

te

ntercosta

A

externa

ntercosta

s

n

eart

engorged

most

woman

ater

sgnicant

dstant

a

s

a

sounds,

brougt

rom

dstress.

externa

key

musces

and

te

nterna

membrane

42-year-od

department

ntercosta

a

Pysca

reduced

juguar

caracterzed

te

emergency

he

patent

examnaton

systoc

vens.

by

to

bacony.

sgns?

sows

pressure,

Wc

tese

brougt

or

2

Pysca

s

to

te

emergency

monts.

Vtas

examnaton

o

te

oowng

o

te

x-ray

pan

struck

o

te

sows

durng

oowng

sensaton

E.

horacc

are

sows

a

S

1

vave(s)

eart

s/

sound?

by

cest

tat

te

pan

sows

te

s

emergency

truck

we

a

a

patent

nspraton

nerves

o

to

a

and

most

durng

s

cross-

cest.

exper-

expraton.

key

respon-

respraton?

spancnc

62-year-od

woman

wt

souder.

sows

brougt

was

Cardopumonary

te

s/are

sound?

Vtas

sows

an

s

severe

are

no

brougt

dyspnea

wtn

nerves

s

o

te

norma

abnormates.

aneurysm

oowng

to

and

te

most

emergency

pan

mts.

An

aortc

key

over

er

Pysca

x-ray

arc.

afected

o

te

Wc

by

te

aneurysm?

musces

Between

e

Intercosta

o

space

vave(s)

eart

2

mtra

man

D.

cest

S

n

nor-

aortc

C.

examnaton

A.

E.

Vagus

et

nserted?

te

Prenc

B.

department

be

and

An

te

te

A.

A

s

producton

examnaton

o

or

te

spttng

sowed

mtra

and

severe

Wc

sympatetc

wde

oowng

o

dyspnea

Wc

ater

street.

Intercosta

a

cest

breat

norma

aortc

or

57-year-od

B.

D.

and

E.

a

te

o

wtn

vave

D.

A

te

emergency

eart sound. An x-ray o te cest sowed

Mtra

o

are

sows

o

te

aortc

mts.

responsbe

ng

C.

1

Pumonary

musce

and

wt

B.

caracter-

o

woman

A.

oowng

reaxaton

are

x-ray

producton

and

Pysica

and

smoot

te

torax

An

to

sortness

Vtas

examnaton

norma

very oud S

emergency

dyspnea.

weezes

te

te

monts.

o

mtra

35-year-od

A.

A

and

E.

wtn

brougt

vave

D.

A

s

compant

Wc

or

Mtra

type

a

3

sound.

Pumonary

tis

weezes,

o

Wc

cause

to

severe

expiratory

arways.

bocked

department

120.

or

exerton

B.

musce?

119.

on

A.

diameter

diameter

brougt

and

broncospasm

bronca

coud

is

coug

sows

dagnosed.

sgns

transverse

boy

wit

examination

stc

wt

norma

o

woman

department

during

diameter

dimension

tromboss

movements

torax

was

ven

35-year-od

department

C.

A

A

responsbe

torax

118.

Deep

ma

breating?

A.

Pneumotorax

E.

S

exami-

ande\movements”

Wic

wa

to

empysema.

“bucket

toracic

brougt

tamponade

D.

mts.

woman

inspiration.

te

te

An

te

T4

wit

cest

jaw.

o

oowing

A.

A

upper

inarction

and

condton

s

125.

A.

Prenc

B.

Vagus

C.

Cardopumonary

D.

Intercosta

E.

horacc

A

spancnc

62-year-od

department

er

et

arm.

narcton.

stent

s

woman

wt

An

at

brougt

cest

ECG

sows

Coronary

paced

s

severe

te

an

angograpy

proxma

to

pan

te

tat

acute

s

emergency

radates

perormed

porton

o

to

myocarda

te

and

a

anteror

CHAPTER

interventricuar

ar

in

cardiac

te

eart.

structures

artery

rytm,

he

s

a

(LAD).

cardiac

uncton

essentay

Because

o

pacemaker

o

wc

repaced

by

o

is

te

irregu-

Vtas

aso

paced

sows

te

te

oowng

nserton

o

a

pacemaker?

AV

node

B.

Snuatra

C.

Purknje

node

ibers

Wc

te

B.

V entra

C.

Dorsa

o

Hs

D.

V entra

Kent

E.

Dorsa

A

astma

wt

tat

attack,

tered. Wc

system

aton

must

o

man

te

brougt

severe

te

and

o

be

s

dyspnea.

patent

a

te

to

s

te

Pysca

nbted

smoot

by

te

musce

drug

eements

o

drug

te

o

to

an

s

ower

and

reax-

Postgangonc

B.

Pregangonc

C.

Postgangonc

D.

Vscera

E.

Somatc

A

traceobronca

because

was

cyanotc

te

eart.

es

o

s

se

was

condtons

to

bue.

tests

actor

s

131.

most

o

sow

Nodal.

key

te

he

evdence

Bood

TGF-β

ibers

brougt

gves

ibers

ibers

eferent

gr

ibers

emergency

act

te

abnormay

be

o

assocated

ev-

Dextrocarda

B.

Ectopa

C.

T ransposton

D.

Unequa

E.

Coarctaton

A

dvson

35-year-od

department

sponsve

ound

o

a

er

were

At

he

C.

he

D.

he

are

A

and

and

te

emergency

s

unre-

acetamnopen

requred

stes

n

o

te

resstance

was

Interna

Radoogc

ptoss

te

crcoparyngea

te

te

Prenc

n

o

azygos

ven

te

crcotyrod

con-

arc

azygos

arc,

and

trunk

constrcton,

crcotyrod

comes

scan

to

te

pyscan

er

back

because

and

cest.

o

te

w

most

te

4

o

key

Pysca

moss

o

emergency

monts.

conirms

a

day

te

he

or

30

presence

examnaton

te

andross

structures

pup,

o

as

te

most

par-

ace.

key

pexus

s

brougt

severe

Vtas

greaty

n

vena

Let

are

sows

sows

key

to

te

dyspaga.

wtn

no

be

Wc

emergency

he

patent

norma

ost

m-

abnormates.

carcnoma

esopagus.

most

D.

o

afected



o

te

te

te

A

mdde

oowng

carcnoma

sze?

cava

atrum

artery

ventrce

V ertebra

body

62-year-od

sows

s

man

wt

an

a

s

acute

racton

rom

60%

brougt

compant

stabzed,

ejecton

30%

to

2.3)

Let

to

to

or

cgarettes

2.2).

and

examnaton

Pumonary

te

o

as

eyed,

monts.

C.

ECG

pack

(Fg.

man

(Fg.

Ineror

patent

across

6

B.

A

te

trunk

due

department

tymus

radatng

133.

s

nerve

Pysca

E.

ven

ateectass,

accumuaton

aorta

ast

ncreases

con-

brougt

examnaton

Cardopumonary

A.

te

cest

emotorax?

dyspnea

oowng

35-year-od

b

Wat

ne,

n

te

nerve

Arc

segment

constrc-

cartage

te

D.

A

te

o

njured?

C.

CT

com-

te

Sympatetc

ts.

duct

constrcton,

constrcton,

and

o

1

patent

Vagus

actvated

constrcton

crcod

o

x-ray

o

Pysca

artery

s

severe

tumor

te

B.

20

to

wt

smoked

tat

cest.

percusson

An

te

depart-

compans

artery

woman

A.

nserton

due

toracc

Pancoast

et

roots

vesses

45-year-od

a

on

rom

cause

E.

department

esopagus

to

carotd

s

mdaxary

space.

arteres

E.

132.

peura

vens

structures

toracc

woman

pan

o

te

patent

admnstraton

tree

crcoparyngea

69-year-od

to

he

patent

antcpate

arc,

pumonary

severe

he

constrcton,

constrcton,

o

botte

te

pumonary

he

arterosus

brougt

dapragmatc

and

cardac

truncus

organ?

te

cardac

strcton,

te

tube

arteres

overdose.

empty

aortc

and

te

was

andbag.

te

strcton,

E.

an

great

aorta

drug

soud

on

te

ton,

B.

a

Wat

one

presson

o

te

woman

nasogastrc

carcoa.

A.

o

or

and

n

te

te

Pumonary

been

o

at

D.

ta

cords

duness

Pumonary

as

er

nerve

emergency

patent

o

bateray.

Intercosta

A

spna

te

he

sde

resutng

beedng

to

tree.

rgt

ungs

common

Wc

A.

te

a

C.

sows

indngs?

brougt

B.

o

tese

s

Let

years.

oowng

wt

o

oowng

necton

across

T4

A.

patent

wtn

g

te

s

and

T5

racture

department

patent

abnormates

Wc

to

tat

depart-

rb

n

source

ibers

parasympatetc

aferent

3-day-od

ment

sympatetc

sympatetc

a

back

examnaton

zoster

T3

sows

o

et

Pysca

erpes

T4

rom

emotorax

bood

tree?

A.

boy

over

obes

sows

nervous

aceve

pan

o

T3

o

o

a

examnaton

acute

admns-

te

root

a

te

o

o

root

ater

severe

examna-

experencng

broncodaton

oowng

emergency

root

3-year-od

ment

22-year-od

sows

A

mts.

vrus?

o

root

o

upper

o

root

Bunde

126–148

er

actve

Dorsa

Bunde

ton

129.

nppe.

A.

norma

caracterstc

rom

E.

department

128.

wtn

ras

D.

130.

127.

a

passng

seds

A.

Questions

126.

are

59

Thorax

2

to

o

myocarda

o

te

et

emergency

cest

narcton.

angograpy

on

te

severe

s

perormed

ventrce

prevous

pan.

Ater

s

te

and

reduced

ecocardogram

3

60

C H A P T E R

2

Thorax

L

•

Fig.

2.2

•

•

monts

ata

te

134.

ago.

tip

o

Rigt

B.

Let

C.

Rigt

te

Let

is

Wat

paced

is

te

to

o

ago.

patent

te

structures

D.

T racea

135.

A

Ineror

s

comes

ater

surgery

patent

ad

a

surgery

woud

no

cava

up

te

2.5).

most

pysician

vave

we

been

sgnicant

(Fg.

be

to

mitra

went

as

vena

wtout

we

snce

cardac

Wc

key

or

post-

repacement

o

8

compca-

te

surgery.

ypertropy

te

oowng

compressed?

cava

cava

man

ater

He

as

becomes

(Fg.

st.

mm

o

s

Wc

descrbe

Hg.

externa

sows

ts

o

to

n

37°C

are

progressvey

2.6)

brougt

nvoved

sgnicant

respratons

sgns

s

beng

temperature

120/90

.4

trunk

vena

29-year-od

mn,

man

he

Superor

coson.

vena

te

C.

Hs

oow

and

Pumonary

depar tment

pacemaker?

68-year-od

Esopagus

B.

E.

prevent

ocation

ventrice

operative

beore

2.4).

ventrice

Superior

he

pacemaker

(Fig.

atrium

E.

weeks

.3

atrium

D.

tons

cardiac

arrytmias

A.

A

A

Fig.

A.

Fig.

no

te

te

a

dcuty

(96.8°F),

25/mn,

Pysca

and

worse.

oowng

n

puse

bood

An

but

te

x-ray

bones

o

or

Fa

B.

Empysema

cest

wt

condtons

C.

Hemotorax

paradoxca

s

100/

pressure

sows

dyspnea

te

cest

medastna

case?

A.

vece

breatng.

examnaton

njures,

ractured

emergency

motor

respraton

woud

best

CHAPTER

•

•

Fig.

.5

not

ave

botte

136.

D.

Spontaneous

E.

T ension

A

pneumotorax

56-year-od

department

Pysica

o

Wic

sown

137.

o

in

cest

te

te

Rigt

upper

Rigt

midde

Rigt

ower

D.

Rigt

upper,

E.

Rigt

upper

perormed

ound

ing

to

A.

Rigt

B.

Let

C.

Inerior

is

ronci.

pneumonia

o

te

ung

(Fig.

Sortenng

is

An

C.

aected

and

as

D.

o

an

te

(Fig.

Diagona

47-year-od

to

pain

acute

te

2.8).

obviousy

a

a

myocardia

stabiized,

major

emergency

ater

wie

inarc-

angiograpy

but

years.

as

a

drunk

Pysca

caracterstcs

prmary

resut

ympatc

suspensory

ta

o

te

te

o

coronary

Wic

bocked

o

by

arteries

te

cest

severa

te

a

exam-

n

er

o

wc

rgt

o

vesses

gaments

by

cancer

breast

retnacua

pectoras

a

o

A.

are

he

B.

interventricuar

ts

er

rigt

to

te

cuts

major

breast.

he

or

patent

an

does

s

s

o

o

te

o

te

areoa

by

metastatc

brougt

o

to

te

te

to

and

bood

admtted

notaton

o

o

te

te

rom

emergency

wound

ntercosta

s

sternum.

s

trad”

s

oowng

Hs

resp-

100/70

surgca

mm

oor

and

entered

are

to

space,

110/mn,

pressure

“Beck’s

o

te

te

puse

to

nppe

buet

trd

et

(96.8°F),

te

breast

sma-caber

regon

37°C

nverson

system

cart. Wc

on

eatures

trad?

here

was

he

he

njury

patent

o

as

ung,

te

et

pumonary

artery,

et

esopagus

beedng

and

as

pressure;

pressure

te

and

nto

te

medastna

peura

st

to

cavty,

te

a

rgt

torax

patent

puse

to

broncus,

coapsed

pysician

a

26/mn,

patent’s

sde

comes

s

patent

prmary

woman

te

premnary

te

man

centmeters

ratons

is

aterosce-

n

sde)

duct

ater

temperature

Hg.

oow-

(same

te

27-year-od

C.

in

te

o

o

Ipsatera

is

interventricuar

cange

s

cancer

10

nppe

department

cot?

(posterior)

Circumlex

d’orange

cutaneous

o

axary

Invason

te

brougt

is

A

coronary

E.

te

o

Contracton

2.7).

ower

cest

sows

one

anterior

abnorma

is

patient

most

or

and

severe

ECG

D.

A

and

Bockage

B.

n

o

or

occurrences?

A.

percussion,

ower

occuded

paque

obes

midde,

man

and

arteries

rotic

sounds,

on

ever.

peau

day

cancer

and

te

be

duness

obar

emergency

ig

.6

story

every

condton

oowng

cancer

wit

An

breat

te

and

139.

62-year-od

Ater

sows

hs

E.

C.

tion.

o

sows

to

coug,

sows

oowing

B.

jogging.

brougt

amy

breast.

image?

A.

A

is

a

wne

naton

te

dyspnea,

intensity

te

department

138.

man

wit

examination

decreased

x-ray

pneumotorax

o

Fig.

61

Thorax

2

a

sma,

and

quet

ncreased

eart;

decreased

centra

venous

62

C H A P T E R

2

Thorax

D.

he

young

emptyng,

E.

he

et

man

ung

respraton,

eart

140.

A

and

and

34-year-od

and

o

reaxes

te

sbe

or

cavty

oowng

A.

s

“bucket

B.

o

o

C.

s

Hs

n

s

st

o

te

emergency

breat.

te

week

wa

tte

tat

vertca

s

o

dsease

o

s

o

te

o

te

dsease?

and

oss

o

te

rbs

nerve

“pump

as

respon-

Wc

s

musces

ntercosta

contracts

dmensons

cause

he

wt

movement

most

cavtes).

movement”

te

arc

paradoxca

degeneratve

musce

key

o

dastoc

aortc

te

o

toracc

tere

ntercosta

oss

to

earer

peura

most

s

medastna

sortness

te

te

tere

brougt

he

te

s

Generazed

n

a

marked

o

et

but

wa.

ande

resuted

s

(and

te

Parayss

s

te

syndrome.

ncreasng

toracc

to

voenty,

afected

rom

daton

dagnosed

abdomna

obvousy

tere

severe

been

Guan-Barré

and

coapsed,

man

or

ad

suferng

as

tracea

department

patent

s

dyspnea,

parayss

ande

tat

movement”

rbs

Parayss

o

s

nterruptng

musces,

meda

te

an

and

uncton

atera

o

mportant

s

pectora

nerves,

pectoras

accessory

major

musce

o

respraton

141.

•

Fig.

D.

Parayss

E.

Degeneraton

A

department

.7

a

ater

te

cardac

tons,

te

o

contracte

Rgt

C.

Pregangonc

.8

began

become

patent

T wo

cardac

output.

caused

an

days

asssted

experencng

cardac

as

he

syndrome.

ad

by

severe

contrac-

Wc

o

nterrupton

nerve

sympatetc

ibers

orn

te

eart.

he

better

te

ibers

carred

neurons

man

coser

n

by

upper

upper

eart

vave

B.

Pumonary

C.

Mtra

D.

Aortc

Vave

o

te

45-year-od

department

te

utrasound

mout

to

structure

utrasound

T rcuspd

spna

to

toracc

toracc

can

mage

be

neror

man

because

cord

s

o

best

vena

or

sp-

drecty

to

te

tat

T1–T4

a

(TEE).

transducer

e

s

eves

pyscan

ecocardograpy

or

a

o

comes

an

nose

A.

E.

Fig.

pan

procedure,

troug

A

breat.

nerves

emergency

stmuus?

transesopagea

Wc

te

decreased

reduced

key

to

nerves

V entra

te

wt

prenc

nerves

45-year-od

ued

e

musces

s

nerve

prenc

Cardac

E.

o

breatng

most

B.

A

brougt

sortness

n

Let

na

o

Guan-Barré

arrytma,

vagus

myen

s

ventaton,

resutng

spna

143.

o

A.

D.

te

man

patent’s

oowng

te

sternocedomastod

o

wt

story

mecanca

142.

s

34-year-od

as

•

o

s

sced-

Durng

paced

bend

te

transducer,

te

can

vsuazed

be

obtaned.

by TEE?

cava

brougt

to

contnuous

te

emergency

vomtng

or

te

CHAPTER

past

is

2

days.

severey

ud

te

He

as

repacement

cest

presence

tures

s

istor y

deydrated.

sows

o

a

and

a

he

e

md

wc

o

acoo

recovers

abuse

was

we.

oowng

andmark

An

te

A.

Pregangonc

on

B.

Postgangonc

x-ray

anatomc

or

and

paced

pneumomedastnum.

te

radoogc

o

patent

o

nary

he

struc-

dagnoss

o

144.

A.

Let

superor

B.

Vagus

C.

Superor

horacc

D.

Postgangonc

E.

Postgangonc

Pumonary

Aortc

ends

to

sows

muncaton

o

145.

born

te

upper

te

between

s

most

congenta

at

34

weeks

pneumonts.

esopagus.

condtons

ts

was

and

sma

o

o

commony

o

an

tracea

Wc

o

seen

scan

te

te

esopagus

te

com-

ower

oowng

n

and

o

abnorma

and

te

gestaton

CT

segment

presence

te

A

assocaton

mass

atera,

to

bopsy

seg-

and

wt

a

tumor,

A.

Anteror

B.

Latera

Parasterna

Centra

C.

Anydramnos

E.

Apca

D.

Hydatdorm

E.

Corocarcnomas

sure,

man

because

tat

ar ter y

and

externa

Questions

s

o

as

oowng

b rougt

a

o

to

s ow s

nos e b ee d

ove r

d ecre ase d

 e m or a

e m er ge ncy

seve ra

marke d y

p u se s .

nam m at on.

embr yoog c a

te

s  gn icant

w or s ene d

pres s ure ,

deayed

sgns

Fourt

B.

hrd

C.

Let

dorsa

D.

Let

it

E.

Sxt

A

paryngea

paryngea

ment

or

naton

sows

te

a

et

tons

severe

sows

s

et

he re

s tr uctures

were

w c

d oe s

o

te

ts

no

B.

Laryngea

C.

Empysema

D.

Respratory

E.

atng

cest.

te

to

s

ECG

key

d e ect

are

sweatng?

and

te

emergency

cyanoss.

An

o

Pysca

x-ray

and

te

depart-

et

man

o

exam-

te

key

irst

(pectora)

(nracavcuar)

pockets

arm

wa

and

an

o

o

to

severe

te

cest

sweatng

myocarda

et

ventrce.

responsbe

pan

or

rad-

over

narcton

Wc

te

s

o

nerve

ncreased

151.

key

o

te

oowng

suferng

o

te

ower

aortc

pumonary

C.

Stenoss

o

aortc

D.

Regurgtaton

E.

Stenoss

A

o

was

man

to

was

by

reerred

Vagus

B.

Intercostas

te

Prenc

E.

Cardopumonary

n

dmpng

er

o

brougt

arm.

woman

rgt

skn

o

to

te

A

te

emergency

breat

and

dagnoss

rom

o

scema

vasodaton

Wc

te

comes

breast.

to

o

ntrogycerne

eart.

pan

Intercostobraca

ump

et

te

D.

41-year-od

vave

vave

sortness

resutng

C.

A

mtra

causng

to

vave

vave

Subngua

ow

A.

o

s

made

condton

bood

troug

because

radatng

abnor-

vave

pumonary

58-year-od

vave

rom?

troug

ng

emergency

Wc

most

troug

nerves

ncreased

acute

te

key

space.

se

Regurgtaton

te

erna

brougt

edema

Regurgtaton

n

ar

sows

B.

cond-

o

oowng

examnaton

myocardum.

istua

s

s

pectors

cest

syndrome

compants

sows

most

most

to

ymp

tumor?

A.

pan

dagnoss?

dstress

Pysca

mates

atresa

wt

posteror

ibers

to

Wc

T raceoesopagea

department

w

traced

te

149–173

department

dapragmatc

55-year-od

were

recevng

tssue

ymp

axary

axary

ntercosta

150.

pneumotorax

most

nodes

te

te

mbs and a systoc murmur was eard n te et second

te

arc

abdomen.

emtorax.

Congenta

vesses

nodes

by

A 51-year-od woman comes to te pyscan compan-

mts.

p res-

arc

brougt

at

A.

A

s

sde

he

nto

up

and

node

Se aso as generazed atgue. Vtas are wtn norma

arc

dyspnea

a

njected

above,

ymp

ng because o dyspnea on exerton or te past 2 monts.

arc

paryngea

boy

te

sgty

underwent

taken

a

and

aorta

paryngea

3-day-od

area.

ymp

perormng

Mammogram

days .

n cre as e d

e mor a

From

149.

arse?

A.

T4

moe

examnato n

braca

was

Wc

wen

sower.

dameter

Se

was

axary

D.

Pysca

to

superor,

axary

C.

eadace

n

a

dye

rom

Poyydramnos

3 0-year-od

T1

rom

ganga

breast

takng

wc

te

tumor.

ymp

rgt

cm

te

expose

Ogodramnos

A

cardopumo-

rom

ibers

cervca

areoa.

specic

dranng

te

1

rgt

vesses,

receve

er

we

about

er

te

rom

anomay?

ibers

sympatetc

n

around

surgcay

cnca

te

aferents

sympatetc

neror

mass

B.

a

147.

and

A.

depar tment

146.

a

sows

ave

tat

bndy

ment

ven

boy

ound

vscera

se-examnaton

arc

newborn

cest

cava

n

A 35-year-od woman comes to te pyscan ater ind-

ng

vena

E.

was

148.

nerve

D.

A

ven

sympatetcs

nerve

mdde,

ntercosta

parasympatetcs

C.

pneumomedastnum?

63

Thorax

2

and

te

o

te

reeved

mprov-

oowng

arm?

to

te

Pysca

breast

o

cest

angna

over

pyscan

examnaton

te

mass.

A

or

a

sows

CT

scan

o te breast sows a 3-cm mass at te rgt upper quad-

rant

o

er

dmpng

o

te

rgt

o

te

tumor

breast

breast

nto

wt

s

wc

mutpe

most

o

key

te

cacicatons.

caused

oowng

by

he

nvason

structure(s)?

64

C H A P T E R

2

Thorax

C.

Rgt

dorsa

segmenta

155.

D.

Ft

E.

V entra

A

arc

e

runs

tat

o

eet

sort

emora

te

man

cod

a

o

puses

te

irst

comes

to

and

are

aorta

arc

to

te

sevent

nter-

pyscan

and

pan

Pysca

muc

CT

artery

te

egs,

dstance.

hree-dmensona

taton

proxma

artery

part

25-year-od

eadace,

aorta

artery

scan

n

weaker

to

te

severe

egs

examnaton

tan

angograpy

proxma

wt

s

et

rada

sows

wen

sows

puses.

a

coarc-

subcavan

artery .

he condton tat creates tese symptoms s a resut o a

aure

•

152.

A.

Lactierous

B.

Mammary

C.

Suspensory

Cavipectora

Media

and

65-year-od

department

upper

jaw

cardia

beind

artery

153.

and

te

is

te

Circumlex

Anterior

C.

Inerior

D.

Let

E.

Rigt

A

i

B.

Prenic

C.

Let

D.

Rigt

E.

Greater

te

to

wit

is

eart

be

brougt

a

to

a

to

A

er

cest

coronary

wi

ab

pain.

or

an

aure

Foramen

Septum

Wic

emergency

scan

(Fig.

aneur ysm.

most

ypopastc

C.

dyspagia

ikey

continues

T runcus

E.

Bubus

to

or

25-year-od

oss

or

6

day

or

10

o

surace

a

beng

Prenc

Vagus

cest

Intercosta

D.

Recurrent

E.

horacc

te

emergency

sowed

was

emergency

severe

depart-

menta

B.

Let

ta

to

o

cateter.

regress

dsta

to

te

snce

monts.

te

dorsa

aorta

dsta

to

structures?

and

are

a

te

emergency

2

packs

o

norma

tumor

nvadng

um.

wegt

cgarettes

wtn

te

te

to

unntentona

mts.

te

Wc

a

An

ung

nerve

s

tumor?

Se

comes

as

a

to

te

story

pyscan

o

severe

or

a

rou-

reumatc

vave

repacement

o

et

cateter

to

n

te

Wc

ts

o

as

a

te

condton?

sevent

te

sevent

nterseg-

ntersegmen-

surgery

2

years

ago,

but

An

x-ray

o

te

cest

sows

sternotomy

wres,

prostetc aortc and mtra vaves, and a greaty enarged

artery

artery

ypertro-

se as deveoped some new symptoms over te past ew

inerior

brougt

cateterzaton

passage

onger

aed

aorta

oowng

smoked

to

woman

up.

atrum.

drect

Wc

resut

o

processes

dorsa

and

aryngea

nous

structures

te

brougt

sows

by

and

Rgt

ventrce,

vscera

60-year-od

oow

s

Vtas

anteror

C.

stabe

to

patent

Durng

a

Se

compressed

B.

A

o

dyspnea

years.

te

A.

com-

woman

wt

just

2.9)

grow?

wc

monts.

Wic

be

rgt

arterosus

Nausea

A.

s

utrasono-

cords

Pan

oowng

An

he

Se

prmum

B.

requres

atresa.

cyanoss.

story .

cusons

A.

tus

vave

or

amy

secundum

D.

A

o

a rgt subcavan artery passng posterory to te esop-

and

pyscan

cardac

eart dsease. Her cardac symptoms ave been reatvey

ECG

he

deect

rom s rgt rada artery t s noted tat te patent as

agus

te

any

trcuspd

B.

tne

brougt

arteres.

to

ave

wt

arc

arc

comes

not

per-

is

spancnic

is

gr

does

immediatey

aryngea

inarcton.

cateterzaton

newborn

Endocarda

158.

a

A

opmenta

aryngea

man

arc

paryngea

paryngea

A.

te

CT

aortic

aneur ysm

toracic

structure?

aorta

myo-

inarcted.

worsening

sma

ner ves

recurrent

myocardia

it

Sxt

department

oarseness.

aortic

59-year-od

s

as

recurrent

Let

E.

x-ray

sows

te

Vagus

ment

sows

interventricuar

graduay

oowing

A.

A

radiating

ECG

cateterization

o

ound

woman

aso

Se

torax

D.

paryngea

wc

ped et ventrce. he patent most key reects a deve-

coronary

mont.

te

emergency

margina

wit

pressed

pain

ours.

te

occuded?

(posterior)

dorsa

septa

to

157.

department

o

nerves

cest

3

Cardiac

is

Let

patent

interventricuar

42-year-od

te

nodes

brougt

portion

ikey

B.

is

or

sternum

most

hrd

C.

o

arc

grapc sows a wdey patent oramen ovae, ventrcuar

severe

arms

A.

o

154.

wit

B.

deveopment

paryngea

dagnosed

pectora

woman

and

ymp

ascia

atera

inarction.

ormed

156.

apica

igaments

E.

norma

Fourt

.9

ducts

and

D.

A

Fig.

o

A.

159.

and

C.

Dcuty

D.

Epgastrc

E.

Increased

A

59-year-od

ment

wt

symptom

er

et

woud

most

key

atra

enargement?

over

toracc

deveop

vomtng

tenderness

vertebra

sp-

swaowng

pan

ater

eatng

atty

oods

cougng

man

severe

s

brougt

cest

pan

to

and

te

emergency

sweatng.

He

depart-

as

a

ong

CHAPTER

istory o ypertension and uncontroed diabetes. Vitas

or

are

concern

witin

sigt

160.

norma

rytmic

Pysica

pusation

on

examination

te

cest

wa

sows

at

te

a

et

artery

s

n

a

Anteror

C.

Let

Rgt

B.

Let

C.

Aortc

D.

Apex

E.

Mtra

woud

be

te

cause

o

ts

pusaton?

atrum

atrum

arc

o

te

eart

164.

vave

Snuatra

cronc

severey

just

ts

accompanyng

snce

ater

ven

Mdde

B.

Great

cardac

C.

Sma

cardac

D.

Anteror

E.

Posteror

t

monts

o

te

a

be

and

ECG

Coronary

arses

or

must

6

yesterday.

bockage

artery

A.

or

narcton.

tota

artery

angna

worse

myocarda

exposng

rom

sows

an

(S1)

te

et

rom

pd

o

IV

murmur,

vave.

o

te

et

a

present

bood

puse

sows

a

torax

on

te

te

cocentess

s

s

at

et

at

rgt

n

ne

n

over

ts

mm

An

Hg.

te

o

ower

woud

are

woman

Vtas

are

sows

was

and

absent

Cest

C.

Nasogastrc

D.

horacocentess

E.

Percardocentess

o

A

space

most

te

tora-

n

166.

te

A

appro-

tube

and

cardac

son

was

man

he

Sevent

nerve

C.

Nnt

symptoms?

A

7 0-year-od

depar tment

not

or

been

5

sma

trc

abe

mgt

a

n,

ofe r

b rougt

a ve

x-ray

o

surgca

or

n

Wen

w c 

te

tub e

as

or

atus

a

s

m o st

pas s es

tat

to

te

stomac?

Posteror

B.

Leve

C.

Posteror

to

D.

Posteror

to

E.

Esopagea

o

to

te

te

et

atrum

superor

aortc

te

et

atus

man

o

aperture

te

Somatc

D.

Pregangonc

broncus

E.

167.

A

T1–T4

o

te

ung

secton

o

o

te

narcton.

tenson,

Se

and

as

a

story

uncontroed

o

an

acute

morbd

dabetes.

myocarda

obesty,

Se

s

yper-

scedued

te

as

60%

he

wt

apart-

exam-

systoc

condton

wc

o

te

to

te

rb

pyscan

a

story

eart

wt

and

o

yperten-

aure.

ejecton

he

racton.

damaged

to

dzz-

reduced

cause

rom

ast

Wc

te

tese

vagus

pexus

n

n

te

te

aor ta

hs

orn

prenc

toracc

nerve

vscera

rom

T1

to

nerves

T4

atera

ta t

te

vesse

es

e  t

oowng?

Urne

E.

Oxygenated

bood

bood

on

an d

wou d

 ob e ctomy

Durng

m ed as t num,

te

b e twe en

Lymp

D.

op en

a d e n ocarcn oma.

bodes

on

neurons

und er wen t

post e r  or

Deoxygenated

ave

er

Pysca

bradycarda

sympatetcs

an

vesse

ver tebra

te

A.

a

or

Sava

to

to

been

wom an

C.

ound

emergency

o

reduced

parasympatetcs

ventra

6 5-year-od

B.

s

ave

eferents

pan

se

superor

patent

aferents

A 55-year-od woman comes to te pyscan or cest

and

sternum

orn

rgt.

dapragm

te

vens.

aevated

ave

cardac

Vscera

racc

arc

te

C.

te

toracc

te

may

n

to

sowed

B.

denties

A.

mts.

sounds,

congestve

Pregangonc

a

nas o gas-

te

es op ag us

t

as

s owe d

ns e r t ng

to,

t e

e m er ge ncy

p at en t

ab d ome n

re s  de nt,

to

te

he

move me nts

te

re  at on

resstanc e

to

p a n .

b owe 

obstr uct on .

by

ste

s

abdomn a

to

An

bowe

dsta

man

or

days.

tube

ibers

nerve

to

bacony

juguar

comes

dastoc

B.

A.

te

o

ne

ound

ecocardogram

Egt

ne

sternum

tube

output.

and

border

brougt

eart

nserton

venous

55-year-od

ness

rgt

norma

be

Centra

Ft

Eevent

can

B.

are

mdcavcuar

o

vave?

sternum

procedures?

A.

cest

s

rom

engorged

A.

E.

a

wtn

created

oowng

a

24/

trd

be

s

o

border

trcus-

hrd

Crackes,

te

ne.

ntercosta

patent

coug

remtus

x-ray

mdcavcuar

Wc

and

temperature

decreased

obe.

te

ever

te

ts

Second ntercosta space at rgt border o sternum

ater

at

border

wtn

systoc

E.

42-year-od

space

et

a

D.

A

ntercosta

at

o

auscutate

space

njury?

space

to

space

prate or nserton o te neede durng ts procedure?

D.

ts?

depart-

are

sows

regurgtaton

ste

ntercosta

respratons

110/70

and

ower

scedued.

mdcavcuar

s

efuson

rgt

o

o

best

ntercosta

naton

Hs

110/mn,

sounds,

rgt

peura

story

te

Ft

ventrce

sputum.

pressure

breat

n

1-week

s

Vtas

examnaton

Ft

ment.

puruent

(102°F),

decreased

s

emergency

endocardts.

suggestve

ntercosta

department

o

and

C.

165.

ven

use

B.

wc

tat

and

to

coronary.

ment

mn,

brougt

Pysca

Wat

Fourt

pressure,

38.9°C

drug

mts.

A 25-year-od man s brougt to te emergency depart-

o

artery

nterventrcuar

s

A.

cardac

because

woman

nterven-

procedure,

protected

as

angograpy

anteror

bypass

t

cardac

productve

Wc

prmary

crcumex

ment wt dyspnea or 3 monts. he patent as a s-

norma

In

o

te

noda

(posteror)

35-year-od

tory

trcuar

eart.

artery

rom

nterventrcuar

Ineror

ment

neary

domnant

he

arses

margna

E.

A 48-year-od man s brougt to te emergency depart-

wt

tat

margna

D.

A

operaton.

vesse

et

B.

mts. Wat

A.

Rgt

bypass

te

ma

sows

163.

coronary

A.

acute

162.

a

it ntercosta space. An x-ray o te cest s wtn nor-

gotten

161.

imits.

65

Thorax

2

te

m os t

anter or

te

a

a

s ur  ace

d es ce nd  ng

az ygos

 ke y

d s -

surge on

ve n

con ta n

o

to-

on

te

w c

66

C H A P T E R

168.

Thorax

A 10-year-od boy comes to te pysician or a ard mass

tone.

in

issures,

is

cest

tat

existed

or

2

monts

and

was

ound

to

rom

arge

systoc

to

tumor

o

te

rom

te

a

structure

superior

wc

Frst

B.

Second

C.

hrd

o

te

Fourt

Ft

s

most

paryngea

anterior

posterior

key

a

derved

a

pouces?

wt

was

n

te

he

an

o

te

and

brdge,

wa

deect

uson

was

ts

woman

ater

was

respratons

temperature

mm

Hg.

wt

brougt

suferng

Her

are

he

s

a

38.9°C

Faed

uson

o

septum

was

breat

on

110/

arger

s

o

te

Sort

E.

Incompete

te

172.

A

rgt

to

perorm

torax.

be

an

to

te

and

emergency

Between

paced

Between

wc

reeve

vscera

te

te

pyscan

decompresson

ayers

w

te

o

32-year-od

neede

na

pneumotorax?

and

pareta

ayers

B.

Between

C.

Between

te

serous

and

ibrous

ayers

medastna

peura

and

o

te

woman

o

te

ibrous

pareta

and

vscera

ayers

o

te

te

endotoracc

ton

woman

cesarean

sowed

devered

secton.

tat

C.

It

s

D.

he

he

asca

and

pareta

173.

A

te

a

gr

Utrasound

eta

eart

at

was

at

37

16

weeks

weeks’

ocated

by

tor y

te

Pysca

pnk

examnaton

wtout

o

te

gr

cardopumonary

sowed

dstress.

day

and

a

Wat

cm

was

seen

outsde

te

skn

n

te

mdne

o

te

num.

was

A.

he

te

gr

most

Faed

was

key

uson

dagnosed

wt

embryoogca

o

ectopa

cause

o

peuropercarda

cords.

ts

Wat

A.

at

Faed

21

key

te

AV

wt

septum

uson

Faed

part

o

te

septum

o

s

ts

a

by

cesarean

pansystoc

utrasound

a

et

deect

septum.

concernng

sowed

n

rgt

te

te

cra-

o

te

cardac

patent?

o

te

to

o

bood

to

sec-

mur-

and

Wc

parttonng

et

sunt

at

bubus

at

cords

brt

brt

septum

and

endocarda

use

prmum

woman

o

te

se

and

septum

devered

gr

was

wt

secundum

sowed

unt.

batera

cardac

most

2.7-kg

aed

an

Se

sadow.

orentaton

key

cause

respra-

admtted

deveoped

An

azy

A

o

o

gr

Pysca

eevated

tacypnea.

basa

(6-b)

dever y.

subsequenty

care

norma

a

vagna

persstent

sowed

te

gr

between

true

spontaneous

a

a

sows

troug

cyanoss

ntensve

sows

nto

brt

and

ater

venosus

to

a

te

ever

x-ray

o

opacicaton

woe-body

te

CT

oter

vscera.

gr’s

cardac

ts

and

superor

growt

o

te

prmorda

atrum

te

B.

Anteror

and

neror

growt

o

te

prmorda

ventrce

o

peuropercarda

C.

at

Posteror

mdne

B.

et

condton?

deect?

ods

rgt

rgt-sded

5

torax. An x-ray o te cest sowed a “spt” n te ster-

n

aed

va

cest

scan

6

a

septum

rate

Vta sgns were wtn norma mts. A pusate mass o

×

most

wt

snus

Cardac

key

uneven

cause

use

te

drecty

nterventrcuar

neonata

te

was

a

term

a

e

s

examnaton

gesta-

outsde

crana

nterventrcuar

most

30-year-od

te

tat

te

trsomy

te

prmum

devers

systoe,

dscovered

causes

cest cavty but te moter opted aganst termnaton o

pregnancy .

s

It

at

38-year-od

te

B.

to

peura

eectve

o

here

E.

bood

durng

cusons

te

Between

o

A.

peura

A

part

deect

percardum

Between

jet

oowng

percardum

te

sma

ventrces

percardum

E.

s

prmum

o

cyanoss.

D.

rom

wt

atrum

wtout

A.

rgt

a

sowed

secundum

resorpton

a

pneumotorax

A

septum

mur

tenson

cest.

resorpton

D.

tan

auscutaton

et

Excess

as

to

sowed

prmum

tracea tug to te rgt sde was noted. Se was assessed

a

te

s

C.

te

pressure

notaby

o

to

puse

bood

sounds

percusson

emergency

wound

examnaton

ave

cest

eye

tongue

patent?

septum

Pysca

et

te

Wat

o

ton.

avng

to

te

(102°F),

and

torax

decreased

to

gunsot

24/mn,

et

yperresonance

te

obque

utrasound

dagnosed

deect.

n

te

Cardac

separatng

septa

o

wt

protrudng

secundum

mn,

prepared

at

and

Auscutaton

murmur.

patent

atra

Faed

broad

nose

jaw.

ejecton

deect

B.

back.

rgt

sma

atrum.

A.

25-year-od

and

most

immediatey

structure

oowng

te

ace

attened

septum

E.

te

hs

in

cause

D.

90/70

ocated

mediastinum

manubrum.

A.

A

in

department

170.

Hs

ave a tymoma. CT scan o te cest sows a singe but

part

169.

2

uson

te

septum

transversum

wt

ods

o

atera

body

wa

ods

n

te

C.

Anteror

D.

Growt

o

and

prmorda

neror

growt

E.

Growt

o

te

eart

prmorda

o

te

tube

eart

to

bubus

te

tube

to

cords

et

te

rgt

mdne

D.

Faed

uson

o

peuropertonea

E.

Faed

uson

o

percarda

at

coeom

te

and

mdne

Questions

coeom

171.

A

174.

42-year-od

sgns

mbs

o

te

woman

boy

equay,

were

tere

devered

norma.

was

a

boy

at

Atoug

generazed

term.

e

174–188

pertonea

Vta

moved

decreased

a

musce

A

o

54-year-od

a

rom

sm

2-week

acd

and

man

story

reux.

was

He

comes

o

as

dagnosed

to

te

pyscan

progressvey

a

20-year

wt

story

Barrett

because

ncreased

o

pan

acoo-

esopagus

3

years

CHAPTER

ago.

ta

An

part

e

as

esopagea

o

Hg.

is

are

An

mediastinum.

tion

te

o

luid

te

CT

in

oowing

and

cest

o

structures

is

is

te

is

His

azy

cest

dis-

178.

respira-

opacity

sowed

ikey

tem-

120/80

mediastinum.

most

te

120/min,

pressure

sows

posterior

and

Postoperativey,

discomort.

puse

bood

scan

te

perormed

excised.

cest

(99.5°F),

24/min,

o

is

is

increased

37.5°C

x-ray

surgery

esopagus

graduay

perature

tions

te

a

in

horacc

B.

Esopagus

tis

Descendng

D.

Azygos

E.

Bronca

4-day-od

ment

aorta

ven

ympatcs

gr

because

s

o

brougt

to

dyspnea,

te

emergency

tacycarda,

depart-

179.

tacypnea,

ernaton

a

o

bowe

ypopastc

ture

most

et

key

nto

te

ung.

aed

o

te

et

toracc

Wc

to

abdomen

cavty

embr yoogc

deveop

and

resuted

and

176.

Septum

B.

Peuropertonea

C.

T raceoesopagea

D.

Laryngotracea

E.

V entra

dure

s

groove

2

Let

ment because e was stabbed n s rgt anteror cest

C.

Let

wa

D.

Rgt

E.

Let

trd

and

a

sarp

examnaton

rgt

dstended

neck

and

torax.

x-ray

te

wt

ng

An

et

and

acute

s

te

sows

ntercosta

percusson

to

nstrument

space

vens.

absent

o

te

key

at

domestc

te

here

cest

a

puncture

breat

batera

respratory

most

a

n

s

n

te

ne

yperresonance

sows

dstress.

wound

mdcavcuar

sounds

opactes

dspute.

a

on

rgt

devated

wc

Wc

are

o

180.

on

em-

a

tracea

Rgt

tenson

B.

Rgt

smpe

pneumotorax

C.

Rgt

smpe

pneumotorax

oow-

a

pneumotorax

cardac

tampon-

Rgt

tenson

E.

Cardac

pneumotorax

and

cardac

tampon-

ade

tamponade

35-year-od

department

motor

vece

mutpe

An

skn

x-ray

evdence

o

o

opacied.

notc.

man

ater

brougt

coson.

te

cest

Pysca

s

not

most

ater

key

a

emergency

t

and

examnaton

any

he

te

te

n

broken

peura.

ours

te

but

sows

punctured

to

nvoved

aceratons

Severa

Wat

s

beng

major

rbs

ung

patent

cause

o

sows

beedng.

5–7,

ied

but

no

appears

appears

te

run

cya-

cyanoss?

Cardac

Lung

a

te

con-

proce-

underyng

structures

s

most

procedure?

nerve

severe

s

cest

on

pan

te

breat

cest

o

a

durng

breat-

puse

bood

examnaton

rgt

Wc

upon

and

rgt-sded

te

emergency

cest

(102°F),

Pysca

o

te

te

25/mn,

decreased

et.

n

38.9°C

are

Hg.

to

stabbed

sows

yperresonance

sounds

sows

sde

te

s

pres-

and

over

te

decreased

a

tracea

oowng

s

te

dagnoss?

pneumotorax

pneumotorax

tamponade

department

cest

sty,

pan.

myocarda

te

oowng

C.

Parayss

ts

man

because

he

dabetes,

Hemotorax

dapragm

pumonary

sows

toracoscopc

te

and

sows

Pneumona

Fa

te

te

72-year-od

B.

o

cest

contuson

A.

cest

a

x-ray

Spontaneous

D.

cavce,

ncreased

durng

cross-

accompaned

te

o

to

dstress.

murmur

s

et

o

brougt

beng

and

T enson

A

s

dstenton

B.

C.

te

x-ray

correcton

njury

brougt

nerve

markngs

key

s

systoc

and

aryngea

mm

A.

E.

181.

o

as

An

to

boy

oowng

respratons

ung.

most

or

temperature

devaton

D.

He

ven

a

beow

An

te

ater

80/50

vascuar

to

nerves?

respratory

Ecocardograpy

man

percusson,

rgt

and

recurrent

juguar

on

o

do-

nerve

prenc

igt.

s

A

nerve

prenc

Hs

sure

x-ray

nerve

vagus

110/mn,

ade

A

bar

An

admnstered

murmur

vdeo-asssted

rsk

vagus

born

souette

o

27-year-od

ng.

dagnoss?

A.

at

depar tment

consstent

te

A

s

days.

percusson

ange.

oowng

wt

he

eard

consdered

Rgt

te

sows

cest.

A

Wc

B.

wt

best

te

cardac

A.

on

coug,

3

nerve

sound.

markngs.

commony

mesogastrum

s

over

A 30-year-od man s brougt to te emergency depart-

past

bateray.

agent)

o

department

deect.

deect.

duness

costoprenc

prematurey

eart

tr,

genta

septum

aryngea

examnaton

enarged

te

nerve

emergency

a

emergency

dry

a

nerves

Recurrent

S

or

te

by

nerve

3-week-od

te

a

ung

wc

E.

n

membrane

to

Vagus

A

sows

te

Cardopumonary

radates

transversum

o

to

oowed

ever

bunted

D.

struc-

te

and

C.

vascuar

A.

Pysca

177.

Intercosta

brougt

cs

anestetc

pan

Prenc

by

ernaton?

oca

B.

te

sows

obe

A.

ng

x-ray

pan

sows

te

Pysca

An

s

o

examnaton

(a

caved

abdomen.

because

ower

and cyanoss. Pysca examnaton sows a depressed

n

pneumotorax

man

cest

cest

cane

duct

C.

A

te

te

reduce

A.

pneumotorax

55-year-od

n

o

patient?

175.

A

Pysca

coec-

damaged

Spontaneous

peurtc

te

Wic

T enson

E.

department

mm

o

D.

67

Thorax

2

patent

and

dapragmatc

brougt

a

to

tgt,

as

a

o

te

surace

coronary

o

arteres

s

te

story

o

An

cardac

te

emergency

burnng

ypertenson.

narcton

patent?

s

o

ECG

musce

eart.

most

substerna

morbd

a

ormng

Wc

key

obe-

sows

o

te

occuded

n

68

C H A P T E R

182.

2

Thorax

A.

Anterior

B.

Circumlex

interventricuar

coronary

C.

Let

D.

Rigt

coronary

artery

E.

Rigt

margina

brances

A

coronary

37-year-od

term

via

artery

artery

artery

woman

spontaneous

186.

A

eart

deivered

vagina

a

3.6-kg

deivery.

(8-b)

he

boy

at

newborn

ace

s

by

o

and

pacng

te

trd

eart

costa

vaves

s

Pumonary

Aortc

embryoog-

C.

Mtra

D.

T rcuspd

E.

Bcuspd

boot

events

sape.

most

Abnorma

B.

Endocarda

C.

Aortc

D.

Pumonary

E.

Abnorma

A

a

and

ormed

man

s

because

o

te

te

eart

187.

o

2-day

te

A

te

stor y

tat

o

A

70-year-od

cutures

acng

w

posterory.

be

g

te

ever,

sows

eco

s

s

mmedatey

woman

and

at

oowng

strate

ts

o

te

B.

Posteroanteror

C.

Latera

D.

Apca

E.

Axa

posteror

to

188.

A

50-year-od

pyscan

s

because

a

nursng

pneumona,

An

x-ray

(o

vews

oowng

auscutatng?

patent

o

ange

te

sur-

second

o

Lous).

woud

dabe-

te

cest

Wc

best

o

demon-

man

ater

brougt

nvoved

te

motor

Rgt

atrum

A cest tube s paced to dran ud. he oowng ana-

D.

Rgt

ventrce

tomc

E.

Aorta

52-year-od

department

ga

o

and

retrosterna

acoosm

copy,

tp

te

te

and

o

te

te

s

o

brougt

2-day

esopagea

endoscope

most

He

as

upper

endoscope

atus

o

te

eves

Interna

2.

Skn

3.

Innermost

story

4.

Pareta

endos-

5.

Externa

6.

Vscera

dyspa-

a

unt

ts

dapragm.

dd

structures

1.

emergency

severe

Durng

te

vertebra

key

te

o

pan.

dsease.

advances

oowng

to

story

“burnng”

ver

pyscan

reaces

Wc

man

because

x-ray

te

tp

Wc

o

o

end?

o

ntercosta

te

structures

4-6-5-1-3-2

2-5-1-3-6-4

C.

T10

C.

2-3-1-5-6-4

D.

T11

D.

2-1-3-5-4-6

E.

2-5-1-3-4

T12

deny

tp

o

man

was

perced

te

s

barb

te

vens.

Wc

barb

cest

te

te

boat,

cardac

o

o

we

removed

onto

reduced

brougt

perced

nstnctvey

brougt

sounds,

ar

ater

te

t

to

a

e

n

te

emergency

stngray’s

was

rgt

water.

and

s

sud-

snorkeng.

were

oowng

ta

ventrce

te

tere

output,

dagnoss?

he

and

Wen

muled

te

e

eart

engorged

jugu-

te

key

most

189.

A

14-year-od

ment

because

breatng.

a

and

te

Wc

dagnoss

o

te

constrcton

te

torax.

musce

best

by

A.

Vagus

B.

Prenc

comes

4-our

te

represents

cest

Pneumotorax

C.

Greater

D.

horacc

C.

Cardac

E.

Intercosta

o

te

to

te

stor y

examnaton

pase

astma

oowng

o

Deep

tamponade

o

efuson.

musce

exprator y

B.

tromboss

gr

o

Pysca

proonged

A.

ven

wa

peura

tube

te

order

durng

te

procedure?

B.

department

te

a

musce

oowng

traversed

A.

s

sows

peura

T7

man

comprse

ntercosta

T8

55-year-od

cest

percus-

peura

B.

E.

te

ntercosta

A.

A

o

on

co-

Pumonary

an

duness

emergency

vece

C.

and

sows

to

a

B.

son

examnaton

n

Let

vens

Pysca

was

beng

A.

A

son.

te

et

ordotc

department

atrum

sterna

o

key

he

aure.

anteror

te

a

te

andmark?

or

transducer?

to

or

auscutates

te

Wc

story

radograpc

per-

te

a

pyscan

on

most

comes

eart

Anteroposteror

o

te

between

coug.

as

A.

n

cest

pyscan

te

paced

Wc

mass

to

pyscan

cartages.

congestve

a

he

stetoscope

story

resdent

and

sows

postve

transducer

3-week

emergency

toward

are

a

tes,

examnaton

radates

transesopagea

utrasound

structures

oopng

to

Pysca

bood

aureus.

tube

brougt

pan.

md-esopagus

oowng

mgraton

deect

murmur

sets

and

ce

condton?

ome

prmtve

Stapylococcus

oowng

ts

a

ypertenson

cest

T wo

crest

cuson

sows

o

oosystoc

axa.

te

eart

constrcton

70-year-od

cs,

o

s

underes

neura

arc

department

Wc

key

A.

and

a

te

B.

enarged,

comes

patent’s

A.

s

man

examnaton.

carac-

ventrce

embosm

38-year-od

rgt

ca

185.

Hemotorax

was cyanotc at brt. An x-ray o te cest sows tat s

terstc

184.

Pumonary

E.

routne

transerred to te neonata ntensve care unt because e

183.

D.

toracc

vscera

o

was

severe

sows

wt

ner ves

bronca

emergency

a

tat

se

as

broncospasm

subsequenty

s

responsbe

smoot

spancnc

depar t-

dcuty

musce

made.

or

te

ces?

CHAPTER

69

Thorax

2

A n swe r s

Answers

1.

et

1–25

D.

he

te

aortcopumonary

truncus

ascendng

A.

he

B.

he

and

et

C.

he

bubar

ds

between

and

ay

w

o

to

date,

208;

rom

s

to

te

and

a

ncompete

sepa-

nto

rom

te

rgt

bubus

nterventrcuar

septum

nto

pay

rgt

to

roe

and

cor-

E.

te

ste

and

o

te

nverts,

te

eta

atresa

s

a

ound

unequa

rare

te

a

TEF ,

dvson

o

o

probaby

oregut

B.

3.

A.

nants

C.

da-

wt

s

excess

o

and/or

esopagea

reduced

wt

a

atresa

ung

or

uar

eart

n

septum

N

septa

a

stunted

A

C.

Muscuar

ung

TEF .

amnotc

he

o

Faot

congenta

eart

most

or

ud,

o

te

ventrcuar

makes

up

213,

25%

common

porton

eads

and

as

o

C.

septa

deects

deects).

D.

10%

membranous

occur

ventrcuar

E.

Ostum

tat

s

GAS

7%

prmum

most

drome

4.

around

N

congenta

deect

commony

(trsomy

208;

o

s

an

eart

atra

assocated

ess

septa

syn-

12).

216;

to

and

reac

pumonary

te

oxygenated

tssues.

ABR/McM

196,

203

bood

aowng

transposton

enters

te

o

te

pumonary

great

occur

N

trunk

rom

te

s

or

narrowng

oxygenated

enance

to

te

te

systemc

206

by

our

cardac

septa

ead

to

caracterzed

two

deect

rgt

ven-

rom

to

te

te

et

te

com-

It

cardac

vesses,

and

te

te

pu-

ventrce.

aure

deveop.

o

great

ventrce

nvoves

by

atra.

o

o

can

te

pumo-

occur

deects,

but

aong-

tere

s

presentaton.

deect

s

te

caracterzed

two

aongsde

228;

ventrces

oter

ABR/McM

stenoss

our

of

s

cardac

200,

by

com-

and

may

deects.

201

s

ormaton

A

te

o

trunk.

and

s

hs

known

aortcopumonary

transposton

and/or

murmur,

at

T etraogy

o

te

murmur

can

N

It

septa

ductus

resut

ejecton

s

our

connectons

s

ata

deect

uness

patent

an

atra

a

septa

deect.

ABR/McM

produces

a

arterosus.

n

septa

228;

wt

connecton

nvoves

anomaous

ventrcuar

208;

assocated

venous

tat

atra

patent

deect

s

deects.

crcuaton.

an

systoc

200,

wdey

murmur

201

ixed

best

and

eard

border.

septa

S2

o

wt

or

a

septa

sterna

makng

deect

197–198,

et

dsorder

venous

ovae,

deect

septa

pumonary

vens

ventrcuar

tc

cuson

eart

cana

murmur

C.

o

ventrcuar

systemc

atra

te

A.

pumonary

mentoned

caracterstc

anomaous

AV

S2

te

Fallot.

n

concurrent

GAS

o

symptoms

endocarda

te

An

bood

arteres,

arses

septa

congenta

An

B.

at

oxygenated

ves-

bood

arteres.

T ota

spt

trunk,

In

E.

7.

not

turn

rgt

between

causes

te

deect

A. A patent ductus arterosus acts as a sunt between te

aorta

An

t

deect

Down

w

ventrcuar

n

te

te

pattern

208;

deect

to

deects.

septa

wt

deect

orice

not

oramen

up

more

caracterzed

congenta

typca

to

a

Ostum secundum deect s an atra septa deect tat

makes

umbca

congenta

bood

tese

atresa

pumonary

septa

aorta

crcuaton.

transposton

membranous

deects.

D.

oter

great

are

a

dever

stenoss,

rom

trunk

septum

nterventrc-

approxmatey

o

vave

may

A

con-

tese

s

between

arses

tetralog y

216

o

te

te

crcuaton.

A. Superor maagnment o te subpumonary nun-

deects.

ventrcuar

tan

account

212,

contrast,

oxygenated

ABR/McM

and

septa

case

GAS

6.

233;

ventrcuar

or

oten

deveopment

ABR/McM

membranous

commony

n

o

stenoss

Faot

muncaton

B.

237;

(membranous

T etraogy

decrease

deects

deects.

te

B.

o

wt

or

N

o

Pumonary

no

ypopasa.

175–182;

ventrcuar

deects

a

sde

ud,

dapragmatc

atra

nary

esopa-

voume,

congenta

In

s

not

systemc

aorta,

monary

tracea,

amnotc

In

systemc

ypertropy.

aorta

E.

an

te

oxygenated

muncaton

arways

aorta

w

pumonar y

dbuum

assocated

genta

An

resutng

nto

ungs.

to

adequate

artery

o

208;

te

tat

te

T etraogy

eta

te

te

to

overrdng

obstruc-

asctes

obstructon

wt

s

ypopasa

pumonary

GAS

A.

deects:

oter.

upper

ecogenc,

and

by

o

aorta

Pumonary

D.

Ogoydramnos,

s

te

trcuar

arway

o

atresa,

become

5.

erna.

E.

Coarctaton

crcuaton.

dv-

te

patency

provde

eventu-

aves

eac

not

devery

te

to

bood

Mantaned

septum

tracea.

n

C:

woud

o

203

g

obstructon

n

et

approac

(congenta

or

a

goes

survva.

D.

atrum

ABR/McM196,

rare

assocated

Lung

and

ses

and

deoxygenated

GAS

cusons

Poyydramnos

seen

to

cana

enarge

te

oten

D.

an

te

derved

cusons

atresa

commony

gus

B

deveop.

T racea

C.

te

atra.

dvdes

s

rse

216;

attens

ydrops

nto

ventrce

carres

t.

AV

N

Dsta

ungs

pragm

cords

dvde

trunk.

aortcopumonary

AV

syndrome)

arway.

B.

te

wt

te

Laryngea

ton

to

bood

gve

te

causng

GAS

bubus

orms

two

septum

endocarda

son

A.

te

prmum

unctons

aves.

usng

he

and

pumonary

secundum

septum

neror

E.

and

septum

raton

2.

arterosus

aorta

septum

aong

Faot

tat

deect

te

w

occurs

produces

ower

not

at

et

resut

S1

or

a

pansystoc

sterna

n

S2.

a

border.

caracters-

70

C H A P T E R

D.

2

Thorax

T ransposition

mid-diastoic

E.

Aortic

toic,

Down

is

stenosis

associated

and

nasa

C.

it

arteries

and/or

a

N

224,

a

A.

An atra septa deect s a communcaton between

sys-

B.

Mtra

te

o

te

crease,

201

“trisomy

deects.

suc

It

D.

is

papebra

as

te

aso

E.

o

dence

o

deect

because

atra

s

assocated

septa

t

deect

may

resut

wt

and

n

ncreased

ventrcuar

endocarda

o

syndrome.

22q11

Faot

It

s

congenta

D.

E.

Down

wt

Aortc

not

assocated

commony

te

oramen

wt

Down

assocated

B.

wt

great

dsorder

arteres

tat

s

s

a

not

cyanotc,

C.

assocated

o

te

T urner

but

s

aorta

s

most

commony

assoc-

D.

syndrome.

not

may

9.

A.

208;

T etraogy

cated

wt

N

o

224,

wt

assocated

Faot

T ransposton

C.

Atra

D.

Coarctaton

E.

Maran

wt

are

225;

and

DGeorge

B.

o

materna

septa

present

Down

wt

ABR/McM

truncus

syndrome

te

syn-

E.

great

200

arterosus

are

asso-

(22q11).

arteres

s

assocated

ventrcuar

ndvduas

o

te

wt

aorta

s

septa

Down

deects

to

B.

T urner

aortc

GAS

10.

N

C.

o

ABR/McM

te

great

200

arteres

assocated

o

(22q11

septa

Faot

wt

D.

T runcus

E.

Coarctaton

wt

(22q11

o

and

wt

s

DGeorge

s

septa

deects

A.

11.

C.

he

tat

nar y

ductus

acts

trunk

njected

troug

nar y

as

a

wt

N

arterosus

contrast

arter y.

208;

218;

s

an

te

aorta.

medum

I

DGeorge

wt

ABR/McM

T urner

between

remans

woud

communcaton

196,

embr yoogc

t

et

communcaton

two

aso

at

and

I

s

as

t

s

openng

te

o

n

oramen

remans

te

cosey

patent,

and

remnant

reated

te

arterosus

congenta

not

but

o

te

te

et

assocated

s

eart

posteror

not

to

aorta.

s

ormaton

te

s

ormaton

te

resut.

nerve

s

communcaton

te

known

brt.

w

a

In

atra,

arterosum

and

207

te

certan

dran

atra

N

nto

necessary

condtons.

aspect

nvoved

te

septa

224–225;

aveoar

Aveoar

ces

capary

barrer,

Bronca

n

o

atra

te

septa

rgt

deect

atrum.

te

come

s

not

ormaton.

ABR/McM

are

It

ony

199

ces

tat

produce

endotea

but

mucous

do

ces

not

ces

contrbute

produce

(gobet

to

te

suractant.

ces)

do

not

pro-

suractant.

Bronca respratory eptea ces act to mosten

protect

T ype

t

I

te

respratory

aveoar

and

do

169–177;

to

ces

not

N

protrude

tract.

are

responsbe

produce

202;

nto

Peuropercarda

te

or

gas

suractant.

ABR/McM

te

T ypcay,

D.

he

ow

and

te

patent,

te

te

E.

pumo-

toracc

212

cavty

ormng

a

GAS

15.

C.

he

caused

te

s

te

tat

N191;

ods

tat

pertonea

262;

a

or

peura

to

ts

separat-

cavty.

poston

prmorda

separates

centra

te

eart

ver.

anomaes

by

te

mgrates

dapragm

membranes

te

responsbe

rom

percardum.

transversum

peuropertonea

rom

aorta

pumo-

he

are

cavty

dapragm

ibrous

o

te

tonea

te

te

septum

rom

structure

te

rom

nto

203

ods

percarda

C.

wt

assocated

communcaton

and

ts

208;

II

tendon

202–203,

te

bypassng

ormaton.

n

ng

syndrome.

GAS

a

s

atra.

deect

venar um

nvoved

causes

syndrome.

assocated

aorta

rom

cava,

B. An absence o muscuature n one a o te dapragm

syndrome).

te

vave

pouc nto wc te abdomna vscera protrude.

ventrcuar

Down

arterosus

syndrome

assocated

n

and

GAS

syndrome).

deects

assocated

s

bood

s

et

ductus

septa

atrum

excange

s

te

togeter

and

14.

syndrome

are

wt

dabetes.

T etraogy

Atra

ndvduas

D.

218;

B. T ransposton

A.

n

atresa.

208;

materna

present

AV

he coronary snus s were te cardac vens

duce

C.

s

coses

aryngea

o

bood-ar

syndrome.

syndrome

te

suractant.

syndrome.

reated

deect

deect

survva

S n u s

deect

secundum,

atra

E. T ype

A.

and

o

ventrce.

vena

ABR/McM

and

arterosus

Patency

GAS

13.

218;

gamentum

deect

Maran

dabetes.

deects

n

he

rgt

assocated

be

et

neror

septa

between

septa

wt

syndrome.

GAS

atra

or

and

transports

te

septa

typcay

ductus

syndrome.

atresa

drome

te

to

rgt

recurrent

o

eart

Coarctaton

ated

s

most

te

septa

ovae,

narrowng

ventrces.

N

atra

partton

syndrome.

T ransposton

wt

208;

An

te

cuson

venosus

ven

te

nc-

an

T etraogy

B.

A.

a

atrum

ver.

GAS

12.

s

et

ventrcuar

between

deects.

A.

A

issure,

cnodactyy

te

ductus

between

syndrome

stenoss

umbca

dgt.

Down

he

21”)

bracycepay,

and

atra.

between

abnormaities

cusion

sant

sman

a

ABR/McM

caed

retardation,

upward

tongue,

in

S2.

produces

225;

propery

menta

resut

singe

murmur.

cardiovascuar

by

may

oud,

commony

endocardia

bridge,

protrudng

208;

(more

wit

caracterized

te

great

most

202–203,

syndrome

arrytmias

lat

te

crescendo-decrescendo

GAS

8.

o

rumbe

orm

separate

te

te

peuroper-

peura

cavty

cavty.

ABR/McM

present

coarctaton

o

n

te

184

ts

ndvdua

aorta.

he

are

porton

a

o

CHAPTER

te

aortic

ourt,

A.

arc

and

he

tat

sixt

bubus

is

constricted

paryngea

cords

arises

rom

te

tird,

retardaton

arces.

becomes

part

not

o

te

ventrcuar

as

system.

B.

he

D.

ductus

arterosus

becomes

te

gamentum

venosus

as

snus

snuatra

E.

he

becomes

venarum,

node

rgt

and

part

and

o

aso

coronary

cardna

ven

s

te

rgt

atrum

contrbutes

to

E.

necton

snus.

not

nose,

nvoved

n

ts

anomay.

GAS

16.

D.

222;

he

structure

agus.

I

resut,

tat

ts

n

separate

as

separates

wc

mk,

t

A.

resut

o

Faure

n

a

o

Faure

C.

Improper

two

coud

te

rom

nant

oxygen

to

atra

esop-

w

w

pouc

reaces

A.

and

B.

te

o

n

woud

not

orm

w

resut

not

resut

C.

n

E.

a

a

ormaton

GAS

to

223;

N

assocated

afects

n

te

and

mosoma

B.

stenoss

E.

Congenta

brt

wegt,

GAS

but

335;

eart

ated

GAS

20.

o

to

s

amnotc

or

ud,

a TEF .

mony

ods

te

nor-

wt

excess

ud

wt

o

certan

238;

deects

patent

may

TEF

as

cause

s

not

may

among

and

ow

brt

s

ductus

wt

con-

stenoss.

A.

may

brt

cause

and

arterosus

s

adverse

ow

not

brt

assoc-

may

sequeae,

cause

suc

premature

as,

menta

it

te

entry

o

o

te

te

nter-

near

te

ossa

prmum

and

s

s

ess

because

common

not

te

wt

orm

endo-

septum

endocarda

pr-

cusons

prmum.

a

cncay

sgnicant

deect.

s

an

uncommon

te

N

224,

outsde

a

type

nteratra

o

atra

septum

s

2.11).

condton

te

aure

toracc

te

a

assocated

225;

n

ABR/McM

wc

toracc

o

hs

occurrence

o

s

199

eart

cavty,

uson

wa.

te

o

te

s

com-

atera

ncompatbe

necton,

cardac

Fauty

he

te

and

yod

nterna

paryngea

musce,

arc

tyrod

artery,

paryngea

bone,

carotd

and

arc

te

gves

and

te

tymus,

and

arteres.

rse

to

epgottc

aortc

te

cr-

cartage,

arc.

dervatves

are

not

cn-

reevant.

d eveopmen t

to

ASDs

o

and/or

te

o

te

t at

sn us

unusu a

s nus

res ut

venos us

 rom

ve nos us

 nto

d e ve op me nt

s

de ice nt

te

o

r gt

te

s ep-

secundum.

196–198;

rgt

smoot

te

oter

coud

ABR/McM

te

deveops

o

n

an

te

te

te

snus

184

venosus

snus

rgt

as

atra

pumonary

venosus

two

venarum,

can

wa;

vens.

ead

to

connectons.

deveopment

resut

o

nto

te

pumonary

snus

nto

aspect

deveops

septaton

Abnorma

216;

o

nteror

a

Abnorma

N

orn

One

te

B.

o

subcavan

he

napproprate

cytomegaovrus

a

musce,

ourt

dvsons:

t.

neuroogca

he

GAS

21.

s

and

rom

common

atrum

arterosus

to

porton

he trd paryngea arc gves rse to te styopa-

tum

assocated

sadde

specicay

ypoxema.

absorpton

t.

s

padum

ras,

not

ocated

oramen

203;

s

te

because

reated

209

patent

ductus

E.

s

septum

te

wc

2.10

cords

and/or

cay

adverse

n

196–198,

ormng

e

te

D.

tem.

cause

wt

as

pumonary

septa

atrum

(Fgs.

cotyrod

caracterstc

brt

premature

patent

as

assocated

arterosus.

assocated

necton

artery

be

suc

ductus

ABR/McM

suc

may

deect

resutng

n

te

C.

necton

patent

deect

and

wt

a

ryngeus

cro-

n

are

bot

deects

use

abnormay,

aure,

amnotc

It

arterosus.

arterosus.

cose

deect

cana

atra

Ectopa

hs

swaow

deicency

assocated

not

A.

B.

te

toxopasmoss

but

and

be

ocated

tereore,

premature

rubea

Congenta

brt

not

ormaton.

to

common

septa

sac.

atoug

deects

suc

wt

abty

ud;

eart

as

N

Congenta

wegt,

be

and

TEF

pumonary

efects

C.

A

ead

209

atresa

toxopasmoss

suc

Congenta

and

not

soud

istua

excess

exposure

deects,

efects

s

rubea

hadomde

genta

woud

abnormates.

D.

A.

eta

may

congenta

artery

an

amnotc

t

to

esopagea

amnotc

Congenta

wt

B.

s

Ogoydramnos

ud,

parynx

ead

ABR/McM

wt

o

amount

te

237;

ma

remans

18.

o

specicay

abnormaty

A.

tongue

o

absent

Poyydramnos

oten

te

TEF .

Maormaton

C.

o

wegt,

deects.

deect

cuson

as

AV

type

D.

expected

17.

An

ASDs

prmum

septa

resutng

atresa.

brt

207

superor

encompass

ostum

atra

mum

esopagea

but

ductus

occur

te

secundum

carda

TEF .

to

An

ungs

n

secundum

and

septum

because

s

septum.

ovae

to

It

suc

damage.

T reponema

ABR/McM

ASDs

cava

oss.

deects

caracterstc

trve

patent

218;

venosus

vena

Ostum

not

attempts

cyanotc

ormaton

tracea

te

TEF

208;

Snus

tracea.

resut

N

superor

a

esopagea

E.

wt

GAS

a

to

ow

ductus

wt

cause

aure

cause

neuroogca

patent

syps

assocated

prmorda

structures

te

te

a

deveop,

becomes

o

esopagea

o

to

maormed

but

B.

nto

cd

19.

s

tracea

te

amount

te

TEF

te

Wen

sps

207

septum

as

event

he

nsucent

a

ABR/McM

structure

regurgtated.

an

216;

competey.

swaow

s

N

traceoesopagea

and

may

and

wt

may

eart

arterosus.

brt,

assocated

earng

congenta

varcea

Congenta

te

sensorneura

wt

ductus

premature

not

Snus

te

patent

Congenta

arterosum.

D.

and

assocated

71

Thorax

2

atra

o

te

septa

septum

deect.

secundum

72

C H A P T E R

2

Thorax

RA

—

right

atrium

LA

RA

RA

RV

—

right

ventricle

L V

RV

RV

Septum

Dorsal

left

atrium

—

left

ventricle

L V

primum

Foramen

—

LA

RA

LA

primum

endocardial

cushions

A

A

1

Perforations

foramen

represent

secundum

in

Foramen

Fused

the

developing

septum

primum

primum

endocardial

cushions

B

B

1

Red

arrows–well—oxygenated

blood

Foramen

Blue

arrows—poorly

secundum

Foramen

primum

C

C

1

Developing

septum

Foramen

secundum

Septum

Foramen

secundum

primum

primum

Primordial

closed

AV

septum

D

D

1

•

Fig.

2.10

oxygenated

blood

CHAPTER

Septum

secundum

Foramen

Valve

of

oval

from

ovale

foramen

septum

Septum

limb)

secundum

Foramen

(derived

(upper

primum)

secundum

(lower

limb)

E

E

1

Septum

secundum

Foramen

Septum

(upper

limb)

ovale

secundum

(lower

limb)

F

F

1

Remnant

of

foramen

secundum

Degenerating

septum

Foramen

by

valve

of

part

of

primum

ovale

closed

foramen

ovale

G

G

1

Superior

Valve

of

vena

cava

foramen

Inferior

vena

(carrying

ovale

cava

well-

oxygenated

blood)

H

H

1

Fig.

C.

Abnorma

woud

snus.

nary

E.

he

nto

Abnorma

wit

et

snus,

rated

D.

deveopment

present

te

rgt

o

te

et

abnormaities

snus

and

te

orn

deveops

rgt

atra

deveopment

in

snus

sinus

te

nto

orn

2.10,

orn

coronary

te

s

coro-

ncorpo-

wa.

o

te

cont’d

22.

C.

te

ty

A.

coronary

snus

he

septum

mesoderm

woud

tat

dapragm.

and

As

te

te

cana,

transversum

gves

It

tey

not ead to totay anomaous pumonary connectons.

tonea

Abnorma

posteroatera

woud

not

ead

nary

connectons.

GAS

196–198,

208;

to

o

te

totay

common

anomaous

cardna

pumo-

B.

he

stuated

and

grow

gve

nea

deveopment

s

orgn

s

to

rse

nto

to

are

two

o

peuropercarda

centra

ods

toracc

o

o

cav-

percardopertonea

ods:

te

ods.

te

te

ayer

tendon

duct.

te

responsbe

aspect

tckened

between

peuropercarda

ods

a

te

ompaomesenterc

ungs

potentay dsrupt cardac venous dranage but woud

ven

73

Thorax

2

or

peuroperto-

he

peuroper-

ormaton

o

te

dapragm.

deveop

nto

te

ibrous

percardum and woud not be nvoved wt aure

N

218;

ABR/McM

203–205

o

te

centra

tendon

o

te

dapragm

to

deveop.

74

C H A P T E R

2

Thorax

Right

atrium

Superior

vena

cava Normal

Opening

coronary

Right

of

foramen

ovale

atrium

sinus Short

Tricuspid

RA

septum

primum

valve

LA

Inferior

vena

Papillary

cava

Perforations

the

valve

of

in

septum

the

muscles

primum,

foramen

ovale

Abnormally Large

foramen

ovale

foramen

Normal

large

(ASD)

septum

ovale

(large

Very

primum

short

septum

C

oval

fossa

Patent

foramen

primum

(ASD)

Normal

Cleft

in

mitral

cervca

pragmatc

E.

he

o

crura

te

23.

C:

he

arc

on

provde

o

258,

te

te

subcavan

Improper

orgn

wc

centra

208;

ourt

are

responsbe

or

te

da-

muscuature.

esopagus,

opment

GAS

myotomes

N

aortc

et

sde

arteres

on

and

te

deveopment

o

s

te

not

o

dorsa

o

te

deveops

te

rgt

te

mesentery

nvoved

ABR/McM

arc

ovalis

Fig.

2.11

cause

ncreased

subsequenty,

tendon

201;

fossa

valve

•

he

primum

D

Normal

D.

ASD)

n

deve-

dapragm.

arc

n

A.

204–225

nto

te

o

o

te

te

troug

te

aortc

and

embryo.

aorta

w

te

emora

he

n

braca

aorta

te

subcavan

artery.

w

ead

artery

Smary,

to

and,

decreased

decreased

pressure

artery.

second

aspect,

bracocepac

sde

ow

pressure

te

aortc

deveops

nto

arc,

specicay

aspects

o

te

te

sma

dorsa

stapeda

artery.

B.

he

to

proxma

te

ead.

part

common

o

te

carotd

trd

aortc

arteres,

arc

wc

gves

rse

suppy

te

CHAPTER

D.

he

n

E:

it

aortc

uman

arc

embryos.

s

sad

he

not

to

usuay

proxma

part

o

deveop

te

sxt

Answers

26.

26–50

E.

A

ure

he

Wtout

ductus

venosus

tat

gamentum

s

remans

a

eta

ater

venosum

and

cardovascuar

deveopment

woud

not

as

cause

GAS

A.

A.

ts

he

et

ductus

sxt

te

reaces

te

patent

te

trunk.

arteres

remans

ductus

wtn

and

24

o

te

te

te

between

aorta

oten

ours

oten

B.

he

ater

C.

by

part

rgt-to-et

woud

te

te

proxma

rgt

part

o

sxt

te

aortc

rgt

arc

27.

aortc

rgt

cavan

E.

he

o

et

arc

D.

208;

W t 

monar y

does

ear t

te

et

a

not

contrbute

A.

218;

patent

and

to

any

and

he

It

s

ss,

n

aso

septa

ton

suc

woud

wt

and

may

o

not

oter

to

te

208;

te

eadng

28.

to

te

A.

caracterzed

wc

sow

oten

eart

promnent

AV

pres-

AV

sounds.

ow

presents

troug

overrdng

n

te

pumonary

ypertropy,

wt

a

wt

x-ray.

suc

It

hs

n

o

aorta

promnent

aso

C

D.

be

et

eart

29.

A.

ABR/McM

207

(o

tus

wt

te

o

te

cavty

erna.

orgn

but

s

not

s

to

not

istua

gves

assocated

and

maor-

ormaton.

rse

to

contrbute

te

to

gastrontestna

on

over

arynx

deveop-

aong

te

te

te

to

and

o

te

IV

s

te

te

rgt

te

rgt

te

septomar-

as

Purknje

and

te

ven-

contracton.

nerory

t

and

does

not

septum.

vave

s

not

drecty

septum.

(LAD)

septum

coronary

on

te

ante-

eart.

208;

atresa

an

to

end

passes

aortc

o

te

tereore,

nterventrcuar

te

197–198,

dvson

to

ventrcuar

artery

as

t

septum,

musces

nterventrcuar

o

course

suc

band)

groove;

not

branc

rom

troug

nterventrcuar

superica

deect

bunde

mpuse

te

papary

AV

te

septa

rgt

nterventrcuar

brances

rom

s

deveopment.

eart

Foowng

te

and

225

te

te

tract

duodenum

stmuatng

coronary

surace

n

not

ts

between

toracc

dapragm,

groove

o

trcuspd

causng

te

pos-

n

ntestnes.

ventrcuar

te

anteror

s

te

deect

provdes

te

resut

suture

eadng

wt

A

dapragm

ABR/McM

apex

troug

he

a

ts

207

orms

and

septum

(moderator

n

but

dapragmatc

proxma

a

Hs).

trave

Esopagea

pete

218;

te

rgt

GAS

assocated

ypopastc

te

cause

brt

communcaton

dapragmatc

191;

carres

to

was,

he

ror

pumo-

o

to

te

nnervatng

E.

et-to-

dapragm.

to

trabecua

he

a

between

may

ater

205,

cavty

o

does

reers

branc

artery

but

and

to

not

bunde

&

or

congenta

woud

cosng

t

assocated

narrow-

syndrome.

te

258;

node

pass

cond-

t

te

dorsay

owever.

aortc

T urner

may

as

B.

steno-

o

N

trcuar

te

corrected.

transversum

GAS

ibers

rgt-

ventrces.

artery

murmur,

narrowng

a

nterventrcuar

aorta.

resuts

notceabe

wt

a

wt

mpuses

pumonary

n

arteres

membrane

ernaton

mout

bunde

A

et-to-

assocated

dapragm.

aow

assocated

gna

oten

o

Wen

a

by

n

oregut

mportant

pumonar y

te

tendon

tracea

because

assocated

dsorders

N

o

te

or

o

aryngotracea

he

pumonar y

p re s s u re ,

syndrome.

GAS

E.

not

ABR/McM

deveopment

ment

o

nto

re s p o n s  b  e

auscutaton

oten

aorta

resuts

on

s

back

s

great

traceoesopagea

and

orms

gradent

mmedatey

once

218;

septum

he

pu-

ve n t r  c  e

sunted

abnorma

present

ead

arteres

et

te

typcay

aorta

abdomna

centra

he

D.

abnorma

and

notceabe,

wt

an

te

be

atresa

te

bood,

Faot

bood

not

Aortc

and

not

et

nvoved

C.

et

cases.

o

o

deect,

an

aor ta

atra

are

o

assocated

E.

nary

he

a

between

ventrce.

te

persst

N

resut

matons

bood

and

ventrcuar

Coarctaton

woud

coud

part

te

x - r a y.

sunt

woud

C.

ng

upper

and

207

Ts

t  e re  o re

deects

sunt

rgt

o

to

o

te

o

woud

wt

s

durng

cest

tetraogy

to-et

a r t e r y.

dyspnea

x-ray

arteres

B.

te

A.

sub-

oxygenated

orms

gradent

pressure

rgt

sunt

aspect

arterosus.

te

aor ta

 n c re a s e d

septa

wt

cest

rgt

orgn

ar terosus

eavng

te

 e a rd

te

ductus

b e t we e n

B o o d

et-to-rgt

ents

te

contrbutes

te

ABR/McM

d  ve r s  o n

enarged,

on

te

ductus

nto

causes

Atra

orms

arc

between

and

perssts

Te

ar teres

arc

aortc

pumonar y

ar teres

to

N

murmur

ear t.

aortc

arc

tr unk.

te

not

208;

teroatera

pumonary

by

a-

aorta.

atrum.

peuropertonea

te

ourt

artery

connecton

te

ourt

aortc

carotd

25.

he

artery.

te

GAS

B.

typcay

deect

to

cd

and

ormaton.

T ransposton

GAS

o

septa

o

te

rom

trunk

resut.

pressure

rgt

and

Coarctaton

D.

to

due

ventrce

membrane

it

he

sunt

sunt

brt,

and

o

w

deect

due

resuts

pumonary

peruson

ventrcuar

et

ormaton

occur

atrum

arterosus

te

septa

sunt

rgt

structures.

D.

A

ductus

arterosus

subsequent

arterosum

or

and

o

cyanoss

atra

et

205

responsbe

regresson

he

cosure

196,

artery.

C.

proper

severe

An

week.

proxma

becomes

s

pumonary

connecton

gamentum

he

arc

te

cosure

anatomc

postnata

ABR/McM

Wtout

unctona

twet

B.

o

pumonary

wereas

o

a

211;

aortc

bot

arterosus.

arterosus,

and

N

truncus

separaton

rgt

217–220;

deveopment

o

bood,

te

presentaton.

24.

common

aortc arc deveops nto te et pumonary artery.

structure

75

Thorax

2

s

N

224;

oten

te

absence

ABR/McM

te

resut

o

199,

an

traceoesopagea

o,

or

bnd

200

ncom-

septum,

endng

o,

te

76

C H A P T E R

2

Thorax

esopagus.

te

tebra

TEF ,

indngs

anomaes,

and

ana

te

patent

correate

VACTERL

cardac

rena

wt

ncudes

32.

ver-

maormatons,

anomaes

and

tat

he

te

rada

a

motty

nvoves

and

te

te

dsorder

smoot

ower

he

o

musce

stenoss

drome.

It

s

a

s

not

seen

congenta

n

o

te

B.

he

syn-

dapragmatc

to

vscera

nary

E.

30.

A.

D.

esopagus

a

GAS

175–177;

a

et

number

cervca

ven

most

he

C.

he

as

to

te

t

s

nerve

but

he

to

te

to

be

artery .

pumo-

mass.

te

te

by

t.

te

crcod

across

eve

o

and

Durng

C.

ncson

s

not

suc

s

esopagus

damaged

a

not

te

te

not

at

stuated

durng

A.

trace-

ocated

and

te

a

openng

1053,

tracea

and

and

s

traceotomy,

made

n

1112;

not

key

D.

as

a

pat

ABR/McM

between

te

o

and

o

neck

te

B.

courses

anteror

to

Because

antero-

te

root

meda

o

as

nerves

tey

pumonary

carna

he

and

gve

of

pexuses

on

te

ntercosta

tumor

run

ocated

to

te

roots

brances

to

te

cardac

upon

ung

nerves

at

posteror

te

te

tracea

o

te

and

near

te

roots.

not

be

surace

afected

anteror

by

to

he

roots

E.

he

by

o

te

te

tumor

nerves

vagus

a

arse

nerves

pass

227;

te

B.

ocated

at

te

woud

ung

N

not

surace

be

te

s

ABR/McM

219

be

afected

next

torax

et

et

to

te

by

a

te

et

between

te

common

recurrent

be

carotd

aryngea

afected

woud

N

190;

not

be

by

ts

afected

ABR/McM

tree

aceraton:

an

nabty

toracc

abduct

nerves

te

207

are

ong

to

uy

nerve)

te

umerus

15

to

mnor

s

most

toracc

abduct

te

necessary

scapua,

above

nerve

te

to

cause

degrees

due

to

to

actate

souder.

woud

90

movements

oss

and

o

weak-

parayss

o

te

musces.

accessory

trapezus

njury

patent

N

he

he

or

o

nerve

musce

woud

on

and

produce

were

somatc

te

woud

cause

poory

oca-

caracterstc

njury

dorsa

ste

s

and

as

Pan

to

te

trunk

o

te

nerve

nerve

genera

ocazed

CNS

ganga

wa

va

w

back

spna

any

oss

umerus,

o

ga-

can

be

135

aferent

cest

orn

suc

te

contan

back

te

ndcate

o

toracodorsa

ABR/McM

processes.

o

not

ganga

sympatetc

pan

does

adducton

te

194;

root

transmtted

he

atera

nomc

E.

he

to

cord

proprocepton,

ce

bodes

vscera

on

te

sensory

not

te

cest

ibers.

carry

sen-

CNS.

receves

gt

afer-

sensory

touc,

and

GAS

orn

o

te

o

te

spna

cord

carres

auto-

sgnas.

ventra

sgnas

197;

irst

to

vbraton.

afected

to

o

spna

njury

183;

nput

te

anteror

or

dependng

neurona

sory

vagus

bend

te

pan.

dorsa

genera

ent

D.

nerve

um.

GAS

rom

ungs.

cardopumonary

a

te

beore

aryngea

he

or

C.

recurrent

nerves

A.

te

um.

D.

34.

wa

woud

ung

te

trunk

rom

rotaton

or

GAS

vagus

to

ocated but woud not cause te symptoms descrbed.

ung.

he

ungs

C.

t

te

drecty

axary

te

nerve

emnated.

nerve,

te

te

ton

te

te

torax.

yng

te

procedures,

teres

o

te

o

to

ong

souder

meda aspect o te ung and te medastnum. Aong

pat

and

not

and

abducton

Rada

E.

nerve

o

o

symptoms

198;

o

posteror

not

arc

225–230;

te

te

zed

tan

208

prenc

by

rotate,

weakness

t.

N

rse

gaton

abducton

Injury

atera

oter

arc

anteror

te

enters

artery

compans

detod

B.

posteror

te

descrbed.

Injury

ness

by

tymectomy.

s

to

and

woud

aortc

sympatetc

to

passes

enters

nerve

169–172,

eevate,

traceotomy

atrogencay

meda

artery

pexus

mastectomy

arm

rsk

te

umerus above te orzonta. he serratus anteror

traceotomy.

durng

damaged

durng

836–837,

o

rsk

s

t

woud

mass

patent

mdne.

be

as

duct

at

artery

as

gves

(supped

carotd

beneat

In te event o njury to te ong toracc nerve, te

trunk.

tus

passes

nerve, ntercostobraca nerve, and toracodorsa nerve.

tracea

bracocepac

et

susceptbe

cartage.

te

It

te

GAS

33.

at

structure

he

connecton

209

nerve

artery.

vagus

but

nerve

te

subcavan

nerve

surround

made

passes

superica

may

ntentona

207,

he

s

beow

ven

to

nerve

t

toracc

tat

ncson

postoned

prenc

GAS

A.

and

wtn

et

and

damaged.

mdne

procedures

31.

abdom-

cavty

istuous

ABR/McM

vertebra,

be

not

otomy,

te

237;

an

most

a

structures

N

common

vagus

he

E.

o

anteror

te

et

near

D.

s

key

B.

ypopasa

orm

bracocepac

mmedatey

hs

aows

toracc

ven

esopagea

he

E.

can

traceotomy,

sxt

he

erna

te

pumonary

wt

In

nto

ypertenson.

he

te

bot

pass

groove,

subcavan

pumonary

pyorc

et

na

aryngea

prenc

te

subcavan

esopagea

VACTERL

stenoss

Congenta

to

o

growt

Pyorc

eads

et

part

spncter.

D.

recurrent

traceoesopagea

spncter.

C.

et

aorta. It s te ony nerve ocated near te descrbed mass.

A.

s

esopagus

C.

gamentum arterosum and ten oops superory toward

anomaes.

acaasa

esopagus

nng

ts

atresa,

atresa,

mb

Esopagea

te

n

syndrome.

esopagea

apasa,

B.

he

VACTERL

to

orn

skeeta

137–138;

N

spna

cord

carres

musce.

197;

ABR/McM

189

motor

CHAPTER

35.

D.

he

umns,

rons

atera

o

te

T1–T4

te

or

ce

oten

ntermedoatera

bodes

sympatetc

are

toracc

A.

orns,

contan

o

system.

assocated

Spna

wt

ce

pregangonc

te

cord

upper

co-

38.

neu-

nerve.

and

key

organs.

he

woud

ce

not

be

bodes

ound

o

at

te

te

mpcated

deep

A.

cardac

he

dorsa

motor

not

nuceus

contan

autonomc

o

te

pregangonc

ibers

nvoved

n

vagus

ce

ner ve

bodes

rasng

te

o

B.

eart

sympatetc

T5–T9

cuar

p

smoot

as

he

te

or

te

eart

GAS

36.

n

te

sweat

te

cervca

gands,

and

te

segments

and

vas-

E.

arrector

abdomna

cavty,

o

wa

nerves

to

rom

A:

te

are

N

bodes

eart

woud

o

rate

te

but

neurons

specicay

not

contan

ibers

respon-

&

vagus

nc

C:

mary)

E:

he

nerves

to

he

207;

contans

tat

some

nnervate

ABR/McM

100,

organs

GAS

C.

he

te

te

217

A.

usuay

he

he

N

te

214;

s

n

toracc

spna

or

B.

gan-

pan

(pr-

and

abdomna

te

to

cavty,

o

vas-

arrector

wa

as

specicay

oregut.

o

nerve

te

205

responsbe

spancnc

te

or

B.

and

esser

abdomen

a

or

nerves

do

somatc

te

are

not

nerve

tat

part

o

te

nnervate

spancnc

sympatetc

and

pan

not

nnervate

GAS

223–235;

N

te

not

somatc

te

C.

ner-

bronca

ibers

aferents

te

190;

nerve

carres

(prmary)

rom

te

to

te

abdomen.

ungs.

ABR/McM

pre-

205,

219

It

s

or

te

not

E.

aso

o

s

nerve,

nnerva-

area

o

key

s

te

to

be

parts

o

162,

oten

o

734;

s

te

ibers

jont

N

195;

he

ong

musce.

suppy

n

to

cutane-

o

and

te

atera

te

areoa

axa.

aspect

o

normaton

“regmenta

o

badge”

te

144

te

rcton

s

t

on

wt

te

or

transmt

rcton

provdes

arm’s

pan

te

coarser.

responsbe

woud

percarda

carry

percardum

rub,

graduay

soey

nerve

skn

not

toracc

It

wt

rub.

sensory

meda

ibers

te

rom

sur-

ts

greater

toracc

toracc

vscera

and

assocated

wt

GAS

N

189;

suppes

not

carry

te

serratus

pan

ibers

ante-

rom

a

spancnc

nerve

s

nvoved

nnervaton.

postsynaptc

eart

nerve

woud

percardts.

abdomna

he

te

sensa-

condton.

ror

he

o

woud

axa.

nnervates

nppe

becomng

ntercostobraca

It

T4

ABR/McM

nerve

rom

responsbe

te

regon.

sensory

percardum,

radatng

or

te

musce.

percarda

prenc

s

o

motor

te

te

not

o

cutaneous

aspect

nammaton

a

te

and

com-

are

surace

nvoved

te

provdes

be

and.

o

to

meda

percardum

o

axary

branc

detod

an

causes

te

he

te

te

to

207

nerve

not

ner ve.

nerves

responsbe

aspect

nnervates

and

souder

Percardts

s

woud

arynx.

s

or

pro-

aortcopumo-

nerves

te

provdes

and

te

te

nerve

te

meda

o

correspondng

souder

te

te

nerve

o

wndow

spancnc

nerve

atera

cutaneous

suppes

over

o

not

patent.

ar yngea

ABR/McM

aspect

ts

unkey

responsbe

anteror

axary

woud

n

spancnc

on

te

toracc

over

to

tus

199;

meda

atera

he

te

are

skn

nnervaton

he

are

posteror

N

nerve

serratus

patent

D.

toracc

ntercostobraca

te

ong

nerve

recurrent

nnervaton

suppy

on

ace.

eart.

esser

toracc

te

nnervaton

not

does

and

to

descrbed

rgt

and

te

o

unar

he

n

toracc

does

he

pan

musce.

gangonc

Ony

surace

carres

does

wndow

patent.

dorsa

prenc

as

ntercostobraca

sensory

and

A.

nerve

abdomen

ts

aortco-

aryngea

aryngea

responsbe

wndow

and

223–235;

patent’s

s

ungs

and

he

GAS

40.

ungs.

nerve

n

nnervaton

ungs.

to

aortcopumonar y

te

wndow

Because

ABR/McM

ony

neror

nvoved

te

segments

and

te

s

passes

te

and

dermatome

E.

o

te

he

ous

spanc-

nnervaton

at

pressed.

te

para-

ibers

cord

gands,

abdomna

toracc

te

system

smoot

E.

t

oarseness

greater

ton

cardac

carryng

sympatetc

wt

cest

te

ibers

ntercosta

vous

or

east

sweat

nnervaton

te

prenc

he

and

neurons

rom

nerve

greater

nnervate

D.

ibers

o

te

recurrent

recurrent

nerve

arynx,

compress

and

esser,

te

n

derved

sympatetc

B.

aferent

responsbe

correate

o

234–235;

nnervate

s

musce,

organs

vagus

he

te

sympatetc

mass

he

arm.

abdomen.

parasympatetc

A.

and

pregangonc

smoot

as

carryng

te

te

nnervaton

ibers.

greater,

musces

we

or

rom

A

C.

D.

nerve

carry

T5–T9

p

ibers

vscera,

sympatetc

cuar

te

Compresson

GAS

39.

organs.

sympatetc

B

oarseness

o

between

et

adjacent

et

vagus

nary

or

responsbe

eferent

toracc

tese

he

or

te

te

arse

as

sympatetcs.

234–235;

sympatetc

ga

wtn

compress

te

te

not

oregut.

gangon

ce

cord

nnervaton

abdomna

postgangonc

wt

spna

wt

cest

rom

rasng

n

D. he toracc vscera (or cardopumonary spanc-

nc)

37.

te

pregangonc

sbe

o

musce,

derved

neror

neurons

correate

o

organs

organs

E.

usuay

musces

we

mass

and

n

duce

D.

he

proxmty

compressed.

rate.

C.

cose

wndow

aortcopumonary

woud

te

s

houg

ton

pexus.

B.

A

to

resutng

pregangonc

neurons

here

pumonary

segments

mbs

C.

77

Thorax

2

or

cardopumonary

sympatetc

ungs

but

nerves

woud

not

tat

carry

percardts.

215;

ABR/McM

205,

nerves

suppy

207

ibers

78

C H A P T E R

41.

C.

he

ous

a

2

Thorax

ntercostobraca

branc

o

cutaneous

aspect

A:

o

he

C5

no

B.

te

and

te

o

E.

to

torax

mary

GAS

te

gut,

some

rom

and

atera

nerve.

axa

cutane-

It

and

162,

X

D.

Sympatetc

serves

ibers

meda

to

te

te

te

neck,

pexus

C6.

and

It

N

and

195;

as

GAS

sensory

te

te

receves

A.

te

ourt

and

trd

te

C.

upper

ton

pr-

areas

In

o

ts

te

patetcs

ne;

te

A.

ony

he

supra-

D.

144

suppyng

tssues

o

te

(numbness)

dsrupted

at

brances

te

o

a

back.

and

roots

ram

s

somatc

rom

te

sensaton

s

and

vscera

perpery.

ost

te

vscera

sen-

he

no

ts

brances

musce

reaton

he

ram

s

o

nnervaton

to

te

nervous

somatc

GAS

58–59;

N

rom

aorta.

aferents,

organs,

n

hese

aferents

n

he

te

n

ibers

te

rom

nerve

case

get

dorsa

pan.”

counterparts

contan

are

ce

bodes

body,

tat

wt

s

sensaton

(or

crana

wt

somatc

a

and

ter

nerves)

et

te

temperature

not

be

rom

te

responsbe

body’s

or

te

pan

o

an

aneurysm.

motor

assocated

ibers

wt

an

tereore

vagus

ung,

sympatetc

and

aortc

woud

ibers

not

aneurysm.

are

auto-

transmt

pan

o

te

sen-

and

second

te

skn

motor

major

and

above

second

not

toracc

nppes

meda

nnerva-

musce,

nnervaton

te

te

197;

sp-

and

and

sde

o

te

o

second

ABR/McM

o

sen-

areoae

te

arm

and

trd

te

188

passes

ater

ts

aryngea

superory

oopng

nerve

and

tracea

around

compres-

woud

not

descend

courses

t

as

resut

branc

at

greater

rom

sympatetc

toracc

nto

eve

ts

woud

te

torax.

te

of

o

te

ar-

um

ts

te

nerve

et

aortc

woud

symptoms.

spancnc

trunk

te

to

gven

te

o

around

toward

posteror

aready

presentng

he

oops

passng

compresson

te

tereore

nerve

beore

does

nerve

ater

n

nerve

groove

aganst

aryngea

he

prenc

presentng

ganga

not

nerve

at

cause

eves

te

arses

T5–T9

presentng

GAS

46.

A.

he

223–226;

patent’s

owng.

cea

B.

nerve

o

Wt

ts

a

N

199;

ce

dated

beng

te

woud

dapragm;

not

te

ABR/McM

compant

et

et

nto

s

atrum,

compressed

descends

to

nnervates

nerve

resut

n

te

symptoms.

s

te

atrum

207

pan

te

te

swa-

probabe

esopagus.

abdomen

beow

upon

most

te

he

mmedatey

eve

o

te

tra-

carna.

he

root

tat

o

enter

he

te

ung

te

or

pumonary

postgangonc

te

aryngea

artery

tereore,

esopagus

surace.

and

or

recurrent

resut

posteror

woud

nomc

and

structure

touc,

he

ynx

he

vscera

pan,

te

a re o  a e

symptoms.

subcavan

sensory

o

o

musce

compresson

compresson

somatc

Somatc aferents are nvoved n sensaton

aortc

E.

penomenon

ganga

brances

symptoms.

abdomna

genera

sensory

assocated

toracc

sensaton.

hey

D.

N

esopagus

rgt

and

te

te

provde

brances

recurrent

he

te

not

nvoved

te

carry

te

root

ncudng

te

188

rom

hs

dorsa

wt

not

to

pectoras

above

cutaneous

recurrent

sensaton.

ibers

roots.

he

are

te

3.9).

presentng

he

o

ave

o

aortc

transmt

p r ov  d e

nnervate

nerves

ram

ibers

132–140;

arc;

ncudng

mxed

assocated

te

and

pan

B.

components

ABR/McM

aferents,

unctons

tus

motor

an

205

ner ves

brances

traceoesopagea

o

te

cutaneous

and

Fg.

et

rgt

answer.

back

not

cutaneous

suppy

te

nnervaton

aorta.

son

cannot

ne.

are

system

ts

motor

provde

te

aferent

197;

ibers

te

“reerred

to

mdaxary

genera

vscera

no

correct

ram

communcantes

wt

Genera

te

dorsa

sympatetc

vscera

C.

C.

A.

Because

not

woud

ABR/McM

nerves

provde

sensory

Latera

te

roots.

eferents.

to

prmary

nerves

GAS

45.

Because

deict

o

ntercosta nerves woud not suppy te afected area.

n

carry

dorsa

dsrupted,

and

A.

E.

sym-

mdaxary

ventra

pan

areoae.

V entra

sory

he ventra roots o te spna cord carry ony somatc

are

o

are

normaton

te

or

ibers

wa,

and

suppy.

na

coce.

cutaneous

and

B.

except

cutaneous

dorsa

nvove

E.

wa

sensory

(andross)

correct

ony

C.

bot

tereore,

sory

B.

body

case,

body

autonomc

te

aneurysm.

atera

pectora

sensory

(GAS

te

214;

and

cutaneous

many

and

to

N

sympatetc

atera

and

sympatetcs

aferents

aortc

ntercosta

D. V entra ram contan bot sensory and motor ibers

aso

are

transmt

ntercosta

nppes

he

musces.

ABR/McM

an

anteror

Anteror

n

eves

ibers

not

nppes.

structures.

rom

te

rom

58–59;

Te

sor y

torax.

at

B.

o

and

orgnates

nnervates

nraspnatus

225–235;

exure,

trunk

abdomna

orgnates

sgnas

autonomc

and

nerve

sympatetc

and

coc

pregangoncs

woud

Parasympatetc

C3–

nerve

and

aneurysm.

44.

motor

spancnc

nerve

hs

suppes

et

ead,

nerves

arm.

and

nnervates

te

te

autonomc

n

C5

and

spna

dapragm.

up

braca

rom

rom

nto

CN

toracc

te

spnatus

43.

te

te

s

suprascapuar

o

n

arses

pass

organs

greater

trunk

42.

tat

nerve

to

T5–T9

he

te

E.

nerve

provdes

suppy

he

bot

nnervates

vagus

aso

s

ntercosta

arm.

brances

uncton

nerve

second

uncton

prenc

he

D.

te

root

durng

s

not

and

s

te

arteres,

esopagus

pan

ung

eave

te

vens,

so

coecton

ung

um,

and

swaowng.

not

structures

prmary

ntmatey

woud

o

ncudng

be

te

bronc.

assocated

assocated

wt

wt

CHAPTER

Axillary

79

Thorax

2

process

Axillary

lymph

nodes

Internal

thoracic

Second,

third,

perforating

thoracic

Pectoralis

artery

and

fourth

branches

of

major

anterior

internal

artery

Parasternal

lymph

nodes

Lactiferous

sinus

Fourth

intercostal

nerve

Lactiferous

ducts

Secretory

Lymphatic

Deep

vessel

A

(pectoral)

fascia

B

GAS

C.

he

te

by

D.

tracea

et

a

he

s

ends

atrum

dated

et

superor

not

cose

and

and

above

woud

te

be

eve

E.

he

to

3.9

o

burcates

unafected

ond

cava

reaton

D.

s

anteror

to

te

n

poston

esopagus

or

te

vena

rgt

cava

atrum

ascends

and

s

not

rom

te

nearby

et

GAS

E.

he

our

afected

pass

ty.

It

N

esopagea

at

rom

s

te

237;

atus

assocated

eve

te

te

o T10

toracc

ste

o

te

ABR/McM

o

te

wt

and

cavty

most

205

apex

dapragm

te

aows

nto

te

te

neror

s

one

dapragm.

o

o

It

s

esopagus

to

abdomna

our

A.

he

n

te

tebra.

te

parynx

neck,

It

s

here

te

or

o

no

passage

he

te

ends

te

eve

irst

and

juncton

and

o

te

constrctons

toracc

o

te

B.

te

eart

rgt

te

o

esopagea

te

s

te

ste

esopagus

sxt

C.

et

te

he

most

superor

at

E.

ound

aperture;

structures

at

ts

passng

te

s

te

et

te

rom

eve

ts

o

openng

te

neck

aorta.

It

49.

aortc

s

at

ts

posteror

eve,

to

were

te

te

te

tat

s

te

sec-

ound.

te

esopagus

broncus.

207

ocated

nces

te

s

arc

n

to

eart

by

te

te

s

et

et

to

it

o

papated,

trobbng

toracc

ocated

o

GAS

190;

hese

n

a

spata

torax.

te

any

o

te

o

te

wa.

te

rgt

tracea

ocated

on

be

te

posteror

papaton

ocated

sternum,

s

aspect

reazed.

posteror

above

te

to

te

second

space.

te

mtra

not

space

be

eart

N

cest

216;

te

most

s

aong

auscutated

te

assocated

ABR/McM

x-ray.

conus

vave

at

te

md-cavcuar

wt

papaton

it

ne,

as

te

s.

o

It

arrangement

he

on

drect

te

components

pan

arc

ocated

no

woud

o

te

woud

apex

s

tus

ntercosta

A.

te

descends

o

as

man

generated

aganst

atrum

eart,

Atoug

ver-

o

be

s

3½

area

atrum

ntercosta

begns

cervca

et

ABR/McM

eart

ts

occurs

te

about

woud

te

he

cav-

torax.

esopagus

te

199;

space,

Wen

to

esopagus,

constrctons

sternum.

constrctons.

superor

nto

C.

are

at

te

esopagea

B.

N

o

manubrum

paryngoesopagea

wc

o

he

constrctons.

A.

128;

sternum.

te

constrcton

apex

pusatons

223–226;

openngs

ocated

he

to

esopagea

posterory

ntercosta

structures.

GAS

D.

anteror

te

trd

passes

abdomen

te

o

he

and

48.

neror

te

Fig.

atrum.

vena

n

burcates

tereore

atrum.

47.

glands

te

s

o

regon

184

eart

are

mportant

te

o

anteror

eart

te

aspect

ready

to

as

t

rgt

o

te

vewed

understand

rests

n

te

ventrce

eart,

s

tus

80

C H A P T E R

it

is

2

te

Thorax

most

anterior

portion

o

te

eart

witin

te

E.

torax.

B.

he

et

border

he

apex

rory,

and

o

but

te

t

et

s

occupes

ventrce

ocated

tte

area

s

aso

atera

to

compared

ocated

te

wt

ante-

or

sternum

te

second

o

te

ntercosta

sternum

auscutaton

o

s

te

space

te

near

ste

te

cosen

pumonary

vave

atera

typcay

(GAS

Fg.

3.110).

GAS

rgt

208,

238;

N

217;

ABR/McM

184

ventrce.

C.

he

et

sde

and

ventrce

s

postoned

on

te

et

atera Answers

sgty

posteror

poston

n

te

51. D.

he

rgt

atrum

s

ocated

on

te

rgt

51–75

torax.

atera

B.

he

besde o

te

great

te

he

anteror

margn

o

te

et

atrum

s

posterory

n

te

inay

190–195;

N

235;

ABR/McM

he

et

s

it

ntercosta

space,

just

beow

te

joned

s

typcay

te

vave.

Atoug

best

te

ocaton

to

sten

to

ourt

mtra

vave

s

ocated

ntercosta

space

te

sound

s

best

just

to

te

et

o

te

coronary

snus

n

ts

wen

obque

reazed

must

ven

be

(o

Marsa)

protected

wen

o

te

et

perormng

“downstream”

o

cardac

te

eart,

ven

and

s

t

ocated

aso

on

drans

te

posteror

nto

te

coro-

snus.

ster-

he

sma

cardac

ven

drans

bood

aong

te

same

rom

he

rgt

ower

part

o

te

body

o

te

sternum

as

te

rgt

margna

branc

o

te

rgt

cor-

ocaton

o

te

trcuspd

he

anteror

rgt

second

ntercosta

space

near

te

rgt

o

te

sternum

s

te

typca

ocaton

auscutaton

o

te

aortc

dcut

to

ear

te

so

auscutatng

vavuar

drecty

sounds

over

te

manubrum

Auscultation

for

aor tic

s

not

a

te

and

atrum,

and

are

nterventrcuar

good

not

assocated

he

posteror

bood

(or

neror)

rom

many

ven

te

o

et

te

209;

N

222;

ABR/McM202,

203

Auscultation

for

position

pulmonar y

Pulmonary

Tricuspid

valve

Mitral

Auscultation

for

position

tricuspid

et

wt

ventrce

ventrce.

coce.

position

valve

rom

drecty

artery.

o

valve

Aortic

bood

dran

troug

mdde

GAS te

rgt

anteror

drans bone,

dran

vave.

E. s

vens

anterory

o

te

It

ventrce

atera

nto border

cardac

vave.

te he

artery.

s

D.

D.

te

vave.

te

C.

te

ven

mdde

onary B.

n

procedures.

he

pat te

termnatng

at

C. num,

ntay

(LAD)

te

nary te

by

hs

aspect mtra

patway

artery

et

A. nppe,

a

204

bypass A.

takes

torax.

atrum.

50.

ven

nterventrcuar

pos-

t toned

GAS

anteror

eart.

course, E.

cardac

sde

for

GAS

Fig.

3.110

valve

valve

Auscultation

valve

valve

mitral

position

valve

CHAPTER

52.

B.

he

anteror

nterventrcuar

ror

nterventrcuar

and

et

ventrces

artery,

and

LAD)

anteror

artery

(et

suppes

two

trds

ante-

te

o

GAS

rgt

te

53.

IV

septum.

A.

he

rgt

trce

and

suppy

C.

he

et

or

te

o

artery

te

and

suppes

eart;

te

tereore,

rgt

t

ven-

does

et

to,

vent r  c  e ;

te

t

co ron ar y

por ton

anteror

descendng,

maker”)

arses

ventrcuar

not

A.

ar te r y

o

supp  e s

cours es

s uc us

te

 e t

te

e  t

p os te ro r y

and

s up p  es

ventr ce

artery

suppy

o

to

te

snuatra

rgt

et

coronary

B.

neror

ror

nter ventrcuar

arses

about

85%

rgt

teror

( GAS

rom

o

or

te

peop  e

asp ect

o

t rd

o

Fg.

artery

(usuay)

and

does

te

p os ter or

r  gt

( t s

patt e r n )

bo t

 nte r ve ntr  cuar

a

not

s

and

re e rre d

supp  e s

ve ntr ce s

an d

 n te r ve ntr cuar

to

te

te

as

C.

right

n

coronary

rgt

he

w

A V

be

et

tat

ave

norma

artery,

artery

te

to

85%

he

a

o

s



I

bood

tere

ow

wdow

tere

s

te

rgt

occuson

peope,

neror

o

o

pattern.”

p os -

o

p o s-

nterventrcuar

s e ptum

D.

bot

he

ventrces

snuatra

coronary

coronary

te

upon

rgt

ndvduas,

domnant

suppy

(posteror)

rom

margna

te

by

eart

te

coronary

posterory .

and

It

to

and

te

A V

coatera

node

ts

s

te

artery

known

te

mgt

suppy .

nterventrcuar

coronary

suppes

noda

artery

n

artery

about

n

as

a

posteror

posteror

trd

artery

about

“rgt

aspect

o

s

supped

55%

o

te

by

te

rgt

auricle

ar tery

left

branch

coronary

ar tery

marginal

circumflex

branch

branch

atrium

branch

interventricular

of

left

ventricle coronary

Left

ar tery

ventricle

Diagonal

anterior

marginal

coronary

branch

ar tery

Inferior

branch

(posterior)

of

right

A

GAS

Fig.

3.78A

interventricular

coronary

ar tery

te

popuaton

ar tery

Anterior

right

I

septum.

of

Right

o

te

ar tery

Right

s

ow.

rom

rom

supped

crux

dependng

Left

of

“te

artery .

brances

tereore,

crosses

of

Right

203

branch

coronary

coronary

ncknamed

coronary

artery

Circumflex

Right

202,

compromsed.

noda

reduced,

85%

3 .78A ).

nodal

LAD,

st

te

Left of

w

margna

orgnates

Left

Sinu-atrial

or

te

artery;

up

( ne-

ar ter y

ABR/McM

ts artery arses rom te rgt coronary , as t does n

de sc e nd ng)

coronar y

222;

coronary

be

(poste r  or )

domnant

teror

s

ventrce.

he

ar ter y

node

rom

artery

rgt

artery

te

te

he

artery

and

atrum.

he

N

E. he anteror nterventrcuar artery (aso caed te et

occuson n te rgt coronary artery , te anteror nter-

ventrce.

crcume x

near

branc

E.

et

posteror

et

D.

apex

te

atrum

n,

margna

203–207;

81

Thorax

2

branch

of

interventricular

branch

82

C H A P T E R

2

(ony

Thorax

35%

coronary

rom

te

dominant,

sinuatria

noda

et);

it

as

woud

artery

wi

te

be

not

patient

is

predicted

ave

rigt

tat

norma

E.

he

te

bood

te

low.

D.

203–207;

Because

nant,

i

No

rom

way

te

undergo

e

w

atera

o

te

B.

he

C.

he

not

be

s

80%

and

to

ar ter y.

ave

te

ow

or

te

patent

bypass

te

substanta

te

two

n

are

ar ter y,

does

A.

not

major

o

and

o

C.

tere

are

wt

suppy

o

et

to

arteres

anastomoses

musces

afected

bood

coronary

te

vave

artery

snuatra

not

between

trcuspd

coronary

te

are

node

end

bood

mgt

or

tem.

occuson.

woud

GAS

58.

not

suppy

o

not

by

a

te

be

regon

o

adequate,

branc

o

te

or

te

t

AV

node

coud

55.

A.

rgt

te

coronary

he

mtra

B,

C,

toe.

sound,

E.

D:

to

he

S2

aortc

to

202,

te

S

203

eart

1

sound

B.

aso

pumonary

be

aso

eard

produced

corresponds

woud

vave

best

and

sound

vaves

cor-

durng

wt

te

S2

ony

te

et

wt

te

ower

S1

D.

sterna

56.

C.

he

te

wt

n

s

te

ABR/McM

dsrupted,

upper

nner vaton

band)

as

o

te

and



o

o

to

te

wt

porton

compromsed

vave

connectons

hereore,

te

te

te

te

201

system

o

te

narcton

septum,

w

be

w

te

be

drecty

afected.

A.

B.

he

ventrce

and

attaced

to

he

aortc

between

nvoved

D.

he

et

D.

vave

vave

et

vave

atrum

assocated

and

wt

artery

nterventrcuar

drecty

mtra

ound

pumonary

te

te

s

s

a

an

et

te

and

te

AV

s

te

not

and

rgt

ventrce.

drecty

vave

aorta.

tat

It

ound

It

s

nterventrcuar

s

not

septum.

between

not

es

te

ntmatey

septum.

o

conus

ventrce

were

te

trunk.

te

tat

conus

anteror

anastomotc

trcuar

and

ventrce

trce

except

ventrcuar

rom

te

te

o

wt

eart

ear-

te

wt

are

o

S1

te

spe-

ibers)

and

et

tat

bunde

afected,

bunde

ts

eads

to

s

te

ventrces.

branc

branc

woud

system

ventrce,

s

s

te

be

rgt

s

gven

s

nto

a

eads

and

te

does

te

(posteror

et

not

n

n

to

o

mus-

conduc-

regon

te

rgt

conus

arte-

part

o

te

(nundbuum)

te

pumonary

upper

as

anteror

te

suppy

a

artery.

atrum

rgt

o

n

ven-

nter-

arter y

cases

surace

sma

nterven-

et

te

porton

(posteror)

unusua

te

roo

te

rom

descendng)

or

o

coronary

neror

bot.

te

cardac

usuay

suppes

ter-

afect

ere.

te

te

te

sec-

te

201

nto

suppes

arter y

not

superor

cone

n

atrum.

of

around

te

m-

ibers

woud

rate

ocated

te

be

greater

n

nvoved

wt

passes

te

specazed

ventrce

o

to

woud

Purknje

ABR/McM

vave

crcumex,

crcumex

ventrce.

o

and

artery

wen

be

correct.

coecton

patway

courses

and

be

S2

stated

dysuncton

not

229;

branc

te

(as

T ermna

one

wa

tapers

crcumex

eart

sound.

rgt

decrease

connecton

(LAD)

he

a

ts

yet

s

regon

rgt

S1

cannot

assocated

actvty

o

to

pumonary

hs

not

bunde

conus

and

t

(Purknje

bot

group

N

te

s

bunde

and

a

2

vaves

201

conducton

septa

artery

he

or

ventrces

te

artery

rosus.

A.

nterventrcuar

vave

rgt

septum.

semunar

ventrce

wt

s

between

he

coronary

o

pumonary

s

211–213;

59.

te

et

serve

GAS

pap-

to

tat

2

correate

te

wt

s

ventrces

nternoda

n

septum

vave

node

S

ventrce.

secton

atrum

S

te

nvoved.

eart

te

ventrce.

te

te

n

woud

assocated

ces

eectrca

o

201

wt

wt

s

not

Hs)

ventrces,

deep

myocarda

trcuspd

te

ton

sde,

and

nter-

pumonary

cannot

S2

to

199,

tereore,

s

s

rgt

rgt

ntmatey

septomargna

muscuar

AV

(o

te

sma

ces

te

spttng

and

ABR/McM

te

posteror

he

vave

bot

et

te

rgt

ce

to

part

a

answer

njury,

rgt

anteror

eectrca

a

te

s

on

nter ventrcuar

te

200,

septum

trcuspd

(moderator

musce.

eart

te

muscuar

trabecua

ar y

225;

nter ventrcuar

nvoved

va

N

he

wt

neror

cava

vave.

vave

suppyng

te

te

o

mna

ncorrect.

corresponds

aong

to

tons

E.

207–209;

njury

transmt

das-

border.

GAS

An

ts

actvty

to

to

and

assocated

musce

o

A

sound

abnorma

brances

mted

s

226;

Because

njury

ted

aortc

eart

tereore

sound,

ABR/McM

corresponds

vave

trcuspd

eart

222;

S2

mtra

bunde

ste

ts

tereore

an

N

eectrca

An

systoe.

he

te

and

he

vave

durng

and

respond

N

te

cardac

ogca

te

vena

assocated

assocated

trcuspd

o

s

systoe;

te

vave

and

AV

bunde

A.

203–207;

produced

he

brances.

st

ony

but

208;

cazed

artery.

GAS

C.



ABR/McM

aortc

n

s

occurrence

woud

o

assocated

dastoe.

te

n

he

vave

neror

smutaneousy

tereore,

E:

n

vave

sound

carry

mgt

supped

and

eart

not

224;

produced

aortc

er);

s

te

te

vave

deect

mtra

sound,

brances

N

tat

cosng

possbe

he

co-

It

produced

deectve

D

te

a

or

septum.

ndcates

sound,

occuson,

type

sound

he

by

nadequate.

be

atrum.

pumonary

not

wt

vave,

between

211–213;

he

sound

ow

coronar y,

B.

eart

ar ter-

coatera

et

et

bot

crcumex

or

te

I

any

between

n

o

57.

coronar y.

papary

he

ound

rgt

GAS

domi-

nter ventrcuar

rom

remove

to

203

ar ter y

occusion

avaabe

(posteror)

202,

coronar y

deicences

derved

brances

be

et

to

crcumex

arteres,

E.

be

unabe

et

he

is

ABR/McM

nter ventrcuar

crcuaton

A.

be

wi

surger y

be

222;

70%

neror

woud

o

is

possbty

te

t

N

patient

tere

anteror

es.

as

te

tere

coronar y,

te

s

ventrcuar

GAS

54.

Eustacan

cava,

arses

wc

te

rgt

CHAPTER

B.

he

anteror

rgt

and

trds

o

te

coronary

te

C.

ror

he

rgt

trce

60.

D.

o

but

ventrce.

202–209;

node

AV

gone.

a

te

he

dense

rgt

area

mtra,

te

It

et

A.

not

o

te

surace

B.

I

poste-

suppy

te

te

te

upper

porton

te

C.

te

ABR/McM

Hs

s

a

(Purknje

passes

trgone

and

202

strand

ibers)

troug

connectve

trcuspd,

te

te

o

te

te

o

tssue

specazed

tat

arses

rgt

(centra

aortc

te

ibrous

ibrous

tat

vave

rom

E.

tr-

nterconnects

rgt

tese

structures

tey

he

are

s

nnervate

E.

he

o

te

trca

te

et

n

AV

bunde

brances.

afect

te

(o

Hs)

Damage

respectve

to

te

ven-

s

a

coecton

node

o

to

te

o

et

conductng

ibers

and

patway,

prncpa

between

te

aso

known

patway

snuatra

o

as

te

eec-

node

A.

and

N

B.

227;

ABR/McM

he

te

torax

trce

woud

because

t

most

s

key

adjacent

an

201

I

te

rgt

irst

to

anteror

afect

te

te

deep

njury

rgt

surace

to

ven-

o

he

be

drecty

ateray

C.

to

te

as

t

te

et

s

ventrce

ocated

rgt

woud

posterory

rgt

rgt

be

wc

compressed

answer

by

woud

part

not

he

te

ave

te

and

E.

he

cardac

been

w

most

tamponade,

te

rgt

te

atrum.

GAS

64.

B.

he

vave)

pressures

o

o

tan

et

te

eart

trauma

he

to

apex

drecty

GAS

te

and

te

o

he

afected

tssues

ar

septum

up

woud

not

et

by

N

components.

te

be

posteror

afected

by

ts

n

anteror

woud

aso

ts

drect

and

not

be

and

(o

Hs)

rgt

o

te

and

anteror

o

te

(posteror)

commony

te

rgt

a

o

artery.

202

crcuaton

te

et

nter-

branc

coronary

ABR/McM

et

nterven-

te

brances

artery

and

means

neror

tat

(poste-

aspect

o

ventrce

te

conus

suppes

eart

and

te

s

s

com-

supped

by

branc.

rgt

ventrcu-

artery

domnant

rgt

part

o

were

occuded

eart),

t

ventrce,

part

te

o

te

te

posteror

woud

SA

(n

a

afect

and

AV

nterventrcuar

aspect

o

te

et

rgt

an

he

artery

but

coronary

o

N

te

and

s

regresses

cause

or

cava

arse

can

te

222;

te

neror

most

not

aso

vena

vave

s

to

o

but

bood

ocated

te

as

brances

202

cava

te

unctona

postnatay

between

arse

ABR/McM

remnant

a

commony

(et-anteror

crcumex.

neror

obstructon

trcuspd

suppes

nterventrcuar

embryoogc

eart

vave

can

arteres

anteror

et

artery

ventrce.

(Eustacan

deveopment

vave.

rarey

perssts

ow.

beow

rgt

T ypcay,

t

te

atrum

neror

and

rgt

ventrce.

ABR/McM

case,

most

anteror

septum,

te

nterventrcuar

posteror

203–209;

vena

njury.

ts

te

te

vave

s

te

aspect

A.

ventrce

235;

afected

and

cardac

makes

sternum.

te

190–195;

D.

oter

atrum

te

bunde

trd

suppes

et

margna

o

te

te

hs s due to te act tat te rgt atrum as ower

he

part

posteror

nterventrcuar

neror

o

222;

te

dagona

rom

eart

nodes,

te

bocked,

AV

afect

most

posteror

and

rgt

margn

ventrce.

o

te

domnant”

atrum,

te

o

but

s

coronary

descendng)

njured

N

coronary

been

correct

E.

afected

reatve

o

were

are

te

artery

o

o

I te queston dd not ask wc part o te eart as

key

D.

margn

agan

woud

ventrce.

D.

obtuse

o

t

a

wa.

septum,

te

sternum.

B.

and

(posteror)

artery

ree

nodes,

hereore,

AV

and

crcumex

segment

he

neror

te

ventrce.

and

ventrce,

posteror

he

artery

coronary

o

rgt

occuded,

et

(n

septum.

et

arteres

coronary

A. he sternocosta surace o te eart conssts mosty

te

SA

ar ter y

woud

te

artery

prmary

ar

umans.

211–213;

were

te

afected

nter ventrcuar

t

203–209;

crcumex.

posed

nternoda

te

et

te

(posteror)

septum.

termna

“et

be

ror) nterventrcuar artery as a termna branc o te

to

atrum.

s

A

te

atrum

ibers

C.

anteror

afected.

occuded,

GAS

63.

te

domnance,

ventrce,

and

te

be

trcuar

et

nterventrcuar

wt.

snuatra

patway,

node

ony

coecton

actvaton

GAS

te

bunde

Bacmann

ony

posteror

hore’s

AV

woud

rom

te

septum,

et

assocated

bunde

runnng

and

and

o

neror

ventrces

rngs.

atrum,

burcaton

woud

were

body)

o

I

te

artery

coronary

atrum

ventrcuar

nterventrcuar

nto

coronary

coronar y

et

o

bocked,

eart).

nterventrcuar

et

area

were

domnant

rgt

te

artery

woud

posteror

o

I

porton

ventrce

rgt

cuar

spts

et

rgt

te

part

ven-

o

and

coronary

afect

coronary

rgt

proxma

artery.

crcumex

assumng

o

rgt

o

te

atrum

artery

te

te

coronary

B.

62.

I

suppy

rgt

and

does

by

nterventrcuar

A and C. Ater reacng te upper porton o te mus-

trces

61.

223,

ibrous

o

supped

ventrce.

branc

o

ibers

and

by

te

two-

ventrce.

ventrces

rgt

reac

of

specicay

nterventrcuar

et

bot

gven

rgt

suppes

anteror

two-trds

N

bunde

te

s

te

not

septum.

te

not

GAS

AV

IV

o

does

musce

te

and

suppy

cardac

s

te

rgt

he

o

margna

can

It

does

(posteror)

rgt

porton

artery

and

artery

and

septum.

porton

te

trd

upper

E.

IV

neror

suppes

ventrces

artery

upper

he

nterventrcuar

et

83

Thorax

2

204,

te

ventrcuar

208

nterventrcu-

wa,

are

mosty

C.

he

s

a

vave

o

te

semcrcuar

snus.

coronary

od

at

snus

te

(hebesan

orice

o

te

vave)

coronary

84

C H A P T E R

D.

2

he

septum

tat

he

and

et

ossa

septum

A.

s

an

snge,

embryoogc

prmtve

structure

atrum

nto

68.

a

prmum

he

embryonc

and

septum

ocated

remnant

pace

between

te

o

te

ascendng

rgt

and

A.

196–197;

N

224;

termnas

cava.

te

posteror

te

SA

gn

o

B.

and

te

ABR/McM

s

nodes.

pectnate

orgn

wt

te

o

rgt

a

201

muscuar

tus

cava,

provdes

patway

he

crsta

musces

te

B.

rdge

te

o

s

crsta

vave

s

between

te

(o

tat

te

rgt

a

ocated

te

by

te

he

E.

te

answer

A.

ng)

rgt

B.

he

cava

s

ment

E.

te

and

AV

D.

N

remnant

space

vena

C.

neror

o

he

te

sxt

tat

est

s

trange

were

not

used

o

te

deveop-

way

te

too

o

neede

te

o

te

te

et

nserted

it

or

because

te

n

te

wa

trd

o

te

s

an

GAS

C.

he

et

anteror

a

and

toward

transverse

cross

A.

he

N

te

he

ice

216,

et

apex.

ncson

aurcuar

It

n

an

o

to

and

te

ts

ts

A.

are a

te

ABR/McM

snus

(LAD)

more

o

te

aye rs .

B.

percardum,

o

he

te

E.

et

et

and

s

he

et

between

vena

cava

C.

to

wc

be

ung,

just

deep

to

es

anteror

be

sympatetc

between

rgt

to

njured

trunk

s

te

n

te

root

ts

aso

o

not

s

185–189;

222;

ABR/McM

C.

be

cannot

be

be

accessbe,

ready

avaabe

196

parae

wt

te

(posteror

te

passes

are

te

a

222;

ne-

descend-

coronary

to

te

parae

severa

rgt

wde

n

snus.

anteror

wt

te

venous

te

sma

vens

atrum.

canne

posteror

by

ABR/McM

artery

artery

part

tat

o

te

198

burcates

(LAD)

branc

suppes

gves

te

nto

and

te

of

te

atera

te

ante-

crcumex

et

mar-

wa

(obtuse

nterventrcuar

septum

ventrce.

part

by

o

te

AV

or-

not

be

at

eart

te

and

te

our

s

and

te

anteror

ung,

surace

neror

te

nterventrcuar

artery

rgt

te

o

part

by

rgt

ventrce

s

nterventrcu-

a

branc

o

te

o

te

n

known

porton

te

as

te

te

conus

rgt

cases

(posteror)

a

branc

o

arte-

ventrce.

nterventrcuar

neror

most

o

septum

nterven-

te

rgt

artery.

node

te

crux

te

margna,

aso

outow

202–209;

AV

o

(posteror)

artery.

artery,

N

s

rgt

o

cardac

te

A.

te

posteror

he

branc

posteror

196

s

rgt

N

et

supped

GAS

71.

te

222;

ABR/McM

most

coronary

eart

cambers

198

commony

artery.

(te

pont

posterory);

supped

hs

o

branc

juncton

ts

s

te

by

a

arses

o

a

ocaton

occuson.

he

rgt

atrum

s

supped

by

te

rgt

coronary

artery.

B.

to

he

rgt

atra

D.

N

to

coronary

trcuar

s

be

ncson.

too

may

parae

vens

nto

nundbuum,

he

woud

atrum

woud

njured.

GAS

E.

by

o

nerve

cannot

snus.

be

nto

s

ven

snus

wc

te

artery

rosus,

te

ncson.

te

not

run

ven

dapragmatc

he

es

njured

woud

and

cavae

arteres

trunk

drecty

crcumex

supped

ar

196

artery

et

t

ongtudna

s

neror

prenc

too

he

coronary

te

vena

ABR/McM

vens

coronary

supped

artery.

tereore,

acces-

groove.

anteror

he

It

pe rc ar-

vertcay

easy

not

snus.

w

219;

cardac

et

branc,

o

are

artery.

nterventrcuar

s

and

artery.

207-209;

et

he

easy

trunk

(LAD).

afected.

D.

N

drecty

rom

margn)

ow-

ntercosta

musc e

descends

be

appendage

anteror

coronary

and

210;

can

posterory;

njured

coronary

gna

percar-

at

pe r  or m ng

nterventrcuar

perpendcuar

ocated

B.

to

te

he

rgt

185–189;

anterory

anteror

dran

branc.

ungs.

arteres

to

snus.

cardac

tat

ror

poston.

o

 or

or

are

cava

drans

he

he

surgeon

vens

nterventrcuar

margna

GAS

D.

percar-

great

snus.

transverse

pumonary

vena

cardac

sma

coronary

sxt

spaces

peura

dranng

 ac k

ocat on

s

70.

toracc

ence

a

E.

two

pumonary

coronary

te

cardac

and

great

neror

et

transverse

artery

runs

ntercosta

to

superor

s

cava.

border.

aus c u taton

tere

dea

n

vena

docentess.

67.

te

(posteror)

rgt

te

transverse

and

185–189;

he

201

cncay

njury

anatomcay,

be

or

sevent

penetratng

woud

back

not

efectve

by

pont

he

s

are

most

space

neror

te

sterna

and

keood

dum

te

ABR/McM

process,

at

ncreased

he

and

224;

percardocentess,

ocatons

E.

te

D.

orice

xpod

ntercosta

C.

o

eart.

196–197;

Durng

beow

A

vave

embryoogc

te

rgt

GAS

B.

o

or

he ostum o te coronary snus s ocated between

te

66.

an

vave

te

pumonary

and

nterventrcuar

Eustacan

aowng

transverse

troug

mdde

he

ventrce.

D.

te

he

ror

neror

and

rgt

GAS

69.

coce.

te

atrum

ter-

transverse

te

upon

et

te

te

superor

va

crsta

va

Atoug

or-

assocated

te

beow

rgt

between

and

superor

accessed

aurce.

musces

better

C.

camp

troug

accessed

by

tus

te

bend

aorta.

rgt

he

runs

taken

provdes

provded

s

pat

hore)

aso

pectnate

aurce

trcuspd

vena

rdge

nternoda

he

he

hs

AV

mnas,

C.

he

troug

drecty

eart,

vascuar

sbe

crsta

vena

a

passng

passes

te

te

secundum

o

rom te openng o te superor vena cava to te ne-

ror

inger

snus

extng

an

septum,

A

da

atrum.

s

D.

atra.

GAS

65.

te

ovas

nteratra

et

prmum

separates

rgt

E.

Thorax

he

te

coronary

artery

aso

suppes

te

snu-

node.

et

et

margna

ventrce.

artery

suppes

te

atera

wa

o

CHAPTER

E.

he

anteror

tum

s

porton

supped

by

o

te

te

nterventrcuar

anteror

sep-

B.

72.

C.

he

irst

trcuspd

A

and

by

eart

and

B;

te

Any

C.

211–214;

D

mtra

cosure

pumonary

o

A.

he

vaves

te

B,

aortc

C,

by

second

te

mtra

vaves

he

eart

t

tat

passes

A.

240;

It

75.

B.

he

n

hs

te

s

te

be

GAS

77.

ncorrect.

by

te

te

and

eter

s

to

te

tat

vaves.

o

Any

A.

and/or

te

o

irst

te

o

B.

anteror

branc

tssue

o

o

te

burcaton

n

C.

eart;

o

superor

vena

rom

neror

vena

snus

obque

o

te

te

snus

not

not

area.

be

suppy

te

obque

snus,

provde

access

o

te

w

access

A.

above.

to

te

nto

eart

te

s

GAS

B.

not

rgt

atrum

can

be

to

papabe

as

C.

t.

212;

76.

D.

access

to

te

posteror

exsts

as

neror

a

cu-de-sac,

rgt

son,

ven

tacycarda,

dstenton.

s

aso

be

accessed

ABR/McM

w

va

te

Beedng

to

between

“dstant”

tcuary

A.

eart

severe,

appearance

here

on

w

opposed

ar

te

eart

nto

vens.

to

sounds.

te

an

be

cest

eart

wa

by

sounds,

te

and

Wen

may

ypoten-

and

decrease

n

te

not

In

suc

smpy

provdes

cases,

or-

(posteror

t

provdes

coud

resut

suppy

s

n

poor

nterventrcuar

artery

and

dysuncton

or

absent.

artery

woud

comes

not

be

scenaro.

artery

comes

woud

not

artery

of

be

te

et

coronary

nvoved.

woud

not

be

mpcated

margna

artery

s

a

branc

o

te

rgt

artery.

N

223;

tendneae

musces

take

o

te

on

te

eart,

efuson

a

“water

to

ABR/McM

198

are

cords

ibrous

vave

eaets.

tat

he

con-

restrant

he

s

o

A.

as

jugu-

s

a

neror

rgt

rom

tat

nto

prevents

te

rdge

vena

ventrce

te

rest

musces

et

tat

cava

s

tat

o

te

are

ead

(coud

o

be

paced

te

te

pro-

atrum.

runs

to

rom

te

a

te

superor

muscuar

separates

te

strp

conus

ventrce.

parae,

rgt

answer

near

musces

hs

te

vena

mtra

cava

answer

s

hs

tat

vave,

answer

cocepac

tures

tat

s

s

be

rgt

n

not

passed

te

wc

te

t

entered.

te

rgt

et

It

does

one

It

sde

does

one

ncude

between

o

aso

o

sts

te

ncude

te

sts

te

ncude

o

aso

te

te

eart.

t

s

on

s

com-

be

cava,

vave.

et

because

as

more

woud

ventrce.

entered.

wc

are

t

vena

does

be

ventrce

bracocepac

case

be

ncorrect

ven,

must

s

ven,

must

te

trcuspd

ncorrect

wc

t

must

wc

bracocepac

structures

rgt

as

myocar-

200

te

superor

and

and

s

wc

ncorrect

vave,

to

o

ventrces.

pacemakers

n

ven),

wc

rdges

te

ABR/McM

eads

et;

et

vave,

s

atrum,

225;

tat

or

te

trcuspd

hs

rreguar

wtn

pacemaker

bracocepac

te

C.

N

pat

on

are

present

195–200;

superor

B.

carneae

are

correct

rgt

par-

vens,

musces,

cusps

supraventrcuars

te

T rabecuae

te

botte”

te

te

pectnate

mtra

juguar

papary

vave

termnas

o

crsta

or

cavty

eadng

te

cava.

he

he

x-ray.

dmensons

o

mtra

crsta

GAS

juguar

percarda

te

anteror-posteror

dstenson

reers

artery

nterventrcuar

artery .

bockage

202–209;

te

he

D.

woud mule te eart sounds because o te ncreased

dstance

o

mony

196

caracterzed

muled

w

A V nodes. It mgt be antcpated

coronary

papary

atrum,

tamponade

car-

184

crcuaton”

coronary

coronary

cordae

dum

pumonary

76–100

Cardac

durng

ypotenson.

artery

ABR/McM

coatera

aso

overa

carotd

(posteror)

ts

be

n te atra wa tat make up te atra appendage.

et

Answers

he

ven

N

gradua

scenaro.

arterosus

te

snus.

184–188;

n

rgt

wtn

snus.

79.

obque

he

vena

rgt

and

ven.

he

et

ts

223;

anteror

and

openng

198

E.

wc

a

dastoe.

dstnct.

rgt

crcumex

he

apse

emptes

provdes

aso

D.



et

contracton

area

atrum.

he

node,

te

he

nect

mp-

produce

durng

sgnicanty

w

domnant

coronary

dsta

GAS

report.

obque

cava

N

te

neror

coronary

arterosus.

scemc

expaned

aspect

provdes

et

te

ABR/McM

cava

superor

papabe

he

he

224;

as

ncrease

here

nterna

coronary

A V

he

n

te

78.

not

provded by tese cords on te vave eaets, aong wt

patoogy

N

conus

woud

does

ncorrect

he

te

artery

te

artery

te

area.

artery

te

s

te

n

te

tat

nvoved

D.

mpcated

act

of

201

branc

w

ventrces

ncreasngy

coronary

rgt

te

ncorrect.

suppes

noda

202–206;

on

and

o

descendng)

o

caused

trcuspd

ABR/McM

s

“Rgt

or

not

184–189;

E.

gn

201

cosure

eart

mtra

te

be

Puses

vaves.

and/or

w

tamponade.

become

Hs).

scemc

GAS

wa

E.

dac

caused

aortc

te

suppy or te SA and

by

pont

(o

te

be

conductng

te

sound

pumonary

caused

(LAD)

te

to

noda

answer

obque

D.

o

vaves.

222;

artery

not

AV

drecty

C.

s

trcuspd

N

snuatra

he

atrum

A.

cosure

222; ABR/McM

peroratng

bunde

descrbed

E.

N

tereore

artery

woud

cated

C.

pressures

he artery o te conus s a sma branc o te rgt

coronary

B.

and

eter

sound

ncudng

suppes

AV

sound

te

septa

te

eart

tereore

240;

irst

drecty

common

aortc

pumonary

nterventrcuar

LAD

19,

o

by

o

he dference between systoc and dastoc artera

198

E.

ncudng

woud

208,

irst

caused

second

woud

he

coce

GAS

D.

E:

cosure

answer

74.

and

D,

he

te

coce

s

ABR/McM

vaves.

E.

GAS

73.

229;

sound

and

answer

N

tamponade

enargement

artery.

GAS

Cardac

nterventrcuar

85

Thorax

2

te

eart.

te

irst

irst

bra-

struc-

86

C H A P T E R

E.

2

hs

answer

mtra

et

A.

te

a

stenoss

ventrce)

wc

B.

vave

es

to

efect

t

te

ncudes

et

to

turn

ABR/McM

et

on

vave

ead

n

drecty

atrum

te

C.

here

and

te

atra

te

et

enargement

mpnge

posteror

to

o

daton,

between

o

et

wc

te

and

et

te

can

Stenoss

atrum

upon

te

Bood

205

esopagus.

o

et

C.

T o

be

atrum,

paced

woud

atrum.

mdaxary

tebra

he

ce

upon

o

w

te

te

te

aortc

and

and

o

vave

ocated

n

o

te

bood

(LAD)

(posteror

no

anteror

A

torax.

et

troug

systemc

ave

te

te

between

nterventrcuar

nterventrcuar

woud

because

trunk

Regurgtaton

decrease

Anteror

(posteror)

s

aorta.

utmatey

E.

esopagus

pumonary

vave

te

pumonary

D

and

and

ow

neror

te

artera

paga. In te norma poston o te eart te et atrum

te

he

reac

best

C.

he

te

event

199

cest

ungs,

n

pont

o

nnt

ntercosta

tube

te

entrance

8

spaces

and

10

10,

and

or

te

space.

at

te

recess

and

and

tube

At

8,

te

at

s

te

paraver-

12.

sxt

too

6

soud

costoda-

costodapragmatc

and

be

a

rb

g

spaces

up

to

aong

reac

te

te

cos-

te

and

twet

s

between

te

mdaxary

spaces

peura

and

too

tent

rb

N

s

221;

ABR/McM

nnervated

202–209;

N

228;

node,

ABR/McM

te

prmary

204

peura

pacemaker

o

te

eart, s a mass o specazed cardac ces wtn te myo-

A.

to

openng o te superor vena cava nto te rgt atrum.

he

AV

snus

and

trgone

B.

he

rgt

ng

eta

o

rom

atrum

so

te

tat

IVC

rgt

upon

can

te

te

B.

D.

vena

as

te

venous

et

ocated

E.

and

te

GAS

et

atra.

passes

ary

musce

band

carres

conducton

GAS

he

te

woud

atrum

o

N

te

rgt

te

just

s

te

o

ventrce.

AV

regurgtate

subsequenty

ncreasng

ayer.

D.

between

te

rase

capary

E.

rgt

oten

pressure

carna

rgt

he

ar

GAS

86.

D.

te

mtra

et

vave.

atrum

s

a

resut

o

proapse

back

o

te

te

A

a

object

as

to

to

need

to

s

te

be

penetrated

costa

te

be

pareta

costa

par-

nitrated

to

tat

191

sorter,

broncus.

wder,

hereore,

oregn

s

objects

not

w

163–179;

torax.

or

B.

hs

be

a

N

o

as

and

ts

w

s

key

vertca

s

te

and

n

tere

ABR/McM

most

s

by

keood

mnma.

woud

descend

209

vertca

mportant

pumonary

o

supported

te

(descent)

ntratoracc

orced

et

broncus.

dapragm

te

o

road.”

and

object

tertary

contracton

nvoved

openngs

te

structure

odged

ncreasng

nterna

he

a

te

n

rngs,

oregn

208;

te

decreasng

te

“ork

tubuar

tat

nerory,

and

a

separatng

te

obstruct

Contracton

usuay

rdge

s

unkey

ncreasng

ventrce

pror

peura.

te

ABR/McM

cartagnous

an

s

raton

nto

s

tat

woud be a resut o an ncompetent pumonary vave.

et

aso

reac

broncus

bronc;

It

Regurgtaton

te

trunk

215;

ocaton

tracea

B.

rom

pumonary

to

pacement.

penetrated

pareta

deep

not

broncus

prmary

he

Regurgtaton

bood

te

anestetzed

tube

anestesa.

prmary

te

et

A.

o

nto

to

es

does

N

man

and

dome

bood

163–174;

vertca

so

pressure

edema.

o

C.

te

ncompetent

nto

peura

and

ncompete

ocated

case

tereore does not present te pat o east resstance.

199

An

be

ts

peura.

must

costa

penetrated

adequate

rgt

he

pap-

o

must

n

odged.

B.

moderator

branc

endocarda

vave

ventrce.

anteror

he

bunde

ts

be

nterventrcuar

te

ABR/McM

to

and

system,

base

rgt

te

rgt

bood

o

beneat

229;

vave

systoe

venous

causng

te

and

aow

durng

te

and

atrum

porton

to

system

trcuspd

rgt

vave

n

part

211–213;

he

most

muscuar

and

A.

more

he septomargna trabecua (moderator band) arses

te

peura

aceve

85.

between

be

vscera

eta

bood

atrum

te

be

cest

pareta

musces

reacng

must

he

dur-

possbe.

asca

costa

must

or

pan,

186

nter-

peura.

troug

ovae

to

tat

to

te

he subcutaneous at s a reatvey superica ayer

(Eustacan)

cava

te

ntercosta

pror

ibrous

ayer

aspraton

endotoracc

he

coronary

rgt

oramen

reac

s

cava

umbca

soon

septum

te

deepest

durng

reacng

tat

vena

neror

te

as

o

body).

toward

ead

nteratra

atrum

neror

te

septum

n

te

e,

juncton

ibrous

te

he

te

rgt

by

rom

D.

at

utmatey

and

E.

te

bood

te

carred

s

(centra

vave

drects

D.

node

te

pan

he

cardum at te upper end o te crsta termnas, near te

A.

s

reduce

senstve

by

beng somatc nnervaton. hereore, te costa pareta

snuatra

very

egt

be

Ideay

costa

he

s

may

recess.

ne.

241–242;

pareta

and

rb

costodapragmatc

ead to scema and possby myocarda narcton.

C.

nerves

n

recess.

tent

163–174,

costa

rbs

w

te

te

ntercosta

ourt

poston

aong

GAS

84.

he

ventrce

ungs,

o

between

ne

et

between

aorta.

es most posterory . An occuson o a coronary artery w

GAS

82.

E.

to

spaces

occusons can cause a myocarda narcton, but not dys-

81.

ne,

todapragmatc

vave

ow.

descendng)

B.

eve

or

ne

reatonsp

ascendng

ABR/McM

te

he

between

mdaxary

ventr-

any

and

te

between

ne

te

228;

egt

mdcavcuar

A

N

recess.

te

tract o te rgt ventrce and te pumonary trunk.

n

te

ncompetence.

damagng

beow

be

and

poo

196–198;

avod

anatomc

vave

vave

pragmatc

esopagus

drect

woud

ocazed

stenoss

no

aortc

GAS

83.

s

trcuspd

he pumonary vave s ocated between te outow

poston

D

because

between

229;

eads

(AV

woud

woud

efect

C.

s

E.

N

compressve

mtra

wc

ncorrect

wc

189–194;

Mtra

exert

s

vave,

ventrce.

GAS

80.

Thorax

pus

te

dmenson

actor

pressure,

n

o

nsp-

tereby

voume.

ntercosta

nspraton,

musces

resutng

s

n

CHAPTER

increases

sions

C.

o

in

te

te

transverse

toracic

Straigtening

woud

not

vertca

E.

a

te

as

and

dimen-

D.

spine’s

o

te

wou d

needed

orward

o

an

toracc

o

n ot

to

te

be

curvature

mpact

on

te

te

E.

cavty.

87.

B.

he

r b s

to

e xp and

sp e cic

nc reas e

orzonta

usuay

te

te

o

A.

here

C.

he

te

s

N

200;

issure

superor

extends

mdaxary

border

to

88.

 ns p  r ator y

o

ne

usuay

te

obe

meday

ourt

ABR/McM

he

to

rom

rom

te

rgt

ung

te

te

skn,

s

mdde

obque

sternum,

a

aong

issure

obe.

issure

te

It

A.

breast

no

orzonta

issure

n

ower

te

B.

et

D.

obque

by

issure

stab

o

te

wound

to

et

te

ung

rgt

woud

not

be

thoraco-acromial

Apical

axillary

axillary

gaments

thoracic

o

are

(o

nppe

Obstructon

cause

n

o

thoracic

not

be

are

a

axillary

Pectoral

dmpng

to

te

o

symptoms

o

te

retracton

passes

and

eta

sus-

tumors

dscarge

te

te

o

sow

breast

(GAS

cutaneous

o

state

te

nppe

symptoms

ump,

Fg.

ympatcs

nppe

and

breast

3.16).

te

woud

canges

d’orange.

artery

Pectoralis

major

muscle

node

node

node

lobule

ligament

Lactiferous

duct

Lactiferous

sinus

node

and

of

te

nverson.

enargement,

Retromammary

process

from

part

nam-

overyng

o

Parasternal Lymphatic

venous

lateral

the

and

breast

space

node

drainage

superior

into

axilla

Mammary

Areola

internal

Lymphatic

drainage

of

Secretory

the

and

of

artery

venous

passes

breast

branch

thoracic

from

medial

par t

parasternally

lobule

Some

may

lymphatic

pass

breast

GAS

Fig.

3.16

from

into

by

ncude

of

artery

to

186

artery

axillary

Axillary

afected

ndcatve

Suspensory

Lateral

eve

cartage.

Secretory

Lateral

a

Cooper).

nverson

peau

woud

ABR/McM

and

due

cancerous

pan,

costa

to

superor

torax.

patoogc

breast

reaces

tereore

Common

nante

cause

ncudng

and

ung

205;

nppe

Intraducta

seen

Internal

N

s

ourt

rgt

cancer.

tat

not

te

et

ung

and

symptoms

te

Retenton

not

cest.

branch

o

canges

n

te

163–179;

woud

rb.

to

rgt

rb

te

patent’s

pensory

at

o

wound

matory

225

Pectoral

Central

C.

te

irst

wound

root

GAS

te

ung.

afected

stab

he

o

te

nverson

163–166;

separatng

apex

stab

capacty.

GAS

he

above

e x b    ty

drectons

movements

anteroposterior

sgnicant

dmensons

Orentaton

n

o

ave

and

cavity.

87

Thorax

2

the

and

venous

inferior

part

abdomen

drainage

of

the

88

C H A P T E R

E.

2

Inlammation

woud

GAS

89.

C.

te

not

as

te

he

B.

he

E.

o

te

ta

A.

D.

rgt

apca,

he

o

ocated

te

wtn

are

aso

neror

e

at

o

to

man

bronc

nodes

N

212;

obar

run

besde

broncus

and

nodes

and

ABR/McM

broncus.

anteror,

te

te

and

mdde

obar

s

one

hs

e

te

te

superor

answer

mdde

atera

tracea.

E.

rom

te

answer

rgt

brances

cest

segmen-

A.

he

B.

he

as

GAS

and

ower

segments

obar

rom

atera

obar

and

te

te

rgt

o

rom

na

te

rgt

o

segment

as

arses

obar

ABR/McM

te

breast

specicay

to

rom

bronc.

s

te

axary

mb,

but

node

not

rom

axary

troug

receves

te

nodes

anteror

te

ymp

breast

receve

anteror

te

ax-

rom

A.

te

area.

B.

ymp

axary

ater

he

t

(pectora)

centra

te

axary

axary

anteror

axary

border

o

te

E.

he

posteror

not

rom

rom

edema

tectomy,

axary

GAS

92.

A.

te

o

te

n

emora

o

te

n

te

artery)

aorta.

mnor

trunk,

breast

upper

and

atoug

tere

s

tat

may

te

be

a

tota

N

te

ror

o

191;

te

ower

are

ABR/McM

braca

mbs

common

Oter

n

te

185

artery)

(as

and

ncude

o

n

coarctaton

tortuous

and

t

B.

due

s

and

to

te

te

te

rb

te

te

anteror

ar te -

n er or

vbraton

resuts

grooves,

ar ter y,

ntercosta

aor ta

rb

notc-

coatera

p os te ror

te

card -

reversa

toracc

carr y

and

coarcta-

wen

o

troug

n

wc

n

o

to

te

eroson

s

vsbe

It

A

B

a

o

can

be

voume

216;

D

seen

or

o

N

te

toracc

ventra

ram

Due

may

be

s

te

s

te

s

te

te

o

torax

but

nerve

ts

s

not

o

be

ar

ud

assoc-

toracc

toward

te

afectng

not

con-

oter

te

to-

assocated

wt

207

arses

rom

nnervates

ocaton

n

Injury

on

axary

o

te

ts

te

C5,

serratus

te

atera

dssecton

nerve

w

C6,

ante-

cest

durng

resut

n

scapua.

pectora

major

nerve,

wc

nnervates

musce.

nerve,

wc

nraspnatus

toracodorsa

dors.

o

assoc-

aorta.

suprascapuar

atssmus

be

aorta.

ABR/McM

wnged

and

not

poong

woud

condtons

and

to

atera

te

wa.

aorta.

and

o

toracc

coecton

woud

movement

n

njured

pectoras

te

pressure

197;

te

njury.

abnorma

space

coarctaton

one

and

o

to

s

o

abnorma

space

st

rest

traumatc

an

reers

supraspnatus

D.

One

nterna

te

ater

s

mastectomy.

te

te

symptoms

breat

occurs

descend ng

rom

peura

caracterstc

(as

decreased

demonstrated

symptoms

symptoms

mbs

te

musce.

radca

A.

upper

not

207

s

ar teres

coarctaton

ong

C7

wa,

a

pressure

he

and

remova

te

costa

peura

coarctaton

and

nodes.

o

caracterstc

aganst

te

seen

Medastna

GAS

mas-

te

wt

racc

C.

a

rbs

ow

o

te

detaced

wt

sde.

a

o

Hydrotorax

te

or

woud

woud

assocated

sy mptom s

Enargement

Pneumotorax

te

breast

s

te

troug

ar teres

s

to

ater

cava

sortness

constrcted.

sma

nto

usuay

s

nto

reason

occurs

artery

puse.

condton

bood

ow

It

tents

regon

ac

vena

emora

tese

hs

o

o

and

ated

E.

94.

ds-

most

Fa cest s seen wen a segment o te rbs breaks

wtn

nodes.

souder

hs

mb

te

receve

te

radograpy.

upper

nodes

be

eadace.

ABR/McM

brances

and

te

some

or

onset

sgns

coarctaton.

ated

troug

neror

an

abnormay

respratory

not

common

superor

or

aor ta.

bood

apca

passes

o

woud

commony

211;

usuay

he

to

(subscapuar)

area.

rom

passed

nodes.

ymp

posteror

artera

n

as

supracavcuar

wc

te

t

ymp

superor

nodes,

axary

141–142;

demonstrated

pressure

tese

ymp

Increased

ater

(pectora)

pectoras

enter

receve

ocated

ymp

may

ymp

are

From

subcavan

ymp

nodes,

axary

nodes

cavce.

nodes

Most

“Notcng”

wtn

C.

apca

te

abnormay

tese

on

nodes.

C.

s

ntercos ta

to

o

decreased

N

(“notcng”)

typcay

s

and

condton

condton.

rgt

sudden

drect on

te

212

aorta

compan

nosebeed

radograpc

ra

te

te

hs

pan.

te

ar teres

segments

be

ntercos ta

mdde

not

te

dagnoss

o

aor ta

broncus.

ower

209;

te

or

216;

he

ton

bronc.

basa

ncudes

rgt

N

more

centra

passed

rom

arse

D.

nodes.

atera

upper

te

dranage

nodes,

(pectora)

segments

arse

o

n

wen

pumonae

Obstructon

ng.

arses

ower

169–179;

underyng

woud

broncus,

ncudes

coce

mdde

obar

rgt

and

key

dvsons

or

does

cor

coarctaton

deveopment.

so

symptoms.

te

tertary

basa

segments

coce

and

patent

te

emorrage.

A pumonary embosm w not present wt tese

209

o

occurs

tress,

resut

above

cerebra

durng

account

broncus.

branc

Lympatc

ower

segment

hs

ary

D.

vesses

o

Dssecton

tracea.

broncus

posteror

meda

atera

rgt

axary

and

rgt

hs

he

C.

93.

meda

he

B.

not

te

rsk

coarctaton

ungs.

nodes

bood

constrcted

tracea.

te

(ar)

traceobronca

superor

GAS

D.

e

185

nodes

o

enarged

ncreased

bronc.

rgt

91.

are

ining

ere.

ungs.

juncton

superor

obar

E.

and

burcaton

nodes

141–142;

rom

C.

te

described

ABR/McM

nodes

o

paratracea

GAS

he

ste

superor

he

nto

o

te

B.

188;

epiteia

canges

broncopumonary

he

to

carna

te

nippe’s

te

traceobronca

pumonary

um

D.

te

N

neror

carna,

A.

o

produce

141–142;

he

known

90.

Thorax

nerve,

nnervates

te

musces.

wc

nnervates

CHAPTER

E.

E

is

te

95.

B.

te

major.

GAS

717,

by

cavcuar

te

ates

wt

ton

o

te

to

body

be

wt

o

te

nvoved

tat

innervates

musce

and

tumor

te

pac

at

wt

par

sterna

te

wt

are

o

body

te

and

juncton

drect

hey

te

are

traumatc

te

te

o

o

carac-

rbs

E.

too

manubrum

njury

most

to

te

wt

key

sterna

B.

he

o

te

te

148–153;

toracc

entre

duct

body

quadrant.

aorta

Daton

rom

a

eadng

beow

and

o

to

te

192;

s

ABR/McM

mportant

wt

he

te

tons,

ven

esopagus

poma

can

mparment

bockage

duct

ere

o

dranage

te

ascends

n

te

te

te

ympatc

resutant

hs

ymp

bend

compress

o

and

n

183

excepton

toracc

azygos

te

arge

N

upper

ower

n

te

C.

A.

D.

toracc

o

te

aorta

esopagus

to

produce

woud

not

symptoms

compress

o

ower

C.

Superor

by

cava

medastna

nicant

D.

vena

An

ower

aortc

cerous

occuson

tumors

mb

most

woud

oten

not

produce

and

s

B.

woud

assocated

not

cause

wt

ower

can-

egn

mb

A.

97.

C.

edema.

GAS

231–232;

arteres

costa

egt,

B.

he

tus

242;

not

o

te

o

part

o

E.

he

toracodorsa

GAS

he

may

suppy

toracc

axary

artery,

suppy

posteror

a

or

ower

compres-

wc

crosses

bracocepac

or

woud

atera

not

ABR/McM

be

to

ven,

ts

key

oca-

mpnge

oca

rb

te

regonay

and

peura

nto

cervca

topograpc

peura,

and

228

dvded

cervca

o

peura

nes

s

reatons.

te

cupua.

projectng

correspondng

por-

nto

to

te

te

area

or

upper

o

and

te

body

man

body

N

tan

s

222;

broncus

te

o

te

s

s

not

near

ocated

te

es

irst

n

rb.

between

te

216

sorter,

man

t

ocated

medastnum.

wder,

broncus.

more

(atoug

vascuar

s

nor

ABR/McM

et

et

not

peura

te

broncus

te

s

cavce

n

asprated,

enters

suraces

rb.

broncus

pareta

prmary

vertca

irst

rgt

organs

166–169;

nterna

broncus

te

obe

te

te

spaces.

manstem

cavce

rgt

157–158;

extend

nto

hs

D.

s

o

o

te

te

arteres

N

es

te

artery

te

ncorrect

not

s

n

key

some

to

and

Wen

enter

cases

te

a

te

or-

broncus).

resstance

s

not

reated

to

te

ante-

E.

he

not

rgt

venous

woud

GAS

as

te

rgt

man

broncus

s

te

rgt

man

broncus

s

narrower.

ncorrect

sorter,

nter-

provde

ower

passes

abdomna

artery

sevent,

arses

artery

o

a

nto

te

rec-

wa.

rom

branc

te

as

onger.

ower

ung

dranage

167–170;

tan

N

obe

te

215;

does

oter

not

ave

poorer

obes.

ABR/McM

221-222

101–125

D.

he

by

second

trd

o

te

part

sub-

o

te

221

medastnum

medastnum.

A

area

mdne

poston

as

te

superor

cava.

he

superory,

and

(on

te

arc

he

o

et

te

rgt

structure

o

te

rgt

s

o

te

and

just

ts

by

et

eart

s

as

seen

te

n

eart

atrum,

ormed

artery,

arrow

sde),

eart

and

te

a

pan

ormed

neror

aortc

aurce,

arc

et

ven-

neroateray.

neror

marks

te

to

te

he

cav-

ocaton

o

aorta.

superor

upper

cava,

border

apex

by

te

border

pumonary

te

te

o

rgt

vena

et

et

ndcated

ce

A.

and

norma

x-ray

te

vena

te

ABR/McM

superor

anteror

101.

trce,

s

205–206;

te

Answers

cest

artery.

branc

n

hs

wt

artery.

tymus

C.

226

spaces.

artery

anteror

atera

D.

cause

suppy.

epgastrc

te

he

axary

te

225,

Lgaton

te

ntercosta

D.

te

produce

anastomose

muscuoprenc

nnt

superor

arteres

arteres.

artera

ntercosta

seat

not

ABR/McM

afect

because

and

scapuar

98.

N

ntercosta

Brances

woud

ntercosta

coatera

anteror

dsease

woud

spaces

provde

to

ven,

medastna,

te

medastna

wder,

anteror

posteror

ror

A.

artery

mb

te

and

queston.

Femora

he

supe-

tymus

mdne.

dsta

can

upon

irst

Pumonary

edema.

E.

key

te

222;

ntercosta

rgt

oregn

rgt

not

N

dome

vcnty

he

more

sg-

s

ocated

te

mass.

rgt

n

ven

peura

te

rgt

GAS

caused

te

tymus

or

te

costa

he

mb

edema.

aneurysm

growts

and

s

ts

more

ocated

te

name

ungs

100.

bracoce-

t.

rgt

te

te

sweng.

not

and

he

E.

Daton

tan

220–222;

above

he

ower

mbs.

et

are

o

bracocepac

dependng

te

rom

s

s

vens

poston

by

dapragmatc,

he

duct,

dranage

et

pareta

rbs

torax

te

njury.

A.

esopagus.

toracc

edema

o

tumor

te

orms

neck

between

afected

and

Anoter

GAS

rgt

he

costa,

ange.

96.

B.

compress

juguar

te

subcavan

GAS

99.

to

mdne,

ton,

ow

be

o

he

te

can

nterna

mdne

upon

are

te

he

wc

sternum.

gand

atera

not

te

jont.

rbs

not

A

junc-

o

B.

son

artcu-

te

te

C.

rbs

ts

and

woud

sterno-

irst

o

ven.

and

ror

manubrum

it

o

s

ange,

sternocavcuar

sternum.

n

Lateray

te

144

manubrum

second

ourt,

te

ABR/McM

artcuatons

he

te

trd,

te

notc.

connects

beow

he

nteract

te

to

E.

194;

o

te

sternum

rb

sternum

D,

and

manubrum

irst

N

margn

juguar

te

nerve

subscapuaris

795;

manubrum.

te

he

te

A

jonts

wt

subscapuar

o

727,

superor

terzed

C,

part

teres

he

A.

ower

ower

89

Thorax

2

vena

cava

border

aong

te

woud

and

te

eart’s

comprse

arrow

et

s

te

eart’s

pontng

border.

to

a

90

C H A P T E R

B.

he

2

Thorax

rgt

anteror

C.

he

te

E.

et

he

A

te

ndcatve

s

cancer

ents

A.

as

en

a

o

D.

ow

s

a

more

woud

by

te

eart’s

nodes.

te

arrow.

te

neror

to

were

B.

hs

e

he

to

o

te

pysca

C.

208

te

D

queston

coce

o

condton

are

answers

tat

pres-

te

skn

by

exam

tat

indng

resembes

obstructon

axary

s

o

ymp

oten

a

an

B.

ym-

orm

and

not

an

hs

s

a

descrpton

pysca

o

te

condton

and

symptoms

not

best

n

te

depcted

GAS

A.

ment

a

o

tan

D

and

be

afected

te

E.

are

te

s

a

moton

sucked

n

nspraton,

he

on

move

n

te

drecton,

ractured,

norma

as

tey

“pump

te

N

subcavan

201;

o

by

ne

n

te

ner ve

and

w

not

ande”

to

be

es

to

gery

A.

moton

o

rbs,

te

not

B.

as

t

s

te

damage

meda

structure

wen

to

E.

a

te

key

superor

o

vena

cava

pacement

es

and

meda

s

too

he

E.

he

be

damaged

vagus

ment

carotd

by

te

nerve

and

s

s

not

artery

s

and

aso

o

be

ne

dam

B.

neror

to

be

to

A.

too

meda

to

GAS

A.

221;

Lymp

drans

ymp

drans

nto

key

to

te

be

ste

N

204;

te

te

ABR/McM

ower

o

ne

damaged

pace-

posteror

he

posteror

medastna

mdde

and

o

by

ts

D.

trd

superor

o

E.

te

and

te

esopagus.

ungs.

prmary

broncus

traceobronca

receve

ymp

woud

nodes.

rom

te

nodes.

nodes

ympatc

receves

woud

not

dranage

ymp

wc

paratracea

tat

te

artery

be

te

rom

te

rom

n

te

turn

bron-

receve

nodes.

spna

eve

to

rgt

orgn

o

ts

te

be

artery

as

coronary

te

artery

artery

but

ne-

(usuay

wt

can

pevc

woud

coud

an

te

ante-

durng

ts

o

s

to

ocated,

taken

unctons

parapega

are

anastomoses

soud

o

bood

specicay

neurons

coatera

Care

damage

to

o

Adamkewcz)

oxygenated

cord,

motor

ateraton

te

(o

provdes

ower

ead

to

te

to

te

sur-

ead

to

organs.

not

spe-

dsrupt

car-

et

ata

common

but

s

carotd

not

artery

specicay

coud

be

assocated

te

rgt

subcavan

artery

woud

not

parapega.

Iatrogenc

njury

key

An

to

o

te

produce

104–106;

enarged

te

et

atera

he

he

esopagus

et

he

esopagea

parapega

artery

as

an

s

aso

assocated

medastna

ymp

to

A.

y

he

be

n

te

and

w

ven

most

wc

key

es

com-

mmed-

neck.

s

subcavan

devaton

be

nerve

not

ven

as

es

key

neror

to

to

te

be

afected

by

artery

at

s

te

not

descrbed

nerve

s

w

eve

as

not

o

be

njured

by

key

te

to

tyrod.

be

afected

by

ere.

aso

not

te

most

key

struc-

afected.

173–177;

carna

seen

gand

juguar

devaton.

prenc

GAS

109.

t

gand

vagus

he

185

bracocepac

scenaro

ture

gastrc

esopagus

et

N

tyrod

nterna

to

et

tracea

228

trd

te

te

parapega.

Injury

te

rom

nodes.

nto

to

tracea

C.

to

o

uncton.

Injury

atey

easy

procedure.

105.

Injury

GAS

108.

ne.

meda

patoogy

trunks,

artery.

and

tyrod

common

receve

symptom.

ste

not

deep

not

traceobronca

o

nodes

provdes

prevent

not

ven.

to

and

produce

tat

pacng

aso

219

o

spna

wt

C.

posteror

superor

rgt

radcuar

potentay

patent.

drecty

most

w

except

receve

broncus.

vertebra

cicay

damaged.

D.

to

press

ste

te

parapega

190–191

subcavan

s

w

dapragm

not

esopagus.

dranage

neror

te

artery

were

T12–L1),

abe

n

duct

N

porton

ror

wa.

rom

great

rater

aged.

te

he

cord

drec-

cest

n

receve

prmary

183;

ror

opposte

broken

efort

tereore,

vunerabe

prenc

te

te

ABR/McM

artery

ven;

most

venous

sde

breatng

subcavan

he

D.

anteror

te

to

toracc

dac

excursons

eter

pacement

C.

he

ower

te

and

w

te

traceobronca

ste

mportant

expraton.

nodes

rom

broncopumonary

deep

and

te

te

paratracea

ymp

te

w

219

rom

comedastna

seg-

o

upon

enarged

nto

nodes

he broncomedastna trunk s not a ymp node.

nspraton.

he

he

w

area

wt

n

a

experenced

a

same

rbs

154;

centra

te

occurs

te

te

restrcts

be

he

rgt

107.

produce

paradoxca

outward

GAS

woud

B.

n

actate

durng

A:

s,

190–191

ractures

wa,

segment

not

Because

to

104.

tat

a

ton,

ABR/McM

rb

commony

movement

he

pan

s

expandng

reverse

C.

197;

toracc

segment

nspraton;

B.

N

mutpe

te

irst

neror

N

nto

esopagus.

nvoved

183;

GAS

143;

Wen

be

drans

he

queston.

103.

he

esopagus

D.

exam

te

te

C.

E.

aso

te

dranage

not

Lymp

irst

indng.

E.

rom

superor

mammograpy.

symptom

may

dran

nodes.

md

E.

are

GAS

A.

o

traceobronca

and

hey

trd

nodes.

broncopumonary

he

nodes

106.

pysca

tumor

by

to

upper

cervca

ympatc

n

best

nvaded

cancerous

neror

texture.

caused

troug

more

ABR/McM

patoogc

s

he

deep

he

arrow.

descrbed

reers

detected

a

e

te

ke”

texture

pee.

cancer

hs

by

224;

“wood

Intraducta

comprse

ndcated

ymp

cancer.

curasse,

abnorma

patc

C.

to

N

breast

d’orange

orange

woud

symptoms

ard,

Peau

o

o

aso

not

artery

ponted

195–198;

o

s

pontng.

pumonary

area

GAS

B.

s

woud

and

ventrce

arrow

te

102.

ventrce

surace

n

s

N

te

cest

199;

ony

ABR/McM

answer

x-ray.

he

218

sted

carna

tat

s

at

can

te

eas-

eve

CHAPTER

o

T4–T5

Lous]).

te

B.

t

to

s

he

and

not

as

pacement

as

wit

venous

artery

easy

vena

s

seen

cava

o

a

not

be

tey

s

a

a

not

centra

[o

E.

an

dea

and-

venous

113.

A.

ne

as

te

andmark

to

to

te

et

or

reaby

and

rgt

centra

seen

on

173–179;

N

Gynecomasta

mammary

A.

gands

Poytea

216;

s

n

ABR/McM

te

B.

vena

cest

o

supernumerary,

or

te

and

to

te

E.

C:

E.

A

breasts

condton—an

Amasta

GAS

111.

Supernumerary

same

reers

135,

tenson

to

te

141–143;

and

absence

N

190;

pneumotorax

s

o

reer

E.

by

o

negatve

ung

to

durng

s

not

wc

a

a;

be

tere

cest

te

ment

n

not

s

a

reers

s

o

te

114.

cnca

peura

te

reers

ractures

to

voume

te

produce

te

to

D.

condton

te

o

a

a

seg-

bood

wtn

assocated

wt

s

not

cavty.

te

te

duct,

B.

169;

duct.

te

et

N

te

te

he

subcavan

et

ven.

211;

s

te

ven,

C.

Injury

to

and

eard

B.

as

or

D

and

o

te

seen

produce

resut

Injury

o

te

tey

E.

et

A.

toracc

te

cavty.

orm

at

to

te

venous

ven

te

te

et

to-

to

B:

te

braco-

aso

o

C:

dsrupt

hs

rgt

to

te

ven

toracc

duct

ven.

not

as

te

resu-

o

te

superor

wen

se

es

n

te

n

to

upper

mbs.

carotd

artery

bood

nterna

as

pressure

juguar

n

se

eevated,

not

w

seen

vens

bood

n

w

press ure

woud

te

ungs

o

te

ne

te

ung

woud

and

to

At

ne,

efects

ntercosta

assocated

o T2

one

wt

tat

te

posterory

te

tereore

o

mgrates

te

sxt

be

anterory.

issure

budup

Remember

eve

mdaxary

te

usuay

due

te

ung.

te

to

ud

over

rgt

rom

due

he

sxt

woud

over

to

nter-

be

te

per-

ower

te

efects

ess

obe

o

queston

not

o

key

te

does

gravty,

to

be

rgt

not

te

but

ud

up

n

budup

te

upper

ung.

ndcate

any

examnaton

172–176;

N

ange

rgt

s

he

to

ventrce

et

o

and

too

adjacent

he

rgt

to

neede

woud

223–224

troug

passng

up

percardum.

eart

s

argey

tereore

te

troug

he

da-

composed

be

entered

o



a

ar.

woud

not

troug

te

atrum

ABR/McM

perormed

ibrous

te

eart

ace

te

te

ventrce

te

usuay

wt

surace

nserted

213–214;

s

be

te

encountered

wen

dapragmatc

sur-

mdne.

woud

not

be

encountered

dur-

percardocentess.

he

et

ace

atrum

and

es

woud

on

not

te

eart’s

be

encountered

posteror

sur-

durng

percardocentess.

subcavan

ven

woud

not

E:

he

cardac

apex

approacng

proxma

s

a

compressed

ead

common

raes.

cartage

dapragm

ng

D:

ven

wt

ung.

enterng

duct.

juguar

be

canges

n

as

te

ts

s

mdde

neede

system

and

to

runs

n

beow

pragmatc

begnnng

commony

toracc

externa

te

eart,

n

ed

274

Percardocentess

te

juguar

njures

ven

te

njury

s

compresson

patent

woud

te

te

o

costa

Due

te

cyotorax.

cepac

pac

te

enters

nterna

were

et

by

may

mdaxary

crackng

cyotorax.

to

n

duct

et

to

toracc

te

ts

canges

porton

obe

space

GAS

115.

212

caused

Penetratng

te

njury

te

ABR/McM

usuay

o

termnaton

Injury

ater

enterng

bracocepac

A.

D.

seen

toracc

juncton

cepac

s

ymp

Cyotorax

racc

at

wt

te

com-

moter

obe.

A

toracc

sgns

N

issure

sxt

costa

ar

condton

tat

peura

te

compresson

n

Auscutaton

te

nrasterna

Cyotorax

GAS

at

ower

te

obe

te

or

te

o

noses

neror

obque

n

wa.

n

undergoes

wen

case

pressure

o

te

reerred

gravty.

space

condton

wtout

are

te

o

occurred

134;

Crackng

cussng

ncreased

t

canges

not

ack

ere.

112.

C.

enter

pneumotorax,

te

respratory

Hemotorax

and

as

rb

by

cavty

te

to

he

causes

pneumotorax

cause

cavty

caracterzed

ar

cavty.

cavty

etus

ts

bood

prod uce

GAS

to

trauma.

toracc

Empysema

C.

o

mutpe

te

peura

spontaneous

rupture

w

peura

te

te

not

descrbed.

185

njury

aowng

eave

tereore,

a

s

to

tenson

occurrence

wereby

B.

to

vave,

not

n

he

voent

case

but

pressure

key

Fa

n

one-way

coapse.

necessary

A.

a

w

228

key

troug

aorta

but

patent.

to

as

cavty

qute

ts

occur

patent’s

ts

wound

acts

ven

pressure.

reason

to

produce

ud

peura

no

In

ow

bood

not

ung, eadng to ar n te peura cavty. he ste o te

te

bood

n

supne,

not

breasts.

caused

juguar

ABR/McM

cava

poston.

s

externa

growng

Compresson

breast.

ABR/McM

te

depressed,

extra,

poymasta

addtona

219;

vena

Compresson

nppes.

B

N

cava

he

D.

to

rgt

supne.

men.

reers

drop

es

growt

by

here

209

abnorma

159;

reduced

ne

te

cyotorax.

neror

supne

tant

C.

GAS

D:

he

presson

x-ray.

dea

to

produce

x-ray.

110.

Injury

gude

ne.

suc

be

to

GAS

most

andmarks

not

ange

used

cest

centra

dea

may

sterna

ne.

te

o

on

structures

not

te

commony

pacement

Cardac

woud

s

centra

pacement

E.

atrum

a

gude

superor

very

D

o

subcavan

mark

as

associated

andmark

pacement

he

C.

(pane

hs

91

Thorax

2

as

part

o

cosey

orgn

o

te

rgt

assocated

te

et

braco-

wt

not

eart

be

va

encountered

te

wen

dapragmatc

surace.

te

bracoce-

woud

te

GAS

116.

B.

te

he

190–194;

pan

N

223;

experenced

sympatetc

ABR/McM

by

te

nnervaton

o

208

patent

te

traves

eart,

wt

derved

92

C H A P T E R

rom

te

2

Thorax

spina

eart

monary

nerve

and

eves

te

nerves.

T1–T4.

cardac

he

pexuses

Subsequenty,

pan

va

te

ibers

te

pan

eave

D.

cardopu-

ibers

ng

pass

E.

troug te sympatetc trunk, enter te spna nerve,

and

ce

pass

root

B.

o

ganga

hs

T4

C.

nto

bodes

and

pan

te

answer

s

roots

ibers

spna

o

te

are

nerves

ncorrect

as

t

spna

ocated

rom

does

nerves.

n

T1

te

to

not

117.

T4.

ncude

s

spna

A.

as

t

does

ncude

te

he

and T6

nerves T5, T6,

138;

ts

pan

te

act

T3

to

ncrease

he

be

nerves.

ande

te

rbs

and

by

te

Left

cardiac

Superior

vena

dameter

“pump

vagus

from

ner ve

cardiac

branches

cardiac

plexus

aor ta

cava

lar yngeal

Right

Vagal

vagus

cardiac

ner ves

from

sympathetic

trunk

ner ve

Left

recurrent

Left

vagus

lar yngeal

ner ve

ner ve

branches

Vagal

Deep

cardiac

carry-

be

nvoved

3.84).

te

plexus

B

GAS

Fig.

3.84

cardiac

branches

o

te

trunk

A

recurrent

o

ande

Pulmonar y

Right

o

branches

Cardiac

n

238

dameter

ner ves

Superficial

of

not

Fg.

ner ve

Vagal

Arch

w

sternum.

sympathetic

Vagal

N

transverse

Cardiac

vagus

nvoved

(GAS

movement”

anteroposteror

ncreased

te

Right

not

and T7

sgna

244–246;

“bucket

are

sgna.

rbs

afects

te transverse dameter o te torax. Inspraton woud

B.

ncorrect

pan

carryng

GAS

he

dorsa

nerves T5

ts

Spna

n

nerve.

answer

T4

dorsa

te

o

spna

hs

te

Spna

ner ve

trunk

te

torax.

torax

woud

movements”

o

CHAPTER

C.

he

by

D.

vertca

dmensons

contracton

he

durng

movements”

he

durng

118.

C.

Bronca

patetc

te

o

te

N

rbs

and

due

rbs

te

due

are

o

to

ncreased

by

dapragm.

te

n

torax

“pump

A.

to

(GAS

te

te

Fg.

o

o

te

prenc

wc

nerve

to

coud

be

bocked

motor

ande

3.35).

D.

te

provdes

motor

and

to

ter

respectve

ntercosta

o

sympatetc

nnervaton

resuts

s

te

nduced

by

arways.

hs

te

parasym-

s

E.

he

supped

recurrent

vagus

and

aryngea

nnervates

183;

N

nerve

parts

o

s

a

te

branc

o

te

arynx.

220

A. he ocaton were one s east key to damage mpor-

structures

by

makng

an

ncson

or

pusng

tube nto te torax s over te upper border o

B.

At

te

ter

neror

ntercosta

(VAN

Pump

handle

or

Entrance

space

ty

D.

cest

not

percng

Enterng

costa

o

eac

artery,

tube

te

te

w

ts

mdde

emnate

between

one

w

nerve,

s

n

a

te

encoun-

tat

not

cest

rb.

order

an

dea

pacement.

te

mportant

musces

rb,

and

tereore

troug

does

o

border

ven,

structures),

ocaton

C.

of

n

broncodaton.

tant

and

sensory

dapragm.

nnervaton

Stmuaton

GAS

movement

resut

spaces.

119.

Superior

to

arways.

he ntercosta nerves provde sensory and somatc

decreases

“bucket

nerves,

nnervaton

B.

torax

vagus

he

ande

sternum.

o

te

reaxaton

201

constrcton

nnervaton

torax

o

dameter

dameter

164–165;

te

expraton

expraton

movement”

GAS

o

transverse

o

reaxaton

anteroposteror

decreases

E.

and

93

Thorax

2

te

ntercosta

possb-

structures.

nterna

not

o

egtened

permt

and

externa

entry

to

te

nter-

peura

cavty.

anterior

ster num

E.

Enterng

nterna

to

te

GAS

120.

B.

between

peura

rom

N

205;

tamponade

accumuates

n

ntercosta

membrane

musces

w

not

and

aow

te

entry

cavty.

152–153;

Cardac

te

ntercosta

te

percarda

s

ABR/McM

a

percarda

efuson

232–233

condton

or

n

cavty.

rom

wc

It

can

eakage

o

ud

resut

bood

A

rom

ses.

te

he

eads

to

eart

proxma

ncreased

cardac

reduced

reduced

portons

pressure

decreased

tereore

te

or

systoc

pumpng

wtn

ing

bood

capacty

o

te

te

dastoe

pressure.

te

ves-

percarda

durng

o

great

sac

and

Because

eart,

tere

o

s

Bucket

ncreased

pressure

n

te

venous

system,

eadng

to

te

handle

dstenson

o

te

juguar

venous

system.

movement

A.

Hemotorax

descrbed

C.

te

not

resut

n

te

symptoms

vgnette.

Hemopneumotorax w not produce te reduced

eart

sounds,

tenson

D.

seen

engorged

n

ts

Pneumotorax

w

sounds,

seen

E.

n

w

n

Deep

engorged

ts

ven

mbs

juguar

vens,

and

ypo-

patent.

not

produce

juguar

te

vens,

reduced

and

eart

ypotenson

patent.

tromboss

and

oten

ncreases

te

occurs

rsk

n

o

te

ower

pumonary

embosm.

Elevation

shaft

of

of

lateral

GAS

190–194;

N

223;

ABR/McM

208

rib

121.

B.

he

S 2

sound.

aortc

A.

eart

hs

and

he

sound

sound

s

pumonary

cosure

o

reers

to

te

produced

semunar

by

second

te

(dub)

cosure

eart

o

te

vaves.

mtra/bcuspd

and

trcuspd

vaves

B

produces

GAS

Fig.

3.35

ts

te

answer

s

irst

S1

(ub)

ncorrect.

eart

sound,

tereore

94

C H A P T E R

2

Thorax

C.

hs

s

D.

he

trcuspd

ncorrect

as

t

vave

ncudes

te

contrbutes

mtra

to

te

vave.

irst

125.

eart

sc

sound.

E.

hs

s

ncorrect

as

t

ncudes

te

trcuspd

E.

he

vaves

N

224;

o

produces

s

ABR/McM

te

te

190–191

mtra/bcuspd

irst

S

(lub)

eart

1

A.

and

hs

s

B.

Cosure

vaves

not

sound,

so

correct

o

te

ts

as

te

te

bot

irst

te

eart

pumonary

second

eart

mtra

and

trcuspd

D.

ng

to

sound.

and

C.

aortc

sound,

so

vaves

ts

he

pro-

s

not

s

ncorrect

utes

to

te

GAS

243;

Fa

cest

correct

irst

N

as

s

to

t

ncudes

mtra

opton

s

Hs.

te

aortc

caracterzed

by

provded

ntercosta

prenc

nerve

dapragm

aso

contrb-

ntercosta

s

breat-

ractures.

vagus

vaton

to

testna

C.

he

spaces

supped

va

E.

te

tract

organs,

and

horacc

sensory

provde

toracc

as

dsta

nnervaton

pareta

te

rom

pan

T1

to

N

et

to

T4

to

prenc

souder.

te

prenc

t

arc

does

certan

he

do

to

te

and

eves

rom

to

tese

he

te

are

et

pan

may

transmt

organs

n

nner-

norma

unctonng

te

or

do

te

te

or

A

urter

ntercosta

to

te

nerves

pan

to

te

D.

tat

are

not

abdomen

abdomna

N

208;

and

carry

and

organs

to

te

te

aor-

tere,

rom

A.

but

sgnas

deayed

tme

or

te

te

conductng

te

to

ave

sends

n

bunde

contract

no

o

n

a

pacemaker

te

to

conducton

te

Purknje

determnng

s

te

an

tat

te

abnorma,

s

present

popuaton.

N

236;

It

s

sg-

ibers,

rate

o

accessory

n

a

sma

assocated

wt

syndrome.

ABR/McM

o

rgt.

te

B.

211

peura,

nner-

normaton

ibers

musce

nbtng

ibers

eter

sympatetc

ts

o

s

te

N

o

te

eart

te

traceo-

w

daton

va

w

te

are

te

cause

tree.

n modaty, and

o

smoot

nerves.

motor

not

ts

or

tereore

daton

motor

musce,

o

pregangonc

ibers

aow

tree.

n

uncton,

smoot

but

musce

o

tree.

221

s

a

eart

actor

durng

cords

eter

nvoved

traceobronca

ibers

skeeta

are

te

tem

cause

te

moduate

done

traceobronca

183;

n

condton

tube

Noda

te

s

tat

te

pays

et

a

embryonc

an

par tay

toracc

to

anomay

or

roe

It

s

n

rom

o

te

to

a

te

oopng

perod.

n

entrey

cavt y.

resuts

nstead

wc

te

ocated

not

ear t

extern a

assocated

wt

Noda.

T ransposton

wt

D.

souder.

sympatetc

smoot

traceobronca

eferent

TGF-β

to

to-

normaton

te

te

cannot

as

Ectopa

s

souder

o

Sympatetc

suppy

bendng

o

parasympatetc

hereore,

Dextrocarda

ner ves

rom

pareta

sensory

202

o

constrcton

GAS

127.

except

te

supped.

ABR/McM

va

Vscera aferent ibers are sensory

tey

aso

pevs.

sensory

reerred

spancncs

te

222;

spaces

be

s

trougout

specazed

down

Kent

Inbtng

Somatc

o

regon.

ibers

E.

et

eves

aneurysm

to

pan

carry

B.

musce

cardopumonar y

carr y

reaxaton

postgangonc

toracc

aganst

and

te

traves

sgna

Hs)

node

o

tree.

te

eves

an

(o

constrcton

and

C.

woud

toracc

te

structure.

root

sensatons

abdomen

reerred

tey

by

sgna

ventrces

patway

216–219;

esopagea

gastron-

organs.

vaton

GAS

pan

bunde

sympatetc

pan

es

te

nvoved

126–148

sympatetc

souder

nerve

afected

vscera

cause

but

be

nerve

te

vagus

and

tat

rom

over

are

te

manner,

AV

Postgangonc

C.

200

o

because

C3–C5,

not

tereore

reerra

occurs

skn

ntercosta

rom

he

causng

s

te

126.

organs.

carry

ABR/McM

ibers

bunde

Answers

abdomen.

not

not

racc

E.

te

toracc

regon,

D.

not

depoarzaton

he

ten

Wof-Parknson-Wte

exure.

carry

nerves

206;

reerra

nerve

to

Atoug

tc

C.

nerve,

hs

dstrbuted

B.

s

(provdng

and

aow

proporton

te

peura

te

coc

nerves

ibers

te

152–155;

and

te

node.

node

receve

and

A. An aneurysm o te aortc arc coud mpnge upon

te

node

rytm.

a

nnervaton

parasympatetc

vscera,

as

AV

GAS

motor

medastna

spancnc

nnervaton

124.

tat

rom

he

nerves.

provdes

cardopumonary

GAS

cardac

musce.

conducton

n

nerves

nnervaton

E.

AV

he

percardum.

he

te

producng

depoarzaton.

paradoxca

rb

receves

contract),

hey

and

by

to

he

na

190–191

peura

and

and

vave

mutpe

pareta

dapragmatc

B.

n

uncton

sound.

ABR/McM

caused

underyng

te

te

eart

nnervaton

he

as

224;

movements

correspondng

A.

settng

asssts

snuatra

Purknje

ibers

D.

hs

te

eart,

snuatra

syncronzed

answer

sensory

te

te

to

cardac

vave.

123.

te

node

te

wtn

ncorrect.

D.

AV

rom

atra

produce

duces

hs

wen

he

trcuspd

correct.

A.

C.

o

pacemaker

normay.

243;

cosure

opton

artica

rytm

vave.

122.

pacemaker

An

answer

GAS

B. he snuatra node unctons as te prmary ntrn-

An

aso

E.

te

unequa

not

o

Noda

te

great

dvson

assocated

o

wt

syndrome

te

Noda

GAS

208;

te

o

wt

Coarctaton

T urner

arteres

te

te

not

aorta

s

but

truncus

Noda

most

s

not

actor.

N

s

assocated

actor.

233;

ABR/McM

196

arterosus

s

actor.

oten

assocated

assocated

wt

CHAPTER

128.

A.

he

te

arc

(3)

s

esopagus

torax

o

te

te

n

te

typcay

aorta,

(2)

dapragm.

te

neck.

as

esopagus

te

he

Answer

s

our

constrctons.

compressed

et

prncpa

A

s

correct

as

In

(1)

te

broncus,

and

crcoparyngea

t

by

C.

he

A

constrcton

ncudes

eart,

age

w

he

D.

he

E.

he

tese

D.

te

not

toracc

constrct

azygos

ven

duct,

te

and

te

crcod

cart-

E.

eart

arc

w

not

are

constrct

te

tymus

GAS

129.

C.

o

he

ras

ng

by

tat

s

A.

he

nppe

B.

he

D.

he

E.

he

te

by

not

ped

GAS

Due

pareta

T5

N

D.

peura

by

parencyma

due

E.

to

an

te

case

dorsa

cause

te

nppe

te

root

te

s

eart

gangon

A.

te

te

T3

are

not

D.

sup-

root

gangon

area

are

not

te

s

oss

te

sup-

o

n

and

coapse

carotd

o

te

artery

vesses

and

A

gus

irst

and

as

dam-

nto

te

wtn

te

parta

not

N

te

206;

ptoss,

ng

Horner

syndrome.

te

cervca

sympatetc

ganga

and

known

as

apex

o

tarsa

under

ung.

o

vagus

cause

not

be

wtn

te

vena

not

o

ts

tract,

ead

be

njured

gands

gands

o

te

n

be

be

n

cervca

symp-

nerves

and

toracc

s

te

and

upper

organs.

autonomc

206

to

te

to

cava

te

et

te

eart.

atrum

esopagus

n

te

runs

cavty

arteres

O

es

te

most

wen

te

medastnum.

on

and

s

too

does

t

te

by

te

emptes

e

s

too

an

rgt

ts

sde

contents

an

aganst

a

te

east

te

te

musce

easy

te

med-

tumor.

bod-

esopa-

structure

resstance,

reatvey

to

tumor.

vertebra

afect

smoot

o

devated

wtn

esopagea

woud

pat

anteror

esopagea

anteror

by

tumor

because

be

are

afected

afected

A.

are

a

cncay

and

o

a

dator

eyed,

does

Pancoast

and

o

eart

neck

te

sweat

te

but

eson

B.

tumor,

tumor

te

o

aso

o

gands

are

to

any

but

rater

ts

tan

structure

arynx.

tan

and

V on

mucous

te

t

n

te

te

passes

ina

ibers.

atrum

he

et

he

superor

s

access,

te

vena

as

t

te

ten

s

superor

te

te

rgt

Purknje

atrum

rgt

does

not

pays

o

most

te

no

ibers

reac.

dcut

pacemaker

cambers

atrum

contan

Purknje

to

te

te

rgt

te

no

among

cava

treat

pacemaker

to

te

but

dcut

so

to

conducton

contracton.

contans

reatvey

troug

and

troug

ocaton

aso

te

ven

stmuate

ventrce,

ventrce

to

to

used

eart

o

atrum

used

rgt

be

“tp”

ventrcuar

Purknje

woud

or

ang

subcavan

rgt

s

he

et

or

205

commony

w

rgt

roe

n

be

eart.

cardac

pacng.

GAS

134.

suppy,

oter

E.

a

ibers

resut

nserted

te

bronc,

nto

te

ABR/McM

are

weak

pacemaker

not

223;

eectrode

cambers

superor

tracea,

not

D.

ave

were

reac

and

trunk

contro.

(aryngea

and

a

parasympatetc

tongue)

parynx

sucus

pupae,

system

carry

gands

s

sympatetc

to

he

N

pacemakers

troug

cava

ibers

emotorax.

syndrome

trunk

pumonary

and

and

Ebner

n

atrum.

growng

he

ventrce

200

andross

Horner

nervous

and

to

wo

treaded

descrbed.

ABR/McM

and

resut

he

nerve

musces

te

a

te

sympatetc

dgestve

n

oten

superor

te

musce

he

to

a

s

vena

228–229;

systems.

woud

s

149–153;

te

postgangonc

pexus

poston

ventrce

Artica

patents

ung.

ound

tat

C.

sternum

Moss,

produce

nnervate

eart,

anteror

rgt

can

are

posteror

toracc

to

ere.

resut

cardopumonary

tat

ABR/McM

te

tereore

GAS

133.

ere.

are

woud

suc

are

ows

pressure

descrbed

ungs

vesses

bood

negatve

njury

s

n

esopagus

es.

to

and

et

he

mportant consteaton o symptoms possby ndcat-

B.

he

not

orgnate

es

pumonary

organ

ntercosta

torn,

njury

te

externa

te

woud

eart.

norma

te

astnum

o

or

and

204;

just

ts

esopagus

E.

dorsa

N

ibers

descrbed

patent.

nerves

hey

te

autonomc

nerve

woud

ts

vscera

neror

he

supped

are

n

nto

dermatome.

area

surroundng

pumonary

o

not

area

s

wtn

ncud-

aso

n

esopagus

he

caracterstc

dermatome

to

posterory,

erpes

prenc

ganga

140;

carry

symptoms

cardopumonary

cambers

he nterna toracc artery s we protected by te

GAS

A.

te

to

ts

not

te

compressed.

common

he

toracc

he

180

racture,

resuts

afected

B.

dermatome.

cavty

and

132.

does

dapragm.

arc

spancnc

GAS

root.

te

peura

C

n

ventra

and

he

et

not

engt.

te

descrbed

suppy

w

dermatome.

space.

he

In

surroundng

ound

te

rb

ts

surroundng

te

peura

A.

n

aong

te

T3

s

138;

to

aortc

he

engt.

musce

encompasses

actvated

and

te

by

aong

T4.

dermatome,

nppe

ts

constrct

our

tat

nerve

and

te

vrus

aong

not

C.

nppe

T4,

aged,

T4

o

te

sympatetc.

244

dstrbuted

nppe.

ped

131.

be

w

crcotyrod

arbored

can

te

B.

N

ven

pont

te

esopagus

spna

s

azygos

any

dermatome

and

by

130.

te

vrus

T4

at

and

233–234;

supped

zoster

te

nerve

produce

to

toracc

and

esopagus

constrct

he

he

esopagus.

esopagus.

te

eson

toms

he

C.

woud

parayss

constrctons

B.

prenc

tat

95

Thorax

2

211–212;

N

236;

ABR/McM

211

A. Cardac ypertropy s a compensatory mecansm

o

te

on

myocardum

te

eart

due

ypertenson.

woud

to

te

nto

most

n

to

et

to

ncreased

sze

key

compress

te

mtra

atrum

can

ncreasng

ncompetent

he

ncompetent

te

response

scema,

vave,

cause

o

te

demands

vaves,

eart

esopagus,

a

a

backow

et

atra

or

musce

and

o

due

bood

daton.

96

C H A P T E R

he

te

B.

2

et

Thorax

atrum

es

just

anteror

to

te

esopagus

n

E.

he

py

bood

woud

trunk

to

not

te

s

ocated

ungs,

cause

so

drect

superory

cardac

and

ypertro-

compresson

to

ts

vena

and

cava

woud

devers

not

be

bood

to

te

compressed

rgt

n

eart.

ts

A.

he

eart

not

compress

he

es

neror

te

to

te

tracea

tracea

and

secondary

to

woud

vena

by

cava

ts

s

aso

partcuar

not

key

exampe

o

to

be

and

o

GAS

228–229;

T enson

ton

o

ar

te

nated

te

n

A.

A

he

s

cest

tssues

ous

D.

136.

s

and

o

does

not

GAS

169;

per

upper,

ng

te

A.

N

and

rbs

no

to

durng

as

L AD

on

beng

broken

broken

rbs

are

n

seen

te

ungs

area

resut

n

or

a

n

wc

are

s

comes

on

te

a

and

destroyed,

artery

s

secondary

excange.

nary

spontane-

et

to

x-ray

(car

a

cest

cras)

spontaneous

n

te

dentiabe

by

to

o

t

rgt

B.

hs

C.

hs

rgt

rgt

s

In

sxt

ne

on

te

cest

a

ncorrect

and

ncorrect

upper

s

eadng

patent’s

te

x-ray

present

B.

te

C.

he

an

o

te

n

a

as

te

crux

branc

and

branc

arter y

te

te

et

L AD

s

not

coronar y

arter y.

he

nter ventrcuar

nterventrcuar

artery

crux

comes

te

o

of

two

coronary

o

and

te

o

an

coronary

te

et

arses

aorta

and

trunk.

208–210

ar

orange

te

passes

vesses

te

coro-

rom

pumonary

ympatc

ke

et

ABR/McM

surroundng

“rgt

nterventrcuar

artery

ascendng

artery

te

eart.

te

brances

229–230;

n

te

anteror

et

appearance

At

noda

groove

eart.

te

atrum

noda

coronary

branc.

of

te

N

coronary

nterventrcuar

coronary

te

te

ts

rom

snuatra

te

AV

n

arses

pattern).

te

at

skn

o

dmpng

te

te

ung

D.

x-ray

te

o

suspensor y

te

overyng

ower

obe

rb

o

s

n

te

to

GAS

139.

C.

he

tat

s,

retnacua

major

ts

o

irmy

to

te

cancer

nverson

143;

N

patent

ing

te

but

o

o

resuts

oces,

pee

(peau

gaments

eads

skn,

not

peau

te

resuts

and/or

as

n

retrac-

areoa.

notng

resut

n

to

ixng

do

te

wa.

te

breast

w

not

drecty

nppe.

ABR/McM

suferng

te

can

cest

o

199–200;

s

cuts

nppe

nvovement

condton

Intraducta

ead

o

nverson

Pectoras

tumor

E.

nerory

opacty

and

wt

emnat-

tent

Contracton

ton

pneumona.

extends

to

to

occuded

anteror

cutaneous

te

Sortenng

to

rgt

te

cest

sde,

ung

case

extendng

te

o

he

rgt

et

o

o

o

wt

o

et

dago-

d’orange).

patent

afected.

apex

rb.

obe

afectng

woud

Bockage

an

te

artery

207–211;

edema

of

known

rgt

snus

te

n

comes

apex

o

a

d’orange.

are

te

te

mdde

rb

A.

aso

he

to

surace

artery

runs

of

(posteror)

one

rse

rom

percarda

196

cardac

cavty

tamponade,

wt

ud.

he

cassc sgns o ts tamponade are reerred to as “Beck’s

mdde

s

138.

218

ourt

beng

te

ndcates

obes

rom

te

x-ray

ung.

hs

GAS

pneumotorax.

ABR/McM

ower

rgt

rb.

te

s

bood

pneumotorax

on

opactes

te

t

o

It

aong

aortc

and

(posteror)

pattern

artery.

not

margna

gves

crcumex

artery

n

extends

possbty

sxt

cest

accompanyng

obe

he

gves

nter ventrcuar

te

eas-

gas

accumuaton

way

and

of

s

gves

aong

te

223

nterventrcuar

anteror

coronary

domnant”

s

domnant”

ud.

cavce)

n

a

to

artery

rgt

neror

between

an

On

he

te

descends

ere.

and

groove

two

a

t

“rgt

runs

te

occuded.

snus

anteror

arter y,

an

seen

of

neror

te

he

occupes

ABR/McM

artery

on

rgt

ten

occuded

dmn-

mantan

ung

condton

n

surace

211;

mdaxar y

rgt

pressure

coapsed

o

aveo

trauma

mutpe

te

neror

te

trapped

E.

same

ave

upper

te

o

mdde,

Opacty

to

a

spontaneous

story

sows

o

requred

cronc

may

space.

te

(above

s

pneumotorax.

present

rgt

resut

a

te

menscus

As

tat

B.

he

eart,

arge

(n

accumua-

x-ray.

Atoug

D.

a

emotorax

peura

a

n

205

progressve

ncrease

pressure

ocatons,

Empysema

A

a

C.

cest

reducng

C.

s

cavty

resutng

resutng

Empysema

tc

ABR/McM

x-ray.

more

ts

B.

223;

peura

negatve

a

or

te

ung,

cest

N

pneumotorax

nspraton.

ses

a

s

usuay

t

aso

anteror

coronary

aortc

gves

te

te

descends

It

opacty

212–213;

coronary

rgt

groove.

cardac

N

branc

rgt

te

cardac

ypertropy.

E.

he

et

tat

branc;

neror

compressed

135.

te

hs

te

peope,

angogram.

ypertropy.

E.

o

branc

as

obe.

172–176;

many

branc

scenaro.

D.

In

na

superor

atrum

D.

ncorrect

mdde

GAS

137.

structure.

he

s

rgt

pumonary

devers

C.

hs

medastnum.

and

and

te

ower

as

te

ower

ncorrect

upper

as

as

opacty

aso

occupes

te

obes.

opacty

rom

aso

occupes

te

aso

occupes

te

obes.

te

mdde

opacty

obes.

trad.”

hs

carda

mules

sac,

te

resutng

and

tro,

by

compresson

and

a

dastoc

te

te

quet

cardac

rom

deinton,

o

eart

eart

sounds;

reduced

pressure

ncudes

by

te

because

te

decreased

dference

because

te

a

sma

ud-ied

eart

per-

tamponade

puse

pressure

between

tamponade

systoc

restrcts

CHAPTER

te

abiity

centra

enter

A.

o

te

venous

te

compressed

Beck’s

trad

secondary

B.

A

eart

to

hs

D.

hese

E.

hese

to

s

te

be

canges

dastoe;

and

venous

ncreased

bood

aws

cannot

te

sgns

ud

by

beedng

resutant

not

symptoms

wt

te

A.

o

B.

symptoms

tenson

140.

E.

pneumotorax,

wt

te

GAS

190–194;

Myen

occur

n

prenc

indngs

uncton

and

te

B.

C.

hs

as

n

D.

patent’s

rbs

te

epng

musce

C.

he

may

resuts

ca

to

he

oss

wt

st

o

ack

respratory

are

musces

as

ony

o

n

ts

te

rase

s

not

te

o

st

unctonng

“voenty”

dsturbance

n

(orce

seen

a

o

dur-

ere

durng

are

st

neck

s

breatng.

movng

so

In

and,

tereore,

uncton

n

Interrupton

n

transmsson

ncreasng)

o

o

sowng

te

te

and

(nor-

T1–T4

o

or

eectr-

reducton

o

cardac

actvty;

woud

o

cardac

just

te

C.

(as

nerve

ts

actvty

nerve

as

nnervates

no

D.

te

Dsturbng

ibers

te

E.

rom

cardac

he

but

woud

cess

C.

he

because

drecty

not

eart

te

tny

woud

myenated

ave

no

pan

nuence

rater

be

mtra

neurons

skeeta

drecty

te

on

not

musce;

afected

by

nnervate

tereore,

te

dsease

te

208;

vave

s

to

te

144.

A.

te

pro-

ay

best

vsuazed

wtn

et

202

te

on

an

atrum.

by

TEE

he

s

pysca

te

te

s

as

wc

s

to

te

te

suc

s

rgt

not

te

TEE.

bood

not

s

on

seen

te

te

as

to

te

vave

et

te

posteror

or

te

one

N

223;

and

ungs

tat

sde

mtra

most

vave

tat

s

s

o

te

vave

camber

o

best

he

te

et

as

o

te

neror

vsuazed

by

te

te

meda

o

s

te

around

o

term

aortc

o

used

rom

arc

as

nppe

te

te

or

suc

pneumotorax.

aortc

appearance

ar

range

sometmes

projecton

he

o

wde

condtons

radograpc

sde

cases

a

we-descrbed

t

oter

radoogcay

In

presence

rom

Despte

x-ray.

“nverted

205

te

arse

and

coursng

et

aortc

to

te

seen

corre-

superor

knob

and

ympadenopaty

pneumomedastnum,

aortc

t

nppe”

rom

appearance

smar

t

and

condtons

3.89).

or

o

o

te

vagus

dagnoss

vena

o

cava

nerve

s

not

a

reabe

pneumomedastnum.

s

not

used

as

a

dagnostc

pneumomedastnum.

pumonary

he

may

nppe-ke

end-on

superor

he

s

cest

presence

he

ABR/McM

descrbes

rom

dferentate

Fg.

or

aortc

ven

s

not

used

as

a

dagnostc

pneumomedastnum.

arc

dagnoss

A

o

tse

s

not

useu

at

dferentatng

pneumomedastnum

190–193;

TEF

tat

paned

mony

te

s

tracea

an

and

resuts

esopagus

esopagus

te

and

vave,

atera

ven

esopagea

ABR/McM

queston

rom

smar

condtons.

tey

eart.

N

transducer

posteror

do

s

nppe”

te

eps

a

tat

better

reated

between

and

transports

condtons.

mstaken

GAS

orn

164–165;

te

o

rate.

afectng

GAS

142.

te

ventra

eart,

E.

irng

to

marker

dapragm).

D.

by

vave

dferentate

te

marker

prenc

rate

to

ndcator

occur.

atrum,

ound

ceary

not

neopasm.

(GAS

B.

nerves

a

ts

cronotropc

s

PA/AP

be

takes

hs

drecty

pneumomedastnum,

knob,

an

may

eart.

vagus

o

ntercosta

pregangonc

ibers

atrum

“aortc

sponds

te

as

pneumopercardum

on

te

TEE.

aortc

not

medastnum

aortc

202

s

vave

by

228–229;

descrbe

ts

te

s

patoogca

he

et

ventrce

Pneumomedastnum

te

dctate

TEE.

dcut

by

t

cava,

magng

musce

respraton

ter

stmuaton

woud

on

s

o

ABR/McM

rom

mpuses

o

resut

opposte

cage

sympatetc

nterrupton

ncreasng)

musce

musce

rbs

208;

myen

notropc

efect

are

movng

mpcated.

myenated)

Reducton

rb

te

N

A.

mage.

most

te

ceary

Eustacan

GAS

143.

magng

transducer,

eart.

vena

unctonng

s

ventrce

vsuazed

he

eforts.

“voenty”

rgt

et

te

E.

as

accessory

164–165;

n

not

B.

an

stmuatng

(rate

A.

as

oss

postve

n

dapragm.

te

good

vave

pumonary

te

n

descrbed

presentaton,

GAS

te

a

o

rgt

most

Atoug

can

dapragm.

acts

ts

n

movng

sternocedomastod

tat

141.

wa

musces

as

pectora

are

respraton.

he

resuts

o

seen

eart,

as

to

vave

aspect

and

te

best

D.

nerves,

predctabe

abdomna

consstent

208

prenc

parayss

s

va

presentaton.

s

ng

not

he

o

trad.

syndrome

descrbed

presentaton

s

Beck’s

te

and

ntercosta

are

cassc

ABR/McM

o

parayss

te

he

rbs

patent’s

o

a

wc

n

223;

Guan-Barré

nerve

movement

as

seen

N

degeneraton

Dapragmatc

A

descrbe

obtan

ear t

trcuspd

vave

trad.

utrasound

vave.

atrum

Beck’s

to

str ucture

to

posteror

he

trad.

te

wc

mtra

indngs.

Beck’s

caracterstc

te

nto

pysca

appy

abty

asks

accumuaton.

consstent

are

and

tat

coser

te

deined

and

not

n

cardac

percarda

space,

woud

i

because

eart.

reers

emotorax

peura

to

pressure

97

Thorax

2

by

N

241–242;

abnorma

esopagus.

rom

ods

hs

tat

esopagea

amnotc

separate

s

In

atresa.

wt

ud

s

ncompete

embryoogcay.

assocated

ABR/McM

219

communcaton

TEF

unabe

a

uson

te

most

between

congenta

o

te

tracea

cases

t

rom

s

Poyydramnos

and

to

esopagea

pass

nto

anom-

traceo-

te

accom-

s

com-

atresa,

te

as

stomac

98

C H A P T E R

2

Thorax

Clavicle

Left

common

carotid

Brachiocephalic

Left

brachiocephalic

artery

Esophagus

trunk

vein

Left

subclavian

Left

Left

phrenic

Ligamentum

vagus

artery

nerve

nerve

Left

recurrent

laryngeal

Left

pulmonary

nerve

arteriosum

artery

Bronchus

Thoracic

Pericardial

aorta

sac

Diaphragm

GAS

and

intestines

otic

sac.

B.

or

ud

and

anomaes,

C.

not

Anydramnos

amnotc

urnary

and

are

E.

wt

GAS

ud

reers

s

coects

wt

a

in

te

amni-

te

a

deicency

s

It

wt

145.

C.

hs

N

to

aso

a

compete

assocated

carres

moe

pacenta

237;

amn-

and

type

a

poor

and

are

ABR/McM

absence

wt

o

gento-

prognoss.

corocarcnomas

not

usuay

assoc-

upper

gves

case

ts

a

ound

Durng

type

n

o

a

aduts.

and

te

o

It

te

s

o

te

weak

puses

te

n

te

aorta

s

most

wt

coarc-

common

te

typca

ypertenson

te

te

toracc

coarctaton,

o

postducta

te

rbs,

deveopment,

arc

a

s

assocated

o

descendng

postducta

area

coarctaton

notcng

mb,

to

descrpton

o

embryonc

rse

s

typca

et

ower

dorsa

aorta.

aorta

Snce

ts

deveopment

rom

te

n

mbs.

o

dorsa

aorta.

A.

208

s

hs

symptoms

te

poyydramnos.

223;

o

gentournary

TEF .

reers

and

anomaes.

o

to

assocated

Hydatdorm

tumors

ated

and

3.89

taton.

Oigoydramnios

otc

D

absorption

Fig.

Atoug

utes

to

te

te

ourt

aortc

paryngea

arc,

snce

ts

arc

s

a

contrb-

postducta

CHAPTER

coarctation,

correct

B.

he

trd

mon

D.

he

any

E.

et

dorsa

aorta

is

most

ikey

te

146.

it

sxt

arterosus

GAS

227;

as

N

Congenta

gves

rse

to

te

com-

posteroatera

te

n

te

paryngea

trunk

arc

artery.

paryngea

nary

A.

dapragmatc

erna

s

a

reatvey

common congenta anomay. It s most oten seen as a

paryngea

carotd

structures

he

tus

te

answer.

on

te

we

240;

arc

does

deveoped

arc

et

(Fg.

not

contrbute

and

to

parts

o

parts

to

te

te

duc-

pumo-

cord

219

4th

arch

arteries

Truncus

arteriosus

pharyngeal

deect

o

te

n

te

ormaton

membranes

ntestnes

2.12).

pharyngeal

deectve

nea

adut.

contrbutes

ABR/McM

3rd

wt

te

dapragm.

return

durng

te

to

or

I

te

tent

vscera

hs

compresses

te

6th

pharyngeal

arteries

Aortic

Dorsal

sac

deveopng

Left

dorsal

embryoogca

rom

pass

o

te

te

nto

ungs

wen

ntestnes

te

and

torax.

resuts

aortae

aorta

aorta

External

carotid

artery Internal

carotid

artery

3

3 4

Aortic 4

Pharyngeal

sac

arch 5

arteries

5 6

Ductus

Truncus

(partly

arteriosus

arteriosus

divided

into

Right aortic

and

subclavian

artery

Left

dorsal

aorta

pulmonary

arteries)

Pulmonary

Left

A

arteries

subclavian

artery

B 7th

intersegmental

Internal

carotid

artery

arteries

Left

External

carotid

Brachiocephalic

common

artery

subclavian

artery

arteries

Arch

Right

Ascending

artery

arteries

Left

Subclavian

carotid

pulmonary

of

aorta

artery

aorta

Ligamentum

Ductus

Left

Left

pulmonary Ascending

aorta

artery

C

Descending

arterial

arteriosum

arteriosus

D

aorta

trunk

•

Fig.

2.12

pulmonary

artery

te

umbca

arch

dorsal

rom

peuroperto-

perssts

some

may

resutng

te

tree

deect

week,

abdomna

arch

oter

ts

o

abdomen

and

arteries

dapragm

uson

Left

Pulmonary

99

Thorax

2

n

100

C H A P T E R

2

Thorax

pumonary

some

enter

into

pysica

lat

B.

ypopasia.

primordia

te

peura

exam,

te

“scapoid”

Laryngea

ing

rupture

arge

air

E.

TEF

a

o

gands

he

s

and

resuts

seen

is

te

to

a

is

149.

in

aduts

resut-

te

usuay

present

to

tere

s

tracea

accompaned

system

skn

rom

wa.

by

wt

A.

T1–T4

are

no

ts

and

to

C.

ncreasng

cord

sbe

T4,

ocated

wc

va

te

gray

spna

ram

nerves

s

space

D.

sweat

n

tssue.

te

sym-

to

get

arm.

to

te

te

ibers

n

te

body

te

eart

n

nerves

te

are

toracc

vs-

responsbe

A.

148.

patent’s

back

ibers

but

compant

o

to

and

are

respon-

and

severe

cest

to

A.

he

75%

te

atera

B.

o

te

C.

he

ts

o

D

and

axary

nodes

te

eart

tat

231;

o

ABR/McM

te

irst

breast

wc

s

he

C.

he

dran

to

no

nto

te

E.

te

njected

anteror

w

not

receve

some

dran

dranage

breast.

to

hs

nto

te

te

mass

not

centra

rom

te

hey

receve

apca

anteror,

w

dranage

aso

axary

atera,

not

rom

be

ts

nodes

and

nodes

dran

mass.

receve

posteror

among

te

vave

w

produce

a

vave

w

aso

n

be

s

n

systoc

second

murmur

ntercosta

correct.

te

tat

a

rgt

mtra

vave

auscutated

te

vave

resuts

at

te

mdcavcuar

regurgtaton

n

et

ne.

resut

n

N

233–234;

tat

body

s

aso

CN

pan

prenc

to

and

nerve

eart.

cord

At

s

cuta-

and

sde

stmuates

spna

s

nerves

a

gut,

o

s

te

vscera

wt

te

te

eve

nterpreted

major

up

some

organs

not

wa,

o

as

to

supper

te

et

autonomc

n

produce

te

te

o

coc

motor

ead,

neck,

reerred

pan

ere.

nnervate

and

woud

te

anteror

not

and

produce

te

descrbed

nerve

tat

toracc

190–191

atera

meda

stmuus

provdes

nnervates

brances

te

te

descrbed

cest

te

te

X

to

woud

ntercosta

te

wa.

suppy

It

to

vscera

uncton

and

to

myocardum

back

nnervate

nerve

s

ntercosta

sensaton

ts

te

second

te

ABR/McM

nerve

arses

te

pass

vscera

rom

spna

dapragm.

nto

or

te

nerves

hs

C3–

nerve

as

arm.

cardopumonary

nerves

are

vscera and aferent ibers or pan rom tese organs

GAS

C.

he

satons

ng

o

te

irst

o

204,

o

te

overyng

rom

produces

o

dmpng

o

te

(o

tat

major

breast.

te

tenson

te

o

tssue

pectoras

breast

Invason

408

gaments

connectve

skn

dmpng

A.

3.114C).

N

suspensory

te

breast

Fg.

163;

asca

pend

and

s

tur-

ent ibers rom te sympatetc ganga to te toracc

parasterna

w

n

nto

dranage

parasterna

resuts

ax-

151.

quadrants

o

torax.

(GAS

nodes

te

responsbe or carryng te cardac sympatetc efer-

approxmatey

dye

not

space

te

te

sensory

and

he

te

aortc

trave

vagus

he

205

dran

o

cord,

reerred

to

nodes.

nodes.

to

to

drected

and

at

bood

vave.

resuts

troug

243;

or

posteror

C5

dranage.

w

opposte

ympatc

or

are

mass.

tese

E.

neck

(pectora),

axary

wt

te

nto

ganga

resuts

murmurs.

rom

he

superor,

nodes.

meda

nodes

N

ympatc

atera

rom

and

rom

systoe,

pumonary

at

woud

penomenon

rate.

214;

descrbed

ibers

cervca

quadrants

(pectora)

he

ead

eart

axary

mass

ary

te

te

sympatetc

vave

murmur.

aso

and

autonomc

sp-

te

te

murmur

Iscema

exure,

trave

sympatetc

neror

36–44,

anteror

ts

branc

he

or

rate.

aferents

196

auscutated

Durng

aortc

ntercostobraca

spna

be

ventrces

te

o

stenoss

so

aferents

pumonary

can

narrowed

auscutated

responsbe

te

te

dastoc

214,

he

neous

communcantes

order

D.

a

o

ntercosta

comng

sympatetcs

vscera

and

ncrease

a

systoc

GAS

150.

corresponds

eave

ABR/McM

murmur.

dastoc

B.

eter

aganst

te

space.

rom

Regurgtaton

a

ncorrect.

Postgangonc

mdde,

s

it

ibers

n

parasympatetc

wt

or

GAS

Aortc

and

pan.

E.

ow

but

dyspnea

subcutaneous

are

postgangonc

(cardopumonary)

horacc

na

expeed

produce

an

o

tat

ntercosta

sympatetcs

Postgangonc

cera

second

stenoss

Regurgtaton

in

esopa-

te

199–200;

murmur

dastoc

target.

so

systoc

Regurgtaton

eed.

nnervates

bodes

T1

he

trunk

wa

a

Pumonary

ce

to

here

n

buent

deicency.

were

between

seen

N

149–173

Pumonary

et

in

ost

usuay

142–143;

E.

deveopment

suractant

attemptng

te

sympatetc

ter

Answers

222

n

trunk

te

a

orcby

tissue

condton

usuay

wen

N

ocated

enter

tat

usuay

ung

aveoi

due

sympatetc

cest

On

and

airways.

syndrome

Patents

postgangonc

te

GAS

to

B.

distress

cokng

patetc

C.

te

inants

atresa.

he

air

dyspnea

anomay

te

connecton

D.

B.

o

congenta

372;

severe

condition

and

GAS

A.

upper

esopagus

and

ypopasia,

causing

(pneumotorax).

as

rare

abnorma

gea

severe

pockets.

Respiratory

to

a

a

easticity

D.

s

is

te

is

te

premature

147.

o

were

o

o

rupture,

cavity

patient

atresia

Empysema

in

cases

may

abdomen.

obstruction

C.

In

aveoi

cest

on

Cooper)

run

musce

hey

wa.

tese

are

rom

to

conden-

te

nvest-

te

derms

support

and

Carcnoma

gaments

and

sus-

o

te

causes

breast.

te

te

acterous

breast.

ducts

w

not

produce

CHAPTER

Pain

inter preted

originating

of

somatic

in

101

Thorax

2

as

distribution

sensor y

ner ves

Visceral

sensor y

ner ve

Somatic

sensor y

ner ve

T2

T3

T4

T1

Patient

perceives

diffuse

T1–4

pain

in

der matomes

C

GAS

B.

Invasion

o

stagnaton

peau

D.

E.

not

GAS

E.

te

Invason

w

152.

d’orange

Invason

duce

he

ce,

wc

he

B.

he

o

te

resut

n

and

dmpng

N

197;

artery

artery

most

ventrce

te

atera

and

te

te

suppes

posteror

suppes

breast

C.

in

he

te

D.

pro-

to

te

te

sternum.

et

atrum,

two

trds

o

C.

et

ex

artery

te

margna

and

207–213;

CT

he

arc

B.

scan

et

o

esopagea

te

te

he

aorta.

A.

camber.

suppes

he

GAS

153.

ventr-

(posteror)

posteror

nterventrcuar

trd

o

te

artery

nterventrcuar

artery

suppes

s

a

branc

te

o

obtuse

te

crcum-

margn

o

te

eart.

nerves

tssue.

rgt

te

septum.

skn.

not

neror

suppes

te

196

artery

anteror

septum.

w

pectora

cardac

nterventrcuar

nterventrcuar

overyng

asca

n

3.114C

ere.

o

posteror

resuts

resutng

ABR/McM

mmedatey

te

o

descrbed

meda

nodes

ymp

cavpectora

coronary

anteror

ymp

o

appearance

canges

es

s

axiary

ibross

te

crcumex

wc

et

o

141–143;

rgt

A.

te

and

Fig.

te

aorta

groove

et

vagus

arc

and

w

te

prenc

ung

230–231;

an

recurrent

he

he

N

sows

and

to

aryngea

beore

suppy

nerve

not

be

nerve

w

ABR/McM

aneurysm

o

nerve

traveng

te

traves

te

208–210

arc

oops

n

te

o

te

around

traceo-

arynx.

atera

to

te

aortc

compressed.

traves

not

be

anteror

afected

n

to

te

ts

root

case.

o

102

C H A P T E R

D.

he

te

E.

rgt

he

recurrent

aryngea

subcavan

greater

torax

toracc

rom

te

nerve

oops

around

C.

dd

spancnc

nerve

sympatetc

orgnates

trunk

at

te

n

ta

eves

deormty

not

arose

regress

artery,

proxma

but

to

ts

te

because

dsta

to

te

opton

sevent

te

rgt

sevent

dorsa

aorta

ntersegmen-

ncorrecty

states

ntersegmenta

t

was

artery.

D.

he it arc artery s not nvoved n ts deormty.

Fg. 3.50).

E.

he

233–235;

Durng

orms

artery

te

and

te

te

sevent

w

be

artery

N

243;

deveopment,

rom

ntersegmenta

ourt

arteres.

rgt

by

te

dorsa

segmenta

ormed

te

rgt

paryngea

I

In

te

te

ts

rgt

206

and

case

rgt

sevent

155.

hs

s

ncorrect

occurrng

not

on

n

te

te

et

as

te

deormty

gea

patent’s

rgt

subcavan

part

ts

te

ormed

arc

te

In

carotd

B.

artery

he

te

as

C.

artery,

he

trd

s

et

case

ormed

by

carotd

dorsa

aorta

Cer vical

but

Posterior

pulmonary

Esophageal

sac

te

te

and

et

dorsa

aorta.

te

regon

ourt

he

ourt

o

te

Fig.

3.50

n

not

aorta

aortc

paryn-

arc

vagus

arc

gve

lar yngeal

ner ve

nerve

ar teriosum

trunk

to

ts

ner ves

Sympathetic

plexus

w

contrbutes

nvoved

plexus

plexus

aortc

artery

nerve

GAS

s

206

arc

not

Ligamentum

pulmonary

artery

o

te

artery .

rse

to

artery.

recurrent

Left

Anterior

arc

toracc

te

aorta

s

cardiac

Left

vagus

aortc

ts

paryngea

common

endng

sde.

Right

irst

deveopment,

descendng

by

artery .

te

ABR/McM

embryonc

to

o

deormty.

aorta between te subcavan artery and te et common

subcavan

descrbed

rse

s

n

225–226;

Durng

arc

to

artery

ntersegmenta

s

A.

gves

arc

crana

subcavan

te

GAS

artery

sevent

paryngea

dsappear

rgt

ventra

nvoved

subcavan

arc

ourt

aorta

artery

retroesopagea.

s

ABR/McM

artery and te dsta dorsa aorta, wc does not regress.

B.

he

artery.

o T5–T9 and nnervates abdomna structures (GAS

GAS

A.

Thorax

rgt

te

154.

2

te

desc

anomay.

CHAPTER

D.

he

it

paryngea

bateray

E.

structures.

he

sxt

GAS

he

septum

uterne

not

a

overgrows

te

AV

oramen

prmum.

ovae

D.

he

E.

he

ng

and

w

part

sgni-

GAS

159.

orm

o

te

te

D.

wa

te

o

rom

te

septum

one

way

te

te

prmtve

prmum,

vave

a

AV

s

n

deormtes

even

ntra-

te

t

w

pumonary

w

232,

nerve

te

are

E.

patent

te

oramen

160.

B.

and

he

gve

rse

to

te

ascend-

rse

te

he

and

te

te

and



he

smoot

s

roots

te

aryngea

to

on

are

causes

te

bot

o

te

C.

around

nerve

ocated

rom

te

te

dyspnea.

apex

243;

he

D.

he

sdes.

aspect

rom

te

o

s

ar

and

pexus

s

GAS

he

icuty

172;

N

sma

and

not

a

o

nerves

te

aorta

on

too

jon

arranged

te

te

on

te

rgt,

te

superor

es

t

drecty

wen

te

to

E.

he

te

be

drect

and

spnous

o

wde

te

te

tracea

resut

o

te

processes

compresson

ungs.

pan

ndcaton

to

te

esopa-

n

ton

o

not

sensory

resutng

o

acute

above

te

vagus

eve

te

s

atra

be

te

present

but

coud

eatng

o

te

ony

above

et

cause

pusatons,

et

eart

pusatons

as

on

o

w

te

ony

aortc

wy

be

pres-

arc.

at

ts

te

oca-

pyscan

ABR/McM

te

vesse

190–191

te

anteror

wc

must

be

njury.

ven

accompanes

artery

procedures

te

and

s

neror

tereore

nvovng

te

ante-

artery.

ven

accompanes

s

not

aong

te

assocated

te

rgt

acute

wt

mar-

margn

te

o

anteror

artery.

rgt

vens

are

ound

ventrces,

brances

and

of

on

te

tey

te

anteror

accompany

rgt

coronary

te

tere

to

oods

tebra

wc

s

s

rom

arynx,

te

rrta-

wc

s

ne,

E.

s

rsk

t

o

spncter

ne.

s

and

te

ound

t

et

on

accom-

ventrce

space

egt

be

as

extent

rbs

and

sx

damagng

a

o

te

N

esopagea

durng

te

and

ten,

wc

spaces.

te

egt,

spaces.

A

te

o

te

ung

ud

s

tent

oter

and

rom

te

recess

te

At

recess

te

paraver-

between

and

eves

w

te

md-

wc

ncudes

At

s

to

costoda-

at

ntercosta

ncudes

spaces.

o

queston

reerence

costodapragmatc

ntercosta

wc

n

cavty

costodapragmatc

12,

toracentess

ts

done

peura

sevent

te

208–210

per ormng

he

te

and

168–171;

he

o

ABR/McM

s

soud

ne,

rbs

te

229;

o

sxt

extract

ventrce

ventrce,

artery

between

nnt

and

et

te

ntercosta

ntercosta

GAS

162.

ne

and

10

ent

due

N

recess

between

te

o

answer

were

te

o

posteror

md-axar y

egt

s

ven

aspect

3.82).

sevent

ncudes

s

atty

resut

te

atra.

te

auscutated

s

passes

md-cavcuar

rbs

coetass,

nerves

n

accompanes

t

207–215;

are

vertebra

because

te

correct

are

atrum.

toracc

resut

and

nerves.

rom

ibraton.

vsbe

arc

BP51;

and

cardac

te

pragmatc

tvey

cougng

te

he

te

d-

gastones.

Increased

B.

at

resutng

dysunctons

enarged

over

w

o

o

and

Fg.

reerrng

anteror

may

as

posteror

GAS

161.

205

enarged,

array

n

cardac

posteror

cavcuar

tenderness

Epgastrc

and

durng

beat.

N

cardac

unnamed

panes

cardopumo-

around

roots

ABR/McM

vomtng

a

and

md-

artery.

swaowng.

Pan

to

208;

atrum

symptoms

an

s

aong

compresses

Nausea

no

vscera

tat

ocated

et

and

o

to

nterventrcuar

anteror

(GAS

toracc

nary

te

beat”

t

atra

reasons

ven

artery

nterventrcuar

and

be

te

atrogenc

artery

eart

aortc

may

o

cardac

mdde

gna

nner-

esopagus

separated

artery

nerve

um

wraps

asca.

arc

subcavan

te

and

s

cause

aneurysm

one

ocate

(posteror)

tere

not

ibraton

te

an

vave

s

great

he

parts

211

prenc

damaged

and

to

sdes

atera

at,

around

te

anteror

nerves

musce,

Wrappng

ABR/McM

rgt

pass

ung

ntercosta

by

and

nerves

to

240;

nerory .

dapragm

vagus

“apex

aganst

o

wa.

200–206,

protected

A.

to

atra

rom

mtra

GAS

uness

woud

posterory

tere

woud

afected.

E.



he

septum

s

toracc

ton

between

tere

too

ent

trunk.

gve

passes

et

structures

recurrent

D.

s



wa

atrum

Pusatons

ter

but

deveopng

n

C.

ovae.

space

te

n

et

sma

et

B.

toracc

he

bot

te

orced

vsuazed

space

he

nterventrcuar

cords

prenc

on

205

typcay

termed

mpcated

tumor

A.

s

s

B.

te

atra

orma-

deects

oramen

nvoved

arterosus

N

ABR/McM

ntercosta

beng

nterventrcuar

he

gus

hs

bood

ror

213;

posteror

C.

it

not

vates

158.

ne.

o

et

223;

eart

GAS

ar

E.

te

N

te

he rgt atra soud not gve a vsbe pusaton on

wc

durng

nvoved

septa

patent

and

not

are

and

cause

wt

prmum

and

n

o

A.

dorsa

ormaton.

bubus

apex

resut

te

septum,

s

truncus

228–229;

he

cavcuar

pu-

206

deveops

te

cuson

It

aorta

he

D.

dsappear

any

(artera outow) o bot te et and rgt ventrces.

ung

C.

artery

et

cusons

may

assocated

endocarda

B.

and

rgt-to-et

o

he

te

arc

te

secundum

deveopment

A.

to

contracton.

endocarda

ton

157.

w

deveopment.

he

B.

on

ABR/McM

cuson

It

becomes

artery

contrbute

trunk.

endocarda

A.

paryngea

220–226;

ventray.

arc

not

papated

arterosus

monary

C.

does

cant

ductus

156.

and

103

Thorax

2

not

eev-

stand

efec-

space.

208

atus

creates

dapragmatc

a

pysoogca

contracton.

As

te

104

C H A P T E R

2

Thorax

Great

Anterior

of

right

cardiac

veins

ventricle

Coronary

sinus

Anterior

Small

cardiac

A

Inferior

of

the

interventricular

vein

Right

Great

vein

vein

cardiac

marginal

vein

Middle

cardiac

vein

vein

(posterior)

left

ventricle

Small

Coronary

sinus

Middle

B

GAS

Fig.

3.82

cardiac

vein

cardiac

vein

vein

CHAPTER

esopagogastric

junction

anatomicay

pysioogicay

point

A.

o

he

B.

At

sgty

passng

te

gve

o

eve

to

but

te

o

ofered

te

D.

area

E.

t

he

te

t

passes

woud

et

A.



o

or

he

may

gve

be

to

ts

D.

s

s

te

openng

ocated

te

irst

N

te

aortc

o

et

te

man

to

to

and

te

w

GAS

166.

resstance

arc

serves

acts

nasogastrc

as

A.

s

does

artery

nterventrcuar

corona

t

o

s

a

te

GAS

te

pays

te

by

artery

rgt

et

coronary

t

arses

no

rom

roe

n

I

C.

but

n

te

te

artery

arses

artery

s

not

comes

rom

determne

te

rgt

to

E.

te

GAS

167.

ar

may

a

anasto-

determnant

te

of

et

te

It

crcumex

coronary

domnance.

snuatra

coronary

node

artery

N

te

does

arses

not

to

con-

he

ABR/McM

vave

ntercosta

can

space

at

be

best

te

B.

auscu-

te

best

sde

aortc

et

border

space

ste

at

to

te

et

C.

mdcavcu-

auscutate

te

D.

mtra

E.

he

known

eart

a

s

not

used

o

te

space

to

and

at

te

auscutate

trd

sternum

rgt

te

te

areas

o

trcuspd

ntercosta

are

border

243;

patent

N

spaces

to

trad:

and

Percardocentess

nto

te

tube

sgns

ven

s

te

to

te

he

a

C.

rom

a

Cest

nserton

B.

Centra

venous

nes

are

venous

uds,

and

not

not

w

muled

be

cardac

be

to

a

absent

a

to

neede

aevate

to

to

anteror

aevate

a

cardac

D.

vscera

and

are

te

211

te

te

et,

abdomen,

cy,

te

crosses

eve

to

nto

scenaro,

wt

azygos

and

o

te

te

te

te

et,

te

ven

ver-

sterna

posteror

superor

ts

and

dapragm.

te

anterory,

At

motor

uncton.

csterna

n

nerves

bronc.

somatc

n

te

uncton.

vesse

med-

woud

contan

deoxygenated

not

a

bood

as

ven.

contan

sava

as

t

s

a

ym-

not

contan

urne

as

t

s

a

ym-

w

not

contan

structure,

N

242–243;

structures

to

n

posteror,

deveops

tract,

rom

neror

oxygenated

not

te

are

ABR/McM

tymus,

as

t

228

medastnum,

vens,

ympatc

trd

paratyrod

bood

artery.

superor

and

te

an

arteres,

trunks.

paryngea

he

pouc

as

gand.

he irst paryngea pouc dervatves are te endo-

te

ntra-

w

amentary

brane.

C.

dever

suppy

cardac

ABR/McM

ts

structure,

not

236–238;

nng

antrum,

a

not

structure.

tympanc,

ud.

rom

w

ymp.

not

w

unop-

arsng

medastnum

on

ts

pregan-

are

pexus

cardac

atus

ascends

n

te

structure.

major

te

on

caed

duct

ympatc

derm

s

tamponade.

utzed

A.

resut,

perormed.

extract

done

or

As

does

w

eart

238;

aorta

te

ncrease

nerve

on

orgnates

aortc

and

ibers

cardac

neurons

efect

236,

rom

rate.

toracc

te

posteror

contan

vesse

tymus

tamponade,

wereby

space

A.

tamponade.

cardac

soud

procedure

percarda

190–191

o

to

pexus

prenc

esopagus

ympatc

he

peura

208

damaged

efect

te

posterory.

vesse

GAS

168.

te

te

vesse

he

N

hereore,

a

a

rate.

te

daton

te

vesse

he

s

vave.

on

sten

dstenton.

procedure

s

pneumotorax,

o

ypotenson,

juguar

percardocentess

nserted

BP51;ABR/McM

exbts

Beck’s

sounds,

any

cardac

management

T1–T4

eart

te

no

n

no

toracc

key

arway,

214,

as

te

n

duct

esopagus,

patc

te

vave.

GAS

165.

ntercosta

Second

to

resove

cardac

te

eart

orn

toracc

rgt,

he

t

E.

E.

n

are

te

rom

ave

a

ibers

ave

ventra

troug

astnum.

210–212

and

ibers

as

ibers

wtn

te

toracc

patc

ntercosta

s

it

sternum

and

rgt

te

most

229;

trcuspd

ourt

it

ne

aevate

normaton

parasympatetc

aferents

bodes

ange,

usuay

and

ts

tebra

to

wt

ABR/McM

down

eferents

and

ascends

on

artery.

sow

216–219;

he

ascends

vave.

D

A.

done

receves

rom

nerve

pan

T1–T4

rgt

domnance.

o

not

secondary

assst

223;

tese

ncrease

Vscera

sternum.

he

vagus

carry

s

determnng

I

dapragm

domnant

N

ibers

w

Somatc

were

arses.

rate.

to

be

not

node

Pregangonc

tube

may

pregangonc

vaga

descendng

to

w

occur

tamponade.

sometmes

posteror

207–213;

Murmurs

tated

artery

and

nterventrcuar

not

nserton

tat

w

190–194;

and

act

determned

t

snuatra

eart

posed

B.

crcumex

margna

hs

he

gonc

esopagus.

broncus

te

as

244

rgt

D.

but

sympatetc

domnance.

wc

tube

symptoms

efuson,

esopagus.

domnance

te

he

te

horacocentess

te

to

te

margna

wt

trbute

C.

Nasogastrc

o

com-

resstance

toracc

juncton

resstance

artery

et

et

rom

B.

C.

ast

domnance.

artery

o

eiter

te

nerves

anteror

mose

A.

o

te

rgt

rgt

164.

o

te

rom

he

D.

be

domnant.

coronary

C.

vave

cardac

resstance

(posteror)

rom

he

B.

o

231–234;

neror

atrum

not

superor

troug

queston

arses

eart;

a

woud

esopagus.

ste

ste

et

owever,

posteror

trd

GAS

163.

te

te

posteromeda

second

te

as

by

area

he

ave

tis

tube.

te

resstance;

he

not

tamponade.

posteror

paryngoesopagea

C.

does

resistance.

area

pressed

te

or

105

Thorax

2

te

and

hs

tymus

Atoug

uture

Eustacan

nner

aspect

answer

coce

comes

te

rom

second

t

he

paryngea

ourt

s

te

contrbutes

gand

o

tube

mdde

te

tereore

trd

to

te

pouc

and

(paryngo-

ear,

mastod

tympanc

mem-

ncorrect

paryngea

paryngea

obterated,

paratyrod

audtory

tube),

pouc

paatne

orms

te

s

as

arc.

argey

tonss.

superor

utmobranca

body,

106

C H A P T E R

2

wic

roid

E.

Thorax

orms

te

paraoicuar

C-ces

o

te

ty-

B.

he

tum

it

paryngea

structure

tat

as

no

pouc

s

a

rudmentary

contrbutons

to

GAS

sgnicant

ated

D.

ar

A

tenson

on

medastna

and

vscera

reeve

A.

o

te

and

te

he

space

serous

C.

ayers

te

Insertng

peura

a

arrest

be

rapd

s

to

nserted

te

ntrapeura

postve

be

It

uar

to

and

ayers

te

o

pareta

a

te

between

A.

neede

between

te

not

w

reeve

B.

Insertng

asca

te

and

C.

GAS

C.

neede

pareta

n

164–165,

Wt

an

pa

on

ectopa

abnorma

cords,

te

between

peura

do

undergo

169–170;

cords,

eart

o

not

w

te

aso

endotoracc

not

aevate

E.

he

a

s

te

N

rare

In

te

ABR/McM

toracc

or

torax.

deveop

211;

condton,

party

he

uson

te

pa

B.

her

o

tat

ods

unte

ncompete

durng

o

exposed

te

o

te

peuropercarda

and

o

ead

to

orm

a

wa

key

te

does

not

A.

Faure

and

o

cause

septum

transversum

does

not

o

te

ead

wt

to

171.

A.

here

uson

between

pertonea

septa

our

deect:

deect

venosus

deect,

cuson

matey

deects

20%

N

coeom

erna,

te

w

o

222-223;

cncay

ostum

cuson

and

o

aso

assoc-

septa

trsomy

are

deects

21

(Down

211–213

te

most

accountng

A

by

common

or

approx-

membranous

common

aed

type

endocarda

t

may

o

te

It

s

nter-

cusons.

deect

arterosus

ventrc-

but

septum.

uson

parttonng

at

et

deect

brt

eart

septa

not

C.

or

ead

to

transposton

o

ntay

due

and

to

te

deect

may

s

causes

pressure

rgt

an

a

et

gradent

eart.

acyanotc

eart

E.

coeom

ectopa

ead

to

wt

and

wt

ABR/McM

sgnicant

secundum

ostum

ostum

persons

deect,

endocarda

21

snus

Endocarda

occur

trsomy

atra

n

approx-

(Down

syn-

A.

and

s

soud

w

ead

to

(e.g.,

great

by

poston

dspacement

compcated

snge

vesses).

ventrce

hs

growt

o

case

te

o

by

and

most

prmor-

et.

superor

not

211–213

abnorma

usuay

abnorma

te

and

w

ead

growt

to

o

neror

not

te

ead

te

o

te

prmorda

dextrocarda

growt

to

bubus

truncus

seen

n

o

soated

cords

arterosus

or

te

prmorda

dextrocarda.

coud

ead

to

transposton

per-

o

te

vesses.

Growt

o

o

te

te

227;

prmorda

norma

N

223;

eart

tube

deveopmenta

ABR/McM

to

te

rgt

s

process.

203

174–189

he

toracc

as

troug

ts

deect

rom

w

te

accompaned

te

to

cosure

ABR/McM

dextrocarda,

anomaes

tube

Deects

tmes

n

233–235;

o

secundum

o

patent.

GAS

174.

o

deect,

atrum.

prmum

wt

types

prmum

common

203

septum

Faure

ovae.

hs

resuted

eart

and

brt.

not

cardac

great

ectopa

not

s

ventrce

ods

percarda

N

soated

Anteror

te

Answers

are

sep-

s

syndrome).

types

nterventrcuar

caused

ater

vscera.

ts

ectopa

peuropertonea

dapragmatc

195–199;

te

prmum

213;

atrum

ecto-

cords.

GAS

te

specicay

ABR/McM

most

septa

te

eart

part

te

o

sunt

Posteror

percarda

cords.

E.

o

vesses.

transposton

peuropercarda

become

uson

ods

uson

to

te

oramen

sstent

Faure

w

te

severe

cords.

D.

not

wt

deects

truncus

soon

Wt

oter

atera

toracc

D.

B.

uson

rgt

GAS

173.

ecto-

percardum

because

s

cords.

Faed

rare

deects.

cords

Ventrcuar

da

peuropercarda

sac.

part

great

use

218

eart

orm

competey

propery

ncompete

membranes

s

septum

Septum

a

ormaton.

A.

any

patent

ocaton.

surace

sternum

ods

te

uson

secundum

dsease.

pneumotorax.

170.

deect

between

a

eart

Ventrcuar

pneumotorax.

E.

s

(Down

233–235;

septa

o

bubus

te

medastna

w

t

assocaton

commony

to

percardum

but

21

aed

septum

maormaton,

persstent

pneumotorax.

ibrous

25%

at

A

te

percardum

to

te

reatvey

N

eart

ventrcuar

s

pneumotorax.

space

no

213;

septa

occur

ayers

percardocentess

aevate

nto

o

most

vscera

were

trsomy

are

Ventrcuar

matey

te

order

D.

type

avoded.

n

wt

sow

due

wt

common,

hese

GAS

172.

recogn-

between

peura

s

deect

syndrome).

pres-

structures.

requrng

o

not

neede

te

and

s

w

ibrous

aevate

wen

exertng

and

pneumotorax.

and

te

228

ntratoracc

must

between

and

occurs

cardac

percardum

Insertng

not



pareta

tenson

te

ABR/McM

occurrence

neede

perormed

B.

and

treatment

hereore,

222;

progressvey,

e-treatenng

ton

N

pneumotorax

accumuates

sure

a

C–E.

220–222;

septa

prmum

reatvey

structures.

169.

Atra

gand.

te

a

te

te

and

o

sterna

te

te

te

atus

n

medastnum

azygos

rory ,

orgnates

caed

aortc

posteror

et,

duct

daton

ven

on

vertebra

ange,

te

ts

n

te

csterna

te

te

rgt,

te

duct

some-

ascends

It

toracc

ascends

aorta

esopagus

posterory .

toracc

and

dapragm.

wt

bodes

abdomen,

cy,

At

crosses

te

to

on

ante-

te

eve

et,

drome); oterwse, t s a reatvey uncommon cardac

posteror to te esopagus, and ascends nto te superor

deect.

medastnum. Gven ts ocaton, t s most key respon-

o

te

hs

specic

septum

deect

prmum

arses

wt

te

due

AV

to

aed

septum.

uson

sbe

or

te

coecton

o

ud

seen

on

cest

CT .

CHAPTER

B.

he

esopagus

indngs

C.

Injury

to

te

coecton

but

D.

t

E.

due

azygos

he

ts

uson

arge

o

pragm.

are

N

B.

produce

a

medastnum,

mmedate

C.

dscom-

produce

te

o

n

woud

ts

coec-

produce

s

pertonea

anoter

hs

and

wt

resuts

regon

o

te

transversum

esopagea

atresa

a

da-

A.

opment

cavtes

B.

te

he

n

presents

can

ead

tat

tracea.

canges

It

to

to

C.

by

te

te

GAS

176.

A.

A

ar

ventra

septum

372;

tenson

on

tna

N

descrbed

D.

not

n

son

to

B.

to

cea

most

C,

D,

eart

and

arrest

key

tat

as

st

o

to

ar

detect

E.

te

on

Cardac

occurs

ton.

hese

optons

wen

be

he

eart

sgns

patent

a

to

be

s

to

medas-

e-treatenng

and

treatment

avoded.

a

pres-

In

ts

rgt-sded

ten-

contents

ave

as

t

te

not

s

ung

te

or

not

as

s

can

pressure

ud

buds

and

be

kewse

not

may

resut

be

contents

ung

tere

s

not

cause

n

opaci-

assocated

toward

w

ieds

oss

169–170;

due

s

to

te

aso

but

wt

oppo-

not

oss

o

peura

N

211;

o

cause

vascuar

ntegrty

ABR/McM

nammaton

many

nerve

wc

to

supped

even

by

o

te

218

te

par-

ntercosta

te

pareta

he

suppes

te

te

centra

dapragmatc

typcay

afected

and

and

pareta

not

ame-

suppes

ungs

and

vscera

vscera

eferents

peura

and

but

not

peura.

toracc

carry

not

o

bocks.

nerve

to

ony

parts

s

nerve

vagus

he

vscera

somatc

to

(cardopumonary)

aferent

aevate

169;

as

N

n

E.

Due

rent

ror

d-

ts

up

n

te

te

te

ibers

and

peurtc

ven

patent,

deayed

to

poo

n

ABR/McM

presentaton

te

toracc

o

ear t

nerves

woud

pan

do

not

seen

n

be

ts

ave

a

systoc

eard

n

ncreases

he

wt

te

oter

ner ves,

o

a

crossng

a

S

2

ar ter osus.

ductus

te

patent

dec ne

toward

et-

te

(mac n-

p atent

troug

pysoogca

ntro-

pumonar y

ductus

o

supe -

durng

ro m

contnuous

rsk

te

recur -

te

presence

patent

pressure

et

n

damaged

te

te

sunt

te

n

end

o

te

te

e.

nerve

procedure

muc

ess

vagus

procedure

easy

murmur

te

bood

vagus

rgt

te

ocaton

tan

ndcate

A

o

he

more

o

ungs.

200

o

Increased

irst

B.

ts

caracterzes

te

course

torac os cope.

ar ter y

et

branc

te

protected

pumonar y

were

a

ABR/McM

and

s

s

nnervate

and

ncre ases

he

t

markngs

mont

220;

oopng

posteror

sunt.

sound

nerve

not

procedures

murmur

duct

A.

N

ner ve

te

ar teros us.

runs

rsk

o

nerve

does

not

deep

woud

and

take

posteror

pace

and

to

woud

njury.

woud

nvove

not

be

afected

structures

o

as

te

ts

rgt

torax.

can

as

o

does

ong

more

Prematurty

he

as

cyanoss

cavty.

are

to-rgt

tese

tat

te

medastnum,

vascu ar

218

emotorax

166–172;

to

ducton

dsten-

so

aryngea

and

ar yngea

wc

ay-

ypoten-

nerve

toracoscopc

C.

211;

deveoped

recurrent

vagus

tamponade

trad:

juguar

on

pareta

cardac

Beck’s

and

seen

tra-

non-expandng

tat

vscera

Cassca

known

te

exam.

tamponade

bood

a

cause

ncorrect.

wt

contnues

E.

ormed

ntrapeura

eadng

s

woud

sounds,

are

be

164–165,

assocated

bood

s

postve

medastna

et

between

sgns,

woud

GAS

A.

tree

muled

s

pysca

percardum.

son,

It

recognton

around

ers

te

he

er y)

cavty

o

and

scenaro

te

wen

exertng

sde.

rapd

percarda

ncudes

177.

to

wc

orm

et.

coecton

icut

te

s

wc

prenc

GAS

occurs

structures

opposte

pneumotorax

to

gament

179.

progressvey,

te

te

Smpe

acorm

mesogastrum,

requrng

te

and

pneumotorax

pneumotorax

sted

and

pan

targeted

transversum.

cardorespratory

patent,

he

not

ts

222

medastna

st

occurrence



omentum

accumuates

sure

peura

te

deve-

woud

w

pneumotorax

o

164–165,

peura

rudmentar y

contrbutes

and

te

a

w

observabe.

aferents

s

sot

nvove-

ieds.

and

medastna

ied

cyanoss.

ung

ieds

mnma

ung

patent.

esser

rom

not

nabe

deects

groove

ar ynx

mpcated

patent

TEF .

structure

o

te

te

sow

any

nerves.

posteror

patent.

E.

ung

o

Peurtc

eta

cause

pneumotorax

o

just

ung.

GAS

178.

w

wtout

dapragm

o

Spontaneous



erna.

septum

or

ar yngotracea

resprator y

deect

dapragmatc

T raceoesopagea

be

T enson

not

te

dapragmatc

mdne

he

w

o

markngs

te

n

te

peura

aong

un-

and/or

tse

and

Parayss

opacicaton

usuay

membranes

by

ment

ste

228

ormaton

dapragm.

one

not

E.

erna

posteroatera

te

aso

ABR/McM

deectve

te

wt

cest

opacicaton

caton

patent.

242–243;

te

a

tssue

opacicaton

D.

not

A

stng

rom

resut,

septum

wt

D.

te

wa.

In

C.

a

contnuous

body

A.

As

aso

peuropertonea

n

or

pressure.

dapragmatc

parts

openng

mgt

posteror

more

ympatcs

resuts

te

responsbe

aorta

te

woud

seen

236–238;

tree

be

patent.

ere.

bronca

and

n

cause

g

ven

Congenta

oter

key

coecton

atera

not

ts

descendng

descrbed

GAS

B.

to

n

bood

woud

ort

te

175.

o

he

ton

woud

descrbed

107

Thorax

2

et

te

muc

D.

he

prenc

et

more

rgt

GAS

nerve

recurrent

oopng

prenc

228–233;

N

s

not

as

aryngea

and

nerve

243;

key

varabe

w

to

nerve,

not

be

afected

wc

course.

be

ABR/McM

afected.

202

as

a

108

C H A P T E R

180.

B.

Any

2

Thorax

pneumotorax

percussion,

cuar

site

markings,

side

ony

caused

resut

to

o

motorax

wa

but

tat

by

te

a

is

cause

a

by

yperresonance

sounds,

tracea

opposite

and

deviation

distended

tension

tension

side

caused

deects

in

reduce

to

te

juguar

o

te

by

eiter

to

muscuar

can

ung

te

is

cest

cardum

viscera

not

sit

tures

to

torax

C.

te

same

sde

space

now

Cardac

juguar

Lung

sgns

tracea

o

te

decreased

D.

he

rom

but

node

may

ung

area

rgt

o

pes

te

ror

te

matc

o

et

i

to

te

B.

te

peura

muled

and

te

some

any

sot

eart

tssue

te

cause

ung

to

te

AV

E.

N

aorta.

artery

(coser

wa.

It

artery

suppes

to

In

arse

he

to

or

anteror

te

rse

o

to

(posteror

te

cor-

posteror

A.

B.

te

peroratng

o

et

te

he

and

et

and

atera

o

C.

nterventrcuar

suppy

he

te

te

dagona

artery

o

anteror

most

te

of

o

eart

te

va

te

It

A.

ante-

GAS

A.

coronary

gves

(LAD)

not

dapragmatc

o

207–211;

he

artery

of

and

gve

o

but

o

te

do

te

te

of

surace

brances

o

N

229–230;

embr yoogca

esons

ment)

B.

te

s

te

bass

come

to

anterosuperor

deveopng

te

devaton

outet

208–210

combnaton

(maagn-

ventrcuar

septum

185.

w

eart

es

te

te

outet

anterosuperor

be

s

abnor-

responsbe

produce

not

or

cyanoss.

produce

symptoms

woud

eart

te

observed

n

eart

produce

symp-

aure.

tube

seen

n

oopng

ts

ABR/McM

mmedatey

woud

not

patent.

211–213

posteror

aorta,

and

posteror

o

te

atrum

to

are

te

es

to

o

te

te

to

te

tereore

to

te

t

utra-

esopagus,

posteror

adjacent

et

cause

vens

posteror

rgt

anteror

resdng

and

to

atrum

te

can

but

surace

esopa-

compress

dyspaga.

too

atera

at

ts

pont

to

transducer.

urter

anteror

and

w

not

seen.

rgt

be

ventrce

228–229;

at

he

te

T10

T7

N

223,

vertebra

any

and

w

s

he

T11

vertebra

T12

or

te

205

dapragm

s

s

not

passage

ound

IVC/rgt

eve

s

dapragmatc

dapragmatc

usuay

assocated

openngs.

at

te

prenc

not

T8

verte-

nerve.

assocated

wt

any

aorta

and

openngs.

atus

s

or

te

duct.

228–229;

Cardac

N

244

tamponade

decreased

(Beck’s

bood

w

decreased

markngs,

and

w

cause

pressure,

muled

and

eart

dstended

jug-

trad).

Pneumotorax

cusson,

te

eve.

eve

eve

sde,

anteror

ABR/McM

wtn

dapragmatc

dapragmatc

vens

244;

vertebra

bra

sounds,

urter

atus

he

he

es

seen.

esopagea

ar

and

majorty

we

he

uar

not

descendng

GAS

C.

A.

rgt

atrum

seen

GAS

of

o

devated

septum

woud

mmedatey

orm

toracc

eart.

contrbute

ABR/McM

o

E.

tat

do

233–235;

te

sgnicant

crcumex

brances

eart

not

anteror

o

pumonary

wt

obtuse

sgns

Enargement

he

ound

D.

artery

does

margna

C.

et

structures ound at te eart’s dapragmatc surace.

182.

184.

wa

te

deect

deects

o

esopagus

not

brances.

comes

suppes

suraces

artery

artery.

rgt

rgt

t

and

te

he

be

comes

troug

he

myo-

mgraton.

structure

seen

et

he

be

daprag-

septum

te

abnorma

symptoms

N

s

does

te

B.

brances.

coronary

coronary

wt

coronary

artery

et

margna

he

brances

ventrce

crcumex

ror

E.

nterventrcuar

septa

coronary

C.

o

ventrcuar

transducer.

he

gus.

poste-

artery

ventrcuar

overrde.

consequence

by

te

wt

responsbe

o

aortc

ventrcuar

prmtve

te

213;

be

o

D.

(LAD)

te

aso

rgt

ypertenson

typca

man

sup-

eart.

nterventrcuar

he

ven-

descendng)

or

s

o

conused

patent.

Abnorma

t

ndvd-

te

te

constrcton

Pumonary

sound

te

dapragm)

85%–90%

gves

tat

E.

of te et coronary artery and suppes te anteror

two-trds

arc

woud

snuatra

artery

o

cuson

cuson

esopagus

drecty

suppes

te

created

ce

Aortc

GAS

183.

218

rgt

te

aso

margna

nterventrcuar

te

ABR/McM

arteres

node.

rgt

coronary

o

211;

or

percusson.

o

outet

carda

toms

and

devaton

to

nundbuum

te

porton

anteror

tracea

duness

te

crest

Endocarda

ts

above

edema

te

consteaton

dstended

o

neura

n

be

type

emodynamc

cause

o

to

septum)

resuts

esons

produce

ascendng

rse

to

artery

surace

cause

te

(not

ypertroped

devaton

deects n te AV septum and AV vaves. he endo-

C.

cause

coronary

ventrcuar

rgt

not

not

but

to

and

ower

hs

he

to

ma

pneumo-

deviation

pressure,

169–170;

gves

(neror)

artery.

ung

w

produce

pumonary

wa

te

Spontaneous

struc-

and

he

devaton

ung.

bood

w

w

artery

anteror

uas,

A.

root

te

trcuar

mediastina

wi

nammaton.

and

artery

and

it

D.

164–165,

te

onary

as

vens.

yperresonance

181.

te

tamponade

incorrect

tracea

coapsed

by

is

oter

side.

causes

unused

Pneumona

GAS

and

opposite

contuson

mnor

E.

te

normay

sounds,

D.

pneumotorax

s

he

maagnment

ypertropy

anatomca

septum.

Spontaneous

septum

te

deect

assocated

peura.

A.

outet

creatng

septa

and

trabecuatons.

aortcopumonar y

or

pneu-

te

or

nundbuum)

septopareta

oppo-

T ension

parieta

(pumonar y

T racea

aected

injuries

te

to

vas-

veins

pneumotorax.

pneumotorax.

typicay

cause

may

breat

accompanied

be

deviation

a

decreased

cause

breat

tracea

dstended

yperresonance

sounds,

devaton

juguar

vens.

reduced

to

te

to

per-

vascu-

opposte

CHAPTER

B

and

nary

and

E.

D.

Deep

emboism,

even

deat

ung

GAS

A.

he

area

correct

B.

na

at

te

E.

ntercosta

o

te

D.

n

o

space

te

pane,

ror

he

ror

o

As

sterna

te

to

to

best

Beck’s

A.

te

hs

trad.

at

cest

te

space

et

B.

para-

and

s

at

te

ntercosta

wc

hs

s

to

s

ange

(o

pane

woud

to

hs

Lous)

as

atera

aone

s

n

bot

we

between

ourt

te

te

trans-

anteror

superor

med-

vew

make

anteror

and

t

d-

poste-

aone

woud

make

posteror

t

and

d-

ante-

tat

woud

s

may

not

be

to

examne

mssed

deay

on

vsuaze

a

areas

A/P

te

or

ange

te

GAS

sterna

an

ange

axa

cut

132–133;

E.

he

ta

musces,

ibers

o

rom

order

N

(o

may

mss

2192;

traversed

nterna

Lous)

s

es

te

wtn

eve

ABR/McM

skn,

ntercosta

te

axa

competey.

199,

externa

musces,

201

ntercos-

nnermost

as

wen

te

he

peura

answer

t

s

cest

because

removed.

coce.

pareta

structures

as

s

te

peura

traversed

vscera

by

(4)

te

peura

(6)

ncorrect

woud

ntercosta

N

or

as

B,

C,

D,

te

and

to

abdomen,

T5

as

toracc

nnervaton

o

(3)

nter-

tat

o

as

carry

to

te

or

te

te

dorsa

and

sufers

musces

constrcted,

he

te

vagus

mucous

vagus

nerve

gand

w

provde

greater

root

many

inay,

sensory,

motor

toracc

sympatetc

gangon

pan

tat

tree,

sensaton.

ceac

vscera

motor,

N

smoot

pregangonc

are

musces

patent

traceobronca

pan

te

dermatome

358–364;

are

nerve

nerves

eart,

smoot

answer.

te

199–200

te

dapragm,

to

te

parasympatetc

te

te

tree

or

carry

ntercos-

beore

(5).

nnervatng

T9

back

o

musce

nterna

Snce

correct

te

w

vscera

responsbe

nnervaton

GAS

tree.

Prenc

o

to

we

abdomen

(6)

peura

externa

traversed

ABR/McM

responsbe

nerve

rom

or

E.

te

be

contractng

key

musce

spancnc

te

postgangonc

submucosa

beng

as

musce

condton

responsbe

n

peura

pareta

ntercosta

not

206;

carres

most

vsc era

te

(5).

s

a

te

beore

traceobronca

te

we

are

traversed

(1)

nerve

as

beore

nnermost

be

musce

te

s

as

T9,

te

not

astma,

aso

ibers

ncorrect

traversed

traceobronca

o

nerve

s

responsbe

te

te

Lous.

ast

ncorrect

153–157;

Vagus

suppy

used

te

peura.

vscera

correct

ncorrect

o

be

musce

ound

between

vew

A.

ces

vew.

woud

most

s

answer

GAS

189.

190–191

not

externa

border.

structures.

apces

It

a

te

te

pneumotorax

s

one

and

costa

D.

et

structures.

ordotc

ung

be

at

parasterna

vew

as

vew

dstngus

vew.

et

ABR/McM

dstngus

apca

te

auscutated

te

pareta

tube.

woud

it

te

be

a

te

answer

(4),

ne,

s

answer

hs

auscutated

te

E

woud

paraster-

typcay

cause

and

traverse

woud not be traversed beore te pareta peura (4).

te

space.

vave

s

rgt

not

answer

woud

C.

eard

medastnum,

medastna

pane,

188.

percussion

produce

coud

hereore,

208

mdcavcuar

posteroanteror

P/A

E.

to

not

up

ntercosta

aong

BP51;

medastna

he

o

te

anteroposteror

icut

D.

make

(bcuspd)

vave

structures,

he

icut

B.

w

auscutated

eart,

space

N

posteror

astna

A.

243;

Snce

and

duness

musce,

soud

ta

trcuspd

GAS

C.

breat

ts

ABR/McM

best

second

at

o

tube

scenaro.

s

mtra

te

ntercosta

pumo-

sternum.

he

verse

ts

te

ntercosta

187.

n

s

to

sortness

but

wc

223;

ead

triad.

wit

second

vave

he

apex

N

vave

te

aortc

area

and

n

answer

he

C

symptoms

188–194;

may

cause

Beck’s

opacicaton

pumonc

sterna

can

not

presents

ied

descrbed

trombosis

wic

but

Hemotorax

and

186.

vein

109

Thorax

2

n

sensaton

ganga

o

te

rom

T5–

responsbe

ntercosta

and

tey

or

nerves

sympatetc

nnervate.

214; ABR/McM

218

3 Abdomen

Q u e st i o n s

Questions

1.

A

1–25

1-year-od

genta

tons

mass.

and

majus

to

sue

2.

to

s

ts

Pareta

T ransversas

D.

Dartos

E.

Interna

sgns

A

et

rena

Wc

o

are

and

From

mass

reducbe

o

te

wc

o

o

te

non-

Rena

A

wtn

ageness

weeks’

o

vst.

Her

te

Se

obque

urne

to

lud

norma

sows

mts.

anrda.

lanks.

A

are

o

Hs

exam-

5.

papated

te

Wms

mutatons

s

Rena

D.

T raceoesopagea

E.

Uretra

condton?

38

he

gene

responsbe

or

HGF

matc

C.

he

gene

responsbe

or

VEGF

dcutes

D.

he

gene

responsbe

or

GDNF

tat

E.

he

gene

responsbe

or

FGF-2

o

aton

o

story

sgns

are

sows

n

te

te

recurrent

o

deayed

wtn

norma

up-santng

pams

lanks.

kdneys

norma

o

An

urnary

nectons.

mts.

papebra

te

ands.

utrasound

bateray.

appearng

tract

deveopmenta

A

CT

rena

o

Pysca

masses

te

scan

tssue

and

abdomen

o

at

te

te

as

vo  u m e s

key

dagnoss

o

te

A.

Bcornuate

uterus

B.

Cryptorcdsm

o

patent’s

te

Ogoydramnos

Poycystc

examnaton

C.

Poyydramnos

D.

Rena

E.

Uretra

creases

n

abdomen

sows

L3–L4

vertebra

oowng

s

te

most

condton?

 ow

x-ray

and

o-

o

te

o

tat

by

te

nant

te

te

tube,

b oy’s

n

etus

cest

o

ud

re d u c e d

re s p  r a t o r y

p ro b  e m

urnate.

best

and

s  ow s

daprag-

u t e ro

to

a

d e ve  -

re s u s c  t a t  o n

sgns

an

d e   ve r s

pyscan

amnotc

te

o

no

0,

Te

endotracea

re  a t  o n s   p s

B.

absent

congenta

 a   u re

para

re q u  r  n g

An

caused

A.

sows

wt

congenta

Wc

descrbes

ts

condton?

6.

A

ment

days.

ow

brt

boy

s

wt

nked

nked

to

to

brougt

He

as

not

medca

wegt,

wtn

norma

sunken

eyes

and

moter

to

and

oss

o

tat

stoo

Pysca

or

s

snce

21.

vscera

emergency

ncudes

skn

ungs

suractant

ectopc

te

says

trsomy

mts.

to

vomtng

passed

story

ypopastc

TEF

nsuicent

nked

greens-yeow

patent’s

Hs

nked

obstructon

wt

he

kdneys

ageness

2-year-od

began.

Wc

n

1,

d e   ve r y,

appears

 o   ow  n g

canged.

mdne.

It

we re

re s u  t s

poes

te

d  s t re s s

a

papated

eve

sows

ndngs

 a b o r.

s e ve re  y

te

b   a t e r a   y,

ernas.

eve wt uson o te et and rgt kdneys at te ower

n

to

vta

Her

sman

are

evau-

Se

mestones.

ssures

No

or

due

ater

postoned

c o r re c t  y

B.

pyscan

te

(TEF)

gravda

a

ung

te

cnca

nduced

ve n t   a t  o n .

WT1

to

an

re s p  r a t o r y

or

brougt

va

mecanca

responsbe

s

at

consstent

ds-

Pysca

abdomen

oowng

te

stua

woman,

abor

gene

gr

cm,

at

pre-

cronc

mts.

egt

te

1,

a

atresa

we e k s

he

10-year-od

o

or

stenoss

S o r t  y

te

aborta

ageness

2 8 - ye a r - o  d

at

o

te

expans

C.

A

story

unda

5

o

1,

examnaton?

Anencepay

ops

most

tan

Pyorc

 e ve  s .

tumor.

te

ess

B.

nduced

kdneys.

uterne

para

pyscan

norma

utrasound

A.

b oy

tomograpy

nvovng

dagnoss

gene

depart-

pan.

Pysca

Masses

computed

masses

te

oowng

emergency

abdomna

3,

te

wtn

Wc

best

to

medca

are

a

An

o

goydramnos.

te

no

sows

gravda

comes

sgns

umbcus.

amnotc

aponeuross

and

as

vta

A.

A

woman,

gestaton

examnaton

ts-

kdney

35-year-od

utrasound

batera

ts

E.

eases.

derved?

brougt

rgt

Hypospadas

nata

embryonc

oowng

Horsesoe

D.

29

abum

deep

an

te

and

rgt

ntestne

aure

at

C.

maormatons

conrms

te

or

s

wtn

bopsy

common

o

o

a

4.

tssue

dark

eye

sows

o

oop

compca-

deveopmenta

sows

s

a

asca

boy

te

scan

mass

because

abdomna

because

te

(CT)

wtout

wt

asca

3-year-od

n

pyscan

pertoneum

C.

o

term

utrasound

structure

Extrapertonea

naton

he

An

obterate.

s

u

te

age-approprate

ernated

B.

vta

110

a

A.

A

born

to

examnaton

majus.

condton

ayers

ment

3.

was

papaton.

structure

brougt

Pysca

sows

hs

s

aceved

abum

tender

t.

Se

as

mestones.

rgt

gr

depart-

te

det

te

past

as

vomtng

premature

Hs

vta

te

brt,

sgns

examnaton

turgor,

2

not

are

sows

abdomen

s

CHAPTER

sot

but

tender

abdomen

te

n

sows

abdomen

oowng

te

a

epgastrc

regon.

“doube-bubbe”

sows

an

structures

annuar

s

most

An

sgn.

pancreas.

key

x-ray

A

CT

o

te

scan

Wc

obstructed

o

n

many

o

wat

7.

Pyorus

B.

Frst

o

part

C.

Second

D.

hrd

E.

Jejunum

A

an

He

s

brougt

degrees

to

become

te

anteror

degrees

to

become

te

posteror

C.

270

degrees

to

become

te

anteror

D.

270

degrees

to

become

te

posteror

E.

180

degrees

to

become

te

rgt

te

11.

A

newborn

ment

aceved

scrotum

sde

te

processus

o

te

oowng

pyscan

was

spontaneous

examnaton

o

sows

o

te

te

tat

gr

because

vagnas

s

te

s

most

not

oowng

term

ta

s

o

o

s

te

a

An

swoen,

utrasound

por ton

obterated.

