1.

The general name for an alternate pathway of blood flow in or

around an organ, around a joint, or past an obstruction is called:
an arteriovenous anastomosis
a periarticular network
a perivascular plexus
a venous plexus
collateral circulation
2. When standing in the Anatomical Position the palms of the hands
face:
anteriorly
laterally
medially
posteriorly
superiorly
3. While wandering around in the dark in an unfamiliar home, a visitor
accidentally walks into a plate glass door. The door shatters and a
shard of glass severs the posterolateral aspect of the woman's
neck. Examination reveals that the she is unable to elevate the tip
of her shoulder on the injured side. The nerve injured is:
accessory
dorsal scapular
greater occiptal
spinal nerve C4
thoracodorsal
4. The regionally named layer of tissue which encloses and binds
muscle groups together is the:
deep fascia
intermuscular septum

neurovascular bundle
skin
subcutaneous tissue
5. The portion of the skin that serves as a barrier to water loss is the:
dermis
subcutaneous tissue
superficial fascia
epidermis
deep fascia
6. Hair, nails and teeth (enamel) originate in common with what
layer?
deep fascia
epidermis
panniculus adiposis
subcutaneous tissue
superficial fascia
7. A person receives a laceration along the anterior border of the
trapezius muscle in the neck and subsequently the point of his
shoulder (scapula) sags and he has some difficulty fully abducting
his arm. What nerve appears to have been severed?
accessory (Cr. N. XI)
axillary
dorsal scapular
greater occipital
suprascapular
8. When people are severely burned they have great difficulty with
fluid loss because the portion of the skin which is the fluid barrier is
destroyed. Which layer of the skin is responsible for preventing

fluid loss?
dermis
epidermis
investing fascia
panniculus adiposus
subcutaneous tissue
9. The cutaneous branch of the posterior primary ramus of C2 is
called the:
Accessory nerve
Great auricular nerve
Greater occipital nerve
Lesser occipital nerve
Superior ramus of the ansa cervicalis
10. Interruption of cranial nerve XI would paralyze which
muscle?
deltoid
latissimus dorsi
levator scapulae
rhomboideus major
trapezius
11. A motorcyclist lost control of his bike after hitting a wet spot
on the pavement. He hit a curb and was catapulted several feet,
landing on the point of his right shoulder and the right side of his
head and neck, severely stretching his neck. He was taken to the
emergency room with abrasions, lacerations and multiple injuries
to both fleshy and bony tissues. Given this scenario, answer the
following:
For the integument to bleed or for tissue fluid to ooze from the
abrasions, what layers must be damaged?

epidermis and dermis
epidermis and superficial fascia
epidermis and deep fascia
dermis and superficial fascia
dermis and deep fascia
12. Sutures (stitches) would be placed in which tough layer of
the skin in order to sew up the lacerations?
epidermis
deep fascia
dermis
subcutaneous tissue
superficial fascia
13. After initial examination, the patient is sent to radiology.
Radiographs reveal that the portion of the scapula forming the tip
or point of the shoulder has been fractured. This bone is the:
acromion
angle
coracoid
glenoid
spine
14. Elevation of the tip of the patient's right shoulder was still
possible indicating that which of the following nerves was intact?
accessory
axillary
dorsal scapular

suprascapular
thoracodorsal
15. Panniculus adiposus refers to an abundance of fat in the:
deep fascia
muscular fascia
skin
subcutaneous tissue
neurovascular bundles
16. In order to make an intramuscular injection, the needle must
pass through several layers of tissue to reach the muscle. Choose
the correct order of tissues the needle would pass through from
superficial to deep.
Epidermis, dermis, investing fascia, subcutaneous tissue,
muscle
Epidermis, dermis, subcutaneous tissue, investing fascia,
muscle
Epidermis, investing fascia, dermis, subcutaneous tissue,
muscle
Epidermis, subcutaneous tissue, dermis, investing fascia,
muscle
Epidermis, subcutaneous tissue, investing fascia, dermis,
muscle
17. From your observations while removing the skin from the
cadaver, in which area did you find the skin to be the thickest?
Anterior surface of the forearm
Anterior surface of the chest
Medial surface of the arm

