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Gray ’s
Anatomy
Review
This
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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
Proessor,
Dean
St.
o
Department
Basic
George’s
Grenada,
o
Sciences;
University
West
Anatomica
Dean
o
Scoo
o
Sciences
Abraams
FHEA
Researc
Pro.
Medicine
MBBS
FRCS(ED)
FRCR
DO(Hon)
FRSA
“Emeritus”
o
Cinica
Anatomy,
Warwick
Medica
Scoo,
Indies
Nationa
T eacing
eow
&
Lie
Feow,
Girton
Coege,
Cambridge
R. Shane Tubbs, MS, PA-C, PhD Visiting
Pro.
Consutant
LKC
Brune
Scoo
o
Médica
Medicine
NTU
Singapore
Scoo
Proessor
Departments
and
Ceuar
T uane
Neurosurgery,
University
Louisiana,
United
Department
ence
o
Neuroogy
and
Structura
Stephen W. Carmichael, PhD, DSc
Bioogy
o
Institute,
Scoo
o
Medicine,
New
Oreans,
States
Mayo
Neurosurgery
Ocsner
Proessor
and
Heat
Ocsner
System,
Neurosci-
New
Emeritus
o
Anatomy
Rocester,
Minnesota,
United
Oreans,
Thomas Gest, PhD Louisiana,
United
Department
o
States
Anatomica
Sciences Proessor
St.
George’s
Grenada,
o
University
o
Coege
Medicine
additional
Houston
Indies o
Houston,
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methods,
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authors,
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nstructons,
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lablty,
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and
advances
should
or
be
contrbu-
neglgence
contaned
n
or
the
T o
my
fater
pysician,
and
Cristos
and
sare
it
more
wit
tat
gave
me
importantly
te
rest
of
te
te
te
foundations,
inspiration
world.
Love
and
you
love,
empaty
continuous
Dad,
I
am
and
tirst
care
to
tinking
of
to
create
you
become
every
day.
ML
T o
Rut
Jones.
You
are
te
best.
RST
T o
“Lucy
in
te
Sky
wit
Diamonds,”
and
all
te
descendants
of
“Papi
and
Lulu”
PA
Susan
Lee
Stoddard,
Allen
St.
P .
Carmicael,
and
Magnolia
Quinn
Carmicael
SWC
T o
my
family,
for
all
of
teir
support,
and
to
TG
my
students,
for
all
of
teir
a
knowledge
inspiration
Preface
Rote memorization o anatomic acts as been te cardina ea-
ture
or
o
exaustive,
many
oter
and
generations
aied
eat
exausting
o
students
science
courses
in
in
uman
medicine,
programs.
Oten,
dentistry ,
itte
6.
anatomy
Finay,
te
and
distinction
te
earning
te
in
was
in
to
Gray ’s
te
practica,
Anatomy
cinica
Review
was
appication
designed
or
o
te
use
inorma-
by
students
wo wis to test teir knowedge o cinica anatomy . he ques-
tions,
serve
1.
answers,
mutipe
his
by
various
T o
expanations
purposes
review
study
2.
and
provides
students
programs
avoid
are
students
a
in
o
pointess
questions
or
in
tis
in
various
are
preparation
gross
anatomy
witin
or
source
te
te
tat
a
he
mutipe-coice,
questions
aration
nation
4.
he
is
or
designed
te
expanations
uman
5.
o
o
simiar
te
student
Medica
review
te
prep-
Exami-
examinations.
empasize
norma
o
in
Licensing
quaiying
answers
understanding
understanding
examination
vi
and
aciitate
States
ormat
and
te
critica
dysunctiona
migt
o
be
urter
aternative,
tempted
to
enanced
incorrect
coose.
by
answers
critica
tat
stu-
majority
correated
con-
o
te
o
te
questions
wit
te
oowing
Netter
•
Abraams ’
A.
Wayne
Eac
ter’s
(N)
For
ca
of
and
ed
and
is
and
8,
by
Peter
Loukas,
reerenced
Abraams’
wit
W .
and
We
H.
to
7,
pages
we
by
Frank
Atlas
Abraams,
Abert
in
McMinn’s
Are
Mitce
ed
Clinical
and
capter
Before
M.
Anatomy,
McMinn ’s
embryoogy
vignettes
Adam
Human
Marios
answer
te
V og,
Atlas
Anatomy,
ave
Born:
N.
of
Jonatan
Van
Gray’s
Netter
Human
D.
Scoor
(GAS),
Net-
(ABR/McM).
correated
Essentials
of
te
cini-
Embryol-
og y and Birt Defects, ed 9, by Keit L Moore, TVN Persaud,
and
Mark
We
coor
G.
ave
T orcia.
incorporated
iustrations,
acceerate
ing
is
are
important
•
Spratt,
anatomy.
Student
dents
to
United
(USMLE)
importance
singe-best-answer
book
he
o
irrespective
o
te
in
te
coice.
medicine,
assisting
Gray ’s Anatomy for Students, ed 4, by Ricard L. Drake,
student toward practica appications o te textua materia.
3.
review
o
distiation
anatomy,
understanding
practice
career
succinct
•
te
guide
and
a
cinica
gobe.
student,
vignettes
in
textbooks:
to
or
examinations
around
by
cinica
intended
programs.
tougt-provoking
memorization
ramed
book
tis
provides
acts
cepts
student’s
given
o
student’s
was made between te weat and te ca, and itte attention
tion.
review
petora
o
te
bot
earning
te
sources
materia
are
of
on
rom
Human
or
adapted
many
radioogica
images
process
to
anatomy
primary
Atlas
and
and
wic
and
te
we
Abraams ’and
Anatomy.”
an
enance
cinica
ave
drawings,
in
McMinn ’s
or
ed
to
understand-
appications.
drawn
u-
attempt
he
iustrative
8,
“Clinical
Acknowledgments
A
cinica
but
aso
eagues
and
ave
te
o
ave
very
and
enormousy
ter
wt
rends
board
o
t
not
St.
wt
ep.
or
o
te
rends
ter
hs
te
autors
and
co-
knowedge
book
woud
contrbutons
o
beow.
medca
at
ony
cnca
and
not
sted
o
Socety
o
o
eac
T anya
Mark
at
te
members
Department
Unversty,
ts
project
capter
o
as
eped
troug
part
o
book.
te
Cabrto,
Cares,
Vncent
Se
Lake,
Asad
Manda,
Board
(for
Ra,
Messa
the
First
and
Second
Noe,
Rzv,
Sonja
MD
MD
Roberts,
Saandy,
Twadayo
MD
MD
Roberts,
Wasa
Advisor y
MD
MD
Annesa
Rabjot
MD
MD
Lee,
Gaurav
MD
MD
Courant,
Ed,
Sang
MD
Carrasco,
Stacey
Sasa
students,
George’s
competon
crtcsm
ts
and
Researc
te
and
work
generous
were
Scences
comments
advsory
so
group
Cnca
Anatomca
te
eedback
possbe
speca
Student
is
scentc
been
sgncant
been
coeagues
A
book
numerous
wo
gven
not
te
review
o
MD
MD.,
MBA
MD
Sam-Odusna,
MD
editions) Krsna
Nkos
Mea
Lann
Rana
Avarez
Cn
Monca
Guo
De
(Lower
Howard
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heoanns
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Du
Perineum)
Amed
Eward
Am,
part
o
very
te
ep-
advsory
(Head
and
Vd
Neck)
the Third
edition
MSc
MD,
Rames
MD
PD
Koas,
MD
MD
MD,
Obadna,
Persaud,
MD,
Petua
Rao,
MSc
MD
MBBS
PD
Pp,
Raeburn,
Rao,
MD
PD
Montabano,
Madonna
MD
MD
Marsa,
MD,
MD
MSc
MD
PD
MD Deepak
Cassandra
Anatomca
MD
Magoud,
Ouem
Neck)
Vs
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as
o
been
PD
Hargrove,
Jordan,
heoans
and
Pesss,
Hage,
Geobrna
Robert
(Back)
for
crtcsm
aso
MBBS
George,
Mcae
Board
and
ave
MD
Gbenmaco,
Kazzara
Advisor y
Department
MD
MD,
Forrester,
Robert
and
Perineum)
(Head
Patten
Burns,
Racae
(horax)
Van
Bubb,
Iketc
(Abdomen)
Brunt
te
Unversty
Antone-Frank,
Kateen
Deon
(Pelvis
and
rom
comments
Badoo,
James
(Head)
Van
ter
acuty
George’s
Emanue
Danny
(horax)
Tgue
Lndsey
Limb)
(Neck)
hyagangam
hornton
Randy
Limb)
(Head)
(Pelvis
St.
board:
Limb)
(Lower
at
Crysta
(Upper
MD
Limb)
(Upper
Neyubna
Pau
wt
Mara
(Lower
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u
(Back)
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Prateek
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oowng
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he
(Abdomen)
(Upper
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Limb)
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Ramya
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(Neck)
Bargava
hakore,
Ang,
Sarma,
MD
MD Fematta
Sowa,
MD
vii
Acknowledgments
viii
Kristna
Aena
hompson,
Wade,
MD
Mr.
MD
Jon
trict
Dr. Antony D’Antoni, PD, Proessor, at Pysician Assistant
Mr.
Program,
trict
W agner
Coege,
One
Campus
Road,
Staten
Isand,
Craven,
Hospita,
Jon
ormery
Consutant
Surgeon,
York
Dis-
Consutant
Surgeon,
York
Dis-
York
Craven,
Hospita,
ormery
York
NY, as aways been a great riend and coeague. His continu-
ous
support,
tributed
comments,
enormousy
to
criticism,
te
and
entusiasm
competion
o
tis
ave
con-
project.
Proessor
ment
o
Scoo,
Dr.
Kitt
Vice
sity,
tise
Saer,
Cair
or
o
er
MD,
P.D.
Department
comments
contributed
o
and
toward
Proessor
Radioogy
criticism,
tis
o
at
and
Radioogy
Boston
Hobsey,
Studies,
ormery
he
Head
Middesex
te
Depart-
Hospita
o
Medica
London
and
Univer-
invauabe
Micae
Surgica
Mr.
Rap
Hutcings,
Mr.
Umraz
potograper
or
Imagingbody.com
exper-
project.
Kan,
Pastic
Surgeon,
Caring
Cross
Hospita,
London
We
are
vier,
he
especiay
or
er
autors
Benson
and
opmenta
troug
he
scopic,
woud
te
for
and
tank
ike
Riey,
and
a
preparation
kindly
to
te
o
Madeene
advice,
to
our
te
tis
and
tank
Hyde,
at
at
Ese-
encouragement.
Jeremy
Bowes
commissioning
team
Esevier
and
or
Kim
Jon
Unit,
Bartoomew’s
tas,
us
Dr.
o
individuals
various
Proessor
clinical,
and
St.
teir
operative,
insti-
endo-
University
J.
Spratt,
Radioogy
Dr.
Hospita,
Soutampton,
Proessor
Pau
and
Artritis
Researc
Gii
Mddesex
Bouos,
Coege
Norman
Hodder
trations
Surgeon,
London
edition,
Browse,
Arnod
rom
2005.
Vascuar
Ormond
Surgery
Street
Hospi-
Radioogist
Hospitas,
T aagt,
and
Cinica
Director
Sunderand
Radioogist,
he
Adeaide
and
Dubin
Institute
Medica
o
Emeritus
Pubisers,
Symptoms
and
or
Surgica
Scoo,
Signs
Proessor
permission
of
Surgical
Vads,
Optamoogst,
Hospta,
ormery
at
Centra
London
Campaign
Stud-
London
oogy,
o
to
Surgery,
use
ius-
Disease,
4t
Jame
Wer,
Grampan
Scotand,
Human
and
Director,
Great
London
T orreggiani,
Hospita,
Proessor
Proessor
and
Consutant
City
Wiiam
Meat
Miss
University
o
ormery
potograps:
Dr. Ray Armstrong, Reumatoogist, Soutampton Genera
ies,
Lumey,
deve-
guiding
book.
following
supplying
imaging
Ms.
insigts,
aso
Andrew
editors,
autors
tutions
tanku
invauabe
and
edtor
Anatomy,
Emertus
Unversty
ed
o
5,
Wer
Proessor
Hosptas
and
Esever.
o
Cnca
T rust,
Abraams
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,
55
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
anteror
man
mnutes
coson.
most
D.
Question
35-year-od
Pysca
musce.
key
anteror
to
s
admtted
ater
beng
be
o
njured
te
emergency
nvoved
examnaton
Wc
to
te
sows
n
a
oowng
aong
wt
a
motor
damaged
nerves
njury
to
be
atssmus
rotates
te
Second
toracc
3.
B.
Axary
ment
C.
Accessory
coson.
D.
Dorsa
anteror
E.
horacodorsa
scapuar
he
toracc
s
te
ony
nerve
tat
ner ve
nner vates
te
nnervates
detod
te
eevates
superor
ts
atera
ange
o
te
ange
or
te
dors
adducts,
extends,
and
meday
arm.
te
and
teres
Question
35-year-od
te
anteror.
axar y
A
Order
Long
ong
eevates
trapezus
serratus
musce?
serratus
B.
he
A.
he
scapuae
we
acromon.
E.
Explanation
A.
evator
scapua,
vece
serratus
woud
te
he
depart-
30
man
mnutes
Pysca
musce.
patent
most
s
admtted
ater
beng
examnaton
Wc
key
o
te
o
be
te
Retracton
B.
Eevaton
C.
Depresson
o
te
scapua
D.
Protracton
o
te
scapua
E.
Downward
rotaton
te
te
sows
emergency
n
a
a
to
depart-
motor
damaged
oowng
unabe
A.
o
to
nvoved
vece
serratus
unctons
w
perorm?
scapua
scapua
o
te
scapua
mnor.
C.
he
accessory
and
trapezus.
D.
he
dorsa
and
te
E.
he
nerve
nnervates
te
sternocedomastod
Explanation
Dferent
scapuar
ower
nerve
porton
toracodorsa
o
suppes
te
n e r ve
te
evator
rombod
musces
scapuae.
nne r vates
te
ua
A.
2.
A
30
coson.
anteror
te
A.
man
mnutes
Pysca
musce.
s
anteror
scapua
Depresses
Protracton
D.
Eevaton
E.
Adducts,
o
to
te
emergency
nvoved
examnaton
serratus
C.
beng
Wc
Adducts
B.
admtted
ater
te
sows
n
a
a
damaged
oowng
depart-
motor
C.
vece
serratus
unctons
D.
serve?
E.
o
o
scapua
and
meday
rotates
arm
te
B.
he
C.
he
and
rombod
major
and
mnor
retract
scapua.
serratus
serratus
upward.
o
scapua
te
o
s
and
o
musces
and
scapua
o
te
evator
scap-
scapuae,
carred
out
by
te
rombods
te
out
many
by
te
tra-
musces.
s
perormed
o
musce
toracc
te
serratus
te
carred
prmary
by
te
trapezus.
anteror
on
s
scapuae
te
rotaton
rotaton
A
pus
scapua
s
te
scapua
orward
wa.
anteror
scapua
evator
Order
s
accompsed
togeter,
perormed
we
by
by
te
downward
te
rombod
scapuae.
anteror
neror
depresses
protracts
and
te
rotates
ower
te
rbs.
scapua
30
coson.
wa
posteror
Question
35-year-od
ment
trapezus
te
serratus
Upward
Second
Explanation
he
movement
trapezus,
scapua
extends,
4.
A.
te
mnor.
scapua
evator
bers
trapezus
rotaton
o
and
Depresson
he
te
to
anteror,
pectoras
o
(protracton)
rbs
and
and
Eevaton
ower
does
contrbute
serratus
trapezus.
pezus
Question
35-year-od
ment
te
Retracton
and
B.
Order
musces
as
rombods,
at ss mus
dors.
First
suc
te
n
man
mnutes
Pysca
te
axary
oowng
A.
Levator
B.
Serratus
s
admtted
ater
beng
examnaton
regon
musces
s
to
te
nvoved
and
most
sows
wnged
key
emergency
n
a
motor
njury
to
scapua.
depart-
vece
te
cest
Wc
o
njured?
scapuae
anteror
1
2
C H A P T E R
C.
1
Back
T rapezus
D.
Rombod
E.
Serratus
major
and
posteror
mnor
superor
Explanation
A.
he
B.
he
evator
scapuae
serratus
(protracton)
pezus
to
opposed
and
keep
to
eevates
anteror
scapua.
pus
te
counterbaances
te
te
te
te
musce
costa
toracc
surace
wa,
o
scapua
pu
te
orward
o
te
scapua
preventng
tra-
cosey
wngng
o
te
scapua.
C.
Atropy
o
wngng,
but
posteror
D.
he
wngng,
he
A
te
major
musce
te
ead
traves
to
scapuar
troug
te
neck.
and
mnor
atropy
ter
may
accessory,
eevate
may
nerve,
ead
te
and
to
dorsa
retract
sgt
te
scapuar
scapuar,
traves
neck.
posteror
superor
eevates
te
2nd
troug
rbs.
Second
5.
but
te
o
ter
serratus
5t
nerve,
trange
and
troug
trapezus
ts
rombod
scapua
E.
te
Order
Question
35-year-od
ment
30
man
mnutes
s
admtted
ater
beng
to
te
emergency
nvoved
n
a
depart-
motor
vece •
coson.
wa
te
A.
n
Pysca
te
axary
oowng
Long
examnaton
regon
nerves
s
and
most
sows
njury
wnged
key
to
scapua.
te
Fig.
.
cest
Wc
o
njured?
Pysca
toracc
examnaton
sows
te
ndngs
n
Fg.
1.1.
Wc
o te oowng nerves s most key njured?
B.
Axary
A.
Long
C.
Accessory
B.
Axary
D.
Dorsa
C.
Accessory
E.
horacodorsa
scapuar
toracc
D.
Dorsa
E.
horacodorsa
scapuar
Explanation
A.
he
ong
ror
scapua.
he
axary
C.
arm
we
he
accessory
pezus
te
and
on
nerve
he
nnervates
protracts
wt
protrude
musces.
nerve
wc
Patents
scapuae
B.
toracc
musce,
njury
ter
teres
te
s
te
nerve
ke
a
sternocedomastod
w
and
lexes,
ateray
and
rotates
or
ante-
rotates
ave
te
Explanation
A.
ter
wng.
detod
responsbe
serratus
upwardy
ts
abducts,
mnor
nerve
to
back
suppes
detod
and
teres
te
and
t
tra-
traves
te
to
D.
te
opposte
zus
and
he
dorsa
neck
to
wc
ep
E.
eevates
and
upwardy
sternocedomastod
he
anteror
scapuar
suppy
are
to
sde.
serratus
te
traves
or
te
pus
o
prevents
rombod
scapuar
rotates
and
baance
nerve
responsbe
prevent
lexes
scapua
te
pu
troug
retracton
and
o
root
mnor
o
wc
adducts,
te
te
6.
Order
and
rotates,
and
extends
te
D.
he
and
Question
mnutes
ater
beng
n
a
motor
vece
coson.
E.
and
te
rotates
s
ner ve
s
rom
te
scapua
“wngng,”
scapua.
ter
scapua
detod
lexes,
te
Patents
protrud-
teres
extends
mnor
and
te
arm.
or
s d e.
te
and
s cap u a
common y
e s on
te
tr a -
w e
te
at rop y
w ng ng,
te
he
pus
W e
s c a puar
s upp y ng
mus ce s .
rotate s
lexe s
m ore
and
and
re s p ons b e
opp os te
n
t
anteror
te
cn
o
te
o
te
c ause
o
scapua.
mnor
scapuar
musces
scapua.
n
te
u pw ard y
resut
serratus
ods
wng.
abducts,
ner ve
may
dorsa
te
ave
sternoc e d om as tod
eevates
to
rotates
w
suppes
ateray
toracc
resut
nvoved
a
te
scapua,
preventng
sternocedomas to d
ong
arm.
nerve
detod
and
te
wa
ke
nerve
accessor y
wnged
A 35-year-od man s admtted to te emergency department
30
mnor
nnervates
upwardy
ts
back
he
trape zus
o
Third
ter
upward
wngng.
meday
he
and
to
axary
pe zus
musces
scapua
on
he
trape zus
trape-
he toracodorsa nerve suppes te atssmus dors mus-
ce,
C.
wngng.
te
te
we
njury
nerve
protracts
toracc
abducts
teres
upward
between
scapuar
major
cn
te
to
musces.
troug te posteror cervca trange, not te axa. he
trapezus
cose
wt
B.
toracc
wc
ng
te
ong
musce,
and
te
arm.
suppyng
musces,
mnor
extends
he
sgt
nerve
and
Atropy
scapuar
suppes
are
o
te
rombod
responsbe
te
rombod
or
major
retracton
musces
may
wngng.
he toracodorsa nerve suppes te atssmus dors mus-
ce,
wc
adducts,
meday
rotates,
and
extends
te
arm.
CHAPTER
Fourth
7.
A
Order
Question
35-year-od
ment
ce
n
30
mnutes
coson.
Fg.
1.1.
patent
man
s
ater
beng
Pysca
Wc
most
admtted
key
te
te
emergency
nvoved
examnaton
o
be
to
to
a
sows
oowng
unabe
n
motor
te
w
durng
B.
Perormed
C.
Perormed
ve-
ndngs
unctons
perorm
depart-
major,
D.
te
pysca
examnaton?
In
A.
Latera
B.
Abducton
rotaton
C.
Fexon
D.
Extenson
E.
Abducton
o
o
te
o
o
te
arm
0
to
15
degrees
and
above
90
degrees
te
s
Explanation
A.
ror
bers
Main
te
A
coug,
sows
nto
toracc
a
teres
s
brougt
o
a
and
o
te
vertebra
“gbbus
condtons
s
sweats,
tubercuoss
te
ogc
man
because
ngt
ducng
detod
pectoras
musces.
bers,
atssmus
musces.
patent
resut
mnor,
and
ts
as
o
a
wnged
damage
musce
rotaton
90
o
done
are
te
degrees
(superor
normay
to
scapua.
te
hs
ong
usu-
toracc
by
protracton
genod
requres
rotaton
te
o
te
te
rotaton
genod
anteror
scapua
Eevatng
upward
te
serratus
o
ossa.
ossa)
and
o
tat
trapezus,
togeter.
poste-
5-day
key
te
rgt
ung,
bodes
to
o
A
o
o
severe
cest
wt
T6
Wc
be
emergency
story
emoptyss.
deormty.”
most
to
x-ray
extenson
and
te
conrmed
T7,
pro-
4.
A.
Hypertropy
o
supraspnous
B.
Hypertropy
o
nterspnous
C.
Hypertropy
o
gamentum
D.
Hypertropy
o
anteror
E.
Hypertropy
o
nuca
A
35-year-od
oowng
department
by
coson.
rado-
examnaton?
te
B.
Hyperkyposs
neck
C.
Scooss
scapua.
D.
Spna
njured
E.
Osteoartrts
bda
68-year-od
s e v e re
began
o
re c e n t
sensor y
te
tebra
L4
ver tebrae
L5.
te
a g o.
as
He
s t re n g t
o
most
Dorsa
D.
Greater
E.
Suprascapuar
and
5.
and
ver-
sde
eve
ts
Spnous
B.
V ertebra
process
C.
T ransverse
D.
Superor
E.
Intervertebra
process
back
and
sgt
te
owe r
owe r
man
cana
te
o ow n g
m b.
An
stenoss
by
a
examnaton?
s
b ro u g t
stor y
oss
mbs.
na
rmed
dsc
2 - we e k
batera
processes
n
o
P y s c a
o
te
condtons
o
o
te
umbar
s
te
ospta
pan
examnaton
sensaton
x-ray
magnetc
to
s e ve re
te
spne
s ow s
most
key
ove r
sp-
Wc
to
magng
be
o
con-
(MRI)
In
wc
most
key
he
sympatetc
dorsa
root
C.
he
atera
orn
E.
A
he
posteror
o
er
as
et
mb
x-ray
o
s
o
te
most
o
te
rgt
key
4-day
are
te
ocazed
oowng
C7.
zoster
o
to
story
he
vra
te
emergency
panu
entrey
te
to
on
ras
one
dermatome
patent
was
necton
oowng
proerated
o
dag-
known
structures
cause
te
as
as
patent’s
trunk
gangon
o
ventra
o
C7
te
C7
spna
cutaneous
orn
ower
as
o
woman
experenced
and
te
spna
cord
branc
nerve
segment
o
te
dorsa
C7
45-year-od
se
border
nerves
brougt
a
nerve
erpes
he
he
An
surace
condton?
ramus
6.
spna
a
s
o
cosey
B.
D.
meda
oowng
tat
A.
te
s ow s
skn
re g o n .
re s o n a n c e
n
body,
te
vrus
man
because
s
wt
current
artcuar
4 5 - ye a r - o d
o
te
bodes
sde.
dorsa
scapua
occpta
eruptons
“snges.”
A.
because
o
nosed
patent?
A
skn
o
te
te
vece
te
scapuar
64-year-od
ver -
o
te
sows
afected
to
emergency
motor
toracc
department
parts
n
A
te
njury
te
a
sde?
Long
to
o ow n g
tat
C.
te
r a c t u re d
on
to
n
examnaton
o
B.
x-ray
brougt
on
gament
gament
nvoved
racture
due
5/5
r a c t u re s
te
key
o
a
Wc
pan
stor y
An
and
lavum
ongtudna
s
an
Axary
Pysca
o
mts.
osteopoross
Wc
no
actvtes.
c o m p re s s o n
a re
te
sows
gament
gament
beng
ateray
neck
A.
ospta
says
norma
s e v e re
wt
o
to
patent
muscuar
wtn
s ow s
tebrae
Te
s t re n u o u s
s ow s
and
brougt
monts
or
ndngs
coumn,
te
4
trauma
spne
s
pan.
nsdousy
examnaton
o
man
back
man
ater
Pysca
retracted
Hyperordoss
to
3.
a
tan
scapua
A.
A
posteror
major
bers,
coracobracas
musce.
1–25
55-year-od
department
2.
nraspnatus,
detod
and
musce.
detod
Q u e st i o n s
Questions
1.
by
o
o
urter
workng
Perormed
te
te
as
superor
arm
arm
by
mage,
unctons
arm
te
anteror
brac
teres
occurs
supraspnatus
te
nerve, wc nnervates te serratus anteror musce. he
rom
arm
te
o
te
arm
bceps
and
ts
ay
te
by
Perormed
dors,
E.
by
3
Back
1
back.
te
C7
comes
spna
to
moderate
he
become
a
pan
te
pan
radates
nusance
cord
segment
pyscan
or
to
more
2
because
years
er
et
over
ower
recenty.
Se
says tat ater tng a case o sot drnks, te pan sud-
deny
became
ntense.
An
MRI
o
te
umbar
regon
4
C H A P T E R
sows
bra
s
7.
1
an
ntervertebra
eves
most
Back
L4
key
dsc
ernaton
Wc
afected
by
te
o
te
dsc
between
oowng
verte-
no
motor
nerves
on
te
ernaton?
s
ntact
on
sde
te
compresson
B.
L2
oramen
C.
L3
oowng
D.
L4
space-occupyng
E.
L5
A
3-year-od
tory
s
o
conrms
snus
A
te
and
te
s
o
anayss
o
Hs
wt
as
a
umbar
te
approprate
B.
Nuceus
C.
Posteror
D.
Anteror
s-
s
menngts
or
te
Hs
ongtudna
ater
puses
L1–L2
A.
horacodorsa
L2–L3
B.
Axary
D.
L4–L5
C.
Dorsa
E.
L5–S1
D.
Accessory
ever,
tory
etargy,
o
and
conrms
na
aboratory
te
o
s
te
he
neror
B.
he
gest
to
rgt
exter-
determne
er
te
was
s
studes
neck
wen
s
n
to
car
a
trauma
surace
o
te
oowng
te
pan
emergency
ater
was
to
was
te
a
13.
wp-
struck
cer vca
(Ldocane)
sow
te
spnes
brougt
paced
njecton
Anteror
ongtudna
B.
Lgamentum
C.
Nuca
D.
Posteror
E.
T ransverse
and
gament
cer vca
65-year-od
gament
s
most
not
bod-
key
te
department
toes.
ng
n
because
ower
mb
Pysca
on
tptoes
gament
gament
s
o
brougt
severe
motons,
examnaton
on
s
et
back
to
pan
especay
sows
eg.
te
emergency
and
pontng
weakness
Rgt
te
ower
n
mb
weak-
s
et
stand-
sows
by
by
te
umerus.
norma.
Wc
njured?
brus
se
to
o
a
er
ar
ad
a
s
most
pyscan
et
wt
to
reac
er
rgt
mastectomy
node
norma
te
nabty
dssecton
examnaton
14.
man
ater
te
te
sows
pro-
o
er
wngng
scapua.
key
top
o
b rougt
a
opposn g
Wc
damaged
te am
souder
oow ng
sow s
musc e s
s
a
s
te
o
o
durng
e m e r ge ncy
s ou de r
dur ng
w e
te
o
to
s
e me t
o
abducton
an
p ay ng
d s ocat on,
arm .
tor n
most
An
e
oo tb a.
e
MRI
musc e.
ke y
wen
ofe ns ve
c an-
o
te
W c
d amage d
o
by
njur y?
A.
Coracobracas
B.
Long
C.
Pectoras
ead
o
te
Supraspnatus
E.
T eres
moter
or
se
not
dd
advsed
png
o
brac
major
1-year-od
was
trceps
mnor
D.
A
s
ds oc at ng
treatmen t
ntate
afected
lavum
man
meda
scapuar
Foowng
yng
vertebra
t
pay
admnstered.
gament
cervca
key
comes
ymp
ner ves
1 9-year-od
was
gament
ongtudna
mts.
durng
o
and
vece
norma
toracc
depar tment
rom
coar
A
te
A.
ness
oowng
horacodorsa
severe
te
ts
emergency
motor
weakness
most
ago,
and
E.
crests
dsrupted?
A
scapua
Dorsa
man
o
or
surger y?
bateray
ac
a
adducton
s
to
Pysca
Long
wt
o
breast.
D.
neror
Wc
te
n
wtn
stor y
axar y
C.
rbs
and
monts
Axary
o
sows
to
symmetrca
ead
Accessory
par
anteror
er
wt
rgt
te
spne?
o
T wo
cedure
lud
are
woman
B.
sustaned
Wc
punc-
oowng
top
and.
atus
39-year-od
es.
umbar
sgns
2-mont
A.
posteror
te
reabe
te
menngts
cerebrospna
te
s
o
scapuae
he
on
most
o
because
ac
E.
Imagng
Wc
a
39-year-od
te
owest
He
te
s-
S1.
responsbe
Rada
A
te
sacra
anestetc
o
a
temperature
bactera
wt
as
E.
12.
o
he
bend.
anayss
Hs
He
te
g
sows
ntervertebra
scapuar
o
he
njur y,
o
to
Sensaton
spne
gament
brougt
nerves
anges
D.
as
conuson.
evauaton
vertebra
moter
eadace,
oowng
ponts
C.
department
and
s
severe
dagnoss
te
L4
by
wt
nectons.
dagnoss.
A.
A
A
Furter
andmarks
poston
brougt
snus
(104.2°F).
suspected.
ture
s
maase,
mutpe
40.1°C
s
boy
numbness
gament
nvoved
are
C.
department
s
te
and
key
s
extenson,
B.
3-year-od
at
beng
vta
T12–L1
emergency
te
o
as
oot.
lavum
man
Hs
rada
L5
most
ongtudna
A.
A
o
vertebrae
examnaton
rotaton,
puncture?
MRI
eements
s
and
puposus
27-year-od
Pysca
An
patent
mb
eson?
Lgamentum
A
coson.
ver-
nerve
he
et
brosus
department
lud
oowng
ocaton
E.
11.
punc-
cerebrospna
o
te
g
a
te
structures
Annuus
temperature
bactera
te
Wc
He
o
dects.
o
rgt.
between
A.
to
eadace,
conuson.
evauaton
most
moter
severe
nectons.
dagnoss.
s
by
wt
dagnoss
Furter
aboratory
eves
umbar
brougt
maase,
mutpe
and
tebra
s
(104.2°F).
suspected.
ture
boy
department
etargy,
40.1°C
10.
strengt
atera
L1
ever,
9.
L5.
A.
emergency
8.
and
te
gr
a
s
brougt
routne
aways
to.
skn
take
Pysca
n
to
te
examnaton.
te
er
pyscan
he
prenata
vtamns
examnaton
mdne
o
by
moter
te
sows
umbar
as
a
er
says
se
dm-
regon
CHAPTER
wt
te
15.
a
tut
ar
s
growng
te
most
over
te
key
dmpe.
Wc
o
major
dagnoss?
pressure
B.
Menngocee
respratons
C.
Spna
bda
occuta
suspected
D.
Spna
bda
cystca
bar
E.
Racscss
A
26-year-od
an
ton
tc
ton
on
bte.
n
o
o
a
spnous
woman
Fve
comes
back
days
tat
ago,
Amerca
te
process
o
se
were
oowng
mosquto
bte
te
to
pyscan
to
be
te
ked
bers
back,
because
caused
returned
se
nerve
on
T4
te
appears
rom
n
a
a
tat
an
te
atera
te
vaca-
at
are
and
te
sensa-
A.
T11
and
T12
to
B.
T12
and
L1
C.
L1
and
L2
te
Somatc
aferent
D.
L2
and
L3
Somatc
eferent
E.
L3
and
L4
C.
Vscera
aferent
D.
Vscera
eferent
E.
Somatc
A
15-year-od
department
ever,
are
up
to
on
catons.
Her
pressure
s
pected.
spna
must
25/mn.
n
te
paced
In
te
B.
Between
s
not
mm
obtan
A.
and
a
say
Se
as
40.3°C
o
progressve
no
te
te
tp
o
o
s
posteror
Superca
D.
Between
E.
In
to
severe
patent
ke
or
back
sootng
MRI
man
pan.
Wc
te
o
poston
He
presson
n
as
ts
no
spne
te
was
te
oowng
are
o
up
to
date
on
a
and
upper
D.
Lower
cervca
and
upper
toracc
spna
nerves
E.
Batera
by
20.
A
accessory
69-year-od
o
neck
pan
te
past
(98.6°F),
ew
bood
and
sows
as
comes
been
weeks.
pressure
respratons
te
because
an
motor
Rombod
he
B.
Serratus
eectrc-
C.
Supraspnatus
uncton
neuro-
cord.
ernated
n
an
rom
most
A.
no
spna
w
osteopytes
to
te
pyscan
progressvey
Her
s
mm
21/mn.
An
dsc.
anatomc
drect
com-
21.
Hg,
An
37°C
puse
MRI
o
s
te
Dapragm
Latssmus
worse
or
wakng
te
tat
past
Pysca
te
woman
pan
down
2
comes
as
s
to
te
story
he
stenoss
o
oowng
emergency
A.
Anteror
progressve
B.
Dentcuate
C.
Lgamentum
D.
Nuca
E.
Crucorm
patent’s
ter
Se
o
parents
daugter
as
no
s
not
story
o
ts
condton?
two
o
te
Her
sows
upper
te
gaments
lavum
pyscan
pan
s
w
s
se
wen
bends
relexes
ower
and
mbs.
vertebra
key
An
cana.
perormed.
most
wt
gettng
worse
wen
norma
and
umbar
vertebrae
ongtudna
te
progressvey
aevated
examnaton
n
to
been
monts.
and
bateray
sows
by
dors
42-year-od
back
afected
oramen
anteror
E.
ower
be
ntervertebra
worse
s
major
D.
A
key
te
because
gettng
temperature
126/84
are
n
removed?
vaccnatons.
roots
nerves
woman
tat
amnectomy
say
o
sympatetc
sus-
o
and
toracc
roots
over.
etargy.
n
eements?
dorsa
lavum
vaccnatons
wc
ventra
neede
uggage.
as
sows
s
3-day
o
toracc
mater
neck
cord
brougt
dvson
toracc
ongtudna
eavy
gaments
o
Raynaud
symptoms
upper
gament
and
surgca
and
te
and
vasospasm.
upper
ocatons?
pyscan
a
s
cronc
rom
because
ngers
and
ongtudna
eadace,
aganst
cervca
er
sceroderma
Ree
requre
to
pyscan
o
and
Anteror
ever,
39.
neura
te
cervca
C.
gr
due
wt
o
to
cervca
MRI
because
comes
Lower
ongtudna
15-year-od
vertebra
Lower
Posteror
department
age
woud
Lower
B.
A
te
ands
sensaton
Lgamentum
sae
C.
patent?
Nuca
s
termnates
oowng
dscooraton
temperatures
te
Supraspnous
E.
o
dagnosed
at
A.
D.
te
eve
usuay
te
ensure
between vertebrae C2 and C3. Wc o te oowng
sows
spna
o
hs
to
s
um-
spne
oss
to
wc
cord
In
between
vertebrae
njured.
spna
ordered.
nserted
L5
and
menngts
dura
te
s
njury
oowng
protect
n
not
o
lavum
examnaton
or
cervca
te
to
Se
musces
to
tng
pan
Pysca
and
and
s
bood
110/mn,
B.
space
ater
te
abnormates
o
mater
comes
pan
descrbes
sensaton.
ogc
gamentum
subaracnod
59-year-od
o
te
aracnod
oten
s
woman
story
ow
92/mn,
C.
te
n
or
and
s
bers
space
anteror
s
med-
res-
lud
te
6-year
toes
A.
bood
and
menngts
oowng
a
med-
(104.5°F),
110/mn,
o
not
story
known
cerebrospna
regon,
s
gaments
A
45-year-od
dsease
parents
daugter
any
s
emergency
o
patent’s
ter
puse
o
te
he
dagnoss
wc
epdura
s
sampe
umbar
n
to
takng
Hg,
A
aferent
story
etargy.
temperature
are
tap
3-day
vaccnatons.
and
101/64
T o
be
brougt
o
and
a
nesses
pratons
s
vaccnatons
date
major
A
o
gr
eadace,
aganst
19.
because
puse
puncture
known
(104.5°F),
dagnoss
L4
te
any
40.3°C
eves?
vertebra?
vscera
A
te
cord
between
takng
s
Hg,
neede
o
adut
B.
and
mm
umbar
te
A.
eferent
a
te
dsc
not
25/mn.
spna
n
s
101/64
processes
because
ranorest.
carry
just
by
s
and
temperature
puncture,
spnous
er
Latn
Wc
18.
Her
Menngomyeocee
nsect
17.
nesses
catons.
A.
o
16.
o
oowng
5
Back
1
A
Wc
aso
be
6
C H A P T E R
22.
1
Back
A 28-year-od prmgravda woman at 40 weeks’ gesta-
ton
s
admtted
sgns
are
eart
rate
na
wtn
va
spaces
o
te
n
te
are
abor,
sacra
te
ospta
norma
montor
stages
tered
to
mts.
paced
a
sacra
A
on
cauda
atus.
cana
game
Her
vta
stfness
n
tocometer
and
eta
mts.
er
abdomen.
anestetc
Into
s
sotba
devery.
or
wc
te
o
s
te
anestetc
In
te
rgt
der.
admns-
oowng
most
key
ng
paced?
A.
V ertebra
cana
B.
V ertebra
venous
C.
Epdura
D.
Subaracnod
E.
23.
severe
s
by
s
te
24.
lud
oowng
Hs
pressure
s
o
s
are
141/91
suspected,
s
most
ever
mm
and
a
ces.
penetrated
Dorsa
D.
Greater
E.
Axary
A
ater
man
Pysca
An
MRI
ematoma.
A.
Anteror
B.
T ransverse
Lgamentum
D.
Supraspnous
E.
Nuca
A
ater
transverse
wt
o
a
te
B.
V ertebra
C.
Ascendng
D.
Deep
E.
Posteror
key
a
motor
sows
a
sows
o
arge
arteres
te
trd
s
most
vece
sows
damage
pusatng
ospta
suggs
examnaton
MRI
process
n
te
to
18-year-od
co-
no
abty
oter
tp
XI.
Wc
damaged?
29.
spna
story
o
osteopoross.
condton
o
te
pyscan
ncreasngy
examnaton
convexty
to
to
sows
te
o
te
patent’s
o
oowng
s
lex
o
major
Rombod
mnor
E.
T eres
A
by
t
s
te
owng
a
spna
te
o
te
Lgamentum
Nuca
30.
department
ng
nto
because
second
o
base
an
brougt
njury
eadrst
to
te
emergency
sustaned
durng
er
ater
sd-
company’s
odontod
uretra
to
n
njury
gaments
te
a
sows
s
emergency
roover
motor
mutpe
max-
weakness
wt
musces
n
njury
s
to
most
er
CN
key
Crucorm
Posteror
E.
Supraspnous
s
cord
woud
te
most
deat
be
most
o
a
motor
a
arrves
te
o
conrmaton
reports
racture
wc
key
oca
at
cause
oicay
was
Rupture
on
key
Upon
examner
o
(C2).
g-speed
rend
examner
njury.
o
o
te
te
o-
mpcated
n
g
stabzed,
gament
to
o
s
njured
speed
te
and
gament
gament
man
rate
brougt
lavum
ongtudna
65-year-od
a
tat
a
s
gament
D.
at
n
njury?
C.
A
ked
medca
cause
gaments
B.
s
brougt
racng
medca
axs
A.
dsc
te
patent’s
ata
was
ater
determned
autopsy,
pedces
spne?
Wen
was
te
most
man
coson
tat
stenoss
woman
te
et
x-ray
major
23-year-od
resutng
26–50
a
atas
oowng
Rombod
Spna
42-year-od
te
assocated
D.
Hyperkyposs
A
by
oowng
consderabe
C.
C.
Questions
response
sows
open-mout
cord
50
co-
toracs
B.
Lordoss
and
Iocostas
ts
Hernated
suggs
mb
sows
njured
neck,
te
Scooss
E.
vece
gament
examnaton
er
A.
D.
ospta
motor
ower
te
s
beng
Sternocedomastod
deat
ncreased
curvature
a
spna
o
B.
scene,
ambuaton.
abnormay
toracc
Wc
ts
an
panu
because
n
pevs
o
A.
gway.
comes
te
woman
ater
Wc
vece
man
patent?
afected?
o
cervca
an
gament
aceratons
to
te
and
oow-
lavum
Pysca
oaca
vertebra,
ematoma.
key
vece.
response
te
cervca
30
cervca
3-mont
posteror
nvoved
to
spna
79-year-od
rom
An
oowng
Anteror
Pysca
admtted
examnaton
sgncanty
A.
A
s
Neuroogc
abnormates.
te
man
beng
Pysca
stmu.
An
to
te
gament
department
25-year-od
to
28.
ts
cervca
te
gament
Anteror
ongtudna
o
o
a
ongtudna
Dentcuate
Posteror
o
er
sou-
torn?
C.
Nuca
o
tat
ractures
n
sows
te
Wc
B.
E.
o
and
compresson
key
admtted
examnaton
C.
D.
no
and
norma
droopng
Wc
damaged
pan
wtn
eevatng
sows
nvoved
x-ray
racture
An
s
beng
Supraspnous
ongtudna
sows
n
damage.
key
severe
are
occpta
stmu.
most
spne
as
sgns
scapuar
53-year-od
and
by
most
Accessory
process.
Wc
te
C.
sows
te
s
Se
vta
dicuty
tssue
B.
emora
A
o
sot
horacodorsa
to
puse
o
nerves
ago.
Her
examnaton
and
A.
son.
umbar
examnaton
key
and
Hg.
x-ray
sows
mnutes
temperature
19/mn,
ematopoetc
gaments
emergency
g
nta
Mcroscopc
sows
te
Pysca
A.
son.
26.
because
back.
respratons
bood
ordered.
to
neede?
mnutes
25.
s
menngts
cerebrospna
te
brougt
parents
n
and
o
puncture
o
s
was
(101.8°F),
94/mn,
dagnoss
27.
boy
stfness
38.8°C
space
space
12-year-od
department
s
space
Subdura
A
pexus
ours
neck.
souder
An
MRI
2
er
an
ts
emergency
x-ray
o
wen
s
car
a
vece
rom
department
te
spne
traveng
bend.
were
sows
tat
He
e
s
two
CHAPTER
o
s
artcuar
condton
s
scedued
ng
processes
known
regons
te
o
as
same
te
are
now
“jumped
day.
spne
In
as
ocked
acets.”
wc
ts
togeter,
Surgca
o
te
njury
a
coson
repar
An
oow-
most
o
key
o
sensaton
or
Cervca
mbs. Wc
woud
C.
Lumbar
A.
Rotaton
D.
Lumbosacra
B.
Fexon
E.
Sacra
C.
Abducton
47-year-od
back
s
40
pan.
spne
te
sows
o
Se
respratons
a
arge
s
space
a
rom
te
vece
eadace
mm
32/mn.
pexus
s
emergency
motor
severe
ematoma
oowng
te
99/78
are
venous
to
n
as
pressure
vertebra
te
brougt
nvoved
ago.
bood
and
s
beng
mnutes
Her
nterna
wc
woman
ater
122/mn,
te
Hg,
An
MRI
beedng
(o
and
most
Subaracnod
B.
Subdura
C.
Centra
o
an
In
key
Batson)
te
Aracnod
D.
Dura
oss
n
eray
because
te
been
spne
upper
o
te
an
Hs
atete
are
emergency
o
severe
rgt
and
e
norma
MRI
L4–L5
or
most
key
he
mg).
bat-
and
umbar
An
dsc.
Hs
puse
saow,
MRI
to
be
Head
B.
L4
B.
Neck
C.
L2
C.
Head
D.
L5
D.
T uberce
E.
S1
E.
Head
a
we
met
o
and
tme.
patent
te
s
because
ost
s
to
patent
toracc
spne
or
te
an
and
oowng
not
ater
depart-
a
wearng
unknown
sows
te
sows
extendng
o
tese
bendng
emergency
stran
was
examnaton
ateray
or
te
back
conscousness
Wc
to
ower
he
Pysca
ower
suppy
a
skng.
responsbe
trunk.
brougt
o
pan
trunk.
njury
to
ateray
arteres
te
o
MRI
back.
and
te
ng
bood
musces?
meda
s
T eres
B.
T rceps
Supraspnatus
Inraspnatus
E.
T eres
D.
Suprascapuar
E.
Posteror
department
unconscous
oowng
te
a
emergency
ead-to-ead
wa
n
sows
excess
beore
structures?
a
to
te
n
a
and
emergency
busy
te
s
asprn
ourt
war-
(325mg
are
112/72
costa
ntersec-
ncude
24/mn
mm
Hg.
toracc
structures
s
ver-
most
njury?
rb
rb
s
brougt
s
a
ater
back
eson
on
o
s
key
to
e
te
durng
between
te
a
te
rgt
sows
arm.
emergency
sustaned
a.
deep
trapezus
atera
weak
Wc
a
Pysca
o
sde
and
o
s
adducton
te
oow-
njured?
major
22-year-od
department
to
te
just
brac
D.
brougt
o
stop
(o
compres-
mnor
Anteror
s
sows
pexus
rb
to
most
horacodorsa
man
been
durng
spne
respratons
o
te
trd
rotaton
C.
22-year-od
te
medcatons
examnaton
B.
A
object
rb
musces
C.
ntercosta
emergency
causng
car
pressure
mnutes
A.
A
ead
rb
ker
Subscapuar
38.
n
t
sows
Pysca
a
oowng
trd
45
dors
musces
by
112/mn,
ourt
A.
ntercosta
te
avng
venous
soud
brougt
t
bood
te
wound
atssmus
o
o
aspraton
metormn,
te
te
examnaton
musces
bendng
o
s
ourt
te
20-year-od
puncture
te
o
te
o
a
e-
te
o
oowng
dsocaton
te
o
department
amount
provde
A
o
severe
wen
An
37.
MRI
neede
current
nvoved
A.
24-year-od
s
and
sows
L3
ment
to
story
unknown
Wen
beng
patent’s
A.
A
o
oss
ower
lavum
man
metoproo,
key
or
mater
ater
tebra. Wc
afected?
sows
no
mater
Lgamentum
arn,
upper
movements
vertebra
te
as
mater
65-year-od
ton.
sensory
te
A
s
ematoma
te
o
n
He
cord
department
mts.
ntervertebra
s
E.
36.
wen
ntact
o
and
tng
sesson
uy
pan
tg
was
weakness
are
mbs.
nerves
s
wtn
motor
ruptured
te
tranng
Relexes
ower
oowng
o
ntense
no
to
story
aspect
vtas
mbs.
and
a
3-our
ete
sows
ower
sows
Wc
an
durng
exam
n
o
brougt
posteror
appeared.
s
s
a
cord.
wc
Pa
man
to
spna
puncturng
An
ootba.
dsocaton
examnaton
jont.
brougt
an
sgt
afected?
2-our
wt
perormed,
C.
wegts
Pysca
te
s
s
o
nterna
eadng
B.
as
pan
o
bood
strengt
robbery.
te
space
department
eavy
space
space
32-year-od
He
o
tat
severey
man
aggravated
ruptures
Pysca
at
payng
sows
oowng
be
back
cstern
Epdura
eg.
te
Spna
Lumbar
to
n
jont.
te
we
neck
moton
because
A.
E.
radatng
42-year-od
struck
cana
D.
A
Extenson
Adducton
payer
and
motor
o
E.
A
o
key
D.
son
A.
most
department
rom
Batson).
bood
35.
puse
accumuatng?
34.
range
horacc
A
ead
atantoaxa
B.
coson
33.
anoter
te
A.
department
32.
te
o
decreased
occurred?
31.
wt
x-ray
7
Back
1
gt
tat
man
ater
te
2
e
s
was
ours
atera
brougt
trown
ago.
An
border
to
te
troug
o
x-ray
s
emergency
a
o
rgt
pate
te
gass
torax
scapua
s
8
C H A P T E R
39.
1
Back
sattered. Pysca examnaton sows dicuty rotat-
A.
L3–L4
ng
B.
L3
C.
L4
s
arm
rgt
upper
most
key
mb.
Wc
no
o
oss
te
o
sensaton
oowng
n
s
musces
s
njured?
major
D.
T12–L2
E.
T11
B.
Inraspnatus
C.
Latssmus
D.
T rapezus
ower
E.
Supraspnatus
congenta
43.
dors
Examnaton
o
s
o
spna
back.
a
3-day-od
cord
and
Wc
o
mae
mennges
te
sows
rom
oowng
a
best
ment
potopoba,
B.
Menngts
moved
C.
Spna
bda
occuta
D.
Spna
bda
wt
myeomenngocee
E.
Spna
bda
wt
menngocee
6-day
stfness
o
on
story
er
back.
campus
wo
date
vaccnatons.
er
sgns
perormed
brospna
w
or
to
lud.
penetrate
Wat
beore
Aracnod
B.
Dura
C.
Pa
D.
Lgamentum
E.
and
a
te
a
Se
reacng
s
umbar
s
structure
te
umbar
up
to
sows
puncture
n
te
te
a
oter
not
examnaton
patogen
ast
nto
one
44.
s
cere-
neede
cstern?
stf
wt
examnaton
suspected
umbar
owng
man
s
g
tat
ever,
ave
sows
a
sampe
puncture
spaces
s
was
severe
s
a
te
emergency
eadace,
or
3
days.
purpurc
A
dagnoss
o
cerebrospna
obtaned.
te
to
perssted
tere
extremtes.
and
gament
brougt
o
From
Pysca
ras
on
s
menngts
lud
wc
cerebrospna
nausea,
lud
usng
o
te
s
45.
a
o
te
es
perormed.
are
used
Vscera
Somatc
eferent
C.
Somatc
aferent
D.
Sympatetc
E.
Parasympatetc
65-year-od
b).
uses
He
an
ease
C.
Subaracnod
regon.
D.
Pretracea
caracterstc
E.
Centra
A
38-year-od
department
vece
man
ater
coson.
aceratons
aceratons
and
or
te
admtted
Pysca
to
o
oowng?
centra
o
to
te
njures
over
te
nervous
s
skn
wtn
and
sows
severa
C.
Abducton
(CNS)
by
rom
con-
wc
46.
Adducton
E.
Inverson
A
72-year-od
V entra
ram
cepton
D.
V entra
roots
computed
E.
Intercosta
se
ad
spne.
encng
sows
er
no
started
At
tumor
retan
ncontnence.
pysca
wc
most
o
sgns
te
key
pyscan
wt
a
urne
Utrasound
obstructons
are
te
recenty
to
oss
on
metastatc
dagnosed
symptoms
wt
examnaton
nerves
as
recta
drome.
te
been
Se
ment
ram
o
n
oowng
ocated?
te
conus
because
tumor
and
o
s
te
on
prmary
te
A.
badder
badder.
meduars
vertebra
er
exper-
Bot
B.
eves
s
pan
oca
oowng
pyscan
(5
t,
11
n)
or
as
needed.
s
age.
movements
oowng
Hs
He
o
s
rou-
78
sgns
tested
s
n
kg
astma
vta
or
umbar
movements
jonts
a
and
exercse-nduced
or
te
he
he
wt
o
s
et
tumors
oss
sde
n
to
te
and
s
te
most
um-
te
te
o
CT
and
te
scan
scan
te
cancer
sezures.
vbraton
beow
o
o
emergency
te
te
Pysca
ne.
bran
pevs
oowng
te
propro-
umbca
o
o
and
o
depart-
best
A
sows
sows
a
expans
bran?
venous
pexus
contans
te
ongest
body.
nterna
venous
movement
nterna
aracnod
story
to
(CT)
a
Wc
nterna
a
conscousness
tomograpy
one-way
C.
o
brougt
sows
metastass
he
s
tumor.
vens
syn-
te
ntervertebra
man
gand
C.
o
ram
te
he
lexon
D.
Dorsa
to
te
Crcumducton
s
o
stud-
sows
coccyx.
wc
m
naer
o
te
to
1.8
mts
Latera
Communcatng
comes
o
o
s
story
B.
Pan
te
MRI
s
te
regon?
prostate
woman
a
norma
Wc
B.
66-year-od
as
A.
back
o
n
pregangonc
He
motor
te
dynamc
ater
coccyx
njected
examnaton
regon
comes
lexbty
A.
A
man
a
back.
o
system
emergency
rom
examnaton
eccymoss
rrtatons
veyed
te
s
sustanng
bar
ten
nterrupt
abutero
Subdura
cord
rst
te
pregangonc
examnaton.
and
s
because
area
aferent
B.
spna
to
B.
are
te
te
pyscan
coccygea
patways?
Epdura
o
to
and
te
te
weter
Pysca
A.
A
to
n
anestetc
coccyx
papaton
s
comes
pan
determne
oca
A.
cana
T o
regon
(172
coected?
o
a
tne
o-
story
nvoved,
nerve
ongtudna
mennges
woman
brt.
anestetc
neck
and
2-week
wt
lavum
o
32-year-od
gvng
mater
department
A
o
mater
Posteror
trunk
sck.
wt
mater
19-year-od
and
ves
Pysca
s
recenty
se
been
menngts
determne
A.
A
not
eadace,
Se
were
roommate,
on
as
o
te
ts
anomay?
Avuson
a
n
descrbes
A.
wt
protruson
deect
A 20-year-od woman comes to te emergency depart-
postve
42.
as
T eres
dormtory
41.
He
A.
and
40.
ateray.
venous
space.
pexus
o
as
vaves
tat
ensure
bood.
pexus
s
ocated
n
te
sub-
CHAPTER
D.
he
nterna
venous
E.
he
nterna
venous
ra
47.
A
department
te
o
Genod
D.
Spne
E.
Acromon
to
te
be
vaveess.
te
subdu-
Questions
51.
A
a
adder
s
ouse.
abnormates.
te
te
rom
porton
gest
Wc
o
o
te
o
(98.8°F),
and
o
et
ave
been
te
ng
wc
oowng
te
scapua
scapua
Between
B.
As
C.
Between
D.
Between
E.
Between
tey
wo
s
emergency
n
sows
o
a
constructon
department
Pysca
s
ower
crused
te
a
examnaton
mbs.
spna
oowng
ater
An
MRI
cord
musces
at
worker
a
bra
rom
sows
oss
52.
A
39
vertebra
ar
te
most
weeks’
ate
ng
D.
Latssmus
epdura
E.
Detod
dors
36-year-od
sze
or
ra
te
vta
A
Feta
dagnoss
o
ts
o
vst.
n
u
Se
as
o
protrudng
oowng
congenta
term
no
ad
dev-
nerves
o
age,
An
dscs
resut-
ernaton.
most
neror
and
a
53.
sows
te
a
key
At
to
be
oramen
artcuar
superor
wegt
acets
vertebra
vca
anomay?
ca
C.
Spna
bda
cystca
o
D.
Hemotorax
E.
Cauda
regresson
gr
because
s
o
a
examnaton
superor
to
protruson
Wc
ac
s
syndrome
brougt
Pysca
te
sot
crest
te
to
te
ump
sows
deep
o
te
pyscan
above
ump
unateray
to
te
skn
oowng
on
and
s
te
s
er
buttocks.
ocated
te
et
pabe
te
by
most
just
sde.
to
te
key
dagnoss?
A.
T umor
te
B.
Hernaton
C.
Indrect
D.
Drect
E.
Femora
at
externa
te
nguna
nguna
erna
o
abdomna
umbar
erna
erna
trange
obque
(o
musce
Pett)
54.
a
cm
and
bock
Wc
used
o
to
te
or
tat
Pysca
50%
aev-
oow-
te
cauda
te
T ransverse
Latera
no
o
ad
stor y
o
to
te
s
o
to
cer vca
sows
and
spne
o
or
-
ocazed
scan
bran
parts
key
o
CT
te
pan
cs,
medca
areas
A
certan
most
pyscan
back
ever,
major
sows
te
te
any
spne.
metastass
MRI
to
persstent
cer-
conrms
te
ocated
n
cer v-
wc
ocatons?
process
process
mass
D.
Pedce
E.
Spnous
process
22-year-od
department
pan
upper
radatng
mb.
and,
He
s
brougt
et
te
ture
troug
ture
extends
a
t
upper
te
s
s
cose
mb
scapua
superory
o
n
a
back
et
to
an
te
and
mb
He
s
wt
Any
ncreases
unusua
te
emergency
down
body.
et
toward
te
tavern.
upper
s
greaty
sows
spne
nto
braw
across
supports
odng
te
o
man
oowng
severe
x-ray
not
cer vca
wt
oowng
move
as
comes
stor y
as
Metastass
C.
atus
crest
metastass
B.
An
ntervas
4
at
oramna
Se
An
Odontod
to
to
epdura
0,
regu-
oramna
examnaton
n
cancer
spne.
rgt
para
wt
strengt.
dated
commony
woman
Se
spne.
te
n
devery.
1,
ospta
12-mnute
cauda
sacra
3-mont
A.
A
te
sacra
oss.
ocazed
bda
gravda
te
oramna
sacra
Pysca
breast
at
cervx
a
most
sacra
o
tenderness
key
ntercostoverte-
bock?
eadaces.
ness.
a
vagna
s
to
ncreasng
gven
durng
Medan
neu-
o
sows
s
38-year-od
and
etus
Se
Intervertebra
A
neror
woman,
contractons
andmarks
wt
back
most
pan
because
beedng
possbe
te
n
and
comes
steady
D.
occuta
o
dsc
vertebra
and
neror
pregnant
Cornua
bda
touc.
Pysca
gaments
te
superor
C.
Cranum
he
te
Anteror
Spna
parents
te
Posteror
B.
7-year-od
Hg.
s
15/
abnormates.
because
spna
superor
B.
A.
A
mm
are
ntervertebra
and
dentcuate
A.
E.
mts.
sampe
rom
s
as
consstent
serum
ndcatve
comes
norma
utrasonograpy
te
Se
uterus
materna
s
gestaton
wtn
a
gestaton.
dscarge.
Wc
are
sows
myeomenngocee
cd.
weeks’
resutng
sgns
14-week
deect.
14
prenata
pregnancy
er
a
at
a
apa-etoproten
tube
wt
or
examnaton
vagna
g
woman,
pyscan
wt
te
sze
troug
te
examnaton
Dapragm
T oday,
te
gestaton,
been
T rapezus
Pysca
te
pass
uterne
ave
key
C.
ery.
n
stenoss
are
respratons
138/74
tat
because
temperature
jonts
B.
prevous
s
pyscan
Her
neuroogc
sows
spna
37-year-od
cer-
o
C6
w
a
s
efaced.
one
no
te
74/mn,
pressure
decreased
A.
Sternocedomastod
te
s
to
pan.
compressed?
parayzed?
to
back
puse
spne
ocatons
comes
o
sows
md
A.
A
bood
MRI
n
woman
story
examnaton
An
s
pont
1-year
mn,
ractured?
te
budng.
Wc
e
a
37.1°C
emergency
pantng
no
tat
tp,
te
51–75
74-year-od
notces
sensaton
spne
o
man
te
two-story
eve.
n
process
ange
43-year-od
vca
50.
o
sows
te
key
C.
and
sows
most
Coracod
a
genera,
to
we
ractured.
Superor
o
spped
been
B.
a
49.
s
brougt
beow
orms
as
parts
brougt
e
scapua
tat
A.
A
s
examnaton
souder
48.
man
ater
te
scapua
bony
n
ocated
o
pavement
Pysca
x-ray
s,
s
space.
26-year-od
onto
pexus
pexus
9
Back
1
te
he
superor
s
attempt
sagtta
scapua.
as
et
pan.
rac-
rac-
scapuar
10
C H A P T E R
notc.
1
Back
Wc
o
te
oowng
nerves
s
most
key L
afected?
55.
A.
Suprascapuar
B.
horacodorsa
C.
Axary
D.
Subscapuar
E.
Suprascapuar
A
5-year-od
ment
back
because
and
some
o
a
boy
webbed
o
2-day
a
An
uson
key
neck.
Hs
and
ow
to
te
story
s
symptoms.
neck.
g-rdng
most
o
toracodorsa
brougt
earng
as
abnorma
and
s
“stf”
s
steatons
te
boy
o
o
C5
o
e
upper
as
tese
examnaton
and
cervca
and
Wc
depart-
te
wt
arne
te
n
says
concerned
Pysca
te
scapua.
pan
moter
posteror
x-ray
emergency
o
C6
te
ost
con-
sows
a
sort-
spne
sows
vertebrae
and
oowng
s
a
te
dagnoss?
A.
Lordoss
B.
Kyposs
C.
Scooss
D.
Spna
E.
Kppe-Fe
bda
syndrome •
56.
A
53-year-od
3-mont
story
radatng
down
mnutes
beore
examnaton
peda
puses
o
egs
and
pan
sows
are
to
pyscan
progressve
s
te
comes
back
e
can
becomes
norma
present,
pan.
wak
Hs
or
unbearabe.
patear
and
because
tere
s
pan
s
about
6
a
Pysca
tendon
n
body
ee-
sensaton
tg.
as
An
ton
te
o
te
o
body
te
o
te
oowng
A.
Spondyoyss
B.
Spondyostess
C.
Hernaton
D.
Lordoss
E.
Scooss
A
sows
exam
boy
tabe.
s
most
upon
te
sacrum.
key
dagnoss?
dsc
mk,
o
and
te
and
abe
Wc
o
te
to
wt
arm
t
a
Pysca
s
arms
congenta
and
spna
s
of
te
Menngocee
B.
Kppe-Fe
C.
Car
D.
Hydrocepaus
E.
A
II
T etered
because
a
orward
utes.
and
Pysca
strengt
worse
key
te
o
te
zyg-
oowng
s
ernaton
wc
was
er
sows
a
te
brougt
njured
neck
struck
o
s
beng
was
rom
to
n
o
oowng
emergency
motor
vece
yperextended
bend.
racture
te
a
te
An
x-ray
odontod
structures
s
wen
o
er
process
aso
most
njured?
Anteror
Posteror
key
C.
Atantooccpta
D.
Ineror
E.
Anteror
A
o
o
vertebra
racture
woman
ater
Wc
racture
Wc
aspect
L4
syndrome
B.
60.
s
arc
o
te
tuberce
o
woman
ater
a
atas
te
atas
process
tuberce
34-year-od
o
jont
artcuar
department
examnaton
admtted
story
Se
wen
n
o
ees
te
back
reeved
se
examnaton
bateray
Kppe-Fe
spne
wt
te
spondyostess
dsc
A.
syndrome
worse.
vertebra
vece
meda
te
s
o
te
axs
atas
admtted
motor
vece
to
te
emergency
coson.
Se
rear-
ended a stopped vece at a ow rate o speed. Pysca
woman
5-mont
progressvey
E.
and
ver-
te
syndrome
cord
Intervertebra
(dens).
sows
maormaton
62-year-od
Crus
D.
cervca
te
dagnoss?
A.
C.
n
1.2).
et
sows
dagnoss?
Spondyoyss
40-year-od
te
spne
anterory,
Spondyostess
A
on
te
(Fg.
B.
er
maor-
most
key
o
A.
coson
d-
protrudng
nto
most
jont
department
s
exam
cord
are
magnum
oowng
by
weakness,
obongata
oramen
te
pyscan
strdor.
bran
medua
te
to
batera
dagnosed
troug
cana.
s
barey
MRI
cerebeum
brougt
o
s
He
An
nerory
tebra
s
swaowng
te
te
ntervertebra
boy
because
maton.
te
o
s
vertebra
59.
1-year-od
cuty
L5
.
dect
x-ray
spped
apopysa
moter
58.
sgt
te
relexes,
dicuty
Fig.
o
wakng. An MRI examnaton sows anteror dsoca-
Wc
57.
man
waks
sows
ower
to
te
pan
as
wen
or
se
ospta
a
as
gotten
se
ew
5/5
extremtes.
te
cervca
mted
range
bends
to
perorm
mn-
to
te
motor
here
s
mts
o
te
sows
and
et.
n
a
o
se
moton
task
wen
Neuroogc
te
spne
as
toracc
upper
sows
n
se
a
s
Se
axes
ower
wpas
tenderness
as
and
asked
examnaton
and
a
paraspna
regon.
to
s
se
turn
s
n
unabe
er
wtn
extremtes.
njury
n
sgncanty
ead
norma
An
MRI
addton
to
CHAPTER
yperextenson
oowng
61.
o
A.
Lgamentum
B.
Anteror
C.
Posteror
D.
Annuus
E.
Interspnous
A
and
er
upper
are
extremtes.
te
ng
MRI
cord
structures
as
wt
te
and
n
over
motor
key
50-oot
a
num-
er
n
n
er
examnatons
sows
Wc
back
strengt
upper
been
a
strengt
relex
te
et.
emergency
rom
sows
motor
spne
te
most
3/5
5/5
mts
to
te
eccymoss
and
o
to
jumpng
examnaton
Sensor y
norma
spna
admtted
and
extremtes
extremtes.
o
te
gament
ater
Pysca
extremtes
wtn
o
gament
s
mnutes
aceratons
ower
Wc
njured?
gament
woman
50
upper
spne.
key
lavum
ongtudna
watera.
o
cervca
most
brosus
department
ber
s
ongtudna
23-year-od
g
er
gaments
11
Back
1
a
and
o
torn
ower
atera
te
to
st
oow-
cause
te
devaton?
A.
Posteror
B.
T entorum
ongtudna
C.
Dentcuate
gament
cerebe •
62.
D.
Lgamentum
E.
Nuca
A
n
s
ung
lavum
boy
because
dyspnea.
he
on
te
oowng
orm
A.
one
says
soud
to
te
story
e
te
ees
eard
scapuae
te
pace
o
ke
tere
sows
most
a
by
s
cougng
s
to
to
dors,
trapezus,
meda
o
scapua
B.
Detod,
evator
C.
Latssmus
scapuae,
dors,
externa
trapezus
abdomna
obque,
ac
65.
Quadratus
obque,
E.
Rectus
A
a
neror
tesa.
s
he
pan
exacerbated
or
examnaton
wt
norma
syndrome,
o
o
te
nguna
comes
souder
as
been
wen
many
sows
e
twet
gament,
MRI
causng
te
to
te
pan
C.
L2
D.
L5
E.
S1
neror
pror.
parayss
ep-
boterng
n
n
sows
te
weakened
oowng
coege
nerves
o
or
s
Injury
B.
Injury
ete
radate
tg
an
and
MRI
o
suddeny
eg.
o
te
atete
was
tranng
Se
er
to
was
spne
oowng
t-
sesson
te
at-
brougt
was
per-
nerves
was
n
o
an
o
te
te
to
o
exbts
actvty
aneurysm
sows
hese
n
to
patent’s
o-
te
wdespread
unctons
admsson
ts
unt
eca
aortc
mbs.
pror
care
or
examnaton
cause
o
ntensve
urnary
abdomna
ower
key
o
te
contro
te
were
ospta.
current
cond-
oowng?
et
vertebra
te
great
artery
radcuar
artery
(o
Adamkewcz)
Pysca
Axa
C.
Lgaton
D.
T ransecton
o
te
o
posteror
te
spna
conus
artery
meduars
o
te
spna
cord
space
E.
movements.
afected?
man
s
to
an
ntense
afected?
norma
wc
A.
movements
key
most
ton
and
extremtes.
most
he
s
an
Wc
Pysca
o
payed
years
He
o
pares-
quadranguar
souder
s
because
arm
years.
souder
upper
sgns
m
basketba.
s
weakened
atera
were
vountary
repar
pan
rgt
1.3).
(Fg.
wo
durng
severe
er
58-year-od
days
rb
pyscan
and
pays
years
sensaton
T1-wegted
Wc
L4
owng
abdomna
o
ospta
essentay
man
severe
basketba
border
nterna
vesses
45-year-od
2-week
umborum,
abdomns,
gastrc
63.
L3
B.
A
et
probaby
A.
tte
crest
D.
te
most
ear
border
se
woman
wegts
aspect
ormed
o
sounds?
Latssmus
eavy
era
space
best
29-year-od
wen
dur-
Wc
A
ng
gass
ceary
tranguar
stetoscope
64.
and
abnorma
protracted.
borders
te
ospta
o
examnaton
auscutaton
wt
ung
2-day
Pysca
naaton
te
brougt
a
patent
ungs.
sounds
s
o
ng
were
.
gament
6-year-od
parents
Fig.
gaments
66.
A
Dvson
o
23-year-od
te
toracc
woman
Subscapuar
pan.
C.
Axary
was
D.
Rada
examnaton sows no neuroogca dects. CT o er
E.
Unar
spne
sows
a
wen
wt
cnca
a
se
story
was
muscuar
condton
8
o
emergency
B.
dagnosed
2-day
trunk
te
department
poo
a
to
Suprascapuar
ad
o
sympatetc
brougt
A.
Se
because
s
years
severe
o
dystropy.
afectng
er
back
age
and
Pysca
vertebra
12
C H A P T E R
1
coumn.
n
67.
ts
Back
Wc
o
te
oowng
s
most
key
present
resutng
patent?
sows
A.
Hyperordoss
and
B.
Hyperkyposs
te
C.
Scooss
o
D.
Spna
patent
E.
Osteoartrts
A
bda
26-year-od
pan,
weakness,
mb
or
sows
no
cervca
and
a
te
te
2
o
and
te
annuus
damaged
key
te
tngng
MRI
o
s
and
tense
te
compressng
cord.
An
nuceus
Wat
n
C.
Rombod
D.
Semspnas
E.
Latssmus
sows
nerve
a
roots
cervca
perormed.
remova
puposus
are
71.
and
most
ntervertebra
upper
B.
Eastc
ogca
C.
Fbrous
arge
Eppysa
E.
Eastc
23-year-od
n
cervca
dsc
s
remova
te
he
are
te
te
te
mb.
MRI
nuceus
puposus,
o
cord.
te
dsc
and
damaged
orgn
o
An
because
numbness,
compressng
spna
severey
pyscan
weakness,
ntervertebra
embryoogc
nuceus
to
pan,
upper
o
and
puposus
comes
o
spne
te
ACDF
s
examned
annuus
and
te
annuus
s
upon
brosus
and
Neura
C.
Scerotome
D.
Mesencyma
E.
Mesencyma ces rom scerotome and notocord
a
1-week
Se
as
ad
a
a
been
o
ces
story
and
neura
moss,
te
examnaton
sow
dranage.
parta
nlamed
o
te
wc
ce
te
notceabe
necton
conjunctva.
and
to
canges
or
te
Se
ptoss,
Pysca
o
te
o
past
n
er
recenty
tat
deveoped
and
examnaton
membrane.
oowng
neurons
ace.
73.
red-
sows
B.
Latera
C.
Posteror
D.
Spna
E.
Latera
A
gray
gray
orn
orn
gray
o
o
orn
te
te
o
spna
spna
te
by
62-year-od
department
o
man
ater
a
spna
s
cord
cord
cord
wte
to
motor
matter
te
emergency
vece
coson
74.
Latera
mass
D.
Pedce
(pars
E.
Spnous
neuro-
sows
and
a
greater
musces
w
mnor
to
Despte
as
n
o
major
severa
terapy,
cond-
a
n
er
Autopsy
resut
resutng
emergency
osptazed
erse.
a
te
epsode
o
angng.
deat
racture
sows
o
s
a
he
orcbe
wc
o
te
process
process
er
wtn
artcuars)
process
72-year-od
woman
norma
coumn
and
Scooss
C.
Hyperordoss
Norma
Prmary
65-year-od
3-day
woman
story
o
An
te
ago.
x-ray
cortca
seres
bone
w
curvature
to
group
pyscan
Her
racture
Wat
comes
a
to
days
wedge
tn
spna
B.
E.
a
canges.
abnorma
2
mts.
sows
vertebra
D.
comes
batroom
osteoporotc
a
been
angs
racture
Hyperkyposs
o
and
severe
as
years.
se
A.
A
neck
structures?
C.
o
strengt
no
normay?
brougt
a
Se
njury
Odontod
n
s
o
resutng
T ransverse
o
cord
spna
brougt
severe
o
B.
A
8
and
vertebra
toracc
ts
ganga
coumn
past
A.
type
Anteror
because
worsens,
tebra
dsease?
A.
woman
dsorder.
te
and
te
monts.
motor
wt
oowng
major
neror
36-year-od
n
ead
6
ead.
to
capts
superor
are
structures
afected
posteror
ast
suboccpta
te
capts
ang
Bopsy
o
progres-
s
weakness
te
ead
unctonng
capts
oowng
because
mont
anydross,
tympanc
bodes
pyscan
te
Obquus
mecansm
scerotome
te
emergency
o
capts
yperextenson
rom
te
E.
cervca
ectoderm
comes
o
ear
producng
bugng
woud
and
ces
myotome
woman
mdde
rgt-sded
ness
ces
and
crest
ces
55-year-od
o
neura
o
te
decreased
o
Spenus
ton
B.
A
and
sows
Obquus
tmes
respectvey?
or
D.
depressve
te
weakness
oowng
rotatng
back
C.
A
and
musce
Wc
capts
department
Wat
Notocord
crest
72.
te
story
some
MRI
be
Rectus
nuceus
posteroateray.
st
Semspnas
surgery
extendng
compressng
B.
a
o
to
1-mont
rotaton
nerves.
key
brougt
a
s
An
A.
A.
crest
dects.
o
roots
s
o
and
o
and
sows
nerve
wt
rgt
tumor
most
ernaton
porton
perormed.
s
man
story
tngng
a
brous
njury
afected?
man
because
examnaton
and
te
some
n
ram
capts
eadaces
occpta
and
3-mont
et
Wc
dorsa
mnor
musces
n
and
70.
as
st
ead
dors
weakness
He
te
ater
s
te
ractures
major
22-year-od
sve
musce.
o
scapuae
department
severey
cartage
A
a
upon
tere
examnaton
MRI
vertebra
monts
but
key
Rombod
Pysca
D.
o
most
An
arne
T wo
we,
Levator
Hyane
A
s
Pysca
mpngng
eves.
recovers
uncton
A.
a
69.
te
njury.
dects.
severa
regon
same
musces
dsc?
68.
cervca
B.
s
te
sows
A.
spne
o
o
wpas
upper
upon
o
s
anteror
type
strengt
because
a
neuroogca
examnaton
te
surgery
examned
posteroateray.
gves
pyscan
Pysca
(ACDF)
dsc
brosus
and
spna
uson
ntervertebra
te
monts.
ernaton
porton
to
numbness,
past
abnormates.
dsc
dscectomy
he
comes
neck
te
n
man
n
no
n
te
o
be
at
ater
vta
o
sgns
er
te
sowng
te
suc
most
a
sgns
key
patent?
pyscan
panu
ver-
ourt
because
bsters
over
CHAPTER
er
back
Se
n
te
notced
te
bsters
saton
se
over
75.
are
te
or
te
o
skn.
ras
ce
Dorsa
B.
Latera
C.
Dorsa
D.
Sympatetc
E.
Wte
son
An
ta
ntense
bodes
erupton
burnng
examnaton
dermatoma
zoster
dermatome.
te
(snges)
ocated
tat
made.
are
o
x-ray
n
te
responsbe
dens
and
mm
compress
Anteror
and
B.
T ransverse
C.
Interspnous
D.
Supraspnous
E.
Nuca
te
neck
a
te
spna
an
cord?
key
te
30
co-
cord.
atantoden-
o
torn
79.
odon-
ntervertebra
8
C8
B.
Dorsa
C.
C6
D.
Dorsa
E.
C7
oped
a
gaments
bood
atas
a
gament
gament
gament
A
76–100
16-year-od
tne
er
pysca
scoo
nesses
are
to
bend
77.
s
te
te
wast
rbs
oowng
to
te
story
Pysca
tan
te
te
pyscan
o
s
te
Her
er
rgt
most
rou-
vta
key
s
sgns
sows
se
toes
sde
o
medca
examnaton
touc
te
a
begnnng
oter. Wen
to
on
or
major
medcaton.
mts.
at
o
te
pror
no
no
ger
orward
o
as
receves
bugng
Wc
brougt
Se
norma
souder
teror
s
examnaton
year.
and
wtn
one
gr
80.
asked
a
A.
L1
B.
S1
C.
L3
D.
S3
E.
L5
A
pos-
days
sown.
o
bt
by
story
C6
Wc
by
nto
and
C7.
neura
te
meta-
segment
nerve
2-day
to
te
Her
to
temperature
s
Hg,
s
o
moter
100/60
mm
ends
says
se
s
he
wc
er
deve-
(104.0°F),
puse
94,
and
suspected
and
s
puncture
termnaton
at
by
eedng,
over-te-counter
Menngts
te
poor
40.0°C
perormed.
beow
pyscan
story
o
te
vertebra
must
spna
eve
n
a
o
a
age?
man
o
an
comes
tcy,
returned
n
nsects
rom
te
an
Botswana.,
we
on
because
s
back.
expedton
durng
outsde.
Sorty
e
ater
arrv-
were e was btten as become nected and puruent
C.
Lordoss
matera
D.
Spondyostess
te
E.
Scooss
tebra
30-year-od
because
and
woman
3-mont
skn
test
sgns
o
te
most
coug.
progressvey
postve
a
persstent
tng
n
o
(PPD:
ours.
tubercuoss
toracc
key
ts
48
be
n
condton
says
te
x-ray
ungs
Wc
efect
te
te
coug
studes
proten
o
te
and
o
n
te
te
ospta
back
pyng
pan
s
rom
get-
sow
are
Spondyoyss
B.
Spondyostess
C.
Hernaton
D.
V ertebra
E.
Wedge
coapse
racture
te
skn
ce
and
dervatve)
B.
V entra
orn,
C.
V entra
cest
sows
dssemnaton
oowng
toracc
In
bodes
orn
surgca
erector
perormed.
abscess.
V entra
te
o
ts
o
te
nerve
dorsa
dorsa
orn,
he
at
are
ver-
sup-
severed
structures
ocated?
orn
orn,
dorsa
musce
area
debrde
branc
oowng
branc
to
musce
nerve
underyng
wc
and
procedure
spnae
te
and
root
atera
orn
gangon,
and
atera
orn
w
D.
V entra
spne
tetc
E.
A
orn,
dorsa
paravertebra
root
gangon,
and
sympa-
gangon
V entra orn, dorsa orn, and dorsa root gangon
28-year-od
department
dsc
s
A.
81.
ntervertebra
te
te
T8
a
untreated?
A.
o
to
toracc
tat
pured
ong-term
et
o
Laboratory
An
vertebrae.
a
admtted
Se
worse.
Mantoux
ater
s
story
eve
A
te
notced
n
was
Spondyoss
dranng.
e
saar
wc
B.
nvovng
States,
hree
ng
was
Unted
oice
ras
Kyposs
abscess
te
to
red
A.
A
to
sma
pan?
spna
38/mn.
Deta
many
back
norma.
unresponsve
usuay
e
between
cord
brougt
a
s
s
are
ts
ago,
a
extendng
compressed
te
neck
norma
neuroogca
sows
regon
spna
etargy.
puncture
Okavango
dagnoss?
s
tat
26-year-od
3-day
C7
o
Her
wc
beng
or
C6
o
gr
perormed
cord
appear
no
to
s-
nerve
pressure
umbar
be
o
and
respratons
dscs
s
wtn
spne
oramen
key
because
ever
cervca
rom
are
sows
s
brougt
4-our
nerve
orn
3-day-od
sgns
s
a
nerve
spna
rrtabty,
te
te
account
orn
spna
patent
76.
most
to
spna
moter
mm.
or
s
A.
A
n
o
o
radatng
vta
MRI
cancer
because
pans
Hs
ntervertebra
mass
prostate
examnaton
An
mass
medcaton.
ongtudna
o
vece
spna
dspacement
most
gament
motor
ospta
open-mout
s
posteror
te
sows
on
mass
oowng
A.
n
to
crusng
and
atera
dens
admtted
nvoved
ead
sows
s
mb.
Pysca
et
statc
was
sootng
upper
metastatc
wt
department
abnormates.
ganga
te
7.3
o
Questions
sarp
te
mts.
Were
te
trunk
beng
te
o
nto
A
man
emergency
tory
a
communcantes
o
70-year-od
structure
man
ater
A
te
sen-
sows
dstrbuton.
s
78.
o
he
Wc
to
a
T9
to
ganga
ram
nterva
tod
an
Pysca
n
te
orn
root
resutng
x-ray
o
pror
orn
53-year-od
mnutes
days
sensaton?
A.
A
ew
erpes
neura
pan
a
experenced
er
macuopapuar
dagnoss
dstrbuton
tat
13
Back
1
coson
Pysca
te
man
ater
s
brougt
beng
nvoved
resutng
n
examnaton
cervca
to
n
te
a
yperextenson
sows
vertebrae.
He
mdne
was
emergency
motor
o
vece
s
neck.
tenderness
paced
n
a
over
cervca
14
C H A P T E R
coar.
82.
Back
he
Wc
aged
1
o
Anteror
B.
Posteror
E.
Supraspnous
38-year-od
ee.
severe
ca
te
nerve
s
A.
Superor
B.
Lamna
C.
Ineror
D.
Pedce
E.
An
an
o
artcuar
o
wen
neck
acute
wtn
te
nerves
te
o
radatng
te
extng
and
tat
s
te
pan
e
ower
now
back
nerve
root.
accessed
te
o
rom
oowng
D.
te
n
wc
spnous
A
surg-
a
te
spnous
68-year-od
ew
ours
sensaton
nter-
Motor
extng
vertebra
he
A
bony
MRI
o
rom
te
te
process
s
o
brougt
a
45-mnute
was
extng
to
payng
emergency
story
o
ootba.
ernaton
dsc
o
wc
ntervertebra
nerve.
key
te
Wc
njury
An
MRI
te
most
s
87.
te
and
te
skn
s
anteror
o
s
C.
V ertebra
D.
Segmenta
E.
Posteror
A
er
or
vta
o
sgns
spne
spne.
Osteopoross
Scooss
E.
C5
ng
a
was
orced
no
s
durng
er
se
te
most
er
Nuca
C.
Lgamentum
curb,
e,
suc
dects
a
way
tere
gaments
stretced
to
te
anded
was
tat
Pysca
but
and
se
wear-
er
neck
s
o
neck
te
rgd-
greatest
Supraspnous
Anteror
degree
ongtudna
preparaton
papated,
a
or
and
skn
a
a
89.
umbar
ne
marker
s
to
puncture,
drawn
te
across
connect
te
ac
te
crests
patent’s
gest
ponts
35-year-od
s
neck
men
on
most
key
A.
C6
B.
C7
C.
C8
D.
T1
E.
T2
A
subaracnod
space
termnates
et.
orzonta
orzonta
te
tat
sows
te
n
o
te
artery
a
mbs.
our
mbs.
tumor
arsng
spna
cord
compressed
superory
oowng
began
decreased
ower
a
ne
emergency
by
at
by
drect
arteres?
to
te
emergency
pan
progressvey
norma
neuroogca
a
tat
gettng
mts.
been
worse.
Pysca
abnormates.
emvertebra
addtona
depart-
as
o
ndng
te
An
ower
woud
most
x-ray?
er
he
ent
e
s
o
brougt
a
was
o
to
45-mnute
payng
te
ootba.
C7–T1
Wc
o
te
te
emergency
story
o
njury
MRI
sows
ntervertebra
oowng
ora-
nerves
s
compressed?
15-mont-od
moter
gr
because
moter
says
prevousy
scedued
te
wen
te
te
wc
man
because
narrowng
started
at
te
Sacrazaton
A
o te et and rgt crests. he neede s nserted above
pont
orzonta
arge
md-back
s
te
Hyperordoss
severe
cervca
on
Spondyostess
at
lavum
E.
orzonta
te
pan
a
ormed
sows
D.
department
examnaton
he
wtn
no
C.
E.
88.
ongtudna
D.
wt
a
Atoug
njury?
B.
back
n
oowng
key
Posteror
are
anded
neuroogca
o
of
ago.
yperextenson.
A.
In
bcyce
mnutes
nto
Wc
spne
45
emet,
sows
ty.
lpped
te
over
ssure
te
or
Wc
present
B.
ace
orzonta
te
to
to
5/5
sows
brougt
are
A.
room
o
and
sows
C3
emergency
s
weeks
te
be
gr
C4
se
ends
spna
parents
examnaton
x-ray
te
key
wc
D.
er
repre-
space
spna
12-year-od
by
at
vertebra.
most
C.
to
spne
medan
te T3
rom
bateray
assessed
toracc
by
md-back
cervca
key
on
key
te
to
examnaton
meduary
toracc
brougt
acute
Pysca
Ascendng
C1
ater
to
superor
brougt
Segmenta
C2
s
to
neror
bsected
s
B.
Her
njured?
man
A.
ongong
oow-
o
tumor
ment
ocated
oramen
o
processes
wt
ago.
te
eve
te
ntervertebra
gr
neror
processes
process
strengt
B.
14-year-od
most
subaracnod
superor
processes
spnous
A.
A
processes
spnous
department
atera
te
T wo
E.
86.
removed?
e
most
oowng
te
ne
procedure
usng
(roo )
to
as
sows
oramen,
durng
margn
correspondng
compressng
ng
MRI
posteroatera
ocated
te
wc
ne
process
man
o
at
spnous
hree
because
process
because
superory
wt
ntervertebra
o
artcuar
department
an
T wo
brances
Spnous
s
pyscan
decompressed
key
35-year-od
sows
te
debtatng
oramen
Wc
most
Wc
eve
ne
C.
to
pan
so
s
te
hree
B.
superor
oramen
root.
eatures
A
s
o
ntervertebra
vertebra
A.
gament
perormed,
he
sents
ne
back
compresson
approac.
nerory.
dam-
gament
comes
ambuatng.
s
panu.
key
gament
man
pan
procedure
and
most
dsc
narrowng
causes
stf
s
lavum
ower
he
was
nerory?
ongtudna
Lgamentum
cronc
neck
structures
ongtudna
Intervertebra
A
s
pan?
D.
troube
85.
n
C.
te
84.
day
oowng
resutng
A.
o
83.
next
te
tat
and
standng
s
brougt
o
a
ts
tat
and
cdood
to
curvature
se
te
n
curvature
notced
wakng.
Se
pyscan
er
was
t
not
wen
as
mmunzatons.
ow
pres-
te
receved
Se
by
back.
gr
a
attends
CHAPTER
a
day-care
wtn
sgt
90.
te
ture
dd
spna
te
horacc
B.
Cervca
Lumbar
D.
Cervca
E.
horacc
te
comes
onto
te
umerus.
most
key
loor
o
Spnous
processes
o
T ransverse
o
processes
o
T2–T5
processes
o
C7
34-year-od
tat
er
beedng
woman,
comes
and
job
or
o
A.
Nuceus
B.
V ertebra
C.
Dorsa
woud
Spna
we
oowng
to
struc-
a
cervca
rgt
2,
a
1,
at
13
prenata
to
Se
known
as
er
no
vta
sgns
oowng
n
A
are
A
he
durng
o
underde-
structures?
ng
dscs
te
o
wt
tat
te
s
brougt
at
s
s
to
sows
key
musces,
and
s
ste
no
passes
30
mn-
o
te
96.
mmedatey
rom
drecton
crosses
upper
neuroog-
Wc
ocated
superomeda
emergency
to
constructon
abnormates.
most
processes,
te
njury
between
a
to
te
o
te
L4
C.
S2
vertebra
D.
S1
vertebra
E.
L5
attac
sows
a
zonta
radoucent
type
aspect
III
o
D.
Iocostas
B.
Superor
E.
Spnas
C.
T ransverse
He
ton
as
severe
sows
motor
ower
norma
dects.
An
back
pan.
brougt
Pysca
a
examnaton
x-ray
umbar
te
te
examna-
neuroogca
o
to
scafod.
and
spne
no
sows
97.
te
te
te
te
neror
ne
umbar
o
o
te
bot
te
snge
transverse
and
appear
to
beow
to
bone
because
n
or
te
enarge-
vertebra.
processes
te
be
t,
ave
er
spne
batera
a
enarged
appears
to
pyscan
boterng
marked
eatures
neror
artcuat-
so
muc
so
morpoogc
mmedatey
bony
area
beow
o
te
racture
on
C2
te
were
emergency
n
superor
a
body.
as
racture
a
by
o
drect
a
spne
or-
te
Wc
was
motor
cervca
demonstrated
key
te
te
njured
upper
vertebra
most
to
beng
pos-
o
te
attacment
ocated?
gament
ongtudna
gament
Ineror
story
o
band
o
ongtudna
65-year-od
gressvey
brougt
ater
x-ray
ne
gaments
Lgamentum
a
An
te
E.
o
o
was
dens
D.
A
and
nuca
been
o
are
mnutes
coson.
Apca
rom
man
45
A.
s
o
vertebra
45-year-od
to
e
ne
vertebra
Longssmus
e
to
as
mmedatey
smar
B.
Rotatores
worker
o
on
oowng?
C.
ater
nserts
vertebra
B.
constructon
musce
superor
processes
vertebra
L1
teror
department
tat
border
he snge vertebra dented on x-ray s most key
oowng
32-year-od
bony
bone
snge
Mutdus
emergency
tumor
atas
wdt
vece
vertebrae?
te
sows
vertebra
tese
department
and
n
MRI
atera
nuca
neror
x-ray
vew
atera
two
week.
eatures?
comes
tat
An
and
A.
A
pan
A.
A
o
transverse
snge
aspects
hs
neror
te
woman
weeks.
engt
ts
ast
1-cm
te
because
growng
atas
te
o
tuberce
back
o
te
sma
on
bony
o
pyscan
sowy
bone
anteroposteror
ment
or
a
between
porton
Posteror
2
te
trange.
o
bone
68-year-od
ast
verte-
woud
nes
Meda
ower
L5
vews
bone
Occpta
te
sows
process
porton
to
notced
musce
oowng
Latera
o
sows
gestaton.
resut
ntervertebra
examnaton
a
te
B.
t.
semspnas
n
o
T ransverse
E.
95.
vagna
scerotomes
key
Se
terato-
examnaton
13-week
weeks’
vst.
a
e
regon
suboccpta
occpta
para
or
tat
spne
wtn
A.
D.
penetratng
workng
orgn
te
ocated
te
mout
comes
cervca
caracterstcs
man
ater
musces
te
posteror
o
radograpc
ractures?
open
man
growt
nuca
T oday,
a
sma
wc
yper-
ganga
Pysca
spnous
our
te
o
muscuoskeeta
o
te
a
wc
24-year-od
pont
o
cord
department
Anteroposteror
45-year-od
te
ganga
Sympatetc
E.
A
s
bodes
E.
Obque
T1
destroys
most
o
puposus
root
Posteroanteror
D.
C.
Pysca
wt
wc
Latera
occpta
exposure
pans.
mts.
D.
to
oowng
tese
C.
o
hs
ntertubercuar
orgn
cemcas.
preerentay
veopment
ago.
oice
nvoves
consstent
tat
and
gravda
te
crampng
norma
embryogeness
deep
to
dangerous
uterus
or
back.
sow
ractures
oowng
B.
C1–C4
Spnous
ca
examnaton
s
key
te
Anteroposteror
te
C7–T12
processes
Spnous
utes
te
a
nterartcuars
o
A.
T7–L5
E.
back
te
o
D.
A
o
or
musce?
C.
drug
pyscan
Pysca
vertebra
B.
a
te
musce
Wc
te
o
wtn
most
curva-
observe?
to
examnaton.
processes
gens
reassured
Wc
pars
bra. Wc
o
Spnous
says
s
batera
a
94.
A.
A
moter
norma.
key
ypertroped
nserts
gestaton,
93.
most
man
arge
troped
he
was
are
sows
ordoss
pysca
o
spne.
vtas
kyposs
sows
s
te
Her
examnaton
ordoss
routne
tures
sbngs.
kyposs
24-year-od
sucus
92.
o
no
Pysca
ordoss
C.
a
as
curvature
moter
A.
A
and
mts.
curvature
tat
musce
91.
center
norma
15
Back
1
o
crucorm
gament
atas
band
o
crucorm
gament
lavum
man
comes
1-year
gettng
back
worse.
to
te
pan
Pysca
pyscan
tat
as
because
been
examnaton
pro-
sows
16
C H A P T E R
1
Back
C.
Underdeveopment
center
D.
n
E.
n
te
n
te
54-year-od
pan
tat
pan
was
et,
as
o
man
ntay
but
now
s
aevate
decreased
o
te
natng
body
rom
o
nerve
cervca
te
and
most
te
prmary
to
te
worse
e
severey
wen
e
te
o
arge
compressng
rom
ead
et
or
a
no
sows
axes.
MRI
ema-
o
te
te
he
wc
te
rgt.
osteopyte
above
t.
he
to
medcatons
n
area
mmedatey
s
neck
year.
examnaton
moton
a
or
ast
turns
Pysca
sows
emanatng
osscaton
pyscan
or
turned
posteroatera
vertebra
key
te
wen
range
spne
osscaton
arc
comes
pan.
osscaton
secondary
ant-nlammatory
te
cervca
o
ected
Over-te-counter
onger
te
gettng
ony
prmary
body
vertebra
been
te
body
vertebra
Underdeveopment
center
A
o
vertebra
Underdeveopment
center
99.
te
vertebra
C3
spna
osteopyte
o
te
s
oowng
vertebrae?
100.
A.
C2
B.
C3
C.
C4
D.
C5
E.
C1
A
38-year-od
at
40
se
weeks’
began
mnutes
Se
s
Se
njecton Fig.
or
te
te
relexes,
abdomen,
amnectomy
because
eve
te
due
to
oowng
pressed
98.
reduced
and
o
te
a
detectabe
T8
to
te
roots
s
most
Segmenta
spna
C.
Segmenta
meduary
Anteror
An
motor
vertebrae
were
dects.
at
Wc
beng
over
A
perormed
compressed
eson.
key
s
skn
tat
o
drecty
Pysca
restng
cd
ated
(Fg.
wt
1.4).
ts
brougt
to
te
pyscan
pysca
queston
bass
o
or
n
te
n
te
a
vertebra
a
or
a
we-groomed
he
gure
potograp
cd’s
o
te
best
o
assoc-
te
cd
descrbes
te
condton?
secondary
osscaton
te
process
prmary
most
beore
abortus
ospta
n
and
an
as
o
10
ntervas.
been
epdura
Wc
every
sorter
1,
ater
so
or
14
anestetc
key
t
to
reaces
be
te
te
te
ast
oowng
penetrated
epdura
by
space?
gament
gament
C.
Anteror
D.
Posteror
E.
Lgamentum
Questions
A
ongtudna
gament
ongtudna
gament
lavum
101–123
48-year-od
a
1-week
et
osscaton
wt
te
o
te
gament
occpta
te
C2
s
te
tssues.
paced
s
te
post-surgca
te
key
te
emess.
te
to
at
to
te
te
orcby
patent
dagnoss
o
o
stretced
resuted
n
on
te
open-
troug
a
te
exter-
eve
se-retanng
te
o
undergoes
neror
ended
oss
sde
at
He
Wc
drecty
and
et
ncson
A
because
and
earng
tumor
1-cm
and
made.
surgery
a
ncson
and
s
te
meatus.
recovery,
pan
pan?
on
mdne
began
pyscan
nausea,
compete
perormed.
nto
most
durng
a
te
sows
acoustc
tat
neuraga
was
sows
bran
Durng
occpta
occpta
to
vertgo,
protuberance
vertebra
tor
tors
o
wereby
na
severe
comes
emanestesa
nterna
cranotomy
nuca
man
story
examnaton
MRI
o
nerves
arc
o
spnous
dstress.
oowng
ts
Underdeveopment
center
s
te
Underdeveopment
center
B.
no
sows
s
Supraspnous
ng
examnaton
Wc
embryoogc
A.
n
ave
Interspnous
ace.
was
abor
to
B.
te
routne examnaton. Her vta sgns are wtn norma
mts.
neede
Pysca
spna
gr
n
contro.
3,
te
contractons
and
be
pan
para
to
te
com-
spna
8-year-od
stronger
agreed
A.
o
B.
Posteror
te
101.
Radcuar
E.
o
eson?
A.
D.
T9
space-occupyng
arteres
by
sensaton
no
posteror
to
4,
brougt
sustaned
gettng
as
gravda
s
.4
structures
norma
avng
and
conrmed
ours.
•
woman,
gestaton,
o
retrac-
separate
experences
postsurgca
te
by
oowng
te
ts
retrac-
patent’s
CHAPTER
102.
A.
hrd
B.
Suboccpta
Spence)
C.
Greater
ormed
D.
Lesser
E.
Accessory
A
occpta
are
a
pan
te
used
a
s
as
a
B.
Fum
C.
Conus
termnae
Posteror
Lgamentum
45
man
mnutes
compete
oter
tear
o
te
spne
undergoes
spna
o
te
cord.
anteror
sgns
Protruson
rootets
C.
was
te
rgt
o
te
a
spne
resut
o
Weak
rom
nvoved
aar
cervca
woud
sow
to
depart-
a
retracton
adducton
2-mont-od
None
spne
wc
be
anteror
sows
o
umbar
w
te
te
key
tear?
A.
L3
B.
L4
Fexon
C.
L5
D.
S1
E.
S2
Latera
E.