Wc 

dagnoss

 or

12.

ts

o

a

C.

Faure

o

mgraton

D.

Faure

o

deveopment

E.

Absence

A

o

2-day-od

a

u

department

term

D.

Ectopc

E.

Epspadas

“dada”

ung

tests

s

and

done

An

“mama”

moter

and

s

pyscan

says

now

tat

or

te

pung

oow-

cd

mse

sows

to

x-ray

A

to

durng

crackes

tat

pouc.

structures

Esopagus

T racea

nguna

C.

T ongue

D.

T raceoesopagea

E.

Parynx

te

scrotum

canas

key

and

te

bateray.

testes

Wc

are

o

Pseudoermaprodtsm

B.

T rue

Cryptorcdsm

D.

Congenta

E.

Cordee

28-year-od

gestaton

woman,

Pysca

An

o

te

most

13.

A

3-day-od

care

gand

gravda

resuted

o

te

yperpasa

2,

pyscan

no

past

n

a

examnaton

nto

te

utrasound

te

as

utrasound

bowe

wc

to

Se

pregnancy

term.

sma

s

unt

te

or

eaty

etus

32

nta

baby

sows

at

weeks’

prenata

story

unda

cavty.

structures

1,

an

medca

sows

amnotc

oowng

para

men,

gr

and

born

egt

ernaton

o

o

as

resuted

n

x-ray

te

et

bowe

o

sows

structures

te

D.

Cervca

E.

Dorsa

Neura

ods

ntoerance

D.

Latera

ods

(102°F).

E.

Amnon

ng

a

seres

structures.

o

rotatons

Rotaton

o

tat

te

poston

stomac

te

a-

durng

approxmatey

ow

durng

moter

Pysca

n

te

nserted,

coed

n

suspected.

to

te

breatng.

are

o

te

ad

exam-

rgt

and

ower

an

x-ray

te

tube.

proxma

Wc

aed

to

neonata

he

sows

sows

CT

bowe

scan

o

o

te

o

o

te

deveop

ntensve

s

currenty

sunken

n

te

s

cest

centra

durng

cest.

eves

and

tendon

o

abdo-

et

ar-lud

wc

occurred

boy

a

auscutated

te

n

abdo-

o

te

oowng

embryogeness?

ods

ods

o

te

esopagus

greens-yeow

te

wt

An

a

past

sows

ntestne

tender

and

are

sows

consstent

te

vesses

wt

a

and

eedng

s

absent

te

o

te

duodenoje-

te

ntestnes.

bowe

magng

marotaton

ncreasng

40°C

toxc-appear-

contrast

around

gangrenous

and

temperature

abdomen

obstructed,

deveopng

vomtng

Her

gastrontestna

ndngs

juncton

day.

examnaton

upper

sma

patent

hroug

o

or

study

juna

poston.

Hs

key

emergency

myotomes

Pysca

nant

sounds.

rom

orgna

te

cyanoss

transversum

because

deveopment resuts n movement o te et vagus nerve

ts

to

A 1-mont-od gr s brougt to te emergency depart-

ment

nvoves

mentary

key

mesentery

T a

gastrontestna

s

s

transversum

postonng

most

absence

Septum

od

tube

Maormaton

Peuropercarda

C.

tract

A

C.

B.

te

cest

B.

o

14.

o

te

most

Head

deveopment

te

te

od

s

examnaton

Peuropertonea

A.

embryonc

congen-

septum

sounds

A.

ndngs?

he

ts

o

te

od

pregnancy.

admtted

emtorax.

dapragm.

at

s

32

Maormaton

septum

brougt

correct

dicuty

Pysca

and

An

men

er

boy

wt

aebre.

suprarena

comes

examnaton.

cm.

te

oowng

ermaprodtsm

C.

ast

n

testes

dagnoss?

A.

A

papated

te

o

o

propery?

B.

te

s

tube

as

rom

o

Wc

dapragm

te

deveopng

TEF

examnaton

absence

o

te

te

A

A.

batera

te

auscutated

te

stand. he patent’s vaccnatons are up to date. Pysca

sows

depart-

dagnoss

od

breasteedng.

nasogastrc

sows

oowng

o

o

evauate

esopagea

says

up

attempts

ed.

o

boy

because

naton

ydrocee

he

A

mecansm

peuropertonea

Congenta

examnaton.

emergency

made.

peuropercarda

Sterty

up

trunk

trunk

Absence

C.

te

vaga

Absence o muscuature n one a o te dapragm

B.

to

trunk

vaga

B.

poyydramnos

brougt

key

s

trunk

vaga

A.

Hypospadas

s

te

trunk

vaga

breatng.

dapragm

most

A.

boy

to

vaga

deect?

mutpe

1-year-od

brougt

dicuty

te

patent?

A

and

dever y.

ntermedate

key

wt

at

move,

d eveopmenta

sows

scrotum.

te

b orn

vagna

age-approprate

Pysca

rgt

to

patent

nerve

90

duodenum

he

te

90

eventraton

boy

does

B.

duodenum

uncompcated

as

nontend er

10.

te

te

rotaton

poston?

A.

duodenum

scrotum.

mestones.

o

o

o

o

na

te

stomac

te

part

part

swoen

by

9.

o

3-year-od

a

8.

te

ts

ts

condton?

A.

degrees

s

111

Abdomen

3

rsk

o

te

Laboratory

112

C H A P T E R

studes

Abdomen

sow

occurred

15.

3

to

eukocytoss.

cause

A.

Dapragmatc

B.

Subepatc

Mdgut

D.

Dupcaton

E.

Congenta

A

te

ts

a

B.

Incompete

x-ray

sows

te

o

neura

dsta

o

Ogoydramnos

by

examnaton

An

erna.

most

most

pass

wt

coon.

responsbe

Greater

Dorsa

barum

C.

Prenc

coon

recta

19.

te

nd-

to

mgrate

o

o

s

te

te

wa

o

te

te

coon

brougt

to

te

examnaton.

cm

er

a

he

As

o

te

o

s

te

attaced

tat

reducbe

cres

te

abdomen

to

was

te

puses

and

sows

te

nner

20.

te

does

tract

surace

o

te

cana

Ionguna

D.

Subcosta

E.

Pudenda

E.

Stomac

sows

coronc

ste

or

n

te

ts

Uterne

B.

Cervx

C.

Mesentery

D.

Lower

past

type

o

year.

ower

Se

says

tey

Her

ast

te

tat

te

s

dagnoss

oowng

s

te

o

o

part

cervca

os

Fundus

o

te

an

o

uterne

body

overappng

te

nterna

22.

23-year-od

uterus

woman

because

o

s

severe

to

te

abdomna

emergency

pan,

nausea,

te

emergency

Pysca

o

te

te

s

depart-

examnaton

abdomna

nguna

nerves

erna

compressed

nguna

te

to

te

cana

to

emergency

abdomna

antrum

o

pan.

te

ordered

to

s

by

resut

to

be

depart-

Gastroscopy

stomac.

evauate

stomac. Wc

key

woman

o

o

te

nvoved

A

te

CT

ym-

oowng

n

a

mag-

brougt

upper

pan

sows

te

ater

a

gament

o

te

eatng

sows

he

coecystectomy.

Wc

te

postve

abdomen

coecystts.

to

emergency

abdomna

patent

s

sgn.

conss-

undergoes

te

camped

Se

meas.

Murpy

ndngs

Durng

oowng

pan.

atty

nstead

vesses

a

procedure

o

was

te

most

occuded?

Superor

B.

Proper

mesenterc

epatc

C.

Spenc

D.

Common

E.

Ineror

wt

epatc

vena

mass

patent

s

artery

cava

man

gron

Pysca

reducbe

artery

artery

artery

45-year-od

he

s

rgt

smar

o

acute

artery.

mts.

brougt

n

s

most

epatoduodena

ment

te

nerves

ndrect

brougt

te

wt

A.

A

s

examnaton

wt

key

ntestne

te

mesenterc

story

cystc

most

o

mesenterc

utrasound

te

An

bers

stomac?

aparoscopc

pregnancy?

sma

a

tent

Urne

postve.

aferent

abdo-

Wc

Hepatc

An

men-

o

s

47-year-od

Pysca

ave

tube

department

A

as

examnaton

quadrant.

(HCG)

te

emergency

and

Pysca

conrms

o

te

beedng.

ago.

rgt

Wc

to

usband,

te

weeks

examnaton

o

er

gonadotropn

pregnancy.

A.

A

8

vagna

wt

conceve

was

tenderness

ectopc

E.

severe

actve

to

utrasound

key

wt

perod

uman

o

department

sexuay

tryng

strua

nodes

Lumbar

Ieum

brougt

te

gabadder.

protruson

an

upper

n

dranage

Ineror

D.

s

to

pan.

oowng

abdomen

C.

E.

been

tumor

te

Ceac

D.

s

a

o

Superor

Cecum

woman

o

te

ocazed

cutaneous

man

severe

B.

Appendx

se

wt

A.

C.

department

emora

54-year-od

B.

38-year-od

a

o

structure

C.

Ana

21.

te

Ioypogastrc

nancy

erna?

o

Latera

ymp

s

as

B.

patc

te

s

and

nerves

spna

brougt

gron

dagnoss

ernatng

sows

part

te

scan

beow

nerves

s

o

patent

a

Wc

tat

o

CT

just

pan

constant

regon

pan?

A.

A

te

and

scan

surace

man

because

ment

not

to

te

te

spancnc

toracc

A.

A

been

nerves

32-year-od

ncreases

gastrontestna

to

a

Pysca

mass

nner

or

devered

devery.

mass

se

attaced

porton

be

mass

pan.

utrasound

s

0.5

pyscan

Se

o

nerves

n

ndgut

toracc

ram

spancnc

made.

coaca

sows

to

nto

A

n

carres

as

epgastrc

cest

Currenty

nerves

Vagus

te

up

organ

key

ces

te

stones

Pevc

sows

and

te

ypocondrum.

E.

ment

n

around

D.

A

severe

pan?

B.

A

s

began

caced

oowng

A.

represents

or

te

pan

pan

scapuae.

rgt

sot

s

Hrscsprung

key

te

sows

reerred

Pysca

tat

proxma

wt

vagna

Wat

umbca

gr

outwards.

sze.

te

spontaneous

cause

anoter

o

sgmod

consstent

recanazaton

oow

o

te

e.

abdomen

oowng

rotaton

4-mont-od

n

o

o

abdomen

to

coon

E.

to

te

daton

separaton

Faure

appear

o

crest

Deectve

umbcus

ours

aure

wa

D.

preterm

48

mecansm

C.

A

rst

or

he

he

bateray

o

te

o

evauated

patent?

Faure

days.

men

dstended

ndngs

A.

we-cd

18.

te

o

vomtng.

4

radated

beng

An

Wc

te

or

ntestne

narrowng

sows

n

o

17.

s

embryoogc

ngs

and

n

sows

contrast

dsease.

as

eve

te

wtn

marked

bopsy

oowng

megacoon

nontender.

and

te

atresa

o

boy

examnaton

enema

o

vovuus

5-day-od

and

Wc

obstructon?

cecum

C.

meconum

16.

te

s

brougt

pan.

Hs

examnaton

just

superor

dagnosed

to

vta

te

emergency

sgns

sows

to

wt

te

an

are

a

wtn

depart-

norma

papabe,

nguna

non-

gament.

ncarcerated

nguna

CHAPTER

erna

te

and

s

scedued

operaton,

troug

ng

te

types

a

oop

deep

o

or

o

nguna

ernas

surgca

ntestne

rng.

accuratey

s

repar.

observed

Wc

o

represents

Durng

C.

Gentoemora

passng

D.

Pudenda

E.

Ventra

te

te

oow-

Questions

nguna

Umbca

ment

C.

Femora

as

D.

Lumbar

E.

Indrect

wt

pan

ng.

ucer

severe

past

dsease.

panc

to

ar

wtn

Wc

most

Rgt

B.

Hepatorena

C.

Omenta

D.

Rgt

E.

Greater

s

he

s

sgncant

tender

x-ray

ucer

te

n

patent

depart-

says

progressvey

medca

te

oowng

A

tat

mn,

(o

(esser

atory

aparotomy

were

s

tym-

sows

rate

gastroscopy

wa

one

woud

te

Mdaxary

B.

Arcuate

per-

C.

Semunar

D.

T endnous

E.

Lnea

ntay?

Morson)

27.

A

space

epsode

at

o

east

te

emergency

vomtng

two

dark

pnts

o

red

depart-

bood.

vodka

every

rgt

man

He

wegt

sows

ke

he

assessment

day.

s

o

oose

to

ave

ntravenous

access

s

estabsed,

vomt

bood.

broad-spectrum

An

ant-

wc

botcs and octreotde s started, and te patent s taken

od

to

te

sows

ng

endoscopy

ruptured

rom

venous

wt

porta

sute.

cava

A.

Spenc

B.

Let

varces,

ypertenson.

trbutares

te

Esopagogastroduodenoscopy

esopagea

to

vens

to

te

Wc

porta

cause

most

or

te

o

te

oowng

C.

T ransversas

D.

Extrapertonea

E.

Externa

A

C.

Let

gastrc

any

D.

Let

epatc

s

E.

Rgt

gastrc

care

becomng

patent

day

2

days.

pared

s

Hs

medca

rgt

40°C

and

bood

examnaton

to

scrotum.

touc

dagnoss

te

o

he

and

o

oowng

te

s

pressure

dusky

rgt

te

a

rgt

cremasterc

s

and

sgncant

erna.

s

98/83

skn

Hs

o

te

erna

responsbe

or

or

te

relex

or

an

past

unre-

temperature

Hg.

s

made.

te

are

Pysca

rgt

scrotum

s

te

respratons

mm

over

cremasterc

relex?

ever

100/mn,

sde

stranguated

nerves

s

nguna

puse

sows

pan

story

ndrect

(102.2°F),

20/mn,

te

abdomna

s

sde

o

tender

absent.

Wc

eferent

A

s

or

sow

and

beng

man

tat

a

s

sepa-

he

e

s

b).

s

abdomen

or

operaton

te

s

pyscan

ayers

o

te

surgca

rom

Pysca

patent’s

t

or

b)

s

exam-

tat

e

preoperatve

te

surgery

and

(“tummy-tuck”)

perormed

coses

te

wt-

ncson,

abdomna

wa

w

estabs

pr-

past

o

he

CT

marked

wt

and

wc

o

but

skn,

te

Gven

oowng

A.

Be

mb

B.

Common

C.

Cystc

duct

epatc

duct

duct

A.

Ionguna

D.

Accessory

B.

Ioypogastrc

E.

Proper

pancreatc

epatc

artery

duct

te

not

gnawng

He

ave

pan

says

e

portons.

packs

we

abdomen

pancreas.

obstructed?

o

does

o

as

n

s

he

cgarettes

examnaton

as

(conjugated)

19-9.

te

o

a

mea

two

Pysca

and

te

as

to

e

worsenng.

smokes

scan

says

reduced

years.

drect

aponeuross

pyscan

patent

dseases

o

CA

to

graduay

eyes

ead

obque

comes

30

te

A

te

ayer)

ayer)

tssue

aster

smoker

eevated

patent,

to

asca

medca

te

tenderness.

at

he

abdomna

u

yeowng

mass

procedure,

made

(200

abdomnopasty

(atty

contact.

cronc

wt

kg

(395

(membranous

asca

stomac

A 45-year-od man comes to te emergency department

ower

asca

49-year-od

mary

tat

oowng

Scarpa

28.

An

expor-

sutures?

Camper

varces?

around

As

B.

anastomose

ts

be

pyscan

90

skn

week.

A.

gastro-omenta

severe

te

te

kg

an

resut-

key

system

o

te

to

ost

179

ndcates

scedued

compcatons.

to

An

seats?

removed.

oowng

contnues

comes

recenty

out

e

Pysca

ntersecton

te

traged,

key

s

20/

ne

te

s

Hg.

are

epgastrum.

Durng

most

rectus

mm

te

dapragm.

perormed.

ncson

Medca story s sgncant or porta ypertenson. As

patent

te

wc

temperature

respratons

135/85

n

or

Se

relux

ne

45-year-od

woud

100/mn,

s

(GE)

dsease,

Her

depart-

nausea.

aba

prevous

to

s

under

s

and

ne

consutaton.

sac)

comes

and

A.

naton

drnkng

et

ucer

tenderness

ar

te

te

o

woud

ree

emergency

gastroesopagea

pressure

sows

dmnsed

sac

man

bood

te

pan

medcatons.

puse

tat

space

space

and

to

peptc

any

(98.4°F),

examnaton

o

and

takng

sows

posteror

ocatons

(GERD)

not

comes

abdomna

story

x-ray

abdomen

cavty.

te

or

s

36.9°C

worsen-

woman

severe

peptc

sows

abdomen

o

abdomna

subprenc

wt

patent

s

emergency

examnaton

deveop

bursa

pan.

story

An

subepatc

58-year-od

ment

o

key

te

and

rgd,

te

A.

A

a

peroratng

stomac.

tonts

and

percusson.

a

to

abdomna

suddeny

Pysca

sounds,

sows

comes

medca

bowe

ree

a

se

man

began

Hs

wt

dsease

nguna

55-year-od

T12

26–50

32-year-od

B.

te

25.

A

Drect

ment

24.

26.

A.

A

o

surgca

ndngs?

23.

ramus

113

Abdomen

3

sows

epgastrc

sows

Laboratory

4-cm

studes

yperbrubnema

presentaton

structures

s

o

most

te

key

114

C H A P T E R

29.

A

3

Abdomen

44-year-od

ment

wt

examnaton

he

sounds

sgns

o

comes

sunken

sot,

sows

n

a

tat

between

structures

s

s

most

or

te

he

A

beng

o

o

te

supe-

C.

Gabadder

D.

Pancreas

E.

Uterus

compressed?

33.

hrd

o

s

Frst

E.

Jejunum

puse

s

s

88/65

ucer.

s

w

n

A.

Ineror

B.

Let

o

Hg.

and

s

are

Pysca

te

repar

to

o

bood

examnaton

sows

he

a

provde

Rgt

Proper

E.

Superor

gastroduodena

C.

Duodenum

D.

Speen

E.

Pancreas

suppy

to

te

34.

wt

dabetes.

narcton.

110/mn,

95/85

man

He

a

was

bowe

IV

ma

s

sane

ater

are

at

te

rom

te

aorta.

most

key

and

s

orgn

o

Wc

provde

te

An

te

o

te

a

Let

B.

Mdde

C.

Sgmod

and

coc

Spenc

E.

Superor

and

te

a

wt

pan

acy

n

story

s

structures

s

most

pan

20/mn,

n

sows

pan

s

te

and

to

back

A

CT

pres-

sows

scan

o

part

te

o

te

eukocytes.

key

wc

and

puse

bood

upper

ncreased

most

te

(104°F),

examnaton

tenderness.

abscess

n

40°C

caused

o

te

he

by

te

oowng

coon

man

dfuse

o

and

s

o

sows

mesenterc

oowng

to

arteres

te

na

s

comes

to

abdomna

cronc

te

emergency

pan.

he

obstructve

acoosm.

to

nor-

90%

artery

woud

descendng

artery

artery

recta

35.

a

woman

abdomna

He

ocated

caracter.

pan

around

Her

to

te

and

te

emergency

nausea.

umbcus

temperature

s

Se

and

s

40°C

depart-

says

tumor

n

ts

Intercosta

Prenc

D.

Vagus

E.

Subcosta

52-year-od

ty

ad

department

patent

as

pumonary

smoked

Pysca

wt

tree

examnaton

norma

He

esteroema,

He

a

s-

dsease

packs

o

as

bowe

md

sows

sounds

tenderness

a

aus-

n

te

due

gentaa.

Laboratory

ng

arteres

s

Externa

and

B.

Ineror

(104°F),

C.

Umbca

a

to

examnaton

sows

ow

most

te

te

pancreas.

by

he

aferent

oowng

artery

per

abdom-

bers

tat

nerves?

pyscan

story

dsease,

day

sows

and

key

epgastrc

te

aterosceross.

sperm

ac

to

medca

studes

GnRH,

a

o

comes

as

cgarettes

norma

o

medated

spancnc

Pysca

A.

s

coronary

dsease

o

ead

wc

man

evauaton.

packs

te

patent

toracc

C.

A

o

wt

Greater

tat

du

pack.

quadrants.

B.

anayss

comes

a

ntay

eves,

artery

one

abdomen

A.

two

artery

to

n

pan

trave

ypo-

tender

bous

down

sows

pressure

sows

arterogram

suppy

puse

artery

24-year-od

(psoas

abdomna

epgastrc area upon papaton. A CT scan o te abdomen

emergency

bood

abdomen

neror

coatera

gastro-omenta

D.

te

tory

vascuar

A.

ment

du,

cutated

myocarda

(98.4°F),

examnaton

estabsed,

pan.

coon?

A

wt

nondstended

ypertenson,

rom

36.9°C

depart-

abdomna

avng

22/mn,

admnstered.

bockage

s

Pysca

access

emergency

severe

dscarged

sounds,

papaton.

and

temperature

Hg.

te

aterosceross,

ago

respratons

mm

to

darrea

week

Hs

62-year-od

cut

comes

ncudes

department

resstance

ower

cgarettes per day snce e was 20-year-od but as recenty

boody

and

A

(COPD)

mesenterc

story

bood

structures?

Dapragm

bood

ange

s

Pysca

nlammaton

B.

epatc

Hs

te

are

Hg.

an

souder

o

duo-

patent?

and

examnaton

pan?

excrucatng

Urnayss

negborng

oowng

rgt

oowng

temperature

mm

Descendng

te

aganst

te

te

respratons

A.

o

and

Hs

sows

kdney.

spread

gastrc

70-year-od

ever,

100/95

patent’s

under-

perorated

te

wc

patent

te

cause

costovertebra

et

(101°F),

and

o

surgery

branc

38.3°C

s

abdomen

generazed

20/mn,

obstpaton.

surgca

severe

depart-

gastrc

D.

actve

story

emergency

mesenterc

C.

s

mm

A

te

temperature

contnue

ts

to

o

100/mn,

sure

respratons

Durng

gated.

pancreas

ment

Hs

emergency

artery

A

3-our

rgdty

dena

arteres

a

pan.

board-ke

an

o

100/mn,

pressure

goes

duodenum

o

p

n

20/mn,

Pysca

badder

souder.

et

because

abdomna

because

duodenum

te

pan

are

Hg.

A 35-year-od man comes to te emergency department

D.

brougt

to

Appendx

C.

s

Wc

nlamed

mm

o

sarp

Urnary

duodenum

man

a

B.

et

47-year-od

lexon

A.

coon

o

tat

te

ntestna

respratons

135/85

com-

T ransverse

part

s

causes

key

“nutcracker

oowng

100/mn,

quadrant.

no

Second

ment

32.

test)

Bowe

beng

and

sows

te

are

scan

s

aorta

te

n

s

pressure

turgor.

here

CT

dagnoss

o

skn

rgdty.

bowe

puse

B.

part

o

asctes.

o

Wc

o

tenderness

quadrants.

abdomna

key

oss

depart-

Pysca

A.

A

part

and

guardng

or

artery.

made.

emergency

vomtng.

mnma

our

part

te

mesenterc

syndrome”

te

and

eyes

wt

wtout

eard

to

nausea

organomegay

pressed

ror

s

regon

are

abdomen

31.

sows

abdomen

epgastrc

30.

man

excessve

or

and

He

te

norma

sow

perpera

as

smoked

37

years.

externa

mae

LH

count. Wc

occuded?

nert-

yperco-

past

norma

norma

or

o

testosterone

eves.

o

te

Semen

oow-

CHAPTER

36.

D.

T estcuar

E.

Deep

A

40.

crcumlex

42-year-od

examnaton.

Pysca

n

te

o

nvove

nodes

37.

sde

te

te

to

o

Superca

B.

Interna

to

wtn

are

An

a

routne

mass

44-year-od

mts.

te

rst

mass

group

te

o

s

o

ymp

te

te

area?

rectus

nguna

ac

contour.

and

A.

Supracrsta

B.

Lnea

Lumbar

C.

Arcuate

D.

Pectnea

E.

Axary

E.

Semunar

ncarcerated

na

te

obque

spermatc

obque

spermatc

cord

s

B.

Cremaster

C.

T unca

D.

Interna

E.

Dartos

derved

rom

te

nterna

Wc

te

Durng

te

o

Se

abdomna

are

o

wt

comes

stng

A.

Azygos

B.

Ineror

system

vena

C.

Let

D.

Superor

E.

Subcosta

Hs

lud

he

wc

emergency

oter

sgns

sows

duness.

varces

te

gastrc

wtn

C.

Fundus

D.

Psoas

E.

Suspensory

rom

a

42.

resut

ven

A

a

our

ven

ven

vens

o

regon

te

o

structure.

te

key

be

because

patent

B.

Superor

exporatory

C.

Ineror

D.

Hepatc

E.

Spenc

o

vomtng

aparotomy

son

8

mts.

ater

Pysca

An

possbe

sma

useu

beng

monts

sounds.

wc

and

o

to

ago.

Jejunum

B.

Jejunum

C.

Jejunum

vta

examnaton

bowe

as

ess

pan.

and

n

a

sgns

sows

te

motor

s

rom

at

bowe

perormed

Durng

te

are

te

co-

norma

yperactve

compared

mesenterc

vece

wtn

eatures

jejunum

was

he

an

are

aparoscopy

anatomc

tnner

as

12,

obstructon.

oowng

dstngus

A.

age

nvoved

Hs

exporatory

te

abdomna

at

or

surgery,

te

most

eum?

wt

te

compared

te

eum

pared

D.

wt

as

wt

Jejunum

te

as

te

Jejunum

more

numerous

arcades

com-

eum

more

mucosa

as

vascuar

pyscan

omenta

ewer

numerous

v

ympatc

wt

compared

te

wt

oces

eum

te

eum

te

Wc

o

compared

atty

te

here

vta

upper

margn.

An

x-ray

or

a

quadrant

te

s

no

umbar

caced

s

sgns

sows

here

o

oowng

tuber-

te

most

Wc

te

to

te

emergency

and

norma

bowe

mnma

tat

s

o

pan.

sounds

tenderness

or

te

n

rgdty.

trd

beng

te

depart-

abdomna

A

n

te

CT

(transverse)

compressed

oowng

by

vesses

a

w

compresson?

artery

mesenterc

porta

duodenum

guardng

duodenum

artery

ven

ven

ven

woman

o

oods.

and

te

surgca

te

s

te

Aorta

Ineror

vena

C.

Hepatc

ven

o

s

cava

te

or

pan

(ts

te

s

te

depart-

assocated

sows

eectve

coe-

scssors

o

posteror

posteror

mmedatey

vesses

s

abdomen

an

mmedatey

oramen

ed

emergency

he

operaton

tssues

beedng?

B.

te

scedued

oowng

A.

to

pan.

Utrasound

se

Durng

enter

comes

abdomna

(eppoc)

o

s

sows

mesenterc

because

gastones

te

sows

causng

61-year-od

ment

and

beneat

E.

A

o

mesenterc

cystectomy.

eum

wt

43.

T12–L1.

Her

examnaton

rgt

wt

tuber-

abscess?

comes

wtout

vascuar

Ineror

appendectomy

te

vomtng,

abdomen

A.

an

te

or

eves

years.

costa

suspcous

musce

woman

nausea,

A 34-year-od man comes to te emergency department

ad

te

stomac

porton

most

10

tenderness.

suspected

quadrants.

o

n

o

pyscan

treated

vertebra

or

ower

Wc

te

Pysca

mass

te

examnaton

epgastrc

scan

o

asca

wt

Pysca

vesses?

ocate

ayer

pancreas

45-year-od

ment

and

o

mts.

densty

te

Cecum

vens

mesenterc

o

Body

undergoes

key

a

abscess.

B.

dstended

o

to

prevousy

nvovng

ange

A.

cava

umbca

sows

ste

comes

was

papabe

eve

He

beedng

most

et

are

a

He

sows

are

depart-

(ematemess).

vta

tat

between

o

te

bood

examnaton

examnaton

varces.

to

to

acoosm.

anastomoses

trbutares

te

cuous

vomtng

Se

asymptomatc

costovertebra

Pysca

endoscopc

esopagea

s

woman

norma

nontender

regon

man

tendnous

Wc

to

ne

pan.

been

wtn

beow

asca

wa.

used

ne

spondyts

as

key

e

mts.

abdomen

asca

oten

abdomns

surroundng

toracc

most

posteror

te

te

restore

ne

31-year-od

cuous

te

asca

story

A

te

s

rectus

rom

to

ne

abdomna

abdom-

coverng

nterna

41.

a

spermatc

as

te

and

erna.

or

vagnas

because

o

cord

ernopasty

musce

63-year-od

an

nguna

dented.

spermatc

ment

a

s

open

musce?

Externa

norma

ndrect

musce

A.

A

undergoes

to

Durng

used

aba

Presacra

man

te

s

psatera

andmarks

o

lap

seat?

D.

35-year-od

he

reconstructve

mastectomy.

careuy

transposed

end

C.

A

undergong

a

muscuocutaneous

oowng

neror

s

oowng

detaced

structures

not

a

toracc

musce

exam-

does

woman

surgery

procedure,

papated

utrasound

tat

te

or

norma

nontender

sows

afected

pyscan

are

a

scrotum.

Wat

te

te

sgns

sows

te

testes.

dran

operaton,

39.

vta

abdomen

A.

an

38.

Hs

A

breast

comes

examnaton

et

naton

man

ac

115

Abdomen

3

ed

most

to

te

te

boundary)

wt

key

bood.

source

116

C H A P T E R

44.

3

Abdomen

D.

Rgt

E.

Superor

A

rena

32-year-od

ment

sows

acute

pan

postoperatvey,

te

n

skn

an

over

to

n

n

appendcts

removed

tory

pan

tenderness.

week

o

ven

comes

severe

uy

sa

45.

o

rebound

sows

tenderness

woman

because

examnaton

wt

artery

mesenterc

A

te

rgt

CT

scan

te

emergency

te

abdomen.

te

and

te

emergency

te

appendx

and

quadrant

B.

Cystc

C.

Let

D.

Pancreatc

s

success-

One

pareste-

te

E.

48.

anteror

njured

durng

te

appendectomy?

abdomna

Pysca

key

C.

Subcosta

oowng

D.

Ioypogastrc

A.

Ineror

E.

Spna

B.

Let

coc

C.

Let

gastrc

D.

Lumbar

E.

Sgmod

man

s

brougt

to

te

emergency

depart-

assessment

utrasound

wt

sonograpy

examnaton

sows

n

lud

trauma

n

te

(FAST)

abdomen

49.

A

o

ment

aparotomy.

Wc

o

te

sps

be

ceary

woud

pyscan

A.

he

exposes

second

anterory

B.

he

ror

seen

te

te

he

porta

D.

he

second

ory

by

he

trd

wtout

part

ven

aspect

o

um

te

o

mesenterc

trd

C.

oowng

nta

porton

to

superor

to

te

te

o

crosses

o

te

rgt

artery

reaton-

wen

te

s

reated

ven

pass

poste-

duodenum.

anteror

to

te

neck

o

te

pancreas.

E.

to

A

te

50.

te

as

um

been

monts.

son

Se

tat

sure

s

purpe

centraton

ror

a

most

et

A

o

te

te

severe

past

a

6

Inguna

E.

Pectnea

“bufao

serum

scan

o

posteror

oowng

sows

to

buet

con-

abdomen

te

organs

ne-

s

te

mass?

Questions

51.

A

ment

because

epsodes

story

Gabadder

beedng

D.

Ovary

venous

E.

Uterus

tese

2-day

story

upper

naton

o

nausea

quadrant

sows

an

o

obese

and

te

ntermttent

abdomen.

woman

wt

because

pan

Pysca

scera

most

o

te

prenc

to

te

emergency

erna

tat

as

a

passes

Wc

andmark

an

ndrect

to

depart-

troug

o

te

o-

dstngus

nguna

a

erna?

musce

(atera

border)

brougt

buet

sows

wa

te

by

abdomen.

penetrated

to

posteror

emergency

te

buet

structures

te

te

to

superor

drecty

rst

to

wound

te

n

was

te

umbcus.

te

mdne,

most

key

to

buet?

aorta

51–75

48-year-od

o

o

man

e

n

made.

n

te

te

past

Wc

and

but

A.

Let

B.

Rgt

gastrc

C.

Rgt

rena

gastrc

to

o

most

sgns

spenc

to

to

et

rgt

He

tree

and

recenty

as

been

sows

asctes

o

esopagea

varcea

te

oowng

surgca

beore

a

ven

ven

gonada

depart-

ad

ours

as

commony

gastrc

as

24

examnaton

dagnoss

s

emergency

bood.

attempted?

te

and

A

anastomoses

symptoms

to

acoosm

Pysca

spenomegay.

s

comes

vomtng

cronc

exam-

cterus

s

ematemess

reabtated.

pyscan

wc

dag-

coon

Pancreas

C.

rgt

struck

E.

and

o

gand

te

A

He

recta

rom

oowng

Stomac

a

to

made.

between

Hessebac).

was

a

passed

te

Gabadder

Suprarena

comes

asctes.

s

vesses

man

D.

Appendx

woman

(o

used

erna

C.

B.

45-year-od

acoo

ump.”

gucose

te

b)

pres-

erytema,

coc

massve

s

wt

Abdomna

(10

pamar

gament

T ransverse

kg

o

and

ver

because

story

gament

B.

bood

a

abdomns

A.

4.5

ar,

te

comes

abdomna

A.

A

o

yperten-

Her

pyscan

a

sows

superor

superor

examnaton

been

te

esopagea

man

36-year-od

ave

gastone?

cana

Rectus

o

o

and

epgastrc

D.

anteror

body

mdde

trange

C.

te

s-

rena

and

antypertensve

examnaton

and

CT

te

o

b).

Pysca

astng

Femora

wc

a

vens?

and

nguna

Ineror

I

over

and

structures

Pysca

because

o

and

nguna

B.

A

a

as

anastomoses

prenc

department

anterory

pyscan

ganed

mmedatey

o

anter-

mesocoon.

reated

wt

(165

abdomen

sow

s

te

story

kg

mg/dL.

crossed

transverse

atgued

recenty

Wc

orgn

to

treatment

75

s

kdney.

easy

Hg.

te

te

comes

as

mass

cava.

o

3-mont

studes

140

duodenum

duodenum

and

mm

over

o

key

te

wegs

6-cm

vena

a

Se

170/100

strae

Laboratory

sows

o

te

requred

currenty

te

woman

as

medcatons.

and

o

weak

as

o

attacment

part

30-year-od

se

part

pars

A.

o

crross

enarged

because

drect

kdney.

and

as

owng

jejunum?

duodenum

te

te

anatomc

dssecton

severe

45-year-od

and e s taken to te operatng room or an exporatory

by

to

He

examnaton

dstrbuton

Ionguna

25-year-od

comes

dscomort.

B.

A

as

structures

duct

man

noss

T9

obstructed

Se

oowng

duct

epatc

Gentoemora

nerve

te

duct

o

emae

key

quadrant.

o

duct

A.

Focused

47.

Rgt

was

upper

Wc

been

epatc

67-year-od

abuse.

rgt

duct

A

porton o er perneum. Wc o te oowng nerves

most

key

abdomen

ment ater beng nvoved n a motor vece coson. A

46.

most

Be

experences

regon

te

A.

appendectomy.

patent

pubc

te

as

n

gastones.

Pysca

ower

o

depart-

o

ven

used

ver

to

reeve

transpant

s

CHAPTER

52.

D.

Spenc

E.

Superor

A

to

et

55-year-od

ment

A

scan

posteror

tat

as

ureter,

pan

man

because

CT

o

o

surace

and

most

Skn

B.

Skn

C.

Skn

at.

te

to

aneurysm

neror

comes

to

o

te

o

te

and

a

poe

rena

ven

emergency

sows

te

wc

be

te

neror

troug

mesenterc

vomtng,

abdomen

T o

key

o

ven

nausea,

te

nvaded

A.

rena

mesenterc

o

te

depart-

A.

Ceac

B.

Ineror

C.

Let

D.

Mdde

E.

Superor

n

et

rena

oowng

te

kdney

capsue,

regons

w

56.

reerred?

anteror

atera

tgs

and

emora

trange

te

over

te

over

te

D.

Skn

E.

Skn

A

a

over

te

over

weakness

3-mont

and

to

abdomen

Wc

o

te

o

C.

Pregangonc

D.

Postgangonc

E.

A

vaga

abdomen

sows

o

bood

past

6

s

monts.

6-cm

tat

Se

as

mg/dL.

mass

n

structures

s

A

te

ces

beng

Laboratory

o

o

most

te

adre-

to

n

toracc

orgn

tat

mgrated

to

o

te

pos-

rom

comes

pevc

to

te

o

te

n

oowng

te

organs

a

o

s

to

et

58.

nerves

te

Common

Ineror

C.

Let

D.

Sort

E.

Spenc

o

E.

Epgastrc

A.

Duodenum

examnaton

B.

Gabadder

sows

C.

Kdney

penetraton

D.

Lver

ng

E.

Speen

te

A

57-year-od

ment

because

resonance

bood

an

man

o

magng

low

artera

Laboratory

n

comes

pan

te

n

te

(MRI)

et

aneurysm

studes

rena

te

et

o

were

sow

to

te

ven

te

emergency

abdomen.

abdomen

s

beng

ven

ematura

A

sows

tat

occuded

crosses

and

depart-

magnetc

te

by

aorta.

anema.

he

and

key

to

te

anema.

cause

o

te

ar

artery

te

testcuar

bers

n

ven

te

umbar

bers

n

te

to

n

te

vagus

te

te

nerve

emergency

abdomen.

tenderness.

under

te

o

An

x-ray

dapragm

te

resutng

oowng

depart-

Pysca

undc

n

and

o

an

regon

o

ntra-abdomna

arteres

s

te

most

beedng?

artery

artery

artery

artery

n

comes

te

Pysca

oowng

to

te

emergency

abdomen

examnaton

s

te

most

depart-

radatng

sows

to

a

er

erna.

common

type

o

nguna

because

n

anteror

scan

rena

nguna

42-year-od

ment

pan

ucer,

woman

te

Drect

A

et

women?

Indrect

59.

posteror

ar

o

te

regon.

D.

ave

depart-

CT

te

sympatetc

penetraton

pan

C.

to

A

artery

wt

n

n

aferent

rebound

epatc

39-year-od

pancreas.

key

severe

an

gastrc

Femora

tumor?

n

crosses

most

bood

comes

gastro-omenta

Umbca

organ.

te

prenc

B.

a s

te

testes.

ematura

testcuar

te

sows

o

A.

tumor

o

Wc

B.

erna

man

o

oow-

emergency

and

low

t

sows

te

o

o

by

source

Wc

6

te

nerves

sows

stomac

te

scan

anoter

ts

past

o

sows

A.

A

te

bood

s

o

woman

abdomen

nguna

dep ar t-

te

cacexc

te

most

by

or

CT

ta t

suppy

compromsed

A

ta

sows

bood

pan

sows

tendernes s.

tumor

spancnc

emergency

abdomna

examnaton

te

s uppy

brances

o

pexus

because

ment

ar terogram

te

brances

to

lank

were

te

low

Compresson

key

te

o

o

51-year-od

te

tat

studes

Compresson

endoscopy

sgn

nerves

a

Compresson

beedng.

axons

parasympatetc

vague

C.

te

patent?

bers

Compresson

examnaton

reeas-

te

et

oowng

Occuson

ment

suspected.

key

te

B.

A

wc

pan?

A.

E.

57.

comes

s

occuded

s

preaortc

suprarena

s

eadng

scan

n

ven

D.

Fastng

CT

man

pan

spancnc

as

n

mesenterc

sows

not

ocated

coc

examnaton

because

medcatons.

140

(cromain)

crest

man

o

comprom sed

ts

posteror

pyscan

ypertenson

boodstream

ab domna

dagnostc

Wc

wt

Wc

trunk

Pysca

md

te

te

parasympatetc

vagus

because

monts .

A

o

medua

48-year-od

wt

sde

nerves

Postgangonc

ment

to

sympatetc

neura

suprarena

55.

ts

Ces

and

peocromocytoma

te

B.

rgt

a

oowng

spancnc

54.

a

nto

symptoms

or

over

severe

secretory

Pregangonc

teror

o

sows

A.

o

umbcus,

comes

atgue

and

products

and

atera

key

mesenterc

57-year-od

aorta.

umbcus

concentraton

afectng

medua

and

antypertensve

o

ng

and

areas

musces

woman

gucose

na

pubc

anteror,

pubs,

wa

serum

gand

pubs

te

story

responded

te

meda,

and

most

coc

testcuar

30-year-od

o

regon

tg

abdomna

53.

gutea

A

ment

and

s

arteres?

ematura.

neopasm

pevs,

ng

117

Abdomen

3

woman

o

sows

under

o

oowng

te

te

prouse

comes

severe

pan

to

n

rebound

te

te

tenderness

dapragm.

duodena

s

te

An

bub

ntra-abdomna

arteres

emergency

abdomen.

and

by

an

ucer,

key

Posteror

B.

Superor

superor

pancreatcoduodena

mesenterc

C.

Ineror

mesenterc

D.

Ineror

pancreatcoduodena

E.

Rgt

gastrc

x-ray

sows

resut-

Wc

source

beedng?

A.

an

endoscopy

beedng.

most

depart-

Pysca

o

o

te

118

C H A P T E R

60.

A

a

te

to

n

s

expose

te

o

asca

ayer

Externa

B.

Interna

C.

T ransversus

D.

T ransversas

E.

Processus

tumor

nate

o

to

te

be

B.

Cystc

C.

Superor

D.

Ineror

E.

Hepatc

63.

obque

te

cord

Appendcts

repar

C.

Coecystts

D.

Kdney

E.

Peroraton

relected

vesses.

nterna

sper-

65.

deveop?

aponeuross

aponeuross

CT

o

to

te

abdomna

cterus

and

scan

te

Wc

o

pan.

md

o

te

pancreas

te

emergency

depart-

Pysca

exam-

tenderness

abdomen

nvovng

oowng

n

te

sows

te

vesses

a

unc-

s

66.

most

because

upper

o

An

most

key

Be

B.

Cystc

C.

Let

D.

Pancreatc

E.

Rgt

Lumbar

Pevc

to

and

scera

emergency

abdomna

and

mgrates

o

o

by

te

cterus

tat

Wc

te

te

te

pan.

depart-

o

o

Wc

Pysca

Pudenda

sympatetc

E.

Vagus

nerves

A

42-year-od

posterory

abdomen

oowng

An

o

te

gastrc

D.

Mecke

E.

Borborygm

mu-

s

67.

An

80-year-od

Pysca

s

epgastrc

most

key

Crross

ng

a

E.

Kdney

te

rectus

most

at

rsk

about

ods

wen

o

2

cm

te

Wc

ts

te

above

skn

o

ncson

externa

te

s

te

and

seat

pubc

curves

oowng

o

bones.

68.

superor

nerves

A

s

(Fg.

3.1).

In

B.

T11

ence

C.

Ioypogastrc

poston?

Ionguna

A

37-year-od

ment

because

ower

sows

a

emora

woman

o

quadrant

rebound

postve

psoas

eukocytoss.

dagnoss?

cutaneous

g

comes

ever,

to

te

nausea,

abdomna

pan.

tenderness

over

test.

Wc

te

vomtng,

Pysca

studes

oowng

s

depart-

and

rgt

examnaton

McBurney

Laboratory

o

emergency

pont,

sow

te

and

marked

most

key

69.

o

te

te

te

te

ntestna

tat

te

dsta

te

te

wa.

eson

oowng

or

seg-

con-

cnca

symptoms

and

te

woman

asctes

wc

wc

o

te

examnaton

asctc

lud

tat

s

marked

te

a

or

rou-

some

bood

pres-

pusaton

oowng

and

Rectouterne

D.

Vescouterne

E.

Costodapragmatc

19-year-od

ater

a

n

dagnoses

sgns?

te

emergency

s

conrmed

oowng

most

key

te

depart-

Pysca

by

a

ocatons

conrm

patent

n

exam-

CT

scan

w

te

te

an

pres-

supne

recess

recess

(pouc

recess

s

motor

L4

(pouc

o

o

Morson)

Dougas)

recess

man

sows

te

to

dscomort.

wt

C.

at

o

comes

Subprenc

sected

as

or

appette

symptoms

abdomna

Hepatorena

abdomen

sows

e

pyscan

poor

aneurysm

B.

ment

te

a

ver

A.

A

to

Wc

aortc

o

sows

utrasound

Latera

o

exam-

necton,

stone

because

naton

made?

o

48-year-od

ment

T10

E.

o

depart-

Pysca

erna

A.

D.

o

ad

and

expan

Abdomna

troug

as

Hg

regon.

D.

ncson

emergency

expan

comes

He

mm

Pannenste ncson s used to reac te uterus by mak-

he

cesarean

eson

evdence

examnaton

175/95

Spenomegay

contractons.

emergency

te

a

key

man

examnaton.

C.

pubs.

ts

dvertcuum

B.

mons

most

n

emorrods

s

te

w

pan

emorrods

A

o

an

to

te

stoos.

nlammaton,

Wc

most

Dvertcuoss

w

comes

w

to

er

examnaton

sows

mucosa.

C.

sows

o

stoogc

toward

structures

sgns

eum

sows

secton.

to

o

patent

afectng

trunks

n

endoscopc

Interna

gastones?

P0

no

Externa

duct

musces,

nerves

transmsson

comes

bood

B.

s

G1,

o

sows

bopsy

sure

woman

natura

syndrome”

oowng

te

depart-

he

trunks

woman

because

decson

oows

pan.

nerves

Hata

It

emergency

nerves

Sacra

A.

n

duct

transverse

te

bowe

te

or

D.

tme.

because

to

abdomna

sympatetc

te

tenderness

duct

perorm

o

spancnc

A.

to

severe

“rrtabe

emergency

made

duodenum

comes

sgns?

duct

epatc

te

man

C.

tne

36-year-od

o

responsbe

B.

tans

duct

epatc

be

condtons

jaundce

obstructed

A.

rectum.

A.

A

artery

utrasound

gastones.

story

a

ment

artery

comes

quadrant

scapua.

as

tumor.

ven

sows

because

ment

ven

man

stone

ment

key

artery

mesenterc

porta

pregnancy

56-year-od

naton

epatc

and

A

s

aponeuross

comes

mesenterc

department

64.

A

ead

tpe

A

spermatc

erna

and

testcuar

does

obque

severe

scera

artery

examnaton

te

and

Ectopc

B.

case?

woman

35-year-od

rgt

open

A.

occuded?

Common

ment

te

te

dented

o

an

sows

asca

regon.

A.

A

o

abdomns

o

process.

key

oowng

because

vagnas

sows

epgastrc

s

pyscan

examnaton

deerens

abdomna

because

naton

te

Durng

asca

abdomna

45-year-od

ment

erna.

te

to

Pysca

ductus

A.

A

comes

spermatc

wc

matc

man

scrotum.

nguna

nterna

From

62.

Abdomen

23-year-od

buge

ndrect

61.

3

recess

brougt

vece

tat

cord

te

to

te

emergency

coson.

spna

eve.

An

cord

Wc

as

o

depart-

MRI

o

been

te

te

tran-

oowng

CHAPTER

and

an

x-ray

o

te

abdomen

sows

119

Abdomen

3

tat

se

as

rac-

tures o te nnt and tent rb on er et sde. Pysca

examnaton

oowng

cnca

73.

Lver

B.

Pancreas

C.

Let

D.

Speen

E.

Ieum

o

as

sows

ntestne

system

70.

Jejunum

B.

Ascendng

C.

Ieum

D.

Descendng

E.

T ransverse

scan

o

as

wc

key

71.

te

man

oss

abdomen

atty

o

B.

Let

C.

Porta

D.

Facorm

E.

Hepatogastrc

obe

obe

o

o

because

o

C.

Superor

a

tumor

studes

manutrton,

ocatons

s

ver

te

A

o

tat

scedued

aparoscopc

arteres

n

and

an

te

s

to

te

be

emergency

abdomen.

He

ntermttent.

stones

eectve

n

A

s

most

camped

te

says

An

depart-

42-year-od

te

to

wc

remove

o

Common

B.

Proper

C.

Rgt

D.

Let

E.

Cystc

most

oow-

gabadder

A.

Hepatc

B.

Ineror

Superor

D.

Latera

E.

Superca

A

pan

A

n

Wc

ranstorm

FAST

ater

and

er

t

a

examnaton

automobe

tree.

Se

sows

to

et

was

te

te

A.

wearng

vena

te

a

ntra-abdomna

seat

o

bet.

ypotensve,

aparotomy

pertonea

occurred

oowng

wa.

and

o

to

cavty

durng

vesses

recta

coc

te

patent

te

must

be

artery

artery

emergency

s

CT

cterc

an

scan

or

te

exam-

(jaundced)

are

o

endoscopy

oowng

depart-

Pysca

medusae”)

A

te

seen

te

sows

venous

on

s

abdomen

esopa-

structures

deveopment

o

caput

ven

ven

epgastrc

man

ven

comes

upper

sows

te

he

rgt

o

Aferent

C.

Vscera

a

to

postve

te

te

pyscan

quadrant

gabadder

and

Murpy

abdomen

oowng

vagus

te

sgn.

sows

and

nerves

because

ever.

Utrasound

numerous

percoecystc

transmts

o

Pysca

arge

lud.

te

pan

o

nerve,

n

spna

aferent

spancnc

nerve,

rom

T8

T6

to

wt

reerra

to

te

neror

scapua

bers

Sympatetc

spancnc

n

beedng

s

cava

rgt

n

B.

emergency

gway

tat

A

or

appendectomy,

e

te

taken

coecystts?

D.

brougt

s

cava

toracc

58-year-od

epatc

s

porta

vena

C.

epatc

woman

te

ematemess.

obstructed

s

Durng

n

superor

(“caput

Wc

key

te

quadrant.

e

exporatory

mdde

te

epatomegay

gastones

epatc

45-year-od

vens

varces.

An

comes

abdomna

o

and

te

tese

artery

severe

tat

examnaton

epatc

department

a

dated

ange

A.

A

sows

examnaton

te

te

o

pan

gabadder

o

n

medusae?

saey?

72.

because

ater

vesse

and

and

man

utrasound

coecystectomy.

coecystectomy

must

artery

gea

75.

comes

sows

or

artery

Ieococ

sows

ypoxa.

tumor

gament

eatng

Ieococ

E.

anteror

te

resut

ower

and

(102.2),

o

mesenterc

D.

and

CT

causng

sow

and

s

because

monts.

ver

pan

abdomen

ng

artery

artery

ver

man

o

s

coc

coc

gament

ater

te

te

te

occurs

a

tat

6

Wc

to

beedng?

Rgt

epats

61-year-od

e

pyscan

te

rgt

bood

a

Wc

Rgt

ocated?

Rgt

ment

sows

oowng

A.

A

te

precedng

Laboratory

stoo,

te

to

te

stop

o

to

B.

naton

comes

njury

A.

ment

over

an

ose

coon

sock.

njured

made,

days

pan.

nervous

coon

ypertenson.

patent

At

centra

74.

wegt

porta

predctaby

te

coon

55-year-od

severe

most

rom

(CNS)?

A.

A

w

nnervaton

to

te

s

39°C

amounts

appendectomy.

gated

te

o

n

T wo

s

abdomna

arge

because

o

pan

appendcts

temperature

and

parasympatetc

severe

o

appendectomy.

s

portons

key

A 45-year-od man comes to te emergency department

an

.

ypovoemc

most

kdney

dagnoss

Fig.

s

sgns?

A.

because

•

sows

organs

nerves

bers

wt

va

T1–T4

te

reerra

T10–T12

nerve

n

portons

ceac

greater

to

te

o

toracc

dermatomes

greater

gangon

toracc

and

ceac

pexus

E.

Aferent

T6–T8,

bers

wt

o

dorsa

reerra

to

te

ram

o

epgastrc

spna

regon

nerves

120

C H A P T E R

Questions

76.

A

3

Abdomen

76–100

descendng

15-year-od

ment

ca

because

pan,

rgt

gr

o

McBurney

descrbes

wt

te

B.

T wo-trds

te

C.

A

rgt

ne

A

E.

One-trd

A

ac

an

upper

gnawng

sows

o

Spna

Greater

C.

Vagus

D.

Lumbar

E.

Spna

o

wt

s

an

ower

ses

rebound

made.

A.

ncson

at

B.

rom

te

o

te

ower

cm

rom

one-trd

o

to

te

pan.

usuay

te

te

rom

to

o

te

pubc

te

81.

ngu-

Se

pyscan

te

ood.

endoscopy

wt

n

An

te

nerves

pan

body

o

transmts

as

toward

te

o

er

pubc

abdomen

obstructng

oowng

ocatons

te

sympyss.

tat

rgt

te

a

79.

B.

Mnor

C.

Pevc

D.

Mdporton

E.

Between

A

42-year-od

A

FAST

woman

ater

a

s

brougt

traumatc

examnaton

te

sows

to

to

prevent

urter

A.

Coronary

B.

Gastrococ

C.

Spenorena

D.

Hepatogastrc

E.

Facorm

Wc

be

te

ntrapertonea

At

cacu-

A.

key

to

B.

cervx

beedng

te

oowng

beedng?

84.

te

stoo.

ower

te

et

coc

artery

and

neror

emergency

ower

er

over

se

A

under-

postoperatvey,

te

gentas.

key

depart-

quadrant.

and

weeks

skn

brougt

T wo

days

An

webs

pubc

Wc

njured

regon

o

te

durng

te

to

te

and

ater,

a

emergency

story

te

boy

o

depart-

recurrent

deveops

asp-

Esopagogastroduodenoscopy

and

A

coonos-

porton

o

te

8t

strctures

n

te

dsta

trd

o

recanazaton

atresa

E.

Duodena

stenoss

A

5-day-od

te

esopagus

dur-

because

te

atresa

gr

s

o

abdomen

stomac

sows

duodenum.

to

ganed

be

any

to

he

stenoss

ungry

deveopmenta

emergency

te

contents

cd

wegt

te

or

a

o

cres

o

snce

and

te

2

te

depart-

days.

be.

An

ourt

amost

tme.

brt.

condtons

past

part

o

constanty,

he

Wc

most

he

x-ray

o

gr

as

te

o-

key

expan

emergency

depart-

symptoms?

Patent

B.

Duodena

be

duct

stenoss

C.

Hypertropc

D.

Atropc

E.

TEF

4-day-od

does

pyorc

gastrc

gr

because

projecte

but

brougt

vomtng

contans

A.

A

o

week

Esopagea

as

n

te

nerve

made,

T wo

te

dyspaga

Duodena

te

gament

o

te

appearng

manpuated

gament

bood

and

eococ

rgt

s

most

D.

te

gament

passng

nerves

TEF

o

skydvng.

gament

o

sows

vomtus

gament

dvertcuoss

to

te

o

C.

ment

because

s

o

pneumona.

ng

ment

sows

boy

Incompete

wc

A 74-year-od woman comes to te emergency depart-

copy

recta

T10

nectons.

(EGD)

emergency

we

o

superor

menta condtons w most key expan te symptoms?

most

careuy

nerve

because

owng

must

coc

Utrasound

rena

ntra-abdomna

perormed.

n

o

was

Ionguna

spenectomy

s

nerves

5-year-od

not

structures

mdde

te toracc esopagus. Wc o te oowng deveop-

uterne

andng

and

and

brougt

porton

E.

A

ment

and

numbness

anteror

and a CT scan sows a ruptured speen. An emergency

pertonea

80.

brm

ves-

operaton?

and

spancnc

appendectomy.

Spna

ureter

pevc

pexus

appendcts

Subcosta

83.

te

s

D.

cayx

te

nerve

nerve

pan

C.

brm

department

an

o

o

te

cayx

o

te

patent’s

wc

er

ureter.

cacuus

gr

Pudenda

emergency

rom

durng

nvoved

te

artery

Gentoemora

odge?

Major

vagus

B.

82.

radatng

sows

er

s

to

pan

te

I

pattern,

spancnc

toracc

because

ees

cest

comes

o

15-year-od

raton

severe

cut

typca

vagus

pevc

A.

nerves

woman

te

te

nerves

be

tat

removed.

operaton?

regon?

spancnc

most

o

esser

oowng

T12–L2

because

A.

A

se

because

descrbes

oowng

ts

spancnc

partay

Let

ment

nerves

o

Brances

E.

goes

ne-

T5–T12

toracc

D.

dagnoss

tuberce

anteror

be

mesenterc

Brances

and

te

uceratons

rom

trd

determned

artery

umbcus

comes

w

mesenterc

upper

te

o

s

artery

ne

umbcus

nerves

Superor

C.

n

oows

It

soud

artery

andmarks

gament

and

coon.

bowe

Brances

An

nerve

back

te

sows

te

anatomy

spne

te

2

te

sma

pan

examnaton

s

to

occurs

68-year-od

us

ac

dstance

woman

nerves

department

ower

te

o

ment

abdomna

o

B.

A

te

Wc

A.

n

oowng

nguna

dstance

about

spne

and

sensaton

te

ntersects

mutpe

stomac.

78.

tat

41-year-od

o

te

perumb-

pont?

ntersects

gament,

ror

begun

area

gament

D.

na

ocazed

appendcts

o

te

superor

tat

ne

o

dfuse

depart-

nppe

o

anteror

nguna

77.

McBurney

mdpont

o

s

Wc

he

and

emergency

examnaton

procedure

A.

te

becomes

dagnoss

pont.

to

nausea,

Pysca

a

appendectomy

best

ater

quadrant.

and

brougt

ever,

wc

tenderness

s

o

and

not

s

spncter

antrum

brougt

vomtng.

contans

appear

to

to

te

he

te

vomtng

contents

contan

be.

o

s

descrbed

er

he

stomac

gr

makes

CHAPTER

suckng

to

movements

sucke

to

by

trve.

mass

n

w

best

Duodena

stenoss

atresa

C.

Hypertropc

D.

Atropc

E.

TEF

because

stomac

or

o

2

constanty

key

A.

An

trd

wegt.

o

Wc

expan

te

Incompete

Esopagea

D.

Duodena

E.

TEF

n

w

vomtus

vomtng

abdomen

but

se

oowng

boy

was

days.

An

sows

a

o

o

te

te

he

stenoss

cd

not

w

any

Duodena

atresa

C.

Hypertroped

D.

Atroped

E.

TEF

te

stomac

o

te

but

best

s

90.

o

he

as

made.

Wc

descrbes

te

o

te

o

o

pancreatc

tat

opened

B.

Be

ducts

C.

he

ventra

pancreatc

bud

around

te

D.

he

dorsa

he

88.

A

91.

an

part

bca

te

or

mnor

to

as

an

accessory

ts

expan

duct

Ompaocee

Gastroscss

Epgastrc

E.

Indrect

te

ormed

a

rng

dorsa

o

pancreatc

o

te

pan

past

tat

appendectomy

s

o

or

week.

he

He

to

because

o

aso

te

patent

to

te

vomtng,

te

descrbes

rgt

ower

undergoes

a

emergency

and

ruptured

an

a

const-

perum-

quadrant

emergency

appendx.

A

brougt

rom

te

wen

te

to

because

s

mass

te

emergency

an

abnorma

abdomen.

contans

and

boy

oowng

te

o

sma

cres,

An

MRI

some

por-

ntestne.

strans,

condtons

w

and

most

symptoms?

erna

etus,

antenata

ndcates

atera

to

protrude

oowng

a

te

nto

examnaton.

deect

on

medan

te

condtons

te

pane,

amnotc

w

most

Utrasound

rgt

n

cavty.

key

sde

wc

Wc

expan

o

te

o

tese

Nonrotaton

B.

Patent

Abdomna

mdgut

contents

Incompete

E.

Persstent

cosure

coaca

2-day-od

te

te

not

returned

rom

te

b oy

2

o

s

and

days.

V t a 

sgns

a re

s

ods

be.

te

Te

e

eces

to

most

emergency

vomtng

vomtng

examnaton

and

wtn

te

to

contnuous

Pysca

earest

 o   ow  n g

atera

brougt

o

dstenson,

(te

te

membrane

because

contents

or

ave

cord

D.

A

o

uracus

s

be

unabe

o

con-

s  ow s

to

pass

emnated

ater

norma

mts.

common

cause

Wc

o

ts

condton?

pan-

around

artery

erna

er

A.

Inarcton

B.

Incompete

C.

Faure

D.

Remnant

enterc

brougt

nausea,

ocazes

abdomen.

deveoped

stak)

omentum

nguna

A.

duodenum.

because

te

bud

Suc

deve-

A 24-year-od woman comes to te emergency depart-

brt).

wt

oowng

erna

D.

meconum

duodenum.

bud

te

C.

o

used

o

B.

tnues

papa.

bud

s

tat

protrudes

Wc

stomac

canaze.

pancreatc

35-year-od-man

paton

perssted

about

noted.

sac)

parents

greater

department

tssue.

department

o

te

aed

dorsa

trd

at

duct

s

sows

te

abdomna

he

eum

s

te

ndngs?

oowng

deveopment

(yok

protrudng

umbca

dagnoss

te

te

mesenterc

(yok

boy

by

Umbca

spncter

A

to

nger-

cord

A.

te

cond-

o

juncton

o

access

5-cm-ong

dvertcuum

mass

vscera

300

a

border

wc

duct

vesce

tssue

o

o

superor

3-mont-od

te

cd

ost

oowng

te

symptoms?

vomtng.

A.

E.

Umbca

o

examnaton

condton?

creatc

Ceca

E.

ment

antrum

severe

pancreas

D.

key

wt

A 4-year-od boy s admtted to te emergency depart-

o

Umbca

C.

pyorc

gastrc

because

C.

o

greater

structures?

Branc

A

or

eoceca

remnant

B.

he

contents

utero

sgn.

ungry

te

n

examnaton

bubbe”

aways

emergency

a

anteror

te

Ompaoenterc

tons

dur-

te

rom

examnaton

most

esopagus

dagnosed

expan

B.

s

made

Intraoperatvey,

A.

mass

cres

gan

on

away

pouc

was

cavty.

department

duodenum

to

vomtng

brt. Wc

key

stenoss

mecansms

89.

contnues

condtons

utrasound

s

ncson

pouc

cm

cougs.

was

“doube

and

snce

most

o

Duodena

annuar

60

depart-

contans

sows

does

brougt

He

A.

ment

ke

a

emergency

he

recanazaton

constanty

wegt

ove-ke

oowng

atresa

poyydramnos.

87.

te

because

tons

an

te

symptoms?

2

g

te

duodenum.

ungry,

and

cres

pertonea

ang

symptoms?

he

te

te

department

abdomen

mdne

s

atresa

2-day-od

or

oferngs

week

C.

be

to

recanazaton

8t

B.

A

te

be.

o

o

o

er

Incompete

ng

and

s

sows

o

to

Se

undus

x-ray

and

botte.

Wc

vomtng.

part

response

spncter

brougt

contents

days.

te

s

n

te

opmenta

pyorc

gastrc

gr

o

expan

Duodena

5-day-od

ps

or

regon.

B.

A

er

examnaton

epgastrc

A.

ment

86.

o

moter

Pysca

te

condtons

85.

s

121

Abdomen

3

E.

92.

A

o

te

ts

boy

because

o

o

s

o

due

te

to

vovuus

atera

o

proxma

and

an

procedure,

te

te

ods

eum

porton

o

te

ompao-

mdgut

brougt

sudden

perumbca

made

bowe

recanazaton

Nonrotaton

and

eta

cosure

duct

5-year-od

ment

s

o

o

pan.

to

A

ea

o

emergency

nausea,

dagnoss

appendectomy

an

te

onset

s

o

appendcts

perormed.

(Mecke)

depart-

vomtng,

Durng

dvertcuum

s

122

C H A P T E R

3

Abdomen

dscovered.

mon

cause

Wc

o

A.

Inarcton

B.

Incompete

C.

Faure

D.

Retenton

o

oenterc

E.

93.

A

tat

48

ts

te

most

com-

A

due

te

to

vovuus

o

te

atera

o

te

ods

eum

porton

o

te

ompa-

mdgut

to

pass

brt.

ana

stoo

(meconum)

n

Pysca

examnaton

sows

ageness

s

Faure

te

wt

most

a

pernea

common

te

98.

stua.

cause

devaton

te

D.

Abnorma

E.

Remnant

stoo

a

o

te

coaca

by

te

te

by

bowe

s

membrane

o

proxma

o

er

te

made.

cause

o

s

to

te

septum

perorate

coon

porton

brougt

parents

2

o

o

ana

B.

Dorsa

C.

Faure

D.

Abnorma

E.

Remnant

to

because

wc

te

cana

o

ompao-

o

emergency

severa

10

a

dagnoss

oowng

s

sows

o

te

ana

o

te

o

ana

te

te

coaca

urorecta

membrane

o

proxma

ts

o

te

cecum

Nonrotaton

E.

Hernaton

23-year-od

or

wtn

etus

by

te

urorec-

to

te

perorate

coon

o

te

nant

o

s

o

te

brougt

eca

to

dscarge

oowng

te

ompao-

emergency

rom

s

dagnoses

Poycystc

C.

Ureterc

D.

Faure

E.

Wms

as

Vovuus

5-day-od

An

vs

best

sows

te

o

ts

te

B.

Ageness

C.

Faure

D.

Abnorma

E.

Premature

s

dagnosed

examnaton

o

s

te

o

o

te

red.

and

o

ogoy-

condtons

most

dsease

ureterc

gr

mesonepros

bud

was

because

to

orm

and

to

breast

te

a

pys can

yes.

cannot

Pysca

s

he

be

negatve

oowng

by

mass es.

deveopment

gentaa.

uter us

sows

o

te

 ngun a

menstr uate

externa

te

to

batera

norma

studes

Wc

brougt

o

star ted

and

saow,

A.

Mae

B.

Femae

C.

Androgen

D.

Inguna

E.

T urner

An

sex

te

or

vagna

papated.

cro matn

most

ke y

pseudoermaprodtsm

pseudoermaprodtsm

nsenstvty

as

syndrome

woman

because

been

aso

o

syndrome

ernas

18-year-od

noss

a

wt

o

anorecta

te

key

ageness.

abdomen

rectouretra

most

proctodeum

te

urorecta

xaton

o

te

parttonng

rupture

12-year-od

dark

a

emae

age

te

presence

Faure

to

dvertcuum

o

as

a

exam.

bus

an

te

te

he

past

a

sma

emergency

pan

6

ymen

cycc

he

amenorrea.

suprapubc

te

s

key

s

monts.

examnaton

between

most

to

prmary

vagna

membrane

s

te

o

sows

A

pan.

over

mperorate

oowng

brougt

story

examnaton

on

s

pevc

worsenng

A.

Faure

pe-

B.

Cervca

Wc

C.

Patent

D.

Androgen

E.

Faure

and

stua.

embryoogca

cause

condton?

nspecton,

py-

examnaton

ageness

oowng

te

aba.

made.

mass

sows

A

Wc

expanaton

a

dag-

or

o

ts

condton?

boy

oowng

department

o

er

Pysca

stua

A.

A

rena

te

te

sows

patent

cyst

utrasound

o

Utrasound

to

examnaton

tumor

not

bugng

E.

o

examnaton

Vtene

A

comes

Pysca

dupcaton

parents

B.

(Mecke)

o

kdney

15-year-od

papated

Iea

appendx

woman

mts.

Wc

te

condton?

ntestnes

unatera

Degeneraton

and

condton?

Vtene

and

norma

sows

ts

ea

s

mdgut

prmgravd

B.

Enterocystoma

D.

te

an

occurred?

A.

C.

te

o

sows

oowng

regress

examnaton.

department

umb-

w

o

to

te

dagnos s?

septum

porton

o

A.

A

stak

routne

Laborator y

100.

because

Wc

expan

o

recanazaton

2-mont-od

cus.

Marotaton

D.

pattern.

te

duct

department

C.

s

most

condton?

separaton

devaton

enterc

ntestne

Se

wt-

septum

o

te

er

perods

days

examnaton

and

te

te

asted

Pysca

Wc

ts

Incompete

o

key

99.

gr

movement.

A.

ta

urorecta

recanazaton

o

nrequency,

stenoss

te

yok

cause

Faure

A

o

scan

o

Dupcaton

te

urorec-

duct

narrowng

key

o

ana

3-mont-od

department

embryoogca

dramnos.

separaton

Wc

B.

s

o

pertecnetate

dvertcuum.

A.

scan

septum

o

tecnetum-99m

underyng

condton?

C.

A

o

oowng

Dorsa

out

s

(Mecke)

proxma

as

as

te

enterc

97.

te

ater

B.

o

oowng

bowe

cosure

boy

Incompete

ta

96.

eta

o

A.

A

te

duct

boy

o

o

condton?

recanazaton

ours

te

Wc

95.

o

Nonrotaton

newborn

rst

94.

ts

boy

wt

te

s

o

cd

septum

te

te

Questions

ana

to

bood

to

te

vagna

processus

pate

to

canaze

o

vagnas

nsenstvty

te

syndrome

snovagna

bubs

to

deveop

be

ree

rom

o

Upon

brgt

any

pan.

101–125

22-year-od

woman

dyspareuna.

er

emergency

beedng.

ranged

A

o

membrane

recta

appeared

101.

coaca

brougt

te

te

atresa

deveop

ndgut

o

massve

coor

he

o

to

o

ast

ormed

sexuay

1

mont

examnaton

atera

Se

wa

examnaton

to

ad

transmtted

ago,

sows

o

comes

as

te

a

3

was

cm

vagna.

sows

tat

te

one

pyscan

sexua

dsease

negatve.

cystc

screenng,

A

mass

because

partner

routne

detected

A

transvagna

te

abnorma

and

per-

pevc

on

te

utrasound

structure

s

CHAPTER

key

a

Gartner

embryonc

102.

A.

Mesoneprc

B.

Paramesoneprc

C.

Urogenta

D.

Mesoneprc

E.

Snovagna

cyst

o

te

oowng

orgnate

generazed

rom?

sma

tubues

upper

duct

te

ods

Were

A.

Rgt

wa

s

te

Paracoc

weeks’

D.

Vescouterne

E.

Rectouterne

gestaton

vst.

wt

a

a

wt

ears,

o

tese

te

B.

Poycystc

C.

Rena

Wms

Exstropy

o

s

s

s

Hg,

we

and

are

e

rgt-sded

s

obstructng

partay

te

second

s

te

o

ureter

most

ureterc

B.

Eary

C.

Faure

D.

Persstent

uracus

E.

Faure

ureterc

spttng

o

by

gastrc

pan.

wc

s

er

ucer

s

asprated

n

pertonea

wen

te

A.

Rgt

B.

Hepatorena

C.

Let

cavty

D.

Vescouterne

E.

Rectouterne

43-year-od

department

as

Pysca

a

atter

pres-

o

te

o

to

te

sudden,

severe

ep-

eartburn,

108.

over-te-counter

sows

wa

o

surgca

te

a

(o

pertonea

sma,

woman

o

story

(o

s

roty

cavty.

most

gray

sows

sudden,

sarp

says

A

tat

te

er

pregnancy

sows

pevs.

most

In

a

n

ast

test

n

s

negatve.

cyst

approxmatey

o

te

menstrua

ruptured

wc

key

emergency

pan

te

on

100

oowng

accumuate?

space

(o

Morson)

pouc

pouc

man

o

(o

s

severe

ypertenson

to

te

sows

a

te

and

o

Pysca

CT

trombus

te

pyscan

te

emergency

n

and

angograpy

te

artery

ayers

to

He

wt

examnaton

rgdty

oowng

enter

pan.

aterosceross

guardng,

abdomen.

Wc

to

abdomna

medcaton.

tenderness,

o

Dougas)

brougt

o

key

Pareta

pertoneum

B.

Greater

and

access

n

o

a

te

suppyng

o

te

perto-

afected

Lesser

Pareta

pertoneum

E.

Greater

omentum

A

to

te

epgastrc

52-year-od

o

smokng

drug

epgastrc

and

pan.

he

ong-term

because

pan

109.

or

greasy

aspect

te

man

o

te

o

o

A.

C3–C5

B.

C5–C8

C.

T1–T4

D.

T5–T9

E.

T10,

greater

omentum

2

gastrospenc

te

te

persstent

to

transverse

te

sows

wt

spna

pan

n

began

An

te

quad-

sorty

sows

ower

utrasound

mutpe

be

segments

wt

depart-

upper

examnaton

norma

nerve

assocated

rgt

pan

souder.

mesocoon

emergency

he

Pysca

and

gament

mesentery

severe

ours.

ood.”

gabadder

pan

and

abdomen

oowng

back

te

comes

rgt

te

and

sweatng,

s

te

and

past

“ast

prouse

nlamed

emergency

omentum

and

omentum

D.

naton

rst

esser

C.

ror

Were

Dougas)

o

severe

nausea,

poston?

brougt

to

a

resuted

because

story

ater

Durng

Morson)

sudden

Dougas)

brougt

Se

A.

te

ant-nlammatory

examnaton

60-year-od

rant

pouc

pouc

Vescouterne

Rectouterne

ment

stomac

repar.

bood-tnged,

supne

emergency

cronc

qud

n

stom-

gutters

E.

w

(o

o

pouc

D.

eum.

ucer

te

vesse?

deveop

o

Paracoc

te

o

a

An

ocated?

s

ago.

te

C.

abdomen

ndng?

perorated

curvature

key

sows

space

subprenc

quadrants

x-ray

dapragm.

pouc

lud

Rgt

sows

gutter

because

Nonsteroda

s

te

n

noncompance

space

pouc

paracoc

or

woud

patent

subprenc

and

An

stone

most

wc

Hepatorena

a

te

sma,

utrasound

B.

as

a

greater

pouc

days

ovary,

woud

neum

endoscopy

o

kdney

10

lud

cest

under

space

A.

A

ar

quadrant.

was

o

te

woman

transvagna

et

sows

o

because

department

examnaton

a

ts

107.

130/85

sde. Wc

varous

te

86/

bud

to

posteror

mL

s

branc

story

rom

puse

He

tenderness.

ureter

o

tat

orm

because

te

pan

regon.

pressure

tat

brougt

wt

Hs

ange

rgt

cause

to

s

taken

150

s

rgt

to

bud

a

severe

Pysca

ureterc

upper

n

patent

procedures,

patent

perod

emergency

pubc

bood

septum

son

as

An

qud

A

te

se-treated

perorated

coect

o

te

o

te

sows

te

bud

woman

Se

medcatons.

on

urorecta

50-year-od

department

s

key

Faure

to

caracter.

abdomen

A.

o

n

to

costovertebra

s

te

expanaton

ower

te

because

back

aebre.

o

te

key

et

badder

18/mn,

utrasound

te

most

brougt

cocky

mm

and

ogoydramnos.

kdney

urnary

ower

respratons

A

department

uprgt

ar

gutters

25-year-od

mL

man

s

pan

a

brdge,

A

spaces

te

mn,

o

nasa

106.

A

dyspastc

by

rom

oowng

te

utrasonograpy

broad

and

prena-

conss-

tumor

department

ence

eet,

a

ndngs?

58-year-od

sows

s

Feta

or

uterus

kdney

E.

te

cubbed

a

ageness

D.

says

pyscan

sows

gestaton.

oowng

nta

Mutcystc

radates

te

mcrognata,

A.

A

to

examnaton

27-week

etus

ow-set

Wc

comes

Pysca

An

ree

subprenc

Supravesca

or

bubs

o

endoscopy

posteror

ac.

duct

rgdty.

amount

C.

sows

105.

Wc

ts

B.

tent

104.

cyst.

does

A 30-year-od woman, gravda 1, para 0, abort 0, at 30

ta

103.

duct

structures

123

Abdomen

3

poste-

exam-

stones

duct.

are

n

an

Wc

nvoved

n

coecystts?

T11

A 64-year-od woman comes to te emergency depart-

ment

because

(NSAID)

use.

tory

o

tenderness

and

mts.

o

severe

gastones.

Pysca

Her

abdomna

vta

examnaton

sgns

pan.

are

sows

Se

as

wtn

a

s-

norma

tenderness

n

te

124

C H A P T E R

rgt

3

Abdomen

upper

quadrant.

ecystectomy

durng

110.

surgery.

woud

most

reduce

te

Prnge

B.

Kocer

C.

Vasava

be

was

epatc

o

te

taken

artery

oowng

perormed

by

te

or

was

co-

oss?

maneuver

naton

puse

o

most

coon.

B.

Mdde

C.

Superor

D.

Ineror

E.

Let

An

woman

because

te

sows

o

o

te

B.

Iopsoas

C.

Obturator

D.

Murpy

Coug

te

says

te

n

ater

te

te

s

pan,

pan

upper

sows

dagnoss

most

115.

key

be

because

s

o

tssue

ana

te

protrudng

o

rst

Interna

B.

Externa

C.

Mdde

D.

Superca

E.

Deep

A

o

ympatc

wt

an

area

to

o

ymp

ympatc

an

nor-

abnorma

superor

te

to

pectnate

s

made.

nodes

dranage

beedng

wtn

Wc

woud

rom

te

ne.

ts

most

area?

ac

nguna

man

severe

a

wtn

ong

tat

repar

story

s

Sdng

ernas

B.

In

C.

Paraesopagea

o

te

emergency

abdomna

smokng.

A

CT

as

scedued.

be

te

and

patent

and

A.

sdng

to

mts.

te

woud

sdng

comes

eartburn

norma

sows

between

sows

emorrods

groups

recta

are

recta

as

surgca

rom

o

ac

32-year-od

brougt

recevng

120/mn,

s

a

Hs

prouse

te

transected

gunsot

mm

to

Hg.

wound

s

are

An

s

a

gan

vesse

possess

ernas,

te

a

GE

o

useu

to

juncton

ave

a

vta

te

te

GE

depart-

pan.

he

sgns

abdo-

erna,

and

oowng

dstngus

ata

norma

ernas

o

ata

Wc

most

Hs

scan

a

paraesopagea

wtn

entry

116.

In

ernas?

juncton.

s

dspaced.

dspaced

GE

stomac

He

paraesopagea

move

because

as

te

sows

te

o

nto

te

tures

a

o

abdomen

to

te

woud

o

sows

most

te

Round

Facorm

gament

C.

Spenorena

C.

Coronary

gament

D.

Gastrococ

D.

Hepatoduodena

E.

Hepatoduodena

E.

Gastroduodena

brougt

to

beedng

te

emergency

and

abdomna

117.

A

and

rgt

nto

and

te

stomac.

be

n

pan

nausea.

and

subprenc

a

o

te

A

exam

CT

abscess

oowng

poston

te

vomtng.

Pysca

tenderness.

Wc

across

B.

s

a

key

abscess

A.

recta

moves

antrum

te

abdomna

mdne.

Coronary

o

antrum

te

o

abdomna

Gastrospenc

woman

body

ever

B.

because

te

ernas,

te

severe

ow-grade

generazed

extends

te

ernas,

corpus.

A 43-year-od man s brougt to te emergency depart-

ment

woud

to

paraesopagea

carda

beed-

and

gaments

adequate

E.

utrasound

perormed,

be

n

16/mn,

In

te

36.9°C

ntrapertonea

oowng

to

emergency

temperature

aparotomy

o

te

respratons

80/60

appears

to

spread

55-year-od

o

nguna

andmarks

sac?

department

receve

sgns

superor

nterna

receve

vta

examnaton

spncter,

oowng

epsodes

Hs

A.

A

rst

groups

patoogy?

mutpe

pan.

Pysca

dagnoss

D.

s

sows

Wc

be

o

oowng

nguna

o

A.

a

present

key

beow

presence

nguna

mts.

men

coecystts.

area

te

te

ac

ma

are

ga-

o

most

protrudng

recta

abdomna

patent

quadrant.

tssue

conrms

ac

and

ment

examna-

mutpe

o

nau-

radates

o

bopsy

wegt

examnaton

A 53-year-od man s brougt to te emergency depart-

A

emergency

Pysca

rgt

woud

quadrant.

beedng

key

Deep

unntentona

Pysca

juncton.

emergency

most

Superca

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o

abdomna

back.

te

te

to

tat

abdomen

wt

pressure

sac.

esser

to

man

puse

esser

D.

sgn

abdomen

o

Mdde

externa

tenderness

bood

source

arteres

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C.

mass

Wc

te

B.

mass

te

sgn

upper

(98.4°F),

An

CT

test

department

ng.

oowng

A

rom

tenderness

35-year-od

te

te

negatve.

beedng

emorrage?

sudden

oowng

Rebound

o

s

et

examnaton?

A.

and

o

tenderness

pysca

et

o

comes

Se

abdomen

Wc

te

guaac

ower

rom

and

monts.

A

woud

Interna

ment

exam-

recta

consstent

E.

Pysca

and

114.

recta

stones,

A

Hg.

38°C

20/mn,

coc

vomtng.

ne.

A.

key

utrasound

on

mm

s

are

and

gastro-omenta

and

ton

temperature

massve

te

emergency

beedng

coc

department

rom

Stoo

o

te

dstenton,

sows

Wc

to

recta

respratons

100/73

source

51-year-od

sea,

Hs

abdomna

key

Let

A

s

abdomen

A.

brougt

panu

100/mn,

tenderness.

te

descendng

te

s

o

pan.

s

pressure

sows

quadrant

scan

man

6

abnorma

nodes

dranage

maneuver

abdomna

an

atgue

past

pectnate

ymp

because

reports

te

adenocarcnoma.

Hemc

bood

te

maneuver

73-year-od

Se

or

sows

to

Pacement o a vascuar camp on te porta epats

and

oss

procedures

pyscan

E.

A

pan.

njured

maneuver

(100.4°F),

113.

patent

D.

severe

112.

he

rgt

Wc

bood

A.

te

key

department

111.

and

to

scan

tat

struc-

prevent

te

mdne?

gament

21-year-od

department

gament

gament

man

because

s

o

brougt

back

to

pan

te

ater

emergency

sustanng

CHAPTER

an

njury

s

ower

et

torax

et

sde.

most

back

sows

Wc

key

to

He

Pysca

a

s

brused

racture

o

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sustan

aso

as

a

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examnaton

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o

te

oowng

njury

at

swoen.

eevent

organs

ts

pan

sows

An

rb

and

x-ray

w

on

woud

gabadder

tat

be

A.

Jejunum

B.

T ermna

C.

Be

Duodenum

ste?

C.

Kdney

D.

Lver

department

E.

Pancreas

and

rgt

tat

te

122.

comes

to

te

emergency

depart-

Hepatc

A

upper

pan

and

papabe

node

ces.

Wc

most

key

superca

bopsy

o

te

prmary

A.

Prostate

B.

Urnary

Pysca

sows

nguna

te

oowng

source

examnaton

ymp

presence

ocatons

o

o

sows

nodes.

A

radates

woud

be

te

te

A.

carcnoma?

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badder

w

te

he

ntersecton

wt

te

T o

D.

Superory

E.

Sgmod

E.

Upper

because

Pysca

ca

and

sows

o

s

examnaton

massve

tumor

key

to

emergency

severe

tenderness

A

CT

scan

orgnatng

Wc

be

te

and

sows

regons.

duodenum.

most

to

vomtng

epgastrc

a

te

o

comes

o

te

wegt

o

te

o

te

rom

te

oowng

compressed

or

depart-

123.

ment

umb-

gron

abdomen

trd

Be

B.

Hepatc

ocaton

te

rmed

A.

Superor

D.

Gastroduodena

E.

Posteror

superor

department

Pysca

ower

men

te

cedure

tures

because

pevs

adnexa

to

te

remove

te

ureter

o

te

just

Mdde

recta

B.

Superor

to

Interna

D.

Uterne

E.

Gonada

A

CT

artery

abdomna

scan

Durng

o

o

mass

te

occupyng

and

te

ureter

are

structures

o

te

te

124.

pro-

struc-

dented.

crosses

te

ness

n

sound

te

o

te

ower

a

A

epgastrc

comes

to

papabe

and

a

oowng

ocaton

o

wa?

nea

semunars

nea

semunars

regon

regon

a

o

mass,

e

type

te

o

o

depart-

mass

stands

at

erna

te

asca

or

sows

based

dagnoss

s

oowng

nguna

s

erect

examnaton

nguna

and

Wc

ts

emergency

panu

wen

drect

te

te

and

Pysca

on

con-

s

te

erna?

around

around

or

abdomna

sows

past

2

days.

patent

wt

quadrants.

numerous

Pysca

woman

tender-

An

stones

utra-

n

te

because

te

te

deep

rom



Sorty

te

te

te

te

deep

nguna

Subprenc

C.

Rectouterne

D.

Vescouterne

A

o

recess

scan

o

te

pan

s

a

an

te

and

emergency

perumbca

strong

bood

regon

sttng

ruptures.

and

most

pan.

possbty

appendectomy

appendx

(pouc

recess

s

In

be

wc

nectous

key

o

to

lu-

tend

to

uprgt?

o

Morson)

Dougas)

space

woman

te

an

o

(pouc

space

because

CT

tssue

obque

space

subepatc

22-year-od

department

beore

was

to

severe

appendcea

Hepatorena

Rgt

abdomna

musces

sows

nlamed

patent

connectve

abdomna

extravasatng

B.

A

externa

comes

o

examnaton

A.

E.

125.

nterna

22-year-od

coect

te

o

abdomns

woud

o

extrapertonea

transversus

area

ds

dstressu

abdomen

Deectve

perormed,

uterus?

ven

sows

rgt

aponeuross

Weakness

appendcts.

ment because o crampng abdomna pan around er

examnaton

body

rgt

umbca

pertoneum

E.

Pysca

ven

vomtng

te

says

musce

department

artery

and

dagnoss

o

precse

te

Se

souder.

pane

transversas

D.

abdo-

surgca

ureter

cervx

et

A 32-year-od woman comes to te emergency depart-

umbcus

vomtng,

pan.

rng

Deectve

obque

pan.

te

te

te

vascuar

C.

artery

pudenda

te

te

to

emergency

posteror

Wc

te

mse.

cause

Deectve

emergency

artery

vesca

C.

te

to

te

tenderness

abnorma

tumor,

oowng

atera

A.

an

pevs.

meda

to

ower

sows

sows

mmedatey

Wc

comes

quadrant.

n

te

nausea,

rng

o

examnaton

and

B.

pancreatcoduodena

woman

abdomna

et

artery

a

o

o

Deectve

artery

te

aparoscopcay.

key

nguna

mesenterc

24-year-od

exerts

probabty

rgt

te

exacerbated

te

ven

C.

s

te

by

ocatons

ound?

quadrant

o

part

nvaded

gabadder

cartage

o

te

man

structures

duct

porta

rgt

tat

o

costa

o

to

because

pyscay

most

A.

rgt

45-year-od

oss.

tumor?

A

A

be

to

conrms

ntertubercuar

C.

man

te

nnt

te

respect

ntersecton

T ests

coon

te

abdomna

descrbe

wt

wt

Ana

54-year-od

key

onset

panned.

he

D.

A

s

best

gabadder

C.

cana

n

oowng

comes

acute

to

examnaton

andmarks

magnant

o

quadrant

coecystectomy

paness.

most

woman

because

Pysca

s

te

duct

37-year-od

tat

mass

stone

o

eum

ment because o a arge mass n s rgt gron. He says

te

accumuaton

wc

duct

E.

man

At

te

D.

46-year-od

ar

te

Speen

A

and

tree.

obstructve

Lung

ment

121.

an

B.

ymp

120.

bary

A.

ard

119.

ootba.

breatng.

o

118.

durng

durng

125

Abdomen

3

o

comes

severe

abdomen

nlamed

to

upper

sows

te

emergency

abdomna

tat

appendx.

te

Wc

pan.

source

o

te

126

C H A P T E R

3

Abdomen

oowng

rom

n

te

te

structures

appendx

contan

tat

are

te

nerve

causng

te

ce

bodes

reerred

epgastrum?

A.

Sympatetc

B.

Ceac

E.

sympatetc,

129.

trunk

ganga

o

A

21-year-od

department

gangon

orn

Pregangonc

pan

ower

te

spna

cord

Latera

Dorsa

root

ganga

o

spna

nerves

T8–T10

vta

E.

Dorsa

root

ganga

o

spna

nerves

L2–L4

examnaton

Questions

A

comes

a

te

126–150

30-year-od

o

a

6-mont

3-mont

as

o

er

A

woman

story

acute

requred

catons.

CT

rgt

made,

and

tomy.

to

be

scan

s

o

te

te

o

pyscan

and

atgue.

Se

A

te

a

sows

dagnoss

suprarena

o

nerve

and

Pregangonc

B.

Postgangonc

C.

Somatc

Postgangonc

E.

Pregangonc

B.

Ioypogastrc

C.

Ionguna

D.

Latera

E.

Obturator

a

peo-

s

130.

w

need

tumor

72-year-od

and

te

te

te

cancer

pevs

et

tat

vesses

te

a

es

s

ago.

new

o

key

Ineror

B.

Rgt

C.

Let

testcuar

ven

D.

Let

common

ac

E.

Rgt

A

o

te

common

er

pan.

nerve

te

A.

A

emergency

An

o

as

te

or

abdomen

ncorporated

and

compressed

utrasound

venous

nvoved

et

o

n

ower

te

te

Wc

ac

o

tat

severe

to

abdomna

carcnoma

o

oowng

te

are

te

most

s

o

te

pan.

ead

perormed

best

key

sows

to

to

A

o

descrbes

be

te

present

n

and

somatc

motor

and

vscera

afer-

Postgangonc

D.

Pre-

sympatetc

and

vscera

aferent

bers

man

monts.

n

parasympatetc,

sympatetc,

and

vscera

pregang-

aferent

bers

as

o

te

w

a

and

te

o

tacy-

rgdty.

dapragm.

ucer

most

to

s

made.

commony

an

o

sows

regon.

key

emergency

and

relux

smokng

tenderness

Upper

anteror

duodenum.

most

te

pan

story

exam

epgastrc

o

condtons

brougt

abdomna

He

penetraton

part

s

o

Pysca

te

o

or

and

and

endoscopy

duodena

Wc

ucer

te

n

oow-

occur?

rom

superor

C.

Beedng

rom

posteror

D.

Beedng

artery

mesenterc

superor

artery

pancreatcoduo-

artery

rom

posteror

neror

pancreatcoduo-

artery

Pertonts

56-year-od

department

epsodes

use

o

movement

tenderness

aparotomy

used

a

n

and

sows

s

Superor

B.

Ineror

he

days.

o

to

juncton?

mesenterc

reease

artery

artery

te

te

ave

sows

An

oops

oowng

mutpe

not

exam

dstenton.

te

emergency

and

dd

dated

determne

mesenterc

te

pan

Pysca

mutpe

to

to

patent

moderate

Wc

andmark

A.

3

brougt

abdomna

perormed

ntestnes.

as

s

o

vomtng.

abdomen

te

man

because

duodenojejuna

postgangonc

story

pancreatcoduodena

Beedng

o

s

a

sows

pancreatcoduodena

B.

A

emergency

abdomna

ucer?

gastroduodena

te

parasympatetc

as

exam

duodena

arteres

rom

A

te

severe

under

Beedng

E.

132.

o

ts

artery

because

abuse.

dena

te

reeve

ar

A.

CT

or

gastrc

2

rst

stone

Wc

mesenterc

50-year-od

bowe

parasympatetc

C.

onc

neror

rgdty

bers

and

superor

Posteror

acoo

emergency

o

D.

dena

comes

type

Posteror

past

kdney

tenderness,

perorated

Superor

Rgt

Her

utrasound

ureter.

Se

Pysca

oowng

C.

A

a

er

pan

sarp.

An

to

and

boatng.

sows

B.

ven

bock

Postgangonc

ent

ts

mb,

bers

B.

by

as

te

responsbe

brougt

sudden

use.

Gastroduodena

te

producton

by

A.

oowng

gangon?

Pregangonc

eroded

te

pexus

tat

te

s

o

cest

o

o

department

ven

sows

ceac

dagnoss

key

abdomna

te

Wc

E.

131.

sows

tromboss

te

Wc

pros-

woman

NSAID

o

rgt

rom

tat

pan?

because

dfuse

x-ray

ng

woman

because

structures

ceac

be

tat

artery

t.

te

cava

abdomen

pancreas.

to

treatment

scan

rom

pan.

bers

ven

48-year-od

department

A

tromboss?

A.

rena

to

return

to

CT

ac

deep

and

venous

vena

a

A

tumor

neror

venous

most

An

most

pan

sows

er

emergency

cutaneous

accompaned

ong-term

bers

admtted

common

scema

deep

s

cemoterapy

monts

sows

bock

causng

o

6

a

deveopment

coud

42-year-od

pan

are

bers

parasympatetc

man

ater

proxma

ven

A

emora

department

bers

parasympatetc

o

tat

tumor

s

says

mts.

abdomen

nerves

sensaton

te

norma

te

radatng

Se

para-

bers

to

pan

pevs.

obstructng

med-

bers

sympatetc

motor

department

128.

sympatetc

D.

tatc

oowng

brougt

descrbes

te

pregangonc

aferent

severe

er

and

o

s

o

wtn

partay

carda,

A.

are

Subcosta

removed?

A

s

reerred

adrenaec-

bers

gand

waves

A.

medua)

aparoscopc

suprarena

a

n

sgns

as

ypertenson

abdomen

or

because

antypertensve

oowng

te

te

severe

gand.

(tumor

o

o

wt

scedued

wen

to

weakness

story

suprarena

Wc

cut

comes

o

treatment

cromocytoma

127.

toward

D.

vscera

woman

because

C.

tat

126.

back

sympatetc,

and

x-ray

o

a

d-

o

bowe.

obstructon

structures

poston

o

s

te

CHAPTER

133.

C.

Vasa

D.

Suspensory

T retz)

o

E.

Ladd

key

A

recta

markedy

musce

4-mont-od

ton

te

duodenum

(gament

o

tomoses

bands

department

actvty

o

and

sows

gr

by

s

er

brougt

parents

dicuty

cyanoss,

to

te

because

breatng.

decreased

A.

Hepatc

B.

Ineror

examna-

C.

Hepatc

D.

Be

E.

Cystc

Pysca

sounds,

bowe

te

abdomen

dapragm

and

cavty.

Wc

o

deect?

ts

A.

Absence

B.

Absence

sows

a

posteroatera

abdomna

o

te

contents

oowng

s

n

te

deect

te

most

et

o

te

137.

peura

key

a

peuropercarda

o

muscuature

cause

recta

od

n

are

one

a

o

te

Faure

o

mgraton

D.

Faure

o

te

E.

Faure

o

peuropertonea

58-year-od

sarp

o

ness

pan

to

acetc

acd

sage

nto

te

te

dagnoss

135.

CT

o

ts

A.

Bocdaek

B.

Sdng

says

scan

to

to

o

tat

e

as

se

as

n

test

te

L1–L2

D.

L1–L4

gabadder

s

te

xpod

rgt. Wat

s

unctons

sows

trapped

at

tat

ts

most

a

and

man

because

o

s

o

vomtng

dfuse

epsodes

A

CT

o

scan

mecanca

oowng

o

Hepatopancreatc

E.

Hata

B.

Duodena

pan

and

abdomna

er

vomtng.

tenderness

abdomen

sows

gn

superor

o

ema

te

to

organs

an

s

s

son

an

Pysca

and

aortc

key

to

o

A

aneurysm

organ.

te

emergency

severe

exam

rgdty.

mesenterc

abdomna

most

brougt

because

abdom-

sows

CT

dfuse

scan

o

afectng

te

resutng

n

artery

Wc

o

te

te

139.

or-

sc-

oowng

afected?

Proxma

D.

Pyorc

E.

Ieoceca

swaowng

ater

vta

sgns

ton

s

are

wtn

wtn

D.

Stomac

A.

Brances

E.

Duodenum

B.

Bronca

motor

repar

A

erna

was

CT

scan

wc

to

o

te

te

pyscan

sustanng

coson

aceved

te

troug

Wnsow).

comes

vece

vst,

n

peroraton

Wc

ater

ts

ernated

(o

man

examnaton

pan.

to

te

pan

past

2

emergency

and

mutpe

days.

Pysca

abdomna

Auscutaton

abnorma

abdomen

o

dstenton

te

sows

bowe.

gastrontestna

bowe

gastones

Wc

tract

s

o

most

o

(o

Vater)

te

te

brougt

te

pan

a

2

s

bone

mts.

mts.

ower

oowng

to

esopagea

norma

norma

o

s

o

Upper

s

ours

Pysca

odyno-

ago.

by

most

te

Her

examna-

endoscopy

esopagus

arteres

emergency

and

s

key

at

sows

bone.

rsk

o

njury?

41-year-od

Durng

woman

paga

Speen

gca

sows

descend-

dermatomes

papaton.

ampua

because

C.

a

te

juncton

T ransverse

rom

o

bub

43-year-od

B.

up

tender-

eum

Ieum

A

sows

aso

sgns

spncter

A.

coon

vta

reerred?

assocated

te

department

a

paness

obstructed?

C.

A

te

to

te

A.

na

key

woman

Her

oowng

been

obstructon

parts

Morgagn

by

or

o

Coecystts

62-year-od

part

brougt

pan

D.

A

te

sgncant

C.

erna

most

patent

coonoscopy

abdomna

tenderness

te

erna

s

emergency

and

he

exam

A

dsta

key

and

and

erna

te

te

pan

boatng.

Pysca

o

most

to

monts.

quadrant.

sows

sounds.

erna

esopagea

3

and

mts.

examnaton

sows

condton?

brougt

abdomna

past

wc

61-year-od

epsodes

key

structures

anas-

(vens

T10–L2

A

department

pas-

process

te

E.

te

afectng

ave

C.

138.

s

o

ower

T o

pan

exacerbaton

Barum

abdomen

coon.

T5–T9

mnod-

or

et

T10–L1

juncton.

woman

norma

te

B.

tender-

oowng

ormng

systems

ven

constpaton

A.

sows

cava

cava

because

o

because

te

vens

artery

beedng

woud

cose

exam

omentum

te

deveop

(Hepatobary

between

on

ng

to

pyscan

xpsterna

scan)

torax

od

te

Pysca

te

greater

margn

department

136.

A

to

njectons

[HIDA]

o

costa

at

dye

negatve.

porton

te

and

He

ood.

dapragm

transversum

comes

pan.

wt

papaton

swaow

are

man

epgastrc

te

o

septum

o

te

and

duct

wtn

ness

porta

duct

dvertcuoss

C.

A

porta

vena

48-year-od

says

o

Wc

department

dapragm

134.

A

ncudng

te

compressed?

decreased

sounds n te torax, and respratory dstress. An x-ray

o

Retzus).

emergency

o

breat

dated,

between

127

Abdomen

3

omenta

Gastrontestna

o

Intercosta

D.

Brances

E.

Rgt

A

sur-

abdomna

an

te

nterna

coon

(eppoc)

vens

C.

compcatons.

sows

lexure

oow-

trauma

ago.

experences

abdomen

epatc

te

monts

wtout

patent

te

2

or

abdomna

o

ad

oramen

appear

to

be

140.

A

o

42-year-od

radates

upper

naton

to

te

o

te

s

brougt

beng

nvoved

man

et

quadrant

gastrc

prenc

man

ater

he

gastrc

rgt

neror

department

coson.

et

s

stabe

souder.

but

as

Pysca

tenderness.

abdomen

to

n

An

sows

te

a

emergency

motor

severe

exam

tat

sows

utrasound

spenc

vece

pan

et

exam-

emorrage.

128

C H A P T E R

Wc

3

o

Abdomen

te

experenced

141.

oowng

by

te

sgns

best

descrbes

te

pan

oowng

patent?

transmt

be

te

Mttescmerz

A.

Sympatetc

pregangonc

Ker

B.

Sympatetc

postgangonc

sgn

C.

Rovsng

D.

Psoas

E.

Obturator

A

sgn

sgn

sgn

43-year-od

obe

ormed,

to

te

rgt

most

rgt

man

ater

o

s

brougt

sustanng

te

dgta

ver.

pressure

ndcatng

epatc

artery.

common

obe

o

to

a

n

o

but

n

s

brsk

te

te

te

wound

to

aparotomy

varaton

Wc

emergency

maneuver)

gament,

a

te

kne

Ater

varaton

te

a

(Prnge

epatoduodena

contnues,

s

te

per-

suppy

Vscera

D.

Pregangonc

E.

Postgangonc

A

vomtng,

he

patent

necton.

and

Pysca

o

te

tenderness.

s

te

eus.

to

te

be

ver?

An

Wc

present

o

durng

Increased

Absent

B.

he

C.

Borborygm

D.

Crampy

E.

Locazed

te

C.

superor

he

rgt

epatc

orgnates

rom

te

et

gastrc

D.

he

rgt

epatc

orgnates

rom

te

et

epatc

E.

he rgt epatc orgnates drecty rom te aorta

146.

A

ment

nau-

betes.

ater

and

because

meas.

Pysca

derness

n

te

gograpy,

te

o

patent

rgt

te

eter

key

nto

A.

Cystc

B.

Spra

nterere

cystc

duct

(o

T ortuosty

o

rom

E.

Porta

upper

a

a

quadrant.

successu

on

oowng

ts

coan-

passage

o

te

o

nto

structures

a

epatc

s

s

cat-

Se

o

artery

nausea

rgt

t

te

and

upper

sgn.

to

woud

duct

te

pan

pan

n

as

but

Pysca

be

Wc

key

and

undergoes

deveops

most

rgt

tenderness

patent

day.

te

cocky

quadrant

he

147.

emergency

vomtng.

postoperatve

condtons

gament

cystc

abdomna

descrbes

Murpy

te

per-

o

account

te

or

be

duct

B.

he

ducts

C.

he

rgt

D.

he

cystc

E.

he

et

o

epatc

tpe

epsodes

story

o

o

acoo

tenderness

eevated

s

serum

Let

Cystc

s

s

and

vomtng.

abuse.

rgdty.

amyase

he

Pysca

patent

exam

Laboratory

and

pase.

and

as

sows

sow

te

te

crcuaton

neror

severe

superor

vesses

between

oss

and

w

te

o

da-

tenderness

sows

occuson

mesenterc

most

ceac

key

trunk

artery?

pancreatcoduodena

epatc

gastroduodena

coc

A 22-year-od man s brougt to te emergency depart-

ment

ng

because

or

te

rebound

sows

taken

o

te

pass

A.

o

C.

2

o

An

reac

Externa

obque

ayers

te

obque

sows

he

ts

te

and

abdomen

patent

hroug

must

troug

musce,

vomt-

s

wc

pyscan

ncson?

musce,

nterna

transversas

asca,

pertoneum

Aponeuross

o

nterna

te

externa

abdomna

abdomns

musce,

abdomna

obque

obque

musce,

transversas

trans-

asca,

and

pertoneum

Aponeuross

musce,

o

appendcts.

appendx

and

tenderness,

appendectomy.

abdomna

pareta

quadrant

abdomna

te

nausea,

examnaton

utrasound

acute

aparoscopc

pan,

Pysca

ower

tenderness.

oowng

to

days.

rgt

evdence

or

abdomna

past

tacycarda,

ong

o

o

gastro-omenta

o

te

nterna

transversus

epgas-

studes

Wc

part

oowng

et

mu-

a

key

emergency

and

ateroscerotc

et

pareta

emergency

to

te

pan

Angograpy

and

musce,

pan

sows

and

B.

te

paraytc

most

ypertenson

Rgt

eakng

to

due

and

to

Rgt

versus

abdomna

o

mesenterc

and

gastrc

brougt

E.

eakng

brougt

days.

abdomna

sows

woud

abdomna

D.

eakng

sudden

and

eakng

s

s

quadrants.

te

superor

and

are

duct

duct

man

wt

o

and

C.

generazed

sgns

2

pneumona

examnaton?

story

a

coatera

B.

past

a

pan

o

md-proxma

te

te

abdomen

examnaton

n

Wc

Superor

or

rom

sounds

a

provde

eakng

Luscka

duct

as

abdomna

epatc

35-year-od

department

s

emergency

sounds

scema

A.

sows

te

pysca

man

Pysca

te

appette

oowng

because

rgdty

artery.

duct

brougt

te

tenderness

He

ntestna

compcaton?

he

trc

by

coecystectomy

te

ten-

dicuty

oowng

te

and

Durng

wt

epatoduodena

sudden

sows

A.

A

wt

cystc

te

wt

postve

tonts

te

compresson

wt

examnaton

and

te

woman

accompaned

o

and

jaundce

quadrant.

nserted

pan

exacerbated

Hester)

Adesons

ven

s

duct?

D.

44-year-od

pan

sows

compresson

vave

department

s

Wc

C.

A

quadrant

te

upper

cateter

to

te

upper

tat

examnaton

gabadder.

most

rgt

says

o

abdomna

65-year-od

appette.

he

to

recovered

exam

bowe

bowe

department

A 38-year-od woman comes to te emergency depart-

sea.

brougt

poor

te

B.

rom

s

x-ray

A.

orgnates

to

parasympatetcs

recenty

he rgt epatc orgnates rom te gastroduodena

epatc

key

parasympatetcs

man

A.

rgt

most

aferent

54-year-od

sea,

beedng

orgn

C.

te

pancreas?

department because o abdomna pan, boatng, nau-

apped

oowng

artera

145.

mesenterc

144.

woud

rom

B.

rgt

143.

bers

sensaton

A.

department

142.

neura

pan

externa

abdomna

abdomna

abdomns

obque

musce,

and

obque

musce,

pareta

pertoneum

D.

Aponeuross

o

te

externa

abdomna

obque

musce, aponeuross o nterna abdomna obque

CHAPTER

•

musce,

s

E.

transversus

asca,

and

Aponeuross

externa

obque

musce,

musce,

o

•

Fig.

.4

transversa-

abdomna

nterna

aponeuross

musce,

.

o

transversas

obque

abdomna

transversus

asca,

and

par-

pertoneum

A 12-year-od boy s brougt to te emergency depart-

ment

recta

atc

no

by

s

parents

beedng.

and

s

story

are

common

up

to

age

date.

B.

Externa

C.

Dvertcuoss

D.

Iea

E.

Borborygm

as

a

o

oowng

says

o

beedng

s

te

n

te

Subprenc

te

emergency

pan

te

over

sown

past

w



bood

te

and

Fg.

be

ave

our

In

monts.

Rectouterne

Rectovesca

E.

Subepatc

detected

wt

o

an

uprgt?

space

(pouc

(pouc

o

te

oowng

Rgt

B.

o

Dougas)

Appendx

Ieoceca

D.

Ascendng

E.

Ieum

Questions

151.

A

to

te

rgt

ower

woman

o

s

brougt

abdomna

to

te

pan

emergency

and

sudden

and

vomtng

and

rgdty.

Fg.

3.4.

An

sceross,

owng

mdde

o

A

CT

s

coc

coc

to

but

te

key

afected?

scan

tract

o

bowe

most

He

today’s

te

sows

are

pyscan

pan.

generazed

angogram

producng

Mdde

te

pan,

sows

arteres

Rgt

n

comes

abdomna

gastrontestna

B.

started

man

severe

exam

A.

pan

most

coon

abdomna

appette.

te

s

151–174

or te past 2 days. Se as a ow-grade ever and oss o

tat

structures

quadrant.

Fg. 3.3. Wc

juncton

61-year-od

te

space

says

sted

ovary

C.

Pysca

Morson)

space

because

Se

ten

A.

cronc

space

D.

abdomen

he

wc

stands

o

been

smokng.

3.2.

patent

depart-

sortness

symptoms

te

n

and

space

C.

27-year-od

to

tat

examnaton

Hepatorena

o

ypertenson

s

ocatons

B.

department

comes

mage

A.

A

oowng

te

abdomna

worsenng

story

utrasound

te

recta

s

vaccna-

dvertcuum

patent

radograpc

te

o

here

and

A CT scan o te abdomen s sown n

man

because

progressvey

He

mts.

contacts,

severe

paness

asymptom-

emorrods

(Mecke)

he

and

emorrods

48-year-od

breat.

norma

sck

Wc

o

prouse

oterwse

group?

Interna

ment

o

s

wtn

trave,

cause

A.

A

patent

are

recent

most

because

he

vtas

o

tons

pedatrc

150.

te

Fig.

pertoneum

aponeuross

eta

149.

abdomns

pareta

o

•

.

musce,

abdomns

148.

Fig.

129

Abdomen

3

story

epsode

abdomen

tat

because

a

abdomna

s

due

Wc

occuded

n

s

o

o

severe.

tenderness

severa

occuded

scema.

key

as

te

sown

n

arteres

o

to

o

atero-

te

CT

o-

scan?

130

C H A P T E R

3

Abdomen

•

ymp

nodes

w

Fig.

most

.6

key

rst

receve

metastatc

ces?

•

152.

C.

Let

D.

Ieococ

E.

Margna

A

an

rom

153.

te

o

anus.

te

most

te

s

sows

Wc

key

n

to

te

rst

o

pyscan

ana

examnaton

tssue

s

cana.

seen

squamous

n

An

Fg.

ce

te

oowng

receve

cancerous

because

mage

3.5.

ymp

A

Deep

Superca

C.

Interna

D.

Externa

E.

nguna

Lumbar

ymp

nguna

ac

are

te

wtn

154.

says

nodes

ymp

s

to

Stomac

C.

Duodenum

D.

Pancreas

E.

Descendng

nodes

te

uses

mts.

s

pyscan

because

o

A

n

most

ong-term

and

pysca

CT

Fg.

scan

3.6.

key

NSAIDs

156.

or

s

examnaton

Wc

o

te

mts.

are

o

man

comes

ater

ong

o

story

An

rom

sows

gastrectomy

te

gastrc

abdomna

endoscopy

an

a

s

a

to

gastrc

bopsy.

pan

s

abnorma

pyscan

Coecystts

C.

A

cauda

he

patent

reated

perormed,

mass

n

te

to

Wc

o

as

ood

and

a

and

te

a

and

bopsy

stomac.

adenocarcnoma,

perormed.

oow-up

a

he

tota

oowng

157.

o

te

Her

te

key

n

pyscan

as

vta

mts.

sown

An

Fg.

no

sgns

are

and

x-ray

3.7.

or

a

compants

wtn

aboratory

o

te

abdo-

Wc

o

te

dagnoss?

ver

extenson

o

te

rgt

epatc

obe

obe)

D.

Pancreatc

E.

Carcnoma

carcnoma

o

te

stomac

A 35-year-od woman comes to te emergency depart-

because

te

rgt

are

sows

or

most

Carcnoma

sgns

coon

te

s

to

patent

examnaton

norma

patent

s

protrudes

afected?

eaty.

wtn

ts

comes

he

Pysca

B.

at

o-

woman

examnaton.

oterwse

n

ment

examnaton

cy

28-year-od

A.

s

examnaton

bopsy

A

gastrc

te

o

a

ntestna

as

most

norma

key

B.

Spgean

C.

Paraumbca

D.

Incsona

E.

Ventra

rgt

s

not

ts.

A

n

s

Fg.

tat

paness.

Pysca

wt

no

er

te

Her

o

vta

examnaton

evdence

3.8. Wc

skn

mass

te

o

stran-

oowng

dagnoss?

erna

erna

erna

erna

s

sde

and

beneat

says

erna

3-year-od

by

n

Se

mts.

ernaton

sown

Rcter

ment

protrudng

quadrant.

ntermttenty

A.

A

mass

ower

wtn

guaton,

52-year-od

taken

e

sgns

sown

structures

B.

s

tat

norma

Speen

relux.

Csterna

(Rede

comes

vta

A.

acd

E.

nodes

man

Hs

abdomen

owng

Rgt

men

nodes

He

pan.

Suprapancreatc

D.

resuts

te

4-mont story o boatng, nausea, and md abdom-

pan.

C.

norma

nodes

ac

49-year-od

jont

Spenc

and

nodes

rom

Ceac

B.

routne

carcnoma

ces

A.

oowng

B.

na

155.

tumor?

A.

A

comes

mass

pysca

o

ana

man

abnorma

bopsy

w

.

coc

53-year-od

o

Fig.

o

boy

s

brougt

parents

s

pan.

scrotum.

Hs

premnary

to

because

vta

He

o

s

sgns

dagnoss

te

a

oterwse

are

o

emergency

papabe

a

wtn

depart-

mass

n

eaty

norma

congenta,

te

and

m-

ndrect

CHAPTER

4

monts.

barum

Hs

study

vta

sgns

sows

are

wtn

evdence

o

131

Abdomen

3

norma

acaasa.

mts.

Wc

A

o

te oowng s te most key cause o ts condton?

A.

Faure

o

reaxaton

o

te

ower

esopagea

spncter

B.

159.

Dyspepsa

C.

Gastrts

D.

Gastroparess

E.

Peptc

A

by

recta

beedng.

ma

s

o

61

Wc

A

cm

o

Ruptured

B.

Vovuus

Dvertcuoss

Iea

E.

Borborygm

(Mecke)

45-year-od

tp

o

wt

are

161.

most

s

B.

T6–T7

C.

T7–T8

D.

T9–L1

E.

T5–T9

A

erna

made.

an

o

.

Wc

ndrect

o

te

oowng

nguna

erna

s

n

he

deep

cessus

158.

nguna

Congenta

C.

Ectopc

D.

Epspadas

E.

Rupture

o

43-year-od

o

cronc

a

nto

an

ntact

An

pressure

to

te

nguna

most

accuratey

and

mutpe

wtn

sows

key

a

nor-

mass

juncton.

dagnoss?

te

rgt

te

worsens

emergency

upper

pan

ater

quad-

radates

meas.

patent

comes

and

to

GE

asca

te

relux.

worsenng

he

dyspaga

because

An

erna

E.

Rupture

patent

or

te

o

te

abdomna

arge

cystc

te

pyscan

rgt

return

o

s

contents

(cana

ts

o

s

were

o

procedure,

o

luc-

patent

te

a

sac

rom

te

oowng

orgn

er

mass.

sotary

te

protrudng

te

by

perormed

te

ceary

te

wen

organ

Durng

costa

nerves

nguna

nontender

vsbe

vagnas

transversas

woman

o

pan

mass.

mass

o

s

terms

s

structure?

Nuck)

as

been

CT

to

and

scan

sows

o

a

emergency

te

pan.

cronc

worsenng

conrmng

te

abdomna

abuse

examnaton

A

asca

brougt

severe

acoo

Pysca

says

to

rgt

oowng

ncson?

repar

Wc

because

story

past

te

coecystec-

te

uterus

48-year-od

he

o

ts

a

open

stones

ydrocee

Ectopc

monts.

to

seen

processus

Femora

a

not

descrbng

D.

atts.

pyscan

used

C.

A

sows

s

gabadder

(aong

papabe

surgca

be

An

Wc

durng

a

rng.

Congenta

162.

transversas

dyspaga

are

to

te

sows

brougt

mass

can

A

pro-

s

o

s

deep

as

progressve

and

abdomen.

pertoneum

department

man

ad

eoceca

sows

ncson

rsk

open

B.

ydrocee

te

he

A.

tests

A

as

opens

gr

te

vagnas

B.

e

rng

at

ts

patent?

A.

n

coecystts.

examnaton

mass.

dgta

o

te

most

brougt

abdomen

Kocer

because

standng.

s

to

pan

scapua

te

a

3-year-od

tuant

cause

s

key

T5–T6

Pysca

erna

s

o

perormed.

A.

moter

key

sgns

abdomen

te

examnaton

o

usng

margn)

most

boy

depart-

pan

dvertcuum

man

assocated

tomy

nguna

s

te

vta

te

emergency

abdomna

.7

utrasound

Fig.

o

say

proxma

because

Pysca

te

Hs

te

o

appendx

D.

to

parents

scan

t)

to

because

oowng

C.

rant.

•

(2

A.

A

brougt

Hs

CT

te

department

Fig.

s

parents

vomtng.

mts.

about

•

boy

ment

epsodes

160.

ucer

3-year-od

a

over

te

papabe

abdomen

pancreatc

Se

pancre-

ast

4

upper

sows

a

pseudocyst.

132

C H A P T E R

3

Wc

o

ocaton

163.

te

or

Rgt

Hepatorena

Omenta

D.

Rgt

E.

Greater

A

typca

topograpc

appears

vesses

space

space

sac

o

man

md

te

dagnoss

ocate d

n

te

process.

o

spna

to

te

An

gastrc

ner ve

or

et

te

 or

ucer.

are

sensor y

2

sows

upper

upper

eves

outpatent

pa n

examnaton

prmary

xpod

comes

abdomna

Pysca

gastrc

te

bursa

te

es

s

pseudocyst?

space

subprenc

38-year-od

owng

o

subepatc

C.

ocated

years

a

At

wc

n

pan

s uc 

te

ce

a

Ineror

B.

Hepatc

be

porta

Ceac

D.

Posteror

E.

Great

superor

49-year-od

s  ow s

men

s  ow s

o

Be

C.

T7–T8

B.

Hartmann

D.

T9–L1

C.

Let

E.

T5–T9

D.

Pancreatc

E.

Rgt

and

an

epsode

men

sows

num

at

an

te

undergoes

most

brougt

key

A

paraduodena

at

rsk

o

CT

erna

exporatory

erna.

to

because

vomtng.

nterna

et

an

paraduodena

s

o

s

we

te

scan

(o

aparotomy,

Wc

durng

o

nvovng

ossa

o

te

te

emergency

abdomna

te

te

abdo-

Landzert).

wc

o

A

arteres

erna?

because

te

pan

mgrates

abdomen

toward

sows

Wc

o

te

A.

Be

Ieococ

B.

Hepatopancreatc

D.

Iea

C.

Let

department

pan

ay

tat

ost

as

at

rettes

a

radates

11.3

day.

o

scan

te

o

te

receve

Wc

Stomac

B.

Speen

C.

Duodenum

D.

Lver

E.

Vertebra

A

cay-coored

a

o

te

noma

te

a

o

tumor

at

ducta

He

te

neck

w

mass

rst

because

stoo,

te

o

and

smokng

nontender

o

worsenng

story.

te

Pysca

pancreas.

emergency

epgastrc

He

as

ducta

A

pan,

dabetes

examnaton

gabadder.

pancreatc

te

to

jaundce.

papabe

sows

neck

brougt

A

CT

scan

adenocarc-

major

vesse

aso

te

In

gastone

to

te

o

Pysca

toward

te

skn

An

rgt

sde

utrasound

wt

te

and

examnaton

patent’s

scapua.

s

emergency

te

a

arge

most

o

ga-

key

ste

ampua

(o

Vater)

duct

duct

woman

mass

nces

wc

Wc

A.

Umbca

B.

Spgean

comes

n

te

above

s

o

to

te

mdne

te

eve

sows

a

te

o

te

wt

oowng

s

because

abdomna

umbcus.

nontender

reproducbe

te

pyscan

o

sot

pa-

cougng

te

most

and

key

Epgastrc

D.

Femora

A

s

to

erna

erna

Ompaocee

23-year-od

Hs

120/mn,

surgery

abdomen

to

erna

erna

C.

regon.

s

gastone.

s

dagnoss?

ces?

man

pan.

te

examnaton

stranng.

adenocar-

structures

severa

Pysca

A

te

abdo-

duct

papabe

pabe

o

te

odge?

epatc

26-year-od

wa

and

mass.

Pancreatc

Rgt

a

to

epatc

E.

A

o

te

duct

D.

o

cga-

jaundce

quadrant

conrms

oowng

monts.

packs

sows

169.

unntenton-

3

two

upper

sows

bopsy

te

ast

smokng

rgt

as

abdomna

170.

abdomen

at

over

He

emergency

coumn

35-year

a

o

epgastrc

back.

b)

te

gastone

department

department

sows

s

to

E.

62-year-od

and

o

metastatc

A.

severe

abdomen

A

coc

examnaton

papabe

pancreas.

cnoma.

(25

story

et

brougt

o

to

Pysca

nontender

CT

Kg

o

s

because

40-year

a

man

brougt

oowng

Sgmoda

brances

cterus

arge

coecystts

C.

Ascendng

a

yeowng

epgastrc

B.

62-year-od

wt

s t r u c t u re s

s

o

Mdde

E.

o

utrasound

te

t ow a rd

duct

A.

A

evdence

woman

te

a

posterory

An

Pysca

t ow a rd

duct

epatc

posterory

or

pan.

radates

te

acng

duct

and

stone.

coc

no

to

s t e a d y,

pouc

epatc

acng

sows

a

a

ocated?

47-year-od

severe

artery

duct

department

He

sows

ts

168.

duode-

oowng

repar

pan

key

pan

 o   ow  n g

A.

s

oowng

brougt

o

abdomna

coecystts

te

T5–T6

man

s

s

because

and

conjunctva.

T6–T8

by

woman

te

sde

T  e re

or

B.

43-year-od

te

obstructed?

pancreatcoduodena

quadrant

A.

A

o

be

artery

obese

rgt

skn

most

to

ven

department

upper

wc

key

ven

pancreatc

scapua.

o

most

trunk

p a t  e n t’s

o-

occuded. Wc

te

mesenterc

C.

A

neary

examnaton

bod-

ca se

be

A.

rgt

around

o

to

woud

emergency

conr ms

neurona

bers

167.

dura -

du

q uadran t

endoscopy

te

cnc

ucer?

department

166.

type

B.

ton.

165.

oowng

ts

A.

because

164.

Abdomen

be

te

and

njured

Prnge

vascuar

s

between

maneuver

s

but

s

o

te

te

wt

epgastrc

Hg,

He

s

puse

taken

Wen

ver

s

a

contnues

te

noted

gabadder

beedng

perormed

bood

mm

aparotomy.

bed

and

emergency

te

20/mn.

nspecton,

te

gament,

te

n

96/60

are

exporatory

or

to

stabbed

respratons

an

camp,

brougt

pressure

opened

acorm

s

beng

bood

or

s

man

ater

prousey.

and

he

nontraumatc

spurtng

rom

CHAPTER

te

surace

wc

A.

B.

o

artery

171.

part

o

te

ver

and

examnaton

njured?

et

ower

wt

woud

segment

and

et

segment

te

epatc

rgt

Meda

segment

et

te

o

obe,

branc

te

ver,

wt

njury

bot

to

te

arteres

te

rgt

obe,

wt

njury

to

o

te

wt

rgt

et

obe,

wt

njury

to

an

artery

njury

to

epatc

te

mdde

epatc

artery

be

source

o

Mdde

Rgt

Superor

D.

Ieococ

and

worsens

ew

modcatons

proton

In

ucers,

to

te

dvson

Wc

ours

s

patent

bot

o

te

te

ast

wc

year.

oowng

ave

cronc

undergoes

vaga

a

oowng

not

mea.

te

a

o

pan.

n

Parasympatetc

suppy

to

te

wt

A.

T7

B.

T8

key

coon

s

o

coon,

or

te

t

camp

oowng

gated?

and

2

126/88

16/mn,

s

brougt

grrend

epsodes

mm

and

examnaton

perumbca

atus.

most

descendng

te

Wc

of)

te

Hg,

to

o

s

s

Hs

regon

to

bood

respra-

36.6°C

tenderness

hs

abdomna

105/mn,

temperature

area.

emergency

o

vomtng.

puse

sows

te

because

(98°F).

papaton

receves

ts

sen-

sory suppy rom wc o te oowng spna nerves?

occur?

A.

are

Pysca

peptc

vagotomy

w

tons

s

man

by

nausea,

pressure

wt

s

case

esopagea

condtons

s-

ood

Lestye

resoved

reractory

at

as

wt

treatment

batera

trunks

He

mproves

parmacoogc

nbtors

reeve

o

or

pan

and

pump

order

pan

ucer

(te

at

patent

coc

pan,

epgastrc

peptc

be

transverse

gate

suppy.

key

a

mesenterc

27-year-od

o

o

te

on

coc

department

severe

o

rst

papaton

operatng

coc

A 47-year-od man s brougt to te pyscan because

tory

upon

permt

to

artera

most

C.

Let

T o

dvertcuoss

w

B.

A

tenderness

necessary

A.

E.

174.

sows

quadrant.

severe

arteres

artery

epatc

Quadrate

o

o

epatc

Anteror

aberrant

E.

Wc

key

artery

rgt

D.

ver.

most

Latera segment o te et obe and te et epatc

Caudate

C.

te

s

133

Abdomen

3

s

C.

T10

D.

T12

E.

L1

ost.

B.

he

patent

woud

no

onger

ave

contracton

o Questions

te

urnary

C.

he

patent

D.

he

patent

te

E.

ductus

172.

woud

A

be

1-our

der.

man

because

duraton.

He

wc

tender

papaton.

ytc)

eus

made.

sows

An

Wc

o

s

te

to

te

or

absent.

s

brougt

o

as

A

pan

oowng

te

n

a

s

durng

o

coon

te

pan

rgt

records

o

te

w

and

woud

B.

Borborygm

not

sow

te

presence

o

ar

sow

A.

decreased

n

te

B.

He

ucer

key

C.

E.

173.

A

rgt

sufered

rater

patent’s

ond

part

he

patent

68-year-od

skn

te

s

odor.

yeow.

o

te

Hs

Laboratory

ypertenson. Wc

eature

past

dsorented

deveopment

o

o

te

ts

ncreased

pressure

n

ven

efuson

o

lud

rom

te

neror

ven

emorrods—rom

wtn

and

Expanson

wc

tan

rom

rom

a

an

posteror

anteror

penetrat-

E.

te

superor

o

vens

ncreased

mesenterc

wtn

anastomose

ucer

te

probaby

occurred

n

te

sec-

duodenum.

probaby

woman

s

ad

acute

brougt

Recanazaton

peroratng

te

A

wt

appendcts.

te

to

na

emergency

te

ven

acorm

vens

s

Durng

as been experencng ong-term efects o dvertcuo-

meday

ss

o

nlammaton

o

te

transverse

coon.

Pysca

te

we

made,

te

to

expanson

pres-

and

ts

o

te

gament,

umbca

he

o

a

ste

oowng

o

best

te

A

s

to

and

a

vesses

dagnoss

te

te

a

te

wtn

emergency

buge

gymnast

aparoscopc

procedure,

te

comes

pan

patent

tranng.

and

o

gaments

woman

because

tuberce.

buge

and

umbca

24-year-od

department

pubc

te

meda

department wt et ower quadrant pan. he patent

and

s

or

a

beng

medca

trbutares

176.

he

o

Hs

abuse

sows

strong

varces—rom

gastrc

Interna

under

ucer.

D.

emergency

ound

street.

acoo

a

te

was

regon

probaby

ng

porta

e

te

words;

ave

severe

mesenterc

amptude.

C.

s

to

severe

a

on

o

to

ater

examnaton

Asctes—rom

cavty.

requency

story

Esopagea

D.

be

a

ound

s

brougt

wanderng

surrng

studes

s

dapragm.

woud

s

s

sure

x-rays

s

wo

breat

occur?

A.

and

s

daugter

condton?

abdomen

most

s

Pysca

oowng

(para-

ucer

pertonea

condtons

rgd

man

by

sow

years.

man

o

sou-

respraton,

peptc

55-year-od

department

emergency

adynamc

ruptured

nto

A

begerent

dstended,

examnaton

beedng

o

duct.

ascendng

to

sows

a

parayss

abdomna

dagnoss

rom

175.

o

7

ntense

aso

utrasound

tte

because

ejacuatory

mmobe

resutng

very

and

examnaton

abdomen

mpotent.

stere

suppy

reduced

Pysca

to

be

deerens

35-year-od

department

become

woud

Parasympatetc

woud

175–199

badder.

o

repar

opubc

emora

caracterzes

a

atera

and

emora

s

er-

perormed.

tract

s

ernaton.

ts

to

notced

traced

Wc

structure?

134

C H A P T E R

A.

he

gn

B.

3

Abdomen

opubc

o

he

te

opubc

nguna

C.

he

D.

he

E.

he

trange

tat

orms

tract

s

or-

te

atera

border

o

te

180.

te

atera

border

o

te

department

te

to

tract

man

part

te

s

o

te

pectnea

te

atera

nguna

ga-

gament.

extenson

s

He

but

s

brougt

o

aso

108/mn,

perature

sows

and

s

s

to

abdomna

as

now

a

oss

more

te

te

tenderness

made,

te

rotaton

sue

an

to

nausea,

appette.

he

to

te

sgn.

o

te

t

commony,

s

procedure

ntestne,

to

o

and

178.

B.

Descendng

C.

Ieum

D.

Posteror

E.

T aenae

A

ceca

to

adesons,

co

appendx

s

C.

T10

D.

T11

E.

T12

tem-

181.

as

aso

naton

te

aed

sows

recta

s

ascendng

brougt

epsode

pass

A

CT

dated

Hrscsprung

te

te

s

to

rgt

coc

o

er

bous

ts-

rst

o

te

descendng

embryoogc

stoo.

Pysca

wt

abdomen

coon

and

(megacoon)

mecansm

no

by

s

sows

a

responsbe

Faure

was

B.

179.

o

o

neura

te

an

separaton

C.

Faure

D.

Deectve

E.

Ogoydramnos

A

o

gron

wegts

pan

area

n

sows

an

abe

to

ndrect

or

to

mgrate

nto

He

to

past

Ioypogastrc

B.

Latera

C.

Ionguna

emora

E.

Kdney

te

183.

e

reduce

t.

wa.

pan

pyscan

days.

ad

He

a

a

He

sudden

buge

says

erna

Wc

due

nerve

n

tat

Pysca

because

was

te

te

s

ts

same

buge

rgt

key

te

umbcus.

made.

A

Wc

to

pyscan

sde

xed

te

ts

o

because

er

back.

nontender

mass.

abdomen

tumor

nvaded

te

n

te

sow

a

posteror

superor

oowng

te

was

most

o

mesen-

structures

Genta

D.

Subcosta

E.

Obturator

b)

n

te

and

ast

sows

A

a

CT

te

w

Ceac

B.

Superor

C.

Ineror

D.

Lumbar

patent

wt

appendcts

as

majus.

te

s

weeks

parestesa

abum

durng

to

te

epgastrc

scan

papaton

o

over

Wc

procedure?

gentoemora

comes

2

on

oca-

Pysca

onguna

n

o

node

ntay

He

as

because

ost

unntentonay.

te

te

pyscan

pan.

monts

tumor

ymp

nodes

A.

A

man

appette

o

tat

perormed. T wo

rgt

njured

and

branc

54-year-od

te

s

pan

quadrant.

dagnoss

er

key

Ionguna

C.

o

guardng

A

surgery,

part

B.

A

perumbca

abdomna

appendectomy

Ioypogastrc

E.

184.

a

o

te

and

ower

sows

an

anteror

oowng

transmsson?

cutaneous

s

contrbutes

rgt

tssue

as

tenderness.

and

evauate

ocaton

most

te

and

exam-

coon

nausea

te

stomac.

examnaton

to

wt

to

troscopy

o

sows

o

to

te

MRI

tat

A.

(10

tng

onset

severe

Pysca

A 35-year-od woman comes to te emergency depart-

nerve

coon

te

4

notced

nguna

te

A.

Stomac

Descendng

oss

te

as

says

wt

coon

D.

te

coaca

te

He

erupted

pan

around

because

days.

afected?

C.

oowng

ts

ndgut

sporadcay.

abdomna

responsbe

te

o

te

wen

gron.

goes

o

comes

or

gym

et

was

and

te

man

pan

te

ts

and

comes

on

at

o

recanazaton

rotaton

32-year-od

et

ces

Ascendng

made

coon

Incompete

o

crest

be

Rectum

rebound

dsease?

A.

key

examnaton

n

Wat

or

te

2

area

(snges)

comes

sot

Wc

B.

zed

dagnoss

made.

te

nerves

on

and

wa

A.

ment

exam-

woman

sweng

pexus.

most

gr

stoo

pyscan

past

burnng.

ras

spna

eterogeneous

terc

ater

he

ten

and

zoster

examnaton

abdomna

182.

pyscan

te

te

descrbes

vescuar

utrasound

arge

artery

vomtng.

dstenton

scan

dsease

te

ocazed

An

Most

coon

to

a

He

to

or

and

sarp

erpes

68-year-od

Pysca

juncture

abdomna

vaut.

abnormay

o

an

te

A

o

Durng

ocated

o

as

oowng

rgt

adpose

best

te

tcy

pan.

t

comes

abdomen

rst

sows

T8

embryoogc

appendx.

s

and

T9

appendcts

and

te

on

was

B.

artery

o

gr

experencng

o

eoceca

ceca

2-day-od

ras

A.

artery

branc

te

ras

and

ocatng and tracng wc o te oowng structures?

Anteror

a

spancnc

man

dermatome?

tenderness,

perormed.

atypca

denty

vermorm

A.

o

pan

examnaton

rebound

dagnoss

appendectomy

dicut

te

A

18/mn,

Pysca

papaton,

operatve

made

are

(100.1°F).

Rovsng

and

open

65-year-od

dagnoss

emergency

pan,

o

ocazed

respratons

37.83°C

postve

A

naton

o

spancnc

toracc

caracterzes

ower quadrant. Hs bood pressure s 128/86 mm Hg,

puse

Greater

o

s

because

dfuse

Lumbar

E.

te

gament.

constpaton.

D.

vesces

attaces

47-year-od

was

aponeurotc

Hessebac).

tract

opubc

pectnea

A

orms

(o

te

abdomns.

rng.

opubc

ment

represents

tract

opubc

emora

177.

tract

transversus

pyorc

nvovement.

te

A

antrum

abdomen

dran

4.5

s

gas-

te

ordered

Wc

pyorc

o

o

o

kg

to

te

antrum?

mesenterc

mesenterc

Hepatc

21-year-od

department

man

wt

s

severe

brougt

back

to

pan.

te

he

emergency

pan

s

sarp

CHAPTER

and

severe

Pysca

aong

back

et

at

185.

and

te

et

sows

sde.

rsk

a

Wc

or

B.

Descendng

C.

Kdney

D.

Lver

E.

Pancreas

pan

ater.

an

ucer

CT

te

Superor

C.

Be

D.

Proper

eevent

organs

brougt

o

sows

te

to

upper

wt

w

s

rb

o

te

tc

on

te

key

most

key

a

most

and

but

abdomen

wa

emergency

abdomna

du

meas

te

C.

he

rgt

D.

he

greater

E.

he

omenta

burnng

worsens

sows

o

te

key

be

pan.

2

type

evdence

o

pont.

An

ts

rgt

artery

A.

wt

te

te

o

mass

A

repar

o

pan

s

s

and

papabe

mass

Pysca

examna-

reducbe

o

notced

erna

s

a

wt

erna

Durng

n

te

no

s

te

deep

just

evdence

made,

a

procedure

a

nguna

C.

D.

T10

E.

190.

A

Umbca

pan

C.

Femora

was

D.

Lumbar

pan

E.

Indrect

nguna

abdomna

souder.

rebound

ar

a

Pysca

o

te

A.

Rgt

B.

Hepatorena

Omenta

D.

Rgt

E.

Greater

a

o

course

Pysca

story

pan

te

severe

te

o

te

posteror

and

and

A.

was

bood

o

(esser

B.

drecty

C.

sac)

E.

191.

severe

ucer

NSAIDs

abdomna

dsease

or

o

abdomen

and

artrts

te

te

pan.

Se

recenty

pan

abdomen

wt

emergency

n

er

sows

guardng

and

as

a

resumed

knees.

a

non-

rebound

te

2

rgt-

pan

was

days

ago.

abdomen

A

10

an

1

lud

oowng

appendx

sare

n

te

meca-

pan

ts

and

te

somatc

same

spna

s

o

a

Se

we

g

aferent

T7–T9

as

wt

a

te

stmu-

aferents

vscera

at

aferents

te

to

o

te

n

o

woman

oz),

ypo-

postve

sympatetc

bers

cord

spread

by

to

te

eves

to

prenc

daprag-

nerve

te

abdom-

T7–T9

wt

ntercosta

nerves

eves

a

eaty

pregnancy.

and

a

er

but

mecansms

contacted

devers

mnutes,

rgt

wt

spna

cord

regon,

and

pan?

dermatomes

trave

Intay,

eves

supped

spna

GERD

te

sympatetc

gabadder

abdomna

sows

synapse

cord

T7–T9

at

o

oowng

pattern

emergency

o

epgastrc

ocazed

and

te

gastones.

nlammaton

11

to

story

story

wt

bers

sare

b

were

vscera

brougt

o

aferents

(7

wt

1-day

spna

aferent

5

sares

umbcus.

examnaton

nta

T7–T9

appendx

te

pertoneum

synapse

uncompcated

and

te

eve.

pertoneum

to

to

wt

trave

Wc

nlamed

3500

at

te

appendx.

ocazed

te

28-year-od

was

auscutaton.

perumbca

te

te

dagnosed

and

sgn.

at

o

Pysca

Vscera

ater

upon

sows

eve.

cord

pertoneum

back

eves

woman

sarp

he

to

suppy

cord

Gabadder

D.

o

nta

nlamed

poory

matc

to

emergency

severe

nondstended

umbcus

because

gabadder

areas?

brougt

a

decreased

suppy

te

vomtng.

Vscera

te

space

s

o

regon,

abdomen

te

aferents

expans

na

woman

wt

and

bers

abdomen

wa

te

Intay,

Wc

aferents

spna

Vscera

sows

sac

rm

best

are

cord

te

spna

Murpy

rgt

guardng

abdomen

scan

contents

o

n

to

story

umbca

te

aferents

by

condrum.

space

examnaton

dstended

emergency

space

peptc

o

te

te

sows

o

CT

n

oowng

bursa

55-year-od

story

A

stomac

subprenc

department

2-our

x-ray

ucer

subepatc

C.

A

An

dapragm.

spng

wc

a

assocated

examnaton

peroratng

stomac,

nto

te

o

and

tenderness.

under

sows

because

pan

to

pan.

sows

gutter.

spna

prevousy

became

brougt

o

to

45-year-od

B.

s

brougt

1-day

eves.

department

woman

s

a

te

expans

Somatc

T10

nguna

67-year-od

east

patent?

experenced?

Somatc

Drect

department

best

Somatc

rng.

ts?

to

sounds

paracoc

ated

o

and

o

abdomna

Bowe

same

A.

A

because

Parasympatetc

emergency

a

perormed.

s

te

gament.

dagnoss

ntestne

type

gron

nguna

to

ts

pep-

s

bursa

Sympatetc

B.

brougt

n

stes

gutter

woman

examnaton

cord

artery

s

oowng

sac

utrasound

artery

man

te

sows

perorated

wt guardng and tenderness maxmay at McBurney

cap.



o

abdomen

o

pouc

paracoc

ocazed

Pysca

ours

duodena

afected

poory

te

Morson

45-year-od

ower

o

dagnoss

coecton

rectouterne

A

o

lud

Pouc

sensaton

ncarceraton.

surgca

sow

A

Wc

he

patent

mesenterc

epatc

sows

to

made.

B.

duct

to

s

utrasound

lud.

A.

sde

ven

Gastroduodena

Wc

ucer

nsms

porta

45-year-od

oop

x-ray

perorates?

superor

188.

o

s

posteror

structure

department

187.

woman

scan

n

B.

ton

te

An

An

ntrapertonea

coon

mproves

Hepatc

E.

o

back.

oowng

because

A.

A

ange

te

examnaton

ucer

Wc

te

tenderness.

tenderness

department

tat

A

o

nspratons.

and

189.

32-year-od

o

sde

deep

brusng

njury?

Stomac

Pysca

o

wt

sows

ractured

department

186.

atera

A.

A

worsens

examnaton

135

Abdomen

3

Apgar

respectvey.

nant

Hs

brt

scores

at

were

Pysca

term

wegt

8

and

examna-

ton sows a cear lud dranng rom te umbcus o

te

s

nant.

Fud

perormed

on

s

coected

te

sampe.

and

he

a

urne

lud

s

dpstck

test

determned

136

C H A P T E R

to

be

Abdomen

urne.

deects

192.

3

best

Wc

dsta

B.

Obterated

proxma

C.

Competey

D.

Patent

E.

Competey

A

uracus

33-year-od

ng,

and

derness

te

guardng

s

rebound

aferents

patetcs

to

Inlamed

C.

he

D.

Contact

E.

Contact

to

a

or

sot

regon

bowe

CT

scan

s

2

a

te

te

Between

rena

B.

Between

te

s

days.

mass.

are

s

te

lud

pan

and

Wc

o

te

same

a

pareta

per-

n

te

pan

s

evdence

oowng

o

oowng

and

and

most

ater

wt

or

and

o

eatng

cewabe

se

s

proton

s

structure

stomac?

he

started

pump

not

as

on

A

o

A

E.

Rgt

part

obe

o

te

duodenum

pancreas

o

te

ver

and

bary

Wc

ee

90/5

sows

an



mucous

struc-

eves

o

ntestna

artery

bood

s

Her

a

here

s

s

occuded,

wt

pae

o

s

guardng

and

absent.

sma

bowe

cons”

made.

are

Pysca

ep-

scema

ow

140/

te

are

“stacked

vesses

s

abdomen

papaton

sounds

mesenterc

puse

as

wara-

respratons

woman

dated

Se

take

(104°F).

appearng

dspayng

dagnoss

40°C

membranes.

sows

abdomna

to

Her

Hg,

upon

emergency

o

anorexa.

unwe.

regons.

te

reuses

mm

Bowe

abdomen

and

but

s

tenderness

umbca

to

story

I

An

wt

appear-

secondary

te

coud

to

superor

te

mdgut

suppy?

Anastomoss

between

et

and

B.

Anastomoss

between

et

and

rgt

gastrc

rgt

arteres

gastroeppoc

arteres

C.

Anastomoss

ta

Se

D.

between

between

creatcoduodena

estye

E.

et

and

rgt

gastro-omen-

arteres

Anastomoss

Anastomoss

superor

and

neror

pan-

arteres

between

adjacent

sort

gastrc

arteres

197.

A

72-year-od

department

week,

te

brougt

darrea,

er

tenderness.

ts

retrograde

perormed

low.

no

sow

gabadder

3-day

temperature

wt

to

a

braton

makes

dry

te

but

extraepatc

duct

a

ampua

s

o

pressure

and

and

s

and

abdomen

studes

endoscopc

A.

o

o

t

bood

and

woman

because

atra

because

te

18/

mem-

abdomen

o

gabadder

(ERCP)

te

are

mucous

duct

vomtng,

o

mesenterc

patent

rom

epatc

ever,

Speen

Second

pan

duct

72-year-od

story

dry

te

An

te

et

greasy

patent’s

o

he

Rgt

T a

sarp

he

duct

E.

B.

D.

ntay

became

obstructed?

be

A.

C.

abdom-

was

respratons

tender

o

pancreatc

key

epatopancreatc

started

broncus

but

Laboratory

aong

he

nbtors.

ts

brubn.

he

pan.

derved

wa

D.

receve

antacds.

daporess.

organs

embryoogca

asca

burnng

or

te

C.

embous

emergency

spcy

emergency

severe

pan

utrasound

abdomen.

nundbuum

x-ray

asca

pan,

o

and

sows

and

An

cystc

ance.

abdomna

sot

he

rebound

capsue

epgastrc

a

sgn.

he

gastrc

asca

te

wt

norma

dstended

at

to

he

te

o

ypocondrum.

110/mn

B.

skn

A

w

at

te

examnaton

negatve

pertonea

rena

upper

breat

tra

rena

ever.

rgt

A.

ar-lud

and

to

because

epgastrum

obstructon

most

20/mn,

sows

arge

an

s

mn,

and

a

s

serum

wt

a

umbar

o

n

department

emergency

et

and

te

te

tckenng

ture

rn

te

transversas

sows

GERD

and

per-

examnaton

brougt

mproves

wt

196.

vscera

abdomna

te

asca

s

worsens

o

o

cortex

because

s

ocaton?

paraneprc

sortness

to

to

Murpy

tree

pan,

wt

but

capsue

woman

tat

dagnosed

te

rena

wt

auscutaton.

asca

rena

pan

aferents

sows

Wc

examnaton

modcaton

sym-

somatc

tus,

brougt

examnaton

cterc,

lud

sows

best

upon

Wtn

55-year-od

he

test

decreased

E.

no

wt

stmuates

s

usband

coangopancreatograpy

patent?

trave

puse

eevated

aso

sgn

transversas

as

HCG

mecansms

ts

ree

rom

s

psoas

te

oods.

urne

sows

ten-

he

Between

nature,

vomt-

sows

here

to

Pysca

postve

aferents

Pysca

ocazed

branes,

aso

dermatomes

et-sde

Between

n

rgt-

s

o

er

vomtng,

setted

mn.

eve

brougt

D.

Pysca

Se

dstance

structure,

somatc

C.

department

n

appendx

abdomen

A.

A

A

appendx

abdomen

abscess.

descrbe

T11

o

rm

sounds

o

perneprc

key

past

tender

tere

te

appendx

cord

vscera

man

because

te

and

and

stmuates

and

o

umbcus.

mdgut

nlamed

81-year-od

ever

a

nlamed

o

department

emergency

epsodes

pertoneum

stmuates

toneum

An

s

T10

o

toneum

2

pan

te

te

woman

by

radates to er rgt souder. Her temperature s 40°C

nerves

appendx

reerred

poory

engt

duraton.

oowng

o

pan,

(104°F),

to

tenderness.

te

ts

examnaton

te

spna

vscera

ntercosta

uracus

aong

one-trd

o

T10

te

ever,

to

dstrbuton

Vscera

B.

at

45-year-od

na

we-demarcated,

Pysca

o

uracus

uracus

sarp,

A

and

o1-day

spne

Wc

te

195.

department

brougt

ow-grade

ac

o

pont

s

o

stoos.

and

negatve.

expans

A.

a

te

end

one

pan

papaton

anteror

o

obterated

because

oose

on

at

deveopmenta

uracus

woman

abdomna

experencng

end

patent

oowng

ndng?

Obterated

sde

194.

te

ts

A.

department

193.

o

expans

man

s

because

o

suddeny

dvertcuar

and

pressure

tons

ton

s

are

1

our

dsease,

drnks

12

100/50

mm

and

a

ago.

s

daporetc

a

every

Hg,

to

puse

patent

emergency

pack

s

pan

as

o

a

Hs

110/mn,

Pysca

wt

a

tat

story

cgarettes

weekend.

aebre.

man

te

abdomna

he

smokes

beers

30/mn,

sows

brougt

severe

rm

a

bood

respra-

examna-

abdomen

CHAPTER

and

ng

tenderness

and

sows

o

wa

te

n

Aorta

B.

Superor

C.

Head

o

T ransverse

GERD

pylori

per

a

a

o

te

duodenum.

key

n

we

and

An

pos-

and

10

4

oss.

ng

mmedate

6

cm

patent

He

Pysca

An

a

story

a

rreguar

o

Josep

Let

D.

Spenc

E.

Let

A

gastrc

rgt

te

and

s

s

te

te

Psoas

curvature. Wc o te oowng structures s most key

C.

Obturator

at mmedate rsk o damage by te tumor n ts patent?

D.

T ransversus

E.

Quadratus

gastro-omenta

B.

Rgt

and

et

pancreatcoduodena

C.

Rgt

and

et

gastrc

D.

he

E.

Sort

A

porta

3-day

urne.

o

te

An

o

comes

pae

o

serum

Increased

aanne

Increased

aspartate

Increased

akane

Increased

gamma-gutamy

Increased

protrombn

s

se

s

ound

te

Ineror

B.

Gabadder,

C.

Ineror

be

pospatase

epatc

eevated

ton

sows

o

o

te

daton

at

trange

mg/dL,

(AST),

(ALP),

(GGT),

o

and

aberrant

te

trange

et

scedued

Durng

te

cystc

o

ventrce

or

a

203.

procedure,

artery.

duct,

be

be

duct

duct,

common

epatc

Cystc

D.

Rgt

E.

Cystc

py

D.

Cystc

artery,

neror

E.

Cystc

artery,

common

border

o

epatc

LV ,

be

duct,

duct

be

duct

se

appen-

keeps

at

te

pan

er

p.

caused

pertoneum

yng

I

by

over

obque

pan

s

o

be

brougt

o

a

breatng

se

to

mea.

A

te

on

undergoes

o

te

te

o

sou-

examna-

papaton

acute

co-

aparoscopc

oowng

and

upper

rgt

deep

a

emer-

rgt

Pysca

dagnoss

dented

to

severe

radates

eatng

Wc

epatc

structures

gated

wtn

te

duct

duct

epatc

artery

artery

s

man

ater

a

90/50

sows

te

wc

Fundus

B.

Kdney

C.

Pyorc

D.

Head

E.

Spenc

te

o

te

may

s

An

speen

ts

emergency

Hs

120/mn,

te

te

bood

respra-

utrasound

requrng

um.

occude

te

coson.

procedure,

at

oowng

te

puse

aebre.

gated

to

vece

Hg,

and

Durng

s

brougt

acerated

gature

o

A.

a

s

motor

mm

30/mn,

speen

o

38.8°C

duct

are

te

s

acute

Caot?

34-year-od

ment

duct

Questions

C.

o

Her

115/mn,

musces?

and

key

spenectomy.

duct,

LV ,

Be

Rgt

abdomen

duct

o

o

B.

tons

cystc

most

pressure

Caot?

(LV),

severe

pareta

quadrant.

made

department

Wat

an

extenson

s

woman

he

upper

s

A.

A

s

temperature

avng

because

ater

coecystectomy.

woud

5

obese

cessaton

rgt

sow:

puse

abdomns

pan.

sows

te

Hg,

depart-

pan.

umborum

worsens

ecystts

(ALT),

transerase

an

te

epatc

border

yeowng

studes

coestass

ave

o

because

tea-coored

tme.

wt

to

and

abdomen

coecystectomy.

border

common

to

pyscan

stoo

amnotranserase

boundares

A.

te

amnotranserase

dagnosed

aparoscopc

are

brubn

te

sows

Laboratory

Increased

Se

to

coored

hs

nternus

department

and

emergency

abdomna

examnaton,

tere

abdomna

40-year-od

der

examnaton

tree.

A

gency

trave-

pancreas.

major

abdomna

utrasound

bary

202.

vesses

woman

story

Pysca

scerae.

vesses

vesses

trad

gastrc

55-year-od

vesses

o

ressts

rrtated

Externa

et

vesse

o

te

oowng?

te

mm

and

pysca

and

to

severe

suspected

oowng

B.

and

and

extended

A.

Rgt

te

te

o

artery

brougt

130/85

lexed

arge mass nvovng te stomac n te regon o te esser

A.

body

artery

20/mn,

s

Durng

o

s

ever

are

Se

tg

wc

o

pressure

stretcng

nodue

scan

te

artery

gr

because

tg

te

brusng

CT

ven

gastro-omenta

(102°F).

o

o

A

artery

5-year-od

dcts.

wc

o

around

border

sows

wa.

aceraton

mesenterc

n te umbca area. A CT scan o te abdomen sows a

o

200.

C.

a

as

porta

respratons

abdo-

nonpusate

Mary

o

sows

te

Superor

Hepatc

examnaton

abdomna

superor

dented

B.

te

emorragng

te

A.

bood

20-pack

examnaton

s

ment

Helicobacter

as

utrasound

Sster

a

or

aso

depart-

swaowng,

as

antbotcs

ard,

resembng

emergency

dicuty

prevousy .

smokng.

201.

Pysca

on

sows

wt

aong

vesse

ven

te

o

he

wt

abdomen.

×

mass

to

abdomen

pancreas

Wc

stomac

story

years

o

te

campng.

tenderness

te

cava

brougt

treated

nontender

sows

s

wegt

was

story

nontender

most

guard-

abdomen

dapragm.

peroraton

te

artery

o

2-mont

necton

sot

te

as

te

coon

man

and

and

year

men

a

s

aso

o

pancreas

curvature

51-year-od

o

vena

mesenterc

te

Greater

vomtng,

sows

He

CT

under

part

structures

neror

E.

ater

trd

A

patent?

and

D.

ment

199.

te

ts

A.

A

epgastrum.

aparotomy

o

oowng

danger

198.

te

tenderness.

pneumopertoneum

exporatory

teror

n

rebound

137

Abdomen

3

o

te

an

urgent

bood

suppy

Improper

arteres

pace-

tat

sup-

structures?

stomac

spncter

o

te

pancreas

200–223

A 10-year-od boy s brougt to te emergency depart-

ment

ater

ang

down

a



and

ttng

a

tree

trunk

204.

A

lexure

55-year-od

department

o

man

wt

te

s

coon

brougt

severe

to

abdomna

te

emergency

pan.

Pysca

138

C H A P T E R

3

Abdomen

examnaton

skn,

cus.

and

he

patent

crross

made.

A

sows

a

sows

vascuar

and

CT

a

abdomna

markngs

as

a

story

dagnoss

scan

crcuar

o

te

grey

sweng,

cterus

surroundng

o

o

acoo

porta

cest

at

structure

te

abuse

structure

Gven

ts

205.

te

to

and

be

vertebra

eve

mmedatey

muc

te

wt

arger

patent’s

s

208.

T7

anteror

tan

Ineror

B.

Superor

E.

Ana

A

ew

s

cava

vena

are

s

key

E.

Pumonary

A

ven

65-year-od

because

o

and

abdomen

o

surgca

as

a

w

reac

most

key

Pareta

B.

Dapragmatc

C.

Pareta

D.

T ransversas

E.

Vscera

A

ens

ater

ness

upon

or

a

a

sma

te

wc

be

scan

te

o

rena

scedued

a

o

te

as-

209.

or

scope

port

n

oowng

C.

Stomac

D.

T ransverse

E.

Appendx

te

posteroatera

ncsed?

Pysca

a

a

o

brougt

upper

started

te

rgt

coecystts

passed

te

nto

anteror

organs

s

te

wors-

quadrant.

and

s

greater

pyscan

wa.

Femora

E.

Ioypogastrc

Wc

unabe

to

210.

o

vew

A

15-year-od

an

goa

s

to

and

crunces

tat

ts

C.

Pancreas

eta

D.

Stomac

E.

T ransverse

ment

by

bood

s

per

to

o

rgt

sows

n

te

most

a

moter

rectum

appear

te

coon

be

n

ong

Gastrts

B.

Hrscsprung

e

he

cres

A

o

o

depart-

brgt

boy

durng

does

te

red

not

papaton

tecnetum-99

radoactve

Wc

dagnoss?

A.

o

emergency

epsode

daper.

but

spot

te

an

quadrant.

mdabdomen.

key

s

dstress,

ower

2-nc

n

ater

to

scan

accumuaton

oowng

s

te

211.

ts

Rbs

C.

Pubc

D.

Costa

E.

Xpod

rgt

(103°F).

ce

count.

necton

structures

CT

te

s

most

emergency

o

rgt

sensaton

n

te

here

s

aso

obque

scan

o

te

te

posteror

at

kdney,

rena

nerves

te

o

transversus

abdomen

sows

breaks

capsue

quadratus

oowng

papa-

rb

weakness

and

rgt

rgt

regons.

to

twet

ower

te

pubc

tenderness

to

n

te

to

onset

anteror

sows

cutaneous

wo

and

umborum

s

most

key

s

an

nerve

amateur

abdomna

a

to

“6-pack”

s

s

by

routne.

ncorporatng

regmen.

soatng

to

bodybuder

workout

workout

attaces

n

wc

s

o

he

st-ups

musce

workout

te

as

Hs

to

oowng

get

ske-

10–12

crest

cartages

swaowng

5

years.

onger

7–12

process

52-year-od

te

39.4°C

puse

respra-

crest

department

no

Hs

Hg,

bood

back

saow

areas?

B.

ast

a

tumor?

adoescent

Iac

undergo

dsease

boy

deveop

“6-pack”

o

psatera

ntensve

A.

A

o

emora

begun

A

te

D.

Ieum

brougt

o

te

Ionguna

Jejunum

s

by

C.

B.

boy

Wc

oss

ange.

te

Subcosta

A.

2-year-od

center

on

Latera

troug

and

orgnates

B.

drecty?

A

te

sudden

neror

musces.

tat

A.

sac

mm

ever.

s

abdomna

brougt

a

abdomna

An

proce-

s

o

gutea

nlamed

te

wte

oowng

assocated

nterna

compressed

scedued

Durng

was

attenton.

124/86

g

g

n

coon

regon

pressng

musce.

ga-

te

costovertebra

tumor

s

o

t

temperature

examnaton

rgt

medca

a

emergency

o

wound

snce

retropertonea

man

wt

te

troug

tender-

ecogenc

abdomna

te

and

tckened

arge

emer-

quadrant

sows

upper

coecystectomy.

s

te

suddeny

sows

severa

to

rgt

examnaton

abdomen

wt

s

severe

pan

acute

at

and

because

back

pan

stab

pressure

te

coon

68-year-od

rgt

woman

he

was

as

Jejunum

te

Pysca

te

Descendng

B.

abdomns

wt

papaton

o

A.

A

seek

to

story

afected?

posteroatera

oowng

a

5-day

sma

sows

Wc

be

department

peura

obese

pan.

Se

te

to

s

Usng

kdney,

ave

wtn

patent

mass.

CT

asca

aparoscopc

dure,

he

A

pertoneum

gabadder

stones.

week.

ange

smokng

pertoneum

meas.

utrasound

costovertebra

40-pack-per-year

a

depart-

ton

department

abdomna

rgt

emergency

peura

43-year-od

gency

te

conned

te

te

A.

s

drnk

mass

o

to

a

kdney.

remova

to

at

as

one

rgt

approac

ayers

He

sows

te

comes

pan

ematura.

story

ca

man

to

o

brougt

a

owever,

not

22/mn,

made.

Esopagus

Azygos

a

bood

cemstry

dagnoss

s

o

ago;

dd

A

D.

ven

e

100/mn,

Bood

cava

avng

monts

wound,

s

man

because

reports

tons

vena

dvertcuum

ssure

21-year-od

C.

and

207.

Mecke

a

usua.

wat

Hemorrods

D.

He

o mdne.

story

C.

department

structure?

A.

ment

206.

appears

ocaton

te

ypertenson

te

to te vertebra bodes and just to te rgt

he

o

umb-

man

by

s

sods

He

tat

as

resoves

an

procedure

s

we

a

brougt

because

as

been

burnng,

wt

to

o

te

severe

gettng

emergency

dicuty

worse

retrosterna

antacds.

He

s

pan

endoscope

s

advanced

n

te

wc

scedued

esopagogastroduodenoscopy.

te

over

to

Durng

unt

ts

tp

CHAPTER

reaced

wc

te

212.

te

o

atus

oowng

endoscope

most

o

te

vertebra

key

dapragm.

eves

dd

te

At

tp

o

end?

216.

gutter

Omenta

bursa

A 68-year-od woman comes to te emergency depart-

T7

ment

T8

pan.

C.

T10

occuson

D.

T11

eve.

E.

T12

ng

A

65-year-od

man

because

o

utrasound

aortc

room.

aortc

grat

At

were

anteror

te

te

s

s

center

wc

o

o

n

te

te

an

taken

grat

an

was

te

A

CT

As

a

o

te

o

most

bood

to

Hemazygos

abdomna

C.

Ascendng

D.

Azygos

E.

Let

te

key

217.

vertebrae?

A

common

ment

ater

man

L2

and

C.

L3

oowng

D.

L4

1.

Interna

E.

L5

2.

T ransversas

stor y

a

an

o

tumor

to

o

ver

te

comes

acoosm

n

te

undergo

te

man

abdomna

rgt

s

and

ver,

te

ver

patent

crross.

and

n

emergency

he

te

te

A

CT

patent

epatectomy.

dvded

oowng

to

pan.

prncpa

segments

w

V ,

B.

IV ,

VI,

V ,

C.

III,

D.

II,

E.

I,

A

IV ,

III,

II,

sows

5.

Scarpa

6.

Externa

pane.

most

Wc

key

tures

be

V ,

VI

IV ,

V

III,

man

to

sows

obstructed

unon

o

n

wt

te

pan.

ts

ong

patent

o

te

s

most

bood

key

B.

Superor

C.

Ineror

mesenterc

and

et

D.

Ineror

mesenterc

and

paraumbca

E.

Superor

mesenterc

65-year-od

ment

because

ound

wa

ts

te

to

o

te

stomac

key

o

rst

a

a

A

tumor

CT

lud

te

Supracoc

B.

Omenta

C.

Inracoc

and

n

tat

scan

as

ater

et

te

te

te

traversed

oramen

compartment

ormed

by

4-5-6-1-3-2

C.

4-5-1-6-3-2

D.

4-2-6-1-3-5

E.

5-4-6-1-3-2

72-year-od

o

vens

te

te

abdomen

te

te

depart-

patent

s

posteror

stomac

sows

resutant

dd

because

as

at

tat

aperture.

lud

aperture?

most

219.

a

te

upper

parts

to

o

s

Hepatc

Spenc

sot

he

o

a

buet

abdomna

ayers

depart-

wt

ts

9mm

entered

wa.

he

wa:

musce

musce

obque

musce

represents

te

order

o

struc-

comes

1-day

to

story

coonoscopy

troug

any

te

story

o

te

te

Wc

ndcatve

tat

emergency

boody

coon

next

o

te

te

cancer

end

o

te

s

scope

n

canges

oowng

he

and

he

coon

surace

depart-

stoos.

day.

entre

abnorma

coon.

o

order

n

te

coonc

coon

as

lexure

Paracoc

D.

Ieoceca

E.

GE

gutter

vave

juncton

55-year-od

because

as

a

cronc

story

tomoss

man

o

o

B

o

wc

can

A.

Rgt

B.

Perumbca

gastrc

te

crross

n

and

He

aso

ver

as

dated

recta

depart-

vomtng

te

system

te

emergency

o

o

dstenton,

wa,

porta

resut

to

story

necton.

abdomna

abdomna

vens

comes

2-our

story

epatts

o

anteror

gea

a

lexure

C.

He

emergency

reaced?

B.

ment

te

obque

best

man

o

or

A.

A

oow-

cannes

buet?

passes

o

te

abdomns

amy

or

examne

umen

vens

te

4-5-2-6-1-3

typcay

to

quadrant.

orm

abdomna

B.

to

to

vertebra

te

asca

A.

been

he

by

andmarks

emergency

te

spaces

compartment

s

tat

o

asca

oowng

traversed

A

ower

compete

L3

asca

scedued

vens

pan.

perorated

o

o

vesse

a

vens

mdde

traversed

t

gastrc

gastrc

spenc

to

wt

arteres

abdomna

oowng

enter

A.

and

comes

du

stomac

ocaton.

Wc

man

o

ave

te

patent

vesses?

Rgt

mesenterc

ac

acoo

examnaton

he

oowng

common

o

department

Pysca

medusae.

story

A.

A

et

a

emergency

caput

wc

and

o

ment

abdomna

abdomen

te

218.

IV

comes

severe

VIII

te

te

coatera

anteroatera

abdomna

scedued

Wc

as

at

wc

sustanng

ower

te

Camper

surger y

acted

comes

structures

T ransversus

VII

50-year-od

abuse

s

VII,

VI,

traversed

4.

te

occuson,

gt,

rgt

3.

removed?

A.

s

ong

a

scan

s

Durng

depart-

as

cava

abdomna

sows

ac

gang

B.

or

to

a

buet

59-year-od

sarp

rena

19-year-od

L1

ment

vena

rom

a

umbar

A.

A

o

abdomen

body?

Let

wt

te

low

B.

most

story

te

key

A.

n-ne

o

neror

resut

oper-

an

2-our

scan

o

vens

er

abdomna

s

because

aow

endovascuar

grat

oowng

depart-

abdomen.

to

patent’s

usng

o

s

sows

urgenty

center

te

emergency

mass

repared

he

te

abdomen

e

exporaton,

pane.

to

to

pusate

and

aneurysm

subcosta

comes

a

o

aneurysm

atng

215.

Paracoc

E.

B.

An

214.

D.

A.

ment

213.

esopagea

te

139

Abdomen

3

a

ven

wt

ematemess?

to

a

2-mont

vens

varces.

bood.

due

over

he

te

te

anas-

esopa-

140

C H A P T E R

220.

3

Abdomen

C.

Let

D.

Spenc

E.

Let

A

gastrc

abdomna

28

221.

te

mm

Superor

epatc

around

sows

s

wt

te

emergency

story

area.

n

nerve

Questions

224.

na

CT

tat

carred

224–244

because

pan.

tumor

s

A

at

perormed

te

pan

organ?

ra

aferents

rom

A.

Vagus

sympatetc

B.

Prenc

C.

Pregangonc

parasympatetc

C.

Ceac

D.

Postgangonc

E.

Vscera

32-year-od

wt

over

boody

s

te

cayces

stone.

to

be

on

et

tat

te

pevs

te

te

et

bood.

quadrant

examnaton

and

An

appears

enarged

key

and

ocaton

o

norma

because

te

o

or

a

ur-

te

sze,

rena

ts

stone

Uretra

B.

Urnary

C.

Ureter

badder

at

te

uretero-vesca

D.

Ureter

at

te

pevc

E.

Ureter

at

te

uretero-pevc

49-year-od

man

juncton

226.

brm

comes

pan

to

te

depart-

Lesser

wegt

A

CT

te

oss

o

scan

ead

obstruct

te

Be

B.

Common

C.

Let

D.

Cystc

E.

Rgt

or

he

an

te

sows

as

a

s-

unntentona

past

a

tumor

oowng

epatc

3

3

cm

w

monts.

most

E.

Ioypogastrc

or

because

An

At

o

and

e

s

duodena

artery

to

te

s

gated.

suppy

patent?

emergency

sows

and

te

A

ree

to

was

part

o

procedure

branc

bood

pan

a

taken

patent

ucer

Durng

te

abdomna

x-ray

urgenty

exporaton,

resected.

contnue

severe

uprgt

to

to

o

te

and

ar

te

te

wc

A

A

CT

dsease

nerve

w

and

scan

o

and

a

transmt

nerve

nerve

surgery,

branc

te

te

artery

bowe

B.

Superor

gastroduo-

C.

Ceac

D.

Rena

E.

Superor

ng

B.

Let

naton

C.

Rgt

o

comes

aso

to

jaundce

he

artery

te

a

rgt

ureter

sows

te

s

emergency

epgastrc

patent

and

nervous

te

and

utrasound

s

stones

scedued

next

day.

gated

structure

pan.

n

and

te

or

Durng

cut.

traveng

A

aong

cut?

pexus

mesenterc

pexus

pexus

ypogastrc

ours

and

were

er

pexus

ts

Spenc

o

mesenterc

w

Seven

o

s

structures?

coecystectomy

wc

was

odged

part

sows

artery

woman

cystc

rom

abdomen

ower

ower

stone

artery

gabadder.

aparoscopc

te

er

kdney

artery

quadrant

a

te

rom

A

cava

Upper

and

o

oowng

because

duct

radatng

sympyss.

probaby

department

rgt

pan

artery

ac

40-year-od

Ineror

n

s

mesenterc

A.

artery

radates

nerve

te

Ineror

ave

emergency

tat

ematura

kdney

Wc

utrasound

umbar

a

duodenum

o

E.

A.

gastrc

stone

wc

Fourt

228.

gastrc

he

Common

te

as

nectons.

obstructng

D.

operatng

sma

te

partay

C.

boated

te

sde

nerve

pubc

an

key

depart-

to

and

ac

under

ound

er

vena

be

comes

aso

spancnc

abdomna

Ineror

duct

man

an

toward

Interna

227.

neu-

A 21-year-od woman comes to te emergency depart-

B.

duct

oowng

pexus

A.

structures?

Se

spancnc

spancnc

at

tumor

s

carryng

CNS?

toracc

Pevc

crosses

duct

epatc

perorated

dena

te

patent

ad

duct

dapragm

was

b)

abdomen

pancreas.

o

epatc

abdomen.

room.

(20

he

and

to

rgt

poycystc

capsue.

toracc

suspected,

duct

47-year-od

ment

jaundce.

kg

te

wc

A.

A

9

o

o

and

pancreatts

te

er

tract

sows

Ceac

ureter.

pan

urnary

D.

abdomna

cronc

cm

severed?

comes

n

regon.

C.

stone

o

to

B.

ment because o a 3-mont story o worsenng acute

tory

pan

kdney

Greater

back

emergency

o

A.

ment

juncton

patway

te

2

gangon

woman

wt

abdomen

te

kdney

o

a

neurectomy

gangon

mesenterc

suprapubc

stretced

key

A

nerve

39-year-od

story

neura

abdom-

sows

gangon

Aortcorena

a

te

most

ntense

nerve

Ineror

te

pancreas.

Wc

E.

to

te

o

abdomen

pancreas.

D.

A

o

story

te

te

was

department

sows

utrasound

o

225.

rad-

subsequent

are

bunted

depart-

odged?

A.

A

ower

ureters

and

most

emergency

Pysca

te

rounded

s

to

underwear

postve

rena

Were

n

back.

s

sows

were

comes

pan

ower

sowed

abdomen

but

man

severe

stans

nayss

sympatetc

o

nterrupt

te

structure

Somatc

3-mont

scan

ead

to

Pregangonc

aferent

o

CT

te

B.

A

mesenterc

A 70-year-od woman comes to te emergency depart-

ment

rgt

A

appendx

bers

and

Pysca

te

guardng.

nlamed

Wc

nlamed

depart-

nausea

tenderness

nvountary

sows

o

umbca

rebound

dameter.

te

to

A.

atng

223.

a

abdomen

n

rom

ment

222.

3-mont

quadrant

o

pan

comes

o

pan

examnaton

scan

man

because

ower

Proper

E.

gastro-omenta

55-year-od

ment

D.

ater

started

sows

to

te

vgorousy

dstended

meconum.

pexus

devery,

T wo

baby

vomt.

abdomen

abdomna

gr

began

Pysca

and

sma

x-rays

cry-

exam-

amounts

are

sown

CHAPTER

A

B

•

beow

(Fg.

ogca

3.9).

Wc

abnormates

s

o

te

te

oowng

most

key

embryo-

cause

o

Fig.

3.9

231.

ts

Deect

B.

Faure

C.

Faure

to

a

n

te

o

traceoesopagea

te

extend

muscuar

nto

o

te

tssue

Marotaton

E.

Deectve

o

rom

peuropertonea

recanazaton

D.

septum

te

o

te

te

body

wa

membrane

o

Au t o p s y

genta

poory

40

I

o

eart

od

ad

wc

newborn

deects

deveoped

years

se

a

o

and

b oy

and

peuropertonea

ad

con-

230.

An

x-ray

dvertcuum

stua

cyst

Ompaoenterc

Persstent

at

28

woud

w e e k s’

most

gestaton,

key

A

4-year-od

or

ave

ary

CT

pancreas

E.

Ogoydramnos

A

neonate

admtted

nts.

A

CT

segment

presence

tracea

o

te

wt

was

to

o

o

and

te

te

at

34

emergency

scan

an

gut

o

te

esopagus

ower

congenta

weeks’

gestaton

department

or

sows

and

endng

o

condtons

anomay?

He

o

Pyorus

B.

Frst

pneumo-

C.

Second

D.

hrd

bndy

E.

Jejunum

and

most

te

between

esopagus.

s

upper

Wc

key

seen

233.

A

o

part

s

part

parents

te

o

part

2-year-od

a

te

key

x-ray.

contrast

sma

(4–5

umbcus.

dagnoss?

te

te

emergency

patent

toeratng

up

by

det

te

most

an

key

not

unt

pyscan

deveopmenta

sows

department

does

ave

a

ew

regu-

mestones.

annuar

A

pancreas.

obstructed

by

ts

stomac

te

o

o

arge

Poyydramnos

tests.

Ogoydramnos

key

lud

duodenum

te

te

boy

s

notced

T ransumnaton

B.

duodenum

duodenum

brougt

a

Wc

o

deveoped

Anydramnos

A.

Deep

D.

Umbcoea

B.

T unca

E.

Down

C.

Processus

to

graduay

and

coecton

C.

syndrome

s

te

uceraton

oowed

a

and

most

he

was

abdomen

structure

A.

A.

stua

was

te

to

vomtng.

meetng

scan

was

and

te

communcaton

segment

cnca

ago.

tat

mate-

artery

comes

and

contrast

abdomna

ds-

nto

condton?

abdomen

abnorma

boy

syndrome

Wc

dysgeness

born

te

oowng

ts

te

vtene

be-staned

Down

wt

nserted

troug

eum

te

Ompaoenterc

E.

232.

s

Iea

D.

c a re .

eum

s

and

an

sows

te

C.

was

p re n a t a 

o

B.

Poyydramnos

o

oowng

and

any

umbcus

dvertcuum

Annuar

gonada

oops

yeow-brown

cateter

acqurng

between

Mo t  e r

ad

A

abdomen

te

te

te

Iea

B.

Marotaton

te

ed

o

n

A.

A.

Batera

o

ou-smeng

beore

connecton

weeks

D.

njected

kdneys

s  ow n ?

C.

openng

s

a

umbcus.

o

not

 o   ow  n g

mutpe

as

s

b   a t e r a   y.

utrasonograpy

te

s  ow s

absence

u re t e r s

sma

Wc

te

boy

rom

ra

cm)

ntestnes

uson

newborn

matera

duodenum

membranes

229.

A

carge

condton?

A.

141

Abdomen

3

te

scrota

around

rng

abugnea

vagnas

pyscan

a

because

scrota

utrasound

oowng

abnormay?

nguna

te

enargng

normay

structures

mass.

sowed

a

deveoped

as

most

142

C H A P T E R

234.

3

Abdomen

D.

Gubernacuum

C.

Interna

E.

Dartos

D.

Latera

A

tunc

25-year-od

comes

to

te

utrasound

sows

ods

n

cavty

due

to

abdomna

expans

mont

routne

te

abdomen

bowe

aure

pregnancy

o

te

ernatng

o

uson

regon. Wc

ts

o

examnaton.

o

o

E.

239.

etus

nto

te

te

An

Superca

A

department

te

procedure

atera

oowng

presentaton?

nguna

33-year-od

te

coverng

te

erens

tat

o

so

te

man

or

a

spermatc

t

can

oowng

Nonrotated

C.

Stus

D.

Gastroscss

C.

Externa

E.

Iea

D.

T ransversus

E.

T ransversas

A

asca

dvertcuum

35-year-od

no

typca

care

aca

devers

durng

s

causng

te

wt

o

Down

ater

be.

Atresa

o

te

trd

o

te

rst

C.

Congenta

ypertropc

D.

Esopagea

stenoss

E.

TEF

a

ow-grade

sows

or

he

juncton

are

gangrene

o

ng

most

te

key

B.

Subepatc

C.

Mdgut

D.

Dupcaton

E.

Congenta

gron

as

an

key

pan

o

C.

Ionguna

emora

ce

An

CT

te

stenoss

sma

and

pyscan

x-ray

o

wa

te

tere

pan

rom

Deep

B.

Externa

and

Wc

ts

nguna

ac

area

o

s

ductus

From

nterna

de-

wc

spermatc

musce

musce

recurrent

began

but

1

bous

mont

ave

key

unxed

a

vomtng.

ago

worsened

sows

te

to

241.

oow-

pyscan

and

Wc

te

nerve

n

as

durng

sgty

Hs

postpran-

te

past

tender

and

A.

Cystc

B.

Be

most

te

pyscan

te

eve

o

suspected,

can

te

skn?

to

w

com-

skn

on

umbcus.

wc

progress

nodes

scay

s

a

pre-

squamous

rst

receve

243.

In

wc

sgn-

structures

s

artery?

duodenum

duodenum

o

to

te

crampng

and

vomtng

examnaton

upper

sows

o

ar

te

wa

n

te

or

sows

quadrant

gabadder

emergency

md-abdomna

te

postve

utrasound

tckenng.

gabadder

oowng

stes

s

a

An

and

ga-

odged?

duct

duct

Duodenum

Jejunum

E.

Ieum

o

te

te

oowng

bones

A.

13–15

years

B.

16–18

years

C.

19–21

years

D.

22–24

years

E.

25–27

years

68-year-od

ment

te

rgt

wt

key

D.

A

te

between

s

duodenum

te

dstenton,

and

C.

Wc

ange

aorta

oowng

brougt

Pysca

abdomen

tree.

most

s

242.

to

sgn

o

s

because

gastones

patent

s

man

ours.

te

by

te

te

lexure

porton

abdomna

o

te

te

o

tat

and

bub

70-year-od

24

o

porton

Duodenojejuna

stone

transmsson?

porton

T ransverse

A

o

obstructed

E.

department

because

sweng

tat

be

sows

artery

Wc

D.

x-ray

sows

to

Duodena

pan,

te

abdomen

mesenterc

C.

wt

o

te

abdomen

progresson

Wc

o

Ascendng

duodenojejuna

tckened

ymp

o

te

te

cut.

te

ayers

aponeuross

examnaton

decreased.

bary

to

comes

condton

A.

scan

past

erna.

a

and

pan,

Descendng

ntestne

s

nausea

superor

Murpy

beow

s

varous

asca

ntay

B.

spancnc

keratoss

and

obque

abdomns

A.

dagnoss?

areas

expose

obque

abdomna

o

cutaneous

o

te

emergency

Durng

musce

Pysca

canty

because

te

ntestne

wegttng

man

carcnoma.

dranage

duodenum

spancnc

abdomna

magnant

te

around

te

abdomna

epgastrc

week.

wen

because

actnc

to

comes

toracc

26-year-od

An

da

severe

sows

or

Ioypogastrc

s

he

duodenum

pyorc

ntestne.

nguna

Latera

panng

te

te

examnaton

B.

A

o

o

days.

te

te

ater

A.

Lumbar

symptoms

most

to

gated

structures

te

A 45-year-od man comes to te emergency department

wt

megacoon

ndrect

Greater

s

Cremaster

se

atresa

man

responsbe

E.

eedng.

condton

Interna

B.

gr

cecum

Pysca

D.

rst

and

240.

vovuus

32-year-od

scrotum.

o

sma

Dapragmatc

o

2

obstructed

te

newborn

syndrome

er

gr

ad

separates

cord

be

to

vasectomy.

derved?

A.

most

vesses

A.

A

part

part

brougt

marotaton

mesenteres.

s

s

ever

he

b)

not

admtted

dstended abdomen wt g-ptced bowe sounds. A

Atresa

gr

(10

ad

vomtng?

B.

2-day-od

kg

se

Wc

A.

A

4.5

pregnancy.

sorty

staned

a

However,

eatures

vomtng

vomtus

key

woman

compcatons.

prenata

begns

gut

nversus

s

scedued

pyscan

B.

ad

238.

o

sma

8t

a

Vovuus

any

237.

te

te

or

A.

wt

236.

o

te

condtons

235.

n

examnaton

part

amnotc

woman

pyscan

ac

aortc

because

subsequent

tat

man

o

orm

te

comes

pan

bopsy

age

to

durng

sow

a

ranges

best

acetabuum

te

emergency

urnaton.

tumor

represents

use?

tat

depart-

Imagng

orgnated

and

rom

te nng o te urnary badder. Durng transuretra

resecton

te

to

urnary

remove

te

tumor,

badder. Wc

o

te

te

cystoscope

oowng

enters

structures

CHAPTER

w

ng

244.

te

te

cystoscope

urnary

A.

Intramura

B.

Membranous

C.

Prostatc

D.

Spongy

E.

Parauretra

A

a

part

o

part

o

to

by

te

man

te

mdne.

A.

Let

B.

Rgt

uretra

s

brougt

o

te

wc

rest

o

testcuar

a

was

te

to

te

sweng

negatve

cancer

oowng

te

n

or

o

cancer

scrotum.

ydrocee

te

most

emergency

s

et

key

spread

and

testes

s

represents

rom

te

vena

cava;

et

vena

C.

et

D.

E.

rena

A

a

testcuar

vena

ven;

neror

Iscum

ven;

common

ac

ven;

cava

ven;

testcuar

ven;

medan

et

sacra

rena

ven;

ven;

ne-

wt

oss

et

te

te

s

a

bony

on

te

umbcus.

et

structure

oowng

ee

man

s

pam

n

te

structures

pam

brougt

to

on

sensaton

and

Pysca

rgt

o

to

te

twet

s

te

te

s

A

at

te

he

onto

ower

dd

et

te

and?

emergency

posteror

rena

te

psatera

quadratus

te

oowng

nerves

s

aso

o

postero-

te

rgt

tenderness

costovertebra

parayss

and

rgt

and

o

transversus

abdomen

te

capsue,

key

on

as

te

rom

umborum

most

te

severe

obque

scan

orgnated

n

rgt

patent

CT

skn

regons

sows

abdomna

musces.

tat

rb

he

te

pubc

examnaton

nterna

tumor

o

anteror

papaton.

enterng

vena

o

gutea

abdomns

neror

neror

o

key

67-year-od

a

testcuar

Let

et

and

to

owered

Pubs

A

ange

cava

vena

sows

kdney,

pressng

musce.

on

Wc

compressed

by

o

te

tumor?

25-year-od

routne

ormed.

woman

comes

examnaton.

totomy

were

Sacrum

D.

te

Let

ndex

C.

sde.

cava

245.

Ium

Coccyx

pan

cava

Let

ror

testcuar

most

B.

neror

et

neror

department because o an acute-onset rgt ower back

ven

ven;

skn

Wc

A.

atera

neror

abdomen

concomtanty

patent’s

E.

246.

body?

ven;

testcuar

te

uretra

part

o

on

pyscan

metastatc

Wc

route

press

o

transumnaton

testes

enter-

pyscan

because

dagnoss

te

beore

uretra

38-year-od

made.

mmedatey

uretra

department

he

traverse

badder?

143

Abdomen

3

poston

In

and

order

nsde

er

and

to

mdde

he

a

pevc

vagna

o

te

patent

papate

ngers

to

we

s

paced

patent’s

used

s

A.

Subcosta

te

B.

Latera

s

per-

C.

Ionguna

D.

Femora

E.

Ioypogastrc

uterus,

pyscans’

e

or

n

examnaton

te

te

pyscan

rgt

et

te

and

and

emora

cutaneous

nerve

to

A n swe r s

Answers

1.

A.

3.

1–25

he

cess)

s

cedes

tests

umbar

process

porton

vagnas

composed

te

upper

hs

processus

tat

vagnas

as

o

t

wa

pareta

to

a

deveopment

most

maes,

o

te

aso

as

te

are

ave

a

a

dsta

tan

n

women.

nvoved

B,

C,

A.

and

289;

Wms

can

caused

be

suppressor

D,

by

to

a

nguna

kdney

as

n

are

are

285,

not

A.

B.

not

nvoved

te

WT1

2-t

and

E.

kdneys

gene,

mode

or

hese

373–374;

N

genes

Wms

311;

are

not

nvoved

E.

beav-

ABR/McM

265,

268

to

o

ts

arrested

te

typcay

poston

te

by

te

neror

te

about

te

are

poes

“ascent”

mdne

mesenterc

s

on

kdneys

neror

rst

“ascend”

g

te

appens,

kdney

te

Müeran

o

struc-

artery.

0.25%

o

he

o

te

duct

uson

process

uterus

occurs

descend

at

te

C.

In

ton

o

ageness

wen

rom

one

te

s

te

te

or

bot

abdomen

o

te

nto

te

maormaton

s

nstead

ocated

o

ts

at

o

te

norma

te

ven-

oca-

pens.

congenta

aure

o

absence

one

or

o

bot

rena

ts-

kdneys

to

embryogeness.

N

kdney

te

openng

pens

o

rom

373–374;

durng

congenta

te

te

durng

norma

a

n

ead

resutng

GAS

te

s

were

surace

Rena

sue

tumor

n

a

Atoug

bcornuate

Hypospadas

ton

t

4.

T umors.

to

a

deveop

nvoved

s

Cryptorcdsm

tra

usuay

tat

Wen

orsesoe

rse

uretra,

tat

to

occasonay

encounter,

o

wa.

kdneys

scrotum.

n

D.

sown

use.

Interrupton

gves

288

been

tey

testes

magnancy

Knudson

used

men

cana.

recenty

mutatons

structures

te

ernas.

structures

ABR/McM

It

te

sted

n

kdneys

te

pevs

popuaton.

processus

common

te

structures,

2

genes.

mutatons

GAS

s

more

nguna

te

264;

cdren.

accordng

C,

o

are

oter

hese

tumor

n

B,

he

E.

N

occurs

ng

ernas

congenta

ormaton

GAS

2.

n

D,

te

nguna

n

abdomna

ncdence

o

deveopment,

poston

te

ture

tunca

vagnas tat extends nto te abum majus, atoug

congenta

a

batera

te

typca

Durng

posteror

pre-

n

C.

rom

pro-

abdomen.

ony

tests

eatures

emaes

tat

poston

eavng

te

tese

a

outsde

obterates,

Wereas

n

rom

poston

surrounds

seat-ke

pertoneum

“mgrates”

usuay

tests.

(meanng

eta

312;

ABR/McM

deveopment

perod

wt

269,

te

te

260

kdneys

unc-

resutng

urne

144

C H A P T E R

3

Abdomen

contrbutng

te

kdneys

buton

lud

A.

to

to

te

a

te

to

lud

lud

s

s

te

a

amnotc

(rena

mssng

(ogoydramnos)

Anencepay

n

deveop

cavty.

ageness),

and

ts

decreased

Wen

part

o

hs

an

portons

deect

eves

Pyorc

pc

be

amnotc

stenoss

outet

crcuar

spectrum

s

o

neura

a

s

an

to

o

7.

deveop.

pregnancy

apa

as

wt

our

to

acqured

6

pyorus.

he

te

te

o

A.

tckenng

a

deveopment

here

owever,

o

te

tra

o

te

ton

wt

B.

A

bnd

5.

A.

hs

GAS

373–374;

here

nked

are

severa

te

most

esopagea

o

te

types

o

pouc

tracea

ts

common

but

D.

ma-

wt

mates

a

C.

here

are

are

deects

E.

cause

wc

poyura.

tus

Rena

eadng

dramnos).

maturty

Ectopc

o

te

are

not

mportance

a

to

6.

C.

In

norma

creatc

tube

a

bud

and

n

eta

w

and

he

as

o

o

te

s

te

be

or

te

o

te

ventra

te

urne

he

nc-

7000.

a

o

wt

s

lud,

congenta

nstead

creatng

perssts,

nguna

ocated

o

ts

to

processus

at

a

te

erna.

maormaton

s

con-

reated

te

vagnas

openng

te

vagnas

tat

porton

s

pens

o

o

te

norma

te

ven-

oca-

pens.

vagnas

w

not

afect

mae

A.

and

atresa,

B.

D.

s

rena

te

lud

uretra

N

215;

deveopment,

te

dorsa

bud

tube

pancreatc

ABR/McM

dorsa

(ogoy-

te

juncton

te

hs

gy

n

tat

around

an

s

te

annuar

afected

enters:

211

bud.

te

s

a

o

on

te

te

ure-

dorsa

ocaton

at

279

n

te

sgty

nto

A

te

woud

o

te

or

tests

tests,

gonad

scrotum

ower

were

tan

core

spermato-

tat

scrotum

oter wse

occurs

cromosoma

o

te

s

tubues

s

be

o

cannot

usuay

prone

to

as

te

gand

ead

curvature

coexstence

occurs

te

s

wen

syntetc

ormones.

wc

upward

and

gen-

oces.

bocemca

weren

gonads

sex.

ovaran

te

te

externa

yperpasa

(eter

te

but

dened

suprarena

curved

wen

sex,

opposte

and

n

condton

abnorma

GAS

D.

he

289;

pan-

te

gut

Rarey,

ventra

te

same

part

o

N

atera

muscuar

pancreas.

second

s

by

or

sat

most

te

ead

downward)

o

te

obvous

o

at

pens.

durng

erecton.

s

o

t

te

a

descend

undescended

mportant

suprarena

o

s

to

afected

norma

278,

uncton.

aberratons

patways

Cordee

ts

mgraton

s

ermaprodtsm

are

ocated

an

ocaton

hs

eatures

Congenta

as

not

cancer.

semnerous

pens

by

a

reocated

te

ventra

sde

pancreatc

rotates

duct

te

T rue

tere

ageness.

to

testcuar

express

o

caed

temperatures

te

s

ABR/McM

oten

ncompete

to

te

afected

o

nstead

Pseudoermaprodtsm

o

can

369;

o

s

pens.

because

taa

or

N

tests

maormaton

openng

pens

te

a

process

congenta

te

testcuar

me-

con-

a

te

o

surgcay

represent

and

s

wen

hs

vagnas.

temperature.

One

mpared,

excreton

amnotc

by

resutng

gut

te

occurs

abdomen

removed

amnotc

Feta

o

265;

te

be

E.

producton

not

around

tube,

tests

congenta

te

wc

exposed

geness

dabetes

esopagea

obstructng

wt

s

assoc-

ncreases

may

or

decreased

pancreatc

gut

porton

were

t

congenta

poyydramnos.

mpar

etus,

rotates

duct).

n

245

processus

processus

resut

abnor-

ypergycema

poyura

to

373–374;

uses

porton

sde

rom

9.

170,

te

be

poyydramnos.

swaowng

vscera

a

n

Cr yptorcsm,

body

ogoydramnos

actors

n

resuts

Suractant

te

o

tests

ead

ncudng

congenta

poyydramnos

Feta

to

C.

s

o

unkey.

GAS

8.

deveopment.

reported

tese

s

poyydramnos.

ageness

etus,

te

GAS

apparenty

ung

surace

266

abnormates

materna

eadng

n

oten

deveop

s

processus

n

deveop

anencepay

resut

to

wt

resut

o

aso

were

exampe,

E.

can

eta

dtons

D.

severa

tus,

lud,

nked

ure-

s

norma

dsease

265,

te

hs

However,

not

to

ead

Epspadas

e.

ogoydramnos

reated

n

o

wt

ungs.

tat

materna

aso

Ectopc

patent

dsta

tat

congenta

kdney

ypopastc

ABR/McM

ungs.

lud

TEFs.

t

(cryptorcdsm).

anomay

and

absence

ncompatbe

311;

rater

amnotc

poycystc

congenta

s

evdence

ypopastc

Gentournary

ated

te

N

some

nk

adequate

s

condton

s

to

genetc

B.

atresa

tra.

te

patent

tra,

Uretra

1

processus

vagnas

entre

were

surace

te

ntermedate

te

key

at

o

tunca

an

I

uretra,

TEF .

E.

te

I

ABR/McM

porton

perssts,

s

o

present

be

about

pancreas.

288;

Hypospadas

brt.

obstructon

te

s

sterty.

abnorma

ormaton;

to

tests.

patent

con-

N

dsta

vagnas

ypertro-

weeks

Inants

C.

ydrocee.

common

wt

pancreas

annuar

366

trbutes

etoproten

nante

reatvey

progressve

te

to

an

GAS

anencepay.

known

s

as

(aong

annuar

A, B, D, and E. hese structures w not be compressed

vomtng.

esopagus.

conssts

tube

durng

n

wtn

due

musce

projecte

and

aso

stenoss,

occurrng

gastrc

TEF

eevated

stenoss,

Pyorc

neura

notced

o

by

te

addtonay,

are

pyorc

dton

D.

can

te

utrasound;

(AFP)

B.

o

duodenum

dence

resuts.

tube deects (NTDs). Anencepay occurs wen te

upper

te

contr-

porton

Faure

o

suc

an

as

368;

ods

te

ABR/McM

are

o

atera

umbca

key

te

ods

278,

279

structures

anteror

can

erna,

or

cause

a

n

ormng

abdomna

a

major

mnor

deect,

te

wa.

deect,

suc

as

gastroscss.

A,

B,

C,

not

na

and

E.

nvoved

hese

n

oter

ods

ormaton

o

and

te

te

wa.

GAS

261,

308;

N

254;

ABR/McM

amnon

anteror

232

are

abdom-

CHAPTER

10.

A.

Rotaton

o

deveopment

tube

rotate

ccay

ony

or

te

B,

D,

and

te

GAS

B.

he

te

era

o

C5.

tve

C,

D,

not

he

tat

n

to

a

and

a

are

te

N

as

toracc

te

torax.

o

oter

rom

esopagus

te

te

to

o

201;

nto

te

B.

gan-

and

E.

muscuar

2

C3,

wen

Wt

ow

or

abdomna

by

o

B.

s

C.

coud

cause

rom

D.

te

aspraton

E.

A.

I

te

esopagus

hs

s

knd

not

te

o

Abnorma

o

woud

not

deveop

woud

end

atoug

an

nto

a

te

as

bnd

n

wt

TEF ,

tracea,

16.

and

but

t

s

not

te

be

drect

cause

o

A,

Abnorma

E.

Abnorma

tongue

deveopment

does

not

resut

n

a

cated

GAS

o

he

te

A.

B.

wt

172;

a

N

te

parynx

s

not

asso-

17.

TEF .

237;

septum

o

n

ABR/McM

transversum

208

orms

centra

tendon

he

peuropertonea

part

o

he

peuropercarda

cavty

ods

orm

te

posteroatera

B,

dapragm.

rom

te

ods

peura

he

cervca

dapragm.

myotomes

te

descent

absence

o

an

a

o

not

cause

xed

vo-

mesentery

ntestnes.

ces

s

nto

due

te

to

auty

wa

o

parasympatetc

creatng

coon

o

be

a

unctona

proxma

to

te

te

post-

bock-

bock.

290

(Hrscsprung

neura

crest

ces

dsease)

to

mgrate

o

wt

te

or

coaca

woud

wtout

te

resut

n

presence

o

recanazaton

weren

are

or

not

no

o

C,

te

cause

most

can

and

E.

n

resuts

cana

due

to

and

n

rec-

ncompete

s

te

ndgut

can

a

decency

o

common

s

a

attaced

but

lud,

woud

dsease.

249

approxmatey

he

vovu-

amnotc

ypopasa

ABR/McM

tese

cause

ste

o

2

persstence

to

parts

te

o

optons

o

rom

te

dvertcu-

te

vtene

umbcus.

te

are

eet

Mecke

abdomna

not

derved

vscera

rom

te

duct.

315;

N

281;

ABR/McM

common

uterne

os

be

coon

ana

contents.

pumonary

eum

most

te

o

ts

271;

te

connected

Hrscsprung

N

o

te

recanazaton.

outpoucng

t

bot

o

ste

(aopan)

te

nterna

cer vx

os

o

233

ectopc

tube.

can

te

o

resut

cer vx

pregnancy

Impantaton

s

n

pacenta

not

te

n

s

te

preva,

most

com-

ste.

C,

D,

and

E.

he

oter

coces

sted

are

not

te

most common stes o ectopc pregnancy. he endo-

separate

cavty

and

te

orm

percarda

te

metrum

brous

ste

percardum.

D.

can

te

hs

and

he

mon

A.

coon.

rotaton

321;

s

B,

but

and

eter

o

dsta

nterna

te

dapragm.

te

A.

te

but

cause

GAS

deveopment

te

ack

separaton

twstng

vtene

TEF .

tat

sc-

gangrene.

o

te

megacoon

crest

a

aure

o

presented

C.

C.

exst

he

duct

o

ABR/McM

Ogoydramnos

D.

n

cause

vovuus.

woud

st

megacoon

atresa,

or

cecum

assocated

n

270;

te

Deectve

um.

can

N

aure

GAS

t.

13.

he

not

tube.

resut.

deveopment

tereore,

correcty,

as

assocated

openng

not

tracea

wt TEF ,

t

deect,

resut

pneumona

B.

dd

atresa,

can

aure

ntestne

neura

ageness

wc

esopagea

ma-

vascuature

o

n

o

mesentery.

stua.

us

pneumona.

to

resuts

woud

enarged

canazaton

presence

lud

te

tere

neurons

was

tum

(esopa-

he

o

308;

recta

downgrowt

te

hs

cause

te

270

xed

resutng

a

due

movement

Incompete

a

270

oregut

tube.

passage

and

te

te

s

and

225,

wtout

around

not

o

dapragm.

compcaton

tem.

agangonc

o

an

rom

ana

w

o

Congenta

nto

ods

posterory.

225,

te

A.

resuts

organs

bud

resutng

and

GAS

15.

nega-

mentoned

ree

Congenta

age

s

mesentery

te

coon.

gangonc

one

pos-

no

oop

ntestne,

cecum

because

coon,

and

te

o

ABR/McM

or

atresa

ceca

mgraton

bat-

C4,

o

dorsa

possbe

twst

support

Dupcaton

vuus

a

mdgut

Subepatc

te

te

crura

201;

s

ntestnes

ascendng

D.

200,

te

necross

o

dapragm.

septum

tracea

o

become

be

N

Dapragmatc

267

nnervated

and

ABR/McM

n

te

o

sma

o

te

vovuus

provdng

nerve.

peuropertonea

aryngotracea

resut

to

dapragm

wa

s

myobasts

te

occurs

cavty,

te

251,

deveop.

mecansms

ventra

woud

are

o

regon,

rom

cavty,

he

te

traceoesopagea

stua

musces

he

o

part

orms

163;

Mdgut

rotaton

hs

rotaton

vagus

Later,

orm

derved

te

200,

C5.

C.

emc

w

cervca

to

CT

surace

dorsa

GAS

14.

components.

consdered

abdomna

he

severa

dapragm

eventraton

371;

wa

hese

te

et

(wc

and

spe-

rotates

poston

ABR/McM

te

oten

porton

E.

separates

gus)

te

nto

cause

GAS

o

n

pressure

pused

contrbute

D.

body

tat

o

n

C4,

emdapragm

pressure

tve

12.

C3,

te

Eventraton

muscuar

A,

orms

te

he

esopagus

torax.

and

depct

rom

E.

te

standard

anteror

te

o

transversum

rom

nerves

270;

deveops

septum

(te

te

o

oregut,

esopagus,

te

rotatons

N

n

Parts

countercockwse.

onto

accuratey

dapragm,

prenc

proxma

beow

s

event

system.

te

orentaton

emdapragms.

te

major

troug

oter

363–364;

rom

te

nerve

not

and

tendon)

n

a

te

rom

passes

dapragm

mgrate

are

do

nnervaton

part

t

s

orms

rotaton

he

tube

centra

ng

as

E.

261,

Intay,

te

Lookng

ts

nerve

gut

but

tat

vagus

esopagus

C,

vagus

11.

et

tube

degrees,

vew),

te

gut

gastrontestna

porton

degrees.

MRI

brngs

te

270

tat

90

te

o

145

Abdomen

3

o

GAS

orm

te

muscuature

o

te

18.

A.

he

era

n

te

undus

o

te

uterus

s

te

norma

mpantaton.

471,

524

greater

vscera

N

304;

toracc

aferent

ABR/McM

spancnc

bers

rom

287

nerve

carres

abdomna

gen-

organs,

146

C H A P T E R

3

Abdomen

speccay

te

occurrence

B.

o

he

dorsa

era

somatc

resut

as

D.

he

are

t

does

he

rom

GAS

An

bowe

rng

te

tat

te

A.

S2

he

pan

to

S4

38;

te

carry

tese

not

gen-

B.

nerves

and

he

bers

du

vscera

aferent

but

are

and

D.

aferent

nguna

te

runs

parts

o

306;

erna

cana

troug

o

te

he

E.

bers

tey

do

vscera

te

pevs

he

tat

te

ABR/McM

occurs

not

A.

troug

epgastrc

te

gentas

and

deep

vesses).

nguna

abum

te

cana

majus

coud

a

o

B

or

rom

to

be

D.

on-

he

nnervate

ac

and

E.

compressed

compressed

by

te

te

crest

trunk

and

superor

eve

receve

beore

te

aor tic

Inferior

and

o

mesenteric

iliac

stomac

and

nto

mesenterc

not

cava

ymp

neror

to

nodes

te

Fg.

358;

and

nodes

not

rom

rom

receve

stomac

are

ymp

organs

te

stom-

dranage

and

not

assocated

dranage

te

rom

stom-

rom

wt

te

268;

ABR/McM

245

nodes

mesenteric

nodes

nodes

lumbar

trunk

aor tic

with

(lumbar)

nodes

iliac

nodes

nodes

Exter nal

Inter nal

Fig.

iliac

4.168

nodes

iliac

nodes

ver

stomac

4.168).

N

Left

GAS

te

duct.

with

•

and

dranage

dran

dranage

Common

Exter nal

ymp

tey

neror

ympatc

lateral

Inferior

te

234

nodes

vena

te

skn

to

chyli

trunk

(lumbar)

o

muscuature

toracc

Pre-aor tic

lateral

band

neror

trunk

Cister na

lumbar

te

ABR/McM

nodes

stomac

ymp

dranage

erna.

263;

Superior

Right

nnervates

te

and

nnervates

Celiac

Intestinal

te

drecty.

Hepatc

(GAS

be

N

receve

umbar

GAS

to

nerve

te

he

structures

are

key

o

tse.

durng an ndrect nguna erna. he oter nerves sted

not

nerve

nnervates

ac

ymp

ymp

C.

ac

nguna

scrotum

skn

perneum.

298–299;

and

o

te

ceac

beow

he

te

tg.

nerve

te

he

ntestna

not

oop

to

GAS

drecty

246

wen

nnervates

cutaneous

atera

pudenda

skn

aferent

but

emora

te

subcosta

nodes

neror

porton

over

nerve

regon.

umbcus.

parasympatetc

contan

rom

atera

skn

gabadder.

relexes,

pan

N

nguna

oypogastrc

superor

carres

vscera

vscera

nerves

rom

pan.

nerve

nnervate

transmt

te

to

nerve

proxma

te

20.

358–365,

anteror

n

gabadder.

ndrect

enters

guna

Pan

ocazed

spancnc

rom

(atera

spna

reerred

carres

or

nvoved

pan.

pevc

bers

n

not

be

suprapubc

bers.

sarp,

nerve

can

toracc

prenc

mportant

nerves

C.

n

te

vagus

transmt

o

occurs

Atoug

and

pan.

aferent

dfuse

bers,

19.

ram

woud

C.

E.

oregut,

reerred

nodes

CHAPTER

21.

B.

he

te

proper

epatc

epatoduodena

occuded.

hs

artery

passes

gament

artery

es

and

wtn

superory

tereore

te

rgt

Inferior

wtn

woud

anteror

epigastric

Abdomen

3

vessels

be

ree

Extraperitoneal

fascia

Deep

inguinal

ring

margn o te omenta (or eppoc) oramen (o Wnsow).

Parietal

A.

he

superor

abdomna

mesenterc

aorta

artery

neror

to

brances

te

rom

peritoneum

te

epatoduodena

gament.

C.

he

spenc

not

D.

artery

ocated

he

n

common

proper

he

neror

margn

woud

artery

te

be

te

artery

but

stomac

gves

does

and

s

gament.

orgn

not

run

to

te

wtn

Conjoint

tendon

te

gament.

vena

o

not

bend

epatoduodena

epatc

epatc

epatoduodena

E.

runs

te

cava

Superficial

s

ocated

omenta

at

oramen

te

22.

E.

343;

Indrect

te

A.

N

Drect

wa

C.

to

nguna

deep

Femora

and

tereore

Lumbar

ror

deep

nguna

ernas

to

ext

ernas

abdomna

vesses

Hessebac)

nguna

o

T estis

troug

and

do

not

rng.

troug

te

umbcus,

not

•

rng.

te

(Grynet)

ernaton

rng.

anteror

epgastrc

(o

ext

rom

nguna

te

neror

troug

nguna

can

or

te

emora

rng

GAS

Fig.

4.48

pos-

gament.

penetrate

neror

sac

234

resut

deep

penetrate

te

ernas

teroneror

D.

te

trange

te

Umbca

te

commony

ernas

penetrate

B.

ABR/McM

troug

meda

te

291;

ernas

ntestnes

troug

(Pett)

te

umbar

supe-

Inferior

epigastric

vessels

tranges. Deep

(GAS

Fgs.

ring

camped. Peritoneal

GAS

inguinal

posteror

4.48

and

inguinal

ring

4.49)

Extraperitoneal

GAS

298;

N

263;

ABR/McM

235

Parietal

23.

C.

he

omenta

posteror

most

A

to

key

and

B.

te

he

posteror

hs

to

esser

te

sac

or

ocated

tereore

pouc

ver

can

s

pertonts

subepatc

space,

space

and

deveop

rgt

to

or

stomac

space

epatorena

ney.

bursa

and

woud

(aso

be

te

caed

Morson)

anteror

potentay

drecty

ntay.

space

o

to

s

te

rgt

accumuate

te

te

area

kd-

lud

and Conjoint

may

te

partcpate

patent

s

n

n

pertonts

te

supne

but

fascia

peritoneum

prmary

tendon

wen

poston. Superficial

D.

he

rgt

subprenc

dapragm

on

accumuate

Pertonts

patent

E.

te

(GAS

GAS

C.

to

coud

n

te

rgt

rom

sde

a

just

and

n

ts

neror

s

perorated

deveop

supne

es

area

not

to

key

stomac

ony

te

Peritoneal

he

te

stomac

Fg

to

wen

te

poston.

et

s

not

key

to

enter

te

greater

sac

N

gastrc

epatc

T estis

273;

ABR/McM

ven

porta

carres

ven.

241

bood

Above

rom

te

te

stomac

esopagea-gastrc

•

wt

pressure

te

he

et

n

te

te

porta

ven

(porta

(cava

system

te

and

speen

anastomoss.

ven

vens

causng

spenc

rom

gastrc

esopagea

anastomoss,

A.

ring

ucer.

4.102).

304;

juncton,

ses

inguinal

bulge

Fud rom a perorated ucer on te posteror aspect

o

24.

s

te

lud

space

causes

ruptured

ts

and

system)

system).

g

trbutares

do

not

pressure

esopagea

carry

orm

a

GAS

Fig.

4.49

anastomo-

Hg

bood

n

ts

B.

bood

et

wt

away

cava-porta

he

gastro-omenta

gastro-omenta

varces.

D.

he

te

no

et

drect

ven

and

anastomoss

epatc

neror

artery

ven

vena

s

cava.

a

accompanes

jons

wt

cava

te

cava

ven

te

spenc

et

ven

vens.

and

emptes

nto

147

148

C H A P T E R

E.

he

te

not

3

Abdomen

rgt

gastrc

stomac

ave

GAS

and

any

269,

ven

s

cava

354;

N

drans

part

o

te

te

anastomoss

296;

esser

porta

(GAS

ABR/McM

curvature

system

Fg.

but

o

25.

does

C.

he

tra

4.41).

skn

258

to

part

Diaphragm

Subphrenic

recess

o

te

L1

te

and

emora

traves

pes

Liver

gentoemora

ram

as

ner ve

L2.

trange

part

o

cremaster

orgnates

he

area,

te

musce

rom

“emora”

wereas

spermatc

and

aba

te

part

te

cord

or

ven-

suppes

“gento”

and

sup-

scrota

skn

anterory.

A.

he

te

o

B.

onguna

skn

te

he

over

nerve

te

scrotum

root

n

over

bers

te

te

rom

pens

L1

and

and

suppes

anteror

part

maes.

oypogastrc

sby

arses

o

nerve

rom T12)

ypogastrc

and

arses

rom

suppes

regon

and

L1

skn

(and

pos-

nnervaton

anteroatera

gutea

regon.

D.

E.

he

vate

cremaster

te

he

ventra

ower

GAS

296–298;

o

o

N

to

260;

n

T12

te

nnervaton

sexes

but

aso

anteror

te

GAS

Fig.

ABR/McM

aba

s

tssues

musces.

ormed

between

It

by

te

o

te

represents

abdomna

fascia

Transversalis

fascia

Transversus

abdominis

muscle

Internal

abdominal

External

oblique

abdominal

muscle

oblique

muscle

Testis

Processus

Gubernaculum

•

GAS

Fig.

4.41

to

not

te

nner-

assocated

abdomna

cremasterc

4.102

Extraperitoneal

does

maes.

s

wt

wa;

t

relex.

271

a

te

rgt

vaginalis

ntersecton

and

mdne

Kidney

•

peritoneum

musce

contrbute

nea

aponeuroses

Parietal

provdes

bot

26–50

he

abdomns recess

porton

not

aponeurotc

Hepatorenal

or

ramus

does

Answers

E.

nerve

gentaa

te

26.

pudenda

externa

musces.

et

unon

o

rectus

o

te

CHAPTER

A.

he

mdaxary

stragt

B.

ne

he

arcuate

ne

tat

ncson

he

te

D.

dvde

ay

we

Fg.

A.

to

te

n

a

E.

o

te

separate

tus

posteror

te

nppes

rectus

musce

not

An

by

and

28.

252;

o

nto

te

s

ABR/McM

te

tck,

adpose

magnary

usuay

te

paraes

te

rectus

sectons

2

aong

rectus

are

tese

seats

nature

ts

o

B.

(GAS

tc

te

s

anteror

o

te

tssue

typcay

ayer

te

tat

ste

to

deep

abdom-

D.

makes

up

mantan

E.

and

tends

ncreased

sue

asca

not

to

ceuar

ound

n

T ransversas

D.

Extrapertonea

muscuature

te

a

od

asca

and

pareta

atty

we,

te

due

to

connectve

29.

ts-

assocated

asca

s

deep

to

te

deepest

o

te

ayer,

pan

te

orm

duct

te

be

to

ts

to

be

to

enter

C.

he

to

bood

292;

trd

te

N

rom

287;

part

o

te

ead

a

o

to

te

backup

more

o

epatc

superor

wt

te

te

cys-

gabadder

(dranng

s

not

due

two

te

abdomna

mesenterc

aorta).

ver

to

te

ver)

afected

to

a

ack

by

o

an

any

ducts.

te

ABR/McM

neror

artery

(a

Because

and

takes

a

cava.

pat

posteroneror

major

te

vena

256

duodenum

aorta

ventra

trd

part

branc

o

te

ante-

to

o

te

te

duode-

num es n te ange between (“sandwced” between (as

adjacent

abdomna

s

wa.

a

nut

tons

o

n

a

ts

nutcracker)

porton

o

tese

te

External

alba

oblique

two

structures,

duodenum

part

can

muscle

abdominal

muscle

abdominal

of

external

oblique

spine

Inguinal

•

GAS

Fig.

4.27

ligament

constrc-

occur

of

major

Aponeurosis

iliac

cystc

nerory

duct.

duct

te

pectoralis

superior

te

common

muscle

Linea

rec-

posteror

te

untes

duct

duct

Abdominal

Anterior

and

ocated

and

be

be

o

passes

causes

and

s

be

epatc

between

ayer

te

duct.

pancreatc

te

te

to

jaundce.

duct

te

t

enter

ste

duct

and

aows

common

unon

and

gament

pancreas

connectons

abdomna

aponeuroses.

te

to

o

at

epatc

s

233

te

duct,

be

o

ror

abdomna

ead

accessory

superor

ocated

te

obstructon

GAS

te

by

duodenum

obstructon

seat

superca

he proper epatc artery w not be obstructed, or t

(subcutaneous)

ayer.

s

dorsi

as

versus

pertoneum

Latissimus

ayer

sutures

content

Scarpa

C.

to

s

ABR/McM

ormed

resutng

te

carres

Camper

rectus

and

anterory.

epatc

te

reeases

he

reatvey

o

cystc

and

s

troug

duct

he

te

asca

musce

324;

common

te

o

epatoduodena

An

wt

to

N

duct

part

rom

Because

connectve

ayer

te

he

nter-

wa

Scarpa

common

back

duct,

usu-

sutures.

B.

and

rst

229

n

276;

be

pancreas.

abdomns

and

to

abdomns

he

be

membranous

asca

(subcutaneous).

asca,

A.

duct

rectus

seat.

ncson

dvde

an

deep

GAS

seat.

te

anteror

just

orzonta

abdomns

represented

te

te

he

axa.

C.

asca

toug

Scarpa

not

o

and

wtn

s

dened.

N

Camper

wa

tck,

w

curved

edge

rectus

ntersectons

woud

278;

Scarpa

na

a

jont

4.27).

GAS

27.

beow

tendnous

sectons

s

ower

te

ne

ne

edge

musces

not

te

vertcay

souder

Dougas)

o

ts

orented

te

seats.

ne

atera

he

at

semunar

vertca

(o

porton

abdomns

C.

ne

s

to

represents

tendnous

An

ne

neror

149

Abdomen

3

muscle

ready.

150

C H A P T E R

A.

3

Abdomen

he

second

and

to

te

normay

terc

B.

part

n

cose

duodenum

te

es

abdomna

proxmty

to

parae

aorta

te

and

superor

wt,

s

C.

he

not

te

anteror

te

superor

he

rst

abdomna

part

o

he

mesen-

te

te

he

creas

s

s

346;

te

to

contnues

second

rom

part

o

anterosuperor

mesenterc

extenson

and

mesenterc

N

288;

to

D.

o

artery

to

te

to

rom

sma

urter

ABR/McM

te

te

te

creas

te

omenta

te

structures

speen

he

te

rom

and

248

artery

ceac

suppy

s

te

gated.

trunk

pan-

It

rom

n

A.

348;

he

coces

to-

It

es

exbted

tese

superor

rom

anastomose

wt

te

pancreatcoduodena

te

gastroduodena

and

posteror

anteror

arteres

branc

o

and

(wc

te

brances,

posteror

take

common

te

orgn

epatc

he

o

neror

te

mesenterc

tree

man

gastrontestna

te

B.

et

he

coc

et

artera

tract.

lexure

gastrc

artery

It

to

artery

s

te

brances

suppes

te

s

most

te

B.

ndgut

te

branc

o

C.

he

te

esopagus,

he

epatc

esser

wt

he

artery

te

et

proper

It

s

trad

GAS

B.

he

py

to

terc

348;

mdde

te

o

s

te

bot

to

te

ror

rom

tomotc

A.

he

et

coc

or

It

ound

It

and

D.

te

and

E.

badder.

group

ree

and

ormng

edge

o

te

It

and

wt

artery,

te

as

artery

a

o

te

et

greater

by

supe-

artery,

hs

he

a

te

te

curvature

as

te

spenc

o

te

o

te

prenc

o

te

s

occurs

A.

he

at

wc

he

do

not

te

appendx,

drect

rr-

te

to

umbcus

te

ste

o

te

ver

and

abdomna

It

s

s

pos-

quadrant,

not

assoc-

sgn.

te

n

stomac

and

te

te

and

s

pos-

duodenum.

upper

et

It

quadrant

umbcus.

te

pevs

anteverted

and

be

280;

ave

over

meda

afected

to

by

ABR/McM

spread

cose

he

spna

to

souder

and

s

te

te

pos-

urnary

opsoas

lexon

o

psoas

pan.

proxmty

nerve

spna

271

te

dapragm

bateray,

prenc

tat

nerve

hs

to

s

wc

eves

cord

dapragm

and

te

and

because

superor

nnervated

descend

C3,

te

s

C4,

to

and

reerra

somatc

o

by

te

C5.

pan

aferents

eves.

coon

rom

carry

s

lexure.

spancnc

o

because

4.22).

nnervates

coc

te

patent

sgn.

to

wtn

and

n

duodenum

wc

et

nerves

wt

s

te

to

umbcus.

speen

not

N

te

tose

psoas

te

te

te

lexon

and

s

o

he

hs

reated

rgt

neror

te

not

bend

to

descendng

tetc

C.

at

wen

neror

s

psoas

reerred

between

enterng

to

Fg.

rom

probaby

pan.

tat

and

occur.

es

ocated

es

sgn

neror

te

nerves,

o

artery.

ony

assocated

o

attempted.

can

and

kdneys.

duodenum

gastroduodena

no

branc

structure

beneat

es

may

te

psoas

upper

319–320;

cosey

reerra

prmary

es

stomac aong wt te rgt gastro-omenta branc

te

suppes

quadrant,

contact

woud

abscess

dapragm

anas-

It

dapragm

poes

It

s

(GAS

causng

te

artery.

known

o

suppy

coon

margna

aso

rst

suppes

te

coc

artery.

branc

te

and

o

sup-

mesen-

bood

branc

te

artery,

s

one

descendng

coc

to

s

coatera

neror

coatera

mesenterc

reerred

suppes

te

mesenterc

and

GAS

B.

es

and

musce

be

provde

pan-

gastro-

248

key

drecty

antelexed

ver

te

te

et

suppes

musce,

es

superor

common

o

was

postve

uterus

te

248

gated.

rgt

s

he

te

n

arg-

suppes

o

termna

and

ower

most

postve

between

rom

structures

te

es

superor

tereore

anastomoses

a

te

a

most

badder

pancreas

suppy

wen

coon

s

toned

common

suppes

n

wt

he

proper

33.

can

gastro-omenta

and

to

provdes

te

gastroeppoc

artery

arses

tree

coon

neror

s

o

artery

artery

canne

et

s

superor

te

te

s

ts

pevs

wt

toned

ABR/McM

ascendng

mesenterc

branc

one

291;

wt

o

stomac.

te

gament.

coon.

anastomosng

te

trunk.

stomac

artery

bocked

transverse

branc

ascends

descendng

artery

brances

te

N

a

o

rom

artery.

and

epatoduodena

arses

ceac

te

gastrc

and

s

te

o

epatc

gabadder.

curvature

artery

rom

artery

porta

esser

wc

curvature

epatc

te

te

gastrc

artery,

epatc

D.

and

rgt

o

gabadder

ated

s

way

appendx

te

or

wc

ceac trunk and suppes te GE juncton, te neror

C.

It

te

It

and

no

mdgut.

oten

ta

por-

coon,

ndgut.

artery

rgt

postve

urnary

pan

rom

a

t

musce

te

toned

smaest

and

ne -

ave

or

trunk.

stomac.

or

artery

and

gastrc

ABR/McM

te

by

lexon

wtn

rectum.

te

to

he

neror

suppyng

upon

taton

artery) n suppyng te pancreas wt oxygenated bood.

A.

te

te

resstance

opsoas

and

s

n

regon

aganst

anteror

295;

provded,

umbca

p

as

recta

N

aso

wc

to

body,

mdgut

sgmod

ar ter e s

ceac

sort

te

ner or

oregut

ongest

neck,

mesenterc

appendx

dena

artery,

te

te

te

provdes

te

superor

te

rom

brances

neror

nlamed.

arses

te

and

aso

s

te

s g mod

to

rom

te

rectum.

32.

w

he

artery

suppy

coon,

brances

arsng

brances

and

descendng

spenc

artery

are

ar ter y

rectum.

te

ntestne

removed

te

racc aorta. Its rst branc s te neror pancreatcoduo-

and

31.

and

GAS

artery

te

o

he

artery.

mesenterc

neror

s

ton

est

te

ocated

gastroduodena

mmedatey

anteror

E.

an

duodenum

superor



ead

t

traves

aorta.

superor

GAS

but

ar teres

mesenterc

contrbutng

artery.

duodenum

to

superor

jejunum

ater

te

tus,

te

abdomna

E.

o

lexng

duodenum;

orgn

cavty

mesenterc

sgmod

ror

artery.

pyorus,

E.

te

o,

he transverse coon takes a orzonta pat troug

D.

30.

o

rgt

s

S2

s

S4

and

by

parasympa-

vscera

aferents,

pan.

nnervated

te

by

te

vagus

gastrontestna

Sympatetc

provded

nerves,

nnervated

to

rom

by

eves

nerve,

tract

to

te

nnervaton

to

te

te

greater

T5–T9.

toracc

Innervaton

CHAPTER

B.

Intercosta

part

o

nerves

te

aferents

or

abdomen.

pass

by

D.

pan

hereore,

way

o

to

ram,

te

he

prenc

aso

carres

peura

and

wt

any

he

vagus

medua

upper

Left

quadrant

upper

nerve

he

no lower

Left

o

spna

way

o

aferent

but

te

ascends

te

not

te

pancreas

It

and

medastna

does

te

te

roots.

dapragm

t

bran.

to

nay

dorsa

rom

a

te

commun-

nerves,

rom

bers

o

pancreas

nerves

o

te

te

aferents

enters

te

carry

pancreas.

wt

way

as

up

no

para-

to

te

vscera

pan.

quadrant

nerve

s

structures

vscera

aferents

rom

beow

rom

te

te

te

eve

o

pancreas

T12

and

and

carres

pancreas.

lower

GAS

332,

358–364;

N

303;

ABR/McM

247

quadrant

35.

D.

he

aorta

cord,

A.

testcuar

and

s

he

he

deep

ormed) plane

Median

Fig.

as

components

artery

s

o

ocated

testcuar

any

rng

artery

probems

epgastrc

a

te

abdomna

te

spermatc

artery

(were

branc

o

te

“downstream”

rom

n

te

sperm

orgnates

te

aorta

count.

cose

spermatc

externa

to

and

ac

to

te

cord

artery

s

and

plane

s GAS

te

nguna

rom

tests.

cause

neror

orgnates

te

ac

o

not

o

te

externa

orgn

woud

B.

artery

one

suppyng

te

•

t

or

subcosta

nnervates

T ransumbilical

by

way

vscera

muc

rom

by

nnervates

and

and

termna

o

quadrant

E.

Right

ram

nnervates

bers

te

cord

spancnc

percardum,

vscera

bers

bers

ten,

cord

vscera

te

spna

torax

pan

and

nerve

were

aferent

te

ventra

spna

provde

te

toracc

catng

sympatetc

Right

te

trunks

t

to

rom

sympatetc

enterng

C.

T1–T12

patway

151

Abdomen

3

not

assocated

wt

te

testcuar

producton

o

4.22

sperm.

C.

o

te

te

duodenum

eve

and

o

does

aferents

tereore

w

not

enter

rom

not

te

resut

te

spna

souder

n

reerred

cord

at

to

he

speen

ceac

ver

E.

by

does

te

he

pancreas

not

rom

te

te

eve

actate

aferent

racc

cord

not

at

te

resut

n

to

o

te

ceac

o

N

pancreas

spancnc

o

266;

te

eve

souder

pan

to

and

te

ABR/McM

ntay

he

pancre-

te

spna

tereore

A.

wt

and

ead

o

vscera

tures

te

to

nnervate

te

aferent

te

dorsa

bra

eve,

structures

pancreas.

bers

dorsa

orn

wc

tat

orn

are

o

te

Runnng

te

o

reay

te

pan

pan

spna

somatc

medate

oregut

wtn

rom

rom

cord.

aferents

rom

te

tus

te

are

Aso

rom

body

to

to

nterna

dsta

gament),

superor

he

te

ts

vesca

umbca

part

and

te

arteres

artery

pays

te

N

ac

and

nodes,

suc

arses

does

rom

not

te

provde

testes.

266;

dranage

artery

as

o

ABR/McM

te

but

271

scrotum

te

tests

s

nto

drans

te

to

super-

umbar

nodes.

he

nterna

he

ac

portons

ymp

o

D.

te

nodes

dran

perneum,

te

enterng

and

wa.

ac

te

te

and

pevs,

te

gutea

nodes

presacra

ana

part

o

are

and

and

te

or

rom

te

ovares,

uterne

kdneys,

upper

tubes.

common,

postoned

posteror

nodes

cana,

te

rom

ymp

testes

hey

nterna,

por-

aso

and

nodes.

sacrum

cervx,

dran

gands,

uterus,

ymp

Presacra

to

nodes

te

externa

he

verte-

o

receve

struc-

tat

umbar

suprarena

tons

to-

nerves

oregut

suppy

rom

aduts:

producton.

artery

387–389;

nguna

orgn

crcumlex

ac

n

umbca

badder.

sperm

ymp

te

te

spancnc

and

tese

gves

urnary

n

orgnates

dvded

(meda

part

deep

deeper

nerves arse rom sympatetc ganga at te eves o T5–

T9

s

regon.

greater

toracc

he

ymp

B.

C.

te

he

ca

souder.

pan

roe

GAS

can-

270

te

greater

te

enter

te

no

bood

o

nerve,

or

artery

and

obterated

externa

reerred

vagus

and

nerves

medatng

run

nerves.

by

gangon,

tese

te

bers

E.

te

te

36.

o

reerra

he

te

w

nerves

Innervaton

spna

nnervated

None

373–374;

o

te

tereore

s

GAS

ead

enter

nerve.

rom

souder.

pexus.

at

sympatetcay

parasympatetc

vagus

and

to

cord

A.

not

pan

atc

te

te

souder

brances

34.

nnervated

gangon;

are

speen

te

s

artery

proxma

te

souder.

D.

umbca

s

(C4–C5)

pan

he

ac

n

ower

dran

maes

vagna.

mmedatey

te

ymp

te

porton

to

rom

prostate,

o

te

anteror

mesorecta

te

and

uterus,

n

asca.

rectum

emaes

and

upper

152

C H A P T E R

E.

Axary

wa

B.

he

tus

Abdomen

ymp

above

GAS

37.

3

514;

te

N

arteres;

branc

te

o

master

he

pexus

obque

he

o

te

tunca

processus

covers

te

pexus

B.

o

ncude

and

ymp

orgnate

te

te

o

genta

he

te

asca

tests

(rom

anteror

s

abdomna

vagnas

and

he

nterna

E.

he

dartos

cre-

s

a

derved

obque

E.

pose

o

(Camper)

rom

o

pertoneum)

sdes

o

te

te

GAS

38.

A.

275;

o

porta

trc

te

te

te

41.

tat

tests

N

tem

orm

pressure

gastrc

B,

an

n

C,

D,

te

s

way

does

ave

crcuares

are

not

te

ay

A,

n

at

and

GAS

40.

o

te

(Scarpa)

ayers

ven,

he

te

et

gas-

sys-

anastomoss

and

n

turn

vasa

he

based

at.

te

he

te

oter

to

v,

and

te

runnng

n

s

oces

be

are

vsbe,

o

cross

he

or

ramus

te

pec-

nsertons

curved,

te

(covered

or

abdomns

vertca

seat

o

te

ne

rectus

230

n

processes,

psoas

a

asca)

org-

ntervertebra

coumn

contans

at

eves

caced

eongated

and

n

organ

bend

dsks,

T12–L5.

tubercuous

ocated

te

near

rgt

and

es

o

te

neror

to

o

te

t

musce

o

te

duodenum

s

attaced

ascend-

ossa.

eve

tat

he

sgty

speen.

pouc

ac

stomac

te

across

stomac.

orzontay

ends

te

te

265;

o

te

te

he

te

apex

rb.

to

te

s

a

rgt

bro-

crus

o

and

pancreas

t

enters

transverse

rom

It

te

aorta,

descends

and

te

coon.

mesenterc

recta

trd

ven

and

te

root

can

across

trd

o

te

part

mes-

compress

neck

duct

te

ven

s

s

ormed

superor

te

et

by

vens

te

and

unon

t

does

duodenum.

te

te

to

duodenum.

ormed

ormed

epatoduodena

and

te

by

superor

o

and

s

te

s

te

passes

o

sgmod

o

ven

and

te

be

artery

porton

part

porta

to

speen

te

beore

ven

te

arses

pancreas,

duodenum.

te

te

o

267

artery

mesenterc

spenc

te

te

orzonta

epatc

wtn

ABR/McM

mesenterc

process

spenc

bend

te

unon

mesenterc

pancreas.

proper

It

o

ven

ascends

epatc

artery

gament.

by

to

te

te

trbutares

trd

part

rom

o

te

duodenum.

GAS

262

orgn

meda

bnd-endng

te

superor

posteror

te

N

te

wt

E.

at

neck

tan

usu-

et

te

o

neror

te

te

eum.

ABR/McM

he

D.

s

neror

not

he

o

sympyss.

superor

transversus

ABR/McM

an

yng

bend

part

o

naccuratey

dferences

te

he

C.

eum.

coces

an

te

o

abdomen,

band

371;

bend

dstnctons

onger

s

border

extends

duodenum

trd

A.

s

te

eart

uncnate

te

pcae

comparson

to

to

superor

bend

jejunum

ncsed.

te

dapragm.

he

entery

ess

pubc

o

and

and

vertebra

suspensory

GAS

B.

te

as

tg

asca

body

undus

te

te

te

te

provdes

ne

te

cecum

he

et

s

to

eature

obques

te

o

coon,

te

easest

ger

tese

wa

tend

opton

te

jejunum

Atoug

arcades

te

appearance

eum,

rectae

o

wc

t

transverse

ts

muscuar

orms

2/5ts

n

surgery

on

morpoogca

270;

E.

221

ways

ntestna

n

coces

proxma

Durng

Lympatc

gross

N

te

severa

more

te

oter

a

te

254;

pancreas

he

o

o

vascuar

ts

E.

te

eum.

wt

uness

C.

wen

te

s

musces

o

upward

rom

azygos

N

te

back

he

te

two

te

compared

310;

o

283;

taperng

submu-

resut

o

atera

mage,

te

smoot

te

crross.

vens

mesenterc

eum.

te

n

oten

te

bodes

ng

vens

process

bone;

musce

psoas

he

ad-

ABR/McM

dfer.

rape

abscess.

anastomoses.

up

was,

ewer

and

jejunum

o

are

stoogcay,

depct

te

42.

241;

te

tan

and

te

D,

o

pubc

rom

te

278

porta-cava

makes

compared

as

ony

C,

rom

nterspersed

hey

ver

porta

here

tcker

eum,

tose

N

jejunum

vsbe

jejunum

to

porta-cava

356;

amount

mesenterc

due

None

dstngus

reatve

bendng

dated

esopagea

E.

jejunum

and

to

are

epatc

ntestne.

eum

derved

he

nate

and

ncreased.

and

270,

he

sma

a

wt

esopagus.

mportant

mportant

B.

o

ABR/McM

varces

te

ven,

GAS

39.

369;

ower

and

D.

B.

ypertenson

ven

s

membranous

asca,

medan

abdomns.

bers.

Esopagea

cosa

asca

conssts

superca

musce

tendnous,

ne

semunar

GAS

A.

and

a

xpod

abdomna

he

musce.

contnuaton

pareta

atera

spermatc

s

musces.

nterna

asca.

tunc

te

te

In

transversas

te

aong

spermatc

aba

pectnea

tneus

musce.

externa

nea

he

testcuar

vesses.

rom

D.

deerenta

vens;

and

duc-

epddyms.

D.

he

rom

cord

nerve;

aso

asca

vagnas

te

abdomna

278

spermatc

cremasterc,

and

and

externa

asca

anteror

vertcay between te two rectus abdomns musces

gentoemora

musce

te

ABR/McM

o

testcuar,

te

abdomna

dran

pampnorm

sympatetc

C.

268;

components

deerens;

A.

nodes

umbcus.

43.

B.

he

348;

N

omenta

266;

ABR/McM

(eppoc)

245

oramen

(o

Wnsow)

s

te

C. he arcuate ne s a curved orzonta ne tat demar-

ony natura openng between te esser and greater sacs

cates

o

te

ower

mt

o

te

posteror

aponeurotc

porton

te

pertonea

cavty.

o te rectus seat. It s aso were te neror epgastrc

vscera

pertoneum

vesses

caudate

obe

A.

enter

he

te

te

seat

supracrsta

orzonta

crests.

to

ne

pane

suppy

s

at

an

te

te

rectus

magnary

upper

abdomns.

ne

margn

drawn

o

te

n

ac

on

te

edge

by

rst

o

te

o

part

te

te

o

It

s

(ver

ver,

te

bounded

capsue

nerory

duodenum,

epatoduodena

pareta

pertoneum

superory

o

Gsson)

by

te

coverng

and

te

te

te

pertoneum

anterory

gament,

by

on

by

te

ree

posterory

neror

vena

CHAPTER

cava.

most

A.

hereore,

key

he

te

C,

D

aorta

and

E.

GAS

he

tra

on

o

et

epatc

o

be

te

B.

he

N

te

neror

vena

cava

n

C

and

ven,

ven

are

rgt

not

te

ABR/McM

ner ve,

L1

wc

spna

aspect

rena

artery,

o

mons

gentoemora

he

genta

pes

he

or

te

borders

o

te

D.

te

It

rom

te

abum

as

been

ven-

te

skn

majus

njured

o

anteror

he

to

wereas

te

skn

n

n

up

Spna

nerve

dermatome

and

T9

at

nstances

A.

upper

gutea

te

ower

branc

regon,

part

o

n

B

nnervates

ypogastrc

suppes

eve

sensory

o T9,

te

skn

and

over

nnervaton

above

te

eve

45.

D.

he

rory

can

398;

second

by

be

and

o

C.

E.

he

trd

46.

A.

on

he

rgt

te

tay

te

te

te

part

and

te

um

N

278;

C.

he

to

pended

rom

s

te

nnt

costa

rectus

s

cecum

s

cartage

abdomns,

by

and

qute

s

ante-

a

s

ven

part

can-

te

GAS

he

caused

o

unon

386;

N

te

o

by

be

way

or

rng;

ven

pass

ante-

reated

ante-

rgt

organ

kdney,

par-

cava.

reversa

duct,



dranage

o

o

common

t

by

low

eyes

s

o

tat

s

sus-

obstructed,

nguna

o

be

rom

te

dranng

o

as

drans

pan-

duodenum.

256

o

Bood

to

te

anasto-

anastomoses

enarges

or

te

backs

neror

porta-cava

woud

wt

expands

prenc

not

mdde

be

te

coc

system.

umbar

superor

porta

vens

n

are

afected

venous

recta

venous

(he

vens

he

are

same

vens,

by

bot

bot

can

be

compo-

system.

vens

system

porta-cava

are

bot

and

com-

woud

ypertenson

anastomoses

patoogc

cava,

wc

begns

vens.

jaundce

te

no

ver

woud

boodstream.

coatera

or

be

pat-

gabadder.

by

s

not

expe-

between

te

na

a

types

gament,

jont

cana,

beneat

te

te

es

emora

GAS

o

et

are

between

or

a

bend,

cana

present

te

a

te

N

deep

Fg.

264;

te

o

o

to

A

dgt.

ngu-

te

atera

sympyss,

provdes

ernas.

seat,

he

4.50A).

230

s

et

drect

te

he

passes

provdng

pectnea

proxma

ABR/McM

be

te

tg,

erna.

te

patent

bones,

emora

to,

drect

nger

may

pubc

It

te

a

above

types

nto

n

nger.

sde

pubc

emora

or

(GAS

296–298;

o

nto

tte

te

atera

he

two

gament

by

te

occur

dstngusng

eature

taken

examnng

cana.

rng

erna

and

troug

nguna

common

aganst

abdomns.

tract

passes

and

ater-

meday,

abdomns;

examner’s

rng

ernas

bot

ven;

rectus

nguna

te

be

nguna

patway

gament

tp

rectus

normaton

ess

te

nguna

nguna

bordered

superca

superca

w

and

te

o

ndrect

nguna

emora

te

te

tp

te

opubc

te

nguna

deep

o

s

erna

nto

te

varces.)

drect

and

o

te

eature

te

an

very

o

a

edge

and

a

te

trange

artery

by

recta

porton

ndrect

rng

I

nto

erna

hs

troug

coug,

mdne

no

An

abum,

te

ower

atera

o

troug

epgastrc

te

nguna

o

te

as

247

eature

pass

bordered

or

to

not

Hessebac).

neror

t

nserted

ypertenson

ABR/McM

troug

erna.

Bot

te

does

nguna

te

o

t

scrotum

asked

porta

299;

descends

nguna

border

n

gament.

deep

ttng

to

nto

aows

and

crross.

bordered

te

o

268

be

(o

juncton

atera

and

and

dstngusng

tat

te

mesoappendx.

te

ac

ABR/McM

yeow

ver

nabty

low.

superor

porta

and

to

N

passes

trange

s

tube

sma

vena

coc

te

n

key

nerory,

retropertonea

te

and

and

cava-systemc

356;

s

t

oten

anteror

neror

te

324;

symptoms

he

he

border

conluence

A.

A.

ay

D and E. he ovares and uterus are bot neror to te

47.

49.

te

at

epatc

te

It

te

to

bood

and

te

expand

GAS

erna

second

porta

can

tat

jejunum

te

not

oow

ocated

(cava)

te

sgmoda

due

kdney.

vena

narrow,

et

ABR/McM

(porta)

rena

engorge

crossed

te

and

te

ven

to

ead

areas

te

te

mass.

as

o

to

o

249

a

o

neror

a

gabadder

gand

at

vens

et

o

duodenum.

et

aspect

te

appendx

artery

287;

woud

prenc

ponents

superory.

o

epatc

te

te

s

o

duodenum

o

suprarena

posteror

he

o

duodenum.

pancreas

crcuaton,

ven

te

dssecton.

ABR/McM

superomeda

B.

te

some

te

N

ver

gastrc

to

reatonsp

coon

reatonsps

part

o

a

begnnng

transverse

or

rom

superor recta vens and mdde or neror recta vens

duodenum

mesenterc

trd

te

309;

or

he

230

mesocoon,

wtout

superor

to

te

posteror

seen

to

rory

o

wen

ror

GAS

ABR/McM

duodenum

be

he

part

tng

he

te

not

B.

by

260;

transverse

seen

exposed

A

te

he

renced

N

rgt

dranage

ypertenson.

D.

nents

E.

te

or

dranage

crross.

trbutares

regon.

eter

te

poong

systemc

porta

te

ver.

accommodate

neror

bot

cutaneous

to

et

o

to

rom

te

esopagea

he

ver

340–342;

o

wt

he

abum

sup-

o

gabadder

te

aow

systemc

cava,

te

umbcus.

GAS

toward

musce

branc

te

enzymes

330,

sad

nerve

te

te

emora

te

st

bock

rom

gabadder.

rom

system

moses.

trange.

over

te

Crross

porta

wa.

oypogastrc

crest

o

low

he pancreatc duct s not nvoved n te pat o be

or

brances:

cremaster

atera

te

dstrbuton

abdomna

ac

te

a

two

porton

emora

as

nto

te

anteror

nerve

nnervates

spts

suppes

te

scrotum

addton

te

o

subcosta

tat

C.

woud

be

Obstructon

as

GAS

48.

duct

or

woud

creatc

nner vates

tg,

pubs.

241

arses

ner ve,

nerve

branc

skn

E.

we

vena

skn

aow

low

273;

he

te

cystc

but

porta

mesenterc

te

and

majus

E.

woud

patent.

and

D.

cava

oramen.

meda

scrotum,

C.

te

onguna

te

A.

vena

beedng.

duct

301–304;

ramus

ts

to

he

superor

omenta

B.

es

neror

o

abdomen.

and

44.

te

source

153

Abdomen

3

end

o

154

C H A P T E R

3

Abdomen

Inferior

epigastric

vessels

Deep

inguinal

ring

T ransversus

abdominis

muscle

Anterior

superior

Iliopubic

Rectus

abdominis

muscle

Inguinal

Exter nal

iliac

ar ter y

Exter nal

iliac

vein

Ductus

B.

he

verse

buet

coon

ocated

ligament

sgty

ang

erect

posture.

A.

C.

bra

coumn,

to

aorta

and

stomac

s

and

posteror

to

afected

rst

penetrate

most

te

te

superca

umbcus,

toward

te

Fig.

4.50A

trans-

nefectua

structure

atoug

pevc

cavty

nent

t

C.

n

he

by

s

ocated

woud

ocated

te

te

not

deep,

be

more

on

encountered

superor,

transverse

te

coon

to

and

anteror-posteror

verte-

rst.

te

52.

et,

woud

quadrant

te

he

ver.

s

o

pancreas

ead

s

273,

s

craded

te

ocated

N

superory

abdomen,

woud

by

by

320;

ocated

te

hs

penetrated

GAS

B.

te

excude

mdne

deep

to

n

argey

ts

te

A

cover

possbty

o

and

ts

ABR/McM

53.

51.

D.

Surgca

anastomoss

ypertenson

o

a

arge

aows

A,

B

or

a

rooted

epatc

E.

porta

he

are

deay

y

perormed

ven

to

et

te

ven

to

to

o

ven

to

to

o

aow

spenc

ven,

neror

a

te

a

porta

te

te

ven

te

et

rena

venous

rgt

superor

ven

receve

mesenterc

a

be

by

te

380–381;

N

compo-

vens

are

bot

connec-

tat

321;

s

te

te

va

n

te

at

and

reerred

suppy

rom

ureter

T11

upper

umbar

spna

246

nerve,

regon,

T10

a

surgca

and

pan

n

upper

reerred

cromain

are

moded

neura

crest

ces

to

te

T12

tese

gutea

and

partcuar).

te

anteror

orgn

and

and

woud

kdneys.

te T10

dermatome,

s

nerve.

ABR/McM

orgn,

nto

suprarena

o

te

271

suprarena

postgangonc

passes

te

and

te

epneprne

(noradrenane)

suprarena

medua

medua.

sympatetc

receves

(adrenane)

reeased

(adrena)

hese

neurons

by

tese

vens.

stmuaton

rom

pre-

gangonc sympatetc bers carred by te greater

toracc

C

and

te

et

ven

pan

and

medated

pan

umbca

ces

eas-

te

kdneys

subcosta

o

norepneprne

ven,

gastrc

he

are

and

o

system,

woud

o

he

trbutary

ow-resstance,

te

mesenterc

porta

system.

Anastomosng

ven,

or

a

o

connecton

systemc

major

and

or

tat

arge

cava-systemc

anastomoss.

te

symptoms

premse

ven,

system,

te

gastrc

te

te

dranage

ocated

gastrc

aevate

spenc

venous

component

to

n

porta

coatera

and

te

are

te

s

benet.

dermatomes

tgs

gonada

ABR/McM

s

to

vens

system.

B. he mass eads to ncreased stmuaton and secretons

ces

51–75

he

E.

GAS

229

o

Answers

and

no

te

tese

system,

hereore,

eadng

(rom

rgt

299;

neopasm

o

venous

cava

rom

eves.

supped

duodenum.

298;

C.

not

D

stomac

areas

atera

buet.

te

te

cord

and

and

te

provde

pan

dermatomes

upper

under

o

eac

porta

356–357;N

o

spna

o

te

rena

woud

Vscera

pont

not

trajectory

because

just

rgt

GAS

pubc

gabadder

beng

he

o

trbutares

buet.

rgt

E.

te

down

he

o

s

GAS

ton

abdomna

te

probaby

t

superor

varaby

he

be

D.

woud

because

may

deferens

ring

•

50.

vessels

triangle

inguinal

Lacunar

spine

tract

T esticular

Superficial

iliac

D.

suprarena

paton

E.

he

and

spancnc

n

te

pevc

do

GAS

nerves.

Parasympatetc

not

386;

medua

efects

o

spancnc

trave

N

322;

to

neurons

and

te

not

ave

ound

no

n

partc-

tumor.

nerves

te

are

woud

are

suprarena

ABR/McM

268

parasympatetc

medua.

CHAPTER

54.

E.

he

te

spenc

pancreas.

speen,

wc

creatc

ta.

be

artery

he

s

ocated

Bood

afected

n

es

aong

organ

t

at

te

suppy

te

event

te

superor

prncpay

to

o

termnaton

te

a

speen

tumor

border

suppes

o

te

can

n

te

s

o

he

te

pan-

te

tereore

ta

o

A

he

B.

he

dena

artery,

o

wt

he

kdneys

arteres.

te

E.

epatc

ead

by

o

te

artery,

gastroduo-

te

and

s

greater

pancreas.

cystc

artery,

not

n

to

a

E.

con-

pancreas.

are

rena

by

te

artery

tumor,

rgt

es

and

and

deep

bood

et

and

rena

meda

suppy

woud

D.

he

superor

to

he

A.

n

ceac

291;

ABR/McM

mesenterc

te

et

te

rena

artery

ven

neror

artery

compress

rena

s

te

as

vena

are

ocated

rena

es

te

just

superor

ven

passes

and

to

somewat

346;

o

coc

te

te

poston

te

superor

most

GAS

key

348,

Bood

te

te

too

B

n

to

et

et

to

and

occude

woud

be

arter y

An

et

rena

ABR/McM

because

stem

woud

te

C.

et

o

wt

nguna

na

women.

n

he

bot

medated

T11

D.

and T12

rom

toracc

spancnc

presson

o

umbar

Compresson

not

eve

he

o

te

vagus,

ated

by

he

most

undc

eter

area

ror

regon

te

spenc

o

N

296–298;

rom

te

porton,

tereore

be

pancreas.

Duodena

porton

teror

te

and

here

more

o

B.

part

o

superor

spenc

n

te

te

woud

n

be

ts

t

cause

to

and

C.

he

or

um

te

ucer.

aong

stomac,

ar ter y

no

te

te

dsta

woud

o

com-

D.

te

woud

te

ta

o

T7

te

to

not

E.

pan

s

carry

n

porton

te

gastrc

case

brances

arteres

undus,

ts

part

rom

woud

pass

o

rom

suppyng

o

te

te

be

te

A.

ante-

stomac.

he

B.

he

o

o

externa

most

Fg.

to

artery

It

equa

and

nc-

er-

artery

traves

suppyng

te

ead

arse

te

o

te

wtn

makng

artery

te

one

suppes

a

es

rom

o

te

pos-

o

te

s

to

te

te

regon

responsbe

dervatves,

et

coc

artery

and

part

or

gener-

lexure

te

to

rom

te

ds-

duodenum,

counterparts.

responsbe

te

arses

suppes

o

superor

s

o

dervatves

duodenum

rectum.

artery

ts

te

neror

artery

esser

or

suppyng

curvature

o

te

o

te

4.67).

ABR/McM

asca.

he

te

s

externa

asca

obque

s

a

te

coverngs

nterna

spermatc

musce

247

ayer

ayers:

obque

not

common

artery

tus

dsta

asca

and

woud

235

commony

second

abdomna

cremaster

common

regon.

duodenum,

te

wt

tree

musce,

emora

more

ernas

ndgut

artery

291;

spermatc

ndrect

vesses.

te

porton

N

o

tan

exbtng

te

brances

te

te

gastrc

abdomna

not

mesenterc

transversas

externa

muc

pancreatcoduodena

(GAS

consst

greater

nguna

te

ntestne

o

pyorc

cremaster

te

o

rgt

347;

are

mesenterc

anastomoses

cord

gron

commony

pancreatcoduodena

lexure.

and

he

more

ABR/McM

ucers

he

nterna

beedng

ts

D.

o

aspect

neror

GAS

60.

s

duodenum,

most

superor

stomac

med-

trunks.

268

or

dorsa

to

does

abdomen;

gastrc

brances

nerve,

coc

superor

he

common

occurrence

we

are

264;

rom

suppyng

te

occur

te

mesenterc

neror

ay

case.

at

he

most

umbca

te

njured

mdgut

et

to

wt

te

superor

te

suppyng

east

reerra

termnate

sympatetc

stomac

sort

o

ocaton

pancreatcoduodena

requenty

te

canddate

gastrc

posteror

pass

esser

sympatetcs

pan

ABR/McM

te

he

abdomna

compressed.

cord.

313;

o

te

nerves

woud

or

te

woud

va

preaortc

nor

o

o

251

gastroduodena

proxma

occuson

rst

N

bend

reduced

te

and

superor

o

testcuar

beng

kdneys

eves

nerves.

bers

key

sort

artery.

not

parasympatetc

pan

511;

rom

s

spancnc

aferents

brances

GAS

te

te

spna

a

and

cord

pan,

Vscera

vscera

D.

o

produce

pan.

E.

orgnates

spna

te

te

te

women

ernas,

to

rst

s

ernas

sexes,

posteror

te

Pan

area

spenc

to

ernas

pan

uceraton.

nerory

mdpor-

aspect

women.

neror

greaty

te

n

aneur ysm

ven.

et

tan

o

artery

te

men,

n

Epgastrc

to

C.

te

A.

swoen.

more

te

dorsa

courses

o

ABR/McM

Inguna

vesses

aorta

te

artery

body

erna

n

ernas

n

arses

248

or

Drect

tan

drans. hs woud resut n pan as te testcuar venous

testcuar

te

o

emora

o

he

rom

neror

290;

dence

GAS

anteror

N

ven

become

wc

te

woud

mpeded

ven

ven—nto

rom

ven.

arter y

te

295;

testcuar

rena

rena

occude

N

arses

E.

present

superory

mesenterc

et

mesenterc

379;

low

arter y

te

rom

te

women.

men

and

ven.

nerory

superor

o

o

nguna

women

n

ts

59.

mdde

aspect

n

pass

ernas.

cava.

ocated

et

to

undus.

Atoug

244

ven.

he

B.

curvature

man

erna

and C. he neror mesenterc artery and ts et coc

D.

te

removed

gastro-omenta

Indrect

arteres.

N

qute

he

GAS

58.

unnterrupted.

337–346;

arses

passes

uceraton.

supped

et

are

et

nguna

branc

57.

te

te

he

epatc

not

56.

rgt

pancreatc

termnaton

B

near

supped

rom

wc

artery,

undus.

n

anteror

A.

s

bood

artery,

spenc

he ver s aso supped by te common and proper

GAS

55.

te

he

proceed

D.

te

tact

to

ocated

gabadder

branc

C.

receves

gastrc

te

artery

C.

duodenum

o

and B. he common epatc artery and neror prenc

te

pancreas.

A.

dorsa

ton

155

Abdomen

3

s

ts

spermatc

spermatc

an

asca

and

te

spermatc

asca,

asca.

extenson

and

dervatve

musce

source

o

o

te

aponeuross.

o

te

asca.

nterna

156

C H A P T E R

3

Abdomen

Posterior

superior

pancreaticoduodenal

E.

artery

Left

gastric

he

o

Proper

hepatic

epatc

porta

ven,

ormed

by

te

conluence

artery

artery

te

passes

Right

GAS

gastro-

superor

deep

348;

to

N

mesenterc

te

266;

neck

o

ven

te

ABR/McM

and

spenc

ven,

pancreas.

248

Gastroduodenal

omental

artery

62.

artery

A.

he

bned

be

wt

duct

s

occuded.

jaundce

he

ndcates

pattern

bockage

o

o

pan

reease

com-

o

be

Supraduodenal

nto

artery

B.

te

duodenum.

he

cystc

orm

te

badder

duct

be

nto

toknn.

te

ampua

denum.

presence

o

bocked

to

w

te

s

be

coecys-

normay

te

descendng

wt

assocaton

oten

s

o

te

wt

resutng

te

rom

concentraton

precptate

o

duo-

mutpe

nlammaton

n

can

coecystts,

to

epatopancreatc

Increasng

Bockage

to

ga-

te

an

and

duct

te

lows

present

requenty

duct.

rom

response

enter

oten

gabadder

concomtant

n

duct,

and

gastones,

cystc

nlammaton.

Anterior

duct

epatc

reeased

duct

cystc

Vater)

most

common

s

Coecystts

gabadder,

n

be

(o

te

Be

cystc

te

Patents

gastones.

be

te

From

troug

jons

duct.

a

bout

te

cystc

duct,

not

necessary

a

o

o

wt

assoc-

superior

ated

pancreaticoduodenal

Superior

artery

epatc

artery

Posterior

inferior

pancreaticoduodenal

Abdominal

wt

jaundce.

An

obstructon

n

te

common

mesenteric

aorta

duct

tus

prevent

num

and

and

subsequenty

communcaton

te

ver,

causng

te

be

duct

between

obstructve

te

woud

duode-

jaundce.

artery

C

Anterior

and

E.

An

occuson

n

eter

te

et

or

rgt

epatc

inferior

duct mgt cause md jaundce; owever, gastones pancreaticoduodenal

artery

mgt

•

GAS

Fig.

D.

An

he

transversus

nto

te

untes

pubc

wt

abdomna

E.

processus

tat

precedes

cessus

o

te

s

tests.

nguna

medate

part

he

deep

o

superor

te

neck

process

uncnate

tumor

mesenterc

he

by

B.

a

he

der,

D.

he

L3,

o

a

n

te

o

orms

te

te

or

a

porton

remans,

tra

ABR/McM

o

and

te

o

te

tumor

n

neror

wc

pancreas

te

artery

aso

pancreas.

epatc

T10

B.

Nerves

te

can

nter-

orm

part

o

ten

a

te

duodenum.

o

te

s

artery

uncnate

superor

ven,

to

mesenterc

tus

s

te

passes

regon

An

be

te

E.

arses

neror

to

te

te

cord

and

an

passng

afected

tg.

ead

o

o

te

It

s

te

jaun-

te

oypogas-

nerve

and

arses

and

over

rst

runs

te

o

rom

te

te

skn

ven-

transversey

owest

cutaneous

porton

nerve

stu-

pubs.

umbca

T11

te

256

o

nnervaton

nerve

te

mons

and

regon.

te

umbcus

nerve

s

courses

on

te

tereore

musce

spne,

eve

wa

emora

psoas

about

gabad-

branc

or

commony

atera

te

GAS

64.

B.

nc

398;

N

Appendcts

maton

at

onguna

cana,

he

to

pancreas.

te

ABR/McM

hs

te

beow

te

to

pancreas.

artery

stuated

o

to

suppyng

he

287;

spna

te

nor

T12

but

ventra

superor

ram

to

te

troug

atera

sde

typcay

te

o

ngu-

te

neror

sper-

to

te

ncson.

superor

superor

unkey

rom

pancreatc

gastones

pubs.

matc

te

te

nnervates

mons

aorta,

crosses

to

termnate

na

te

seat.

superor

A.

L1

accessory

pancreatts.

pubs.

te

or

neter

cutaneous

abdomna

rectus

o

rom

compresson

and

and

te

N

man

n

responsbe

o

te

te

cause

340;

mons

ramus

ated

230

arses

pancreas,

trd

cause

artery

te

around

pro-

s

congenta

o

t

te

may

330,

n

resut

anteror

nerve

above

7t

part

he

trc

tunca

proxma

C.

D.

264;

present.

woud

but

GAS

63.

artery.

cystc

are

N

can

common

body

I

troug

porton

te

orms

nterna

tendon.

cana

patway

processus

mesenterc

uncnate

A.

o

and

te

dce

pertoneum

descends

retaned

a

o

nserts

ydrocee.

292–293;

to

t

o

conjont

pouc

hat

erna.

te

te

nguna

Retenton

ne

nserton

a

as

and

provdes

ndrect

lud-ed

C.

s

tests

rng

normay

processus

GAS

61.

te

aponeuross

pectnea

orm

deveopment.

tat

vagnas

to

vagnas

nguna

mont

and

aponeurotc

obque

he

deep

abdomns

crest

te

be

occuson

ducts

C.

not

4.67

and

and

s

rebound

pont

es

superor

meda

pan

spne

te

to

over

o

to

rom

anteror

te

wt

te

te

atera

abdomen

superor

aspect

ac

o

te

263

bot

a

McBurney

te

traves

atera

caracterzed

ndcated

one-trd

ac

to

ABR/McM

oten

nerve

emerges

tereater

260;

s

cutaneous

and

dstance

by

acute

postve

pont.

rom

umbcus.

In

nlam-

psoas

test

McBurney

te

anteror

patents

wt

CHAPTER

T aeniae

coli

D.

he

umbar

ute

musce

and

sensory

E.

and

sacra

sympatetc

gands

bers

he

vagus

and

aferent

sympatetc

bers

or

o

trunks

nnervaton

certan

te

nerve

or

pevc

157

Abdomen

3

contrb-

o

smoot

vscera,

but

not

rectum.

provdes

parasympatetc

nnervaton

(excudng

suppy

pan)

to

te

Pre-ileal

ntestne

GAS

Postileal

66.

D.

It

358–364;

Mecke

eum

occurs

about

2

s

about

eet

coc

lexure.

ABR/McM

s

2%

ong,

et

a

o

281

ngerke

remembered

proxma

nces

te

392;

generay

n

2

N

to

dvertcuum

tat

matey

proxma

te

rom

occurs

projecton

by

te

“rue

popuaton,

te

2

eoceca

tmes

as

s

o

o

te

2s”:

approx-

juncton,

oten

n

s

men

Ileum

as

n

and

women,

may

be

condtons.

mucosa

ng

he

and

and

may

contan

conused

two

types

pancreatc

pan,

may

2

oten

o

o

2

hese,

ndcatons

ectopc

dferent

ectopc

tssue.

gve

types

wt

tssue

aong

o

tssue,

cnca

are

gastrc

wt

peptc

beed-

ucer

or

Pelvic

Retrocecal

appendcts.

A

and

B.

Interna

and

externa

emorrods

nvove

Cecum

te

rectoana

wc

area,

bopsy

presence

o

o

not

te

eum,

emorrods

gastrc

n

woud

addton

not

sow

to

te

mucosa.

Subcecal

C. •

GAS

Fig.

Dvertcuoss

or

dvertcuar

dsease

s

a

condton

4.84

n

wc

te

sma

coon

outpoucngs

and

woud

occur

tereore

be

n

te

ned

was

wt

o

coc

mucosa.

appendcts,

McBurney

et

A.

ower

An

rebound

pont

C.

quck,

deep

may

be

et

compresson

over

o

E.

Borborygm

te

passage

quadrant.

ectopc

et

abdomna

over

gabadder

gastrc

woud

pan

McBurney

Coecystts

resuts

and

regon

an

o

te

wt

ocazed

GAS

67.

to

n

te

D.

pan

rgt

over

o

te

te

n

ep-

and

E.

Peroraton

or

stones

possby

on

nguna

o

papaton

namc

wa,

resut

te

o

reerra

reerred

ypocondrac

coud

abdomen,

eus,

o

pan

to

te

togeter

rgdty

pan

to

te

resut

A,

B,

umbar

o

te

n

pan

wt

ady-

(GAS

te

Fg.

4.84).

GAS

65.

B.

he

319–320

vscera

transmtted

wc

aso

N

280;

aferent

by

way

provde

o

te

ABR/McM

nnervaton

te

pevc

261

o

umbar

bers

C.

he

sympatetc

te

(recta)

nerve

pes

te

rom

pudenda

ana

sa

C,

rectum

spancnc

s

o

nerve

nerve,

pens.

nerve

and

o

ne

dorsa

te

and

trunk

body

provdes

te

somatosensory

pectnate

tures

undus

te

tat

occur

contents

to

bers

and

te

nerve

urogenta

o

388;

n

to

te

perana

regon.

ana

ana

skn;

pens

te

and

C

and

rgt

and

sensory

wt

te

troug

te

neror

dor-

nerve

sup-

te

nnervate

struc-

oten

o

pressure,

occurs

te

between

aorta,

creatng

resutng

te

marked

N

remanng

n

reerred

eevated

266;

lud

epatorena

te

o

woud

woud

not

be

pressure.

268

(o

pertonea

te

coces

and

accumuaton

pouc

epatorena

ront

bood

ABR/McM

patent,

n

answer

pan

space

cavty

s

pareta

w

Morson),

n

ocated

oten

wc

te

bend

pertoneum

s

supne

te

coverng

kdney.

ver

D.

and

he

space

te

vescouterne

potenta

areas

o

accumuaton

s

s

n

an

between

te

rgt

obe

o

dapragm.

n

erect

and

lud

rectouterne

spaces

accumuaton;

tese

spaces

poston

occurs

rater

are

owever,

wen

tan

a

te

supne

poston.

E.

he

costodapragmatc

peura

beow

pernea

n

wt

subprenc

lud

242

aneurysm

burcaton

he

space

patent

te

cana

te

owest

te

resut

supne

he

uterus.

or

nerve,

neror

te

te

orgn

pernea

he

receves

o

to

GAS

te

ts

E.

n

nerves,

suppy

and

In

a

ABR/McM

ncrease

he

A.

281;

assocated

aso

he

sounds

bowe

pusaton.

ver

organ.

A.

bowe

and

aortc

beow

poston.

te

te

parasympatetc

B.

occur

abdomna

souder

L4,

key

68.

N

sgncant

regons.

duodenum

te

(paraytc)

and

n

315;

abdomna

be

Kdney

are

gas

Abdomna

L3

nlammaton

resut

stng

assocated

pont.

rom

woud

be

nstead

regon.

D.

o

ntestnes.

pregnancy

generazed

pan

ater

tenderness

GAS

69.

D.

319

N

345;

Descendng

lexure,

recess

s

a

space

n

te

cavty.

ABR/McM

co on.

nner vaton

gastro ntestna

tract

o

s

279

Begnnng

te

at

ndgut

supped

by

te

et

por ton

coc

o

te

parasympatetc

158

C H A P T E R

3

Abdomen

Left

bers

o

te

patet c

coc

o

te

spancnc

nner vaton

lexure

s

spna

nner vat on

vc

pevc

o

te

supped

cord

o

mdgut

te

occurrng

te

spancnc

by

ner ves.

ner ves

arse

up

vagus

beow

descendng

to

te

A

Left

artery

gastric

artery

et

Right

hepatic

artery

Propoer

hepatic

artery

eson

woud

because

sp na

hepatic

par asym -

ner ve.

L4

coon

 rom

he

afect

te

ner ve

pe -

eves

S2–S4.

A,

B,

C,

and

and

E.

he

transverse

jejunum,

coon

are

ascendng

a

coon,

nnervated

by

eum,

te

vagus

nerve.

70.

C.

GAS

319;

he

porta

mts

te

N

306;

proper

common

A

menta

because

patcs

tat

A

are

and

n

o

coud

A

be

tumor

as

obstruct

n

a

o

regon

to

a

o

o

and

be

ven,

ymp

most

vesses

tese

trans-

porta

nerves,

woud

o

ver)

epatc

abundance

ead

detr-

and

symptoms

ym-

Cystic

wen

artery

unctonay.

eter

serous

ssure

artery,

autonomc

ts

ts

compromsed

B.

not

duct,

tumor

249

(transverse

epatc

epatc

vesses.

tey

ABR/McM

epats

te

because

tese

rgt

t

or

et

woud

obes

not

woud

competey

vesses. Supraduodenal

D.

he

acorm

gament

does

not

carry

any

artery

vesGastroduodenal

ses

(except

some

sma

paraumbca

vens),

so

Right

tumor

n

ts

area

woud

not

ead

to

te

gastric

artery

symptoms

Abdominal

descrbed.

E.

he

epatogastrc

tonea

gament

connecton

curvature

o

symptoms

te

and

between

stomac

sgns

s

te

te

bamnar

ver

and

s

and

te

unreated

Superior

per-

329;

N

284;

to

E.

he

cystc

•

te

to

artery

te

s

GAS

Fig.

D.

he

te

eococ

ony

gabadder.

It

artery

s

te

ony

artery

sted

epatc

artery

and

artery

s

must

sted

tat

te

oten

a

branc

appendx,

gvng

of

an

appendcuar

s

cut

ree

rom

ts

sup-

be

camped

branc

goes

o

or

rom

one

o

ts

brances.

te

beore

gves orgn

te

to gabadder

tat

255

A, B, C, and E. he superor mesenterc artery rgt

artery

4.106A

ere.

ABR/McM

drecty drecty

artery

Splenic

pes 71.

aorta

mesenteric

esser

73. GAS

artery

a

te

eococ,

rgt

coc,

and

mdde

coc

arteres;

attacments.

owever, te atter 2 e superor to te ste o te appenA,

B,

C,

and

orgn

nto

to

D.

he

te

rgt

common

proper

and

et

epatc

epatc

epatc

artery

artery,

provdes

wc

arteres

dx.

he

te

neror

superor

recta

artery

s

te

termna

branc

suppes

te

o

dvdes

suppyng

mesenterc

artery

and

ower

te

porton o te sgmod coon and superor rectum. ver, gabadder, and bary tree (GAS Fg. 4.106A).

GAS GAS

330;

N

287;

ABR/McM

74. 72.

D.

he

speen

s

a

arge

ympatc

organ

tat

A.

Caput

te

dapragm

and

rbs

9,

10,

and

11

n

te

ar

area.

A

aceraton

o

ts

organ

s

wt

severe

bood

oss

and

was

ormed

porta

to

te

261

to

by

te

snakes)

s

ead

o

caused

Medusa,

by

pressure,

wt

venous

relux

severey

rom

paraumbca

vens,

sma

vens

te

wtn

te

sock.

acorm A.

ABR/McM

(reerrng

oten

ver assocated

294;

et

eevated ypocondrac

N

medusae

rests

wose aganst

350;

256

gament.

he

presence

o

caput

medusae

s

Amost a o te ver s ocated n te rgt ypocon-

usuay

assocated

wt

end-stage

dsease.

Caput

medu-

drum and epgastrum, atoug some protrudes nto

sae te

et

ypocondrum

beow

te

s

dented

radatng B.

he

pancreas

es

bend

te

stomac

and

w

njured

n

ts

he

et

kdney

s

es

retropertoneay

C,

te

and

centra

D.

te

eve

o

te

T11–L3

vertebrae

on

te

et

te

he

o

engorged

he

epatc

vens

porta

connecton

Obstructon

o

o

tese

te

anastomoses.

neror

vena

cava,

and

atera

toracc

vena

ven

cava,

do

porta

ypertenson

and

woud

not

not

produce

body.

tese E.

mbs.

sde

cause o

appearance

ower

approxmatey

superor at

te

te

case.

B, C.

toward

not

ven be

by

dapragm.

um

s

te

upper

porton

o

te

p

bone

E. contrbutes

to

te

bony

pevs.

Ieum

s

te

he

o

te

sma

ntestne

and

s

superca

epgastrc

ven

aso

s

not

assocated

dsta

wt porton

symptoms.

and

pronounced

te

deveopment

o

porta

ypertenson

but

te

coud provde a coatera canne or venous dranage. same

as

“um.”

GAS GAS

337;

N

288;

ABR/McM

245

271;

N

299;

ABR/McM

246

CHAPTER

75.

C.

Coecystts

due

te

to

cystc

rgt

s

ncreased

duct

an

by

gastones.

ypocondrac

T6–T8

carry

bers

as

trave

o

be

s

Lesser

gabadder

obstructon

et

corresponds

aferents

wt

te

or

utmatey

wc

Sensory

tey

o

Pan

regon,

dermatomes.

pan

nlammaton

concentraton

rom

omentum

o

te

to

te

sympatetc

n

159

Abdomen

3

te

Stomach

vscera

axons

n

te greater toracc spancnc nerves. Pan cannot be et

n

te

vscera

and

s

tereore

reerred

to

te

body

wa. Gastrosplenic

A.

he

te

vagus

ead,

pan

nerve

neck,

carres

and

vscera

trunk,

but

sensory

tese

do

bers

not

rom

ligament

ncude

bers.

Spleen

B.

Spna

rom

nerves

o

toracc

T1–T4

vscera,

receve

aferents

ncudng

te

or

eart,

pan

but

not

Visceral

peritoneum

abdomna

organs.

D.

Sympatetc

E.

Aferent

and

neurons

tereore

do

bers

not

o

are

autonomc

carry

te

sensory

dorsa

motor

nerves

normaton.

ram

o

spna

nerves Splenorenal

T6–T8

convey

sensory

bers

rom

te

back

but

not ligament

rom

nterna

GAS

340;

N

organs.