Posterior surface of the forearm
Posterior surface of the neck and scalp
18. Loss of function, paralysis, of which muscle would result in
drooping or sagging of the shoulder?
Erector spinae
Latissumus dorsi
Levator scapulae
Rhomboideus major
Trapezius
19. During the first day of class a student lacerated his finger
while putting a new blade on his scalpel. The cut penetrated the
skin and it was necessary for him to go to the emergency room to
have it stitched up. Which layers would the ER physician include in
the stitches in order to close only the skin?
Dermis, subcutaneous tissue, deep fascia
Dermis, superficial fascia, deep fascia
Epidermis, dermis
Epidermis, dermis, investing fascia
Epidermis, subcutaneous tissue
20. As you are sitting in a quiz, the skin immediately over the
base of the spine of your scapula begins to itch. The sensation
from this area is mediated through which nervous structure?
Accessory nerve
Dorsal primary ramus of C7
Dorsal root of T2
Ventral primary ramus C7
Ventral root of T2

21. A patient complains of pain on the lower left side of her back.
A radiograph confirms a hernia passing posterolaterally
immediately superior to the iliac crest. This hernia passes through
the:
Lumbar triangle
Triangle of auscultation
Inguinal triangle
Triangle of Calot
Greater sciatic foramen
22. If the right dorsal scapular nerve were cut near its origin,
what would result:
Skin of the upper back on the right side would be numb
The point of the right shoulder would droop
Scapular retraction on the right would be weakened
Extension of the right arm would be weakened
Inability to adduct the right arm
23. The transverse cervical artery is severed in an auto accident.
What muscle would be affected the most?
Levator scapulae
Rhomboideus minor
Rhomboideus major
Trapezius
Latissimus dorsi
24. During a triathalon biking accident, a rider fell and landed
with the handle bar of her bike forced upward into her right axilla.
Subsequently while swimming in another triathalon event she
found that her right arm tired so badly during the swimming portion
that she could barely finish the event. During examination it was
found that movements involving adduction, medial rotation and

extension of her arm were particularly weak and affected her
swimming stroke. The nerve injured was the:
Accessory
Dorsal scapular
Lateral pectoral
Medial pectoral
Thoracodorsal
25. In order for a skin abrasion to bleed, the lesion must
penetrate at least into the:
Dermis
Deep fascia
Epidermis
Muscular fascia
Subcutaneous tissue
26. After a penetrating wound in the area of the posterior axillary
fold a patient had weakness in extension and adduction of the arm.
Which muscle is likely involved?
Latissimus dorsi
Pectoralis major
Levator scapulae
Rhomboideus major
Trapezius
1. The correct answer is: collateral circulation
When the body moves, vessels in certain locations may become
constricted. Collateral circulation allows blood to flow around potential
constrictions, such as at moveable joints. An arteriovenous anastomosis
is a shunt between arterioles and venules that can divert blood away

from a capillary bed. A periarticular network sounds good, and is pretty
much descriptive of collateral circulation, but it's not the winner. A
perivascular plexus is a collection of autonomic nerve fibers that follow
blood vessels to reach a target to innervate (including the vessels
themselves). A venous plexus is a network of small veins - the internal
vertebral plexus around the dural sac is a good example.

2. The correct answer is: anteriorly
In the anatomical position, the body stands erect, upper limbs at the
sides, palms facing forward or anteriorly, thumbs pointing away from the
body.

3. The correct answer is: accessory nerve
The accessory nerve innervates the trapezius which is the muscle
responsible for elevating the acromion of the scapula, also known as the
tip of the shoulder. If a patient has damaged her accessory nerve, she
will be unable to elevate her acromion. The dorsal scapular nerve
innervates three muscles: rhomboideus major, rhomboideus minor, and
the lower portion of levator scapulae. The rhomboids and trapezius
retract the scapula toward the midline. So, if the dorsal scapular nerve is
injured and rhomboids are paralyzed, retraction of the scapula on the
affected side will be weakened. The greater occipital nerve supplies
upper deep neck muscles and cutaneous sensation to the posterior
scalp. Spinal nerve C4 refers to the nerve formed by the dorsal and
ventral roots of C4. This nerve does not innervate the trapezius.
Although branches from the ventral primary rami of C3 and C4 combine
with the accessory nerve to form the subtrapezial plexus, C3 and C4
provide only proprioception and are not involved with the motion of the
trapezius. Finally, the thoracodorsal nerve innervates latissimus dorsi.
The latissimus dorsi is the muscle used to extend the arm or raise the
trunk to the arms, as if climbing or doing chin-ups. If the thoracodorsal
nerve was injured, a patient would be unable to complete these motions.