Abducton
A
a
lexon
107.
2-week
der.
et
upper
te
rgt
power
back
sde.
on
toward
te
te
mnor
w
A.
e
nerves
most
and
o
were
upper
to
aso
te
rotaton
back
te
and
o
aganst
arm
te
o
we
tan
bades
and
meda
Eevaton
E.
Abducton
rgt
o
te
scapua
and
neror
38-year-od
6-mont
te
rgt
woman
story
arm
comes
o
a
rom
to
ard
te
0
to
and
unctons
108.
arm
te
rotaton
15
n
te
o
because
breast.
Se as a story o carcnoma o te et breast and ad
a
umpectomy
te
axa
2
sows
years
a
3-
prevousy.
×
4-cm
Utrasonograpy
ard
mass
n
te
o
upper
most
o
di-
Wc
key
te
aganst
ever
been
(dura
a
to
o
be
et
scapua
wa
upper
mb
to
n
te
emergency
ras
tat
and
temperature
and
a
neede
At
s
39.6°C
s
s
wc
typcay
are
sgty
puncture
he
be
began
eedng
respratons
sows
sac).
te
and
rrtabe
Hs
arge
109.
brougt
cystc
embryonc
condton?
54/
bugng
perormed
nserted
nto
vertebra
eve
ound
Neura
D.
Intraembryonc
E.
Neura
n
ts
53-year-od
n
earer
bar
spne
and
norma
dented
ayers. Wc
most
key
eedng
examnaton
15
was
×
tssue
o
10
cm
removed,
rom
te
a
oow-
responsbe
or
streak
coeom
te
sows
s
day.
Spondyoyss
Spondyostess
Hernaton
D.
Lordoss
E.
Scooss
22-year-od
te
o
MRI
o
Wat
B.
C.
back
racture
agnment
sacrum.
brougt
severe
A.
to
mass
because
been
Pysca
he
prmtve
man
deny
comes
as
crest
wt
A
s
pyscan
He
ods
department
te
te
approxmatey
studes
tssues
C.
o
regon.
germ
te
to
back.
rrtabe.
mass
embryoogca
ts
A
s
sacrococcygea
ng
upon
degrees
et
a
umbar
been
v
pyscan
mass
not
o
souder
o
as
Remnants
o
A
on
Coronc
rotaton
ead.
scapuae
et
152/mn,
s
B.
arm
D.
gr
ump
A.
rgt
o
stopatoogca
tree
souder
a
te
and
musce
orzonta
hree
umerus
meduars
resstance.
te
te
and
n
scapua
o
arge
sows
te
weakness?
above
a
o
major
s
brougt
dagnoss.
neurapraxa
oowng
adducton
adducton,
and
rombod
te
o
s
examnaton
conus
removed.
(o
per-
scapua
te
ours.
s
cstern
3-day-od
sou-
arger
souder
conrms
demonstrate
rgt
rgt
decrease
back
o
because
musces
notaby
pu
te
s
te
notabe
s
wc
pyscan
movng
examnaton
In
o
Extensons,
a
a
asked
protracton
C.
o
was
key
Meda
A
was
suppyng
B.
rgt
souder
mdde
musces.
te
sows
rgt-sded
conducton
eve
to
dicuty
and
e
Abducton
te
o
here
s
wen
o
comes
examnaton
musces
Nerve
man
story
Pysca
A
o
25-year-od
24
te
s
patent?
Extenson
Rotaton
te
as
ontanee.
conrm
te
was
o
most
to
B.
D.
ast
ta
experences
border
pused
te
o
gr
puse
bot
o
o
He
Pysca
A.
C.
te
s
er
ndngs
meda
because
pror.
tumor
patent
above
axary
mastectomy
range
Weak
days
te
examnaton?
o
abducton
Weak
A
te
te
are
E.
mn.
motor
neck
gament.
movements
te
n
and
ands
nto
radca
arm
te
D.
poory
ead
upper
examnaton
cervca
as
e
o
te
te
o
15–90-degree
gament
emergency
et
protracton
wen
s
and
pysca
B.
surgery
A
addtona
durng
(103.2°F),
ater
o
oowng
department
te
er
sows
106.
brougt
MRI
rasng
Weak
structures
breast.
successuy,
A.
to
extendng
te
postoperatvey,
ound
2
s
o
sows
surgery
Durng
oowng
denty
vta
examnaton
te
nternum
gaments
Pysca
ncreased
105.
He
Hs
ower
lavum
coson.
oowng
104.
MRI
ongtudna
45-year-od
torn.
weeks.
or
meduars
E.
te
to
2
pyscan
gament
D.
a
s
wc
te
rootets?
Dentcuate
vece
o
cord.
rom
cord,
to
Pysca
dects.
spna
A.
ment
course
mts.
andmark
posteror
A
brougt
te
tumor
spna
weeks
s
norma
n
remove
o
boy
neuroogca
mass
quadrant
cuty
over
wtn
no
103.
occpta
occpta
7-year-od
back
outer
17
Back
1
o
te
s
pregnant
te
pars
body
te
o
most
woman
or
te
tat
examnaton
ntervertebra
ospta
to
pan
emergency
began
o
te
sud-
um-
nterartcuars
te
key
L5
vertebra
dagnoss?
dsc
at
devery.
40
weeks’
Her
gestaton
cervx
s
60%
18
C H A P T E R
efaced
1
Back
and
anestesa
se
te
An
back
tat
oowng
cm.
pan
MRI
epdura
nerve
5
Se
antcpaton
deveoped
weakness.
n
dated
n
o
space
exts
at
vesses
rgt
spne
resutng
eve
most
undergoes
abor.
and
er
te
s
o
ower
sows
n
o
epdura
Ater
a
key
extremty
D.
Wc
responsbe
o
te
o
te
or
te
110.
Interna
B.
Great
C.
Anteror
vertebra
radcuar
pan
spna
Posteror
E.
Externa
spna
7 1-year-od
n
s
vece
sows
cras.
te
anteror
ver tebra
A
111.
and
r upted
n
ts
E.
Intertransverse
28-year-od
eart
In
te
are
na
o
wat
L3
to
d ue
C4 –C5
re qu re d
s
B.
nter-
to
wtn
te
ospta
norma
o
are
abor,
mmedatey
and
L4
be
paced
an
ast
devery.
er
to
te
Durng
ts
Anteror
Great
E.
Segmenta
A
pan
tumor
ng
same
te
C.
Nuceus
te
D.
Apca
E.
Cavara
A
vece
E.
Intertransverse
a
er
o
ng
deect
mbs.
at
tat
MRI
pacement
te
te
o
assocated
te
te
wt
here
umbar
L5
cana.
Compresson
B.
Compresson
o
wt
was
te
obvous
body
an
and
w
past
o
te
o
te
anteror
ds-
narrowng
most
key
cord
and
batera
mb
o
te
weakness
spna
cord
and
te
spna
cord
ow?
vertebra,
and
ntercostas,
medan
sacra
was
wt
o
te
er
struck
arteres
and
ntercos-
to
te
pyscan
te
ast
a
trauma
et
o
MRI
or
at
because
tat
nsect
nger
te
te
nger
were
structures
s
a
nter-
s
sus-
ocazed
recommended.
most
wt
as
btes.
wt
dsta
condroma
o
orgn
week
ndex
mass
excson
and
as
Pysca
a
er
cervca
Atantooccpta
Ineror
E.
Anteror
o
te
key
sar-
tumor?
Se
s
emergency
vece
secured
se
wtn
rate
sown
o
s
on
around
breat-
norma
1.5).
er
n
m-
109/mn.
(Fg.
key
co-
wen
brougt
sows
are
most
s
coar
eart
An
Wc
njured?
atas
te
atas
process
man
because
s
o
te
jont
tuberce
o
a
aso
artcuar
aspect
vtas
o
to
motor
yperextended
cervca
te
tuberce
32-year-od
department
a
bend.
spne
was
Posteror
D.
was
Her
excepton
arc
brougt
examnaton
te
oowng
s
survved
rom
C.
atera
posteror
arteres
over
recent
an
neck
B.
A
sacra
vertebra
dagnoss
se
o
ower
vertebra,
Adamkewcz)
te
sows
woman
be
unatera
temporary
anastomoses
ganga
Anteror
116.
o
arge
operated
ganga
ater
wc
neck.
A
spontaneousy.
x-ray
oowng?
spna
n
no
and
A.
weakness
ower
ts
“step-of”
weakness
sows
patoogy
o
te
an
some
spne
vertebra
hs
wc
A.
mb
vertebra
eve.
o
vertebra
L5
tenderness
abdo-
a
gament
backboard
A 38-year-od man s brougt to te pyscan because
sows
ower
s
a
puposus
40-year-od
son
as
embryoogc
root
department
examnaton
or
sows
s
te
comes
surgca
procedure,
te
back
artera
o
spna
nger
oowng
Dorsa
Interspnous
over
te
Sympatetc
D.
spne
and
o
B.
ongtudna
Pysca
An
A.
durng
ow
sows
patent
atera
we-crcumscrbed
Wc
Posteror
days.
Se
s
115.
pan
ndex
te
space?
back
te
aorta
te
(o
rom
woman
er
Her
and
artery
arteres
x-ray
ongtudna
ower
o
umbar,
posteror
examnaton
bue
C.
5
n
worse.
Lgamentum
o
and
radcuar
22-year-od
Anteror
story
and
arteres
B.
5-day
rom
and
A.
a
L5
batera
pyscan
dangerousy
rom
jont.
lavum
he
s
umbar,
pected.
by
and
abdomen
scema
epgastrc,
pro-
perorated
and
examnaton
oowng
drops
arteres
paangea
anestetc
te
repar
te
prevent
pressure
te
papaton
o
arteres
ta
abdomen.
spnous
on
aneurysm.
o
ges-
weeks’
tocometer
on
gament
epdura
A
epdura
atera
vertebrae.
te
te
or
mts.
key
to
ntercosta,
gotten
40
equna
Pysca
Segmenta
Pysca
montor
access
most
D.
o
at
equna
cauda
comes
te
Wc
C.
ds-
114.
woman
aortc
Segmenta
o
wc
ke y
roots
arteres
ntu b ato n.
m os t
nerve
weakness
cauda
te
pusatons
superca
to
r up ture
o
man
durng
bood
pae
stages
woud
neede
a
e matoma
game nts
prmgravda
rate
admnstered
cesses
and
njur y
te
A.
s tr uck
e xam n aton
sow s
o
stop gt
was
lavum
admtted
eta
ne ck
b ros us
a
te
te
Utrasonograpy
and
w
a
ongtudna
Lgamentum
sgns
Py s ca
p re ve r teb r a
ar w ay
at
and
n
njur y ?
Interspnous
s
a
d ng
MRI
e m er ge ncy
nvoved
ongtudna
D.
vta
was
te
w as
ead res ts
tr uc k .
oow n g
C.
taton
112.
s
te
A
a
annuus
o
Posteror
He
to
e
ypere xte n s on
Wc
B.
a ter
o
examnaton.
camped.
b rougt
T2-wegte d
compromsed
Anteror
s
w tout
by
dsc
A.
on
pexus
cos on .
severe
te
men.
spna
mb
weakness
62-year-od
abdomna
mn ute s
car
bend
Adamkewcz)
artery
man
30
vntage
rom
A
te
ower
ony
notceabe
(o
artery
vertebra
depar tment
motor
pexus
artery
mb
Compresson
routne
D.
A
Compresson
E.
113.
o
unatera
ower
ematoma?
A.
Compresson
wt
ematoma
compresson
L2–L3.
C.
devery,
o
s
o
te
o
te
brougt
severe
rgt
axs
atas
tg
to
pan
and
te
emergency
radatng
eg
wen
to
e
te
was
CHAPTER
19
Back
1
B
A
C
•
tng
son.
sa,
eavy
oss
n
sows
a
MRI
o
ruptured
oowng
durng
examnaton
sensaton,
extremtes.
117.
wegts
Pysca
nerves
s
or
an
musce
te
key
no
tranng
sadde
weakness
umbar
ntervertebra
most
ntense
sows
spne
dsc.
n
(see
Fig.
1.5
ses-
CT
aneste-
s
ower
Fg.
Wc
to
1.3)
o
o
wt
s
te
te
superor
artery
te
wt
afected?
neck
and
ts
sows
racture
ractures
nes
ocated
artcuar
nerve
woud
Anteror
spna;
B.
Posteror
spna;
C1
B.
L3
C.
Posteror
spna;
C2
C.
L4
D.
V ertebra;
C1
E.
V ertebra;
C2
L5
S1
118.
utes
ment
rom
dvng
severe
pan
s
bruse
but
as
parents
because
ead-rst
nto
on
te
top
o
no
notceabe
o
an
saow
s
ead
ater
njury
sustaned
we
water.
He
wt
and
cutaneous
ntense
sensory
as
a
neck
oss.
A
o
te
greatest
atas,
atas.
rsk
o
Wat
njury
A 25-year-od man s admtted to te ospta 30 mn-
A 16-year-od boy s brougt to te emergency depart-
by
at
te
posteror
ypogossa
L2
E.
suraces
be
to
racture?
A.
A.
D.
bateray
mmedatey
ap-seat
modern
e
beng
drvng
was
cars.
nvoved
n
a
bets
Hs
wearng
rater
car
s
n
vntage
t
a
a
motor
car,
tan
tree
ap-bet,
e
vece
wc
was
souder
ead-on,
bets
and
sustaned
coson
equpped
as
n
atoug
njures.
he
20
C H A P T E R
patent
o
s
o
te
s
Back
conscous
12t
toracc
vertebra
te
neura
as
are
body,
arc
ntense
sows
vertebra.
a
pece
o
key
Wat
been
he
te
back
a
pan.
Cance
anteror
spnous
posteror
porton
o
to
A
porton
process,
te
te
CT
as
racture
o
a
and
dicuty
sows
resut
aso
vertebra
neura
notced
torax
o
eary
arc
wat
njured?
Kyposs
Lordoss
Lamna
B.
Pedce
C.
Prmary
C.
Spnous
D.
Scooss
process
Superor
E.
T ransverse
A
artcuar
70-year-od
owed
a
by
ture
te
A
o
as
te
tp
oowng
o
Dentcuate
Interspnous
Lgamentum
Nuca
E.
Posteror
weakness
cacanea
urnary
tat
se
s
n
o
and
was
an
process
o
key
a
pop
ower
unabe
avuson
C7.
o-
o
neck
to
Wc
tendon
te
Cauda
Obturator
equna
C.
Prorms
D.
Pudenda
E.
Scatca
an
tone,
past
urne
20
and
years.
s
pass-
123.
tng
urnary
spondyts
scan
more
dsease.
o
n
s
s
o
s
rgd
here
spne.
umbar
or
te
a
he
to
cuture.
tssues
second
neede
s
te
I
as
are
ts
regon,
a
o
pop
a
As
neede
te
te
structures
s
s
sampe
back,
he
a
te
resut
tssue.
key
s
rst
second
nto
te
eastc
most
A
obtan
pop.
gy
emergency
menngts.
ntroduced
rst
troug
to
suspected
perormed
lud
space.
oowng
te
brougt
o
ten
o
and
Wc
an
o
absent
te
A.
Dura
B.
Interspnous
C.
Lgamentum
D.
Posteror
E.
Supraspnous
A
pop
sub-
o
te
Wc
te
eastc
o-
wc
past
dagnosed
30
years,
wt
and
anky-
atey
s
ye a r
e
b oy
dagnosed
bone
as
to
n
wt
a u re
o
atera
o
but
aso
and
te
c u r va t u re
patent
brtte
n
bone
por tons
o s t e o p e t ro-
osteocasts
Te
re m o d e
norma
r a c t u re d
type
a
bone,
as
te
bodes
o
re s o r p t o n .
dense
s t re s s e s
Wat
s
re s u t
bone
ago,
gament
gament
te
ve r y
te
a t e r a y.
been
lavum
norma
ve r t e b r a
te
gament
ongtudna
1 2 - ye a r - o d
On e
pasy
te
mater
unctona
n
or
CT
reduced?
s
s
te
passng
because
dagnoss?
as
and
tat
d e ve o p e d
numbness,
syndrome
man
et,
per orm
syndrome
67-year-od
be
troug
neede
ss,
Pysca
te
skn
mb,
severe
been
wtn
pernea
ower
as
o
erna
nerve
s
aracnod
emergency
story
Se
bateray.
key
te
ncontnence,
te
te
to
8-our
contro.
or
relex
most
brougt
eca
o
puncture
ndcates
o
te
prmary
gr
cerebrospna
pop
njured?
o
stragtenng
because
ntroduced
rac-
a
w
13-year-od
umbar
gament
retaned
recta
musces
B.
osng
or
o
A
becomng
tssue?
s
cannot
sows
poor
A.
A
woman
proessonay
badder,
ten
sows
most
et
back
we
s
T ertary
A
department
lavum
because
examnaton
owng
spnous
sustaned
He
and
neck
ongtudna
department
wegts
pato.
upper
dggng
s
e
emergency
gament
42-year-od
pan,
a
te
gament
D.
latus
te
njury
s
ower
to
gament
C.
ng
n
gaments
B.
back
was
s
an
or
pan
e
o
brougt
o
oundaton
A.
A
s
because
CT
E.
122.
man
ntense
posterory
move.
process
process
breatng.
cage
occurs
curvature
A.
n
rb
progresson
sgns
stragtenng
B.
D.
s
te
A.
dggng
121.
as
regon
mmedatey
ractured.
most
department
120.
and
toracoumbar
te
body
119.
1
bone
re s p o n s e
( Wo ’s
o
two
bodes
dd
to
as
to
Law)
adjacent
coapsed
ts
p ro d u c e
spne?
A.
Kyposs
B.
Lordoss
C.
Prmary
D.
Scooss
E.
Secondary
E.
Osteoartrts
A n swe r s
Answers
1.
B.
1–25
Hyperkyposs
back”
ror
due
to
an
cur vature
s
c aracter ze d
abno r m a
o
te
nc reas e
tor ac c
by
n
re g on
a
“unc -
concave
afects
ante-
o
te
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
pysoogc,
o
suc
te
as
spne.
seen
n
a
L o rd o s s
p re g n a n t
woman.
C.
Scooss
rotaton
D.
Spna
by
s
o
a
bda
aure
atera
te
o
s
curvature
o
te
spne
wt
vertebrae.
a
neura
cosure
o
2.
B.
deect
vertebra
caracterzed
arc.
A
te
n
75;
crus
reated
entre
tat
t
N
vertebra
afects
ractures
body.
Bot
A,
162;
racture
sma
a
tube
te
a
degeneratve
cartage
to
te
o
dsorder
jonts
toracc
and
regon
tat
s
not
o
te
spne.
GAS
Hy p e r o rd o s s ,
s
artcuar
speccay
coumn.
A.
te
o
ABR/McM
s
body.
te
he
te
by
wedge
vertebra
around
tese
87
caracterzed
bodes,
permeter
ractures
compresson
racture
cause
but
o
s
t
te
o
smar
nvoves
vertebra
reductons
n
over-
egt.
C,
D.
Fracture
superor
o
te
artcuar
spnous,
suraces
transverse,
can
be
due
or
to
CHAPTER
an
obque,
transverse,
or
commnuted
as
racture.
E.
Intervertebra
ton,
3.
C.
o
not
dscs
GAS
78;
Te
gamentum
two
wa
adjacent
o
coce
bra
164,
te
are
168;
assocated
s
oramen.
gamentum
ABR/McM
ve r t e b r a e
n
92,
dsc
erna-
D.
and
orms
It
s
te
B.
wt
p re s e n t
E.
supraspnous
connect
D.
he
ony
te
cana
4.
C.
he
o
and
te
nterspnous
gaments
te
81–83;
dorsa
s
gament
connects
bodes
and
te
29;
posteror
above
te
ABR/McM
scapuar
nerve
responsbe
rombods,
or
retracton
extenson
eve
o
o
te
C7.
A.
te
ae
dspaced
remans
provded
tese
A.
by
oter
retracted
he
te
ventra
ramus
B.
major
C3–C4
nerves
axary
ts
due
by
te
trapezus,
scapua.
case,
to
spna
woud
rotates
nerve
C.
are
hereore,
te
evator
addtona
nerves.
not
he
te
te
detod
and
wt
to
a
detod
musce
te
D.
scapu-
D.
he
te
any
o
aso
contrbutes
spnas
nerve
E.
he
and
teres
ateray
and
GAS
te
s
te
ateray
91–92,
n
musces.
101;
N
te
468;
and
sensory
o
te
greater
dorsa
vrus
It
s
no
becomes
assocated
motor
soey
root
A.
ganga
actve
ony
o
te
he
te
but
or
as
he
ony
sensory
bers
he
and
atera
T1–L2
are
A
do
or
not
nerves
a
sem-
or
spna
natve
contans
musces.
98
regon
nerve
es
orn,
skeeta
umbar
oramen
dsc
dsc
roots.
drecty
between
Even
L4
toug
between
te
L4
L5
superor
spna
and
s
to
nerve
n
te
root
greatest
nterverte-
es
drecty
jeopardy
n
a
ernaton.
C.
suprasp-
skn
bers
s
eson.
and
coce
te
te
as
tat
s
are
sensory
efer-
E.
nerve
exts
between
L1
and
L2
nerve
exts
between
L2
and
L3
nerve
exts
between
L3
and
L4
nerve
exts
between
L4
and
L5
orns
ound
n
outlow
170,
165;
puncture
s
beow
L5
ts
te
or
ABR/McM
perormed
eve
o
te
spna
sometmes
regon
because
he
t
te
8.
B.
a
and
because
L1–L2
es
101–102
by
takng
cord)
a
sampe
between
between
te
and
te
between
he
L3
spna
dura
tese
he
te
he
verte-
and
cord
sac
areas
107,
a
he
o
L4.
It
typcay
ends
at
te
and
te
rsk
he
owest
D.
he
sacra
he
o
at
as
at
te
eve
at
te
te
L1–L2
te
eve
te
ends
ends
te
eve
spna
and
te
eve
o
o
eve
o
o
L1–
S2.
eve
o
L1–
S2.
o
L1–
S2.
cord
typcay
dura
sac
ends
S2.
N
170;
o
ocatng
ABR/McM
te
te
puncture;
te
o
ac
t
te
s
103
crests
poston
vertebra
anges
rbs
te
109,
ead
atus
o
are
te
dented
coumn
used
as
spne
o
and
(T uier
scapuae
e
at
traced
ne).
vertebra
s
one
to
ocated
T12.
ower
at
te
dsta
por-
sacrum.
posteror
GAS
te
ends
at
cauday.)
at
T7.
C.
ton
at
ends
ow
o
ponts
umbar
toward
sac
too
119;
or
ends
typcay
eve
neror
eve
E.
be
te
eve
sac
more
ends
typcay
dura
gest
meday
A.
cord
te
woud
at
sac
dura
spna
and
hs
or
cord
te
sgty
typcay
dura
spna
and
ends
cord
te
andmark
L4
cord
spna
ends
normaton.
sympatetc
N
space
and
n
at
L2
dorsa
vscera
spna
80;
GAS
wen
spna
L4
L4
L2
supraspna-
and
answer
ntermedoatera
responsbe
B.
100
panu
nerve
bers
contan
anteror
ABR/McM
te
root
te
spna
umbar
at
nnervaton
pregangonc
L5
spna
L3
he
L2
occpta
gangon.
Sympatetc
he
cdren
nraspnatus
ABR/McM
sensory
te
controng
171;
n
nerve
te
L2
done
umerus.
spna
presents
wt
nvovement.
responsbe
ent
C.
root
dorsa
and
o njurng te spna cord s mnmzed. (Remember n
neuraga.
nnervates
umerus,
rotates
te
occpta
nerve
he
skn
eve o S2. hereore, t s te saest pace to do te pro-
serratus
B. Herpes zoster s a vra dsease tat remans atent n
te
he
ends
ateray
te
many
nnervaton
addton,
nvoved
te
s
to
aracnod
teres
abducts
mnor
nnervates
nerve
nraspnatus
abducts
musce
5.
be
to
In
suprascapuar
natus
tus
capts.
can
D.
A.
occpta
skn.
o
o cerebrospna lud rom te umbar cstern (te sub-
scapua.
greater
or
or
N
wereas
L1
GAS
7.
anteror, wc unctons to protract and upwardy
rotate
he
cedure
nerve
back
dorsa
brances
vertebrae.
umerus.
toracc
te
secton
te
vertebrae.
nnervaton
Injury
present
nnervates
prmary,
ong
dsc,
brae
musces.
umerus
he
In
to
sma
n
sensory
vertebrae.
scapua.
mnor
B.
scapua.
unctona
resde
vertebrae.
ts nerve s damaged, ndvduas present wt a ater-
ay
parasympatetc
back.
te
spna
not
cutaneous
vrus
a
ernaton
posteroatera
103
(rom
asssted
o
112;
does
ts
orn,
ntervertebra
bra
and mnor and usuay te ower porton o te evator
he
te
afects
L4
te
nter-
o C5) s responsbe or nnervatng rombods
scapuae.
or
and L5 vertebrae, t exts rom te spna cana troug
vertebra
a
gament
N
L5
te
neurons
61,
Dsc
posteror
gament
supraspnous
GAS
E.
o
ventra
GAS
6.
dscs.
nuca
S2–S4
vrus
nnervate
motor
processes.
ongtudna
porton
vertebra
he
spnous
anteror
anteror
E.
he
ve r t e -
spna
transmt
musces
a n s we r
te
o
as
zoster
atoug
and
he
eves
Herpes
ram
posteror
ony
y p e r t ro p y
woud
amnae
stenoss.
A,
at
ramus,
w
te
te
contact
T e re o re
113
connects
cana.
d re c t
avum
wt
ractures.
avum
ve r t e b r a
tat
as
outlow.
compresson
N
we
21
Back
1
neror
117–118;
ac
N
spnes
161;
e
beow
ABR/McM
S2.
103
22
C H A P T E R
9.
A.
he
te
1
Back
anteror
vertebra
B.
he
two
adjacent
C.
he
nuca
te
he
spnous
(GAS
GAS
B.
Fgs.
81;
troug
te
a
A.
A
o
te
o
te
C.
nto
he
193;
or
not
amnae
contnuaton
C7,
o
wc
at
te
o
o
wa.
con-
s
a
not
s
asso-
A.
98,
102
B.
A
dsc
ernaton
nuceus
oramen.
responsbe
s
D.
or
nto
tor
E.
te
annuus
commony
o
te
bro-
ver tebra
bodes.
he
gament
traverses
te
a
he
p oster or
asp e ct
p os te r or
e ngt
anteror
he
o
GAS
A.
he
dors,
and
ary
80;
one
te
B.
N
o
nerve
28,
te
ces,
164,
te
te
but
s
te
te
tat
umerus.
te
detod
he
ower
o
nerve
rotate
prmary
ABR/McM
nnervates
umerus,
rotators
can
168;
nerve
umerus.
axary
wc
te
amnae
o
he
dorsa
and
t
meda
D.
he
te
he
te
and
atera
nerve
can
te
o
te
as
a
n
te
91,
he
o
trceps
arm
he
eter
drecton
o
te
s
and
teres
trapezus
and
or
sometmes,
nner-
te
eva-
te
atssmus
T eres
not
C.
te
by
te
and
stes
teres
o
s
o
musces
mnor,
perormed
detod
dam-
ncude
abducton
rom
serratus
ossa
to
to
move
and
o
te
by
te
15
to
90
s
turn
above
anteror
mus-
superory
90
responsbe
and
degrees.
or
adducton
arm.
s
responsbe
mnor
s
adducton
or
extenson
o
not
responsbe
o
te
nvoved
or
umerus.
n
meda
hs
abducton
mus-
at
te
jont.
s
responsbe
o
te
or
umerus.
nvoved
n
meda
hs
rotaton
musce
abducton
at
te
s
and
tere-
genou-
jont.
711–712,
Spna
rom
hese
orearm.
and
major
144–149
common
degrees)
brac
and
are
orzonta, te scapua s upwardy
tereore
McM
14.
15
pectoras
mera
musce
abductor
course
responsbe
Intaton
coracobracas
GAS
detod
te
nraspnatus,
umerus
lexon
ore
nerve
suppes
musces
te
wc
rombods
eevate
and
and
o
101;
nnervates
and
s
depresses
skn
orearm.
N
te
responsbe
and
te
ents
717;
N
180,
409,
412–413;
ABR/
138
bda
s
ncompete
a
deveopmenta
uson
over
ebow,
414;
te
or
te
hese
trapezus
te
and
ABR/McM
are
dgts.
144,
146
Spna
CNS
aspect
neary
suc
ogc
B.
as
a
bda
terzed
nnervaton
musces
wrst,
wc
scapua.
posteror
asymptomatcay
stgmata
A.
nerve
nerve
extensors
GAS
te
adducton
te
scapua.
musces
arm
E.
or
pecto-
suppy
tora-
not
detod
nnervates
njures.
genod
genoumera
ax-
extend
s
and
ABR/McM
trapezus
te
te
te
umerus
known
scapuae
eevates,
rada
o
he
te
te
rotaton
umerus.
suppes
scapuar
accessory
retracts,
E.
Above
Wereas
subscapuar
te
C.
atssmus
wc
nerve
oowed
ce
not
te
nnervates
musces
rst
adducts,
musce
and
do
musces.
nerve
(SITS).
extends,
does
mastectomy
o
te
condton
vertebra
resutng
arces
wtn
te umbar regon. Spna bda occuta commony pres-
evator
retract
B.
103
te
umerus.
C.
A.
189;
cuf
(te
by
and
connect
musces
rotates
and
meda
he
traverses
N
souder
causng
te
nnervates
te
gament
a
ong
toracc
wa.
rombods
supraspnatus,
rotated
ve r teb r a
cana.
lavum
major
rotate
nerves
oter
durng
degrees.
vertebrae.
meday
adduct
ongtudna
vertebra
toracodorsa
meday
ra
te
gamentum
adjacent
11.
726;
supraspnatus,
on g tud na
o
nerve
scapuar
te
subscapuars
o ny
o
o
rotator
aowng
engt
E.
he
te
cana.
D.
D.
age
pupo-
te
toracc
te
te
toracc
nerves
suppes
toracodorsa
umerus
s
toracc
aong
durng
remanng
te
nerve,
eve
scapuae.
GAS
cana.
gamen t
aganst
ong
pro-
orzonta
dors.
com-
causng
nuceus
njury
te
serratus
and
musces.
dorsa
he
afected
te
to
nerve
accessory
he
te
poston
te
eevaton
toracodorsa
rom
te
atera
vaton
13.
o
dsc,
te
nerves,
or
supercay
subject
Asde
nnervates
beyond
sternocedomastod
genera,
be
ts
te
runs
axary
he
puposus
In
may
wt
s
te
he
ora-
scapua
nerve
and
nerve
responsbe
mantanng
Aong
aong
s
te
procedure.
coumn
roots.
ong tud n a
spannng
spna
posteroateray
rupture
vertebra
o
toracc
te
toracc
wc
codorsa
gament
gament
dspacement
posteror
on
ntervertebra
te
brosus
nerve
s
es
ong
tracton
bodes.
te
ABR/McM
ntervertebra
dsc
he
anteror,
mnor
ernaton.
but
C.
2.38).
ntervertebra
gament
te
gament
(cardna)
and
nerves
spna
te
12.
wa
protruson
posteroatera
sus
above
vertebra
ongtudna
ernated
sus
and
dsc
ernaton
presson
te
annuus
cana
posteror
te
a
o
o
by
torn
spna
te
by
29,
ndcates
caracterzed
posteror
gament
uterus
2.35
Compresson
men
to
we
a
cervca
te
N
s
ongtudna
surace
wt
connects
anteror
coumn.
processes.
transverse
cated
es
vertebra
vertebrae.
gament
posteror
posteror
gament
te
lavum
supraspnous
he
E.
aong
gamentum
nects
D.
10.
ongtudna
bodes
by
tut
wt
o
wt
and
and
a
umbar,
sma
s
o
bot
oten
te
cutaneous
skn
myeomenngocee
protruson
tssues
mdne,
ar,
dmpe.
s
carac-
mennges
assocated
wt
and
neuro-
dects.
Menngocee
troug
te
mony
due
cyst
a
or
sac
s
te
sku
to
a
or
protruson
te
spna
deveopmenta
ed
wt
o
te
coumn,
deect,
cerebrospna
mennges
most
com-
ormng
lud.
a
CHAPTER
D.
Spna
bda
mennges
E.
Racscss,
wt
te
to
use
aso
spna
GAS
72;
and
cord
N
presents
te
or
164;
as
resuts
s
wt
unused
known
myeoscss,
ods
15.
cystca
troug
protruson
vertebra
spna
rom
a
spna
nerves
ABR/McM
bda
aure
caracterzed
by
and
o
te
18.
arces.
cord
neura
protruson
te
touc,
CNS.
temperature,
Aferent
B.
Somatc
C.
Vscera
bers
o
mennges.
eferent
bers
aferents
regardng
te
proprocepton
convey
motor
generay
pysoogc
sensory
canges
to
B.
stmu.
te
D.
to
dac
eferents
tree
musce,
nervous
and
s
o
nterna
wereas
E.
wt
musce,
to
cardac
te
tree
car-
Somatc
and
o
te
16.
E.
nterna
nto
A.
and
and
o
and
te
ts-
te
ganduar
B.
anteror
C.
he
two
adjacent
D.
he
subdura
dura
GAS
107,
ament
dsc
he
o
te
o
te
te
o
te
um
conus
o
L1
te
and
termnae
conus
L2
n
te
nternum
meduars.
at
te
eves
o
T11
and
cord
s
present
at
te
eves
o
T11
and
meduars
s
oten
stuated
at
L3
n
meduars
s
oten
stuated
at
L3
n
pexus
(o
ongtudna
vertebra
te
Batson).
te
119;
ony
N
as
170;
te
a
aracnod
potenta
D.
A.
o
aspect
s
B.
and
o
Wt
puposus
te
ony
C.
g-
he
vertebra
te
te
spnous
nterver-
vertebra
bodes
tus
te
woud
supraspnous
runs
to
te
81–82;
N
s
a
externa
near
te
contnuaton
te
occpta
ABR/McM
to
to
oss
o
woud
ead
to
oss
o
spna
artera
nerves
but
suc
woud
are
constrcton
not
and
ave
reated
te
pan-
dgts.
o
te
accessory
nerves
and
woud
trapezus
N
175;
s
C3
major
ramus
o
ABR/McM
nnervated
to
s
by
prenc
nerve,
C5.
nnervated
C5
100–101
te
wc
by
a
branc
contrbutes
to
o
te
te
bra-
pexus.
anteror
ram
o
s
nnervated
C5,
6,
and
7
by
brances
wc
o
te
contrbute
to
pexus.
ram
s
nnervated
o
C5
and
by
C6
brances
rom
te
o
te
braca
dors
ventra
ram
s
o
nnervated
C7
and
C8
by
brances
rom
te
o
braca
he
ments
to
161–162;
N
gamentum
ound
te
n
anteror
greaty
te
196
lavum
aspect
o
tckened
smutaneousy
s
vertebra
te
n
one
o
cana
vertebra
spna
removed
te
and
upon
s
two
ga-
aderent
arces
patoogy.
excson
and
It
o
s
te
amna.
posteror
gaments
30;
connect
vertebrae.
gament
ganga,
outlow
ead
sternocedomastod
rom
braca
GAS
C.
he
adjacent
woud
roots
o
te
te
Latssmus
E.
o
n
Supraspnatus
tus
gaments
trunk
sympatetc
roots
consequences,
36–37;
Serratus
he
lavum
ner-
vasoconstrc-
pexus.
processes
traverses
and
dorsa
dvson
arses
te
21.
gament
or
pexus.
E.
posteroateray.
connects
101
autonomc
sympatetc
te
ventra
o
Rombod
D.
nuca
o
dapragm
ventra
ntervertebra
o
seected
dvson
Surgca
ventra
103
te
responsbe
decrease
ncreased
ventra
mater
space
te
actvty.
scema
te
ABR/McM:
dscs.
protrudes
te
te
wc
lud.
gament
posteror
nuceus
gamentum
o
ABR/McM
o
mbs.
Surgca
ca
ongtudna
o
prmary
Separaton
GAS
20.
gaments
amnae
169–170;
dvson
musces.
at
vertebrae.
sde
E.
bodes.
connects
cerebrospna
te
s
Separaton
u
dura
contans
165,
woud
upper
oten
GAS
and
Atoug
eve
present
N
Dvson
to
te
ventrces
between
vertebrae,
between
exsts
te
anteror
amnae
101;
system
not protect te spna cord rom drect compresson.
and
te
a
spna
sensaton.
subarac-
ventrces
rom
venous
ongtudna
usuay
anteror
te
equna
sympatetc
denervate
te
lavum
supraspnatus
he
o
ntervertebra
adjacent
lows
te
postoned
space,
109,
ernaton,
tebra
C.
and
C.
canges
vertebrae.
contan
spannng
wtn
wt
posteror
engt
posteror
bodes
dsc
and
mater,
not
normaton
space).
vertebra
gamentum
does
he
A.
te
motor
pysoogc
D.
ound
lud
space,
he
and
s
perosteum
B.
convey
transmt
contnuous
nterna
traverse
he
unwanted
lud
s
epdura
and
at
meduars,
termna
s
conus
owever,
6
subaracnod
he
he
ton.
dever
vscera.
N
(cerebrospna
te
mater
B.
bers
aferent
31–33;
space
bran
17.
eferent
cerebrospna
nod
te
cord
conus
motor
vscera
GAS
conus
o
termnaton.
rests
beyond
spna
he
vous
autonomc
types
A.
epteum.
E.
he
GAS
19.
Vscera
eferents
musce,
unc-
musce,
epteum.
vscera
uncton
motor
smoot
ganduar
motor
smoot
autonomc
tssue:
assocated
system,
autonomc
dever
types
nnervaton
sue:
cauda
spna
te
newborns.
Vscera
ton
neror
usuay
beow
he
o
projecton
newborns.
vscera.
D.
ocaton
T12.
normaton
o
te
T12.
normaton.
carry
ts
te
extend
A.
ony
at
adut,
93
and
carry
s
conca
meduars
A. Somatc aferents are responsbe or conveyng pan,
pressure,
hs
tapered
cystca
o
C.
23
Back
1
98
C7
o
vertebrae
protuberance.
A.
he
anteror
ongtudna
anteror-most
C1
to
ected
te
by
a
aspect
sacrum
o
and
gament
te
woud
amnectomy.
runs
vertebra
aong
coumn
tereore
be
te
rom
una-
24
C H A P T E R
B.
1
Back
Dentcuate
rom
te
to
D.
te
gam e n ts
pa
mater
aracnod
he
at
gament
eve
and
he
to
s
N
not
29;
orame n
posteror
rom
C7
te
to
A.
ongtudna
externa
s
a
an
ga-
anteror
be
to
nvoved
space
at-ed
s
n
spna
cord,
extendng
to
C1
extends
troug
mennges,
hs
cana
te
te
spna
answer
s
vertebrae,
cord,
coce
ongtudna
and
does
cana
contanng
assocated
not
tat
te
descrbe
a
he
A.
nterna
vaveess
nay
D.
he
network
aong
does
vertebra
not
te
he
te
he
te
nterspnous
adjacent
B.
he
C.
he
te
most
and
can
eve
o
ment
w
be
ormed
body
E.
he
or
to
GAS
24.
B.
he
CNS
mater.
te
space
pressure
drected
and
te
te
to
are
o
te
because
ateray.
extends
vertebra
n
ts
at
ongtudna
vertebra
te
extends
gament
o
transverse
29,
n
165,
arteres
cervca
most
Answers
26.
te
processes.
167;
run
vertebrae
cosey
176;
s
rom
ga-
s
were
te
te
eve
procedure
case,
cranay
dened
to
not
as
eter
drecty
spna
to
te
w t
cur va -
convex ty) .
torac c
t s
111
pr mar y
and
p ate nt’s
s acr a
c n ca
a
atera
devaton
o
te
sp-
sde.
o
assocated
wt
a
dspacement
coumn.
s
an
ncreased
posterory)
secondary
afectng
te
curvature
cervca
and
regons.
ernated
te
nto
he
(CN
dsc
s
a
rupture
ntervertebra
te
75;
N
vertebra
162;
o
dsc,
dspacement
accessor y
XI)
resuts
but
per-
ema-
te
ony
and
n
te
annuus
commony
o
te
bro-
causng
nuceus
a
pupo-
cana.
ABR/McM
ne r ve
trape zus,
musce
to
to
can
te
te
test
patent
resstance
ng
s
87
te
o
te
wos e
te
cn c a
sr ug
er
p o nt
o
or
os s
o
due
o
to
XI
p aray s s
te
soude r.
te
MRI,
ne r ve
as
and
CN
by
soude r s
tr ap e z us ),
ne r ve
re p re se nt
te
t s
e r
aga n st
c r an a
tra p e z us
b er s
o
nd ngs
s
te
ead
he
s up er or
te
te
s ou de r
nner vat on
to
e e ve nt
bot
m us c es .
rase
(testng
or
s
nner vate s
droopng
addton
we
res stan ce
In
o ne
as k ng
aga ns t
as
turn-
(te s t ng
te
sternocedomastod ) .
A.
vertebra
rom
cervca
ABR/McM
troug
C6
98–99,
(poste r or
ke y
tat
cervca
he
toracodorsa
dors,
wc
as
nerve
no
nnervates
drect
acton
te
on
atssmus
te
souder
grde.
ower
assocated
te
aderent
nc reas ed
c o um n
o
costo-
cord.
ABR/McM
an
te
artery
musces.
are
spna
artery,
26–50
B.
te
C.
regon
te
troug
wt
102,
103
transverse
C1
njury
and
to
are
te
he
dorsa
musces
D.
N
te
very
rom
vertebrae.
sma
aspect
neck
asso c ate d
posteroatera
gament.
gament
vertebra
tereore
A
sus
o
aong
bodes
perormed
correct
asprated
te
ocated
gament
posteror
as
correct
ventray.
ony
were
o
te
rom
very
arteres
a
artery
spnous
connectng
not
generay
te
E.
tese
GAS
structure
eve
are
and
he
at
s
te
sus
s
(concave
101
neede,
ts
deep
mos t
Hyperordoss
cerebro-
te
s
a
usuay
subcavan
o
arses
aso
spna
spna
te
posteror
sternocedomastod
ony
s
D.
space.
connects
ts
o
assocated
Spna stenoss s a narrowng o te vertebra cana
and
between
Normay,
te
29,
s
o
s
tyrod
aspect
artery
s
suppy
N
coumn
and
contanng
te
sku.
81–83;
oramna
L5.
ces
nuca
space
wtn
he
aspect
ncorrecty
anteror
te
at
T12
punctured
supraspnous
true
ABR/McM
ongtudna
present
topoetc
to
gaments
reaced
C.
coce
o
potenta
penetrate
at
na
ongtud-
answer
anterory
drecty
artery
trunk
and
aspect
and
umbar
gament
puncture
L4
s
a
subaracnod
anteror
be
Lumbar
hs
to
cur vature
Scooss
mosty
processes.
termnate
anteror
a
vertebrae.
spnous
extendng
ound
due
gament
te
S2.
s
166;
w
dentcuate
tey
D.
te
N
supraspnous
o
s
s
space.
aracnod
used
n
s
o
space
104;
mdne,
It
pexus
cana.
specc
eve
te
are
lud
57,
processes
te
and
ayers
GAS
n
te
vens
space
lud
subdura
spna
A.
to
dura
two
23.
a
subaracnod
extends
E.
o
vertebra
descrbe
cerebrospna
venous
ocated
not
condton.
space.
B.
aong
te
regons
s
s
neror
anteror
cervca
102;
o
hs
specc
te
Hype rkyposs
ture
gaments.
te
posteror
GAS
B.
cervca
o
trunk
posteror
25.
vertebra
deep
he
te
rom
on
vertebrae
E.
and
vertebrae.
branc
courses
artery
cord
tyrocervca
he
amnectomy.
superca
te
ascendng
cervca
103
ound
space
te
wt
runnng
answer
spna
spna
he
te
occpta
ncorrect
te
sma
D.
s
anteror
aong
magnum
sacrum.
he
he
troug
supraspnous
te
ABR/McM
epdura
It
a
gament
woud
spna
o
ocated
81–83;
mater.
te
A.
t
tus
GAS
dura
te
e x te ns ons
mate r
(non).
crucorm
because
s
contnung
te
protuberance
he
C.
rom
ate ra
d ur a
C.
nuca
ment
22.
mater
te
T12.
extenson
E.
are
to
he
greater
nerve
E.
he
scapuar
and
axary
and
te
nerve
It
s
not
GAS
101;
N
nnervates
evator
nerve
a
te
140,
rombod
prmary
aspect
detod
n
te
scapuae
branc
nvoved
138,
s
posteror
s
nnervates
musces.
89,
te
occpta
nnervatng
pexus
nerve
usuay
o
o
te
and
souder
183;
musce.
a
sensory
te
scap.
braca
teres
mnor
eevaton.
ABR/McM
100
CHAPTER
27.
B.
he
dens
transverse
anterory
ment
o
te
gament
ateray
dens.
hs
to
o
te
prevent
gament
atas
ancors
posteror
as
been
te
B.
It
dspace-
torn
n
ts
C.
he
C.
he
anteror
anteror
o
he
E.
he
te
A.
paced
68,
N
s
o
cana
te
s
and
contracton)
n
and
not
te
does
te
te
afected.
not
ocated
D.
not
back
and
above
te
musce
lexon
C.
Rombod
D.
Rombod
E.
T eres
nerve
uar
nerve
and
toracs
wt
major
and
extenson
eve
s
o
o
31.
C7.
nnervated
rotaton
(batera
s
to
by
woud
A.
(un-
to
by
te
dorsa
GAS
89,
he
ment
dorsa
B.
s
rotate
scap-
C.
scap-
ound
te
at
pedces
A.
be
101,
sku
and
N
base
and
te
s
ABR/McM
te
a
te
It
dens.
spna
39,
transverse
stabzng
C1/C2.
stabze
severs
171;
caed
gament
eps
oten
122;
(aso
atas)
te
gament
can
91,
Rupture
cord
and
138
to
o
are
vertebra
arces
mentum
lavum
te
vertebra
ated
wt
bony
to
te
runs
cana
te
structures
te
L5
ts
he
nuca
vertebra
on
and
amnae
te
s
body.
posteror
more
tan
to
he
B.
o
o
s
a
ongtudna
C.
te
extenson
D.
he
and
30.
A.
or
s
o
te
meda
te
te
most
posteror
spnous
to
te
aspect
o
te
processes.
ongtudna
anteror
nous
processes
GAS
68;
N
ocked
tons
gament
aspect
o
te
extends
vertebra
te
cana
acets,
tan
oter
condton
te
Due
te
ockng
te
te
to
more
cervca
vertebrae.
o
known
as
te
rom
C7
orzontay
vertebrae
hs
can
dspaced
“jumped
are
E.
ead
to
acets.”
dsoca-
o
artcuar
tey
sacra
vertebrae
because
tey
ABR/McM
epdura
91,
space;
ematoma
space,
n
113
ence
ts
te
beed-
space.
contanng
emorrage
te
woud
ntracerebra
woud
rom
superor
cana
cerebrosp-
a
most
resut
torn
sagtta
key
aneurysm.
most
key
cerebra
snus
ven
wtn
te
be
L2,
L2,
N
L2,
S1
ext
L3,
w
as
L4
te
te
gray
o
conus
cauda
end
matter
te
sub-
meduars
o
te
sub-
descends
te
L5
ext
vertebrae.
te
L5
te
In
verte-
an
spna
between
L4
L4,
nerve
and
L5
eve.
nerves
ave
aready
exted
ave
aready
exted
ave
aready
exted
ernaton.
spna
o
L4
102
nerves
named
spna
L4
eve
spna
ernaton,
t
o
eve
ext
ter
dsc
eve
and
te
te
enargement
ABR/McM
regon
beow
and
te
an
and
175;
and
L3,
s
between
cord
beow
te
wtn
space.
afected
L3,
ocated
cstern
space
umbar
to
s
cord.
spna
coumn
A.
80,
Posteror
nerves
ernaton.
spna
o
nerves
ernaton.
beow
n
111;
te
te
musces
atera
he
N
164,
ntercosta
extendng
oter
L4,
L5
ntervertebra
dsc
toracc
and
regon,
ateray
sted
lexon
170
arteres
are
o
subscapuar
not
te
suppy
wc
bendng
te
are
te
responsbe
deep
back
responsbe
trunk.
or
he
extenson
trunk.
artery
suppes
te
subscapuars
musce.
he
toracodorsa
artery
suppes
te
atssmus
dors.
C.
tgty
processes
te
ts
because
beed
te
ntervertebra
or
one
orented
ess
artcuar
o
o
to
eves
vertebrae
ematoma
spna
104;
te
GAS
33.
B.
dspacement
anges
ower
ernaton.
nerory.
98
anteror
In
and
vertebrae
at
sacra
ruptured
umbar
musces
pedces.
ABR/McM
s
vertebrae.
wt
o
30;
Spondyoyss
more
he
above
o
he supraspnous gament s ocated aong te sp-
artcuar
a
aong
posteror
engt
E.
on
te
venous
centra
te
above
assoc-
pedces
167;
te
a
enters
above
ga-
aspect
cosey
te
te
E.
gament
runnng
vertebrae
rom
a
vertebrae
te supraspnous gament rom C7 to te occput,
bot
t
woud
tereore
connectng
n
subdura
he
bra
vertebrae.
B.
D.
A.
pedces
te
subaracnod
GAS
32.
ata.
he
A
o
gament
attaces
n
N
cause
aracnod
te
ga-
susceptbe
pressures
sagtta
te
subaracnod
o
E.
adduct
somewat
te
vertebrae
rbs.
sku.
subscapuar
and
toracc
te
togeter.
mater
rom
scapuae.
ower
n
seen
aracnod
crucorm
o
he
A
te
It
o
na lud s ocated between pa and aracnod mater.
scapuae.
te
te
te
meday
te
by
adduct
nnervated
serves
n
posture.
te
te
togeter.
83–84;
dura
umerus.
C.
not
ng
as
by
adduct
to
ound
seen
used
te
lexon.
nnervated
serves
s
and
are
o
n
actor
D. he nterna vertebra pexus (o Batson) surrounds
contracton)
mantan
nnervated
serves
and
s
musce
to
neck
s
mnor
major
nerve
s
are
98
contraatera
unctons
assocated
uar
It
te
not
GAS
ongtudna
because
used
resut
ocostas
deep
29.
vertebrae
spne
s
are
neck.
he
It
contact
aong
common
stabzng
acets.
posteror
E.
s
ABR/McM
unctons
s
on
on
vertebrae.
a
sternocedomastod
XI
and
runs
dens.
gament
30;
and
ound
gament
gament
69;
gament
vertebrae
vertebra
supraspnous
he
te
te
lavum
processes
nuca
GAS
o
o
supraspnous
spnous
atera
te
anterory
D.
CN
aspect
gamentum
aspect
te
ongtudna
ess
te
probem
A.
B.
muc
to
Lumbar
njury.
28.
s
due
25
Back
1
he
anteror
ntercosta
D.
he
tus
suprascapuar
and
GAS
ntercosta
suppes
te
upper
nne
te
supraspna-
spaces.
artery
nraspnatus
102–103;
N
suppes
musces.
168,
197
26
C H A P T E R
34.
A.
1
he
sbe
Back
atantoaxa
or
rotaton
extenson,
B.
Te
n
or
jont
o
te
s
a
synova
ead,
not
jont
lexon,
respon-
exon
and
D.
jont
s
extenson
prmary
o
te
ead
on
toaxa
D.
he
lexon
jont
and
GAS
D.
he
na
to
rate
69;
te
were
te
he
spna
B.
he
pa
C.
he
na
26,
by
atan-
s
s
te
wc
aracnod
woud
es
(o
nvoved
te
te
n
not
to
112
pass
reac
T o
te
te
wtn
te
asp-
te
dura
ocated
o
te
E.
he
gamentum
GAS
E.
he
o
te
he
o
te
te
te
rb.
own
on
te
ead
he
39.
sp-
A.
dura
ts
our t
body
to
jont)
s
unt,
te
nto
te
rb
as
ton
wt
T4.
he
neck
o
a
o
te
T3
C.
he
D.
he
acet
te
ead
artcuates
or ms
ve r teb ra,
ve r te b ra
t
rb
o
w t
o
he
wt
nod
so
and
as
a
A.
ead
GAS
he
meda
o
te
ourt
trd
o
w e n
te
move
one
at-
as
rb
w
a
not
te
rb
w
trd
key
rb
not
w
be
A.
he
B.
he
o
te
te
N
major
rotaton
teres
lud
not
o
192;
s
te
mnor
s
ABR/McM
he
na
responsbe
or
te
adducton
and
responsbe
atera
rotaton
ebow.
brac
responsbe
or
extenson
o
adducton,
scapua
and
o
te
pane.
or
s
te
rst
15
104–106
per ormed,
gamentum
te
Te
w e re
umbar
te
avum,
aracnod
space
subaracnod
pexus
mater
s
n
te
aderent
lavum
mater
te
c e re -
cstern
space
(o
s
b e ow
Batson)
epdura
to
s
te
a
te
es
exter-
space.
spna
ocated
ongtudna
o
te
N
cord.
deep
space
gament
vertebra
174;
space,
ocated
to
te
ep-
and
s
ABR/McM
te
lud
can
attaced
pa
103
te
and
crcuates
be
to
bodes.
contanng
between
space
epdura
nterna
cerebro-
te
arac-
wtn
asprated
ony
te
rom
and
s
te
does
not
space
vertebra
ste
to
contan
contans
venous
nject
an
cerebrospna
te
epdura
pexus
anestetc
at
(Batson
or
ep-
anestesa.
subdura
he
space
does
subdura
te
dura
pretracea
not
space
and
space
s
contan
ony
aracnod
does
not
a
cerebrospna
potenta
space
mater.
contan
cerebrosp-
lud.
te
centra
substance
GAS
s
and
rom
o
te
lud
ts
cana,
spna
contaned
cord,
extracton
space
woud
does
o
resut
wtn
contan
cerebrospna
n
spna
cord
njur y.
umerus.
trceps
te
cerebrospna
he
te
lud
or
te
ABR/McM
nay
aspect
cerebrospna
umerus.
a
umerus.
abducton
p u n c t u re
117–119;
Atoug
102
o
or
te
responsbe
vertebra
epdura
lud.
D.
not
ocaton.
he
be
o
durng
ocated.
dura
s
mater.
dura
njured.
key
rotaton
mnor,
adducton
responsbe
422;
te
mater
109,
vens)
be
atera
or
rotaton
eevator
s
subaracnod
and
ar t cua-
key
te
space.
lud.
E.
126–127;
teres
te
between
tuberce
o
posteror
he
cos to tr ans-
r b
ony
ts
ve r teb r a
s
posteror
he
B.
te
ud
pa
spna
ar tcuat on
te
o
105–107
or
teres
orzonta
and
gamentum
C.
te
subaracnod
he
GAS
njured.
E.
m a t e r,
nterna
to
te
40.
413,
he
E.
s
an
te
D.
vertebra).
supe-
s
C.
ourt
te
15
umerus.
penetrate
te
dura
neror
(te
wt
pon ts
T4
te
acet
jo nt
te
te
wt
rotator
ABR/McM
responsbe
te
umbar
subaracnod
tub e rc e
njured,
wereas
artcuates
wt
na
acets.
body
rst
meduars.
he
ead
te
above
artcuates
rb
on
two
on
consderaton,
tw o
orms
rb
and
neror
rb.
as
acet
te
s
o
scapua
N
a
must
dura
conus
wt
te
abducton.
contnuaton
njured.
37.
717;
re a c
B.
rb
vertebra
neror
t
te
te
ourt
te
te
space.
superor
vertebra)
o
vertebra
ead
and
verse
T4
and
te
rb
(te
wtn
atera
wt
meda
above
o
Wen
te
te
or
umerus.
responsbe
supraspnatus
neede
102
artcuates
o
te
vertebra
rb
o
(te
ead
wt
wt
ocated
epdura
vertebra
body
s
ABR/McM
he
acet
T4
o
ourt
te
vertebra
te
acet
ter
to
lavum
175;
artcuates
artcuates
ror
B.
N
toracc
t
T akng
A.
deep
superor
acet
rb
sac
104;
T4
rb
ts
he
degrees
sac.
wtn
te
umerus
neede
sac.
a
413;
s
dors
and
trapezus
GAS
surace
major
rotaton
rotates
epdura
dura
te
s
(aong
atssmus
he
exter-
accumuate.
te
teres
he
D.
es
responsbe
o
ere).
he
C.
180,
umerus
meda
s
N
extenson,
space.
must
717;
nraspnatus
b ro s p n a
dura
36.
te
A.
sac.
D.
o
neck.
ead
Batson)
wtn
on
s
o
epdura
ocated
mater
on
ABR/McM
lavum
ocated
he
dsocaton.
pyscan
bood
cord
prmary
pexus
n
te
mater
cord,
afected
ead
jont
28–29;
gamentum
A.
s
te
reducton)
mater
bood,
te
o
vertebra
dura
excess
troug
space
22,
nterna
te
not
s
abducton
nraspnatus
GAS
B.
coce
jont
atantoaxa
N
s
o
umerus.
dsocaton.
(atera
by
ead
extenson
Adducton
afected
35.
te
atantooccpta
lexon
E.
o
supraspnatus
he
n vo ve d
38.
Latera
he
degrees
adducton.
atantooccpta
neck.
C.
C.
abducton,
41.
A.
109;
Genera
te
skn
o
N
120;
somatc
te
back
ABR/McM
aferent
va
te
101
bers
dorsa
are
conveyed
ram.
rom
CHAPTER
B.
Communcatng
eferent
aferent
C.
mbs
D.
bers
V entra
nerves
he
ram
(sympatetc)
o
ram
te
to/rom
a
ventra
mxed
oter
te
roots
genera
and
autonomc
convey
excudng
contan
bers
nervous
sensory
parts
vscera
genera
o
B.
In
aow
system.
and
te
45.
vscera
A.
o
and
C.
ony
eferent
(motor)
GAS
42.
D.
L2
he
A.
regon
L3–L4
o
te
ABR/McM
s
te
s
a
s
D.
s
te
ram
o T1–T11.
subcosta
E.
GAS
any
ocated
coce
at
tat
te
L1–
46.
contans
ocaton
cauda
to
to
te
perorm
apex
o
umbar
te
L3
s
cauda
to
te
conus
meduars.
C.
L4
s
cauda
to
te
conus
meduars.
E.
T11
GAS
D.
superor
101;
N
Because
ncuded
ton
s
a
to
169,
te
n
n
ocated
n
tass
te
conus
170;
te
and
protr uson,
cassc
Avuson
truson
B.
101
B.
o
cord
patent’s
spna
are
bda
C.
tants
o
cord
by
A
nvove
pro-
It
or
does
resut
o
te
mennges
numerous
not
n
cause
oter
rr-
deormaton
protruson
o
occuta
n
wc
te
tut
s
a
te
normay
vertebra
durng
o
ar
afected
s
embryoogc
commony
regon
spna
(usuay
a
tssue,
contans
t
s
ony
known
as
spna
bda
Somatc
cay
A.
rom
w
D.
aferent
body
bers
wa
aferents
present
convey
as
du
and
bers
pan,
typ-
C.
Pan
rom
nervous
tese
and
do
bers
not
are
bers
vscera
eferents
normaton.
GAS
31–33;
due
to
te
orentaton
o
te
to
te
orentaton
o
te
ABR/McM
a
can
(Batson)
vaveess
space
o
provde
rom
low
87
venous
te
o
network
te
a
route
s
vens
vertebra
prostate
bood
venous
o
or
or
te
cana.
metas-
breast
to
bdrectona
te
due
o
te
s
nterna
rreevant
ncorrect
because
pexus,
one-way
vertebra
to
te
te
n
nterna
genera,
movement
o
venous
queston.
vertebra
does
not
ave
bood.
te
he
epdura
nterna
wtn
104;
N
te
o
te
not
te
venous
epdura,
175;
acromon
part
space,
vertebra
not
ABR/McM
(te
gest
scapua
tat
subaracnod.
(Batson)
te
pexus
subdura
s
space.
102
pont
orms
o
te
te
souder)
“pont”
o
te
superor
he
near
genod
ead
he
A
C.
o
te
be
te
o
to
te
scapua
s
back.
scapua
artcuates
orm
ocated
192,
nerves
atssmus
ntact
w
and
te
wt
genou-
and
ossae.
409
rom
be
posterory
nraspnous
C6
and
nerve
beow
w
(C7–C8)
be
wc
ost.
sternocedomastod
because
tey
are
musces
nnervated
by
te
nerve.
ntact
and
sternocedomastod
because
tey
are
musces
nnervated
by
te
nerve.
dapragm
nerve
36,
s
and
toracodorsa
trapezus
be
scapua
N
spna
trapezus
he
te
te
umerus
supraspnous
te
so
he
o
ange
o
jont.
accessory
sensor y
te
702–711;
he
meda)
mdne
ossa
o
spne
o
w
(or
te
suppy
s
w
work
derved
propery
rom
te
as
ts
prenc
motor
nerve
(C3–C5).
Parasympatetc
vscera
he
w
nnervaton
contan
s
(Batson)
accessory
pregangonc
bers
162;
pexus
or
nnervates
B.
motor
te
he nterna vertebra venous (Batson) pexus s ocated
GAS
D.
sys-
dfuse.
convey
vaves
separates
normaton.
E.
s
mera
musce.
Sympatetc
hs
te
A.
autonomc
o
due
epdura
engt
afected,
ocazed
orentaton
pressures.
ocated
wt
mbs.
te
he coracod process s ocated more neromeday.
but
93
convey
and
normaton.
eferent
skeeta
eferent
ABR/McM
to
he
to
48.
164;
sensory
Somatc
to
N
te
Vscera
tem
B.
72;
orentaton
B.
umbar
mennges
te
A.
growng
mdne
to
souder.
deveop-
seen
due
due
vertebra
te
he
te
D.
protruson
CNS
GAS
C.
s
asymptomatc
amnae
E.
N
because
GAS
47.
mted
(e.g.,
ocated
menngocee.
44.
E.
poston).
te
no
vra,
or
not
cord.
nlammaton
competey
over
I
an
bood).
bda
ment.
E.
s
vertebrae
condton
n
spna
woud
contents.
Spna
use
mennges
s
te
o
wtn
bactera,
(e.g.,
te
te
mted
cancer
vaves
wt
s
genera,
venous
cond -
vertebrae
acets.
(Batson)
spna
te
presentaton
te
Menngts
caused
C.
o
o
o
oca
A.
meduars.
ABR/McM
mennges
to
myeomenngocee.
A.
ack
mted
umbar
rotaton.
acets.
nterna
pexus,
s
te
and
acets.
mted
62–69;
he
bran)
B.
s
D.
he
conus
meduars.
43.
Adducton
artcuar
99
s
lexon,
acets.
Inverson
nerve.
answer.
common
t
s
usuay
tereore
correct
but
ventra
T12
meduars
eve;
puncture,
are
ramus
31–33;
conus
vertebra
ts
nerves
ventra
atera
extenson,
artcuar
artcuar
Intercosta
he
te
artcuar
contan
to
lexon,
Abducton
back.
bers.
E.
or
Crcumducton
motor
trunk
addton
27
Back
1
pregangonc
and
do
not
bers
contan
are
aso
sensory
E.
he
detod
motor
rom
N
6
GAS
w
suppy
C5
91,
and
101;
not
s
C6.
N
be
rom
414
afected
te
because
axary
ts
nerve
nerve
derved
28
C H A P T E R
49.
C.
1
Spna
Back
bda
menngocee
cystca
or
reers
to
spna
myeomenngocee
bda
and
s
wt
te
a
E.
Intercostovertebra
correct
tebra
answer.
A.
GAS
Cranum
n
B.
te
sku,
back.
Spna
but
bda
s
a
deect
and
be
n
does
cord,
regresson
and
o
te
menngocee
GAS
72;
N
bood
ocated
n
te
not
te
ormaton
usuay
te
ower
ower
or
52.
o
o
obque,
Pett
A.
hs
and
s
Cauda
and
o
and
ABR/McM
(o
te
space
te
s
wt
oss
spne,
not
reated
n
or
A.
ts
not
by
ormed
s
a
te
to
by
a
possbe
best
ste
answer
crest.
C.
D.
a
tumor,
An
ndrect
na
cana
A
drect
as
tumors
nguna
o
te
nterna
o
D.
loor
(Hessebac)
to
be
s
o
ocated
te
n
te
anteror
A
erna
occurs
beow
ngu-
areas
nguna
or
abdomna
te
N
161,
180;
ABR/McM
nguna
51.
105
to
hs
queston
dsc
te
ernatons
nto
cana.
he
eray,
were
te
and
tebra
dsc
te
te
posteror
wen
annuus
so
nuceus
s
te
puposus
te
oramen
protruson
s
s
gament.
most
or
vertebra
renorced
he
te
key
neror
ocaton
he
pa
mater
mantan
B.
ancor
spna
space.
he
oramen
vertebra
spna
pace
o
o
are
te
atera
dura
n
extensons
mater,
poston
and
s
passes;
te
cana
we
t
s
ts
not
te
troug
may
most
a
aso
be
a
ste
acets
processes
o
te
te
ocatons
vertebrae
were
artcuate
te
artcu-
wt
eac
by
anestes-
and
to
cdbrt.
te
opens
sp-
epdura
between
te
are
and
ocated
are
not
on
te
papabe
ram
are
o
te
sacra
openngs
nerves
ext
oramna
nerves
are
ext
te
n
openngs
cervca,
to-
regons.
sacra
he
B.
s
N
crest
s
166;
crana
to
ABR/McM
te
55,
te
njecton
95
typca
o
he
o
66;
o
metastass
o
metastass
o
metastass
N
27,
and
deep
hs
scapuar
he
o
to
nerve
spne
n
te
cervca
spne
n
te
cervca
spne
n
te
cervca
spne
as
te
s
passes
most
afected
te
te
supe-
transverse
n
queston.
bend
to
be
key
n
te
ax-
subscapuars
protected.
posterory
s
te
superor
runs
wc
89
troug
descrbed
tereore
space,
o
te
dsta
troug
to
te
te
superor
nerve
orgnates
braca
pexus,
rom
wc
te
s
poste-
dsta
to
racture.
suprascapuar
combnaton
bend
wt
te
to
te
be
protected.
GAS
cervca
notc.
cord
he
te
ABR/McM
superca
nerve
subscapuar
ste
te
n
passes
nerve
es
woud
quadranguar
164;
nerve
scapua
and
axary
n
pedces.
metastass
toracodorsa
he
bran
metastass
pedces.
notc,
artery
o
recenty
eter
pedces.
pace
te
pace
wo
to
pedces.
pace
gament.
women
pedces.
pace
60,
n
metastass
vertebra
pace
vertebra
musce
E.
he
vertebra
scapuar
te
suggests
suprascapuar
ary
D.
tenderness
vertebra
typca
te
runs
are
wc
sacra
perneum.
andmarks.
spna
vertebra
racture
wc
key
te
te
used
abor
oramna
dorsa
papabe
spne.
typca
scapuar
o
te
he
ror
o
ernaton.
oter.
A.
ep
wtn
bock
rom
sacrum
sacra
cancer
typca
te
ror
compresson,
Artcuar
ar
cord
to
cord
subaracnod
te
C.
tat
te
gaments
to
oramna
te
umbar
typca
GAS
54.
C.
dentcuate
ABR/McM
approac.
wc
spne
te
he
s
nterver-
compresson.
A.
E.
o
annuus
posteroat-
not
rame
reatng
Intervertebra
troug
notces
ts
cord.
brosus
ongtudna
vertebra
oramen,
te
protrudes
common
te
knowedge
spna
ntervertebra
most
superor
anatomc
and
occur
ntervertebra
brosus
by
tests
vertebra
o
ocazed
te
he
s
typca
o
he
s
51–75
D.
164;
anestetc
atus,
sacra
109–113;
breast
s
C.
Answers
not
and
cervca
B.
87–88;
oca
wc
medan
cervca
gament.
GAS
ver-
D. Patents wt persstent eadace or back pan wt
A.
emora
used
durng
ntervertebra
GAS
53.
wa.
E.
he
ad
te
were
ste.
wa.
n
o
dorsa
are
he
s
masses.
28,
commony
sacra
surace
a
racc,
E.
ump
ard
ocated
abdomna
erna
trange
s
te
troug
abdomna
ts
N
sensaton
pan
posteror
and
ernaton.
because
tend
erna
anteror
nguna
s
anteror
he
meday
he
ocatons
rbs.
cornua.
rom
B.
genera.
bordered
ac
te
va
s
carry
reeve
troug
s
te
s
pevc
descrbed as sot and pabe, wc woud not key
ndcate
to
he
spna
93
Pett)
nerory
s
tat
procedure
sacra
presents
part
mbs
n
111–112;
anestesa
nerves
oogsts
ungs.
myeomenngocee,
trange
trange
obque,
C.
hs
by te atssmus dors, ateray by te externa abdom-
na
101–103,
are
wt
103
present
accumuaton
syndrome
te
164;
umbar
to
surroundng
deormaton
he
not
menngocee
jonts
artcuate
Admnstraton
reers
space
Cauda
B.
wt
menngocee.
peura
50.
present
woud
arces
Hemotorax
E.
t
occuta
vertebra
wt
coud
na
ower
te
D.
bda
bodes
nerve
te
axary
subscapuars
717–718;
s
artery
musce
N417,
correct,
toracodorsa
468
and
and
but
nerve,
es
not
n
wc
superca
woud
tereore
CHAPTER
55.
E.
Kppe-Fe
wc
or
tere
more
sort,
A.
s
a
syndrome
s
a
reducton,
or
extensve
cervca
stf
neck
vertebrae.
wt
Hyperordoss
s
It
mted
an
congenta
oten
deect
uson
o
manests
n
B.
one
as
between
a
ets
moton.
abnorma
ncrease
n
umbar
C.
Scooss
D.
Spna
ncrease
GAS
A.
te
a
N
te
curvature
present
s
arc
wc
pacement
s
spne.
and
condton
and
o
not
o
te
nuceus
deormtes
n
te
us
neror
te
L5
te
case
s
or ward
n
ts
s
L4
rater
acets
s
(on
n
(and
te
E.
ds-
ante-
suc
tat
sometmes
beng
L3)
restraned
troug
cated
te
wt
a
protruson
annuus
Hyperordoss
E.
Scooss
s
an
te
brosus,
vertebra
D.
o
nuceus
and
ts
not
asso-
A.
he
ory
n
B.
he
te
C.
umbar
curvature.
an
abnorma
atera
curvature
o
te
wc
s
te
L5
not
te
racture
o
GAS
C.
83–84;
Car
II
N
167;
ABR/McM
maormaton
91,
ncudes
a
e r n atons
protr ud e s
te
m os t
w e re
by
te
o
syndrome
cervca
and
cerebeum
verms
beow
te
o
occur
troug
te
Menngocee
wc
B.
ony
Kppe-Fe
number
D.
o
s
te
a
syndrome
cervca
Hydrocepaus
low,
or
sma
deect
mennges
N
te
arc
o
te
posteror
on
167;
resuts
resuts
te
te
o
or
te
rom
an
rom
te
axs
91,
dens,
and
obstructon
tuberce
o
te
surace
o
atas
te
T etered
caused
tube.
hs
A.
syndrome
nternum.
a
congenta
cosure
oten
o
he
atantooccpta
lexon
and
jo n t
s
exte n s on
o
te
he
ates
neror
wt
artcuar
te
C3
acet
vertebra
s
were
(GAS
and
a
on
ar ticular
lateral
mass
facet
of
CI
n
ts
neura
tckened
by
an
coumn
sometmes
racture
te
at
te
pars
suc
L3)
an
n
anteror
te
tat
a
um
te
and
protrude
nterartcuars.
hs
s
known
margn
te
here
ncudng
condton
anteror
as
cre-
o
te
overyng
orward.
jont
Addtonay,
vertebrae
dspacement
anteror
L5
zygapopysea
spondyoyss.
o
s
rreguarty
s
te
L4
s
a
area
known
dspace-
spondyostess. Superior
ar ticular Dens
hereore,
n
ts
spondyostess.
patent,
a
spondyoyss
as
ed
to
a
b ro s us
abnorma
113
s
super-
wt
a
bony
te
em-
arc
o
nvo ve d
ead
facet
of
CII
•
GAS
Fig.
.
te
Fg.
lud
caracterzed
an
pr m ar y
anomay
te
or
protr us on
atas.
117
by
ment
s
meduars
Spondyostess
(and
s
deectve
termnae
vertebra
as
a
conus
ated
o
syndrome
by
ow-yng
N
58.
cord
oten
a nnu -
oram en
posteror
absorpton.
E.
te
projects
te
o
w en
te
artcuates
abnorma
cerebrospna
ver-
ong tud n a
rom
bodes.
wt
o
atas.
outer
oramen
cranum
ts
bodes.
ABR/McM
process,
body
resuts
ernate.
vertebra
ntererence
n
s
n
annuus
p oster or
magnum.
A.
case
coapse
comm on
vertebra
Inferior
branstem
ac-
vertebra)
n te r ver te br a
he
renorced
s
113
ernaton
regon
trauma.
spne.
57.
te
artcuar
on
t e
neck.
D.
s
nto
83–84;
rom
n
ncrease
dsc
cana.
odontod
anteror
dsocaton.
abnorma
o
wc
resut
puposus
Kppe-Fe
GAS
59.
puposus
s
a
posteroateray,
not
nence
s
n
neror
arc
vertebra
as
brosus
number
ver tebra
and
gament.
or
exampe.
coumn
tan
regon
damaged
rreguarty
ver tebra
te
artcuar
anteror
an
overyng
wc
vertebra)
an
by
te
n
S1.
Hernaton
bodes
Inter ver tebra
s
a
created
margn
protr ude
by
wt
te
condton
mssng,
Compresson
tebra
BP19
Spondyostess
L5
abnorma
D.
o
a
posteror
or
ver tebra
superor
posteror
ror
an
curvature.
atera
can
s
regon.
76;
mssng,
C.
toracc
Spondyoyss
between
B.
s
bda
umbar
56.
n
(“uncback”)
te
s
superor
exampe.
C.
Hyperkyposs
(on
te
damaged
curvature.
B.
Spondyoyss
29
Back
1
axs
2.21).
artcu-
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
anteror
nence
te
60.
tuberce
te
outer
he
anteror
brous
son.
N
band
aspect
dscs;
te
atas
o
te
s
a
bony
anteror
em-
arc
o
t
It
BP34;
o
can
covers
te
be
by
and
vertebra
torn
stabty
by
gamentum
posture
ABR/McM
ongtudna
tat
mantans
he
gament
and
cervca
te
112
connects
bodes
lavum
connectng
89,
he
te
o
vertebra
D.
he
E.
he
s
te
and
a
strong
anteroat-
cana
mantan
amnae
o
two
gament
s
and
te
te
posteror
prevents
outer
gament
part
o
an
193;
adjacent
sp-
he
he
98,
102
Fig.
2.38
gaments
to
roots
tougt
to
te
o
ligament
are
atera
dura
te
spna
uncton
extensons
mater
n
between
nerves.
keepng
hese
te
o
te
g-
spna
posteror
ongtudna
aspect
o
te
gament
vertebra
supports
bodes
wtn
te
te
cana.
tentorum
supports
cerebe
te
and
gamentum
by
s
occpta
covers
te
lavum
connectng
te
a
ayer
obes
o
o
dura
te
mater
cerebra
cerebeum.
eps
mantan
amnae
o
two
uprgt
adjacent
vertebrae.
E.
he
son
nuca
o
te
te
gament
s
supraspnous
C7
vertebra
to
a
posteror
gaments
te
exten-
extendng
externa
occpta
protuberance.
GAS
ABR/McM
Supraspinous
stabzed.
he
rom
connects
ventra
are
posture
aspect
GAS
attac
emsperes
wtn
yperlexon.
brous
processes.
N
and
tat
adjacent
runs
tat
vertebra
B.
flavum
dentcuate
mater
posteror
uprgt
dsc.
nterspnous
81;
A.
yperexten-
yperextenson.
supportng
bodes
brosus
ntervertebra
GAS
he
cord
ntervertebra
prevents
eps
ongtudna
vertebra
annuus
nous
pa
D.
posteror
te
C.
aments
vertebrae.
C.
61.
dorsa
69;
era
o
surace
atas.
GAS
B.
A.
on
ligament
106–107;
100,111
N
174–175;
ABR/McM
98,
CHAPTER
62.
A.
he
regon
atssmus
and
te
meda
trange
most
o
he
te
border
rom
ts
between
detod,
not
by
orm
o
te
skn
s
because
o
o
te
te
te
o
can
as
be
mnma
back
and
and
te
te
B.
he
te
spna
noted
tssue
n
ungs.
A.
auscutaton.”
C.
he
D.
externa
abdomna
obque,
C.
(o
as
te
quadratus
and
te
neror
umbar
umborum,
neror
border
o
nterna
border
te
trange
o
Pett).
abdomna
te
superor
o
twet
umbar
D.
rb
trange
he
rectus
neror
nguna
GAS
he
abdomns,
epgastrc
trange
87,
90;
N
weakness
o
ary
wc
nerve,
(o
te
orm
257;
border
and
o
E.
te
movement
mnor
passes
and
resuts
detod
troug
te
by
rom
te
ax-
quadranguar
artery
to
can
and
be
resut
(oss
neror
s
posteror
soud
t
parapega
movement
vertebra
ts
artery
ocaton
posteror
o
not
L2
te
eves
vertebra
cana.
Dvson
o
be
and
o
at
a
te
to
spna
protected
woud
te
not
surgca
artery
woud
ocaton
be
ste.
not
nsde
te
cana.
woud
te
key
parayss,
conus
occur
and
as
s,
te
meduars
ts
agan,
toracc
as
woud
N
te
protected
sympatetc
dsrupton
102–103;
o
structure
symptoms
wc
sympatetc
GAS
66.
te
o
o
s
nsde
trunk
descrbed
not
be
(GAS
a
Fg.
spna
ocated
te
woud
ncude
consequence
2.55A).
176
C. Scooss can be a secondary condton n suc dsor-
ders
as
muscuar
musces
tat
border
te
quadran-
n
contact
te
detod
ca
A.
wt
musce
cutaneous
he
nerve.
may
branc
suprascapuar
natus
tus
and
T eres
te
ateray
major
nerve
and
Numbness
resut
o
s
te
musces.
and
te
nnervated
te
nerve
nnervates
umerus,
to
o
superor
axary
nerve
rotates
serves
te
nraspnatus
abducts
musce
B.
te
atera
s
te
he
te
skn
A.
over
by
te
back
afected.
B.
suprasp-
te
he
anguated
subscapuar
adduct
D.
te
o
te
te
E.
nerve
musces
arm
Unar
and
GAS
718;
responsbe
and
skn
on
or
te
te
nnervaton
posteror
aspect
damage
o
n
manest
wt
and
67.
te
an
L5
L4–L5
nerve
L5
exsts.
vertebra
414
In
wc
vertebrae
be
to
ext
Compresson
B.
Compresson
ness
on
te
over
te
Compresson
E.
Compresson
ness
GAS
beow
o
on
te
te
80;
N
o
nerve
o
t
regon,
ter
dsc
as
beow
anteror
C.
ness
umbar
afected
A.
ness
te
coumn
spna
named
ernaton,
descends
nerves
te
L5
between
spna
L4
o
nerve
te
L5
L3
woud
produce
numb-
woud
produce
numb-
L4
165;
L2
abnor-
he
S1
anke
numb-
produce
numb-
tg.
woud
and
74;
ABR/McM
101–102
N
brosus
s
a
o
most
eson
to
tear.”
tubercuoss,
resuts
n
ste.
and
woud
presents
It
o
uncback
dystropy
commony
and
curvature
a
wc
deect
muscuar
ABR/McM
dsc
nner
rom
between
s
or
not
poo.
wt
gy
age
unkey
cartage
synova
jonts
s
and
cartage
nuceus
te
87
conssts
o
an
outer
puposus.
annuus
he
brosus,
annu-
tense
wc
m-
vertebrae.
Hyane
Eastc
te
pregnancy .
woman.
162;
and
secondary
deormty,”
at
“wear
ate
prmary
produces
congenta
resut
comes
rotaton
D.
he
E.
Eastc
68.
E.
eppysa
derved
A.
bers
79;
N
Notocord
centrc
oot.
a
and
be
kyposs
ntervertebra
GAS
produce
agnment
ound
on
eppysa
s
ound
artcuar
suraces
n
pates.
n,
or
exampe,
te
epgotts.
eve.
woud
can
norma
puposus
anteror
nerve
atera
B.
and
tg.
nerve
upper
A.
In
knee.
o
ts
ext
vertebrae.
norma
durng
ncreased
“gbbus
23-year-od
strengt
ntervertebra
woud
C.
us
D. In ts MRI a posteroatera ernaton between L4
and
a
GAS
woud
It
a
bda
as
common
s
regons
Osteoartrts
rom
abnormates.
N
Spna
present
orearm.
nerve
movement
s
qute
toracc
producng
E.
rada
s
deormty.
umerus.
D.
and
Hyperkyposs
supraspna-
and
te
Hyperordoss s ncreased secondary curvature o te
nraspnatus
ower
rotate
keep
umbar regon. It can be caused by stress on te ower
bra-
umerus.
meday
not
n
o te vertebra coumn and resuts n a atera curvature.
te
does
poo
s
o
acton
and
ma
ypertropy
musce
dystropy
space. Quadranguar space syndrome occurs wen tere
guar space or bross o portons o te musces tat are
64.
o
et
because
L1,
ts
damage
ncudng
superor
T ransecton
not
105–106
ts
cord
mb
ABR/McM
souder
teres
gament,
te
Hessebac).
161,
n
denervaton
nguna
vesses
te
due
Lgaton
at
Grynett).
Adamkewcz)
njury).
vertebra
known
(o
anteror
o
because
vountary
to
(aso
orm
C.
te
occur
obque,
63.
o
Injury
to
ocaton
surgery
and
and ac crest orm te border o te umbar trange
he
E.
dors,
he
artery
suppy
consequences,
key
atssmus
bood
arteres.
dre
eve
o
radcuar
or
durng
sensaton
do
“trange
great
mportant
eard
trapezus
so-caed
65.
trapezus,
known
sounds
scapuae,
borders
border
o
scapua
ocaton
te
upper
border
Lung
evator
te
te
atera
auscutaton.
ceary
ntervenes
B.
bounded
dors,
31
Back
1
and
rom
rngs
Nuceus
and
ces
164,
168;
remnant
te
te
o
ts
s
s
a
ound
type
n
te
adjacent
te
no
a
drect
yane
te
103
geatnous
mesencyme
orms
nuceus
wc
te
s
con-
brosus.
remnant
o
nvovement
deveopment.
cartage.
epgotts.
scerotome
annuus
s
o
ABR/McM
orms
surroundng
puposus
tere
n
pate
are
te
o
notocord,
neura
crest
32
C H A P T E R
1
Back
B.
here s no drect neura crest or ectoderm nvove-
C.
he
ment
n
deveopment
scerotome
annuus Posterior
spinal
but
n
tere
deveopment
s
no
o
te
scerotome
nvovement
n
te
deveopment
o
or
te
puposus.
ar ter y
D.
We
ment
Segmental
eter.
ar ter y
nuceus spinal
o
nvoved
brosus,
myotome
Anterior
s
o
crest
medullar y
te
scerotome
te
ce
s
annuus
nvoved
brosus,
nvovement
n
te
n
te
tere
s
deveop-
no
neura
deveopment
o
te
ar teries
nuceus
GAS Ver tebral
puposus.
79;
N
164,
168;
ABR/McM
103
ar ter y
69. Ascending
B.
Horner
syndrome
s
caracterzed
by,
among
oter
cer vical
tngs,
constrcted
pups,
sunken
eyes,
partay
ar ter y
droopng Deep
cer vical
skn Costocer vical
on
Subclavian
trunk
era
to
ar ter y
te
te
A.
ar teries
It
s
caused
from
C.
patways
Horner
by
and
dryness
probems
bodes
spna
cord
anteror
gray
bers.
Ces
te
orn
as
a
te
n
upper
posteror
s
o
ocated
te
eferent
n
suppy
are
n
suc
syndrome
sympatetc
ce
he
medullar y
(branch
segmental
(beparoptoss),
ace.
autonomc
orn.
aptc
Segmental
te
n
o
te
sympa-
trunk
tetc
Thyrocer vical
eyed
ar ter y
damage
resut
ead
te
gray
ce
te
at-
presyn-
gray
orn
o
regon.
bodes
orn
to
dsrupton
wose
atera
toracc
as
o
or
receve
somatc
te
sgnas
spinal
rom
sensory
bers
wose
ce
bodes
are
ocated
ar ter y)
n
D.
te
here
spna
are
no
ganga.
sympatetc
nerve
ce
bodes
ocated
nerve
ce
bodes
ocated
Segmental
spinal
n
ar ter y
E.
Posterior
te
here
intercostal
spna
are
n
te
N
172;
no
wte
ganga.
sympatetc
matter
ABR/McM
o
te
spna
cord.
100
ar ter y
70.
D.
Semspnas
coces
nerves.
ventra
Ar ter y
of
(branch
Adamkiewicz
A.
tat
A
capts
s
o
s
te
supped
te
oter
ony
by
musce
dorsa
musces
among
ram
are
o
te
cervca
supped
by
te
ram.
he
rombod
major
s
nnervated
by
te
dorsa
from
scapuar
nerve,
a
branc
o
te
ventra
ramus
o
segmental
C5. spinal
ar ter y)
B.
he
evator
brances
o
scapuae
C3
and
s
C4,
oten
as
we
nnervated
as
rom
by
brances
Segmental
o spinal
te
dorsa
scapuar
nerve.
ar ter y
C.
he
rombod
scapuar
mnor
nerve,
a
s
nnervated
branc
o
te
by
te
ventra
dorsa
ramus
o
C5.
E.
he
atssmus
codorsa
ventra
GAS Lateral
sacral
ram
95;
dors
nerve,
N
o
s
wc
C7
184;
and
nnervated
contans
by
te
bers
tora-
rom
te
C8.
ABR/McM
110
arter y
71.
C.
o
he
C3
A.
spenus
and
Rectus
are
capts
s
supped
by
te
dorsa
ram
C4.
capts
posteror
nnervated
by
major
brances
and
o
mnor
te
musces
suboccpta
nerve.
B.
he
s
•
GAS
Fig.
greater
occpta
nerve
suppes
te
semspna-
capts.
2.55A
D.
he
obquus
brances
pes
te
o
capts
te
rectus
musces
suboccpta
capts
are
nerve
posteror
nnervated
wc
major
aso
and
by
sup-
mnor.
CHAPTER
E.
he
obquus
brances
72.
D.
pes
te
GAS
95,
Wt
racture
C2
capts
te
rectus
100;
te
s
a
hs
In
and
crucorm
upper
te
odontod
A.
he
B.
here
C.
he
s
he
s
process
o
torn
s
te
te
a
C2
E.
he
te
mnor.
most
GAS
key
o
te
Answers
76.
E.
are
a
ractured
resuts
crused
n
by
s
“rb-ump”
A.
be
no
s
105;
process
not
atera
spnous
toracc
curvature,
ractured
n
N
convex
necessary
mass
process
26
(T able
vertebrae
nvoved
B.
so
nvovement.
2.1);
to
Wedge
necton,
or
Scooss
tebrae
C.
on
one
113
C.
prmary
racture
ere
eads
aso
D.
woud
not
ead
woud
not
ead
es
A.
75;
Somatc
are
N
and
te
he
C.
he
bers
GAS
he
dens
ment
A.
s
orn
not
ram
cur-
n
te
to
a
N
te
te
171;
are
C.
to
o
prevent
as
te
te
sympa-
because
te
been
98
he
n
gament
vertebra
ancors
posteror
torn
nous
processes
sacrum.
spnous
D.
he
tps
It
gaments
to
restrcts
processes
spnous
eac
te
attac
oter
degree
durng
supraspnous
o
E.
te
runs
on
s
te
C2
separaton
to
o
o
s
ocated
B.
vertebrae.
te
sp-
wt
bendng
curvature
coumn.
toracc
and
patent’s
term
coumn
hs
sacra
cnca
meanng
or
or
162;
typca
s
an
any
degen-
number
secondary
afectng
anteror
te
o
curva-
cervca
case
n
more
dsease,
spne.
te
toracc
coapse
s
racture
a
o
racture
a
o
wc
hs
s
vertebra
o
te
te
ds-
eventuay
bodes
vertebrae.
neura
coumn
arc.
typcay
bodes.
s
or
o
vertebra
an
vertebrae,
arc
vertebra
te
and
te
a
87
Pott
dscs
o
to
(spondyoyss).
o
o
dspacement
consequent
ABR/McM
vertebra
neura
Wedge
In
anteror
oten
dspacement
oowng
spondyoyss.
coumn
o
typcay
77;
racture
T ubercuoss
afects
te
o
o
o
vertebra
te
dorsa
From
by
te
nerves
te
named
te
nerves
he
te
orn
dorsa
by
o
orn
not
usuay
a
resut
o
yper-
porton
o
ver-
osteopoross.
N
and
te
spna
te
170
verte-
te
beow
regon,
cord
woud
sp-
ter
spna
cervca
not
be
oramen.
beow,
coumn
spna
te
te
vertebrae.
and
named
te
at
beow,
ntervertebra
regon
n
ext
coumn
cervca
vertebra
but
o
nerves
vertebrae.
named
te
ter
mass
111–112;
n
te
at
te
above
spna
regon
toracc
a
to
vertebra
but
mass
ext
te
anteror
named
ter
vertebrae,
ext
afected
GAS
ter
above
a
s
162
vertebrae,
ext
te
reated
toracc
ext
dscs
necton.
typcay
o
regon,
above
nerves
are
oten
N
cervca
coumn
he
tubercuoss
crusng
bodes,
From
ntervertebra
o
ractures
and
73,
te
na
sp-
te
ncreased
vertebra
tubercuoss
afected
D.
aong
a
N
te
nerves
not
lexon.
gament
processes
adjacent
rom
o
wen
prmary
ts
genera
te
destructon
named
njury.
and
te
Hernaton
na
dspace-
ts
bodes
te
Spondyostess
GAS
78.
C.
nterspnous
s
lexon
A.
atas
o
assocated
spna
key
spna
Spondyoyss
bra
ABR/McM
o
C7.
regons.
consequence
pregangonc
white
te
wt
nterartcuars
74;
tebra
carry
o
bodes.
autonomc
te
o
pars
to
te
and
E.
caed
o
not
s
te
ntervertebra
one
body.
ongtudna
o
B.
normaton.
dever
devaton
oten
ncreased
assocated
T ubercuoss
eves
receve
myen.
wc
A.
bod-
afected.
C.
o
umbar
hs
eads
typ-
ce
cord
tat
an
Spondyostess
te
presynaptc
ganga
gament
aspect
pan,
spna
nuce
eve
98
examnaton
posterory)
semnated
neurons.
and
ateray
anteror
anteror
at
sensory
more
dens,
D.
curvature.
te
extenson
te
toes.
s
s
s
s
GAS
ganga.
communcantes
112;
and
s
(concave
afects
mbs,
root
trunk
bers
contan
35,
and
on
te
atera
and
Hyperordoss
te
curvature.
spna
ocazed
somatosensory
nnervaton
anterory
he
te
ver-
87
convey
ound
o
sensory
transverse
o
secondary
spna
prmary
comprses
sympatetc
Wte
o
te
accentuated
norma
a
dorsa
orn
sympatetc
B.
te
wa
ncomng
atera
tetc
s
ABR/McM
comprsed
neurons,
D.
n
to
to
bers
body
dorsa
s
process
B.
162;
aferent
ound
he
te
a
ture
and
hs
rom
wen
posterory,
hs
cay
o
regon.
E.
GAS
curvature
rotaton
77.
occurs
D.
C.
atera
nvoves
as
posterory)
Spondyoss
and
to
anoter.
concave
umbar
75.
abnorma
Hyperordoss
vature,
74.
an
wc
above
ABR/McM
sde
seen
and
porton
s
vertebrae,
ongtudna
reasons.
te
trauma
as
Hyperkyposs
eraton
ABR/McM
contrbute
a
condton.
nvovement.
posterory.
osteopoross,
nvovement.
eter
touc
curvature
yperkyposs.
B.
to
(convex
not
30;
dened
to
regons
transverse
no
84,
s
coumn
orward
person.
typcay
N
s
gaments
76–100
na
beng
gament
68-69;
Scooss
“angman’s”
wc
nuca
supraspnous
109
(pedce)
as
juncton
kng
vertebra
may
here
rom
process,
no
C1
GAS
A.
pedces
and
by
sup-
cases.
tere
E.
te
known
gament
spnomeduary
odontod
descrbed,
aso
aso
ABR/McM
nterartcuars
s
nnervated
wc
major
3.2–3.3;
njury
angng,
te
are
nerve
posteror
T able
pars
racture.
te
capts
o
te
musces
suboccpta
N
type
o
vertebrae.
suc
73.
o
33
Back
1
te
beow
regon,
sp-
ter
spna
vertebrae.
cord
woud
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
aduts
s
generay
spna
and
oten
cord
at
perormed
ends
te
at
eve
te
o
at
te
82.
he
n
cord
typcay
aduts
but
ends
may
at
L2–L3
n
gn
te
extend
to
eve
L3
n
o
he
L2
D.
he
dura
spna
E.
he
L2
D.
sa
he
te
109;
are
bodes
N
ce
adjacent
hs
o
o
we
n
te
eve
te
eve
o
o
L1–
beow,
newborn.
sa
S2,
Eac
so
te
answer
te
te
at
te
L3
n
eve
te
supped
sensory,
motor
ce
dorsa
o
L1–
A.
bodes
are
we
not
te
dor-
tetc
S2–S4
outlow
atera
account
ganga.
o
ound
te
ganga.
n
sympatetc
or
are
te
orns
responsbe
or
B.
or
te
ce
te
ce
C.
te
ce
outlow
hs
o
n
te
or
n
E.
does
95–97;
he
anteror
brous
era
son.
B.
band
aspect
dscs;
t
It
he
N
can
tat
o
not
we
be
n
83.
outlow
C.
he
dsc
parasympa-
are
S2–S4
outlow
n
are
te
te
be
or
wc
te
are
ce
bodes
ound
n
A.
E.
he
torn
by
and
stabty
by
connects
bodes
and
cervca
cana
ver teb r a
s
te
and
a
te
o
te
by
te
vertebra
zygapopy-
processes.
neror
vertebra
adjacent
rom
te
wt
te
vertebrae.
amnae
o
o
n
bone
te
tat
mdne
extend
to
orm
arc.
process
process
artcuates
o
project
adjacent
rom
te
wt
te
vertebrae.
amnae
o
N
163–164;
te
C2
s
rom
te
te
ste
mdne
or
C3
a
C3
ner ves
vertebrae
C3
ABR/McM
postoned
and
spna
he
by
and
superory
te
and
projects
amnae
gament
attacment.
62–70;
most
C2
and
ner ve
102
nter vertebra
vertebrae.
ext
take
nter vertebra
In
superor
a
cer-
ter
somewat
or-
exts
oramen
dsc
te
to
tereore
posteroatera
between
and
ernaton
woud
at
ts
anteroat-
bod es
r uns
D.
w t n
E.
lavum
te
eps
mantan
amnae
o
two
uprgt
adjacent
E.
s
te
outer
brous
part
o
an
dsc.
connects
adjacent
processes.
N
sp-
ABR/McM
98
te
C1
cranum
69;
N
vertebra
and
and
woud
not
surace
o
te
dscs
sku
sacrum.
he
anterory
coumn
te
and
ts
second
verte-
ernated
dsc
te
ts
restrct
te
and
vertebra
ernated
dsc
and
aong
ts
nerory
99–100
movement.
courses
vertebra
bodes
way.
to
he
downward
It
te
stretces
anteror
gament
extenson.
on
anteror
te
attacng
ongtudna
postoned
ts
dsc
correspondng
o
ABR/McM
to
vertebra
ernated
afected.
anteror
mts
a
correspondng
o
eve
be
gament
ntervertebra
o
170;
te
by
afected.
to
te
not
serve
to
afected
eve
be
superor
tereore
superor
be
to
te
not
beow
ongtudna
most
167–168;
s
Lgaments
te
te
C3.
superor
beow
exts
base
gament
s
not
and
C5
ror
brosus
C2
tereore
w
84.
between
o
passes
woud
w
wc
pre ve nts
exsts
bone
nerve
exts
GAS
nterspnous
81–84;
C4
wc
p os te r or
an d
C2
and
between
yperexten-
te
nerve
afected.
bra
yperextenson.
game nt
C1
occpta
he
strong
ntervertebra
prevents
s up p or t ng
connectng
ntervertebra
GAS
vertebra
process
two
pat.
te
B.
gament
ongtud n a
te
annuus
nous
jon
artcuar
between
he
te
vertebrae.
he
te
artcuates
o
seets
to
processes
o
afected
be
vertebra
gamentum
posture
D.
and
project
lat
artcuar
regon
zonta
yperlexon.
he
s
vca
responsbe
eves
are
te
musce
GAS
174
ver tebra
o
account
bers,
covers
te
posteror
aspect
C.
o
correspondng
T1–L2
ongtudna
mantans
te
o
artcuar
process
process
pedces
spnous
and
ganga.
GAS
A.
te
neror
he
te
ound
sympatetc
parasympatetc
sympatetc
paravertebra
81.
by
bodes
(loor)
o
te
eve.
answer
te
margn
by
vertebrae.
pevs.
n
pedce
superor
processes
superor
bodes
ound
orns
responsbe
ound
te
margn
adjacent
artcuar
artcuar
roo
he
para-
bodes
ound
are
atera
or
te
contans
amnae
rom
pevs.
E.
he
n
sensory
he
n
te
are
wc
he
o
margn
vertebra
mar-
notc
vertebrae.
autonomc
are
ound
wc
bers,
o
te
oramen
superor
vertebra
anteror
neror
notc
te
neror
between
te
ntervertebra
te
posteror
superor
unon
responsbe
eves
te
neror
ganga.
does
are
account
bers,
dsc
jont
pedce
he
newborn.
by
and
part
root
bers
not
sympatetc
T1–L2
and
te
vertebra,
vertebra
(acet)
by
an
oowng:
notces.
to
s
a
vertebrae,
Artcuar
does
sympatetc
te
or
n
ganga.
te
he
motor,
sympatetc
paravertebra
C.
te
o
o
te
ormed
Artcuar
carry
answer
hs
te
ends
extend
musce
bodes
paravertebra
B.
at
at
L3
ger.
typcay
may
to
170
orn,
te
ends
end
spnae
ound
o
vertebra
o
but
ends
extend
usuay
cord
wc
he
typcay
may
must
erector
anteror
bers
A.
cord
aduts
ram,
bers.
but
sac
spna
n
GAS
80.
cord
aduts
s
pedce
superor
spna
n
(roo )
ncude
ntervertebra
te
newborn.