309;

ABR/McM

Left

247

•

Answers

76.

Mc Bu r n e y

ocaton

o

attaces

te

rom

to

pont

te

te

o

cecum.

abdomen,

te

usuay

base

It

about

umbcus

to

c o r re s p o n d s

te

s

appendx

ound

on

t w o - t   rd s

te

te

o

anteror

to

rgt

te

D.

t

he

or

sde

ureter

dstance

superor

C,

and

be

E.

he

neror

or

ac

as

a

318;

are

ents

o

appendx

and

ocazed

ence

woud

te

rom

te

ents

upper

to

abdomna,

he

vagus

D.

he

umbar

E.

Spna

he

t

te

ower

trunk

tese

do

porton

anteror

ureter

he

pan

spna

bers

rom

te

B.

afer-

toracc,

o

s

N

nerves

te

or

te

and

constrcted

brm

rom

E.

to

to

degree

mnor

80.

C.

he

ureter

kdney

mnor

and

stones.

and

not

major

typca

cayces

stes

or

are

proxma

obstructon

to

by

te

not

t

s

and

not

s

a

typca

entrance

a

by

muscuar

ste

o

common

compressed

te

o

te

uterne

ABR/McM

s

te

ste

ur-

wa

as

ony

te

o

s

dapragmatc

attaced

artery

te

anteror

tat

to

o

to

contans

te

speen

te

te

te

te

and

te

o

te

bare

relecton

ver

area

o

onto

ver;

speen.

gament

vesses

pertonea

surace

encoses

to

wa

stomac.

gament

tat

271

attacment

gament

spenc

te

cervx.

269,

te

abdomna

te

gastrococ

contans

but

brances

soud

not

be

a

o

te

actor

spenectomy.

he

epatogastrc

gament

connects

te

ver

to

stomac.

he

acorm

te

N

to

273;

spancnc

te

he

gament

ver

abdomna

338;

Pevc

suppy

A.

B.

s

he

GAS

some

s

coronary

anteror

tg.

222

major

and

nectng

abdom-

badder

gament

posteror

dapragm

te

wt

area.

ower

anteror

ABR/McM

D.

s

obque

s.

and

317;

gastro-omenta

not

pan.

assocated

abdomnopevc

perneum,

pevc

are

nnervate

303;

normay

te

aferents

N

curvature

he

n

carry

badder

brances

te

T5–T9,

sensory

to

rom

pass

pevs.

and

A.

o

because

contents

spenorena

greater

afer-

tereore,

nerves

receve

come

not

spancnc

358–364;

crosses

vscera

and,

organs.

nerves

nerves T12–L2

wa,

genera

major

ganga

ureter

ste

urnary

brm

380;

kdney

t

do

pevc

he

et

rom

cord.

T1–T5

but

to

arse

sympatetc

organs

stomac.

spna

pan,

C.

na

o

te

carryng

abdomna

nerves

or

GAS

or

toracc

nerves

te

here are no common stes o obstructon between

speen

231

spancnc

badder

GAS

C.

te

urnary

te

ABR/McM

T5–T9

sympatetc

Spna

te

282;

toracc

te

body

tereater

A

E.

not

nto

o

he

obstructon

te

atera

79.

responsbe

rom

rom

as

te

s

andmark.

N

greater

eves

and

C.

to

gament

umbcus.

he

te

78.

nguna

McBurney pont s two-trds o te dstance rom

GAS

A.

D.

used

te

B.

mdporton

obstructon.

nary

and

77.

kidney

4.113

te

w  e re

spne.

A,

Fig.

76–100

B.

o

GAS

vagus

nerve

⅔

de

artery

coc

transverse

o

s

wa

nerves

pertonea

aspect

(GAS

Fg.

o

od

te

con-

upper

4.113).

260

and

te

et

coc

artery

coon.

suppes

te

te

transverse

suppes

coon.

a

nner

ABR/McM

descendng

proxma

te

te

bowe

coon,

same

ony

and

to

te

porton

te

md-

o

te

160

C H A P T E R

B.

he

D.

he

E.

he

3

Abdomen

superor

cecum,

ng

to

E.

he

tra

esser

do

ramus

o

urogenta

usua

can

ac

be

njured

306;

nerve

and

takes

t

wt

te

a

L1.

te

as

It

not-

branc

ven-

te

skn

ratory

te

wc

nner

an

o

tg.

pont,

tents

Its

but

t

appendectomy

B,

and

and

te

C.

Spna

ncson;

does

not

wat

s

are

more,

we

te

not

te

wt

gentoemora

ocated

area

ter

o

n

te

sensory

njury.

nerve,

area

he

be,

o

dect

ncson.

sensory

to

gentoemora

cremaster

scrotum

ony

wa

D.

ar

subcosta

skn

o

agea

te

may

A TEF

and

gea

not

C.

and

E.

an

and

8t

s

te

o

esop-

te

wt

tracea

esopa-

strctures

woud

n

n

225;

o

o

N

to

te

and

o

n

an

A

C.

A

B.

but

tey

are

and

woud

cnca

not

occur

cause

manestatons

n

hs

s

caused

te

stomac

occuson,

Vater)

Lack

o

by

be

duct

ncompete

contents

dsta

were

to

te

wegt

woud

309;

te

n

te

be

gan

because

s

cd

A.

duct

enters

to

C.

not

cause

vomtng

vomtng

pyorc

spncter

wtout

te

woud

presence

cause

o

be.

pro-

not

te

con-

o

to

te

resp-

te

ste

at

246

spncter

pyorc

cana,

contents,

but

duodenum

n

not

and

cases

o

begn

can

and

tere

s

wtout

dsta

to

undus

be.

to

te

V omtng

atresa;

vomtng

necessary

occur

due

cause

because

and

days

woud

mmed-

ater

constant

277;

vomtng

t

s

occurs

added

by

to

a

devery .

vomtng.

not

dsta

produce

o

te

oten

pus

n

n

con-

resp-

ste

at

te

or

duodenum

te

s

par ta

duodenum

ater

constanty

to

te

246

o

por ton

resuts

be

o

contents.

stenoss

te

stomac

proxma

ABR/McM

trd

o

deect

ntestna

duodena

D.

week

and

t

t

o

and

te

ungr y

and

but

occu-

usuay

duodenum.

vomtng

e

may

ton

o

cated

brt,

te

etus

atresa

s

o

te

dd

rom

s

stom-

reason

not

gan

a

seen

wt

drecton.

aure

week

o

o

o

a

and

In

sep-

some

recanaza-

due

aed

duodenum

wtn

poyydramnos,

TEF

and

to

an

lud.

resut

te

a

deveopment

poyydramnos

te

vomtng

esopagea

strctures.

traceoesopagea

amnotc

o

causes

and

posteror

wt

umen

wt

te

egt

swaow

te

webs

generay

by

resut

te

a

to

n

as

s

caused

durng

Duodena

deveopment

atresa

s

as

o

presents

devatng

te

te

reorma-

and

rst

ew

“doube

s

asso-

days

o

bubbe”

sgn.

E.

TEF

s

an

abnorma

esopagus

tng

because

system

ypertropc

stomac

contents.

pyorc

recanazaton

Esopagea

ton

te

be.

N

egt

cases,

te

wt

o

Incompete recanazaton o te esopagus durng

tum

not

constant

s

w as

stenoss

epatopancre-

due

con-

wegt.

be

o

o

not

deect

contents

s

gastrc

occuson

te

te

recana-

contans

o

te

and

umen

te

nabty

vomt

te

brt

gan

system

contents

226

he

entrance

woud

proxma

stomac

does

be

be

presents

ABR/McM

a

stomac

o

stomac

woud

ac

esopagus.

238;

te

te

stomac

ere.

eter

o

occurs

aspraton

woud

to

enters

brt

and

because

stenoss

s

ABR/McM

o

ater

Incompete

and

patent

jecte

GAS

85.

o

seen

ratory

examnaton

stenoss,

279;

vomtng

t

occurs

narrowng

atropc

tents

atresa.

duodenum.

(o

ntestne.

o

atresa

stenoss

te

cases

cases

and

te

n

ound

and

added

wegt

A TEF

te

are

vomtng.

A.

E.

son

o

deveopment,

between

o

sgns

caused

atresa.

and

An

and

12t

cause

because

stenoss

wc

230

aure

assocated

webs

D.

or

regon.

a

week

passage

and

strctures

ntestne

ampua

sma

te

te

nerve

musces

N

ater

Lack

abdomna

beow

ABR/McM

rom

o

nnervatng

Spna

te

te

pubc

to

majus

s

soon

to

atey

regon.

rom

esopagea

tereore,

Duodena

addton

ocaton

te

resuts

abnorma

esopagus

Duodena

zaton

o

nnervates

260;

n

branc

skn

wa

suppy

trange.

motor

branc

abum

umbca

appen-

bot

not

be

vomtng

seen.

seen

GAS

atc

N

cause

pneumona,

be

and

te

above

esopagus

notced

sma

n

to

stenoss

atresa;

te

not

s

be

Webs

o

B.

nerve

317;

aso

te

as

s

te

genta

te

emora

abdomna

posterory

286,

a

nerve

motor

to

emora

musces

recanazaton

wc

and

te

anterory

Esopagea

B.

over

bers

beow

he

provdes

sensory

he

GAS

D

skn

we

pudenda

perneum.

nerve

and

nnervates

as

rb

A.

te

anterory,

te

T10

he

rng,

by

te

A and B. Duodena atresa, ke duodena stenoss, causes

genta

due

nguna

o

o

constrcton.

at

superca

vomt

vomtng

begns

te

ste

te

system

be

because

pyorc

te

be

assocated

branc o te gentoemora nerve eaves te body wa

and

83.

nerve

correate

dectomy

82.

nerve T10,

pudenda

caused

to

ypertropy

projecte

te

s

nng

tereore,

woud

309;

Wt

te

ncson.

A,

C.

antrum

membranous

proxma

duct;

and

GAS

84.

gastrc

te

be.

A TEF

o

porton

McBurney

o

be

tan

E.

o

occurs

te

282

nnervates

upper,

atropc

remova

coon.

ABR/McM

extenson

An

and

nerve

anteror

beow

D.

eum,

coon.

termna

te

rectum.

termna

spancnc

s

crest;

regon;

patway

ascendng

N

nerve

spna

te

te

descendng

358–364;

onguna

overyng

and

te

suppes

suppes

toracc

wt

350,

artery

artery

appendx,

et

GAS

81.

recta

eococ

and

and

t

aso

s

passage

woud

assocated

occurs

between

not

be

a

wt

proxma

GAS

261;

N

279;

ABR/McM

te

to

deect.

246

te

cause

tracea

or

vom-

respratory

te

ste

o

te

CHAPTER

86.

B.

Duodena

ton

o

ated

te

wt

atresa

umen

vomtng

Poyydramnos

o

amnotc

grapc

or

“doube

s

te

o

s

by

te

due

te

utrasound

bubbe”

sgn

o

a

aed

duodenum

wtn

seen

lud

resut

te

rst

to

ew

examnaton

o

s

days

abnorma

ntestnes.

because

reorma-

and

omentum

assoc-

o

woud

brt.

B.

Umbca

In

rado-

sow

dstended,

te

tat

gas-ed

azaton

stenoss

o

vomtng

te

o

s

caused

by

duodenum

stomac

ncompete

and

contents

oten

pus

recan-

resuts

be

ater

n

C.

jecte

D.

An

pyorc

woud

cause

pro-

te

vomtng.

atroped

remova

and

spncter

o

occurs

antrum

membranous

proxma

to

te

s

caused

nng

ste

o

o

te

te

by

te

D.

stomac

entrance

E.

TEF

and

o

s

o

esopagus

symptoms

GAS

87.

C.

309;

Annuar

to

te

and

ventra

cess;

not

A.

o

te

A,

porton

a

tat

te

dorsa

Bot

nvoved

and

E

ton

o

ma

te

335;

an

porton

arses

as

a

s

be

N

remnant

as

o

or

GAS

90.

ventra

be

te

B.

he

C.

he

te

eoceca

superor

nvoved

wt

pro-

and

correct

A.

buds,

ack

o

canaza-

245

ompaoenterc

pouc

border

duct

about

o

te

duct.

3–6

eum

n

It

cm

and

generay

te

arter y

prox-

part

normay

ong

B.

rom

40–50

C.

remnant

he

A

ceca

not

a

remnant

o

te

5

mm

n

turns

nto

dameter

a

by

Mecke

GAS

A.

An

does

o

te

atera

n

wc

cavty,

sur-

a

deect

te

n

te

umbcus

aduts.

te

commun-

and

oop

suc

te

o

as

te

nguna

cecum

rng

urter

rng

perto-

ntestne

nto

nto

descent

te

scro-

ABR/McM

te

n

te

cause

and

epgastrc

te

cases

narcton

t

to

n

te

te

ower

abdomen

rgt

sde

yng

asymptomatc;

superor

and

cavty

ntestne

are

te

erna,

coverng.

te

to

arge

te

deve-

o

amnotc

resuts

passng

o

cosure

o

pane

pertonea

te

Most

ntestne

an

returnng

ntestne

et.

n

mdgut

oop

week

meda

nto

a

233

ncompete

ourt

te

resuts

te

an

mesenterc

gangrene

o

te

suppes.

between

te

umbcus

erna

ernates

not

cose

part

and

resuts

troug

an

competey.

o

te

te

urnary

wen

an

umbca

Suc

greater

a

badder.

abdomna

rng

erna

omentum

tat

oten

and

sma

ntestne.

week

E.

315;

s

te

prmordum

o

te

he

coaca

membrane

dvertcuum

N

270;

s

not

a

remnant

o

te

resuts

appropratey

umbca

cord.

91.

usuay

ruptures

durng

te

In

at

suc

248

wen

te

cases,

ste

o

te

twstng

te

o

part

body

wa

attacment

o

te

greater

261;

te

N

ana

254;

cana

and

ABR/McM

te

amnotc

cavty .

232

A. he nabty to pass meconum denotes an obstruc-

ton

ABR/McM

erna

between

GAS

cord.

cose

ton

appendx.

umbca

not

te

o

umbca

does

pear-

n

possbe

rom

obstructon

te

and

a

o

wen

nguna

wtout

sma

contans

normay

dvertcuum

and

umbca

89.

An

organ

s

artery

about

o

wt

254;

abdomen,

can

s

deep

protrude

te

on

o

A patent uracus occurs wen tere s a communca-

ton

cm

juncton.

vesce

te

te

owever,

dvertcuum

ompaoenterc

mesenterc

o

are

skn.

troug

organ

te

durng

lud

Nonrotaton

o

N

hs

tat

skn.

egt week o deveopment, creatng a communca-

cecum

A.

vscera

amnotc

umb-

by

structures

amnotc

vagnas

cose,

deect

wa.

abdomna

te

erna,

eve

erna

resuts

a

so

majus.

ods

rom

porton

20.

D.

atera

entrey

dvertcuum

umbca

wt

ABR/McM

(Mecke)

ngerke

ea

saped

te

o

cavty

erna

and

commony

superca

298–299

abdomna

dorsa

te

abum

o

cosure

te

te

anoter

cana,

aure

lud.

occurs

not

o

te

tssue

tunca

troug

Gastroscss

opment

pancre-

ventra

D.

o

dur-

ts

or

te

does

nguna

tum

ducts.

te

ea

o

not

BP80;

antmesenterc

rom

a

troug

hs

muc

te

n

cannot

dorsa

or

duodenum

te

due

surrounds

brt

rom

rng.

are

te

obstructon

duodenum.

te

wt

D,

eter

or

ernates

ater

around

between

o

epgastrc

to

more

a

o

ernatng

nto

nguna

or

any

te

an

erna

ar

cavty

rst,

anomay

presents

occurs

ndrect

te

tssue

resut

ormng

to

cause

te

ompaocee.

s

porton

ncompete

n

superor

nea

bot.

A

te

can

buds

a

rom

abdomna

coverng

amnotc

tracea

246

sorty

usng

answers

hs

GAS

88.

and

be

duodena

part

wrappng

reer

not

te

queston.

pancreatc

pancreatc

tey

between

ABR/McM

ound

tereater,

tereore,

because

te

second

be

deveopment

bud,

woud

n

pancreas

bud

and

passage

causes

o

te

can

Annuar

atc

B.

279;

band

constrcts

pancreatc

ng

N

and

cted

pancreas

tck

obstructon

ater.

An

aba

a

protrude

by

rom

ernaton

proxma

s

epgastrc

caton

abnorma

ernate

tere

te

subcutaneous

vscera

and

E.

be.

an

An

to

erna,

resutng

nea

te common be duct; tereore, vomt woud not

contan

by

dfers

apparent

wtout

rounded

gastrc

te

an

te

Gastroscss

ods,

Hypertroped

s

umbca

covered

e.

C.

can

ompaocee,

return

nto

cord,

In

n

to

tere

vscera

ca

Duodena

ntestne

ernaton

congenta

ntestne

stomac.

A.

sma

abdomen.

absorpton

Fnay,

and

161

Abdomen

3

o

B.

te

eta

o

te

sma

bowe.

and/or

Gastroscss

o

te

Mdgut

ntestnes

atera

s

arge

and

resuts

n

te

obstructon

ntestnes.

caused

ods

vovuus

utmatey

by

durng

ncompete

te

ourt

cosure

week

o

162

C H A P T E R

3

Abdomen

deveopment

pane

o

gastrc

te

erna,

amnotc

C.

Faure

50%

and

o

creates

wt

cavty

o

t

abdomna

vscera

and

are

obstructve

s

tat

o

te

esons

caused

deect

hs

by

o

n

te

resuts

by

an

te

te

wt

ntestne.

hs

atresa

o

D.

A

remnant

presents

ong

eum

an

arses

and

o

sma

ompaoenterc

ea

o

ntestne

duct

dvertcuum

ngerke

rom

mdgut

returnng

sttng

on

generay

ompaoenterc

pouc

antmesenterc

cm

te

oop

te

a

te

40–50

te

(Mecke)

o

as

rom

Nonrotaton

ton

te

porton

normay

cm

o

as

proxma

E.

94.

te

te

te

about

border

eoceca

resuts

to

n

te

sde

A.

ower

o

te

C.

D.

owever,

obstructon

323;

N

remnant

eum

proxma

rom

40–50

and,

arge

and

rom

woud

as

as

te

be

te

ea

a

o

cause

o

o

o

te

o

cosure

o

atera

opment

o

te

otc

ods

and

t

caused

wt

cavty

durng

creates

are

ncompete

te

a

wa.

vscera

and

by

ourt

deect

hs

tat

n

week

te

resuts

n

protrude

covered

by

o

C.

te

an

nto

amnotc

obstructve

ton

s

caused

Nonrotaton

porton

o

so

te

tat

rgt

sde

yng

by

te

o

septum

B.

Dorsa

C.

Faure

resut

part

N

Incompete

ta

on

ana

o

externay

ageness.

et.

can

n

to

A

te

amn-

te

te

Most

ana

o

o

n

te

t

te

xed

te

asymp-

and

gan-

E.

urorec-

septum

woud

resuts

ana

n

mperorate

to

anus,

perorate

not

ana

te

and

o

to

resuts

exsts

coon

s

a

no

but

s

resuts

n

connecton

o

te

Mecke

ompa-

dvertcu-

ts

open

te

te

o

wt

te

te

descrbed.

and

woud

not

resut

vtene

duct;

n

a

te

outsde

vtene

can

o

appear

a

n

o

te

due

sma

vascuature.

te

oten

or

to

s-

porton

dferent

stua).

mdgut

to

It

oop

ntestnes

can

and

resut

woud

descrbed.

ABR/McM

s

te

resut

tat

or

o

drecty

persstence

233

abnorma

assocated

rectouterne

proctodeum

to

parttonng

wt

a

rectoure-

stua.

deveop

w

resut

n

anus.

te

a

persstence

connectons

symptoms.

can

symptoms

s

280

te

remnant

o

254;

te

urorec-

cana.

n

by

twstng

ageness

ead

urorecta

stua

but

septum

woud

not

woud

cause

most

anorec-

ageness.

Faure

o

xaton

Premature

A.

cause

stak.

It

s

rom

tcuum

to

498;

Me c k e 

ma

membrane

o

Ageness

GAS

97.

urorecta

N

te

perorate

porton

tumor

suspendng

mperorate

not

te

n

o

te

ndgut

can

resut

n

vovuus.

suppes.

by

n

315;

Faure

a

duct

te

by

not

cyst

rectovagna,

ta

C.

248

coaca

resut

key

superor

stenoss.

te

B.

a

marotaton

coaca

an

ntestne

are

te

A.

rst

on

te

s

smpy

as

s

Anorecta

tra,

ower

ageness.

te

o

ntestnes.

arge

cases

o

obstruc-

abdomen

narcton

ntestne

ABR/McM

hs

resuts

descrbed.

s

vtene

ter

by

cana

te

ana

symptoms

cause

s

(suc

Vovuus

not

D.

t

o

caused

can,

woud

not

to

tere

resut

dvertcuum

but

te

GAS

96.

septum

coaca

ABR/McM

s

te

cyst

t

woud

Mecke

rom

lud.

ompa-

dvertcu-

stenoss.

wc

vtene

around

epgastrc

te

becomes

wt

cause

te

o

resuts

obstructon

o

devaton

n

ntestne

separaton

resuts

atresa

mdgut

te

270;

ntestne.

or

abdomen,

artery

te

311;

te

returnng

owever,

mesenterc

grene

te

oop

sma

o

o

stenoss

o

te

entrey

tomatc;

GAS

esons

E.

te

tssue.

and

woud

symptoms

orms

pane

o

Mecke

280

ana

proxma

311;

cause

o

wc

enterocystoma

tua,

deve-

meda

Faure o recanazaton o te eum s seen n 50%

o

A.

s

abdomna

erna,

93.

n

stua

duct,

te

o

Gastroscss

te

An

ayer

rectum

o

N

vtene

so

s

sgns

A

owever,

sma

bowe

te

B.

te

appendcts.

E.

te

Remnants

n

juncton.

eta

o

A.

n

ageness.

he

recanazaton

atresa,

umbcus,

pouc

border

D.

te

Abnorma

vtene

(Mecke)

twstng

obstructon

te

ompa-

ngerke

eoceca

Inarcton

not

o

an

a

rom

utmatey,

suppes.

95.

antmesenterc

resuts

ntestnes.

t

239

porton

arses

te

cm

vovuus

ntestne

presents

normay

ong

and

ntestnes

seen

te

te

ABR/McM

generay

It

cm

Mdgut

and

o

duct

3–6

324;

o

a

membrane

anus.

a

o

ana

by

ana

part

n

urorecta

obstructed

not

te

n

ana

479;

about

C.

te

um,

dvertcuum.

B.

o

mperorate

GAS

o

te

separaton

and

gangrene

resut

resuts

connecton

cana.

porton

ABR/McM

o

resuts

o te superor mesenterc artery can cause narcton

oenterc

A.

asymptomatc;

no

ageness.

311;

duct

A

te

are

septum

between

E.

ana

coon

s

stenoss.

recta

abdo-

and

te

tere

proxma

woud

devaton

Faure

D.

te

N

oenterc

GAS

92.

cases

ana

n

men, and te arge ntestne yng entrey on te et.

Most

not

498;

ta

por-

rst,

um,

Incompete

te

te

GAS

o

wc

rectum

o

duct

Dorsa

It

3–6

o

B.

n

oenterc

ana

te

te

Remnants

juncton.

abdomen

rgt

n

duct.

recanazaton

atresa,

between

E.

te

ntestnes.

Abnorma

recta

lud.

seen

or

s

D.

ep-

nto

amnotc

eum

stenoss

meda

n

protrude

covered

recanazaton

obstructon

a

wa.

s

rupture

anorecta

N

usuay

te

2

to

tat

ana

ABR/McM

s

nces

eoceca

prone

te

membrane

woud

ageness.

dver tcuum

peroraton)

beedng.

311;

o

a

279

re m n a n t

ong

juncton.

uceraton

can

and

re s u  t

2

o

Me c k e 

(possby

n

te

eet

yok

prox -

dver-

eadng

gastrontestna

CHAPTER

B.

Dupcaton

te

C.

A

patent

o

to

te

GI

subepatc

aure

o

ntestne

does

not

predspose

owever,

beedng.

cecum

an

and

compete

appendx

mdgut

s

due

rotaton

to

woud

durng

E.

he

deveopment.

D.

Nonrotaton

but

E.

s

not

Hernaton

becomes

GAS

98.

D.

ageness

A.

o

te

muttude

o

C.

E.

kdney

Wms

tumor

more

not

373–374;

wt

and

ng

A

s

does

cause

deveopment

a

B.

tons

and

Answers

resuts

s,

n

rena

decent

pro-

wt

may

go

occurs

sma

on

due

and

can

orm

a

cdren

o

o

tan

n

ureter.

te

kdney

t

s

n

can

and

emae

vagna

s

and

rom

46XX

Inguna

a

B.

tose

absence

consstent

ernas

ave

descrbed

genotypes,

o

wt

te

te

n

resut

notng

to

uterus

emae

wt

102.

C.

ypopasa

sstent

GAS

he

na

wt

470;

vagna

bubs,

pate,

deveopment.

Faure

sstent

pate

ymen

s

openng

a

od

o

te

o

te

a

ageness

absence

wc

ta,

o

te

durng

con-

membrane

It

s

tat

oten

snovag-

n

a

torn

E.

he

and

n

te

at-

remnants

n

o

mesoneprc

ncudng

men,

and

te

women.

he

ducts

Gartner

duct

ejacuatory

ony

are

duct,

te

wc

are

eongatons

hese

by

te

tubues

o

are

gomeru

te

subse-

to

orm

a

corpusce.

ducts

uterus,

are

responsbe

cervx,

and

or

uppermost

te

bubs

are

te

orm

te

spongy

aba

uretra

responsbe

vagna

n

or

pate

mnora

men.

te

n

E.

deve-

embryonc

N

371;

B.

or

ypopasa.

or

nasa

are

and

assocated

Atered

ears,

o

te

aca

etc.

a

rare

rena

caracterstcs

mcrogna-

Absence

kdneys

s

wt

mandbuar

or

causes

ack

o

ogoy-

anydramnos.

dyspastc

usuay

tereore

286

syndrome,

s

brdge,

ow-set

possby

are

Potter

trat

Mutcystc

kdney

secondary

not

te

to

cause

and

poycystc

Potter

o

Potter

sequence

sequence

ogoydramnos.

Wms

tumor

presents

s

n

wa;

o

tat

urnary

n

ABR/McM

a

and

te

s

t

Potter

urnary

exposes

badder

tere

reatvey

cdren;

on

no

te

te

common

s

not

tumor

wt

sequence.

badder

posteror

exteror

ndcaton

rena

assocated

o

o

s

a

congenta

surace

te

ts

o

te

abdomna

deect

n

te

patent.

processus

vagnas

pertoneum

cedes

B

or

deect

te

eary

and

ods

and

o

Exstropy

e.

te

te

vagna.

ogoydramnos

he

covers

In

mesoneprc

rena

te

lattened

tat

per-

ymen.

o

deveopment

and

embryonc

resuts

he

deerens

tubues

te

recessve

kdney

or

mperorate

cana.

sed

not

o

maormed

and

D.

rom

canazaton

mucous

s

A

285

arses

tus

and

and

con-

descrbed.

canazaton

and

neck,

o

structures,

dsappears

te

sequence,

autosoma

46XY

genotype

symptoms—and

ABR/McM

vagna

45X

webbed

ympatcs,

symptoms

371;

undergoes

vagna

o

oter

te

N

rom

stature,

o

vesces.

te

474;

dramnos,

resuts

o

Potter

T urner

sort

o

deveopment.

proper

wt

oten

appear

duct.

o

ductus

nvagnated

opment

presenta-

rom

te

urogenta

o te uterus and a negatve sex cromatn pattern.

syndrome

te

deve-

cyst.

women

ncude

do

absence

resut

tubues.

parooporon,

Snovagna

present-

and

dferent

and

or

o

285

oten

te

varety

paramesoneprc

he

gentaa,

te

t

ormaton

respectvey.

ave

a

a

mesoneprc

he

t

C.

externa

to

traces

quenty

tat

nvoves

pseudoermaprodtsm

cest—among

A.

orm

he

are

(Woian)

mesoneprc

263

syndrome

Faure

compete

wc

coectng

component

aduts;

cysts,

orms

wereas

aspect

ABR/McM

n

responsbe

pate.

ABR/McM

vagna,

rse

and

epooporon,

dv-

eter

te

te

gves

ureter

remanng

ageness.

311;

hs

resut

are

vagna

resut

370;

duct

o

eventuay

parts

premature

o

magnancy

rena

to

N

mesoneprc

te

A.

occurs

bud

n

N

wa

te

durng

porton

to

474;

Gartner

era

recessve

kdneys

a

cana

canazaton.

bubs

te

woud

wt

vagna

101–125

D.

GAS

Mae

genta

A.

gangrene.

autosoma

dupcaton

testes

tubes.

presents

100.

an

owever,

pseudoermaprodtsm

E.

tat

GAS

symptoms.

and

D.

any

ducts,

a

a

bnd-endng

uterne

orm

o

present

te

ntestne

101.

spongy

nsenstvty

o

to

mesonepros

tubues

common

Androgen

o

system.

or

GAS

C.

wtout

242

to

s

by

te

ureterc

doube

s

o

dupcaton

te

undergo

woud

because

vagna.

cysts.

urogenta

o

ead

opment

duct

dsease

deveopment;

Ureterc

son

99.

o

mesoneprc

te

oop

vovuus

beedng.

lud.

kdney

Degeneraton

te

exst

can

to

GI

can

bud

caracterzed

norma

t

ead

or

te

ABR/McM

ureterc

amnotc

dsease



ogoydramnos,

Poycystc

B.

270;

coud

cause

ntestnes

owever,

N

o

and

ducton

mdgut

key

stranguated,

315;

Faure

te

most

o

symptoms;

st

dsorder

ymen

snovagna

deveopment

o

te

neter

mperorate

163

Abdomen

3

te

D.

stvty

nto

descent

Bot

o

te

cervca

syndrome

s

te

a

tube-ke

nguna

projecton

cana

tat

o

pre-

tests.

atresa

woud

and

resut

GAS

103.

B.

o

androgen

n

nsen-

amenorrea;

he

te

bud

te

373–374;

ureterc

ureter,

woud

bud

and

resut

psatera

N

s

311;

tus

n

sde.

ABR/McM

responsbe

an

eary

or

268

te

spttng

ormaton

o

a

deveopment

o

te

second

ureterc

ureter

on

164

C H A P T E R

A.

3

Abdomen

Faure

o

te

compete

C.

he

ureterc

absence

urorecta

deveop

D.

stua

patent

tat

anteror

Faure

may

n

runs

GAS

104.

o

stuated

coverng

hs

n

o

o

an

tssue

te

as

urne

an

A,

joned

to

to

ureter.

abnorma

badder

eakng

to

to

branc

occurs

deveopment

and

cavty

A.

bot

s

he

and

toned

C.

not

n

but

t

te

not

ton,

tey

recess

patent

s

resuts

lud

GAS

328;

neror

stomac

B,

o

te

hese

and

n

tese

GAS

E.

he

s

te

s

te

te

n

a

stes

ta

space,

atera

to

houg

lud

to

te

lud

coverng

rec-

A,

or

te

rgt

and

gutters

and

uceraton

te

te

are

n

passage

subprenc

n

ocated

woud

not

traverse

between

te

te

o

ar

space

omenta

te

va

superor

sory

to

cent

te

an

A.

to

te

ar.

ste

B.

he

pevc

cavty;

rectouterne

ar

woud

pouces

not

328;

most

N

key

ere

ovar y

pont

erect.

be

pouc

n

te

or

(o

are

te

lud

accumuate

wen

lud

mesovaran

ocated

on

accumuate

Dougas)

te

because

t

patent

s

a

woud

accumu-

gament

posteror

causes

aspect

o

o

s

ntmate

extends

and

ts

“te

con-

rom

coon.

penetraton

pertonea

wa,

omen-

transverse

o

aso

uterus.

285

stomac

te

te

rom

abdomna

n

te

between

mesentery

te

te

requre

enter

were

separated

omentum

beow

to

s

o

pertoneum

o

cavty

te

and

mesentery”

vesse.

Atoug

relect

te

omenta

apron

or

adequate

expo-

omentum

ordnary

structures

requre

w

an

not

ABR/McM

rom

o

bers

t

woud

ncson.

provde

access

to

are

pan

are

because

239

coecystts

te

toracc

spna

neror

stmuated

o

te

s

ange

generay

spancnc

nerves

generay

o

rom

by

te

te

T5

nerve.

proxmty

provde

souder

spna

prmary

T1–T4

te

T4

E.

to

to

264;

upper

C5–C8

to

254

pevs

Addtonay,

because

to

ABR/McM

ocaton

rectouterne

owest

te

nerves

to

spna

upper

vscera

wt

284;

ayer

te

pouc,

cavty

poston.

ocated

nes

te

suprarena

Morson

ABR/McM

woud

between

rgt

to

hese

T9

sen-

gabadder

o

te

adja-

te

sensory

nnervaton

sensory

nnervaton

area.

provde

upper

mb,

to

te

eve

o

te

and;

C.

and

C3–C5

to

ascendng

o

structures.

to

coons.

vescouterne

or

rom

troug

te

bers

o

regon

greater

Neter

to

accumuaton

and

as

and

gament

angs

pan

hese

nlammaton

bursa.

neror

te

to

atera

vesse.

N

te

posteror

accumuate

atera

to

scapua.

ocated

dapragm

aow

structures

s

285

387;

Reerred

reerred

space

An

D.

hese

afected

s

uterus

greater

greater

not

lud

neror

superor

ocated

pertonea

pertoneum

te

and

stuated

supne

pouc

necessary

woud

GAS

108.

te

350;

he

ocated

coons.

o

known

doube

N

s

kdney

te

trombosed

te

E.

n

pertoneum

o

be

o

C,

te

atoug

s

B,

a

eum

te

probaby

t

n

s

rgt

and

pertoneum

sure,

patent

rectouterne

standng.

aso

curvature

te

ste

recess

broad

porton

to

we

te

communcaton

te

are

descendng

s

vscera

nterrupton

te

by

te

organs.

greater

porton

and

as

te

apron

epatore-

patent,

wen

te

tese

spaces

badder

space

gutters

key

space

381–382;

wt

Access

accumua-

potenta

supne

te

a

te

coect

pareta

pareta

vescouterne

be

ABR/McM

te

woud

te

or

coect

not

t

cav-

regon.

coons.

he

quadrant,

he

tact

s

recess,

ovares

wereas

spaces.

standng

ate

o

ver.

descendng

he

ocated

n

276;

uceraton

paracoc

E.

E.

subprenc

nto

ts

te

pos-

pertonea

grooves

not

predctabe

communcaton

C.

D,

N

wa

n

s

subprenc

neror

woud

recess

can

GAS

D.

and

deepest

known

pertonea

between

or

and

dapragm

paracoc

bot

hs

te

vescouterne

te

ambuatng.

aspect

o

stomac

open

or

rgt

surace

D,

te

rgt

spaces

woud

pouc

provde

uprgt

he

and

ts

te

he

n

o

patent

and

urnary

107.

abdomna

are

ocated

te

ocated

wtn

te

potenta

accumuaton

tey

A.

space

n

D.

gand.

pouc.

s

descendng

are

lud

aows

ovar y

subprenc

sde

he

te

gand.

pertoneum

cavty

te

epatorena

lud

suprarena

hs

o

ocatons

ver

271

pertonea

Atoug

gutters

supne.

touterne

o

ts

accumuate

and

te

space

reac

paracoc

are

n

he

nor-

rgt

ascendng

wen

s

pareta

and

n

approprate

may

ascendng

recesses

coect

deepest

te

kdney

Accumuaton

te

w

and

space

subprenc

te

Fud

na

rgt

dapragm.

ty.

he

ver

owest

ordnary

rgt

ver

s

te

te

patents.

w

te

lud

rgt

ver.

tese

kdney.

ABR/McM

he

te

te

rom

gament.

te

te

te

B.

eac

317;

C.

to

wa.

bud

broad

pouc.

te

structure

addtona

urnary

o

between

ts

acts

te

ureterc

between

recess

supne

106.

a

B. he epatorena pouc (or recess or space o Morson)

s

105.

cause

between

deveops

uracus

373–374;N

woud

secton

n

embryonc

ureter

orm

Faure

rom

resutng

te

a

tat

resut

abdomna

durng

one

not

to

ureter.

s

ndgut.

woud

umbcus,

E.

orgn

and

Persstent

bud

te

septum

mesencyma

aantos

o

bers

reerred

T10–T11

vaton

to

nerves

provde

toracc

or

pan

spna

te

wa

pan

rom

are

te

nerves

abdomna

sensory

and

nnervaton

meda

generay

arm;

T1–

assocated

eart.

provde

wa

at

sensory

te

eve

nner-

o

te

umbcus.

GAS

109.

A.

he

340,

empoyed

gated.

358–364;

Prnge

wen

he

N

309;

maneuver

a

epatc

s

artery

epatoduodena

ABR/McM

a

surgca

as

been

gament

s

246

tecnque

accdentay

camped

of

CHAPTER

to

prevent

proper

te

passage

epatc

artery

o

bood

and

te

low

troug

epatc

porta

bot

Right

te

he

Kocer

maneuver,

n

wc

te

ead

oten

o

te

pancreas

empoyed

to

are

expose

relected

common

and

arrest

iliac

te

neror

vena

to

a

te

et,

inter nal

iliac

ar ter y

s

emorrage

he

Vasava

sage

o

ar

toracc

D.

he

maneuver

wt

Hemc

compressons

oregn

E.

te

pressure,

Puttng

stop

a

major

te

rom

camp

te

ods

to

stoppng

to

cougng

bud

or

te

te

up

inter nal

iliac

ar ter y

pas-

ntra-

sarp,

regon

rapd

to

expe

tracea.

te

porta

but

te

ar ter y

vocazaton.

nvoves

xpsterna

on

beedng

njury

or

maneuver

o

bodes

nvoves

voca

as

rectal

cava.

Right

C.

ar ter y

ar ter y

Superior

rom

iliac

duodenum

Left

and

common

ven. Left

B.

165

Abdomen

3

epats

coud

woud

certany

numerous

not

produce

vascuar

eements

tere.

GAS

110.

A.

he

te

304;

most

et

coc

mesenterc

N

artery.

te

O

ony

o

te

ABR/McM

source

artery,

deveopment

coon.

276;

key

wc

a

emorrage

branc

o

dvertcuar

end

sacs

coces

suppyng

247

ts

s

Coonc

bnd

seected

artery

o

a

rom

te

o

s

wa

coc

te

rom

neror

dsease

te

et

porton

te

s

te

o

te

artery

s

descendng

coon.

B.

he

mdde

mesenterc

C,

D.

he

coc

artery

superor

artery

and

and

s

a

branc

suppes

neror

te

o

te

superor

transverse

recta

coon.

(emorroda) Inferior

arteres

suppy

te

rectum

and

ana

Inter nal

E.

he

et

spenc

te

D.

350;

Murpy

and

na

artery

stomac

GAS

111.

gastro-omenta

o

rgt

costa

deepy.

295;

sgn

te

s

Fg.

It

a

s

specc

n

gabadder:

causes

greater

sarp

te

pan

Middle

o

to

Rebound

deepy

te

under

to

112.

apped

pressure

ton

te

on

body

and

upper

B.

he

s

rgt

te

ects

C.

he

o

not

experenced

qucky

specc

ndcatve

test

o

rom

to

a

areas

probems

n

s

generay

lexng

to

appendx

used

te

te

s

to

te

obturator

a

nternus

postve

test

cecum

to

and

ts

dagnose

musce

wt

te

Coug

s

woud

assocated

assocated

wt

rses

GAS

340;

N

330,

te

and

not

wt

n

309;

be

present

ernas

and

ntra-abdomna

ABR/McM

246

to

te

esser

ts

o

to

area

te

te

and

s

te

te

pont

requre

extends

to

at

transverse

owest

wc

wc

stomac

epatogastrc

occurs

and

woud

gament,

omentum

sac

gament

trave

gastrococ

stomac

vdes

entry

musce

not

appen-

provde

B,

D.

because

t

probems

pressure.

ana

best

and

E.

o

entry

te

por-

rom

te

transverse

epatoduodena

ga-

ng

tat

te

pectnate

te

esser

access

N

o

275;

te

duodenum,

gament

but

because

neror

tese

t

pro-

ts

does

aspect

carcnoma

were

gaments

te

esser

ABR/McM

carcnoma

o

to

nodes.

musce

resuts

ne

te

omentum,

pont

exposure

nguna

te

he

o

o

s

not

te

4.60).

skeeta

tat

cana.

te

part

epatogastrc

T ransectng

300–306;

s

rst

te

exposure

Fg.

adequate

Superca

suggests

te

eicent

(GAS

C,

GAS

113.

troug

te

sac

and

Dvdng

most

provde

not

current

te

esser

pressure

woud

woud

Access

greater

he

o

gastrococ

curvature

spncter

tenderness

generay

te

rrtaton

patent’s

pont

te

o

symptoms.

E.

4.92

te

dagnose

opsoas

nlamed,

used

ar ter y

Fig.

ments attac between te ver and te esser curvature

A,

s

rectal

GAS

te

pan.

sgn

sac.

te

coon.

oca-

o

o

greater

wen

o

Beedng

esser

respectvey.

pressure

te

obturator

ect

s

because

appes

Wen

pan

removed

It

not

s

owest

troug

wt

quadrant.

appendcts

dx.

s

body.

opsoas

group

he

coon.

te

breate

patent

D.

ntersecton

ds-

ton

tenderness

ar ter y

detect

abdom-

dagnose

patent

n

to

rgt

coecystts.

A.

pudendal

te

curvature

desgned

upper

used

asks

ar ter y

249

pressng

one

rom

•

test

te

casscay

margn,

hs

te

arses

4.92).

ABR/McM

probems

quadrant.

eases

suppes

(GAS

N

dagnose

and

artery

rectal

cana.

te

o

s

he

te

most

externa

ana

cana.

support

key

squamous

not

240

orgnatng

bopsy

w

sac.

rom

te

occurred

ces

o

ana

hs

te

nd-

beow

te

ana

166

C H A P T E R

3

Abdomen

Hepatogastric

Hepatoduodenal

ligament

ligament Liver

(retracted )

Lesser

omentum

Lesser

cur vature

of

the

stomach

Gallbladder

Stomach Omental

foramen

Duodenum

Ascending

colon

Descending

•

cana

are

ound.

superca

A.

he

te

he

he

o

o

pevc,

deep

te

GAS

114.

A.

he

Beow

w

o

te

drans

to

D.

te

E.

nodes

dran

te

pens

superca

ymp

superor

dran

and

te

nto

te

te

ower

115.

te

B.

some

o

o

te

superca

above

ac

te

nguna

pevc,

superor

lows

recta

nto

ac

and

nodes

deep

aspect

o

nodes,

te

prmary

pernea

te

umbar

rom

nodes.

s

draned

wc

Sdng

A

zed

te

ower

anayzng

te

GE

te

te

juncton

ernas

do

ernaton

owever,

s

te

pens,

dran

recevng

nguna

nodes.

281

juncton

esopagus

GE

s

dspaced.

can

juncton.

dspaced

not

be

In

car-

sdng

superory

possess

116.

B.

he

spaces

te

372;

N

ver

rgt

and

te

te

GE

ernas

265;

acorm

nto

erna

o

te

medastnum,

GAS

by

o

paraesopagea

by

tnum;

(or-

eventuay

superca

te

dran

prmary

and

ABR/McM

ernas

GE

nodes

ctors

te

390;

nodes

ne.

nto

medastnum.

C–E.

cana

structures.

rectum

ymp

dran

ymp

te

rom

N

ymp

pectnate

a

norma

GE

juncton.

te

nodes.

ana

te

ernas,

by

te

o

paraesopagea

externa

mdde

sdng

ernas,

te

A.

nterna

aso

514;

acterzed

gands

nodes.

rectum

In

nguna

to

nguna

Dapragmatc

234

ympatcs

te

dran

receve

nguna

neror

nto

ne,

dran

structures.

nodes

ABR/McM

dran

pectnate

prmary

pernea

ymp

o

deep

gands

GAS

nodes

268;

superca

superor

he

te

nodes.

deep

and

he

area

nodes.

he

he

N

ne

prmary

mb,

C.

prmary

nodes.

ymp

nguna

514;

te

zonta)

ac

and

ympatcs

pectnate

B.

cana

4.60

rectum.

ctors

ymp

ac

recta

te

externa

mb,

E.

nterna

mdde

aspect

C.

ana

ymp

Fig.

he neror rectum above te pectnate ne drans

nto

B.

he

nguna

GAS

colon

but

et

te

te

nto

caracter-

te

remans

undus

antrum

medas-

xed.

ernates

does

In

nto

not.

270

separates

recesses

anteror

generay

juncton

ABR/McM

gament

and

s

stomac

and

abdomna

te

subprenc

extends

wa.

between

Because

o

CHAPTER

ts

ocaton

te

oter

A.

and

spread

o

across

he

te

round

remans

margn

te

C.

o

o

te

E.he

te

te

and

te

acorm

to

te

te

to

117.

A.

he

ror

te

to

speen

te

most

B.

he

C.

he

he

pancreas

A

te

te

s

GAS

373–374;

B.

he

rom

urnary

he

na

te

te

umbar

N

o

sde

get

o

rbs

te

rectum,

esser

toug

A.

gaments

stomac,

ver

It

B.

te

twet

rb.

C.

t

o

to

ocated

te

E.

tent

n

te

kdneys

121.

te

ocated

on

n

te

nto

at

dran-

scrotum

cavtes,

te

dran

anteror

o

he

terc

ymp

GAS

119.

C.

he

te

te

and

trd

nate

coud

N

part

o

o

ready

nto

te

neror

390;

o

te

te

across

te

duodenum.

pancreas

afected

and

by

a

at

As

rom

te

te

L1

anteror

te

t

crosses

duodenum,

tumor

n

te

te

mmedate

B.

he

assocated

he

te

curvature

common

te

trd

he

wt

ead

o

o

creas

te

epatc

part

o

te

suppes

pancreas,

artery.

and

hs

s

and

a

artery

porta

ven

E.

over

te

does

greater

o

not

te

cross

bot

porton

te

o

te

artery

dent-

vesses.

te

nterna

uterus

and

te

rom

te

umb-

enters

te

oramen

pevs

and

ateray

at

term-

te

pe-

emaes

near

ABR/McM

te

te

o

passes

wa

o

and

can

te

ovary

ovary

or

brm.

undus

most

o

or

nto

key

te

te

be

o

can

ga-

troug

eadng

ead

vomtng

ndcatve

Gastones

coon,

possby

coud

te

te

pevc

be

gabadder

ten

hs

te

ntestne.

transverse

te

o

271

regon

arge

rom

gament

te

duode-

entrapped

to

an

predctaby

experenced

ntes-

to

by

te

te

and

as

A.

he

te

coud

dstay

unkey

cear

out

te

te

pass

as

reey

te

tat

troug

eoceca

tey

junc-

woud

accu-

jejunum.

resuts

(ndcated

te

be

stes

o

duct

suggest

by

or

duodenum,

tat

te

presence

o

epatc

obstructon.

woud

ts

te

common

gastone

gastones

330,

340;

costa

he

and

pass

woud

te

runs

n

tereater

not

be

te

ste

ocated

s

a

provde

varous

te

te

promnent

o

anteror

wtn

wt

upper

pont

te

o

248

semunars

rgt

te

quadrants

ocaton

nea

te

wt

parae

and

ABR/McM

rgt

wt

undus

vscera

seat

te

cartage

anatomc

semunars

309;

o

typcay

gabadder

rectus

N

ntersecton

nnt

tures

be

potenta

assocated

te

ar

bockage.

GAS

122.

as

are

rue

Because

o

gastones

a

contact

useu

body.

too

or

or

struc-

he

border

andmark

o

abdomna

anatomc

atera

wt

quadrant

nea

o

te

surace

anatomy.

ead

ead

te

rom

be

pevs.

ven,

radograpc

trees

understandng

branc

to

gament,

woud

te

wa.

pancreatcoduodena

te

n

he

te

duode-

n

te

woud

duodenum.

duodenum.

superor

suppes

second

rst

artery

te

posterory

and

te

te

stomac

epatc

part

and

te

o

te

posteror

courses

and

duct

gastroduodena

num,

C.

be

to

surgca

uterne

must

uterne

ven

ac

juncton,

te

troug

s

and

are

B.

D.

unc-

artery

nto

body

t

bary

o

area.

A

and

vertebra

ts

rom

stone

muate

aorta

surace

te

arses

te

suspensory

317;

ntestne

ton,

mesen-

te

ven

crampng,

duct

arses

te

scatc

nterna

obstructon.

te

281

artery

pancreas,

nerory

te

be

ABR/McM

artery

umbca

eoceca

ar)

mesenterc

neck

passes

process

drans

te

Because

nodes.

superor

bend

eve,

514;

coon

meda

patent.

C

sgmod

o

durng

and

arses

pudenda

troug

he

te

exter-

aspect

by

cervx

dorsa

n

greater

N

te

and

o

pan,

and

nto

part

248

gaton

crossed

passes

vesca

te

pan

badder

A.

ocated

o

n

ucerate

prostate,

te

380;

Pan

tna

te

second

mmedatey

gatng

anterory

gonada

md-

aorta.

E.

B.

num.

receve

to

artery

nundbuopevc

263

nodes

and

ABR/McM

te

wen

te

n

way

reerred

dran

te

wa.

he

wa

woud

s

to

recta

nterna

rbs.

at

wt

stuated

ureter

superor

artery

by

rbs.

uterus,

artery

vc

nodes.

ymp

ac

troug

to-

body

295;

subject

atera

avoded

GAS

te

he

so

mdde

he

njured.

sde

N

oten

he

he

be

processes

to

and

353;

structures

are

or

nates

wtn

assocated

rectum.

supe-

woud

respratory

cana

abdomnopevc

nodes

nc

ed

omentum.

te

rb,

te

ureter

ca

ABR/McM

te

o

probems

twet

ymp

area

343,

procedures.

an

and

meda

ac

bare

and

o

rgt

o

ana

rom

ver.

more

duodenum.

Vascuar

te

gaments.

9–11.

beng

te

311;

te

ree

D.

njured.

twet

to

te

te

te

rbs

wt

more

o

120.

badder.

testes,

to

te

254

predomnanty

nterna

te

to

eve

nguna

age

orm

eve

on

eevent

magnancy

superca

tereore

te

te

ascendng

competey

te

n

epatogastrc

et

to

te

te

body

o

and

C.

around

eve

A

te

rom

es

o

te

te

at

ocated

and

de

D.

s

stop

to

obterated

es

duodenum

tey

organ

and

encoses

and

assocated

resut

ver

to

sde

te

surace

ABR/McM

ocated

es

ven

s

gament

adjacent

above

pan

woud

118.

are

cavty

serve

one

tranguar

te

under

common

wt

E.

es

kdney

he

284;

kdneys,

ungs

racc

D.

N

ver

neror

gament

orms

ver

328;

te

umbca

respectvey . T ogeter

GAS

woud

rom

GAS

o

epatoduodena

attac

t

abscess

mdne.

coronary

ver

an

gament

umbcus

he

D,

attacments,

suc

167

Abdomen

3

o

o

te

te

B.

he

ntersecton

o

te

pan-

rgt

ntertubercuar

pancreas

rgt

quadrant;

duodenum.

It

s

cse

ocaton

o

rgt

pane

owever,

te

s

semunars

stuated

ts

s

gabadder.

not

n

te

wt

te

te

upper

most

pre-

168

C H A P T E R

C

and

3

Abdomen

D.

te

he

trc

regon

porton

regon,

te

to

E.

te

he

s

te

not

be

407;

N

o

owever,

te

best

251;

musces

and

nguna

o

te

or

B.

stranng.

A

nguna

rng,

rng,

nguna

D.

not

a

key

ts

t

a

o

or

te

too

rgt

o

N

te

o

w

and

transversus

cose

of

te

contract,

te

te

weakness

as

or

o

vagnas

o

te

te

te

te

wen

nguna

externa

or

asca

o

Answers

126.

nterna

ABR/McM

pouc

he

te

a

or

n

te

Any

lud

or

asca

main

tse

nor

n

te

pouc

drecty

by

because

te

gangonc

te

ow-

wen

undergo

B,

C,

due

127.

D.

ts

ocaton

wc

does

n

not

te

tend

superor

to

et

to

o

E.

he

as

rgt

cavty,

epatorena

te

rgt

rom

te

he

vescouterne

ary

ocated

s

o

te

n

te

sgty

Dougas)

space

te

s

he

lud

broad

o

luds

N

350;

475;

dorsa

to

root

neurons

aspect

rom

s

a

A.

aso

ocated

o

tat

te

n

to

te

but

body

B.

t

(o

E.

C.

N

wa

ower

mb

target

to

adrena-

te

wc

and

are

te

bers.

te

to

send

cro-

nnervated

hs

embryoogcay

to

nor-

s

ten

tssue,

gand

are

wt

cases,

neror

L5

te

he

to

ac

s

post-

medua

and

vena

to

eve,

artery

tat

cava

can

te

n

tromboss

dranage

cause

mb

to

ven

tat,

o

o

extreme

n

te

some

mb

or

to

wc

et

and

s

ormed

common

ac

posteror

woud

be

to

by

te

vens

te

at

rgt

compressed

by

artery.

not

extend

vens

gonada

te

venous

te

passes

qute

wt

superory

te

o

o

venous

hs

woud

vens

et

neror

amputaton

and

testcuar

no

deat.

vens

neror

s,

cava,

o

tese

deep

rgt

ac

rena

o

receves

268

passes

Compresson

tat

ead

gand

nnervaton.

ven

vena

vertebra

because

o

scema

can

eadng

o

suprarena

obstructed.

te

mbs.

runnng

Unke

gangon

ABR/McM

mb;

s

ng

and

n

sympa-

ndcated

durng

sympatetc

types

cause

togeter

he

he

may

te

bodes

bers

cut

mgrate

artery.

te

ce

ound

not

nnervaton,

ces

tat

322;

o

jon

ven

ar

pass

te

compromsed

te

above

kdneys

te

atera

rgt

te

be

rom

to

te

gonada

neror

termnatng

te

area

ven

vena

n

to

bockage.

cava,

te

et

o

pass-

and

rena

ven.

E.

a

s

catecoamne-secretng

te

ac

obstructon,

pouc.

to

common

prevent

285

contan

are

medua.

suprarena

neurons

common

patway

gament

tends

sm-

pouc

te

vescouterne

ganga

te

cromain

394;

et

he

on

pregangonc

et

ower

te

abdomen

uterus,

and

broad

s

te

222

be

sympatetc

bers

enargement

and

t

a

and

unon

abdomna

rectouterne

ABR/McM

rom

te

recess

rom

te

te

o

porton

gament

n

Morson),

s

to

postgang-

cord

sympatetc

synapse

recognzed

gangrene

cavty.

te

by

(o

space,

badder

separated

GAS

sensory

ower

superor

and

coecton

he

pevc

urnary

eakng

uterus.

subepatc

posterosuperor

ar

between

pouc

axons

by

pregangonc

L2–L4

woud

suprarena

o

ocaton

te

te

lud

spna

o

sympatetc

n

common

ts

abdomna

coect

musce.

(T5–T9)

dferentaton.

D,

he

n

space.

o

ces

untreated

o

eart

nerve

ormed

ABR/McM

gand

postgangonc

ndrect

accumuaton

neror

s

te

ganga

306;

te

synapse

GAS

rectouterne

dependent

N

tey

rst

cavty

and

sympatetc

contans

pregangonc

nguna

abdomna

s

o

and

root

suprarena

ectomy

232

Dougas)

abdomnopevc

uprgt.

sette

(o

vscera

spancnc

126–150

A.

route

deects

postgangonc

bodes.

311;

ma

by

dorsa

appendcts

deep

ernaton,

or

ce

dorsa

wtn

te

o

te

neurons.

orn

T1–L2

ces

transversas

ormaton

transversas

o

sympatetc

GAS

attrton

deep

n

part

egress

at

trave

contans

te

wc

atera

n

o

toracc

onc

he

pos-

wen

suc

E.

ax

ower

trunk

gands

he

tetc

and

pertoneum,

emae

most

and

gangon,

pan,

te

o

C.

227

orm

appendx

pregangonc

ceac

eves

and

te

T8–T10.

greater

because

known

D.

he

men-

te pevs wen te body s n te uprgt poston.

125.

musce

B.

anatomc

as

rom

o

sympatetc

he subprenc space woud key not coect lud

and

D.

he

oter

264;

te

bers

ganga

sympatetc ce bodes tat are targeted to smoot

atera

genera

keood

o

to

te

te

sttng

te

cavty,

B

A.

musces.

298;

cavty

beng

A.

o

rectouterne

standng

s

to

expanson

eature

o

aponeuroses

recess

root

ernas.

weakness

est

and

and

Hessebac)

wa

stretcng

s

GAS

te

gabadder

cana

Gradua

contrbute

s

he

to

correct

obque

processus

or

Weakness

obque

te

te

(o

provdes

patent

can

C.

Aferent

erna.

wt

tere,

and

trange

musces

s

down

abdomna

nguna

and

C

te

nguna

cougng

A

ver

superor

aponeuroses

moves

tese

to

epgas-

ypocondrac

stuated

ABR/McM

o

wa

drect

te

rgt

ts

abdomna

wc

o

te

answer.

teror

te

o

superor

o

carres

quadrant

ocaton

earer;

nterna

musces

he

ocated

ngunas,

o

ocated

porton

regon

regon,

rgt

or

abdomns

124.

et

s

contents

gabadder.

woud

GAS

he

stomac.

anatomc

upper

he

te

te

te

toned

E.

are

o

regon

regon.

epgastrc

regon

123.

epgastrc

umbca

he

rgt

aong

mon

te

ac

common

pevc

ven

ac

brm

to

to

orm

ven

unte

te

passes

wt

neror

superory

te

vena

et

com-

cava

and

CHAPTER

woud

not

common

GAS

128.

D.

be

268;

N

bers

are

bodes

taned

295;

B,

C,

aso

run

E.

B.

he superor mesenterc artery does not e drecty

te

organs

te

sympatetcs,

vscera

and

he

bers

ter

D.

he

aferent

gangon.

sympatetc

gangon

are

ce

es

con-

axons

E.

but

do

not

te

131.

E.

A

s

te

ts

na

vaga

No

ganga

eves

nerves

wtn

E

are

te

rom

wa

are

termna

sympatetc

wc

run

GAS

he

359;

N

ureter

sympatetc

310;

s

te

gangon

A,

C.

ocated

Answers

not

bodes

C

ncude

and

ter

o

B.

and

key

at

tese

L1

eves.

ventra

abdomna

anteror

A.

he

ramus

wa

dermatome

B.

he

because

GAS

para-

D.

he

ment

rom

skn

T12.

branc

te

o

ac

te

crest

o

ng

te

t

to

te

be

E.

skn

at

te

It

as

nerve

t

nnervates

to

we

and

as

s

a

aso

abdomna

parae

skn

branc

may

over

wt

te

o

T retz)

pubc

L1

and

he

te

obturator

133.

E.

cord

spna

atera

nerve

eves

cord

contans

and

eves

and

nnervates

tg.

286,

bers

nnervates

rom

te

L2

to

adductors

L4

o

Peroraton

commony

N

o

a

damages

he

posteror

s

branc

orgn

but

rom

321;

posteror

te

o

te

230

duodena

gastroduodena

superor

te

ABR/McM

ucer

pancreatcoduodena

gastroduodena

common

epatc

most

artery

artery.

B.

artery

near

ts

te

duo-

duodenum

pertoneum,

contents

ucers

and

nto

te

perce

penetratng

te

ucers

posterory.

posteror

not

key

artery

superor

E.

artery

he

s

to

be

crosses

duodenum

a

o

he

musce

pan-

damaged.

te

trd

anterory

posteror

branc

o

or

and

s

neror

te

supe-

used

as

and

to

a

duodenum

te

te

(ga-

rgt

crus

o

te

ourt

part

o

te

juncton.

papabe

hs

ga-

andmark

dur-

o

N

o

cecum

te

to

treat

are

hs

respratory

te

cavty

ead

to

he

muscuature

symptoms

o

n

cases

bands

o

as

a

can

te

o

be

ntes-

common

244

contents

erna),

deect

dstress

between

o

te

can

to-

com-

mpar

and

ung

te

most

can

te

ods

nto

ung

cyanoss.

peuropercarda

communcaton

peura

used

abdomna

peuropertonea

abdomna

o

cannot

4.69).

te

sde.

te

hese

not

ABR/McM

o

to

marotaton

dapragmatc

et

arteres,

and

duodenum

ntestne.

Fg.

uson

absence

te

bands

271;

varabe

andmarks.

te

(GAS

mesenterc

gy

obstruct

dvded

te

te

neror

are

connect

causng

te

o

duodenum.

246

duodenojejuna

Ladd

te

te

rom

attaced

reabe

(congenta

on

to

ABR/McM

recta

ernaton

and

artery.

o

surgeres.

can

310;

uncton,

A.

s

te

bands

cause

381;

as

and

Faure

mony

tg.

GAS

a

L3

te

used

GAS

rax

and

over

are

orgnates

vasa

andmark

nguna

sympyss.

stomac

posteror

superor

te

tne,

rom

L2

he

surgcay

bers

musces

te

o

anterory;

te

291;

commony

wa

cause

skn

s

Ladd

T12

te

receve

ayer

damaged.

suspensory

marotaton

atoug

be

N

abdomna

and

majus.

nnervates

he

Peroratng

and

o

passes

312;

o

A–C.

ower

eve.

superor

spna

C.

a

musces

rom

abum

s

tere-

nerves

he atera emora cutaneous nerve contans bers

te

A.

te

skn

nerve

ramus,

gament,

E.

te

Genera

to

246

wa

and

proper

porton

stomac.

ntestna

or

and

ror mesenterc artery and s not key to be damaged

axons,

T11–L2;

reerred

nerve

nnervates

oypogastrc

ventra

D.

o

subcosta

t

be

sac.

pancreatcoduodena

132.

eves

w

onguna

and

and

portons

he

cord

bers

te

te

pyorc

pertonts.

a

artery

artery

rom

te

anteror

mesenterc

to

ment

spna

by

aow

part

patetc

tese

aong

te

cause

duodenum

superor

not

post-

and

pexus.

te

at

rom

be

damaged.

o

gastroduodena

orzonta

or

252

ureterc

he

he

gangon.

sympatetc

to

n

stomac

duodenum

rom

to

creatcoduodena arteres e posteror to te rst part

or

upon,

or

vscera aferent bers n te ureterc pexus oow sym-

bers

te

key

mesenterc

ABR/McM

duodenum

and

pan

n

by

not

brances

runs

ucer

pertonea

te

be

artery

291;

woud

dapragm

ore,

bers

te

perce

parasympatetc

ceac

s

pancreatcoduodena

to

and

anterory

duodenum

passng

para-

do

ABR/McM

nnervated

bers

postgangonc

organs.

ce

troug

wtn

nerve

wtn

tey

and

superor

curvature

N

key

eroson

greater

abdom-

spna

ganga

target

because

gangonc

aso

no

te

esser

covered

an

preaortc

present

at

he

extensons

te

o

cord

Postgangonc

o,

ncorrect

are

a

aferent

spna

runnng

gangon.

are

wtn

bers

vscera

te

bers

troug

te

here

bers

pexus.

arse

n

run

motor

aso

reac

T5–L2.

ceac

and

Runnng

are

to

sympatetc

te

trunks

somatc

gangon.

superory

nerves

parasympatetc

gastrc

artery

312;

s

te

neror

peroratng

gonc

parasympatetc

rgt

GAS

neror

rom

ar

epatc

nerves

synapse

too

he

pass

o

parasympatetc

gangon

duodenum

posteror

brances

(oregut).

Pregangonc

troug

and

ceac

te

damaged.

denum

pexus.

130.

et

wtn te gangon; tereore, tere are no postgan-

rom

C.

te

271

postgangonc

ceac

abdomna

pregangonc

129.

and

wtn

te

and

by

beneat

ABR/McM

postgangonc

wtn

upper

A,

compresson

parasympatetc,

present

o

to

artery.

Pregangonc

pregangonc

to

subjected

ac

169

Abdomen

3

od

woud

percarda

and

woud

sac

not

descrbed.

te

dapragm

s

derved

rom

te trd to t cervca myotomes. Absence o mus-

cuature n one a o te dapragm (eventraton o

te

dapragm)

woud

cause

paradoxca

respraton.

170

C H A P T E R

3

Abdomen

135.

A.

he

eum

suppy

rom

promsed.

rom

te

creas.

It

denum

te

te

to

root

hs

brances:

te

te

o

te

ar ter y

neror

com-

ar ter y

neck

trd

ar ter a

s

o

par t

o

te

pan-

te

duo -

mesenter y

gves

arses

bend

orgn

to

te

pancre atcoduodena

recta

coc

m dde

ar ter y,

coc

and

ar ter y,

eococ

ntestna

ar ter y,

ar teres.

he

rgt

eoc oc

arcades

ar ter y

rgt

A

descends

and

ar ter y,

ends

na

do

eum

not

s

he

(o

arsng

arse

te

rom

he

tc

by

toward

ascend ng

ceca

t e

ea

te

coc

ar te res ,

brances.

anastomoses

rgt

te

speen,

by

rom

atus

GAS

coon

s

te

he

term -

brances,

wc

wt

supped

anoter

354;

neror

N

te

o

and

te

abdomna

te

major

margna

arsng

et

mesenterc

stomac,

te

and

by

possesses

artery

artery

brances

te

o

wc

coc

mesenterc

supped

arcades

ea

Drummond),

o

superor

C–E.

te

posteror

and

supped

transverse

moses

recta

p ertoneum

 nto

vesse.

artery

Vasa

and

any

te

dvdng

ar ter y,

ave

source

B.

bend

by

anteror

appendcuar

Ar terial

across

coon.

wen

ar ter y

mesenterc

posteror

enters

 scemc

mese nterc

sup eror

aor ta

an d

ar ter y,

Ar terial

he

transverse

become

superor

descends

oow ng Vasa

can

te

anasto-

rom

coc

artery.

duodenum

ceac

aorta

just

te

artery

are

trunk,

beow

a

wc

te

aor-

dapragm.

294;

ABR/McM

248

B

136.

•

GAS

Fig.

4.69

A.

he

troug

te

(o

C.

he

to

te

not

D.

downward

eongaton

key

Faure

woud

te

to

o

C.

ead

te

cause

373–374;

Morgagn

deects

n

erna

te

s

te

xpod

dstress.

sarp,

epgastrc

A.

oter

due

be

B,

D.

to

near

In

patent’s

o

not

N

200;

and

tat

can

t

be

a

ts

can

cause

posteroatera

xpod

case,

deveop

o

wt

270

are

can

s

due

to

Morgagn

just

atera

cause

A

congenta

te

can

o

stomac

be

ta

to

as

wt

te

smar

ernaton

barum

process

woud

and

372;

ata

by

a

he

to

omenta

not

but

and

not

woud

200;

C.

test

rues

out

erna

nto

occurs

te

present

between

part

cavty

esopagus.

hs

te

E.

he

and

o

and

type

as

xpod

vens

te

bood

dated.

woud

270

GAS

s

aong

te

In

pass

gas-

por-

reey

trbutares

he

be

o

wa.

cannot

normay

t

oramen

ocated

parts

anastomose

are

passage

communcate

body

porta-cava

hese

key

te

o

to

be

o

s

and

superor

wt

te

trbutary

te

as

rst

and

para-

to

te

afected

Retzus

suppy

to

serum

woud

ead

due

woud

te

to

porta

not

resut

354–357;

N

s

ven.

artery

coud

te

t

ernaton

n

resut

te

n

concevaby

gabadder

woud

bood

to

Wnsow);

epatc

but

o

n

and

ver.

jaundce

brubn.

jons

te

route

posteror

epatc

proper

compresson

orm

te

s

(o

compressed

gament

o

man

and

oramen

te

vens

duct

te

atrum

oramen

bood

cystc

to

cava

rgt

ncreased

ts

te

become

vena

te

duct

duct

are

and

wt

be

to

an

te

duct.

common

296;

epatc

Compresson

nlamed

(coecystts).

margn.

ABR/McM

wen

toracc

o

porta

(eppoc)

dmns

Be

was

ts

because

(eppoc)

Retzus

vens

wc

Compresson

D.

omenta

o

n

gament

retropertonea

and

epatoduodena

esopagea

compressed

ypertenson.

return

sev-

te

ven.

neror

daton

sortened

not

costa

N

vens,

o

and

ver,

porta

te

vens

epgastrc

porta

B.

a

symptoms

tract

anastomoses

epatc

s

abdomna

ypertenson

ter

n

he

te

te

ven

o

trbutares

troug

process.

ernates

caused

erna

GAS

between

resp-

perceved

conused

border

o

umbca

probems; te negatve HIDA rues out coecystts

E.

sdes

porta

epatoduodena

Wnsow).

troug

erna

te

anteror

neror

ernas

severe,

te

te

trontestna

tendon

membrane.

commony,

pan

s

erna.

ABR/McM



and

assocated

retrosternay

and,

to

centra

normay

Bocdaek

ound

More

te

wa

due

condton.

transversum

absence

s

body

s

maades.

Bocdaek

s

posteror

process

ratory

era

te

peuropertonea

normay

dapragm

ts

dapragmatc

GAS

te

o

and

Bot

o

to

septum

an

dapragm

congenta

134.

mgraton

epatc

ABR/McM

246

o

gabadder

CHAPTER

Inferior

Right

phrenic

vena

Superior

cava

ner ve

epigastric

Central

ar ter y

tendon

Left

phrenic

ner ve

Esophagus

and

Inferior

171

Abdomen

3

with

posterior

anterior

vagal

trunks

phrenic Greater

splanchnic

ner ve

ar ter y

Hemi-azygos

LI

LII

Lesser

Least

LIII

Thoracic

vein

splanchnic

splanchnic

ner ve

ner ve

duct

LIV

Left

crus

Aor ta

Sympathetic

Right

•

137.

C.

a

A

dermatome

snge

spna

vscera

sensory

L1

L2.

and

reerra

A,

B,

o

E.

na

138.

E.

A

or

te

te

o

pan

gastone

306;

eus

rom

to

te

te

te

occurs

wen

4.143

C.

D.

segments

can

he

pancreas

and

portons

o

te

GAS

139.

A.

he

agus

te

by

owest

odged

supped

ceca

cts.

te

juncton

and

wt

were

be

reerred

entrance

woud

be

te

pan

o

to

te

to

te

or

and

eo-

append-

above

be

s

ducts

upper

and

pont.

B.

C.

D.

key

ste

or

gastone

surrounds

rate

te

o

te

pyorc

emptyng

duodenum.

entrance

o

o

orce

te

hs

stom-

ocaton

gabadder

s

contents

ntestne.

N

280;

ABR/McM

ntermedate

bood

o

by

suppy

242

portons

rom

tyrod,

coud

prenc

te

te

easy

Bronc a

te

obstructon

he

tree

o

te

esop-

brances

bronca,

and

et

esopagus,

et

gastrc

njure

ar teres

and

gastrc

beow

artery.

ts

o

te

esopagea

to

te

arteres.

he

dapragm,

Peroraton

to

s

ts

artery.

suppy

neror

ntercosta

do

he

not

rgt

a

te

he

sma

eve

neror

te

te

sect on

o

o

c ar na

t e

te

ntercosta

esopagea

rom

te

pyorc

proper

part

o

suppes

neror

to

te

te

343–344;

suppy.

epatc

te

porton

dapragm

4.143).

GAS

spaces

artera

esser

stomac.

prenc

just

suppy

to

arses

suppes

o

esopagus

Fg.

arteres

contrbute

gastrc

and

curvature

E.

any

and

neror

artery

pan

to

te

neror

part

and

quadrant,

proxma

nto

340;

esopagus

jon

scapua.

s

a

( T4).

te

obstructon

radatng

te

area

obstructon.

Vater)

An

and

rgt

bub,

duct,

ts

te

correcton.

(o

duodenum.

be

to

mmcs

surgca

te

n

exaggerated

ampua

nto

cap,

te

dsta

dsta

jaundce,

ocazed

be

pancreatc

cause

duodena

tat

w

requre

te

enterng

woud

woud

he

absent

woud

Obstructon

pan

sounds

epatopancreatc

beore

ere

regon.

produce

bowe

obstructon

he

ocaton

B.

can

However,

obstructon

hs

A.

eoceca

not

arteres; te ower porton o te esopagus s supped

and nto te duodenum. In ts case, gastones became

te

te

sma

upper

ucerates troug te wa o te body o te gabadder

n

to

330,

receve

aorta:

(coet)

s

spncter

contents

nto

te

abdom-

eum

contros

proxma

bad-

coon.

gastone

pyorc

ac

upper

urnary

he

and

cause

suppy

proxma

obstructon.

ts

101

a

Fig.

dermatomes.

descendng

ABR/McM

GAS

by

receves

spna

rectum,

suppy

supped

coon

T5–T9

ncudng

suppy

s

coon

descendng

segments

L3–L4

N

tat

correspondng

proxma

405;

skn

descendng

uterus. T10–L1

vscera

GAS

to

to

organs,

duodenum.

and

area

he

Spna

abdomna

der,

an

suppy

Injury

pan

D,

s

nerve.

trunk

crus

N

240;

ABR/McM

251

o

te

(GAS

172

C H A P T E R

140.

B.

3

Ker

speen

to

sgn

and

te

A.

Abdomen

top

s

o

s

a

te

et

Mttescmerz

an’s

menstrua

tures

C.

and

Rovsng

te

D.

sgn

der,

aso

he

opsoas

tons

s

o

w

E.

nerves

be

he

he

py

to

most

C,

D,

tons

142.

B.

he

neck.

s

E.

N

te

mdde

graaan

rom

ndcator

reerred

as

to

encountered

pan

pancreas,

s

te

o

tat

age

rup-

A,

D.

may

meda

291;

obe

o

are

te

rea-

contact

major

not

I

C.

ver

tomy

sgn

A,

s

and

spasms

te

o

common

rgt

rests

rse

drecton

pont

o

E.

o

low

o

a

o

a

on

epatc

most

te

he

cystc

cystc

D.

he

ree

epatc

can

upper

he

s

duct.

te

B.

porta

be

duct)

te

porta

he

tat

are

by

and

suc

tat

tres,

o

te

ven

o

330;

ducts

not

te

trad

and

spra

N

te

wt

te

duct.

dicuty

te

be

a

wt

o

as

s

omentum,

ven,

A.

te

epatc

tat

wt

te

artery,

a

to

te

gabadder

separate

te

rgt

te

s

branc

B.

and

and

be

to

tender

o

te

te

As

by

papaton,

rom

bowe

ave

te

pan.

bor-

bockage

usuay

te

mgt

bowe

stomac).

bowe

become

abdomna

bowe.

kdney

ncreased

caused

o

can

te

T ypcay,

by

borborygm

to

wt

tese

vascuar

ncudng

etc.

be

patent

and

as

245

compresson

ts

nterere

partcuary

sounds

te

neurec-

nerves,

vscera

ntay

mmedatey.

te

pan.

causes,

can

transmt

o

an

oow

musce

reduced

or

pertonts,

data

smpy

Crampy

pan

N

270;

ABR/McM

rom

te

262

neror

pancreatcoduodena

he

artery

te

(a

et

(a

branc

gastrc

o

te

te

ead

n

artery

o

hey

te

artery

ceac

o

and

not

and

te

te

common

neror

te

gastro-

epatc

pancreatco-

mesenterc

and

not

do

te

ceac

between

o

artery

artery).

are

derv-

anastomose

artery.

gastroduodena

common

woud

wen

epatc

mesenterc

te

pancreas

occur

te

te

superor

and

trunk

and

te

te

brances

dervatve

o

o

stuatons

anastomoses

trunk)

superor

cystc

trunk.

to

te

Suc

ceac

dervatves

troug

to

duodenum

pancreatcoduodena

o

he

suppy

te

epatc

typcay

rom

provde

artery

te

an

are

ceac

anasto-

moss between te ceac trunk and superor mesen-

terc artery (uness tere s an aberrant rgt epatc

branc

accessory

removed,

duct

tat

parayss

pertonts,

bowe

occuded.

wt

C.

256

ndvduas.

gabadder

epatc

s

o

duodena

and

unkey

many

or

to

ABR/McM

Increased

suppy

atves

conducts

pass

s

surgery

noted.

305;

bood

part

superor

duct.

are

been

Bood

rst

bary

Durng

a

ducts

D.

coe-

usng

rom

et

te

sarp

ver.

epatc

dssecton

Routney,

duct

are

not

he

rom

rgt

margna

cystectomy, te cystc duct and cystc artery are gated

and

not

atera

tckened

t

ntact

artery va te superor mesenterc artery can provde co-

tortuous.

and

gament

ABR/McM

n

te

potenta

ony

et

produce

target

want

essentay

generazed

GAS

146.

s

obstructon

bowe

abdomen

duodena

contact

structures

Luscka

present

artery,

be

to

vave.

hs

cystc

reaton

epatc

partcuary

(porta

oter

cose

tey

eak-

256

vscera

not

sounds,

Atoug

an

he

caracterzed

source.

ndcate

duct

potentay

woud

gament

esser

287;

te

nto

not

epats.

te

and

n

dicuty

comes

s

s

are

te

parasympatetc

njury,

owever,

absent.

nar-

determne

present

ter

eak.

not

bers

nnervaton

obstructons

trunk

te

and

o

compress

143.

not

coud

duct

epatoduodena

GAS

does

woud

310;

(bowe

te

nerve

pan.

rom

s

Mecanca

body

hs

o

durng

ABR/McM

are

and

N

spna

wtn

end

part

neck

unaware

patent,

and

ducts

not

woud

eradcate

eus

resut

obstructon

vara-

body,

coon.

patency

394;

It

stone,

artery

artery.

bnd

cystc

coud

cystc

duct

artery

edge

and

hs

tat

cause

constrcton

C.

be.

porta

key

to

One

Adynamc

externa

he

mantans

vave

o

te

be

E.

borygm

undus,

te

coon.

to

sup-

cateter.

houg

te

a

constrcton

nserton

A,

tat

actuay

D,

287;

vscera

B.

contans te spra vave (o Hester), wc s a redun-

not

o

woud

B,

N

aferents

motor

246

transverse

gves

s

gated

gaton

musce.

anatomca

epatc

te

and

hs

duct

smoot

cases.

rounded,

rowest

od

soud

provde

mesenterc

te

transverse

mucosa

epatc

o

artery

rgt

was

te

pertonts.

and

s

n

cpped

surgery

sensory

145.

epatc

s

18%

te

and

part

334;

Vscera

sensaton

any

psoas

259

n

or

and

proper

GAS

ABR/McM

wt

part

te

gated

be

pyscan

present

duct

cystc

GAS

144.

nodes,

wa.

and

n

be

te

were

pertonts.

appendx,

panu

tg

superor

conssts

undus

been

resut

he

wt

tg.

te

o

291;

gabadder

te

varaton

rom

orgn

N

cause

o

ABR/McM

duodenum

dant

he

sou-

mportant

postve

woud

I

Luscka

ave

durng

gabadder

ymp

not

E.

drecty.

o

sympatetc

sgn

hese

te

ducts

C,

ovary.

cecum,

a

wom-

rgt

abdomna

dseased,

a

rrtaton.

umbar

posteror

o

oce

te

cncay

ureters,

approxmatey

347;

n

te

te

dapragmatc

common

n

he

comes

ruptured

woud

reeased

musces

te

rgt

o

GAS

s

pan

to

te

orgnatng

occurrng

A,

n

342;

te

artery,

a

observed.

dects

B.

o

ntense

n

cnca

structures

adductor

GAS

radatng

wen

kdneys,

obturator

te

a

and

coon,

tese

o

by

occur

musce

te

sgmod

and

can

cyce

owng

to

ndcaton

souder.

ovum

nlammaton

141.

cnca

caracterzed

atera

E.

te

and

artery

suppy

superor

et

coc

o

to

te

te

mesenterc

arteres

coon,

neror

artery).

anastomose

but

ts

va

provdes

mesenterc

te

co-

artery.

he rgt and et gastro-omenta arteres anastomose

and provde coatera suppy to te greater curvature

o

te

stomac

but

are

derved

rom

te

ceac

trunk

CHAPTER

and

te

tus

GAS

147.

B.

he

pont

ncson

to

reac

abdomns

te

pareta

C,

to

D,

to

be

GAS

148.

D.

Iea

ng

n

o

E.

o

te

hese

389;

N

dsta

hus,

not

ve

te

s

as

t

wt

Answers

151–174

151.

he

separates

an

te

pen-

n

tat

n

B,

need

CT

D,

a

coc

men

ror

as

mportant

B.

compcaton

tat

he

Interna

o

te

te

B.

ana

C.

te

vens

o

te

edery

E.

Fg.

aortc

an

can

trbutares

proapse

o

nto

s

and

are

trombosed

externa

recta

ordnary

ntestne.

does

as

are

not

tey

prmary

beedng

created

pass

by

troug

n

te

o

afects

most

gas

A.

pexus.

outpoucng

hs

cause

sounds

an

trbutares

venous

and

315;

3.2

N

a

aneurysm

erect

280;

ABR/McM

CT

scan

wt

poston,

tat

pens

he

emorrage.

te

bood

I

w

te

be

abdomna

man

E.

stands

detected

n

ste

te

GAS

owest

A.

B.

space

he

between

te

superor

part

he

ace

na

te

space

te

ver

men

and

s

te

a

153.

pertonea

and

te

pouc

anteror

B.

to

and

A.

ver.

space

(pouc

pocket

and

n

cavty.

s

dapragm

o

pertonea

o

rectum

pertonea

epatorena

o

between

te

rgt

Morson)

te

posteror

kdney

and

s

a

he

recess

he

(pouc

ormed

te

subepatc

GAS

space

women

between

transverse

o

te

sgn-

expan

te

te

sur-

and

and

one

descendng

wc

most

key

suppes

occuded

rgt

an

coc,

and

coon,

anastomoss

mesenterc

artery

eo-

and

te

between

and

ne-

neror

wa

ower

dsta

ac

ne.

ncudng

umbcus,

mb.

nodes

dran

te

he

pevc

and

gans

and

ymp

externa

nterna

ac

structures

receve

o

receve

nguna

dran

nodes.

neror

te

uretra

nodes

structures

te

scro-

structures

trunk,

te

rst

ke

pectnate

to

superca

ac

te

pens,

dran

te

spongy

ymp

dran

o

o

te

aso

neror

ymp

te

to

nodes

are

structures

prepuce

quadrant

te

nodes

pernea

regon,

te

239

ymp

dranage

and

rom

nodes.

a

ymp

te

te

nodes

above

toracc

are

te

ymp

duct

by

na

nodes

way

dranage

beore

o

te

tey

umbar

trunks.

392;

wte

N

268;

arrows

ABR/McM

n

te

CT

376

scan

n

Fg.

3.6

pont

stomac.

he

speen

t

ocated

s

yng

suprare-

te

ng

more

Aso,

on

tat

woud

te

te

not

be

n

ts

superory

note

tat

sdes

o

secton

s

te

te

n

n

CT

te

psoas

mage

body

musces

vertebra

te

umbar

because

tan

are

body,

ts

seen

mean-

regon

o

te

body.

rectouterne

n

he

to

artery,

ABR/McM

cana

nodes

secton.

gand.

space

E.

te

subprenc

deep

C.

n

te

o

tat

261

coc,

nguna

rom

to

ymp

and

part

musce

not

ascendng

superor

common

or

dran

te

nguna

umbar

te

badder

scan

artery.

nguna

sacra

he

te

superca

pernea

rectovesca space, wc s a pertonea recess between

urnary

ac

one

regon.

pont

coc

mdde

295;

nterna

ymp

te

an

or

deep

nodes.

gastrontes-

N

regon,

and

s

abdomna

dranage

C–D.

scan

et

provdes

neroatera

te

cases.

te

ana

te

ntest-

he

perana

anteror

he

CT

te

suppy

o

ste

and

te

248

sows

E.

350;

deep

s

s

te

are

ts

w

ABR/McM

coon,

superca

te

te

tract.

GAS

D.

te

arge

contents

tna

trombosed

wc

te

artery

te

gutea

o

Borborygm

na

are

ven,

emorrods

Dvertcuoss

wa

recta

ucer.

cana.

Externa

n

n

emorrods

mdde

peptc

n

superca

o

tum,

or

o

umbar

structures

306;

mesenterc

he

quenty

appendcts

N

artery

GAS

152.

may requre emergent surgery. Sgns and symptoms re-

mmc

te

n

body

rgt

scan

scan.

and

skn

s

structures

secton

te

CT

symptoms

hereore,

ng,

obstructon

nto

he

vertebra

rom

hese

descendng

te

outpouc-

cncay

te

cut

arrows

coon.

rom

be

C.

dranage

and

a

E.

brances

s

o

he

T ransverse

407;

because uceraton o te dvertcuum wt pan, beed-

peroraton,

s

margna

prevaent

s

rgt

D,

GAS

231

wc

twce

dvertcuum

tat

progressng

appendcts.

appendx.

patent’s

A,

ayers

te

pan

o

musce.

C,

appendx.

ABR/McM

eum,

ntraper-

must

sgn

wt-

abdomns

correct

dvertcuum,

he

A,

pareta

covered

ayers

to

abdomna

asca

a

nlamed

es

appendx.

te

expose

282;

(Mecke)

s

s

psoas

musce,

bunty,

ocated

t

transversus

nlamed

to

s

tus

Paraumbca

e

te

transversus

nterna

transversas

te

are

dssected

te

he

McBurney

and

separated

B.

an

obque

asca,

appendx

150.

ossa

encounter

musce,

te

be

abdomen,

pertoneum.

access

o

can

he

te

surace

women.

A.

149.

tem.

abdomna

bers

at

usuay

obque

between

artery .

247

separaton

w

transversas

pertoneum.

nterna

A,

externa

Musce

wtn

te

etrated

te

mesenterc

ABR/McM

tssue

transversus

cuttng

vscera

291;

appendx

musce,

and

toneay

N

communcaton

superor

abdomna

pertoneum.

obque

provde

and

and

te

o

nterna

out

not

trunk

344–350;

aponeuross

te

do

ceac

173

Abdomen

3

rectum

space

s

by

and

a

o

Dougas)

N

a

C.

between

te

ver

and

te

ABR/McM

281

duodenum

te

te

A.

stomac

302–303;

Cancerous

rst

to

s

te

structure

n

te

scan

N

276;

and

ocated

s

to

te

rgt

posteroatera

to

aorta.

GAS

154.

373;

he

o

uterus.

coon.

473–474;

s

pertonea-ned

te

ces

ceac

n

te

nodes.

ABR/McM

stomac

229,

woud

238

metastasze

174

C H A P T E R

B.

3

he

Abdomen

spenc

artery

creas;

and

he

ces

he

pancreatc

rgt

statc

but

entre

GAS

Because

es

sow

on

te

obe

a

s

a

extenson

te

an

receve

rst

assocated

expanded

t

te

dranage

woud

not

eaty

ABR/McM

rgt

and

woman,

expected

o

te

obe

extends

te

o

to

B.

ver,

te

upper

rom

te

ems

be

rst

to

te

about

4

ver,

or

5

cm

an

seen

D.

to

te

cyme

te

as

wen

GAS

156.

B.

A

A.

te

328;

te

E.

Peptc

gabadder

C.

A

D.

An

A

segment

troug

near

ater

GAS

on

o

can

ony

N

t

protrude

not

ne

not

o

does

beneat

ca

o

a

te

a

an

a

stran-

A.

or

te

ower

esopa-

esopagea

dscomort

usuay

s

n

accompanes

not

o

woud

s

dened

stomac

assocated

te

aso

and

te

prob-

wt

d-

mucosa

not

nng

contrbute

to

stomac

wc

stomac

te

resut

te

deayed

emp-

woud

and

sow

esopagus

esopagus).

n

pan

duodenum,

n

te

due

to

stomac,

eroson

o

remnant

o

nng.

N

237;

duct

n

ABR/McM

an

te

t

225

embryoogc

embryo

to

nected,

te

s

te

proxma

o

te

ony

mosty

as

parayss,

n

dvertcuum

becomes

ater

at

an

eve

o

te

occur

ocated

cecum.

produces

abdomen,

operatve

nc-

or

n

I

on

ts

pan

n

te

dsta

dvertcu-

te

addton

te

nto

s

ema

to

umb-

possbe

ngs

abdomen,

aso

te

durng

D.

and

remans

nguna

caused

ndrect

wen

te

te

ntestnes

a

scrotum,

but

occurs

onto

generay

a

te

te

ts

does

wen

dorsa

assocated

te

te

sur-

wt

transversas

ernate

GAS

woud

troug

not

te

315;

C.

Pan

by

vscera

nerve

Open

and

te

rom

o

suppy

o

n

are

te

s

gut

te

contact

n

wen

wt

adja-

by

a

te

twsted

bous

bowe,

and/or

sc-

occuded.

tube,

ower

sounds

movng

cause

pan

actvty

A.

N

280;

te

usuay

et

ound

n

quadrant.

produced

troug

n

one

moves

rom

te

specc

te

tat

ABR/McM

gabadder

aferents

bers

and

spna

nerves

gabadder.

rb

aso

provde

coecystectomy

T8

assocated

te

asca

pan

gas

bowes.

area

engt

and

hs

because

o

te

GI

tract.

160.

and

wa

contents

woud

lud,

does

bood

present

perstatc

badder.

to

o

oter

patent

gubernacuum

caracterzed

obstructon

Borborygm

arge

tat

wt

deveopment

opens

s

so

n

wt

abdomen,

te sgmod coon. Pan rom ts condton woud

cana.

by

ed

a

erna.

Epspadas

urnary

o

te

wen

s

te

come

te

pertoneum.

causes

as

presents

o

Dvertcuoss s a condton tat causes outpouc-

erna

E.

occur

vagnas

an

vovuus

usuay

quadrant

processes

pareta

usuay

vagnas

orce

tear,

te

o

appendx

rgt

nectve

wc

229

ernas

reac

erna.

te

A

descence

ncsona

surace

ower

cent

surgery.

cause

pens

o

ruptured

te

te

te

wt

o

ABR/McM

correcty

o

A

ntestna

B.

type

ventra

uretra

cause

o

as

C.

s

processus

not

a

rupture,

not

wa

occurs

ydrocee

not

does

exstropy

A

troug

causes

Acaasa

condtons.

pan

and

and

nvoves

307;

regon

openng.

reopenng)

ernates

testes

cause

externa

ace

tese

hs

commony

vtene

um

mdne.

processus

mgrate

tests

te

presents

occurs

erna

nguna

te

Ectopc

erna

258;

congenta

but

tat

o

erna

and

ntestne

segment

part

te

te

Congenta

o

erna

o

erna

298;

patency

E.

and

semunar

to

ucers

Mecke

te

surgery.

ventra

occurrng

A

a

any

ncsona

ocated

oop

s

paraumbca

son

C.

regon

D.

eum

te

esopagus.

ood

nlammaton

mucosa

GAS

159.

245

aong

te

esopagea

spncter)

beedng.

erna

(breakdown

B.

occurs

woud

examnaton,

nlamed.

ABR/McM

erna

umbcus,

A.

284;

s

coecystts

pysca

te

skn.

Rcter

oop

157.

and

abnorma

umbca

guated

E.

an

N

Spgean

beow

te

examnatons,

cause

233

ower

constrcted

o

overoadng

(acaasa

rb

A–B, D–E. Carcnomas woud present wt abnorma

wt

s

stomac

due

more

present

te

cardac

n

o

A

dgeston

not

swaowng.

te

tyng

cage.

aboratory

o

cronc

Gastroparess

neror

atera

ABR/McM

te

ood

cause

s

woud

dyspaga.

Rede

beow

as

motty

te

wt

tereore

erna.

264;

stomac.

Gastrts

stud-

anomay

o

o

abdomen.

cuty

o

bengn.

oten

s

N

known

Dyspepsa

246

te

te

o

aboratory

be

aure

nto

and

reaxaton

(aso

spncter

cy,

o

accumuaton

gus

esser

csterna

porton

s

ts

rng

nguna

296–298;

Faure

C.

BP79;

be

A.

spncter

meta-

receve

aong

he

ymp

receve

to

nguna

ndrect

GAS

ces.

varaton

tat

E.

examnaton

woud

o

to

deep

pan-

158.

be

may

te

ocated

tereore,

N

norma,

gabadder

rst

woud

be

are

receves

358;

norma

te

spenc

te

cancer.

nodes

not

proxma

pysca

x-ray

be

te

rom

an

stomac.

cancerous

315,

nodes

tey

te

duct,

not

stomac

ymp

abdomen;

receve

C.

o

occasona

toracc

155.

a

aong

dranage

w

woud

because

curvature

ocated

to

carcnoma.

gastrc

ces

ymp

an

tey

rom

suprapancreatc

wt

D.

are

reated

tereore,

metastatc

C.

nodes

are

and

s

pan

to

te

to

te

medated

cause

ter

nerves

aong

237

sent

sensaton

woud

due

hese

s

are

same

a

spna

to

te

rsk

cose

cord

(reerred)

by

scapua.

to

te

T7

proxmty

ocated

beow

orzonta

to

te

pane

as

gabadder.

T5

and

son

T6

and

nerves

tus

are

are

not

ocated

afected.

superor

to

an

nc-

CHAPTER

B.

For

te

not

be

same

te

durng

ts

D.

Nerves

E.

T5–T9

a

340,

to

due

rom

T6

to T6

to

not

T7

woud

beng

at

163.

rsk

not

are

ocated

tat

afected

358–364;

neror

to

te

N

by

309;

te

many

nerves

ncson.

ABR/McM

ayer

evagnates

ues

o

troug

ts

te

troug

te

evagnaton

or

deveopment.

te

processus



between

B.

te

te

deep

cana;

abum

C.

An

D.

A

s

aso

n

227

A,

B,

reerred

not

nguna

rng

and

te

contn-

n

to

a

as

te

dur-

segment

te

cana

and

nguna

not

woud

te

present

nguna

erna

woud

gament

as

a

A

C.

base

be

mass

n

n

o

(usuay)

wtn

te

deect

o

te

aong

ar ter y

te

te

te

265;

most

be

to

te

asca

area

nguna

te

cavty

te

resut

woud

not

because

n

A.

be

known

between

pertoneum

kdney

he

and

rgt

neror

matc

ts

muate

Fnay,

cavty

cates

lud

te

o

te

te

potenta

ts

space

n

to

upper

vscera

o

per-

Morson,

ver

and

poe

s

ocated

te

pareta

o

te

s

It

te

te

space

above

s

te

above

pancreas

coud

te

o

te

wt

m

omenta

(eppoc)

cavty

o

around

and

on

te

304;

abdomen.

te

sp

s

genera

greater

bursa

(o

rgt

drecty

not

A.

tat

reey

ABR/McM

by

aows

aganst

te

te

a

o

to

nto

L andzer t)

ar ter y

te

and

et

te

wt

a

mesenterc

(o

coc

te

s

n

juncton

jejunum.

ar ter y

coon

he

suppy

and

te

coon.

rom

suppes

s

et

er na

to

coc

arses

and

et

re-

p araduodena

desce ndng

artery

artery

a

te

ossa

te

ts

adjacent

et

more

rgt

o

o

te

te

nto

o

s

te

and

on

occurs

te

repar

anastomoses

coc

coc

transverse

coc

te

more

artery

te

te

et

coc

dsta

and

superor

transverse

artery.

branc

suppes

o

te

coon.

coon

artery

te

te

o

o

ea

te

to

and

te

ower segment o

sgmod

te

eum,

coon.

cecum,

and

appendx,

proxma

por-

coon.

arteres

superor

te

te

suppes

ascendng

352–353;

ces

venous

he

are

te

sma

mesenterc

termna

artery

suppy-

eum.

N

295;

because

system

stomac

s

and

he

no

ABR/McM

tey

rom

woud

woud

te

249

not

low

pancreas

receve

communcaton

pancreas

speen

caton

C.

he

but

te

ces

duodenum

as

aton

E.

aso

wt

metastatc

very

anoter

o

te

te

encosng

Hernaton

te

carry

troug

troug

to

tese

te

ces

between

because

te

crcuatory

te

ver.

stom-

or

ducta

patways.

he

organs

one

same

rom

not

( o

ods

brance s

o

porton

bood

he

tese

tey

328,

not

pancreas

ave

and

drect

woud

commun-

not

s

te

ste

not

or

pass

pass

coumn

because

tey

pancreatc

troug

nto

woud

woud

te

N

BP80;

crcu-

duodenum.

not

not

emptyng,

venous

receve

enter

pexus.

354;

receve

rst.

woud

venous

GAS

does

metastases

vertebra

metastases

bra

240

o

Fnay,

ac

accu-

way

o

eococ

tere

commun-

except

tese

238

Landzer t)

duodenum

descendng

metastatc

pertonea

sac)

s

D. he ver woud be te rst structure to receve tese

pancreas;

Wnsow).

notng

wa.

288;

sac

(esser

oramen

lud

reatvey

te

he

contans

serous

body

N

sac

are

hs

presentaton.

resp ectvey,

quadrant,

superor

GAS

165.

B.

greater

te

dermatome

and

woud

 os sa

ocaton

artery

and

rgt

he

ng

daprag-

te

o

pan

T8.

tese

he sgmoda arteres suppy te

porta

and

o

aferents

et

durng

se gment

brances

space,

(o

te

mdde

ton

D.

te

ven,

b rances

termna

surace

subepatc

superor

space

C.

space.

te

et

lexure

he

te

te

gand.

ver.

rom



B.

coon.

te

te

a

anteror

w

neror

o

dapragm

o

s

s

tere.

pertonea

GAS

te

pouc

obe

coverng

omenta

tn

te

suprarena

te

bursa

rsk

ascendng

bursa,

o

ernaton

termna

coon

pseudocyst

omenta

drecty

transverse

space

rgt

surace

tereore,

te

te

subprenc

to

and

space

between

as

te

te

extravasatons

epatorena

aso

pancreatc

o

soma

and

pan,

nerves

per tonea 

ossa

mesenterc

233

omenta

stomac

and

a

loor

he

subepatc

ver

tat

te

o

ABR/McM

ascendng

at

ascendng

emora

coud

but

gament

ABR/McM

pace

n

Pancreatc

tonea

he

s

stomac.

rgt

te

264;

key

bend

he

o

N

ormed

pancreas.

E.

te

specc

at

patent’s

duodenum.

tan

upper

te

he

te

because

te

ts

303;

b ranc

are

GAS

space

D.

a

s

T7

vscera

spna

or

two

he

he

deep

B.

transversas

n

te

sensaton

o

process

mesenterc

o

Kob).

te

beow

N

paraduodena

o

papated

eve

paraduodena

by

sde

asca ayer s ocated deep to te nguna gament.

w

A.

et

spenc

nlammaton

ocated

358;

o

regon.

be

te

sensatons

hese

he

quenty

te

woud

te

receve

bers

GAS

neror

trange.

E.

E.

erna

uterus

E.

ascendng

majus.

emora

D,

o

competey

at

somatc

ormed

tests.

present

sweng

164.

Normay,

obterated

obterated

woud

case,

s

at

xpod

ner ves

sensory

regon)

and

rng.

deveop

s

ts

rng

contanng

stomac.

(nguna

nguna

can

ydrocee

ectopc

pevs

cyst

processus

Congenta

wa

nguna

outpoucng

A

(wc

ts

deep

superca

ng

Nuck)

abdomna

te

eves

transportng

key

te

or

spna

cord

bers

tan

eves

ncudes

spna

because

A. he processus vagnas s ormed as te pareta per-

toneum

162.

he

sensor y

procedure.

range

be

C.

more

L1

ts

broad

woud

GAS

161.

T9

durng

s

nerves

coce

procedure.

rom

ncson

tat

reason,

rgt

175

Abdomen

3

ABR/McM

258

te

te

verte-

176

C H A P T E R

166.

B.

he

to

be

3

epatc

nto

A.

s

te

o

due

C.

he

E.

epatc

trunk

ceac

B.

juncton

ent

tc

wt

duct

A,

C,

s

E.

o

to

be

te

B.

te

A,

s

C,

o

N

GAS

te

umb cus.

oter

to

dsta

te

tumor.

Smary,

A.

te

te

nor

ceac

B.

duct.

patent

jaundce

n

E.

duct

he

tan

Fg.

and

and

et

at

Wen

w

because

te

and

rgt

postepatc

duct

D.

a

pres-

te

ABR/McM

E.

epatc

duct

rgt

te

n

te

cause

170.

rgt

s

ocated

duct.

duct,

at

It

te

s

te

epatc

duct

a

epatopancreatc

N

to

known

juncton

D.

he

ave

o

be

n

o

n

super or

to

branc

duodenal

Major

n

te

and

passes

wt

newborn

trd

oca

at

babes

trmester

usuay

structure

te

arger

ampua

(o

s

case,

te

o

represents

eve

o

te

dam-

Vater)

257

passes

troug

s

o

te

not

reduced

a

et

tat

assocated

o

et

hs

I

o

stop

branc

o

te

epatc

artery;

and

s

were

te

te

et

GAS

Fig.

4.109

ampulla

an

te

epa-

beed-

gastrc

rater

tereore

hus

te

owever,

gament

maneuver.

ac-

o

artery,

ts

or

unc-

te

area

epatc

(compresson

sow

te

between

te

t

tan

not

beedng

tecnque.

duct

Hepatopancreatic

•

wt

wa.

duct

papilla

com-

ntestnes

228

trunk.

gament

Prnge

by

te

epatogastrc

epatoduodena

cana,

ess

te

segment

ocated

ceac

epatc

te

body

gabadder.

by

(but

o

cavty,

te

woud

te

semunar

emora

serous

meda

maneuver

repace

n

o

ver,

te

te

aure

ABR/McM

supped

aberrant

can

more

te

gament)

artery

te

a

te

and

Prnge

troug

abdomna

258;

te

seat.

gament.

growt

o

branc

toduodena

An

te

N

usuay

te

are

troug

rectus

pass

njured

gament

o

pancreatc

to

obe

occur

te

papilla

duodenal

 at

papabe,

aso

Pancreatic Minor

o

a

assocated

erna

representng

proper

298;

et

ndrect

Bile

pancreatic

ner ve

wa

nguna

deect,

kne

te

part

to

ernas

te

return

as

narrowest

duct,

ABR/McM

weakness

causes

common

knd

te

Ompaocees

compressed

287;

a

a

aba

ern at on

deect

can

are

ernas

atera

Femora

ng.

et

epatc

Accessory

Spgean

tona

4.109).

332–336;

n

weakness

ack

system.

be

a

ver

aso

I

t

by

nea

cases,

women

hs

GAS

woud

not

s

ormed

te

te

ernas

pregnancy.

to

due

256

ampua

mass.

pregnant

deep

cys-

jaundce

duct

regon,

most

deect,

Umbca

nes,

system.

pancreatc

be

te

s

o

umbcus.

gabadder

cystc

te

In

troug

paness,

and

253

te

erna

bers

pan.

tumor.

metastases,

tssue

troug

part

orm

287;

Vater

duct

and

(GAS

pan-

emptes

quadrant.

bary

eters

te

epgastrc

nte rsectng

mon)

cause

te

An

te

tumor.

n

area,

no

C.

pancreatcoduode-

tese

te

and

and/or

woud

epatopancreatc

duct,

te

artery.

o

ts

usuay

duct

te

340;

D,

to

ocated

neck

obstructed

pancreatc

o

neror

receve

umbca

ampua

s

superor

pan

he

te

wc

169.

te

but

superor

o

GAS

o

o

occuded.

be

n

structure

neck

most

drans

ABR/McM

n

key

te

ven

ven

and

pane

299;

at

he

spenc

Obstructon

upper

168.

te

most

ven.

never

but

not

A

s

pouc

obstructon

D.

porta

ocated

pan

s

te

pancreatc

N

te

tumor

proxmty.

va

ntestne

great

354;

s

mesenterc

outsde

gastone

ven

arge

posteror

Hartmann

te

ts

woud

te

s

a

trunk

he

GAS

167.

arge

artery

woud

to

neror

te

D,

by

draned

he

na

porta

occuded

pancreas

creas

Abdomen

duct

CHAPTER

A.

he

te

B.

atera

et

he

o

caudate

neror

we

C.

E.

he

o

GAS

E.

te

lexure

o

vaga

trunks

N

o

te

te

ver

s

ocated

to

251;

ocated

porton

s

o

n

te

te

ver,

et

obe

s

s,

epatc

to

174.

and

te

be

Pevc

lexure,

rectum

te

D.

te

te

s

ts

deprve

mdgut)

o

o

te

suppy

vagus

para-

erecte

he

to

nerves

tssues

duct

troug

GAS

s

te

363;

nerves

o

o

306;

te

te

te

carred

pevc

N

and

cana,

B.

Adynamc

actvty

eus

ceases.

s

te

A.

T7

s

B.

T8

and

D.

coon,

te

E.

L1

and

area,

deerens

and

nerve

ejacu-

GAS

suppy

ar

under

pan

bers

prenc

nerve

o

to

pan

sory

A.

an

o

te

(bowe

ts

ar

bowe.

are

absent

175.

nerve

te

by

te

afer-

te

C3–C5.

because

enter

perorated

somatc

carred

eves

occurs

souder

rom

D.

rgt

C.

A

Reerra

somatc

spna

te

sen-

rom

usuay

ndcate

te

suppy

te

penetratng

o

cord

at

presence

o

ar

Acute

der

ucer

prouse

te

woud

bub,

be

beedng,

gastroduodena

duodena

pan

and

A.

he

artera

B.

he

408;

s

not

te

rst

assocated

adynamc

owever,

mdde

suppy

rgt

superor

276;

coc

to

te

coc

asso-

B.

mosty

arter y

part

o

w

 eus.

wt

A

p roduce

he

ABR/McM

artery

s

ng

te

acorm

artery,

an

sou-

ower

⅔

porton

skn

306,

in

o

st

te

o

wt

to

two

te

pre-

te

rectus

motor

and

and

onguna

regon,

te

162;

new

te

urogenta

ABR/McM

pubc

regon.

215

(no

edition)

source

o

te

portons

o

artery

branc

suppes

transverse

te

s

o

te

ascendng

o

te

he

A.

te

coon,

pancreas.

ower

he

rotc

ncud-

B.

caracterstc

appearance

anastomoses

vens

tat

teres

wt

he

due

te

vens

between

o

te

vens

o

on

sma

accompany

wa

porta

o

epats)

vens

body

to

body

o

by

te

(wtn

anteror

become

ypertenson.

lud

o

te

356;

opubc

at

te

atera

Hessebac)

and

299;

new

tract

tn-

jonng

tract

ret-

wt

resut

rom

ven

ac

expanson

recta

and

o

trbutares

mdde

recta

ven.

gaments

do

not

recanaze

ypertenson.

ABR/McM

s

a

o

te

border

280

relectve

te

(no

clinical

band

transversus

o

aponeu-

abdomns,

aparoscope.

o

te

provded

ven.

rom

vesses

edition)

orgn

s

esopa-

vens.

transudate

superor

nterna

wt

and

o

gastrontestna

mesenterc

porta

N

in

ven

system

wa.

umbca

to

gastrc

anastomotc

between

te

meda

artery

et

azygos

emorrods

vsuazed

he

te

te

vens

neror

tssue

to

dated

response

GAS

176.

wa.

ormed

and

thumbnails

te

end-stage

rom

between

brances

o

an

gament)

trbutares

Interna

to

o

coon.

suppes

s

(gamentum

anastomoses

per orated

prncpa

and

Asctes

n

nrequent

artery,

mesenterc

to

to

te

body

Esopagea varces resut rom porta-systemc anas-

wen

duodenum

contacts

process.

suprapubc

snakeke

resuts

gament

vens

241

te

transverse

mesenterc

superor

nerve

Wen

adjacent

between

owest

paraumbca

ropertonea

te

symptoms

wa

caed

waed

tat

coon.

C.

body

he

tortuous,

E.

N

N

medusae

tomoses

pertonts.

GAS

e

oypogastrc

thumbnails

dated

C.

appendcts

appendx,

pan

xpod

portons

body

under

duodenum.

E.

and

te

spna

T10.

eves.

te

anteror

crross.

gea

wt

brances

by

abdomna

A.

posteror

o

o

overyng

285–286;

Caput

round

dapragm.

cated

rom

175–199

vens

eves.

woud

s

Perstatc

sounds)

rrtates

dapragm,

spna

te

perumbca

251

te

dapragm

wa;

souder

rom

x-ray

te

D,

to

te

bers

smar

o

te

crosses

respectvey.

suppes

clinical

T10

appendcts

pexuses.

parayss

te

suppy,

and

te

te

and

dstrbuton

nerves

o

nerve

nnervates

sensory

badder,

ste

te

quadrant.

eve

spna

n

ruptures

dermatomes

te

sgmod

apparent

eve

rom

embryoogc

bers

te

suppy

spenc

rst

and/or

to

248

wc

sensory

suppy

coon.

nerve

Pan

o

T9

abdomns

sympatetc

ABR/McM

Borborygm

duodena

at

spancnc

te

ent

173.

T12

swes

abdomna

and

at

eve

appendx,

te

rgt

spna

umbcus.

somatc

cause

ower

s

to

wa,

ABR/McM

o

te

bood

descendng

perceved

te

appendx

ver

due

oten

to

wen ts occurs, as n pertonts. Pan n te souder

anteror

te

provdes

and

295;

suppy

Answers

172.

o

pevc

urnary

ductus

N

relectng

pens.

by

348;

cedng

rom

spancnc

nnervaton

atory

nerves

ana

most

wa

artery

lexure

dermatome

eve

body

spenc

coc

coc

regon,

ost.

descendng

and

C.he

te

woud

eve

te

o

receves

artery.

Parasympatetc

by

t

255

trunks

to

et

et

A, B, C. Dsta to te spenc lexure, te coon receves

nerves.

he

ver,

ocated

segment

and

ABR/McM

carred

parasympatetc

E.

te

(oregut

woud

he eococ branc o te superor mesenterc artery

GAS

rgt

vaga

tat

coon.

D.

suppes te dsta eum, cecum, and ascendng coon.

s

meda

te

te

bot

vscera

and

obe

njury.

o

rom

o

coon

te

upper

s

obe

suppy,

te

ascendng

et

gament.

gabadder.

328–331;

abdomna

o

obe

et

suppy

sympatetc

te

ste

te

Interrupton

te

o

segment

quadrate

artera

o

te

unctona

171.

segment

anteror

rgt

o

acorm

aspect

above

he

te

segment

te

177

Abdomen

3

by

nguna

te

trange

neror

(o

epgastrc

178

C H A P T E R

3

Abdomen

Anterior

superior

iliac

spine

Super

Pectineal

artery

Ileocolic

artery

ligament

Inguinal

Pectineal

mesenteric

ligament

line

Anterior

cecal

Posterior

cecal

Appendicular

•

178.

A.

Inants

wt

Hrscsprung

n

te

o

norma Pubic

he

number

rom

symphysis

Lacunar

aure

•

GAS

Fig.

ven

rom

D.

he

te

border

and

te

o

te

te

pectnea

emora

tssue

rng

s

te

coon

ure

o

he

separatng

te

te

ven

B.

cana.

nguna

gament

gament

s

te

tat

acunar

attaces

ra

as

artery

nguna

GAS

177.

E.

298;

hose

can

o

be

even

D.

are

te

wen

he

are

a

to

gament

structures

o

A,

B,

te

C.

GAS

te

and

sted

hese

and

316;

to

s

te

dated

segment

ces.

he

daton

te

resuts

reaxaton

o

movement

te

unctona

crest

to

agangonc

te

segment,

ntestna

obstructon

t.

ces

o

Megacoon

to

mgrate

and

daton

resuts

nto

contents,

te

rom

wa

o

a-

o

te

or

structures

o

te

t

he

coon.

and

appendx,

oten

te

n

to

s

pro-

very

d-

179.

C.

he

ramus

261

te

coaca

ke

n

deveop

n

causes

mperorate

anus

atresa

appens

ments

he

te

ten

be

te

316;

te

to

t,

o

te

oter

and

upper

appendx.

or

and

te

abum

best

rst

and

may

at

te

can

be

ectopc

ma-

anus

or

snus.

abnorma

recan-

mdgut.

be

he

ABR/McM

nerve

assocated

to

tg,

wt

o

and

te

orates

ventra

te

abdomna

atera

and

nguna

skn

te

nerve

ramus

o

obque

n

s

ventra

perces

spermatc

Its

upper

te

root

cord

bers

and

are

meda

mons

o

te

a-

te

pubs

pens

men.

te

spna

superor

nerve

abdomns

musces,

anteror

te

te

te

dstrbutng

over

or

It

rng.

te

skn

scrotum

transversus

an

o

o

(L1).

musce,

women

oypogastrc

te

250

branc

accompanes

te

n

a

nerve

obque

ten

majus

part

s

umbar

superca

dstrbuted

parts

A.

283;

abdomna

and

ocaton

N

onguna

o

nterna

o

vermorm

ABR/McM

to

t.

GAS

o

presence

tssue.

not

ces

resuts

coon.

Ogoydramnos

4.85).

woud

te

rotaton

hs

pexuses.

o

ndgut

recta

te

weeks.

gangon

nsuicent

o

o

te

E.

retroea

artery,

easy

o

D.

cecum

te

atoug

ead

Fg.

sevent

Messner

emo-

te

to

separaton

o

ongtudna

te

o

n

and

anus,

cause

troug

adpose

not

Auerbac

he

t

parasympatetc

Incompete

o

to

base

te

Hrscsprung dsease, but t’s not one o te causes

eature

especay

(GAS

283;

te

porton

retrococ

artery,

muc

ocatng

N

rom

o

azaton

and

235

extend

te

dense

4.29).

appendcuar

do

neura

absent

(o

dden.

qucky,

appendx

tracng

coon

ceca

ess

conspcuous

caracterstc

to

marotaton

Fg.

ABR/McM

appendx

nd

ateray

tree

tereore

orgn

becomes

opectnea

(GAS

nerory

te

and

cut

te

264;

posteror

vdes

traced

ascendng

traced

poston,

N

co

tat

s

gament

T aenae

bands

t

gament

toward

a

ormaton

to

C.

pectnea

tnner

to

or

ces

coon—megacoon—as

gangon

proxma

durng

aure

emo-

Gmbernat).

E.

dsta

gangon

4.29

connectve

emora

part

o

n

te

coon

atera

o

prevents

resutng

ra

megacoon,

autonomc

ligament

wc

he

o

agangonc

ack

pexus

artery

4.85

congenta

enarged

artery

tubercle

Pubic

C.

Fig.

dsease,

myenterc

coon.

GAS

artery

and

cutaneous

L1

branc

tat

and

dvdes

branc.

per-

nterna

nto

a

CHAPTER

C,

E.

hese

mesenterc

GAS

182.

T7

B.

he

o

te

ments

358–364;

te

ten

part

N

to

rst

t,

and

te

te

301;

supped

by

a

ten

to

branc

nerve

obque

te

superor

te

musce,

and

te

o

skn

ventra

ramus

perces

te

dstrbutng

Its

upper

te

a-

spermatc

rng.

te

o

It

te

nguna

skn

244

o

(L1).

accompanes

superca

tg,

ABR/McM

s

umbar

dstrbuted

o

not

nerve

abdomna

troug

are

pexus.

onguna

nterna

T8

regons

179

Abdomen

3

cord

bers

and

mons

are

meda

pubs

and

T9

aba

and

T10

C.

majora

upper

he

women

part

o

genta

w

na

n

te

but

o

te

n

te

abum

te

over

scrotum

branc

suppy

nerve

te

and

root

o

te

pens

men.

gentoemora

majus

onguna

wt

te

nerve

s

nerve

ongu-

more

com-

T11

mony

A,

D,

E.

hese

majus

T12

duce

damaged

and

te

GAS

durng

structures

njury

to

symptoms

398;

N

260;

appendectomy.

do

not

tese

seen

suppy

nerves

n

te

ABR/McM

te

woud

abum

not

pro-

patent.

271

L1

183.

A.

n

he

te

ympatc

abdomen.

trunk,

so

te

dranage

he

oows

stomac

ymp

w

s

te

artera

supped

dran

to

te

by

suppy

te

ceac

ceac

ymp

nodes.

B,

C,

D,

or •

GAS

Fig.

GAS

B.

he

anteror

abdomna

ratng

te

obque

cutaneous

obque,

nguna

rng,

about

and

branc

becomes

aponeuross

musce

s

o

te

cutaneous

te

2.5

perces

cm

externa

above

dstrbuted

to

nterna

by

184.

te

D,

E.

he

nerves

GAS

180.

C.

he

sory

skn

umbar

do

not

398;

N

o

he

a

on

and

gve

260;

unatera

bers

tome.

te

of

snge

anteror

toracoabdomna

te

atera

greater

cutaneous

o

skn

spna

o

o

poe

te

A.

te

B,

nerve

s

caed

branc

suppes

B,

D,

te

a

o

area

py

te

te

GAS

he

ram

area

12t

gastrc

A.

he

pexus.

B,

te

D.

o

te

(GAS

in

oregut

he

as

as

toracc

spna

N

10t

around

te

brances

spna

process,

nerves

o

nerves

we

suppy

te

sup-

tose

te

o

ypo-

185.

E.

s

ABR/McM

he

na

215

(no

clinical

many

mesenterc

spenc

by

pexus

lexure

te

ceac

suppes

and

to

te

ped

terc

by

te

spancnc

coon

neror

pexuses,

as

we

nerves.

not

te

part

nta

nodes

B.

and

te

mesenterc

as

by

pancreas

rectum

te

by

and

brances

ntermesen-

o

te

te

sup-

pevc

C.

he

o

T12–L3

tan

te

te

te

te

posteror

vertebra

vertebrae.

te

11t

on

te

rgt,

and

co-

he

ts

et

upper

rb.

ange

o

stomac,

te

rb

wc

woud

can

be

ave

a

te

descendng

coon

are

at

a

ound

N

cap

te

prmary

311;

or

te

rst

te

part

gastroduodena

epatc

retroduodena

te

on

ABR/McM

o

and

brances.

artery

and

duodenum

arses

supraduo-

gastroduode-

posteror

dvdes

anteror

sde.

wc

ts

he

retropertoneay,

and

te

artery,

artery,

duodenum,

rgt

265

nto

superor

to

te

te

rgt

pancreat-

artery.

porta

ven

s

ormed

bend

te

neck

pancreas.

te

mesenterc

abdomna

approxmatey

trunk,

and

arter y

aorta

w

at

1

te

cm

suppy

usuay

eve

o

neror

te

arses

te

to

L1

te

dervatves

o

mdgut.

be

orm

te

o

and

descends

vertebra,

some

are

s

superor

rom

te

sde

L1.

epatc

he

247

eve.

o

te

eac

ger

common

and

he

o

eve

duodena

te

on

njure

gastro-omenta

A.

one

troug

to

ABR/McM

retropertoneay

373–374;

ceac

descendng

te

ver

artery

rst

pancreas.

he

are

stomac.

BP79;

e

sgty

supped

o

nnervated

he

he

dena

N

racture

GAS

edition)

te

te

eve

coduodena

4.38).

171;

new

s

cutaneous

xpod

Fg.

superor

ar

7t

te

287–288;

ntestnes

o

anteror

o

toracc

area

thumbnails

181.

D.

sen-

derma-

te

es

beow

rom

E.

ventra

E.

eve

te

te

vared

brances.

umbcus.

A,

structures

o

wa,

unkey

tg.

271

by

358;

reaces

A

spancnc

nnervated

cutaneous

nerve

part

toracc

ABR/McM

area

hese

kdneys

at

kdney

superca

skn

he

umn

abdomna

te

C.

abdomna

pero-

ypogastrc regon. Latera emora cutaneous nerve

nnervates

E.

dranage

4.38

te

duct

s

joned

by

epatopancreatc

second

te

part

o

te

te

pancreatc

ampua

(o

duodenum.

duct

to

Vater)

at

180

C H A P T E R

D.

3

he

Abdomen

proper

brances

rom

te

com-

toracc

ta ven and te be duct wtn te epatoduodena

vscera

dvdng

GAS

E.

artery

T11.

gament.

186.

epatc

mon epatc artery and traves wt te epatc por-

he

orm

It

gves

nto

309,

344;

ndrect

o

te

erna

of

te

rgt

N

291;

nguna

and

s

rgt

and

gastrc

et

ABR/McM

erna

beeved

to

artery

epatc

s

be

beore

B.

cs

most

congenta

A.

rng

Drect

atera

nguna

nguna

drecty

te

to

te

ernas

ernas.

he

anterory

nguna

neror

cana

epgastrc

make

sac

o

troug

meda

up

a

te

to

deecate)

nvoved

15%

erna

neror

he

erna

umbca

regon

na

o

scar,

o

te

aduts

umbca

C.

he

D.

he

o

a

buges

wa

GAS

190.

o

epgastrc

te

s

C.

he

teror

a

structures.

mted

ayers

neror

o

te

A,

B.

sac

D.

tat

GAS

he

space

n

pragm

A,

B,

(o

te

et

or

stmuated

racc

emora

cana

emora

trange

(Pett

part

o

N

space

to

Vscera

eng

as

a

dapragm

gament

te

o

superor

tat

es

C,

and

te

te

parts

o

D

te

or

subepatc

ver

rom

te

communcates

rgt

wt

oramen

and

are

e

273;

separated

ABR/McM

at

sac

by

an

cavty,

te

begnnng

pevc

te

rgt

are

a

te

C.

te

te

w

gutter,

coect



n

o

te

te

and

A,

to

nlammaton.

te

spna

cord

appendx

sympatetc

by

s

te

te

per-

patent

w

vscera

traveng

mdgut

suppy

wt

w

afer-

sympa-

structure,

te

greater

rom

T5

experence

a

t

to-

to

T9.

vscera

te

spna

cord

by

trav-

s

rom

te

C3,

dapragmatc

nerve.

rgt

to

C4

te

he

and

C5.

I

dermatomes

sarp

ypogastrum

and

we-

corresponds

B,

n

D,

he

rgt

N

o

te

a

I

to

te

te

rom

te

N

body

wa.

rgt

ower

n

te

hs

wc

te

etus.

and

In

243

cord

tat

connectng

te

some

eadng

entre

to

It

s

te

s

cases

te

a

a

rem-

urnary

nvoved

excreton

uracus

stua

o

n

waste

remnant

o

deveopment

o

umbcus.

hs

at

contacts

resuts

o

n

aows

t

urnary

urne

to

233

te

appendx

McBurney

somatc

patent,

te

orce.

ABR/McM

ocaton

remans

connectng

umbca

324;

appendx

suppy

nerve,

snus.

quadrant

stmuates

ABR/McM

brous

tube

embryo).

persst,

uraca

301;

309;

tck

(a

sympatetc

spancnc

T9.

nutrton

and/or

E.

to

umbcus

can

ower

T5

a

anatomca

nlamed

t

s

major

toracc

te

pareta

aferents

sarp,

pont.

tat

n

te

Wen

s

te

pertoneum,

nnervate

ocazed

pan

n

te

te

quadrant.

A, B, C, D. Vscera aferents are stmuated by nlam-

appendx

hese

a

rom

nnervates

receves

aantos

cyst

GAS

E.

rom

te

umen

escape

da-

238

nnervate

vscera

oregut

orgnates

to

spna

te

greater

processng

uraca

a-

pouc

te

gabadder

hese

correspondng

ts

354–364;

products

192.

areas

a

ntay

orgnates

n

uracus

badder

most

te

rectouterne

paracoc

ABR/McM

tat

te

he

nant

te

cavty.

dependent

lud

wt

not

261

te

traveng

s

suppy

return

pan

by

pan

te

badder

te

by

wc

nerve

and

gabadder

GAS

ora-

te

s

sympatetcs.

neck

orgnates

240

encompasses

Morson,

324;

major

and

rom

greater

between

cord

w

aferents

prenc

orms

te

Snce

he

he

te

spaces

organ

toneum but does not expan te nta epgastrc pan.

E.

ayers

(eppoc

and

are

to te nlammaton spreadng to te abdomna per-

kdney.

te

so

der

pos-

s

and

te

and

space

urge

t were afected, te patent woud compan o sou-

posteror

te

may

te

tr-

recess,

ver,

relexes

ABR/McM

nnervate

sympatetc

nerve,

(tat

and

condton.

vscera

gabadder

patent

parasympatet-

nausea

nlammaton.

spna

a

eve.

nerves.

306;

tat

te T10

pertoneum

adjacent

superor

as

T10–

tr-

191.

space

ver

were

N

te

wt

ocazed

and

N

te

wt

patent’s

a

at

sensatons

suc

s

s

at

experence

pan at te epgastrc regon, wc s at te T7–T9 eves.

235

omentum,

bursa

pertonea

aferents

te

wc

trave

somatc

te

spancnc

hereore

erna.

umbar

standng.

by

return

receves

te

para-

posteror

potenta

subprenc

and

bursa

304;

patetcs.

major

a

te

ABR/McM

omenta

Pouc

sac,

A. Vscera

t

te

Dougas),

GAS

a

te

bursa

endng

E.

supne

ents

by

pertonea

and

omenta

189.

receves

gament.

304;

tonea

as

to

te

Wnsow).

greater

C,

te

esser

separates

and

corm

D.

s

between

troug

Rgt

n

a

troug

umbar

264;

epatorena

o

to

return

by

Snce

er-

by

orgnates

ntay

pysoogca

ts

aferents

tetcs.

omentum.

dapragm

188.

N

omenta

omenta

men

n

and

appendx

nnervated

coronary

recess

he

area

te

creatng

occurs

he

bursa

he

greater

space

E.

aba

umbca

reerred

troug

seat,

stomac,

te

he

nea

stmuated

wa.

superory

o

troug

be

tat

eves,

n

358–364;

Vscera

A.

rare.

weak

omenta

te

te

Acqured

correcty

descends

296–298;

to

protrude

troug

more

erna

s

abdomna

GAS

s

emora

and

ange)

but

not

umbcus.

sac

umbar

ange

does

he

B.

ents

erna.

erna

wtn

187.

sac

E.

nnervated

vesses.

B.

D,

umbcus,

conscous

not

C,

w

unconscous

te

orgn.

wc

patent

aferents

common

posteror

te

te

n

vesses.

about

drect

at

nerve,

te

medate

reac

he erna sac enters te nguna cana troug te deep

nguna

pan

Vscera

arteres.

246

te

spancnc

hereore

rom

wt

be

afer-

sym-

structure,

te

esser

maton,

cord

not

wt

contact.

hey

sympatetcs

trave

o

te

back

T10

to

te

spna

dermatome.

he patent w experence du perumbca pan,

wc

GAS

s

usuay

320;

N

a

306,

preude

N

282;

to

te

somatc

ABR/McM

pan.

231

CHAPTER

Anterolateral

wall

181

Abdomen

3

abdominal

Peritoneum

muscles

Kidney

Perinephric

T ransversalis

fat

fascia

Inferior

Renal

Paranephric

•

Immedatey

muaton

at.

hs

cay

rena

at

abundant

asca

s

woud

A,

rc

D,

A.

E.

and

rena

at

o

rom

n

te

te

kdney

um

N

A

te

na

rena

at

perneprc

(GAS

do

not

s

an

badder.

derved

o

te

o

papae,

D,

espe-

wtn

s

asca

caed

ayer

ascae.

GAS

o

te

s

te

te

te

D.

parynx,

esopagus,

duodenum

ver,

te

derved

up

to

pancreas

rom

te

te

rst

major

te

dorsa

ga-

meso-

he

N

(ever,

or

but

not

here

are

dervatves

o

te

o

ABR/McM

te

duct

and

hereore

eadng

postve

be

te

w

te

common

tere

to

duct

rece ves

w

te

Murpy

be

resut

cystc

epatc

sgn,

duct

backlow

symptoms

pan

o

n

d uct

stass

rom

rom

n to

te

coecyst -

tat

began

at

te

be

n

to

te

rgt

backlow

ser um

w

yp ogas -

nto

te

ver

b r ub n.

nundbuum

duct

o

afect

te

te

gabad-

gabadder

ver.

backlow

n

nto

serum



te

Obstructon

ony

and

te

atc

duct

196.

D.

o

ead

ver,

te

ver

brubn,

obstructon

te

eadng

wc

was

to

te

cannot

soey

o

n

be

te

be

340;

superor

branc

o

enterc

N

to

te

to

te

ampua

w

et

te

pancreas

obstructed

te

epatc

gabadder

as

(GAS

te

Fg.

duct

ABR/McM

pancre-

4.111).

w

ony

256

p a n c re a t  c o d u o d e n a 

gastroduodena

ceac

arter y

a r t e r y.

occuded,

trunk

be

287;

te

te

w

aso

rom

ver.

GAS

o

epatopancreatc

symptoms

aso

Te

brances

te

to

but

w

Obstructon

vesses

246

o

cystc

te

s

move d

aso

ncrease

te

coduodena

structures

324;

be

gabadder

ver.

der

afect

ower

te

and

E.

Oter

and

te

Obstructon

not

pernep-

oregut.

upper

ten

w

duct.

te

4.152).

a

to

expaned

wc

between

here

ncrease

he

267

rom

epgastrum

was

307;

gabadder

ts

B.

o

stomac.

hese

Obstr ucton

be.

te

A.

te

mem-

oregut.

C.

te

accu-

a

ndcate

ncude

te

te

speen

E.

ABR/McM

oregut

parts

he

gastrum

s

te

system,

second

duodena

195.

4.152

eadng

s

abscess,

at

Fig.

but

at

and

Fg.

GAS

trum).

externa

perneprc

asca

regons

318;

stomac

o

muscle

muscle

perneprc

and

perneprc

extrapertonea

a

te

capsue

caed

rena

te

Gerota).

rena

hese

377;

respratory

C,

te

lumborum

abscess.

he

B,

te

competes

ocated

dervatves

and

(o

suferng

be

GAS

194.

at

capsue

C,

near

Surroundng

paraneprc

patent

to

surrounds

condensaton

rena

rena

externa

extrapertonea

varaby

snus.

branous

te

o

major

fat

Quadratus

B.

cava

fascia

Psoas

193.

vena

I

te

a   ow

trunk.

s

a

te

Te

branc

anastomoss

bood

mdgut

to

to

te

superor

between

rom

bood

a re

s

a

p a n c re a t  -

mesenterc

  ow

p r ov  d e

wc

neror

o

superor

arteres

a r t e r y,

mes-

arter y

tese

te

two

ceac

s u p p  y.

A, B, C, E. he rgt and et gastrc arteres, te et and

rgt

gastro-omenta

arteres

(ormery

caed

gastro-

eppoc arteres), te sort gastrc arteres a provde

bood

GAS

suppy

to

347–348;

te

N

stomac

291;

(GAS

Fg.

ABR/McM

4.115).

244

182

C H A P T E R

3

Abdomen

Gallbladder

Needle

Right

Left

hepatic

hepatic

Common Cystic

duct

duct

hepatic

duct Common

duct

hepatic

Cystic Bile

duct

duct

duct

Bile

duct

Descending

part

of

B

duodenum

Descending

part

of

duodenum

A Pancreatic

duct

•

Hepatic

artery

proper

gastric

Fig.

4.111

197. Short

Right

GAS

gastric

A.

he

trd

ongest

Splenic

aorta,

artery

secton.

and

posteror Left

part

(neror)

o

te

duodenum

s

te

arteries

artery

It

crosses

vertebra

wa

w

over

coumn.

te

neror

Any

jeopardze

vena

peroraton

tese

cava,

to

te

structures.

gastric

B.

It

s

crossed

anterory

by

te

superor

mesenterc

artery

C,

artery

and

D,

hese

E.

tere

trd

GAS

198.

C.

he

te

he

gastrc

rgt

B.

gastro-omental

Anterior

superior

wa

wen

o

te

ABR/McM

branc

o

a

te

branc

anastomose

wt

et

245

ceac

artera

on

te

te

we

proper

esser

curva-

suppy.

gastro-omenta

greater

trunk

o

curvature

vesses

and

anas-

provde

ts

between

te

ceac

trunk

and

te

superor

artery

te

pancreaticoduodenal

afected

he pancreatcoduoduodena vesses orm an anas-

D.

artery

artery

and

suppes

te

pancreas

and

duodenum.

he

te

porta

trad

s

ocated

at

te

porta

epats

o

ver.

artery

E. Gastroduodenal

be

posteror

artery

aorta

pancreaticoduodenal

291;

usuay

and

mesenterc

superior

a

s

te

not

te

suppy.

tomoss

Posterior

N

hey

on

w

at

duodenum

s

t

4.66).

gastro-

omental

Abdominal

te

provde

bood

Right

structures

gastrc

tomose

Left

o

artery.

and

Fg.

(GAS

peroraton

346–347;

rgt

ture

a

part

et

epatc

A.

s

ven

he

sort

gastrc

vesse

suppes

te

undus

o

te

artery

stomac. •

GAS

Fig.

4.115

GAS

199.

A.

he

are

te

duct

344;

N

borders

cystc

meday

291;

o

te

duct

and

ABR/McM

244

cystoepatc

nerory,

te

te

neror

trange

(o

common

border

o

Caot)

epatc

te

ver

CHAPTER

Inferior

vena

183

Abdomen

3

cava Esophagus

Hepatic

Right

portal

suprarenal

vein

gland

Bile

duct

Duodenum

—superior

Spleen

part

Gallbladder

Right

kidney

Pancreas Position

of

minor L1

duodenal

papilla

Left

kidney

L2 Position

of

duodenal

major Superior

mesenteric

vein

artery

papilla

Duodenum

—descending

L3

Descending

part

—inferior

—ascending

part

•

cystc

ormed.

wc

It

one

B,

C,

s

n

s

te

D,

ange

E.

o

used

were

te

te

cncay

o

te

descrbed

o

te

structures

to

ocate

coecystectomy

gabadder.

orgnay

boundares

hese

a

ocaton

drans

Caot

o

GAS

currenty

cases

aso

drecty

Francos

as

It

arter y

node

(O

te

o

s

GAS

te

not

C.

cystc

E.

up

GAS

tr-

A.

347;

N

291;

ABR/McM

t.

s

psoas

By

200.

D.

he

argest

ous

spenc

branc

course

pancreas.

pancreas

ta

A.

o

o

As

t

te

he

to

te

t

s

te

ceac

ongest

trunk.

and

It

oten

takes

a

te

pareta

te

or

superor

border

o

passes

aong

te

superor

border

o

brances

to

te

neck,

coverng

ts

te

of

te

tortu-

aong

body,

and

B,

mesenterc

process

to

te

aorta

o

arter y

and

te

s

runs

a

drect

branc

anteror

pancreas

beore

to

te

gvng

ntestnes.

E.

he

are

artery

excessve

es

suppes

most

te

o

te

to

te

te

tg

appendx

common

to

patent

nlamed

pertoneum

s

r ub

sarp

he

poster or

pareta

resutng

and

cecum.

lexed,

contact

I

on

stomac.

245

to

tg

musce.

nlamed

ocated

te

drecty

underyng

psoas

s

o

( te

posteror

rgt

and

extended,

aganst

somatc

te

pan

patent.

D,

GAS

202.

er

on

stomac.

curvature

musce

te

te

ocated

ABR/McM

pe rtoneum

E.

durng

te

s

te

appendx

major

hese

appendx

abdomna

brances

te

291;

ocated

and

causes

C,

pancreas.

superor

te

te

et

gves

uncnate

B.

artery

o

N

a ny

appendx

200–223

greater

keepng

prevents

Answers

o

gastro-omenta

te

retroceca

poston )

246

artery

curvature

347;

he

rgt

gastrc

et

suppes

arter y

te

et

esser

he

Jean-

201.

make

he

te

Caot,

note:

aorta

4.66

per-

trange.).

do

Fig.

Caot.

331,

part

colon

Abdominal

superory.

colon

Duodenum

Duodenum

Ascending

and

to

tg

cystc

te

are

not

resutng

n

contact

sarp

wt

somatc

te

pan

extenson.

318–319;

borders

te

musces

cause

o

N

te

duct

282;

ABR/McM

cystoepatc

nerory,

te

261

trange

(o

common

Caot)

epatc

he epatc porta ven s ormed by te unon o te

duct meday and te neror border o te ver supe-

spenc and superor mesenterc vens posteror to te

rory.

It

neck

artery

n

o

te

pancreas

beore

ascendng

to

te

ver.

s

currenty

cases

used

were

a

cncay

to

ocate

coecystectomy

s

te

cystc

perormed.

184

C H A P T E R

A,

B,

3

C,

te

D.

A.

he

te

ture

by

by

trunk

rgt

and

py

rom

pass

te

ead

neror

o

D.

ror

mesenterc

tnum,

o

te

coc

coon

344;

passng

superor

vena

aorta

to

pass

te

gus.

to

B,

te

GAS

205.

D.

he

te

B.

racc

C,

he

he

neys

te

and

s

te

trontestna

between

GAS

206.

C.

he

ony

A,

B,

D,

te

B.

aorta.

te

a

gastro-

and

C.

and

va

te

nto

due

ower

ne-

It

o

lexure

medas-

te

arces

ung

coon

vsuazed

N

are

ng

way

o

te

et

te

epatc

o

porta

In

209.

unabe

ven,

to

o

es

ony

ormng

te

te

A.

n

te

pareta

to

covers

wt

o

C.

a

ntrapertonea

273;

te

scope.

ABR/McM

237

E.

subsequenty

nng

o

appearance

te

o

mdabdomen

a

on

congenta

stoo

sampe.

dsorder

and

he

structure

may

bood

w

as

w

not

be

vens

and

n

protrude

to

te

pass

tat

resut

ana

te

o

cana

cana



excessve

stoo.

may

tryng

te

rom

resut

to

pass

rom

stran-

ard

or

dry

N

to-

kd-

D.

A

N

and

and

not

237

te

ony

opton

sted

organ.

organs

be

are

afected

ABR/McM

and

posteror

over

o

te

ntrapertonea

by

a

retroperto-

236

oypogastrc

to

te

te

kdney.

nerves

Muc

oypogastrc

posteroatera

C.

gutea

o

are

te

nerve

and

s

pubc

emora

and,

and

over

tum

n

crest

D.

te

nerve

root

to

skn

te

o

12t

te

sur-

nerve

gves

sensory

tg.

suppes

te

te

skn

upper

over

meda

te

mons

majus

anterory

n

o

pens

anteror

nerve

suppes

N

musce

te

260;

tat

te

s

and

nerve

and

ABR/McM

w

costa

te

musces

abdomns,

women

or

scro-

provde

wc

te

o

anteror

ts

regon.

263

te

runs

margn

o

skn

n

“6-pack”

between

te

ook

te

mdne

s

pubc

o

te

wa.

10–12

rectus

7t

neror

and

cutaneous

atera

abum

398;

Rbs

he

te

speccay,

te

and

and

or

just

musces

men.

abdomna

B.

to

emora

rectus

runs

te

area.

onguna

skn

he

nerve

suppes

atera

GAS

trans-

tereore

s

oter

295;

subcosta

and

tg

te

may

te

dstrbuton

skn

he

gas-

pareta

ABR/McM

coon

tereore

drecty

he

cavty

and

280;

necton.

tg

A,

wt

a

typcay

tears

320;

he

peura.

te

te

posteror

stomac,

may

retropertonea

roundng

B.

260

retropertoneay

jejunum,

te

2-nc

tryng

are

onguna

rb

210.

te

te

te

passng

varcose

are

GAS

he

requre

pertonea

ABR/McM



a

pubs

anteror

t

may

regons.

varces.

tereore,

ocated

are

he

te

asca.

s

s

n

te

wc

we

nnervaton

w

n

boody

and

and

315;

w

sensory

esopa-

assocated

and

so

It

radograpy.

ssures

D,

ocated

ypertenson.

approac

drecty

E.

221

pertoneum

ocated

C,

s

nea

submucosa

esopagea

not

a

descendng

and

trbutares

te

te

B,

arc

bood

porta

systemc

and

o

gve

dsease

excessvey

he

te

ung.

s

A.

wc

te

jon

ncreased

bood

208.

bodes

over

to

te

trd

are

peura

312;

Ana

GAS

causes

subdvson

eum,

easy

E.

matera

eum.

stoos.

to

ormng

to

spenc

sdes

te

bood

te

posteror

rgt

ABR/McM

vscera

s

arge

regress,

te

studes.

red

on

rom

condton

ompaoenterc

nlammaton.

not

dicuty

rectum,

very

coon.

retropertoneay

N

brgt

te

competey

structure

Hemorrods

wc

superor

o

w

produce

present

superor

eca

congenta

o

nlammaton

by

resut

be

artery.

by

s

and

ong

marked

not

resutng

Hrscsprung

rena

dvded.

he

332;

Gastrts

a

projecton

wt

wt

s

porton

does

radograpc

sup-

tem.

s

A.

speen

to

arteres,

system),

pertoneum

verse

GAS

te

244

root

structures

a

vsuazed

E.

te

transversas

374–375;

pertoneum

te

by

by

te

te

smar

te

o

tract

pancreas

be

o

posteror

pareta

and

o

branc

abnormay

ver

at

e

a

rgt

te

low

210;

a

n

venous

dapragmatc

cavty

E.

o

s

vertebrae.

root

(an

varces

N

sted,

o

te

markedy,

kdneys

ayers

transecton

A,

te

ed

obstructed

arteres

gament

supped

descendng

over

hese

356;

to

voume

esopagea

aong

abdomna

suppes

(SVC),

vens

enarge

E.

become

curva-

duct

ngerke

2-nc

supped

ABR/McM

porta

reversa

C,

sup-

a

gastrc

supraduodena

ascends

te

passes

arge

orms

dvertcuum

proxma

stomac

supped

s

te

stranng

toracc

o

cava

azygos

he

vens

A,

a

Mecke

(vtene)

rom

s

esser

and

um

te

wc

te

cose

troug

causng

o

n

s

o

s

te

artery,

ypertenson

pressure

D.

gastro-omenta

gastroduodena

artery,

290;

8

aspect

te

te

kdney

te

ven

neror

porta

sort

at

pancreas

and

N

azygos

superor

o

207.

arteres.

et

he

et

gastrospenc

and

o

he

GAS

204.

wt

246

arses

bood

te

arteres,

and

he

brances

te

Most

aong

gastrc

artery

he

stomac

pancreatcoduodena

brances

te

assocated

ABR/McM

te

rgt

spncter

and

o

et

te

te

artery

mesenterc

E.

n

are

he

not

brances.

arteres.

pyorc

duodena

are

by

B.

291;

o

ormed

spenc

wc

he

D.

ts

and

orward

undus.

arteres,

C.

te

N

suppy

and

curvature

are

were

347;

artera

(gastroeppoc)

arse

structures

Caot.

anastomoses

te

greater

o

330–331,

rc

ceac

ped

hese

trange

GAS

203.

Abdomen

upper

costa

costa

and

te

abdomns

attacment

cartage

cartages

ac

to

s

and

or

crest

attac

a

te

te

to

are

too

ower

border

musce

sort

ar

atera

t.

oten

dstance

o

te

covers

anterory.

CHAPTER

E.

he

but

xpod

does

GAS

211.

C.

at

D.

T8

he

C.

he

attac

a

ror

vertebra

part

responds

A,

D,

B.

and

o

te

wt

11

n

rb.

are

L3

te

musce

213.

(B)

w

part

assocated

te

as

tey

hs

tat

margn

wt

consstng

move

o

te

B,

to

poste-

2

are

too

E.

cor-

and

and

correspond

to

s

rc

and

L4

GAS

258,

and

too

269,

5

are

cose

to

te

pevc

area

and

ow.

307;

265;

ABR/McM

225

aor ta

Posterior

medial

segment

Medial

sgn

by

spenc

ar teres

N

VII

a re

and

VIII

segment

Te

 ro m

te

carr y

o

te

epatc

te

Te

rc

superior

area)

superior

to

and

lateral

Anterior

segment

superior

medial

(Anterior

anterior

lateral

(Posterior

Anterior

medial

(Anterior

Posterior

lateral

(Posterior

Medial

area)

segment

(Medial

inferior

IV

anterior

(Lateral

common

te

te

II

superior

area)

segment

III

area)

area)

V

VII

area) segment

(Lateral

Caudate

(caudal)

segment

I

process

Right

caudate

Left

•

lobe

caudate

GAS

Fig.

lobe

4.116

superior

s

ac

abdomna

t ow a rd

segment

lateral

inferior

and

mesenterc

area)

Lateral

Posterior

o

nutrent

  ve r

area)

segment

superior

takes

a re a

epatc

V

VI

segment

inferior

te

area)

segment

inferior

n

VII

Left

Right

enarged

area)

segment

inferior

epatec-

pane.

o

te

et

bood

(Lateral

(Posterior

rgt

4.116).

superor

Lateral

Posterior

seg-

obe

remove

umbca

ve  n

brances

ox y g e n

et

te

rgt

prncpa

te

por ta

rgt

obes

s

255

ntestnes

termna

Fg.

rom

p re s s u re

te

te

tereore

appearance

 ro m

o

and

ne

obes.

obe

Removng

(GAS

aong

te

IV

et

quadrate

caudate

w

ABR/McM

s

uson

(Medial

III.

obes

 n c re a s e d

ve  n s .

te

VIII

set

o u t w a rd

o

(Anterior

IV

and

284;

and

Cante

and

and

segment

II

as

rgt

he

resecton

resected

N

ver.

obe

ts

medusae

ve  n .

E.

tereore

VI,

wen

bood

ormed

Leves

to

known

caudate

te

Incorrect

338;

a

te ower margn o te 11t and 12t rbs respectvey .

are

V ,

te

segments

radatng

por ta

g

o

aso

unctona

o

quadrate

E.

Caput

ve  n s

vertebra.

and

D,

GAS

214.

obe

accordng

C,

pane

nto

makes

et

te

tomy

beng

tereore

I,

segments;

produces

pont

te

tra-

any

ver

dvson

o

ment

dapragm.

anteror

tan

prncpa

te

w

obe

mdne.

costa

troug

esopagus

cava

downward

te

he

hs

pass

(E).

not

A.

dvdes

228

te

troug

ower

he

by

tat

vena

T12

owermost

eves

L1

o T10

at

vertcay

te

V ertebrae

ABR/McM

passng

wt

covered

neror

aorta

sternum

cage

be

attacment.

structures

eve

te

te

sope

an

253;

te

we

and

te

toracc

severa

At

structures

rbs

to

N

may

as

major

eves T7

partcuar

212.

tree

troug,

verse

A,

are

dapragm.

pass

serve

282–283;

here

te

process

not

185

Abdomen

3

II

area)

 owe r

186

C H A P T E R

3

Abdomen

Stomach

Liver Short

gastric

veins

Spleen

Left Hepatic

portal

gastric

Left

gastro-omental

Splenic

Inferior

Superior

vein

vein

mesenteric

vein

mesenteric

vein

vein

Descending

Ascending

vein

colon

colon

Ileum

Sigmoid

colon

Rectum

•

mbs.

Te

superor

do

not

por ta

contrbute

ve  n .

typcay

ve  n s

a re

te

A,

to

te

C,

D.

GAS

E.

ary

he

o

trad

(o

do

N

mesenterc

ve  n .

take

F g .

not

o

Te

te

wa

spenc,

ve  n s

te

and

ve  n

bood

o

bood

ro u t e

w

w

te

muncaton

resut

sac.

s

te

vena

are

A

n

omenta

between

gutters

part

bursa.

pertonea

neror

descendng

ate

wen

te

drans

t ow a rd

and

nracoc

epatc

A,

by p a s s

C.

responsbe

or

te

he

by

te

te

ony

esser

to

te

B,

vens

to

ora-

com-

sacs.

he

ascendng

N

to

an

et

E.

he

cava

et

azygos

receves

te

aternatve

GAS

te

N

sac.

spaces

240

or

to

o

jon

te

te

receve

most

drans

L3

or

198;

te

common

and

woud

bood.

wt

neror

emazygos

gonada

patway

390–391;

and

beow

greater

tose

bateray

w

rse

n

ven

et

accumu-

and

te

nto

connects

system

ac

w

to

ven

was

vens

rena

n

low

patway

and

and

above

ocated

not

may

supracoc

aperture.

gve

toracc

superor

are

azygos

to

lud

he

spaces

ABR/McM

common

subcosta

are

umbar

ac

wc

supne.

w

te

285;

addtona

he

and

and

lud

te

respectvey

as

porta

D.

coon

he

301;

posteror

te

beng

(eppoc)

s

and

atera

n

reerred

bounded

wc

bound-

eson

contents

aso

omenta

greater

spaces

anteror

stomac

space

D.

traversng

he

n

s

compartments

common

perorated

coons

patent

ascendng

provde

258

bursa,

cava,

te

o

he

ac

unon

C,

GAS

216.

te

transverse

B,

ater

te

  ow

4.132).

ABR/McM

orms

Wnsow)

and

4.132

paraumbca

d  re c t  o n

orm

Fig.

A.

299;

omenta

nto

paracoc

ormaton

a  t e r n a t  ve

( GAS

hey

stomac

te

esser

men

Ts

te

por ta

medusa.

posteror

te

tat

nto

epatc

a  t e r n a t  ve

ear t.

356;

expeed

te

spenc

ones

an

dran

and

neror

te

e n t  re  y

caput

215.

as

te

  ve r

B,

ve  n s

to

Te

nto

umbcus

back

gastrc

mesenterc,

GAS

vens

rgt

te

te

rgt

vena

cava.

dran

and

et

ascendng

te

sdes

umbar

nstances.

nto

te

vertebra,

ven

t

neror

and

cannot

bood.

ABR/McM

vena

atoug

221

provde

t

an

CHAPTER

Tributaries

to

azygos

187

Abdomen

3

vein

Stomach

Liver

Spleen

Left

Hepatic

portal

gastric

Splenic

Para-umbilical

that

round

the

ligament Inferior

teres

mesenteric

vein

hepatis)

Superior Superficial

on

vein

veins

accompany

(ligamentum

vein

vein

mesenteric

vein

veins

abdominal

wall

Inferior

vena

Superior

Common

iliac

Internal

Inferior

vein

vein

iliac

rectal

rectal

vein

iliac

External

cava

vein

veins Rectum

•

217.

A.

he

ayers

anteror

abdomna

wa

n

te

4.133

A.

rgt

he

rgt

porta

asca, Scarpa asca, externa abdomna obque, nterna

systemc

asca,

D.

he

wa

o

sma

obque,

276;

N

te

he

B.

he

te

between

te

paracoc

D.

he

GE

coon

GAS

Let

work

ces

at

n

o

cases

ower

o

te

juncton

te

te

descendng

and

te

transverse

externa

at

stomac

D.

meda

o

te

te

and

to

te

not

te

ocated

n

ven.

obstructon

wt

te

Dstenson

resuts

n

esopagea

o

ts

net-

esopagea

var-

et

drecty

to

te

epatc

communcaton

wt

a

medusae

jons

te

around

wen

ven

and

s

te

wt

te

umbcus.

dstended.

superor

descrbed

gastro-omenta

ven

anastomose

vesses

mesenterc

ven

dsorder.

drans

nto

tereore

te

not

supe-

nvoved

ematemess.

Pan

durng

te

no

cncay

mesenterc

354,

356;

rom

pan.

appendx

te

hs

area

s

to

a

gut

base

(at

N

299;

pan

rotaton,

t

area

te

te

ts

et

regon)

and

(durng

n

et

as

a

around

te

because

te

embr yoogcay

erna).

appendx,

rests

251

orgnay

ntay

T10

o

cecum,

mantans

embr yoogy).

s

structure

umbca

te

s

about

reducton

o

ABR/McM

appendx

mdgut

te

and

However,

n

no

ror

umbca

at

ven

he

erna

261

caput

orms

reated

ABR/McM

orm

and

vscera

coon.

were

E.

drans

vens

epgastrc

spenc

GAS

220.

coons.

ven

orms

ven.

he

n

coon.

transton

pont

s

between

4.89).

anastomoses

azygos

juncton

ndcates

are

281;

esopagus.

te

n

and

paraumbca

hey

230

E.

ocated

Fg.

N

ven

te

s

te

(GAS

317–318;

gastrc

brances

and

he

gastrc

ven

superca

coon.

gutters

jons

B.

transversas

pertoneum.

narrowng

ndcates

coon

juncton

abdomns,

pareta

ndcates

ascendng

he

esopagus

a

lexure

C.

te

te

lexure

spenc

s

hs

and

transverse

and

ABR/McM

vave

cecum.

epatc

at,

258;

eoceca

ntestne

A.

C.

transversus

extrapertonea

GAS

219.

te

Fig.

ower quadrant rom superca to deep are: skn, Camper

abdomna

218.

o

GAS

pysoogca

Subsequenty

wc

te

rgt

nner vaton

s

ocated

ac

(ts

s

ossa.

a

rue

188

C H A P T E R

3

Abdomen

Liver

Spleen

et

epatc

concavty

te

D.

ead

he

o

cystc

denum

duct

and

he

duct

and

rgt

GAS

E.

he

s

above

cancer

epatc

332;

proxma

be

to

te

obstructed

and

pancreatc

n

duodenum

223.

aso

not

duodena

n

cancer

o

pancreas.

compressed

E.

s

w

and

N

te

s

ead

BP80;

neror

o

artery

te

to

ead

te

rgt

and

ead

not

o

te

proxma

o

te

ABR/McM

o

te

key

duo-

to

be

pancreas.

and

above

te

pancreas.

257

pancreatcoduodena

artery

w

con-

tnue to suppy te pancreas, partcuary te ead o te

pancreas,

hs

A.



artery

he

te

s

a

gastroduodena

branc

spenc

o

artery

te

does

artery

superor

not

s

compromsed.

mesenterc

suppy

te

artery .

ead

o

te

pancreas.

B.

Right

colic

flexure

T ransverse

•

GAS

colon

Fig.

Left

colic

flexure

Somatc

wa

aferent

structures.

carres

hs

pan

w

be

sensaton

te

case

rom

Pregangonc

w

sympatetc

synapse

esser

n

toracc

gonc

bers

te

bers



to

aortcorena

spancnc

w

te

nerve)

accompany

te

GAS

bood

(te

postgan-

vesses

to

Answers

224.

Pregangonc

D.

Postgangonc

secreton

by

he

to

te

358–364;

ureters.

at

te

uretra

and

stones

n

obstr uc ton

te

rupt

appendx

te

exampe,

ABR/McM

s

ave

o

urnar y

ureters

most

n

n

to

o

B.

be

C,

Stones

D.

Stone

ton

and

w

GAS

A.

o

he

te

duct

to

obstructon

ead

n

N

317;

o

nto

te

pancreas

te

he

r are y

pevc

at

urnary

te

D.

at

te

pevc

o

s

te

or

be

duct

te

begnnng

tereore

o

te

te

te

ampua

porton

obstruct

te

C.

he

o

te

be

duodenum

carcnoma

and

o

epatc

not

te

duct

key

to

pancreatc

s

be

pan

ocated

n

Vscera

he

patway

bers.

te

o

artery.

esser

proper

te

ne-

cur-

epatc

ver.

253

rom

ncudng

te

as

prenc

te

pancreas

te

are

sympa-

pancreas,

vscera

are

aferent

he

aortcorena

w

he

to

E.

he

rom

skn

pancreatc

te

duct

o

at

te

ts

226.

to

compressed

Smary,

te

by

te

pancreas

motor

bers

do

not

nnervatons

to

capsue

te

mesenterc

N

o

te

east

suppes

o

te

toracc

sympatetc

gangon

receves

pexus.

hs

bers

gangon

sympatetc

bers

4.137).

310;

te

pubc

ocaton

te

postgangonc

(Fg.

dermatome

beow

te

o

mdgut.

ntermesenterc

suppes

s

bodes

wc

te

358–364;

GAS

second

dsruptng

tese

o T5–T9.

te

gangon

ce

ndgut

onguna

Vater)

by

o

nerve.

suppes

oypogastrc

te

vatng

concavty

ead

te

te

GAS

most

225.

(o

neror

many

junc-

bodes

ganga

rom

vagus

nerve

pancreas

ce

dapragm.

rom

ureters,

root

bers

te

te

nerve

dorsa

pan

wt

rom

he

nerve,

proxma

ead.

te

aferent

ABR/McM

nerve

kdney

over

w

and

te

s

s

sensaton

typcay

pubc

sympyss

245

receve

nner-

sympyss.

nnervated

he

by

te

nerve.

373–374,

394–401;

N

260;

ABR/McM

270

C. he ureter s narrowed at some regons, ence stones

are

more

ton.

common

te

Postgangonc

gangon,

to

regon.

B,

ceac

nnervaton

269

to

o

to

bers

nerves.

oregut,

spancnc

to

badder.

brm

and

Carcnoma

te

te

ead

caycea

ureters.

265,

reated

n

to

postgangonc

ureterovesca

enargement

epatopancreatc

duodenum.

can

te

ABR/McM

ead

duodenum.

at

n

enargement

pancreatc

jon

to

obstructon

resut

381;

open

part

ormed

te

to

curvature

gastrc

suppes

suppy

aferent

stones,

E.

not

key

stone

key

222.

are

esser

rgt

and

ABR/McM

sympatetc

nerves

te

wc

superor.

urnar y

badder

resut

vscera

trave

proxma

propensty

te

te

A.

261

was

enargement.

B.

he

ocated

te

are

nvoved

w

te

or

utrasound

areas

not

tat

306;

te

artery

bood

291;

brances

te

bers. Neurectomy o ts gangon w tereore nter-

to

unctons,

on

juncton

s

to

uncton

stones

narrow

bers

bers

N

of

wt

stomac,

provdes

accompany

te

gands.

N

seen

Rena

3

ureteropevc

he

motor

ntestna

abnormaty

odged

A.

317,

motor

sympatetc

vscera

E.

te

perorm

perorm

GAS

221.

parasympatetc

gastrc

te

348;

gves

suppes

224–244

C.

tetc

C.

and

togeter

rgt

o

artery

mdgut

gangon

beore

he

artery

nlam-

gastrc

stomac

vature

appendx.

appendx

esopagus

D.

body

maton o te appendx spreads to te pertoneum.

B.

et

ror

te

4.89

C,

A.

he

At

rowed

te

key

te

at

te

common

urnary

to

ower

be

pont

ac

badder

at

trapped

part

o

were

artery

te

at

te

t

tese

ureter,

crosses

and

were

vescouretera

areas

te

te

t

o

constrc-

ureter

s

nar-

burcaton

opens

juncton.

nto

o

te

CHAPTER

Celiac

Abdomen

3

ganglion

Prevertebral

plexuses

Celiac

plexus

Aor ticorenal

Superior

ganglion

mesenteric

ganglion

Aor tic

Inferior

plexus

mesenteric

ganglion

Superior

hypogastric

plexus

Hypogastric

Inferior

ner ve

hypogastric

plexus

•

A,

B,

D.

cava

arter y

ac

he

n

arteres.

te

te

E.

t

not

dvdes

he

arteres

ureters

do

tey

4t

are

and

cross

cross

nto

neror

vena

common

ac

nterna

umbar

ocated

te

te

arter y

meda

tereore

are

and

and

n

and

not

externa

act

a

posteror

crossed

by

ureters.

he

neror

unpared

ters

pat;

were

umbar

to

ureters

ts

GAS

are

neror

mesenterc

branc

more

o

te

ateray

mesenterc

artery

s

a

abdomna

ocated

artery.

and

mdne

aorta.

do

not

he

and

ure-

cross

te

Fig.

4.137

GAS

227.

C.

he

332,

structures.

o

358–364;

gabadder

he

ceac

postgangonc

spancnc

tures.

A

branc

o

artery

to

suppy

te

he

neror

rom

spancnc

317;

ts

ABR/McM

bary

gangon

nerve

ts

trees

rom

nnervate

traves

271

are

contans

bers

tat

nerve

oregut

ce

bodes

te

greater

tese

wt

te

struc-

cystc

gabadder.

mesenterc

postgangonc

mosty

N

sympatetc

toracc

A.

and

pexus

sympatetc

te

nerves.

esser

contans

bers

and

to

ten

te

east

mosty

mdgut,

toracc

189

190

C H A P T E R

3

Abdomen

Esophagus

Anterior

and

posterior

vagal

trunks

Celiac

trunk

Superior

Inferior

Pelvic

•

B.

he

superor

gonc

D.

spancnc

nerve

he

pexus

rom

rena

te

kdney

E.

mesenterc

sympatetc

he

east

to

superor

te

te

228.

C.

oca

(GAS

bers

to

pexus

to

contans

te

te

4.137,

post-

pevc

4.138

and

and

o

atresa

bous

te

N

301;

presents

vomtng,

Atresa

ABR/McM

and

resuts

duodenum.

wt

a

256

doube-bubbe

rom

aure

o

E.

a

tanted

sgn

on

ar ter y

ner ves

309;

Batera

s

o

te

N

279;

wt

An

nto

ros

atresa

gonads

or

ts

wereas

vovuus

or

or

pancreas

are

not

to

CNS

to

wt-

present

wt

x-ray.

uropaty

because

tte

or

s

no

cavty.

s

assocated

wt

deects.

duodena

dervatve

dvertcuum.

ead

245

amnotc

causes

a

ods

obstructve

conversey

and

not

above

ABR/McM

te

ead

marotaton

w

te

ogoydramnos

excreted

annuar

he

peuropertonea

ageness

Poyydramnos

septum

vomtng.

ernas

vomtng

rena

esopagea

B.

traceoesopagea

concomtant

assocated

epgas-

recanaza-

splanchnic

nonbous

Deects

be

GAS

229.

A.

dstended

E.

te

out

urne

radograpy.

ton

D,

o

wt

dapragmatc

suppy.

bers

Fgs.

nerve

Deects

TEFs

B,

spancnc

bood

ypogastrc

358–364;

Duodena

trum,

A.

toracc

postgangonc

mesenteric

ar ter y

4.138

postgan-

esser

4.170).

GAS

Fig.

mdgut.

sympatetc

regons

contans

rom

contans

toracc

reguate

gangonc

pernea

to

pexus

bers

GAS

mesenteric

o

obstructon.

te

metanep-

CHAPTER

Celiac

191

Abdomen

3

ganglion

Prevertebral Superior

mesenteric

ganglion

plexus

Aor ticorenal

ganglion

Celiac

plexus

Lumbar

splanchnic

Sympathetic

trunk

ner ves

and

ganglion

Aor tic

plexus

Inferior

mesenteric

ganglion

Superior

hypogastric

plexus

Hypogastric

Inferior

•

GAS

Fig.

GAS

230.

A.

374;

N

TEFs

and

te

D.

te

Batera

s

no

Down

C.

s

urne

amnotc

N

238;

ea

brous

E.

An

rom

te

a

o

drecty

wc

occurs

A

or

obstructve

te

n

because

reated

to

n

t-

A,

become

at

234.

B,

D.

wereas

cyst

te

connected

band,

s

an

te

s

te

eum

A.

N

annuar

bd

ater

te

te

not

be

324;

an

D,

outpoucng

o

border,

C.

B,

235.

wc

a

o

oowng

buds

n

wc

a

E.

eter

nlammaton

wc

deveop

orms

te

may

at

or

at

deveops

brt

bross.

te

second

Snce

cauda

part

or

o

part

te

hey

ABR/McM

answer

can

be

te

s

N

end

nto

te

not

324;

te

he

be

(GAS

nvoved

aure

to

too

sma

passng

scrotum,

ABR/McM

due

be

lud

orm-

gubernacuum

scrotum

congenta

wa

may

pertonea

tests.

nto

245

vagnas

aow

woud

s

o

twstng

o

a

nversus

Fg.

n

ads

4.41).

ydrocee.

278

o

cosure

ncompete

o

te

cosure

o

n

s

te

w

wen

a

opposte

not

present

N

syndrome

duodena

w

around

o

te

bowe

and

may

dvertcuum.

256–257;

atresa

B, C,

obstruct

oter

258;

s

to

as

be

nterna

o

te

sma

but

to

dsta

to

are

ernaton.

237

wt

get

organs

body.

bowe

ABR/McM

assocated

atresa

ave

te

sde

ncreased

bous

te

1st

nc-

vomtng

part

o

te

duodenum.

case.

probaby

o

descent

resut

Down

dence

vtene

may

abdomna

hese

D,

te

bud,

duodenum

a

ts

E.

Stus

A.

237

pancreatc

te

persstent

dagnoss

pancreas,

part

and

BP80;

289–294;

stuated

o

te

te

ods.

be

te

cyst

ABR/McM

ventra

oregut,

s

antemesenterc

E:

abdomna

V ovuus

and

remnant

D,

processus

Gastroscss

and

ompaoenterc

to

wc

abnorma

surace

N

ydrocee

atera

ucerated.

woud

315;

a

GAS

230

umbca

C,

but

testcuar

cavty.

traceo-

335;

troug

uropa-

amnotc

B,

persstent

bowe

ng

stua

te

dvertcuum

pancreatc

te

crcuaton

C.

GAS

ea

second

muc

te

a

Ompaoenterc

artery

C.

a

umen

GAS

233.

stak.

An

can

D,

atre-

anteror

umen,

by

ea

or

nto

(vtene)

umbcus

B.

o

ogoydramnos

between

s

A,

ack

lud,

ABR/McM

cyst

yok

GAS

esopagea

plexus

excuded.

tracts.

excreted

not

duodenum,

syndrome.

267

wt

to

ageness

wt

(vtene)

te

due

Potter

stuae.

connecton

termna

ABR/McM

rena

s

n

assocated

dgestve

Ompaoenterc

patent

sown

deects

syndrome

374;

be

te

assocated

or

GAS

o

and

esopagea

232.

311;

CNS

absorpton

C,

E.

and

respratory

ty

231.

not

Poyydramnos

sa,

B,

woud

hypogastric

4.170

C, D. Marotaton o te gut and batera gonada dys-

geness

ner ve

GAS

236.

C.

E. A te oter condtons occur proxma

major

309;

Mdgut

sma

duodena

N

ntestnes

ton

oowng

tant

twstng

vascuature

279;

vovuus

ABR/McM

occurs

enter

rotaton

o

at

to

te

te

gut

to

papa.

te

o

241

oowng

abdomna

te

mdgut

usuay

oop.

occurs

duodenojejuna

aure

cavty

and

o

or

he

resu-

afects

juncton.

te

xa-

te

192

C H A P T E R

A,

B,

3

D.

Abdomen

hese

syndrome

sma

E.

237.

GAS

309–310;

N

te

onguna

regon,

majus,

D,

GAS

238.

E.

E.

o

reated

as

to

Down

marotaton

te

c re s t ,

perneum

are

n

dsta

neura

te

ower

scrotum

tg,

abdomna

as

or

260;

superca

responsbe

ndrect

structures,

nodes

 ro m

te

or

trans-

C.

he

run

badder,

o

te

230

b e  ow

back

b e  ow

s t r u c t u re s

wt

cervx,

and

receve

te

ac

o

te

ower

te

pens,

receve

o

rom

he

tubes,

aortc

and

body

abdomna

te

and

o

nodes

o

te

ac

vscera

receve

can

239.

E.

he

288,

tat

gves

he

to

C,

D.

tests,

run

E.

he

eve

asca

and

verse

porton

o

artery.

and

wt

o

to

te

te

B.

At

egt

Normay,

an

ange

dmnses

te

superor

Fg.

264;

o

te

te

te

te

A,

C.

are

By

te

gve

artery

te

D.

ess

tan

duodenum

mesenterc

eaves

and

and

E.

sper-

externa

to

te

and

235,

te

rom

lexure.

es

and

nterna

superor

mesenterc

20

can

artery

degrees,

get

aorta

te

A.

At

at

age

to

ong-

edery

greater)

gut

he

gastone

aows

ga-

tssue

stua

nto

te

sma

between

ntestna

tree.

due

ut-

Oten

te

gas

ts

to

gas

x-ray.

cystc

duct

bary

don’t

or

coc,

odge

be

duct

jaundce,

at

about

7–9

14

o

by

and

duodenum

te

and

or

secondary.

or

ram

week

centers

o

growt

portons

pubs

te

ossy.

are

and

at

At

ave

grow

around

13–15

ony

just

acetabuum.

od,

centers,

centers

and

centers

o

years

remanng

rom

hese

nnt

prmary

acetabuum,

base

256

ossed

used.

3

growt

24

240,

s

egt

neror

te

te

ve

tree

competey

or

toward

25–27

te

remanng

22

pbone

and

te

te

prmary

te

ABR/McM

te

prmary

base

3

287;

age

brt

13

te

n

N

rom

remanng

he

versng

osscaton

and

tey

takes

use

wt

bone.

years,

434–435;

tese

te

o

trans-

at

artery

te

I

C.

te

and

between

eadng

to

te

bones

wa

o

soud

to

te

he

to

ave

aready

o

pene

s

part

s

te

s

uretra,

te

459–462;

N

most

part

aso

sortest

wc

eads

te

segment

tra-

caed

and

rom

one

te

ts

passng

segment

runs

349;

troug

eads

to

parencyma.

corpus

w

o

aong

te

engt

o

te

spongosum.

not

traversed

cystoscope.

GAS

te

nta

bub.

prostatc

te

te

badder.

segments,

uretra

troug

Parauretra

part

295

uretra

wt

urnary

Peroraton

te

spongy

te

porton,

uretra

prostate.

ABR/McM

o

uretra,

te

narrowest

Prostatc

pens

E.

te

membranous

damage

D.

o

250;

part

ntermedate

te

te

ts

transverse

part

prostate

mesenterc

ange.

aorta,

at

N

ntramura

he

te

duode-

he

entrapped

and

tssues.

bary

te

to

o

tree

te

te

GAS

243.

278

orzontay

45-degree

te

bowe

usuay

amost

Between

te

B.

coc

superor

or

gastone

wt

used.

tests

te

rse

ntestne

aorta

cm

adjonng

abdomna

o

years

age

puberty

super-

musce

on

and

By

toward

musce.

ABR/McM

et

rom

patents

communcaton

and

eads

appear

e,

proxma

approxmatey

to

es

sma

340–341;

extended

o

o

resutng

gabadder

centers,

scum

umbar

extenson

on

passage

and

16–18

eta

atera

4.47).

te

te

245

2.5

tese

Gastones

centers

deep

230

musce

between

not

“nut-

b e twe en

mdde-aged

and

gastone

GAS

uterne

te

abdomns

duodenum

between

orm

te

N

do

hs

or

jejunum.

artery,

asca.

suppes

aorta

o

an

obque

covers

ound

(GAS

pancreas

L3,

porton

s

mesenterc

and

num

eve

musce

It

289–294;

L1

s

cremaster

structures

superor

o

te

oc ated

n

(oten

gabadder

observed

pace

spermatc

hese

GAS

asca

transversus

to

cord.

spermatc

240.

te

artery,

suferng

occurs

(typcay

Obstructon

D.

te

rom

ovares,

ABR/McM

abdomna

cremaster

nterna

319;

spermatc

orgn

matc

N

obstructon.

coangts.

C,

asca.

nterna

ca

B.

514;

nterna

he

be

B.

years

transversas

A.

te

a

tat

and

ymp

gands,

uterus,

musces

not

pressure

te

te

adductor

ympatcs

and

enter

rom

undus

nterna

pevc

suprarena

are

key

tat

arge

te

te

vens.

GAS

A

separate.

atera

kdneys

bowe

mesenterc

ABR/McM

most

coetass

gabadder

perneum.

D.

par ts

291;

s

condton

te

242.

brances

ymp

N

aows

bowe,

mbs.

ympatcs

prostate,

gans

nodes

a

matey

ymp

tg.

nterna

recevng

nodes

as

348;

persstent

A,

nodes

hese

patent

between

to

re c e  ve

wa

super ca

suc

hs

women).

erna.

ABR/McM

ymp

ac

D.

standng

buttock.

externa

sma

superor

stone causes te ormaton o a coecystenterc stua

abdomna

 ro m

E.

eus,

and

he

regon

241.

we

obque

parta

caed

syndrome.

C,

GAS

o

anteror

not

an

B,

o

s

superor mesenterc artery and aorta at te eve o L3.

B.

urnary

A,

coon.

he deep nguna nodes receve some o te ymp

deep

condton

250

skn

meda

nguna

te

and

te

o

A.

rom

symptoms

o

musces.

umbcus,

and

aure

ABR/McM

pubs,

nerves

N

to

suppes

nterna

sgna

 ro m

n

adjacent

super ca

dranage

ac

hese

pan

398–401;

Te

 e ve 

mons

and

due

occurs

324;

abdomns

mttng

s

nerve

nerormost

transversus

C,

not

cracker,”

and

abum

are

present

megacoon

mgraton

nguna

B,

not

crest

he

as

w

bowe.

Congenta

C.

condtons

and

ABR/McM

279

by

te

CHAPTER

Genital

branch

of

genitofemoral

Testicular

nerve

artery

pampiniform

Cremasteric

vessels

and

plexus

Parietal

of

veins

peritoneum

Extraperitoneal

Ductus

fascia

deferens

Transversalis

Artery

Inferior

to

epigastric

ductus

193

Abdomen

3

fascia

deferens

vessels

External

abdominal

oblique

aponeurosis

Internal

Transversus

Conjoint

abdominis

oblique

muscle

muscle

tendon Deep

External

abdominal

abdominal

Superficial

oblique

inguinal

inguinal

ring

ring

aponeurosis

External

spermatic

Cremasteric

spermatic

Parietal

layer

of

Visceral

•

244.

E.

he

et

testcuar

epddyms,

te

A,

neror

B,

C,

jons

vena

D.

tures,

he

so

nvoved

testcuar

cava.

ton

et

ater

dranng

rena

ven,

te

wc

tests

ater

GAS

the

of

the

tunica

layer

Fig.

fascia

of

tunica

rgt

te

ven

vaginalis

vaginalis

the

tunica

vaginalis

4.47

and

sacra

jons

and

cava.

vens

dran

testcuar

dranage

drans

o

he

et

testcuar

wt

te

et

ven

common

ven

te

drecty

psatera

et

nto

as

ac

soud

tests.

te

no

not

neror

he

266,

receves

nto

516;

te

N

bood

et

313;

rom

common

te

sacra

ac

ABR/McM

regon

ven.

271

struc-

he

drect

ven.

ven

drans

GAS

testcuar

te

n

ven,

te

fascia

Internal

Cavity

fascia

be

rgt

vena

connec-

medan

Answers

245.

E.

o

245–246

he

te

above

bony

pubs

pevs.

te

s

descrbed

he

pubs

mons

and

promnence

as

pubs

te

beow.

te

s

pubs

a

anteroneror

atty

can

be

pad

tat

papated

part

rests

as

a

194

C H A P T E R

3

Abdomen

Left

Rib

kidney

Right

kidney

XI

Diaphragm

Rib

XII

Rib

Psoas

Quadratus

T ransversus

• •

A.

he

um

and

termnates

ac

artcuates

spne,

sympyss

B.

he

be

C.

papated

he

he

and

part

GAS

E.

he

part

o

s

te

smar

te

bone.

n

te

up

Its

433–436;

case

N

atera

part

te

te

o

te

te

te

a

pubc

agan

o

t

ve

te

makng

ABR/McM

o

emerges

te

psoas

muscle

4.151

crosses te quadratus umborum to te ac crest runnng

just

posteror

abdomns

A.

to

be

C.

s

posterone-

papaton

he

as

to

he

285

on

major

te

upper

musce

and

to

ts

or

te

GAS

perorates

does

cutaneous

not

gutea

te

te

obque

area

transversus

musces

nnervate

regon,

wt

and

brances.

te

wc

sensory

skn

does

dects

case.

emora

quadratus

cutaneous

nerve

cana

nerve

does

not

umborum.

and

nnervates

anteror

te

part

o

skn

te

over

abum

scrotum.

emora

(GAS

anteror

nerve

onguna

anteror

rom

n

nguna

majus

D.

and

It

abdomna

posteroatera

atera

he

te

kdneys.

correspond

reate

part

eature

atera

descrbed

B.

te

nterna

subcosta

te

not

to

and

nto

he

o

wa.

mpossbe.

nerve

Fig.

wa.

neror

promnent

on

abdominis

sacra

cannot

abdomna

posteror

most

vertebra

structure

abdomna

uson

coccyx,

ocated

250;

border

to

sacrum

superor

muscle

dvdes

posteror

anteror

bone,

ts

atera

anteror

by

to

te

anteror

muscle

lumborum

GAS

mdne.

too

ormed

oypogastrc

te

te

wt

te

ocated

tuberosty

o

as

termna

t

makes

pevc

descrbed

246.

s

troug

sca

ror

te

troug

scum

te

te

s

s

rom

suc,

sacrum

papated

o

away

As

vertebrae

D.

wc

coccyx

coumn.

posterory

anterory

major

XII

nerve

nnervates

compartment

anteror

Fg.

398;

aspect

o

o

te

te

te

tg

4.151).

N

260;

ABR/McM

musces

tg

263

and

and

o

te

te

skn

meda

eg

4 Pelvis

and

Perineum

Q u e st i o n s

Questions

1.

A

1–24

29-year-od

an

uncompcated

tons

sowed

sows

tra

Wc

te

o

te

uretra

use,

Laboscrota

B.

Coaca

C.

Urogenta

D.

Genta

E.

Urogenta

Se

by

gans

and

n

examnaton

te

wt

externa

superor

embryoogc

resutng

va

examna-

pens

te

boy

to

anus.

structures

most

ocaton

Genta

D.

Semnerous

E.

Laboscrota

A

32-year-od

o

as

te

ze

A.

s

ater

brougt

wt

at

to

te

rotng

term

va

a

emergency

and

rapd

vagna

depart-

breatng.

ome

brt.

5.

s

made.

o

o

Insuicent

D.

Kneeter

E.

Persstent

ng

and

dsta

o

te

sgmod

rectum.

vagna,

and

dstress

abdomen

coon,

An

wt

an

jon

no

nto

structures

mperorate

daton

nvertogram

coon

oowng

and

sows

te

sadow

sows

a

s

gas

o

snge

drecty

tat

anus.

An

descend-

seen

te

n

te

urnary

rectum,

canne.

s

Wc

nvoved

n

ts

ts

Laboscrota

B.

Persstent

Urogenta

D.

Genta

E.

Urogenta

A

ods

tuberce

4-year-od

moter

membrane

boy

because

deveopmenta

examnaton

te

a

nonpapabe

men

as

no

sows

cnca

brougt

o

a

mestones

o

a

tat

te

most

key

presentaton?

o

pyscan

te

been

met.

ocated

abdomna

Examnaton

s

an

te

aed

o

ectopc

deveop

s

A

Pysca

externa

obque

te

o

et

te

tests,

oowng

to

by

abdomen.

Utrasonograpy

mass

Wc

n

mass

externa

tests.

te

ave

papabe

te

rgt

to

sweng

abnormates.

nterstta.

structures

s

sows

aponeuross

sows

ods

coaca

C.

to

and

tests

abdo-

cassed

embryoogca

resutng

n

te

scan

te

te

ower

aed

dagnoss

oowng

to

o

s

te

part

vsua-

badder

te

most

streak

mesoderm

to

mgrate

ods

to

use

stmuaton

syndrome

boy

s

o

brougt

cryng

sows

te

and

s

Wc

o

te

and

o

by

te

A

Urne

dagnoss

urter

kdneys

oowng

s

Pysca

tenderness.

ntrtes.

made,

Utrasonograpy

pyscan

urnaton.

suprapubc

necton

ureter.

to

durng

eukocytes

6.

cnca

o

workup

sows

a

embryoogca

condton?

A.

Ureterc

B.

Mesoneprc

bud/metaneprc

C.

Paramesoneprc

D.

Metaneprc

E.

Pronepros

A

31-year-od

1-week

duct

mesoderm

man

story

dvertcuum

duct

o

comes

panu

to

te

pyscan

urnaton

and

because

pan

beow

o

a

te

umbcus. One year ago, e was treated or a urnary tract

necton.

ness

o

and

te

aong

o

examnaton

tender

abdomen

structure

Wc

Pysca

a

te

Hydrocee

B.

Epdermod

C.

Mecke

te

anteror

oowng

A.

sows

nraumbca

sows

te

s

presence

aspect

te

suprapubc

mass.

o

most

tender-

Utrasonograpy

o

te

key

a

1.5

cm

urnary

cystc

badder.

dagnoss?

cyst

dvertcuum

A.

Gubernacuum

D.

Ompaocee

B.

Processus

E.

Uraca

vagnas

n

preg-

o

structures s most key abnormay dvded resutng n

maormaton?

A.

Her

aantos

tract

bd

gestaton

vst.

membrane

androgen

sows

ndcated.

et

mass

he

o

weeks’

Utrasonograpy

prenata

prmtve

because

dpstck

A

Wc

uretra

6-year-od

examnaton

te

wa.

20

prenata

condton?

coaca

Faure

sows

respratory

te

C.

moter

o

ts

te

o

at

er

abdomna

badder.

B.

A

an

abdomna

cause

Faure

or

abnormates.

urnary

around

membrane

prmgravda

sows

exstropy

key

cords

swengs

pyscan

no

eta

te

ods

devered

te

abdomen

ods

gr

to

nancy

o

tuberce

Antenata records are unavaabe. Pysca examnaton

x-ray

3.

C.

comes

ure-

te

ectopc

4.

an

tuberce

er

was

Pysca

mmedatey

b)

Antenata

te

ventray

(9.8

membrane

5-our-od

ment

o

kg

orce?

A.

A

4.5

brt.

curvature

oowng

to

a

abnormates.

openng

aed

devers

vagna

prepuce

orce

key

no

downward

ncompete

2.

woman

cyst

195

196

C H A P T E R

7.

A

4

Pelvis

30-year-od

gestaton

er

o

care.

Her

ean

or

because

o

10

ater

and

secondary

pregnancy

admsson,

se

was

te

embryoogca

8.

patent

an

te

A

C.

Faure

o

te

D.

Faure

o

recanazaton

E.

Regresson

7-year-od

boy

o

as

te

uson

s

an

to

weeks’

no

brt.

emergency

progress.

aed

o

to

cesar-

he

notes

a

key

condton?

ducts

paramesoneprc

ducts

o

uterus

most

paramesoneprc

te

uy,

secton.

and

te

ours

date

cesarean

s

by

an

antena-

vagna

adesons

ts

mesoneprc

te

n

cervx

o

An

o

35

astng

receved

oowng

B.

A

uson

at

department

norma

emergency

A.

ncompete

a

aure

patent

o

2,

unavaabe. T wenty-our

expanaton

compete

was

patent’s

te

Wc

para

contractons

resuted

to

or

3,

emergency

severe

he

were

taken

Intraoperatvey,

ddepys.

te

pregnancy

pregnancy

secton

ts

seconds.

rst

Perineum

gravda

to

Her

second

woman,

brougt

partner

average

ta

s

and

te

to

ducts

degenerate

Müeran

ducts

pronepros

brougt

to

te

pyscan

because

o

an

nabty to contro s urnary badder, despte beng toet

traned at te age o 5. Fve monts ago, e was treated or

a urnary tract necton. Utrasonograpy o te abdomen

sows

a

md

Dagnostc

drecty

made.

deect.

cystoscopy

nto

An

dataton

te

o

te

sows

uretra.

A

o

te

oowng

ty te poston o et ureter

9.

A.

Anteror

B.

Meda

C.

Anteror

to

to

te

te

to

et

et

te

s

common

gonada

Anteror

to

te

et

rena

to

te

et

neror

and

a

te

use,

n

A.

Processus

B.

Laboscrota

Uretra

D.

Urogenta

E.

Genta

a

examnaton

as

are

no

Fg.

structures

was

4.1.

most

by

beng

met.

notced

Wc

key

o

to

te

aed

to

11.

s

brougt

n

no

Spongy

B.

Laboscrota

C.

Coaca

D.

Urogenta

E.

Genta

n

ts

to

te

pyscan

examnaton.

oter

Fg.

structures

A.

25-year-od

tum

mmunzatons

resutng

A

3-mont

Pysca

sows

4.1.

most

cnca

are

up

key

s

Deveopmenta

to

date.

abnormaty

Wc

by

o

te

except

or

abnor-

ods

membrane

tuberce

12.

lud-ed

mass

s

te

B.

Rectocee

C.

Cystocee

D.

Hydrocee

E.

Hypospadas

54-year-od

eeng

rgt

compared

sot

and

accumuaton

o

o

o

s

te

tests

key

(Fg.

sde

to

wt

te

o

tests.

lud

n

te

Wc

scro-

et.

A

On

and

CT

a

scan

cavty

o

a

rgt.

te

te

nontender

te

4.2).

on

te

o

o-

dagnoss?

comes

bood

pyscan

scrotum

to

man

story

te

anteror

most

Varcocee

sows

arger

et

vagnas

A.

sstent

s

to

enarged

scrotum

abnorma

tunca

3-week

comes

an

examnaton

te

A

o

remarkaby

owng

presentaton?

man

story

papaton,

te

oowng

deveoped

s

sows

Pysca

uretra

ods

4.

s

abnormates

currenty

uretra

n

artery

pyscan

maposton?

oow-up

noted

embryoogc

may,

He

te

ods

and

Fig.

artery

ods

boy

•

den-

tuberce

or

deect

to

ods

6-mont-od

te

used

s

te

vagnas

C.

mestones

ts

ureter

correct

artery

epgastrc

te

sown

embryoogca

resutng

moter

as

4.

artery

to

mestones

crcumcson,

Fig.

ven

brougt

crcumcson.

mapostoned

oowng

A

s

deveopmenta

Durng

be

or

boy

ac

s

to

•

procedure?

epgastrc

Anteror

15-day-od

perormed

system.

nsertng

ectopc

andmarks

E.

A

orce

o

durng te

neror

et

uretera

D.

moter

10.

a

pevcaycea

dagnoss

ureteroureterostomy

Wc

et

n

to

s

generazed

te

pyscan

urne.

He

tredness

because

aso

and

as

2.2

kg

a

o

per-

(5

b)

CHAPTER

wegt

bood

ence

oss.

ces.

o

a

Wc

te

anayss

scan

mass

o

wt

Varcocee

B.

Rectocee

C.

Cystocee

D.

Hydrocee

ts

sows

te

te

presence

abdomen

extendng

oowng

A.

E.

nto

condtons

sows

te

s

et

most

o

te

and

197

Perineum

red

pres-

rena

ven.

key

to

be

dsease?

Hypospadas

A

30-year-od

o

nabty

ke

a

bag

man

to

examnaton

o

sows

asked

bear

Fg.

most

4.3.

down.

Varcocee

B.

Rectocee

C.

Cystocee

D.

Hydrocee

et

An

o

sde

x-ray

pyscan

past

ts

Pysca

scrotum

rgt

wen

wt

because

years.

te

he

sde

te

ees

o

te

patent

contrast

oowng

wt

2

o

ndng

te

assocated

te

te

papaton.

smar

Wc

key

A.

E.

a

on

to

or

te

worms

sows

to

comes

conceve

scrotum

n

14.

CT

rena

o

assocated

13.

Urne

A

Pelvis

4

s

condtons

radograpc

s

sown

w

be

pcture?

Hypospadas

A

16-year-od

department

abdomna

woman

because

pan

s

o

and

brougt

te

ever.

to

te

sudden

emergency

onset

Laboratory

o

studes

severe

sow

a

3

eukocyte

nancy

n

count

test.

te

o

Copocentess

pevs

sows

conrmng

ectopc

pregnancy.

was

neede

te

20,000/mm

te

Wc

most

key

and

te

a

postve

presence

dagnoss

o

te

o

a

troug

bood

ruptured

oowng

nserted

o

preg-

structures

to

perorm •

te

A.

pernea

B.

posteror

uterne

C.

body

nto

part

o

te

te

vescouterne

vagna

ornx

te

recto-

experencng

part

vagna

o

te

vagna

ornx

nto

te

endocer-

E.

pernea

nto

te

membrane

greater

nto

vestbuar

te

gand

externa

uretra

spncter

46-year-od

o

1-mont

vc

regon

wom

troug

wen

tocee

story

were

Pysca

o

vagna

asked

made.

responsbe

a

devered

er

s

comes

or

va

bear

A.

Compromsed

B.

Weakened

o

o

Se

a

pyscan

eavness

as

5

vagna

wc

down.

te

A

because

n

te

cdren,

notceabe

openng,

to

te

norma

sows

Wc

ts

to

eeng

constpaton.

examnaton

se

s

woman

and

o

ncreases

dagnoss

s

o

deveres.

buge

oowng

pe-

a

tssue

n

o

most

sze

rec-

key

condton?

rectovagna

superca

and

16.

Parayzed

Loose

E.

septum

deep

Ruptured

scocavernosus

sacrospnous

68-year-od

nabty

to

prostate

Anteror

B.

Medan

C.

Latera

D.

Posteror

E.

externa

man

pass

and

noctura

or

te

past

6

Latera

u

o

pernea

uretra

comes

urne

musce

gament

or

to

spncter

te

te

pyscan

past

2

days.

because

He

as

o

an

been

and

sweng

o

antbotcs

no

efect.

mass

no

most

key

be

ypertroped?

posteror

te

was

ctors

Pysca

arsng

rom

node

o

to

ces

s

ts

te

Superca

B.

Externa

and

ac

C.

Para-aortc

D.

Presacra

E.

Axary

a

o

deep

ymp

ymp

ymp

nodes

nodes

but

a

course

as

ad

tender

studes

aong

te

A

t

rm,

aggressve

o

ave

nguna

nodes

days.

aspraton

excson

to

nodes

sows

an

Wc

key

14

Laboratory

neede

wde

made.

cancer

A.

past

prescrbed,

ctors.

Fne

suggestve

s

te

examnaton

perorm

cearance

or

prevousy

abnormates.

decson

transverse

w

A 19-year-od woman comes to te pyscan wt pan-

nodes

D.

A

17.

te

A.

presence

musces

C.

urnaton

and rreguarty o te uvua. Wc o te oowng obes

o

orce

panu

monts. Utrasonograpy o te pevs sows enargement

cana

D.

A

4.

space

nto

pouc

anteror

vca

15.

Fig.

copocentess?

sow

sows

te

sarcoma.

A

wt

ymp

oowng

ymp

draned

ymp

to

rst?

nodes

198

C H A P T E R

18.

A

4

Pelvis

45-year-od

man

to

te

emergency

depart-

22.

A

24-year-od

ng

ng

expedton.

ower

A

too

Pysca

mbs

o

muc

te

o

orce

s

be

and

sacra

cateter

ruptured. Wc

key

examnaton

bateray

dagnoss

nserton

used,

o

te

traumatzed

a

cord

to

njury

reeve

and

te

made.

urnary

structures

o

bad-

Durng

uretra

3

progress.

retenton,

woud

was

s

owng

most

and

te

Antelexed

Retrolexed

Antelexed

B.

Externa

spncter

D.

Retrolexed

C.

Corpus

E.

In

D.

Iscocavernosus

E.

Openng

o

22-year-od

te

woman

ntermttent

or

o

te

10

monts.

any

o

te

bodes

s

made.

Dorsa

and

root

he

sensory

D.

he

preaortc

S2,

tcuar

S3,

Dorsa

o

wom

tear

te

rom

dagnoss

spna

o

5

eres.

a

to

o

o

te

n

ts

cord

a

pan

9

out

dag-

on

ce

coumn

o

on

spna

at

te

nerves

ste

o

to

contro

s

er

to

tear

or

ts

B.

Iococcygeus

C.

Coccygeus

D.

Pubovescocervca

E.

Externa

Se

s

Her

nto

te

Broad

tes-

deectve

a

Se

and

A

te

o

a

te

rst

C.

Para-aortc

D.

Node

E.

Interna

presentaton?

artery

Questions

25.

asca

spncter

obese

woman

A

spne

nerves

was

sows

tenderness

te

comes

n

mb. T appng

gament

just

reproduces

most

pyscan

o

n

te

te

because

Se

recenty

vagna

uterne

ymen,

ts

dev-

proapse

wc

ncreases

gaments

s

most

condton?

uterus

gament

uterus

comes

o

to

3

and

monts.

examnaton

spread

ymp

pyscan

to

rom

a

as

sows

never

boat-

(10

ad

pevc

b)

any

mass.

batera

nodes.

most

dseased

nguna

kg

sows

ymp

woud

because

and

4.5

a

pevs

te

te

pan

as

Se

and

nodes

deep

te

abdomna

atgued

ymp

and

a

oowng

abdomen

wt

ac

Wc

key

be

te

ovares?

ymp

nodes

nodes

nodes

at

te

eve

o

te

rena

vesses

Coquet

ac

and

nodes

accompanyng

te

uterne

ven

to

te

pyscan

25–49

29-year-od

tes

ospta

metus

body.

ac

uterus?

musce

wc

nguna

receve

o

examnaton

te

masses

Superca

most

o

ast

te

oowng

Externa

musce

uretra

ower

o

B.

s worsened by standng and aevated by sttng. Pysca

rgt

te

sows

(cardna)

Pysca

A.

te

te

a

o-

gament

o

ees

te

IV

Wc

te

mesometrum

story

se

n

scan

to

because o pan n er eg or te past 3 monts. he pan

o

says

oss

ovaran

avods

tus,

CT

and

woman

6-mont

cdren.

grade

to

sows

o

te

dscomort.

te

te

resutng

gament

60-year-od

ng.

because

musce

40-year-od

A

o

pregnancy

a

o

uncompcated

o

o

E.

cord

va

eve

cervca

anus).

deectve

patent’s

n

te

Wc

Latera

cdren,

ast

resuted

to

stranng.

D.

or

to

pevc

examnaton

gament

and

Wc

poston

comes

a

brted

Round

movements

ve

were

Pysca

C.

S3,

T10–L2

as

o

Inundbuopevc

pyscan

embarrassed

and

extendng

structures

responsbe

te

vagnay.

devery

Pubococcygeus

eves

bowe

settngs.

devered

orceps

(pernea

spna

partcuary

soca

were

a

o

comes

woman

story

Mesosapnx

te

vagna

Dougas

B.

o

uterus.

hs

aure

retroverted

o

A.

ce

T5–T9

orgn

and

neura

patent?

spna

te

to

anteverted

key

24.

o

wom

extendng

-

S2,

pregnancy.

due

a

anteverted

nterstta

eves

o

or

screen-

as ad dicuty passng urne. Se as ve cdren, a

requency

Durng

experences

ocaton

because

5-mont

rst

secton

examnaton

and

pouc

pyscan

prevous

retroverted

and

55-year-od

wegt

A.

A

vares

sensaton

o

ganga

ganga

nto

oowng

key

urnary

S4

woman

Se

out

requred

and

ganga

root

nabty

year.

gong

pyscan

arteres

55-year-od

an

A

te

ntermedoatera

eves

past

s

pan

te

and

A

o

S4

C.

o

or

duct

trggers.

woman

ganga

he

A

pan

badder.

Wat

B.

E.

he

te

urnary

responsbe

to

pan

partcuar

cystograpy,

cystts

A.

3

23.

comes

suprapubc

wtout

nostc

ng

past

musce

bubouretra

te

te

Her

er

cesarean

common

and

C.

durng

a

to

screenng.

retrolexed

most

A.

B.

cavernosus

n

Bmanua

musce

A

ocaton?

s

pror,

ended

retroverted

comes

cancer

years

pregnancy

Bubospongosus

uretra

ts

te

s

parayss

urnary

membranous

oowng

at

sows

dstended

woman

cervca

A.

o

21.

brougt

routne

der.

20.

s

Perineum

ment ater ang 4.5 m (15 t) durng a mountan cmb-

te

19.

and

key

A.

Femora

branc

B.

Femora

nerve

C.

Ioypogastrc

D.

Ionguna

E.

Latera

pan.

afected

o

over

meda

te

te

te

to

te

te

Wc

n

ts

atera

o

nerve

cutaneous

nerve

te

tg

aspect

anteror

o

superor

oowng

patent?

gentoemora

nerve

emora

anteroatera

nerve

vagna

key

durng

extends

hree

an

a

rom

damaged

weeks’

was

te

te

epsodes

te

durng

te

rng

s

to

“song

epsotomy

Durng

pernea

te

er

structures

woman

under-

was

eadng

most

to

ts

presentaton?

A.

Superca

B.

Externa

and

ana

deep

transverse

spncter

C.

Iscocavernosus

D.

Sacrospnous

E.

Externa

musce

gament

uretra

spncter

pernea

to

dabe-

perormed

te

devery,

o

oowng

comes

wt

examnaton.

epsotomy

ymen

ater

gestaton

dagnosed

antenata

mdne

requent

o

39

Se

monts

Wc

at

abor.

devery,

experences

wear.”

woman

n

musces

CHAPTER

26.

A

41-year-od

mutpe

monts.

durng

5

Se

deect

tat

o

o

s

uretra.

key

o

Wc

been

resutng

27.

n

ts

T endnous

B.

Coccygeus

C.

T endnous

D.

Obturator

E.

Rectovagna

gery,

o

o

pevc

ts

28.

nodes.

Mucosa

sows

atered

badder

and

as

te

E.

30.

most

deveres

te

ony

o

te

most

porton

past

sacra,

are

Bopsy

at

te

key

o

ana

ne

rectum

50-year-od

a

Enterocee

Urnary

E.

Proapsed

parts

prmary

sows

o

te

31.

gas-

afected

by

tra.

eakage

o

Iscoana

B.

Pernea

C.

Retropubc

D.

Superca

E.

Deep

by

says

tat

3

ton

se

sows

vestbue.

te

musce

s

ten

he

spaces

t

to

opera-

te

n

rectus

a

posteror

vsuaze

wa,

was

32.

and

s

to

pan

te

MRI

to

cet

because

started

a

bues

Incson

a

breast

ew

te

a

emergency

severe,

ours

smar

days.

ago.

s

ymen

epsodes

and

observed

sows

depart-

deep

Her

Pysca

deveopment

membrane

o

o

ew

experenced

astng

norma

a

pevc

moter

or

te

examna-

pubc

ar.

across

te

ematocopos.

33.

woman

says

te

4.4).

to

A

reduce

te

Cuna

D.

Pudenda

E.

Broad

sympatetc

te

o

s

o

ony

er

and

s

s

pe-

nega-

te

most

pyscan

epsodes

sessons.

due

to

because

o

urnary

Se

te

ad

sgncant

norma

te

er

presence

nterna

oowng

o

men-

sows

spnc-

musces

s

to

te

pan

aways

boated

mass

bopsy

o

te

pan

te

past

tat

a

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tate

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to

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cavty

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an

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prostatectomy.

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secondary

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nodes.

more

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tumor?

uterus

rectum

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o

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cancerous

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and

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space

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pouc

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part

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te

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abdomen.

and

a

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most

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spancnc

panu

te

A.

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36.

o

eadng

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woman

te

o

A

ypogastrc

34-year-od

or

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and

day

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numbness.

pevs

oowng

to

back

a

man

dysuncton.

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A

pace

gutea

50-year-od

A.

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gutea

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emergency

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eadng

te

onto

expedton.

tone

Wc

traumatzed

m

symptoms?

35.

A

erecte

te

pack

ang

te

urnary

was

spancnc

he

woman

nerves

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E.

ater

as

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34-year-od

pevs

externa

spancnc

Superor

department

e

te

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A

to

wt

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and

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o

bopsy

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uretra

most

rupture

(Buck)

cet

te

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prostate

34.

oowng

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externa

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membrane

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comes

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te

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deep

cm

sows

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provde

exporaton

space

man

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detumescence

3

pouc

pernea

Subsequenty,

•

a

space

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urgency.

ave

rapd

sow

and

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68-year-od

o

and

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Superca

A

uretra

woud

A.

E.

surgca

spongy

o

sound

examnatons

Durng

dsta

wc

37.

poppng

Pysca

or

bot

cana

34-year-od

pevc

urnaton,

o

er

ovares

rectum

superor

woman

and

and

to

te

comes

abdomna

pectnate

to

te

pan,

constpaton.

A

ne

pyscan

boatng,

CT

scan

o

because

ncreased

er

pevs

CHAPTER

sows

41.

an

ovaran

ymp

nodes

cerous

ces?

Superca

Externa

C.

Lumbar/atera

D.

Deep

E.

Interna

ter

Presacra

E.

Axary

to

past

vagna.

o

A

2

rst

bopsy

ymp

ts

weeks.

o

ce

nodes

wt

te

nodue

Posteror

Isca

D.

Posteror

E.

Coccyx

Cardna

Uterosacra

Levator

E.

Medan

to

46.

se

38

o

er

A

key

er

nerve

papated

a

man

beedng

te

as

and

to

at

pyscan

anus

or

aso

o

ymp

D.

Obturator

E.

Lumbosacra

A

32-year-od

panu

ntercourse.

y

as

and

sows

te

transmsson

o

A.

Sacra

B.

Superor

C.

Pevc

D.

Pudenda

E.

Ionguna

A

o

vagna

ton

week.

o

mtted

naton

ng

s

women

mass

responsbe

rom

ts

or

te

recenty

regon?

te

vagna.

dseases

er

s

te

or

te

pyscan

past

oneymoon.

presence

anatomca

more

to

abnormates.

te

necton

best

are

urnaton

rom

no

and

comes

o

made.

A

Fbroma

ss

trogram

Wc

o

or

to

te

te

oow-

act

tese

tat

knds

woud

A.

vagna

contans

B.

he

prostate

C.

he

uretra

ess

bactera

lora

tan

te

pens

produces

s

muc

antbactera

sorter

n

prostatc

women

luds

te

as

extremey

cronc

te

past

anema

mont,

abdomna

dented.

pan.

Wc

te

wa

on

a

o

ts

pyscan

very

artery?

n

studes

because

conservatve

attempted

key

sexua

or

actvtes.

dagnoss

o

te

ts

n

o

examna-

sexuay

o

o

am-

contractons

manua

Wc

pernea

s

brougt

nvoved

s

n

90/80

and

trans-

oowng

patent?

te

pudenda

te

an

to

a

te

mm

Hg

sows

ntact

o

te

ntay

superor

and

and

grde.

Between

Camper

D.

Between

Coes’

here

o

contrast

te

pevc

E.

Between

Buck

asca

nto

asca.

te

Were

externa

and

and

and

and

Scarpa

te

asca

Gaaudet

te

uretra

dapragm

membrane

asca

s

extravasate?

te

asca

102/

cystoure-

Gaaudet

C.

s

eccymo-

retrograde

te

depart-

coson.

puse

mutpe

superca

aspect

pernea

vece

pevc

extravasaton

beneat

emergency

motor

A

musce

te

body

eccymoss.

contrast

Between

te

nvountary

examnaton

sows

Between

gaton

uterus

man

pevs,

spncter

B.

he

s

compresson

te

peruretra

abdomna

o

nectons?

A.

te

sows

o

In

engagng

negatve.

pressure

Pysca

o

o

beng

bood

mn.

dpstck

dagnoss

o

46-year-od

ater

to

rom

Laboratory

nerve

E.

aso

urne

men

Se

a

cana

Dsrupton

A

s

sows

most

Endometross

exam-

A

tan

days.

te

D.

Pysca

ntrtes.

expanaton

susceptbe

3

because

s

durng

begun

are

C.

Hs

upon

tract

48.

woman

key

nodes

muscuature

(Acock)

ment

sows

te

sensaton

s

ypogastrc

returned

eukocytoss

urnary

pan

bues

nerves

spancnc

burnng

recenty

tender,

spancnc

26-year-od

o

a

oowng

Se

n

artery

comes

Se

examnaton

Pudenda

o

vagna.

tan

trunk

woman

B.

Wc

te

ur-

nerve

peranay.

examnaton

mont.

te

te

more

sgncant

njury

artery

Vagnsmus

1

uter.

resuted

uterne

ac

condtons

past

te

ac

A.

te

o

o

ascae

suppements.

Interna

Pysca

or

ron

atrogenc

epsode

constpaton

wa

s

sows

past

probem?

experenced

He says tat e s generay n good eat, except or an

o

anteror

ave

Interna

andmark

past

proapse

structures

eomyoma

C.

because

te

use

surgery,

Pysca

te

s

or

wc

B.

spne

comes

pan

a

orce

gament

s

te

55-year-od

umbca

bony

spne

ac

examnaton

gament

Ureter

tuberosty

superor

bactera

because

an

perods,

potenta

47.

ac

sows

to

pyscan

vagna

vescocervca

A.

nerve?

neror

te

o te oowng adjacent structures s most susceptbe to

me-

bock

Wc

as

to

devery.

dabetes

approac.

be

comes

scedued

pudenda

transvagna

most

gestaton

er

pregnancy,

uncontroed.

a

weeks’

or

ts

and

ysterectomy

despte

at

te

resstant

A 40-year-od woman comes to te pyscan to undergo

a

nduced

te

201

Perineum

gament

D.

spne

C.

Pubovesca

B.

Durng

be

woud

B.

A.

to

to

and

mucus

luds

Pysca

cystogram

eadng

C.

key

urne.

troug

oowng

s

most

comes

troug

te

s

area?

woman

A

eson

aortc

woman

usng

o

produces

produce

passng

rng.

gand

gands

extendng

badder

eavy

course

ts

dicuty

mass

carcnoma

nguna

to

been

52-year-od

deectve

Pysca

uceratng

squamous

rom

pyscan

ymp

Isca

recta

te

te

ymp

A.

A

or

to

ac

te

bock

comes

erytematous,

te

D.

structure

44.

are

Lumbar/atera

as

an

er

C.

perormed

43.

o

Superca

pyscan

A

parauretra

semna

ymena

beedng

dranage

34-year-od

he

Wc

dagnoss

Wc

ymp

he

E.

nary

Interna

tus

aortc

sows

A

D.

o

woman

vestbue

Durng

can-

ac

B.

te

by

a

A.

A

oowng

nguna

vagna

perormed.

made.

te

nvaded

nguna

examnaton

te

o

become

ac

62-year-od

n

Wc

key

45.

B.

A

tumor.

most

A.

paness

42.

w

Pelvis

4

dartos

asca

ayer

asca

o

202

C H A P T E R

49.

A

a

4

Pelvis

45-year-od

4-mont

vagna

and

woman

story

uness.

o

In

Perineum

comes

ower

te

to

te

back

ast

pyscan

pan

mont

and

se

a

as

because

o

D.

Sacra

sensaton

o

E.

Dorsa

notced

di-

53.

ment

cervx

naton

te

eve

o

te

vagna

orce.

An

abdomna

2

ts

oowng

procedure,

te

promontory

vagna

oowng gaments provdes te natura anatomca sup-

C.

Prostatc

port

D.

Urnary

E.

Ureter

tat

ts

procedure

A.

Uterosacra

B.

Round

C.

Broad

D.

Arcus

E.

Levator

gament

o

tres

te

to

gaments.

Wc

sup-

o

reestabs?

uterus

54.

gament

A

tendneus

ascae

repar.

pevs

an

ower

Questions

A

1-mont

patent

A

man

story

as

monts.

9.1

cancer

(20

s

s

nodes

soud

B.

Externa

C.

Superca

D.

Deep

E.

Gutea

s

ac

A

CT

o

te

durng

urgency.

te

eves

and

scan

because

over

g

o

metastass

Wc

removed

and

oss

sow

perormed

made.

and

pyscan

wegt

ympatc

be

Interna

b)

te

noctura,

studes

perormed.

A.

to

dysura,

bopsy

regona

tomy

A

o

kg

transuretra

sows

comes

Laboratory

prostate

a

past

o

te

a

ton

he

4

an

o

D.

Pudenda

E.

Obturator

A

pan-

o

on

te

te

abdomna

ympatc

s

rgt

scrotum

most

and

key

to

Interna

B.

Externa

C.

Superca

pan

Deep

Para-aortc

nvoved

n

sows

oowng

ts

ner.

Specuum

a

attempt

to

e

ater

was

mantan

postoperatvey,

wtout

nocturna

probaby

pene

te

Pudenda

B.

Pernea

C.

Pevc

s

e

use

durng

spancnc

radca

on

mucopuruent

o

e

s

Sacra

spancnc

Lesser

spancnc

te

Wc

He

o

aso

o-

nerve

n

A

was

o

been

s

te

o-

expe-

rom

et

Pysca

o

a

erna

s

nner

examna-

et

nguna

et

s

sde

s

notced.

responsbe

or

ts

to

te

not

ave

a

te

past

stabe

sows

an

weeks.

sexua

rom

part-

cervx

examnaton

Wc

bers

because

2

nlamed

Bmanua

tenderness.

sensory

pyscan

or

o

ts

te

o-

nlamed

One

ypogastrc

24-year-od

pap

wc

o

te

sowed

rom

er

uterne

ts

Perneum

no

B.

Suprapubc

most

C.

Umbca

D.

Inguna

E.

Epgastrc

57.

cervx

areas

A.

operaton?

no

and

s

to

te

Se

pyscan

ad

abnormaty.

sows

secreton.

oowng

durng

comes

examnaton.

cervx

mucod

pan”

woman

smear

cear

te

pene

as

te

dscarge.

conveys

E.

unctonaty.

sdena.

nerves

comes

moton

D.

(Vagra)

ncapabe

cervca

spancnc

a

on

nerves

examnaton

Pevc

or

scrotum.

as

spreads

aspect

ntercourse

does

C.

nodes

prostatectomy.

sdena

sexua

says

tumescence.

damaged

A.

a

paced

se

Pudenda

metastass?

pyscan

tat

Superor

ton

te

e

wc

or

eectve

gentoemora

sexua

B.

pror

to

weeks

papaton

relex

woman

durng

says

tne

comes

an

nerve

regona

umbar

man

te

on

pyscan

ater

structure?

nguna

or

2

meda

to

o

A.

ymp

te

nerve

An

56.

examnaton

Preoperatvey,

erecton

te

eson.

nguna

50-year-od

mont

o

examnaton

testcuar

examnaton

nod-

ac

E.

an

CT

Wc

be

ntrnsc

te

ruptured?

nerve

Se

wt

ac

D.

ow-up

Utrasonograpy

an

pevc

spread.

A.

A

tests.

sows

papabe

and

o

nerve

branc

19-year-od

owng

nontender,

past

oowng

Ioypogastrc

Pysca

a

te

C.

ymp

sows

sows

to

mont

te

cremasterc

o

Ionguna

nguna

examnaton

key

sensaton

tenderness

Genta

a

1

sometmes

B.

wt

comes

te

to

A.

prostatectomy?

pyscan

and

absent

o

te

or

abdomen

nguna

to

man

burnng

sows

most

Wc

relex?

sacra

comes

s

urne.

exam-

scrotum

uretra

prostatec-

oowng

extravasated

boy’s

badder

says

a

te

depart-

MRI

uretra

abdomen

Wc

55.

man

and

o

bcyce.

regon beow te mdpont o te nguna gament and

PSA.

dagnoss

and

o

ac

22-year-od

He

ess enargement o te rgt gron or te past 3 monts.

ue

52.

tg

50–74

68-year-od

edema

examnaton,

rencng

s

uretra

35-year-od

ow-up

crasng

structures

Spongy

by

anatomca

te

Preprostatc

provded

natura

rom

B.

usuay

te

suspended

wa

A.

s

create

s

pens

severe

te

tat

to

vaut

o

ater

sows

abdomna

port

51.

days

sacrocopopexy s panned to treat ts condton. Durng

sacra

50.

nerve

A 15-year-od boy s admtted to te emergency

cuty vodng. Pysca examnaton sows descent o te

to

spancnc

a

smoot,

Durng

se

most

ees

key

pan.

a

3

rou-

years

examna-

surace

coecton

md

to

or

done

Pysca

pnk

te

a

one

wt

o

Wc

experence

a

ces

o

“reerred

procedure?

posteror

porton

o

te

tg

regon

regon

regon

regon

A 35-year-od man comes to te emergency department

ater

beng

kcked

n

te

gron

we

payng

ootba.

CHAPTER

Pysca

MRI

dranng

tests.

woud

njured

58.

Ineror

B.

Let

vena

rena

Let

neror

Let

nterna

E.

Let

ac

a

by

er

cryng

sweng

n

treated

te

to

nd

Uracus

Suspensory

Uterne

E.

Mesosapnx

a

bood

er

B.

Wa

C.

Uterne

te

te

Mesentery

o

or

se

was

papabe

mass

s

dagnosed

10

o

s

B.

Semna

Cryptorcdsm

D.

Congenta

E.

Cordee

A

te

te

surgeon

ovary

because

started

o

er

1

te

o

ast

mm

wt

ago.

Hg

puse

and

sows

te

s

A.

Uterne

B.

Cervx

s

te

cervca

os

Fundus

o

te

are

Wc

coected

o

te

te

raped

or

emergency

2

ours

DNA

oowng

depart-

ago.

and

organs

s

Hypogastrc

E.

Pevc

sows

nto

g

te

a

n

traumatc

dvng

s

o

ever.

A

porton

te

CT

te

and

be

structures

was

nerves

Pevc

spancnc

nerves

D.

Sympatetc

E.

Vagus

or

devered

br t,

t

pabe.

Pysca

pabe

was

tests

a

va

o   ow - up

a

noted

n

n or m a

tat

 s

exam  n at on

te

e  t

e xam nat o n.

vagna

s c rota

e t

tes t s

sow s

sac.

b r t

A

at

w as

ab se nce

mas s

s

he

b oy

te r m.

not

o

a

At

p a -

p a -

p ap ated

65.

abdomen

o

s

are

wt

ntrarec-

papated

o

grade

oowng

1

best

transmsson

a

swmmng

patent

Ater

te

coon

excsed.

C.

mote r

te

nto

he

experences

spancnc

was

te

He

program.

tender,

orce

or

because

12-step

a

Sx

as

o

deveops

sows

and

monts

key

tat

rectum

mpotence.

most

poo

mutpe

reconstructve

patent

examnaton

Sacra

s

nterna

week.

dagnoss

o

descendng

must

patent

oowng

scan

B.

by

A

organs

Bubouretra

pys  c an

a

ana

cavty.

abdomna

o

septc

second

abdomna

s

E.

te

n

past

dstended

andng

Pudenda

to

te

pyscan

te

Mutpe

patorm.

te

b rougt

pa-

nerves

A.

s

te

bers

Kdneys

boy

o

ow-

made.

nerve

T ests

6 -mont-od

s

regon?

D.

A

a

te

C.

gands

preva

ceck-

a

pexus

aferent

g

eratvey

(Cowper)

te

Wc

(recta)

spancnc

ater

a

become

gands

sows

A 34-year-od man s admtted to te emergency depart-

ower

producton?

prenata

nerve

Vscera

a

respon-

er

and

wa

or

responsbe

ts

ana

D.

operaton

ructose

to

duness.

nerves

C.

traumas

Fuds

because

ago

abdomna

overappng

acooc

made.

rom

Pernea

any

mpantaton

examnaton.

s

te

Ineror

rom

to

recta

B.

o

brougt

mnutes

pacenta

o

rectum

projectng

A.

ment

beng

stng

bers

o

body,

comes

per

examnaton

postve

10

s

spouse

abdomen

abdomna

recoverng

pos-

bowe

brougt

a

er

uterus

man

bood

most

ovary

s

te

63-year-od

descrbes

os

s

tubes

uterne

emorrods

etoogy?

cervca

(aopan)

red

any

ste

o

dgta

a

key

gestaton

by

denes

te

dagnoss

o

pan

o  ow ng

dsorder?

part

masses

te

A

weeks’

Se

to

Mesentery

A

te

o

203

yperpasa

started

o

Dsta

on

sow

been

D.

ta

abdo-

wc

C.

a

112/

not

most

ts

perod.

rgd

and

te

n

35

stopped.

pacenta.

s

studes

oowng

as

at

gand

department

beedng

Se

Pysca

s

respratons

a

Laboratory

woman

Utrasonograpy

currenty

ower

Se

menstrua

eukocytoss

o

nctng

emergency

ntense

our

(100.22°F),

examnaton

Wc

to

suprarena

emergency

vagna

E.

Perineum

ermaprodtsm

38-year-od

centa

nonreducbe.

woud

brougt

95/80

reported

ructose

Prostate

C.

Wat

supe-

64.

vagna

A.

Pseudoermaprodtsm

T rue

yng

years

mass

W c

B.

ups.

bowe

te

se

examnaton.

sbe

s

tenderness.

te

32-year-woman

er

was

can a .

and

dagn os  s ?

A.

pan.

notced

tube

Surace

rom

te

37.9°C

test.

o

E.

ater

o

date

s

nterna

D.

ment

a

nconso-

aso

nguna

key

spontaneousy

uterus

emogobn

te

o

wen

he

moter

Pysca

ste

Over

moter

sows

and

moter

structures

wc

pressure

pregnancy

common

vomtng

he

depart-

et

most

brgt

rebound

A.

emergency

cana?

o

woman

reca

decnng

A

te

63.

pan

20/mn.

tve

te

Her

gament.

te

temperature

wt

o

tumor

gament

by

abdomna

men

rom

tube

25-year-od

to

area.

CNS

gament

department

61.

n

to

our.

oowng

D.

are

oowng

rst

te

te

to

because

past

gron

a

C.

mn,

n

62.

brougt

examnaton

te

B.

Her

s

nguna

o

Round

unabe

te

An

te

o

te

or

A.

A

o

pass

n

pudenda

te

Pysca

expect

wc

key

bood

epgastrc

moter

od.

to

Into

most

scrotum.

o

cava

gr

or

and

Wc

et

ven

1-year-od

ror

swoen

ven

D.

abe

60.

te

trombus

C.

ment

59.

a

a

coaguaton

area?

A.

A

sows

sows

vens

vens

examnaton

examnaton

Pelvis

4

te

as

postop-

Wc

njured

o

durng

operaton?

nerve

trunk

nerve

A 27-year-od woman comes to te pyscan or a oow-

up

examnaton.

eectrosurgca

T wo

excson

weeks

ago,

because

o

se

an

underwent

abnorma

pap

a

oop

smear.

204

C H A P T E R

66.

Pelvis

and

Perineum

A bopsy specmen sows an nvasve carcnoma wt pos-

postoperatvey,

tve

puse

margns.

A

CT

scan

o

te

abdomen

sows

oca

ym-

s

patc spread. Wc o te oowng ymp nodes s most

pressure

key to ave receved metastass

pevs

A.

Interna

B.

Externa

C.

Superca

D.

Deep

E.

Sacra

A

rom ts

magnancy?

gency

ac

nguna

te

nguna

o

sows

boy

s

brougt

te

so-caed

oowng

C.

Superor

o

D.

Mdde

E.

Ineror

nated

sde

o

te

troug

oowng

s

o

and

scrotum

most

te

examnaton

otoscope

scrotum

te

te

An

key

s

paced

te

(see

tests

Fg.

dagnoss

4.4).

n

sows

beneat

s

transum-

Wc

ts

no

te

o

70.

te

A

a

patent?

1-mont

man

ejacuaton.

He

C.

Cystocee

postvasectomy

D.

Hydrocee

oowng

E.

Hypospadas

A.

past

s

2

days,

38°C

mn,

e

as

bood

to

te

worsenng

pyscan

perrecta

experenced

(100.4°F),

and

comes

o

cs.

because

pan.

Hs

For

s

83/mn,

respratons

pressure

s

115/86mm/Hg.

are

Pysca

wc

s

nerves

te

t

an

vesse

crossng

descends

deat.”

te

(o

emer-

nto

te

presence

Wc

o

te

njured?

artery

Ionguna

Genta

E.

Vscera

to

te

branc

a

to

most

o

to

pan

and

uness

papaton.

s

key

made.

7

o

A

because

pan

vasectomy

sows

syndrome

aferents

pyscan

testcuar

tender

bers

Ioypogastrc

D.

o

was

Sympatetc

C.

71.

o

key

comes

pan

B.

Laboratory

as

conrmng

crce

underwent

o

16/

stape,

examnaton

te

temperature

puse

surgery,

or

artery

story

deerens,

man

room

te

pouc

vesca

41-year-od

Rectocee

story

bood

o

recta

B.

34-year-od

operatng

most

vesca

ago.

1-week

s

(98.24°F),

and

rectouterne

gament

a

36.8°C

20/mn

Utrasonograpy

te

Durng

by

s

are

artery

Varcocee

a

to

obturator

A.

A

n

“artera

arteres

cuent mass. he testes are papabe on te posteror aspect

remander

Pysca

a

Obturator

abnormates.

week.

o

taken

njured

Aberrant

atera

past

because

was

Hg.

lud

(Cooper)

B.

he

te

pyscan

s

mm

aparotomy.

A.

mass.

or

te

Se

examna-

te

scrotum

to

ree

temperature

respratons

90/80

ton sows an enarged et scrotum wt a nontender loc-

oter

et

s

pectnea

pevs

er

105/mn,

Dougas).

ac

2-year-od

swoen

67.

4

o

upon

monts

te

ductus

dagnoss

Wc

o

o

te

njured?

ductus

deerens

gentoemora

rom

T10

to

L2

A 41-year-od woman undergoes a scedued tuba ga-

3

studes

85%

sows

eukocyte

neutrops).

count

Pysca

o

15,000/mm

examnaton

(wt

sows

an

ton. T wo

days

(98.6°F),

puse

extremey tender, ndurated mass n te scoana ossa.

and

T o

o

actate

son

s

a

made

owng

68.

a

to

nerves

A.

Dorsa

B.

Superca

C.

Pernea

D.

Ineror

E.

Pudenda

A

compete

anestetze

w

nerve

most

o

te

branc

te

key

examnaton

area.

need

Wc

to

be

te

o

dec-

te

o-

anestetzed?

most

ctors

o

pernea

recta

nerve

nerve

nerve

man

1-week

story

o

s

(100.4°F),

comes

to

panu

puse

te

pyscan

deecaton.

s

90/mn,

Hs

because

o

a

72.

temperature

respratons

are

bood

te

16/

key

njured

Ascendng

C.

Descendng

D.

Superor

E.

Ineror

arge

durng

temperature

mm

Hg.

o

te

ts

are

s

37°C

18/mn,

Utrasonograpy

ematoma

Wc

branc

vesca

a

o

branc

vesca

1-mont

sows

96/80

a

er

respratons

adjacent

oowng

to

vesses

te

was

procedure?

arteres

31-year-od

a

s

artery.

B.

ton

mn, and bood pressure s 120/78 mm/Hg. Laboratory

ac

Ovaran

o

100/mn,

sows

A.

A

s

pressure

pevs

externa

nerve

40-year-od

39°C

pysca

postoperatvey,

arteres

uterne

arteres

artery

artery

woman

story

o

comes

o

papabe

Utrasonograpy

uterne

o

to

pevc

mass

te

n

te

pyscan

pan.

te

Pysca

rgt

abdomen

ower

and

because

examna-

quadrant.

pevs

sows

a

3

studes

sow

Pysca

te

ana

posteror

te

pan

69.

te

mdne

oowng

Dorsa

Superca

nerve

C.

Pernea

D.

Ineror

E.

Pudenda

an

o

by

o

o

eve

s

ts

te

o

20,000/mm

peroraton

te

openng

te

branc

count

sows

eve

nerves

experenced

B.

wt

o

most

ana

te

key

patent

o

vaves.

pus

ana

te

partay

o

aton.

Anoscopc

dranng

vaves.

responsbe

upon

wa

.

at

tomy

te

Wc

or

o

te

deecaton?

ctors

o

pernea

nerve

recta

nerve

73.

nerve

or

an

undergoes

nguna

a

tenson-ree

erna

repar.

vagna

T wo

days

dagnoss

perormed

o

njury

te

wen

te

Uterne

artery

B.

Vagna

artery

C.

Ureter

D.

Interna

E.

Pudenda

A

pyscan

sows

s

o

a

wt

posteror

teratoma

and

te

s

vesses

sound

made.

ovaran

structures

ovaran

pudenda

s

An

vesses

most

are

are

attenu-

ovarec-

gated.

key

at

rsk

gated?

artery

nerve

23-year-od

wc

mass

oowng

A.

te

woman

procedure

ecogenc

A

s

Wc

nerve

35-year-od

tape

at

sows

A.

A

eukocyte

examnaton

cana

examnaton

o

a

woman

because

exacerbated

tenderness

at

o

on

over

30

a

weeks’

2-week

wakng.

te

pubc

gestaton

story

o

Pysca

sympyss.

comes

pevc

to

pan

examnaton

An

x-ray

o

CHAPTER

te pevs sows a 20 mm dastass o te pubc sympyss.

Utrasonograpy

A dagnoss o perpartum dastass o te pubc sympyss

ypoecoc

s

tomy

made.

reaxn

jont

he

s

pubc

most

T ransverse

B.

Interspnous

C.

T rue

D.

Dagona

E.

Obque

cs

o

ormone

separaton

Wc

reman

o

o

te

te

caed

sacroac

oowng

s

pevc

dstance

dameter

conjugate

78.

woman

magnancy .

atera

undergoes

Durng

pevc

wa

te

are

an

ovarectomy

procedure,

aso

te

removed.

or

an

Four

Deep

Externa

C.

Interna

D.

Lumbar

E.

Superca

te

days

past

ua

o

te

nnermost

sows

o

a

te

aspect

o

te

sensory

dect

n

oowng

nerves

was

tg.

te

Pysca

dsta

most

exam-

meda

key

tg.

njured?

coatera

C.

Ioypogastrc

A.

Externa

D.

Obturator

B.

Ineror

E.

Lumbosacra

man

Preoperatvey,

an

attempt

mont

pene

e

to

undergoes

was

paced

mantan

s

postoperatvey,

erecton

He

aso

te

ce

denes

bodes

damaged

wtout

durng

te

Sacra

parasympatetc

sympatetc

C.

Ineror

A

to

te

prevous

to

pregnancy

gestatona

Laboratory

eves.

Se

s

te

oowng

patent

rsk

o

requres

B.

Interspnous

C.

T rue

D.

Dagona

E.

Obque

nerve

tat

a

n

sow

gestaton

examnaton.

cesarean

er

Se

a

s

cesarean

cesarean

was

most

due

dagnosed

pregnancy.

bood

secton

dsproporton.

te

Her

secton

prevous

uncontroed

or

comes

key

sugar

due

Wc

reason

o

wc

to

examnaton

s

pyscan

sows

a

ndstngusabe

because

n

s

te

pa-

tests.

most

o

bman-

sows

a

dmensons

s

perormed.

key

gestaton

cervx

s

arrested

vagna

s

made

to

te

structures

uy

as

orce.

uretra

superca

D.

Rgt

scocavernosus

E.

Pernea

A

provdes

te

In

goes

nto

dated,

ead

an

but

as

attempt

to

to

te

na

seconds.

to

ne

Eac

s

descrbes

D.

uy

he

s

ts

Injecton

Injecton

pernea

musce

woman

nerve

near

te

more

wt

sows

o

te

eta

pan

Wc

o

brougt

abdom-

tan

te

strong

uter-

abdomen.

ree.

te

A

10

urge

membranes

sca

te

superomeda

most

sca

and

near

ror

majora

tuberosty

anteror

rom

near

astng

s

severe

assocated

requests

sca

Injecton

aba

was

o

he

ave

pudenda

oowng

best

bock?

and

near

eac

and

gestaton

because

papaton

perormed.

cervx

weeks’

examnaton

on

anestetzes

Injecton

36

mnutes,

dated,

pan

Injecton

at

contracton

pubs

uterus,

E.

3

Pysca

bock

mantaned?

musce

department

contractons

cervx

mdne. Wc

spncter

transverse

woman

every

“pus.”

te

key

spncter

emergency

pan

o

most

body

34-year-od

to

rgt

s

Rgt

rgt

nontender,

rom

o

te

as

Externa

A.

sweng

pevs

mass

weeks’

er

C.

prevents

te

etus

40

B.

B.

paness

at

ater,

ana

C.

a

racng.”

on

organ?

Externa

mons

comes

te

oowng

spne

o

te

For

ntermen-

“eart

mass

embozaton

arteres

A.

dameter

man

woman

o

perneum

te

nerve

conjugate

artery

ts

ours

troug

ruptured.

dstance

story

descent

o

secton?

to

o

ntramura

oowng

er

uterne

because

beedng.

experenced

notced

a

pyscan

mesenterc

Fteen

to

ts

as

te

pudenda

34-year-od

te

was

80.

weeks’

key

rst?

decrease te rsk o tearng, an obque surgca ncson o

are

L2

Superor

dameter

Pysca

mass

te

(Vagra).

Were

most

to

ac

E.

progress

orcec-

semnoma

mesenterc

Ovaran

dameter

20-year-od

pabe

L1,

dsproporton.

conjugate

scrotum.

32

dabetes

a

or

oow-up

dmensons

T ransverse

2-mont

a

o

cepaopevc

A.

a

at

scedued

g

sdena

tumescence.

o

ganga

requred

studes

te

A

or

cepaopevc

wt

ncapabe

aso

sows

uterne

suppy

Interna

A

te

menstrua

Utrasonograpy

te

D.

te

pexus

nuce

woman

pyscan

s

One

o

C.

abor.

gangon

ypogastrc

32-year-od

unctonaty.

n

nuceus

trunk

mesenterc

Superor

o

(Vagra)

79.

procedure?

Sacra

Intermedoatera

prostatectomy.

sdena

ocated

B.

E.

use

pene

A.

D.

on

patent

te

key

radca

sexua

te

nocturna

most

a

se

A

cm.

Ionguna

68-year-od

and

to

eavy

as

7.2

B.

A

se

ypoecoc

Wc

75–98

are

metastasze

comes

o

examnaton

Gentoemora

Questions

woman

story

mont,

A.

trunk

w

omogeneous

testcuar

oowng

cancer

concentrc,

8

o

a

radca

nguna

papaton.

×

A

ac

beedng

ces

dagnoss

te

sows

mass.

205

Perineum

ac

5-mont

strua

scrotum

and

nguna

42-year-od

a

A

o

ts

B.

o

ympat-

Wc

nodes

A.

A

te

ntratestcuar

perormed.

made.

ymp

unafected?

dameter

s

Pysca

Wc

77.

a

postoperatvey , te patent as panu spasms o te mus-

naton

76.

te

key

conjugate

te

or

tat

dameter

63-year-od

ovaran

75.

w

normed

sympyss.

A.

A

s

responsbe

and

dstances

74.

patent

o

Pelvis

4

and

anestetzes

te

majora

tuberosty

anestetzes

and

uterus

to

te

anteror

pernea

spnes

upper

sca

aba

⅔

spnes

superor

ac

skn

prevents

pan

rom

te

vagna

anestetzes

neror

vagna

te

poste-

206

C H A P T E R

81.

A

Pelvis

75-year-od

man

5-mont

story

anorexa.

He

and

sot,

prostate.

most

a

ard,

te

oowng

n

ts

wt

o

wt

ts

o

te

oowng

used

s

condton?

obe

Medan

C.

T ransverse

D.

McBurney

E.

Suprapubc

D.

Latera

zone

te

E.

Latera

capsue

He

86.

A

nabty

says

ang

not

of

egs

s

te

and

te

coud

moter

bcyce

pysca

te

around

te

oowng

Deep

B.

he

membranous

C.

he

attacment

urne

(Buck)

low

were

n

ts

was

pens,

pene

bood

around

CT

t

poston,

and

o

nto

n

te

uretra

o

te

ts

Wc

o

was

was

ntact

njured

pernea

asca

mted

87.

tg

C.

Mdne

Fundorm

Bub

A

35-year

a

ayers

o

cae)

Ater

ton

student

an

he

stood

most

key

B.

Posteror

C.

Isca

D.

Pubc

E.

Isca

sacra

pubc

key

nto

te

asca

te

anorecta

atty

and

(Camper

trange

membranous

and

Scarpa

as-

ours

oca

stragt

o

n

a

(nonradatng)

te

responsbe

resoved

oowng

or

seated

examnaton,

mmedatey

te

a

pos-

pan

n

ac

s

te

most

Ionguna

C.

he

D.

Latera

E.

Pudenda

promontory

sympyss.

by

a

pevc

MRI

and

Wc

te

te

o

te

o

superor

te

a

22-year-od

dstance

between

margn

oowng

o

was

te

most

radoogst?

says

ast

tat

3

ew

se

breast

ts

s

ago

a

Pysca

and

D.

Sagtta

outet

B.

Patent

E.

Bspnous

C.

Faure

o

te

urorecta

D.

Faure

o

te

vagna

E.

Incompete

vagnay

to

a

at

40

macrosomc

weeks’

nant.

gestaton

Se

was

gves

brt

dagnosed

as

or

o

te

a

on

te

te

te

past

o

swoen

serosangunous

s

scro-

lud,

anteroatera

oowng

stmu

nerves

rom

n

emergency

te

perssted.

smar

as

A

wc

moter

or

never

te

ad

norma

bugng

bues

Wc

processes

presentaton?

vagnas

uson

o

septum

pate

te

to

to

deveop

canaze

paramesoneprc

o

most

atresa

processus

a

sows

vestbue.

structures/

ts

Her

epsodes

Se

ar.

te

depart-

dscomort

examnaton

embryoogc

resutng

te

days.

pubc

Cervca

woman

cream

mprovements

pevc

across

A.

net

pan

sows

o

to

ew

net

aed

because

severe

nerve

experenced

astng

observed

oowng

key

was

branc

and

Sagtta

net

structures

pyscan

panu

deep

Maxmum

o

“sngs”

support

organ?

brougt

C.

dameter

tat

eps

(L1)

B.

transverse

o

Durng

(L1)

Bspnous

35-year-od

te

and

(S3)

deveopment

s

o

or

A.

A

outet

a

perod.

membrane

Wc

severe,

as

a

cutaneous

ours

monts

menstrua

gr

o

te

and

no

oozng

cutaneous

nerve

because

a

been

nerve

emora

to

pronounced

nerve

anteror

13-year-od

started

measured

surace

Ioypogastrc

spne

pens

made.

and

does

pens

examnaton

scrotum.

B.

A

He

examna-

dagnoss

structure

antunga

responsbe

A.

ment

and

te

key

stu-

spne

A

oowng

tcng

an

uceratons

te

88.

observed

o

o

ave

partcuary

eatures

tuberosty

woman

tere

Pysca

anteroatera

pan?

te

s

o

weeks.

experenced

own.

Pysca

pens

2

pens

comes

o

tred

bony

student’s

o

because

past

e

ts

noted.

te

te

o

gament

wen

tuberce

measured

s

on

dsrupton

body

o

te

between

aso

tat

te

pyscan

or

urne.

gap

gament

He

but

wt

surace

medca

ramus

superor

ago

wc

o

te

ntercourse

s

gament

story

scrotum.

tum

ast

passng

od-man

symptoms.

abdomen

anatomy

Wc

pubc

radoogst

pregnant

pan

up.

Ineror

te

severa

upcomng

A.

A

ower

experenced

buttocks.

was

te

studyng

or

dent

superca

over

low

between

umbcus

pens

2-week

week

urne

urne

o

o

was

te

rape

E.

ca

te

sympyss

D.

here

to

subsded

Wc

Pubc

E.

o

ncson

damaged?

Suspensory

et

s

observed

B.

he attacment o te superca pene (Coes) as-

beow

erecton

papabe

base

key

an

nstabty

A.

D.

prevented

a

s

Wc

surgca

o

An

ncson

comes

ssues

damaged.

most

patent?

pens

superca

te

scrotum.

s

t

te

perormed.

abdomna

just

wc

suspensory

surgery,

prousey.

ncson

ave

durng

Pene

beed

was

repar

ncson

man

any

to

wc

Ater

procedure?

pont

pan

sows

pubs.

were

A

ave

ton

scrotum,

swoen.

norma

to

urne

scrotum

tere

te

o

were observed. An MRI dented

asca

nto

wa

was

attempted

and

examnaton,

and

between

amounts

pens

meatus,

occurred

A.

e

sma

te

prostate

pens

as

mse

Wen

ony

abdomna

te

and no bony ractures

lud

strkng

bar.

tat

uretra

tat

and

produce

anteror

sowed

seat

notced

Durng

externa

ower

scan

bcyce

wt

e

swoen.

at

s

gestaton,

pregnancy.

ncson

ncson

to

tat

sgncant

s

key

ongtudna

36-year-od

o

er

contnues

ts

subcosta

A 5-year-od boy s companng o pan o te pens ater

weeks

most

perorm

B.

Medan

se

te

Rgt

Fbromuscuar

zone

to

16

ysterectomy

s

A.

C.

zone

at

trougout

epsotomy,

emergency

a

te

organ

dabetes

uncontroed

examna-

papaton

aspect

patent’s

a

and

urnaton.

man

recta

on

o

B.

and

85.

Dgta

nodue

oss,

estancy,

wt

emacated

abdomen.

nontender

o

dysura,

emptyng

an

because

wegt

Posteror

urnate,

84.

urnatng,

sows

mpcated

pyscan

atgue,

A.

te

83.

te

ncompete

Wc

key

to

dicuty

nontender

sows

Perineum

generazed

examnaton

lat

ton

o

and

comes

o

as

eengs

Pysca

82.

4

ducts

CHAPTER

89.

A

60-year-od

o

abdomna

Se

a

says

4.5

kg

does

pevs

a

pevc

durng

Round

B.

Suspensory

C.

Ovaran

D.

T ransverse

E.

Mesosapnx

A

oss

n

s

A

CT

ng

mass

comes

order

o

to

oca

te

3

and

to

te

as

monts.

a

oowng

B.

Superor

C.

Ioumbar

D.

Latera

E.

Superor

excessve

ac

E.

Uterne

Se

examnaton

abdomen

oca

te

o

(10

not

sows

wc

o

Obturator

ureter

te

95.

s

reacng

s

tear.

oow-

dd

examnaton

tona

o

cava

at

not

receve

an

nward

s

B.

V ertebra

C.

Urnary

tract

D.

Cardac

abnormates

E.

Iea

to

o

be

brt

eta

care.

anus

te

gves

o

Pysca

wt

te

Skeeta

n

te

96.

et

weeks’

patent?

a

ram

gravda

dstress

te

oca

A.

S2,

S3,

B.

L4,

L5,

C.

L5,

S1,

nto

spne

anestetc.

dd

anestetc

Se

0,

woman

appears

anestesa.

he

transvagnay

Wc

te

aborta

abor.

requests

sca

segments

by

goes

and

Isca

D.

Posteror

E.

Coccyx

A

nerve

orgnate

o

te

tat

to

and

most

be

pys-

oowng

was

at

ten

ven-

key

rom?

97.

S1

be

man

upon

Sacra

C.

Pevc

D.

Pudenda

E.

Ionguna

done

e

o

rst

and

a

Wc

autogenous

B.

Interna

C.

Deep

D.

Lumbar/atera

E.

Axary

Bot

mastectomy

er

moter

due

and

to

oder

a

recent

sster

BRCA1

ave

been

dagnoss.

dagnosed

posteror

proper

to

a

vagna

adequatey

cosure

o

transvagnay,

determne

to

te

He

Pysca

te

te

wc

proper

pyscan

deecaton

says

red

ste

o

tat

because

wc

n

bood

te

A

by

o

nerves

2

toet

sows

ana

o

asts

past

te

dagnoss

oowng

afected

te

on

examnaton

mucosa.

regon

metastatc

to

te

pyscan

edges.

o

o

ac

ac

nguna

aortc

on

eson

Pysca

nodes

spread

te

eson

roed

dagnoss

propyactc

batera

a

necessary

brgt

comes

ymp

Externa

a

o

musces

spne

panu

wt

rst

ad

oowng

condton?

durng

ana

panu.

A.

batera

ncont-

spne

ac

notced

became

eson

a

S3

se



man

S5

ago,

eca

dysuncton

st-

ana

most

ssures?

ypogastrc

S2,

undergoes

ts?

spancnc

story

tat

ac

Wc

ts

S4,

monts

s

spancnc

69-year-od

says

s

to

comes

te

made.

nnervates

Superor

made.

Sx

te

actate

notced

n

B.

s

woman

o

perormed

pan

wpng.

openngs

2-week

o

S1,

surgery.

arteres

o

to

ncurs

bock

aterward.

aso

A.

A

s

superor

story

s

and

to

neror

S3,

30-year-od

pevc

dented

tuberosty

E.

breast

due

wc

papated

D.

A

te

s

spne

as

ucerated

S2

be

patent’s

nerve

area

mnutes

e

recenty

S4

exts

njecton?

30-year-od

1-week

ssures

0,

o

ts

bock

can

C.

ke

para

te

Isca

key

1,

oowng

companed

to

ospta

ts

Posteror

paper

stua

deects

gestaton

papated

I

B.

days

atresa

panu

te

anestetc

severa

add-

te

and

oramen

ts

umbosa-

nternus

pudenda

A.

a

survey

oowng

ound

ds-

abnormates

20-year-od,

bocked

because

downward.

key

T raceoesopagea

njected

gestaton

antenata

Wc

A.

can

any

and

most

weeks’

secton

mperorate

emvertebra.

deects

25

cesarean

sows

rotated

a

A

anestetze

artery

S1

gu-

A 28-year-od pregnant woman devers er baby beore

andmark

woman

caused

E.

et

ovarectomy

et

key

Iococcygeus

a

te

Dysuncton

Coccygeus

mass.

An

ound

D.

pevc

spread.

woman

was

Pubococcygeus

artery

unpanned

sows

tat

C.

sows

o

te

a

o

gutea

69-year-od

B.

a

between

scatc

utze

arvestng

sacra

dura-

any

o

to

207

Perineum

vesca

wegt

ave

ramus

made

te

courses

greater

Wc

s

Durng

and

gutea

Puborectas

pevs

procedure,

to

b)

tat

te

A.

monts

kg

does

and

meda

6

because

artery

23-year-od

oot

A

decson

lap.

ventra

preserved.

Ineror

pyscan

4.5

and

troug

A.

avod

he

vesse

spread.

ven

ac

vena

Se

trunk

cavty

and

cancer.

bood

wound.

Ineror

an

a

musce.

boatng

and

wtout

Interna

tra

abdomen

wtout

Wc

cra

94.

and

te

D.

tress.

93.

pan

C.

n

te

Se

examnaton

gament

mmedatey

Gonada

38

monts.

lap,

vesses?

Externa

A

o

notced

breast

myocutaneous

most

Durng

B.

va

scan

n

3

as

tea

nence

woman

o

A.

A

ast

Pysca

wt

surgery?

cervca

Pysca

perormed.

papated

gated

and

because

duraton.

gament

ast

scan

ovaran

te

te

mass

perormed.

be

atgued

te

cdren.

atgued

n

CT

monts

gament

abdomna

Se

A

pyscan

6

gament

60-year-od

ton.

oss

ovaran

s

soud

A.

o

92.

et

te

o

cdren.

mass.

a

eeng

any

to

boatng

wegt

ovarectomy

beedng

91.

b)

sows

comes

and

been

ave

structures

90.

as

(10

not

sows

An

se

woman

pan

Pelvis

4

1

te

year

te

ago,

A

bopsy

most

cancer

ce

o

o

pens.

but

examnaton

squamous

w

because

gans

t

ony

sows

te

an

eson

carcnoma

key

occurs?

be

a

He

s

afected

208

C H A P T E R

98.

A

4

Pelvis

4-mont-od

parents

te

because

dorsa

boy

and

s

urne

surace

o

Perineum

brougt

s

to

eakng

te

pens.

te

pyscan

troug

Wat

s

an

by

s

openng

te

most

103.

on

A

48-year-od

ectomy

key

or

dagnoss?

rgt

Epspadas

A

B.

Hermaprodsm

et

C.

Hydrocee

pected

D.

Hypospadas

structure

E.

Ectopc

99.

A

99–105

maase,

botcs

cystc

te

a

s

admtted

panu

urnary

An

vodng.

tract

abdomna

mass

attaced

urnary

to

Se

ospta

s

necton,

CT

to

te

te

badder. Wat

scan

treated

but

te

most

a

and

ever,

wt

te

sows

umbcus

s

wt

ant-

symptoms

104.

ower

rena

Ovaran

artery

Ovaran

gament

C.

Mesosapnx

D.

Round

E.

Uterne

A

o

dagnoss?

A

CT

Ompaocee

tat

s

unabe

were

wc

to

njured

aceve

durng

erecton.

te

prostatectomy

Foowng

he

procedure

te

opera-

nerve

are

bers

carred

by

nerve(s)?

105.

te

scan

D.

e

A.

Ana

B.

Dsta

E.

Ana

A

spancncs

(Fg.

Sacra

spancncs

receve

oow-up

monts

ave

examnaton.

ago

an

or

prostate

erecton

tumescence.

secondary

oowng

A

to

ever

He

snce.

radaton

He

He

o

pyscan

aso

s

been

denes

unabe

te

as

te

rgt,

been

wc

urne

o

output.

matera

and

t

102.

Erecte

Gans

bodes

o

comes

A

B.

B

3

C.

C

D.

D

E.

E

to

bood

a

n

to

te

er

cancerous

mass

tract.

most

neror

to

part

superor

woman

o

undergo

4.5)

A.

o

pyscan

In

stoos.

because

mass

n

wc

key

te

Pysca

te

o

o

rom

Externa

D.

Interna

uretra

uretra

E.

Semna

gand

34-year-od

6-week

ture

s

story

37°C

124/80

man

ocated?

pectnate

ne

wc

dranage

er

to

te

wt

vagna

pectnate

a

s

admtted

cemoterapy.

o

te

rom

In

oowng

ts

ne

magnancy

te

nvovng

to

te

mage

nodes

te

tese

o

a

spncter

panu

(98.6°F),

mm

Hg

and

puse

te

et

s

pyscan

scrotum.

90/mn,

respratons

are

because

Hs

bood

o

B

a

tempera-

pressure

13/mn.

s

Pysca

C

examnaton sows a grossy enarged et scrotum, wc

s

tender

sows

a

to

papaton.

compex

Utrasonograpy

ecoc

mass

connected

o

to

te

te

scrotum

tests.

A

dagnoss o scrota abscess s made. Wc o te oow-

D

ng ymp nodes s most key to be tender and swoen?

A.

Externa

B.

Interna

C.

Latera

ac

ac E

aortc/umbar

D.

Sacra

E.

Superca

nguna

•

Fig.

4.

os-

above

woud

area?

pens

to

part

oowng

spncter

comes

exam

ower

te

pens

C.

A

te

hat

uterus

A

B.

te

sus-

oowng?

nerves?

A.

n

s

damaged.

te

damage

Wc

bers

to

a

nocturna

nerve

made.

eferent

or

radoterapy

as

cavernous

terapy

receve

te

receved

cancer.

dagnoss

structures

to

to

ow

rectum

cana

ower

Pevc

comes

n

a

contrast

coon

35-year-od

C.

man

as

rectum

Sgmod

pta

spancncs

te

Proxma

B.

Lumbar

s

cana

D.

te

ypogastrc

55-year-od

o

woman

sows

C.

Superor

D.

aso

ureter

gastrontestna

A.

A

pro-

artery

story

ocatons

ton,

yster-

te

sows rm, enarged superca nguna ymp nodes.

key

radca

ater

te

apex

5-day

dvertcuum

mass.

gament

55-year-od

cyst

undergoes

day

o

Mecke

prostatc

abdomna

suprapubc

Mecke

man

rgt

neror

B.

C.

cancerous

an

One

sows

none

A.

B.

a

and

te

passes

o

72-year-od

uter.

Se

pyeogram

pevs

tat

Hydrocee

A

quadrant.

retrograde

A.

or

101.

gr

and

or

persst.

100.

ureter

6-year-od

undergoes

cedure, pysca examnaton sows tenderness over te

A.

Questions

woman

eomyomata

rst

CHAPTER

Pelvis

4

and

209

Perineum

A n swe r s

Answers

1.

A.

degree

aso

In

to

o

are

resutng

unused.

s

genta

he

ods.

coaca

te

he

to

reerred

pene

uson

te

o

ment

he

o

uture

te

t

to

as

trd-

ypospadas,

te

urogenta

s

te

t

o

te

o

o

te

te

C.

he

aso

o

ods

E.

wc

ormed

te

body

ts

n

coaca

and

4t

ods.

gans

tuberce

te

he

pens.

resuts

n

ods

and

ruptures

bounded

to

orm

by

at

to

te

B.

GAS

B.

n

urnary,

ated

te

parts.

and

wt

he

a

o

he

uro-

urogenta

o

D.

he

genta

E.

he

te

genta

to

C.

body

ods

are

o

te

D.

A.

he

mae

E.

A

assoc-

and

ormng

te

5.

ony.

te

use

aong

spongy

responsbe

gans

te

ventra

or

te

to

orm

by

te

452;

N

370;

gubernacuum

ABR/McM

arses

n

te

te

uro-

456

B.

ts

wt

regard

te

ectopa;

descent

scrotum.

to

te

a

o

um

testes

passes

descend

or

he

to

279

One

C.

popuar

processus

a

te

traverse

he

vagnas

ts.

porton

Faure

o

s

te

an

te

he

as

processus

te

te

wc

as

to

o

arses

wa

as

tes-

to

he

competey

a

;

N

46

and

reerred

exstropy

mesoderm

and

t

occurs

epspadas.

ods,

by

wt

between

te

a

aure

te

o

externa

two

unused

or

XY

deveopment

Insuicent

etus

resuts

o

te

androgen

n

varyng

s

352;

rom

te

s

assocated

ABR/McM

n

wc

te

a

patent

ura-

279

mesoneprc

rena

bd

kdney

dvertcuum,

duct.

pevs,

Incompete

a

wt

metaneprc

ureter,

tubues.

doube

condton

cyst.

or

te

wt

a

cromosomes.

bud,

n

a

te

It

s

s

pr-

and

resuts

Compete

bd

te

cayces,

dvson

ureter.

wt

duct,

te

n

a

dvson

ureter,

or

sepa-

aso

known

ormaton

o

as

te

te

Woian

mae

nterna

organs.

emae

nterna

gves

to

pronepros

open

nto

duct

rse

te

are

resuts

sexua

to

te

he

components

dsta

convouted

transtory

te

n

organs.

coaca

o

te

nep-

tubues.

structures

and

ormaton

metanep-

regress

wc

by

n-

te

5t

te

vs-

week.

GAS

6.

A.

380,

cera

B.

455;

Hydrocee

and

scrotum.

vagnas

s

streak

membrane,

utero.

aantoc

extendng

te

te

te

279

he

caracterzed

n

aantos

mesoderm

tests.

and

s

paramesoneprc

te

musces.

oter

condton

prmtve

wt

syndrome

resuts

tay

tat

scrotum.

obterates

tunca

E.

o

gubernacu-

extenson

vagnas

roe

eac

badder.

responsbe

mesoneprc

te

ron

testcu-

oterwse

o

and

exst

postuates

abdomna

usuay

retaned

te

s

o

or

skn

scrotum

gubernacuum

dsta

te

vagnas

nto

processus

porton

o

ntegra

teory

poston

to

orgn

te

wa

teores

te

ocated

o

an

o

a

sexua

abdomna

recognze

wen

xed

te

competng

embryoogc

abnorma

become

pertoneum

Severa

exact

occur

an

troug

wc

gubernacuum.

ectopc

B.

te

are

kdney

n

he

rc

n

o

ureters.

te

nto

prmorda

ABR/McM

te

aboscrota

47,XXY

coectng

o

ten

te

pseudoermaprodtsm.

outgrowt

rate

abdomen

paus

scrotum.

ureterc

dvded

urogenta

upper

te

o

GAS

te

deveop-

368;

coaca

gentaa

and

resuts

bounded

te

persstent

he

o

te

orce

o

cus

rom te ower end o te gonada rdge and eps gude

ar

o

mordum

uretra.

pens.

s

ruptures

A.

an

normay

s

n

N

urnary

ypospadas

as

duct,

422,

tests

aure

Kneeter

and

ntestna,

speccay

nvoved

membrane

and

s

resut-

urogenta

o

nguna

prmorda

approac

newborn,

te

combnaton

degrees

orce.

3.

n

or

o

stmuaton

abnorma

utmatey

nto

463;

around

Androgens

278

rom

outet

tracts

orm

tuberce

te

septum,

coaca

orce

ods

pens

urogenta

GAS

etus

rom

aves

coaca.

ods

uretra

sde

ABR/McM

resut

common

persstent

o

te

reproductve

he

ment

370;

urorecta

aboscrota

externa

C.

o

N

anomaes

nondvson

anorecta

A.

512;

anorecta

deveopment

ng

te

exstropy

externa

459–461,

Most

n

Pene

orce.

2.

te

289–298,

uson

urogenta

te

orm

scrotum.

oten

dorsa

cords

swengs

orm

mgrate

deveop-

te

ydrocee

tubues.

to

uretra

s

as

ndrect

epspadas.

aboscrota

as

epspadas.

membrane

an

A. Wen te urnary badder mucosa s open to te out-

to

tuberce

he

te

suc

or

orms

wt

use

sde

and

week

cord

he

resuts

s

condtons

tuberce

assocated

semnerous

GAS

endoderm

proctodeum

n

spermatc

genta

s

he

uro-

4.

rom

te

or

semnerous

ods

te

deect.

ormed

D.

scrotum

aboscrota

aure

ts

o

ods

te

urogenta

or

s

o

resuts

tests

erna.

(ure-

anus.

end

nto

aboscrota

aves

nta

ectoderm

tuberce

urogenta

genta

aure

responsbe

and

dspacement

te

te

membrane

anteror

matures

n

to

hus,

coaca

genta

te

he

secondary

utmatey

orms

E.

Smar

aure

ypospadas,

use

uson

D.

aso

and

pernea

beng

o

rom

s

ods.

a

B.

ypospadas

ypospadas.

resuts

tra)

A.

obterate

1–24

Pernea

trauma

body.

or

ABR/McM

accumuaton

presents

cyst

ectoderma

te

317;

ayers

epdermod

rom

o

t

N

lud

pareta

hus,

An

s

o

as

s

a

a

tssue.

te

tunca

vagnas

nontender

rare

It

Epdermod

surgca

280

between

eson

may

sweng

wc

occur

cysts

mpantaton

tend

o

n

te

o

te

orgnates

any

to

o

ocaton

resut

ectoderma

ater

tssue.

210

C H A P T E R

4

hus,

C.

Pelvis

te

patent’s

A

dvertcuum

Mecke

ntestne.

n

te

patents

present

rage

or

bowe

hs

presents

he

s

can

n

t

GAS

o

A

te

rom

N

A

o

te

Faure

D.

Faure

o

woman

may

o

emae

he

o

GAS

8.

A.

380,

he

can

455;

C,

o

as

a

resuts

te

as

t

D,

s

n

E.

s

n

nng

cyst.

E.

a

cord.

GAS

10.

ocated

o

te

uretra

hs

ods

ura-

he

and

N

B.

A

a

ducts

symptoms

C.

o

to

to

a

te

tubes

pevc

neror

te

ac

E.

he

parts

n

n

a

4

or

te

beng

no

tese

to

D.

a

te

to

as

pene

o

te

te

te

s

durng

te

resut

B.

A

wen

o

te

C.

A

o

te

perto-

apaa,

deect

ods

orce

aves.

to

hs

externa

to

be

s

s

derved

te

genta

tat

s,

con-

278

n

te

rom

spongy

te

use

w

stuated

reerred

ormed

ts

to

by

dor-

cause

between

as

pene

ectoderm

membrane

more

and

covers

te

he

370;

to

an

te

wt

s

drecty

ead

cause

to

ABR/McM

excess

to

ep-

deveop,

o

n

or

by

and

attaced

occurs

o

lud

Hydrocee

retenton

nants.

pareta

budup

279

amount

vagnas.

tests

lud

cosey

lud

woud

dorsay.

N

conssts

use

ods.

contnues

processus

s

to

not

st

rom

njury

wc

tese

woud

507;

resuts

tat

ods

uretra

tuberce

ocated

o

s

typcay

tuberce

o

he

tunca

vscera

ayers,

to

te

wtn

tests

te

and

cavty

ayers.

pexus

and

pressure

n

accumuaton

s

posteror

cystocee

a

s

te

and

s

assocated

testcuar

te

o

wt

ven,

coaguaton

ernaton

vagna

Hypospadas

o

te

ncreased

oowed

venous

rectum

by

bood.

troug

wa.

ernaton

o

te

posteror

wa

o

on

reers

to

te

to

te

ventra

dspacement

surace

o

te

o

uretra

body

o

te

wtn

te

pens.

GAS

12.

A.

463

Varcose

was

extenson

to

te urnary badder troug te anteror vagna wa.

te

ure-

o

expeed

aboscrota

te

rectocee

te

resuts

surace

occurs

pens

ABR/McM

beng

urogenta

te

rom

meatus

ventra

370;

membrane

tests

atter

te

E.

wc

urne

persstent

venous

271

deect

ead

A varcocee conssts o varcosed vens o te pamp-

ure-

use.

an

s

a

between

surgery.

o

te

Faure

n

woud

pens.

N

uretra

te

as

epddyms.

structures.

maormaton

vagnas

artery

o

use

ods.

coaca.

o

processus

hus,

to

ts

te

to

pens.

and

Hydrocee

te

dentcaton

deveopmenta

on

bateray.

assocaton

oter

to

n

459–461,

vagnas

weeks

o

ABR/McM

o

norm

anteror

damaged

reabe

t

wtn

urnary

rst

body

resuts

507;

te

genta

GAS

can

ducts

te

ods

deveopmenta

scrota

spadas,

287

artery

o

coaca

Faure

te

cyst.

bockage

brm

proxmty

o

aure

ageness

orm

o

a

te

endoderm

deveopment

prmorda

n

o

embryonc

degenerate

duct

s

resutng

he

erytema,

(Müeran)

ead

o

competey

processus

reerred

uretra

tuberce.

o

459–461,

two

11.

ABR/McM

openng

to

s

ypospadas.

D.

aure

absence

te

parts

etus,

deveop

regon.

pan.

crana

to

externa

asymptomatc

uterne

te

degenerates

te

382;

s

hs

externa

genta

te

ducts.

part

mae

te

aspect

A.

s

aves.

urogenta

te

Epspadas

uretra

233

Gartner

common

ectopc

a

A.

te

o

sweng

umbca

overyng

te

by

may

o

tuberce

te

te

te

rom

but

n

s

danger

te

pens.

In

ernaton

hs

abnorma

o

caused

371;

o

scrota

ageness

tract.

here

459–461;

Faure

emor-

centray

abdomna

because

andmark

Because

n

o

quenty

N

372;

te

vesses.

date

oss

te

vens

pressure.

retaned

as

n

cord

aure

te

tunca

vagnas

condtons

matc

A

te

or

o

externa

nguna

obterates

suc

an

te

to

as

vagnas

te

ydrocee

o

nguna

aboscrota

orce

ods

to

he

dsta

tests.

competey

ndrect

uretra

musces.

and

be

processus

porton

Faure

obterate

te

tests

o

s

te

resuts

or

sper-

can

te

use

rom

ncreased

B.

erna.

to

arse

testcuar

A

w

cause

between

C.

A

tumor

due

pressure

rectocee

posteror

stuated

a

ven

a

s

A

o

varcocee

te

an

te

tey

conse-

oten

pampnorm

et kdney,

anatomca

dranng

ernaton

te

badder

n

to

vens

vagna

cystocee

urnary

s

n

vens

eastcty

weaken,

occurs

pexus, resutng n a sweng o te vens. hs condton

te

usuay

te

279

o

uum

traverse

o

wt

As

under

varcosty

ABR/McM

occur

wt

vagnas

a

;

vens

neum nto te scrotum wc arses as te gubernac-

processus

B.

D.

and,

umbca

oten

paramesoneprc

te

Hypospadas

A.

oter

Presentng

ABR/McM

cross

C.

tra

te

dvertcuum

suc

o

a

te

are

mesoneprc

N

ters

9.

n

ower

generay

ureters

serve

ureter,

GAS

o

ncden-

deveopment.

ureters.

B,

as

wt

portons

pronepros

burcaton

t

te

te

uraca

cyst

competey

and

eum

ducts.

genta

system

nto

nected.

resut

te

On

eptea

a

mass

tubes

te

recanaze

E.

te

to

and

uterus

two

genta

wt

paramesoneprc

C.

te

Mecke

persstence

mdne

352;

unused

doube

te

sa

uraca

paramesoneprc

B.

o

uson

uterne

ts

deect

te

UTIs

456;

te

te

becomes

compete

n

dscovered

compcaton

brt

papabe

recurrent

be

patents.

contents

rse

wt

ncude

A.

wa

gve

ound

Patents

unt

s

at

persstence

cus

makes

obstructon.

abdomna

abdomna

o

wt

ompaocee

te

ocated

to

symptomatc

to

An

s

tends

majorty

wt

presentaton

ypospadas.

It

tends

o

7.

cnca

unkey.

tay

E.

Perineum

dagnoss

sma

D.

and

o

te

te

wc

venous

occudes

constrcton

and

tests.

rectum

nto

te

wa.

ernaton

nto

te

o

posteror

anteror

vagna

wa

wa.

o

te

CHAPTER

D.

A

ydrocee

wtn

te

s

Hypospadas

uretra

na

GAS

13.

A.

or

swoen

petent

te

n

and

x-ray

norm

s

te

et

B.

A

C.

A

D.

A

o

o

te

te

te

n

o

cavty.

ven

a

as

on

Insertng

pamp-

o

one

a

he

te

N

o

nvoved

nto

rst.

s

te

posteror

wa

vagna

o

o

cavty.

o

ventra

n

o

an

te

exter-

surace

o

te

ABR/McM

pouc,

te

aso

owest

most

he

te

aso

known

pont

gravty

most

to

wc

and

o

as

te

lud

hereore,

to

route

t

ocated

s

s

part

superor

woud

a

to

to

not

be

neede

te

uterne

te

anteror

C.

he

o

aong

te

endocervca

cavty,

wt

cana

te

woud

probabty

consequences.

he

te

E.

gand

enterng

ts

dagnostcay

s

ocated

gand

useu

wt

n

n

a

te

te

neede

presence

uretra

te

lud

n

musce

membrane.

te

pevc

es

postero-

hus,

cavty

by

one

s

examn-

345;

tear

can

rectum

vagna

n

ABR/McM

te

aow

(n

a

wa,

vagna

285

18.

B.

he

nea

by

sma

ntestne

rectocee)

even

orce.

to

septum

to

te

(n

an

ernate

pont

o

(asca

o

entero-

nto

te

protruson

not

atoug

uvua

o

to

s

at

descrbed

ts

obe

s

not

conssts

te

te

uretra

begnnng

most

assocated

requenty

wt

corresponds

N

bengn

to

were

wat

most

s

ade-

ound.

tat

s

most

ready

exam.

366;

te

are

porton

recta

skn

nguna

te

zone,

prostate

te

466;

ABR/McM

o

te

nodes.

gans

he

ctors

281

ctors

dran

deep

and

rst

nguna

receve

ymp

nodes.

nodes

dran

ymp

dranage

wt

te

s

rom

te

te

nodes,

rom

te

uterne

common

upper

ac

or

vagna

umbar

undus

tubes

and

nodes

aso

nodes

dran

495;

N

(or

389;

membranous

o

ts

musce

to

porton

eak

mted

te

and

o

nodes,

te

ovares.

dran

uterus

Lymp

nto

tese

o

nerory

pernea

wa

s

uretra

by

te

s

n

uretra

above

te

s

to

te

deep

to

damage

njured,

retropubc

externa

uretrae)

uretra

uretra.

I

n

urne

uretra

spncter.

te

space

per-

surrounded

(compressor

externa

susceptbe

te

pass

376

te

membranous

nto

structures

ocated

musce

te

can

umbcus).

space,

orm

te

upward

body

te

nodes

nodes.

ABR/McM

ts

s

ymp

ac

uretra

skeeta

coectvey

damage

nous

presacra

nterna

dermatome

seet

hus,

o

o

or

space. Wtn

a

te

event

membra-

and

(o

bood

Retzus)

spncter

and

membrane.

A, C, D. he bubospongosus musce and oter pernea

sus

rectovagna

te

ac

dranage

musces,

N

ocated

cervx.

common

T10

can

spncter

pernea

o

dran

te

Axary

wc

pregnancy.

assess

or

te

D.

te

te

s

t

(or

nodes.

advs-

o

medan

oten

mdde

tssue

perpera

obe

para-aortc

receve

s

dgta

externa

o

s

adjacent

rougy

te

superca

to

accu-

nto

part

obe

as

by

nodes

body

te

obstructed,

te

prostate

he

to

s

o

and

obes,

ganduar

superca

rom

an

gament

ypertropy.

459–461,

te

he

between

unkey

nsert

to

ympatcs

GAS

troug

vestbuar

be

Denonvers)

troug

B.

te

dependent

drect

posteror

s

uterus,

hus,

nto

hus,

to

477;

or

he

nto

278

ts.

posteror

A.

orce

he

badder,

obe

posteror

GAS

17.

regon

wt

yperpasa.

papated

uson

anteror

sacrospnous

badder

dorsa

hs

atera

he

space.

nto

externa

break

D.

te

assocaton

enargement

prostate.

urnary

nocarcnomas

lud

n

211

Perineum

285

uroogsts.

bengn

reerred

an

-dened

anteror

he

te

te

tssue

prostatc

wa.

excess

resutng

troug

ntay

neede

not

superor

GAS

he

te

he

uretra

urnary

ve

te

n

to

most

uretra.

ymp

385;

space,

space.

ectopc

unabe

te

o

pexus

rectum

aure

ods,

on

s

badder

greater

an

o

tests

rom

t

undesrabe

perneum.

woud

te

by

ganduar

meatus

around

o

D.

a

no

and

condton.

nterna

te

are

ave

ABR/McM

due

possessng

rom

ornx

oter

he

o

o

accepted

seectve

te

obe

base

demonstratng

venous

represents

pouc

attempt

cee)

te

anteror

accumuate.

tere

A

ncom-

o

rectouterne

hus,

to

urnary

ead

A.

te

abe

ng

o

ornx.

vagna

15.