4. The correct answer is: deep fascia
Deep fascia is a dense layer of connective tissue that invests structures
such as the muscles. Intermuscular septae are specific fascial planes
that separate groups of muscles into different compartments, a concept
that will be very important for understanding the limbs. A neurovascular
bundle is a combination of a nerve and vasculature (arteries, veins, and
lymphatics) which may travel together in a packet. These bundles may
vary in size and do not always contain all of these elements. Skin is the
most superficial structure of the body, and it is comprised of the
epidermis and dermis. The subcutaneous tissue, also known as the
hypodermis or superficial fascia, is the mostly fat filled layer which lays
directly underneath the skin. Although skin and subcutaneous tissue
cover the muscles, these layers do not directly invest and enclose
regional muscle groups--that's the job of the deep fascia.

5. The correct answer is: epidermis
The keritinized epidermis, which is the most superficial layer of skin, is
responsible for serving as a barrier to water loss. The dermis, found
directly below the epidermis, contains collagen and elastin, fibers which
provide the skin with tensile strength and tone. The dermis also contains
hair follicles, sweat glands, and sebaceous glands. The subcutaneous
tissue (hypodermis, superficial fascia) is a loose and fatty connective
tissue. It protects the skin from bony protuberances and helps with
thermal regulation. The subcutaneous tissue also contains sweat glands
and cutaneous nerves. The deep fascia is a dense layer of connective
tissue that invests structures such as the muscles.

6. The correct answer is: epidermis

Ectoderm is the embryonic layer that gives rise to skin, nails, hair, and
the enamel of teeth, as well as some nervous and connective tissues,
and even a type of endocrine tissue (suprarenal medulla).

7. The correct answer is: accessory nerve (CN XI)
If the accessory nerve is damaged and the trapezius is denervated, a
person will no longer be able to raise the acromion of the shoulder. The
dorsal scapular nerve innervates rhomboideus major, rhomboideus
minor, and levator scapulae. If the dorsal scapular nerve is damaged,
the rhomboids will be denervated, and retraction of the scapula will be
weakened. An injury to the greater occipital nerve will result in a loss of
sensation on the posterior scalp and denervation of the upper deep neck
muscles on the affected side.
The axillary nerve and suprascapular nerve will be covered with the
upper limb, but for completeness, note that the axillary nerve innervates
the deltoid muscle. If this nerve is damaged, the deltoid may atrophy,
and the person will be unable to abduct the arm. If the suprascapular
nerve is injured, lateral rotation of the humerus will be severely
weakened.

8. The correct answer is: epidermis
Once again, remember that the epidermis is responsible for serving as a
barrier to water loss. The dermis sits below the epidermis and helps give
the skin strength. The panniculus adiposus/ subcutaneous tissue/
superficial fascia is the layer of fat that sits beneath the skin. Investing
fascia is the deep fascia which covers muscle groups and binds them
together.


9. The correct answer is: Greater occipital nerve
The greater occipital nerve is the dorsal primary ramus of spinal nerve
C2--it provides cutaneous innervation to the skin of the back of the head.
The accessory nerve is cranial nerve XI--it innervates trapezius. The
great auricular nerve, the lesser occipital nerve, and ansa cervicalis are
all structures from the cervical plexus, which is made of ventral primary
rami. They will be studied with the head and neck.

10. The correct answer is: trapezius
Cranial nerve XI is another name for the accessory nerve, which
innervates the trapezius. The deltoid muscle is innervated by the axillary
nerve. (More to come with the upper limb.) Latissimus dorsi is innervated
by the thoracodorsal nerve. Levator scapulae and rhomboidus major are
both innervated by the dorsal scapular nerve, with the upper part of
levator scapulae receiving some branches of C3 and C4.

11. The correct answer is: epidermis and dermis
The epidermis is the layer of the skin which serves as a barrier to water
loss, and the dermis is the layer of skin directly below the epidermis. For
fluid to ooze from the abrasions, both of these layers must be damaged.
Damaging other layers, such as the subcutaneous tissue or deep fascia,
would not necessarily lead to fluid loss.