B.
boundares
(cockwse)
te
spna
L1–L2
he
o
newborns.
A.
D.
eve
rom
te
te
surace
gament
o
ante-
to
te
s
o
te
vertebra
CHAPTER
A.
he
posteror
posteror
to
te
ment
he
o
te
ntervertebra
serves
tebra
B.
ongtudna
surace
to
coumn
nuca
dscs
prevent
and
aong
way.
lexon
rom
mts
traves
bodes
te
excessve
extends
gament
gament
vertebra
C2
to
excessve
on
te
87.
B.
Hemvertebra
attacng
more
hs
causes
o
ga-
te
te
ver-
umn
sacrum.
lexon
o
A.
he
o
gamentum
adjacent
tem
D.
he
rom
tay,
termed
GAS
C.
A
81–82;
te
ac
o
te
L4
he
S2
rory
rom
A.
spnous
woud
be
spna
ends
D.
T wo
C.
te
cord
spnous
at
to
spna
ends
he
marked
eve
tereore
te
L1,
te
not
above
eve
tereore
drawn
wc
nerory
pa
be
drawn
170;
ssure
hs
ABR/McM
spna
and
artery
s
key
ormed
spnous
E.
he
a
te
vertebra
he
es
be
n
te
ascendng
te
compressed
superory
by
te
ses
to
and
suppy
ses
and
suppy
o
te
aong
te
te
atera
not
te
ory
unon
arse
spna
to
rom
spna
dorsa
aspect
o
te
E.
cord.
A.
cd
once
and
ave
GAS
ony
sma
102–103;
N
brances
176;
te
to
te
ABR/McM
posteror
drect
98
aspect
area.
B.
n
o
by
an
o
te
an
n
become
ractures
ncrease
n
umbar
or
ncrease
tckness
anteror
n
tck-
posteror,
dspacement
consequent
to
a
o
racture
a
o
(spondyoyss).
te
t
ABR/McM
cervca
Nerves
umbar
vertebra
87
vertebrae
C1–C7
vertebrae,
and
ext
wereas
egt
(8)
superor
nerve
C8
to
exts
vertebra.
ext
superor
to
ter
correspond-
ext
superor
to
ter
correspond-
toracc
to
ter
te
ter
s
born,
od
cd
are
54;
o
a
a
None
stes
and
te
are
n
te
s
curvatures
convex
orms
wc
Durng
n
anter-
response
cervca
sttng
spne;
and
com-
wak.
te
norma
o
be
be
ts
ABR/McM
to
musce
te
ac
oter
musces
wen
ts
woud
cd
te
o
curvature
wt
te
baby
begns
consdered
crest
abnorma
age.
consdered
abnorma
age.
87
s
te
spnous
ntertubercuar
o
or
to
woud
cd
162;
attaced
te
s
cd
deveops
ypertroped
s
rst
present
up.
ordoss
N
s
kyposs.
addtona
and
te
s
curvature,
born.
neck
n
regons
vertebrae.
curvature
wc
he
starts
kyposs
horacc
one
termed
ead
kyposs
n
regons
vertebrae.
subsequent
prmary
two
ordoss.
ordoss
Cervca
and
ony
te
curvatures,
ts
ts
subsequent
correspondng
and
once
we
and
correspondng
toracc
to
tng
Cervca
he
te
orms
te
loor
on
162;
(7)
coumn,
termed
brae T7–L5
sucus
an
deveopment
n
posteroatera
bones
resut
170
secondary
here are two posteror spna arteres; eac s ocated
te
s
anterory
horacc
wc
o
vertebra
GAS
90.
o
N
curvatures
ves-
roots
co-
rota-
bodes.
C7
cd
curvatures
spna
ventra
spna
D.
cord.
te
meduary
and
ves-
roots
N
neror
second
to
resut
wen
C1–C7
a
wc
spna
ventra
oow
segmenta
te
A.
B.
te
meduary
and
te
arteres
wtn
contrbute
te
111;
and
te
te
cord.
oow
dorsa
o
ound
oten
segmenta
aspect
aong
s
not
arteres
te
spna
provde
does
te
spna
atera
run
artery
and
provde
run
te
wc
cervca
suppy
segmenta
nerves
to
bood
wc
he
by
orm,
a
decrease
nerves.
nerves
C. Wen
petes
cana
segmenta
nerves
anteror
arteres.
vertebra
he
process
spna
ncude
sacrum.
neror
ext
GAS
89.
101
artery
woud
te
were
mater.
s
a
s
seven
nerves
ext
postnata
N
anteror
wt
pa
ne
woud
or
hs
vertebrae.
he
a
one
vertebrae.
ng
D.
te
aso
were
may
curvature
vertebra
C1–C7
Nerves
enoug.
wc
ocaton
te
B.
te
mater.
ow
te
L2,
ng
woud
te
to
Nerves
ne
were
It
correspondng
GAS
to
E.
crests
and
caracterzed
or
te
spna
concave
te
D.
ter
o
may
condton
nterartcuars
are
s
101;
ntersects
cervca
ne-
o
73–77;
here
A.
ocaton
approxmate
and
ac
to
C.
s
vertebra
to
GAS
88.
o
traumas.
spnes.
pars
uses
ne).
subarac-
part
competey.
bendng
wc
anteror
Sacrazaton
process
processes
te
E.
processes.
above
vertebra
te
a
Spondyostess
te
ponts
(T uier
te
o two anteror spna brances tat drecty
B.
on
D.
o te L4 vertebra. he dura sac ends at te S2 eve.
tumor.
A.
sagt-
were
deveop
atera
dense
anteror,
te
medan
te
ness
n
he
ne
cervca
correspondng
between
woud
convex
te
and
s
ess
mnor
te
98
gest
spnous
spnous
approxmate
and
te
te
eve
spnous
processes
correspond
cord
ne
vertebra
te
te
nterspace
hree
n
porton
represents
te
processes
spnous
be
at
S2
te
o
to
tranguar
ABR/McM
processes
to
woud
86.
at
to
correspond
T wo
L4–L5
drawn
hree
B.
E.
te
tps
C7
not
scooss,
Hyperordoss
te
broadens
and
bsects
wc
process.
correspond
te
rom
gament
connects
typcay
termnates
C.
gament.
tat
or
attaces
as
condton
deormtes.
even
prevent
a
abnorma
graduay
suraces
and
s
does
Osteopoross
lexon.
oter
dstnct
167–168;
ne
cstern,
spnous
woud
N
vertebra
space,
te
more
nterna
oter
durng
eac
nuca
crests
umbar
nod
te
te
orzonta
o
to
te
eac
apart
Superory
becomng
attac
to
gament
processes
sacrum.
85.
pung
supraspnous
spnous
s
lava
amnae
an
known
tona
te
cervca spne and serves as an attacment or musces.
C.
vertebrae
35
Back
1
and
atssmus
processes
ten
o
attaces
dors,
verte-
to
te
sucus.
optons
attacng
descrbes
to
te
attacments
upper
mb.
36
C H A P T E R
C.
1
Back
None
stes
D.
o
or
None
stes
E.
o
or
None
stes
te
te
or
te
optons
attacng
oter
musces
o
GAS
oter
musces
optons
attacng
oter
musces
86–92;
descrbes
to
attacng
180
attacments
upper
descrbes
to
optons
N
te
te
te
(T able
he
ror.
mb.
3.2);
ta
mb.
B.
deveop
and,
te
nto
he
ABR/McM
D.
he
w
dorsa
D.
he
neura
E.
he
sympatetc
A.
as
GAS
65
root
tube
a
B.
s
transverse
processes
he
bone
and
tat
neror
cartage
E.
he
o
te
remnant
are
te
te
te
te
noto-
95.
annuus
by
neura
deveop
perpera
te
neura
and
a
deep
crest
usuay
rotatores
crosses
wc
cord.
crest
our
to
on
segments.
te
and
peope
sacrum
vertebra.
and
hs
wen
s
owever
panu
sacrum
bot
ess
sep-
competey
caed
ts
hs
wt
transverse
or
or
vertebra
wc
sacrum.
more
party
L5
L4–L5
producng
s
te
o
s
process
te
strong;
S1
vertebra
popuaton.
o
wdt
te
L5
te
s
umbar-
sacrazed,
puts
pressure
eventuay
degen-
symptoms.
nvoved
n
sacrazaton.
nvoved
n
sacrazaton.
processes
C.
he
S2
vertebrae
s
not
nvoved
n
sacrazaton.
D.
he
S1
vertebrae
s
not
nvoved
n
sacrazaton.
one
not
or
deep
two
to
segments
beow.
semspnas
but
s
GAS
s
not
deep
to
semspnas
but
s
96.
s
not
97–98;
deep
to
N
182;
semspnas
seen;
were
te
In
te
atera
te
y
seen.
In
te
he
pars
vew,
GAS
84;
te
to
s
26;
but
s
may
te
te
see
76;
he
nserts
o
te
capts
porton
o
and
on
“Scotte
pars
vertebra
to
B.
nterartcu-
vertebra
are
so
t
C.
he
be
vertebra
s
a
E.
hese
trange.
musces
orm
te
runs
o
o
te
crucorm
transverse
gament
aspect
(C2).
rom
te
te
tp
oramen
band
superory
bodes
wc
o
orms
trange.
nserts
nuca
ne
on
and
te
te
ne
o
meda
te
occpta
border
o
te
odng
te
bra
cana
to
o
te
dens
magnum.
o
te
attac
cruc-
onto
te
and
o
te
atas
meda
aspects
dens
pace.
lavum
connects
n
s
spans
o
ocated
te
n
amnae
te
te
te
o
ds-
atera
verte-
adjacent
vertebrae.
97.
A.
he
68–70;
radcuar
arteres.
oow
process
te
gamentum
GAS
radograpc
gament
between
and
posteror
presses
te
es
tat
B.
he
es
and
30;
A
roots
every
suppy
w
spna
renorce
arse
n
at
to
aso
o
te
segmenta
vertebra
te
eve
anteror
eson
tat
compress
te
and
and
com-
arter-
tem.
te
torax,
te
occur
98
brances
space-occupyng
segmenta
and
are
bood
posteror
suppy
ABR/McM
arteres
provde
tat
te
N
hey
roots.
arteres
bone.
axs
runs
95
posterosuperor
ongtudna
transverse
cord
nuca
te
te
te
margn
he
spna
neror
major
he
masses,
eas-
nterartcuars.
suboccpta
neror
to
o
gament
gament
porton
te
body
anteror
rectus capts posteror mnor nserts on te meda
o
rom
attaces
superor
tance
supermposed
cannot
transverse
neror
apca
te
orm
bodes
113
te
and
93,
band
occput.
regon.
capts
te
he
ABR/McM
ongtudna
nerory
o
te
dog”
runs
atas
nterartcuars.
te
pars
posteror
te
te
pars
mout
cervca
sow
166;
te
seen.
vew,
te
a
to
N
neror
o
A.
dea
te
pedces
open
obquus
border
rectus
be
s
vew,
see
107
s
projecton
dog
ABR/McM
tat
te
neror
atera
upper
N
musce
vew
nterartcuars
dicut
o
he
to
anteroposteror
atas
te
posteroanteror
t
vew
he
ts
o
racture
dicut
on
make
In
neck
anteroposteror
t
te
te
ABR/McM
radograpc
nterartcuars.
be
D.
gament
obque
make
B.
o
te
wt
not
In
te
uses
not
ars,
te
engt
rom
109–110
were
5%
orgnates
s
pars
A.
te
s
GAS
94.
te
atas.
ABR/McM
process
at
on
vertebrae
he
E.
mnor
te
caracterstcs
are
rom
nserts
vertebrae
superca.
C.
te
arses
and
L1
s
between
te
above
oten
o
about
te
eves
eve
posteror
184;
a
n
T ypcay,
L5–S1
N
s
mnor
atas
meday.
tuberce
oter
L5
te
L4
Spnas
B.
wt
erates,
superca.
A.
nuca
he
Iocostas
can
occp-
neror
he
D.
D.
rom
te
superca.
93.
and
transverse
te
B.
vertebra
attac
te
onto
te
supe-
A.
Longssmus
typcay
sx
te
n
In
o
ncompetey
adapts
ncrease
arated
spnous
or
pace
processes.
attaces
to
superor
o
capts
sp-
o
musces
musce,
border
rom
nserts
posteror
ne
capts
99–100;
takes
used
superomeday
atera
obquus
nous processes or amnae o vertebrae and transverse
C.
E.
rectus
vertebra
ganga.
back
processes
and
te
capts
Sacrazaton
an
spna
rom
E.
hs
deveopment.
or
te
te
orgnates
tuberce
nuca
competey
scerotome.
ormed
precursor
ganga
o
wtn
rom
durng
s
a
s
atas
between
posteror
zaton.
Mutdus
rom
somtes
underdeveopment
encased
ganga
mgrate
do
s
deveops
he
ces,
ke
n
o
te
rectus
GAS
becomes
wc
tat
tssues
resut
puposus
C.
ces
dervatves
coumn.
It
bross,
te
connectve
nuceus
cord.
92.
are
emnated,
vertebra
A.
bone
orms
trange
musce
o
posteror
Scerotomes
tat
nes.
105–107
91.
hs
process
attacments
upper
musce
suboccpta
attacments
upper
descrbes
to
C.
mb.
rom
arteres
bood
te
neck,
te
atera
te
vertebra
te
umbar
sacra
are
and
posteror
arteres
arteres
eeder
suppy
n
n
te
to
te
deep
arter-
spna
cervca
ntercostas
te
n
abdomen,
pevs.
CHAPTER
C.
he segmenta meduary arteres are aso brances o
on
wt
ng
D.
he
E.
he
te
and
hs
vertebra
ters
soud
one
one
ary
n
te
n
and
o
superor
here
ton
hree
n
(to
o
centers
at
te
rms
are
no
cord
tp
o
te
ony
arc.
n
te
and
s
spnous
no
prmary
processes,
batera
secondary
n
bda
body
D.
cord
occuta,
V ertebra
GAS
A.
In
vertebra
bodes
osscaton,
wc
ts
s
not
reated
to
72;
te
bodes
o
possess
prmary,
not
N
164;
te
he
te
te
trd
dorsa
meday
B.
he
spna
vertebra
C.
secondary,
D.
E.
nerve
exts
n
B.
vertebrae
In
te
te
named
nerve
exts
In
te
te
te
named
exts
te
te
beow
te
te
named
exts
beow
A.
te
te
GAS
C3
regon,
he
C2
102.
A.
mater
correspond-
spna
and
C3
es
spna
above
te
hereore
vertebrae
nerve
spna
te
drecty
exts
te
C3
es
spna
above
hereore
vertebrae
nerve
te
n
te
C3
es
te
C3
spna
above
te
hereore
vertebrae
spna
D.
170;
ABR/McM
te
C3
es
87;
t
not
hs
e
te
ga-
cana.
gament
anteror
w
spna
n
spna
drecty
It
to
be
te
es
spna
punctured
103
nerve
pa
te
he
E.
end
he
he
D.
he
surace
A.
tat
te
to
te
atera
n
to
ts
Fg.
md-
patent.
te
ear
and
patent.
te
and
te
ts
trapezus
as
no
and
cutane-
2.52).
108
s
an
on
te
extenson
eter
dura
between
rootets
sde
mater.
te
servng
o
pa
o
te
Meday,
orgn
as
a
o
te
andmark
tem.
nternum
connects
spna
meduars
dura
s
te
s
te
an
extenson
conus
o
meduars
sac.
termna
end
o
te
cord.
ongtudna
vertebra
o
o
es
posteror
lavum
connects
te
amna
o
vertebrae.
106–107;
aar
gament
bodes.
gamentum
rotaton
(GAS
es
pro-
suppes
bend
n
suppes
t
between
posteror
te
e
ABR/McM
gament
o
es
musces
gament
occpta
regon.
and
afected
nerves
neck
ts
o
musce
trange.
ongtudnay
mater
adjacent
103.
te
184;
be
o
branc
trapezus
wtn
afected
termnae
conus
to
nerve
posteror
um
es
meda
te
externa
skn
ner ve
key
be
te
te
te
connectng
and
s
perces
suboccpta
to
n
N
N
gament
te
te
174;
ABR/McM
connects
occpta
te
condyes.
atantoaxa
100
dens
It
to
te
mts
meda
excessve
jonts.
Fexon o te upper cervca spne occurs at te atan-
tooccpta
89
not
connects
vertebra
es
nerve
occpta
key
cord,
he
to
drecty
exts
adjacent
does
bodes.
ABR/McM
occpta
ess
dentcuate
to
C.
n
correspond-
and
vertebrae.
N
nerve
passes
cana.
between
gament
te
t
beow
dentcuate
GAS
te
s
runnng
te
correspond-
and
and
vertebra
es
ongtudna
and
C3.
neck
dferentate
B.
drecty
exts
te
vertebra
cana,
168;
o
te
suppy
spna
te
N
accessory
anteror
correspond-
and
o
esser
ess
he
n
te
exts
to
te
oramen
vertebrae.
above
112;
vertebrae.
nerve
te
te
vertebrae.
ntervertebra
nerve
vertebrae
oramen
vertebrae.
cervca
ngy
C3
regon,
above
C2
above
above
ts
epdura/
anestetc.
gament
wtn
sternocedomastod
vertebrae.
cervca
named
te
te
ntervertebra
exts
C2
spna
hereore
oramen
vertebrae.
C2
nerve
In
regon,
above
ngy
C3
te
exts
te
te
cana.
te
suppes
greater
he
te
vertebrae.
cervca
nerve
te
E.
C2
te
nerve
beow
te
oramen
vertebrae.
above
ngy
In
drecty
regon,
ntervertebra
beow
D.
es
ntervertebra
ngy
beow
C.
and
cervca
spna
te
and
and
GAS
C3
n
he
ous
C3
hs
occpta
ne
vertebrae.
te
wtn
sac
suboccpta
ntervertebra oramen above te correspondngy named
hereore
connect-
procedure.
ramus
musces
93
spna
e
dura
81–83;
101–123
A.
are
ABR/McM
regon,
nto
connects
gament
posteror
spna
te
Answers
osscaton.
cervca
e
o
not
te
and
101.
prmary
exbts
o
arces
Puncturng
te
osscaton
possess
cd
enter
ongtudna
aspect
te
durng
deveopment.
centers
99.
te
o
to
njecton
vertebra
does
tuberance
Atoug
centers
te
wtn
te
ossca-
center
vertebra
vertebrae.
gament
processes.
Atoug
ater
n
te
not
anteror
ment
D.
centers.
C.
he
GAS
centers
or
does
anteror
neror
prmary
osscaton
ony
C.
and
centers.
here
wtn
body.
osscaton
two
o
second-
te
te
neede
nterspnous
spnous
cen-
processes,
te
space
o
adjacent
supraspnous
he
week:
body)
Fve
on
B.
resutng
vertebrae
spnous
vertebra
secondary
arc,
vertebra
aows
gament
egt
o
aong te tps o te vertebra spnous processes. hs
bda
uson
aspect
amna
he
98
spna
te
A.
drecty.
o
anteror
te
gament
verte-
osscaton
by
te
processes,
te
as
aure
vertebra
o
cord
te
extradura
te
condton
and
deveop
vertebra
drecty.
ABR/McM
above
etus
orm
te
rom
spna
prmary
te
te
transverse
vertebra
B.
a
one
gure
osscaton
centrum
te
te
arteres.
rom
arses
deveopmenta
present
osscaton
tps
a
spna
176–177;
te
arces.
be
eac
puberty:
A.
s
ncompete
te
N
n
spna
arses
artery
suppes
102–104;
occuta.
te
spna
and
patent
posteror
artery
suppes
artery
GAS
and
spna
posteror
he
rom
anteror
anteror
bra
E.
E. he gamentum lavum es wtn te vertebra cana
te segmenta spna arteres tat anastomose drecty
artery
98.
100.
37
Back
1
jonts
and
te
zygapopesa
jonts.
hese
are not mted by te aar gaments (GAS Fg. 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.
Extenson
te
o
te
upper
atantooccpta
cervca
jonts
and
spne
te
occurs
at
106.
zygapopysa
lexon
s
a
uncovertebra
lexon
s
not
combnaton
jonts
mted
(o
by
te
movement
Luscka).
aar
at
at
Latera
gament
Abducton
s
a
uncovertebra
by
te
GAS
104.
D.
by
te
uncton
rotaton
o
o
te
ormed
smus
C.
smus
te
many
B.
vates
ts
te
o
and
by
N
ateray
suc
w
not
be
he
ng
and
wen
wa,
serratus
arm
toracc
and
wa
o
degrees)
owed
by
s
Retracton
E.
Adducton
s
s
te
major,
n
D.
S1
E.
S2
A.
s
cauda
s
te
to
te
eve
arm
at
15
s
a
conus
meduars
wc
te
te
s
to
te
aduts.
aduts.
n
dura
D.
to
he
N
108.
s
A.
A
s
pro-
B.
by
te
aduts.
sac
normay
not
tse
rse
ods
to
are
to
ods
o
te
contrbute
but
te
structure
mesoderm
dsc
wc
to
te
and
con-
ormaton
membranes
not
germ
contan
o
te
ces
tat
ayers.
rom
ectoderm
and
gves
ces.
coeom
a
ormed
crest
te
does
tereore
are
neura
101
epbast
tramnar
ormed
crest
s
te
ayers.
do
ntraembryonc
orms
te
embryonc
space.
rom
ectoderm
and
gves
ces.
153
racture
pacement
supped
n
tereore
neura
Neura
per-
v
and
s
deveopment
germ
gve
cavtes
E.
te
and
ABR/McM
streak
embryo
Neura
rse
169–170;
resutng
tree
woud
arm.
degrees
or
embryo
are
ats-
N
prmtve
Coronc
o
nerves
and
101;
he
B.
ats-
o
o
te
te
pars
vertebra
nterartcuars
vertebrae
Spondyostess
te
106
to
nerve
ts
s
to
or
u
te
s
s
s
E.
a
s
responsbe
tereore
wen
or
odng
workng
protract-
t
aganst
togeter
wt
Lordoss
s
s
termed
wen
dspaced
te
te
wtout
anteror
ater
ds-
spondyoyss.
racture
porton
o
te
o
pars
A.
An
s
te
s
wen
te
te
nuceus
annuus
norma
puposus
brosus.
curvature
o
te
cervca
spne.
an
wc
abnorma
usuay
aso
atera
as
a
curvature
degree
o
o
te
rotaton
o
vertebrae.
GAS
109.
s
Scooss
dsc
troug
umbar
spne
er
caed
ernated
and
damaged
puses
wat
D.
ee-
above
A
protrudes
musce.
aow
ted
patent
n
dam-
anteror
musce
te
was
anteror
serratus
and
wen
C.
detod
o
te
te
by
rom
scapua
major,
s
o
te
15
s
mnor,
dors,
(te
supraspnatus,
to
90
many
and
accompsed
atssmus
umerus
te
by
teres
rst
83–84;
epdura
epdura
vertebra
woud
N
(Batson)
te
164;
ABR/McM
anestetc
space
cause
possby
(Upper
Limb
B.
o-
wc
pexus.
spna
cord
113
procedure
contans
compresson
trapezus.
major,
C.
N
417;
he
and
ocated
he
T12,
A
at
s
te
resutng
perormed
and
ematoma
on
medan
n
ocated
n
arteres
spna
te
te
artery
o
epdura
spna
ssures
and
ger
ssure
posteror
teroatera
meduary
te
n
n
regon
nerves
severe
n
nterna
ts
spna
artery
Adamkewcz)
muc
anteror
ror
ABR/McM
(o
segmenta
pectora-
te
anteror
artery
around
D.
Chapter);
great
spna
accompsed
te
he
uar
degrees.
subscapuars.
106
n
meduars
rse
te
scapuae
te
perormed
rombod
GAS
meduars
conus
per-
hese
major
te
serratus
abducton
te
D.
by
te
ends
and
pan
and
dects.
Intaton
15
conus
te
and
trapezus.
C.
te
trape-
and
arm.
wc
resutng
anteror
cord
poston
to
te
scapua
ver-
o
wc
to
te
toracc
pectora
o
toracc
arm,
suppy
te
nterartcuars.
ong
te
ts
dsc,
cauda
endoderm,
pro-
to
and
major
atera
ABR/McM
te
o
canges
ntervertebra
cauda
nerve.
te
te
s
respectvey.
troug
graduay
L1–L2
cord,
s
responsbe
neror
due
te
te
extends
It
spna
s
growt
eve.
GAS
107.
he
scapua.”
te
te
aso
aceved
te
o
pectoras
te
cord
L5
C.
adducton
rotates
nerve
ong
extends
and
te
468;
as
degrees
pectoras
arm
suppes
te
“wnged
te
supraspnatus,
surgery
aganst
by
nerve,
te
te
I
ands
te
meda
abducton
and
and
anteror
adducton
aso
wc
90–92;
abducton,
ead.
and
by
many
wc
Durng
aso
scapuae.
possbe
serratus
nant.
o
te
spna
dferenta
C.
supped
respectvey.
wc
rotaton
by
Durng
aged
A.
by
o
are
supped
suprascapuar
GAS
105.
are
dors,
duced
are
sometmes
eevaton
90
an
and
to
termnates.
mnor
above
scapua
nerves,
Abducton
mted
coumn
te
Due
L4
tans
arm
toracodorsa
ormed
E.
te
actons
dors,
Meda
not
2.20B).
evator
s
s
te
entrey.
B.
85
wc
o
scapuae
rotaton
supped
Fg.
and
nerve
porton
te
wc
Meda
(GAS
ABR/McM
It
at
scapua.
o
o
accessory
movement
Luscka).
major
evator
combned
zus,
(o
scapuar
Abducton
and
23;
ower
tracton
B.
N
rombod
dorsa
suppes
A.
jonts
gaments
68–69;
he
te
aar
combnaton
n
eve
adut
(GAS
Fg.2.20B).
E.
L3
te
deveopment,
cana
vertebra
Latera
te
Durng
tebra
jonts.
C.
A.
39
Back
1
te
s
te
or
great
argest
usuay
radc-
o
te
ocated
at
L2–L3.
ocated
spna
n
cord,
te
and
ante-
s
not
space.
te
epdura
s
tan
arteres
o
s
are
spna
space.
ocated
cord,
n
te
and
pos-
are
not
40
C H A P T E R
E.
he
1
Back
externa
vertebra
pexus
s
ocated
externa
to
C.
Narrowng
te vertebra coumn and a ematoma o ts pexus
w
not
GAS
110.
A.
produce
102–104;
Lgaments
ongtudna
ror
serve
o
ntervertebra
te
o
te
most
restrct
and
courses
ts
anteror
ts
patent.
he
downward
bodes
way.
to
ower
It
te
on
te
stretces
anteror
gament
rom
o
te
surace
gament
te
ower
te
s
GAS
113.
o
te
vertebra
extenson.
ng
to
surace
te
gament
o
te
vertebra
to
dscs
prevent
coumn
and
Lgamentum
o
adjacent
tem
D.
he
rom
bodes
aong
excessve
extends
processes
sacrum;
spnous
111.
he
A.
t
to
anteror
and
te
B.
way.
C2
restrcts
processes
eac
te
ntertransverse
hs
o
and
attac
to
dura
procedure
supraspnous
gamentum
gap
o
degree
sted.
termed
te
o
n
te
he
te
C.
s
skn,
gament,
lavum
gamentum
anteror
vertebra
he
te
beow
te
o
py
te
bodes
connect
posteror
adjacent
durng
nterspnous
s
tere
an
tssue,
ep-
musce,
gament,
s
oten
a
E.
cannot
be
s
reaced
by
to
ts
processes
spnous
L2
as
be
te
o
81–83;
spna
cauda
o
te
N
cord
he
end
cana
nerves
s
posteror
be
reaced
114.
te
eson
o
D.
to
to
but
beow
ts
te
te
beow
at
te
C2
sp-
to
separaton
o
are
te
descrbed
spna
s
cord.
atera
o
nerves
As
L5
a
Dorsa
B.
Sympatetc
and
C.
resutng
L1–
n
on
batera
te
L5
eve,
beow
te
te
L5
eve,
beow
te
root
N
not
cord
te
and
mutpe
s
usuay
arses
at
te
arteres
to
te
do
spna
addtona
course
rom
not
cord
sup-
mutpe
canne
cord,
t
s
or
not
te
ow-
te
crcuaton
ony
to
te
to
te
spna
aong
not
cord
te
s
entre
smpy
n
provded
engt
te
neck
o
and
176–177
s
typcay
wc
a
s
s
bengn
tumor
encapsuated.
mesoderm
wc
as
te
consdered
brocar tage
crest
Nuceus
he
o
ganga
deveop
paravertebra
It
apca
as
a
o
as
ga-
r udmen-
derved
rom
te
rom
neura
ganga
arse
crest
ces.
rom
neu-
ces.
puposus
te
bones
s
derved
rom
te
mesoderma
notocord.
o
te
unsegmented
crana
paraxa
vaut
deveop
mesoderm
rom
and
crana
neura
crest
ces.
nar-
mpact
do
spna
vesses
receve
coatera
rom
atas
A.
contnue
resut,
w
rom
spna
ter
coumn,
orgn,
te
E.
te
and
vesses
nter ver tebra
ces
between
te
regon.
suppy
spna
suppy
orgn
te
GAS
115.
A.
he
rom
B.
101–104
odontod
te
he
C.
he
body
arc
on
process,
o
o
te
posteror
nence
at
do
sacra
regons.
te
cord.
descrbed
spna
at
medan
arteres
tese
anastomotc
te
102–104;
o
anteror
s
te
tese
scerotome.
103
eve.
eve
too
o
posteror
provde
vertebra
same
ra
spna
ts
vertebra
resuppy
but
or
to
course
umbar
bood
aong
condroma
ment
tecnque.
eve
eve
ts
rom
o
ABR/McM
at
adjacent
o
segmenta
A
te
lexon.
by
101
te
to
Adamkewcz
eves
mportant
GAS
by
weakness.
eson
o
ends
dsc
oter
gaments
168;
equna
te
mb
he
not
attac
degree
durng
perorated
ntervertebra
end
B.
processes
eac
te
not
ower
A.
to
restrcts
ntertransverse
rowng
a
t
may
he
aso
gaments
he
GAS
D.
gament
ts
upper
and
cervca
porton
te
tar y
nterspnous
sacrum;
112.
an
by
mdne
anteror
or
segmentay
cest
gament
can
pan.
o
spna
suppy
argest
o
suicent
Anastomotc
and
procedure.
he
nous
E.
and
w
cord.
lavum).
ongtudna
bodes
L5
batera
We te great radcuar arter y (o Adamkewcz)
102
subcutaneous
and
w
sources.
D.
perced
ongtudna
back
arteres,
posteror
aong
artery
anteror
car tagnous
vertebra
ts
D.
he
sp-
to
separaton
ABR/McM
(atoug
o
n
ABR/McM
epgastrc
L5
batera
weakness.
resutng
eves
spna
o
n
eve
brances
bood
he
toracc
provde
approac.
C.
segmentay
ower
prevents
C2
and
suicent
sources
lexon.
structures
te
ony
a
superca
py
vesse
order
at
170;
at
posteror
te
unatera
not
N
eve
resutng
nerves
anastomotc
te
suraces
adjacent
rom
gaments
167–168;
te
121;
te
beow cervca eves and w receve addtona sup-
GAS
N
not
cana
arteres
te
est
81;
o
at
nerves
weakness,
anteror
provde
lexon.
oter
durng
nterna
oter
durng
gaments
to
ncude
he
attac-
lexon
rom
te
eac
apart
a
mb
transverse processes and prevent excessve rotaton.
he
B.
attaces
amnae
pung
nterspnous
nous
E.
lavum
te
108–111,
send
sacrum.
C.
o
on
coumn
cana
te
artery.
vertebra
nter vertebra
ser ves
o
weakness,
Segmenta
not
he posteror ongtudna gament traves on te
posteror
A.
te
a
mb
mpact
ante-
to
o
on
Narrowng
anteror
attacng
ongtudna
postoned
mts
ts
movement.
vertebra
aong
o
E.
nerory
he
anterory
coumn
B.
sku
sacrum.
to
te
dscs
symptoms
178
gament
surace
base
te
N
mpact
ts
te
and
dens,
and
projects
superory
artcuates
wt
te
atas.
tuberce
posteror
atantooccpta
lexon
or
axs
o
jont
extenson
te
atas
s
a
bony
em-
arc.
o
s
te
prmary
ead
on
nvoved
te
neck.
n
CHAPTER
D.
he
to
E.
neror
te
he
C3
anteror
nence
A,
on
te
x-ray
C2
s
body
te
In
ter
nerve
te
N
ts
s
a
bony
n
s
118.
em-
s
1.5,
pass
crosses
umbar
te
produce
B,
s
C.
to
vertebrae,
to
odontod
n
wc
te
t
w
L4
ext
case
o
nerves
symptoms
ernaton.
be
dsc
to
and
As
ext
compressed
L4
L2,
L3,
dferent
L4,
to
and
tose
S1
seen
produce
o
nerves
symptoms
119.
D.
L2,
L3,
dferent
L4,
to
and
tose
S1
seen
produce
o
nerves
symptoms
L2,
L3,
dferent
L4,
to
and
tose
S1
seen
woud
produce
o
nerves
symptoms
L2,
L3,
dferent
L4,
to
and
tose
S1
seen
D.
he
te
ar
C.
E.
ts
te
n
as
t
165;
type
o
artery
C1
Bot
wc
ABR/McM
passes
he
atas.
ts
N
vertebra
atas
o
on
tese
ts
es
s
and
a
may
typca
posteror
surace
superor
beneat
structures
hs
anteror
to
nerve
superor
be
t,
artcu-
aganst
njured
Jeferson
arces
o
he
o
sac
ay
B.
he
na
not
he
na
cord
he
s
C2
ess
te
n
a
n
n
te
racture
a
key
te
racture
spna
to
s
be
ypogossa
posteror
wtn
not
occpta
posteror
wtn
pared
cord
te
njured
pared
njured
E.
be
artery
woud
he
above
njured
C.
and
racture.
eray
spna
nerve
be
an
te
dura
te
and
and
69,
ts
usu-
e
on
te
woud
be
sac
and
e
on
te
woud
not
dects
o
te
wt
N
176–177
neu-
body
rom
meet
te
n
and
attac
te
ne-
to
te
sde,
te
te
and
bodes.
90
extenson
It
eabo-
attaces
process
An
o
aong
avuson
C7
s
oten
racture.
s
a
dura
ter
eac
vertebrae.
gaments
not
rom
on
gament.
gament
atera
extenson
o
sac.
connect
adjacent
sp-
tps.
lavum
and
connects
adjacent
29;
am-
ABR/McM
because
cauda
te
es
anteror
vertebra
bod-
nvoves
dsc,
o
by
or
spna
oss
108–109
nvoved
equna
a
wde-rangng
compresson
a
mass
tumor.
roots
radcuar
or
reduced
he
L2
pan,
suc
It
o
as
a
typcay
and
beow.
absent
urnary
treatment
knee
badder
nvoves
sterods.
erna
may
musces
nerve,
t
contro.
and
to
dscs.
syndrome
and
gament
posteror
unatera
tg
but
cause
due
t
to
woud
weakness
compresson
not
afect
n
te
o
te
structures
perneum.
Prorms
syndrome
mon
buar
neve
passes
We
not
nerve
n
compresson
nstances
te
pernea
pudenda
neve
structures
mb
s
troug
afect
prorms
te
part
com-
o
ts
musce.
It
structures.
pasy
afected,
nvovement
o
were
n
mgt
tere
ts
expan
woud
type
o
not
te
be
ner ve
njur y.
C1
C1,
and
C2
wc
and
es
on
E.
Scatca
te
s
pat
GAS
121
a
o
perneum.
102–104;
N
obturator
ower
atas.
tan
te
ateray
posteror
spnous
ntervertebra
pernea
be
a
Soveer’s
spncter
woud
sp-
s
ongtudna
sac
surgery
te
not
amna
ABR/McM
te
wtn
relex,
ana
n
C.
D.
arteres
es
obturator
sp-
not
o
vertebra
superory
project
cervca
compresson
meda
anteroat-
woud
te
do
vertebra
ntervertebra
emergent
sort
o
Cay
equna
anke
An
te
tp
a
81–81;
presents
te
atas.
atas.
GAS
n
runs
and
arteres
between
njured
wtn
as
dura
nerves
and
o
posteror
nvoves
racture.
sac
spna
es
nerve
atas
dura
o
damaged
condyes
spna
o
ocated
con-
njured
vertebrae.
ernated
It
te
163;
gamentum
te
and
and
supraspnous
te
Cauda
B.
anteror
dura
A.
to
N
processes,
o
GAS
120.
racture
are
tat
part
amnae
project
processes
pedce
nterspnous
he
and
C1
arc
te
posterory
pared
amnae
dentcuate
he
n
o
s
porton
projects
te
gament
a
and
he
te
te
posteror
spna
racture.
te
es
99
ractured.
A.
he
to
woud
ts
o
nous
woud
te
unctona
80;
acet.
tps
pa
ts
patent.
117.
nuca
to
A.
te
attac
o
woud
n
t
contact
processes
te
66–67;
o
es
Compresson
neura
bodes.
o
reerred
ts
n
te
and
posteror
not
process
transverse
racture
patent.
GAS
he
te
te
n
te
were
rom
not
nae
Compresson
E.
he
raton
patent.
C.
arc,
artcuar
GAS
beow
n
o
body,
does
spnous
he
do
te
by
s
and
vertebra
B.
Compresson
he
rory
beow
te
part
mdne.
D.
reconstructon
nerves
ntervertebra
vertebra
arc
te
racture.
amna
neura
racture
vertebrae
spna
s
vertebra
Cance
he
unon
between
superor
te
drecty.
at
19).
posterory.
he
open-mout
CT
p.
pedce
to
ra
patent.
B.
a
E.
regon
te
Compresson
he
n
ernaton.
A.
B.
ony
reatve
anged
racture.
as
centered
Fg.
posterory
and
a
patent
wc
Sagtta
dsc
umbar
woud
t
jons
BP34–BP35
correspondng
nerve
on
C,
ernated
te
axs
racture.
66–71;
he
te
A.
dspaced
subte
sows
atas
arrowheads
ndcate
(arrows).
L5.
were
te
tat
(arrow)
x-ray
D.
o
sweng,
(see
ndngs
extremey
GAS
s
arc.
sows
prevertebra
hese
L5
tuberce
odontod
te
acet
nects
anteror
odontod
he
116.
ts
Latera
md
s
artcuar
vertebra.
41
Back
1
term
te
used
scatc
oosey
ner ve
or
and
pan
not
aong
n
te
42
C H A P T E R
121.
B.
1
Lordoss
cave
to
craw
and
ts
produce
a
a
a
type
ten
o
tebra
ung
o
te
tat
dsease
use
because
o
te
and
and
togeter,
can
nto
cause
o
te
may
te
costover-
restrctve
cest
wa
to
s
a
prmary
convex
posteror
curvature
n
te
curvature
toracc
tat
and
s
sacra
regons.
C.
he
prmary
anterory.
cervca
and
curvature
ordoss,
ten
as
As
a
o
te
te
vertebra
nant
secondary
wakng
begns,
begns
coumn
to
curvature,
a
umbar
craw,
s
a
deveops,
ordoss
s
acqured.
Scooss
son
E.
o
here
GAS
122.
C.
he
cause
nto
A.
o
te
N
an
abnorma
162;
rst
o
pop
te
curvature
ABR/McM
lavum
two
bendng
and
tor-
ts
et
s
pops
n
te
87
he
and
wt
nner
n
a
puncturng
aracnod
bone
bones
as
a
eastc
neede
s
and
s
bone
sow
acdc
surace,
D.
te
Once
or
umbar
a
water
a re
ed
p u n c t u re ,
baoon,
wt
ary
gament
contnuous
supraspnous
gament.
s
wt
not
te
more
eastc
superca
hs
spaces
crana
nerve
and
s
Kyposs
tat
a
by
due
te
tps
not
woud
o
gy
smpy
t.
103
aure
o
osteocasts
to
a
and
norma
uncton.
mutaton
as
produces
o
and
creates
oramna
sceross
bone.”
a
are
n
te
curvature
dense
tat
susceptbty
nvoved
and
aso
to
patents
pases.
known
extrameduary
deects
and
bones
Laboratory
congenta
resut,
tck
cortca
compresson
atera
a
te
a
s
s
X-rays
as
bone-
studes
sow
ematopoess.
o
te
spne
condton
or
tat
may
trauma
to
n
te
posterory
toracc
convex
and
sacra
curva-
regons
spne.
a
secondary,
acqured
begns
te
prmary,
ound
adut
tat
he
s
s
Lordoss
wen
C.
c e re b r o s p n a
gy
are
t
s
beneat
ABR/McM
deectve
symmetrc
rom
nant
because
t
anteror
vertebra
spne.
ture
te
because
troug
overgrowt
“stone
Scooss
o
o
crana
ture
mater
produces
to
aong
and
gament
envronment
marrow
dfuse
n-bone
ntroduced
aracnod
due
es
processes,
caracterzed
osteocasts
because
exbt
B.
te
168;
es
te
dscs.
passng
resorpton.
ractures.
to
cd
prmary
n
craw,
begns
concave
te
and
to
curvature
posteror
cervca
n
regon
te
curva-
wen
umbar
an
regon
wak.
o
te
spne
s
convex
posterory.
E.
nterspnous
s
deectve
generate
te
A.
gy
N
s
resorpton
te
ud.
B.
neede
to
gene or carbonc anydrase II tat mpars ter abty
spne.
space.
m a t e r,
aganst
ke
atera
spnous
gament
posteror
gament
nterspnous
81–83;
resut
tertary
dura
second
and
he
spne.
subaracnod
yng
s
no
75;
Te
t
s
gamentum
te
GAS
A
te
Osteopetross
bone
and
ntervertebra
vertebra
pancytopena
te
s
and
sac,
supraspnous
enter
123.
ongtudna
dura
eastc.
te
concave
D.
te
to
Kyposs
he
n
expand.
A.
E.
Typca
pro-
posteror
te
bodes
even
resutng
he
to
stfness.
Furtermore,
nabty
D.
spondyts
spne.
spondyts
jonts
con-
begns
spondyts
regon
pan
spne.
ankyosng
person
Ankyosng
afects
bamboo
costosterna
dsease
cur vature,
te
umbar
ncude
eventuay
or
as
Ankyosng
n
kyposs.
te
te
and
secondar y
acqured
wak.
artrts
o
spne
gresson
s
cur vature
vertebrae
rgd
norma
tat
umbar
symptoms
he
s
posterory,
reverse
s
Back
he
spne
cervca
craw
GAS
and
74
acqures
and
umbar
ater
to
secondary
regons
wak.
as
curvatures
te
nant
n
te
begns
to
2 Thorax
Q u e st i o n s
Questions
1.
A
4.
1–25
31-year-od
norma
spontaneous
pications
te
boy
unt
woman
during
is
Wc
o
wt
dogram
sows
o
to
te
2
he
s
ater
pregnancy
prmary
te
was
An
great
nto
com-
on
2.
Septum
secundum
B.
Septum
prmum
C.
Bubar
D.
Aortcopumonary
E.
Endocarda
32-year-od
surgca
at
30
nata
weeks’
vst.
mts.
n
sze
py
T oday,
Pysca
wt
sows
nverted
a
a
3.
er
etus
wt
dapragm,
consstent
wt
Laryngea
B.
T racea
C.
Poyydramnos
B.
Umbca
arteres
C.
Umbca
ven
D.
Coarctaton
E.
Pumonary
Lung
sowed
norma
or
no
wtn
uterus
Feta
pre-
norma
sows
a
routne
wt
ungs,
no
te
and
murmur.
te
a
Prevous
moter
wt
no
he
cd
Wc
anomaes
Membranous
B.
T etraogy
o
C.
Muscuar
ventrcuar
D.
Ostum
secundum
E.
Ostum
prmum
od,
ventrcuar
septa
septa
deect
deect
deect
a
u-term
ater
oud,
brt
snge
gr.
sows
S2
sound
ecocardogram
sows
te
T ransposton
Pumonary
E.
ventrcuar
6-day-od
bue
te
we
o
ts
s
because
sows
a
ars
An
an
deect
x-ray
and
o
te
condton
o
va
vag-
brt.
At
emergency
skn
appeared
we
systoc
eedng.
murmur
ecocardogram
overrdng
ypertropy
cest
s
ts
te
er
border.
sows
most
key
cnca
aorta,
o
a
te
boot-
respon-
pcture?
Faot
o
te
great
vesses
atresa
s
he
artery
septa
Wc
Superor
to
stenoss,
septa
most
brougt
gr
durng
dscooraton
deect
brougt
moter
deect
o
te
te
o
says
An
stenoss,
key
o
to
because
breasteedng.
custer
newborn
artery
moter
bue.
pumonary
ansms
perormed?
deect
gr
er
ventrce.
most
o
septa
a
sterna
Wc
D.
by
s
deveopment
C.
turnng
devers
compcatons
moter
An
T etraogy
ment
s
aorta
gr
septa
eart.
or
maormaton
bus
upper
ventrce.
as
o
er
Atra
deect
Faot
et
ventrcuar
no
by
sgt
B.
A
no
te
A.
A.
A.
a
An
to
days
stenoss
woman
wt
ventrcuar
sbe
te
examnaton
exam-
occurs
commony?
ad
com-
a
o
artery
pumonary
saped
s
to
te
rgt
oter
brougt
Pysca
condtons.
cardac
s
dever y
pregnancy.
medca
congenta
cd
ave
sows
an
condtons
examnaton.
vagna
cardac
assocated
oowng
a
devery
monts
at
indngs?
abnormates
durng
29-year-od
Pysca
consstent
ecogenc
asctes
a
utrasonogra-
oowng
Amercan
spontaneous
pcatons
A
to
6.
Arcan
pyscan
oter
eta
te
or
0,
ypopasa
2-year-od
naton
o
oce
are
a
aborta
atresa
Ogoydramnos
a
sgns
sows
enarged,
tese
E.
vsts
te
and
eart.
te
te
atresa
D.
te
to
gestaton.
and
Wc
A.
A
vta
examnaton
30-week
abnormates.
most
comes
2
arterosus
department
0,
o
great
or
cusons
gestaton,
correcton
Ductus
6
para
te
A.
septum
1,
tacypnea,
o
brt
gr
structures must reman patent or te gr to survve unt
na
gravda
te
com-
5.
woman,
cyanoss,
auscutaton
gves
o
transposton o te great arteres. Wc o te oowng
septum
A
woman
examnaton
care
ar teres?
A.
27-year-od
centra
ar teres.
te
A
Pysca
ecocar-
responsbe
ar terosus
via
deiver y
intensive
metus.
o
boy
witout
neonata
dabetes
tr uncus
u-term
ours
transposton
te
a
deiver y
T wo
cyanoss.
type
str ucture
dvson
vagina
bir t.
admitted
because
pcated
deivers
and
emergency
a
sudden
te
gr’s
depart-
epsode
ps
ecocardogram
overrdng
o
ypertropy
oowng
responsbe
te
o
or
te
sows
aorta,
te
embryoogc
o
turned
rgt
mec-
deveopment
anomaes?
maagnment
o
te
subpumonary
nundbuum
B.
Deect
C.
Endocarda
n
te
aortcopumonary
D.
T ota
E.
Atroventrcuar
cuson
anomaous
septum
deect
pumonary
(AV)
cana
venous
connectons
maormaton
43
44
C H A P T E R
7.
A
2
Thorax
5 -year-od
depar tment
ness
he
o
naton
ixed
key
says
sows
a
o
an
Atra
septa
T etraogy
E.
o
Aortc
u
or
ear t.
e xam-
a
term
proie,
w de ,
contrast
occur
n
T etraogy
B.
T ransposton
C.
Atra
D.
T runcus
E.
Coarctaton
pumonary
s
te
mo st
aorta.
septa
oter
examnaton
o
te
and
great
o
te
boy
or
s
a
sows
a
sows
te
snge
a
s
septa
severe
boy
s
papebra
most
congenta
Wc
most
key
wt
o
be
Pysca
and
an
cardac
a
te
eon-
ow-set
10.
A.
T etraogy
B.
T ransposton
Atra
D.
Coarctaton
septa
E.
Aortc
28-year-od
at
32
weeks’
department
vta
es
sgns
sow
irmng
o
te
key
Faot
o
and
o
and
te
at
oowng
assocated
truncus
great
te
ma-
wt
because
o
wtn
arterosus
septa
deects
14.
gravda
wt
T etraogy
B.
T ransposton
C.
Atra
D.
T runcus
E.
Coarctaton
septa
2,
brougt
dzzness
serum
o
eta
A.
s
norma
dagnoss
oowng
o
and
sows
key
nto
te
n
te
arc
expanaton
A
te
et
o
or
te
ts
or
mts.
gucose
1,
te
aborta
severa
days.
Laboratory
dabetes.
maormatons
moter’s
condton?
Faot
o
and
te
great
ductus
arterosus
venosus
E.
ventrcuar
A
3-year-od
o
te
aorta
Her
stud-
con-
Wc
s
most
septa
or
septa
boy
a
s
deect
brougt
routne
sows
spt
a
S2
eart
septa
systoc
An
and
deect.
ncompete
to
te
pyscan
examnaton.
oud
sound.
rgt
atra
A.
Foramen
B.
Lgamentum
C.
Ductus
murmur
x-ray
te
o
te
patent
hs
cosure
Cardac
s
wc
o
a
usuay
te
wde,
an
wt
resuts
oowng
Snus
E.
Coronary
venarum
A
2-our
s
brougt
a
snus
premature
to
te
boy,
o
dstress
type
s
n
va
boy
he
boy
or
24
s
weeks
he
cesarean
sows
syndrome.
responsbe
at
department
breatng.
moter
te
gruntng.
tory
born
emergency
dcuty
17-year-od
and
arterosum
arterosus
boy
dagnosed
Wc
o
was
devery.
tacypnea,
te
synteszng
gestaton,
because
o
born
Pysca
nasa
wt
ar-
respra-
oowng
suractant
n
A.
Aveoar
B.
Bronca
mucous
C.
Bronca
respratory
D.
T ype
I
E.
T ype
II
An
ce
ts
admtted
dever y
o
gastrc
te
nto
rgt
o
cest
sows
te
te
torax
oowng
te
sows
n
s
te
et
ntensve
o
a
et
ypopastc
nspraton,
most
et
1
ung
Pysca
ascend-
we
normay.
key
unt
dstress.
emtorax.
contracts
te
care
resprator y
emdapragm
durng
emdapragm
te
to
because
contents
examnaton
ng
epteum
aveoar
s
ater
x-ray
and
endotea
aveoar
nant
An
capary
cause
te
Wc
o
ts
o
te
condton?
A.
Absence
B.
Absence
o
a
peuropercarda
o
muscuature
n
od
one
a
dapragm
deects
s
sows
dagnosed
condton
o
and
cest
by
exam-
ovae
D.
arteres
ventrcuar
arterosus
0,
emergency
concentratons
gestatona
cardac
te
para
to
deect
syndrome?
ts
aorta
woman,
assocated
most
examna-
murmur.
mmedatey
reeased
ductus
our
eevated
te
vsbe
Patent
ng,
arteres
ventrcuar
te
gestaton,
are
Cardac
Pysca
abdom-
stenoss
examnaton
eco-
atresa
A
be
arng,
perormed
Patent
to
ears.
maor-
deeton
septa
progressve
condton?
C.
s
wen
te
nasa
department
breat.
structures?
pyscan
issures,
and
ypocacema
dagnosed
cromosome.
te
examnaton.
mcrognata,
sows
o
to
o
macnery-ke
D.
rom
13.
routne
cardogram
w
emergency
breatng.
C.
an
o
deects
to
Mtra
enarged
murmur.
indng
Atra
B.
ixed,
pa-
dagnoss
A.
naton
a
arteres
brougt
narrow
eatures,
he
s
to
sortness
tacypnea,
durng
artery
Wat
moter
Pysca
aorta
sow
ormatons
and
12.
born
macrogossa,
cardac
ventrcuar
studes
22q11
s
condton?
Laborator y
matons.
by
was
devery.
brdge,
conirms
Wat
cd
ods,
examnaton
ts
pyscan
he
vagna
epcantc
nasa
te
arterosus
moter
aca
to
Faot
3-mont-od
gated
brougt
anayss
o
o
contnuous
medum
c e s t
arteres
examnaton.
Cardac
A.
s
great
spontaneous
syndrome.
to
s
depressed
crease.
brougt
cateterzaton
te
Wat
s
because
sows
a
o
deect
te
sows
Cromosoma
Down
o
boy
va
sows
cardac
Faot
routne
examnaton
by
and
x-ray
boy
moter
retractons
ton
stenoss
3-mont-od
A
mur mur
An
s
na
os p ta-
Pys ca
2-year-od
examnaton
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-
deect
T ransposton
moter
9.
s
as
e m er gency
se vere
indng?
D.
key
s occe r
c d
He
sound.
r gt
septa
C.
mar
te
m ajor
2
te
o
dagnoss?
B.
at
S
enarged
ventrcuar
at
o
oud
te
A.
A
tat
to
b ec ause
p ay ing
actv t e s .
stor y
spt
sows
8.
or
b rougt
m ote r
wen
pysca
zatons
is
is
breat
moter
durng
boy
by
C.
Faure
o
mgraton
D.
Faure
o
te
E.
Absence
o
a
o
septum
dapragm
transversum
peuropertonea
od
to
deveop
CHAPTER
15.
A
35-year-od
department
ening
tion
eadace
sows
a
extremities,
murmur
Wic
o
ikey
A.
Bubus
B.
Ductus
E.
Rgt
cardna
ourt,
5-day-od
s
emergency
weekend.
Pysica
upper
puses,
anterior
body,
and
cest
tese
a
a
a
wors-
septa
ower
oud
and
and
et
boy
sxt
orns
o
vena
s
to
because
o
Ostum
secundum
prmum
C.
AV
Common
E.
Snus
A
depart-
droong
4
and
te
at
(7
and
5
cardac
te
cest
rax
wt
sows
ar
a
swaowng
nasogastrc
bubbes
structures
n
te
aed
tube
mk.
cong
stomac.
to
An
deveop
n
x-ray
te
Wc
n
ts
o
to-
o
te
patent?
embryoogc
Fauty
B.
T racea
era
C.
T ongue
D.
T raceoesopagea
E.
Parynx
s
born
te
durng
o
te
torax
oowng
ts
s
brougt
eedng.
cest
he
a
bubbes
istua
(TEF)
condtons
o
te
s
emergency
excessve
moter
wen
sows
ar
to
because
cyanotc
wt
esopagea
wt
boy
moter
became
x-ray
n
s
says
swaowng
nasogastrc
te
stomac.
key
te
new-
A
be
21.
An
cong
o
D.
Interrupton
E.
Fauty
A
2-day-od
n
unt
was
te
born
Pysca
assocated
and
and
gr
er
brougt
parents
dscooraton
o
o
1
er
te
gr
breatng,
was
o
ts
a
te
ater
and
tey
at
u
Pysca
was
term
depart-
a
bus
and
severe
uncomp-
va
oowng
s
key
o
and
examna-
Despte
ater
te
rom
oow-
responsbe
sternum
and
uson
or
percar-
o
te
paryngea
magnetc
wt
at-
arc
magng
s
at
he
te
u
arng,
An
boy
term.
gruntng,
ecocardogram
(MRI)
connectons.
events
and
devery
nasa
ntensve
tacypnea.
sow
Wc
responsbe
macne-ke
septaton
deveopment
o
te
septum
C.
Abnorma
deveopment
o
te
et
D.
Abnorma
deveopment
o
te
coronary
E.
Abnorma
deveopment
o
common
A
3-day-od
breatng.
dur-
ng
eart
w
Abnorma
Abnorma
and
most
by
er
abdomen
sows
totay
o
te
or
ts
o
Varcea
C.
Septum
E.
T reponema
brougt
requent
breat.
to
te
pyscan
epsodes
Cardac
o
by
s
atgabty
examnaton
sows
23.
Cervca
E.
Dorsa
o
orn
snus
cardna
to
te
because
o
dcuty
upon
scan
te
sows
o
centra
oowng
ven
emergency
wt
nasa
ar-
nspraton.
er
cest
tendon
structures
o
A
and
te
aed
ods
ods
transversum
myotomes
mesentery
30-year-od
easy
secundum
snus
normay?
D.
A
o
te
venosus
brougt
(CT)
absence
Wc
D.
s
s
snus
retractons
Peuropercarda
padum
te
examnaton
B.
vrus
gr
tomograpy
dapragm.
deveop
o
moter
Pysca
abdomna
computed
anomay?
newborn
Cytomegaovrus
o
neonata
and
B.
C.
sortness
deveopment
A.
to
o
te
vagna
sows
embryoogc
Peuropertonea
because
to
arc
venosus
breatng.
resonance
A.
boy
snus
uncompcated,
pumonary
T oxopasmoss
5-year-od
paryngea
cyanoss
examnaton
Rubea
and
te
brougt
B.
moter
days
Wc
most
o
spontaneous
retractons
department
sows
retractons
nectons
22.
sponta-
examnaton
abdomna
congenta
noted
abdomen
contnuous
te
emergency
pregnancy
born
arng,
and
Wc
to
he
devery.
nasa
to
our
cest
breat.
vagna
it
A.
A
3
was
5
maormaton?
exposure
s
boy
va
T oxopasmoss
2-day-od
o
was
E.
ead
des
ourt
course
pregnancy
hadomde
key
Pysca
ncompete
o
o
Poyydramnos
murmur.
were
condtons?
o
to
because
D.
ng
s
suc
brougt
abnormates.
newborn
deveopment
C.
tacypnea,
o
scores
s
wegt
Interrupton
oowng
and
Apgar
respectvey.
events
cords
brt
Interrupton o trd paryngea arc deveopment
Rubea
neous
sep-
C.
B.
cated,
superor
atra
B.
care
traceo-
Wc
to
and
mk.
tube
suspected.
most
depart-
droong
condton?
sortness
2
ods
anomaous
by
and
deveopment
Ogoydramnos
ment
te
o
S
atra
descrpton?
Hs
ypoxema.
secondary
A.
A
ts
spt
an
deveopment
5-day-od
by
o
types
ectopa
cardac
te
and
deveopment
dum,
A
care,
te
Esopagus
wt
11oz),
ng
A.
or
department.
mnutes,
aure
A.
septum
newborn
mutpe
became
wen
openng
oowng
ixed,
sows
atrum
b,
sows
approprate
cyanotc
te
caracterstc
emergency
kg
1
wde,
venosus
1-our-od
ton
a
cana
D.
to
emergency
at
Ostum
20.
are
and
examnaton
te
B.
arces
deects
o
A.
is
symptoms?
excessve
ocated
Wc
back.
venosus
te
murmur
utrasound
deect
cava.
3500
brougt
An
ta
ven
moter
systoc
mid-
structure(s)
paryngea
snus
oud
sound.
examina-
cod
wa
embryoogic
produce
and
cokng durng eedng. he moter says te newborn
cokng
19.
to
te
arteriosus
and
ment
18.
is
to
nosebeed
cordis
hrd,
oowng
17.
aected
Rgt
by
te
emora
on
D.
ment
severe
oowing
C.
A
brougt
a
deveoped
absent
te
is
o
over
more
systoic
most
16.
man
because
45
Thorax
2
man
atgabty.
o
te
comes
esopagus
to
Pysca
te
pyscan
examnaton
because
sows
te
46
C H A P T E R
2
bracia
arteria
emora
puses
artery
are
arteria
Thorax
deayed.
low
Wic
pressure
pressure
o
in
He
te
te
is
is
is
markedy
decreased,
diagnosed
proxima
oowing
part
increased,
and
wit
o
te
structures
te
a
te
bockage
toracic
aied
examnaton
emora
to
x-ray
o
toracc
24.
Second
B.
hrd
C.
Fourt
D.
Ft
E.
Ductus
A
aortic
aortc
aortc
aortc
n
sterna
because
te
oogc
25.
Let
B.
Rgt
C.
Let
D.
Rgt
E.
Let
sxt
are
An
pyscan
o
breat.
n
te
does
te
and
ductus
pat-
embry-
s
gr
s
39.4°C
29.
arc
arc
brougt
ater
because
to
o
(102.9°F).
norma
mts.
murmur
cest
arc
arc
aortc
a
he
Cardac
eard
sows
Ecocardograpy
te
on
g
a
Laryngotracea
E.
Foregut
and
depart-
An
pumonary
vaves
to
bunde
coronary
C.
T rcuspd
D.
Let
E.
Aortc
5-day-od
o
dcuty
and
vertebra
cardac
brougt
rada
abnormates.
dvson
o
te
portons
o
s
te
made.
maormatons
septa
B.
T etraogy
o
Pyorc
D.
Congenta
dapragmatc
Faot
E.
Esopagea
istua
Coarctaton
Patent
ductus
o
E.
Aortc
atresa
te
expans
tese
indngs?
aorta
30.
arterosus
A
A
ton
26–50
3-day-od
ta
ntensve
cyanoss
bue.
dd
boy
care
because
were
he
not
u-term
boy
oowng
type
o
was
mprove
examnaton
te
unt
te
boy’s
gven
s
sows
s
brougt
ace
o
an
and
epsode
suppementa
w
o
most
severe
Interatra
septa
B.
Interventrcuar
njury
C.
Patent
D.
Corrected
E.
Common
ductus
because
o
key
produce
ts
D.
Prenc
E.
horacc
A
great
arteres
and
sows
cest
cyanoss.
ntensve
Pysca
ror
sows
te
spne
ecocardogram
dagnoss
nto
o
ncom-
respratory
o
te
tract
s
and
oowng
assocated
erna
unconscous
s
vece
Hg,
88%.
s
most
to
te
emer-
coson.
puse
Hs
s
105/mn,
Pysca
examna-
on
te
cest
perormed.
commony
wa.
Wc
at
g
o
An
te
rsk
o
ven
carotd
artery
duct
woman
wtn
cear
to
an
o
procedure?
because
te
by
a
s
mts.
to
to
Pysca
te
nerve
resut
te
n
emergency
breatng.
bateray.
nvadng
Wc
tumor
brougt
dcuty
sounds
tumor
um.
te
o
norma
breat
sows
pressed
x-ray
nerve
45-year-od
are
because
nerve
department
arterosus
dyspnea
ts
Vagus
A 2-day-od boy s brougt nto te neonata
unt
structures
durng
C.
sgns
te
traceostomy
bracocepac
31.
o
s
common
o
A
aceratons
Let
Wc
and
mm
saturaton
mutpe
Let
sunt.
An
motor
62/30
B.
deect
transposton
a
A.
arterosus
truncus
s
brougt
ater
wc
deect
septa
oxygen
sows
oowng
turned
oxygen,
pressure
emergency
sunt?
A.
care
neona-
s
Ecocardograpc
rgt-to-et
condtons
te
extremtes
symptoms.
a
nto
boy
department
bood
artery
stenoss
2-year-od
gency
pyscan
gastrontestna
C.
D.
key
wen
deect?
examnaton
Wc
deect
C.
most
struc-
surgeon
syndrome?
ta
Atra
a
subpumo-
descendng)
te
oregut
atresa
A.
to
abnormates
acaasa
and
sows
sows
oowng
te
Pysca
apasa.
Esopagea
aureus
and
27.
s
eedng.
Esopagea
Questions
26.
boy
B.
Stapyococcus
te
te
o
(anteror
A.
sows
te
by
ste
o
er
eed-
artery
antb-
cuture
examnaton
area
o
by
durng
vave
otc terapy s ntated. Wc o te oowng congen-
Bood
te
pyscan
branc
wt
atresa
ts
te
careuy
at
te
vave
A
wt
at
nterventrcuar
condtons
norma.
paced
Rgt
dgestve
arteres.
be
are
to
ecocardogram
Wc
avoded
Rgt
pete
x-ray
be
B.
sows
a
et
propery?
breatng
Pysca
An
deect
A.
sgns
sows
septa
nundbuum.
vta
te
embryoogca
deveop
brougt
atgue.
must
remanng
examnaton
nto
An
and
septum
murmur.
tures
sows
to
dcuty
nary
tem-
ntestnes
oowng
ung
membrane
s
o
excessve
oosystoc
ana
te
retractons.
groove
gr
because
sutures
o
and
ypopastc
transversum
3-mont-od
Her
auscutaton.
te
D.
ever.
promnent
sows
emergency
T raceoesopagea
A
et
aed
Peuropertonea
te
arterosus
key
C.
ventrcuar
arc
aortc
most
arng
a
abdomna
Wc
B.
a
rgt
a
te
Septum
ng
mur-
o
nasa
sows
A.
moter
upper
sows
oowng
te
s
Pysca
et
arrytmas
angogram
o
by
macne-ke
space
sows
Wc
aortc
aortc
er
ars
te
ECG
aortc
ourt
wtn
o
sortness
structures
ourt
by
oud,
te
contnuous
ntercosta
An
sxt
it
perature
a
arterosus.
4-year-od
ment
severe
to
rom?
A.
A
brougt
ypertropy.
artera
orgnate
o
sows
border.
ductus
28.
s
second
ventrcuar
ent
arc
boy
examnaton
mur
arc
venosus
1-year-od
moter
aorta
arc
cest
cavty.
structures
deveop
sows
te
ernaton
aorta.
normay?
A.
o
s
An
ung
Her
vta
examnaton
x-ray
o
surace
most
key
dyspnea?
te
ante-
com-
CHAPTER
32.
A.
Prenic
B.
Vagus
department
C.
Intercosta
ke
D.
Recurrent
E.
Cardiopumonary
A
36.
aryngea
62-year-od
man
3-mont
istory
signs
witin
are
s
to
te
progressive
norma
pysician
voice
imits.
because
sotening.
Pysica
o
A
CT
te
aortic
artery.
Wic
compressed
33.
to
cause
prenic
Esopagea
C.
Let
recurrent
D.
Let
vagus
E.
Let
sympatetic
Vita
2-mont
se
ago,
se
just
beyond
most
90
patient’s
structure
is
canges
a
growt
te
in
et
most
te
tra
Least
D.
horacc
E.
T5–T9
o
er
a
sows
tons
to
being
ead
te
unabe
due
to
mastectomy
weakness
in
er
damaged
o
rigt
during
pysician
to
reac
pain. T wo
procedure.
souder
arm.
to
a
Hg.
pan-
s
nerve
in
Greater
Prenc
C.
Vagus
condition?
s
D.
Intercosta
B.
Spina
E.
Lesser
C.
Long
D.
Radia
gency
E.
horacodorsa
2-mont
A
41-year-od
department
zed
pan
sows
ung
ieds.
An
bodes
te
centra
Dorsa
root
B.
Sympatetc
C.
Dorsa
D.
Latera
E.
V entra
brougt
s
or
cest
ocaton
te
nerve
nervous
n
te
te
ibers
to
ower
rgt
peu-
neurona
tat
cest
carry
d ow.
orn
o
orn
o
orn
te
te
o
te
spna
norma
ung
Vagus
Prenc
ts
C.
Let
D.
Rgt
E.
Greater
39.
A
o
cord
10-day
Hg,
and
ton
sows
o
te
nvoved
115/mn,
respratons
brusng
pregangonc
ncreasng
te
eart
cardac
are
o
cord
a
ng
motor
vece
pressure
25/mn.
te
cest.
neurona
coson.
120/78
Pysca
Wat
ce
s
s
bodes
mm
te
examna-
te
te
ocaton
nvoved
A.
n
rate?
A.
Deep
B.
Dorsa
C.
Latera
orn
T5–T9
D.
Latera
orn
T1–T4
E.
Ineror
motor
n
bood
pexus
nuceus
cervca
o
ganga
oowng
to
te
cen-
te
2-our
110/mn,
pressure
s
nnervaton
o
oowng
o
mm
expratory
dagnoss
te
s-
respra-
120/80
dfuse
A
o
emergency
o
te
acute
nerves
bronca
s
by
o
mass
te
brougt
er
oarseness.
Pysca
te
te
emer-
because
V t a
sgns
examnaton
b a t e r a y.
at
to
usband
A
CT
s ow s
scan
o
aortcopumonar y
o ow n g
ner ves
s
o
a re
most
te
wn-
key
aryngea
aryngea
toracc
spancnc
woman
story
o
comes
to
te
dysestesa
n
pyscan
te
nner
because
aspect
o
te arm and axa. Se ad a tota mastectomy ncud-
excson
ago.
beng
s
s
sows
Wc
mts.
o
42-year-od
ment
ater
te
spancnc
recurrent
dagnosed
puse
a
to
because
puse
bood
woman
recurrent
A 23-year-od man s brougt to te emergency depart-
Hs
o
eart
and
conirm-
spancnc
sounds
Wc
B.
cord
spna
Her
te
stor y
s ow s
brougt
auscutaton.
department
A.
system?
spna
ST -eevatons
te
s
ces?
toracc
ce
ganga
puse
pressure
c o m p re s s e d ?
ganga
trunk
s
made.
or
42-year-od
norma
percus-
rgt
A
wtn
oca-
examnaton
sows
o
emergency
poory
duness
remtus
te
te
but
Pysca
sounds,
o
te
to
sarp,
wa.
tacte
x-ray
Wat
A.
s
severe,
breat
responsbe
to
o
cest
decreased
efuson.
pan
te
decreased
and
ra
woman
because
on
son,
38.
bood
troponns
Wc
boyrend
toracc
Axiary
toracic
and
pressure-
Hs
(cardopumonary)
and
ung
A.
accessory
arm.
ram
er
musce
B.
et
sows
rom
examnaton
on
A.
emergency
spancnc
dyspnea.
attack
te
te
spancnc
35/mn,
was
s
eevated
ibers
gr
by
responsbe
smoot
to
substerna,
30/mn,
narcton.
vscera
Pysca
astma
Pysica
resut
are
to
ECG
sow
ventra
severe
weezng
monts
abduction
Wic
surgery
because
are
An
toracc
17-year-od
o
radates
pan
toracc
department
trunk
istory
degrees
A
brougt
severe,
system?
C.
nerve
comes
te
nervous
tory
woman
carry
Vagus
voice?
Hg.
myocarda
Greater
patient’s
tat
studes
B.
37.
aryngea
mm
A.
being
s
o
respratons
ocated
ikey
man
because
pan
pumonary
pexus
underwent
ikey
to
a
nerves
nerve
above
examination
sows
90/70
ng
examination
nerve
39-year-od
a
cest
adjacent
te
B.
A
te
neura
Let
try
35.
o
arc
A.
o
34.
scan
witin
cest
aboratory
sows cear ung sounds biateray and no murmurs are
eard.
55-year-od
110/mn,
comes
o
A
47
Thorax
2
vagus
40.
Vta
o
te
wt
sgns
oowng
axary
(o
Spence)
o
are
norma
wtn
nerves
was
te
most
breast
mts.
key
ater
two
beng
weeks
Wc
njured
o
durng
procedure?
Unar
B.
Long
C.
Intercostobraca
D.
Latera
E.
Axary
A
ta
carcnoma
toracc
cutaneous
39-year-od
department
svey
sarp
nerve
o
T4
nerve
man
because
s
o
retrosterna
brougt
3-day
pan
to
te
story
tat
emergency
o
radates
progres-
to
te
et
48
C H A P T E R
2
souder.
worse
or
41.
he
wt
mts.
ton
Thorax
pan
Pysca
rub.
te
s
reeved
nspraton.
o
radatng
te
pan
Intercostobraca
B.
Prenc
C.
Long
D.
Greater
E.
horacc
retc
toracc
man
percarda
nerves
s
o
rc-
s
o
A.
te
An
sow
pan
ECG
wa
sarp,
sows
te
a
s
arm
A
and
or
on
a
myocarda
15
kg
(33
Prenc
oarseness.
a
Intercostobraca
esopagus.
D.
Greater
key
E.
Suprascapuar
o
1-week
axa.
and
o
He
over
e
sustaned
sensaton
Wc
ne.
n
te
a
te
axa
were
Dorsa
B.
V entra
wre
and
severa
key
oss
o
wounds.
damaged
to
o
dorsa
o
ventra
E.
Ram
46.
resut
department
patent
because
radatng
and
150/100
are
to
ram
aortc
endovascuar
oowng
Let
Greater
E.
Prenc
A
a
ram
A
a
a
sensaton
a
s
a
Hs
urgent
s
o
apex
o
dated
et
resut
n
47.
A
o
o
te
sows
a
or
te
A
scan
CT
sows
Sympatetc
postgangoncs
expected
D.
Sympatetc
pregangoncs
stomac?
E.
Parasympatetc
2-mont
n
te
story
nppes
enancement.
and
Wat
o
oss
areoae
Pysca
to
o
te
sensaton
oowng
examnaton
comes
Vta
by
and
severe
se
o
dys-
as
and
been
as
cougng
swaow
te
ost
se
as
and
sow
toracc
nerves
s
most
nerve
to
te
um
o
te
s
nerve
nerve
te
are
a
wtn
scan
o
te
structure
o
wt
s
m-
murmur
cest
et
at
sows
most
te
o
swa-
norma
dastoc
expanson
key
atrum
symptoms?
cava
woman
s
masses
needs
ast
te
a
woman
o
n
ste
at
wt
te
te
Paryngoesopagea
bateray
C.
Posteror
to
D.
Posteror
to
E.
Esopagea
superor
ungs
te
oarse
and
and
tube
s
resstance
rom
te
toracc
aortc
te
et
man
te
broncus
dapragm
voce.
abdomen
ver.
For
nser ted.
woud
nose
aperture
arc
ospta
examnaton
juncton
te
o
a
cest
wc
passes
to
Pysca
nasogastrc
tube
atus
admtted
cancer.
examnaton
te
because
dcuty
cava
ar yngea
as
pyscan
ung
vena
te
o
to
Wc
te
Leve
breast
o
emergency
o
weeks,
oowng
sgns
A
B.
reducton
te
monts
progressve
A.
eectve
sows
to
barum
spancnc
because
pyscan
a
posteror
patent’s
mutpe
horacc
comes
ramus
second
compressng
aryngea
eart.
vena
nutrtona
woman
and
te
tn-appearng
C.
o
te
o
B.
22-year-od
te
69-year-od
because
Somatc
A
o
atrum.
Ineror
aferents
te
attacks
CT
Superor
aferents
o
severa
te
compressed
A.
vscera
te
(ntercostobra-
dyspaga
sows
E.
back?
durng
o
ood.
D.
aferents
o
examnaton
T racea
respra-
Wc
responsbe
sod
Pysca
Root
an
ventra
story
2
past
aryngea
man
C.
o
past
te
nerve,
story
B.
cest
o
nerve
cest
te
te
tracea
toracc
yper-
pressure
and
te
Wc
Esopagus
pacement
perormed.
to
o
trd
afected?
A.
tearng
bood
100/mn,
key
emergency
story
examnaton
An
most
radatng
as
day.
s
scan
stent-grat
are
He
pack
aneurysm.
nerves
te
n
35-year-od
beng
sudden-onset,
puse
CT
to
njury?
and
brances
te
brougt
5-our
Fuoroscopy
recurrent
4-mont
to
brougt
back.
Hg,
22/mn.
an
o
te
smokes
mm
s
s
because
Over
recurrent
D.
a
communcantes
62-year-od
second
nerves
brances
For
det
vagus
C.
te
brances
tearng
eang
et
roots
brances
sows
sows
oowng
ung
week
te
Let
ts.
Cutaneous
tons
ast
aong
Rgt
B.
te
o
o
spna
o
sputum
be
A.
owng
Cutaneous
s
n
roots
D.
tenson
ence
examnaton
C.
pan
andross
aceratons
most
because
sgns?
A.
A
pyscan
and
barbed
deep
Pysca
et
to
numbness
severa
structures
tese
comes
story
mdaxary
n
man
te
atrogenc
cutaneous
brances
woman
b).
mass
C.
43-year-od
o
to
nc-
nerves
because
boody
to
to
and
nerves
toracc
anxety.
Vagus
spancnc
ateray
nerves
cutaneous
qud
4-cm
Wc
brances
atera
ntercosta
32-year-od
pnea
areoae
erytema
nerves)
Latera
B.
et
44.
second
A.
A
and
ntercosta
department
troponns.
responsbe
durng
45.
no
nerves
pectora
trd
ventrce.
te
s
subject
cutaneous
cutaneous
dapo-
myocarda
et
eang.
Latera
E.
rom
here
key
Latera
ad
toracc
and
D.
ca
to
skn
nes.
C.
sub-
radates
cardac
nerves
te
o
pan
te
most
Anteror
te
narcton?
43.
dry
were
Anteror
emergency
sows
o
eevated
to
te
he
examnaton
oowng
o
to
story
pan.
posteror
studes
o
30-mn
dyspnea.
te
radaton
brougt
cest
Pysca
o
are
nerves
souder?
o
mdaxary
sons
responsbe
(cardopumonary)
because
Laboratory
42.
sensaton
te
ntercosta
man
wt
narcton
te
and
norma
spancnc
vscera
arm.
Wc
te
a
orward
wtn
ourt
pressure-ke
et
sows
oowng
to
are
B.
department
s
eanng
toracc
72-year-od
sterna
by
sgns
examnaton
Wc
A.
A
Vta
to
be
te
CHAPTER
48.
A
59-year-od
department
brougt
to
sortness
te
o
emergency
breat.
52.
Pysica
A
55-year-od
department
was
ago
brougt
wt
to
cest
te
pan.
emergency
Cardac
cat-
juguar
venous
et
edema.
A
te
or
can
it
ntercosta
be
seen.
Rgt
B.
Let
C.
Aortc
D.
Apex
E.
Mtra
was
trauma
Pysca
te
be
space
part
o
n
te
on
and
te
te
pitting
cest
wa
o
s
responsbe
te
eart
vave
man
ater
a
s
brougt
ead-on
an
unrestraned
to
s
anteror
key
Rgt
B.
Apex
C.
Let
D.
Rgt
and
rom
te
to
sows
wa.
be
part
by
eart
et
wee.
Anteror
C.
Crcumex
D.
Artery
E.
Posteror
as
woud
a
o
mpact?
te
s
et
atrum
brougt
to
te
emergency
department because se ees er eart beatng. Se expe-
rences sortness o breat wt exerton, ortopnea, and
te
man
wt
Rgt
B.
AV
s
systoc
mtra
cck
vave
perormed
and
ecocardograpc
proapse.
at
Let
B.
Rgt
ower
C.
Rgt
second
D.
Drecty
E.
Let
der
der
it
wc
A.
o
te
o
te
te
o
o
oowng
space,
te
beow
o
space
vave
severe
noda
Ineror
D.
Snuatra
s
Anteror
best
ts
te
near
sternum
te
atera
te
bor-
wat
s
noss
o
A.
mdde
ntercosta
o
te
space
manubrum
near
te
man
A
bor-
A
B.
cest
sure
s
te
by
brougt
we
he
pan
rest.
Hs
130/80
mm
Hg,
angograpy
artery.
bypass
s
s
wt
crcumex
nary
man
pan.
Coronary
artery
Wen
procedure,
protected
te
tat
emergency
s
worse
wt
It
s
s
te
s
rgt
aortc
coronary
vave.
mnma.
wc
key
Hs
Assumng
to
o
st
te
ave
artery
most
a
o
Coronar y
to
be
proxma
to
et
et
surgca
expanaton
ts
precudng
w
and
Havng
no
emergency
arter y
ponts
crcumex
and
te
pan.
coronar y
tree
arteres.
key
to
cest
et
at
te
or
anteror
domnant
nter venton,
or
a
poor
prog-
patent?
te
te
coronary
cance
artery
tat
are
end
anastomotc
occur.
tat
musces
artery
brougt
te
brances
probabe
artery
o
te
anteror
te
and
trcuspd
posteror
vave
ave
pap-
been
damaged.
51–75
mproves
(L AD)
recover y
te
n
o
most
severe
nto
connectons
sternum
48-year-od
department
o
to
nterventrcuar
s
crcuaton
te
ary
Questions
con-
artery
occuded
arteres,
atera
most
node
domnant,
be
nterventrcuar
burcaton
coronar y
nppe
snus
margna
noda
55-year-od
descendng
te
he
bypass
artery
(posteror)
70%–80%
ocatons?
just
body
ntercosta
ts
sows
md-
sternum
over
second
o
Auscutaton
ntercosta
part
studes
a
coronary
ow?
sows
wt
brances
bocked.
surgeon
pan
occuson
coronary
angograpy
murmur
a
brougt
cest
woud
ts.
a
(SA)
crcuaton
wt
sows
s
rgt
rgt
(acute)
C.
A
te
arteres
bood
A.
E.
54.
to
department
examnaton
te
be
nterventrcuar
severe
an ntermttent coug. Vta sgns are wtn norma m-
Pysca
s
snuatra
(neror)
cardac
patent
norma
te
to
sgnicant
coatera
ventrce
woman
undergo
artery
bunde
to
nterventrcuar
dsta
oowng
margn
et
margna
58-year-od
artery,
atrum
Anteror
Rgt
B.
e
on
ventrce
54-year-od
Wc
to
and
system
exerton. Upon cardac cateterzaton, t s ound tat
ventrce
o
rgt
wt?
A.
A
te
conducton
scedued
department
bunt
eccymoses
te
53.
coson.
steerng
o
te
emergency
sustaned
extensve
Wat
njured
te
vece
drver
sternum
cest
to
motor
s
operaton.
arc
and
cardac
patent
mdcavcuar
eart
ventrce
te
cerned
examnaton
most
E.
gaop,
atrum
o
A.
A
S3
atrum
42-year-od
He
Wat
an
pusation
pusaton?
A.
A
rytmic
et
ts
distention,
sigt
department
51.
man
5-days
eterzaton sowed te vesse tat suppes muc o te
ne
50.
is
o
examination sows crackes at te ung bases, increased
at
49.
man
because
49
Thorax
2
rom
ts
because
s
worse
puse
and
ts
o
wt
neary
s
tota
exposed
njury?
bood
are
and
to
must
a
he
E.
he
55.
A
a
routne
promnent
Great
cardac
ntercosta
C.
Sma
cardac
ne.
Ts
D.
Anteror
ton
or
E.
Posteror
te
et
ventrce
o
te
efectve
and
w
suppy
neror
not
be
o
snuatra
node
s
coatera
crcuaton
(posteror)
nterven-
possbe.
te
vaves?
woman
S1
s
AV
brougt
examnaton.
mts.
B.
o
arteres
35-year-od
or
Mdde
ven
anteror
bood
A.
cardac
o
node
w
be
nadequate.
norma
cardac
suppy
deveopment
trcuar
o
be
bood
between
coro-
perorm
ven
D.
25/mn.
et
he
nadequate.
pres-
bockage
te
C.
story
exerton
rom
accompanyng
emergency
5-day
98/mn,
orgn
artery
wat
s
te
respratons
sows
near
to
Pysca
eart
space
best
auscutaton
o
to
te
sgns
pyscan
a re
examnaton
sound
aong
ocaton
V t a
ocated
te
et
n
o
te
et
a
t
md-cavcuar
c o r re s p o n d s
wc
wtn
s ow s
to
te
te
oca-
o ow n g
50
C H A P T E R
A.
Mitra
B.
Aortic
Thorax
vave
Pumonary
D.
Aortic
was
te
boy
des
perormed
eart
o
te
unexpectedy
and
boy .
It
man
is
because
brougt
o
severe
to
cest
te
pain
emergency
wit
aby
radia-
te
a
ata
arrytma.
conducton
tssue
Rgt
B.
he
bunde
C.
he
et
bunde
branc
D.
he
AV
bunde
o
E.
he
posteror
o
te
tum.
w
he
be
and
sows
ECG
ower
part
respirations
a
o
te
o
severey
are
diaporetic
sows
uncton
most
severe
man
in
Pysica
severe
myocardia
muscuar
wc
30/min.
inarction
interventricuar
o
te
dis-
oowng
sep-
vaves
61.
afected?
A
department
Pumonary
taned
B.
Aortc
wee
C.
T rcuspd
mm
D.
Mtra
mnutes.
E.
Eustacan
department
s
95
ton
because
pressure
sows
ECG
te
sows
a
oowng
Pumonary
C.
Aortc
T rcuspd
T rcuspd
gr
B.
Let
C.
AV
D.
Posteror
AV
gr
s
te
bunde
bunde
u
s
and
eart
2
Rgt
B.
Obtuse
C.
Rgt
o
term
wt
T wo
te
te
va
spontaneous
membranous
neror
days
arrytmas
o
a
a
cardac
to
te
ven-
repar.
noncoro-
postoperatvey,
s
A
afectng
conducton
(o
was
s
te
margn
wa
most
Crcumex
B.
Anteror
C.
Ineror
D.
Artery
E.
Rgt
s
and
porton
to
be
o
te
cest
te
Se
te
pressure
sows
s
most
75/55
are
muled
Utrasound
Wc
key
o
be
sus-
steerng
22
eart
exam-
te
o-
njured?
et
ventrce
pan.
wt
ventrce
because
Pysca
crackes
s
brougt
o
severe
examnaton
n
te
ventrcuar
narcton
te
n
septum
to
ung
et
sows
bases.
septa
anteror
and
te
emergency
substerna,
a
An
ECG
musce,
two-trds
anteror
o
“crusng”
daporetc
sows
myocarda
te
nterven-
ventrcuar
wa.
A
te
oowng
arteres
rgt
Proxma
et
D.
Proxma
anteror
E.
Ineror
A
most
key
occuded?
coronary
coronary
nterventrcuar
(posteror)
49-year-od
s
woman
because
o
artery
nterventrcuar
s
brougt
severe,
to
crusng,
artery
te
emergency
retrosterna
pan
te
myocarda
ventrce
te
o te oowng arteres s te most key to be occuded?
te
A.
Artery
ven-
B.
Rgt
oowng
C.
Crcumex
artery
64.
artery
coronary
Rgt
E.
Dagona
A
te
te
patent
s
conus
coronary
D.
artery
margna
75-year-od
md
artery
o
and
o
musce.
coronary
rgt
perormed,
aspect
papary
ound to ave et domnant coronary crcuaton. Wc
artery
s
posteror
A
te
angogram
n
posteromeda
and
tat
coronary
narcton
and
and
o
rgt
et
ECG
anteror
Wc
acute
er
narcton
Emergency
sows
te
w
by
respratons
dstenton.
ypoknetc
to
o
bood
and
tamponade.
te
man
Proxma
emergency
pan.
nterventrcuar
branc
et
C.
conus
margna
sternum
Her
emergency
atrum
B.
occuded?
nterventrcuar
(posteror)
te
o
occuded.
key
to
myocarda
regurgtaton.
te
coson.
or te ast our. An ECG sows tat se s suferng rom
brougt
a
o
ven-
patway
severe
o
atrum
most
procedure?
perormed
upper
A.
o
sow
parts
ventrce
department
s
oowng
nterrupted?
to
vece
er
structures
Crcumex
Hs)
man
ven
cardac
69-year-od
o
63.
nternoda
vave
o
o
patway
examnaton
A.
bot
tssue
te
key
brougt
105/mn,
te
branc
because
ree
Apex
an
angograpy
porton
et bunde branc bock s aso noted on ECG. Wc
branc
ecocardograpy
suppyng
Let
E.
trcuar
node
pumonary
D.
to
cras.
s
a
s
motor
juguar
cardac
A.
Wc
te
sows
and
An
a
Pysca
examna-
sound.
bock.
owng
deectve?
undergoes
patced
durng
bunde
department
arteres
born
aorta.
part
62-year-od
trcuar
breats/mn,
Pysca
branc
key
dagnosed
severe
njured
Rgt
E.
S
puse
cest
deect
Wc
A.
A
most
er
Her
aortc
deect
o
deveops
key
a
An
taken
Hs
nternoda
woman
puse
and
naton
man
and
septa
septa
trces.
bunde
breat.
21
Hg.
emergency
mtra
devery
cusp
n
o
te
62.
3-mont-od
nary
tat
seep.
were
Bacmann
trauma
durng
Hg,
department
and
E.
he
spttng
s
are
mm
to
vave
D.
trcuar
brougt
sortness
120/80
rgt
B.
vagna
o
vaves
Mtra
s
respratons
s
wde
A.
A
woman
beats/mn,
bood
s
branc
o
ater
bunt
sounds
35-year-od
bunde
42-year-od
A.
A
n
sampes
ound
o
most
A.
Hg,
An
was
Wc
was
90/60
mm
tssue
te conducton tssue tat penetrates te rgt ibrous tr-
tion to te jaw. His puse is 105/min, bood pressure is
comort.
59.
3-mont-od
gone ad become necrotc. he cause o deat was prob-
72-year-od
examination
58.
pumonary
T ricuspid
A
A
rom
and
department
57.
60.
autopsy
C.
E.
56.
2
man
sortness
swoen
o
egs.
comes
breat
Vta
Ecocardogram
to
and
sgns
sows
a
te
an
are
pyscan
nabty
wtn
arge,
because
to
wak
norma
mobe
o
due
mts.
structure
n
CHAPTER
te
rigt
cava
atrium
dentied
Wc
o
resembe
65.
te
a
B.
Eustacan
C.
hebesan
D.
Septum
E.
Fossa
septa
68.
most
boy
ment because o acute onset cest pan. ECG sows ST
key
eevaton
ocaton?
he
da
wt
a
o
te
te
A.
Crsta
B.
Pectnate
C.
T rcuspd
D.
Eustacan
E.
Coronary
te
sde
ncson
te
s
Wc
to
te
o
protect
and
ascendng
trunk
and
superor
69.
oowng
durng
A
48-year-od
department
te
because
o
myocarda
sows
Mdde
bood
B.
Great
cardac
cardac
ven
resp-
cardac
ven
E.
Coronary
ade
s
a
suspected
perormed.
te
A.
myocarda
neede
Rgt
At
be
and
an
wc
sevent
emergency
o
nserted
narcton.
te
to
ECG
Cardac
sows
ntercosta
te
70.
tampon-
percardocentess
oowng
reeve
ocatons
s
n
te
mdaxary
Let
C.
Rgt
it
D.
Let
E.
T range
ntercosta
trd
space
ntercosta
at
te
space,
1
sterna
nc
border
atera
to
sxt
ntercosta
space
n
te
mdcavcuar
ne
o
auscutaton
55-year-od
department
pressure
s
rreguar.
wt
ater
beedng
orceps
njury
o
to
he
and
te
vece
Hg
te
bood
ibrous
te
A.
Aurcuar
B.
Coronary
C.
Anteror
D.
Let
prenc
E.
Let
sympatetc
puse
o
A
te
trunk
s
to
be
s
artery
and
nterna
to
te
aorta
preserve
s
cere-
eevated
ongtudna
made
to
structures?
et
bood
98/mn
taken
mdne,
snus
nerve
Hs
toracc
and
woud
nterventrcuar
s
percardum
oowng
appendage
emergency
sows
patent
oss
punctured.
o
te
coson.
descendng
percardum
wc
and
to
examnaton
and
he
mnmze
ow.
brougt
motor
mm
room.
to
bood
ncson
a
s
Utrasound
operatng
camped
man
70/55
abdomna
bra
conirmng
(posteror)
rgt
atrum
prevent
71.
a
s
neror
patent
bypass.
te
vesse
ECG
arterog-
te
he
artera
perorm
o
ave
te
Anteror
et
part
s
Wen
bypass
most
Dapragmatc
D.
Latera
E.
Posteror
began
crusng
sows
a
o
part
70-year-od
proce-
susceptbe
new
rgt
s
o
severe
ago.
rgt
to
cest
Se
down
artery
te
Rgt
B.
Snuatra
C.
AV
D.
Latera
E.
Anteror
s
bocked
artery
Wc
key
be
node
te
et
occuded?
ventrce
nterventrcuar
septum
te
emergency
pan.
he
wt
just
n
o
septum
te
arm.
a
a
symp-
pan
An
as
ECG
ventrcu-
sows
dsta
tat
to
rgt
te
afected
node
o
myocar-
crcumex
septum
angograpy
atrum
wa
ne-
rom
ventrce
et
bockade?
A.
te
te
descrbes
narcton
margna
most
o
te
arses
becomes
brougt
crcuaton.
woud
part
suppy
te
I
branc
sows
tropo-
ventrce
Coronary
rgt
domnant
structures
narcton.
artery
o
emergency
ECG
eevated
nterventrcuar
ours
coronary
te
et
te
myocarda
te
nary
te
radaton
arrytma.
o
sow
wc
surace
o
ew
wt
abs
te
pan.
nterventrcuar
woman
ar
orgn
te
because
a
to
cest
bood
coronary
Inundbuum
toms
artery,
o
C.
department
and
reduced
wa
brougt
severe
myocarda
B.
A
o
arter y.
nterventrcuar
coronary
w
s
o
eevatons
ror
A.
sternum
man
nns
branc
te
Coronar y
ven
because
segment
dum
B.
pan.
snus
54-year-od
te
ne
A
A
ST
soud
emergency
cest
ven
cardac
department
tamponade?
space
to
cava
te
njur y?
eart
conirmng
arter y
Hs
and
to
bockage
coronar y
A.
Anteror
dstenton.
a
camp.
aorta
vena
substerna
tota
emergency
100/mn,
brougt
accompanyng
Sma
ven
s
ts
wc
D.
juguar
puse
pan.
ave
C.
and
Hg,
cest
to
vascuar
cava
narcton.
neary
he
percar-
arteres
nter ventrcuar
ratons are 22/mn. Pysca examnaton sows muled
sounds
mm
severe
te
o
rapy
to
to
because
a
dure,
snus
s
surgery.
vens
vena
coronary
man
sows
exposng
vave
et
a
cor-
artery.
camped?
trunk
correct
pumonary
o
are
Pumonary
scedued
brougt
vesses
Pumonary
are
and
(posteror)
s
pacement
neror
Cardac
et
transverse
E.
te
and
te
bypass
te
D.
n
et
n
Rgt
atrum?
patent
easy
oowng
and
coronary
C.
vave
90/60
te
a
ingers
nterven-
to
te
aowng
o
or
er
o
nterventrcuar
Rgt
ST segment eevatons and abs sow eevated troponns
67.
snus
taken
pace
anteror
Superor
made
vave
s
can
te
narcton.
bockage
B.
musces
52-year-od
s
patent
and
myocarda
severe
A.
termnas
department
artery
a
sows
or
room
Instruments
trcuspd
cruca
o
irst
atrum.
deect.
nterventrcu-
operatng
rgt
rgt
most
rgt
muscuar
to
te
wde
septa
te
sma
access
troug
ventrcuar
s
a
taken
conirmng
cateterzaton
surgeon
s
o
nserted
A 45-year-od man s brougt to te emergency depart-
Wc
surace
pressure
vena
eart.
prmum
septum,
A
woud
te
vave
deect
structures
66.
ts
inerior
o
vave
trcuar
openng
structures
n
te
onary
repar. T o
te
o
component
vave
surgca
ten
opening
ovas
4-year-od
anteror
te
norma
trombus
T rcuspd
ar
a
oowng
A.
A
near
as
51
Thorax
2
te
coro-
oowng
ater
suc
a
52
C H A P T E R
72.
A
2
Thorax
43-year-od
o
sortness
witin
norma
mid-diastoic
opening
gram
73.
te
eart
irst
imits.
mitra
vaves
eart
to
and
te
an
eard
vave
are
pysician
atigue.
Pysica
wit
sound
a
comes
breat
rumbe
snap
sows
owing
o
woman
o
Vita
because
signs
examination
abnormay
ater
S2.
stenosis.
responsibe
S1
a
te
o
Ineror
E.
Rgt
te
o-
Questions
76.
production
A
sound?
voent
and
mtra
mm
and
trcuspd
mn.
T rcuspd
Mtra
E.
T rcuspd
A
and
and
pan
and
eart
s
radatng
o
to
narcton
Pysca
sound.
responsbe
Wc
te
te
et
and
o
te
substerna,
a
te
arm.
rgt
examnaton
or
to
A.
Aortc
and
pumonary
B.
Aortc
and
trcuspd
T rcuspd
D.
Mtra
E.
T rcuspd
A
and
and
ECG
oowng
o
sows
a
oud
eart
te
3-mont-od
department
sve
n
er
vaves
n
are
C.
ra
te
gr
des
ormed
ducton
tssue
sows
te
vave.
to
key
o
Snuatra
C.
Atroventrcuar
D.
Frst
uar
o
te
rest
area
o
eaet
o
te
te
te
o
con-
te
eart
te
department
an
a
at
radates
epsode
systoc
te
to
o
brougt
cest
pan,
antng.
to
second
carotds.
njured
sortness
C.
Let
D.
Margna
E.
Rgt
Pysca
ntercosta
o
te
te
examnaton
murmur
space
and
Ecocardogram
n
te
nterna
te
ventrces
a
te
a
arte-
sounds
carotd
as
to
arteres
detected
w
bend
ospta
surgca
rgt
tat
bock
most
and
te
key
a
o
coronary
pyscan
resuts
severe
s
angogra-
usuay
hs
by
repar
domnant
procedure,
vesse
was
te
Pre-operatve
system.
suppes
n
nter-
arrytma.
drect
branc
o
arteres?
nterventrcuar
artery
artery
artery
woman
because
sows
it
s
o
a
brougt
sortness
oosystoc
ntercosta
radaton
severe
vave
dastoc
artery
to
mtra
oowng
mtra
te
et
vave
structures
cusps
space
nto
te
et
Crsta
termnas
wc
B.
Crsta
supraventrcuars
C.
Pectnate
D.
Cordae
E.
T rabecuae
emergency
breat.
murmur
at
te
axa.
prevents
te
to
o
Pysca
best
eard
mdcavcuar
Ecocardogram
regurgtaton.
A.
te
o
and
scedued
as
AV
coronary
et
eart
dstnct,
best
sows
and
artery
coronary
wt
boy
o
anteror
42-year-od
sows
breat,
per-
key
sgnicanty
anomay.
oowng
most
systoc
brougt
Durng
artery
te
unre-
emergency
te
most
mandbe
s
te
perods
o
te
njured
was
at
35/
cammy
decrease
juguar
nterna
conducton
was
nterventrc-
te
crescendo-decrescendo
rgt
te
o
te
Dsta
ne
because
tat
system.
o
te
cardac
examnaton
anteror
n
w
a
70/55
are
and
ud
papabe
ncrease
prevousy
Crcumex
artery
s
a
department
o
coo
enargement
dmnsed
boy
B.
artery
s
respratons
sows
or
between
w
n
o
A.