522;

vescouterne

to

te

vagnas

Dougas,

vescouterne

E.

te

ts

345;

key

mdde)

varcosty

sows

most

sted

and

rectocee.

to

N

Wen

become

worms”

musces

or

475;

become

o

mage

B.

s

perneum.

muate

o

to

resut

accumuaton

occurs

te

lud

vagna

he

an

openng

rectouterne

D.

can

he

perneum

unreated

GAS

278

vens

a

s

te

C.

aboscrota

rectouterne

o

as

a

testcuar

nto

s

women,

pouc

te

C.

a

te

tey

te

E.

te

enterocee

16.

“bag

ernaton

tunca

and

or

aowng

te

te

exter-

o

C,

o

wa.

te

511–512,

pertonea

A.

s

uretra

GAS

In

o

ernaton

badder

uretra

pens

a

vagna

Hypospadas

te

an

B,

E.

A.

ydrocee

wtn

B.

tortuous,

et

n

o

surace

ABR/McM

pampnorm

s

cystocee

na

resutng

causes

o

uson

ventra

lud

tests.

testes.

rectocee

urnary

14.

te

te

o

eastcty,

appearance

pexus

excess

respectvey.

383;

hs

caracterstc

posteror

E.

he

N

ter

otentmes

venograpy

dataton

522;

date.

venous

te

o

vagnas

aure

ods,

on

perneum,

ose

oten

tunca

rom

openng

te

vaves.

te

aboscrota

vens

and

accumuaton

o

occurs

511–512,

Wen

weak

or

uretra

pens

an

cavty

Pelvis

4

E.

te

musce,

We

deep

ducts

te

cavernosum

ocated

n

te

bubouretra

pernea

perce

proxma

GAS

corpus

are

space,

te

spongy

459–461;

N

te

and

gands

ducts

pernea

te

superca

o

are

membrane

ABR/McM

279

space.

ocated

te

uretra.

367;

scocaverno-

pernea

n

te

bubouretra

to

open

n

te

212

C H A P T E R

4

Pelvis

and

Perineum

Piriformis

Coccygeus

muscle

muscle

Coccyx

Ischial

spine

Coccygeus

Obturator

Levator

internus

muscle

ani

Midline

Iliococcygeus

muscle

Pubococcygeus

muscle

Deep

perineal

Perineal

Puborectalis

muscle

Vaginal

Urethral

•

19.

A.

Conscous

resuts

rom

badder

pevc

o

wa.

he

spna

te

and

hese

were

cord

contan

T10–L2,

are

nto

te

S4.

ganga.

dorsa

parasympatetc

and

preaortc

bers

rom

te

root

soma.

he

are

urnary

we

around

te

te

te

rty

B.

eves

ntermedoatera

eves

S2,

S3,

and

S4

ce

s

coumn

not

o

spna

responsbe

or

are

he

cord

sensory

he

ganga

or

preaortc

testcuar

o

pevc

spna

T5–T9

are

not

at

are

te

ste

o

orgn

responsbe

o

or

te

pevc

pan.

E.

root

responsbe

20.

A.

or

he

p ubococcy ge us

two

n

eca

major

cygeus,

te

n

ep

spna

te

te

m us ce ,

he

pubococcygeus .

not

271

s

o

e vator

pe v c

an 

he

and

and

n

he

ront

o

p or t o n

 or ms

a

oo p

(n

too-tgt

s ou d

d egre es ;

te

te

ke ep

 nte g-

m a nte nance

o

n

ts

te

L2)

suppes

atera

a

just

s

te

and

ma n

 as c a

re ctum.

uretra

s p  ncter

b ut

no t

c an

 eca

5.7 ).

sde

o

and

te

psoas

te

eve

ts

rom

277

nerve

troug,

te

n

causng

branc

te

nnervates

case

an .

lo o r

contne nce .

ABR/McM

to

 e vator

p e v c

p ub ove s cocer vca

cutaneous

acus

tg

te

p ub ore cta s

 e c a

Fg.

and

o

te

 n c ont ne nce

340;

atera

jeans)

emora

te

or

te

knee.

“Cavn

patent’s

pan,

o

te

o

L3)

and

bend,

skn

o

case

(L2,

musce

hs

Ken

obesty,

tngng,

or

te

at-

not

burnng

tg.

o

sma

te

area

neror

to

gentoemora

o

te

skn

(over

mdpont

nerve

te

o

(L1,

emora

te

ngu-

gament.

he

ceps

ror

N

te

par t

ex te r n a

constrcted

he

na

B.

n

w  t

emora

te

been

 or

and

( GAS

te

o

trange),

res s t

w  c

90

e  e vate

he

urnar y

gament

sensatons

A.

o

p ub ore c -

te

to

rom

as

to

con tac t

446–448;

aspect

nerve

  ococ-

and

n e r  o r

p ub ore cta s

mo s t

 mp o r-

cons s ts

v sce r a

pre s sure.

me d a

ts

p r  me

to

atera

nguna

ter

es pe c a y

p ub oc occygeus

s up p or t

m os t

T10–L2

drect

syndrome”

ABR/McM

ntra-ab d om  n a

s

eves

pan.

399;

p ub orecta s ,

por tons,

musce

te

N

contne n c e .

wc

ncreases

tas

488;

por ton,

o

pevc

456,

tance

o

ganga

GAS

meda

n

he

 or m s

s

coccygeus

Damage

runs

c r  t ca

res ponsbe

he

not

E.

aroun d

cana.

ncontnence

21.

s

uncton

anorecta

D.

era

Dorsa

musce

jun c t on,

to

ococcygeus

emerges

not

ange

contrbute

pevc

pan.

ganga

arteres

nerves

anorecta

man

GAS

responsbe

D.

he

are

pan.

C.

ts

musce

C,

E.

he

membrane

orifice

contnence.

te

ocated.

B.

o

Its

S2,

te

anorecta

eca

above

badder

space

orifice

enter

eves

raphe

5.7

ganga

bers

cord

ganga

Fig.

spancnc

Sensory

Spna

n

troug

pevc

GAS

uness

receptors

carred

te

enter

and

badder

stretc

bers

S3,

tese

urnary

o

and

bers

S2,

va

sensory

to

pan

pexuses

sensory

S4

T5–T9,

due

exctaton

nerves

spna

S3,

pan

te

nerve

nerves.

muscle

emora

and

nerve

sartorus

tg

and

te

(L2–L4)

musces

meda

s

motor

and

tg

to

sensory

and

te

to

eg.

quadr-

te

ante-

CHAPTER

C.

he

onguna

part

o

te

upper,

D.

meda

Cutaneous

nnervate

22.

C.

cervx

te

A.

he

and

o

a

n

eary

regon;

perneum;

te

and

oypogastrc

anteroatera

D.

te

te

s

body

te

gutea

nerve

area

An

and

pregnancy.

It

te

at

juncton

te

ndng.

s

uterus

s

now

requenty

been

observed

n

regarded

encountered

persstence

assocated

retrolexed

women

uterus

ts

wo

GAS

nto

wt

Answers

25.

te

B.

E.

retrolexed,

rare.

It

s

e

ave

s

s

dicuty

paton,

and

GAS

23.

D.

he

s

or

asca

A.

he

a

he

a

A.

cesarean

te

gament

and

age

by

pa-

o

pouc

as

vesses

Its

cervca

to

drape

gament,

hese

te

te

s

and

gament

o

rom

o

It

bands

o

pe-

atera

24.

C.

A.

at

he

te

are

parts

uterne

o

tube

te

wa

and

and

he

te

354;

ymp

eve

wa

te

parts

B.

N

o

te

te

s

aso

ovary.

and

s

known

he

ovares

uncton

to

to

o

uterus

attaces

extends

ABR/McM

rst

and

beow

deep

as

te

ac

s

a

rom

rom

to

suspen-

te

te

base

te

he

cervx

te

externa

receve

te

uterne

te

ymp

rom

ovares.

368

uterus

o

to

te

uterus

te

uterus

te

te

deep

te

pernea

susceptbe

transverse

superca

he

and

to

te

deep

extends

to

pernea

deep

superca

support.

o

o

body

damage

t

does

body

musce

not

s

spaces,

pernea

pernea

pernea

ts

musces

pernea

transverse

transverse

te

We

te

te

te

te

wa

externa

musce.

to

cut

uncton

wc

durng

n

eca

scocavernosus

ctors.

crura

t

s

to

not

It

musce

traverses

attac

to

susceptbe

covers

ateray

te

to

rom

scopubc

njury

durng

gament

sacrum

and

attaces

coccyx.

It

rom

s

an

te

sca

ntegra

part

o te esser pevs. hus, t s not at rsk o

uretra

deep

26.

C.

he

space.

durng

n

te

an

s

a

hus,

component

t

s

epsotomy

superca

o

unkey

wc

pernea

to

targets

space

( GAS

5.17).

452–453;

tendnous

connectve

te

spncter

pernea

njured

Fg.

o

n

psatera

351;

tat

o

ABR/McM

pevc

jons

pubocervca

te

sde

N

arc

tssue

etke

wa

A.

he

te

dran

ower

ana

te

vagna.

o

badder

te

and

tendnous

mbs,

cana

and

te

vagna,

drecty

ymp

body

pays

B.

nto

ts

rom

o

te

node.

o

provdes

he

vc

drans

to

ror

para-aortc

nodes

te

receve

and

te

hus,

porton

nguna

upper

to

man-

spncter

I

te

asca

asca

asca

ts

vagna

a

o

tat

asca

as,

uretra,

290

s

dense

te

covers

band

s

carryng

oten

band

evator

te

eadng

ante-

torn,

wt

to

o

an

t

te

te

urnary

ncontnence.

nto

o

be

or

ana

epsotomy.

sacrospnous

to

287

mportant

externa

posteror

woud

epsotomy,

structure

te

remnant

s

he

procedure.

he

be

atera

contan

te

od

umbcus,

nodes

not

spncter

and

woman

crura

te

vesses.

porton

nodes.

nto

te

ga-

njury.

perneum.

externa

and

drans

rena

te

cutaneous

te

nguna

uterus,

In

GAS

te

unctons

te

node

to

nguna

accompany

ABR/McM

ana

overes

te

o

to

gament

superca

body

n

mdne

urnary

475;

Ovaran

nodes

388;

musce

spne

poston.

GAS

D.

uterus.

majora.

broad

ymp

adjacent

te

drans

nodes

but

contnence.

provdes

te

nerve.

gament

gubernacuum.

aba

N

mdne

ramus.

tssues

E.

man

rng,

contnence.

es

Mackenrodt

bromuscuar

vesses.

gament

nodes

mmedatey

ound

t

C.

mesometrum

extends

nguna

beneat

hese

uterus

superca

hs

a

known

support

wc

wa.

round

he

te

uterne

deep

Coquet

ac

tendon)

musce

dysmen-

respectvey.

ovaran

E.

partcuary

and

286

transverse

drect

suspensory

he

te

te

gament

abdomna

C.

495;

a

he

s

rectum.

aso

nundbuopevc

sory

te

eca

durng

requenty

rectouterne

te

condensatons

mesosapnx

uterus,

or

and

or

s

gestatona

ABR/McM

gament,

provde

broad

te

353;

atera

o

accompany

vc

o

ocated

compcatons.

Dougas

uterus

N

cardna

composed

B.

te

471;

gament

tat

o

uterus

dyspareuna

estmatng

obstetrc

pouc

between

wt

and

o

ven.

externa

tanng

uterne

generay

more

undergone

retroverted

assocated

orrea,

he

and

respectvey.

he

a

emora

25–49

he

devery.

D.

node

s

te

ven

nterna

(centra

However,

he

muc

juncton

ac

n

213

Perineum

nodes.

he

o

Coquet

and

cana.

However,

as

at

o

ocated

artery

anteverted

retroverted

anteverted

rare

s

ac

ncarceraton.

B.

node

ment.

and

271

antelexed

cervca

varant.

trmester

he

tat

E.

ABR/McM

uterus

and

norma

second

o

te

395;

antelexed,

as

suprapubc

regon.

te

vagna

te

anteror

externa

brances

N

Normay,

te

o

398;

and

tg.

skn

suprapubc

GAS

suppes

gentaa

Pelvis

4

no

arc

te

part

o

drect

coccygeus

loor

but

o

asca

te

roe

te

o

orgn

n

not

an

s

obturator

o

te

a

tckened

nternus

evator

an,

and

but

t

ncontnence.

musce

s

evator

te

supports

drecty

and

rases

assocated

wt

te

pe-

urnary

ncontnence.

D.

he

ton

obturator

o

te

nternus

tg.

s

nvoved

wt

atera

rota-

214

C H A P T E R

4

Pelvis

and

Perineum

Bulbospongiosus

muscle

Ischiocavernous

muscle

Superficial

perineal

Perineal

body

Levator

External

•

E.

I

te

rectovagna

subject

as

te

to

Fg.

and

te

rom

28.

C.

495;

he

N

te

posteror

te

patent

rectocee

te

te

or

can

wa

o

te

be

vagna

ne)

(GAS

most

zone

parts

o

nto

o

te

ABR/McM

s p ac e

between

o

nto

te

ana

te

parts

te

te

o

ana

cana

ac

aso

not

( o

te

ossa

ocated

Re tz us)

s

te

surrounds

te

ana

posteror

nodes.

terc

te

nto

deep

na

body

troug

merge.

represents

wc

It

E.

pernea

uretra

GAS

456,

to

Beedng

te

s

a

centra

musces

ocated

n

o

te

te

tendnous

pevs

superca

C.

An

A.

A

space

spncter

te

459;

s

and

musce.

urnary

N

bounded

superor

378;

It

nerory

asca

s

te

tereore

badder.

ABR/McM

o

by

te

exter-

ocated

An

a

te

te

vagna

due

to

ducts

tereore,

cause

te

a

open

cyst

n

ematocopos.

rom

and

ven,

(o

Dougas).

cremaster

but

none

ematocopos.

a

must

sma

be

kept

o

uterne

he

branc

(sometmes

dvson

te

pouc

dmnutve

uterus

wt

N

wa

358;

o

n

te

to

mnd

musce

o

tese

cremas-

te

caed

round

vens

te

s

uretrocee

cystocee

uretra).

wt

tat

round

“Samson’s

durng

a

ys-

gament.

woud

not

low

nto

te

s

te

s

n

te

s

te

or

te

te

by

te

by

by

badder.

vagna

are

asca

and

te

te

o

te

wa.

o

assocated

badder

uretrocee

o

loor.

proapse

usuay

urnary

nto

tear

proapse

anteror

vagna

a

pevc

te

pubocervca

o

urnary

o

It

ntestne

caused

caracterzed

vagna.

wa

285

sma

weakens

troug

(proapse

deects

portng

vagna)

Cystocee

anteror

o

caracterzed

badder

nto

ABR/McM

(ernaton

septum

cystocee

te

279

gand

vagna;

not

artery

wt

wc

474;

urnary

B.

a

provdes

o

enterocee

posteror

and

per-

o

occurs

vagna.

uretra

membrane

nerory

artery

gament

te

pubc

vestbuar

te

rectouterne

assocated

30.

ng

ymen.

woud

ave

are

spncters.

to

te

oten

(above

space.

pernea

nto

cremasterc

and

o

by

commony

Women

drans

e xtrap e r -

s ymp ys s

greater

gand

terectomy,

p ub c

hs

D.

376

mmedatey

or

vestbue

rectovagna

pernea

nea

te

caracterzed

mperorate

Barton

GAS

It

perneum

an

s

bood.

and

drans

sphincter

Bood rom a ruptured ectopc pregnancy most oten

rectum

cana

muscle

B.

superca

te

nterna

rectum

o

Barton

badder.

scoana

he

menstrua

artery”),

388;

he

he

A.

nodes.

N

Hematocopos

presence

288

porton

drans

rom

drans

some

structure

E.

C.

wt

tract

sympyss.

B.

29.

enterocee,

gastrontestna

ABR/McM

ne)

mucosa

retropubc

s

360;

cutaneous

Lymp

space

urnar y

A.

E.

rom

sacra

tonea

torn,

anal

ani

5.17

nto

pectnate

pectnate

GAS

te

o

s

o

Fig.

nodes.

D,

Lymp

te

nto

rom

te

nguna

C,

porton

447–450;

Lymp

(beow

B,

septum

occurrence

GAS

5.34).

GAS

A.

te

ower

proapses

27.

transverse

muscle

te

wt

nto

te

assocated

tat

asssts

covers

n

sup-

CHAPTER

Pelvis

4

and

215

Perineum

Piriformis

muscle

Coccygeus

muscle

Anococcygeal

ligament

Obturator

internus

muscle

Tendinous

Obturator

arch

canal

Sacrospinous Iliococcygeus

ligament

(cut)

muscle

Pubococcygeus Levator

Anal

ani

aper ture

muscle

Puborectalis

muscle

Urogenital

hiatus

•

D.

Urnary

E.

ncontnence

te

musces

not

be

caused

Proapse

ng

tat

or

o

by

a

tear

te

tearng

uterus

can

resut

surround

o

te

te

uterus

rom

weakenng

uretra

but

rectovagna

s

caused

o

te

gaments

(especay

te

cardna

by

tat

31.

A.

s

O

te

arcus

te

B,

te

ony

C,

D.

any

347;

ABR/McM

answer

coces

musce

tat

he

do

drect

ave

N

and

not

pevc

te

s

septum.

ococcygeus

but

t

s

urnary

te

uterosacra

he

ocated

tereore

weaken-

n

te

urnary

and

o

te

nternus,

parts

to

sted,

asca

obturator

285

te

drecty

support

orm

support

roe

E.

GAS

32.

A.

does

447–448;

he

o

te

ovary);

pubococcygeus

assocated

connectve

urnary

urogenta

an

organs,

ncontnence.

te

tssues

bers

B.

o

badder.

prorms,

evator

wt

and

and

nor

coc-

ovaran

do

tey

orm

pay

to

a

part

te

o

te

evator

pubococcygeus

drect

roe

n

an,

and

mantanng

N

rom

340;

gament

te

ABR/McM

and

nerves

277

e

wtn

(suspensory

cuttng

ts

te

gament

gament

nun-

o

nterrupts

te

pan

ovary.

Cuttng te sympatetc trunk mgt ep to reduce

some

o

suc

a

surgca

C.

not

vesses

tereore,

te

he

vate

wt

pan

rom

procedure

ocatng

provde

does

atera

contnence.

dbuopevc

tendneus

vagna

cygeus

no

474;

5.34

o

gaments).

GAS

Fig.

woud

support

and/or

GAS

te

are

umbar

te

ovary,

rater

but

te

resuts

unpredctabe,

sympatetc

trunk

s

more

o

pus

o

a

caenge.

cuna

parts

te

nerves

o

te

ovares.

are

cutaneous

buttocks.

hey

nerves

are

tat

not

nner-

assocated

216

C H A P T E R

4

Pelvis

and

Perineum

Ureter

Median

sacral

ar ter y

Ovarian

Ovarian

ar ter y

vessels

Ureter

Branches Uterine

anterior

of Broad

inter nal

ar ter y iliac

•

he

pudenda

does

E.

he

na

not

broad

GAS

33.

C.

te

he

nerve

carry

vesses

nerve

gament

nerve

rom

N

te

346;

superca

pernea

pan

contans

pexus

ovary

pernea

musces

and

te

n

perneum

rom

ony

and

te

te

does

(GAS

and

carry

o

s

asca

s

abdomna

te

deep

te

or

te

wa

superca

and

te

cet

es

D.

ayer

E.

atty

ayer

o

te

o

(GAS

Coes

te

Scarpa

ante-

asca

abdomna

wa.

te

s

deep

te

neror

tat

pernea

GAS

he

ce,

asca

orms

te

o

te

neror

compartment.

way

rom

o

te

border

o

te

anteror

ossa.

between

and

te

te

externa

apex

o

uretra

te

prostate

5.70).

500–507;

t

neror

space

musce

urnary

and

ton

Fg.

te

scoana

no

spncter

B.

te

bounds

o

here

o

pernea

o

o

s

spncter

he superor asca o te externa uretra spncter

musce

between

membrane

uretra

boundary

any

(asca

superca

perneum;

ayer

pernea

recess

membranous

membranous

he

externa

34.

Camper

ror

B.

5.66).

Gaaudet

ar ter y

5.66

ovary.

asca.

A.

Fig.

uterovag-

not

Fg.

GAS

287

space

asca

te

bers

ABR/McM

pernea

compartment)

nnervates

aferent

and

bers

492;

externa

neror

trunk

ligament Vaginal

D.

of

ar ter y

N

378;

badder

receves

bot

ts

parasympatetc

pevc

ABR/McM

wa

ncudes

motor

nerve

spancnc

279

te

and

bers

nerves

detrusor

sensory

mus-

nnerva-

transmtted

rom

S2

to

S4.

by

CHAPTER

4

Pelvis

and

Perineum

Coccygeus

muscle

Obturator

internus

muscle

Sacrotuberous

ligament

Sacrospinous

ligament

Ischio-anal

fossae

Anterior

recesses

ischio-anal

of

fossae

A Deep

perineal

space

Perineal

Obturator

membrane

internus

muscle

Tendon

internus

Ischio-anal

of

obturator

muscle

fossae

B Anterior Anterior

recesses

recesses

of

ischio-anal ischio-anal

fossae

Levator

Deep

perineal

ani

space

Obturator Perineal

membrane

C

•

GAS

Fig.

5.70

internus

muscle

fossae

of

217

218

C H A P T E R

A.

he

4

Pelvis

superor

patetc

resuts

he

te

te

D.

n

pexus

he

It

perneum

GAS

A.

he

pont

lud

ates

to

te

te

rom

te

jon

te

te

n

uretra

ter,

musce.

sacra

te

aspect

neror

o

nnervaton

N

te

arses

rom

nerve

bot

umbar

nnervaton

ypogastrc

to

te

sacra

te

somatc

B.

ABR/McM

he

p ouc 

( o

Dougas)

p e r  tone a

te

tensor

sen-

E.

s

troug

te

or

te

 owe st

h ereore ,

cavty

stand ng

w  t

te

It

pos te r  or

pat e nt

coect

he

he

te

E.

urnary

a

genta

ornx

o

procedure

te

s

artery

A.

he

es

te

to

C.

nto

te

ts

space

not

E.

pouc

s

an

anatomc

neede

n

Durng

w

not

te

36.

E.

477;

Because

asca

luds

he

te

ABR/McM

spongy

bot

rupture

nto

w

he

n

occur

superca

ossa

trange,

(GAS

and

te

ere,

s

pouc

te

deep

wt

ocated

Fg.

39.

copo-

pene

ts

o

represents

to

ower

he

pernea

externa

D.

and

uretra

retropubc

Retzus,

s

GAS

to

459–461,

space

s

lows

C.

uro-

te

owest

were

aso

urnary

507;

It

Lymp

D.

te

te

Lymp

N

te

te

pont

E.

he

o

te

o

wt

378;

Lympatc

te

erecte

ABR/McM

o

to

bodes

cave

dsta

ana

nodes,

o

sympyss

GAS

40.

C.

he

patcs

279

n

gves

to

te

arses

rse

te

bot

tereore,

pudenda

emora

ower

rom

te

externa

severa

urnary

artery

mb.

abdomna

to

te

deep

dysuncton).

te

umbca

wa.

superor

badder

and

gament.

orgnates

superca

suppy

te

to

te

rom

te

exter-

crcumlex

superca

o

abdomna

ABR/McM

te

wc

ac

o

at

te

cancerous

cancer

te

nodes

eve

ces

must

ower

wa.

280

nguna

uterus

te

Uterne

ower

te

eve

te

be

mb,

two-trds

ac

ymp

ovares

o

te

o

can

te

dran

to

especay

vuva,

and

o

te

rectum

nodes.

lows

to

te

para-aortc

kdneys.

proxma

one

but

uterus.

te

w

tose

trds

o

te

rectum

te

N

to

nto

above

s

aso

coumns

neror

o

te

te

te

te

wc

strated

ne

ana

dran

end

beow

mucosa

te

cana

squamous

assocated

and

ana

pectnate

superca

pectnate

ne

s

ep-

wt

vaves.

ne

o

nguna

low

to

nodes.

388;

ympatc

hese

o

vesses

ac

rom

marks

cana,

pectnate

ends

cana

495;

ne

ana

he

te

badder.

guteus

he

nterna

anteror

nonkeratnzed,

te

deep

te

tssue;

te

artery

te

to

erecte

suppyng

387;

te

te

asca

as

and

norma.

pectnate

te

pubc

rse

pens.

gves

te

nterna

rom

nterna

known

to

te

te

o

artery

tssues

rom

at

N

by

rom

to

te

s

o

suppy

cancer

te

between

superor

nnerva-

medus,

dran to te neror mesenterc group o ymp nodes.

one-trd

space

musce.

posteror

te

a

o

appear

cana

B. Lymp

o

bood



ound.

space,

ocated

anteror

and

s

spncter

pernea

spongy

he

space

membrane

uretra

superca

and

pernea

or

meda

and

regon.

teum.

deep

te

wt

279

gves

rse

tat

present

nguna

ned

te

ABR/McM

artery

or

crcumlex

gaments,

te

and

tat

jon

pevs

motor

artery

te

artery

provde

nng

badder

nerves

te

guteus

(erecte

artery

490–491;

o te pertonea cavty n men. It s ocated between

urnary

suppy

mpotence

suppes

ana

njury.

te

nnerva-

tey

nnervates

artery

epgastrc

It

suspected

rectum.

C.

deep

ndcatve

te

(Buck)

te

ac

arteres

ac

nodes

posteror

Instead,

provdes

nerve

suppy

n

becomes

Cancer

cet.

area

to

nerve

393;

deep

umbca

be

pernea

extravasaton

N

responsbe

A.

round

5.59)

superca

pernea

bend

rectovesca

285

uretra

ocated

scoana

genta

B.

345;

te

are

space,

A.

N

s

artery.

Bot

space.

GAS

te

artery arses rom te begnnng o te emora artery.

uro-

penetrate

resut

neror

na

va

space

te

autonomc

mnmus,

pudenda

man

ac

GAS

membrane

are

nerves

gutea

and

he

he

and

s

o

atae.

485;

externa

ten

sampes.

uterus

spnc-

parayss

parasympatetc

musce.

aterosceross

may

he

vagna.

perneum.

te

te

wc

space

soud

lud

between

pernea

te

neede

pevc

Entrance

o

483,

s

he

te

space

extrapertonea

coect

pernea

trange

centess

to

badder.

te

ts

nerves

skeeta

gutea

nterna

sgncant

p ar t

o

suppy

guteus

ascae

vesca

s

pouc

beow

sde

te

artery

artery

p os  t o ned

eter

penetrate

badder.

space

superca

ocated

not

on

uretra

n

nnervaton.

neror

he

space.

space

uterovesca

anteror

ormed

w

urnary

te

he

lud

ts

te

s

neede

pevc

penetrate

he

ossa

paravesca

around

D.

D.

dorsa

ac cum u-

s tt ng.

resut

maxmus.

B.

rectum.

C.

he

nner-

38.

s

cavty.

p e r ton ea

p at e n t

orn  x,

pararecta

to

externa

can

ncontnence.

ypogastrc

superor

ton

and

281

suppy

sympatetc

he

te

pevs.

spancnc

not

o

nerve

urnary

te

neror

pevc

and

to

Sacra

segments

motor

ts

spancncs

Pevc

D.

sympatetc

to

A.

sym-

pevs

nnervaton

and

ton

pexus.

o

to

to

te

njury

GAS

399;

transvagn a  y

vagna

rom

addton

wt n

te

or

and

spncter

ypo-

uprgt.

B.

C. he pernea branc o te pudenda nerve s respon-

sbe

skn.

woman’s

w en

arse

man

provdng

coecton

accessbe

o

s

rectouterne

ere

detrusor

sympatetc

provde

nerve

486–488;

o

nterna

37.

hs

do

superor

nnervaton,

vaton

35.

provde

and

te

pudenda

sory

te

and

spancncs

trunk

va

S2–24.

te

sym-

badder.

organs.

umbar

organs

o

provdes

urnary

o

arse

trunk

to

pexus

te

reaxaton

spancncs

pevc

he

to

constrcton

and

sacra

patetc

E.

ypogastrc

sympatetc

gastrc

Perineum

nnervaton

spncter

C.

and

te

ABR/McM

vesses

uterne

ascend

to

o

te

tubes

te

rgt

287

ovares

and

and

jon

wt

te

undus

et

umbar

ym-

o

te

(cava/

CHAPTER

Pelvis

4

and

Perineum

Ureter

Suspensor y

ligament

of

ovar y

Recto-uterine

Broad

fold

ligamen t

Round

ligament

of

Inferior

uterus

epigastric

ar ter y

Lateral

umbilical

Medial

fold

umbilical

fold Recto-uterine

Ligament

Median

of

pouch

ovar y

umbilical

fold

V esico-uterine

pouch

Sagittal

section

of

broad

ligament

Mesosalpinx

Uterine

tube Ovar y

Broad

ligament

Mesovarium

Mesometrium

Ureter

Round

ligament

of

uterus

Uterine

ar ter y

A

aortc)

to

ymp

receve

nguna

nodes

abdomna

ca

nodes.

cancerous

wa

pernea

hese

ces

dran

neror

structures.

ymp

rom

te

to

te

ower

te

nodes

are

ovares.

mb,

umbcus,

te

rst

Superca

te

and

anteror

super-

A.

he superca nguna nodes dran superca

nea

structures,

body

o

near

te

ce

o

ncudng

attacment

perneum

te

o

te

te

(ncudng

vagna

neror

to

superoatera

round

te

te

per-

uterne

gament,

vuva),

and

ymen.

te

skn

or-

219

220

C H A P T E R

4

Pelvis

and

Perineum

Ureter

Inferior

epigastric

Lateral

umbilical

Small

ar ter y

fold

rectovesical

Medial

fold

umbilical

Median

fold

umbilical

fold

Rectovesical

pouch

B

•

B,

D.

he

externa

ac

nodes

dran

te

deep

GAS

nguna

5.59

to

sca

te

E.

vagna

he

nterna

and

ac

deep

nodes

pernea

dran

neror

pevc

struc-

structures.

B,

GAS 493–495, 509; N 388; ABR/McM 368, 374–375

B

he

nterna

vagna,

C.

cervx,

he

ac

and

nodes

body

umbar/atera

dran

o

te

aortc

te

mdde

and

upper

uterus.

ymp

D.

he

dran

te

E.

receves

and

te

he

axary

cest

GAS

node

wa,

494-

he

to

admnster

sca

crosses

wc

dranage

prostate

A.

nerve

ocated

artcuate

C.

n

ymp

509;

spne

a

te

s

ound

te

n

te

rectum,

mesorec-

ana

reate

he

te

N

te

pudenda

te

upper

mb

and

correct

nerve

sacrospnous

bony

bock.

gament,

wt

to

376

andmark

he

to

used

pudenda

wc

attaces

te

te

te

sca

te

sca

most

superor

posteror

atera

course

spne

easy

he

tuberostes

nerve

o

emora

te

are

skn

o

and

usng

te

o

te

a

most

sot

nerve.

ac

te

tus

trans-

spnes

pevs

sacrum.

and

hey

do

nerve.

neror

tssues

sensory

pernea

cutaneous

neror

pudenda

and

receve

and

and

aspect

aspect

tuberostes

pevs.

njectons

ABR/McM

done

suppy

brances

o

Injectons

aspect

around

rom

te

nto

o

te

te

poste-

te

area

around te tuberostes are ess certan, owever, tan

breasts.

389;

on

pudenda

ror

dran

s

posteror

bony

sca

cana,

men.

nodes

ncudng

495,

s

rom

Accessng

nerve

approac.

he

te

presacra

tum

D.

not

nodes

spne.

pudenda

are

ovares.

42.

te

nodes tat dran te ctors and superca nguna nodes.

tures

41.

Fig.

E.

at

te

anestetze

he

coccyx

tzng

GAS

te

s

sacrospnous

te

a

ana

poor

pudenda

433–437;

N

gament

trange

target

or

ocatng

nerve.

395;

and

oten

a

we.

ABR/McM

96

and

aneste-

CHAPTER

43.

D.

Hemorrods

na

s

and

medated

wc

A.

by

serves

he

sacra

B.

te

not

bers

anteror

pan

ne

spancnc

he

to

skn

44.

498;

B.

bers

postgangonc

organs

are

tey

to

te

do

pevc

wt

te

at

base

majus;

N

398;

47.

te

B.

he

as

more

provdes

o

te

and

sensory

nnervaton

pens/ctors;

upper

ABR/McM

to

bactera

prostate

not

been

te

nner

te

proven

uterus

D.

he

parauretra

ton

no

a

o

as

mucus

mpact

no

tan

a

t

known

gands

UTI.

tg.

B,

women,

t

com-

48.

pens.

akane

protects

lud,

aganst

sperm

or

te

antbactera

are

responsbe

sexua

E.

ructose-contanng

te

but

t

bactera

C,

A.

he

uterus

badder

ts

by

actvty .

he

lud

journey

to

proapse

or

hs

semna

tat

unctons.

gands

provdes

troug

te

te

secre-

mucus

as

possbe

352;

and

emae

can

nto

D,

te

te

urnary

he

to

base

o

o

te

te

badder

sacrum

D.

Injury

E.

he

nary

to

te

badder

medan

ocated

be

torn,

te

to

te

and

aowng

anteror

but

hs

genta

gament

on

ayer

ernate

ayer.

to

lud

te

B,

to

A.

ureter

vesses

s

ocated

(“water

woud

not

troug

347;

aspect

s

te

pevc

s

te

uterne

te

o

sdewa

te

uterne

ocated

pevc

uterne

on

te

sdewa,

vesses.

288

gynecoogc

dstenson

a

o

and

te

trans-

C.

he

te

D.

uterus

o

te

gaton

reatvey

mmedatey

under

to

or

njur y

because

ts

neror

te

aba;

s

te

broad

arcus

o

te

he

te

288

o

easy

due

nea

E.

and

t

to

s

ocaton.

to

brdge”)

te

n

te

or

and

N

te

to

he

nvade

and

evdent

te

due

between

te

evdence

te

279

transverse

man

cervca

gaments

nbt

te

ay-

present

area.

ABR/McM

te

oter

w

abdomna

two

usu-

asca.

between

and

to

asca

s

abdomen

378;

te

nto

and

n

te

o

s

uterus

nguna

te

te

stab-

uterus

s

not

reated

rom

cana.

pertonea

uterus,

to

and

pevs

te

to

hs

ga-

ovary.

coverng

over

vesses.

jons

te

musce

pubocervca

drecty

te

deveopment

gubernacuum

ascae

an

s

embryoogc

tubes,

evator

assocated

asca

wt

te

gaments.

an

and

does

475;

o

tendneus

evator

pevs

(Buck)

bood

hs

uretra.

begn

exampe

cnca

ovares

uterne

ts

spongy

w

o

space.

vagna.

gament

vagna

te

te

ep

remnant

te

nvo-

durng

not,

te

N

musces

support

o

owever,

vagna

355;

contrbute

a

(GAS

te

prevent

Fg.

ABR/McM

to

pevc

te

loor

vscera

proapse

o

nd-

o

te

5.58).

288

te

te

he

uterne

te

hey

cause

extravasaton

coects

are

not

muscuature

pernea

musce

gaments

te

ovares,

uterus

vagna.

uracus

s

asca

ur-

o

to

te

evator

289

o

pene

perneum

contnues

he

up

and

496–498;

uterus.

round

woud

(urne)

deep

and

dyspareuna.

vagna.

o

lud

to

vagna

te

lud

gament



o

te

te

te

te

extravasaton

B.

ment

vagna.

te

gaments

descent

major

te

n

pervagna

ead

superca

nto

ocated

te

cause

te

or

ABR/McM

structure

passes

and

te

turn

rupture

uterosacra

te

on

gament

ysterectomy,

appen

near

te

bubospongosus

exampe

proapsng

wt

support

I

459–461,

he

o

perneum,

GAS

can

te

trunk

condtons

tssues

GAS

susceptbe

to

gaton

nvovng

o

n

nvadng

nto

most

aong

o

te

ABR/McM

o

hs

D.

te

and

no

ancor

C,

o

can

te

o

t

N

te

burcates

psycosomatc

as

spasms

between

dartos

zng

urnary

wa,

resut

(cardna)

cdbrt

and

ofer

troug

serves

an

posteror

471;

to

panu,

cassc

rom

dferenty

49.

ascae

a

a

uterus

a

ste

ABR/McM

and

353;

recty;

457,

a

hese

te

Durng

s

hs

N

s

s

support.

umbca

te

supravagna

cervx.

sacrum

382;

examnaton

474;

ay

orce.

woud

ernates

evator

to

te

te

te

tssues

E.

urne

ers

urnary

te

vagna

vagna

broad

gament

or

te

proxmty

traves

descrbed

gament s an embryoogc remnant o te aantos.

ureter

on

te

uterus

uterosacra

to

contractons

and

A,

to

285

vescocervca

pregnancy

te

troug

ABR/McM

ancored

and

Durng

tssue

ernate

gament

A.

N

stabzed

surace.

s

subcutaneous

produce

nutrents

he transverse cervca (cardna) gament s

wtn

C.

507;

pubovesca

connectve

badder

B.

s

te

anteror

ts

E.

GAS

459–461,

t

o

proxmty

N

extravasaton

tract.

GAS

cose

472,

musces.

untary

n

te

cear,

tat

durng

on

to

artery

cose

umbosacra

o

nvountary

an

te

he

he

Vagnsmus

te

scro-

279

vestbue

lora

produces

C.

E.

cavernous

nectons.

46.

A.

GAS

contans

atera

ac

n

nerve

cose

sde

n

manua

proxmty

not

dsorder;

pevc

mony eads to nectons o te urnary tract. he vagna

45.

s

GAS

not

vcnty

and

o

cose

te

s

obturator

C. he uretra s sorter n women tan n men. Because

ts

cm

221

Perineum

verse pernea musces, te stmuaton o wc trggers

nerve

te

n

not

organs.

beow

1

nterna

but

he

atera

pregang-

organs

retrogradey

and

he

vesses.

perneum

carry

pevc

D.

C.

brm

vesses

trunk

nerves

promontory

te

and

suppy.

mxed

rom

approxmatey

and

cer vx.

pevc

sympatetc

nerves

te

cavty

nerves.

tum/abum

GAS

te

sacra

rom

trave

onguna

te

transmt

normaton

pan

nter-

emorrods

(somatosensory),

sacra

and

te

categores:

perneum.

nerves

parasympatetc

pevc

nerve

te

spancnc

Addtonay,

E.

to

two

externa

te

nerves

rom

vesses

pan

pevc

onc

o

ypogastrc

medate

he

to

pudenda

majorty

abdomna

ocated

nto

due

spancnc

Superor

C.

dvded

Pan

te

te

sympatetc

to

are

externa.

Pelvis

4

pevc

Answers

50.

50–74

A. he nterna ac ymp nodes and sacra nodes woud

be

nvoved

woud

be

n

a

desred

pevc

n

ympadenectomy ,

surgca

resecton

or

wc

prostate

oten

cancer.

222

C H A P T E R

4

Pelvis

and

Perineum

Uterosacral

Transverse

cervical

Pubocervical

ligament

ligament

ligament

Rectovaginal

septum

A

Rectum

Rectovesical

septum

Anal

Prostate Puboprostatic

ligament

Prostatic

fascia

B

Prostatic

•

GAS

Fig.

5.58

venous

plexus

canal

CHAPTER

4

Pelvis

and

Perineum

Ureter

External

iliac

artery

Inferior

epigastric

artery

Deep

inguinal

ring

Inguinal

Ductus

canal

deferens

Ampulla

of

Superficial

inguinal

ductus

deferens

ring

Seminal

Spermatic

vesicle

cord

Ejaculatory

Prostate

Bulbo-urethral

in

Ductus

deferens

Musculofascial

space Head

of

epididymis

Body

of

epididymis

Testis

Tail

of

epididymis

Scrotum

A

Tunica

vaginalis

deep

gland

perineal

pouch

ducts

223

224

C H A P T E R

4

Pelvis

and

Perineum

Ductus

Ligamentous

of

processus

deferens

remnant

vaginalis

Head

Straight

of

epididymis

tubule

Efferent

Seminiferous

ductules

tubule

Rete

testis

Body

Parietal

of

in

mediastinum

testis

epididymis

layer

T unica

Cavity vaginalis

Visceral

layer

Capsule

(tunica

albuginea)

T ail

of

epididymis

B

•

Sacra

ympatcs

wtn

te

B.

he

can

vertebra

externa

superor

ac

pevc

perneum,

and

communcate

cana

and

tus

nodes

te

body

a

te

wa

o

te

he

D.

he

nguna

structures

deep

beow

nguna

nodes

te

nodes

dran

eve

a

o

D.

o

te

te

gans

te

n

te

he

gutea

and

neror

ts

E.

he

495,

w

testcuar

cose

te

tat

514;

most

cancer

assocaton

testes

s

and

nto

wc

te

are

superor

ound

N

or

390;

ABR/McM

umbar

key

be

because

wt

te

node

at

ntrated

testcuar

he

B.

he

nterna

deep

testcuar

or

sweng

te

by

vesses

te

a

run

and

s

men,

oten

o

metastass

cancer

young

s

eve

a

vc

D.

dran

ntra-

cnca

A.

ac

dran

te

neror

pevs

and

anterosuperor

pe-

structures.

ac

structures.

nodes

nodes

dran

be

spancnc

o

lud

contnuty

superca

body

C,

D.

uretra,

o

te

pens,

te

o

te

superca

368



at

a

as

and

on

medated

spancnc

te

postero-

possbe,

to

tese

avod

mpotence.)

ts

termna

branc,

prmary

skeeta

te

to

contan

398;

te

externa

sympatetc

ABR/McM

uretra

te

Coes

eads

superca

asca

superca

genta-

or

(te

bers.

282

to

accumua-

pernea

(superca

pernea

wa

aows

pevc

bers.

N

n

super-

prostatectomy,

carry

spongy

abdomna

asca)

o

men.

bundes

(In

nnervaton

(edema)

a

more

n

te

known

nerve

510;

te

he

o

aso

nerves

486–488,

ayer

nerve

sympatetc

o

B,

o

va

ntact,

pudenda

receve

pens

ABR/McM

prostate.

et

sensory

Rupture

nous

te

dran

umbcus.

parasympatetcay

devered

nerve

aso

a

troug

o

ton

te

a

he

and

GAS

53.

pass

gans

390;

s

nodes

te

nodes

te

N

dysuncton,

E.

and

Sacra

n

dsease

as

ate

o

a,

s

soud

dorsa

asca

pernea

externa

B,

motor

ympatcs

T estcuar

dangerous

ymp

nodes

281

presentaton.

A.

aspect

A,

514;

tat

tat

erecte

aong

dran

erecton

atera

te

epddyms.

especay

abdomna

subdvded

nodes,

vesses.

para-aortc

kdneys

are

gutea

respectve

GAS

51.

nodes

495,

nerves

bundes

beow

nguna

and

Pene

response

men.

E.

deep

GAS

C.

nguna

structures

vesses

super-

pens

superca

he

and

umbcus.

dran

he

ca

52.

superca

ca

C.

antero-

mb

umbcus.

C.

5.47

cranay .

te

ower

to

Fig.

ympatcs

metastasze

dran

structures,

wt

GAS

asca)

wt

membranous

lud

spread

cet.

membra-

Scarpa

ayer

upward

o

upon

wa.

Rupture

or

o

urnary

te

preprostatc

badder

woud

uretra,

ead

to

prostatc

nterna

lud

CHAPTER

accumuaton

ocated

E.

n

wtn

te

Damage

to

abdomen

rupture

GAS

54.

B.

he

pevs

because

tey

are

not

58.

te

or

ureter

pevs,

(GAS

Fg.

459–461,

cremasterc

woud

manest

dependng

upon

wtn

te

te

eve

a

o

N

relex

Durng

seen

sma,

B.

373;

ABR/McM

aferents

are

by

o-

C.

contans

are

pubc

to

skn

regon,

C.

he

D,

E.

he

troug

anteror

te

GAS

te

rom

mt

pevc

Pan

he

and

obturator

cana

and

and

parts

scrotum.

te

D.

he

supra-

E.

or

he

te

woud

not

pay

be

no

trave

59.

damaged

roe

n

te

N

391;

cervx

ABR/McM

s

C.

he

because

te

pertoneum,

cervx

wc

s

s

va

te

A.

beow

aso

pevc

te

known

te

te

te

pevc

pan

prmary

ypogastrc

upper

ner ves

por tons

ner ves

are

ne

s

carred

sympatetc

o

n

carr y

te

B.

prncpay

pan

va

A.

he

and

sensory

te

D.

n

E.

bers

n

he

esser

Pan

rom

bers

to

te

skeeta

and

externa

motor,

provdes

gentaa,

sen-

prmary

ncudng

nerves

are

ts

area

cord

s

woud

pevc

perneum

D.

397;

tus

aso

carry

trave

suprapubc

by

onguna

va

to

bers.

te

62.

S2–S4

he

sensory

S2,

and

and

nguna

regons

oypogastrc

umbca

rom

sory

In

te T10

te

GAS

B.

he

rena

te

regon

eve.

nnervaton

by

C.

et

receves

In

te

sensory

epgastrc

provded

regon

510;

testcuar

wc

neror

B,

D.

urnary

nerves,

nerves

354;

o

badder.

and

gament

ympatc.

projectons

o

te

o

te

pertoneum

ABR/McM

ectopc

nterna

ead

to

are

ABR/McM

produce

o

285

pregnancy

s

te

cervca

os

pacenta

ess

woud

be

preva.

common

stes

o

287

te

akane

ructose

secretes

are

te

produce

and

porton

o

te

cone.

prostagandns,

366;

proper

wtn

tat

D,

E.

463;

N

Ectopc

te

ctrc

acd,

and

368;

te

tuba

ormones.

pene

produce

bub.

281

as

te

or

aed

scrotum

n

do

ABR/McM

te

sex

gands)

to

descend

and

te

nguna

not

correate

may

be

cana.

wt

te

symptoms.

ste

n

279

o

nterna

pregnancy

n

n

producton.

and

te

tests

condtons

or

denton,

overaps

enter

abdomen

hese

sgns

urne

(Cowper

ABR/McM

ocaton

te

o

gands

secretons

N

stes

spermatozoa

cryptorcdsm,

By

mpantaton

cervca

te

n

pacenta

os.

uterne

(aopan)

tubes

pregnancy.

B.

he cervx s not a notabe ste o ectopc mpantaton.

C.

Impantaton

E.

men

w

he

undus

te

by

nnervaton

regon

te

sen-

GAS

63.

T7–T10.

sensory

vena

ven

ten

cava

N

D.

wtn

resut

471–473;

Interna

nate

nnervaton

s

ne.

o

n

an

te

te

mesenteres

abdomna

uterus

symptom

397;

ABR/McM

drans

crosses

(coce

drecty

over

te

285

nto

mdne

A,

te

to

et

te

enter

A).

B,

C.

ton.

and

et

ac

vens

are

not

nvoved

testes.

266,

493,

n

te

dranage

383;

ABR/McM

271

355;

tssue

s

o

te

abdo-

pregnancy.

te

N

nterna

norma

ste

o

removed

n

285

ocated

nerves.

rom

Pan

above

te

s

te

pect-

ndgut

not

a

and

common

emorrods.

do

not

carry

pan

bers

above

ne.

381;

ABR/McM

spancnc

same

te

are

derved

nerves

parasympatetc

hese

ABR/McM

s

vscera

tese

pevc

ndgut,

N

o

E.

498;

he

da,

te

by

pectnate

GAS

64.

C,

N

emorrods

hs

nnervated

tan

GAS

he

regon.

pospatase.

ts

C, D, E. he et neror epgastrc, et nterna puden-

o

may

oten

overooked.

ts

etus’s

porton

ste

ncudes

prostate

467;

In

are

T7–T10.

486–488,

ven,

s

epgastrc

provded

57.

s

mpantaton.

he

E.

hs

resuts

o

355;

gands

bubouretra

(L1).

C.

n

atera

coces

he

A.

tg.

oter

E.

and

nnervaton

a

and

kdneys

preva

eves

S3,

are

te

testes

GAS

282

at

he

A,

parasympatetc

nerves.

provde

posteror

aferent

easy

t

tube.

he

nto

sympatetc

ABR/McM

medated

spancnc

eves

and

nerves

N

he

supped

N

presentng

510;

uterus

(nundbuopevc)

353,

D.

ound

prncpay

N

C.

GAS

61.

vagna.

spancnc

and

te

spna

B,

o

486–488,

troug

te

trd

spancnc

responses

S4

contans

uncton.

GAS

A.

nnervaton

dsta

Sacra

nerve

sympatetc

te

ovares.

s

uterus

he

mucous

pudenda

sory,

o

atoug

pregnances.

471;

he

uncton.

A.

E.

acd

Sacra

sympatetc

te

common

te

Semna

uncton.

uter us.

te

vesses,

tubes

toward

470–473;

ejacuate.

are

spancnc

D,

GAS

60.

ne.

tat

ovaran

(Faopan)

ectopc

ne-

as

s

ound

suspensory

te

Impantaton

B,

te

te

most

uterne

275

transmtted

tat

not

dran’s

mesosapnx

GAS

not

cana,

te broad gament tat attaces to te uterne tubes.

area.

do

are

wc

uterne

uterus

tg.

sensaton

nerves

tey

o

nner

provdes

suprapubc

and

510;

superor

rom

to

wtn

te

above

ner ves

nerve

addton,

nerves

o

pan

trange

sensory

relex.

486–488,

spancnc

B.

In

emora

s

perneum,

and

nguna

erna.

Pan

ror

wa

pudenda

cremasterc

C.

te

nerve

oypogastrc

abdomna

by

over

onguna

gament

225

Perineum

he ovaran gament connects te ovary to te uterus,

wereas

he

round

nguna

strand

coces

toemora nerve. he sensory bers o te gentoemora

A.

56.

brous

aantos

te

te

te

and

he uracus s a brous remnant embryoogc o te

279

carred

repar,

wtn

remanng

5.47).

507;

A.

be

nguna nerve; te motor (eferent) output s by te gen-

nerve

55.

te

perneum.

Pelvis

4

eferent

nerves

portons

ts

(nerv

bers

nnervate

o

patent.

281

nerves

te

te

arge

ergentes)

tat

medate

dervatves

ntestne

con-

erec-

o

tat

te

were

226

C H A P T E R

A,

B,

ts

E.

Te

o

ymp

to

Lesons

nodes

 n vo  ve

nodes

do

n

515;

nterna

cer vx.

and

Perineum

tese

structures

woud

not

cause

symptoms.

486–488,

A.

ne

Pelvis

patent’s

GAS

65.

D,

4

N

ac

tat

te

not

398;

ABR/McM

a re

re c e  ve

ces

nterna

 a ve

te

tumor

ympatc

nodes

C a n c e ro u s

tat

te

rst

ymp

 ro m

ac

c a n c e ro u s

te

282

n

 ro m

cer vx

nodes

ces,

tmes

rst.

ts

a

te

a re

I

tr unk

uter-

key

tese

ndcates

as

cannes.

 n vo  ve d

and

not

s p re a d ,

Pre s a c r a 

can

be

et

at

east

nodes

a re

durng

a

t  ro u g 

aso

some-

dgta

re c t a 

examnaton.

B,

to

C,

D,

E.

receve

he

structures

are

GAS

514;

495,

nterna

ymp

rom

ac

te

ymp

uterne

nodes

are

cervx,

te

te

rst

oter

not.

N

388;

ABR/McM

373

S2

S3

S4

Pudendal

Obturator

nerve

internus

muscle

Coccygeus

muscle

Pudendal

fascia

of

obturator

canal

in

internus

Sacrospinous

Inferior

rectal

nerve

ligament

Levator

Perineal

Dorsal

nerve

of

penis

Motor

branches

muscle

Posterior

A

in

scrotal

to

skeletal

urogenital

nerve

triangle

ani

nerve

CHAPTER

Pelvis

4

Dorsal

Motor

and

nerve

227

Perineum

of

clitoris

branches

Posterior

Perineal

labial

nerve

Pudendal

Inferior

ner ve

nerve

rectal

nerve

B

•

66.

D.

As

seen

contans

n

accumuaton

ayers

o

te

accounts

A.

or

o

cear

lud

te

Varcocee

s

pressure

tese

C.

Cystocee,

projects

wen

s

n

te

ts

swoen

ts

5.76

scrotum

ydrocee

vscera

tests,

and

s

wdespread

te

wat

pareta

condton

best

tere

venous

pexus

te

known

urnary

s

te

anteror

an

ncreased

causng

data-

openng

o

te

a

protrudes

congenta

s

on

urnary

te

nto

badder,

te

condton

ventra

surace

o

or

abscess

dranage

he

te

67.

C.

he

te

A.

t

he

dorsa

anteror

he

D.

he

and

te

ABR/McM

woud

area

o

te

need

C.

he

need

to

ana

be

o

te

suppes

skn

best

292

te

around

nerve

to

abscess.

to

externa

te

anus.

anestetze

area.

ctors

te

branc

skn

o

ABR/McM

te

te

o

superluous

o

te

te

does

not

nnervate

perneum.

pernea

abum

anestetzed

n

nerve

majus

te

suppes

and

event

o

woud

a

orse-

abscess.

he pernea nerve suppes a te pernea musces and

o

te

ctors

ana

anus

te

o

skn

te

o

(recta)

and

to

be

perces

ctors

scoana

branc

279

ave as drect a suppy as

anestetzed

abum

nerve

te

not

ana

te

skn

spncter

and

tus

GAS

B.

An

ror

te

majus.

nnervates

externa

suppes

pudenda

510;

perneum

and

nerve

gves

tereore,

rse

s

to

te

a

man

o

anestetzng

te

t

nerve

o

te

aberrant

geres



“corona

aorementoned

reatng

zng

n

to

te

Patents

te

hs

Fg.

artery

be

s

resut

o

serousness

o

ts

aware

s

te

n

n

rom

20%

durng

o

te

to

varaton

as

ts

error.

above

addtona

5.76).

are

o

more

certan

“crown

artery

ne-

30%

presence

aternatvey

transates

cuttng

brances

resut

arsng

damage

not

recta nerve.

te

292

ound

wt

artery

wc

a

woud

(GAS

nadvertent

morts,”

to

can

surgeon

artery.

te

t

neror

of

ABR/McM

obturator

artery

te

gves

efects

395;

popuaton.

woud

resut

sde

N

epgastrc

susceptbe

nerve

anestetzng

unwanted

te

69.

nerve

he

aberrant

pudenda

nerves;

E.

pernea

ossa.

pernea

te

te

and

musce.

E.

not

soe

descrbed.

nnervates

posteror

neror

around

te

nerve

recess

te

369;

nerve

superca

ony

N

suppes

membrane

B.

posteror

ts

o

recess

superca

te

395;

te

be

dranage

nerve

be

n

nerve

posteror

N

and

woud

woud

or

te aba majora, but or te area n queston t does not

463–468;

pernea

because

dorsa

he

s

te

musce

A.

pens.

GAS

spncter

510;

recta

ts

vagna.

were

neror

tat

needed

hereore,

B.

proapsed

efects

actuay

480–488;

he

rectum

vagna.

as

badder

a

wa

D.

ana

s

s

GAS

68.

patent.

wen

te

wen

Hypospadas

uretra

n

te

Snce

Fig.

vens.

towards

te

between

vagnas

caused

ton

Rectocee

lud.

ndngs

venous

o

potograp,

a

tunca

B.

E.

te

mosty

GAS

sur-

o

te

caed

te

o

deat,”

wtout

rea-

228

C H A P T E R

A,

C,

to

be

are

E.

to

GAS

E.

he

stape

na

o

to

te

B.

he

do

n

so

he

te

s

and

and

woud

be

ess

key

woud

assume

care

makng

n

as

he transverse dameter s te ongest dstance extend-

B.

he

ng

sure

wy

a

he

n

nerve

at

s

te

ductus

D

tose

to

te

sp-

root

o

GAS

74.

te

as

te

to

tat

s

nnervates

cutaneous

o

cremaster

to

te

anteror

transverse

suppes

suppy

branc

an

skn

A.

not

te

and

te

atera

musce

and

skn

o

71.

A.

C.

pubs,

nerve

te

aorta,

ac

510;

ovaran

descend

abdomna

o

N

398;

ABR/McM

arteres

arse

and

he

bood

cross

just

ovaran

rom

a

aong

anteror

arteres

are

ematoma

C,

vesca

te

GAS

C.

s

he

o

bood

an

E.

anteror

posteror

te

te

externa

most

oowng

te

n

N

ts

e

burcaton

(aso

ovaran

te

are

and

artery,

not

75.

vesses

to

aorta.

te

he

vagna

and

es

an

t

vesses

nerve

GAS

73.

C.

he

he

E.

tuba

te

to

te

o

aso

to

rom

be

gated.

just

s

does

to

te

be

rsk

he

a

nterna

e

n

N

conjugate

not

branc

o

te

pudenda

artery;

durng

D.

te

perneum

382;

d  am e te r

ate re d

and

ABR/McM

by

o

te

s

he

te

most

aong

key

s

by

motor

skn

te

cause

te

to

to

te

atera

or

te

patent.

te

over

nnervates

nner

nerve

cremaster

te

emora

te

skn

over

te

tg.

suppes

regon

trunk

L5

and

contans

and

umbosacra

te

E.

ovar-

510;

N

or

he

and

are

pudenda

not

at

rsk.

o

(antero-

te

pe vc

ce

skn

te

s

area

motor

te

over

te

above

te

and

umbar

sensory

contrbu-

pexus.

392;

ABR/McM

responsbe

parasympatetc

coumn).

or

he

285

o

or

te

or

erecton

nuceus

an

trunk

acton

ejacuaton.

parasympatetcs

nervous

erecton.

ganga

o

are

(nterme-

parasympatetc

producng

sympatetc

woud

erecton

but

not

rater

(Mnemonc:

“Pont

or

sympatet-

erecton,

and

ejacuaton.).

neror

he

mesenterc

superor

he

gangon

woud

or

B.

ce

and

an

he

bers

pexus

and

s

parasympatetc

bodes

o

tereore

not

contan

not

te

neura

nuce

o

L1

pregangonc

woud

o

not

te

contans

ndgut.

ew



prmary

ce

and

any

oca-

bodes.

L2

contans

sympatetc

contrbute

to

neu-

produc-

erecton.

480–488,

510;

nterspnous

te

sca

ay

te

spnes.

sortest

dmenson

he

te

to dervatves

ypogastrc

ntermedoatera

GAS

C.

pev s

bodes

responsbe

acton

ng

o

artery.

ce

sacra

sacra

rons

owever,

gaton

te

responsbe

ton

artery

285

re axat on

dam-

due

290

course

te

upper,

and

parasympatetc

vesses.

uterne

artery

to

ton because tey trave

to

structure

ac

wt

te

obque

parasympatetc neura ce bodes responsbe or erec-

76.

s

a

te

nerve

gutea

L4

neura

n

nerve

uterne

at

and

pregnancy

experenced

nerve

and

480–488,

Soot”:

he

proxma

nterna

anastomose

durng

jonts.

75–98

te

te

ooporectomy)

ureter

to

he

be

ovary.

ascendng

artery

B.

C.

be

s

sensory

majus

rom

domeda

arteres

vesses.

mosty

s

branc

dstay

489–492;

posteror)

jonts.

va

vagna

and

a

artery

ar

ovaran

he

D

too

s

neror

uterne

es

te

B.

artery

we

he

A.

superor

key

must

ureter

and

umbosacra

ocated

285

caed

runs

dect

oypogastrc

he

Answers

key

a

tat s at te most rsk wen gatng te ovaran

A.

he

cs

ABR/McM

anteror

o

umbca

arteres

vesca

arteres

nerve

onguna

bers

stuaton.

382;

te

vesses

neror

ac

rom

hese

ovarectomy

perormed,

ovaran

and

nterna

branc

ac.

489–492;

Wen

uterne

te

arteres

nterna

source

72.

E.

rom

conjugate

durng

oter.

between

dramatcay

te

ABR/McM

nerve

gentoemora

he

system

D,

branc

o

te

abdomna

te

to

canges

to

dstance

pubs.

sup-

gaton.

B,

he

GAS

te

brm

te

reaxn.

336;

motor

anteroatera

279

rom

retropertoneay

wa,

vesses.

source

and

ton

480,

he

obturator

abum

buttocks.

gentoemora

s

trange.

obque

te

ormone

N

pevc

reaxaton

ncreased

obturator

musce

abdomna

above

and

to

dagona

438–445;

te

anteror

pens,

te

one

te skn on te meda aspect o te dsta tg. Damage

nerves

nnervates

te

he

o

dstance

spnes

due

sgty

o

he

B.

nerve

E.

are

sensory

and

we

D.

mdde

pevc wa and nnervates te adductors o te tg and

spancncs.

sympatetc

o

sca

efects

testes

regon

porton

somatc

as

te

nterspnous

and

eters

normaton.

tg

te

o

kck

pevc

to

te

at T10–L2,

perumbca

proxma

sensory

meda

skn

te

te

reers

carry

ganga

orceu

n

o

trunk

scrotum.

GAS

rom

pregnancy

most

te

root

more

bers

285

and

enter

dorsa

musces,

genta

te

A.

tey

deerens.

nerve

pes

to

severey

and

abdomna

he

great

tests

oypogastrc

wa

take

ABR/McM

te

coce

not

upper

ductus

D.

o

sensory

scrotum

sted

surgeon

te

onguna

te

C.

tus

(Wc

answer

wc

te

sympatetcs

urt

as

hs

arteres

382;

abdomen.)

ductus

A.

N

bodes

nerves.

Perineum

tem.

aferents

ce

seems

oter

w

489–490;

he

and

because

and

accompany

wt

Pelvis

njured

present

not

70.

D,

4

dstance

he

te

does

ABR/McM

s

te

tereore

brt

conjugate

and

399;

t

between

dstance

s

te

s

usu-

mnmum

cana.

dameter

not

279

dstance

nterspnous

dstance,

aong

true

N

dstance

s

te

anteroposteror

cange.

A, D, E. he transverse dameter, obque dameter, and

dagona

conjugate

dameter

can

cange

sgty

durng

CHAPTER

Pelvis

4

and

229

Perineum

S1

S2

S3

S4

Ischial

spine

Sacrospinous

Attachment

ani

and

of

coccygeus

(pelvic

floor)

Pudendal

•

pregnancy,

most

GAS

77.

D.

te

Lymp

superca

o

dranage

B.

te

te

te

spongy

mb,

and

te

nto

ymp

he

nodes

receve

a

nguna

pevc

te

deep

and

deep

C.

Uterne

sma

A,

do

ym-

and

receve

nguna

ymp

rom

te

nodes.

D,

not

GAS

79.

E.

to

musces

o

cdbrt,

keood

45

GAS

damagng

390;

ABR/McM

365

N

receves

perormed

suppy

bengn

externa

and

to

starve

resutng

tumors.

n

Foowng

coatera

ac,

bood

neror

superor

adequate

386;

wc

otomy

N

uterus

he

pernea

vc structures and receve ymp rom te sacra nodes.

514;

E.

provde

he nterna ac nodes dran ymp rom neror pe-

495,

tese

pudenda,

489;

he

tssue

anterosu-

te

o

s

bood

a

te

suppy

mesenterc,

mesenterc

coatera

bood

arteres

suppy

to

te

uterus.

o

gans

B,

nterna

nguna

te

sze

ter

aorta).

and

porton

n

embozaton

o

rom te ovaran artery (a drect branc o te abdomna

um-

wa,

artery

brods

procedure,

dran

deep

nodes,

o

and

uretra.

structures

and

pat

nodes

he externa ac nodes dran ymp rom

superca

78.

uterne

aorta),

abdomna

A.

poptea

superca

oow

nerve

5.15

decrease

drans

ower

structures.

te

Fig.

measured.

(abdomna

testes

canges

GAS

289

nguna

mb,

rom

ower

easy

testes

suppy

ower

ymp

te

and

peror

C.

rom

rom

dstance

more

ABR/McM

superca

te

rom

aso

336;

pernea

dran

patcs

pens,

he

rom

s

bood

ymp

nodes.

nodes

N

nterspnous

t

vesses

testcuar

ymp

te

brt;

438–445;

tereore

bar

but

durng

ligament

levator

s

te



o

ABR/McM

body

te

etus’

pernea

away

ead

hs

pernea

o

288

te

attac.

tears.

rom

283,

condensed

perneum

te

te

a

musces

perormed.

degrees

s

s

te

s

In

mass

pevc

In

ts

tere

done

n

Damage

and

cases

stuaton

mdne

body.

connectve

loor

many

arrested,

usuay

o

n

to

s

a

an

an

order

te

durng

g

eps-

ncson

to

ts

avod

tssue

230

C H A P T E R

4

destabzes

urnary

nary

A,

Pelvis

te

and

C,

D.

80.

E.

451;

he

vates

o

te

and

S2

greater

va

to

S4

scatc

te

esser

spne.

area

hs

o

dstrbuton

anestetze

organs

A,

B,

(GAS

C,

81.

A.

nerve

he

te

urnary

obes,

a

te

not

te

D.

by

eaves

by

t

tat

te

te

nto

te

coursng

bock

w

cervx

te

te

It

are

84.

s

te

not

do

not

descrbe

te

te

posteror

ABR/McM

n

men

and

tat

as

and

a

289

accessory

es

surrounds

prostate

obe,

284,

te

organ

o

mmedatey

te

our

extng

obes:

medan

obe

GAS

85.

uretra.

two

tat

te

beow

atera

drecty

necessary

obstruct

te

uretra

but

t

s

requenty

cancerous.

C

and

Bengn

te

medan

w

be

and

prostatc

atera

obstructed

symptoms

82.

and

ncudng

stream,

a

urnary

to

access

te

sow

urgency.

yperpasa

obes.

Mcturton

patents

dicuty

stream

o

usuay

present

urnary

badder

n

urne,

(urnaton)

margn.

ntatng

urnary

varety

te

o

operate

urnary

requency,

B.

on

can

men,

by

major

te

o

hs

bub

te

tat

o

te

erecte

space.

(Coes)

te

rom

a

pens.

bodes

t,

hs

asca

tear

and

s

can

spreadng

te

s

sp

pene

te

te

pernea

body

te

s

ure-

apped

(Buck)

body

he

to

GAS

C.

urne

459–461;

he

neror

s

te

roug

end

arge

wegt

te

N

on

te

nto

te

posterory,

body

o

te

tuberosty.

at

te

trange.

o

281

and

te

he

te

sory

juncton

wen

o

te

nea

ramus

ment

bends

and

scrota

and

a

o

poste-

porton

o

A,

459;

aba

body’s

t

te

te

by

pubc

dstance

te

on

s

te

arc.

between

dameter

o

brm

96,

o

superor

one

sde

to

233

are

hey

needed.

made

are

Wen

not

tns

begn

te

5

used

cm

wen

perormng

perorate

around

neror

neror

are

te

te

te

urnary

and

eas

just

atera

suppy

nea

o

oss

te

to

aba.

abdo-

he

s

However,

te

procedure,

nerve

costa

sde

nea

mnma,

because

t

sowy.

beow

to

te

engt

bood

avoded.

t

rgt

umbcus.

so

xpod

te

ver.

troug

te

te

to

te

te

woe

around

are

on

and

made

to

parae

used

gabadder

as

to

te

umbcus

umbcus.

t

te

causes

hs

te

abdomna

s

s

east

mus-

we.

o

N

s

to

dstance

mosty

345;

and

o

s

descends

to

te

surround

nerory

n

ABR/McM

asca,

tat

between

used

gament

anteror

spts

B,

te

It

undorm

gament

ts

sttng,

by

ncsons

asca

by

outet)

ateray

s

ater-

sde.

taken

many

used

superca

upper

attacment

musces

D.

te

s

anterory

wdt

te

net)

McBurney ncson s perormed at McBurney pont

GAS

86.

o

be

ncson

te

umbcus).

he

organs

nerves

eas

(one-trd

urne

o

scum

tendnous

(amstrng

magnus).

te

Muc

tuberostes

proxma,

279,

D.

near

scum

300

(sagtta

te

ABR/McM

vascuarzed

to

and

te

transverse

opposte

vascuarzed,

commony

ces,

s

sympyss.

are

neror

damage

o

294,

coccyx,

outet

extended

transverse

a

per-

tg.

ABR/McM

projecton

tese

musces

adductor

378;

bony

o

te

tg

enterng

sca

rests

provdes

ror

rom

A

crest.

projecton

(sagtta

and

anterory

extend

poory

poory

made

pene

attacment o Coes asca to te scopubc ramus pre-

vents

C.

tear

attacment

prevents

anorecta

s

asca

superca

superca

superory.

to

(pene)

accompanyng

nto

by

pernea

posterory

orce

an

deep

bound

te

281

spongy

wen

te

membrane

to

te

tere

nerory,

asca

279,

n

occurs

I

urne

area

pernea

Coes

ABR/McM

as

commony

o

surrounds

nea

and

366;

at

project-

pubc

promontory,

outet

greatest

must

curvng

and

N

patent

sacra

te

mdde

336;

te

be

orward

body

brm

nes,

by

te

ncsons

hey

GAS

467;

does

area.

hey

s

he

te

pevc

ncsons

aba

D.

and

termnatng

te

ABR/McM

pevc

by

te

as

and

Medan

and

338;

or

pubs

badder,

process,

a

N

care

Subcosta

o

and

(Pannenste)

urnary

afects

wt

te

pevc

ncson,

end

Maxmum

on

te

B, E. hese structures are not nvoved n ts condton.

tra.

83.

superor

A.

D.

rom

pont

promnent

ramus

and

across

440–445;

to

lat

spne.

posteromeda

he

spnes.

Suprapubc

ts

surrounds te uretra. A tumor o te posteror obe does

not

E.

a

(nterspnous)

extends

same

and

posterory,

ac

opectnea

tuberostes,

sca

net

N

net

posterory

Bspnous

tn

spne.

sympyss.

sca

vscera

s

atera

te

posterory

bounded

te

o

sca

te

s

te

ponted

pevc

by

pubc

te

coces

wanut-saped

badder

he

ay

on

433–437;

aperture,

395;

a

C.

extends

superor

juncton

te

ramus

tuberce

sma

bounded

sca

w

pubc

GAS

perneum

anestetze

tese

s

crest

tuberce

te

orms

va

ac

he

part

around

to

nerve.

as

E.

pubc

wegt.

posteror

he

onguna

pevs

attaces

nner-

nerve

neror

bear

he

nvove

anteror

pudenda

pudenda

or

answer

system

Anatomcay ,

te

does

nerve

o

enters

nerve

he

not

bock.

N

prostate

reproductve

It

were

o

A.

5.15).

hese

480–488;

he

and

uterus

Fg.

D.

pudenda

GAS

te

to

ur-

ng

excepton

oramen

pudenda

ead

structures.

somatc

ram.

gament

can

uterne,

289

(nnervated

oramen

scatc

sacrospnous

and

as

B.

tese

a

nerves).

ventra

t

we

procedure

o

s

wt

majus

to

as

proapse.

ts

nerve

gentoemora

rom

attac

ABR/McM

perneum

abum

o

ntegrty

360;

pudenda

te

tat

recta

am

te

N

Perineum

ncontnence

and

he

mantanng

GAS

musces

eca

badder,

B,

and

wt

te

te

s

a

to

and

te

tckenng

te

mdne

sympyss.

pens

and

dartos

ten

asca

suspen-

rom

he

te

ga-

untes

and

ormng

te

septum.

C,

E.

hese

structures

are

case.

GAS

pens

superca

n

ASIS

279

te

pubc

te

te

appendectomes.

502;

N

349;

ABR/McM

230

not

damaged

n

ts

CHAPTER

87.

A.

he

nerve

upper

te

and

root

men

ventra

he

and

part

rst

te

and

mons

o

te

o

umbar

skn

te

te

pubs

o

te

atera

te

o

skn

B,

te

s

over

scrotum

and

cutaneous

C,

n

D.

by

rng,

suprapubc

and

branc

wc

o

per-

dvdes

perces

GAS

91.

nto

about

and

s

te

nterna

2.5

te

cm

above

to

n

atresa

septum

mdde

an

te

dameter

o

B.

he

s

C.

are

rom

tan

one

most

patent

Most

n

and

o

te

te

pate

he

sma

to

n

80,000

te

to

te

vagna

arge,

nerve.

resuts

92.

vagna

o

Faure

o

ng

nerve

te

ndrect

te

n

or

te

B,

C,

be

nguna

erna

resut

o

te

rom

septum,

coaca

abnorma

resutng

nto

n

E.

D,

any

474;

ovares

rom

pevc

D,

E.

s

N

brm

At

te

atera

pevc

ovaran

n

vesses

tat

mbra

portons

o

org-

vesses

end

o

B,

gament

to

s

accompaned

remanng

gaments

E.

o

to

te

and

C,

A.

vesses

nterna

runs

nerory

as

ac

o

andmark

t

enters

artery

as

te

te

by

ts

nto

t

org-

te

pevs.

descends

past

suc

ts

as

t

288

here

te

urorec-

coaca

urogenta

tract

and

anus

deects.

ncude

and

no

traceo-

cardac

as

here

s

mperorate

o

mperorate

may

deects.

st

tat

s

deects

between

no

assoca-

assocaton

wt

292

s

ess

used

common

cncay

N

GAS

95.

A.

nous

ts

to

tan

obtan

an

per-

ascae

as

a

eca

and

as

ventra

scatc

does

atae.

te

289,

o

not

ocatng

source

orgnate

t

exts

greater

gutea

runs

te

exts

to

gutea

pevs

scatc

remanng

ac

and

superor

Ineror

te

argest

between

S1

te

ac,

te

nterna

o

oramen

A.

s

passes

ramus

nterna

t

290

te

prorms,

ABR/McM

part

o

te

te

te

mus-

artery,

neror

troug

to

te

oramen.

vesses

281,

traverses

te

deecaton

289

evator

anorecta

ange

proxma

remanng

or

an

group,

ange

and

Reaxaton

between

porton

or

te

o

unctons

s

cru-

tereby

njury

to

ampua

te

ncontnence,

musces

ana

o

cana

respectvey.

n

mantan-

ange.

N

343;

ABR/McM

nerve

sacrotuberous

wt

te

contnence.

pudenda

a

by

he

ram.

wc

dvson

te

te

te

anorecta

and

nerve

pudenda

anestetz-

oramen.

384;

n

ventra

artery,

and

o

te

and

respectvey.

ABR/McM

greater

o

cana

transvagnay

brances

o

ocatng

ocatons.

and

decreases

te

bock

used

395;

nerve

446–448;

he

pudenda

mantanng

adng

or

S2–S4

gutea

part

scatc

s

oter

dvson

by

pudenda

suppyng

None

musce

te

done

tuberosty,

spna

te

sacra

o

s

te

posteror

and

rectum

ng

common

N

tensor

D.

to

It

trunk

va

489;

None

crossng

s

not

at

artery

ncompete

common

bock

but

he

te

mantanng

are

ureter

as

E.

nerve

tese

Puborectas,

tus

retropertoneay,

burcaton

mportant

gonada

te

and

GAS

94.

287

ocated

pevs

cose

ts

s

or

mb,

ABR/McM

or

superor

rst

te

ABR/McM

rena

brm.

he

not

270,

ncudng

urnary

rena,

s

exts

provdes

greater

te

abdom-

t

nraprorm

cross

gament

te

as

syndrome

sadde

spne

anteror

te

suspensory

ovares,

and

an

286

Ovaran

te

uterus

deveop.

vesses.

wc

te

artery.

to

ovaran

as

o

pevs

ca

355;

ureter,

rom

meda

te

tube,

ympatcs.

major

470;

pevc

ac

suppy

he

o

te

by

bcornuate

w

285,

aorta.

descend

a

or

umbosacra

ureter.

devod

nates

to

(Faopan)

and

he

supped

and

one,

(cornu)

ABR/McM

abdomna

brm

ovary

353;

are

te

nerves

GAS

N

oter

orn

376;

480–488;

he

te

te

wt

ac

abnorma

and

transcutaneousy

ces,

wt

nterna

deveopment

n

anorecta

pudenda

artery,

urogenta

or

a

use

N

sca

branc

parts.

rudmentary

artery

brm

abnorma

atresa.

epsotomy.

eter

GAS

93.

urorecta

separaton

anorecta

o

and

te

ABR/McM

resuts

anestesa

n

ng

vagnas.

anomaes

o

an

o

may

to

vertebra,

ea

452;

te

rom

cause

hs

Pudenda

n

tere

uterne

ureter

but

nea anestesa durng te na stages o abor or preced-

orce.

common

A.

resuts

and

te

artery

atresa.

te

vares

to

abnorma

VATER

wt

appearance

orce

or

abnormates

assocaton

epdura

women.

juncton

perorate

n

ts

GAS

transverse

vagna.

Varatons

common.

very

1

at

but

230

pate

cava

ac

231

Perineum

adjacent,

externa

pevc

382;

eadng

urogenta

pudenda

te

N

rom

D.

not

te

te

o

vagna

anorecta

na/pevc

It

trds

A

te

atera

assocated

B,

wt

uterne

A.

ocated

te

vagna

vagna.

occur

usuay

A,

tg.

228,

te

455;

does

he

A,

s

te

nnervates

s

past

anorecta

prorms

nate

te

o

380,

Growt o one paramesoneprc duct s retarded and

GAS

B.

o

approxmatey

processus

ncompete

o

branc

te

ymen.

deveopment

E.

a

part

ABR/McM

o

superor

end

ymen

more

391;

septum

mperorate

te

(S2),

(bockage)

and

neror

N

upper

canazaton

occurs

Usuay,

ureter

s

ea

atera

nerve

o

vena

compartments

te

480–488,

neror

esopagea,

nerve

te

anorecta

ton

Faure

te

septum

he skn o te pens (or ctors) s many supped by

D.

to

separaton.

apo-

dstrbuted

mmedatey

reaton

Most

anus

regon.

cutaneous

C.

ta

peroratng

obque

nguna

L1,

E.

dorsa

to

not

n

he

he

te

Atoug

and

ocaton.

abum

D.

on

E.

meda

cose

brances.

branc

cutaneous

emora

superor

nerve

abdomns,

externa

superca

s

spna

cutaneous

neuross

skn

nerve

o

anteror

becomes

GAS

90.

te

te

to

descends

obque,

skn

89.

o

tg,

anteror

transversus

anteror

te

branc

te

coverng

ramus

te

atera

te

o

and

a

dstrbuted

women.

orates

88.

part

pens

skn

s

are

oypogastrc

te

C.

nerve

bers

te

te

n

he

Its

meda

o

and

majus

B.

onguna

(L1).

Pelvis

4

an

passes

gaments.

nterna

andmark

as

t

s

281

between

approac,

easy

te

Wen

te

papated

sacrosp-

perormng

sca

spne

s

transvagnay.

232

C H A P T E R

C.

he

4

Pelvis

sca

B,

D.

ror

ac

spnes

E.

he

vertebra

and

s

GAS

96.

D.

cana

s

nerves

B.

te

carry

pevc

he

N

te

te

tey

most

be

pudenda

to

procedure

papated

s

n

Answers

99.

cannot

be

te

are

o

te

transvagnay,

nerve.

A.

present

wt

occurs,

t

ture,

289,

A.

290

ncudng

he

sacra

sympatetc

te

nerve

bers

to

B.

Mecke

on

spancnc

nerves

nerves

to

te

ypogastrc

carry

pexus

D.

organs.

s

an

upper

he

onguna

meda

486–488,

te

tg

510;

perneum,

suppy

deep

te

nguna

scrotum

and

N

and

nodes.

woud

te

gans

to

te

to

pens

skn

skn

superca

B.

deep

hese

to

te

pens

Externa

ac

and

nodes

te

receve

nterna

ymp

ac

te

B.

te

as

he

suc

common

he

axary

ac

and

te

externa,

nterna,

C,

nodes.

nodes

dran

te

upper

mb

and

abnorma

N

343;

tuberce

ABR/McM

ectoderm

and

more

ruptures,

te

aspect

te

o

s

a

GAS

nadequate

more

dorsay

pens.

snus

n

wa

te

dorsa

te

to

As

a

open

o

te

tere

te

B.

o

o

luds

rup-

between

tests

o

sur-

nto

deveopment

te

wa

o

were

umbca

cord

abdomen.

233,

285

cranosacra

pevc

outlow

spancnc

rom

and

ormed

anatomca

ndngs.

te

orgn

are

te

abdomna

te

te

ave

deectve

ABR/McM

are

aferent

te

enter

nerves.

ventra

te

ram

sacra

o

pexus.

recta

as

bers.

gentas

provde

nnervaton

reguatng

controng

motty ,

as

spancnc

umbar

on

te

a

C.

dorsa

te

te

we

to

vodng

nterna

as

soud

spancncs

and

n

D.

te

part

vdua

te

reproductve

an

accumuaton

possesses

a

condton

n

wc

organs

te

sexua

pe-

o

te

uretra

unctons

or

not

be

sacra

conused

spancncs

E.

nd-

bot

s

o

serous

lud

Hypospadas

surace

o

te

te

ureter

te

urnary

s

a

uretra

pens.

termnates

E.

at

openng

on

te

Ectopc

ureter

anoter

ocaton

512;

N

363;

ABR/McM

wen

oter

badder.

459–461,

ventra

occurs

278

tan

aferents.

N

rom

ABR/McM

pregangonc

medate

derve

398;

are

pene

te

erecton.

pevc

271,

282

parasympa-

Its

pregan-

spancnc

nerve

he gans pens receves ts suppy rom te puden-

nerve.

he

externa

he

uretra

somatc

nterna

he

are

spncter

nerve

uretra

tetc

GAS

102.

E.

cs

he

tat

caed

s

nnervated

te

spncter

he

dferent

gands

nervous

(GAS

Fg.

scrota

pudenda

receves

by

a

nerve.

parasympa-

w

rst

externa

s

va

N

te

398;

draned

empty

nguna

te

cavernous

nnervated

by

neror

te

nerves.

sympa-

ypogastrc

5.16).

510;

skn

rom

are

system

486–488,

superca

A.

very

semna

pexus

ydrocee

510;

tetc bers aso rom te neror ypogastrc pexus,

o

o

vscera

nerves

tat

bers

vountary,

urnary

deect

genera

486–488,

wc

s

GAS

CT

ernate

spancncs

te

bers

da

membrane

between te tunca vagnas pareta ayer and te tests.

D.

or

(S2–S4).

genta

protrudng.

Hermaprodsm

An

umbcus

vagnas

not

anteror

segments

and

Cavernous

gonc

consequence,

badder

A.

tetc

between

urnary

s

sde

genta

te

urogenta

w

wc

wt

o

nteracton

dorsay.

Exstropy

condton

on

eads

ocated

urogenta

are

uretra

101.

sexes.

C.

te

rom

ter

pevc

and

281

deveopment

mesoderm

abdomna

uretra

te

te

or

deveopng

te

o

Durng

deectve

tuberce

te

openng

pens.

anteror

tey

stuaton

erecton.

wt

A. Epspadas s te correct opton. Epspadas descrbes

badder

cysts

wc carry pre- and postgangonc sympatetcs

446–448;

wen

as

D. he

cest

wa.

te

344;

badder,

spncter,

GAS

B.

pevc

vscera

te

and

te

te

take

he umbar/atera aortc nodes receve ymp rom

organs

n

outsde

spna

urnary

abdomna

I

te

extra-

Uraca

ever.

te

an

nected,

dvertcuum

do

components

vscera

vc

pevc

organs.

o

nerves



as

hey carry bot pregangonc parasympatetc bers

nguna

rom

rom

and

resut

o

N

sacra

S2–S4

we

nguna,

456;

he

and

tunca

Mecke

eum

(parasympatetcs)

arteres

te

B.

pan

te

descrbed

tey

regon.

owever,

te

testes.

and

musces

GAS

100.

290

drans

o

o

area.

289,

accordng

Superca

dran

te

pernea

ABR/McM

drans

so

suppes

anteror

398;

ymp

area,

nerve

nodes.

te

cyst

presents

accumuaton

o

are

E.

umbca

troug

te

vscera

and

98.

te

Ompaocees

te

autonomc

are

dsta

It

o

between

pertonts.

ayers

reatons

pregangonc

pevc

te

dran

to

Hydrocees

roundng

spancnc

te

abdomna

may

two

n

remnants

occurrng

badder.

asymptomatc;

eadng

te

ana

embryoogca

uracus

urnary

mass

generay

are

te

and

pertonea

papated

pudenda

porton

papated

umbcus

supe-

nerve.

perneum

postgangonc

wt

neror

ABR/McM

te

posteror

o

were

te

E.

cysts

abdomna

tat

D.

Uraca

regon.

In

A,

99–105

E.

organs.

superor

GAS

C.

te

easy

pexus carryng sympatetc nnervaton to te pevc

te

97.

s

pudenda

pevc

he

and

assocated

cannot

parasympatetc

C.

be

epteum

not

393;

suppy

va

wen

can

posteror;

are

te

480–488;

t

neror

coccyx

near

Nerve

te

are

and

coumn,

not

used

as

ossa.

posteror

transvagnay

nerve.

s

externay

scoana

he

Perineum

tuberosty

perormed

te

and

nto

ABR/McM

by

te

291,

superca

orzonta

292

ympat-

group

o

nodes.

ac

nodes

recevng

ympatcs

structures

beow

te

are

rom

deep

deep

umbcus,

ymp

nodes

abdomna

te

pevc

wa

vscera

as

CHAPTER

Pelvis

4

Pelvic

(from

Hypogastric

Inferior

Attachment

ani

of

and

splanchnic

S2

to

233

Perineum

ner ves

S4)

ner ve

hypogastric

(levator

and

plexus

pelvic

floor

coccygeus)

Anal

Urogenital

triangle

triangle

Prostate

Nerves

•

we

as

rom

superca

and

deep

nguna

GAS

ymp

nodes.

B.

he

dran

perneum,

and

te

posteror

C.

atera

ymp

he

GAS

495,

are

v s c e r a,

dran

o

n to

nod e s

as o

d ee p er

te

d eep

par ts

uretra.

 um bar

d ra n

nodes,

o

he

y mp 

te

te

te stes

node s ,

rectum

ovares

nodes

ymp

and

dran

nodes

oter

te

N

390;

rectum

ABR/McM

drans

pevc

wa.

514;

nod e s

an d

103.

E.

376

and

poste-

Durng

ac

A.

B.

gaton

he

artery,

ment

be

ysterectomy,

proper

uterus.

te

organs.

tissue

5.16

wa .

aortc/umbar

sacra

pevc

n od e s

par ts

sacra

ac

ror

pevc

pevc

he

D.

ac

and

ovare s

we

erectile

by

nterna

tat

Fig.

to

o

he

uterne

s

te

gated

o

to

te

n

te

nundbuopevc

suspensory

ses

and

s

a

Durng

mstakeny

te

arteres

artery,

anteror

uterus.

emostass

te

atera

branc

ureter

be

o

ensured

suppy

te

te

nterna

n

te

broad

ga-

surgeres,

te

ureter

may

pace

o

te

gament,

gament,

ocated

may

tat

aso

contans

to

te

uterne

te

ureter

artery.

known

ovaran

n

te

as

ves-

pevs.

he ovaran gament attaces te ovary to te atera

and

superor

tat

s

and

part

contaned

as

no

drect

o

n

te

te

uterus.

broad

reatonsp

It

s

a

gament

wt

te

brous

o

te

cord

uterus

ureters.

234

C H A P T E R

4

Pelvis

and

Perineum

Axis

Inter nal

iliac

of

vagina

ar ter y

Axis

of

uterine

Ureter body

Uterine

artery

Pelvic

(pelvic

brim

Axis

of

cervix

inlet) Angle

of

anteflexion Uterus

Angle

A

of

Internal

anteversion

os

Posterior

•

GAS

Fig.

5.12A vaginal

Anterior

vaginal

External

Vaginal

fornix

fornix

os

canal

B

•

C.

he

mesosapnx

tat

stretces

s

te

rom

part

te

o

ovary

te

to

broad

te

gament

uterne

D.

tube

he

ogc

no

E.

round

gament

remnant

drect

o

te

o

te

uterus

s

gubernacuum

reatonsp

wt

te

an

embryo-

ovary

ureters

and

(GAS

as

Fg.

5.12A).

GAS

104.

A.

he

drans

B.

472;

he

N

382;

rom

ABR/McM

te

superca

ymp

sacra

C.

te

rom

neror

nguna

te

dsta

287,

part

288

o

te

ymp

ne

drans

E.

Fg.

he

ana

cana

nodes.

495,

4.5

rectum

drans

to

te

nodes.

mesenterc

ng

and

ten

to

te

umbar

nodes.

answer

te

ana

514;

rectum

groups

at

drans

to

te

part

495,

Fg.

above

te

pevc

are

as

nguna.

o

te

and

376

sowng

nguna

oows

ac,

A=Lumbar,

typcay

nodes,

so

N

388;

ABR/McM

severa

regon.

D=Deep

E

s

5.79).

514,

pectnate

Magnances

vagna

ymp

te

nodes.

ABR/McM

C=Externa

nguna

(GAS

388;

ac

ympangogram

groups

ac,

cana

nterna

N

a

ower

GAS

proxma

te

E=Superca

superca

nodes

rom

to

ympatc

te

5.55

te

depcts

B=Common

and

he ymp rom te sgmod coon drans to te ne-

ror

he

GAS

105.

rom

Fig.

nodes

ympatc

ymp

to

ymp

sacra

above.

D.

he

GAS

376

ac,

nvov-

nvove

te

te

correct

CHAPTER

4

Thoracic

Pelvis

and

Perineum

duct

LI Pre-aortic

nodes

Lateral

Lymph

from

Inguinal

Deep

aortic

(lumbar)

nodes

External

iliac

testis

nodes

ligament

inguinal

nodes

Superficial

inguinal

nodes

T estis

Lymph

from

superficial

Lymph

(glans

from

clitoris,

and

lower

glans

labia

par t

and

(clitoris

minora,

of

in

penis

penis

in

vagina

women)

•

GAS

Fig.

5.79

tissues

of

scrotum

and

women)

labia

majora

235

5 Lower

Limb

I n t ro d u c t i o n

First

1.

Order

Question

Explanation

A 22-year-od woman s brougt to te emergency depart-

ment

30

mnutes

coson.

njures.

Se

aceratons

o

te

A.

sgns

sows

o

se

appears

Vta

examnaton

ater

over

oowng

to

be

are

no

te

was

nvoved

we

and

wtn

abnormates

nnervates

a

motor

wtout

norma

quadrceps

nerves

n

oter

emors

ts

any

mts.

B:

vece

emors

major

tear

Pysca

tan

a

ner ve.

mus ces

turator

musce?

te

vaton

B.

Femora

branc

C.

Obturator

Sapenous

Third

E.

Tba

3.

te

vece

A:

Ony

rs.

he

emora

scatc

nerve

nerve,

nnervates

speccay

te

te

quadrceps

tba

part,

emo-

suppes

er

wtn

gves

te

A.

Mdde

B.

Latera

C.

Superca

A

Order

22-year-od

er

30

coson

wtn

tat

se

owng

cannot

nerves

Scatc

B.

Femora

C.

Obturator

musces.

s

brougt

ater

er

et

appears

mts.

extend

most

se

er

and

to

to

was

be

rgt

we,

Pysca

rgt

key

te

emergency

nvoved

eg

and

n

a

pnned

er

Wc

o

s

quad r  cep s

va

te

s

he

com p ar tme nt

s up p y

a

by

m o to r

s e nsor y

p a-

te

po s te ro r

comp ar tment.

not

te

sup p  ed

s up p e s

me d a

b ut

te

tb a

ob-

and

 nne r -

(c utane ous )

n e r ve .

cannot

rse

wt

Se

to

er

brougt

mts.

o

se

et

appears

extend

wc

s

ater

er

te

and

to

to

was

be

rgt

we,

Pysca

rgt

emergency

eg

n

a

motor

pnned

and

er

under

vta

examnaton

knee.

oowng

te

nvoved

he

afected

cutaneous

sgns

sows

nerve

nerves?

cuna

emora

cutaneous

buar

D.

Sapenous

E.

Deep

buar

under

vta

examnaton

knee.

motor

sgns

sows

te

o-

afected?

Explanation

D: he sapenous nerve s a cutaneous branc o te emora

nerve

great

o

and

s

rom

emora

nerve

are

suppes

sapenous

posteror

ous

nerve

Sapenous

ram

L2

nerve

brances

te

ven.

to

o

L3

S1

te

to

and

branc.

o

skn

on

Mdde

te

S3.

te

Latera

and

buar

eg

nerves

umbar

Superca

common

meda

cuna

aong

are

emora

pexus

deep

te

brances

but

cutane-

s

buar

not

a

nerves

nerve.

nerve

Q u e st i o n s

Questions

te

1–24

42-year-od

ment

30

man

mnutes

vece

coson.

severa

deep

o

s

brougt

ater

He

s

te

and

great

e

to

te

was

treated

aceratons.

dorsexon

extenson

236

any

nerve

Tba

tat

suppy

nerve

E.

A

Se

s

D.

Main

wt

norma

A.

1.

woman

mnutes

motorcyce.

are

not

Question

department

vece

does

te

d oe s

mnutes

norma

tat

nerve

ner ve

by

te

group

an te r or

woman

30

he obturator nerve suppes te meda compartment and

sapenous

te

emor a

coson

se

s c  at c

ner ve

motorcyce.

are

m us c e

out

to

Question

te posteror tg musces not te anteror compartment.

Second

2.

te

carr e d

attaces

musc  e s

22-year-od

department

Explanation

s

supp  e s

any

o

Order

A

he

not

ne r ve

to

kn e e

w c 

hs

sapenous

Scatc

D.

te

gament.

tg

Wc

o

musce,

emora

coupe

musce.

Extenson

nvoved

or

Pysca

nverson

toe

are

very

emergency

a

pevc

n

depart-

a

racture

examnaton

o

te

weak.

motor

et

and

sows

oot

Sensaton

and

rom

dorsum

aspect

o

norma.

o

te

o

te

te

oot

he

oot

oowng

A.

he

B.

L5

oot,

as

s

and

S1

trunk

spna

o

ost

everted

structures

umbosacra

oramna

skn

been

te

and

s

at

nerves

soe,

and

key

nea

torn

at

and

te

patear

pantar

most

te

te

exed.

atera

reex

s

Wc

njured?

termnas

te

ntervertebra

CHAPTER

C.

Fbuar

neck

D.

(peronea)

o

Scatc

te

E.

2.

A

Tba

ment

nerve

Ater

wt

te

sows

a

te

n

beedng

tat

te

o

durng

pysca

Reducton

o

te

te

scatc

poptea

brougt

as

been

ventra

te

greater

at

te

scatc

oramen

ossa

to

te

stab

emergency

wound

stopped,

ramus

oowng

o

w

o

MRI

L4

depart-

te

o

as

most

pevs.

s

pevs

been

key

tran-

be

seen

examnaton?

or

te

oss

o

sensaton

rom

te

meda

eg

B.

Loss

o

sensaton

over

te

rgt

C.

Loss

o

sensaton

over

te

upper

D.

Loss

o

sensaton

over

te

mdde

E.

Loss

o

nerve

regon”)

beedng

rgt

Wc

aspect

s

deep,

at

gutea

te

man

sected.

A.

njury

to

23-year-od

o

237

Limb

bua

nerve

(“doorway

dvson

Lower

5

sensaton

over

te

tte

toe

meda

tg

toe

posteror

aspect

o

te

knee •

3.

A

30-year-od

ment

20

vece

deep

ew

s

te

o

days

o

B.

Saggng

n

o

C.

Droopng

D.

Weakened

E.

Dicuty

A

ce

to

40

ton,

o

et

afected

et

eg

n

a

te

C.

Superca

D.

Sapenous

E.

Deep

tay

te

C.

Deep

D.

Sapenous

E.

Obturator

p.

patent

gat

meda

A

and

rotaton

key

to

6.

sow

rom

a

sttng

A

we

standng

ony

s

on

te

pevs

we

standng

ony

on

s

rom

a

e

was

p

to

te

racture

An

dsta

nerves

In

(Fg.

x-ray

to

a

e

a

depart-

motor

s

5.1).

neck

most

ve-

not

supne

abe

pos-

Everson

examnaton

te

s

n

sows

mb.

pantarexed

ntact.

emergency

nvoved

afected

poston

o

te

key

o

o

s

bua.

njured?

e

o

te

s

most

key

be

Superca

Latera

C.

Deep

D.

Tba

stor y

o

a

examnaton

o

nto

te

o

pass

tg?

te

o

panu

o

abdomna

to

pyscan

ump

o

te

openngs

to

w

rom

te

because

er

sows

beneat

appears

extend

n

abdomen

aspect

bowe

oowng

troug

te

vscera

meda

te

te

te

te

a

er-

nguna

anteror

be

gron.

department

wt

anke

wegt

on

o

sweng

severe

o

anded

because

sows

wc

and

he

te

o

oowng

afected

severe

te

tenderness.

te

wt

roed

I

pan.

meda

a

reated

nerves

woud

buar

te

atera

and

o

sows

o

n

et

An

and

procedure

Wc

pevs

te

se

aspect

sortenng

tssues

mark

woman

ater

o

emur.

A

Guteus

C.

Ineror

D.

Prorms

E.

Quadratus

et

pevs

gemeus

gemeus

emors

and

o

tota

o

p

te

reac

o

s

et

An

racture

o

o

s

and

te

consdered

area?

wt

o

er

te

per-

superca

perormed,

ts

eg

artropasty

neck

ard

Pysca

x-ray

overyng

s

te

musces

emergency

anded

tg.

te

ntracapsuar

exporaton

medus

te

and

poston.

muscuature

to

to

bcyce

rotaton

dvson

oowng

Superor

a

supne

an

contnues

te

te

te

brougt

rom

sow

nta

surgca

s

e

atera

n

gutea

B.

nto

bearng

possbe

pt.

s

ag

Sura

A.

abdomen

payers

by

payng

buar

tg.

n-

oter

pyscan

We

sura

rreducbe.

erna

te

njured?

68-year-od

ormed.

to

anke

to

spran.

unexpected

ten,

ractured,

B.

on

anke

over

an

been

A.

A

brougt

an

examnaton

bone

neck

comes

over

Snce

as

s

o

jumped

oot

not

tg

woman

boy

oot

some

buar

openng

because

rgt

rng

rng

cana

outward.

E.

7.

nguna

nguna

Pysca

jont

standng

examnaton

te

s

rgt

brougt

ater

s

te

rng

16-year-od

moter

poston

buar

ernaton

Wc

Superca

examnaton

2-week

he

and

most

Femora

B.

buar

55-year-od

gament

s

te

waddng

A.

ootba,

at

oowng

Tba

naton

patent

pevs

sttng

oot

Common

Pysca

rgt

te

sows

aspect

on

oot

B.

o

a

abducton

rgt

Pysca

A.

A

te

man

sows

o

et

exon

wegt

te

Wc

te

.

motor

mb

mnutes

te

o

treatment,

exbts

a

beneat

examnaton

part

and

n

caugt

Fig.

depart-

mb

coson.

bear

emergency

nvoved

p

upper

standng

te

45-year-od

ment

he

was

Pysca

e

perorm

ower

et

and

te

oowng?

Dicuty

te

5.

to

A.

rgt

te

to

rgt

stabzaton

tg.

te

e

s

scene.

o

wak,

rgt

ater

te

ater

to

nabty

te

wc

4.

at

brougt

wt

aceraton

asked

s

mnutes

coson

motorcyce

a

man

as

te

emur.

a

and-

238

C H A P T E R

8.

A

Lower

16-year-od

ment

s

ten

te

wound

rst

Poptea

B.

V ertca

Deep

D.

Horzonta

E.

Interna

3-mont

o

and

arge

nerve

man

n

te

o

tat

superca

o

a

n

ump

cystc

Dorsexon

n

o

o

o

ossa

w

te

te

dgts

te

eg

E.

Pantar

exon

o

mb.

he

aspect

o

ymp

no

wound?

department

put

was

tat

oot

Pysca

njured

Meda

B.

Anteror

Latera

D.

Posteror

E.

T endon

ong

ossa

knee

key

n

s

poptea

a

te

e

ts

sows

because

o

artera

to

a

o-

s

o

brougt

knee

atera

s

pan.

sde

ground.

o

He

unabe

structure

woud

te

In

s

et

to

sows

to

to

a

Meda

A

a

just

poppng

key

brougt

15.

to

30-mnute

angograpy

te

emergency

story

sows

occuson

o

o

cest

depart-

pan.

myocarda

te

A

anteror

pan

eg

coronary

and

and

vested.

bypass

oss

oot

o

on

Wc

ven.

bypass

sensaton

te

mb

nerve

grat

procedure

Postoperatvey,

was

on

te

te

meda

rom

wc

most

key

te

usng

surace

grat

njured

part

Frst

D.

Ineror

to

te

er

dorsas

pyscan

rgt

peds

tomograpy

te

provde

o

bood

puse

(CT)

te

adductor

oot.

suppy

and

to

cod

angograpy

emora

cana.

because

Pysca

artery

Wc

te

eg

n

artery

troug

A

Descendng

mb

sows

an

was

seres

at

Ineror

Frst

C.

Meda

D.

Obturator

E.

Superor

rsk

te

Femora

B.

Obturator

most

Common

D.

Tba

Tba

et

to

te

wegt

sorter

o

on

Pysca

te

et

te

patent

afected

and

te

p

neck.

te

examnaton

eg,

tan

emergency

he

te

rgt

sow

an

Wc

et

ower

extra-

artery

s

njury?

branc

o

deep

emora

emora

wt

rgt

advanced

because

sows

tg

mb.

key

wakng

C.

E.

o

emora

ospta

ower

A.

njur y.

emora

batroom.

bear

x-rays

carcnoma

te

Sapenous

to

be

te

examnaton

rgt

D.

to

or

man

te

badder

Latera

emora

gutea

to

o

C.

o

ncdent.

crcumex

o

E.

deep

gutea

56-year-od

Common

o

er

rotated

pan

peroratng

aspect

A

o

racture

B.

Superca

te

brougt

n

abe

te

appears

key

B.

not

ater

mb

te

o

branc

s

ang

externay

A.

A

woman

ater

se

ower

A

branc

gencuar

75-year-od

tat

emora

gutea

ar-

16.

o-

njured?

n

occuson

o

peroratng

s

buar

pan

weak

crcumex

n

te

sows

te

anastomoss?

resut

durng

o

(sprng)

comes

o

computed

key

C.

A.

sura

sows

A

nerve

o

was

Wc

(detod)

woman

story

te

surgery?

buar

coatera

as

patent

atera

anke

Meda

undergoes

a

exam-

te

Descendng branc o te atera crcumex emora

te

sapenous

te

te

avod

B.

Pysca

nter-

key

over

o

sweng.

on

to

A.

ventrcuar (et anteror descendng) artery. he patent

great

most

admtted

narc-

most

x-ray

tryng

Pysca

sweng

An

pyscan

e

pantar

gencuar

most

gament?

tssue

trombotc

capsuar

aso

s

anke.

we

practce.

and

te

e

taobuar

proxma

mb.

va-

n

to

ater

pantar

oot.

ower

wtout

nverted

opponent

sot

comes

anke

cacaneonavcuar

6-week

a

oot

afected

72-year-od

says

mock

postve

most

ts

a

knee

wak

a

emer-

gament

compete

E.

te

gament

s

Sort

w

afected?

semtendnosus

man

Long

D.

te

menscus

o

C.

et

tenderness

gaments

Anteror

payer

s

et

but

department

attacment

crucate

te

Pantar

sows

An

oot

te

an

B.

rgt

supne

te

o

n

s

examnaton

sows

adjacent

o

by

A.

o

story

ossa

Wc

be

13.

tgt-

exed.

an

a

wt

racture

E.

examnaton

crucate

69-year-od

due

to

and

o

ootba

pan

sows

owng

menscus

C.

coronary

ten,

Wc

due

A.

a

compressng

payer

on

on

Snce

test.

as

vertcay.

because

t

assstance.

stress

pan

examnaton

te

te

because

o

tacke

naton

14.

te

ootba

sensaton.

ton

a

oot

o

ment

te

tg

o

e

He

poptea

most

Extenson

A

ground

and

nected

knee

22-year-od

ever

group

pyscan

rgt

te

Extenson

19-year-od

te

structure

te

te

to

wen

D.

be

ater

A

because

nguna

Pysca

C.

gus

12.

o

sutured,

days

g

sde

nguna

wakng.

examnaton

Fexon

e

s

ower

te

superca

dsappears

B.

as

Four

Wc

depart-

atera

wound

wt

rom

posteror

movements

practce,

te

afected

ymp

comes

o

descendng

gency

11.

ospta

nected.

group

A.

A

he

dscarged.

osteoartrts.

pure

owng

o

dicuty

utrasound

a

be

emergency

on

ac

presence

poston

s

te

receve

story

cronc

te

to

te

cut

nguna

45-year-od

ness,

to

ootba.

nodes

group

C.

A

brougt

superca

to

appears

A.

s

a

patent

ymp

w

Limb

payng

returns

swoen

nodes

o

we

patent

10.

boy

because

oot

and

9.

5

beng

dicuty

rgt

ower

te

by

meda

adducton

metastass

mb.

te

sensory

s

wakng.

te

n

sows

afected

and

on

weakness

MRI

te

carcnoma

dicuty

numbness

and

An

n

badder

o

o

Wc

tumor

to

dect?

buar

Scatc

15-year-od

depar tment

An

t ba,

by

boy

s

x-ray

and

a

o

s

b rougt

m ote r

 s

eg

kne e -  g

to

b e caus e

sow s

eg

cas t

t e

o

a

em e r gen cy

owe r

a

 racture

s

p a c ed .

 m b

o

te

Se ver a

CHAPTER

weeks

ate r,

numbness

ty

to

17.

tese

ste

Poptea

B.

Neck

C.

Latera

D.

Anteror

E.

Meda

o

o

o

te

 s

 s

n e r ve

cas t,

r gt

 oot.

te

pat e nt

oot

and

W c

com pre ss  on

s

as

woud

contnue

 nab  -

njur y

occurred?

te

t at

to

e

compartment

A.

Prorms

B.

Obturator

C.

Guteus

medus

D.

Guteus

maxmus

E.

Guteus

man

mnmus

o

eg

te

21.

eg

s

te

to

to

a

to

s

gutea

pyscan

standng

nerve

dsorder.

Autopsy

he

patent

tg,

and

receves

regon.

A

because

poston

most

a

key

rom

a

afected

most

seated

by

te

Ineror

B.

Superor

gutea

he

B.

A

C.

C.

Obturator

D.

Nerve

to

prorms

D.

E.

Nerve

to

quadratus

23-year-od

o

a

oot

nng

he

njur y.

mea,

bade

Pysca

te

web

be

se

emors

comes

dropped

te

o

oowng

web

just

sarp,

web

te

at

sender

a

I

to

o

an

ktcen

eve-

jont

ner ve

wc

s

most

deep

emora

er

were

as

structures

te

son

key

o

s

te

Puboemora

Iscoemora

Ioemora

D.

T ransverse

E.

Lgament

D.

Pantar

exon

and

E.

Pantar

exon

ony

te

ands,

dsta

dspaced

damaged

te

part

n

n

A.

Anteror

B.

Fbuar

ts

te

Tba

D.

Patear

E.

Posteror

and

An

durng

a

te

be

he

oowng

matc.

te

pressed

emur.

Wc

pyscan

soccer

odng

can

30

rgt

Pysca

tba

backward

et

tba

gament

was

wt

te

under

cannot

most

s

rgt

sgncant

sock

te

and

des.

meda

exsangu-

crcuatory

autopsy,

at

te

njured

wat

nguna

at

transected

at

emora

be

a te r

Se

exam  n at on

on

te

sow s

an

W c 

s e

to

was

was

s

te

te

gament

apex

o

te

ts

juncton

wt

was

severed

at

ts

ateray

ndngs

te

a

arge

o

er

 racture

oow n g

br u se

 p.

o

te

m us ce s

te

wen

te

on

man

te

e

orgn

patent

te

te

pung

Wc

or

o

te

resstng

a

o-

patent

down

terapy,

n

ts

ad

steps

terapst

er

tg

oowng

yperexten-

gament

s

o

man

te

te

s

by

ead

p

rgt

o

te

te

Intertrocanterc

C.

Intracapsuar

D.

hromboss

E.

Commnuted

abe

wt

p

emergency

to

to

oicer

some

o

aban-

wtout

range

pan

sortenng

Fg.

te

depart-

an

mted

because

o

n

ambuate

sows

sown n

wc

and

n

a

5.2. Based on

oowng

cond-

m?

wt

tearng

o

te

gament

emur

racture

emora

o

te

poce

jont

eg

occurred

o

a

not

emur

to

examnaton

rgt

magng,

key

te

brougt

rescued

he

Dsocaton

te

at

pyscan

ago,

se

possbe.

ead

B.

te

o

neck

te

obturator

racture

o

emur

racture

artery

te

extracapsuar

emora

neck

a

unres tran ed

asp e ct

avu s on

e m er gency

n

monts

pysca

acetabuar

rotated

most

te

gament

at

moton

dvded

to

gament

was

ouse.

T wo

supne poston. An x-ray s

key

 nvoved

te

sow s

 ater a

o

te

e

was

comes

sgncant

Pysca

a

artery

as

o

tons

b rougt

cos  on .

trocanter.

ater

o

mn ute s

p

was

aganst

assstance.

A.

tendernes s

o

te

mb.

e

gament

o

75-year-od

doned

knee?

wom an

Pysca

severe

greater

to

crucate

vece

x-ray

comes

coatera

depar tment

drver.

way.

rgt

A

ment

crucate

2 4-year-od

motor

er

23.

coatera

C.

A

o

nverson

tat

tba

on

depart-

ower

jont?

B.

nverson

bot

cut

were

racture

A.

and

ony

knee

and

o

s

ven

most

Inverson

sows

an

njury?

was

Durng

p

Dorsexon

te

ven

muc

C.

o

artery

resstance

backward

B.

njury

resuts

s

woman

neck

C.

examnaton

rapd

crcumex

garage.

everson

woman

o

emora

and

32-year-od

n

emergency

measures,

aceraton

ypovoemc

examnaton.

provdes

and

o

he

Dorsexon

an

20.

meda

A.

A

te

rom

e-savng

vesses

emora

he

s uc

trange

72-year-od

to

on

toes

A

a

mpared?

19.

or

to

beedng

te

sapenous

ow-up

oot.

aceraton

afected

22.

kne.

rgt

second

orgn,

anke

because

o

er

deep

and

te

ts

te

pyscan

space

rst

space.

dsta

movements

te

preparaton

sows

between

te

njured

a

E.

to

te

rst

examnaton

space

by

on

emora

he



orgn

Durng

perced

numbness

to

woman

brougt

sasng

nature

vesse

te

s

resuted

Based

key

A.

gutea

a

oowed

emora

A.

A

sows

coapse.

as

man

massve

wc

naton

week

e

a

approprate

oow-

medcaton

s

te

or

njecton?

18.

or

norma y

239

Limb

nternus

58-year-od

ment

pyscan

menta

njecton

back

rsng

to

antpsycotc

Wc

A

Despte

comes

o

an

comes

poston.

te

maeous

start

dicuty

o

 un c t on

most

bua

compartment

to

re suted

ossa

te

ntramuscuar

ater,

e ve r t

te

examnaton

agrees

an

and

o

32-year-od

up

rem ova

dor s um

symptoms?

A.

A

te

dorslex

probabe

n

upon

o

Lower

5

24.

A

45-year-od

10-day

a

box

pan

and

man

story

o

n

te

o

books.

my

sde

comes

sarp

He

tod

backsde,

o

my

to

back

te

te

oot.”

te

pyscan

pan

we

pyscan

back

o

Pysca

e

tat

my

because

was

e

tg,

“et

my

examnaton

o

tng

te

eg,

sows

240

C H A P T E R

5

Lower

Limb

C.

Abducton

and

adducton

o

te

dgts

(atera

our

toes)

27.

D.

Fexon

o

te

great

E.

Fexon

o

te

dgts

A

22-year-od

to

te

pyscan

dsabty

et

knee

•

Fig.

a

sows

bua.

An

be

28.

tat

n

naton

ture.

man

took

a

o

pace

arge

o

o

te

et

rom

a

bruse

te

our

practces

competton

knee

a

to

ago.

dsta

sows

oowng

pan

kck

week

just

eg

toes)

marta

a

arts

and

te

sde

Pysca

to

te

comes

serous

o

ead

o

commnuted

musces

w

s

exam-

most

te

rac-

key

parayzed?

A.

Tbas

anteror

B.

Tbas

posteror

C.

Soeus

D.

Pantars

E.

Fexor

A

(atera

wo

because

x-ray

Wc

toe

and

and

extensor

dgtorum

ongus

gastrocnemus

and

popteus

dgtorum

24-year-od

ongus

woman

and

comes

exor

to

te

aucs

pyscan

ongus

because

.

o a sweng n er gron and persstent ow-grade ever.

weakened

afected

cause

cacanea

sde.

o

te

(Aces)

Wc

o

te

tendon

oowng

s

jerk

te

on

most

te

Se

was

not

been

ton

key

umbar

uctuant

a

L3–4

B.

Dsc

ernaton

at

L4–5

wc

C.

Dsc

ernaton

at

L5–S1

A.

Abducton

D.

Dsc

ernaton

at

S1–2

B.

Adducton

E.

Gutea

crus

syndrome

o

te

scatc

nerve

or

pr-

syndrome

A

55-year-od

department

vece

30

cannot

s

mnutes

coson.

examnaton

se

woman

Se

sows

easy

ater

was

tat

nvert

brougt

te

was

nvoved

patent’ s

A

te

unrestraned

te

t.

se

to

weakness

n

s

oowng

Extenson

D.

Fexon

Meda

A

because

n

ng

o

motor

dorsexon

ceanup

dentay

cut

a

cutter.

and

posteror

brus

to

owng

don reex s brsk. Knee extenson s amost norma, as are

A.

Cacaneus

a

greaty

B.

Fbua

oow-

C.

Cubod

D.

T aus

E.

Navcuar

reduced

ng

on

nerves

te

s

dorsum

most

L2

and

B.

L4

spna

nerve

C.

L5

spna

nerve

D.

S1

spna

nerve

S2

spna

nerve

A

spna

46-year-od

department

te

tat

te

sarp

oot.

It

ave

been

w

A

s

most

s

o

te

Sensaton

over

B.

Abducton

o

41-year-od

o

aong

s

brougt

on

a

entered

tat

er

Loss

ound

by

o

te

urter

o

botte

wound

pantar

wc

emergency

wne

te

posteror

atera

o

te

broken

observaton

as

to

part

o

nerve

te

on

sows

er

may

er

examnaton



te

te

te

pantar

great

toe

surace

o

te

trd

toe

wt

sows

o

te

n

ts

A.

at

ago

sweng

o

asca

a

a

but

as

examna-

n

arge

o

te

er

et

abscess

musce

at

wt

p?

to

as

s

rgt

a.

o

to

te

and

stfness

causng

taus

te

o

te

o

a

te

pan

ong

o

yng

te

rgt

te

o-

or

now

oot.

evau-

story

A

become

te

bade

o

pyscan

te

dur-

acc-

tendon?

as

as

be

te

e

tendon

Wc

meda

woud

a

tat

cty,

wt

or

patent

pan

te

tat

emergency

says

maeo

nserton

te

Wat

o

obquey.

he

and

ead

atera

te

He

anke

sows

comes

soe

area

rgt

and

an

oot.

tereby

oot

o

to

njury.

resdenta

woman

rgt

te

brougt

anke

transected

sweng

tat

nerory,

CT

scan

dspaced

ongtudna

most

o

comes

key

arc

cause

case?

T earng

o

te

pantar

cacaneonavcuar

(sprng)

gament

oowng

rgt?

A.

A

s

an

meda

serves

actvty-reated

steppng

be

Wc

aton

transected.

key

oot.

s

30.

suspected

assumpton

te

Sensaton

nerves

cose

gass

exon.

njured?

woman

ater

sdewak.

o

key

A.

E.

L3

knee

od

back

severey

bones

o

Examnaton

te

s reduced n quaty , atoug te cacanea (Aces) ten-

and

s

te

anke

movements

an

and

Pysca

everted

te

actons

worker

department

a

spread

year

Pysca

rotaton

32-year-od

nverson o te oot s noted. Her psatera patear reex

p

wtn

emergency

drver.

oot

te

C.

E.

29.

25–47

sows

vertebrae

at

a

medcne.

nontender,

ernaton

o

tubercuoss

wt

scan

Dsc

Questions

26.

a

CT

A.

orms

25.

A

wt

compant

sows

gron.

ndng?

dagnosed

B.

Fracture

C.

Interrupton

o

te

D.

Spran

o

te

anteror

E.

Spran

o

te

meda

o

cubod

te

bone

pantar

aponeuross

taobuar

coatera

gament

(detod)

gament

CHAPTER

31.

A

21-year-od

because

game,

e

aganst

was

te

bocked

by

a

emergency

Durng

nebacker,

wo

trew

mse

owng

abe

a

gaments

Pantar

E.

Long

A.

Fbuar

B.

Anteror

C.

Latera

D.

Fbuar

E.

A

An

te

coatera

te

passng

part

te

o

36.

A

ment

gament

eg.

coatera

and

posteror

crucate

gament

ness

woman

story

tat

routnes

mbs

eg,

oowng

Deep

B.

Poptea

o

pan

mb

te

sows

te

knee

comes

o

er

n

te

to

n

eat

aperture

arteres

s

te

spa.

pyscan

eg

worse

An

ow

and

te

because

A

durng

er

te

te

o

Posteror

Fbuar

E.

Anteror

Wat

proxma

Wc

A.

A

o

afected?

s

arge,

scatc

Superca

An

man

comes

knee

to

jont.

te

he

pyscan

patent’s

because

story

o

a

37.

sows

A

o

approac

te

s

synova

used,

ud.

and

te

A

standard

neede

passes

because

tat

new

te

Adductor

B.

Sort

onstrate

Rectus

D.

Sartorus

E.

Vastus

and

deep

to

musces

te

patea.

woud

te

hroug

neede

pass?

o

emors

wakng

comes

and

examnaton

ntatng

gat

exon

o

ordered.

afected

A.

Common

B.

Deep

C.

Superca

D.

Tba

to

pan

sows

rom

responsbe

te

a

or

eg

Wc

te

at

pyscan

te

tat

te

back

s

te

suspected,

te

te

as

poston.

unockng

o

o

patent

standng

because

knee

and

oowng

an

o

knee.

a

prob-

A

mus-

jont

to

magng

nerves

nner-

musce?

s

buar

emergency

codness

cyanoss

n

an

posteror

gutea

o

depart-

s

and

rgt

tender-

sows

tat

te

unusua,

area

aberrant

branc

rater

compartment

and

appearng

te

te

o

neror

te

o

contnuous

poptea

artery.

artery?

o

te

deep

emora

gutea

meda

artery

crcumex

emora

o

an

spran.

down

Yesterday,

ard

examnaton

tenderness

on

on

sows

te

te

te

s

sot

pyscan

patent,

anke

meda

comes

weakness

e

was

to

e

dropped

soe

gutea

o

te

artery

atera

nverson.

a

to

te

sarp

vece.

sensaton

and

emergency

rgt

rom

et

te

n

te

te

attemptng

automobe

dects

branc

o

marked

Wat

s

38.

ernaton

at

L1–2

ernaton

at

L2–3

C.

Dsc

ernaton

at

L3–4

D.

Dsc

ernaton

at

L4–5

E.

cr-

ower

t

one

ground

pan

n

Pysca

on

te

He

sde

to

n

key

o

dem-

s

back

examna-

mddorsum

weakness

most

depart-

mb.

o

dorsexon

nature

o

s

Dsc

ernaton

at

L5–S1

A 43-year-od woman comes to te pyscan because o

6-mont

as

pan

and

story

n

pan

ton

a

durng

tssue

aspect

o

and

nvoved

er

A

sde

and

s

wt

te

te

o

a

rst

n

says

nerve.

key

space,

everson

o

Weakness

to

C.

Foot

pantar

te

Wc

ound

com-

o

eg

extenson

n

adducton

at

te

knee

drop

and

D.

Weakness

he

E.

Loss

o

sensaton

n

te

o

te

tg

meda

aspect

o

te

te

durng

ex

n

o

entrap-

examnaton?

B.

se

mb

examna-

web

prorms

compresson

most

Se

afected

Pysca

te

weakness

scatc

aso

mb.

o

over

dagnoss

o

eg

ntercourse.

made,

condtons

ower

and

sensaton

dvson

basketba

anke.

s

n

tg,

atera

syndrome

buar

Inabty

matc.

pan

sexua

oot.

A.

te

o

p,

reduced

because

sweng

te

te

durng

sows

pysca

to

man

Dsc

mon

comes

superor

artery

Dsc

ment

buar

man

te

B.

te

Femora

32-year-od

o

A.

oowng

A

severe

o

strengt,

and

anke

dorsum,

buar

came

An

o-

njury?

ateras

man

oot

and

bceps

emors

34-year-od

Pysca

s

magnus

ead

C.

to

oowng

A.

payer,

te

utrasound

descendng

eectrc

sows

proxma

anke

to

and

seen

peroratng

o

we

ton

E.

o

branc

51-year-od

ment

datey

te

s

norma

emora

qucky

vates

a

enarged

and

s

te

njured?

sows

te

te

branc

E.

rom te atera aspect o te tg nto te regon mme-

study

pan

n

n

branc

D.

cumex

cuture

suprapatear

permt

vesse

t

T ransverse

s

bactera

njury

brougt

Dopper

dentty

A

or

ce

s

eg.

wt

te

C.

says

em

eg.

o

(detod)

severe

arsng

B.

tba

swoen

Pysca

afected

Wc

artery

tba

43-year-od

dicuty

key

occuson

arge

tg,

cronc gonococca artrts. A knee aspraton s ordered

A

te

artery

D.

o

most

on

racture.

examnaton

rgt

nerory

artery

emora

C.

wc

o

trombotc

tortuous,

te

wegt

emora artery o te afected mb termnates mdtg.

angograpy

n

Pysca

te

bua.

man

because

o

put

241

Limb

pantar

beow

troug

present

key

afected

rgt

gets

tba

most

be

te

er

pan

mnma

between

w

s

coatera

23-year-od

crucate

troug

panu,

to

posteror

A.

A

subject

knee?

gament

gaments

te

te

and

says

ower

requenty

menscus

3-mont

Se

s

aganst

gament

crucate

82-year-od

a

orce

to

bmaeoar

D.

structures

o

knee.

not

Wc

type

et

s

sows

Sprng

oowng

recever’s

x-ray

meda

ts

te

patent

ootba

C.

te

o

depart-

a

B.

rom

aspect

te

pan.

naton sows sweng and tenderness over te knee jont.

o

atera

to

knee

recever grasped s knee n obvous pan. Pysca exam-

workout

35.

brougt

T aonavcuar

knee.

34.

s

severe

A.

o

33.

o

he

njury

32.

man

ment

Lower

5

eg

242

C H A P T E R

39.

hree

years

ment,

s

musces

on

s

been

te

ad

scans

been

musces

s

by

Rectus

emors

C.

Guteus

D.

Prorms

E.

Quadratus

wt



18t

tat

t

a

adpose

o

tssue.

gutea

nerve

repacement

tat

rom

nerve

o

te

repace-

arger

he

coud

superor

oss

not

o

bood

deat

Dr.

prmary

wt

Jon

can

and

artery

o

te

saey

Hunter

te

be

very

sows

he

patent

and

room.

and

potenta

and

tg

oss

efectvey.

(1728–1793)

s

burst-

o

In

43.

Foot

C.

Dorsexed

D.

Pantar

E.

T ota

ong

er

surgcay,

Fg.

5.3

wt

tat

s

treat

te

saety.

reated

aneurysm

Wat

to

s

n

te

structure

surgca

poptea

s

ossa

ndcated

n

ower

et

owng

ne

cdood

ven

A.

Superor

C.

Femora

artery

B.

Latera

D.

Gracs

C.

A

E.

Adductor

D.

Ineror

E.

Meda

mpactng

sows

on

te

batera

to

ees

stand

and

on

key

s

a

te

o

eet.

wc

aggravates

te

te

emergency

wt

Pysca

o

o

pan

wegt

44.

examnaton

s

ractures.

one

te

s

batera

X-rays

cacanea

o

to

adder,

eet.

sweng

contracton

most

brougt

rom

o

commnuted

te

musces

s

ang

tenderness

nabty

njury,

man

ater

a

and

te

o

te

ossa.

operatng

superca

Suc

to

examna-

an

to

njury

oowng?

knee

on

o

at

says

o

tat

sows

te

great

se

jont

n

ead

ts

pan

n

te

te

er

rgt

a

er

abe

to

ront

ower

sorter

Wc

o

n

not

sows

racture.

te

emergency

was

oor

tat

jont

te

notceaby

p

subcapta

knee

to

posed

and

onger

te

brougt

te

suppyng

no

oot

eg

tan

dsrupted

o

te

emur

n

o-

eary

patent?

gutea

crcumex

o

te

emora

obturator

artery

gutea

crcumex

29-year-od

3-mont

man

emora

comes

story

o

examnaton

to

te

pyscan

dscomort

sows

a

n

te

rater

because

atera

o

tg.

overwegt

man,

wearng a eavy eater bet, to wc numerous objects

te

are

oowng

te

wound

poptea

to

nerve

te

because

son

rotated

by

but

branc

Pysca

sow

Ater

te

n

ees

eet

A

s

son

Her

X-rays

arteres

Sartorus

49-year-od

at

emergency

oot

te

examnaton

mb.

Femora

department

te

ven.

wc

eg

nverted

ex

er

ateray

B.

A

to

sppng

A.

brevs

n

te

woman

by

Pysca

s

to

te

te

buet

Pysca

transerred

everted

and

mb.

ater

Senton

procedure?

and

nabty

rgt

a.

wound

poptea

resut

extend

exed

department

mb

to

to

82-year-od

up

assaant.

severed

te

to

drop

te

com-

key

B.

get

ad

aong

Inabty

An

brougt

sma-caber

drve-by

buet

most

s

a

mmedatey

A.

pressed, bood ow n te poptea artery can be reduced

enoug

he

a

o

penetratng

s

te

dscovered

temporary

a

coursng

woud

woman

because

rom

ton

nerve?

rage,

knee

and

emors

aneurysm

24-year-od

te

musces

gutea

A

department

ave

atroped

oowng

42.

p

opn-

procedure,

ad

te

p

s

atae

artera

century,



man’s

two

maxmus

great

s

tat

by

Wc

nnervaton

B.

eg

by

at.

ascae

ng

te

supped

T ensor

poptea

62-year-od

superor

durng

A.

A

a

ndcated

repaced

tat

repaced

ts

Limb

oowng

CT

ofered

receves

41.

Lower

njured

been

40.

5

attaced,

oug

njured

s

eet?

ncudng

examnaton,

made.

Wc

a

o

s

empty

dagnoss

te

o

oster.

Ater

meraga

oowng

nerves

a

tor-

parestetca

s

most

key

nvoved?

A.

Fexor

A.

Superor

B.

Gastrocnemus

dgtorum

proundus

B.

Femora

C.

Tbas

posteror

C.

Obturator

D.

Tbas

anteror

D.

Fbuar

E.

Fbuars

E.

Latera

ongus

45.

A

te

et

meda

pressed

o

.

te

Fexor

B.

Pantars

racture

oowng

dspaced

aucs

dstance

An

maeous

x-ray

o

se

o

te

structures

s

o

s

brougt

spraned

te

et

dspaced

ragment

ongus

runner

ater

anke

oot

er

sows

wt

te

posteronerory.

most

te

key

com-

bone?

tendon

tendon

C.

Tbas

anteror

D.

Tbas

posteror

E.

Tba

A

ong

runnng.

te

te

by

tendon

tendon

nerve

42-year-od

ater

Pysca

Fig.

o

scatc

department

maeous

A.

ment

•

we

part

Wc

o

cutaneous

emae

emergency

anke

dsta

46.

dvson

emora

23-year-od

to

a

gutea

man

ang

s

brougt

to

examnaton

te

to

te

emergency

sdewak

sows

te

rom

patent

s

s

not

depart-

adder.

abe

to

put wegt on s et eg. here s a sweng and bruses

CHAPTER

around

on

s

te

et

racture

o

te

te

47.

et

o

te

eg.

as

An

proxma

we

sat

arteres

as

x-ray

o

mutpe

o

te

te

suppes

et

te

aceratons

emur

sows

emur.

sweng,

a

te

Wc

afected

part

toe

te

crcumex

B.

Acetabuar

C.

Latera

D.

A

E.

Meda

branc

ater

rgt

ments.

rgt

An

severed

s

s

x-ray

by

ave

s

s

o

te

te

to

eg

Durng

to

put

perorm

sows

a

ound

pysca

wegt

certan

sows

compartment

o

depart-

te

51.

Sensory

oss

o

B.

Sensory

oss

on

C.

Foot

Parayss

Sensory

48.

A

o

te

oss

ce

at

30

o

te

dorsum

te

soe

extensor

te

o

o

te

te

te

pysca

wt

pued

sows

oot

brevs

oot

ng

te

s

e

te

dsta

o

te

most

te

te

emur

and

o

vesses

to

a

o

depart-

motor

sows

te

are

racture.

n

ower

angogram

key

emergency

nvoved

ragment

An

o

was

to

mdde

poptea

ragment

musces

brougt

x-ray

o

te

s

posterory.

tat

A.

Soeus

B.

Gastrocnemus

C.

Semtendnosus

D.

Gracs

E.

Tbas

A

and

oot

ater

pne

a

can

50.

man

ang

a

a

racture

o

te

te

by

te

n

receve

brougt

rom

bone

s

te

o

can

prmary

te

te

be

An

taus.

ost

n

From

vascuar

x-ray

Muc

suc

wat

depart-

ceanng

o

o

an

pantar

D.

Superca

E.

Deep

te

artery

73-year-od

6-mont

he

puse

Dopper

pysca

o

te

Latera

to

Posteroneror

Groove

Meday ,

Young

eg,

as

te

neuroogc

ts

over

o

er

not

toes.

D.

Anteror

D.

Superca

E.

Posteror

E.

Tba

tba

tba

o

batera

bunons.

Pysca

because

because

examnaton

sows

and

s

wound

ater,

dur-

dicuty

no

Wc

te

se

wakng

te

week

great

tere

ater

we

n

namma-

nerve

s

most

se?

te

a

te

and

nontender,

posteror

o

pyscan

cod

tba

eg

w

artery

a

Absence

most

oot.

cyanotc

ndcates

artery.

because

pae

cod

absent.

trombotc

o

key

s

puse

be

dur-

ound

n

ocatons?

bey

o

te

abductor

54.

A

o

meda

emora

te

condye

atera

maeous

and

between

te

meda

maeous

and

te

two

eads

o

te

concerned

tat

yet

wakng.

begun

sayng

tat

tertus,

as

te

Wat

beore

oot

s

and

te

ter

one

to

most

her

te

cd

ts

o

centra

coud

wtout

common

pedatr-

musces

compete

te

wak

o

gastrocnemus

14-mont-od

t

te

stumbng

nerve

suppy

pantar

buar

22-year-od

5-day

Her

te

musce?

Deep

work

o

to

between

tem,

o

C.

er

sows

deveopment

Dorsas

peds

are

buars

corner

ts

to

between

parents

reassures

outer

pyscan

sot,

as

oot.

muscuar

mdway

C.

te

se

se

cacaneus

Sura

to

wt

nserts.

cacaneus

Groove

and

suppy?

durng

pyscan

One

progressve

te

mdway

Latera

pan

comes

o

te

C.

B.

comes

tetanus

te

poptea

B.

A.

o

te

sna

toug

o

oowng

pantar

woman

aso

te

rom

togeter

musce

sutured.

examnaton

pantar

stor y

o

s

Meda

6-mont

a

percng

utrasound

o

Latera

58-year-od

man

examnaton

B.

o

to

sarp

even

soe

story

A.

A

o

buar

A

te

bood

does

te

tssues

reected

buar

o

can

rgt

njury

a

and

te

Sura

daugter

eaves

te

s

o

te

aucs

racture

emergency

we

gutters.

osteonecross.

ts

to

roo

by

C.

A.

53.

s

te

pantar

te

rom

n

damaged

wc

on

toe,

Latera

ng

brougt

examnaton,

great

present

sot

paanx,

wc

receves

Meda

oow-

dsta

oow-up

occuson

mb

Se

B.

A

te

beng

ower

compressed

Wc

dspace

o

s

torougy

er

and

musce

base

Durng

pantae

gr

stepped

beac.

atera

toes.

nterosseous

A.

D.

racture

ts

resut

bone

te

ceaned

E.

needes

o

Quadratus

oot.

racture

trds

te

ve-

anteror

sows

suppy

E.

te

65-year-od

ment

umbrca

Pysca

ragment?

49.

Frst

ton

oot

dgtorum

entre

ater

An

juncton

emur

dsta

man

mnutes

coson.

te

D.

exng

48–71

24-year-od

ment

dorsa

ng

52.

Questions

aucs

Frst

s

drop

E.

Abductor

7-year-od

bony

a

te

243

Limb

ts?

C.

to

sgns

s

at

great

proxma

upon

B.

te

eg

te

aucs

key

A.

musce

te

ten

Adductor

te

te

o

bone,

o

o

and

A.

A

causes

o

protrudng

sde

tat

examnaton?

D.

atera

accdentay

oowng

durng

on

te

sesamod

and

paanx

excsed,

move-

racture

MRI

Wc

key

emergency

abe

An

posteror

most

te

bcyce.

anke.

racture.

been

to

not

unabe

te

te

emora

brougt

are

Wat

emora

rom

and

n

obturator

patent

above

nerve

woud

te

eg

tba

major

man

ang

examnaton,

te

deep

o

emora

crcumex

22-year-od

ment

branc

o

a

ac

crcumex

redness,

proxma

operaton,

o

emur?

Deep

s

and

oowng

A.

A

mdtg,

arm

Lower

5

buar

woman

story

temperature

o

s

comes

g

39°C

to

ever

te

and

(102.2°F),

pyscan

vagna

and

because

dscarge.

puse

s

105/

244

C H A P T E R

mn.

Lower

Laboratory

seres

Into

5

o

te

o

te

Anteror

B.

In

C.

Ineroatera

superor

te

ror

ac

E.

ac

and

te

to

a

to

te

greater

te

A

58.

ordered.

nerve

between

regon

durng

poste-

but

trocanter

anteror

posteror

tons

superor

greater

posteror

supe-

trocanter

tuberosty

and

te

greater

59.

trocanter

55.

A

gency

a

department

tour

He

s

bus

we

abe

to

ront

Wc

56.

o

o

sows

te

mnutes

te

n

ater

wtout

due

oowng

to

brougt

te

“adductor

oter

s

te

crossng

unopposed

most

p

key

emer-

struck

o

assstance.

gat,”

nerves

te

beng

mdde

an

to

by

Inabty

D.

Numbness

E.

Weakness

5-week

nerve

te

n

s

te

Superca

B.

Obturator

B.

Tba

C.

Ineror

C.

Common

D.

Superor

D.

Sura

E.

Femora

E.

Sapenous

nto

a

vagnay,

te

deep

27-year-od

te

perneum

njecton

s

woman

decson

s

made

made

s

to

tryng

nject

because

meda

to

dever

oca

o

te

to

er

60.

anestetc

severe

sca

pan.

A

A

was

tuberosty

se

by

er

payng

as

tenderness

o

An

te

perneum

very

njecton

as

not

and

posteror

ton

s

Wat

suppy

to

most

o

te

te

ew

n

enoug

to

some

A

te

provde

n

mnutes

attendance

perneum.

atera

can

perneum

n

te

o

t

te

centra

separate

sca

muc

ater,

tat

x-ray

most

key

te

C.

Intercondyar

Tba

E.

Anteroatera

An

81-year-od

C.

Ioypogastrc

pan

D.

Ineror

osteoartrts.

Mdde

cuna

undergo

son

o

an

te

operaton

ow

soud

ower

s

oemora

proxma

s

between

Durng

and

man

ac

reabtaton,

be

papated

bypass

aspect

perormed

te

admtted

to

o

to

te

because

te

emora

wc

o

montor

o

emora

successuy

and

and

arteres

te

good

ospta

an

te

causng

bood

te

arteres

crcuaton

o

te

mb?

A.

Anteror

B.

Deep

buar

C.

Deep

pantar

D.

Dorsas

tba

E.

Dorsa

peds

metatarsa

s

62.

o

one

takng

repace

ater

an

area

on

te

o

o

te

Wat

a

te

uncton

s

because

sde

o

deectve

successu

prevousy

skn

atera

nerve

er

cutane-

was

on

te

sde

used

o

n

to

te

ang

Se

s

Pysca

o

emergency

rom

a

tree

abe

depart-

we

to

wak,

examnaton

te

knee

and

bony

sows

sweng.

Osgood-Scatter

oowng

se

but

dsease

structures

s

tba

area

emnence

o

Genu

varus

Genu

vagus

C.

Coxa

varus

D.

Coxa

vagus

E.

Haux

he

te

to

o

s

o

as

a

te

knee

meda

bowed

An

sde

he

o

te

wen

terms

best

o

sweng

x-ray

jonts.

severe

story

sows

outward

oowng

wt

ong

bateray.

te

tuberce)

pyscan

examnaton

on

te

(Gerdy

te

patent

knee

be

to

e

o

te

degen-

knees,

stands

descrbes

knees?

vagus

57-year-od

and

tuberce

comes

severe

knees

Wc

o

tba

o

B.

gan,

to

aso

sows

degeneraton

condton

because

toes

pyscan

grat,

o

aspect

Pysca

A.

A

and

te

o

knees.

more

s

uprgt.

restored.

oowng

s

sows

eraton

he

second

te

monts

here

pan.

man

tenderness

knee

occu-

artery.

s

to

cond-

examnaton?

tuberosty

Ineror

65-year-od

mb

Sx

ntercondyar

B.

gutea

oowng

oot

to

rends.

o

condye

D.

n

cut,

afected?

Meda

61.

and

nerve

brougt

knee

Posteror

cuna

a

ater

er

Wc

B.

ndvduas?

s

dsta

A.

cutaneous

been

toe

parayss

sensaton.

knee

te

Posteror

A

gr

njec-

sensory

ave

accompanyng

pysca

te

restoraton

no

wt

o

5.4).

o

ower

parent

at

(Fg.

o

comes

ateray

tuberosty.

te

te

te

buar

A.

E.

emora

A

tose

efectve

nserted

nerve(s)

cases.

to

been

parts

tereore

oter

n

obvous

o

te

on

torougy,

buar

severe

to anestetze te pudenda nerve, wc suppes muc

becomes

emergency

dog

procedure?

10-year-od

ment

s

as

A.

We

tendons

rst

aca

musces.

eg

gratng

o

te

tere

Tba

gutea

te

stray

ceaned

and

great

te

panned.

aca

tat

te

woman

musces?

gutea

to

a

s

durng

nverson

rom

te

oot

extend

between

surgery

nerve,

parayzed

tese

no

artery

njured. Wc

story

Pastc

o

tat

peds

by

wound

expected

to

31-year-od

back

he

seen

brougt

btten

drop

procedure,

mb

be

C.

a

s

been

Cuboot

aca

adductors.

suppy

ave

Foot

ous

Pysca

one

t

s

beng

oot.

dorsas

woud

ace.

street.

wc

A.

baby

57.

30

man

wakng

ambuate

examnaton

n

ntoxcated

te

B.

A

woman

ater

A.

o

45-year-od

o

te

nerve

supe-

trocanter

te

55-year-od

dorsum

njury?

te

A

department

tuberosty

te

between

ac

are

gutea

avod

te

sca

te

te

between

between

ne

o

ne

and

greater

and

between

a

necton.

njectons

parts

to

ne

ne

te

spne

Haway

a

gonorrea

njected

spne

a

and

to

Ineromeda

ror

o

spne

spne

be

superor

mdde

ac

ac

D.

and

conrm

antbotc

oowng

antbotc

A.

ror

studes

ntramuscuar

wc

soud

Limb

a

dabetc

6-mont

woman

story

constpaton.

o

comes

ow

Pysca

to

te

energy

pyscan

eve,

examnaton

wegt

sows

CHAPTER

•

markedy

neck.

reduced

Fig.

patear

Laboratory

studes

63.

oowng

relex

and

conrm

sgt

sweng

o

ypotyrodsm

s

stretced

durng

te

reex

Quadrceps

emors

C.

Sartorus

worse

wen

D.

Pectneus

sows

constant

E.

Bceps

jonts,

wen

se

65.

emors

emors

ater

e

s

severey

rom

a

A

63-year-od

o

woman

brougt

njurng

trampone.

to

er

Se

te

rgt

s

not

a

1-year

emergency

jonts,

ower

(Fg.

abe

mb

to

put

rate

and

descrbe

Pes

panus

Pes

cavus

X-ray

anke

and

o

te

anke

nvovng

te

owng

posteror

bones

sows

te

process

w

a

atera

aso

anke

o

trmaeoar

maeous,

o

most

te

tba.

key

be

te

rgt

racture

meda

oot.

o

te

maeous,

Wc

o

te

o-

afected?

66.

C.

Hammer

D.

Caw

E.

Haux

A

pan

B.

Cacaneus

examnaton

C.

Cuneorm

s

D.

Cubod

te

E.

T aus

vs

a

72-year-od

3-year

examnaton

Fg.

5.5.

man

story

o

sows

Wat

s

comes

severe

te

te

to

te

pan

probems

most

pyscan

wen

key

n

because

wakng.

s

eet

dagnoss?

as

o

Pysca

sown

n

treatment

reaxaton

oowng

Coxa

varus

A.

L4

vagus

B.

L5

C.

Genu

vagus

C.

S1

D.

Genu

vara

D.

S2

E.

Haux

E.

S3

te

o

because

pan

gets

examnaton

metatarsopaangea

nterpaangea

nterpaangea

oowng

comes

mb

sows

scatc

ower

prorms

Coxa

te

Pysca

proxma

dsta

sgns

man

ower

posteror

B.

vagus

s

greater

A.

o

he

terms

pysca

s

jonts

most

accu-

examnaton?

vagus

Navcuar

and

te

at

te

pyscan

oot.

toes

58-year-od

n

at

te

er

soes.

extenson

o

to

n

toes

A.

A

wears

Wc

B.

te

comes

pan

extenson

A.

around

o

yperexon

5.6).

to

se

sweng

bruses

.6

woman

story

wegt on te afected oot. Pysca examnaton sows

and

Fig.

test?

Quadratus

52-year-od

•

te

B.

A

.

and

A.

department

64.

musces

Fig.

245

Limb

.4

approprate treatment s ntated. he tendon o wc o

te

•

Lower

5

or

pont

aspect

mb

o

o

a

te

nerves

s

sows

pyscan

past

musce.

2

n

pan

tg.

An

tat

te

terapst

te

MRI

He

or

mmcks

regon

s

o

o

s

sufers

pe-

rom

drected

wc

o

down

stretcng

te

o

Pysca

radatng

patent

Entrapment

key

because

monts.

wt

syndrome.

pysca

most

te

tenderness

oramen,

entrapment

by

to

te

o

to

and

te

syndrome?

246

C H A P T E R

67.

5

Lower

Limb

A 22-year-od woman s brougt to te emergency depart-

ment

ater

beng

ound

n

a

comatose

condton,

avng

an or an unknown engt o tme on te te loor o te

courtyard.

Cocane

s

ound

n

er

possesson.

Pysca

examnaton sows sgns o scema n te gutea regon.

Ater

knee

oss

68.

reganng

lexon

n

te

Tba

B.

S1–2

C.

Gutea

D.

Prorms

E.

Femora

nerve

nerve

was

MS

and

ead

(Fg.

key

a

5.7).

Deep

Acetabuar

C.

Descendng

D.

Second

tea

mower.

o

Wc

o

o

branc

an

o

sows

p.

o

oowng

avascuar

and

and

oowng

te

necross

p

(MS)

•

Fig.

.7

•

Fig.

.

an

reduced

An

te

MRI

emora

arteres

s

most

necross?

atera

branc

o

o

obturator

o

woman

Pysca

sceross

ac

branc

by

te

n

emergency

rgt

cortcosterods

avascuar

because

regon

mutpe

te

er

examnaton

peroratng

department

to

at

moton

branc

27-year-od

o

pan

range

crcumlex

Ascendng

A

o

sensory

dagnoss?

Pysca

resutng

B.

brougt

severe

wt

sows

njured,

key

and

syndrome

s

o

story

actve

A.

E.

69.

woman

treated

examnaton

most

parayss

lexon

entrapment

because

as

exbts

njury

exacerbaton.

passve

te

entrapment

nerve

recenty

s

se

pantar

compresson

45-year-od

Se

and

njury

crus

department

tg.

dorsa

mb. Wat

A.

A

conscousness,

and

meda

s

a

crcumlex

o

deep

crcumlex

brougt

to

penetratng

object

trown

examnaton

emora

emora

emora

te

emergency

njury

rom

sows

a

n

te

rdng

no

pop-

awn-

motor

and

sensory oss beow te knee. Durng te operaton, ater

makng

ossa,

a

tssues.

70.

a

mdne

ven

o

Wat

ven

Poptea

B.

Peroratng

C.

Great

sapenous

D.

Sma

sapenous

E.

Superor

A

meda

58-year-od

o

a

artera

Wc

puse,

o

adequate

te

toes

te

and

A.

Anteror

B.

Fbuar

Arcuate

pantar

E.

Latera

pantar

32-year-od

wt

e

s

eard

an

man

a

deep

te

te

at

ts

poptea

superca

ocaton?

emora

no

comes

a

panu

tba

w

rom

pyscan

oot.

Pysca

puse

s

key

pantar

on

perpera

dorsas

most

te

te

as

detectabe

arteres

te

to

patent

posteror

o

peds

provde

to

oot?

brougt

to

s

rends.

poppng

sows

te

oot

at

te

te

nabty

emergency

we

Wen

sound

an

to

payng

njury

anke

to

ootba

occurred,

jont.

stand

depart-

on

tears

eg

An

wt

Navcuar

B.

Cubod

te

Cacaneus

D.

Sustentacuum

E.

T aus

department

er

te

Wc

musce

wt

anke

o

severe

sows

te

sweng

mutpe

oowng

ten-

bones

s

tears?

ta

72–95

18-year-od

ead

tenderness

o

5.8).

C.

An

and

MRI

(Fg.

A.

sot

oot

Pysca

o

te

sows

toes

ee.

assocated

72.

s

afected

te

dnous

strong.

surace

te

near

Questions

njury

coege

examnaton

o

te

suppy

dorsum

Meda

ater

te

o

n

tba

D.

ment

s

oowng

C.

A

tat

te

coatera

skn

sown

expected

patent

here

but

to

story

sows

dsease.

be

te

s

gencuar

dabetc

2-year

examnaton

vascuar

trbutary

n

sze

woud

A.

because

71.

ncson

moderate

te

woman

ater

se

durng

nverted.

atera

an

er

s

brougt

wen

tenns

Pysca

aspect

avuson

e

o

to

practce

oot.

o

te

te

eaped

and

examnaton

te

racture

se

An

emergency

or

an

over-

anded

sows

x-ray

tuberosty

o

o

wt

sweng

te

oot

te

t

CHAPTER

metatarsa.

ng

pan

pung

73.

on

te

te

tuberosty

Wc

ractured

Fbuars

B.

Tbas

C.

Fbuars

brevs

D.

Extensor

dgtorum

E.

Adductor

A

to

key

was

Latera

Patear

emae

o

to

empoyee

te

pan

Pan

o

ouseceanng

wt

n

er

o

oowng

a

2-day

knees.

gets

sows

tenderness

te

a

usuay

examnaton

and

Wc

pyscan

burnng

artrts.

o

severe

te

s-

Se

worse

76.

as

wt

ty

structures

s

sown

most

a

afected?

Prepatear

bursa

A.

and

Semmembranosus

D.

Suprapatear

E.

Subsartora

yet

natons

even

sow

sows

cdood

owng

bursa

o

e

s

unstabe

key

4

cdren

son

years

p

deormty.

most

bursa)

tree

because

od.

jont.

he

An

by

e

x-ray

o

wc

o

te

exam-

o

te

to

cannot

Pysca

stabty

provded

comes

te

jont

te

77.

p

n

32-year-od

Lgament

T ransverse

post

s

brougt

ambuance

wen

a-terran

e

was

vece.

ater

to

s

trown

te

rom

Pysca

emergency

et

eg

a

department

mpacted

poweru

examnaton

a

ence

our-wee

sows

mnor

78.

n

njury

a

severe

pan,

te

B.

1.5

cm

meda

C.

1.5

cm

atera

D.

1.5

cm

meda

E.

Mdway

to

to

Fig.

.9

6

eeng

nab-

monts.

te

to

most

arc,

patent

perorm

common

wt

everson

ongtudna

to

39-year-od

arc

t

and

and

to

te

a

o

nerve

Wat

X-rays

te

o

te

he

proxma

s

a

over

o

emur.

bock

pubc

n

sows

aceratons

andmark

njecton

te

emergency

nvoved

examnaton

mnor

anteror

to

accurate

anestetcs?

tuberce

superor

ac

spne

puse

emora

te

te

was

mdtg.

emora

te

to

se

gament

gament

puse

anteror

superor

ac

spne

sympyss

woman

oot.

wearng

(detod)

racture

or

te

between

pubc

panu

nerve

as

he

comes

pan

been

•

to

soes.

planus

Fig.

te

started

graduay

narrow-toed

Pes

•

te

an

gament

et

admnstered.

superoatera

and

o

tryng

brougt

dsta

cm

wt

s

Pysca

te

ocazng

ago,

eet

meda

ater

bruses,

o

sow

s

s

1.5

a

past

cacaneonavcuar

or

A

te

upon

coatera

A.

o

te

pantar

coson.

aspect

mb

and

caused

oreoot

mnutes

mutpe

atera

E.

te

Wat

o

woman

30

vece

D.

an

egt

pantar

s

over

because

wtout

oot

o

te

as

ongtudna

te

Coapse

patent

45-year-od

o

E.

Iscoemora

by

meda

ong

Puboemora

A

o

meda

C.

pan

pan

test.

pyscan

condton?

o

B.

emur

rse

te

mnutes

sows

o

A

he

and

Coapse

ower

te

5.10

ee

to

5

actvtes

Coapse

Ioemora

o

day

D.

A.

ead

eet.

abducton

sweng,

acetabuar

tan

C.

te

te

ts

te

motor

o-

comes

more

s

Fg.

department

gaments?

o

n

Exaggerated

o

youngest

toug

no

s

er

an

B.

(anserne

moter

wt

bursa

bursa

postve

structures

gament

man

wak

Coapse

bursa

C.

42-year-od

o

and

gament

snge-eg

cause

knee

oowng

gament

examnaton

n

et

te

gament

crucate

perorm

Pysca

knee

o

njured?

coatera

pan

to

te

247

Limb

menscus

cannot

severe

o

test. Wc

crucate

55-year-od

e

sweng,

afected

A

sweng

key

E.

Pysca

pyscan

most

D.

brevs

aucs

Inrapatear

jont

ragment?

and

drawer

Fbuar

B.

wak

posteror

C.

A.

A

aceratons

s

Posteror

touc,

5.9).

(Fg.

produc-

musces

B.

constant

warm

of,

posteror

tory

story

pued

oowng

Anteror

comes

a

s

te

A.

busness

o

o

ongus

58-year-od

actvtes.

75.

o

edema.

A.

no

74.

Part

and

Lower

5

.

a

pyscan

because

coupe

monts

o

worsenng

Se

aso

as

especay

a

tngng

248

C H A P T E R

5

sensaton

Morton

ng

o

te

a

Limb

oot.

neuroma.

sowed

A.

Lower

An

MRI

Pysca

papabe

mass

o

te

oot

examnaton

between

wc

sows

most

o

te

a

reex

key

a

oow-

te

trd

and

ourt

metatarsopaangea

jonts

B.

Between

te

second

and

trd

metatarsopaangea

jonts

C.

Between

te

rst

and

second

metatarsopaangea

83.

jonts

Between

E.

In

te

ourt

and

t

metatarsopaangea

regon

o

te

tarsopaangea

79.

A

34-year-od

1-week

wt

tar

toug

te

tons

80.

s

steps

te

band

o

most

o

te

everson

C.

T arsa

tunne

D.

Pantar

E.

Inverson

oot

terms

te

pyscan

oot.

he

mornng.

and

warm

ndcatng

tssue

meta-

Deep

Tba

Superca

stretcng

Wc

o

o

s

over

o

rom

te

a

ater

s

tc

pan-

eet.

tat

e

o

te

He

anke

s

because

a

care.

nverson

te

and

ndoot

s

dagnostc

ound.

or

boy

o

u-term

prenata

deormty

Motor

D.

Injury

E.

Provdes

te

s

an

brougt

atypca

and

s

moter

Pysca

pantar

Wc

sgns

o

te

te

o

ad

o

te

ore-

exon.

te

observed

ca

No

pysca

te

vagus

D.

Haux

varus

E.

Pantar

85.

A

ng.

te

papatng

because

sows

s

e

jonts.

ton

o

at

bot

Wc

or

te

te

o

ts

wakng.

metatarsopaan-

proxma

te

Pysca

and

oowng

patent’s

atera

dsta

Fg.

descrp-

A.

toes

86.

cavus

to

te

eaty

e

was

sows

a

62-year-od

emergency

an

wt

brsk

man

department

nabty

wakng

very

te

ater

p

a

sensaton

posteror

oowng

s

sows

successu

dmnsed

te

te

ateray

emora

caracters-

superor

aspect

o

te

gu-

nerve

eves

S1,

obturator

S2,

and

nternus

S3

and

o

parestetca

sura

ater

Se

te

and

te

was

sustaned

dsocaton

to

to

se

rgt

Pysca

musces

nerve

brougt

knee

a

drect

by

te

radoogc

o

requres

prevent

te

emergency

nvoved

a

to

dasboard

examnatons

patea.

Wc

strengtenng

uture

n

bow

by

dsocaton

o

pys-

o

te

gament

ootba

payer

to

wak

s

by

dog.

reacton

20

n

s

brougt

mnutes

mse

Pysca

te

by

ater

propery

examna-

deep

tendon

to

examnaton

over

te

te

5.11.

probems.

condton?

vagus

experenced

we

extenson

n

panus

oterwse

son

dicuty

approprate

Pes

An

o

exon

Caw

s

emors

Pysca

aceraton

E.

o

t

depart-

tat

comes

to

te

pyscan

because o a sma cut over te knee e ad durng tran-

ascts

D.

aspect

15-year-od

A 71-year-od man wt a past story o poo comes to

Hammertoes

sows

and

x-ray

o

te

s

coson.

ntermedus

Haux

C.

o

mnutes

ateras

C.

Haux

30

medas

Patear

Pes

te

te

Vastus

E.

B.

eg

as

meraga

o

Vastus

equnovarus

A.

emergency

monts

te

spna

B.

T apes

most

o

o

A.

B.

s

An

patent

woman

reabtaton

Vastus

tons

n

atera

Rectus

nterpaangea

te

rgt

T wo

Wc

orgn

oowng

D.

wt

te

poston.

sacra

vece.

C.

vara

jonts

key

musces

Coxa

gea

to

examnaton

dstrbuton

resuts

examnaton?

examnaton

tan

nnervaton

A.

pyscan

sows

most

patea?

oowng

on

ead

s

buar

Pysca

suppy

rom

meda

te

te

arc?

brougt

te

o

vece

te

sow

examnaton

adducton

and

to

appear-

s

racture.

34-year-od

motor

2-week-od

ater

as

to

Arses

C.

A

o

nerves

regon

geme

84.

scan

nerve?

department

eaty

reguar

ts

deep

supne

nerve.

B.

symptoms?

syndrome

s

a

neck

regon

tea

cond-

e.

Cutaneous

o

cacaneus

oowng

o

A.

e

on

cutaneous

exam-

te

and

repacement,

te

reex

man

sorter

emora

n

ntense

nammaton

te

tese

pan

Pysca

skn

an

because

CT

oowng

buar

72-year-od

eg

te

A

te

buar

E.

A

anke.

o

buar

D.

a

spran

spran

by

s

s

ourt

ascts

reatve

oter

and

neuroma

oterwse

sows

trd,

te

s

caracterstc

Anke

o

n

oot.

B.

receved

to

n

oot

Morton

ance

82.

pan

A.

An

C.

p

comes

tenderness

o

ba

pyscan

81.

ew

sows

surace

te

to

rst

o

second,

jonts

man

story

te

naton

Common

Superca

rotated

te

or

B.

et

jonts

te

A.

ment

D.

o

Wc

responsbe

space?

Between

test

stroke.

te

knee

patent

Wat

s

te

Osgood-Scatter

C.

Norma

D.

Bpartte

E.

Injury

A

48-year-od

ngs.

s

A

2

cm

te

bony

o

te

past

key

ong

et

superca

knee.

We

structure

knee

story

s

o

s

et

sown

any

n

knee

dagnoss?

bursa

dsease

emnence

patea

to

CT

no

most

atera

menscus

woman

because

pan.

o

scan

bood

comes

a

Pysca

dsproportonate

reduced

a

o

sma

x-ray

ntercondyar

department

pan

a

as

prepatear

B.

abdomna

An

sows

aspect

jont,

patea.

he

Enarged

atera

o

ow

te

to

to

30-mnute

te

examnaton

to

pysca

abdomen

te

sows

o

severe

tat

examnaton

wt

superor

emergency

story

contrast

mesenterc

te

nd-

sows

artery.

CHAPTER

Lower

5

249

Limb

L

•

poptea

ton

ng

o

ossa

te

te

sows

meda

poptea

gastrocnemus,

ormed

•

An

s

abdomnopevc

ordered

oowng

puncture

A.

B.

4.5

cm

between

atera

Mdpont

Meda

aspect

E.

Latera

to

ater

he

An

MRI

o

(Fg.

most

te

most

key

anteror

emora

Wc

used

superor

to

access

o

te

5.12).

key

Posteror

B.

Tba

gude

Fbuar

Anteror

E.

ac

spne

89.

Coronary

A

skn

ead

s

s

knee

beng

o

te

te

payng

ocked

a

a

wt

meda

border

ead

o

te

o

te

ossa

s

structures?

and

te

aponeurotc

coverng

te

supped

semmembranosus

band

o

Guteus

mnmus

Guteus

maxmus

D.

T ensor

ascae

E.

Rectus

emors

mensca

gaments

s

90.

A

28-year-od

knee

n

a

comes

to

te

seen

musce

more

o

o

te

ceary

to

An

Semmembranosus

Gracs

o

C.

Popteus

experences

track-and-ed

event.

An

deep

pan

utrasound

n

o

te

atera

gutea

as

part

payer

o

o

MRI

te

s

a

o

ts

te

a

removed

sku.

T o

bran,

aspect

s

used.

nerve,

o

a

te

Wat

nserts

nserton?

brougt

knee

te

o

n

knee

te

most

te

emer-

Pysca

aspect

sows

tuberce

emora

tuberce?

to

njury.

meda

te

knee,

meda

tan

ts

B.

oten

te

musce,

sweng

gament

attaces

o

s

te

o

neror

because

sows

aspect

nvaded

coverng

o

sows

procedure

bran

ateras

tssue

basketba

tenderness.

meda

superor

surgca

te

because

Imagng

atae

department

and

te

as

tssue

te

dense

tat

pyscan

monts.

coverng

tssue

vastus

by

te

2

Durng

tumor

C.

bucket-ande

compettor

te

to

past

mater

mportant

examnaton

traton

bran.

dura

B.

o

comes

te

ootba.

sweng

poston.

oowng

te

te

or

medus

exed

te

n

and

woman

A.

regona

te

meda

por-

compress-

atus

one

a

Above

oowng

ts

ts

gency

e

accessory

pantars

Guteus

be

because

an

emors

ca. A week ago, te pan amost caused m to drop out

pyscan

o

gastrocnemus,

semtendnosus

A.

crucate

man

o

depart-

emergency

we

o

o

musce,

tenderness

sows

o

tg,

crease

nto

to

knee

sows

Wc

o

te

superor

bceps

o

eadaces

tumor

band

ovas

brougt

s

o

45-year-od

togeter

and

coatera

27-year-od

Popteus

a

crucate

D.

Adductor

E.

te

coatera

C.

D.

severe

njured?

A.

T endon

te

tuberce

emora

ossa

knee

pubc

nguna

o

man

C.

porton

te

njurng

knee.

tear

to

te

T endons

repace

examnaton

te

A

o

23-year-od

Pysca

s

va

angograpy.

sympyss

D.

A

cateterzaton

artery?

C.

ment

88.

te

T endon

B.

exstence

o

artery.

te

wc

A.

te

ead

.

.

antegrade

andmarks

o

Haway

pubc

87.

or

Fig.

by

Fig.

o

a

on

te

tear

te

condye

coud

ndvduas.

Wat

250

C H A P T E R

91.

5

Lower

D.

Adductor

E.

Vastus

A

magnus

son

o

an

te

operaton

ow

emora

te

92.

te

emora

bypass

aspect

ac

s

orms

to

an

te

s

he

a

postve

sgns

s

drawer

expected

te

to

sgn.

be

knee

Wc

present

o

he

tba

can

be

sgty

dspaced

anterory

he

tba

can

be

sgty

dspaced

posterory

o

te

te

rom

seat,

oor

C.

he

bua

can

be

sgty

dspaced

posterory

D.

he

bua

can

be

sgty

dspaced

anterory

E.

he

o

tba

and

bua

can

be

sgty

trange?

Sartorus

durng

D.

Pectneus

department. An MRI examnaton sows a

E.

Rectus

around

ongus

emors

woman

prorms

by

surgca

te

was

o

te

troug

two

Part

pan

o

and

a

te

or

wc

te

Wen

ceared,

esser

a

musces

and

96–120

23-year-od

monts

sows

owng

was

te

not

Pantar

Cacaneobuar

o

C. Long

E.

nerves

97.

A

ts

te

oowng

musces

pass

troug

openng?

ead

30

o

coatera

boy

coson.

te

Obturator

nternus

ematoma.

B.

Obturator

externus

key

Quadratus

A.

Deep

mnmus

B.

Acetabuar

E.

Guteus

medus

C. Descendng

o

a

1-year

ower

axs

mb

o

te

Wc

tese

story

sows

te

o

an

emora

o

comes

te

pyscan

osteopoross.

ange

neck

to

oowng

examnaton

to

o

160

te

An

degrees

axs

o

condtons

te

s

x-ray

o

te

made

by

te

emora

sat.

assocated

E.

98.

wt

A

72-year-od

department

ndngs?

scan

o

vara

Neuroogc

vaga

anke

C.

Genu

vagum

D.

Genu

varum

E.

Haux

ton

sows

stretcng

Wc

tese

o

man

o

comes

pan

rom

te

te

to

n

nammaton

te

s

o

te

cacaneus

oowng

pyscan

oot.

to

toug

te

condtons

because

Pysca

band

ba

s

o

Pott

B.

Dupuytren

C.

T arsa

D.

Pantar

E.

Rupture

tssue

te

oot.

caracterstc

o

L3

E.

99.

woman

s

mnutes

se

to

was

te

emergency

nvoved

n

a

te

emergency

nvoved

sows

a

n

depart-

a

motor

racture

examnaton

oowng

atera

o

sows

Wc

responsbe

a

3-mont

and

man

o

sows

arteres

crcumex

atera

a

s

te

arge

most

emora

crcumex

brougt

ost

an

area

te

or

to

te

emora

emergency

conscousness.

sows

o

o

scemc

no

response

oowng

ts

comes

story

meday

o

nerve

A

CT

stroke.

to

te

roots

s

reex?

Wc

o

Rectus

B.

T ensor

te

emors

ascae

atae

ntermedus

D. Semmembranosus

Sartorus

to

te

pyscan

progressve

rotatng

damaged?

A.

E.

s

se

examnaton

o

C. Vastus

brougt

ater

to

S1

key

gament

o-

emora

woman

test.

20-year-od

cmbng.

sprng

te

obturator

o

brances

bran

A

ng

ascts

30

L2

B.

D. L5

o

racture

50-year-od

A.

C. L4

tunne

department

key

o

racture

o

reex

examna-

symptoms?

A.

A

most

vagus

story

te

o

branc

because

te

Coxa

34-year-od

o

ac

branc

Retnacuar

Coxa

1-week

Wc

tear?

arteres

B.

a

ematoma

examnaton

(sprng)

was

MRI

o

crcumex

A.

A

e

x-ray

An

crcumex

D. Meda

because

ater

Wc

Guteus

woman

a

oot

njured?

D.

67-year-od

oot.

s

emergency

(detod)

brougt

An

emur.

C.

A

s

mnutes

A.

emors

Pysca

as

cacaneonavcuar

5-year-od

vece

o

te

te

pantar

meda

tendon

o

key

njured

to

pantar

D. Sort

at

payer

admtted

maeous.

most

B.

coud

s

everson

gaments

A.

ment

wc

meda

excessve

and vesses destned or te regon o te perneum. he

o

te

basketba

and

made

oramen,

severa

mae

tranng

nerve

area

tendon

scatc

A

was

scatc

decson

musce.

and

smaer

n

syndrome,

terapy.

dented

emergng

by

been

prorms,

resecton

dden

ad

entrapment

pysca

troug

entrapment

rst

Questions

96.

37-year-od

seen

dspaced

anterory

C.

be

o-

examnaton?

Iopsoas

or

te

pysca

B.

t

an

examna-

durng

B.

A

sows

Pysca

restored.

emora

o

sows

owng

o

A.

porton

te

ton

MRI

gament.

bood

separated

porton

to

occu-

artery.

and

arteres

genty

atera

ospta

o

emora

proxma

and

Posteror

te

te

emora

te

soated

tssues.

te

successuy

and

procedure

o

to

because

An

crucate

Adductor

passed

95.

admtted

coson.

anteror

A.

reeved

94.

te

artery

musce

rom

93.

s

perormed

surroundng

wat

man

proxma

s

vece

njured

oemora

between

Durng

motor

medas

65-year-od

undergo

Limb

s

tg

dicuty

we

oowng

because

to

ex-

runnng

musces

s

and

most

CHAPTER

100.

A

a

69-year-od

6-mont

pae

oot.

poptea

sows

artery.

an

s

vascuar

andmark

A.

Adductor

B.

Femora

to

o

te

A

o

te

tg

artery

dagnoss

utrasound

emora

at

te

o

patent

o

to

and

artery?

comes

o

ower

o

coatera

mb.

sows

Descendng

o

te

vascuar

to

te

o

because

n

105.

n

te

s

102.

adductor

most

s

cana.

crcumex

Obturator

tg?

te

atera

crcumex

34-year-od

o

a

abdomen

eavy

wegts

maxma

datey

era

to

upper

te

emora

e

s

T wo

upper

at

He

days

te

a

be

as

ago,

wegt

tg,

sows

te

ound

o

been

and

2-our

rgt

oot

An

by

B.

Fbuars

22-year-od

pan.

vta

a

ty

s

te

to

nerve

most

E.

detoxcaton

107.

program.

He

as

been

an

a

ntravenous

he

vta

oot

most

patent

o

group

returns

g

o

s

te

ever

nodes

rst

wound?

nguna

to

te

n

ospta

te

patent

sgns

sows

atera

s

are

wtn

tat

o

emodynam-

te

obterated.

key

because

aspect

afected

norma

base

Wc

by

ts

o

te

o

te

njury?

A

ongus

er

brougt

ater

wt

motorcyce.

are

o

wtn

er

eang

er

key

s

coson

ncdent,

adduct

n

te

er

et

and

Se

pysca

appears

tat

bone

examnaton

o

te

to

be

An

not

Sx

a

eg

we,

x-ray

requre

racture,

caus.

n

rgt

mts.

does

pevc

tg. Wc

emergency

nvoved

norma

te

te

was

pevs

o

to

se

a

nerve

monts

sows

nab-

oowng

nerves

afected?

gutea

D. Superor

or

s

entrapped

C. Ineror

musce

ospta

and

nguna

sot

competey

racture

artery

te

s

mnutes

Durng

Femora

to

s

brougt

beng

te

sgns

B.

admtted

o

30

under

er

ater

at-

musce

Wc

superca

woman

vece

becomes

structures?

s

and

aucs

A

Obturator

man

te

because

nected

buet.

brevs

Extensor

Femora

ongus

o

s

E.

B.

Adductor

ater

superca

o

D. Fbuars

A.

25-year-od

admnstered,

ongus

ven

E.

te

wound

anteror

Femora

A

a

musces

Tbas

A.

D. Femora

man

x-ray

A.

surgery.

Wat

mmedatey

o

story

stabzed,

sows

mak-

n

nodes.

group

metatarsa

and

mme-

erna.

days

posteror

superca

ac

a

pnned

te

tng

we

wrtng

emora

because

area

Four

s

emergency

s

ac

department

pyscan

pan

drops

woud

ernated

te

tg.

years.

efort,

at

to

ncreased

10

structure

C. Pectneus

103.

comes

o

examnaton

reerence

deep

sot

he

te

on

C. Gastrocnemus

106.

o

ago.

to

btten

department

rom

group

19-year-od

motor

and

or

grabbed

Pysca

branc

man

story

ower

a

emora

was

251

Limb

nguna

oowng

pro-

artery

A

ng

ymp

admtted

ours

ymp

o

t

made.

key

2

reeased.

A

mts.

gencuar

peroratng

2-day

s

s

e

antrabes

swoen

cay

emora

emora

E.

an

Interna

te

examnaton

o

dsease

w

o

wakng.

puses

utrasound

arteres

branc

o

occuson

porton

perpera

pyscan

dicuty

absence

An

an

crcuaton

B.

te

sows

oowng

Descendng

to

progressve

proxma

A.

D. Frst

dog

emergency

receves

E.

man

te

C. Meda

te

man

because

D. Horzonta

mb

te

o

a

sutured,

perormed. Wat

te

by

C. Deep

story

dagnoss

vde

aso

puse

a

An

42-year-od

department

Externa

examnaton

o

Wc

te

s

poptea

and

made.

n

A

V ertca

ower

artery

artery

s

arteres

ee

te

puse

104.

B.

49-year-od

arteres

te

o

no

o

and

sympyss

6-mont

Pysca

sows

cod

A.

cana

a

o

dsease

because

worsenng

cana

D. Inguna

A

pyscan

trange

ossa

Pubc

te

utrasound

tba

C. Poptea

E.

101.

An

and

to

progressve

examnaton

occuson

emora

te

comes

o

Pysca

perpera

te

man

story

Lower

5

gutea

Tba

29-year-od

remova

o

racture

o

a

man

cast

te

s

rom

et

brougt

s

ower

et

mb

to

eg.

6

te

He

weeks

pyscan

ad

or

sustaned

pror,

wc

a

was

drug abuser njectng mse wt temazepam (a power-

mmobzed n a cast tat extended rom just beow te

u

knee

ntermedate

epam

actng

[V aum])

resdua

scar

and

tssue

drug

eron

over

n

te

or

ponts

same

5

group

years,

o

as

eavng

vascuar

daz-

muc

access.

he

pan

cast

to

te

but

was

oot.

norma

At

te

tme

strengt

removed,

n

pysca

o

njury,

te

ower

tere

mb.

examnaton

was

severe

Wen

sowed

a

te

pro-

emora vens n s gron are te ony accessbe and pat-

nounced et oot drop wt parestesa and sensory oss

ent

over

vens

or

andmarks

s

ntravenous

te

most

use.

reabe

Wc

to

denty

A.

he

emora

ven

es

meda

B.

he

emora

ven

es

wtn

C. he

emora

D. he

emora

ven

ven

es

es

atera

o

to

te

te

to

drecty

te

tese

vens?

emora

emora

te

oowng

emora

meda

to

artery.

cana.

te

artery.

emora

nerve.

E.

he

emora

te

dorsum

o

ts

patent’s

A.

Common

B.

Superca

C. Deep

es

atera

to

te

emora

nerve.

te

et

E.

Tba

symptoms?

buar

buar

buar

D. Scatc

ven

o

oot

and

atera

eg.

Injury

to wc o te oowng nerves s te most key cause

252

C H A P T E R

108.

A

5

Lower

12-year-od

ater

or

24

oot

te

te

w

oot

and

te

maeous,

te

department

sows

tba

to

o

te

nodes

Tba

Fbuar

sde.

D. Posteror

wc

o

s

area

e

unabe

te

coded

wak.

posteror

n

s

to

te

wt

one

Pysca

drawer

test

reaton

to

conrmed

s

o

s

Fbuar

C. Tba

D. Meda

te

o

A

and

te

patent

Wc

A.

Sapenous

B.

Obturator

te

C. Latera

perormng

ts

E.

A

emora

spran

gament

o

te

er

anke

most

oowng

njecton

mt

easy

He

n

receves

te

rst

nerves

s

n

s

o

o

s

correcton.

key

rgt

te

anestetc

space

and

most

pan

racture

oca

web

manpuaton

oowng

a

o

a

and

to

Wc

by

per-

o

te

E.

115.

te

B.

Cutaneous

branc

o

deep

C. Cutaneous

branc

o

superca

oca

an

buar

buar

buar

patent

cam

m

cuar

njecton

buttock.

to

down,

he

t e

up p e r

s

dam age

s

at

an

o

s

a

 ntramus -

q uadr ant

t s

w  c

wo

aggres s ve . T o

g ven

ate ra

g ven

to

m an

b ecome s

p at e nt

njecto n

prevent

3 0- ye ar-o d

sud d e n y

te

n

a

o

s p ec c

te

te

o ca -

o ow ng

ner ves?

Latera

B.

Scatc

emora

cutaneous

gutea

Ineror

a

ootba

anteror

te

pyscan

o

cass.

an

by

Pysca

tenderness

er

nverson

exam-

over

wc

(sprng)

to

Pysca

to

reex.

te

te

pyscan

examnaton

Wc

tendon

o

tat

te

s

or

sows

a

a

oowng

struck

wen

reex?

Quadrceps

Quadratus

E.

116.

A

emors

emors

Bceps

emors

22-year-od

department

motor

pnned

and

under

er

vta

because

game.

drawer

structures

o

te

s

o

bow

An

knee,

nabty

to

Pysca

sgn.

brougt

te

knee

to

to

sows

ncudng

er

emergency

wak

durng

examnaton

MRI

te

ater

a

sows

njury

meda

se

tacke

n

postve

to

severa

menscus.

oot

n

o

ensure

ts

er

over

poptea

woud

woman

coson

are

wt

wtn

et

knee

artery.

Meda

crcumex

emora

Latera

crcumex

emora

E.

Fbuar

tba

artery

artery

artery

and

appears

and

o

B.

tba

et

sows

A.

D. Posteror

er

Se

bood

emergency

nvoved

an

jont.

severe

te

to

be

x-ray

we,

deor-

sows

racture.

An

compresson

oowng

suppy

to

te

a

eg

Pysca

obvous

An

n

rgt

mts.

supracondyar

patent?

C. Anteror

te

was

knee

Wc

adequate

to

se

norma

brusng,

er

dsocated

te

brougt

ater

motorcyce.

sows

seen

s

mnutes

sgns

posterory

te

atera

s

woman

30

vece

utrasound

gutea

24-year-od

department

a

contrbute

ts

B.

mty

D. Obturator

receved

dance

sows

comes

patear

A.

a

C. Superor

E.

key

(detod)

man

examnaton.

examnaton

A.

A

most

o

and

D. Pectneus

nter ve w,

psycatrc

ton

eg

C. Sartorus

Common

Durng

coatera

58-year-od

testng

to

story

cacaneonavcuar

yperreexve

D. Sura

E.

A

musces

Sapenous

s

er

pantar

meda

routne

anestetc?

A.

nerves

o

pantar

D. Sort

(docane)

oot,

bocked

oot.

rst

aspect

mont

because

gaments?

C. Long

sows

2-day

w

ment

because

brougt

a

durng

key

Pantar

toes.

gament

oot

meda

meda

procedure

One

pyscan

oowng

s

o

Cacaneobuar

parents

strpng

removed.

te

because

te

cutaneous

gr

because

o

naton

menscus

te

on

Femora

16-year-od

gament

o

ven

are

to

pyscan

vens

D. Tba

coatera

s

te

procedure?

B.

by

vens

te

te

A.

x-ray

varcose

over

te

to

varcose

returns

o

durng

comes

o

oot.

sensaton

moter

crucate

er

perormed,

gament

Posteror

second

112.

o

njured

Injury

njured

gament

woman

story

team-

emur.

key

semtendnosus

A 16-year-od boy s brougt to te emergency depart-

An

111.

5-year

crucate

coatera

te

examnaton

perormed

s

by

emergency

114.

B.

a

aso

gament

crucate

o

58-year-od

oot.

brougt

to

backward

structure

Anteror

A

oss

because

wen

A.

E.

113.

s

menscus

T endon

aspect

test?

110.

E.

structures

gament

coatera

C. Latera

sde

oowng

coatera

wt

tg

s

te

B.

ater

man

o

tacke?

A.

atera

n

te

s

atera

te

by

exam-

abrason

te

Wc

posterory

nguna

s

moves

wc

ymp

scraped

Pysca

rom

s

oot

oot

22-year-od

and

on

by

et

ossa

Superca

mates

ad

puruent

spread

s

o

Meda

E.

e

o

dtc.

tenderness

regona

B.

A

a

pyscan

areas?

surace

o

earer

key

Latera

D. Soe

te

sweng

dranage

sows

A.

C. Poptea

109.

oot

a

to

and

days

n

most

to

oowng

brougt

hree

erytema,

Inecton

s

redness

wadng

o

edema,

te

o

ours.

we

naton

o

boy

because

Limb

o

arteres

eg

and

CHAPTER

117.

A

a

68-year-od

6-mont

ng.

man

story

Pysca

ower

mb.

absent.

A

he

ton

s

puse

oowng

sow

te

A.

Femora

B.

Obturator

C. Common

o

eg

artery

A

nerve

te

tg.

120.

E.

A

s

revas-

s

conduc-

B.

Anke

nerve

Wc

tat

o

D. Latera

E.

20

te

and

CT

room

er

eg

ner ves

te

and

n

a

o

oot.

te

key

s

o

wc

n

te

te

oss

o

meda

o

te

te

B.

o

or

122.

te

te

to

deep

anteror

35-year-od

vece

reconstructve

D. Tba

weak

a

6-mont

an

area

o

Pysca

story

o

ncreasng

numbness

on

examnaton

te

sows

pyscan

dicuty

dorsum

a

ard

o

because

wakng

s

mass

at

rgt

te

o

beng

scan

o

bua

ng

or

owng

on

te

and

s

s

eg

sows

tba

tat

te

most

neuroogc

Weakness

o

on

o

te

C. Weakness

sensaton

o

te

o

Gracs

B.

Sartorus

C. Rectus

toes

Wc

o

te

account-

o

te

123.

abnormates

aspect

at

sensaton

o

te

rst

o

knee

aspect

te

reex

te

and

te

and

second

te

o

pantar

exon,

te

exon

decreased

oot

at

te

te

decreased

te

rst

anke,

sensaton

o

tat

Wc

sen-

toes

at

3-day

anke,

and

sec-

weakness

te

pantar

arm

o

extensor

te

ongus

dorsum

o

just

dsta

to

te

s

ater

te

tg.

to

he

eg

a

woman

an

Wc

ts

to

emergency

nvoved

s

autograt

a

usng

supercay

musce

n

undergong

s

on

most

a

te

key

reconstructon?

and

paced

a

et

nodes

te

pyscan

et

unwttngy

sows

o

to

panu

buttock.

se

on

w

sat

er

named

rst

on

a

because

Se

s

a

tumb-

car.

Pysca

panu

buttock.

receve

ymp

rom

wound?

Superca

nguna

orzonta

nguna

vertca

C. Superor

and

D. Externa

ac

neror

group

group

gutea

nodes

nguna

25-year-od

2-week

te

was

patent

wt

comes

o

student

group

nected

Deep

to

e

ocated

perorm

meda

maeous

brougt

surgery

and

maeous

meda

Superca

a

ts

pens

B.

E.

artery.

typcay

sympyss

te

A.

A

stockng

peds

aucs

on

ongus

meda

te

te

story

examnaton

eg

decreased

dorsexon

between

decreased

o

te

to

medas

Vastus

39-year-od

a

s

examna-

and

dorsas

a

and

emors

scooteacer,

oot

anke

and

and

to

E.

A

Pysca

ongus

pubc

ven

ateras

o

o-

124.

Weakness

o

between

nerve,

te

D. Vastus

tack

jerk

te

nverson,

decreased

toe

at

everson

ond

aspect

meda

pantar

and

o

a

descrpton

knee

exon

between

D. Weakness

tumor

o

A.

examnaton?

B.

sensaton

bone

symptoms.

key

Decreased/absent

E.

arge

compressng

neuroogca

A.

saton

a

s

sde

and

antero-

te

or

dabetc

gove

ocatons

coson.

arvested

oot.

atera aspect o s rgt eg just beow te knee. A CT

years.

o

pyscan

been

cassc

o

mnutes

adductor

meda

te

te

as

aucs

man

20

C. Obturator

to

to

dorsa

posteror

motor

comes

puse

exor

cm

Sapenous

man

a

dgtorum

cm

2

to

20

n

tendons

E.

B.

Fbuar

and

condtons

tunne

department

57-year-od

tptoeng

oowng

oot

Femora

E.

tn-

exercse.

symptoms?

He

oowng

extensor

A.

A

tese

past

ow

D. 2

A

troube

te

comes

te

and

Superor

te

te

durng

syndrome

man

C. Ineroatera

o

oowng

repar

o

tarsa

sensa-

sde

ee

spran

parestesa

Between

te

T wo

o

o

because

and

papated?

and

operat-

s

sows

examnaton.

sows

artery

wt

o

pyscan

numbness

121–143

Wc

A.

aspect

o

gament

tunne

50-year-od

meda

te

neuroma

dstrbuton

ypovo-

emur

to

as

a

caugt

str uctures.

and

njured

n

racture?

119.

A

ton

utrasound

n

te

taken

tg

s

An

o

patent

Brances

most

sock.

damaged

p

Se

ematoma

Se

te

anteromeda

were

a

scene.

emergency

nvoved

rgt

racture

ar ter y.

repar

postoperatvey,

to

be

te

was

er

te

massve

sows

emora

or

at

to

se

wt

motorcyce

to

brougt

ater

coson

appears

r uptured

s

mnutes

scan

ton

T arsa

to

bouts

sgn. Wc

nverson

ypertensve

tg.

days

meda

o

253

Limb

ascts

C. Morton

te

comes

caracterstc

Pantar

121.

woman

sows

ng

most

man

story

examnaton

A.

ts?

examnaton

a

te

ac

Questions

vece

A

on

oow-up

depar tment

emc

3-mont

postve Tne

Scatc

beneat

a

Pysca

a

buar

30-year-od

motor

60-year-od

gng

D. Tba

118.

A

o

cod

common

n

o

wak-

ndcates

artery.

te

actvty

te

tba

te

emora

o

wt

nontender,

Postoperatvey,

decreased

s

a

posteror

s

because

dicuty

nvovng

adductors

nerves

pyscan

sows

te

o

perormed.

nnervates

o

procedure

studes

te

utrasound

occuson

cuarzaton

to

progressve

examnaton

Dopper

trombotc

artery

comes

o

Lower

5

man

story

o

comes

pan

at

to

te

s

pyscan

knee

jont.

because

He

o

exercses

reguary, and 2 weeks ago e njured mse as e was

runnng

n

te

open

stadum.

Pysca

examnaton

254

C H A P T E R

sows

s

a

Lower

“tearng”

knee.

owng

Based

actons

A.

Fexon

B.

Extenson

o

are

o

afected

p

te

and

p

as

e

symptoms

due

to

ts

extenson

and

s

tryng

wc

o

to

lex

rgt

te

o-

extended

njury?

o

te

te

knee

ments

was

o

te

p

A.

Fbuar

o

te

p

B.

Tba

Hp

extenson

24-year-od

Se

and

because

was

suddeny

and

tg

movement.

Adducton

sows

an

Wc

key

A.

been

B.

pectneus,

Bceps

sus,

C. Iacus

n

and

medus

E.

Guteus

maxmus

F .

Iacus,

6-year-od

parents

y

or

story

a

standng

uses

and

s

ten

ease

s

te

to

Quadratus

posteror

129.

exon.

arge

tuberosty.

most

adductor

mag-

bar

knees

semtendno-

and

pyscan

He

to

to

sows

He

up

as

a

am-

se

as

ton

er

orward,

te

Wc

by

o

oor,

or

o

ts

te

ds-

dsease.

dicuty

rgt

Wc

most

key

ts

past

Se

drops

te

or

Durng

every

oowng

correspond

wt

ntramuscuar

tme

to

er

a

se

sexuay

doctor

pysca

er

rgt

ocatons

pysca

tat

examna-

rases

njecton

te

o

w

presentaton

patent?

A.

Superomeda

B.

Superoatera

C. Ineromeda

D. Ineroatera

Posteror

quadrant

quadrant

quadrant

o

o

o

o

te

te

te

te

buttock

Wc

ts

B.

Psoas

buttock

tg.

te

cosey

oowng

s

because

o

admtted

a

to

30-mnute

te

emergency

In

story

o

acute

It

ncreased

anteror

ten-

superor

most

wc

a

um-

o

key

te

o-

te

sows

ower

s

made.

te

T o

te

te

A

rgt

suspcon

conrm

patent’s

patent

oowng

and

quadrant.

n

tenderness.

stragten

causes

te

rgt

depart-

vomtng,

tenderness

rebound

to

emergency

to

musces

ts

exed

wnce

most

wt

key

nternus

man

story

to

pan

Pysca

aspect

te

on

te

pyscan

te

pan

meda

to

be

examnaton

o

nvoved

nto

ascent

arces

wt

te

n

a

s

n

eg

ts

because

aspect

constant

sows

and

wt

o

and

numbness

meda

patent’s

structure

to

n

to

poptea

te

te

te

te

posteror

assocated

zonta

comes

o

descrbes

ascent

anteror

s

n

te

nausea,

maxmus

posteror

ts

to

pantar

numbness

wc

o

s

te

caracterstcs?

B.

E.

hs

nerve

Emptes

D. It

man

rgt

and

magnus

He

A.

es

taken

pan

assocated

ts

s

appendcts

meda

he

C. In

aong

year,

atera

nvovement

anorexa,

wt

o

nonradatng.

buttock

te

s

emors

3-day

es

o

ast

sows

psatera

trackng

attempt

60-year-od

arc.

over

progres-

n

major

Guteus

s

mass

symptom?

Adductor

on

o

made.

A.

buttock

tg

22-year-od

department

quadrant

man

o

an

s

a

te

examnaton

pan.

o

growng

ound

emergency

o

nternus

quadrant

tg

A

te

story

tubercuoss

was

pattern

abdomna

C. Bceps

treatment

compans

wakng.

p

o

week

deep

and

or

to

to

2-mont

ongus

because

dagnoss

E.

te

ga-

maxmus

Obturator

dagnoss,

mnmus

receves

tba

major

23-year-od

ower

131.

oot.

Prorms

D. Obturator

woman

te

musces?

Pysca

n

brougt

a

examnaton

abscess

Psoas

A

mass

hs

an

s

o

treated

meda

B.

severe

gastrocnemus

guteus

o

oowng

njured?

coug

Pysca

just

spne.

ment

weecar

bends

nvoved

130.

s

dicuty

rom

stand.

by

Iopsoas

transmtted

spne.

A.

E.

sartorus

Hamstrngs

43-year-od

was

D. Guteus

and

eadng

key

te

an

tat

coatera

man

occuent

suggests

emors

maxmus

njectons

He

derness

magnus

te

pus

dspacement

o

to

sowed

coatera

because

worsenng

gron.

x-ray

as

emors,

poston.

m

njury

mb

crucate

51-year-od

svey

mnmus

to

kck

poptea

department

severe

An

A

owng

dsease

and

medus

E.

te

ac

ongus,

adductor

most

D. Guteus

A

on

orceu

knee

musces

examnaton

s

s

C. Guteus

o

Obque

caused

B.

F .

F .

process?

Tbas

A

se

sows

weak.

examnaton.

seated

stragtens

A.

E.

and

C. Adductor

brougt

ep

musces

a

sca

o

Posteror

process?

rectus

muscuar

rom

oowng

and

Pysca

ands

te

guteus

key

a

ower

crucate

E.

magnus

and

te

anteror

(atera)

D. Anteror

gracs

oow-up

o

dependency.

and

sgty

o

o

emur. Wc

(meda)

er

sweng

oowng

group

ts

major,

boy

aso

s

most

n

major

D. Guteus

A

gym,

semmembranosus,

psoas

psoas

and

emergency

pan

examnaton

adductor

adductor

and

pan

racture

emors,

and

s

oowng

te

oca

extenson

tg

brevs,

te

appened

p

nvoved

Adductor

nus,

te

te

at

to

sustanng

MRI

C. Patear

to

excrucatng

Pysca

avuson

o

o

hs

rgt

o

exon

brougt

deveoped

buttock.

o

s

exercsng

rgt

weakness

knee

woman

ater

An

caused

respect

rotaton

A

pan

eg.

trauma

wt

dorsexon

knee

rotaton

e

128.

sensaton

tese

D. Latera

tg.

127.

pan

on

te

department

126.

Limb

C. Meda

E.

125.

5

group

o

meda

meda

meda

meda

to

wt

te

ven

aspect

o

condye

aspect

o

condye

meda

nodes

superca

tat

te

o

te

o

eg,

te

eg,

te

t

trav-

emur

t

trav-

emur

maeous

dran

nguna

to

te

nodes

or-

CHAPTER

132.

A

56-year-od

ow-up

man

comes

examnaton

s

great

te

past

toe.

10

He

years

soes

because

easy

wear

weekends

as

and

te

o

te

ound

examnaton

two

Wc

o

t

used

Pysca

toes.

te

dabetes

He

as

to

repeated

nds

tps

down.

but

o

and

soes

to

t

a

o-

ucers

te

payng

dicut

to

nerves

utrasound

o

on

Superor

B.

Ineror

C. Deep

gutea

gutea

buar

D. Superca

E.

133.

Common

o

a

ng

story

makng

Dorsexon

B.

Fexon

a

tat

or

10

at

tg.

e

s

examnaton

radatng

wc

upon

at

te

as

te

tg,

pan

nsde

tg

most

o

been

ago,

Femora

B.

Superca

we

wegt

and

o

and

key

A

et

erna

nguna

ovas

Obturator

to

ers

s

o

dscarged.

te

oowng

B.

Superca

A

Interna

taar)

pace

Pantar

B.

Inverson

D. Pantar

E.

superca,

days

o

stab

ater

area

ymp

wound

sutured

se

tat

are

wt

and

o

te

and

an

t

5

maase.

metus,

nsect

and

2

a

n

A

ater.

tender,

aspect

o

oowng

panu

and

patent

se

Pysca

ndngs

s

te

ud

exam-

sweng

trd

o

Se

to

puruent

mdde

was

ago.

acoo

amounts

pysca

o

he

uctuant

te

copous

emergency

week

apped

days

cm

te

story

ncreased.

durng

o

te

puruent

most

examnaton

key

o

ts

s

a

ts

and

exon

se

brougt

e

down

racture

o

te

E.

ac

A

Enarged

22-year-od

department

wound

motor

dran-

Wc

o

ts?

and

o

to

te

te

te

An

taocrura

oowng

x-ray

(tbo-

movements

are

tere

and

nverson,

and

everson

mnutes

x-ray

nguna

ymp

ater

wt

te

and

Urnary

B.

Weak

se

was

nvoved

er

et

and

n

rgt

a

eg

E.

Weak

ton

are

nguna

te

nodes

te

pevs

te

er

et

and

Se

appears

o

te

sows

rgt

te

rgt

an

and

o

oowng

to

be

to

mb,

nerory

neror

n

and

ds-

pubc

jont

conrms

pysca

ncontnence

we,

scopubc

rgt

seen

be

a

eg

Pysca

ower

sacroac

te

n

rgt

mts.

examnaton

key

emergency

nvoved

superor

te

te

norma

rupture

eca

to

was

over

MRI

o

and

te

obturator

examna-

ts

patent?

dmnsed

perneum

o

ower

te

p

meda

o

and

dmnsed

sensa-

tg

te

p

and

postve

sgn

o

anteror

extenson

te

ymp

se

deormty

o

An

most

over

exon

over

wt

rgt

abducton

te

brougt

ater

wtn

te

te

sows

and

over

s

no

adducton

C. Weak

over

are

dsocaton

A.

emergency

superca

nodes

motorcyce.

o

o

T rendeenburg

to

o

nguna

ymp

tenderness

ndngs

D. Weak

brougt

er

sgns

membrane. Wc

ton

deep

mnutes

sympyss.

ton

everson

coson

An

wt

group

coson

racture

dagnoss

nverson

s

superca

nodes

sows

s

sensaton

dorsexon

dorsexon,

and

vta

examnaton

emergency

stars.

30

under

er

o

woman

vece

pnned

jont?

and

woman

30

vece

poptea

everson

exon,

Dorsexon

138.

orzonta

group

pubc

a

o

nodes

D. Enarged

ram

s

group

C. Enarged

ramus.

woman

vertca

Enarged

paced

Wc

at

T ender

but

exon

department

×

draned

present

patent

receve

enarged.

nodes

er

ay-

te

deveops

rst

to

two

ac

22-year-od

motor

s

ympatcs

because

A.

A

and

wound

sows

jont.

C. Pantar

136.

deep

emergency

ac

oot

takng

a

te

nguna

69-year-od

er

o

wound

to

nguna

department

o

comes

ac

D. Common

135.

te

group

Externa

E.

hree

deep

A.

C. Deep

he

deep

and

te

B.

woman

sutures,

rom

5

anteroatera

aso

by

area

rom

wc

nerve.

nodes

rng

because

age

rng

cana

tg.

necton,

eg

to

2-day

dabetes

sweng

a

tba

dmnsed

movements?

brougt

a

ever,

2

prurtc

Wc

be

eg,

et

te

An

oot

s

o

type

dran

ymp

22-year-od

posteror

te

et

o

sows

eg,

ud.

ts

te

te

to

te

woman

te

wen

over

A.

nguna

D. Fossa

department

on

naton

tg

cause

to

o

because

story

began

n

tngng

s

a

ste

rng

C. Deep

E.

exon

50-year-od

knee.

ematoma

patent?

A.

A

eg

scratced

presentaton?

134.

dgts

A

we,

oot

te

Pantar

be

Pysca

tg

te

btten

t-

te

er

sow

oowng

o

as

te

wrtng

movement.

woud

because

area

days

dropped

upper

te

He

T wo

sows

down

openng

pan

years.

efort,

exacerbated

troug

upper

grabbed

Pysca

s

and

maxma

sensaton

ncreased

pyscan

w

rgt

arge

255

Limb

to

mts.

er

a

compressng

o

sweng

te

o

te

o

sows

D. Extenson

department

njury

to

o

te

appears

norma

sweng

C. Extenson

E.

137.

a

Se

wtn

artery

o

A.

njury

comes

o

wegts

mmedatey

nerve

wc

rst

njury

are

examnaton

key

njury

motorcyce.

sows

poptea

strengt

njury

nerve

man

abdomen

eavy

pan.

nerve

buar

34-year-od

ower

nerve

buar

A

2-day

nerve

te

er

sgns

examnaton

Neuroogc

afected?

A.

vta

examnaton

area

te

most

under

er

s

nvoved.

o

s

and

or

soccer

be

numbness

toe

pnned

to

mantanng

around

enjoy

oowng

or

and

ypertenson

dicut

sows

te

pyscan

njury

Lower

5

te

p

tg

o

te

posteror

and

and

p

dmnsed

meda

and

tg

sensaton

eg

dmnsed

sensa-

256

C H A P T E R

139.

A

5

Lower

32-year-od

pan

n

te

a

e

runnng

was

ootba

Pysca

and

He

s

maeous

o

descrbes

Weak

B.

Weak

sum

and

E.

A

te

and

under

nabty

a

jont

te

o

s

seen

pysca

o

o

te

te

tba

s

to

over

ee

a

ater

se

wt

er

and

on

et

sde

te

et

Se

te

pn

et

te

te

varus

knee

prck

over

Inabty

to

ex

nvoved

et

and

appears

and

be

a

te

te

mmedate

wegt

rgt

te

knee

wen

swoen

te

o

oot

and

A

A

to

s

w

x-ray

correct

A.

Posteror

B.

Pantar

o

and

here

o

te

knee

s

examnaton

bers

te

to

swoen,

o

te

quad-

oowng

s

te

structure?

neura

crest

o

ces

condrcaton

wakng

and

te

and

game,

te

o

te

o

te

s

up

anke.

wt

sowed

were

sweng

se

a

a

Se

knee.

be

a

gt

o

wak-

ractures.

taobuar

cacaneonavcuar

to

key

te

rgt

to

spke

soe

wt

“pop”

and

unabe

An

mesoderm

boy

at

pregnancy.

37

weeks’

Pysca

ges-

exam-

ray

te

or

neura

sows

o

te

14

patent’s

te

crest

trd

ce

apoptoss

paanges

oowng

ter

deormty?

toe

dd

not

mgraton

o

n

embryoogc

tssue

deveop

nto

te

between

oot

dgta

o

sgna

rom

te

zone

o

poarzng

actvty

(ZPA)

E.

Fauty

Questions

144.

A

deveopment

o

condrcaton

centers

144–148

22-year-od

and

under

er

vta

nabty

to

Wc

o

ror

poe

most

A.

a

o

te

te

o-

o

key

Bood

eus

B.

o

wtn

pan

5-cm

extend

te

te

be

et

and

Se

te

he

appears

aso

knee

An

superor

o

and

over

x-ray

o

te

te

Bood

C. Jont

te

Se

o

te

te

ne-

o

te

anteror

oowng

may

occur?

and

at

rom

te

njury

can

enter

te

popt-

and

at

rom

te

njury

can

enter

te

supra-

bursa

ud

can

enter

te

subcutaneous

nrapatear

bursa

D. he

deep

E.

gastrocnemus

he

an

acera-

ragment

over

we,

patea.

racture

rdng”

be

a

eg

Pysca

severa

te

knee.

Wc

to

aceraton

exposes

n

rgt

mts.

rgt

are

obque

“g

emur.

er

transverse

patea.

to

emergency

nvoved

norma

rgt

te

was

here

wc

dspaced

te

n

to

se

bursa

patear

teared?

are

knee,

appears

wt

wegt.

deep,

a

brougt

ater

motorcyce.

sows

to

sows

patea

er

sgns

bear

a

s

mnutes

coson

rgt

unabe

surace

neror

x-ray

and

et

bear

to

anteror

knee

woman

30

vece

er

sows

tenderness

maeous.

most

emergency

examnaton

maxma

no

was

oot

Wc

expans

dgta

D. Lack

stress

gt

jumped

oud

a

rays

over

key

down

te

rgt

C. Incompete

negatve.

dicuty

opponent’s

Pysca

atera

to

paraxa

devers

dsrupton

most

wakng

rom

uneventu

poston.

condtons

motor

knee

earng

te

anke,

anke

te

deveopment

woman

an

Excessve

vagus

test

ater

B.

eg

o

23-year-od

Pysca

mb.

compete

brougt

pan

on

recas

gaments

s

soccer

anded

to

o

a

pan

mp

mesoderm

mesoderm

s

subsequenty.

anteror

owng

o

woman

because

and

sows

Extenson

o

ony

utrasound

n

because

partcpat-

onset

coud

afected

ces

Mgraton

pnned

o

pan

te

E.

he

knee

wen

Se

sudden

and

Wc

D. Intermedate

An

eg

knee

knee

extenson

ten

oot.

An

mgraton

te

department

te

recent

a

We

examnaton

deect

o

pyscan

naton sows te rgt second and trd toes are used.

a

downstars

ba

rgt

pate

examnaton

department

te

Latera

Dorsoatera

A.

and

structures

o

22-year-od

a

orgn

B.

et

area

pan.

musce.

te

tg.

anterory.

o

sows

emors

A.

tons

In

tg

se

Pysca

tg

we,

tenderness

jont.

symptoms

rgt

to

mts.

knee

n

stars

anke.

143.

eg

stars

ng

te

race,

to

et

mdtg

because

C. Preceded

emergency

examnaton?

B.

A

rgt

comes

anteror

ne.

embryoogc

dorsum

was

stress

sows

support

oowng

extend

Excessve

woman

te

100-m

ns

rceps

dor-

meda

te

afected

knee,

o

te

to

norma

panu

te

over

brougt

wtn

wegt

to

D. Instabty

141.

o

numbness

te

a

mted

njury?

over

to

anteror

tender

oowng

ts

n

te

te

oot

numbness

a

Inabty

E.

n

neck

te

te

pan

ng

meda

o

30-year-od

o

swoen

te

A

taobuar

Cacaneobuar

taton

are

A.

o

o

and

numbness

motorcyce.

gament

o

C. Instabty

o

s

x-ray

racture

numbness

nabty

atera

Wc

n

o

and

o

te

te

142.

eg

sows

and

mutpe

and

coson

bear

o

was

E.

eg

and

and

er

postve,

MRI

An

wakng

D. Anteror

as

twsted

rgt

racture

Wc

C. Tbonavcuar

subsequenty.

te

eg.

oe

anke

anke

over

a

knee

wegt

consequences

mnutes

efuson

meda

test

An

to

n

o

tat

centers

gat

sgns

examnaton

recas

he

te

rgt

atera

we

woman

30

vta

te

dspaced

key

gat

vece

er

ed.

commnuted

space

gat

22-year-od

pnned

a

anded

we

bear

maeous.

anteroatera

department

drt

because

patent

oot

web

Swng-out

oot

tenderness

everson

steppng

rst

motor

to

pyscan

he

everted

posteromeda

D. Waddng

te

a

most

anke

o

C. Hg

et

sows

“pus-of”

te

s

proxma

and

te

uneven

sows

meda

te

to

knee.

unabe

te

mb

and

over

an

and

exquste

bua

paond

A.

was

and

ower

rgt

on

examnaton

tere

rgt

and

game,

rotated

meday.

comes

anke

durng

externay

140.

man

et

Limb

nrapatear

bursa

bursa

w

w

be

not

afected

be

afected

CHAPTER

145.

A

53-year-od

o

a

woman

6-mont

wakng.

Pysca

T rendeenburg

er

rgt

afected

to

A.

Scatc

B.

Rgt

sgn

produce

neror

D. Let

superor

A

back

down

era

to

s

et

oot.

to

s

postve

a

asked

to

et

mb.

as

on

anke,

been

sgn?

o

tere

s

a

te

as

he

tg,

on

o

atera

absent

te

dorsexon

wc

o

o

te

o

o

decreased

te

et

oot.

anke,

te

oowng

tese

sde

et

nerve

148.

and

and

a

bua.

Forceu

B.

Drect

pantar

Extreme

15-year-od

s

s

anke

ton

ndngs?

s

C. L4

n

Deep

B.

Femora

and eg.

to

pan

te

to

emergency

te

et

meda

et

surace

mb

sows

meda

trd

descrbes

ma-

o

te

te

most

anke

te

taus

nto

te

tba

te

s

o

everson

te

tat

s

an

anke.

anke

to

ater

s

eastc

Wc

n

te

e

te

and

Pysca

mdy

o

anke

emergency

as

he

boy

oowng

pan

njures

examna-

spraned,

bandage.

carr yng

te

oot

brougt

parents

o

oot

and

st

t

as

perpera

sensaton

rom

te

jont?

A.

brougt

et

ower

s

swoen

atera

dsta

skateboardng.

nvoved

E.

severe

et

te

o

te

te

and

o

exon

s

wt

s

s

D. S1

S3

by

sows

rotaton

boy

we

wrapped

anke

s

a

ed.

on

njury?

rom

E.

A

ner ves

o

et

o

te

orce

dorsexon

pan

man

o

over

o

drt

wegt

sows

oowng

ts

nverson

atera

T12

because

o

te

D. Forceu

L2

32-year-od

te

racture

o

upward

o

uneven

bear

trd

racture

C. Forceu

B.

department

dsta

x-ray

spra

mecansm

A.

A.

A

An

Wc

an

to

tenderness

te

dspaced

department

oot.

roots

over

eg.

nerory

on

examnaton

exquste

and

et

runnng

subsequenty

257

Limb

paond

posteroat-

et

o

o

was

Pysca

wt

te

radates

atera

sows

sde

at

because

pan

and

te

examnaton

te

are

cause

pyscan

days.

posteror

over

weakness

o

2

numbness

reexes

key

past

te

e

unabe

maeous

key

to

as

postve

eous

comes

or

oe

was

et

Pysca

Compresson

147.

a

He

stand

nerve

n

n

gutea

man

pan

tendon

most

sows

oowng

because

dicuty

gutea

aso

Deep

te

se

te

te

buttock,

He

sensaton

wen

o

pyscan

gutea

pan

te

eg.

te

gutea

neror

55-year-od

severe

to

progressve

an

superor

Rgt

o

examnaton

Wc

C. Let

E.

146.

eg.

comes

story

Lower

5

buar

C. Obturator

anke

D. Posteror

Durng a game o ootba, s et oot anded

E.

emora

cutaneous

Sura

A n swe r s

Answers

1.

A.

ton

umbosacra

o

ramus

bar

te

o

and

suppy

torum

o

te

te

are

s

dorsum

o

by

trunk

woud

Ner ve

root

sensaton

njur y

o

te

o

and

abducton.

by

posed

are

o

te

woud

at

a

L5

pantar

he

o

n

te

oss

o

L5,

dvson

uncton

o

o

a

n

and

p

and

s

te

upper

second,

S2;

scatc

musces

te

and

B.

tese

and

ner ve

o

te

N

Injury

acterstc

to

bze

te

guteus

te

eg.

te

te

rom

Injur y

to

In

pevs.

and

ner ve

275

bot

stab

an

L4

sensory

wound

area

o

suppes

s

te

and

coud

supped

skn

te

medus

sup-

meda

aspect

L5.

(GAS

by

and

S2

o

te

o

S1.

L3.

atera

E.

Fg.

by

aspect

provdes

tg,

te

knee,

6.16).

293

nerve

parayss

to

ter

and

o

resuts

te

roe

te

we

te

n

guteus

n

mnmus

exampe,

contract

toes

aspect

gutea

wt

atera

nnervated

nnervated

by

eg

and

are

ourt

posteror

For

tba

nverson.

dermatome

s

toe

ee

tg

addton

guteus

a

te

tte

te

superor

oss,

te

oot.

ABR/McM

mnmus

rom

nerve;

te

o

to

mpared

contans

nnervated

a

motor

te

o

trd,

398;

mnmus.

tg,

and

meda

to

Injur y

and

dermatome

spna

are

upper

35;

com-

S1).

eg

o

ABR/McM

L4

Injury

ncudng

sensaton

3.

eg

he

GAS

A

sensaton

he

o

sup-

te

o

sensaton

D.

motor

are

o

snge

oot

487–489;

bers.

C.

o

extenson

brevs

a

o

he

te

te

oss

(especay

te

B.

oss

N

knee.

exon

ramus

segment.

by

aspect

n

patear

by

nerve

n

te

pantar

ventra

ts

ped

symptoms.

wc

S1,

oot

by

compartments

w afect amstrng musces and a o

beow

o

486–487;

he

resut

o

umbosacra

oot

and

L4

A.

oss

motor

afect

to

te

resut

ner ve,

te

dg-

nner vaton

devered

o

GAS

2.

unctons

woud

atera

musces

causes

receves

dorsexon

te

te

um-

te

and

te scatc ner ve

ventra

te

Injur y

te

ongus

o

man

L4

woud

por-

extensor

patent’s

weakness

segments

buar

o

S1

to

a

suppes

afect

are

te

buar

everson

to

not

aspect

buars

rom

or

and

te

and

njur y

o

wt

superca

bers

resut

n

It

cutaneous

bers

an

te

ner ve

S1.

anteror.

woud

o

anteror,

Injur y

tese

exon,

responsbe

T ransecton

oot.

a

rom

between

buar

and

toes

or

bers

and

tertus,

te

tbas

trunk

resut

pantar

o

hereore

oss

ped

te

because

ner ve.

L5,

tbas

buars

te

L4

deep

L4,

responsbe

umbosacra

reex

o

o

contnuty

he

o

ongus,

and

nverson

emora

ramus

extenson

L5

conssts

provdes

pexuses.

ongus,

tendon

trunk

segments

aucs

anke.

oot

and

sacra

wc

te

ventra

L5

rom

extensor

o

anteror

1–24

he

a

car-

medus

abductng

uncton

guteus

to

medus

contraatera

te

sta-

and

oot

s

258

C H A P T E R

5

Lower

Limb

4.

E.

he

ng

deep

te

eg,

L2

buar

musces

wc

are

dorsexon,

L1

resut

S3

L1

rst

n

a

and

s

responsbe

anteror

and

between

(pantar)

toe

Injury

aso

oss

te

exors

or

nnervat-

compartment

or

nverson.

drop

space

Unopposed

te

responsbe

oot

web

nerve

o

o

to

o

rst

o

extenson,

ts

te

nerve

sensaton

and

w

o

second

oot,

te

oot

te

toes.

nnervated

S4

by

brances

pantar

L2

o

exon

te

o

tba

te

oot

nerve,

n

ts

w

resut

patent.

n

he

te

abty

L2

to

evert

ca

A.

L3

Injury

S2

te

buar

to

afected

nerve

te

partment

s

tba

musces

posteror

oot

ndcates

tat

te

super-

ntact

nerve

o

afects

te

compartment

eg.

are

te

posteror

he

musces

responsbe

or

com-

n

te

pantar

L3

S2

exon

L3

B

and

and

C.

superca

era

toe

he

exon.

common

and

deep

compartment

ces

n

bot

respectvey.

o

te

he

buar

buar

te

atera

oot,

and

superca

nerve

nerves

as

and

spts

t

tese

anteror

buar

nto

enters

te

te

suppy

at-

mus-

compartments,

nerve

nnervates

te

L4 L4

buars

ongus

everson

o

and

te

buars

brevs,

wc

provde

L5

L5

njured

ost

D.

n

n

te

ts

oot.

case,

addton

he

to

pes

s

a

te

te

common

o

dorsexon

sapenous

nerve,

I

everson

nerve,

cutaneous

meda

sde

a

te

buar

oot

and

o

sensory

te

eg

were

aso

be

nverson.

contnuaton

pure

nerve

woud

and

o

te

nerve

emora

tat

sup-

oot.

S1

GAS

627,

660;

N

531;

ABR/McM

344

S1

5.

S1

A.

In

te

dvded

L4

L5

and

aso

subnguna

nto

meda

tree

space,

compartments:

compartment.

known

as

te

te

he

emora

emora

atera,

meda

cana.

seat

s

ntermedate,

compartment

he

cana

s

contans

L4

ymp

nodes

and

adpose

tssue.

he

emora

rng

s

L5

te •

GAS

Fig.

openng

te

acunar

anterory

preventng

Wen

asked

te

to

te

patent

stand

contraatera

wt

on

te

a

superor

afected

pevs

rom

gutea

mb,

te

droppng.

nerve

pevs

njury

s

descends

on te opposte sde. hs s caed postve T rendeenburg

sgn.

over

In

ground.

A.

steppng

te

he

njured

he

standng

C.

Tppng

ng

on

Spna

E.

he

are

ng

o

oot

569,

to

te

a

te

te

sde

te

part

poston

njury

to

or

te

aow

scatc

564,

are

L2

and

te

C.

emora

a

person

responsbe

to

nnervated

st

by

down

te

N

489;

rom

tba

ABR/McM

ex-

325

a

dv-

te

superca

s

he

by

rng

may

te

and

s

connectve

meday

emora

ven,

posterory

cosed

by

becomes

protrude

anteroatera

he

o

nguna

tuberce

openng

o

te

wc

te

deep

ses,

et

aspect

by

connec-

weakened,

troug

o

te

te

pubc

te

nguna

wc

pubc

s

ocated

nguna

end

spermatc

o

te

cord

superor

gament.

nguna

or

It

to

s

cana

round

ga-

exts.

rng

atera

s

rng

te

meda

uterus

and

and

s

to

ocated

te

approxmatey

tuberce

and

te

above

neror

a

te

mdpont

anteror

nguna

epgastrc

ves-

between

superor

ac

spne.

nerve

or

nerve.

579;

bounded

gament,

ntestne

wc

pubc

gament

D.

many

gament.

rng,

ment

a

exon.

musces,

to

cana,

ateray

nguna

sma

troug

or

to

gament,

te

Wen

te

he

te

and

p

emora

tuberce.

B.

stand-

te

o

te

p).

we

tssue.

emora

neror

responsbe

exed

rgt

eans

of

by

pectnea

tve

orward.

sttng

te

mb

by

musce

rom

ndcates

L1

poston,

492,

swung

supped

man

ndvdua

good

te

nerve.

roots

knees

te

ten

(extendng

et

gutea

te

s

rse

pevs

amstrng

son

to

te

responsbe

te

mb

te

poston

o

nerve

standng

GAS

s

person

te

superor

D.

a

afected

tng

maxmus,

nerve,

aowng

te

wen

unnjured

guteus

gutea

orward,

sde

te

6.6

by

ted,

o

he

ata

ng

to

sapenous

on

s

te

just

openng

anteror

atera

to

s

aspect

te

nguna

gament.

passes

troug

te

ven.

o

aperture

te

pubc

te

emora

an

he

sapenous

o

tg.

tuberce

great

te

he

and

asca

open-

neror

sapenous

openng

to

ven

jon

te

CHAPTER

E.

he

tor

obturator

oramen

he

obturator

tg

GAS

6.

D.

298;

N

abducton

may

ous

orces,

be

o

eous.

tunne,

tba

most

A.

te

he

atera

buars

B.

sum

o

he

atera

he

te

atera

te

deep

te

musces

n

te

web

branc

jon

GAS

D.

o

scatc

te

te

rom

teror

tus

under

te

superor

o

A.

te

s

a

branc

downward

It

s

te

o

A.

orm

to

te

guteus

deep

426,

wc

E.

oot

and

nerve

and

to

te

te

dran

Deep

tg

te

border

o

medus

cs

over

sura

te

anteror

greater

te

te

he

to

scatc

to

can

nerve,

te

E.

t

te

border

o

te

posteror

to

te

prorms.

eg

oot

poptea

te

superca

and

ymp

deep

and

te

superca

oot

takes

deep

group

nguna

te

ymp

ympatcs

nguna

nto

anterome-

vertca

nodes.

and

deep

dran

group

group

es

ower

regon

562;

N

nodes.

externa

and

te

parae

descends

o

can

te

Baker

Most

mb

ac

nto

n

he

vertca

to

and

te

te

deep

nodes.

group.

beow

te

cystc

jont

can

te

ormaton

termna

nto

te

te

te

a

and

crest.

o

te

ympat-

group

nodes

exon

and

o

structure

and

group.

o

ts

s

suc

and

musce

by

te

exon

key

artrts

ud

s

responsbe

most

as

as

It

posteror

nerve

oot

ound

excessve

te

are

nerve

ossa.

ntrnsc

te

condtons

tba

n

musces

semmembranosus

o

part

vertca

poptea

musces

exon,

n

ac

orzonta

key

hese

resut

te

poptea

Compresson

pantar

te

superca

te

troug

eg.

perneum,

o

348

most

pantar

oot.

he

n

s

o

nto

ABR/McM

te

Knee

tears

nto

te

eve

te

dran

nnervatng

o

afect

typcay,

te

o

toes.

cartage

aong

dranng

exon,

cyst.

es

vertcay

compartment

te

ven.

nerve

or

umbcus,

beow

dranng

475;

afected

knee

beow

group

gutea

he

or

wa

tose

a

and

producton,

bursa,

eadng

to

cyst.

A.

Dorsexon o te oot woud be compromsed  te

B.

Fexon

deep buar nerve were compressed by ts Baker cyst.

ped

C

and

by

D.

extenson

GAS

598;

o

te

tg

umbar

he

o

responsbe

es

te

325

atera

nto

nto

wereas

te

sapenous

responsbe

trave

wereas

superor

to

gemeus.

te

he

ac

te

buttocks

except

GAS

pos-

quadra-

nternus

prorms,

o

gutea

regon

nerve,

nerve

te

sur-

greater

trocanter

key”

gutea

obturator

over

te

node.

orzonta

vertca

great

te

nerve

and

ymp

rst,

nto

te

and

unctons

troug

pudenda

te

courses

atera

o

nodes

abdomna

anteror

buar

tg

externa

orzonta

he

cutaneous

musce

nguna gament, recevng ymp rom te anteror

cyst

“anatomc

n

he

te

atera

obtu-

emors.

neror

neror

ymp

emur.

te

neror

s

ABR/McM

te

dran

nodes

dran

groups:

D.

back

364

rom

nerve,

to

te

te

Superca nguna ymp nodes are dvded nto two

nerve.

te

to

nodes.

nguna

nto

most

and

nto

te

to

quadratus

superca

rst

carry

dranage

poptea

te

nerve.

prorms.

te

sura

common

sura

o

eg

superca

nerve

skn

rom

o

neror

te

te

te

492;

te

dran

Superca

and

nnervates

and

N

s

to

regon

and

rom

B

com-

nto

575;

w

pro-

troug

It

arses

trocanter

ocated

superor

nternus

554,

s

emors

nguna

nodes

eg

enters

te

anteroneror

gemeus

greater

gutea

superca

C.

9.

ateray

nerve

nerve

enters

meda

te

nerves

nerve,

t

buar

septum.

nerve

nserts

major

neror

gutea

quadratus

te

te

and

nodes,

te

oot.

arses

passes

te

dvdes

deep

coursng

ABR/McM

cutaneous

and

by

he

musce

and

and

te

t

buar

buar,

nerve

te

o

common

eg

and

rom

535;

gutea

nternus

eg

dor-

atera

o

posteroatera

cutaneous

and

upper

branc

te

te

a

nerve,

compartment

tba

N

te

s

neror

gemeus

Lympatcs

o

n

prorms.

he

GAS

8.

te

enters

nnervates

te

cutaneous

consdered

emora

emors,

a

te

aspect

obturator

to

nerve

nnervatng

nerve

a

o

te

te

reatve

neror

s

o

area.

to

because

ocated

te

s

o

neror

he

n

te

njury

tba

brevs.

and

s

eg

ca

sacrum,

It

o

te

branc

oramen,

emur.

eg,

buar

neck

anteror

prorms

te

te

E.

pos-

hereore

cause

courses

over

buar

space

togeter

anatomy

be

te

635–645;

he

ace

tarsa

nerve.

base

rator

cose

te

just

o

trocan-

he

exor

ongus,

ocated

surace

greater

meda

ma-

n

s

externa

te

co-

te

wc

ntermuscuar

nerve

cutaneous

s

It

te

to

he

contnu-

meda

emur.

rom

attaces

prorms.

he

gaments

wt

te

arses

and

upper sde o te sca tuberosty and attaces to te

posteror,

may

te

o

spne

259

Limb

and

da

asca

nerve

o

crura

o

o

Ater

te

hen

sura

meda

njured.

tba

aucs

nerve,

nerve

nerve.

buar

he

and

troug

optons,

skn

compartment

aspect

7.

to

buar

compartment

E.

ter

case.

common

superca

rst

everson

te

tbas

cutaneous

sensory

around

anteror

te

gemeus

sca

nguna

sura

buar

courses

o

te

buars

deep

to

te

oot.

o

deep

o

nerve,

and

percng

te

mon

buar

wt

wc,

tba

te

ts

buar

ongus

by

vdes

C.

n

pevs

(detod)

passng

compartment

oot

branc

bone,

o

Superor

te

become

maeous

Among

B.

C.

avuson

te

te

maeous

exor

and

njured

common

te

and

ext

obtura-

membrane.

cana.

may

tendons

superca

te

n

meda

nerve.

key

te

te

235

maeous

vesses,

o

nerve

coatera

structures

ongus,

tba

racture

te

tan

o

obturator

outward

meda

resut

ncudng

dgtorum

roed

te

meda

o

and

meda

may

proxmty

teror

te

he

s

openng

te

obturator

gaments

stronger

orce,

an

by

ABR/McM

oot

(detod)

strengt

te

256;

te

s

vesses

troug

Wen

atera

cana

bordered

Lower

5

or

N

deep

te

s

nerves

buar

dgts

uncton

te

o

te

ABR/McM

te

eg.

352

o

musces

emora

nerve

wereas

extenson

507;

a

and

s

sup-

nerve.

responsbe

emora

or

nerve

s

260

C H A P T E R

10.

A.

he

5

postve

njury

to

te

menscus

ment.

Lower

s

vagus

tba

rmy

Damage

causes

Limb

attaced

to

te

concomtant

because

o

ts

stress

test

coatera

to

tba

te

te

knee

tba

coatera

damage

reatonsp.

o

gament.

to

te

ndcates

he

coatera

gament

meda

12.

meda

B.

ga-

A.

oten

cck

te

meda

test

C.

he

ong

B.

cubod

anteror

capsue

durng

te

be

but

s

o

te

n

njury

damaged

to

es

nsde

te synova

knee

yperextended.

postve

were

gament

outsde

extenson

knee

ts

crucate

and

aong

cavty.

may

Anteror

anteror

wt

be

It

knee

s

torn

drawer

crucate

te

te

taut

gament.

meda

te

w

D.

I

te

and meda crucate gament, an “unappy trad” (o

O’Donogue

rect];

C.

he

aso

atera

atera

to

D.

synova

w

E.

a

spengs

njury

attaced

receves

to

are

woud

te

muscuar

cor-

E.

resut.

tba

co-

to

and

te

mts

aso

attacment

outsde

yperexon

posteror

postve

es

crucate

posteror

drawer

o

o

13.

te

B.

deep

gament

te

A.

pes

ansernus,

gracs

wt

makng

up

te

te

tendons

oter

o

te

sartorus

two-trds.

he

pes

o

te

tba

surgca

GAS

D.

607–609;

he

great

coronary

te

rom

te

s

meda

oot.

ton

A

neck

can

anke

te

can

B.

o

wc

anteror

great

C.

o

and

ower

te

grats

E.

he

s

o

tat

ment

o

560;

N

w

te

on

o

dsta

te

te

meda

n

a

eg,

n

a

cutaneous

te

E.

s

aspect

te

a

contnues

s

o

te

tat

buar

and

hese

wt

te

oten

arses

common

nnervates

te

eg

te

and

buar

skn

atera

arvested

or

he

GAS

14.

C.

or

by

deep

n

ABR/McM

branc

te

347

o

te

posteror

compart-

3

to

5,

o

te

and

t

arc

s

o

ocated

and

and

s

arc

aso

o

It

te

out

s

(supe-

rom

nvoved

attaces

ans

anke.

deep

extends

n

oot.

proxmay

to

renorce

nvoved

n

an

te

superor

not

te

rom

and

o

meda

te

te

sends

emur

gencuar

a

to

artery

artery.

emora

to

arses

artery

engt

gencuar

bood

does

artery

emors)

down

te

359

emora

artery

ead

s

and

anastomose

responsbe

neck

wt

o

te

dsta

ves-

knee.

peroratng

tat

artery

anastomoses

sends

wt

te

an

ascendng

meda

crcumex

t

as

gutea

artery

mportant

s

a

branc

anastomotc

o

te

suppy

nterna

to

te

p

typcay

emora

sma

artery

be

N

490;

meda

suppyng

a

o

te

artery

gven

of

emora

s

dsta

gencuar

just

artery

to

te

branc

proxma

as

te

to

o

te

poptea.

occuson,

t

w

epu.

592;

he

te

descendng

s

number

ABR/McM

crcumex

bood

o

to

te

brances

gament.

327

emora

ead

tat

hs

artery

and

pass

under

artery

s

neck

s

responsbe

o

te

most

te

emur

edge

key

o

at

te

rsk

or njury n an extracapsuar racture o te emora neck.

A.

he

neror

ac

greater

B.

he

rst

artery

D.

he

and

n

te

oramen,

te

ent

n

ent

by

artery

te

artery

te

nter-

troug

te

prorms.

sends

wt

o

arses

troug

suppes

te

person

te

beow

rom

regon

te

an

ascendng

neror

gutea

buttock.

passes

ead

a

arses

gutea

anastomoses

obturator

and

artery

te

peroratng

tat

commony

o

gutea

enters

scatc

branc

sde

scatc

pantar

ran.

atera

t

s

and

te

crcumex

neror

artery

termna

te

scoemora

on

nerve

wt

contnuaton

rom

body.

eg.

513;

he

te

sensa-

te

te

jont.

te

at

te

ongtudna

(detod)

ABR/McM

branc

rst

not

atera

assocated

nerve

rom

and

at

ac;

te

area.

o

sp

517;

and

te

burcates

deep

anke

meda

o

te

te

gament

maeous

suppyng

Because

o

n

coatera

superor

he

na

nerve

n

te

te

sde

rom

tuberosty

metatarsas

ongtudna

(prounda

on

respectvey.

not

te

essen

oss

and

o

o

emora and te neror gutea artery n te buttock.

D.

sapenous

dysestesas

nerve

te

strpped

ven

and

he

nnervate

te

s

nnervatons

superca

to

part

ven

nerve

resut

buar

nerve

hs

nerve

te



te

cronc

brances

esewere

tba

te

n

o

supports

depresson

te

cubod

emora

ses

C.

used

brances

patents.

and

or

ven.

tba

oot.

commony

te

tereore

posteror

nerve

GAS

nerve

and

s

n

used

gament.

te

te

capsue

N

branc

Strppng

o

be

jont

emur,

339

cutaneous

eg

nto

nerve

juncton

nerve

te

or

contnue

sapenous

te

knee.

common

atera

sura

ven

can

crucate

Because

protect

compartments

are

he

te

create

bua

porton

ven

grats.

te

ts

can

he

te

o

a

ABR/McM

dscomort

to

aso

and

anteror

damaged

to

Injury

nerves

be

drecton

surace

nerves,

cross

responsbe

and

and

498;

bypass

nerve

postoperatve

nerve

te

sapenous

nerve

opposte

o

N

artery

sapenous

eg,

tuberosty,

repar

commony

gament

passes

to

gament

crcumex

he

o

pantar

atera

or

ansernus (goose oot) s ocated at te meda border

bases

to

meda

anastomose

and

aso

anke.

ressts

gament

cacaneus

ong

meda

descendng

test.

and

mantanng

cacaneus

638;

he

s

te

oot.

pantar

te

everson

he tendon o te semtendnosus orms one trd o

and

to

te

te

GAS

gament

n

sort

he

to

taus

te

te

mantanng

musce.

cavty

n

[bot

knee”)

not

crucate

Damage

resut

s

but

popteus

knee.

“bow

menscus

posteror

te

Donaue

a

gament

te

he

or

caed

and

o

oot.

he

ror)

menscus

o

te

mportant

wen

test

te

pantar

o

gament

spran

cacaneonavcuar

o

arc

surace

he

nverson

pantar

ead

w be postve n njury to meda and atera menscus.

jont

11.

cacaneobuar

n

he

te

menscus

ABR/McMurray

he

njured

o

teenage

te

but

s

agesnce

years.

te

nterna

obturator

artery

emur

ts

rom

te

wtn

te

It

gament

not

key

t

usuay

s

ac

oramen.

to

be

pat-

not

pat-

CHAPTER

E.

he

superor

ac

artery

oramen

GAS

15.

B.

and

cana.

te

partment)

tg.

te

A.

he

or

C.

p

scatc

tba

common

or

B.

o

486,

he

te

ror

ror

o

meda

resut

and

n

o

C.

tat

o

are

te

o

eg,

D.

o

te

common

N

to

o

te

deep

respon-

atera

com-

everson

o

p,

te

pos-

wc

exon

o

are

te

ng

superca

te

te

and

atera

and

he

nverson

deep

o

part

o

ante-

ton

ony.

responsbe

or

ts

and

A.

n

dects

n

tese

he

ment

nerve

hs

o

resut

n

es

nerve

te

a

eg,

oss

supercay

nnervates

so

o

te

compresson

pantar

n

te

posteror

n

exon

ts

and

poptea

C.

compart-

area

woud

weakness

o

nnervated

by

D

he

n

everson

o

asca

suppy

he

te

n

anteror

te

he

deep

meda

jecton

tba.

te

and

GAS

A.

oot.

o

o

nerve

maeous

many

cutaneous

emerge

aspect

nvoved

brances

troug

o

te

eg

N

gutea

nerve

and

n

an

te

s

eg

s

many

o

runs

oss

o

te

near

drected

te

groove

compresson

o

toe

end

A.

at

n

B.

exon,

C.

te

D.

oca-

and

he

he

ABR/McM

s

adducton,

ts

346

s

and

and

abducts

te

he

courses

atera

deep

are

hese

neror

o

te

buar

by

ntermuscuar

oot

over

key

afected

rst

ts

as

and

web

space

te

dsta

sensory

occurs

o

septum.

compartment

njured

at

ts

unc-

orgn,

we.

carred

everson

ten

cours-

dorsexon,

te

te

nerve

nerve

eg

anteror

nerve

s

around

compartment

buar

afectng

te

oot

emors

emors.

by

te

te

deep

oot

s

bu-

by

te

nerve.

buar

nerve

and

at

ts

nverson

medates

pantar

orgn

o

te

w

oot.

exon

o

te

he

words,

te

anteror

Patear

GAS

D.

te

gament,

N

500;

te

to

gament

drawer

coatera

pusng

o

gament

reatve

emur

on

te

test

knee

wt

te

responsbe

emur

prevents

te

xed

prevents

tba,

and

knee

gament

te

s

te

te

gament

pusng

stragten

606;

te

coatera

knee,

tba

te

tba

346

gament

sdng

crucate

o

(ence

knee,

ABR/McM

orward

o

buar

511;

crucate

on

posteror

emur.

posteror

muc

drawer

prevents

or

te

ke

a

sgn).

varus

orces

ateray.

resst

vagus

orces

on

meday.

quadrceps

emors

mus-

knee.

ABR/McM

339

he guteus maxmus nserts nto te gutea tuberos-

ty and te otba tract. Atoug te guteus maxmus

nnervated

musce

prorms,

superca

skn

be

te

nerve

N

te

oter

te

ce,

20.

531;

te

most

to

deep

posteror

In

te

bend

ts

to

emur.

nerve

he

dorsexon

Tba

drawer

pro-

o

bre-

musces

324

nerve

w

o

te

dspacement

nnervated

dsta

and

njury

buar

622–623;

he

tba.

and

nvoved

or

compart-

adductor

ateray.

crura

patent

dspacement

nerory

sde

and

maxmus

nerve,

E.

oot.

o

E.

mn-

tg.

exed

extenson,

owever,

bot

preventng

te

abducton.

guteus

19.

on

s

meda

resut

s

s

oot.

maeous,

woud

he

te

eg

and

anteroatera

te

te

te

nerve

compartment

tba

538–541;

he

ror

he

te

o

nerve

buar

buar

rom

meda

ton

17.

te

dorsum

dorsexon

E.

buar

superca

deep

by

compartment

superca

te

D.

GAS

atera

te

nerve;

and

meda

quadratus

te

n

buar

te

to

to

oot.

nverson.

C.

he

uncton

Injury

nto

nerve.

oot

Dorsexon

afect

pr-

used

guteus

ateray

compartment

toe

deep

I

te

anteror

te

superca

tba

ossa.

motor

ar

movements.

A.

te

te

tg

enters

musces

or

oot.

ante-

respectvey,

dvdes

te

o

te

responsbe

quadratus

buar

t

buar

anteror

responsbe

are

resut

and

troug

s

adductor

nerve

and

ABR/McM

buar,

neck

oot,

395;

nnervates

te

te

te

te

te

he

tg

to

abducts

common

deep

by

te

nerve

te

eg

te

enters

271

around

te

and

It

respectvey.

te

woud

eg,

ABR/McM

nto

eg,

o

o

s

te

are

ongus,

rotate

gemeus

by

rotate

N

It

and

emur.

aso

572;

nnervates

magnus.

rotates

neror

Ater

p

tat

adductor

nnervated

gemeus

neck

o

wnds

nnervate

B.

tg.

nnervates

medus

meday

s

musces

GAS

18.

oot.

529;

nerve

te

nerves

and

and

te

te

and

exed

he

nerve

adductor

musce

te

E.

buar

te

nerve

musces

tg

o

o

dvdng

on

nto

buar

anteror

te

exon

and

te

exed

tg.

ncudng

Prorms

ante-

responsbe

te

obturator

adduct

on

nerve

guteus

o

nnervated

brances

te

compartments

and

tese

te

gutea

and

o

te

261

Limb

poston.

te

vs,

respectvey.

buar

go

o

seated

mus

ments

o

dect

a

rotaton

extends

Superor

he

com-

sde

rom

atera

tat

abducton

weakened

sensory

musces

nto

nerve

563–565;

atera

to

nnervaton

(adductor

te

can

obtura-

extenson.

extenson

compartments

njury

on

te

pexus

and

musce

te

nnervates

beore

tat

and

umbar

or

tg

tg

brances

te

or

500,

dorsexon

skn

brances

pantar

bua

te

te

buar

common

brances

mary

tg.

eg

compartment

and

extenson

scatc

B.

te

troug

nnervates

and

nerve

responsbe

eg,

o

nerve

o

nnervaton

tba

teror

nterna

nerves.

partments

GAS

nerve

superca

he

tg

wakng

te

nerve

te

greater

327

rom

responsbe

ts

o

exon

and

sbe

16.

s

dicuty

aspect

he

he

arses

te

compartment

and

D.

to

rom

te

rse

ABR/McM

nnervates

emora

ror

E.

491;

Injury

arses

troug

prorms.

nerve

nerve

and

meda

te

compartment

and

adducton

artery

enters

enters

hs

meda

te

N

obturator

(L2–L4)

tor

above

589–592;

he

gutea

and

Lower

5

by

te

ne-

responsbe

or

woud

ter

contnue

orentaton

to

contract

woud

be

at

te

regons

dspaced

by

te

o

nserton,

racture.

262

C H A P T E R

A,

B,

C,

5

and

obturator

aspect

GAS

21.

B.

o

te

apex

o

te

adductor

ts

e

o

N

trocanter

479;

te

medus,

prorms

emora

and

(subsartora,

emora

te

deep

on

bood

some

ment

te

occurs

to

at

te

cana)

ts

junc-

musces.

anatomc

deep

overyng

emora

one

A.

o

to

te

te

ead

gament

o

x-ray

rare

pont

B.

n

te

damage

a

butcer’s

ocaton

Fata

are

oss

pressure,

A.

he

C.

he

at

te

n

but

bood

C.

he

deep

oss

564;

A.

and

he

occur

N

s

te

and

te

s

a

ton,

ra

s

not

D.

woud



atera

E.

artery

ra

te

to

emora

aso

ven

at

known

usuay

as

GAS

24.

near

o

arses

3

te

emora.

any

oten

to

5

orgn

te

o

to

gament

t

te

te

ead

It

resst

Y

mus

and

te

wt

te

te

by

a

ga-

artery

o

nsgncant.

racture

vascuar

o

not

te

njury

bood

suppy

not

o

te

ordnary

woud

o

because

or

artery

atoug

racture

emur

ead

ste

obturator

he

vesses,

S1

root

o

te

gament

bot

o

A.

renorcng

n

te

s

not

emur

te

greater

severa

gutea

coud

tere

are

te

resut

severa

n

co-

tg.

extracapsuar

mper

yperexten-

te

B.

A

jont

ne-

D.

te

jont

E.

rotaton.

brdges

te

pos-

dsc

notc

at

on

an

GAS

te

emo-

vascuar

gutea

a

ard

N

two

a

nsert

n

S1

surace

or

dsc

at

at

te

under

or

nerve

te

S1

L5–

tenson,

parayss

o

exors.

te

L4

spna

te

probems

wt

L5

extenson).

sacrum

o

s

te

usuay

unconscous

an

cacaneus.

spna

pantar

cause

and

extended

ABR/McM

te

afect

trceps

extenson);

syndrome

yng

gastrocne-

coumn

root

te

umbarzaton

been

te

by

weakness

woud

woud

S1–2

on

ernated

te

o

o

eads

prmary

knee

nverson

at

531;

puts

and

crus

as

but

335

uncton

vertebra

L3–4

was

a

especay

L4–5

eson

619;

at

oot

tat

possbe

exon

tere

patent

across

nto

he

and

eson

eson

A

space

s

te

te

sacrum,

musces,

(p

uness

meda

gament

dsc

nerve

ABR/McM

provded

eaves

pan

(afectng

renorces

and

A

o

musces

s

ntervertebra

n

495;

reex

composed

soeus

S1

N

tendon

nnervaton

oramen

jont.

renorces

o

te

emur

connects

acetabuar

branc

te

ossa.

o

suppy

ABR/McM

key

te

te

to

s

a

decate

ovea

he

on

band

obturator

te

emora

te

car-

artery

ead

n

an

be

te

arteres

and

reaces

most

emora

retnacuar

gament

surace

ndcatng

as

te

tat

te

o

approxmatey

25.

C.

mprobabe,

S1

vertebra.

occurs

and

wen

a

unmovng

perod

o

tme.

355

25–47

Wt

ened,

L5

and

parta

denervaton

o

te

n

te

6

te

add-

A.

L4

years

sco-

o

nous

and

Unt

an

age,

o

he

are

o

It

wc

oot

s

superca

B.

L2

An

s

to

eg

aso

everted

buar

be

L3,

te

L4

woud

o

eg.

o

com-

cause

cutaneous

he

prmary

wereas

patear

te

rom

derved

sensory

L4.

dermatome

by

te

weak-

ntegrty.

s

L4

oot,

way

o

on

te

quadrceps

he

te

sape-

emors

knee.

because

nerve)

te

be

because

anteror

oss

prncpay

te

suppes

he

o

te

to

and

reex

and

extends

o

nerve

and

suppes

te

unopposed.

sde

woud

weakened

njury

L4

te

L2

sad

s

reex

to

o

nerves

arc

sde

nverson

musces

meda

test

nerve

nerve.

musce

D.

te

te

patear

sde

spna

spna

o

eg.

te

to

motor

meda

avas-

to

used

he

sde

racture

te

s

rom

necross.

te

neck.

10

reex

meda

beneat

to

neck,

anke

dorsexon

weakness

emo-

te

damage,

oot

partment

ntracapsuar

caused

emora

In

rgt

because

pass

te

te

avascuar

key

ead

emora

racture.

o

tat

brances

perce

Answers

nnervaton

o

ntracapsuar

concuded

racture

o

333

racture

artcuar

attened,

can

crcumex

ndvdua

musce,

resutng

gament

convertng

band.

te

sows

necross

te

to

attacment

670;

Aces

S1-supped

p

extenson

bood

477;

s

o

suppy

te

woud

surae

yperabducton.

acetabuar

tssue

major

N

o

558–561,

he

S1.

Serous

tese

C.

he

ata.

(“nverted

woud

at

neck

s

neck

addton,

racture

symptoms,

sources

emur

compcatons

an

Commnuted

In

provded

hereater

te

emora

p.

s

runs

dsocaton.

cause

s

o

emur

tat

emur.

te

bood

hromboss

muscuar

329

gament

acetabuar

neck

damages

emora

te

gament,

njury

s

notc,

superor

ead

atera

tat

mts

ead

most

hereore

cuar

emora

p

te

oramen.

x-ray

te

emora

mnutes

peope.

553;

wc

te

emora

mportant

rotaton

gament

young

he

ts

njury.

mmedatey.

approxmatey

rom

gament

prevents

and

emora

C.

ew

atus,

artery

wt

most

anterory

connectve

tat

or

crcumex

tem

transverse

res

jons

ABR/McM

acetabuar

he

a

at

bock”

te

ead

te

o

artery

suppy.

ven

artery

scoemora

he

GAS

to

475;

acetabuar

E.

just

apped

becomes

nguna

puboemora

he

te

te

emora

can

terory

D.

to

atera

rory

B.

n

not

openng

oemora

jont

son

njures

(suc

gament.

emora

njury

Bgeow”)

te

artery

meda

neror

he

s

reason,

objects

“butcer’s

occur

sapenous

deep

atoug

GAS

te

sarp

ovas.

E.

te

ts

as

can

ac

nguna

te

nces

For

to

tournquet,

sapenous

and

rom

bood

a

great

ossa

o

o

or

externa

te

D

kne).

reerred

andng

o

te

musces.

we

o

te

Intertrocanterc

artery,

caused

sppng

ead

sows

trocanter

by

te

obturator

dsocaton

at

anoter

o

he

he

begns

suppy

branc

emur.

sartorus

ven,

oten

mnmus,

nsert

305

Hunter

emora

ven,

guteus

a

trange

ongus

artery,

o

ABR/McM

Immedatey

emora

deep

guteus

and

adductor

cana

Limb

tat sequence. hs as storcay been a ste o njures

as

23.

he

greater

ocaton.

te

and

22.

E.

nternus,

566–567;

he

ton

Lower

te

S1-supped

buars

Aces

ongus

reex

s

(by

and

aso

te

brevs

prmary

CHAPTER

supped

mary

by

by

S1.

L5-

Hp

and

movements

S1-supped

are

produced

musces,

as

s

pr-

he

knee

lexon.

E.

S2

o

spna

ower

obturator

ongus,

s

dect

GAS

26.

C.

so

woud

m,

atera

trd,

absent

over

o

te

A,

B,

D

and

sensaton

te

and

aucs,

531;

te

o

lexor

o

drect

aucs,

abductor

te

a

musces

o

o

te

meda

pantar

te

o

knee

te

dgt

27.

A.

Sensaton

te

and

te

mn-

te

te

In

651;

pantar

surace

ourt

toe

musces:

aucs

532;

ts

o

as

rst

brevs,

ABR/McM

gves

(L5,

case

are

o

te

B,

and

te

te

C,

D,

and

B.

buar

and

nnervated

by

E.

deep

nerve

te

we

and

provdes

rst,

as

exor

C.

o

D.

A

dgtorum

taus

te

and

oot,

are

bot

o

are

by

nnervated

GAS

31.

B.

(o

te

oter

musces

sted

o

te

not

an

o

te

rom

28.

D.

621–622;

T ubercuoss

tebrae

an

N

(wc

abscess.

sgns

o

cay

ound

can

s

he

acks

531;

spread

abscess

acute

wen

te

o

arc

te

tat

surace

supports

meda

resstance

te

oot.

may

and

te

vertebrae

to

T earng

seat

resut

n

sweng

o

no

upon

s

caed

s

eve

o

spna

tubercuoss)

cod

nammaton

nvoved,

te

te

psoas

tenderness.

exor

o

te

esser

he

p

at-

o

te

bone

te

te

pantar

ts

unke

not

dsrupt

aponeuross

aponeuross

te

anteror

sprng

te

njury

meda

s

not

provdes

te

ony

gament.

taobuar

nverson

te

woud

oot.

gament

o

te

woud

anke

ongtudna

and

arc

o

Fg.

N

type

meda

te

coatera

o

meda

te

(detod)

anke

jont

ongtudna

gament

and

arc

o

woud

te

oot

6.103).

518;

o

ABR/McM

njury

O’Donogue)

coatera

can

359

resut

njury,

n

wt

gament

te

“unappy

damage

(MCL),

to

trad”

te

anteror

tba

crucate

s

beng

and

collateral

ligament

abscess

(red

because

and

ormed.

ver-

orm

t

ot)

typ-

Wen

um-

Tibiocalcaneal

part

abscess

major

to

can

ts

spread

nserton

wtn

Tibionavicular

part

wt

Posterior

trocanter,

opsoas

presentng

musce

s

tere

te

part

te Anterior

acus

o

destabzes

346

any

spna

abscess

are

ong-

aganst

tibiotalar

bar

s

anteror

pantar

gament

gament

stfness,

gament

te

nerve.

ABR/McM

caed

o

everson

Medial

GAS

and

sprng

provdng

cubod

dsrupt

dsrupt

(meda)

o

te

arc

because

rom

635;

hs

(sprng)

oot.

(GAS

dgtorum

supped

o

spran

not

ta

arc

pan,

tendon

tendon.

connects

mantans

by

meda

support,

spran

resuts

suppy

nerve.

tba

A

respectvey.

extensor

tat

and

nerves

E.

b-

and

gastroc-

he

355

and

he

oot

wt

answer

resut

neck o

superca

two

te

sted

brances,

Eac

te

he

o

anteror

musces

and

bone.

ongtudna

racture

te

band

and

263

Limb

oot.

passve

abductor

cacanea

cacaneonavcuar

deormty

best

te

ABR/McM

te

Interrupton

second,

uncton

umbrca,

(L4–5)

evertors

nerve

o

meda

wt

soeus

tuberosty.

cacaneonavcuar

te

o

te

cacanea

sustentacuum

pantar

A

361

brances.

tbas

ony

tese

deep

of

S1–2)

dorsexors

eter

by

N

nerve

ongus

o

woud

bua

uar

te

arc

afected

and

506;

navcuar

ead

oot

woud

t

he common buar nerve passes around te

te

o

te

te

and

nserts

pantar

depresson

dorsa

mnm,

soe,

N

connects

te

brocartagnous

brevs.

GAS

616;

he

to

ongtudna

he

o

pantars

aspect

S2’s

337

exor

te

A.

tendon

musces

tudna

dgt

umbrcas.

o

GAS

30.

oot.

nnervates

sde

te

aucs

efect

extenson

te

ABR/McM

nerve

atera

LAFF

exor

none

No

n

prorms,

te

toes.

te

a

so-caed

N

ourt

E.

over

on

adductor

te

ourt

S2.

ound

pantae,

and

musces

maxmus,

owever,

by

nverson

657;

nterosse,

a

trd,

be

pantar

quadratus

second,

on;

and

many

guteus

semtendnosus,

nnervated

626–627,

pantar

be

nternus,

everson

he

nnervates

ncudng

and

soey

or

nerve

mbs

cacanea

nemus

Lower

5

tibiotalar

part

wt

prncpa

Medial

jont.

tubercle

A.

Abducton

o

te

ps

s

perormed

by

te

guof

teus

medus

and

mnmus

wt

assstance

talus

rom

prorms.

B.

Adductor

ongus,

adductors

C.

Extenson

maxmus,

E.

o

o

te

brevs,

and

magnus

are

major

tg.

te

p

togeter

Interna

(meda)

adductor

musce

s

wt

a

uncton

te

o

amstrng

rotaton

s

te

guteus

musces.

perormed

by

te Tuberosity

navicular

GAS

29.

A.

535–536;

he

tendon

maeo

s

N

486;

yng

most

of

Sustentaculum

tali

group.

ABR/McM

posteror

key

te

to

bone

of

calcaneus

335

te

cacanea

atera

and

(Aces)

meda

tendon.

Plantar

calcaneonavicular

•

GAS

Fig.

6.103

ligament

bone

264

C H A P T E R

5

gament

atera

s

tensed

to

te

A,

C,

(ACL),

sde

wc

durng

D,

and

on

E.

606;

he

anteror

aperture

te

tba

ts

dvson

posteror

artery,

eg.

or

teror

A,

B,

nto

C,

ACL

o

s

te

artery

are

dvdes

he

Pott

o

te

ated

beore

nto

te

hs

o

pantar

between

te

eg,

arteres.

or

te

provdes

brances

tat

orgn

suppy

do

not

33.

E.

620,

he

aspect

es

o

vastus

o

nserted

etrates

te

he

C.

ead

o

tba

ceps

te

584;

Wen

o

atera

cartage

knee

(e.g.,

by

te

Wen

to

te

on

a

t

course

as

not

runners)

A

to

patear

neede

s

on

n

may

ts

emora

s

resut

gate.

or

on

pes

o

he

as

te

condye

hs

he

It

aso

gdes

se

aows

to

A.

damage

o

to

te

te

s

are

a

C.

te

E.

oten

break

tears.)

he

rotaton

aso

be

or

dev-

racture.

atera

te

It

o

racture

capsue

passes

o

drect

known

rom

te

o

te

navcu-

contact

or

and

runs

o

wc

oot

a

wt

te

woud

not

anke.

composed

supports

and

woud

te

ca-

o

te

s

everson

rom

pantar

te

part

gament

gaments,

or

te

rom

s

nverson

te

as

extends

hs

o

te

te

o

at-

tereore

oot.

cacaneus

he

to

te

o

vesse

scatc

cases,

vesse

359

o

te

ts

to

enarged

o

common,

as



mb

te

s

mb,

te

scatc

beedng)

o

vesse

te

deveopment

te

ower

branc

s

emora

n

te

tere

artery.

te

o

gu-

as

weren

rupture

are

retaned

retaned

artery

tey

s

neror

gutea

te

exposed

n

ves-

te

brances

branc

emors

artery

to

suc

te

as

or

deep

usuay

posteror

tat

emora

provdes

branc

tree

o

perorat-

compartment

but

not

descrbed.

he transverse branc o te meda crcumex em-

anastomoses

te

he

deep

by

582;

afected

expans

te

N

489;

dects

oot

n

wt

o

peroratng

anastomoses

L5

branc

wt

te

brances.

crcumex

atera

genc-

artery.

325

mddorsum

spna

or

atera

superor

ABR/McM

te

branc

te

te

poptea

on

ndcate

weakness

artery

branc

o

rst

superca

anastomoses

branc

491,

a

te

artery.

gutea

gutea

descendng

Sensory

wt

emora

superor

he

GAS

D.

some

prounda

uar

37.

ABR/McM

axa

reatvey

emora

ros

popteus.

o

gament

prouse

neror

ts

popteus

be

gament

aspect

bone

arc.

nverson

tny)

emora

ora

draws

nner-

to

to

per-

area.

he

ng

unockng

popteus

aso

pantar

proxma

(wt

gutea

dsta

and

used

tba,

tba.

no

gament,

arc

by

ypopastc

regon

te

proxma

protectng

as

gament,

everson

517;

In

Aneurysms

D.

drecton.

w

can

jont.

posteror

navcuar

sort

(usuay

s

superor

te

N

artery.

o

rotates

dsta

racture

(detod)

Dupuytren

and

a

and

oot

renorces

gament

pantar

orgna

te

musce.

t

n

afected

te

to

and

635;

B.

ansernus,

te

to

te

here

te

gament,

ongtudna

be

as

or

oten

bua

(detod)

gament

te

he

te

quadr-

ateray

E.

prmary

on-

on

te

maeous.

afected

ong

GAS

te

ateray

anteror

te

Overuse

n

passes

o

s

maeous

everson.

taus

sprng

and

musce.

tereby

exed.

nerve.

on

to

bua.

328

atera

ntate

ts

wt

nserts

tendon,

aspect

posterory,

knee

and

nserted

contracts,

a

emors

te

o

meda

neede

ABR/McM

tba

n

coson,

njury

coatera

abducton

aspect

he

cacaneobuar

te

orgn

nserts

nserted

penetrate

part

ts

merges

and

emur

penetrate

dsta

te

te

A

rectus

te

te

popteus

te

musce

as

emur,

emors,

he

to

te

emur

deepest

te

o

aowng

known

rom

ongtudna

not

pen-

to

aso

term

term

meda

meda

meda

era

aspect

neede

racture

to

te

musce

patea,

ts

emors

te

orms

on

menscus

jont

C.

not

tba.

529;

te

as

backward,

vated

ts

atera

atera

he

caneus

tea

orgnates

woud

N

o

tendon.

and

te

te

bceps

va

woud

nserts

o

s

bceps

bua.

spne

patea

te

te

sartorus

part

te

o

te

te

atera.

o

tuberosty,

wc

porton

o

knee.

musce

magnus

anteror

emors

ac

D.

ateras

on

anke.

coatera

extreme

o

he

D

porton

part

ateray

aspect

o

patea

he

GAS

te

and

ead

gtudnay

34.

o

not

posteror

ead

D.

dsta

345

ocated

vece

acute

339

arcac

cacaneonavcuar

36.

tg,

sort

ong

te

s

proxma

capsue

vastus

musce

he

te

adductor

he

te

to

ABR/McM

an

rater

te

(he

s

bone.

meda

te

capsue.

meda

B.

tg.

superory

nterna

A.

te

jont

503;

ateras

superca

te

N

motor

n

taocacaneonavcuar

ar

be

617;

n

meda

posteror

neck

descrpton.

GAS

te

te

pos-

matc

(e.g.,

resut

gament,

T aonavcuar

to

te

te

tear

racture

te

A.

tg.

optons

a

ateray.

oot

a

bmaeoar

n

te

or

te

a

te

he

o

knee

can

ABR/McM

s

at

resuts

buar

compartment

bua

racture

o

artery

500;

coatera

te

tba

N

wt

te

tba

te

racture

ndcate

troug

membrane

orgn

atera

oter

617;

B.

o

anteror

posteror

atera

o

atus

compartment

te

artery

te

GAS

aps

contnuaton

to

wegts)

popteus.

descrbe

wc

orce

tng

tba

arteres.

and

te

knee,

great

and

subsequent

coces

compartment

te

A

trauma.

troug

provdes

emora

A

te

MCL,

he

tear

te

nterosseous

artery

D.

te

wereas

peroratng

and

o

anteror

posteror

compartment

to

te

339

poptea

suppes

deep

our

s

tba

meda

tba

o

type

passes

te

te

te

wc

he

tree

t

bua,

n

can

answer

surace

ts

he

nto

n

and

contnues

by

posteror

courses

bow

menscus.

and

remanng

artery

magnus.

and

A

tears

35.

ABR/McM

ater

and

MCL.

atera

500;

meda

extenson

he

njured

N

menscus.

stretces

te

te

te

artery

adductor

te

to

poptea

emora

artery

o

meda

knee

knee

E.

Limb

and

te

rupture

usuay

GAS

32.

o

attaced

structures

not

Lower

nerve

dorsexon

and

njury,

and

soe

o

wc

anke

te

aso

nverson

CHAPTER

due

to

ror

dsc

L5

parta

eg

denervaton

compartment.

at

L4–5

spna

resuts

nerve.

ntervertebra

under

L5–1

A.

L4

but

o

n

spna

passes

te

te

te

compresson

nerve

te

o

L5

ante-

E.

nerve.

exts

at

spna

ernaton

o

te

nerve

to

te

s

put

at

L1–2

Sensory

most

dect

key

w

afects

GAS

40.

te

be

just

te

beow

A.

he

hs

L2

and

te

he

gament.

(Hunter

and

Dsc

eson

at

spna

L3–4

nerve.

and

o

at

woud

Sensory

patear

aspect

regon,

te

w

toe

te

sde

afect

te

o

S1

over

te

eg

E.

spna

te

te

and

anteror

expected.

afect

sensory

tg.

key

over

s

ound

body,

o

most

meda

w

be

sde

dect

great

L5–S1

dect

vertebra

ee

GAS

C.

te

and

N

by

529;

te

te

ABR/McM

n

mb,

and

be

nerve

te

and

gutea

anteror

te

o

by

te

te

area,

possbe

Parayss

can

Hunter

nerve.

te

emora

o

arter y

te

prorms

pan

n

dvson

o

o

te

buar

Foot

dvson

posteror

te

o

B.

o

eg.

scatc

wt

nerve

a

or

eson

te

o

C.

E.

Skn

n

ra

GAS

obturator

o

N

nerve

te

at

te

emora

njury

knee

s

assocated

he

resuts

D.

n

weakness

n

nerve

o

te

wc

s

eg

a

s

nnervated

and

te

rm

o

by

n

te

te

emors

and

atae

branc

o

te

sa

emo-

te

tensor

o

and

B.

and

he

t

upon

anteror

te

atera

two

nserts

tea

nerve.

D.

he

o

supped

by

te

and

rotators

te

quadratus

o

sacra

te

p

pexus.

and

are

eg

and

as

oot.

exposng

te

poptea

wc

poptea

o

sen-

coud

arter y

be

was

buars

o

upon

tat

passes

te

ractured

te

gastroc-

bone,

te

oot,

kewse,

compex

cuneorm

va

te

anke

were

med-

t

nserts

passes

bend

nsertons

bones,

te

upon

metatarsa

te

bases,

bone.

anteror,

a

nserts

musce

upon

and

wt

te

te

Aces.

o

wt

cuneorm

o

on

because

paanges.

bone,

and,

pan

ongus

soe

posteror,

cubod

bone,

te

tendon

te

328

te

te

o

te

base

tbas

te

anteror

meda

o

te

sde

rst

posteror,

eg

o

te

metatar-

s

a

strong

oot.

ongus

te

s

a

eg.

It

te

soe

enterng

musce

passes

o

o

te

bend

te

oot

atera

te

by

com-

atera

ma-

crossng

te

prmary

o

te

te

p

rst

p

emors

and

jonts.

spne

te

It

GAS

42.

C.

tea

s

615;

he

ven

poptea

bot

supped

by

most

njury

ntact

n

te

te

to

t

te

cuneorm

tba

te

to

nerve.

one

o

te

gastrocnemus

o

n

and

o

and

o

ts

case

by

te

te

musce,

te

te

oot

eg.

It

wc

nerve;

tba

A

ossa

and

woud

exes

te

severe

o

te

evertor

resut

o

te

nerve

woud

because

because

pop-

nerve

enters

buet.

(anteror)

exon

tba

t

poptea

everted

knee

te

as

te

buar

te

ateray

extensor

compartments

weakenng

n

aong

common

ven

severed

nerve

dorsexed

runnng

he

courses

hereore

te

base

350

and

poptea

tba

and

ateray.

ABR/McM

typcay

ossa.

a

meda

bone

superca

musces

some

te

511;

key

o

(atera)

n

s

adjacent

quadr-

are

N

nerve

owever,

gu-

nto

metatarsa

and

neror

emors

provdng

tereby

atus),

cana

sde

crest,

o

resut

prorms

atera

s

te

meda

te

contnues

soeus

dgtorum

tbas

eous,

s

maxmus

o

sartorus,

adductor

rom

ac

tendon.

guteus

te

te

ts

passng

atera and neror surace o te cubod, and nserts

major

nto

on

by

mus-

te

ac

troug

ner ve,

nto

atae

rectus

exes

neror

guteus

aspect

abducton

nerve;

actng

te

ascae

rom

te

tg.

emora

te

te

he

te

or

dsta

partment

nnervates

ongus

borders.

pass

cana

gastrocnemus

augment

maeous,

nverter

325

arses

tract

acetabuum

he

brances

nerve

exon

o

tus

rom

C.

sort

ascae

knee,

part

ABR/McM

gutea

rotaton

nnervated

te

490;

otba

asssts

meda

n

te

te

compartment,

by

a

5.3.

subsar-

sapenous

emerges

sde

Fg.

or

adductor

te

aneur ysma

wt

enter

meda

sde

meda

n

muscuar

tereater

ABR/McM

o

tbas

he

tg.

mnmus,

tensor

tg,

extends

to

and

nerve.

E.

482,

guteus

nto

ceps

te

meda

superor

nserts

arses

extenson

o

nerve.

444;

medus,

and

o

te

sapenous

he

ces.

eg

patoogy

adducton

te

exor

ay

navcuar

Weakness

he

496;

tendon,

meda

nerve.

wt

N

he

he

tba

te

te

sartorus

adductor

an

arrow

medas

ner ve

te

poste-

neror

emors.

adductor

oter

eaves

(wc

te

nserts

upon

occurs

arter y

woud

cacanea

A.

te

te

te

surgcay.

585;

nemus

te

to

Contracton

atera

wt

proxmay,

we

cacaneus

pont

part

n

41.

nvove-

produce

musces

te

exon

nerve

may

te

o

ernaton.

buar

common

weakness

pantar

dsc

GAS

te

te

te

atus,

mobzed

beyond

treated

wt

compartments

o

tba

D.

brances

Dr.

101

mmc

antcpated

Compresson

scatc

pan

prorms

woud

ment.

mb

camped

80;

drop

beneat

ower

sor y

Dsc

Entrapment compresson o a or part o te scatc

nerve

rom

by

ven,

arter y

o

wt

265

Limb

328

o

vastus

sapenous

L3

meda

musce

aong

quadratus

cana),

te

emora

roo

adductor

and

te

he

to

a

ormng

arter y

ner ve

to

ndcated

te

medas

emora

te

s

orms

te

L2

over

oot.

te

cana

nerve

ABR/McM

he

Sensory

s

sartorus

musce

vastus

and

te

496;

magnus.

be

ernaton

A.

by

N

s

nnervated,

troug

between

w

meda

39.

485;

emors

s

naton

tg

B.

tat

cana.

L4

A.

p

gemeus,

L3–4

reac

quadratus

ror

Wen te L3 spna nerve s compressed by dsc er-

dects

38.

he

ntervertebra

tora

ernaton

nguna

C.

t

musces

oramen.

Dsc

spna

B.

as

te

typcay

he

oramen,

tenson

o

Hernaton

Lower

5

aso

oss

knee

o

and

266

C H A P T E R

pantar

knee,

A.

Lower

lexes

so

he

te

B.

5

ts

uncton

drop

partment

nerve.

drop

I

o

E.

43.

C.

amstrngs

he

nnervaton

be

ntact.

621;

on

514;

or

to

ra

ead.

ment

ton.

ead

In

s

s

es

tat

py

44.

te

GAS

549;

E.

he

vs

ror

te

N

any

on

to

A.

he

te

buar

nerve

s

te

GAS

45.

D.

wen

s

o

te

made

ter

te

knee.

o

by

upon

Ken

superor

guteus

1

bet,

or

o

deep

wt

eaves

meda

to

beneat,

I

t

s

o

sensatons

n

or

s

avng

extended

panu

provdes

mnmus

te

aong

regon

tat

o

oss,

are

too

someone

st-

o

tme

atera

motor

and

nguna

wegt

perod

gutea

he

gament

obturator

or

nerve

and

s

not

suppy

tensor

46.

usuay

te

pevs

te

tected

ocaton.

It

nnervates

te

adductor

musces

es

t

takes

tte

o

tendon

ts

N

to

to

cana

520;

he

to

te

o

be

to

tbas

Fgs

ABR/McM

te

content

or

tun-

pantar

resut

and,

Fascotomy

and

te

to

anteror

and

to

dranage

pace.

6.110

tarsa

nondstensbe;

requred

take

o

ncreased

aponeuross

o

regon.

oot

key

meda

tssues

to

pantar

ud

te

“T om,

te

te

venous

te

can

te

(GAS

o

restrct

aucs

processes,

n

reatvey

te

anterory

te

due

tssues

o

most

o

wtn

usuay

contents

be

eang

nor

s

ragment

ncrease

eg

most

s

poste-

among

mnemonc:

As

te

t

posteror

exor

tendon,

osseous

soe

tendon,

and

o

hroug

tbas

nammatory

te

asca

te

aow

te

Harry.”)

oot,

now

and

te

posterory

pressure

and

area

artera

and

o

dspaced

adequate

skn

ongus

o

Lasty,

roo.

to

te

surace

suraces

a

tar-

o

surace

meda

posteror,

posteror

te

as

nerve,

meda

tba.

course

syndrome).

ts

te

most

bass

o

o

dorsum

aspect

neror

posteror

to

tba

afect

brous

arge

A.

to

te

emur,

oramen

o

posteror

reduce

te

Neter

te

tendon

pass

6.115).

356

to

passes

aso

around

he

te

tat

passes

proxma

troug

part

o

te

a

rater

sat.

he

to

neck

GAS

and

592;

N

te

aspect

atera

o

p

crcumex

te

ead

o

o

part

te

o

ac

te

495;

te

te

te

suppes

o

obturator

o

usuay

ead

emora

suppes

regon

te

socket,

crcumex

artery

and

branc

gament

artery

meda

ature

n

te

atera

emora

meda

ower

crest,

anteror

wa.

tssues

branc

he

te

acetabuar

pes

E.

vesse

te

suppyng

abdomna

B.

a

enter

he deep crcumex ac branc o te externa ac

emora

troug

aso

te

o

dgtorum

o

te

te

cacaneus,

and

emorrage,

meda

artery

ascae

obturator cana and enters te tg deepy n a pro-

te

Nervous

aspect

can

by

anteror

te

or

posteromeda

structures

te

te

rs (deep emora) artery commony provdes te nutrent

to

afected

s

suppes

D. he second peroratng branc o te prounda emo-

can

tg.

compresson.

eaves

te

compartments

bers

retnacuum

vens,

tunne

645;

o

wc

by

pressures

GAS

C.

tracton

o

330

maeous

tbas

cause

troug

o

ta

nerve

atera

maeous,

ormed

Increases

oter

pantars

te

meda

V ery

rom

pressure

ante-

ste

pan

te

sudden

te

nguna

a

tereater,

pe-

on

s

exor

and

te

tereore

te

musces.

smar

and

surace

sup-

afected,

trousers

or

aspect

oot.

meda

rom

(hs

(tarsa

and

troug,

ts

te

tus

wc

meda

scatc

and

sensory

te

exor

tendon,

pantar

ne

sup-

te

te

or

o

wearng

and

and

crcumex

and

artery

nectons,

arter-

some

tendon,

ud

musces.