12. The correct answer is: dermis
The dermis is filled with collagen and elastic fibers which account for the
strength and tone of the skin. Therefore, this layer of skin is strong
enough to hold the sutures used to sew up the lacerations. The

epidermis is thin and weak, so it would not be able to hold sutures by
itself. Superficial fascia/ subcutaneous tissue is the loose and fatty
connective tissue below the dermis, and not an appropriate location for
sutures. The deep fascia invests muscles or groups of muscles, and it
would be too deep to place sutures.

13. The correct answer is: acromion
The acromion is the point of the scapula that corresponds to the tip of
the shoulder. Because most of the scapula is protected by muscles and
the thoracic wall, most scapular fractures involve the protruding
acromion. The angles of the scapula are inferior to the acromion and not
involved with the tip of the shoulder. The coracoid process is a beaklike
process on the anterior face of the scapula. It is inferior to the acromion
and projects anteriorly. The glenoid cavity is on the lateral side of the
scapula. It articulates with the head of the humerus. The spine of the
scapula is the ridge of bone on the posterior face of the scapula.
Although it continues laterally to become the acromion, it is not the same
as the acromion, which specifically refers to the tip of the shoulder.

14. The correct answer is: accessory
The accessory nerve (CN XI) is responsible for innervating the trapezius
which lifts the tip of the shoulder, or acromion. The axillary nerve, which
will be covered with the upper limb, innervates the deltoid muscle. The
dorsal scapular nerve innervates rhomboideus major, rhomboideus
minor, and levator scapulae. If the dorsal scapular nerve is damaged,
the rhomboids will be denervated, and the patient will not be able to
retract his scapula fully. The suprascapular nerve, which will also be
covered during the upper limb, innervates the supraspinatus and
infraspinatus muscles. Finally, the thoracodorsal nerve innervates
latissimus dorsi. If this nerve is injured and latissimus dorsi is
denervated, the patient will not be able to raise his trunk to his arms (the
motion associated with pull-ups).

Noticing lots of questions about the accessory nerve, the trapezius, and
lifting the acromion? It's important to remember this relationship!

15. The correct answer is: subcutaneous tissue
Of all the answer choices, the subcutaneous tissue is the only tissue
where large amounts of fat may be deposited. The muscular fascia and
deep fascia are tighter types of connective tissue that invest muscles or
muscle groups. The skin, composed of the epidermis and dermis, is not
the site of abundant fat deposition. Instead, fat collects under the skin in
the subcutaneous tissue. Finally, a neurovascular bundle, composed of
some combination of an artery, vein, lymphatics, and nerve, is not a site
for fat deposition.

16. The correct answer is: Epidermis, dermis, subcutaneous tissue,
investing fascia, muscle
The first layer through which the needle must cross is the skin,
composed of the superficial epidermis and deeper dermis. Then comes
the subcutaneous tissue--it's filled with fat and fairly loose. Finally, the
investing fascia covers the muscle. Remember this sequence to keep
yourself oriented when thinking about the different layers of skin and
fascia!

17. The correct answer is: posterior surface of the neck and scalp
Other than the palms of the hands and the soles of the feet, skin is
thickest on the upper back, posterior neck and scalp. Why is a good
question - perhaps it's an evolutionary adaptation for defense against
back stabbing.


18.
The correct answer is: trapezius
The trapezius, innervated by the accessory nerve (CN XI), is the muscle
responsible for elevating the tip of the shoulder. Erector spinae, which is
innervated by the dorsal primary rami of C1-S5, extends and laterally
bends the trunk, head and neck. Latissimus dorsi, innervated by the
thoracodorsal nerve, allows the trunk to be lifted up to the arms (like with
climbing or pull-ups). Levator scapulae, innervated by the dorsal
scapular nerve, elevates the scapula. Rhomboidus major and minor are
both innervated by the dorsal scapular nerve and aid trapezius in
retracting the scapula.

19. The correct answer is: epidermis, dermis.
The epidermis and the dermis are the two layers that comprise the skin.
The subcutaneous tissue/superficial fascia and the deep or investing
fascia are all below the skin. As long as sutures are crossing through the
thick dermis, the skin will be able to hold the sutures, and the wound will
be repaired.