A
durng
pressure
oowng
externa
gradua
be
o
artery
man
or
sows
wc
trcus-
narcton
arteres
he
78.
noda
anges
mttent
body,
emergency
cest
examnaton?
vsbe
te
bood
and
te
s
sows
te
ncreasngy
congenta
part
necrotc
ibrous
sowed
oowng
o
be
w
accdentay
per-
a
o
puses
artera
efort,
s
o
to
to
ven
15-year-od
py
cardac
autopsy
centra
septa
he
te
perorator
75-year-od
eard
he
a
doctor’s
An
porton
te
unrespon-
ad
conus
noda
septa
he
a
occuded?
B.
sows
and
tssue.
Artery
and
to
examnaton
A.
A
necrotc.
emergency
er
gr
te
arrva.
sgnicant
septum,
Wc
ound
te
Despte
neror
Furter
surroundng
markabe.
ago,
ater
a
be
ocated
membranous
pd
moter
days
corrected.
tssue
was
er
T en
sorty
and
here
E.
parents
te
Hs
115/mn,
dference
D.
A
brougt
wound
pysca
be
pressures
te
to
ven
dastoe
he
eart
77.
brougt
s
Wc
w
become
s
atrum
examnaton
w
here
s
stab
dspute.
durng
juguar
B.
pumonary
because
maormaton
here
mtra
gr
crb.
ound
second
second
et
Ecocardogram
space.
A.
a
branc
pumonary
and
puse
Pysca
dmensons
sound?
C.
Hg,
be
pressure-ke
bunde
sows
producton
emergency
a
domestc
carda
brougt
man
ater
extremtes.
pumonary
woman
because
myocarda
bock.
mtra
pumonary
75-year-od
te
atrum
department
Aortc
D.
o
pumonary
76–100
Aortc
C.
wa
rgt
42-year-od
B.
cest
75.
Posteror
D.
A.
department
74.
C.
and
ecocardio-
Wic
or
sows
oud
An
are
Wc
regurgtaton
atrum
durng
o
o
te
systoe?
musces
2
aortc
vave
stenoss.
area
Patent
ment.
As
snus,
wc
wt
te
to
te
tps
A.
Ineror
B.
Superor
be
o
te
te
vena
cm
undergoes
surgeon
o
0.7
an
expores
oowng
ingers?
cava
vena
conirmng
cava
aortc
te
s
aortc
vave
obque
not
vave
repace-
percarda
drecty
papabe
79.
A
tendneae
58-year-od
department
degree
maker
te
carneae
woman
because
eart
bock
pacement.
pacemaker
o
s
and
he
must
be
brougt
antng.
se
s
te
emergency
sows
scedued
eectrca
passed
to
ECG
conductng
nto
te
a
or
a
trd-
pace-
eads
eart.
o
Wc
CHAPTER
o
te
oowing
passage
A.
B.
o
vena
atrium,
because
s
126/78
o
cava,
vave,
vave,
superior
o
mm
te
vave
Regurgtaton
Hg.
A
vave
Occuson
o
E.
Occuson
o
te
emergency
22/mn,
barum
Hs
bood
swaow
sows
department
most
ypertro-
key
o
te
te
te
bood
conirmng
specazed
cause
s
nterventrcuar
(posteror)
brougt
artery
nterventrcu-
te
s
mm
ibraton.
conductng
At
te
rgt
C.
At
o
82.
tssue
te
Between
In
Hg,
batera
te
te
an
ower
woud
o
et
a
te
and
tat
rgt
s
P-waves
te
mass
te
and
85.
o
vena
wc
o
te
vena
cava
rgt
and
cava
and
pyscan
sweng.
best
te
pan
contro.
ayer
tat
A
exam-
Ecocardogram
o
an
sows
ncompetent
te
bood
oowng
ow
n
ts
at
tr-
areas
cardac
Let
trunk
C.
Ascendng
D.
Rgt
E.
Let
remtus
te
ne
dran
cest
ange
s
te
con-
wc
t
most
efuson
86.
boy
earer
object
rgt
te
a
o
tenson
te
cest
necessary
s
te
oca
or
deepest
anestetc
peura
s
brougt
started
to
s
prmary
he
carna
begnnng
E.
he
et
o
suspected
s
o
Wc
o
sma
te
ago.
toy
breat
suspected.
most
he
cars.
n
common
was
Pysca
sounds.
Were
and
boy
A
te
ste
or-
tra-
or
a
broncus
te
s
brougt
a
te
a
emergency
sudden
astma
and
oowng
ncreasng
te
s
gven
te
onset
sows
retractons.
severe
oxygen
o
examnaton
ntercosta
on
to
because
Pysca
avng
te
tracea
ater
and
paced
s
our
broncus
breat.
weezng
an
tracea
o
cd
by
a
depart-
breatng
broncus
te
tertary
3-year-od
emergency
odge?
he
department
s
te
dcuty
decreased
prmary
o
to
or
wt
tree
D.
n
s
oowng
wt
dstended
at
C.
s
tube
Hg,
sows
asca
sows
et
patent
te
and
sows
anestesa
cest
sort-
mm
anestesa?
aspraton
he
s
o
86/52
sde
cest
oca
a
s
examnaton
rgt
te
nitrated
payng
he
use
te
o
o
moter
wc
sortness
pressure
emergency
severe
peura
B.
A
on
te
and
musces
s
body
to
pan
d-
he
boy
attack.
he
broncoda-
most
ntratoracc
mportant
capacty
n
nspraton?
aorta
A.
ande
movement”
o
anteror-posteror
te
rbs—tereby
dmensons
o
te
torax
man
because
“Pump
ncreasng
ventrce
34-year-od
be
pareta
A.
atrum
department
to
Pysca
Adequate
adequate
by
actor
atrum
tube
breat.
sounds,
hroug
mdaxary
brougt
x-ray
Wc
must
5-year-od
tors.
B.
An
ceobronca
te
eard
o
costoprenc
cest
bood
nserton
examnaton
because
Pysca
murmur
and
to
aceve
s
o
sounds
vens.
cougng
atra
to
border.
atrum
Into
Pumonary
breat
pror
ment
cardac
te
tacte
x-ray
efuson.
cest
115/mn.
Vscera
respratons
absent
septum
comes
regurgtaton
s
E.
and
snus
superor
extremty
rgt
A.
A
puse
Costa
abnormaty?
83.
and
Hs
Subcutaneous
ntates
neror
oosystoc
sterna
vave.
te
breat.
oregn
ower
enarged
cuspd
te
woman
sows
et
o
D.
Were
coronary
nterventrcuar
45-year-od
naton
o
juncton
E.
o
ness
man
because
C.
rreguar,
atrum
D.
A
51-year-od
gteadedness,
sows
te
An
o
breat
T wet
A
Endotoracc
and
a
sortness
decreased
ieds.
rgt
aong
and
decreased
peura
nsert
Intercosta
atrum
te
T ent
egn
juncton
te
rgt
Egt
D.
seen
juncton
to
B.
120/mn
examnaton
atra
C.
to
atrum
B.
space
A.
te
te
sded
emergency
to
paptatons,
puse
130/80
ECG
Sxt
wa
aorta
s
o
Fourt
B.
absent
ocated?
At
rgt
and
ung
o
pneumotorax.
anteror
Her
pressure
25/mn.
buntng
juguar
neror
because
ower
department
stenoss
woman
weakness.
percusson,
rgt
A.
E.
84.
compresson.
cardac
te
ood.
and
to
sgnicant
s
cava,
artery
35-year-od
to
te
coug,
sows
ud?
ventrice
to
secondary
oowng
vena
swaowng
are
cava,
stenoss
D.
duness
ntercosta
ventrice
superior
rigt
dcuty
vena
wa,
examnaton
sows
dyspaga?
C.
A.
mitra
tricuspid
rigt
brougt
sows
Pumonary
cyce
vein,
vave,
is
constrcton
B.
are
atrium,
respratons
Mtra
and
rigt
mitra
A.
A
vena
toracc
Pysca
approprate
man
patent’s
ar
81.
cava,
vein,
Wc
te
anteror
irmng
braciocepaic
Ecocardogram
o
atrium,
vave,
esopagea
py.
superior
tricuspid
85/mn,
pressure
or
n
rigt
braciocepaic
atrium,
department
s
structures
ventrice
cava,
vena
68-year-od
puse
vein,
o
ventrice?
ventrice
Rigt
rigt
rigt
order
rigt
ventrice
Rigt
rigt
A
te
braciocepaic
rigt
E.
correct
into
vave,
Superior
D.
te
mitra
Superior
C.
is
eads
Rigt
rigt
80.
te
53
Thorax
2
s
o
a
brougt
sarp,
to
te
ocazed
emergency
pan
over
te
B.
“Bucket
ng
te
ande
movement”
transverse
dameter
o
o
te
te
rbs—ncreas-
torax
54
C H A P T E R
C.
2
Thorax
Straigtening
racic
spine,
sions
D.
o
te
Descent
te
te
A
Hg,
a
puse
Pysca
expansion
woman
igt.
s
is
o
Her
o
te
vertica
wit
to-
oowng
dimen-
be
increasing
o
in
te
a
a
stab
and
ribs
to
te
wound
Superor,
B.
Apca,
vertica
C.
Posteror,
D.
Apca,
E.
Anteror,
baby,
91.
emergency
s
are
25/mn.
mogram
ymp
sounds.
metastaszed
o
ts
te
oowng
pumonary
A.
he
orzonta
issure
o
te
et
B.
he
orzonta
issure
o
te
rgt
C.
he
obque
D.
he
apex
E.
he
root
A
o
55-year-od
a
panu
dscarge
ton
te
n
Wc
o
A.
o
rgt
et
woman
ump
er
te
te
ung
ung
ung
er
92.
to
te
rgt
rgt
o
upper
oowng
te
skn
because
a
(peau
o
te
te
o
te
eta
and
nante
state
o
Apca
D.
Anteror
E.
Posteror
An
Intraducta
C.
Retracton
D.
Obstructon
o
edema
skn
A
by
ng
o
te
te
and
te
sbe
or
gaments
o
te
93.
man
as
s
puses
sgns
te
o
most
B.
Cor
o
Dssectng
o
s
carna
s
group
ympatcs,
wt
te
o
eptea
s
nng
Pumonary
A
o
te
nppe
Hg,
35/mn.
ymp
to
te
sortness
mm
dstorted
and
tat
o
breast.
te
key
to
to
te
atgue,
severa
braca
deayed.
irst
to
contan
emergency
and
days.
artery
a
ead-
Pysca
pressure
he
patent
Wc
o
sows
te
s
and
no
oow-
dagnoss?
te
aorta
puse
s
wdened.
s
most
no
76/mn,
Broncoscopy
nodes
and
Her
as
o
te
sows
x-ray
rgt
respon-
Ineror
D.
Superor
traceobronca
E.
Paratracea
72-year-od
ound
wt
condtons
common
ac
Fa
Pneumotorax
department
dcuty
aspratng
sows
wt
s
partay
rgt
A
rom
breatng.
unc.
dgested
superor
dsease
obar
a
s
brougt
nursng
An
our
Broncoscopc
ood
bockng
ome
ago,
e
exam-
te
broncus. Wc
o
or-
te
ca
pan
o
beng
wc
are
artery
deayed.
most
emergency
and
days.
pressure
nammaton.
w
te
key
he
ead-
pressure
s
s
decreased,
patent
Wc
be
a
Pysca
o
sows
te
observed
o-
on
an
te
condton?
te
wt
dagnosed
wen
p re s e n t s
we a k n e s s
ago,
P y s c a
o
rbs
woman
mastectomy
scapua
severa
braca
emora
te
st
and
we e k s
b re a s t .
over
to
atgue,
cest
5 6 - ye a r - o d
ater
cava
cest?
B.
wt
Parknson
o
A.
T wo
man
emergency
o
94.
traceobronca
brougt
tat
puses
Medastna
C.
carna?
sows
sgns
te
vena
nosebeed,
worsened
emora
o
superor
s
o
ncreased,
externa
owng
Enargement
key
te
te
man
E.
te
are
because
examnaton
emergency
breat.
o
Broncopumonary
o
te
s
wt
mam-
embosm
22-year-od
markedy
brougt
severe
120/80
te
Obstructon
E.
department
ypoderms
are
o
aterng
cutaneous
D.
B.
gn
over
aneurysm
Hydrotorax
naton
o
A
pumonae
Notcng
was
brougt
nosebeed,
tat
key
D.
te
nodes
most
nammaton.
C.
because
s
o
sows
Pumonary
to
and
breast,
axa.
carcnoma
ymp
worsened
A.
A
rgt
ces?
because
Coarctaton
ace
woman
pressure
wc
er
(subscapuar)
A.
C.
tumor
suspensory
te
because
respratons
tat
te
underyng
58-year-od
bood
90.
o
cancer
o
department
o
cancerous
Inammaton
and
n
because
examnaton
artery
B.
E.
pyscan
(pectora)
emora
externa
nppe
breast
tat
te
Pysca
psatera
conirm
dranage
18-year-od
te
a
nppe?
Retenton
Centra
C.
te
basa
markedy ncreased, emora pressure s decreased,
breast.
nverson
B.
to
mass
n
axary
tumor
examnaton
an
sows
Latera
ace
d’orange)
Mammogram
expans
boody
wt
A.
department
examna-
nppe
quadrant
best
and
Pysca
o
te
areoa.
pyscan
breast
nppe.
nverson
te
rgt
et
ung
ung
appearance
o
te
comes
n
unatera
vcnty
tumor
er
te
rom
sows
orange-pee
n
issure
te
o
structures
ste?
o
basa
atera
breast.
ixed
nodes
bopsy
receve
o
89.
and
comes
rgt
and
ourt costa cartage wt assocated decreased breat
at
te
irm
w
atera
atera
meda,
woman
ymp
meda
superor,
meda,
er
group
Wc
n
a
swoen
atera,
superor,
n
segments
posteror
anteror,
atera,
mass
sows
mm
meda,
Wc
present
aceraton
a
broncopumonary
obstructon?
anteror,
35-year-od
o
sustained
90/60
A
o
ts
rgt
s
a
te
se
pressure
by
A.
directions
respratons
sows
in
groups
afected
o
protrusion
cavity
brougt
bood
105/mn,
examnaton
te
tereby
toracic
lexibiity
because
bar
curvature
cavity
wa,
te
and
aowing
54-year-od
ater
88.
o
Orientation
department
orward
increasing
diapragm,
abdomina
tus
87.
te
toracic
o
dimensions
E.
o
tereby
n
patent
puses
o ow n g
pyscan
s o u d e r.
axar y
c a rc n o m a
examnaton
se
te
rgt
u n d e r we n t
e x t e n s ve
wt
to
te
s ow s
aganst
n e r ve s
te
a
o
te
wngng
wa.
woud
rad-
dssecton
rgt
o
te
In j u r y
re s u t
n
to
ts
CHAPTER
B
A.
Muscuoprenc
B.
Superor
C.
Posteror
D.
Latera
E.
horacodorsa
55
Thorax
2
epgastrc
ntercosta
toracc
A
98.
A
10-year-od
boy
o
retrosterna
o
cancer.
opment
scan
te
by
Pysca
and
sows
no
a
brougt
to
te
here
examnaton
gross
mdne
oowng
te
s
dscomort.
vens
woud
o
o
te
most
no
story
norma
te
deve-
neck.
tymus.
key
because
amy
sows
deormtes
tumor
pyscan
s
be
A
CT
Wc
o
compressed
tumor?
C
D
E
95.
B.
Let
nterna
nterna
C.
Rgt
D.
Let
E.
Rgt
juguar
juguar
bracocepac
bracocepac
subcavan
A
B.
B
ment ater sustanng a gunsot wound n te neck. Hs
C.
C
temperature
D.
D
bood
E.
E
A
99.
sows
te
ing
te
is
steering
wee
woud
most
aso
te
during
o
motor
cest
o
te
o
te
rgt
key
An
A.
Costa
sternum
B.
Cupua
in
oow-
suc
an
Rgt
manstem
Rgt
upper
E.
Medastna
C.
hrd
o
D.
Fourt
Se
E.
Ft
ntractabe
47-year-od
examnaton
barum
severe
man
because
sows
sows
nammaton
atus
key
cause
rom
o
a
te
brougt
dcuty
sweng
swaow
agea
s
o
due
severe
B.
horacc
duct
bockage
C.
Superor
vena
cava
Aortc
Femora
nar y
and
nterna
ar ter y
puse
Hg.
esop-
te
ower
s
120/mn,
Pysca
and
examnaton
mbs?
A.
te
dab e te s .
gated.
Wc
provde
trd
o
te
Dur ng
ar ter y
gr a t.
to
te
he
s xt
s
a
te
us ed
s up p y
ar ter e s
tes e
D.
o
t e
E.
coro-
structures
tenson
severe
te
te
cest
pneu-
was
most
pneumotorax?
cest
o
to
pan.
two
duness
are
sows
te
te
Se
emergency
as
oroparyngea
days
vomtng.
Crackes
Wc
o
o
sows
ied.
o
brougt
cest
cemoterapy
he
ung
rgt
he
to
ago
a
and
on
afectng
ad
over
te
auscutaton.
pneumona
s
as
examna-
percusson
eard
story
dyspaga.
Pysca
oowng
pneumona
he
he
age
vascuar
tan
o
te
te
te
most
rgt
key
rgt
ower
man
te
resstance
et
s
ger
n
te
te
et
ung
broncus
s
stragter
tan
broncus
rgt
man
broncus
s
narrower
tan
te
broncus
rgt
man
p roce d ure ,
anter or
to
to
s tor y
as
ntercosta
o ow ng
coate r a
p ys c an
as
o
tenson
peura
s
o
and
Pumonary
man
He
a
obe?
man
to
te
x-ray
and
broncus
woman
cest
obe.
rgt
byp ass .
An
oowng
n
pareta
epsodes
ung
x-ray
ung
B.
c om es
tor ac c
te
rb.
ung
broncus
obe
tumor
expanaton
most
C.
ar te r y
o
irst
rgt
te
because
receved
ower
dsease
bypass
n
spaces?
te
te
s
An
wt
occuson
man
coronar y
ar teres
key
o
at
bran
rgt
extremtes.
Wat
51-year-od
ton
Pysca
daton
A
constrcton
artery
yper tenson
et
emergency
aneurysm
49-year-od
undergo
ower
constrcton
edema
horacc
E.
te
poma.
A.
D.
aorta
te
esopagea
to
arge
o
to
swaowng.
o
resut
D.
department
department
to
and
te
C.
Second
te
mm
peura
B.
100.
o
Wc
First
A
(98.6°F),
85/45
cavce
njured
A.
A
37°C
s
coapse
motorax.
swe-
injury?
A
s
pressure
sows
veice
wa.
te
invoved
o
upon
prouse
te
Wic
be
emergency
injury
a
sows
racture
joint.
ikey
to
cest
deormation
uncommon
manubriosterna
ribs
a
examination
and
an
brougt
sustaining
Pysica
erytema,
x-ray
at
woman
ater
wit
coision.
ing,
A 25-year-od man s brougt to te emergency depart-
sows a buet wound n te neck just above te mdde
22-year-od
impact
97.
Rgt
A.
department
96.
A.
man
broncus
s
onger
as
poorer
tan
te
et
broncus
rgt
tan
ower
te
ung
oter
obe
venous
dran-
obes
nterc os ta
sp aces
w
are
m os t
n te rcos ta
Questions
101.
A
101–125
41-year-od
department
dzzness,
man
wt
and
s
brougt
compants
sarp
cest
o
pan.
to
te
sortness
Patent
emergency
o
as
breat,
a
ong
56
C H A P T E R
istory
ture
are
is
o
smoking
37°C
arge
regon
o
and
B.
Rgt
C.
Let
vena
Arc
Pumonary
o
te
42-year-od
a
n
te
by
Durng
n
structure?
B.
n
he
n
rgt
er
te
nppe.
nverson
o
to
rgt
o
te
s
o
and
Pysca
te
skn
quadrant
pyscan
breast
rgt
over
te
most
a
because
a
mass
breast.
and
o
a
104.
tssue
Wc
A
sde
ste
sde
department
o
nvoved
caracterzed
s
37°C
D.
Obstructon
breast,
curasse
cancerous
o
te
wt
Inammaton
department
coson.
110/mn,
and
te
te
o
dranng
te
skn
o
skn
eptea
nng
o
te
nppe
ypoderms
s
beng
brougt
nvoved
temperature
bood
cest
te
s
pressure
sows
our
n
37°C
s
to
a
te
emergency
motor
(98.6°F),
115/85
broken
mm
rbs
o
vece
puse
105.
s
Hg.
An
te
et
a
s
te
te
procedure
rbs
A.
Penetraton
B.
Injury
o
Hg.
te
s
A
a
o
o
te
superor
te
et
E.
Impaement
sows
an
A
presence
trd
o
nodes
te
w
CT
o
vagus
s
o
B.
Broncopumonary
T raceobronca
E.
Superor
A
a
Wc
be
te
man
wt
smoked
sow
emergency
ater
beng
temperature
and
bood
ne
s
oowng
pres-
paced
njures
centra
venous
artery
cava
carotd
artery
nerve
a
to
te
A
at
te
et
te
as
n
a
swaow
eve
urter
cancer
o
emergency
Patent
barum
bopsy
afected
and
20
o
te
ndcate
te
oowng
dsta
ymp
irst?
gastrc
te
brougt
cgarettes
and
irst
s
retrosterna
bopsy
magnant
o
Hs
oppo-
traceobronca
department
Endoscopy
te
te
traceobronca
42-year-od
as
on
njures
swaowng.
and
medastna
Ineror
on
smokng.
be
Posteror
D.
afected
vena
Wc
A.
C.
be
aso
te
esopagea
key
w
constrcton
esopagus.
most
on
to
brougt
scan
an
afected
common
panu
esopagea
dapragm.
te
te
story
be
nerve
o
ong-standng
not
be
venous
subcavan
Penetraton
man
w
perormed?
Penetraton
wt
rbs
subcavan
D.
50-year-od
moves
w
115/mn,
C.
A
segment
te
and
centra
prenc
o
o
moves
wa
wa
coson.
ncorrecty
o
te
a
brougt
vece
occur
s
most
rbs
resusctaton. Wc
to
segment
cest
cest
traumatc
puse
mm
a
te
dapragm
severe
motor
key
department
106.
te
(98.6°F),
ud
te
o
dapragm
broken
man
wt
89/39
most
ne
ympatcs
woman
ater
Her
tumor
edema
o
underyng
25-year-od
s
s
n
te
o
be
ractures
broken
te
33-year-od
or
Intraducta
o
rb
o
te
as
w
examnaton?
movements”
te
descent
te
oowng
nspraton,
ande
o
drecton
drecton
descent
te
pysca
nspraton,
deep
same
by
o
durng
deep
sde
he
examnaton
nppe
key
E.
boody
d’orange
C.
o
comes
Wc
opposte
“Pump
sure
en
te
te
condtons
Peau
te
Durng
indngs?
Cancer
x-ray
ts
A.
te
D.
ump
upper
B.
A
s
Hg.
wa.
observed
afected
texture
oowng
tese
and
Wat
mm
ndcates
C.
er
A.
E.
100/65
cest
key
cava
woman
rom
rgt
te
2.1).
(Fg.
is
te
toracc
aorta
unatera
woody
te
o
tempera-
respirations
artery
panu
dscarge
ard,
pressure
x-ray
His
120/min,
ventrce
E.
sows
te
is
ventrce
D.
as
ypertension.
puse
bood
n
patoogy
Superor
A
and
(96.8°F),
arrow
A.
se
103.
Thorax
24/min,
he
102.
2
to
pan
day
te
or
or
te
examnatons
growt
oowng
at
te
ymp
nitrated
by
6
rgt
nodes
cancerous
emergency
monts.
past
o
20
te
man
w
tracea
broncus.
most
ces
He
years.
key
rom
te
magnancy?
A.
Ineror
B.
Paratracea
C.
Broncomedastna
D.
Broncopumonary
E.
107.
A
horacc
scan
sows
toracc
Fig.
.
man
wt
a
s
brougt
severe
pan
dssectng
aorta.
aneurysm
trunk
duct
60-year-od
department
•
traceobronca
Durng
ruptured
and
n
to
s
aneurysm
s
e
ospta
was
te
emergency
mdsecton.
o
te
stay,
te
transerred
A
CT
descendng
or
patent’s
surgery.
CHAPTER
Postoperativey,
gia.
Wic
injured
108.
o
te
te
during
te
Rigt
B.
Let
C.
Rigt
subcavian
D.
Great
radicuar
E.
Esopagea
A
coronary
in
er
enarged
ment
benign
most
te
resut
in
te
ikey
paraysis?
(o
Adamkiewicz)
woman
gand
tracea.
tumor.
on
An
to
to
te
et
rigt
o
te
compressed
te
pysician
examination
x-ray
te
Wic
be
comes
Pysica
A.
Let
braciocepaic
B.
Let
interna
C.
Let
subcavian
D.
Vagus
E.
Prenic
A
side
o
te
and
a
by
te
and
80/min,
centra
te
rect
cest
Let
B.
Site
wi
C.
Rigt
tyroid
110.
invoved
o
is
pressure
is
as
a
te
37°C
is
paced.
a
emergency
motor
Superior
D.
Let
E.
Rigt
Wic
to
mm
o
ine
inerior
B.
superior
oowing
C.
aorta
in
te
te
tip
cor-
artery
vena
42-year-od
cava
man
pain.
comes
He
as
gands,
secondary
o
te
is
a
sows
ikey
an
tis
to
te
pysician
diagnosed
resut
o
resut
o
cinica
wit
o
is
or
iver
acooism.
enargement
oowing
describe
raes
costa
space
is
an
rigt
and
to
obar
ung.
be
does
te
not
sow
oowing
is
compressed
any
signs
cavity.
o
conditions
by
te
externa
wi
most
rom
s
te
ng
voume
A.
Rgt
B.
Let
Wic
o
tis
cest
wit
B.
Empysema
paradoxica
respiration
116.
ange.
te
te
is
cest
o
most
er
ikey
is
ung
ung
brougt
ever.
cest
An
te
x-ray
neede
neede
percardum
by
pain,
efuson.
he
te
to
o
te
te
Wen
s
and
cest
too
up
sows
rom
deepy,
enterng
cambers
tacy-
percardocen-
nserted
passes
emergency
dyspnea,
woud
te
be
te
perc-
eart.
te
irst
neede?
ventrce
ventrce
C.
Rgt
D.
Let
atrum
he
cardac
A
rigt
oowng
penetrated
o
E.
Fai
obes
inter-
sounds
ung
rigt
severe
and
vscera
o
examination
describe
man
wit
rigt
te
te
perormed,
te
be
te
o
o
o
pneumonia?
percarda
nrasterna
case?
A.
o
ungs
obe
sixt
obes
ungs
injuries.
ikey
oowing
te
et
a
great
Pysica
te
x-ray
o
because
du
et
to
peura
o
An
one
te
and
and
x-ray o te cest sows tat er rigt ung is coapsed
ung
percussion.
in
o
ine,
and
tess
rigt
eve
rigt
Wc
et
te
midaxiary
rigt
emergency
te
examination
te
uneven parae bars during er gymnastic practice. An
er
at
pysician
Pysica
te
Amastia
te
te
o
E.
o
to
days.
o
sgnicant
in
4
obes
Gynecomastia
air
by
coug,
er
o
compressed?
obes
D.
and
or
during
35-year-od
wen
Wic
Lower
cardia,
a
Hg.
Upper
A
examina-
supine,
E.
most
Poymastia
ater
ikey
preg-
because
artery
crackes
Wic
department
dyspnea
mm
is
D.
wi
breast
severe
most
patient
obe
C.
wit
90/50
o
norma
Lower
Supernumerary
department
te
is
C.
process.
B.
te
Pysica
Midde
disease
to
days.
B.
conditions
brougt
is
trimester
department
mammary
115.
is
to
vein
Upper
case?
woman
tird
pressure
Wen
pneumonia
obe
te
severa
comes
te
invoved
vein
vein
A.
Poyteia
21-year-od
in
braciocepaic
Pysica
A.
A
gir
at
o
veins
ever
and
produced
sows
disease
a
sows
most
pacement
braciocepaic
bood
carotid
and
was
is
cy-
cava
juguar
17-year-od
are
examination
Wic
interna
dyspnea
atrium
as
common
E.
a
cava
vena
D.
A
or
drops
vena
te
ine
sows
structures
during
emergency
er
structures
A.
tat
is
pressure
a
and
rigt
sitting.
is
Hg,
te
veriy
venous
puse
or
venous
cest
tem-
bood
vein
et
juguar
te
tat
centra
His
and
vein
woman
to
emergency
90/min,
te
oowing
te
o
dizziness
sows
oowing
atrium
pancreatic
comes
severe
o
part
te
ine?
externa
28-year-od
bood
veice
(96.8°F),
119/89
andmark
centra
in
te
114.
Subcavian
A
being
to
pace?
abdomina
111.
used
C.
Proxima
o
te
is
A
o
damaged
subcavian
Rigt
Hg.
to
unconscious.
puse
x-ray
juguar
origin
E.
nancy
mm
o
venous
externa
o
brougt
ound
(96.8°F),
120/90
D.
A
is
being
subsequent
centra
A.
enarged
37°C
Wic
a
structures
man
ater
accidentay
a
113.
brougt
ine
cateter
B.
is
A
sows
vein
temperature
Carina
pressure
sows
vein
is
bood
A.
is
te
artery
man
venous
is
perature
standing
ater
His
structures
o
juguar
pneumotorax
34-year-od
ikey
nerve
and
T ension
A
tion
33-year-od
coision.
Cyotorax
otorax.
an
dispace-
biopsy
oowing
wit
sows
nerve
department
Hemotorax
D.
department
gand?
109.
C.
E.
112.
carotid
deviation
ikey
to
parape-
most
artery
neck.
tyroid
o
tracea
rom
was
paced.
47-year-od
pain
suers
arteries
operation
A.
common
patient
oowing
57
Thorax
2
atrum
45-year-od
department
apex
man
wt
s
severe
brougt
cest
to
pan
te
emergency
radatng
to
s
58
C H A P T E R
et
2
arm
Thorax
and
myocardia
Wic
most
117.
o
et
te
ikey
receive
T1,
T2,
T3
B.
T1,
T2,
T3,
C.
T1,
T2
D.
T4,
T5,
T6
E.
T5,
T6,
T7
55-year-od
department
o
te
nation
deep
o
ECG
inerior
spina
o
sows
an
acute
A.
Hemotorax
wa.
B.
Cardac
woud
C.
Hemopneumotorax
ventricuar
cord
sensations
segments
pain
in
tis
case?
121.
coug
sows
sows
is
and
an
is
severe
te
emergency
dyspnea.
An
Pysica
o
te
oowing
caracteristic
or
x-ray
Increase
B.
Increase
o
te
o
transverse
te
diameter
anteroposterior
o
Increase
D.
Decrease
E.
Decrease
o
te
o
vertica
te
anteroposterior
o
te
15-year-od
department
te
o
be
he
expratory
to
Pysca
eart
2
indngs.
C.
Aortc
o
\
te
torax
o
te
122.
te
torax
T rcuspd
T rcuspd
o
te
o
te
o
are
o
indngs.
astma
C.
Aortc
te
nerves
123.
smoot
T rcuspd
T rcuspd
department
Prenc
Pysca
encng
Vagus
T1–T4
E.
Recurrent
aryngea
34-year-od
racc
wa.
percusson
efuson.
son
wt
a
and
A
an
cest
an
brougt
x-ray
tube
s
to
ocazed
examnaton
o
s
te
te
te
pan
cest
space.
cest
\
to
At
tube
emergency
over
sows
nserted
ntercosta
ocatons
sbe
nerve
s
sarp,
Pysca
troug
owng
man
ibers
te
to-
duness
sows
dran
wc
most
a
peura
te
o
on
efu-
te
key
124.
o-
to
Superor
B.
Ineror
C.
At
D.
Between
to
to
te
te
mdde
te
upper
ower
o
te
border
border
o
o
te
ntercosta
nterna
and
te
rb
rb
te
ntercosta
A
externa
ntercosta
s
n
eart
engorged
most
woman
ater
sgnicant
dstant
a
s
a
sounds,
brougt
rom
dstress.
externa
key
musces
and
te
nterna
membrane
42-year-od
department
ntercosta
a
Pysca
reduced
juguar
caracterzed
te
emergency
he
patent
examnaton
systoc
vens.
by
to
bacony.
sgns?
sows
pressure,
Wc
tese
brougt
or
2
Pysca
s
to
te
emergency
monts.
Vtas
examnaton
o
te
oowng
o
te
x-ray
pan
struck
o
te
sows
durng
oowng
sensaton
E.
horacc
are
sows
a
S
1
vave(s)
eart
s/
sound?
by
cest
tat
te
pan
sows
te
s
emergency
truck
we
a
a
patent
nspraton
nerves
o
to
a
and
most
durng
s
cross-
cest.
exper-
expraton.
key
respon-
respraton?
spancnc
62-year-od
woman
wt
souder.
sows
brougt
was
Cardopumonary
te
s/are
sound?
Vtas
sows
an
s
severe
are
no
brougt
dyspnea
wtn
nerves
s
o
te
norma
abnormates.
aneurysm
oowng
to
and
te
most
emergency
pan
mts.
An
aortc
key
over
er
Pysca
x-ray
arc.
afected
o
te
Wc
by
te
aneurysm?
musces
Between
e
Intercosta
o
space
vave(s)
eart
2
mtra
man
D.
cest
S
n
nor-
aortc
C.
examnaton
A.
E.
Vagus
et
nserted?
te
Prenc
B.
department
be
and
An
te
te
A.
A
s
producton
examnaton
o
or
te
spttng
sowed
mtra
and
severe
Wc
sympatetc
wde
oowng
o
dyspnea
Wc
ater
street.
Intercosta
a
cest
breat
norma
aortc
or
57-year-od
B.
D.
and
E.
a
te
o
wtn
vave
D.
A
te
emergency
eart sound. An x-ray o te cest sowed
Mtra
o
are
sows
o
te
aortc
mts.
responsbe
ng
C.
1
Pumonary
musce
and
wt
B.
caracter-
o
woman
A.
oowng
reaxaton
are
x-ray
producton
and
Pysica
and
smoot
te
torax
An
to
sortness
Vtas
examnaton
norma
very oud S
emergency
dyspnea.
weezes
te
te
monts.
o
mtra
35-year-od
A.
A
and
E.
wtn
brougt
vave
D.
A
s
compant
Wc
or
Mtra
type
a
3
sound.
Pumonary
tis
weezes,
o
Wc
cause
to
severe
expiratory
arways.
bocked
department
120.
or
exerton
B.
musce?
119.
on
A.
diameter
diameter
brougt
and
broncospasm
bronca
coud
is
coug
sows
dagnosed.
sgns
transverse
boy
wit
examination
stc
wt
norma
o
woman
department
during
diameter
dimension
tromboss
movements
torax
was
ven
35-year-od
department
C.
A
A
responsbe
torax
118.
Deep
ma
breating?
A.
Pneumotorax
E.
S
exami-
ande\movements”
Wic
wa
to
empysema.
“bucket
toracic
brougt
tamponade
D.
mts.
woman
inspiration.
te
te
An
te
T4
wit
cest
jaw.
o
oowing
A.
A
upper
inarction
and
condton
s
125.
A.
Prenc
B.
Vagus
C.
Cardopumonary
D.
Intercosta
E.
horacc
A
spancnc
62-year-od
department
er
et
arm.
narcton.
stent
s
woman
wt
An
at
brougt
cest
ECG
sows
Coronary
paced
s
severe
te
an
angograpy
proxma
to
pan
te
tat
acute
s
emergency
radates
perormed
porton
o
to
myocarda
te
and
a
anteror
CHAPTER
interventricuar
ar
in
cardiac
te
eart.
structures
artery
rytm,
he
s
a
(LAD).
cardiac
uncton
essentay
Because
o
pacemaker
o
wc
repaced
by
o
is
te
irregu-
Vtas
aso
paced
sows
te
te
oowng
nserton
o
a
pacemaker?
AV
node
B.
Snuatra
C.
Purknje
node
ibers
Wc
te
B.
V entra
C.
Dorsa
o
Hs
D.
V entra
Kent
E.
Dorsa
A
astma
wt
tat
attack,
tered. Wc
system
aton
must
o
man
te
brougt
severe
te
and
o
be
s
dyspnea.
patent
a
te
to
s
te
Pysca
nbted
smoot
by
te
musce
drug
eements
o
drug
te
o
to
an
s
ower
and
reax-
Postgangonc
B.
Pregangonc
C.
Postgangonc
D.
Vscera
E.
Somatc
A
traceobronca
because
was
cyanotc
te
eart.
es
o
s
se
was
condtons
to
bue.
tests
actor
s
131.
most
o
sow
Nodal.
key
te
he
evdence
Bood
TGF-β
ibers
brougt
gves
ibers
ibers
eferent
gr
ibers
emergency
act
te
abnormay
be
o
assocated
ev-
Dextrocarda
B.
Ectopa
C.
T ransposton
D.
Unequa
E.
Coarctaton
A
dvson
35-year-od
department
sponsve
ound
o
a
er
were
At
he
C.
he
D.
he
are
A
and
and
te
emergency
s
unre-
acetamnopen
requred
stes
n
o
te
resstance
was
Interna
Radoogc
ptoss
te
crcoparyngea
te
te
Prenc
n
o
azygos
ven
te
crcotyrod
con-
arc
azygos
arc,
and
trunk
constrcton,
crcotyrod
comes
scan
to
te
pyscan
er
back
because
and
cest.
o
te
w
most
te
4
o
key
Pysca
moss
o
emergency
monts.
conirms
a
day
te
he
or
30
presence
examnaton
te
andross
structures
pup,
o
as
te
most
par-
ace.
key
pexus
s
brougt
severe
Vtas
greaty
n
vena
Let
are
sows
sows
key
to
te
dyspaga.
wtn
no
be
Wc
emergency
he
patent
norma
ost
m-
abnormates.
carcnoma
esopagus.
most
D.
o
afected
o
te
te
te
A
mdde
oowng
carcnoma
sze?
cava
atrum
artery
ventrce
V ertebra
body
62-year-od
sows
s
man
wt
an
a
s
acute
racton
rom
60%
brougt
compant
stabzed,
ejecton
30%
to
2.3)
Let
to
to
or
cgarettes
2.2).
and
examnaton
Pumonary
te
o
as
eyed,
monts.
C.
ECG
pack
(Fg.
man
(Fg.
Ineror
patent
across
6
B.
A
te
trunk
due
department
tymus
radatng
133.
s
nerve
Pysca
E.
ven
ateectass,
accumuaton
aorta
ast
ncreases
con-
brougt
examnaton
Cardopumonary
A.
te
cest
emotorax?
dyspnea
oowng
35-year-od
b
Wat
ne,
n
te
nerve
Arc
segment
constrc-
cartage
te
D.
A
te
o
njured?
C.
CT
com-
te
Sympatetc
ts.
duct
constrcton,
constrcton,
and
o
1
patent
Vagus
actvated
constrcton
crcod
o
x-ray
o
Pysca
artery
s
severe
tumor
te
B.
20
to
wt
smoked
tat
cest.
percusson
An
te
depart-
compans
artery
woman
A.
nserton
due
toracc
Pancoast
et
roots
vesses
45-year-od
a
on
rom
cause
E.
department
esopagus
to
carotd
s
mdaxary
space.
arteres
E.
132.
peura
vens
structures
toracc
woman
pan
o
te
patent
admnstraton
tree
crcoparyngea
69-year-od
to
he
patent
antcpate
arc,
pumonary
severe
he
constrcton,
constrcton,
o
botte
te
pumonary
he
arterosus
brougt
dapragmatc
and
cardac
truncus
organ?
te
cardac
strcton,
te
tube
arteres
overdose.
empty
aortc
and
te
was
andbag.
te
strcton,
E.
an
great
aorta
drug
soud
on
te
ton,
B.
a
Wat
one
presson
o
te
woman
nasogastrc
carcoa.
A.
o
or
and
n
te
te
Pumonary
been
o
at
D.
ta
cords
duness
Pumonary
as
er
nerve
emergency
patent
o
bateray.
Intercosta
A
spna
te
he
sde
resutng
beedng
to
tree.
rgt
ungs
common
Wc
A.
te
a
C.
sows
indngs?
brougt
B.
o
tese
s
Let
years.
oowng
wt
o
oowng
necton
across
T4
A.
patent
wtn
g
te
s
and
T5
racture
department
patent
abnormates
Wc
to
tat
depart-
rb
n
source
ibers
parasympatetc
aferent
3-day-od
ment
sympatetc
sympatetc
a
back
examnaton
zoster
T3
sows
o
et
Pysca
erpes
T4
rom
emotorax
bood
tree?
A.
boy
over
obes
sows
nervous
aceve
pan
o
T3
o
o
a
examnaton
acute
admns-
te
root
a
te
o
o
root
ater
severe
examna-
experencng
broncodaton
oowng
emergency
root
3-year-od
ment
22-year-od
sows
A
mts.
vrus?
o
root
o
upper
o
root
Bunde
126–148
er
actve
Dorsa
Bunde
ton
129.
nppe.
A.
norma
caracterstc
rom
E.
department
128.
wtn
ras
D.
130.
127.
a
passng
seds
A.
Questions
126.
are
59
Thorax
2
to
o
myocarda
o
te
et
emergency
cest
narcton.
angograpy
on
te
severe
s
perormed
ventrce
prevous
pan.
Ater
s
te
and
reduced
ecocardogram
3
60
C H A P T E R
2
Thorax
L
•
Fig.
2.2
•
•
monts
ata
te
134.
ago.
tip
o
Rigt
B.
Let
C.
Rigt
te
Let
is
Wat
paced
is
te
to
o
ago.
patent
te
structures
D.
T racea
135.
A
Ineror
s
comes
ater
surgery
patent
ad
a
surgery
woud
no
cava
up
te
2.5).
most
pysician
vave
we
been
sgnicant
(Fg.
be
to
mitra
went
as
vena
wtout
we
snce
cardac
Wc
key
or
post-
repacement
o
8
compca-
te
surgery.
ypertropy
te
oowng
compressed?
cava
cava
man
ater
He
as
becomes
(Fg.
st.
mm
o
s
Wc
descrbe
Hg.
externa
sows
ts
o
to
n
37°C
are
progressvey
2.6)
brougt
nvoved
sgnicant
respratons
sgns
s
beng
temperature
120/90
.4
trunk
vena
29-year-od
mn,
man
he
Superor
coson.
vena
te
C.
Hs
oow
and
Pumonary
depar tment
pacemaker?
68-year-od
Esopagus
B.
E.
prevent
ocation
ventrice
operative
beore
2.4).
ventrice
Superior
he
pacemaker
(Fig.
atrium
E.
weeks
.3
atrium
D.
tons
cardiac
arrytmias
A.
A
A
Fig.
A.
Fig.
no
te
te
a
dcuty
(96.8°F),
25/mn,
Pysca
and
worse.
oowng
n
puse
bood
An
but
te
x-ray
bones
o
or
Fa
B.
Empysema
cest
wt
condtons
C.
Hemotorax
paradoxca
s
100/
pressure
sows
dyspnea
te
cest
medastna
case?
A.
vece
breatng.
examnaton
njures,
ractured
emergency
motor
respraton
woud
best
CHAPTER
•
•
Fig.
.5
not
ave
botte
136.
D.
Spontaneous
E.
T ension
A
pneumotorax
56-year-od
department
Pysica
o
Wic
sown
137.
o
in
cest
te
te
Rigt
upper
Rigt
midde
Rigt
ower
D.
Rigt
upper,
E.
Rigt
upper
perormed
ound
ing
to
A.
Rigt
B.
Let
C.
Inerior
is
ronci.
pneumonia
o
te
ung
(Fig.
Sortenng
is
An
C.
aected
and
as
D.
o
an
te
(Fig.
Diagona
47-year-od
to
pain
acute
te
2.8).
obviousy
a
a
myocardia
stabiized,
major
emergency
ater
wie
inarc-
angiograpy
but
years.
as
a
drunk
Pysca
caracterstcs
prmary
resut
ympatc
suspensory
ta
o
te
te
o
coronary
Wic
bocked
o
by
arteries
te
cest
severa
te
a
exam-
n
er
o
wc
rgt
o
vesses
gaments
by
cancer
breast
retnacua
pectoras
a
o
A.
are
he
B.
interventricuar
ts
er
rigt
to
te
cuts
major
breast.
he
or
patent
an
does
s
s
o
o
te
o
te
areoa
by
metastatc
brougt
o
to
te
te
to
and
bood
admtted
notaton
o
o
te
te
rom
emergency
wound
ntercosta
s
sternum.
s
trad”
s
oowng
Hs
resp-
100/70
surgca
mm
oor
and
entered
are
to
space,
110/mn,
pressure
“Beck’s
o
te
te
puse
to
nppe
buet
trd
et
(96.8°F),
te
breast
sma-caber
regon
37°C
nverson
system
cart. Wc
on
eatures
trad?
here
was
he
he
njury
patent
o
as
ung,
te
et
pumonary
artery,
et
esopagus
beedng
and
as
pressure;
pressure
te
and
nto
te
medastna
peura
st
to
cavty,
te
a
rgt
torax
patent
puse
to
broncus,
coapsed
pysician
a
26/mn,
patent’s
sde
comes
s
patent
prmary
woman
te
premnary
te
man
centmeters
ratons
is
aterosce-
n
sde)
duct
ater
temperature
Hg.
oow-
(same
te
27-year-od
C.
in
te
o
o
Ipsatera
is
interventricuar
cange
s
cancer
10
nppe
department
cot?
(posterior)
Circumlex
d’orange
cutaneous
o
axary
Invason
te
brougt
is
A
coronary
E.
te
o
Contracton
2.7).
ower
cest
sows
one
anterior
abnorma
is
patient
most
or
and
severe
ECG
D.
A
and
Bockage
B.
n
o
or
occurrences?
A.
percussion,
ower
occuded
paque
obes
midde,
man
and
arteries
rotic
sounds,
on
ever.
peau
day
cancer
and
te
be
duness
obar
emergency
ig
.6
story
every
condton
oowng
cancer
wit
An
breat
te
and
139.
62-year-od
Ater
sows
hs
E.
C.
tion.
o
sows
to
coug,
sows
oowing
B.
jogging.
brougt
amy
breast.
image?
A.
A
is
a
wne
naton
te
dyspnea,
intensity
te
department
138.
man
wit
examination
decreased
x-ray
pneumotorax
o
Fig.
61
Thorax
2
a
sma,
and
quet
ncreased
eart;
decreased
centra
venous
62
C H A P T E R
2
Thorax
D.
he
young
emptyng,
E.
he
et
man
ung
respraton,
eart
140.
A
and
and
34-year-od
and
o
reaxes
te
sbe
or
cavty
oowng
A.
s
“bucket
B.
o
o
C.
s
Hs
n
s
st
o
te
emergency
breat.
te
week
wa
tte
tat
vertca
s
o
dsease
o
s
o
te
o
te
dsease?
and
oss
o
te
rbs
nerve
“pump
as
respon-
Wc
s
musces
ntercosta
contracts
dmensons
cause
he
wt
movement
most
cavtes).
movement”
te
arc
paradoxca
degeneratve
musce
key
o
dastoc
aortc
te
o
toracc
tere
ntercosta
oss
to
earer
peura
most
s
medastna
sortness
te
te
tere
brougt
he
te
s
Generazed
n
a
marked
o
et
but
wa.
ande
resuted
s
(and
te
Parayss
s
te
syndrome.
ncreasng
toracc
to
voenty,
afected
rom
daton
dagnosed
abdomna
obvousy
tere
severe
been
Guan-Barré
and
coapsed,
man
or
ad
suferng
as
tracea
department
patent
s
dyspnea,
parayss
ande
tat
movement”
rbs
Parayss
o
s
nterruptng
musces,
meda
te
an
and
uncton
atera
o
mportant
s
pectora
nerves,
pectoras
accessory
major
musce
o
respraton
141.
•
Fig.
D.
Parayss
E.
Degeneraton
A
department
.7
a
ater
te
cardac
tons,
te
o
contracte
Rgt
C.
Pregangonc
.8
began
become
patent
T wo
cardac
output.
caused
an
days
asssted
experencng
cardac
as
he
syndrome.
ad
by
severe
contrac-
Wc
o
nterrupton
nerve
sympatetc
ibers
orn
te
eart.
he
better
te
ibers
carred
neurons
man
coser
n
by
upper
upper
eart
vave
B.
Pumonary
C.
Mtra
D.
Aortc
Vave
o
te
45-year-od
department
te
utrasound
mout
to
structure
utrasound
T rcuspd
spna
to
toracc
toracc
can
mage
be
neror
man
because
cord
s
o
best
vena
or
sp-
drecty
to
te
tat
T1–T4
a
(TEE).
transducer
e
s
eves
pyscan
ecocardograpy
or
a
o
comes
an
nose
A.
E.
Fig.
pan
procedure,
troug
A
breat.
nerves
emergency
stmuus?
transesopagea
Wc
te
decreased
reduced
key
to
nerves
V entra
te
wt
prenc
nerves
45-year-od
ued
e
musces
s
nerve
prenc
Cardac
E.
o
breatng
most
B.
A
brougt
sortness
n
Let
na
o
Guan-Barré
arrytma,
vagus
myen
s
ventaton,
resutng
spna
143.
o
A.
D.
te
man
patent’s
oowng
te
sternocedomastod
o
wt
story
mecanca
142.
s
34-year-od
as
•
o
s
sced-
Durng
paced
bend
te
transducer,
te
can
vsuazed
be
obtaned.
by TEE?
cava
brougt
to
contnuous
te
emergency
vomtng
or
te
CHAPTER
past
is
2
days.
severey
ud
te
He
as
repacement
cest
presence
tures
s
istor y
deydrated.
sows
o
a
and
a
he
e
md
wc
o
acoo
recovers
abuse
was
we.
oowng
andmark
An
te
A.
Pregangonc
on
B.
Postgangonc
x-ray
anatomc
or
and
paced
pneumomedastnum.
te
radoogc
o
patent
o
nary
he
struc-
dagnoss
o
144.
A.
Let
superor
B.
Vagus
C.
Superor
horacc
D.
Postgangonc
E.
Postgangonc
Pumonary
Aortc
ends
to
sows
muncaton
o
145.
born
te
upper
te
between
s
most
congenta
at
34
weeks
pneumonts.
esopagus.
condtons
ts
was
and
sma
o
o
commony
o
an
tracea
Wc
o
seen
scan
te
te
esopagus
te
com-
ower
oowng
n
and
o
abnorma
and
te
gestaton
CT
segment
presence
te
A
assocaton
mass
atera,
to
bopsy
seg-
and
wt
a
tumor,
A.
Anteror
B.
Latera
Parasterna
Centra
C.
Anydramnos
E.
Apca
D.
Hydatdorm
E.
Corocarcnomas
sure,
man
because
tat
ar ter y
and
externa
Questions
s
o
as
oowng
b rougt
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 .
nam m at on.
embr yoog c a
te
s gn icant
w or s ene d
pres s ure ,
deayed
sgns
Fourt
B.
hrd
C.
Let
dorsa
D.
Let
it
E.
Sxt
A
paryngea
paryngea
ment
or
naton
sows
te
a
et
tons
severe
sows
s
et
he re
s tr uctures
were
w c
d oe s
o
te
ts
no
B.
Laryngea
C.
Empysema
D.
Respratory
E.
atng
cest.
te
to
s
ECG
key
d e ect
are
sweatng?
and
te
emergency
cyanoss.
An
o
Pysca
x-ray
and
te
depart-
et
man
o
exam-
te
key
irst
(pectora)
(nracavcuar)
pockets
arm
wa
and
an
o
o
to
severe
te
cest
sweatng
myocarda
et
ventrce.
responsbe
pan
or
rad-
over
narcton
Wc
te
s
o
nerve
ncreased
151.
key
o
te
oowng
suferng
o
te
ower
aortc
pumonary
C.
Stenoss
o
aortc
D.
Regurgtaton
E.
Stenoss
A
o
was
man
to
was
by
reerred
Vagus
B.
Intercostas
te
Prenc
E.
Cardopumonary
n
dmpng
er
o
brougt
arm.
woman
rgt
skn
o
to
te
A
te
emergency
breat
and
dagnoss
rom
o
scema
vasodaton
Wc
te
comes
breast.
to
o
ntrogycerne
eart.
pan
Intercostobraca
ump
et
te
D.
41-year-od
vave
vave
sortness
resutng
C.
A
mtra
causng
to
vave
vave
Subngua
ow
A.
o
s
made
condton
bood
troug
because
radatng
abnor-
vave
pumonary
58-year-od
vave
rom?
troug
ng
emergency
Wc
most
troug
nerves
ncreased
acute
te
key
space.
se
Regurgtaton
te
erna
brougt
edema
Regurgtaton
n
ar
sows
B.
cond-
o
oowng
examnaton
myocardum.
istua
s
s
pectors
cest
syndrome
compants
sows
most
most
to
ymp
tumor?
A.
pan
dagnoss?
dstress
Pysca
mates
atresa
wt
posteror
ibers
to
Wc
T raceoesopagea
department
w
traced
te
149–173
department
dapragmatc
55-year-od
were
recevng
tssue
ymp
axary
axary
ntercosta
150.
pneumotorax
most
nodes
te
te
mbs and a systoc murmur was eard n te et second
te
arc
abdomen.
emtorax.
Congenta
vesses
nodes
by
A 51-year-od woman comes to te pyscan compan-
mts.
p res-
arc
brougt
at
A.
A
s
sde
he
nto
up
and
node
Se aso as generazed atgue. Vtas are wtn norma
arc
dyspnea
a
njected
above,
ymp
ng because o dyspnea on exerton or te past 2 monts.
arc
paryngea
boy
te
sgty
underwent
taken
a
and
aorta
paryngea
3-day-od
area.
ymp
perormng
Mammogram
days .
n cre as e d
e mor a
From
149.
arse?
A.
T4
moe
examnato n
braca
was
Wc
wen
sower.
dameter
Se
was
axary
D.
Pysca
to
superor,
axary
C.
eadace
n
a
dye
rom
Poyydramnos
3 0-year-od
T1
rom
ganga
breast
takng
wc
te
tumor.
ymp
rgt
cm
te
expose
Ogodramnos
A
cardopumo-
rom
ibers
cervca
areoa.
specic
dranng
te
1
rgt
vesses,
receve
er
we
about
er
te
rom
anomay?
ibers
sympatetc
n
around
surgcay
cnca
te
aferents
sympatetc
neror
mass
B.
a
147.
and
A.
depar tment
146.
a
sows
ave
tat
bndy
ment
ven
boy
ound
vscera
se-examnaton
arc
newborn
cest
cava
n
A 35-year-od woman comes to te pyscan ater ind-
ng
vena
E.
was
148.
nerve
D.
A
ven
sympatetcs
nerve
mdde,
ntercosta
parasympatetcs
C.
pneumomedastnum?
63
Thorax
2
and
te
o
te
reeved
mprov-
oowng
arm?
to
te
Pysca
breast
o
cest
angna
over
pyscan
examnaton
te
mass.
A
or
a
sows
CT
scan
o te breast sows a 3-cm mass at te rgt upper quad-
rant
o
er
dmpng
o
te
rgt
o
te
tumor
breast
breast
nto
wt
s
wc
mutpe
most
o
key
te
cacicatons.
caused
oowng
by
he
nvason
structure(s)?
64
C H A P T E R
2
Thorax
C.
Rgt
dorsa
segmenta
155.
D.
Ft
E.
V entra
A
arc
e
runs
tat
o
eet
sort
emora
te
man
cod
a
o
puses
te
irst
comes
to
and
are
aorta
arc
to
te
sevent
nter-
pyscan
and
pan
Pysca
muc
CT
artery
te
egs,
dstance.
hree-dmensona
taton
proxma
artery
part
25-year-od
eadace,
aorta
artery
scan
n
weaker
to
te
severe
egs
examnaton
tan
angograpy
proxma
wt
s
et
rada
sows
wen
sows
puses.
a
coarc-
subcavan
artery .
he condton tat creates tese symptoms s a resut o a
aure
•
152.
A.
Lactierous
B.
Mammary
C.
Suspensory
Cavipectora
Media
and
65-year-od
department
upper
jaw
cardia
beind
artery
153.
and
te
is
te
Circumlex
Anterior
C.
Inerior
D.
Let
E.
Rigt
A
i
B.
Prenic
C.
Let
D.
Rigt
E.
Greater
te
to
wit
is
eart
be
brougt
a
to
a
to
A
er
cest
coronary
wi
ab
pain.
or
an
aure
Foramen
Septum
Wic
emergency
scan
(Fig.
aneur ysm.
most
ypopastc
C.
dyspagia
ikey
continues
T runcus
E.
Bubus
to
or
25-year-od
oss
or
6
day
or
10
o
surace
a
beng
Prenc
Vagus
cest
Intercosta
D.
Recurrent
E.
horacc
te
emergency
sowed
was
emergency
severe
depart-
menta
B.
Let
ta
to
o
cateter.
regress
dsta
to
te
snce
monts.
te
dorsa
aorta
dsta
to
structures?
and
are
a
te
emergency
2
packs
o
norma
tumor
nvadng
um.
wegt
cgarettes
wtn
te
te
to
unntentona
mts.
te
Wc
a
An
ung
nerve
s
tumor?
Se
comes
as
a
to
te
story
pyscan
o
severe
or
a
rou-
reumatc
vave
repacement
o
et
cateter
to
n
te
Wc
ts
o
as
a
te
condton?
sevent
te
sevent
nterseg-
ntersegmen-
surgery
2
years
ago,
but
An
x-ray
o
te
cest
sows
sternotomy
wres,
prostetc aortc and mtra vaves, and a greaty enarged
artery
artery
ypertro-
se as deveoped some new symptoms over te past ew
inerior
brougt
cateterzaton
passage
onger
aed
aorta
oowng
smoked
to
woman
up.
atrum.
drect
Wc
resut
o
processes
dorsa
and
aryngea
nous
structures
te
brougt
sows
by
and
Rgt
ventrce,
vscera
60-year-od
oow
s
Vtas
anteror
C.
stabe
to
patent
Durng
a
Se
compressed
B.
A
o
dyspnea
years.
te
A.
com-
woman
wt
just
2.9)
grow?
wc
monts.
Wic
be
rgt
arterosus
Nausea
A.
s
utrasono-
cords
Pan
oowng
An
he
Se
prmum
B.
requres
atresa.
cyanoss.
story .
cusons
A.
tus
vave
or
amy
secundum
D.
A
o
a rgt subcavan artery passng posterory to te esop-
and
pyscan
cardac
eart dsease. Her cardac symptoms ave been reatvey
ECG
he
deect
rom s rgt rada artery t s noted tat te patent as
agus
te
any
trcuspd
B.
tne
brougt
arteres.
to
ave
wt
arc
arc
comes
not
per-
is
spancnic
is
gr
does
immediatey
aryngea
inarcton.
cateterzaton
newborn
Endocarda
158.
a
A
opmenta
aryngea
man
arc
paryngea
paryngea
A.
te
CT
aortic
aneur ysm
toracic
structure?
aorta
myo-
inarcted.
worsening
sma
ner ves
recurrent
myocardia
it
Sxt
department
oarseness.
aortic
59-year-od
s
as
recurrent
Let
E.
x-ray
sows
te
Vagus
ment
sows
interventricuar
graduay
oowing
A.
A
radiating
ECG
cateterization
o
ound
woman
aso
Se
torax
D.
paryngea
wc
ped et ventrce. he patent most key reects a deve-
coronary
mont.
te
emergency
margina
wit
pressed
pain
ours.
te
occuded?
(posterior)
dorsa
septa
to
157.
department
o
nerves
cest
3
Cardiac
is
Let
patent
interventricuar
42-year-od
te
nodes
brougt
portion
ikey
B.
is
or
sternum
most
hrd
C.
o
arc
grapc sows a wdey patent oramen ovae, ventrcuar
severe
arms
A.
o
154.
wit
B.
deveopment
paryngea
dagnosed
pectora
woman
and
ymp
ascia
atera
inarction.
ormed
156.
apica
igaments
E.
norma
Fourt
.9
ducts
and
D.
A
Fig.
o
A.
159.
and
C.
Dcuty
D.
Epgastrc
E.
Increased
A
59-year-od
ment
wt
symptom
er
et
woud
most
key
atra
enargement?
over
toracc
deveop
vomtng
tenderness
vertebra
sp-
swaowng
pan
ater
eatng
atty
oods
cougng
man
severe
s
brougt
cest
pan
to
and
te
emergency
sweatng.
He
depart-
as
a
ong
CHAPTER
istory o ypertension and uncontroed diabetes. Vitas
or
are
concern
witin
sigt
160.
norma
rytmic
Pysica
pusation
on
examination
te
cest
wa
sows
at
te
a
et
artery
s
n
a
Anteror
C.
Let
Rgt
B.
Let
C.
Aortc
D.
Apex
E.
Mtra
woud
be
te
cause
o
ts
pusaton?
atrum
atrum
arc
o
te
eart
164.
vave
Snuatra
cronc
severey
just
ts
accompanyng
snce
ater
ven
Mdde
B.
Great
cardac
C.
Sma
cardac
D.
Anteror
E.
Posteror
t
monts
o
te
a
be
and
ECG
Coronary
arses
or
must
6
yesterday.
bockage
artery
A.
or
narcton.
tota
artery
angna
worse
myocarda
exposng
rom
sows
an
(S1)
te
et
rom
pd
o
IV
murmur,
vave.
o
te
et
a
present
bood
puse
sows
a
torax
on
te
te
cocentess
s
s
at
et
at
rgt
n
ne
n
over
ts
mm
An
Hg.
te
o
ower
woud
are
woman
Vtas
are
sows
was
and
absent
Cest
C.
Nasogastrc
D.
horacocentess
E.
Percardocentess
o
A
space
most
te
tora-
n
166.
te
A
appro-
tube
and
cardac
son
was
man
he
Sevent
nerve
C.
Nnt
symptoms?
A
7 0-year-od
depar tment
not
or
been
5
sma
trc
abe
mgt
a
n,
ofe r
b rougt
a ve
x-ray
o
surgca
or
n
Wen
w c
te
tub e
as
or
atus
a
s
m o st
pas s es
tat
to
te
stomac?
Posteror
B.
Leve
C.
Posteror
to
D.
Posteror
to
E.
Esopagea
o
to
te
te
et
atrum
superor
aortc
te
et
atus
man
o
aperture
te
Somatc
D.
Pregangonc
broncus
E.
167.
A
T1–T4
o
te
ung
secton
o
o
te
narcton.
tenson,
Se
and
as
a
story
uncontroed
o
an
acute
morbd
dabetes.
myocarda
obesty,
Se
s
yper-
scedued
te
as
60%
he
wt
apart-
exam-
systoc
condton
wc
o
te
to
te
rb
pyscan
a
story
eart
wt
and
o
yperten-
aure.
ejecton
he
racton.
damaged
to
dzz-
reduced
cause
rom
ast
Wc
te
tese
vagus
pexus
n
n
te
te
aor ta
hs
orn
prenc
toracc
nerve
vscera
rom
T1
to
nerves
T4
atera
ta t
te
vesse
es
e t
oowng?
Urne
E.
Oxygenated
bood
bood
on
an d
wou d
ob e ctomy
Durng
m ed as t num,
te
b e twe en
Lymp
D.
op en
a d e n ocarcn oma.
bodes
on
neurons
und er wen t
post e r or
Deoxygenated
ave
er
Pysca
bradycarda
sympatetcs
an
vesse
ver tebra
te
A.
a
or
Sava
to
to
been
wom an
C.
ound
emergency
o
reduced
parasympatetcs
ventra
6 5-year-od
B.
s
ave
eferents
pan
se
superor
patent
aferents
A 55-year-od woman comes to te pyscan or cest
and
sternum
orn
rgt.
dapragm
te
vens.
aevated
ave
cardac
Vscera
racc
arc
te
C.
te
toracc
te
may
n
to
sowed
B.
denties
A.
mts.
sounds,
congestve
Pregangonc
a
nas o gas-
te
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
te
he
move me nts
te
re at on
resstanc e
to
p a n .
b owe
obstr uct on .
by
ste
s
abdomn a
to
An
bowe
dsta
man
or
days.
tube
ibers
nerve
to
bacony
juguar
comes
dastoc
B.
A.
te
o
ne
ound
ecocardogram
Egt
ne
sternum
tube
output.
and
border
brougt
eart
nserton
venous
55-year-od
ness
rgt
norma
be
Centra
Ft
Eevent
can
B.
are
mdcavcuar
o
vave?
sternum
procedures?
A.
cest
s
rom
engorged
A.
E.
a
wtn
created
oowng
a
24/
trd
be
s
o
border
trcus-
hrd
Crackes,
te
ne.
ntercosta
patent
coug
remtus
x-ray
mdcavcuar
Wc
and
temperature
decreased
obe.
te
ever
te
ts
Second ntercosta space at rgt border o sternum
ater
at
border
wtn
systoc
E.
42-year-od
space
et
a
D.
A
ntercosta
at
o
auscutate
space
njury?
space
to
space
prate or nserton o te neede durng ts procedure?
D.
ts?
depart-
are
sows
regurgtaton
ste
ntercosta
respratons
110/70
and
ower
scedued.
mdcavcuar
s
efuson
rgt
o
o
best
ntercosta
naton
Hs
110/mn,
sounds,
rgt
peura
story
te
Ft
ventrce
sputum.
pressure
breat
n
1-week
s
Vtas
examnaton
Ft
ment.
puruent
(102°F),
decreased
s
emergency
endocardts.
suggestve
ntercosta
department
o
and
C.
165.
ven
use
B.
wc
tat
and
to
coronary.
ment
mn,
brougt
Pysca
Wat
Fourt
pressure,
38.9°C
drug
mts.
A 25-year-od man s brougt to te emergency depart-
o
artery
nterventrcuar
s
A.
cardac
because
woman
nterven-
procedure,
protected
as
angograpy
anteror
bypass
t
cardac
productve
Wc
prmary
crcumex
ment wt dyspnea or 3 monts. he patent as a s-
norma
In
o
te
noda
(posteror)
35-year-od
tory
trcuar
eart.
artery
rom
nterventrcuar
Ineror
ment
neary
domnant
he
arses
margna
E.
A 48-year-od man s brougt to te emergency depart-
wt
tat
margna
D.
A
operaton.
vesse
et
B.
mts. Wat
A.
Rgt
bypass
te
ma
sows
163.
coronary
A.
acute
162.
a
it ntercosta space. An x-ray o te cest s wtn nor-
gotten
161.
imits.
65
Thorax
2
te
m os t
anter or
te
a
a
s ur ace
d es ce nd ng
az ygos
ke y
d s -
surge on
ve n
con ta n
o
to-
on
te
w c
66
C H A P T E R
168.
Thorax
A 10-year-od boy comes to te pysician or a ard mass
tone.
in
issures,
is
cest
tat
existed
or
2
monts
and
was
ound
to
rom
arge
systoc
to
tumor
o
te
rom
te
a
structure
superior
wc
Frst
B.
Second
C.
hrd
o
te
Fourt
Ft
s
most
paryngea
anterior
posterior
key
a
derved
a
pouces?
wt
was
n
te
he
an
o
te
and
brdge,
wa
deect
uson
was
ts
woman
ater
was
respratons
temperature
mm
Hg.
wt
brougt
suferng
Her
are
he
s
a
38.9°C
Faed
uson
o
septum
was
breat
on
110/
arger
s
o
te
Sort
E.
Incompete
te
172.
A
rgt
to
perorm
torax.
be
an
to
te
and
emergency
Between
paced
Between
wc
reeve
vscera
te
te
pyscan
decompresson
ayers
w
te
o
32-year-od
neede
na
pneumotorax?
and
pareta
ayers
B.
Between
C.
Between
te
serous
and
ibrous
ayers
medastna
peura
and
o
te
woman
o
te
ibrous
pareta
and
vscera
ayers
o
te
te
endotoracc
ton
woman
cesarean
sowed
devered
secton.
tat
C.
It
s
D.
he
he
asca
and
pareta
173.
A
te
a
gr
Utrasound
eta
eart
at
was
at
37
16
weeks
weeks’
ocated
by
tor y
te
Pysca
pnk
examnaton
wtout
o
te
gr
cardopumonary
sowed
dstress.
day
and
a
Wat
cm
was
seen
outsde
te
skn
n
te
mdne
o
te
num.
was
A.
he
te
gr
most
Faed
was
key
uson
dagnosed
wt
embryoogca
o
ectopa
cause
o
peuropercarda
cords.
ts
Wat
A.
at
Faed
21
key
te
AV
wt
septum
uson
Faed
part
o
te
septum
o
s
ts
a
by
cesarean
pansystoc
utrasound
a
et
deect
septum.
concernng
sowed
n
rgt
te
te
cra-
o
te
cardac
patent?
o
te
to
o
bood
to
sec-
mur-
and
Wc
parttonng
et
sunt
at
bubus
at
cords
brt
brt
septum
and
endocarda
use
prmum
woman
o
te
se
and
septum
devered
gr
was
wt
secundum
sowed
unt.
batera
cardac
most
2.7-kg
aed
an
Se
sadow.
orentaton
key
cause
respra-
admtted
deveoped
An
azy
A
o
o
gr
Pysca
eevated
tacypnea.
basa
(6-b)
dever y.
subsequenty
care
norma
a
vagna
persstent
sowed
te
gr
between
true
spontaneous
a
a
sows
troug
cyanoss
ntensve
sows
nto
brt
and
ater
venosus
to
a
te
ever
x-ray
o
opacicaton
woe-body
te
CT
oter
vscera.
gr’s
cardac
ts
and
superor
growt
o
te
prmorda
atrum
te
B.
Anteror
and
neror
growt
o
te
prmorda
ventrce
o
peuropercarda
C.
at
Posteror
mdne
B.
et
condton?
deect?
ods
rgt
rgt-sded
5
torax. An x-ray o te cest sowed a “spt” n te ster-
n
aed
va
cest
scan
6
a
septum
rate
Vta sgns were wtn norma mts. A pusate mass o
×
most
wt
snus
Cardac
key
uneven
cause
use
te
drecty
nterventrcuar
neonata
te
was
a
term
a
e
s
examnaton
gesta-
outsde
crana
nterventrcuar
most
30-year-od
te
tat
te
trsomy
te
prmum
devers
systoe,
dscovered
causes
cest cavty but te moter opted aganst termnaton o
pregnancy .
s
It
at
38-year-od
te
B.
to
peura
eectve
o
here
E.
bood
durng
cusons
te
Between
o
A.
peura
A
part
deect
percardum
Between
jet
oowng
percardum
te
sma
ventrces
percardum
E.
s
prmum
o
cyanoss.
D.
rom
wt
atrum
wtout
A.
rgt
a
sowed
secundum
resorpton
a
pneumotorax
A
septum
mur
tenson
cest.
resorpton
D.
tan
auscutaton
et
Excess
as
to
sowed
prmum
tracea tug to te rgt sde was noted. Se was assessed
a
te
s
C.
te
pressure
notaby
o
to
puse
bood
sounds
percusson
emergency
wound
examnaton
ave
cest
eye
tongue
patent?
septum
Pysca
et
te
Wat
o
ton.
avng
to
te
(102°F),
and
torax
decreased
to
gunsot
24/mn,
et
yperresonance
te
obque
utrasound
dagnosed
deect.
n
te
Cardac
separatng
septa
o
wt
protrudng
secundum
mn,
prepared
at
and
Auscutaton
murmur.
patent
atra
Faed
broad
nose
jaw.
ejecton
deect
B.
back.
rgt
sma
atrum.
A.
25-year-od
and
most
immediatey
structure
oowng
te
ace
attened
septum
E.
te
hs
in
cause
D.
90/70
ocated
mediastinum
manubrum.
A.
A
in
department
170.
Hs
ave a tymoma. CT scan o te cest sows a singe but
part
169.
2
uson
te
septum
transversum
wt
ods
o
atera
body
wa
ods
n
te
C.
Anteror
D.
Growt
o
and
prmorda
neror
growt
E.
Growt
o
te
eart
prmorda
o
te
tube
eart
to
bubus
te
tube
to
cords
et
te
rgt
mdne
D.
Faed
uson
o
peuropertonea
E.
Faed
uson
o
percarda
at
coeom
te
and
mdne
Questions
coeom
171.
A
174.
42-year-od
sgns
mbs
o
te
woman
boy
equay,
were
tere
devered
norma.
was
a
boy
at
Atoug
generazed
term.
e
174–188
pertonea
Vta
moved
decreased
a
musce
A
o
54-year-od
a
rom
sm
2-week
acd
and
man
story
reux.
was
He
comes
o
as
dagnosed
to
te
pyscan
progressvey
a
20-year
wt
story
Barrett
because
ncreased
o
pan
acoo-
esopagus
3
years
CHAPTER
ago.
ta
An
part
e
as
esopagea
o
Hg.
is
are
An
mediastinum.
tion
te
o
luid
te
CT
in
oowing
and
cest
o
structures
is
is
te
is
His
azy
cest
dis-
178.
respira-
opacity
sowed
ikey
tem-
120/80
mediastinum.
most
te
120/min,
pressure
sows
posterior
and
Postoperativey,
discomort.
puse
bood
scan
te
perormed
excised.
cest
(99.5°F),
24/min,
o
is
is
increased
37.5°C
x-ray
surgery
esopagus
graduay
perature
tions
te
a
in
horacc
B.
Esopagus
tis
Descendng
D.
Azygos
E.
Bronca
4-day-od
ment
aorta
ven
ympatcs
gr
because
s
o
brougt
to
dyspnea,
te
emergency
tacycarda,
depart-
179.
tacypnea,
ernaton
a
o
bowe
ypopastc
ture
most
et
key
nto
te
ung.
aed
o
te
et
toracc
Wc
to
abdomen
cavty
embr yoogc
deveop
and
resuted
and
176.
Septum
B.
Peuropertonea
C.
T raceoesopagea
D.
Laryngotracea
E.
V entra
dure
s
groove
2
Let
ment because e was stabbed n s rgt anteror cest
C.
Let
wa
D.
Rgt
E.
Let
trd
and
a
sarp
examnaton
rgt
dstended
neck
and
torax.
x-ray
te
wt
ng
An
et
and
acute
s
te
sows
ntercosta
percusson
to
nstrument
space
vens.
absent
o
te
key
at
domestc
te
here
cest
a
puncture
breat
batera
respratory
most
a
n
s
n
te
ne
yperresonance
sows
dstress.
wound
mdcavcuar
sounds
opactes
dspute.
a
on
rgt
devated
wc
Wc
are
o
180.
on
em-
a
tracea
Rgt
tenson
B.
Rgt
smpe
pneumotorax
C.
Rgt
smpe
pneumotorax
oow-
a
pneumotorax
cardac
tampon-
Rgt
tenson
E.
Cardac
pneumotorax
and
cardac
tampon-
ade
tamponade
35-year-od
department
motor
vece
mutpe
An
skn
x-ray
evdence
o
o
opacied.
notc.
man
ater
brougt
coson.
te
cest
Pysca
s
not
most
ater
key
a
emergency
t
and
examnaton
any
he
te
te
n
broken
peura.
ours
te
but
sows
punctured
to
nvoved
aceratons
Severa
Wat
s
beng
major
rbs
ung
patent
cause
o
sows
beedng.
5–7,
ied
but
no
appears
appears
te
run
cya-
cyanoss?
Cardac
Lung
a
te
con-
proce-
underyng
structures
s
most
procedure?
nerve
severe
s
cest
on
pan
te
breat
cest
o
a
durng
breat-
puse
bood
examnaton
rgt
Wc
upon
and
rgt-sded
te
emergency
cest
(102°F),
Pysca
o
te
te
25/mn,
decreased
et.
n
38.9°C
are
Hg.
to
stabbed
sows
yperresonance
sounds
sows
sde
te
s
pres-
and
over
te
decreased
a
tracea
oowng
s
te
dagnoss?
pneumotorax
pneumotorax
tamponade
department
cest
sty,
pan.
myocarda
te
oowng
C.
Parayss
ts
man
because
he
dabetes,
Hemotorax
dapragm
pumonary
sows
toracoscopc
te
and
sows
Pneumona
Fa
te
te
72-year-od
B.
o
cest
contuson
A.
cest
a
x-ray
Spontaneous
D.
cavce,
ncreased
durng
cross-
accompaned
te
o
to
dstress.
murmur
s
et
o
brougt
beng
and
T enson
A
s
dstenton
B.
C.
te
x-ray
correcton
njury
brougt
nerve
markngs
key
s
systoc
and
aryngea
mm
A.
E.
181.
o
as
An
to
boy
oowng
respratons
ung.
most
or
temperature
devaton
D.
He
ven
a
beow
An
te
ater
80/50
vascuar
to
nerves?
respratory
Ecocardograpy
man
percusson,
rgt
and
recurrent
juguar
on
o
do-
nerve
prenc
igt.
s
A
nerve
prenc
Hs
sure
x-ray
nerve
vagus
110/mn,
ade
A
bar
An
admnstered
murmur
vdeo-asssted
rsk
vagus
born
souette
o
27-year-od
ng.
dagnoss?
A.
at
depar tment
consstent
te
A
s
days.
percusson
ange.
oowng
wt
he
eard
consdered
Rgt
te
sows
cest.
A
Wc
B.
wt
best
te
cardac
A.
on
coug,
3
nerve
sound.
markngs.
commony
mesogastrum
s
over
A 30-year-od man s brougt to te emergency depart-
past
bateray.
agent)
o
department
deect.
deect.
duness
costoprenc
prematurey
eart
tr,
genta
septum
aryngea
examnaton
enarged
te
nerve
emergency
a
emergency
dry
a
nerves
Recurrent
S
or
te
by
nerve
3-week-od
te
a
ung
wc
E.
n
membrane
to
Vagus
A
sows
te
Cardopumonary
radates
transversum
o
to
oowed
ever
bunted
D.
struc-
te
and
C.
vascuar
A.
Pysca
177.
Intercosta
brougt
cs
anestetc
pan
Prenc
by
ernaton?
oca
B.
te
sows
obe
A.
ng
x-ray
pan
sows
te
Pysca
An
s
o
examnaton
(a
caved
abdomen.
because
ower
and cyanoss. Pysca examnaton sows a depressed
n
pneumotorax
man
cest
cest
cane
duct
C.
A
te
te
reduce
A.
pneumotorax
55-year-od
n
o
patient?
175.
A
Pysca
coec-
damaged
Spontaneous
peurtc
te
Wic
T enson
E.
department
mm
o
D.
67
Thorax
2
patent
and
dapragmatc
brougt
a
to
tgt,
as
a
o
te
surace
coronary
o
arteres
s
te
story
o
An
cardac
te
emergency
burnng
ypertenson.
narcton
patent?
s
o
ECG
musce
eart.
most
substerna
morbd
a
ormng
Wc
key
obe-
sows
o
te
occuded
n
68
C H A P T E R
182.
2
Thorax
A.
Anterior
B.
Circumlex
interventricuar
coronary
C.
Let
D.
Rigt
coronary
artery
E.
Rigt
margina
brances
A
coronary
37-year-od
term
via
artery
artery
artery
woman
spontaneous
186.
A
eart
deivered
vagina
a
3.6-kg
deivery.
(8-b)
he
boy
at
newborn
ace
s
by
o
and
pacng
te
trd
eart
costa
vaves
s
Pumonary
Aortc
embryoog-
C.
Mtra
D.
T rcuspd
E.
Bcuspd
boot
events
sape.
most
Abnorma
B.
Endocarda
C.
Aortc
D.
Pumonary
E.
Abnorma
A
a
and
ormed
man
s
because
o
te
te
eart
187.
o
2-day
te
A
te
stor y
tat
o
A
70-year-od
cutures
acng
w
posterory.
be
g
te
ever,
sows
eco
s
s
mmedatey
woman
and
at
oowng
strate
ts
o
te
B.
Posteroanteror
C.
Latera
D.
Apca
E.
Axa
posteror
to
188.
A
50-year-od
pyscan
s
because
a
nursng
pneumona,
An
x-ray
(o
vews
oowng
auscutatng?
patent
o
ange
te
sur-
second
o
Lous).
woud
dabe-
te
cest
Wc
best
o
demon-
man
ater
brougt
nvoved
te
motor
Rgt
atrum
A cest tube s paced to dran ud. he oowng ana-
D.
Rgt
ventrce
tomc
E.
Aorta
52-year-od
department
ga
o
and
retrosterna
acoosm
copy,
tp
te
te
and
o
te
te
s
o
brougt
2-day
esopagea
endoscope
most
He
as
upper
endoscope
atus
o
te
eves
Interna
2.
Skn
3.
Innermost
story
4.
Pareta
endos-
5.
Externa
6.
Vscera
dyspa-
a
unt
ts
dapragm.
dd
structures
1.
emergency
severe
Durng
te
vertebra
key
te
o
pan.
dsease.
advances
oowng
to
story
“burnng”
ver
pyscan
reaces
Wc
man
because
x-ray
te
tp
Wc
o
o
end?
o
ntercosta
te
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
deny
tp
o
man
was
perced
te
s
barb
te
vens.
Wc
barb
cest
te
te
boat,
cardac
o
o
we
removed
onto
reduced
brougt
perced
nstnctvey
brougt
sounds,
ar
ater
te
t
to
a
e
n
te
emergency
stngray’s
was
rgt
water.
and
s
sud-
snorkeng.
were
oowng
ta
ventrce
te
tere
output,
dagnoss?
he
and
Wen
muled
te
e
eart
engorged
jugu-
te
key
most
189.
A
14-year-od
ment
because
breatng.
a
and
te
Wc
dagnoss
o
te
constrcton
te
torax.
musce
best
by
A.
Vagus
B.
Prenc
comes
4-our
te
represents
cest
Pneumotorax
C.
Greater
D.
horacc
C.
Cardac
E.
Intercosta
o
te
to
te
stor y
examnaton
pase
astma
oowng
o
Deep
tamponade
o
efuson.
musce
exprator y
B.
tromboss
gr
o
Pysca
proonged
A.
ven
wa
peura
tube
te
order
durng
te
procedure?
B.
department
te
a
musce
oowng
traversed
A.
s
sows
peura
T7
man
comprse
ntercosta
T8
55-year-od
cest
percus-
peura
B.
E.
te
ntercosta
A.
A
o
on
co-
Pumonary
an
duness
emergency
vece
C.
and
sows
to
a
B.
son
examnaton
n
Let
vens
Pysca
was
beng
A.
A
son.
te
et
ordotc
department
atrum
sterna
o
key
he
aure.
anteror
te
a
te
andmark?
or
transducer?
to
or
auscutates
te
Wc
story
radograpc
per-
te
a
pyscan
on
most
comes
eart
Anteroposteror
o
te
between
coug.
as
A.
n
cest
pyscan
te
paced
Wc
mass
to
pyscan
cartages.
congestve
a
he
stetoscope
story
resdent
and
sows
postve
transducer
3-week
emergency
toward
are
a
tes,
examnaton
radates
transesopagea
utrasound
structures
oopng
to
Pysca
bood
aureus.
tube
brougt
pan.
md-esopagus
oowng
mgraton
deect
murmur
sets
and
ce
condton?
ome
prmtve
Stapylococcus
oowng
ts
a
ypertenson
cest
T wo
crest
cuson
sows
o
oosystoc
axa.
te
eart
constrcton
70-year-od
cs,
o
s
underes
neura
arc
department
Wc
key
A.
and
a
te
B.
enarged,
comes
patent’s
A.
s
man
examnaton.
carac-
ventrce
embosm
38-year-od
rgt
ca
185.
Hemotorax
was cyanotc at brt. An x-ray o te cest sows tat s
terstc
184.
Pumonary
E.
routne
transerred to te neonata ntensve care unt because e
183.
D.
toracc
vscera
o
was
severe
sows
wt
ner ves
bronca
emergency
a
tat
se
as
broncospasm
subsequenty
s
responsbe
smoot
spancnc
depar t-
dcuty
musce
made.
or
te
ces?
CHAPTER
69
Thorax
2
A n swe r s
Answers
1.
et
1–25
D.
he
te
aortcopumonary
truncus
ascendng
A.
he
B.
he
and
et
C.
he
bubar
ds
between
and
ay
w
o
to
date,
208;
rom
s
to
te
and
a
ncompete
sepa-
nto
rom
te
rgt
bubus
nterventrcuar
septum
nto
pay
rgt
to
roe
and
cor-
E.
te
ste
and
o
te
nverts,
te
eta
atresa
s
a
ound
unequa
rare
te
a
TEF ,
dvson
o
o
probaby
oregut
B.
3.
A.
nants
C.
da-
wt
s
excess
o
and/or
esopagea
reduced
wt
a
atresa
ung
or
uar
eart
n
septum
N
septa
a
stunted
A
C.
Muscuar
ung
TEF .
amnotc
he
o
Faot
congenta
eart
most
or
ud,
o
te
ventrcuar
makes
up
213,
25%
common
porton
eads
and
as
o
C.
septa
deects
deects).
D.
10%
membranous
occur
ventrcuar
E.
Ostum
tat
s
GAS
7%
prmum
most
drome
4.
around
N
congenta
deect
commony
(trsomy
208;
o
s
an
eart
atra
assocated
ess
septa
syn-
12).
216;
to
and
reac
pumonary
te
oxygenated
tssues.
ABR/McM
196,
203
bood
aowng
transposton
enters
te
o
te
pumonary
great
occur
N
trunk
rom
te
s
or
narrowng
oxygenated
enance
to
te
te
systemc
206
by
our
cardac
septa
ead
to
caracterzed
two
deect
rgt
ven-
rom
to
te
te
et
te
com-
It
cardac
vesses,
and
te
te
pu-
ventrce.
aure
deveop.
o
great
ventrce
nvoves
by
atra.
o
o
can
te
pumo-
occur
deects,
but
aong-
tere
s
presentaton.
deect
s
te
caracterzed
two
aongsde
228;
ventrces
oter
ABR/McM
stenoss
our
of
s
cardac
200,
by
com-
and
may
deects.
201
s
ormaton
A
te
o
trunk.
and
s
hs
known
aortcopumonary
transposton
and/or
murmur,
at
T etraogy
o
te
murmur
can
N
It
septa
ductus
resut
ejecton
s
our
connectons
s
ata
deect
uness
patent
an
atra
a
septa
deect.
ABR/McM
produces
a
arterosus.
n
septa
228;
wt
connecton
nvoves
anomaous
ventrcuar
208;
assocated
venous
tat
atra
patent
deect
s
deects.
crcuaton.
an
systoc
200,
wdey
murmur
201
ixed
best
and
eard
border.
septa
S2
o
wt
or
a
septa
sterna
makng
deect
197–198,
et
dsorder
venous
ovae,
deect
septa
pumonary
vens
ventrcuar
tc
cuson
eart
cana
murmur
C.
o
ventrcuar
systemc
atra
te
A.
pumonary
mentoned
caracterstc
anomaous
AV
S2
te
Fallot.
n
concurrent
GAS
o
symptoms
endocarda
te
An
bood
arteres,
arses
septa
congenta
An
B.
at
oxygenated
ves-
bood
arteres.
T ota
spt
trunk,
In
E.
7.
not
turn
rgt
between
causes
te
deect
A. A patent ductus arterosus acts as a sunt between te
aorta
An
t
deect
Down
w
ventrcuar
n
te
te
pattern
208;
deect
to
deects.
septa
wt
deect
orice
not
oramen
up
more
caracterzed
congenta
typca
to
a
Ostum secundum deect s an atra septa deect tat
makes
umbca
congenta
bood
tese
atresa
pumonary
septa
aorta
crcuaton.
transposton
membranous
deects.
D.
oter
great
are
a
dever
stenoss,
rom
trunk
septum
nterventrc-
approxmatey
o
vave
may
A
con-
tese
s
between
arses
tetralog y
216
o
te
te
crcuaton.
A. Superor maagnment o te subpumonary nun-
deects.
ventrcuar
tan
account
212,
contrast,
oxygenated
ABR/McM
and
septa
case
GAS
6.
233;
ventrcuar
or
oten
deveopment
ABR/McM
membranous
commony
n
o
stenoss
Faot
muncaton
B.
237;
(membranous
T etraogy
decrease
deects
deects.
te
B.
o
wt
or
N
o
Pumonary
no
ypopasa.
175–182;
ventrcuar
deects
a
sde
ud,
dapragmatc
atra
nary
esopa-
voume,
congenta
In
s
not
systemc
aorta,
monary
tracea,
amnotc
In
systemc
ypertropy.
aorta
E.
an
te
oxygenated
muncaton
arways
aorta
w
pumonar y
dbuum
assocated
genta
An
resutng
nto
ungs.
to
adequate
artery
o
208;
te
tat
te
T etraogy
eta
te
te
to
overrdng
obstruc-
asctes
obstructon
wt
s
ypopasa
pumonary
GAS
A.
deects:
oter.
upper
ecogenc,
and
by
o
aorta
Pumonary
D.
Ogoydramnos,
s
te
trcuar
arway
o
atresa,
become
5.
erna.
E.
Coarctaton
crcuaton.
dv-
te
patency
provde
eventu-
aves
eac
not
devery
te
to
bood
Mantaned
septum
tracea.
n
C:
woud
o
203
g
obstructon
n
et
approac
(congenta
or
a
goes
survva.
D.
atrum
ABR/McM196,
rare
assocated
Lung
and
ses
and
deoxygenated
GAS
cusons
Poyydramnos
seen
to
cana
enarge
te
oten
D.
an
te
derved
cusons
atresa
commony
gus
B
deveop.
T racea
C.
te
atra.
dvdes
s
rse
216;
attens
ydrops
nto
ventrce
carres
t.
AV
N
Dsta
ungs
pragm
cords
dvde
trunk.
aortcopumonary
AV
syndrome)
arway.
B.
te
wt
te
Laryngea
ton
to
bood
gve
te
causng
GAS
bubus
orms
two
septum
endocarda
son
A.
te
prmum
unctons
aves.
usng
he
and
pumonary
secundum
septum
neror
E.
and
septum
raton
2.
arterosus
aorta
septum
aong
Faot
tat
deect
te
w
occurs
produces
ower
not
at
et
resut
S1
or
a
pansystoc
sterna
n
S2.
a
border.
caracters-
70
C H A P T E R
D.
2
Thorax
T ransposition
mid-diastoic
E.
Aortic
toic,
Down
is
stenosis
associated
and
nasa
C.
it
arteries
and/or
a
N
224,
a
A.
An atra septa deect s a communcaton between
sys-
B.
Mtra
te
o
te
crease,
201
“trisomy
deects.
suc
It
D.
is
papebra
as
te
aso
E.
o
dence
o
deect
because
atra
s
assocated
septa
t
deect
may
resut
wt
and
n
ncreased
ventrcuar
endocarda
o
syndrome.
22q11
Faot
It
s
congenta
D.
E.
Down
wt
Aortc
not
assocated
commony
te
oramen
wt
Down
assocated
B.
wt
great
dsorder
arteres
tat
s
s
a
not
cyanotc,
C.
assocated
o
te
T urner
but
s
aorta
s
most
commony
assoc-
D.
syndrome.
not
may
9.
A.
208;
T etraogy
cated
wt
N
o
224,
wt
assocated
Faot
T ransposton
C.
Atra
D.
Coarctaton
E.
Maran
wt
are
225;
and
DGeorge
B.
o
materna
septa
present
Down
wt
ABR/McM
truncus
syndrome
te
syn-
E.
great
200
arterosus
are
asso-
(22q11).
arteres
s
assocated
ventrcuar
ndvduas
o
te
wt
aorta
s
septa
Down
deects
to
B.
T urner
aortc
GAS
10.
N
C.
o
ABR/McM
te
great
200
arteres
assocated
o
(22q11
septa
Faot
wt
D.
T runcus
E.
Coarctaton
wt
(22q11
o
and
wt
s
DGeorge
s
septa
deects
A.
11.
C.
he
tat
nar y
ductus
acts
trunk
njected
troug
nar y
as
a
wt
N
arterosus
contrast
arter y.
208;
218;
s
an
te
aorta.
medum
I
DGeorge
wt
ABR/McM
T urner
between
remans
woud
communcaton
196,
embr yoogc
t
et
communcaton
two
aso
at
and
I
s
as
t
s
openng
te
o
n
oramen
remans
te
cosey
patent,
and
remnant
reated
te
arterosus
congenta
not
but
o
te
te
et
assocated
s
eart
posteror
not
to
aorta.
s
ormaton
te
s
ormaton
te
resut.
nerve
s
communcaton
te
known
brt.
w
a
In
atra,
arterosum
and
207
te
certan
dran
atra
N
nto
necessary
condtons.
aspect
nvoved
te
septa
224–225;
aveoar
Aveoar
ces
capary
barrer,
Bronca
n
o
atra
te
septa
rgt
deect
atrum.
te
come
s
not
ormaton.
ABR/McM
are
It
ony
199
ces
tat
produce
endotea
but
mucous
do
ces
not
ces
contrbute
produce
(gobet
to
te
suractant.
ces)
do
not
pro-
suractant.
Bronca respratory eptea ces act to mosten
protect
T ype
t
I
te
respratory
aveoar
and
do
169–177;
to
ces
not
N
protrude
tract.
are
responsbe
produce
202;
nto
Peuropercarda
te
or
gas
suractant.
ABR/McM
te
T ypcay,
D.
he
ow
and
te
patent,
te
te
E.
pumo-
toracc
212
cavty
ormng
a
GAS
15.
C.
he
caused
te
s
te
tat
N191;
ods
tat
pertonea
262;
a
or
peura
to
ts
separat-
cavty.
poston
prmorda
separates
centra
te
eart
ver.
anomaes
by
te
mgrates
dapragm
membranes
te
responsbe
rom
percardum.
transversum
peuropertonea
rom
aorta
pumo-
he
are
cavty
dapragm
ibrous
o
te
tonea
te
te
septum
rom
structure
te
rom
nto
203
ods
percarda
C.
wt
assocated
communcaton
and
ts
208;
II
tendon
202–203,
te
bypassng
ormaton.
n
ng
syndrome.
GAS
a
s
atra.
deect
venar um
nvoved
causes
syndrome.
assocated
aorta
rom
cava,
B. An absence o muscuature n one a o te dapragm
syndrome).
te
vave
pouc nto wc te abdomna vscera protrude.
ventrcuar
Down
arterosus
syndrome
assocated
n
and
GAS
syndrome).
deects
assocated
s
bood
s
et
ductus
septa
atrum
excange
s
te
togeter
and
14.
syndrome
are
wt
dabetes.
T etraogy
Atra
ndvduas
D.
218;
B. T ransposton
A.
n
atresa.
208;
materna
present
AV
he coronary snus s were te cardac vens
duce
C.
s
coses
aryngea
o
bood-ar
syndrome.
syndrome
te
suractant.
syndrome.
reated
deect
deect
survva
S n u s
deect
secundum,
atra
E. T ype
A.
and
o
ventrce.
vena
ABR/McM
and
arterosus
Patency
GAS
13.
218;
gamentum
deect
Maran
dabetes.
deects
n
he
rgt
assocated
be
et
neror
septa
between
septa
wt
syndrome.
GAS
atra
or
and
transports
te
septa
typcay
ductus
syndrome.
atresa
drome
te
to
rgt
recurrent
o
eart
Coarctaton
ated
s
most
te
septa
ovae,
narrowng
ventrces.
N
atra
partton
syndrome.
T ransposton
wt
208;
An
te
cuson
venosus
ven
te
nc-
an
T etraogy
B.
A.
a
atrum
ver.
GAS
12.
s
et
ventrcuar
between
deects.
A.
A
issure,
cnodactyy
te
ductus
between
syndrome
stenoss
umbca
dgt.
Down
he
21”)
bracycepay,
and
atra.
between
abnormaities
cusion
sant
sman
a
ABR/McM
caed
retardation,
upward
tongue,
in
S2.
produces
225;
propery
menta
resut
singe
murmur.
cardiovascuar
by
may
oud,
commony
endocardia
bridge,
protrudng
208;
(more
wit
caracterized
te
great
most
202–203,
syndrome
arrytmias
lat
te
crescendo-decrescendo
GAS
8.
o
rumbe
orm
separate
te
te
peuroper-
peura
cavty
cavty.
ABR/McM
present
coarctaton
o
n
te
184
ts
ndvdua
aorta.
he
are
porton
a
o
CHAPTER
te
aortic
ourt,
A.
arc
and
he
tat
sixt
bubus
is
constricted
paryngea
cords
arises
rom
te
tird,
retardaton
arces.
becomes
part
not
o
te
ventrcuar
as
system.
B.
he
D.
ductus
arterosus
becomes
te
gamentum
venosus
as
snus
snuatra
E.
he
becomes
venarum,
node
rgt
and
part
and
o
aso
coronary
cardna
ven
s
te
rgt
atrum
contrbutes
to
E.
necton
snus.
not
nose,
nvoved
n
ts
anomay.
GAS
16.
D.
222;
he
structure
agus.
I
resut,
tat
ts
n
separate
as
separates
wc
mk,
t
A.
resut
o
Faure
n
a
o
Faure
C.
Improper
two
coud
te
rom
nant
oxygen
to
atra
esop-
w
w
pouc
reaces
A.
and
B.
te
o
n
woud
not
orm
w
resut
not
resut
C.
n
E.
a
a
ormaton
GAS
to
223;
N
assocated
afects
n
te
and
mosoma
B.
stenoss
E.
Congenta
brt
wegt,
GAS
but
335;
eart
ated
GAS
20.
o
to
s
amnotc
or
ud,
a TEF .
mony
ods
te
nor-
wt
excess
ud
wt
o
certan
238;
deects
patent
may
TEF
as
cause
s
not
may
among
and
ow
brt
s
ductus
wt
con-
stenoss.
A.
may
brt
cause
and
arterosus
s
adverse
ow
not
brt
assoc-
may
sequeae,
cause
suc
premature
as,
menta
it
te
entry
o
o
te
te
nter-
near
te
ossa
prmum
and
s
s
ess
because
common
not
te
wt
orm
endo-
septum
endocarda
pr-
cusons
prmum.
a
cncay
sgnicant
deect.
s
an
uncommon
te
N
224,
outsde
a
type
nteratra
o
atra
septum
s
2.11).
condton
te
aure
toracc
te
a
assocated
225;
n
ABR/McM
wc
toracc
o
hs
occurrence
o
s
199
eart
cavty,
uson
wa.
te
o
te
s
com-
atera
ncompatbe
necton,
cardac
Fauty
he
te
and
yod
nterna
paryngea
musce,
arc
tyrod
artery,
paryngea
bone,
carotd
and
arc
te
gves
and
te
tymus,
and
arteres.
rse
to
epgottc
aortc
te
cr-
cartage,
arc.
dervatves
are
not
cn-
reevant.
d eveopmen t
to
ASDs
o
and/or
te
o
te
t at
sn us
unusu a
s nus
res ut
venos us
rom
ve nos us
nto
d e ve op me nt
s
de ice nt
te
o
r gt
te
s ep-
secundum.