Obesty,

nerve

te

meda

te

severa

are,

compartment

nerve

compresson

an

neck

o

ound

te

maeous.

acetabu-

te

emora

ateras

ga-

60%

nterven-

emora

atera

parestetca,

medus

te

consequence

syndrome),

ap

he

cm

tg,

nerve.

te

to

compressed

335

nerve.

te

o

brances

and

te

hey

ocated,

acetabuar

surgca

emur,

te

te

ABR/McM

meda

tunne,

Dck,

emo-

sde

tunne

by

o

provdes

cacaneus,

contents.

dsrupts,

te

wtn

crcumex

te

burnng

gun

te

on

anteror

486;

s

and

ongus

subcapta

o

hereore

passng

or

te

o

te

anoter’s

te

te

tba

bood

dvson

sustentacuum

ror

an

N

he

covered

rac-

approxmatey

suppy

te

a

by

te

coursng

n

he

atera

tunne

taus,

w

sufers

neck

cdood,

cutaneous

As

neck.

necross

arteres.

rom

subcapta

patent

emora

atretc.

o

and

sensaton

te

and

398;

anke.

proxma

uncton

eg

o

Posteror

te

te

(n

buar

and

oot

he emora nerve emerges rom beneat te mdde

o

C.

o

meraga

atae

B.

deep

te

sa

dsrupted

te

atera

spne,

ee

eavy

(Cavn

ead

o

s

suppes

he

com-

njured,

exors

ne

emur

neck

afect

aspect

tng

s

tba

emora

ABR/McM

ac

te

tgt

and

emora

may

a

D.

oot.

tat

te

ntermedus

ndvdua

wearng

as

355

artera

gament.

can

dstrbuton

te

observed

tereore

retnacuar

arses

tenson

atera

ntact

case.

s

major

approxmatey

superor

gament

by

amstrngs

artery

gutea

495;

atera

nguna

ext,

s

njured.

concern

te

by

te

vastus

ateray,

and

tg.

anteror

nerve

ts

avascuar

te

east

te

artery

pes

s

durng

o

emora

rom

emora

n

adut

perce

aso

te

musces

te

te

anke

ead

becomng

a

provded

crcumex

o

obturator

ead

te

n

Senton

racture

resut

ater

branc

but

ndcate

emora

te

te

cases),

ar

te

Prmary

o

o

o

buar

ABR/McM

racture

te

may

branc

o

o

ntracapsuar

wc

oss

te

te

ossa;

magng

ntracapsuar

suppy

are

o

ex

ts

N

te

te

aso

ost.

emors

nnervated

nerve

poptea

Dsrupton

ture

eg,

buar

te

rom

at

be

afected.

afected

exon

to

not

observed,

one

amstrngs

not

quadrceps

s

common

he

GAS

te

te

be

common

he

woud

resuts

key

Pantar

o

nerve

te

w

most

oot.

uncton

emora

Foot

D.

te

Limb

te

p

ABR/McM

330

o

ateras

branc

proxma

emur.

te

branc

vastus

emora

o

artery

o

a

emur.

te

deep

musce.

te

adductor

jont,

sup-

ncudng

deep

muscu-

ncudng

te

CHAPTER

T endon

Tibia

of

digitorum

Tibial

T alus

T arsal

267

Limb

flexor

longus

T endon

Posterior

tibial

Lower

5

tibialis

ar ter y

of

posterior

ner ve

tunnel

T endon

of

hallucis

flexor

longus

Pulse

of

midway

and Flexor

post-tibial

between

medial

ar ter y

heel

malleolus

retinaculum

Calcaneus

A

B

•

GAS

Fig.

6.110

47.

B.

he

tba

pantar

two

A.

nerves

te

drop

common Superficial

transverse

metatarsal

ligaments

to

te

sura

woud

motor

E.

spna

Anterior

part

of

48.

656;

B.

aponeurosis

coud

s

N

te

to

end

o

process

te

te

entre

to

s

nerve,

sensaton

nerve.

pro-

wt

or

te

rom

njury

to

o

Sensory

extensor

buar

oot

oot

toes.

resuts

te

hese

oot.

oss

te

oss

o

te

dgtorum

te

termna

nerve.

woud

resut

rom

te

356

te

dsta

n

surace

aceraton

n

emora

rom

hs

ragment

addton,

structure

artery.

arses

condyes.

dsta

In

poptea

to

musce

emora

te

o

ts

te

te

dsta

scenaro

s

ractured

emur)

as

te

just

musce

ossa

pued

surgeons

emur

poptea

poptea

ragment

Ortopedc

o

te

te

strong

artery

(rgt

and

s

ractured

aganst

aways

ook

te

or

of

damage calcaneal

te

deepest

poptea

to

te

poptea

artery

n

a

patent

wt

a

supra-

tuberosity

condyar

A.

he

racture.

soeus

efect 6.115

deep

ABR/McM

posterory.

susceptbe

Fig.

531;

dspace

aganst

GAS

o

te

te

nterrupton

buar

oot

atera

njury.

gastrocnemus

emur

•

te

o

buar

by

and

anke.

48–71

he

proxma

Medial

te

o

second

caused

deep

te

soe

provdng

and

attrbuted

o

o

dorsum

Parayss

be

te

te

retinaculum

Answers

Plantar

oss

cord

be

o

or

meda

o

inferior

GAS extensor

sde

branc

Sensory

rst

or

te

sde

superca

nerve

te

D.

te

te

woud

atera

brevs

to

by

buar

nerve.

nto

meda

sensaton

buar

between

Foot

dvdes

te

suppy

mosty

deep

skn

on

provde

Sensory

vded

C.

nerve

nerves

arses

upon

te

rom

emur.

te

tba

and

woud

ave

no

268

C H A P T E R

C.

he

ty

5

pes

nserts

D.

he

gracs

E.

he

tbas

orm

GAS

E.

ra

tssues

or

o

te

A.

te

te

on

andmark

va

edge

proxma

transverse

eads.

te

tba.

taus

sura

pass

around

cune-

away

te

are

arte-

te

he

provde

atera

pantar

dstrbuted

puse

to

GAS

53.

te

at

te

ante-

o

anke

supped

by

on

great

ts

te

te

toe

atera

abductor

te

bone

proxma

o

wtn

assst

gea

are

C

te

t

n

ts

D.

he

he

gus

te

musce.

meda

GAS

51.

B.

te

651;

he

A.

te

he

N

ormed

exor

rst

pantar

buar

C.

sura

and

atera

sde

he

brevs

musce

te

exor

and

te

pes

atera

cacaneus

and

supped

quadratus

54.

on-

D.

o

exor

and

532;

nnervates

he

to

scatc

abductor

o

te

nerve

brevs,

nvertors

o

artery

approxmatey

ntrnsc

posteror

and

buar

buars

a

eg

nerve

eg.

55.

te

dorsexors,

toe

oot.

659;

passes

bend

between

te

meda

tat

bony

neror

te

can

n

I

n

obturator

nerve,

common

eg

and

te

nerve

te

s

It

aucs,

s

sensory

tree

and

suppes

te

tba

te

a

quadratus

atera

ne

te

te

skn

nerve

on

sup-

meda

and

avod

gutea

are

n

nerve

te

nerve

gutea

to

te

ess

te

ts,

te

te

s

or

gutea

stay

gest

too

can

near

ntrate

oowng

neura

scatc

usuay

must

oter

nerve

area

“orgvng”

te

eements.

nerves,

are

n

n

espe-

babes.

babes.

324

te

pectneus,

suppes

pantar

te

te

suppes

adductor

and

ca

porton

nnervates

nerve

t

nerve,

to

cutaneous

one

rom

te

vesses.

ts

matera

nnervates

gracs,

but

and

supe-

avod

and

atera

nerves,

te

nsut

ABR/McM

tba

te

njected

motor

to

nerves

nerve,

o

anteror

posteror

Certany,

trauma

nerve

te

dropped

seat

to

gven

trocanter

encounter

njectng

te

musces

superor

and

te

ever-

357

between

major

cause

474;

he

rom

o

and

adductor

nto

mportant

dmensons

ncudng

ntrnsc

base

pantar

he

be

greater

oter

tssue

resut

N

te

nerve

tat

oter

(extensor)

cutaneous

te

dvdes

te

orgn

nnervates

oot.

probem.

or

mportant

he

ces,

can

Precautons

externus.

361

away

B.

te

um.

nerve

reduced

a

te

ABR/McM

oter

vertca

connectve

GAS

o

tba

buar

oypogastrc

te

he

te

ts

nterosse.

and

soud

drawn

and

one

scatc

neede

te

and

te

and

512;

ne

te

and

N

serous

te

o

o

or

tertus

tnk

wt

nnervates

soe

brevs

s

te

toe,

o

artera

buars

posteroatera

t

between

mdne.

extenson

atera

superca

and

and

a

te

tte

te

n

nerve

be

nerves.

te

pont

cay

nner-

n

no

kewse.

common

nerve

o

o

musces

a

to

he

comb-

brevs

te

o

can

te

anteror

dorsum

he

a

njectons

anteror

nerve,

rom

nerve

suppes

ABR/McM

oter

ca

ac

te

te

rom

nerve;

dorsum

Occasonay,

oot.

atera

arses

tba

and



te

te

t

superca

ongus

tba

o

ongus

spne

ror

aucs

he

to

te

te

aspect

passes

to

caca-

emora

puse

were

te

named

asssts

sura

and

n

s

te

and

oot.

o

4,

sde

pantar

causes

nnervates

to

superor

te

s

suppes

tba

622–625;

by

nnervated

2

Gutea

pantae,

are

no

compartment

It

upon

he

te

te

te

branc

regon

te

A.

t

o

atera

te

t

eg.

bone

musces

o

te

te

ven

354

suppes

atera

nserts

dgts.

o

dgtorum

nterosse

oot;

a

GAS

te

s

te

most

sde

o

te

o

nerves;

sde

buars

360

sensory

o

buar

posteror

maeous,

s

buars

extensors,

D.

a

toe.

brevs,

nerve

compartment

N

a

nerve

pantar

brances

deep

656;

he

to

nerve.

meda

rom

te

ABR/McM

nerve

nerve.

GAS

52.

te

buar

he

te

and

nerve.

dgtorum

o

atera

E.

pantar

umbrca

and

pantar

naton

te

o

aucs

ABR/McM

te

meda

artery

just

aucs.

meda

usuay

meda

meda

approxmatey

and

te

proxma,

nerve

he

papated

sapenous

oot,

maeous

deepy,

contrbutons

umbrcas

metatarsopaan-

exor

second

rst

4,

on

arses

nerve.

pantar

n

he

vates

te

pantar

and

brevs

(esser)

poptea

513;

be

abductor

gastrocnemus,

very

oot.

by

pantae,

are

It

te

branc

sesamod

bones

aucs

rst

sde

umbrca.

atera

musces

to

te

meda

sesamod

te

bend

te

musces,

o

son

and

meda

can

te

ansernus;

he

N

n

metatarsa

aso

te

nterosseous

nsert

o

te

exor

meda

tendon

524;

meda

aucs,

and

2

at

dorsa

he

atera

and

te

pantae

pantar

umbrcas

by

te

bot

expanson

on

o

upon

he

abductor

by

rst

quadratus

nserts

toe.

uncton

he

umbrca

nserts

paanx

great

tendons

jont.

extensor

E.

te

nnervated

and

rst

aucs

s

t

atera

he

o

bua.

and

atera

on

buar

buars

obque

nerve.

B.

653;

o

atera

te

et

deep

musce

two

te

o

by

620,

be

compartment

nserts

te

may

o

o

sma

sde

passes

pes

tere.

eads

he

ts

354

way

C.

te

cacaneus.

musce. Atoug ts name mgt ead one to

oot.

te

two

te

nsert

va

te

bey

te

atera

sartorus

to

or

aponeuross

and

te

between

ceary

te

ee,

muscuar

nerve

he

tba

et

a

oot.

o

te

he

bone.

aso

and

o

to

te

pantar

nserts

artery.

musce

by

o

and

te

condye

most

te

ends

peds

ABR/McM

s

te

and

meda

contnuaton

paanx

It

o

neus.

artery

dorsum

bone,

te

artery

artery

aucs

to

tba

309

meda

o

te

te

509;

sesamod

o

o

tba

tba

s

tba

N

body

surace

bone

te

provdes

he

dorsas

adductor

atera

and

B.

peds

te

653–654;

o

tuberos-

tba,

metatarsa.

ABR/McM

posteror

anteror

he

sde

and

artery

becomng

50.

sca

proxma

pubc

surace

rst

anteror

pantar

tba

he

te

te

rom

artery

neck

A

dorsas

ror

506;

te

te

arses

te

tba

and

te

rom

meda

o

N

suppy.

n

he

GAS

te

base

artery

brances

D.

onto

and

suppy

vascuar

C.

arses

posteror

buar

rom

on

meda

anteror

621–623;

he

arses

meday

ansernus.

mosty

49.

Limb

semtendnosus

and

te

Lower

o

musces

te

guteus

te

mus-

obturator

oot.

and

he

maxmus;

guteus

medus

CHAPTER

and

mnmus

nerve

rs,

and

provdes

sartorus,

gat

pattern

mb.

As

a

degrees,

tgt

and,

s

ascae

suppy

n

most

resut

gvng

tese

te

N

o

areas

488;

atae.

te

he

te

become

o

extreme

emo-

pectneus.

n

exed

te

to

Anterior

hs

A.

he

ous

pernea

nerve

ous

provdes

nnervaton

and

can

tesa

o

requre

cdbrt

or

are

a

o

varous

croucng,

we

327

posteror

sgncant

te

used.

n

surgery,



o

cutane-

Anterior

ar ter y

durng

o

Dorsalis

posteror

emora

cutaneous

nerve

brances

suppy

te

o

te

branc

or

o

te

skn

te

o

te

buttocks.

oypogastrc

anteror

superor

he

nerve

aspect

o

atera

o

gutea

musce.

he

nerve

mdde

nnervates

cunea

te

nerves

area.

guteus

arse

lateral

sensaton

gutea

he Arcuate

neror

and

branches

cutaneous

provdes

te

pedis

ower tarsal

part

ar ter y

ar ter y

anes-

Medial

te

medial

malleolar

ndvduas

types

cuna

lateral

malleolar

cutane-

bockade

oter

neror

te

some

anestetc

he

emora

porton

perneum

separate

pernea

not

te

ar ter y

adducton.

ABR/McM

branc

tibial

ower

Anterior

56.

269

Limb

emora

quadrceps

ypertona

appearance

produce

556–557;

to

cases,

caracterstc

adductors

GAS

tensor

motor

Lower

5

Dorsalis

arter y

maxmus

rom

te

pedis

ar ter y

dorsa Extensor

ram

o

S1

to

S3

and

suppy

skn

over

te

mdde

o

te hallucis

gutea

GAS

57.

D.

(buttock)

485;

he

N

regon.

531;

dorsas

longus

ABR/McM

peds

s

289

te

First

contnuaton

o

te

dorsal

metatarsal

ante-

ar ter y

ror

tba

end

o

artery

nto

te

oot,

as

t

passes

te

dsta

Deep

te

tba

and

te

anke

jont.

he

puse

o

plantar

te ar ter y

dorsas

peds

can

be

et

between

te

tendon

o

te

Extensor

extensor

aucs

ongus

and

te

tendon

o

te

extensor hood

dgtorum

postve

ongus

to

ndcator

te

o

second

toe.

crcuaton

A

strong

troug

te

puse

mb.

s

a

First

he

dorsal

interosseous

buar

artery

s

a

branc

o

te

posteror

tba

artery muscle

and

passes

n

and

tbas

te

ca

between

te

exor

aucs

ongus Dorsal

deep

posteror,

pantar

artery

makng

passes

t

dicut

deep

to

te

to

papate.

he

aponeurotc

Tendon

digitorum

ts-

to

sues

and

centra

unkey.

he

musces

dorsa

o

te

metatarsa

oot,

makng

brances

o

of

toe

extensor

digital

longus

ar teries

II

papaton

te

dorsas •

peds

gus

pass

and

oter

cut

brevs

dorsa

to

D.

te

o

N

Injury

oot

te

oot,

rst

torum

(GAS

te

can

ts

o

tendons.

521;

to

deep

and

cover

metatarsa

detect

GAS654;

58.

under

coud

second

brevs

Papabe

Fg.

cause

toes

and

o

te

tereore

rst

be

n

In

to

te

te

oss

o

te

sensaton

o

dorsum

termna

proxma

parayss

extensor

on

te

aucs

o

porton

part

o

te

between

te

extensor

brevs

dg-

musces.

In te dsta part o te oot, ony te sensory oss mgt

be

apparent.

observed

pantar

Neter

n

exon,

ongus

o

oot

o

nerve

GAS

nor

tese

654;

N

o

te

parayss

nverson)

muc

s

a

congenta

patents.

nverson,

extenson

cs

bot

Cuboot

pedatrc

musces

and

great

o

woud

are

hs

te

adducton

toe

by

tbas

occur

maormaton

syndrome

by

proxmay

n

te

533;

ABR/McM

358

by

o

te

oot.

au-

(weakness

njury

te

eg.

combnes

extensor

anteror

ts

nnervated

more

te

because

deep

Fig.

6.125

or

di-

59.

D.

he

te

tba

nerve.

artery

trauma

and

te

puses

can

GAS

on-

354

peds

nerve.

resut

dgtorum

6.125).

ABR/McM

buar

extensor

arteres

dorsas

aso

te

buar

ton

oten

or

nerve

nerve

as

ca

te

used

end”

nerve

sura

wtn

t

anastomosed

were

o

t

surgcay

t

seats

Growt

woud

(due

and

to

In

te

to

to

ts

te

te

grow

a

s

o

case

to

opposte

sde

te

troug

te

usuay

to

te

te

o

a

occur

te

sur-

branc

rennervate

woud

te

te

at

con-

aca

ace,

empty

to

“v-

nto

parayzed

now

s

severed

dsta,

rom

to

It

bopsed

unctona

degeneraton)

rennervaton

oot.

grow

surgeon

te

o

por-

ma-

te

grow

te

nerve

to

axons

can

atera

and

nerve,

rom

buar

atera

te

nerve

brances

waeran

te

grated

gude

hus

nerve

sura

t

sensory

as

ower

nerve

“vng”

t

nerve.

motor

musces.

tunne

te

usng

te

common

procedures

Wen

or

contrbutons

te

beneat

cutaneous

motor

seat,

portons

or

contnues

purposes.

cut

by

rom

nerve-gratng

unctona

nerve,

jon

a

ormed

branc

sensaton

and

processes

parayzed

nect

s

a

atera

or

o

nerve

gcay

a

and

provdes

te

dagnostc

ng

o

It

o

eous

sura

and

nerve,

nerve

musces.

a

rate

o

270

C H A P T E R

1

5

mm/day

beore

bers

musces

te

and

to

o

GAS

60.

te

based

traverse.

te

N

te

te

he

te

ca

buar

o

te

oot.

tme

and

and

te

te

ABR/McM

L3

te

rectus

te

nerve

wtn

a

gutea

area

on

emur

348

te

It

s

not

boys

age.

V ery

are

at

ste

gament

o

a

attacment

GAS

s

and

578,

tba

o

te

tba

660;

te

he

o

or

o

tat

growt

ead

tat

occur

to

t

te

480;

a

ton,

he

or

s

te

teror

connects

te

not

342

a

nstabty

o

tvey

ts

s

between

120

te

genu

te

and

sat

hs

135

and

can

genta

deect

vaga

resuts

vaga

cuature.

In

resut

wc

Coxa

neck

s

ts

or

o

n

can

ead

Haux

coxa

bone

vara

s

to

p

rom

te

n

o

ange

tan

subuxaton

o

te

between

te

120

degrees.

or

coxa

angua-

dsocaton.

known

ponts

In

adductor

as

toward

dstay

hs

mus-

bunon.

te

tte

GAS

64.

E.

toe,

sa

ead,

cated

tends

due

to

mony

metatarsa

te

metatarsopaangea

te

dsta

aso

not

Bunons

routney

GAS

A.

protrudng

occur.

546;

he

N

478;

patear

connects

te

te

nserton

te

tba.

bone

ceps

te

or

bre

to

te

te

bony

n

sac

growt

metatarsa

rarey

bone

peope

at

s

a

te

very

tba

can

be

wtn

musce.

gament,

t

emors

tougt

te

Wen

te

n

o

tendon

reex

stretces

resutng

strong

gament

te

reex

t

as

o

a

tat

upon

quadr-

ammer

gament

strkes

sgty

contracton

o

great

bunon.

te

meday,

aso

te

protrudng

occur.

Bunons

routney

bowegs,

outward.

knee.

or

he

he

neck

vara

ange

te

ess

oter

tan

s

ng

and

o

ange

or

mpng.

o

n

120

sat

hs

In

deect

coxa

aso

vagus

s

te

genu

te

and

resuts

aso

are

tere

or

s

o

te

mb

an

to

knock

In

te

do

bowed

sat

rom

at

o

can

wo

reerred

degrees.

o

rst

sac

bone

vagus,

n

great

growt

peope

neck

ten

com-

te

bursa

knees

resut

asso-

te

emora

135

be

s

o

metatarsa

n

great

metatar-

wc

bony

sotness

vaga

te

can

base

varus

can

t

swoen

rarey

and

congenta

hs

a

s

wt

artcuates

deormty

wc

ts

te

rea-

cacaneus

o

toe,

Excess

Genu

to

are

dstay

bone

and

te

te

ony

te

degrees.

neck.

ts

between

between

between

njures,

emora

egs,

opposte

120

te

soes.

bandy

norma

emora

s

wear

part

occur

sted

s

o

orced

artcuates

Haux

toe;

jont.

be

promnent

second

wt

type

357

soes,

In

tte

pos-

bones.

te

toe.

te

addng

dspacement

te

te

por-

artcuar

ts

he

taus

navcuar

rom

dsta

sesamod

te

ponts

te

and

paond

can

artcuates

over

o

n

ractures.

o

anke

nvoves

as

te

bones

ABR/McM

te

provdes

tendon

as

te

and

pan

te

o

racture,

oter

he

can

as

tuberosty;

o

rubbng

toward

ts

te

everson

to

taus

metatarsopaangea

do

on

Henderson

dsta

he

n

atera

as

(te

reerred

part

a

posteror

anke.

te

wo

ong

sort

maeous);

te

way

o

339

quadrceps

patea

tme,

Excess

bursa

not

ABR/McM

gament

o

o

ony

swoen

soes.

deveops

emors

part

occur

patea

he

tat

patear

a

wear

jont.

a

to

(atera

cuneorm

deormty

known

metatarsa

wt

or

overrde

ponts

a

a

nsert

njury

ts

ead

517;

by

hs

and

paond

taus

tree

N

comes

wt

to

wen

caed

acts

bone.

vagus,

usuay

toe

meday,

te

629–640;

bua

he

ste

he

navcuar

Haux

unte

caused

taus.

tba;

but

te

te

be

posteror

anke.

te

aso

sometmes

he

bone.

wt

as

ten-

oot).

342

te

tba

o

te

rom

toe and may overrde te second toe; te base o te rst

ponts

o

o

poston

beneat

te

may

te

maeous

cubod

wt

con-

neck.

neck

or

ar

resdes

mpng.

sat

ange

between

njures,

and

emora

toe

s

emora

commony

great

norma

neck

te

oter

te

weakness

s

he

ess

sortenng

vagus

deormty

knee.

emora

emur

ncrease

resuts

and

ractures,

te

mb

an

In

te

rom

o

knock

sat

degrees.

sotness

tere

ton,

vagus,

emora

te

norma

A. he patent as bowegs, or genu varus. he opposte

tree

and

te

prox-

(goose

tg

tey

rom

te

te

tuberosty

externay

racture,

dsta

tba,

racture

ts

emur;

rotated

o

maeous).

truy

rom

te

o

te

posteror

o

ansernus

sca

ABR/McM

be

racture

o

p,

te

te

dspacement

o

twstng

ABR/McM

can

maeous

porton

one

on

te

nserts

bua.

482;

he

as

pes

o

and

arses

nserts

bone

deveops

musce

tuberosty

sartorus

and

ncudes

ntermedus,

tat

emors

and

ected

sesamod

bone

te

te

trmaeoar

racture

meda

wc

N

a

s

emors

ateras,

sca

tba

arc

component

argest

s

he

te

o

rom

te

taus

bone

spne

o

rom

arses

578;

he

posteror

pos-

o

emors

te

quadratus

ac

aspect

arses

o

racture.

ateray.

N

E.

sustans

and

attaced.

tuberce,

tus

te

nter-

te

ead

GAS

63.

emnence

pateau

are

s

gament

o

te

he

eang

condye

orgn

bceps

vastus

te

reex

nput

quadrceps

s

proxmay.

components

ead

posteror

Gerdy

tract;

a

meda

he

he

rom

superor

o

gament.

ntercondyar

tba

years

tat

perod

emora

mensc

otba

12

durng

coatera

te

tuberce,

typcay

to

sweng

jont.

he

on

overuse,

10

ong

ocaton

and

tuberos-

patear

a

tba

te

tba

usuay

and

meda

gament.

te

o

grs

n

knee

gaments

anteroatera

o

te

te

protuberance

crucate

emur

o

emnence

crucate

or

resutng

he

o

probem

pan

attacment

o

area

grs,

te

treatment.

bony

te

a

and

to

tear,

te

years

boys

menscus

condyar

s

o

but

14

attacment

meda

teror

to

subject

can

oowng

area

dsease

12

actve

spurt,

te

a

o

afects

te

patea

sesamod

arses

hs

sensory

he

and

he

tendon.

anteror

(L4

output).

A

meda

musces.

nerve

emors

body.

dnous

and

motor

medas.

ma,

apopysts

emors

emora

L2,

n

oot.

531;

te

and

sensa-

sapenous

on

by

surace

nnervates

ven

quadrceps

regen-

suppes

pantar

musces

he

te

nerve

nerve

sapenous

estmated

dstance

tba

compartment

great

and

658;

to

common

so

on

ty

n

62.

to

dorsum

eg

624,

s

D. Osgood-Scatter dsease s aso caed tba tuberos-

ty.

61.

nc/mont)

anteror

te

Limb

sensaton

he

accompanes

sde

1

need

and

oot.

atera

ton

(or

rennervaton

eratng

o

Lower

and

coxa

emur

ractures,

bone

o

sorten-

ncrease

n

CHAPTER

emora

sat

subuxaton

weakness

GAS

65.

C.

he

mony

toe,

or

ta

paanx

panu

te

ponts

can

In

caw

te

tary

exed

motor

because

GAS

66.

C.

o

In

hese

and

be

sensory

N

te

dorsa

weaken

nerve

sensory

and

surace

pantar

dvson

prorms

nerve

GAS

woud

n

n

be

te

Pes

te

te

on

te

te

oot.

or

cus

s

and

S1

te

pernea

nerve

passes

eadng

to

Incapactaton

s

489;

and

ABR/McM

esser

o

most

emora

te

GAS

E.

tomoses

o

tme

nerves

hs

can

and

can

tssues

o

te

wt

ra

cause

oss

n

oss

oss.

nerve

o

te

gutea

te

oot.

nor

oss

o

posteror

o

he

o

te

oot

nerve

o

and

oss

nor

wt

exon

or

oter

and

te

te

eg,

eg

and

not

generazed

oss

emo-

o

neck

artery

age

by

te

reaces

traveng

o

brances

te

and

rom

te

wtn

can

gutea

te

o

emora

emur

brances

to

o

as

crcumex

arses

arse

arteres.

te

externa

um,

te

abdomna

a-

wa.

C.

s

n

as

653;

te

te

te

N

oot,

and

cubod

n

to

some

te

o

gutea

wt

te

tba

and

pantar

exon

GAS

627–640;

N

te

te

up

tba

ossa

nerve,

to

te

o

te

trbutares

ven

tereater

gencuar

by

ven.

wc

deep

emora

te

maeous,

poptea

structures

513;

ABR/McM

te

o

he

at

orgn

o

te

nto

te

ven

s

a

te

peds,

to

te

te

atera

he

repaces

arcuate

orgn

artery,

or

te

toes.

361

njured

te

gament

bone,

ocated

wt

ongtudna

te

te

cuneorm

cacaneus.

n

by

artery

jont.

branc,

he

deep

anas-

peds

tba

anke

provdes

te

arc

dorsas

anteror

te

344

to

vascuar

ndvduas.

posterory

518;

deep

o

330

atera

peroratng

wt

bua

te

poptea

provdes

peds

a

atera

te

o

artery

ascends

te

tg,

navcuar

artcuates

o

N

ABR/McM

he

te

deep

porton

o

te

meda

artery.

wc

wt

to

Meday,

arteres

513;

at

te

artery

dorsas

anterory

bone

posterory

way

te

anastomoses

ven.

655;

dsta

ven

jonng

te

superor

dorsas

by

te

bone

o

n

branc

peroratng

to

descendng

suppes

ABR/McM

major

he

pantar

cacaneus.

te

taus

deep

o

tat

ony

6.31).

495;

and

dran

arc.

metatarsa

he

es

he

nutrent

beneat

poptea

peds

o

te

artery

suppes

emora

partcpates

Fg.

N

t

capts.

sapenous

asca

609,

tat

peroratng

rom

pantar

artery,

dorsa

GAS

71.

and

termnatng

he

deep

ovea

so

crcumex

670.e3;

te

e,

suppes

asca.

560,

te

branc

dorsa

com-

te

nor

a

sot

musces

woud

entrapment

assocated

knee

tg

nerve

wc

and

exors

perods

compressed.

compartments

prorms

s

n

are

musces

knee

Tba

dorsexon

Neter

njury,

area

compresson.

atera

n

te

crus

gutea

parayss

entrapment

muscuature,

o

nerve

and

oss

n

gutea

o

oss

scatc

can

sensory

sensory

to

n

anteror

sensory

resut

resut

and

presson

ead

vesses

extended

suc

Smar

emora

n

(GAS

ven

wt

buar

or

n

suppy

(varaby,

suppy

capts

vesses

brances

second

ven

artera

contnues

supne

te

artera

artery

meda

te

te

superca

atera

pantar

o

to

542,

he

o

oten

deep

ven.

trbutary

o

we

o

compartment

ous cases o te “gutea crus syndrome.” Compresson

regon

ts

artera

ovea

portons

musce

ca

poptea

te

way

gutea

by

te

ac

(sma)

te

te

cocane and oter poweru narcotcs ave ed to numer-

te

gets

he

jont.

atera

commony

posteror

he

area

550–553,

he

emora

use

o

eary

emur

deep

S1–S3

rom

te

woud

325

unconscousness

emur

te

ater

ower

he

artery

poptea

70.

N

D.

he

Pudenda

L5,

oss

325

approxmatey

obturator

at

suppes

te

deep

regon.

te

p

regresses

on

troug

sensory

ABR/McM

unt

crcumex

and

knee.

percng

te

oss

compresson

te

ateras

o

most

oot

o

te

oramna

o

and

o

mdde

weakness

sensory

everson.

GAS

69.

woud

sde

by

te

sat

nerve.

but

o

branc

mmedate

emora

mb.

extenson,

meda

at

con-

eson

genera

vdes te branc to te ead o te emur, an

posteror

dsc

to

he acetabuar branc o te obturator artery oten pro-

a

scatc

spna

ndcated

ndvduas,

a

489;

emora).

repaced

musce,

te

area,

o

crcumex

artery

panu

s

s

deep

ac

s

ower

unusua

oot

afect

scatc

te

S1

knee

te

be

and

n

gutea

nverson,

woud

557;

he

normay

te

N

emur

atera

ered-

prorms

te

nto

te

vastus

resembng

o

pass

branc

te

o

o

It

branc

capsue

o

as

ead

ascendng

rom

dsta

cavus

ead

cdren

crcumex

suppy

te

o

compresson.

524.e1,

o

te

toe

tey

566;

and

te

drect

ead

tat

patent

resut

a

Causes,

resut

nants

years,

ammer.

and

do

wtn te gament o te ead o te emur. hs source

358

rater

oss

oot

some

te

8

te

ds-

surace

entrapment,

emors

exon

o

canges.

sensatons

woud

o

entrapment

buar

or

wen

pan

compresson

dorsexon

a

ammer

a

are

nor

527–528,

meda

am-

te

te

probems.

requenty

quadrceps

and

ke

exed,

as

tat

and

dorsa

case

by

oot,

271

Limb

mb.

In

com-

toes.

In

E.

o

extended,

proxma

ABR/McM

compresson

compresson

L5

ts

most

soes

s

Eter

neura

panu

most

te

te

te

am-

ourt

bunon.

te

occurs

syndrome

nvove

wt

te

515;

to

o

compresson.

compressed

eg,

L5–S1,

eg.

C.

t

metatarsa

and

nverson,

67.

arc;

eadng

nvove

n

pantar

a

o

g.

exed,

o

artrtc

In

but

too

ookng

oot.

oot.

usuay

tg,

rom

p

rom

68.

case

or

jont

strongy

te

toe

are

s

on

bot

er

wearng

resut

at

prorms

can

tracted,

L4

o

a

are

n

to

360

trd

tat

orm

toe,

jonts

occur

632–635;

nerve

at

can

opposte

g,

can

mbaance

toe

rom

jont

as

to

any

te

downward,

caw

nterpaangea

musce

due

afect

ees

occur

corns,

jonts.

s

metatarsopaangea

toe

ead

resuts

GAS

ABR/McM

ten

commony

wt

can

vaga

muscuature.

can

toe,

wc

Coxa

515;

nterpaangea

Hammer

or

toe

soes

te

proxma

N

compant

second

most

sort

mer

adductor

640;

Hammer

resuts

too

te

629,

te

anguaton,

dsocaton.

patent’s

mertoes.

It

o

625,

neck

or

Lower

5

he

anke

ABR/McM

355

ead

o

bones.

arc

taus

jont

attaces

meday

te

he

artcuates

artcuates

mortse.

272

C H A P T E R

5

Lower

Limb

Cut

Acetabular

Acetabular

synovial

membrane

labrum

fossa

Synovial Lunate

sleeve

surface around

Obturator

Pubic

ligament

ar ter y

tubercle

Pubis

Acetabular

Acetabular

of

foramen

branch

obturator

Ar ter y

of

ar ter y

ligament

of

head

T ransverse Ligament

acetabular

ligament

Obturator

of

head

of

Obturator

A

Answers

C.

upon

Fig.

Its

racture

tuberosty

o

te

o

te

te

s

oot.

t

rom

base

oten

hs

wen

anke.

arses

at

attacment

overooked

spran

brevs

s

he

te

o

bua

te

t

nvoved

common

n

wt

ongus

nserts

o

metatarsa

an

can

an

oten

rom

ts

rods

ar

nverson

arses

patea,

ud.

but

nverson

racture

combned

buars

and

may

need

ntroduced.

bursa

tme

te

resutng

T reatment

n

(as

posteror

crucate

meday

dspacement

nto

upon

bones.

he

posteror

meda

dorsay

rom

atera

GAS

n

and

mad’s

o

ayers,

workng

patea

constant

sma

on

te

bone

642,

o

N

bended

move

rcton

ubrcatng

peope

knees.

o

sac

tese

te

jon

te

ras

and

tarsa

paanx

and

363

74.

D.

n

pan

a

ot

normay

under

te

and

ouse-

pumbers,

spend

as

o

car-

tme

enabes

an

stabty

strengt

crucate

(te

he

anteror

rrtates

ts

o

n

ront

o

te

te

o

te

and

te

upon

knee

to

be

njured

patear

tssue

tat

vastus

ate-

menscus

atera

o

he

posteror

he

o

te

atera

te

perods

knee.”

wt

emur.

ste-

nrapate-

can

bands

tendon

he

te

ong

knee,

te

cuson

dranage,

occasonay

o

“parson’s

te

between

502;

o

ABR/McM

te

or

ead

suppy

and

jont

ts

roe

It

n

o

jont.

bone

as

s

condyes

a

o

te

te

he

and

o

s

te

o

gament

o

stabzng

pedatrc

s

an

he

bone

ocated

on

to

stretced

to

jont

p

ncrease

n

deveop-

te

he

anteror

gament

Bgeow”)

ressts

on

te

yperextenson

gament

te

p

nant’s

oemora

o

a

emur

popuaton.

comparabe

gament

conveys

te

te

potenta

puboemora

s

emur

ead

rotaton

te

knee.

p

342

te

reconstructon

te

gament

o

n

p

n

o

he

atera

“Y-saped

aspect

p

n

tendnous

musces.

dyspasa

gament

pubc

o

o

emors

wakng.

nverted

skn.

just

o

p

tba

mportant

beore

requent

cdood).

abducton

as

menta

N

vesse

n

and

rrtaton

resut

tense

smpe

tba.

gament

bood

or

structure

and

(prmary

jont

te

requres

repeated

can

strong,

598–603;

sma

be

exon

medas

emur

he

to

quadrceps

and

GAS

and

bursa,

so-caed

afects

ocated

te

o

are

deormabe

gament

strong

cartagnous

arses

aucs

te

durng

occupatons

(bursa)

retnacua

prox-

transverse

resut

te

bursa

smooty

te

prepatear

can

wo

he

brevs

upon

ABR/McM

bursa,

bursts

t

toe.

te

knees,

prepatear

under

adductor

and

n

navcuar

proxma

510;

were

metatarsa

tba

passes

he

great

o

te

te

nserts

te

te

t

oot,

rst

dgtorum

metatarsas

664;

oter

rom

eg;

toes.

upon

te

and

upon

and

atera

atera

ter

to

te

extensor

Prepatear

and

on

o

compresson

te

knee.

he

o

arses

nserts

cacaneus

nserts

622–623,

workng

te

o

te

Excessve

pet

te

sesamod

sweng

and

bones.

surace

cuneorm

posteror

compartment

rom

gament

A.

tbas

paanges

arses

pantar

meda

maeous

metatarsa

ma

te

te

sudden,

a

Excessve

prayer)

n

n

usuay

kneeng

n

bua, passes under te atera maeous, and ten turns

nserts

tuberosity

6.

te

buars

te

bone.

73.

GAS

Ischial

72–95

he

be

membrane

B

•

72.

femur

foramen

arses

neror

sde

rom

o

te

CHAPTER

p

jont;

mora

arses

over

t

ressts

gament

rom

te

te

he

te

margns

or

te

but

B.

gament

regarded

he

o

te

as

o

seated,

by

s

rupture

hs

crucate

te

rom

It

knee

o

oter

It

76.

A.

Fat

to

bones.

te

an

sve

meda

oot

s

Occasonay,

ess

o

(uson

te

oot

te

s

a

passve

pantar

bones.

n

It

can

te

cubod

buars

ment

tba

s

ment

s

te

t

s

mbs.

In

appears

ure

o

GAS

he

a

to

te

534,

to

o

needed

a

anomaes

n

n

te

wt

ong

a

ong

cana

ead

N

s

be

arc.

coatera

n

and

orces

te

gradua

ABR/McM

ng,

ong

batera

s

te

te

he

ga-

te

te

pes

weakenng

ower

panus

and

a-

cases

ext

ac

o

spne.

artery

or

cm

te

externa

puse

te

ante-

atera

can

rom

n

s

are

o

te

ma

usuay

get

used

o

n

everson

maeous

An

or

nverson

cacaneobuar

bed

wo

reerred

common

or

nam-

rom

are

on

he

n

Morton

between

te

te

anke

meda

or

at-

pan

te

begn

ter

n

o

morn-

to

wak.

antnammatory

A

o

te

aponeuro-

neuroma

nterconnecton

spran

gament

s

a

engaged

and

and

te

In

wt

njectons.

pantar

sgncant

spran

tear

s

jumpng.

nerves

to

wear-

eased

tearng

or

treatment.

pantar

to

oreoot.

be

stretcng

peope

neura

te

men

361

(te

spnts,

te

te

cortsone

carrers,

rom

due

aponeuross

and

pan-

ourt

and

tan

can

rom

most

up

on

tssue

to

te

compressed

key

ascts

oot

runnng

ngt

atera

gament.

resuts

band

as

you

An

pantar

Pantar

tat

o

or

be

can

sensaton

gament

pan

pantar

pan

atera

o

key

stress

soes

he

te

a

com-

anastomos-

atera

toes.

can

most

te

an

and

toes;

more

nvoves

o

and

ABR/McM

te

ba

eson

toes.

meda

tod)

sprng,

tereby

ater

panu

ourt

te

o

trd

can

break

coatera

commony

anteror

te

and

(de-

njures

taobuar

gament.

ongtudna

and

ascts

and

4

to

abdomen

provdes

metatarsa

requenty

ortotcs,

meda

ga-

ts

a

o

o

suc

medcatons

converts

o

te

day,

just

Rest,

to

nerve

toe

excessve

toug

especay

he

cubod

te

ourt

probem,

ascts.

appens

pantar

or

troug

a

gament

bones.

beore

It

eet

etcs,

aponeuross

taus

ss).

errors.)

o

te

te

utra-

328

meda

a

tmes

532;

condton

cacaneus

and

N

Inammaton

soes.

(detod)

bone

320

put

80%

as

pantar

a

tte

10

ts

to

GAS

80.

B.

or

647;

he

N

cd

cuboot.

observed

and

hs

519;

wt

te

and

and

te

are

tat

o

at-

sympyss

meda

nterconnecton

D.

pysca

pubc

commony

pantar

(ess-connng)

maton

arc

tendon

meda

taus

exerted

case,

o

te

79.

n

eter

te

between

enargement)

transverse

656–657;

nten-

nterconnects

racture

te

tarsa

artrod-

and

gament

tat

soes

GAS

tree

Women

alcted

te

or

cose

ste

emora

ABR/McM

trd

meda

neura

te

dferent

be

deormty

pantar

te

te

rased

te

o

a

cacaneonavcuar,

o

te

meda

pantar

or

cacaneus,

usuay

n

orm

cavus

g

te

o

o

may

ootprnts

cacaneus

gament

resut

te

pantar

t

ncude

worn

arces.

644;

emo-

(normay

may

Pes

he

wet

soe

very

meda

present

te

oor.

rom

rom

Mdway

most

connects

suppes

he

very

superor

te

and

cm

490;

te

meda

between

strong,

attenng

ongtudna

eement

te

vertca

be

te

pantar

key

te

by

nto

w

to

seen

bones).

he

he

toe.

N

tat

he

nerve

1.5

possbe

approxmatey

congenta,

te

te

tar

spne

neuroma

between

severe.

anteror

ven.

cm

atrogenc

vesses

nerve

to

1.5

ntersect

approxmatey

and

273

Limb

artery.

(and

branc

or

te

emora

666;

Morton

ng

supports

toes.

navcuar,

supports

subject

s

strong

maeous

tears.

gament

arc;

groove

very

o

arc

nvoved

ongus.

a

wt

meda

be

be

meda

quadrceps

660,

nerves

capsue

te

A.

ng

o

crcuar

te

emora

te

w

approxmate

meda

ac

avod

epgastrc

to

cm

approxmatey

presson

te

wtn

jont

s

78.

tat

o

superor

GAS

b-

ead

neary

te

te

339

due

be

connects

ascts.

te

T reatment

te

gament

gament

pantar

can

tarsa

o

s

structura

caracterzed

yperextenson

o

band

tan

to

he

capsue

gament

Oten

surace

surgery

o

patear

arc.

or

anteror

te

ateray

njured

ABR/McM

vsbe.

exercses

a

to

te

te

to

tuberce

he

t

(Fuoroscopc

ocated

cutaneous

meda

1.5

s

pubc

ven.

emora

cm

enter

vary

because

he

1.5

rng

neror

puse,

cases.

advsabe

te

and

approxmatey

emora

most

s

to

te

atera

ror

tuberosty.

condton

arc)

te

s

attaced

panus)

mnor

to

ocated

nserton

500;

(pes

wt

hs

wc

he

under

cordke

menscus

not

tba

drawer.

condye

patent

sgn

o

nserted

nguna

artery

w

n

gudance

Injectons

demonstrated

drawer

tck,

s

be

exon

te

posterory

externa

tat

s

o

N

a

te

dspace-

yperextenson.

requenty

t

ongtudna

assocated

n

te

oot

meda

ess

band

576–578;

s

Wt

can

desk

emora

atera

gaments.

musce

GAS

s

a

knee

ocated

because

gamentous

rs

s

he

jont.

n

gament

atera

tba

ac

s

maxma

nerve

deep

orgn

s

posteror

emur.

posteror

ressts

brocartage

menscus

te

te

trans-

abrum.

n

neede

te

superoatera

cartagnous,

tgtens

by

gament

pusng

te

jont.

band

pus

gament

bua.

knee

or

to

coatera

passes

te

te

he

334

gament

te

to

sound

to

orgn

he

I

emora

pos-

attaces

C.

era

ateray

provdes

not

77.

tat

capsue

emur.

acetabuar

damaged

upon

caed

te

ABR/McM

be

o

to

s

smar

uar

can

o

te

and

scoe-

bers

and

gament

brous,

te

crucate

tba

abty

emur.

t

te

a

te

It

s

he

strong

upward

notc

ead

o

477;

jont.

o

strengtenng

te

part

N

wnds

acetabuar

o

te

band

acetabuar

gament

posteror

knee.

ment

neck,

te

GAS550–553;

75.

and

transverse

o

o

tranguar

scum

acetabuar

s

abducton

a

emora

terory.

verse

s

Lower

5

and

rst

n

523;

as

ABR/McM

te

Cuboot

s

a

approxmatey

appears

syndrome

adducton

n

te

te

1

oot.

o

tapes

congenta

n

rst

combnes

o

361

probem

1000

pedatrc

trmester

pantar

he

equnovarus,

maormaton

o

exon,

ee

s

patents

pregnancy.

nverson,

drawn

upward

274

C H A P T E R

by

s

te

Lower

tendo

aso

tan

emora

degrees,

nvoves

great

o

a

to

great

meda

It

coxa

can

aso

aso

resut

oreoot

usuay

ange

ess

o

te

known

adductor

rom

te

metatarsa

rst

rom

artrts

saton

bunon,

or

or

GAS

D.

muscuar

caw

angea

jonts

mbaance

extensors

by

te

o

tra

but

t

wearng

too

jont

s

s

t

and

may

Hammer

or

a

toe

Haux

and

rst

may

oot;

cavus

sory

to

toe

overrde

bone

a

orm

on

patent

occurs

as

a

a

resut

probems.

It

soes

o

wt

a

be

a

any

82.

D.

he

nea

s

534,

ten

te

anke

medated

nerve

jerk

by

suppes

te

toe.

cavus

a

ammer.

reerred

he

s

exed

base

and

te

s

arc.

motor

because

o

and

te

te

te

anteror

ected

tendon)

tba

oot

te

o

te

oot

wt

nerve.

evertor

eg

and

oot.

extensor

compartment

o

by

te

he

he

te

reex

musces

and

o

deep

and

D.

u

te

sen-

atera

suppy

buar

nerve

musces

dorsum

o

n

te

tar

o

nerve

te

meda

GAS

B.

toe,

pantar

he

o

emora

S1

to

and

ABR/McM

It

exor

musces

and

sensaton

a

a

o

pan-

exor

or

te

toes.

arses

neror

rom

cuna

can

o

atera

superor

tg,

te

325

he

oot,

nerve

emora

ABR/McM

pan

com-

atera

tba

and

cuna

o

nerve.

and

posteror

pop-

arses

rom

cutaneous

ca

and

sen-

te

occurrence

nerve

patea

ast

does

and

quarter

o

papabe

musce

s

(VMO).

essen

te

emors

and

and

cutane-

not

nner-

superor

draws

n

atera

to

as

te

te

upward,

hs

te

te

vas-

strengt

dsocaton

rom

o

med-

contracton.

Increasng

rm

t

extenson—dur-

reerred

arses

vertcay

511;

ABR/McM

s

a

o

anteror

acetabuum

as

does

te

te

ne-

and

vastus

337

norma

secondary

or

te

varant

osscaton

ton

o

GAS

D.

te

578;

ror

to

te

y

te

o

an

center,

unused

wc

to

na

are

o

can

spne

and

atera

or

be

can

o

as

n

an

te

A

to

dsta

presentng

o

he

and

gas

to

more

centmeters

te

o

age.

por-

patea.

at

at



te

s

te

rsk

atera

not

or

to

o

s

s

s

and

artera

mdngu-

eter

ac

meda

dependabe

te

can

te

tat

cateter-

superor

a

eas-

di-

ere

or

were

o

ead,

orgn

It

he

be

eve

It

puse

be

edge

structures

ste

anteror

and

ne-

can

meda

emur.

te

anayss.

can

ocazed

just

artery

artery

a

common

be

puse

toracc

emora

te

tba

most

patent.

aso

te

artery

te

pan-

years

can

te

emora

s

te

emora

o

obese

nserted

s

te

expanded

emora

sympyss,

emora

neede

neror

Four

or

14

artery

ead

It

to

on

toward

utrasound

te

crawng

dsease

an

assstance

between

pubc

one

te

te

nto

obtaned

te

s

or

Dopper

s

enarged

n

342

emora

gament.

away

10

tendon

angograpy.

artery

artery,

njury.

he

eeng

suc

as

gament

cdren

abdomnopevc

to

andmark.

n

puncture

passed

antegrade

pont,

patear

retnacuum

porton

detect,

panuy

Osgood-Scatter

te

uoroscopc

by

become

compresson,

ABR/McM

nguna

upper

zaton

ra

artery

wt

can

medas

498;

smpy

cateters

or

vastus

ocazed

cut

o

procedures.

by

accessed

o

knees.

patear

N

Femora

oten

bursa

cronc

commony

meda

emora

nerve

provdes

on

crease,

355

cutaneous

S3.

unctons

meda

musce,

provdes

tree

te

he

and

umbrca

and

and

514;

combnes

brances.

abductor

rst

musce

N

posteror

ram

te

surace

615–619;

ventra

te

brevs

nerve

deep

nnervates

great

dgtorum

and

(.e.,

rom

te

te

prepatear

he

bood

buar

eve

nnervaton

te

ower

he

especay

nvovement

he

common

o

te

patea

acute

or

superca

N

tuberosty,

Pes

buar

n

patea

582;

about

o

caca-

te

531;

rectus

Bpartte

wt

te

ammer,

sensory

nvertor

eg

te

te

(sensory)

obquus

spne

te

neous

metatarsa

superca

provdes

he

vascuar

tappng

L3

s

regon

suppes

easy be mstaken or a racture on a x-ray. he subcuta-

as

318

N

o

musce

ac

oot and suppes skn between te rst and second toes.

te

83.

o

ABR/McM

s

superoatera

subject,

opposte

ts

GAS

85.

tte

o

te

emora

to

and

ntermedus.

te

to

te

pantar

eredtary

o

t

porton

draws

Causes,

surace

on

nerve.

aspect

medas

ror

jont

554;

especay

patea.

dorsexed,

toward

meday

panu

515;

reex,

te

dorsum

nnervates

N

(Aces

compartment

or

o

tat

to

to

contrbutons

cutaneous

wc

tus

rom

L1

atera

buar

480,

ower

86.

636–641;

tendon

ng

toe,

o

gutea

regon

parestetca

sensory

meda

ay,

neu-

te

tg

gutea

ram

te

B. he ower porton o te vastus medas nserts upon

te

s

posteror

o

perneum

musces.

GAS

84.

occur

ees

bunon.

dorsa

second

o

toe,

commony

g,

s

afect

ke

anguated

Pes

n

can

commony

may

te

drected

as

be

toe

can

te

jont

nterpaangea

resut

s

te

s

musce

overpowered

can

ookng

more

toe

o

compresson.

GAS

o

rom

a

te

sensatons

nerve,

s

vate

metatarsopaangea

paanx

as

s

great

or

proxma

occur

are

second

te

downward,

can

toe

ous

nterpa-

mbaance,

caw

most

sort

compresson.

te

neura

too

t

or

te

resuts

dsta

vagus

he

metatarsa

panuy,

at

can

toe

toe

afects

te

te

corns,

bunon.

toe

are

resut

jonts

Hammer

It

te

364

dsta

metatarsopaangea

ammer

pont

panu

jonts.

tat

In

extended,

exed,

or

toes.

and

muscuar

ammer

commony

ourt

ABR/McM

exed,

ammer

canges.

soes

516;

Wt

he

n

Eter

g.

N

proxma

nterpaangea

wereas

most

or

oot.

exors.

artrtc

trd

are

te

te

strongy

te

poston.

rom

656;

bot

are

n

ong

extended,

628,

toe,

porton

to

Superor

dorsa

burnng

arses

ower

Meraga

common

534–535,

In

te

sura

probems.

81.

te

presson

correcton

or

to

te

branc

ossa.

nerves).

varus

to

pernea

tea

as

attempted

a

120

Haux

o

brances

s

between

tan

ateray.

o

resut

te

oot

to

actvty

ponts

te

te

reduced

s

devaton

he

vara,

s

excessve

toe

nward;

nward.

vagus

sometmes

bunons.

turned

neck

Haux

te

toe,

In

and

due

and

turned

norma.

oten

wc

or

sat

muscuature.

n

Limb

cacaneus

adducted,

smaer

te

5

nguna

enter

deep

te

emo-

accdenta

vascuar

te

tuberce

pubc

CHAPTER

overes

te

spermatc

s

te

te

openng

great

GAS

87.

D.

660,

s

and

seen

ay

n

to

dagnosed

o

te

ande

o

ment.

A

rupture

wc

te

cck

o

te

operaton,

ss

reparng

B.

to

treated

GAS

o

party

poptea

but

sma

and

be

tears.

n

and

s

are

usu-

presentng

or

a

ock-

bucket-

cartage

wedges

urter

move-

assocated

wt

o

ansernus

he

te

band,

te

on

just

quadrceps

and

ten

GAS

91.

B.

ke

te

oor

N

nserts

te

481;

porton

meda

o

he

Fg.

564;

N

poste-

nserts

598;

N

500;

o

provde

ossa.

s

Mensca

some

ABR/McM

te

components

branosus

nserts

o

superor

to

rom

rom

nsert

GAS

C.

te

on

590,

he

s

usuay

cysts

o

te

can

atera

trange.

oor.

or

emors

emors,

he

he

te

atera

305

porton

a

o

to

by

te

nserts

and

507;

tract

75%

s

te

te

just

te

as

supped

ceps

482;

ABR/McM

wt

90.

D.

s

te

by

570;

o

te

pes

Inguinal

te

a

dense,

atera

nsert

Femoral

as

te

te

ony

tensor

guteus

one

o

Adductor

ead

on

te

Gracilis

and

are

te

by

te

and

wt

aponeuross

ascae

musces

nerve;

n

ascae

emora

tendon

on

Adductor

magnus

a

Sar torius

muscle

tat

atae

gu-

sted

tat

t

Adductor

and

he

act,

he

and

te

s

rectus

va

te

tba

hiatus

te triangle

nerve.

greater

superor

nserts

patea

gutea

on

te

atae.

nerve,

te

nsert

by

N

490;

tendnous

nserts

on

der

o

meda

te

passes

te

ABR/McM

dsta

gutea

emors,

quadr-

tuberosty.

condye

troug

329

porton

adductor

te

o

te

tuberce

o

te

on

adductor

te

emur.

adductor

atus

muscle

muscle

ateray

emur,

neror

mnmus

nnervated

tensor

muscle

longus

popteus

maxmus.

te

gutea

symphysis

triangle

Pectineus

pan-

345

wde

ligament

bceps

ossa,

he

he

superory

o

te

menscus.

neror

nus

artery

tran-

aso

semmem-

he

o

to

tendon.

passes

o

o

he

te

dstay

ABR/McM

nnervated

and

emors

he

emora

orm

te

mag-

upper

he

bor-

emora

proxma

to

•

GAS

Fig.

6.4

canal

at

contrbutor

329

Adductor

GAS

and

trange,

semmem-

bua.

above

condye

s

tba.

border

on

passng

atera

N

medus

trocanter

nerve,

orms

ongus

6.42).

Femoral

musce

Guteus

troug-

trange

te

superca

atera

te

adductor

emora

border

s

o

pectneus

suc-

can

border

posterory.

atera

cacanea

nserton

maxmus

tba

emur

atera

te

610;

supped

ony

patea

empa-

tese

and

meda

meda

nserton

te

te

to

approxmatey

s

to

tba

otba

receves

teus

te

superor

te

besde

connecton

89.

on

te

gastrocnemus,

cacaneus

arses

te

o

oter

339

semtendnosus

proxma,

passes

arses

te

te

orms

tendon

tars

ead

wt

on

te

te

porton

atera

nserts

Pubic

on

te

atera

te

o

Sometmes

greater

semtendnosus

te

he

ansernus

emors

wt

aspect

dsta

o

medas

ts

te

rectus

te

ABR/McM

border

sartorus,

artery.

tuberosty.

te

emora

poptea

proxma,

meda

orgn

musce

tba

te

te

gracs

on

te

vastus

orms

quadrceps

(GAS

GAS

a

te

apex.

te

ge

o

mdde

meets

to

te

opsoas

provdes

te

to

he

as

on

proxma,

above

he

586–590;

he

te

emors

on

nserts

tba.

popteus

emur,

contnung

exon/extenson

tere

and

tears

suggests

Menscectomy

tears

attaced

Commony

gament.

eard

tendnous

gastrocnemus.

separated

he

oten

o

gament

sweng,

nbtng

s

s

s

jont.

knee

currenty

mensca

tendons

branosus

can

knee.

t

to

mens-

gament

detaced

tear

porton

o

pes

meda

mensca

crucate

ror

subject

coatera

knee

te

emur,

are

menscus

pan

semmembranosus

ven.

because

artroscopy.

be

he

275

Limb

artroscopcay.

579,

he

a

and

anteror

cessu

secondary

88.

or

may

Lockng

tba

momentary

be

MRI

ts

tba.

he

coatera

knees,

to

ovas

328

tba

te

entry

ossa

termnaton

emora

njury

o

te

torn.

te

he

mensc

atera

payers’

by

or

te

be

buar

bucket-ande

o

movements

on

he

tearng

n

te

to

o

capsue

knee.

tear,

between

a

te

ootba

symptoms

ng

ayer

or

ata

atera

may

potenta

artery.

ABR/McM

abe

deep

wt

or

nto

and

and

more

atera

asca

490;

capsue.

te

externa

N

rng,

ven,

ven

meda

used

jont

rom

te

njures

muc

te

n

667;

te

rotatona

to

nguna

emora

sapenous

Bot

cus

deep

cord,

Lower

5

muscle

276

C H A P T E R

92.

A.

he

vc

5

Lower

tendon

cavty

by

wrappng

o

Limb

te

passng

around

obturator

troug

te

nternus

te

esser

esser

scatc

eaves

scatc

te

pe-

notc,

te

tem

he

o

superor

on

te

te

he

ty

quadratus

crest

mnmus

nsert

B.

genera,

te

arses

togeter

oramen

rom

emur.

te

ne

he

on

trocanter.

externa

and

surace

sca

beow

guteus

te

atera

aspect

N

te

a

on

o

te

ABR/McM

ange

o

ncnaton

GAS

between

te

neck

98.

E.

degrees.

Wen

reerred

dton

Genu

to

as

by

a

emur

D.

o

wt

546,

to

oot

s

are

o

bua

racture

caton

sudden

GAS

A.

Wen

tba

o

645;

he

can

te

upon

s

a

be

GAS

wt

N

Pott

te

o

crucate

patent

drawer

500;

oot.

as

100.

B.

Rest,

a

seated

te

bma-

wt

be

tans

o

to

A.

te

torn,

rom

te

bot

poston.

te

gencuar

339

96.

o

te

anke.

everson

can

he

gament

cause

te

s

meda

so

o

excessve

strong

tat

maeous

to

extenson

excessve

be

pued

artery

suppy

s

crcumex

te

as

s

N

n

It

a

L2–

com-

tese

be

best

by

to

motons.

he

te

he

knee.

meday

o

rotates

and

te

atera

knee.

to

o

to

and

te

te

common

papated

te

and

ossa

contans

s

ven,

anteror

tereore

te

buar

ere.

and

ngu-

ossa

poptea

he

nguna

wa.

round

at

artery

nerve.

he

abdomna

men

te

respectvey).

between

tg

te

musce

emora

atera,

te

papate

sartorus

meday,

n

tg,

semmembra-

pace

te

contans

anteror

cord

te

Damage

exon

exon

deep

and

he

and

poptea

and

o

329

meda

he

ABR/McM

artery

atera

artery

s

aso

s

a

be

a

s

It

con-

gament

329

occuded,

crcumex

crcuaton

artery

not

women.

482;

te

eves.

s

exon

n

n

te

es

ower

S2

L5

extends

exes

ongus

nerve,

n

asssts

we

cannot

and

knee.

bounded

knee

330

to

te

branc

tg.

o

occuded.

proxma

te

emora

descendng

w

he

te

emora

he

meda

branc

o

te

provde

descendng

and

tere-

crcumex

deep

emo-

ead

te

deep

te

emur.

te

ay

artery

a

558,

peroratng

a

tg.

sma

part

durng

553,

rst

suppes

very

proxma

ony

GAS

he

posteror

most

preventon

torson

ts

o

tod)

te

at

te

te

suppes

s

o

ra artery and suppes retnacuar brances to

E. One mportant uncton o te meda coatera (de-

gament

emur

o

abducton.

and

te

and

cana

te

woud

emora

o

96–120

te

emora

afect

p

(rom

emora

o

area

hs

obtu-

emora).

repeated

reex.

and

compartments

uterus

coatera

ore

s

spermatc

te

ands

as

papated.

n

564;

I

te

gament

artery,

years

suppy

355

ABR/McM

It

tba

te

GAS

o

source

S1

asssts

superory.

puse

s

te

trange

nerve

o

ven,

emora

Answers

atae

adductor

back

cana

dso-

due

p,

puse.

emora

maeous,

8

reex.

sartorus

484;

meda

and

end

sgn.

ABR/McM

patear

adversey

te

te

and

cannot

medca-

to

te

ts

nvoves

rotaton

exes

adductor

and

o

te

meda

ABR/McM

ascae

gament

he

just

101.

wt

te

woud

N

ateray,

Pantar

on

ABR/McM

tendon

532;

emora

emora

artery,

a

o

branc

anterory

n

deep

he

570;

he

engaged

dsta

s

495;

reex

meda

knee.

na

occurs

gament

a

N

musce

te

o

oot.

rmy

n

we

Dupuytren

bua

ractures

te

ba

wak.

s

tat

360

pung

te

dsta

as

band

mornng,

te

N

jerk

tensor

appens

or

meda

te

tese

dspaced

by

and

o

he

rotaton

jumpng.

o

te

p

te

racture

o

extends

toug

to

brances

ead

due

turn,

nosus

usuay

te

racture

ABR/McM

anteror

605–608;

o

o

n

o

615;

GAS

to

In

extends

condton

begnnng

A

a

everson

anteror

jont

eg,

postve

Eac

sgty

knee

te

523;

and

maeous)

racture

It

e.

emors

tat

meda

artera

crcumex

wtn

tereore

ntermedus

between

te

Probaby

vastus

toe.

te

reaces

ts

branc)

meda

rectus

302

o

n

te

approxmatey

gets

acetabuar

te

traveng

and

nvoved

B.

ts

by

to

emur

carac-

ange

arge

99.

by

anke

are

GAS

te

(te

emur.

eary

tearng

359

up

Q-ange,

antnammatory

dspacement

oot.

te

and

and

treatment.

orceu

N

bed

con-

condton

a

s

ncnaton.

requenty

panu

a

te

cacaneus

eet

s

t

s

pysca

runnng

most

(atera

te

and

ter

spnts,

nvoves

o

te

o

ncreased

te

ABR/McM

speccay

outward

o

vara

deormtes

to

vagus

aponeuross).

rom

n

reers

rom

especay

used

are

predcted

ncreases,

ange

and

condtons

te

coxa

nammaton

on

usuay

racture,

te

wt

are

up

vagum

common

or

pantar

ngt

decreased

devaton

a

rom

contrast,

Haux

s

patoogc

ncnaton

Q-ange

478;

tearng

gettng

eoar

N

ascts

wo

a

Q-ange

stretcng

ortotcs,

tons

In

tba.

576;

atetcs,

ascts

ater

vaga.

atera

(te

peope

n

a

rom

tssue

te

o

by

n

decrease

ange

genu

he

and

Pantar

resuts

and

or

decreased

respectvey.

GAS

coxa

varum

comes

te

caracterzed

terzed

te

However,

ncrease

te

tan

prmary.

ponent

120

eter

o

suppy

capts

551–554;

matey

can

ABR/McM

cdren

(varaby,

gament

repaced

289

and

rater

gament.

branc

artera

ovea

occudes

te

518;

ead

artery

artery,

485;

te

drect

ead

and

o

by

te

ntertro-

medus

age,

he

ossa.

tuberos-

te

o

N

nants

rator

obturator

ntertrocanterc

quadrate

te

greater

te

wt

In

racture)

(detod)

634;

B.

L4

vaue.

95.

n

nserts

GAS

97.

trocanter.

440–443;

In

obturator

te

o

te

on

and

avuson

and sat o te emur n oder age decreases to approx-

t

94.

on

canterc

GAS

te

o

arses

nserts

emors

nserts

greater

93.

o

and

geme

surace

externus

margns

and

neror

meda

obturator

membrane

and

(an

coatera

cangng

drecton by approxmatey 90 degrees. It s joned tere

by

of

oramen,

te

574;

sma

o

te

eary

N

porton

Fnay,

artery

and

ead

years

495;

branc

te

o

o

te

obturator

vascuarzes

o

o

musces

te

emur

e.

ABR/McM

330

artery

ony

and

te

usu-

CHAPTER

102.

A.

In

a

emor

troug

acunar

te

te

gament

emora

te

n

emora

artery

adductor

ce

564;

A.

he

n

te

nto

N

artery.

cana

nguna

medate

n

n

as

deep

seat.

atera

meda

and

and

contans

te

o

o

to

te

emora

ymp

cor-

peope,

ta

te

seat

contans

te

encoses

ymp

ymp

broken

areoar

tssue

tssue.

105.

and

nserts

emo-

a

he

he

atera

emora

and

D.

pevc

562;

tarsa.

deep

on

ven.

w

te

oot.

and

tbas

tuberce

njury

to

present

Fbuars

anteror

at

te

te

wt

a

Inguinal inguinal

saphenous

on

o

•

GAS

Fig.

6.9

receve

he

ymp

6.39).

iliac

n

nodes

t

ts

nodes

nodes

(deep)

te

and

meta-

musce.

everson

meda

ligament

knee)

rom

bua

aucs

vein

(behind

Fg.

te

afect

te

inguinal

Popliteal

and

te

nodes

Deep

Great

w

o

weakness

Exter nal

Superficial

and

nguna

nodes).

orgnates

sat

extensor

nsert

regons

receve

(GAS

base

area

ongus,

receves

orzon-

deep

ata

te

376

musce

o

ts

a

he

structures

brevs

te

gutea

rst

near

superca

group

(poptea

nodes

ABR/McM

te

and

asca

vesses

ac

two-trds

te

wa.

te

ocated

vertca

tg,

rom

to

pernea

475;

te

Any

deep

ymp

nterna

buars

ower

Patents

nter-

ymp

277

Limb

329

are

dran

he

abdomna

e

and

N

and

superca

deep

and

nodes

perneum.

te

nodes

ABR/McM

nguna

receves

rom

externa

GAS

490;

juncton

anteroatera

he

artery

te

N

and

rom

group

te

erna.

s

mb

mus-

ntermedate,

575;

superca

sapenoemora

ower

bot

emora

560,

he

ound

trange.

te

to

B.

s

pectneus

to

104.

rom

to

atera,

emora

be

GAS

te

235

ympatc

pus

to

hs

majorty

te

orced

meda

woud

emora

compartment

node,

just

erna.

meda

meda

he

are

atera

meda

as

compartment

conssts

ymp

te

ABR/McM

es

and

te

we

just

ven

more

compartments:

he

he

nerve

ven

s

emora

ound

musce

256;

emora

tree

emora

te

because

ound

emora

meda.

ra

be

to

s

and

ongus

woud

GAS

103.

cases

ven

contents

wc

Gmbernat)

he

atera

most

emora

abdomna

rng,

(o

ven.

mmedatey

rect

erna,

emora

Lower

5

o

ongus

sde

o

te

278

C H A P T E R

oot

5

and

Lower

w

trocnemus

on

te

GAS

106.

posteror

622–625;

surace

N

506;

n

ts

patent.

cacanea

o

te

he

(Aces)

gas-

nnervates

tendon

ony

cacaneus.

ABR/McM

web

351

pevs,

were

pevs,

above

o

nto

te

ror

te

GAS

ossa

and

It

ten

space.

sde

njured

just

te

(va

venous

o

dranage.

nto

hereore

to

te

a

meda

n

we

s

he

and

buar

and

atera

hs

sdes

te

deep

buar

o

o

oot,

te

o

te

tested

bua.

tat

o

t

te

and

te

o

an

te

and

eas-

run

s

te

o

oot

ger

te

knee

o

s

te

to

te

113.

A.

drawer

te

meda

respectvey.

brocartage

he

tat

tba.

o

motor

te

com-

nerve

tat

to

te

eg

and

sensory

nerve

s

ony

tba

runs

te

s

gament

on

gament

sgn”

and

meda

sde

gament

on

te

a

tese

s

stron-

damaged

o

a

exed

meda

to

te

sde

oter

type.

330

wt

te

removed

areas

o

o

great

rom

oss

by

te

te

tg.

to

woud

emora

orgn

skn

he

tba

posteror

aso

produce

s

te

on

cutaneous

te

nerve

o

s

sapenous

emora

nnervaton

sape-

patent.

descrbed

te

nnervates

Latera

te

te

are

tgty

because

stran

cosey

damaged

s

are

tuberosty

s

he

gament

typcay

carred

he

and

to

crucate

aspect



put

bow

nerve

dysuncton.

gament,

drawer

a

tro

hs

gament.

damaged

not

a

trad.”

crucate

tg.

atera

produces

coatera

be

njury

cutaneous

quadrant

njectons.

tey

buar

beng

wc

meda

te

GAS

114.

B.

596;

N

513;

Lgaments

jonts.

Wen

ament

s

orce

s

oot

gament

te

ABR/McM

act

a

to

jont

stretced

severe

s

gaments

o

was

he

meda

crucate

ABR/McM

nerve

hs

a

motor

sapenous

nerve.

te

339

branc

and

ts

te

tuberosty.

coatera

attaced

499;

obturator

suppes

muscuar

anteror

meda

root,

he

aspect

n

N

wc

neror

nerve

t

taut

not

o

mdway

quadrants.

coatera

semtendnosus

s

pont

posteror

te

by

andmarks.

“posteror

and

on

our

oten

not

durng

nnervaton

nnervates

drawer

he

and

te

as

o

sapenous

L4

te

sura

oot.

quadrants

gest

because

posteror

but

or

nerve

te

to

o

part

he

and

bony

“unappy

woud

postve

anteror

598–605;

nerve.

to

te

dspace

posteror

knee

Sensory

pos-

he

te

person

he

a

damaged

T endon

te

nous

prevents

to

a

knee

meda

324

tba

he

Its

rst

branc

orzontay

anteror

woud

te

oot.

eg

ntragutea

tba

eg.

te

anteror

nto

ower

te

te

te

te

sca

knee

as

oter.

Damage

knee.

tan

GAS

backward

prevents

emur.

a

It

tba

te

to

to

atera

produce

te

togeter

eac

te

structures

It

w

tba

posteror

emur

many

te

te

stabze

a

o

ossa.

reatve

te

jont,

te

ts

ossa.

oot

rom

attempt

ABR/McM

s

to

te

durng

to

menscus

typcay

skn

eg.

to

atera

woud

(va

drans

te

ossa.

damage

structures.

dor-

oows

o

bow

te

runs

ABR/McM

reerred

damaged

bow

by

runs

postve

on

o

area

gament

nerve

It

atera

knee.

poptea

ntracapsuar

500;

buar

wt

te

artcuaton

njures

attaced

te

s

poptea

tba

gaments

te

A

o

oten

365

puses

n

tba

an

nerve.

te

ntercondyar

caed

o

sde

gament

crucate

s

n

te

ABR/McM

exed

A.

485;

and

posteroatera

n

avoded

N

menscus

space

ven

be

573;

o

346

nto

troug

meda

(wc

oot

runs

o

o

te

dvded

rom

and

te

nnervates

papabe

regon

poptea

325

te

nerve

be

ne

crests

and

suppes

web

ac

gutea

menscus,

te

dorsum

ntercondyar

te

s

o

te

sde

usng

meda

nerves

casts

can

o

skn

cutaneous

dorsum

nerory

te

nnervates

ABR/McM

second

to

he

atera

scatc

course,

rst

te

and

atera

pyscan

N

eg

te

nodes

coatera

605–608;

he

mon

o

menscus

mproves

GAS

o

s

te

deep

nerve

te

ven

te

475;

anteror

dspacement

meda

on

usuay

knee

and

te

compartments

sapenous

and

crucate

te

o

o

te

te

regon

he

te

must

wen

sma

oot

te

wa

posterory.

sgn.

o

wc

eg

dranage

he

N

o

112.

and

512;

runs

nvoves

ead

ABR/McM

dspacement

hs

te

te

poptea

posteror

posteror

skn

evertors

poptea

aspect

emur.

te

sde

ong

he

te

271

superca

wt

o

nerve

s

nerve

oot.

postoned

ne

GAS

oot.

N

crest.

scatc

and

and

eg

gutea

dvdes

tba

sapenous

buar

626;

compartment

nnervaton

eg

ower

between

mn-

he

he

te

nes

ac

ante-

anteror

nnervates

he

One

buar).

eson

te

ts

531;

te

562–563;

he

test,

o

pantar

sup-

we

guteus

atae.

B.

two

gutea

musce,

branc

te

anteror

to

o

N

a

superca

te

sde

s

around

te

compartment

te

GAS

111.

cana

to

neror

te

ascae

atera

knee).

ympatc

drans

te

eg,

superca

sde

teror

te

he

esser

It

te

nerve

adductors

nnervates

nnervates

te

te

maxmus

nerve

te

to

te

vesses.

obturator

and

ABR/McM

and

Due

buar),

atera

dran

on

nto

624–626;

he

GAS

te

nerve

o

o

nto

membrane)

tg.

posteror

meda

and

wa

te

musce

musces

patents

atera

te

GAS

C.

o

deep

te

n

va

tensor

486;

jont,

obturator

obturator

buar

atera

beow

tg

nerve

wndng

dvdes

te

sexors

B.

N

descends

atera

te

guteus

te

It

to

te

and

te

respectvey.

rom

o

descends

beore

te

emora

te

common

suppy

y

te

gutea

555–558;

he

nerve.

E.

he

medus

mb

aong

externus

nnervates

ower

o

above

L4.

sacroac

anteror

obturator

and

to

te

meda

nnervates

nerve

eg

te

superor

mus

It

runs

and

tg.

L2

over

compartment

nerve

A.

t

openng

te

rom

major,

te

cutaneous

o

orgnates

psoas

py

110.

te

tat

(an

109.

afected

va

superca

enters

108.

be

nserts

A. he obturator nerve s a branc o te umbar pexus

te

107.

not

Limb

tat

s

bua

on

and

s

orced

and

enoug.

turned

te

w

be

excessve

nto

ts

atera

and

s

or

s

tat

rupture

wen

he

and

It

movement

poston,

tereore

acton.

sde

cacaneus.

a

tender

Inverson

meday

oppose

te

356

prevent

te

w



o

g-

te

soe

o

stretc

cacaneobuar

stretces

te

ony

between

gament

CHAPTER

tat

woud

pantar

gaments

oot

and

res.

durng

ocated

not

be

and

on

suc

ong

te

an

and

pantar

damaged

acton.

sort

surace

durng

and

w

634–643;

he

patear

not

N

be

518;

reex

he

o

nverson

te

nju-

ocated

afected.

ABR/McM

causes

359

extenson

o

te

knee

and Superior

s

produced

wc

by

consst

te

o

quadrceps

rectus

emors

emors

and

musce

and

era

rotator

p

and

exor

ntermedus.

vastus

o

te

knee,

o

te

tg.

and

te

Quadratus

he

sartorus

pectneus

s

s

a

s

exor

a

o

adductor

gluteal

116.

B.

578,

te

and

Lateral

p.

he

598;

atera

N

490;

ABR/McM

femoral

te

gves

te

deep

crcumex

a

branc

tg

superor

ex

emora

emora

and

tat

emora

runs

jons

atera

descend

artery

te

down

artery

artery

does

te

to

s

a

not

atera

he

provde

he

p

branc

jont.

aspect

anastomoss

artery.

knee.

te

te

gencuar

gencuar

toward

cose

meda

any

va

and

arteres

are

te

termna

brances

artery

poptea

te

s

and

woud

damaged.

posteror

tba

not

he

artery

receve

Deep

te

ar ter y

buar

(GAS

artery

Fg.

te

bood

s

a

tat

First

117.

B.

558,

he

ton

574;

495;

obturator

o

te

te

o

s

perforating

tg.

compartment



anteror

te

o

tba

te

118.

A.

and

are

brances

480,

he

oot

s

nerve

s

or

orm

emora

and

s

D.

o

o

o

aspect

deep

te

rst

nverson

ped

or

by

te

pantar

o

te

ocated

deep

GAS

te

o

te

611,

he

he

te

te

N

o

s

a

and

suppes

N

271

te

ace

s

te

oot,

te

not

between

te

exon,

superor

wt

and

be

te

damaged.

tba

and

533;

ABR/McM

357

most

and

and

he

te

o

and

tba

te

s

a

he

te

nerve

tbas

compresson

compresson

tarsa

maeous,

cacaneus,

are

te

tunne.

meda

posteror

n

te

be

tba

area

most

sgncant.

w

te

te

exor

and

o

tunne

neu-

te

s

tba

ocated

neromeda

retnacuum.

ts

pantar

posteror,

hs

story

and

retnacuum

te

skn

over

615–622;

te

N

Tne

nerve.

sgn

ects

cacaneus

520;

on

exor

sur-

he

brances,

dgtorum

s

nammaton

tese

he

compressed,

pysca

te

GAS

Any

syndrome

a

exor

postve

vesses.

compress

tba

easy

ncudng

n

ocaton

bua

6.

syndrome

sgncanty

w

patent’s

sup-

responsbe

te

te

sweng

sensaton

everson,

to

Fig.

rom

tarsa

te

tendons

ven

musces

nerves

GAS

ongus, and te exor aucs ongus musces togeter

sup-

Dorsexon

by

he

knee

ocated

w

oot.

or

te

te

contents

328

responsbe

n

o

tunne

resutng

between

suppes

eg

T arsa

nerve

ower

nerve

te

E.

ropaty

and

ony

anke,

buar

o

eg

te

nerve

atera

aspect

•

tba

sapenous

suppes

nerve.

626;

and

meda

ABR/McM

nerve.

reex,

space

we

120.

he

tba

produced

buar

are

eg

most

529;

space

jerk

and

superca

nerve

anke

deep

te

or

suppes

oot.

615;

web

and

eg,

atera

nner-

compartments

ABR/McM

obturator

tg.

o

buar

nerve.

emora

he

te

tg

ar ter y

meda

nerve

nerve.

486;

emora

te

oot.

te

te

buar

o

buar

tumor

scatc

N

posteroatera

o

knee

n

te

over

exon

te

perforating

nnerva-

te

responsbe

posteror

common

anteror

by

o

te

skn

te

he

o

oot.

537–541,

he

over

te

and

aspect

te

GAS

o

compartments

555–557;

branc

eg

soe

dorsa

119.

a

skn

pes

494,

skn

meda

and

tg.

supped

meda

te

atera

suppes

eg

nerves

GAS

and

nerve

ar ter y

te

branc

extenson o te knee. Common buar nerve

te

ar ter y

perforating

330

wc

he

ar ter y

6.51).

responsbe

adductors

te

anteror

ABR/McM

nerve

tg

compartment

vates

N

thigh

pop-

Third

GAS

of

posteror

o

any

ar ter y

o

Second

tea

femoral

circumflex

crcum-

brances

anteror

It

Femoral

tba

ar ter y

332

Medial

o

ar ter y

at-

circumflex

GAS

ar ter y

ateras,

emors

an

gluteal

group

Inferior

medas,

279

Limb

pantar

he meda coatera (detod) gament s

GAS

A.

damaged

are

w

meday

115.

be

cacaneonavcuar

Lower

5

posteror

but

te

dagnosed

examnaton

(gty

numbness

and

te

ABR/McM

tba

nerve

wt

and

o

s

te

ndngs

tappng

soe

or

structures,

over

tngng

te

oot).

355

nerve

s

te

Answers

121–143

121.

Dorsas

A.

peds

puse

s

papated

at

te

promnent

arc o te top o te oot between te rst and second

280

C H A P T E R

5

Lower

metatarsa

aucs

second

GAS

122.

A.

bones

ongus

te

tonng

E.

nto

B.

he

te

N

rests

strng

as

are

he

musce

p.

te

o

are

exon.

at

te

and

o

o

wen

ts

te

sttng,

attacment

musces

magnus).

wt

te

juncton

Muc

(amstrng

582,

p

te

and

gaments

te

he

by

te

o

tendon

N

476;

a

It

starts

cd

runnng,

te

unctons

(stragt)

te

a

s

t

te

aspect

am-

and

w

o

te

be

o

sttng

poston,

poston,

wakng

GAS

485;

ABR/McM

(buttocks)

njecton

o

njecton

scatc

B.

s

drugs,

arge.

nerve,

on

te

(superoatera

s

te

a

tat

ntervertebra

and

t

umbar

canter

te

sgn.

te

pus

o

present

as

o

tg,

te

seat

quadrant).

T rendeenburg

gat

te

njury

to

soud

be

quadrant

o

he

pattern



patent

(or

s

guteus

B.

It

to

derved

he

te

te

te

meda

attaced

poptea

rom

te

te

to

te

sem-

gament

patea

o

s

ga-

posteror

patear

o

tuberosty

o

to

te

consequenty

strengtens

border

to

coatera

above

rmy

obque

capsue.

s

not

psoas

te

wt

tba.

quadrceps

te

umbar

canter

o

p

jont

te

trunk

poston.

s

part

wt

N

and

It

emors

dscs,

on

he

o

te

o

te

rom

and

he

trunk,

or

tg,

named

nserts



as

te

n

tg

sttng

s

but

n

te

tat

a

asca.

at-

asca.

te

transverse

and

toracc

nto

exes

appendx

may

vcnty

encosed

bodes,

twet

psoas

tro-

retans

umbar

o

te

276

rom

vertebra

te

esser

te

asca,

ayer

ABR/McM

arses

s

te

to

psoas

(n

te

umbar

and

tubercuoss

psoas

anteror

te

te

gron

rom

transverse

toracc

nto

o

spna

te

he

musce

emur.

te

and

derved

vertebrae

te

nserts

339

te

bodes,

twet

seat

n

te

rom

vertebra

te

he

486;

sdes

te

on

rom

ABR/McM

arses

te

abscess,

major

ntervertebra

t

o

abscess

tat

bends

processes,

500;

trocanter).

582–583;

he

N

emur.

cod

seat

edge

130.

dscs,

psoas

a

era

avod

outer

a

he

or

he

ower

vertebrae

esser

brous

and

ste

s

and

ds-

coatera

overapped

tba

beow

It

sorter,

proxmay

bua

s

te

anterory.

Fbuar

he

and

tba

anteror

attaced

tba.

musce

sdes

te

stragten-

njecton

upper

o

605;

major

te

up

partcuary

T o

psoas

processes,

extenson

common

s

te

part

exed,

stronger,

attaced

emors.

on

jont

prevents

te

to

condye.

te

pued

s

menscus

jont

on

knee

beng

o

and

te

emora

are

emur

te

te

buttock.

posteror

tba.

ead

te

attaced

te

contnuaton

300

326

te

expanson

convexty

578–580,

he

GAS

N

and

s

emur

and

on

o

te

atera

te

rom

musce.

knee

te

and

te

njured.

connects

n

tendon.

standng

te

te

smoot

becomes

te

between

o

o

(tendon)

be

te

324

gament

meda

tendnous

and

Gower

prmary

to

nerve

gament

o

band

o

njecton

quadrant

area

te

sat

o

guteus

key

o

te

te

most

bceps

o

te

membranosus

cdood

postons

a

o

te

rest

requres

edge

te

ment

and

condton

cassc

o

prone

porton

dicuty

surace

more

ABR/McM

n

as

wc

as

s

condye

mme-

s

emur

o

between

scatc

obque

at

meda

body’s

129.

586;

a

o

jont

te

s

and

border

he

tba

o

prorms

L5,

notc

key

cordke

sde

te

he

amstrng

te

te

(L4,

scatc

posteror

te

most

ACL. Wt

te

o

musces

s

crucate

are

atera

te

ABR/McM

ess

o

ramus

extenson

p

atoug

dystropy

patent

586;

prevents

posteror

pacement

pase

te

nerve

Intramuscuar

dspacement

by

hese

greater

orward

crucate

surace

gutea

te

neromeda

485;

meda

broader,

norma

ntact.

wen

orward

te

knee

N

prevented

espe-

mdstance

scum

tendnous

afected,

regon

te

buttock

sowng

Posteror

but

nerve.

te

weakness

(superomeday)

ntercondyar

o

are

runs

by

musces.

te

o

beneat

quadrant

anteror

ngu-

runnng.

underyng

we

s

te

rom

border

and

ts

caused

superor

mnmus.

n

573;

he

mbs,

and

her

and

nner

anteror

superor

te

upper

damage

D.

by

s

mnmus

emerges

medus

damaged

327

te

adducton

rom

582,

gutea

voume

te

runnng,

and

adductor

bendng

ntramuscuar

gven

te

regon

ower

jonts

njured.

assocated

maxmus

and

567,

o

standng

te

gutea

nto

two

tuberostes

because

or

rsng

rom

o

weakness.

hs

guteus

he

te

to

not

o

wc

and

dsappears

medus

are

superca

troug

tuberosty.

567,

notced

upstars,

A.

o

upper

surgery

te

te

gracs.

he

o

projecton

muscuar

cmbng,

GAS

te

wc

gament

musces

sgty

wen

ng

supped

guteus

376

easy

body

porton

Ducenne

o

cross

swng

tese

tg

and

medus

datey

unc-

adductors

o

te

dran

pases

proxma,

543–545,

exed

127.

on

musces

he

ree

musces

drans

extenson

sca

adductor

te

urc),

guteus

ACL

ABR/McM

te

magnus

be

a

bony

o

exon.

causes

medus

above

very

p.

adductor

o

a

mpor-

used

128.

n

group

group

are

482;

musces

afected

up,

s

nodes.

p

te

te

amstrng

may

te

332

njures

ate

tey

end

posteror

D.

oter

remanng

amstrngs

te

roug

provdes

126.

te

reconstructve

ABR/McM

durng

arge

wegt

GAS

more

as

absence

nammaton

gutea

rotate

590;

knee

te

orzonta

ncudes

not

neror

s

te

vertca

te

durng

GAS

or

and

suppy,

surgery

ABR/McM

475;

runnng,

do

or

S1),

sze,

addton,

durng

gutea

N

cruca

acton

125.

te

he

Because

o

In

490;

deep

514;

cay

extensor

GAS

neror

very

sape,

reconstructve

superca

wereas

GAS

te

ongus

358

neurovascuar

reasons

N

nodes.

and

o

mb.

drans

124.

n

ts

o

compensate

586;

Any

na

to

canddates

GAS

A.

due

smar

upper

tendon

dgtorum

ABR/McM

autograt.

tg

good

123.

521;

nature

commony

For

te

extensor

are

N

Gracs,

te

between

and

toe.

654;

tanty

Limb

te

te

s

esser

tg

xed,

up

to

rom

pused

up

t

a

at

te

te

tro-

te

exes

yng

aganst

CHAPTER

te

t

pertoneum

s

ng

n

touc

acute

pan.

puruence

may

s

encosed

te

umbar

bar

asca

o

GAS

131.

o

present

ayer

B.

as

tat

te

brous

te

and

te

ven

s

N

GAS

and

C.

to

he

deep

cs

o

Wen

ar

t

skn

GAS

E.

te

amost

a

and

ment

he

o

nodes.

It

as

upper

s

te

A

tey

s

obque

meda

to

superca

nguna

na

te

o

oot.

and

emur

te

deep

a

It

to

te

te

on

and

o

te

te

te

web

rst

and

t

s

o

o

and

suppes

eg

to

area

suppy

so

nverson

nerves,

most

o

s

caed

obturator

o

to

sma

or

0.5

te

n

ramus

ymp

o

n

es

he

ong,

It

te

te

te

deep

s

ven.

above

nguna

and

as

rng

te

s

an

615;

he

oot

oot

and

ten

to

and

te

(1.3

pubc

cm)

te

above

te

anteror

sympyss.

Fossa

nguna

superor

ovas,

gament,

ac

aso

spne

dran

caed

te

are

ongus,

perormed

buars

by

ongus,

dgtorum

movements

te

transverse

to

te

o

tar-

te

by

te

poptea

w

oot

s

anteror

tba

ossa

soeus

vesses.

artery

te

gastrocnemus

and

poptea

o

n

te

supped

eaves

te

508;

by

musces

hereore

aso

due

a

compress

to

contrac-

compartment

o

deep

te

o

a

dran

te

te

(except

sde

nodes

o

wa

suc

oot,

receves

dran

n

men

ana

te

and

an

rst

group

o

ym-

and

a

orzonta

ymp

te

te

to

w

eg,

he

o

te

as

superca

beow

o

n

nodes

vertca

te

tat

sde

patent

wc

tg.

pens

trd

eventuay

hs

he

te

gans

ower

poptea

receves

rom

s

ympatcs

njury,

ympatcs

te

and

te

nodes.

nodes.

abdomna

eg

anteroatera

deep

mdeg

meda

te

te

nodes

ymp

o

nto

poptea

women),

poptea

on

nguna

superca

anteror

n

and

nguna

rom

344

dranage

ympatcs

superca

group

ABR/McM

anteroatera

nto

patcs

N

rst

superca

rs

s

359

due

poptea

musces

eg

perneum

n

pan-

anteror,

exor

at

oter

tbas

he

gastrocnemus

to

te

eg

matey

between

wc

Dorsexon

te

nected

te

mosty

nerve

te

and

te

0.5

pace

and

possbe.

pantars,

take

tan

dgtorum

ongus.

te

between

are

exon

ABR/McM

s

ympatc

ova openng n te transversas asca and es approx-

mdway

te

tat

wt

eg.

te

te

to

o

te

and

abdom-

known

o

superca

meday

emora

externa

hs

as

C.

518;

posteror

nerve.

GAS

137.

wegt

posteror,

aucs

everson

tba

deep

and

gament;

pubs;

te

meda

soeus,

tree

jont

bua

upward)

extensor

tbas

nge

downward)

by

ver-

exter-

o

artcuaton

more

Pantar

and

te

groups

and

pontng

ongus,

musces,

he

es

ton

nerve

compart-

rng.

te

te

tba

he

perormed

exon

ematoma

eav-

vesses

cm)

mmedatey

tuberce.

te

nguna

ateray

deect

enter

meda

emora

tat

ramus,

obturator

(1.3

te

seet

oramen,

pubc

te

pevs

and

brous

superor

te

and

357

a

te

te

376

synova

pontng

exor

N

soeus

passng

s

te

634;

nerve.

oot.

n

vesses).

bears

(toes

aong

te

to

nguna

orzonta

e

to

n

nguna

te

atera

taus.

tertus.

and

Pantar

and

te

and

o

necton

superory

o

sgn

jont.

GAS

E.

s

nto

aong

mportant

beow

nodes

a

e

presence

arranged

s

ocated

and

superca

ABR/McM

taus

(toes

brevs,

skn

136.

end

gastrocnemus,

ongus,

nto

te

buars

buars

sa

475;

te

aucs

skn

skn

dvdes

cutaneous

te

second

te

exon

and

jonts.

nerve,

and

o

are

and

an

he

es

284

are

he

an

asca

ac

jont

Dorsexon

extensor

au-

N

ven.

dran

dvded

tey

dsta

Dorsexon

te

be

taocrura

tba

ten

te

It

tuberce.

nodes

ndcate

n

tg.

ABR/McM

s

281

Limb

openng

te

crbrosa)

nodes

nodes.

Externa

end

(asca

hey

o

pubc

477;

emora

may

meday,

te

N

ova

ata

ymp

ymp

can

an

te

superca

vesses;

proxma

extensor

musces

and

connects

ends

te

ymp

562–563;

he

tar

sma

dorsa

te

ac

A.

o

te

groups.

GAS

135.

passes

and

n

(anterory,

338

nerve

o

te

rng.

o

cutaneous

anterory

pubc

tca

sapenous

tarsometatarsa

passage

aponeuross

te

a

seat

gament;

gament

eg

sde

ac

to

572;

asca

sweng

gves

ven

deep

to

asca

nguna

extremtes.

e

te

557,

nguna

rom

te

ven

dgtorum

ony

te

superor

It

o

great

te

ABR/McM

cana

emora

te

o

not

486,

meda

nodes

reers

o

neroatera

te

externa

t

part

deep

swoen

wdey

nerve;

knee.

maeous

anke

te

eave

tranguar-saped

na

te

te

most

dorsa

ntrnsc

sdes

approxmatey

acunar

anteror

he

jonts.

and

as

coses

borders:

posterory

o

or

openng

oowng

te

mb

arc

passes

te

membrane

emora

te

te

sapenous

he

te

ABR/McM

beneat

cana,

vesses

tg.

ts

gap

o

buar

533;

competey

obturator

um-

te

C.

cm

433,

beneat

o

134.

ven.

aspect

dorsum

N

4

rom

aspect

nnervaton:

across

obturator

sma

eg.

ntermedate

625–626;

he

ng

and

to

GAS

derved

and

great

condye

contguous

contnue

on

3

ower

te

meda

meda

tat

or

anteroatera

wc

te

psoas

emora

ower

venous

tarsa

superca

meda

retan

openng,

superomeda

he

wt

te

te

(extensors

oot

and

te

sapenous

277

beyond

te

emerges

te

o

te

nerve

te

between

te

resut,

tubercuoss

part

ongest

unon

suppes

avaabe

on

o

529;

oot

and

n

he

n

te

te

buar

and

remans

toes.

te

emora

N

nay

dsta

to

meda

te

ongus)

s

dorsa

to

te

658;

retnacuum

dorsum

s

not

bends

branc

te

te

te

jons

615,

s

may

gron.

tat

ABR/McM

extend

sde

by

anteror

t

edge

branc

to

meda

posteror

te

seat

accompanes

ormed

ascends

n

t

spna

a

produc-

because

486;

nerve

nerve

It

toe

wen

atera

nnervatons

over

cases

seat

As

asca.

nerve

oot.

great

he

psoas.

pertoneum,

and

abscess

cutaneous

ony

scatc

oter

abscess,

cod

a

582–583;

sensory

133.

a

contracted

pareta

some

asca.

but

te

te

psoas

hesapenous

te

132.

In

a

n

dstrbuted

s

rom

wt

Lower

5

rom

umbcus,

and

cto-

cana.

deep

he

nguna

282

C H A P T E R

nodes

deep

ca

B.

but

Lower

are

and

not

are

papabe.

not

be

he

ac

papabe

nodes

durng

are

cmbng,

pys-

ror

examnaton.

562–563;

he

part.

nto

ng

ate

N

obturator

covers

te

he

te

475;

obturator

meda

troug

key

ead

nerve

tor

musces

ton

to

eca

tg

meda

te

medus

tors.

and

durng

aso

superor

gutea

te

greater

ce.

Fexors

ment

o

wc

te

as

brane.

tg

no

he

posteror

most

o

486,

eep

o

te

te

p

eaves

n

te

te

tg

572;

nerve

skn

It

rom

N

s

te

te

477;

a

o

500;

te

s

as

njury

and

sde

o

634–641;

away

te

N

paraxa

musces

somtes

rom

s

deepy

s

response

(GAS

atera

sde.

anteror

njury.

Fg.

are

te

on

he

te

6.104).

359

te

to

o

and

ocated

deveops

rom

gaments

te

to

maeo-

jont,

ocated

pont

ABR/McM

deveop

at

gament

oot

518;

te

ga-

neror

atera

anke

s

crucate

ocated

te

gament

mesoderm

n

te

tenderness

tbobuar

jont,

o

dicuty

339

s

tbonavcuar

meda

no

acton.

he

te

surace

te

wc

cacaneus.

cacaneonavcuar

he

s

gament,

ts

ABR/McM

te

wc

posteror

gament

puses

gt,

patent

durng

te

mus-

nto

ventra

somtes.

myotome

moecuar

sgnas.

n

te

sends

posteror

regon.

ABR/McM

o

o

he

stars;

knee

crucate

a

te

by

tg

Gravty

down

o

posteroat-

te

gutea

branc

E.

knee.

ante-

cruc-

cmbng

many

connects

anke

Lmb

nerve,

aso

te

GAS

142.

case.

done

posteror

and

on

o

te

wakng

norma

dicuty

maeous

anteror

te

o

s

he

a

anteror

dspacement

wt

knee

by

te

mem-

musces

enters

mus-

te

tba

te

cacaneobuar

pantar

compart-

emora

and

te

te

to

posteror

musce.

ts

N

to

opposed

posteror

603–608;

pantar

troug

obturator

tg

oot.

pevs

by

n

down

atera

he

to

te

te

pont

abduc-

prorms

te

te

rea-

by

s

Injury

te

we

stabzes

ocated

swng-sde

anteror

by

us

guteus

p

te

te

te

no

he

and

o

exon

orward

he

te

nerves

supped

te

suppes

to

ave

man

on

are

wt

o

te

557,

buar

are

nnervated

nerve

Urnary

E.

n

to

emors

damaged

GAS

141.

nnerva-

autonomc

nerves

above

ound

nnervatons

and

433,

he

are

scatc

compartment

GAS

wc

reatonsp

sensory

te

reaton

provde

ment

externus,

o

Extenson

wakng

adduc-

porton

tg.

by

musces

compartment

cutaneous

eg

p

a

stars.

not

obtura-

te

obturator

and

most

resuts

n

stabzed

tat

gament.

gament

emur

obturator

acton

emur

ces

pass-

w

an

crucate

quadrceps

enters

by

he

to

membrane.

te

oramen

te

damage.

Bot

and

te

tat

superor

tg

membrane

te

musces

nerve,

scatc

o

o

ts

pevs

te

provdes

obturator

hese

at

wt

brevs

aso

stabze

moton.

te

medated

mnmus

hey

te

(gracs,

nerve.

te

membrane

nnervatons

aspect

s

pudenda

wt

It

tn

o

nerve

adductor

magnus).

te

tonsp

C.

te

365

except

cana

to

motor

ncontnence

and

era

o

a

exts

njures

obturator

ongus,

adductor

nerve

obturator

suppes

adductor

s

oramen

compartment

te

to

tor

ABR/McM

membrane

obturator

vesses. T raumatc

139.

Limb

usuay

structures

GAS

138.

5

te

284

Malleolar

fossa

Anterior

talofibular

ligament

common

Posterior

buar

nerve

and

begns

at

about

te

eve

o

te

neck talofibular

o

te

bua,

between

t

and

te

buars

ongus.

hs ligament

nerve

suppes

torum

gus,

ongus,

tbas

extensor

space

te

o

extensors

buars

anteror,

aucs

te

te

tertus,

extensor

brevs).

oot.

o

It

Fracture

oot

(extensor

extensor

aucs

dgtorum

nnervates

o

te

dg-

te

ead

on-

brevs,

o

and

rst

te

web

bua

Calcaneofibular

can

damage

ts

nerve,

resutng

g

steppng

gat,

as

sum

and

web

space

posteror

tar

rst

compartment

exon.

nerve,

sura

hese

wc

s

a

cutaneous

o

musces

are

branc

sde

eg.

at

anteroatera

o

oot.

eg

are

o

over

nvoved

scatc

suppes

te

drop

by

nerve;

sensaton

gat

eg

are

a

te

pan-

te

tba

ts

ligament

A

dor-

n

n

to

and

and

te

Musces

nnervated

te

Waddng

sde

oot

numbness

te

te

branc

te

as

o

o

teror

te

we

n

Tibia

Fibula

meda

te

pos-

numbness

assocated

T alus

wt

Malleolar

te

superca

buar

and

te

atera

sura

fossa

cutaneous

Posterior

nerves. process

GAS

625–626;

N

533;

ABR/McM

of

talus

Posterior

346 talofibular

140.

D.

te

A

postve

tba

vagus

coatera

stress

test

gament.

ndcates

Injures

to

njury

ts

to

gaB

ment

he

usuay

emur

s

nvove

usuay

te

anteror

pused

crucate

posterory

gament.

durng

star

•

GAS

Fig.

6.4

ligament

CHAPTER

Embryoogc

ncude

and

not

te

derms.

ncude

cated

dervatves

crcuatory

Dervatve

te

wt

and

and

C.

neura

and

eventuay

te

mesoderm

wa

crest

not

s

out

wc

gves

nng

o

stabty

asso-

toward

he

sde

crcua-

body

cae

et

te

apoptoss

may

may

ncude

n

ces

oot.

he

te

n

bone.

Faure

o

do

not

ZPA

and

dd

and

tus

o

te

te

or

patternng

te

not

any

he

paanges,

ave

rom

been

o

or

144.

o

te

a

mb

auty

o

In

and

at

bursa.

rom

rom

tear

bursa

te

he

as

GAS

B.

coce.

cae

s

knee

ste

and

o

te

eve

o

a

n

te

he

at

te

(pevc

under

o

te

ts

te

bursa.

te

patea

o

nrapa-

on

one

mnmus,

stabze

tt).

s

between

gament.

te

knee,

hese

te

eg

and

te

s

te

as

342

nerve

ture

correct

or

waks,

tensor

p

as-

jont

musces

by

receve

o

A.

pevs

he

te

ts

and

te

orceuy

opposte

drecton.

resuts

to

he

psatera

tensor

n

a

as-

postve

droppng

on

te

o

to

Pott

due

spne

as

N

nerves

tat

jont.”

A

move

to

GAS

a

hs

“a

aw

n

jont

s

626;

It

and

and

S3

posteror

oot.

te

anke

bony

s

com-

commony

maeous

coatera

ateray,

egt

o

and

a

extreme

cause

orce

s

(de-

causng

Inverson,

a

rup-

te

w

taus

dam-

te

359

Law

a

by

woud

moded

nnervated

musces

o

2013.

tat

he

533;

deep

346

to

be

same

move

aw

ts

can

te

et a.,

nnervates

ABR/McM

by

tat

Hebert-Boun

sted

ead

orm,

ts

jont.

N

do

regon

oot

te

o

te

meda

upward

expanaton

27:548–555,

611,

as

meda

great

p

te

o

tb-

355

dorsexon

Drect

te

oot;

everson

moves

Hton’s

artce

anke

o

o

musces

maeous).

rom

te

receves

roots

buttocks,

(te

strong

ABR/McM

o

nerve

sde

T12

oot

cacaneus.

518;

as

reac

te

and

orceu

a

coce.

orceuy.

taus

nnervate

an

ony

te

and

compete

Anatomy

te

te

It

njury

racture

te

atera

and

answer.

n

by

gaments.

remembered

ound

rotaton

te

va

nvertors

sma

apart

te

exes

roots

and

o

o

te

reex.

ABR/McM

type

pused

te

te

533;

ts

a

area

o

to

jerk

w

te

sdes

nnervaton

nerve

correct

roots

nnervaton

atera

pantar

S2

anke,

and

te

motor

anke

S1,

te

eg,

N

exon,

637;

te

L2

anke,

and

326

cutaneous

wc

te

externa

as

ABR/McM

te

sttng

Knowedge

correct

s

same

nnervates

te

nerve.

mantan

pevs

mnmus,

nnervates

aba,

are

te

te

GAS

148.

to

causng

musces

oot,

D

oot;

te

or

usuay

age

o

o

rom

gament

pantar

knee,

te

tat

provdes

musce,

orceuy

racture

nrapatear

njury,

back

tod)

bood

between

deep

te

pued

493;

durng

L4

eads

reerred

suprapatear

bend

superca

he

o

te

eg,

nerve

wt

root

meda

Forceu

ponents

superor

njury.

stands

to

anteror

condton,

patea,

te

gutea

guteus

synergy

p

s

nto

and

ABR/McM

person

ts

te

ste

tba

bursa

medus,

act

exposure

skn.

te

te

emur

ocated

njury.

te

te

s

n

g-rdng

enter

beow

superor

Wen

abductng

o

beow

502;

rgt

atae

bursa

ocated

part

guteus

te

can

te

N

to

te

A

te

beow

602;

he

te

eads

gastrocnemus

we

o

oowng

ocated

upper

part

ound

epsodes

gament

s

s

musce.

poptea

away

bursa

145.

ragment

he

patea

neror

emors

traumatc

bursa

soe

537–542;

oten

te

quadrceps

patear

over

GAS

N

aspect

te

nnervates

C.

gutea

contract

draw

n

tese

sgn

makng

tg;

scrotum

suprapatear

surace

and

reac

skn

by

atera

nerve,

and

by

tt

guteus

nerve

contracts

abnormaty

sown

jont,

to

o

567;

S1

nnervaton

as

caused

557,

he

not

14

he

Loss

and

te

superor

tey

283

Limb

sde.

te

ts

te

as

gutea

ray

144–148

B.

pevs

gastrocnemus

147.

Answers

p

medus,

atae.

dorsum

Neura

rom

p,

weg-bearng

te

te

dgta

toe.

ormaton

dameter.

nvove

coud

to

o

aone

D.

to

condrcaton.

GAS

te

superor

GAS

146.

(syndactyy).

orm

nger

apop-

ncompete

tssues

rays

a

or

dgts

deveopment

moduates

undergoes

sot

Dgta

contrbute

not

rays

Faure

used

skn

anteroposteror

descrbed

x-ray

te

dgta

orm.

underdeveopment

crest

te

to

resuts

nvove

pate.

resuts

between

dgts

usuay

hs

and

te

T rendeenburg

Mesencyme

or

o

guteus

wa

o

te

o

rgt

ateray

te

te

nnervaton

abductors

does

musces.

tns

ter

nng,

ces

Condrcaton

ormaton

pus

pate

body

29–32

toss

n

te

mesoderm,

was,

wa,

derms.

GAS

143.

te

gut

atera

gut

o

mesoderm

becomes

tory

te

musces.

cartage

ntermedate

and

mb

o

and

Lower

5

tat

can

be

Pysca

buar

nerve

musces

tat

6 Upper

Limb

I n t ro d u c t i o n

First

1.

Order

A

Question

25-year-od

ment

rgt

over

because

upper

s

nerves

A.

Second

man

e

e

mb.

trceps

s

brougt

on

te

te

sppery

Pysca

brac

nnervates

a

to

emergency

tra

and

examnaton

musce.

trceps

njured

sows

Wc

brac

o

depart-

te

3.

s

A

Order

ment

abrasons

oowng

over

a

man

because

rgt

musce?

Question

25-year-od

upper

s

e

mb.

trceps

racture

at

s

e

brougt

on

oowng

musces

s

most

B.

Axary

A.

T rceps

C.

Medan

B.

Bceps

D.

Unar

C.

Coracobracas

E.

Muscuocutaneous

D.

Bracas

E.

Detod

te

emergency

tra

examnaton

musce.

md-body

Rada

to

sppery

Pysca

brac

te

a

o

An

te

key

x-ray

and

sows

o

s

umerus.

depart-

njured

s

abrasons

arm

sows

Wc

o

te

parayzed?

brac

brac

Explanation

A:

he

nerve

most

nnervates

nar

te

nerves

axary

key

trceps

do

not

nerve

nnervate

nnervates

muscuocutaneous

s,

bceps

afected

brac

brac,

compartment

o

and

te

any

te

nerve

s

te

musce.

rada

he

musces

detod

and

nnervates

bracas

nerve

medan

n

te

teres

te

musces

wc

and

u-

Explanation

A:

he

he

nerve

2.

Order

A

mnor.

he

surace

rada

n

wrst

te

anteror

arm.

ment

rgt

over

a

because

upper

s

at

oowng

e

mb.

trceps

racture

A.

e

s

brougt

on

a

s

most

te

emergency

tra

examnaton

musce.

md-body

nerves

to

sppery

Pysca

brac

te

o

o

An

te

key

x-ray

and

o

s

umerus.

musces

s

abrasons

arm

Wc

Third

4.

sows

o

Order

mb.

njured?

o

Axary

most

A.

D.

Unar

B.

Inabty

E.

Muscuocutaneous

C.

Inabty

key

Wrst

es

n

te

surace

runs

te

around

nerve

te

o

rada

passes

musces

n

o

te

nerve

usuay

runs

284

umerus

te

ward

groove

to

surgca

te

te

meda

between

and

arm,

te

neck

te

te

he

and

te

and

bceps

t

runs

trav-

posteror

axary

te

compartment

nerve

as

te

umerus,

meda

meday

musce

brac

orearm),

nerve

nnervated

te

te

te

te

musces

and

by

to

rada

posteror

musce

bceps

are

he

(and

brac,

nnervated

detod

axary

te

orearm.

brac

wereas

bracas

s

te

and

teres

by

m-

nerve.

An

te

be

x-ray

sows

o

s

umerus.

present

abrasons

arm

sows

Wc

durng

o

pysca

over

a

te

s

trceps

racture

at

oowng

te

w

examnaton?

to

lex

to

s

lex

wrst

te

nterpaangea

(PIP)

and

ndex

oss

and

(DIP)

o

pronaton

mdde

and

ngers

proxma

at

te

nterpa-

jonts

D.

Inabty

to

lex

E.

Parayss

o

te

te

rng

and

umbrcas

tte

and

ngers

at

nterosseous

DIP

musces

nerve

medan

to

to-

muscuocutaneous

coracobracas

bracas

nerve

aong

orearm.

o

unar

epcondye,

te

rada

descends

neurovascuar

perces

te

te

trceps

x-ray

aong

drop

angea

Explanation

s

te

and

descends

te

examnaton

musce.

Medan

afected

are

Pysca

brac

C.

key

n

te

Question

md-body

most

and

n

groove

A 25-year-od man s brougt to te emergency department

B.

nerve

umerus

rada

because e e on a sppery tra and njured s rgt upper

te

Rada

he

afected

te

nnervates

extensors

dsta

A:

te

nerve

n

depart-

njured

sows

key

traves

muscuocutaneous

nor

man

most

t

coracobracas,

Question

25-year-od

as

coracobraca-

te

First

nerve

arm.

and

ten

musces.

Explanation

A:

he

n

ner ve

te

surace

o

nner vates

tese

key

rada

te

te

musces

afected

groove

umerus

wrst

are

s

and

to

te

rada

descends

te

extensor

parayzed

ner ve

aong

orearm.

musces

because

he

o

te

as

te

t

traves

posteror

rada

te

ner ve

orearm.

rada

ner ve

I

s

CHAPTER

njured,

as

B:

wrst

te

Inabty

key

to

pronaton

nervated

C: Inabty

by

and

te

cannot

be

extended.

hs

s

reerred

to

D: Inabty

as

o

o

by

to

jonts

lex

coce

nervaton

ma

wrst

drop.

and

lexon

musces

te

te

lex

DIP

te

te

o

wrst

pronaton

s

medan

aso

s

an

perormed

and

perormed

unar

by

va

un-

E:

n-

nerves,

musces

a

and

Parayss

te

and

uncton

o

ngers

at

musces

te

prox-

s

by

unar

wc

mdde

o

and

nervated

n-

nerve.

ndex

s

oss

te

te

s

medan

jonts

medan

by

and

and

o

to

x-ray

lex

descrbes

te

an

te

an

(GAS

umbrcas

brances

2

key

Fg.

and

nerve

ncorrect

(unar

were

rng

unar

o

tte

and

te

tese

and

durng

at

te

te

2

njury

sown

nnervated

nerve.

Deep

interval

brachial

Radial

artery

nerve

Inferior

lateral

Posterior Branch

to

medial

head

of

triceps

Medial

brachii

epicondyle

Ulnar

nerve

•

GAS

Fig.

.

(in

radial

groove)

cutaneous

cutaneous

nerve

nerve

of

of

are

o

n-

umbrcas)

nterosse)

7.69).

Triangular

DIP

musces

musces

(rada

a

285

Limb

njury.

nterosseous

as

medan

umbrcas

spared

ngers

branc

coce

Upper

6

arm

forearm

nerves

on

te

286

C H A P T E R

Fourth

Order

6

Upper

Limb

Question

Anterior

view

Greater

5.

A

25-year-od

man

s

brougt

to

te

emergency

Superior

depart-

facet

on

tubercle greater

ment

because

e

e

on

a

sppery

tra

and

njured

Inter tubercular

rgt

upper

sons

over

mb.

s

Pysca

arm.

An

examnaton

x-ray

o

s

arm

s

sows

sown

abra-

Wc

o

te

oowng

dects

w

most

n

(supraspinatus)

sulcus

Head

Fg. Lesser

6.1.

tubercle

s

key

tubercle

be (subscapularis)

encountered

durng

pysca

examnaton?

Anatomical

Inter tubercular

A.

Inabty

to

make

a

neck

st sulcus

B.

Inabty

C.

Inabty

to

lex

D.

Inabty

to

lex

E.

Parayss

o

te

to

s

lex

wrst

te

and

ndex

oss

and

o

pronaton

mdde

Surgical

ngers

at

Lateral

te

and

DIP

and

PIP

lip,

neck

floor,

medial

lip

of Lateral

jonts

view

inter tubercular

rng

and

tte

ngers

at

te

DIP sulcus

umbrcas

and

nterosseous

(pectoralis Attachment

musces

major,

latissimus for

o

te

dorsi,

and

and

pectoralis

teres major

major,

respectively)

Explanation

A:

he

nerve

key

afected

s

te

rada

nerve

as

t

traves

n

Deltoid

tuberosity

Deltoid

(deltoid)

te rada groove as t descends aong te posteror surace

tuberosity

o

te

umerus

to

te

orearm.

Atoug

te

rada

nerve Attachment

does

a

not

st,

t

provde

does

and

brevs

and

are

nnervaton

nnervate

musces.

necessary

te

hese

or

to

musces

extensor

musces

makng

a

carp

act

st,

tat

as

as

ep

radas

wrst

tey

make

for

(deltoid)

coracobrachialis

ongus

extensors

contract

syn-

Greater

ergstcay

wt

te

lexors

o

te

ngers

to

keep

te

wrst tubercle

extended,

acton.

makng

he

t

ndspensabe

“poston

o

uncton”

we

o

te

perormng

and

s

ts

wt

Superior

te

facet

(supraspinatus)

wrst

B:

extended

Inabty

key

to

about

lex

coce

te

as

30

degrees.

wrst

lexon

and

o

oss

te

o

wrst

pronaton

s

s

perormed

an

un-

va

o

musces

Pronaton

o

by

te

medan

and

unar

neck

nerves. Inferior

te

and

s

aso

perormed

by

a

musce

nervated

by

te

to

medan

lex

te

and

DIP

jonts

and

s

a

mdde

ngers

uncton

o

te

at

te

ner ve.

descrbes

E:

Parayss

to

lex

an

o

te

unar

te

rng

nerve

and

tte

branc

umbrcas

and

ngers

at

te

DIP

o

musces

s

an

n-

correct coce as tese musces are nnervated by brances

Main

A

naton

mary

woman

breast

od

eter

at

te

te

eve

structure(s)

s

he

to

te

consutaton.

areoa

o

luctuance,

breast.

comes

surgery

tat

as

te T8

sweng,

ntegrty

GAS

o

pyscan

Pysca

beow

te

dermatome.

dmpng,

wc

o

or

a

.

te

and

njury

unar

nerves,

sown

on

te

wc

x-ray

were

(see

key

Fg.

spared

7.22

rom

3e).

ture

exam-

te

nramam-

here

or

te

s

umps

Scarpa

B.

Pectoras

major

C.

Pectoras

mnor

D.

Suspensory

no

s

ness

Serratus

department

musce

man

ater

e

gaments

musce

was

was

brougt

nvoved

x-ray

atera

and

o

comes

n

on

Wc

to

te

actvtes.

pan

te

border

rgt

o

te

rgt

te

pyscan

souder

Pysca

meda

o

te

souder

scapua.

and

oowng

a

rac-

weeks

ater,

because

we

examnaton

rotaton

sows

Sx

o

sows

adducton

nerves

s

pan

perormng

weak-

o

most

te

key

njured?

musce

anteror

27-year-od

day

umerus.

asca

(Cooper)

An

te

weakness

on

oowng

o

patent

and

compromsed?

A.

A

medan

coson.

sows

erytema,

E.

te

durng

1–25

45-year-od

cosmetc

2.

Fig.

Q u e st i o n s

Questions

1.

GAS

jont

dect.

nterosse

view

medan

•

D: Inabty

minor)

nerve.

ndex

Posterior

proxma

facet

n(teres

C: Inabty

facet

(infraspinatus)

neck

Surgical

nervaton

Middle

Anatomical

n-

to

n

te

a

emergency

motor

vece

3.

A.

Lower

B.

Axary

subscapuar

C.

Rada

D.

Accessory

E.

Suprascapuar

A

o

48-year-od

a

1-year

woman

story

o

comes

pan

to

and

te

pyscan

parestesa

n

because

er

rgt

CHAPTER

sows

o

a

md-body

structures

A.

Medan

B.

Axary

s

racture

most

nerve

and

nerve

o

key

te

umerus.

njured

braca

and

Upper

6

at

te

287

Limb

Wc

racture

par

ste?

artery

posteror

crcumlex

umera

artery

6.

C.

Rada

D.

Suprascapuar

E.

Long

An

nerve

toracc

18-year-od

department

we

sows

a

nerves

s

broken

most

bone

A.

Axary

B.

Medan

3-day

er

ncreased

pan

outstretced

naton

o

as

he

er

tes.

sows

rgt

Wc

as

exercse

o

and.

n

severty

one

musce(s)

et

s

durng

persstent

year

sensaton

Her

ago.

n

and

most

ater

and

4.

B.

Lumbrcas

no

nerves

on

C.

henar

D.

Pamar

E.

Hypotenar

A

or

C.

Deep

D.

Medan

weakened

n

ts

a

bcyce

et

race.

ebow.

ng,

and

over

s

te

musces

B.

Bceps

C.

Bracoradas

D.

Fexor

E.

Supnator

A

arm

carp

te

od

te

pan

et

1½

et

and

sows

ebow

dgts.

INSERT

most

s

An

o

warmt,

x-ray

o

te

Wc

atera

swe-

decreased

o

mb

se

oss

o

and.

er

on

x-ray

to

wet

rgt

sensaton

An

x-ray

umerus

te

o

an

njury

sows

o

about

te

jagged

sg-

te

1

arm

nc

oowng

edges

o

te

te

pyscan

rgt

atetc

arm

because

ater

tournament.

extenson

o

te

o

strenuous

Pysca

wrst

te

te

and

Pysca

upper

and

aert

puse

sows

weakened

o

and

te

mutpe

oowng

Medan

Latera

cord

E.

Latera

antebraca

ater

beng

te

but

wound

ore-

sweng

mb

graspng

te

and

s

as

90/mn,

s

no

at

te

o

oss

te

te

o

rgt

oowng

as

most

on

wt

An

o

Hg.

te

are

over

orearm

o

16/

Pysca

sensaton

x-ray

te

to

on

te

umerus.

te

are

te

upper

Wc

njured?

nerve

te

er

emergency

and

copous

te

coson.

temperature

pexus

progressvey

pncng

o

key

examnaton

base

emergency

brusng

o

oss

cutaneous

comes

Her

mm

and

o

te

vece

respratons

118/72

braca

btten

wound

Pysca

at

te

woman

wased

te

o

to

arrva.

orearm.

D.

ours.

s

x-ray

motor

ractures

Muscuocutaneous

24-year-od

s

se

nerves

o

a

supnaton

C.

6

An

Wc

tenderness

and

B.

e

here

brougt

upon

pressure

Fexon

surace

s

ater

Rada

exam-

posteror

rgt

woman

o

emergency

pavement

arm.

o

o

te

mb.

ractures.

A.

A

strengt.

njured?

our

bood

sows

te

no

te

parayzed?

brougt

spped

njurng

An

Wc

by

to

o

grp

et

9.

s

arm.

te

s

afected

(98.6°F),

and

severey

s

wt

awake

arm.

ment

ater

dorsa

s

37°C

et

durng

supercas

woman

examnaton

rada

1

examnaton

depart-

sweng

IMAGE.

key

arm

unars

curb,

sows

and

as

emergency

to

brac

department

naton

s

dgtorum

24-year

aganst

o

meda

Fexor

te

examnaton

sown.

A.

to

njury

patent

Pysca

mb

oowng

5.

comes

tenderness

sensaton

upper

he

emergency

ater

nterosseous

department

IV

an

oss

key

32-year-od

mn,

man

pan

rada

Superca

A

s

sustanng

n

major

sows

abnorma-

nterosse

ater

comes

pan

a

te

most

Unar

Se

45-year-od

ment

s

Anteror

8.

and

mb

B.

exam-

3½

nterosse

III

o

sows

n

A.

rada

sows

upper

past

E.

Dorsa

njured

artery

te

ocaton?

decreased

dgts

Pysca

te

key

te

ang

condton?

A.

o

to

6.1

been

and

oss

ts

man

story

et

racture

Unar

52-year-od

arm

epcondyes.

E.

A

et

te

Muscuocutaneous

sensaton

tat

over

toracc

brougt

Pysca

Rada

wrst

mont.

o

key

at

examnaton

and

atera

D.

ed

Fig.

and

s

C.

a

•

nerve

rugby.

te

artery

artery

transverse

to

braca

and

man

brusng

proxma

deep

nerve

because

payng

ncant

7.

and

by

a

amounts

worsened

sows

tumb,

o

n

te

dicuty

he

Se

water,

tenderness

and

movements.

depart-

dog.

ast

and

wt

necton

288

C H A P T E R

6

eventuay

wc

10.

spreads

musce

to

w

Limb

te

most

rada

key

bursa.

be

he

tendon(s)

o

14.

afected?

2

dgtorum

proundus

durng

B.

Fexor

dgtorum

supercas

atete

C.

Fexor

pocs

D.

Fexor

carp

E.

Fexor

pocs

ongus

studes

24-year-od

woman

bood

a

te

outpatent

ncuded

Wc

assessment

o

te

o

oowng

key

crcuat-

proundus

cubta

D.

Anteror

E.

Rada

nterosseous

anoma

ng

nterosseous

He

as

30

a

ong

years.

consstent

wc

ymp

as

nodes

A.

Deep

B.

V ertca

C.

Horzonta

D.

Axary

E.

stor y

A

punc

wt

a

o

sun

dagnoss

most

over

o

to

be

as

te

skn

a

Deep

group

superca

group

o

superca

man

Medan

D.

Recurrent

E.

Deep

worsenng

atgue

and

day

due

to

cest

test,

a

tasks

tve

stress

and

sows

te

ses

a

w

coronary

anteror

part

o

pan

artery

key

te

te

ncreasng

artery

toracc

most

to

coronary

coronary

nterna

nguna

on

dicuty

angograpy

stenoss.

upper

to

He

grat

artery. Wc

contnue

o

because

Ater

a

pos-

as

dicuty

bood

spaces

he

upper

he

ste

to

te

ater

te

ar

E.

A

toracc

rada

te

and

puse

patent.

owng

bood

s

pressure

cecked

hs

puse

to

s

to

motor

s

Her

te

atera

to

emergency

vece

coson.

respratons

100/50

determne

et

mm

te

Hg.

eart

wc

o

are

he

rate

te

Pamars

B.

Fexor

Fexor

dgtorum

D.

Fexor

carp

E.

Fexor

dgtorum

proundus

radas

supercas

te

grp

oss

pad

a

o

depart-

On

o

pys-

s

ndex

o

paper

seet

sensaton

oowng

te

on

nerves

pyscan

axa

rgt

by

s

te

most

arm

ater

durng

above

sows

a

recev-

a.

te

He

eve

te

o

neror

protruson

aganst

o

te

s

most

braca

s

a

more

wa.

key

prom-

Wc

o

njured?

pexus

nerve

te

o

te

s

way

ventra

boy

s

braca

mdde

recas

an

sows

cd

extend

extremty

sows

Wc

te

o

wt

on

no

s

ts

e

pexus

and

C8,

te

ower

subscapu-

er

to

son’s

car

move

ebow.

o

out

and

ts

sweng

and

or

An

te

gaments

T1

emergency

screamed

dsocaton

oowng

C7,

to

reusa

oncomng

examnaton

cannot

or

tat

voenty

o

ram

brougt

moter

n

to

pu

brusng,

ead

o

o

most

depart-

et

pan

mornng.

x-ray

s

s

arm.

ater

m

out

Pysca

but

te

te

key

te

upper

radus.

assoc-

njury?

A.

Annuar

B.

Jont

C.

Interosseous

D.

Rada

E.

Unar

18.

cord

o

nerve

tugged

te

he

puses

trunk

o

ongus

C.

to

orgn

o-

ongus

pocs

o

moter

ated

tendon?

A.

and.

nerves

Spna

o

horacodorsa

30/mn,

no

te

structures

toracc

4-year-od

Latera

brougt

neura

D.

D.

a

can

emergency

s

examnaton

patent

C.

ves-

se

ater

o

rgt

te

scapua.

usng

ntercosta

unconscous.

most

medan

s

te

posteror

Posteror

s

to

et

ong

C.

mnutes

o

comes

te

he

Hs

se

as

o

wen

he

epgastrc

30

ourt

s

rada

Pysca

B.

Superor

arrva,

te

musces

unar

o

man

A.

B.

On

o

eevatng

oowng

ment

department

te

touc

but

and

trauma

to

oowng

suppy

o

Muscuoprenc

s

bunt

souder.

te

perormed

scedued

procedure

te

ntercosta

woman

to

pam

cannot

branc

branc

a

nent

17.

22-year-od

o

a

examna-

nterosseous

55-year-od

A.

A

te

Wc

branc

ng

part

perormng

s

s

o

procedure?

E.

jonts

te

n

ange o s rgt scapua protrudes more tan te ower

pyscan

exerton.

bypass

resutng

njured?

C.

A

e

ngers

oow-

ts

comes

to

tumb

and.

Anteror

nguna

comes

a

s

B.

s

and

o

s

me-

n

man

wound

Deep

nguna

superca

wt

key

16.

o

a

A.

papabe

and

wen

unars

examnaton,

between

ceuar

magnant

o

o

xpod

sows

Wc

key

because

s

exposure

bopsy

metastaszed.

are

pyscan

moe

nguna

49-year-od

undergo

wt

nger

a

carp

24-year-od

ca

patent?

A

A

ment

o

canges

15.

te

DIP

depart-

et

Pysca

oowng

supercas

Unar

o

te

te

dgtorum

Common

to

o

dgtorum

C.

sape

lex

s

occurred

dgt.

Fexor

B.

comes

to

lexed

Fexor

Interosse

and

s

to

jersey

B.

E.

man

njury

A.

Braca

sze

o

emergency

njury

afected?

A.

n

te

opponent’s

nabty

Lumbrcas

52-year-od

to

an

s

arteres

te

he

dgts. Wc

Fexor

armer

n

a

sows

brougt

s

extenson

t

s

sustanng

game.

grpped

D.

process.

venpuncture

on

rugby

C.

cange

durng

cnc

ater

ossa?

A

at-rsk

and

n

cemstry.

key

ton

brevs

man

ours

orceu

radas

Laboratory

a

13.

20-year-od

Fexor

most

12.

A

ment

A.

ng

11.

Upper

capsuar

coatera

coatera

A 28-year-od nugravda woman gves brt to a 3500

g

(7

b

11

oz)

baby

boy

by

orceps

devery.

he

preg-

nancy was compcated by gestatona dabetes. Pysca

CHAPTER

examnaton

ay

rotated

part

ng

19.

o

te

te

braca

B.

Meda

cord

C.

V entra

ram

D.

V entra

ramus

E.

V entra

ram

35-year-od

2

cm,

red,

dgt.

ocazed

by

cod

son

s

ave

to

Common

Superca

D.

Deep

E.

Recurrent

ment

poe

vaut.

te

wrst.

key

med-

souder

Wc

njured

musces

dur-

trunk

upper

to

te

nodue

as

o

trunk

pyscan

and

severe

eson,

tat

pressure.

Wc

o

or

na

attacks

are

T ota

te

because

te

o

o

o

man

o

surgca

oowng

paness

exc-

o

dorsa

s

branc

remova

wrst

key

Scapod

C.

Captate

D.

Hamate

n

s

o

rgt

medan

and

a

emergency

wrst

we

examnaton

An

racture

o

ours

md

upon

x-ray

s

2

depart-

ater

perormng

sows

tenderness

snufbox.

I

te

and

Supraspnatus

E.

T eres

A

te

sweng

papaton

s

and

suspected,

o

sows

wc

ead

o

3-day

a

trceps

man

story

comes

rgt

gament.

he

severe

a

damage

T ransverse

D.

Genoumera

E.

Coracoacroma

depar tment

on

te

meda

Neuroogc

od

oss

and

a

sde

o

on

most

o

paper

sensaton

meda

s

1½

on

key

Axary

B.

Medan

n

te

years

Muscuocutaneous

D.

Rada

E.

Unar

19-year-od

ater

soccer

der

s

ton,

te

game.

as

A

A

nds

s

s te

s

comes

meda

(Fg.

to

tree

graspng

ater

examnaton

6.2).

key

Wc

cause

o

o

 njur y

te

s

 s

o

te

a

and

e xtre me y

 o ow  ng

s

brougt

dagnoss

o

reducton

Pysca

but

magnetc

to

te

onto

pan

a

o

te

ne r ve s

s

unabe

rgt

dorsa

sows

to

no

n

sou-

dsoca-

regon

abduct

magng

depart-

souder

souder

te

examnaton

e

rgt

dsocated

over

resonance

emergency

s

o

obvous

te

(MRI)

arm

o

te

Wc

most

•

Fig.

pyscan

dgts

sows

to

as

te

objects

gt.

and

years

graduay

musce.

pyscan

workng

bone

unab e

nge rs

asp e ct

o

o

e

a

as

sou-

te

key

gament

w ound

n

over

sagtta

a

gament

e m er gency

kn e

 ore arm

m ed a

he

te

tat

b e twe e n

panuy

Ater

deormtes

normay.

to

de ep

d s ta

W c

persstent

souder.

bone

man

ang

made.

e

a

o

o

part

gament

earer,

Pysca

most

(AC)

njured ?

C.

ment

 s

te

dgts .

papaton .

A.

b rougt

sus ta n  n g

examnat on

pece

o

tender

man

ater

gament

te

because

takng

obque

tat

underyng

s

nvoved?

36-year-od

te

expans

T rapezod

A

n

ater

gament

man

dicuty

emnence

te

te

pyscan

pan

gament

scapuar

79-year-od

numbness

s

oowng

to?

C.

years.

to

gaments

Coracoumera

9

te

njury?

ypertropy

souder

Acromocavcuar

as

te

MRI

and

pyscan

tenns,

oowng

retred

o

ts

brac

to

An

tckenng

B.

He

by

souder

competton.

sows

payng

o

A.

A

Wc

major

tenns

te

te

musce.

damaged

289

Limb

mnor

32-year-od

reerrng

24.

to

D.

o

o

medan

brougt

pan

abnormates.

B.

o

Pectoras

caused

nerves

unar

outstretced

anatomca

most

dgta

C.

o

rada

branc

Coracobracas

der

exacerbated

torn

key

Long

pane

pan

a

most

B.

n

s

sows

s

A.

a

under

sudden

te

23.

trunk

anestetzed

Pysca

Lunate

a

most

mdde

comes

branc

an

A.

A

was

adducted,

at

rada

on

te

te

22.

te

area

be

because

ang

s

o

pamar

25-year-od

E.

an

tumor?

C.

s

nds

lexed

ower

te

temperatures

B.

no

o

patent

te

Superca

on

te

man

he

to

o

bancabe

A.

A

s

pexus

recommended.

woud

te

tat

devery?

cord

A

neonate

arm

Latera

t

21.

te

A.

a

20.

o

et

Upper

6

6.2

te

o

wt

as

a

s

because

rgt

tat

atropy

o

oowng

probems

and.

carpenter

n

s

te

o

and.

or

He

50

tenar

condtons

and?

290

C H A P T E R

A.

6

Upper

Compresson

Limb

o

te

medan

nerve

n

te

carpa

28.

tunne

B.

Formaton

C.

Hypertropy

D.

Osteoartrts

nerve

at

E.

aert,

ma

and

wrst.

ay.

o

most

te

et

s

te

s

body.

o

and.

njured,

to

He

te

sgns

n

te

Wc

and

s

n

s

te

wat

He

are

unabe

atera

o

emergency

sows

ebow

s

nor-

severa

cuts

to

extend

o

te

te

bater-

te

oowng

o

awake,

wtn

norma

a

part

x-ray

most

te

coson.

vta

on

carpa

nerve

brougt

examnaton

ost

saton

com-

s

s

te

key

Scapod

D.

T rapezod

E.

T rquetrum

45-year-od

vta

Medan

nerve,

arm

Rada

nerve,

md

umerus

ganga

D.

Rada

nerve,

md

atera

sory

E.

Unar

A

26–50

17-year-od

s

sustanng

gt.

te

dsc

regon

Pysca

proxma

lexon

and

brougt

a

kne

wound

arm.

supnaton

ebow

ng

addtona

te

examnaton

meda

te

to

and

wrst

s

o

emergency

to

He

te

et

woud

et

a

as

norma.

ndngs

s

sows

4

arm

cm

n

and.

a

street

wound

weakness

Wc

be

department

o

on

ebow

Extenson

o

present

Meda

B.

Long

Latera

Deep

E.

Anteror

te

n

a

pysca

as

se

adduct

and

B.

Inabty

to

lex

s

ngers

structures

C.

Inabty

to

lex

s

tumb

A.

D.

Sensory

oss

over

E.

Sensory

oss

over

A

52-year-od

ment

o

wt

s

been

rgt

upon

tered.

A.

wt

Pysca

Wc

o

to

pan

For

te

te

cm

dsta

n

oowng

s

o

orearm

s

orearm

depart-

posteror

severa

aspect

days

orcestra

sows

and

s

petey

emergency

te

past

Intramuscuar

te

o

surace

te

sympony

examnaton

2

epcondye.

o

meda

orearm.

papaton

atera

te

comes

excrucatng

reearsng

ductor.

nsm

man

surace

e

as

sterods

most

are

by

pan

o

te

unar

nerve

o

te

medan

by

te

o

Compresson

nerve

by

te

Compresson

dgtorum

D.

o

te

medan

nerve

by

o

te

superca

rada

nerve

Compresson

supnator

o

te

deep

rada

nerve

over

te

T wo

te

te

nger

DIP

te

days

end

seet.

s

to

he

ce

and

sows

T1

md

dorsa

bodes

oowng

jont.

dgt

pyscan

o

ago,

o

te

se

te

o

root

sen-

nerves?

and

was

most

dgta

was

makng

nger

s

one

o

key

branc

unabe

te

o

paanx

a

n

examnaton

se

Wc

because

termna

ndex

Pysca

swoen

pamar

te

base

a

bed

od

sows

to

com-

oowng

njured?

o

te

medan

nerve

B.

he

C.

he

vncuum

nserton

onto

te

base

ongum

o

o

te

te

tendon

dsta

as

te

lexor

by

neuroogc

C8

spne

aert

exam-

nerve

comes

te

bracoradas

E.

and

nerve

carp

by

te

s

nerve

supercas

Compresson

a

s

depart-

patent

te

cutaneous

pronator

te

o

nerve

teres

C.

o

bones

Pysca

cutaneous

unars

B.

scap

contan

meca-

lexor

he

and T1–T2.

njury?

Compresson

sen-

dgts.

dsocaton

emergency

cervca

admns-

key

3½

oowng

mts.

te

te

wc

unar

caugt

wtn

te

dect

woud

woman

proper

o

pan

to

out-

restrcted

nerve

o

te

to

norma

C7–T1

nger.

and

extend

he

te

pan

er

decreased

atera

anteror

o

wt

onto

sows

and

te

coson.

con-

excrucatng

posteromeda

te

a

o

o

nterosseous

ndex

to

an

sensory

and T1

stragtened

Inabty

atera

ngers

ndex

rgt

orce

pan

o

brougt

antebraca

severe

ote

s

vece

x-ray

branc

23-year-od

o

to

Wc

antebraca

D.

sudden

sows

aceratons

carred

C.

A

due

wtn

toracc

A.

te

s

C8

A.

te

abduct

o

bers

at

examnaton?

sows

ernatons

oow-

te

on

30.

are

An

C.

mdpamar

sgns

dermatomes.

B.

nerve,

man

motor

nds

anteror

orearm

a

examnaton

nerve,

pyscan

examnaton

aspect

6.3).

te

wt

dsocated?

Lunate

ater

wrst

wrst

(Fg.

to

ang

Pysca

pamar

C.

A

comes

ater

te

te

B.

naton

wrst

o

bone

Captate

and

ocated?

o

te

A.

ment

dor-

ner ves

arm

29.

woman

wrst

and.

movement

musce

spne

unar

rgt

stretced

An

motorbke

s

unar

er

Medan

ater

27.

30-year-od

A.

Questions

26.

on

te

pexus

and

Extenson

key

njur y

a

compress

brac

cervca

s

Pysca

Sensaton

sum

to

man

ater

bruses

et

trceps

te

trauma

tat

epcondye

te

o

orented

mts.

and

o

braca

20-year-od

department

osteopytes

meda

te

Repeated

A

o

te

pressng

25.

A

n

te

•

Fig.

6.3

o

extensor

paanx

dgtorum

CHAPTER

D.

he

nserton

o

te

lexor

dgtorum

proundus

35.

tendon

E.

he

nserton

o

te

lexor

dgtorum

supercas

A

wt

ang

An

te

s

o

he

bones

te

s

and

onto

orearm

carpa

most

B.

T rapezum

a

o

emergency

s

lexed,

sows

bone

te

a

rgt

n

o

depart-

wrst

outstretced

racture

dspaced

resutng

tunne. Wc

key

Scapod

to

sweng

ractured

A.

a

o

carpa

nerve

te

o

dsta

bone

aspect

pan

and

naton

wt

ng

er

rgt

sweng

sows

severe

and

ts

o

er

symmetrc

pan

sows

o

and.

no

on

Se

rgt

to

as

woud

on

o

he

ncude

Parayss

o

abducton

A

emergency

te

te

njured

o

severe

rst

te

Wc

deep

B.

he

rada

oow-

C.

he

superor

D.

he

neror

E.

he

anteror

Extensor

dgtorum

ment

D.

Extensor

ndcs

s

butcer’s

E.

Extensor

carp

ts.

Pysca

ment

a

ater

atered

and.

An

owng

s

ang

rom

o

MRI

cord

brougt

routne.

sensaton

meda

unars

gr

gymnastc

o

spna

37.

to

uneven

parae

te

meda

braca

1½

dgts

nds

pexus.

njury

Wc

o

rgt

be

to

te

te

o-

ater

1½

An

unar

kne.

o

and

o

te

te

o

wrst

o

te

ts

PIP

t

tumb

E.

Opposton

38.

A

ment

depart-

e

axa.

s

on

abducton

weakness

angea

on

Pysca

and

extenson

extenson

(MCP)

abnormates.

jonts.

An

centra

aspect

o

owng

musces

carp

Fexor

B.

Extensor

C.

Bracoradas

D.

Extensor

E.

Supnator

o

te

An

te

x-ray

o

sot

and

te

spared

weakness

here

s

aso

o

metacarpopa-

arm

tssue

umerus.

key

sows

tumb.

wrst

sows

atera

most

A.

o

MRI

te

s

examnaton

o

carp

dorsa

no

depart-

wrst

wt

norma

sensaton

strengt

oter

woud

o

te

t

o

m-

on

te

te

et

abnorma-

most

key

dgt

(tte

e

dgt

tumb

comes

s

unabe

car

to

wt

examnaton

ngers

aspect

nerves

s

and

o

te

most

te

to

emergency

move

a

book

sows

afected

o

and.

Latera

cord

o

te

braca

pexus

Meda

cord

o

te

braca

pexus

te

o-

C.

Rada

pectora

nerves

Medan

E.

Latera

o

te

extend

atera

Wc

sde

o

te

nerve

and

32-year-od

meda

woman

Pysca

upper

to

s

nerve

D.

er

e

nto

compressed?

B.

A

te

depart-

ater

wedged

A.

njury?

arm

nabty

numbness

key

s

no

39.

ongus

o

te

dayss.

radas

to

most

tumb

te

s

and

oowng

unars

ndcs

et

wtn

to

njury

Wc

rom

sows

o

Pysca

wrst

te

n

te

man

because

aseep

a

game.

o

23-year-od

ment ater se was struck n te arm by a ne drve durng

sotba

was

emergency

actons

jont

te

emergency

wc

suppy

njury?

o

te

bood

s

grp

sows

oowng

Abducton

to

meda

artery

arteres

te

oss

decreased

D.

comes

te

was

artery

are

sows

C7

woman

an

Hs

nerve

artery

to

sgns

examnaton

resut

Fexon

Vta

C6,

21-year-od

bend

sased

B.

A

major

rom

sustaned

ebow.

artery

recurrent

brougt

accdentay

dgts

a

s

te

T1

e

te

artery

o

C8,

A

passed

coatera

Adducton

E.

arm

depart-

nger)

afected?

T1

mts.

coatera

unar

man

x-ray

as

unar

Extenson

C8

te

artery

coatera

e

Wc

ost

A.

o

oowng

C.

C8,

key

er

tes.

wc

suppyng

B.

C7,

most

an

o

and.

nds

n

te

braca

60-year-od

meda

durng

roe

t

n

o

emergency

sde

stopped

C6

C7,

s

bars

examnaton

was

C5,

D.

eves

depart-

te

robbery

A.

C.

nerve

emergency

Neuroogc

examnaton

te

te

A

to

meda

norma

o

and

adducton

repared?

n

brevs

te

and

were

mportant

he

pocs

te

ste

A.

brevs

extensor

to

ebow

o

brougt

Beedng

C.

and

and

an

s

wtn

te

Extensor

17-year-od

ongus

at

Abductor

ongus

man

opposton

te

attempted

are

nerve.

key

te

tendons

te

sgns

pays

dgt

o

an

tumb

wound

epcondye.

exam-

x-ray

ater

buet

repared

dorsoat-

o

58-year-od

B.

A

radas

pysca

E.

A.

pocs

on

pronaton

musces?

carp

present

te

Wc

o

An

wc

suspected.

Parayss

Pysca

extenson.

be

rac-

o

D.

ncreasngy

and.

woud

s

a

Injury

extend

te

dog

enargement

passve

abnormates.

compartment

a

groove

nabty

sows

to

vta

by

sgns

umerus.

sus-

base-

Inabty

carpa

Lunate

brougt

oowng

rada

sows

x-ray

a

C.

oowng

E.

bte

te

te

An

ater

wt

Weakness o tumb abducton and tumb extenson

a

was

n

arm

examnaton

wrst.

o

pyscan

Weakness

ment

severe

te

te

B.

Captate

a

at

to

proxma

A.

dsocated?

gr

Pysca

and

md-body

nerve

et

n

Hamate

ater

gt.

comes

er

compresson

36.

15-year-od

o

291

Limb

examnaton?

D.

A

a

er

te

te

woman

njury

n

o

rada

and.

te

bat

ture

ater

an

extend

C.

era

34.

brougt

drecton,

department

33.

s

bke

te

pamar

wtn

man

pan

rom

x-ray

radus.

32.

to

16-year-od

ment

21-year-od

ba

tendon

31.

A

tanng

Upper

6

mb

major

to

examnaton

was

ven

comes

te

unexpectedy

on

te

atera

ospta

sows

dicut

aspect

or

venous

er

as

emo-

access

te

arm

n

caber

was

too

292

C H A P T E R

sma.

tat

A

Upper

ven

passed

jon

vens

owng

40.

6

besde

vens

s

te

te

braca

most

meda

superca

key

sde

and

artery.

o

deep

Wc

te

arm

asca

o

te

a

to

4

cm

te

o-

et

noted.

ocated?

aceraton

sde

he

sgty.

s

ocated

neck.

superor

Neuroogc

Latera

Cepac

A.

Suprascapuar

D.

Medan

cubta

B.

he

termna

E.

Medan

antebraca

C.

he

upper

D.

he

accessory

E.

he

toracodorsa

29-year-od

te

woman

ater

part

o

norma

ourt

unabe

to

lex

Sensaton

te

s

pamar

oowng

te

absent

nerve(s)

B.

Unar

and

C.

Unar

nerve

D.

Rada

and

E.

Rada

nerve

der

o

te

atera

rst

key

unabe

o

sde

3½

t

MCP

dgts

o

dgts

to

and

rgt

te

44.

at

pam

An

excrucatng

arm

ater

tat

rotated.

s

a

te

he

at

o

te

te

pan

emergency

n

wrestng

arm

s

patent

attempted.

x-ray

umerus

oowng

45.

te

Rada

souder

te

most

key

depart-

rgt

matc.

sgty

ressts

puses

o

n

te

o

te

nerve

n

woman

te

rada

key

to

te

MCP

jont

te

MCP

jont

C.

Inabty

to

extend

MCP

Inabty

to

extend

te

MCP ,

E.

Inabty

to

extend

te

PIP

A

27-year-od

man

because

rom

more

to

a

15

he

rgt

and

o

He

s

degrees

te

s

An

x-ray

racture

Fracture

o

te

meda

Fracture

o

te

genod

ossa

neck

umerus

s

dspaced

posterory

D.

Fracture

o

te

anatomca

C.

he

ead

o

te

umerus

s

dspaced

nerory

E.

Fracture

o

te

mdde

47-year-od

breast.

o

and

a

breast

ard

o

nodue

er

te

rgt

tssue

expose

o

ump

te

breast.

around

te

te

dye

Anteror

B.

Rotter’s

C.

Parasterna

and

Centra

E.

Apca

n

A

te

rom

above

and

radoactve

and

vesses

o

te

nterpectora

mont

ago

s

to

te

nodes

a

te

s

cm

noss.

to

te

Wc

be

rst

A.

aong

te

axary

axary

1

our

neck.

souder

ater

He

and

or

as

upper

sustanng

neck

back.

pan

te

o

arm

most

rotaton

sensaton

sows

key

wc

an

cause

o

te

o

o

te

umerus

te

te

pyscan

breast.

s

prmary

o

warmt,

breast

condton

umerus

umerus

canges

sows

rgt

ndngs

te

A

te

rgt

erytema,

mammogram

cancer

to

because

er

and

a

u-

conrm

te

resut

wc

o

dag-

o

ta

Bockage

Contracton

o

(o

Spence)

cutaneous

o

te

o

te

ympatc

retnacua

cancer n

breast

vesses

cuts

o

te

areoa

and

nppe

nterna

nracavcuar

to

to

skn

perormed

axary

toracc

artery

D.

Invason

E.

Ipsatera

skn

comes

te

o

s

C.

nodes

man

hs

o

o

neck

bopsy

B.

nodes

rgt

oowng?

te

nodes

o

he

ater

s

atera

oss

Sortenng o te suspensory gaments by

to

tumor?

dmpng

skn

o

examnaton

suspcous

tckness

a

depart-

arm

abduct

afectng

trd

comes

story

Pysca

skn

sows

nto

made

area.

w

se-

1

areoa

njected

ncson

dranng

on

sows

atera

dye

an

ymp

(pectora)

nodes

1

examnaton

tumor,

groups

axary

45-year-od

te

notced

ven

D.

ment

just

ympatc

oowng

receve

se

Pysca

ocated

A.

A

tat

examnaton.

woman

3-mont

he 35-year-od woman comes to te pyscan because

to

rgt

epcondye

te

a

jonts

ocatons?

B.

A

DIP

jonts

s

ressts

umerus.

a

and

emergency

o

as

A.

o

te

and

aso

o

breast

to

ony

DIP

unabe

ead

46.

PIP ,

and

sweng

patent

symptoms

oowng

brougt

souder.

racture

tese

s

pan

adder.

tan

pan.

te

o

he

superory

jonts

D.

o

o

te

B.

meday

pysca

at

surgca

dspaced

Wat

durng

at

te

dspaced

cosed

dgts

o

s

ater

racture.

dgts

Fracture

s

present

a

dag-

te

C.

umerus

pasy

or

was

te

ateray

umerus

se

abduct

dspaced

te

pyscan

ago,

adduct

s

te

trange

to

umerus

o

te

nerve

te

o

cervca

umera

o

ead

nerve

axa

to

be

ossa

pexus

monts

ead

ead

te

comes

he

he

bat-

oowng

scapuar

posteror

n

A.

he

power

te

to

obque

njury?

E.

s

protrudes

Inabty

over

papated

D.

5/5

o

dorsa

braca

md-body

most

nds

supraspnous

te

nerve

ate-onset

are

scapua

Wc

o

njured?

segment

a

trange

souders

Inabty

due

passve

Wc

o

ead.

nerve

trunk

o

et

te

B.

arm

dsocaton

jont.

mecansm

sou-

abducted

are

a

te

o

A.

ang

Pysca

wen

sows

genoumera

s

s

te

key

posteror

examnaton?

te

njured?

to

o

examnaton. T wo

wt

ndngs

nerves

brougt

most

reducton

and

o

turnng

65-year-od

nosed

s

and.

Wc

A

s

oow-up

extend

jonts

er

dgts.

te

examnaton

and

s

n

nerves

s

sows

rotaton

bateray.

te

emergency

ment

man

externay

meda

te

unar

proxma

examnaton

and

most

medan

because

and

s

tree

te

Se

at

te

aceraton

Pysca

ourt

jonts.

te

to

deep

nerve

25-year-od

ment

on

o

a

te

dgts

rst

suraces

Medan

brougt

orearm.

o

(IP)

t

A.

o

te

lexon

and

s

sustanng

nterpaangea

te

A

nerves

te

examnaton

C.

cubta

wen

n

Asymmetry

ange

B.

A

eray

o

Basc

sows

43.

on

te

A.

proxma

42.

ound

troug

department

41.

was

Limb

te

a

nodes

saow

tat

Pysca

47.

emergency

stab

radates

to

depart-

wound

te

examnaton

et

sows

A

o

rom

pectoras

sde)

ductuar

29-year-od

department

te

(same

2

Pysca

examnaton

brusng

over

tus

on

te

papaton,

s

ater

brougt

ang

sows

cavce.

and

by

te

o

cancer

te

perareoar

cancer

woman

ours

major

nverson

to

te

rom

notceabe

here

decreased

s

emergency

er

bacony.

sweng

tenderness,

range

o

moton

and

crep-

o

er

CHAPTER

et

upper

racture

mb.

o

te

suspected.

to

48.

be

njured

n

Subcavan

B.

Cepac

C.

Latera

a

Subcavan

Interna

ome.

te

Wc

Coes

Scapod

C.

Bennett

D.

V okmann

E.

Boxer’s

brougt

se

Pysca

o

wrst

o

te

te

e

to

on

te

te

et

dsta

an

types

batroom

sows

wrst

obque

oowng

emergency

wet

examnaton

sows

ts

a

and

and.

racture

o

o

racture

52.

te

wt

most

contracture

sweng

as

on

and

et

cavce

et

souder

occurs

s

to

Dspacement

B.

Parta

type

o

o

An

te

or

te

x-ray

Wc

et

and

te

ours

ater

Parta

compete

or

souder.

a

he

“step-of”

a

o

tearng

compete

50.

Rupture

E.

Dsrupton

A

o

22-year-od

ment

ater

upper

mb

to

te

et

most

te

transverse

te

umerus

o

te

o

typ-

s

rom

te

coracoacroma

rom

a

na

s

and.

key

gun.

s

jonts

An

o

te

njury

mm

ourt

no

Hg.

and

37.6°C

s

Wat

s

te

unar

nerve

near

B.

T rauma

to

te

unar

nerve

at

C.

Medan

damage

Medan

nerve

E.

T rauma

to

damage

spna

te

te

te

trocea

to

te

te

root

51.

A

pronator

wrst

C8

44-year-od

a

crossbow

cm

man

comes

penetratng

bot.

aceraton

Scapod

54-year-od

Pysca

o

te

to

wound

te

to

pyscan

s

examnaton

anteror

ater

souder

sows

souder

and

a

wound

to

te

tran-

orgn

artera

pat-

njury?

scapuar

artery

artery

wt

deep

bra-

artery

wt

a

bang

to

toracoacroma

nerves

Medan

Deep

C.

Rada

D.

Recurrent

E.

Anteror

s

s

to

s

o

te

to

touc

pad

o

s

o

key

depart-

s

orearm

temperature

mm

sows

te

Hg.

te

to

tps

tumb.

o

out-

be?

to

Hs

tumb

abe

s

respratons

100/70

mb

on

emergency

njury

armng.

upper

most

ts

te

common

e

s

22/

Pysca

patent

te

o

are

tp

te

Wc

o

rng

o

te

s

te

and

o-

njured?

rada

medan

story

worsens

woman

o

story

naton

o

te

o

te

arm

souder

sows

o

s

a

te

a

overead.

o

consstent

tendon

wtn

oowng

rgt

o

he

as

a

exam-

test

sou-

tendnopa-

rgt

te

tendons

Se

Yergason

te

wt

te

pan.

Pysca

postve

utrasound

o

because

souder

artrts.

examnaton

o

pyscan

ted

sows

An

ndngs

Artroscopc

eroson

er

batera

reumatod

souder.

Wc

vsts

worsenng

wen

40-year

an

woud

117/mn,

tp

e

nterosseous

62-year-od

jont

s

te

te

branc

rgt

we

te

He

to

B.

comes

pressure

o

nger.

bone

most

wen

penetratng

puse

oppose

ngers

te

a

ook

bood

A.

A

o

te

bones

Wc

(98.6°F),

and

sufered

man

because

A.

Genoumera

B.

Long

ead

o

trceps

C.

Long

ead

o

bceps

D.

Inraspnatus

E.

Coracobracas

A

26-year-od

1-week

51–75

tanng

te

sows

souder

genoumera

was

most

key

observed?

55.

Questions

E.

sows

wrst

proxma

at

nerve

Hamate

ty.

teres

D.

Psorm

D.

jont.

to

o

artery

braca

artery

carpa

and.

Lunate

A

boy

te

C.

der

o

njury?

T rauma

o

B.

o

unabe

dgts

umera

wt

toracc

T rapezum

pan

et

22/mn,

t

ractures.

s

s

are

He

depart-

to

temperature

A.

nerve

54.

emergency

toracc

A.

3-year

respratons

sows

s

te

Hs

108/65

o

x-ray

cause

to

penetratng

107/mn,

pressure

DIP

a

gament

ste

toracodorsa

crcumlex

17-year-od

owng

abrum

brougt

A

ndex

coracocavcuar

te

scapuar

genod

sustans

puse

bood

lex

o

man

e

(99.68°F),

and

te

Superor

tte

te

tearng

Latera

E.

unabe

njury?

ead

dsta

coatera

te

crcumlex

wt

on

artery

examnaton

g-grade

oowng

paced

angogram

just

Wat

bypass

wt

s

An

artery

artery.

to

scapuar

D.

mn,

o

gament

D.

Dorsa

37°C

gament

C.

Suprascapuar

B.

rom

cavty

or

avaabe

Posteror

compress

apped.

axary

A.

ment

examnaton

sows

o

emergency

2

Pysca

papaton

o

te

to

pan

sope.

brusng

noted.

ts

A.

genod

sk

separaton.

n

brougt

souder

a

tenderness

te

s

te

A

s

subscapuar

are

stretced

53.

et

tree

o

ractures

racture

woman

artery.

pressure

293

Limb

artery

racture

a

te

pos-

patent?

scemc

rada

deep

secton

racture?

racture

struck

cay

key

racture

department

patent

most

te

and

ca

s

ater

n

34-year-od

sows

o

C.

o

occurred

B.

se

s

a

strongy

artery

ours

A.

A

vesses

sows

s

artery

dspacement

key

souder

beedng

ways

woman

loor

radus.

oowng

cavcuar

3

o

et

ven

68-year-od

x-ray

te

nterna

artery

department

An

te

toracc

er

o

and

ven

E.

o

x-ray

o

toracc

D.

teror

49.

Wc

A.

A

An

cavce

Upper

6

sus-

rom

a

deep,

4

asymmetry

der

ater

a

movement.

Durng

rom

man

story

o

He

s

surgery,

ts

bed.

comes

pan

tenns

brac

brac

to

and

matc.

reerred

te

te

pyscan

weakness

he

to

pan

an

artery

s

te

because

rgt

was

o

musce

seen

s

a

sou-

exacerbated

ortopedc

supraspnatus

Wc

n

by

surgeon.

relected

crossng

te

294

C H A P T E R

6

gament

o

56.

te

Upper

tat

Limb

brdges

te

notc

o

te

superor

border

esons

scapua?

te

o

ead

te

Subscapuar

tures

B.

T ransverse

A.

Subscapuar

B.

Inraspnatus

C.

Genoumera

D.

Subacroma

E.

T eres

C.

Dorsa

D.

Posteror

E.

Suprascapuar

A

scapuar

crcumlex

61-year-od

department

a

crcket

He

s

2

bat.

180

man

ours

Hs

cm

(5

umera

s

ony

t

brougt

ater

e

was

to

t

medcaton

11

n)

ta

te

n

s

and

emergency

te

et

arm

by

60.

acetamnopen.

wegs

82

kg

A

key

od

rgt

te

extendng

oowng

over

struc-

nlamed?

musce

jont

cavty

bursa

musce

woman

ntermttent

er

o

bursa

mnor

60-year

o

(180

most

nlammaton

umerus. Wc

A.

cervca

s

ntermuscuar

o

comes

numbness

and,

wc

to

te

and

oten

pyscan

tngng

wakes

because

sensaton

er

up

at

o

ngt.

2

b);

BMI

ma

s

te

et

to

o

dgts.

he

wrst.

57.

Wc

te

over

sgns

s

s

puses

over

a

proxma

unabe

to

are

tra

area

te

o

seat

et

orgn

terapy

an

s

wc

o

A.

Rada

C.

Buccoparyngea

B.

Posteror

D.

Cavpectora

C.

Latera

E.

Prevertebra

A

nterosseous

cutaneous

antebraca

cutaneous

cutaneous

45-year-od

n

wt

et

a

woman

2-week

souder.

wrst

extenson

and

orearm.

ated

dsc

n

te

nerves

s

comes

and

emergency

neck

parestesa

cervca

most

te

o

pan

examnaton

MRI

on

Wc

te

45-year-od

back

te

a

o

because

tomograpy

to

an

weakness

nds

o

depart-

radatng

sows

examnaton

regon.

key

A

ment

to

story

An

61.

unar

Pysca

arm

spna

o

er

ern-

rreguar

oowng

(CT)

cervca

to

T wo

ymp

and

C5

was

B.

C6

A.

Suprascapuar

nerve

C.

C7

B.

Long

nerve

D.

C8

C.

Accessory

E.

T1

D.

C5

E.

Rada

because

rgt

o

wrst

and.

te

wrst

An

x-ray

te

scapod

mended.

wc

pan

Pysca

and

o

tenderness

te

wrst

bone.

Wen

artery

ater

n

te

sows

brusng

dspaced

23-year-od

ment

3

ketba

o

recom-

tota

exposed,

wt

at

s

ater

s

te

o

Rada

C.

T endon

C.

Anteror

D.

AC

A

78-year-od

worsenng

Se

as

ead

severe

bookse

combng

paton

An

o

MRI

er

o

pan

at

pan

wen

work

mb

te

over

pan

musce

upper

to

pacng

and

Abducton

detod

te

comes

souder

ar.

te

63.

woman

rgt

E.

arc

o

te

pyscan

past

books

n

te

er

sows

on

monts.

te

over-

souder

we

rgt

produces

6

wt

arm

and

exquste

yperntense

A

o

o

cm

er

as

o

tumor

ora

perormed

and

te

and

reated

te

weakness

te

radca

A

te

tssues

patent’s

on

oowng

wt

cavty.

turnng

structures

neck

surgery?

to

te

s

emergency

souder

Pysca

examnaton

papaton.

souder

most

(Fg.

key

An

depart-

payng

x-ray

a

sows

a

6.4). Wc

been

bas-

sows

o

te

torn?

gament

ead

o

bceps

brac

gament

T ransverse

scapuar

2-week

man

story

gament

comes

o

posteroatera

rgt

by

actvtes.

overead

enarged

souder

pan.

quadranguar

space

here

and

umerus.

te

he

tat

s

pan

pont

MRI

s

because

pan

o

te

sze

tenderness

on

atera

te

o

te

exacerbated

examnaton

reduces

weakness

An

pyscan

ntermttent

Pysca

musces

space.

abducted

to

du,

souder.

quadranguar

te

se

on

as

pa-

oca

7

depart-

computed

gament

ong

30-year-od

a

s

nodes,

brougt

te

B.

nterosseous

×

o

A

postoperatvey

njurng

structures

Genoumera

pamar

emergency

nerves

rends.

Coracoacroma

nterosseous

5

sde

durng

souder

separaton

oowng

bone?

man

ours

step-of

spna

B.

Posteror

ractured

s

s

A

C6

A.

Deep

te

snufbox

62.

o

snufbox.

racture

nterventon

anatomca

crossng

outstretced

anatomca

a

surgca

s

sows

ts

structures?

nerve

Unar

E.

seen

on

takes

nerve

A.

D.

s

A

te

ang

examnaton

njured

toracc

and

axar y

seat

monts.

snge

et

rgt. Wc

key

te

2

procedure

A.

A 22-year-od man comes to te emergency department

most

Durng

te

asca

to

or

a

te

monts

droops

te

comes

on

deep

souder

ant-nlam-

neck

pan

sows

tumor,

ead

60

asca

neck

surgca

er

or

3-mont

pan.

nto

axar y

nvestng

woman

o

neck

et

te

A

asca

border

removed.

reeve

oowng

te

wrst

asca

radca

are

njured?

o

te

non-steroda

not

he

te

o

symptoms.

njecton

admnstered.

asca

antebraca

and

anestetc

rom

lexon

panu

dd

cervca

Meda

key

spntng

drugs

surger y,

sows

te

Superca

Dorsa

most

wrst

mator y

atera

te

o

examnaton

reproduces

Superca

E.

s

seconds

regon

sma

to

Pysca

and

papabe

extend

ner ves

nor-

B.

D.

oowng

wtn

brusng

md-umera

mb

and

are

sows

decreased

et

te

te

Upper

patent

o

vta

A.

te

59.

Hs

njured?

ment

58.

mb.

Sensaton

dorsum

two

.

examnaton

papaton

upper

bateray.

te

kg/m

Pysca

tenderness

o

25

mts.

sows

o

te

over

te

rotaton

souder

o

sows

CHAPTER

66.

C.

Recurrent

D.

Deep

E.

Anteror

A

ater

upper

mn,

abe

Hs

te

and

key

Fig.

6.4

B.

Medan

C.

Unar

D.

Deep

a

atropy

o

structures

64.

te

teres

woud

A.

Axary

B.

Anteror

Cepac

Rada

E.

Subscapuar

nerve

a

pece

o

o

wc

Weakness

umera

s

o

o

er

er

comes

paper

ndex

tumb.

te

hs

because

er

tumb

wtout

s

a

wt

specc

oice

between

nger

consstent

wc

to

postve

unar

musce

lexng

se

and

te

68.

causes

ts

sgn

Fexor

pocs

B.

Adductor

C.

Fexor

dgt

D.

Fexor

carp

E.

Extensor

A

o

a

1-mont

tngng

rom

n

seep

and.

A

was

scopc

nerve

as

opposton.

te

A.

he

te

to

was

common

pyscan

by

compresson

and

pamar

an

wt

s

oss

norma.

durng

dgta

te

o

nerve

wa.

E.

horacoacroma

1

our

game.

arm

s

dgta

due

He

to

o

te

Sensaton

o

s

te

most

One

to

year

breast.

lap

to

breast.

s

nerve

te

pyscan

ago,

Se

se

s

scedued

cosmetcay

Durng

orms

te

to

a

or

augment

surgery,

advanced

or

underwent

te

part

o

anteror

vascuar

base

o

bood

pressure

sows

An

surgca

x-ray

o

brougt

ang

a

te

o

o

128/76

and

te

te

dsta

most

te

ebow

range

o

s

mm

Hg.

eccymoss

souder

umerus

caused

37°C

at

te

sows

a

18/mn,

exam-

proxma

racture

eevaton

Wc

o

a

s

te

o

and

oow-

adducton

o

te

ragment?

mnor

Pectoras

major

mnor

74-year-od

woman

s

brougt

to

te

department because o pan and sweng o

ater

o

(98.6°F),

are

Pysca

wt

te

depart-

durng

moton

respratons

ragment.

key

emergency

s

temperature

reguar,

s

to

onto

restrcted

Hs

sweng

neck

musces

artery

artery

s

and

Supraspnatus

te

te

jonts

artery

pan.

90/mn

D.

o

medan

artery

as

endo-

o

o

artery

ater

Pectoras

operaton?

branc

man

C.

A

te

et

cervca

toracc

31-year-od

E.

te

IP

nerves

s

n

jonts

te

s

artery

scapuar

carpa

69.

weak.

oowng

comes

et

Wc

Bracas

te

IP

e

orearm

musce

Latera

stumbng

and

ang

over

er

pet

emergency

er

dog.

orearm

Pysca

examnaton o te orearm sows no open wounds and

te

pamar

dors

T eres

nerve

common

absent

B.

Wc

branc

er

A.

tumb

s

nds

ngers

o

92/

nerve

musce

er

postoperatvey,

tumb,

njured

te

underwent

weeks

te

n

o

er

awake

sakng

o

woman

D.

dsta

and

te

s

pressure

wrst

md

unar

T ransverse

ng

because

numbness

symptoms

reeved

patent

T wo

Sensaton

second

medan

te

n

te

he

are

nerve

reease.

to

ntermttent

and.

and

nerves

o

and

o

weakness

rst

medan

B.

made,

oowng

he

rgt

ngt

dagnoss

tunne

patent

story

er

at

comes

o

dors

er

adducton

woman

te

C.

te

ndcs

48-year-od

o

souder.

mnm

radas

n

horacodorsa

naton

pocs

s

rgt

broken

ebow

te

Dorsa

and

ongus

a

a

puse

bood

examnaton

o

depart-

s

onto

(98.6°F),

extenson

te

o

lap?

puse

A.

te

at

B.

et

to

at

A.

A

e

and

extend

dgts

o

examnaton.

atssmus

ockey

neuropaty.

appear?

65.

ste

ment

Froment

trd

branc

mastectomy

ts

artery

to

and

Wc

branc

atssmus

te

37°C

jonts

unabe

nerve

Recurrent

te

oowng

artery

woman

sde

jont

sgn,

te

ven

od

atera

dsta

o

compressed?

nerve

43-year-od

te

Wc

be

MCP

emergency

and

18/mn,

dgts,

nerve

41-year-od

toracc

crcumlex

D.

cannot

key

nerve

C.

A

mnor.

most

stumbed

s

te

aceraton

njured?

Rada

a

to

deep

Neuroogca

and

norma.

nerve

nerve

a

are

295

Limb

nerve

brougt

e

s

t

second

oow-up

•

s

te

He

and

A.

A

Hg.

extend

s

medan

unar

temperature

mb.

ourt

E.

wen

mm

to

rgt

o

man

respratons

128/75

o

te

sustanng

mb

botte.

o

nterosseous

19-year-od

ment

67.

branc

branc

Upper

6

neurovascuar

he

ton

patent

and

s

ods

examnaton

er

unabe

to

et

s

orearm

supnate

wtn

n

te

te

et

norma

mts.

pronated

and.

An

pos-

x-ray

296

C H A P T E R

6

o

te

rgt

o

te

radus.

ateray.

orearm

he

Wc

responsbe

70.

Upper

or

Limb

sows

a

proxma

o

te

te

racture

end

o

oowng

atera

o

te

te

upper

racture

musces

s

trd

caugt

devates

prmary

aspect

devaton?

s

jont

nto

Supnator

MCP

Pronator

atera

D.

Bracoradas

Wc

E.

Bracas

A.

De

B.

Navcuar

C.

Boxer’s

Hs

D.

Gamekeeper’s

res-

E.

Bennett

quadratus

12-year-od

30

o

boy

s

wrst

s

we

are

mm

Pysca

Hg.

te

are

s

ntact.

to

te

o

te

payng

and

wt

a

cut

most

sur-

kne.

116/mn,

pressure

he

depart-

pamar

sarp

s

sows

he

wound.

tendon

te

puse

bood

wrst.

te

emergency

acerated

examnaton

wtn

Wc

e

(98.6°F),

20/mn,

mdne

exposed

brougt

ater

37°C

pratons

at

s

mnutes

a

2

ends

lexor

s

100/70

cm

o

a

74.

and

n

Pamars

B.

Fexor

tes.

ongus

carp

Abductor

D.

Fexor

carp

E.

Fexor

pocs

A

pocs

22-year-od

ment

o

because

s

rgt

macne

drnk

ton

o

sows

te

one

n

ater

o

s

o

te

knuckes

key

A.

Fracture

o

te

B.

Fracture

o

te

C.

Coes

D.

Smt

E.

Bennett

neck

o

racture

meda

o

racture

te

t

dd

x-ray

MRI

w

s

et

not

te

o

Wc

o

t

te

s

o

a

st,

te

o-

Pan

D.

s

te

skn

and

be

rgt

on

te

extensor

Pan

E.

Pan

te

75.

deormty?

s

et

una

Wc

o

o

metacarpa

s

te

o

er

a

A

1-week

dgts,

o

te

s

rgt

te

and

te

patent

tumb,

abduc-

IP

jont

n

and

mts.

rb

Long

wrst

An

te

Mdde

C.

Rada

nerve

structures

to

s

C.

to

o

o

oowng

D.

Lower

trunk

sows

D.

scooss.

E.

T1

A

ventra

23-year-od

department

er

and

n

4

a

te

te

most

key

braca

over-

abnorma-

te

o

ong

te

present

braca

s

pexus

ater

brougt

se

sk-sope

souder

abducton

and

and

on

ead

oow-

pysca

durng

durng

orced

orced

lexon

o

adducton

souder

comes

ebow

rgt

Pysca

o

te

durng

te

o

te

lexon

pyscan

Se

tat

extensor

o

conrm

to

over

te

te

pos-

tenderness

radas

made.

perormed

te

studes

s

because

pan

sows

carp

epcondyts

be

as

radates

examnaton

soud

to

to

pan.

ebow

te

atera

Observng

te

rng

aganst

o

pan

te

brevs.

Wc

durng

o

pys-

dagnoss?

(nerve

te

experenced

ebow

conducton

veoc-

te

lexon

and

o

pan

wen

te

wrst

s

resstance

presence

and

durng

jont

presence

aganst

tte

o

numbness

ngers

wen

te

and

tngng

wrst

s

lexed

resstance

Evauaton

o

pan

durng

76.

A

et

over

bracoradas

te

styod

process

o

contracton

76–100

29-year-od

department

woman

dry

arm

a

du

pexus

ramus

ours

o

souder

atera

atera

o

te

o

Observng

n

te

tests

Evauaton

Questions

o

s

o

s

test)

radus

o

pan

no

Wc

extenson

conducton

extended

nerve

trunk

ts

sows

be

because

he

jont

orgn

extenson

lexor

appear

x-ray

due

B.

o

E.

B.

dagnoss?

oice

pan.

patent

anteror

woman

orearm.

to

ty

exten-

anestesa

orearm.

rst

neura

he

notabe

and

norma

te

o

and.

mpared?

Medan

te

key

te

story

aspect

dagnoss

te

rgt

here

sde

oowng

A.

te

musce.

durng

et

43-year-od

teror

tumb

te

o

wtn

eevaton

to

souder

durng

souder

A

atera

radus

n

and.

meda

unctonng

marked

co-

repar.

jont

o

dsta

opposton

musces

unar

jont

to

pen

adducton

key

tendnopaty

te

n

et

souder

radus

te

et

souder

dorsum

make

knucke

C.

examna-

te

to

dgt

vendng

receve

s

s

te

most

te

surgca

o

te

contracton

Nerve

o

te

most

n

examnaton

and

wen

sows

ca

son

o

or

at

(tenosynovts)

souder

brac

A.

ton

te

comes

et

o

odng

perorm

rupture

axty

extenson

tumb

o

dicuty

unabe

ncreased

and

unar

Ldocane

racture

man

A 14-year-od gr s brougt to te pyscan because o

a

dgt.

tumb

ndngs

Pan

depart-

t

a

Pysca

seen.

te

te

asked

process

o

te

o

be

o

e

aspect

s

expans

styod

racture

e

twce.

patent

cannot

best

ago,

wen

te

emergency

sweng

money

te

te

ours

ospta

o

and

lexon

Pysca

te

tumb

bceps

Pan

B.

to

and

T wo

Wen

rst

scedued

s

e.

at

contracton

pan

sweng

most

A.

comes

nsertng

and.

owng

ongus

ongus

and.

bone

te

a

se

examnaton?

unars

man

s

as

sweng

jont

syndrome

exacerbated

An

o

sows

Se

oowng

stor y

An

te

ng

radas

C.

s

ead.

ts

te

26-year-od

o

A.

o

and

durng

MRI

Quervan

tendon

es

An

mattng

MCP

noted

gament.

2-week

poston?

s

jont.

wound

retnacuum

commony

A

tumb

te

C.

temperature

73.

MCP

te

njected

te

te

pan

B.

A

teres

o

n

sows

Pronator

ace

72.

tumb

A.

ment

71.

er

examnaton

ad

to

a

te

emergency

panu

competton.

njury

he

to

patent

Hs

temperature

respratons

mm

man

ater

Hg.

are

He

a

s

s

37.5°C

18/mn,

as

brougt

panu

du

a

(99.5°F),

and

pan

to

n

te

aganst

bood

te

a

emergency

rocky

puse

s

pressure

atera

edge.

95/mn,

s

118/70

souder

wt

CHAPTER

radaton

sows

a

to

te

proxma

arne

umerus.

assessng

racture

Wc

te

o

status

arm.

o

te

o

An

te

x-ray

surgca

oowng

te

nerve

o

te

neck

tests

s

arm

o

best

assocated

wt

79.

te

or

to

ts

Have

B.

Have

C.

T est

4.5

kg

(10-b)

o

T est

patent

te

or

sde

E.

te

abduct

we

odng

a

o

te

skn

souders

sensaton

te

atera

te

sensaton

over

te

meda

skn

o

axa

Have

te

object

patent

ke

a

pus

wa

and

aganst

assess

an

te

mmovabe

poston

o

te

scapua

77.

A

27-year-od

department

wtn

te

et

ater

norma

brusng

on

on

te

ost.

An

wt

te

made.

era

x-ray

and

s

Batera

rb

oss

Lower

Dupuytren

D.

Let

E.

he

was

o

o

s

sows

te

ater

a

sows

but

severe

a

he

C.

he

D.

he

E.

he

to

s

t

te

at-

dgts

81.

and

o

ooked

njury,

parestesa

unar

te

or

nerve

medan

ater

a

tendon

te

te

patent

cawng

s

abe

o

a

o

to

tese

nerve

comes

been

and

unar

s

o

are

ebow

and

te

at

nerves

ave

unar,

and

md-umerus.

rada

te

te

An

Wc

racture

and

n

x-ray

wt

o

o

te

ts

pres-

sows

te

voar

er

puse

bood

examnaton

radus

and

Dupuytren

on

a

bapayer

s

Maet

A

t

ngertp

bare-anded.

mdde

E.

nger

te

wrst

angua-

oowng

s

patent?

we

Pysca

cannot

o

most

s

key

attemptng

examnaton

stragten

rgt

and.

te

DIP

Wc

o

dagnoss?

deormty

deormty

deormty

contracture

nger

31-year-od-woman

department

oowng

draw

a

rom

gure

catcng

grasped

DIP

s

s

et

wrst.

o

He

te

afected

s

most

te

n

s

oss

Medan

B.

Anteror

Rada

ror

s

an

brougt

njury

skatng

er

er

D.

rom

to

tat

te

orced

competton.

an

orearm

te

overead

poweruy .

emergency

er

to

Her

wt-

partner

poston

Pysca

and

exam-

E.

82.

A

been

njured

at

nerves

ave

been

nger

termna

sensaton

nerve

over

njured

nterosseous

on

caspng

paanx

te

o

tenar

te

te

ands

tumb.

aspect

o

te

wtn

nerve

te

cubta

njury

at

ossa

te

pronator

Unar

nerve

department

te

njury

at

ts

entrance

nto

te

poste-

compartment

nerve

19-year-od

njury

ater

Hs

at

te

proxma

e

He

vta

and

or

sgns

A.

Ineror

B.

Muscuocutaneous

Intercostobraca

D.

Meda

at

skn

crease

E.

Medan

cf

a

by

te

o

orearm

te

emergency

we

kng

graspng

norma

IP

te

n

jonts

o

te

cutaneous

nerve

nerve

cutaneous

nerve

n

tree

te

ourt

nerves

afected

nerve

o

te

oowng

a

mts.

yperextenson

te

o

a

to

wtn

dects

antebraca

nerve

are

braca

C.

s

sows

Wc

atera

rom

broke

sensory

aong

brougt

e

lexon

dgts.

responsbe

away

s

examnaton

jont

t

trauma

man

mountans.

MCP

te

o

ndex

te

wrst

te

at

te

lex

nerve

Medan

Pysca

damaged

o

to

orearm

wrst.

carpa

jont

unabe

A.

C.

py-

regon.

medan,

njured

unar

was

ba

D.

hree

wrst.

medan

e

a

tat

o

branc.

at

njured

nerves

o

o

racture

oowng

and

medan

ragment.

step

(98.6°F),

racture

ater

catc

examna-

mecansms

severed

wrst.

dsta

ast

teres

gunsot

to

dgts

dgts

16/mn,

Pysca

dsta

te

te

37°C

and. Wat s te most key mecansm o er njury?

and

ndngs?

been

as

a

mb.

Pysca

te

are

s

A 27-year-od-man s brougt to te emergency depart-

and

te

tunne.

te

Boxer’s

emergency

upper

extend

ve

oowng

as

te

sustanng

o

examnaton.

patent

o

Smt

E.

mssed

compart-

bateray;

ke

to

mssed

naton sows brusng o te orearm. Se s unabe to lex

posteror

absent

emergency

racture

Swan-neck

ractures

te

racture

C.

trauma

brougt

surace

compete

te

D.

te

n

was

mnutes

responsbe

B.

deep

boy

te

Bennett

here

ongus

oow-up

Wc

he

trunk)

njury

ventra

C.

Caw

oppos-

to

racture

Boutonnère

te

se

Hg.

type

B.

orearm

30

te

Coes

te

s

o

dsta

A.

sensory

wt

te

key

Scapod

nstead

(ower

normay

to

or

A.

T1

te

B.

jont

cut

monts

and.

nerve

o

racture

oter

tree

tumb

o

o

mm

tendons

on

rst

o

no

a

sows

te

orearms

absent

cause

tssue

o

brougt

temperature

respratons

A.

to

tendons

tose

bot

te

parayss

key

spna

nerve

te

department

key

mbs

o

sot

brevs

repace

sensaton

aso

and

tendons

te

unctons

s

wen

Her

138/75

most

ment

contracture

15-year-od

wound

o

pamars

nerve

as

to

suraces

most

pexus

rada

ment

and,

ongus

o

are

sows

bateray

C.

ton

ongus

s

te

B.

scan

oss

he

upper

Vtas

80.

dects?

rst

A

te

emergency

examnaton

and

radas

te

coson.

and.

decson

here

Wat

motor

78.

body

et

pamar

to

Pysca

Postoperatvey,

bateray.

A.

s

o

A

brougt

motorcyce

upper

o

pamars

pam

ton.

a

carp

abnormates.

s

mts.

dorsum

extensor

are

man

woman

a

deormty

ton

souder

norma

s

sows

over

er

80/mn,

sure

a

srug

presence

or

mb

wegt

patent

te

te

break

motorome.

s

A.

te

68-year-od

297

Limb

department ater ang on a lexed wrst n an attempt

njury?

D.

A

Upper

6

mb?

s

298

C H A P T E R

83.

A

6

Upper

52-year-od

nvasve

te

excsed.

Sx

or

a

a

te

deep,

cause

te

Part

o

he

n

he

atera

meda

he

atera

and

o

to

te

neror

as

to

no

major

n

te

T rocod

Gngymus

pyscan

C.

Enartroda

D.

Synartross

E.

Sear

or

a

sensory

87.

key

bke

cut

and

o

spna

musce

nerve

was

o

te

removed

entrey

and

On

s

s

sows

was

er

s

most

to

Spne

mm

are

Hg.

absence

wc

o

o

a

emer-

at

s

n

respratons

pae,

arm

and

o

tracture

te

s

Surgca

B.

Rada

C.

Supracondyar

Pysca

D.

Oecranon

bra-

oow-

responsbe

or

E.

88.

te

groove

Latera

A

se

e

C5

conductng

B.

C6

sows

C.

C7

te

D.

C8

te

E.

T1

o

department

sustaned

ture

are

s

a

ater

18/mn,

oss

o

extenson

te

dsc

trceps

te

n

spna

On

s

to

te

nerves

arrva,

s

n

s

cervca

e

as

we

T rquetrum

Hamate

Hg.

absence

an

o

nterverte-

regon.

Wc

o

afected?

C.

Radus

D.

Radus

E.

89.

and

Psorm

A

wakng

C5

examnaton

B.

C6

a

C.

C7

sde

D.

C8

o

E.

T1

oowng

A

29-year-od

o

2-day

he

patent

apped

sows

a

derness

sows

and

o

a

te

te

man

story

an

e

ce

comes

of

a

meda

oowng

adder

to

and

te

te

pan

2

An

ste.

ebow

aspect

jont

o

x-ray

wt

te

pyscan

o

days

s

ago

Pysca

dscoored

papaton.

dsocated

to

worsenng

pack

swoen

to

o

rgt

o

te

at

dsta

ebow

et

work

wt

upper

o

te

umerus.

best

ebow.

and

ten-

mb

Wc

te

a

o

a

arm

o

sows

a

arge

scemc

con-

oowng

o

s

swo-

movement

te

ormaton

te

100/

pressure

ocatons

umerus

comes

a

nto

te

dsta

at

to

panu,

te

Pysca

o

wrst

An

styod

racture.

compex

wrst

wt

pt

ater

we

examnaton

wrst.

te

rada

emergency

orcestra

meda

te

te

swoen

x-ray

o

process

o

Dsrupton

s

suspected.

wc

o

te

unate

trquetrum

woman

er

te

dog

nds

and,

ebow

comes

ang

te

on

a

oss

and

sows

ocatons

o

o

te

beore.

lexon

o

te

te

nerve

o

te

on

At

wrst

te

n

meda

An

wc

njury

and

Neuroogc

ngers.

abnormates.

as

emergency

outstretced

sensaton

cawng

no

to

an

evenng

weakness

drecton,

A.

Bend

B.

Between

most

x-ray

o

te

key

te

meda

te

epcondye

psorm

bone

and

te

lexor

retnacuum

C.

Wtn

D.

At

una

descrbes

Any

sou-

s

occurred?

examnaton

separaton

casscatons

because

rgt

o

et

puse

occurred?

racture

ater

A.

er

o

brocartage

and

department

meda

te

motor-

sows

V okmann

reearsa.

n

as

67-year-od

we

er

bood

x-ray

a

andebars

bones?

B.

mm

o

artcuates

A.

extenson,

o

stage

a

tranguar

oowng

te

umerus

durng

sows

una

and

o

key

ne

te

tempera-

and

key

he

arm.

emergency

umerus

because

respratons

ebow

sows

most

wc

140/82

o

jonts,

MRI

s

emergency

110/mn,

oss

MCP

An

te

coson

pressure

sows

relex.

ernaton

oowng

puse

bood

o

vece

njury.

(98.6°F),

and

brougt

motor

examnaton

psatera

bra

a

s

wpas

37°C

Pysca

man

una

o

and

An

wc

o

tenderness

te

nvoved

epcondye

rom

wrst

over

examnaton

pan.

55-year-od-woman

department

relex?

43-year-od

o

te

rom

(98.6°F),

15/mn,

most

to

pont

proxma

At

37°C

er

te

37°C

umerus

16/mn,

te

s

dagnoss

neck

A.

A

te

racture

A.

bones

njures

propeed

on

severe

made.

a

two

brougt

Pysca

coo

A

s

was

are

Hg.

causes

racture

as

Se

andng

mm

te

sustanng

temperature

ematoma.

njur y

mmobzed

temperature

key

njured

te

unconscous

respratons

unatera

was

to

coson.

142/84

Injur y

pexus

ound

neck

arrva,

te

brougt

vece

120/mn,

en,

cut

braca

beng

er

relex.

ts

bke,

Her

mn,

cut

was

was

ater

motor

was

nerve

woman

ner ves

o

er

der.

woman

ater

coson.

145/87

pressure

coradas

45-year-od

department

examnaton?

was

A

between

njury?

B.

most

musce

ormed

patent

A.

meda

te

ts

were

examnaton

motor

s

artcuaton

centra

groups

Pysca

pysca

mnor

cord

a

examnaton

absence

pectora,

comes

or

Durng

mastectomy

pectora

puse

bood

ng

breast.

node

oowng

on

pectora

coar.

(98.6°F),

86.

te

suspected,

cer vca

area

te

department

scene

was

85.

o

54-year-od

te

te

ymp

patent

mastectomy

et

surgery

he

gency

and

se

pectoras

n

D.

A

he

te

C.

E.

84.

oow

pectoras

te

ater

ndngs

removed

B.

tumor

te

examnaton.

Wc

o

o

axary

monts

cavce.

dects.

A.

te

apca

oow-up

sows

underwent

carcnoma

procedure

and

o

woman

ducta

axary,

Limb

te

eads

E.

At

o

te

tear

te

carpa

cubta

orgn

rada

(HCA)

tunne

ossa,

o

between

lexor

neck,

jont

1

cm

te

unar

dgtorum

dsta

to

and

rada

supercas

te

umerocap-

CHAPTER

90.

An

18-year-od

ment

ater

ature

s

are

e

37.5°C

14/mn,

Pysca

dsta

sues

A.

to

B.

o

ound

here

te

te

on

tps

woud

meda

C.

he

D.

here

be

sde

patent

oss

be

s

emergency

Hs

82/mn,

s

depart-

temper-

respratons

120/72

2.5-cm

wrst

mm

aceraton

wt

at

underyng

oowng

sgns

s

94.

Hg.

touc

be

here

a

91.

A

to

woud

te

to

on

o

te

te

lex

abty

on

et

s

and

and.

sutured.

cts

o

man

was

A

nger.

wereas

A.

Maet

B.

Boutonnère

Dupuytren

D.

Swan-neck

E.

Dnner

a

tumb

dorsum

o

o

te

to

IP

jonts

extend

te

IP

ton

wc

te

key

93.

s

jonts,

lexon

o

Dupuytren

Swan-neck

E.

Dnner

oow-up

er

95.

breast

most

o

to

nger

nto

n

a

key

te

wt

a

wen

o

te

DIP

was

o

because

oss

e

s

sows

te

Ape

and

C.

Caw

and

D.

Wrst

drop

E.

Maet

A

procedure.

skn

wrst

te

range

a

PIP

Wat

o

o

oss

o

sows

B.

Rada

pan

unc-

pantng.

o

base

o

moton

atera

E.

Muscuocutaneous

bceps

ng

s

man

a

Pysca

at

te

brac

s

rng

o

s

n-

te

lex

and

extend

dagnoss?

and

B.

Mdporton

C.

Juncton

o

wt

o

te

to

emergency

er

souder

souder

Pysca

o

s

exter-

examnaton

te

souder.

dsocaton. Wat

n

ts

brougt

(Fg.

key

most

rgt

et

te

6.5).

ocaton

type

to

arm

examnaton

relex

most

s

to

njury

contour

panu

anteror

Intertubercuar

he

njured

Medan

wt

an

souder

Unar

A.

jonts,

te

te

D.

brusng

uy

key

brougt

abducted.

anteror

o

lexon

s

and

85-year-od

s

game.

C.

wne.

to

most

sustanng

commony

Axary

o

te

woman

ater

basketba

A.

An

unabe

o

ebow

o

te

emergency

tng

a

sweng

and

Wc

o

An

nerve

njury?

te

ater

sows

oss

te

o

case

and

te

oow-

rupture?

groove

te

te

bceps

sort

brac

ead

Proxma

end

o

te

o

musce

te

combned

musce

E.

comes

One

o

nodes

wen

s

nerve

Wat

A.

he

upper

B.

he

posteror

C.

V entra

s

was

te

trunk

o

Bony

nserton

o

te

musce

te

vst

to

njured

o

o

te

braca

and

te

er

Pysca

a

wa.

surgeon,

te

njured

o

et

accentu-

aganst

er

te

pan

ar.

durng

braca

or

rasng

pus

a

treatment

wngng

wt

or

under-

axa

er

scapuar

se

and

weakness

dicuty

orgn

dvson

o

rgt

combng

er

pyscan

ago,

stagng

asked

consut

te

er

as

as

meda

patent

to

mont

or

Se

and

ead

sows

ram

te

nger

rotated

most

s

deormty

cancer.

a

at

contracture

24-year-od

D.

dssecton

er

tat

te

n

s

Dupuytren

s

o

He

B.

deormty

subsequent

tod

nger.

A.

x-ray

constant

worsenng

we

jonts.

decrease

ngers. Wat

sows

de-

poston

oice

ands

pexus

pexus

bceps

brac

musce

woman

te

rng

nay

dagnoss?

gradua

promnent

o

rng

department

progressvey

extenson

souder

above

gradua

durng

sammed

unctona

ed

o

96.

comes

te

ymp

examnaton

was

mdde

dgt

deormty

examnaton.

o

rgt

a

was

pued

s

a

contracture

ork

surgca

remova

In

s

s

ater

door

sows

braca

braca

deormty

32-year-od

ated

a

on

jont

te

oice

nger

D.

a

te

dagnoss?

C.

arm

at

deormty

more

Maet

er

cut

jont

s

assocated

Boutonnère

o

Wat

man

B.

went

wen

PIP

DIP

wrst

A.

A

he

examnaton

MCP

sgt

te

examnaton

stor y

ands

Pysca

probem

contracture

ork

6-mont

s

unctona

deormty

67-year-od

n

to

te

gers. Pysca examnaton o bot ands sows ocazed

nger

C.

A

comes

te

tckenng

department

superca

yperextenson.

92.

serous

njured

Pysca

te

lexon,

no

o

te

A 72-year-od man comes to te pyscan because o an

te

unabe

o

and rm rdges n te pamar skn tat extend to te base

tp

sensaton

cord

cord

as

patent

45-year-od

s

be

atera

ts-

most

jonts

E.

posteror

he

ngers over te past year. He as no pan n s and but

and

decreased

he

E.

abnorma

dgts

o

te

te

D.

Limb

te

examnaton?

oter

o

a

te

not

woud

woud

puse

o

pysca

te

te

aceraton.

pressure

meda

coud

o

to

wrst

sows

Wc

patent

te

a

bood

examnaton

crease

he

comes

(99.5°F),

and

exposed.

key

man

sustaned

Upper

6

se

surgca

nerve?

pexus

mdde

pexus

trunk

•

Fig.

6.5

bceps

brac

299

300

C H A P T E R

97.

A

6

55-year

o

a

Upper

od

2-week

souder

man

tat

te

to

te

weakness

dsturbs

nternay

o

o

sows

mon. T enderness

MRI

comes

story

examnaton

and

Limb

s

pyscan

and

seep

at

ected

rotates

s

souder

wen

arm

sows

beow

te

s

te

Compresson

and

E.

supraspnatus

true

98.

about

te

It

nserts

B.

It

ntates

C.

It

s

nnervated

onto

supped

It

s

E.

It

orgnates

5-year-od

ater

njured

he

cdren

te

te

and

te

o

abducts

s

te

by

das

a

An

to

tree.

are

treated

bones

was

umerus.

te

o

patent

ter

most

key

6.6.

key

pexus

pexus

son’s

D.

Medan,

E.

Upper

n

Wc

o

102.

A

n

er

weakness

as

dicuty

parestesa

pam.

wt

aong

Pysca

ne

te

motor

meda

tasks

surace

examnaton

pyscan

sows

upper

o

o

te

te

tat

rgt

gr

rgt

ater

se

rada

trunks

comes

and

takng

ad

and.

Se

and

and

orearm

and

musces

wen

er

Adson

test).

te

s

and.

he

rotated

Wat

s

te

to

most

Erb-Ducenne

parayss

B.

Aneurysm

te

o

rada

te

A.

pexus

100.

o

neck

puse

psatera

key

s

emnence

and

and

atro-

(postve

dagnoss?

bracocepac

trunk,

wt

compresson

C.

horacc

D.

Carpa

E.

Injury

outet

tunne

to

te

syndrome

syndrome

meda

cord

o

te

braca

pexus

A 25-year-od man comes to te pyscan wt numb-

ness

s

and

tngng

pone

ours.

we

Pysca

adducton,

te

and,

owng

te

and

s

o

sensaton

cawng

s

o

ater

ebows

examnaton

mecansms

patent’s

A.

oss

and

o

eanng

te

most

payng

aganst

sows

on

game

desk

weakness

te

dgts.

key

a

a

meda

Wc

o

on

or

responsbe

6

wrst

aspect

o

o

te

o-

or

ts

presentaton?

Compresson

umera

and

o

a

unar

nerve

eads

passng

o

orgn

between

o

lexor

te

carp

unars

B.

Compresson

between

C.

te

Compresson

tunne

o

a

nerve

psorm

o

a

passng

bone

nerve

and

passng

at

Guyon

lexor

cana

retnacuum

troug

te

carpa

•

Fig.

braca

pyscan

past

arts

6

sown

was

n

most

6.6

o

cass.

concrete

te

he

sows

o

patent

a

and

er

o

wc

bocks

rgt

adducton

pexus

because

monts

examnaton

dmnsed

sde

te

marta

Pysca

abducton

te

te

breakng

py o grppng musces (“ong lexors”) and te ntrn-

sc

s

presen-

consder-

nerves

o

to

or

a

been

ypotenar

o

and

ower

because

mb.

weakness

unar,

and

17-year-od

pan

wt

was

abor.

cdbrt?

braca

Cavce

et

te

gestaton

preterm

nerve

braca

ractured?

te

unar

bracora-

structures

te

E.

to

to

newborn

te

tened

er

durng

he

oowng

o

Scapod

n

te

dgtorum

ootng

o

D.

comes

te

breec

vagnay

trunk

er

pan

a

o

n

trunk

Una

o

sows

devered

tracton.

o

weeks

ospta

Lower

C.

woman

o

32

te

Upper

says

story

s

at

to

C.

worsened

ong

deep

B.

Humerus

a

passng

no

Radus

22-year-od

lexor

rac-

B.

o

baby

njured

Rada

A.

A

nerve

G1P0,

Wc

A.

racture

nonoperatvey.

a

examnaton

he

s

nds

tat

occurrng

o

urgenty

amounts

Fg.

depart-

non-dspaced

normed

22-year-od

abe

scapua.

crades

examnaton

a

A

taton.

nerve.

emergency

he

between

o

musce

admtted

nerve.

te

passng

orgn

101–125

Pysca

spna

border

commony

be

C5

subscapuar

sows

parents

most

can

oowng

x-ray

te

o

s

101.

o

nerve

o

oowng

souder.

te

atera

brougt

rom

te

a

An

tendon

musce?

upper

te

o

tuberce

Neurovascuar

cd’s

s

by

boy

arm.

racture

esser

cely

rom

ang

abnormates.

ture.

te

adducton

D.

A

Wc

supraspnatus

A.

ment

99.

musce.

o

eads

Compresson

Questions

te

rada

supercas

acro-

resstance.

to

D.

et

Pysca

te

patent

aganst

njury

because

n

ngt.

pont-tenderness

s

pan

wt

lat-

and

ngers.

CHAPTER

Se

s

abe

decreased

ourt

and

descrbes

A.

to

lex

te

sensaton

t

te

dgts

over

dgts.

nature

Compresson

o

o

normay.

te

pamar

Wc

er

te

o

here

s

suraces

te

Upper

6

301

Limb

aso

o

oowng

te

best

njury?

medan

nerve

n

te

carpa

tunne

B.

Fracture

sa

C.

o

branc

te

o

Dsocaton

trquetrum,

te

o

unar

a

bone

wt

njury

to

te

dor-

nerve

n

te

proxma

row

o

te

carpus

103.

D.

Fracture

E.

Injury

A

o

o

te

te

10-year-od

department

mon

lexor

bursa)

o

body

unar

boy

ater

s

a

te

t

n

bte

seat

orearm.

to

tat

(aso

he

metacarpa

Guyon

brougt

dog

synova

s

o

nerve

cana

te

emergency

entered

known

wound

was

te

as

com-

te

unar

ceaned

and •

dressed,

serum.

and

e

T wo

days

ospta

wt

sweng

o

typca

ng

was

a

s

s

ater,

treated

te

pam.

o

seat,

susceptbe

te

to

anatomy

o

te

te

wound

and

oow-

o

Frst

and

B.

Second

trd

C.

hrd

ng.

D.

Fourt

vdes

E.

Ft

ment

2

and.

days

He

Pysca

on

te

te

o

pamar

te

a

sows

o

he

most

o

key

a

emergency

kne

a

te

red

wound

o

38°C

and

t

necton

dgtorum

wc

te

temperature

aspect

paanx.

lexor

to

sustanng

deveops

dsta

necton

te

dgt

oowng

spread

to

at

s

et

(100.4°F).

swoen

spreads

proundus

depart-

te

to

wound

base

te

tendons.

spaces

o

107.

I

coud

T ransverse

C.

Suprascapuar

Supreme

E.

Latera

A

penetratng

s

Hypotenar

C.

Mdpamar

D.

henar

compartment

pysca

E.

henar

space

make

36-year-od

(Fg.

pan

rest.

because

6.7).

s

venous

swoen

man

o

Vta

a

days

comes

sgns

ne

was

rgt

patent’s

ago,

are

wt

e

Axary-subcavan

Compresson

C.

Dsc

D.

Impngement

E.

Injury

o

ernaton

1

souder

norma

actvty

and

s

osptazed

Pysca

s

emergency

s

te

a

examnaton

most

key

B.

by

cause

o

ven

a

te

o

spna

unar,

woman

our

s

ater

and

MCP

o

to

sustanng

te

a

D.

he

rst,

he

A

kne

most

and

and

beed-

key

pro-

deep

braca

scapuar

toracoacroma

to

sustanng

te

o

te

wen

wound

examnaton

orearm.

and

Sensaton

te

emergency

kne

orearm

tumb.

on

te

a

proxma

pamar

oowng

IP

s

here

te

s

a

s

patent

decreased

key

patent

to

sows

surace

most

te

jonts

and

lexed

MCP

o

axa.

meda

ss

o

w

s

o

te

seen

on

asked

to

o

w

te

be

second

n

a

and

trd

condton

o

IP

and

man

ater

and

trd

jonts

w

s

be

sgty

dgts

o

n

o

sde

te

a

w

abducted.

be

te

scapua

te

to

bunt

examnaton

o

second

condton

brougt

sustanng

Pysca

rgt

lexed

and

ed

n

a

poston.

and

te

wngng

te

be

second,

55-year-od

rgt

emergency

severe

te

poston.

tumb

department

brougt

second

contro

he trd and ourt dgts w be ed n a sgty

dgts

nerves

and

he

E.

108.

medan

deto-

proxma

scapua?

brougt

dgts

te

te

C.

nerve

C4–C8

o

te

exam-

st?

sgty

tromboss

C5–C8

3½

te

apped

and

Pysca

te

examnaton

lexed

centra

sows

atera

he

s

pronaton

at

suprascapuar

ater

on

Pysca

suprascapuar

toracc

gt.

oppose

Wc

a

a

36.9°C

16/mn,

extenson.

he

reeved

to

dgts

axa

mts.

and

A.

depart-

and

syndrome

rada,

22-year-od

department

te

presentaton?

B.

A

n

wtn

was

arm. Wat

A.

to

to

ace

paced.

current

te

and.

du

exacerbated

Four

n

man

ours

te

umera

and

wound

o

unabe

B.

compartment

2

to

crcumlex

(superor)

toracc

durng

weakness

and

are

arteres

to

and

Hg.

s

are

wound

between

artery

oowng

cervca

mm

entry

njury

crcumlex

24-year-od

arm

o

temperature

respratons

camps

crcuaton

Posteror

D.

deep

axary

te

B.

te

space

ste

A.

te

to?

o

Her

115/72

Vascuar

te

coatera

s

3-cm

te

o

Wc

Centra

A

to

parts

et

compartment

a

cest.

82/mn,

pressure

department

seat

s

groove.

dsta

A.

ment

106.

ater

comes

examnaton

untreated,

105.

man

upper

sows

pectora

23-year-od

te

puse

bood

naton

te

A.

A

to

(98.4°F),

te

necton?

104.

6.7

te

and

o

spread

Fig.

ant-

(100.4°F)

wc

to

rabes

returns

38°C

Foowng

lexor

most

wt

patent

temperature

common

dgts

urter

te

emergency

to

s

pronounced

parta

dapragm.

trd

lexon.

trauma

sows

and

and

o

paray-

Wc

o

te

302

C H A P T E R

6

oowng

been

109.

Upper

parts

o

Limb

te

braca

pexus

as

most

key

orearm.

njured?

tender

A.

Cords

ton.

Passve

B.

Dvsons

pan.

An

C.

V entra

D.

T ermna

E.

T runks

A

a

jont

3½

seep

as

a

s

He

carpenter

key

A.

o

ngt.

atropy

tumb

comes

story

dgts

at

sows

o

man

3-mont

rst

between

brances

rgt

30

te

opposton

cause

o

ts

Compresson

to

and

9

years.

(see

te

pyscan

and

wc

years

tenar

ater

Pysca

6.2).

because

pan

o

Wat

s

te

n

te

C.

Syncondross

D.

T rocod

E.

Gngymus

113.

most

C.

pressng

at

te

o

Osteoartrts

E.

Repeated

A

tes

and

ours

and

carpa

and

pamar

and

tat

o

ago,

te

aspect

n

te

anteror

wt

oowng

te

bones

musce

com-

two

s

spne

to

er

nerve

te

pyscan

rgt

spped

on

er

nds

wrst

on

3½

radus

a

(see

An

a

Fg.

x-ray

carpa

6.3).

commony

Bracoradas

114.

A

59-year-od

Wc

T rquetrum

symptoms

ts

and

der.

A.

are

occur

Pysca

arm.

An

more

wen

o

ture.

Wc

a

dgts

severe

e

o

cervca

o

te

and

o

pan,

s

te

s

sows

rgt

rb

te

n

rases

examnaton

x-ray

ence

ntermttent

ourt

arm

accessory

oowng

and

over

weakness

souder

and.

s

o

sows

scaene

structures

s

t

te

In

C.

Beow

dg-

D.

Between

Axary

B.

Upper

rgt

nerve

braca

Subcavan

D.

Lower

E.

Bracocepac

pexus

o

artery

pexus

23-year-od

T wo

vece

115.

A

and

ower

trunk

o

braca

woman

because

days

coson

o

ago,

and

comes

severe

se

was

to

pan

te

n

nvoved

sustaned

a

emergency

er

n

et

a

contuson

ore-

ongus

dgtorum

ongus

and

lexor

dgtorum

s

brougt

and

puse

s

were

emergency

pae.

aceratons

18/mn,

jont,

te

coson.

markedy

severa

rada

to

vece

on

bood

absent.

can

te

Se

s

Pysca

er

body.

pressure

Ater

rada

s

cross-

artery

dented?

two

eads

o

te

snufbox

te

o

tendon

te

te

adductor

numbness

rst

te

and

two

te

rst

lexor

dorsa

pocs

second

nterosse-

ongus

dorsa

nterosse

pocs

atera

s

most

A.

Unar

B.

Rada

Recurrent

motor

D.

Medan

o

E.

Posteror

comes

o

to

brevs,

key

and

sows

te

and.

pamar

Wc

o

medan

nterosseous

or

and

because

te

weakness

pocs,

Sensaton

compressed?

branc

musce

pyscan

and

opponens

musces.

rgt

te

er

examnaton

pam

er

nterosseous

ongus

tngng

umbrca

o

dorsa

woman

Pysca

dgts

nerves

rst

pocs

and

C.

te

pocs

anatomca

69-year-od

o

3½

pexus

arm.

te

over

braca

ongus

lexor

are

Her

te

Between

rst

artery

trunk

department

E.

abductor

o

C.

A

te

monts.

trunk

oowng

musces

pres-

key

te

to

between

musce

B.

compressed?

A.

be

he

muscua-

most

o

es

and

appears

radocarpa

key

ous

sou-

te

te

Hg.

Between

a

parestesa,

rgt

lexor

motor

sows

respratons

mm

a

and

examnaton

E.

te

attempted

artery

Wc

he

coapsed

ongus

woman

ater

unconscous

most

o

and

pocs

department

ng

o

wrsts.

er

tendons?

pocs

Fexor

Scapod

story

pyscan

rada

arm.

se

pamars

Psorm

numbness

et

bracoradas

D.

and

er

mnutes

n

substerna

proundus

bone

wt

was

and

Fexor

o

emergency

and

D.

type

pan

radas

E.

dsocated?

pyscan

A

pan

and

10

te

radas

C.

te

he

he

to

severe

carp

80/60

to

ater

te

o

C.

severe

membrane

te

carp

Lunate

comes

o

Fexor

B.

man

causes

compartment

Fexor

Her

32-year-od

Wc

brougt

mandbe

puse.

par

a

B.

Captate

A

s

wegts.

and

near

wrst

sows

and

dscrmna-

nterosseous

una.

unconscous.

correct

te

experencng

te

rada

swoen

A.

n

o

er

o

te

a

supercas

and.

sensaton

dgts.

o

a.

to

dzzy

tendons

te

batroom

outstretced

dsocaton

most

wet

decreased

atera

because

ater

et

became

A.

3-mont

112.

and

s

unar

comes

patent

o

te

woman

tng

radated

at

and

sows

two-pont

afected?

ater

we

ocate

brac

cervca

te

orceuy

sows

compress

pexus

examnaton

artcuates

te

to

tat

condye

trceps

te

woman

e

te

o

numbness

Neuroogc

te

osteopytes

unar

te

trauma

54-year-od

pan

te

te

braca

D.

T wo

111.

o

nerve

Hypertropy

o

28-year-od

woman

Formaton

unar

A

department

tunne

B.

key

s

cest

nerve

most

Synartross

atropy?

medan

radus

Sympyss

weakness

o

orearm

orgnatng

te

B.

workng

oss

te

A.

examnaton

and

o

te

nterrupts

ago

emnence

Fg.

patent’s

o

te

numbness

retred

or

o

o

s

examnaton

wt

dorslexon

MRI

syndrome

ram

69-year-od

o

110.

Pysca

orearm

was

aspect

o

te

past

o

and

3

te

te

decreased

o

te

rst

oowng

CHAPTER

116.

A

32-year-od

operatve

motor

tpe

ca

vece

rgt

to

extend

n

andgrp

surgca

nerves

A.

Posteror

B.

Rada

nerve

C.

Rada

and

D.

Rada,

E.

Rada

A

cord

x-rays

s

tat

extenson

te

sows

aganst

most

key

te

and

mu-

120.

norma

and

o

at

te

te

braca

dsta

o

te

unar,

and

and

ater

ang

on

to

wet

T1

E.

C7,

C8,

T1

A

56-year-od

ua.

durng

te

compensate

emergency

jonts

o

te

dgts.

or

Dorsa

C.

Posteror

D.

Latera

E.

Superor

Dorsa

ater

awake,

mted

te

te

ractured

te

oowng

A.

Anteror

B.

Deep

C.

Rada

Deep

Medan

Se

An

o

porton

and

rada

te

key

musce.

radus

between

Wc

key

o

njured?

nerve

unar

nerve

122.

s

x-ray

Superor

B.

Mdde

C.

Ineror

du

aso

brougt

nvoved

pan

norma

s

n

o

arm

braca

te

te

a

et

to

ntate

atera

sows

arm,

lex

pexus

s

te

ebow

abducton

no

edema,

ractures.

most

key

Latera

cord

Meda

cord

1

our

coson.

no

He

as

and

te

posteror

te

he

rom

wc

A.

C5,

C6

B.

C5,

C6,

beng

severe

an

nerve

te

C7

nvoved

pan

n

brusng

ngers.

o

te

er

Wc

te

cd’s

o

o

te

most

entre

scap-

key

scapua?

artery

et

te

2

Se

years

a

Se

sweng

sows

carpa

as

ago.

examnaton

and

and

ts

emergency

bones

type

o

a

o

Coes

are

most

racture?

arm

to

car.

ressts

oowng

te

n

tat

to

emergency

er

se

s

upper

voenty

er

ted

rom

and

movement

te

depart-

extrem-

most

te

wakng

examnaton

pronated

any

s

et

prevent

Pysca

orearm

se

scapod

pan

recas

movng

and

te

and.

Pysca

n

and

brougt

severe

rased

a

to

psorm

sows

extended

due

key

to

cause

at

pan.

o

te

pan?

ema-

A.

Compresson

o

Wc

B.

Separaton

te

njured?

sur-

unate

s

o

patent’s

ebow

te

et

oowng

dsocated

and

moter

er

uaton

o

wt

Separaton

te

te

o

medan

ead

o

trocea

te

wt

Separaton

te

orearm

damaged

te

o

unate,

gr

because

o

D.

sows

and

3-year-od

te

be

ead

te

o

una

nerve

te

o

radus

te

te

and

rom

ts

artc-

ts

artc-

umerus

radus

te

rom

captuum

o

te

umerus

wounds.

and

arm

T rquetrum

C.

sows

open

s

o

E.

uaton

ater

examnaton

wt

Scapod

T rquetrum,

te

A 22-year-od man s brougt to te emergency depart-

ment

o

D.

trunk

E.

x-ray

or

C.

trunk

D.

An

scapod

ront

o

w

tenderness,

unate

tat

trunk

orented.

and

n

and

and

er

and

by

to

dagnosed

movement,

ractured

o

momentum

marked

and

Vta

wrst.

Her

border

brougt

on

T rquetrum

gr

examnaton

s

ang

T rquetrum

ty.

vece

souder.

unabe

to

emergency

motor

Pysca

unabe

te

to

n

mts.

estabsng

proxma

te

A.

s

suppy

to

muscuo-osseous

arteres

B.

A

needed

a

meda

A.

ment

patent

rst

te

o

o

ematoma

supnator

most

beng

as

te

wtout

toma

s

woman

wtn

tat

o

ater

sgns

mb.

racture

nerve

coson.

arm

o

branc

34-year-od

souder

and

nerves

a

nterosseous

department

sows

sows

expandng

nerve

E.

are

an

radus

branc

D.

A

orearm

sows

et

wa

wt

umera

osteopoross

racture. Wc

o

emergency

artery

woman

An

MRI

te

artery

toracc

te

an

to

toracc

o

aert,

cest

te

crcumlex

56-year-od

story

er

repaced

bood

scapuar

and rada devaton s noted on extenson o te wrst.

x-ray

brougt

oowng

te

B.

sows

MCP

te

Suprascapuar

A

o

and

A.

s

te

s

nvovng

o

department

Pysca

area

grat

Wc

and

o

arge

scapuar

pavement.

T1

woman

removed

te

examnaton sows weakened abducton o te tumb

extenson

A

as

umerus

te

C8,

C8,

o

121.

brougt

C7,

C7,

son.

medan

s

C6,

C6,

gcay

muscuocutaneous

man

C5,

D.

He

pexus

trd

C.

303

Limb

department ater beng nvoved n a motor vece co-

orearm

Wc

njured

a

surg-

and.

gravty

supnaton.

post-

sowed

o

orearm

wrst

and

a

nvoved

requred

examnaton

and

or

beng

unar

52-year-od

and

119.

Prevous

o

were

pyscan

ater

procedure?

department

118.

arm

sensaton

unabe

te

ractures

Pysca

te

to

monts

mb

weakness

oowng

117.

o

norma

5

coson.

nterventon.

and

comes

up

upper

abducton

s

man

oow

Upper

6

he

s

most

s

oss

oowng

arm.

mb

extend

sensaton

and.

o

te

eves?

An

over

x-ray

umerus.

composed

spna

Pysca

to

E.

vece

upper

unabe

o

racture

key

motor

rgt

dorsoatera

obque

s

a

rgt

te

patent

here

and

te

o

n

o

bers

123.

A

o

trocea

o

epcondye

meda

Pysca

te

man

ater

and

o

x-ray

body

Wc

rada

s

beng

examnaton

wrst

dorsum

te

o

te

o

o

te

Medan

B.

Unar

et

ts

nerve

o

te

artcuaton

wt

by

sows

a

and

to

bat

oss

to

sows

umerus

t

just

nerves

passes

te

on

weakness

proxma

arm

oowng

as

bend

umerus

brougt

t

jonts,

and

te

te

A.

MCP

rom

umerus

te

61-year-od

An

una

te

Stretcng

department

te

te

o

o

te

a

o

et

sensaton

rst

to

most

arm.

extenson

arne

dsta

s

emergency

te

ts

two

on

at

te

dgts.

racture

o

mdpont.

key

njured?

304

C H A P T E R

6

Upper

Limb

te

oowng

grapc

A.

A

eson

crease

B.

A

expected

o

o

te

te

IP

be

present

durng

rado-

o

te

Avuson

unar

nerve

at

te

dsta

lexor

o

te

extenson

expanson

over

te

jont

Compresson

ton

D.

to

wrst

separaton

mdde

C.

s

examnaton?

o

te

unate

deep

unar

nerve

by

dsoca-

bone

racture

o

te

dorsum

o

te

dsta

paanx

E.

127.

A

Fracture

o

42-year-od

te

ourt

woman

or

t

comes

metacarpa

to

te

bone

pyscan

or

a

oow-up ater njurng er et souder. T wo monts

ago,

se

branc

•

Fig.

Se

6.8

was

and

as

Rada

condtons

Muscuocutaneous

ca

Axary

A

34-year-od

motor

ma

Pysca

over

te

et

6.8).

ater

coson.

e

s

tat

act

Wc

Vta

wrst,

was

emergency

nvoved

are

aert,

and

and

and.

te

IP

oowng

n

wtn

numerous

extend

te

te

sgns

sows

to

o

e

awake,

orearm,

to

a

nor-

orented.

aceratons

Parayss

jonts

s

ner ves

128.

o

noted

s

A.

Unar

B.

Recurrent

to

ateray

C.

Parayss

o

ntrnsc

D.

Parestesa

E.

Loss

A

te

Rada

o

ts

E.

Anteror

tory

o

n

mm

and

nerves

An

MRI

cervca

s

most

brougt

are

neck

20/mn,

Pysca

key

o

a

pan.

and

range

extenson

examnaton

regon.

te

Wc

o

o

nds

o

te

emergency

2-week

Her

bood

examnaton

restrcted

on

to

because

ncreasng

weakness

ebow.

te

s

usband

Hg.

mobzaton,

neck,

te

er

respratons

128/32

wt

by

progressvey

80/mn,

s

nterosseous

a

s

pressure

sows

moton

te

s-

puse

pan

o

te

orearm

ernated

oowng

129.

te

dsc

ater

o

transverse

o

teres

quadratus

C.

Bracas

D.

Supnator

E.

Bracoradas

ater

er

atera

beng

and

2

oter

sde

o

C7

A.

Centra

C8

B.

Humera

E.

T1

C.

Pectora

D.

Subscapuar

E.

Parasterna

department

coson.

as

Vta

severe

Pysca

ater

pan

beng

sgns

and

examnaton

nvoved

are

wtn

n

a

mobty

sows

maet

a

motor

norma

mted

emergency

o

vece

mts.

te

nger.

Se

nger.

Wc

o

130.

A

vta

er

D.

te

a

o

te

oowng

durng

pys-

and

te

o

o

to

te

n

a

most

and

emergency

motor

norma

o

te

radus

teres

prox-

orearm

proxma

musce.

key

ve-

mts.

devated

x-ray

te

arm

te

ateray

An

group

o

by

ago.

examnaton

C.

to

s

btten

days

be

brougt

te

to

Wc

responsbe

or

A 45-year-od woman comes to te emergency depart-

Wc

s

musces

o

wtn

pronator

Pronator

C5

woman

o

te

aspect

are

racture

Pronator

Pysca

126–150

mted

arm

o

nvoved

sows

te

te

dorsum

radus.

B.

C6

34-year-od

and

racture

present

brougt

sgns

te

oowng

s

beng

Vta

B.

A

be

musces

te

woman

A.

Questions

n

examnaton

(102.9°F);

compressed?

Wc

rotate

meda

A.

o

spna

no

tree

pasy.

devaton?

ment

at

te

sensaton

porton

a

n

attacment

Muscuocutaneous

woman

o

coson.

D.

45-year-od

to

ang

scapua

41-year-od

C.

A

expected

Wnged

Pysca

medan

aso

Inabty

sows

o

s

a

pan

sowed

grde.

by

Erb-Ducenne

worsenng

B.

ma

branc

souder

souder

wt

x-rays

A.

ce

most

et

examnaton?

department

njured?

department

126.

brougt

mnutes

and

musces

key

s

examnaton

s

(Fg.

30

vece

mts

man

te

Prevous

te

D.

department

125.

o

C.

E.

124.

on

dagnosed

progressvey

movement.

bones

t

was

et

a

sgns

and

te

wtn

an

and

nodes

on

atera

temperature

are

sows

ymp

dog

Her

most

wound

mts.

on

ymp

key

sde

39.4°C

norma

open

swoen

s

s

te

te

nodes.

rst

to

nvoved?

axary

25-year-od

department

coson.

arm

Pysca

appears

absent

woman

ater

and

beng

brougt

nvoved

examnaton

swoen,

any

s

pae,

movement

and

o

to

n

te

a

sows

coo.

te

emergency

motor

tat

Rada

arm

vece

te

rgt

puse

causes

s

severe

CHAPTER

pan.

te

An

hree

er

arm.

ater

Wc

expan

se

as

severe

o

te

te

C.

Compartment

D.

Raynaud

dsease

E.

Injury

te

on

sows

and

pan

oowng

ndngs

V enous

a

a

racture

cast

over

s

te

condtons

pysca

at

paced.

engt

w

o

135.

most

outet

o

examnaton?

Smt

E.

Boxer’s

A

syndrome

nerve

s

unar

tumb.

brougt

norma

D.

Smt

E.

Boxer’s

o

ractured

te

oowng

A.

Medan

B.

Recurrent

Rada

D.

Anteror

E.

Deep

a

on

can

w

amate

most

tenderness

o

te

bones.

key

be

and

Wc

136.

njured?

A

o

medan

man

comes

o

a

reacng

rgt

to

s

beow

postve.

Wc

s

wen

te

pyscan

rgt

ead

Pysca

papaton

present

te

panu

over

sde.

to

because

souder.

and

examnaton

te

o

te

A.

Panu

abducton

0

to

15

B.

Panu

abducton

0

to

140

he

oowng

abducts

s

ts

A.

C5

B.

C6

ten-

s

most

arm?

137.

degrees

C.

C7

D.

C8

E.

T1

A

arm

and

Panu

abducton

70

to

140

degrees

sgns

D.

Panu

abducton

15

to

140

degrees

sows

E.

Panu

abducton

40

to

140

degrees

tra

54-year-od

department

as

severe

ton

An

bones.

key

ater

pan

sows

x-ray

o

te

er

and

o

s

ang

n

tenderness

Wc

be

woman

te

brougt

on

an

rgt

over

to

te

sows

te

emergency

outstretced

wrst.

and.

Pysca

anatomca

dsocaton

oowng

carpa

te

o

bones

o

C5

B.

C6

snufbox.

C.

C7

D.

C8

E.

T1

carpa

most

A

55-year-od

coson.

Se

C.

Hamate-unate

sgns

wtn

D.

Psorm-trquetrum

ton

E.

Hamate-captate

o

department

pan

n

mts.

te

te

ater

et

Pysca

ang

and.

x-ray

te

rst

jont.

o

te

and

metacarpa

Wc

A.

Coes

B.

Scapod

C.

Bennett

o

Vta

wet

sgns

examnaton

carpometacarpa

An

on

te

sows

bone

tat

oowng

racture

racture

racture

are

jont

a

wtn

a

o

extends

most

He

te

at

nto

key

s

a.

te

to

6,

er

o

te

emergency

he

temperature

respratons

129/79

te

te

unconscous.

mm

bceps

Hg.

are

s

19/

Pysca

brac

aferent

brougt

Se

o

as

relex.

component

te

mts.

to

spna

te

pan

et

o

Pysca

nerve

s

emergency

aong

upper

bracoradas

te

mb.

et

Vta

examnaton

relex.

he

responsbe

s

key

ven-

or

ts

Coes

and.

B.

Scapod

C.

Bennett

CMC

dagnoss?

139.

V okmann

and

Wc

te

xed

lexor

decreased

o

te

musces

lexon

o

te

sensaton

oowng

s

o

te

scemc

contracture

racture

62-year-od

because

te

o

Vta

examna-

racture

Boxer’s

o

noted.

Pysca

and

vece

orented.

racture

E.

ment

cyanoss,

emergency

motor

racture

D.

A

tenderness

te

a

and

mts.

papaton

to

n

dagnoss?

A.

o

aert,

norma

on

aso

brougt

nvoved

awake,

exquste

Sweng,

s

beng

s

orearm

and

most

ater

o

base

te

sows

te

te

norma

et

te

are

dgts.

as

dsocaton

racture

s

emergency

pavement.

sows

(CMC)

te

s

o

woman

T rapezod-trapezum

to

a

wc

B.

brougt

eve

norma

o

department

s

o

relex?

138.

man

s

absent

mobty

Scapod-unate

62-year-od

ound

97/mn,

an

woman

A.

A

s

pressure

ater

wtn

ramus

A.

w

jont

dagnoss?

brougt

score

puse

spna

absence

Se

nvoved?

scae

mted

are

examna-

te

s

beng

sows

54-year-od

C.

A

woman

bood

department

degrees

key

MCP

relex?

as

empty

most

te

tumb

rupture

tumb

ater

coma

and

seep-

sows

acromon.

patent

He

dicuty

o

te

o

swoen

o

racture

examnaton

s

gament

sows

we

Pysca

and

weakness

and

a

racture

(98.6°F),

Wat

rgt

a

mts.

tender

and

emergency

racture

54-year-od

37°C

te

te

rom

norma

severey

and,

to

tumb

racture

department

nterosseous

story

s

test

key

and

sows

x-ray

mn,

wen

derness

nerves

An

unar

2-week

ng

psorm

branc

43-year-od

pan

wrst.

Gasgow

C.

A

examnaton

pan

s

Gamekeeper’s

Bennett

et

as

Wat

A.

Scapod

te

Se

o

coatera

C.

Pysca

tree.

emergency

brougt

er

wtn

a

rgt

MRI

B.

o

a

te

te

and

mts.

rom

to

are

sows

o

s

njurng

sgns

mted mobty o er et wrst. Vta sgns are wtn

sweng

ang

dgt

woman

ater

Vta

abducton.

te

rada

racture

examnaton

rst

305

Limb

racture

23-year-od

skng.

syndrome

woman

ater

D.

department

tromboss

22-year-od

sows

134.

arm

umerus

horacc

A

rgt

te

B.

and

133.

te

o

A.

department

132.

o

groove

days

key

131.

x-ray

rada

Upper

6

rgt

man

o

a

and

comes

3-our

ater

a

to

te

story

a.

emergency

o

pan

Vta

and

sgns

depart-

sweng

are

wtn

306

C H A P T E R

6

norma

ness

mts.

to

and.

Upper

Pysca

papaton

An

x-ray

te

psorm

ng

area.

Limb

and

o

te

bone

Wc

rgt

and

o

examnaton

sgncant

a

te

sows

sweng

and

sows

ematoma

oowng

o

o

a

s

Pysca

rgt

racture

te

nerves

tender-

te

sgty

o

musce

surround-

most

rgt

key

most

afected?

140.

key

Anteror

AC

Rada

C.

Cavcuar

C.

Medan

D.

Spra

D.

Deep

unar

E.

Rotator

E.

Deep

rada

A

ment

s

1

our

er

ton

bcyce.

njurng

Vta

examnaton

wt

and

ton.

ater

te

te

rst

tree

ourt

Wc

o

sgns

sows

and

te

er

ebow

are

a

wtn

n

te

ngers

oowng

se

norma

Benedcton

dgts

t

wen

mts.

sgn

o

extended

n

nerves

e

te

lexed

are

most

here

pos-

te

key

Injury

to

medan

and

B.

Injury

to

medan

nerve

C.

Injury

to

rada

D.

Injury

to

unar

Injury

to

medan,

E.

A

54-year-od

department

cest

pan

and

ton.

Wc

durng

wt

surgery

o

s

o

an

te

nerves

and

n

s

rada

or

2

eads

rada

oowng

ours.

An

ECG

and

te

and

soud

beore

s

be

te

sows

Aen

B.

T rceps

artery

Tne

Bracoradas

E.

Bceps

A

grat

146.

wt

he

pan

ton

s

n

patent

ness.

ourt

owng

A.

te

ater

ead

t

te

a

o

s

most

Compresson

s

key

o

te

a

onto

or

sows

te

a

department

concrete

oss

o

Fexon

pamar

decreased.

n

loor.

B.

Injury

C.

Compresson

between

D.

E.

A

te

te

rada

o

two

Compresson

Injury

o

te

65-year-od

department

he

patent

Rada

E.

Unar

A

o

te

Wc

o

nerve

n

o

te

unar

o

rada

nerve

s

te

o

on

ractured

nerve

by

a

s

severe

as

pronator

nerve

brougt

ang

compans

rom

medan

eads

man

ater

nerve

te

dgts

s

sgns

are

sows

by

te

te

te

ractured

to

te

s

at

s

pronated.

sweng.

key

by

extrem-

arm

orearm

or

he

Wc

njured

norma

o

n

o

ts

Fracture

o

te

md-body

D.

Fracture

o

te

surgca

E.

Laceraton

o

22-year-od

routne

te

ven.

deep

to

and

as

o

Pysca

exam-

contour

o

te

depresson

oowng

se

te

neck

o

njures

to

o

to

te

pyscan

wtdraw

te

te

er

or

venpuncture,

bood

neede

ven

rom

te

and

competey

oowng

cubta

prevented

umerus

cord

passed

medan

umerus

te

Durng

Wc

te

te

njur-

process

comes

unabe

tat

and

responsve.

appearng

posteror

woman

s

and

jont

examnaton.

reazes

barrer

te

aert

norma

o

coronod

souder

emergency

sustan?

C.

A

te

Wc

te

mts.

te

key

to

motorcyce

s

abnorma

most

o

a

patent

oss

an

brougt

rom

Avuson

structures

as

acted

puncturng

as

an

arter y?

Bcpta

carpa

souder

s

depart-

ted

upper

ods

and

most

Dsocated

C.

outstretced

rgt

rgt

He

B.

Fexor

147.

retnacuum

teres

musce

aponeuross

D.

Bracoradas

E.

Bceps

A

brac

21-year-od

department

ror

psorm

beng

gament

acromon.

Pronator

emergency

s

emergency

ater

gament

wtn

patent

B.

supnator

te

s

pan.

ang

te

and

A.

teres

md-body

tendon

man

souder.

o-

passes

te

membrane

ater

te

t

o

extended

coatera

te

umerus

to

to

pan

ematomas

coatera

o

te

arm

A.

a

dagnoss?

medan

te

s

gament

brac

35-year-od

ocated

tunne

o

D.

troug

abduc-

surace

over

umerus

umera

structures

Interosseous

qucky

conscous-

weakness

ngers.

over

ngers

emergency

trauma

examnaton

Sensaton

and

s

arm

te

te

brougt

et

vsbe

C.

a

comes

adducton

norma.

no

pebotomst

man

denes

Pysca

and

relex

relex

34-year-od

s

due

Annuar

dd

perormed

test

te

ebow

Bceps

beow

proposed.

relex

D.

s

souder

test

C.

o

Movement

B.

naton

operaton?

A.

o

o

A.

Vta

narc-

bypass

boy

oowng

ng

patent

coronary

grat

absent

oowng

tear

restrcted

department

substerna

myocarda

artery

tests

145.

emergency

severe

wa

examnaton

nerves

te

V1–V3

perormed

a

to

constant

anteror

usng

pysca

nerves

brougt

sweatng

Angograpy

bypass

unar,

man

eevaton

dagnosed

unar

aso

te

and

detod

patent?

nerve

because

ST -segment

s

and

rada

cuf

because

are

s

o

te

racture

racture

wt

pos-

njured?

A.

s

sde

Wc

rotated

o

subuxaton

parents.

ty

te

jont

4-year-od

ment

externay

Fattenng

sensaton

dsocaton

B.

144.

and

an

arm.

dagnoss?

A.

A 32-year-od woman comes to te emergency depart-

sows

rgt

musce.

B.

and

143.

noted

Unar

Pysca

142.

s

detod

A.

rom

141.

examnaton

abducted

crease.

ng

man

ater

surace

o

wte

and.

or

tngng

pan.

or

te

te

and

and.

brougt

et

a

wrst

examnaton

structure

o

s

sustanng

s

Pysca

extenson

musce

tendon

deep

wrst.

no

oss

Sensaton

to

he

o

to

to

te

aceraton

dsta

sows

te

a

te

broad,

as

o

pnprck

any

s

te

skn

superca

patent

moton

to

emergency

on

no

o

ante-

od

gsten-

asca

on

numbness

te

norma

ngers

n

a

o

CHAPTER

te

ngers

as

148.

te

and

Fexor

retnacuum

B.

Fexor

carp

C.

Pamar

te

and. Wc

tendon

skn

dgtorum

supercas

proundus

o

te

tumb

norma.

er

s

Pysca

to

o

te

te

Wc

o

te

medan

o

te

pamar

C.

Injury

o

medan

Injury

te

te

te

o

te

22-year-od

s

ts

most

Rada

C.

Anteror

D.

Posteror

Deep

meda

norma

on

most

and

n

C6–C8

s

C.

C4

D.

C2–C4

E.

C5–C7

A

a

accounts

carpa

te

tunne

medan

pamar

unar

payer

s

s

o

a

o

s

exposed

o

o

te

a

te

s

key

nerve

at

strengt

key

brougt

to

Durng

and

te

njury

an

tat

emer-

ater

a-

surgery,

artery

orms

oowng

s

te

te

153.

Inraspnatus

Pectoras

C.

Subscapuars

D.

Supraspnatus

E.

T eres

A

vsu-

o

weakness

loor

e

grabbed

arteres

was

Pysca

s

brougt

o

dsta

a

deep

te

kne

orearm. Vta

and

o

paper

dgt

and

Wc

o

wound

o

te

s

te

wtn

154.

weak-

dgts.

meda

te

on

are

sows

between

te

emergency

sgns

examnaton

adducton

pece

t

to

He

s

tumb

oowng

o

o

was

A.

Lower

B.

Medan

te

mus-

nnervated

nerve

pyscan

ago,

er

was

souder

o

hs

wc

o

or

a

sustaned

reduced

rotaton

n

se

we

n

examnaton

vst.

E.

Upper

A

te

sows

er

arm

ndng

te

at

was

oowng

trunk

o

te

and.

ater

Wc

Lumbrca

D.

Pamar

E.

Extensor

155.

ater

ang

s

rgt

puse

s

x-ray

a

souder.

s

te

te

poe

Hs

emergency

and

on

rgt

and-

temperature

respratons

109/79

tenderness

o

street

68/mn,

pressure

sows

of

to

mm

Hg.

are

Pysca

movement

souder

s

12/

o

te

sows

a

A

two

n

o

tree.

abducton

unabe

Wc

ago,

a

to

te

oppose

oowng

pexus

braca

s

an d

te

or

ton

sows

o

te

te

sow s

d g ts

te

 os s

n

os s

at

te

nge rs

o

e m er ge ncy

an d

kn  e

e xte n -

IP

jo  nts,

o

te

musc es

IP

a

o

r  gt

s

e xte ns o n

most

o

te

musces

dgtorum

musces

nterosseous

dgt

72-year-od

as

 t

to

r gt

 o  ow ng

nterosseous

Se

 s

exam n at on

o

pexus

b rougt

ngers?

department

tendon,

s

rom

njured?

nj ur  n g

responsbe

C.

brougt

weakness

because

weeks

nerve

abduct on

Rada

s

ew

ang

He

braca

te

our t

o

Unar

man

o

man

Pysca

oss

pyscan

A

nerve

2 8-year-od

key

151–175

key

te

was

and.

te

Muscuocutaneous

and

nerves

o

e

dgts.

rgt

most

to

and.

sows

s

Unar

E.

An

tear

as

D.

D.

souder.

s

o

he

nerve

Dorsa

bood

o

Pysca

rgt

C.

son

te

o

trunk

Extensor

(98.6°F),

jont

comes

s

s

B.

examnaton

loor

oowng

te

souder

a

examnaton

A.

and

te

to

meda

branc

adducton

gt.

ngers.

sde

a

Muscuocutaneous

mn,

racture

o

week

today’s

by

man

o

depar tment

njured?

on

te

mnor

29-year-od

Medan

drecty

o

umerus.

major

C.

37°C

on

caused

B.

ng

te

durng

B.

meda

department

and

A.

and

absent.

28-year-od

One

department.

Axary

A

comes

genoumera

A.

Questions

woman

soccer

souder

most

nerves

bone

te

Pysca

od

dgt

te

wc

appontment.

dsocated

te

arc

man

abducton

o

by

o

rgt

C5

21-year-od

decreased

nerve

branc

medan

wrst

and.

ractured

because

o

engt

te

C4

and

payng

nterosseous

mts.

to

and

oow-up

nterosseous

pamar

Sensaton

s

te

best

152.

C3

B.

structures

sde

o

afected

composed

A.

te

department

ourt

te

o

branc

and

Wc

36-year-od

unabe

base

vsuazed?

B.

ness

acera-

te

weakness

n

njures

n

and

because

te

space.

key

Unar

E.

rada

snufbox

A.

A

recurrent

ootba

crossng

entre

musces?

outstretced

anatomca

or

nerve

branc

recurrent

department

on

azed

and

Sensaton

a

rom

was

wrst

Injury

ng

se

sows

pam

bones,

emergency

we

nerve

o

key

nerve

emergency

Injury

gency

te

ndngs?

Injury

A

er

oowng

B.

E.

o

psorm

te

to

and

examnaton

aspect

A.

D.

er

tumb.

o

tendons

tendons

brougt

njurng

proxma

opposton

or

woman

ater

wood.

te

a

te

sucus

307

Limb

roots?

dgtorum

34-year-od

troug

most

by

Fexor

on

racture

ce

unars

Fexor

A

structure

ntertubercuar

E.

ton

151.

o

D.

carvng

150.

pam

ocated?

A.

department

149.

te

pyscan

Upper

6

woman

ater

a

sgncant

a

and

a

s

brougt

on

ebow

papabe

pan

musces

mnm

er

pan.

deect

durng

to

te

emergency

outstretced

over

ebow

Pysca

er

et

bceps

lexon

arm.

examna-

brac

wtout

any

restrcton on movement. An x-ray o te et arm does

not

sow

wt

ractures

rupture

o

te

or

dsocatons.

bceps

brac

Se

s

tendon.

dagnosed

Wc

o

308

C H A P T E R

te

6

oowng

contnue

to

Bracas

B.

Fexor

C.

Fexor

D.

Pronator

E.

T rceps

A

Se

carp

teres

a

te

o

a

dect

o

Adducton

B.

Extenson

C.

Fexon

o

o

Pysca

te

o

te

ndex

te

s

a

He

at

most

o

a

rst

B.

Fracture

o

te

trapezum

E.

Frst

A

o

CMC

bat

at

te

rgt.

te

rgt

here

son.

s

s

o

part

C8

D.

C8

and

T1

E.

C5–T1

key

to

161.

and

o

s

on

o

o

pan

as

a

to

a

outstretced.

C.

henar

D.

Fexor

E.

Hypotenar

te

atera

metacarpa.

A

emergency

rom

a

wt

te

pexus

s

tat

e

ond

and

s

and.

A.

Deep

B.

Anteror

arm.

C.

Medan

D.

Recurrent

E.

Deep

key

163.

A

B.

Dvsons

Pysca

V entra

E.

T runks

A

a

ram

1-week

ater

and

a

story

game

extends

atera

wrst

woman

o

o

rgt

tenns.

nto

te

sows

A.

Rada

B.

Unar

C.

Fexon

w

devaton

devaton

he

md

to

ebow

te

o

most

because

pan

at

te

orearm.

and

one

key

he

begns

te

sweng

Wc

cnc

pan.

pan

dorsum

epcondye.

movements

comes

te

exacerbate

o

extended

te

o

rotated

and

te

a

da-

Pysca

pro-

oowng

rm.

and.

pyscan

rgt

wrst.

te

sgn

w

works

examna-

wrst

poston

Tne

because

Se

Pysca

o

musces

wt

te

reproduces

s

postve.

most

key

be

nterosse

IV

I

and

II

to

a

and

te

buttonng

seet

and

o

srts.

are

o

tenderness

oowng

because

Vta

examnaton

paper

tere

proundus

pyscan

s

Pysca

te

because

te

between

no

and

sgns

sows

s

sensory

sec-

dects

nlammaton

nerves

s

mosty

are

key

lexor

on

man

comes

o

and

a

o

pysca

Weakened

sows

te

o

abduct

Weakened

lexon

Weakened

opposton

E.

Inabty

23-year-od

pan

he

n

te

pan

s

o

adduct

man

rgt

deep

dects

depart-

broken

aceraton

transverse

wrst.

here

Durng

o

te

D.

to

a

emergency

rom

crease

s

no

pysca

w

gass.

across

on

njury

examna-

most

key

be

examnaton?

pronaton

to

te

dsta

te

C.

A

to

njury

retnacuum.

Inabty

164.

medan

neuromuscuar

B.

pan?

o

rada

surace

A.

over

o

engt

ebow

oowng

unar

examnaton

wc

ound

o

branc

branc

Pysca

te

mts.

o

nterosseous

anteror

ton

started

tenderness

o

to

lexon

mts.

grp

o

branc

entre

te

to

examnaton

te

te

brances

55-year-od

aw

comes

ngers

22-year-od

ment

T ermna

story

meday

Wc

supercas

wt

Sgns

o

Cords

D.

to

s

te

umbrcas

man

Wc

A.

C.

abe

and

abducted

and

norma

trd

a

afected?

excur-

most

wtn

te

III

dgtorum

te

asymmetry

dapragmatc

braca

on

and

as

because

oowng

condton?

pamar

dicuty

absent.

baseba

and

24-year-od

as

and

rgt

ts

Dorsa

souder

orward

durng

by

n

arge

arm

njured?

comes

oowng

Lumbrcas

te

sows

te

te

B.

on

key

pyscan

norma

lexed.

maxma

A.

e

and

n

o

a

lexed

days

2

162.

bow

pan

s

woman

n

moter

orearm

numbness

tat

a

weakened

n

neck

n

Wc

perorm

pan.

rst

to

sows

ebows

pan

and

secretary

ton

weakened

njured?

159.

48-year-od

are

pusng

te

A

te

te

te

brougt

asymmetry

Wc

s

examnaton

scapua

aso

C7

and

extensors

sustanng

juncton

Pysca

and

C7

te

rgt

adducted

rgt

most

C6

emergency

abe

to

s

C.

worsenng

been

ram

to

te

wtn

an

wrst

B.

artrts

man

ater

o

te

ten-

dgts

te

and

Her

dgto-

nger

sgty

arm.

o

Her

are

sows

C6

metacarpa

tumb

sgns

and

scapod

jont

55-year-od

department

o

te

most

devaton

brougt

devery.

Vta

ventra

s

movement

C5

dagnoss?

te

T enosynovts

mted

unar

gr

A.

ngers

to

due

base

o

Fracture

wrst.

te

lexor

tenderness

Fracture

D.

be

tte

and

not

wt

te

er

nger

te

car

and

newborn

nated

examnaton

between

te

te

trd

A.

C.

o

tte

sows

key

w

because

as

drve

examnaton

and

brougt

we

cuttng

depart-

nger

and

s

adder

wrst

A

compcated

oowng?

tumb

second

man

or

Fexon

o

dgto-

emergency

wound

patent

base

of

te

te

te

te

Extenson

E.

rgt

Pysca

radas

abducton

wrst.

te

s

hs

o

dutes

e

o

over

by

rgt

work

by

and

36-year-od

Wat

lexor

D.

examnaton

sucde

rng

Sensaton

o

radas

and

te

te

Opposton

sde

carp

to

depresson.

wc

o

E.

e

160.

lexor

brougt

carp

and

D.

ago

to

coracobracas

part

lexor

A.

s

patent

supnator

and

s

deepest

te

ave

s

te

betes.

o

supercas.

n

and

attemptng

rum

A

aow

supercas

and

gr

story

department

158.

unars

brac

lexon

157.

key

bracoradas

dgtorum

ater

dons

most

ebow?

proundus

as

sows

er

and

16-year-od

ment

Limb

musces

lex

A.

rum

156.

Upper

sarp,

te

comes

orearm

tumb

o

te

upper

te

tumb

te

tumb

tumb

to

te

pyscan

extremty

exacerbated

by

or

because

severa

movement,

o

weeks.

and

s

CHAPTER

progressvey

ng

o

or

te

te

rgt

pan

s

ton

o

te

upper

te

rgt

rgt

durng

arm,

resstance.

snce

e

basketba

extremty

reproduced

aganst

o

worsenng

upcomng

souder.

s

sows

te

and

here

ncreased

season.

no

nta

wen

Wc

arm

nerve

tran-

deormty.

n

309

Limb

Examnaton

pase

te

weakness

s

Upper

6

o

s

abducted

atera

was

he

abduc-

rotaton

most

key

njured?

165.

A.

Lower

B.

Axary

subscapuar

C.

Rada

D.

Suprascapuar

E.

Upper

A

subscapuar

35-year-od

man

comes

to

te

pyscan

or

a

o-

•

ow-up

examnaton.

aceraton

ever

part

ts

o

and

nodes

s

rom

and

ad

a

to

tenar

Wc

key

ts

sustaned

be

te

njured

te

rst

168.

25-year-od

Her

s

a

oow-

to

A

because

Durng

emnence

o

te

rst

pece

motor

receve

asked

njury?

o

o

axary

to

B.

Subcavan

openng

C.

Latera

aong

D.

Anteror

E.

Centra

axary

by

moter

et

o

ca

et

arm

An

and

sown

Jont

C.

Interosseous

Rada

E.

Unar

son

arm

was

s

s

he

n

toys.

extremty

axty

ts

o

wc

woman

because

potograp

o

examnaton

wrst

unar

sows

or

key

and

Numbness

to

worsenng

D.

Ineror

trunk

o

te

braca

E.

Posteror

169.

voa.

“stuck”

er

te

and

sows

s

pan

and

racture

arne

cana. Wc

durng

weakness

te

n

o

o

te

te

o

Fg.

te

An

by

er

6.9.

numbness

strengt.

pysca

o

pyscan

sown

a

and

no

Wrst

C.

Atropy

D.

Postve

E.

Weakness

te

te

Tne

n

tenar

musces

test

wrst

a

neck

o

and

cosng

to

and

reproduced

rom

te

axa

s/are

most

te

dsta

to

or

te

ndex

nger

wen

sound

te

o

Wat

s

to

nger

extend

and

eard.

te

payng

ndex

asked

be

because

wen

extenson

can

aspect

atropy.

pexus

pyscan

sows

passve

pamar

pexus

braca

poston

Durng

radus

tunne

examnaton

snappng

erytema

te

er

epcondye

o

comes

o

lexed

nger.

over

x-ray

amate

oowng

at

w

examnaton?

ourt

and

t

170.

T enosynovts

B.

Dupuytren

lexon

Se

nger.

te

as

here

most

key

Maet

D.

Boutonnere

E.

Boxer’s

A

an

great

era

er

s

dstress.

tree

used

to

are

adducton

nger)

deormty

racture

woman

unsgty

and.

(trgger

nger

25-year-od

o

stenosans

contracture

C.

ump

Se

and

a

as

a

Durng

A.

Neurobroma

B.

Gangon

cyst

a

er

o

to

te

wrst

tngng

dgts

te

wc

Wc

dagnoss?

comes

on

pysca

umnate

draned,

symptoms.

drop

o

te

A.

ump

dgts

B.

woman

“ockng”

n

meda

te

dvsons

nger

on

te

at

Pysca

ndex

te

at

nerve

sudden

er

per-

nerve

50-year-od

o

and

o

A

no

Wen

compressed?

carpa

s

degrees

structure(s)

te

o

deormty

pnc

present

ner ve

sows

mb.

are

mb,

n

te

90

and.

carr yng

dagnoss?

brougt

er

te

nerve

ndng?

decreased

Guyon

be

s

o

o

pyscan

rgt

we

upper

symptoms

border

Wc

ago

to

Medan

pys-

s

te

er

repeatedy

C.

o

lexed

and.

mb

we

s

movng

On

ands,

meda

te

Unar

ours,

not

sgty

upper

out

ew

upper

poston,

te

n

examnaton

n

Rada

tugged

m

next

Pysca

dects

er

weeks

B.

s

dgt

A.

pu

er

our

A.

membrane

er

most

to

wt

resuted

se

te

er

et

beow.

Pysca

te

te

ater

ts

to

tngng

Hs

depart-

pan.

coatera

daugter

te

as

arm

coatera

62-year-od

o

road

emergency

et

capsue

D.

te

pan

B.

t

o

Over

cd’s

o

structures

Annuar

A

te

car.

te

te

started

payng

x-ray

A.

and.

pan

worred

we

to

because

crossng

became

oowng

er

te

examnaton,

ormed

brougt

oncomng

pronated.

A

s

moter

wen

an

moter

s

boy

s

abduct

te

key

axary

expans

arm

way

to

axary

uggage.

comes

and

was

sensor y

mantan

Posteror

4-year-od

6.9

woman

numbness

epsode

or

A.

A

Fig.

a

ow-grade

examnaton.

swoen.

most

He

e

ocazed

pysca

and

ago,

tumb.

tumb

w

dranage

days

sweng

on

entre

erytematous

ymp

ment

167.

tp

tumb

te

ympatc

166.

te

redness

te

vst,

aso

ng

and

o

to

hree

o

s

te

ump.

a

s

te

te

er

at-

aspect

pen

contents

mmedate

oowng

on

pamar

he

because

causng

sensaton

examnaton

cause

te

pyscan

tat

o

torc

o

ree

most

o

te

er

key

310

C H A P T E R

6

Upper

Limb

tumb

and

weakness

on.

ndex

n

nger.

pronaton

Wc

o

te

Pysca

o

te

examnaton

orearm

oowng

and

ner ves

s

sows

wrst

most

lex-

key

afected?

A.

Unar

B.

Medan

C.

Anteror

ead

D.

nerve

o

Deep

at

nerve

Guyon

n

te

cana

carpa

nterosseous

pronator

branc

tunne

nerve

beneat

te

unar

teres

o

te

rada

nerve

beneat

te

supnator

E.

174.

A

Medan

nerve

2 4-year-od

depar tment

coson.

compex

ture

are

s

He

ton.

6.10

171.

s

te

norma.

D.

Osteoma

wc

E.

Osteopyte

apparent

19-year-od

te

o

as

made.

Wat

n

been

two

and.

comes

pan

Pysca

meda

s

ca

and

and

terran.

man

s

ngers.

tranng

a

a

dagnoss

oter

sgns

Sensory

te

o

He

ong

s

on

be

o

on

roug

oss

dorsa

to

aspect

neuropaty

ected

durng

oss

s

pamar

te

aspect

meda

o

te

Weakness

n

abducton

C.

Weakness

n

extenson

D.

henar

E.

Tne

musce

sgn

at

20-year-od

an

practce.

naton

ty

to

He

sows

IP

jonts

a

dgts

on

and

o

o

s

any

tumb

o

o

te

to

te

pyscan

trauma.

tenar

and

dgts.

because

racquetba

Pysca

emnence,

dicuty

Wat

s

n

te

exam-

nab-

lexng

Hypertropy

B.

Pronator

C.

Meda

D.

T enns

E.

Goer’s

most

abe

to

A

o

tps

a

A.

ngers.

tumb

togeter

successuy

as

od

to

He

and

attempts

ndex

sown

a

pyscan

pece

n

o

to

nger

Fg.

paper

because

make

by

6.10.

He

between

s

s

x-ray

11 0 /7 8

mm

sow s

s

we aknes s

o

abduc-

te

m e da

and

 t

 our t

 njur y

s

mos t

an d

and

a ong

te

d g ts.

an d

not

 t

rep are d,

 ke y

ove r

H g.

rep ar

t e

b eco me

ne xt

e w

emnence

at

at

te

te

wrst

MCP

bone.

brougt

ater

a

te

“gutterng”

and

sgns

orearm

Wc

te

He

o

sows

te

pan

most

over

norma

ractures

and

stars

constant

wtn

o

bot

dsocaton

oowng

are

te

as

burnng

are

processes

ndngs

emergency

down

and.

tngng

Vta

styod

motor

nto

stumbng

outstretced

and

o

wt

metacarpas

s

unar

jonts

bones

abnorma

key

to

be

examnaton?

te

and

weakness

tumb,

n

(tngng

meda

Dysestesa

over

tte

nger

over

te

mdde

Numbness

tumb,

pam

and

te

and

to

and

o

and

mdde

te

dorsum

te

aspect

and

te

and

meda

gt

and

te

touc)

tte

n-

tumb

pamar

ngers

border

weakness

dorsa

over

o

te

adducton

te

ngers

ndex,

adducton

n

response

o

aspect

and

o

weak-

opposton

aong

Numbness

n

border

ndex,

tumb

Numbness

and

E.

s

and

ncudng

a

brng-

o

te mpe r a-

re s p rat o ns

s urgc a

 our t

w  

tenar

man

Dysestesa

ger

te

mnutes.

and

on

te

te

Her

add ucton

n e r ve

af e c te d

ours

wrst,

carpa

aong

C.

3

30

An

ness

comes

te

adjacent

on

s

rada

ound

D.

s

s

n

past

and

man

n

ang

sensory

supnator

ebow

jo n ts

metacarpa

30-year-od

key

racture

s

and

n ge r

an d

devaton

department

syndrome

between

te

te

I

devaton

between

ebow

weakness

ng

o

supracondyar

54-year-od

rng

Promnent

B.

A.

o

E.

te

dagnoss?

A

Rada

Unar

te

durng

p re s s ure

oow  n g

o

D.

te

te

w r st.

ve ce

 ncud n g

drop

C.

pan

tumb

racquet

recent

tumb,

Wrst

and

te

te

Fattenng

B.

mts.

comes

atropy

te

a

scapod

grp

denes

oppose

mdde

to

and

atropy

te

man

nabty

one

an d

e m er ge ncy

m oto r

1 1 5/ m n,

exam  n aton

DIP

te

A.

pys-

175.

o

s

a

monts?

proessona

sensory

te

andebar

may

a

because

dstances

sows

dgts

B.

o

pyscan

examnaton?

A.

A

te

examnaton

and

A

to

te

n

r  gt

te

dgts

A

te

aponeuross

te

 njur es

and

te

o

m u t p e

s e n sat on

Condroma

s

n

decreas e d

o

cycst

173.

o

 n voved

stab    ze d

adducton

bcpta

to

p u s e

bo od

are

Fexon

numbness

172.

and

Pysca

here

border

C.

o

(98.6°F),

te

b rougt

sustane d

njures

tumb

Fig.

s

be n g

 ractures

7°C

panned.

•

ater

19/mn,

Hs

beneat

man

n

o

o

te

te

weakness

pam

and

mdde

tumb

o

wrst

and

n

grp

ndex,

strengt

aspect

and

and

ateray

tumb,

pamar

ngers

te

extenson

o

te

weakness

n

CHAPTER

Questions

176.

A

176–186

ment

ater

ebow

sons

o

over

te

and

te

comes

on

and.

a

Pysca

weakness

meda

o

adducton,

one

nger

and

te

a

a

abducton

and

was

nerve

at

meda

B.

Unar

nerve

at

C.

Medan

nerve

n

te

cubta

D.

Medan

nerve

n

te

carpa

E.

Meda

Guyon

o

rng

key

s

ness

sows

and

s

te

key

B.

Opponens

C.

Adductor

njured?

181.

pocs

ongus

brevs

43-year-od

axary

net

naton

Wc

ater

ang

sde

o

ndex,

wt

te

and

mdde

outstretced

on

carpa

o

bones

a

s

compressng

B.

Hook

te

C.

Scapod

amate

Lunate

E.

T rapezod

compressng

bone

o

te

Pysca

te

on

te

te

te

wrst

rada

medan

compressng

cated

Carpa

B.

De

wrst

sows

o

te

182.

artery

nerve

rada

A

54-year-od

woman

ater

coson.

Vta

examnaton

around

owng

te

md-body

areas

w

brougt

nvoved

sgns

brusng

a

s

beng

Pysca

sows

are

sows

neck.

umera

most

to

te

n

a

wtn

sot

An

norma

tssue

x-ray

emergency

motor

o

key

ave

Latera

aspect

o

te

orearm

B.

Meda

aspect

o

te

arm

C.

Meda

aspect

o

te

arm

D.

Posteror

Latera

aspect

and

52-year-od

department

mts.

arm

are

sows

ematoma

key

numbness

mpared

and

et

o

a

a.

a

o

te

racture

te

Vta

and

sgns

and

IP

neck

ste.

C.

Medan

nerve

n

D.

Ineror

trunk

o

E.

Dvsons

wtn

o

o

x-ray

te

Wc

te

te

o

norma

o

et

ngers.

o

radus

nerve

and

tumb,

te

s

rgt

and

Anteror

B.

Deep

C.

Rada

D.

Unar

E.

Superca

and

te

sows

C.

Captate

D.

Hamate

E.

T rapezod

21-year-od

a.

because

Vta

ts

because

te

rgt

exam-

and

a

a

retnacuum.

most

key

a

neck

asso-

snufbox.

comes

are

te

border

Wc

o

nerve

radus

to

n

te

a

et

emergency

motor

and.

tenderness

mm

carpa

Hg.

bone

Wc

o

vece

Pysca

temperature

respratons

ractured

pan

and,

meda

90

pexus

and

Her

129/79

o

te

to

repeat-

tunne

te

sweng

key

o

upper

pexus

n

97/mn,

a

te

brougt

wrst.

we

and.

nvoved

pan

te

mb

epcondye

o

braca

s

te

and

examna-

compressed?

te

s

n

upper

because

and

Pysca

dgts

carpa

beng

arm

dects

te

key

man

sgns

te

to

pyscan

poston

aong

braca

most

T rquetrum

a

s

anatomca

Scapod

A

te

pressure

B.

ment

rada

puse

s

tree

rgt

er

te

dorsa

A.

184.

te

as

a

rada

at

sows

bones

sensory

meda

woman

most

nterosseous

te

ater

te

bood

carpa

afected?

A.

o

(98.6°F),

wrst

o

at

te

er

abduct

most

absent

nerve

Se

s

n

Pysca

lexor

uggage.

axa

Rada

paton

weakness

o

s/are

examnaton

or

to

n

extendng

B.

emergency

o

to

te

nerve

55-year-od

pyscan

atera

te

condtons

reproduced

rom

department

te

over

mantan

and

orearm

jonts

An

to

te

are

extenson

te

racture

to

sows

dects.

at

te

motor

o-

A

o

te

numbness

trauma.

comes

pece

Unar

coson.

o

a

asked

are

to

o

tngng

A.

orearm

brougt

MCP

sensory

at

aspect

s

no

structure(s)

183.

and

mb,

sgn?

damage

and

Wen

lexng

Froment

musce

syndrome

woman

carryng

and

o

syndrome

arm

te

or

te

orearm

examnaton

abducton

no

te

posteror

ater

extenson

here

o

man

Pysca

extenson,

and

nerve

symptoms

mts.

edema

te

racture. Wc

A.

E.

Rada

sows

most

tenosynovts

outet

25-year-od

edy

ve-

sensaton?

A

E.

degrees

department

ce

nger

mb.

nerve

tunne

Quervan

horacc

ton

superca

sgn.

musces

sgn?

Maet

we

Vta

examnaton

Froment

and

story

oowng

ts

D.

o

artery

no

C.

A

Pysca

numb-

and.

oowng

comes

pan

tenderness

te

A.

dsocated?

te

o

o

percusson

wt

rada

Wc

unar

wt

tumb,

nerve

compressng

te

o

o

bone.

key

unar

compressng

D.

tngng

aspect

X-ray

most

Psorm

o

and

carpa

A.

and.

movement

pamar

ngers.

dsocaton

oowng

an

pan

numbness

pam

and

anteror

on

sows

s

sows

ment

woman

story

here

et

pocs

pocs

2-week

er

emergency

and

pocs

Fexor

and.

te

presence

nterosseous

te

311

Limb

ncudng

te

Fexor

o

tunne

te

dorsa

o

to

tngng

o

mts.

E.

A

as

border

D.

dgts

assocated

179.

expans

tumb

tte

brougt

Se

norma

wc

Frst

and

s

a.

abnormates

o

A.

A 29-year-od woman comes to te emergency depart-

examnaton

178.

severa

a

meda

wtn

aso

cana

n

are

woman

ater

te

Weakness

ossa

pexus

aong

pam

epcondye

(unar)

braca

te

42-year-od

department

sgns

o

here

adducton,

o

most

Unar

and

A

abra-

“pns

border

dgts.

DIP

A.

cord

te

te

sows

wt

unar

depart-

njurng

epcondye,

decreased

and

structure

and

examnaton

s

at

emergency

tra

aong

lexon

Wc

te

meda

Sensaton

(parestesa)

and

to

sppery

oecranon,

and.

ngers.

man

ang

and

needes”

177.

180.

25-year-od

Upper

6

are

to

s

19/mn,

X-ray

n

te

pa-

37°C

o

te

te

loor

oowng

ractured?

to

n

wtn

te

te

emergency

rgt

norma

depart-

souder

mts.

ater

Pysca

312

C H A P T E R

6

Upper

Limb

•

Fig.

6.11

•

examnaton

sve

sows

adducton

x-ray

o

Wc

te

o

o

te

te

rgt

te

stretced/torn

reproducton

rgt

arm

souder

oowng

resutng

s

ts

pan

te

sown

structures

n

o

across

most

key

jont

capsue

and

coracocavcuar

B.

AC

jont

capsue

and

coracoacroma

C.

Sternocavcuar

capsue

and

gament

gament

Unar

D.

Medan

Muscuocutaneous

A

14-year-od

department

Pysca

coracoacroma

gament

185.

C.

E.

186.

AC

jont

An

6.11.

njury?

A.

te

D.

Coracocavcuar and transverse scapuar gaments

ton,

E.

Coracocavcuar

and

A

67-year-od

department

Se

as

sows

arm

An

a

ater

story

brusng

wt

x-ray

Wc

woman

o

brougt

er

et

osteopoross.

and

te

te

s

njurng

o

exquste

o

coracoacroma

dmpng

o

tenderness

et

souder

oowng

nerves

to

te

souder

Pysca

te

over

s

s

gaments

emergency

rom

upper

te

part

a.

o

afected

sown

most

a

examnaton

n

key

Fg.

te

6.12.

te

on

sows

ossa.

lexon,

te

brougt

epcondyes

cubta

wrst

o

s

ang

examnaton

opposton

jonts

are

ourt

to

s

pont

and

here

a

s

grp

mpared.

strengt.

dgts

and.

tenderness

weakness

aso

t

emergency

pusate

and

and

te

outstretced

just

on

prona-

humb

lexon

Fexon

s

above

mass

at

norma.

te

An

DIP

x-ray

sows a supracondyar racture o te umerus. Wc

o

te

A.

area.

njured?

boy

ater

umera

above

and

6.12

pas-

cest.

Fg.

n

were

on

Fig.

oowng

Axary

structures

nerve

and

are

most

posteror

key

njured?

crcumlex

umera

artery

B.

Rada

C.

Medan

nerve

and

nerve

A.

Rada

D.

Superca

B.

Axary

E.

Unar

A.

Scarpa

rada

nerve

deep

and

and

braca

braca

nerve

unar

and

artery

artery

rada

artery

artery

A n swe r s

Answers

1.

1–25

D. he suspensory gaments o te breast, aso known

as

Cooper

te

pectoras

te

ay

be

gaments,

derms

te

major

breasts

due

o

to

repared

brous

to

musce

aganst

te

are

skn

and

gravty.

stretcng

wt

te

pastc

bands

deep

are

prmary

Ptoss

o

o

tese

surgery.

tat

asca

te

run

rom

coverng

supports

breast

gaments

s

B

and

te

are

or

te

usu-

and

can

asca

superca

C.

breast

structure

ments

ng

he

musces

o

te

tat

but

o

te

o

membranous

te

pectoras

move

do

te

te

s

asca

te

not

breast,

breast

pectoras

anteror

major

and

upper

provde

major

to

drect

te

musce.

o

pectoras

mb

atoug

attac

ayer

abdomna

te

and

e

mnor

deep

support

to

suspensory

pectora

te

wa.

asca

to

te

ga-

cover-

CHAPTER

E.

he

serratus

te

anteror

movements

o

musce

te

s

nvoved

scapua,

or

n

A.

te

protracton.

GAS

2.

A.

he

and

o

133,

B.

140–142;

ower

C6

nerves.

subscapuars

scapuars

sbe

or

eson

and

and

ts

188;

It

te

teres

adductng

o

N

subscapuar

spna

nerve

teres

major

meday

woud

resut

are

C5

weakness

arm.

n

he

axary

5

mnor

te

trbutes

mnor

to

arm

o

rada

D.

n

he

te

GAS

5.

A

te

he

nous

o

te

te

responsbe

GAS

te

he

crana

o

and

teres

and

nerve

ormed

and

te

N

and

drome

s

417;

and

and

attac

Bot

and

t

mus-

D,

te

to

he

o

or

ABR/McM

(and

nner-

and

ongus,

are

nner-

atera

rotaton

te

by

a

nerve

he

bones.

Carpa

contans

lexor

n

te

te

carpa

tendons

dgtorum

supercas

s

syn-

musces

are

a

III

nnervated

and

by

te

and

unar

Fracture

damage

to

nner vates

on

to

and.

o

one

N

te

and

unars

a

ABR/McM

ner ve

te

and

most

due

musces

te

to

te

he

ts

he

n

meda

musces.

o

168

epcondye

epcondye.

a

proundus

nner vate

455;

meda

unar

bend

carp

dgtorum

799;

te

groove

lexor

neck

te

a

can

poston

unar

orearm,

o

ner ve

ntrnsc

te

n

ner ve

te

lexor

contnues

musces

n

te

artery

and

nerve

at

artery

tat

and

o

te

te

can

occurs

partay

umerus

posteror

can

crcumlex

nerve

can

be

njured

t

artery,

te

n

es

and

nerve

meda

by

to

s

to

te

troug

te

te

wnds

Injury

axary

nerve

posteror

around

to

te

te

surg-

nerve.

perces

te

between

musce.

atera

njury

musce.

descends

bracas

artery

procedure.

medan

posterory

umerus.

and

te

resuts

te

accompaned

damage

as

o

ebow

passes

te

toracc

152

oten

bracas

space,

o

atera

mastectomy

course

te

te

musce

and

a

racture

umera

may

and

durng

nerve

orearm

he

rada

he

unar

duces

GAS

ner ve

o

It

coraco-

te

bceps

contnues

antebraca

courses

te

C. he

ong

and

anteror

umerus,

passes

around

o

te

to

nto

cutaneous

te

troug

nerve

eads

and

It

te

atera

cubta

o

te

o

nterosseous

o

radus

te

dsta

to

and

nto

te

on

te

nerve.

trceps

te

and

ep-

pro-

to

enter

rada

te

and

Some

ateray

two

te

te

as

com-

ossa,

brances.

wnds

to

trceps

cubta

nnervates

reer

umerus

anteror

te

te

musce

te

deep

nerve

musce

te

o

te

between

and

supnator

o

eads

enters

between

brac

back

atera

runs

musce

orearm.

meda

151

posterory

superca

te

and

te

njured

symptoms.

eventuay

branc

easy

ABR/McM

descends

dvdes

bend

s

descends

meda

supnator

musces

438;

nerve

musce.

t

bone”

and

neroateray

te

deep

descends

groove

N

atera

partment

he

ts

752;

rada

and

were

nerve

n

“unny

750,

brac

cause

braca

and

on

umerus.

racture

neck

and

muscuocutaneous

between

788–789,

on

neck

condye

ter

and

and

ocated

te

njury

because

ossa.

E.

lexor

IV ,

nerve

o

n

artery

groove

nerve

he

and

epcondye

tunne.

and

bra-

nerve.

D.

medan

o

spra

ABR/McM

nerve.

artery

he

te

and

proundus,

musces

umbrcas

422;

axary

brac

7.

nterosse,

toracc

N

medan

ca

II)

tunne

tunne

o

te

752;

surgca

o

te

dsocaton.

supracondyar

he

te

153

resut

braca

md-body

surgca

damaged

crcumlex

runs

retnacuum

compresson

space

and

wc

carpa

lexor

be

bracas

I

te

axary

quadranguar

abducton,

nerve.

te

A.

by

artery.

ong

braca

supraspna-

arm

o

te

anteroatera,

greater

seats.

ypotenar

A

can

outstretced

souder

he

150

medan

carpa

tunne

E. he

B.

an

bot

ABR/McM

supracondyar

n

GAS

6.

on

nnervated

nnervates

deep

medan

a

s

racture

or

suprascapuar

a

by

musces.

437;

te

he

may

nrasp-

te

umbrcas

tunne.

by

reduced

dgtorum

synova

D.

E.

musces

te

to

musces

nerve.

aows

te

carpa

by

carpa

lexor

by

caused

due

pocs

4.

D.

N

and

o

by

racture

njure

o

nnervated

ebow.

umera

cord

eevates

nraspnatus

ntaton

musces

te

A

orearm.

XI,

wc

supraspnous

or

anterory

posterory

GAS

B.

a

musces.

anconeus

o

ang

lexed

nerve

rada

te

by

he

branc,

to

and

con-

arm

te

surace

caused

C.

nnervated

he

n

Injury

te

suprascapuar

tenar

nerve

e

musce

umera

nerve

be

and

posteror

argest

musce,

nraspnatus

troug

B,

te

753–758;

rada

s

nerve.

supnator

md-body

te

A.

rada

and

teres

souder.