20. The correct answer is: dorsal primary ramus of C7
Dorsal and ventral primary rami are the first branches off of spinal
nerves. Dorsal rami provide sensory innervation to the skin over the
back and give motor innervation to the true back muscles; ventral rami
supply sensory innervation to the skin over the limbs and the skin over
the ventral side of the trunk. Ventral rami also give motor innervation to
the skeletal muscles of the neck, trunk, and extremities. So, if the skin
over the spine of your scapula began to itch, the sensation of that area
would be transmitted by the dorsal primary rami of C7. The accessory

nerve, which innervates the trapezius, is not responsible for any sensory
innervation. The dorsal and ventral roots of spinal nerves are not directly
responsible for any sensory innervation to the skin. Dorsal and ventral
rootlets emerge from the spinal cord to form the dorsal and ventral roots.
The ventral roots contain efferent motor fibers to skeletal muscles, while
the dorsal roots contain afferent sensory fibers. These roots combine to
form the spinal nerve, which then gives off the primary rami.

21. The correct answer is: Lumbar triangle
The lumbar triangle is the site of a lumbar hernia. It is a triangle defined
by the border of the latissimus dorsi medially, the external abdominal
oblique laterally and the iliac crest inferiorly. This is the exact site of the
hernia that is described here, so that's the answer. The triangle of
auscultation is a triangle located below the inferior angle of the scapula,
bounded by the trapezius medially, rhomboideus major superiorly and
the latissimus dorsi inferiorly. This is a place where you can place your
stethoscope and auscultate the lungs.
The inguinal triangle is bounded medially by rectus abdominis,
inferiorally by the inguinal ligament, and superolaterally by the inferior
epigastric artery. It is the site of a direct inguinal hernia. The triangle of
Calot is a triangle found near the gall bladder. It is bounded by the cystic
artery, cystic duct, and common hepatic duct, Finally, the greater sciatic
foramen is a pelvic structure created by the sacrospinous ligament and
the sacrotuberous ligament.

22. The correct answer is: Scapular retraction on the right side would
be weakened
The dorsal scapular nerve is a motor nerve off the C5 nerve root that
innervates the rhomboids and levator scapula. These muscles help to
retract and elevate the scapula, so these motions would be weakened
following that damage. The skin of the upper back on the right side is

innervated by the dorsal primary rami of a spinal nerve. The point of the
right shoulder, the acromion, is elevated by trapezius. Trapezius is
innervated by the accessory nerve, so the point of the shoulder would
droop if the accessory nerve was damaged. Latissimus dorsi, innervated
by the thoracodorsal nerve, allows for extension and adduction of the
arm.

23. The correct answer is: trapezius
The transverse cervical artery supplies blood to trapezius. Levator
scapulae and the rhomboids receive blood from the dorsal scapular
artery. Latissimus dorsi receives blood from the thoracodorsal artery.

24. The correct answer is: Thoracodorsal
The thoracodorsal nerve innervates latissimus dorsi, which is an
important muscle for adducting, medially rotating, and extending the
arm. This is the muscle that is used when swimming the crawl. Since
she can't do these motions, the triathelete must have injured her
thoracodorsal nerve. Another indication of this injury is that the
thoracodorsal nerve is particularly vulnerable following trauma to the
axilla.
The accessory nerve innervates trapezius. If this nerve was injured, the
patient could not raise the tip of her shoulder. The dorsal scapular nerve
innervates the rhomboids and levator scapulae. If this nerve was injured,
the patient would have problems elevating or retracting her scapula. The
lateral and medial pectoral nerves innervate pectoral major, a medial
rotator and flexor of the arm. An injury to this nerve would cause a
problem with flexion, not extension, of the arm.


25. The correct answer is: Dermis
The epidermis is the most superficial layer of the skin, and it's not
vascularized. But the dermis, sitting immediately below the epidermis, is
very vascular and will bleed following an injury. So that's the answer.
If an abrasion goes to the deep fascia, muscular fascia, or subcutaneous
tissue, it will definitely bleed, but this question is asking you to choose
the first layer to bleed after a skin wound, and that's the dermis.

26.
The correct answer is: Latissimus dorsi
Latissimus dorsi makes the posterior axillary fold, so it's easy to see why
that should be the muscle injured following a wound to the posterior
axillary fold. Latissimus dorsi is the muscle important for medial rotation,
extension, and adduction of the arm; the patient's symptoms fit with an
injury to this structure.
Pectoralis major medially rotates and flexes the arm--this muscle makes
the anterior axillary fold. Levator scapulae elevates the scapula, while
rhomboideus major retracts the scapula. Trapezius elevates and
depresses the scapula (depending on which part of the muscle
contracts), rotates the scapula superiorly, and retracts the scapula. It
also helps raise the tip of the shoulder, or acromion.