196–198;
rgt
smoot
te
oter
coud
ABR/McM
te
deveops
o
n
an
te
te
te
snus
184
venosus
snus
rgt
as
atra
pumonary
venosus
two
venarum,
can
wa;
vens.
ead
to
connectons.
deveopment
resut
o
nto
te
pumonary
snus
nto
aspect
deveops
septaton
Abnorma
216;
o
nteror
a
Abnorma
N
orn
One
te
B.
o
subcavan
he
napproprate
cytomegaovrus
a
musce,
ourt
dvsons:
t.
neuroogca
he
GAS
21.
s
and
rom
common
atrum
arterosus
to
porton
he trd paryngea arc gves rse to te styopa-
tum
assocated
sadde
specicay
ypoxema.
absorpton
t.
s
padum
ras,
not
ocated
oramen
203;
s
te
because
reated
209
patent
ductus
E.
s
septum
te
wc
2.10
cords
and/or
cay
adverse
n
196–198,
ormng
e
te
D.
tem.
cause
wt
as
pumonary
septa
atrum
(Fgs.
cotyrod
caracterstc
brt
premature
patent
as
assocated
arterosus.
assocated
necton
artery
be
suc
ductus
ABR/McM
suc
may
deect
resutng
n
te
C.
necton
patent
deect
and
wt
a
ryngeus
cro-
n
are
bot
deects
use
abnormay,
aure,
amnotc
It
arterosus.
arterosus.
cose
deect
cana
atra
Ectopa
hs
swaow
deicency
assocated
not
A.
B.
te
toxopasmoss
but
and
be
ocated
tereore,
premature
rubea
Congenta
brt
not
ormaton.
to
common
septa
sac.
atoug
deects
suc
wt
abty
ud;
eart
as
N
Congenta
wegt,
be
and
TEF
pumonary
efects
C.
A
ead
209
atresa
toxopasmoss
suc
Congenta
and
not
soud
istua
excess
exposure
deects,
efects
s
rubea
hadomde
genta
woud
abnormates.
D.
A.
eta
may
congenta
artery
an
amnotc
t
to
esopagea
amnotc
Congenta
wt
B.
s
Ogoydramnos
ud,
parynx
ead
ABR/McM
wt
o
amount
te
237;
ma
remans
18.
o
specicay
abnormaty
A.
tongue
o
absent
Poyydramnos
oten
te
TEF .
Maormaton
C.
o
wegt,
deects.
deect
cuson
as
AV
type
D.
expected
17.
An
ASDs
prmum
septa
resutng
atresa.
brt
207
superor
encompass
ostum
atra
mum
esopagea
but
ductus
occur
te
secundum
carda
TEF .
to
An
ungs
n
secundum
and
septum
because
s
septum.
ovae
to
It
suc
damage.
T reponema
ABR/McM
ASDs
cava
oss.
deects
caracterstc
trve
patent
218;
venosus
vena
Ostum
not
attempts
cyanotc
ormaton
tracea
te
TEF
208;
Snus
tracea.
resut
N
superor
a
esopagea
E.
wt
GAS
a
to
ow
ductus
wt
cause
aure
cause
neuroogca
patent
syps
assocated
prmorda
structures
te
te
a
deveop,
becomes
o
esopagea
o
to
maormed
but
B.
nto
cd
19.
s
tracea
te
amount
te
TEF
te
Wen
sps
207
septum
as
event
he
nsucent
a
ABR/McM
structure
regurgtated.
an
216;
competey.
swaow
s
N
traceoesopagea
and
may
and
wt
may
eart
arterosus.
brt,
assocated
earng
congenta
varcea
Congenta
te
sensorneura
wt
ductus
premature
not
Snus
te
patent
Congenta
arterosum.
D.
and
assocated
71
Thorax
2
atra
o
te
septa
septum
deect.
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
woud
snus.
nary
E.
he
nto
Abnorma
wit
et
snus,
rated
D.
deveopment
present
te
rgt
o
te
et
abnormaities
snus
and
te
orn
deveops
rgt
atra
deveopment
in
snus
sinus
te
nto
orn
2.10,
orn
coronary
te
s
coro-
ncorpo-
wa.
o
te
cont’d
22.
C.
te
ty
A.
coronary
snus
he
septum
mesoderm
woud
tat
dapragm.
and
As
te
te
cana,
transversum
gves
It
tey
not ead to totay anomaous pumonary connectons.
tonea
Abnorma
posteroatera
woud
not
ead
nary
connectons.
GAS
196–198,
208;
to
o
te
totay
common
anomaous
cardna
pumo-
B.
he
stuated
and
grow
gve
nea
deveopment
s
orgn
s
to
rse
nto
to
are
two
o
peuropercarda
centra
ods
toracc
o
o
cav-
percardopertonea
ods:
te
ods.
te
te
ayer
tendon
duct.
te
responsbe
aspect
tckened
between
peuropercarda
ods
a
te
ompaomesenterc
ungs
potentay dsrupt cardac venous dranage but woud
ven
73
Thorax
2
or
peuroperto-
he
peuroper-
ormaton
o
te
dapragm.
deveop
nto
te
ibrous
percardum and woud not be nvoved wt aure
N
218;
ABR/McM
203–205
o
te
centra
tendon
o
te
dapragm
to
deveop.
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
cervca
pragmatc
E.
he
o
crura
te
23.
C:
he
arc
on
provde
o
258,
te
te
subcavan
Improper
orgn
wc
centra
208;
ourt
are
responsbe
or
te
da-
muscuature.
esopagus,
opment
GAS
myotomes
N
aortc
et
sde
arteres
on
and
te
deveopment
o
s
te
not
o
dorsa
o
te
deveops
te
rgt
te
mesentery
nvoved
ABR/McM
arc
ovalis
Fig.
2.11
cause
ncreased
subsequenty,
tendon
201;
fossa
valve
•
he
primum
D
Normal
D.
ASD)
n
deve-
dapragm.
arc
n
A.
204–225
nto
te
o
o
te
te
troug
te
aortc
and
embryo.
aorta
w
te
emora
he
n
braca
aorta
te
subcavan
artery.
w
ead
artery
Smary,
to
and,
decreased
decreased
pressure
artery.
second
aspect,
bracocepac
sde
ow
pressure
te
aortc
deveops
nto
arc,
specicay
aspects
o
te
te
sma
dorsa
stapeda
artery.
B.
he
to
proxma
te
ead.
part
common
o
te
carotd
trd
aortc
arteres,
arc
wc
gves
rse
suppy
te
CHAPTER
D.
he
n
E:
it
aortc
uman
arc
embryos.
s
sad
he
not
to
usuay
proxma
part
o
deveop
te
sxt
Answers
26.
26–50
E.
A
ure
he
Wtout
ductus
venosus
tat
gamentum
s
remans
a
eta
ater
venosum
and
cardovascuar
deveopment
woud
not
as
cause
GAS
A.
A.
ts
he
et
ductus
sxt
te
reaces
te
patent
te
trunk.
arteres
remans
ductus
wtn
and
24
o
te
te
te
between
aorta
oten
ours
oten
B.
he
ater
C.
by
part
rgt-to-et
woud
te
te
proxma
rgt
part
o
sxt
te
aortc
rgt
arc
27.
aortc
rgt
cavan
E.
he
o
et
arc
D.
208;
W t
monar y
does
ear t
te
et
a
not
contrbute
A.
218;
patent
and
to
any
and
he
It
s
ss,
n
aso
septa
ton
suc
woud
wt
and
may
o
not
oter
to
te
208;
te
eadng
28.
to
te
A.
caracterzed
wc
sow
oten
eart
promnent
AV
pres-
AV
sounds.
ow
presents
troug
overrdng
n
te
pumonary
ypertropy,
wt
a
wt
x-ray.
suc
It
hs
n
o
aorta
promnent
aso
C
D.
be
et
eart
29.
A.
ABR/McM
207
(o
tus
wt
te
o
te
cavty
erna.
orgn
but
s
not
s
to
not
istua
gves
assocated
and
maor-
ormaton.
rse
to
contrbute
te
to
gastrontestna
on
over
arynx
deveop-
aong
te
te
te
to
and
o
te
IV
s
te
te
rgt
te
rgt
te
septomar-
as
Purknje
and
te
ven-
contracton.
nerory
t
and
does
not
septum.
vave
s
not
drecty
septum.
(LAD)
septum
coronary
on
te
ante-
eart.
208;
atresa
an
to
end
passes
aortc
o
te
tereore,
nterventrcuar
te
197–198,
dvson
to
ventrcuar
artery
as
t
septum,
musces
nterventrcuar
o
course
suc
band)
groove;
not
branc
rom
troug
nterventrcuar
superica
deect
bunde
mpuse
te
papary
AV
te
septa
rgt
nterventrcuar
brances
rom
s
deveopment.
eart
Foowng
te
and
225
te
te
tract
duodenum
stmuatng
coronary
surace
n
not
ts
between
toracc
dapragm,
groove
o
trcuspd
causng
te
pos-
n
ntestnes.
ventrcuar
te
anteror
s
te
deect
provdes
te
resut
suture
eadng
wt
A
dapragm
ABR/McM
apex
troug
he
a
ts
207
orms
and
septum
(moderator
n
but
dapragmatc
proxma
a
Hs).
trave
Esopagea
pete
218;
te
rgt
GAS
assocated
ypopastc
te
cause
brt
communcaton
dapragmatc
191;
carres
to
was,
he
ror
pumo-
o
to
te
nnervatng
E.
et-to-
dapragm.
to
trabecua
he
a
between
may
ater
205,
cavty
o
does
reers
branc
artery
but
and
to
not
bunde
&
or
congenta
woud
cosng
t
assocated
narrow-
syndrome.
te
258;
node
pass
cond-
t
te
dorsay
owever.
aortc
T urner
may
as
B.
steno-
o
N
trcuar
te
corrected.
transversum
GAS
ibers
rgt-
ventrces.
artery
murmur,
narrowng
a
nterventrcuar
aorta.
resuts
notceabe
wt
a
wt
mpuses
pumonary
n
arteres
membrane
ernaton
mout
bunde
A
et-to-
assocated
dapragm.
aow
assocated
gna
oten
o
Wen
a
by
n
oregut
mportant
pumonar y
te
tendon
tracea
because
assocated
dsorders
N
o
te
or
o
aryngotracea
he
pumonar y
p re s s u re ,
syndrome.
GAS
E.
not
ABR/McM
deveopment
ment
o
nto
re s p o n s b e
auscutaton
oten
aorta
resuts
on
s
back
s
great
traceoesopagea
and
orms
gradent
mmedatey
once
218;
septum
he
pu-
ve n t r c e
sunted
abnorma
present
ead
arteres
et
te
typcay
aorta
abdomna
centra
he
D.
abnorma
and
notceabe,
wt
an
te
be
atresa
te
bood,
Faot
bood
not
Aortc
and
not
et
nvoved
C.
et
cases.
o
o
deect,
an
aor ta
atra
are
o
assocated
E.
nary
he
a
between
ventrce.
te
persst
N
resut
matons
bood
and
ventrcuar
Coarctaton
woud
coud
part
te
x - r a y.
sunt
woud
C.
ng
upper
and
207
Ts
t e re o re
deects
sunt
rgt
o
to
o
te
o
woud
wt
s
durng
cest
tetraogy
to-et
a r t e r y.
dyspnea
x-ray
arteres
B.
te
A.
sub-
oxygenated
orms
gradent
pressure
rgt
sunt
aspect
arterosus.
te
aor ta
n c re a s e d
septa
wt
cest
rgt
orgn
ar terosus
eavng
te
e a rd
te
ductus
b e t we e n
B o o d
et-to-rgt
ents
te
contrbutes
te
ABR/McM
d ve r s o n
enarged,
on
te
ductus
nto
causes
Atra
orms
arc
between
and
perssts
Te
ar teres
arc
aortc
pumonar y
ar teres
to
N
murmur
ear t.
aortc
arc
tr unk.
te
not
208;
teroatera
pumonary
by
a-
aorta.
atrum.
peuropertonea
te
ourt
artery
connecton
te
ourt
aortc
carotd
25.
he
artery.
te
GAS
B.
typcay
deect
to
cd
and
ormaton.
T ransposton
GAS
o
septa
o
te
rom
trunk
resut.
pressure
rgt
and
Coarctaton
D.
to
due
ventrce
membrane
it
he
sunt
sunt
brt,
and
o
w
deect
due
resuts
pumonary
peruson
ventrcuar
et
ormaton
occur
atrum
arterosus
te
septa
sunt
rgt
structures.
D.
A
ductus
arterosus
subsequent
arterosum
or
and
o
cyanoss
atra
et
205
responsbe
regresson
he
cosure
196,
artery.
C.
proper
severe
An
week.
proxma
becomes
s
pumonary
connecton
gamentum
he
arc
te
cosure
anatomc
postnata
ABR/McM
Wtout
unctona
twet
B.
o
pumonary
wereas
o
a
211;
aortc
bot
arterosus.
arterosus,
and
N
truncus
separaton
rgt
217–220;
deveopment
o
bood,
te
presentaton.
24.
common
aortc arc deveops nto te et pumonary artery.
structure
75
Thorax
2
s
N
224;
oten
te
absence
ABR/McM
te
resut
o
199,
an
traceoesopagea
o,
or
bnd
200
ncom-
septum,
endng
o,
te
76
C H A P T E R
2
Thorax
esopagus.
te
tebra
TEF ,
indngs
anomaes,
and
ana
te
patent
correate
VACTERL
cardac
rena
wt
ncudes
32.
ver-
maormatons,
anomaes
and
tat
he
te
rada
a
motty
nvoves
and
te
te
dsorder
smoot
ower
he
o
musce
stenoss
drome.
It
s
a
s
not
seen
congenta
n
o
te
B.
he
syn-
dapragmatc
to
vscera
nary
E.
30.
A.
D.
esopagus
a
GAS
175–177;
a
et
number
cervca
ven
most
he
C.
he
as
to
te
t
s
nerve
but
he
to
te
to
be
artery .
pumo-
mass.
te
te
by
t.
te
crcod
across
eve
o
and
Durng
C.
ncson
s
not
suc
s
esopagus
damaged
a
not
te
te
not
at
stuated
durng
A.
trace-
ocated
and
te
a
openng
1053,
tracea
and
and
s
traceotomy,
made
n
1112;
not
key
D.
as
a
pat
ABR/McM
between
te
o
and
o
neck
te
B.
courses
anteror
to
Because
antero-
te
root
meda
o
as
nerves
tey
pumonary
carna
he
and
gve
of
pexuses
on
te
ntercosta
tumor
run
ocated
to
te
roots
brances
to
te
cardac
upon
ung
nerves
at
posteror
te
te
tracea
o
te
and
near
te
roots.
not
be
surace
afected
anteror
by
to
he
roots
E.
he
by
o
te
te
tumor
nerves
vagus
a
arse
nerves
pass
227;
te
B.
ocated
at
te
woud
ung
N
not
surace
be
te
s
ABR/McM
219
be
afected
next
torax
et
et
to
te
by
a
te
et
between
te
common
recurrent
be
carotd
aryngea
afected
woud
N
190;
not
be
by
ts
afected
ABR/McM
tree
aceraton:
an
nabty
toracc
abduct
nerves
te
207
are
ong
to
uy
nerve)
te
umerus
15
to
mnor
s
most
toracc
abduct
te
necessary
scapua,
above
nerve
te
to
cause
degrees
due
to
to
actate
souder.
woud
90
movements
oss
and
o
weak-
parayss
o
te
musces.
accessory
trapezus
njury
patent
N
he
he
or
o
nerve
musce
woud
on
and
produce
were
somatc
te
woud
cause
poory
oca-
caracterstc
njury
dorsa
ste
s
and
as
Pan
to
te
trunk
o
te
nerve
nerve
genera
ocazed
CNS
ganga
wa
va
w
back
spna
any
oss
umerus,
o
ga-
can
be
135
aferent
cest
orn
suc
te
contan
back
te
ndcate
o
toracodorsa
ABR/McM
processes.
o
not
ganga
sympatetc
pan
does
adducton
te
194;
root
transmtted
he
atera
nomc
E.
he
to
cord
proprocepton,
ce
bodes
vscera
on
te
sensory
not
te
cest
ibers.
carry
sen-
CNS.
receves
gt
afer-
sensory
touc,
and
GAS
orn
o
te
o
te
spna
cord
carres
auto-
sgnas.
ventra
sgnas
197;
irst
to
vbraton.
afected
to
o
spna
njury
183;
nput
te
anteror
or
dependng
neurona
sory
vagus
bend
te
pan.
dorsa
genera
ent
D.
nerve
um.
GAS
rom
ungs.
cardopumonary
a
te
beore
aryngea
he
or
C.
recurrent
nerves
A.
te
um.
D.
34.
wa
woud
ung
te
trunk
rom
rotaton
or
GAS
vagus
to
ocated but woud not cause te symptoms descrbed.
ung.
he
ungs
C.
t
te
drecty
axary
te
nerve
emnated.
nerve,
te
te
ton
te
te
torax.
yng
te
procedures,
teres
o
te
o
to
ong
souder
meda aspect o te ung and te medastnum. Aong
pat
and
not
and
abducton
Rada
E.
nerve
o
o
symptoms
198;
o
posteror
not
arc
225–230;
te
te
zed
tan
208
prenc
by
rotate,
weakness
t.
N
rse
gaton
abducton
Injury
atera
oter
arc
anteror
te
enters
artery
compans
detod
B.
posteror
te
descrbed.
Injury
ness
by
tymectomy.
s
to
and
woud
aortc
sympatetc
to
passes
enters
nerve
169–172,
eevate,
traceotomy
atrogencay
meda
artery
pexus
mastectomy
arm
rsk
te
umerus above te orzonta. he serratus anteror
traceotomy.
durng
damaged
durng
836–837,
o
rsk
s
t
woud
mass
patent
mdne.
be
as
duct
at
artery
as
gves
(supped
carotd
beneat
In te event o njury to te ong toracc nerve, te
trunk.
tus
passes
nerve, ntercostobraca nerve, and toracodorsa nerve.
tracea
bracocepac
et
susceptbe
cartage.
te
It
te
GAS
33.
at
structure
he
connecton
209
nerve
artery.
vagus
but
nerve
te
subcavan
nerve
surround
made
passes
superica
may
ntentona
207,
he
s
beow
ven
to
nerve
t
toracc
tat
ncson
postoned
prenc
GAS
A.
and
wtn
et
and
damaged.
mdne
procedures
31.
abdom-
cavty
istuous
ABR/McM
vertebra,
be
not
otomy,
te
237;
an
most
a
structures
N
common
vagus
he
E.
o
anteror
te
et
near
D.
s
key
B.
ypopasa
orm
bracocepac
mmedatey
hs
aows
toracc
ven
esopagea
he
E.
can
traceotomy,
sxt
he
erna
te
pumonary
wt
In
nto
ypertenson.
he
te
bot
pass
groove,
subcavan
pumonary
pyorc
et
na
aryngea
prenc
te
subcavan
esopagea
VACTERL
stenoss
Congenta
to
o
growt
Pyorc
eads
et
part
spncter.
D.
recurrent
traceoesopagea
spncter.
C.
et
aorta. It s te ony nerve ocated near te descrbed mass.
A.
s
esopagus
C.
gamentum arterosum and ten oops superory toward
anomaes.
acaasa
esopagus
nng
ts
atresa,
atresa,
mb
Esopagea
te
n
syndrome.
esopagea
apasa,
B.
he
VACTERL
to
orn
skeeta
137–138;
N
spna
cord
carres
musce.
197;
ABR/McM
189
motor
CHAPTER
35.
D.
he
umns,
rons
atera
o
te
T1–T4
te
or
ce
oten
ntermedoatera
bodes
sympatetc
are
toracc
A.
orns,
contan
o
system.
assocated
Spna
wt
ce
pregangonc
te
cord
upper
co-
38.
neu-
nerve.
and
key
organs.
he
woud
ce
not
be
bodes
ound
o
at
te
te
mpcated
deep
A.
cardac
he
dorsa
motor
not
nuceus
contan
autonomc
o
te
pregangonc
ibers
nvoved
n
vagus
ce
ner ve
bodes
rasng
te
o
B.
eart
sympatetc
T5–T9
cuar
p
smoot
as
he
te
or
te
eart
GAS
36.
n
te
sweat
te
cervca
gands,
and
te
segments
and
vas-
E.
arrector
abdomna
cavty,
o
wa
nerves
to
rom
A:
te
are
N
bodes
eart
woud
o
rate
te
but
neurons
specicay
not
contan
ibers
respon-
&
vagus
nc
C:
mary)
E:
he
nerves
to
he
207;
contans
tat
some
nnervate
ABR/McM
100,
organs
GAS
C.
he
te
te
217
A.
usuay
he
he
N
te
214;
s
n
toracc
spna
or
B.
gan-
pan
(pr-
and
abdomna
te
to
cavty,
o
vas-
arrector
wa
as
specicay
oregut.
o
nerve
te
205
responsbe
spancnc
te
or
B.
and
esser
abdomen
a
or
nerves
do
somatc
te
are
not
nerve
tat
part
o
te
nnervate
spancnc
sympatetc
and
pan
not
nnervate
GAS
223–235;
N
te
not
somatc
te
C.
ner-
bronca
ibers
aferents
te
190;
nerve
carres
(prmary)
rom
te
to
te
abdomen.
ungs.
ABR/McM
pre-
205,
219
It
s
or
te
not
E.
aso
o
s
nerve,
nnerva-
area
o
key
s
te
to
be
parts
o
162,
oten
o
734;
s
te
ibers
jont
N
195;
he
ong
musce.
suppy
n
to
cutane-
o
and
te
atera
te
areoa
axa.
aspect
o
normaton
“regmenta
o
badge”
te
144
te
rcton
s
t
on
wt
te
or
transmt
rcton
provdes
arm’s
pan
te
coarser.
responsbe
woud
percarda
carry
percardum
rub,
graduay
soey
nerve
skn
not
toracc
It
wt
rub.
sensory
meda
ibers
te
rom
sur-
ts
greater
toracc
toracc
vscera
and
assocated
wt
GAS
N
189;
suppes
not
carry
te
serratus
pan
ibers
ante-
rom
a
spancnc
nerve
s
nvoved
nnervaton.
postsynaptc
eart
nerve
woud
percardts.
abdomna
he
te
sensa-
condton.
ror
he
o
woud
axa.
nnervates
nppe
becomng
ntercostobraca
It
T4
ABR/McM
nerve
rom
responsbe
te
regon.
sensory
percardum,
radatng
or
te
musce.
percarda
prenc
s
o
motor
te
te
not
o
cutaneous
aspect
nammaton
a
te
and
com-
are
surace
nvoved
te
provdes
be
and.
o
to
meda
percardum
o
axary
branc
detod
an
causes
te
he
te
te
to
207
nerve
not
ner ve.
nerves
responsbe
aspect
nnervates
and
souder
Percardts
s
woud
arynx.
s
or
pro-
aortcopumo-
nerves
te
provdes
and
te
te
nerve
te
meda
o
correspondng
souder
te
te
nerve
o
wndow
spancnc
nerve
atera
cutaneous
suppes
over
o
not
patent.
ar yngea
ABR/McM
aspect
ts
unkey
responsbe
anteror
axary
woud
n
spancnc
on
te
toracc
over
to
tus
199;
meda
atera
he
te
are
skn
nnervaton
he
are
posteror
N
nerve
serratus
patent
D.
toracc
ntercostobraca
te
ong
nerve
recurrent
nnervaton
suppy
on
ace.
eart.
esser
toracc
te
nnervaton
not
does
and
to
descrbed
rgt
and
te
o
unar
he
n
toracc
does
he
pan
musce.
gangonc
Ony
surace
carres
does
wndow
patent.
dorsa
prenc
as
ntercostobraca
sensory
and
A.
nerve
abdomen
ts
aortco-
aryngea
aryngea
responsbe
wndow
and
223–235;
patent’s
s
ungs
and
he
GAS
40.
ungs.
nerve
n
nnervaton
ungs.
to
aortcopumonar y
te
wndow
Because
ABR/McM
ony
neror
nvoved
te
segments
and
te
s
passes
te
and
dermatome
E.
o
te
he
ous
spanc-
nnervaton
at
pressed.
te
para-
ibers
cord
gands,
abdomna
toracc
te
system
smoot
E.
t
oarseness
greater
ton
cardac
carryng
sympatetc
wt
cest
te
ibers
ntercosta
vous
or
east
sweat
nnervaton
te
prenc
he
and
neurons
rom
nerve
greater
nnervate
D.
ibers
o
te
recurrent
recurrent
nerve
arynx,
compress
and
esser,
te
n
derved
sympatetc
B.
aferent
responsbe
correate
o
234–235;
nnervate
s
musce,
organs
vagus
he
te
sympatetc
mass
he
arm.
abdomen.
parasympatetc
A.
and
pregangonc
smoot
as
carryng
te
te
nnervaton
ibers.
greater,
musces
we
or
rom
A
C.
D.
nerve
carry
T5–T9
p
ibers
vscera,
sympatetc
cuar
te
Compresson
GAS
39.
organs.
sympatetc
B
oarseness
o
between
et
adjacent
et
vagus
nary
or
responsbe
eferent
toracc
tese
he
or
te
te
arse
as
sympatetcs.
234–235;
sympatetc
ga
wtn
compress
te
te
not
oregut.
gangon
ce
cord
nnervaton
abdomna
postgangonc
wt
spna
wt
cest
rom
rasng
n
D. he toracc vscera (or cardopumonary spanc-
nc)
37.
te
pregangonc
sbe
o
musce,
derved
neror
neurons
correate
o
organs
organs
E.
usuay
musces
we
mass
and
n
duce
D.
he
proxmty
compressed.
rate.
C.
cose
wndow
aortcopumonary
woud
te
s
houg
ton
pexus.
B.
A
to
resutng
pregangonc
neurons
here
pumonary
segments
mbs
C.
77
Thorax
2
or
cardopumonary
sympatetc
ungs
but
nerves
woud
not
tat
carry
percardts.
215;
ABR/McM
205,
nerves
suppy
207
ibers
78
C H A P T E R
41.
C.
he
ous
a
2
Thorax
ntercostobraca
branc
o
cutaneous
aspect
A:
o
he
C5
no
B.
te
and
te
o
E.
to
torax
mary
GAS
te
gut,
some
rom
and
atera
nerve.
axa
cutane-
It
and
162,
X
D.
Sympatetc
serves
ibers
meda
to
te
te
te
neck,
pexus
C6.
and
It
N
and
195;
as
GAS
sensory
te
te
receves
A.
te
ourt
and
trd
te
C.
upper
ton
pr-
areas
In
o
ts
te
patetcs
ne;
te
A.
ony
he
supra-
D.
144
suppyng
tssues
o
te
(numbness)
dsrupted
at
brances
te
o
a
back.
and
roots
ram
s
somatc
rom
te
sensaton
s
and
vscera
perpery.
ost
te
vscera
sen-
he
no
ts
brances
musce
reaton
he
ram
s
o
nnervaton
to
te
nervous
somatc
GAS
58–59;
N
rom
aorta.
aferents,
organs,
n
hese
aferents
n
he
te
n
ibers
te
rom
nerve
case
get
dorsa
pan.”
counterparts
contan
are
ce
bodes
body,
tat
wt
s
sensaton
(or
crana
wt
somatc
a
and
ter
nerves)
et
te
temperature
not
be
rom
te
responsbe
body’s
or
te
pan
o
an
aneurysm.
motor
assocated
ibers
wt
an
tereore
vagus
ung,
sympatetc
and
aortc
woud
ibers
not
aneurysm.
are
auto-
transmt
pan
o
te
sen-
and
second
te
skn
motor
major
and
above
second
not
toracc
nppes
meda
nnerva-
musce,
nnervaton
te
te
197;
sp-
and
and
sde
o
te
o
second
ABR/McM
o
sen-
areoae
te
arm
and
trd
te
188
passes
ater
ts
aryngea
superory
oopng
nerve
and
tracea
around
compres-
woud
not
descend
courses
t
as
resut
branc
at
greater
rom
sympatetc
toracc
nto
eve
ts
woud
te
torax.
te
of
o
te
ar-
um
ts
te
nerve
et
aortc
woud
symptoms.
spancnc
trunk
te
to
gven
te
o
around
toward
posteror
aready
presentng
he
oops
passng
compresson
te
tereore
nerve
beore
does
nerve
ater
n
nerve
groove
aganst
aryngea
he
prenc
presentng
ganga
not
nerve
at
cause
eves
te
arses
T5–T9
presentng
GAS
46.
A.
he
223–226;
patent’s
owng.
cea
B.
nerve
o
Wt
ts
a
N
199;
ce
dated
beng
te
woud
dapragm;
not
te
ABR/McM
compant
et
et
nto
s
atrum,
compressed
descends
to
nnervates
nerve
resut
n
te
symptoms.
s
te
atrum
207
pan
te
te
swa-
probabe
esopagus.
abdomen
beow
upon
most
te
he
mmedatey
eve
o
te
tra-
carna.
he
root
tat
o
enter
he
te
ung
te
or
pumonary
postgangonc
te
aryngea
artery
tereore,
esopagus
surace.
and
or
recurrent
resut
posteror
woud
nomc
and
structure
touc,
he
ynx
he
vscera
pan,
te
a re o a e
symptoms.
subcavan
sensory
o
o
musce
compresson
compresson
somatc
Somatc aferents are nvoved n sensaton
aortc
E.
penomenon
ganga
brances
symptoms.
abdomna
genera
sensory
assocated
toracc
sensaton.
hey
D.
N
esopagus
rgt
and
te
te
provde
brances
recurrent
he
te
not
nvoved
te
carry
te
root
ncudng
te
188
rom
hs
dorsa
wt
not
to
pectoras
above
cutaneous
recurrent
sensaton.
ibers
roots.
he
are
te
3.9).
presentng
he
o
ave
o
aortc
transmt
p r ov d e
nnervate
nerves
ram
ibers
132–140;
arc;
ncudng
mxed
assocated
te
and
pan
B.
components
ABR/McM
aferents,
unctons
tus
motor
an
205
ner ves
brances
traceoesopagea
o
te
cutaneous
and
Fg.
et
rgt
answer.
back
not
cutaneous
suppy
te
nnervaton
aorta.
son
cannot
ne.
are
system
ts
motor
provde
te
aferent
197;
ibers
te
“reerred
to
mdaxary
genera
vscera
no
correct
ram
communcantes
wt
Genera
te
dorsa
sympatetc
vscera
C.
C.
A.
Because
not
woud
ABR/McM
nerves
provde
sensory
Latera
te
roots.
eferents.
to
prmary
nerves
GAS
45.
Because
deict
o
ntercosta nerves woud not suppy te afected area.
n
carry
dorsa
dsrupted,
and
A.
E.
sym-
mdaxary
ventra
pan
areoae.
V entra
sory
he ventra roots o te spna cord carry ony somatc
are
o
are
normaton
te
or
ibers
wa,
and
suppy.
na
coce.
cutaneous
and
B.
except
cutaneous
dorsa
nvove
E.
wa
sensory
(andross)
correct
ony
C.
bot
tereore,
sory
B.
body
case,
body
autonomc
te
aneurysm.
atera
pectora
sensory
(GAS
te
214;
and
cutaneous
many
and
to
N
sympatetc
atera
and
sympatetcs
aferents
aortc
ntercosta
D. V entra ram contan bot sensory and motor ibers
aso
are
transmt
ntercosta
nppes
he
musces.
ABR/McM
an
anteror
Anteror
n
eves
ibers
not
nppes.
structures.
rom
te
rom
58–59;
Te
sor y
torax.
at
B.
o
and
orgnates
nnervates
nraspnatus
225–235;
exure,
trunk
abdomna
orgnates
sgnas
autonomc
and
nerve
sympatetc
and
coc
pregangoncs
woud
Parasympatetc
C3–
nerve
and
aneurysm.
44.
motor
spancnc
nerve
hs
suppes
et
ead,
nerves
arm.
and
nnervates
te
te
autonomc
n
C5
and
spna
dapragm.
up
braca
rom
rom
nto
CN
toracc
te
spnatus
43.
te
te
s
suprascapuar
o
n
arses
pass
organs
greater
trunk
42.
tat
nerve
to
T5–T9
he
te
E.
nerve
provdes
suppy
he
bot
nnervates
vagus
aso
s
ntercosta
arm.
brances
uncton
nerve
second
uncton
prenc
he
D.
te
root
durng
s
not
and
s
te
arteres,
esopagus
pan
ung
eave
te
vens,
so
coecton
ung
um,
and
swaowng.
not
structures
prmary
ntmatey
woud
o
ncudng
be
te
bronc.
assocated
assocated
wt
wt
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
te
by
D.
tracea
et
a
he
s
ends
atrum
dated
et
superor
not
cose
and
and
above
woud
te
be
eve
E.
he
to
3.9
o
burcates
unafected
ond
cava
reaton
D.
s
anteror
to
te
n
poston
esopagus
or
te
vena
rgt
cava
atrum
ascends
and
s
not
rom
te
nearby
et
GAS
E.
he
our
afected
pass
ty.
It
N
esopagea
at
rom
s
te
237;
atus
assocated
eve
te
te
o T10
toracc
ste
o
te
ABR/McM
o
te
wt
and
cavty
most
205
apex
dapragm
te
aows
nto
te
te
neror
s
one
dapragm.
o
o
It
s
esopagus
to
abdomna
our
A.
he
n
te
tebra.
te
parynx
neck,
It
s
here
te
or
o
no
passage
he
te
ends
te
eve
irst
and
juncton
and
o
te
constrctons
toracc
o
te
B.
te
eart
rgt
te
o
esopagea
te
s
te
ste
esopagus
sxt
C.
et
te
he
most
superor
at
E.
ound
aperture;
structures
at
ts
passng
te
s
te
et
te
rom
eve
ts
o
openng
te
neck
aorta.
It
49.
aortc
s
at
ts
posteror
eve,
to
were
te
te
te
tat
s
te
sec-
ound.
te
esopagus
broncus.
207
ocated
nces
te
s
arc
n
to
eart
by
te
te
s
et
et
to
it
o
papated,
trobbng
toracc
ocated
o
GAS
190;
hese
n
a
spata
torax.
te
any
o
te
o
te
wa.
te
rgt
tracea
ocated
on
be
te
posteror
papaton
ocated
sternum,
s
aspect
reazed.
posteror
above
te
to
te
second
space.
te
mtra
not
space
be
eart
N
cest
216;
te
most
s
aong
auscutated
te
assocated
ABR/McM
x-ray.
conus
vave
at
te
md-cavcuar
wt
papaton
it
ne,
as
te
s.
o
It
arrangement
he
on
drect
te
components
pan
arc
ocated
no
woud
o
te
woud
apex
s
tus
ntercosta
A.
te
descends
o
as
man
generated
aganst
atrum
eart,
Atoug
ver-
o
be
s
3½
area
atrum
ntercosta
begns
cervca
et
ABR/McM
eart
ts
occurs
te
about
woud
te
he
cav-
torax.
esopagus
te
199;
space,
Wen
to
esopagus,
constrctons
sternum.
constrctons.
superor
nto
C.
are
at
te
esopagea
B.
N
o
manubrum
paryngoesopagea
wc
o
he
constrctons.
A.
128;
sternum.
te
constrcton
apex
pusatons
223–226;
openngs
ocated
he
to
esopagea
posterory
ntercosta
structures.
GAS
D.
anteror
te
trd
passes
abdomen
te
o
he
and
48.
neror
te
Fig.
atrum.
vena
n
burcates
tereore
atrum.
47.
glands
te
s
o
regon
184
eart
are
mportant
te
o
anteror
eart
te
aspect
ready
to
as
t
rgt
o
te
vewed
understand
rests
n
te
ventrce
eart,
s
tus
80
C H A P T E R
it
is
2
te
Thorax
most
anterior
portion
o
te
eart
witin
te
E.
torax.
B.
he
et
border
he
apex
rory,
and
o
but
te
t
et
s
occupes
ventrce
ocated
tte
area
s
aso
atera
to
compared
ocated
te
wt
ante-
or
sternum
te
second
o
te
ntercosta
sternum
auscutaton
o
s
te
space
te
near
ste
te
cosen
pumonary
vave
atera
typcay
(GAS
Fg.
3.110).
GAS
rgt
208,
238;
N
217;
ABR/McM
184
ventrce.
C.
he
et
sde
and
ventrce
s
postoned
on
te
et
atera Answers
sgty
posteror
poston
n
te
51. D.
he
rgt
atrum
s
ocated
on
te
rgt
51–75
torax.
atera
B.
he
besde o
te
great
te
he
anteror
margn
o
te
et
atrum
s
posterory
n
te
inay
190–195;
N
235;
ABR/McM
he
et
s
it
ntercosta
space,
just
beow
te
joned
s
typcay
te
vave.
Atoug
best
te
ocaton
to
sten
to
ourt
mtra
vave
s
ocated
ntercosta
space
te
sound
s
best
just
to
te
et
o
te
coronary
snus
n
ts
wen
obque
reazed
must
ven
be
(o
Marsa)
protected
wen
o
te
et
perormng
“downstream”
o
cardac
te
eart,
ven
and
s
t
ocated
aso
on
drans
te
posteror
nto
te
coro-
snus.
ster-
he
sma
cardac
ven
drans
bood
aong
te
same
rom
he
rgt
ower
part
o
te
body
o
te
sternum
as
te
rgt
margna
branc
o
te
rgt
cor-
ocaton
o
te
trcuspd
he
anteror
rgt
second
ntercosta
space
near
te
rgt
o
te
sternum
s
te
typca
ocaton
auscutaton
o
te
aortc
dcut
to
ear
te
so
auscutatng
vavuar
drecty
sounds
over
te
manubrum
Auscultation
for
aor tic
s
not
a
te
and
atrum,
and
are
nterventrcuar
good
not
assocated
he
posteror
bood
(or
neror)
rom
many
ven
te
o
et
te
209;
N
222;
ABR/McM202,
203
Auscultation
for
position
pulmonar y
Pulmonary
Tricuspid
valve
Mitral
Auscultation
for
position
tricuspid
et
wt
ventrce
ventrce.
coce.
position
valve
rom
drecty
artery.
o
valve
Aortic
bood
dran
troug
mdde
GAS te
rgt
anteror
drans bone,
dran
vave.
E. s
vens
anterory
o
te
It
ventrce
atera
nto border
cardac
vave.
te he
artery.
s
D.
D.
te
vave.
te
C.
te
ven
mdde
onary B.
n
procedures.
he
pat te
termnatng
at
C. num,
ntay
(LAD)
te
nary te
by
hs
aspect mtra
patway
artery
et
A. nppe,
a
204
bypass A.
takes
torax.
atrum.
50.
ven
nterventrcuar
pos-
t toned
GAS
anteror
eart.
course, E.
cardac
sde
for
GAS
Fig.
3.110
valve
valve
Auscultation
valve
valve
mitral
position
valve
CHAPTER
52.
B.
he
anteror
nterventrcuar
ror
nterventrcuar
and
et
ventrces
artery,
and
LAD)
anteror
artery
(et
suppes
two
trds
ante-
te
o
GAS
rgt
te
53.
IV
septum.
A.
he
rgt
trce
and
suppy
C.
he
et
or
te
o
artery
te
and
suppes
eart;
te
tereore,
rgt
t
ven-
does
et
to,
vent r c e ;
te
t
co ron ar y
por ton
anteror
descendng,
maker”)
arses
ventrcuar
not
A.
ar te r y
o
supp e s
cours es
s uc us
te
e t
te
e t
p os te ro r y
and
s up p es
ventr ce
artery
suppy
o
to
te
snuatra
rgt
et
coronary
B.
neror
ror
nter ventrcuar
arses
about
85%
rgt
teror
( GAS
rom
o
or
te
peop e
asp ect
o
t rd
o
Fg.
artery
(usuay)
and
does
te
p os ter or
r gt
( t s
patt e r n )
bo t
nte r ve ntr cuar
a
not
s
and
re e rre d
supp e s
ve ntr ce s
an d
n te r ve ntr cuar
to
te
te
as
C.
right
n
coronary
rgt
he
w
A V
be
et
tat
ave
norma
artery,
artery
te
to
85%
he
a
o
s
I
bood
tere
ow
wdow
tere
s
te
rgt
occuson
peope,
neror
o
o
pattern.”
p os -
o
p o s-
nterventrcuar
s e ptum
D.
bot
he
ventrces
snuatra
coronary
coronary
te
upon
rgt
ndvduas,
domnant
suppy
(posteror)
rom
margna
te
by
eart
te
coronary
posterory .
and
It
to
and
te
A V
coatera
node
ts
s
te
artery
known
te
mgt
suppy .
nterventrcuar
coronary
suppes
noda
artery
n
artery
about
n
as
a
posteror
posteror
trd
artery
about
“rgt
aspect
o
s
supped
55%
o
te
by
te
rgt
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
te
popuaton
ar tery
Anterior
right
I
septum.
of
Right
o
te
ar tery
Right
s
ow.
rom
rom
supped
crux
dependng
Left
of
“te
artery .
brances
tereore,
crosses
of
Right
203
branch
coronary
coronary
ncknamed
coronary
artery
Circumflex
Right
202,
compromsed.
noda
reduced,
85%
3 .78A ).
nodal
LAD,
st
te
Left of
w
margna
orgnates
Left
Sinu-atrial
or
te
artery;
up
( ne-
ar ter y
ABR/McM
ts artery arses rom te rgt coronary , as t does n
de sc e nd ng)
coronar y
222;
coronary
be
(poste r or )
domnant
teror
s
ventrce.
he
ar ter y
node
rom
artery
rgt
artery
te
te
he
artery
and
atrum.
he
N
E. he anteror nterventrcuar artery (aso caed te et
occuson n te rgt coronary artery , te anteror nter-
ventrce.
crcume x
near
branc
E.
et
posteror
et
D.
apex
te
atrum
n,
margna
203–207;
81
Thorax
2
branch
of
interventricular
branch
82
C H A P T E R
2
(ony
Thorax
35%
coronary
rom
te
dominant,
sinuatria
noda
et);
it
as
woud
artery
wi
te
be
not
patient
is
predicted
ave
rigt
tat
norma
E.
he
te
bood
te
low.
D.
203–207;
Because
nant,
i
No
rom
way
te
undergo
e
w
atera
o
te
B.
he
C.
he
not
be
s
80%
and
to
ar ter y.
ave
te
ow
or
te
patent
bypass
te
substanta
te
two
n
are
ar ter y,
does
A.
not
major
o
and
o
C.
tere
are
wt
suppy
o
et
to
arteres
anastomoses
musces
afected
bood
coronary
te
vave
artery
snuatra
not
between
trcuspd
coronary
te
are
node
end
bood
mgt
or
tem.
occuson.
woud
GAS
58.
not
suppy
o
not
by
a
te
be
regon
o
adequate,
branc
o
te
or
te
t
AV
node
coud
55.
A.
rgt
te
coronary
he
mtra
B,
C,
toe.
sound,
E.
D:
to
he
S2
aortc
to
202,
te
S
203
eart
1
sound
B.
aso
pumonary
be
aso
eard
produced
corresponds
woud
vave
best
and
sound
vaves
cor-
durng
wt
te
S2
ony
te
et
wt
te
ower
S1
D.
sterna
56.
C.
he
te
wt
n
s
te
ABR/McM
dsrupted,
upper
nner vaton
band)
as
o
te
and
o
o
to
te
wt
porton
compromsed
vave
connectons
hereore,
te
te
te
te
201
system
o
te
narcton
septum,
w
be
w
te
be
drecty
afected.
A.
B.
he
ventrce
and
attaced
to
he
aortc
between
nvoved
D.
he
et
D.
vave
vave
et
vave
atrum
assocated
and
wt
artery
nterventrcuar
drecty
mtra
ound
pumonary
te
te
s
s
a
an
et
te
and
te
AV
s
te
not
and
rgt
ventrce.
drecty
vave
aorta.
tat
It
ound
It
s
nterventrcuar
s
not
septum.
between
not
es
te
ntmatey
septum.
o
conus
ventrce
were
te
trunk.
te
tat
conus
anteror
anastomotc
trcuar
and
ventrce
trce
except
ventrcuar
rom
te
te
o
wt
eart
ear-
te
wt
are
o
S1
te
spe-
ibers)
and
et
tat
bunde
afected,
bunde
ts
eads
to
s
te
ventrces.
branc
branc
woud
system
ventrce,
s
s
te
be
rgt
s
gven
s
nto
a
eads
and
te
does
te
(posteror
et
not
n
n
to
o
mus-
conduc-
regon
te
rgt
conus
arte-
part
o
te
(nundbuum)
te
pumonary
upper
as
anteror
te
suppy
a
artery.
atrum
rgt
o
n
ven-
nter-
arter y
cases
surace
sma
nterven-
et
te
porton
(posteror)
unusua
te
roo
te
rom
descendng)
or
o
coronary
neror
bot.
te
cardac
usuay
suppes
ter-
afect
ere.
te
te
te
sec-
te
201
nto
suppes
arter y
not
superor
cone
n
atrum.
of
around
te
m-
ibers
woud
rate
ocated
te
be
greater
n
nvoved
wt
passes
te
specazed
ventrce
o
to
woud
Purknje
ABR/McM
vave
crcumex,
crcumex
ventrce.
o
and
artery
wen
be
correct.
coecton
patway
courses
and
be
S2
stated
dysuncton
not
229;
branc
te
(as
T ermna
one
wa
tapers
crcumex
eart
sound.
rgt
decrease
connecton
(LAD)
he
a
ts
yet
s
regon
rgt
S1
cannot
assocated
actvty
o
to
pumonary
hs
not
bunde
conus
and
t
(Purknje
bot
group
N
te
s
bunde
and
a
2
vaves
201
conducton
septa
artery
he
or
ventrces
te
artery
rosus.
A.
nterventrcuar
vave
rgt
septum.
semunar
ventrce
wt
s
between
he
coronary
o
pumonary
s
211–213;
59.
te
et
serve
GAS
pap-
to
tat
2
correate
te
wt
s
ventrces
nternoda
n
septum
vave
node
S
ventrce.
secton
atrum
S
te
nvoved.
eart
te
ventrce.
te
te
n
woud
assocated
ces
eectrca
o
201
wt
wt
s
not
Hs)
ventrces,
deep
myocarda
trcuspd
te
ton
sde,
and
nter-
pumonary
cannot
S2
to
199,
tereore,
s
s
rgt
rgt
ntmatey
septomargna
muscuar
AV
(o
te
sma
ces
te
spttng
and
ABR/McM
te
posteror
he
vave
bot
et
te
rgt
ce
to
part
a
answer
njury,
rgt
anteror
eectrca
a
te
s
on
nter ventrcuar
te
200,
septum
trcuspd
(moderator
musce.
eart
te
muscuar
trabecua
ar y
225;
nter ventrcuar
nvoved
va
N
he
wt
neror
cava
vave.
vave
suppyng
te
te
o
mna
ncorrect.
corresponds
aong
to
tons
E.
207–209;
njury
transmt
das-
border.
GAS
An
ts
actvty
to
to
and
assocated
musce
o
A
sound
abnorma
brances
mted
s
226;
Because
njury
ted
aortc
eart
tereore
sound,
ABR/McM
corresponds
vave
trcuspd
eart
222;
S2
mtra
bunde
ste
ts
tereore
an
N
eectrca
An
systoe.
he
te
and
he
vave
durng
and
respond
N
te
cardac
ogca
te
vena
assocated
assocated
trcuspd
o
s
systoe;
te
vave
and
AV
bunde
A.
203–207;
produced
he
brances.
st
ony
but
208;
cazed
artery.
GAS
C.
ABR/McM
aortc
n
s
occurrence
woud
o
assocated
dastoe.
te
n
he
vave
neror
smutaneousy
tereore,
E:
n
vave
sound
carry
mgt
supped
and
eart
not
224;
produced
aortc
er);
s
te
te
vave
deect
mtra
sound,
brances
N
tat
cosng
possbe
he
co-
It
produced
deectve
D
te
a
or
septum.
ndcates
sound,
occuson,
type
sound
he
by
nadequate.
be
atrum.
pumonary
not
wt
vave,
between
211–213;
he
sound
ow
coronar y,
B.
eart
ar ter-
coatera
et
et
bot
crcumex
or
te
I
any
between
n
o
57.
coronar y.
papary
he
ound
rgt
GAS
domi-
nter ventrcuar
rom
remove
to
203
ar ter y
occusion
avaabe
(posteror)
202,
coronar y
deicences
derved
brances
be
et
to
crcumex
arteres,
E.
be
unabe
et
he
is
ABR/McM
nter ventrcuar
crcuaton
A.
be
wi
surger y
be
222;
70%
neror
woud
o
is
possbty
te
t
N
patient
tere
anteror
es.
as
te
tere
coronar y,
te
s
ventrcuar
GAS
54.
Eustacan
cava,
arses
wc
te
rgt
CHAPTER
B.
he
anteror
rgt
and
trds
o
te
coronary
te
C.
ror
he
rgt
trce
60.
D.
o
but
ventrce.
202–209;
node
AV
gone.
a
te
he
dense
rgt
area
mtra,
te
It
et
A.
not
o
te
surace
B.
I
poste-
suppy
te
te
te
upper
porton
te
C.
te
ABR/McM
Hs
s
a
(Purknje
passes
trgone
and
202
strand
ibers)
troug
connectve
trcuspd,
te
te
o
te
te
o
tssue
specazed
tat
arses
rgt
(centra
aortc
te
ibrous
ibrous
tat
vave
rom
E.
tr-
nterconnects
rgt
tese
structures
tey
he
are
s
nnervate
E.
he
o
te
trca
te
et
n
AV
bunde
brances.
afect
te
(o
Hs)
Damage
respectve
to
te
ven-
s
a
coecton
node
o
to
te
o
et
conductng
ibers
and
patway,
prncpa
between
te
aso
known
patway
snuatra
o
as
te
eec-
node
A.
and
N
B.
227;
ABR/McM
he
te
torax
trce
woud
because
t
most
s
key
adjacent
an
201
I
te
rgt
irst
to
anteror
afect
te
te
deep
njury
rgt
surace
to
ven-
o
he
be
drecty
ateray
C.
to
te
as
t
te
et
s
ventrce
ocated
rgt
woud
posterory
rgt
rgt
be
wc
compressed
answer
by
woud
part
not
he
te
ave
te
and
E.
he
cardac
been
w
most
tamponade,
te
rgt
te
atrum.
GAS
64.
B.
he
vave)
pressures
o
o
tan
et
te
eart
trauma
he
to
apex
drecty
GAS
te
and
te
o
he
afected
tssues
ar
septum
up
woud
not
et
by
N
components.
te
be
posteror
afected
by
ts
n
anteror
woud
aso
ts
drect
and
not
be
and
(o
Hs)
rgt
o
te
and
anteror
o
te
(posteror)
commony
te
rgt
a
o
artery.
202
crcuaton
te
et
nter-
branc
coronary
ABR/McM
et
nterven-
te
brances
artery
and
means
neror
tat
(poste-
aspect
o
ventrce
te
conus
suppes
eart
and
te
s
s
com-
supped
by
branc.
rgt
ventrcu-
artery
domnant
rgt
part
o
were
occuded
eart),
t
ventrce,
part
te
o
te
te
posteror
woud
SA
(n
a
afect
and
AV
nterventrcuar
aspect
o
te
et
rgt
an
he
artery
but
coronary
o
N
te
and
s
regresses
cause
or
cava
arse
can
te
222;
te
neror
most
not
aso
vena
vave
s
to
o
but
bood
ocated
te
as
brances
202
cava
te
unctona
postnatay
between
arse
ABR/McM
remnant
a
commony
(et-anteror
crcumex.
neror
obstructon
trcuspd
suppes
nterventrcuar
embryoogc
eart
vave
can
arteres
anteror
et
artery
ventrce.
(Eustacan
deveopment
vave.
rarey
perssts
ow.
beow
rgt
T ypcay,
t
te
atrum
neror
and
rgt
ventrce.
ABR/McM
case,
most
anteror
septum,
te
nterventrcuar
posteror
203–209;
vena
njury.
ts
te
te
vave
s
te
aspect
A.
ventrce
235;
afected
and
cardac
makes
sternum.
te
190–195;
D.
oter
atrum
te
bunde
trd
suppes
et
margna
o
te
te
hs s due to te act tat te rgt atrum as ower
he
part
posteror
nterventrcuar
neror
o
222;
te
dagona
rom
eart
nodes,
te
bocked,
AV
afect
most
posteror
and
rgt
margn
ventrce.
o
te
domnant”
atrum,
te
o
but
s
coronary
descendng)
njured
N
coronary
been
correct
E.
afected
reatve
o
were
are
te
artery
o
o
I te queston dd not ask wc part o te eart as
key
D.
margn
agan
woud
ventrce.
D.
obtuse
o
t
a
wa.
septum,
te
sternum.
B.
and
(posteror)
artery
ree
nodes,
hereore,
AV
and
crcumex
segment
he
neror
te
ventrce.
and
ventrce,
posteror
he
artery
coronary
o
rgt
occuded,
et
(n
septum.
et
arteres
coronary
A. he sternocosta surace o te eart conssts mosty
te
SA
ar ter y
woud
te
artery
prmary
ar
umans.
211–213;
were
te
afected
nter ventrcuar
t
203–209;
crcumex.
posed
nternoda
te
et
te
(posteror)
septum.
termna
“et
be
ror) nterventrcuar artery as a termna branc o te
to
atrum.
s
A
te
atrum
ibers
C.
anteror
afected.
occuded,
GAS
63.
te
domnance,
ventrce,
and
te
be
trcuar
et
nterventrcuar
wt.
snuatra
patway,
node
ony
coecton
actvaton
GAS
te
bunde
Bacmann
ony
posteror
hore’s
AV
woud
rom
te
septum,
et
assocated
bunde
runnng
and
and
o
neror
ventrces
rngs.
atrum,
burcaton
woud
were
body)
o
I
te
artery
coronary
atrum
ventrcuar
nterventrcuar
nto
coronary
coronar y
et
o
bocked,
eart).
nterventrcuar
et
area
were
domnant
rgt
te
artery
woud
posteror
o
I
porton
ventrce
rgt
cuar
spts
et
rgt
te
part
ven-
o
and
coronary
afect
coronary
rgt
proxma
artery.
crcumex
assumng
o
rgt
o
te
atrum
artery
te
te
coronary
B.
62.
I
suppy
rgt
and
does
by
nterventrcuar
A and C. Ater reacng te upper porton o te mus-
trces
61.
223,
ibrous
o
supped
ventrce.
branc
o
ibers
and
by
te
two-
ventrce.
ventrces
rgt
reac
of
specicay
nterventrcuar
et
bot
gven
rgt
suppes
anteror
two-trds
N
bunde
te
s
te
not
septum.
te
not
GAS
AV
IV
o
does
musce
te
and
suppy
cardac
s
te
rgt
he
o
margna
can
It
does
(posteror)
rgt
porton
artery
and
artery
and
septum.
porton
te
trd
upper
E.
IV
neror
suppes
ventrces
artery
upper
he
nterventrcuar
et
83
Thorax
2
204,
te
ventrcuar
208
nterventrcu-
wa,
are
mosty
C.
he
s
a
vave
o
te
semcrcuar
snus.
coronary
od
at
snus
te
(hebesan
orice
o
te
vave)
coronary
84
C H A P T E R
D.
2
he
septum
tat
he
and
et
ossa
septum
A.
s
an
snge,
embryoogc
prmtve
structure
atrum
nto
68.
a
prmum
he
embryonc
and
septum
ocated
remnant
pace
between
te
o
te
ascendng
rgt
and
A.
196–197;
N
224;
termnas
cava.
te
posteror
te
SA
gn
o
B.
and
te
ABR/McM
s
nodes.
pectnate
orgn
wt
te
o
rgt
a
201
muscuar
tus
cava,
provdes
patway
he
crsta
musces
te
B.
rdge
te
o
s
crsta
vave
s
between
te
(o
tat
te
rgt
a
ocated
te
by
te
he
E.
te
answer
A.
ng)
rgt
B.
he
cava
s
ment
E.
te
and
AV
D.
N
remnant
space
vena
C.
neror
o
he
te
sxt
tat
est
s
trange
were
not
used
o
te
deveop-
way
te
too
o
neede
te
o
te
te
et
nserted
it
or
because
te
n
te
wa
trd
o
te
s
an
GAS
C.
he
et
anteror
a
and
toward
transverse
cross
A.
he
N
te
he
ice
216,
et
apex.
ncson
aurcuar
It
n
an
o
to
and
te
ts
ts
A.
are a
te
ABR/McM
snus
(LAD)
more
o
te
aye rs .
B.
percardum,
o
he
te
E.
et
et
and
s
he
et
between
vena
cava
C.
to
wc
be
ung,
just
deep
to
es
anteror
be
sympatetc
between
rgt
to
njured
trunk
s
te
n
te
root
ts
aso
o
not
s
185–189;
222;
ABR/McM
C.
be
cannot
be
be
accessbe,
ready
avaabe
196
parae
wt
te
(posteror
te
passes
are
te
a
222;
ne-
descend-
coronary
to
te
parae
severa
rgt
wde
n
snus.
anteror
wt
te
venous
te
sma
vens
atrum.
canne
posteror
by
ABR/McM
artery
artery
part
tat
o
te
198
burcates
(LAD)
branc
suppes
gves
te
nto
and
te
of
te
atera
te
ante-
crcumex
et
mar-
wa
(obtuse
nterventrcuar
septum
ventrce.
part
by
o
te
AV
or-
not
be
at
eart
te
and
te
our
s
and
te
anteror
ung,
surace
neror
te
nterventrcuar
artery
rgt
te
o
part
by
rgt
ventrce
s
nterventrcu-
a
branc
o
te
o
te
n
known
porton
te
as
te
te
conus
rgt
cases
(posteror)
a
branc
o
arte-
ventrce.
nterventrcuar
neror
most
o
septum
nterven-
te
rgt
artery.
node
te
crux
te
margna,
aso
outow
202–209;
AV
o
(posteror)
artery.
artery,
N
s
rgt
o
cardac
te
A.
te
posteror
he
branc
posteror
196
s
rgt
N
et
supped
GAS
71.
te
222;
ABR/McM
most
coronary
eart
cambers
198
commony
artery.
(te
pont
posterory);
supped
hs
o
branc
juncton
ts
s
te
by
a
arses
o
a
ocaton
occuson.
he
rgt
atrum
s
supped
by
te
rgt
coronary
artery.
B.
to
he
rgt
atra
D.
N
to
coronary
trcuar
s
be
ncson.
too
may
parae
vens
nto
nundbuum,
he
woud
atrum
woud
njured.
GAS
E.
by
o
nerve
cannot
snus.
be
nto
s
ven
snus
wc
te
artery
rosus,
te
ncson.
te
not
run
ven
dapragmatc
he
es
njured
woud
and
cavae
arteres
trunk
drecty
crcumex
supped
ar
196
artery
et
t
ongtudna
s
neror
prenc
too
he
coronary
te
vena
ABR/McM
vens
coronary
supped
artery.
tereore,
acces-
groove.
anteror
he
It
pe rc ar-
vertcay
easy
not
snus.
w
219;
cardac
et
branc,
o
are
artery.
nterventrcuar
s
and
artery.
207-209;
et
he
easy
trunk
(LAD).
afected.
D.
N
drecty
rom
margn)
ow-
ntercosta
musc e
descends
be
appendage
anteror
coronary
and
210;
can
posterory;
njured
coronary
gna
percar-
at
pe r or m ng
nterventrcuar
perpendcuar
ocated
B.
to
te
he
rgt
185–189;
anterory
anteror
dran
branc.
ungs.
arteres
to
snus.
cardac
tat
ror
poston.
o
or
or
are
cava
drans
he
he
surgeon
vens
nterventrcuar
margna
GAS
D.
percar-
great
snus.
transverse
pumonary
vena
cardac
sma
coronary
sxt
spaces
peura
dranng
ac k
ocat on
s
70.
toracc
ence
a
E.
two
pumonary
coronary
te
cardac
and
great
neror
et
transverse
artery
runs
ntercosta
to
superor
s
cava.
border.
aus c u taton
tere
dea
n
vena
docentess.
67.
te
(posteror)
rgt
te
transverse
and
185–189;
he
201
cncay
njury
anatomcay,
be
or
sevent
penetratng
woud
back
not
efectve
by
pont
he
s
are
most
space
neror
te
sterna
and
keood
dum
te
ABR/McM
process,
at
ncreased
he
and
224;
percardocentess,
ocatons
E.
te
D.
orice
xpod
ntercosta
C.
o
eart.
196–197;
Durng
beow
A
vave
embryoogc
te
rgt
GAS
B.
o
or
he ostum o te coronary snus s ocated between
te
66.
an
vave
te
pumonary
and
nterventrcuar
Eustacan
aowng
transverse
troug
mdde
he
ventrce.
D.
te
he
ror
neror
and
rgt
GAS
69.
coce.
te
atrum
ter-
transverse
te
upon
et
te
te
superor
va
crsta
va
Atoug
or-
assocated
te
beow
rgt
between
and
superor
accessed
aurce.
musces
better
C.
camp
troug
accessed
by
tus
te
bend
aorta.
rgt
he
runs
taken
provdes
provded
s
pat
hore)
aso
pectnate
aurce
trcuspd
vena
rdge
nternoda
he
he
hs
AV
mnas,
C.
he
troug
drecty
eart,
vascuar
sbe
crsta
vena
a
passng
passes
te
te
secundum
o
rom te openng o te superor vena cava to te ne-
ror
inger
snus
extng
an
septum,
A
da
atrum.
s
D.
atra.
GAS
65.
te
ovas
nteratra
et
prmum
separates
rgt
E.
Thorax
he
te
coronary
artery
aso
suppes
te
snu-
node.
et
et
margna
ventrce.
artery
suppes
te
atera
wa
o
CHAPTER
E.
he
anteror
tum
s
porton
supped
by
o
te
te
nterventrcuar
anteror
sep-
B.
72.
C.
he
irst
trcuspd
A
and
by
eart
and
B;
te
Any
C.
211–214;
D
mtra
cosure
pumonary
o
A.
he
vaves
te
B,
aortc
C,
by
second
te
mtra
vaves
he
eart
t
tat
passes
A.
240;
It
75.
B.
he
n
hs
te
s
te
be
GAS
77.
ncorrect.
by
te
te
and
eter
s
to
te
tat
vaves.
o
Any
A.
and/or
te
o
irst
te
o
B.
anteror
branc
tssue
o
o
te
burcaton
n
C.
eart;
o
superor
vena
rom
neror
vena
snus
obque
o
te
te
snus
not
not
area.
be
suppy
te
obque
snus,
provde
access
o
te
w
access
A.
above.
to
te
nto
eart
te
s
GAS
B.
not
rgt
atrum
can
be
to
papabe
as
C.
t.
212;
76.
D.
access
to
te
posteror
exsts
as
neror
a
cu-de-sac,
rgt
son,
ven
tacycarda,
dstenton.
s
aso
be
accessed
ABR/McM
w
va
te
Beedng
to
between
“dstant”
tcuary
A.
eart
severe,
appearance
here
on
w
opposed
ar
te
eart
nto
vens.
to
sounds.
te
an
be
cest
eart
wa
by
sounds,
te
and
Wen
may
ypoten-
and
decrease
n
te
not
In
suc
smpy
provdes
cases,
or-
(posteror
t
provdes
coud
resut
suppy
s
n
poor
nterventrcuar
artery
and
dysuncton
or
absent.
artery
woud
comes
not
be
scenaro.
artery
comes
woud
not
artery
of
be
te
et
coronary
nvoved.
woud
not
be
mpcated
margna
artery
s
a
branc
o
te
rgt
artery.
N
223;
tendneae
musces
take
o
te
on
te
eart,
efuson
a
“water
to
ABR/McM
198
are
cords
ibrous
vave
eaets.
tat
he
con-
restrant
he
s
o
A.
as
jugu-
s
a
neror
rgt
rom
tat
nto
prevents
te
rdge
vena
ventrce
te
rest
musces
et
tat
cava
s
tat
o
te
are
ead
(coud
o
be
paced
te
te
pro-
atrum.
runs
to
rom
te
a
te
superor
muscuar
separates
te
strp
conus
ventrce.
parae,
rgt
answer
near
musces
hs
te
vena
mtra
cava
answer
s
hs
tat
vave,
answer
cocepac
tures
tat
s
s
be
rgt
n
not
passed
te
wc
te
t
entered.
te
rgt
et
It
does
one
It
sde
does
one
ncude
between
o
aso
o
sts
te
ncude
te
sts
te
ncude
o
aso
te
te
eart.
t
s
on
s
com-
be
cava,
vave.
et
because
as
more
woud
ventrce.
entered.
wc
are
t
vena
does
be
ventrce
bracocepac
case
be
ncorrect
ven,
must
s
ven,
must
te
trcuspd
ncorrect
wc
t
must
wc
bracocepac
structures
rgt
as
myocar-
200
te
superor
and
and
s
wc
ncorrect
vave,
to
o
ventrces.
pacemakers
n
ven),
wc
rdges
te
ABR/McM
eads
et;
et
vave,
s
atrum,
225;
tat
or
te
trcuspd
hs
rreguar
wtn
pacemaker
bracocepac
te
C.
N
pat
on
are
present
195–200;
superor
B.
carneae
are
correct
rgt
par-
vens,
musces,
cusps
supraventrcuars
te
T rabecuae
te
botte”
te
te
pectnate
mtra
juguar
papary
vave
termnas
o
crsta
or
cavty
eadng
te
cava.
he
he
x-ray.
dmensons
o
mtra
crsta
GAS
juguar
percarda
te
anteror-posteror
dstenson
reers
artery
nterventrcuar
artery .
bockage
202–209;
te
he
D.
woud mule te eart sounds because o te ncreased
dstance
o
mony
196
caracterzed
muled
w
A V nodes. It mgt be antcpated
coronary
papary
atrum,
tamponade
car-
184
crcuaton”
coronary
coronary
cordae
dum
pumonary
76–100
Cardac
durng
ypotenson.
artery
ABR/McM
coatera
aso
overa
carotd
(posteror)
ts
be
n te atra wa tat make up te atra appendage.
et
Answers
he
ven
N
gradua
scenaro.
arterosus
te
snus.
184–188;
n
rgt
wtn
snus.
79.
obque
he
vena
rgt
and
ven.
he
et
ts
223;
anteror
and
openng
198
E.
wc
a
dastoe.
dstnct.
rgt
crcumex
he
apse
emptes
provdes
aso
D.
et
contracton
area
atrum.
he
node,
te
he
nect
mp-
produce
durng
sgnicanty
w
domnant
coronary
dsta
GAS
report.
obque
cava
N
te
neror
coronary
arterosus.
scemc
expaned
aspect
provdes
et
te
ABR/McM
cava
superor
papabe
he
he
224;
as
ncrease
here
nterna
coronary
A V
he
n
te
78.
not
provded by tese cords on te vave eaets, aong wt
patoogy
N
conus
woud
does
ncorrect
he
te
artery
te
artery
te
area.
artery
te
s
te
n
te
tat
nvoved
D.
mpcated
act
of
201
branc
w
ventrces
ncreasngy
coronary
rgt
te
ncorrect.
suppes
noda
202–206;
on
and
o
descendng)
o
caused
trcuspd
ABR/McM
s
“Rgt
or
not
184–189;
E.
gn
201
cosure
eart
mtra
te
be
Puses
vaves.
and/or
w
tamponade.
become
Hs).
scemc
GAS
wa
E.
dac
caused
aortc
te
suppy or te SA and
by
pont
(o
te
be
conductng
te
sound
pumonary
caused
(LAD)
te
to
noda
answer
obque
D.
o
vaves.
222;
artery
not
AV
drecty
C.
s
trcuspd
N
snuatra
he
atrum
A.
cosure
222; ABR/McM
peroratng
bunde
descrbed
E.
N
tereore
artery
woud
cated
C.
pressures
he artery o te conus s a sma branc o te rgt
coronary
B.
and
eter
sound
ncudng
suppes
AV
sound
te
septa
te
eart
tereore
240;
irst
drecty
common
aortc
pumonary
nterventrcuar
LAD
19,
o
by
o
he dference between systoc and dastoc artera
198
E.
ncudng
woud
208,
irst
caused
second
woud
he
coce
GAS
D.
E:
cosure
answer
74.
and
D,
he
te
coce
s
ABR/McM
vaves.
E.
GAS
73.
229;
sound
and
answer
N
tamponade
enargement
artery.
GAS
Cardac
nterventrcuar
85
Thorax
2
te
eart.
te
irst
irst
bra-
struc-
86
C H A P T E R
E.
2
hs
answer
mtra
et
A.
te
a
stenoss
ventrce)
wc
B.
vave
es
to
efect
t
te
ncudes
et
to
turn
ABR/McM
et
on
vave
ead
n
drecty
atrum
te
C.
here
and
te
atra
te
et
enargement
mpnge
posteror
to
o
daton,
between
o
et
wc
te
and
et
te
can
Stenoss
atrum
upon
te
Bood
205
esopagus.
o
et
C.
T o
be
atrum,
paced
woud
atrum.
mdaxary
tebra
he
ce
upon
o
w
te
te
te
aortc
and
and
o
vave
ocated
n
o
te
bood
(LAD)
(posteror
no
anteror
A
torax.
et
troug
systemc
ave
te
te
between
nterventrcuar
nterventrcuar
woud
because
trunk
Regurgtaton
decrease
Anteror
(posteror)
s
aorta.
utmatey
E.
esopagus
pumonary
vave
te
pumonary
D
and
and
ow
neror
te
artera
paga. In te norma poston o te eart te et atrum
te
he
reac
best
C.
he
te
event
199
cest
ungs,
n
pont
o
nnt
ntercosta
tube
te
entrance
8
spaces
and
10
10,
and
or
te
space.
at
te
recess
and
and
tube
At
8,
te
at
s
te
paraver-
12.
sxt
too
6
soud
costoda-
costodapragmatc
and
be
a
rb
g
spaces
up
to
aong
reac
te
te
cos-
te
and
twet
s
between
te
mdaxary
spaces
peura
and
too
tent
rb
N
s
221;
ABR/McM
nnervated
202–209;
N
228;
node,
ABR/McM
te
prmary
204
peura
pacemaker
o
te
eart, s a mass o specazed cardac ces wtn te myo-
A.
to
openng o te superor vena cava nto te rgt atrum.
he
AV
snus
and
trgone
B.
he
rgt
ng
eta
o
rom
atrum
so
te
tat
IVC
rgt
upon
can
te
te
B.
D.
vena
as
te
venous
et
ocated
E.
and
te
GAS
et
atra.
passes
ary
musce
band
carres
conducton
GAS
he
te
woud
atrum
o
N
te
rgt
te
just
s
te
o
ventrce.
AV
regurgtate
subsequenty
ncreasng
ayer.
D.
between
te
rase
capary
E.
rgt
oten
pressure
carna
rgt
he
ar
GAS
86.
D.
te
mtra
et
vave.
atrum
s
a
resut
o
proapse
back
o
te
te
A
a
object
as
to
to
need
to
s
te
be
penetrated
costa
te
be
pareta
costa
par-
nitrated
to
tat
191
sorter,
broncus.
wder,
hereore,
oregn
s
objects
not
w
163–179;
torax.
or
B.
hs
be
a
N
o
as
and
ts
w
s
key
vertca
s
te
and
n
tere
ABR/McM
most
s
by
keood
mnma.
woud
descend
209
vertca
mportant
pumonary
o
supported
te
(descent)
ntratoracc
orced
et
broncus.
dapragm
te
o
road.”
and
object
tertary
contracton
nvoved
openngs
te
structure
odged
ncreasng
nterna
he
a
te
n
rngs,
oregn
208;
te
decreasng
te
“ork
tubuar
tat
nerory,
and
a
separatng
te
obstruct
Contracton
usuay
rdge
s
unkey
ncreasng
ventrce
pror
peura.
te
ABR/McM
cartagnous
an
s
raton
nto
s
tat
woud be a resut o an ncompetent pumonary vave.
et
aso
reac
broncus
bronc;
It
Regurgtaton
te
trunk
215;
ocaton
tracea
B.
rom
pumonary
to
pacement.
penetrated
pareta
deep
not
broncus
prmary
he
Regurgtaton
bood
te
anestetzed
tube
anestesa.
prmary
te
et
A.
o
nto
to
es
does
N
man
and
dome
bood
163–174;
vertca
so
pressure
edema.
o
C.
te
ncompetent
nto
peura
and
ncompete
ocated
case
tereore does not present te pat o east resstance.
199
An
be
ts
peura.
must
costa
penetrated
adequate
rgt
he
pap-
o
must
n
odged.
B.
moderator
branc
endocarda
vave
ventrce.
anteror
he
bunde
ts
be
nterventrcuar
te
ABR/McM
to
and
system,
base
rgt
te
rgt
bood
o
beneat
229;
vave
systoe
venous
causng
te
and
aow
durng
te
and
atrum
porton
to
system
trcuspd
rgt
vave
n
part
211–213;
he
most
muscuar
and
A.
more
he septomargna trabecua (moderator band) arses
te
peura
aceve
85.
between
be
vscera
eta
bood
atrum
te
be
cest
pareta
musces
reacng
must
he
dur-
possbe.
asca
costa
must
or
pan,
186
nter-
peura.
troug
ovae
to
tat
to
te
he subcutaneous at s a reatvey superica ayer
(Eustacan)
cava
te
ntercosta
pror
ibrous
ayer
aspraton
endotoracc
he
coronary
rgt
oramen
reac
s
cava
umbca
soon
septum
te
deepest
durng
reacng
tat
vena
neror
te
as
o
body).
toward
ead
nteratra
atrum
neror
te
septum
n
te
e,
juncton
ibrous
te
he
te
rgt
by
rom
D.
at
utmatey
and
E.
te
bood
te
carred
s
(centra
vave
drects
D.
node
te
pan
he
cardum at te upper end o te crsta termnas, near te
A.
s
reduce
senstve
by
beng somatc nnervaton. hereore, te costa pareta
snuatra
very
egt
be
Ideay
costa
he
s
may
recess.
ne.
241–242;
pareta
and
rb
costodapragmatc
ead to scema and possby myocarda narcton.
C.
nerves
n
recess.
tent
163–174,
costa
rbs
w
te
te
ntercosta
ourt
poston
aong
GAS
84.
he
ventrce
ungs,
o
between
ne
et
between
aorta.
es most posterory . An occuson o a coronary artery w
GAS
82.
E.
to
spaces
occusons can cause a myocarda narcton, but not dys-
81.
ne,
todapragmatc
vave
ow.
descendng)
B.
eve
or
ne
reatonsp
ascendng
ABR/McM
te
he
between
mdaxary
ventr-
any
and
te
between
ne
te
228;
egt
mdcavcuar
A
N
recess.
te
tract o te rgt ventrce and te pumonary trunk.
n
te
ncompetence.
damagng
beow
be
and
poo
196–198;
avod
anatomc
vave
vave
pragmatc
esopagus
drect
woud
ocazed
stenoss
no
aortc
GAS
83.
s
trcuspd
he pumonary vave s ocated between te outow
poston
D
because
between
229;
eads
(AV
woud
woud
efect
C.
s
E.
N
compressve
mtra
wc
ncorrect
wc
189–194;
Mtra
exert
s
vave,
ventrce.
GAS
80.
Thorax
pus
te
dmenson
actor
pressure,
n
o
nsp-
tereby
voume.
ntercosta
nspraton,
musces
resutng
s
n
CHAPTER
increases
sions
C.
o
in
te
te
transverse
toracic
Straigtening
woud
not
vertca
E.
a
te
as
and
dimen-
D.
spine’s
o
te
wou d
needed
orward
o
an
toracc
o
n ot
to
te
be
curvature
mpact
on
te
te
E.
cavty.
87.
B.
he
r b s
to
e xp and
sp e cic
nc reas e
orzonta
usuay
te
te
o
A.
here
C.
he
te
s
N
200;
issure
superor
extends
mdaxary
border
to
88.
ns p r ator y
o
ne
usuay
te
obe
meday
ourt
ABR/McM
he
to
rom
rom
te
rgt
ung
te
te
skn,
s
mdde
obque
sternum,
a
aong
issure
obe.
issure
te
It
A.
breast
no
orzonta
issure
n
ower
te
B.
et
D.
obque
by
issure
stab
o
te
wound
to
et
te
ung
rgt
woud
not
be
thoraco-acromial
Apical
axillary
axillary
gaments
thoracic
o
are
(o
nppe
Obstructon
cause
n
o
thoracic
not
be
are
a
axillary
Pectoral
dmpng
to
te
o
symptoms
o
te
retracton
passes
and
eta
sus-
tumors
dscarge
te
te
o
sow
breast
(GAS
cutaneous
o
state
te
nppe
symptoms
ump,
Fg.
ympatcs
nppe
and
breast
3.16).
te
woud
canges
d’orange.
artery
Pectoralis
major
muscle
node
node
node
lobule
ligament
Lactiferous
duct
Lactiferous
sinus
node
and
of
te
nverson.
enargement,
Retromammary
process
from
part
nam-
overyng
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
ncude
of
artery
to
186
artery
axillary
Axillary
afected
ndcatve
Suspensory
Lateral
eve
cartage.
Secretory
Lateral
a
Cooper).
nverson
peau
woud
ABR/McM
and
due
cancerous
pan,
costa
to
superor
torax.
patoogc
breast
reaces
tereore
Common
nante
cause
ncudng
and
ung
205;
nppe
Intraducta
seen
Internal
N
s
ourt
rgt
cancer.
tat
not
te
et
ung
and
symptoms
te
Retenton
not
cest.
branch
o
canges
n
te
163–179;
woud
rb.
to
rgt
rb
te
patent’s
pensory
at
o
wound
matory
225
Pectoral
Central
C.
te
irst
wound
root
GAS
te
ung.
afected
stab
he
o
te
nverson
163–166;
separatng
apex
stab
capacty.
GAS
he
above
e x b ty
drectons
movements
anteroposterior
sgnicant
dmensons
Orentaton
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
woud
GAS
89.
C.
te
not
as
te
he
B.
he
E.
o
te
ta
A.
D.
rgt
apca,
he
o
ocated
te
wtn
are
aso
neror
e
at
o
to
man
bronc
nodes
N
212;
obar
run
besde
broncus
and
nodes
and
ABR/McM
broncus.
anteror,
te
te
and
mdde
obar
s
one
hs
e
te
te
superor
answer
mdde
atera
tracea.
E.
rom
te
answer
rgt
brances
cest
segmen-
A.
he
B.
he
as
GAS
and
ower
segments
obar
rom
atera
obar
and
te
te
rgt
o
rom
na
te
rgt
o
segment
as
arses
obar
ABR/McM
te
breast
specicay
to
rom
bronc.
s
te
axary
mb,
but
node
not
rom
axary
troug
receves
te
nodes
anteror
te
ymp
breast
receve
anteror
te
ax-
rom
A.
te
area.
B.
ymp
axary
ater
he
t
(pectora)
centra
te
axary
axary
anteror
axary
border
o
te
E.
he
posteror
not
rom
rom
edema
tectomy,
axary
GAS
92.
A.
te
o
te
n
emora
o
te
n
te
artery)
aorta.
mnor
trunk,
breast
upper
and
atoug
tere
s
tat
may
te
be
a
tota
N
te
ror
o
191;
te
ower
are
ABR/McM
braca
mbs
common
Oter
n
te
185
artery)
(as
and
ncude
o
n
coarctaton
tortuous
and
t
B.
due
s
and
to
te
te
te
rb
te
te
anteror
ar te -
n er or
vbraton
resuts
grooves,
ar ter y,
ntercosta
aor ta
rb
notc-
coatera
p os te ror
te
card -
reversa
toracc
carr y
and
coarcta-
wen
o
troug
n
wc
n
o
to
te
eroson
s
vsbe
It
A
B
a
o
can
be
voume
216;
D
seen
or
o
N
te
toracc
ventra
ram
Due
may
be
s
te
s
te
s
te
te
o
torax
but
nerve
ts
s
not
o
be
ar
ud
assoc-
toracc
toward
te
afectng
not
con-
oter
te
to-
assocated
wt
207
arses
rom
nnervates
ocaton
n
Injury
on
axary
o
te
ts
te
C5,
serratus
te
atera
dssecton
nerve
w
C6,
ante-
cest
durng
resut
n
scapua.
pectora
major
nerve,
wc
nnervates
musce.
nerve,
wc
nraspnatus
toracodorsa
dors.
o
assoc-
aorta.
suprascapuar
atssmus
be
aorta.
ABR/McM
wnged
and
not
poong
woud
condtons
and
to
atera
te
wa.
aorta.
and
o
toracc
coecton
woud
movement
n
njured
pectoras
te
pressure
197;
te
njury.
abnorma
space
coarctaton
one
and
o
to
s
o
abnorma
space
st
rest
traumatc
an
reers
supraspnatus
D.
One
nterna
te
ater
s
mastectomy.
te
te
symptoms
breat
occurs
descend ng
rom
peura
caracterstc
(as
decreased
demonstrated
symptoms
symptoms
mbs
te
musce.
radca
A.
upper
not
207
s
ar teres
coarctaton
ong
C7
wa,
a
pressure
he
and
remova
te
costa
peura
coarctaton
and
nodes.
o
caracterstc
aganst
te
seen
Medastna
GAS
mas-
te
wt
racc
C.
a
rbs
ow
o
te
detaced
wt
sde.
a
o
Hydrotorax
te
or
woud
woud
assocated
sy mptom s
Enargement
Pneumotorax
te
breast
s
te
troug
ar teres
s
to
ater
cava
sortness
constrcted.
sma
nto
usuay
s
nto
reason
occurs
artery
puse.
condton
bood
ow
It
tents
regon
ac
vena
emora
tese
hs
o
o
and
ated
E.
94.
ds-
most
Fa cest s seen wen a segment o te rbs breaks
wtn
nodes.
souder
hs
mb
te
receve
te
radograpy.
upper
nodes
be
eadace.
ABR/McM
brances
and
te
some
or
onset
sgns
coarctaton.
ated
troug
neror
an
abnormay
respratory
not
common
superor
or
aor ta.
bood
apca
passes
o
woud
commony
211;
usuay
he
to
(subscapuar)
area.
rom
passed
nodes.
ymp
posteror
artera
n
as
supracavcuar
wc
te
t
ymp
superor
nodes,
axary
141–142;
demonstrated
pressure
tese
ymp
Increased
ater
(pectora)
pectoras
enter
receve
ocated
ymp
may
ymp
are
From
subcavan
ymp
nodes,
axary
nodes
cavce.
nodes
Most
“Notcng”
wtn
C.
apca
te
abnormay
tese
on
nodes.
C.
s
ntercos ta
to
o
decreased
N
(“notcng”)
typcay
s
and
condton
condton.
rgt
sudden
drect on
te
212
aorta
compan
nosebeed
radograpc
ra
te
te
hs
pan.
te
ar teres
segments
be
ntercos ta
mdde
not
te
dagnoss
o
aor ta
broncus.
ower
209;
te
or
216;
he
ton
bronc.
basa
ncudes
rgt
N
more
centra
passed
rom
arse
D.
nodes.
atera
upper
te
dranage
nodes,
(pectora)
segments
arse
o
n
wen
pumonae
Obstructon
ng.
arses
ower
169–179;
underyng
woud
broncus,
ncudes
coce
mdde
obar
rgt
and
key
dvsons
or
does
cor
coarctaton
deveopment.
so
symptoms.
te
tertary
basa
segments
coce
and
patent
te
emorrage.
A pumonary embosm w not present wt tese
209
o
occurs
tress,
resut
above
cerebra
durng
account
broncus.
branc
Lympatc
ower
segment
hs
ary
D.
vesses
o
Dssecton
tracea.
broncus
posteror
meda
atera
rgt
axary
and
rgt
hs
he
C.
93.
meda
he
B.
not
te
rsk
coarctaton
ungs.
nodes
bood
constrcted
tracea.
te
(ar)
traceobronca
superor
GAS
D.
e
185
nodes
o
enarged
ncreased
bronc.
rgt
91.
are
ining
ere.
ungs.
juncton
superor
obar
E.
and
burcaton
nodes
141–142;
rom
C.
te
described
ABR/McM
nodes
o
paratracea
GAS
he
ste
superor
he
nto
o
te
B.
188;
epiteia
canges
broncopumonary
he
to
carna
te
nippe’s
te
traceobronca
pumonary
um
D.
te
N
neror
carna,
A.
o
produce
141–142;
he
known
90.
Thorax
nerve,
nnervates
te
musces.
wc
nnervates
CHAPTER
E.
E
is
te
95.
B.
te
major.
GAS
717,
by
cavcuar
te
ates
wt
ton
o
te
to
body
be
wt
o
te
nvoved
tat
innervates
musce
and
tumor
te
pac
at
wt
par
sterna
te
wt
are
o
body
te
and
juncton
drect
hey
te
are
traumatc
te
te
o
o
carac-
rbs
E.
too
manubrum
njury
most
to
te
wt
key
sterna
B.
he
o
te
te
148–153;
toracc
entre
duct
body
quadrant.
aorta
Daton
rom
a
eadng
beow
and
o
to
te
192;
s
ABR/McM
mportant
wt
he
te
tons,
ven
esopagus
poma
can
mparment
bockage
duct
ere
o
dranage
te
ascends
n
te
te
te
ympatc
resutant
hs
ymp
bend
compress
o
and
n
183
excepton
toracc
azygos
te
arge
N
upper
ower
n
te
C.
A.
D.
toracc
o
te
aorta
esopagus
to
produce
woud
not
symptoms
compress
o
ower
C.
Superor
by
cava
medastna
nicant
D.
vena
An
ower
aortc
cerous
occuson
tumors
mb
most
woud
oten
not
produce
and
s
B.
woud
assocated
not
cause
wt
ower
can-
egn
mb
A.
97.
C.
edema.
GAS
231–232;
arteres
costa
egt,
B.
he
tus
242;
not
o
te
o
part
o
E.
he
toracodorsa
GAS
he
may
suppy
toracc
axary
artery,
suppy
posteror
a
or
ower
compres-
wc
crosses
bracocepac
or
woud
atera
not
ABR/McM
be
to
ven,
ts
key
oca-
mpnge
oca
rb
te
regonay
and
peura
nto
cervca
topograpc
peura,
and
228
dvded
cervca
o
peura
nes
s
reatons.
te
cupua.
projectng
correspondng
por-
nto
to
te
te
area
or
upper
o
and
te
body
man
body
N
tan
s
222;
broncus
te
o
te
s
s
not
near
ocated
te
es
irst
n
rb.
between
te
216
sorter,
man
t
ocated
medastnum.
wder,
broncus.
more
(atoug
vascuar
s
nor
ABR/McM
et
et
not
peura
te
broncus
te
s
cavce
n
asprated,
enters
suraces
rb.
broncus
pareta
prmary
vertca
irst
rgt
organs
166–169;
nterna
broncus
te
obe
te
te
spaces.
manstem
cavce
rgt
157–158;
extend
nto
hs
D.
s
o
o
te
te
arteres
N
es
te
artery
te
ncorrect
not
s
n
key
some
to
and
Wen
enter
cases
te
a
te
or-
broncus).
resstance
s
not
reated
to
te
ante-
E.
he
not
rgt
venous
woud
GAS
as
te
rgt
man
broncus
s
te
rgt
man
broncus
s
narrower.
ncorrect
sorter,
nter-
provde
ower
passes
abdomna
artery
sevent,
arses
artery
o
a
nto
te
rec-
wa.
rom
branc
te
as
onger.
ower
ung
dranage
167–170;
tan
N
obe
te
215;
does
oter
not
ave
poorer
obes.
ABR/McM
221-222
101–125
D.
he
by
second
trd
o
te
part
sub-
o
te
221
medastnum
medastnum.
A
area
mdne
poston
as
te
superor
cava.
he
superory,
and
(on
te
arc
he
o
et
te
rgt
structure
o
te
rgt
s
o
te
and
just
ts
by
et
eart
s
as
seen
te
n
eart
atrum,
ormed
artery,
arrow
sde),
eart
and
te
a
pan
ormed
neror
aortc
aurce,
arc
et
ven-
neroateray.
neror
marks
te
to
te
he
cav-
ocaton
o
aorta.
superor
upper
cava,
border
apex
by
te
border
pumonary
te
te
o
rgt
vena
et
et
ndcated
ce
A.
and
norma
x-ray
te
vena
te
ABR/McM
superor
anteror
101.
trce,
s
205–206;
te
Answers
cest
artery.
branc
n
hs
wt
artery.
tymus
C.
226
spaces.
artery
anteror
atera
D.
cause
suppy.
epgastrc
te
he
axary
te
225,
Lgaton
te
ntercosta
D.
te
produce
anastomose
muscuoprenc
nnt
superor
arteres
arteres.
artera
ntercosta
seat
not
ABR/McM
afect
because
and
scapuar
98.
N
ntercosta
Brances
woud
ntercosta
coatera
anteror
dsease
woud
spaces
provde
to
ven,
medastna,
te
medastna
wder,
anteror
posteror
ror
A.
artery
mb
te
and
queston.
Femora
he
supe-
tymus
mdne.
dsta
can
upon
irst
Pumonary
edema.
E.
key
te
222;
ntercosta
rgt
oregn
rgt
not
N
dome
vcnty
he
more
sg-
s
ocated
te
mass.
rgt
n
ven
peura
te
rgt
GAS
caused
te
tymus
or
te
costa
he
mb
edema.
aneurysm
growts
and
s
ts
more
ocated
te
name
ungs
100.
bracoce-
t.
rgt
te
te
sweng.
not
and
he
E.
Daton
tan
220–222;
above
he
ower
mbs.
et
are
o
bracocepac
dependng
te
rom
s
s
vens
poston
by
dapragmatc,
he
duct,
dranage
et
pareta
rbs
torax
te
njury.
A.
esopagus.
toracc
edema
o
tumor
te
orms
neck
between
afected
and
Anoter
GAS
rgt
he
costa,
ange.
96.
B.
compress
juguar
te
subcavan
GAS
99.
to
mdne,
ton,
ow
be
o
he
te
can
nterna
mdne
upon
are
te
he
wc
sternum.
gand
atera
not
te
jont.
rbs
not
A
junc-
o
B.
son
artcu-
te
te
C.
rbs
ts
and
woud
sterno-
irst
o
ven.
and
ror
manubrum
it
o
s
ange,
sternocavcuar
sternum.
n
Lateray
te
144
manubrum
second
ourt,
te
ABR/McM
artcuatons
he
te
trd,
te
notc.
connects
beow
he
nteract
te
to
E.
194;
o
te
sternum
rb
sternum
D,
and
manubrum
irst
N
margn
juguar
te
nerve
subscapuaris
795;
manubrum.
te
he
te
A
jonts
wt
subscapuar
o
727,
superor
terzed
C,
part
teres
he
A.
ower
ower
89
Thorax
2
vena
cava
border
aong
te
woud
and
te
eart’s
comprse
arrow
et
s
te
eart’s
pontng
border.
to
a
90
C H A P T E R
B.
he
2
Thorax
rgt
anteror
C.
he
te
E.
et
he
A
te
ndcatve
s
cancer
ents
A.
as
en
a
o
D.
ow
s
a
more
woud
by
te
eart’s
nodes.
te
arrow.
te
neror
to
were
B.
hs
e
he
to
o
te
pysca
C.
208
te
D
queston
coce
o
condton
are
answers
tat
pres-
te
skn
by
exam
tat
indng
resembes
obstructon
axary
s
o
ymp
oten
a
an
B.
ym-
orm
and
not
an
hs
s
a
descrpton
pysca
o
te
condton
and
symptoms
not
best
n
te
depcted
GAS
A.
ment
a
o
tan
D
and
be
afected
te
E.
are
te
s
a
moton
sucked
n
nspraton,
he
on
move
n
te
drecton,
ractured,
norma
as
tey
“pump
te
N
subcavan
201;
o
by
ne
n
te
ner ve
and
w
not
ande”
to
be
es
to
gery
A.
moton
o
rbs,
te
not
B.
as
t
s
te
damage
meda
structure
wen
to
E.
a
te
key
superor
o
vena
cava
pacement
es
and
meda
s
too
he
E.
he
be
damaged
vagus
ment
carotd
by
te
nerve
and
s
s
not
artery
s
and
aso
o
be
ne
dam
B.
neror
to
be
to
A.
too
meda
to
GAS
A.
221;
Lymp
drans
ymp
drans
nto
key
to
te
be
ste
N
204;
te
te
ABR/McM
ower
o
ne
damaged
pace-
posteror
he
posteror
medastna
mdde
and
o
by
ts
D.
trd
superor
o
E.
te
and
te
esopagus.
ungs.
prmary
broncus
traceobronca
receve
ymp
woud
nodes.
rom
te
nodes.
nodes
ympatc
receves
woud
not
dranage
ymp
wc
paratracea
tat
te
artery
be
te
rom
te
rom
n
te
turn
bron-
receve
nodes.
spna
eve
to
rgt
orgn
o
ts
te
be
artery
as
coronary
te
artery
artery
but
ne-
(usuay
wt
can
pevc
woud
coud
an
te
ante-
durng
ts
o
s
to
ocated,
taken
unctons
parapega
are
anastomoses
soud
o
bood
specicay
neurons
coatera
Care
damage
to
o
Adamkewcz)
oxygenated
cord,
motor
ateraton
te
(o
provdes
ower
ead
to
te
to
te
sur-
ead
to
organs.
not
spe-
dsrupt
car-
et
ata
common
but
s
carotd
not
artery
specicay
coud
be
assocated
te
rgt
subcavan
artery
woud
not
parapega.
Iatrogenc
njury
key
An
to
o
te
produce
104–106;
enarged
te
et
atera
he
he
esopagus
et
he
esopagea
parapega
artery
as
an
s
aso
assocated
medastna
ymp
to
A.
y
he
be
n
te
and
w
ven
most
wc
key
es
com-
mmed-
neck.
s
subcavan
devaton
be
nerve
not
ven
as
es
key
neror
to
to
te
be
afected
by
artery
at
s
te
not
descrbed
nerve
s
w
eve
as
not
o
be
njured
by
key
te
to
tyrod.
be
afected
by
ere.
aso
not
te
most
key
struc-
afected.
173–177;
carna
seen
gand
juguar
devaton.
prenc
GAS
109.
t
gand
vagus
he
185
bracocepac
scenaro
ture
gastrc
esopagus
et
N
tyrod
nterna
to
et
tracea
228
trd
te
te
parapega.
Injury
te
rom
nodes.
nto
to
tracea
C.
to
o
uncton.
Injury
atey
easy
procedure.
105.
Injury
GAS
108.
ne.
meda
patoogy
trunks,
artery.
and
tyrod
common
receve
symptom.
ste
not
deep
not
traceobronca
o
nodes
provdes
prevent
not
ven.
to
and
produce
tat
pacng
aso
219
o
spna
wt
C.
posteror
superor
rgt
radcuar
potentay
patent.
drecty
most
w
except
receve
broncus.
vertebra
cicay
damaged.
D.
to
press
ste
te
parapega
190–191
subcavan
s
w
dapragm
not
esopagus.
dranage
neror
te
artery
were
T12–L1),
abe
n
duct
N
porton
ror
wa.
rom
great
rater
aged.
te
he
cord
drec-
cest
n
receve
prmary
183;
ror
opposte
broken
efort
tereore,
vunerabe
prenc
te
te
ABR/McM
artery
ven;
most
venous
sde
breatng
subcavan
he
D.
anteror
te
to
toracc
dac
excursons
eter
pacement
C.
he
ower
te
and
w
te
traceobronca
ste
mportant
expraton.
nodes
rom
broncopumonary
deep
and
te
te
paratracea
ymp
te
w
219
rom
comedastna
seg-
o
upon
enarged
nto
nodes
he broncomedastna trunk s not a ymp node.
nspraton.
he
he
w
area
wt
n
a
experenced
a
same
rbs
154;
centra
te
occurs
te
te
restrcts
be
he
rgt
107.
produce
paradoxca
outward
GAS
woud
B.
n
actate
durng
A:
s,
190–191
ractures
wa,
segment
not
Because
to
104.
tat
a
ton,
ABR/McM
rb
commony
movement
he
pan
s
expandng
reverse
C.
197;
toracc
segment
nspraton;
B.
N
mutpe
te
irst
neror
N
nto
esopagus.
nvoved
183;
GAS
143;
Wen
be
drans
he
queston.
103.
he
esopagus
D.
exam
te
te
C.
E.
aso
te
dranage
not
Lymp
irst
indng.
E.
rom
superor
mammograpy.
symptom
may
dran
nodes.
md
E.
are
GAS
A.
o
traceobronca
and
hey
trd
nodes.
broncopumonary
he
nodes
106.
pysca
tumor
by
to
upper
cervca
ympatc
n
best
nvaded
cancerous
neror
texture.
caused
troug
more
ABR/McM
patoogc
s
he
deep
he
arrow.
descrbed
reers
detected
a
e
te
ke”
texture
pee.
cancer
hs
by
224;
“wood
Intraducta
comprse
ndcated
ymp
cancer.
curasse,
abnorma
patc
C.
to
N
breast
d’orange
orange
woud
symptoms
ard,
Peau
o
o
aso
not
artery
ponted
195–198;
o
s
pontng.
pumonary
area
GAS
B.
s
woud
and
ventrce
arrow
te
102.
ventrce
surace
n
s
N
te
cest
199;
ony
ABR/McM
answer
x-ray.
he
218
sted
carna
tat
s
at
can
te
eas-
eve
CHAPTER
o
T4–T5
Lous]).
te
B.
t
to
s
he
and
not
as
pacement
as
wit
venous
artery
easy
vena
s
seen
cava
o
a
not
be
tey
s
a
a
not
centra
[o
E.
an
dea
and-
venous
113.
A.
ne
as
te
andmark
to
to
te
et
or
reaby
and
rgt
centra
seen
on
173–179;
N
Gynecomasta
mammary
A.
gands
Poytea
216;
s
n
ABR/McM
te
B.
vena
cest
o
supernumerary,
or
te
and
to
te
E.
C:
E.
A
breasts
condton—an
Amasta
GAS
111.
Supernumerary
same
reers
135,
tenson
to
te
141–143;
and
absence
N
190;
pneumotorax
s
o
reer
E.
by
o
negatve
ung
to
durng
s
not
wc
a
a;
be
tere
cest
te
ment
n
not
s
a
reers
s
o
te
114.
cnca
peura
te
reers
ractures
to
voume
te
produce
te
to
D.
condton
te
o
a
a
seg-
bood
wtn
assocated
wt
s
not
cavty.
te
te
duct,
B.