703–706;

are

s

umerus.

by

te

te

spna

arge

pane.

o

extensors

respectvey,

te

any

group

te

s

brac

he

741,

A

tey

scapua.

tus

s

n

brac

te

nerve

vated

and

A,

and

rom

ossae,

tuberce

C.

te

s

trceps

supraspnatus

orgnate

3.

te

It

trapezus

depresses

E.

C.

to

tese

and

souder,

rotator

rom

cervca

detod

musce

te

cuf

arses

pexus.

accessory

vates

atera

rotator

arm

o

movement

a

rom

te

detod

surace

s

te

arses

nnervates

he

nerve

nnervates

aso

and

entre

braca

ces

6

musce

member

te

nerve

and

musces.

covers

he

E.

posteror

nerves

C.

and

supercas

313

Limb

nerve.

bceps

coradas

sub-

respon-

te

C

border

he

bot

rotatng

n

te

ower

musces.

musces

dgtorum

muscuocutaneous

rom

te

lexor

medan

he

185

arses

nnervates

major

and

nerve

ABR/McM

motons.

B.

he

exampe,

Upper

6

deep

te

eads

extensor

rada

posteror

314

C H A P T E R

B.

6

he

Upper

anteror

medan

pronator

to

D.

be

to

ton

n

te

ts

ts

njury

lexor

nerve

o

te

does

skn

arses

rada

pocs

none

rom

a

o

te

ongus,

o

wc

o

causes

not

may,

and

8.

B.

he

te

as

resut

he

atera

a

caracterstc

n

oss

mb,

o

t

njured

be

abe

rada

C

sensa-

to

proxma

777,

to

11.

prox-

extend

to

te

were

antebraca

orearm

brac

musce.

te

n

N

435;

suppes

wc

to

s

ts

and

are

sde

Injury

te

orearm

A

rom

and

te

eferents

B,

most

te

bceps

lexors

te

wc

orearm

poston).

resut

and

te

he

supnator

n

at

weakness

atera

to

Injury

te

n

orearm

te

rada

to

and

te

nerve

a

medan

dgtorum

woud

resut

caracterstc

nerve

causes

supercas

n

wrst

weak-

and

o

he

atera

to

nerves.

or

cord

te

o

te

braca

muscuocutaneous

here

weakness.

s

no

ndcaton

Injury

to

te

pexus

and

o

atera

gves

atera

pectora

cord

can

orgn

B.

pectora

atera

branc

not

o

antebraca

te

suppy

muscuocutaneous

any

motor

muscuocutaneous

oow

GAS

9.

749;

penetratng

N

465;

can

synova

o

tumb

lexor

may

spread

pocs

aone

and

Injury

unusua

be

to

te

but

can

to

te

tendon,

and

B.

he

supercas

te

D

common

and

pocs

E.

tendons

and

synova

Neter

brevs

lexor

te

tendons

T enosynovts

n

te

atera

te

te

synova

seat

known

as

te

o

rada

te

lexor

seat

carp

are

or

unar

radas

contaned

792–793;

dgtorum

enveoped

n

n

bursa.

13.

D.

451;

ABR/McM

145

and

N

te

te

ngu-

perneum

ymp

nodes

tssues

o

185

deep

and

are

sx

s

upper

wt

one

a

crcumlex

s

o

anastomoses

as

oter

and

te

te

ower

It

anas-

artery.

artery,

pertoneum,

branc

te

wa.

ac

te

jons

artery.

suppes

musces

abdomna

artery

usuay

known

t

yng

posteror

termna

(aso

toracc

sma

spaces

artery

te

ntercosta

and

and

tweve

ntercosta

ower

artery

te

and

termna

and

te

wt

n

t

sup-

anteror

te

tendon

artery

can

rada

pocs

brevs

neror

accompanes

te

be

can

o

te

tora-

atssmus

te

dors

et

tendons

puse

radas,

aganst

be

pocs

be

rada

carp

aso

te

can

pec-

189

lexor

extensor

artery

te

compressed

between

atera

wa.

papaton

o

te

major,

anteror.

toracc

puse

and

rada

artery

aong

pectoras

suppyng

ABR/McM

or

runs

te

serratus

atera

197;

artery

suppes

nerve

snufbox

o

te

n

te

ongus

compressed

s

were

dsta

te

ana-

extensor

musces,

aganst

te

scapod.

nor

lexor

A, B, C, E. Pamars ongus, lexor pocs ongus, lexor

synova

lexor

dgtorum proundus, and lexor dgtorum supercas

tendons

N

and

ctors.

superca

posteror

artery),

toracc

and

he

te

n

he

artery

nterna

and

tomca

were

te

toracc

wa

mnor,

te

rada

radus.

o

epgastrc

ocaton

to

or

superca

anastomoss

toracodorsa

he

some

nodes,

artery.

wa

156;

te

wa

eferents

mb,

pens

superca

borders.

dapragm,

codorsa

o

musces

lexor

are

he

GAS

an

seats.

GAS

E.

o

te

vens.

cest

receve

ower

o

te

resut

wtn

nodes.

nguna

upper

wereas

te

te

atera

toras

necton

aso

o

proundus

he

musce

dgts.

troug

te

cest

does

bursa.

A

D.

a

150

due

o

epgastrc

njures.

te

ongus

s

superor

abdomna

s

te

arteres

dapragm,

wt

resut

nerve

nerve

nnervaton.

nerve

ABR/McM

C. T enosynovts

seats

cutaneous

te

anteror

nodes

group

o

are

deep

ymp

gans

o

nterosseous

superca

structures

te

an

spaces

pes

weakened adducton and meda rotaton o te arm.

he

o

mammary

parayss

n

te

160

ABR/McM

ower

nterna

branc

weakened lexon and supnaton n te orearm, and

416;

muscuoprenc

he

te

o

te

most

eac

percardum,

emnence.

o

group

branc

tomoses

tenar

nvoves

ntercosta

arteres,

lattenng

te

artery

axary

rom

orms

ntercosta

o

skn

drans

N

and

space

nterna

oter

are

medan

ossa.

arteres

nguna

rom

n

lexors n te orearm and resuts n a caracterstc

bot

E.

upper

te

anteror

superca

vertca

two

he

rada

orzonta

nodes

coatera

o

parayss

musce

A.

ossa

and

mb.

ntercosta

drop.

and

cubta

ympatcs

anteror

eac

cubta

artery,

ABR/McM

te

dranage

737–738;

arteres,

te

to

te

he

te

braca

438;

deep

ymp

C. he

and

te

N

rom

te

te

V enpuncture

he

ower

GAS

12.

o

deep

E.

to

unar

rom

ymp

receve

contnues

poweru

woud

lexon

E.

wereas

common

drans

te

C,

te

extenson

lexor

Lymp

tr-

ABR/

nerve,

o

anatomca

nerve

ossa.

prmary

oss.

ened

D.

he

o

braca

meda).

dsta

758–760;

er

te

nerve

cutaneous

atera

te

musce

Injury

supnaton

sensory

to

E.

to

he

arse

ympatc

792;

nerve

musces,

D.

contents

tendon,

burcaton

GAS

groove.

752,

(atera

cubta

key

ce

brac

and

te

s

very

nerve

muscuocutaneous

sensaton

te

bceps

D.

750,

not

arse

rada

bracas

ebow.

(wt

C.

te

were

te

tree

and

na

and

te

A.

o

muscuocutaneous

suppes

o

woud

musce

n

B

161

brac

o

runs

nerve

emnence.

upper

nerve

brances

733–745,

McM

rada

woman

he

brac

nerve

GAS

te

te

ebow.

ceps

I

he

arteres

tenar

te

A.

bceps

seem

tat te superca branc o te rada nerve s not

njured.

10.

lexor

exampe.

medan

te

te

musces,

(atropy)

over

nerve

suppes

proundus,

lattenng

Because

and

quadratus

njured

Injury

E.

nterosseous

nerve

dgtorum

Limb

GAS

are

772,

not

818;

used

N

to

437;

ocaze

te

ABR/McM

rada

169

puse.

CHAPTER

14.

A.

he

lexor

nnervated

gers

and

ngers.

te

t

woud

resut

ts

B.

s

medan

and

assst

he

dgtorum

he

can

o

GAS

and

o

an

DIP

te

he

to

njury

o

D.

tumb

lexes

lex

IP

acts

lexes

te

ngers.

te

MPtop

te

and

to

by

te

by

and

a

te

meday

te

ngers

movng

te

IP

to

te

emnence,

jonts

te

GAS

o

o

te

s

on

te

an

era

o

te

o

controed

nerve,

te

by

dgts

wc

s

not

njured

C.

Medan

neous

E.

he

ay

GAS

16.

B.

he

deep

te

he

to

he

ong

posteror

nerve

meda

as

easy

sub-

rom

te

ventra

contrbute

to

te

nerve.

wt

to

rom

band

ormng

capsue

a

te

o

te

encr-

te

o

tat

coat-

ebow.

he

dspacement

umerorada

o

body

tat

coar

rada

prevent

te

ead

te

to

te

149

uses

te

o

radus

te

s

jont.

amost

bone,

so

te

dsocate.

C.

he

s

jont

and

ng

D.

ts

does

not

nterosseous

between

te

tese

he

uncton

membrane

radus

two

rada

atera

not

trave

E.

vertca

wa

bones

and

unar

n

ts

s

a

tat

stabzaton.

brous

asssts

ayer

n

od-

togeter.

coatera

epcondye

gament

to

te

extends

annuar

rom

gament

te

o

te

he unar coatera gament s a tranguar gament

cord

and

nerve,

n

s

nerve

does

not

usu-

18.

E.

ts

o

patent

te

te

axary

nerve

rom

o

he

o

s

te

ts

aganst

serratus

te

caed

he

te

njury

by

asssts

pane

of

nerve,

does

C5

and

not

to

C7

te

n

A,

ong

beng

nerves,

rada

arse

to-

nerve.

rom

ventra

rse

te

spna

he

o

D.

or

te

spna

resuts

lexon,

aso

and

ventra

any

o

an

a

to

te

wt

rotaton

braca

ram

s

dicut

njury

atera

Erb-

and

presentng

te

tese

as

and”

ater

rom

o

7.72).

known

tp

pexus,

trunk

nerve

to

s

and

154

cdren

braca

superor

Injury

7.73A

“water’s

n

usuay

o

abducton,

arm.

C,

descrbed

common

hs

Fgs.

ABR/McM

o

pexus

C5–C6.

structures

woud

pasy.

te

GAS

19.

gves

B,

(GAS

428;

not resut n te cassc presentaton o Erb-Ducenne

rotaton

tat

o

una

N

parayss

trunk

conssts

aganst

te

so

pexus

subscapuar

oss

ress-

superory.

braca

upper

anteror

scapua

nnervated

devery.

scapua

scapua

puses

anteror

more

o

753–755;

reatvey

orzonta

ower

but

ranon

GAS

168

wa.

and

o

cuta-

Ducenne

border

te

o

dgts.

“Wngng”

serratus

drected

cord

rada

patent

meda

3½

oss

wrst.

border

te

toracc

roots.

te

te

descrbed

he

upper

racodorsa

o

to

above

posteror

te

does

nvove

rada

ABR/McM

cest

s

nerve

woud

te

scapua.

a

te

nerve.

ossa

on

wen

as

scapua

genod

A.

te

wa

posteror

te

dsta

463;

ods

toracc

radus

age,

not

brous

radus,

and

aspect

nerves,

braca

tat extends rom te meda epcondye to te oec-

damage

branc

o

suc

musce

o

N

wen

cest

tance,

te

nterosseous

condton

occurs

a

artcuar

dameter

reatvey

s

te

major.

ormed

toracc

subscapu-

spna

o

aso

he jont capsue unctons to aow ree rotaton o

wrst.

nerve

trave

“wngng”

te

te

sensaton

808;

s

ower

w

unctons

te

ts

s

C6

te

s

nnervates

ower

cord

teres

rom

It

te

ong

radus.

anteror

to

same

ong

una

and

o

nerve

te

gament

o

te

te

ABR/McM

o

to

posteror

gament

te

C5

and

rse

o

te

pexus.

he

com-

B.

hese

n

to

rom

to

brances

nerve

s

gves

trunk

bers

braca

C8–T1

te

417;

ead

ead

te

branc

o

nerve

musce.

and

upper

suppy

te

nnervates

toracc

N

cd

ead

does

ngers

deep

a

te

te

trape-

ngers.

te

te

In

te

C5–C7.

gament

I

nerve

te

te

o

dors

musce

annuar

annuar

oppose

medan

716;

he

lexor

oppose

oter

can

between

adducton

are

brevs,

cannot

tat

te

paper

A.

attaces

dstrbuton.

o

o

pads

motor

musces.

one

metacarpa

branc

pece

pocs

s

wc

pocs

musce

rst

nerve

o

not

and

315

Limb

pexus

roots

he

toracodorsa

rom

ong

braca

nerve

nerve.

does

orgnates

and

te

C6

subscapuar

te

ormaton

ces

medan

parayzed,

cutaneous

unar

te

abductor

ony

recurrent

test

o

as

nerve

he

and

169

opponens

s

te

a

E.

o

and

dvson

atssmus

pexus,

patent.

dsta

nerve.

mdde

ram

extendng

tenar

te

tumb

s

smpe

he

toracc

scapuars

lex

abduct

we

branc

o

movements

B.

pexus

brances

jonts

C5

braca

ar

jonts.

trunk

te

suprascapuar

known

wrst.

ABR/McM

and

te

ts

he

o

te

MP

to

te

o

musce

o

posteror

17.

pocs

Hodng

a

te

caused

o

ave

at

adduct

437;

brevs,

pad

te

he

dgto-

tat

upper

prsed

unar

jonts

lexor

musce

C.

n-

ndex

te

Suc

te

ony

jonts

unars

and

lex

N

opponens

because

IP

uncton

carp

musces

pocs

A.

lex

because

te

extendng

recurrent

te

not

course

duay

two

ngers.

771;

zum.

n

te

aso

eevaton

te

mdde

supercas

dsta,

nterosse

te

D. he

not

lexor

devate

to

s

to

s

meda

aceraton.

dgts

musce

umbrcas

and

15.

te

superca

to

musce

te

te

lexor

he

E.

to

or

nabty

t

proundus

proxma,

D.

nerve

te

an

nerve

jont.

he

C.

o

n

proundus

unar

vunerabe

ourt

rum

te

Because

nerve,

te

dgtorum

by

Upper

6

727–736;

C. he

te

skn

rng

A.

N

superca

o

te

420;

ABR/McM

branc

tte

o

nger

te

and

145

unar

te

nerve

meda

suppes

sde

o

te

nger.

he

superca

cutaneous

sum

ts

o

over

branc

nnervaton

te

te

and

and

proxma

o

te

to

te

rada

te

rada

and

nerve

rada

two

mdde

provdes

(atera)

and

a

a

paanges.

dor-

dg-

316

C H A P T E R

6

Upper

Limb

dgts,

te

D.

and

te

second

part

o

he

deep

te

radas

dsta

ourt

brevs

jont

nterosseous

rada

Radial

dsta

as

we

paanges

as

te

o

atera

dgt.

suppes

supnator

musces

nterosseous

wrst

o

nger

nerve

and

extensor

aspect

trd

rada

posteror

te

dorsa

and

(note:

nerve

beore

nerve,

some

as

te

extensor

musces

and

a

contnung

wc

s

consder

synonymous

carp

o

te

as

te

sensory

te

to

posteror

wt

te

deep

nerve).

collateral

E.

he

recurrent

branc

o

te

medan

nerve

suppes

ligament

te

abductor

pocs

brevs,

lexor

pocs

brevs,

Ulnar

and Anular

ligament

collateral

of

ligament

GAS radius

20.

B.

of

683–687;

he

dons

Sacciform

opponens

synovial

gus.

N

463;

anatomca

o

te

abductor

recess

pocs

he

loor

s

ABR/McM

snufbox

extensor

pocs

musces.

pocs

ongus,

s

brevs

and

ormed

by

169

ormed

te

te

by

te

ten-

accompanyng

extensor

scapod

pocs

bone,

te

on-

and

t

membrane

s

ere

tat

scapod.

pan

o

Wtn

at

greatest

te

GAS

Fig.

A.

.A

C,

he

unate

n

te

D,

E.

GAS

E.

he

s

o

to

6

possbe

weeks

n

wt

te

te

a

most

ractured

ater

njury,

detecton

scapod

bone

o

racture

avascuar

scapod

retrograde

te

a

deveopng

o

captate,

necross

due

to

an

vascuature.

commony

amate,

commony

791–792;

he

unar

wc

Fat

ts

2

mted

Patents

part

or

dsocated

bone

wrst.

as

21.

to

rst

are

rsk

proxma

papate

te

ractures.

nterrupton

•

can

radograps

scapod

are

one

N

434;

nerve

adduct

as

ABR/McM

nnervates

te

and

ractured

are

not

scapod.

174

te

ngers.

trapezod

te

pamar

hs

s

te

nterosse,

movement

pads

tat

A.

woud

he

te

B.

nerve

te

paper

does

not

between

nnervate

te

ngers.

musces

o

and.

he

Synovial

mantan

axary

medan

nerve

umbrcas,

te

cs

and

brevs,

None

o

tese

suppes

opponens

te

lexor

musces

te

rst

pocs,

pocs

woud

and

second

abductor

brevs

afect

te

po-

musces.

abty

to

membrane

od Annular

a

pece

o

paper

between

te

ngers.

ligament

C and D. of

not

suppy

GAS

22. Sacciform

799;

D. he

muscuocutaneous

musces

N

455;

o

te

and

rada

nerves

do

and.

ABR/McM

supraspnatus

musce

171

s

one

o

te

our

rotator

recess

cuf of

he

radius

musces—te

oter

tree

beng

te

nraspnatus,

synovial

teres

mnor,

and

subscapuars

musces.

he

tendon

membrane

o

s

te

supraspnatus

oten

musce

woud

A.

GAS

Fig.

he

te

s

reatvey

souder

abducton

ts

o

te

s

avascuar

dsocated.

arm,

and

and

hs

damage

movement.

coracobracas

coracod

body,

.

wen

ntates

mpar

te

•

njured

musce

process

unctons

n

musce,

to

te

wc

umerus

adducton

and

runs

near

rom

ts

lexon

md-

o

te

arm.

B.

he

common

medan

pamar

nerve

and,

pamar

dgta

nnervate

te

pamar

te

brances

atera

surace

o

aspect

te

o

te

o

te

rada

3½

B.

he

s

ts

to

man

uncton

extend

ong

ead

te

can

o

te

orearm

aso

trceps

at

ep

te

n

brac

ebow,

arm

musce

atoug

extenson

and

CHAPTER

adducton.

afect

C.

he

pectoras

sory

and

E.

not

E.

706;

he

major

rotate

N

415;

o

ment

te

te

s

A.

tendon

te

ead

woud

not

can

and

AC

o

te

t

te

acces-

to

scapua

to

adduct

and

rarey

contrbutes

superor

wt

te

coracoumera

te

te

te

he

nstead,

te

n

n

te

anteror

subscapuars

te

contrbute

D.

he

ar

notc

natus

GAS

24.

A.

a

wt

o

o

wt

E.

sensory

nerve

nger.

ar

te

sory

scapu-

brances

wc

te

o

orms

he

te

tese

musces

te

roo

te

o

nerve

to

GAS

Answers

26.

to

te

s

te

lexor

carpa

not

aso

n

Compresson

be

because

to

o

attrbuted

te

toms

ts

to

musce

pexus.

woud

rater

tan

te

braca

pressure

In

s

ocated

addton,

ncude

te

rom

and

te

oca

posteror

braca

oter

upper

symptoms

A.

B.

to

GAS

25.

ncreasng

788;

C. he

ments

ceps

N

o

te

brac

te

cervca

compexty

452;

rada

o

ABR/McM

nerve

arm

o

proxma

te

to

te

rada

It

te

and.

nerve

and

ter-

deep

o

te

ts

sensory

te

te

brances.

1½

does

te

not

carp

dgtorum

Addtonay,

on

key

dvson

lexor

lexor

meda

dgts

It

most

to

ts

dgts

dorsa

suppy

sen-

on

te

aspect

extensor

422;

ABR/McM

152

brac

nerve

s

by

o

o

he

on

ts

te

te

te

case,

atera

t

ore-

contnuaton

as

te

name

“muscuar”

nerve

o

and

brevs

te

n

o

atera

“muscuo-

te

ngers

woud

musce

nnervated

arm

and

not

are

be

med-

afected

te

by

te

lexes

te

tumb

recurrent

branc

nerve.

te

ngers

s

ngers,

perormed

nnervated

by

by

te

te

ong

medan

nerves.

te

a

braca

meda

drect

o

te

meda

antebraca

branc

o

te

orearm

s

cutaneous

meda

cord

pro-

nerve,

o

te

pexus.

N

421;

deep

between

dsta

bra-

man

Because

n

to

(known

nerve).

s

nnervaton

by

735;

te

nerve

t

pocs

medan

unar

he

damaged

te

te

nserts

supnator.

abducton

unar

many

te

brac

are

orearm.

and

te

and

GAS

te

s

wc

percepton

supped

n

bceps

mportant

sensory

nnervates

nstance.

usuay

E.

he

nerve

musces,

te

ABR/McM

branc

two

parts

o

o

151

te

te

rada

nerve

supnator

courses

musce

and

s

ocated just meda and dsta to te atera epcondye.

compart-

suppes

groove,

patent

ony

a

2½

cutaneous

lexor

Ater

extensor

ts

vded

ts

ead

by

Sensory

symp-

aso

o

wrst.

ndcates

he

and

E.

dsta

symptoms.

orearm.

te

woud

oca-

sensory

pamar

rada

superca

superca

to

and.

an

s

Fexon

not

169

nnervates

and

spne

and

N

o

wc

lexors

27.

Osteoartrts

and

te

ts

orearm.

s

muscuocutaneous

n

C.

tese

n

oss

ated

be

case.

D.

descrbed

lexors

proxma

suppes

meda

ebow.

Adducton

dects,

descrbed

and

te

te

s

“cutaneous”

brac

pexus

mb

to

o

and

te

cutaneous”

nerve

coud

trceps

o

antebraca

tunne.

pexus

te

n

bceps

at

arm,

te

w

n

te

nerve

muscuocutaneous

and

radus

symptoms. It does not provde sensaton to dgts 1 to 3.

C.

te

750;

lexors

retnacu-

mpcated

as

up

26–50

D. he

tunne.

rada

are

provdes

dgts

mpared,

nerve

meda

735,

eads

tenar

pam

te

s

muscuocutaneous

nnervated

carpa

proxma

o

to

te

conjuncton

are

ngers

mdumera

and

ossa

nto

rada

(motor)

aspect

te

cas

compartment

te

branc

proxma

unar

lexor

te

nerve

n

to

nerve

o

medan

dects

proxma

n

medan

musces

te

o

pamar

of

he

te

nner-

orearm

mdde

nnervates

3½

cubta

dstrbuton

musces

suprasp-

aso

atera

te

and

pamar

te

nnervaton

and

and

sensory

and

not

musce.

te

arm

Symptoms

to

nerve

dvdng

unar

unars

142

ngers

to

tese

nnervaton

usuay

E.

rng

because

medan

and

wt

to

due

musces

te

nerve

deep

he

ocated

woud

crosses

sensory

mdde

unctonng

because

B

suppes

and

nnervaton

norma

um

contact

te

by

njured

deep

and

supraspnatus

gament

ABR/McM

expans

orearm

te

te

n

Compresson

norma

Aso,

nerve

te

tunne

te

by

not

415;

ndex,

motor

emnence.

carpa

s

N

medan

provdes

o

scapuar

to

extng

rada

tendon.

tumb,

atera

njury

and

693–694;

he

te

to

transverse

capsue,

prmary,

are

mb

medan

as

supraspnatus

bands

ndex,

ngernas.

tenar

proundus

or

genoumera

musce

he

and

te

too

provdes

eson.

tendon

contact

ocated

aso

posteror

317

Limb

branc. Because bot motor and sensory uncton o

nto

not

te

o

acromon

s

s

upon

gaments

B.

It

te

tumb,

dsta

mnates

o

genoumera

te

Upon

ga-

eroson

as

D.

tendon.

C.

o

o

te

ere.

o

dorsa

eve

n

ntact

nnervaton

tendon.

gament

mpnge

te

and

gament.

cavce,

supraspnatus

or

to

ts

damaged;

musce

connectng

he

as

ton

dspace-

Because

be

te

to

orearm

nlammaton

te

muc

A

under

o

s

vaton

we

143

supraspnatus

to

an

extenson

ony

unctons

umerus.

w

ort

as

stabze

gament

cause

end

anterory

to

preventng

gament,

atera

unctons

arm.

arc,

te

and

musce

strong,

o

back

te

ong

abducton.

ABR/McM

ead

very

he

B.

te

gament

moves

n

coracoacroma

coracoacroma

ment

ts

musce

musce

nvoved

teres

meday

23.

to

mnor

respratory

s

he

GAS

Damage

abducton.

Upper

6

te

so

tr-

ebow

te

te

nerve

posteror

ypertropy

nerve,

emerges

rom

nterosseous

o

causng

te

pan

te

nerve.

supnator,

and

supnator

It

can

wc

weakness.

be

t

s

caed

rrtated

compresses

by

te

318

C H A P T E R

A.

6

he

Upper

unar

meda

lexor

B

and

lexor

D.

nerve

courses

epcondye

carp

C.

Limb

and

unars

he

ateray

contnues

bend

anteror

te

to

32.

te

nerve

he

brevs

musce.

medan

B.

te

passes

nto

te

orearm

A.

era

superca

aspect

cause

o

pan

te

rada

te

due

nerve

posteror

to

courses

orearm

pressure

apped

down

and

to

te

at-

woud

not

te

C

GAS

28.

B.

782;

he

pa

and

ments

N

C

s

ABR/McM

te

o

anterory.

te

and

trum

469;

because

entrapment

wtn

are

most

ts

posteror

E.

hs

161

he

GAS

commony

sape

and

dsocated

reatvey

dsocaton

neuropaty

carpa

E.

may

nvovng

te

weak

resut

car-

ga-

n

medan

33.

an

o

te

GAS

29.

A.

reatvey

dsta

783;

he

B.

he

C.

he

N

te

D,

o

te

scapod

and

trque-

he

motor

nerve

deep

o

731;

contracton

extenson

o

extensor

paanx,

te

dgt

s

attaced

son

A.

s

roots

and

jont.

te

torn

and

n

te

dgta

te

rada

B.

respectve

Vncua

rom

can

D

onga

te

carry

and

E.

supercas

o

te

act

to

GAS

31.

E.

o

lex

A,

A

IP

racture

te

unate

B,

C.

dspaced

GAS

te

suppy

te

proundus

are

te

dsta

to

te

o

t

te

s

an

medan

te

n

he

a

C,

N

te

o

te

on

te

nerve

pamar

761–764;

GAS

36.

connectons

N

dsta

dsta

radus

o

and

n

n

brevs

are

te

trd

com-

n

te

sxt

te

s

tr unk

175

njured

by

tracton

pexus.

neror

ormed

typcay

B.

he

C8

eve

and

tus

on

meda

(ower)

by

assocated

sted

bones

trunk

and

T1.

wt

te

by

te

atera

GAS

ABR/McM

173

to

racture.

be

te

te

and

te

o

ateray.

arses

rom

te

rada

rada

te

w

ts

s

w

bot

ead

to

Weakness

s

not

lexed,

men-

nger

because

tenson.

s

and

aso

ncreased

t

groove

wrst).

weakened

s

nner-

groove.

musce

wrst

under

grp

radas

a

158

njury

are

are

rada

ongus

wen

Note

wen

te

ow

your

lexed.

ABR/McM

passes

152

down

unar

and

coatera

N

o

te

nerve

te

D.

te

arm

are

artery

braca

nto

recurrent

wt

t

dgt

s

by

to

coatera

and

accom-

te

rom

te

te

neror

ebow.

158

produced

nterosseous

nnervated

proxma

arses

wt

to

deep

rada

orearm.

artery

anteror

te

te

unar

artery

te

ABR/McM

pamar

rom

wt

neror

anastomoses

artery

te

arses

rada

he

nerve

438;

trd

nterosse

artery

anastomoses

te

medan

artery

o

unar

te

te

te

artery

rada

lexor

carp

musces

atoug

not

coatera

branc

C. Adducton

o

n

hs

I

te

he

by

extensor

to

extend

o

431;

artery

745–747;

tracton

are

versus

N

anteror

unar

dspaces

to

n

nerve.

nerve.

pocs

strengt

braca

rada

panes

devaton

rada

ABR/McM

occur,

strengt

145

nnervated

nerve

to

spna

pasy.

umerus

dsta

tumb.

grp

ebow

he

not

queston.

809;

te

njury

C7

nerve.

artery

and

422;

aso

An

te

supnator

rada

te

deep

rada

te

N

extended

752,

te

unar

nerve

tendons

your

unar

unkey

Smt

and

s

and

(nabty

lexor

to

s

te

abductor

te

o

bracoradas,

te

woud

n

by

trunk.

nvove

ABR/McM

njury

rada

o

braca

175

oten

are

te

mdde

usuay

Kumpke

420;

racture

n

777;

drop

he

surace

N

musce

recurrent

lexor

typca

he

to

te

woud

brevs,

te

767,

he

dgtorum

wt

segment

drecton

442;

A.

tat

respectvey,

ABR/McM

by

grp

E.

454;

E.

and

muc

37.

oter

o

ocated

braca

wc

are

rater

Injury

ong

avu-

paanx

lexor

paanges,

D,

lexon

dsta

bone.

D.

A.

a

resuts

toned

lexor

s

but

tendons.

te

hs

unars

o

dsta

jonts.

o

pam

to

o

799;

s

been

te

orms

md-body

wrst

tendon

te

by

bandke

tendons

nsertons

and

777–778,

toward

te

and

mdde

o

cord

nerve

te

sender,

lexor

bood

he

s

ABR/McM

as

(upper)

C7

extensors

te

rom

pece

A

GAS

35.

dgts.

are

deep

435;

exus,

729–736;

vated

pro-

suppy umbrca musces and carry sensaton rom

ter

N

cord

C6

carp

B,

157

tendon,

brances

D.

parayze

Wen

a

A.

wrst

pamar

pocs

compartment

ndcs.

unars

contnuaton

and

ongus

predomnanty

lexon

I

ds-

racture.

he

te

groove

nerve,

mecansm

torn

nto

arses

eves.

nerve

ABR/McM

s

34.

eves.

extensor

DIP

GAS

C5–C7.

s

C7

coursng

C5–C8

463;

te

carres

eves.

nerve

carry

musce.

to

T1

ner ve

unar

bers

pued

paanx

and

C6,

te

dgtorum

proundus

te

C5,

o

te

te

nerve

muscuocutaneous

te

N

dgtorum

C8

nerve

o

extensor

ongus

dgtorum

extensor

carp

trunk

posteror

nerve.

cutaneous

te

sensory

rom

and

dorsa

compartment.

braca

C,

te

caracterstcay

o

B,

173

te

te

branc

derved

683–687,

te

ram

rom

he

te

meda

s

radas

extensor

s

superor

bones.

cutaneous

ner ve

nterosseous

are

duces

o

bers

bers.

C. he

rom

antebraca

contnuaton

E.

GAS

ABR/McM

antebraca

anteror

rst

cord.

carpa

toracc

atera

anteror

30.

te

derved

ong

carryng

as

carp

extensor

C5

rare.

o

442;

bers

rom

ta

row

meda

sensory

he

ower

te

A.

ongus

te

compartment.

775–780;

he

cord

nerve

tunne.

Dsocatons

E.

te

A and D. he trapezod and captate bones are ocated

n

D.

dorsa

unate

bone

extensor

second

partment,

orearm.

pocs

occupy

wrst.

he

compartment.

he

abductor

musces

te

by

con-

musce.

deep

A

branc

o

CHAPTER

B.

Compete

te

deep

D.

vs.

he

te

deep

tor

branc

pocs

branc

te

te

s

s

a

uncton

o

abductor

and

by

te

extended

(by

o

te

pocs

bre-

supped

posed);

a

uncton

abductor

ongus

rada

s

nerve

nnervated

medan

nnervated

and

by

te

te

ntact

medan

by

PIP

abduc-

te

nerve.

medan

799;

N

pressed

to

pasy

oten

or

edy

tereby

he

ebow,

c

wrst,

woud

nerve

te

hs

ngt

back

It

a

o

n

o

type

a

on

a

car

te

so

te

and

ous

atera

n

te

oss

atera

cord

nerves

cord

o

o

o

o

te

D

te

patent

braca

and

or

musces

he

medan

arm

and

E.

he

atera

te

pectoras

not

extend

basc

te

ts

sde

o

ven

as

te

he

t

te

can

and

be

mnor

nerves

ven

s

or

judged

ven

troug

can

te

to

be

be

especay

too

sma,

eevated

asca

on

rom

te

as

ts

meda

(bracum).

cepac

ven

more

ateray

up

cuf

s

aso

It

and

woud

It

D.

he

medan

ne

o

GAS

A.

688,

he

tude”

to

he

748,

te

exbts

tumb

s

N

te

and

nerve

o

te

ven

cubta

courses

(antebracum)

758–760;

medan

tumb

eve

antebraca

orearm

patent

o

te

te

te

E.

A

405;

A.

te

rom

tat

N

rst

proxmay

somewat

extended

n

rom

he

breast

and

te

(rada

he

supped

nerves

lexon

o

a

woud

o

mosty

te

te

ourt

nterosse-

ourt

and

t

woud

tumb,

cause

and

MCP

he

E.

he

te

ary

GAS

te

158

dspaced

nerory

supported

by

rota-

coracoacroma

te

to

te

coracod

arc.

tendon

process

o

by

musces.

teres

posterory

mnor

and

because

t

nraspnatus

dspaced

superory

and

because

supraspnatus

te

ren-

drecton.

s

ressted

ABR/McM

axary

(or

nodes

by

te

subscapu-

to

artery

centra

te

or

o

ven

te

apca

axary

aong

N

ymp

407;

From

apca

sequence.

e

between

speedng

ymp

posteror,

te

an

te

te

ater-

rate

nterna

ymp

nodes

and

group

vesses

o

o

to-

rom

receve

atera

ymp

rom

nodes.

737;

nppe.

unortunatey,

receve

nodes

ymp

te

ymp

group

o

nodes.

axary

eferent

te

breast.

anteror,

ymp

e

and

n

o

axary,

nodes

patents,

nodes

and

centra

nodes

are,

pectora)

most

areoa,

Rotter

and

some

and

part

receve

troug

musces

n

142

anteror

parencyma,

lows

parasterna

axary

orearm.

pro-

MCP

medan

o

nerve

(reatve

supracavcuar

route

rom

att-

te

second

o

te

not

gament

nterpectora

racc

D.

s

s

dspaced

te

be

410;

ymp

meda

njury

be

ymp

pectora

157

“benedcton

ngers

o

ABR/McM

umerus

dsocaton

anteror

axary,

and

md-

o

tendon.

te

tere,

te

n

701;

he

are

ventray.

ABR/McM

cassc

atera

te

a

wrst,

beneat

by

not

meda

ars

ossa.

up

438;

coracoacroma

C.

at

tumb,

tendons.

woud

he

vens

te

and

DIP

rada

te

subscapuars

supported

C.

basc

afect

te

o

anterory

not

metastass.

te

o

brac)

nate

jons

o

nerve

te

umbrcas

te

pued

trceps

mb.

ven

N

o

he atera cubta ven s a trbutary to te cepac

cepac

40.

808;

ead

B.

cubta

te

eson

he

medan

woud

extenson

C.

ven.

te

supercas

(rst

and

te

o

dgtorum

parayss

o

or

B.

passes

A

musce

42.

dayss,

dgts

are

ter

o

lexon

lexon

unar

tendons

do

145

te

musce

ore-

and

o

lexon

and

and

n

774,

s

nnervate

musces

n

tor

contro

te

eson

t

GAS

used

E.

orce

pectora

ABR/McM

basc

passes

arm

o

A

ocaton

B.

arm.

419;

cepac

case.

poston

N

lexors

jont

(lexor

unar

or

tat

musces.

medan

major

nto

750–752;

he

nnervates

tenar

and

te

wen

n

nerve

te

n

D.

D.

bot

because

Neter

tat

IP

3

trd

weakness

dgts

pectoras

extenson.

GAS

and

te

brances

nerve.

D.

C. he

It

not

and.

pexus

unar

nnervates

pexus

do

te

and

(by

eson

dgtorum

weakened

and

A

3

unop-

dgts.

musces

GAS

41.

muscuocutaneous

wc

o

cause

o

2

and

lexed

weakened

(lexor

dgts

second

n

2

ndcs

jonts.

of

can

resut

and

partay

proundus).

lexon

o

weakness

weakness

bra-

comes

braca

nerve,

orearm

te

nerve

te

te

pectora

te

t

are

dgts

and

319

Limb

dgts.

groove.

o

and

5

dgts

musce),

te

cause

benc,

trceps

typcay

C

rea-

Saturday

or

rada

te

nerve

suppos-

extensors

nnervates

compresson,

o

o

eson

o

a

oss

o

A

com-

One

woud

te

branc

nerve

pasy.”

peope

nerve

motor

medan

tese

key

ntoxcated

te

te

extenson

te

most

tat

over

o

te

meda

nto

o

ebow.

resut

medate

he

s

ngers.

te

ste

o

and

branc

and

woud

jonts

woud

symptoms.

nnervates

and

te

Parayss

te

beng

arm

but

to

extend

o

ater

nerve

musce

recurrent

171

“Saturday

compressng

proxma

st

s

nckname

ter

rada

te

B.

tese

caed

aseep

wt

by

ABR/McM

nerve

cause

ts

a

ngt

A.

DIP

undus

nerve.

455;

rada

s

supped

4

dgtorum

dgtorum

o

umbrcas).

son

39.

jonts

unopposed);

extensor

nerve

musce),

recurrent

extensors

dgts

lexor

jonts

pocs,

C. he

B.

o

s

s

and

pocs

brevs

It

nerve.

tumb

ongus

abductor

o

rada

te

tumb

nens

te

A.

te

te

ongus.

Opposton o te tumb s a uncton o te oppo-

GAS

38.

o

o

pocs

o

pocs

branc

Abducton

abductor

E.

extenson

extensor

Upper

6

ABR/McM

185

a

nodes

te

receve

oter

ax-

320

C H A P T E R

43.

D.

he

6

et

posteror

n

and

te

o

A

ead

he

to

and

atera

B.

here

te

devaton

meda

N

extensor

sor

dgt

nerve,

a

A

are

esser

B.

are

and

E.

ormed

by

te

te

to

are

n

patent

ntact,

C.

ducts

parayss

lexors

o

te

D

(supra-

nerve

resuts

n

scapua

te

and

n

a

te

woud

musce,

an

n

paray-

extensor

47.

and

jonts.

he

tendons

ndcs,

o

proxma

and

by

te

and

o

o

te

unar

GAS

45.

and

782,

adducton

o

and,

B.

and

te

teres

between

te

o

a

te

o

and

PIP

and

A.

N

nerve,

and

DIP

jonts

nterosse.

by

te

he

deep

degrees

musce.

ost

n

ts

unar

msed

n

and

te

s

are

C.

per-

rst

rotaton

detod

he

s

o

and

detod

teres

teres

s

mnor,

mnor

are

case.

Fracture

ng

D.

o

w

but

racture

o

o

be

te

potentay

meda

compro-

epcondye

o

te

o

woud

most

GAS

46.

te

o

N

ossa

and

cancer

te

te

o

te

o

by

s

not

te

caused

pectoras

cancer

upon

major.

can

eevaton

ven

key

s

on

tat

courses

rom

resut

o

te

o

te

deep

to

rom

te

682,

t

s

not

s

artery

runs

n

be

te

to

te

cavce.

te

sub-

approprate

damaged

to

te

sde

too

and

near

because

axary

o

te

ven

arm.

superca

te

and

cavce

artery

ts

meda

Its

at-

N

419;

ts

Its

te

rst

orgn

cavcuar

te

cavcuar

ABR/McM

or-

man-

descent.

o

to

bend

te

o

descendng

pont

atera

ax-

mnor.

not

rom

beore

s

te

pont

does

durng

course

to

ts

t

arses

artery

artery

rom

pectoras

rom

and

cartages.

Furtermore,

725–736;

branc

meda

te

costa

a

to

artery,

toracc

qute

s

atera

subcavan

s

o

posteror

atera

subcavan

te

racture

te

struc-

poston.

body

axary

poston

nterna

between

superca

njury.

neror

te

a

trbutary

te

te

o

a

most

runs

anatomca

ste

anterory

te

toug

woud

wtn

te

s

oowng

artery

he

anterory,

wrst

proxma

wt

oten

Coes

te

he

porton

dsta

o

te

s

te

bone

dspacement

gves

racture

woud

ead

to

droop-

B.

A

s

te

a

qute

mdde

te

neck

o

droopng

necessary

njure

409;

to

aso

scapod

afect

te

o

umerus

te

abducton

o

te

unusua.

trd

rada

ABR/McM

o

te

ment

souder

te

costa

racture.

135

oten

radus

s

ragment

o

appearance

C

and

rom

umerus

woud

nerve.

te

o

reerred

a

to

dspaced

projectng

radus

dnner

as

a

rom

ork,

“dnner

te

tus

ork”

E.

V okmann

deormty

tumor

lexor

te

skn

becomes

edematous,

except

te

musce

pany

te

an

term

overa

peau

resembance

d’orange.

to

an

orange

and

o

boxer’s

a

not

racture

racture

cause

usuay

te

(rst

o

te

dspace-

occurs

scapod

ractures

metacarpas

GAS

scemc

tat

can

wt

o

contracture,

ts

contracture

oow

compartment

hs

skn

hs

rom

tus

(“wast”)

te

umerus,

were ar oces cause sma ndentatons o te skn.

te

o

resuts

woud

radus.

aspect

Bennett

ractures

by

embo,

te

and

bot

and

at

bone.

resut

t,

re-

spectvey).

D.

146

o

racture

bone

narrow

o

ence



185

es

and

ary

Wen cutaneous ympatcs o te breast are bocked

pee,

nto

major

artery

ascendng

B.

gves

t

scapod

anatomca

ead

not

It

key

693;

genod

te

smary

Fracture

rb

toracc

radus.

a

te

A Coes racture s a racture o te dsta end o te

souder.

umerus.

E.

A.

ntensed

(o

o

ead.

nvovement

breast

seen

ven

atera

GAS

48.

pttng

deormty.

te

Fracture

ven,

posterory.

woud

rst

cartages

by

umerus

to

nvovement

to

ABR/McM

damaged

njury.

umerus

perormed

te

musce,

detod

te

te

190;

deeper

a

o

breast,

to

he

oten

umerus.

B.

E.

164

o

te

era

tan

o

s

er

wt

due

pectoras

cepac

gn

skn

cancer

he

It

two

branc

umerus

nnervates

orzonta

te

nerve

a

o

Abducton

Latera

by

ABR/McM

neck

wc

musces.

nraspnatus.

he

454;

surgca

perormed

te

bot

te

axary

15

ts

ater

MCP

wc

te

subcavan

part

mnor

detod

many

o

be

he

dsta

nerve.

nterosse,

805–809;

N

ocaton,

nerve.

C. Fracture

njures

te

o

cavan

umbrcas are supped by te medan nerve; te oter

umbrcas

te

ocaton

nterosse,

te

umbrcas

to

tat

above

be

orange

o

and

rada

MCP

(PIP)

d’

cavce

exten-

te

aso

gaments

eads

mb.

737;

he

arm

areoar

subcavan

A.

cuts

cuts.

Peau

o

suspensory

pttng

er

D. he

ture

138

extenson

unar

E.

xaton

GAS

resut

nnervated

and

deep

o

nvason

psatera

souder.

extensor

te

skn,

woud

Invason

MCP

te

and

by

te

retnacua

rases

Inverson

turnng

o

or

overyng

protrude

jonts.

o

Extenson

by

Sortenng

Cooper)

umerus.

or

degree,

Abducton

nnervated

te

musces,

unctons

o

ebow

psatera

dors

dgtorum,

responsbe

or

njury

te

nterpaangea

and

jonts

te

te

extend

to

musces

A.

retnacua

ABR/McM

mnm

muc

(DIP)

o

souder

strengt

scapuar

nerve

417;

to

te

o

atssmus

njured

resutng

trunk).

retractng

rotator

703;

C. Inabty

D

n

te

scapua

ndcaton

dorsa

horacodorsa

te

te

n

souder

upper

atera

GAS

to

or

to

o

o

been

et.

no

te

Injury

ss

44.

and

as

musce,

aowng

ange

symmetry

s

o

nerve

weakness

E.

by

rgt

rotators

scapuar

XI)

sternocedomastod

te

C.

(CN

trapezus,

superor

demonstrated

te

nerve

sternocedomastod

te

te

posterory.

Limb

accessory

to

parayss

droop

as

Upper

a

artera

te

wt

s

N

442;

muscuar

aceraton

orearm.

extreme

racture.

761–764;

a

supracondyar

ABR/McM

130

racture

nto

Iscema

pan,

te

and

accom-

CHAPTER

49.

B.

In

souder

separaton,

coracocavcuar

petey

and

n

a

troug.

dsta

compete

away

and

C.

(but

torn

he

E.

t

s

nes

he

and

process

N

cant

B.

te

o

nterosse,

and

ead

and

52.

com-

upward

mb

tat

be

pa-

te

o

te

umerus

s

sou-

A.

s

used

not

n

torn

te

n

repar

o

te

gament).

gament

s

not

nvoved

abrum

oten

unar

oss

trocea

a

woud

o

te

resut

o

near

te

o

te

lexor

(among

lexon

o

na

te

and

nerve

jonts,

at

ypotenar,

damage

afect

PIP

2

E.

T rauma

afect

GAS

to

a

D.

pocs

3

as

2

lexon

we

and

as

54.

cause

774,

805;

but

not

ong

nerve

nger

N

wt

ore,

t

51.

o

te

axary

ne

between

te

braca

lex

as

438;

lexors

ventra

braca.

suppy

hs

te

A.

he

B.

he

and

s

cumlex

o

te

ramus

he

jont

B.

o

te

toracodorsa

D.

he

atera

E.

he

te

braca

artery)

as

D.

7.39

GAS

and

te

to

s

oten

part

can-

artery

o

and

crcum-

te

deep

nadequate

to

mb.

medan

but

moton

466;

superca

o

nerve

any

te

woud

and

deep

and

efect

nerve

s

suppes

o

o

te

ong

troug

synova

te

ong

te

s

not

te

deep

branc,

assoc-

nerve;

on

aso

te

tumb

ABR/McM

tere-

lexors

o

a

branc

tenar

o

te

emnence

ead

te

Fg.

o

te

7.89.

bceps

genoumera

gaments

genoumera

ead

(GAS

160

brac

jont,

sur-

membrane.

o

nragenod

he

te

or

jont

trceps

tuberce,

te

te

cr-

nraspnatus.

(passng

scapua)

te

artery

wt

bands

are

capsue

brac

beneat

tcken-

anterory.

arses

te

rom

genod

as

no

scope

as

epu

no

te

(rst

coracobracas

anastomoses

o

424;

695;

verse

o

wt

axary)

te

to-

Fgs.

145

421;

passes

to

and

on

posteror

nsert

nerve

on

te

to

te

greater

ten

tereater,

passes

notc

te

pass

t

te

coracod

pro-

143

passes

under,

hs

n

to

and

over,

te

upper

to

te

and

superor

gament

te

notc

deep

suppyng

scapuar

rom

umerus.

artery

gament.

convertng

nerve

arses

te

ABR/McM

scapuar

brdges

border

oramen.

ten

passng

notc

te

o

he

supraspnatus

(spnogenod)

te

trans-

te

artery

musce

troug

to

suppy

te

te

nraspnatus.

he

o

subscapuar

te

axary

scapuar

B.

he

ts

ste.

he

dorsa

meda

D.

and

he

GAS

artery

wt

te

708–709;

s

a

t

cervca

scapuar

border

posteror

axary

artery

artery;

branc

dvdes

toracodorsa

transverse

space

ABR/McM

N

scapuar

scapua,

axary

(GAS

nserts

suprascapuar

superor

anastomoses

part

tendon

umerus

and

suprascapuar

te

njury.

te

cess

he

C.

artery

part

E.

anastomoss

o

o

tuberce.

A.

beneat

nraspnatus

he

neror

artery.

(second

N

trd

posteror

branc

7.50).

708–710;

by

ead

woud

artera

axary

anastomoses

wtn

toracc

no

racoacroma

te

artery

toracc

superor

te

pat

o

deep

wt

wt

N

o

te

ngers.

C8

te

coatera

o

artery

scapuar

border

nteros-

nerve

nterosseous

ave

genoumera

he

158

beyond

ascendng

needs

scapuar

dorsa

meda

ony

between

te

suprascapuar

just

part

anastomotc

artera

to

contnuaton

not

nerve

passes

E.

ABR/McM

he

trd

artery

umera

774;

ngs

lexors.

occurred

artery.

te

ts

lexors.

rse

anteror

recurrent

rounded

55.

njury

compromsed.

anteror

orearm.

tendon

lexon

51–75

C. he

and

lex-

dects.

nterosseous

woud

musce

GAS

Answers

not

gves

te

te

C. he

A.

DIP

orearm,

and

opposabe

pronator

tumb

to

njured,

musces, and ts njury woud resut n probems wt

umbrca,

te

wdespread

nerve

posteror

medan

musces.

to

te

ated

he

o

woud

woud

more

s

be

te

njury

proundus,

t

w

to

te

ossa.

spna

ong

n

However,

rse

o

ongus,

rada

opposton.

musces

resut

te

Medan nerve njury at te wrst woud cause oss o

tenar

nerve.

tumb

gves

I

branc

pocs

dgtorum

musces.

te

a

n

sgn-

wrst

t

meda

proxma

jont

and

te

atoug

adductor

dgts

seous

GAS

unar

IP

o

nerve

s

lexor

sors

gun

jonts

jont

s

173

nerve

te

lexor

bone

bone.

he

dgtorum

DIP

te

quadratus

medan

brances

umerus.

suppes

navcuar)

carpa

C.

coronod

oter

te

IP

o

term,

ABR/McM

nterosseous

tat

a

oder

ractured

he deep branc o te rada nerve suppes exten-

accompa-

te

nerve

te

te

nerve

te

o

te

321

Limb

B.

n

142

rom

442;

pronator

he

separa-

N

anteror

atera

on

(or

commony

787;

he

medan

dgts.

nerve

o

E.

scapod

most

te

exposvey

and

te

woud

he

GAS

53.

droops

can

E.

te

nterrupted

devate

upper

of”

gament

meda

te

o

Medan

lexon

be

AC

or

separaton.

genod

te

wt

afect

teres

“step

ABR/McM

una

t

parayss

D.

te

not

red

te

T rauma

C.

can

may

te

te

dsocaton.

musce

and

not

a

bot

partay

observed.

te

415;

dects),

ourt

o

was

o

proundus

jont

we

scapuar

perced

o

Parayss

or

be

separaton.

na

ten

AC

sometmes

souder

699;

can

cavce

coracocavcuar

Dsrupton

GAS

o

transverse

souder

A.

causng

coracoacroma

ton

D.

te

sometmes

dsocaton,

he

he

o

separaton,

Dspacement

der

50.

end

nerory,

pated

A.

torn

te

eter

gaments

Upper

6

N

o

trd

part

crcumlex

and

courses

nerve

anteror

pass

aong

to

te

scapua.

crcumlex

passes

axary

418;

te

nto

brances.

artery

artery

te

o

umera

troug

te

nerve.

ABR/McM

139

branc

o

te

quadranguar

322

C H A P T E R

6

Upper

Limb

Rib

I T ransverse

cervical

Suprascapular Right

common

carotid

artery

ar tery

artery

Clavicle Thyrocervical

trunk

Subscapular Right

subclavian

Axillary

Deep

branch

of

artery

artery

ar tery

Anterior

circumflex

humeral

artery

transverse Posterior

cervical

ci rcumflex

artery humeral

artery

Circumflex

Deep

brachial

Brachial

•

56.

A.

he

n

te

patent

sensaton

tumb

te

B.

and

rada

he

to

te

ndex

he

s

he

te

te

to

te

nerve

and

rada

tat

te

pes

te

meda

meda

to

atera

o

dorsa

nerve

normaton

sde

o

meda

o

suppes

rom

te

cutaneous

750,

o

te

te

te

cord

wrst

782;

s

nerve

and

a

con-

B.

and

suppes

a

skn

o

branc

te

unar

422;

ABR/McM

C8

E.

T1

152

nerve

GAS

58.

B.

ace

te

to

major

s

dermatome

runs

over

down

dgts

souder

contrbu-

te

o

te

2

prme

C7

s

n

posteror

and

3.

movement

and

detod.

o

afect

te

woud

on

and

afect

a

nerve

te

woud

arm

upper

afect

orearm

meda

afect

lexon

and

skn

on

te

mb.

sde

and

o

musces

te

prmary

upper

musces

and

mb.

skn

o

te

meday.

734,

As

and

ts

he

wc

woud

woud

skn

oss

and

te

sde

oss

and

te

and.

artery

artery

makes

and

extenson.

C5

over

oss

arm

o

o

nerve

nerve,

descrbed,

orearm,

atera

drect

cervca

rada

wrst

regon

C6

sup-

D.

s

n

skn

orearm.

cutaneous

te

Loss

jont.

orearm.

cutaneous

N

A.

sevent

to

mover

propro-

nerve

muscuocutaneous

antebraca

te

sde

C. he

ton

te

branc

suppes te meda a o te dorsum o te

GAS

57.

provdes

proxma

superca

nerve

ar ter y

.

arm,

nterosseous

antebraca

o

he

he

o

nger

sensory

atera

branc

E.

njury

regon.

Fig.

nerve.

tnuaton

D.

sufered

dorsum

posteror

ceptve

C.

as

md-umera

GAS

scapular

777,

780;

rada

te

N

artery

dorsum

o

420;

ABR/McM

passes

te

rom

wrst,

t

162

te

ventra

crosses

sur-

troug

CHAPTER

Subclavius

Superior

Thoracoacromial

thoracic

Pectoralis

6

Upper

323

Limb

minor

ar tery

ar tery

Subscapularis

Subscapular

Anterior

Posterior

circumflex

circumflex

artery

humeral

humeral

(quadrangular

Latissimus

ar tery

space)

dorsi

Circumflex

scapular

branch

(triangular

Teres

space)

major

Thoracodorsal

Deep

Lateral

head

of

artery

brachial

(triangular

Long

artery

thoracic

triceps

artery

interval)

ar tery

brachii

•

te

anatomca

snufbox

and

passes

over

te

GAS

scapod

bone.

A.

he

unar

bone

to

carpa

te

E.

he

GAS

o

but

on

te

beneat

cana

n

meda

te

between

retnacuum.

not

59.

D. he

sde

lexor

te

psorm

Guyon

communcaton

o

carp

cana

wt

s

te

te

Fg.

rom

unar

pamar

two

anastomose

nterosseous

arse

te

artery

between

extensor

te

and

and

te

pass

radus

compartments,

branc

eads

wt

te

o

o

N

457;

posteror

common

te

patent

te

rada

n-

proxma

una,

can

artery

adductor

artery

n

176

a

wen

woud

to

as

te

te

te

may

mb

bursa,

not

subacroma

papaton

s

more

or

ess

sub-

wen

te

bur-

subacroma,

supraspnatus

be

drawn

tendon

back

under

abducted.)

beneat

present

wt

s

orzonta,

beng

wt

bursa

communcate

he

man

tus

uncton

rotaton

as

te

te

subscapuars

superca

pan.

genoumera

It

jont

musce

s

o

not

o

te

te

nraspnatus

souder.

nvoved

n

he

musce

s

nraspna-

overead

souder

movements.

C.

Inlammaton

genoumera

ABR/McM

more

subscapuar

atera

passes

pam

o

on

cavty.

B.

pocs

te

rom

pan

eevated

suc

acromon

he

te

tougt

assocated

or

suferng

(I

been

be

musce,

to

n

s,

peraps,

nterosse-

and

as

may

tat

s

bursts.

arm

sts

respectvey.

unar

te

7.88 ).

801–805;

te

A.

anteror

orearm

and

deep

(GAS

Guyon

lexor

arteres

between

to

to

te

lexor

te

he

branc

n

reac

ocated

rom

tunne.

D.

terosseous

dsta

s

passng

and

adjacent

and

artery

wrst,

unars

ous

.

detod

te

C

Fig.

souder

pan

or

artrtc

jont

tan

present

tat

canges

as

present

more

ere.

wtn

te

generazed

324

C H A P T E R

6

Upper

Limb

Ulnar

Brachial

ner ve

artery

Humeral

of

head

pronator

teres

Flexor

Supinator

car pi

ulnaris

Radial

(cut )

artery Ulnar

artery

Common

Superficial

of

branch

radial

interosseous

ar ter y

nerve Flexor

digitorum

superficialis

Posterior

(cut )

interosseous Anterior ar ter y interosseous

Pronator

teres

ar ter y

(cut )

Perforating Flexor

digitorum

branches profundus of

anterior

interosseous

artery

Brachioradialis

Interosseous

(cut )

tendon

membrane Flexor

pollicis

longus

Pronator

Flexor

radialis

car pi

quadratus

tendon

(cut )

Flexor

palmar

of

tendon

(cut )

branch

radial

car pi

ulnaris

Superficial

artery Ulnar

ner ve

Deep

palmar

arch

Superficial

palmar

•

•

GAS

Fig.

he

teres

neror

GAS

60.

696,

E.he

to

axary

te

cuar

A

between

contans

It

o

o

te

gands.

te

C.

he

te

tendon

marked

a

asca

deep

upper

and

asca

o

te

o

te

neurovas-

deep

te

connectve

nvestng

nerves,

parynx

pretracea

61.

tra

asca.

asca

and

ympatcs,

asca

s

tssue

covers

te

contnuous

an-

te

and

710,

C. he

wt

730;

o

magnum

juguar

ead

.

C6

N

oow

416;

ten

and

(CN

tat

ext

It

trapezus

and

nnervates

te

te

te



and

con-

dors

as-

367

arses

rom

troug

crana

cavty

te

te

te

ven-

ora-

troug

sternocedo-

wc

uncton

n

souders.

receves

C4

s

armpt.

ascend

musces,

nerve

rom

XI)

cavce

asca

atssmus

te

nnervates

eevatng

suprascapuar

and

o

te

axary

ABR/McM

nerve

C1–C4

to

nvests

he

pectora

te

(occasonay

and

musce

musce.

oramen.

rotaton

he

te

accessory

mastod

A.

mnor

orms

rootets

men

oose

vesses,

GAS

te

extendng

mb.

s

cavpectora

tnuous

ca

contnuaton

nerves

he

pectoras

ocated

dscomort.

buccoparyngea

and

are

142

cervca

te

asca

cutaneous

musces

wt

s

encoses

derms

at,

o

and

ABR/McM

te

Superca

buccnator

terory

424;

seat

axa.

B.

musce

pont

N

ayer

bunde

and

and

te

713;

prevertebra

nto

mnor

Fig.

.

D.

E.

GAS

arch

te

bers

pexus

supraspnatus

rom

s

C5

to

“prexed”)

musce,

wc

s

CHAPTER

responsbe

Erb

pont

C5–C6

B.

he

D.

ong

C6,

he

accessory

Rada

62.

D.

he

known

to

renorces

gament

ments

as

o

separated

superor

GAS

A.

he

ong

by

mnor

ce.

B,

C,

te

o

te

be

te

E.

s

o

routes

anteror.

te

ventra

space

he

te

by

ts

coracocavcuar

anteror

are

be

and

not

bordered

njured

gament,

tendon

key

meday

musce,

ateray

superory

by

te

and

by

teres

to

o

be

by

te

by

te

te

teres

major

posteror

structures

sted

mus-

crcumlex

n

te

ong

are

space.

detopectora

and

to

ga-

dsoca-

space.

ocated

atera

wt

wc

142

s

nerve

te

assocated

gament

genoumera

an

te

souder,

souder.

umerus,

n

neck.

and

te

key

quadranguar

s

s

gament,

brac

oter

o

te

he

not

nerory

te

te

cavce

AC

brac

te

o

coracoacroma

ABR/McM

traverse

te

te

are

he

o

rotaton

orms,

scapuar

axary

ner ve

and

but

te

ocated

between

pexus

rom

Separaton

trceps

and

wtn

rada

unon

serratus

arses

n

njured

trceps

o

vesses

D,

taned

ven

may

410;

neck

Bot

abducton.

te

rom

separaton,

souder.

musce,

umera

arm

at

138

damaged.

quadranguar

surgca

o

s

te

connects

severe

be

separaton

o

XI)

nvoved

jont

umerus

N

ead

(CN

jont

more

ead

694;

arses

suppes

scapua.

transverse

ong

njured

not

AC

bands

te

pexus

ABR/McM

aso

by

te

s

AC

In

ton

a

nerve

and

nerve

te

te

t.

degrees

C1–C4.

may

or

C7,

gament

o

15

not

he

con-

trange,

tranguar

eads

o

•

GAS

B.

718–720,

speccay

musce.

A.

C.

te

s

tests

patent

tumb

lexor

od

he

a

o

dgt

te

seet

lexor

s

pocs

asked

unar

o

to

lat

ongus

te

A.

he

s

s

nerve

te

s

pasy.

adductor

od

a

seet

he

by

medan

nnervated

and

woud

te

by

not

65.

C.

(Fg.

not

by

and

te

E.

deep

used

s

nnervated

by

te

GAS

826;

recurrent

D.

n

467;

branc

ABR/McM

o

te

te

166

medan

nerve

nner-

s

tor

te

s

not

responsbe

Damage

medan

o

brevs,

to

or

te

sensory

n

o

or

nerve

te

uncton.

lexor

any

pamar

unar

opposton

and

pocs

cutaneous

cutaneous

woud

tumb

or

not

brevs)

nnervaton.

brances

cause

tey

and

are

o

te

weakness

prncpay

musces

MCP

rada

vates te tenar musces (opponens pocs, abduc-

pocs

oss

to

be

o

B.

s

te

to

5,

and

branc

or

te

o

o

te

movement

te

o

extenson

te

oss

o

present

umbrcas

medan

rada

ts

o

te

t

te

deep

mus-

responsbe

unar

te

a

te

ourt

or

two

resuts

umbr-

Extenson

and

o

t

weak

and

IP

trd

ngers

are

o

te

dgts

umbrcas

Some

second

te

uncton

respectve

tese

nerve

and

dgts.

s

musces.

n

o

not

musces

wc

ter

nterosseous

n

o

and

ntact,

does

168

branc

ourt

s

and

musces.

nterosseous

te

s

te

mus-

brevs.

suppes

It

suppes

abductor

pocs

pocs

nerve

ABR/McM

deep

nerve

and

adductor

abductor

tenar

IP

he

unar

o

st

te

o

movement

dgta

adductor

orearm.

a

o

a

ntact

pamar

lexor

jonts

te

by

and

o

te

466;

due

o

because

vated

2

te

nerve.

absent,

extenson

A

N

to

branc

or

responsbe

nterosseous

te

parayss

ca

N

817;

Injury

not

musces,

dgts

movement

pam.

rada

o

s

branc

nnervate

ces

medan

deep

o

dgta

responsbe

musces.

deep

Anteror

to

6.13).

814–816,

he

ndcs

he

pamar

not

common

nerve

tenar

ces

ante-

te

be

tumb

nnervated

te

nerve.

66.

extensor

nerve

GAS

D.

paper

nerve.

E.

te

s

musces.

second

medan

pocs

o

tenar

he

More

common

nerve

ypotenar

nnervated

te

between

radas

B.

144

nerve

rst

medan

trceps

pam.

o

mnm

paper

carp

a

branc

unar

o

ABR/McM

or

acton

and

nterosseous

lexor

417;

te

ror

he

N

postve

he

branc

D.

t

he

between

730;

sgn

6.13

and

nter va

te

Froment

Fig.

cepac

brac.

64.

325

Limb

nerves.

422;

AC

damage

63.

o

N

acromon

aso

and

nerve

703;

rst

braca

toracc

C5,

GAS

te

te

spna

rootets

E.

or

o

Upper

6

and

jont

dgts

nner-

nerve.

nerve

case.

and

te

medan

nerve

appear

326

C H A P T E R

C.

I

te

6

unar

regon,

dgts

E.

he

Upper

and

tenar

67.

A.

he

on

o

te

he

te

o

t

n

te

oss

dorsum

te

not

ts

md-orearm

n

o

te

te

medan

does

o

vde

D

GAS

suppes

ave

artery

te

arses

atssmus

71.

aong

and

artery

GAS

are

and

provde

he

no

te

subscapuar

N

he

and

adducted.

neck

major,

te

he

o

te

to

es

bceps

major,

due

and

to

s

te

and

s

tyro-

can

(n

o

a

te

GAS

72.

E.

dors.

to

GAS

B.

693;

he

es

N

417;

racture

between

and

te

ment

ne

te

tracton

and

o

o

musces.

ay

by

te

te

bony

teres

are

he

musces.

nerve

te

s

s

prox-

not

teres

(A)

proxma

unopposed

and

o

o

dsta

to

te

te

rada

rag-

unopposed

con-

pronator

ragment

contracton

radus

quadratus

devates

o

te

ater-

supnator

musce.

he

bracoradas

E.

he

bracas

una

ton

GAS

A.

lexor

B.

o

te

te

he

N

te

o

be

te

on

te

coronod

nvoved

n

radus.

process

te

atera

o

te

deva-

o

435;

ABR/McM

te

passes

orearm

161

aong

he

and

carp

te

radas

orearm

to

s

passes

seen

mdne

dstay

n

te

supercay,

nsert

at

te

border

he

n

o

te

te

lexor

pated

on

pocs

wrst,

were

anatomca

carp

te

ongus

unars

meda

t

o

base

atera

o

te

por-

tendon

eps

s

orm

o

te

5t

st.

meta-

hs

type

racture.”

te

unar

o

styod

te

dsta

nor

a

radus

can

be

seen

and

pa-

n

cord

o

he

te

te

trunk

o

o

nerve

te

te

T1

braca

sde

pexus.

to

a

o

dysuncton

te

Long

medan

he

te

sensory

n

te

T1

te

afects

lexors

nerve

extensors

rada

o

cutaneous

braca

dgts.

njured.

tereore,

nor

ascends

meda

suppy

Its

te

wrst,

spne)

o

te

te

tereore,

ony

te

antebraca

pam.

not

as

motor

o

njury

not

o

or

meda

te

are

he

compresson

observed

o

pexus

woud

n

patent.

ts

744–745;

“Gamekeeper’s

by

te

and

N

tumb”

and

te

s

o

(A)

o

nerve

dsturbance

mdde

not

gve

170;

was

a

seen

n

braced

and

rse

te

(C)

tat

ower

to

te

ABR/McM

term

s

o

trunk

symp-

98

coned

a

jont

sk

he

ts

and

poe,

suc

te

because

njury

njury

vagus

to

s

te

rab-

te

te

orce

unar

more

com-

wt

ter

awkwardy

causng

as

ground,

resutng

caused

days

wo

anmas

between

nger.

hese

skers

on

sma

necks

MCP

gament.

vagus

orce

on

tumb.

De

Quervan

o

wrst

A

navcuar

A

o

a

key

te

(tenosynovts)

aspect

upon

o

turnng

te

te

It

wrst,

te

presents

graspng,

racture

s

scapod

to

be

tumb

aso

s

known

te

as

carpa

a

scapod

bone

wc

s

ractured.

s

a

racture

dsocaton

at

te

base

tumb.

Bennett

tumb

metacarpa

reers

to

bone.

racture

It

o

785–786;

N

443;

te

contnues

jont.

GAS

afects

wrst.

st.

he

boxer’s

atera

pan

makng

most

syndrome

te

or

racture.

E.

ked

ter

ndex

abducted

wt

B.

wo

breakng

tendons

ateray

ventray.

te

ntact;

683–687,

rst

wrst

ower

movements

braca

mony

over

atera

te

CMC

te

stretcng

rb

sensaton

te

173

or

rst

o

tat

wrst.

curvature

te

source

nerve

and,

or

ABR/McM

meda

are

te

are

dermatome.

coatera

second

te

by

unctona;

D.

tumb,

super-

passng

T1

bts

te

snufbox.

tendon

sde

te

dsocaton

and

atera

orm

musces

gamekeepers

C.

abductor

deep

ts njury was most commony assocated wt Scotts

retnacuum.

trapezum

ocated

D.

D.

A.

te

metacarpa.

C.

73.

te

parayzed.

GAS

te

ongus

lexor

lexor

ton

not

on

dstay

radus.

pamars

surace

to

nserts

woud

762–764;

he

ca

and

nserts

o

compresson

va

motor

are

te

on

D.

s

racture

o

te

443;

ramus

prncpa

unar

toms

supnator

N

(severe

rom

and

o

due

o

wt

Indcatons

sde

o

causng

ngers

wrst

umerus.

trd

s

ne

and

dors.

sde

orearm,

te

pectora-

meda

nerve

te

a

coracobracas

o

te

ntrnsc

eevated

contracton

acton

he

neck

“boxer’s

nvoves

provdes

o

148

upper

a

tumb.

and

nsertons

dors

te

C8

te

rom

attacments

passes

167

te

racture

T1

o

abducts

ragmented

pronated

pronator

(C)

te

ABR/McM

pronator

and

o

tendon

macne

Smt

jon

B

aspect

as

pexus.

te

dsta

a

nor

783–784;

spna

ton

te

te

racture

o

Scooss

A, B, D, E. hese answer coces w not resut n adduc-

o

Neter

atera

patent

axary

atssmus

and

on

ste

ragment

atssmus

ractured

known

racture

te

pro-

30%).

typca

te

and

te

ABR/McM

as

ttng

s

Bennett

scapua.

atssmus

resuts

D.

jont

149

musce

brac,

s

E.

toracoacroma

above

dsta

eevaton

te

part

te

437;

ongus

tunne.

woud present wt te absence o a knucke as observed

rombod

rom

neck

and

major,

te

deep

branc

umerus

ne

teres

o

te

ABR/McM

adducton

teres

o

second

suppy

wereas

detod,

he

no

418;

racture

carpa

ere.

arses

scapuar

supraspnatus

ragment,

te

root

N

wen

C,

pocs

te

patent

Coes

ten

border

toracc

o

major,

ma

musces.

te

and

767;

he

o

dors.

artery

dorsa

racture

pectoras

o

meda

atera

surgca

musces.

a

brances

709–710;

ractures.

at

or

he

pexus

cervca

trunk

E.

he

te

te

B.

carpa

168

rom

lexor

troug

umbrcas.

woud

he

A,

ABR/McM

braca

orgn

arteres

70.

E.

and

and.

nerve

suppy

nerve

pam

jonts.

467;

transverse

cervca

s

IP

N

provdes

musces

69.

te

njured

sensory

he dorsa scapuar artery passes between te ventra

C.

C.

on

branc

toracodorsa

It

ram

68.

and

parayss

805–807;

artery.

B.

5

be

musces;

Moreover,

efect

were

woud

recurrent

te

GAS

nerve

tere

4

Limb

ABR/McM

172

to

base

te

o

te

CMC

CHAPTER

74.

A.

he

n

ong

ead

souder

cause

der,

pan

on

te

B.

n

were

Forced

o

lexon

te

t

tendon

w

anteror

orced

te

w

be

contracton

eads

genod

o

te

te

n

o

te

and

a

n

te

bceps

tuberce

musce

o

greater

more

te

bceps

can

woud

te

sou-

B.

tenson

brac

orce

coracod

Intact

te

te

as

process

o

are

te

E.

C.

Pan

te

w

ton

D.

not

o

te

lexon

te

E.

arm

he

bceps

C.

721;

he

atera

a

423;

common

ts

uncton

o

o

extensor

and

ts

a

o

unc-

GAS

77.

te

musce

and

w

resut

adducton

o

musce.

experence

ABR/McM

epcondye,

lexon

not

E.

pan

n

souder

te

atera

jont.

tendon

orgnates

o

rom

ts

te

tendon

tendons.

te

ventra

as

tenns.

part

son

o

o

Because

te

te

te

extensors

common

wrst

extensor

w

o

te

wrst

tendon,

exacerbate

te

ressted

pan

Nerve

and

tes

(e.g.,

carpa

B.

In

conducton

on

sor

or

te

are

used

to

consstent

and

parestesa)

sgns

suc

as

ebow,

tere

woud

extenson

radas

brevs

o

be

te

ony

no

pan

ebow

abduct

as

on

te

and

he

are

te

w

not

and

tngng

present

consstent

wt

n

n

te

tenns

meda

ourt

ebow.

and

hese

epcondyts

t

sgns

(goer’s

ebow).

E.

process

o

w

te

te

orearm

te

proxma

o

757,

radus

be

musce

N

et

n

over

tenns

extensor

orearm.

atera

775;

not

common

extensor

toms

GAS

GAS

C.

he

and

te

dsta

ebow.

he

tendon

s

orgn

o

ocated

at

bracoradas

w

styod

contrbute

s

a

to

ore-

symp-

epcondyts.

431;

161

76.

sors

te

he

te

ca

neck

o

crcumlex

te

te

s

provdes

era

aspect

not

be

o

abe

because

o

te

artery)

sensaton

at

to

souder.

abduct

njury

dorsay

besde

(accompaned

ractured

te

to

passes

umerus

umera

umerus

nerve

nerve

te

(A),

a

by

and

can

tat

ocaton.

te

skn

over

Atoug

arm

rom

smpe

be

te

15

test

o

te

te

on,

he

te

90

resuts

skn

sensaton

4

o

n

rb

not

o

o

o

te

e

te

n

te

ser-

medan

pamars

te

oten

he

tendon

s

on-

mdne

and

ongus

te

s

o

ave

nerve

s

present.

absent,

anatomca

ractures.

expan

te

te

poston

T1)

Addtonay,

o

sensaton

woud

musces

sensory

oss

o

s

5

oss

a

on

pam.

(C8,

lexor

and

njury

jont

N

bot

n

a

and

over

te

te

resut

a

n

ntrnsc

meda

dor-

and.

lexon

rom

n

te

contracture

connectve

posteror

extenson,

tssue

o

ds-

orearm

tumb

woud

extenson,

and

dsturbances.

437;

to

ABR/McM

te

tota

I

medan

cawng

II

are

deep

159

and

o

te

I

o

unar

nerves

ngers.

te

IP

te

capabe

o

at

he

te

MCP

was

n

te

te

o

umbrcas

te

and

o

degree

tey

nner-

responsbe

are

nto

and

and

parayzed,

a

poston

medan

woud

mdde

tose

o

motor

are

by

parayzed,

appearance.

damaged

o

ndex

some

ter

are

o

umbr-

nnervated

IV

ngers

“caw”

ony

are

and

branc

nterosse;

and

Wen

te

nterosse

deep

umbrcas

pu

te

tey

III

A

te

te

as

jonts.

cawng

ntact.

provdes

and

tendons

nerve

because

be

nerve

competng

unar

a

umbrcas

unar

lexor

s

because

parayzed,

nterosse

extenson

lexon,

nerve

suppes

nerve;

he

ong

rada

parayzed

nerve

and

te

te

are

medan

s

at-

mgt

be

te

nerve.

145

dameter.

pamars

to

tests

toracc

orearm

and

suraces

pamar

promnent

wen

degrees

o

pam.

not

spared,

axary

patent

to

surg-

upper,

object

ong

segments

wen

contracture

774–775;

vaton.

posteror

njured

te

dsta

te

and

dgts

te

because

snce

A.

axary

tat

aspect

nerves

structures

trauma

pamar

MCP

unar

cas

te

76–100

C.

meda

jonts o a dgts are extended by te unopposed exten-

or

ABR/McM

te

ntercostobraca

nstead

coor

orearm

nerve

T rauma

wrst

o

Answers

n

umbrcas

T enderness

arm

so

n

woud

musces

afect

78.

numbness

dgt

ease

exten-

extend

o

and

Rada

lex-

o

meda

dsta

tendon,

porton

Dupuytren

D.

trapezus

te

and

te

o

pexus

(usuay)

n

wrst.

D.

C.

assess

te

ABR/McM

evdence

rb

atera

and

neuropa-

on

mmovabe

te

appears

no

atera

conrm

wt

s

parayss

syndrome.

passve

carp

are

numbness

tunne

tenns

studes

tat

o

tendon.

sum

symptoms

njury

perormance

ndcaton

and

te

o

te

tendon

Lower

epcondyts.

A.

to

nerve

exten-

o

o

surace

te

here

B.

ep

te

skn

an

orearms,

Bot

ractured

orgnate

s

468;

deep

te tendon s oten rrtated durng te backand stroke

te

an

took

appearance

atera epcondyts, ncknamed “tenns ebow” because

n

N

ocated

te

nerve

XI).

musce

smar

A.

o

arm

bot

gus

o

s

(CN

aganst

anteror

rom

medan

nlammaton

can

testng

cutaneous

surgeon

Wen

142

and

707–709;

he

nerves

brac

extenson

lexon

and

s

musce.

bceps

not

abducton

movement

brac

arm;

w

durng

N

durng

as

te

te

not

patent

souder

GAS

o

o

s

et

jont

Contracton

n

75.

be

assocated

unctona.

ratus

souder

s

souders

sensaton

Pusng

scapua.

te

nerve

axa

braca

supra-

tere

tereby

accessory

durng

musce

rom

weter

327

Limb

nerve.

uncton,

D.

souder

ndcate

axary

Sruggng

tuberce.

pan.

atera

orgnates

te

asssts

tendnopaty

supragenod

cause

resut

et

brac

a

compartment

at

woud

tat

not

bceps

durng

orgnates

contracton

Pan

te

and

Upper

6

nerve

be

ngers.

dgts

extenson

ess

hs

woud

o

st

tose

IP

jonts.

B.

I

te

medan

tunne,

not

tere

cawng.

nerve

woud

aone

be

oss

s

o

njured

tenar

n

te

carpa

opposton

but

328

C H A P T E R

D.

I

6

te

medan

at

te

o

te

te

Upper

ebow,

oss

o

and

te

ntrnsc

79.

D.

te

774,

racture

dsta

ragment

s

o

woud

805–809;

N

s

nerves

a

n

te

be

bot

totay

addton

and.

ntact

438;

n

E.

racture

o

n

a

reerred

te

Rada

to

as

nerve

at

patent.

166

radus

wt

te

B.

n

C.

E.

racture

dsta

he

a

racture

ragment

scapod

te

s

wrst

s

tumb

te

base

o

te

CMC

boxer’s

te

o

dspaced

te

and

Bennett

A

E.

most

does

reverse

rst

dsta

nvove

Coes

radus

tumb)

metacarpa

GAS

wt

bone

reers

to

It

o

case

contnues

to

tree

a

racture

o

te

5t

metacarpa

80.

E.

he

N

extensor

443;

ABR/McM

tendons

o

te

162

ngers

te

dstay

on

he

te

te

proxma

DIP

posed

gves

A.

jont

lexor

te

Caw

unar

te

te

and

IP

te

ngers,

arm

are

by

at

te

dsta

jonts.

rada

o

a

In

s

te

musce.

to

ts

hs

te

cnca

MCP

and

te

nerves,

ngers

are

te

te

E.

B.

In

te

extensor

PIP

te

o

jont,

tendon

aowng

pamar,

te

deormty,

PIP

jont.

centra

expanson

te

causng

te

te

hs

s

tendon

tendon

causes

torn

to

to

te

porton

over

move

te

upper

act

as

DIP

a

GAS

83.

C.

jont

to

Swan-neck

MCP

jonts,

sgt

lexon

most

oten

ntrnsc

D.

sue

GAS

81.

A.

Because

te

pocs

aso

B.

o

te

ong

ongus

ony

jonts.

as

4

n

medan

jonts,

condton

o

te

te

o

causng

ts-

nerve

rreversbe

ABR/McM

s

njured

Loss

wou d

o

162

wtn

te

atera

pamar

cubta

E.

no

nger,

N

o

we re

case

te

C8

and

and

te

T1

te

a

ventra

ram,

orearm

and

ventra).

ower

trunk.

braca

wc

o

ts

or

trunk

meda

sde

and

n

ower

te

nerve,

as

and

(dorsa

o

njures.

reaced

arm

o

patent

cdren

and

o

meda

C5

te

o

o

B.

to

te

o

and

suppes

bracum

no

Loss

on

Injury

a

to

o

713,

o

o

suppy

o

te

atrogenc

nodes

and

C7

sensory

tumb,

ndex,

nger.

I

t

s

ony

ead

njured

wen

removed),

atropy,

te

cavcuar

njury

pectora

te

ts

eavng

or

o

ead

cord

an

(as

o

n

apca

part

o

nraca-

te

o

ead

nerve

atera

n

ABR/McM

woud

to

but

oss

aso

bceps

ave

not

te

ony

mus-

brac

and

sensory

dstrbuton

149

no

major.

antebraca

proxma

major

examnaton

pectoras

woud

motor

dects.

nerve

nerve.

419;

provdes

pectoras

Pysca

resutng

and

te

sensory

pectora

nerve,

parayss

nerve

o

pectora

atera

atera

part

mnor.

motor

meda

N

sup-

dect.

te

731;

and

arm.

typcay

te

were

cutaneous

144

s

to

atera

bers.

pam,

rng

te

cutaneous

ramus

te

arses

pexus.

atera

C6

te

musce.

pectoras

oss

sde

arses

tse

rom

prmary

nerve

cavcuar

te

te

ABR/McM

te

and

medan

a

meda

te

s

dstrbutes

undergoes

obvous

o

arses

dermatome

part

nerve

wc

antebraca

nerve

sternocosta

te

C6

braca

nerve

C6

major

cosmetc

he

te

atera

meda

420;

an

cutaneous

and

ventra

and

ymp

musce

oss,

GAS

and

motor

cuocutaneous

s e nsor y

to

cases

nerves,

tree

meda

pectora

sensaton

ner ve

oder

T1

eson

braca

te

atera

o

cutane ous

te

nerve

te

bracas

 nteross eous

brt

a

to

ts

wt

extenson

trunk

te

te lexor

njury.

be

on

atera

efect

ncudng

te

o

Most

n

cutaneous

T2

pectoras

a

reveas

D.

parayzed,

nerve

and

and

te

orgn

o

n

te

729–734;

suppy

connectve

to

vcuar

A

o

an

a

te

nerve,

C5

medan

te

resuts

tendons

o

axary

and

artrts.

rom

usuay

o

5.

anter  or

tere

resuts

454;

are

musce.

medan

hs

lexon

PIP

reumatod

pam,

and

N

lexors

o

sortenng

te

802;

te

damaged,

dects.

n

dgts

conrms

I

DIP

contracture

777–780,

ossa,

o

rom

dsorder

lexon

sgt

yperextenson

musces,

Dupuytren

nvoves

wt

skn

ts

deormty

or

on

ntercostobraca

te

yperextended.

C.

endng

source

be

In

muscuocutaneous

he

lexor

nerve

158

pasy.

and

rom

a.

atera

rom

mdde

te

toward

occur

C8

e

gves

rada

he

o

a

s

te

bers

boutonnère

can

te

sde

cord

neror

pes

“caw”

pocs

medan

sensaton

ndngs

assocated

oss

cord

branc

appearance.

lexor

te

suppy

ABR/McM

pexus,

rom

he

and

break

dermatome

nerve,

C.

he



antebracum.

cord,

o

not

Kumpke

patent

meda

he

ore-

ntact

nto

B.

sup-

lexors

n

a

exten-

extensors,

ong

proxmay

unar

pung

te

te

D.

he

nnervaton

wrst.

438;

are

sensory

he

and

probem

jont

and

A.

and.

ong

extensors.

cutaneous

examnaton

antebraca

T1

and

resut

medan

he

more

unop-

maet.

ncudng

nerve,

detaced,

by

parayzed,

supped

unopposed,

lexon

esons

wrst.

are

medan

paanx

tota

proundus

wt

te

musces

te

by

te

nto

appearance

occurs

nerves

o

ped

o

pued

dgtorum

dgt

ntrnsc

sors

part

s

extensors,

jont

parayzed

does

njury

to

meda

or

te

njure

te

meda

meda

te

be

wt

braca

s

te dsta paanx o eac dgt. I te tendon s avused,

te

te

tey

te

he

nsert

N

pasy

branc

and

761–764;

795;

were

tere

o

nerve

pysca



suppes

not

at

wrst

MCP

pam.

consstent

racture

o

s

unar

757,

aduts

jont.

racture

njured

he

suppes

and

aso

woud

However,

neck.

GAS

D.

are

radus.

bone.

dorsum

te

Kumpke

ractured

te

to

atera

dorsay.

commony

not

(boxer’s

te

nerve

he

Smt

nerve

abductor,

rada

were

drecton.

a

rada

ongus

82.

Coes

he

tumb

o

racture.

A.

C.

because

parayss

dsta

voar

transected

lat

to

ts

ABR/McM

dspaced

sometmes

are

appears

lexors,

musce

Smt

racture

unar

and

ong

md-umerus

GAS

Limb

o

te

CHAPTER

84.

B.

he

C6

spna

bracoradas

A

and

B.

brac

te

C5

and

relex;

relex

nerve

C5

arc;

s

prmary

responsbe

or

te

88.

relex.

C6

s

are

bot

motor,

te

key

nvoved

C6

or

spna

te

n

te

bceps

sensory

nerve

n

part

te

a

o

85.

trceps

C8

s

responsbe

E.

T1

s

not

744;

he

nerve

o

B.

86.

B.

relex

any

he

o

C8

te

a

(lexon

nerve

deep

jerk

relex.

tendon

tage

relexestop.

E.

tat

brac

s

ndcatve

to

te

C7.

o

a

rada

te

Absence

C7

radcu-

GAS

89.

relex

spna

420;

s

more

GAS

87.

C.

tan

19,

A

753;

condyes

most

he

(or

s

sarp

oter)

nvoved

n

ment

nerves

are

not

nvoved

It

n

a

correct

aows

te

tecnca

moton

case

unaxa

on

o

te

term

n

one

to

oss

umerounar

and

n

te

te

pressure

ten

racture

tat

opened

te

nto

paced

te

te

a

cast

dgts,

ts

compartment

cast

be

removed

ten

reducng

scemc

unt

and

A

o

Fracture

not

o

te

Fracture

pressure

te

great

type

den

o

o

tracton

755;

te

E.

dsta

N

on

424;

n

and

te

or

endangers

te

deep

to

tssue

are

vascu-

te

ax-

artery,

does

racture

GAS

90.

D.

common

due

to

ABR/McM

s

as

a

158

te

o

orgn

trauma.

at

o

outstretced

n

ts

oecranon

at

te

te

t

passes

umerus.

Unar

n

oss

aso

as

meda

o

te

resuts

parayss

nerve

oss

o

n

te

cawng

at

te

carp

on

te

lex-

lexor

sensory

nterosse

especay

to

te

passes

o

te

o

medan

n

te

eads

bone

woud

and

te

unar

nerve

unc-

wrst.

ts

meda

o

nor

o

branc

afect

ndcated

psorm

unars,

dorsum

cutaneous

te

te

he

to

patent’s

te

lexor

o

passes

to

wrst

meda

A.

two

te

case.

cubta

carp

lexor

n

and

he

ossa

unars,

dgtorum

unar

te

sud-

meda

neous

te

te

te

nerve

a

branc

unar

dsta

o

⅓

o

o

te

as

te

te

te

adductor

njury

n

a

to

te

jonts.

n

add-

njury

nterosse

n

ter

ngers,

tese

nerve

s

o

and

at

te

pocs.

manestaton

te

opponens

mdne

he

ndngs

o

te

patent’s

are

ncon-

njury.

and

ourt

cutaneous

dorsum

dgt.

unar

orgnates

te

o

retnacuum.

nerve

te

o

Unar

es

resut

musces

manner

extenson,

opposton

or

dvson

not

patent.

axes

IP

a

suppes

te

nerve)

o

nerve

surace

o

n

o

153

examnaton

medan

pamar

ts

expanson

we

lexor

ste

woud

mportant

jonts.

njury

pysca

wt

to

as

tumb

te

transverse

parayss

medan

to

most

assst

MCP

nerve

he

deep

sstent

o

n

because

te

musces

te

afect

parayss

seen

extensor

to

umbrcas

medan

ts

ABR/McM

te

jonts

te

Imparment

njury

are

IP

resuts

pocs.

B.

467;

dorsa

lexng

neck

and

probems

N

te

umbrca

ton

rada

nerve,

784;

nto

wc

n

te

o

bone.

orearm,

nerve

rom

lexor

eads

nterosse

hs

by

te

not

cnca

757,

he

wrst

una.

te

te

weakness

wt

he

tat

129

te

njury

and

probems

s

rada

nserton

brac

rare.

resut

extensor

drect

o

qute

nerve

te

brocar-

prmary

on

unar

wrst,

proxma

nerve

o

can

resut

trceps

o

wt

rom

trquetrum.

s

navcuar)

a

cause

unar

te

extenson

artery.

not

te

ragment

epcondye

occurs

groove

s

te

umbrcas,

between

Injures

o

rada

can

dorsa

of

te

troug

on

separated

tranguar

radus

name

supnaton.

artcuate

dgts.

tunne

unar

te

pan

umera

braca

atoug

usuay

musces

ony

radus.

wt

te

up

sensory

wc

n

demand-

and

Carpa

te

te

and

not

s

ABR/McM

te

afect

te

and

woman’s

and

te

produce

mus-

contracture.

oecranon

atera

racture

extensor

GAS

nerve

te

te

neck

o

he

o

t

by

epcondye

at

two

not

t

tracton

t

does

nstead,

dsocaton

Unar

woud

te

compartment

reducton

crcumlex

umerus

contracture,

dspace

Fracture

scemc

te

o

surgca

posteror

rada

V okmann

can

te

and

artcuates

supercas.

te

nerve

una

pronaton

bones

442;

ebow

Injury

not

umera

major

and

o

repar.

Fracture

te

una

od

te

meda

meda

as

souder

syndrome,

and

te

between

compart-

bockng

rom

D.

mb

N

meda

unars.

ton,

compart-

(te

n

te

brances

C.

braca

compartment

he

scema

nsensate

te

because

te

rst

contracture.

n

s

dsta

te

ep-

racture.

te

te

nto

eves.

hs

lexor

to

compartment,

artera

or

te

pressure,

troug

te

scemc

acerates

Beedng

unreeved

Cod,

o

njure

E.

to

conceang

atoug

D.

and

(“reeased”)

ary

B.

te

nto

to

racture.

suppy

ncreased

sometmes

occurs.

oten

artera

rom

rses

o

artcuates

o

puttng

n

t

proxma

V okmann

scema.

low

oten

a

beedng

o

undergo

s

warnngs

A.

wt

greaty

outlow

B.

unate

transmtted

at

n

te

between

resutng

ourt

126

just

supracondyar

o

was

carp

jont.

ABR/McM

ragment

artery,

artera

ar

a

part

bones;

(adducton)

axs

o

artcuaton

orce

around

152

and

753–754;

trauma

umerus

cause

bony

te

ng

445;

te

caed

causes

venous

wrst,

carpa

psorm

he

case

axs.

Dmnuton

resuts

oss

N

o

common

ment.

ces

one

racture

A.

ead

scapod

ebow,

ABR/McM

te

jont.

tereore

are

mb.

N

jont

nerves

patway.

and T1

upper

spna

A, C, D, E. he oter types o jonts sted aow moton

n

dsta

partcpates

compex

carpa

contrbutes

trceps

C6

extenson

s

te

he

te

he

151

usuay

and

nge

and

and

te

s

756;

Gngymus

jont)

tat

C.

o

and

C5

734–735,

descrbe

nger

or

njury.

brac

relexes

GAS

spna

he

bceps

te

ABR/McM

nnervates

or

D and E.

n

437;

trceps

and

te

N

and

te

or

responsbe

man

opaty

A

B,

trquetrum

D.

C.

jont

A,

relex.

GAS

Normay

329

Limb

wt te radus at te dsta radounar jont at te wrst,

or

C7

D.

Upper

6

nnervaton

te

However,

nerve

rom

orearm

o

(dorsa

te

wc

t

te

branc

unar

s

and

cuta-

nerve

proxma

o

at

to

330

C H A P T E R

te

6

wrst.

woud

C.

Upper

An

not

te

deep

MCP

ped

o

by

medan

poston.

he

ts.

Loss

o

recurrent

E.

hs

GAS

91.

B.

In

ng

te

causes

te

tendon

tendon

te

paanx

C,

cause

GAS

92.

D.

may

D,

ts

MCP

sgt

most

jonts,

oten

so

and

te

A,

neck

B,

C,

cause

GAS

93.

C.

o

ts

eve

meda

C6,

o

te

obvous

C7

arm,

te

te

a

o

caus-

jont.

he

C.

oss

E.

o

o

te

hs

te

PIP

nger

jonts,

condton

tendons

s

and

asked

to

te

oter

answer

GAS

95.

nerve

he

o

was

n

to

to

do

one

n

oss

(“wngng”

puts

rom

te

mportant

te

n

arm

wc

resstance.

ventra

ram

o

musces

or

o

dvson

posteror

and

n

A.

souder

o

cord

and

cord

o

motor

extensor

w

suppes

te

to

and

mdde

ebow

trunk

extensor

suppes

rotator

ts

o

D,

te

nerve

braca

nnervaton

respectvey.

not

resut

orgnate

n

pexus.

to

hus

wng

te

and

an

hese

stc

to

a

resut

In

o

resutng

o

to

te

50%

o

n

te

dgts,

cases,

t

a

resut

te

o

ebow,

ngers

can

and

aso

and

a

oss

o

wt

be

te

paray-

a

ntrn-

specc

lattened

or

tenar

parayss

o

IP

umbrcas,

jont

exten-

nnervated

pr-

wt

rada

carp

rom

te

lexon

a

parayss

ongus

detacment

dsta

o

ABR/McM

s

nerve

radas

tat

and

o

paanx

DIP

te

o

and

brevs.

exten-

a

nger

jont.

166

drect

branc

o

te

posteror

te

teres

to

mnor

E.

on

te

te

hese

and

te

arrangement,

proxma

s

nerves

musces.

axary

umerus.

dsocated

axary

detod

te

nerve

Wen

anterory,

t

s

te

oten

nerve.

are

not

njured

n

an

anteror

N

tendon

musce

417;

o

runs

n

umerus

to

attac

hs

as

to

type

caed

o

canges

te

n

te

to

overuse

wear

te

presents

“Popeye

sgn”

and

an

wt

a

te

turns

o

te

osseous

and

bceps

ater

bra-

on

tuberce

wtn

tendon

wo

bceps

groove

drecton

supragenod

njur y

te

o

drecton

te

peope

150

ead

ntertubercuar

t

predsposes

hs

sgn

ong

te

cange

n

ABR/McM

te

tear,

brac

caracter-

te

cartoon

caracter.

GAS

97.

C.

720–721;

he

pay

A.

o

by

he

o

te

te

421;

at

te

s

sad

souder.

musce

esser

supraspnatus

ton

o

arm

and

120

nserts

It

on

to

s

te

greater

ntate

abduc-

supped

prnc-

C5.

he

te

musce

te

nerve

subscapuars

on

ABR/McM

umerus

arm

spna

nserts

B.

N

supraspnatus

tuberce

detod

njury

scapua.

s

dsocaton.

partcuary

rom

ere

osses.

nerve.

rom

nerve

707–708;

scapua.

ton

rada

and

umerus

structure

te

sted

attacments

te

term

rom

resuts

449;

te

C5,

o

o

njury

occurs

“tetered”

he

ke-

nerve.

144

dgts.

s

he

anatomca

meday

s

contans

extensors

N

proxma

lexors.

musces;

to

patent;

dermatome

contracton

at

extensors

axary

he

c

o

and.

nerve

provde

nerves

te

C6)

dstrbuton

posteror

arm

(C5,

eements

asca

and,

unar

unopposed

musce.

trunk

ts

aponeuross,

t

lexors

resuts

te

tracton

C,

GAS

96.

above

protruson

scapua),

aganst

te

ax-

serratus

medan

n

deormty

nerves

nerve

nger

nnervate

tgty

woud

te

te

s

rasng

resuts

o

puses

arses

o

anteror

scapua

Its

durng

te

and

lat

mecansm

souder

njured

o

nterosse

te

791;

he

Wt

168

parayss

serratus

te

wen

orearm,

tese

A.

B,

ABR/McM

or

orgn

cord and wraps around te surgca neck o te umerus

resembes

coces

nerve

ABR/McM

gradua

unar

ong

drop

o

and

ntrn-

unabe

somewat

te

resuts

o

Wen

patent

o

te

mb

specc

pamar

musces.

by

Maet

sor

artrts.

te

Wrst

woud

lexon

or

and

by

mary

176

sgt

a

o

te

gves

muscuocutaneous

occurrence.

medan

son

proxma

coces

and

Caw

D.

answer

o

wt

C7)

te

emnence.

n

buttonoe

te

te

and

sc

n

oter

417;

ourt

n

and,

just

hs

tear

N

causes

te

ss

ead

o

nerve

axary

nerves

and

pam,

PIP

te

jont,

oe.

jonts.

resutng

posteror

bers

he

te

ead

nvoves

te

souder.

upper

wse,

D.

te

o

PIP

te

tckenng

batera

Ape

o

and

root

oss

contracture

o

wc

especay

C7.

he

he

te

oter

nger,

454;

border

abductor

B.

te

resembe

ABR/McM

o

toracc

toracc

and

te

porton

over

o

te

reumatod

N

rotaton

te

ong

or

swan.

musce.

te

more

skn,

appearance.

ong

upward

centra

toward

to

sortenng

None

dssecton,

anteror

A.

a

rreguar

dg-

medan

715–716;

medan

yperextended.

and

DIP

curvature

E.

medan

tese

atera

assocated

Dupuytren

C6,

nerve,

sensory

any

be

bromatoss

appearance.

te

n

st

B.

168

torn

lexor

sad

454;

njured

784–786;

he

ary

as

te

te

a

troug

o

te

s

yperextenson

o

rom

GAS

94.

te

no

to

woud

A.

be

deormty

rom

musces,

stragten

as

to

s

dstnctve

lexon

are

te

on

njury

te

“caw”

s

(C5,

pectora

and

here

(sup-

cord

atera

nerve,

s

move

Frenc),

N

by

3

atera

te

te

n

te

and

muc

resut

ABR/McM

to

act

None

784–786;

woud

deormty,

stck

E.

2

he

extenson

ngers

nto

E.

by

o

proxmay

supped

as

n

te

dgts

seen

expanson

jont

n

o

are

ed

lexed

wrst

nnervated

extenson

o

nerves

be

te

ands.

ase.

tendon

Swan-neck

sc

s

454;

to

DIP

extensor

to

not

be

at

te

parayss.

tendon

(boutonnère

A,

N

boutonnère

te

unar

opposton

statement

aowng

s

to

n

are

lexors

umbrcas

nerve

799–800;

extensor

tem

tey

nerve

dects

jonts

ong

and

cawng

unar

Unopposed

tem

because

so

te

MCP

nerve.

causes

cause

nerve,

o

sensor y

unopposed

orearm)

ntact

n

te

rada

jonts

wereas

njury

resut

Extensors

Limb

musce

but

s

te

ony

musce

tat

tuberce.

rater

does

not

ntate

abducton.

adduc-

CHAPTER

D.

E.

he

subscapuars

and

ower

he

teres

border

E.

border

706;

N

te

are

o

are

B,

C,

tured

GAS

99.

C.

at

to

D.

bone

699;

he

N

te

atera

musce

ange

B.

takes

and

te

upper

and

o

te

to

s

mb,

up

bones

compressve

orces

jons

jont.

te

wt

he

sternum,

resutng

n

neura

most

E.

tat

rac-

eements.

te

rada

GAS

767,

Answers

B.

rb,

accessory

sue

bands

toms

aong

te

n

te

A.

or

rater

nerve.

he

to

syn-

mbs

hs

cana.

dmen-

as

a

hs

orearm

and

probem

tan

a

eson

atera

pam

out

o

as

medan

artery

puse

proxma

o

hs

unctons,

C,

by

ts

o

ong

com-

trunk

or

probem,

GAS

102.

(C8,

unar

as

arm

eson

s

coud

not

sde

compress

Carpa

o

lexor

soated

te

atropy

does

tcs.

he

et

sde,

nvoved

aortc

braca

te

o

rotaton

t

arses

moreover,

and

meda

t

rom

not

meda

o

not

a

ong

expan

scemc

pan

eson

lexors

te

n

A.

100.

A.

151;

he

N

unar

between

and

nerve

te

two

descends

carp

lexor

ABR/McM

unars

te

eads

between

(or

dgtorum

Injurng

enters

and

not

ntrnsc

puse

arm

or

te

B.

te

o

o

and

meda

proundus

unar

nerve

s

musces

te

te

woud

pas-

amate

not

pres-

symptoms.

carpa

te

tunne

and

te

bracoradas.

between

deep

to

te

to

do

ABR/McM

devery

s

as

to

unar

and

bracoradas

wt

te

patent’s

153

tracton

descrbed

te

orcby

can

on

oten

te

a

I

te

te

upper

te

trunk

tracton

rom

down-

and

rom

upper

recover.

avused

ere,

souders

extracted

causng

nerves

N

420;

are

not

brt

o

te

njury

rom

ventra

ram

spna

cord,

commony

njured

te

te

njured

te

tunne

te

two

ormed

hs

one

and

njury

and

a

by

a

te

te

psorm

to

pamar

resut

te

dgts

o

cana.

attacng

te

and

sde

Guyon

woud

pam

musces,

meda

n

retnacuum

meda

meda

te

nerve

ateray,

ypotenar

35

wt

unar

lexor

amate

to

bocks

te

tranguar

anterory.

te

ABR/McM

concrete

te

carpa

n

oss

pamar

sur-

and

nterosse,

motor

and

te

umbrcas.

medan

nerve

musces

to

dorsa

ma

to

D.

vascuar

lexor

here

te

s

and

te

n

a )

caw

not

nvoved

atera

s

no

o

pamar

t

most

unar

ndcaton

boxer’s

because

te

sensatons

are

o

nerve

not

arses

be

requenty

t

nerve

t

woud

at

te

prox-

ost.

dsocated

not

cause

wrst.

metacarpa

racture,

racture.

N

lexor

lexor

unar

woud

dsocated,

te

805–806;

and

te

(te

were

common

ong

o

tus

bone

bone)

so-caed

tunne

lexor

452;

ABR/McM

seat

tendons

proxma

o

or

te

pam.

unar

168

bursa

ngers

hs

n

seat

encoses

te

s

carpa

usuay

contnuous wt te lexor seat o te tte (t)

and

nger,

wc

musces.

connecton

and.

C,

It

enters te and superca to te lexor retnacuum

branc

wrst,

unate

774,

he

te

unars

devaton)

(meda

E.

passng

carp

nnervates

wrst

by

te

te

compresson

caracters-

due

orearm

resuts

passes

apped

are

te

te

carpa

103.

te

passes

oten

736;

he

I

expan

144

te

o

o

GAS

192;

te

to

notng

hese

as

tenar

compresson.

GAS

E.

te

he

woud

expan

and,

woud

rada

te

C6

meday,

meda

C.

cord

ere

o

ntact.

woud

orearm

deep

467;

baby

baby

sensaton

ace

bracocepac

because

arc;

t

cana,

ook

mecansm.

gament

woud

pexus.

syndrome

te

so

s

ook

atropy.

An

and

be

te

te

tunne

probems

ong

o

te

D,

and

oss

on

vuner-

permanent.

729,

bone

s

exerts

Strkng

hs

wc

Canges

trunk

E.

er

compresson.

upper

N

pexus,

s

A,

medan

suc

njury

symp-

possbe

vascuar

te

ts-

C5

Parestesa

nvovement.

to

o

case,

ower

te

cervca

atropy

a

sensory

nerve

pont

ts

and.

to

a

connectve

and

te

eter

parayss

mb

pont

no

In

and

and

tracton

rgt

not

E.

neck.

o

as

breec

te

braca

abducton.

trunk

D.

te

resut

atypca

orearm,

musces

rada

te

o

arm,

Erb-Ducenne

and

and/or

ntrnsc

rue

afect

B.

root

te

meda

and

presson

tends

te

nvove

lexors

T1)

at

musces,

a

nerve

tracton

and

be

s

101–125

Durng

te

coud

Guyon

and

to

enters

nerve

774;

o

It

nerve

and

wc

outet).

damage

passes

medan

o

toracc

enters

psorm

aorementoned

nerve

sons o te superor toracc aperture (te orma name

te

t

presentaton.

com-

outet

decreases

aso

te

but

te

medan

musce

ward

vascuar

were

bone.

common

toracc

nerve

wrst,

wt

he

orces

te

bone,

s and does not gve rse to te symptoms observed.

te

118

rom

condton

te

psorm

rada eads o orgn o lexor dgtorum superca-

101.

and

between

he

causng

sgmoda-saped

te

D.

te

unar

rada

troug

to

331

Limb

damage.

sage

he

te

tese

skeeton

orce,

ts

on

Oten

sternocavcuar

te

to

he

at

C.

te

transerred

atera

ent

pass

suferng

nvovng

and

121

ABR/McM

s

any

upper

scenaro.

465;

rom

neror

successon.

cavce

ts

patent

drome,

resuts

he

n

n

racture

rom

major

outstretced

rater

te

orgn

te

troug

absorb

pedatrc

o

appendcuar

suicenty

cavce

mon

but

te

scapua.

an

mb

he

skeeton

not

te

te

racture

proxmay.

axa

on

by

abe

teres

ABR/McM

a

conducted

bones

not

te

nnervated

takes

te

regon

o

415;

a

musce

te

s

nerves.

scapua;

rom

orces

A,

te

atera

Durng

do

mnor

o

orgn

GAS

98.

musce

subscapuar

Upper

6

GAS

D),

wc

791–793;

N

contnues

wt

do

451;

wtn

seats

not

o

te

te

pam,

oter

extend

nto

ABR/McM

167

te

avng

dgts

dgts.

(A,

no

B,

332

C H A P T E R

104.

C.

6

he

te

seat

nger.

nlammatory

uness

agent

o

te

was

space

ntroduced

ong

Proxmay,

mdpamar

space

Limb

nectous

synova

(t)

Upper

(or

o

seat

runs

ts

centra

processes

treated

te

te

rupture

wt

te

tereby

tte

ces

troug

compartment),

typcay

aggressvey

nto

tendons

nto

by

n

ts

unar

B,

te

E.

D.

ong

he

tendons

tenar

gus

wtn

ndex

mar

105.

A.

ts

dgta

te

synova

vesses

o

N

extensve

451;

cronc

ss

s

wt

or

o

wt

as

n

he

dramatc;

wtn

ty.

most

24

souder

Conversey,

pan.

Patents

cavan

te

deep

arm

hey

axa,

rest

wt

ven

or

o

atera

s

E.

rotaton

o

and

te

are

du

eevaton

oten

cateter-assocated

ave

arm,

o

C,

C3–C5

te

reeve

A,

te

symptoms

centra

GAS

106.

C.

E.

hese

venous

748;

The

N

condtons

ne

419;

are

not

B,

ong

GAS

109.

ndweng

compcatons

injury

is

at

o

artery.

The

second

part

of

suprascapular

is

exerted

extended

medan

trd

can

on

ad

by

te

sze

to

ngers.

oowng

njury

nerve,

DIP

dgt

and

w

tere

w

be

opposton.

be

extended

o-

njury.

jonts

extended

N

466;

o

due

te

to

second

and

unopposed

nerve,

hs

above

rom

nerve,

ABR/McM

scapua

pexus.

D,

resuts

wc

musce

trd

acton

o

te

he

s

comes

4

eson

he

ram

s

rom

and

o

5

or

rotatng

ong

toracc

supped

te

o

te

by

ventra

keep

te

ante-

abducton

C5–C7

te

o

serratus

durng

orzonta.

ventra

C3,

a

te

responsbe

occurs

dapragm

wc

157

rom

suppes

wc

te

E. hese

716;

o

N

te

ram

o

dapragm

stes

are

dsta

to

te

orgn

o

te

nerve.

417;

ABR/McM

135

ndex, and mdde ngers as we as to te atera

te

rng

nger.

nnervaton

to

Compresson

o

expans

dects

tonng

the

artery

musces

nnervated

nsuicent

orces

mus-

A. he medan nerve suppes sensory nnervaton to te

B

axillary

o

te

nnervated

nerve.

toracc

motor

218

the

are

are

abducton

nerve

(mnemonc:

tumb,

pacement.

ABR/McM

and

to

are

ave).

actv-

a

D,

arm

be

te

upward,

arses

braca

axary-sub-

te

te

usuay

n

and

be

musce.

nerve

o

and

wnged

scapua

tey

power”

wc

and

extensor

tumb

731–735;

prenc

ace

smar

wt

te

w

o

o

ntrnsc

jonts

w

medan

toracc

ror

arm

n

a

nerve.

parayss

rada

ary

upon

dgt

MCP

he

ong

coppng

prompty,

a

oter

C.

te

second

he

GAS

108.

souder

stenoss

pan

sde

o

or

te

trombo-

te

baseba,

o

o

cateter.

B,

he

he

However,

medan

owng

becomng

domnant

worsenng

te

D.

te

because

te

rotaton

compan

on

and

Efort-nduced

tromboss

souder

tumb

patents

present

and

te

pa-

dgt

years

subcavan

wt

te

o

te

“baance

dgts,

MCP

or

weakness

167

cancer

voeyba,

o

and

te

trd

te

Wt

on-

nger.

use

patents

ours.

and

n

and

symptoms

o

pocs

tendons

tromboss

downward

crcket,

te

musce,

recent

strenuous

and

payng

wood.

ven

to

te

te

nerve.

o

nerve.

he

wt

C.

lexor

nerves

condtons.

yperabducton

backward

te

ABR/McM

n

correate

nger.

ndex

cateters

medca

seen

not

seat,

and

te

common

use

do

umbrca

Axary-subcavan

more

t

contans

rst

porton

800–801;

muc

at

o

space

nger,

atera

GAS

compartments

rada

lexon

B.

hese

extend

compensate

antbotcs

A,

te

and

approprate

swngng

tat

tese

o

and

te

E.

te

lexor

he

he

medan

musces

medan

n

o

nerve

nerve

s

o

not

aso

tenar

n

conjuncton

compartment

unar

nerve

te

te

carpa

wt

te

provdes

emnence.

tunne

norma

unc-

orearm.

mpcated

n

tese

a symptoms.

branch

of

the

thyrocervical

trunk

off

the

subC.

clavian

The

of

artery,

proximal

subscapular

the

third

to

artery

part

of

the

is

the

axillary

the

major

axillary

artery.

branch

artery,

Compresson

attrbuted

ceps

te

giv-

brac

pexus.

severa

ing

off

the

thoracodorsal

and

the

to

arteries.

In

this

case

blood

from

the

artery

circumflex

retrograde

would

scapular

direction

be

artery

into

the

flowing

and

then

axillary

into

blood

distal

to

the

in

to

a

artery,

GAS

110.

B.

upper

B,

D,

E

hese

arteres

do

734,

he

817;

unate

bone.

not

provde

o

te

around

709–710;

N

te

424;

A.

hs

proxma

ABR/McM

njury

to

te

medan

nerve

te

a

o

meda

te

a

ong

o

D,

tat

lexes

lexors

te

te

dects

rater

dsta

woud

tan

to

ncude

n

ts

te

oca

nstance.

o

te

cervca

compexty

N

466;

bone

s

o

spne

ABR/McM

te

most

Dspacement

s

woud

aso

ead

symptoms.

168

commony

anteror

n

dsocated

te

cases.

Dsocaton

o

te

unate

major-

bone

te

sgns

typcay

assocated

wt

can

carpa

lexor

o

syndrome.

te

dgts,

dgtorum

E.

do

DIP

jonts

o

hese

not

bones

artcuate

are

wt

not

te

commony

dsocated

radus.

except he

scapod

artcuates

wt

te

radus

proundus more

musce

ocated

be

tr-

woud

C. or

s

te

140

and parayze

t

symptoms

not

o

scapua.

A, 107.

coud

coatera

tunne GAS

mb

pexus

ypertropy

because

addton,

descrbed

ncreasng

precptate crcuaton

rom

injury. ty

A,

musce

In

Osteoartrts

carpa

supplying

braca

the D.

suprascapular

te

circumflex symptoms

scapular

o

pressure

dgts

4

and

commony

ractured

tan

dsocated.

5, GAS

783–785;

N

446;

ABR/McM

128

but

s

CHAPTER

111.

D.

A

cervca

toracc

by

weak

puse

te

tone

te

he

(usuay

he

axary

nerve

B.

he

upper

pes

nnervaton

sow

a

at

C7)

may

cause

condton

caracterzed

and

oss

te

mb

s

and

abducted

suggest

a

ower

o

D.

te

njury

no

oss

o

trunk

unafected

souder

te

te

based

te

musces,

he

pexus

musces,

patent’s

sup-

wc

GAS

115.

presentng

t

E.

pexus

passes

he

o

artery

unt

under

braca

te

mdne

GAS

112.

A.

151;

A

N

192,

mted

supnaton

membrane

s

420;

to

nto

(D)

not

due

s

a

s

te

bra-

cords

are

ts

as

te

radus

bones;

te

and

tat

so

pronaton/

age

tat

T rocod

rada

E.

GAS

B.

at

te

between

bone

pvot

made

typcay

o

ater

jonts,

nge

junctons

s

jonts

n

te

te

an

an

as

te

te

puse

s

just

N

429;

best

ABR/McM

ocated

proxma

rada

lexor

artery

carp

to

on

te

tose

traves

radas

on

te

te

and

dsta

At

radus

bracoradas

pamars

ay

to

te

ongus

rada

tendon

artery

traves

and

more

above

te

med-

lexor

E.

he

structure

meday

GAS

114.

B.

he

te

te

N

he

and

s

s

a

aso

deeper

ocated

artery.

ABR/McM

artery

artery

eads

enter

he

lexor

on

rada

tendon

enters

te

B.

troug

te

ana-

gests

aspect

te

o

te

moves

te

pocs

o

dorsa

rst

deep

te

on

dorsa

aspect

ongus

and

aspect

to

o

o

perce

nterosseous

te

te

te

te

musce

pam.

tendon

and

troug

runs

rada

and

o

te

and

rst

po-

o

to

te

most

o

orearm;

aspect

o

te

sec-

atera

pam;

and

musces:

pocs

brevs,

wrst

on

rst

and

opponens

te

te

o

te

be

to

o

tese

o

te

musces,

s

wrst.

com-

Because

tunne,

ts

te

rst

compressed.

nerve

te

carpa

ead

and

tenar

to

medan

provdes

acton

nnervaton

proundus

hese

musces

o

te

and

N

carpa

on

or

and

are

te

part

lexor

not

cutaneous

orearm

o

carp

weakened

as

suppy

we

as

to

te

exten-

orearm.

nerve

provdes

466;

can

appears

s

a

sensory

as

branc

nerve

branc

o

te

nnervaton

o

posteror

ost

te

o

o

te

cord

provdng

rada

nerves.

hs

nerve

nnervaton

te

rada

rada

te

tat

nerve

does

not

te

oss

te

supna-

tat

te

he

rom

te

umerus.

te

ave

o

te

o

ntact.

pexus

o

does

s

grasp

o

sensaton

separates

o

braca

nnervaton

no

te

ndcatng

nerve

and

and

part

nnervaton

to

sug-

weakened.

However,

trd

patent

wc

not

wt

brances

ntact,

dsta

o

aong

orearm.

te

te

te

s

s

ndcate

beow

and

166

orearm,

musce

weak

above

n

at

be

woud

been

and

s

brac

to

and

ABR/McM

extend

hs

branc

or

and

nterosseous

extensors

rada

provdes

and

trceps

orearm

he

te

key

te

opponens

branc

weakenng

sakng

coud

nerve

drop.

superca

A.

recurrent

as

traverses

brevs,

musces,

jont.

brac

and

te

te

smpy

tat

nerve

784;

nerve

trceps

pocs

most

dgtorum

patent

Supnaton

rada

s

vgorous

nerve

734,

tat

by

not

musces.

wrst

sbe

ten

and

posteror

he

deep

and

te

adductor

170

pamar

brevs

patent

nerve

musces

superca

170

snufbox.

and

mar

ongus

antebracum

437;

rada

two

C.

to

818;

tomca

A.

n

pocs

te

patent.

rada

he

GAS

116.

tor

lexor

artery.

patent.

unar

ts

sor

E.

orearm

jont.

pocs

he

nerve

lexor

he

and

he

D,

he

te

retnacuum.

C,

B.

154

wrst

te

dorsum

tendons.

A.

o

rada

774–775;

te

nnervaton

and

abductor

ndcaton

s

unars

oot

te

lexor

medan

te

growt

and

te

ntrnsc

te

cart-

umero-

suc

o

abductor

part

exampe.

and

rst

can-

between

compartment

dgts

nnervated

medan

n

and

jont

ve

compresson

pate).

ebow

are

IP

jont

o

ABR/McM

lexor

tunne

DIPs).

rada

pont,

to

te

jonts

(antebracum)

ts

are

o

te

and

17–19,

he

temporary

eppysea

jonts

Gngymus

(PIPs

113.

(.e.,

porton

ocated

a

transtons

competes

D.

s

te

tereore

denty

run

te

tendon.

between

and

and

provdes

ourt

umbrcas

te

A.

Syncondross

to

not

tereore

ts

run

musce

musce

457;

te

nerve.

pressed

una.

s

does

nerve

and

are

Anoter

nterosseous

sympyss

not

andmark

nnervaton

and

medan

brocartagnous

pubc

n

contans

musces

two

case,

by

permanent

two

te

sternum.

ts

N

umbrcas,

pocs,

exampe.

C.

812;

trd,

ment

135

aowed

a

and

beow

pocs, and lexor pocs brevs. he tenar compart-

assocated

connecton

as

artery

medan

nnervaton

te

near

does

nterosseous

musces

ond,

trunk

correct;

ocaton

brous

te

ower

drecty

to

In

te

partay

ABR/McM

between

jonts

and

bend

jont

between

separates

ony

movement.

jont

anteror

pam,

run

333

Limb

ongus.

second

s

pexus

movement

Sympyss

usons

artery

body

synartross

aows

B.

te

pexus

artery

braca

o

ocated

te

not

nterosseous

used

791,

he

te

cavce.

pexus

bracocepac

wt

s

te

te

bracocepac

te

D.

o

does

artery

rada

cutaneous

subcavan

ca

be

dorsa

abnormates.

C.

second

cs

braca

souder

on

rada

and

he

uncton.

o

to

te

aspect

artery

he

not

E.

suppes

deep

rada

rada

above

trunk

te

pexus.

A.

are

n

upper

symptoms

braca

wc

ound

syndrome,

musce

wen

souder.

to

rb

outet

Upper

6

s

respon-

axary

and

some

rada

axary

nerve

uncton.

on

te

artery

beore

pa-

runs

enterng

C and D.

ton

o

he

te

njured.

patent

wrst,

ndcatng

ave

tat

te

weakened

unar

adduc-

nerve

s

not

334

C H A P T E R

E.

I

6

Upper

bot

te

njured,

te

supnator

supnaton

117.

rada

are

GAS

Limb

and

muscuocutaneous

supnaton

and

o

750–752,

te

785;

woud

bceps

not

brac

be

nerves

possbe

musces

121.

as

468;

he

provde

Coes

dsrupted

ABR/McM

151

A,

B,

dsta

ocaton;

to

te

severa

o

te

aspect

MCP

eray

o

te

A.

and

he

deep

a

ematoma

and

lexor

quadratus

te

s

tus

between

te

te

te

at-

GAS

122.

two

key

and

to

ractured

pocs

s

te

a

branc

lexor

ongus,

and

o

te

te

rada

prona-

tnct

A.

nerve

gves

rse

to

ts

deep

te

precse

njured

branc

o

te

rada

B.

ea

D.

A.

he

superor

469;

trunk

ABR/McM

o

te

s

E.

pexus

nnervates

supraspnatus

n

abducton

detod

arm

B.

he

C.

D

15

te

ncudes

t

E.

s

not

he

meda

729,

GAS

120.

A.

D,

o

It

te

as

artery

to

by

degrees.

C5,

C7

and

n

as

GAS

123.

he

abducts

notng

nta

s

N

o

None

composed

te

to

do

abducton

o

te

s

to

correct

C8–T1

musce;

brancng

neter

nerve

s

son

by

to

te

te

te

B.

rom

cord

o

te

a

te

oter

answers

ncude

a

420;

tyrocervca

rc

and

provde

dorsa

None

709;

trunk

anastomoses

coud

he

grat.

ABR/McM

artery

o

N

418;

rom

wt

te

oter

suppy

te

D.

te

ABR/McM

31

branc

subcavan

sted

scapuar

suppy

woud

be

s

scapua.

n

artery.

to

ost

te

wt

poston

s

n

key

be

do

not

a

more

as

key

common

dsocated

wc

and

but

n

a

be

ave

dsta

to

be

t

sps

n

young

as

out

pace,

captuum

gament

n

cdren

and

ods

te

deveoped,

o

te

medan

poston

n

not

o

a

te

good

cdren

eadng

nerve

te

s

cubta

artcuate

te

not

E.

124.

A.

una

nerve

to

an

te

nds-

not

key

due

ossa.

wt

te

troc-

artcuates

at

ts

o

body

o

o

because

as

ony

t

te

bend

nerve

te

does

meda

ts,

so

answer.

428;

ABR/McM

nerve

can

be

because

te

te

umerus.

oss

o

sensaton

wrst

n

an

154

caused

he

and

area

o

by

a

nerve

bow

wnds

symptoms

nger

skn

exten-

supped

nerve.

medan

nerve

atera

and.

3½

he

provdes

dgts

medan

on

sensory

te

nerve

s

nnervaton

pamar

not

aspect

responsbe

o

or

extenson.

nerves

1½

te

provde

dgts

meda

and.

he

on

2½

sensory

te

nnervaton

to

he

nerve

axary

detod

752;

N

te

regon

468;

unar

ngers

lexng

te

and

assst

te

MCP

te

and

aspect

responsbe

provdes

sensory

o

or

sensory

nnervaton

to

152

 n ne r vates

te

dorsa

not

to

te

souder.

ABR/McM

w  c 

o

orearm.

provdes

o

aspect

te

s

nerve

atera

ner ve

nterosse,

on

nerve

extenson.

nnervaton

pamar

dgts

unar

muscuocutaneous

he

wc

pass

unar

regon

te

dsocated

support.

not

te

N

rada

be

radus,

ts

correct

775;

te

oss

or

does

rater,

te

to

te

wrst

pamar

te

key

tan

he

GAS

major

bood

vesses

te

a

crcumlex

artery

to

as

a

meda

100

te

essenta

scapuar

adequate

arses

drect

129

annuar

neck,

uy

ncude

Unar

te

N

to

te

te

extenson

s

rada

he

and

derved

una

te

gament

te

and

te

28

or

te

mdumera

around

answer.

responsbe

radus

does

755–757,

te

tere-

atera

ave

not

s

gament,

stabe

not

to

C5–T1.

o

s

Injury

and

o

most

sted

and

woud

umerus;

rada

wrst

te

ABR/McM

hs

una

C.

answer.

dsta

tereore,

420;

o

supraspnatus

rgt

are

suprascapuar

provde

GAS

15

he

nvoved

ram.

scapua.

te

te

nerve

ram

E.

te

ngers.

734–735;

he

to

te

descrbed

just

s

musce;

cord

and

ventra

B,

s

trunk

cords

736;

rada

and

ventra

0

prmary

nvoved

suppy

supraspnatus

A,

rom

musce.

musce

degrees.

trunk

neror

ore,

C. he

90

prmary

meda

more

ts

A.

not

GAS

arm

musce

does

nor

te

te

not

epcondye;

arm.

he

and

te

supraspnatus

s

supped

to

mdde

wt

te

o

musce,

rom

te

musce

a

racture.

ABR/McM

rada

s

radus

he

C5 and C6, wc gve rse to te suprascapuar nerve,

wc

tey

aduts

te

annuar

161

braca

woud

bones

radus

dsocaton

wt

In

o

he

lexor compartment o te arm (GAS Fg. 7.92).

N

ave

ractured

poston.

o te arm, respectvey . hese nerves prmary suppy te

782;

ts

he

nerve.

medan nerve traverse te meda and anteromeda aspect

775,

o

annuar

at

s

neck.

to

D and E. Bot te deep branc o te unar nerve and te

GAS

442;

wen

ead

bones

wc

tey

carpa

te

Coes

Compresson

branc,

ts answer coce s too genera and woud not nd-

cate

te

“grp”

musces.

rada

N

artcuatng

dgtorum

a

type

resuts

rom

oter

wt

tereore,

764;

hs

carpa

radus,

ractured.

wt

umerus.

nerve

suppes

C.

unate

te

tereore,

he

contact

njured

extenson

courses

between

and

o

musce.

nterosseous

nerve

nerve

passes

musce

nnervaton

ncudng

rada

and

or

compartment

orearm,

he

radus

by

anteror

houg

te

responsbe

extensor

supnator

proundus,

C.

s

te

supnator

te

medan

tor

o

te

compressed

radus

n

jonts.

around

eads

be

supnator,

musces

or

E

drect

posteror

119.

D,

and

wt

racture;

B. he deep branc o te rada nerve, ater t emerges

o

118.

scapod

artcuaton

orearm.

N

C.

act

to

te

 umb r cas

jo n ts

do r s a

ab duct

and

n

and

a nd

adduc t

te r

act ons

exte nd  ng

te

IP

jonts.

B.

he

recurrent

vates

te

te

branc

tenar

movement

o

o

musce

te

te

medan

group

tumb.

tat

nerve

nner-

unctons

n

CHAPTER

Radial

Branch

Upper

6

335

Limb

nerve

to

brachioradialis

Branch

car pi

to

extensor

radialis

Branch

car pi

to

longus

extensor

radialis

brevis

Deep

branch

Posterior

interosseous

nerve

Common (continuation interosseous Superficial

of

ar ter y

branch deep

branch

radial

of

nerve)

Anterior

interosseous

ar ter y

Posterior

interosseous

ar ter y Ulnar

ar ter y

Posterior

interosseous

Interosseous

ar ter y

membrane

Anterior

view

Posterior

view

Anterior

interosseous

•

C.

he

D.

he

E.

he

any

rada

nerve

s

responsbe

muscuocutaneous

musces

n

anteror

te

ongus

we

te

as

orearm

or

nterosseous

pocs

and

rada

or

nerve

te

a

wrst

does

extenson.

not

nnervate

and.

te

te

lexor

quadratus

lexor

as

dgtorum

proundus.

GAS

125.

C.

799–800;

he

rada

spna

trceps

nerve

.

A and B. As

trceps

467;

brac

ABR/McM

musce

C7),

s

wc

168

comes

suppy

ventra

te

ram

of

by

te

C5–T1

patent’ s

musces,

bers

and

E.

we

and

One

ram

meda

as

woud

souder

ventra

nnervated

te

brac

to

ony

one

te

motor

can

dect

rue

axary ,

out

nvoves

C5

and

te

C6,

muscuocutaneous,

and upper subscapuar nerves. Damage to eter o tese

D

N

(prmary

nerves.

Fig.

wc

nner vates

pronator

o

GAS

ar ter y

can

orm

braca

as

medan

te

resut

lexor

aso

te

and

unar

nerve.

n

addtona

compartment

rue

out

meda

and

te

to

te

C8–T1

pectora

antebraca

Damage

motor

o

dsta

tese

dects

because

nerve

tese

and

cutaneous

ram

te

nerves,

dstrbuton

ventra

o

arm.

o

te

woud

336

C H A P T E R

6

Upper

resut

n

neous

sensaton

mb,

GAS

oss

and

o

oss

734,

pectora

over

o

750;

Limb

te

and

N

musce

meda

uncton

surace

and

o

te

cuta-

D.

upper

teror

uncton.

420;

Subscapuar

Answers

100

E.

Parasterna

Maet

nger,

deormty

te

DIP

extensor

GAS

127.

GAS

126–150

D.

n

wc

jont

due

tendon

793;

aso

N

te

to

at

446;

known

nger

as

s

avuson

te

dsta

baseba

nger,

permanenty

o

te

s

lexed

nserton

o

a

at

and

nerve

and

atera

A

axary

rotaton

cutaneous

A.

gong

muscuocutaneous

scapuar

and

bers

nerve

wnged

te

ong

ormed

te

te

scapua

serratus

rom

te

woud

te

toracc

ntrnsc

woud

spna

cord

anteror

be

eves

C5

o

te

to

C5,

C6,

are

be

Parestesa

be

caused

neous

E.

Loss

woud

GAS

D.

te

caused

747;

to

(C8–T1;

sensaton

be

C7,

by

N

and

te

D.

s

420;

te

by

te

arm

E.

he

to

E.

eter

te

epcondye

nserts

teres

and

onto

to

te

cause

orgnates

coronod

te

and

n

or

B.

radus

a

process

mdde

o

te

on

C.

atera

o

te

te

he

pronator

anteror

te

C.

surace

anteror

radus

he

atera

sde

and

o

o

te

surace

o

musce

dsta

te

orgnates

bracas

surace

coronod

causng

o

process

an

te

and

una

dsta

and

radus,

acton

on

orgnates

umerus

unar

te

pung

n

and

te

767,

Lymp

drecty

ten

C.

he

he

te

rdge

o

rada

nserts

tuberosty,

132.

te

n

ence

te

A.

he

to

rom

nto

te

Pectora

ror

N

te

atera

eptrocear,

centra

nodes

toracc

430;

and

process,

receve

wa,

ABR/McM

sde

ten

axary

o

ar

nserts

beow

at

te

ncudng

127

te

atera

nodes

ymp

dsta

to

te

axary,

and

(A).

many

most

drans

o

rom

te

te

ante-

breast.

afects

n

oss

wt

nerves

artery

bood

to

rada

njury

437;

o

te

trauma

n

and

low

te

or

bra-

bood

to

temperature

groove

but

ves-

te

mbs

canges

probaby

woud

ABR/McM

o

te

or

not

resuted

be

respon-

o

and

te

nerve

151

unar

bone

medan

nerve

wen

as

s

nerve

arses

passes

amate;

most

nerve

at

between

ence

key

enters

dvdes

t

enters

nto

te

nterosseous

te

atter

pronator

anteror

te

to

te

be

pam

teres

o

superca

cubta

arses

courses

aspect

ongus

N

455;

empty

o

te

te

deep

njured

troug

te

rom

It

and

deep

ossa.

between

musce.

te

te

medan

two

contnues

nterosseous

ead

on

to

membrane

C,

not

GAS

A.

musce,

E

o

N

ts

o

he

and

and

o

te

racture

a

unate

are

to

te

styod

C,

E.

A

te

be

afected

GAS

ts

783–784,

uncton

te

resut

n

o

te

rst

papaton

te

empty

s

o

pan

15

te

rom

responsbe

rst

can

15

a

caused

te

by

two

process

oter

degrees

test.

a

a

wrst

o

wrst

te

bones

on

N

442;

an

out-

racture;

bones

te

most

radus.

are

ess

njury.

797;

or

and

138

scapod-unate

B,

by

arm;

musce

ABR/McM

s

te

ntates

woud

beyond

proxma

D,

te

detod

durng

amark

scapod

wc

supraspnatus.

arm

415;

171

assesses

pase

te

te

assessed

he

test

abducton

D,

706;

musces.

ABR/McM

can

durng

stretced

and

resut

tunne.

tendnopaty

B,

umerus

not

subcavan

ook

anteror

805;

tendon

not

133.

777–778;

a

suppy,

symptoms.

N

te

rada

te

degrees

radus.

styod

puses

assocated

afects

te

unar

carpa

pocs

GAS

ower

racture.

B.

ater

s

o

bood

by

o

between te lexor dgtorum proundus and lexor

on

te

at

te

te

supracondyar

GAS

129.

o

abducton

base

space

patent.

te

te

nserts

and

he bracoradas musce orgnates on te atera

te

caracterzed

compartment.

psorm

supraspnatus

musce

ower

7. 5 7 ).

he recurrent branc o te medan nerve brances

o

te

on

not

exposed

branc

te

nerve

meday.

anteror

E.

quadratus

te

Fg.

conned

o

woud

s

te

nerve

763;

brances

meda

una

are

tese

deep

o

ts

radus, pung te radus meday beow te racture.

B.

582,

te

woud

t

dsease

tey

or

psorm

31

attaces

musce

pos-

scapuar

371

mpars

oss

syndrome

and

rada

eve

cuta-

unar

outet

racture

a

he

D.

pronator

and

 rom

(GAS

s

te

wc

musce

n

GAS

131.

woud

te

a

pexus

sbe

devaton.

A.

ymp 

b re ast

ABR/McM

wtn

and

he

branc

o

to

Raynaud

of

ractured

te

and

stress.

trunk).

ABR/McM

musce

wen

te

syndrome

tromboss

puse

wen

so

o

braca

dorsum

damage

rom

wa

ses between te neck and te axa, ar above te cast.

musce

Most

te

meda

neror

on

o

ca

weakened

te

nnervated

aspect

te

407;

paeness

horacc

(C6–T1).

supnator

proxmay

meda

damage

nerves

729,

he

by

nerve

o

rada

n

B.

to

nerve

unar nerve, wc woud most key reman ntact.

D.

n

njury

orearm.

and

but

C.

supra-

damage

C6,

parayzed.

and

re c e  ve

o

compartment,

V enous

muscuo-

toracc

woud

and

N

pressure

rada

abducton

te

by

A.

axary ,

te

te

o

caused

ong

musce

to

to

mpared

lexon

be

competey

musces

suprascapuar,

Damage

he

nodes

quadrant

737–738;

resutng

Damage

mpared

ymp

toracc

compartment.

causes

arm.

nerve.

damage

not

te

receve

te

Compartment

asca

175

nerves.

nerves

o

causes

rom

to

C.

ncreased

B. Injury to te superor trunk o te braca pexus can

damage

128.

130.

paanx.

ABR/McM

o

regon.

ABR/McM

meda

126.

nodes

aspect

ABR/McM

128

key

to

CHAPTER

Anterior

Apical

Some

Central

Pectoral

of

upper

nodes subclavian

trunk

nodes

limb

nodes

nodes

Superior

part

mammary

Humeral

nodes

Subscapular

nodes

Most

of

upper

and

of

•

C.

te

A.

Bennett

racture

a

CMC

racture

at

te

base

o

Fig.

mammary

135.

A.

to

suc

D.

Smt

te

racture

anatomca

ture

s

Boxer’s

GAS

ndcated

aso

by

pan

n

wen

te

a

reverse

dsta

Coes

ragment

rac-

o

te

reers

bone,

to

usuay

racture

te

t

o

or

te

neck

ourt

o

a

meta-

poe,

ts

442;

ABR/McM

128

mon

njury

te

to

sad,

s

more

wt

vagus

on

te

orce

te

on

te

term

“gamekeeper’s

anmas

ndex

abducted

coatera

and

seen

n

s

MCP

skers

on

tumb,

“sker’s

te

n-

gament.

braced

tumb”

term

between

and

commony

ter

a

Scotts

sma

necks

tumb

unar

was

among

ked

ter

orce

te

Wereas

used,

usage.

s

vagus

njury

patent.

sometmes

N

t

tumb”

common

breakng

awkwardy

causng

njury

gamekeeper’s

resutng

and

ts

by

te

caused

T oday

n

and

an

wo,

rabbts

he

jont

wo

a

as

ground

ger.

caed

bone.

783–786;

posterory.

orward.

racture

metacarpa

carpa

s

caused

anges

be

dspaced

snufbox.

racture

and

radus

woud

s

“gamekeeper’s

descrbe

gamekeepers

ragment

gland

Interestngy,

because

dsta

wall

par t

.

Coes racture s aso caed “dnner ork deormty”

te

body

centrolateral

coned

Scapod

E.

s

GAS

tumb.

B.

of

gland

limb

Anterolateral

134.

337

Limb

scalene

Right

Infraclavicular

Upper

6

a

as

sk

seen

tumb”

st

n

s

com-

338

C H A P T E R

B.

6

Upper

Scapod

stretced

Limb

racture

and,

occurs

ater

nvovng

te

a

a

on

scapod

an

and

out-

A.

te

bones.

B.

C.

Bennett

D.

Smt

racture

s

a

racture

at

te

base

o

te

and

tured

s

aso

caused

and

orward.

s

te

caed

wen

dsta

Coes

a

te

dsta

rada

racture

s

reverse

Coes

radus

ragment

aso

caed

s

s

rac-

E.

dspaced

Boxer’s

dnner

ork

and

s

a

(and

o

te

necks

sometmes

o

te

te

t)

136.

B.

783–786;

he

te

bceps

tendon

radus.

spna

te

he

aferent

C5

C,

D,

E

brac

GAS

137.

B.

o

sde

D,

E

and

te

N

motor

C5

on

poston.

C6

te

C6

unar

te

bceps

nvoved

n

te

bceps

C7.

he

major

not

nvoved

n

te

s

te

s

s

a

te

lexor

aso

wrst

dnner

ragment

Smt

racture

o

racture

and

ractured,

an

scemc

s

wt

ork

te

s

radus

aso

caused

te

deor-

and

wen

rada

s

te

E.

N

and

ater

nvove

a

a

te

on

an

out-

scapod

and

unar

te

It

s

a

racture

Boxer’s

at

racture

and

trd

two

enters

eads

between

enters

vunerabe

and

to

E.

te

s

base

a

(and

o

te

racture

rst

te

or

te

o

o

and

hese

o

te

atera

and

to

damage

orearm

te

lexor

carp

te

proundus

superca

te

and

psorm

provdes

by

passng

unars

s

te

N

o

were

deep

t

unar

a re

and

n-

medan

supped

rada

te

n e r ve

o

te

extended

  e xe d

because

supped

by

out

te

4

te

o

and

s

to

te

rada

lexed

Pressure

to

te

te

I

5.

arteres

wt

te

does

s

to

or

te

and

artery

pam

artery

arvested

s

succes-

anastomoses

rada

te

suicent

do

o

suppy

o

te

unar

ngers

pam.

o

rada

not

te

unar

patency

to

te

166

te

and

due

we

dgts

wt

assessed.

s

3,

compresson

neuroogca

vascuature.

438;

reeased,

suppy

a

or

not

te

grat.

patency

he

o

te

tunne

enters

te

and

and

are

and

and

atera

hese

due

te

not

s

to

a

assess

cnca

compres-

a

by

superca

te

and

o

because

rada

ts

to

o

te

te

te

te

to

psorm

adductor

musces

abducton

spared

nnervated

by

do

test

169

te

nterosse

branc.

s

and

Tne

syndrome

ABR/McM

a

tests

D.

nerve.

nerve

tunne,

te

te

B

prox-

are

po-

responsbe

ngers.

lexor

lexor

medan

te

bone

Fexon

dgtorum

dgtorum

nerve,

wc

njury.

Had te medan nerve been compressed n te car-

pa

bone,

ps-

tte

te

spared

to

o

useuness

notng

are

deep

unafected

a )

te

s

degree

te

artery

carpa

ngers

(meda

lexor

n

a re

1

wrst

rada

wen

medan

adducton

carp

te

te

extensors

be

ABR/McM

bood

artery

nnervates

lexor

to

te

nerve

dgts

te

be

retnacuum

te

A.

ps-

ndex

and

to

sgty

lexon

te

he

te

unar

proundus

te

nnervates

dgtorum

te

159

at

and

ave

805;

va

o

te

rng

dgts

to

a re

nvoves

rada

assess

o

lexor

sometmes

te

jonts

o

to

te

bood

te

E.

he

cs

to

arses

unopposed

tem

5

wt

njur y

suppy

466;

tereby

supercas

ABR/McM

nerve

lexor

retnacuum

142.

te

artery.

to

son

to

atera

nerve

te

an

o

rada

te

on

unar

tests

GAS

occur

second

437;

te

C,

N

test

tem.

oter

test

tan

158

and

te

PI P

due

vesse

can

ntegrty

ragment

rada

and

by

and

determne



B,

4

he

move

and

and

racture

te

to

to

rada

caed

atera

ocated

te

n e r ve

te

807;

wt

ten

musces.

caed

dsta

rom

o

o

  e xo r s

arteres

eter

lus

deormty

te

extenson

Aen

between

159

lexon

o

reeased

svey

bra-

o

causng

spared

unar

ten

by

are

s

tgty

relex

metacarpa.

and

branc.

and

ABR/McM

ractures

descends

musces.

C6,

tappng

he

bones.

o

764;

between

437;

orearm

metacarpa.

he

C5,

by

musce.

orward.

Bennett

t)

ected

3,

E.

774,

bypass

Coes

stretced

necks

s

C6.

posterory.

Scapod

unate

relex

not

n e r ve ;

D g  t s

D,

he

and

njured

n e r ve .

C,

A.

s

caused

unar

unopposed

157

key

ocated

ABR/McM

sgn

ong

  e xo r s

GAS

not

extended

s

to

te

A,

o

1

on

arc.

467;

medan

deep

dgts

more

orearm.

ngers

and

component;

component

not

sometmes

radus

anged

s

nserton

nvoves

ABR/McM

nerves

racture

reverse

unars

are

contracture

because

dsta

and

tappng

relex.

dspaced

D.

relex

nerves

hese

o

Coes

mty

139.

ts

bracoradas

rom

775–777;

necross

GAS

te

eferent

421;

te

s

ngers

C.

near

by

N

Te

te

nerve

N

spna

te

B.

te

nerves

o

V okmann

a

o

ected

relex

provdes

te

s

branc

te

  e xe d

and

141.

D.

A.

bceps

brac

bracoradas

coradas

GAS

relex

173

relex.

tendon

C,

ABR/McM

relex.

contrbuton

138.

C5

hese

nvoves

A,

te

720–721;

he

te

brac

provdes

brac

445;

bceps

nerves.

A.

by

N

n

774;

n e r ve .

s

nerve

Be n e d  c t  o n

gers

metacarpas.

GAS

B.

s

bone.

deep

mdde

racture

trd

he

GAS

140.

nerve

medan

may

posterory.

racture

second

E.

branc

bone.

orm

anged

deormty because te dsta ragment o te radus

s

he

rac-

unar

nerve.

rada

orm

C.

racture

deep

unar

he

rst

metacarpa.

ture

he

unate

and

re s u  t s

and.

one

tumb

tenar

D.

n

An

woud

as

a

ave

resut

o

dicuty

a

ack

o

wt

moton

nnervaton

o

musces.

njur y

extenson

o

te

rada

dect

n

ner ve

te

n

te

 o re a r m

arm

and

CHAPTER

C.

he

medan

abducton

provdes

o

GAS

143.

A.

te

jont

wt

te

ma

s

to

o

tere

te

musce),

axary

ead

s

mnor

to

B.

to

sde

and

C.

superor

he

n

D.

A

a

s

rada

some

GAS

A.

s

s

y

N

B.

o

a

s

to

s

bow

at

a

te

It

s

te

cavce.

but

bone

ractures

here

rarey

any

s

racture

ractured

usuay

te

D

njury

up

o

as

oca

resut

he

rada

t

runs

teres

ebow”),

te

te

s

n

te

supnaton

he

rota-

tendons.

most

we

te

or

and

te

ts

panu

te

rada

cuf

but

ong

t

te

ead

acterstc

extremey

bey

E.

te

ans

o

s

uncommon

most

te

bceps

deormty

te

s

brac.

wen

promnent

caed

or

common

buge

“Popeye

musce

te

arm

he

It

produces

lexng

o

sgn.”

te

o

a

car-

ebow:

unattaced

to

an

musce

n

atera

te

te

meda

unou-

154

and

promnence

te

acromon

s

and

te

occurs,

te

ead

nerory,

eadng

umerus.

and

o

assocated

Wen

anterory

o

dsocaton

usuay

ncdent.

acromon,

coronod

te

sope

depressed

here

o

te

and

as

N

process

o

yperextenson,

te

una

wc

can

afects

md-body

o

te

umerus

dam-

nerve.

a

a

racture

not

428;

wc

be

any

te

o

surgca

te

neck

posteror

nnervates

depresson

te

o

cord

detod

beneat

te

case.

ABR/McM

cubta

ven

s

aponeuross.

brosus

rom

to

aceraton

nerve,

eter

out

s

a

te

lat

142

a

superca

he

ven

bcpta

seet

meda

o

sde

o

tat

es

aponeuross

connectve

te

D.

bceps

tssue

brac

E.

covers

te

and

and

ead

sde

o

te

teres

una.

rom

runs

to

carpa

tus

bceps

te

and

It

te

meda

te

te

as

two

te

and

t.

bones

orms

on

te

757–758;

N

attacments:

umerus

meda

braca

musce

artery

es

on

te

tendon

sde

atera

mt

bcpta

braca

lexes

dependng

atera

brac

he

o

and

coronod

runs

o

o

te

on

te

pro-

atera

nserts

to

te

407;

on

bceps

es

ABR/McM

o

and

poston

te

cubta

aponeuross

artery

ebow

te

sde

te

te

ore-

ossa.

rada

orgnates

brac

underneat

aponeuross.

GAS

ossa

deep

musce.

supnates

orearm.

tuberosty.

musce

he

teres

and

ormng

rom

te

epcondye

bracoradas

he

don,

o

arsng

pronator

te

cubta

retnacuum

meda

pronates

o

te

wc

tunne.

te

he

renorces

artery,

pronator

unar

It

braca

pamar

he

to

musces.

te

carpa

B.

te

te

on

Anteror

contour

te

te

w

lexor

te

eas-

tendons

to

axary

lexor

protects

te

tendon

te

radoum-

tendon to bend wt te antebraca asca o te ore-

cess

o

te

and

tere

acertus

tat

o

compresson

es

ABR/McM

detod

o

bcpta

to

tssue.

on

te

renorcng

dspaced

rada

te

ead

be

ste

jont.

on

under-

o

es

gament

traumatc

Atoug

695;

axty

can

and

attacment

renorcng

moton.

ebow

medan

orearm

he

o

wt

he

common

resuts

seet

radus

appearance.

te

arm

Atoug

atera

umerus

GAS

subux-

oten

an

gament

common

norma

C.

jont.

rupture,

and

o

s

o

ebow

musce,

146.

as

te

orearm.

jont

428;

most

te

te

racture

afect

A.

ead

extended.

and

s

suprasp-

and

njur y

rom

extremey

tere

142

rada

ead

aows

dsocate)

s

mnor

and

rada

tendons.

te

he

ebow

gament

wt

and

te

wen

subscapuars,

ABR/McM

on

te

o

to

te

cdren.

(par tay

treated

A

te

neurovas-

may

and.

occur

experencng

pu

condton

o

o

Avuson

C.

typ-

s

soated

occur

occur

N

umerus

“dented”

A.

or

ebow

range

protruson

not

njures

ractured

outstretced

428;

s

and

an

oss

or

n

sarp

wde

te

sweng

cavce.

nerve

Most

md-body

an

tears

422,

annuar

ebow

rom

arm

produces

te

a

acromon

made

deveopment

hs

te

expansve

jont.

lattenng

suppy

serves

jont

coatera

753–755;

souder

resuts

It

o

trauma.

commony

njur y

subux

cutaneous

wen

commony

trd

on

patent

a

o

teres

te

ebow

te

umerus

wt

njured

o

It

an

B. he genoumera jont s an extremey mobe jont

te

umera

te

o

wt

te

anteror

te

commony

major

tenderness

cuf

pronated

te

a

(“nursemad’s

ebow

rom

s

nraspnatus,

695;

aton

(due

on

unar

sde

mera

145.

bodes.

s

connects

339

Limb

jont.

ages

degeneratve

cuf

he

ner-

tat

coatera

te

he

GAS

musce.

typcay

specc

s

te

groove.

natus,

144.

detod

and

o

nnervates

provdes

adducted.

umerus

a

Rotator

tor

aso

pung

acromon,

most

and

promnence

umerus

wc

arm

rada

membrane

tssue

musces

o

era

E.

abnor-

te

anterory

movement

he

te

drect

and

spra

nerve

E.

te

te

ds-

ter

te

sde

dsocatons

we

at

he

mobe

were

nterosseous

connectve

una

damage.

rom

he

o

surace

rotated. Wen

detod

te

dspacement

mdde

sweng

cuar

C.

dects.

ater

te

te

o

souder

wt

cavce

cay

and

te

njures

souder

nerve,

sgty

assocated

sensory

o

subuxaton

and

o

ony

Anteror

Anteror

dspaced

to

overyng

o

pamar

extremey

externay

ocaton).

tp

It

D.

an

oow

o

(due

axary

jont

te

te

movement.

te

wegt

detod

skn

AC

s

lattenng

ts

and

te

to

protruson

te

o

and

umerus

uness

nto

nerve

apped

s

to

musces

ngers.

167

s

common.

usuay

ncreased

te

or

jont

range

most

abducted,

te

nnervate

o

dgts.

ABR/McM

wde

te

umerus

orce

ory,

a

s

extended,

ead

tree

455;

not

nnervaton

genoumera

ocaton

o

N

does

adducton

sensory

rst

805;

he

nerve

and

Upper

6

157

ten-

te

340

C H A P T E R

6

Upper

Limb

Flexor

Three

hypothenar

digiti

minimi

brevis

Flexor

pollicis

brevis

muscles

Three

Adductor

pollicis

interosseous

side

of

and

inser t

extensor

first

into

thenar

palmar

medial

hood

Extensor

Opponens

digiti

pollicis

pollicis

of

digiti

Deep

ar ter y

branch

and

Flexor

car pi

•

era

te

B,

lexor

tat

sdes

o

don,

and

lexor

osses

n

he

and

GAS

148.

D.

te

a

tunne.

to

tck

te

It

connectve

te

meda

protects

and

GAS

Fig.

not

Fg.

tssue

and

A

at-

stabzes

carp

unars

tendons,

resut

n

and

rom

margn

tree

pocs

made

as

a

o

oose

sny,

lexor

o

atera

o

te

tenar

brevs,

te

sde

lexor

musces:

and

median

nerve

brevis

o

Injury

we

te

E.

tssue

medan

o

te

Injury

GAS

nerve

retnacuum.

te

abductor

B.

t

medan

It

opponens

pocs

usuay

nerve

at

to

pocs,

B.

te

njury

medan

o

te

nerve,

Injury

resuts

two

A.

C

te

and

n

o

nerve

n

recurrent

causes

te

oss

N

to

eads

te

o

te

and

bot

pamar

o

te

and

enters

and

D.

arteres

rst

artery

te

he

are

Fg.

enters

posteror

unar

and

carpa

pamar

sensory

branc

sensaton

unar

dects

ony

and

o

te

o

te

on

anteror

ound

resuts

n

dstrbuton

anatomca

o

te

and

nterosseous

courses

and

nerves

te

o

166

te

aspect

dorsa

n

7.107).

ABR/McM

artery

he

ous

(GAS

466;

rada

rada

motor

nerves

808;

he

passes

nner-

brevs.

o

medan

nerve

teses

appearance

167

as

pam.

unctona

connectve

gstenng

ABR/McM

branc

pollicis

dects.

medan

149.

452;

te

C.

branc

ten-

7.107).

N

and

tunne,

motor

lexor

tendons

ave

of

.

t.

supercas

s

branch

ner ve

sensory

skn

pollicis

retinaculum

and.

recurrent

te

s

between

beneat

proundus

does

dsta

lexor

run

Damage

788–790;

he

vates

carpa

pamar

orgnates

space

dgtorum

te

(GAS

te

tat

E.

dgtorum

C.

te

tendons

D

retnacuum

spans

side

hood

ulnaris

Flexor

he

abductor

lateral

of

Median

band

and

into

ner ve

Abductor

A.

brevis

inser t

minimi

Recurrent

147.

brevis

extensor

Opponens

ulnar

hood

minimi

Flexor

Abductor

muscles

n

te

te

orearm

surace.

posteror

anterory

as

te

musce.

anteror

pamar

and

snufbox

between

and

nterosse-

posterory,

CHAPTER

Area

of

superficial

distribution

branch

Palmar

ulnar

in

hand

branch

ner ve

from

of

ulnar

forear m

Palmar

Medial

341

Limb

of

of

nerve

Upper

6

view

two

lumbrical

muscles

Deep

(of

Superficial

branch

ulnar

(of

ner ve)

Ulnar

ulnar

branch

ner ve)

nerve

Ulnar

ar ter y

Dorsal

branch

nerve

of

from

ulnar

forearm

Dorsal

•

respectvey,

wc

E.

s

he

on

deep

pamar

branc

150.

E.

772,

he

vaton

to

o

te

are

responsbe

te

acton

he

tat

te

axary

mnor

te

o

te

unar

s

or

radus

s

an

and

membrane,

on

and

by

te

te

musces

n

B.

te

N

o

and

te

a

ABR/McM

or

a

adducton

used

he

o

to

cas.

nner-

dgts

motor

and

musces

nterosse

te

od

dgts,

a

pece

o

lex

C.

te

ton

musces

wc

o

s

paper

he

te

arm.

te

hs

detod

nerve

and

aso

teres

carres

o

te

s

atera

part

MCP

jonts,

te

anteror

souder

te

and

a

and

or

and

ngers,

emnence.

atera

oppose

te

musce.

cutaneous

a

te

to

jont

detod

tenar

uncton

It

two

te

nner-

and

te

nner-

umbr-

tumb

and

respectvey.

muscuocutaneous

o

te

musces

musces

te

o

responsbe

tree

ncudng

tenar

hese

te

nerve

te

pam

rom

neror

nerve

s

responsbe

compartment

o

te

or

arm,

nnerva-

endng

as

te atera antebraca cutaneous nerve beow te ebow.

D.

he

It

o

nnervates

te

medan

atera

170

cutaneous

ntrnsc

nterosse.

be

he

vates

457;

normaton

over

vaton

deep

nger

nerve

sensory

skn

ormed

artery

.

una.

anastomoss

s

Fig.

artery.

one

woud

and

tat

responsbe

most

te

nterosseous

te

rada

801–806;

meda

to

te

arc

o

nerve

ncudng

between

A.

te

791,

nnervaton

and

pamar

part

unar

near

between

surace

termna

GAS

or

ocated

GAS

view

te

ead

GAS

rada

aso

nerve

carres

and.

to

ts

N

o

467;

te

extensors

normaton

hereore,

array

805–806;

nnervates

sensory

damage

symptoms

to

rom

ts

(GAS

ABR/McM

168

o

te

te

nerve

Fg.

and.

dorsum

w

7.113).

not

342

C H A P T E R

Answers

151.

6

he

ar

te

o

some

he

Nerve

C4

tons

not

C5

te

te

N

nerves

and

s

te

ts

and

s

E.

uncton

B.

he

153.

A.

15

700;

he

te

sbe

unar

or

ormed

by

to

o

tat

man

C5

nerve

o

are

o

toracodorsa

to

te

wt

as

C6

or

can

cause

tears

and

n

teres

n

ts

o

oss

E.

te

not

musce,

GAS

mnor

musces

155.

o

responsbe

rotaton

a

souder

s

or

and

te

not

or

or

s

s

o

te

deep

musces

va

o

ventra

o

te

te

Bot

trunk

w

not

produce

nerve

damage

wrst,

except

except

or

gers.

w

It

tumb.

te

musces

C.

o

te

tese

ram,

te

or

bceps

C.

nter-

atera

w

resut

atera

he

C5

te

t

n

o

wc

D.

or

E.

com-

two

two

o

te

dgts,

t

te

n-

entre

lexon

upper

C6

trunk

receves

ventra

cuocutaneous,

lexor

te

o

o

te

musces

at

te

ts

nerve

ebow

sensaton

jont,

n

te

contrbutons

nto

rom

ram

and

dvdes

te

medan,

and

suprascapuar

te

mus-

nerves.

are

dgts

as

we

responsbe

are

or

responsbe

aso

assst

n

ead

to

woud

dgts.

s

responsbe

and

s



or

damaged

w

168

aceved

bracas,

musce

te

s



by

and

major

te

te

contracton

bracoradas

te

wt

ebow

unars

lexon

or

and

o

lexor

o

bracoradas

bceps

radas

te

brac

s

o

are

prmary

wrst.

supercas

lexon

teres

and

421;

Opposton

wt

te

te

and

and

dgts

supnator

supnaton,

tay

rst

nvoves

jont.

te

he

medan

te

prncpa

te

orearm

te

supercas,

tenar

proundus

at

te

MCP

are

responsbe

respectvey.

he

C.

he

s

and

(C8,

o

te

te

o

ourt

and

two

cas

(supped

two

undus

(supped

o

by

lexon

lexor

medan

at

te

te

te

te

pocs

branc

nerve

compartment

musces

o

te

wt

te

proundus,

lexor

ongus

extends

t

tendons

meda

he

pocs

acton

recurrent

n-

o

jont,

by

and

te

begns

and

to

and.

s

o

It

tendons

dgtorum

suppy

te

and.

ndcs

meda

te

ten

tunne

tat

rotaton

CMC

anteror

tenar

te

and

by

T1).

carpa

lexor

te

by

pocs

te

dgtorum

and

extensor

at

extensor.

poston

meda

produced

supped

nerve

ebow

movement

and

opponens

are

te

159

extended

musce,

nerve

musces

B.

te

musce

brevs

musces

s

compex

hs

pocs

pocs

brevs

a

n

abducton

metacarpa.

opponens

brac

ABR/McM

s

tumb

lexor

to

our

togeter

trceps

N

o

rom

te

respon-

respectvey.

pronator

pronaton

te

te

o

E.

o

jonts,

troug

bracas.

are

two

o

dgt.

dgtorum

passes

normaton

te

Interosse

ABR/McM

lex

or

coracobraca-

njury

oss

156.

MCP

umbrcas)

IP

744;

(ourt

ntrnsc

jonts

extenson.

nterosse

dgt,

ebow

carp

lexor

we

GAS

lexor

orearm.

and

to

o

IP

mnm

t

and

IP

dgtorum

te

bracas

jont

and

nerve,

meda

he coracobracas does not cross te ebow jont

o

weakness

nnervates

most

and

o

n

as

te

sensory

hereore,

pronaton,

and

o

umbrcas.

nerve

and

most

proundus

we

namey

carres

oss

as

and

resut

Medan

o

ourt

responsbe

he

are

pexus.

lexors

uncton

w

meda

arm,

te

he

and

recurrent

braca

ourt

dgtorum

atera

orearm.

supnaton,

E.

oss

he

unar

nterosse

nterosse

dgt

te

te

dgts.

brac,

contnue

are

respon-

nerves

symptoms.

o

unars,

lexon),

and

a

te

damage

brac,

Addtonay,

te

n

lexor

anteror

tese

o

muscuocutaneous

te

s,

o

(nterosse

except

he

resut

jont

o

carp

jonts

nerve

a

IP

a

nvove

lexor

IP

aso

Unar

t

and,

te

te

meda

and

woud

bceps

he

branc

B and D. Damage to eter te medan or unar nerves

aone

o

te

and

te

adducton

extensor

te

te

n

oss

extenson.

BP105;

responsbe

tumb

T1

o

dects

exampe

damaged.

te

B.

nnervaton

o

N

ebow

w

dsocaton.

responsbe

te

to

extend

pamar

IP

te

afect

musces.

lexon,

woud

o

extensor

805;

te

te

to

or

nterosse

lexon

dorsa

ead

166

damage

we

and

w

nerves,

jont.

umbrcas

extenson

Fexon

142

nerve.

and

A.

te

and

extenson

patent.

bot

MCP

to

o

he

te

as

we

lexon

ebow

key

he

Injury

damage

rotaton

n

trunk

tese

ABR/McM

abducton

D.

o

ngers,

adducton

B.

souder

weakened

neror

or

and

or

te

he

tte

abducton,

orm

upper

420;

afected

assstng

A

nerve.

prenc

at

N

patent

and

sbe

does

abducton.

te

he

rng

root

subscapuars

musce

arm

C.

te

lexon

805;

umbrcas.

te

contrbu-

o

Innervaton

C8

te

te

meda

durng

medan

te

154.

musces.

or

ABR/McM

nerve.

orm

wt

121

s

responsbe

te

part

are

mpared

meda

opposton

o

are

he

axa

major

and

415;

C7–C8

GAS

te

rotators.

degrees

N

C4

“strap”

te

nraspnatus

musces

branc

bne

te

damaged

nerve

osseous

o

be

and

togeter

Interna

supraspnatus

rst

GAS

o

uncton

atera

o

MCP

acton

as

key

C8

prmary

he

roots

o

nnervated

nerve.

n

ony

s

branc

to

dstrbuton

wc

te

ABR/McM

pectoras

he

to

te

adducton,

D.

and

musces.

a

contrbutes

dsocaton

ocated

cuf

te

roots

root

C7

420;

C3,

nerve.

contrbute

we

717;

rotator

arm

nerve

toracodorsa

Anteror

C2,

suppy

nerve

o

s

te

ntertubercu-

possbe.

roots

C5

up

te

musce

wc

made

prenc

usuay

nerve,

GAS

te

nto

hs

nerve,

s

and

and

to

he

C.

and

pexus

attaces

umerus.

nvovement

D.

cervca

E.

cord

C6

and

C.

te

dors

toracodorsa

posteror

A

Injury

atssmus

sucus

by

152.

Limb

151–175

B.

A

Upper

by

tendons

by

o

te

ngers

te

te

o

te

ndex

are

lexor

lexor

unar

by

dgtorum

medan

te

nger.

lexed

nerve)

and

dgtorum

nerve).

te

super-

te

pro-

CHAPTER

D.

he

te

GAS

157.

D.

unar

base

808;

he

nerve

o

N

te

455;

scapod

carres

t

sensory

rom

te

most

168

te

across

te

occurs

cay

I

prmary

te

ony

A.

on

te

rom

ragment

metacarpa

axa

atera

bow

and

suppy

degeneratve

te

(“wast”)

avascuar

resutng

Frst

an

part

bood

proxma

produce

abducted,

dorslexon

dstay,

bone

te

s

narrow

durng

bone

o

and

ractured

to

racture

o

te

sde

car-

o

te

jont

dsease

drected

o

te

aganst

te

te

acton

te

A.

occur

te

o

B.

C.

partay

ts

lexed

E.

B.

An

soated

mon

aongsde

ton

s

ave

te

jont

afectng

787;

he

ventra

ong

wc

dapragm,

A.

te

ng

rst

o

te

movng

te

te

te

nnervaton

n

te

te

dgta

upper

synova

ncude

jont

te

pan,

jont

te

An

njury

wngng

ram

he

te

te

nnervates

C3,

C4,

te

pexus

excurson

o

do

not

te

musces

braca

tat

here

D.

T ermna

are

no

braca

motor

brances

uncton

Nerves

nerves

grde.

o

o

arsng

te

te

arsng

pexus

A

C.

nerves

pexus

stabze

te

rom

te

An

te

to

braca

te

njury

braca

upper

to

any

pexus

o

te

w

to

te

729;

upper

mpar

suprascapuar

o

nerve

te

and

bra-

te

o

not

exacerbate

cana.

o

epcondy-

meday

meda

occurs

te

te

oowng

ange

between

extensvey

Stretcng

te

devate

epcondyts.

153

wc

superor

tat

n

Lumbrcas

D.

lexor

pa

tunne.

he

o

or

te

roots

te

neck

o

te

o

te

o

roots

sma

w

o

mus-

present

7.52A).

pexus

upper

w

resut

mb.

168

s

a

reatvey

numbness,

ngers.

tenar

tp

pexus

Injury

te

he

Fg.

hs

water’s

patents

entre

compresson

te

o

avuse

cord.

wt

graspng

braca

common.

braca

pan,

water

te

may

and

te

and

a

rotated,

pronated.

name

o

(GAS

syndrome

by

to

ess

spna

ABR/McM

and

nerve

ypotenar

and

Carpa

o

te

musces

common

a

tngng

tunne

medan

and

te

syn-

nerve,

rst

and

IV

are

o

nnervated

te

beore

orearm

t

musces

traves

are

by

are

unar

nerve.

supped

by

troug

te

car-

nnervated

by

te

nerve.

788–789;

Recurrent

answer.

s

troug

te

gven

452;

s

ABR/McM

o

te

branc,

of

carpa

wc

we

N

branc

hs

musces,

tumb

o

most

III

medan

used

muc

te

musces

te

rect

trunk

and T1)

and

caused

wrst

smar

afected,

causes

te

s

meday

te

deormty

455;

he

unar

162.

are

sde,

and

are

rom

tunne

D.

o

termna

exacerbate

umbrcas.

musce,

trunk

N

Carpa

B.

souder

not

and

aternatve

(C8

to

suppes

and

a

not

meda

ncreased

ower

njury

parayss

wc

dapragm.

te

C5–T1

te

ars-

extremty

o

commony

ter

te

and

s

provde

w

ABR/McM

bers

at

te

and

caw

drome

dvsons

lex

s

mb

trunk

C5

provde

pexus

to

nerves

te

a

GAS

o

rom

are

o

sensaton

pexus.

brances

nnervaton

souder

ca

spna

E.

B.

E.

te

condton

grde.

te

neror

GAS

161.

te

contrbute

he

n

epcondye,

ebow).

pan

brt

parayss)

te

second

dapragm.

o

and

te

Injures

n

hus

or

to

te

extended

ence

tp

E.

ong

scapua.

restng

a

wt

dapragm.

o

mb

o

anteror,

(C3–C5).

o

reducng

to

o

wc

ram

tree

(C5–C7).

serratus

pan

durng

nerve

posturng

sgn.

dsease

upper

te

souder

te

w

wrst

goer’s

431;

te

orearm

musces

ebow.”

wrst

te

newborns

transt

orearm

ces

rom

N

tose

atera

extensor

te

braca pexus (C5–C6). Inants w ave te afected

wrst

partcuar

and

sear

as

devery

(Kumpke

pexus

nerve,

ventra

cords

to

can

njury

168

ventra

braca

nnervaton

tumb

he

to

n

te

o

epcondyts.

patent

757;

pasy

dicut

baby

jont.

scapua.

resut

te

te

degeneratve

arses

dapragm,

o

jont.

741,

common

musces

on

te

o

worsen

tese

serratus

epcondyts.

exacerbates

te

to

te

149

te

“tenns

o

atera

known

s

Puttng

pan

atera

o

w

neck

area.

devaton

(aso

Erb

te

occurs.

a

braca

rom

a

racture

te

wt

tenosynovts

s

prenc

presenta-

A.

te

o

nnervates

te

w

te

part

rom

o

nerve

nerve

and

necton

ABR/McM

arses

o

te

o

GAS

160.

devated.

CMC

nvovng

mpar

Cords

an

artrts

nerve

psatera

s

447;

Addtonay,

can

on

dicuty

protracts

njury

a

toracc

ram

toracc

an

base

raday

occur

CMC

tumb.

nlammaton

toracc

te

te

te

N

ong

o

uncom-

can

on

te

and

were

GAS

nvovement

Symptoms

CMC

depends

at

a

an

Cnca

o

T enosynovts

E.

njures.

and

s

trapezum

pan

and

sweng,

trapezum

te

movement

wt

seats.

o

varabe

Patents

may

te

carpa

and

extended

C.

oter

restrcted

o

racture

gy

occurs

158.

A

dspacement

or

C.

racture

njury.

o

pan

wrst

ts

o

343

Limb

dapragm.

extensor

devaton

Askng

metacarpa.

te

trauma

uncton

ABR/McM

epcondye

o

hus,

te

te

ncknamed

Fexon

by

or

417;

exacerbate

pan

te

N

rom

Unar

and

caused

Most

Rada

deat

afect

musce

atera

w

subcavus.

not

730;

condton

wrst.

usuay

he

orgnate

and.

suppy)

may

D.

te

w

716,

orgn.

Pan

enters

bood

o

are

159.

espe-

(patoogca

scapod

ractures

wrst,

scapod

nadequate

te

te

GAS

occurrng

scapod.

abducton

necross

o

to

anteror

requenty

pa bone. Fracture oten resuts rom a a on te pam

wen

nerve

nerves

ABR/McM

s

normaton

dgt.

Upper

6

te

tunne.

part

buttonng

opposton.

wc

ater

o

a

168

medan

te

medan

he

an

s

cor-

tenar

nerve

musce

acton

te

te

opponens

tenar

srt,

nerve

suppes

passes

pocs

group,

tat

s

requres

344

C H A P T E R

6

Upper

Limb

Middle

scalene

muscle Superior

cervical

ganglion

Roots

(anterior

rami

of

C5

to

T1) Gray

ramus

communicans

C5

Trunks

(superior,

middle,

inferior) C6

Middle Divisions

cervical

C7

ganglion (anterior,

posterior)

C8

Inferior

Cords

(medial,

lateral,

cervical

ganglion

posterior) T1

Anterior

scalene

tendon

A

•

A.

he

deep

branc

to

and

te

except

umbrcas.

B.

a

It

one

and

and

a

he

patent

te

vated

he

by

by

and

te

te

deep

E.

Inabty

because

lexor

deep

to

o

te

ong

te

unar

musce,

Pronaton

o

by

B.

Abducton

o

nnervated

by

C.

he

pocs

lexor

musce

nerve

sparng

te

te

nerve

and

te

te

s

by

o

o

are

te

per-

nner-

nerve.

te

te

motor

ar

perormed

rada

a

A.

by

to

te

te

o

te

to

te

a

(C5,

neror

up

he

to

he

te

C.

medan

retnacu-

retnacuum.

rst

he

rotate

notc

to

axary

nerve

musces

sde

o

arm

beyond

a

rada

and

te

20

o

te

Snce

lexor

by

te

retnacu-

wt

lexor

a

acera-

retnacuum.

166

by

te

suprascapu-

contnues

nnervates

ntates

troug

te

abducton

nra-

o

te

degrees.

superor

and

te

teres

and

neror,

neror

major.

sup-

subscapuar

Bot

musces

arm.

suppes

aso

degrees,

nerve

te

nerve

a

souder.

atera

perormed

nerve.

njured

and

20

te

te

to

be

o

te

nerves,

nnervates

era

he

and

15

aso

nnervated

supraspnatus

compartments

he

aceraton

C6)

s

medan

ABR/McM

s

subscapuars

atoug

hs

455;

subscapuar

te

mnor

musces

N

not

ntegrty

scapuar

meday

B.

te

te

deep

woud

supraspnatus

nerve

tumb

by

traves

nerve

sparng

nerve

musces

nerve.

lexor

wt

lexor

by

te

805–806;

he

py

adductor

tumb.

nterosseous

njured

nerve

arm

nerves.

te

branc

medan

te

answer

tumb.

out

D.

te

nnervated

ton

164.

o

musces

spnatus.

wrst.

correct

superca

lexes

deep

be

two

between

provdes

te

carred

and

ongus

anteror

and

Opposton

um,

nerve.

s

medan

ntegrty

unar

traves

s

two

meda

argey

wc

nerve

adducts

D.

te

GAS

paper

nnervates

tumb

not

te

extensors

medan

courses

woud

o

uncton

tumb

and

nnervated

caed

medan

um

s

te

o

rada

orearm

nnervated

a

sde

.A

sde.

pece

musces,

nerve

wc

te

a

te

Fig.

motor

o

atera

to

pamar

dorsa

dgts,

te

te

sensaton

te

branc

adduct

te

te

nterosse

retnacuum

pocs

A.

to

on

suppes

musces

musces

grp

trd

branc

nnervaton

163.

on

st

nerve

ntrnsc

suppes

ngers

can

unar

te

tenar

ngers

second

te

a

aso

a

a

ormed

C.

o

nnervatons

GAS

arm

detod

o

skn

detod

te

does

suppes

te

he

and

rotator,

te

patc

teres

not

at-

abducts

te

mnor

n

teres

te

abduct

musces

and

and

on

te

te

orearm,

musce,

arm.

posteror

wc

are

extensors o te ebow , wrst, and ngers n tat order.

E.

he

upper

uars,

GAS

706,

a

subscapuar

meda

731;

N

rotator

417;

nerve

o

suppes

te

arm.

ABR/McM

144

te

subscap-

CHAPTER

165.

C.

Wt

ymp

ten

te

to

A.

he

B.

he

D.

he

te

te

A.

te

N

n

pu

gament,

ax

u

s

tus

te

attaced

C.

to

te

nod

process

o

te

he

sde

o

te

s

te

pa

caused

te

subux

he

unabe

a

annuar

n

E.

to

to

ead

te

adut

ts

addng

to

rater

t

to

jont

passes

attac

s

te

te

coatera

bnds

radus

and

radus

attaces

te

te

atera

o

te

unar

gament

ead

to

te

attaces

atera

meda

o

167.

A.

hs

age

a

755;

o

N

patent

te

unar

or

musces.

back

o

ood

anx.

MCP

ost

extends

suppes

B.

gvng

he

Injury

o

(rng

to

wrst

and

musces

te

deep

IP

branc

jonts

orearm

to

nerve

he

te

rada

extensor

and

as

te

te

rom

wt

as

cronc

t

courses

compartment

patents

wt

car-

a

cnca

te

o

musce

nerve

a

tunne

o

o

s

at

at

aso

te

nd-

carpa

postve Tne

syndrome.

nnervated

ts

te

(e.g.,

tat

nerve

atropy,

carpa

devaton)

unar

sgn

medan

musce

wrst.

te

by

aows

Proxma

regon

o

te

a

ractured

807;

D. In

N

o

cervca

rb

ram

or

as

a

o

trave

by

neror

a

pexus.

te

a

dsta

be

te

o

njury,

rb.

he

o

to

he

pexus

meda

braca

te

arm)

be

axa.

anteror

te

caused

com-

In

s

ts

beng

dvson

cord

o

cutaneous

and

by

band—ven-

can

te

braca

as

meda

nerve

tus

mpared.

pexus

neck

te

contnues

n

patent

168

braca

cervca

cutaneous

s

not

dect

ts

brous/muscuar

rom

trunk

trunk

sensory

However,

syndrome—sometmes

cervca

neror

cause

wc

w

ABR/McM

trunks

tey

aso

and.

wrst

outet

or

may

te

amate

te

467;

toracc

te

and

o

te

nerve

meda

ante-

are

brances

o

te

meda

cord

o

te

pexus,

te

o

te

sown

te

dsta

te

on

n

meda

te

produces

nerve

te

te

by

C.

aso

a

to

te

Medan

sgns.

worsen

E.

o

o

te

and

ebow

pan

and

reumatod

trunks

o

and

present

tte

as

ngers.

lexon.

o

at

te

at

te

te

neck

te

are

te

o

te

dorsora-

exacerbated

orearm.

wrst

w

parestesas

ourt

postve

ncude

epcondye,

n

dgt.

Tne

ead

te

Pysca

and

ypotyrodsm,

to

rst

Paen

obesty,

artrts.

te

anteror

a

on

and.

meda

rng

pexus,

parestesa

and

Symptoms

at

braca

and

sensaton

and

sow

actors

te

syndrome,

nerve

pronaton

rada

w

te

te

rada

orearm.

as

he

sons:

n

compresson

suc

o

at

decreased

and

o

orearm,

tunne

wt

te

cause

nerve

Rsk

arm,

cubta

lexon

dgts

te

cord

numbness

numbness

examnaton

motor

te

aspect

wrst

tree

sde.

o

w

o

neror

wt

compresson

and

symptoms

cnca

provdes

nnervaton

da

te

as

Compresson

radus

te

and

nerve

Symptoms

B.

s

po-

part

known

tngng

nerve

nerve

compartment

sensory

te

Unar

o

presents

meda

aso

pa-

o

one

A.

hs

lex

pamar

te

te

uncton

unar

tereore,

and

ood.

unar

Compresson

he

at

extenson

tere s a meda cord contrbuton to te medan nerve.

by

tenar

nsert

hs

and

o

ngers)

occurs

n

occur

braca cutaneous nerve (meda cutaneous nerve o te

dam-

cana.

musces

jont.

branc

rada

to

te

appearance

tte

and

te

caused

o

(extensor)

jont

IP

nnervaton

drop.

to

te

to

Guyon

nterosse

dorsa

MCP

te

te

and

te

nnervaton

arm

te

o

superca

cutaneous

ngers

sgn

to

lexon

jont,

tograp.

a

damage

or

mecansm,

extend

due

nerve

umbrcas

and

te

te

ts

and

ntrnsc

nerve

wt te unar nerve as ts termna branc. Addtonay ,

unar

unar

two

va

rom

and

n

te

te

atera

ngers

jont

at

te

s

unars

njury

orearm

(meda

154

caw

o

umbrcas

hroug

wt

MCP

te

te

cassc

suppes

he

resutng

a

branc

amate

nerve

except

ABR/McM

as

deep

ractured

proxma

orearm)

428;

o

sensory

car.

henar

Contractons

(unar

te

meda

condye

carp

nerve.

to

compressed

condye

te

a

nerve,

ndng

musce

sgn

te

pressed

umerus.

GAS

lexor

unar

braca

coatera

eve

or

rada

may

over

musces

tunne.

o

tenar

damage

case,

to

he

tat

medan

test

adducton

tra

not

umerus.

unar

cnca

a

axa

angng

common

Lke

GAS

168.

and

does

te

syndrome.

Tne

adducton

jont.

gament

te

te

bodes

on

motor

mpared.

te

te

compresson

s

te

a

ter

a

n

arm

carpa

test

A

te

coro-

eter

ebow) can resut n te nabty to adduct te wrst.

not

around

to

be

tenar

o

tunne.

as

radounar

s

postve

te

n

provde

ead

Dependng

nerve,

may

te

te

te

tunne

he

pace,

(dsocate)

rada

ossed

by

una.

o

A

commony

s

radus

rada

membrane

o

nodes

subuxaton.

te

aong

ead

te

to

uy

nerory

te

stabty

rada

o

o

radus;

radus

togeter

he

sde

rada

nterosseous

mantan

E.

te

o

una

D.

o

to

age,

cdren,

o

ead

gament

capsue

o

o

troug

cates

dstay.

not

support

neck

he

as

sde

D.

condton

In

wt

atropy

axary

bot,

compresson

nodes.

ead

rada

and

rsk

jont

and.

pued

annuar

o

ncreased

he

te

upper

rada

compresson

Atropy

receve

371

years

te

te

te

or

seepng

C.

posteror

a

5

receve

nodes

and

dermatomes.

o

345

Limb

s oten njured wt md-body umera ractures or

wa.

ebow,”

s

rom

nodes.

axary

cd’s

sma

capacty

te

B.

and

njury

rom

breast

and

beow

ods

aows

te

cdren

te

wc

and

wen

sze,

o

te

ABR/McM

cdren

C5–C8

and

dects,

ymp

nodes

(pectora)

cest

centra

“Nursemad’s

sarp

o

atera,

407;

musces,

nodes

nodes.

receve

axary

axary

anteroatera

to

nodes

axary

most

anteror,

737;

ound

s

rom

tenar

(umera)

apca

te

te

eptrocear

souder.

or

a

anteror

dran

166.

and

o

te

axary

back

rom

to

axary

subcavan

te

A

GAS

atera

upper

ymp

o

ntay

posteror

ymp

E.

nvovement

drans

Upper

6

braca

and

pexus

posteror

gve

rse

dvsons

o

to

sx

te

dv-

upper,

346

C H A P T E R

6

mdde,

unte

vde

and

to

151;

te

N

or

ntereres

duces

B.

a

snap

or

deormty

te

C.

te

rng

Maet

and

ater

nger.

ng

at

D.

o

o

te

presents

Boxer’s

pa

caused

Pysca

ton

GAS

B.

793;

te

N

anywere

gt

are

s

occur

be

C.

Condromas

D.

Osteomas

orgn.

mosty

E.

GAS

A.

s

a

hey

ound

791–792,

term

pressure

te

n

o

te

actve

o

he

can

t

to

a

nerve

C.

be

t

neck

D.

to

papa-

dorsa

and

hey

jont

may

occur

contan

On

papaton,

hey

and

are

A

deep

a

and

sod

tey

commony

may

tumor

tumor

tat

o

ebow

GAS

C.

443;

ong-dstance

becomes

upper

at

causes

a

and

due

wegt

wrst,

tus

oss

te

o

unar

to

te

restng

to

te

on

oss

andebar

te

pamar

o

abduc-

nerve.

by

te

tenar

near

te

te

rada

musce

o

te

eads

It

w

o

medan

a

yper-

present

tenar

and

at

168

two

te

amate

scapod.

damage

rada

wt

musces,

sensory

oss

musce

nerve

and

o

te

wrst

w

tat

nterosseous

te

afect

contnues

nerve

and

aso

jont.

racture

ony

w

o

te

o

mgt

afect

te

aso

and

causes

between

lexors.

extensor

or

oppos-

tumb,

It

respec-

lexor

to

te

as

ebow,

te

meda

myo-

epcon-

tenderness

wt

ebow

lexon.

160

nerve

runs

membrane

te

weakness

dstay

suppyng

proundus

ourt

and

n

ected

dgtorum

ongus,

goer’s

presents

wrst

ABR/McM

as

pan

te

pan

nterosseous

te

lexor

known

tat

ressted

tendons

unar

dgts

epcondye,

Fg.

common

cause

7.85).

wrst

te

te

not

nterosseous

ence

and

t

pronator

n

and

te

musce,

ngers),

quadratus

pronaton

and

wrst

7.89).

nerve

D.

medan

tngng

suppes

he

deep

E.

nerve

and

medan

wrst

tat

n

supnator

te

afects

466;

(GAS

he

not

he

correspond

sensory

N

to

a

he

as

167

condton

compressed

te

jonts

pocs

te

te

meda

aspect

o

te

and.

outgrowts

cycsts.

body

symptoms

uncton

neuropaty

A.

te

rom

and

and

pocs

te

ABR/McM

te

sends

cartagnous

te

o

juncton

lexor

B.

at

te

dgts.

njury

anteror

lexon

to

dgts

epcondyts,

meda

767;

rada

a

Fg.

overuse

and

anteror

degeneraton.

s

(GAS

te

he

te

dicutes

Meda

te

projectons

and

medan

at

musce.

posteror

orgn

wc

bony

and

dgts.

abductor

supped

resut

due

supracondyar

and

draned.

dgts

a

nerve.

sur-

be

te

observed

atropy

o

te

extenson,

ead.

neuropaty

te

o

a

te

ABR/McM

s

sensaton

be

tumors.

peces

cartagnous

N

as

tumors

neuroeptea

cannot

tumors

sod

bony

he

o

are

a

nerve

ateray

teres

branc

musce

at

173.

a

T enns

an

be

not

467;

o

and

meda

s

syno-

wen

by

by

can

between

Hypertropy

dye

te

N

passes

tree

tvey

E.

but

syndrome

tendnous

o

s

tumb

a

and

rada

supped

mgt

dicuty

ton

st.

and

te

pasy

pronator

unar

metacar-

transumnated

te

sgn

cana

dstay

patent

cosed

and

two

tumb

te

opposton,

te

racture.

tem.

bengn

wt

o

A.

rest-

dsrupton

hs

tenderness

eet.

be

o

atera

extenson.

te

tendons

or

as

musce,

te

wrst

andebars.

unar

o

o

one

meda

by

brevs

805–807;

lexon

166

bengn

aso

afects

n

unar

DIP

trauma

te

te

bengn

807;

drect

or

a

are

are

nerve

o

to

jont.

aceraton.

and

oters

andebar

commony

te

s

are

assocated

he

due

PIP

crcumscrbed.

sod

are

Osteopytes

are

ack

oss

most

to

te

nerve

Pronator

troped

ngertp

and

B.

nerve

Patent

njury

A Tne

GAS

172.

termna

jont

Medan

Guyon

parta

draned.

Neurobroma

It

to

can

he

DIP

outpoucngs

dorsum

A.

orgn.

171.

te

te

pocs

provdes

sows

troug

treated.

cannot

or

and

we

E.

ncude

jont.

sows

metacarpa

o

and

o

o

te

supped

Extensors

o

metus.

DIP

occurs

drect

are

actors

meda

o

atropy.

and

afects

te

nerve.

D.

surace

mosty

dabetes

C.

pro-

brotc

permanent

It

tor

wc

and

tckenng

Rsk

te

te

o

aspect

Abducton

ater

lexon.

pamar

swoen

ABR/McM

te

and

on

gcay

n

sned

rm

by

seat

lud

to

racture

proxma

cysts

or

va-ke

a

t

451;

Gangon

capsue

s

o

degrees

lexon

examnaton

over

anguaton

170.

trauma

racture

dorsa

jont.

over

PIP

or

mpacton

45

DIP

sp

to

wt

neck

and

tendon,

puey

damage

to

deormty

centra

secondary

E.

te

Boutonnère

by

occurs

progressve

te

examnaton

approxmatey

extenson

te

jonts.

and

traumatc

Pysca

nger

resut

on

PIP

dsta

aspects

pro-

ongus

lexor

a

ngers.

panu

a

a

use

not

B.

extenson

eadng

caused

tendon

wt

as

and

acoo

s

te

s

asca

tte

nger

presents

oten

te

MCP

and

extensor

o

troug

occurs

o

dvsons

does

nerve.

trgger

actve

eventuay

o

tobacco

on

posteror

wc

149

or

contracture

tat

and

unar

growt

gdng

cck

contractures

lexon

te

stenosans

t

Dupuytren

te

to

he

cord

ABR/McM

noduar

wt

trunks.

posteror

419;

A. T enosynovts

sweng

Limb

ower

orm

contrbutons

GAS

169.

Upper

nerve

branc

extensors.

pronator

acterzed

supped

weakness

by

by

o

nterosseous

GAS

te

carpa

n

o

te

te

Wrst

n

tunne

te

areas

w

present

supped

by

and.

rada

nerve

extenson

nnervates

w

be

te

weakened,

lexon.

Compresson

te

at

numbness

774;

N

o

te

teres

pan

te

te

medan

causes

and/or

dsta

nerve

pronator

numbness

medan

musces

nerve

nnervated

nerve.

466;

at

ABR/McM

160

te

ebow

syndrome

n

as

by

te

we

te

by

car-

areas

as

te

anteror

CHAPTER

Ulnar

ner ve

Humeral

pronator

Ulnar

head

6

Upper

ner ve

of

teres

Humeral

flexor

Brachial

head

pronator

of

teres Ulnar

head

flexor

Flexor

carpi

of

ulnaris

nerve

carpi

radialis

ar ter y

Palmaris

Pronator

of

ulnaris

ar ter y

Median

Radial

head

carpi

ar ter y Ulnar

Ulnar

Limb

teres

longus

(cut )

Flexor

carpi

ulnaris

Pisohamate

ligament Pisifor m

Pisometacar pal

Palmar

ligament

aponeurosis

Hook

A

B

•

GAS

Fig.

.

of

hamate

347

348

C H A P T E R

6

Upper

Limb

D.

Median

Unar

nerve

stc

devaton

o

damage

GAS Ulnar

Radial

te

to

te

805–807;

unar

N

MCP

artrts

467;

jont

and

s

not

a

caracter-

as

a

resut

o

nerve.

ABR/McM

153

nerve

nerve

175.

B.

he

bone.

Humeral

of

at

reumatod

head

unate

It

Wen

s

eps

t

s

te

to

most

orm

dsocated,

commony

te

t

loor

o

dspaces

dsocated

te

nto

carpa

te

carpa

tunne.

carpa

tun-

pronator

ne,

potentay

compressng

te

medan

nerve.

he

teres

patent

pam Flexor

Deep

of

branch

radial

w

and

ten

present

pamar

wt

aspect

o

dysestesa

te

tumb,

over

ndex,

te

and

car pi

ulnaris

mdde

(cut )

ngers,

and

weakness

n

tumb

opposton.

nerve

A.

Dysestesa

aong

te

meda

border

o

te

and

s

Supinator Ulnar

head

pronator

a

of

C.

o

nerve

Flexor

to

te

unar

nerve.

aong

weakness

unar

and

o

te

meda

wrst

rada

border

extenson

nerves,

are

o

te

and

caracterstcs

respectvey.

digitorum

D. superficialis

Pronator

damage

Numbness

and

branch

radial

o

teres

Superficial

of

resut

Weakened

grp

strengt

s

due

to

damage

to

te

(cut )

unar

nerve.

Numbness

and

ateray

over

te

dorsum

o

te

to

te

o

te

teres

(cut )

medan

E.

Anterior

rst

interosseous

Flexor

nerve

nerve

Sensory

digitorum

s

a

and

resut

rada

nnervaton

tree

Adductor

and

a

pocs

o

o

compromse

nerve.

te

dgts

pamar

s

adducts

by

te

te

aspect

medan

tumb

and

nerve.

s

nner-

profundus

vated

GAS

Answers

by

te

782–785;

deep

N

branc

442;

o

te

ABR/McM

unar

nerve.

128

176–186

Brachioradialis

176. tendon

A. he dects descrbe unar nerve damage cose to ts

(cut )

entry

te Dorsal

(of

te

orearm.

he

epcondye

unar

and

s

nerve

passes

reatvey

bend

unprotected,

branch

ulnar

ner ve)

makng

ts

arm,

ts

va

carp Flexor

area

prone

muscuar

unars

musce

to

nerve

brances,

and

te

njury.

t

In

nnervates

meda

a

o

te

ore-

te

lexor

te

lexor

car pi

Flexor radialis

nto

meda

car pi

dgtorum

tendon

ulnaris

proundus

musce.

In

te

and,

te

deep

tendon

(cut )

branc

o

te

unar

nerve

nnervates

te

ypotenar

(cut )

musces,

Palmar

branch

(of

Palmar

median

(of

lexor

branch

ulnar

ner ve)

cas,

adductor

dgt

and

pocs,

mnm

opponens

brevs,

dgt

abductor

trd

dgt

and

mnm.

mnm,

ourt

he

umbr-

sensory

nner-

ner ve)

vaton

dgts

s

and

expan

B.

to

te

t

correspondng

te

dects

Entrapment

Guyon

n

te

and

rng

part

o

experenced

o

cana

meda

te

unar

eads

and

to

tte

a

te

by

te

and,

te

nerve

tngng

ngers

o

ourt

wc

can

patent.

n

te

and

unar

or

numbness

wtout

te

oter

symptoms. •

GAS

Fig.

.

C.

Compresson

ossa

174.

A.

Snce

tenar

B.

I

te

medan

nerve

s

ntact

tere

w

be

no

te

rada

Rada

wrst

extensors,

ner ve,

are

wc

ntact,

no

are

wrst

supped

drop

w

by

carp

extenson

(unar)

te

and

sde.

rada

s

not

unars

pus

wc

te

Extensor

nerve.

seen

due

acton

contrbutes

and

carp

to

toward

unars

s

o

to

te

te

wrst

and

by

to

te

medan

symptoms

dects

n

te

nterosseous

medan

nerve

nerve

o

n

musces

nerve

beore

te

pronator

supped

wc

te

cubta

syndrome

atter

by

brances

enters

te

tunne.

Medan

causes

meda

supped

te

carpa

o

te

anteror

rom

be

D.

devaton

extensor

addton

te

obser ved.

C.

n

atropy.

causes

nerve

te

compresson

symptoms

afects

sensaton

o

o

n

carpa

te

te

carpa

tunne

atera

tunne

syndrome

border

o

te

and.

E.

he

and

meda

cord

antebraca

gves

rse

to

cutaneous

te

meda

nerves,

braca

unar

nerve,

CHAPTER

and

aso

patent

GAS

177.

774;

D. he

A.

N

as

te

one

he

s

aso

a

ncorrect.

te

te

artery

tat

hs

D.

te

unar

o

not

te

exst

nerve.

nerve

te

s

skn

te

te

E.

ncor-

on

unar

te

180.

C.

produce

te

te

rada

he

te

B.

he

and

artery.

C.

lex

nerve

s

not

because

rada

artery

occuson.

compressng

te

te

superca

te

superca

branc

o

D.

at

rada nerve suppes te rada aspect o te tumb

and

rada

meda

GAS

782,

D. In

te

808;

runs

umerus

te

aong

he

te

atera

rom

he

not

bone

by

t

te

te

to

o

te

sor

aso

afect

deep

A.

he

te

te

deep

cts

o

s

cussng

nerve

dect

B.

nnervated

nerve.

md-body

we

by

wc

racture

separated

(C)

o

nerve

nerve

te

orearm

tat

and

braca

makng

t

durng

s

te

te

D.

ts

E.

md-body

t

tree

mentoned,

so

bone

nerve

but

ocated

are

not

must

atera

152

nerve

mnm,

best

not

nnervates

ongus,

and

ave

extensor

any

te

exten-

po-

cutaneous

answer.

nerve

lexors

te

no

does

gve

cutaneous

rada

nerve

rse

to

sensory

proper

te

de-

was

not

n

te

te

tested

s

te

dagnoss

uncton

by

o

abductng

evauated

squeeze

musce

s

a

nstructng

s

aganst

ed

brevs

s

n

tested

usng

test.

lexor

te

o

te

patent

resstance

to

we

extenson.

musce

proxma

455;

used

te

lexes

by

te

askng

paanx

ABR/McM

to

ad

It

s

carpa

n

o

tumb

te

te

nd-

tumb

168

te

dagnoss

perormed

tunne

tenosynovts

or

contro

tunne

te

brevs.

were

te

vdua

beng

horacc

Maet

Rada

by

were

s

o

car-

gty

per-

te

medan

tested

grps

and

nlammaton

o

surrounds

tendons

exampe,

extensor

or

tested

examner

s

tat

tumb,

It

outet

usng

te

Fnkesten

tumb

unary

syndrome

nger

182.

D.

descrbes

dgtorum

s

nerve

damage

testng

extensor

788–789;

N

Compresson

pexus

ram.

braca

and

test,

o

te

nd-

devates

te

and

tested

usng

Adson

to

rada

o

cervca

te

te

nerve

hs

rada

nerve

motor

here

729,

n

o

te

te

or

by

166

o

te

rom

T1)

to

T1

te

meda

te

meda

hey

aso

pectora,

unar,

toracc

outet

as

compresson

by

to

T1).

meda

braca

C8

and

(C8,

oten

nerve

and.

trunk

patent

no

o

736;

o

nerve

te

dects

are

dvsons

GAS

to

o

te

te

neror

presence

o

a

rb.

epcondye,

te

(C8,

pexus

due

evauatng

contrbute

nerve

causes

by

rada

derved

nerves

braca

te

neror

medan,

nerves.

wc

tested

ABR/McM

cutaneous

deormty

njury.

musces

te

hese

nger

o

nerves

cutaneous

syndrome,

trunk

452;

on

compresses

ventra

E.

s

dstrbuton

te

a

tendon

cutaneous

medan

nerve

are

and

tumb

A, B, C. Compresson

nnervates

by

and

te

N

s

seat

contrbute

pocs

jont

Quer van

antebraca

dgts.

rada

tere

dspaced

rada

rada

does

te

orearm

te

s

musce

ongus

syndrome.

extensor

pexus

nerve.

abductor

It

te

supercay

te

De

GAS

o

ad

test.

extremey

a

to

nerve.

sarpy.

te

takes

cutaneous

161

resstance.

pocs

paanx

lex

sgn

pocs

hese

and

unar

ocated.

tat

s

aganst

pocs

above

s

te

resstance.

tunne

te

nerve,

are

aspects

nterosseous

te

branc,

afected.

on

dgt

musces.

Atoug

te

drecty

sensory

and

nerves

ABR/McM

wrst,

atera

a

arm

cord

bot

very

branc

makng

a

o

pa

a

evauates

nterosseous

tested

o

805–807;

Tne

C.

te

cutaneous

anteror

by

tey

cutaneous

mpnge

te

racture

rada

A.

orearm.

orearm

because

extensor

ongus

o

C.

o

ndcs,

brances,

o

posteror

to

cs

aganst

umerus.

and

468;

te

te

mpnge

cutaneous

afected

meda

as

he

te

o

supercay,

ony

N

key

ntercostobraca

coces

extensors

and

musce.

njure

antebraca

B.

atera

umerus

groove;

because

by

runs

atera

752;

ts

181.

muscuocutaneous

be

unkey

GAS

va

177

producng

o

aspect

rom

racture

179.

te

te

w

aspect

antebraca

dicut

he

nerve,

umerus

meda

o

rada

pont

aspect

may

supped

E.

regon

te

rom

te

were

nger

ABR/McM

antebraca

meda

orgn

ndex

GAS

posteror

atera

te

te

455;

ts

rada

nerves

B.

N

n

at

te

derved

o

o

to

test

test

opposton

s

MCP

vdua

brances.

md-body

nerve

on

sde

te

n

noted

musce.

proxma

lexor

s

ABR/McM

he

pocs

tp

were

349

Limb

out.

nerve

speca

nger

and

te

he

te

a

dorsa

lexor

because tere s coatera crcuaton rom te pamar

trapezod

s

lexors

dects

rued

469;

opponens

he

be

pasy.

pup-to-pup

tumb

he

A.

rst

nnervates

rada

N

pocs

ndex

aso

sensory

can

test

nerve

he scapod compressng te rada artery s ncorrect

rada

178.

775–777;

Froment

A.

dects

crcuaton

njury

adductor

orms

no

superca

unar

compresson

nerve

snce

he

GAS

artery

amate

cana;

coatera

wt

unar

but

o

ook

w

o

he

orearm.

nerve

Guyon

arces to compensate or

E.

or

medan

compressng

or

because

nerve.

arm

160

nnervates

he

unar

unar

te

dgts.

amate

anastomoses

C.

nerve

a

medan

n

te

compressng

o

descrbed

te

oss

ABR/McM

unar

o

to

sensory

compressng

and

ook

part

o

s

psorm

meda

B.

no

466;

unate

he

rect

contrbutes

as

Upper

6

present

te

n

nerve

neck

tunne

ts

o

at

te

te

woud

meda

radus,

not

or

cause

patent.

orgnatng

braca

420;

unar

te

carpa

nerves

N

te

at

drecty

pexus.

ABR/McM

135

rom

te

350

C H A P T E R

183.

B.

he

carpa

scapod

a

at

and

he

te

te

hs

snuf

snuf

te

te

part

o

orces

to

orearm.

wt

and

assocaton

te

argest

artcuates

scapod

as

trd,

no

he

scap-

transmtted

ment

te

te

unate

amate

wt

te

ater-

ton

dstay.

B.

s

te

carpa

proxmay

and

and

o

dstay

ourt

assocatons

aso

and

a

wt

wt

te

te

o

te

te

s

he

he

te

orented

loor

o

te

carpa

s

anatomca

457;

a

ateray

artcuaton

s

orented

wt

artcuaton

not

snuf

te

wt

assocated

second

te

wt

bone

E.

bone

o

te

ar

128

Acromioclavicular

T rapezoid

Conoid

ligament

ligament

ligament

cavity

Suprascapular

•

GAS

to

wc

410;

neck.

te

space

or

sows

he

resut

and

on

Fig.

.

notch

(o

te

ga-

cavce.

dsoca-

between

o

exsts

te

te

cause

extends

te

o

njury

te

or

te

es

converts

t

suprascapuar

te

scapua.

between

end

gament

te

cavce.

x-ray.

process

jont

and

a

te

cavce

x-ray.

above

nto

te

a

ora-

nerve

runs

rom

wraps

way

ts

passes

a

umerus

he

te

o

te

axary

termna

troug

provde

tubercle

te

dmpng

njury.

as

around

to

o

and

pexus

It

B.

142

racture

brusng

cord.

ts

A

ABR/McM

braca

posteror

te

and

te

to

woud

proxma

notc

on

cora-

wegt-

coracocavcuar

gament

eter

te

acromon

process

on

o

crtca

te

7.24).

Conoid

process

Glenoid

N

te

coracod

ligament

Acromion

Coracoid

Fg.

x-ray

umerus

Coracoclavicular

seen

te

scapuar

troug

woud

eaves

and

scapuar

expanaton

he

arm

box.

ABR/McM

B.

and

mb

te

gaments

as

te

unreated

694;

surgca

meta-

loor

See

GAS

scapod.

te

jont

and

upper

are

partcuar,

muc

attaces

coracod

tese

transverse

men

anatomca

carpa

te

o

AC

superor

anatomca

te

sternocavcuar

and

D.

or

gaments

In

provdes

cavce

manubrum

bases

souder.

coracoacroma

he

bones.

metacarpas.

wt

meday

orm

dsta

trapezod

te

acromon

185.

proxma

N

to

te

capsue

attaces

he

anatomca

coracocavcuar

o

gament

jont

(GAS

not

and

support

AC

scapua)

box.

787;

AC

stabty

bearng

process,

te

he

te

cocavcuar

queston,

styod

A.

box.

carpa

GAS

o

artcuates

s

trapezod

wt

resut

ts

184.

te

Interrupton

no

second,

does

he

(“wast”)

dsta

n

te

wt

C.

amate

and

he

a

te

aganst

proxmay,

as

and

captate

E.

unar

captate

te

he

as

n

descrbed

pused

ractured

reatonsp

box.

unate

snuf

radus

as

commony

te

bones.

captate

he

D.

as

most

o

narrowest

bone

he

o

te

trquetrum

ay,

C.

o

ractures

troug

te

resut

gets

te

Limb

s

a

person

scapod

usuay

A.

as

process

Wen

od

Upper

bone

styod

te

6

te

surgca

at

te

upper

nerve

branc

o

quadrangu-

neck

nnervaton

to

o

te

te

teres

CHAPTER

mnor,

ower

geant’s

A.

te

te

rada

body

te

o

D.

he

medan

ere

and

unar

at

GAS

C.

body

o

coud

nerve

be

cubta

and

692–693;

o

skn

known

Injur y

weakness

N

arter y

or

s

and

te

be

rada

over

as

te

te

“ser-

groove

woud

be

aong

njured

n

umerus.

njured

be

njured.

tte

n

a

racture

ner ve

o

deep

at

te

be

to

te

be

njured

carpa

carr y

out

te

kewse

by

ts

B.

tunne

ndcates

te

s

DIP

tat

a

jonts

te

unar

supracondyar

te

regon

n

o

te

ner ve

rng

s

te

and

ntact.

racture

wc

351

o

te

medan

passes.

racture

at

te

nerve

surgca

and

neck

posteror

woud

njure

crcumlex

te

umera

ner ve

wrst

s

ndcated

lexon,

nner vates

tese

movements.

medan

ner ve

and

te

and

by

grp

musces

he

bra-

can

aso

te

o

te

rada

body

nerve

o

and

te

deep

umerus

braca

woud

artery.

he superca rada nerve and rada artery woud

damaged

by

njury

over

or

n

te

anatomca

snufbox.

E.

were

racture

be

njury.

arter y

A

njure

wtn

142

braca

medan

ner ve

s

afected

and

pronaton,

medan

A

at

ndcates

wc

axary

D.

nerve

ABR/McM

ner ve

near

too

ossa.

not

x-ray

umerus,

A.

Fexon

ngers

Limb

artery.

traves

422;

to

o

he

govern

te

compressed

w

medan

strengt.

ca

s

epcondye.

coud

tssue

he

tat

n

muscuocutaneous

njured.

te

te

traves

umerus

te

nerve

meda

he

te

porton

tat

he

he

or

te

detod

nerve

C.

E.

and

te

o

racture

te

186.

o

patc.”

he

a

detod,

aspect

Upper

6

Unar

and

nerve

pasy

deormty.

dsrupt

artery

te

s

GAS

te

745,

a

unar

750,

woud

dsta

present

supracondyar

ntegrty

Supracondyar

to

A

o

te

branc

racture

unar

o

w

te

not

wt

a

racture

nerve.

he

braca

cause

drect

nerve.

757;

N

438;

cawed

w

ABR/McM

158

not

unar

artery.

njury

7 Head

and

Neck

Q u e st i o n s

Questions

1.

A

4.

1–25

2-mont-od

routne

sma

pt

at

te

A

key

o

CT

to

te

brougt

wt

he

scan

te

n

area

ts

ossa

arc

B.

Second

paryngea

pouc

C.

hrd

hyrogossa

Second

A

parents

he

we

a

oter

gr

say

s

and

neck

sows

branca

structures

n

to

te

stua.

s

most

groove

an

rom

and

to

s

te

er

te

cet

and

by

Latera

B.

Medan

paate.

cd

porton

o

oowng

5.

Intermaxary

D.

Medan

A

s

nasa

Frontonasa

sows

wt

because

mssng.

eye

rgt

o

eye

Wc

te

pa-

ts

te

te

ca

cause

Faure

B.

Abnorma

C.

Abnorma

B.

Mastod

se

o

a

brougt

notced

norma

and

a

to

sma

te

area

sows

cary

rgt

deect

eye.

te

oice

o

s

by

rgt

body,

most

s

rs

age-approprate

and

macuar

Examnaton

consstent

s

wt

a

key

o

te

cooboma.

embryoog-

condton?

te

crest

ssure

to

cose

ormaton

nteractons

D.

Posteror

E.

Weak

adeson

o

optc

te

norma

sagtta

and

a

a

by

spontaneous

depresson

and

tat

w

corona

wc

te

s

Pysca

o

cose

ontanees

typcay

ontanee,

boy

compcatons.

moter

oowng

ontanee

te

sku.

depresson

at

a

certan

ocated

sutures

and

at

at

te

wat

cose?

coses

wc

ontanee,

Spenoda

E.

Anteror

A

at

about

coses

wc

between

te

optc

vesce

ontanee,

ontanee,

3-year-od

ater

6.

boy

se

recenty

coses

wc

at

at

coses

wc

cervca

s

8

at

coses

s

te

B.

Deect

C.

Branca

D.

Cystc

E.

Deect

he

Pysca

and

A

n

2

years

about

16

monts

to

1

about

at

3

years

about

18

no

key

o

o

ts

by

he

respratory

a

sot,

tender

to

tongue,

upward.

s

cd

tract

anteror,

papaton.

te

mass

Wc

o

n

te

dagnoss?

cyst

te

trd

arc

paryngea

paryngea

woman

sows

cet

p

oowng

a

gr

devery

maormatons

was

arc

arc

devers

and

examnaton

te

neck.

sows

s

move

pyscan

s

upper

s

paryngea

o

rst

oter

o

an

wc

to

duct

pregnancy

dagnoss

wc

rom

te

n

cyst

stua

n

to

ump

protrude

most

sxt

25-year-od

ton.

to

observed

hyrogossa

a

examnaton

mass

asked

s

brougt

recovered

A.

A

s

notced

Pysca

e

neck

cause

retna/corod

neura

sows

ontanee,

D.

oowng

examnaton

oowng

ts

o

a

et

s

s

te

Lambdod

a

gap

or

by

were

n

er

dects

made.

structures

cesarean

te

upper

are

Faure

s

sec-

uncompcated.

o

most

p,

observed.

uson

key

o

te

condton?

A.

Latera

nasa

and

B.

Meda

nasa

promnences/processes

C.

Latera

ectoderm

te

does

Posteror

Wen

segment

Pysca

A.

and

age

mdne

embr yonc

process

boy

sows

o

te

necton.

promnences

movements,

sparng

o

ad

no

emnence

3-mont-od

moter

juncton

moter

process

paatne

C.

E.

352

paatne

sku

A.

boy

reassures

o

te

A.

boy’s

te

any

monts

structures?

3.

te

er

eedng

examnaton

eaty

major

o

pyscan

or

Pysca

he

snus

deveopng

oter wse

wc

pyscan

age. Wc

C.

cervca

examnaton

deect.

and

o

devers

wtout

year

pouc

cd

abnormates.

deveops

he

woman

devery

monts

brougt

up

te

te

paate

a

examnaton

duct

oow

despte

cet

ate

or

parents

as

a

ntermttenty

tender

28-year-od

vagna

sternoce-

sgty

and

sows

A

a

pouc

paryngea

6-mont-od

et

or

anomay?

paryngea

E.

s

embryoogc

Second

D.

pyscan

drppng

ead

A.

paryngea

o

appears

te

tonsar

te

examnaton

border

mucus

o

oowng

nvoved

to

Pysca

anteror

musce

extendng

Wc

2.

te

openng.

papaton.

pt

s

examnaton.

domastod

rom

boy

nasa

maxary

and

promnences/processes

meda

nasa

promnences/

processes

camber

cavtaton

between

vesce

te

nner

and

outer

ayers

D.

Latera

E.

Maxary

ary

promnences/processes

promnences/processes

segment

and

te

ntermax-

CHAPTER

7.

A

30-year-od

cated

ton

sows

deects

o

ateray

sows

o

8.

on

no

te

o

key

Frst

B.

Second

C.

hrd

D.

Fourt

E.

Sxt

ead

te

9.

paryngea

Rbolavn

B.

Inectous

examnaton

C.

Mutant

D.

Cortsone

E.

Irradaton

deveopment

arces

woud

symptoms?

12.

o

woman

te

boy

sacrum.

daton

o

te

(o

C.

D.

Meroanencepay

E.

Hooprosencepay

s

o

care

te

and

te

s

aso

most

ew

seen.

te

Frst

B.

Second

ventrces,

C.

hrd

D.

Fourt

E.

Ft

te

Wc

o

13.

1-mont-od

moter

says

Obstructve

s

naton

cear

because

se

tymc

key

to

o

ave

Juguodgastrc

B.

Lngua

C.

Paratyrod

D.

Submandbuar

E.

hyrod

mass

neck

mass.

on

A

ectopc

te

by

Lung

bopsy

he

to

to

te

orgn

are

o

s

ocaton?

node

14.

gand

s

brougt

to

te

examnaton

sow

a

no

ypopasa,

o

or

and

and

absence

wc

arces

or

o

w

a

o

ow

oow

brt

up.

abnormates.

ypocacema

deveopment

story

pyscan

sows

o

utrasound

te

te

Frst

and

B.

Second

C.

hrd

most

key

Pysca

D.

Fourt

E.

Fourt

and

sows

pcated

neonate

matons

Abnorma

was

Second

D.

hrd

E.

produce

tese

15.

Fourt

o

sows

a

gap

dects

made.

n

are

Wc

a

term

Pysca

er

upper

observed.

o

sows

no

ypocacema.

neck

sows

absence

gands.

pouces

s

s

ess

te

act

o

we.

te

Wc

most

key

pyscan

durng

nosy

Pysca

neck

o

to

sounds

yod

wen

te

oowng

were

as

swaowng.

he

te

te

he

aure

o

embryonc

er

he

nant

sows

greater

bone

musce

by

breatng.

examnaton

sows

assocated

a

cornua

absent

at

potenta

gr

appears

deveopment

structures

most

deects?

promnence

paryngea

paryngea

arc

arc

paryngea

woman

te

gr

an

uncom-

examnaton

p,

A

by

no

oter

dagnoss

oowng

s

o

te

maor-

o

a

cet

consdered

to

er

neck.

Pysca

tat

s

o

ange

arc

comes

paness

te

o

te

musce.

B.

Inlamed

C.

Accessory

D.

hyrogossa

E.

Latera

to

te

ton

emergency

depart-

no

te

cause

duct

An

was

sma

te

most

o

utrasound

we-dened

anteror

bgger

area

to

cystc

te

key

and

swe-

exam-

mass

at

sternocedo-

dagnoss?

boy

o

suc

a

kept

ead.

or

nant

wt

An

an

MRI

observaton

he

uncompcated.

sma

Wc

s

enarged

were

a

tssue

cyst

5-day-od

an

gand

cyst

abnormates.

7.1).

o

s

a

a

node

tyrod

dagnoss

(Fg.

Wat

ymp

devery

oter

sweng

sows

cyst

because

sows

te

papaton.

sows

mandbe

cervca

preterm

says

on

neck

Dermod

A

Se

examnaton

A.

and

devers

devery.

te

s

twtc-

promnence

22-year-od

mastod

paryngea

sxt

vagna

or

C.

te

trd

woman

te

Maxary

naton

ty-

ourt

and

an

tese

Mandbuar

brt

31-year-od

part

eed

B.

A

te

te

and

o

o

n

A.

ng

second

and

o

sow

ater

and

examnaton

paratyrod

brougt

breatng

x-ray

to

was

ars

stomac.

neror

ed

tender.

Laboratory

tymus.

oowng

wegt

deects?

A.

te

er

deect

wc

sde

wt

pyscan

ment because o 1-week story o a sweng on te rgt

gand

boy

A

respre

key

te

structures

pregnancy

te

studes

paryngea

o

compromse

o

mass

on

An

te

brt.

exam-

sounds

o

addtona

er

neck.

Pysca

embryonc

oowng

ymp

n

swaowng.

Based

an

pyscan

gand

3-mont-od

pouces

a

te

tons

A

rod

to

bateray.

te

A.

resuts

n

mdne

tssue.

wc

and

notced

dicuty

a

ayng

strdor.

brougt

auscutaton

tymus,

most

no

sows

to

sows

ydrocepaus

s

to

Pysca

neror

gr

Anencepay

as

ydrocepaus

A

because

gr

produc-

nvoved?

A.

dagnoss?

te

musce-jerkng

examnaton

and

durng

brougt

Laboratory

oowng

a

o

s

unusua

occasons.

tymus

s

o

boy

moter

5-year-od

p

admnstraton

wtnessed

a

n

genes

utrasound

te

o

or

sows

Stenoss

key

wo

unt

boy

trd

ventrce.

Syvus)

condtons

preterm

Utrasonograpy

atera

ourt

at

ntensve

examnaton

te

aqueduct

a

neonata

Pysca

over

devers

B.

A

on

actor

decency

5-mont-od

An

Nonobstructve

cd

11.

A

causatve

353

Neck

dsease

abnormates.

to

a

mportant

and

anomay?

A.

arc

oowng

moter

10.

te

ts

and

ound

ng

A.

A

o

Abnorma

most

o

un-

were

paate,

te

ton

parents

norma-szed

cerebra

cet

be

examna-

arc

ar

a

rest

uncomp-

arc

sows

wt

deects

he

an

arc

observaton.

o

suc

by

Pysca

mandbe,

A

oowng

produce

boy

arc

brougt

tut

te

ear.

sde.

a

devery.

abnormates.

te

28-year-od

was

o

and

rgt

oter

A.

A

eye

devers

vagna

ypopasa

te

wc

most

woman

spontaneous

Head

7

o

Pysca

enarged

te

noncommuncatng

o

te

condton?

oowng

prenata

s

ead

ater

course

examna-

ead

and

conrms

ydrocepaus

te

most

key

354

C H A P T E R

7

Head

and

Neck

18.

A

68-year-od

depar tment

pan

a

over

te

stor y

hree

o

dton,

ago,

Gencuate

C.

Ineror

D.

Otc

E.

Pterygopaatne

gr

o

n

“danger

ernous

•

Fig.

on

or

he

(t c

o

as

douo ure ax).

medcaton

o d ay.

 ke y

bouts

pat e nt

we

In

t s

er

co n-

resp o ns b e

or

Gasseran)

area”

brougt

eyes.

o

snus

trgemna

o

m os t

ntense

wt

MRI

snus

s

an

er

potopoba

cavernous

s

(semunar

because

An

w as

e m e r ge ncy

gossoparyngea

17-year-od

eyes.

md  ace .

out

te

pan?

T rgemna

sensaton

to

e xcr uc at  ng

ne ur ag a

ran

gangon

te

B.

ment

e r

pysc  an

wc

b rougt

s ud de n,

o

se

A.

A

s

o

trgem  n a

care

medatng

19.

area

monts

prmar y

wom an

because

to

Pysca

dicuty

te

ead

o

o

te

ace

nvove

nerve.

I

ts

emergency

and

depart-

“bugng”

gaze

te

sows

n

easy

spread

optamc

occurs,

wc

to

n

te

branc

o

bot

dagnoss

hrombopebts

can

te

a

examnaton

atera

conrms

tromboss.

and

te

eadace

te

o

te

cav-

o

te

oowng

.

symptoms

w

most

key

be

present

durng

pysca

examnaton?

A.

Obstructon

lud

B.

16.

n

Excess

producton

C.

Increased

D.

Dsturbances

E.

Faure

A

were

o

at

1

sows

sde.

crcuaton

te

and

and

an

o

te

cerebrospna

te

or

pt

s

tube

wegt

o

Hs

dd

o

and

CSF

20.

cose

to

prenata

te

Appearance,

(APGAR)

egt.

and

Puse,

scores

He

s

Pysca

acoustc

oowng

pyscan

course

respectvey.

externa

te

ts

to

brougt

he

mnutes,

atretc

o

ead

resorpton

neura

boy

CSF

Respraton

5

Wc

cause

o

te

uncompcated.

percente

te

o

n

examnaton.

Actvty,

9

sze

1-mont-od

routne

te

(CSF)

meatus

condtons

were

8

te

s

Otc

not

B.

Deveopment

te

rst

paryngea

17.

Meata

D.

Aurcuar

pug

E.

he

dd

not

ocks

was

tubotympanc

not

recess

over

Tngng

21.

deveop

Genoyod

C.

Paatogossus

D.

Genogossus

A

oss

te

woman

abnormates,

returns

wt

and

anagescs.

sma

vesces

A

over

se

was

sent

ew

days

ater,

te

same

area,

o

as

an

cause

tese

ave

erupted.

Se

s

dagnosed

wt

a

der-

o

te

most

o

tumor.

key

A.

Aurcuotempora

B.

Lesser

B.

Bucca

C.

Faca

C.

Lesser

D.

Ineror

D.

Menta

E.

Pterygopaatne

E.

Inraorbta

petrosa

to

contan

te

vrus?

te

P y s  c a 

o

te

An

te

dzzness,

o

c  ro n  c

tongue

cana.

ace

examnaton

MRI

be

o

emergency

stor y

key

brougt

severe

nasa

oss

o

An

o

and

te

Wc

aected

petrosa

been

nerve

nerve

nuceus

gangon

and

taste

o

te

no

ead

o

by

te

ts

emergency

dzzness,

sows

tat

paranasa

rom

o

te

afected

nerve

savatory

to

eadace,

MRI

Wc

symptoms?

oowng

key

a

examnaton

te

and

Aurcuotempora

most

a

tongue.

te

s

s

o

Pysca

A.

nerves

most

regon

to

eadace,

as

ypogossa

w

woman

dryness

ntracrana

matoma erpes zoster nlammaton (snges). Wc o

wc

s e ve re

p ro t r u s  o n

te

acrmaton,

two-trds

as

o

a

abnormates.

because

vomtng.

tures

some

bucca

hyroyod

45-year-od

examnaton

no

at

o

te

b ro u g  t

monts.

n

musces

Myoyod

patent

sows

mass

s

patent

6

or

B.

burnng pan n te area o er cn and ower p. Pysca

over-te-counter

Te

or

p

eyed

over

man

we a k n e s s

and

wt

ower

because

dects

A 65-year-od woman comes to te pyscan because o a

ome

te

upper

eyeba

sensaton

vo m  t  n g .

a

paate

te

te

4 0 - ye a r - o  d

department

degenerated

ard

o

A.

E.

canaze

dd

te

mass?

afected

C.

Pan

E.

 o   ow  n g

key

pouc

D.

s  ow s

orm

o

rom

oter

deect?

A.

Pan

s  ow s

and

rgt

most

C.

A

n

eadaces

90t

te

Anestesa

and

examnaton

on

Pan

B.

depar tment

or

devery

Grmace,

at

A.

te

te

te

snuses,

anteror

bran

sows

oowng

struc-

by

te

tumor

to

CHAPTER

22.

A

17-year-od

symptoms

or

te

we

se

An

B.

Reduced

bood

C.

Reduced

venous

n

ts

low

to

return

te

upper

te

nterna

31-year-od

ace.

A

te

as

beng

a

s

CT

te

on

Questions

26.

a

pressure

scan

brougt

o

te

neror

oowng

to

n

a

Coma

sows

and

ead

te

and

neck

sows

emergency

vece

(GCS)

pupary

o

a

te

27.

afected

by

Externa

C.

Maxary

D.

Deep

E.

Mdde

ay

ematoma?

eyed,

A.

Submandbuar

ng

B.

T rgemna

C.

Superor

D.

Gencuate

E.

Cary

A

because

descrbes

s

o

rgt

te

eye

genera

tongue,

te

ead

Wc

te

A.

man

o

taste

te

be

tmes.

sows

o

to

a

to

bouts

on

rom

and

o

te

Pysca

te

tumor

emergency

severe

rgt

sde

anteror

wtn

nerves

are

te

s

depart-

eadaces.

and

examnaton

savaton

oowng

te

nvovng

sows

two-trds

ntact.

An

a

key

28.

oss

o

s

MRI

nratempora

most

He

Lngua

proxma

to

ts

juncton

wt

te

a

er

as

depart-

bat.

exam

a

be

o

te

ractured

Brances

to

He

sows

regon

sows

key

o

wc

njured?

Faca

nerve

Cary

E.

Superor

he

to

story

n

er

wt

s

most

o

seem

rgt

dated.

uncon-

eadaces

gettng

worse

abnormates.

Wen

eye

compete

emergency

ound

be

no

bran.

key

te

cronc

to

sows

er

to

beng

s

Wc

o

o

by

er

te

te

ater-

upper

oow-

tumor

cervca

man

gangon

s

brougt

sustanng

patent

person,

severe

wound

s

tssue

and

s

but

conscous

Pysca

prouse

sutured.

and

necton

durng

and

or-

examnaton

beedng.

Ater

panu.

most

depart-

key

3

he

days,

Between

ocated?

A.

he

perosteum

Corda

tympan

B.

he

aponeuross

C.

Ineror

aveoar

C.

he

dense

connectve

tssue

and

te

aponeuross

D.

Lesser

D.

he

dense

connectve

tssue

and

te

skn

he

derms

A

department

enarged

avng

to

st

tons

te

o

E.

Gossoparyngea

60-year-od

wt

ymp

sudden

or

a

e

bouts

o

sows

a

oowng

s

brougt

cronc

nodes.

down

eeng

ead

te

woman

tumor

patent

dzzness

cose

uness

woud

epsodc

he

o

and

n

at

er

er

te

be

to

se

causng

eyes.

rgt

most

emergency

eadaces

says

as

er

Se

ear.

juguar

te

te

A

to

aso

CT

oramen.

key

and

been

ave

men-

scan

o

Wc

neuroogc

29.

A

36-year-od

department

son.

and

he

tme,

Pysca

CT

to

patent

any

te

scan

most

dect?

te

beng

s

says

o

key

te

se

No

to

Let

Rgt

vagus

C.

Rgt

ypogossa

earng

D.

Let

gag

E.

Rgt

o

tongue

Loss

o

aca

movements

C.

Loss

o

sensaton

D.

Loss

o

E.

Loss

o

expresson

relex

rom

te

ace

and

te

scap

as

gossoparyngea

gossoparyngea

to

a

te

motor

orented

to

uvua

s

no

n

ts

n

over

ound

ractures.

emergency

vece

person,

pan

tenderness

abnormates

resut

vagus

n

sgncant

he

oter

B.

Loss

B.

brougt

sows

sows

A.

A.

s

conscous,

ead

afected

perosteum

nvoved

aceratons.

rgt.

te

epderms

woman

ater

and

bone

and

examnaton

wtout

ated

and

and

ead

and

swoen,

te

te

and

ceaned

nlamed,

ayers

emergency

to

tme.

aceratons

qucky

te

njury

dstraugt,

pace,

scap

were

s

an

(SCG)

to

B.

E.

to

nerve

tympan

petrosa

A

woman

drected

ptoss

afected

te

gangon

55-year-od

work.

ater

symptoms?

D.

ater

brougt

tey

tumor

pup

C.

ment

a

says

was

nerve

wc

corda

sows

tese

s

examnaton

Ocuomotor

te

tumor?

ead

most

amy

patent

and

wounds

by

er

Optc

sows

ossa.

afected

baseba

tempora

te

are

a

Pysca

ematoma.

woman

by

B.

ented

o

rgt

o

emergency

menngea

A.

A

te

scan

arteres

downward,

n

te

wt

tempora

structures

resut

Gasseran)

brougt

sudden

pan

at

s

sensaton

but

or

cervca

35-year-od

ment

(semunar

on

conscousness,

and

to

ead

unresponsve.

CT

daugter

scan

te

tempora

Pysca

regans

te

355

Neck

carotd

he

er

brougt

on

epdura

48-year-od

CT

arge

A

an

Superca

atey.

o

oramen. Wc

key

and

B.

and

moss,

and

ead.

A.

A

and

oowng

scous.

12.

sde

te

s

t

ematoma

department

co-

o

rgt

racture

juguar

most

te

motor

rgt

rgt

s

ven

Scae

andross

ganga

wa

to

arge

o

on

man

beng

unconscous

pteron

o

ead

juguar

ater

patent’s

woud

and

26–50

34-year-od

s

te

mb

Gasgow

eyed,

te

A

ment

dagnoss

symptom

toracc

nvoved

examnaton

ematoma

o

woman

ater

te

o

and

symptoms

takng

because

rom

o

o

rgt

te

conrms

Wc

te

n

ptoss

or

because

er

nerve

Numbness

Pysca

o

syndrome?

Dstenton

Se

ar

respraton

E.

A

pyscan

notced

neck

D.

son.

25.

rst

er

te

present

wt

prenc

te

syndrome.

Probems

department

24.

Se

o

A.

te

23.

MRI

be

to

dscooraton

brusng

outet

key

comes

and

mont.

was

toracc

most

gr

pan

past

pone.

o

o

Head

7

er

er

to

were

neck.

neck

dev-

ound.

Wc

devaton?

be

co-

pace,

nerve

A

s

356

C H A P T E R

30.

A

man

gen

ater

s

not

by

s

s

Neck

brougt

ound

responsve

passng

and

te

breatng

dangerousy

an

to

emergency

unconscous

ow

endotracea

on

very

and

tube

te

depart-

street.

sowy .

Hs

ntubaton

troug

an

s

he

oxy-

nt-

35.

openng

C.

Maxary

D.

Optamc

and

ocuomotor

E.

Optamc

and

aca

A

a

experenced

sows

B.

V estbue

cornea

C.

V entrce

rms

D.

Vaecua

ocaton

E.

Rma

any

e

s

relex

an

comes

o

recent

unabe

on

te

te

Ineror

B.

Optc

ment wt et-sded toot pan n s upper jaw. Pysca

C.

Superor

examnaton

D.

Foramen

rotundum

E.

Foramen

ovae

he

maxary

condtons

Spenod

B.

Anteror

teet

as

w

no

be

to

te

on

emergency

te

wen

et

tappng

aerges.

te

most

sde

Wc

key

o

s

on

o

ace

s

et

te

o-

36.

dagnoss?

Posteror

D.

Maxary

E.

Fronta

snusts

etmoda

snusts

man

o

worse

s

brougt

severe

sonne

durng

naton

sows

s

Wc

o

te

key

ears.

or

Accessory

Vagus

E.

Gossoparyngea

ng

a

crana

nerve.

Wc

dicuty

ead

nerve

sows

s

cougng

a

most

tumor

key

and

afect-

afected?

A.

Mandbuar

B.

Maxary

o

C.

Gossoparyngea

patent

D.

Vagus

e

E.

Hypogossa

Pysca

A

7-year-od

ment

says

as

tympanc

any

made.

o

a

tympanc

o

A.

Coanae

B.

Interna

C.

Externa

D.

Audtory

E.

Paryngea

department

responsve

cecked

ntact

te

emergency

g

and

ever.

troat.

nlamed

and

o

oowng

or

depart-

he

transucent

vra

structures

necton

to

most

spread

tc

asked

necton

we

C.

T rgemna

D.

Faca

E.

Accessory

A

29-year-od

ow-up

ang

and

but

beedng.

ts

te

ttng

er

breatng.

Pysca

gt

o

to

te

relex?

test

emergency

ead.

here

examnaton

relex

oowng

s

s

no

sows

bateray.

nerves

he

a

con-

key

because

securty

te

but

exam-

tympanc

he

e

patent

as

yperacuss

nerve’s

o

per-

s

njury

some

made.

s

most

to

n

te

s

pyscan

rgt

precedng

n

an

an

and

o

nearby.

acoustc

te

rom

te

te

condton,

ake

meatus

resuts

area

s

te

because

Wen

externa

externa)

acoustc

coug

ear.

s

patent

nspected

rrtaton

externa

to

acous-

meatus?

V estbuococear

38.

brougt

he

nner vatng

Vagus

te

most

Pysca

wt

reguary

(otts

as

meatus.

o

sows

externa

specuum.

ner ve

notced

but

er

Wc

durng

woman

examnaton,

dsease.

s

te

B.

to

acks

ead

symptoms?

events

swmmng

key

meatus

woman

about

A.

ear)?

pan

examnaton

rodectomy.

wc

durng

a

te

pyscan

earng,

crana

comes

o

s

recess

o

s

man

stor y

mentons

wc

wt-

tube

ater

1-week

wt

he

paryngts

34-year-od

cougs

Pysca

parynx.

A

meatus

boy

meatus

pupary

o

ear

and

are

unresponsve

sgn

ntegrty

rgt

red

(mdde

acoustc

33-year-od

obvous

te

acoustc

te

o

dagnoss

patway

cavty

s

A

to

story

s

a

membranes

Wc

patent

brougt

n

sows

exudate.

provded

A

s

2-day

pan

examnaton

out

boy

because

e

37.

and

te

symptoms?

works

acoustc

tese

D.

as

te

s

o

not

examnaton

eye

o

estvas.

dagnoss

C.

aso

and

oowng

responsbe

te

He

troube

A

s

o

descrbes

n

Hypogossa

MRI

He

pro-

rngng

ave

Faca

patent

weeks.

depart-

gotten

externa

not

B.

An

ew

ave

tese

abnormates

A.

he

past

emergency

tat

no

te

vson.

te

te

MRI

Were

to

sound.

concerts

or

does

comes

to

pan as severe and as no story o trauma or canges to

swaowng.

n

to

eadaces

et

as

ssure

man

senstvty

e

An

s

because

patent

ssure

orbta

34-year-od

says

snusts

because

orbta

he

cana

membrane

snusts

70-year-od

A

recent

snusts

etmoda

C.

gressvey

brougt

tenderness

patent

A.

ment

s

sows

psatera

owng

A

man

sde.

causng

A.

55-year-od

pyscan

Pysca

adduct

eson.

eson

te

vson.

trauma.

to

et

ntracrana

o

to

doube

depart-

A

gottds

tat

aca

man

story

Prorm

recess

and

48-year-od

2-week

between te voca ods. Wat s te name o ts openng?

maxa.

34.

and

A.

and

33.

man

beng

saturaton

ated

32.

Head

22-year-od

ment

31.

7

Se

a

Se

says

as

te

te

dagnosed

he

A.

Interna

B.

Externa

C.

Recurrent

become

oowng

aryngea

aryngea

aryngea

A.

Optc

and

aca

D.

Superor

aryngea

B.

Optc

and

ocuomotor

E.

Gossoparyngea

te

as

pyscan

ater

wt

oarse

nerves

ntractabe

n

and

was

or

undergong

eaed

mprovement

operaton?

beng

to

weeks

wound

sgncant

voce

o

was

er

comes

two

we

er

as

and

o-

ty-

Graves

se

as

symptoms,

not

most

a

a

mproved.

key

njured

CHAPTER

39.

A

48-year-od

we

eye.

recenty

Pysca

tat

te

mm,

mm

s

a

man

rgt

respectvey;

and

6

eson

mm,

to

te

sometng

examnaton

patent’s

norma.

comes

notced

under

and

wen

et

te

ndngs

nvovng

wc

norma

pup

gts

respectvey.

hese

pyscan

strange

Hs

are

o

te

2

and

tey

n

key

s

rgt

sows

mm

of,

vson

most

s

gtng

are

are

because

wt

are

bot

Ocuomotor

B.

SCG

C.

Nervus

Ednger-Westpa

55-year-od

tomy

o

rgt-sded

and

o

41.

and

a

Corda

C.

Greater

D.

Lesser

E.

Nasocary

says

or

ater

et

scan

o

o

te

o

te

a

tat

te

e

te

Maxary

D.

Nasa

and

amy

or

by

or

a

patent

seeng

ose

Pterygod

B.

Superor

C.

Fronta

s

Faca

D.

Maxary

E.

Mandbuar

A

to

mastodts.

was

s

s

ora

A

te

o

to

treat

boy

eye,

was

and

key

ot-

mastodec-

te

deveops

examnaton

sows

droopng,

tere

vestbue.

most

emergency

perormed

mout

rgt

rgt

was

te

compcaton

Pysca

o

was

out

most

punced

o

s

et

sows

sot

a

(bow-out)

key

be

durng

45.

sunken

tssue.

ectopcay

n

eye.

A

o

sows

racture

ound

n

Anteror

Posteror

C.

Mdde

D.

Interna

E.

Posteror

ear

te

was

Wc

njured

e

ood

o

te

durng

te

eadace.

he

ypertenson.

n

te

te

nerve

emergency

A

CT

cerebra

oowng

depart-

patent

as

scan

o

artera

vesses

a

te

crce

does

not

communcatng

cerebra

woman

or

te

past

deveoped

te

ts

o

can

mastod

occurs,

troug

venous

te

to

3

ten

necton

necton

I

comes

te

md

se

an

between

ossa.

te

crce?

ntay

sku

o

to

carotd

sows

bone

and

nerve

trgemna

cerebra

yesterday

todts,

severe

trgemna

te

communcatng

pan

was

ead

a

aneurysm

45-year-od

and

wc

to

te

o

comes

Wc

B.

pan

postoned.

an

A.

A

o

smokng

Ws).

o

dvson

man

because

severe

CT

dvson

55-year-od

story

depart-

conscousness

neror

gobe

er

amy

tat

se

week

se

brougt

because

as

tat

seemed

ad

as

dp.

te

te

to

A

rom

venous

pexus

venous

ven

pexus

te

worsenng

case

ever,

sow

o

snus.

te

ace

and

examna-

eukocytoss

ead

A

sows

dagnoss

tromboss

most

to

ever.

snus-

tacycarda,

te

snus

o

better

Pysca

scan

cavernous

emergency

gotten

studes

s

te

severe

not

cavernous

optamc

o

a

wt

CT

oowng

necton

to

conused.

woman

Laboratory

urne

o

s

snus?

A.

n

cose

C.

oowng

wtn

o

to

Gossoparyngea

te

secondary

spread

corner

Vagus

na

etargc

Wc

a

a

postoperatvey,

B.

ment

passage?

emergency

examnaton

an

woud

te

edematous

et

woman

past

negatve

made.

acrma

spaces?

tacypnea.

sepss

44.

snus

by

trombus

o

a

days

or

a

ever.

says

A

ces

te

and

tn

te

necton

venous

s

most

o

In

ayer

o

spread

Wc

key

te

te

mas-

te

posteror

can

system.

te

worse,

scan

ces.

wt

tat

got

CT

mastod

erode

structures

pyscan

Se

progressvey

te

te

te

days.

cra-

nto

o

te

route

o

necton?

says

te

sows

a

tumor

snus

mornng

and

te

cavty

department

ton

a

te

nasa

o

ces

Spenoda

ts

by

at

rgt

snus

35-year-od

or

te

structures

C.

ts

not

sows

wt

oowng

he

Pysca

ead

to

dicuty

surrounded

Etmoda

a

dd

gt.

Fronta

Her

gt.

avng

became

ner ves

contrbute

brougt

brougt

parents

dects.

rgt

unabe

ead

s

s

A.

(o

street

s

B.

A

rom

er

er

Wc

compressed

o

tumor

notced

dry.

secreton

membrane

man

A.

E.

key

ee

wors-

petrosa

orbt

Orbta

rgt-sded

recenty

or

tympan

and

orbt

pyscan

petrosa

ater

He

a

gangon

petrosa

24-year-od

eye

te

constanty

most

mucous

Deep

te

as

decreased

B.

ment

42.

n

s

to

rom

Se

nostr

A.

A

sku.

nerves

resut

gand

eadaces

ven

was

myrngotomy

aca

te

357

Neck

surger y?

Gasseran)

comes

by

Fve

oowng

nuceus

woman

te

rgt

oowng

to

wt

severa

boy

wc

necton.

was

(semunar,

cronc

eye

meda

coecton

T rgemna

base

7-year-od

and

pexus

emssary

ts

ntermedus

E.

te

venous

2

nerve

D.

enng

A

tat

A.

A

Pareta

department

structures?

40.

Basar

E.

4

eyes

because

oowng

43.

D.

Head

7

drect

te

s

route

cavernous

46.

A.

Superor

B.

Ineror

sagtta

sagtta

C.

Stragt

D.

Cavernous

E.

Sgmod

A

snus

been

says

s

e

ood

a

oowng

A

comes

troube

doesn’t

catces

mout.

pressng

man

avng

tat

tmes

snus

snus

63-year-od

as

snus

snus

seem

mse

CT

nerve

scan

o

wtn

openngs

s

Foramen

ovae

B.

Foramen

rotundum

Interna

D.

Juguar

E.

Superor

acoustc

to

pyscan

rom

taste

s

te

rom

te

sows

ead

sku.

nerve

meatus

oramen

orbta

te

droong

te

te

A.

C.

to

earng

ssure

a

ear.

same

te

hroug

most

because

et

et

and

at

sde

o

tumor

wc

key

e

He

com-

o

passng?

te

358

C H A P T E R

47.

7

Head

and

Neck

A 70-year-od man comes to te pyscan or a scedued

bopsy

past

o

6

rettes

a

growt

monts.

day

or

e

he

40

as

ad

patent

years

and

on

as

ost

s

ower

smoked

9

kg

1

(20

p

or

pack

b)

o

over

te

cga-

te

ast

3 monts. A bopsy o s ower p sows a squamous ce

carcnoma.

wt

p

wc

48.

ymp

A.

Occpta

B.

Parotd

nodes

w

Retroparyngea

D.

Juguodgastrc

E.

Submenta

A

54-year-od

s

and

as

an

cavernous

most

afected

Ocuomotor

C.

Optamc

D.

Maxary

nerve

E.

T rocear

nerve

s

tetc

any

ng

a

A

artery

te

o

pan

•

examna-

o

aneurysm

o

te

nsde

nerves

examnaton

ead

trgemna

te

Wc

teet

to

te

pyscan

extracted

rom

2

bot

te

n

tat

ront

e

two-trds

was

patent

te

as

o

most

Aurcuotempora

B.

Corda

C.

Lngua

D.

Menta

E.

Ineror

s

ost

s

key

A.

notced

o

tat

tongue.

s

sense

tongue.

njured

e

weeks

sdes

dd

ater

o

not

Pysca

o

taste

Wc

durng

o

te

T rgemna

Gencuate

Superor

D.

Otc

pace

ave

to

pass

o

te

te

wc

te

B.

Subaracnod

C.

Subdura

procedure?

53.

pexus

Superor

sagtta

and

A

22-year-od

eye.

aveoar

are

Se

o

a

3-mont

reumatod

story

artrts

o

tat

ear

pan.

afects

er

Se

as

a

temporo-

dd

wtn

er

CSF ,

te

key

te

te

tumor.

damaged?

dranage

not

be

beng

o

te

abe

and

snus

CSF

keep

produced,

aow

oowng

superor

and

o

to

and

CSF

spaces?

space

cavernous

woman

ound

to

sown

key

n

Fg.

7.2.

responsbe

Wc

or

te

o

te

pan

oowng

sensaton?

sagtta

snus

snus

juguar

ven

space

s

brougt

to

be

te

Faca

C.

Nasocary

Aurcuotempora

D.

Ocuomotor

Lesser

V estbuococear

petrosa

E.

Corda

E.

54.

tympan

A

te

emergency

as

area

56-year-od

man

resecton

patent

durng

s

beow

admtted

te

notces

eatng

tan

base

tat

to

o

s

beore

te

s

ospta

sku.

mout

s

s

Ater

or

a

ea-

somewat

surgery.

An

MRI

he

Wc

aferent

eye

cornea

o

te

mb

o

and

er

vta

examnaton

movements

relex

s

are

tested

oowng

ts

sgns

sows

a

and

nerves

s

relex?

Optc

21-year-od

department

51–75

Pysca

extraocuar

norma.

or

B.

D.

conscousness

mts.

and

A.

C.

ose

uncanged.

Fronta

s

most

not

vson

and

Lacrma

te

o

may

subdura

subdura

norma

B.

drer

and

Epdura

A.

ng,

wt

most

CSF

two

space

space

E.

MRI

tumor

o

and

D.

responsbe

A

v

amount

between

mandbuar jont. he patent as no oter symptoms. An

Questions

s

o

durng

Gasseran)

overproducton

aracnod

oow-

ntact

s

nvovement

ganga

dvson

key

cervca

Corod

tat

scan

ts

most

department ater se was t by a soccer ba n er rgt

because

nerves

51.

case

wt

ment

o

o

(semunar,

A.

tympan

mandbuar

ydrocepay may resut. he aracnod v

exam-

rom

te

te

troug

s

te

Submandbuar

In

A 56-year-od woman s brougt to te emergency depart-

story

.

damaged,

oowng

B.

C.

tat

s

because

te

A.

E.

52.

o

sows

nerve

procedure

woud

rst?

comes

Fig.

mgranes

Pysca

oowng

te

epsodes

o

scan

rst?

because

tat

story

CT

te

nerve

man

of,

sows

nerves

says

ntermttent

ave

oterwse.

o

nvoved

pyscan

He

excson

metastasze,

nerve

wsdom

wore

anteror

be

to

Rgt ater te procedure wen te oca anes-

sensaton

naton

te

surgca

was

nerve

24-year-od

ad

wt

carotd

B.

ower jaw.

to

not

Wc

Abducens

e

key

eadaces.

eaty

A.

A

most

or

cancer

abnormates.

snus.

be

te

does

nterna

key

evauated

I

nature

He

no

s

comes

o

been

sows

sows

n

vson.

e

ton

man

story

trobbng

doube

50.

patent

C.

5-mont

49.

he

reconstructon.

stopped,

known

common

area

s

Wc

man

because

and

as

o

te

a

area

te

to

were

to

brougt

severe

patent

Kessebac

exposed

anastomoses

was

o

(or

s

ts

Ltte)

epstaxs

area?

te

pexus

orgnates

arteres

canges

most

emergency

he

oterwse

envronmenta

oowng

to

nosebeed.

beedng

stabe.

s

he

te

most

rom.

hs

and

key

trauma.

provde

CHAPTER

A.

Ascendng

B.

Posteror

paatne

C.

Latera

D.

Septa

E.

Descendng

superor

brances

and

ascendng

aveoar

o

and

posteror

paryngea

accessory

etmoda

te

menngea

and

mdde

o

te

spenopaatne

and

superor

be

paatne

and

tonsar

brances

o

te

paryngea

12-year-od

because

days.

Pysca

ts

6

As

tese

A.

Levator

B.

Paatogossus

C.

Styogossus

ts

ve

and

and

Paatoparyngeus

ar

tube

nserted

te

top

Under

by

o

te

wc

par

A.

Posteror

an

B.

Latera

ew

swoen

o

tons-

o

te

te

comes

mask

to

T rapezus

s

67-year-od

te

rgt

tat

and

hs

or

te

te

been

ensure

mask

s

te

keep

rma

te

as

most

D.

Hypogossa

to

It

o

E.

60.

s

arway

open.

20-year-od

not

te

crcoarytenods

A

CT

o

a

scan

o

any

te

patent

ange

te

ost

jaw.

key

Supracavcuar

E.

Crcotyrods

B.

T ransverse

C.

Great

D.

Greater

E.

Lesser

a

3-day

he

story

sweng

worse

ee

a

durng

sot,

o

s

a

panu

ocazed

meas.

tn

at

he

rdge

o

sweng

te

patent

tssue

o

rgt

says

aong

s

rgt

ower

tat

te

jaw

e

can

nsde

o

ceek.

and

s

aso

o

te

key

emergency

sweng

utrasound

wt

abscess.

and

Wc

exam-

yperecoc

he

cervca

recovery,

droop

abscess,

trange,

pysca

nabty

o

te

exam-

to

rase

oowng

njured?

brougt

n

61.

s

A

to

te

te

emergency

superor

regon

o

sows

tat

structures.

pysca

o

te

te

wound

Foowng

examnaton

rom

te

oowng

sows

skn

as

surgca

tat

over

nerves

s

te

most

njured?

cervca

aurcuar

occpta

occpta

2-year-od

tne

neck

sensaton

Wc

A.

arytenods

because

an

wound

te

wound,

as

hyroarytenods

pyscan

was

stab

o

T ransverse

te

An

posteror

ead.

been

major

D.

to

te

er

to

structure

Durng

man

wt

afected

repar

comes

most

Suprascapuar

A

mts.

opened

musces?

man

w

to

po-

s neck durng a bar gt. Vta sgns are wtn norma

crcoarytenods

32-year-od

order

erytematous

neck.

wt

o

key

C.

A

n

restore

cervcas

department

aganst

and

musces

brougt

souder

above

Faca

cuf.

s

and

Ansa

rests

gottds

rgt

C.

oxy-

er

mdde

B.

paced

o

surgcay.

sows

s

consstent

a

or

anastomosed

nerve

arynx

panu,

lud-ed

operat-

composed

cuf

s

te

draned

rgt

a

Accessory

proper

se-seang

unt

eps

as

In

n

a

sde

A.

pyscan

te

359

Neck

surgery?

woman

wt

sows

nerves

constrctors

o

s

and

Crcotyrod

A

er

te

arway

mout

and

Sternoyod

D.

naton

coecystectomy.

nlatabe

te

C.

cervcas

aryngea

oowng

te

Sternocedomastod

debrs

sapngoparyngeus

te

Patysma

naton

paatn

o

B.

on

oowng

musces

ater

department

anteror

ansa

A.

E.

59.

recommended.

ve

paryngea

condtons,

o

case

s

past

and

between

tensor

surgery.

gotts

norma

trd

Wc

anestesa

te

troug

te

rgt

recurrent

te

parayzed

ocated

and

and

aryngea

wt

or

ever

paatoparyngeus

woman

durng

s

ocated

mdde

contnuous

genaton

an

a

sows

pars.

aparoscopc

room,

dever

swaowng

depart-

styoparyngeus

Superor

35-year-od

emergency

tonsectomy

paatn

and

te

pars?

E.

A

a

to

was

are

D.

ng

boy

examnaton.

s

brougt

He

was

to

te

born

va

pyscan

or

spontaneous

a

rou-

vagna

ceek, runnng orward rom s rgt ower jaw toward

devery wc was compcated causng s ead posture

s

to

rgt

never

m

upper

et

tat

ng

s

tat

te

nlamed

58.

troube

examnaton

tonsar

orm

scedued

57.

brougt

tonss

posteror

musces

s

monts,

paatne

and

o

tonss.

wtn

he

56.

boy

ment

paatne

te

rgt

naton. Wc

brances

aba

A

te

rennervate

menngea

55.

surgery,

wt

Head

7

because

te

most

Faca

B.

Maxary

Parotd

D.

Margna

E.

Faca

he

norma

because

pyscan

and

t

as

necton. Wc

structure

se

s

as

reassures

just

o

e

become

te

oow-

branc

o

aca

sore

man

troat

he

comes

and

patent

cnoma.

A

surgca

tumor

successuy

s

to

te

pyscan

te

nerve

worsenng

ound

to

procedure

s

removed

or

oarseness

ave

a

te

or

aryngea

perormed,

rom

a

and

arynx.

per-

te

car-

te

Durng

s

s

A

cd

tted.

ed

cose

superory

dagnoss

o

s

on

started

consderng

medca

ng

was

musces

A.

Anteror

B.

Omoyod

a

to

s

te

tra

key

examnaton

rgt

et.

o

souder

No

neck

tortcos

pysca

management.

most

s

masses

are

made,

terapy

Wc

damaged

s

o

durng

sows

and

te

and

beore

oow-

brt?

scaene

Sternocedomastod

D.

T rapezus

A

Pysca

to

congenta

C.

E.

62.

ear

turned

vsbe.

eeng?

te

contnuousy

rgt

ace

duct

mandbuar

be

s

ven

year.

s

beore.

s

te

concerned

artery

43-year-od

past

o

key

s

artery

C.

sstent

He

structure

structure

A.

A

moars.

Patysma

35-year-od

department

son.

On

woman

ater

beng

arrva,

te

s

brougt

nvoved

patent

n

s

a

to

te

motor

emergency

vece

unconscous

co-

wt

an

360

C H A P T E R

upper

be

and

gand

Wc

present

Neck

obstructed

suctonng,

tyrod

arway.

to

Head

arway

vacuum

te

7

o

at

a

by

stmus

te

te

bood

mdne

s

o

mucus.

perormed

oowng

ste

and

traceostomy

vesses

ncson

to

are

and

Ater

A.

Rgt

gossoparyngea

to

B.

Rgt

ypogossa

er

C.

Let

ypogossa

D.

Let

ngua

E.

Let

vagus

neror

secure

most

w

key

need

to

be

cauterzed?

63.

66.

A.

Mdde

tyrod

ven

B.

Ineror

tyrod

artery

C.

Ineror

tyrod

ven

neror

and

and

neror

tyrod

tyrodea

ma

ven

se

artery

ment

because

o

a

arge

Pysca

examnaton

a

o

tumor

tumor

but

ectomy

te

te

because

s

cuty

ng

n

te

ts

was

at

most

center

Bopsy

arge

te

sze

neror

deveops

on

te

key

o

er

suggests

a

Wc

durng

Hypogossa

tyrod-

C.

Interna

D.

Lngua

E.

Recurrent

artery

as

was

d-

te

oow-

te

surgca

67.

A

arge

at

a

nucear

Ansa

cervcas

tumor

C.

Ansa

subcava

tomy

D.

Recurrent

aso

as

cuty

as

branc

because

been

and

monts.

tumor

oramen.

tures

s

o

to

atgue

o

CT

Invovement

most

key

Se

exam

te

o

as

te

wc

and

lud

oss

9

te

kg

o

te

Ansa

B.

Cervca

sympatetc

C.

Externa

aryngea

D.

Hypogossa

A

Vagus

hyroarytenod

D.

Arytenod

E.

Crcotyrod

68.

A

struc-

tumor.

artery

te

nerve

department

ater

eeng

dzzy

and

te

ang.

emergency

Recenty,

se

69.

mm

Hg,

naton

and

sows

undergong

n

bot

ectomy

are

carotd

an

s

nerves

carotd

perormed,

tat

was

er

asked

was

are

bruts

arterogram

common

removed.

sows

se

respratons

and

bood

18/mn.

tat

tongue

most

arge

devated

protrude

key

sows

arteres.

t.

njured

A

s

190/110

Pysca

bateray.

Postoperatvey,

to

pressure

he

90%

carotd

toward

Wc

endarter-

durng

te

paques

examnaton

te

o

s

occuson

ateroscerotc

pysca

exam-

patent

rgt

te

wen

o

oowng

aryngea

pyscan

neck.

says

as

he

tat

ump

parta

ours

a

o

does

swa-

bengn

tyrodec-

oowng

te

Wc

patent

o

te

denervated

a

works

dicuty

conrms

a

sows

cords.

because

patent

te

some

and

key

Externa

Ineror

D.

Interna

E.

Recurrent

A

a

ater

cd

tat

can

A.

o

branc

te

coud

oow-

durng

te

gr

s

as

key

te

a

to

a

ospta

tyrod

superor

andmark

nerve.

order

Wc

ts

o

n

externa

mgt

te

superor

ansa

te

aryngea

cervcas

superor

aryngea

te

membrane

been

te

Wc

taste

te

emergency

penc

o

wt

njury

te

or

te

nto

depart-

er

examnaton

meatus.

externa

ceck

n

a

Pysca

acoustc

ave

to

to

nsertng

pan.

nnervates

perormed

Ceck

to

te

artery?

a

ew

here

to

te

surace

oowng

njury

anteror

to

drops

s

te

tat

tym-

cnca

ts

te

sensaton

to

te

and

tests

nerve?

two-trds

parynx

o

concern

nerve

o

ear.

sows

o

tongue

B.

a

tyrod

n

accompany

or

gand

trunk

brougt

tympanc

membrane.

Ceck

o

te

aryngea

cryng

te

tere

be

o

te

to

remove

companon

most

branc

root

s

prncpay

panc

s

to

used

accdentay

ruptured

n

brougt

procedure,

sympatetc

3-year-od

bood

s

and

sma

nerves

C.

oowng

procedure?

ts

B.

he

100/mn,

voca

te

dented

Cervca

zness.

s

te

tat

od

paryngea

examnaton

woman

Durng

s

A.

ment

puse

He

e

tyrodectomy

damage

as been avng requent epsodes o eadaces and dz-

Her

sows

voca

s

er

crcoarytenod

46-year-od

n

nerve

to

o

and

aed

crcoarytenod

scedued

nerve

brougt

te

gand

most

C.

b)

trunk

s

to

T wenty-our

true

was

luds

oowng

woman

te

Posteror

cervcas

55-year-od

superor

examnaton

Latera

not

A.

but

perormed.

pysca

B.

juguar

ndngs

te

Wc

superor

pant.

tyrod

A.

turgor

oowng

tese

above

anteror

utrasound

di-

sku

te

comes

pan,

ntake

a

examnaton

recess

te

ower

power

musces

lud

patent

a

room,

operaton?

patent?

E.

s

man

s

te

abduct

ng

Se

(20

skn

sows

bend

o

or

oss.

aspratng

ost

ead

space

responsbe

emergency

eadaces

patent’s

sows

o

not

te

wegt

requenty

scan

occupyng

to

and

te

drnk.

Pysca

A

aryngea

brougt

recurrng

because

dyspaga.

base

s

Recenty,

attemptng

3

superor

avng

decreased

over

o

An

drnkng

he

or

recovery

njured?

o

o

pyscan

te

aryngea

any

o

surgery,

woman

swaowng.

wen

owng.

aryngea

65-year-od

department

aryngea

branc

n

cause

Interna

Externa

superor

mass

key

branc

38-year-od

B.

A

o

most

B.

oowng

Pysca

te

In

ungs.

anestetzed.

bengn

not

branc

was

was

er

prorm

Externa

A.

E.

65.

arynx

nerves

procedure?

64.

evauaton.

te

to

dicutes

nto

o

A.

and

o

avng

asprate

te

area

comes

tyrodectomy.

swaow

te

neck.

been

to

woman

parta

sow

a

parta

ours

tyrod

njured

depart-

utrasound

oarseness

exerton.

ven

emergency

T wenty-our

wc

patent

breatng

nerves

o

te

subsequent

gand.

perormed.

surgery,

gated,

mass

and

tyrod

to

as

noted

Crcotyrod

comes

tyrod

34-year-od

scedued

Let bracocepac ven and neror tyrod artery

woman

neror

artery

E.

34-year-od

and

tyrod

D.

A

artery

and

A

paate

te

CHAPTER

C.

Ceck



dbuar

70.

tere

s

parestesa

at

te

temporoman-

severa

jont

ng

D.

Ceck

or

sensaton

n

te

arynx

Wc

E.

Ceck

or

sensaton

n

te

nasa

to

A

27-year-od

department

wtout

neck

woman

ater

se

wearng

sows

a

a

s

brougt

was

I

to

trown

emet.

type

cavty

An

LeFort

te

rom

MRI

racture

a

o

patent

and

s

recoverng

up

examnaton,

ty

to

most

71.

underwent

oud

patent

Wc

Lngua

Ineror

C.

Bucca

D.

Menta

E.

Myoyod

ead

and

commnuted

te

surgery

subsequent

experences

o

g

oowng

74.

oow-

tng

s

e

pan

aways

ad

D.

Styoyod

temporomandbuar

E.

Crcotyrod

o

ng

ve

43-year-od

racture

sows

toms

n

A.

B.

to

to

dryness

gands

dryness

o

gand

Loss

o

Loss

o

o

o

a

38.9°C

CT

s

te

wt

scan

sku.

o

te

durng

mout

te

a

bat.

te

An

petrosa

MRI

nerve

sgns

o

depart-

o

as

a

o

o

te

mout

rom

te

rgt

cornea

because

parotd

A.

T emporas

B.

Meda

C.

Masseter

Latera

E.

Buccnator

o

62-year-od

patent

sa-

o

subn-

ack

o

sa-

because

o

most

ack

o

acr-

sensaton

rom

te

rgt

anteror

two-

tongue

o

sensaton

te

gr

ever

s

te

rgt

anteror

brougt

mdde

pexus

rgt

ear

to

emergency

ear

pan.

nectons.

puse

s

Se

Her

101/mn,

dtons

w

be

n

te

been

ound

ost,

Dmnsed

mucus

n

B.

Dmnsed

mucus

on

C.

Dmnsed

sava

D.

Dmnsed

sava

E.

A

and

subngua

Dmnsed

38-year-od

acute

toot

sweets

and

tear

pan.

department

as

a

story

Optc

C.

Abducens

D.

T rocear

E.

Fronta

Questions

76.

temperature

bood

te

nasa

te

sot

producton

cavty.

tat

te

pysca

A

e

te

been

pont

jaw

as

e

e

as

moves

o

be

to

grnd-

jaw.

artrts.

key

ead-

used

a

s

o

get-

were

constant

nlammaton

most

ts

because

as

o

An

te

Wc

afected

by

jont?

brougt

ne

Pysca

se

o

a

to

te

lgt

and

se

just

examnaton

attempts

sows

wc

or

no

o

ts

to

emergency

o

stars.

e

sows

ook

te

worsen-

downward.

ntracrana

process

oowng

patent’s

he

because

A

or

nerves

s

compant?

76–100

65-year-od

experencng

doube

pressure

Snce

pass

te

troug

oowng

examnaton?

e

vson

nose

paate

te

by

te

gand

submandbu-

comes

woman

seeng

a

to

by

te

te

denta

admts

dentst.

acrma

to

he

gand

cnc

eatng

a

dentst

wt

ot

o

ound

77.

s

and

o

te

patent

ook

Wc

or

patent

to

turn

nerve

e

s

s

most

Nasocary

Ocuomotor,

neror

D.

Ocuomotor,

superor

E.

T rocear

woman

he

been

to

e

on

as

as

to

not

examnaton

nward

ook

o

tat

gong



dpopa,

eye

says

patent

Pysca

key

and

wen

toward

nward

s

but

not

or

o-

nvoved?

dvson

dvson

comes

Se

as

because

He

wonderng

abe

C.

examnaton.

vson.

and

rgt

B.

44-year-od

pyscan

experences

s

down,

s

dzzness.

Abducens

ow-up

te

gasses.

A.

A

to

doube

ntermttent

he

eadaces

tat

comes

prescrpton

asked

down.

parotd

s

any

s

man

epsodes

monts.

sows

cavty

by

3

ad

con-

gands

producton

he

o

producton

woman

rarey

ear

bers

wc

durng

A.

ar

mdde

parasympatetc

ave

s

because

down

eeng

eson

Ocuomotor

cange

te

to

sows

acute

o

tat

gettng

wt

w

s

a

responsbe

B.

te

pregangonc

jont

ead

A.

or

pexus

a

wen

te

A

key

125/80 mm Hg. Pysca examnaton sows a eson n

tympanc

need

toot?

tongue

and

(102°F),

rom

s

wen

an

process

s

vson.

o

racture.

gand

teet.

dentst

pyscan

pan

examnaton

woman

se

dpopa

scan

te

ncreased

troube

sows

ater

says

doube

ng

te

tat

penetrat-

moar

pterygod

department

njury?

and

A

n

a

361

Neck

pterygod

D.

75.

to

and

musces

nlammatory

been

ack

o

oowng

ead

symp-

cares

sensaton

ead

te

examnaton

submandbuar

te

aso

nerve

because

brus-

sows

and/or

ts

te

Pysca

aca

ead

pysca

dagnoss

rom

emergency

aceraton,

oowng

te

o

ead

sku

greater

genera

recurrent

s

te

te

12-year-od

because

o

te

secreton

taste

o

A

to

Pysca

cckng

o

te

CT

secretons

two-trds

A

o

te

deep

dented

gua

trds

E.

be

conrm

Dryness

D.

base

secretons

ma

n

a

rgt

vary

vary

C.

te

Wc

Parta

brougt

t

sows

te

need

Parta

s

and

MRI

ematoma.

at

order

man

beng

tat

njured.

paatn

boxer.

as

propery

T ensor

a

a

he

eat

Stapedus

and

be

te

beng

woud

mandbuar

C.

ng,

dgastrc

He

worst

mandbuar

nerves

comes

o

B.

ater

o

worse.

aces.

man

story

cannot

te

and

aveoar

59-year-od

3-mont

senstv-

musces

A

treat

Posteror

A

bey

to

B.

reconstructve

te

anestetze

te

o

oowng

A.

parayzed?

examnaton

73.

te

Durng

te

wt

one

A.

ment

72.

we.

sounds.

key

extensve

o

emergency

racture o te mandbe and temporomandbuar jont.

he

cares,

afectng

motorcyce

te

and

denta

cavty

Head

7

s

to

te

beng

pyscan

treated

or

Raynaud

362

C H A P T E R

dsease

Head

and

systemc

regmen

tat

admnstered

s

occur

as

an

A.

Exoptamos

B.

Enoptamos

C.

Dry

D.

Wde

E.

Ptoss

A

and

open

and

MRI

nvovng

to

be

age.

ask

age

In

te

o

s

ead

7.3).

be

o

drug

te

o-

expected

to

drug?

80.

pup

eye

to

and

s

o

by

oss

o

dept

to

a

to

or

readng

Constrcted

B.

Dry

C.

Exoptamos

Pae,

E.

Sweaty

A

snus,

rgt

emergency

gand

A

te

rgt

te

nerve

compete

was

tumor

key

beore.

parayzed

orbta

papebra

C.

Levator

exam-

dam-

D.

Superor

obque

most

key

E.

Superor

tarsa

or

dam-

81.

C.

Downward

te

because

he

past

2

Down

and

out

pustues,

E.

Down

and

n

and

o

because

7.4).

Horner

ter

te

as

at

ospta

owng

ound

a

droopng

a

or

te

rgt

examnaton

he

age.

urter

amy

he

on

s

te

te

(ptoss)

o

s

sgns

anxous

story

o

sde

o

as

te

or

years.

and

ead

as

never

notced

er

musces

on

ap-

eyed

s

most

part

part

Müer)

te

ever,

drowsness,

awake

He

nodues

as

a

on

routes

be

and

not

story

te

o

rgt

snus

entry

o

severe

sows

around

sde.

A

te

or

menta

to

or

papues,

s

CT

nose

scan

o

Wc

cavernous

te

per-

acne

tromboss.

to

responsbe

atered

orented

examnaton

cavernous

key

but

predomnanty

edema

oowng

most

s

Pysca

sows

snus

necton

and

tromboss?

A.

Carotd

to

B.

Mastod

o-

C.

Mdde

D.

Superor

E.

Pareta

woud

te

superors

(o

tme.

perorbta

woud

strokes

admtted

Wc

rgt

depart-

cassca

very

patent

evauaton.

sgns

eyed

sows

moter

sgncant

young

addtona

n

a

syndrome.

amy

occurrng

o

Pysca

emergency

o

patent

pace,

D.

te

tat

andross

A 16-year-od boy s brougt to te emergency depart-

son,

(Fg.

papebrae

eadaces

ptoss?

ocu,

nerve

assess

er

ocu,

eye

ts

tat

emergency

o

sows

oowng

Orbcuars

Outward

ment

cause

potenta

to

sster

te

Orbcuars

ment

to

to

pyscan

eye

er

o

te

and

says

B.

nerve?

brougt

was

Se

A.

B.

s

It

ace.

moss,

nta

state.

boy

ptoss,

er

to

onset

examnaton

appears

Inward

9-year-od

o

brougt

sudden

Pysca

parta

sde

s

o

droopng. Wc

A.

A

woman

because

as

rgt

ace

ace

dzzness.

pened

tromboss.

conrmng

denty

er

te

abducens

to

w

banced

32-year-od

patent

pup

eye

D.

and

percepton

snus

ptutary

tumor.

turn

abducens

brougt

cavernous

te

drecton

patent

A.

department

accommodate

sows

he

conducted

te

dry

cavernous

(Fg.

wc

te

med-

te

sgns

compressed

naton

o

Her

bockng

Wc

key

dated

and

woman

te

te

dagnoss

and

doses.

most

efect

eyeds

erytematosus.

sympatetc

g

nabty

wt

o

n

a

moss

47-year-od

An

upus

w

adverse

eye

Neck

contans

condtons

department

79.

and

caton

owng

78.

7

be

patent?

82.

A

emssary

he

wak

emssary

man

ater

patent

on

artery

optamc

68-year-od

ness.

ven

menngea

department

to

artery

s

a

ven

ven

s

brougt

sudden

as

own.

onset

dicuty

A

CT

to

o

te

speakng

scan

o

emergency

one-sded

te

and

ead

s

weak-

unabe

sows

an

acute cerebra vascuar accdent n te anteror neror

•

Fig.

.

•

Fig.

.

CHAPTER

cerebear

te

te

at

ts

oowng

afected

A.

83.

artery,

artery

by

Optc

nerves

te

Ocuomotor

T rocear

T rgemna

E.

Abducens

s

5-year-od

by

s

to

It

s

reeve

te

he

o

patent

mmedatey

up

s

te

n

to

te

or

anteror

and

and

best

et

pan.

meda

te

ocaton

and

to

make

he

o

te

superor

quadrant

o

87.

mem-

D.

he

A

anteror

panc

o

te

ste

neror

o

te

o

openng

o

rm

o’cock

84.

A

ncson

crana

te

patent

s

owng

o

ossa.

s

pars

te

comes

an

te

Durng

to

12

uvua

ead

to

te

te

o’cock

pyscan

tumor

pysca

to

n

tym-

te

poston

to

te

by

6

rm

protrude

musces

made

membrane

extradura

devates

o

be

tympanc

o

asked

tongue

rom

te

man

dagnoss

ror

out,

o

poston

56-year-od

recent

soud

te

because

n

te

examnaton,

s

tongue

rgt. Wc

and/or

nerves

are

o

poste-

wen

stragt

o

te

most

o-

85.

Rgt

B.

Let

C.

Rgt

yogossus

D.

Rgt

genoyod

E.

Contraatera

A

6

ypogossa

ypogossa

62-year-od

rst

tme

or

monts.

o

poor

ous

o

He

says

te

and

and

et

and

cervca

to

te

worsenng

as

Rgt

D.