169;
duct.
te
et
N
te
te
he
subcavan
et
ven.
211;
s
te
ven,
C.
Injury
to
and
eard
B.
as
or
D
and
o
te
seen
produce
resut
Injury
o
te
tey
E.
et
A.
toracc
te
cavty.
orm
at
to
te
venous
ven
te
te
et
to-
to
B:
te
braco-
aso
o
C:
dsrupt
hs
rgt
to
te
ven
toracc
duct
ven.
not
as
te
resu-
o
te
superor
wen
se
es
n
te
n
to
upper
mbs.
carotd
artery
bood
nterna
as
pressure
juguar
n
se
eevated,
not
w
seen
vens
bood
n
w
press ure
woud
te
ungs
o
te
ne
te
ung
woud
and
to
At
ne,
efects
ntercosta
assocated
o T2
one
wt
tat
te
posterory
te
tereore
o
mgrates
te
sxt
be
anterory.
issure
budup
Remember
eve
mdaxary
te
usuay
due
te
ung.
te
to
ud
over
rgt
rom
due
he
sxt
woud
over
to
nter-
be
te
per-
ower
te
efects
ess
obe
o
queston
not
o
key
te
does
gravty,
to
be
rgt
not
te
but
ud
up
n
budup
te
upper
ung.
ndcate
any
examnaton
172–176;
N
ange
rgt
s
he
to
ventrce
et
o
and
too
adjacent
he
rgt
to
neede
woud
223–224
troug
passng
up
percardum.
eart
s
argey
tereore
te
troug
he
da-
composed
be
entered
o
a
ar.
woud
not
troug
te
atrum
ABR/McM
perormed
ibrous
te
eart
ace
te
te
ventrce
te
usuay
wt
surace
nserted
213–214;
s
be
te
encountered
wen
dapragmatc
sur-
mdne.
woud
not
be
encountered
dur-
percardocentess.
he
et
ace
atrum
and
es
woud
on
not
te
eart’s
be
encountered
posteror
sur-
durng
percardocentess.
subcavan
ven
woud
not
E:
he
cardac
apex
approacng
proxma
s
a
compressed
ead
common
raes.
cartage
dapragm
ng
D:
ven
wt
ung.
enterng
duct.
juguar
be
canges
n
as
te
ts
s
mdde
neede
system
and
to
runs
n
beow
pragmatc
begnnng
commony
toracc
externa
te
eart,
n
ed
274
Percardocentess
te
juguar
njures
ven
te
njury
s
compresson
patent
woud
te
te
o
costa
Due
te
cyotorax.
cepac
pac
te
enters
nterna
were
et
by
may
mdaxary
crackng
cyotorax.
to
n
duct
et
to
toracc
te
ts
canges
porton
obe
space
GAS
115.
212
caused
Penetratng
te
njury
te
ABR/McM
usuay
o
termnaton
Injury
ater
enterng
bracocepac
A.
D.
seen
toracc
juncton
cepac
s
ymp
Cyotorax
racc
at
wt
te
com-
moter
obe.
A
toracc
sgns
N
issure
sxt
costa
ar
condton
tat
peura
te
compresson
n
Auscutaton
te
nrasterna
Cyotorax
GAS
at
ower
te
obe
te
or
te
o
noses
neror
obque
n
wa.
n
undergoes
wen
case
pressure
o
te
reerred
gravty.
space
condton
wtout
are
te
o
occurred
134;
Crackng
cussng
ncreased
t
canges
not
ack
ere.
112.
C.
enter
pneumotorax,
te
respratory
Hemotorax
and
as
rb
by
cavty
te
to
he
causes
pneumotorax
cause
cavty
caracterzed
ar
cavty.
cavty
etus
ts
bood
prod uce
GAS
to
trauma.
toracc
Empysema
C.
o
mutpe
te
peura
spontaneous
rupture
w
peura
te
te
not
descrbed.
185
njury
aowng
eave
tereore,
a
s
to
tenson
occurrence
wereby
B.
to
vave,
not
n
he
voent
case
but
pressure
key
Fa
n
one-way
coapse.
necessary
A.
a
w
228
key
troug
aorta
but
patent.
to
as
cavty
qute
ts
occur
patent’s
ts
wound
acts
ven
pressure.
reason
to
produce
ud
peura
no
In
ow
bood
not
ung, eadng to ar n te peura cavty. he ste o te
te
bood
n
supne,
not
breasts.
caused
juguar
ABR/McM
cava
poston.
s
externa
growng
Compresson
breast.
ABR/McM
te
depressed,
extra,
poymasta
addtona
219;
vena
Compresson
nppes.
B
N
cava
he
D.
to
rgt
supne.
men.
reers
drop
es
growt
by
here
209
abnorma
159;
reduced
ne
te
cyotorax.
neror
supne
tant
C.
GAS
D:
he
presson
x-ray.
dea
to
produce
x-ray.
110.
Injury
gude
ne.
suc
be
to
GAS
most
andmarks
not
ange
used
cest
centra
dea
may
sterna
ne.
te
o
on
structures
not
te
commony
pacement
Cardac
woud
s
centra
pacement
E.
atrum
a
gude
superor
very
D
o
subcavan
mark
as
associated
andmark
pacement
he
C.
(pane
hs
91
Thorax
2
as
part
o
cosey
orgn
o
te
rgt
assocated
te
et
braco-
wt
not
eart
be
va
encountered
te
wen
dapragmatc
surace.
te
bracoce-
woud
te
GAS
116.
B.
te
he
190–194;
pan
N
223;
experenced
sympatetc
ABR/McM
by
te
nnervaton
o
208
patent
te
traves
eart,
wt
derved
92
C H A P T E R
rom
te
2
Thorax
spina
eart
monary
nerve
and
eves
te
nerves.
T1–T4.
cardac
he
pexuses
Subsequenty,
pan
va
te
ibers
te
pan
eave
D.
cardopu-
ibers
ng
pass
E.
troug te sympatetc trunk, enter te spna nerve,
and
ce
pass
root
B.
o
ganga
hs
T4
C.
nto
bodes
and
pan
te
answer
s
roots
ibers
spna
o
te
are
nerves
ncorrect
as
t
spna
ocated
rom
does
nerves.
n
T1
te
to
not
117.
T4.
ncude
s
spna
A.
as
t
does
ncude
te
he
and T6
nerves T5, T6,
138;
ts
pan
te
act
T3
to
ncrease
he
be
nerves.
ande
te
rbs
and
by
te
Left
cardiac
Superior
vena
dameter
“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
nvoved
3.84).
te
plexus
B
GAS
Fig.
3.84
cardiac
branches
o
te
trunk
A
recurrent
o
ande
Pulmonar y
Right
o
branches
Cardiac
n
238
dameter
ner ves
Superficial
of
not
Fg.
ner ve
Vagal
Arch
w
sternum.
sympathetic
Vagal
N
transverse
Cardiac
vagus
nvoved
(GAS
movement”
anteroposteror
ncreased
te
Right
not
and T7
sgna
244–246;
“bucket
are
sgna.
rbs
afects
te transverse dameter o te torax. Inspraton woud
B.
ncorrect
pan
carryng
GAS
he
dorsa
nerves T5
ts
Spna
n
nerve.
answer
T4
dorsa
te
o
spna
hs
te
Spna
ner ve
trunk
te
torax.
torax
woud
movements”
o
CHAPTER
C.
he
by
D.
vertca
dmensons
contracton
he
durng
movements”
he
durng
118.
C.
Bronca
patetc
te
o
te
N
rbs
and
due
rbs
te
due
are
o
to
ncreased
by
dapragm.
te
n
torax
“pump
A.
to
(GAS
te
te
Fg.
o
o
te
prenc
wc
nerve
to
coud
be
bocked
motor
ande
3.35).
D.
te
provdes
motor
and
to
ter
respectve
ntercosta
o
sympatetc
nnervaton
resuts
s
te
nduced
by
arways.
hs
te
parasym-
s
E.
he
supped
recurrent
vagus
and
aryngea
nnervates
183;
N
nerve
parts
o
s
a
te
branc
o
te
arynx.
220
A. he ocaton were one s east key to damage mpor-
structures
by
makng
an
ncson
or
pusng
tube nto te torax s over te upper border o
B.
At
te
ter
neror
ntercosta
(VAN
Pump
handle
or
Entrance
space
ty
D.
cest
not
percng
Enterng
costa
o
eac
artery,
tube
te
te
w
ts
mdde
emnate
between
one
w
nerve,
s
n
a
te
encoun-
tat
not
cest
rb.
order
an
dea
pacement.
te
mportant
musces
rb,
and
tereore
troug
does
o
border
ven,
structures),
ocaton
C.
of
n
broncodaton.
tant
and
sensory
dapragm.
nnervaton
Stmuaton
GAS
movement
resut
spaces.
119.
Superior
to
arways.
he ntercosta nerves provde sensory and somatc
decreases
“bucket
nerves,
nnervaton
B.
torax
vagus
he
ande
sternum.
o
te
reaxaton
201
constrcton
nnervaton
torax
o
dameter
dameter
164–165;
te
expraton
expraton
movement”
GAS
o
transverse
o
reaxaton
anteroposteror
decreases
E.
and
93
Thorax
2
te
ntercosta
possb-
structures.
nterna
not
o
egtened
permt
and
externa
entry
to
te
nter-
peura
cavty.
anterior
ster num
E.
Enterng
nterna
to
te
GAS
120.
B.
between
peura
rom
N
205;
tamponade
accumuates
n
ntercosta
membrane
musces
w
not
and
aow
te
entry
cavty.
152–153;
Cardac
te
ntercosta
te
percarda
s
ABR/McM
a
percarda
efuson
232–233
condton
or
n
cavty.
rom
wc
It
can
eakage
o
ud
resut
bood
A
rom
ses.
te
he
eads
to
eart
proxma
ncreased
cardac
reduced
reduced
portons
pressure
decreased
tereore
te
or
systoc
pumpng
wtn
ing
bood
capacty
o
te
te
dastoe
pressure.
te
ves-
percarda
durng
o
great
sac
and
Because
eart,
tere
o
s
Bucket
ncreased
pressure
n
te
venous
system,
eadng
to
te
handle
dstenson
o
te
juguar
venous
system.
movement
A.
Hemotorax
descrbed
C.
te
not
resut
n
te
symptoms
vgnette.
Hemopneumotorax w not produce te reduced
eart
sounds,
tenson
D.
seen
engorged
n
ts
Pneumotorax
w
sounds,
seen
E.
n
w
n
Deep
engorged
ts
ven
mbs
juguar
vens,
and
ypo-
patent.
not
produce
juguar
te
vens,
reduced
and
eart
ypotenson
patent.
tromboss
and
oten
ncreases
te
occurs
rsk
n
o
te
ower
pumonary
embosm.
Elevation
shaft
of
of
lateral
GAS
190–194;
N
223;
ABR/McM
208
rib
121.
B.
he
S 2
sound.
aortc
A.
eart
hs
and
he
sound
sound
s
pumonary
cosure
o
reers
to
te
produced
semunar
by
second
te
(dub)
cosure
eart
o
te
vaves.
mtra/bcuspd
and
trcuspd
vaves
B
produces
GAS
Fig.
3.35
ts
te
answer
s
irst
S1
(ub)
ncorrect.
eart
sound,
tereore
94
C H A P T E R
2
Thorax
C.
hs
s
D.
he
trcuspd
ncorrect
as
t
vave
ncudes
te
contrbutes
mtra
to
te
vave.
irst
125.
eart
sc
sound.
E.
hs
s
ncorrect
as
t
ncudes
te
trcuspd
E.
he
vaves
N
224;
o
produces
s
ABR/McM
te
te
190–191
mtra/bcuspd
irst
S
(lub)
eart
1
A.
and
hs
s
B.
Cosure
vaves
not
sound,
so
correct
o
te
ts
as
te
te
bot
irst
te
eart
pumonary
second
eart
mtra
and
trcuspd
D.
ng
to
sound.
and
C.
aortc
sound,
so
vaves
ts
he
pro-
s
not
s
ncorrect
utes
to
te
GAS
243;
Fa
cest
correct
irst
N
as
s
to
t
ncudes
mtra
opton
s
Hs.
te
aortc
caracterzed
by
provded
ntercosta
prenc
nerve
dapragm
aso
contrb-
ntercosta
s
breat-
ractures.
vagus
vaton
to
testna
C.
he
spaces
supped
va
E.
te
tract
organs,
and
horacc
sensory
provde
toracc
as
dsta
nnervaton
pareta
te
rom
pan
T1
to
N
et
to
T4
to
prenc
souder.
te
prenc
t
arc
does
certan
he
do
to
te
and
eves
rom
to
tese
he
te
are
et
pan
may
transmt
organs
n
nner-
norma
unctonng
te
or
do
te
te
or
A
urter
ntercosta
to
te
nerves
pan
to
te
D.
tat
are
not
abdomen
abdomna
N
208;
and
carry
and
organs
to
te
te
aor-
tere,
rom
A.
but
sgnas
deayed
tme
or
te
te
conductng
te
to
ave
sends
n
bunde
contract
no
o
n
a
pacemaker
te
to
conducton
te
Purknje
determnng
s
te
an
tat
te
abnorma,
s
present
popuaton.
N
236;
It
s
sg-
ibers,
rate
o
accessory
n
a
sma
assocated
wt
syndrome.
ABR/McM
o
rgt.
te
B.
211
peura,
nner-
normaton
ibers
musce
nbtng
ibers
eter
sympatetc
ts
o
s
te
N
o
te
eart
te
traceo-
w
daton
va
w
te
are
te
cause
tree.
n modaty, and
o
smoot
nerves.
motor
not
ts
or
tereore
daton
motor
musce,
o
pregangonc
ibers
aow
tree.
n
uncton,
smoot
but
musce
o
tree.
221
s
a
eart
actor
durng
cords
eter
nvoved
traceobronca
ibers
skeeta
are
te
tem
cause
te
moduate
done
traceobronca
183;
n
condton
tube
Noda
te
s
tat
te
pays
et
a
embryonc
an
par tay
toracc
to
anomay
or
roe
It
s
n
rom
o
te
to
a
te
oopng
perod.
n
entrey
cavt y.
resuts
nstead
wc
te
ocated
not
ear t
extern a
assocated
wt
Noda.
T ransposton
wt
D.
souder.
sympatetc
smoot
traceobronca
eferent
TGF-β
to
to-
normaton
te
te
cannot
as
Ectopa
s
souder
o
Sympatetc
suppy
bendng
o
parasympatetc
hereore,
Dextrocarda
ner ves
rom
pareta
sensory
202
o
constrcton
GAS
127.
except
te
supped.
ABR/McM
va
Vscera aferent ibers are sensory
tey
aso
pevs.
sensory
reerred
spancncs
te
222;
spaces
be
s
trougout
specazed
down
Kent
Inbtng
Somatc
o
regon.
ibers
E.
et
eves
aneurysm
to
pan
carry
B.
musce
cardopumonar y
carr y
reaxaton
postgangonc
toracc
aganst
and
te
traves
sgna
Hs)
node
o
tree.
te
eves
an
(o
constrcton
and
C.
woud
toracc
te
structure.
root
sensatons
abdomen
reerred
tey
by
sgna
ventrces
patway
216–219;
esopagea
gastron-
organs.
vaton
GAS
pan
bunde
sympatetc
pan
es
te
nvoved
126–148
sympatetc
souder
nerve
afected
vscera
cause
but
be
nerve
te
vagus
and
tat
rom
over
are
te
manner,
AV
Postgangonc
C.
200
o
because
C3–C5,
not
tereore
reerra
occurs
skn
ntercosta
rom
he
causng
s
te
126.
organs.
carry
ABR/McM
ibers
bunde
Answers
abdomen.
not
not
racc
E.
te
toracc
regon,
D.
not
depoarzaton
he
ten
Wof-Parknson-Wte
exure.
carry
nerves
206;
reerra
nerve
to
Atoug
tc
C.
nerve,
hs
dstrbuted
B.
s
(provdng
and
aow
proporton
te
peura
te
coc
nerves
ibers
te
152–155;
and
te
node.
node
receve
and
A. An aneurysm o te aortc arc coud mpnge upon
te
node
rytm.
a
nnervaton
parasympatetc
vscera,
as
AV
GAS
motor
medastna
spancnc
nnervaton
124.
tat
rom
he
nerves.
provdes
cardopumonary
GAS
cardac
musce.
conducton
n
nerves
nnervaton
E.
AV
he
percardum.
he
te
producng
depoarzaton.
paradoxca
rb
receves
contract),
hey
and
by
to
he
na
190–191
peura
and
and
vave
mutpe
pareta
dapragmatc
B.
n
uncton
sound.
ABR/McM
caused
underyng
te
te
eart
nnervaton
he
as
224;
movements
correspondng
A.
settng
asssts
snuatra
Purknje
ibers
D.
hs
te
eart,
snuatra
syncronzed
answer
sensory
te
te
to
cardac
vave.
123.
te
node
te
wtn
ncorrect.
D.
AV
rom
atra
produce
duces
hs
wen
he
trcuspd
correct.
A.
C.
o
pacemaker
normay.
243;
cosure
opton
artica
rytm
vave.
122.
pacemaker
An
answer
GAS
B. he snuatra node unctons as te prmary ntrn-
An
aso
E.
te
unequa
not
o
Noda
te
great
dvson
assocated
o
wt
syndrome
te
Noda
GAS
208;
te
o
wt
Coarctaton
T urner
arteres
te
te
not
aorta
s
but
truncus
Noda
most
s
not
actor.
N
s
assocated
actor.
233;
ABR/McM
196
arterosus
s
actor.
oten
assocated
assocated
wt
CHAPTER
128.
A.
he
te
arc
(3)
s
esopagus
torax
o
te
te
n
te
typcay
aorta,
(2)
dapragm.
te
neck.
as
esopagus
te
he
Answer
s
our
constrctons.
compressed
et
prncpa
A
s
correct
as
In
(1)
te
broncus,
and
crcoparyngea
t
by
C.
he
A
constrcton
ncudes
eart,
age
w
he
D.
he
E.
he
tese
D.
te
not
toracc
constrct
azygos
ven
duct,
te
and
te
crcod
cart-
E.
eart
arc
w
not
are
constrct
te
tymus
GAS
129.
C.
o
he
ras
ng
by
tat
s
A.
he
nppe
B.
he
D.
he
E.
he
te
by
not
ped
GAS
Due
pareta
T5
N
D.
peura
by
parencyma
due
E.
to
an
te
case
dorsa
cause
te
nppe
te
root
te
s
eart
gangon
A.
te
te
T3
are
not
D.
sup-
root
gangon
area
are
not
te
s
oss
te
sup-
o
n
and
coapse
carotd
o
te
artery
vesses
and
A
gus
irst
and
as
dam-
nto
te
wtn
te
parta
not
N
te
206;
ptoss,
ng
Horner
syndrome.
te
cervca
sympatetc
ganga
and
known
as
apex
o
tarsa
under
ung.
o
vagus
cause
not
be
wtn
te
vena
not
o
ts
tract,
ead
be
njured
gands
gands
o
te
n
be
be
n
cervca
symp-
nerves
and
toracc
s
te
and
upper
organs.
autonomc
206
to
te
to
cava
te
et
te
eart.
atrum
esopagus
n
te
runs
cavty
arteres
O
es
te
most
wen
te
medastnum.
on
and
s
too
does
t
te
by
te
emptes
e
s
too
an
rgt
ts
sde
contents
an
aganst
a
te
east
te
te
musce
easy
te
med-
tumor.
bod-
esopa-
structure
resstance,
reatvey
to
tumor.
vertebra
afect
smoot
o
devated
wtn
esopagea
woud
pat
anteror
esopagea
anteror
by
tumor
because
be
are
afected
afected
A.
are
a
cncay
and
o
a
dator
eyed,
does
Pancoast
and
o
eart
neck
te
sweat
te
but
eson
B.
tumor,
tumor
te
o
aso
o
gands
are
to
any
but
rater
ts
tan
structure
arynx.
tan
and
V on
mucous
te
t
n
te
te
passes
ina
ibers.
atrum
he
et
he
superor
s
access,
te
vena
as
t
te
ten
s
superor
te
te
rgt
Purknje
atrum
rgt
does
not
pays
o
most
te
no
ibers
reac.
dcut
pacemaker
cambers
atrum
contan
Purknje
to
te
te
rgt
te
no
among
cava
treat
pacemaker
to
te
but
dcut
so
to
conducton
contracton.
contans
reatvey
troug
and
troug
ocaton
aso
te
ven
stmuate
ventrce,
ventrce
to
to
used
eart
o
atrum
used
rgt
be
“tp”
ventrcuar
Purknje
woud
or
ang
subcavan
rgt
s
he
et
or
205
commony
w
rgt
roe
n
be
eart.
cardac
pacng.
GAS
134.
suppy,
oter
E.
a
ibers
resut
nserted
te
bronc,
nto
te
ABR/McM
are
weak
pacemaker
not
223;
eectrode
cambers
superor
tracea,
not
D.
ave
were
reac
and
trunk
contro.
(aryngea
and
a
parasympatetc
tongue)
parynx
sucus
pupae,
system
carry
gands
s
sympatetc
to
he
N
pacemakers
troug
cava
ibers
emotorax.
syndrome
trunk
pumonary
and
and
Ebner
n
atrum.
growng
he
ventrce
200
andross
Horner
nervous
and
to
wo
treaded
descrbed.
ABR/McM
and
resut
he
nerve
musces
te
a
te
sympatetc
dgestve
n
oten
superor
te
musce
he
to
a
s
vena
228–229;
systems.
woud
s
149–153;
te
postgangonc
pexus
poston
ventrce
Artica
patents
ung.
ound
tat
C.
sternum
Moss,
produce
nnervate
eart,
anteror
rgt
can
are
posteror
toracc
to
ere.
resut
cardopumonary
tat
ABR/McM
te
tereore
GAS
133.
ere.
are
woud
suc
are
ows
pressure
descrbed
ungs
vesses
bood
negatve
njury
s
n
esopagus
es.
to
and
et
he
mportant consteaton o symptoms possby ndcat-
B.
he
not
orgnate
es
pumonary
organ
ntercosta
torn,
njury
te
externa
te
woud
eart.
norma
te
astnum
o
or
and
204;
just
ts
esopagus
E.
dorsa
N
ibers
descrbed
patent.
nerves
hey
te
autonomc
nerve
woud
ts
vscera
neror
he
supped
are
n
nto
dermatome.
area
surroundng
pumonary
o
not
area
s
wtn
ncud-
aso
n
esopagus
he
caracterstc
dermatome
to
posterory,
erpes
prenc
ganga
140;
carry
symptoms
cardopumonary
cambers
he nterna toracc artery s we protected by te
GAS
A.
te
to
ts
not
te
compressed.
common
he
toracc
he
180
racture,
resuts
afected
B.
dermatome.
cavty
and
132.
does
dapragm.
arc
spancnc
GAS
root.
te
peura
C
n
ventra
and
he
et
not
engt.
te
descrbed
suppy
w
dermatome.
space.
he
In
surroundng
ound
te
rb
ts
surroundng
te
peura
A.
n
aong
te
T3
s
138;
to
aortc
he
engt.
musce
encompasses
actvated
and
te
by
aong
T4.
dermatome,
nppe
ts
constrct
our
tat
nerve
and
te
vrus
aong
not
C.
nppe
T4,
aged,
T4
o
te
sympatetc.
244
dstrbuted
nppe.
ped
131.
be
w
crcotyrod
arbored
can
te
B.
N
ven
pont
te
esopagus
spna
s
azygos
any
dermatome
and
by
130.
te
vrus
T4
at
and
233–234;
supped
zoster
te
nerve
produce
to
toracc
and
esopagus
constrct
he
he
esopagus.
esopagus.
te
eson
toms
he
C.
woud
parayss
constrctons
B.
prenc
tat
95
Thorax
2
211–212;
N
236;
ABR/McM
211
A. Cardac ypertropy s a compensatory mecansm
o
te
on
myocardum
te
eart
due
ypertenson.
woud
to
te
nto
most
n
to
et
to
ncreased
sze
key
compress
te
mtra
atrum
can
ncreasng
ncompetent
he
ncompetent
te
response
scema,
vave,
cause
o
te
demands
vaves,
eart
esopagus,
a
a
backow
et
atra
or
musce
and
o
due
bood
daton.
96
C H A P T E R
he
te
B.
2
et
Thorax
atrum
es
just
anteror
to
te
esopagus
n
E.
he
py
bood
woud
trunk
to
not
te
s
ocated
ungs,
cause
so
drect
superory
cardac
and
ypertro-
compresson
to
ts
vena
and
cava
woud
devers
not
be
bood
to
te
compressed
rgt
n
eart.
ts
A.
he
eart
not
compress
he
es
neror
te
to
te
tracea
tracea
and
secondary
to
woud
vena
by
cava
ts
s
aso
partcuar
not
key
exampe
o
to
be
and
o
GAS
228–229;
T enson
ton
o
ar
te
nated
te
n
A.
A
he
s
cest
tssues
ous
D.
136.
s
and
o
does
not
GAS
169;
per
upper,
ng
te
A.
N
and
rbs
no
to
durng
as
L AD
on
beng
broken
broken
rbs
are
n
seen
te
ungs
area
resut
n
or
a
n
wc
are
s
comes
on
te
a
and
destroyed,
artery
s
secondary
excange.
nary
spontane-
et
to
x-ray
(car
a
cest
cras)
spontaneous
n
te
dentiabe
by
to
o
t
rgt
B.
hs
C.
hs
rgt
rgt
s
In
sxt
ne
on
te
cest
a
ncorrect
and
ncorrect
upper
s
eadng
patent’s
te
x-ray
present
B.
te
C.
he
an
o
te
n
a
as
te
crux
branc
and
branc
arter y
te
te
et
L AD
s
not
coronar y
arter y.
he
nter ventrcuar
nterventrcuar
artery
crux
comes
te
o
of
two
coronary
o
and
te
o
an
coronary
te
et
arses
aorta
and
trunk.
208–210
ar
orange
te
passes
vesses
te
coro-
rom
pumonary
ympatc
ke
et
ABR/McM
surroundng
“rgt
nterventrcuar
artery
ascendng
artery
te
eart.
te
brances
229–230;
n
te
anteror
et
appearance
At
noda
groove
eart.
te
atrum
noda
coronary
branc.
of
te
N
coronary
nterventrcuar
coronary
te
te
ts
rom
snuatra
te
AV
n
arses
pattern).
te
at
skn
o
dmpng
te
te
ung
D.
x-ray
te
o
suspensor y
te
overyng
ower
obe
rb
o
s
n
te
to
GAS
139.
C.
he
tat
s,
retnacua
major
ts
o
irmy
to
te
cancer
nverson
143;
N
patent
ing
te
but
o
o
resuts
oces,
pee
(peau
gaments
eads
skn,
not
peau
te
resuts
and/or
as
n
retrac-
areoa.
notng
resut
n
to
ixng
do
te
wa.
te
breast
w
not
drecty
nppe.
ABR/McM
suferng
te
can
cest
o
199–200;
s
cuts
nppe
nvovement
condton
Intraducta
ead
o
nverson
Pectoras
tumor
E.
nerory
opacty
and
wt
emnat-
tent
Contracton
ton
pneumona.
extends
to
to
occuded
anteror
cutaneous
te
Sortenng
to
rgt
te
cest
sde,
ung
case
extendng
te
o
he
rgt
et
o
o
o
wt
o
et
dago-
d’orange).
patent
afected.
apex
rb.
obe
afectng
woud
Bockage
an
te
artery
207–211;
edema
of
known
rgt
snus
te
n
comes
apex
o
a
d’orange.
are
te
te
mdde
rb
A.
aso
he
to
surace
artery
runs
of
(posteror)
one
rse
rom
percarda
196
cardac
cavty
tamponade,
wt
ud.
he
cassc sgns o ts tamponade are reerred to as “Beck’s
mdde
s
138.
218
ourt
beng
te
ndcates
obes
rom
te
x-ray
ung.
hs
GAS
pneumotorax.
ABR/McM
ower
rgt
rb.
te
s
bood
pneumotorax
on
opactes
te
t
o
It
aong
aortc
and
(posteror)
pattern
artery.
not
margna
gves
crcumex
artery
n
extends
possbty
sxt
cest
accompanyng
obe
he
gves
nter ventrcuar
te
eas-
gas
accumuaton
way
and
of
s
gves
aong
te
223
nterventrcuar
anteror
coronary
domnant”
s
domnant”
ud.
cavce)
n
a
to
artery
rgt
neror
between
an
On
he
te
descends
ere.
and
groove
two
a
t
“rgt
runs
te
occuded.
snus
anteror
arter y,
an
seen
of
neror
te
he
occupes
ABR/McM
artery
on
rgt
ten
occuded
dmn-
mantan
ung
condton
n
surace
211;
mdaxar y
rgt
pressure
coapsed
o
aveo
trauma
mutpe
te
neror
te
trapped
E.
same
ave
upper
te
o
mdde,
Opacty
to
a
spontaneous
story
sows
o
requred
cronc
may
space.
te
(above
s
pneumotorax.
present
rgt
resut
a
te
menscus
As
tat
B.
he
eart,
arge
(n
accumua-
x-ray.
Atoug
D.
a
emotorax
peura
a
n
205
progressve
ncrease
pressure
ocatons,
Empysema
A
a
C.
cest
reducng
C.
s
cavty
resutng
resutng
Empysema
tc
ABR/McM
x-ray.
more
ts
B.
223;
peura
negatve
a
or
te
ung,
cest
N
pneumotorax
nspraton.
ses
a
s
usuay
t
aso
anteror
coronary
aortc
gves
te
te
descends
It
opacty
212–213;
coronary
rgt
groove.
cardac
N
branc
rgt
te
cardac
ypertropy.
E.
he
et
tat
branc;
neror
compressed
135.
te
hs
te
peope,
angogram.
ypertropy.
E.
o
branc
as
obe.
172–176;
many
branc
scenaro.
D.
In
na
superor
atrum
D.
ncorrect
mdde
GAS
137.
structure.
he
s
rgt
pumonary
devers
C.
hs
medastnum.
and
and
te
ower
as
te
ower
ncorrect
upper
as
as
opacty
aso
occupes
te
obes.
opacty
rom
aso
occupes
te
aso
occupes
te
obes.
te
mdde
opacty
obes.
trad.”
hs
carda
mules
sac,
te
resutng
and
tro,
by
compresson
and
a
dastoc
te
te
quet
cardac
rom
deinton,
o
eart
eart
sounds;
reduced
pressure
ncudes
by
te
because
te
decreased
dference
because
te
a
sma
ud-ied
eart
per-
tamponade
puse
pressure
between
tamponade
systoc
restrcts
CHAPTER
te
abiity
centra
enter
A.
o
te
venous
te
compressed
Beck’s
trad
secondary
B.
A
eart
to
hs
D.
hese
E.
hese
to
s
te
be
canges
dastoe;
and
venous
ncreased
bood
aws
cannot
te
sgns
ud
by
beedng
resutant
not
symptoms
wt
te
A.
o
B.
symptoms
tenson
140.
E.
pneumotorax,
wt
te
GAS
190–194;
Myen
occur
n
prenc
indngs
uncton
and
te
B.
C.
hs
as
n
D.
patent’s
rbs
te
epng
musce
C.
he
may
resuts
ca
to
he
oss
wt
st
o
ack
respratory
are
musces
as
ony
o
n
ts
te
rase
s
not
te
o
st
unctonng
“voenty”
dsturbance
n
(orce
seen
a
o
dur-
ere
durng
are
st
neck
s
breatng.
movng
so
In
and,
tereore,
uncton
n
Interrupton
n
transmsson
ncreasng)
o
o
sowng
te
te
and
(nor-
T1–T4
o
or
eectr-
reducton
o
cardac
actvty;
woud
o
cardac
just
te
C.
(as
nerve
ts
actvty
nerve
as
nnervates
no
D.
te
Dsturbng
ibers
te
E.
rom
cardac
he
but
woud
cess
C.
he
because
drecty
not
eart
te
tny
woud
myenated
ave
no
pan
nuence
rater
be
mtra
neurons
skeeta
drecty
te
on
not
musce;
afected
by
nnervate
tereore,
te
dsease
te
208;
vave
s
to
te
144.
A.
te
pro-
ay
best
vsuazed
wtn
et
202
te
on
an
atrum.
by
TEE
he
s
pysca
te
te
s
as
wc
s
to
te
te
suc
s
rgt
not
te
TEE.
bood
not
s
on
seen
te
te
as
to
te
vave
et
te
posteror
or
te
one
N
223;
and
ungs
tat
sde
mtra
most
vave
tat
s
s
o
te
vave
camber
o
best
he
te
et
as
o
te
neror
vsuazed
by
te
te
meda
o
s
te
around
o
term
aortc
o
used
rom
arc
as
nppe
te
te
or
suc
pneumotorax.
aortc
appearance
ar
range
sometmes
projecton
he
o
wde
condtons
radograpc
sde
cases
a
we-descrbed
t
oter
radoogcay
In
presence
rom
Despte
x-ray.
“nverted
205
te
arse
and
coursng
et
aortc
to
te
seen
corre-
superor
knob
and
ympadenopaty
pneumomedastnum,
aortc
t
nppe”
rom
appearance
smar
t
and
condtons
3.89).
or
o
o
te
vagus
dagnoss
vena
o
cava
nerve
s
not
a
reabe
pneumomedastnum.
s
not
used
as
a
dagnostc
pneumomedastnum.
pumonary
he
may
nppe-ke
end-on
superor
he
s
cest
presence
he
ABR/McM
descrbes
rom
dferentate
Fg.
or
aortc
ven
s
not
used
as
a
dagnostc
pneumomedastnum.
arc
dagnoss
A
o
tse
s
not
useu
at
dferentatng
pneumomedastnum
190–193;
TEF
tat
paned
mony
te
s
tracea
an
and
resuts
esopagus
esopagus
te
and
vave,
atera
ven
esopagea
ABR/McM
queston
rom
smar
condtons.
tey
eart.
N
transducer
posteror
do
s
nppe”
te
eps
a
tat
better
reated
between
and
transports
condtons.
mstaken
GAS
orn
164–165;
te
o
rate.
afectng
GAS
142.
te
ventra
eart,
E.
irng
to
marker
dapragm).
D.
by
vave
dferentate
te
marker
prenc
rate
to
ndcator
occur.
atrum,
ound
ceary
not
neopasm.
(GAS
B.
nerves
a
ts
cronotropc
s
PA/AP
be
takes
hs
drecty
pneumomedastnum,
knob,
an
may
eart.
vagus
o
ntercosta
pregangonc
ibers
atrum
“aortc
sponds
te
as
pneumopercardum
on
te
TEE.
aortc
not
medastnum
aortc
202
s
vave
by
228–229;
descrbe
ts
te
s
patoogca
he
et
ventrce
Pneumomedastnum
te
dctate
TEE.
dcut
by
t
cava,
magng
musce
respraton
ter
stmuaton
woud
on
s
o
ABR/McM
rom
mpuses
o
resut
opposte
cage
sympatetc
nterrupton
ncreasng)
musce
musce
rbs
208;
myen
notropc
efect
are
movng
mpcated.
myenated)
Reducton
rb
te
N
A.
mage.
most
te
ceary
Eustacan
GAS
143.
magng
transducer,
eart.
vena
unctonng
s
ventrce
vsuazed
he
eforts.
“voenty”
rgt
et
te
E.
as
accessory
164–165;
n
not
B.
an
stmuatng
(rate
A.
as
oss
postve
n
dapragm.
te
good
vave
pumonary
te
n
descrbed
presentaton,
GAS
te
a
o
rgt
most
Atoug
can
dapragm.
acts
ts
n
movng
sternocedomastod
tat
141.
wa
musces
as
pectora
are
respraton.
he
resuts
o
seen
eart,
as
to
vave
aspect
and
te
best
D.
nerves,
predctabe
abdomna
consstent
208
prenc
parayss
s
va
presentaton.
s
ng
not
he
o
trad.
syndrome
descrbed
presentaton
s
Beck’s
te
and
ntercosta
are
cassc
ABR/McM
o
parayss
te
he
rbs
patent’s
o
a
wc
n
223;
Guan-Barré
nerve
movement
as
seen
N
degeneraton
Dapragmatc
A
descrbe
obtan
ear t
trcuspd
vave
trad.
utrasound
vave.
atrum
Beck’s
to
str ucture
to
posteror
he
trad.
te
wc
mtra
indngs.
Beck’s
caracterstc
te
nto
pysca
appy
abty
asks
accumuaton.
consstent
are
and
tat
coser
te
deined
and
not
n
cardac
percarda
space,
woud
i
because
eart.
reers
emotorax
peura
to
pressure
97
Thorax
2
by
N
241–242;
abnorma
esopagus.
rom
ods
hs
tat
esopagea
amnotc
separate
s
In
atresa.
wt
ud
s
ncompete
embryoogcay.
assocated
ABR/McM
219
communcaton
TEF
unabe
a
uson
te
most
between
congenta
o
te
tracea
cases
t
rom
s
Poyydramnos
and
to
esopagea
pass
nto
anom-
traceo-
te
accom-
s
com-
atresa,
te
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
ud
and
anomaes,
C.
not
Anydramnos
amnotc
urnary
and
are
E.
wt
GAS
ud
reers
s
coects
wt
a
in
te
amni-
te
a
deicency
s
It
wt
145.
C.
hs
N
to
aso
a
compete
assocated
carres
moe
pacenta
237;
amn-
and
type
a
poor
and
are
ABR/McM
absence
wt
o
gento-
prognoss.
corocarcnomas
not
usuay
assoc-
upper
gves
case
ts
a
ound
Durng
type
n
o
a
aduts.
and
te
o
It
te
s
o
te
weak
puses
te
n
te
aorta
s
most
wt
coarc-
common
te
typca
ypertenson
te
te
toracc
coarctaton,
o
postducta
te
rbs,
deveopment,
arc
a
s
assocated
o
descendng
postducta
area
coarctaton
notcng
mb,
to
descrpton
o
embryonc
rse
s
typca
et
ower
dorsa
aorta.
aorta
Snce
ts
deveopment
rom
te
n
mbs.
o
dorsa
aorta.
A.
208
s
hs
symptoms
te
poyydramnos.
223;
o
gentournary
TEF .
reers
and
anomaes.
o
to
assocated
Hydatdorm
tumors
ated
and
3.89
taton.
Oigoydramnios
otc
D
absorption
Fig.
Atoug
utes
to
te
te
ourt
aortc
paryngea
arc,
snce
ts
arc
s
a
contrb-
postducta
CHAPTER
coarctation,
correct
B.
he
trd
mon
D.
he
any
E.
et
dorsa
aorta
is
most
ikey
te
146.
it
sxt
arterosus
GAS
227;
as
N
Congenta
gves
rse
to
te
com-
posteroatera
te
n
te
paryngea
trunk
arc
artery.
paryngea
nary
A.
dapragmatc
erna
s
a
reatvey
common congenta anomay. It s most oten seen as a
paryngea
carotd
structures
he
tus
te
answer.
on
te
we
240;
arc
does
deveoped
arc
et
(Fg.
not
contrbute
and
to
parts
o
parts
to
te
te
duc-
pumo-
cord
219
4th
arch
arteries
Truncus
arteriosus
pharyngeal
deect
o
te
n
te
ormaton
membranes
ntestnes
2.12).
pharyngeal
deectve
nea
adut.
contrbutes
ABR/McM
3rd
wt
te
dapragm.
return
durng
te
to
or
I
te
tent
vscera
hs
compresses
te
6th
pharyngeal
arteries
Aortic
Dorsal
sac
deveopng
Left
dorsal
embryoogca
rom
pass
o
te
te
nto
ungs
wen
ntestnes
te
and
torax.
resuts
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
te
umbca
arch
dorsal
rom
peuroperto-
perssts
some
may
resutng
te
tree
deect
week,
abdomna
arch
oter
ts
o
abdomen
and
arteries
dapragm
uson
Left
Pulmonary
99
Thorax
2
n
100
C H A P T E R
2
Thorax
pumonary
some
enter
into
pysica
lat
B.
ypopasia.
primordia
te
peura
exam,
te
“scapoid”
Laryngea
ing
rupture
arge
air
E.
TEF
a
o
gands
he
s
and
resuts
seen
is
te
to
a
is
149.
in
aduts
resut-
te
usuay
present
to
tere
s
tracea
accompaned
system
skn
rom
wa.
by
wt
A.
T1–T4
are
no
ts
and
to
C.
ncreasng
cord
sbe
T4,
ocated
wc
va
te
gray
spna
ram
nerves
s
space
D.
sweat
n
tssue.
te
sym-
to
get
arm.
to
te
te
ibers
n
te
body
te
eart
n
nerves
te
are
toracc
vs-
responsbe
A.
148.
patent’s
back
ibers
but
compant
o
to
and
are
respon-
and
severe
cest
to
A.
he
75%
te
atera
B.
o
te
C.
he
ts
o
D
and
axary
nodes
te
eart
tat
231;
o
ABR/McM
te
irst
breast
wc
s
he
C.
he
dran
to
no
nto
te
E.
te
njected
anteror
w
not
receve
some
dran
dranage
breast.
to
hs
nto
te
te
mass
not
centra
rom
te
hey
receve
apca
anteror,
w
dranage
aso
axary
atera,
not
rom
be
ts
nodes
and
nodes
dran
mass.
receve
posteror
among
te
vave
w
produce
a
vave
w
aso
n
be
s
n
systoc
second
murmur
ntercosta
correct.
te
tat
a
rgt
mtra
vave
auscutated
te
vave
resuts
at
te
mdcavcuar
regurgtaton
n
et
ne.
resut
n
N
233–234;
tat
body
s
aso
CN
pan
prenc
to
and
nerve
eart.
cord
At
s
cuta-
and
sde
stmuates
spna
s
nerves
a
gut,
o
s
te
vscera
wt
te
te
eve
nterpreted
major
up
some
organs
not
wa,
o
as
to
supper
te
et
autonomc
n
produce
te
te
o
coc
motor
ead,
neck,
reerred
pan
ere.
nnervate
and
woud
te
anteror
not
and
produce
te
descrbed
nerve
tat
toracc
190–191
atera
meda
stmuus
provdes
nnervates
brances
te
te
descrbed
cest
te
te
X
to
woud
ntercosta
te
wa.
suppy
It
to
vscera
uncton
and
to
myocardum
back
nnervate
nerve
s
ntercosta
sensaton
ts
te
second
te
ABR/McM
nerve
arses
te
pass
vscera
rom
spna
dapragm.
nto
or
te
nerves
hs
C3–
nerve
as
arm.
cardopumonary
nerves
are
vscera and aferent ibers or pan rom tese organs
GAS
C.
he
satons
ng
o
te
irst
o
204,
o
te
overyng
rom
produces
o
dmpng
o
te
(o
tat
major
breast.
te
tenson
te
o
tssue
pectoras
breast
Invason
408
gaments
connectve
skn
dmpng
A.
3.114C).
N
suspensory
te
breast
Fg.
163;
asca
pend
and
s
tur-
ent ibers rom te sympatetc ganga to te toracc
parasterna
w
n
nto
dranage
parasterna
resuts
ax-
151.
quadrants
o
torax.
(GAS
nodes
te
responsbe or carryng te cardac sympatetc efer-
approxmatey
dye
not
space
te
te
sensory
and
he
te
aortc
trave
vagus
he
205
dran
o
cord,
reerred
to
nodes.
nodes.
to
to
drected
and
at
bood
vave.
resuts
troug
243;
or
posteror
C5
dranage.
w
opposte
ympatc
or
are
mass.
tese
E.
neck
(pectora),
axary
wt
te
nto
ganga
resuts
murmurs.
rom
he
superor,
nodes.
meda
nodes
N
ympatc
atera
rom
and
rom
systoe,
pumonary
at
woud
penomenon
rate.
214;
descrbed
ibers
cervca
quadrants
(pectora)
he
ead
eart
axary
mass
ary
te
te
sympatetc
vave
murmur.
aso
and
autonomc
sp-
te
te
murmur
Iscema
exure,
trave
sympatetc
neror
36–44,
anteror
ts
branc
he
or
rate.
aferents
196
auscutated
Durng
aortc
ntercostobraca
spna
be
ventrces
te
o
stenoss
so
aferents
pumonary
can
narrowed
auscutated
responsbe
te
te
dastoc
214,
he
neous
communcantes
order
D.
a
o
ntercosta
comng
sympatetcs
vscera
and
ncrease
a
systoc
GAS
150.
corresponds
eave
ABR/McM
murmur.
dastoc
B.
eter
aganst
te
space.
rom
Regurgtaton
a
ncorrect.
Postgangonc
mdde,
s
it
ibers
n
parasympatetc
wt
or
GAS
Aortc
and
pan.
E.
ow
but
dyspnea
subcutaneous
are
postgangonc
(cardopumonary)
horacc
na
expeed
produce
an
o
tat
ntercosta
sympatetcs
Postgangonc
cera
second
stenoss
Regurgtaton
in
esopa-
te
199–200;
murmur
dastoc
target.
so
systoc
Regurgtaton
eed.
nnervates
bodes
T1
he
trunk
wa
a
Pumonary
ce
to
here
n
buent
deicency.
were
between
seen
N
149–173
Pumonary
et
in
ost
usuay
142–143;
E.
deveopment
suractant
attemptng
te
sympatetc
ter
Answers
222
n
trunk
te
a
orcby
tissue
condton
usuay
wen
N
ocated
enter
tat
usuay
ung
aveoi
due
sympatetc
cest
On
and
airways.
syndrome
Patents
postgangonc
te
GAS
to
B.
distress
cokng
patetc
C.
te
inants
atresa.
he
air
dyspnea
anomay
te
connecton
D.
B.
o
congenta
372;
severe
condition
and
GAS
A.
upper
esopagus
and
ypopasia,
causing
(pneumotorax).
as
rare
abnorma
gea
severe
pockets.
Respiratory
to
a
a
easticity
D.
s
is
te
is
te
premature
147.
o
were
o
o
rupture,
cavity
patient
atresia
Empysema
in
cases
may
abdomen.
obstruction
C.
In
aveoi
cest
on
Cooper)
run
musce
hey
wa.
tese
are
rom
to
conden-
te
nvest-
te
derms
support
and
Carcnoma
gaments
and
sus-
o
te
causes
breast.
te
te
acterous
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
stagnaton
peau
D.
E.
not
GAS
E.
te
Invason
w
152.
d’orange
Invason
duce
he
ce,
wc
he
B.
he
o
te
resut
n
and
dmpng
N
197;
artery
artery
most
ventrce
te
atera
and
te
te
suppes
posteror
suppes
breast
C.
in
he
te
D.
pro-
to
te
te
sternum.
et
atrum,
two
trds
o
C.
et
ex
artery
te
margna
and
207–213;
CT
he
arc
B.
scan
et
o
esopagea
te
te
he
aorta.
A.
camber.
suppes
he
GAS
153.
ventr-
(posteror)
posteror
nterventrcuar
trd
o
te
artery
nterventrcuar
artery
suppes
s
a
branc
te
o
obtuse
te
crcum-
margn
o
te
eart.
nerves
tssue.
rgt
te
septum.
skn.
not
neror
suppes
te
196
artery
anteror
septum.
w
pectora
cardac
nterventrcuar
nterventrcuar
overyng
asca
n
3.114C
ere.
o
posteror
resuts
resutng
ABR/McM
mmedatey
te
o
descrbed
meda
nodes
ymp
cavpectora
coronary
anteror
ymp
o
appearance
canges
es
s
axiary
ibross
te
crcumex
wc
et
o
141–143;
rgt
A.
te
and
Fig.
te
aorta
groove
et
vagus
arc
and
w
te
prenc
ung
230–231;
an
recurrent
he
he
N
sows
and
to
aryngea
beore
suppy
nerve
not
be
nerve
w
ABR/McM
aneurysm
o
nerve
traveng
te
traves
te
208–210
arc
oops
n
te
o
te
around
traceo-
arynx.
atera
to
te
aortc
compressed.
traves
not
be
anteror
afected
n
to
te
ts
root
case.
o
102
C H A P T E R
D.
he
te
E.
rgt
he
recurrent
aryngea
subcavan
greater
torax
toracc
rom
te
nerve
oops
around
C.
dd
spancnc
nerve
sympatetc
orgnates
trunk
at
te
n
ta
eves
deormty
not
arose
regress
artery,
proxma
but
to
ts
te
because
dsta
to
te
opton
sevent
te
rgt
sevent
dorsa
aorta
ntersegmen-
ncorrecty
states
ntersegmenta
t
was
artery.
D.
he it arc artery s not nvoved n ts deormty.
Fg. 3.50).
E.
he
233–235;
Durng
orms
artery
te
and
te
te
sevent
w
be
artery
N
243;
deveopment,
rom
ntersegmenta
ourt
arteres.
rgt
by
te
dorsa
segmenta
ormed
te
rgt
paryngea
I
In
te
te
ts
rgt
206
and
case
rgt
sevent
155.
hs
s
ncorrect
occurrng
not
on
n
te
te
et
as
te
deormty
gea
patent’s
rgt
subcavan
part
ts
te
ormed
arc
te
In
carotd
B.
artery
he
te
as
C.
artery,
he
trd
s
et
case
ormed
by
carotd
dorsa
aorta
Cer vical
but
Posterior
pulmonary
Esophageal
sac
te
te
and
et
dorsa
aorta.
te
regon
ourt
he
ourt
o
te
Fig.
3.50
n
not
aorta
aortc
paryn-
arc
vagus
arc
gve
lar yngeal
ner ve
nerve
ar teriosum
trunk
to
ts
ner ves
Sympathetic
plexus
w
contrbutes
nvoved
plexus
plexus
aortc
artery
nerve
GAS
s
206
arc
not
Ligamentum
pulmonary
artery
o
te
artery .
rse
to
artery.
recurrent
Left
Anterior
arc
toracc
te
aorta
s
cardiac
Left
vagus
aortc
ts
paryngea
common
endng
sde.
Right
irst
deveopment,
descendng
by
artery .
te
ABR/McM
embryonc
to
o
deormty.
aorta between te subcavan artery and te et common
subcavan
descrbed
rse
s
n
225–226;
Durng
arc
to
artery
ntersegmenta
s
A.
gves
arc
crana
subcavan
te
GAS
artery
sevent
paryngea
dsappear
rgt
ventra
nvoved
subcavan
arc
ourt
aorta
artery
retroesopagea.
s
ABR/McM
artery and te dsta dorsa aorta, wc does not regress.
B.
he
artery.
o T5–T9 and nnervates abdomna structures (GAS
GAS
A.
Thorax
rgt
te
154.
2
te
desc
anomay.
CHAPTER
D.
he
it
paryngea
bateray
E.
structures.
he
sxt
GAS
he
septum
uterne
not
a
overgrows
te
AV
oramen
prmum.
ovae
D.
he
E.
he
ng
and
w
part
sgni-
GAS
159.
orm
o
te
te
D.
wa
te
o
rom
te
septum
one
way
te
te
prmtve
prmum,
vave
a
AV
s
n
deormtes
even
ntra-
te
t
w
pumonary
w
232,
nerve
te
are
E.
patent
te
oramen
160.
B.
and
he
gve
rse
to
te
ascend-
rse
te
he
and
te
te
and
he
smoot
s
roots
te
aryngea
to
on
are
causes
te
bot
o
te
C.
around
nerve
ocated
rom
te
te
dyspnea.
apex
243;
he
D.
he
sdes.
aspect
rom
te
o
s
ar
and
pexus
s
GAS
he
icuty
172;
N
sma
and
not
a
o
nerves
te
aorta
on
too
jon
arranged
te
te
on
te
rgt,
te
superor
es
t
drecty
wen
te
to
E.
he
te
be
drect
and
spnous
o
wde
te
te
tracea
resut
o
te
processes
compresson
ungs.
pan
ndcaton
to
te
esopa-
n
ton
o
not
sensory
resutng
o
acute
above
te
vagus
eve
te
s
atra
be
te
present
but
coud
eatng
o
te
ony
above
et
cause
pusatons,
et
eart
pusatons
as
on
o
w
te
ony
aortc
wy
be
pres-
arc.
at
ts
te
oca-
pyscan
ABR/McM
te
vesse
190–191
te
anteror
wc
must
be
njury.
ven
accompanes
artery
procedures
te
and
s
neror
tereore
nvovng
te
ante-
artery.
ven
accompanes
s
not
aong
te
assocated
te
rgt
acute
wt
mar-
margn
te
o
anteror
artery.
rgt
vens
are
ound
ventrces,
brances
and
of
on
te
tey
te
anteror
accompany
rgt
coronary
te
tere
to
oods
tebra
wc
s
s
rom
arynx,
te
rrta-
wc
s
ne,
E.
s
rsk
t
o
spncter
ne.
s
and
te
ound
t
et
on
accom-
ventrce
space
egt
be
as
extent
rbs
and
sx
damagng
a
o
te
N
esopagea
durng
te
and
ten,
wc
spaces.
te
egt,
spaces.
A
te
o
te
ung
ud
s
tent
oter
and
rom
te
recess
te
At
recess
te
paraver-
between
and
eves
w
te
md-
wc
ncudes
At
s
to
costoda-
at
ntercosta
ncudes
spaces.
o
queston
reerence
costodapragmatc
ntercosta
wc
n
cavty
costodapragmatc
12,
toracentess
ts
done
peura
sevent
te
208–210
per ormng
he
te
and
168–171;
he
o
ABR/McM
s
soud
ne,
rbs
te
229;
o
sxt
extract
ventrce
ventrce,
artery
between
nnt
and
et
te
ntercosta
ntercosta
GAS
162.
ne
and
10
ent
due
N
recess
between
te
o
answer
were
te
o
posteror
md-axar y
egt
s
ven
aspect
3.82).
sevent
ncudes
s
atty
resut
te
atra.
te
auscutated
s
passes
md-cavcuar
rbs
coetass,
nerves
n
accompanes
t
207–215;
are
vertebra
because
te
correct
are
atrum.
toracc
resut
and
nerves.
rom
ibraton.
vsbe
arc
BP51;
and
cardac
te
pragmatc
tvey
cougng
te
he
te
d-
gastones.
Increased
B.
at
resutng
dysunctons
enarged
over
w
o
o
and
Fg.
reerrng
anteror
may
as
posteror
GAS
161.
205
enarged,
array
n
cardac
posteror
cavcuar
tenderness
Epgastrc
and
durng
beat.
N
cardac
unnamed
panes
cardopumo-
around
roots
ABR/McM
vomtng
a
and
md-
artery.
swaowng.
Pan
to
208;
atrum
symptoms
an
s
aong
compresses
Nausea
no
vscera
tat
ocated
et
and
o
to
nterventrcuar
anteror
(GAS
toracc
nary
te
beat”
t
atra
reasons
ven
artery
nterventrcuar
and
be
te
atrogenc
artery
eart
aortc
may
o
cardac
mdde
gna
nner-
esopagus
separated
artery
nerve
um
wraps
asca.
arc
subcavan
te
and
s
cause
aneurysm
one
ocate
(posteror)
tere
not
ibraton
te
an
vave
s
great
he
parts
211
prenc
damaged
and
to
sdes
atera
at,
around
te
anteror
nerves
musce,
Wrappng
ABR/McM
rgt
pass
ung
ntercosta
by
and
nerves
to
240;
nerory .
dapragm
vagus
“apex
aganst
o
wa.
200–206,
protected
A.
to
atra
rom
mtra
GAS
uness
woud
posterory
tere
woud
afected.
E.
he
septum
s
toracc
ton
between
tere
too
ent
trunk.
gve
passes
et
structures
recurrent
D.
s
wa
atrum
Pusatons
ter
but
deveopng
n
C.
ovae.
space
te
n
et
sma
et
B.
toracc
he
bot
te
orced
vsuazed
space
he
nterventrcuar
cords
prenc
on
205
typcay
termed
mpcated
tumor
A.
s
s
B.
te
atra
orma-
deects
oramen
nvoved
arterosus
N
ABR/McM
ntercosta
beng
nterventrcuar
he
gus
hs
bood
ror
213;
posteror
C.
it
not
vates
158.
ne.
o
et
223;
eart
GAS
ar
E.
te
N
te
he rgt atra soud not gve a vsbe pusaton on
wc
durng
nvoved
septa
patent
and
not
are
and
cause
wt
prmum
and
n
o
A.
dorsa
ormaton.
bubus
apex
resut
te
septum,
s
truncus
228–229;
he
cavcuar
pu-
206
deveops
te
cuson
It
aorta
he
D.
dsappear
any
(artera outow) o bot te et and rgt ventrces.
ung
C.
artery
et
cusons
may
assocated
endocarda
B.
and
rgt-to-et
o
he
te
arc
te
secundum
deveopment
A.
to
contracton.
endocarda
ton
157.
w
deveopment.
he
B.
on
ABR/McM
cuson
It
becomes
artery
contrbute
trunk.
endocarda
A.
paryngea
220–226;
ventray.
arc
not
papated
arterosus
monary
C.
does
cant
ductus
156.
and
103
Thorax
2
not
eev-
stand
efec-
space.
208
atus
creates
dapragmatc
a
pysoogca
contracton.
As
te
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
esopagogastric
junction
anatomicay
pysioogicay
point
A.
o
he
B.
At
sgty
passng
te
gve
o
eve
to
but
te
o
ofered
te
D.
area
E.
t
he
te
t
passes
woud
et
A.
o
or
he
may
gve
be
to
ts
D.
s
s
te
openng
ocated
te
irst
N
te
aortc
o
et
te
man
to
to
and
te
w
GAS
166.
resstance
arc
serves
acts
nasogastrc
as
A.
s
does
artery
nterventrcuar
corona
t
o
s
a
te
GAS
te
pays
te
by
artery
rgt
et
coronary
t
arses
no
rom
roe
n
I
C.
but
n
te
te
artery
arses
artery
s
not
comes
rom
determne
te
rgt
to
E.
te
GAS
167.
ar
may
a
anasto-
determnant
te
of
et
te
It
crcumex
coronary
domnance.
snuatra
coronary
node
artery
N
te
does
arses
not
to
con-
he
ABR/McM
vave
ntercosta
can
space
at
be
best
te
B.
auscu-
te
best
sde
aortc
et
border
space
ste
at
to
te
et
C.
mdcavcu-
auscutate
te
D.
mtra
E.
he
known
eart
a
s
not
used
o
te
space
to
and
at
te
auscutate
trd
sternum
rgt
te
te
areas
o
trcuspd
ntercosta
are
border
243;
patent
N
spaces
to
trad:
and
Percardocentess
nto
te
tube
sgns
ven
s
te
to
te
he
a
C.
rom
a
Cest
nserton
B.
Centra
venous
nes
are
venous
uds,
and
not
not
w
muled
be
cardac
be
to
a
absent
a
to
neede
aevate
to
to
anteror
aevate
a
cardac
D.
vscera
and
are
te
211
te
te
et,
abdomen,
cy,
te
crosses
eve
to
nto
scenaro,
wt
azygos
and
o
te
te
te
te
et,
te
ven
ver-
sterna
posteror
superor
ts
and
dapragm.
te
anterory,
At
motor
uncton.
csterna
n
nerves
bronc.
somatc
n
te
uncton.
vesse
med-
woud
contan
deoxygenated
not
a
bood
as
ven.
contan
sava
as
t
s
a
ym-
not
contan
urne
as
t
s
a
ym-
w
not
contan
structure,
N
242–243;
structures
to
n
posteror,
deveops
tract,
rom
neror
oxygenated
not
te
are
ABR/McM
tymus,
as
t
228
medastnum,
vens,
ympatc
trd
paratyrod
bood
artery.
superor
and
te
an
arteres,
trunks.
paryngea
he
pouc
as
gand.
he irst paryngea pouc dervatves are te endo-
te
ntra-
w
amentary
brane.
C.
dever
suppy
cardac
ABR/McM
ts
structure,
not
236–238;
nng
antrum,
a
not
structure.
tympanc,
ud.
rom
w
ymp.
not
w
unop-
arsng
medastnum
on
ts
pregan-
are
pexus
cardac
atus
ascends
n
te
structure.
major
te
on
caed
duct
ympatc
derm
s
tamponade.
utzed
A.
resut,
perormed.
extract
done
or
As
does
w
eart
238;
aorta
te
ncrease
nerve
on
orgnates
aortc
and
ibers
cardac
neurons
efect
236,
rom
rate.
toracc
te
posteror
contan
vesse
tymus
tamponade,
wereby
space
A.
tamponade.
cardac
soud
procedure
percarda
190–191
o
to
pexus
prenc
esopagus
ympatc
he
peura
208
damaged
efect
te
posterory.
vesse
GAS
168.
te
te
vesse
he
N
hereore,
a
a
rate.
te
daton
te
vesse
he
s
vave.
on
sten
dstenton.
procedure
s
pneumotorax,
o
ypotenson,
juguar
percardocentess
nserted
BP51;ABR/McM
exbts
Beck’s
sounds,
any
cardac
management
T1–T4
eart
te
no
n
no
toracc
key
arway,
214,
as
te
n
duct
esopagus,
patc
te
vave.
GAS
165.
ntercosta
Second
to
resove
cardac
te
eart
orn
toracc
rgt,
he
t
E.
E.
n
are
te
rom
ave
a
ibers
ave
ventra
troug
astnum.
210–212
and
ibers
as
ibers
wtn
te
toracc
patc
ntercosta
s
it
sternum
and
rgt
te
most
229;
trcuspd
ourt
it
ne
aevate
normaton
parasympatetc
aferents
bodes
ange,
usuay
and
ts
tebra
to
wt
ABR/McM
down
eferents
and
ascends
on
artery.
sow
216–219;
he
ascends
vave.
D
A.
done
receves
rom
nerve
pan
T1–T4
rgt
domnance.
o
not
secondary
assst
223;
tese
ncrease
Vscera
sternum.
he
vagus
carry
s
determnng
I
dapragm
domnant
N
ibers
w
Somatc
were
arses.
rate.
to
be
not
node
Pregangonc
tube
may
pregangonc
vaga
descendng
to
w
occur
tamponade.
sometmes
posteror
207–213;
Murmurs
tated
artery
and
nterventrcuar
not
nserton
tat
w
190–194;
and
act
determned
t
snuatra
eart
posed
B.
crcumex
margna
hs
he
gonc
esopagus.
broncus
te
as
244
rgt
D.
but
sympatetc
domnance.
wc
tube
symptoms
efuson,
esopagus.
domnance
te
he
te
horacocentess
te
to
te
margna
wt
trbute
C.
Nasogastrc
o
com-
resstance
toracc
juncton
resstance
artery
et
et
rom
B.
C.
ast
domnance.
artery
o
eiter
te
nerves
anteror
mose
A.
o
te
rgt
rgt
164.
o
te
rom
he
D.
be
domnant.
coronary
C.
vave
cardac
resstance
(posteror)
rom
he
B.
o
231–234;
neror
atrum
not
superor
troug
queston
arses
eart;
a
woud
esopagus.
ste
ste
et
owever,
posteror
trd
GAS
163.
te
te
posteromeda
second
te
as
by
area
he
ave
tis
tube.
te
resstance;
he
not
tamponade.
posteror
paryngoesopagea
C.
does
resistance.
area
pressed
te
or
105
Thorax
2
te
and
hs
tymus
Atoug
uture
Eustacan
nner
aspect
answer
coce
comes
te
rom
second
t
he
paryngea
ourt
s
te
contrbutes
gand
o
tube
mdde
te
tereore
trd
to
te
pouc
and
(paryngo-
ear,
mastod
tympanc
mem-
ncorrect
paryngea
paryngea
obterated,
paratyrod
audtory
tube),
pouc
paatne
orms
te
s
as
arc.
argey
tonss.
superor
utmobranca
body,
106
C H A P T E R
2
wic
roid
E.
Thorax
orms
te
paraoicuar
C-ces
o
te
ty-
B.
he
tum
it
paryngea
structure
tat
as
no
pouc
s
a
rudmentary
contrbutons
to
GAS
sgnicant
ated
D.
ar
A
tenson
on
medastna
and
vscera
reeve
A.
o
te
and
te
he
space
serous
C.
ayers
te
Insertng
peura
a
arrest
be
rapd
s
to
nserted
te
ntrapeura
postve
be
It
uar
to
and
ayers
te
o
pareta
a
te
between
A.
neede
between
te
not
w
reeve
B.
Insertng
asca
te
and
C.
GAS
C.
neede
pareta
n
164–165,
Wt
an
pa
on
ectopa
abnorma
cords,
te
between
peura
do
undergo
169–170;
cords,
eart
o
not
w
te
aso
endotoracc
not
aevate
E.
he
a
s
te
N
rare
In
te
ABR/McM
toracc
or
torax.
deveop
211;
condton,
party
he
uson
te
pa
B.
her
o
tat
ods
unte
ncompete
durng
o
exposed
te
o
te
peuropercarda
and
o
ead
to
orm
a
wa
key
te
does
not
A.
Faure
and
o
cause
septum
transversum
does
not
o
te
ead
wt
to
171.
A.
here
uson
between
pertonea
septa
our
deect:
deect
venosus
deect,
cuson
matey
deects
20%
N
coeom
erna,
te
w
o
222-223;
cncay
ostum
cuson
and
o
aso
assoc-
septa
trsomy
are
deects
21
(Down
211–213
te
most
accountng
A
by
common
or
approx-
membranous
common
aed
type
endocarda
t
may
o
te
It
s
nter-
cusons.
deect
arterosus
ventrc-
but
septum.
uson
parttonng
at
et
deect
brt
eart
septa
not
C.
or
ead
to
transposton
o
ntay
due
and
to
te
deect
may
s
causes
pressure
rgt
an
a
et
gradent
eart.
acyanotc
eart
E.
coeom
ectopa
ead
to
wt
and
wt
ABR/McM
sgnicant
secundum
ostum
ostum
persons
deect,
endocarda
21
snus
Endocarda
occur
trsomy
atra
n
approx-
(Down
syn-
A.
and
s
soud
w
ead
to
(e.g.,
great
by
poston
dspacement
compcated
snge
vesses).
ventrce
hs
growt
o
case
te
o
by
and
most
prmor-
et.
superor
not
211–213
abnorma
usuay
abnorma
te
and
w
ead
growt
to
o
neror
not
te
ead
te
o
te
prmorda
dextrocarda
growt
to
bubus
truncus
seen
n
o
soated
cords
arterosus
or
te
prmorda
dextrocarda.
coud
ead
to
transposton
per-
o
te
vesses.
Growt
o
o
te
te
227;
prmorda
norma
N
223;
eart
tube
deveopmenta
ABR/McM
to
te
rgt
s
process.
203
174–189
he
toracc
as
troug
ts
deect
rom
w
te
accompaned
te
to
cosure
ABR/McM
dextrocarda,
anomaes
tube
Deects
tmes
n
233–235;
o
secundum
o
patent.
GAS
174.
o
deect,
atrum.
prmum
wt
types
prmum
common
203
septum
Faure
ovae.
hs
resuted
eart
and
brt.
not
cardac
great
ectopa
not
s
ventrce
ods
percarda
N
soated
Anteror
te
Answers
are
sep-
s
syndrome).
types
nterventrcuar
caused
ater
vscera.
ts
ectopa
peuropertonea
dapragmatc
195–199;
te
prmum
213;
atrum
ecto-
cords.
GAS
te
specicay
ABR/McM
most
septa
te
eart
part
te
o
sunt
Posteror
percarda
cords.
E.
o
vesses.
transposton
peuropercarda
become
uson
ods
uson
to
te
oramen
sstent
Faure
w
te
severe
cords.
D.
not
wt
deects
truncus
soon
Wt
oter
atera
toracc
D.
B.
uson
rgt
GAS
173.
ecto-
percardum
because
s
cords.
Faed
rare
deects.
cords
Ventrcuar
da
peuropercarda
sac.
part
great
use
218
eart
orm
competey
propery
ncompete
membranes
s
septum
Septum
a
ormaton.
A.
any
patent
ocaton.
surace
sternum
ods
te
uson
secundum
dsease.
pneumotorax.
170.
deect
between
a
eart
Ventrcuar
pneumotorax.
E.
s
(Down
233–235;
septa
o
bubus
te
medastna
w
t
assocaton
commony
to
percardum
but
21
aed
septum
maormaton,
persstent
pneumotorax.
ibrous
25%
at
A
te
percardum
to
te
reatvey
N
eart
ventrcuar
s
pneumotorax.
space
no
213;
septa
occur
ayers
percardocentess
aevate
nto
o
most
vscera
were
trsomy
are
Ventrcuar
matey
te
order
D.
type
avoded.
n
wt
sow
due
wt
common,
hese
GAS
172.
recogn-
between
peura
s
deect
syndrome).
pres-
structures.
requrng
o
not
neede
te
and
s
w
ibrous
aevate
wen
exertng
and
pneumotorax.
and
te
228
ntratoracc
must
between
and
occurs
cardac
percardum
Insertng
not
pareta
tenson
te
ABR/McM
occurrence
neede
perormed
B.
and
treatment
hereore,
222;
progressvey,
e-treatenng
ton
N
pneumotorax
accumuates
sure
a
C–E.
220–222;
septa
prmum
reatvey
structures.
169.
Atra
gand.
te
a
te
te
and
o
sterna
te
te
te
atus
n
medastnum
azygos
rory ,
orgnates
caed
aortc
posteror
et,
duct
daton
ven
on
vertebra
ange,
te
ts
n
te
csterna
te
te
rgt,
te
duct
some-
ascends
It
toracc
ascends
aorta
esopagus
posterory .
toracc
and
dapragm.
wt
bodes
abdomen,
cy,
At
crosses
te
to
on
ante-
te
eve
et,
drome); oterwse, t s a reatvey uncommon cardac
posteror to te esopagus, and ascends nto te superor
deect.
medastnum. Gven ts ocaton, t s most key respon-
o
te
hs
specic
septum
deect
prmum
arses
wt
te
due
AV
to
aed
septum.
uson
sbe
or
te
coecton
o
ud
seen
on
cest
CT .
CHAPTER
B.
he
esopagus
indngs
C.
Injury
to
te
coecton
but
D.
t
E.
due
azygos
he
ts
uson
arge
o
pragm.
are
N
B.
produce
a
medastnum,
mmedate
C.
dscom-
produce
te
o
n
woud
ts
coec-
produce
s
pertonea
anoter
hs
and
wt
resuts
regon
o
te
transversum
esopagea
atresa
a
da-
A.
opment
cavtes
B.
te
he
n
presents
can
ead
tat
tracea.
canges
It
to
to
C.
by
te
te
GAS
176.
A.
A
ar
ventra
septum
372;
tenson
on
tna
N
descrbed
D.
not
n
son
to
B.
to
cea
most
C,
D,
eart
and
arrest
key
tat
as
st
o
to
ar
detect
E.
te
on
Cardac
occurs
ton.
hese
optons
wen
be
he
eart
sgns
patent
a
to
be
s
to
medas-
e-treatenng
and
treatment
avoded.
a
pres-
In
ts
rgt-sded
ten-
contents
ave
as
t
te
not
s
ung
te
or
not
as
s
can
pressure
ud
buds
and
be
kewse
not
may
resut
be
contents
ung
tere
s
not
cause
n
opaci-
assocated
toward
w
ieds
oss
169–170;
due
s
to
te
aso
but
wt
oppo-
not
oss
o
peura
N
211;
o
cause
vascuar
ntegrty
ABR/McM
nammaton
many
nerve
wc
to
supped
even
by
o
te
218
te
par-
ntercosta
te
pareta
he
suppes
te
te
centra
dapragmatc
typcay
afected
and
and
pareta
not
ame-
suppes
ungs
and
vscera
vscera
eferents
peura
and
but
not
peura.
toracc
carry
not
o
bocks.
nerve
to
ony
parts
s
nerve
vagus
he
vscera
somatc
to
(cardopumonary)
aferent
aevate
169;
as
N
n
E.
Due
rent
ror
d-
ts
up
n
te
te
te
ibers
and
peurtc
ven
patent,
deayed
to
poo
n
ABR/McM
presentaton
te
toracc
o
ear t
nerves
woud
pan
do
not
seen
n
be
ts
ave
a
systoc
eard
n
ncreases
he
wt
te
oter
ner ves,
o
a
crossng
a
S
2
ar ter osus.
ductus
te
patent
dec ne
toward
et-
te
(mac n-
p atent
troug
pysoogca
ntro-
pumonar y
ductus
o
supe -
durng
ro m
contnuous
rsk
te
recur -
te
presence
patent
pressure
et
n
damaged
te
te
sunt
te
n
end
o
te
te
e.
nerve
procedure
muc
ess
vagus
procedure
easy
murmur
te
bood
vagus
rgt
te
ocaton
tan
ndcate
A
o
he
more
o
ungs.
200
o
Increased
irst
B.
ts
caracterzes
te
course
torac os cope.
ar ter y
et
branc
te
protected
pumonar y
were
a
ABR/McM
and
s
s
nnervate
and
ncre ases
he
t
markngs
mont
220;
oopng
posteror
sunt.
sound
nerve
not
procedures
murmur
duct
A.
N
ner ve
te
ar teros us.
runs
rsk
o
nerve
does
not
deep
woud
and
take
posteror
pace
and
to
woud
njury.
woud
nvove
not
be
afected
structures
o
as
te
ts
rgt
torax.
can
as
o
does
ong
more
Prematurty
he
as
cyanoss
cavty.
are
to-rgt
tese
tat
te
medastnum,
vascu ar
218
emotorax
166–172;
to
ducton
dsten-
so
aryngea
and
ar yngea
wc
ay-
ypoten-
nerve
toracoscopc
C.
211;
deveoped
recurrent
vagus
tamponade
trad:
juguar
on
pareta
cardac
Beck’s
and
seen
tra-
non-expandng
tat
vscera
Cassca
known
te
exam.
tamponade
bood
a
cause
ncorrect.
wt
contnues
E.
ormed
ntrapeura
eadng
s
woud
sounds,
are
be
164–165,
assocated
bood
s
postve
medastna
et
between
sgns,
woud
GAS
A.
tree
muled
s
pysca
percardum.
son,
It
recognton
around
ers
te
he
er y)
cavty
o
and
scenaro
te
wen
exertng
sde.
rapd
percarda
ncudes
177.
to
wc
orm
et.
coecton
icut
te
s
wc
prenc
GAS
occurs
structures
opposte
pneumotorax
to
gament
179.
progressvey,
te
te
Smpe
acorm
mesogastrum,
requrng
te
and
pneumotorax
pneumotorax
sted
and
pan
targeted
transversum.
cardorespratory
patent,
he
not
ts
222
medastna
st
occurrence
omentum
accumuates
sure
peura
te
deve-
woud
w
pneumotorax
o
164–165,
peura
rudmentar y
contrbutes
and
te
a
w
observabe.
aferents
s
sot
nvove-
ieds.
and
medastna
ied
cyanoss.
ung
ieds
mnma
ung
patent.
esser
rom
not
nabe
deects
groove
ar ynx
mpcated
patent
TEF .
structure
o
te
te
sow
any
nerves.
posteror
patent.
E.
ung
o
Peurtc
eta
cause
pneumotorax
o
just
ung.
GAS
178.
w
wtout
dapragm
o
Spontaneous
erna.
septum
or
ar yngotracea
resprator y
deect
dapragmatc
T raceoesopagea
be
T enson
not
te
dapragmatc
mdne
he
w
o
markngs
te
n
te
peura
aong
un-
and/or
tse
and
Parayss
opacicaton
usuay
membranes
by
ment
ste
228
ormaton
dapragm.
one
not
E.
erna
posteroatera
te
aso
ABR/McM
deectve
te
wt
cest
opacicaton
caton
patent.
242–243;
te
a
tssue
opacicaton
D.
not
A
stng
rom
resut,
septum
wt
D.
te
wa.
In
C.
a
contnuous
body
A.
As
aso
peuropertonea
n
or
pressure.
dapragmatc
parts
openng
mgt
posteror
more
ympatcs
resuts
te
responsbe
aorta
te
woud
seen
236–238;
tree
be
patent.
ere.
bronca
and
n
cause
g
ven
Congenta
oter
key
coecton
atera
not
ts
descendng
descrbed
GAS
B.
to
n
bood
woud
ort
te
175.
o
he
ton
woud
descrbed
107
Thorax
2
et
te
muc
D.
he
prenc
et
more
rgt
GAS
nerve
recurrent
oopng
prenc
228–233;
N
s
not
as
aryngea
and
nerve
243;
key
varabe
w
to
nerve,
not
be
afected
wc
course.
be
ABR/McM
afected.
202
as
a
108
C H A P T E R
180.
B.
Any
2
Thorax
pneumotorax
percussion,
cuar
site
markings,
side
ony
caused
resut
to
o
motorax
wa
but
tat
by
te
a
is
cause
a
by
yperresonance
sounds,
tracea
opposite
and
deviation
distended
tension
tension
side
caused
deects
in
reduce
to
te
juguar
o
te
by
eiter
to
muscuar
can
ung
te
is
cest
cardum
viscera
not
sit
tures
to
torax
C.
te
same
sde
space
now
Cardac
juguar
Lung
sgns
tracea
o
te
decreased
D.
he
rom
but
node
may
ung
area
rgt
o
pes
te
ror
te
matc
o
et
i
to
te
B.
te
peura
muled
and
te
some
any
sot
eart
tssue
te
cause
ung
to
te
AV
E.
N
aorta.
artery
(coser
wa.
It
artery
suppes
to
In
arse
he
to
or
anteror
te
rse
o
to
(posteror
te
cor-
posteror
A.
B.
te
peroratng
o
et
te
he
and
et
and
atera
o
C.
nterventrcuar
suppy
he
te
te
dagona
artery
o
anteror
most
te
of
o
eart
te
va
te
It
A.
ante-
GAS
A.
coronary
gves
(LAD)
not
dapragmatc
o
207–211;
he
artery
of
and
gve
o
but
o
te
do
te
te
of
surace
brances
o
N
229–230;
embr yoogca
esons
ment)
B.
te
s
te
bass
come
to
anterosuperor
deveopng
te
devaton
outet
208–210
combnaton
(maagn-
ventrcuar
septum
185.
w
eart
es
te
te
outet
anterosuperor
be
s
abnor-
responsbe
produce
not
or
cyanoss.
produce
symptoms
woud
eart
te
observed
n
eart
produce
symp-
aure.
tube
seen
n
oopng
ts
ABR/McM
mmedatey
woud
not
patent.
211–213
posteror
aorta,
and
posteror
o
te
atrum
to
are
te
es
to
o
te
te
to
te
tereore
to
te
t
utra-
esopagus,
posteror
adjacent
et
cause
vens
posteror
rgt
anteror
resdng
and
to
atrum
te
can
but
surace
esopa-
compress
dyspaga.
too
atera
at
ts
pont
to
transducer.
urter
anteror
and
w
not
seen.
rgt
be
ventrce
228–229;
at
he
te
T10
T7
N
223,
vertebra
any
and
w
s
he
T11
vertebra
T12
or
te
205
dapragm
s
s
not
passage
ound
IVC/rgt
eve
s
dapragmatc
dapragmatc
usuay
assocated
openngs.
at
te
prenc
not
T8
verte-
nerve.
assocated
wt
any
aorta
and
openngs.
atus
s
or
te
duct.
228–229;
Cardac
N
244
tamponade
decreased
(Beck’s
bood
w
decreased
markngs,
and
w
cause
pressure,
muled
and
eart
dstended
jug-
trad).
Pneumotorax
cusson,
te
eve.
eve
eve
sde,
anteror
ABR/McM
wtn
dapragmatc
dapragmatc
vens
244;
vertebra
bra
sounds,
urter
atus
he
he
es
seen.
esopagea
ar
and
majorty
we
he
uar
not
descendng
GAS
C.
A.
rgt
atrum
seen
GAS
of
o
devated
septum
woud
mmedatey
orm
toracc
eart.
contrbute
ABR/McM
o
E.
tat
do
233–235;
te
sgnicant
crcumex
brances
eart
not
anteror
o
pumonary
wt
obtuse
sgns
Enargement
he
ound
D.
artery
does
margna
C.
et
structures ound at te eart’s dapragmatc surace.
182.
184.
wa
te
deect
deects
o
esopagus
not
brances.
comes
suppes
suraces
artery
artery.
rgt
rgt
t
and
te
he
be
comes
troug
he
myo-
mgraton.
structure
seen
et
he
be
daprag-
septum
te
abnorma
symptoms
N
s
does
te
B.
brances.
coronary
coronary
wt
coronary
artery
et
margna
he
brances
ventrce
crcumex
ror
E.
nterventrcuar
septa
coronary
C.
o
ventrcuar
transducer.
he
gus.
poste-
artery
ventrcuar
overrde.
consequence
by
te
wt
responsbe
o
aortc
ventrcuar
prmtve
te
213;
be
o
D.
(LAD)
te
aso
rgt
ypertenson
typca
man
sup-
eart.
nterventrcuar
he
ven-
descendng)
or
s
o
conused
patent.
Abnorma
t
ndvd-
te
te
constrcton
Pumonary
sound
te
dapragm)
85%–90%
gves
tat
E.
of te et coronary artery and suppes te anteror
two-trds
arc
woud
snuatra
artery
o
cuson
cuson
esopagus
drecty
suppes
te
created
ce
Aortc
GAS
183.
218
rgt
te
aso
margna
nterventrcuar
te
ABR/McM
arteres
node.
rgt
coronary
o
211;
or
percusson.
o
outet
carda
toms
and
devaton
to
nundbuum
te
porton
anteror
tracea
duness
te
crest
Endocarda
ts
above
edema
te
consteaton
dstended
o
neura
n
be
type
emodynamc
cause
o
to
septum)
resuts
esons
produce
ascendng
rse
to
artery
surace
cause
te
(not
ypertroped
devaton
deects n te AV septum and AV vaves. he endo-
C.
cause
coronary
ventrcuar
rgt
not
not
but
to
and
ower
hs
he
to
ma
pneumo-
deviation
pressure,
169–170;
gves
(neror)
artery.
ung
w
produce
pumonary
wa
te
Spontaneous
struc-
and
he
devaton
ung.
bood
w
w
artery
anteror
uas,
A.
root
te
trcuar
mediastina
wi
nammaton.
and
artery
and
it
D.
164–165,
te
onary
as
vens.
yperresonance
181.
te
tamponade
incorrect
tracea
coapsed
by
is
oter
side.
causes
unused
Pneumona
GAS
and
opposite
contuson
mnor
E.
te
normay
sounds,
D.
pneumotorax
s
he
maagnment
ypertropy
anatomca
septum.
Spontaneous
septum
te
deect
assocated
peura.
A.
outet
creatng
septa
and
trabecuatons.
aortcopumonar y
or
pneu-
te
or
nundbuum)
septopareta
oppo-
T ension
parieta
(pumonar y
T racea
aected
injuries
te
to
vas-
veins
pneumotorax.
pneumotorax.
typicay
cause
may
breat
accompanied
be
deviation
a
decreased
cause
breat
tracea
dstended
yperresonance
sounds,
devaton
juguar
vens.
reduced
to
te
to
per-
vascu-
opposte
CHAPTER
B
and
nary
and
E.
D.
Deep
emboism,
even
deat
ung
GAS
A.
he
area
correct
B.
na
at
te
E.
ntercosta
o
te
D.
n
o
space
te
pane,
ror
he
ror
o
As
sterna
te
to
to
best
Beck’s
A.
te
hs
trad.
at
cest
te
space
et
B.
para-
and
s
at
te
ntercosta
wc
hs
s
to
s
ange
(o
pane
woud
to
hs
Lous)
as
atera
aone
s
n
bot
we
between
ourt
te
te
trans-
anteror
superor
med-
vew
make
anteror
and
t
d-
poste-
aone
woud
make
posteror
t
and
d-
ante-
tat
woud
s
may
not
be
to
examne
mssed
deay
on
vsuaze
a
areas
A/P
te
or
ange
te
GAS
sterna
an
ange
axa
cut
132–133;
E.
he
ta
musces,
ibers
o
rom
order
N
(o
may
mss
2192;
traversed
nterna
Lous)
s
es
te
wtn
eve
ABR/McM
skn,
ntercosta
te
axa
competey.
199,
externa
musces,
201
ntercos-
nnermost
as
wen
te
he
peura
answer
t
s
cest
because
removed.
coce.
pareta
structures
as
s
te
peura
traversed
vscera
by
(4)
te
peura
(6)
ncorrect
woud
ntercosta
N
or
as
B,
C,
D,
te
and
to
abdomen,
T5
as
toracc
nnervaton
o
(3)
nter-
tat
o
as
carry
to
te
or
te
te
dorsa
and
sufers
musces
constrcted,
he
te
vagus
mucous
vagus
nerve
gand
w
provde
greater
root
many
inay,
sensory,
motor
toracc
sympatetc
gangon
pan
tat
tree,
sensaton.
ceac
vscera
motor,
N
smoot
pregangonc
are
musces
patent
traceobronca
pan
te
dermatome
358–364;
are
nerve
nerves
eart,
smoot
answer.
te
199–200
te
dapragm,
to
te
parasympatetc
te
te
tree
or
carry
ntercos-
beore
(5).
nnervatng
T9
back
o
musce
nterna
Snce
correct
te
w
vscera
responsbe
nnervaton
GAS
tree.
Prenc
o
to
we
abdomen
(6)
peura
externa
traversed
ABR/McM
responsbe
nerve
rom
or
E.
te
be
contractng
key
musce
spancnc
te
postgangonc
submucosa
beng
as
musce
condton
responsbe
n
peura
pareta
ntercosta
not
206;
carres
most
vsc era
te
(5).
s
a
te
beore
traceobronca
te
we
are
traversed
(1)
nerve
as
beore
nnermost
be
musce
te
s
as
T9,
te
not
astma,
aso
ibers
ncorrect
traversed
traceobronca
o
nerve
s
responsbe
te
te
Lous.
ast
ncorrect
153–157;
Vagus
suppy
used
te
peura.
vscera
correct
ncorrect
o
be
musce
ound
between
vew
A.
ces
vew.
woud
most
s
answer
GAS
189.
190–191
not
externa
border.
structures.
apces
It
a
te
te
pneumotorax
s
one
and
costa
D.
et
structures.
ordotc
ung
be
at
parasterna
vew
as
vew
dstngus
vew.
et
ABR/McM
dstngus
apca
te
auscutated
te
pareta
tube.
woud
it
te
be
a
te
answer
(4),
ne,
s
answer
hs
auscutated
te
E
woud
paraster-
typcay
cause
and
traverse
woud not be traversed beore te pareta peura (4).
te
space.
vave
s
rgt
not
answer
woud
C.
eard
medastnum,
medastna
pane,
188.
percussion
produce
coud
hereore,
208
mdcavcuar
posteroanteror
P/A
E.
to
not
up
ntercosta
aong
BP51;
medastna
he
o
te
anteroposteror
icut
D.
make
(bcuspd)
vave
structures,
he
icut
B.
w
auscutated
eart,
space
N
posteror
astna
A.
243;
Snce
and
duness
musce,
soud
ta
trcuspd
GAS
C.
breat
ts
ABR/McM
best
second
at
o
tube
scenaro.
s
mtra
te
ntercosta
pumo-
sternum.
he
verse
ts
te
ntercosta
187.
n
s
to
sortness
but
wc
223;
ead
triad.
wit
second
vave
he
apex
N
vave
te
aortc
area
and
n
answer
he
C
symptoms
188–194;
may
cause
Beck’s
opacicaton
pumonc
sterna
can
not
presents
ied
descrbed
trombosis
wic
but
Hemotorax
and
186.
vein
109
Thorax
2
n
sensaton
ganga
o
te
rom
T5–
responsbe
ntercosta
and
tey
or
nerves
sympatetc
nnervate.
214; ABR/McM
218
3 Abdomen
Q u e st i o n s
Questions
1.
A
1–25
1-year-od
genta
tons
mass.
and
majus
to
sue
2.
to
s
ts
Pareta
T ransversas
D.
Dartos
E.
Interna
sgns
A
et
rena
Wc
o
are
and
From
mass
reducbe
o
te
wc
o
o
te
non-
Rena
A
wtn
ageness
weeks’
o
vst.
Her
te
Se
obque
urne
to
lud
norma
sows
mts.
anrda.
lanks.
A
are
o
Hs
exam-
5.
papated
te
Wms
mutatons
s
Rena
D.
T raceoesopagea
E.
Uretra
condton?
38
he
gene
responsbe
or
HGF
matc
C.
he
gene
responsbe
or
VEGF
dcutes
D.
he
gene
responsbe
or
GDNF
tat
E.
he
gene
responsbe
or
FGF-2
o
aton
o
story
sgns
are
sows
n
te
te
recurrent
o
deayed
wtn
norma
up-santng
pams
lanks.
kdneys
norma
o
An
urnary
nectons.
mts.
papebra
te
ands.
utrasound
bateray.
appearng
tract
deveopmenta
A
CT
rena
o
Pysca
masses
te
scan
tssue
and
abdomen
o
at
te
te
as
vo u m e s
key
dagnoss
o
te
A.
Bcornuate
uterus
B.
Cryptorcdsm
o
patent’s
te
Ogoydramnos
Poycystc
examnaton
C.
Poyydramnos
D.
Rena
E.
Uretra
creases
n
abdomen
sows
L3–L4
vertebra
oowng
s
te
most
condton?
ow
x-ray
and
o-
o
te
o
tat
by
te
nant
te
te
tube,
b oy’s
n
etus
cest
o
ud
re d u c e d
re s p r a t o r y
p ro b e m
urnate.
best
and
s ow s
daprag-
u t e ro
to
a
d e ve -
re s u s c t a t o n
sgns
an
d e ve r s
pyscan
amnotc
te
o
no
0,
Te
endotracea
re a t o n s p s
B.
absent
congenta
a u re
para
re q u r n g
An
caused
A.
sows
wt
congenta
Wc
descrbes
ts
condton?
6.
A
ment
days.
ow
brt
boy
s
wt
nked
nked
to
to
brougt
He
as
not
medca
wegt,
wtn
norma
sunken
eyes
and
moter
to
and
oss
o
tat
stoo
Pysca
or
s
snce
21.
vscera
emergency
ncudes
skn
ungs
suractant
ectopc
te
says
trsomy
mts.
to
vomtng
passed
story
ypopastc
TEF
nsuicent
nked
greens-yeow
patent’s
Hs
nked
obstructon
wt
he
kdneys
ageness
2-year-od
began.
Wc
n
1,
d e ve r y,
appears
o ow n g
canged.
mdne.
It
we re
re s u t s
poes
te
d s t re s s
a
papated
eve
sows
ndngs
a b o r.
s e ve re y
te
b a t e r a y,
ernas.
eve wt uson o te et and rgt kdneys at te ower
n
to
vta
Her
sman
are
evau-
Se
mestones.
ssures
No
or
due
ater
postoned
c o r re c t y
B.
pyscan
te
(TEF)
gravda
a
ung
te
cnca
nduced
ve n t a t o n .
WT1
to
an
re s p r a t o r y
or
brougt
va
mecanca
responsbe
s
at
consstent
ds-
Pysca
abdomen
oowng
te
stua
woman,
abor
gene
gr
cm,
at
pre-
cronc
mts.
egt
te
1,
a
atresa
we e k s
he
10-year-od
o
or
stenoss
S o r t y
te
aborta
ageness
2 8 - ye a r - o d
at
o
te
expans
C.
A
story
unda
5
o
1,
examnaton?
Anencepay
ops
most
tan
Pyorc
e ve s .
tumor.
te
ess
B.
nduced
kdneys.
uterne
para
pyscan
norma
utrasound
A.
b oy
tomograpy
nvovng
dagnoss
gene
depart-
pan.
Pysca
Masses
computed
masses
te
oowng
emergency
abdomna
3,
te
wtn
Wc
best
to
medca
are
a
An
o
goydramnos.
te
no
sows
gravda
comes
sgns
umbcus.
amnotc
aponeuross
and
as
vta
A.
A
woman,
gestaton
examnaton
ts-
kdney
35-year-od
utrasound
batera
ts
E.
eases.
derved?
brougt
rgt
Hypospadas
nata
embryonc
oowng
Horsesoe
D.
29
abum
deep
an
te
and
rgt
ntestne
aure
at
C.
maormatons
conrms
te
or
s
wtn
bopsy
common
o
o
a
4.
tssue
dark
eye
sows
o
oop
compca-
deveopmenta
sows
s
a
asca
boy
te
scan
mass
because
abdomna
because
te
(CT)
wtout
wt
asca
3-year-od
n
pyscan
pertoneum
C.
o
term
utrasound
structure
Extrapertonea
naton
he
An
obterate.
s
u
te
age-approprate
ernated
B.
vta
110
a
A.
A
born
to
examnaton
majus.
condton
ayers
ment
3.
was
papaton.
structure
brougt
Pysca
sows
hs
s
aceved
abum
tender
t.
Se
as
mestones.
rgt
gr
depart-
te
det
te
past
as
vomtng
premature
Hs
vta
te
brt,
sgns
examnaton
turgor,
2
not
are
sows
abdomen
s
CHAPTER
sot
but
tender
abdomen
te
n
sows
abdomen
oowng
te
a
epgastrc
regon.
“doube-bubbe”
sows
an
structures
annuar
s
most
An
sgn.
pancreas.
key
x-ray
A
CT
o
te
scan
Wc
obstructed
o
n
many
o
wat
7.
Pyorus
B.
Frst
o
part
C.
Second
D.
hrd
E.
Jejunum
A
an
He
s
brougt
degrees
to
become
te
anteror
degrees
to
become
te
posteror
C.
270
degrees
to
become
te
anteror
D.
270
degrees
to
become
te
posteror
E.
180
degrees
to
become
te
rgt
te
11.
A
newborn
ment
aceved
scrotum
sde
te
processus
o
te
oowng
pyscan
was
spontaneous
examnaton
o
sows
o
te
te
tat
gr
because
vagnas
s
te
s
most
not
oowng
term
ta
s
o
o
s
te
a
An
swoen,
utrasound
por ton
obterated.
Wc
dagnoss
or
12.
ts
o
a
C.
Faure
o
mgraton
D.
Faure
o
deveopment
E.
Absence
A
o
2-day-od
a
u
department
term
D.
Ectopc
E.
Epspadas
“dada”
ung
tests
s
and
done
An
“mama”
moter
and
s
pyscan
says
now
tat
or
te
pung
oow-
cd
mse
sows
to
x-ray
A
to
durng
crackes
tat
pouc.
structures
Esopagus
T racea
nguna
C.
T ongue
D.
T raceoesopagea
E.
Parynx
te
scrotum
canas
key
and
te
bateray.
testes
Wc
are
o
Pseudoermaprodtsm
B.
T rue
Cryptorcdsm
D.
Congenta
E.
Cordee
28-year-od
gestaton
woman,
Pysca
An
o
te
most
13.
A
3-day-od
care
gand
gravda
resuted
o
te
yperpasa
2,
pyscan
no
past
n
a
examnaton
nto
te
utrasound
te
as
utrasound
bowe
wc
to
Se
pregnancy
term.
sma
s
unt
te
or
eaty
etus
32
nta
baby
sows
at
weeks’
prenata
story
unda
cavty.
structures
1,
an
medca
sows
amnotc
oowng
para
men,
gr
and
born
egt
ernaton
o
o
as
resuted
n
x-ray
te
et
bowe
o
sows
structures
te
D.
Cervca
E.
Dorsa
Neura
ods
ntoerance
D.
Latera
ods
(102°F).
E.
Amnon
ng
a
seres
structures.
o
rotatons
Rotaton
o
tat
te
poston
stomac
te
a-
durng
approxmatey
ow
durng
moter
Pysca
n
te
nserted,
coed
n
suspected.
to
te
breatng.
are
o
te
ad
exam-
rgt
and
ower
an
x-ray
te
tube.
proxma
Wc
aed
to
neonata
he
sows
sows
CT
bowe
scan
o
o
te
o
o
te
deveop
ntensve
s
currenty
sunken
n
te
s
cest
centra
durng
cest.
eves
and
tendon
o
abdo-
et
ar-lud
wc
occurred
boy
a
auscutated
te
n
abdo-
o
te
oowng
embryogeness?
ods
ods
o
te
esopagus
greens-yeow
te
wt
An
a
past
sows
ntestne
tender
and
are
sows
consstent
te
vesses
wt
a
and
eedng
s
absent
te
o
te
duodenoje-
te
ntestnes.
bowe
magng
marotaton
ncreasng
40°C
toxc-appear-
contrast
around
gangrenous
and
temperature
abdomen
obstructed,
deveopng
vomtng
Her
gastrontestna
ndngs
juncton
day.
examnaton
upper
sma
patent
hroug
o
or
study
juna
poston.
Hs
key
emergency
myotomes
Pysca
nant
sounds.
rom
orgna
te
cyanoss
transversum
because
deveopment resuts n movement o te et vagus nerve
ts
to
A 1-mont-od gr s brougt to te emergency depart-
ment
nvoves
mentary
key
mesentery
T a
gastrontestna
s
s
transversum
postonng
most
absence
Septum
od
tube
Maormaton
Peuropercarda
C.
tract
A
C.
B.
te
cest
B.
o
14.
o
te
most
Head
deveopment
te
te
od
s
examnaton
Peuropertonea
A.
embryonc
congen-
septum
sounds
A.
ndngs?
he
ts
o
te
od
pregnancy.
admtted
emtorax.
dapragm.
at
s
32
Maormaton
septum
brougt
correct
dicuty
Pysca
and
An
men
er
boy
wt
aebre.
suprarena
comes
examnaton.
cm.
te
oowng
ermaprodtsm
C.
ast
n
testes
dagnoss?
A.
A
papated
te
o
o
propery?
B.
te
s
tube
as
rom
o
Wc
dapragm
te
deveopng
TEF
examnaton
absence
o
te
te
A
A.
batera
te
auscutated
te
stand. he patent’s vaccnatons are up to date. Pysca
sows
depart-
dagnoss
od
breasteedng.
nasogastrc
sows
oowng
o
o
evauate
esopagea
says
up
attempts
ed.
o
boy
because
naton
ydrocee
he
A
mecansm
peuropertonea
Congenta
examnaton.
emergency
made.
peuropercarda
Sterty
up
trunk
trunk
Absence
C.
te
vaga
Absence o muscuature n one a o te dapragm
B.
to
trunk
vaga
B.
poyydramnos
brougt
key
s
trunk
vaga
A.
Hypospadas
s
te
trunk
vaga
breatng.
dapragm
most
A.
boy
to
vaga
deect?
mutpe
1-year-od
brougt
dicuty
te
patent?
A
and
dever y.
ntermedate
key
wt
at
move,
d eveopmenta
sows
scrotum.
te
b orn
vagna
age-approprate
Pysca
rgt
to
patent
nerve
90
duodenum
he
te
90
eventraton
boy
does
B.
duodenum
uncompcated
as
nontend er
10.
te
te
rotaton
poston?
A.
duodenum
scrotum.
mestones.
o
o
o
o
na
te
stomac
te
part
part
swoen
by
9.
o
3-year-od
a
8.
te
ts
ts
condton?
A.
degrees
s
111
Abdomen
3
rsk
o
te
Laboratory
112
C H A P T E R
studes
Abdomen
sow
occurred
15.
3
to
eukocytoss.
cause
A.
Dapragmatc
B.
Subepatc
Mdgut
D.
Dupcaton
E.
Congenta
A
te
ts
a
B.
Incompete
x-ray
sows
te
o
neura
dsta
o
Ogoydramnos
by
examnaton
An
erna.
most
most
pass
wt
coon.
responsbe
Greater
Dorsa
barum
C.
Prenc
coon
recta
19.
te
nd-
to
mgrate
o
o
s
te
te
wa
o
te
te
coon
brougt
to
te
examnaton.
cm
er
a
he
As
o
te
o
s
te
attaced
tat
reducbe
cres
te
abdomen
to
was
te
puses
and
sows
te
nner
20.
te
does
tract
surace
o
te
cana
Ionguna
D.
Subcosta
E.
Pudenda
E.
Stomac
sows
coronc
ste
or
n
te
ts
Uterne
B.
Cervx
C.
Mesentery
D.
Lower
past
type
o
year.
ower
Se
says
tey
Her
ast
te
tat
te
s
dagnoss
oowng
s
te
o
o
part
cervca
os
Fundus
o
te
an
o
uterne
body
overappng
te
nterna
22.
23-year-od
uterus
woman
because
o
s
severe
to
te
abdomna
emergency
pan,
nausea,
te
emergency
Pysca
o
te
te
s
depart-
examnaton
abdomna
nguna
nerves
erna
compressed
nguna
te
to
te
cana
to
emergency
abdomna
antrum
o
pan.
te
ordered
to
s
by
resut
to
be
depart-
Gastroscopy
stomac.
evauate
stomac. Wc
key
woman
o
o
te
nvoved
A
te
CT
ym-
oowng
n
a
mag-
brougt
upper
pan
sows
te
ater
a
gament
o
te
eatng
sows
he
coecystectomy.
Wc
te
postve
abdomen
coecystts.
to
emergency
abdomna
patent
s
sgn.
conss-
undergoes
te
camped
Se
meas.
Murpy
ndngs
Durng
oowng
pan.
atty
nstead
vesses
a
procedure
o
was
te
most
occuded?
Superor
B.
Proper
mesenterc
epatc
C.
Spenc
D.
Common
E.
Ineror
wt
epatc
vena
mass
patent
s
artery
cava
man
gron
Pysca
reducbe
artery
artery
artery
45-year-od
he
s
rgt
smar
o
acute
artery.
mts.
brougt
n
s
most
epatoduodena
ment
te
nerves
ndrect
brougt
te
wt
A.
A
s
examnaton
wt
key
ntestne
te
mesenterc
story
cystc
most
o
mesenterc
utrasound
te
An
bers
stomac?
aparoscopc
pregnancy?
sma
a
tent
Urne
postve.
aferent
abdo-
Wc
Hepatc
An
men-
o
s
47-year-od
Pysca
ave
tube
department
A
as
examnaton
quadrant.
(HCG)
te
emergency
and
Pysca
conrms
o
te
beedng.
ago.
rgt
Wc
to
usband,
te
weeks
examnaton
o
er
gonadotropn
pregnancy.
A.
A
8
vagna
wt
conceve
was
tenderness
ectopc
E.
severe
actve
to
utrasound
key
wt
perod
uman
o
department
sexuay
tryng
strua
nodes
Lumbar
Ieum
brougt
te
gabadder.
protruson
an
upper
n
dranage
Ineror
D.
s
to
pan.
oowng
abdomen
C.
E.
been
tumor
te
Ceac
D.
s
a
o
Superor
Cecum
woman
o
te
ocazed
cutaneous
man
severe
B.
Appendx
se
wt
A.
C.
department
emora
54-year-od
B.
38-year-od
a
o
structure
C.
Ana
21.
te
Ioypogastrc
nancy
erna?
o
Latera
ymp
s
as
B.
patc
te
s
and
nerves
spna
brougt
gron
dagnoss
ernatng
sows
part
te
scan
beow
nerves
s
o
patent
a
Wc
tat
o
CT
just
pan
constant
regon
pan?
A.
A
te
and
scan
surace
man
because
ment
not
to
te
te
spancnc
toracc
A.
A
been
nerves
32-year-od
ncreases
gastrontestna
to
a
Pysca
mass
nner
or
devered
devery.
mass
se
attaced
porton
be
mass
pan.
utrasound
s
0.5
pyscan
Se
o
nerves
n
ndgut
toracc
ram
spancnc
made.
coaca
sows
to
nto
A
n
carres
as
epgastrc
cest
Currenty
nerves
Vagus
te
up
organ
key
ces
te
stones
Pevc
sows
and
te
ypocondrum.
E.
ment
n
around
D.
A
severe
pan?
B.
A
s
began
caced
oowng
A.
represents
or
te
pan
pan
scapuae.
rgt
sot
s
Hrscsprung
key
te
sows
reerred
Pysca
tat
proxma
wt
vagna
Wat
umbca
gr
outwards.
sze.
te
spontaneous
cause
anoter
o
sgmod
consstent
recanazaton
oow
o
te
e.
abdomen
oowng
rotaton
4-mont-od
n
o
o
abdomen
to
coon
E.
to
te
daton
separaton
Faure
appear
o
crest
Deectve
umbcus
ours
aure
wa
D.
preterm
48
mecansm
C.
A
rst
or
he
he
bateray
o
te
o
evauated
patent?
Faure
days.
men
dstended
ndngs
A.
we-cd
18.
te
o
vomtng.
4
radated
beng
An
Wc
te
or
ntestne
narrowng
sows
n
o
17.
s
embryoogc
ngs
and
n
sows
contrast
dsease.
as
eve
te
wtn
marked
bopsy
oowng
megacoon
nontender.
and
te
atresa
o
boy
examnaton
enema
o
vovuus
5-day-od
and
Wc
obstructon?
cecum
C.
meconum
16.
te
s
brougt
pan.
Hs
examnaton
just
superor
dagnosed
to
vta
te
emergency
sgns
sows
to
wt
te
an
are
a
wtn
depart-
norma
papabe,
nguna
non-
gament.
ncarcerated
nguna
CHAPTER
erna
te
and
s
scedued
operaton,
troug
ng
te
types
a
oop
deep
o
or
o
nguna
ernas
surgca
ntestne
rng.
accuratey
s
repar.
observed
Wc
o
represents
Durng
C.
Gentoemora
passng
D.
Pudenda
E.
Ventra
te
te
oow-
Questions
nguna
Umbca
ment
C.
Femora
as
D.
Lumbar
E.
Indrect
wt
pan
ng.
ucer
severe
past
dsease.
panc
to
ar
wtn
Wc
most
Rgt
B.
Hepatorena
C.
Omenta
D.
Rgt
E.
Greater
s
he
s
sgncant
tender
x-ray
ucer
te
n
patent
depart-
says
progressvey
medca
te
oowng
A
tat
mn,
(o
(esser
atory
aparotomy
were
s
tym-
sows
rate
gastroscopy
wa
one
woud
te
Mdaxary
B.
Arcuate
per-
C.
Semunar
D.
T endnous
E.
Lnea
ntay?
Morson)
27.
A
space
epsode
at
o
east
te
emergency
vomtng
two
dark
pnts
o
red
depart-
bood.
vodka
every
rgt
man
He
wegt
sows
ke
he
assessment
day.
s
o
oose
to
ave
ntravenous
access
s
estabsed,
vomt
bood.
broad-spectrum
An
ant-
wc
botcs and octreotde s started, and te patent s taken
od
to
te
sows
ng
endoscopy
ruptured
rom
venous
wt
porta
sute.
cava
A.
Spenc
B.
Let
varces,
ypertenson.
trbutares
te
Esopagogastroduodenoscopy
esopagea
to
vens
to
te
Wc
porta
cause
most
or
te
o
te
oowng
C.
T ransversas
D.
Extrapertonea
E.
Externa
A
C.
Let
gastrc
any
D.
Let
epatc
s
E.
Rgt
gastrc
care
becomng
patent
day
2
days.
pared
s
Hs
medca
rgt
40°C
and
bood
examnaton
to
scrotum.
touc
dagnoss
te
o
he
and
o
oowng
te
s
pressure
dusky
rgt
te
a
rgt
cremasterc
s
and
sgncant
erna.
s
98/83
skn
Hs
o
te
erna
responsbe
or
or
te
relex
or
an
past
unre-
temperature
Hg.
s
made.
te
are
Pysca
rgt
scrotum
s
te
respratons
mm
over
cremasterc
relex?
ever
100/mn,
sde
stranguated
nerves
s
nguna
puse
sows
pan
story
ndrect
(102.2°F),
20/mn,
te
abdomna
s
sde
o
tender
absent.
Wc
eferent
A
s
or
sow
and
beng
man
tat
a
s
sepa-
he
e
s
b).
s
abdomen
or
operaton
te
s
pyscan
ayers
o
te
surgca
rom
Pysca
patent’s
t
or
b)
s
exam-
tat
e
preoperatve
te
surgery
and
(“tummy-tuck”)
perormed
coses
te
wt-
ncson,
abdomna
wa
w
estabs
pr-
past
o
he
CT
marked
wt
and
wc
o
but
skn,
te
Gven
oowng
A.
Be
mb
B.
Common
C.
Cystc
duct
epatc
duct
duct
A.
Ionguna
D.
Accessory
B.
Ioypogastrc
E.
Proper
pancreatc
epatc
artery
duct
te
not
gnawng
He
ave
pan
says
e
portons.
packs
we
abdomen
pancreas.
obstructed?
o
does
o
as
n
s
he
cgarettes
examnaton
as
(conjugated)
19-9.
te
o
a
mea
two
Pysca
and
te
as
to
e
worsenng.
smokes
scan
says
reduced
years.
drect
aponeuross
pyscan
patent
dseases
o
CA
to
graduay
eyes
ead
obque
comes
30
te
A
te
ayer)
ayer)
tssue
aster
smoker
eevated
patent,
to
asca
medca
te
tenderness.
at
he
abdomna
u
yeowng
mass
procedure,
made
(200
abdomnopasty
(atty
contact.
cronc
wt
kg
(395
(membranous
asca
stomac
A 45-year-od man comes to te emergency department
ower
asca
49-year-od
mary
tat
oowng
Scarpa
28.
An
expor-
sutures?
Camper
varces?
around
As
B.
anastomose
ts
be
pyscan
90
skn
week.
A.
gastro-omenta
severe
te
te
kg
an
resut-
key
system
o
te
to
ost
179
ndcates
scedued
compcatons.
to
An
seats?
removed.
oowng
contnues
comes
recenty
out
e
Pysca
ntersecton
te
traged,
key
s
20/
ne
te
s
Hg.
are
epgastrum.
Durng
most
rectus
mm
te
dapragm.
perormed.
ncson
Medca story s sgncant or porta ypertenson. As
patent
te
wc
temperature
respratons
135/85
n
or
Se
relux
ne
45-year-od
woud
100/mn,
s
(GE)
dsease,
Her
depart-
nausea.
aba
prevous
to
s
under
s
and
ne
consutaton.
sac)
comes
and
A.
naton
drnkng
et
ucer
tenderness
ar
te
te
o
woud
ree
emergency
gastroesopagea
pressure
sows
dmnsed
sac
man
bood
te
pan
medcatons.
puse
tat
space
space
and
to
peptc
any
(98.4°F),
examnaton
o
and
takng
sows
posteror
ocatons
(GERD)
not
comes
abdomna
story
x-ray
abdomen
cavty.
te
or
s
36.9°C
worsen-
woman
severe
peptc
sows
abdomen
o
abdomna
subprenc
wt
patent
s
emergency
examnaton
deveop
bursa
pan.
story
An
subepatc
58-year-od
ment
o
key
te
and
rgd,
te
A.
A
a
peroratng
stomac.
tonts
and
percusson.
a
to
abdomna
suddeny
Pysca
sounds,
sows
comes
medca
bowe
ree
a
se
man
began
Hs
wt
dsease
nguna
55-year-od
T12
26–50
32-year-od
B.
te
25.
A
Drect
ment
24.
26.
A.
A
o
surgca
ndngs?
23.
ramus
113
Abdomen
3
sows
epgastrc
sows
Laboratory
4-cm
studes
yperbrubnema
presentaton
structures
s
o
most
te
key
114
C H A P T E R
29.
A
3
Abdomen
44-year-od
ment
wt
examnaton
he
sounds
sgns
o
comes
sunken
sot,
sows
n
a
tat
between
structures
s
s
most
or
te
he
A
beng
o
o
te
supe-
C.
Gabadder
D.
Pancreas
E.
Uterus
compressed?
33.
hrd
o
s
Frst
E.
Jejunum
puse
s
s
88/65
ucer.
s
w
n
A.
Ineror
B.
Let
o
Hg.
and
s
are
Pysca
te
repar
to
o
bood
examnaton
sows
he
a
provde
Rgt
Proper
E.
Superor
gastroduodena
C.
Duodenum
D.
Speen
E.
Pancreas
suppy
to
te
34.
wt
dabetes.
narcton.
110/mn,
95/85
man
He
a
was
bowe
IV
ma
s
sane
ater
are
at
te
rom
te
aorta.
most
key
and
s
orgn
o
Wc
provde
te
An
te
o
te
a
Let
B.
Mdde
C.
Sgmod
and
coc
Spenc
E.
Superor
and
te
a
wt
pan
acy
n
story
s
structures
s
most
pan
20/mn,
n
sows
pan
s
te
and
to
back
A
CT
pres-
sows
scan
o
part
te
o
te
eukocytes.
key
wc
and
puse
bood
upper
ncreased
most
te
(104°F),
examnaton
tenderness.
abscess
n
40°C
caused
o
te
he
by
te
oowng
coon
man
dfuse
o
and
s
o
sows
mesenterc
oowng
to
arteres
te
na
s
comes
to
abdomna
cronc
te
emergency
pan.
he
obstructve
acoosm.
to
nor-
90%
artery
woud
descendng
artery
artery
recta
35.
a
woman
abdomna
He
ocated
caracter.
pan
around
Her
to
te
and
te
emergency
nausea.
umbcus
temperature
s
Se
and
s
40°C
depart-
says
tumor
n
ts
Intercosta
Prenc
D.
Vagus
E.
Subcosta
52-year-od
ty
ad
department
patent
as
pumonary
smoked
Pysca
wt
tree
examnaton
norma
He
esteroema,
He
a
s-
dsease
packs
o
as
bowe
md
sows
sounds
tenderness
a
aus-
n
te
due
gentaa.
Laboratory
ng
arteres
s
Externa
and
B.
Ineror
(104°F),
C.
Umbca
a
to
examnaton
sows
ow
most
te
te
pancreas.
by
he
aferent
oowng
artery
per
abdom-
bers
tat
nerves?
pyscan
story
dsease,
day
sows
and
key
epgastrc
te
aterosceross.
sperm
ac
to
medca
studes
GnRH,
a
o
comes
as
cgarettes
norma
o
medated
spancnc
Pysca
A.
s
coronary
dsease
o
ead
wc
man
evauaton.
packs
te
patent
toracc
C.
A
o
wt
Greater
tat
du
pack.
quadrants.
B.
anayss
comes
a
ntay
eves,
artery
one
abdomen
A.
two
artery
to
n
pan
trave
ypo-
tender
bous
down
sows
pressure
sows
arterogram
suppy
puse
artery
24-year-od
(psoas
abdomna
epgastrc area upon papaton. A CT scan o te abdomen
emergency
bood
abdomen
neror
coatera
gastro-omenta
D.
te
tory
vascuar
A.
ment
du,
cutated
myocarda
(98.4°F),
examnaton
estabsed,
pan.
coon?
A
wt
nondstended
ypertenson,
rom
36.9°C
depart-
abdomna
avng
22/mn,
admnstered.
bockage
s
Pysca
access
emergency
severe
dscarged
sounds,
papaton.
and
temperature
Hg.
te
aterosceross,
ago
respratons
mm
to
darrea
week
Hs
62-year-od
cut
comes
ncudes
department
resstance
ower
cgarettes per day snce e was 20-year-od but as recenty
boody
and
A
(COPD)
mesenterc
story
bood
structures?
Dapragm
bood
ange
s
Pysca
nlammaton
B.
epatc
Hs
te
are
Hg.
an
souder
o
duo-
patent?
and
examnaton
pan?
excrucatng
Urnayss
negborng
oowng
rgt
oowng
temperature
mm
Descendng
te
aganst
te
te
respratons
A.
o
and
Hs
sows
kdney.
spread
gastrc
70-year-od
ever,
100/95
patent’s
under-
perorated
te
wc
patent
te
cause
costovertebra
et
(101°F),
and
o
surgery
branc
38.3°C
s
abdomen
generazed
20/mn,
obstpaton.
surgca
severe
depart-
gastrc
D.
actve
story
emergency
mesenterc
C.
s
mm
A
te
temperature
contnue
ts
to
o
100/mn,
sure
respratons
Durng
gated.
pancreas
ment
Hs
emergency
artery
A
3-our
rgdty
dena
arteres
a
pan.
board-ke
an
o
100/mn,
pressure
goes
duodenum
o
p
n
20/mn,
Pysca
badder
souder.
et
because
abdomna
because
duodenum
te
pan
are
Hg.
A 35-year-od man comes to te emergency department
D.
brougt
to
Appendx
C.
s
Wc
nlamed
mm
o
sarp
Urnary
duodenum
man
a
B.
et
47-year-od
lexon
A.
coon
o
tat
te
ntestna
respratons
135/85
com-
T ransverse
part
s
causes
key
“nutcracker
oowng
100/mn,
quadrant.
no
Second
ment
32.
test)
Bowe
beng
and
sows
te
are
scan
s
aorta
te
n
s
pressure
turgor.
here
CT
dagnoss
o
skn
rgdty.
bowe
puse
B.
part
o
asctes.
o
Wc
o
tenderness
quadrants.
abdomna
key
oss
depart-
Pysca
A.
A
part
and
guardng
or
artery.
made.
emergency
vomtng.
mnma
our
part
te
mesenterc
syndrome”
te
and
eyes
wt
wtout
eard
to
nausea
organomegay
pressed
ror
s
regon
are
abdomen
31.
sows
abdomen
epgastrc
30.
man
excessve
or
and
He
te
norma
sow
perpera
as
smoked
37
years.
externa
mae
LH
count. Wc
occuded?
nert-
yperco-
past
norma
norma
or
o
testosterone
eves.
o
te
Semen
oow-
CHAPTER
36.
D.
T estcuar
E.
Deep
A
40.
crcumlex
42-year-od
examnaton.
Pysca
n
te
o
nvove
nodes
37.
sde
te
te
to
o
Superca
B.
Interna
to
wtn
are
An
a
routne
mass
44-year-od
mts.
te
rst
mass
group
te
o
s
o
ymp
te
te
area?
rectus
nguna
ac
contour.
and
A.
Supracrsta
B.
Lnea
Lumbar
C.
Arcuate
D.
Pectnea
E.
Axary
E.
Semunar
ncarcerated
na
te
obque
spermatc
obque
spermatc
cord
s
B.
Cremaster
C.
T unca
D.
Interna
E.
Dartos
derved
rom
te
nterna
Wc
te
Durng
te
o
Se
abdomna
are
o
wt
comes
stng
A.
Azygos
B.
Ineror
system
vena
C.
Let
D.
Superor
E.
Subcosta
Hs
lud
he
wc
emergency
oter
sgns
sows
duness.
varces
te
gastrc
wtn
C.
Fundus
D.
Psoas
E.
Suspensory
rom
a
42.
resut
ven
A
a
our
ven
ven
vens
o
regon
te
o
structure.
te
key
be
because
patent
B.
Superor
exporatory
C.
Ineror
D.
Hepatc
E.
Spenc
o
vomtng
aparotomy
son
8
mts.
ater
Pysca
An
possbe
sma
useu
beng
monts
sounds.
wc
and
o
to
ago.
Jejunum
B.
Jejunum
C.
Jejunum
vta
examnaton
bowe
as
ess
pan.
and
n
a
sgns
sows
te
motor
s
rom
at
bowe
perormed
Durng
te
are
te
co-
norma
yperactve
compared
mesenterc
vece
wtn
eatures
jejunum
was
he
an
are
aparoscopy
anatomc
tnner
as
12,
obstructon.
oowng
dstngus
A.
age
nvoved
Hs
exporatory
te
abdomna
at
or
surgery,
te
most
eum?
wt
te
compared
te
eum
pared
D.
wt
as
wt
Jejunum
te
as
te
Jejunum
more
numerous
arcades
com-
eum
more
mucosa
as
vascuar
pyscan
omenta
ewer
numerous
v
ympatc
wt
compared
te
wt
oces
eum
te
eum
te
Wc
o
compared
atty
te
here
vta
upper
margn.
An
x-ray
or
a
quadrant
te
s
no
umbar
caced
s
sgns
sows
here
o
oowng
tuber-
te
most
Wc
te
to
te
emergency
and
norma
bowe
mnma
tat
s
o
pan.
sounds
tenderness
or
te
n
rgdty.
trd
beng
te
depart-
abdomna
A
n
te
CT
(transverse)
compressed
oowng
by
vesses
a
w
compresson?
artery
mesenterc
porta
duodenum
guardng
duodenum
artery
ven
ven
ven
woman
o
oods.
and
te
surgca
te
s
te
Aorta
Ineror
vena
C.
Hepatc
ven
o
s
cava
te
or
pan
(ts
te
s
te
depart-
assocated
sows
eectve
coe-
scssors
o
posteror
posteror
mmedatey
vesses
s
abdomen
an
mmedatey
oramen
ed
emergency
he
operaton
tssues
beedng?
B.
te
scedued
oowng
A.
to
pan.
Utrasound
se
Durng
enter
comes
abdomna
(eppoc)
o
s
sows
mesenterc
because
gastones
te
sows
causng
61-year-od
ment
and
beneat
E.
A
o
mesenterc
cystectomy.
eum
wt
43.
T12–L1.
Her
examnaton
rgt
wt
tuber-
abscess?
comes
wtout
vascuar
Ineror
appendectomy
te
vomtng,
abdomen
A.
an
te
or
eves
years.
costa
suspcous
musce
woman
nausea,
A 34-year-od man comes to te emergency department
ad
te
stomac
porton
most
10
tenderness.
suspected
quadrants.
o
n
o
pyscan
treated
vertebra
or
ower
Wc
te
Pysca
mass
te
examnaton
epgastrc
scan
o
asca
wt
Pysca
vesses?
ocate
ayer
pancreas
45-year-od
ment
and
o
mts.
densty
te
Cecum
vens
mesenterc
o
Body
undergoes
key
a
abscess.
B.
dstended
o
to
prevousy
nvovng
ange
A.
cava
umbca
sows
ste
comes
was
papabe
eve
He
beedng
most
et
are
a
He
sows
are
depart-
(ematemess).
vta
tat
between
o
te
bood
examnaton
examnaton
varces.
to
to
acoosm.
anastomoses
trbutares
te
cuous
vomtng
Se
asymptomatc
costovertebra
Pysca
endoscopc
esopagea
s
woman
norma
nontender
regon
man
tendnous
Wc
to
ne
pan.
been
wtn
beow
asca
wa.
used
ne
spondyts
as
key
e
mts.
abdomen
asca
oten
abdomns
surroundng
toracc
most
posteror
te
te
restore
ne
31-year-od
cuous
te
asca
story
A
te
s
rectus
rom
to
ne
abdomna
abdom-
coverng
nterna
41.
a
spermatc
as
te
and
erna.
or
vagnas
because
o
cord
ernopasty
musce
63-year-od
an
nguna
dented.
spermatc
ment
a
s
open
musce?
Externa
norma
ndrect
musce
A.
A
undergoes
to
Durng
used
aba
Presacra
man
te
s
psatera
andmarks
o
lap
seat?
D.
35-year-od
he
reconstructve
mastectomy.
careuy
transposed
end
C.
A
undergong
a
muscuocutaneous
oowng
neror
s
oowng
detaced
structures
not
a
toracc
musce
exam-
does
woman
surgery
procedure,
papated
utrasound
tat
te
or
norma
nontender
sows
afected
pyscan
are
a
scrotum.
Wat
te
te
sgns
sows
te
testes.
dran
operaton,
39.
vta
abdomen
A.
an
38.
Hs
A
breast
comes
examnaton
et
naton
man
ac
115
Abdomen
3
ed
most
to
te
te
boundary)
wt
key
bood.
source
116
C H A P T E R
44.
3
Abdomen
D.
Rgt
E.
Superor
A
rena
32-year-od
ment
sows
acute
pan
postoperatvey,
te
n
skn
an
over
to
n
n
appendcts
removed
tory
pan
tenderness.
week
o
ven
comes
severe
uy
sa
45.
o
rebound
sows
tenderness
woman
because
examnaton
wt
artery
mesenterc
A
te
rgt
CT
scan
te
emergency
te
abdomen.
te
and
te
emergency
te
appendx
and
quadrant
B.
Cystc
C.
Let
D.
Pancreatc
s
success-
One
pareste-
te
E.
48.
anteror
njured
durng
te
appendectomy?
abdomna
Pysca
key
C.
Subcosta
oowng
D.
Ioypogastrc
A.
Ineror
E.
Spna
B.
Let
coc
C.
Let
gastrc
D.
Lumbar
E.
Sgmod
man
s
brougt
to
te
emergency
depart-
assessment
utrasound
wt
sonograpy
examnaton
sows
n
lud
trauma
n
te
(FAST)
abdomen
49.
A
o
ment
aparotomy.
Wc
o
te
sps
be
ceary
woud
pyscan
A.
he
exposes
second
anterory
B.
he
ror
seen
te
te
he
porta
D.
he
second
ory
by
he
trd
wtout
part
ven
aspect
o
um
te
o
mesenterc
trd
C.
oowng
nta
porton
to
superor
to
te
te
o
crosses
o
te
rgt
artery
reaton-
wen
te
s
reated
ven
pass
poste-
duodenum.
anteror
to
te
neck
o
te
pancreas.
E.
to
A
te
50.
te
as
um
been
monts.
son
Se
tat
sure
s
purpe
centraton
ror
a
most
et
A
o
te
te
severe
past
a
6
Inguna
E.
Pectnea
“bufao
serum
scan
o
posteror
oowng
sows
to
buet
con-
abdomen
te
organs
ne-
s
te
mass?
Questions
51.
A
ment
because
epsodes
story
Gabadder
beedng
D.
Ovary
venous
E.
Uterus
tese
2-day
story
upper
naton
o
nausea
quadrant
sows
an
o
obese
and
te
ntermttent
abdomen.
woman
wt
because
pan
Pysca
scera
most
o
te
prenc
to
te
emergency
erna
tat
as
a
passes
Wc
andmark
an
ndrect
to
depart-
troug
o
te
o-
dstngus
nguna
a
erna?
musce
(atera
border)
brougt
buet
sows
wa
te
by
abdomen.
penetrated
to
posteror
emergency
te
buet
structures
te
te
to
superor
drecty
rst
to
wound
te
n
was
te
umbcus.
te
mdne,
most
key
to
buet?
aorta
51–75
48-year-od
o
o
man
e
n
made.
n
te
te
past
Wc
and
but
A.
Let
B.
Rgt
gastrc
C.
Rgt
rena
gastrc
to
o
most
sgns
spenc
to
to
et
rgt
He
tree
and
recenty
as
been
sows
asctes
o
esopagea
varcea
te
oowng
surgca
beore
a
ven
ven
gonada
depart-
ad
ours
as
commony
gastrc
as
24
examnaton
dagnoss
s
emergency
bood.
attempted?
te
and
A
anastomoses
symptoms
to
acoosm
Pysca
spenomegay.
s
comes
vomtng
cronc
exam-
cterus
s
ematemess
reabtated.
pyscan
wc
dag-
coon
Pancreas
C.
rgt
struck
E.
and
o
gand
te
A
He
recta
rom
oowng
Stomac
a
to
made.
between
Hessebac).
was
a
passed
te
Gabadder
Suprarena
comes
asctes.
s
vesses
man
D.
Appendx
woman
(o
used
erna
C.
B.
45-year-od
acoo
ump.”
gucose
te
b)
pres-
erytema,
coc
massve
s
wt
Abdomna
(10
pamar
gament
T ransverse
kg
o
and
ver
because
story
gament
B.
bood
a
abdomns
A.
4.5
ar,
te
comes
abdomna
A.
A
o
yperten-
Her
pyscan
a
sows
superor
superor
examnaton
been
te
esopagea
man
36-year-od
ave
gastone?
cana
Rectus
o
o
and
epgastrc
D.
anteror
body
mdde
trange
C.
te
s-
rena
and
antypertensve
examnaton
and
CT
te
o
b).
Pysca
astng
Femora
wc
a
vens?
and
nguna
Ineror
I
over
and
structures
Pysca
because
o
and
nguna
B.
A
a
as
anastomoses
prenc
department
anterory
pyscan
ganed
mmedatey
o
anter-
mesocoon.
reated
wt
(165
abdomen
sow
s
te
story
kg
mg/dL.
crossed
transverse
atgued
recenty
Wc
orgn
to
treatment
75
s
kdney.
easy
Hg.
te
te
comes
as
mass
cava.
o
3-mont
studes
140
duodenum
duodenum
and
mm
over
o
key
te
wegs
6-cm
vena
a
Se
170/100
strae
Laboratory
sows
o
te
requred
currenty
te
woman
as
medcatons.
and
o
weak
as
o
attacment
part
30-year-od
se
part
pars
A.
o
crross
enarged
because
drect
kdney.
and
as
owng
jejunum?
duodenum
te
te
anatomc
dssecton
severe
45-year-od
and e s taken to te operatng room or an exporatory
by
to
He
examnaton
dstrbuton
Ionguna
25-year-od
comes
dscomort.
B.
A
as
structures
duct
man
noss
T9
obstructed
Se
oowng
duct
epatc
Gentoemora
nerve
te
duct
o
emae
key
quadrant.
o
duct
A.
Focused
47.
Rgt
was
upper
Wc
been
epatc
67-year-od
abuse.
rgt
duct
A
porton o er perneum. Wc o te oowng nerves
most
key
abdomen
ment ater beng nvoved n a motor vece coson. A
46.
most
Be
experences
regon
te
A.
appendectomy.
patent
pubc
te
as
n
gastones.
Pysca
ower
o
depart-
o
ven
used
ver
to
reeve
transpant
s
CHAPTER
52.
D.
Spenc
E.
Superor
A
to
et
55-year-od
ment
A
scan
posteror
tat
as
ureter,
pan
man
because
CT
o
o
surace
and
most
Skn
B.
Skn
C.
Skn
at.
te
to
aneurysm
neror
comes
to
o
te
o
te
and
a
poe
rena
ven
emergency
sows
te
wc
be
te
neror
troug
mesenterc
vomtng,
abdomen
T o
key
o
ven
nausea,
te
nvaded
A.
rena
mesenterc
o
te
depart-
A.
Ceac
B.
Ineror
C.
Let
D.
Mdde
E.
Superor
n
et
rena
oowng
te
kdney
capsue,
regons
w
56.
reerred?
anteror
atera
tgs
and
emora
trange
te
over
te
over
te
D.
Skn
E.
Skn
A
a
over
te
over
weakness
3-mont
and
to
abdomen
Wc
o
te
o
C.
Pregangonc
D.
Postgangonc
E.
A
vaga
abdomen
sows
o
bood
past
6
s
monts.
6-cm
tat
Se
as
mg/dL.
mass
n
structures
s
A
te
ces
beng
Laboratory
o
o
most
te
adre-
to
n
toracc
orgn
tat
mgrated
to
o
te
pos-
rom
comes
pevc
to
te
o
te
n
oowng
te
organs
a
o
s
to
et
58.
nerves
te
Common
Ineror
C.
Let
D.
Sort
E.
Spenc
o
E.
Epgastrc
A.
Duodenum
examnaton
B.
Gabadder
sows
C.
Kdney
penetraton
D.
Lver
ng
E.
Speen
te
A
57-year-od
ment
because
resonance
bood
an
man
o
magng
low
artera
Laboratory
n
comes
pan
te
n
te
(MRI)
et
aneurysm
studes
rena
te
et
o
were
sow
to
te
ven
te
emergency
abdomen.
abdomen
s
beng
ven
ematura
A
sows
tat
occuded
crosses
and
depart-
magnetc
te
by
aorta.
anema.
he
and
key
to
te
anema.
cause
o
te
ar
artery
te
testcuar
bers
n
ven
te
umbar
bers
n
te
to
n
te
vagus
te
te
nerve
emergency
abdomen.
tenderness.
under
te
o
An
x-ray
dapragm
te
resutng
oowng
depart-
Pysca
undc
n
and
o
an
regon
o
ntra-abdomna
arteres
s
te
most
beedng?
artery
artery
artery
artery
n
comes
te
Pysca
oowng
to
te
emergency
abdomen
examnaton
s
te
most
depart-
radatng
sows
to
a
er
erna.
common
type
o
nguna
because
n
anteror
scan
rena
nguna
42-year-od
ment
pan
ucer,
woman
te
Drect
A
et
women?
Indrect
59.
posteror
ar
o
te
regon.
D.
ave
depart-
CT
te
sympatetc
penetraton
pan
C.
to
A
artery
wt
n
n
aferent
rebound
epatc
39-year-od
pancreas.
key
severe
an
gastrc
Femora
tumor?
n
crosses
most
bood
comes
gastro-omenta
Umbca
organ.
te
prenc
B.
a s
te
testes.
ematura
testcuar
te
sows
o
A.
tumor
o
Wc
B.
erna
man
o
oow-
emergency
and
low
t
sows
te
o
o
by
source
Wc
6
te
nerves
sows
stomac
te
scan
anoter
ts
past
o
sows
A.
A
te
bood
s
o
woman
abdomen
nguna
dep ar t-
te
cacexc
te
most
by
or
CT
ta t
suppy
compromsed
A
ta
sows
bood
pan
sows
tendernes s.
tumor
spancnc
emergency
abdomna
examnaton
te
s uppy
brances
o
pexus
because
ment
ar terogram
te
brances
to
lank
were
te
low
Compresson
key
te
o
o
51-year-od
te
tat
studes
Compresson
endoscopy
sgn
nerves
a
Compresson
beedng.
axons
parasympatetc
vague
C.
te
patent?
bers
Compresson
examnaton
reeas-
te
et
oowng
Occuson
ment
suspected.
key
te
B.
A
wc
pan?
A.
E.
57.
comes
s
occuded
s
preaortc
suprarena
s
eadng
scan
n
ven
D.
Fastng
CT
man
pan
spancnc
as
n
mesenterc
sows
not
ocated
coc
examnaton
because
medcatons.
140
(cromain)
crest
man
o
comprom sed
ts
posteror
pyscan
ypertenson
boodstream
ab domna
dagnostc
Wc
wt
Wc
trunk
Pysca
md
te
te
parasympatetc
vagus
because
monts .
A
o
medua
48-year-od
wt
sde
nerves
Postgangonc
ment
to
sympatetc
neura
suprarena
55.
ts
Ces
and
peocromocytoma
te
B.
rgt
a
oowng
spancnc
54.
a
nto
symptoms
or
over
severe
secretory
Pregangonc
teror
o
sows
A.
o
umbcus,
comes
atgue
and
products
and
atera
key
mesenterc
57-year-od
aorta.
umbcus
concentraton
afectng
medua
and
antypertensve
o
ng
and
areas
musces
woman
gucose
na
pubc
anteror,
pubs,
wa
serum
gand
pubs
te
story
responded
te
meda,
and
most
coc
testcuar
30-year-od
o
regon
tg
abdomna
53.
gutea
A
ment
and
s
arteres?
ematura.
neopasm
pevs,
ng
117
Abdomen
3
woman
o
sows
under
o
oowng
te
te
prouse
comes
severe
pan
to
n
rebound
te
te
tenderness
dapragm.
duodena
s
te
An
bub
ntra-abdomna
arteres
emergency
abdomen.
and
by
an
ucer,
key
Posteror
B.
Superor
superor
pancreatcoduodena
mesenterc
C.
Ineror
mesenterc
D.
Ineror
pancreatcoduodena
E.
Rgt
gastrc
x-ray
sows
resut-
Wc
source
beedng?
A.
an
endoscopy
beedng.
most
depart-
Pysca
o
o
te
118
C H A P T E R
60.
A
a
te
to
n
s
expose
te
o
asca
ayer
Externa
B.
Interna
C.
T ransversus
D.
T ransversas
E.
Processus
tumor
nate
o
to
te
be
B.
Cystc
C.
Superor
D.
Ineror
E.
Hepatc
63.
obque
te
cord
Appendcts
repar
C.
Coecystts
D.
Kdney
E.
Peroraton
relected
vesses.
nterna
sper-
65.
deveop?
aponeuross
aponeuross
CT
o
to
te
abdomna
cterus
and
scan
te
Wc
o
pan.
md
o
te
pancreas
te
emergency
depart-
Pysca
exam-
tenderness
abdomen
nvovng
oowng
n
te
sows
te
vesses
a
unc-
s
66.
most
because
upper
o
An
most
key
Be
B.
Cystc
C.
Let
D.
Pancreatc
E.
Rgt
Lumbar
Pevc
to
and
scera
emergency
abdomna
and
mgrates
o
o
by
te
cterus
tat
Wc
te
te
te
pan.
depart-
o
o
Wc
Pysca
Pudenda
sympatetc
E.
Vagus
nerves
A
42-year-od
posterory
abdomen
oowng
An
o
te
gastrc
D.
Mecke
E.
Borborygm
mu-
s
67.
An
80-year-od
Pysca
s
epgastrc
most
key
Crross
ng
a
E.
Kdney
te
rectus
most
at
rsk
about
ods
wen
o
2
cm
te
Wc
ts
te
above
skn
o
ncson
externa
te
s
te
and
seat
pubc
curves
oowng
o
bones.
68.
superor
nerves
A
s
(Fg.
3.1).
In
B.
T11
ence
C.
Ioypogastrc
poston?
Ionguna
A
37-year-od
ment
because
ower
sows
a
emora
woman
o
quadrant
rebound
postve
psoas
eukocytoss.
dagnoss?
cutaneous
g
comes
ever,
to
te
nausea,
abdomna
pan.
tenderness
over
test.
Wc
te
vomtng,
Pysca
studes
oowng
s
depart-
and
rgt
examnaton
McBurney
Laboratory
o
emergency
pont,
sow
te
and
marked
most
key
69.
o
te
te
te
te
ntestna
tat
te
dsta
te
te
wa.
eson
oowng
or
seg-
con-
cnca
symptoms
and
te
woman
asctes
wc
wc
o
te
examnaton
asctc
lud
tat
s
marked
te
a
or
rou-
some
bood
pres-
pusaton
oowng
and
Rectouterne
D.
Vescouterne
E.
Costodapragmatc
19-year-od
ater
a
n
dagnoses
sgns?
te
emergency
s
conrmed
oowng
most
key
te
depart-
Pysca
by
a
ocatons
conrm
patent
n
exam-
CT
scan
w
te
te
an
pres-
supne
recess
recess
(pouc
recess
s
motor
L4
(pouc
o
o
Morson)
Dougas)
recess
man
sows
te
to
dscomort.
wt
C.
at
o
comes
Subprenc
sected
as
or
appette
symptoms
abdomna
Hepatorena
abdomen
sows
e
pyscan
poor
aneurysm
B.
ment
te
a
ver
A.
A
to
Wc
aortc
o
sows
utrasound
Latera
o
exam-
necton,
stone
because
naton
made?
o
48-year-od
ment
T10
E.
o
depart-
Pysca
erna
A.
D.
o
ad
and
expan
Abdomna
troug
as
Hg
regon.
D.
ncson
emergency
expan
comes
He
mm
Pannenste ncson s used to reac te uterus by mak-
he
cesarean
eson
evdence
examnaton
175/95
Spenomegay
contractons.
emergency
te
a
key
man
examnaton.
C.
pubs.
ts
dvertcuum
B.
mons
most
n
emorrods
s
te
w
pan
emorrods
A
o
an
to
te
stoos.
nlammaton,
Wc
most
Dvertcuoss
w
comes
w
to
er
examnaton
sows
mucosa.
C.
sows
o
stoogc
toward
structures
sgns
eum
sows
secton.
to
o
patent
afectng
trunks
n
endoscopc
Interna
gastones?
P0
no
Externa
duct
musces,
nerves
transmsson
comes
bood
B.
s
G1,
o
sows
bopsy
sure
woman
natura
syndrome”
oowng
te
depart-
he
trunks
woman
because
decson
oows
pan.
nerves
Hata
It
emergency
nerves
Sacra
A.
n
duct
transverse
te
bowe
te
or
D.
tme.
because
to
abdomna
sympatetc
te
tenderness
duct
perorm
o
spancnc
A.
to
severe
“rrtabe
emergency
made
duodenum
comes
sgns?
duct
epatc
te
man
C.
tne
36-year-od
o
responsbe
B.
tans
duct
epatc
be
condtons
jaundce
obstructed
A.
rectum.
A.
A
artery
utrasound
gastones.
story
a
ment
artery
comes
quadrant
scapua.
as
tumor.
ven
sows
because
ment
ven
man
stone
ment
key
artery
mesenterc
porta
pregnancy
56-year-od
naton
epatc
and
A
s
aponeuross
comes
mesenterc
department
64.
A
ead
tpe
A
spermatc
erna
and
testcuar
does
obque
severe
scera
artery
examnaton
te
and
Ectopc
B.
case?
woman
35-year-od
rgt
open
A.
occuded?
Common
ment
te
te
dented
o
an
sows
asca
regon.
A.
A
o
abdomns
o
process.
key
oowng
because
vagnas
sows
epgastrc
s
pyscan
examnaton
deerens
abdomna
because
naton
te
Durng
asca
abdomna
45-year-od
ment
erna.
te
to
Pysca
ductus
A.
A
comes
spermatc
wc
matc
man
scrotum.
nguna
nterna
From
62.
Abdomen
23-year-od
buge
ndrect
61.
3
recess
brougt
vece
tat
cord
te
to
te
emergency
coson.
spna
eve.
An
cord
Wc
as
o
depart-
MRI
o
been
te
te
tran-
oowng
CHAPTER
and
an
x-ray
o
te
abdomen
sows
119
Abdomen
3
tat
se
as
rac-
tures o te nnt and tent rb on er et sde. Pysca
examnaton
oowng
cnca
73.
Lver
B.
Pancreas
C.
Let
D.
Speen
E.
Ieum
o
as
sows
ntestne
system
70.
Jejunum
B.
Ascendng
C.
Ieum
D.
Descendng
E.
T ransverse
scan
o
as
wc
key
71.
te
man
oss
abdomen
atty
o
B.
Let
C.
Porta
D.
Facorm
E.
Hepatogastrc
obe
obe
o
o
because
o
C.
Superor
a
tumor
studes
manutrton,
ocatons
s
ver
te
A
o
tat
scedued
aparoscopc
arteres
n
and
an
te
s
to
te
be
emergency
abdomen.
He
ntermttent.
stones
eectve
n
A
s
most
camped
te
says
An
depart-
42-year-od
te
to
wc
remove
o
Common
B.
Proper
C.
Rgt
D.
Let
E.
Cystc
most
oow-
gabadder
A.
Hepatc
B.
Ineror
Superor
D.
Latera
E.
Superca
A
pan
A
n
Wc
ranstorm
FAST
ater
and
er
t
a
examnaton
automobe
tree.
Se
sows
to
et
was
te
te
A.
wearng
vena
te
a
ntra-abdomna
seat
o
bet.
ypotensve,
aparotomy
pertonea
occurred
oowng
wa.
and
o
to
cavty
durng
vesses
recta
coc
te
patent
te
must
be
artery
artery
emergency
s
CT
cterc
an
scan
or
te
exam-
(jaundced)
are
o
endoscopy
oowng
depart-
Pysca
medusae”)
A
te
seen
te
sows
venous
on
s
abdomen
esopa-
structures
deveopment
o
caput
ven
ven
epgastrc
man
ven
comes
upper
sows
te
he
rgt
o
Aferent
C.
Vscera
a
to
postve
te
te
pyscan
quadrant
gabadder
and
Murpy
abdomen
oowng
vagus
te
sgn.
sows
and
nerves
because
ever.
Utrasound
numerous
percoecystc
transmts
o
Pysca
arge
lud.
te
pan
o
nerve,
n
spna
aferent
spancnc
nerve,
rom
T8
T6
to
wt
reerra
to
te
neror
scapua
bers
Sympatetc
spancnc
n
beedng
s
cava
rgt
n
B.
emergency
gway
tat
A
or
appendectomy,
e
te
taken
coecystts?
D.
brougt
s
cava
toracc
58-year-od
epatc
s
porta
vena
C.
epatc
woman
te
ematemess.
obstructed
s
Durng
n
superor
(“caput
Wc
key
te
quadrant.
e
exporatory
mdde
te
epatomegay
gastones
epatc
45-year-od
vens
varces.
An
comes
abdomna
o
and
te
tese
artery
severe
tat
examnaton
epatc
department
a
dated
ange
A.
A
sows
examnaton
te
te
o
pan
gabadder
o
n
medusae?
saey?
72.
because
ater
vesse
and
and
man
utrasound
coecystectomy.
coecystectomy
must
artery
gea
75.
comes
sows
or
artery
Ieococ
sows
ypoxa.
tumor
gament
eatng
Ieococ
E.
anteror
te
resut
ower
and
(102.2),
o
mesenterc
D.
and
CT
causng
sow
and
s
because
monts.
ver
pan
abdomen
ng
artery
artery
ver
man
o
s
coc
coc
gament
ater
te
te
te
occurs
a
tat
6
Wc
to
beedng?
Rgt
epats
61-year-od
e
pyscan
te
rgt
bood
a
Wc
Rgt
ocated?
Rgt
ment
sows
oowng
A.
A
te
precedng
Laboratory
stoo,
te
to
te
stop
o
to
B.
naton
comes
njury
A.
ment
over
an
ose
coon
sock.
njured
made,
days
pan.
nervous
coon
ypertenson.
patent
At
centra
74.
wegt
porta
predctaby
te
coon
55-year-od
severe
most
rom
(CNS)?
A.
A
w
nnervaton
to
te
s
39°C
amounts
appendectomy.
gated
te
o
n
T wo
s
abdomna
arge
because
o
pan
appendcts
temperature
and
parasympatetc
severe
o
appendectomy.
s
portons
key
A 45-year-od man comes to te emergency department
an
.
ypovoemc
most
kdney
dagnoss
Fig.
s
sgns?
A.
because
•
sows
organs
nerves
bers
wt
va
T1–T4
te
reerra
T10–T12
nerve
n
portons
ceac
greater
to
te
o
toracc
dermatomes
greater
gangon
toracc
and
ceac
pexus
E.
Aferent
T6–T8,
bers
wt
o
dorsa
reerra
to
te
ram
o
epgastrc
spna
regon
nerves
120
C H A P T E R
Questions
76.
A
3
Abdomen
76–100
descendng
15-year-od
ment
ca
because
pan,
rgt
gr
o
McBurney
descrbes
wt
te
B.
T wo-trds
te
C.
A
rgt
ne
A
E.
One-trd
A
ac
an
upper
gnawng
sows
o
Spna
Greater
C.
Vagus
D.
Lumbar
E.
Spna
o
wt
s
an
ower
ses
rebound
made.
A.
ncson
at
B.
rom
te
o
te
ower
cm
rom
one-trd
o
to
te
pan.
usuay
te
te
rom
to
o
te
pubc
te
81.
ngu-
Se
pyscan
te
ood.
endoscopy
wt
n
An
te
nerves
pan
body
o
transmts
as
toward
te
o
er
pubc
abdomen
obstructng
oowng
ocatons
te
sympyss.
tat
rgt
te
a
79.
B.
Mnor
C.
Pevc
D.
Mdporton
E.
Between
A
42-year-od
A
FAST
woman
ater
a
s
brougt
traumatc
examnaton
te
sows
to
to
prevent
urter
A.
Coronary
B.
Gastrococ
C.
Spenorena
D.
Hepatogastrc
E.
Facorm
Wc
be
te
ntrapertonea
At
cacu-
A.
key
to
B.
cervx
beedng
te
oowng
beedng?
84.
te
stoo.
ower
te
et
coc
artery
and
neror
emergency
ower
er
over
se
A
under-
postoperatvey,
te
gentas.
key
depart-
quadrant.
and
weeks
skn
brougt
T wo
days
An
webs
pubc
Wc
njured
regon
o
te
durng
te
to
te
and
ater,
a
emergency
story
te
boy
o
depart-
recurrent
deveops
asp-
Esopagogastroduodenoscopy
and
A
coonos-
porton
o
te
8t
strctures
n
te
dsta
trd
o
recanazaton
atresa
E.
Duodena
stenoss
A
5-day-od
te
esopagus
dur-
because
te
atresa
gr
s
o
abdomen
stomac
sows
duodenum.
to
ganed
be
any
to
he
stenoss
ungry
deveopmenta
emergency
te
contents
cd
wegt
te
or
a
o
cres
o
snce
and
te
2
te
depart-
days.
be.
An
ourt
amost
tme.
brt.
condtons
past
part
o
constanty,
he
Wc
most
he
x-ray
o
gr
as
te
o-
key
expan
emergency
depart-
symptoms?
Patent
B.
Duodena
be
duct
stenoss
C.
Hypertropc
D.
Atropc
E.
TEF
4-day-od
does
pyorc
gastrc
gr
because
projecte
but
brougt
vomtng
contans
A.
A
o
week
Esopagea
as
n
te
nerve
made,
T wo
te
dyspaga
Duodena
te
gament
o
te
appearng
manpuated
gament
bood
and
eococ
rgt
s
most
D.
te
gament
passng
nerves
TEF
o
skydvng.
gament
o
sows
vomtus
gament
dvertcuoss
to
te
o
C.
ment
because
s
o
pneumona.
ng
ment
sows
boy
Incompete
wc
A 74-year-od woman comes to te emergency depart-
copy
recta
T10
nectons.
(EGD)
emergency
we
o
superor
menta condtons w most key expan te symptoms?
most
careuy
nerve
because
owng
must
coc
Utrasound
rena
ntra-abdomna
perormed.
n
o
was
Ionguna
spenectomy
s
nerves
5-year-od
not
structures
mdde
te toracc esopagus. Wc o te oowng deveop-
uterne
andng
and
and
brougt
porton
E.
A
ment
and
numbness
anteror
and a CT scan sows a ruptured speen. An emergency
pertonea
80.
brm
ves-
operaton?
and
spancnc
appendectomy.
Spna
ureter
pevc
pexus
appendcts
Subcosta
83.
te
s
D.
cayx
te
nerve
nerve
pan
C.
brm
department
an
o
o
te
cayx
o
te
patent’s
wc
er
ureter.
cacuus
gr
Pudenda
emergency
rom
durng
nvoved
te
artery
Gentoemora
odge?
Major
vagus
B.
82.
radatng
sows
er
s
to
pan
te
I
pattern,
spancnc
toracc
because
ees
cest
comes
o
15-year-od
raton
severe
cut
typca
vagus
pevc
A.
nerves
woman
te
te
nerves
be
tat
removed.
operaton?
regon?
spancnc
most
o
esser
oowng
T12–L2
because
A.
A
se
because
descrbes
oowng
ts
spancnc
partay
Let
ment
nerves
o
Brances
E.
goes
ne-
T5–T12
toracc
D.
dagnoss
tuberce
anteror
be
mesenterc
Brances
and
te
uceratons
rom
trd
determned
artery
umbcus
comes
w
mesenterc
upper
te
o
s
artery
ne
umbcus
nerves
Superor
C.
n
oows
It
soud
artery
andmarks
gament
and
coon.
bowe
Brances
An
nerve
back
te
sows
te
anatomy
spne
te
2
te
sma
pan
examnaton
s
to
occurs
68-year-od
us
ac
dstance
woman
nerves
department
ower
te
o
ment
abdomna
o
B.
A
te
Wc
A.
n
oowng
nguna
dstance
about
spne
and
sensaton
te
ntersects
mutpe
stomac.
78.
tat
41-year-od
o
te
perumb-
pont?
ntersects
gament,
ror
begun
area
gament
D.
na
ocazed
appendcts
o
te
superor
tat
ne
o
dfuse
depart-
nppe
o
anteror
nguna
77.
McBurney
mdpont
o
s
Wc
he
and
emergency
examnaton
procedure
A.
te
becomes
dagnoss
pont.
to
nausea,
Pysca
a
appendectomy
best
ater
quadrant.
and
brougt
ever,
wc
tenderness
s
o
and
not
s
spncter
antrum
brougt
vomtng.
contans
appear
to
to
te
he
te
vomtng
contents
contan
be.
o
s
descrbed
er
he
stomac
gr
makes
CHAPTER
suckng
to
movements
sucke
to
by
trve.
mass
n
w
best
Duodena
stenoss
atresa
C.
Hypertropc
D.
Atropc
E.
TEF
because
stomac
or
o
2
constanty
key
A.
An
trd
wegt.
o
Wc
expan
te
Incompete
Esopagea
D.
Duodena
E.
TEF
n
w
vomtus
vomtng
abdomen
but
se
oowng
boy
was
days.
An
sows
a
o
o
te
te
he
stenoss
cd
not
w
any
Duodena
atresa
C.
Hypertroped
D.
Atroped
E.
TEF
te
stomac
o
te
but
best
s
90.
o
he
as
made.
Wc
descrbes
te
o
te
o
o
pancreatc
tat
opened
B.
Be
ducts
C.
he
ventra
pancreatc
bud
around
te
D.
he
dorsa
he
88.
A
91.
an
part
bca
te
or
mnor
to
as
an
accessory
ts
expan
duct
Ompaocee
Gastroscss
Epgastrc
E.
Indrect
te
ormed
a
rng
dorsa
o
pancreatc
o
te
pan
past
tat
appendectomy
s
o
or
week.
he
He
to
because
o
aso
te
patent
to
te
vomtng,
te
descrbes
rgt
ower
undergoes
a
emergency
and
ruptured
an
a
const-
perum-
quadrant
emergency
appendx.
A
brougt
rom
te
wen
te
to
because
s
mass
te
emergency
an
abnorma
abdomen.
contans
and
boy
oowng
te
o
sma
cres,
An
MRI
some
por-
ntestne.
strans,
condtons
w
and
most
symptoms?
erna
etus,
antenata
ndcates
atera
to
protrude
oowng
a
te
nto
examnaton.
deect
on
medan
te
condtons
te
pane,
amnotc
w
most
Utrasound
rgt
n
cavty.
key
sde
wc
Wc
expan
o
te
o
tese
Nonrotaton
B.
Patent
Abdomna
mdgut
contents
Incompete
E.
Persstent
cosure
coaca
2-day-od
te
te
not
returned
rom
te
b oy
2
o
s
and
days.
V t a
sgns
a re
s
ods
be.
te
Te
e
eces
to
most
emergency
vomtng
vomtng
examnaton
and
wtn
te
to
contnuous
Pysca
earest
o ow n g
atera
brougt
o
dstenson,
(te
te
membrane
because
contents
or
ave
cord
D.
A
o
uracus
s
be
unabe
o
con-
s ow s
to
pass
emnated
ater
norma
mts.
common
cause
Wc
o
ts
condton?
pan-
around
artery
erna
er
A.
Inarcton
B.
Incompete
C.
Faure
D.
Remnant
enterc
brougt
nausea,
ocazes
abdomen.
deveoped
stak)
omentum
nguna
A.
duodenum.
because
te
bud
Suc
deve-
A 24-year-od woman comes to te emergency depart-
brt).
wt
oowng
erna
D.
meconum
duodenum.
bud
te
C.
o
used
o
B.
tnues
papa.
bud
s
tat
protrudes
Wc
stomac
canaze.
pancreatc
35-year-od-man
paton
perssted
about
noted.
sac)
parents
greater
department
tssue.
department
o
te
aed
dorsa
trd
at
duct
s
sows
te
abdomna
he
eum
s
te
ndngs?
oowng
deveopment
(yok
protrudng
umbca
dagnoss
te
te
mesenterc
(yok
boy
by
Umbca
spncter
A
to
nger-
cord
A.
te
cond-
o
juncton
o
access
5-cm-ong
dvertcuum
mass
vscera
300
a
border
wc
duct
vesce
tssue
o
o
superor
3-mont-od
te
cd
ost
oowng
te
symptoms?
vomtng.
A.
E.
Umbca
o
examnaton
condton?
creatc
Ceca
E.
ment
antrum
severe
pancreas
D.
key
wt
A 4-year-od boy s admtted to te emergency depart-
o
Umbca
C.
pyorc
gastrc
because
C.
o
greater
structures?
Branc
A
or
eoceca
remnant
B.
he
contents
utero
sgn.
ungry
te
n
examnaton
bubbe”
aways
emergency
a
anteror
te
Ompaoenterc
tons
dur-
te
rom
examnaton
most
esopagus
dagnosed
expan
B.
s
made
Intraoperatvey,
A.
mass
cres
gan
on
away
pouc
was
cavty.
department
duodenum
to
vomtng
brt. Wc
key
stenoss
mecansms
89.
contnues
condtons
utrasound
s
ncson
pouc
cm
cougs.
was
“doube
and
snce
most
o
Duodena
annuar
60
depart-
contans
sows
does
brougt
He
A.
ment
ke
a
emergency
he
recanazaton
constanty
wegt
ove-ke
oowng
atresa
poyydramnos.
87.
te
because
tons
an
te
symptoms?
2
g
te
duodenum.
ungry,
and
cres
pertonea
ang
symptoms?
he
te
te
department
abdomen
mdne
s
atresa
2-day-od
or
oferngs
week
C.
be
to
recanazaton
8t
B.
A
te
be.
o
o
o
er
Incompete
ng
and
s
sows
o
to
Se
undus
x-ray
and
botte.
Wc
vomtng.
part
response
spncter
brougt
contents
days.
te
s
n
te
opmenta
pyorc
gastrc
gr
o
expan
Duodena
5-day-od
ps
or
regon.
B.
A
er
examnaton
epgastrc
A.
ment
86.
o
moter
Pysca
te
condtons
85.
s
121
Abdomen
3
E.
92.
A
o
te
ts
boy
because
o
o
s
o
due
te
to
vovuus
atera
o
proxma
and
an
procedure,
te
te
ods
eum
porton
o
te
ompao-
mdgut
brougt
sudden
perumbca
made
bowe
recanazaton
Nonrotaton
and
eta
cosure
duct
5-year-od
ment
s
o
o
pan.
to
A
ea
o
emergency
nausea,
dagnoss
appendectomy
an
te
onset
s
o
appendcts
perormed.
(Mecke)
depart-
vomtng,
Durng
dvertcuum
s
122
C H A P T E R
3
Abdomen
dscovered.
mon
cause
Wc
o
A.
Inarcton
B.
Incompete
C.
Faure
D.
Retenton
o
oenterc
E.
93.
A
tat
48
ts
te
most
com-
A
due
te
to
vovuus
o
te
atera
o
te
ods
eum
porton
o
te
ompa-
mdgut
to
pass
brt.
ana
stoo
(meconum)
n
Pysca
examnaton
sows
ageness
s
Faure
te
wt
most
a
pernea
common
te
98.
stua.
cause
devaton
te
D.
Abnorma
E.
Remnant
stoo
a
o
te
coaca
by
te
te
by
bowe
s
membrane
o
proxma
o
er
te
made.
cause
o
s
to
te
septum
perorate
coon
porton
brougt
parents
2
o
o
ana
B.
Dorsa
C.
Faure
D.
Abnorma
E.
Remnant
to
because
wc
te
cana
o
ompao-
o
emergency
severa
10
a
dagnoss
oowng
s
sows
o
te
ana
o
te
o
ana
te
te
coaca
urorecta
membrane
o
proxma
ts
o
te
cecum
Nonrotaton
E.
Hernaton
23-year-od
or
wtn
etus
by
te
urorec-
to
te
perorate
coon
o
te
nant
o
s
o
te
brougt
eca
to
dscarge
oowng
te
ompao-
emergency
rom
s
dagnoses
Poycystc
C.
Ureterc
D.
Faure
E.
Wms
as
Vovuus
5-day-od
An
vs
best
sows
te
o
ts
te
B.
Ageness
C.
Faure
D.
Abnorma
E.
Premature
s
dagnosed
examnaton
o
s
te
o
o
te
red.
and
o
ogoy-
condtons
most
dsease
ureterc
gr
mesonepros
bud
was
because
to
orm
and
to
breast
te
a
pys can
yes.
cannot
Pysca
s
he
be
negatve
oowng
by
mass es.
deveopment
gentaa.
uter us
sows
o
te
ngun a
menstr uate
externa
te
to
batera
norma
studes
Wc
brougt
o
star ted
and
saow,
A.
Mae
B.
Femae
C.
Androgen
D.
Inguna
E.
T urner
An
sex
te
or
vagna
papated.
cro matn
most
ke y
pseudoermaprodtsm
pseudoermaprodtsm
nsenstvty
as
syndrome
woman
because
been
aso
o
syndrome
ernas
18-year-od
noss
a
wt
o
anorecta
te
key
ageness.
abdomen
rectouretra
most
proctodeum
te
urorecta
xaton
o
te
parttonng
rupture
12-year-od
dark
a
emae
age
te
presence
Faure
to
dvertcuum
o
as
a
exam.
bus
an
te
te
he
past
a
sma
emergency
pan
6
ymen
cycc
he
amenorrea.
suprapubc
te
s
key
s
monts.
examnaton
between
most
to
prmary
vagna
membrane
s
te
o
sows
A
pan.
over
mperorate
oowng
brougt
story
examnaton
on
s
pevc
worsenng
A.
Faure
pe-
B.
Cervca
Wc
C.
Patent
D.
Androgen
E.
Faure
and
stua.
embryoogca
cause
condton?
nspecton,
py-
examnaton
ageness
oowng
te
aba.
made.
mass
sows
A
Wc
expanaton
a
dag-
or
o
ts
condton?
boy
oowng
department
o
er
Pysca
stua
A.
A
rena
te
te
sows
patent
cyst
utrasound
o
Utrasound
to
examnaton
tumor
not
bugng
E.
o
examnaton
Vtene
A
comes
Pysca
dupcaton
parents
B.
(Mecke)
o
kdney
15-year-od
papated
Iea
appendx
woman
mts.
Wc
te
condton?
ntestnes
unatera
Degeneraton
and
condton?
Vtene
and
norma
sows
ts
ea
s
mdgut
prmgravd
B.
Enterocystoma
D.
te
an
occurred?
A.
C.
te
o
sows
oowng
regress
examnaton.
department
umb-
w
o
to
te
dagnos s?
septum
porton
o
A.
A
stak
routne
Laborator y
100.
because
Wc
expan
o
recanazaton
2-mont-od
cus.
Marotaton
D.
pattern.
te
duct
department
C.
s
most
condton?
separaton
devaton
enterc
ntestne
Se
wt-
septum
o
te
er
perods
days
examnaton
and
te
te
asted
Pysca
Wc
ts
Incompete
o
key
99.
gr
movement.
A.
ta
urorecta
recanazaton
o
nrequency,
stenoss
te
yok
cause
Faure
A
o
scan
o
Dupcaton
te
urorec-
duct
narrowng
key
o
ana
3-mont-od
department
embryoogca
dramnos.
separaton
Wc
B.
s
o
pertecnetate
dvertcuum.
A.
scan
septum
o
tecnetum-99m
underyng
condton?
C.
A
o
oowng
Dorsa
out
s
(Mecke)
proxma
as
as
te
enterc
97.
te
ater
B.
o
oowng
bowe
cosure
boy
Incompete
ta
96.
eta
o
A.
A
te
duct
boy
o
o
condton?
recanazaton
ours
te
Wc
95.
o
Nonrotaton
newborn
rst
94.
ts
boy
wt
te
s
o
cd
septum
te
te
Questions
ana
to
bood
to
te
vagna
processus
pate
to
canaze
o
vagnas
nsenstvty
te
syndrome
snovagna
bubs
to
deveop
be
ree
rom
o
Upon
brgt
any
pan.
101–125
22-year-od
woman
dyspareuna.
er
emergency
beedng.
ranged
A
o
membrane
recta
appeared
101.
coaca
brougt
te
te
atresa
deveop
ndgut
o
massve
coor
he
o
to
o
ast
ormed
sexuay
1
mont
examnaton
atera
Se
wa
examnaton
to
ad
transmtted
ago,
sows
o
comes
as
te
a
3
was
cm
vagna.
sows
tat
te
one
pyscan
sexua
dsease
negatve.
cystc
screenng,
A
mass
because
partner
routne
detected
A
transvagna
te
abnorma
and
per-
pevc
on
te
utrasound
structure
s
CHAPTER
key
a
Gartner
embryonc
102.
A.
Mesoneprc
B.
Paramesoneprc
C.
Urogenta
D.
Mesoneprc
E.
Snovagna
cyst
o
te
oowng
orgnate
generazed
rom?
sma
tubues
upper
duct
te
ods
Were
A.
Rgt
wa
s
te
Paracoc
weeks’
D.
Vescouterne
E.
Rectouterne
gestaton
vst.
wt
a
a
wt
ears,
o
tese
te
B.
Poycystc
C.
Rena
Wms
Exstropy
o
s
s
s
Hg,
we
and
are
e
rgt-sded
s
obstructng
partay
te
second
s
te
o
ureter
most
ureterc
B.
Eary
C.
Faure
D.
Persstent
uracus
E.
Faure
ureterc
spttng
o
by
gastrc
pan.
wc
s
er
ucer
s
asprated
n
pertonea
wen
te
A.
Rgt
B.
Hepatorena
C.
Let
cavty
D.
Vescouterne
E.
Rectouterne
43-year-od
department
as
Pysca
a
atter
pres-
o
te
o
to
te
sudden,
severe
ep-
eartburn,
108.
over-te-counter
sows
wa
o
surgca
te
a
(o
pertonea
sma,
woman
o
story
(o
s
roty
cavty.
most
gray
sows
sudden,
sarp
says
A
tat
te
er
pregnancy
sows
pevs.
most
In
a
n
ast
test
n
s
negatve.
cyst
approxmatey
o
te
menstrua
ruptured
wc
key
emergency
pan
te
on
100
oowng
accumuate?
space
(o
Morson)
pouc
pouc
man
o
(o
s
severe
ypertenson
to
te
sows
a
te
and
o
Pysca
CT
trombus
te
pyscan
te
emergency
n
and
angograpy
te
artery
ayers
to
He
wt
examnaton
rgdty
oowng
enter
pan.
aterosceross
guardng,
abdomen.
Wc
to
abdomna
medcaton.
tenderness,
o
Dougas)
brougt
o
key
Pareta
pertoneum
B.
Greater
and
access
n
o
a
te
suppyng
o
te
perto-
afected
Lesser
Pareta
pertoneum
E.
Greater
omentum
A
to
te
epgastrc
52-year-od
o
smokng
drug
epgastrc
and
pan.
he
ong-term
because
pan
109.
or
greasy
aspect
te
man
o
te
o
o
A.
C3–C5
B.
C5–C8
C.
T1–T4
D.
T5–T9
E.
T10,
greater
omentum
2
gastrospenc
te
te
persstent
to
transverse
te
sows
wt
spna
pan
n
began
An
te
quad-
sorty
sows
ower
utrasound
mutpe
be
segments
wt
depart-
upper
examnaton
norma
nerve
assocated
rgt
pan
souder.
mesocoon
emergency
he
Pysca
and
gament
mesentery
severe
ours.
ood.”
gabadder
pan
and
abdomen
oowng
back
te
comes
rgt
te
and
sweatng,
s
te
and
past
“ast
prouse
nlamed
emergency
omentum
and
omentum
D.
naton
rst
esser
C.
ror
Were
Dougas)
o
severe
nausea,
poston?
brougt
to
a
resuted
because
story
ater
Durng
Morson)
sudden
Dougas)
brougt
Se
A.
te
ant-nlammatory
examnaton
60-year-od
rant
pouc
pouc
Vescouterne
Rectouterne
ment
stomac
repar.
bood-tnged,
supne
emergency
cronc
qud
n
stom-
gutters
E.
w
(o
o
pouc
D.
eum.
ucer
te
vesse?
deveop
o
Paracoc
te
o
a
An
ocated?
s
ago.
te
C.
abdomen
ndng?
perorated
curvature
key
sows
space
subprenc
quadrants
x-ray
dapragm.
pouc
lud
Rgt
sows
gutter
because
Nonsteroda
s
te
n
noncompance
space
pouc
paracoc
or
woud
patent
subprenc
and
An
stone
most
wc
Hepatorena
a
te
sma,
utrasound
B.
as
a
greater
pouc
days
ovary,
woud
neum
endoscopy
o
kdney
10
lud
cest
under
space
A.
A
ar
quadrant.
was
o
te
woman
transvagna
et
sows
o
because
department
examnaton
a
ts
107.
130/85
sde. Wc
varous
te
86/
bud
to
posteror
mL
s
branc
story
rom
puse
He
tenderness.
ureter
o
tat
orm
because
te
pan
regon.
pressure
tat
brougt
wt
Hs
ange
rgt
cause
to
s
taken
150
s
rgt
to
bud
a
severe
Pysca
ureterc
upper
n
patent
procedures,
patent
perod
emergency
pubc
bood
septum
son
as
An
qud
A
te
se-treated
perorated
coect
o
te
o
te
sows
te
bud
woman
Se
medcatons.
on
urorecta
50-year-od
department
s
key
Faure
to
caracter.
abdomen
A.
o
n
to
costovertebra
s
te
expanaton
ower
te
because
back
aebre.
o
te
key
et
badder
18/mn,
utrasound
te
most
brougt
cocky
mm
and
ogoydramnos.
kdney
urnary
ower
respratons
A
department
uprgt
ar
gutters
25-year-od
mL
man
s
pan
a
brdge,
A
spaces
te
mn,
o
nasa
106.
A
dyspastc
by
rom
oowng
te
utrasonograpy
broad
and
prena-
conss-
tumor
department
ence
eet,
a
ndngs?
58-year-od
sows
s
Feta
or
uterus
kdney
E.
te
cubbed
a
ageness
D.
says
pyscan
sows
gestaton.
oowng
nta
Mutcystc
radates
te
mcrognata,
A.
A
to
examnaton
27-week
etus
ow-set
Wc
comes
Pysca
An
ree
subprenc
Supravesca
or
bubs
o
endoscopy
posteror
ac.
duct
rgdty.
amount
C.
sows
105.
Wc
ts
B.
tent
104.
cyst.
does
A 30-year-od woman, gravda 1, para 0, abort 0, at 30
ta
103.
duct
structures
123
Abdomen
3
poste-
exam-
stones
duct.
are
n
an
Wc
nvoved
n
coecystts?
T11
A 64-year-od woman comes to te emergency depart-
ment
because
(NSAID)
use.
tory
o
tenderness
and
mts.
o
severe
gastones.
Pysca
Her
abdomna
vta
examnaton
sgns
pan.
are
sows
Se
as
wtn
a
s-
norma
tenderness
n
te
124
C H A P T E R
rgt
3
Abdomen
upper
quadrant.
ecystectomy
durng
110.
surgery.
woud
most
reduce
te
Prnge
B.
Kocer
C.
Vasava
be
was
epatc
o
te
taken
artery
oowng
perormed
by
te
or
was
co-
oss?
maneuver
naton
puse
o
most
coon.
B.
Mdde
C.
Superor
D.
Ineror
E.
Let
An
woman
because
te
sows
o
o
te
B.
Iopsoas
C.
Obturator
D.
Murpy
Coug
te
says
te
n
ater
te
te
s
pan,
pan
upper
sows
dagnoss
most
115.
key
be
because
s
o
tssue
ana
te
protrudng
o
rst
Interna
B.
Externa
C.
Mdde
D.
Superca
E.
Deep
A
o
ympatc
wt
an
area
to
o
ymp
ympatc
an
nor-
abnorma
superor
te
to
pectnate
s
made.
nodes
dranage
beedng
wtn
Wc
woud
rom
te
ne.
ts
most
area?
ac
nguna
man
severe
a
wtn
ong
tat
repar
story
s
Sdng
ernas
B.
In
C.
Paraesopagea
o
te
emergency
abdomna
smokng.
A
CT
as
scedued.
be
te
and
patent
and
A.
sdng
to
mts.
te
woud
sdng
comes
eartburn
norma
sows
between
sows
emorrods
groups
recta
are
recta
as
surgca
rom
o
ac
32-year-od
brougt
recevng
120/mn,
s
a
Hs
prouse
te
transected
gunsot
mm
to
Hg.
wound
s
are
An
s
a
gan
vesse
possess
ernas,
te
a
GE
o
useu
to
juncton
ave
a
vta
te
te
GE
depart-
pan.
he
sgns
abdo-
erna,
and
oowng
dstngus
ata
norma
ernas
o
ata
Wc
most
Hs
scan
a
paraesopagea
wtn
entry
116.
In
ernas?
juncton.
s
dspaced.
dspaced
GE
stomac
He
paraesopagea
move
because
as
te
sows
te
o
nto
te
tures
a
o
abdomen
to
te
woud
o
sows
most
te
Round
Facorm
gament
C.
Spenorena
C.
Coronary
gament
D.
Gastrococ
D.
Hepatoduodena
E.
Hepatoduodena
E.
Gastroduodena
brougt
to
beedng
te
emergency
and
abdomna
117.
A
and
rgt
nto
and
te
stomac.
be
n
pan
nausea.
and
subprenc
a
o
te
A
exam
CT
abscess
oowng
poston
te
vomtng.
Pysca
tenderness.
Wc
across
B.
s
a
key
abscess
A.
recta
moves
antrum
te
abdomna
mdne.
Coronary
o
antrum
te
o
abdomna
Gastrospenc
woman
body
ever
B.
because
te
ernas,
te
severe
ow-grade
generazed
extends
te
ernas,
corpus.
A 43-year-od man s brougt to te emergency depart-
ment
woud
to
paraesopagea
carda
beed-
and
gaments
adequate
E.
utrasound
perormed,
be
n
16/mn,
In
te
36.9°C
ntrapertonea
oowng
to
emergency
temperature
aparotomy
o
te
respratons
80/60
appears
to
spread
55-year-od
o
nguna
andmarks
sac?
department
receve
sgns
superor
nterna
receve
vta
examnaton
spncter,
oowng
epsodes
Hs
A.
A
rst
groups
patoogy?
mutpe
pan.
Pysca
dagnoss
D.
s
sows
Wc
be
o
oowng
nguna
o
A.
a
present
key
beow
presence
nguna
mts.
men
coecystts.
area
te
te
ac
ma
are
ga-
o
most
protrudng
recta
abdomna
patent
quadrant.
tssue
conrms
ac
and
ment
examna-
mutpe
o
nau-
radates
o
bopsy
wegt
examnaton
A 53-year-od man s brougt to te emergency depart-
A
emergency
Pysca
rgt
woud
quadrant.
beedng
key
Deep
unntentona
Pysca
juncton.
emergency
most
Superca
E.
o
abdomna
back.
te
te
to
tat
abdomen
wt
pressure
sac.
esser
to
man
puse
esser
D.
sgn
abdomen
o
Mdde
externa
tenderness
bood
source
arteres
Externa
C.
mass
Wc
te
B.
mass
te
sgn
upper
(98.4°F),
An
CT
test
department
ng.
oowng
A
rom
tenderness
35-year-od
te
te
negatve.
beedng
emorrage?
sudden
oowng
Rebound
o
s
et
examnaton?
A.
and
o
tenderness
pysca
et
o
comes
Se
abdomen
Wc
te
guaac
ower
rom
and
monts.
A
woud
Interna
ment
exam-
recta
consstent
E.
Pysca
and
114.
recta
stones,
A
Hg.
38°C
20/mn,
coc
vomtng.
ne.
A.
key
utrasound
on
mm
s
are
and
gastro-omenta
and
ton
temperature
massve
te
emergency
beedng
coc
department
rom
Stoo
o
te
dstenton,
sows
Wc
to
recta
respratons
100/73
source
51-year-od
sea,
Hs
abdomna
key
Let
A
s
abdomen
A.
brougt
panu
100/mn,
tenderness.
te
descendng
te
s
o
pan.
s
pressure
sows
quadrant
scan
man
6
abnorma
nodes
dranage
maneuver
abdomna
an
atgue
past
pectnate
ymp
because
reports
te
adenocarcnoma.
Hemc
bood
te
maneuver
73-year-od
Se
or
sows
to
Pacement o a vascuar camp on te porta epats
and
oss
procedures
pyscan
E.
A
pan.
njured
maneuver
(100.4°F),
113.
patent
D.
severe
112.
he
rgt
Wc
bood
A.
te
key
department
111.
and
to
scan
tat
struc-
prevent
te
mdne?
gament
21-year-od
department
gament
gament
man
because
s
o
brougt
back
to
pan
te
ater
emergency
sustanng
CHAPTER
an
njury
s
ower
et
torax
et
sde.
most
back
sows
Wc
key
to
He
Pysca
a
s
brused
racture
o
te
sustan
aso
as
a
sarp
examnaton
and
o
te
oowng
njury
at
swoen.
eevent
organs
ts
pan
sows
An
rb
and
x-ray
w
on
woud
gabadder
tat
be
A.
Jejunum
B.
T ermna
C.
Be
Duodenum
ste?
C.
Kdney
D.
Lver
department
E.
Pancreas
and
rgt
tat
te
122.
comes
to
te
emergency
depart-
Hepatc
A
upper
pan
and
papabe
node
ces.
Wc
most
key
superca
bopsy
o
te
prmary
A.
Prostate
B.
Urnary
Pysca
sows
nguna
te
oowng
source
examnaton
ymp
presence
ocatons
o
o
sows
nodes.
A
radates
woud
be
te
te
A.
carcnoma?
B.
badder
w
te
he
ntersecton
wt
te
T o
D.
Superory
E.
Sgmod
E.
Upper
because
Pysca
ca
and
sows
o
s
examnaton
massve
tumor
key
to
emergency
severe
tenderness
A
CT
scan
orgnatng
Wc
be
te
and
sows
regons.
duodenum.
most
to
vomtng
epgastrc
a
te
o
comes
o
te
wegt
o
te
o
te
rom
te
oowng
compressed
or
depart-
123.
ment
umb-
gron
abdomen
trd
Be
B.
Hepatc
ocaton
te
rmed
A.
Superor
D.
Gastroduodena
E.
Posteror
superor
department
Pysca
ower
men
te
cedure
tures
because
pevs
adnexa
to
te
remove
te
ureter
o
te
just
Mdde
recta
B.
Superor
to
Interna
D.
Uterne
E.
Gonada
A
CT
artery
abdomna
scan
Durng
o
o
mass
te
occupyng
and
te
ureter
are
structures
o
te
te
124.
pro-
struc-
dented.
crosses
te
ness
n
sound
te
o
te
ower
a
A
epgastrc
comes
to
papabe
and
a
oowng
ocaton
o
wa?
nea
semunars
nea
semunars
regon
regon
a
o
mass,
e
type
te
o
o
depart-
mass
stands
at
erna
te
asca
or
sows
based
dagnoss
s
oowng
nguna
s
erect
examnaton
nguna
and
Wc
ts
emergency
panu
wen
drect
te
te
and
Pysca
on
con-
s
te
erna?
around
around
or
abdomna
sows
past
2
days.
patent
wt
quadrants.
numerous
Pysca
woman
tender-
An
stones
utra-
n
te
because
te
te
deep
rom
Sorty
te
te
te
te
deep
nguna
Subprenc
C.
Rectouterne
D.
Vescouterne
A
o
recess
scan
o
te
pan
s
a
an
te
and
emergency
perumbca
strong
bood
regon
sttng
ruptures.
and
most
pan.
possbty
appendectomy
appendx
(pouc
recess
s
In
be
wc
nectous
key
o
to
lu-
tend
to
uprgt?
o
Morson)
Dougas)
space
woman
te
an
o
(pouc
space
because
CT
tssue
obque
space
subepatc
22-year-od
department
beore
was
to
severe
appendcea
Hepatorena
Rgt
abdomna
musces
sows
nlamed
patent
connectve
abdomna
extravasatng
B.
A
externa
comes
o
examnaton
A.
E.
125.
nterna
22-year-od
coect
te
o
abdomns
woud
o
extrapertonea
transversus
area
ds
dstressu
abdomen
Deectve
perormed,
uterus?
ven
sows
rgt
aponeuross
Weakness
appendcts.
ment because o crampng abdomna pan around er
examnaton
body
rgt
umbca
pertoneum
E.
Pysca
ven
vomtng
te
says
musce
department
artery
and
dagnoss
o
precse
te
Se
souder.
pane
transversas
D.
abdo-
surgca
ureter
cervx
et
A 32-year-od woman comes to te emergency depart-
umbcus
vomtng,
pan.
rng
Deectve
obque
pan.
te
te
te
vascuar
C.
artery
pudenda
te
te
to
emergency
posteror
Wc
te
mse.
cause
Deectve
emergency
artery
vesca
C.
te
to
te
tenderness
abnorma
tumor,
oowng
atera
A.
an
pevs.
meda
to
ower
sows
sows
mmedatey
Wc
comes
quadrant.
n
te
nausea,
rng
o
examnaton
and
B.
pancreatcoduodena
woman
abdomna
et
artery
a
o
o
Deectve
artery
te
aparoscopcay.
key
nguna
mesenterc
24-year-od
exerts
probabty
rgt
te
exacerbated
te
ven
C.
s
te
by
ocatons
ound?
quadrant
o
part
nvaded
gabadder
cartage
o
te
man
structures
duct
porta
rgt
tat
o
costa
o
to
because
pyscay
most
A.
rgt
45-year-od
oss.
tumor?
A
A
be
to
conrms
ntertubercuar
C.
man
te
nnt
te
respect
ntersecton
T ests
coon
te
abdomna
descrbe
wt
wt
Ana
54-year-od
key
onset
panned.
he
D.
A
s
best
gabadder
C.
cana
n
oowng
comes
acute
to
examnaton
andmarks
magnant
o
quadrant
coecystectomy
paness.
most
woman
because
Pysca
s
te
duct
37-year-od
tat
mass
stone
o
eum
ment because o a arge mass n s rgt gron. He says
te
accumuaton
wc
duct
E.
man
At
te
D.
46-year-od
ar
te
Speen
A
and
tree.
obstructve
Lung
ment
121.
an
B.
ymp
120.
bary
A.
ard
119.
ootba.
breatng.
o
118.
durng
durng
125
Abdomen
3
o
comes
severe
abdomen
nlamed
to
upper
sows
te
emergency
abdomna
tat
appendx.
te
Wc
pan.
source
o
te
126
C H A P T E R
3
Abdomen
oowng
rom
n
te
te
structures
appendx
contan
tat
are
te
nerve
causng
te
ce
bodes
reerred
epgastrum?
A.
Sympatetc
B.
Ceac
E.
sympatetc,
129.
trunk
ganga
o
A
21-year-od
department
gangon
orn
Pregangonc
pan
ower
te
spna
cord
Latera
Dorsa
root
ganga
o
spna
nerves
T8–T10
vta
E.
Dorsa
root
ganga
o
spna
nerves
L2–L4
examnaton
Questions
A
comes
a
te
126–150
30-year-od
o
a
6-mont
3-mont
as
o
er
A
woman
story
acute
requred
catons.
CT
rgt
made,
and
tomy.
to
be
scan
s
o
te
te
o
pyscan
and
atgue.
Se
A
te
a
sows
dagnoss
suprarena
o
nerve
and
Pregangonc
B.
Postgangonc
C.
Somatc
Postgangonc
E.
Pregangonc
B.
Ioypogastrc
C.
Ionguna
D.
Latera
E.
Obturator
a
peo-
s
130.
w
need
tumor
72-year-od
and
te
te
te
cancer
pevs
et
tat
vesses
te
a
es
s
ago.
new
o
key
Ineror
B.
Rgt
C.
Let
testcuar
ven
D.
Let
common
ac
E.
Rgt
A
o
te
common
er
pan.
nerve
te
A.
A
emergency
An
o
as
te
or
abdomen
ncorporated
and
compressed
utrasound
venous
nvoved
et
o
n
ower
te
te
Wc
ac
o
tat
severe
to
abdomna
carcnoma
o
oowng
te
are
te
most
s
o
te
pan.
ead
perormed
best
key
sows
to
to
A
o
descrbes
be
te
present
n
and
somatc
motor
and
vscera
afer-
Postgangonc
D.
Pre-
sympatetc
and
vscera
aferent
bers
man
monts.
n
parasympatetc,
sympatetc,
and
vscera
pregang-
aferent
bers
as
o
te
w
a
and
te
o
tacy-
rgdty.
dapragm.
ucer
most
to
s
made.
commony
an
o
sows
regon.
key
emergency
and
relux
smokng
tenderness
Upper
anteror
duodenum.
most
te
pan
story
exam
epgastrc
o
condtons
brougt
abdomna
He
penetraton
part
s
o
Pysca
te
o
or
and
and
endoscopy
duodena
Wc
ucer
te
n
oow-
occur?
rom
superor
C.
Beedng
rom
posteror
D.
Beedng
artery
mesenterc
superor
artery
pancreatcoduo-
artery
rom
posteror
neror
pancreatcoduo-
artery
Pertonts
56-year-od
department
epsodes
use
o
movement
tenderness
aparotomy
used
a
n
and
sows
s
Superor
B.
Ineror
he
days.
o
to
juncton?
mesenterc
reease
artery
artery
te
te
ave
sows
An
oops
oowng
mutpe
not
exam
dstenton.
te
emergency
and
dd
dated
determne
mesenterc
te
pan
Pysca
mutpe
to
to
patent
moderate
Wc
andmark
A.
3
brougt
abdomna
perormed
ntestnes.
as
s
o
vomtng.
abdomen
te
man
because
duodenojejuna
postgangonc
story
pancreatcoduodena
Beedng
o
s
a
sows
pancreatcoduodena
B.
A
emergency
abdomna
ucer?
gastroduodena
te
parasympatetc
as
exam
duodena
arteres
rom
A
te
severe
under
Beedng
E.
132.
o
ts
artery
because
abuse.
dena
te
reeve
ar
A.
CT
or
gastrc
2
rst
stone
Wc
mesenterc
50-year-od
bowe
parasympatetc
C.
onc
neror
rgdty
bers
and
superor
Posteror
acoo
emergency
o
D.
dena
comes
type
Posteror
past
kdney
tenderness,
perorated
Superor
Rgt
Her
utrasound
ureter.
Se
Pysca
oowng
C.
A
a
er
pan
sarp.
An
to
and
boatng.
sows
B.
ven
bock
Postgangonc
ent
ts
mb,
bers
B.
by
as
te
responsbe
brougt
sudden
use.
Gastroduodena
te
producton
by
A.
oowng
gangon?
Pregangonc
eroded
te
pexus
tat
te
s
o
cest
o
o
department
ven
sows
ceac
dagnoss
key
abdomna
te
Wc
E.
131.
sows
tromboss
te
Wc
pros-
woman
NSAID
o
rgt
rom
tat
pan?
because
dfuse
x-ray
ng
woman
because
structures
ceac
be
tat
artery
t.
te
cava
abdomen
pancreas.
to
treatment
scan
rom
pan.
bers
ven
48-year-od
department
A
tromboss?
A.
rena
to
return
to
CT
ac
deep
and
venous
vena
a
A
tumor
neror
venous
most
An
most
pan
sows
er
emergency
cutaneous
accompaned
ong-term
bers
admtted
common
scema
deep
s
cemoterapy
monts
sows
bock
causng
o
6
a
deveopment
coud
42-year-od
pan
are
bers
parasympatetc
man
ater
proxma
ven
A
emora
department
bers
parasympatetc
o
tat
tumor
s
says
mts.
abdomen
nerves
sensaton
te
norma
te
radatng
Se
para-
bers
to
pan
pevs.
obstructng
med-
bers
sympatetc
motor
department
128.
sympatetc
D.
tatc
oowng
brougt
descrbes
te
pregangonc
aferent
severe
er
and
o
s
o
wtn
partay
carda,
A.
are
Subcosta
removed?
A
s
reerred
adrenaec-
bers
gand
waves
A.
medua)
aparoscopc
suprarena
a
n
sgns
as
ypertenson
abdomen
or
because
antypertensve
oowng
te
te
severe
gand.
(tumor
o
o
wt
scedued
wen
to
weakness
story
suprarena
Wc
cut
comes
o
treatment
cromocytoma
127.
toward
D.
vscera
woman
because
C.
tat
126.
back
sympatetc,
and
x-ray
o
a
d-
o
bowe.
obstructon
structures
poston
o
s
te
CHAPTER
133.
C.
Vasa
D.
Suspensory
T retz)
o
E.
Ladd
key
A
recta
markedy
musce
4-mont-od
ton
te
duodenum
(gament
o
tomoses
bands
department
actvty
o
and
sows
gr
by
s
er
brougt
parents
dicuty
cyanoss,
to
te
because
breatng.
decreased
A.
Hepatc
B.
Ineror
examna-
C.
Hepatc
D.
Be
E.
Cystc
Pysca
sounds,
bowe
te
abdomen
dapragm
and
cavty.
Wc
o
deect?
ts
A.
Absence
B.
Absence
sows
a
posteroatera
abdomna
o
te
contents
oowng
s
n
te
deect
te
most
et
o
te
137.
peura
key
a
peuropercarda
o
muscuature
cause
recta
od
n
are
one
a
o
te
Faure
o
mgraton
D.
Faure
o
te
E.
Faure
o
peuropertonea
58-year-od
sarp
o
ness
pan
to
acetc
acd
sage
nto
te
te
dagnoss
135.
CT
o
ts
A.
Bocdaek
B.
Sdng
says
scan
to
to
o
tat
e
as
se
as
n
test
te
L1–L2
D.
L1–L4
gabadder
s
te
xpod
rgt. Wat
s
unctons
sows
trapped
at
tat
ts
most
a
and
man
because
o
s
o
vomtng
dfuse
epsodes
A
CT
o
scan
mecanca
oowng
o
Hepatopancreatc
E.
Hata
B.
Duodena
pan
and
abdomna
er
vomtng.
tenderness
abdomen
sows
gn
superor
o
ema
te
to
organs
an
s
s
son
an
Pysca
and
aortc
key
to
o
A
aneurysm
organ.
te
emergency
severe
exam
rgdty.
mesenterc
abdomna
most
brougt
because
abdom-
sows
CT
dfuse
scan
o
afectng
te
resutng
n
artery
Wc
o
te
te
139.
or-
sc-
oowng
afected?
Proxma
D.
Pyorc
E.
Ieoceca
swaowng
ater
vta
sgns
ton
s
are
wtn
wtn
D.
Stomac
A.
Brances
E.
Duodenum
B.
Bronca
motor
repar
A
erna
was
CT
scan
wc
to
o
te
te
pyscan
sustanng
coson
aceved
te
troug
Wnsow).
comes
vece
vst,
n
peroraton
Wc
ater
ts
ernated
(o
man
examnaton
pan.
to
te
pan
past
2
emergency
and
mutpe
days.
Pysca
abdomna
Auscutaton
abnorma
abdomen
o
dstenton
te
sows
bowe.
gastrontestna
bowe
gastones
Wc
tract
s
o
most
o
(o
Vater)
te
te
brougt
te
pan
a
2
s
bone
mts.
mts.
ower
oowng
to
esopagea
norma
norma
o
s
o
Upper
s
ours
Pysca
odyno-
ago.
by
most
te
Her
examna-
endoscopy
esopagus
arteres
emergency
and
s
key
at
sows
bone.
rsk
o
njury?
41-year-od
Durng
woman
paga
Speen
gca
sows
descend-
dermatomes
papaton.
ampua
because
C.
a
te
juncton
T ransverse
rom
o
bub
43-year-od
B.
up
tender-
eum
Ieum
A
sows
aso
sgns
spncter
A.
coon
vta
reerred?
assocated
te
department
a
paness
obstructed?
C.
A
te
to
te
A.
na
key
woman
Her
oowng
been
obstructon
parts
Morgagn
by
or
o
Coecystts
62-year-od
part
brougt
pan
D.
A
te
sgncant
C.
erna
most
patent
coonoscopy
abdomna
tenderness
te
erna
s
emergency
and
he
exam
A
dsta
key
and
and
erna
te
te
pan
boatng.
Pysca
o
most
to
monts.
quadrant.
sows
sounds.
erna
esopagea
3
and
mts.
examnaton
sows
condton?
brougt
abdomna
past
wc
61-year-od
epsodes
key
structures
anas-
(vens
T10–L2
A
department
pas-
process
te
E.
te
afectng
ave
C.
138.
s
o
ower
T o
pan
exacerbaton
Barum
abdomen
coon.
T5–T9
mnod-
or
et
T10–L1
juncton.
woman
norma
te
B.
tender-
oowng
ormng
systems
ven
constpaton
A.
sows
cava
cava
because
o
because
te
vens
artery
beedng
woud
cose
exam
omentum
te
deveop
(Hepatobary
between
on
ng
to
pyscan
xpsterna
scan)
torax
od
te
Pysca
te
greater
margn
department
136.
A
to
njectons
[HIDA]
o
costa
at
dye
negatve.
porton
te
and
He
ood.
dapragm
transversum
comes
pan.
wt
papaton
swaow
are
man
epgastrc
te
o
septum
o
te
and
duct
wtn
ness
porta
duct
dvertcuoss
C.
A
porta
vena
48-year-od
says
o
Wc
department
dapragm
134.
A
ncudng
te
compressed?
decreased
sounds n te torax, and respratory dstress. An x-ray
o
Retzus).
emergency
o
breat
dated,
between
127
Abdomen
3
omenta
Gastrontestna
o
Intercosta
D.
Brances
E.
Rgt
A
sur-
abdomna
an
te
nterna
coon
(eppoc)
vens
C.
compcatons.
sows
lexure
oow-
trauma
ago.
experences
abdomen
epatc
te
monts
wtout
patent
te
2
or
abdomna
o
ad
oramen
appear
to
be
140.
A
o
42-year-od
radates
upper
naton
to
te
o
te
s
brougt
beng
nvoved
man
et
quadrant
gastrc
prenc
man
ater
he
gastrc
rgt
neror
department
coson.
et
s
stabe
souder.
but
as
Pysca
tenderness.
abdomen
to
n
An
sows
te
a
emergency
motor
severe
exam
tat
sows
utrasound
spenc
vece
pan
et
exam-
emorrage.
128
C H A P T E R
Wc
3
o
Abdomen
te
experenced
141.
oowng
by
te
sgns
best
descrbes
te
pan
oowng
patent?
transmt
be
te
Mttescmerz
A.
Sympatetc
pregangonc
Ker
B.
Sympatetc
postgangonc
sgn
C.
Rovsng
D.
Psoas
E.
Obturator
A
sgn
sgn
sgn
43-year-od
obe
ormed,
to
te
rgt
most
rgt
man
ater
o
s
brougt
sustanng
te
dgta
ver.
pressure
ndcatng
epatc
artery.
common
obe
o
to
a
n
o
but
n
s
brsk
te
te
te
wound
to
aparotomy
varaton
Wc
emergency
maneuver)
gament,
a
te
kne
Ater
varaton
te
a
(Prnge
epatoduodena
contnues,
s
te
per-
suppy
Vscera
D.
Pregangonc
E.
Postgangonc
A
vomtng,
he
patent
necton.
and
Pysca
o
te
tenderness.
s
te
eus.
to
te
be
ver?
An
Wc
present
o
durng
Increased
Absent
B.
he
C.
Borborygm
D.
Crampy
E.
Locazed
te
C.
superor
he
rgt
epatc
orgnates
rom
te
et
gastrc
D.
he
rgt
epatc
orgnates
rom
te
et
epatc
E.
he rgt epatc orgnates drecty rom te aorta
146.
A
ment
nau-
betes.
ater
and
because
meas.
Pysca
derness
n
te
gograpy,
te
o
patent
rgt
te
eter
key
nto
A.
Cystc
B.
Spra
nterere
cystc
duct
(o
T ortuosty
o
rom
E.
Porta
upper
a
a
quadrant.
successu
on
oowng
ts
coan-
passage
o
te
o
nto
structures
a
epatc
s
s
cat-
Se
o
artery
nausea
rgt
t
te
and
upper
sgn.
to
woud
duct
te
pan
pan
n
as
but
Pysca
be
Wc
key
and
undergoes
deveops
most
rgt
tenderness
patent
day.
te
cocky
quadrant
he
147.
emergency
vomtng.
postoperatve
condtons
gament
cystc
abdomna
descrbes
Murpy
te
per-
o
account
te
or
be
duct
B.
he
ducts
C.
he
rgt
D.
he
cystc
E.
he
et
o
epatc
tpe
epsodes
story
o
o
acoo
tenderness
eevated
s
serum
Let
Cystc
s
s
and
vomtng.
abuse.
rgdty.
amyase
he
Pysca
patent
exam
Laboratory
and
pase.
and
as
sows
sow
te
te
crcuaton
neror
severe
superor
vesses
between
oss
and
w
te
o
da-
tenderness
sows
occuson
mesenterc
most
ceac
key
trunk
artery?
pancreatcoduodena
epatc
gastroduodena
coc
A 22-year-od man s brougt to te emergency depart-
ment
ng
because
or
te
rebound
sows
taken
o
te
pass
A.
o
C.
2
o
An
reac
Externa
obque
ayers
te
obque
sows
he
ts
te
and
abdomen
patent
hroug
must
troug
musce,
vomt-
s
wc
pyscan
ncson?
musce,
nterna
transversas
asca,
pertoneum
Aponeuross
o
nterna
te
externa
abdomna
abdomns
musce,
abdomna
obque
obque
musce,
transversas
trans-
asca,
and
pertoneum
Aponeuross
musce,
o
appendcts.
appendx
and
tenderness,
appendectomy.
abdomna
pareta
quadrant
abdomna
te
nausea,
examnaton
utrasound
acute
aparoscopc
pan,
Pysca
ower
tenderness.
oowng
to
days.
rgt
evdence
or
abdomna
past
tacycarda,
ong
o
o
gastro-omenta
o
te
nterna
transversus
epgas-
studes
Wc
part
oowng
et
mu-
a
key
emergency
and
ateroscerotc
et
pareta
emergency
to
te
pan
Angograpy
and
musce,
pan
sows
and
B.
te
paraytc
most
ypertenson
Rgt
eakng
to
due
and
to
Rgt
versus
abdomna
o
mesenterc
and
gastrc
brougt
E.
eakng
brougt
days.
abdomna
sows
woud
abdomna
D.
eakng
sudden
and
eakng
s
s
quadrants.
te
superor
and
are
duct
duct
man
wt
o
and
C.
generazed
sgns
2
pneumona
examnaton?
story
a
coatera
B.
past
a
pan
o
md-proxma
te
te
abdomen
examnaton
n
Wc
Superor
or
rom
sounds
a
provde
eakng
Luscka
duct
as
abdomna
epatc
35-year-od
department
s
emergency
sounds
scema
A.
sows
te
pysca
man
Pysca
te
appette
oowng
because
rgdty
artery.
duct
brougt
te
tenderness
He
ntestna
compcaton?
he
trc
by
coecystectomy
te
ten-
dicuty
oowng
te
and
Durng
wt
epatoduodena
sudden
sows
A.