Let

a

dagnoss

oowng

secreted

by

spaces

te

o

or

drvng

sows

sows

a

receves

epteum

A

o

and

Hs

n

we

te

aque-

cary

et

o

te

pa-

par yngea

CT

key

te

wa

wa

scan

cana.

or

exam-

depressor,

o

Gven

examnaton,

most

past

asted

par yngea

A

juguar

brougt

a

be

te

sweng

neary

ower

tat

week

worse

jaw

e

been

s

te

te

wc

key

n

o

afected

emergency

te

totay

e

day.

examna-

loor

o

occuded

upper

ad

and

tat

te

Pysca

and

just

ago

snce

most

to

dyspnea.

wt

s

says

extracted

one

ad

neck

o

been

Wc

s

s

o

s

ar-

aso

ower

eeng

te

o-

dagnoss?

Qunsy

paatnus

D.

Ranua

E.

Ludwg

angna

5-year-od

parents

Her

gr

because

moter

s

s

o

brougt

ever

and

concerned

to

te

coug

se

pyscan

or

may

be

te

ast

avng

by

2

er

days.

troube

breatng and says tat te patent may ave decreased

Anteror

B.

Posteror

C.

Pup

troug

D.

Vtreous

key

E.

Lacrma

camber

camber

sac

17-year-od

ued

parynx

w

s

sgncant

sweng

A.

A

a

T orus

te

ave

sde

et

smar.

te

severe

Ankyogossa

A

n

man

wt

C.

89.

te

s

t

av-

te

Pysca

tongue

te

dzzness

been

or

tme

rgt

and

as

dzzness

a

emergency

o

vagus

because

made.

sur-

mandbuar

B.

s

te

te

se

vomt.

pysca

ner ves

A.

ntra-

to

Wen

er

to

rst

wt

et

tumor

te

mted

te

wen

te

past

g

gaucoma

rst

or

te

ypogossa

sows

owng

te

o-

gossoparyngea

progressvey

nerves

as

te

gossoparyngea

Rgt

moars

pyscan

examnaton

a

45-year-od

noted.

body?

86.

C.

way.

nerve

vson

dicuty

ed. T onometry

and

genogossus

genogossus

ypogossa

comes

e

rgt

et

styogossus

rst

and

Pysca

vsua

umor

and

vagus

man

pressure,

Wc

nerve

nerve

graduay

vson.

perpera

ocuar

Let

mout

A.

ssues

se

tumor?

B.

ton

njured?

o

durng

bout

says

and

er

response

oowng

Rgt

A

to

rom

department

key

Wc

brougt

was

touced

upward.

te

sows

te

ts

tat

s

devates

A.

E.

88.

any

surgery,

njured

sudden

patent

caused

sows

wa

s

o

eadaces

wc

naton

tympanc

he

However,

touced,

te

woman

because

recurrent

year.

tympanc

key

ear.

he

oow-

tympan

vomtng.

ng

umbo

quadrant

most

er

ad

a

petrosa

49-year-od

ndngs

membrane,

te

A

contracts

troug

vertca

Vagus

and

membrane

E.

Lesser

C.

department

tympanc

te

was

n

not

te

or

Aurcuotempora

B.

ours

quadrant

pan

as

ater

363

Neck

compcaton.

week

snce

and

procedure?

r yngea

posteror

Drecty

experencng

Gossoparyngea

membrane

C.

been

a

patent

owever,

Corda

dranage?

superor

tonss,

E.

Wc

an

he

er

wtout

cnc

D.

membrane

B.

appontment.

nerves

done

te

ts

membrane

lud.

to

he

exam-

tympanc

tympanc

dran

depart-

Otoscopc

nlamed

te

ear

otts

monts.

ncse

pressure

s

6

emergency

o

recurrent

bugng

decded

te

because

o

epsode

to

was

returns

wt

A.

brougt

story

a

procedure

owng

nerve

(myrngotomy)

he

be

o

gca

parents

a

oowng

A.

key

Wc

nerve

s

ad

sows

brane.

most

emorrage

trunk.

nerve

boy

ourt

naton

sma

man

nerve

D.

patent

w

a

te

nerve

C.

ment

n

rom

emorrage?

B.

A

resutng

orgn

Head

7

gr

earng.

Pysca

ear

a

te

comes

tonsectomy

to

te

because

o

pyscan

recurrent

or

a

wt

te

drect

upper

examnaton

goden-brown

tympanc

route

or

respratory

sced-

A.

Audtory

nectons.

B.

Coanae

tube

lud

sows

tat

membrane.

te

spread

tract

to

te

a

can

tender

be

Wc

o

an

te

most

necton

rom

mdde

s

rgt

observed

ear

cavty?

364

C H A P T E R

90.

7

Head

C.

Nostrs

D.

Faca

E.

Interna

A

94.

pan

tey

rst

wtout

ntense

tory

a

o

mass

started,

n

Ineror

D.

Nasoparynx

E.

Spenoetmoda

o

te

most

A.

key

to

Cavernous

Fronta

Maxary

oow-up

o

te

n

te

team

repar.

access

D.

Superor

E.

Uvua

te

to

a

recent

artery,

cavty

routes

crana

s

s

te

nerves

pan.

an

s

brougt

ater

a

te

sensory

was

most

te

A

ear

A.

wtout

Second

hrd

D.

Fourt

E.

Sxt

A

sows

absence

posteror

porton

key

part

o

o

o

te

wc

o

te

burnt

or

s

te

stngng

Ineror

C.

Lngua

D.

Greater

E.

Lesser

Gossoparyngea

C.

Mandbuar

scedued

D.

Maxary

gand

E.

Hypogossa

says

56-year-od

scedued

woman

tota

comes

tyrodectomy

to

te

pyscan

because

o

a

or

arge

a

A

as

ost

sa,

owng

to

experence

oarseness

tat

asted

or

te

te

te

abty

te

adducted

rgt

s

most

voca

key

to

be

od?

A.

Aryepgottc

B.

Posteror

C.

hyroarytenod

e

D.

T ransverse

boy

E.

V ocas

crcoarytenod

arytenods

98.

A

s

te

patent

to

wc

te

md-

embryonc

nerves

to

was

not

pyscan

1

te

day.

mout

o

te

wt

he

wen

burnt

e

was

parts

ate

o

te

caused

oowng

o

a

patent

wc

nnervaton

te

nerves

tat

pyscan

because

o

postoperatvey,

se

sows

te

key

s

area?

tat

Wc

o

o

a

patent

or

te

or

tyrod

te

eatng

presence

vestbue.

drnk-

patent

oregn

te

o-

njured?

superor

o

superor

aryngea

aryngea

nerve

nerve

nerve

nerve

aryngea

boy

to

to

wen

detect

o

branc

ound

dd

pyscan

or

rus

s

comes

most

branc

1-year-od

was

te

aveoar

aryngea

Recurrent

te

musces

o

examnaton

Hypogossa

or

oowng

a

tat

cokes

E.

responsbe

te

n

monts

oten

D.

o

boy

because

paryngts.

spread

o

tyrodectomy

Gossoparyngea

wc

trauma

and

severe

may

Wc

woman

parta

C.

to

Surgca

he

paatne

Externa

sde.

o

paatne

Interna

rgt

structures

dranage

tonss.

postve

to

sensory

B.

te

te

ear

tumor.

aveoar

se

n

roo

A.

on

postnasa

swaowng

wt

mout

beeves

adducted

od

was

dervatve

s

3 weeks. Subsequent examnaton sows a permanenty

voca

swoen

comes

n

superor

Pysca

objects

started

test

yesterday

cancer. T wo

tat

rod gand tumor. Ater se recovered rom te aneste-

se

monts.

mdde

oowng

dicuty

te

man

or

32-year-od

ng.

ty-

a

3

as

and

musce

and

sensaton.

Posteror

B.

A

97.

te

nasoparynx

He

responsbe

B.

njured?

sows

ast

te

nose

pouc?

scratced

tongue

Faca

te

n

compromse

dagnosed

aong

toast

A.

o-

ever

strep

te

cass.

gag

te

o

to

avng

sensaton

ate

s

o

25-year-od

toast

compca-

wc

or

lud

s

ear,

e

Frst

C.

tonsectomy.

any

n

B.

a

ead

troug

tat

tons

s

cavty

cosen.

or

te

constrctor

rapd

surgeon

pyscan

scedued

perormed

wen

to

oss

sows

says

because

one

tons

and

paryngea

cavty?

wegt

key

subsequenty

de

approac

patent

n

tons

because

Inecton

rup-

he

pyscan

earng

A 10-year-od boy s brougt to te emergency depart-

s

cose

o

recommended

anteror

nasa

te

or

te

tube?

Paryngea

te

96.

week

he

audtory

C.

rsk

as

o

Paatne

o

o

most

Lngua

basar

te

scan

B.

o

An

oowng

examnaton

et

be

stngng

was

Pysca

CT

to

dicuty

breatng

examnaton

A.

snus

1

unexpaned

sows

atus

pyscan

Because

troug

te

te

dicuty

oowng

o

to

surgery

gr

vst

surgery

depressed.

A.

te

te

snus

10-year-od

owng

bock

ead

te

snus

Spenoda

on

te

o

s-

snus

E.

s

o

or

woud

comes

pan,

nosebeeds.

Hypertropy

pate

D.

relex

trauma

away

more

recess

comes

gan

C.

tons.

scan

wc

went

cavty.

ment

snus.

turcca

wc

Crbrorm

he

no

Wen

become

ad

Pysca

95.

aneurysm

B.

A

In

year.

and

ave

as

CT

aneurysm

vascuar

sea

hroug

past

e

avng

man

ear

recurrng

atgued

man

an

endovascuar

to

He

and

meatus

cavernous

te

cavty.

nosebeeds

meatus

54-year-od

eadace,

been

meatus

Mdde

ture,

te

tey

emergency

nasa

occasona

carcnoma

Superor

te

A

s

or

Patent

cavty.

te

n

te

recurrng

atey

nose.

C.

A

were

but

B.

to

93.

s

pan

to

snus?

dagnoss

92.

tey

nasa

woud

maxary

91.

s

brougt

cavty

requent.

pckng

45-year-od

and

avng

nasa

treatment,

ocatons

A.

been

s

and

s

severe

as

wtn

meatus

man

or

e

A

o

acoustc

department

tat

Neck

cana

54-year-od

says

and

s

ave

ave

reerred

nerve

brougt

an

any

m

to

te

probems

or

pyscan

ankyogossa

possbe

wt

at

because

brt.

eedng.

surgery

he

he

because

s

CHAPTER

congenta

o

te

abnormaty

oowng

approprate

99.

or

A.

Remova

B.

Resecton

C.

Cuttng

Repar

E.

Remova

o

te

o

boy

mastod

ad

ar

antbotcs,

perormed.

tat

te

upward

eye.

Sava

drbbe

was

to

A.

ace

key

B.

Parotd

C.

Vagus

e

te

o

damaged

te

te

mastod

dd

mastod

Hs

unabe

s

n

durng

to

s

te

o

a

not

artera

cose

rgt

D.

Basar

E.

Superor

103.

rgt

te

and

operaton?

to

duct

as

te

A.

nerve

o

te

Frey

Be

D.

Qunsy

E.

Pancoast

on

worse

ora

or

te

cavty

and

s

ng

musces

Orbcuars

D.

Levator

E.

Orbcuars

Questions

A

symptoms

he

sava

rom

Be

most

te

te

was

persstenty

patent

pysca

n

pasy.

key

patent

te

examnaton

vestbue

corner

o

s

Wc

o

te

o

papebrae

anopa).

An

tures

superors

because

o

vson

MRI

key

o

s

brougt

o

dicutes

sows

n

to

a

bot

te

oss

ead

Wc

o

compressed

te

D.

Nuceus

E.

SCG

baseba

eyed.

o

rom

Wc

nerve

A.

Orbta

Optc

casm

B.

Lamna

C.

Optc

tract

C.

Orbta

pate

D.

Crbrorm

E.

Greater

stars.

he

brusng

o

nerve

patent

er

as

arms

a

brougt

down

a

contuson

and

egs.

to

te

lgt

on

emergency

o

er

Pysca

te

bodes

n

he

o

te

musce

o

te

evator

ces

supped

oowng

tese

a

dator

bers

o

are

o

(atera

te

and

orn)

to

te

rgt

o

by

struc-

bers?

C1

to

C4

wt

examnaton

turn

s

possbe

oowng

emergency

eye

dscooraton

not

ndcatng

te

concrete

ead

wt

examnaton

106.

A

s

57-year-od

n

o

o

an

ronta

o

man

te

te

o

bones

o

te

pup

ba

rgt

ateray

musce

was

a

sows

entrap-

most

key

s

o

etmod

spenod

bone

bone

bone

brougt

dzzness

examnaton

abducted

bone

etmod

maxa

te

te

because

Pysca

xed

te

pate

wng

department

ace.

o

surace

Ocuomotor

s

body

o

because

ce

part

smoot

Pysca

coud

papyracea

Abducens

ang

cnc

vson.

brougt

t

practce.

o

E.

woman

ce

s

beng

gaze,

D.

ater

pa-

Wc

ractured?

Optc

45-year-od

torax.

cear

to

dagnoss?

te

te

nuceus

sweng

orward

B.

department

Cardac

are

gangon

patent

A.

A

eye.

ungs

tenderness

musce

Wc

man

ater

consderabe

tumor?

says

examna-

sotarus

em-

ment.

rgt

exces-

amy

gangon

22-year-od

he

to

cary

nerve

Gencuate

aves

te

emergency

been

he

rgt

Müer,

and

bers.

te

C.

durng

structures

as

and

s

wt

(o

te

Intermedoatera

s

tumor

o

Pterygopaatne

atera

a

nerve

nerve

Pysca

te

key

smoot

B.

department

oowng

te

nerve

contans

emergency

vson.

te

A.

A

o

upper

comes

musce

vesses

(btempora

sows

te

by

wt

o

eyes

te

most

nerve

te

tmes.

here

dicutes

superors),

bood

eferent

parayzed?

105.

adenoypopyss.

most

te

man

and

tarsa

papebrae

oow-

at

to

wegt.

most

s

tumor

musce,

superor

mout.

arteres

com-

tento-

dsease

32-year-od

pupae

s

ors

man

A

eadace

major

examnaton

eds

104.

underwent

101–125

Pysca

was

days.

he

ocu

32-year-od

department

o

wt

was

Buccnator

o

drbbe

Zygomatcus

C.

7

s

Postoperatvey,

dagnosed

B.

necton.

but

next

accumuaton

He

A.

ear

antbotcs,

mastodectomy.

sows

an

te

te

nerve

se

murmurs,

te

to

syndrome

ment

o

s

n

cerebra

beng

pasy

An 8-year-od boy s brougt to te emergency depart-

because

cest

A

and

ead

nerve

because

moss

no

te

(PCA)/optamc

brougt

bateray.

oowng

C.

s

gaze.

nerve?

artery/trocear

osng

and

sows

Raynaud

B.

artery

amy

been

ptoss

neror

oowng

unresponsve

auscutaton

o

nerve

er

nerve

artery/ocuomotor

woman

and

sows

paton

te

a

assocated

cerebear

examnaton

nerve

Faca

tred

patent

ton

structure

o

o

365

Neck

meda

ractures.

sow

artery/optamc

by

or

and

eadaces

scan

artery/abducens

cerebra

72-year-od

svey

CT

aneurysm

te

cerebra

department

drawn

s

A

MRI

Wc

carotd

A

avng

beedng

an

compressng

Posteror

nerve

Gossoparyngea

cerebe.

C.

ceek

Wat

an

week,

notced

s

by

downward

been

recenty.

pressed

Mdde

was

se’s

and

Interna

and

patent’s

ntracrana

B.

respond

was

no

A.

antrum

t

probems

rgt

te

o

admts

arterograpy

key

emergency

o

mout

mout.

bone

operaton

operaton,

s

yod

course

patent

accumuate

corner

E.

got

102.

te

o

to

antbotc

to

weakness

patent

sows

bateray

necton

dstorted.

D.

started

101.

severe

radca

and

to

Mandbuar

rape

amuus

segment

he

a

s

et,

te

he

vson

brougt

a

te

ces.

tends

rom

most

s

o

Foowng

te

sows

most

rum

spread

and

boy’s

Wc

be

renuum

centra

Wtn

to

speec.

woud

paate

te

mdde

necton

pterygod

ngua

because

te

100.

te

8-year-od

te

s

condton?

department

ear.

afect

procedures

pterygomandbuar

o

te

D.

An

ts

o

may

surgca

Head

7

sows

poston,

to

te

and

te

a

emergency

severe

patent’s

sgty

ead-

eyeba

depressed,

366

C H A P T E R

te

7

pup

te

Head

s

dated

patent

nose,

te

relexes

tumor

s

oowng

nerves

A.

T rocear

B.

Ocuomotor

C.

Abducens

s

Optamc

Superor

e

man

s

te

ater

ace

o

on

te

oowng

durng

te

Entrapment

C.

Hyperacuss

D.

Tnntus

a

made.

te

cornea

sows

Wc

o

o

sort

nerve

A.

s

brougt

rom

A

as

CT

a

e

was

scan

pate

w

to

tree.

Ineror

Aurcuotempora

tvey,

ace

o

te

ang

te

(Fg.

most

emergency

patent

but

ead

7.5).

key

as

Wc

be

bate

no

te

te

opens

te

he

sde

o

neede

patent

comes

prousey

o

came

Frey

to

er

bopsy

te

ace

to

wen

te

se

syndrome

or

2

conrmed

undergoes

hree

cnc

tumor

monts

pyscan

tastes

or

(gustatory

Posteror

Arytenods

because

smes

er

sweatng)

hyroarytenods

Latera

An

ever

and

tonss

bout

o

a

wt

rsks

moter

durng

arteres

B.

Faca

C.

Lngua

Descendng

E.

Superor

55-year-od

open

event

need

order

oowng

wen

sensory

panc

A.

o

n

1

te

to

to

pars

te

tat

ntu-

prevent

o

musce

he

o

te

te

wt

s

a

sev-

rec-

dscusses

parents.

sgncant

bood

o

sows

patent’s

s

Wc

te

because

pyscan

pyscan

tere

most

s

and

surgery



oice

examnaton

hs

year

procedure.

o

to

te

te

te

he

rsk

o

oow-

tonss?

paatne

s

e

s

was

severe

tympanc

suddeny

patent

te

brougt

o

examnaton

te

Wc

asks

te

to

Pysca

te

man

pck

as

brougt

exudate.

because

punctured

te

arad

oowng

nnervaton

o

to

nerves

te

te

pan.

started

sows

was

to

ear

by

ear

s

a

t

accden-

wt

st

out

o

ear

nose.

n

s

mse.

responsbe

surace

an

oud

pck

pu

nner

emergency

He

membrane

or

te

te

tym-

membrane?

Gossoparyngea

B.

Aurcuar

branc

o

aca

C.

Aurcuar

branc

o

vagus

D.

Great

E.

Lngua

aurcuar

45-year-od

ment

10

years

gt

and

te

nerve

man

because

dagnosed

to

te

a

s

tyrod

tay

A

be

n

e

osng

bateray.

tat

n

o

paryngea

D.

ear

o

suppes

Ascendng

A

s

troat.

tonsts

beedng

Pysca

.

te

tonsectomy.

and

department

Fig.

boy

sore

patent’s

A.

112.

may

arway

rsk

njured

tat

batera

crcoarytenods

11-year-od

ng

s

o

a

musces

tere

te

s

s

a

process,

crcoarytenods

E.

benets

ood.

open

D.

ommends

resecton

key

Crcotyrods

ent

postopera-

o

normed

esoned,

undergo

tere

nerve

par

s

to

consentng

surgery

a

Wc

C.

parotd

most

arway?

B.

111.

•

are

A.

monts.

te

partcuar

patent

o

because

a

a

surgcay

te

scedued

durng

present

110.

patent

dagnoss

he

nerves

or

s

Durng

contros

aspyxaton.

a

eyeba

woman



nerve

bot

says

sows

man

tat

arway

hs

examnaton?

compcatons.

sweats

54-year-od

enarged

on

tumor.

wtout

Lngua

te

te

was

aveoar

tyrodectomy.

Deaness

gand

Faca

E.

a

45-year-od

sweng

D.

A

nerves

Bucca

C.

nerve

he

oowng

procedure?

te

pexus

and

te

te

B.

normed

nerve

o

durng

a

artery

cary

Wc

njured

afected?

ocuomotor

branc

Utrasound-guded

A

and

o

ang

pysca

Anosma

o

ead

ssure.

optamc

crbrorm

B.

E.

te

sympatetc

condtons

A.

A

Consensua

o

Wen

toward

arway.

conscousness.

racture

108.

nerve

dvson

57-year-od

o

droopy.

109.

and

te

nerve

t

orbta

s

pup

nerve

nasocary

oss

scan

key

d

te

meday.

CT

most

nerve

E.

department

upper

move

nerve

D.

A

A

superor

accompanyng

107.

te

to

rotates

norma.

te

Neck

and

asked

pup

are

n

and

o

wt

ago.

comes

trgemna

Pysca

touc

upper

o

p.

nvoved

by

to

te

excrucatng

te

A

emergency

aca

neuraga

examnaton

skn

between

treatment

njectng

(tc

te

s

nto

depart-

He

was

dououreux)

sows

opton

acoo

pan.

tenderness

ower

to

eyed

eson

t.

T o

te

reac

CHAPTER

te

nerve,

nserted

113.

te

o

most

te

key

oowng

need

to

be

over

openngs?

tracea.

key

Wc

o

te

oowng

vesses

was

cut?

Foramen

ovae

A.

Ineror

Foramen

spnosum

B.

Crcotyrod branc o te superor tyrod artery

C.

Inraorbta

C.

hyrodea

D.

Mandbuar

D.

Mdde

tyrod

E.

Foramen

E.

Juguar

arc

A

wegt

s

a

to

ods

to

o

pass

ost

te

nerves

s

Interna

key

branc

Externa

Gossoparyngea

D.

Hypogossa

E.

Recurrent

o

man

te

s

area

te

o

regarded

A.

Loose,

B.

Skn

C.

Gaea

as

te

areoar

department

pressure

s

to

no

sgns

te

Wc

o

a

emergency

e

oss

are

sows

o

te

wen

spped

o

he

o

tat

spreadng

oowng

to

118.

ayers

D.

A

E.

he

A

zone”?

and

are

a

pressure

te

a

o

a

20/mn.

cest

T o

x-ray

Hg,

An

te

ocated

border

o

te

o

te

no

to

emergency

sows

atra

te

cartage

s

to

br-

o

o

te

A.

by

te

B.

C.

Let

snus

D.

Rgt

Carotd

body

E.

Let

C.

hyrod

D.

Paratyrod

E.

Ineror

department

ng.

On

open

gency

ater

arrva,

ractured

an

gand

jaw,

tba

ang

te

broken

suddeny

s

rom

patent

racture.

traceotomy

beedng

119.

teet,

T o

a

s

perormed

rom

te

emergency

tree-story

scafod-

unconscous

aca

secure

occurred

to

an

aceratons,

arway,

were

te

wt

an

brsk

mdne

a

and

emer-

artera

ncson

key

was

perormed

n

te

CSF .

dagnoss?

torn,

wt

to

burstng

anteror

as

gand

a

resutng

njury

to

te

(o

te

e

o

a

pre-exst-

communcatng

trombus

to

cancer.

by

way

Batson).

o

he

a

and

rom

te

o

oow-

MRI

te

exam-

pevs

to

verte-

examnaton

ower

wen

patent’s

to

ago

nterna

Pysca

droops

because

story

years

CT

weakness

attempts

ospta

as

2

spread

souder

et.

te

He

tumor

as

ossa

nerves

rgt

are

most

accessory,

ypogossa

tan

te

tongue

protrude

t

te

patent

ponts

rom

s

key

and

afected?

rgt

ypogossa

A

eye

and

ter

and

et

trgemna,

and

rgt

ypogossa

accessory,

boy

or

an

s

rgt

brougt

rrtabty

examnaton

and

sows

optamoogst

evauaton.

te

es

n

An

te

oowng

o

te

gos-

nerves

accessory,

MRI

te

to

nant

consut

sows

te

and

emergency

nconsoabe

a

s

as

a

eson

at

pterygopaatne

structures

pregangonc

contans

axons?

gangon.

te

cryng.

dry

caed

ce bodes o te pregangonc axons o te

termnate

et

nerves

3-mont-od

Pysca

nerves

rgt

nerves

accessory

department

brougt

ntracrana

crce

consderabe

wen

te

brougt

cancer

rgt

aca,

vagus

was

an

aso

bood

pteron

eadaces.

ypogossa,

Carotd

man

n

prostate

pexus

te

vagus,

et

B.

59-year-od

most

noted

weeks

torn

s

crana

soparyngea

gangon

was

s

severa

Let accessory, rgt gossoparyngea, rgt vagus,

A.

A

o

te

oowng

and

te

gand

sows

or

equbrum

nerves

massage?

cervca

o

wound

game

artery

te

snus

and

ead

Rgt

massaged.

targeted

s

prostate

s

rgt

a

court

examnaton

mout. here are no oter sgncant ndngs. Wc

border

eve

s

s

te

te

te

cerebra

man

sow

tere

turns

and

pressure,

anteror

at

bood

a

tat

n

o

ven

pan

venous

et,

cardopumo-

bood

te

structures

Her

115/mn,

acute

musce

tyrod

oowng

s

patent’s

deep

sternocedomastod

superor

te

eadace.

puse

ECG

sows

reduce

pont

severe

mm

to

te

dagnoss

sows

n

vens

emergency

basketba

ack

necton

resuted

cavernous

posteror

bra

comes

o

o

te

3-cm

ead

s

juguar

te

Pysca

puncture

o

racture

cerebra

remova

te

menngea

aneurysm

back

to

vascuature

63-year-od

o

trunk

ematoma

njury

artery

norma

ematoma

te

he

ng

conscous-

wtn

scap,

C.

ng

woman

a

on

A

njury

o

sgns

mdde

s

an

oowng

epdura

anteror

demonstrates

umbar

no

te

here

and

ayer

because

events.

Wc

A.

ayer

190/100

respratons

te

nerve

aponeurotca

45-year-od

o

Wc

te

brougt

dzzness.

scan

A

sowed

natons

Percranum

a

as

zone”

CT

adjacent

ead

vta

“danger

Subcutaneous

nary

s

He

eyeds.

E.

aton

nerve

aryngea

A

s

mparment.

rom

ematoma.

tyrocervca

ven

coapsng

patent

scap

earer.

oowng

n

examnaton

D.

A

aryngea

brougt

Hs

“danger

te

aspra-

te

s

nerve

s

pavement.

n

te

on

tat

superor

ttng

drowsness.

Pysca

causng

o

severe

memory

o

artery

man

ater

o

branc

connectng

because

and

voca

ma

department

B.

e

ormed

te

tyrod

21-year-od

sows

as

nerve

ater

mts.

patent

patent

rom

s

to

A

nerve

aryngea

55-year-od

wet

te

he

arynx

Se

scedued

surgery,

arynx,

superor

department

or

s

117.

njured?

C.

on

because

ntoerance.

and

test.

te

te

pyscan

arway. Wc

o

branc

o

nto

te

B.

ness

eat

swaow

sensaton

nto

most

and

te

Foowng

er

entrance

quds

to

ypertyrodsm

tyrodectomy.

key

A

comes

darrea,

wt

most

A.

oramen

woman

oss,

unabe

ton

oramen

magnum

32-year-od

ave

116.

te

most

367

Neck

B.

dagnosed

115.

w

wc

and

A.

o

114.

neede

troug

Head

7

rgt

or

te

ur-

neura

bers

tat

Wc

neura

ce

o

bod-

368

C H A P T E R

120.

7

Head

A.

SCG

B.

Ednger-Westpa

C.

Superor

D.

Ineror

E.

Nuceus

A

te

s

as

rgt

38°C

savatory

says

a

woman

as

because

o

te

age

o

s

te

oowng

A.

sent

to

A

C.

Superor

D.

Ascendng

E.

branc

Descendng

severe

o

he

or

may

bran.

key

A.

ror

n

acne.

ocazed

mm

s

procedure,

rsk

o

and

te

cary

A.

he

dran-

124.

njury?

examnaton

on

te

wc

to

sows

er

warned

sweng

can

not

to

w

to

optamc

to

ven,

a

Dorsa

Faca

gea

E.

nasa

122.

A

ven

ven

eye.

to

to

because

he

ookng

cavernous

supraorbta

ven,

ten

examnaton

o

ven

ven

man

o

te

superor

ven

cavernous

a

patent

to

to

maxary

aca

emssary

73-year-od

ment

ven

optamc

T ransverse

to

an

to

to

to

to

te

e

sde

rgt

as

eye

te

structures

cause

tese

125.

A.

Subaracnod

B.

Centra

artery

C.

Centra

ven

D.

Optc

E.

Cary

w

ed

s

o

o

te

te

casm

gangon

retna

o

te

nto

te

o

o

vson.

were

te

scera

eyeba.

te

o

type

venous

o

o

sows

system.

te

o

In

he

e

s

venous

a

norma

oowng

qucky

or

a

spaces?

to

sent

urter

compete

he

oowng

a

to

te

evaua-

daton

treatment

pace

cnca

sunt

team

or

condtons

s

con-

most

pcture?

troug

aracnod

granua-

system

cerebra

te

s

admtted

ead

absorpton

nto

patent

weter

Wc

ts

aqueduct

atera

(o

aperture

Syvus)

(o

Luscka)

o

ventrce

Congenta

A

ten

absence

o

54-year-od

ater

te

man

beng

patent

as

as

droopng,

o

te

csterna

magna

nterventrcuar

oramna

(o

a

no

s

brougt

struck

GCS

by

o

obvous

Arm

a

10

s

te

and

sgns

weakness,

examnaton

to

movng

o

stabe

A

CT

arrva,

sgns.

and

dicutes

negatve.

depart-

On

vta

beedng

Speec

aso

emergency

vece.

a

he

Faca

and

scan

Tme

o

te

ead sows a racture troug te crsta ga o te ante-

ven

o

n

and

eye.

depart-

s

rgt

te

dicuty

Pysca

perorbta

o

te

ead

ts

contan

patent?

a

oowng

Mdde

s

te

most

menngea

B.

Great

C.

Superor

D.

Stragt

E.

Superor

cerebra

ven

sagtta

key

source

o

beedng?

artery

(o

Gaen)

snus

snus

optamc

ven

edema,

sows

te

trom-

A

126–150

55-year-od

o

woman

deteroratng

ton

eye

to

retna

and

Cosure

A.

rgt

key

space

to

ourt

(FAST)

tempora

vson

sweng

n

he

E.

te

menn-

emergency

o

sows

most

o

wc

MRI

D.

ment

snus

te

MRI

symptoms

perpera

unt

vsua

Monro)

ten

trombopebts o te cavernous snus. Wc o

to

surgery.

te

Questions

bus

propery

ange

nto

evauatng

Occuson

126.

An

dran

ventrcuar

Bockage

te

optamoscope.

o

A

o

and

ror crana ossa, resutng n sow, oca beedng. Wc

oss

wt

oss

oss

repeatedy .

optamoogst

ead.

MRI

entre

C.

snus

mdde

superca

cavernous

comes

says

ten

an

vson

pan

ange

an

B.

cavernous

ven,

te

urnture

because

no

sac

to

snus

notce

as

body

ts

mted atera movement, and macuar edema troug

oowng

he

tons

snus

to

progressve

rgt

petrosa

cavernous

ven,

or

Lack

supe-

ven,

pyscan

patent

camber

enarged

te

A.

most

to

te

A 2-mont-od gr s brougt to te pyscan because

patent

neror

D.

Vtreous

Lacrma

nose.

as

spread

patways

anguar

ten

ven

o

to

drecty

E.

key

necton?

trbutary

ven,

sde

and

nlamed

o

because

snus

C.

body ,

D.

o

pyscan

not

Posteror

te

ddn’ t

nto

rdoscera

Irdoscera

sder

te

oowng

spread

optamc

neror

te

currenty

antbotcs

arge,

te

venous

does

Pup

o

to

he

sgncant

reerred

C.

o

eson

sows

s

B.

artery

necton

o

at

ton.

to

actuay

a

wc

comes

vson.

bumpng

wc

utrasound.

ncson

s

eye, te aqueous lud s secreted by te epteum o te

eat

sows

sde,

snus

Se

to

test

umor

are

Hg.

unabe

rgt

wt

or

to

temperature

examnaton

Pysca

gven

te

e

tat

started

man

dagnosed wt open ange gaucoma, were te aqueous

artery

comes

Retromandbuar

to

and

te

pan

artery

panu

an

Wc

resut

Nasa

B.

n

says

patent

artery

paatne

at

wt

ospta

gr

was

pck

resut

he

respratons

110/84

on

ts

paryngea

and

patent

press

s

greatest

aca

aca

promnent

at

and

Her

80/mn,

ospta

aryngea

17-year-od

o

s

days.

conrmed

s

pan.

because

artery

B.

A

2

Pysca

Durng

pyscan

ntensed

(qunsy)

te

arteres

te

swaowng

pan.

eson.

Lngua

to

pressure

abscess

67-year-od

dicuty

e

troat

past

puse

on

subsequenty

patent

but

te

bood

pan

pertonsar

was

ace

over

A

ed

comes

worsenng

du

sde

and

se

nuceus

nuceus

ambguus

(100.4°F),

16/mn,

nuceus

savatory

progressvey

started

Neck

123.

22-year-od

o

121.

and

tests

and

ensure

ments,

s

wtout

gobe,

te

extraocuar

u

and

oowng

patent

te

a

comes

vson.

range

o

retna,

eye

abe

to

upward

must

be

abduct

or

te

pyscan

and

te

unctonng

te

eye

downward

are

smootness

bateray.

because

examna-

cornea

movements

moton,

syncroncty

nerves

to

Optamoogc

o

o

Wc

move-

o

propery

wtout

eac

observed



dicuty

devaton?

te

te

and

CHAPTER

A.

Superor

nerve,

dvson

abducens

o

ocuomotor,

optamc

A

nerve

B.

T rocear nerve, abducens nerve, nasocary nerve

C.

Ineror

dvson

o

ocuomotor,

Ocuomotor

E.

Superor

A

A.

he

no

man

because

patent

scan

a

evdence

wc

te

mted

o

as

sows

comes

a

ong

o

to

trocear,

most

In

growng

o

to

past

3

and

s

Wc

o

a

A

arynx

te

caracterzed

contan

depart-

te

tumor

131.

monts.

smokng.

n

addton,

s

dranage.

key

emergency

te

growt

metastass.

s

te

or

story

cancerous

tumor

s

ocuomotor,

oarseness

ympatc

ocatons

o

nerves

nerves

45-year-od

ment

optamc

dvson

abducens

127.

and

CT

by

128.

Anteror

B.

Interarytenod

C.

Laryngea

D.

Crcotyrod

E.

Mdde

A

commssure

n

very

are

sows

te

neck.

o

as

Fracture

B.

A

Leakage

A

tear

te

E.

o

a

A

“berry”

man

resecton

o

Postoperatvey,

psatera

te

parynx

wen

uvua

te

motor

130.

te

w

suppy

et

te

comes

to

n

patent

A.

Nuceus

B.

T rgemna

C.

Dorsa

D.

Nuceus

E.

Superor

wa

ven

sows

patent?

artery

by

to

cot

133.

te

te

s

et

no

gag

a

gag

was

and

neura

sced-

wen

et

o

ce

voca

te

motor

he

C.

Faca

V estbuococear

nerve

Gossoparyngea

nerve

65-year-od

ead

ave

any

te

pan

as

cerebra

Intracerebra

D.

Subdura

E.

Beedng

jaws

te

most

te

mandbe?

coson.

aceratons

and

Pysca

abrasons

examnaton

n

te

ower

boxng

and

and

tested.

severa

n

and

ace.

porton

because

he

an

gr

to

and

te

due

key

to

depart-

te

acc-

and

dd

Currenty,

Pysca

poor

ead

pys-

sows

eakage

cerebra

most

te

an

rom

emspere.

key

dagnoss?

bran

parencyma

system

pyscan

He

o

says

ees

examnaton

n

n

oowng

protruson

and

o

pan

sows

openng

strengt

te

because

e

o

te

openng

musces

s

depressng

temporas

ad

er

an

te

and

he

no

here

pyscan

about

o

pyscan

toot

uncompcated

devery.

Wc

rst?

to

growt

deays.

norms

o

jaw

brougt

moter

ventrcuar

te

Pysca

uneventu

appear

to

matc.

sow

deveopment.

expected

tme.

worsenng.

asymmetry

o

s

o

deveopmenta

teet

ad

urnture

tat

o

nto

Wc

mportant

and

te

symmetry

Patysma

sows

jaw

a

6-mont-od

moter

He

conuson

cerebra

movement.

te

and

at

rgt

s

comes

E.

motor

most

emergency

ead.

probaby

te

te

man

pterygod

a

a

cerebear

beedng

strengt

are

te

scan

beedng

nto

ater

jaw

pan

CT

Masseter

durng

w

tat

wt

beedng

Strengt

nancy

accdent,

beedng

27-year-od

o

vece

A

over

Epdura

A

metus

sows

superor

movng

menta

oowng

C.

opment.

njures

ven

B.

pan

ead

nerves

progressvey

trombus

Subaracnod

moter

aca

been

A.

A

dabetes

te

te

s

we

sows

te

to

ttng

sgncant

coordnaton.

ment

sustanng

ater

comes

bump

not

A 65-year-od man s brougt to te emergency depart-

ater

man

weeks

o

o

emergency

unconscous

nerve

Meda

vagus

s

musces

nerve

D.

134.

o

nerve

nerve

C.

te

by

E.

3

o

te

ound

vascuar

D.

A

to

beng

oowng

pterygod

musces?

ganga

aveoar

oowng

ematoma?

Anteror

nuceus

neror

te

te

Latera

nuceus

te

story

produced

B.

or

o

scan

cerebra

oowng

ambguus

or

Abducens

a

CT

A.

bodes

neror

brougt

ater

as

A

cord

sotarus

motor

T rocear

jaws.

resuted

s

son

a

o

by

B.

decreased

atoug

relex

Wc

durng

cana.

stmuated.

te

Wc

a

relex

stmuated,

and

parayzed

or

juguar

ad

ematoma

afected

jaw

pyscan

s

patent

A.

a

ven

a

he

patent

Wc

entrance

te

Wc

man

by

ypertenson.

ntracrana

njury

ts

ome.

ca

oowng

menngea

at

carotd

wa

rgt

mdne.

te

mdde

as

upward

contan

o

ts

vascuar

64-year-od

examnaton

atrum

tumor

te

te

o

snus

nterna

paryngea

to

toward

te

cerebra

paryngea

rgt

structures

a

moved

devated

drted

te

n

vta

examnaton

and

A

denta

aneurysm

sagtta

n

o

s

Paatogossus

ment

Hs

movement

perormed

wt

bone

te

passve

occurred

depart-

eadaces.

oterwse

Wc

o

o

emergency

Pysca

s

brances

superor

te

key

pteron

132.

severe

on

tempora

55-year-od

ued

CSF .

superor

Occuson

te

mts.

pan

puncture

te

te

o

te

generated

129.

and

most

o

to

Styoyod

E.

be

gaments

cord

(100.4°F),

norma

n

ruptured

wtn

D.

38°C

bood

voca

progressvey

umbar

A.

te

comes

stfness

A

condtons

C.

s

wtn

neck

traces

o

o

D.

artery.

tese

gament

man

because

sgns

voca

Myoyod

sma

od

segment

temperature

te

Hyogossus

C.

te

ventrce

55-year-od

ment

o

tat

orgn.

369

Neck

Genoyod

and

oowng

wt

sows

ts

B.

at

wt

area

at

department

caracterstcs?

A.

scan

and

woud most key be parayzed as a resut o ts njury?

trocear,

abducens

D.

CT

njured

Head

7

te

te

s

no

by

preg-

story

reassures

expected

oowng

er

deve-

te

age

or

teet

are

370

C H A P T E R

A.

7

Head

Superor

and

meda

Neck

ncsor

teet

at

8

to

12

monts

o

138.

age

B.

meda

ncsor

teet

at

6

to

10

monts

o

snus

age

Superor

atera

ncsor

teet

at

8

to

10

monts

o

atera

ncsor

teet

at

12

to

14

monts

o

be

age

E.

135.

A

Frst

moar

severe

eadaces

rngng

and

n

s

patent

o

te

s

owng

sows

troug

structures

he

cocea

B.

he

nterna

C.

he

sgmod

D.

he

superor

E.

he

te

A

adtus

aca

ower

n

jaw.

te

are

a

venous

present

s

patent

te

key

A

mdde

Wc

be

as

B.

ear

o

o-

139.

cana

s

sustanng

ossa.

and

tongue.

Wc

a

o

te

and

pan

s

a

buet

sensaton

n

savary

s

te

te

oss

te

he

o

A

54-year-od

B.

Receptors

absent

C.

he

te

D.

E.

n

or

te

was

transected

dsta

to

te

ot,

preerred

pan,

and

A.

Into

te

ante-

B.

been

orgn

ered

by

ngua

aryngea

nerve

was

obvousy

n

and

sev-

A

he

was

njured

at

ts

orgn

near

te

are

ovae

a

sows

determne

puncture

s

woud

neck

and

te

a

eevated.

Papedema

B.

Separaton

C.

he

ora

and

Wc

o

neck

patent

o

be

Pysca

was

puncture

necton.

perormed

o

ndcate

te

an

examna-

tenderness

wt

te

dagnosed

wt

s

However,

wen

oowng

eevated

pars

optca

retnae

D.

Obvous

E.

Pttng

opacty

or

exbts

emorrage

brances

o

te

compresson

rom

atera

swoen,

ens

te

dsc

to

te

(upper

o

drect

A

emergency

motor

scan

nserton

vece

mutpe

scera

CT

te

relex

pup

te

a

te

by

Anteror

Genoyod

E.

Genogossus

o

to

area

ac-

contans

o

te

suture.

ace

Wat

anestetze

o

sweng

a

ture

o

sac

oramen

eyed

te

and

and

eyed

aso

aso

and

aso

troug

nto

beneat

nto

te

s

mts.

te

to

te

cn

Pysca

skn

tendneus

as

woud

most

depart-

protrudng

pan.

Vta

examnaton

overyng

he

te

wound

sows

submenta

s

stopped.

key

na.

sgns

be

nlamed

Wc

te

ast

o

to

na?

te

dgastrc

comes

sde

parotd

resecton.

sows

anuus

a

moderate

mdne.

patent’s

te

septum

emergency

on

beedng

te

toward

orbta

ateray

te

te

o

te

ssure

o

to

te

er

utrasound-guded

tumor

deepy

between

ees

woman

on

An

te

acrma

comes

te

magnant

or

regon

te

bey

55-year-od

rms

mbc

muscuature

musces

D.

examnaton

optc

to

but

oowng

ued

o

te

conjunctva

aso

e

norma

C.

A

te

on

penetratng

monts.

centras

retna

says

Myoyod

pressure?

te

orbta

man

B.

to

o

sows

gass.

ten

upper

ang

umbar

anteror

on

oramen

and

superor

Patysma

pres-

n

posterory

penetrated

141.

te

oss

cornea

n

and

neede

and

papebra

A.

condtons

CSF

or

or

te

be

CSF

and

rontozygomatc

supraorbta

to

perormed

serrata

ovea

meda

not

key

A.

te

he

atgue.

umbar

etoogy

soud

most

and

stfness

movement.

menngts

sure

ever

te

ste

apex

te

wtn

na

and

o

com-

snus?

carunce

patent

trange

passve

te

ater

ment

because

eyed

broken

at

bubar

45-year-od

ment

buet

nerve

nerve

papebra

abducton

examnaton

o

ossa

Drecty

A 12-year-od boy s brougt to te emergency depart-

ton

te

hroug

and

140.

superor

te

D.

are

njured

consensua

o

brougt

scera

atera

Into

E.

as

cav-

key

ateray

superor

nvoved

contents

te

Into

C.

tongue

nerve



te

s

an

most

cavernous

and

s

nraorbta

te

key

pressure

w

but

sows

njury?

orbta

cod,

patent’s

te

beng

upper

racture

orbta

o

parynx

he

he

te

ragments

te

tympan

gossoparyngea

oramen

137.

nerve

corda

ead

examnaton

te

te

man

Pysca

n

a

o

ater

acrma

aca

te

te

accommodaton

oss

dagnoss?

A.

o

parayss

uncton

most

cavernous

relex

Ipsatera

te

wound

unatera

and

oowng

n

emergency

eadaces

oowng

wtn

o

Ipsatera

sows

emergency

wound

sows

here

T aste

te

to

buet

examnaton

pressure,

te

brougt

ptoss

E.

s

man

o

downward

D.

sma

regon

te

pysca

gaze

oss

department

bub

mastod

to

Batera

eratons

te

scan

as

te

wt

sde

pupary

snus

o

patent

o

suspected

Compete

C.

cavty,

te

to

eyed)

scan

afected?

semcrcuar

afected

he

CT

brougt

dagnosed

CT

Wc

Inabty

eaty

mts.

cancer.

loor.

aso

oterwse

norma

o

A.

o

coson.

antrum

Pysca

ntact.

age

because

he

A

durng

was

artery

juguar

ater

o

most

atera

carotd

ad

he

wtn

n

o

pyscan

He

story

bony

w

monts

te

pan.

tumor

te

nratempora

⅔

8

to

nerve

temperature,

ror

are

and

52-year-od

department

to

ear

amy

A.

6

(tnntus).

sgns

no

ead

at

comes

and

ears

vta

as

nvadng

136.

toot

man

stabe.

snus.

presson

56-year-od

s

beng

aneurysm o te nterna carotd artery wtn

ernous

Ineror

woman

ater

tromboss.

oterwse

age

D.

65-year-od

department

Ineror

C.

A

tumor.

he

Wc

n

past

bopsy

patent

o

because

te

surgery,

weakness

p.

or

neede

Foowng

marked

ower

pyscan

ace

te

te

s

2

con-

sced-

pysca

muscua-

oowng

CHAPTER

nerves

to

most

ts

Margna

B.

Zygomatc

C.

Mandbuar

D.

Bucca

branc

Bucca

nerve

A

past

4

o

te

te

o

ead

oramna

s

trgemna

brougt

a

day

a

to

nerve

du

te

o

sows

btemporay.

cranoparyngoma

nvovng

oowng

s

te

te

most

eyes

sma

atera

wa

s

n

te

oactory

te

caosum

Vta

most

o

o

a

ebear

MRI

o

te

MRI

Car

C.

Smt-Lem-Optz

D.

Sczencepay

E.

Exencepay

pouc

147.

pates

A

ment

tat

te

Wc

ead

o

neona-

norma

camber

tracts,

and

te

audtory

ta

or

boy

because

abnorma

he

deaness.

Inecton

B.

Faure

s

C.

Faure

pres-

tat

te

o

s

and

D.

Exencepay

because

o

te

E.

Menngoencepaocee

been

he

devery

sows

patent

wt

an

te

o

te

oowng

A.

Squamous

B.

Petrous

Squamous

D.

Spenod

E.

Etmod

A

nos.

bran

part

o

term

CT

and

s

o

by

norma

Pysca

scan

o

ventrcuar

most

te

course

was

Cytomegaovrus

149.

bone,

oped

eavng

and

te

ss

exencepay

te

embryoogca

s

cause

T oxopasmoss

B.

Faure

o

vaut

o

te

maormed

A.

A

newborn

he

made.

o

te

boy’s

bran

Wat

ts

wt

sows

sku

te

he

s

care

most

o

te

o

s

sows

a

Cooboma

Anoptama

neura

wt

bony

congen-

ead

arc

to

rst

to

ts

orm

paryngea

aurcuar

o

ocks

rst

paryngea

te

emergency

to

tey

was

he

An

ound

not

wte

vaccnated

patent

as

not

optamoscopc

cataract.

ts

Wc

o

condton?

vrus

to

cose

artery

(CMV)

necton

transerred

ndngs

C.

common

or

te

ocuar

are

bot

o

to

n

te

te

ens

pedatrc

aed

adopted

story.

mutaton

B.

te

sows

and

arc

congenta

condtons

undeve-

dagno-

brt.

amy

A.

150.

part

depart-

respond

necton

parents

ter

oowng

examnaton

condton?

cepac

te

o

te

regon.

as

because

patent’s

o

patent

rubea

yaod

nant

unt

aware

wt

ssure

a

A

o

necton

cosure

o

poyydram-

absence

exposed.

s

a

T oxopasmoss

boy.

Wc

ead

can

o

because

responsbe

E.

afected?

stborn

compcated

s

D.

system. Wc

newborn

examnaton

sows

Persstent

sve

a

not

te

dagnosed

brougt

snce

C.

bone

devers

parent’s

Corod

sows

s

he

Inecton

bone

does

o

porton

parents’

eyes.

osptazed

oowng

not

woman

s

B.

bone

occpta

by

A.

ead

emergency

e

membranous

paryngea

boy

vagna

te

te

porton

dorsa

examnaton

commony

tempora

3-mont-od

examnaton

bone

Pysca

tube

at

tempora

part

nasa

o

o

A

unt

bone

28-year-od

prenata

ead.

bones

part

C.

born

care

menngoydroencepao-

compcatons.

enarged

protruson

o

was

no

neonata

te

cer-

vrus

dorsa

second

s

cee.

A

department

te

spne

o

te

magnum.

paryngea

te

n

to

rubea

deveopment

o

patces

syndrome

wt

te

MRI

dagnoss?

oowng

Abnorma

cet

148.

brougt

te

Faure

Sczencepay

s

was

E.

C.

boy

o

to

te

D.

dagnoss?

dagnosed

An

and

enarged

cet

corpus

Smt-Lem-Optz

beng

key

MRI

o

second

te

B.

1-day-od

an

troug

cystca.

notced

An

patent

wt

o

Hooprosencepay

ater

emergency

rrtabty,

sows

oramen

brougt

Wc

A.

A

te

condton?

A.

oowng

to

syndrome

parents

stmu.

mts.

te

s

te

deveopment

vesce;

sows

sku

structures

maormaton

1-year-od

abyrnts.

teencepac

o

oactory

te

most

Hooprosencepay

pyscan

nasa

te

B.

cause

II

te

371

Neck

a cauda dspacement o

troug

s

o

eedng,

extendng

A.

nterventrcuar

wtn

a

verms

oowng

brougt

bda

occupyng

dencepaon

are

sac

spna

te

key

aar

a

bones

cerebear

poor

suprasear

Ratke

te

te

snge

ypopastc.

key

o

to

sows

An

bubs,

o

sma

as

tat

An

te

o

examnaton

ead and neck sows

tuberas

te

a

s

o

te

dencepaon

sgns

and

mdne.

are

o

pars

because

Pysca

and

n

and

abuse

gr

or

to

brougt

used,

ent

o

deveopment

examnaton

are

porton

acoo

6-mont-od

dentyng

Monro)

examnaton.

Pysca

a

deveopment

gr

Materna

A

deect

dspacement

department

emergency

eadace

examnaton

mted

deveopment

Abnorma

1-day-od

Cauda

seepness.

prmary

te

(o

te

Osscaton

D.

E.

146.

te

deveopment

Abnorma

orm

145.

o

Abnorma

te

aca

tumor?

C.

te

o

Pysca

ed

sows

Abnorma

ta

o

C.

ead

turcca,

Persstence

E.

procedure

aca

o

B.

A

o

because

A.

D.

te

aca

dvson

s

Wc

ts

durng

branc

o

boy

vsua

sea

space.

144.

branc

monts.

patent’s

njured

mandbuar

15-year-od

department

143.

key

symptom?

A.

E.

142.

was

cause

Head

7

and

Genetc

te

can

PAX6

expan

to

tey

study

gene.

te

nten-

deveop.

o

are

te

Wc

pysca

newborn?

Cycopa

D.

Apaka

E.

Mcroptama

and

anrda

A 2-mont-od gr s brougt to te pyscan because

o

aca

sma

asymmetry.

and

lat

Pysca

maxary,

examnaton

tempora,

and

sows

a

zygomatc

372

C H A P T E R

bones,

on

Head

anota,

te

key

7

rgt

and

and

sde.

a

Neck

dermod

Wc

o

tumor

te

n

te

oowng

s

eyeba

te

A.

ourt

dagnoss?

A.

Hemaca

B.

T reacer

mcrosoma

C.

Robn

D.

DGeorge

E.

V eocardoaca

Cons

Faure

most

o

B.

CMV

C.

Faure

Questions

A

syndrome

syndrome

155.

o

D.

Faure

E.

Abnorma

A

because

o

born

Gana

1

n

mont

set

ears,

152.

abnorma

ago.

and

sows

a

and

wdt

an

sowed

te

eart

te

oowng

eatures.

eye

nose

tp.

ypopasa

a

s

he

a

pyscan

patent

Unted

sows

o

basc

was

o

te

Hg.

an

cose

n

are

rgt

ead

lud

coecton

Wc

to

o

most

o

asca

deectve?

te

te

posteror

key

ocated

te

days

s

tons

CT

Hs

102/mn,

pressure

s

and

scan

o

o

te

sows

neck

space

he

o

extend-

te

ayers?

A.

Between

aar

and

prevertebra

B.

Between

aar

and

pretracea

C.

Between

pretracea

2

D.

Between

buccoparyngea

and

aar

D.

PAX

6

E.

Between

buccoparyngea

and

prevertebra

E.

47XXY

156.

boy

as

examnaton

ower

eyeds,

deveopment

A.

Second

hrd

D.

Fourt

E.

Sxt

n

ton

deormed

wc

tese

te

o

bones

ssures,

externa

te

te

o

te

deects

ears.

paryngea

man-

ace,

o

mn,

te

wt

most

o

A.

arc

wt

s

ever.

Hs

parents

say

payground

suspected.

stf

A

Wc

te

day

and

scan

te

to

te

emergency

vaccnaton

tat

te

neck

CT

o

brougt

o

beore.

Kerng

te

ead

oowng

story

boy

e

s

Pysca

sgn.

s

up

a

to

157.

tmes

examna-

Menngts

sows

snuses

depart-

severa

snus

present

s

oowng

s

An

Supratrocear

D.

Ineror

E.

Optc

A

67-year-od

o

progressve

s

background

probems”

s

ocaton

bone

T empora

B.

Fronta

C.

Mastod

process

D.

Externa

occpta

E.

V ertex

A

newborn

mates.

s

nant

Pysca

deectve

num.

ng

A

and

ound

tssue

meroencepay.

cause

o

to

ave

examnaton

te

bran

rudmentary

neura

key

s

ces

are

sows

branstem

o

A

te

condton?

and

bran

tat

protrudng

present.

Wc

ts

s

severe

te

rom

some

dagnoss

oowng

cavara

te

cra-

uncton-

s

s

abnor-

made

te

o

most

158.

A

rgt

Pysca

te

ead

s

25/

rgt

eye

sows

orbt.

an

Wc

vunerabe

wt

we

o

swaowng.

te

s

he

pyscan

n

s

patent

current

says

o

tat

wen

e

as

ncudes

examnaton

te

tunng

because

ear

medcaton

pysca

te

rgt

oowng

ork

to

be

s

te

te

paced

man

sows

A

most

protuberance

ead

comes

or

key

to

te

x-ray

o

3

o

te

groove.

afected

te

past

oarseness

atera

traceoesopagea

nerves

te

bone

cewng

examnaton

te

to

bone

55-year-od

pan

s

or

A.

ces

Hg.

o

are

conducton?

snus

etmoda

te

te

earng

Durng

snus

etmoda

o

o

perormed. Wc

Maxary

Mdde

mm

partcuary

nose.

Spenod

Posteror

128/79

comes

and

asprn.

test

key

test

man

dicuty

C.

E.

s

respratons

movement

x-ray

emergency

temperature

aveoar

B.

D.

s

te

Hs

56/mn,

mted

nerves

to

gt.

njury?

Fronta

to

brougt

racture

C.

Rnne

snus

o

prevertebra

Inraorbta

most

Fronta

s

pressure

sows

bow-out

ow-dose

age?

A.

bood

and

street

puse

B.

“eart

ts

a

enoptamos.

type

tere

nec-

at

and

te

ts

boy

(98.6°F),

neror

symptoms?

man

ater

examnaton

Abnorma

arces

24-year-od

37°C

arc

sows

ton.

o

papebra

o

A

department

arc

Hs

te

ypopasa

mandbe.

arc

1-year-od

date.

sows

sma

arc

C.

ment

and

o

caused

Frst

B.

A

notceaby

underdeveopment

downward-santng

key

a

s

oowng

PAX

3-day-od

te

necton

C.

(SHH)

mm

droong,

sweng

retroparyngea

wc

tem-

respra-

140/79

excessve

medastnum.

between

emergency

accompaned

swaowng.

sows

paatne

A

to

4

puse

bood

parynx.

n

or

dicuty

and

deveop

brougt

ever

examnaton

posteror

to

Sonc

A

to

ormaton

(104°F),

25/mn,

Pysca

enarged

ng

s

o

and

40°C

arc

crest

man

because

pan

s

neura

B.

Hedgeog

te

dvertcuum

22q11

dbe,

154.

ypopysea

neura

rgt

metaboc

deect.

te

cet

ecocardogram

septa

tons

ow-

ace,

troat

perature

States

sma,

ong

x-ray

a

An

te

te

An

and

ventrcuar

genes

to

openngs,

ypocacema.

sows

to

examnaton

o

to

A.

Pysca

153.

aca

enarged

tymc

brougt

mmgrated

Pysca

sort

paate,

pane

s

te

55-year-od

by

151–175

gr

neuropore

deveop

syndrome

sequence

3-mont-od

rostra

necton

department

151.

te

week

oice

voce

neck

Wc

by

te

because

monts.

and

sows

o

te

mass?

o

Pysca

pan

a

on

mass

at

oowng

CHAPTER

159.

A.

Recurrent

B.

Interna

C.

Vagus

D.

Externa

E.

Prenc

A

163.

aryngea

34-year-od

motorbke.

mm

he

eratons

venous

ater

puse

cerebra

D.

Superor

sagtta

E.

Supraorbta

Hs

o

s

s

Supratrocear

Inraorbta

become

coud

most

transmsson

underyng

164.

dura

mm

n

Anteror

A

s

be

to

a

MRI

Wc

o

compressed

and

te

ead

PCA

puse

s

pressure

sows

and

oowng

te

A.

scemc

bood

te

te

by

emergency

(99.32°F),

o

between

te

transent

37.4°C

25/mn,

An

regon

o

an

supe-

nerves

aneurysm?

165.

7.6).

An

bone.

Inraorbta

C.

Anteror

D.

Fronta

E.

Optc

A

34-year-od

department

rgt

E.

Optc

te

eye

sows

orbt.

s

a

ater

unabe

bow-out

Wc

njured

beng

Pysca

or

o

B.

Meda

and

C.

Meda

rectus

D.

Meda

rectus

E.

Ineror

ater

er

o

er

ead

te

most

gr

beng

te

orbta

et

x-ray

s

regon

eye

o

meda

musces

sows

te

wa

vece

eye

An

MRI

te

most

a

key

Ineror

B.

Meda

C.

Ineror

s

brougt

n

te

to

eye

Se

te

as

examnaton

be

turned

bow-out

o

a

tenns

vertca

sows

upward.

racture

te

emergency

o

te

oowng

and

tat

An

most

patent

and

and

neror

o

te

te

says

tat

pup

ead

common

musce(s)

te

s

rectus

and

neror

neror

obque

te

gt

mts.

swoen

racture

orbt.

be

sows

to

n

o

pan,

a

an

Wc

o

anestetzed?

s

a

at

te

a

emergency

motor

was

coson

n

A.

As

t

te

perces

tentora

te

dura

o

notc

At

te

cavernous

C.

At

te

sea

snus

turcca

dur-

te

o

(are)

njured?

and

to

and

a

severe

s

se

te

se

pup

s

street

norma

sows

nto

tat

ocaton

B.

wa

o-

or

emergency

a

dscoored

key

aganst

te

o

te

n

wtn

brougt

torsona

te

to

nvoved

durng

eye

sows

wen

s

depart-

x-ray

te

responsbe

patent’s

njected

s

beng

key

ba

a

te

obque

wt

dorsum

o

te

se

t

er

dasboard.

unabe

te

to

severed

te

poston.

nerve.

ts

rgt

Pysca

depress

adducted

wc

vece

passenger

Wat

nerve

w

s

be

njured?

ead

o

most

Pysca

te

eye?

ead

rect

superor

practce.

Wc

A.

and

t

cannot

sows

orbt.

o

An

oowng

neror

Pysca

eye

racture

et

te

te

rectus

tenns

dpopa.

abduct.

te

o

sows

o

s

are

rectus

16-year-od

ng

n

te

trapped?

Latera

ment

to

te

A.

A

struck

examnaton

te

he

examnaton

ba.

be

over

Wc

njured

sgns

woman

ater

Vagus

a

eye.

emergency

nose.

etmoda

Ocuomotor

by

esons

to

te

te

Optamc

D.

department

to

o

brougt

was

o

nerves

B.

coson.

emergency

to

s

vta

souton

C.

te

key

e

x-ray

oowng

ceekbone

to

ras

rgt

vrus

Because

n

brougt

te

examnaton

eye.

Abducens

s

brougt

erpetc

man

Hs

T rocear

woman

obque

etmoda

ater

B.

36-year-od

neror

etmoda

A.

A

te

22-year-od

anestetc

brougt

are

artery.

key

Posteror

E.

te

s

Hg.

te

cerebear

D.

department

snus

o

s

most

C.

wounds

and

373

Neck

Nasocary

aca

epsode

s

B.

Pysca

temperature

170/100

nerves

A.

ac-

rectus,

panu

on

res-

ven

an

and

100/70

s

vens

man

a

sows

transmsson

rgt

ater

nose

owng

man

wt

97/mn,

vens

te

s

te

neror

and

rectus

Hs

mutpe

necton

to

of

ven

respratons

most

rectus,

36-year-od

o

vens

65-year-od

aneurysm

A

(Fg.

Anteror

97/mn,

Ineror

emet.

pressure

oowng

scap

a

sows

I

emergency

ang

wearng

bood

bone.

te

snuses?

C.

w

njury

not

and

te

Dpoc

ror

to

(98.78°F),

patway

o

Supratrocear

s

was

te

B.

A

ead

ronta

o

a

vens

brougt

examnaton

A.

attack.

162.

te

wc

department

161.

o

patent

Pysca

te

s

37.1°C

provde

rom

Meda

E.

department

25/mn,

over

nected,

key

s

are

Hg.

man

because

temperature

pratons

D.

examnaton

department

160.

aryngea

aryngea

Head

7

obque

rect

•

Fig.

.

te

tentorum

cerebe

n

374

C H A P T E R

166.

7

Head

D.

At

te

neror

E.

At

te

superor

A

56-year-od

department

are

wtn

redness

te

o

rgt

te

te

eye

ead

naton

A.

or

he

B.

sows

eye.

an

te

he

musces

zed

are

he

nasocary

he

optamc

newborn

ntensve

devery.

are

he

care

ead

conducted.

o

te

te

most

sgns

sows

pan

n

An

MRI

rgt

optc

key

(o

as

Znn)

tan

o

usua

s

expa-

oc

te

wtn

te

nerves

because

dd

to

o

nner-

neonata

receve

Hs

vta

Utrasound

wt

mutpe

surroundng

te

vagna

most

bran

key

pre-

Inecton

B.

Corod

wt

C.

Persstent

D.

T oxopasmoss

E.

Epsten-Barr

rubea

ssure

sgns

yaod

to

matter.

cause

o

ts

necton

necton

A 2-mont-od boy s brougt to te emergency depart-

ment

by

s

vta

sgns

ton

sows

o

te

ace,

and

parents

are

bruses

nasoaba

droopng

te

key

o

absence

pace

te

ater

wtn

or

on

te

At

B.

Ineror

C.

Anteror

D.

Proxma

E.

Mandbuar

et

to

te

to

stroer.

ace.

sde

te

n

te

woman

earng

comes

oss,

171.

Pysca

te

rgt

s

Wc

by

o

te

te

patent’s

mout,

s

te

edema

Endoympatc

C.

Semcrcuar

D.

Cocea

E.

Hecotrema

55-year-od

o

sweng

ma

n

mts.

mass

on

hree

woman

er

rgt

bopsy

Se

days

sows

most

key

o

o

ar

te

te

o

eson

A

6-year-od

ment

(Fg.

wt

7.7).

bend

s

tender

s

and

to

pan

scedued

and

gands.

Wc

o

te

sensatons

emergency

te

te

ar

s

Injury

to

neror

tyrod

Injury

to

neror

and

C.

Injury

to

superor

tyrod

D.

Injury

to

superor

and

E.

Injury

s

mdde

vens

bateray

dagnoss

oowng

te

o

mm

enarged

mumps

nerves

regon

gand

s

respratons

120/90

s

o

Hg.

and

parotts

responsbe

te

parotd

•

Fig.

te

dsease?

a

because

wtn

nor-

non-tender

An

utra-

tyrod

gand

tyrod

gand

tyrodectomy.

CT -scan

o

oowng

.

tyrod

artery

mdde,

bucca

e

s

key

s

te

te

artery

superor

temperature

100/mn,

pressure

rom

Hs

ear-

bubbes?

B.

superor,

o

a

a

a

most

owever

most

neck.

sows

tyrodectomy,

Wc

are

sows

a

depart-

parotd

norma,

vaccnes.

sows

A

te

over

s

puse

bood

examnaton

panu

gand?

brougt

deveopment

s

parotd

made.

or

s

ever

(101.0°F),

18/mn,

Pysca

boy

Hs

wt

38.3°C

are

a

s

pyscan

sgns

sows

A.

to

te

patent’s

neck

brances

169.

and

dsease

Ménère

undergoes

bubbes.

cause

to

vta

te

te

oramen

and

decreased

Ménère

wt

examnaton

sde

o

Her

subsequenty

ater

ead

comes

neck.

nant?

zygomatc

because

ear,

sac

Pysca

te

A

o

structures

assocated

gand

o

rgt

canas

examnaton

cancer.

oowng

gand

nvovement

te

sows

dagnoss

oramen

styomastod

pyscan

o

ear

B.

A

A

oss

nant’s

te

examnaton

ear.

Hs

te

to

rngng

examna-

here

o

creases. Were

parotd

te

o

s

Pysca

and

et

sde

parotd

te

to

te

njury

styomastod

rom

mts.

ead

on

oreead

nerve

A.

te

od

o

ang

norma

tympan

o

Mdde

mass.

te

cose

(EBV)

n

o

brgt

artery

vrus

monts.

sound

vrus

aed

epsodes

sows

condton?

A.

Corda

petrosa

55-year-od

afected

genera-

examnaton

bateray.

te

te

not

pregnancy.

Pysca

s

E.

A

made.

uncompcated

ventrces

oowng

Lngua

4

nlamed

brougt

an

te

eyes

enarged

D.

eeng o uness or pressure n er rgt ear or te past

constrcted

moter

mts.

Lesser

o

afected

s

s

ater

neonate’s

Aurcuotempora

C.

A.

s

boy

Faca

B.

ng

afected

artery

unt

norma

ecogenc

168.

170.

symptoms?

nerve

trougout

sows

Wc

experences

contractng

preterm

care

wtn

smaer

vta

nlammaton

E.

nata

s

Her

examnaton

aso

s

emergency

musces

D.

A

te

pan.

Pysca

Se

oowng

tendon

eye

eye

H-test

patent’s

te

to

nlammaton

nlammaton

vatng

C.

o

rgt

te

A.

ssure

comes

mts.

we

annuar

he

o

rgt

te

ssure

orbta

woman

norma

o

Neck

orbta

because

nerve. Wc

167.

and

and

tyrod

and

arteres

ven

vens

neror

tyrod

CHAPTER

172.

A

32-year-od

department

coson.

s

an

s

arway

mm

bood

s

key

te

o

te

sgns

An

oowng

pres-

sows

aceratons

o

puse

bood

on

s

emergency

crcotyrotomy.

sows

An

artery

procedure.

aspraton

arteres

T wo

pneu-

was

most

njured?

A.

Superor

B.

Ineror

tyrod

C.

Crcotyrod

tyrod

D.

Superor

E.

Suprayod

aryngea •

173.

A

22-year-od

woman

s

brougt

to

te

Questions

he patent ost conscousness n te ed. Her tempera-

176.

26/mn, and bood pressure s 140/90 mm Hg. Pysca

ng

examnaton

wtn

ead.

An

s

most

te

to

B.

Second

C.

hrd

D.

Fourt

E.

Ft

ncson

s

ate

o

A.

Wat

wc

br uses

a

T  e re

perormed?

patent?

trd

ourt

to

t

sxt

woman

ater

Her

s

beng

brougt

nvoved

temperature

respratons

mm

aceratons

Hg.

on

s

are

musces

evator

ve

B.

Let

tensor

C.

Rgt

evator

D.

Rgt

tensor

ve

s

te

a

emergency

motor

vece

(99.32°F),

and

examnaton

and

ace,

toward

te

puse

bood

and

pa-

Wc

ve

A

45-year-od

department

tabe

n

mts.

durng

te

a

man

ater

restaurant.

Potograps

neuroogc

oowng

s

and

brougt

Hs

and

vta

were

et

to

te

to

et

njured?

te

ttng

sgns

taken

examnaton

nerves

Nervus

D.

Ednger-Westpa

E.

T rgemna

A

evator

ve

o

are

eye

ead

wtn

te

(Fg.

emergency

s

7.8).

a

norma

patent’s

was

on

eyes

Wc

most

o

key

178.

or

mts.

man

o

3

examnaton

on

te

rgt

 o   ow  n g

te

sde.

re   e x

s t r u c t u re s

patoogy

o

ts

nuceus

comes

te

Hs

te

o

vta

by

sows

te

te

emergency

vomtng,

sgns

examnaton

ead

Wc

compressed

to

an

and

are

depart-

a

severe

wtn

sows

nor-

nystagmus.

acoustc

oowng

neuroma

nerves

s

most

tumor?

Ocuomotor

C.

Vagus

D.

Hypogossa

E.

Abducens

3-year-od

parents

Pysca

to

te

boy

because

s

o

brougt

sweng

examnaton

superor

musce

(Fg.

tender

to

7.10).

he

papaton.

key

sows

one-trd

o

to

o

a

mass

te

sweng

Wc

te

te

o

pyscan

sde

o

o

tssue

s

luctuant

te

T rocear

A.

Branca

cet

B.

Abducens

B.

Ruptured

sternocedomastod

C.

Ocuomotor

C.

Lymp

D.

Optc

D.

T ortcos

E.

Ocuomotor

E.

Externa

cyst

musce

nlammaton

carotd

artery

s

neck.

anteror

aneurysm

and

oowng

dagnoss?

node

by

s

sternocedomastod

A.

abducens

te

a re

s  ow s

Faca

most

and

coaps-

sgns

nuceus

days.

B.

A

vta

accommodaton

n

nausea,

Pysca

o

7.9).

o

emergency

and

gangon

because

MRI

te

ntermedus

32-year-od

A.

paatn

stumbng

C.

key

paatn

Wc

savatory

to

He r

ead

te

 n vo  ve d

Superor

(Fg.

paatn

and

SCG

An

paatn

e ye .

s t re e t .

P y s  c a 

o

B.

ma

parayzed?

ace

key

eadace

paatn

ve

rgt

b ro u g  t

conscousness

te

absence

A.

ment

sows

er

rgt.

177.

pres-

paatn

ve

tensor

37.4°C

ead

asymmetrcay

oowng

n

22/mn,

Pysca

er

to

o

mts.

te

an

s

osng

mdde

on

s

to

to

Rgt

at

woman

ater

norma

te

Let

E.

eve

er

most

to

eevates

te

o

perormed.

cartage

be

sde

s

130/70

severa

soud

s

rgt

te

o

105/mn,

sure

tracea

te

n

second

36-year-od

coson.

on

traceotomy

common

Frst

s

aceraton

emergency

A.

A

a

.

176–200

3 2 - ye a r - o  d

depar tment

department

175.

A

ture s 37.5°C (99.5°F), puse s 70/mn, respratons are

sows

Fig.

emergency

department by ambuance ater ang rom er bcyce.

traceotomy

174.

375

Neck

vece

examnaton

crcotyrotomy

patent

Wc

and

cavty.

and

emergency

motor

(99.32°F),

25/mn,

ora

a

te

a

37.4°C

mutpe

te

wt

te

to

n

Pysca

wt

wtn

durng

ater

mona.

man

s

are

Hg.

estabsed

njured

days

brougt

nvoved

respratons

90/70

and

s

beng

temperature

unconscous

ace

s

Hs

105/mn,

sure

man

ater

Head

7

non-

s

te

376

C H A P T E R

7

Head

and

•

Neck

Fig.

.

•

vesse.

Wc

o

Fig.

te

.

oowng

vesses

s

most

key

nvoved?

180.

A.

Externa

B.

Interna

C.

Common

D.

V ertebra

E.

Superor

A

carotd

carotd

tyrod

9-year-od

wt

ratons

Hg.

and

gr

panu

perature

s

are

carotd

38.3°C

owng

te

and

bend

s

most

s

Her

s

ear.

to

An

mm

sweng,

MRI

Wc

be

tem-

resp-

120/90

erytema,

7.12).

key

department

ear.

110/mn,

pressure

rgt

(Fg.

rgt

puse

sows

te

mastodts

structures

emergency

er

bood

examnaton

tenderness

sows

to

bend

(101.0°F),

15/mn,

Pysca

ead

comes

sweng

o

o

te

afected

te

o-

by

te

nlammaton?

•

179.

A

68-year-od

o

cronc

o

mutpe

and

and

Her

80/mn,

pressure

s

angograpy

to

te

eadaces.

scemc

metus.

s

.

comes

and

transent

puse

bood

cervca

woman

dzzness

dabetes

(98.6°F),

Fig.

Se

attacks,

as

temperature

mm

7.11)

because

a

story

ypertenson,

respratons

145/90

(Fg.

pyscan

Hg.

sows

s

are

37.0°C

15/mn,

Crana

an

and

occuded

181.

A.

Sgmod

B.

Petrous

snus

C.

Inner

D.

Occpta

E.

Interna

part

o

te

tempora

bone

ear

snus

carotd

artery

A 34-year-od woman comes to te emergency depart-

ment

wt

norma

te

o

a

a

panu

mts.

ower

eyed

caazon

et

Pysca

s

o

te

made.

eye.

Her

vta

examnaton

et

An

eye

(Fg.

sgns

sows

7.13).

obstructon

o

are

a

A

wtn

ump

on

dagnoss

wc

o

te

CHAPTER

•

•

Fig.

A.

Spenod

snus

B.

Maxary

snus

C.

Etmoda

Fronta

E.

Nasoacrma

A

progressve

afected

vta

sgns

ton

sows

te

ead

Wc

A.

Fig.

182.

ocuar

most

key

responsbe

or

Hypogossa

D.

Gossoparyngea

E.

T rgemna

A

newborn

tes.

unt

Hs

vta

Scera

arteres.

D.

Pup

accumuate

E.

Nasoacrma

Pysca

ton

o

o

te

sde

te

ead

o

wc

te

o

mpared

sde

duct

dicuty

arway

sows

nasa

a

nasa

oowng

rom

te

on

cavty

to

te

wt

examnaton

nasa

te

comes

breatng

sows

te

sgns

rgt

poyp

(Fg.

emergency

troug

an

A

obstructng

7.14).

structures

obstructon?

o

sde.

depart-

te

Dranage

te

4

pyscan

oss

monts

mts.

te

te

and

duraton.

Pysca

rgt

because

rngng

ear.

examna-

An

MRI

cerebeopontne

nerves

s

most

n

Hs

key

o

ange.

afected?

w

most

rgt

key

be

was

sgns

a

Between

Between

wtn

bood

skn

o

rom

neonata

by

rupture

o

dense

mts.

o

on

sma

w

tssue

dabe-

Pysca

te

most

key

tssues?

tssue

ayer

rgt

perostea

oowng

connectve

connectve

orceps.

materna

eson

te

ntensve

requrng

norma

te

wc

and

oose

te

cepaoematoma

because

between

B.

to

devery

compcated

are

sows

ead

he

brougt

dicut

ayer

and

gaea

aponeurotca

scan

rom

s

A.

s

obstruc-

CT

o

s

a

pregnancy

C.

nose.

boy

ater

examnaton

ducts

gands

o

n

at

oowng

V estbuococear

T arsa

because

tumor

C.

Lacrma

ment

a

o

norma

oss

B.

he

te

patoogy?

man

wtn

to

earng

(tnntus)

earng

te

B.

45-year-od

comes

unatera

ear

are

A.

A

duct

Vagus

care

patent’s

nasoacrma

duct

man

sows

o

and

.

184.

s

.

snus

58-year-od

te

structures

377

Neck

ces

D.

o

oowng

and

.

183.

•

Fig.

Head

7

185.

C.

Between

gaea

D.

Between

percranum

E.

In

A

te

subcutaneous

54-year-od

department

and

aponeurotca

woman

because

vomtng.

Pysca

and

percranum

cavara

ayer

s

o

and

brougt

a

severe

to

te

emergency

eadace,

examnaton

sows

nausea,

tat

se

378

C H A P T E R

s

7

Head

unconscous.

rgt

aso

eye

s

daton

sows

a

s

186.

most

n

o

er

er

bran

o

te

afected

by

and

conscousness,

nerory.

upper

afected

Wc

key

regans

eye.

eyed

An

te

and

a

s

s

Optamc

B.

Nasocary

transtentora

C.

Anteror

D.

T rocear

obes

o

pup-

te

te

bran

tumor?

E.

190.

Optc

department

C.

Occpta

ome.

D.

Fronta

scap.

E.

Pareta

and

54-year-od

because

vta

sgns

ton

o

are

te

te

a

severe

a

crana

or

te

to

te

emergency

eadace

norma

sows

sows

anteror

responsbe

o

comes

wtn

eye

bran

tempora

man

batera

tumor

ossa.

and

mts.

occupyng

sensaton

o

o

pan

a

te

n

ts

Menngea

brances

o

te

maxary

Menngea

brances

o

te

mandbuar

C.

Menngea

brances

o

te

etmoda

D.

T entora

E.

C2

55-year-od

naton

ness

o

acute

s

because

sows

te

a

anteror

myocarda

ntrogycern.

s

most

o

cest

te

to

be

pan.

wa.

A

o

te

route

An

o

Deep

B.

Submandbuar

C.

Subngua

D.

Lngua

E.

Subngua

A

ngua

ment

because

Pysca

n

te

snus.

Wat

an

structures

o

on

te

sows

a

submandbuar

rgt

ard,

s

sde

o

s

regon.

A

bopsy

o

te

as

a

and

pus.

n

ts

type

oowng

o

key

rst

Bucca

B.

Lngua

C.

Ineror

D.

Nerve

E.

Gossoparyngea

o

ace.

a

Parotd

C.

Juguodgastrc

Submenta

E.

Retroparyngea

A

45-year-od

a

to

o

te

nasa

s

to

njury

red

was

and

man

nose,

ever,

examnaton

mucosa

snuses

to

A

wc

pyscan

progressve

oss

o

bateray

bateray.

Injury

and

sows

te

te

oss.

transumnaton

and

dagnoss

o

because

vson

o

sweng

acute

oowng

o

CT

superor

uncon-

s

oss

o

aqueduct

(o

Syvus)

artery

pate

wt

CSF

o

te

snusts

structures

ever

o

a

to

and

a

genetc

Pysca

te

pyscan

sore

troat

by

or

2

mmunodecency

examnaton

paatne

o

artery

te

tonss

oowng

vsby

sows

wt

pete-

ymp

nodes

enarged

durng

man

dagnosed

s

rst

wt

Wc

to

Submenta

Superca

o

et

examnaton

E.

A

comes

vra

o

o

te

te

become

to

eye.

te

Hs

pyscan

conjunctvts

3

et

an

eye

sows

oowng

nvoved



because

3-year-od

groups

te

daug-

days

ago.

njected

o

ymp

necton

were

Submandbuar

45-year-od

dicuty

patent

rom

to

te

becomes

cause

te

spread?

he

comes

o

cerebra

become

panu

D.

o

myoyod

maxary

made.

removed.

prone

o

depressed

non-contrast

menngea

brougt

o

D.

nodes

te

aveoar

to

runny

most

one-story

Submandbuar

conjunctva.

mass

193.

22-year-od

Pysca

s

s

to

B.

Pysca

procedure?

A.

A

nerves

mdde

Wc

Preaurcuar

te

sma,

patent

key

emergency

s

resorpton

tonsts.

Juguodgastrc

o

are

te

erytematous

C.

Wc

duct

A

o

aceraton

a

crbrorm

story

B.

ts

sku.

mdde

boy

because

recurrent

most

A.

ts

o

o

A.

and

sows

cerebra

te

he

gand

a

tromboss

most

te

mass sows a magnancy o te submandbuar gand.

submandbuar

te

roo

tonsts?

depart-

non-tender

He

cae

medcatons

oowng

parents

enarged

ter

ump

te

ater

te

o

11-year-od

wt

ven

a

o

to

te

sows

ead

sows

day

s

Aneurysm

An

days.

exam-

sows

emergency

A

Fracture

E.

subngua

te

vertex

ead

scous.

o

to

ts

rnorrea

192.

comes

te

sagtta

D.

duct

examnaton

rgt

te

te

Laceraton

duct

o

o

scan

o

C.

ven

man

x-ray

racture

o

examnaton

te

ven

35-year-od

An

brougt

rom

CSF

tender-

absorpton

Pysca

s

ang

o

ncudng

o

man

ater

o

emergency

ECG

n

nerve

Obstructon

drug?

A.

55-year-od

nerve

no

vson

nerve

Obstructon

case?

Pysca

etmoda

B.

nerves

wt

o

artery

A.

nerve

te

seres

patent,

te

to

woman

narcton.

to

Wc

key

cest

daporetc

admnstered

A

s

brougt

oss

nerve

s

bers

s

te

conscousness?

191.

woman

n

o

nerve

C3

department

MRI

porton

B.

A

An

oowng

A.

and

Hs

examna-

papedema.

Wc

depart-

vomtng.

Pysca

resut

nerve

T empora

A

to

A.

o

B.

te

189.

key

Pareta

o

188.

most

patent?

ead

MRI

producng

oowng

er

here

A.

ment

187.

te

se

ateray

ptoss

o

tumor

ernaton.

Neck

Wen

drected

compete

ary

and

a

ow

o

mea

a

esopagus

Between

ocated?

tat

se

2

to

pyscan

regurgtated

days

sweng

coectng

te

ngt-tme

ago.

nectons.

esopagus

wc

and

se

ad

cest

papabe

te

comes

swaowng

says

repeated

sows

parotd

woman

n

sows

an

musces

s

n

ts

neck.

ood

as

Pysca

er

contrast

stae

Se

because

cougng

a

stor y

examnaton

Barum

outpoucng

te

ts.

tems

cer vca

pouc

swa-

o

te

regon.

most

key

CHAPTER

A.

Between

styogossus

B.

Between

paatogossa

gottc

and

styoparyngeus

arc

and

medan

198.

gossoep-

od

Between upper and mdde paryngea constrctors

tons

Between

tyroparyn-

Hg.

constrctor

wt

te

crcoparyngea

portons

Between

A

5-year-od

ment

o

te

neror

mdde

and

paryngea

and

neror

paryngea

Durng

beedng

key

B.

Mdde

C.

Let

D.

Ineror

A

norma

a

to

te

te

depart-

An

dark

mdne

oowng

venous

Anteror

venous

C.

Maxary

D.

Mdde

E.

Nasoacrma

ncson

was

ven

s

ven

woman

and

A

n

oowng

n

ear

CT

gament

comes

pan.

scan

te

te

s

pyscan

vta

ead

styod

eongated

nerves

ts

te

Her

o

wc

are

to

most

and

sgns

jugu-

and

process

key

afected

te

sty-

A.

by

ts

patent?

a

te

most

s

we

eatng.

nosed

ma

wt

mts.

dects.

a

eson

to

B.

Greater

nerve

Lesser

D.

Lacrma

E.

Corda

ts

o

aneurysm

te

s

over

ped

te

s

by

by

proxma

oowng

n

An

posteror

ts

s

o

sensaton

o

Cervca

Great

C.

Mandbuar

D.

Margna

E.

T ransverse

acrma

x-ray

bone

to

te

wa

o

unctons

patent?

brougt

mse

te

te

branc

aurcuar

ace

gand

gand

to

te

we

te

ts

a

2

he

s

to

cm

s

save

acera-

area

wound

area

oowng

emergency

tryng

sows

mandbe.

and

over

o

o

eyed

examnaton

ange

wc

a

pres-

sows

tempora

submandbuar

te

anestetzed

B.

gangon

te

te

ower

te

o

cuttng

Pysca

A.

Questions

comes

eds

arteres

beard.

deveoped

gencuate

o

mbs.

te

nerve

ntact

n

by

boy

ater

neuroogc

as

upper

n

puse

bood

examnaton

o

aca

reman

cosure

15-year-od

Cutaneous

nor-

201.

to

wt

te

er

sows

bateray.

o

compressng

Mdde

dag-

te

tympan

producton

aceraton

nerve

dicuty

sows

A.

to

examnaton

vsua

oowng

no

A

ton

condton?

woman

Pysca

an

sows

nerves

was

wtn

tympan

because

bran

are

and

and

o

te

sutured.

normay

sup-

nerves?

aca

nerve

branc

o

mandbuar

cervca

trgemna

branc

o

nerve

aca

nerve

nerve

nerve

tempora

te

patent

sgns

o

occurs

nerve

54-year-od

days.

te

vta

oowng

proxma

petrosa

ago,

Hs

examnaton

te

petrosa

C.

5

o

cause

Faca

ment

weeks

pasy.

Pysca

Wc

A.

A

hree

Be

because

Pysca

vece

(99.5°F),

secretons

V estbuococear

tat

16/mn,

emergency

motor

o

E.

eye

37.5°C

racture

o

te

a

Contro

department

pyscan

are

cest,

a

s

to

n

T aste sensaton rom anteror two-trds o tongue

Hypogossa

rgt

s

and

C.

Gossoparyngea

te

nlammaton

B.

D.

te

meatus.

structures

musces

C.

to

brougt

nvoved

Hg.

ace,

key

T ear

o

nasa

o

V ountary

comes

ts

mm

Contro

E.

man

neror

oowng

by

120/90

nlammaton

te

cavty. Wc

D.

200.

mm

corda

Faca

acrmaton

s

oca

te

temperature

eson

tympanc

woud

Wc

n

o

s

beng

sows

Vagus

62-year-od

pressure

sows

tem-

respra-

ces

woman

te

ead

B.

A

96/mn,

duct

ater

A.

spontaneous

s

because

Her

ces

respratons

on

te

orgn

sows

and

caced.

weeks.

snus

130/90

resutng

wtn

neck

s

bruses

because

are

pyscan

2

379

Neck

duct

etmoda

Her

96/mn,

sure

anteror

o

etmoda

40-year-od

o

troat

syndrome

A

coson.

te

n

te

puse

bood

obstructed

Frontonasa

department

connectng

be

B.

ven

arc

and

wc

A.

ven

tyrod

to

to

asted

(101.0°F),

edema

rom

an

vesses

as

examnaton

mucosa

key

comes

tat

and

edema?

emer-

estabs

prouse

rom

o

tree.

199.

syndrome

te

procedure,

bracocepac

mts.

oyod

o

emergency

rom

38.3°C

15/mn,

Dranage

vens

sore

Eage

te

perormed

Wc

tyrod

Juguar

a

s

occurs

tyrod

55-year-od

o

to

ang

cut?

Superor

ar

te

tracea.

A.

E.

brougt

ater

suddeny

te

most

s

traceostomy

arway.

over

boy

s

are

woman

necton

Pysca

most

unconscous

gency

197.

snus

perature

constrctors

196.

a

D.

gea

195.

22-year-od

o

C.

E.

194.

A

Head

7

one

te

most

o

key

oss

over

o

MRI

arteres

casm.

be

cerebra

vson

An

te

optc

emergency

depart-

te

vson

o

at

te

te

te

ead

base

Wc

nvoved?

past

n

o

o

te

A

201–225

72-year-od

abdomna

Pysca

a

mass

papated

sows

magnant

o

ymp

magnant

sows

n

te

te

tumors

A.

Let

neror

supracavcuar

Anteror

communcatng

B.

Let

C.

Anteror

cerebra

C.

Rgt

neror

D.

Superor

cerebear

D.

Rgt

supracavcuar

E.

Posteror

E.

Juguodgastrc

cerebear

seen

deep

cervca

pyscan

s

bowe

cacectc

ower

are

man

ts

and

quadrant.

o

te

requenty

n

wt

abts.

consstent

Wc

most

cervca

B.

neror

a

rgt

tat

s

as

te

n

cecum.

nodes

deep

to

canges

ndngs

tumor

cervca

wt

comes

and

examnaton

s

CT -scan

ng

man

pan

A

wt

oow-

assocated

patent?

380

C H A P T E R

202.

A

7

Head

60-year-od

enng

man

oarseness

smoked

two

and

Neck

comes

and

packs

to

te

pyscan

dicuty

o

cgarettes

wt

swaowng.

or

te

past

wors-

He

30

as

years.

Pysca examnaton sows a mass on te rgt sde o

te

neck

pated.

nto

te

and

rm

Drect

te

regona

aryngoscopy

prorm

prorm

xed

recess

recess

o

must

ymp

sows

te

be

a

nodes

mass

arynx.

mucosa

or

o te tumor. Wc o te oowng nerves

sbe

or

tumor

A.

s

sensaton

to

te

mucosa

o

o

superor

ater

ss

a

Ineror

A.

Frst

Gossoparyngea

B.

hrd

D.

Hypogossa

C.

he

Interna

branc

25-year-od

o

arrva.

te

At

be

A.

B.

o

bone,

o

e

autopsy,

te

but

ntact.

cause

superor

s

aryngea

brougt

was

apartment.

mdne

yod

to

ater

s

o

man

ound

He

was

te

Wc

An

cavara

o

te

te

emergency

unconscous

pronounced

examnaton

neck.

to

sows

x-ray

and

oter

s

a

207.

on

over

cet

key

te

deat?

narcton

A

a

rom

egt

tat

resuted

n

ata

nterna

beedng

C.

Subdura

D.

Stranguaton

E.

Ingeston

A

zness.

o

necrotc

n

te

cerebra

noma.

ton

n

o

no

te

2

B.

Spenoda

Retna

D.

Ptutary

E.

hymus

Pysca

ror

png

te

o

sows

ater.

and

a

ead

an

o

o

o

o

most

er

brougt

sgns

to

te

drppng

are

sows

rom

embryoogc

Persstence

B.

Persstence

A

rgt

cus.

mea-

and

examna-

or

scap.

source

a

ts

pyscan

rom

wtn

sma

pt

on

wt

openng.

structures

s

te

norma

paryngea

o

te

second

te

groove

gr

paryngea

nto

wc

pouces

pouc

trd

s

paryngea

brougt

consutaton.

rgt

sde.

structures

o

to

he

Se

te

arces

pyscan

nant

as

sows

Faure

s

te

o

most

was

norma

a

key

o

a

at

deveop-

unatera

uson

or

born

upper

wc

cause

o

o

ts

and

meda

nasa

promnences/

A.

by

er

sde

o

mts.

part

o

o

te

arc

te

ntermax-

o

egt

pyscan

Pysca

18

exam-

te

umb-

poyydramnos

oowng

te

at

examnaton.

above

sows

te

durng

te

condtons

utrasound

s

examna-

etus?

Batera

D.

Hydrocepaus

E.

rena

Ompaocee

o

neonata

weeks’

wt

gr

va

and

a

er

brougt

o

optamoogst.

sows

pupary

te

a

A

etoogy

A.

Faure

o

B.

Abnorma

te

Se

rgt

n

te

te

o

crest

Se

norma.

n

body,

nant’s

and

o

ormaton

to

cose

to

6

an

exam-

te

te

condton?

ssure

te

reerred

sector

38

scedued

been

deect

s

or

at

devery

optamoogc

retna/optc

neura

a

as

neror

cary

te

born

vagna

sma

rs.

pyscan

was

receved

a

detaed

margn,

te

spontaneous

sows

te

deect

to

Se

deveopment

examnaton

poston

s

s

oow-up.

compcatons.

vaccnatons

naton

vagna

weness

gestaton

no

ageness

te

4-mont-od

Wat

second

Wc

ound

Ageness

o’cock

te

te

prenata

mts.

undus

examnaton

C.

drp-

ts

to

routne

norma

uterne

be

comes

a

wtn

a

bda.

to

or

B.

A

and

Anencepay

mucus

o

are

Utrasound

Pysca

n

woman

gestaton

sows

ante-

Wc

promnences/processes

promnence/process

segment

spna

ton

te

nasa

sgns

te

nvoved

paryngea

proxma

o

expected

te

o

mgrate

condton?

eart

examnaton

prmgravd

naton

anomay?

A.

Latera

Maxary

Vta

te

skn

key

sternocedomastod

ntermttenty

anay-

cromosome

arc

and

nasa

E.

weeks

ces?

mucus

vta

to

patent’s

o

deect?

D.

a

Her

ces

Laboratory

Rgt and et meda nasa promnences/processes

eson

advanced

autopsy,

208.

209.

s

examnaton

cromosome

arm

wt

repared

Latera

sows

sotary

bopsy

At

esons

te

dz-

te

and

A

and

nstabty

eye

gr

A

a

C.

ary

snus

examnaton

oowng

MRI

gat

gand

because

border

s

te

ncudes

Pysca

depart-

term

B.

emergency

snus

3-mont-od

neck.

eson

monts

sagtta

o

An

te

vomtng,

sows

emspere.

meanoma

C.

eadaces,

pgmented

Superor

to

cerebeum

oowng

A.

er

te

cerebra

des

sows

parents

severe

substance

comes

examnaton

emspere

magnant

A

posonous

emnegect.

Se

Wc

a

wt

esons

rgt

on

at

processes

woman

Pysca

et-sded

p

crest

born

mandbe.

ong

compcatons.

Pysca

was

Latera nasa and maxary promnences/processes

ematoma

40-year-od

department

no

sma

pouc

emergency

story

te

te

ourt

surgery

wt

a

n

neura

te

murmur.

and

paryngea

oowng

A.

Medca

eart

second,

congenta

Myocarda

a

p

ment.

He

expans

2-mont-od

term

appear

most

Second

A

sezure.

deveopng

Frst,

pouc

paryngea

to

a

ears

and

E.

cet

ractured

bones

te

te

dead

creptus

sows

oowng

on

a

ourt

brougt

paryngea

D.

paryngea

ypocacema.

o

best

trd

te

s

deeton

Faure

C.

A

and

sow

sows

area(s)

aryngea

o

boy

ow-set

studes

aryngea

te

duct

avng

paate

sows

te

o

compcatons.

B.

loor

205.

Persstence

3-year-od

22.

branc

department

204.

E.

A

cet

respon-

were

hyrogossa

no

remova

s

Persstence

D.

ment

ocated?

Externa

E.

203.

genera

pa-

protrudng

he

anestetzed

are

206.

C.

rs,

retna.

CHAPTER

C.

Abnorma

and

210.

Posteror

E.

Weak

A

optc

a

norma

and

te

mts.

te

deveoped

onc

structures?

CT

dsc

coud

rom

paryngea

C.

Frst

paryngea

arc

D.

Frst

paryngea

cet

E.

Second

a

contans

te

boy

An

MRI

Wat

Crana

B.

Encepaocee

C.

Meroencepay

te

ead

part

o

te

key

30-year-od

years.

mass

o

(Fg.

ture

n

man

s

Pysca

about

te

2

neck

7.15).

most

cm

C.

hyrogossa

D.

hrd

E.

Cervca

unt

s

wc

boy

and

s

a

te

e

.

•

Fig.

.

ncudng

te

pyscan

gnored

sows

n

o

te

wc

or

ts

bony

a

sot,

neck.

because

or

severa

mdne

A

CT

lud-ed

embryoogca

scan

mass

struc-

mass?

cet

pouc

brougt

to

spontaneous

devery

sows

te

were

pedatrc

vagna

eyeds,

and

papebra

deormed

wt T reacer

arc

ntensve

devery.

uncompcated.

dysostoss).

paryngea

te

down-santng

ower

dagnosed

syndrome?

Fig.

duct

(mandbuoaca

o

bran

•

deect

snus

examnaton

He

te

cecum

ater

o

tat

correc-

(cranum

troug

we-dened,

paryngea

paryngea

pregnancy

ears.

a

accounts

Second

newborn

to

tat

dameter

Persstence

key

Foramen

deects

n

sows

B.

care

comes

neck

examnaton

A.

A

embry-

menngocee

Menngoydroencepaocee

mass

o

musce

dagnoss?

Mcrocepay

a

uy

severe

neck

a

or

bone

sows

E.

o

ospta

occpta

D.

A

te

to

oowng

protrudng

most

A.

to

te

te

and

te

o

njury

te

to

sows

arc

system

s

n

sweng

pouc

n

o

mennges

ead

out

wtn

unabe

racture

o

admtted

deect

ventrcuar

deect.

s

and

resut

are

sows

s

te

emergency

pouc

paryngea

arge

ayers

knocked

sgns

He

o

wc

paryngea

2-day-od

vta

jaw.

scan

Second

bdum).

213.

A

Frst

o

vesce

outer

te

beng

examnaton

B.

A

and

to

ater

Hs

et

A.

ton

212.

te

hs

tat

nner

brougt

Pysca

artcuar

mandbe.

te

pan

matc.

over

mout.

to

s

ace

boxng

s

trauma

optc

cavtaton

between

man

wt

brusng

open

te

381

Neck

cup

26-year-od

department

211.

camber

adeson

te

durng

between

and

ectoderm

D.

o

nteractons

Head

7

w

Cons

Abnorma

most

he

Pysca

ssures,

externa

syndrome

deveopment

key

produce

ts

214.

A

28-year-od

devce

was

examnaton

era

o

swengs

suture

woman

used

nes

to

te

on

(Fg.

gves

assst

nant

te

appears

to

B.

Second

norma.

Wc

C.

hrd

sbe

D.

Fourt

A.

Intracrana

beedng

E.

Sxt

B.

Bockage

te

ts

norma

o

te

patent’s

o

a

boy.

and

brt

ead

tat

neuroogc

oowng

s

A

devery.

not

o

te

bat-

cross

sku

examnaton

most

key

symptoms?

nterventrcuar

vacuum

Pysca

sows

do

7.16). T ransumnaton

Frst

or

to

te

ater

nant’s

A.

be

brt

n

oramen

s

respon-

382

C H A P T E R

7

Head

C.

Faure

D.

Coecton

o

and

Neck

ceavage

o

o

bood

o

edema

te

prosencepaon

beneat

te

perosteum

o

te

bone

E.

Coecton

te

215.

A

2-mont-od

department

wtn

ead

crana

A.

s

o

above

brougt

a

mts.

cororetnts

sows

tese

gr

because

norma

severe

lud

te

perosteum

o

bone

Pysca

and

Wat

s

te

Her

emergency

vta

sgns

examnaton

bateray.

ydrocepaus

caccatons.

to

sezure.

A

CT

severa

te

scan

areas

most

o

o

key

are

sows

te

ntra-

cause

o

symptoms?

he

moter

was

treated

wt

tetracycnes

durng

pregnancy

B.

C.

he

moter

rst

trmester

he

moter

rst

D.

was

nected

o

was

trmester

wt

rubea

durng

te

durng

te

pregnancy

o

nected

wt

CMV

pregnancy

he moter was nected wt T reponema pallidum

durng

E.

he

pregnancy

moter

was

exbtng

nected

congenta

wt

syps

T oxoplasma

gondii •

durng

216.

rst

trmester

o

a

ma

ump

n

mts.

tssue

on

ectopc

reated

s

neck.

Pysca

te

neck

tymus

Hs

and

tssue.

structure

coud

Lngua

tons

C.

Ineror

paratyrod

ymp

Submandbuar

E.

Paatne

probems

mts.

gr

wo

A.

te

wtn

sot

nor-

mass

mass

contnuous

o

owng

sows

A.

ectopc

n

was

s

.

ocaton?

B.

concerned

Her

vta

examnaton

o

te

most

key

he

moter

cd’s

cause

o

te

about

er

normay

sgns

sows

are

a

daugter’s

and

as

wtn

teet.

219.

no

to

smoke

he

te

C.

s

te

treated

caccaton

decency

D.

was

wt

tetracycne

he

durng

moter

was

o

te

dentn

because

o

E.

pregnancy

nected

wt

rubea

durng

te

he

220.

moter

contnued

to

use

acoo

durng

te

pregnancy

A

23-year-od

he

te

moter

vta

care

batera

woman

not

he

unt

sgns

examnaton

sown

boy

or

are

sows

cataracts.

gves

seek

s

to

evauaton

sma

Cardac

o

to

ow

norma

ead

a

preterm

care

transerred

wtn

a

brt

prenata

boy.

trougout

te

neonata

brt

mts.

wegt.

Pysca

crcumerence

auscutaton

and

sows

a

o

te

o-

ndngs?

tadomde

CT

n

durng

to

at

te

durng

te

pregnancy

T .

gondii

scans,

te

term

devery.

cranoaca

durng

are

an

te

Pysca

te

obtaned

3D

to

abnormates

approprate

nvestgaton?

a

examna-

and

a

reconstruc-

gude

are

or

uncomp-

abnormates

ncudng

7.17

pyscan

va

oter

surgca

key

to

be

Hypertyrodsm

Hypopasa

Maormaton

o

D.

Hypopasa

te

E.

Hearng

a

mass

ed

wt

o

a

brougt

cartages

ture

key

to

o

3

s

te

sde

4-cm

rm

made.

neck.

weeks

o

neck

CT

7.18).

Wc

to

He

tat

sows

te

A

ago

a

because

ad

sot

lud-

te

eve

o

te

neck

lud-ed

mass

A

dagnoss

embryoogca

ts

an

resoved

at

scan

dameter,

(Fg.

contrbutes

pyscan

s

examnaton

et

promnence.

outer

cyst

sde

necton

te

branca

most

bone

tymus

et

we-dened,

tn

yod

aryngea

Pysca

on

aryngea

a

s

te

respratory

te

te

boy

on

mass

sows

o

oss

14-year-od

uneventuy.

o

born

vagna

C.

o

CMV

durng

wt

brougt

was

B.

A

durng

pregnancy

s

Fg.

rubea

wt

cocane

nected

o

He

wt

nected

used

was

Wc

wt

upper

dd

pregnancy.

ntensve

Hs

A.

cacum

pregnancy

takng

Wc

tese

pregnancy

mutpe

paate.

pannng.

durng

o

spontaneous

ound

moter

o

pregnancy

was

boy

vst.

sows

cet

ton

durng

murmur.

cause

nected

o

trmester

1-year-od

ton

pregnancy

Poor

moter

moter

cated

pregnancy

B.

he

he

A

was

moter

oow-up

norma

Wat

was

trmester

E.

rst

dscooraton?

contnued

moter

trmester

D.

by

yeows-brown

decduous

ts

pyscan

key

moter

he

rst

to

most

rst

he

gand

brougt

macne-ke

te

pregnancy

node

deveopng

scoo.

Pysca

s

he

deveopmentay

gand

was

cd

dscooraton

te

an

a

tons

6-year-od

he

o

oter

ave

are

sows

C.

D.

moter

sgns

bopsy

aso

B.

teet.

a

Wc

Juguodgastrc

A

vta

examnaton

A.

er

218.

Fig.

pregnancy

A 3-mont-od boy s brougt to te pyscan because

o

217.

te

mass?

o

a

struc-

CHAPTER

223.

A

22-year-od

department

coson.

Hs

temperature

s

mm

100/90

ractures

taste

bers

o

Gencuate

Ineror

D.

Submandbuar

E.

Pterygopaatne

221.

hrd

D.

Cervca

E.

Ectopc

A

newborn

devery

tyrod

wt

te

no

ton

o

and

zygomatc

detected

smar

devered

sows

bones,

externa

on

spontaneous

n

ears.

s

Pysca

ypopasa

santed

auscutaton.

ndngs

va

compcatons.

neonate

maormed

pouc

gand

was

No

cardac

here

ater.

o

mm

222.

B.

DGeorge

C.

Feta

D.

Car

E.

T reacer

A

Robn

I

s

a

Wat

te

are

story

most

225.

and

murmurs

amy

s

mandbe

ssures,

department

apartment

(99.5°F),

mn,

and

Anestesa

C.

Panu

n

ater

bood

Se

p

s

ang

s

(FAS)

brougt

rom

Her

pressure

s

undergoes

and

cn.

te

te

9t

emergency

loor

mm

ractures

surgca

se

Wc

s

respratons

140/90

mutpe

Postoperatvey,

to

temperature

103/mn,

sows

CT

eson

emergency

severe

16/mn,

A

and

scan

o

taste

depar t-

eadace.

puse

bood

te

compressng

Hg.

o

Hs

106/

pressure

ead

te

s

s

sows

a

optamc

are

ner ve

numbness

was

20/

Pysca

te

most

Wc

woud

te

o

te

patent

o-

most

ard

o

paate

te

upper

p

Pan

Tngng

over

te

ower

sensaton

eyed

over

te

bucca

regon

o

te

A

72-year-od

man

dicuty

wen

sgns

wtn

are

a

te

be

or

norma

cacexc

o

comes

eatng

man.

cana.

pyscan

past

ew

o

suc

o

a

te

te

te

because

weeks.

Pysca

MRI

afectng

Wc

by

te

mts.

An

branstem

afected

to

te

Hs

o

vta

examnaton

ead

sows

contents

oowng

o

a

te

musces

tumor?

Genoyod

B.

Myoyod

C.

Paatogossus

D.

Genogossus

E.

Styoyod

an

37.5°C

reconstructon

as

o

ner ve.

symptoms

man-

Questions

226.

A

226–250

71-year-od

tcy

rgt

reeve

te

o

te

resectabe

o

te

naton

key

Wc

man

eye

comes

to

nose.

He

and

dryness.

bran

sows

a

crana

He

tumor

red

4

dry

was

Aurcuotempora

A.

Ineror

B.

Bucca

B.

Dorsa

savatory

C.

Lesser

C.

Superor

D.

Menta

D.

Ednger-Westpa

E.

Inraorbta

E.

Nuceus

vaga

wt

nuceus

nuceus

nuceus

nuceus

ambguus

uses

dagnosed

nuceus

savatory

pyscan

oten

monts

eye

nerve

te

nvove?

A.

petrosa

Wc

te

eyeba

E.

key

njured?

te

a

(102.02°F),

trgemna

te

D.

woud

syndrome

woman

puse

mandbe.

ower

te

B.

A.

syndrome

Cons

ost.

o

te

experence?

tumor

key

syndrome

compex.

examnaton

dbe.

o

Pan

sows

o

maormaton

22-year-od

s

bodes

to

surgery,

ace

syndrome

acoo

are

to

and

38.5°C

addtona

ypogossa

Perre

taken

Foowng

tongue

ce

severe

mut-

tongue?

comes

ever

Hg.

A.

examna-

te

papebra

vagna

dagnoss?

A.

s

enancng

key

arc

snus

boy

te

sows

sows

s

s

pressure

.

pouc

paryngea

o

respratons

owng

C.

bood

gangon

man

because

branc

paryngea

o

te

He

repar.

vece

puse

gossoparyngea

21-year-od

rng

paryngea

bones.

emergency

(99.5°F),

ead

383

Neck

motor

examnaton

neuron

o

te

a

and

te

and

T rgemna

130/90

Second

part

C.

A

aca

tp

37.5°C

o

surgca

te

to

n

22/mn,

scan

te

B.

mn,

Frst

at

ts

temperature

B.

or

contans

are

s

Pysca

CT

te

room

rom

ment

A.

A

sensaton

gangon

A.

Hg.

trauma.

operatng

Fig.

brougt

nvoved

respratons

pe

•

s

beng

105/mn,

aca

224.

man

ater

Head

7

ago.

no

te

a

dry

drops

wt

Pysca

vsua

w

wt

eye

a

to

non-

exam-

mparment.

tumor

most

384

C H A P T E R

227.

A

Head

23-year-od

arm

pan

ma

ng

on

and

mts.

rgt

scan

o

man

and

rgt.

s

consstent

Probems

te

s

prenc

patent

wt

s

te

Reduced

bood

venous

D.

Numbness

n

te

upper

E.

Dstenson

o

te

nterna

a

se

In

ump

ng

o

er

o

te

a

neck.

te

most

to

te

return

o

toracc

rom

A

CT

musces

toracc

symptoms

pressure

on

Pysca

eyed,

eye.

te

by

and

neck

ven

pyscan

toroug

te

to

remove

patent

wt

te

tumor.

deveops

sows

pupary

symptoms

swe-

parta

constrcton

o

compresson

because

nvestgaton,

examnaton

he

caused

wa

ead

juguar

to

Ater

perod

te

extremty

comes

neck.

rgt

key

wt

oowng

nor-

appear-

and.

scaene

because

tyrodectomy

psatera

oowng

A.

er

postoperatve

ptoss

are

low

woman

undergoes

te

o

on

pae

et

rgt

nerve

Reduced

o

wt

wtn

dagnoss?

respraton

C.

29-year-od

te

a

dagnosed

o

ts

are

sows

tan

B.

A

pyscan

sgns

ypertroped

Wc

wt

te

vta

cooer

sows

he

to

Hs

examnaton

tat

neck

syndrome.

aso

Neck

comes

Pysca

s

te

and

weakness.

outet

A.

228.

7

o

ts

patent

wc

o

te

gangons?

Submandbuar

B.

T rgemna

C.

Superor

•

229.

D.

Gencuate

E.

Cary

A

26-year-od

department

mdace

norma

taste

ton

A.

ater

a

mts.

and

nerves

man

durng

te

was

Lngua

brougt

sustanng

but

anteror

to

te

traumatc

Hs

vta

tere

s

oss

emergency

njury

sgns

o

to

te

are

wtn

sows

ntact

genera

sensa-

examnaton

tongue. Wc

key

nerve

a

gt.

Pysca

most

corda

s

street

savaton,

rom

o

te

Corda

tympan

C.

Ineror

aveoar

D.

Lngua

E.

Gossoparyngea

dsta

to

ts

An

oow-up

tumor

ead

o

woud

ton

231.

te

o

ater

to

ts

at

te

juncton

wt

be

te

beng

wt

te

te

corda

pyscan

dagnosed

ossa.

spread

juguar

to

to

crana

perneura

expected

(Fg.

o

An

te

oramen.

ound

on

MRI

tumor

Wc

pysca

or

wt

o

ts

te

oowng

spnosum

ovae

C.

Juguar

Hypogossa

E.

Foramen

er

n

bood

examnaton

neroateray.

aracnod

B.

Loss

o

aca

C.

Loss

o

sensaton

D.

Loss

o

earng

A.

Ocuomotor

E.

Loss

o

gag

B.

Optc

nerve

A 25-year-od man s brougt to te emergency depart-

C.

Faca

nerve

ment

D.

Cary

E.

SCG

ater

says

rom

te

ace

and

te

scap

ng

relex

njurng

tat

mse

te

durng

patent

t

a

s

soccer

ead

game.

Hs

aganst

te

ead

vesse

sows

tat

enters

A

s

te

s

he

Se

a

was

ba.

con-

payng.

n

te

emor-

ruptured

sku

o

te

rgt

troug

gangon

emergency

was

a

temperature

mm

rgt

eye

are

o

s

16/

rgt

devated

sows

most

o

Pysca

and

aso

scan

s

Hg.

eye

s

wc

ound

story

respratons

CT

compressng

nerve

Her

Angograpy

structures?

te

se

as

175/100

non-contrast

ematoma

to

ater

90/mn,

ptoss

emorrage.

structure

brougt

ome.

puse

mydrass.

patent?

a

s

pressure

tongue

sow

he

resumed

unconscous

ypertenson.

sows

o

expresson

s

usband

ter

Loss

movements

o

was

openngs?

woman

by

(99.5°F),

pupary

ater

but

cana

controed

and

oncomng

acerum

55-year-od

mn,

te

oramen

D.

37.5°C

He

ound

emorrage

Foramen

poory

examna-

arrows).

or

conscousness

scan

Foramen

A

reac

was

B.

a

aong

e

A.

unconscous

dect

to

ose

CT

7.19,

a

te

A

A.

coac

ts

.

mnutes.

ater,

room.

o

not

severa

produce

wc

juncton

comes

posteror

tssue

be

man

or

tryng

dd

department

examnaton

sows

nervous

to

we

ours

rage

232.

82-year-od

patent

ocker

tympan

B.

post

he

Four

njured?

proxma

goa

used

oowng

tympan

230.

Fig.

cervca

a

sub-

key

te

to

oow-

CHAPTER

233.

A

20-year-od

ment

wt

a

examnaton

o

te

scap.

ment

because

ton

and

s

te

ead.

occpta

sutured.

te

as

spread

o

te

as

on

te

ocuomotor

C.

Maxary

D.

Optamc

and

ocuomotor

E.

Optamc

and

aca

connectve

tssue

and

te

aponeuross

connectve

tssue

and

te

skn

E.

he

derms

6-mont

s

oss.

deep

papaton

perormed

o

te

pass

te

story

true

and

voca

troug

name

o

o

a

neck

te

arge

tumor

he

openng

ts

pan,

anteror

A

oarseness,

sows

neck.

s

because

vson

aryngoscope

te

and

o

s

on

Wat

superor

rom

beng

A.

B.

T rgemna

C.

Faca

V estbue

C.

V entrce

D.

Vaecua

o

E.

Rma

Pysca

239.

gottds

D.

Vagus

E.

Abducens

An

rgt

a

enarged,

A

te

ocated

sde

o

te

goscope

neck.

sows

Perormng

to

avod

a

a

examnaton

cervca

Vsuazaton

mass

bopsy

njurng

ymp

ocated

o

te

wc

o

wt

n

mass,

te

sows

node

a

te

an

on

lexbe

aryn-

prorm

care

must

oowng

rgt

be

ts

sown

nerves?

te

by

te

vson

and

scan

and

te

ead

wc

most

o

key

Ineror

B.

Optc

orbta

Gossoparyngea

E.

Foramen

ovae

D.

Interna

E.

Hypogossa

brougt

to

te

pyscan

because

pan

n

suddeny

od

(101.0°F),

too

oud.

te

et

bood

naton

puse

sows

membrane.

structure

te

tat

Second

B.

Frst

C.

Second

D.

Frst

E.

hrd

102/60

bugng

s

te

and

te

respratons

mm

Hg.

erytematous

embryoogc

te

mdde

are

necton

ear

26/mn,

Pysca

tympanc

orgn

to

exam-

o

spread

te

rom

A.

cavty?

pouc

groove

241.

pouc

Hs

110/mn,

was

beng

temperature

respratons

90/60

brougt

nvoved

mm

Hg.

s

are

to

n

te

a

37.5°C

27/mn,

Pysca

emergency

motor

vece

(99.5°F),

and

puse

bood

examnaton

pres-

sows

2

et

t

brances

te

crana

nerve

nerve

days

pone

ago

away

Pysca

ear

and

past

nabty

a

crana

and

o

te

dura

to

says

s

rom

pasy

nerve

to

Se

so

er

examnaton

Be

resut

s

6

to

because

monts.

abduct

cornea

mass.

A

growt

structures

or

te

s

relex.

o

te

symptoms

o

s

o

most

n

te

pyscan

tat

ts

severe

ear

tat

et

key

a

t

must

sounds

yperacuss

sde

to

started

se

because

sows

te

because

pan

be

o

te

o

ace.

afected

by

yperacuss?

Hypogossa

Faca

C.

Spna

D.

Vagus

E.

Gossoparyngea

accessory

70-year-od

o

wax)

n

removed

Durng

man

sudden

examnaton

he

pyscan

te

oowng

comes

ear.

B.

A

A

aneurysm

ssure

woman

er

necton

aton

man

ater

te

Wc

te

pouc

coson.

s

s

aowed

to

35-year-od

sure

100/mn,

groove

department

s

a

Wat

parynx

A.

A

s

pressure

orbta

72-year-od

o a severe troat necton. Her temperature s 38.3°C

and

ater

tat

gt.

ssure

C.

was

to

cana

rotundum

o

because

patent?

A.

A

te

or

responsbe

Superor

gr

beng

sows

arge

Wc

an

sows

Foramen

240.

a

just

absence

te

D.

3-year-od

are

pyscan

compressng

to

sows

C.

A

sde

gt

aneurysm?

comes

Maxary

aryngea

artery

eadace

psatera

o

n

s

man

Mandbuar

superor

te

sows

symptoms.

B.

o

te

constrcts.

unresponsve

ead

A.

branc

to

artery,

examnaton

eye

CT

sku

recess.

te

88-year-od

burry

An 82-year-od man comes to te pyscan because o

Pysca

verba

et

Ocuomotor

Prorm

mass.

pup

nerves

examnaton

and

cerebear

or

s

recess

o

basar

to

openng?

non-tender

te

comes

Pysca

dated

compressed

B.

neck

s

angograpy

A.

ard,

woman

pup

responsbe

one

unabe

ods.

or

te

aca

probems.

rgt

te

of

Laryngoscopy

dented

between

CT

tenderness

and

27-year-od

te

examnaton

ods.

te

epderms

o

Pysca

238.

o

pyscan

on

te

crana

aca

dense

te

and

and

dense

to

eye

two

and

he

tacte

385

Neck

tested?

perosteum

comes

rgt

oowng

and

examnaton

Optc

he

patent

te

neuroogc

Optc

D.

te

nto

te

to

observed

B.

C.

and

o

Durng

was

A.

aponeuross

te

drected

Wc

bone

and

ead.

unresponsve

aceraton

te

he

73-year-od

and

s

patent

A

nec-

B.

a

s

tat

perosteum

A

o

days

wound

comatose

eedback.

depart-

anterory

scap

a

regon

hree

emergency

erytematous

ayers

depart-

Pysca

he

on

237.

tender,

wc

n

was

to

emergency

o

spread?

wegt

236.

returns

a

te

back

aceraton

nected

Between

to

te

A.

o

235.

o

on

wound

patent

become

comes

a

he

te

scap.

234.

sows

ater,

as

man

wound

Head

7

te

to

ts

coug

comes

earng

sows

rgt

uy

a

arge

externa

evauate

process

resuts

te

rom

to

oss

te

n

pyscan

s

rgt

amount

acoustc

te

o

patent

begns

o

evau-

Pysca

cerumen

meatus

tympanc

stmuaton

or

ear.

an

(ear-

wc

s

membrane.

to

area

coug.

o

te

386

C H A P T E R

meatus

7

Head

tat

s

and

Neck

nnervated

by

wc

o

te

oowng

acoustc

nerves?

242.

A.

V estbuococear

and

B.

Vagus

unabe

to

C.

T rgemna

crana

nerves

D.

Faca

E.

Accessory

A

A.

30-year-od

o

oarseness

rodectomy

ago.

ca

o

er

or

Pysca

scar.

woman

a

te

Interna

s

Externa

C.

Recurrent

abe

tetc

or

a

tests

o

man

B.

Bnk

C.

Pupary

D.

H-test

E.

Vson

key

te

an

Hs

te

and

V2

E.

V3

taste

75-year-od

panu

sows

to

vta

sgns

sows

are

s

wtn

ansocora.

Wc

o

dferentate

a

nerve

te

o-

248.

sympa-

eson?

s

made.

to

te

key

route

te

Pterygod

and

te

and

cavernous

Wc

a

ocatons

postopera-

o

because

snus,

te

rotundum

D.

Juguar

E.

Superor

acoustc

te

eadng

venous

orbta

50-year-od

o

a

p

and

o

ts

ong

optamc

petrosa

D.

Basar

spread

An

an

because

D.

D

E.

E

3-year-od

o

a

savary

key

A.

surgery

(tumor

at

to

te

sows

et

a

ossa.

o

oss

sde

o

o

s

tumor

on

te

Wc

o

te

n

te

woud

te

a

o

30

resut

o

pyscan

pack-year

acoo

ucerated

te

p.

squamous

rased

o

eptea

wt

are

Pysca

wt

Bopsy

cytopasm

nodes

because

smokng

abuse.

eson

ower

dagnosed

tumor

man

comes

doube

to

abduct

most

n

and

keratn

squamous

rst

to

be

te

ces

ce

afected

ces?

n

to

te

vson.

s

te

key

resutng

boy

panu

(Fg.

structure

ven

te

a

emergency

Pysca

rgt

eye.

arterogram

be

ocated

tese

to

In

depart-

examnaton

wc

(Fg.

o

7.20)

cause

te

te

w

nerve

symptoms/sgns?

A

s

A

to

as

ymp

ndcated

aneurysm

ntra-

250.

because

patent?

arge,

s

te

o

nabty

compresson

B

nectous

oice

baance,

rom

eosnopc

o

84-year-od

Imagng

underwent

o

patent

Juguodgastrc

C

ven

scwannoma

he

an

sde

nests

Submenta

C.

snus

woman

et

E.

necton

pexus

emssary

te

He

story

sows

D.

B.

snus?

surgery?

Occpta

A.

pexus

Superor

on

te

tumor

comes

Parotd

te

s

meatus

eson.

a

sows

te

oroa-

to

Se

oowng

ssure

man

abundant

oreead

structure

te

oramen

A

ocatons

o

vestbue.

o

te

poor

ead

ts

Interna

ower

to

crana

te

by

Retroparyngea

because

te

o

observed

C.

examna-

dagnoss

esons

o

C.

sows

pyscan

durng

ear,

posteror

B.

249.

Pysca

scan

te

to

nerve

ora

Wc

droong

most

gangon

transmsson

Superor

vestbuar

to

and

ovae

A.

gangon

cary

oreead.

ras

C.

Pareta

CT

o

et

Foramen

by

rgt

eye.

comes

s

Foramen

ment

cary

man

n

B.

s

Injury

woud

te

A.

bat.

nerve

abducens

and

B.

87-year-od

move

objects.

structures

treatment

venous

baseba

to

n

rgt

njured

carcnoma. Wc

nerves

and

cavernous

venous

cose

Herpetc

o

a

depart-

condton?

s

compcatons.

by

nabty

on

comes

on

emergency

eye

abducens

nerve

expedtous

spread

te

cary

man

te

nerve

and

vescuar

s

A

sde

pears.

to

was

sensaton,

story

cart)

sows

nerves

ras

a

erpes

oss

oowng

by

te

51-year-od

eson

n

nerve

ong

cary

to

D.

et

pyscan

ocuomotor

ocus

o

nerve

Sort

process

to

ntact.

used

comes

to

cause

Inratrocear

most

are

oowng

E.

a

durng

relex

t

and

te

D.

crana

VII

A

cose

examnaton

beng

Ocuomotor

E.

njured

X

C.

earng

aryngea

examnaton

be

man

SCG

requre

vst.

(readng

C.

An

247.

B.

margns

B.

ton

examnaton

IX

wt

test

T rocear

a

brougt

examnaton

o

be

s

rom

gt

normay

wc

A.

surg-

wtout

relex

ater

Pysca

can

key

water

relex

22-year-od

ment

Pysca

coecton

symptoms

musces

eson

Starte

ca

o

ty-

weeks

aryngea

superor

Pysca

soud

nerve

superor

oow-up

mts.

A.

o

3

we-eang

sps

most

tota

nodue

aryngea

extraocuar

owng

A

a

a

because

aryngea

82-year-od

he

246.

branc

Superor

A.

undergong

tyrod

sows

was

pyscan

ood

mout.

o

Gossoparyngea

eye

te

swaow

nerve

E.

norma

245.

to

D.

A

ater

cancerous

branc

B.

daugter

244.

voce

to

operaton?

A.

An

comes

examnaton

Se

dicuty. Wc

243.

meatus).

tvey sows droopng o te rgt corner o te mout

s

brougt

sweng

7.21)

(arrows)

gand.

sows

wt

Wc

responsbe

on

or

Faca

B.

Aurcuotempora

nterna

C.

Lngua

an

te

pyscan

rgt

te

sde

obstructed

nlammaton

o

te

remove

to

te

o

oowng

pan?

o

and

te

because

s

ace.

enarged

assocated

nerves

s

most

CHAPTER

Head

7

and

387

Neck

A

B

C

D

E

•

•

Fig.

.

Decreased/absent

sensaton

above

B.

Decreased/absent

sensaton

beow

C.

Poory

coordnated

Batera

E.

A

59-year-od

aspect

ead

man

sows

o

s

sows

ydrocepaus.

sorpton

253.

Fig.

.

Vagus

E.

Corda

C.

Subdura

251.

A

o

251–275

persstent

went

ton

a

wt

sows

tat

a

woud

o

be

wt

4

meet

n

te

njury

te

o

wt

et

pyscan

speec.

ago.

scar

sows

te

te

er

mdne.

oowng

expected

to

days

we-eang

aryngoscopy

surgca

Wc

comes

tyrodectomy

Fberoptc

ods

woman

dicuty

on

Pysca

te

and

52-year-od

patent

superor

addtona

to

s

aryngea

nerve?

posteror

mage

oice

crco-

crcoaryte-

te

2

scar

on

ater

Pysca

te

CT

poste-

scan

o

(communcatng)

s

maab-

7.22),

and

to

et

juguar

te

sde

snus

ven

pyscan

o

he

Based

wc

a

sagtta

snus

space

w

as

space

superor

cavernous

weeks.

examnaton

weeks

structures

subdura

monts.

abnormates

2

tumor.

postoperatve

and

comes

on

past

(Fg.

te

wc

snus

severa

te

to

A

Contraatera

o

te

o

most

drect

devaton

sot

s

ump

on

be

o

n

te

neu-

sown

te

o

neck

become

mass

oowng

key

resut

and

as

te

te

because

ace

on

growng

B.

Ipsatera

devaton

voca

C.

Ipsatera

pupary

D.

Ipsatera

weakness

n

E.

Ipsatera

weakness

n

nerve.

254.

A

s

55-year-od

brougt

to

man

te

o

te

uvua

durng

eeva-

paate

neck.

ndngs

et

branstem

subdura

man

ump

past

n

ton

dagnosed

abnorma

ts

A.

examna-

anteror

posteror

mass?

under-

norma-appearng

he

njury

because

Se

ods

occur?

and

sagtta

pysca

44-year-od

space

Superor

growng

to

and

Epdura

CT

te

we-eang

space

E.

roogc

Questions

pexus

D.

te

te

a

Between

Subaracnod

panu

ods

voca

relex

nonobstructve

key

Corod

a

tympan

a

B.

or

D.

most

a

o

ead.

A.

A

o

comes

resecton

examnaton

te

voca

te

musce

undergong

ror

o

te

musces

Weakness/parayss

nod

swaowng

weakness/parayss

arytenod

•

.

A.

D.

252.

Fig.

on

protracton

constrcton

wt

eevaton

tgt

a

o

o

te

tongue

parta

te

cosure

story

emergency

o

and

o

te

eyeds

cocane

department

ptoss

mandbe

abuse

because

o

388

C H A P T E R

severe

7

Head

and

uncontroed

Neck

beedng

rom

s

nose.

Pysca

as

o

et

nerve

nasa

beedng

cavty.

ts

A.

n

nasa

endoscopy

Kessebac

between

wc

area.

arteres

sows

te

Anastomotc

are

nvoved

n

Posteror

and

superor

ascendng

aveoar

one

accessory

B.

Latera

de

D.

anteror

o

department

s

superor

md-

aba,

tonsar

brances

and

o

te

bood

a

durng

past

week.

s

te

te

and

coug

44-year-od

te

nerve

paatne

tonsar

ossa

Wc

needs

to

be

surgery?

may

resut

260.

A

49-year-od

Externa

aryngea

naton

sows

ment.

open

sows

no

nodues

Wc

te

obvous

on

o

rma

te

te

dicuty

te

tan

ndngs.

voca

cords

oowng

because

Pysca

A

wt

move-

unctons

to

gottds?

E.

Rgt

Crcotyrods

daugter.

ness.

srug

to

Sorty

Pysca

s

te

souder

et.

arge

A

CT

aneurysm

responsbe

or

ng

s

arteres

A.

Superor

B.

Posteror

C.

Anteror

D.

Posteror

E.

Basar

A

department

arrvng,

te

scan

o

s

te

on

an

rgt

o

e

sows

te

artery

symptoms.

aneurysm

emergency

regans

tat

sde

e

and

ead

wc

sows

te

s

neck

o

te

te

to

et

ead

se

sows

nerve

oow-

ocated?

neror

because

ated

cerebear

s

o

and

A.

brougt

an

acute

dicuty

to

te

onset

wt

o

emergency

uncoord-

ponaton.

Se

s

a

te

voca

te

voca

to

te

pyscan

ods

ods

because

examnaton

te

te

et

gag

rgt

rgt.

sde

sde

to

te

s

s

sows

Pysca

o

relex

njured

er

area

teet

wde

o

A

spasm

sows

pa-

weaker

touced.

cause

et

s

tese

Masseter

Myoyod

D.

Posteror

E.

Latera

bey

o

pterygod

o

musces

te

noted

s

dgastrc

te

wen

to

a

on

per-

ndcatve

mandbuar

most

to

sows

dicut

tgtness.

are

se

condye

tgtness

et

area

wen

sgty

s

se

concerned

examnaton

s

regon

tat

examnaton

mandbuar

condton?

C.

s

because

te

says

panu

sound

Buccnator

B.

Se

devates

here

te

n

Pysca

depresson

oter

oowng

ts

jaw

pyscan

pan

patent

t

sng.

Pysca

te

aong

no

he

and

to

te

pan.

te

and

cckng

mout.

o

to

(bruxsm).

snger,

around

te

wt

ear.

Mandbuar

musce

o

comes

eadace

et

sde

because

wc

cerebear

er

et

papaton.

a

and

mout

opens

orm

o

eevaton.

Papaton

woman

swaowng

on

panu

o

cerebra

neror

se

conscous-

compressng

In

because

woman

jaw

grnds

er

turn

and

et

opens

unabe

ptc

gossoparyngea

stor y

s

s

by

cerebear

64-year-od

nated

ater

examnaton

te

poor

vagus

A 40-year-od

oten

to

wt

V3

E.

unconscous

on

Let

er

ound

te

te

key

D.

o

brougt

most

gossoparyngea

T ransverse

261.

was

mucosa

s

to

wen

touced,

Rgt

D.

s

te

tat

s

C.

3-day

e

sows

vagus

o

man

ts

symptoms?

relex

devates

Let

hyroarytenods

because

uvua

Let

C.

a

crcoarytenods

61-year-od

njury

to

od

voce

Pysca

B.

Latera

department

sows

njury

oowng

voca

comes

A.

Posteror

A

woman

nerve

B.

arytenods

te

te

atgued

swaowng.

mucosa

A.

crcoarytenods

easy

o

An

weeks

bengn

symptoms?

aryngoscopy

musces

abduct

patent’s

wen

Wc

exam-

norma

wc

nerve.

2

mutpe

examnaton

aryngea

n

pyscan

or

coug

E.

oarseness.

te

Decreased/absent

ryngea

o

to

E.

examnaton

aryngea

story

expresson

oroparynx

beow

Interna

1-mont

comes

Pysca

te

above

Gossoparyngea

a

to

n

sensaton

D.

pyscan

on

relex

sensaton

C.

te

aca

Decreased/absent

tat

to

o

Decreased/absent

Hypogossa

comes

patent

oowng

mastcaton

D.

B.

man

o

C.

o

39-year-od

ts

te

probems

tyrodectomy

externa

Vagus

A

scan

crana

n

o

CT

he

contro

tonss

perormed.

a

nodues.

et

baance

woman

Monotone,

Hg.

and

undergong

Inabty

s

musces

Decreased/absent

B.

swoen

o

E.

A

oss

A.

mm

musces

sensaton

to

di-

o

Decreased/absent

respratons

139/80

wc

Hearng

temperature

s

A

stroke.

dysuncton

D.

ater

emergency

troat,

te

produce

C.

Her

pressure

sows

te

dabetes.

sde

100/mn,

tonsectomy

wtn

to

sore

puse

examnaton

and

brougt

ever,

te

one

tyrod

s

or

aso

II

branstem

sde

A.

o

258.

and

o

or

and

coursng

spared

257.

woman

(100.4°F),

bateray

nerve

and

259.

paatne

because

19/mn,

Pysca

256.

spenopaatne,

swaowng

38°C

are

etmoda

paryngea

49-year-od

cuty

posteror

etmoda

Descendng

ascendng

A

o

menngea

Brances

E.

on

brances

key

type

a

Weakness/parayss

menngea

C.

responsbe

most

o

sows

Weakness/parayss

paryngea

and

story

ead

symptoms?

A.

paatne

ong

te

w

condton?

Descendng

B.

Fexbe

orgnates

connectons

255.

a

examnaton sows brgt red bood drppng rom s

ramus.

Spasms

key

o

assoc-

CHAPTER

262.

A

62-year-od

woman

comes

to

te

pyscan

or

Head

7

and

Neck

a B

routne

examnaton.

se

naes

ces

tat

Bockade

w

ar

w

contanng

adere

o

most

Durng

to

aferent

key

a

o

dferent

mucus

ts

te

n

coug

amounts

prmary

neurons

suppress

test

n

wc

woman’s

relex,

o

te

part-

tracea.

crana

coug

nerve

relex? A

A.

Gossoparyngea

B.

Hypogossa

C.

Externa

D.

T rgemna

E.

Vagus

aryngea

C

263.

Durng

neuroogca

examnaton

woman,

te

strokes

patent’s

ten

nea

pyscan

et

cornea

strokes

and

te

bot

wtout

cotton

eyes

a

a

wsp

a

o

he

te

27-year-od

cotton

response.

across

bnk.

o

he

patent’s

most

key

across

a

pyscan

rgt

cor-

expanaton E

o

tese

crana

A.

264.

ndngs

nerves

on

damage

te

to

wc

o

te

oowng

et?

D

Optc

B.

Ocuomotor

C.

T rgemna

D.

Abducens

E.

Faca

A

s

12-year-od

parents

temperature

ratons

gr

because

are

s

s

o

a

brougt

sore

37.7°C

20/mn,

to

neck

(99.9°F),

and

te

or

bood

pyscan

te

past

puse

s

pressure

4

by

days.

95/mn,

s

•

Fig.

.

•

Fig.

.

er

Her

resp-

120/80

mm

Hg. Pysca examnaton sows a tender sweng ante-

ror

An

to,

and

aong

tract

wc

tssue

owng

265.

above,

te

must

two

tyrod

be

tyrod

to

ts

patent’s

Rgt

obe

o

tyrod

C.

Rgt

obe

o

tyrod

D.

hyrod

stmus

and

oramen

cecum

E.

hyrod

stmus

and

prorm

recess

wen

story

readng

Pysca

a

te

A.

o

arge

posteror

nerve

o

a

n

(Fg.

or

eye.

n

A

CT

one

o

7.23)

s

te

down

o

scan

te

tat

symptoms.

In

because

becomes

weakness

crcuaton

te

tat

o-

bone

pyscan

wakng

sows

et

cerebra

resutng

dagram

yod

vson

te

te

ossa

and

te

tract

o

condton?

tonsar

gand

newspaper

te

o

epgotts

doube

aneurysm

A

and

to

neck.

te

gand

comes

examnaton

movement

sows

man

and

te

n

wc

B.

34-year-od

gand

o

cyst

descended.

between

treat

tyrod

a

Let

A

o

notc

sows

gand

removed

structures

obe

te

examnaton

A.

2-week

266.

just

utrasound

te

stars.

downward

o

te

arteres

ead

o

compresses

wc

aneurysm

o

worse

te

te

artery

n

ocated?

compressng

Wc

A

o

nerve

responsbe

oowng

descrbes

or

te

te

symptoms.

ocaton

o

te

aneurysm?

B.

B

A.

Interna

C.

C

B.

Dvson

D.

D

E.

E

and

C.

A 63-year-od woman comes to te emergency depart-

ment

te

te

because

examnaton

o

droopng

sows

depressed

wt

sows

aneurysm

an

an

te

o

et

absent

te

eye

gt

(arrow,

et

s

relex.

Fg.

eye.

Pysca

abducted

7.24)

o

an

D.

and

Angograpy

artery

Let

ar

o

te

anteror

artery

cerebra

vertebra

n

nterna

artery

te

cavernous

carotd

artery

snus

nto

mdde

arteres

at

te

juncton

wt

te

bas-

artery

Unon

basar

E.

carotd

Basar

and

o

et

and

rgt

vertebra

arteres

ormng

artery

artery

posteror

between

cerebra

te

et

arteres

superor

cerebear

389

390

C H A P T E R

7

Head

and

Neck

C

D

B

E

A

•

Fig.

.

•

267.

ment

because

sows

te

te

ocatons

an

nerve

doube

to

ndcated

aneurysm

PCA

B.

Interna

C.

Externa

carotd

D.

Anteror

cerebra

E.

Posteror

sows

An

or

a

carotd

by

.

examnaton

eye.

In

arterogram

key

resutng

be

n

wc

(Fg.

ocated

tese

to

o

270.

A

10-year-od

past

puse

s

te

past

2

at

ts

resutng

ndngs

on

to

abduct

B.

Inabty

to

depress

Loss

o

E.

Vsua

cornea

A

te

te

te

emergency

eadaces

CT

scan

(Fg.

woud

n

s

to

o

o

o

and

te

7.26,

most

wc

neuroogc

Inabty

Ptoss

artery

aneurysm

ocaton

A.

D.

n

monts.

(berry)

compresson

C.

here

brougt

5

days.

te

s

te

tympanc

s

nected,

most

ed

A.

Cavernous

B.

Pterygod

C.

Sgmod

D.

Stragt

E.

Superor

cause

oowng

eye

271.

eye

A

sensaton

s

s

37.2°C

te

brougt

to

te

emergency

depart-

examnng?

baseba

bat

grap

scan

o

arrow

ng

(Fg.

te

n

to

s

sows

7.27B)

ead

te

s

et

wen

sows

mage

most

eye

eyes

(Fg.

a

durng

move

asked

to

racture,

7.27A).

practce.

seen

gaze

as

n

Pysca

te

poto-

upward.

ndcated

Wc

o

te

A

by

T ransverse

te

C.

Fronta

Spenod

E.

Etmod

Levator

papebrae

B.

Ineror

obque

s

C.

Ineror

rectus

sgns

D.

Meda

E.

Superor

rectus

272.

A

are

o

te

a

and

te

tat

arrow

ts

venous

drect

area

can-

resut

o

bone?

pexus

snus

brougt

puse

and

s

nto

a

te

te

area

patent’s

areas

te

ever.

90/mn,

examnaton

s

oice

Hs

and

sows

respratons

tenderness

sgty

superor

eyebrows.

te

because

o

temperature

to

Wc

pyscan

most

are

wen

te

o

te

key

snus

snus

snus

boy

was

because

wtn

examnaton,

cess

as

red

efuson.

snus

12-year-od

moter

oowng

by

Pysca

a

snus

D.

A.

ndcated

Assumng

tromboss

nose,

anatomc

Maxary

oow-

s

taps

o

B.

afected?

superors

boy

A.

s

te

wt

puruent

nected/nlamed

petrosa

CT

musces

rectus

key

as

area

7.28).

o

boy

wt

(102.5°F),

18/mn.

snus

pyscan

by

39.16°C

snus

(99°F),

oowng

a

depart-

snus

Pysca

mdporton

or

te

runny

ment because o pan and burred vson ater e was t

examnaton

emergency

are

appearng

te

wc

venous

12-year-od

eadaces,



(Fg.

rsk

to

ead

dects

boy

at

proxmty

an

over

CT

s

respratons

membrane

tenderness

18/mn.

16-year-od

te

temperature

and

sows

corona

now

nes

dz-

examnaton?

adducted

te

Hs

98/mn,

arrow).

key

to

te

bugng

because

brougt

cause

symptoms?

artery

s

s

ment because o severe ear pan, eadace, and ever or

artery

we

boy

7.25)

artery

man

s

saccuar

addtona

A

te

communcatng

aneurysm

nerve

n

Pysca

rgt

examnaton

49-year-od

zness

er

most

A.

A

vson.

abduct

compresson

department

269.

o

nabty

woud

268.

Fig.

A 75-year-od woman comes to te emergency depart-

te

o

brougt

pan

norma

pyscan

adoescent

wt

to

bend

mts.

papates

te

s

pyscan

ear.

Durng

te

tenderness

Hs

by

vta

pysca

mastod

ected

pro-

upon

CHAPTER

274.

C.

Sort

D.

Optamc

E.

Anteror

A

posteror

cary

and

391

Neck

artery

artery

cary

16-year-od

Head

7

gr

artery

s

brougt

to

te

pyscan

because

o

oss o sensaton on te et sde o er ead. Se says tat

we

at

a

party

ast

ngt,

se

asked

er

rend

to

perce

te tragus o er et ear. We attemptng to pass a nee-

de

troug

deepy

Pysca

Wc

275.

tragus,

te

sde

o

te

Lesser

o

te

skn

examnaton

tempora

A.

te

punctures

er

sows

scap

oowng

oss

up

to

nerves

s

sps

and

anteror

o

to

te

neede

te

tragus.

sensaton

te

vertex

most

on

o

key

te

er

et

ead.

damaged?

occpta

B.

Greater

C.

Aurcuotempora

occpta

D.

Zygomatcotempora

E.

Great

A

rend

drecty

aurcuar

27-year-od

woman

s

brougt

to

te

emergency

department because o rngng n s ear and a droopng

A

sme. Pysca examnaton sows oss o et nasoaba

od

er

and

acoustc

s

asymmetry

ead

most

A.

sows

a

meatus.

key

o

te

sma

Wc

beng

patents

tumor

o

te

sme.

ocated

at

oowng

compressed

by

te

An

te

MRI

o

nterna

crana

nerves

tumor?

V

B.

VI

C.

VII

D.

IX

E.

X

B

•

Fig.

7.27

Questions

AB

276.

A

276–300

62-year-od

s

we

canges.

Pysca

Hs

sows

crbrorm

oowng

ts

•

papaton.

can

273.

Wc

o

Fig.

te

.

oowng

bones

s

te

pys-

papatng?

patent

Loss

C.

Dicuty

D.

Loss

o

sme

Loss

o

earng

C.

T empora

department

D.

Pareta

guardra.

E.

Spenod

tne

examnaton.

ton

sows

brancng

hese

te

s

cear

An

macua

arteres

arteres

comes

are

to

te

optamoscopc

utea,

emanatng

most

key

optc

Centra

B.

Long

retna

posteror

dsc,

rom

derved

te

or

a

rou-

examna-

and

severa

optc

rom

dsc.

wc

o

artery

cary

artery

o

s

scan

o

Wc

o

aged

ts

n

man

s

s

an

MRI

crsta

bone.

o

ga

Wc

addtona

brougt

mm

ead

te

Spenod

B.

T empora

C.

Occpta

and

a

oowng

patent?

are

Hg.

sows

to

motorcyce

temperature

aceratons

s

be

An

te

mts.

memory

o

te

and

te

symptom

musces

respratons

100/80

mutpe

gat.

etmod

key

aca

ater

Hs

110/mn,

sure

te

norma

nattentveness,

near

by

beavora

swaowng

20-year-od

A.

oowng?

A.

pyscan

wtn

pyscan

and

vson

Zygomatc

man

tumor

te

experences?

Occpta

45-year-od

o

most

B.

E.

are

sows

to

wakng

broad-based

Parayss

o

brougt

sgns

bran

pate

B.

A

and

a

A.

A

s

dicuty

vta

w

A.

277.

o

examnaton

mparment,

ead

man

because

s

te

37.5°C

27/mn,

Pysca

bruses

racture

bones

emergency

sammed

nto

(99.5°F),

and

bood

examnaton

on

o

was

te

te

ace.

sea

most

a

puse

pres-

sows

A

CT

turcca.

key

dam-

392

C H A P T E R

278.

Head

Neck

Etmod

C.

Parayss

o

E.

Fronta

D.

Parayss

o

E.

Parayss

o

A

21-year-od

days

ago,

e

s

ead

medca

ture

s

tons

CT

sagtta

wt

o

snus.

ead

Intercavernous

Ineror

sagtta

C.

Dpoc

ven

D.

Basa

E.

Emssary

department

ton

Hs

to

cose

V ertebra

B.

Common

C.

Parotd

necton

oowng

patent’s

o

te

vens

current

mm

man.

A

Latera

s

cut

sgns

n

te

ts

te

ace

most

and

sme

structures

He

on

was

te

most

musce

man

s

puse

pressure

s

sows

a

5-cm

sows

a

racture

s

on

a

bow

arrva.

80/mn,

130/60

scap

n

to

te

Hs

emergency

back

mm

Hg.

are

CT

bone

depart-

te

s

A.

B.

scan

o

te

extendng

ead

C.

A.

281.

s

transmtted

Crana

nerve

Crana

nerve

IX

C.

Crana

nerve

X

Crana

nerve

XI

Crana

nerve

XII

upper

se

era

te

ror

7

to

tat

te

Loss

s

brougt

Se

most

Se

a

to

on

pyscan

story

and

s

te

repeated

snce

bat-

te

ossa

rom

posteror

a

tonsts

damaged.

resut

o

or

undergoes

perormng

tonsar

tons

sensaton

as

te

subsequenty

te

key

to

nectons

We

n

paatne

s

o

es

procedure,

deep

and

Wc

ts

one

ne-

o

te

njury?

Loss

o

tongue

A

te

er

was

30

bood

saturaton

he

wt

parynx.

A

made

puse

s

s

approx-

a

swoen

patent

oxy-

bag-mask

ven-

because

o

massve

decson

Ater

s

papaton

andmarks,

at

try-

mnutes

pressure

s

sows

mout.

mprove

be

emergency

Se

(99.68°F),

28/mn,

approprate

key

te

town

examnaton

er

te

n

37.6°C

oxygen

o

membrane,

te

he

wc

wc

and

membrane,

cartage

te

made

o

an

o

te

nc-

te

o-

s

ocated

at

sternum

wc

and

membrane,

tyrod

bone

sterna

te

he

cavce

tyrod

te

yod

te

s

ocated

crcod

car-

cartage

wc

(Adam’s

s

ocated

appe)

and

above

notc,

cavce

tracea,

26-year-od

trd

o

s

wc

and

te

wc

s

te

90/60

Pysca

and

an

s

s

ocated

at

te

juncton

sternum

ocated

touces

most

on

te

anteror

two-trds

o

te

s

brougt

beng

nvoved

temperature

respratons

mm

Hg,

and

examnaton

ntubaton

nserted

te

man

ater

Hs

110/mn,

te

key

rom

beow

oxygen

a

te

te

te

crcod

s

A.

Vagus

B.

Gossoparyngea

bood

n

and

oowng

sense

s

82%.

dstress

he

and

puse

pressure

acute

ntated.

pan

vece

(99.68°F),

anestesa

to

emergency

motor

saturaton

patent

patent

procedure?

te

a

28/mn,

causng

o

to

n

37.6°C

wtout

Wc

te

are

sows

epgotts

aows

s

procedure

mmedatey

patent.

comort

taste

o

to

unsuccessu

tyroyod

coson.

to

tongue

B.

s

musce?

beow

department

tract

od.

tonsectomy.

nerve

284.

examnaton.

years

oowng

A.

gr

respratory

was

D.

ts

o

cartage

E.

oow-up

oramen?

E.

D.

11-year-od

ts

te

o

B.

An

troug

oowng

to

breatng.

crcotyrotomy.

most

between

I

s

crcotyrod

he

super-

neck.

mucosa

musce

brougt

s

not

crcotyrod

tage

ory rom te oramen magnum. Wc o te oowng

structures

edema

between

examnaton

s

rom

does

juncton

he

and

te

te

Pysca

te

ocatons?

te

39.5°C

n

as

years.

musce

are

and

Intubaton

soud

o

atera

restaurant

Pysca

denty

he

ead.

15/mn,

Pysca

A

occpta

o

temperature

respratons

ematoma.

te

te

to

new

protrudng

owng

brougt

sustanng

a

Hg,

a

mts.

overyng

He

45

musce

respratons

tssue

because

musce

temperature

perorm

past

nodes

Wc

dicuty

tongue

son

musce

wt

saturaton

te

norma

poyp

woman

at

pyscan

oarseness.

or

ymp

crcoarytenod

mm

to

a

arytenod

80%.

neck

wtn

parynx

paate

musce

matey

to

day

crcoarytenod

ood

te

mmedatey

hyroarytenod

sot

per

musce.

ocated

to

progressve

rm

sows

E.

Her

o

are

Obque

out

comes

sows

Posteror

taton.

artery

tongue

D.

gen

patent?

te

C.

120/80

s

o

Latera

105/mn,

acera-

ceek.

musces

Aryepgottc

ago.

mts.

te

B.

ng

broken

10-cm

rgt

cannot

oowng

a

norma

deep,

s

emergency

sot

cgarettes

34-year-od

te

te

A.

A

o

o

vocas

key

musces

musces

sgns

rgt

most

necton?

wt

wtn

a

across

eye

to

te

are

sows

rgt

o

n

unconscous

(103.1°F),

brougt

beng

vta

pterygod

25-year-od

ater

te

constrctor

te

story

12

vta

te

man

Laryngoscopy

superor

was

2-mont

examnaton

gand

T emporas

bood

s

carotd

E.

s

etargc

o

Hs

respra-

90/60

70-year-od

smoked

artery

D.

He

a

s

not

tempera-

110/mn,

pressure

sows

dd

A

department

obquey

damaged

ment

Hs

we

snus

examnaton

A.

A

s

man

282.

snus

man

sde. Wc

key

he

scap

Fve

ven

runnng

rgt

s

njury.

depart-

nausea.

283.

ater

botte.

unabe

ts

te

ts

on

bade.

puse

an

and

ven

20-year-od

Pysca

o

or

emergency

cut

bood

sows

Wc

responsbe

B.

gass

or

examnaton

s

te

deep

razor

and

A.

A

a

a

to

eadace

(103.1°F),

27/mn,

Pysca

scan

comes

severe

attenton

39.5°C

are

key

o

sustaned

seek

Hg.

man

because

savng

280.

and

D.

ment

279.

7

tube

te

s

tube

dscomort

crana

pan

nerves

and

ds-

CHAPTER

285.

C.

V estbuococear

A.

Weak

abducton

and

D.

Hypogossa

B.

Weak

adducton

o

E.

Faca

C.

Weak

adducton

and

D.

Weak

abducton

o

te

rgt

Weak

abducton

o

te

et

A

a

55-year-od

3-mont

man

story

strange

buzzng

naton

sows

sme,

CT

and

scan

Wc

ton

A.

o

o

n

s

rgt-sded

te

te

te

to

ead

te

earng

nose

decreased

o

o

comes

oss

rgt

and

ear.

earng

cornea

sows

oowng

pyscan

arge

w

n

exam-

E.

289.

asymmetrc

s

rgt

ntracrana

most

o

contnuous

Pysca

oss,

relex

a

a

because

key

be

eye.

A

eadaces.

pressure

oca-

ratons

tumor?

Between

ma

te

medua

and

te

cerebear

286.

Above

C.

Over

D.

Between

te

cerebeum

E.

Between

te

cerebear

A

te

atera

28-year-od

o

pan

mts.

n

tact

er

ear.

nto

te

ts

te

to

vta

meatus.

externa

posteror

te

te

sgns

sows

As

te

acoustc

wa,

pons

pyscan

are

te

eatures

because

wtn

meatus

n

at

s

Burred

te

te

C.

con-

nerves

287.

was

most

stmuated

by

te

specuum?

vson

Inabty

Loss

o

290.

A

to

rom

o

et

detect

ceek,

and

man

bood

and

te

o

no

te

artery

on

descrbes

nor-

sows

basar

mgt

resp-

sows

angograpy

mdbran

best

severe

te

te

at

rgt

cnca

sow?

eye

rgt

eye

and

u

ptoss

o

atera

eds

o

rgt

eye

and

eye

odors

o

troug

te

skn

te

over

rgt

te

nostr

rgt

ore-

mandbe

comes

T rgemna

sensaton over te scap n te posteror tempora regon

D.

Faca

and skn over te aurce anterory . here s weak atera

E.

Accessory

devaton

weeks

artery

an

e

nnervated

A.

te

gated.

adjacent

s

a

s

te

pyscan

tyrod

tota

a

Wc

ts

to

procedure,

here

nerve.

by

o

undergoes

Durng

s

comes

examnaton

ater

cedure.

man

te

superor

te

about

oowng

a

oter

pro-

A.

njury

te

to

B.

nerve?

crcoarytenod

C.

Inabty

D.

Decreased

Latera

Posteror

D.

Crcotyrod

department

E.

V ocas

sde

55-year-od

eadaces.

poba.

pressure

s

pratons

woman

ment

no

te

at

as

155/95

are

te

bran

sde.

ment

and

n

neck

sows

best

patent

s

no

comes

a

s

on

a

o

descrbes

mgt

Hg,

and

neck

te

to

te

sow?

stfness,

or

s

examnaton

dstress.

and

A

and

Range

o

basar

medua

on

neurosurgeon

cnca

Wc

eatures

o

wt

or

te

rgt.

A

CT

oss

scan

o

o

er

key

te

afected

corner

over

sense

to

te

te

o

n

ts

te

upper

o

over

te

n

patent?

rgt

p

te

sde

o

and

to

te

et

a

rgt

eye

gand

eye

to

and

te

emergency

pan

over

sows

mandbe

wc

cnca

a

te

mass

was

et

tender,

anteror

yperecoc

duct,

oter

te

to

te

wtn

dstended

eatures

are

most

patent?

a

A.

Weak

B.

Compete

sows

C.

Numbness o te skn over te et ower mandbe

D.

Excessve

tearng

E.

Pan

te

o

arter y

rgt

assess-

oow-

wc

ts

devaton

n

parotd

examnaton

sows

ts

rgt

sweng

parotd

Wat

body

te

comes

Pysca

utrasound

present

rom

woman

because

o

oregn

abduct

ace.

umen

a

secreton

sweng

An

key

o

move-

te

te

o

proxmay.

res-

angograpy

te

te

bood

sows

o

undoscopy

CT

ear.

poto-

and

Inabty

to

40-year-od

warm

severe

99/mn,

management.

te

o

puse

branc

pons

emergency

(99.32°F),

retna.

dated

te

stor y

37.4°C

norma,

te

reerred

urter

s

Pysca

pan

to

2-week

ever,

mm

20/mn.

s

juncton

Se

o

temperature

abnormates

te

ng

Se

wo

o

woman

because

Her

E.

A

most

sensaton

C.

department

to

nsde

sows

teet

B.

291.

are

eevaton

o

upper

hyroarytenod

A

mandbe

examnaton

te

mout

Loss

s

crcoarytenod

te

unctons

Weak

tyrod

musces

o

and

te bran sows a mass n te nratempora ossa. Wat

hree

tyrodectomy

concern

o

cancer.

or

jaw

numb-

C.

Pysca

ower

wt

o

60-year-od

te

pyscan

Vagus

ceek.

o

te

B.

rgt

sde

to

ness

A

rgt

o

(96.8°F),

V estbuococear

te

te

o

rgt

te

emergency

Fundoscopy

patent

te

eye

eyed

sensaton

60-year-od

to

o

rom

upper

eds

E.

ead,

ts

te

story

110/mn,

CT

and

eye

A.

oow-up

288.

key

o

A

oowng

vson

D.

and s eeng dzzy. Irrtaton o wc o te oowng

te

wc

rgt

examnaton

branc

pons

abducton

meda

cougng

o

te

to

puse

retna.

te

36°C

movements.

te

rgt

eye

s

Pysca

dated

o

rgt

Loss

ntro-

cose

starts

Weak

B.

o

a

wt

A.

norma

erytema

specuum

patent

sows

juncton

sde. Wc

atera

pedunces

comes

Her

ssure

and

examnaton

acoustc

wt

seae

emsperc

woman

Pysca

externa

duced

dapragma

neck

o

2-week

Hg,

te

393

Neck

eye

comes

a

o

and

eye

eevaton

o

mm

16/mn.

o

et

temperature

160/89

range

bran

B.

Her

are

depresson

te

woman

because

abnormates

emspere

te

65-year-od

department

tumor.

te

A

Head

7

over

o

ptoss

te

o

mandbe

te

anteror

et

to

te

rgt

eyed

aurce,

tragus,

and

anteror

ex

292.

A

40-year-od

man

department

ater

te

5

ground

norma

mts.

s

ang

eet

brougt

troug

beow.

Pysca

Hs

to

a

vta

te

gass

sgns

examnaton

emergency

wndow

are

sows

to

wtn

mutpe

394

C H A P T E R

7

Head

superca

tes

o

aceratons

bones

or

ongtudna

o

te

CT

scan

A.

te

to

be

Weak

devaton

Numbness

et

s

cavty.

ead

o

to

te

te

and

body

B.

Latera

pterygod

C.

Savaton;

D.

rgt

tragus

and

sde

and

o

s

te

o

e

te

cear

E.

ex

te

o

ante-

te

and

w

regans

a

A

o

ace

root

o

was

sons

6

a

te

body.

nose

a

ossa.

patent

A

and

rom

n

6

aert

s

cm

ear.

A

ossa

te

owng

conscousness?

n

B.

Postsynaptc

o

C.

a

eye

te

taned

man

ater

s

puse

severa

n

ts

B.

Abty

C.

Sensaton

over

D.

Sensaton

to

E.

Abty

abduct

A

rom

coson.

da.

sve

patent

body.

were

te

He

Pysca

here

as

s

s

te

n

Hs

posteror

ceek

and

o

rgt

sde

te

ber

o

skn

emergency

rgt

te

te

o

te

te

s

a

a

bone

and

o

te

mnmay

mdde

are

abra-

tender

ex

Wc

tat

and

vta

examnaton

sows

cana.

gt

Hs

mutpe

here

o

a

ncdent

ead

tempora

ead

types

wt

knee.

wt

mbs.

loor

o

Pysca

aspect

te

te

rgt

man

ower

te

to

and

pterygod

a

tempora

coded

events

mts.

o

o

crana

te

most

o-

key

parasympatetc

sympatetc;

Postsynaptc

presynaptc

sympatetc;

are

23/

One

postsynaptc

key

o

nar-

man

man-

te

body

te

gand

on

te

dsta

scap

eye

brougt

nvoved

bood

severa

a

aceratons

o

aong

te

a

o

te

te

emergency

motor

pressure

sows

deormty

mobty

to

n

and

tacycar-

poory

on

te

s

rgt

bone

ramus.

s

A

vece

respon-

ace

and

mandbe

noted

CT

wen

scan

o

298.

a

to

24

n

s

to

n

wound

e

open

was

was

te

cana.

o

ts

B.

Movements

C.

Secretons

rom

te

submandbuar

D.

Secretons

rom

te

subngua

E.

Secretons

rom

te

20-year-od

department

and,

ng

and

rom

scousness.

rgt

woman

wt

ebow,

er

te

pan

as

orse.

Pysca

two-trds

sde

acrma

s

Se

te

as

says

te

o

te

te

oowng

te

tongue

ace

gand

gand

gand

brougt

on

we

o

con-

troug

eson?

T aste

o

over

receved

ndngs

passng

by

and

he

exam-

sweng

patent

Wc

spared

anteror

rrgated

Pysca

sows

nerve

co-

racture

dscarged.

dstress.

were

swe-

eadace.

motorcyce

erytematous

te

be

a

emergency

ever,

and

A.

A

te

o

ead,

examnaton

o

te

dspaced

panu

aca

key

rom

he

bone

neurts

te

s

ours

tender

Neuroogc

o

o

to

story

nvoved

bone.

tempora

part

5-day

was

be

a

o

parasympatetc

brougt

mnmay

ater

sows

unctons

eyed

and

wt

s

tempe

e

ad

tempora

rgt

sstent

cornea

ago

appears

naton

sutures.

acrma

anteror

rgt

debrded

Wc

be

and

man

rgt

parasympatetc

postsynaptc

because

te

week

son

ead

wt

area.

over

postsynaptc

sensory;

20-year-od

ng

body.

te

A

sensory;

department

90/83

and

o

orbt

te

297.

responsve

ace

scan

most

s

papated

poory

s

o

beng

bony

abnorma

bone

rgt

examnaton

a

pressure

CT

orbt

oregn

ow

a

on

w

scafod.

respratons

a

apex

te

upper

man

wt

s

a

te

te

ater

and

emergency

patent?

te

detect

30-year-od

department

to

unctons

Secretons

to

te

te

budng

sows

stabzed,

near

to

bood

aceratons

s

openng

spared

a

(96.8°F),

A.

to

rom

110/mn,

oowng

or

brougt

examnaton

patent

te

s

ang

36°C

racture

o

anteror

parasympatetc

30-year-od

rowng

sde

te

parasympatetc

Speca

sows

te

njury?

Presynaptc

Genera

and

et

rom

anteror

a

ebow,

over

te

ts

te

superor

scan

A.

E.

te

CT

descrbes

afected

key

reca

and

racture

D.

Once

over

orented

te

nvovng

Dry

patent

o

Wc

afected?

te

brougt

norma

and

to

to

on

sweng

Bndness

Pysca

to

motorcyce

rgt

upper

aceraton

dspaced

o

Wc

most

×

to

rgt

te

CT

racture

crana

ow

wtn

an

E.

Hg,

be

taste

rom

s

s

pan

back,

D.

mn.

racture

mandbe.

ear

man

unabe

ees

are

sows

te

ater

was

ower

sgns

examnaton

dranng

a

as

e

and

and

stabzed,

sows

te

He

He

Dpopa

mm

jaw

and

skn

sensaton

Anosma

temperature

rom

tragus

C.

department

te

key

te

Savaton;

B.

A

o

sensaton

20-year-od

vson

et

o

jaw

and

ace,

motor

seatbet

seat.

s

anteror

sgns

transverse

ange

most

te

devaton

department

emergency

ead-on

Pysca

lud

patent

perormed

regon

Burred

aso

a

drver’s

about

over

n

te

wearng

tacycarda.

aceratons

Once

once

not

te

te

w

o

Sensaton

and

to

nvoved

n

dspaced,

to

tongue

sava

was

here

was

Eevaton

are

a

oowng

A.

ndngs

mucosa

brougt

beng

He

oowng

descrbe

A.

cnca

te

A

oregn

atera

o

sows

proxma

tongue

o

skn

s

papated

gabea.

te

cm

body.

patent?

jaw

skn

unconscous

severa

mdde

o

ater

pressure

“step-of”

te

Exporaton

oregn

ead

ramus

poe.

coson.

ound

nasa

2

te

te

5-cm

ceek

department

te

ts

a

a

jaw

te

te

man

sows

×

o

jaw.

o

deorm-

was

296.

over

voume

bood

3

no

ear

Decreased

was

n

but

here

et

oowng

te

30-year-od

vece

a

eads

te

o

over

Numbness

E.

A

sows

ound

C.

te

presence

two

o

mbs,

evdent.

over

te

te

B.

ror

295.

o

eevaton

te

294.

te

te

were

ead

Weak

D.

293.

sows

Wc

key

on

jonts

between

musce.

most

o

Neck

aceraton

wound

odged

and

to

et

doube

se

emergency

o

vson

ad

examnaton

te

sde

no

sows

er

ater

oss

o

ace,

a-

con-

perorbta

CHAPTER

edema

here

et

and

s

eye

a

wt

Pupary

sows

ead

ronta

orbt.

key

Weak

Dpopa

C.

Burred

D.

Decreased

E.

Parta

a

over

aong

CT

ture

te

o

ca

o

te

man

te

Parta

Compete

C.

Inabty

o

severe

orbta

o

te

o

o

to

te

C.

racture

o

D.

Corda

E.

T ympanc

descrbes

te

302.

eevate

te

te

depress

produce

acrma

Se

and

aso

et

eye.

Pysca

Paget

o

gand

areas

s

and

aso

loor

a

s

an

eye

rgt

and

te

bone

papated.

orbt

and

A

rac-

addtona

pys-

compans

Her

bones

most

eyeba

te

vta

dry

sgns

CT

o

te

scan

are

et

and

Petrous

B.

Inratempora

tempora

C.

Faca

D.

Mdde

E.

Inner

D.

Optc

cup

E.

Lens

A

to

o

produce

301.

woman

days.

Her

cae.

tenderness

here

o

te

s

nose

Se

was

necton.

structure

tat

Nasoacrma

ts

D.

Spenoetmoda

E.

Superor

and

o

te

here

A

nto

te

sows

bone

te

to

Pysca

cotted

meatus.

wt

ear.

no

A

bood

o

rgt

ear.

rgt

n

gt

was

Weber

ear.

s

tte

swab

te

test

Wc

tympanc

tan

sows

o

te

te

externa

vsuazed.

greater

On

ar

tat

bumped

was

deect

n

eye

a

maxary

otoscope

C.

Mgraton

n

aterazes

descrbes

Fuson

Fuson

o

te

above

sde

an

con-

te

o

te

respratory

s

te

te

most

spread

o

te

at

says

term

se

pregnancy.

connectng

te

rgt

o

te

meda

corner

oowng

n

te

an

aco-

Pysca

te

dscarge

resuted

ater

used

o

te

rom

te

deveop-

deormty

processes

nasa

to

eac

promnences

ectoderm

between

oter

to

eac

oter

maxary

and

promnences

te

o

maxary

305.

o

nasa

E.

or

gr

watery

key

meda

D.

upper

res-

nant?

o

test,

to

wc

most

a

moter

cear,

o

atera

an

eter

oowng

and

o

2

bood

sows

oreead

on

passage

groove

Fuson

membrane

best

a

Fuson

Rnne

sound

he

B.

acoustc

sweng

te

wt

te

99/mn,

wt

or

(101.5°F),

examnaton

devered

A.

conducton

oowng

n

o

pyscan

eadace

recess

deepy

penetrate

wt

rgt

rgt

s

broter

to

examnaton

peary-wte

cone

conducton

te

te

cean

te

and

areas

trougout

rgt

ts

swab,

ens

surace

meatus

sows

processes

causng

to

duct

woman

seen

cotton

space

patent?

pregnancy.

tobacco

p.

groove.

a

te

nundbuum

nasa

20-year-od

cantus

ebow,

by

deveopng

puse

over

te

aowed

C.

A

ts

to

wt

dagnosed

o-

ear

wt

at

Wc

menta

s

oow-

observed?

ssure

38.5°C

mucosa

and

ment

ear

te

he

mpar-

te

ectoderm

te

nose,

Pysca

nasa

tube

301–308

nto

o

connected

Hg,

A 15-year-od boy s brougt to te emergency depart-

s

a

examnaton

ntraretna

comes

mm

18/mn.

examnaton

to

te

overap

erytematous

o

attemptng

va

preg-

tat

vsua

deect

corod

136/87

are

Etmoda

304.

We

sows

Wc

te

term

neroateray.

surace

s

s

uneventu

pan.

o

temperature

Audtory

ossa

ear

at

uneventu

pysca

sma.

runny

B.

ear

rgt

not

A.

cana

wt

o

te

n

bone

gr

an

sgncant

remans

congeston,

upper

Questions

does

nasa

te

sows

te

o

vesce

30-year-od

key

symptoms?

A.

obteraton

necton

conss-

ead

te

any

o

cosure

tract

dry-

ndngs

te

nducton

a

ater

deect

expanaton

Faed

gabea.

or

norma

Wc

afected

wt

ear

wtn

o

sku.

er

mout

sows

A

key

o

pyscan

n

petrosa

examnaton

a

very

Faed

root

to

best

s

vagus

aurcuar

esser

tat

C.

pratons

eyeba

earng

ad

cause

deect

aurcuar

and

devered

pysca

eye

B.

pressure

tears

comes

great

devery

reassured

te

te

rom

ectoderm

303.

eyed

adducted

vagna

key

Faed

aong

maxary

s

as

pan

gossoparyngea

and

woman

et

s

o

395

Neck

neuroectoderm

tenderness

o

te

A.

per-

dspaced

o

ng

eyed

examnaton

was

te

not

percepton

great

and

pexus

Newborn

o

and

and

tympan

20-year-od

woud

emergency

rgt

deect

adducted

reduced

dsease.

te

te

skn

A

upper

te

woman

nausea,

tckenng

A

occpta

spontaneous

zygomatc

upper

o

to

patent’s

Lesser

o

nvov-

te

gossoparyngea,

scan

patent?

to

owng

CT

sows

sows

and

te

Inabty

40-year-od

te

oowng

ts

ptoss

o

ace

margn

Inabty

wt

Faca,

bone

or

and

area?

Aurcuotempora

te

to

margn

and

E.

tent

et

to

pan

margn.

D.

mts.

te

responsbe

B.

nancy.

examnaton

between

ptoss

te

njured

A.

eye

brusng

ead

ne

monts.

nerves

te

papaton.

njury?

brougt

orbta

neror

Wc

o

er

te

undoscopy

depressed

oowng

rom

s

Pysca

examnaton

ness

A

te

ment,

and

B.

3

retna.

zygomatc

te

to

and

eye.

o

moter

neror

o

te

vertgo,

te

et

o

secretons

because

A.

A

o

o

tender

te

ptoss

suture

bones.

s

norma,

o

aspect

vson

neror

te

tat

are

te

skn

rs

edema

scan

o

abducton

vson.

te

neror

superoatera

commnuted,

Wc

30-year-od

orbta

deect

consequence

B.

doube

te

te

relexes

process

department

300.

bony

sows

A.

A

o

over

abnormates

te

most

299.

no

te

a

gt

te

ng

brusng

sweng

Head

7

maxary

te

and

atera

ntermaxary

nasa

segment

processes

wt

te

processes

A 20-year-od woman devered a boy at term by sponta-

neous

vagna

devery.

Newborn

pysca

examnaton

396

C H A P T E R

sows

and

As

tat

as

oten

te

Wc

te

Faed

Lack

C.

Faed

E.

and

306.

A

a

Se

atera

gt.

o

Vta

te

se

botte

nose.

he

aca

most

D.

notes

tat

eedng

moter

E.

ton

307.

abnormates.

key

cause

o

promnences

o

nasa

neura

promnences

crest

ces

to

o

neura

o

rst

ectoderm

comes

o

te

are

sows

ces

to

between

to

s

neck

te

trd

maxary

pyscan

worse

on

norma

motor

because

worsenng

stfness,

wtn

no

te

constant,

pan

ever,

sgns

crest

pouces

te

or

rgt

examnaton

cm

(norma

key

o

upper

or

Wc

o

durng

A.

te

oowng

pysca

Lack

o

rgt

superor

w

examnaton

most

on

accommodaton,

cerebear

key

ts

be

artery.

dented

adducton

o

te

rgt

B.

Burred

rgt

C.

compete

ptoss,

abducton

o

te

te

ptoss,

rgt

adducton,

and

downward

rotaton

eye

to

mbs.

te

te

36

A

CT

ventrces.

cause

o

rota-

atera

D.

Lack

E.

Increased

A

o

bood

64-year-od

man

aca

medca

ago

a

He

sweats

excessvey

says

was

eaed

tat

removed.

surgca

observed.

nerve

te

bers

te

te

Were

tat

e

sows

oowng

o

sees

because

o

te

te

s

rgt

appetzng

sde

now

sde

parotdectomy

here

are

ventrces

arteres

pyscan

Pysca

are

40

condton?

atera

rgt

a

rgt

scar.

ead

te

cerebra

tumor

wen

te

o

o

decreased

granuatons

te

ncudes

on

s

aperture

to

magnant

o

nant’s

te

on

here

aperture

n

n

comes

story

or

tumor

low

sweatng

gand.

we

pexus

pys-

crcumerence

scan

aracnod

corod

sowed

Neonata

Wc

te

te

o

utrasound

cm).

o

gands

eye

Parta

o

vson,

rotaton

downward

bran.

ead

Narrowng

te

eye

be

a

Abnormaty

dects

patent?

te

a

34

eta

C.

a

te

o

trmester

te

sows

range,

o

to

o

B.

te

o

second

medan

a

aneurysm

and

te

ower mbs. A CT scan angograpy o te bran sows

berry

abducton,

upward

eye

o

year

Pysca

te

and

Narrowng

Hs

to

he

ventrces

excessve

sde.

averson

mts.

weakness

308.

ead-

rgt

ca

s

promnences

story

tat

secton.

dataton

te

abducton,

eye

ptoss,

te

movement

meda

woman

o

enarged

and

ptoss,

rgt

A 20-year-od woman devered a boy at term by cesar-

ean

te

nant?

nasa

te

Compete

te

says

Compete

o

A.

nasa

avng

examnaton

s

paryngea

says

not

s

atera

mgraton

Se

s

eedng,

smar

santng

underdeveoped.

arc

4-mont

aces.

o

mgraton

40-year-od

o

downward

were

processes

ourt

Faed

ad

ts

mgraton

Faed

and

are

breast

troug

n

uson

paryngea

D.

eyes

suckng. Wen

oowng

uson

o

te

mandbe

ater

seen

maxary

B.

Neck

attempts

reluxed

deormtes

A.

o

and

dicuty

cd’s

o

and

corners

pnnae

moter

boy

mk

Head

te

te

te

te

7

o

over

a

parotd

ood,

e

ace

were

examnaton

sows

are

s

o

ace.

no

nerve

crana

ce

nerve

bodes

nnervatng

s

or

sweat

ocated?

A.

Cary

B.

Pterygopaatne

gangon

C.

Otc

D.

Submandbuar

E.

Superor

gangon

gangon

gangon

savatory

nuceus

A n swe r s

Answers

1.

E.

2.

1–25

he

cd

ndcates

te

bot

an

ca

te

resuts

and

s ufe rs

rom

m a  or m at on.

b e c aus e

and

an

rom

snus

troug

externa

c as e

par yngea

cer vca

and

be

nterna

stua

second

t s

open

must

second

te

A

an

deect

n

o

te

te

beng

our t

h s

a ure

e xte rna

and

te

s tua

tat

 mp  es

tat

o

co s ure

s tr ucture.

 a ure

p ouc 

a

o

A

co sure

te

cons o d ato n

p ar yn gea

ce ts,

a

te

o

B.

bo t

C.

trd

hs

te

b e ng

D.

excudes

par yngea

ourt

snus.

te

pouc

paryngea

Faure

woud

he

not

o

second

rom

te

present

tongue

n

995;

an

N

wt

o

and

te

an

duct

par yngea

beng

to

te

open

o

ts

deect.

ABR/McM

orm

second

extends

aure

externa

77;

grooves

cosure

tyrogossa

resut

GAS

he

arc

rse

answers

E.

he

28–35

te

cervca

groove

aone

stua.

rom

paatne

paate

p,

woud

and

ormed

by

te

derved

sec-

rom

gves

rse

to

te

smaer

anterory.

segment

te

nasa

wt

part

gves

o

rse

te

promnences

te

maxary

ntermaxary

rontonasa

nose,

to

te

maxa,

mdde

and

te

N

te

o

wt

eac

to

gve

gves

rse

to

parts

o

te

o

te

eyes.

73,

retna ssure to cose

merge

promnences

segment.

emnence

and

1059–1060;

not

s

paate.

cooboma

tyrod

process

ocated

premaxary

medan

to

paate

embryoogcay

processes.

A.

A

te

s

paatne

GAS

B.

te

cosure

3.

o

wc

ntermaxary

oter

he second paryngea groove merges wt te trd

to

he

part

medan

oreead,

and

D.

atera

he

prmary

aone.

B.

paate

upper

str uctures.

C.

argest

prmary

s  nus ,

o

he

ondary

b ran -

o

c er v ca

A.

77;

rs

s

ABR/McM

caused

by

1,

te

9

aure

durng te sxt embryonc week.

Abnorma

neura

abnorma

deveopment

crest

ormaton

o

woud

corod,

ead

scera,

to

and

cornea.

C.

Abnorma

ectoderm

nteracton

woud

ead

between

to

te

abnorma

optc

vesce

and

deveopment

o

CHAPTER

te

entre

deveop

D.

he

rs

E.

pacode

may

a

to

B.

not

be

afect

afected

posteror

by

abnorma

deve-

and

camber.

C.

congenta

925–926;

N

anteror

sagtta

and

corona

o

A.

posteror

detacment.

ABR/McM

ontanee

monts

he

94;

retna

s

51

D

ocated

sutures

and

at

te

coses

juncton

at

around

o

18

o

te

sagtta

at

suture

around

2

to

s

and

3

ocated

at

ambdod

te

juncton

suture,

and

C.

ar

squamous

suture

D.

A.

not

te

a

852;

N

13,

by

opment.

he

te

B.

and

to

3

s

and

cysts

te

n

a

and

ambdod

at

te

corona

juncton

suture

te

te

sxt

duct

o

aong

and

we

pat

durng

deve-

B

cecum

o

ay,

te

na

arc

provdes

orgn

to

te

poston

connected

to

te

and

stapes,

trd

paryngea

musce

bone.

varous

parynx

o

te

musces

and

ourt

and

woud

not

caracterstc

and

cartages

o

produce

rst

arc

s

case

te

n

te

te

ventrce

(o

CSF

s

condton

te

resuts

Syvus).

and

n

ventrcu-

rom

hs

te

eads

rom

trd

te

ventrces

unafected.

producton

woud

a

upstream

atera

ydrocepaus

hs

to

wtn

obstructon

aqueduct

expandng

CSF

reers

obstructed

ncreasng

ourt

D.

a

or

ead

s

because

nefectve

to

o

eter

CSF

enargement

reab-

o

a

cambers.

Anencepay,

parta

bran

GAS

9.

s

absence

cosure

o

te

aso

o

known

te

as

bran

anteror

meroanencep-

and

s

because

o

neuropore.

Hooprosencepay s a aure o ceavage o te ore-

musces

tongue.

woud

te

C.

and

woud

865–866;

Bot

te

N

resut

157;

neror

n

a

snge

ABR/McM

paratyrod

used

72,

ventrce.

81

gands

and

te

tymus

C.

A branca cyst woud not be present n te mdne,

are derved rom te trd paryngea (branca) pouc.

t

hereore,

D.

he

woud

be

trd

present

E.

he

rst

GAS

998;

he

uson

N

77;

most

o

and

te

te

te

atera

arc

musce

paryngea

mastcaton

E.

on

paryngea

styoparyngeus

and

arc

ABR/McM

to

te

wt

bone.

rse

and

orgn

to

musces

o

A.

ncus.

B.

o

process

cet

and

p

te

A.

s

aure

nences

ocated

and

te

deveopment

B.

Faure

woud

o

between

maxary

o

te

uson

produce

a

te

atera

processes

nasoacrma

o

te

meda

medan

cet

nasa

woud

afect

p,

a

E.

rare

te

congenta

he

te

quent

D.

he

not

atera

rom

and

nasa

medan

pacodes

nasa

and

processes

do

not

bot

undergo

arse

subse-

uson.

atera

GAS

musces

N

sted

(branca)

o

C.

tyrod

o

te

N

te

89;

s

o

arses

o

te

nodes

are

tymus.

aggregaton

s

not

o

assocated

rom

stomodeum

o

te

an

ora

out

tyrogossa

te

o

endoder-

and

s

not

tymus.

pocketng

cavty,

deveopment

n

te

an

and

rom

ABR/McM

key

abnorma

ymp

o

deveops

te

prmtve

wt

assocated

an

tymus.

deveopment

route

deect

te

be

pouc.

rom

tongue

gand

loor

gand

o

assocated

nasa

promnences

do

not

use

wt

eac

rod

gands

53;

ABR/McM

symptoms

arc

are

syndrome

mastcaton,

as

14

pouc.

typca

te

o

rst

myoyod,

rst

arc

anteror

paryngea

gves

bey

rse

o

to

te

mus,

derved

A

In

and

are

derved

and

addton,

te

rom

B.

dgastrc, tensor tympan, tensor ve paatn, maeus, and

membrane

te

te

ncus.

te

wt

loor

1011;

he

te

to

o

descendng

duct,

te

and

t

s

tymus.

30

deveopment

o

trd

and

rom

te

ourt

pouc,

wereas

te neror paratyrod gands are derved rom te trd

1066;

he

GAS

10.

deveops

on

deveopment

n

paryngea

deveopment

submandbuar

buds

key

ndcatng

juguodgastrc

tons

nodues

s

tssue,

ourt paryngea pouces because te superor paraty-

oter.

A.

ngua

aong

anomay.

C.

he

he

promnences

trd

o

assocated

duct.

nasa

te

wt

ma

te

o

assocated

wt

prom-

tymus

not

ymp

ntermaxary

ectopc

paratyrod

Deveopment

he

o

D.

Deects

an

ectopc

deveopment

33

cause

maxary

yod

gves

maeus

common

neck.

provdes

segment.

7.

te

deectve

and cartage o te neck and woud produce a mdne

mass

te

deveopment

cerebra

ventrcuar

gand

to

arc

styoparyngeus

ydrocepaus

ts

sorpton.

oramen

mdne

o

te

mandbe

Nonobstructve

retenton

te

ony

afect

CSF

te

pressure

E.

paryngea

In

o

excessve

because

second

expresson,

bone.

yod

and

o

obstructon

tyrod.

he

low

system.

A.

tyrod

at

woud

arynx

stenoss

14

occur

descendng

descends

suture,

s

to

ocated

tyrogossa

begns

here

monts.

ABR/McM

te

ambdod

year.

ontanee.

suture

2

duct

pat

te

rst

ontanee

16;

o

te

and

te

ambdod

around

remnant

tongue

o

squamous

at

oowed

o

a

hyrogossa

o

suture

end

spenoda

coses

GAS

te

but

he

o

at

te

Obstructve

o

te

o

te

397

Neck

GAS 950, 966, 998; N 55–56, 105; ABR/McM 35, 39, 57

8.

wc

coses

afect

ypopastc

B and C. he mastod ontanee s ocated at te juncton

t

yod

Abnorma

arc

o

aca

deveopment

woud

E.

te

o

and

syndrome.

t

monts.

o

parts

te

te

ontanee

musces

parts

and

sxt

age.

deveopment

te

Abnorma

and

to

coses

6.

Abnorma

eads

o

5.

te

ens

arc

he

te

o

a

abnormay.

Weak adeson between te ayers o te optc vesce

GAS

4.

because

deveop

woud

opment

E.

eye

or

Head

7

te

he

and

paatne

te

trd

paraocuar

ourt

rst

tonss

and

o

he

gves

rse

to

tyrod

te

ty-

gand

are

pouc.

rse

second

tonsar

gves

te

paryngea

pouc

cavty.

pouc

ces

to

te

pouc

snus.

tympanc

gves

rse

to

398

C H A P T E R

D

and

sxt

o

E.

Head

and

Abnorma

arc

te

te

7

woud

arynx

deveopment

afect

and

ypopastc

Neck

varous

parynx

mandbe

o

te

musces

and

ourt

and

woud

not

caracterstc

and

B.

Excess

cartages

o

o

produce

rst

GAS

C.

arc

C.

An

1011;

N

89;

a

mutactora

a

studes

A,

D,

B,

pay

a

remans

GAS

12.

C.

te

1066;

te

A.

he

because

pouc

second

and

tonsar

he

ourt

ror

paratyrod

te

maton

pouc,

as

been

ave

seems

a

E.

to

actors

o

a

may

cet

p,

or

may

but

not

genetcs

GAS

16.

actor.

C.

GAS

D.

gves

deectve

ter

deveopment

norma

to

paratyrod

cornua

to

te

N

te

ste

o

o

and

rse

to

pouc

orgn.

tympanc

te

gands

and

gves

te

meata

mem-

n

he

B.

he

paatne

rse

to

tonss

te

supe-

paraocuar

contrbutes

he

o

he

and

GAS

14.

E.

A

te

o

te

n

te

ces

ces

o

to

te

te

atera

or-

yod

to

tyrod

bone,

te

n

greater

E.

addton

ceeks

and

s

mportant

upper

n

te

part

arc

o

te

pay

gves

arces,

o

no

rse

yod

n

A

dermod

te

cyst

and

part

we

n

esser

near

te

atera

B.

A

swoen

C.

Accessory

route

o

D.

extensvey

te

and

C.

mus-

deveopment

ymp

tyrod

s

cystc

tongue

o

node

tssue

o

te

or

A.

1005;

s

77;

low

o

s

caused

by

present

teratoma

te

remnants

anteror

to

o

te

to

oten

occurs

wt

stuated

duct,

mdne

o

aong

eter

te

pan.

n

wtn

te

an

as

a

resut

causatve

to

cose

may

woud

s

he

because

ventrcuar

o

a

18.

B.

o

actor

ead

on

not

te

to

por-

resut

n

an

tat

a

buton

and

neck.

o

te

cd

taste

(Appearance,

o

An

atretc

aure

normay

o

te

occurs

te

petrosa

not

dorsa

ower

N

n

and

s

nerve

n

not

ead

supped

by

te

nerve,

men-

wc

dvson

o

te

suppes

te

regon,

temporo-

te

parotd

s

gangon,

s

o

(aso

externa

and

erpes

aso

and

sensory

nose,

known

a

nerve

dsease

nnervaton

and

as

ocaton

trgemna

know

occurs

nerve

zoster,

upper

p.

38

as

tc

over

te

o

semunar

te

nerve

sensory

(CN

dououreux)

te

area

V).

s

a

o

dstr-

te

aca

brances.

gangon

transmts

te

parasympatetc

te

te

te

pan

a

by

provdes

sde

ABR/McM

o

to

ceek.

ganga.

VII)

woud

aveoar

sensory

nerve

gangon,

(CN

are

tempora

nerve

trgemna

resuts

meatus.

mandbuar

root

wc

deveop

).

afected

neuraga

to

deveop-

meatus.

3

be

bodes

tympanc

acoustc

recess

neror

te

eyed,

59;

te

anterory.

nerve

o

to

57

area

te

ear

absent

deveop.

acoustc

te

V

an

abnorma

externa

to

n

abyrnt.

rse

an

ocks

ear

p

o

jont,

resuts

gves

and

te

te

(CN

gencuate

ner ve

as

o

surace

ce

he

tat

orm

ABR/McM

branc

nerve

to

afect

ower

trgemna

condton

event

tubotympanc

nraorbta

neuron

breatng

because

pouc

externa

branc

Gasseran

A.

obstructon

system.

81

Respraton).

membranous

aurcuar

106;

esser

975;

he

pt

externa

and

woud

te

te

known

te

bucca

te

he

an

aurcuotempora

he

and

and

cavty,

not

te

N

s

he

GAS

s

ound

receves

on

sensor y

pregangonc

bers

or

parasympatetc

bers.

C.

aso

72,

ndcates

occurs

te

and

atretc

cn

turn

te

28–35

ydrocepaus,

o

T rgemna

present

normay

te

tat

eyebrow.

key

ABR/McM

ydrocepaus,

CSF

a

dependng

but

score

paryngea

o

945;

to

tyrogossa

aong

Noncommuncatng

obstructve

to

N

tube

tone,

otc

degenerated

o

tons smar to were accessory tyrod tssue s ound.

15.

A

and

A cyst o te tyrogossa duct woud be ound n oca-

GAS

Faure

nterna

48

woud

aspect

descent

posteror

B.

or

a

occur

be

ABR/McM

cana

and

woud

nerve,

E.

ABR/McM

s

can

not

bda,

Actvty,

te

rst

ta

body.

cartage

157;

canaze,

mandbuar

bone.

cyst

nonob-

e.

he

he

deve-

te

to

vesce

D.

A.

to

N

musce

otc

gand,

paryngea

snus

ead

afected,

APGAR

o

trgemna

p.

mportant

sternocedomastod.

A.

17.

n

s

eta

aure

mandbe.

cervca

cervca

rse

pug

ment

musce.

deveopment

22;

spna

tube

acoustc

Faure

GAS

gves

promnence

arynx,

N

te

paryngea

yod

1080;

o

te

upper

ourt

nvoved

o

te

second

cornu

ces

o

te

membrane

30

arc

promnence

mandbuar

opment

E.

part

maxary

deveopment

C.

ABR/McM

paryngea

styoparyngeus

A.

ate

D.

pouc

paraocuar

ower

te

woud

neura

or

Grmace,

externa

gand.

89;

o

relexes,

Puse,

B.

paryngea

trd

o

but

te

norma

to

1011;

he

o

865–866;

A

puse,

neror

snus.

te

resorpton

or

appeared norma and eaty at brt, based on skn coor,

14

and

rse

paryngea

o

dsturbed

ydrocepaus.

ton

gand.

13.

sze

anencepay

determned

or

communcatng

ydrocepaus.

ncreased

Faure

A.

pouc

tyrod

t

partcuar

determnng

o

gves

D.

o

to

cavty.

he

he

sted

tymus

B.

E.

n

hs

ABR/McM

te

be

and

consdered

CSF

to

ydrocepaus.

mportant

53;

o

rst

or

are

p

factor.

oter

paryngea

brane

cet

deveopment

most

woud

trd

he

te

N

30

cets

twns.

E.

n

Absence

gands

genetic

o

and

roe

o

etoogy,

strong

usng

ABR/McM

orms

o

rse

ydrocepaus

Wereas

ave

gves

structve

syndrome.

11.

producton

CSF

he

te

neror

gossoparyngea

gossoparyngea

gemna

nerve,

medatng

te

and

pan.

s

nerve

not

gangon

(CN

te

ste

IX),

o

s

not

te

part

te

ce

o

tr-

bodes

CHAPTER

D.

he

otc

gangon,

te

ocated

son

o

trgemna

onc

parasympatetc

on

te

nerve,

ce

mandbuar

contans

bodes

or

dv-

parotd

he

te

gand

secreton.

E.

snuses,

postgang-

GAS

22.

pterygopaatne

gopaatne

ossa,

gangon,

aso

ocated

contans

n

te

ptery-

postgangonc

sympatetc ce bodes or acrmaton and

GAS

C.

V1)

to

910;

he

tve

para-

mucosa

o

133;

suppes

pan

A.

N

B,

ABR/McM

sensory

wen

and

branc

o

81

nnervaton

trgemna

to

te

nerve

eyeba,

(CN

Pan

n

te

ard

paate

and

eadng

ower

E.

Parestesa

woud

te

GAS

20.

branc

D.

N

61;

tumor

a

he

te

at

bucca

by

nerve

te

te

(CN

t

nerve

A.

eyed,

(CN V

o

V

B.

ace

o

).

C

and

woud

afect

compress

te

ypogossa

ypogossa

nerve

cana,

by

C1,

ater

and

t

wc

passes

woud

runs

be

he

a

C.

he

he

C2

GAS

21.

C.

nerve

te

(CN

s

by

te

nerve

mandbuar

V

to

dvson

vagus

carred

by

ypogossa

1086–1087;

superor

nnervated

N

70;

by

rom

nerve

C1

te

to

A.

s

aca

carred

ner ve

gand

he

or

and

by

are

snuses,

gencuate

taste

carred

te

rom

by

hs

suppy

or

v a

cord a

pe trosa

 or

auto nomc

o

te

p ter ygopaatne

te

tw o-t rd s

ty m p an

a s o

b ranc

s up p y

contans

an te r  or

branc

te

te

gan g  on

te

te

ner ve.

gre ater

respo n s  b  e

c ar r es

B.

submandbuar

and

te

te

to ngue

o

te

he

vaton

ead,

to

sensaton

externa

B

and

petrosa

bers

tat

D.

skn

o

te

provdes

tempora

temporomandbuar

rom

nerve

carred

E.

te

regon

jont,

anteror-most

and

porton

o

o

te

provde

by

n

te

te

savatory

nuceus

pregangonc

gangon,

esser

parasympatetc

gossoparyngea

otc

and

nerve

(CN

provdng

IX)

parotd

nnervate

ony

gangon

acrmaton

ncudes

and

te

bers

tat

paranasa

vesses

te

to

ocated

braca

te

upper

on

te

o

prenc

C3

to

C5

coumn.

reducton

o

tat

rom

o

and

o

bood

extensve

suppy

te

ead

juguar

toracc

o

anas-

bood

woud

and

ven

to

be

s

woud

syndrome.

ven

not

neck

and

outet

te

ABR/McM

to

run

nerves

s

near

te

occuded

or

ead

and

s

neck.

ptoss,

and

upper-

sympa-

he

usua

known

as

andross

Postgangonc

arteres

te

suppes

commony

moss,

te

wc

trunk,

njury,

regon.

on

218

gangon,

te

are

to

and

te

gangon

eadng

by

n

sympatetc

nto

te

ead

rom

ony

te

ncudes

anteror

aca

to

sympa-

ce

bodes

ead.

ce

bodes

two-trds

nerve;

nnervaton

carry

neck.

t

aso

many

or

o

te

transmts

sectons

o

ace.

gangon

to

bers

not

and

ncudes

te

te

does

ead

nerves

gangon

rom

carred

cary

t

o

sensory

sensaton

ead

gangon

areas

gencuate

te

coursng

woud

not

provdes

eye,

and

troug

account

parasympatetc

aso

or

as

but

te

some

not

sympa-

synapsng;

symptoms

o

te

ace.

GAS

24.

A.

1025;

he

N

142;

corda

nratempora

t

account

to

te

B.

I

s

or

te

oss

sense

corda

present

ducton

savary

o

jons

and

joned

te

speca

woud

ABR/McM

tympan

ossa,

two-trds

pterygopaatne

dmensons

on

ram

because

sympatetc

neck

aferent

he

beore

neror

te

regon.

tetc

te

genera

ncude

ocaton

SCG

nnervaton

nner-

stmuaton.

he

he

te

savar y

sensory

te

parasympatetc

ac a

ear.

he

synapse

gand

E.

te

te

nerve

by

connec-

usuay

eeng

ventra

nterna

195;

trgemna

tus,

aurcuotempora

or

wa.

cervca

or

tongue,

gands.

A.

s

vertebra

wa

submandbuar

taste

paras ympate t c

subngua

o

and

neck

he

D.

gang o n.

b od e s

not

te

body

syndrome,

rom

acrma

ce 

o

br an c

te

o

te

191,

usuay

he

nuceus or te aca ner ve (CN VII). Parasympatetc

bers

mted

rb

mpnge

te

return

nnervaton

tetc

te

musces,

te

some

te

because

te

N

part

ead

and

48

nuce us

caracterzed

mpngement

wt

te

superor

symptoms

nerve.

ABR/McM

sa  vator y

bers

o

151;

he

nerves

s

o

toracc

because

tetc

te

3

te

can

no

between

afected

Horner

by

s

cervca

eaves

does

Venous

myo-

).

nnervated

he

toracc

troug

o

X).

tyroyod

he

supped

o

paatogossus

(CN

E.

s

branc

trgemna

C.

most

myoyod

yod,

E.

s

GAS

23.

unafected.

B.

o

dstended.

troug

tereore

te

anteror

be

hs

t

parae

to

mdne

supped

two-trds

39

constrct

oss

be

syndrome

and

not

geno-

suppes.

s

woud

many

cana

anteror

accessory

and

n

because

te

3

XII)

vertebra

tomoses

81

(CN

tat

nerve

low

dvson

rb,

outet.

here

he

).

te

te

399

Neck

8.87 ).

syndrome

cervca

resutng

on

Fg.

ABR/McM

outet

bands

drecty

2

porton

mandbuar

ypogossa

nerve

musce

te

te

trgemna

ABR/McM

genoyod

wt

te

medated

ypogossa

gossus,

A.

over

trgemna

903;

A

te

be

o

134;

a

C7

taste

and

mb.

and anestesa o te upper p woud be carred by te

maxary

te

damaged.

D.

o

not

( GAS

toracc

pexus,

te

N

tssue

te

on

optamc

900;

horacc

presence

secreton.

19.

D.

but

tongue

Head

7

a

by

o

o

te

a

tongue)

te

te

o

and

tympan

sava

njured,

taste

a

be

wt

n

te

nerve

woud

no

oss

producton.

(rom

decrease

submandbuar

woud

nerve

ngua

sensaton,

were

oss

ngua

to

corda

and

tympan

because

gands

eson

genera

taste

wt

47

te

te

te

n

and

denervated.

patent

anteror

sava

pro-

subngua

400

C H A P T E R

7

Head

and

Neck

Lacrimal

gland

Lacrimal

ner ve

Zygomaticotemporal

nerve

Zygomaticofacial

Foramen

ner ve

rotundum

Maxillar y

ner ve

[V

] 2

Zygomatic Branch

of

zygomaticotemporal

ner ve

Pter ygoid

canal

nerve

Greater

Pter ygopalatine

ganglion

Deep

petrosal

petrosal

Inter nal

Sensor y

ner ve

ner ve

carotid

fibers Sympathetic

Sympathetic

postganglionic

Parasympathetic

preganglionic

Parasympathetic

postganglionic

of

fibers pter ygoid

neror

vaton

to

aveoar

te

nerve

mandbuar

provdes

teet,

sensory

but

no

GAS

Fig.

8.87

nner-

suc

oss

sku

s

he

E.

to

ton

reated

te

he

ven)

Nerve

oss

rom

te

o

he

o

present

na

oss

o

nerve

te

taste

tongue

but

tere

nnerva-

and

s

no

route

one

cavty.

and

he

nput

nerve

no

(CN

(CN

woud

VII)

not

rom

tere

te

motor

te

X],

gag

relex,

ead

to

relex.

wc

exts

by

te

cana.

afected

ace

and

te

woud

te

musces

ts

scap

nvovement

dua

nerve

be

present

vestbuococear

vestbuococear

858;

A.

o

o

njury.

woud

te

but

nerve

was

wt

o

nerve

(CN

ormay

vestibulocochlear

20;

26.

E.

ary

artery

menngea

be

te

B.

njury

te

and

courses

between

a

branc

te

o

dura

te

max-

mater

to

n

a

resutng

arter y

te

arteres,

afects

te

by

(GAS

or

ac-

n

ends

an

bend

maxar y

and

and

neter

mennges

o

o

te

w

(CN

cause

he

o

te

nerves

nner-

rectus

aso

or

te

va

provdes

tus,

nabty

pup

te

(CN

mus-

superors;

ptoss

o

woud

musces

nerve

papebrae

constrcton

parasympatetc

an

because

abducens

atera

ocuomotor

III)

ateray

and

and

compete

(CN

and

IV)

obque

evator

te

to

8.33).

nerve

downward

he

te

penetrate

contrbute

42

contractons

(superor

not

not

Fg.

ocuomotor

trocear

to

do

woud

ABR/McM

pont

eyed.

he

optc

aspect

he

and

o

aca

eyed

D.

he

or

oss

GAS

te

o

d

bnk

s

to

pro-

ocuomotor

neck

oss

or

te

sensory

eye.

te

ocu,

coud

aca

wc

be

musces,

coses

te

tarsa

s

damaged

parasympatetc

ncudng

64;

te

ptoss

sympatetc

sympatetcs

N

o

expan

(superor

ony

te

relex.

gangon

te

n

nnervates

provdes

889–890;

retna

orbcuars

adequatey

and

responsbe

te

nerve

but

SCG

s

va

te

cary

patent,

he

nerve

gt

ncudng

E.

s

artery

nto

arteres

tus

te

respectvey).

vded

to

11

artery

and

to

te

upper

mdde

racture

resuts

nerve.

26–50

he

Any

typcay

carotd

tempora

unopposed

ead

Answers

pteron.

dvdng

drecty

112;

eye

by

not

ABR/McM

N

nerves

any

VIII).

reers

externa

by

ematoma

nnervaton

com-

caed

ceary

te

menngea

tempora

sku

te

te

VI)

uncton.

N

deep

njury

vated

trgem-

any

he

arteres

979;

An

cause

C.

earng

auditory

GAS

27.

rase

by

mdde

C.

epdura

ces,

supped

o

ocaton

bran.

and

jugu-

output.

woud

entrey

nnervates

be

was

or

te

XII),

ypogossa

[CN

ts

superca

he

tree

gossoparyngea

gag

amost

or

(nterna

oramen

tus

are

ext

vagus

ven

provdes

ts

o

area

to

mandbe

tese

dect

te

and

te

sensa-

te

ematoma.

bony

IX],

and

wtn

sensaton

o

B,

82

te

sensory

te



o

[CN

nerve

systems

ony

o

A.

D.

s

crana

te

and

presson

he

no

nerve.

Loss

ts

te

troug

aca

but

provdes

relex,

nerves)

movements

ace

Loss

GAS

XI]

ypogossa

te

D.

gag

ABR/McM

vagus

bot

T ongue

sku

C.

[CN

gand,

o

epdura

patent.

compresson

te

B.

trd

oramen

provdes

wereas

a

53;

te

nerve

(gossoparyngea

nerve

A.

to

ts

N

parotd

postgangonc

te

posteror

juguar

accessory

ar

n

1090;

nerves

te

nnervates

present.

gossoparyngea

present

25.

s

ton

GAS

nerve

suppyng

savaton

he

petrosa

to

trauma

eraton

esser

neurons

E.

cose

mpact

present.

D.

canal

fibers

•

he

plexus

fibers Ner ve

C.

ar ter y

te

te

evdent

n

o

52–54

to

musce

Müer),

ts

ts

w

eyed.

nnervaton

smoot

musce

ABR/McM

o

n

suppy

n

but

patent.

te

te

no

CHAPTER

Posterior

(from

Head

7

meningeal

of

pterion

(from

branch

ascending

phar yngeal

Anterior

(from

meningeal

meningeal

ethmoidal

ar tery

ar tery)

Meningeal

Middle

401

Neck

ascending

pharyngeal

Position

and

ar ter y)

ar ter y

ar teries

ar teries)

Middle

meningeal

ar ter y

Meningeal

(from

Meningeal Maxillar y

Occipital

Exter nal

•

he

scap

nectve

and

dvded

A

tssue,

perosteum).

between

oose

te

ts

zone”

ere

can

vens,

hs

o

te

be

ten

s

scap

oose

s

and

va

w

be

o

te

te

many

because

nto

te

o

to

scap

sku

te

bone

A.

An

cause

tat

te

n

In

“dan-

perosteum

togeter;

between

C

and

sue

and

but

E.

D.

and

te

he

skn

seen

ton

911;

B.

crana

to

areas

provdes

separated,

10,

are

key

C.

te

he

tgty

to

nd

bound

D

nectons

and

do

tese

31;

not

very

and

te

dense

between

vens

a

and

ncude

o

te

strong

and

tus

areas

te

5,

connectng

vens

barrer

aganst

ayers

keood

woud

ABR/McM

4

ts-

tssue

ead.

derms

te

connectve

connectve

be

rare.

are

o

an

sde

ntact

te

te

uvua.

(CN

te

ony

te

te

contraatera

o

te

unnjured

ve

paatn

w

sde

s

musce

sde

vagus

s

uvuae

one

actve

to

evator

woud

hs

muscuus

I

o

X)

rgt.

o

te

nerve).

pu

te

sde.

rgt

vagus

nerve

woud

pu

te

uvua

sde.

and

et

musces

he

ypogossa

and

woud

te

oroparynx

82,

137;

to

tese

ner ves

not

gossoparyngea

to

nnervaton

N

o

to

nner vate

afect

nerve

and

te

te

uvua.

suppes

sensory

nasoparynx,

but

areas.

ABR/McM

47

E. he rma gottds s te openng between te voca ods

and te arytenod cartages

A.

he

prorm

ynx

atera

B.

he

nec-

rarey

889;

nerve

devated

contracton

uvua

te

vagus

nnervates

core

ntact

to

motor

GAS

30.

te

rgt

E.

et

nerve

te

te

et

nnervaton

not

between

epderms

between

bone

not

up

te

Injury

to

ayers.

ayers,

te

N

s

superca

skn

tons;

GAS

tese

and

t

aponeuross,

many

he

tus,

ar ter y

ar ter y

become

(psatera

tongue

he

phar yngeal

ar ter y

nnervated,

addton,

uvua

te

to

vagus

devate

njury

cavty.

A.

te

makes

w

wc

to

uvua

efectvey

emssary

te

njury

te

because

nectons

va

to

29.

tssue,

te

carotid

ar ter y)

8.33

(skn,

ocated

as

Fig.

ocated

wt

vens

reerred

con-

wtn

ease

GAS

tssue,

SCALP

perosteum,

usuay

vens

dense

connectve

nectons

many

dpoc

skn,

connectve

mnemonc

because

spread

area

ayers:

oose

T ypcay,

transmtted

va

ve

aponeuross,

tssue,

agents

regon.

andy

aponeuross

connectve

nectous

nto

aponeuross,

perosteum.

and

ger

s

tssue,

connectve

branch

ver tebral

Ascending

B.

ar ter y)

ar ter y (from

28.

branch

occipital

nec-

and

C.

he

recess

to

vestbue

rma

s

on

te

te

aryngea

te

rgt and

recess

n

te

et sdes.

aryngopar-

openng.

regon

between

te

epgotts

gottds.

ventrce

voca

te

s

cords.

s

te

area

between

te

true

and

ase

402

C H A P T E R

D.

7

he

vaecua

ynx

anteror

tongue

GAS

31.

D.

N

snus,

ar y

s

Neck

batera

te

recess

epgotts

s

s

aryngopar-

posteror

to

C.

D.

 ne cton

n

c an

he

te

be

o

b ody

a

s

o

major

d fe ren ce

c o c e s

te

te

max  -

te

ocat on

o

GAS

35.

te

te

B

and

rory

E.

D.

to

he

te

snus

s

ocated

posterosuperor

to

nasa

snus

anteror

he

vagus

o

part

s

o

N

te

s

n

ocated

te

aterosupe-

he

a

ronta

ower

aso

or

43,

bone

n

B.

he

o

relex

n

te

ony

regon

he

ace

and

dvson

te

nnervaton

and

a

o

A.

surroundng

to

motor

motor

o

te

te

te

nerve

mout

nnervaton

trgemna

to

maxary

te

n er ve

B.

and

to

to

nerve

te

te

ypogossa

o

coug

GAS

33.

D.

ear

ng

A.

and

(gag

s

not

36.

rele x)

and

C.

82;

(eustacan)

and

nasoparynx,

most

o

te

ABR/McM

tube

s

meatuses

but

a re

a re

not

he

but

d  re c t  y

assocated

te

condut

tey

and

te

mdde

or

spread-

are

not

pod

GAS

B.

or

tssue,

945,

he

te

he

947,

optc

gt

optc

but

te

not

afect

recess

te

s

a

to

Adenods,

can

949;

and

sensory

pupary

A.

E.

and

aca

te

and

tat

te

nasocary

nerve;

aows

trocear

brances

te

o

abducens

wt

nner

te

and

mdde

outer

e a r,

deveop

N

st-ke

te

audtory

enarged

ocated

tube

masses

n

o

115;

ocuomotor

nerves

portons,

are

responsbe

o

pup.

te

cornea

relex

eye

orbta

ssure

te

mparment

nerve,

a

o

contans

contans

nerve,

te

to

because

are

trans-

ssure.

te

maxary

nraorbta

pterygopaatne

addton

s

wc

vesses,

gangon.

optamc

sympatetc

artery

and

bers.

dvson

o

te

trgemna

nerve,

te

acces-

923;

N

BP26;

ABR/McM

23,

25

te

ntensty

he

accessory

he

vagus

sound

te

nerve

suppes

does

te

trd

mdde

enterng

te

te

tongue

nner

ear.

musces.

trapezus

and

ster-

not

provde

any

nnervaton

ear.

gossoparyngea

posteror

sound

nnervates

musces.

nerve

n

o

nerve

o

ear

nerve

te

ony

tongue,

cavty ,

and

suppes

te

sensaton

oroparynx

tympanc

to

(gag

membrane,

884,

acoustc

coug

to

be

o

te

A.

D.

107;

and,

wen

20%

“reerred

wc

nner

s

te

te

a

part

57–58

o

stmuated,

o

peope.

sensaton”

nnervated

nerve

s

hs

rom

by

te

can

te

externa

trgger

s

te

vestbue

vagus

assocated

a

tougt

nerve.

ony

wt

ear.

trgemna

to

ABR/McM

nnervates

vestbuococear

he

he

N

about

o

arynx,

afect

te

n

because

he

nerve

meatus

relex

te

C.

887–888;

vagus

nerve

externa

coug

aurcuar

does

provde

acoustc

relex

branc

as

o

does

te

some

meatus

te

but

vagus

aca

nnerva-

does

not

nerve.

nerve

ony

pro-

vdes a sma amount o genera sensory suppy to te

externa ear; t s not assocated wt te coug relex.

woud

nerve

n

ypogossa

he

57–58

respectvey,

o

cana

nerve,

889,

ton

ABR/McM

te

trgemna

he

GAS

B.

te

ym-

orbta

optc

he

tere.

BP29,

motor

openng

o

and musce nnervaton to te styoparyngeus musce.

relex.

nerve

and

components

wereas

te

he

te

nvoved

acoustc

o

brances

or

externa

assocated

wt

entrance

nasoparynx.

openng

trgemna

ocuomotor

nocedomastod

37.

nterna

paryngea

bend

34.

C.

te

re s p e c t  ve  y.

E.

te

nerve

B. he aca nerve nnervates te stapedus musce, wc

45

connects

te

te

neror

reducng

mus-

wt

necton.

Te

s

s responsbe or mtng movement o te stapes, tereby

styopar yngeus

assocated

nerve,

to

relex),

te

te

relex.

sory mdde menngea artery , and an emssary ven.

D.

N

nasoparynx

spreadng

nerve

or

he oramen rotundum contans te maxary nerve.

nectons.

n

ear

nnervates

and

1041–1042;

te

ronta,

te

cornea

51

ocuomotor

o

trgemna

te

he oramen ovae contans te esser petrosa nerve, te

he coanae are te openngs between te nasa cav-

ty

B

nerve

tongue

audtory

and

gt

ssure

motor

and

GAS

s ens o r y

and

mandbuar

relex.

892,

he

te

te

to

E.

A.

ces

o

te

ABR/McM

te

ony

surround-

D.

pro-

bone.

te

eson

optc

mdaca

p rov de s

orop ar ynx

nner vat on

he

not

orbta

dvson

dvson

musce.

E.

but

acrma,

sensory

he

swaowng

trgemna

to

nnervaton

gossopar ynge a

and

o

nnervaton

sensory

nner vaton

dvson

nnervaton

mtted troug te superor

mastcaton.

maxary

vdes

C.

atera

o

o

nerve

skn

are te optamc dvson o te trgemna nerve and te

82

sensaton

motor

coug

dvson

sensory

and

musces

te

ocuomotor

ABR/McM

and

ntate

mandbuar

provdes

97;

te

ven; and te sympatetc bers rom te cavernous pexus.

ace.

responsbe

arynx,

tat

are

he

ocated

49–51;

nerve

te

musces

snuses

(motor).

A.

passage

optamc

septum.

1063–1064;

N

trgemna

to

bone.

sensory

superor

te

nerve; te superor and neror dvsons o te optamc

etmoda

ronta

mucosa

te

889;

he

te

nasoparynx.

C.

te

32.

spenoda

he

GAS

C.

nerve;

he

maxary

relex,

o

nnervaton

optamc

cornea

s ympto m

te

te

he

dvson

sensory

provdes

max -

b e twe en

maxary

provdes

snus.

A.

he

te

ng

an

p a n

snust s .

answer

te

49

 oc ate d

Sarp

n

just

8.221).

ABR/McM

snus  t s

maxar y

remanng

a

Fg.

91;

wc

bone.

and

to

(GAS

1049;

Max ar y

ar y

o

Head

ncude

ony

coses

te

te

sensory

eyed

porton,

and

does

E.

he

te

GAS

accessory

externa

945;

N

nerve

does

not

provde

ear.

106;

ABR/McM

57–58

nnervaton

to

CHAPTER

Laryngeal

Head

7

and

403

Neck

inlet

Epiglottis

Aryepiglottic

fold

Laryngeal Cut

edge

of

mucosa saccule

Cut

edge

of

Middle

right

part

Cuneiform

thyroid

of

lamina

cavity

tubercle

Vestibule

Corniculate Vestibular Laryngeal

tubercle

fold

saccule

(mucosa

Laryngeal

ventricle

overlying

vestibular

ligament)

Infraglottic

space

Vocal

fold

Interarytenoid

(mucosa notch

Cricoid

overlying

arch vocal

ligament)

Trachea

Epiglottis

A

B

Vocal

Vestibular

fold

fold

Rima

Aryepiglottic

Rima

Cuneiform

tubercle

C

Interarytenoid

•

C.

he

te

recurrent

motor

beow

te

 ar y n ge a

nner vat on

tr ue

voca

to

ner ve

te

 o d s.

s upp  es

ar ynx

he

and

ty rod

GAS

most

Fig.

o

sens ato n

g an d

recurrent

ar ynge a

n e r ve

are

n

c os e

fold

8.221ABC

brances

tus

te

ner ve

s

te

mos t

 ke y

to

a

tyrodectom y.

gea

ner ve

In jur y

to

te

o

sympatetc

nterna

tese

resu t

n

sp e ec

nerves

response

s

artery,

to

date

and

te

one

resut

pup

o

(“lgt

or

durng

gt”).

he

ocuomotor

re curren t

d e ec ts,

nerve

woud

not

afect

te

daton

 nj ured te

pup;

rater,

ts

stmuaton

resuts

n

te

ar y n constrcton

can

carotd

p rox m  ty

be

o wt

te

stmuaton

A. and

o

and a

te

glottidis

tubercle

Corniculate

38.

vestibuli

fold

(parasympatetc

nerves).

nc ud  ng

C.

he

nervus

ntermedus

s

te

parasympatetc

oarseness.

A,

B,

and

brances:

mucous

and

D.

te

he

nterna

membranes

te

superor

externa

o

aryngea

aryngea

te

aryngea

nerve

nerve

arynx

above

nerve

as

two

nnervates

te

voca

nnervates

te

component

te

ods,

maton

D.

he

tyrod

musce,

gossoparyngea

wc

tenses

te

nerve

voca

s

true

voca

ods

and

woud

superory

bodes

39.

B.

ony

acr-

te

nuceus

s

te

pregangonc

ocaton

o

te

parasympatetc

not

be

afected

tat

are

carred

by

te

ocuomotor

nerve

sympatetcs).

by he

trgemna

gangon

ony

provdes

sensory

procedure.

1010;

he

ace

afects

eye.

o

nnervaton GAS

and

to

E. ts

nerve

ods.

ocated

(not te

aca

Ednger-Westpa

neurons he

te

te

crcoce

E.

o

to

N

SCG

and

89;

ABR/McM

provdes

neck

te

ace

and

eye

but

49

sympatetc

regons.

to

nnervaton

Sympatetcs

trave

to

te

aong

te

efect

GAS

on

920,

te

1025;

pup.

N

142;

ABR/McM

44

as

no

motor

404

C H A P T E R

40.

7

Head

and

Neck

C. he greater petrosa nerve, a parasympatetc branc

o

o

damaged

te

aca

gand

A.

n

he

nerve,

te

provdes

B.

te

he

te

D.

deep

te

and

esser

he

we

d

to

to

te

as

nerve

o

gands

te

carres

vesses

and

to

aso

te

taste

GAS

sympatetc

and

mucous

nner-

gands

nerve

te

ne r ve

nner vaton

as

provdes

parotd

44.

o

41.

C.

s  n us e s

to

we

te

as

parasympatetc

s k n

te

se ns or y

o

te

py

te

s up e r or

 n ne r va -

cor ne a

upp e r

nos e

A,

as

he

w

n

most

te

tan

A.

snus

to

dspace

to

te

peope

orbta

s

te

te

o

ABR/McM

ocated

te

space

o

e ye-

te

actuay

D,

E.

orbta

beow

so

te

a

neror

wa

structures

te

o

bony

anteror

te

orbt

n

s

to

te

te

(maxary

eyeba

bow-out

o

com-

snus).

stronger

racture

s

te

orbt

more

tan

GAS

45.

he

o

te

N

very

basar,

are

rarey



ocated

njured,

descrbed.

atera

(o

artera

te

carotd,

ts

not

bood

Ws),

crce

nterna

crce

arteres.

contnua-

tereore

t

part

sup-

does

crce.

posteror

ABR/McM

not

and,

receves

te

rom

nterna

151;

t

te

and

crce

o

actua

communcatng

871;

s

artery

cerebra

he

be

61

artera

part

ear

symptoms

artery

suppy

can

sted

mdde

Atoug

any

bood

ner ves

te

carotd

cerebra

arteres.

burcaton

te

wt

nerve

meda.

oter

cerebra

orm

aca

ABR/McM

crce.

and

ts

te

otts

to

nterna

artera

vertebra

rego ns

he

110;

mdde

rom

B,

E.

present

N

te

receves

51–54

drecty

neror

scera

loor,

rupture

he

134;

trauma

key

partment

In

N

maxary

Any

not

he

not

and

and

o

proxmty

875;

te

proxmty,

because

communcatng,

921–922;

orbt.

C.

ton

gand.

p rovd es

D,

woud

tongue.

ateray.

GAS

cose

cose

o

etmod a

meday

ts

n

neck.

nasocar y

ton

acrma

nnervaton

subngua

bood

petrosa

nnervaton

E.

and

provdes

two-trds

petrosa

to

ead

he

te

A, B,

tympan

anteror

vaton

to

orbt.

corda

submandbuar

to

nnervaton

s

(o

ormed

cerebra,

anteror

(GAS

Ws)

carotd

te

posteror

cerebra,

Fg.

and

by

and

8.38A).

67

E. he sgmod venous snus emptes nto te nterna jug-

uar

ven

posteror

ra

and

and

drans

crana

occpta

te

ossa

bran

near

bones

just

te

and

sku.

suture

atera

to

It

runs

between

te

aong

te

mastod

te

tempo-

ces.

key

eyeba.

etmoda

ces

are

ocated

meda

to

te Anterior

communicating

orbt. Anterior

B.

he

ronta

snus

s

 ocate d

s up er ory

to

cerebral

Cerebral

ar terial

circle

te Middle

cerebral

orbt.

D.

he

nasa

cavty

s

toward

te

mdne

and

s

not

Ophthalmic

Posterior

neror

to

te

orbt. Posterior

E.

he

but

GAS

42.

B.

s

not

1063,

he

te

spenoda

snus

neror

1065;

superor

cavernous

N

to

s

deeper

te

ABR/McM

optamc

he

te

aca

regon

ven

18

drans

“danger

area”

Basilar

drecty

o

te

nto

ace

s Right

ocated

n

te

tranguar

communicating

cerebral

orbt.

49–51;

snus.

nto

regon

rom

te

atera

inter nal

ange Left

carotid

o

te

and

eye

s

to

draned

muncates

te

A.

te

te

by

ven,

ernous

o

but

te

aca

wt

t

s

p,

he

near

aca

cavernous

te

ven

snus

nose,

com-

troug

pexus

troug

not

communcates

te

drecty

neror

connected

wt

opta-

to

te

cav-

snus. Right

C

and

sary

E.

he

vens

ernous

D.

do

GAS

43.

C.

venous

pexus

communcate

venous

snuses

vertebra

876;

A

not

basar

petrosa

na

ronta

and

drecty

pareta

wt

ems-

te

common

carotid

cav-

snus.

he

N

eson

symptoms

84;

o

and

venous

pexus

connects

communcates

te

wt

neror

te

Right

ver tebral

Right

subclavian

Left

ver tebral

Left

subclavian

Left

common

nter-

pexus.

ABR/McM

te

aca

descrbed

59

nerve

s

(droopng

key

to

ead

mout,

to

unabe

te

to

Brachiocephalic

carotid

cose

rgt

bue)

because

eye,

and

ood

coecton

n

te

ora

vestAor tic

yzed.

here

ocated

inter nal

carotid

ven.

venous

snus

upper

ven.

te

optamc

pterygod

cavernous

mc

te

drecty

superor

he

mdde

on

te

s

te

a

musces

bony

meda

o

aca

promnence

wa

o

te

expresson

over

te

mdde

are

aca

ear.

arch

para-

nerve

Because

•

GAS

Fig.

8.38A

CHAPTER

Inferior

Superior

sagittal

sagittal

Confluence

of

Sigmoid

petrosal

sinus

sinus

sinuses

cerebral

venous

plexus

vein

Sphenoparietal

sinus

Intercavernous

Ophthalmic

Right

transverse

Sigmoid

sinus

petrosal

sinus

Cavernous

•

superor

aspect

o

cerebra

sagtta

te

snus

ongtudna

es

wtn

ssure,

te

GAS

superor

between

te

two

to

te

cerebr

and

sinus

Fig.

Pterygoid

venous

plexus

8.44

T rochlear

ner ve

[IV]

he

superor

sagtta

sagtta

te

great

snus

snus

runs

wtn

cerebra

ven

neror

te

(o

ax

Gaen)

to

orm

ner ve

C.

he

Pituitar y

D.

he

nto

ven,

ossa

te

vesses

GAS

46.

C.

N

drans

snus

s

Fg.

110;

troug

s

ABR/McM

nterna

nerve.

te

sensaton

to

te

A.

aca

he

o

te

taste

corda

musces,

wtn

snus,

ven

(o

te

and

mdde

optamc

oter

venous

61

te

te

aca

he

te

aca

and

o

te

wc

aong

nerve

o

wt

provdes

two-trds

aso

musces

oramen

nerve,

meatus

anteror

branc

troug

te

tympan

except

mandbuar

courses

cerebra

superor

acoustc

vestbuococear

va

o

medates

te

a

o

mastcaton.

trgemna

ovae

and

nerve

medates Sphenoidal

motor

pan,

sellae

8.44).

te

tongue

to

te

tensor

musces

ve

o

paatn,

mastcaton,

myoyod,

tensor

and

te

(paranasal)

bey

ower

B.

he

o

trd

o

dgastrc

te

maxary

as

we

as

sensaton

ante-

to

(venous)

sinuses

te

Ophthalmic

ace.

branc

sinuses

tym-

Caver nous

ror

Dura

snuses.

te

compressng

te

great

o

ocated

receves

spenopareta

tumor

te

conluence

and

(GAS

875;

he

runs

snus

te

cavernous

crana

gland

te

snus.

stragt

Gaen)

division

of

trigeminal

ner ve

te

trgemna

branc division

of

trigeminal

ner ve

[V

] 2

sory

troug

to

te

te

mdde

oramen

trd

[V

] 1

o

Maxillar y

passes

ner ve

[VI]

ar ter y

[III]

Diaphragma

stragt

carotid

emsperes.

neror

jons

Abducent

Inter nal

Oculomotor

B.

vein

sinus

petrosal

Inferior

he

sinus

sinus

Superior

A.

Neck

sinus

Basilar

Great

and

sinus

sinus

Superior

Straight

Head

7

o

rotundum

te

ace.

and

s

sen-

•

GAS

Fig.

8.45

mater

405

406

C H A P T E R

D.

he

7

juguar

vagus,

E.

and

and

Neck

oramen

accessory

as

te

nerves

gossoparyngea,

coursng

troug

acoustc

t.

E.

A.

he

te

beow

ocuomotor,

887–888;

105;

submenta

ncudng

A.

he

B.

he

o

N

trocear,

occpta

te

ymp

ower

abducens

ABR/McM

two-trds

te

and

nodes

o

approxmatey

mout

and

te

neroposteror

C.

were

D.

nodes

e

anteror

to

te

ear

and

he

serve

he

and

anteror

ynx

and

dran

te

E.

nodes

e

posteror

posteror

aspect

o

to

te

te

he

and

he

to

parotd

mandbe.

scap,

It

and

node

gand

and

receves

s

a

just

ymp

oroparynx

and

arge

node

beow

rom

s

te

posteror

ange

muc

commony

o

o

te

48.

A.

909;

he

o

N

GAS

ace,

enarged

n

Answers

51.

wtn

B,

te

te

nerve

and

o

trgemna

ous

snus

GAS

C.

N

suppy

tere

to

te

nnervated

as

A.

been

he

te

by

t

te

GAS

o

te

te

o

o

te

n

te

ascends

te

te

artery

A.

he

wa

o

B.

artery

owever,

te

he

C.

he

cavern-

afected

Fg.

(GAS

taste

and

o

by

E.

an

es

nerve,

o

at

wc

ts

GAS

52.

pont

s

te

a

B.

trgemna

anterory

as

branc

nerve

we

as

ony

taste

to

menta

te

and

a

key

does

not

s

te

and

N

133;

mandbuar

te

to

ABR/McM

space

oter

a

te

up

near

o

s

A,

C,

skn

o

o

te

menngea

posteror

trgemna

artery

temporomandbuar

te

aurce.

temporomandbuar

Because

jont

and

branc

and

jont

ts

skn

courses

and

nerve

o

nerve.

te

ten

te

te

o

rom

nerve

crana

and

te

ovae,

cavty

nnervates

aca

te

nerve

mandbuar

anteror

to

te

tem-

29

ocaton

ce

es

o

o

te

bodes

on

te

postgang-

nnervatng

te

meda

trgemna

contans

sensory

gangon

rom

te

te

ce

ce

aspects

o

contans

anteror

bodes

nto

o

te

te

surace

nerve

near

bodes

te

te

or

ace.

nerve

two-trds

postgangonc

ead

ganga

and

contan

upper

te

parasympatetc

subngua

GAS

53.

C.

A

he

te

neous

but

s

n

and

ce

o

te

sympa-

neck.

ce

bers

submandbuar

E.

bod-

nner-

savary

te

he

suppy

te

cornea.

o

by

do

to

cosng

not

o

te

o

nnervate

mb

bot

o

te

eyes

n

o

te

subarac-

hese

proper

te

o

v

are

ntracrana

pexus

te

prmary

subaracnod

oter

te

te

spaces

upper

te

cornea

nerve.

It

s

trgemna

acrma

te

te

sted.

62

mb

o

superor

dranage

rom

wtn

nasocary

and

aracnod

te

CSF .

wtn

dvson

parts

proper

corod

lows

low

te

as

crcuates.

te

te

ABR/McM

ronta

eferent

externa

CSF

aferent/sensory

B.

or

o

suc

mantanng

CSF

not

113;

snuses

boodstream

te

n

33

extensons

aow

houg

optamc

suppes

v

crcuaton

does

N

ABR/McM

are

venous

wc

carred

tey

te

v

venous

CSF ,

CSF

and

145;

he

and

864;

s

N

eement

and

D,

produces

o

a

branc

gangon

traveng

dura

te

cruca

space.

branc

as

snus.

nod

te

35

nerve

dvson

mdde

te

nto

and

medate

s

dvson

aracnod

nto

ow-

nnervates

ts

prmary.

te

CSF

coce;

termna

a

neura

postgangonc

o

tongue.

nerve

nerve

be

te

n

oramen

meatus

ABR/McM

submandbuar

pressure

woud

and

troug

nvoved

te

exts

nerve

gangon

taste

877–892;

he

sagtta

posteror

he

bers

o

mater

tympan.

nerve

ear

wc

be

man-

gands.

sensory

tongue,

jont

te

musce

ear.

s

nnervatng

SCG

he

8.45).

damaged

genera

te

o

ovae.

or

vatng

nerve

be

jont.

133;

gencuate

tetc

59

key

N

trgemna

tongue,

o

ramus

masseter

not

nerve

trgemna

mandbuar

brances

nerves,

te

te

troug

nner

gangon

oramen

optamc

was

can

gangon.

ngua

te

gand.

bodes

tese

most

corda

tympan

aveoar

encrces

te

te

o

otc

trocear

atera

two-trds

aurcuotempora

meday

te

te

to

acoustc

tympan

parasympatetc

relex

1090;

he

jons

nerve,

mmedatey

dvson

o

and

carotd

ngua

sensaton

he

neror

to

o

case

cn.

B.

It

E.

a

artery

regon.

carres

genera

te

be

bot

te

skn

corda

ever,

and

te

aurcuotempora

tempora

D

by

mandbuar

he

s

runnng

ocuomotor

ABR/McM

te

n

otc

nterna

n

corda

neurons

Eac

not

oss

rst

carotd

proxmty

nerves

te

nterna

s

afected

nterna

cosest

maxary

nerve

joned

n

be

jont

51–75

parotd

te

oter

anteror

nnervates

B.

te

974–975;

he

snus.

nerve.

115;

ngua

o

wtn,

may

te

13

woud

are

te

or

and

o

876;

he

because

s

bot

aong,

aneurysm

50.

he

snus

nerve,

te

runs

cavernous

cavernous

courses

nerve

daton

C, D, and E.

te

49.

ABR/McM

abducens

aneurysma

because

D.

onc

86;

te

te

tonsts.

GAS

over

woud

exts

te

poromandbuar

juguodgastrc

te

and

jons

dvson

parynx.

D.

and

vestbuococear

and

par-

troat

courses

rom

case.

temporomandbuar

ossa

t

structures

ear.

retroparyngea

pan

ts

superca

gand,

troug

te regon o te atera aspect o te eye, te parotd

gand,

ear,

n

he esser petrosa nerve courses troug te mdde

aspect

ead.

parotd

nerve

te

crana

serve

as

probem.

tongue,

ps.

nodes

and

ear

passng

parotd

58

dran

te

nerves.

te

aca

dbe,

anteror

C.

to

o te trgemna nerve coursng troug t, aong wt

he

te

meatus

reerred

he superor orbta ssure as te optamc branc

GAS

47.

Head

nerves

eyed

cornea.

cornea

response

to

(bnk)

branc

nerve.

provde

and

he

relex

a

aca

and

cuta-

oreead,

nerve

medates

rrtaton

o

te

CHAPTER

D.

he

ocuomotor

te

eyes

by

nerve

medates

contracton

o

te

te

reopenng

evator

o

A,

papebrae

superors.

E.

he

aso

N

97;

Kessebac

he

o

our

ABR/McM

pexus

our

arteres

paatne

he

te

septa

maxary

te

externa

B,

ute

and

E.

987–988;

mucosa)

pars

sense

56.

A.

anteror

are

te

ror

par,

etmoda

artery,

and

contrbutors,

spenopaatne

aba

n

turn

arteres

s

a

s

nasa

an

artery,

B.

C.

te

o

te

D.

pars

47;

ormed

part

o

and

e

Fg.

n

te

posteror

tonsar

pars

o

te

posteror

s

contrb-

he

(covered

wt

te

arc,

par,

ormed

by

hese

57.

te

provded

te

GAS

ante-

contans

openng

cartage

and

ethmoidal

o

and

cause

processes

te

s

and

space

o

on

te

cartage.

atera

te

rota-

arytenod

between

nvoved

cosng

musces

are

aso

arytenod

and

te

wt

te

e

te

voca

adductng

rma

gottds.

aongsde

nvoved

musce

aso

musce

crcod

tensng

voca

C.

cords

1048–1050;

he

parotd

crosses

by

to

paatopa-

te

te

bue

o

to

ora

N

ads

n

eter

adductng

connects

n

s

bot

cosng

ocated

cartage

te

voca

vbrate

65;

duct,

masseter

cavty

opposte

anterior

artery

Septal

Middle

concha

posterior

Posterior

ethmoidal

Superior External

or

on

and

te

te

ads

ods,

rasng

te

ABR/McM

aso

known

musce

were

upper

n

tus

te

ary-

rma

anteror

eonga-

preparng

ptc

o

t

te

Stensen

opens

nto

moar.

and

te

hs

duct,

extends

ora

vest-

structure

branch

ethmoidal

branch

ethmoidal

of

artery

of

artery

artery

concha

Area

of

significant

anastomoses

from

Sphenopalatine

to

“nosebleeds”)

artery

septal

branch

sphenopalatine

Posterior

lateral

branches

branch

of

Inferior

of

of

artery

nasal

sphenopalatine

artery

Terminal

concha

greater nasal

artery

Greater

palatine

palatine

part

of

artery

artery

artery

A

B

•

GAS

Fig.

(prone

artery

anterior

Posterior

te

47

as

transversey

second

nasal

artery

lateral

tey

e

crcod

ods.

cartages

Septal

Alar

te

musce.

Anterior

ethmoidal

orm

voce.

anterory,

he

voca

musces

o

contract,

te

crcotyrod

ton

arc,

not

gottds.

E.

ossa.

do

49

amna

crcoarytenod

transverse

wt

te

musces

407

Neck

gottds.

gament

voca

ossae

posterory.

paatogossa

arc,

not

o

tereby

rma

aspect

paatogossa

arc,

do

8.243AB).

42

boundares

te

te

musce;

arteres

ABR/McM

te

by

o

(GAS

te

tyroarytenod

he

o

crcoarytenod

musces

atera

voca

te

pars

ABR/McM

o

arytenod

he

(brances

branc

te

te

owever,

(rom

tese

he

hese

67;

(abducton)

ods,

greater

N

aspect

cartages,

sep-

E.

and

arces.

posteror

tenod

pexus.

paatoparyngea

ryngeus

aba

superor

paatoparyngea

paatogossus

anteror

te

area)

anteror

and

1033;

he

ton

Ltte

te

argest

o

tonss

ormng

and

te

wc

hese

N

paatne

muscuar

te

te

artery).

Kessebac

he

two

and

artery,

carotd

C,

to

GAS

B.

or

51–52

caed

on

superor

brances

artery)

aca

(aso

are

artery,

artery.

44,

arteres

spenopaatne

A,

eye

Wen

889;

tum.

o

te

relex.

D.

are

nnervates

posteror

anastomoss

55.

GAS

nerve

D,

tonsar

o vson and s te aferent mb o te pupary gt

GAS

54.

optc

C,

te

Head

7

8.243AB

Septal

from

branch

superior

from

labial

nasal

artery

s

408

C H A P T E R

typcay

o

Head

not

bockage

A.

he

B,

to

te

te

ps,

but

te

masseter.

and

GAS

900;

N

Because

does

s,

te

o

65;

ascend

oter

n

te

because

he

groove

aca

aurce

n

ven

es

he

aca

D.

he

s

he

proxmty

to

te

w

are

w

o

most

ocated

te

ansa

key

he

be

more

B.

s

cervca-

GAS

A.

cervcas

te

E.

ocated

o

GAS

nnervated

be

most

by

musce

nerve

nvoved

by

te

wt

61.

ts

te

supercay

cervca

on

branc

o

ge

o

tod

and

branc

s

aso

pays

no

m us c  e

o

and

nnervated

roe

n

ansa

by

te

s

on

38;

neck

musce

te

wo u d

n ot

be

afe cte d

ABR/McM

nerve

ater

and

sde

nnervates

o

te

te

psatera

and

B.

te

he

souder.

souder

ansa

w

especay

te

he

te

te

trapezus

Upon

he

trapezus

musce

surgca

aso

B,

tranges

C.

he

te

does

not

neck;

woud

strap

pass

musces

troug

owever,

resut

gossus,

resut

E.

he

o

te

and

n

n

and

te



t

were

o

o

souder

GAS

py

89;

Four

to

N

te

skn

39;

te

by

te

nerve

he

te

area

great

rom

to

te

cer-

C3

o

to

te

neror

C4

neck,

to

te

ange

o

o

30,

o

A.

o

he

to

B.

yo-

N

te

not

C2

C3

and

It

D.

he

mus

beow

E.

umerus.

o

te

nnervates

posteroneror

s

rom

to

cutane-

o

ead

s

t

te

31,

s

to

et

durng

neck

more

durng

Wen

turn

te

te

most

area

33

njured

and

toward

te

te

poston

s

musces,

n

occput.

dicut.

musce

bend

s

30,

musce

te

bot

skn

te

psatera

ead

key

act-

ead

w

lex

musce

to

sternocedomastod

he

njury

he

to

t

most

tese

s

musces

unkey

ttng

presentaton

and

s

or

coud

t

most

to

be

com-

te

sternoce-

ABR/McM

key

a

mdne

gand

woud

ma

to

ma

te

woud

encounter

or

et

oter

32

one

ncson

be

artery.

just

artery

31,

structures

beow

te

neror

tyrod

ven

he

neror

tyrod

ven

bracocepac

neror

arses

rom

source

stmus

te

but

to

te

s

te

ven,

wc

stmus.

aortc

arc,

present

n

he

verte-

ess

tan

mdde

tyrod

nterna

dran

ven

and

te

are

tyrod

gand

superor

to

te

ste.

neror

tyrod

artery

ange.

and

hey

arteres

meet

branc

te

woud

rom

tyrod

not

be

eter

gand

gated

at

an

wt

a

ncson.

crcotyrod

o

vens

juguar

te

artery

tyrod

courses

superor

to

te

st-

gand.

bracocepac

vens

are

neror

to

te

ste

o

ncson.

sup-

jaw

ascends

neck.

peope.

te

he

GAS

ange

nerve.

29,

vunerabe

ts

ts

supercay,

obque

many

cutaneous

te

provde

posteror

presentaton,

36;

subcavan

suprasp-

we

te

o

not

nnervates

devery

ere

causng

typcay

artery,

10%

32

te

jaw,

te

arm

provdng

over

te

te

rotaton

and

rom

musce.

mdne

wc

and

We

tyrodea

tyrodea

te

E.

tyrod

crosses

ntrnsc

woud

aspects

and

hereore,

ts

most

te

symptoms.

aurcuar

C2

njured,

musces,

29,

n



te

nerve

and

usng

contrbutor.

te

aca

genogossus,

nnervates

externa

ABR/McM

segments

over

and,

abducton

and

te

patent’s

partcpate

neck.

nnervated

spna

to

eve

nerves

he

neck.

o

sde

perormng

te

and

dvded,

o

and

1013;

we

tone

o

any

musces

nnervates

pus

nraspnatus

contrbutes

C.

o

suprascapuar

natus

60.

nerve

tongue,

styogossus

any

skn

does

ABR/McM

te

njured

ncson

ypogossa

musces

rom

aspects

orgnates

atera

nerve

musces

cest.

njury

he

expresson.

D.

soe

bra

nerve

o

parayss

and

aso

neck

sze



Wen

te

D,

drans

nnervates

9;

acton

opposte

been

GAS

62.

dv-

ose

te

domastod

abty to rase

w

oter

contrbute

tran-

 cut, woud not produce droopng o

aca

aurce.

transverse

musce.

A,

souder.

C.

aone,

toward

droop.

cervcas

neck and,

te

orgnate

sternocedomastod

ng

sternocedomas-

te

body.

posteror

N

brt

souder.

te

te

ts

te

mon

te

o

te

33

across

nnervatng

ten

respectve

31,

passes

o

973–974;

te

to

occpta

back

tan

ne r ve ,

by

esser

and

occpta

oten

te

by

ar y nge a

son o te nerve, te patent w ose te

te

o

neror

regon,

cervca

anteror

sensaton

te

brt,

cervcas

nn er vate d

s up e r or

te

Because

te

accessory

te

C.

ave

N

most

nerves

more

detod

greater

he

sternoy-

to

vagus,

1005;

he

te

transverse

he

ous

musces.

s

not

D.

surger y.

59.

he

parayzed

ansa

ncudng

omoyod

and

crcotyrod

rom

upper

as

supracavcuar,

occpta.

supracavcuar

nerve.

externa

esser

nnervate

unctons.

E.

te

we

te

and

vate

resecton.

nnervated

trapezus

accessory

as

he

40

musces,

and

nerve

and

and

ear,

ncude

to C3 spna segments but passes anterory to nner-

dvson

musce

strap

patysma

neck

vca,

A.

surgery.

B.

te

nerves

o

te

cose

ante-

o

oter

ange

toward

vesses

sternocedomastod

accessory

enarged

papated.

surgca

sternotyrod,

he

te

tumor

te

ange.

ABR/McM

te

ts

nnervates

papated

passng

not

be

sternoyod

oowng

be

become

necton.

cavces.

A

o

can

artery,

cannot

C.

od,

te

E.

and

can

gand

mandbuar

to

D,

A.

artery

Neck

but

parotd

anteror

deepy

and

papabe

or

aca

ror

58.

7

McM

63.

D.

1008;

30,

he

nerve

te

cose

te

easy

N

32,

38,

37,

recurrent

damaged

or

87–89,

aryngea

durng

proxmty

njured

84,

204,

215,

241;

ABR/

218

to

te

te

nerve

surgery

neror

transected

wt

s

te

most

because

tyrod

te

t

artery

artery



key

runs

and

n

s

extreme

CHAPTER

care

s

not

recurrent

exercsed

aryngea

durng

nerve

operatve

nnervates

procedures.

te

majorty

he

o

n

musces

addton

tat

to

open

and

provdng

cose

sensory

te

rma

te

voca

ods.

Even

suppy

reatvey

to

gottds,

te

md

•

nerve

can

A.

he

s

te

resut

n

oarseness

and

mandibular

lingual

dicuty

Special

not

n

artery

enter

B.

te

ansa

cervcas

does

not

woud

ansa

tetc

van

superor

te

to

te

aryngea

neror

tyroyod

es

Poster ior

sensation

•

(taste)

one

General

third

and

(phar yngeal)

special

ner ve

[VII]

(taste)

via

sensation

via

glossophar yngeal

tympani

ner ve

[IX]

nerve

tyrod

membrane

to

tat

t

s

part

orms

does

and

any

to

te

ste

structures

o

surgery

tat,



para-

a

not

tus

o

te

oop

cervca

around

contrbute

woud

not

to

cause

sympa-

te

subca-

voca

cord

oarseness



Motor

njured.

he

externa

te

crcotyrod

Damage

woud

]

oarseness.

subcava

artery;

atera

nnervate

cause

trunk

movement,

E.

[V

aryngoparynx.

and

he

te

proxmty

perces

he

yzed,

C.

cose

and

o

ner ve

ner ve

n

chorda

branc

(oral)

3

gotts.

nterna

thirds

sensation

to

facial

openng

two

General

arynx

trauma

•

te

409

Neck

Sensory

via

beow

and

te Anterior

voca

Head

7

to

not

branc

ts

o

superor

musce,

nerve

cause

aryngea

tensng

woud

dicuty

n

te

cause

nnervates

voca

cords.

oarseness

Hypoglossal

ner ve

[XII]

but

Intrinsic

muscle

Genioglossus

breatng.

Hyoglossus

GAS

1009–1010,

1023,

1058;

N

30,

39,

80,

82, Styloglossus

87–89,

92,

245–246;

64.

E.

he

men

and

141,

ABR/McM

vagus

smoot

tve

137,

s

ner ve

n

par ynx,

35–36,

e x ts

responsb  e

musces

tract,

213–216,

o

addton

ar ynx,

 or

te

47,

te

230,

49–50,

s ku

an d

at

motor

tr ace a,

to

te

235–236,

Palatoglossus

84

te

j ugu ar

 nne r vato n

b ronc,

mus c es

s upe r or

243,

to

and

o

te

two- t rd s

•

 or a-

he

o

ansa

te

cervcas

neck,

wt

nnervates

te

te

excepton

o

strap

te

sde),

paate ,

et

o

A.

te

he

cervca

sympatetc

te

juguar

oramen;

seat,

parae

nterna

te

C.

carotd

carotd

deep

areas

as

D.

parayss

an

Injury

to

and

runs

bend

nterna

enter

te

carotd

accompanes

carres

not

te

sympatetc

C.

carotd

artery;

artery

GAS

64,

82–83,

141–142,

304–307,

84,

crcotyrod

voce

tongue

146,

321;

890,

wt

woud

D.

to

173,

te

afected

n

1023;

115,

210,

ABR/McM

N

124,

19,

33,

213–215,

29–30,

231,

34–35,

he

ypogossa

musces

n

o

nerve

te

devaton

provdes

tongue,

Injury

o

to

to

236,

GAS

49,

70,

71,

te

te

wt

motor

te

ypogossa

tongue

nnervaton

excepton

nerve

toward

sde wen te tongue s protruded (n ts

te

case

o

te

woud

afected

te

rgt

te

unatera

ner ve

[X]

te

ner ve

trd

sensaton,

sde.

tssues

contracton

o

dysartra.

posteror

afected

et

devate

66.

C.

nerve

bers

to

o

te

paate,

o

woud

o

te

and

he

cn

resut

tongue,

oss

neror

te

ypogossa

to

te

et

o

gag

aveoar

and

woud

wen

ower

cause

te

te

tongue

44,

(GAS

s

resuts

at

entrance

n

o

o

te

and

anteror

cause

uvua

dicuty

to

n

saggng

te

o

te

unafected

swaowng

and

8.261).

te

N

19,

40–41,

128–129,

and

he

te

was

49,

68,

59,

139–140;

o

n

and

te

lud

paryngea

nterna

njured.

sensaton

arynx,

sensaton

aspraton

tumor,

nerve

o

te

precptate

ungs.

or

64,

ABR/

85

oss

to

bers

woud

te

124,

aryngea

nerve

o

and

Fg.

remova

Loss

nerve

115,

70,

taste

pregan-

gangon

tongue.

890–892;

86,

66,

superor

gotts.

te

parasympatetc

submandbuar

and

vagus

oarseness,

Durng

conveys

te

devaton

883–884,

te

to

sensaton

82–84,

McM

243,

66,

n

te

to

ngua

sde,

te

paatogossus.

resut

suppes

sot

136–138,

47,

te

two-trds

and

39–41,

127–128,

te

gossopar yngea

taste

ner ve

Injury

pro-

sde

o

moderate

oropar yngea

genera

E.

219

te

o

te

and

on

he

presentng

resut

vagus

protruded.

oarseness.

nerve

toward

musce,

because

relex

speakng

892,

87–89,

o

oss

gonc

ypogossa

te

to

n

Injury

nto

bers

Injur y

tongue

ts

dysartra.

883–884,

66,

te

–

8.261

teet.

nto

ead.

atgued

te

o

moderate

to

te

o

easy

truson

B.

branc

cana

o

t

te

does

Damage to te externa aryngea nerve woud resut

n

65.

wt

trunk

many

genogossus,

oss

musces

tyroyod

musce.

B.

Fig.

te

dges -

esopagus.

A.

GAS

above

oss

o

te

nto

nerve

te

rom

to

voca

taste

aryngea

branc

Injury

on

o

ts

cords,

te

ep-

vestbue

can

arynx,

te

tracea,

vagus

nerve

410

C H A P T E R

7

Head

and

Neck

suppes motor nnervaton to te musces o te parynx,

except

A.

te

styoparyngeus

Injury

to

ryngea

o

te

te

externa

woud

voce,

(gossoparyngea

cause

branc

an

eadng

o

nabty

to

a

te

to

superor

cange

monotone

D.

Sensory

nerve).

voce,

te

as

vagus

pa-

E.

he

ptc

we

te

oarseness.

B.

Injury

to

truson

moderate

D.

he

te

to

nerve

to

o

arynx

o

toward

woud

te

resut

afected

n

pro-

sde

te

te

and

parasympatetc

submandbuar

and

taste

bers

pregan-

gangon

or

te

aryngea

te

voca

musces

o

sensory

and

cords

te

and

arynx

motor

except

137;

67.

A.

C,

tat

D,

musces

47,

78,

acuss.

to

te

75,

80,

crcoarytenods

E.

act

1050–1051;

te

he

n

82,

87–89,

voca

bers

75,

80,

o

91,

te

ony

93,

B.

externa

courses

muc

togeter

o

A.

he

C.

he

ts

A

he

to

voca

92,

and

te

coces

69.

C.

he

n

N

o

te

panu

because

o

are

E.

aryngea

n

ocated

or

ts

n

surace

92,

or

71.

qute

pos-

o

by

mandbuar

ts

jont

s

ocated

aryngea

externa

and

but

952,

to

he

A.

o

te

receves

woud

N

9,

tensor

be

cavty

s

sup-

dvsons

unafected

25,

53,

56–57,

tympan

t

be

o

and

te

te

o

by

59,

normay

mdde

preventng

source

receves

bey

o

nnervaton

woud

ve

not

paatn

mandbuar

does

not

ts

o

ear

yper-

yperacuss

nnervaton

te

dgastrc

rom

cause

rom

dampen

te

and

aca

te

nerve,

yperacuss.

receves

motor

dvson

B.

tympanc

47,

membrane

aurcuotempora

o

te

D

temporomandbuar

rom

te

jont

as

we

as

parynx.

o

nnervaton

te

trgemna

movements

o

te

crcotyrod,

branc

resut

107,

nerve

n

As

o

n

129,

a

te

ear

wc

superor

yperacuss.

134,

160;

ABR/

corda

be

gand

E.

aca

T aste

to

nerve

to

te

te

te

to

to

te

ac-

nose,

rgt

resut

n

eye.

gands

te

ngua

receve

aca

nerve

nerve.

hey

eson.

ts

rom

parasympatetc

te

gossoparyngea

and

aurcuotempora

unafected.

tongue

corda

anteror

o

ts

anteror

te

dvson

te

petrosa

be

te

va

rgt

rom

receves

esser

woud

and

by

te

and

njury

te

o

o

expected

bers

tympan

nerve

va

an

be

or

gands

submandbuar

unafected

parotd

and

resut,

parasympatetc

te

parasympatetc

nnervaton

mucosa

secretons

and

carres

te

woud

nnervaton

gua

te

not

64,

te

nerve

acrma

mandbuar

same

N

petrosa

subngua

sensaton

resut

woud

secretory

te

trgemna

addtonay

nnervaton

s

o

externa

nvoved

petrosa

nerves

nerve,

are

and

he

84

te

nerve,

gand,

va

neror

by

greater

he

be

nnervaton

958–960;

tat

ter

nerory,

te

ABR/McM

woud

nasa

57–58

greater

nerve

T aste n te anteror two-trds o te tongue s sup-

by

te

ts

njury.

but

ts

he

oro-

sory

aca

(he

superor

tympanc

and

he

be

and

corda

woud

tympan

ocaton

on

woud

te

te

dvson

unafected

coud

be

ts

o

by

and

te

ts

o

ter

are

and

te

sen-

vagus

supped

trgemna

njury.

njured,

sde

receve

paate

n

unkey.)

gossoparyngea

nasoparynx

unafected

be

meda

make

aryngoparynx

rom

maxary

woud

nerve

membrane

bers

nerves.

te

C.

branc

woud

termnates

dvson

nerve

te

membrane.

sound

posteror

supped

woud

reaton

te

te

by

tongue

te

s

provded

tympan,

s

trgemna

and

provded

nerve

by

genera

by

va

te

te

n-

nerve.

GAS

958,

977,

986,

1094–1095;

N

20,

46,

62,

64,

66,

97, 107, 134–136, 142, 144, 146; ABR/McM 44, 58, 85

ped

B.

nerve

rma

nerve.

A.

te

McM

case.

137;

provded

maxary

woud

1093;

and

because

parayss

Damaged

brances.

87–89,

to

te

artery

nerve

te

movements

mutng

receve

tensor

decreased

superor

ts

he

aryngea

nerve

artery

cervcas

o

and

tympanc

dampen

rom

s

neck.

tat

arynx

movements

ts

te

to

tyrod

prmary

Damage

o

aryngea

te

ansa

anteror

njured

82,

externa

branc

nerve.

be

artery

1057;

nnervated

a

to

nto

tyrod

GAS

ter

he

ABR/McM

tyrod

s

D.

paate,

te

superor

recurrent

passng

te

superor

unkey

he

n

o

branc

route

trunk

s

nerve.

C.

cords.

160;

superor

superor

nerve

stapedus

92,

ocaton.

root

nterna

a

te

A

and

bers

ts

ateray

takes

te

sympatetc

neror

more

E.

wt

o

and

974–975,

probem

91,

route.

cervca

terory

D.

branc

o

optamc

tereby

aca

GAS

he

arynx

nnervaton

stapedus

to

styoyod

musces

te

ossces.

answer

te

te

te

cords.

remanng

adducton

N

are

te

904,

or

47–49

68.

ts

84

abduct

and

tat

Bot

but

BP25,

posteror

arynx

GAS

N

ABR/McM

he

te

B,

1057;

to

901,

ossces,

anteror

bers

te

trgemna

uncton

crcotyrod.

GAS

B.

n

provdes

to

82–83, 133, 136, 145; ABR/McM 29, 39–40, 56, 82–81

tongue.

beow

te

GAS

70.

conveys

sensaton

recurrent

a

nerve

dysartra.

two-trds

he

tongue

bers

genera

E.

ypogossa

te

ngua

gonc

by

njury

te

o

sensory

ped

as

nnervaton

nerve.

nerve

by

and

72.

C.

Pa r a s y m p a t  e t  c

gand

s

p r ov  d e d

par yngea

ner ve

o

Tese

p re g a n g   o n  c

pes

te

at

mdde

synapses

te

n

s e c re t o r y

parotd

axons

tat

pexus

nate

te

nner vaton

by

emerge

ear

as

o

carred

te

rom

esser

otc

gosso-

tympanc

petrosa

bers

gangon,

parasympatetc

parotd

te

te

parasympatetc

te

te

by

ner ve.

term-

wc

sup-

nner vaton

to

gand.

A, B and E. Ganduar secretons o te nasa cavty, sot

paate,

and

acrma

gand

a

receve

parasympatetc

CHAPTER

nnervaton

and

woud

rom

te

reman

bers

ntact

o

te

greater

oowng

a

petrosa

tympanc

nerve

D.

pexus

o

Axons

and

or

secretory

nnervaton

submandbuar

nerve,

ten

beore

synapsng

wt

gands

course

troug

n

te

postgangonc

gands

va

te

are

te

carred

te

subngua

by

eventuay

nerve

te

corda

submandbuar

bers

ngua

to

(GAS

E.

aca

tympan,

8.120

73.

953,

136,

145;

B.

he

son

o

978;

te

he

to

te

tetc

C.

abos

te

he

bucca

It

97,

branc

nerve

bers,

does

106–107,

74.

and

te

dsta

t

does

nerve

anteror

bey

contnuaton

exts

not

myoyod

aveoar

te

as

menta

afect

s

tat

o

te

a

te

te

133–134,

woud

o

te

provdes

and

sensory

woud

dv-

nner-

B.

taste

te

taste

and

sensaton

provde

and

and

to

C.

parasympa-

sensory

nnerva-

and

outer

surace

sensory

o

te

nnervaton

to

he

and

ceek.

GAS

Prominence

of

lateral

semicircular

canal

Prominence

of

facial

and

masseter

atera

branc

te

dgastrc.

966,

10,

972,

19,

margn

o

on

te

te

o

ts

jont.

coronod

mandbuar

te

unctons

extends

o

musce

atera

n

te

extends

pterygod

eevaton

rom

te

ramus

o

rom

pate

te

te

Aditus

arc

mandbe

te

pus

back

te

ange

o

te

mout

974;

N

13,

49,

56–57,

59,

160;

ABR/

tympani

tympani

to

antrum tube

window

Lesser

petrosal

nerve

eminence

Branch

carotid

Chorda

from

internal

plexus

tympani

Sympathetic

Internal Round

carotid

window

Chorda

Tympanic

nerve

branch

of

[VII]

Internal

•

GAS

Fig.

8.120

jugular

vein

to

and

ceek.

Pharyngotympanic

Oval

te

te

jaw.

zygomatc

o

to

jaw.

Tensor

mastoid

pro-

ramus

42–44

Tegmen

canal

o

buccnator

lattens

nlammaton

nserts

Promontory

Facial

o

myoy-

jaw.

surace

te

te

pterygod

surace

eevates

E.

provdes

he

te

meda

by

musce

anteror

retracts

he

te

teet.

nerve

and

mandbe

carres

afected

cess

meda

tongue

bers,

most

temporas

and

requre

sensaton.

o

not

mandbuar

be

he

McM

Pyramidal

te

teet.

motor

suppes

o

oramen

D. Part o te atera pterygod musce as ts nserton on

A.

teet

provdes

two-trds

bers.

to

nner

59,

panu

nerve

sensory

ton

te

and

te

59, 69, 66, 82, 133, 142, 145; ABR/McM 42, 59, 81–82

and

84–85

mandbuar

anteror

genera

44,

aveoar

ngua

te

19–20,

trgemna

te

anestesa

A.

N

ABR/McM

to

to

s

nerve

411

Neck

te artcuar dsc wtn te temporomandbuar jont and

neror

vaton

mandbe

nerve

neror

od

nerve

aveoar

and

GAS 883, 885, 886–887, 889–890, 978; N 25, 68, 56–57,

8.125).

GAS

te

he

te

gangon,

reacng

Fgs.

menta

neror

eson.

D.

he

Head

7

tympani

the

glossopharyngeal

nerve

[IX]

plexus

artery

412

C H A P T E R

7

Head

and

Neck

Prominence

of

facial

canal

Stapes

T ensor

Prominence

of

tympani

lateral Lesser

semicircular

Tympanic

Round

muscle

petrosal

nerve

canal

plexus

window

Phar yngotympanic

Branch

from

internal

(caroticotympanic

T ympanic

(from

tube

carotid

plexus

ner ve)

ner ve

glossophar yngeal

ner ve

[IX])

Promontor y

•

75.

D.

he

trocear

musce,

wc

ateray.

wen

It

te

s

downstars,

resuts

A.



he

t

s

sed

B.

he

nerve

or

and

he

n

a

not

can

obque

downward

depress

an

te

ndvdua

ntated,

and

he

stars,

sory

GAS

n

pup

B.

rectus

as

o

and

ts

ndvdua

a

C

ner ve

nduce

te

an

o

ts

nerve

dmn-

superor,

we

as

te

nward

te

d  p  op a

te

te

ne-

o

te

a

branc

trgemna

nnervaton

883–884,

s

neror

886,

to

te

nerve

movements

not

In

o

te

eye,

96,

 ater a

and

rec -

dam age

p res e nted

n

t s

E.

te

and

optamc

provdes

sen-

E.

N

64,

96,

97,

ward

ts

rom

te

moton,

obque

adducted

n

musce

turns

poston.

conjuncton

wt

56,

resuts

tarsa

A

rectus,

resutng

sensory

o

nerve

nerve

te

orgnatng

trgemna

suppes

te

nerve.

superor,

te

pup

Inabty

dpopa

to

down-

perorm

wen

wak-

ng downstars, ndcates damage to te trocear nerve.

gand

cay

886,

(o

o

waks

nduce

te

In

adducted

nerve

woud

o

dp-

downstars.

n

ocuomotor

889–890,

damage.

be

respon-

932–933;

127–129,

occur

ack

Dry

132,

N

156;

64,

ABR/

response

nnervaton

and

to

(droopng

o

moss

unopposed

bockng

o

te

te

o

eye-

superor

(pupary

con-

parasympatetc

pup.

woud

acton

o

not

te

occur

because

sympatetcay

ts

nner-

pupae.

eye

woud

but

bers,

same

medated

o

rom

pup

dator

n

Ptoss

Müer),

te

te

he

not

downward

nerve

ocuomotor

movements

movement.

nsuicency,

case.

ndvdua

gaze

te

woud

ocuomotor

moss

parasympatetc

ts

nerve

ndcate

resuts

C.

rom

downward

80

dated

and

to

te

rom

requres

ts

nnervaton.

musce

strcton)

B

superor

a

and

124–125,

and

sympatetc

A.

not

115,

61,

Ptoss

to

afected

883–884,

nnervaton

932–933;

76–100

he

an

upward

vated

76.

atera

nnervaton

upward

nabty

does

97,

McM

77.

n

poston

or

GAS

115, 124–125, 127–129, 132, 155; ABR/McM 60, 56, 80

Answers

s

branc

ocuomotor

Damage

wen

ts

sbe

nduce

oreead.

889–890,

he

te

eye.

nerve

Overa,

poston

downstars.

o

te

optamc

resuts

eye.

d)

nerve

D.

addton,

ocuomotor

woud

 n n er vates

te

musces.

afected

rater

rom

nerve

a b d uc ts

t e

and

nnervates

o

nasocary

rom

dpopa

eson

wen

but

wakng

abducens

abducton

he

waks

opa

suppes

upward

he

neror, and meda rectus as we as te neror obque

and

dpopa

nnervaton

wc

ronta

dvson

A.

and

probem.

E.

8.125

propery.

te

nerve

eson

abducens

woud

s

superor

Fig.

bndness.

n

an

musce,

tat

vson,

n

down

meda

resuts

eye,

tus

resut

Overa,

dpopa

C.

not

te

pup

Wen

provdes

waks

and

obque.

musce

unctonng

nerve

vson

te

moton

ocuomotor

ror,

te

eye

woud

nnervates

move

adducted.

not

ndvdua

to

ony

s

ts

optc

nerve

te

eye

nerve

acts

GAS

t

ods

occur

because

woud

true

s

reman

or

accommodaton

because

ts

te

o

acrma

medated

unafected

by

n

parasympatet-

patway.

CHAPTER

D.

Dept

s

GAS

78.

B.

not

percepton

medated

918–920;

he

rgt

rectus,

ton)

te

Inward

C.

Downward

D.

and

trocear

Down

and

o

are

te

s

128,

132;

Horner

ng

suppy

o

o

te

te

meda

nerve.

mdne

accom-

superor

obque

by

te

by

ocuomotor

te

combned

secretes

and

s

te

ent

n

Loss

cate

o

wt

abdu-

pup

rectus

neror

be

66,

933;

80,

nvoves

te

response

s

hs

N

py

83,

64,

resuts

n

pup),

96,

by

97,

ptoss

sympa-

(droop-

andross

ace.

by

he

rom

to

acrma

gand,

parasympatetc

o

te

wc

stmuaton,

gobe)

and

t

te

to

oten

ace,

to

Neck

resut

processes

wc

te

move

superor

te

rom

ocated

ncudes

nose.

hs

nectous

snus.

agents

he

ven,

ptery-

he

suppy

because

cavernous

and

E.

he

C.

he

and

ts

cay

te

s

s

not

re-

pres-

GAS

be

do

s

a

te

not

area

o

a

pro-

drect

sup-

anguar

and

low

possess

ofer

route

bood

and

nose

can

a

pat

more

receves

ead

not

te

vens

te

ower

n

eter

vaves.)

route

necton

n

o

com-

and

vasodataton

o

rater

nnervaton

te

tan

vesses

to

eads

te

to

and

(GAS

909,

916;

N

spread

courses

caed

te

te

carotd

artery,

provdes

Fg.

between

scap

and

o

eadng

to

necton

between

veins

artery,

traverses

orgn

to

spec-

troug

te

op-

8.68).

20,

84,

99,

104,

115;

ABR/

Caver nous

sinus

paeness.

Horner syndrome resuts n ack o sweatng o te ace.

GAS

E.

917–920;

he

superor

N

94,

tarsa

142;

ABR/McM

musce

(o

37

Müer),

nnervated

by

sympatetcs, s smoot musce tat asssts n eevatng te

eyeds and mantanng ts poston. Loss o sympatetc

nnervaton

A

and

nerve,

bra

B.

s

to

part

coses

wen

ncreased

low

C.

Damage

ear

eye

trocear

or

ptoss

ocu,

s

o

te

nnervated

cosure

eyeds

eye

te

o

te

ordnary;

cosed

more

across

evator

eyed.

by

eye.

te

te

he

aca

pape-

orbta

orcby,

te

papebrae

ocuomotor

rater

superor

gazes

parta

part

resutng

gobe

(peraps

ceeks).

te

nerve,

adducted

n

movement

te

to

by

compete,

he

te

te

tear

down

vated

D.

resut

orbcuars

responsbe

contracts

n

w

he

tan

parta,

obque,

moves

poston

down

nerve,

te

(or

woud

te

by

te

downward

exampe,

te

nner-

resut

n

ptoss.

nnervated

pup

toward

ask

superors,

nerve,

as

et

patent

wen

oot).

to

te

T o

ook

troc-

rom

wt

te

rgt

test

Infra-orbital

vein

Facial

vein

te Pter ygoid

eac of

eye

GAS

toward

te

917–920;

N

tp

94;

o

te

Deep

nose.

ABR/McM

37,

80

facial

vein

•

GAS

Fig.

te

precranum

59

Ophthalmic

te

woud

unopposed

ace,

te

snus.

artery

carotd

snus

artery.

te

te

(oten

wereas

nterna

o

cavernous

menngea

cavernous

communcate

vens

nvoved

and

oacaton)

te

47,

vens

perosteum,

875–876,

McM

and

nose

mdde

dura

te

woud

emssary

not

te

ven

around

n

between

ven

ofer

te

snus.

snuses

between

tese

but

supratrocear,

area

bood

artery

tereore

optamc

optamc

te

(V enous

and

necton,

supraorbta,

carotd

venous

o

syndrome.

sympatetc

te

pys-

optamc

cavernous

snus

spread

superor

tamc

ypertyrodsm

te

potenta

nto

superor

te

tat

n

te

o

can

nectous

surroundng

cavernous

te

tereore

o

and

te

te

muncaton

o

80

nterrupton

(protruson

by

A.

musces,

dvson

20,

area

carres

or

drecton

a

unafected.

caused

lusng

te

respectvey .

te

as

te

trave

vded

B

ace.

o

Horner

o

o

meda

(constrcted

Exoptamos

quenty

nerves

te

889–890,

ubrcated

woud

and

by

ABR/McM

to

n

trocear

movement

by

nerve.

moss

eye

nnervated

oter

drecty

pmpe

ten

tromboss

or

danger

ace

pressure

route.

medated

te

te

wc

snus

pmpes

and

god venous pexus and optamc ven bot commun-

s

supped

are

neror

887,

sweatng)

he

and

syndrome

eyed),

(ack

wc

nnervated

124,

tetc

80.

te

by

respectvey.

moton

nward

883–884,

E.

n

musce,

nerves,

ocuomotor,

ocuomotor

D.

ca

o

oreead.

GAS

C.

(abduc-

area

vens

wc

B.

ocuomotor

actvaton

musces,

Down

A.

atera

obque

uncton

79.

Cavernous

around

rgt

movement

accompsed

te

rectus

out

D.

squeezng

53

te

81.

actons o te atera rectus, neror rectus, and superor

cens,

E.

and

s

by

jont

neror

and

rom

movement

and

37,

nnervates

outward

patway

system.

eye.

supped

by

vsua

ABR/McM

nerve

movement

psed

te

sympatetc

142;

medates

rgt

A.

rectus,

94,

te

abducens

wc

o

N

nvoves

by

Head

7

8.68

veins

plexus

413

414

C H A P T E R

82.

E.

he

o

nerve

by

s

rage

o

he

D.

GAS

83.

D.

any

N

no

A

tat

B.

to

be

nerve

ar

a

s

ony

or

adjacent

Incson

n

to

154,

an

n

GAS

juncton

59,

be

and

s

B,

nerves

te

a

n

te

wt

67

C.

tympanc

mem-

mnma

and

or

te

superor

C.

he

de

maeus,

and

meday

umbo

o

wc

s

te

to

stuated

maeus

te

n

s

stuated

tympanc

cose

and

mgt

be

E.

te

damaged

duct

durng

woud

amost

mdde

ear.

ncson

ton

be

GAS

certany

Damage

woud

troug

avoded

945–947,

to

te

nterere

te

to

damage

960;

N

maeus

maeus

wt

mdde

prevent

te

ear

te

audtor y

cavty,

conductve

105–107,

rom

and

109;

86.

te

D.

and

conduc-

soud

to

A.

ypogossa

tongue

o

and

sape

nerve

te

n

te

tongue

on

one

one

he

rom

to

and

te

causng

nonmovng

sde.

B.

to

Damage

gossus

te

C.

et

te

musce

tongue

ments.

wen

te

t

tey

as

to

a

pont

ts

ypogossa

cause

te

nerve

and

tongue

et

te

to

devate

to

o

musce

te

nor

s

responsbe

tongue.

te

rst

D.

or

Neter

cervca

nerve

retracton

te

geno-

contrbute

does

Damage

tongue

to

to

a

contrbute

ypogossa

devate

to

te

to

tongue

nerve

psatera

move-

woud

sde.

cause

N

camber

n

umor;

ts

s

te

tere-

ocaton

can

pressure.

between

smpy

drecty

upper

opens

te

o

an

anteror

lud

does

aperture

connected

do

dated

up

to

end

nto

cavty.

wt

he

te

to

te

o

te

neror

nasoacrma

ncreased

to

te

ntraocuar

vagus

he

to

66,

te

tat

right

te

et

toward

because

as

nerve

A.

Even

o

woud

genera

can

te

anter-

not

be

operaton.

pregangonc

te

beore

externa

888,

gossopa-

synapsng

n

somatc

aferent

acoustc

meatus;

trgger

214;

are

te

o

o

a

gag

relex

devates

musces

pu

o

paryngea

te

a

te

paate,

tensor

or

anteror

66,

te

are

sde

o

ve

he

a

and

uvua

paryngea

unopposed

constrctor

are

ndcat-

unafected,

te

41,

84

et,

propery.

te

N

136–137,

evator

musces,

nnervated

by

as

te

paatn—mandbuar

nerve).

tumor

te

134,

44,

to

workng

unafected

te

afect

or

932–933;

127–128,

ABR/McM

not

trgemna

toug

potentay

taste

889–890,

124,

uvua

(except

te

medates

paata

he

musces

dvson

n

o

scap

tongue.

886,

musces

we

te

musces

paatn.

run

nerves

and

te

te

reerred

skn

and

nerve

n

be

tonsectomy.

contans

tat

meatus

82–83,

devates

ve

te

tympan

o

case,

te

hs

medates

144–146,

ts

membrane

nerve

o

suppes

ndrecty

aurce

o

ts

nerve

can

tube,

rom

relex.

883–884,

141–142,

ng

case

n

genera

audtory

sensatons

as

bers

nerve

te

tube,

tympanc

te

corda

64,

In

Panu

51

medates

parynx,

aurce.

gangon.

otc

ABR/McM

nerve

audtory

petrosa

two-trds

E.

ear.

or

te

49,

te

nerve,

and

GAS

100–101;

te

ryngea

vagus

not

pro-

ncrease

nadequate.

coecton

nasa

to

tympanc

esser

he

E.

te

geno-

te

rom

drecty

cougng

pued

to

an

umor.

and

mdde

stmuaton

restrant

s

secre-

umor

Increased

cause

aqueous

s

not

te

939;

and

suppy

pass

movement.

nerve

C.

protruson.

tongue

tongue

te

tongue.

pu

s

s

parasympatetc

musce

and

te

n

acts

te

he

genogossus

o

mout,

B.

ts

protruson.

eevaton

Vagus

o

woud

and

te

by

nvoved

protruson

mandbe

aspect

contract,

te

parayzed,

tp

et

styogossus

to

E.

te

deep

n

toward

major

he

te

ateraton

eson

upon

te

o

s

body

retna.

aurcuotempora

aurce

87.

he

yod

s

o

s

n

A

tongue

tongue.

musces

out

tongue

te

musce

on

te

o

musces

nvoved

observed

te

te

te

tongue.

o

nsde

nto

genogossus

orward,

te

be

o

genogossus

o

o

genogossus

te

nsert

orward,

sde

drecty

coud

protruson

arse

posterory

nnervates

devaton

wc

tongue.

musces

I

cause

sde,

nvoved

Wen

tereore

movement

woud

njured

o

s

and

nerve

o

ncudng

ear

he

44,

te

osuperor

he

sac

a

ts

aqueous

sensaton

rom

te

A.

57–58

84.

te

gossoparyngea

parynx,

oss.

ABR/McM

te

notng

936–937,

he

somatc

surgca

ts

earng

o

68,

pressure.

GAS

A vertca ncson troug te tympanc membrane

49,

139–140;

aqueous

anteror

dranage

or

duct

meatus

as

te

connecton

body

o

acrma

nasa

an-

o

camber;

onto

vtreous

woud

dranage

o

o

ere,

gt



cary

camber.

ste

ntraocuar

te

nasoacrma

ncson.

E.

occur

he

membrane.

to

s

producton

mmedatey

proxmty

bockage

pup

he

ts

dranage

posteror

40–41,

produces

posteror

ange

ncreased

aow

supe-

te

and

19,

128–129,

receves

body

pressure

o

N

124,

85

rom

he

not

D.

posteror

n

115,

camber

cary

lud

a

889–890;

86,

rdoscera

ore,

ror quadrants o te tympanc membrane woud key

damage

he

s

structures.

anteror

o

cause

tympanc

ncson

ocated

ntraocuar

A.

66,

he

ocaton

and

ABR/McM

o

44,

rst.

s

892,

82–84,

posteror

ducton

key

pons

70,

he

and

and

are

woud

B.

tons

emor-

A,

883–884,

64,

ABR/McM

85.

afected.

te

mportant

te

key

abducens

artery

176;

o

major

cerebe-

emorrage.

be

quadrant

porton

aow

he

and

possbe

stuated

a

woud

trocear

regon

rostray

149–152,

te

to

wt

s

te

oowng

cerebear

and

o

artery.

damaged

neror

neror

woud

proxmty

ts

mdbran

too

artery

porton

pontomeduary

damage

147,

s

damage

and

te

anteror

membrane

o

ocuomotor,

wt

870;

cose

te

key

ocated

he

brane

at

trgemna

tus

cerebear

neror

n

anteror

optc,

he

neror

ocated

most

sufer

Neck

emorrage

te

assocated

and

anteror

stuated

tereore

not

te

Nerves

afected

C.

Head

anteror

supper

um.

7

o

te

juguar

cana

gossoparyngea,

coud

vagus,

and

CHAPTER

accessory

a

eson

nerves,

on

te

paryngea

te

patent’s

vagus

nerve

nerve.

woud

presentaton

A

eson

produce

oss o taste rom te posteror

o

gag

relex,

patent

B.

he

mparment

does

not

present

paryngea

upward

ped

by

by

te

te

wa

o

on

et

C.

or

suc

or

as

D

coug—te

sde

s

gossoparyngea

aso

nerve;

drawn

to

sup-

tus,

t

he

ar

mandbuar

o

trgemna

nnervaton

to

te

musces

he

o

et

and

to

GAS

64,

s

67,

uvua

E.

An

ay

moar

I

te

te

or

146,

321;

resut

area

mandbu-

provdes

motor

does

sensory

suppy

not

90.

to

o

nnervates

te

o

et

ts

sde

nerve

te

o

te

woud

n

o

a

te

patent

s

paryngea

1023;

115,

210,

ABR/McM

o

te

loor

and

N

124,

19,

213–215,

47,

33,

61,

Qunsy,

o

te

n

mout

wt

236,

84,

ed

243,

snus

s

Fg.

o

(Ludwg

sweng

angna).

16,

91.

prompty,

can

ead

to

a

torus

o

and

a

o

te

tonss

te

abscess,

tat

s

a

can

woud

not

wc

he

ranua

s

a

wt

owever,

977,

te

age

a

necton

1092;

are

n

a

B.

o

o

te

ead

te

resprator y

he

wt

tract

on

nto

coanae

cavty

C

N

nto

te

and

as

ound

rom

on

It

can

be

are

loor

caused

35;

o

n

te

by

acute

oca

asymptomatc.

ABR/McM

GAS

o

18,

30,

47,

92.

(eustacan

tube

or

tat

nasopar ynx

necton

to

te

are

te

te

provdes

to

can

te

trave

oropar ynx

mdde

pared

ear

tube

or

va

te

and

a

drect

mdde

rom

or

te

openngs

nasoparynx

audtory

par yngotympanc)

te

cav-

upper

nasopar ynx

audtor y

rom

do

mdde

con-

ear

te

not

ear.

or

tract

43,

49,

136;

56,

ABR/

va

te

middle

semunar

nasal

atus.

atus

are

he

ocated

drans

te

acrma

drans

duct,

te

secre-

wereas

posteror

snuses

dran

et-

nto

te

and

spenoetmoda

proxmty

not

nvoved

to

n

ts

te

recess

maxary

dranage

(GAS

43–44,

50–51;

ABR/McM

3,

12,

snus

provdes

wc

s

te

most

stuated

drect

access

drecty

above

entry

atera

ste

and

te

aso

woud

nerve,

ead

but

subaracnod

potenta

ocated

snus

to

te

ar

to

t

dam-

woud

space,

menngts.

too

te

s

stuated

ptutary

entrance

Neter

drect

tat

ces

nto

and

are

to

te

wt

he

crb-

anterory

rom

ronta

and

potenta

woud

access

N

snus

pont

to

te

t

te

s

crana

not

a

ste

cavty.

nor

wt

tereore

45–46;

wtn

gand;

crana

communcaton

1064–1065;

55,

at

gand.

cavernous

cavty

a

entry

maxary

te

not

nteror

aow

ptutary

ABR/McM

12,

snus

o

te

te

sur-

gand.

17,

25,

43,

79

B. he gag relex s composed o bot an aferent and an

eferent

mb.

paryngea

te

hese

and

contracton

relexes

vagus

and

o

are

nerves,

vagus

te

medated

by

te

gosso-

respectvey. T ogeter,

nerves

musces

o

are

te

responsbe

parynx

was

te

A.

njured

oss

he

ror

nasa

o

wen

te

aca

te

sensory

nerve

two-trds

medate

tonss

te

s

o

gag

sde

o

were

te

nvoved

te

excsed,

or

nerve

resutng

n

relex.

wt

tongue;

te

nvoved

n te gag relex. In ts case te gossoparyngea

tube.

connect

cose

N

CSF

pates

D.

any

geon

oder

(nspssaton)

usuay

31–32,

te

deydraton

to

o

surgca

crana

tey

mucosa-ned

rom

ten

or

a

ste

recesses.

oactory

ptutary

cavty

te

ave

N

BP29,

nasoacrma

meatus

gand,

cranum;

he

sortened

usuay

1079;

109,

spenoda

tereore

spenoda

te

tongue-te,

movement

w

on

usuay

pan.

as

n

gossoparyngea

audtor y

resprator y

and

growt

key

he crbrorm pate coud ofer a pont o entry nto

occur

40

he

A

resuts

coaguaton

secretons.

ty.

cause

restrcts

resutng

trauma;

s

smar

growts

known

person

mucocee

savary

tube

aso

tat

tat

afected

oten

ndvduas,

32–33,

a

a

respratory

snus.

pus-

mpedment.

mout,

GAS

s

Suc

typcay

s

deect

renuum

speec

A

mandbe.

s

conca.

meatus

nasoparynx

ptutary

aso

mandbuars

te

congenta

tongue.

B.

he

to

tonsts.

Ankyogossa,

ngua

A.

E.

rorm

s

89.

pertonsar

acoustc

55

paate;

bengn

D.

as

nterna

upper

semunar

te

he

1058–1060;

44,

ts

tube

8.239).

GAS

usu-

he

eakage

nsde

nasa

nasa

ces.

are

audtory

vestbuococear

tese

te

and

by

stuated

and

o

te

drans

nto

nasa

carred

T orus paatnus s a bengn bony growt on te ard

te

C.

known

nlammaton

because

B.

snus

mdde

E.

not

rom

te

and

1035–1037,

meatus

superor

and

are

mandbuar

antbotcs

submandbuar

D

219

space

te

49,

te

57–58

neror

moda

A.

aso

te

and

aca

105–107,

speccay

nasa

te

136–138,

231,

66–71,

necton

treated

39–41,

127–128,

submandbuar

denta

not

955,

spenoetmoda

892,

173,

55,

tons

ead

cana

or

Neter

77–80,

maxary

he

tongue.

not

60,

wt

415

Neck

ear.

950,

75,

he

ntrnsc

aspyxaton.

A.

72,

connect

necton

mdde

under

aca

passages

o

943,

mdde

te

not

respectvey.

meatus,

te

nnervate

B.

A.

nerve

njury

87–89,

necton

te

and

and

musces

890,

82–83,

306–307,

nerve)

te

devaton.

883–884,

141–142,

(or

parynx.

ypogossa

extrnsc

66,

ace

musces

te

Compresson

88.

nerve

dvson

mastcatory

D.

te

GAS

do

and

ear.

he

are

spread

McM

rgt

E.

nerves,

ntact.

C.

and

te

styoparyngeus,

nostrs

mdde

meatus

symptoms.

et

he

gosso-

symptoms

swaow

te

ndcates

te

⅓ o te tongue, oss

tese

non-parayzed

on

Head

7

taste

o

owever,

t

te

ante-

does

not

relex.

C and D. he mandbuar and maxary nerves are part

o

te

trgemna

nerve

and

are

tus

argey

assocated

416

C H A P T E R

wt

te

7

Head

sensory

and

Neck

suppy

o

te

ace,

snuses,

and

ora

E.

he

cavty.

E.

he

ypogossa

ces

GAS

93.

B.

o

te

1089;

he

66;

nnervates

most

o

te

mus-

does

or

GAS

ABR/McM

aryngea

durng

transected

nerve

tongue.

N

recurrent

damaged

a

29,

nerve

35,

s

oten

tyrodectomy .

damaged

36,

recurrent

44,

at

66,

rsk

Patents

o

wo

aryngea

84

95.

A.

beng

ave

w

1036;

a

bot

oten

or

ear

B.

damage

ony

crcoarytenod

nerve

to

te

musce

and

woud

nerve.

he

responsbe

s

supped

tus

be

posteror

or

by

te

mpared

recurrent

oowng

crcoarytenod

abducton

o

te

voca

s

ar

te

C.

cords,

A,

C,

tors

o

ead

cosure

o

and

tons

B.

he

o

taned

wtn

and

ngua

te

nvoved

oter

cords,

te

ts

s

n

or

te

adduc-

woud

E.

not

n

tons

st-ke

can

bend

tube,

ead

to

space,

and

a

96.

D.

te

pa-

bockage

te

o

A.

s

ossa

n

paatne

between

arces.

An

tons

o

te

posteror

tons

te

s

w

not

not

paatogos-

enargement

B.

he

ncudng

occude

te

to

nvoved

t

s

n

ocated

occuson

more

o

te

audtory

tube

not

be

because

C.

posterory.

Frontal

process

Lacrimal

te

te

do

are

process

Major

alar

mdde

as

te

nto

orms

te

s

not

contrbute

to

we

ne-

te

superor

body.

dened

and

deveopment

45–47,

nerve

ard

s

49

responsbe

paate,

or

te

or

te

ard

ngua

to

te

posteror

nerve

suppy

to

nerve

menta

nerve,

and

suppy

portons

posteror

te

sen-

part

as

o

o

t

s

brances,

nerve

branc.

hese

te

mout

and

nvoved.

nerve

suppes

anteror

taste

two-trds

and

o

te

genera

tongue.

bone

concha

nasal

concha

process

of

ethmoid

bone

of

cartilage

pterygoid

bone

cartilage Perpendicular

of

Inferior

gums,

branc,

maxilla

nasal

te

paate.

severa

denta

roo

o

However,

ard

ncsve

neror

te

teet.

cartilage

alar

ear

tons-

te

utmobranca

sphenoid

A

perssts

pouc

te

Medial

Minor

and

deveops

aveoar

not

not

he

of

n

Uncinate

septal

to

responsbe

tymus,

pouc

upper

myoyod,

Middle

Lateral

te

tube.

te

te

ton

Superior

Nasal

and

ABR/McM

o

neror

te

woud

not

ncudng

and

o

tus

constrctor

tube

s

to

opens

mout.

nvoved

nerves

paryngea

pouc

and

paatne

te

ceeks,

con-

t

he posteror superor aveoar nerve suppes mutpe

audtory tube because o ter ocaton n te oroparynx.

superor

105;

nnervaton

D.

he

audtory

N

pouc

paryngea

gand

tereore

greater

roo

and

crypts.

gand

paryngea

structures,

ocated

te

te

he

sory

tube.

wereas

paatne

a

sxt

950;

wc

pouc

audtory

tonsar

paryngea

ourt

woud

nasoparynx

tube,

paryngea

te

degutton

nasoparynx;

366

te

audtory

paryngea

and

trd

he

GAS

nasoparynx

ocaton

tonsar

te

tese

a

o

te

tube.

60,

rom

te

rst

paratyrod

he

o

(eustacan)

paatoparyngea

tons

are

ABR/McM

bot

paratyrod

47–49

stuated

audtory

tongue,

o

D.

cord.

sted

parayss

ABR/McM

tons

ngua

te

musces

and

audtory

te

voca

arway.

recess,

n

o

aspect

sa

he

o

te

dranage

te

91–93;

paryngea

ryngea

A

N

o

paryngea

openng

te

E.

voca

1051;

he

te

and

te

to

GAS

C.

D,

poston

he

second

he

audtory

spread

o

durng

enterng

cavty.

snus

ror

and parayss o ts musce woud resut n a permanenty

adducted

he

te

way

ormaton

upward

rom

43;

can

spaces.

he

posteror

N

by

(tympanc)

drawn

bock

Inecton

mdde

s

ood

not

present wt a caracterstc oarseness oowng surgery .

aryngea

94.

uvua

prevents

palatine

nasal

plate

bone

concha

plate

of

sensa-

CHAPTER

Superior

nasal

Head

7

and

Neck

concha

Middle

nasal

concha

Opening

of

pharyngotympanic

tube

Nasopharynx

Soft

palate

B

Inferior

nasal

concha

Opening

cells

of

onto

middle

Opening

cells

Infundibulum

duct

that

and

opening

drains

of

the

anterior

frontonasal

frontal

into

of

bulla

posterior

lateral

wall

ethmoidal

of

Opening

sinus

ethmoidal

ethmoidal

ethmoidal

into

superior

of

meatus

sphenoidal

spheno-ethmoidal

sinus

recess

cells

Semilunar

Opening

of

nasolacrimal

hiatus

duct

Opening

floor

C

•

GAS

Fig.

8.235

of

of

maxillary

semilunar

sinus

hiatus

in

417

418

C H A P T E R

E.

7

Head

he

esser

and

upper

nvoved

97.

GAS

984,

133,

142;

A.

to

wt

te

B

n

nerve

te

woud

nerve

o

te

to

te

te

to

suppes

paatne

ard

46,

te

sot

tons

paate

but

s

not

66,

82,

62–64,

67,

branc

voca

detect

Answers

101.

a

o

genera

cords,

ood

superor

oss

o

eavng

or

sensaton

te

oregn

aryn-

patent

objects

B.

branc

aryngea

nerve

musces

patent

cords.

gea

nerve

o

o

superor

nerve

and

D.

parayss

a

oss

o

externa

ead

to

to

n

te

oss

ear,

o

are

o

t

n

at

bers

comng

a

sensaton

parayss

te

C.

beow

o

o

te

superor

te

gossoparyngea

and

posteror

te

o

⅓

to

te

o

te

weakness

or

parayss

o

nerve

parynx,

musce

woud

GAS

movement

o

o

n

te

98.

C.

te

66,

tongue.

range

hs

o

A,

D,

GAS

D.

1057;

O

te

and

te

N

patent

s

styomastod

cess.

A

te

musces.

coud

65;

descrbed

te

137;

can

te

o

cause

as

to

te

a

o

n-

tp

probems

Ankyogossa

o

wt

te

can

te

te

A,

to

B,

be

GAS

100.

C.

resut

upon

psateray

and

E.

damaged

N

B,

43,

procedures

te

47,

et

o

49,

te

to

te

as

we

te

durng

va

mastod

key

o

to

te

te

o

o

a

oss

o

savary

nerves

gases

te

aca

aca

sted

unctons

o

not

58,

tonus

o

te

accumuaton

o

sava

39,

40,

and

te

D,

and

o

very

cose

woud

cause

com-

woud

cause

om-

and

musces

o

lgt

o

te

pupae).

o

te

ABR/McM

nerve

As

a

stars.

te

rom

be

woud

he

59,

66

weakness

patents

ave

wt

dicuty

superor

artery

cerebe-

just

beore

arteres.

dorsa

aspect

compressed

cerebear

to

eye.

cerebra

te

cause

eadng

causes

resut,

basar

posteror

easy

ts

and

musce,

commony

rom

by

papebrae),

nerve

rectus

woud

(parayss

nnervated

evator

constrctor

gaze.

nerve

down”

by

artery

o

he

te

an

aneu-

t

wraps

as

Aneurysms

key

te

154;

to

o

te

compress

nerves

down

sted

oter

te

are

arteres

trocear

not

key

men-

nerve,

to

cause

stars.

ABR/McM

59,

66,

66–67

n

te

n

to

part

A.

key

s

not

n

manner

hese

moss,

are

(hs

te

sympatetc

sted

tumors

ganga

and

because

te

o

nvove

cause

andross).

key

to

cause

rgt

brancng

can

and

naed

upper

o

te

Horner

he

oter

symptoms

o

syndrome.

Raynaud

te

o

bronc.)

(ptoss,

condtons

ung.

preerentay

because

toracc

Horner

rgt

coect

dsease,

extremtes,

patetc

Frey

s

a

vascuar

caused

by

dsorder

excessve

tat

tone

afects

o

sym-

vasoconstrcton.

syndrome,

a

rare

maady

resutng

rom

parot-

dectomy , s caracterzed by excessve aca sweatng

musce

n

pre-

n

te

C.

te

Be

presence

pasy

s

o

ood

or

wen

caracterzed

by

a

tnkng

eson

about

o

te

t.

aca

nerve, wt weakness or parayss o mmetc musces.

E.

parayze

“out

118;

emerges

D.

N

syndrome

B.

oodstufs

n

eye.

tract

trocear

superor

o

tertary

upper

83

buccnator

a

can

not

tend

ung,

gands.

are

nerve

gand.

nerve

(adducton)

117,

wakng

870;

btem-

o

E. A Pancoast tumor s ocated n te pumonary apex,

usuay

patent

te

103.

te

mastodectomy.

ABR/McM

57,

mdbran.

and

are

cause

ocated

abducens

esons

nto

te

te

C,

te

pro-

cause

o

njury ,

branc

as

subngua

59,

emretnas

ocuomotor

o

te

meda

and

esons

GAS

nerve

sku

parayss

ste

tympan

oter

durng

and

56

aca

damaged

s

B,

toned

vestbue.

woud

te

te

and

he

107;

Normay,

ora

s

C,

959;

vents

A,

tongue

submandbuar

A,

te

atera

te

nerve

probems

exts

nerve

o

around

be

nerve, eadng to oss o taste rom te anteror two-trds

o

rysm

ow

o

brances

mdbran

s

optc

(parayss

115,

burcates

can

compresson

afected

devate

te

o

down

trocear

renuum.

oter

te

anteror

aca

corda

to

resut

ngua

be

nerve

just

a

a

te

sted,

key

as

way

by

an

devaton

N

te

o

to

nerve

artery

n

(parayss

downward

ar

condton.

aca

te

te

ABR/McM

most

oramen,

ose

ts

coces

Dependng

aso

91–92,

caracterzed

tongue.

None

treat

he

o

87–88,

ygene

cuttng

E.

53,

eson

symptoms

te

by

answer

mastodectomy .

ora

s

a

condton

moton

woud

82,

t

extends

and

surgcay

B,

80,

(tongue-te)

treated

descrbed

78,

53–55,

(meda)

optc

extraocuar

o

eson

trocear

84

tat

eedng,

o

75,

49–50,

renuum

speec,

99.

N

Ankyogossa

gua

878;

A

wakng

1057;

ABR/McM

E.

nasa

casm

an

o

ptoss

meda

(taste

resut

our

parayss

tongue.

GAS

31,

casm

o

ptutary

o

Compresson

woud

tongue

te

eye

mydrass

102.

ypogossa

N

emanopa.

te

nerve),

optc

te

te

Compresson

crcotyrod

tonss,

above

bndness

cause

voca

sensaton).

Injury

D.

te

te

optc

Compresson

aryn-

nerve

he

onymous

E.

n

1081;

4

because

rom

Compresson

pete

aryngea

render

eyes.

proxmty

rsk

o

emanopa

aryngea

bot

woud

branc

sensaton

900,

39–40,

pora

bot

oarseness.

Damage

mdde

n

crcotyrod;

wt

te

woud

and

resut

resut

te

oarse,

Loss

musce

C.

woud

except

898,

101–125

durng tyrodectomy. Damage to te recurrent aryn-

gea

893,

ABR/McM

Compresson

A.

externa

recurrent

GAS

78;

paate.

48,

55

n

G

vestbue.

he

and

44,

resut

nabty

E.

N

nterna

above

aryngea

and

suppy

to

arynx

an

paatne

porton

ABR/McM

nerve

te

Neck

1112–1113;

Damage

gea

and

Atoug

te

predomnant

oter

a

eson

musces

musce

o

te

o

te

sted,

ceek.

aca

te

nerve

buccnator

D.

Qunsy

s

caracterzed

nlammaton

ABR/McM

218

o

te

by

tonss.

panu,

pus-ed

CHAPTER

104.

E.

he

and

dator

smoot

body

a

receve

synaptc

ce

nnervate

A,

C,

B.

D.

ce

he

B.

A

at

s

A

vesses

superors,

n

te

nnervaton.

sympatetc

are

ocated

structures

do

he

post-

neurons

n

not

te

a

cary

tat

spna

o

key

an

cord

N

te

ce

to

o

A

te

T1

to

te

gaze

t

s

pre-

o

te

etmod

rectus

musce,

A,

ateray.

orbta

pate

te

musce,

o

te

ronta

superor

but

ts

bone

obque

woud

be

or

ces,

D.

A

very

A

106.

B.

tus

o

(nterna

he

patent

he

te

C,

w

ead

990;

he

te

and

A

to

racture

te

and

cause

GAS

C.

E.

A

n

eakage

o

wt

nerve

out”

CSF

assoc-

eyeba,

a

o

reman

(oss

GAS

110.

te

s

can

te

wt

a

u

or

N

te

o

tat

111.

44,

59,

run

n

sense

A.

par-

B

pate

s

not

key

to

oowng

parayss

o

te

vestbuococear

nerve

can

E.

by

C.

wen

aurcuotempora

11–12,

26,

59

parasympatetc

nerve

are

cut

durng

E.

te

or

and

aurcuo-

and

sweatng

taste

savary

nerves

o

ood,

secreton

sted

39–40,

opens

o

te

ter

te

93,

by

do

not

cor-

42,

musce

te

te

56,

s

rma

81–82

te

ony

gottds

arytenod

by

cartages

92;

by

oter

sted

uncton

musces

and

tus

ave

are

not

arway.

ABR/McM

are

gy

te

47–49

vascuar

tonsar

care

ts

he

te

s

taken

arter y

paatne

and

branc

to

we

tons

ascendng

esser

s

by

are

o

te

denty

and

perormng

te

but

most

906–907;

N

aso

receves

paryngea,

paatne,

ar

a

te

te

arte-

dorsa

suppy

rom

sgncant.

72;

he

C.

nerve

ABR/McM

28–32,

parotd

nnervate

te

948;

te

orbt

N

te

w

o

o

te

externa

arses

s

aca

and

branc

o

te

surace

o

te

and

C3

rom

aurce

exts

te

not

te

129;

branc

C2

and

pass

ave

skn

te

over

te

ront

te

o

23,

te

maxary

do

57

dvson

sku

oramen.

oramen

to

membrane.

maxary

nraorbta

nto

anytng

tympanc

ABR/McM

o

nraorbta

A

and

o

beow

neede

drected

dvson

o

te

nerve.

mandbuar

te

sku

mdde

enter

nerve

does

107,

nerve

troug

nto

posterory

he

te

posteror

suppy

nraorbta

pora

brances

aurcuotempora

nerve

sensory

946,

he

membrane

nerve.

gand.

ngua

trgemna

B.

te

aurcuar

te

A.

tympanc

membrane.

suppes

he

te

aurcuar

and

great

he

o

gossoparyngea

he

GAS

112.

surace

te

and

exts

ABR/McM

occurs

o

o

tonss

te

nerves

wt

deaness.

15;

tat

tereore,

artery

tympanc

bub.

sme).

A

91,

rom

and

trgemna

80

axons,

N

nner

and

troug

nerve

E.

1001–1002,

vagus

oss

56,

oter

ABR/McM

mantan

and

aca

he

sted

oactory

te

o

52,

norma

processes

cauterze

D,

te

61,

drecty

te

damage

or

supped

nner-

nerves

sme,

can

nerve

39–40

D.

oter

by

lusng

crcoarytenod

supped

suppy

GAS

papebrae

because

9;

part

arter y;

ngua,

tertary

not

n

nerves

connectons

nnervated

tougt,

arynx

paatne

trgemna

te

as

1051;

C,

ra

rec-

s

perpera

aurcuotempora

resuts

he

voca

and

to

nserted

occur

o

A,

s

parayzed.

evator

bers

te

ntorson

tat

s

te

con-

normay

tonsectomy.

superor

he

cause

26

hs

atera

te

nerve

17,

te

syndrome.

N

te

te

D,

he

descrbed.

crbrorm

and/or

B.

aca

musce.

to

te

C,

gate

cause

uncton

dated

synapse

o

w

and

to

te

nerves

can

12,

poston.

nerve).

s

present

ABR/McM

to

spenod

E.

Frey

o

requred

musces.

unopposed

obque

to

te

ABR/McM

nerve)

condtons

syndrome

te

te

pupae

pate

1061–1062;

axons

and

Damage

eson

A,

dam-

musce.

tnntus

Frey

coud

upon

gand

ateray.

mus-

eyeba.

Hyperacuss

stapedus

108.

o

o

parasympatetc

pate

ts

15;

trocear

oactory

anosma

entrap

D

o

wng

parayss

w

te

can

As

co-

parotd

nnervated

419

Neck

gand.

979;

prmary

ocuomotor

key

96–97;

crbrorm

causng

C.

to

N

axons

Damage

E.

te

te

o

by

n

extraocuar

13,

o

te

o

pup

pate

resut

abducens

by

aso

maxa

obque

te

ater

aberrant

usuay

hs

posteror

adducton

ocuomotor

constrctor

D,

not

GAS

A.

s

11,

superor

because

te

rnorrea),

any

“down

te

uness

stmuaton

A,

B.

te

and

greater

actons

by

rotaton)

ptoss

vate

107.

o

seen

musce.

o

te

(supped

uncton

usuay

N

a

o

neror

necton.

te

n

te

(supped

obque

ta

o

reman

because

838,

he

te

prevous,

and

abductor

gaze.

(CSF

entrap

1062;

eson

to

o

to

or

crbrorm

nerves

nose

surace

rectus

te

menngea

1061,

A

eye

te

key

orbta

upward

o

racture

not

GAS

te

neror

oactory

troug

E.

o

te

mtng

ated

B.

D,

to

te

wt

rotatng

racture

age

B,

GAS

109.

o

parotd

reate

(not

nerve).

are

bers.

and

postgangonc

synapses

wc

between

response

te

estabs

connectons,

gands

nstead

tese

perperay

sympatetc

ormed

n

Wen

grow

gands,

new

tempora

36

meda

by

sweat

ocated

L2.

papyracea

entrap

rectus

racture

entrap

tey

sweat

make

unusua.

C.

surgery,

ony

sympa-

contans

but

ABR/McM

entrap

peraps

superor

eves

143;

to

coumn

neurons,

amna

nabty

racture

coud

axons

ergc

SCG.

contan

parotdectomy.

nergc

be

sympatetc

racture

causng

A.

te

structures

hese

1024–1025;

bone

o

papebrae

bood

sympatetc

ntermedoatera

ony

105.

evator

o

bodes.

synaptc

GAS

ces

bodes

tese

and

tetc

pupae,

musce

Head

7

ossa

te

dvson

troug

menngea

troug

crana

o

te

artery

te

cavty.

te

trgemna

oramen

exts

oramen

nerve

ovae.

te

nratem-

spnosum

to

420

C H A P T E R

D.

7

he

Head

neror

dvson

ten

and

Neck

aveoar

passes

descend

nto

n

te

branc

te

jaw

o

te

mandbuar

mandbuar

to

suppy

oramen

te

116.

to

o

mandbuar

he

be

oramen

exts

te

ascends

ca

GAS

113.

A.

I

sku

nto

spna

923;

N

tere

s

11,

an

aryngea

te

voca

ed

to

he

can

be

Injury

o

more

and

D.

Injury

cts

E.

n

to

n

oss

GAS

o

ABR/McM

114.

A.

he

as

te

easy

sary

te

rom

tat

o

21,

o

sensaton

te

superor

a

te

38

B.

o

o

most

we

D

operatve

damage

gand

aryngea

te

ar

75,

nerve

but

117.

ts

D.

posteror

woud

aryngea

voca

connectve

zone”

ayer

pass

because

nto

nto

te

and

toma

resut

and

o

n

s

C,

D,

and

A.

be

E.

as

None

te

911–912;

he

N

carotd

targete d

pressure.

to

to

canges

tongue,

cause

nerve

A.

woud

musces,

wt

s

B.

91–92,

tssue

ayer

nectons

sku

by

s

137;

means

te

known

can

C.

spread

o

bones

carot d

te

unconscousness

or

ts

c arotd

d e at

scap

ayers

E.

sted

as

to

de crease

are

re ason,

s n us es

te

he

to

C

and

carotd

D.

tyrod

o

bood

he

pressure

toracc

upper

136,

to

s

a

not

te

tyrod

anytng

because

cervca

te

to

and

to

pus e

s

e ad

to

relex ve y

o

gand

orm

neror

postgangonc

nor

wt

te

uses

te

nerve

suppy

mb.

141–142,

It

and

to

te

214;

ABR/McM

35,

45

n

te

t

tracea

te

10%

gand

woud

wt

n

superor

crcotyrod

a

suc

a

tyrod

gament,

ncson.

woud

not

tyrod

ven

87,

oss.

resut

or

o

rom

te

jugu-

a

a

artery

ucd

o

te

artery

s

te

te

ema-

hs

o

te

cumsness,

o

te

bood

subdura

woud

t

te

resuts

o

more

an

ep-

acute

n

and

unconscousness

and

can

proceed

to

untreated.

aso

can

te

resut

n

mdde

vascuature

anteror

a

case.

muc

et

reatvey

sgn

nto

rupture

s

because

adjacent

o

s

no

s

perod

pteron

ematoma

be

nterva

beedng

a

Suc

compresson

space.

ts

wc

bre

dura

Rupture

woud

n

29–32

n

dzzness,

beedng

subaracnod

by

resuts

gradua

symptoms

te

Fracture

n

te

menngea



ABR/McM

ematoma.

here

because

te

89;

oten

conuson,

ncudes

In

GAS

118.

D.

a

be

bood

nerve

tose

te

N

s

an

ep-

menngea

mentoned.

communcatng

because

ness

n

and

111;

o

tat

o

run

snus,

as

njury

ts

a

to

accessory

turnng

te

artery

te

ead

ped

by

ts

B,

C,

crana

toms

nerve.

te

snce

nnervates

A,

o

te

and

nerves

te

rgt

E.

883–884,

44,

te

tongue

rgt

he

wa

mandbuar

and

ypogossa

aso

et,

o

a

o

te

o

s

s

to

te

te

o

aso

te

et

nerve

o

weak-

te

sup-

rgt

tongue

(wc

afected.

combnatons

produce

rgt

Loss

n

uncton

devaton

actvty

te

trapezus

nerve.

resut

wc

musces)

oter

not

te

and

ypogossa

tongue

woud

descrbed

32–33,

he

n

ocuomotor,

accessory

musce,

unopposed

or

Droopng

woud

to

be

te

parayss

rgt

nerve

sternocedomastod

because

o

woud

compresson

62

accessory

resut

o

puncture.

nerves.

patent.

rgt

s

because

(maxary

rgt

tere

troug

ABR/McM

n

umbar

ncudng

abducens

te

upon

tromboss

trgemna

occurs

rgt

CSF

nvovement

nerves

present

souder

te

snus

cavernous

874;

nerves

n

cavernous

Parayss

GAS

147,

o

ven

oten

musces

rst

gangon.

cardac

sympatetc

para-

contro

stmu.

wt

steate

cervca

te

acute

mecanca

gangon

responsve

doxde.

83,

nvoved

dvsons),

b oo d

se ns t ve

can

carbon

do

tereore,

traceostomy

o

o

te

mdde

ematoma,

o

can

s us ta ned

cemoreceptor,

oxygen

gangon

rse

provdes

N

as

neror

gves

o

Neter

gand

E.

body

baance

ront

beedng

dura

te

te

te

subdura

trocear,

tat

reduced.

B.

CSF

Mdde

o

re cep tors

For

about

tyrod

tracea.

branc

te

41,

resutng

woud

te

5

m as s age

pressure .

o

oter

b arorec ep to r

s  n us

tracea;

n

te

woud resut n a subaracnod ematoma, and tere

ems-

o

N

be

deat

zone.”

a

te

ste

cerebra

oowed

and

cords.

troug

te

present

arc.

memory

space,

de-

oarseness,

87–89,

ABR/McM

carot d

n

compresson

10;

sn us

or

he

o

“danger

s

suppes

te

across

te

eter

crana

reerred

GAS

115.

to

can

te

sku.

B,

t

emergency

aong

Artera

torn

bran,

oss

above

E.

1008;

A

tongue.

82,

run

sow-beedng

crcotyrod

woud

aryngea

te

80,

o

an

over

passes

venous

8

areoar

ts

and

GAS

ncudng

obstructon,

beow

n

crcotyrod

artery

above

tyrod

nerve

nerve

recurrent

78,

49–50,

not

he

supe-

voce/oarseness.

te

ront

ncson

does

aryngea

tyrodectomy,

parayss

o

artery

he neror tyrod branc o te tyrocervca trunk

cerv-

membrane.

ypogossa

66,

tat

12,

nterna

oroparynx,

actvty

te

“danger

vens

o

1,

branc

o

or

symptoms,

respratory

oose

A.

n

ma

present

njured

descrpton

parayss

N

oss

poston

n

te

sensaton

1057;

nerve

te

ascends

mdne

ear.

to

possbe

a

gossoparyngea

motor

Damage

resut

te

s

durng

rom

rom

cord

wen

poston tat a mdne ncson coud damage t.

concude

weakened

mdde

spna

accessory

nterna

tyroyod

wdespread

sensaton

te

arsng

case,

must

resut

te

te

ABR/McM

te

branc

woud

and

42;

to

ts

above

te

njured

musce

n

o

ater

tere

one

were

tyrodea

easy

branstem.

21,

In

externa

njury

C.

13,

nerve,

occur,

eve

and

s

were

sku

njury

cords.

extended

te

B.

to

and

te

cord

ror

njury

magnum

he

peope;

and

teet.

E.

C.

o

afected

specc

symp-

ere.

889–892;

66–67,

N

84–85

138–139;

ABR/McM

29,

CHAPTER

119.

C.

he

neura

ce

pterygopaatne

savatory

provdes

te

A.

nuceus,

te

aca

he

bodes

nerve

or

s

B.

he

te

o

D.

o

o

wc

are

va

to

n

te

te

te

te

aca

ts

to

E.

te

GAS

bers

otc

parotd

contans

musces

o

o

te

N

62,

artery

te

te

te

o

te

he

gangon

or

work,

te

ce

bodes

te

sot

paate,

assocated

caed

A.

134,

144;

C.

be

woud

suppy

o

be

te

artera

o

prmary

to

woud

rom

be

surgca

artery

to

s

D.

ess

neror

key

to

te

njury

by

te

menngea

to

be

artery

GAS

ower

o

te

o

be

but

te

paatne,

A.

n

te

te

artery

vesse

at

te

man

936;

N

a

n

te

poe

te

surgca

B,

C,

here

o

ton

39–40,

nto

B,

te

C,

nasa

N

68,

65,

67,

71–72,

77,

79;

ABR/

43

C.

venous

superor

and

E.

because

trbutary

to

optamc

necton

te

ven,

spreads

anguar

wc

ven,

passes

he

51,

907–908;

59

by

structure

te

eye,

cause

tat

snus

pup

by

a

59,

cary

just

scera

s

te

does

gan-

woud

79

body

bend

nto

nto

te

te

rs.

anteror

trabecuar

venous

ange

were

openng

mes-

snus

ormed

te

(aso

between

scera

venous

resdes.

n

te

rs,

camber

not

s

aqueous

to

wc

te

no

n

umor,

nvoved

eads

anteror

s

ound

n

a

E.

condton

(GAS

N

Fg.

157;

te

no

obv-

obstructon,

communcatng

troug

superor

obstructon

o

sagtta

CSF

low

system.

sted

are

ydrocepaus

a

exam-

tat

overproducton

resut

or

tra-

8.35).

ABR/McM

sagtta

o

te

coces

just

and

absorpton

nto

o

oter

not

not

80

ventrcuar

ventrcuar

he

tears,

enarged

nadequate

evdence

te

51–54,

compete

be

wt

umor.

ventrces

wt

superor

he

mdde

snus

snus.

None

o

N

99,

he

because

be

oter

routes

sted

woud

te

115,

147,

151;

ABR/McM

47,

rgt

dsr upt

D.

he

ts

te

72

woud

o

not

cerebra

n

sow

artery

ocaton

aspect

prouse,

great

posterory

te

o

menngea

tempora

woud

B.

be correct or dranage rom te danger area o te ace.

GAS

not

parasympatetc

Scemm

crsta ga and because

A.

tromboss

cavernous

D,

o

865–866;

te

snus

te

te

ABR/McM

obstructon,

cavernous

te

assocated

cavernous

te

granuatons

s

and

answer

to

be

woud

ABR/McM

te

noncommuncatng

A. Inecton n te “danger area o te ace” can ead to

ten

te

most

key

be

te

source o te beedng because t attaces anterory to te

1034–1037;

rom

a

scera,

sac

must

probems

GAS

125.

D,

o

rom

ves-

ere.

s

tered

aqueous

te

ste

somewere

s

treat-

o

ange

te

89;

o

aracnod

snus.

paatne

o

s

occuded,

body.

o

probem

pes

upper

stem

ven

s

Scemm).

o

acrma

snge

te

neror

hs

neura

secreted

by

umor,

vtreous

Wt

ous

surgery.

descendng

endangered

n

carotd

brances.

ste

encountered

tons,

arses

not

artery

te

posteror

ydrocepaus,

externa

te

s

te

secreton

be

surgery

a

n

s

te

cana

pup

he

to

124.

ocated

o

and

Vtreous

te

procedure.

aso

paryngea,

brances

not

woud

a

subject

to

and

coud

t

o

s

ten

cana

or

t

camber.

oroparynx

suppy

artery

paryngea

rse

paatne

28,

he

s

troug

draned

rs



ven

patent

t.

s

rdoscera

te

oroparynx.

nerory

T ermna

ment

he

wt

centra

camber

and

te

centra

and

woud

103–104;

lows

ten

te

he

trombopebts.

gangon

umor

umor

centra

tromb.

100,

posteror

camber

gand.

127–128,

ngua

and

trange

tympanc,

artery

te

aryngea

not

o

gves

ocated

Aqueous

n

te

troug

N

te

snus.

421

Neck

experenced.

trombus

pass

937;

retna

space

casm

cary

snus

source

event

ascendng

and

B.

o

snus

optc

not

c-

because

te

bndness

a

troug

cavernous

and

ensue.

transmt

gon;

E.

woud

carotd

te

he

n

spncter

va

ocated

GVE

te

te

brances

prmary

superor

he

w

rom

o

n

area

te

to

s

he

not

respon-

synapse

te

D.

pass

te

bndness

dranng

hrombus

GVE

may

reac

subaracnod

wt

B.

to

sufer

ven

he

wt

parasym-

ocated

pup

arynx—argey

oroparynx

and

McM

s

suppy

orgn

887–890;

ocaton

he

A.

tons.

njured

GAS

a

trombus

retna

bndness

85

te

he

te

ony

swaowng.

because

s

se

s

bodes

nuceus

ambguus

and

branc

paatne

121.

gves

sava

883–884,

concern

E.

concerned

he

te

woud

o

contanng

accommodaton

nnervatng

and

ABR/McM

D.

ce

te

and

and

savatory

nuceus

nerves

t

nuceus

bers

C.

o

123.

and

parynx,

C.

gangon

neror

speec

122.

secreton.

wc

nerve,

o

rom

and

te

musce.

he

A.

ocuomotor

nerve

A

not

nuceus

te

secreton

GAS

ts

(GVE)

gangon

s

n

superor

cavernous

gossoparyngea

o

B.

and

te

pons;

savary

gangon,

contans

musce

medua

120.

neurons

constrcton

cary

he

E.

and

te

or

pupae

ary

te

eferent

and

Ednger-Westpa

sbe

n

synapse

n

gangon.

mdbran

bers

axons

ocated

sympatetc

pterygopaatne

patetc

s

vscera

acrma

a

postgangonc

te

are

wc

genera

SCG

wose

gangon

Head

7

te

ocaton

o

woud

s

te

near

sku

te

not

te

but

beed.

be

a

good

pteron

ts

on

beedng

sow.

ve  n

(o

c r an  a

or

nature

an

Ga en)

c avty

 njur y

s

and

o

s

t s

o cate d

no t

n

typ e

to

t.

stragt

recevng

dura

bood

venous

rom

te

snus

s

neror

aso

posteror,

sagtta

snus

422

C H A P T E R

7

Head

and

Neck

Arachnoid

Cerebral

granulations

Superior

ar ter y

sagittal

Cerebral

sinus

vein

Exter nal

table

Skull

Diploë Dura

mater Inter nal

Arachnoid

mater

Pia

mater

table

Extradural

(potential

space

space)

Subarachnoid

•

and

te

great

posterory

torcuar

E.

he

te

to

te

nerory

reated

to

852,

(o

Gaen).

o

snuses

It

8.35

drans

A,

(eponym:

cavernous

to

te

te

47,

snus;

crsta

superor

ven

drans

urter,

ga

and

sagtta

rom

t

s

s

te

ocated

not

N

GAS

128.

111–112,

114;

B.

126.

he

vesses

wt

neror

dvson

o

te

abducens

ocuomotor

nerves).

nnervates

te

C.

Latera movement o te eye s ntated by te atera rec-

bood

(abducens

obque

ror

nerve),

(trocear

dvson

(neror

o

and

ocuomotor

dvson

upward

asssted

nerve)

o

devaton

te

tereater

te

nerve).

ocuomotor

exerted

by

te

by

neror

he

te

superor

obque

neror

nerve)

superor

rectus

baances

rectus

D.

A

superor

te

dura

E.

he

o

actate

CSF .

A.

B,

and

nerve,

te

tor

GAS

E.

key

ymp

he

papebrae

or

926–929;

he

ave

nnervates

requred

E.

Incude

wc

eye.

nerve

D.

excurson.

mdde

ocaton

dranage

brances

no

roe

superor

te

superors

N

96,

te

o

103;

o

o

ocuomotor

and

te

musces

eva-

are

not

eye.

GAS

129.

D.

51–54

be

bers

gea

s

A.

te

tere

s

most

poor

sagtta

n

and

te

nterrupted,

and

he

and

gag

s

te

te

te

CSF

wt

wen

o

to

te

tese

ematoma,

mdde

bone

CSF

te

to

nterna

to

to

eak,

ven

as

ead

bood

entry

carotd

wc

ndvdua

a

coects

rse

I

t

to

o

jons

te

subdura

n

te

to

artery

bood

ABR/McM

musces.

cause

wtout

sub-

CSF .

eakage

gves

menngea

woud

lud.

woud

nerve,

branc

damage

bone

cerebra

ead

sotarus

responsbe

and

lows

mxes

suppy

way

te

67

eferent

suppy

oses

by

nto

to

te

motor

te

aryn-

ts

regon

swaowng,

relexes.

nuceus

sensaton

gea,

an

bood

epdura

te

te

147–154;

paryngea

nodes.

367

bran.

o

ambguus

vagus

and

an

te

snus

not

N

nuceus

o

to

wc

o

n

anteror

tempora

wtout

woud

873–874;

he

coug,

woud

because

regon.

trgemna

movement

rectus

tese

te

cord

tumor

ts

te

ABR/McM

voca

te

rom

and

o

o

motor

dvson

superor

abducton

o

n

te

superor

space,

cot

n

o

wtn

occuson

(superor dvson o te ocuomotor nerve) must reax to

atera

a

ematoma,

(supe-

ror dvson o te ocuomotor nerve). he meda rectus

te

o

te

resut

connecton

tear

te

tereore

present

vesses,

brances

vesses

drect

(ne-

o

365,

and

nodes

perormed.

overes

wtn

nodes,

cervca

are

cords

pretracea

deep

and

voca

cervca

to

ruptures,

be

mentoned

te

ABR/McM

space

menngea

Leakage

artery

deep

neror

woud

s

above

dran

85–86;

compresson

neror rectus, te meda rectus, and te neror obque.

tus

cords

aneurysm

woud

ocatons

Areas

te

N

puncture

requred

and

nto

pteron

na nerves tat nnervate te extraocuar eye musces are

trocear,

oter

superor

voca

bood

mdde

(ocuomotor,

te

berry

tus,

C. For proper movements o te eye to occur, a te cra-

he

127.

a

A

subaracnod

umbar

A.

by

te

dranng

te

CSF;

126–150

D.

ympatcs.

1038–1039;

Wen

nto

60–62

and

by

beow

beore

drecty

snus.

1072–1073;

C,

draned

areas

a

Answers

B,

draned

are

optamc

875–876,

ABR/McM

ven

conluence

Fig.

Heropus).

superor

orbt

GAS

cerebra

to

GAS

space

and

taste

vagus

s

or

rom

nerves.

ocated

recevng

te

n

te

branstem

genera

aca,

vscera

gossoparyn-

CHAPTER

B.

he

trgemna

neurons

ton,

tat

te

tensor

myoyod,

C.

he

es

dorsa

o

genera

gangon

n

GAS

and

te

gands

o

and

ce

bers

eart

o

o

arynx,

o

o

te

vagus

aferent

vagus

s

concernng

panu

884–886;

te

somatc

and

rse

te

teet

to

te

and

te

spere

and

A.

A

respratory

N137;

contans

bers,

cely

rom

ABR/McM

myoyod

mylohyoid

A.

he

and

rom

he

eart,

B.

D.

he

a

bey

musce

s

nerve

o

nerve

nerve

te

tat

C.

s

by

s

nnervated

by

te

s

nnervated

by

ypo-

te

E.

he

aca

GAS

975–978;

ABR/McM

131.

A.

he

rom

nerve,

te

o

ear

B.

n

o

D.

and

144,

neror

146;

can

upper

nto

PCA

a

easy

aongsde

te

te

GAS

B.

orbt

wnds

surace

arteres.

he

and

te

njure

te

nterna

troug

supe-

o

A.

te

passes

and

nerve

pons,

tus

sku

te

and

va

bone

oramen,

orward

nterna

868–871;

anteror

59,

he

66–67

te

not

cerebear

nerve

as

acoustc

ave

t

passes

exts

te

an

artery.

rom

nterna

te

te

sku

juguar

t

ven

artery.

147,

149–152,

he

176;

ABR/

cases

rom

and

eson

te

bran

vesse

caused

T ypca

cerebra

tear-

ts

can

rap-

cause

parencyma

nto

by

te

bran

ypertenson

symptoms

or

ncude

acts

te

o

tose

may

bood

reated

to

pexus.

ABR/McM

s

atera

o

system

emorrage

musce

to

conscousness.

especay

150–154;

by

o

ventrcuar

corod

dvson

te

a

66

musce

o

pterygod

trgemna

protrude

porton

rom

o

te

mas-

nerve

o

nerve.

he

mandbe

and

temporas

nnervated

te

nerve

meda

rom

te

nerve.

te

by

te

mandbuar

tat

eevates

pterygod

s

a

deep

dvson

te

musce

mandbuar

hs

D.

he

ccay

he

jaw

masseter

nnervated

E.

musce

contraatera

musce

tempora

o

te

mandbe

tr-

wen

s

a

musce

o

mast-

te

asssts

te

o

jaw

te

and

pterygod

n

trgemna

works

wt

sde-to-sde

movements.

dvson

patysma

meda

musce

by

dvson

coses

o

n

s

a

s

a

musce

masseterc

te

o

branc

trgemna

mastcaton

o

te

nerve

man-

tat

spe-

cewng.

tn

musce

o

aca

expresson

tat es wtn te superca asca o te neck and

o

te

ace.

an

GAS

160;

It

aca

wrnkng

o

obque

draws

154,

N

anteror

ower

troug

sub-

caton nnervated by te nerve to meda pterygod

nerves

meatus

te

contracted.

C.

vcnty

ntmate

key

pterygod

mastcaton

dbuar

nterna

do

between

wtn



bross

jaw.

gemna

troc-

te

resut

CSF .

artery,

mparment

te

pterygod

nerves

artery.

superor

and

not

rom

vestbuococear

te

and

carotd

N

s

cerebear

aca

wt

orgnates

membrane

may

troug

te

most

bood

trauma

nnervated

te

o

carotd

superor

atera

mandbuar

open

te

te

nto

a

arteres,

o

891–893;

he

atera

o

tat

rom

te

o

nearby

suppy

tcaton

trocear

ematoma

te

ter-

brances

cerebear

te

te

mmedatey

to

te

tereore

artery

near

eventuay

cose

dvde

between

and

arses

passes

toward

w

gossoparyngea

juguar

McM

te

tempora

he

GAS

139,

n

o

o

surround-

ours.

and

nto

(grndng)

he

reatonsp

E.

on

enters

superor

enter

te

artery

artery,

nerve,

t

runs

abducens

te

and

bot

artery,

ten

surace

C

te

ssure.

he

o

te

passes

wc

and

136–137,

pedunce,

were

cerebear

nerve,

orbta

basar

wt

nerve

cerebear

artery

cerebear

contnues

anastomose

superor

by

te

cerebra

t

trocear

133–134,

te

cerebeum

ror

N

ocuomotor

te

as

nnervated

81–85

te

around

s

133.

superor

mnaton

beow

musce

nerve.

n

em-

rupture

subsequent

low

menngea

most

nausea,

because

te

paatogossus

vagus

or

CSF

aterosceross.

Beedng

nerve.

E.

o

aracnod

dranage

beedng

beedng

gradua

resut

cerebra

space

space-occupyng

12

n

dura

oca neuroogc dects, wt abrupt onset o ead-

be

musce

te

resuts

mdde

wtn

oca

ace,

musce

beedng

expandng,

rgt

Hydrocepaus

to

a

may

because

beedng

or

tears

te

progresson.

s

between

space

te

and/or

te

nerve.

styoyod

o

o

te

cause

423

Neck

rom

and

subaracnod

obstructons

parencyma,

motor

wt

rate

mater.

Intracerebra

dgastrc.

run

pa

over

and

between

may

pressure

beed

te

bran,

te

deat

gves

suppyng

nnervated

C1

nto

resuts

space,

beedng

bood

subaracnod

dy

aveoar

motor

te

Epdura

84

hs

varabe

artery

ng

nerve.

yogossus

gossa

nerve,

spna

ypogossa

neror

anteror

genoyod

bers

B.

te

a

aracnod

tract.

usuay

subdura

ntracrana

venous

creates

(wt

te

n

wt

te

vscera

te

aracnod.

o

and

te

beedng

cross

subaracnod

an

ce

and

sensatons

sensaton)

amentary

cn,

te

eakage

C. Just beore t passes nto te mandbe to suppy te

ower

tat

ncrease

bod-

musce

te

Subdura

paatn,

dgastrc.

te

D.

ng

uncton

excuson

826,

contans

132.

vens

ve

te

motor

mastca-

tract.

aferent

ungs,

o

o

parasympatetc

gangon

neror

te

130.

o

tensor

bey

nuceus

contans

musces

tympan,

muscuature

superor

bodes

te

nnervatng

ntestna

he

nuceus

anteror

motor

nerve

smoot

and

and

pregangonc

vagus

E.

motor

nnervate

Head

7

s

nnervated

nerve.

te

he

surace

drecton,

down

977–978,

ABR/McM

te

ower

983;

N

42–44

by

te

patysma

o

te

depresses

p

13,

and

49,

cervca

produces

skn

te

ange

o

te

ower

o

56–57,

sgt

neck

jaw,

te

59,

branc

a

n

and

mout.

82,

133,

424

C H A P T E R

134.

B.

he

10

ton

neror

and

to

12

9

D.

and

Neck

meda

qute

ncsor

tend

a

to

range

teet

erupt

exsts

erupt

earer

n

te

n

rst

grs

norma

6

to

tan

at

n

B.

C.

dstrbu-

superor

to

13

and

meda

superor

ncsor

atera

teet

ncsor

erupt

at

8

teet

erupt

atera

ncsor

teet

erupt

at

to

10

16

D.

monts.

E.

he

GAS

135.

D.

rst

he

sgmod

transverse

known

ton

as

o

nate

te

ear.

on

52,

juguar

ocated

13

to

t

paragangoma

s

ces

to

te

o

genera

oss

bub.

n

rom

or

Injury

to

loor

tat

te

may

GAS

tat

te

te

29,

137.

A.

35,

CSF

org-

te

rom

eart

te

rom

bran

ste

sgmod

te

opposte

date

A.

afected

he

ror

to

by

suc

o

afected

te

bran.

dverted

to

Bood

toward

juguar

expand

returnng

te

bub,

and

low

wt

oppo-

B.

te

n

nner

a

ear

are

not

a

ear

tumor

s

reated

cavty

to

and

s

penetratng

not

key

te

he

sgmod

te

(S-saped)

he

at

te

Beow

bone,

ped

GAS

E.

te

by

ngua

mucous

te

tongue

te

ror

te

A.

N

64,

nerve

and

va

part

o

te

he

corda

responsbe

ror

n

by

resut

rom

te

parasympatetc

nerve,

n

oss

te

53,

a

o

branc

sensaton

arynx

68,

above

56–57,

144–146;

o

te

59,

65,

ABR/McM

te

or

and

lud

bran

s

can

may

retnae

or

n

a

wt-

become

be

com-

anteror

detacment,

meda

to

te

may

to

resut

retna

ovea

brances

centras

may

and

can

degeneraton.

ens

and

(cataracts)

may

Cataracts

vson

perormed

bndness.

te

coors.

te

tonss.

optca

retna

rom

macuar

o

te

o

ntracrana

branstem

cerebear

pars

or

(“edema

s

pressure

cstern,

and

te

sweng

ncreased

puncture

CSF

damage

oss

or

aca

vary

Injury

nerve

uncton.

mas-

n

ces

te

open.

eevaton

s

o

occu-

taste

reduce

typcay

and

two-trds

bers

tat

to

resut

n

te

bers

te

hereore,

abducens

yss

o

are

rom

t

to

oss

nerve

w

te

cause

grad-

percepton

progress

potentay

te

ante-

submandbuar

o

branc

taste

and

an

o

sa-

o

n

apparent

C.

o

sowy

to

bndng



te

o

te

lud

te

ead

n

te

tssue

n

exces-

space.

nerve

carotd

s

artery.

carotd

compresson

resut

rom

an

abducens

nterna

or

to

79

nterna

te

woud

resutng

w

artery

on

psatera

te

para-

pup.

downward

trocear

and

nerve,

ateray

wc

s

woud

not

n

be

te

snus.

ptoss

te

woud

be

a

ocuomotor

resut

o

nerve,

a

compete

wc

s

not

ere.

Batera oss o accommodaton and oss o pupary

woud

omotor

D.

o

gaze

te

tenson

hs

dsc,

43–44,

snus,

wt

cause

to

Compete

serous

ABR/McM

aneurysm

abducton

Inabty

o

optc

pressure,

cavernous

nerve.

eson

s

pregangonc

tympan

o

te

contact

cavernous

B.

ante-

bers

te

because

to

103;

qucky

relex

aca

and

te

corda

jon

N

ntmate

coud

o

ntrabubar

accumuaton

931;

Wtn

n

gands.

o

tongue

or

E.

71

nnervaton

parasympatetc

branc

te

ABR/McM

sensaton

subngua

bers

w

te

wc

anteror

taste

sve

GAS

A.

tympan

and

te

to

were

juguar

cavty

an

sensory

te

carryng

parasympatetc

gangon.

ossa,

o

s

114–115;

o

corda

and

to

mastod

Compresson

ncreased

138.

stapes,

suppes

tympan

two-trds

te

E.

bood

musce.

110,

tongue,

submandbuar

oramen

common

antrum

o

membrane

nratempora

te

and

142,

dsc

ernated

oss

n

cause

tortuous

nterna

entrance

wc

ad

stapedus

te

a

bub.

te

te

venous

oows

juguar

wt

s

s

nto

pyramd

te

and

juguar

wc

adtus

874–876;

he

te

antrum

process

te

te

n

ad

coects

bone

to

superor

antrum,

mastod

snus

contnuous

adtus

tod

venous

tempora

course

becomes

ven

E.

woud

bers

untreated.

beneat

t

and

resut

N

umbar

umbar

yeowng

bue

mdde

a

serrata,

Opacty

ua

ear.

C.

te

vson

resut

ante-

optc

caused

emorrage

drecty

te

s

I

te

ora

resut

D.

artery

o

8.150A).

1103;

cauday

by

are

tumor.

mdde

by

and

canas

A

nerve

taste

aryngea

133–134,

s

Separaton

causng

accommo-

semcrcuar

key

ack

gand.

w

Fg.

eevated

rom

pressed

C.

atera

carotd

te

o

bood

low.

and

te

bock

superor

system

bood

n

wa

be

and

venous

nterna

sde

graduay

cocea

ocated

B.

tat

snus

ncreased

he

s

efectvey

1101,

pressure.

patent

tongue

parotd

nerve,

82,

tat

dspaced

may

s

tan

81–82

papa”)

ear

te

superor

(GAS

Papedema

drawn

and

sensaton

rater

and

aryngoparynx

ods

66,

entre

bub

tongue

sensory

o

te

te

vagus

1098,

69–70,

org-

mdde

T umors

te

por-

o

te

voca

cavty

neror

o

damage

gossoparyngea

trd

suppy

nate rom te superor juguar bub can grow to  te

to

136.

Injury

rom

13

sma

bony

tumor

ound

juguar

a

te

te

a

monts.

bood

nto

bub,

beneat

19

ABR/McM

venous

emptes

superor

superor

at

73–74;

coects

and

paraganga

te

erupt

12,

snus

s

A

rom

teet

N

snuses

wc

mdde

and

moar

oss

nerve

n

o

1114–1119;

o

posteror

monts.

neror

patent’s

receptors.

C.

he

monts

he

hs

because

curve.

and

at

Head

monts. T eet

boys,

A

7

be

nerve,

Ipsatera

oss

a

oss

resut

te

ng

o

trgemna

te

te

resut

wc

o

o

te

and

o

not

batera

oss

key

ts

n

consensua

bot

nerve

aferent

s

te

and

te

aca

respectvey.

GAS

876;

N

115;

ABR/McM

47,

59,

80

o

ocu-

relex

dvson

nerve,

mbs

te

stuaton.

cornea

optamc

eferent

o

s

o

suppy-

te

relex,

CHAPTER

Otic

ganglion

(medial

to

[V

Lesser

])

petrosal

nerve

Head

7

and

Neck

[IX]

3

Auriculotemporal

Top

of

parotid

gland

Petrotympanic

Lingual

nerve

fissure

nerve

Auriculotemporal

Chorda

tympani

Lingual

nerve

nerve

from

[VII]

Tongue

Submandibular

Sublingual

ganglion

gland

Preganglionic

from

parasympathetic

glossopharyngeal

Postganglionic

from

otic

Mylohyoid

Submandibular

gland

•

139.

D.

It

s

erng

necessary

o

branc

te

o

te

anestetze

wc

s

optamc

te

conjunctva

cov-

supped

by

te

nasocary

dvson

o

te

trgemna

Fig.

141.

A.

s

he

aca

tereore

Snce

ts

musces

te

tat

upper

orbta

to

eyed

te

septum

anestetze

nerve

and

o

te

A

and

te

to

te

and

by

s

tese

te

to

te

answers

he

te

acrma

ab

maxary

dvson

resut

key

n

cause

puncturng

urter

te

s

up

44,

a

C,

tysma,

and

te

eye.

n

20,

acrma

por ton

wereas

sac,

o

te

Injectons

o

61,

97,

wc

te

s

te

132–133,

as

descrbed

28,

205

899,

one

oca-

cn,

te

na

ts

woud

n

ve

he

te

bot

woud

bey

o

rst

te

genoyod,

perce

te

dgastrc,

and

pa-

te

te

E.

he

ower

995–997;

N

32,

36,

38;

ABR/McM

ceek

GAS

aveoar,

branc

contros

but

te

mentas.

runs

across

orbcuars

woud

trgemna

sensory

o

te

tensor

he

te

cause

te

ocu

weak-

te

s

musces

anteror

sensory

o

bey

tympan

te

consst-

nnervaton.

te

bucca

aca

severa

o

nerve

nerve,

and

he

mas-

o

component

n-

nerves.

nerve

musces

wc

te

tensor

aurcuotempora,

and

none

and

njury .

depressor

s

a

used

drecty

motor

n

aca

contro

p.

bucca

dvson,

and

or

ncude

nerve

te

nerve

mandbuar

atrogenc

trgemna

conssts

musces.

neror

tat

o

and

brances

ors,

o

aca

tgty.

myoyod,

musce,

expressons,

ten

nay

te

p

nerve

eye

te

motor

ower

aca

te

and

gand.

parayss

o

te

gand

parotd

margna

suppy

dvson

o

nvoved

te

ts

parotd

te

branc

angu

to

o

sufered

o

to

component

bucca

te

te

one’s

dvson

paatn

gua,

D.

bone

te

surgery

as

branc

Damage

dgastrc

nerve

na

fibers

ganglion

troug

musces,

depressor

Mandbuar

o

p,

tat

cosng

tcaton,

case,

perce

parasympathetic

submandibular

controng

nerors,

motor

142–143;

n

fibers

[VII]

symptoms

ower

Zygomatc

ng

scera.

genogossus.

896,

musces

argest

nasoac-

eter

o

parasympathetic

nerve

durng

tese

te

ncudes

te

anteror

ten

s

ness

ast.

he

te

musce.

damage

supraorbta

nto

anestetzng

wound

beow

D.

myoyod,

GAS

B.

80–81

puncture

rom

ten

te

N

sac

meda,

resut

51,

genogossus

te

acrma

too

not

or

facial

passes

rsk

patent’ s

o

suppes

branc,

ateray

rom

nerve

at

zygomatc

most

ossa

931–935;

Durng

te

apex

between

muscuature

suppy

rom

orbta

aso

nerve.

above

woud

B,

sensory

woud

he

duct,

passng

A,

papebra

twgs

te

and

C.

C.

ABR/McM

te

toward

nerve,

eye.

oramen

E.

atera

Bot

and

occuped

GAS

te

(peraps)

E.

B

ton

and

trgemna

scera

rma

deepy

nasocary

fibers

8.150A

nerve. T o do tat, te neede soud be paced troug

ntrate

140.

to

scera,

GAS

parasympathetic

Postganglionic

from

fibers

[IX]

ganglion

Preganglionic

from

nerve

nerve

wc

and

te

900–901;

N

s

a

branc

provdes

mucosa

54;

o

sensory

o

te

ABR/McM

ora

40

te

to

mandbuar

te

skn

vestbue.

o

te

425

426

C H A P T E R

142.

A.

7

Durng

tary

ynx

an

(Ratke

(pars

n

o

te

te

B.

Pars

C.

o

te

s

he

trd

o

aar

a

somatc

s

tat

to

te

growng,

more

common

tat

o

s

te

not

(o

A.

te

s

atera

not

te

It

s

te

anteror

C.

s

porton

to

s

not

assocated

N

52;

s

n

neura

orm

n

mpuses

are

woud

E.

n

maormatons

teencepac

camber.

oactory

Aso,

bubs,

Cdren

ave

tube

N

146.

genera

and

te

embryonc

resut

n

durng

sze.

orebran

or

vaut

as

embryoogc

deve-

hese

patents

usuay

ave

to

an

acoo

ABR/McM

neu-

ave

ypotaa-

severe

wt

or

o

o

te

cerebear

sku

s

structures

cavara

eads

(IUGR),

s

caused

dvde

ts

suc

as

s

to

or

vaut.

ntrauterne

causng

mcrocepay

by

aure

nto

two

one

In

te

pros-

em-

wt e,

presented

bran

abnormates.

o

cerebra

ncompatbe

te

near-norma

aca

te

undeveoped

abuse

propery

cases,

norma

tmes

bones

60

speres. In severe cases,

ess

te

retardaton.

Hooprosencepay

to

n

ydrocepaus.

restrcton

encepaon

not

ead

menta

120;

B.

deect

o

dspacement

not

growt

wt

cranoparyngomas.

oss

o

tere

wt

o

te

vesce,

oactory

s

47

A.

mdne

bran

used

oten

tracts,

and

ace.

eyes,

and

corpus

Smt-Lem-Optz

cranoaca

and

mb

a

ypopasa

and

deects

Sczencepay

arge

cets

some

n

cases

o

sku

does

te

cause

Exencepay

part

s

here

are

snge

nto

o

te

C.

te

s

cerebra

oss

caused

neura

not

and,

n

cose,

o

cases,

magnum.

ernaton

te

117;

or

ventrcuar

ABR/McM

It

a

o

cose;

te

bran

dect

part

o

o

te

te

posteror

can

ncude

protrudng

te

n

s

cepac

exposed.

te

aspect

te

bone

o

te

mennges

ncudes

N

147.



part

system.

but

ere,

babes

deveopment,

some-

ts

case,

te

cd

as

neura

te

externa

ear

Rubella

te

B.

stapes,

woud

o

However,

part

ton

te

aspect

occpta

o

protrudng

(most

bone

and,

te

oramen

bran

ncudes

key

te

posteror

n

some

magnum.

part

orn

o

I

te

o

cases,

te

te

ernaton

ventrcuar

te

poste-

atera

or

C.

gea

ventrces),

occurs

B,

at

D,

typcay

GAS

te

posteror

and

E.

nvoved

856–857;

N

ontanee

hese

n

portons

crana

15;

o

te

o

deects.

ABR/McM

27

ness,

D.

sku.

te

sku

are

not

o

N

(As

105;

o

wom

cerebra

te

aure

o

carac-

emsperes.

were

o

s

by

ave

te

sku

bran

to

cepac

cose.

s

It

porton

s

because

system

n

a

oss)

a

mdde

madeveop-

mdde

or

o

crtca

maormed

te

tme

earng

arc

a

deaness,

ear

organ

o

oss.

paryngea

congenta

o

xaton

ear

wtout

and

nner

spra

congenta

conductng

second

a

a

te

structures

durng

to

o

o

to

orm

stapes

bone.

tere

s

a

xa-

stapes.

te

dorsa

woud

hese

are

porton

ead

to

not

o

te

undeveoped

afected

n

rst

paryn-

maeus

congenta

and

dea-

owever.

not

potenta

E.

to

n

Abnorma

does

te

te

cet

ncus.

ten t s reerred to as menngoydroencepaocee. he

dect n te squamous part o te occpta bone usuay

o

Faure

system

ead

earng

ead

caracterzed

66

resutng

Faure

46

and

cose.

infection

(neurosensory

te

neurosensory

can

s

5%

Sczencepay

n

o

magnum

cana.

deects;

conductng

deveopment

cerebear

branstem

oramen

aure

deaness

or

te

assocated

condton

o

to

ABR/McM

o

a

because

tube

Congenta

ear.

s

and

spna

D.

cets

II maormaton.

were

syndrome

mb

because

C. Usuay , dects o te cranum nvove te squamous

o

arge

typcay

116;

A.

ment

cranum

occpta

bran

te

by

s

te

cervca

and

Exencepay

o

tereore,

troug

upper

exposed

tssue.

aure

to

te

terzed

by

wc

ernated

ventrce,

ooprosencepay.

ave

caracterzed

emsperes,

eavng

s

s

bran

by

squamous

some

oramen

te

te

n

tube

Menngoencepaocee

nvovng

and

ourt

cranoaca

syndrome

5%

maormaton

Smt-Lem-Optz

caosum.

and

II

verms,

E.

rare

a

Car

structures

ooprosencepay.

A.

sma

Materna

or-

sensory

a

Cauda

a

n

taamus,

ABR/McM

ooprosencepay,

snge

ror

te

cavara

condton ave a concomtant Car

It

854–855;

nasa

144.

occur,

te

gand.

resuts

N

not

and

necton

osscaton

and

nvoved

o

te

does

a myeomenngocee. Amost a o tese patents wt ts

In

E.

An

oten

ventrces

nvoved

dorsa

sensory

rse

ts

mus, pnea gand, and posteror obe o te ptutary

GAS

D.

T oxopasmoss

cavara

cranoparyngomas.

gves

I

abnorma

opment eads to mcrocepay , n wc te bran and

assocated

Monro)

eventuay

cord.

s

deveop.

D.

tat

w

vscera

wt

Dencepaon

C.

deveopment.

prmordum

gand.

rom

B. he rostra neuropore coses durng te ourt week

o

te

sow

wraps

t

between

part

spna

and

tube

s

145.

menta retardaton because o an undeveoped bran.

oramen

porton

te

assocated

ra

par-

orms

derved

and

gand;

ventrce

pate

o

ptu-

te

cranoparyngomas.

cauda

axons

B.

seat

ptutary

connecton

te

and

te

ptutary

It

ocaton,

o

cdren.

nterventrcuar

and

a

a

tumor

o

roo

te

pouc.

cranoparyngomas.

maton

A.

n

o

he

and

E.

a

te

cepaad

wt

batera

D.

s

Ratke

tumor

tuberas

obe

rom

tuberas)

suprasear

supratentora

deveopment

grows

cranoparyngoma

ound

s

Neck

outgrowt

pouc)

obe

epteum

143.

and

embryoogc

gand,

anteror

A

Head

deveopment

ead

to

deaness

congenta

expaned

n

ABR/McM

B

57

o

te

but

s

anomaes.

and

C)

aurcuar

a

marker

ocks

or

oter

CHAPTER

148.

A.

Wt

and

by

congenta

grays

wte

teratogenc

meases)

can

can

afect

crtca

sevent

B.

agents

cause

te

perod

mates

ssure

tat

but

on

can

rubella

virus

te

hs

ens,

between

woud

to

a

congenta

opaque

ma

(German

N

as

ourt

a

and

149.

a

cet

to

cooboma,

and

woud

reey

nterpreted

optc

ead

by

eye

a

abnor-

ead

A

woud

ead

to

a

B.

to

eye

o

te

and

SHH

o

and

menta

a

sa

Cooboma

to

s

a

absence

typcay

by

oss

te

a

o

tere

n

te

anrda

s

a

ton

suc

as

CMV

1063–1064;

emaca

tat

lat

and

corod

by

dsorder

n

a

usuay

N

eye.

te

eye

tan

usuay

and

102;

o

tssue

and

ssure

te

ton.

and

as

mutaton

o

abnormates

te

ncude

n

ts

ts

rom

B.

to

s

and

occur

tumors

ts

153.

sma

zed

by

Cons

maar

zygomatc

santed

and

C.

ypopasa

papebra

most

normay

wt

normay

(caused

mandbuar

ssures,

s

A.

by

2

undeveoped

eyed

and

ca

and

E.

deect

coobomas,

an

atered

deveopment

Inants

wt

o

te

Robn

cet

rst

arc

mand-

Sequence

paate,

s

ncudes

conotrunca

s

a

severe

veocardoaca

anomaes

ace

arm

o

o

deveopmenta

A.

It

s

cycopa.

to

maor-

are

respon-

a

E.

caracterze

T urner

webbed

syndrome

neck

and

sma

30

or

deveopment

E.

o

te

Mecke

o

gves

o

te

rse

to

te

Recert

yod

sta-

cart-

bone.

It

s

nerve.

arc

s

responsbe

and

te

nnervated

te

maxary

vagus

snus

snus

ronta

sxt

or

ower

by

te

paryngea

cartages,

ABR/McM

ony

man-

mastca-

caracterstc

cornu,

cornu

and

aryngea

o

a

s

te

o

or-

a

o

gosso-

nerve.

ourt

by

eatures

arc

aca

and

musces

rst arc.

esser

greater

speccay

te

wt

te

upper

by

bone

he

105;

te

n

process,

te

yod

nerve,

paryngea

n

arces

addton

to

gve

beng

nerve.

21

arses

ate

present

snus

at

n

eta

deveopment

brt.

deveops

at

approxmatey

7

age.

E.

o

he

etmod

ces

deveop

at

approxmatey

age.

1063–1064;

Meroencepay

tra

neuropore

he

to

N

87;

oten

cose

cavara

ABR/McM

resuts

durng

(.e.,

rom

te

47

a

aure

ourt

skucap)

s

o

week

te

o

absent,

ros-

deve-

wt

a

resutant extruson o te bran rom te cranum. Deects

are oten ound aong te

B.

and

syndrome

to

ead

he spenoda snus deveops durng adoescence.

GAS

154.

CMV

necton

can

vertebra

cause

coumn

as

we.

mcrocepay,

n

wc

bot te bran and cranum are drastcay reduced

cranoa-

syndrome.

ead

mutatons

nnervates

paryngea

o

te

and

n

syndrome

by

presents

te

trd

opment.

by

mcrognata,

DGeorge

tat

to

years

gossoptoss.

D

and

he

C.

o

down-

can

anrda.

trgemna

patent

styod

years

caracter-

ypopasa,

ower

caused

te

afected.

ave

s

ts

ong

mutatons

PAX6

and

tat

second

he

and

bones.

ears.

Sequence

structure,

be

syndrome

bones),

maormed

Robn

B.

syndrome.

dermods

PAX2

and

responsbe

te

he

11,

D

T reacer

by

pes,

and

rse

eyeba.

B.

te

mutatons

ABR/McM

s

paryngea

D

nec-

anoma-

gene

gene

caracterzed

215;

maton

N

and

o

causes

ypopasa,

caracterstcs

eye.

apaka

nnervated

zygomatc

wt

tymc

are

deeton

SHH

Speccay,

s

hs

he

a

deve-

nvove

te

nnervated

51

and

te

dvson

age,

te

norma

an

cranoaca

unateray

aso

tere

two-trds

resuts

deects,

(22q11)

deveopmenta deects

toxopasmoss.

tempora,

anomaes

sma

A

PAX6

o

mandbe,

te

s

cardac

cooboma,

43,

dbuar

rontona-

wc

ABR/McM

mcrosoma

occur

maxary,

eye

te

30

cartage, maeus, ncus, and mandbe. Addtonay , t s

snge

mutaton

mdne

orebran

te

ess

condton

Ear

wc

caused

o

hs

Ear

resuts

and

11,

C.

s

sze.

and

te



usuay

mcroptama,

opment,

In

ens)

gene.

compete

es

a

o

occurs

Anoptama

GAS

n

caused

eadng

wc

PAX2

In

usuay

te

abnor-

A. he rst paryngea arc, wc s oten assocated wt

promnence.

use,

A.

D.

or

o

and

nnervated

condton

usuay

gene,

gene

o

deects,

ypocacema.

stature.

rs).

s

s

PAX6

(absence

underdeveopment

150.

and

sbe

152.

te

cardac

and

ypocacema

22

deect

matons

mcro-

51

apaka

Cycopa

E.

A

project-

N

mutaton

ace,

syndrome.

PAX2

bran.

mcrocepay

ABR/McM

and

cromosome

C

cause

ABR/McM

(absence

C.

paate,

(47XXY)

undeveoped

paate,

151–175

Abnorma

congenta

an

congenta

B.

215;

o

102;

A.

A.

wormke

patent)

woud

43,

DGeorge

dsc.

necton

cet

ypopasa,

427

Neck

deect.

not

movng,

te

by

tymc

cepay and eventuay menta retardaton because

CMV

D.

11,

Answers

151.

retardaton.

N

ace,

and

necton

wc

te

caracterzed

Inecton

cataracts.

artery

rater

T oxopasmoss

E.

appears

resut.

cataracts.

o

ead

yaod

(as

te

aure

not

but

structure

ng

as

deveopment

persstent

cataract

D.

ens

w

cet

condton

A

suc

congenta

deveopment

o

te

bndness

week.

Corod

C.

cataracts,

and

Head

7

sze.

rom

C.

he

wt

However,

te

tere

ypopysea

te

s

no

extruson

o

te

bran

cranum.

ptutary

dvertcuum

gand

and

s

usuay

assocated

regresses

to

428

C H A P T E R

7

eave

Head

ony

tcuum

a

to

and

Neck

remnant

deveop

stak.

woud

Faure

not

be

o

ts

dver-

assocated

te

wt

te

meroencepay.

D.

Faure

te

E.

o

vertebra

Neura

and

crest

N

113;

D.

n

ts

vscera

par ynx

and

merges

asca

constrctor

s

ormed

and

te

tr ue

to

raton

o

r yngea

at

asca

te

toward

asca

and

or

space

o

he

asca

and

he

prevertebra

umn

and

back.

te

tyrod

te

he

te

tere

s

no

o

o

GAS

157.

te

s

s

te

to

te

o

tr ue

as

te

anteror

te

ayer

o

nvests

te

asca

te

s

aar

spaces

o

space

neck.

to

te

base

te

he

GAS

A.

aar

age

te

resuts

loor

te

o

neror

or

sku

te

ater

te

a

a

traveng

nerve

superory

nto

te

orgnates

trgemna

tereore

te

o

s

over

supra-

rom

nerve

not

te

so-caed

87;

te

te

and

key

D,

and

areas

A.

he

to

s

be

te

n

B.

ABR/McM

o

te

te

to

o

C.

he

D.

nerve.

A

orbta

can

wa.

margn,

troug

he

va

te

and

oten

te

to

te

ts

nerve

neror

nraorbta

loor

o

case,

te

orbt

wtn

to

te

ar

te

be

pysca

paced

near

te

detect

ear-

on

te

externa

vbratons.

conducton

Rnne

Weber

ork

test

test

w

s

to

be

oten

rue

out

s

ABR/McM

hese

groove

s

paced

4,

7,

9,

on

any

16

aryngea

artery

aryngea

o

a

a

to

o

o

supe-

arynx.

resut

te

ack

nerve

a

tumor

render

o

te

as

oop

arc

trave

to

nerve

presence

woud

te

ten

groove

because

nerves

and

nerves

aryngea

te

not

test.

recurrent

or

te

a

nterna

sensaton

oss

nerve

cup

47,

159.

B.

o

gves

aryngea

above

taste

on

rse

damage

te

te

to

to

n

o

te

patent

nnerva-

most

o

te

numerous

te

externa

nerve

voca

woud

cords,

n

epgotts.

te

ts

n

49,

recurrent

nerve,

symptoms

voca

oten

or

relex

not

1000,

50,

to

te

aryn-

owever,

beyond

wt

wt

just

atgued

te

prenc

and

swaowng

1058;

N

or

wc

resut

Patents

a

breatng

panu

1023,

o

nerve,

w

crcotyrod

weakness.

present

compresson

probems

aryngea

tyrodectomy,

nnervaton

w

Dpoc

te

durng

resutant

999,

between

o

to

Irrtaton

GAS

eaves

aspect

and

paced

subcavan

o

resut

o

cause

te

oramen,

to

occur

eson

racture

n

49;

et

nerves;

wt

E.

nraorbta

neror

and

47

bow-out

wa,

durng

conducton

onger

Rnne

recurrent

oss

Damage

o

dam-

te

to

oarseness.

nerory

key

unkey

arynx.

vagus

woud

space

superory

no

te

recurrent

te

a

danger

woud

and

enter

oss.

oarseness

te

ten

traceoesopagea

te

hs

by

s

respectvey.

Damage

8.163).

orbt

N

and

rgt

addton

muscu-

buccoparyngea

struck

tunng

nterventon

musces

asca

eve

s

wt

he

1110;

aorta,

ton

posteror

te

eyeba

to

80–82

conducton.

durng

rgt

gea

to

te

orbt

tereore

possbe

patent

bone

E.

B,

tese

oss

Fg.

te

A,

retroparyn-

contnues

te

empoyed

can

conjuncton

Damage

rom

It

patent

eaty

tan

n

rory

tereore

skeeta

te

ork

structures.

oarse.

more

bend

rom

are

determne

traceoesopagea

contnuous

and

to

and

tese

ocated

away

oten

co-

separated

medastnum

(GAS

mmedatey

orbta

s

sku

racture

neror

te

separates

dspaced

nerve

o

nerves

tunng

norma

around

esopa-

neck

s

earng

dapragm.

nraorbta

n

as

space

ascae

N

courses

dvdng

ABR/McM

s

vertebra

asca,

te

porton

posteror

asca

991–992;

An

o

respratory

prevertebra

to

hs

and

63;

te

between

coverng

reerred

te

te

156.

asca

asca

troug

E.

aar

nerve

test

te

GAS827,

158.

retropa-

tracea,

musces

by

neror

o

ts

nerves.

orbt

sensorneura

o

aar

sepa-

ear

surgca

asca

ature

gea

te

hese

N

A

unt

used

te

te

n

oss.

better

posteror

resut

te

In

contnuous

reerred

asca

ear

asca

o

904;

nner

par yngea

Attacments

s

ntrnsc

potenta

te

hus,

mastod process or maxmum bone conducton to te

gand.

prevertebra

s

nerve

dvson

posterory

Rnne

ng

beore

extensons

provdes

encoses

asca

te

cana.

beore

aveoar

to

optc

cause

Between

ronta

supraorbta

cose

examnaton

sku

aar

C.

ayers.

A.

and

damaged.

damaged.

space

te

he

asca

rom

prevertebra

vscera

and

cranum.

buccopa-

superor

wat

space.

tat

gus,

be

contents

neror

he

te

pretracea

he

traves

or

ayer

esopagus

musces.

aar

E.

med -

wa

base

cavty.

te

te

buccopar yngea

anteror

he

danger

groove

to

mandbuar

space.

he

he

be

necton

trave

te

o

nvests

seat

posteror

An

he

buccopar yngea

te

vscera

C.

te

posteror

asca.

boundar y

te

te

batera

carotd

not

retropar yngea

toracc

retropar yngea

asca

B.

te

asca.

neror

D.

types,

rom

buccopar yngea

buccnator

rom

prever tebra

wt

aar

aso

and

ce

kewse

extends

tus

he

te

te

to

coud

superory

nto

o

not

esopagus.

coverng

wt

contnung

woud

space

sku

te

te

begns

r yngea

te

between

and

varety

C.

orbta

trocear

cranum.

a

and

te

key

damaged.

space

asca

afect

62

medastnum.

encosed

te

to

woud

meroencepay.

o

bend

posteror

asca

not

rse

ormaton

wt

aspect

astnum

abscess

gve

deveopment

retropar yngea

neror

s

coumn,

ABR/McM

he

arc

ces

abnorma

assocated

155.

B

neura

nraorbta

most

n

a

musce,

wt

ts

voce.

nerve

trggered

can

c-

oarseness

234–235;

ABR/McM

84

vens

te

are

vens

bran.

o

responsbe

te

Dpoc

scap

vens

or

and

are

communcaton

te

venous

stuated

snuses

wtn

te

CHAPTER

Buccopharyngeal

(posterior

Infrahyoid

of

layer

muscles Prevertebral

Pretracheal

Pretracheal

layer

fascia

space Retropharyngeal

Manubrium

of

•

o

bone

between

o

two

sgncance

provde

vens

te

o

way

o

are

by

he

to

te

he

te

as

874;

near

t

and

ter

a

ems-

cnca

ts

vens.

161.

more

not

te

dsta

o

by

woud

an

vens

o

o

te

nerve

a

o

bood

patway

te

woud

rom

arses

te

tus

at

tese

not

atera

key

A.

by

be

n

te

postovary

nerves

s

pons,

sucus

key

ere

to

because

be

o

te

meda

932;

o

te

bone.

o

teter

N

9,

42,

wa

meda

eye,

but

ancor

n

on

orbt

and

te

responsbe

or

non-

te

ormed

rectus

ts

te

(abducton)

ere,

te

between

meda

he

o

musce

musce

te

or

wa

rectus

cracked

damage

te

and

eye

ateray

and

dects

GAS

orbt.

927–929;

A.

he

are

tus

and

ever,

or

rotates

N

13;

s

case

eyeba,

o

te

musce

eye.

s

not

n

neror

movement

te

broken

entrapped

ocated

or

at

te

ocated

abducts,

52–53,

neror

ter

move

te

eye

loor

move-

at

te

roo

depresses,

and

Normay,

te

o

musces

parts

In

ts

maxa

and

o

superor

responsbe

te

rectus

te

te

eyeba.

pate

neror

are

80

obque

between

obque

o

or

to

eye.

ssure

orbta

te

musce

and

loor.

musces

nabty

o

eye-

patent.

musce

te

te

respectvey.

s

responsbe

ABR/McM

te

an

abducton

rotates

tese

n

musce

ts

rectus

orbta

te

upward

n

to

nerory,

obque

hs

neror

entrapped

and

be

rectus

resut

rectus

seen

nternay

Damage

w

superor

te

neror

woud

Ineror

orbt

s

te

suppy

E.

he

o

162.

rectus

downward.

ractured

ocated

te

mentoned

or

case,

as

neror

te

rec-

an

ow-

snared

obque

musces, causng tem to act as ancors on te eyeba,

near

nterna

prevent

te

o

poste-

pons.

a

ba

and

cerebear

and

te

excurson

eye,

te

B

com-

PCA.

s

he

nerve

compressed

as

te

ment

superor

acts

no

o

889–890,

meda

adducton

nerve

D.

be

musce

o

te

etmod

or

here

A.

scap.

te

layer

80

entrapment

atera

ven

vens;

o

by

rage

s

886,

racture

render

preventng

commu-

emssary

884,

ragments

te

scap.

between

te

t

near

arteres

te

mdbran

nerve

bran.

drect

prevertebral

parayzed.

11

coud

artery,

o

a

o

and

te

and

te

receves

passes

(PCA)

o

commun-

ntracrana

key

responsbe

mmedatey

not

within

ABR/McM

bow-out

racture

vens

ocaton.

to

aneurysm

artery.

nerve

nerve

cose

s

provde

vens

Neter

do

snuses

snus

stuated

te

and

ABR/McM

abducens

scap,

dpoc,

aneurysm

by

optc

Ws

ton

to

s

A

883,

84;

unctona

pat-

supraorbta

mantan

sagtta

cerebra,

and

te

ven

not

cerebear

he

on

externa

juncton

an

C.

woud

emssar y

vascuar

838,

61–64,

te

snuses

he

GAS

ayer

between

space

8.163

ocated

o

venous

potenta

venous

trocear

medua.

he

an

te

artery

vagus

compressed

E.

emssar y

eyed,

does

does

te

by

D.

te

te

te

32–33;

te

superor

damaged

n

N

cerebra

and

o

ocuomotor

Atoug

B

s

wtn

Fig.

te

superor

superor

he

te

underyng

cerebra

wt

muncaton

artery

and

upper

suc,

owever,

ror

dpoe

vens

te

snuses

communcaton

provde

wt

ncaton

C.

he

dpoc

o

connect

venous

supratrocear

anteror

and,

160.

dura.

supercay

drecty

GAS

o

and

te

GAS

necton.

he

D.

sku

to

te

means

dpoe

E.

superor

cate

tat

scap

ocated

C.

ayers

n

te

and

and

te

scap

patway

bran,

vens

A

a

o

te

space

sternum

Fascial

vens

429

Neck

layer)

Investing

sar y

and

fascia

portion

pretracheal

ayers

Head

7

PCA

te

artera

carotd

artery.

crce

Its

o

oca-

preventng

are

not

compresson

oowng

nerve

and

cerebear

te

superor

upward

necessary

njury

bone

barrng

n

w

any

movement

damaged

ts

aow

oter

patent.

ree

njury.

o

and

te

eye.

tere

Freeng

movement

s

te

o

he

no

musces

apparent

musces

te

eye

rom

agan,

430

C H A P T E R

B.

7

Head

Damage

resut

C.

D,

te

or

damage

ts

to

GAS

wt

A.

A

as

Hutcnson

ocated

te

nerve

ton

dorsa

B.

n

ta

C.

te

Posteror

GAS

82,

92,

o

a

woud

rectus

eye,

to

to

s

D.

te

nose

tat

nerve

tat

carry

E.

nnervate

te

GAS

gves

orgn

165.

of

te

nerve

to

s

a

sensory

te

branc

o

te

nnervaton

ron-

rom

te

nerve

te

s

a

branc

trgemna

rom

and

te

tat

nerve

te

skn

upper

nerve

s

a

snus

te

and

o

ps.

sensory

and

te

(a

nnerva-

posteror

te

nerve

nasa

cavty

anteror

te

provdes

and

N

te

etmoda

nasocary

1075;

sensory

111,

nner-

dorsum

nerve

s

o

aso

a

GAS

166.

nerve.

113;

ABR/McM

44,

51,

Anestetcs

o

decate

contans

wt

te

njected

(areoar)

o

“danger

can

wt

space.

are

nerves

oreead

eye,”

he

to

te

te

te

eyed.

zone”

n

passage

Inectons

te

connectve

te

resut

nto

can,

a

o

tssue,

hs

te

o

scap.

bood

te

space

ematoma

kewse,

submuscuar

s

A

nto

te

ayer

tat

B.

bow

as

to

a

te

ts

rectus

D.

o

he

mc

te

orbta

brances

nerve,

o

te

he

ary

o

he

te

ts

deepy

ten

dvson

nasocary

o

nerve

te

o

toward

ntrate

te

branc,

brances

trgemna

exts

te

nraorbta

near

te

orbta

nerve.

can

t

te

trgemna

resutng

E.

cana.

margn

s

rom

nerve

Injecton

ess

te

ater

key

o

to

ater

anestesa

afect

ts

N

167.

supra-

nerve

pays

nerve

a

and

roe

rom

woud

njecton

n

te

not

at

te

be

toward

as

o

n

te

on

te

te

oss

(te

opposte

an

s

bran

not

to

te

unusua

n

easy

an

torn

cerebe

and

te

pr-

he

on

dasboard

s

o

sde

object

tentorum

wt

n

musce).

nerve

te

most

ater

a

at

branstem

orce

te

common

ste

traumatc

dura

160;

o

o

o

o

mpact

njury

njury

te

s

at

to

te

tentorum

ABR/McM

te

optc

wc

tereore,

nerve,

cer-

s

wen

as

59–61

s

connected

te

tere

contractons

s

orgn

an

o

o

nlam-

te

rectus

pan.

afectng

eye

44,

nerve

serves

a

nerves

gy

nlammaton

and

N

downward

poston

nerve

t

decate

severe

te

It

1075;

njury).

tendon

s

resuts

drected

obque

trocear

132,

ong

roe

nerve

to

because

optc

o

1074,

nnervatng

te

unkey.

causng

ocuar

musce

unkey.

nerve

gves

of

cary,

s

a

a

branc

number

posteror

nratrocear

eye

o

o

and

nerves

te

opta-

brances

suc

anteror

et-

and

does

not

movement.

Constrcton or occuson o te optamc artery

n

max-

te

and

above.

nasocary

a

optc

converge

dura

he

evoke

nerve.

te

pay

area.

nraorbta

branc

anestetc

optamc

ncudng

anestesa

B.

apex.

drect

to

coverng

te

can

moda,

ten

It

margn

backward

musces;

te

and

95,

Generazed

space.

anes-

optamc

crana

eye.

adducted

ead

perces

annuar

as

margn,

E.

t

N

One can nsert a neede troug te upper eyed, near

orbta

and

contracton

submuscuar

wtn

te

Inlammaton

C.

be

81

eye

te

te

expaned

musces

“back

te

933–936,

56,

ead

nerve

dura

musces

contnuous

known

pass

ayer

o

normaton

superor

er

notc

and

862;

A.

maton

A.

n

o

perces

were

as

he

cras—te

trocear

ebe

te

trocear

te

patent’s

D,

oramen.

not

supraorbta

vsua

904,

44,

pups

orward

C,

te

te

nerve

njecton.

second

o

orbta

“coup-contrecoup”

B,

et-

s

tt

two

tentora

move

rom

o

an

te

Parayss

t

o

nasocary

woud

branc

te

sensory

dorsum

etmoda

nerve

te

afected

o

must

were

te

a

back

902,

pup

carres

80–81

164.

acton

a

te

margn

to

bran.

by

o

te

automobe

ace

s

te

te

te

mary

pont

he

or

max-

te

branc

provdes

spenoda

rom

nerve

at

887,

wen

wen

s

rse

provdes

and

eyed.

Parayss

loor.

orbt.

nerve

o

anteror

orbta

ABR/McM

te

cavty

nerve.

to

838,

aow

an

afected

abty

nasa

o

A.

te

transmsson

96–97;

nasa

etmoda

gves

optc

upper

naso-

superor

te

be

o

nnerva-

aso

by

tat

retna

nasocary

sensory

enters

ocated

te

s

a

ronta

he

known

vrus

nto

he

nerve

provdng

carres

nerve

935–936,

he

243

dvson

brances

brances.

s

te

t

trocear

sym-

236,

s

anteror

nerve

patent

o

rom

contnuaton

It

te

nerve

nose.

tetzed

and

etmoda

to

he

superory

141,

anteror

nnervaton

ater

resut

upward

optamc

nasocary

etmoda

nose.

branc

eye

ces.

Anteror

vaton

te

tat

orbt

te

moda

te

n

gaze

ndcates

hs

etmoda

nasocary

te

o

he

nerves

and

between

E.

to

dorsum

hs

nnervaton

to

58,

brances

dvson

ton

neror

resut

he

somewat

woud

o

C.

s

acrma

nraorbta

sensory

D.

te

nerve.

superor

ary

woud

te

musce

rectus

he

woud

eye.

nerve.

nerve

he

ts

movement

nabty

supratrocear

skn

rotates

drected

meda

eyeba.

40,

addton

nasa

he

on

and

to

be

rect

devated

eyes.

33,

eye.

etmoda

mucosa,

an

sgn.

drect

te

te

bodes

ronta,

as

or

N

ce

rom

to

te

musce

ras

trgemna

cary,

te

n

o

bot

927–929;

erpes

to

neror

obque

Damage

downward

eyeba

metrcay

and

superory

pup

Damage

devaton

and

neror

ateray.

responsbe

devated

meda

he

cause

downward.

atera

te

Neck

ateray

E.

and

tereore

163.

a

and

upward

n

to

n

and

can

cause

ts

patent

96,

D.

ste

132,

oss

160;

o

ABR/McM

T oxopasmoss

T oxoplasma

undercooked

person

s

vson

exposed

and

to

s

not

observed

n

54

necton

gondii,

meat

wc

s

caused

wc

te

s

eces

by

te

assocated

o

toxopasmoss,

cats.

para-

wt

Once

mmunty

a

s

CHAPTER

deveoped.

exposure

prevous

as

However,

occurs

n

exposure.

A.

on

to

te

Congenta

a

Meases,

pror

to

can

concern

woman

s

wo

wen

as

maormatons

occur



te

asca

no

ayer

suc

necton

tat

s

be

necton

woman

Mumps,

acks

and

pregnancy .

s

key

Rubea

he

to

occur

mmunzaton

MMR

(MMR)

vaccne

wen

wt

s

A.

B.

u

te

and

o

sst

te

yaod

artery

as

s

ng

N

20,

A.

At

te

te

pont

In

te

nerve

s

Injury

gand

C.

te

o

regresses

yaod

resut

te

pror

artery

n

aca

to

t

brt.

per-

Injury

s

njury

a

sku

vrus

dur-

racture

wtn

te

n

as

t

oss,

te

te

sstent,

es

patysma

to

te

and

parotd

peraps

aevate

te

A,

p.

a

gand.

t

o

woud

to

aca

tympan.

o

ave

aso

type

aca

te

nerve

ante-

mecansm

unkey

aca

or

nerve

te

o

te

te

GAS

171.

styo-

uncton

mecansm

aca

nerve

o

o

not

key

presented

Mandbuar

to

n

occur

te

brances

wt

te

o

te

usuay

s

an

o

o

and

bucca

A,

brances

GAS

133,

B.

858,

he

can

959;

dvson

te

be

efects

N

9,

ABR/McM

aurcuotempora

dbuar

nto

910,

parotd

o

due

n

9,

61,

14,

nerve,

a

trgemna

gand,

assocated

are

te

59,

and

ts

wt

severe

arge

part

64,

23,

97,

branc

o

te

te

(CV V3)

he

n

man-

o

te

drans

be

132;

ven

vertcay

vens.

torn

bubbe

and

114–115,

81–82

accumuaton

sac.

s

known

n

epsodc

are

dzzness

About

or

treated

o

as

earng

vomtng.

o

o

Labyrntne

per-

wt

stmuants

body

luds

and

dsease.

Ménère

dsease

accumuaton

oter

n

s

te

structures

are

ABR/McM

57–58

s

te

superor

typcay

a

tyrod

sort,

drect

artery .

trbu-

n

downward

he

tyrod

(because

o

to

superor

surgery ,

negatve

one

and

or

bot

mdde

peraps

pressure

n

o

te

tyrod

admttng

te

vens)

C.

s

or

eta

he

an

GAS

172.

resuts.

most

njury

key

to

te

cause

o

superor

ar

or

bubbes

mdde

n

ty-

ven.

he neror tyrod ven usuay drans nto te et

ess

mumps

contnuty

not

nerves.

accumuaton.

accompanes

bracocepac

eads

compressve

t

tyrod

patent

rod

E.

compresson

to

132–

57

nerve

pan.

115,

97,

reducton

tese

two-

nerve.

woud

tese

resut

above,

o

anteror

56–57,

oters

Ménère

None

te

and

nterventon

voume

stated

rom

cana

ngua

N

and

endoymp

96–97,

deeterous

B,

ts

142–146;

N

ven;

can

ar

wt

zygomatc

sac.

and

o

aca

o

42,

and

It

tat can ascend n te nterna juguar ven nto te sku,

patent.

nvovement

As

ear,

vertgo;

te

nnerva-

gand

can

nausea

ntake,

sensory

ydrops

surgca

endoymp

bracocepac

aca

mecansm

te

ower

excessve

mdde

vens

termna

n

wt

bers

gand.

te

rom

dsease

patent

secretory

te

1093;

38–40,

t

parotd

ts

to

as

pan-

gand.

endoympatc

requre

E.

n

va

resuts

te

orgnates

parotd

975,

by

no

tary to te nterna juguar ven. he neror tyrod ven

te

njury

parotd

compresson

29,

symptoms

n

957;

te

o

hs

sat

to

and

o

te

sensory,

D. he superor tyrod ven s a trbutary to te nterna

he

occur.

specc

D,

resut

juguar

to

te

nvoved

njury

anteror

ow

endoympatc

o

occurred.

proxma

mpar

Gven

ts

be

te

nerve

w

te

Gven

C,

over

te

te

tympan

tongue

ncapactatng

cafene

can

sted

nerve.

generazed

nnervaton

noses

patents

ayer

swes,

and

ence

carres

nerory

te

assocated

duretcs,

ke

neror

o

toug

a

nerves

not

ts

to

endoympatc

roarng

10%

mas-

nerve

or

(vertgo)

o

(edema)

dsease.

rapdy,

gand,

o

nerve

974,

n

te

gand

oter

experenced

any

ABR/McM

lud

Ménère

te

o

904,

te

431

Neck

neck,

te

nerve,

pexus

passes

because

Hydrops

ydrops

cana,

exts

aca

sty-

searng

aca

wom

te

te

B.

t

sensory

901,

motor

corda

sensatons

excessve

skn.

brances

gand

to

as

o

parotd

be

regon

he

porton

155–156;

a

petrosa

te

te

Wen

compresson

provde

observed

GAS

54

wereby

te

njured

nerve

branc

te

exts

to

E.

s

te

tympanc

not

provdes

be

patterns

ABR/McM

nerve

nants,

afect

njury,

njury,

to

te

specc

susceptbe

deveoped,

ower

oramen

to

o

te

wt

o

trggered

None

w

to

are

gand

asca

and

gand.

nerve

troug

nerve

trds

170.

aca

most

In

yet

ony

parotd

and

opta-

may

parotd

esser

ton

maormatons,

any

143;

commony

ndvdua

unkey

te

o

parotd

corda

yed

142,

s

aca

te

o

ocuar

damaged

severa

te

patent’s

nerve

w

D

reactvaton

not

beneat

te

o

njury

te

or

t

not

just

to

mastod

169.

he

Panu

oramen.

nant’s

An

cose

branc

te

133,

be

most

are

to

to

a

wt

were

woud

here

an

o

absence

as

musces

to

to

maormatons

132,

can

process

te

ssure

s

does

oramen

unprotected,

E.

ave

arterosus.

usuay

necton

styomastod

E.

to

cooboma.

peces

97,

ror

a

wc

61,

nerve

tod

o

artery

congenta

omastod

aca

corod

pregnancy

orces.

ductus

assocated

owever

D.

key

“loaters.”

EBV

o

patent

ormaton

Sometmes

C.

more

does

he

B.

are

ear.

sensaton

mates,

mc

168.

n-utero

parotd

nvestng

pan

te

secondary

rom

Faure

E.

vrus

or

to

aca

symptoms suc as sensorneura deaness, eye abnor-

te

C.

to

te

passes

vac-

te

nondstensbe.

bers

he

cne and soud not be gven n pregnancy . Neonates

exposed

amost

suppy

te

ve

s

o

superca

reerred

vaccne

a

capsue

o

sensory

etus.

rubea

pregnant

bggest

pregnant

Congenta

mcroptama

passed

te

a

Head

7

key

1008,

to

be

1009;

ven.

a

N

An

cause

87;

o

njury

ar

to

ts

bubbes

ABR/McM

structure

on

28–30,

CT

s

scan.

32–33

C. he crcotyrod artery s a sma branc o te supe-

ror tyrod artery. It anastomoses wt te crcotyrod

432

C H A P T E R

artery

7

o

Head

te

and

Neck

opposte

sde

at

te

upper

end

o

te

175.

B.

I

medan crcotyrod gament, a common ste or estab-

a

sng

te

an

emergency

arway.

he

crcotyrod

artery

can be pused nto te arway durng a crcotyrotomy.

he

vesse(s)

can

go

tay

A.

he

na

superor

carotd

It

te

te

D.

he

surace

o

tyroyod

ateray.

to

It

s

be

te

o

o

perce

ts

gand.

and

te

key

be

to

te

hs

to

arses

s

rom

te

ess

orgnates

pup

pos-

rom

he

a

and

musce.

rotomy

GAS

837,

McM

173.

C.

artery

runs

It

s

s

a

branc

supercay

not

te

D.

n

te

to

o

te

vcnty

o

N

17,

19,

54,

BP29,

134,

cea

at

cartages

tons

durng

te

eve

usuay

a

o

te

resuts

trd

n

traceostomy

te

(or

and

superor

cause

te

obque

patent

to

to

ook

downward

o

are

optc

make

tey

t

dicut

ave

nerve

“down

te

or

trocear

atera

nnervated

were

and

te

pasy .

njured,

out”

rectus

by

ndvduas

nerve

te

because

and

o

superor

abducens

and

respectvey.

nerve

bndness

n

were

te

abducens

njured,

afected

nerves

te

eye.

were

patent

I

te

njured,

woud

ocuomo-

te

patent

and

te

outward

883–884,

92,

204,

80,

83,

215,

eye

rom

887,

241;

woud

te

be

drected

poston

889–890,

ABR/McM

o

933;

59,

downward

orward

N

38,

61,

gaze.

84,

87–89,

52–54,

66–67,

86

ABR/

ourt

ewest

pup

tra-

compca-

traceotomy).

he

176.

176–200

D. he accommodaton relex s perormed by constrc-

ton

o

hs

te

pup

uncton

tryng

controed

a

near

object.

parasympatetc

ts

n

tares

a

o

te

surgca

A,

just

B,

eve

o

as

externa

procedure

D,

nature

neror

suc

and

te

mgt

E.

a

to

juguar

to

be

tyrod

However,

vens

ma

make

perormed

Because

cause

tat.

tyrodea

o

gand,

njury

to

te

a

at

vas-

trbu-

care.

gy

mportant

or

traceostomy

wt

ncson

oter

artery

any

oter

neurovascuar

structures.

1054;

145;

ABR/McM

he

hs

s

N

uvua

9,

25,

53,

56–57,

36,

37,

209

woud

because

unopposed

ens

ng.

by

move

59,

D,

ntact

te

opposte,

133,

136,

evator

te

ve

ntact

rgt

paatn

parayzed

et

sde.

woud

evator

be

durng

equazaton

C.

do

A

not

10,

834,

47

te

sot

between

o

971,

ve

paatn

paate.

wc

a

rgt

te

te

roe

hs

to

paate

1096,

tere

o

aso

to

open

and

o

te

tense

te

or

5

n

he

te

paatn

te

1098;

N

w

cause

ack

cary

gets

o

te

musce

o

o

to

evoked

or

ocuomotor

nerve

Ednger-Westpa

savatory

t

cary

wose

te

ocus-

means

he

te

cary

by

post-

gangon

ce

bodes

by

are

nuceus.

nuceus

savaton,

te

pup

reaxaton

nnervaton

te

on

n

near

compromsed.

rom

te

aowng

accommodaton,

s

act

cause

ens,

sape

parasympatetc

and

axons

rom

reducton

te

sperca

musce

not

s

nvoved

te

cary

wt

musce

accommodaton.

SCG

s

a

axons

wc

sympatetc

nnervate

causes

C.

he

nervus

gangon;

te

dator

mydrass,

ntermedus

contans

speca

secretomotor

bers.

submandbuar,

ABR/McM

cary

cause

nerve

but

ts

postgan-

pupae

not

te

mus-

moss

o

accommodaton.

tat

et.

109;

he

ce,

pressure

ear.

a

to

gament

more

superor

gonc

aud-

mdde

a

acrmaton

B.

te

ocuomotor

Postgangonc

musce

neurons

bers

ocated

A.

on

s

te

gangonc

ve

eevaton.

ve

on

one

act

aows

parynx

paata

evator

sot

1033,

n

are

hey

eps

swaowng.

pay

parayzed

eevaton

GAS

o

tensor

aponeuross

tube

hey

he

musces

paatne

tory

E.

and

adopt

and

and

pared

I

GVE

toward

te

82–83,

gangon.

pupae

suspensory

to

acton

paatn.

B,

te

musce

GAS

A.

cary

dameter

o

vascuarzed

te

te

spncter

te

on

te

Ednger-Westpa nuceus o te mdbran tat synapse

s

n

ocus

by

nerve

structures

carred

to

s usuay at te eve o te second tracea cartage and

ncson

bers

wen

s

stmus o te tyrod gand (a rcy vascuar structure)

cuar

174.

GAS

Answers

ncson

actons

and

and

crcoty-

34

An

so

te

woud ave ony te actons o te superor obque

ngua

136;



drected

nerves,

te

tor

yogossus

te

te

ocuomotor

be

wc

ave

mdne

te

turn

can

stars

te

woud

I

te

procedure.

1046;

I

musce,

suprayod

artery

E.

obque,

membrane

by

not

decency

unopposed

key

beneat

coud

descend

and

crcotyrotomy.

E.

to

to te et  te rgt trocear nerve were parayzed.

trocear

njured

eye

patent

suppy

procedure.

tyroyod

to

et

eye.

te

woud

be

n te adducted poston. As an exampe, te afected

nto

courses

njured

s

w

musce

exter-

ocaton.

artery



rgt

suppes

tere

rectus

abduct

unafected

nerve

wc

to

njured,

atera

yod

C

It

unabe

te

s

et

te

ateray

ascends

be

nerve

te

te

bood

typcay

as

o

trocear

musce,

njured.

tyrod

artery

ess

o

w

degree

he

poten-

abducens

uncton

ose te abty to turn te pup downward wen t s

of

eve

ocated

and

aryngea

tyrod

te

artery

because

superor

wt

A.

et

o

patent

same

wc

patent.

brances

at

s

to

trunk

te

tracea

crcotyrotomy

tyrod

njured

superor

and

te

te

te

majorty

key

tyrocervca

be

by

artery

te

o

nto

personne,

typcay

gand

ess

neror

teror

to

s

bood

tyrod

pont

t

medca

artery

tyrod

Hence,

drecty

o

provdes

ncson

he

by

aspraton

bone.

B.

beed

unnotced

ata

to

can

te

oss

roe

n

te

and

s

a

part

sensory,

It

o

nnervates

acrma

accommodaton

te

somatc

te

ducts

relex.

aca

nerve

sensory,

and

subngua,

and

pays

no

CHAPTER

E.

he

trgemna

gangon

s

a

sensory

gangon

and

Sensor y

not

ave

parasympatetc

bers

and

does

te

(GAS

8.107).

Fg.

cary

musce

or

433

Neck

ner ve

not Long

nnervate

and

root

Nasociliar y

does

Head

7

ciliar y

ner ve

accommodaton

Sympathetic

N

83,

87;

ABR/McM

79 root

177.

A.

An

acoustc

neuroma

neuroemmoma)

s

a

(vestbuar

bengn

tumor

scwannoma

o

te

or

vestbuoco-

Parasympathetic

(motor)

cear

nerve

(CN

VIII),

wc

causes

compresson

root

o Ciliar y

te

aca

nerve

(CN

VII).

he

vestbuococear

nerve ganglion

eads

rom

te

nner

ear

to

te

bran.

Atoug

many Oculomotor

suc

can

tumors

n

w

some

not

cases

grow

resut

or

grow

very

utmatey

n

sowy ,

ner ve

Shor t

[III]

branstem

Sensor y

com-

(as

n

ts

exampe),

ydrocepaus,

contrast

nto

rgt

te

te corona

o

te

tc

nterna

tumor

s

te

and

o

30

most

peope

scwannoma)

and

ncudng

cocear

can

neuroma

be

seen

•

GAS

60.

Because

ntraoperatve

uncton,

te

rsks

wt

are

o

acous-

advances

montorng

o

E.

dagnosed

aca

n

n

o

An

N

179.

parayss

externa

ts

49,

C.

case

56,

he

carotd

artery

67,

78,

72,

angograp

o

can

kne).

he

romas

are

2.5

outcomes

better,

cm

are

D,

and

compresson

GAS

838,

958–960,

te

onc

o

as

o

and,

N

sma

wt

wt

(e.g.,

bot

gamma

acoustc

neuromas

sgncant

neu-

arger

neuroma

tese

te

nlamed,

cause

resutng

parynx.

o

ruptured

w

tey

a

become

some

Many

may

s

be

no

vded

by

GAS

910,

to

124,

a

cet

trd

n

arc

and

become

ts

a

tender,

abscesses

dranng

n

snus

tese

musce

cn

he

to

C.

resut

D.

enarged,

te

E.

w

skn

GAS

present

181.

B.

o

w

domastod

afected

s

an

abnorma

musce.

sde

and

hs

ead

contracture

causes

rotaton

te

to

o

te

ead

A

te

opposte

to

sde.

te

unkey

carotd

st

tat

patent

artery.

arteres

o

dd

32

te

not

Portons

are

“back

ed

”

However,

compromsed

pro-

vascu-

n

ts

vesses

are

not

te

cause

o

te

angograpy.

N

20,

o

te

tempora

otts

ces

bone,

mastodts

Necross

oten

o

96–97,

115,

wtn

oten

te

caused

meda.

o

w

64,

224

te

o

te

afect

s

te

tempora

nlammaton

bone

because

sgmod

bone

s

o

snus.

unkey

nlammaton.

te

mdde

ear

mastodts

occpta

mastod

o

not

te

carotd

ABR/McM

sows

s

usuay

rater

tan

te

preced-

occurrng

as

a

t.

be

snus

s

process

ts

ocated

and

poston,

afected

N

by

127,

s

ar

posteromeda

unkey

te

ts

to

nterna

be

to

afected.

carotd

artery

nlammaton.

128,

132,

143;

ABR/McM

16

caazon

te

be

sternoce-

ttng

o

nto

necton

part

947–953;

57–58,

contraateray.

event

Because

rup-

cases.

nlammaton

he

te

s

caused

by

an

obstructed

tarsa

gand

eyed.

Swengs

te

tender to papaton wc s not observed n ts patent.

T ortcos

petrous

experence

an

A.

node

necton

160;

ceary

because

s

te

snus.

n

are

an

o

acute

to

tract

te

s

Inecton

ep-

gy

symptoms.

compcaton

sgmod

137,

999–1000;

process

untreated

B.

s

crcuaton.

ABR/McM

ng

tat

w

860,

132;

er

hese

n

process

cysts

to

136,

te

externa

carotd

bran

to

E.

seen

128,

untreated

cav-

te

and

known

o

grows

present.

ymp

by

o

to

81,

njected

coatera

Mastodts

ourt

snus

cet

A.

A

embry-

orms

wt

branca

are

aure

D,

75,

common

and

eadng

mastod

trd

ectoderm-ned

cases

te

hey

te

suppy

B,

te

common

occuson

most

superor

rom

remnant

ndcated

te

mass.

te

te

deveop

pontng

mass

secondary

are

Occasonay

sternocedomastod

wt

cause

nerves

paryngea

covers

may

to

branca

puruent

Surgery

dicuty

mass

n

neck

musce

entrapped

skn.

a

second

cets

oters

n

not

905–906,

cysts

anteror

nvoute.

cyst,

or

crana

901,

cet

second

te

overyng

does

nterna

te

patent,

180.

arse

he

bured

oter

887–892,

utmatey,

and

te

above

ar

earng

208

te

normay

arrested

here

A

o

884,

tat

asymptomatc;

A

tose

(branca)

cysts

he

tat

ture,

any

1002;

teum-ned

or

wt

experence

Acoustc

deveopment.

arces.

or

to

sternocedomastod

cauday

to

tose

efectvey

terapy

A,

883,

obteraton

s

treated

wereas

congenta

eptea

tes

or

key

E.

Paryngea

common

o

be

radaton

postsurgery .

C,

A.

now

targeted

aneurysm

provded

tc

and

fibers

8.107

presentaton.



neuromas

Fig.

fibers

on

medum

B.

D.

postganglionic

competey

oss

C.

unknown;

ages

meatus

te

Parasympathetic

radopaque

tan

B.

acoustc

o

preganglionic

and earng oss ave been greaty reduced. Many acous-

surgery

178.

Extenson

fibers

Parasympathetic

arrow n Fg. 7.9). he exact cause

(vestbuar

mcrosurgery ,

aca

sown.

MRI (see

neuromas

between

as

postganglionic

branstem

ernaton, and deat. It s dagnosed on MRI wt gad-

onum

ner ve

fibers

Sympathetic

presson

ciliar y

growt

upper

o

te

atera

acrma

eyed

gand

and

are

usuay

not

present

ndcatve

on

o

a

caazon.

C and D.

eye,

so

ts

A

caazon

excudes

rect answers.

s

scera

not

and

an

necton

pup

rom

wtn

beng

te

te

cor-

434

C H A P T E R

E.

7

he

Head

Neck

nasoacrma

ocated

te

and

acrma

nose

and

duct

sac

to

woud

runs

te

be

rom

neror

te

meday

nasa

unafected

n

meatus

te

case

D.

o

921;

107,

N

a

hese

110,

115,

ABR/McM

182.

B.

he

A.

41,

49,

124,

128,

59,

62,

64,

133–134,

68,

142,

82,

105,

186.

145–146;

poyp

aso

spenoda

nasoparynx,

s

nvoved

atera

to

snus,

te

te

maxary

nasa

ocated

unkey

to

be

snus,

afected

to

by

a

C.

he

etmoda

atera

he

are

ces,

te

by

cannot

ocated

he

nasa

be

be

hey

and

are

te

nasa

te

by

ducts

to

te

orbt

unkey

183.

C.

tumor

acoustc

at

gea

GAS

ts

204,

D.

te

te

to

are

ronta

te

nasa

eyes

o

and

bony

obstructed

(A),

are

GAS

by

te

a

236,

underneat

between

te

B,

N

10,

ar

E.

o

185.

C.

obe

nasa

and

wen

oramen

ested

A

and

unkey

N

suc

afect

as

rst

nerve.

seen

as

and

n

beavora

memory

ts

ABR/McM

oss.

patent.

9

njury

s

n

te

and

optamc

to

cause

anteror

sensory

aspects

pan

crana

mandbuar

provde

posteror

te

key

dv-

rom

ossa.

dvsons

o

nnervaton

o

te

to

mennges,

an

he

te

to

11,

147,

17,

arteres

as

a

On

64,

149,

196,

23

resutng

coecton

te

82–84,

ead,

t

o

o

s

n

a

bood

ocated

te

sku)

are

a

ocated

a

to

and

superca

areo-

to

te

t

part

w

hs

to

s

as

be

te

te

te

n

te

to

a

tempora

obe

ts

obe,

aganst

symptoms

pareta

te

n

tempora

ocuomotor

symptoms

secondary

o

te

man-

observed

n

compresson

o

obe

woud

compresson.

not

cause

ocuomo-

te

and

N

9,

ven

o

o

nerve,

ax

C3

te

optamc

suppes

te

ten-

cerebr.

bers

do

not

provde

132–133;

ABR/McM

s

most

te

or

ocated

tongue.

absorpton

submandbuar

uncton

as

It

o

s

44,

tereore

te

61

supercay

te

admnstered

ngua

wtn

most

N

70;

ngua

te

ror

to

deep

and

speccay

mandbuar

tereore

ng

s

o

and

o

suppy

taste

savary

to

he

te

to

o

he

te

te

atera

reac

bers

o

te

neror

to

are

absorb

a

to

o

te

atera

and

te

he

o

aso

genera

gand

te

gand

ceek

or

aveoar

to

gve

rse

to

ngua

to

te

nerve

musce

and

traves

o

s

te

mandbuar

suppes

not

n

te

cose

skn

prox-

duct.

nerve,

submandbuar

cana

mandbuar

tse

nerve,

and

tongue

sensaton

he

a

bers

nvoved

subsequenty

branc

trgemna

te

V3)

pterygod

and

atter

o

te

nerve

trgemna

axons

o

s

dur-

tympan,

hese

(CN

tongue.

a

ngua

te

sub-

nerve

trauma

corda

Fbers

supe-

gand,

te

hs

or

two-trds

nerve

not

under-

and

beneat

tongue.

duct.

atera

do

drecty

mout

(CN VII).

mandbe

pterygod

mandbuar

te

dvson

te

te

ocated

35

dvson,

suppy

are

and

absorpton.

parasympatetc

and

o

to

and

anteror

ven

submandbuar

te

secreton.

te

o

rom

nerve

nerve,

mucosa

to

ducts

to

mout

courses

te

submandbuar

bucca

mty

o

te

29,

loor

trgemna

bot

dvson

and

te

gand

te

nerve

te

subngua

uncton

or

ntay

gaton,

two-trds

ramus

deep

C.

to

aca

te

deep

route

mandbuar

gand

o

ngua

passes

te

o

pregangonc

anteror

A.

te

o

ABR/McM

or

carres

branc

n

o

te

drect

passes

rsk

excson

part

and

not

subngua

loor

porton

duct

at

do

and

te

nerve

mucosa

te

and

ntrogycern.

he

te

mty

tumors

883;

ngua

he

1089

neat

ts

te

and

C2

route

n

E.

he

gy

nerve.

nerve

GAS

B.

nerve.

s

branc

nnervaton.

838,

deepy

provde

te

descrbed

resut

o

nearby

o

not

5

compressed

resuts

te

a

C.

dvson

ABR/McM

ernaton

occur

does

tssues

a

trgemna

undersde

and

more

and

cepaoematoma

uncus

produce

are

skn,

nerves

suc

nerve

aponeurotca,

nerve,

te

cerebe

drect

and

D

te

ematoma.

Hernaton

wc

40–41,

te

drug,

hs

beng

o

ntrogycern.

gossoparyn-

rom

(perosteum

105–111;

key

Occpta

tor

(B),

144–145,

subcutaneous

damage

ocuomotor

C.

and

enarged,

E.

patent

gaea

magnum.

by

present

rom

nerve

nerve

and

deep

excretory

(sku).

tentora/unca

most

tumor.

37–38,

perosteum.

rom

te

911–914;

s

33,

dened

tssue

beedng

he

case

to

913,

he

most

16

aca

nerves

perostea

s

he

Beedng

B.

(E)

12,

ange,

te

ypogossa

percranum

cavara

nvove

GAS

3,

key

ten

ABR/McM

te

te

connectve

ste

most

and

141–142,

240;

o

te

and

A.

on

orbt.

188.

cepaoematoma

A,

s

nerve

139,

Rupture

and

ABR/McM

trgemna

959;

136,

214,

orgnate

maxary

menngea

187.

between

te

Spna

snuses

poyp.

ocated

bones

cerebeopontne

vagus

and

942,

nerve

tentora

torum

E.

te

be

he

pos-

answers.

87–89,

184.

63;

scwannoma,

(D),

correct

N

te

vestbuococear

excudes

not

117–118;

tat

he

dvson

B

1063–1065;

A

and

B.

mdde

D.

poyp.

GAS

are

trgemna

trgemna

to

out.

maxary

unkey

to

aso

atoug

dranng

afected

nasoacrma

are

poyp,

rued

ducts

meday

cavty,

superomeday

to

acrma

ocated

nasa

a

rontonasa

unkey

E.

to

afected

sbty

D.

N

can

judgment,

respectvey.

and

be

te

and

te

poyp.

856;

nerves

o

pressure

A

superor

symptoms

850,

moda

cavty.

tumors

mpared

C. A tumor nvovng te menngea brances o te et-

son

mmedatey

he

57,

52–54

nasa

ocated

GAS

20,

obe

canges,

caazon.

GAS

Fronta

o

toug

gand,

musce

suppy

and

te

cose

n

traves

ater

ower

prox-

deep

enters

teet.

to

te

CHAPTER

D.

he

ror

nerve

and

s

to

aveoar

te

te

musce

on

n

te

or

posteror

189.

A.

he

orbta

na,

te

B.

artery

s

w

an

era

sensory

efect

he

on

pes

te

nasa

te

skn

na

nerves

he

te

optc

te

s

and

car-

te

te

no

tereore,

a

o

ts

o

te

eye

and

relex;

It

s

t

opta-

s

te

te

as

on

te

septum,

brdge

s

te

sx

C.

te

anteror

te

atera

te

s

te

second

ocaton

was

or

ead

o

not

ndrecty

to

o

te

menngea

w

Injury

most

key

to

12

cause

te

crbrorm

owever

ts

pate

njury

can

w

12

A

o

A.

te

w

artery

N

mdde

ocuomotor

artery

orm.

w

ymp

node,

tongue,

an

patent’s

artery

a

oss

ABR/McM

aso

It

190.

A.

o

923;

CSF

te

he

s

N

147–149;

mosty

atera,

CSF

ourt

trd,

enters

ventrce,

(oramna

crcuates

o

n

and

te

va

rom

s

as

rom

ourt

atera

and

and

space

oten

he

o

submandbuar

te

p,

tongue,

and

cervca

he

deep

parotd

to

ceek,

o

sdes

te

o

group

te

te

o

space

he

unt

nodes

externa

nodes

upper

ace.

p,

hey

dran

parts

dran

o

are

acoustc

and

ocated

gand

and

s

troug

back

te

nto

te

aracnod

venous

sde

o

granuatons

te

meatus,

posteror

te

atera

orbt.

o

te

te

ten

nay

snus

snus.

can

ead

A

to

trombus

an

o

te

nto

obstructon

o

te

superor

superor

CSF

nodes

crcuaton

Submandibular

sagtta

nodes

sagtta

absorpton Pre-auricular

(communcatng

ydrocepaus)

n

wc

a

o

and

te

•

te

aspects

o

Submental

resorbed

back

ower

deep

supercay

dran

bran.

CSF

te

te

nto

apertures

t

dur-

nodes.

parotd

eyeds,

ymp

gums,

pexuses

rom

tons-

paatne

enarged

artera

te

medan

Magende).

subaracnod

o

te

tonsts.

necton,

corod

ventrces

com-

o

mdde

te

te

53–54

te

subaracnod

te

Luscka

te

ABR/McM

secreted

can

te

suppy.

GAS

n

72–76

known

dranage

parynx.

o

he

by

CSF

resut

ydrocepaus.

owever,

o

ep-

subaracnod

crana

drecty

an

aneurysm

aneurysm

cause

node,

receves

and

I

ruptures,

An

not

119–121;

cerebra

nerve.

cra-

eson

w

mdde

cause

not

gt.

te

(o

artery

te

obque

musces.

o

o

te

aqueduct

sup-

movement

bndness;

te

by

te

vson.

afected

was

aso

superor

n

et-

ntracra-

non-communcatng

nose.

ourt

percepton

te

woud

te

t

te

a

mdde

juguodgastrc

tonss,

gen-

o

875;

he

ar

drect

branc

extraocuar

responsbe

but

a

and

o

te

uncton

not

nerve

necton

te

nerve

s

suppes

nnervates

o

nerve

optc

nerve

anterosuperory;

musces

s

GAS

191.

aferent

no

te

cerebra

cerebra

ng

nerve.

te

ematoma

ret-

o

cerebra

n

ydrocepaus.

artery

o

Aneurysm

and

anastomoses

occuson

branc

te

E.

press

te

te

ydrocepaus.

motor

artery

and

ematoma.

Fracture

nterna

o

enarged

te

resut

o

n

rnorrea;

and

ocuar

centra

as

resut

mdde

artery

he

D.

35

o

to

o

w

menngea

musce.

29,

are

435

Neck

ncreased.

Laceraton

not

responsbe

oroparynx

bran

and

ydrocepaus.

C.

nerve

nerve

s

Obstructon

sub-

vson.

and

nerve

and

and

optc

based

It

centra

bnk

nasa

and

one

eyeba

nerves

te

te

Syvus)

passes

te

mxed

branc

tat

s

B.

B.

on

trocear

extraocuar

E.

te

or

cavty

he

te

a

etmoda

nerve

ces,

musce,

t

vson.

nasocary

te

t

o

pressure

dura

tongue

trgemna

cornea

anteror

mod

a

orgn

retna.

nerve

te

nerve

te

s

o

na

myoyod

beow

te

te

artery

oss

o

s

ABR/McM

sources;

n

nasocary

o

te

as

te

ventrces

excson

trange,

bers.

to

provdes

artera

resut

duct

o

angs

nerve

artery

We

durng

and

ne-

musce

trange.

o

70;

end

dvson

o

N

te

dgastrc.

styoparyngeus

ncudng

mc

mb

D.

te

suppes

oter

he

C.

to

and

vesses,

retna

artery

te

motor

one-trd

optamc

wc

wt

and

1089–1090;

carotd

usuay

wtn

nnervaton

nnervaton

te

o

myoyod

submandbuar

sensory

sensory

branc

damage

gand

gossoparyngea

ryng

o

or

a

te

undersurace

gand

myoyod

he

bey

rsk

te

mandbuar

GAS

at

suppes

submandbuar

orward

to

myoyod,

anteror

somewat

o

E.

te

nerve,

Head

7

GAS

Fig.

8.69

parotid

nodes

o

and

te

aspects

436

C H A P T E R

D.

7

he

Head

submenta

bateray,

E.

he

Fg.

192.

B.

nodes

ower

nasa

dran

p,

te

and

ymp

cavtes,

tp

loor

nodes

and

o

o

te

dran

audtory

tongue

te

constrctor.

mout.

te

tubes

naso-

o

(GAS

musces

preaurcuar

deep

parotd

parotd

gand

85–86;

ymp

nodes.

and

ABR/McM

nodes

hey

dran

are

are

32

aso

ocated

ymp

rom

known

deep

te

to

as

submandbuar

ceek

C.

he

a

te

A,

posteror

to

he

193.

D.

parotd

eyeds,

ay

909,

he

nodes

nodes

ymp

o

Fg.

superca

acoustc

GAS

o

o

te

te

nose

receve

te

sde

and

o

and

194.

ps.

dranage

ace

te

aso

te

B,

D.

o

rom

ora

dran

cavty

te

tp

anterory,

o

te

and

te

aspects

and

at

ymp

and

o

N

dran

te

nodes

te

nose,

85;

e

A.

E.

neror

tyrod

tat

b e twe en

Stas s

 e ad

h s

com mo n

to

s  te

s te

d ve r tc uu m

o

te

p ar yn ge a

mate r a s

w  tn

 nlamm at  o n,

s

a so

or

be caus e

known

as

n  ec -

K  an

A

jon

N

gand

88;

ABR/McM

vens

and

dran

oten

anteror

ven,

te

dvertcuum

s

most

key

trange.

tyrod

descends

may

Zenker

to

unte

te

atoug

rgt

49,

te

to

orm

tracea

te

rgt

bracocepac

60

neror

to

a

jon

neror

ven

aspects

mdne

te

et

tyrod

separatey .

he superor tyrod vens dran te superor aspects

o

superca

atera

and

ABR/McM

( Ze nke r)

te

por to n s

can

Kan

te

tyrod

anges

te

B.

he

o

mdde

tons

externa

te

o

gands

and

39–41

d ver t cu um

c r cop ar yn ge a

o

te

 n e r or

s

and

C.

jon

et

ror

ty -

s

E.

te

he

to

nodes

s

nterna

juguar

Occipital

nodes

vens

to

just

juguar

te

and

te

mdde

aso

ateray,

por-

termnate

superor

to

n

te

ste.

ven

orm

to

te

te

venous

vens

s

typcay

es

arc

o

rgt

vena

te

notc

and

o

o

te

supe-

bracoce-

cava,

wc

mdne.

connectng

varabe

source

wtn

te

superor

rgt

qute

a

ven

jonng

suprasterna

not

dran

gands

bracocepac

ocated

juguar

Mastoid

juguar

medastnum,

pac

par y nge a

vens

tyrod

nterna

he

usu -

tyrod

te

ncson

between

ropar yngea

ocat on .

abscess.

bracocepac

meatus.

par yngea 

mos t

vens bateray and superory to te ste o ncson.

parotd

gand

te

par y n ge a

weakn e s s

ts

1031–1034;

te

ven

dran

C,

he

8.75).

1027–1028;

ocated

nodes

and

occur

ven

loor

(GAS

te

te

superor

submenta

cn

to

aspects

dran

tonss.

he

tongue,

E.

atera

juguodgastrc

o

te

D.

and

nodes

nerent

n

s

a

trange.

te

GAS

he

o

dver tcuum

ton,

orbt.

A.

te

ts

N

hs

deveopment

8.69).

1027–1028;

he

te

te

Neck

retroparyngea

parynx,

GAS

and

te

es

te

anteror

just

superor

manubrum

concern



and

encountered

surgcay.

GAS

195.

C.

135,

he

158,

posteror

oyod

gament

ts

o

te

nerve

A

genera

posteror

rom

A.

te

he

by

trd

o

o

ts

sensaton

te

36–37

enters

between

gament

or

carres

trd

IX)

te

and

tongue

musce.

can

ready

nerve

tongue

and

coud

taste

sty-

compresson.

sensory

nerve

te

te

styoparyngeus

rrtaton

o

ABR/McM

(CN

coursng

te

nerve

eson

nerve

styoyod

by

posteror

parynx.

bot

215–216;

and

te

gossoparyngea

rom

N

oroparynx

Caccaton

afect

172;

gossoparyngea

and

te

cause

sensaton

he

bers

oro-

oss

rom

genera

o

te

sensaton

oroparynx.

vagus

nerve

sympatetc

carres

bers

sensory,

and

s

not

motor,

cose

to

and

te

para-

styod

process.

B.

he

and

D.

aca

s

not

nerve

cose

he

ypogossa

ton

to

te

carres

to

te

nerve

ntrnsc

motor

styod

and

provdes

and

sensory

bers

process.

motor

extrnsc

nnerva-

musces

o

te

tongue.

Submental

nodes

E.

T o

upper

deep

cer vical

he

GAS Submandibular

vestbuococear

about

nodes

earng

887–888;

N

and

nerve

carres

normaton

baance.

127–128;

ABR/McM

35–36

nodes

196.

Pre-auricular

and

parotid

A.

here

GAS

Fig.

8.75

a

eson

o

te

aca

nerve

(CN

VII)

prox-

nodes

ma

•

s

to

gon,

te

te

gencuate

greater

gangon.

petrosa

At

nerve

te

gencuate

brances

gan-

rom

te

CHAPTER

aca

nerve

gangon

gangonc

here

ts

be

and

s

a

te

gands

arses

tat

dsrupton

branc

tat

o

te

actors

nnervated

rom

te

aows

by

te

te

nerve

te

nto

to

C.

he

va

199.

greater

at

paatne

as

C.

he

mucous

te

he

te

te

to

te

te

nasa

aca

cavty

hs

pre-

at

pterygo-

acrma

carres

pexus

parotd

gand

and

nvoved

A.

he

to

te

gand.

It

otc

s

bers

atera

he

and

vdes

and

rom

cerebra

common

superor

artery

te

ste

to

woud

as

we

B.

as

te

opta-

It

and

skn

atera

C.

Leson

o

o

ore-

va

te

N

to

rom

just

te

ngua

oramen.

nerve

nnervaton

to

It

E.

pora

carres

te

two-trds

but

te

aso

pro-

GAS

200.

subngua

crce

(o

ABR/McM

artery,

Ws),

aneurysm.

and

compress

B.

ram

an

te

s

It

44,

a

te

es

up

mdde

nterna

cerebr a

carotd

and

ar ter y

s

most

he

carotd

cerebra

and

n ot

artery

suppes

C.

he

superor

E.

he

of

GAS

198.

E.

ore

cerebear

and

posteror

te

869;

he

may

artery

151;

woud

nto

be

B,

br anc e s

c os e

arses

te

to

te

known

as

conssts

are

te

o

te

he

duct

artery

tree

as

suppyng

styomastod

VII)

corda

to

be

descrbed.

te

aca

musces

nerve

oramen,

as

beow

nerve

proxma

woud

aca

savary

nerve

tympan

to

denervate

two-trds

orgn

o

subman-

gands.

proxma

woud

te

te

cause

o

te

to

a

te

oss

orgn

o

tongue

taste

on

te

o

te

aca

suppy

nerve

te

arsng

orbcuars

beow

ocu

te

tat

tem-

coses

135;

ABR/McM

aurcuar

second

nerve

and

s

44,

58,

derved

trd

85

rom

cervca

te

nerves

ventra

and

sup-

eve

and

te

optc

artery

o

cervca

te

temporomandbuar

branc

patysma

o

te

aca

jont.

nerve

nnervates

musce.

of

t e

we

D.

he

nter-

It

pareta

of

as

nerve.

te

It

teet,

provdes

te

skn

sensory

over

te

nnervaton

mandbe,

to

and

skn anterosuperor to te ear on te psatera sde.

op t c

te

brances

to

cerebear

s

neror

by

margna

motor

te

nerors,

depressor

and

branc

nnervaton

te

angu

mentas

o

to

te

te

ors,

aca

ower

p.

depressor

musces.

he transverse cervca nerve s a cutaneous branc

te

o

te

cervca

vaton

brances

mandbuar

suppes

nnervates

ab

casm.

a

67

te

GAS

Answers

ony

nasa

oca

etmoda

etmod

anteror,

te

unkey

ner ve

te

(CN

to

s

aca

gand.

te ceek skn and ora mucosa va te bucca nerve

te

rom

ronta

cose

ABR/McM

afected

D:

ner ve

ner ve

ater

te

ts

duct

meatus

tat

and

nlammaton

nor-

tere-

n

ts

201.

B.

to

te

943–944;

pexus

skn

N

9;

o

and

te

provdes

anteror

ABR/McM

sensory

cervca

nner-

regon.

29–32

201–225

he

pared

snus.

sets

mdde,

o

and

ces

he

sma

are

coectvey

etmoda

cambers,

posteror

snus

wc

etmod

ces.

supracavcuar

assocated

receves

te

and

o

acrma

n

regon.

A,

aca

aca

55

artery.

nasoacrma

drans

not

neror

vertebra

N

s

te

proxma

arse

te

51,

branc

he mandbuar branc s te argest dvson o te

E.

basar

a

trgemna

obes.

D.

max-

meatus

ts

as

o

te

nerve

anteror

na

te

te

casm.

C.

s

brances

anteror

N

great

he

as

he

he

nasa

eyed.

o

to

A.

drecty

aneurysm

casm,

58

porton

patent.

A.

te

subngua

te

bone

1095;

he

ces

sde.

Brances

at-

structure.

mdde

ABR/McM

te

aca

corda

te

te

petrosa

o

tympan

and

onto

etmoda

bone.

te

o

etmoda

dran

pes te skn over te ange o te mandbe and aurce

134–136;

casm,

key

te

gands.

ntracrana

te

rom

mastod

to

anteror

communcatng

optc

te

pror

rom

corda

pared

suppes

expresson

o

dbuar

provdes

greater

tempora

Leson

a

ner ve

of

nerve

te

ces

posteror

gangon

eson

aca

afected

styomastod

artera

o

te

te

conjunctva

nerve

bers

958–959;

anteror

te

o

nerve.

orgnates

aca

sensory

tongue

dervatve

a

aca

te

nvoved

cantus.

secretomotor

910,

to

tympan

te

a

trgemna

eyed

submandbuar

he

te

atera

o

ext

aferent

te

s

te

upper

corda

ter’s

o

nerve

o

he

n

nto

437

Neck

atus.

95;

comes

emerged

gangon,

not

s

petrosa

gencuate

te

nto

utmatey

branc

te

tympan.

as

para-

secretory

greater

te

nnervaton

segment

o

o

nerve

tympanc

branc

ead

GAS

petrosa

acrma

te

B.

gands

bers

serves

te

provdes

snus

N

open

etmoda

and

meatus.

drans

semunar

tat

o

serves

sensory

197.

wc

rom

and

acrmaton.

mc

E.

orgnates

gangon

parasympatetc

gangon,

esser

wc

D.

nerve

gencuate

and

nasa

maxary

snus

ces

mdde

bua

superor

te

he

snuses.

rom

n

petrosa

te

gangonc

nasa

D.

he

1066–1068;

ner ve

nerve

we

he

GAS

gangon.

B.

te

ary

tat

gencuate

etmod

etmoda

to

hese

tympan

to

te

stmu-

gands.

corda

dsta

nerve

anteror

nundbuum.

gand.

normay

subngua

he

post-

proxma

petrosa

woud

te

on

acrma

nerve

greater

and

pterygopaatne

synapse

te

aca

tat

va

aca

to

bers

nnervate

submandbuar

are

runs

pregangonc

neurons

stmuated

ate

utmatey

were

Head

7

up

wt

ymp

te

rom

gastrontestna

te

toracc

beow

tract.

duct

supracavcuar

ymp

Vrcow

or

ound

on

node

ymp

toracc

are

te

(GAS

on

he

te

known

to

ces

sgn

wen

8.196).

sde

s

duct

ncudng

tat

nvove

Hstorcay

Fg.

et

toracc

dapragm,

Magnant

node.

T roser

papaton

node

duct.

ts

trave

te

s

et

caed

enargement

s

438

C H A P T E R

7

Head

and

Neck

Right

inter nal

jugular

vein Left

Jugular

inter nal

jugular

trunk

Jugular

Subclavian

vein

trunk

trunk

Subclavian

trunk

Left Right

subclavian

Right

subclavian

lymphatic

duct

Bronchomediastinal

Right

brachiocephalic

Bronchomediastinal

Superior

trunk

vena

brachiocephalic

•

and

C.

he

deep

cervca

ymp

nodes

GAS

receve

Fig.

duct

8.196

a Phar yngeal

ymp

dranage

rom

te

ead

vein

cava

Thoracic

te

trunk

vein

Left

A

and

neck

branch

Vagus

or

ndrecty

va

te

superca

ymp

eferent

ympatc

ror

D.

deep

he

vesses

trunk

cervca

rgt

he

GAS

E.

ungs,

te

tongue,

136–137;

he

oten

nterna

caed

N

te

cest

ymp

te

rom

o

nterna

te

node

on

nodes

tonss,

ABR/McM

branc

orm

ymp

te

paatne

85;

to

vesses

jugular

vein

ganglion

juguar

te

supe-

nodes.

and

juguodgastrc

rom

202.

ymp

wt

supracavcuar

esopagus,

E.

converge

togeter

[X]

nodes.

Inferior

her

ner ve

eter Inter nal

drecty

vein

vein

drans

te

rgt

receve

and

te

sde.

ymp

parynx.

30

superor

aryngea

aryngea

nerve,

nerve,

suppes

te

mucosa o te arynx above te voca ods (wc ncudes

te vestbue o te arynx) and te prorm recess.

A.

he

externa

nerve

nnervaton

ryngea

B.

he

o

C.

to

arynx

o

te

aryngea

te

superor

nerve)

crcotyrod

constrctor

neror

te

he

branc

(externa

aryngea

provdes

and

motor

neror

pa-

musces.

aryngea

beow

nerve

te

gossoparyngea

suppes

voca

nerve

te

mucosa

ods.

(CN

IX)

suppes

senInter nal

saton

to

te

posteror

trd

o

te

tongue

and

exter nal

te

D.

oroparynx.

he

ypogossa

and

nnervates

te

GAS

D.

A

and

A

N

and

A

a

key

E.

Fg.

wc

s

Wereas

s

a

motor

muscuature

nnervated

a

ABR/McM

bone

egt

and

by

myocarda

te

48,

suggests

accompaned

possbtes,

XII)

nerve

except

by

te

branches

superior

lar yngeal

ner ve

or

vagus

8.173).

yod

rom

be

(CN

tongue

141–142;

ractured

C.

man

(GAS

1057;

woud

a

paatogossus

nerve.

203.

of

nerve

and

to

subdura

ractured

narcton

medca

Cardiac

84

stranguaton.

ematoma

bones.

or

examner

branch

B

poson

woud

Carotid

re-

body

Exter nal

a

g

ndex

o

suspcon

or

stranguaton

because

o •

te

ractured

GAS

833,

yod

837;

N

bone.

53,

68;

ABR/McM

31,

33

branch

ave

GAS

Fig.

8.173

carotid

ar ter y

CHAPTER

204.

C.

Meanocytes

are

a

potenta

he

tumor

bran

A,

as

D,

and

B,

GAS

205.

B.

A

ond

N

It

te

and

n

E.

A

32–33,

B.

yod

te

ra

to

te

n

structures

te

o

o

snus

aong

te

to

te

sec-

obt-

or

snuses

o

open

te

anteror

to

 ro m

c re s t

or

resuts

rom

branca

o

te

B.

Frst

C.

aryn-

C

retenton

cets

2–4,

o

t   rd

o

because

and

poor

o

s

n

a

te

norma

o

rst

and

o

and

d e ve  -

A.

Howe ve r,

o

neu-

par yngea

mandbuar

eart

arc

deveops

nto

te

rom

te

ayer

he

he

pouc

orms

te

o

te

tymus

and

211.

D.

N

E.

p

n

te

to

use.

paatne



on

tere

cet

and

o

C.

GAS

A.

s

A

and

te

844;

Se v e re

paratyrod

wt

 rom

he

B.

as

s

te

o

deec-

sxt

week

body.

eye

orm

processes

between

o

musce

te

ncudng

rst

te

te

corod,

nvoved

ayers

retna

n

te

o

te

optc

detacment.

ABR/McM

njure

79

attaces

to

te

temporomandbuar

condye

te

te

and

musce.

atera

as

he

artc-

jont,

suc

any

musces

pterygod

paryngea

pouc

cet

orms

gves

arc

N56–57,

o

musce

o

are

arc.

rse

te

to

tonsar

te

snus.

externa

acoustc

gves

rse

to

te

musces

o

aca

59;

ABR/McM

bdum,

te



te

ventrcuar

42–44

protrudng

system

te

bran

con-

condton

s

menngoydroencepaocee.

a

It

s

crana

menngocee

encepaocee

prom nen ces

te

 a s

we reas

 us  on

 a ure

b ot



me d a

o

21,

52;

o

neura

nasa

te

n

conjuncton

C.

promnences

ABR/McM

bda

because

tube.

wt

o

types

26,

72;

te

o

oten

act

descends

te

nonuson

Anencepay

s

tey

duct

poyydramnos

seen

because

o

o

he

B.

he

o

s

t

a



ony

contans

an

te

bran

ony

cysts

nstead

mennges

matter

as

te

and

and

woe

bran.

ead,

beow

cet

mdne

o

o

wc

te

duct

n

usuay

s

tongue

may

te

yod

structure

aure

o

tyrogos-

prmordum

te

ound

s

te

he

gand

aspect

usuay

just

wc

bran.

duct.

tyrogossa

are

a

sma

because

tyrod

paryngea

oter

o

n

unctonng

93

are

posteror

he

deect

mnor

sma

tyrogossa

wc

neck

tube

or

abnormay

ABR/McM

ocaton.

second

an

duct

te

cysts,

bran

abnormay

ormed

te

neura

present

s

te

rom

orm

A.

to

persst

medan

bone.

obterated.

te

oramen

cecum, wc s a persstence o te proxma part o

deects

usuay

s

usua

and

a

o

307;

obteraton

sa

assocated

tat

N

orm

14

a re

resut

n as a

orm

tssue

hyrogossa

pane

spna

d    e re n t

n

GAS

212.

a

s

rudmentary

Mcrocepay

s

c et

s  de s .

 or mat o n

p roces s es

E.

w t

b ater a

te

n as a

 use

a

neura

m ax   ar y

to

on

o

rom

 ater a

Meroencepay

ony

ts

meda

cases

rom

o

s  de



segment.

anencepay

occur

not

mandbuar

second

part

It

mes enc y me

max  ar y

s e gm e n t

D.

te

occur s

s e gm e nt,

a  ure

o

nose.

he

N

an d

af e c te d

occurs

ntermaxary

208.

because

ernate.

C.

 a ure

cet

te

ntermaxar y

aa

te

s

durng

cooboma.

w

cranum

known

14

o

nasa

Unatera

processes.

B

resu  t

meda

Medan

te

a

ntermaxar y

occurs

te

ABR/McM

s

promnence

te

retna

mennges.

234–235;

Cet

nonuson

endoteum.

pterygod

te

rom

93

cary

congenta

te

rst

966;

In

gands.

207.

to

second

he

A.

ormaton

ead

amnotc

expresson.

he rst, second, and trd arces are not nvoved

te

te

meatus.

tans

paryngea

o

rom

D.

maxary

germ

com-

absorpton

condtons

n

occur

ssure

te

102–103;

ere

not

and

n

are

a

capsue

neck

GAS

mesoderma

N

dsc,

B.

a rc 

processes.

derves

Tese

eves

and

or

he rst pouc gves rse to te tubotympanc recess.

E.

paryngea

he

n

hese

atera

derved

ces

cornea

o

do

retna

nvove

crest

mastcaton

ypocace-

ack

ntate

ud

439

Neck

tube.

rs

adeson

936;

damage

te

te

may

eads

he

pouces

re s u  t

t   rd

ormone.

C.

uar

tons.

E.

o

D.

cup

hese

ABR/McM

o

and

Weak

 a   u re

T- c e  

and

because

 n vo  ve m e n t

as

nto

mmunty

p a r a t  y ro  d

o

our t

gands

mgraton

Ab s e n c e

to

second

and

E.

neura

307;

cosure

and

E.

210.

occurs

te

c re s t

and

he

N

Neura

not

ces.

D.

te

scera,

d e ve  o p m e n t .

A.

and

n

72;

e

ound

32–33

p a r a t  y ro  d

dmorpsm

ce

D,

Cooboma

GAS

o

and

ack

aca

snus

s y n d ro m e

eads

A.

tve

usuay

and

tract.

apa-etoproten

patogeness

ABR/McM

neura

C,

GAS

209.

neror

are

neck

to

amnotc

and

ud.

sternocedomastod.

pane

or

aure

contro

o

gastrontestna

g

deects

cervca

neuroogc

s w a   ow  n g

te

to

sted

o

pete

pouces.

pouces.

opment

ma

te

cysts

paryngea

91;

o

our t

ack

ces.

79

rom

border

branca

tymus

 a   u re

drecty

oter

anywere

medan

d    e re n t  a t  o n

nto

te

and

opens

te

D Ge o r g e

o

o

resuts

duct

te

o

paryngea

206.

retna

cartages.

porton

N

te

B,

groove

anteror

beow

gea

a

snus

hyrogossa

just

o

meanoma

prognoss.

ABR/McM

typcay

o

poor

None

103;

branca

ound

C

E.

ayer

magnant

ematogenousy

very

paryngea

trd

D.

a

pgmented

o

meanocytes.

936;

erate.

te

spreads

and

contans

n

source

Head

7

te

D.

tyrogossa

he

trd

duct

and

paryngea

paratyrod

gands

and

s

above

pouc

te

te

yod

orms

tymus.

te

bone.

neror

440

C H A P T E R

E.

he

7

cervca

2nd,

GAS

213.

A.

3rd,

1009;

he

and

N

rst

oaca

wc

bra

and

snus

and

Neck

s

4t

71,

77;

o

neura

s

ssures,

arc

crest

ces

o

te

mergng

o

te

D.

Eary

rse

to

ere

te

or

eads

Cons

maxary

nsuicent

to

syndrome)

eyeds,

N

216.

mandbu-

down-santng

ower

and

n

111;

C.

In

o

te

C,

te

D,

N

71,

and

77;

E.

hese

o

te

arces

are

maxary

rupture

trast,

ayer

he

and

externa

A.

not

nvoved

and

E.

rom

B.

he

B,

a

Caput

911–914;

he

T .

N

te

eyes

111;

gondii

and

n

nects

(cororetnts)

Feta

deat

eary

stages

may

In

s

con-

E.

pasa

Rubea

suc

dac

s

o

N

217.

cepaoe-

n

te

as

vrus

s

great

s

edema

o

te

teet

decency.

dorsa

nto

ventra

n

te

regon

regon

neror

orms

te

te

mucosa

o

te

lud

to

causng

pacenta

n

menta

and

s

destructve

caccatons)

wt

o

C,

te

D.

caccaton,

wt

s

durng

te

most

Most

menta

de-

common

n

rst

approx-

wen

trmester.

may

IUGR,

resut

n

durng

eta

218.

13;

end

te

deaness,

Prmary

B.

7

and

hese

ts

great

and

brt

sxt

n

te

te

second

o

teet

terapy

or

age;

and

durng

permanent

trd

ence,

cdood

aso

yeow

dmnsed

te

te

stes

may

ypopasa),

o

and

at

moars,

ong-term

can

afect

te

vrus

wt

varous

growt

te

symp-

cataract,

anomaes

retardaton,

car-

mcrocepay,

mcroptamos,

retnopaty,

menta

de-

epatospenomegay,

deects.

(German

suc

meases)

as

IUGR,

and

great

s

a

potent

eature

mbs)

sort

necton

brt

epatospeno-

teratogen.

s

he

meromea,

(absence

stages

to

cataract,

retnopaty,

deects.

amea

ntermedate

wt

growt

abnorma-

deaness,

beedng,

toot

rom

assocated

postnata

pgmented

neonata

and

s

vesse

sensorneura

gaucoma,

range

and/or

wt

abnormates,

toot

presentng

tama,

assocated

beedng,

cardac

severe

not

62

sma

CMV

te

membrane

and

teet,

except

years

vesse

and

cerebra

n

te

durng

neonate

troug

C.

o

deaness,

(rudmentary

neary

n

buds

pregnancy

ename

pgmented

hadomde

deects

materna

8

o

assocated

osteopaty,

severe

bones

postnata

decency,

terstc

pacenta

Caccaton

are

s

mcroptamos,

A.

o

case.

anomaes

CMV

ate

rom

T etracycne

and,

to

mcrocepay,

megay,

derved

te

(e.g.,

IUGR,

retardaton,

menta

s

monts

brt

vrus

as

Rubea

appear

endoderma

embryo’s

bones.

cerebra

pregnancy)

necton

te

ABR/McM

varous

mcroptama,

mcrocepay,

decency,

vra

pregnances

(mscarrage)

te

E.

n

osteopaty,

N

aggregaton

tongue.

46

crosses

terapy

Rubea

tes,

occurrng

bndness,

serous

mcroptamos,

epatospenomegay,

pregnancy

(acqured

car-

an

te

teet.

cency,

mcrocepay,

rom

tons

sensorneura

anomaes

deects.

etus,

menta

and

seen

dac

ypo-

retardaton,

retnopaty,

epatospenomegay.

cause

varous

cataract,

ncudng

cororetnts,

pregnant

and

by

gaucoma,

growt

aborton

n

teet

abnormates,

neonates.

ater

deects,

staned

a

at

o

pouc.

nnt

ong

rom

root

gands

dscooraton

o

begns

toms

te

stomodeum.

deects

compete

baby.

beedng,

te

o

to

to

toot

brown

A,

n

caccaton.

ourt

permanent

decency,

durng

n

tetracycne

and

ydrocepay.

especay

te

ABR/McM

growt

ces.

deveops

deveop

paatne

actve

teet

te

hey

o

suc

er

CMV

necton

deects.

te

deveop

tons

nodues

deposted

te

5

tetracycne

toot

occurs

aways

resut

deaness,

wt

and

we

nodues

T etracycne

o

ormaton

bones.

crosses

etus,

postnata

and

1%

nectons

o

crana

necton,

vesse

spontaneous

pasy,

coecton

te

assocated

necton

brt

n

neonata

necton

n

tat

pgmented

osteopaty,

Inecton

a

o

te

o

IUGR,

gaucoma,

matey

s

ABR/McM

assocated

sensorneura

cency,

88;

B.

cause

(ntracrana

oow

ename

and

gand

paryngea

aponeurotc

n

he

em-

pregnancy.

Admnstraton

woman

materna

abnorma

menta

dferentates

submandbuar

loor

emorrage.

mcroptama,

o

and

epteum

pouc

mesencyma

week.

by

compcatons.

nes

nvoved

organsm

bran

mcrocepay,

C.

not

te

more

suture

subgaea

are

perosteum

canges

B.

n

succedaneum

te

untreated

34

week,

ngua

he

te

bones

emorrage

and

wt

cross

crana

perosteum.

perosteum

not

hese

membrane

A.

te

between

cepaoematoma.

GAS

E.

o

te

extensve

does

C.

emorrage

crossng

te

does

but

and

D.

s

(subaponeurotc)

more

sweng

above

215.

vesses

s

trd

Lymp

n

mandbuar

49

perosteum

between

and

matoma

o

te

subgaea

orrage

A,

ABR/McM

o

t

ymp

Cepaoematoma

cranum

ydrocepaus,

ABR/McM

te

o

deaness,

respratory and amentary systems and are derved

ormaton

D.

bones,

congenta

tymus.

promnences.

214.

manestatons

are

paratyrod

pape-

deormtes.

B,

eta

syps

and

Faure

ypopasa,

deects

te

grooves.

60

gves

(T reacer

maar

by

ABR/McM

promnences.

dysostoss

tere

ormed

paryngea

paryngea

mandbuar

mgraton

ear

Head

o

carac-

but

o

te

mbs)

deveopment

mcromea

(abnormay

mbs).

ater

deects

n

pregnancy

suc

cororetnts,

as

may

IUGR,

bndness,

resut

mcrop-

mcrocepay,

CHAPTER

D.

cerebra

caccaton,

cerebra

pasy,

he

efects

ton,

o

T .

and

gondii

brane

and

canges

and

cocane

eyes

D.

te

bran

etus

te

pacenta

causng

tat

N

222.

mem-

destructve

resut

n

219.

103;

E.

In

T reacer

dysostoss),

nant

opment

eyeds,

o

s

o

cear

s

te

te

tat

syndrome

22;

D.

ears,

and

s

bones

ssures,

externa

mdde

no

menta

GAS

220.

D.

rom

ca

1063–1065;

autosoma

o

parts

snus,

cysts,

o

or

te

te

22;

te

nterna

externa

ace)

o

te

sometmes

ears.

From

acoustc

ABR/McM

snuses,

second

second

he

and

3,

paryngea

B.

he

te

C.

second

wt

o

ower

tymus

paryngea

ormed

gea

E.

An

abnor-

te

B.

E.

942,

In

may

pouc

n

Cons

te

o

te

Perre

s

dbe,

cet

Patents

out

a

s

te

a

to

te

paate,

wt

ourt

to

E.

ectopc

ganduar

o

mcrocepay,

and

wen

ears,

GAS

o

B.

rom

are

sort

o

ts

an

are

te

ste

te

o

A.

o

C.

dom-

troug

menta

membrane

It

to

s

comes

dvson

te

D

wt

o

te

syndrome

ower

In

ssure.

and

some

ear.

wt-

ave

cases,

ound.

menta

anomaes,

man-

and

born

gands

tracts.

been

eye

are

jont

N

aca

decency,

abnorma-

o

s

C3

we

a

a

te

te

te

te

ner ve

o

te

mdne,

branc

of

o

rom

and

spna

as

te

branc

o

nerve,

and

te

nerve

te

te

o

te

posteror

trgemna

mandbuar

great

aurcu-

nerves,

nnervate

overyng

te

wc

mucosa

skn.

anteror

dv-

suppes

nng

s

te

te

parasympatetc

to

te

parotd

nerve

exts

vscera

gossoparyngea

upper

te

ora

and

motor

nerve

bers

(CN

rom

te

gand.

nnervates

p,

te

117–119;

part

(sensory)

o

nraorbta

not

te

nasa

oramen

te

ves-

o

te

hs

and

224.

sensaton

gangon

E.

he

are

rom

te

ncudng

brances

moda

ossa

upper

N

scap.

9,

d,

eye,

rom

va

part

rom

n

te

suppy

(anteror

vaate

te

papae,

mandbuar

(wt

ce

responsbe

ts

o

two-

s

by

dvson

bodes

n

te

or

te

taste

sen-

case.

and

presynaptc

tympan

132–134;

pterygopaatne

parasympatetc

and

greater

ABR/McM

nerve

CN

te

V1)

carres

ax

gand.

nasa

cerebr,

superor

o

part

o

te

and

It

petrosa

dura

o

n

te

nose,

orbta

te

anteror

are

sensory

snus,

anteror

te

contents,

tentorum

nerve

o

brances

receves

ronta

and

nerves.

51

dvson

sensory

aso

cavty,

optamc

nasocary

44,

(optamc

conjunctva,

dorsum

and

n

acrma

Brances

ronta,

sensory

ora

te

bodes

respectvey.

nerve,

te

s

not

corda

ces,

and

o

nerve

te

Optamc

trgemna

te

submandbuar

were

synapse,

rom

s

descrbed

958;

o

tympan,

ce

gangon).

nerves

he

ter

genera

regon

trgemna

bers

C.

ave

17

corda

nerve.

Genera

te

te

va

he

membrane

but

s

wc

gangon.

ngua

ABR/McM

sensaton

nerve,

mucous

GAS

te

as

ceek

pexus

taste

ganga

abnor-

recessve

nerve,

nerve,

and

petrosa

and

saton

ears.

o

te

trgemna

ace)

sometmes

ypopasa

as

24

(underdeve-

te

autosoma

IUGR,

papebra

17,

deects

paratyrod

ocuar

cn.

wc

mandbuar

eyed,

gencuate

tyrod

autosoma

and

deects

tssue

11,

nerve

nraorbta

904;

he

te

(mandbuoaca

an

nterna

outlow

FAS

vertebra

maxa.

paryn-

te

C2

seat

carryng

tbue

wt

par

o

te

esser

he

tym-

gands

pars

ypopasa

wt

and

cardac

by

ssures,

and

and

n

Symptoms

resuts

bones

DGeorge

tymus

te

trgemna

rom

tympanc

223.

trd

o

over

IX),

tube.

assocated

te

syndrome

sequence,

deects

tes,

o

he

cerv-

tons.

ABR/McM

externa

assocated

o

troug

vestbue.

o

maar

mdde

pass

he

oramen

mandbuar

bucca

skn

deveop

audtory

competey

caused

papebra

Robn

dsorder,

s

o

ner ve,

component

tat

paratyrod

and

zygomatc

deormed

mates

C.

s

rom

gand

87–89;

tere

o

down-santng

B.

trd

descend

wc

te

mucous

menta

aurcuotempora

son

tongue.

N

mm

cervca

vesses

mandbe.

and

skn

parotd

trds),

to

960;

gene,

opment

A.

te

te

T reacer

eyeds,

pouc

he

rse

and

paatne

derved

tyrod

as

dysostoss),

nant

o

he

CT

pouces.

orgn

221.

te

pouces.

rom

ectopc

gand

GAS

s

o

te

bers

te

17

groove,

gves

antrum,

paryngea

deveopment

he

pouc

mastod

te

5

ar nerve, a branc o te cervca pexus composed

meatus.

12,

stuas

paryngea

paryngea

cavty,

dspacement

tan

nto

and

te

te

aveoar

ower

rst

panc

n

skn

rom

dvson

obterate.

A.

te

p

he

(underdeve-

deects

and

A.

dom-

C.

N

neror

13

ner ve

oramen

neror

syndrome.

Cervca

menta

ncudng

and

A, B, C, and D. hese are not assocated wt T reacer

Cons

s

more

magnum

ABR/McM

he

ower

(mandbuoaca

an

ypopasa

zygomatc

tere

by

maar

papebra

tonss

441

Neck

ner ve.

caused

s

deormed

mates

t

Cons

tere

down-santng

oramen

suppes

52–55

wc

gene,

te

dvson

ABR/McM

maormaton

cerebear

menta

caccatons)

mcroptama,

I

te

and

cana.

neurobeavora

(ntracrana

mcrocepay,

abor-

ydrocepay.

N

Car

cerebra

abnormates.

crosses

(cororetnts)

decency,

spontaneous

anomaes,

organsm

te

deaness,

mcrocepay,

neuroogc

nects

n

decency,

ncude

IUGR,

urogenta

dsturbances,

he

menta

epatospenomegay.

prematurty,

narcton,

E.

and

Head

7

cerebe,

part

te

et-

crana

o

te

acrma,

442

C H A P T E R

A,

B,

7

D,

dbuar

rom

D.

and

904;

he

70;

by

GAS

C,

nerve

carry

te

nerve

A

and

and

E.

are

N

and

man-

pexus,

normaton

35

(CN

nus

XII)

passes

musces

supped

o

by

ypogossa

ncude

te

o

musces

musces

w

not

ABR/McM

be

genogos-

29,

afected.

te

A,

228.

35

and

one

C,

226.

C.

ts

GAS

29–31;

C.

he

to

Superor

nuceus)

nerve

o

savatory

te

nuceus

Pregangonc

nuceus

VII

to

axons.

te

sa

and

nerve

te

ocated

hen

(va

cana)

te

and

corda

o

he

tympan

ts

te

aso

to

te

trave

oter

nerves

to

w

and

to

te

te

s

gossoparyngea

B.

he

or

dorsa

va

o

B.

va te

te

parasympatetc

nput

vagus

to

s

te

abdomen

and

E.

D.

he

parasympatetc

and

E.

te

he

cary

nuceus

tat

te

onc

to

rs

responsbe

spncter

or

contans

musces

paate.

It

parasympatetc

n

te

aso

motor

musce

ar ynx,

contans

neurons

tat

neurons

par ynx,

pregang-

nner vate

te

eart.

GAS

227.

D.

to

923;

he

as

te

GAS

A.

N

147–150;

toracc

Obstructon

ABR/McM

toracc

net

actuay

54–56

aperture

as

we

occurs

as

s

pan

cary

te

outsde

reerred

toracc

te

outet.

aperture

n

te

ngua

to

te

It

suppes

wt

to

ower

cm

te

connecton

rb

rst

te

may

rb

extendng

eevate

and

rom

structures

pace

subcavan

upper

(extra

pressure

artery

or

mb

troug

cervca)

ts

tp

to

normay

on

tese

neror

rb

te

ts

or

a

rst

yng

o

toracc

above

structures,

trunk

aper-

brous

te

te

notaby

braca

s

eye

CN

open);

(droop-

III

causes

responsbe

te

a

ora

or

mucosa,

gand.

sensory

gangon

o

contans

bers

or

taste.

s

a

by

rom

bers

bers

te

te

B,

n

o

te

te

ngua

mout.

parasympatetc

o

C,

D,

rejon

he

and

909,

E.

GAS

t e

by

b ase

te

gan-

pup

and

ty mp an

he y

o

w c

re ay

gand ,

and

  n gua

s a  var y

as o

loor

n

s k u,

te

o

he

are

s

n

dee p

to ngue

med-

s e cre to -

g ve n

of

s us pe nd e d

te

 or

te

g an g on

pos tgan -

tr ans p o r t

lo or

supp e s

te

tym -

mus ce .

atter

s om e

ne r ve

g and s

ne r ve

te

o

te

tymp an .

gan g on ,

co rda

p te r y go  d

tas te ,

c ord a

33

te

tw o-trds

c ord a

te

te

o

 ater a

an d

ng ua

gngva

ABR/McM

jo ne d

te

ner ve .

membrane

ngua

GAS

o

submandbu  ar

mucous

te

s

submandbuar

te

te

85–87;

anter  or

sub ngua

te

s

to

constrcton

sensat on

to

nvove

or

be  ow

border

genera

te

or

2

N

et

supernumerary

and

ner ve

bers

A

mantans

ptoss

subngua

gangon

gangon

gonc

syndrome

te

da-

constrc-

tat

te

gangon

and

te

tereore

pupar y

te

and

sympa-

nerve.

root o te neck, and te manestatons o toracc out-

ture.

nner vate

pupae);

o

con-

erec-

8.194).

gangon

responsbe

about

motor

varaby

Parayss

Fg.

and

(pomotor),

par ta

o

pexus.

Postsynaptc

nnervaton

sensaton

1027–1029;

he

ated

superor

d).

( GAS

number

contrbutes

stmuate

(odng

causes

anteror

neurons

cer vca

musce

es

and

accommodaton.

229.

ambguus

sot

te

s

musce.

nner vate

and

nput

nuceus

upper

d

a

(vasomotor)

aso

te

to

It

ar ter y

and

aso

te

(dator

upper

cranum.

bers

compete

gencuate

gon

Ednger-Westpa

te

trgemna

he

te

assocated

contans

ars

cranum

rs

causes

ptoss.

somatc

torax.

not

carotd

and

to

wt

nner vates

trgemna

he

responsbe

o

weakness

71

te

It

ead

vesses

submandbuar

he

D.

te

te

te

submandbuar,

or

are

seat),

(sudomotor).

parasympatetc

nerve.

nuceus

te

he

scae-

medus).

tngng.

nterna

sympatetc

bood

n

aso

compete

A.

te

and,

nner vaton

te

assocated

o

o

musce.

o

o

n

dscooraton

ABR/McM

(carotd

compresson

gands.

responsbe

te

tereore

ng

sub-

It

o

eevaton

savary

parasympatetc nput to te parotd gand

te

compresson

hereore,

reduced

o

musce

ton.

and

base

communcantes

bers

nose,

te

ven

postsynaptc

musces

tor

subman-

to

ram

at

wtn

tetc

party

etooges

scaenus

oter

symptoms

sympatetc

organs

as

te

te

musces,

capts

sweatng

gan-

ncude

tan

119–122;

cause

te

subngua

nuceus

tor

(e.g.,

scke-saped

hese

es

petro-

pregangonc

gand.

be

pass

N

juguar

tracton

nnervate

o

bers

subngua

patent

motor

known

gands

he

arm

seat

suppy

gray

abnormates

a

coder

E.

ongus

target

te

bers

dstrbuted

ngua

savatory

wt

greater

aso

bers

submandbuar

neror

te

postsynaptc

and

n

pons

rom

Oter

condton.

SCG

te

tat

crana

pterygopaatne

mucosa

are

and

va

te

wereas

and

gand

rom

te

te

cana,

n

savary

tegmentum.

arse

pregangonc

eferent

bers

gangon,

secreton

pontne

ext

te

superor

vsceromotor

bers

gangon

and

parynx,

symptoms

to

synapse

gand

mandbuar

(or

a

te

pterygod

and

Postgangonc

dbuar

A.

ateray

some

parasympatetc

oter

n

s

parasympatetc

pass

acrma

paate,

te

nuceus

nerve

pterygopaatne

Vdan

gon.

aca

symptoms.

symptoms

and

and

wt

deep

226–250

muscuar

and

and

B,

nterna

Answers

cause

musce,

common

ands,

tongue,

tongue

may

anteror

Most

troug

te

te

Extrnsc

nerve

70;

and

coud ncude an eongated transverse process o te C7

styogossus.

hese

1089–1091;

V2)

vertebra

29,

te

ypogossa

(CN

sensory

ace.

paatogossus).

yogossus,

B,

o

extrnsc,

(except

supped

A,

V3)

ABR/McM

cana.

and

Neck

Maxary

(CN

ypogossa

ntrnsc

sus,

and

regons

N

ypogossa

nerve

E.

nerve

oter

GAS

225.

Head

a

mo ut

o

te

an d

(gum s ).

hese

nerves

1027–1029;

are

N

not

91;

nvoved.

ABR/McM

39–42

CHAPTER

Superior To

Head

7

and

443

Neck

cervical

internal ganglion

carotid

plexus

C2 To

carotid

body

and

sinus

Gray

rami

communicantes

C3 To

external

carotid

plexus

Superior

cardiac

C4

nerve

C5 Gray

ramus

communicans

Middle

cervical

Inferior

ganglion

C6

cervical

C7

ganglion C8

Middle

cardiac

nerve

Inferior

cardiac

nerve

Ansa

•

230.

E.

Perneura

aong

a

s

metastass.

mony

ound

In

case

ts

te

oramen,

IX),

vagus

IX

A,

B,

son,

mb

C,

s

XII,

Bood

ects

VII,

he

cranum.

an

V ,

occurs,

ness)

nerve)

o

s

more

bengn

tssue

at

nerves

woud

be

motor

mb

a

te

he

N

w

94;

and

de

are

he

IX,

jugu-

D.

by

E.

ABR/McM

troug

he

GAS

232.

A.



coma

te

(GAS

s

o

crana

61

135,

a

(oss

o

and

dura

bow

ten

co-

te

rom

to

te

orms.

conscousness)

o

(proound

s

or-

menngea

dura

te

ard

nterva

n

spnosum

te

some

ours.

unconscous-

not

reeved

te

8.47).

ocated

bone.

he

hus,

body

te

greater

accessory

wng

menngea

nerve

artery

175;

N

pass

troug

ts

to

ts

troug

nerves

te

te

ypo-

arger,

by

sape

and

te

te

o

te

ens.

te

o

ens

va

gets

eye

dspaced

by

nerve,

te

wtn

In

cary

absence

reaxed

or

ar

or

o

o

muscu-

vson.

ocuomotor

contracton

at-

CN

trocear

te

te

latter

tcker

te

unopposed

te

te

36–37

movements.

abducens

dameter

ens

n

musce

spncter-ke

musce

pass

suppes

eye

(nnervated

(CN

causes

III)

resut

te

o

makng

cana

ABR/McM

(CN

a

cary

te

pterygod

resuts

as

obque

he

te

controng

nerve

(nnervated

IV).

o

stmuaton

ary

crana

oramen.

acerum.

Parasympatetc

III)

te

ts

215–217;

downward

superor

s

and

passes

nerve

musces

stmuaton,

rng

ven

troug

oramen

te

and

CN

nerve

te

near

c-

vson.

hese bers aso nnervate te spncter pupae. hus,

nterrupton

o

tese

bers

causes

daton

o

te

pup

because o te unopposed acton o te sympatetcay

nnervated

motor

on

o

canges

nerve

ar

158,

rectus

and

pass

and

te

damage

nerve,

juguar

XI

ocuomotor

outward

VI)

artera

ematoma

pressure

Fg.

ovae

spenod

ucd

expres-

by

ven

cana.

nerve

he

era

mdde

strps

oows

concusson

and

a

ayer

bood

ts

a

o

s

oramen

(epdura)

by

49,

emorrage

perostea

aca

medated

emssary

ypogossa

troug

CN

X

and

gossa

he

CN

an

nterna

X,

he

(CN

respectvey.

brances

Usuay

oramen

te

VIII

extravasated

bre

movements,

earng

torn

oowed

occur,

C.

because

by

and

oramen.

com-

XI).

afected

predomnanty

and

artery

o

esons.

te

(CN

8.194

tumor

orms

gossoparyngea

accessory

(epdura)

drowsness

patent

o

tan

aong

te

relex)

and

extradura

T ypcay,

Later,

spreads

T ongue

passes

between

ead;

spread

rater

medated

and

rom

wc

cavara.

te

D.

1031–1034;

artery

o

spread

nsdous

Fig.

majorty

and

Extradura

gn.

orm

and

(gag

(or

more

nerve).

nerves

B.

X),

sensaton,

GAS

tumor

te

nvovng

(gossoparyngea

(vagus

A.

hs

tumor

relex

sensory

a

o

magnant

tus

(CN

paryngea

te

n

o

one

tumor

ar

231.

spread

nerve)

GAS

subclavia

eson

dator

nerve

tere

cannot

rase

pupae

suppes

causes

te

te

musce.

evator

parayss

superor

o

eyed

Because

papebrae

te

musce;

(cannot

te

ocuo-

superors,

te

open

a

patent

te

eye).

444

C H A P T E R

Parta

tarsa

B.

7

Head

ptoss

s

musce,

and

reated

wc

s

Neck

more

to

parayss

sympatetcay

o

te

superor

C.

nnervated.

he optc nerve carres sensory bers rom te retna.

Connected

as

a

rom

contains

te

sagittal

s

aca

responsbe

expresson

anteror

two-trds

or

and

o

controng

taste

te

Emissary

Diploic

the

vein

scalp

vein:

into

can

the

spread

cranial

tongue.

infection

from

cavity

vessels Neurovascular

bundle

scalp 3

Aponeurosis

Skin

Subdural

hematoma

1

Periosteum

Extradural

hematoma

Fracture

2

III

Outer Diploë

IV

table Inner V

1

table VI

V

2

Bone Arachnoid

Subarachnoid

space

Periostial

layer

Meningeal

layer

Pia Dura Cavernous

Anterior

cerebral

sinus

Internal

carotid

artery

4

artery Optic

1

Loose

connective

•

In

scalping

•

Infection

•

Blunt

2

Rupture

results

3

Tear

to

can

trauma

forward

into

of

in

easily

can

the

the

a

hematoma

thin

is

is

the

spread

result

middle

cerebral

(danger

this

face,

extradural

separates

4

tissue

injuries,

in

in

this

where

layer

covered

in

meningeal

hematoma.

vein

of

an

which

it

artery

crosses

inner

in

“black

Under

meningeal

by

in

separation

occurs.

layer.

hemorrhage

resulting

tracts

area)

layer

this

layer

(branches)

dura

to

from

limiting

can

spread

eyes”).

pressure,

dura

(blood

by

the

enter

that

fracture

blood

cranial

which

membrane

of

the

inner

table

of

bone

progressively

separates

venous

can

remains

derived

sinus

attached

from

part

of

to

the

result

the

dura

in

from

the

subdural

periosteal

meningeal

bone.

hematoma.

layer.

As

a

The

result,

tear

the

dura.

Aneurysm

•

Ruptured

aneurysms

of

vessels

of

the

cerebral

arterial

•

circle

GAS

Fig.

hemorrhage

8.47

directly

into

the

subarachnoid

space

and

te

sensaton

sinus

tissue:

major

and

the

nerve

o

unit

Superior Connective

of

aca

together

structural

nerves

he

musces

CSF.

CHAPTER

D.

he

cary

tetcs

E.

he

SCG

and

s

a

responsbe

o

te

sympatetc

or

parasympa-

mastcaton.

eye.

mennges

gangon

near

te

sec-

B.

N

requrng

o

te

ABR/McM

52–53

tve

s

because

tssue

composed

ter

o

n

te

ts

easy

te

to

E.

D,

tese

voca

A.

rma

he

he

sde

by

te

he

ase

gottds

te

te

he

or

and

N

and

te

mucosa

o

Eac

ess

or

oose

scap

bood

aso

te

are

one

E.

te

vens,

to

27;

te

o

wc

tube

s

te

saow

ace

s

It

s

te

space

between

neck

te

regon

cavtes

o

on

te

B,

tan

true

above

te

voca

te

te

o

bend

od

rma

te

body,

premature

or

root

o

ntaton

o

te

hs

nterna

nerve

arynx

above

Owng

to

prorm

n

o

te

areas

cords,

t

coud

epgot-

ocaton

be

prorm

nnervates

sen-

n

damaged

ossa

and

wt

oss

o

o

optc

te

somatc

motor

trgemna

sensaton

nnervaton

to

nerve

rom

te

musces

o

by

A.

o

and

trd

eferent

to

tympanc

tongue,

XII)

o

and

nnervates

te

te

tongue.

remans

te

gves

te

te

paatne

structures

do

te

con-

te

o

parynx

tube.

obterates

tonsar

mesencyme

o

cavty,

usuay

ormng

to

audtory

Inectons

rom

audtory

pouc

tympanc

rse

he

parynx.

spread

te

to

tympanc

te

can

rse

antrum.

te

to

troug

C,

te

D,

by

was

te

snus

ormng

te

tons.

not

orm

te

(CN

to

te

gt

pck

E.

musce

hs

wc

cary

he

as

te

aud-

132;

ocuomotor

and

s

gt

te

te

te

efer-

III).

because

sensaton

contracton

rs

s

tat

resuts

speccay

component

ts

o

pregangonc

nuceus

46

aferent

(CN

sone

musce

o

gt

te

and

(CN

relex

oter

ABR/McM

nerve

an

nerve

te

o

57–58,

by

te

ce

postgan-

gangon.

pupary

combnaton

N

up

parasympatetc

te

II)

medates

Ednger-Westpa

at

and

te

ABR/McM

medated

nerve

nerve

pupae

te

s

ocuomotor

wen

abe

nerve,

943–945;

he

optc

by

43;

relex

constrcton.

bers

by

BP29,

ocuomotor

spncter

at

N

gt

constrcts

pupary

GAS

238.

part

hese

nerve

te

III)

s

not

med-

nerves.

54

s

te

eferent

mb

o te pupary relex. It carres parasympatetc nerve

bers

wt

pregangonc

ce

bodes

n

te

Ednger-

Westpa nuceus and postgangonc ce bodes n te

cary

te

gangon

rs.

superor

te

one

te

te

tse

mastod

cavty

nodues

carred

pup

ated

superor

somatc

superca

te

t

voca

te

sensory

arynx.

dvson

suppes

and

te

ts

o

suppes

ossa,

nvovng

te

branc

aso

receves

gvng

recess

remanng

E.

carred

bodes

A,

ossa

tny

ocuomotor

49–50

prorm

(CN

paryngea

pupary

gonc

te

ear

te

nnervated

ubrca-

te

a

1093–1096;

we

o

and

(paryngts)

ts

mb

he

mdbran

te

sava

o

musces

tympanc

second

and

he

ent

n

depresson

to

B.

mb

and

produced.

serves

o

gand,

snus

tube.

GAS

ods.

uman

C,

tory

te

o

net

nerve

extrnsc

tympanc

ympod

ater-

by

somatc

part

trd

membrane

cavty

mdde

he

sound.

porton

te

te

A.

wt

ound

ts

he

parynx

reguated

meday

wder

te

wt

o

aryngea

wt

true

bounded

upper

te

muc

ABR/McM

te

relex

V3)

ptc

orce

and

s

62

237.

a

mandbuar

ower

openng

and

(eustacan),

nects

spread

te

parotd

carotd

posteror

genera

suppes

D. he rst paryngea pouc gves rse to te tympanc

tympanc

and

44,

between

moduate

between

s

procedures

(CN

ts

cartage

are

o

sensaton

he

to

a

ABR/McM

te

nterna

posteror

ypogossa

membrane.

mennges.

key

and

ear,

to

IX)

te

ossa.

styopar yngeus

te

te

nerve

oropar ynx.

he

recess,

nto

cavara

sensor y

to

te

o

prorm

(CN

te

to

to

meatus.

GAS 1067–1070; N 136, 139, 237; ABR/McM 49–45

236.

spreads

pass

aferent

bers

trgemna

te

445

Neck

component

ner ve

to

and

acoustc

te

nnervate

eferent

tongue,

ntrnsc

con-

s

speca

externa

te

not

o

sensory

parasympatetc

membrane,

et-

relex.

vaecua.

protectve

A.

or

te

as

openng

o

preventon

rom

to

s

space

tat

nerve.

ts,

oss

he

te

can

n

s

wc

does

a

sensory

externa

dvson

vscera

te

te

aponeuross,

emssary

suc

aryngea

ods.

CSF

mucosa

bers

te

vestbue

and

vaecua

aryngea

durng

pus

134–137;

s

te

te

ead

nnervaton

sory

o

o

scap

od.

voca

te

869;

he

N

arway,

degutton

GAS

sma

o

unt.

body,

connec-

he

mnemonc

ayer

necton

tyrod

tongue

ton

D.

a

tssue,

oramna

ossa

o

ventrces

were

te

ts

musces

aryngea

aryngea

D.

because

dameter

aryepgottc

In

a

ayer)

structures

gottds

prorm

ay

C.

as

genera

dense

tree

as

musce,

acer-

sends

te

atoug

vscera

abundant

wen

aso

gossopar yngea

perpery

scap.

percranum.

n

he

rst

he

speca

to

aryngea

te

scap

957–960;

atera

B.

and

te

te

C.

beed

ayers.

cords.

te

serves

troug

E.

by

o

move

(ourt

pareta

and

910,

he

by

cavty

ntracrana

C,

GAS

te

te

to

retract

connectve

Inecton

troug

reac

skn,

not

open

te

owng

V2),

trgemna,

wounds

enterng

ayer

and

SCALP

ayer

o

t.

crana

pass

A,

area

n

ed

hese

ends

do

ayers,

tssue,

tssue

danger

ve

ayers,

areoar

nectve

are

second

ntmatey

word

ve

oose

o

bot

arteres

tey

te

care.

arteres

rom

he

n

connected

te

beed

anastomoses.

ated

surgca

It

ncudng

maxary

(CN

127–129;

because

scap

he

vertebrae.

B. Scap aceratons are te most common type o ead

prousey

235.

s

musces

trd

888–889;

njury

234.

gangon

te

ond

GAS

233.

to

Head

7

te

on

he

cerebear

superor

te

ton

and

suppes

ocuomotor

artery

cerebear

ocuomotor

(because

o

te

nerve

and

artery

nerve

spncter

s

te

ound

PCA.

can

resutng

unopposed

pupae

between

Aneurysm

tereore

n

o

compress

pupary

sympatetc

o

te

data-

nnervaton

446

C H A P T E R

o

te

7

dator

afected

B,

C,

D,

and

E.

nerves

GAS

136–138;

he

o

and

te

V1),

te

te

o

te

because

A.

o

he

B.

and

o

te

D.

vagus,

te

he

and

no

pupary

E.

nerve,

to

o

orbta

te

cana

and

o

tese

ssure

te

242.

wngs

wt

and

ocated

N

240.

E.

n

he

te

141–143;

B.

Herpes

te

or

t

(CN

et),

ng

ssure

te

eye

as

can

s

com-

done

nerve

te

unctons

and

sup-

to

nerves.

ocated

nerve

nsde

and

o

te

brances

te

te

part

o

anteror

crana

oramen

ABR/McM

can

rotundum

crana

11,

afect

and

o

A.

resdes

a

sensory

mmunosuppresson

wc

may

dysuncton.

n

te

In

case,

resutng

branc

suppes

o

te

he

stapes

dampen

tenson

te

on

n

are

nerves.

a

n

neck

te

B.

he

It

te

and

nerve

o

te

musce

nserts

ear

stapes

stapes.

and

by

n

te

neck

unctons

o

to

puttng

Denervaton

o

ts

are

nerve

neck

at

te

bers

pared

ooks

o

upon

to

hereore,

to

o

aorta

groove

te

te

te

te

and

emerg-

rgt

recurrent

posteror

a

crco-

(recurs)

arc

under

ter

te

to

(rgt

ooks

te

nadvertenty

GAS

243.

C.

to

o

arynx

te

o

pat

mdde

recurrent

damaged

te

durng

E.

he

tense

te

o

a

mus-

o

te

monotonous

te

voca

nerve

voca

te

hs

Parayss

n

cord.

w

cord

arynx

gossoparyngea

motor

pupary

to

causes

cord.

aryngea

musce.

aryngea

above

relex

voca

cord.

mucosa

nerve

superor

resuts

nabty

ts

te

te

voca

nerve

anestesa

and

o

aryngea

to

above

superor

protectve

te

crcotyrod

tense

te

to

Injury

branc

1008–1009;

he

bers

aryngea

n

te

sory

nerve

te

nerve

cord.

te

because

8.180).

been

to

serves

resut

o

n

suppes

Parayss

necton

aca

way

D.

sensory

(nerve

voca

externa

voce

stress,

as

sensory

te

externa

dormant

erpes

aca

musce

te

te

motor

domnant

mdde

o

o

bot

stapedus

te

Iness,

reactvate

o

stapedus

bone

gangon.

be

o

traceoesopagea

gand.

may

sensory

te

course

nerves

tyrod

nerve

n

84

branc

nnervaton

Beng

arterosum

te

sternocedo-

excudng

aryngea

rgt

In

tese

anestesa

ce

dysuncton

te

vbratons

te

n

gangon

reactvated,

tat

can

resut

ts

gencuate

stapedus).

aso

and

oss

(GAS

nerve

Fg.

carres

sen-

bers.

N

87–89;

gt

relex

ABR/McM

s

used

to

84

test

te

abty

o

te eyes to perceve gt sensaton. he aferent mb o

ts

s

a

relex

te

arc

s

eferent

pengt,

te

mb.

eac

optc

By

eye

s

nerve

snng

tested

we

gt

te

nto

ocuomotor

te

ndvduay

eye

or

a

rom

drect

musce resuts n te percepton o oudness o sound n

constrcton o te pup on te psatera sde and ten

te

or

A,

ear

C,

te

N

241.

n

te

above

80

crana

he

artery.

arynx

te

a

motor

suppes

wtn

te

nerve,

cord.

nerve

gamentum

nerve

and

aso

recurrent

neck,

te

voca

to

ABR/McM

suppes

vagus

traves

motor

he nterna branc o te superor aryngea nerve

ossa.

spna

and

te

te

as

musces.

137;

o

to

meatus,

tyrodectomy.

ossa

ovae

X),

te

suppes

te

N

contrbutes

acoustc

relex.

s

aryngea

musces

arynx.

nto

gangon.

n

nerve

trapezus

(CN

aso

externa

coug

et

te

ten

aryngea

nraorbta

and

te

wc

te

892;

musce

subcavan

ost

and

beow

rom

under

by

aferent

were

nerve

arynx

ven.

te

recurrent

tyrod

brances

nerve

zygomatc

ound

mdde

zoster

wc

vrus,

n

o

accessory

ntrnsc

usuay oows reactvaton o a dormant varcea nec-

ton,

nerve,

885–886,

he

optamc

serves

s

C.

vagus

te

structures,

III),

optamc

and

maxary

s

oter

trgemna

hese

te

greater

(CN

orbta

te

relex.

transmttng

optc

o

VI),

cornea

compresson

o

nerve

n

and transmts te optc nerve and optamc artery .

D

aca

roe

he

GAS

openng

and

Abducton

and

te

67

an

Among

(CN

pterygopaatne

he

n

communcates

superor

cornea

brances

te

te

s

esser

dvson

nerve

neror

orbt,

te

snus.

structures.

sensaton

mb

ssure

ocuomotor

around

tese

aca,

partcpate

ABR/McM

bone

maxary

abducens

pes

132;

orbta

optamc

T umors

trgemna,

not

between

abducens

press

N

spenod

transmts

o

unresponsveness

mastod

ound

orbt

he

do

superor

te

and

nnervatons

relex.

sku

Neck

pupae)

gt

C.

and

eye.

abducens

239.

Head

D,

and

55,

he

58;

vagus

contrbuton

aurcuar

te

t

vagus

hese

Fg.

8.124).

nerves

are

not

responsbe

or

A.

he

ABR/McM

nerve

to

s

te

te

83

(CN

B.

X)

externa

aso

caed

aferent

te

nteror

o

a

acoustc

te

mb

vestbuococear

makes

o

te

meatus

nerve

te

sma

o

sensory

(va

Arnod)

coug

relex

ts

and

earng

n

n

eye.

aca

and

he

te

contrbutes

aurcuotempora

acoustc

coug

relex.

to

meatus,

te

t

branc

nnervatons

does

not

o

o

te

te

partcpate

n

E.

he

s

hs

o

s

a

to

s

etters

N

te

rom

97,

a

relex

o

by

tat

te

te

(aferent

relex

tat

stmuaton.

s

pro-

cornea

o

optamc

mb)

and

te

mb).

are

and

aso

audtory

s

sde.

acoustc

medated

maneuver

test,

883–886;

relex

wc

assess

o

stmuaton

trgemna

trocear,

vson

contraatera

knd

sudden

to

(eferent

musces,

used

to

relex

te

a

cornea

te

H-test

denty

GAS

or

on

s

reacton

nerve

ocuar

relex

relex

reacton

bnk

omotor,

Atoug

te

starte

branc

D.

medate

he

te

snce

arynx.

nerves

trgemna

externa

consensua

he

duced

baance.

C.

a

occurs

branc,

nnervates

A.

E.

(GAS

yperacuss.

53,

B.

(yperacuss)

used

abducens

known

abty

as

o

dferent

132;

to

test

nnervated

te

by

extra-

te

ocu-

nerves.

vsua

te

eye

acuty

to

dstances.

ABR/McM

80

test,

read

or

CHAPTER

Malleus

Tensor

tympani

Head

7

447

Neck

Incus

muscle

Tendon

of

stapedius

muscle

Pyramidal

Footplate

Phar yngotympanic

and

eminence

of

stapes

tube

T ympanic

•

membrane

GAS

Fig.

8.124

244.

D.

he

sort

correct

tat

te

nvoves

and

cary

answer

probem

pup

and

as

It

es

and

s

cary

cear

wt

suc

Eye

gangon

rom

te

ens

movements

te

wc

accommodaton,

were

parasympatetc

s

vgnette

accommodaton,

accommodaton,

convergence.

msed

nerves

opton.

not

dect

s

compro-

te

key

Superior

cause thyroid

o

s

condton.

Pregangonc

axons

rom

te

ar ter y

Ednger-Westpa

nuceus

are

carred

by

te

ocuo-

Superior Posterior

motor nerve. hese parasympatetcs trave

parathyroid

to te

c-

glandular gland

ary

gangon

ocated

n

te

posteror

orbt

and

rom

branch

ere

postgangonc

axons,

carred

by

te

sort

cary

Inferior

nerves, Inferior

thyroid

go

on

to

nnervate

te

spncter

pupae

mus-

parathyroid

ar ter y

ce,

gland

wc

ary

constrcts

musce.

tenson

more

and

on

te

pup

Contracton

te

convex.

zonuar

Absence

spncter

o

te

bers,

o

pupae

and

cary

musce

aowng

acton

resuts

nnervates

o

n

te

oss

te

te

c-

reeves

ens

cary

o

te

to

be

musces

abty

to

Thyrocer vical

ocus

on

near

objects.

trunk

A, Right

Left

B,

C,

and

nerves lar yngeal

nnervate

tus

musces,

unafected,

recurrent

lar yngeal

answer

245.

Fig.

8.180

nerve

obque

and

and

abducens

atera

respectvey.

ts

opton

Snce

combnaton

mmedatey.

eye

can

movements

rec-

be

Oter

emnated

were

as

combnatons

an

are

ncorrect.

GAS

GAS

trocear

superor

ner ve

aso

•

he

te

ner ve

ar ter y

Left

E.

recurrent

subclavian

B.

to

864;

he

N

111–113;

erpetc

ABR/McM

necton

supratrocear

vens,

o

te

wc

61,

72

oreead

jon

to

key

orm

a

spread

snge

448

C H A P T E R

trunk

7

tat

oreead

he

two

orm

runs

vens

o

ernous

te

A.

to

caed

t

ven

to

te

te

anteror

te

cavernous

te

te

ace

pterygod

root

nasa

te

ven

can

va

snce

o

arc.

t

o

nose,

te

te

wt

and

te

C.

sde.

by

a

meda

ven

ts

deep

as

D.

s

to

aca

two

not

dran

he

GAS

nto

246.

pexus.

snus

o

s

te

drans

C.

he

carres

venous

above

neror

to

ocated

n

petrous

te

te

part

cavernous

dran

cvus,

nto

te

te

snus

and

transverse

s

wt

made

te

were

up

ayers

t

o

mutpe

o

te

ven

connects

trbutares

o

N

64,

nerve

motor

component

85–86,

s

a

and

o

99;

mxed

te

te

superor

superca

ABR/McM

crana

(speca)

te

aca

nerve

Jugulodigastric

Superficial

Inter nal

nodes Deep

Omohyoid

jugular

cer vical

rom

nodes

nodes

node

nodes

vein

nodes

muscle

Jugulo-omohyoid

node Exter nal

•

GAS

Fig.

8.197

jugular

wc

bers.

arses

cer vical

47

nerve,

sensory

Mastoid

Submandibular

te

ven.

Occipital

nodes

dura

nterconnects

nodes

Submental

supe-

o

snuses.

emssary

snus

aca

bot

te

pexus

between

petrosa

pareta

875–876;

motor

Pre-auricular/parotid

It

cannes

tempora

danger

drecty

sucus

bone.

basar

sagtta

communcates

te

he

mater

E.

not

petrosa

posteroateray

venous

communcaton

and

petrosa

snus.

cav-

way

superor

traves

to

superor

te

he

ror

tempora

snus.

but

does

At

make

aca

ven

snus

te

nto

aso

pexus

aca

ne

opposte

supraorbta

drans

cavernous

wt

te

communcates

venous

wt

o

te

mdde

o

te

necton

pterygod

area

at

and

optamc

te

ven

jons

wc

he

spread

he

near

te

joned,

orbt,

ven,

snus.

neror

vens

are

anguar

optamc

Neck

wt

branc,

te

te

and

down

parae

transverse

ange

Head

vein

he

te

CHAPTER

aca

nerve

we

te

aca

nerve

dus.

he

enter

te

nterna

nuceus

sensory

and

and

emerge

motor

rom

and

petrous

te

te

aca

bran

sensory

part

acoustc

orms

nerve

parasympatetc

o

parts

te

meatus,

as

nervus

o

te

tempora

wc

s

proper,

parts

aca

t

passes

ve

troug

major

sensory

motor

to

247.

B,

te

E.

or

GAS

883–887;

C.

he

(CN

te

contro

nterna

part

VII)

he

o

o

aca

o

aca

nerve

va

te

to

te

cose

o

135;

te

t

o

te

o

are

aca

meatus

s

bone.

vestbuococear

key

aneurysm

GAS

250.

nto

speca

to

respon-

expresson.

as

cana

n

te

he

aca

nerve

nerve

(CN

VIII)

earng,

or

baance

speca

aca

and

D,

nerves

E.

and

taste

and

VII

he

mout

nodes.

te

he

carryng

sgnas

aca

anteror

tat

sensory

nerve

te

o

and

o

N

he

20;

nvove

ABR/McM

nodes

te

ower

te

Eferent

te

not

te

B.

apex

are

dgastrc

p

o

te

ympatc

ymp

node

occpta

o

rom

nodes

te

nodes

anteror

tongue

deep

te

o

go

to

to

o

occpta

te

eyeds,

na

te

nodes

part

te

he

te

rontotempora

acoustc

nasa

dran

meatus,

o

nasa

te

and

a

parynx

root

o

regon,

deep

and

te

and

group

te

nose,

te

o

posteror

are

ound

n

nasa

he

part

mary

GAS

249.

D.

o

909,

(GAS

915;

Aneurysms

cause

te

parynx,

juguodgastrc

drect

emerges

Fg.

N

o

buc-

te

audtory

dran

te

te

o

ts

rectus

neror

nerve

musce

abduct

te

C,

on

neror

te

branstem

at

cerebear

abducens

te

as

cerebear

eads

to

oss

psateray,

eye.

he

artery

o

uncton

resutng

anteror

n

to

te

te

atera

nabty

communcatng

to

artery

not

te

s

as

to

we

provde

somato-

gand.

33,

are a

o

s up p  ed

an d

abo ut

to

be

ne r ve

te

39,

te

by

40

ar ynx

te

te

s up p  es

voca

supe-

s ens at o n

cords .

gos s op ar yngea

te

sw a ow ng

pos te r  or

b e c aus e

o

(CN

relex.

cr coar yteno d

re cur ren t

ABR/McM

ar yn ge a

47

ydrocepaus

reabsorpton

E.

he

pexus

o

subdura

and

space

snus

N

ocaton

CSF

nerve

te

occurs

va

as

te

a

resut

aracnod

te

te

s

t

s

wc

aracnod

s

te

responsbe

CSF .

lows

ump

key

nto

nto

te

60–61

s

cose

to

te

compressng

styomastod

or

are

he

v.

ABR/McM

and

spaces

contan

reabsorbed

growng

exts

epdura

not

CSF ,

and

va

meatus

as

nerve

and

do

111–115;

o

acoustc

aca

tese

produces

sagtta

D.

Protracton

o

te

A.

tgt

on

oramen.

cosure

o

te

D.

te

te

tongue

nerve

mandbuar

constrcton

damage

889–890;

Brances

and

anteror

nasa

A,

o

ypogossa

to

te

s

because

and

o

eevaton

nner-

o

te

nerve.

and

parta

ocuomotor

ptoss

resut

nerve.

Vagus nerve nnervates evator ve paatn musce.

GAS

254.

by

Pupary

rom

t

Impngement

to

X)

87–89;

874–876;

vaton

pontomeduary

beow.

(CN

brng

spaces,

aca

artery

nerve

brances

aurce

ABR/McM

to

 o d s

ar ynge a

subaracnod

he

C.

anteror

D,

mandbe

juncton between te abyrntne artery above and te

anteror

E.

B,

pr-

85–86

te

of

te

of

posteror

eyeds.

tubes.

tonss

N

decreased

he

8.197).

mpngement

rom

and

nodes

1057;

externa

coparyngea asca and dran te nasa cavtes, te

D.

do

parotd

145;

neror

nonobstructve

GAS

253.

parts

te

gves

o

mand-

gves

damage.

o

te

nodes

area

w oud

superor

cavtes.

retroparyngea

voca

Weakness

corod

te

te

t

aurce.

te

134,

te

superory,

and

nerves

to

o

(to

nerve.

ner ve.

vagus

potenta

exter-

drans

te

neck

gament,

porton

nner vat on

A

te

parotd

N

te

B.

A,

nodes.

scap.

he

to

hese

postgan-

bers

aurcuotempora

turns

condye,

nerve.

67

vsceromotor

te

aso

artery

v.

jugu-

regon

te

ten

anteror

E.

ner ves

E.

GAS

252.

tese

te

group

te

ypogossa

somatosensory

between

and

recurrent

he

ner ve

centra

nto

nodes

party

cervca

dran

he

loor

dran

tese

and

to

te

IX)

te

and

nerve.

w

V ertebra

ABR/McM

receves

rom

nnervaton

he

crana

between

musces.

and

and

musces

ocated

te

906–908;

to

83

gand

passes

ar yngea

D,

18,

o

te

and

do

D,

te

Aneurysm

artery

nerve.

spenomandbuar

Sensor y

o

VIII.

bees

oomoyod

o

hese

afect

nerve.

449

Neck

ocuomotor

cerebear

149–154;

and

251–275

A.

ror

te

musces

o

superor

carres

two-trds

contro

C,

C.

E.

submandbuar

C.

to

bers

submenta

portons

B.

nerve,

equbrum.

motor

958–960;

anteror

A.

vestbuar

speca

N

mandbuar

skn

GAS

expresson.

B,

GAS

te

sensory

tongue

A,

and

carryng

key

brances

sensory

Answers

nerve,

te

te

ocuomotor

anterosuperor

A,

251.

cocear

te

superor

capsue)

nerve

and

te

conssts

te

te

parotd

musces.

te

parotd

abducens

afect

parasympatetc

te

sty-

te

key

te

w

parotd

As

course troug ts cana. he vestbuococear nerve

o

he

te

o

869–870;

gonc

83

a

B.

to

w

afect

be

not

reate

PCA

tongue,

and

dgastrc

nerves

not

te

Aneurysm

and

dvdes

provdes

ABR/McM

tempora

oramen

expresson

musces

acoustc

were

two-trds

crana

110,

te

and

gand,

bey

hese

N

styomastod

anteror

posteror

and

te

parotd

musces

sbe

petrous

248.

te

to

te

and

D,

rom

brances.

bers

oyod

A,

emerges

o

nerve

nner ear; t ten courses troug te aca cana, ater

wc

does

te

nterme-

bone

very

o

Head

7

E.

gea

17,

te

and

are

descendng

arteres

110,

are

135;

ABR/McM

spenopaatne,

etmoda

septum

he

N

o

anastomose

prone

to

paatne

ocated

58

superor

anterory

aba,

on

te

beedng.

and

posterory

ascendng

n

te

paryn-

parynx.

450

C H A P T E R

B.

7

he

Head

posteror

wtn

artery

C.

GAS

255.

te

s

do

superor

wtn

suppy

N

47;

aveoar

and

etmoda

not

1072;

Neck

maxa

ound

Posteror

es

and

te

te

and

te

crana

mdde

nasa

ABR/McM

artery

accessory

traves

B

menngea

cavty.

arter-

D.

septum.

GAS

261.

o

vagus

te

B.

or

nerve

suppy

carotd

he

orms

o

te

wc t nnervates.

part

o

parynx

te

and

paryngea

contnues

n

ypogossa

s

ound

neror

to

te

te

D,

E.

te

he

GAS

A.

he

ce

s

B,

D.

nto

abduct

he

or

on

te

voca

B,

te

artery

C,

E.

870,

he

o

te

aso

nerve

arynx

B.

he

are

or

A.

a

he

ABR/McM

crcoarytenod

84

n

mus-

C.

te

and

voca

stretces

to

atera

cords,

te

GAS

B.

artery

oter

te

cords

ptc

D.

wc

te

arteres

150,

152,

or

parynx

coug

musces

supped

superor

C,

D,

o

te

sted

te

voce.

njury

A.

to

154;

s

te

te

rom

260.

888;

are

not

ng

cer-

GAS

262.

nerve.

cose

E.

o

to

damage

a

paate

damaged,

te

o

not

pro-

ABR/McM

on

te

sur ace

teet

can

o

o

te

ead

ramus

o

to

te

yper-

especay

dicuty

spasms

84

zygomatc

eevator

mastcaton,

ave

to

mucus

ABR/McM

te

32

A.

n

o

eson.

and

ocated

Its

te

depressng

ts

enarged

between

man

te

and

acton

teet.

It

speec

runs

orms

bey

o

s

te

max-

to

com-

s

aso

nvoved

producton.

rom

part

va

te

te

o

mandbe

te

dgastrc

process

te

loor

o

musce

and

to

te

o

are

pays

te

org-

connects

ntermedate

openng

temporas

tendon.

jaw

wen

to

It

te

reaxed.

a

roe

n

mout

open-

protruson.

N

55–56;

nerve

mbs

te

mastod

pterygod

jaw

vagus

o

ABR/McM

medates

te

membranes

he

musces

nerve,

coug

and

39–41

bot

te

relex:

eferent

N

nerve

137;

B.

he

and

and

aca

expres-

aca

or

medates

s

earng

supped

ABR/McM

nerve,

te

C.

and

by

te

to

tensng

te

N

D.

te

te

voca

woud

o

crcotyrod

cords.

not

resut

263.

C.

o

to

aferent

aferent

te

and

to

musces

te

o

te

voca

recurrent

87–89;

ods

woud

aryngea

ABR/McM

resut

nerve.

49

aryngea

(except

tensor

uvua

ve

woud

paatn).

devate

rom

te

sde

by

aryngea

nerve,

motor

crcoparyngeus

889,

he

te

te

he

and

he

te

n

te

gag

o

te

vagus

nerve

s

most

te

nerve.

a

vagus

to

paatogossus

branc

nerve,

te

o

supe-

tat

pro-

crcotyrod

musces.

provdes

sensory

nnervaton

ace.

1003;

ace.

on

nerve

N

137;

trgemna

and

te

or

nnervaton

trgemna

te

nvoved

nnervates

rom

he

eferent

A.

ony

s

except

and

ect

B

nerve

nnervated

ror

ton

te

s

nerve

mb.

muscuature

externa

ary,

rom

aferent

he

GAS

branc

te

ypogossa

vdes

84

externa

suppes

sensaton

as

wc

nerves,

to

nerve,

gossoparyngea

relex

wc

nerve.

te

s

musce

n

and

966–967;

he

It

as

te

tree

optc

D.

s

te

s

s

aca

va

nerve

te

te

trgemna

nerve

sensory

optamc,

was

aferent

(cosng

responsbe

or

and

tryng

mb

nerve

te

nerve

max-

to

(sensa-

and

te

eye).

vson.

abducens

nerves

musces.

pays

relex,

84

major

neuroogst

were

ocuomotor

extraocuar

cornea

te

brances:

aca

nerve

he

s

he

relex

eyeba)

mb

ABR/McM

nerve

mandbuar.

cornea

E.

o

136–137;

te

aganst

bone

roe

and

to

sot

o

smng,

te

atera

nnervate



woud

power u

musce

bone

rom

tongue

mucosa

abduct

1008–1009;

te

a

mandbe.

posteror

A. he vagus nerve s responsbe or motor nnervaton

C.

re-

but

cavty.

eferent

nerve.

aryngea

motor

Inabty

GAS

nerve

atera

s

w

myoyod

yod

he

are

sku

neror

accessory

vagus

trgemna

aryngea

Loss

a

te

It

ceek

masseter

E.

enters

nnervatng

mastcaton

by

responsbe

E.

te

pays

relex.

oroparyngea

externa

musce

mb

arynx.

N

and

he

te

ten-

musces

posteror

nearest

o

ts

or

49

trapezus

he

taut

reduce

ABR/McM

nerve,

responsbe

885–886,

he

coud

aferent

symptoms.

orgnates

because

te

yod

ora

tem

nerve.

te

he

crcoaryte-

brngng

voca

musces

and

magnum.

gossoparyngea

259.

66,

musces

wstng,

nates

adjust

91–93;

vestbuococear

he

on

buccnator

te

baance.

D.

N

musce

Patents

and

press

136;

respectvey.

C.

te

oter

damage

te

symptoms.

Grndng

mandbe

he

superor

ponaton.

N

te

nerves,

te

cords.

accessory

888–890;

ntates

son

s

o

neck.

82,

arytenod

cords

he

accessory

E.

A,

te

oramen

ebear

A,

by

te

80,

tyroarytenod

1050–1051;

te

n

posteror

Sternocedomastod

va

GAS

te

aryngea

brances

72,

voca

Crcotyrod

supped

258.

o

N

adducts

and

nterna

ound

transverse

ponaton

GAS

are

te

apposton

son

and

nterna

890–891;

musce

E.

D.

and

uncton

to

nod

C,

externa

nerve,

877,

o

s

trgemna

tese

nser ts

nerve

t

musce.

externa

aryngea

o

mandbe.

masseter.

nerve

te

te

840–841;

and

tropy

tongue.

to

masseter

te

because

produce

mandbe.

seat.

relex

any

834,

he

bone

pexus

257.

B.

to te styoparyngeus

he

not

duce

55

Gossoparyngea

gag

Damage

o te tonsar ossa ater t passes bend and ten atera

musce,

E.

te

woud

menngea

C. he gossoparyngea nerve s ocated n te ower part

A.

256.

and

duce

a

but

roe

snce

n

te

bot

eferent

eyes

mb

bnk

o

wen

CHAPTER

te

rgt

appear

cornea

to

be

s

stroked,

bot

aca

nerves

A.

An

ntact.

GAS 838, 887, 890; N 97, 132–134, 142; ABR/McM 81

264.

D.

he

te

tyrod

loor

nected

o

to

rogossa

te

te

gand

deveops

prmtve

tongue

duct,

at

wc

as

parynx.

te

a

dvertcuum

It

s

oramen

ten

cecum

degenerates.

It

by

resuts

rom

temporary

B.

An

con-

te

an

n

C.

s

n

B,

te

C,

o

te

pat

E.

o

he

tyrogossa

te

descent

tyrogossa

duct

o

can

te

duct

ead

tyrod

passes

to

a

cystc

gand.

rom

ror

oramen

D.

B.

1007–1008;

he

tmate

pared

N

71,

superor

brances

ABR/McM

C.

nerve

nnervates

responsbe

te

or

adducted

readng

GAS

E.

a

tor

te

nerve,

te

s

wc

abducens

trocear

aneurysm

or

te

and

near

te

te

resut

n

te

and

te

eye

a

beng

n

to

wt

ocuomo-

eye

(done

nerve

abducted

by

te

patent

musces

by

D,

GAS

270.

te

an

tod

(atera

and

eye.

cerebear

s

to

or

because

orbta

musce

te

te

o

ocu-

by

an

poste-

damage

to

anteror

an

bone.

orgnates

part

njur y

o

67

(bow-out)

tendnous

to

o

te

te

te

hs

resutng

n

o

and

te

rectus

te

oss

racture.

te

eyeba.

neror

experence

rom

rng

loor

teters

o

Wt

orbt

an

may

musce

neror

uncton

dpopa

ne-

nserts

wen

by

rectus

o

te

attempt-

gaze.

E.

hese

resutng

musces

racture

or

woud

cause

not

te

be

afected

symptoms

ts

experencng.

927;

N

96;

ABR/McM

C. he area ndcated by te

by

obque).

an

common

bone,

and

s

can

nerve

compressed

ABR/McM

sows

Patents

upward

B,

sensaton

entrapment

o

artery

nerve.

rectus

neror

be

wc

arteres.

te

ragment

A,

cere-

o

trocear

adducted

can

cerebe-

eye.

compresson

superor

150–152;

racture,

musce

artery

(nnervated

ts

te

ng

obque

o

part

te

451

Neck

nerve,

cerebear

te

te

o

wc

te

scan

neror

resut

wen

posteror

o

rectus

superor

(superor

s

n

n

abduct

o

and

neror

abducens

superor

resut

nerve,

N

te

to

depress

a

cornea

CT

musce.

basar

extraocuar

Compresson

depressed

vson

s

67

te

orgn

atera

te

t

876;

orbta

downstars.

cerebear

s

ts

hs

wc

wen

proper

In

nerve.

musce,

eyeba

ABR/McM

ocated

o

nerve)

w

and

aows

nnervates

nerve).

te

wakng

ocaton

cerebeum.

trocear

obque

o

149–154;

excepton

te

or

superor

hs

te

rectus)

N

et

arteres.

wt

hs

aneurysm

between

bra

state.

te

te

superor

newspaper

o

to

depresson

869–870;

he

te

parts

cose

to

as

trgemna

he

on

meda

very

artery

269.

te

and

Eac

penu-

ror

traves

artery.

te

nates rom te basar artery and runs ateray to suppy

t

basar

GAS

are

he

superor

te

36

arteres

org-

course,

o

77;

cerebear

te

o

o

anteror

te

nabty

cerebra

Loss

te

compresson

nabty

aneurysm

GAS

mastod

process.

emssary

vens,

oramen

o

sgmod

snus

te

he

necton

wc

tempora

begns

51

arrow s te mastod ces o

key

passed

bone

to

beneat

spread

troug

te

te

va

te

sgmod

mas-

mastod

snus.

he

bone

and

tempora

A, B, C, and D. None o tese oter ocatons descrbe

traves to te juguar oramen, at wc pont t jons te

te

neror

orgn

woud

GAS

B.

not

o

be

te

he

parts

N

nterna

o

ocuomotor

mpcated

869–870;

majorty

te

ts

149–154;

carotd

bood

ncudng

n

te

s

artery

to

cervca,

and

tereore

A.

ABR/McM

te

suppy

nerve

dect.

te

67

tat

bran.

petrous,

petrosa

he

tons

suppes

It

as

acerum,

te

B.

severa

he

to

te

cavern-

he

men

snuses

are

pared

dura

snuses

tat

are

(o

ocated on te atera wa o te spenod bone on eter

acerum.

sde

or

o

o

and

te

C,

nerve

GAS

D,

as

te

asm.

troug

to

not

a

stuated

115;

s

suferng

aneurysm

and

et

n

vsua

o

n

te

rom

artery.

ts

area

eds

n

to

ts

and

part

D.

nerve

eye.

o

an

oter

te

arteres

E.

abducens

snus.

bone.

aneurysm

artery

to

te

compresses

(btempora

te

te

connects

begnnng

te

outer

o

optc

te

a

o

c-

optc

bot

emanopsa).

GAS

271.

C.

above

A.

te

cavernous

spenoda

oramen

reaton

te

te

te

snus,

emssary

ovae,

to

n

wt

and

by

ora-

oramen

mastod

process

vens.

s

ax

petrosa

te

ocated

cerebr

953;

bood

wtn

meets

te

te

dura

mdne

o

N

110,

ocated

part

rom

and

o

te

n

te

te

petro-

tempora

cavernous

ateray

to

dran

snus

nto

114,

are

115;

ocated

ABR/McM

n

te

36

ronta

bone

margn.

snus

te

maxary

s

snus.

snuses

orbta

beow

snus

petrous

backward

maxary

nose

no

receves

ronta

he

ocated

te

te

snus

transverse

te

s

and

te

on

passes

876,

he

It

pexus

rea-

ces.

cerebe.

superor

sucus

and

across

te

he

sa

drect

mastod

ven

emssary

were

or

ven.

any

communcates

as

stragt

ave

and

V esaus),

tentorum

cavernous

hs

he

juguar

not

process

venous

troug

It

te

does

ossa

aca

mastod

mater,

67

superor

bndness

artery

abducens

te

te

arteres

ssure

n

Damage

te

ABR/McM

cerebra

resutng

carotd

compresson

communcatng

An

t.

afect

abduct

N

anteror

nterna

Aneurysms

n

ongtudna

casm,

rgt

are

875;

patent

two

E.

he

woud

abty

resut

tey

869,

anteror

o

and

not

run

carotd

patent’s

he

te

turcca.

nerve

nterna

woud

E.

sea

abducens

te

A,

te

orm

mastod

pterygod

anteror

to

snus

nratempora

brances

cavernous

snus

cavernous

ous, cnod, optamc, and communcatng segments.

te

268.

cause

degeneraton

cecum o te tongue to te stmus o te tyrod gand.

267.

an

omotor

A,

266.

n

Ptoss

o

compresses

aneurysm

aso

ty-

descends

artery

te neck, passng anteror to te yod bone. Incompete

mass

265.

aneurysm

ar

Head

7

s

ceeks

bone.

ocated

and

on

above

te

te

sdes

teet,

o

te

wtn

452

C H A P T E R

B.

7

he

Head

transverse

drans

te

D.

E.

te

nner

cannot

he

etmod

he

part

A.

he

te

and

te

D.

te

te

te

B.

ntma

artery

he

dbuar

teror

skn

ce,

he

o

a

he

deep

to

to

at

s

11,

16,

te

17

te

A,

back

o

te

as

upper

reerred

o

te

upper

n

to

as

te

part

mdde

o

Answers

276.

occpta

and

tempora

o

or

artery

te

te

arse

and

ony

to

pexus

and

severa

o

as

o

and

te

te

op-

GAS

277.

te

branc

nerve,

gand,

te

o

rom

jont

o

atera

anteror

te

te

te

skn

surace

o

o

te

nerve,

skn

nerve,

pos-

aso

overyng

gand,

te

te

and

exter-

porton

occpta

parotd

suppes

part

superor

esser

suppes

te

te

as

aurce.

part

are

not

or

reated

to

depresson

o

82,

n

nerve

133;

te

and

aca

ABR/McM

nterna

vestbuococear

nerve

unatera

remander

83

acoustc

suppes

aca

o

te

orentatons

aca

parayss.

crana

wt

te

nerves

nterna

18,

20;

ABR/McM

58

a

te

we

he

aress

patc

tempora

ossa.

E.

he

not

1074;

N

on

supe-

te

nasa

te

pate

eter

oac-

and

sde

be

key

end

o

compresses

w

not

te

(ormng

ere

sme

are

o

afected.

to

be

vestbuococear,

te

tese

he

afected.

and

aca

proxmty.

remander

sare

46,

composed

spenod

and

he

tempora

base

o

te

spata

130;

o

te

crana

orentatons

ABR/McM

mdde

o

te

arge,

bones

sku

ras,

mastod

part,

zygomatc

part

nerves

wt

te

55

crana

sea

ossa

turcca

depressed

he

855;

s

on

as

te

atera

wc

a

body

parts

on

he

te

pass

he

are

compact

o

n

te

t.

snuses

are

and

tympanc

process.

te

perced

bones

11,

back

by

a

and

arge

are

ound

n

12

(ayer

scap

Inecton

as

snus

n

and

ound

n

te

nner

ts

ayer

can

emssary

cavara,

te

neror

te

dura

te

dpoc

and

te

and

mennges.

wtn

te

o

puruence

sma

te

te

ormed

dran

n

troug

suc

our)

because

marrow-contanng

between

bone.

at

and

tempo-

magnum.

oramna

structures

te

s

ayer

cavty

troug

vens

4,

tssue

crana

vaut

n

bone

sdes

porton,

styod

ronta

ntercavernous

dpoc

ound

area

venous

crana

ous

and

te

squama

ossa.

easy

te

ntracrana

snus

and

at

te

stuated

ABR/McM

danger

o

and

oramen

connectve

nto

A and B.

s

18;

s

sku

etmod

spreads

pass

reac

N

te

te

stuated

petrous

process,

te

crana

oose

are

consst

bone

o

openng,

E.

and

porton,

occpta

anteror

vens,

C.

o

cose

E.

e

tumor

butterly-saped

bood

tta

sense

vagus,

do

part

he

aso

a

n

crbrorm

wc

casm

n

te

ces

ces

was

sde.

scap

or

te

rom

septa

tese

troug

bubs,

and

and

arse

and

o

hereore,

not

897,

GAS

278.

nerves

atera

ga

and

te

te

aur-

tragus

C,

ova

D

pos-

posterory.

o

N

te

are

he

poste-

te

he

te

and

ower

superor

suppy

on

te

aurcuar

suppes

nerve

o

tereore

he

great

o

to

regon

skn

pexus,

he

B.

man-

emergng

59,

te

spata

pass

tract

te

arteres

te

57,

ound

processes

ga.

he

above.

and

anterory

and

skn

o

E.

oactory

centra

nterna

passes

mandbe

and

A.

C.

a

o

nerve)

B,

cavernous

smaer

53,

cause

oactory

mentoned

musces.

te

te

occpta

meatus.

he

te

crsta

corod,

descrbed

tempora

capsue

zygomatcotempora

A.

to

eye.

arses

ndcated

responsbe

aca

can

and

part

nerves

53

parotd

to

of

oter

nerve,

te

branc,

cose

te

rectus

rarey

suppy

te

rom

exts

arteres

membrane.

te

majorty

he

eac

trgemna

cervca

o

te

276–300

nerves,

opta-

scera,

brances

aurce

aurce.

te

are

two,

sare

Smary,

nerve

te

958–960;

crsta

6

bood

retna

te

atter

aurce

o

D,

N

te

and

not

D.

n

arteres.

ramus

skn

7,

o

optc

processes,

te

4,

major

branc

te

arteres

ABR/McM

meatus

over

a

suppy

cary

te

te

arteres

tat

nerves

are

O

cavty.

te

maxary

ntma

te

dstrbutes

te

s

artery

as

o

two

acoustc

o

and

s

suppes

and

promnence

centra

te

ABR/McM

It

and

te

o

B,

GAS

te

he

974–975;

he

do

etmod,

te

cary

o

te

to

C.

musces

process

E.

nerves

nerve.

bone.

nerve

gaze.

GAS

275.

petrous,

mastod

at

aso

most

temporomandbuar

ex

mandbe

skn

It

wtn

te

rse

te

tympanc

cervca

o

ces

te

D,

crana

sku.

ocated

17;

cary

part

te

we

branc

te

ar

between

tempora

ocated

artery

retna

103;

to

C,

occpta

scap.

optc

cary

dvson

deep

acoustc

teror

as

N

nerve

te

s

aurcuotempora

adjacent

na

s

ace.

eye.

to

gves

anteror

as

sma

mastod,

he

te

te

ronta,

13,

artery

It

931;

te

o

ocated

o

and

optamc

ncudng

he

te

te

posteror

snus.

to

s

bone

artery

carotd

rory,

portons.

orms

traves

centra

A,

tory

get

E.

te

ror

N

o

to

and

te

GAS

o

bone

ncude

orms

retna

and

eyeba

he

C.

bone

greater

o

te

ABR/McM

parts

te

bone

conjunctva,

274.

coecton

51;

bone

anterory

tamc

D.

surace.

spenod

posterory.

centra

C,

he

externay.

porton

and

between

961–962;

he

mc

tat

aong

meatus

part

o

spenod

bones

to

bone

te

snus

runs

ceek.

bones

GAS

wtn

and

cranum.

he

A.

a

49,

bone

ower

pareta

sku

273.

venous

snuses

etmod

tympanc

aspect

te

he

E.

N

bone

“ceekbone”

o

dura

occpta

s

s

te

zygomatc

atera

te

papated

mastod

and

a

o

eye.

occpta

he

o

snus

tempora

o

s

snus

wtn

and

sku

B.

be

1063–1068;

squamous,

s

aspect

and

nose

C.

snus

spenoda

GAS

Neck

conluence

he

ocated

272.

and

bones

space.

area

o

outer

sag-

mater.

o

hs

cance-

ayers

o

CHAPTER

D.

he

basa

dran

GAS

279.

C.

874,

he

te

te

878;

aca

and

gves

gand

rom

bucca,

Motor

emerges

to

pared

te

tat

282.

neror:

are

gand.

te

tempora,

T o

A,

Zanzbar

B,

GAS

283.

C,

B.

te

suppes

o

te

bran

D

and

by

(CN

atera

musces

mandbuar

913–915;

he

te

te

ace

cord

we

and

te

te

vertebra

posteror

part

branstem.

he

are

and

spna

o

pter ygo d

and

m as t cat on

d  v s  on

o

and

te

temp or a s

are

s up p e d

tr ge m na

area

N

bend

squamous

men

s

o

n

margns

te

posteror

mater,

te

spna

o

te

ower

ner ves,

ossa.

te

te

t

wt

s

te

n

he

te

te

roots

oramen

o

occpta

down

tube

te

te

te

B.

CN

C,

sory

I

passes

he

bone

GAS

A.

and

and

C.

o

pass

to

nerve,

rom

nerves

te

N

20,

a

te

It

154;

o

ear

branc

and

to

across

te

11,

te

emerges

E.

ateray

n

tympanc

orms

te

te

nnervate

285.

o

te

esser

te

sur-

branc

and

provdes

te

taste

we

as

B

tongue

o

te

C

and

E.

s

84

te

T aste

D.

o

and

o

nerve

he

te

te

834,

bers

te

by

(CN

vagus

sot

te

he

jugu-

o

ngua

te

ay

corda

mucosa

Snce

as

te

branc

VII).

constrctor

(except

musces

66,

136,

X)

or

o

nner vates

tensor

te

137;

ve

te

paa-

par ynx.

ABR/McM

o

B,

to

te

286.

B.

C,

and

s

cartage

and

te

are

te

s

crcod

ncor-

ocated

cartage

made.

48,

49

nnervaton

branc

nerve

nerve

o

rom

superor

does

not

medates

suppes

we

motor

taste

te

aryn-

nnervate

earng

motor

perormng

suppy

n

not

te

to

bers

and

to

suppy

many

musces

anteror

te

unc-

o

aca

two-trds

sensory

patetc

s

an

ce

ts

nerves

to

o

te

o

o

te

o

taste

te

vertgo,

oss

o

oss

o

o

on

nose,

n

ves-

cose

aso

o

usu-

symp-

baance

and

expresson,

te

cornea

and

tat

eventu-

are

are

aca

sensaton

mout

t

manestaton

anteror

relex

and

and

parayss

mastcaton.

he

oter

and

vestbuococear

N

VIII

nerves

musces

te

cerebeopontne

and

tese

tumor

grows,

te

VII

tongue,

84

nvestng

tumor

subsequent

earng,

49,

ntracrana

seat

porton

nerves

ocaton,

oss

150,

patent

wa

ocatons

154;

o

specuum.

outlow

n

syncope

er

va

te

ater

externa

In

sted

ABR/McM

descrbed

vasovaga

otoscope

As

arge

around

954;

renced

nerve.

wt

o

ABR/McM

Scwann

ts

o

aca

he

137;

parayss

E.

posteror

44,

by

membrane,

optons

ABR/McM

neuroma

mpared

musces

A,

GAS

(CN

perormed

membrane

sensory

nerve

does

92,

a

afected,

sensaton

o

a

s

tyrod

oter

nterna

crana

to

two-trds

gands.

tympan,

and

te

yperacuss,

sensaton

o

N

occupes

proxmty

tonsar

two-trds

te

90;

nerve,

acoustc

rom

ange.

body,

tongue,

te

tongue,

1057;

An

ay

petrosa

tonsar

common

trd

or

ner ve

N

or

anteror

te

paate

840–841;

branc.

conveys

posteror

nnervated

aca

musces

GAS

rom

bers

branc

secretomotor

and

tn)

aferent

ngua

and

tonsar

te

ncson

N

ncudng

nystagmus,

a

va

aca

toms

and

It

procedure

ventaton

musces.

a

branc,

49

arway

crcotyrod

cartage

te

ypogossa

te nerve to te styoparyngeus, paryngea brances,

ngua

te

A

receves

tbuococear

wc

carotd

D.

arses

pontne

nerve,

cosey

epgotts.

GAS

te

anmated

not

arway

obstructon.

crcotyrod

1046;

expresson

obon-

te

are

ABR/McM

mmedate

vestbuococear

he

occpta

rom

sted

emergency

gossoparyngea

he

acces-

61

durng

epgotts.

he

D.

oramen.

compartment

te

and

medua

ABR/McM

traves

of

vagus,

te

juguar

nerve

anteror

gves

o

ateray

te

and

mdde

carotd

sde

run

troug

enter

te

pate

par ts,

baance.

subaracnod

crbrorm

gossoparyngea,

medua

oramen.

suppes

te

seec-

posteror

nerve.

tons

gossoparyngea

te

cstern

ar

arse

890–892;

he

ace

he

tree

and

troug

an

at

tyrod

arynx

nerve

te

bone.

E.

nerves

gata.

1041,

he

accessor y

91–93;

s

E.

te

were

tongue

etmod

B,

ts

he

gea

produce

gaments,

and

musces

between

and

s

space.

A.

D,

because

and

dura

vertebra

o

to

N

ncson

between

A.

gaments

cartage.

C,

vagus

rom

o

s

tyroar y-

voca

musces

voca

ods

te

453

Neck

musce

aryngea

ocated

GAS

284.

o

wc

rect

o

ora-

attaced

sweeps

Wtn

conssts

oter

ensure

an

A,

n er ve

40

bone.

mater

as

spna

39,

magnum

part

dura

medua,

and

traverse

basar

he

34,

occpta

oramen

crana

arteres

oramen

te

te

(basoccput).

te

ABR/McM

te

part

magnum

bone

145;

cases

to

makng

crcod

V3).

GAS

D.

and

E.

te

neck

te

to

te

vocas

te

voca

vocas

1050–1051;

n

suppy

to

anteror

te

Crcotyrotomy

es

meda

he

o

te

he

te

perormed

to

ods.

o

e

atera

and

sngng.

D.

to

A and B. he common carotd artery provdes branc-

artery

voca

and

reated

By

and

reaxng

speec

un

musces

adjustments

respectvey,

zygomatc,

A

te

tvey

he

Car.

musces

281.

vocas

musces

mnute

parotd

cervca.

s

he

wtn

by

styomastod

wtn

brances

5

supped

te

and

E.

tenod

parotd

brances

ve

vens

ABR/McM

rom

mandbuar,

tese

are

Gaen.

113;

troug

superor

or

o

expresson

major

margna

mnemonc

111,

wc

ve

ven

aca

passes

of

Rosenta

10,

o

nerve,

nerve

o

great

N

musces

oramen

280.

vens

nto

Head

7

ts

te

vagus

not

reated

61

queston

as

stmuaton

acoustc

orm

are

nerves.

o

meatus

syncope,

nerve

(CN

expe-

o

te

by

an

parasym-

X)

eads

to

454

C H A P T E R

7

decreased

o

te

sma

Head

puse

te

o

nnervated

nerve

surace

te

te

ts

te

pressure.

meatus

o

te

externa

porton

va

o

bood

branc

te

by

Neck

acoustc

aurcuar

externa

na

and

externa

remander

and

o

vagus

nerve.

nerve

(CN

o

te

s

IX)

ts

musces.

s

o

GAS

D.

nner

carotd

o

te

te

945;

artery,

137;

artery,

ABR/McM

tyrod

and

te

tyrocervca

tyrod

rod

N

superor

and

artery,

neror

trunk,

tympanc

ng

tyrod

tyrod

ven,

artery,

te

gands.

te

bood

he

and

externa

a

suppy

externa

to

rovascuar

gand

and

externa

cose

to

durng

GAS

288.

D.

trad

tat

atera

branc

te

o

superor

basar

two

at

te

ten

juncton

neror

be

GAS

289.

B.

he

are

artery,

I

t

s

te

Because

rsk

ts

III).

VI)

posteror

brances

te

basar

te

ocuomotor

150,

s

passes

te

154;

between

rse

vdua

beng

afected

eye

outward

rectus

meda

ocaton

crana

obque

a

te

te

s

te

te

down

eye

te

n

w

t

s

sxt

comparson

downward

musce

(nnervated

nerve)

rectus,

s

not

neror

o

D.

te

o

te

tongue

GAS

293.

C.

patent

Presentatons

rectus,

and

or

te

ack

nratempora

152,

ossa

154;

s

a

ABR/McM

67,

wedge-saped

It s ocated neror to te tempora ossa and

68

regon.

between

varety

nvoved.

postsynap-

be

nner-

afected

nratempora

o

afected.

te

and

te

p

and

te

he

and

dvde

p

o

cn

mar-

and

Compresson

correspondng

ex

over

s

wc

ascends

externa

membrane,

te

because

nerve,

and

te

bucca

mout),

aurcuotempora

tympanc

tempora

sensaton

gand

te

musces),

musces),

afects

anteror

o

cervcoa-

nto

musce).

suppyng

passng

musces),

corner

Pan

parotd

trunk

supraorbta

and

parotd

te

o

nerves

just

acoustc

and

arge

o

54,

53,

145;

are

brances

nerve.

o

59;

rm

o

te

s

pan

o

tat

bucca

mandbuar

branc

brances

provde

two-trds

adjacent

sen-

o

gums,

te

ceek

44

nvoved

a

brusng

up

o

around

cause

to

te

rm.

te

oten

te

eyes.

anosma,

damage

troug

te

“step-of”

ractures

may

due

racture,

bony

ossa

pate

sme,

pass

te

papaton

crana

and

n

papabe

wt

crbrorm

sense

40

skn.

rnorrea

nerves

39,

and

anteror

ABR/McM

anteror

te

ngua

te

sensaton),

N

o

o

hese

te

ABR/McM

te

to

te

crbrorm

pate.

GAS

294.

A.

885,

he

wtn

150,

CSF

oactory

te

neror

are

compan

racture

gand,

upper

at

demonstrate

and

ourt

by

te

nvov-

a

9

brances

overyng

he

A

te

ngua,

gand

w

umen

urter

nvoved

orbta

may

ncude

by

and

he

parayzed

o

mucosa

te

atera

antagonzed

n

te

unctons.

ear,

N

974–977;

I

and

te

(genera

mucosa,

te

nd-

because

te

gand

(patysma

o

nerves

to

wc

te

man-

tempe.

wc

te

s

ossa.

te

str uctures

temporoaca

ten

te

trgemna

saton

nto

tragus,

te

913–915;

he

nerve),

to

ocaton

te

poston.

because

crana

n

normay.

out

o

surace

te

nerves,

arteres

o

to

n

(ower

ter

troug

o

GAS

cerebear

Bot

resut

area

ocuomo-

aneurysm

eye

and

a

compresson

meatus,

68

at

brances

wt

parotd

ner ves

be

musces

brances

anteror

292.

67,

te

ts

T umors

carres

or

parotd

can

(orbta

and

or

passes

can

sde,

te

ts

oreead,

mandbuar

any

o

nearby

rgt

superor

An

o

ante-

eye.

on

n

aveoar,

present

ABR/McM

wc

tempe,

p

cervca

musce,

a

te

dvdes

dvsons,

gna

arteres.

musces.

N

nerve

(upper

artery

nerve

by

o

pterygod

and

ncude

ner ves.

ner ve

mass

gand

aurce,

rgt

(above).

hs

move

te

tone

superor

869–870;

he

to

by

trocear

te

anteror

rectus

wa

meda

ound

ossa

ossa

o

dstended

pontomedu-

anteroateray

artery.

pasy.

n

o

he

obque

or

parayzed

D.

musce

rectus.

superor

290.

be

(nnervated

mantans

GAS

unabe

w

and

te

and

ABR/McM

te

arteres

gves

te

te

pexus

neror

bers

82–85;

o

musces

o

on

te

N

abducens

between

atera

occurs

o

te

abyrntne

mdbran

basar

he

compressed

152,

and

at

uncton

emergng

pons

nerve

961;

zygomatc

PCA coud resut n compresson o te nerve and ead

to

ca

vertebra

At

te

dependng

to

and

aso

tympan

secretons

Because

aca

njury

cerebear

artery.

te

abducton

te

so

troug

49

two

artery

neror

te

hs

nerve

48,

te

branstem.

ound

and

suppes

cerebra

o

by

emerges

usuay

nerve

It

o

te

condton

N

E.

duct

courses

o

corda

compresson

GAS

291.

tyrod

nerve

at

ABR/McM

part

eyes.

weak

te

92;

anteror

s

te

crana

(CN

and

aryngea

abyrntne

te



n

o

te

nerve

869–870;

juncton

tor

cartage.

ormed

juncton,

and

abducts

resut

s

cerebear

mpared

can

to

are

aurcuotempora

(suppes

87,

nerve

abducens

aneurysm.

N

te

(crana

ror

wc

tyrod

neror

brances:

and

ary

he

tyrod

superor

artery

pontomeduary

nerve

te

te

1050–1051;

he

rst

to

superor

and

ossa.

tyrodectomy.

arteres

to

orgnates

atera

venous

troug

parasympatetc

by

branc

o te superor aryngea nerve course togeter n a neu-

artery

nratempora

vaton,

ty-

and

pterygod

symptoms

tc

branc

superor

ateray

aurcuotempora,

and

te

he

o

masseter,

he

passng

bucca,

84

branc

provde

paratyrod

superor

a

mandbe

maxary

dbuar,

by

o

838,

he

te

Ner ves

branc.

287.

te

temporas,

nnervated

va

o

te

trgem-

he

ramus

parynx meday. he contents o te ossa ncude te

ncudng

branc.

membrane

o

te

te

membrane,

dvson

aurcuotempora

part

by

Most

meatus,

tympanc

mandbuar

gossoparyngea

posteror

nnervated

acoustc

te

tympanc

he

s

1061,

nerves

te

1074;

tat

N

18,

contro

zygomatc

nerve,

46,

130;

acrma

rom

te

ABR/McM

secreton

maxary

12

pass

nerve

and te pterygopaatne gangon, troug te neror

orbta

greater

ssure,

wng

wc

o

te

s

ound

spenod

n

te

and

orbt

te

between

orbta

te

surace

CHAPTER

o

te

maxa.

afected

by

abducens

o

te

part

are

E

295.

A.

te

process

god

B.

A,

E.

and

C,

te

D,

N

E.

o

he

aca

gangon,

te

deep

E.

he

troug

te

and

984;

nerves

te

orbt

and

N

te

tat

wng

contro

orbta

te

o

te

12

to

as

are

te

(Vdan

greater

be

a-

do

Fg.

bers

A,

ner ve,

o

s

bers

te

987;

te

was

te

N

te

afected

te

n

20,

63,

te

were

or

te

oter

patent

trapped

B.

sde

o

by

to

BP

te

26,

te

te

pass

to

t

damage

133;

E.

to

Deep

parta

ower

to

te

An

to

te

superor

superor

obque

cana

bone.

11

because

te

n

o

dam-

neror

transmt

nerve

secreto-

woud

a

damaged

obque

superomeday

n

nabty

ts

not

nerve

musce

s

to

produce

damage

carotid

and

obque

w

tears

and

plexus

petrosal

ner ve

ganglion

carotid

2

ner ve ] 3

Inter nal Facial

carotid ner ve

[VII]

ar ter y Superior

cer vical

trunk sympathetic

Car tilage

foramen

filling

lacerum

Preganglionic

sympathetic

ner ves

pter ygoid

canal

in

zygomaticotemporal

nerve

Fig.

8.157A

rom

not

te

an

resut

musce.

musce

tereore

w

w

ner ve

Sympathetic

w

he

tse

not

be

patent.

Geniculate

ner ve

petrosal

resuts

and

and

Inter nal

GAS

aca

orbt.

]

•

te

aca

resutng

ptoss

eyed

]

nerves

aso

tese

pass.

eter

neror

upper

1

of

are

sted.

ner ve

Zygomatic

Parasympathetic

te

ABR/McM

wtn

gand

rom

te

or

te

Greater

branch

o

te

bone,

tat

gland

of

ace

tempora

zygomatc

symptoms

te

damage

damaged

maxa

Ner ve

n

Inabty to depress te adducted eyeba w resut

run

n

[V

n

orbt

nerves

acrma

sufers

sympatetc

[V

te

and

ter

because

brances

runnng

to

ocated

te

decent

zygomatc

te

musce;

Compete

nerve

bone.

[V

because

cana

mpnged

dstorted

Damage

te

rom

Lacrimal

o

bone.

or

racture

structures

bers

aca

rgt

key

to

key

Inter nal Lacrimal

o

ssure,

he

a

rom

D.

25

ound

n

tempora

nnervated

racture

nabty

synapse

secreton

wc

key

two-trds

submandbuar

deectve.

8.157A).

ABR/McM

surace

spenod

C.

or

pter ygopa-

not

te

455

Neck

GAS 927, 986; N 61, 63, 96, BP 26; ABR/McM 11, 52

299.

( Vdan

petrosa

acrma

orbta

to

motor

artery,

sympatetc

ssure,

983,

he

o

are

resut

orbta

cana).

cana

te

wc

63;

D.

age

te

te

wc

A, B. C. E.

cana

( GAS

a

GAS

298.

rgt.

not

anteror

rom

compromsed

nerve,

ptery-

on

te

te

were

nerve

o

Movements

resut

n

aca

musces

ee-

mandbe,

woud

cana

gands

proxmty,

jaw

rom

secretons

part

key

coronod

parasympatetc

62,

te

petrous

55

synapse

gangon

neror

jons

weaken

meda

te

pter ygod

ner ve,

61,

D,

ramus.

te

to

o

te

T aste

and

and

nerve sgnas are carred by te corda tympan, wc

tey

jaw

pterygod

te

postsynaptc

46,

between

greater

te

to

and

sensaton

va

on

petrosa

pter ygopaatne

982,

o

woud

D.

subngua

jaw.

pterygod

o

C,

as

11,

poweru

atera

pterygod

ner ve

go

ramus

te

presynaptc

eventuay

rom

te

te

B,

C,

tongue

B.

most

ABR/McM

ner ve

contans

te

82;

troug

nerve

te

o

A,

mdde

njury

ABR/McM

eevators

devaton

and

be

he

dvsons

te

optons

te

Masseter

two

o

n

o

not

orbt.

and

troug

attaces

eevate

 r a c t u re

atne

GAS

te

musce,

acton

cause

975–977;

wc

n

snce

to

Sa   va t  o n

by

ner ve)

297.

uncton

woud

133;

mandbuar

jaw,

te

orbt.

26,

oter

Coursng

rom

te

racture.

D,

ven,

o

BP

te

ected

296.

63,

woud

o

nerve,

pass

resuts

te

Unopposed

GAS

wc

temporas

st

nerve

apex

consequences

above

et

C,

a

musces,

coud

te

nasocary

nerve

te

te

near

apex

20,

o

o

te

te

N

Fracture

vator,

key

to

923;

zygomatc

te

ssure,

beng

eevaton

B.

nerve,

coser

GAS

he

racture

ocuomotor

o

and

a

Head

7

from

T1

ganglion

resut

ony

rom

resut

para-

rom

456

C H A P T E R

7

Head

and

Neck

Ner ve

of

pter ygoid

canal

A.

Faure

ace Inferior

orbital

Pter ygopalatine

eye

Faed

n

D.

I

to

to

dferentate

nduce

resuts

n

te

sur-

aure

o

orm.

obteraton

E.

I

303.

N

102;

B.

he

te

optc

te

te

ace

ens

etmod

Preganglionic

parasympathetic

nerves

Postganglionic

parasympathetic

nerves

nasa

Preganglionic

sympathetic

ner ves

Postganglionic

sympathetic

ner ves

te

space

resuts

pgmented

and

meatus

by

te

paranasa

separate

cavtes

are

here

nto

w

groups

are

te

te

and

deveopng

rom

not

way

o

te

sur-

orm.

snuses

nto

tract

meatus),

te

at

te

mdde

nectons

cavty,

n

ces:

nundbuum

spread

nasa

o

meatus

nto

etmod

te

ocated

nasa

nasa

(dran

can

ces

groups

superor

te

hs

o

tree

mdde

anteror

atus).

respratory

te

entrey.

41

nto

bua),

overap

orm

not

eye

snuses

(dran

(dran

semunar

upper

ntraretna

not

to

does

te

bone.

te

a

vesce

ABR/McM

etmod

te

between

does

w

etmod

posteror

nerve

cup

rs

ectoderm,

mdde

o

separaton

ayers.

te

ens,

Fig.

to

retna

neura

GAS

neuroectoderm

fossa

B.

•

te

fissure

te

Infra-orbital

o

ectoderm

at

rom

eadng

to

nectons.

8.157B

A.

he

audtory

tube

runs

rom

te

mdde

ear

to

te

nasoparynx.

damage

te

to

tempora

GAS

300.

A.

927,

he

B.

zygomatc

branc.

929;

N

petrous

mdde

aca

te

pterygopaatne

and

nner

nerve

earng

to

or

Fg.

96;

te

and

as

traveng

ts

rom

ABR/McM

te

52,

bone

aca

53,

54

ouses

cana

wt

D,

te

w

te

D,

E.

ng

oss,

but

not

GAS

he

and

te

1030;

w

produce

not

E.

cause

D.

he

addtona

te

te

ear

nner

ear

pasy

110;

coud

or

or

account

earng

ack

ABR/McM

o

or

oss

te

and

ear-

spenoda

1061;

N

vertgo,

hs

acrmaton.

te

301.

B.

o

ducts

acrma

o

wc

vagus

A.

s

o

he

he

te

esser

aca,

membrane,

gossoparyngea,

aure

and

te

great

aurcuar

jont

and

nerves

305.

externa

947;

nant’s

rom

E.

s

o

suppy

sku

te

bend

responsbe

te

and

tongue

skn

te

or

and

on

te

are

nerve

and

nnervaton

are

not

107;

to

aure

s

taste

to

te

de

to

D.

and

pexus

troug

an

wt

te

o

te

A,

exter-

N

306.

s

57

known

corod

tat

nto

and

rom

te

In

o

ts

grooves

te

oten

te

acr-

sde

o

speno-

wt

p

condton,

te

uson

process

batera

upper

dranng

ubrcates

te

to

te

tears

conjunctva.

o

te

te

mesen-

atera

nasa

as

B.

B,

Cons

63;

Te

coloboma

ssure

to

use.

and

It

g  ve

o

te

arc

and

n

a

nasa

prom-

paate,

we

segment

unatera

(cranoaca

caracterzed

mandbe,

deects

o

wt

cet

p.

dysosto-

by

maar

downward

te

abnormates

syndrome

to

mgrate

week

ower

o

te

eye-

md-

o

s

because

nto

te

o

rst

aure

arc

o

dur-

deveopment.

not

seen

n

ts

case.

16

c e re b e   a r

te

atera

bood

dsorder

cetng

superor

b e  o re

passes

resuts

ssures,

ces

ourt

Faca

and

ears.

rst

crest

meda

p

ntermaxary

syndrome

ears,

ABR/McM

datey

te

underdeveoped

a

te

E.

o

cet

16

autosoma

s

te

processes

nterna

hs

uson

medan

o

externa

and

o

a

papebra

and

ng

te

n

uson

T reacer

ds

sensaton

tympanc

assocated

ABR/McM

condton

te

atera

5

rare

orbt.

open

aure

ABR/McM

santng

ear.

meatus.

N

o

neura

petrosa

drans

are

te

maxary

resuts

maxary

31;

ss)

ear.

acoustc

944,

resuts

tympan

autonomc

ear

nerves

te

two-trds

esser

mdde

he

o

snus

extend

ake

rom

te

ypopasa,

occpta

aspect

mdde

he

na

and

temporomandbuar

corda

carry

C.

tympanc

N

te

anteror

302.

te

respectvey.

he

GAS

te

n

aurcuotempora

posteror

E.

by

s

nerves.

ear,

D.

damage

supped

suppy

C.

nences

area

drans

te

process.

301–308

he

on

ABR/McM

tat

A, B, C. E. Faure

Answers

ndrecty

ocated

cets

margn

resuts

cyme

57

43–44;

aca

anomaes

meda

rom

s

recess.

Obque

aca

duct

wc

orbt.

nasoacrma

mdde

aca

N

gand,

GAS

symptoms.

C,

nasoacrma

ma

etmoda

304.

ossa

he

te

t.

but

C.

zygomatco-

8.157B).

nratempora

vertgo

or

tempora

troug

te

oss

26,

o

ear

passng

Damage

(GAS

BP

part

nerve,

gangon,

ar ter y

termnaton

b e  ow

suppy

to

c e re b e   u m .

te

te

An

o

orgnates

te

basar

ocuomotor

anteror

and

aneur ysm

o

mme-

a r t e r y.

n e r ve

meda

te

to

par ts

superor

CHAPTER

c e re b e   a r

p a  s y.

te

car y

ng

n

ors

o

ar ter y

Ts

and

e ye

(abducton)

A,

C,

cause

D,

GAS

C.

o

o

n

o

age

B,

tat

no

te

D,

o

ts

ng

In

baby

n

adducton,

s

abor.

an

super-

atera

rues

o

devaton

a

ng

and

nerve

woud

compete,

not

308.

C.

low

154;

caused

ts

te

was

o

te

nant

apped

because

However,

tat

Communcatng

reabsorpton

arac-

dran-

te

864;

hs

N

ventrces

cesarean

secton

ydrocepaus,

Some

Juus

s

s

o

te

te

peope

Caesar

moter

probaby

was

te

bodes

hese

tey

o

o

bers

are

appetzng

A.

B.

dev-

dur-

apocrypa.

to



e

Juus

a

o

to

a

seres

tese

woman

te

Caesar

ssued

One

mdwe)

s

ABR/McM

gustatory

s

n

attempt

moter

tat

parotd

gand

rues

abor

devery

ded

dur-

caed

Frey

72

aso

was

nnervated

gand

nerves,

61,

sweatng,

parotd

nerves

trave

were

wc

gands

tat

ood

removed,

te

cut,

are

te

ganduar

but

ocated

n

ts

n

epteum.

te

case),

skn

o

nduce

te

n

nerve

te

te

nerve,

he

otc

occurs

cary

and

cosest

ace.

savaton

sweatng

contros

pupae

mucous

aurcuotempora

normay

gangon

Under

(seeng

nstead.

musce

and

musce.

gangon

secreton

o

contros

nasa

acrmaton

cavtes

and

para-

snuses.

Submandbuar

submandbuar

E.

te

ganduar

Pterygopaatne

nasa

D.

wt

out”

sweat

Cary

and

tnk

ded

as

tose

crcumstances

n

term

a

mmedatey

Wen

“sougt

gands

act

s

codes.

attendng

111–113;

patent

spncter

atoug

Cesarean

to

wen

Neck

gangon, were undamaged and abe to regenerate bers.

system.

by

story

o

or

a

ater

or

te

nterestng.

ncson

cere-

o

venous

te

te

be

responsbe

Incdentay,

or

n

can

tat

Empre,

and

cdbrt.

syndrome.

ce

s

Roman

equvaent

vabe

epteum

reabsorpton,

unctonng

devered

s

CSF .

are

hs

bockage

mpared

condton,

dated.

an

by

68

accumuaton

bran.

mpared

abnorma

nto

te

(oten

wc

ABR/McM

te

somebody

(probaby

re c t u s

expanaton

o

caed

requred

musces

atera

abnorma

o

Syvus),

secton”

troug

152,

s

responsbe

term

ered

CSF

E.

“cesarean

te

te

ocuomotor

producton

s

o

become

way

extrnsc

o

o

key

emperor

GAS

to

150,

granuatons,

bran

te

re s u  t  n g

ventrces

excessve

because

o

and

re s u  t -

papebrae

more

was

e ye .

abnorma

ydrocepaus

nod

 e va t o r

e xc e p t  o n

not

N

te

aqueduct

CSF

constrctor

A

to

postgangonc

869–870;

rarey,

n e r ve

ptoss.

CSF

bra

te

Damage

Hydrocepaus

because

A,

te

ocuomotor

parasympatetcs

pupar y

obque,

E.

n

te

ptoss,

te

abducton,

parta,

307.

n

wt

superor

and

vson,

re s u  t  n g

re s u  t

aect

body

burr y

te

woud

w

Head

7

Superor

gangon

and

savator y

parasympatetc

ner ve.

contros

subngua

nuceus

bers

tat

savaton

savary

contans

are

rom

gands.

presynaptc

carred

by

aca

457

8 Neuroanatomy

Q u e st i o n s

1.

A

28-year-od

ment

40

veice

coision.

patent

s

Pysca

ace

and

tere

s

wc

key

aert

njures

o

be

te

Loss

o

trd

o

C.

Devaton

D.

Loss

E.

Loss

o

a

te

o

te

in

unrestrained

to

pace

severa

te

sku

racture

nerve

emergency

invoved

at

driver.

person

sows

ndngs

he

te

te

max-

te

I

taste

on

te

te

sensaton

to

toward

te

te

ower

eyed,

aferent

man

by

s

nsde

to

and

(CT)

o

scan

o

te

bood

oowng

ouse

pace,

to

a

1

he

te

cnca

rgt

A

s

Hs

mm

pup

a

typca

D.

Meda

ongtudna

E.

Cerebra

and

B.

Let

C.

Let

Let

upper

ower

o

8-year-od

a

moter

says

eadace

vomted

no

awake

puse

37.1°C

mn,

tat

458

te

t

tred

te

s

pyscan’s

s-

ed.

and

bot

98/

puse

s

Se

s

eyes

aert.

nds

t

wc

responsbe

o

or

mdbran

s

brougt

2-mont

Her

te

to

n

te

te

pons

ew

cecks

pyscan

story

scoo

past

nger

abe

to

durng

structures

o

by

monts.

ave

Her

been

er

par-

eadaces

perormance

s

te

most

n

er

track

“H

key

et

te

as

and

been

growt

norma.

test.”

ower

and

Pysca

Wc

afected

n

n

te

pareta

devates

B.

Optc

radaton

n

te

tempora

tomograpy

C.

Optc

nerve

D.

Optc

tract

E.

Optc

casm

co-

ts

o

patent’s

5.

A

62-year-od

by

s

man

we

s

brougt

because

o

to

o

ts

radaton

Wc

tempora

pyscan’s

Optc

wt

macuar

to

te

pyscan

e

2

wakes

te

Pysca

to

because

Hs

day.

He

Hs

o

mm

Hg.

are

he

examnaton

mantan

s

a

as

temperature

respratons

120/70

dicut

up

entre

days.

because

eadaces.

he

swaowng.

et

80/mn,

s

conrms

to

ndngs?

A.

ton

persstent

asts

past

pressure

but

patent

days

typcay

over

bood

o

key

tumor

nger

te

vsua

usng

oowng

patent?

obe

obe

te

emergency

numbness

and

depart-

tngng

on

te et sde o s ace and over s rgt upper and ower

brougt

most

(98.8°F),

and

appears

and

s

a

Bopsy

Damage

Pysca

obe.

emanopsa

story

are

sows

te

as

rom

quadrantanopsa

boy

s

He

examnaton sows tat te patent s unabe to denty

t)

quadrantanopsa

tat

twce

over

extremtes.

4-mont

ossa.

asccuus

a

we-cd

soundng

Let

ead

ne.

II–XII

emergency

sparng

E.

te

stragt

nerves

(7

anopsa

D.

o

probems.

prevous

emanopsa

omonymous

gr

because

vson

crana

n

a

aqueduct

7-year-od

ment

Btempora

An

A

te

examnaton

pyramds

condton?

A.

pysca

emnscus

ents

o

structures

Meda

ceek

tat

o

bran

Meduary

one

n

crana

meduobastoma.

C.

bconvex-saped

tempora

posteror

o

and

scan

B.

njury

Hg.

computed

sows

s

He

patent

person.

rgt

sgns

ago.

m

CT

most

reex

te

2.13

100/85

rgt.

ead

n

nto

our

and

s

cornea

ang

dated

te

te

brougt

ater

pressure

sows

and

s

o

condtons.

tme,

downward

mb

we

ter

bood

examnaton

patent’s

decnng

te

te

oowng

ts

A

verms

posteror

o

n

ee-to-toe

Cerebear

woud

sde

ntact.

dagnoss

wak

probems

A.

4.

tongue

to

vson

ovae,

tongue

o

medca

orented

3.

ocated

reex

and

asked

no

grossy

te

ovae.

oramen

as

ony.

on

mnor

oramen

te

wen

motor

abrasons

te

wtn

cnca

and

depart-

a

p

o

scafod

te

x-ray

jerk

31-year-od

ecton

te

sows

sensaton

department

mn

to

was

orented

oowng

jaw

o

upper

o

was

and

to

e

seen?

B.

tory

He

An

njury

Loss

a

brougt

ater

and

cest.

A.

A

is

examnaton

oaca

2.

man

minutes

more

sows

pup

a

s

oarse

as

we

tan

nondstressed

voce

Pysca

wt

parta

avng

s

norma.

man

wt

been

says

an

dicuty

as

ataxc

droopng

been

examna-

gat,

o

te

te

eye-

d, and tere s a oss o te gag reex. here s decreased

sensory

and

pan

sensaton

on

te

et

sde

o

te

ace,

and rgt sde upper and ower extremtes. Wc o te

oowng

arteres

A.

Anteror

16/

B.

Posteror

boy

C.

Anteror

D.

Mdde

E.

Basar

sows

aso

patent’s

constrcted

s

baance

patent

he

woud

spna

neror

neror

cerebra

artery

most

key

be

occuded?

artery

cerebear

cerebear

artery

artery

artery

(MCA)

(PICA)

(AICA)

CHAPTER

6.

A 65-year-od man comes to te emergency department

by

because

te

He

o

as

never

a

a

istory

been

incude

severe

tis

type

day.

His

mm

He

n

entre

s

te

ower

mb

ead

and

sows

Injury

key

an

area

Anteror

B.

Mdde

o

ts

cerebra

cerebra

artery

artery

Posteror

cerebra

communcatng

E.

Basar

2

wt

a

3

a

on

man

pack

mm

ng

redness

tssue

wtn

access

te

D.

V entromeda

E.

Latera

beers

150/90

et

eg

n

s

sensaton

Hs

s

n

vson

CT

scan

rgt

9.

and

Fronta

6-week

o

er

and

ron-

probems

and

Hs

te

day

and

bood

bend

te

externa

cnca

acoustc

pcture

parencyma

s

usng

Externa

D.

Interna

Pareta

E.

A

o

Se

vsua

a

tumor

te

s

a

a

eds

Meda

gencuate

nuceus

o

te

taamus

10.

s

56-year-od

department

durng

→

Interna

→

ear

Interna

→

→

ear

Interna

Externa

woman

story

no

Etmod

→

ear

ear

a

and

weeks.

day

he

o

he

a

→

te

A

sea

A

tube

Mastod

ces

Maxary

snus

scan

te

Hg,

and

ead

s

symptoms

te

te

o

brougt

sudden

s

to

evdence

emergency

o

s

a

o

eadace

conused

bood

are

stroke.

aso

te

Se

respratons

woud

taamus

onset

103/mn,

scemc

taamus

te

taamus

mornng.

sows

an

o

a

ts

puse

conrmng

owng

→

A.

→

B.

→

→

n

o

o

s

kg

mpar-

Pysca

tempora

ead

says

Se

symptoms

can

tat

eats

b)

n

be

nto

adenoma

scedued.

(10

sows

extenson

ptutary

patent

4.5

er

te

wt

because

vson

probems.

appette.

ganed

new

and

scan

turcca

te

pyscan

vson

CT

resecton

ncreased

patent’s

te

medca

dagnoss

surgca

as

to

decreased

examnaton,

and

Her

mm

o

o

breakast

156/93

PCA

te

ces

Audtory

→

eadaces

oter

sows

sgncanty

tmes

comes

bateray.

ypotaamus.

made,

er

woman

because

dsorented.

gan

o

A

o

nuceus

nuceus

sensory

structures?

16/mn.

A

occuson

Wc

present

and

pressure

o

durng

s

CT

o

te

te

o-

pysca

Contraatera

parayss

and

oss

o

sensaton

o

te

extremtes

Broca

apasa

sensaton

C.

Contraatera

D.

CN

E.

Quadrpega

IV

wt

to

te

contraatera

ace

and

emanopsa

parayss

upper

wt

and

oss

extremtes

macuar

sparng

pasy

wt

oss

o

aca,

tongue,

and

mout

movements

wtn

oow-up

symptoms.

V entra

atera

nuceus

er

examnaton?

→

as

examnaton

oowng

er

o

Lgty

provdes

E.

to

11.

A newborn gr s beng evauated n te neonata nten-

sve

4-mont

ects

patent

D.

2

Interna ear → Externa ear → Fronta snus → Fronta

ment.

te

drnk

Inspecton

taamus

obe

44-year-od

sde

ts

day

and

16/mn

asymmetry.

te

obe

8.

o

rgt

n

Hg.

or

o

obe

ear

wc

mm

rases,

or

are

nuceus

o

ear

T empora

te

respratons

sec-

yperten-

smoke

gencuate

Cerebeum

C.

on

nerve

ncude

not

te

teet,

Latera

ower

ear

ace

er

C.

meatus.

wc

nto

s140/90

severa

type

swe-

to

te

afected

does

sde

stabbng

durng

brusng

76/mn,

esons,

asts

because

rgt

posteroatera

granua-

key

no

tat

te

sarp,

ponts

probems

Se

n

severe,

jaw

cewng,

s

pressure

a

mutpe

medca

puse

as

pyscan

pan

posteromeda

Otoscopc

and

wt

t

and

at

osteoartrts.

Her

te

V entra

39.1°C

sows

ceek

occurs

oter

to

V entra

pressure

ear.

dranage

s

comes

ntermttent

B.

drnks

temperature

and

puruent

ts

a

nuceus

A.

ypercoesteroema.

durng

nuceus

rgt

ncude

examnaton

area

depart-

severe

Her

sows

he

and

rgt

pan

bood

tappng

o

descrbes

worsened

and

ace

emergency

structures

nuceus

woman

Se

er

acoo.

obe

Externa

s

son

condton?

oowng

nuceus

ypotaamc

story

he

smng.

woud

te

nuceus

ace.

n

onds.

o

o

ypotaamc

51-year-od

o

and

ever

cgarettes

te

bran

ear

A

pan

s

routes?

Externa

B.

a

3

is

arteres

current

te

o

101/mn

sows

causng

A.

to

Pysca

o

patogen

to

Anteror

artery

medca

o

s

Hg.

examnaton

oowng

comes

weekends.

puse

128/80

ton

C.

as

(PCA)

stor y

oter

te

(102.5°F),

and

artery

ypertenson,

smokes

beers

a

He

nput

4-day

Hs

dabetes,

He

Posteror

artery

68-year-od

pan.

Supracasmatc

B.

(ACA)

Posteror

ear

n

wc

A.

to

A

to

procedure?

ave

(MCA)

D.

ment

ntact.

damage

probems

sensaton

sensory

ago.

Neuroogic

is

oowng

patent’s

C.

A

in

bateray.

are

te

2

oriented.

ypodensty

o

tey

pressure

3/5

and

5/5

II–XII

wc

expan

A.

was

but

drinks

decreased

Motor

ace

CNs

to

and

and

a

ours

medica

bood

strengt

s

2

ypertension.

and

here

mb.

and

oter

and

aert

is

started

eadaces,

istory

awake,

eg.

tat

His

110/min

sows

mpared

most

7.

et

obe.

is

rgt

upper

not

ta

s

diabetes

is

examination

5/5

tension

smoking

puse

Hg.

o

intense.

2

25-pack-year

eadace

459

Neuroanatomy

8

care

devered

od

he

mm

g).

Hg.

at

he

sezures.

weeks’

devery

necesstatng

weged

Puse

30

s

Pysca

2100

180/mn

g

he

gestaton

was

patent

to

a

compcated

orceps-asssted

at

and

examnaton

brt

(ow

bood

sows

an

by

devery.

brt

pressure

was

22-year-

wegt

s

60/40

rrtabe

nant

wt bugng ontanees. Imagng o te bran conrms

patent

past

new-onset

ago

abor

patent