A
wt
cystc
te
wt
postve
tonts
te
compresson
wt
examnaton
and
te
woman
accompaned
o
and
jaundce
quadrant.
nserted
pan
exacerbated
Hester)
Adesons
ven
s
duct?
D.
44-year-od
pan
sows
compresson
vave
department
s
Wc
C.
A
quadrant
te
upper
cateter
to
te
upper
tat
examnaton
gabadder.
most
rgt
says
o
abdomna
65-year-od
appette.
he
to
recovered
exam
bowe
bowe
department
A 38-year-od woman comes to te emergency depart-
sea.
brougt
poor
te
B.
rom
s
x-ray
A.
orgnates
to
parasympatetcs
recenty
he rgt epatc orgnates rom te gastroduodena
epatc
key
parasympatetcs
man
A.
rgt
most
aferent
54-year-od
sea,
beedng
orgn
C.
te
pancreas?
department because o abdomna pan, boatng, nau-
apped
oowng
artera
145.
mesenterc
144.
woud
rom
B.
rgt
143.
bers
sensaton
A.
department
142.
neura
pan
externa
abdomna
abdomna
abdomns
obque
musce,
and
obque
musce,
pareta
pertoneum
D.
Aponeuross
o
te
externa
abdomna
obque
musce, aponeuross o nterna abdomna obque
CHAPTER
•
musce,
s
E.
transversus
asca,
and
Aponeuross
externa
obque
musce,
musce,
o
•
Fig.
.4
transversa-
abdomna
nterna
aponeuross
musce,
.
o
transversas
obque
abdomna
transversus
asca,
and
par-
pertoneum
A 12-year-od boy s brougt to te emergency depart-
ment
recta
atc
no
by
s
parents
beedng.
and
s
story
are
common
up
to
age
date.
B.
Externa
C.
Dvertcuoss
D.
Iea
E.
Borborygm
as
a
o
oowng
says
o
beedng
s
te
n
te
Subprenc
te
emergency
pan
te
over
sown
past
w
bood
te
and
Fg.
be
ave
our
In
monts.
Rectouterne
Rectovesca
E.
Subepatc
detected
wt
o
an
uprgt?
space
(pouc
(pouc
o
te
oowng
Rgt
B.
o
Dougas)
Appendx
Ieoceca
D.
Ascendng
E.
Ieum
Questions
151.
A
to
te
rgt
ower
woman
o
s
brougt
abdomna
to
te
pan
emergency
and
sudden
and
vomtng
and
rgdty.
Fg.
3.4.
An
sceross,
owng
mdde
o
A
CT
s
coc
coc
to
but
te
key
afected?
scan
tract
o
bowe
most
He
today’s
te
sows
are
pyscan
pan.
generazed
angogram
producng
Mdde
te
pan,
sows
arteres
Rgt
n
comes
abdomna
gastrontestna
B.
started
man
severe
exam
A.
pan
most
coon
abdomna
appette.
te
s
151–174
or te past 2 days. Se as a ow-grade ever and oss o
tat
structures
quadrant.
Fg. 3.3. Wc
juncton
61-year-od
te
space
says
sted
ovary
C.
Pysca
Morson)
space
because
Se
ten
A.
cronc
space
D.
abdomen
he
wc
stands
o
been
smokng.
3.2.
patent
depart-
sortness
symptoms
te
n
and
space
C.
27-year-od
to
tat
examnaton
Hepatorena
o
ypertenson
s
ocatons
B.
department
comes
mage
A.
A
oowng
te
abdomna
worsenng
story
utrasound
te
recta
s
vaccna-
dvertcuum
patent
radograpc
te
o
here
and
A CT scan o te abdomen s sown n
man
because
progressvey
He
mts.
contacts,
severe
paness
asymptom-
emorrods
(Mecke)
he
and
emorrods
48-year-od
breat.
norma
sck
Wc
o
prouse
oterwse
group?
Interna
ment
o
s
wtn
trave,
cause
A.
A
patent
are
recent
most
because
he
vtas
o
tons
pedatrc
150.
te
Fig.
pertoneum
aponeuross
eta
149.
abdomns
pareta
o
•
.
musce,
abdomns
148.
Fig.
129
Abdomen
3
story
epsode
abdomen
tat
because
a
abdomna
s
due
Wc
occuded
n
s
o
o
severe.
tenderness
severa
occuded
scema.
key
as
te
sown
n
arteres
o
to
o
atero-
te
CT
o-
scan?
130
C H A P T E R
3
Abdomen
•
ymp
nodes
w
Fig.
most
.6
key
rst
receve
metastatc
ces?
•
152.
C.
Let
D.
Ieococ
E.
Margna
A
an
rom
153.
te
o
anus.
te
most
te
s
sows
Wc
key
n
to
te
rst
o
pyscan
ana
examnaton
tssue
s
cana.
seen
squamous
n
An
Fg.
ce
te
oowng
receve
cancerous
because
mage
3.5.
ymp
A
Deep
Superca
C.
Interna
D.
Externa
E.
nguna
Lumbar
ymp
nguna
ac
are
te
wtn
154.
says
nodes
ymp
s
to
Stomac
C.
Duodenum
D.
Pancreas
E.
Descendng
nodes
te
uses
mts.
s
pyscan
because
o
A
n
most
ong-term
and
pysca
CT
Fg.
scan
3.6.
key
NSAIDs
156.
or
s
examnaton
Wc
o
te
mts.
are
o
man
comes
ater
ong
o
story
An
rom
sows
gastrectomy
te
gastrc
abdomna
endoscopy
an
a
s
a
to
gastrc
bopsy.
pan
s
abnorma
pyscan
Coecystts
C.
A
cauda
he
patent
reated
perormed,
mass
n
te
to
Wc
o
as
ood
and
a
and
te
a
and
bopsy
stomac.
adenocarcnoma,
perormed.
oow-up
a
he
tota
oowng
157.
o
te
Her
te
key
n
pyscan
as
vta
mts.
sown
An
Fg.
no
sgns
are
and
x-ray
3.7.
or
a
compants
wtn
aboratory
o
te
abdo-
Wc
o
te
dagnoss?
ver
extenson
o
te
rgt
epatc
obe
obe)
D.
Pancreatc
E.
Carcnoma
carcnoma
o
te
stomac
A 35-year-od woman comes to te emergency depart-
because
te
rgt
are
sows
or
most
Carcnoma
sgns
coon
te
s
to
patent
examnaton
norma
patent
s
protrudes
afected?
eaty.
wtn
ts
comes
he
Pysca
B.
at
o-
woman
examnaton.
oterwse
n
ment
examnaton
cy
28-year-od
A.
s
examnaton
bopsy
A
gastrc
te
o
a
ntestna
as
most
norma
key
B.
Spgean
C.
Paraumbca
D.
Incsona
E.
Ventra
rgt
s
not
ts.
A
n
s
Fg.
tat
paness.
Pysca
wt
no
er
te
Her
o
vta
examnaton
evdence
3.8. Wc
skn
mass
te
o
stran-
oowng
dagnoss?
erna
erna
erna
erna
s
sde
and
beneat
says
erna
3-year-od
by
n
Se
mts.
ernaton
sown
Rcter
ment
protrudng
quadrant.
ntermttenty
A.
A
mass
ower
wtn
guaton,
52-year-od
taken
e
sgns
sown
structures
B.
s
tat
norma
Speen
relux.
Csterna
(Rede
comes
vta
A.
acd
E.
nodes
man
Hs
abdomen
owng
Rgt
men
nodes
He
pan.
Suprapancreatc
D.
resuts
te
4-mont story o boatng, nausea, and md abdom-
pan.
C.
norma
nodes
ac
49-year-od
jont
Spenc
and
nodes
rom
Ceac
B.
routne
carcnoma
ces
A.
oowng
B.
na
155.
tumor?
A.
A
comes
mass
pysca
o
ana
man
abnorma
bopsy
w
.
coc
53-year-od
o
Fig.
o
boy
s
brougt
parents
s
pan.
scrotum.
Hs
premnary
to
because
vta
He
o
s
sgns
dagnoss
te
a
oterwse
are
o
emergency
papabe
a
wtn
depart-
mass
n
eaty
norma
congenta,
te
and
m-
ndrect
CHAPTER
4
monts.
barum
Hs
study
vta
sgns
sows
are
wtn
evdence
o
131
Abdomen
3
norma
acaasa.
mts.
Wc
A
o
te oowng s te most key cause o ts condton?
A.
Faure
o
reaxaton
o
te
ower
esopagea
spncter
B.
159.
Dyspepsa
C.
Gastrts
D.
Gastroparess
E.
Peptc
A
by
recta
beedng.
ma
s
o
61
Wc
A
cm
o
Ruptured
B.
Vovuus
Dvertcuoss
Iea
E.
Borborygm
(Mecke)
45-year-od
tp
o
wt
are
161.
most
s
B.
T6–T7
C.
T7–T8
D.
T9–L1
E.
T5–T9
A
erna
made.
an
o
.
Wc
ndrect
o
te
oowng
nguna
erna
s
n
he
deep
cessus
158.
nguna
Congenta
C.
Ectopc
D.
Epspadas
E.
Rupture
o
43-year-od
o
cronc
a
nto
an
ntact
An
pressure
to
te
nguna
most
accuratey
and
mutpe
wtn
sows
key
a
nor-
mass
juncton.
dagnoss?
te
rgt
te
worsens
emergency
upper
pan
ater
quad-
radates
meas.
patent
comes
and
to
GE
asca
te
relux.
worsenng
he
dyspaga
because
An
erna
E.
Rupture
patent
or
te
o
te
abdomna
arge
cystc
te
pyscan
rgt
return
o
s
contents
(cana
ts
o
s
were
o
procedure,
o
luc-
patent
te
a
sac
rom
te
oowng
orgn
er
mass.
sotary
te
protrudng
te
by
perormed
te
ceary
te
wen
organ
Durng
costa
nerves
nguna
nontender
vsbe
vagnas
transversas
woman
o
pan
mass.
mass
o
s
terms
s
structure?
Nuck)
as
been
CT
to
and
scan
sows
o
a
emergency
te
pan.
cronc
worsenng
conrmng
te
abdomna
abuse
examnaton
A
asca
brougt
severe
acoo
Pysca
says
to
rgt
oowng
ncson?
repar
Wc
because
story
past
te
coecystec-
te
uterus
48-year-od
he
o
ts
a
open
stones
ydrocee
Ectopc
monts.
to
seen
processus
Femora
a
not
descrbng
D.
atts.
pyscan
used
C.
A
sows
s
gabadder
(aong
papabe
surgca
be
An
Wc
durng
a
rng.
Congenta
162.
transversas
dyspaga
are
to
te
sows
brougt
mass
can
A
pro-
s
o
s
deep
as
progressve
and
abdomen.
pertoneum
department
man
ad
eoceca
sows
ncson
rsk
open
B.
ydrocee
te
he
A.
tests
A
as
opens
gr
te
vagnas
B.
e
rng
at
ts
patent?
A.
n
coecystts.
examnaton
mass.
dgta
o
te
most
brougt
abdomen
Kocer
because
standng.
s
to
pan
scapua
te
a
3-year-od
tuant
cause
s
key
T5–T6
Pysca
erna
s
o
perormed.
A.
moter
key
sgns
abdomen
te
examnaton
o
usng
margn)
most
boy
depart-
pan
dvertcuum
man
assocated
tomy
nguna
s
te
vta
te
emergency
abdomna
.7
utrasound
Fig.
o
say
proxma
because
Pysca
te
Hs
te
o
appendx
D.
to
parents
scan
t)
to
because
oowng
C.
rant.
•
(2
A.
A
brougt
Hs
CT
te
department
Fig.
s
parents
vomtng.
mts.
about
•
boy
ment
epsodes
160.
ucer
3-year-od
a
over
te
papabe
abdomen
pancreatc
Se
pancre-
ast
4
upper
sows
a
pseudocyst.
132
C H A P T E R
3
Wc
o
ocaton
163.
te
or
Rgt
Hepatorena
Omenta
D.
Rgt
E.
Greater
A
typca
topograpc
appears
vesses
space
space
sac
o
man
md
te
dagnoss
ocate d
n
te
process.
o
spna
to
te
An
gastrc
ner ve
or
et
te
or
ucer.
are
sensor y
2
sows
upper
upper
eves
outpatent
pa n
examnaton
prmary
xpod
comes
abdomna
Pysca
gastrc
te
bursa
te
es
s
pseudocyst?
space
subprenc
38-year-od
owng
o
subepatc
C.
ocated
years
a
At
wc
n
pan
s uc
te
ce
a
Ineror
B.
Hepatc
be
porta
Ceac
D.
Posteror
E.
Great
superor
49-year-od
s ow s
men
s ow s
o
Be
C.
T7–T8
B.
Hartmann
D.
T9–L1
C.
Let
E.
T5–T9
D.
Pancreatc
E.
Rgt
and
an
epsode
men
sows
num
at
an
te
undergoes
most
brougt
key
A
paraduodena
at
rsk
o
CT
erna
exporatory
erna.
to
because
vomtng.
nterna
et
an
paraduodena
s
o
s
we
te
scan
(o
aparotomy,
Wc
durng
o
nvovng
ossa
o
te
te
emergency
abdomna
te
te
abdo-
Landzert).
wc
o
A
arteres
erna?
because
te
pan
mgrates
abdomen
toward
sows
Wc
o
te
A.
Be
Ieococ
B.
Hepatopancreatc
D.
Iea
C.
Let
department
pan
ay
tat
ost
as
at
rettes
a
radates
11.3
day.
o
scan
te
o
te
receve
Wc
Stomac
B.
Speen
C.
Duodenum
D.
Lver
E.
Vertebra
A
cay-coored
a
o
te
noma
te
a
o
tumor
at
ducta
He
te
neck
w
mass
rst
because
stoo,
te
o
and
smokng
nontender
o
worsenng
story.
te
Pysca
pancreas.
emergency
epgastrc
He
as
ducta
A
pan,
dabetes
examnaton
gabadder.
pancreatc
te
to
jaundce.
papabe
sows
neck
brougt
A
CT
scan
adenocarc-
major
vesse
aso
te
In
gastone
to
te
o
Pysca
toward
te
skn
An
rgt
sde
utrasound
wt
te
and
examnaton
patent’s
scapua.
s
emergency
te
a
arge
most
o
ga-
key
ste
ampua
(o
Vater)
duct
duct
woman
mass
nces
wc
Wc
A.
Umbca
B.
Spgean
comes
n
te
above
s
o
to
te
mdne
te
eve
sows
a
te
o
te
wt
oowng
s
because
abdomna
umbcus.
nontender
reproducbe
te
pyscan
o
sot
pa-
cougng
te
most
and
key
Epgastrc
D.
Femora
A
s
to
erna
erna
Ompaocee
23-year-od
Hs
120/mn,
surgery
abdomen
to
erna
erna
C.
regon.
s
gastone.
s
dagnoss?
ces?
man
pan.
te
examnaton
stranng.
adenocar-
structures
severa
Pysca
A
te
abdo-
duct
papabe
pabe
o
te
odge?
epatc
26-year-od
wa
and
mass.
Pancreatc
Rgt
a
to
epatc
E.
A
o
te
duct
D.
o
cga-
jaundce
quadrant
conrms
oowng
monts.
packs
sows
169.
unntenton-
3
two
upper
sows
bopsy
te
ast
smokng
rgt
as
abdomna
170.
abdomen
at
over
He
emergency
coumn
35-year
a
o
epgastrc
back.
b)
te
gastone
department
department
sows
s
to
E.
62-year-od
and
o
metastatc
A.
severe
abdomen
A
coc
examnaton
papabe
pancreas.
cnoma.
(25
story
et
brougt
o
to
Pysca
nontender
CT
Kg
o
s
because
40-year
a
man
brougt
oowng
Sgmoda
brances
cterus
arge
coecystts
C.
Ascendng
a
yeowng
epgastrc
B.
62-year-od
wt
s t r u c t u re s
s
o
Mdde
E.
o
utrasound
te
t ow a rd
duct
A.
A
evdence
woman
te
a
posterory
An
Pysca
t ow a rd
duct
epatc
posterory
or
pan.
radates
te
acng
duct
and
stone.
coc
no
to
s t e a d y,
pouc
epatc
acng
sows
a
a
ocated?
47-year-od
severe
artery
duct
department
He
sows
ts
168.
duode-
oowng
repar
pan
key
pan
o ow n g
A.
s
oowng
brougt
o
abdomna
coecystts
te
T5–T6
man
s
s
because
and
conjunctva.
T6–T8
by
woman
te
sde
T e re
or
B.
43-year-od
te
obstructed?
pancreatcoduodena
quadrant
A.
A
o
be
artery
obese
rgt
skn
most
to
ven
department
upper
wc
key
ven
pancreatc
scapua.
o
most
trunk
p a t e n t’s
o-
occuded. Wc
te
mesenterc
C.
A
neary
examnaton
bod-
ca se
be
A.
rgt
around
o
to
woud
emergency
conr ms
neurona
bers
167.
dura -
du
q uadran t
endoscopy
te
cnc
ucer?
department
166.
type
B.
ton.
165.
oowng
ts
A.
because
164.
Abdomen
be
te
and
njured
Prnge
vascuar
s
between
maneuver
s
but
s
o
te
te
wt
epgastrc
Hg,
He
s
puse
taken
Wen
ver
s
a
contnues
te
noted
gabadder
beedng
perormed
bood
mm
aparotomy.
bed
and
emergency
te
20/mn.
nspecton,
te
gament,
te
n
96/60
are
exporatory
or
to
stabbed
respratons
an
camp,
brougt
pressure
opened
acorm
s
beng
bood
or
s
man
ater
prousey.
and
he
nontraumatc
spurtng
rom
CHAPTER
te
surace
wc
A.
B.
o
artery
171.
part
o
te
ver
and
examnaton
njured?
et
ower
wt
woud
segment
and
et
segment
te
epatc
rgt
Meda
segment
et
te
o
obe,
branc
te
ver,
wt
njury
bot
to
te
arteres
te
rgt
obe,
wt
njury
to
o
te
wt
rgt
et
obe,
wt
njury
to
an
artery
njury
to
epatc
te
mdde
epatc
artery
be
source
o
Mdde
Rgt
Superor
D.
Ieococ
and
worsens
ew
modcatons
proton
In
ucers,
to
te
dvson
Wc
ours
s
patent
bot
o
te
te
ast
wc
year.
oowng
ave
cronc
undergoes
vaga
a
oowng
not
mea.
te
a
o
pan.
n
Parasympatetc
suppy
to
te
wt
A.
T7
B.
T8
key
coon
s
o
coon,
or
te
t
camp
oowng
gated?
and
2
126/88
16/mn,
s
brougt
grrend
epsodes
mm
and
examnaton
perumbca
atus.
most
descendng
te
Wc
of)
te
Hg,
to
o
s
s
Hs
regon
to
bood
respra-
36.6°C
tenderness
hs
abdomna
105/mn,
temperature
area.
emergency
o
vomtng.
puse
sows
te
because
(98°F).
papaton
receves
ts
sen-
sory suppy rom wc o te oowng spna nerves?
occur?
A.
are
Pysca
peptc
vagotomy
w
tons
s
man
by
nausea,
pressure
wt
s
case
esopagea
condtons
s-
ood
Lestye
resoved
reractory
at
as
wt
treatment
batera
trunks
He
mproves
parmacoogc
nbtors
reeve
o
or
pan
and
pump
order
pan
ucer
(te
at
patent
coc
pan,
epgastrc
peptc
be
transverse
gate
suppy.
key
a
mesenterc
27-year-od
o
o
te
on
coc
department
severe
o
rst
papaton
operatng
coc
A 47-year-od man s brougt to te pyscan because
tory
upon
permt
to
artera
most
C.
Let
T o
dvertcuoss
w
B.
A
tenderness
necessary
A.
E.
174.
sows
quadrant.
severe
arteres
artery
epatc
Quadrate
o
o
epatc
Anteror
aberrant
E.
Wc
key
artery
rgt
D.
ver.
most
Latera segment o te et obe and te et epatc
Caudate
C.
te
s
133
Abdomen
3
s
C.
T10
D.
T12
E.
L1
ost.
B.
he
patent
woud
no
onger
ave
contracton
o Questions
te
urnary
C.
he
patent
D.
he
patent
te
E.
ductus
172.
woud
A
be
1-our
der.
man
because
duraton.
He
wc
tender
papaton.
ytc)
eus
made.
sows
An
Wc
o
s
te
to
te
or
absent.
s
brougt
o
as
A
pan
oowng
te
n
a
s
durng
o
coon
te
pan
rgt
records
o
te
w
and
woud
B.
Borborygm
not
sow
te
presence
o
ar
sow
A.
decreased
n
te
B.
He
ucer
key
C.
E.
173.
A
rgt
sufered
rater
patent’s
ond
part
he
patent
68-year-od
skn
te
s
odor.
yeow.
o
te
Hs
Laboratory
ypertenson. Wc
eature
past
dsorented
deveopment
o
o
te
ts
ncreased
pressure
n
ven
efuson
o
lud
rom
te
neror
ven
emorrods—rom
wtn
and
Expanson
wc
tan
rom
rom
a
an
posteror
anteror
penetrat-
E.
te
superor
o
vens
ncreased
mesenterc
wtn
anastomose
ucer
te
probaby
occurred
n
te
sec-
duodenum.
probaby
woman
s
ad
acute
brougt
Recanazaton
peroratng
te
A
wt
appendcts.
te
to
na
emergency
te
ven
acorm
vens
s
Durng
as been experencng ong-term efects o dvertcuo-
meday
ss
o
nlammaton
o
te
transverse
coon.
Pysca
te
we
made,
te
to
expanson
pres-
and
ts
o
te
gament,
umbca
he
o
a
ste
oowng
o
best
te
A
s
to
and
a
vesses
dagnoss
te
te
a
te
wtn
emergency
buge
gymnast
aparoscopc
procedure,
te
comes
pan
patent
tranng.
and
o
gaments
woman
because
tuberce.
buge
and
umbca
24-year-od
department
pubc
te
meda
department wt et ower quadrant pan. he patent
and
s
or
a
beng
medca
trbutares
176.
he
o
Hs
abuse
sows
strong
varces—rom
gastrc
Interna
under
ucer.
D.
emergency
ound
street.
acoo
a
te
was
regon
probaby
ng
porta
e
te
words;
ave
severe
mesenterc
amptude.
C.
s
to
severe
a
on
o
to
ater
examnaton
Asctes—rom
cavty.
requency
story
Esopagea
D.
be
a
ound
s
brougt
wanderng
surrng
studes
s
dapragm.
woud
s
s
sure
x-rays
s
wo
breat
occur?
A.
and
s
daugter
condton?
abdomen
most
s
Pysca
oowng
(para-
ucer
pertonea
condtons
rgd
man
by
sow
years.
man
o
sou-
respraton,
peptc
55-year-od
department
emergency
adynamc
ruptured
nto
A
begerent
dstended,
examnaton
beedng
o
duct.
ascendng
to
sows
a
parayss
abdomna
dagnoss
rom
175.
o
7
ntense
aso
utrasound
tte
because
ejacuatory
mmobe
resutng
very
and
examnaton
abdomen
mpotent.
stere
suppy
reduced
Pysca
to
be
deerens
35-year-od
department
become
woud
Parasympatetc
woud
175–199
badder.
o
repar
opubc
emora
caracterzes
a
atera
and
emora
s
er-
perormed.
tract
s
ernaton.
ts
to
notced
traced
Wc
structure?
134
C H A P T E R
A.
he
gn
B.
3
Abdomen
opubc
o
he
te
opubc
nguna
C.
he
D.
he
E.
he
trange
tat
orms
tract
s
or-
te
atera
border
o
te
180.
te
atera
border
o
te
department
te
to
tract
man
part
te
s
o
te
pectnea
te
atera
nguna
ga-
gament.
extenson
s
He
but
s
brougt
o
aso
108/mn,
perature
sows
and
s
s
to
abdomna
as
now
a
oss
more
te
te
tenderness
made,
te
rotaton
sue
an
to
nausea,
appette.
he
to
te
sgn.
o
te
t
commony,
s
procedure
ntestne,
to
o
and
178.
B.
Descendng
C.
Ieum
D.
Posteror
E.
T aenae
A
ceca
to
adesons,
co
appendx
s
C.
T10
D.
T11
E.
T12
tem-
181.
as
aso
naton
te
aed
sows
recta
s
ascendng
brougt
epsode
pass
A
CT
dated
Hrscsprung
te
te
s
to
rgt
coc
o
er
bous
ts-
rst
o
te
descendng
embryoogc
stoo.
Pysca
wt
abdomen
coon
and
(megacoon)
mecansm
no
by
s
sows
a
responsbe
Faure
was
B.
179.
o
o
neura
te
an
separaton
C.
Faure
D.
Deectve
E.
Ogoydramnos
A
o
gron
wegts
pan
area
n
sows
an
abe
to
ndrect
or
to
mgrate
nto
He
to
past
Ioypogastrc
B.
Latera
C.
Ionguna
emora
E.
Kdney
te
183.
e
reduce
t.
wa.
pan
pyscan
days.
ad
He
a
a
He
sudden
buge
says
erna
Wc
due
nerve
n
tat
Pysca
because
was
te
te
s
ts
same
buge
rgt
key
te
umbcus.
made.
A
Wc
to
pyscan
sde
xed
te
ts
o
because
er
back.
nontender
mass.
abdomen
tumor
nvaded
te
n
te
sow
a
posteror
superor
oowng
te
was
most
o
mesen-
structures
Genta
D.
Subcosta
E.
Obturator
b)
n
te
and
ast
sows
A
a
CT
te
w
Ceac
B.
Superor
C.
Ineror
D.
Lumbar
patent
wt
appendcts
as
majus.
te
s
weeks
parestesa
abum
durng
to
te
epgastrc
scan
papaton
o
over
Wc
procedure?
gentoemora
comes
2
on
oca-
Pysca
onguna
n
o
node
ntay
He
as
because
ost
unntentonay.
te
te
pyscan
pan.
monts
tumor
ymp
nodes
A.
A
man
appette
o
tat
perormed. T wo
rgt
njured
and
branc
54-year-od
te
s
pan
quadrant.
dagnoss
er
key
Ionguna
C.
o
guardng
A
surgery,
part
B.
A
perumbca
abdomna
appendectomy
Ioypogastrc
E.
184.
a
o
te
and
ower
sows
an
anteror
oowng
transmsson?
cutaneous
s
contrbutes
rgt
tssue
as
tenderness.
and
evauate
ocaton
most
te
and
exam-
coon
nausea
te
stomac.
examnaton
to
wt
to
troscopy
o
sows
o
to
te
MRI
tat
A.
(10
tng
onset
severe
Pysca
A 35-year-od woman comes to te emergency depart-
nerve
coon
te
4
notced
nguna
te
A.
Stomac
Descendng
oss
te
as
says
wt
coon
D.
te
coaca
te
He
erupted
pan
around
because
days.
afected?
C.
oowng
ts
ndgut
sporadcay.
abdomna
responsbe
te
o
te
wen
gron.
goes
o
comes
or
gym
et
was
and
te
man
pan
te
ts
and
comes
on
at
o
recanazaton
rotaton
32-year-od
et
ces
Ascendng
made
coon
Incompete
o
crest
be
Rectum
rebound
dsease?
A.
key
examnaton
n
Wat
or
te
2
area
(snges)
comes
sot
Wc
B.
zed
dagnoss
made.
te
nerves
on
and
wa
A.
ment
exam-
woman
sweng
pexus.
most
gr
stoo
pyscan
past
burnng.
ras
spna
eterogeneous
terc
ater
he
ten
and
zoster
examnaton
abdomna
182.
pyscan
te
te
descrbes
vescuar
utrasound
arge
artery
vomtng.
dstenton
scan
dsease
te
ocazed
An
Most
coon
to
a
He
to
or
and
sarp
erpes
68-year-od
Pysca
juncture
abdomna
vaut.
abnormay
o
an
te
A
o
Durng
ocated
o
as
oowng
rgt
adpose
best
te
tcy
pan.
t
comes
abdomen
rst
sows
T8
embryoogc
appendx.
s
and
T9
appendcts
and
te
on
was
B.
artery
o
gr
experencng
o
eoceca
ceca
2-day-od
ras
A.
artery
branc
te
ras
and
ocatng and tracng wc o te oowng structures?
Anteror
a
spancnc
man
dermatome?
tenderness,
perormed.
atypca
denty
vermorm
A.
o
pan
examnaton
rebound
dagnoss
appendectomy
dicut
te
A
18/mn,
Pysca
papaton,
operatve
made
are
(100.1°F).
Rovsng
and
open
65-year-od
dagnoss
emergency
pan,
o
ocazed
respratons
37.83°C
postve
A
naton
o
spancnc
toracc
caracterzes
ower quadrant. Hs bood pressure s 128/86 mm Hg,
puse
Greater
o
s
because
dfuse
Lumbar
E.
te
gament.
constpaton.
D.
vesces
attaces
47-year-od
was
aponeurotc
Hessebac).
tract
opubc
pectnea
A
orms
(o
te
abdomns.
rng.
opubc
ment
represents
tract
opubc
emora
177.
tract
transversus
pyorc
nvovement.
te
A
antrum
abdomen
dran
4.5
s
gas-
te
ordered
Wc
pyorc
o
o
o
kg
to
te
antrum?
mesenterc
mesenterc
Hepatc
21-year-od
department
man
wt
s
severe
brougt
back
to
pan.
te
he
emergency
pan
s
sarp
CHAPTER
and
severe
Pysca
aong
back
et
at
185.
and
te
et
sows
sde.
rsk
a
Wc
or
B.
Descendng
C.
Kdney
D.
Lver
E.
Pancreas
pan
ater.
an
ucer
CT
te
Superor
C.
Be
D.
Proper
eevent
organs
brougt
o
sows
te
to
upper
wt
w
s
rb
o
te
tc
on
te
key
most
key
a
most
and
but
abdomen
wa
emergency
abdomna
du
meas
te
C.
he
rgt
D.
he
greater
E.
he
omenta
burnng
worsens
sows
o
te
key
be
pan.
2
type
evdence
o
pont.
An
ts
rgt
artery
A.
wt
te
te
o
mass
A
repar
o
pan
s
s
and
papabe
mass
Pysca
examna-
reducbe
o
notced
erna
s
a
wt
erna
Durng
n
te
no
s
te
deep
just
evdence
made,
a
procedure
a
nguna
C.
D.
T10
E.
190.
A
Umbca
pan
C.
Femora
was
D.
Lumbar
pan
E.
Indrect
nguna
abdomna
souder.
rebound
ar
a
Pysca
o
te
A.
Rgt
B.
Hepatorena
Omenta
D.
Rgt
E.
Greater
a
o
course
Pysca
story
pan
te
severe
te
o
te
posteror
and
and
A.
was
bood
o
(esser
B.
drecty
C.
sac)
E.
191.
severe
ucer
NSAIDs
abdomna
dsease
or
o
abdomen
and
artrts
te
te
pan.
Se
recenty
pan
abdomen
wt
emergency
n
er
sows
guardng
and
as
a
resumed
knees.
a
non-
rebound
te
2
rgt-
pan
was
days
ago.
abdomen
A
10
an
1
lud
oowng
appendx
sare
n
te
meca-
pan
ts
and
te
somatc
same
spna
s
o
a
Se
we
g
aferent
T7–T9
as
wt
a
te
stmu-
aferents
vscera
at
aferents
te
to
o
te
n
o
woman
oz),
ypo-
postve
sympatetc
bers
cord
spread
by
to
te
eves
to
prenc
daprag-
nerve
te
abdom-
T7–T9
wt
ntercosta
nerves
eves
a
eaty
pregnancy.
and
a
er
but
mecansms
contacted
devers
mnutes,
rgt
wt
spna
cord
regon,
and
pan?
dermatomes
trave
Intay,
eves
supped
spna
GERD
te
sympatetc
gabadder
abdomna
sows
synapse
cord
T7–T9
at
o
oowng
pattern
emergency
o
epgastrc
ocazed
and
te
gastones.
nlammaton
11
to
story
story
wt
bers
sare
b
were
vscera
brougt
o
aferents
(7
wt
1-day
spna
aferent
5
sares
umbcus.
examnaton
nta
T7–T9
appendx
te
pertoneum
synapse
uncompcated
and
te
eve.
pertoneum
to
to
wt
trave
Wc
nlamed
3500
at
te
appendx.
ocazed
te
28-year-od
was
auscutaton.
perumbca
te
te
dagnosed
and
sgn.
at
o
Pysca
Vscera
ater
upon
sows
eve.
cord
pertoneum
back
eves
woman
sarp
he
to
suppy
cord
Gabadder
D.
o
nta
nlamed
poory
matc
to
emergency
severe
nondstended
umbcus
because
gabadder
areas?
brougt
a
decreased
suppy
te
vomtng.
Vscera
te
space
s
o
regon,
abdomen
te
aferents
expans
na
woman
wt
and
bers
abdomen
wa
te
Intay,
Wc
aferents
spna
Vscera
sows
sac
rm
best
are
cord
te
spna
Murpy
rgt
guardng
abdomen
scan
contents
o
n
to
story
umbca
te
aferents
by
condrum.
space
examnaton
dstended
emergency
space
peptc
o
te
te
sows
o
CT
n
oowng
bursa
55-year-od
story
A
stomac
subprenc
department
2-our
x-ray
ucer
subepatc
C.
A
An
dapragm.
spng
wc
a
assocated
examnaton
peroratng
stomac,
nto
te
o
and
tenderness.
under
sows
because
pan
to
pan.
sows
gutter.
spna
prevousy
became
brougt
o
to
45-year-od
B.
s
brougt
1-day
eves.
department
woman
s
a
te
expans
Somatc
T10
nguna
67-year-od
east
patent?
experenced?
Somatc
Drect
department
best
Somatc
rng.
ts?
to
sounds
paracoc
ated
o
and
o
abdomna
Bowe
same
A.
A
because
Parasympatetc
emergency
a
perormed.
s
te
gament.
dagnoss
ntestne
type
gron
nguna
to
ts
pep-
s
bursa
Sympatetc
B.
brougt
n
stes
gutter
woman
examnaton
cord
artery
s
oowng
sac
utrasound
artery
man
te
sows
perorated
wt guardng and tenderness maxmay at McBurney
cap.
o
abdomen
o
pouc
paracoc
ocazed
Pysca
ours
duodena
afected
poory
te
Morson
45-year-od
ower
o
dagnoss
coecton
rectouterne
A
o
lud
Pouc
sensaton
ncarceraton.
surgca
sow
A
Wc
he
patent
mesenterc
epatc
sows
to
made.
B.
duct
to
s
utrasound
lud.
A.
sde
ven
Gastroduodena
Wc
ucer
nsms
porta
45-year-od
oop
x-ray
perorates?
superor
188.
o
s
posteror
structure
department
187.
woman
scan
n
B.
ton
te
An
An
ntrapertonea
coon
mproves
Hepatc
E.
o
back.
oowng
because
A.
A
ange
te
examnaton
ucer
Wc
te
tenderness.
tenderness
department
tat
A
o
nspratons.
and
189.
32-year-od
o
sde
deep
brusng
njury?
Stomac
Pysca
o
wt
sows
ractured
department
186.
atera
A.
A
worsens
examnaton
135
Abdomen
3
Apgar
respectvey.
nant
Hs
brt
scores
at
were
Pysca
term
wegt
8
and
examna-
ton sows a cear lud dranng rom te umbcus o
te
s
nant.
Fud
perormed
on
s
coected
te
sampe.
and
he
a
urne
lud
s
dpstck
test
determned
136
C H A P T E R
to
be
Abdomen
urne.
deects
192.
3
best
Wc
dsta
B.
Obterated
proxma
C.
Competey
D.
Patent
E.
Competey
A
uracus
33-year-od
ng,
and
derness
te
guardng
s
rebound
aferents
patetcs
to
Inlamed
C.
he
D.
Contact
E.
Contact
to
a
or
sot
regon
bowe
CT
scan
s
2
a
te
te
Between
rena
B.
Between
te
s
days.
mass.
are
s
te
lud
pan
and
Wc
o
te
same
a
pareta
per-
n
te
pan
s
evdence
oowng
o
oowng
and
and
most
ater
wt
or
and
o
eatng
cewabe
se
s
proton
s
structure
stomac?
he
started
pump
not
as
on
A
o
A
E.
Rgt
part
obe
o
te
duodenum
pancreas
o
te
ver
and
bary
Wc
ee
90/5
sows
an
mucous
struc-
eves
o
ntestna
artery
bood
s
Her
a
here
s
s
occuded,
wt
pae
o
s
guardng
and
absent.
sma
bowe
cons”
made.
are
Pysca
ep-
scema
ow
140/
te
are
“stacked
vesses
s
abdomen
papaton
sounds
mesenterc
puse
as
wara-
respratons
woman
dated
Se
take
(104°F).
appearng
dspayng
dagnoss
40°C
membranes.
sows
abdomna
to
Her
Hg,
upon
emergency
o
anorexa.
unwe.
regons.
te
reuses
mm
Bowe
abdomen
and
but
s
tenderness
umbca
to
story
I
An
wt
appear-
secondary
te
coud
to
superor
te
mdgut
suppy?
Anastomoss
between
et
and
B.
Anastomoss
between
et
and
rgt
gastrc
rgt
arteres
gastroeppoc
arteres
C.
Anastomoss
ta
Se
D.
between
between
creatcoduodena
estye
E.
et
and
rgt
gastro-omen-
arteres
Anastomoss
Anastomoss
superor
and
neror
pan-
arteres
between
adjacent
sort
gastrc
arteres
197.
A
72-year-od
department
week,
te
brougt
darrea,
er
tenderness.
ts
retrograde
perormed
low.
no
sow
gabadder
3-day
temperature
wt
to
a
braton
makes
dry
te
but
extraepatc
duct
a
ampua
s
o
pressure
and
and
s
and
abdomen
studes
endoscopc
A.
o
o
t
bood
and
woman
because
atra
because
te
18/
mem-
abdomen
o
gabadder
(ERCP)
te
are
mucous
duct
vomtng,
o
mesenterc
patent
rom
epatc
ever,
Speen
Second
pan
duct
72-year-od
story
dry
te
An
te
et
greasy
patent’s
o
he
Rgt
T a
sarp
he
duct
E.
B.
D.
ntay
became
obstructed?
be
A.
C.
abdom-
was
respratons
tender
o
pancreatc
key
epatopancreatc
started
broncus
but
Laboratory
aong
he
nbtors.
ts
brubn.
he
pan.
derved
wa
D.
receve
antacds.
daporess.
organs
embryoogca
asca
burnng
or
te
C.
embous
emergency
spcy
emergency
severe
pan
utrasound
abdomen.
nundbuum
x-ray
asca
pan,
o
and
sows
and
An
cystc
ance.
abdomna
sot
he
rebound
capsue
epgastrc
a
sgn.
he
gastrc
asca
te
wt
norma
dstended
at
to
he
te
o
ypocondrum.
110/mn
B.
skn
A
w
at
te
examnaton
negatve
pertonea
rena
upper
breat
tra
rena
ever.
rgt
A.
ar-lud
and
to
because
epgastrum
obstructon
most
20/mn,
sows
arge
an
s
mn,
and
a
s
serum
wt
a
umbar
o
n
department
emergency
et
and
te
te
tckenng
ture
rn
te
transversas
sows
GERD
and
per-
examnaton
brougt
mproves
wt
196.
vscera
abdomna
te
asca
s
worsens
o
o
cortex
because
s
ocaton?
paraneprc
sortness
to
to
Murpy
tree
pan,
wt
but
capsue
woman
tat
dagnosed
te
rena
wt
auscutaton.
asca
rena
pan
aferents
sows
Wc
examnaton
modcaton
sym-
somatc
tus,
brougt
examnaton
cterc,
lud
sows
best
upon
Wtn
55-year-od
he
test
decreased
E.
no
wt
stmuates
s
usband
coangopancreatograpy
patent?
trave
puse
eevated
aso
sgn
transversas
as
HCG
mecansms
ts
ree
rom
s
psoas
te
oods.
urne
sows
ten-
he
Between
nature,
vomt-
sows
here
to
Pysca
postve
aferents
Pysca
ocazed
branes,
aso
dermatomes
et-sde
Between
n
rgt-
s
o
er
vomtng,
setted
mn.
eve
brougt
D.
Pysca
Se
dstance
structure,
somatc
C.
department
n
appendx
abdomen
A.
A
A
appendx
abdomen
abscess.
descrbe
T11
o
rm
sounds
o
perneprc
key
past
tender
tere
te
appendx
cord
vscera
man
because
te
and
and
stmuates
and
o
umbcus.
mdgut
nlamed
81-year-od
ever
a
nlamed
o
department
emergency
epsodes
pertoneum
stmuates
toneum
An
s
T10
o
toneum
2
pan
te
te
woman
by
radates to er rgt souder. Her temperature s 40°C
nerves
appendx
reerred
poory
engt
duraton.
oowng
o
pan,
(104°F),
to
tenderness.
te
ts
examnaton
te
spna
vscera
ntercosta
uracus
aong
one-trd
o
T10
te
ever,
to
dstrbuton
Vscera
B.
at
45-year-od
na
we-demarcated,
Pysca
o
uracus
uracus
sarp,
A
and
o1-day
spne
Wc
te
195.
department
brougt
ow-grade
ac
o
pont
s
o
stoos.
and
negatve.
expans
A.
a
te
end
one
pan
papaton
anteror
o
obterated
because
oose
on
at
deveopmenta
uracus
woman
abdomna
experencng
end
patent
oowng
ndng?
Obterated
sde
194.
te
ts
A.
department
193.
o
expans
man
s
because
o
suddeny
dvertcuar
and
pressure
tons
ton
s
are
1
our
dsease,
drnks
12
100/50
mm
and
a
ago.
s
daporetc
a
every
Hg,
to
puse
patent
emergency
pack
s
pan
as
o
a
Hs
110/mn,
Pysca
wt
a
tat
story
cgarettes
weekend.
aebre.
man
te
abdomna
he
smokes
beers
30/mn,
sows
brougt
severe
rm
a
bood
respra-
examna-
abdomen
CHAPTER
and
ng
tenderness
and
sows
o
wa
te
n
Aorta
B.
Superor
C.
Head
o
T ransverse
GERD
pylori
per
a
a
o
te
duodenum.
key
n
we
and
An
pos-
and
10
4
oss.
ng
mmedate
6
cm
patent
He
Pysca
An
a
story
a
rreguar
o
Josep
Let
D.
Spenc
E.
Let
A
gastrc
rgt
te
and
s
s
te
te
Psoas
curvature. Wc o te oowng structures s most key
C.
Obturator
at mmedate rsk o damage by te tumor n ts patent?
D.
T ransversus
E.
Quadratus
gastro-omenta
B.
Rgt
and
et
pancreatcoduodena
C.
Rgt
and
et
gastrc
D.
he
E.
Sort
A
porta
3-day
urne.
o
te
An
o
comes
pae
o
serum
Increased
aanne
Increased
aspartate
Increased
akane
Increased
gamma-gutamy
Increased
protrombn
s
se
s
ound
te
Ineror
B.
Gabadder,
C.
Ineror
be
pospatase
epatc
eevated
ton
sows
o
o
te
daton
at
trange
mg/dL,
(AST),
(ALP),
(GGT),
o
and
aberrant
te
trange
et
scedued
Durng
te
cystc
o
ventrce
or
a
203.
procedure,
artery.
duct,
be
be
duct
duct,
common
epatc
Cystc
D.
Rgt
E.
Cystc
py
D.
Cystc
artery,
neror
E.
Cystc
artery,
common
border
o
epatc
LV ,
be
duct,
duct
be
duct
se
appen-
keeps
at
te
pan
er
p.
caused
pertoneum
yng
I
by
over
obque
pan
s
o
be
brougt
o
a
breatng
se
to
mea.
A
te
on
undergoes
o
te
te
o
sou-
examna-
papaton
acute
co-
aparoscopc
oowng
and
upper
rgt
deep
a
emer-
rgt
Pysca
dagnoss
dented
to
severe
radates
eatng
Wc
epatc
structures
gated
wtn
te
duct
duct
epatc
artery
artery
s
man
ater
a
90/50
sows
te
wc
Fundus
B.
Kdney
C.
Pyorc
D.
Head
E.
Spenc
te
o
te
may
s
An
speen
ts
emergency
Hs
120/mn,
te
te
bood
respra-
utrasound
requrng
um.
occude
te
coson.
procedure,
at
oowng
te
puse
aebre.
gated
to
vece
Hg,
and
Durng
s
brougt
acerated
gature
o
A.
a
s
motor
mm
30/mn,
speen
o
38.8°C
duct
are
te
s
acute
Caot?
34-year-od
ment
duct
Questions
C.
o
Her
115/mn,
musces?
and
key
spenectomy.
duct,
LV ,
Be
Rgt
abdomen
duct
o
o
B.
tons
cystc
most
pressure
Caot?
(LV),
severe
pareta
quadrant.
made
department
Wat
an
extenson
s
woman
he
upper
s
A.
A
s
temperature
avng
because
ater
coecystectomy.
woud
5
obese
cessaton
rgt
sow:
puse
abdomns
pan.
sows
te
Hg,
depart-
pan.
umborum
worsens
ecystts
(ALT),
transerase
an
te
epatc
border
yeowng
studes
coestass
ave
o
because
tea-coored
tme.
wt
to
and
abdomen
coecystectomy.
border
common
to
pyscan
stoo
amnotranserase
boundares
A.
te
amnotranserase
dagnosed
aparoscopc
are
brubn
te
sows
Laboratory
Increased
Se
to
coored
hs
nternus
department
and
emergency
abdomna
examnaton,
tere
abdomna
40-year-od
der
examnaton
tree.
A
gency
trave-
pancreas.
major
abdomna
utrasound
bary
202.
vesses
woman
story
Pysca
scerae.
vesses
vesses
trad
gastrc
55-year-od
vesses
o
ressts
rrtated
Externa
et
vesse
o
te
oowng?
te
mm
and
pysca
and
to
severe
suspected
oowng
B.
and
and
extended
A.
Rgt
te
te
o
artery
brougt
130/85
lexed
arge mass nvovng te stomac n te regon o te esser
A.
body
artery
20/mn,
s
Durng
o
s
ever
are
Se
tg
wc
o
pressure
stretcng
nodue
scan
te
artery
gr
because
tg
te
brusng
CT
ven
gastro-omenta
(102°F).
o
o
A
artery
5-year-od
dcts.
wc
o
around
border
sows
wa.
aceraton
mesenterc
n te umbca area. A CT scan o te abdomen sows a
o
200.
C.
a
as
porta
respratons
abdo-
nonpusate
Mary
o
sows
te
Superor
Hepatc
examnaton
abdomna
superor
dented
B.
te
emorragng
te
A.
bood
20-pack
examnaton
s
ment
Helicobacter
as
utrasound
Sster
a
or
aso
depart-
swaowng,
as
antbotcs
ard,
resembng
emergency
dicuty
prevousy .
smokng.
201.
Pysca
on
sows
wt
aong
vesse
ven
te
o
he
wt
abdomen.
×
mass
to
abdomen
pancreas
Wc
stomac
story
years
o
te
campng.
tenderness
te
cava
brougt
treated
nontender
sows
s
wegt
was
story
nontender
most
guard-
abdomen
dapragm.
peroraton
te
artery
o
2-mont
necton
sot
te
as
te
coon
man
and
and
year
men
a
s
aso
o
pancreas
curvature
51-year-od
o
vena
mesenterc
te
Greater
vomtng,
sows
He
CT
under
part
structures
neror
E.
ater
trd
A
patent?
and
D.
ment
199.
te
ts
A.
A
epgastrum.
aparotomy
o
oowng
danger
198.
te
tenderness.
pneumopertoneum
exporatory
teror
n
rebound
137
Abdomen
3
o
te
an
urgent
bood
suppy
Improper
arteres
pace-
tat
sup-
structures?
stomac
spncter
o
te
pancreas
200–223
A 10-year-od boy s brougt to te emergency depart-
ment
ater
ang
down
a
and
ttng
a
tree
trunk
204.
A
lexure
55-year-od
department
o
man
wt
te
s
coon
brougt
severe
to
abdomna
te
emergency
pan.
Pysca
138
C H A P T E R
3
Abdomen
examnaton
skn,
cus.
and
he
patent
crross
made.
A
sows
a
sows
vascuar
and
CT
a
abdomna
markngs
as
a
story
dagnoss
scan
crcuar
o
te
grey
sweng,
cterus
surroundng
o
o
acoo
porta
cest
at
structure
te
abuse
structure
Gven
ts
205.
te
to
and
be
vertebra
eve
mmedatey
muc
te
wt
arger
patent’s
s
208.
T7
anteror
tan
Ineror
B.
Superor
E.
Ana
A
ew
s
cava
vena
are
s
key
E.
Pumonary
A
ven
65-year-od
because
o
and
abdomen
o
surgca
as
a
w
reac
most
key
Pareta
B.
Dapragmatc
C.
Pareta
D.
T ransversas
E.
Vscera
A
ens
ater
ness
upon
or
a
a
sma
te
wc
be
scan
te
o
rena
scedued
a
o
te
as-
209.
or
scope
port
n
oowng
C.
Stomac
D.
T ransverse
E.
Appendx
te
posteroatera
ncsed?
Pysca
a
a
o
brougt
upper
started
te
rgt
coecystts
passed
te
nto
anteror
organs
s
te
wors-
quadrant.
and
s
greater
pyscan
wa.
Femora
E.
Ioypogastrc
Wc
unabe
to
210.
o
vew
A
15-year-od
an
goa
s
to
and
crunces
tat
ts
C.
Pancreas
eta
D.
Stomac
E.
T ransverse
ment
by
bood
s
per
to
o
rgt
sows
n
te
most
a
moter
rectum
appear
te
coon
be
n
ong
Gastrts
B.
Hrscsprung
e
he
cres
A
o
o
depart-
brgt
boy
durng
does
te
red
not
papaton
tecnetum-99
radoactve
Wc
dagnoss?
A.
o
emergency
epsode
daper.
but
spot
te
an
quadrant.
mdabdomen.
key
s
dstress,
ower
2-nc
n
ater
to
scan
accumuaton
oowng
s
te
211.
ts
Rbs
C.
Pubc
D.
Costa
E.
Xpod
rgt
(103°F).
ce
count.
necton
structures
CT
te
s
most
emergency
o
rgt
sensaton
n
te
here
s
aso
obque
scan
o
te
te
posteror
at
kdney,
rena
nerves
te
o
transversus
abdomen
sows
breaks
capsue
quadratus
oowng
papa-
rb
weakness
and
rgt
rgt
regons.
to
twet
ower
te
pubc
tenderness
to
n
te
to
onset
anteror
sows
cutaneous
wo
and
umborum
s
most
key
s
an
nerve
amateur
abdomna
a
to
“6-pack”
s
s
by
routne.
ncorporatng
regmen.
soatng
to
bodybuder
workout
workout
attaces
n
wc
s
o
he
st-ups
musce
workout
te
as
Hs
to
oowng
get
ske-
10–12
crest
cartages
swaowng
5
years.
onger
7–12
process
52-year-od
te
39.4°C
puse
respra-
crest
department
no
Hs
Hg,
bood
back
saow
areas?
B.
ast
a
tumor?
adoescent
Iac
undergo
dsease
boy
deveop
“6-pack”
o
psatera
ntensve
A.
A
o
emora
begun
A
te
D.
Ieum
brougt
o
te
Ionguna
Jejunum
s
by
C.
B.
boy
Wc
oss
ange.
te
Subcosta
A.
2-year-od
center
on
Latera
troug
and
orgnates
B.
drecty?
A
te
sudden
neror
musces.
tat
A.
sac
mm
ever.
s
abdomna
brougt
a
abdomna
An
proce-
s
o
gutea
nlamed
te
wte
oowng
assocated
nterna
compressed
scedued
Durng
was
attenton.
124/86
g
g
n
coon
regon
pressng
musce.
ga-
te
costovertebra
tumor
s
o
t
temperature
examnaton
rgt
medca
a
emergency
o
wound
snce
retropertonea
man
wt
te
troug
tender-
ecogenc
abdomna
te
and
tckened
arge
emer-
quadrant
sows
upper
coecystectomy.
s
te
suddeny
sows
severa
to
rgt
examnaton
abdomen
wt
s
severe
pan
acute
at
and
because
back
pan
stab
pressure
te
coon
68-year-od
rgt
woman
he
was
as
Jejunum
te
Pysca
te
Descendng
B.
abdomns
wt
papaton
o
A.
A
seek
to
story
afected?
posteroatera
oowng
a
5-day
sma
sows
Wc
be
department
peura
obese
pan.
Se
te
to
s
Usng
kdney,
ave
wtn
patent
mass.
CT
asca
aparoscopc
dure,
he
A
pertoneum
gabadder
stones.
week.
ange
smokng
pertoneum
meas.
utrasound
costovertebra
40-pack-per-year
a
depart-
ton
department
abdomna
rgt
emergency
peura
43-year-od
gency
te
conned
te
te
A.
s
drnk
mass
o
to
a
kdney.
remova
to
at
as
one
rgt
approac
ayers
He
sows
te
comes
pan
ematura.
story
ca
man
to
o
brougt
a
owever,
not
22/mn,
made.
Esopagus
Azygos
a
bood
cemstry
dagnoss
s
o
ago;
dd
A
D.
ven
e
100/mn,
Bood
cava
avng
monts
wound,
s
man
because
reports
tons
vena
dvertcuum
ssure
21-year-od
C.
and
207.
Mecke
a
usua.
wat
Hemorrods
D.
He
o mdne.
story
C.
department
structure?
A.
ment
206.
appears
ocaton
te
ypertenson
te
to te vertebra bodes and just to te rgt
he
o
umb-
man
by
s
sods
He
tat
as
resoves
an
procedure
s
we
a
brougt
because
as
been
burnng,
wt
to
o
te
severe
gettng
emergency
dicuty
worse
retrosterna
antacds.
He
s
pan
endoscope
s
advanced
n
te
wc
scedued
esopagogastroduodenoscopy.
te
over
to
Durng
unt
ts
tp
CHAPTER
reaced
wc
te
212.
te
o
atus
oowng
endoscope
most
o
te
vertebra
key
dapragm.
eves
dd
te
At
tp
o
end?
216.
gutter
Omenta
bursa
A 68-year-od woman comes to te emergency depart-
T7
ment
T8
pan.
C.
T10
occuson
D.
T11
eve.
E.
T12
ng
A
65-year-od
man
because
o
utrasound
aortc
room.
aortc
grat
At
were
anteror
te
te
s
s
center
wc
o
o
n
te
te
an
taken
grat
an
was
te
A
CT
As
a
o
te
o
most
bood
to
Hemazygos
abdomna
C.
Ascendng
D.
Azygos
E.
Let
te
key
217.
vertebrae?
A
common
ment
ater
man
L2
and
C.
L3
oowng
D.
L4
1.
Interna
E.
L5
2.
T ransversas
stor y
a
an
o
tumor
to
o
ver
te
comes
acoosm
n
te
undergo
te
man
abdomna
rgt
s
and
ver,
te
ver
patent
crross.
and
n
emergency
he
te
te
A
CT
patent
epatectomy.
dvded
oowng
to
pan.
prncpa
segments
w
V ,
B.
IV ,
VI,
V ,
C.
III,
D.
II,
E.
I,
A
IV ,
III,
II,
sows
5.
Scarpa
6.
Externa
pane.
most
Wc
key
tures
be
V ,
VI
IV ,
V
III,
man
to
sows
obstructed
unon
o
n
wt
te
pan.
ts
ong
patent
o
te
s
most
bood
key
B.
Superor
C.
Ineror
mesenterc
and
et
D.
Ineror
mesenterc
and
paraumbca
E.
Superor
mesenterc
65-year-od
ment
because
ound
wa
ts
te
to
o
te
stomac
key
o
rst
a
a
A
tumor
CT
lud
te
Supracoc
B.
Omenta
C.
Inracoc
and
n
tat
scan
as
ater
et
te
te
te
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-od
o
vens
te
te
abdomen
te
te
depart-
patent
s
posteror
stomac
sows
resutant
dd
because
as
at
tat
aperture.
lud
aperture?
most
219.
a
te
upper
parts
to
o
s
Hepatc
Spenc
sot
he
o
a
buet
abdomna
ayers
depart-
wt
ts
9mm
entered
wa.
he
wa:
musce
musce
obque
musce
represents
te
order
o
struc-
comes
1-day
to
story
coonoscopy
troug
any
te
story
o
te
te
Wc
ndcatve
tat
emergency
boody
coon
next
o
te
te
cancer
end
o
te
s
scope
n
canges
oowng
he
and
he
coon
surace
depart-
stoos.
day.
entre
abnorma
coon.
o
order
n
te
coonc
coon
as
lexure
Paracoc
D.
Ieoceca
E.
GE
gutter
vave
juncton
55-year-od
because
as
a
cronc
story
tomoss
man
o
o
B
o
wc
can
A.
Rgt
B.
Perumbca
gastrc
te
crross
n
and
He
aso
ver
as
dated
recta
depart-
vomtng
te
system
te
emergency
o
o
dstenton,
wa,
porta
resut
to
story
necton.
abdomna
abdomna
vens
comes
2-our
story
epatts
o
anteror
gea
a
lexure
C.
He
emergency
reaced?
B.
ment
te
obque
best
man
o
or
A.
A
oow-
cannes
buet?
passes
o
te
abdomns
amy
or
examne
umen
vens
te
4-5-2-6-1-3
typcay
to
quadrant.
orm
abdomna
B.
to
to
vertebra
te
asca
A.
been
he
by
andmarks
emergency
te
spaces
compartment
s
tat
o
asca
oowng
traversed
A
ower
compete
L3
asca
scedued
vens
pan.
perorated
o
o
vesse
a
vens
mdde
traversed
t
gastrc
gastrc
spenc
to
wt
arteres
abdomna
oowng
enter
A.
and
comes
du
stomac
ocaton.
Wc
man
o
ave
te
patent
vesses?
Rgt
mesenterc
ac
acoo
examnaton
he
oowng
common
o
department
Pysca
medusae.
story
A.
A
et
a
emergency
caput
wc
and
o
ment
abdomna
abdomen
te
218.
IV
comes
severe
VIII
te
te
coatera
anteroatera
abdomna
scedued
Wc
as
at
wc
sustanng
ower
te
Camper
surger y
acted
comes
structures
T ransversus
VII
50-year-od
abuse
s
VII,
VI,
traversed
4.
te
occuson,
gt,
rgt
3.
removed?
A.
s
ong
a
scan
s
Durng
depart-
as
cava
abdomna
sows
ac
gang
B.
or
to
a
buet
59-year-od
sarp
rena
19-year-od
L1
ment
vena
rom
a
umbar
A.
A
o
abdomen
body?
Let
wt
te
low
B.
most
story
te
key
A.
n-ne
o
neror
resut
oper-
an
2-our
scan
o
vens
er
abdomna
s
because
aow
endovascuar
grat
oowng
depart-
abdomen.
to
patent’s
usng
o
s
sows
urgenty
center
te
emergency
mass
repared
he
te
abdomen
e
exporaton,
pane.
to
to
pusate
and
aneurysm
subcosta
comes
a
o
aneurysm
atng
215.
Paracoc
E.
B.
An
214.
D.
A.
ment
213.
esopagea
te
139
Abdomen
3
a
ven
wt
ematemess?
to
a
2-mont
vens
varces.
bood.
due
over
he
te
te
anas-
esopa-
140
C H A P T E R
220.
3
Abdomen
C.
Let
D.
Spenc
E.
Let
A
gastrc
abdomna
28
221.
te
mm
Superor
epatc
around
sows
s
wt
te
emergency
story
area.
n
nerve
Questions
224.
na
CT
tat
carred
224–244
because
pan.
tumor
s
A
at
perormed
te
pan
organ?
ra
aferents
rom
A.
Vagus
sympatetc
B.
Prenc
C.
Pregangonc
parasympatetc
C.
Ceac
D.
Postgangonc
E.
Vscera
32-year-od
wt
over
boody
s
te
cayces
stone.
to
be
on
et
tat
te
pevs
te
te
et
bood.
quadrant
examnaton
and
An
appears
enarged
key
and
ocaton
o
norma
because
te
o
or
a
ur-
te
sze,
rena
ts
stone
Uretra
B.
Urnary
C.
Ureter
badder
at
te
uretero-vesca
D.
Ureter
at
te
pevc
E.
Ureter
at
te
uretero-pevc
49-year-od
man
juncton
226.
brm
comes
pan
to
te
depart-
Lesser
wegt
A
CT
te
oss
o
scan
ead
obstruct
te
Be
B.
Common
C.
Let
D.
Cystc
E.
Rgt
or
he
an
te
sows
as
a
s-
unntentona
past
a
tumor
oowng
epatc
3
3
cm
w
monts.
most
E.
Ioypogastrc
or
because
An
At
o
and
e
s
duodena
artery
to
te
s
gated.
suppy
patent?
emergency
sows
and
te
A
ree
to
was
part
o
procedure
branc
bood
pan
a
taken
patent
ucer
Durng
te
abdomna
x-ray
urgenty
exporaton,
resected.
contnue
severe
uprgt
to
to
o
te
and
ar
te
te
wc
A
A
CT
dsease
nerve
w
and
scan
o
and
a
transmt
nerve
nerve
surgery,
branc
te
te
artery
bowe
B.
Superor
gastroduo-
C.
Ceac
D.
Rena
E.
Superor
ng
B.
Let
naton
C.
Rgt
o
comes
aso
to
jaundce
he
artery
te
a
rgt
ureter
sows
te
s
emergency
epgastrc
patent
and
nervous
te
and
utrasound
s
stones
scedued
next
day.
gated
structure
pan.
n
and
te
or
Durng
cut.
traveng
A
aong
cut?
pexus
mesenterc
pexus
pexus
ypogastrc
ours
and
were
er
pexus
ts
Spenc
o
mesenterc
w
Seven
o
s
structures?
coecystectomy
wc
was
odged
part
sows
artery
woman
cystc
rom
abdomen
ower
ower
stone
artery
gabadder.
aparoscopc
te
er
kdney
artery
quadrant
a
te
rom
A
cava
Upper
and
o
oowng
because
duct
radatng
sympyss.
probaby
department
rgt
pan
artery
ac
40-year-od
Ineror
n
s
mesenterc
A.
artery
radates
nerve
te
Ineror
ave
emergency
tat
ematura
kdney
Wc
utrasound
umbar
a
duodenum
o
E.
A.
gastrc
stone
wc
Fourt
228.
gastrc
he
Common
te
as
nectons.
obstructng
D.
operatng
sma
te
partay
C.
boated
te
sde
nerve
pubc
an
key
depart-
to
and
ac
under
ound
er
vena
be
comes
aso
spancnc
abdomna
Ineror
duct
man
an
toward
Interna
227.
neu-
A 21-year-od woman comes to te emergency depart-
B.
duct
oowng
pexus
A.
structures?
Se
spancnc
spancnc
at
tumor
s
carryng
CNS?
toracc
Pevc
crosses
duct
epatc
perorated
dena
te
patent
ad
duct
dapragm
was
b)
abdomen
pancreas.
o
epatc
abdomen.
room.
(20
he
and
to
rgt
poycystc
capsue.
toracc
suspected,
duct
47-year-od
ment
jaundce.
kg
te
wc
A.
A
9
o
o
and
pancreatts
te
er
tract
sows
Ceac
ureter.
pan
urnary
D.
abdomna
cronc
cm
severed?
comes
n
regon.
C.
stone
o
to
B.
ment because o a 3-mont story o worsenng acute
tory
pan
kdney
Greater
back
emergency
o
A.
ment
juncton
patway
te
2
gangon
woman
wt
abdomen
te
kdney
o
a
neurectomy
gangon
mesenterc
suprapubc
stretced
key
A
nerve
39-year-od
story
neura
abdom-
sows
gangon
Aortcorena
a
te
most
ntense
nerve
Ineror
te
pancreas.
Wc
E.
to
te
o
abdomen
pancreas.
D.
A
o
story
te
te
was
department
sows
utrasound
o
225.
rad-
subsequent
are
bunted
depart-
odged?
A.
A
ower
ureters
and
most
emergency
Pysca
te
rounded
s
to
underwear
postve
rena
Were
n
back.
s
sows
were
comes
pan
ower
sowed
abdomen
but
man
severe
stans
nayss
sympatetc
o
nterrupt
te
structure
Somatc
3-mont
scan
ead
to
Pregangonc
aferent
o
CT
te
B.
A
mesenterc
A 70-year-od woman comes to te emergency depart-
ment
rgt
A
appendx
bers
and
Pysca
te
guardng.
nlamed
Wc
nlamed
depart-
nausea
tenderness
nvountary
sows
o
umbca
rebound
dameter.
te
to
A.
atng
223.
a
abdomen
n
rom
ment
222.
3-mont
quadrant
o
pan
comes
o
pan
examnaton
scan
man
because
ower
Proper
E.
gastro-omenta
55-year-od
ment
D.
ater
started
sows
to
te
vgorousy
dstended
meconum.
pexus
devery,
T wo
baby
vomt.
abdomen
abdomna
gr
began
Pysca
and
sma
x-rays
cry-
exam-
amounts
are
sown
CHAPTER
A
B
•
beow
(Fg.
ogca
3.9).
Wc
abnormates
s
o
te
te
oowng
most
key
embryo-
cause
o
Fig.
3.9
231.
ts
Deect
B.
Faure
C.
Faure
to
a
n
te
o
traceoesopagea
te
extend
muscuar
nto
o
te
tssue
Marotaton
E.
Deectve
o
rom
peuropertonea
recanazaton
D.
septum
te
o
te
te
body
wa
membrane
o
Au t o p s y
genta
poory
40
I
o
eart
od
ad
wc
newborn
deects
deveoped
years
se
a
o
and
b oy
and
peuropertonea
ad
con-
230.
An
x-ray
dvertcuum
stua
cyst
Ompaoenterc
Persstent
at
28
woud
w e e k s’
most
gestaton,
key
A
4-year-od
or
ave
ary
CT
pancreas
E.
Ogoydramnos
A
neonate
admtted
nts.
A
CT
segment
presence
tracea
o
te
wt
was
to
o
o
and
te
te
at
34
emergency
scan
an
gut
o
te
esopagus
ower
congenta
weeks’
gestaton
department
or
sows
and
endng
o
condtons
anomay?
He
o
Pyorus
B.
Frst
pneumo-
C.
Second
D.
hrd
bndy
E.
Jejunum
and
most
te
between
esopagus.
s
upper
Wc
key
seen
233.
A
o
part
s
part
parents
te
o
part
2-year-od
a
te
key
x-ray.
contrast
sma
(4–5
umbcus.
dagnoss?
te
te
emergency
patent
toeratng
up
by
det
te
most
an
key
not
unt
pyscan
deveopmenta
sows
department
does
ave
a
ew
regu-
mestones.
annuar
A
pancreas.
obstructed
by
ts
stomac
te
o
o
arge
Poyydramnos
tests.
Ogoydramnos
key
lud
duodenum
te
te
boy
s
notced
T ransumnaton
B.
duodenum
duodenum
brougt
a
Wc
o
deveoped
Anydramnos
A.
Deep
D.
Umbcoea
B.
T unca
E.
Down
C.
Processus
to
graduay
and
coecton
C.
syndrome
s
te
uceraton
oowed
a
and
most
he
was
abdomen
structure
A.
A.
stua
was
te
to
vomtng.
meetng
scan
was
and
te
communcaton
segment
cnca
ago.
tat
mate-
artery
comes
and
contrast
abdomna
ds-
nto
condton?
abdomen
abnorma
boy
syndrome
Wc
dysgeness
born
te
oowng
ts
te
vtene
be-staned
Down
wt
nserted
troug
eum
te
Ompaoenterc
E.
232.
s
Iea
D.
c a re .
eum
s
and
an
sows
te
C.
was
p re n a t a
o
B.
Poyydramnos
o
oowng
and
any
umbcus
dvertcuum
Annuar
gonada
oops
yeow-brown
cateter
acqurng
between
Mo t e r
ad
A
abdomen
te
te
te
Iea
B.
Marotaton
te
ed
o
n
A.
A.
Batera
o
ou-smeng
beore
connecton
weeks
D.
njected
kdneys
s ow n ?
C.
openng
s
a
umbcus.
o
not
o ow n g
mutpe
as
s
b a t e r a y.
utrasonograpy
te
s ow s
absence
u re t e r s
sma
Wc
te
boy
rom
ra
cm)
ntestnes
uson
newborn
matera
duodenum
membranes
229.
A
carge
condton?
A.
141
Abdomen
3
te
scrota
around
rng
abugnea
vagnas
pyscan
a
because
scrota
utrasound
oowng
abnormay?
nguna
te
enargng
normay
structures
mass.
sowed
a
deveoped
as
most
142
C H A P T E R
234.
3
Abdomen
D.
Gubernacuum
C.
Interna
E.
Dartos
D.
Latera
A
tunc
25-year-od
comes
to
te
utrasound
sows
ods
n
cavty
due
to
abdomna
expans
mont
routne
te
abdomen
bowe
aure
pregnancy
o
te
ernatng
o
uson
regon. Wc
ts
o
examnaton.
o
o
E.
239.
etus
nto
te
te
An
Superca
A
department
te
procedure
atera
oowng
presentaton?
nguna
33-year-od
te
coverng
te
erens
tat
o
so
te
man
or
a
spermatc
t
can
oowng
Nonrotated
C.
Stus
D.
Gastroscss
C.
Externa
E.
Iea
D.
T ransversus
E.
T ransversas
A
asca
dvertcuum
35-year-od
no
typca
care
aca
devers
durng
s
causng
te
wt
o
Down
ater
be.
Atresa
o
te
trd
o
te
rst
C.
Congenta
ypertropc
D.
Esopagea
stenoss
E.
TEF
a
ow-grade
sows
or
he
juncton
are
gangrene
o
ng
most
te
key
B.
Subepatc
C.
Mdgut
D.
Dupcaton
E.
Congenta
gron
as
an
key
pan
o
C.
Ionguna
emora
ce
An
CT
te
stenoss
sma
and
pyscan
x-ray
o
wa
te
tere
pan
rom
Deep
B.
Externa
and
Wc
ts
nguna
ac
area
o
s
ductus
From
nterna
de-
wc
spermatc
musce
musce
recurrent
began
but
1
bous
mont
ave
key
unxed
a
vomtng.
ago
worsened
sows
te
to
241.
oow-
pyscan
and
Wc
te
nerve
n
as
durng
sgty
Hs
postpran-
te
past
tender
and
A.
Cystc
B.
Be
most
te
pyscan
te
eve
o
suspected,
can
te
skn?
to
w
com-
skn
on
umbcus.
wc
progress
nodes
scay
s
a
pre-
squamous
rst
receve
243.
In
wc
sgn-
structures
s
artery?
duodenum
duodenum
o
to
te
crampng
and
vomtng
examnaton
upper
sows
o
ar
te
wa
n
te
or
sows
quadrant
gabadder
emergency
md-abdomna
te
postve
utrasound
tckenng.
gabadder
oowng
stes
s
a
An
and
ga-
odged?
duct
duct
Duodenum
Jejunum
E.
Ieum
o
te
te
oowng
bones
A.
13–15
years
B.
16–18
years
C.
19–21
years
D.
22–24
years
E.
25–27
years
68-year-od
ment
te
rgt
wt
key
D.
A
te
between
s
duodenum
te
dstenton,
and
C.
Wc
ange
aorta
oowng
brougt
Pysca
abdomen
tree.
most
s
242.
to
sgn
o
s
because
gastones
patent
s
man
ours.
te
by
te
te
lexure
porton
abdomna
o
te
te
o
tat
and
bub
70-year-od
24
o
porton
Duodenojejuna
stone
transmsson?
porton
T ransverse
A
o
obstructed
E.
department
because
sweng
tat
be
sows
artery
Wc
D.
x-ray
sows
to
Duodena
pan,
te
abdomen
mesenterc
C.
wt
o
te
abdomen
progresson
Wc
o
Ascendng
duodenojejuna
tckened
ymp
o
te
te
cut.
te
ayers
aponeuross
examnaton
decreased.
bary
to
comes
condton
A.
scan
past
erna.
a
and
pan,
Descendng
ntestne
s
nausea
superor
Murpy
beow
s
varous
asca
ntay
B.
spancnc
keratoss
and
obque
abdomns
A.
dagnoss?
areas
expose
obque
abdomna
o
cutaneous
o
te
emergency
Durng
musce
Pysca
canty
because
te
ntestne
wegttng
man
carcnoma.
dranage
duodenum
spancnc
abdomna
magnant
te
around
te
abdomna
epgastrc
week.
wen
because
actnc
to
comes
toracc
26-year-od
An
da
severe
sows
or
Ioypogastrc
s
he
duodenum
pyorc
ntestne.
nguna
Latera
panng
te
te
examnaton
B.
A
o
o
days.
te
te
ater
A.
Lumbar
symptoms
most
to
gated
structures
te
A 45-year-od man comes to te emergency department
wt
megacoon
ndrect
Greater
s
Cremaster
se
atresa
man
responsbe
E.
eedng.
condton
Interna
B.
gr
cecum
Pysca
D.
rst
and
240.
vovuus
32-year-od
scrotum.
o
sma
Dapragmatc
o
2
obstructed
te
newborn
syndrome
er
gr
ad
separates
cord
be
to
vasectomy.
derved?
A.
most
vesses
A.
A
part
part
brougt
marotaton
mesenteres.
s
s
ever
he
b)
not
admtted
dstended abdomen wt g-ptced bowe sounds. A
Atresa
gr
(10
ad
vomtng?
B.
2-day-od
kg
se
Wc
A.
A
4.5
pregnancy.
sorty
staned
a
However,
eatures
vomtng
vomtus
key
woman
compcatons.
prenata
begns
gut
nversus
s
scedued
pyscan
B.
ad
238.
o
sma
8t
a
Vovuus
any
237.
te
te
or
A.
wt
236.
o
te
condtons
235.
n
examnaton
part
amnotc
woman
pyscan
ac
aortc
because
subsequent
tat
man
o
orm
te
comes
pan
bopsy
age
to
durng
sow
a
ranges
best
acetabuum
te
emergency
urnaton.
tumor
represents
use?
tat
depart-
Imagng
orgnated
and
rom
te nng o te urnary badder. Durng transuretra
resecton
te
to
urnary
remove
te
tumor,
badder. Wc
o
te
te
cystoscope
oowng
enters
structures
CHAPTER
w
ng
244.
te
te
cystoscope
urnary
A.
Intramura
B.
Membranous
C.
Prostatc
D.
Spongy
E.
Parauretra
A
a
part
o
part
o
to
by
te
man
te
mdne.
A.
Let
B.
Rgt
uretra
s
brougt
o
te
wc
rest
o
testcuar
a
was
te
to
te
sweng
negatve
cancer
oowng
te
n
or
o
cancer
scrotum.
ydrocee
te
most
emergency
s
et
key
spread
and
testes
s
represents
rom
te
vena
cava;
et
vena
C.
et
D.
E.
rena
A
a
testcuar
vena
ven;
neror
Iscum
ven;
common
ac
ven;
cava
ven;
testcuar
ven;
medan
et
sacra
rena
ven;
ven;
ne-
wt
oss
et
te
te
s
a
bony
on
te
umbcus.
et
structure
oowng
ee
man
s
pam
n
te
structures
pam
brougt
to
on
sensaton
and
Pysca
rgt
o
to
te
twet
s
te
te
s
A
at
te
he
onto
ower
dd
et
te
and?
emergency
posteror
rena
te
psatera
quadratus
te
oowng
nerves
s
aso
o
postero-
te
rgt
tenderness
costovertebra
parayss
and
rgt
and
o
transversus
abdomen
te
capsue,
key
on
as
te
rom
umborum
most
te
severe
obque
scan
orgnated
n
rgt
patent
CT
skn
regons
sows
abdomna
musces.
tat
rb
he
te
pubc
examnaton
nterna
tumor
o
anteror
papaton.
enterng
vena
o
gutea
abdomns
neror
neror
o
key
67-year-od
a
testcuar
Let
et
and
to
owered
Pubs
A
ange
cava
vena
sows
kdney,
pressng
musce.
on
Wc
compressed
by
o
te
tumor?
25-year-od
routne
ormed.
woman
comes
examnaton.
totomy
were
Sacrum
D.
te
Let
ndex
C.
sde.
cava
245.
Ium
Coccyx
pan
cava
Let
ror
testcuar
most
B.
neror
et
neror
department because o an acute-onset rgt ower back
ven
ven;
skn
Wc
A.
atera
neror
abdomen
concomtanty
patent’s
E.
246.
body?
ven;
testcuar
te
uretra
part
o
on
pyscan
metastatc
Wc
route
press
o
transumnaton
testes
enter-
pyscan
because
dagnoss
te
beore
uretra
38-year-od
made.
mmedatey
uretra
department
he
traverse
badder?
143
Abdomen
3
poston
In
and
order
nsde
er
and
to
mdde
he
a
pevc
vagna
o
te
patent
papate
ngers
to
we
s
paced
patent’s
used
s
A.
Subcosta
te
B.
Latera
s
per-
C.
Ionguna
D.
Femora
E.
Ioypogastrc
uterus,
pyscans’
e
or
n
examnaton
te
te
pyscan
rgt
et
te
and
and
emora
cutaneous
nerve
to
A n swe r s
Answers
1.
A.
3.
1–25
he
cess)
s
cedes
tests
umbar
process
porton
vagnas
composed
te
upper
hs
processus
tat
vagnas
as
o
t
wa
pareta
to
a
deveopment
most
maes,
o
te
aso
as
te
are
ave
a
a
dsta
tan
n
women.
nvoved
B,
C,
A.
and
289;
Wms
can
caused
be
suppressor
D,
by
to
a
nguna
kdney
as
n
are
are
285,
not
A.
B.
not
nvoved
te
WT1
2-t
and
E.
kdneys
gene,
mode
or
hese
373–374;
N
genes
Wms
311;
are
not
nvoved
E.
beav-
ABR/McM
265,
268
to
o
ts
arrested
te
typcay
poston
te
by
te
neror
te
about
te
are
poes
“ascent”
mdne
mesenterc
s
on
kdneys
neror
rst
“ascend”
g
te
appens,
kdney
te
Müeran
o
struc-
artery.
0.25%
o
he
o
te
duct
uson
process
uterus
occurs
descend
at
te
C.
In
ton
o
ageness
wen
rom
one
te
s
te
te
or
bot
abdomen
o
te
nto
te
maormaton
s
nstead
ocated
o
ts
at
o
te
norma
te
ven-
oca-
pens.
congenta
aure
o
absence
one
or
o
bot
rena
ts-
kdneys
to
embryogeness.
N
kdney
te
openng
pens
o
rom
373–374;
durng
congenta
te
te
durng
norma
a
n
ead
resutng
GAS
te
s
were
surace
Rena
sue
tumor
n
a
Atoug
bcornuate
Hypospadas
ton
t
4.
T umors.
to
a
deveop
nvoved
s
Cryptorcdsm
tra
usuay
tat
Wen
orsesoe
rse
uretra,
tat
to
occasonay
encounter,
o
wa.
kdneys
scrotum.
n
D.
sown
use.
Interrupton
gves
288
been
tey
testes
magnancy
Knudson
used
men
cana.
recenty
mutatons
structures
te
ernas.
structures
ABR/McM
It
te
sted
n
kdneys
te
pevs
popuaton.
processus
common
te
structures,
2
genes.
mutatons
GAS
s
more
nguna
te
264;
cdren.
accordng
C,
o
are
oter
hese
tumor
n
B,
he
E.
N
occurs
ng
ernas
congenta
ormaton
GAS
2.
n
D,
te
nguna
n
abdomna
ncdence
o
deveopment,
poston
te
ture
tunca
vagnas tat extends nto te abum majus, atoug
congenta
a
batera
te
typca
Durng
posteror
pre-
n
C.
rom
pro-
abdomen.
ony
tests
eatures
emaes
tat
poston
eavng
te
tese
a
outsde
obterates,
Wereas
n
rom
poston
surrounds
seat-ke
pertoneum
“mgrates”
usuay
tests.
(meanng
eta
312;
ABR/McM
deveopment
perod
wt
269,
te
te
260
kdneys
unc-
resutng
urne
144
C H A P T E R
3
Abdomen
contrbutng
te
kdneys
buton
lud
A.
to
to
te
a
te
to
lud
lud
s
s
te
a
amnotc
(rena
mssng
(ogoydramnos)
Anencepay
n
deveop
cavty.
ageness),
and
ts
decreased
Wen
part
o
hs
an
portons
deect
eves
Pyorc
pc
be
amnotc
stenoss
outet
crcuar
spectrum
s
o
neura
a
s
an
to
o
7.
deveop.
pregnancy
apa
as
wt
our
to
acqured
6
pyorus.
he
te
te
o
A.
tckenng
a
deveopment
here
owever,
o
te
tra
o
te
ton
wt
B.
A
bnd
5.
A.
hs
GAS
373–374;
here
nked
are
severa
te
most
esopagea
o
te
types
o
pouc
tracea
ts
common
but
D.
ma-
wt
mates
a
C.
here
are
are
deects
E.
cause
wc
poyura.
tus
Rena
eadng
dramnos).
maturty
Ectopc
o
te
are
not
mportance
a
to
6.
C.
In
norma
creatc
tube
a
bud
and
n
eta
w
and
he
as
o
o
te
s
te
be
or
te
o
te
ventra
te
urne
he
nc-
7000.
a
o
wt
s
lud,
congenta
nstead
creatng
perssts,
nguna
ocated
o
ts
to
processus
at
a
te
erna.
maormaton
s
con-
reated
te
vagnas
openng
te
vagnas
tat
porton
s
pens
o
o
te
norma
te
ven-
oca-
pens.
vagnas
w
not
afect
mae
A.
and
atresa,
B.
D.
s
rena
te
lud
uretra
N
215;
deveopment,
te
dorsa
bud
tube
pancreatc
ABR/McM
dorsa
(ogoy-
te
juncton
te
hs
gy
n
tat
around
an
s
te
annuar
afected
enters:
211
bud.
te
s
a
o
on
te
te
ure-
dorsa
ocaton
at
279
n
te
sgty
nto
A
te
woud
o
te
or
tests
tests,
gonad
scrotum
ower
were
tan
core
spermato-
tat
scrotum
oter wse
occurs
cromosoma
o
te
s
tubues
s
be
o
cannot
usuay
prone
to
as
te
gand
ead
curvature
coexstence
occurs
te
s
wen
syntetc
ormones.
wc
upward
and
gen-
oces.
bocemca
weren
gonads
sex.
ovaran
te
te
externa
yperpasa
(eter
te
but
dened
suprarena
curved
wen
sex,
opposte
and
n
condton
abnorma
GAS
D.
he
289;
pan-
te
gut
Rarey,
ventra
te
same
part
o
N
atera
muscuar
pancreas.
second
s
by
or
sat
most
te
ead
downward)
o
te
obvous
o
at
pens.
durng
erecton.
s
o
t
te
a
descend
undescended
mportant
suprarena
o
s
to
afected
norma
278,
uncton.
aberratons
patways
Cordee
ts
mgraton
s
ermaprodtsm
are
ocated
an
ocaton
hs
eatures
Congenta
as
not
cancer.
semnerous
pens
by
a
reocated
te
ventra
sde
pancreatc
rotates
duct
te
T rue
tere
ageness.
to
testcuar
express
o
caed
temperatures
te
s
ABR/McM
oten
ncompete
to
te
afected
o
nstead
Pseudoermaprodtsm
o
can
369;
o
s
pens.
because
taa
or
N
tests
maormaton
openng
pens
te
a
process
congenta
te
testcuar
me-
con-
a
te
o
surgcay
represent
and
s
wen
hs
vagnas.
temperature.
One
mpared,
excreton
amnotc
by
resutng
gut
te
occurs
abdomen
removed
amnotc
Feta
o
265;
te
be
E.
producton
not
around
tube,
tests
congenta
te
wc
exposed
geness
dabetes
esopagea
obstructng
wt
s
assoc-
ncreases
may
or
decreased
pancreatc
gut
porton
were
t
congenta
poyydramnos.
mpar
etus,
rotates
duct).
n
245
processus
processus
resut
abnor-
ypergycema
poyura
to
373–374;
uses
porton
sde
rom
9.
170,
te
be
poyydramnos.
swaowng
vscera
a
n
Cr yptorcsm,
body
ogoydramnos
actors
n
resuts
Suractant
te
o
tests
ead
ncudng
congenta
poyydramnos
Feta
to
C.
s
o
unkey.
GAS
8.
deveopment.
reported
tese
s
poyydramnos.
ageness
etus,
te
GAS
apparenty
ung
surace
266
abnormates
materna
eadng
n
oten
deveop
s
processus
n
deveop
anencepay
resut
to
wt
resut
o
aso
were
exampe,
E.
can
eta
dtons
D.
severa
tus,
lud,
nked
ure-
s
norma
dsease
265,
te
hs
However,
not
to
ead
Epspadas
e.
ogoydramnos
reated
n
o
wt
ungs.
tat
materna
aso
Ectopc
patent
dsta
tat
congenta
kdney
ypopastc
ABR/McM
ungs.
lud
TEFs.
t
(cryptorcdsm).
anomay
and
absence
ncompatbe
311;
rater
amnotc
poycystc
congenta
s
evdence
ypopastc
Gentournary
ated
te
N
some
nk
adequate
s
condton
s
to
genetc
B.
atresa
tra.
te
patent
tra,
Uretra
1
processus
vagnas
entre
were
surace
te
ntermedate
te
key
at
o
tunca
an
I
uretra,
TEF .
E.
te
I
ABR/McM
porton
perssts,
s
o
present
be
about
pancreas.
288;
Hypospadas
brt.
obstructon
te
s
sterty.
abnorma
ormaton;
to
tests.
patent
con-
N
dsta
vagnas
ypertro-
weeks
Inants
C.
ydrocee.
common
wt
pancreas
annuar
366
trbutes
etoproten
nante
reatvey
progressve
te
to
an
GAS
anencepay.
known
s
as
(aong
annuar
A, B, D, and E. hese structures w not be compressed
vomtng.
esopagus.
conssts
tube
durng
n
wtn
due
musce
projecte
and
aso
stenoss,
occurrng
gastrc
TEF
eevated
stenoss,
Pyorc
neura
notced
o
by
te
addtonay,
are
pyorc
dton
D.
can
te
utrasound;
(AFP)
B.
o
duodenum
dence
resuts.
tube deects (NTDs). Anencepay occurs wen te
upper
te
contr-
porton
Faure
o
suc
an
as
368;
ods
te
ABR/McM
are
o
atera
umbca
key
te
ods
278,
279
structures
anteror
can
erna,
or
cause
a
n
ormng
abdomna
a
major
mnor
deect,
te
wa.
deect,
suc
as
gastroscss.
A,
B,
C,
not
na
and
E.
nvoved
hese
n
oter
ods
ormaton
o
and
te
te
wa.
GAS
261,
308;
N
254;
ABR/McM
amnon
anteror
232
are
abdom-
CHAPTER
10.
A.
Rotaton
o
deveopment
tube
rotate
ccay
ony
or
te
B,
D,
and
te
GAS
B.
he
te
era
o
C5.
tve
C,
D,
not
he
tat
n
to
a
and
a
are
te
N
as
toracc
te
torax.
o
oter
rom
esopagus
te
te
to
o
201;
nto
te
B.
gan-
and
E.
muscuar
2
C3,
wen
Wt
ow
or
abdomna
by
o
B.
s
C.
coud
cause
rom
D.
te
aspraton
E.
A.
I
te
esopagus
hs
s
knd
not
te
o
Abnorma
o
woud
not
deveop
woud
end
atoug
an
nto
a
te
as
bnd
n
wt
TEF ,
tracea,
16.
and
but
t
s
not
te
be
drect
cause
o
A,
Abnorma
E.
Abnorma
tongue
deveopment
does
not
resut
n
a
cated
GAS
o
he
te
A.
B.
wt
172;
a
N
te
parynx
s
not
asso-
17.
TEF .
237;
septum
o
n
ABR/McM
transversum
208
orms
centra
tendon
he
peuropertonea
part
o
he
peuropercarda
cavty
ods
orm
te
posteroatera
B,
dapragm.
rom
te
ods
peura
he
cervca
dapragm.
myotomes
te
descent
absence
o
an
a
o
not
cause
xed
vo-
mesentery
ntestnes.
ces
s
nto
due
te
to
auty
wa
o
parasympatetc
creatng
coon
o
be
a
unctona
proxma
to
te
te
post-
bock-
bock.
290
(Hrscsprung
neura
crest
ces
dsease)
to
mgrate
o
wt
te
or
coaca
woud
wtout
te
resut
n
presence
o
recanazaton
weren
are
or
not
no
o
C,
te
cause
most
can
and
E.
n
resuts
cana
due
to
and
n
rec-
ncompete
s
te
ndgut
can
a
decency
o
common
s
a
attaced
but
lud,
woud
dsease.
249
approxmatey
he
vovu-
amnotc
ypopasa
ABR/McM
tese
cause
ste
o
2
persstence
to
parts
te
o
optons
o
rom
te
dvertcu-
te
vtene
umbcus.
te
are
eet
Mecke
abdomna
not
derved
vscera
rom
te
duct.
315;
N
281;
ABR/McM
common
uterne
os
be
coon
ana
contents.
pumonary
eum
most
te
o
ts
271;
te
connected
Hrscsprung
N
o
te
recanazaton.
outpoucng
t
bot
o
ste
(aopan)
te
nterna
cer vx
os
o
233
ectopc
tube.
can
te
o
resut
cer vx
pregnancy
Impantaton
s
n
pacenta
not
te
n
s
te
preva,
most
com-
ste.
C,
D,
and
E.
he
oter
coces
sted
are
not
te
most common stes o ectopc pregnancy. he endo-
separate
cavty
and
te
orm
percarda
te
metrum
brous
ste
percardum.
D.
can
te
hs
and
he
mon
A.
coon.
rotaton
321;
s
B,
but
and
eter
o
dsta
nterna
te
dapragm.
te
A.
te
but
cause
GAS
deveopment
te
ack
separaton
twstng
vtene
TEF .
tat
sc-
gangrene.
o
te
megacoon
crest
a
aure
o
presented
C.
C.
exst
he
duct
o
ABR/McM
Ogoydramnos
D.
n
cause
vovuus.
woud
st
megacoon
atresa,
or
cecum
assocated
n
270;
te
Deectve
um.
can
N
aure
GAS
t.
13.
he
not
tube.
resut.
deveopment
tereore,
correcty,
as
assocated
openng
not
tracea
wt TEF ,
t
deect,
resut
pneumona
B.
dd
atresa,
can
aure
ntestne
neura
ageness
wc
esopagea
ma-
vascuature
o
n
o
mesentery.
stua.
us
pneumona.
to
resuts
woud
enarged
canazaton
presence
lud
te
tere
neurons
was
tum
(esopa-
he
o
308;
recta
downgrowt
te
hs
cause
te
270
xed
resutng
a
due
movement
Incompete
a
270
oregut
tube.
passage
and
te
te
s
and
225,
wtout
around
not
o
dapragm.
compcaton
tem.
agangonc
o
an
rom
ana
w
o
Congenta
nto
ods
posterory.
225,
te
A.
resuts
organs
bud
resutng
and
GAS
15.
nega-
mentoned
ree
Congenta
age
s
mesentery
te
coon.
gangonc
one
pos-
no
oop
ntestne,
cecum
because
coon,
and
te
o
ABR/McM
or
atresa
ceca
mgraton
bat-
C4,
o
dorsa
possbe
twst
support
Dupcaton
vuus
a
mdgut
Subepatc
te
te
crura
201;
s
ntestnes
ascendng
D.
200,
te
necross
o
dapragm.
septum
tracea
o
become
be
N
Dapragmatc
267
nnervated
and
ABR/McM
n
te
o
sma
o
te
vovuus
provdng
nerve.
peuropertonea
aryngotracea
resut
to
dapragm
wa
s
myobasts
te
occurs
cavty,
te
251,
deveop.
mecansms
ventra
woud
are
o
regon,
rom
cavty,
he
te
traceoesopagea
stua
musces
he
o
part
orms
163;
Mdgut
rotaton
hs
rotaton
vagus
Later,
orm
derved
te
200,
C5.
C.
emc
w
cervca
to
CT
surace
dorsa
GAS
14.
components.
consdered
abdomna
he
severa
dapragm
eventraton
371;
wa
hese
te
et
(wc
and
spe-
rotates
poston
ABR/McM
te
oten
porton
E.
separates
gus)
te
nto
cause
GAS
o
n
pressure
pused
contrbute
D.
body
tat
o
n
C4,
emdapragm
pressure
tve
12.
C3,
te
Eventraton
muscuar
A,
orms
te
he
esopagus
torax.
and
depct
rom
E.
te
standard
anteror
te
o
transversum
rom
nerves
270;
deveops
septum
(te
te
o
oregut,
esopagus,
te
rotatons
N
n
Parts
countercockwse.
onto
accuratey
dapragm,
prenc
proxma
beow
s
event
system.
te
orentaton
emdapragms.
te
major
troug
oter
363–364;
rom
te
nerve
not
and
tendon)
n
a
te
rom
passes
dapragm
mgrate
are
do
nnervaton
part
t
s
orms
rotaton
he
tube
centra
ng
as
E.
261,
Intay,
te
Lookng
ts
nerve
gut
but
tat
vagus
esopagus
C,
vagus
11.
et
tube
degrees,
vew),
te
gut
gastrontestna
porton
degrees.
MRI
brngs
te
270
tat
90
te
o
145
Abdomen
3
o
GAS
orm
te
muscuature
o
te
18.
A.
he
era
n
te
undus
o
te
uterus
s
te
norma
mpantaton.
471,
524
greater
vscera
N
304;
toracc
aferent
ABR/McM
spancnc
bers
rom
287
nerve
carres
abdomna
gen-
organs,
146
C H A P T E R
3
Abdomen
speccay
te
occurrence
B.
o
he
dorsa
era
somatc
resut
as
D.
he
are
t
does
he
rom
GAS
An
bowe
rng
te
tat
te
A.
S2
he
pan
to
S4
38;
te
carry
tese
not
gen-
B.
nerves
and
he
bers
du
vscera
aferent
but
are
and
D.
aferent
nguna
te
runs
parts
o
306;
erna
cana
troug
o
te
he
E.
bers
tey
do
vscera
te
pevs
he
tat
te
ABR/McM
occurs
not
A.
troug
epgastrc
te
gentas
and
deep
vesses).
nguna
abum
te
cana
majus
coud
a
o
B
or
rom
to
be
D.
on-
he
nnervate
ac
and
E.
compressed
compressed
by
te
te
crest
trunk
and
superor
eve
receve
beore
te
aor tic
Inferior
and
o
mesenteric
iliac
stomac
and
nto
mesenterc
not
cava
ymp
neror
to
nodes
te
Fg.
358;
and
nodes
not
rom
rom
receve
stomac
are
ymp
organs
te
stom-
dranage
and
not
assocated
dranage
te
rom
stom-
rom
wt
te
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
te
duct.
with
•
and
dranage
dran
dranage
Common
Exter nal
ymp
tey
neror
ympatc
lateral
Inferior
te
234
nodes
vena
te
skn
to
chyli
trunk
(lumbar)
o
muscuature
toracc
Pre-aor tic
lateral
band
neror
trunk
Cister na
lumbar
te
ABR/McM
nodes
stomac
ymp
dranage
erna.
263;
Superior
Right
nnervates
te
and
nnervates
Celiac
Intestinal
te
drecty.
Hepatc
(GAS
be
N
receve
umbar
GAS
to
nerve
te
he
structures
are
key
o
tse.
durng an ndrect nguna erna. he oter nerves sted
not
nerve
nnervates
ac
ymp
ymp
C.
ac
nguna
scrotum
skn
perneum.
298–299;
and
o
te
ceac
beow
he
te
tg.
nerve
te
he
ntestna
not
oop
to
GAS
drecty
246
wen
nnervates
cutaneous
atera
pudenda
skn
aferent
but
emora
te
subcosta
nodes
neror
porton
over
nerve
regon.
umbcus.
parasympatetc
contan
rom
atera
skn
gabadder.
relexes,
pan
N
nguna
oypogastrc
superor
carres
vscera
vscera
nerves
rom
pan.
nerve
nnervate
transmt
te
to
nerve
proxma
te
20.
358–365,
anteror
n
gabadder.
ndrect
enters
guna
Pan
ocazed
spancnc
rom
(atera
spna
reerred
carres
or
nvoved
pan.
pevc
bers
n
not
be
suprapubc
bers.
sarp,
nerve
can
toracc
prenc
mportant
nerves
C.
n
te
vagus
transmt
o
occurs
Atoug
and
pan.
aferent
dfuse
bers,
19.
ram
woud
C.
E.
oregut,
reerred
nodes
CHAPTER
21.
B.
he
te
proper
epatc
epatoduodena
occuded.
hs
artery
passes
gament
artery
es
and
wtn
superory
tereore
te
rgt
Inferior
wtn
woud
anteror
epigastric
Abdomen
3
vessels
be
ree
Extraperitoneal
fascia
Deep
inguinal
ring
margn o te omenta (or eppoc) oramen (o Wnsow).
Parietal
A.
he
superor
abdomna
mesenterc
aorta
artery
neror
to
brances
te
rom
peritoneum
te
epatoduodena
gament.
C.
he
spenc
not
D.
artery
ocated
he
n
common
proper
he
neror
margn
woud
artery
te
be
te
artery
but
stomac
gves
does
and
s
gament.
orgn
not
run
to
te
wtn
Conjoint
tendon
te
gament.
vena
o
not
bend
epatoduodena
epatc
epatc
epatoduodena
E.
runs
te
cava
Superficial
s
ocated
omenta
at
oramen
te
22.
E.
343;
Indrect
te
A.
N
Drect
wa
C.
to
nguna
deep
Femora
and
tereore
Lumbar
ror
deep
nguna
ernas
to
ext
ernas
abdomna
vesses
Hessebac)
nguna
o
T estis
troug
and
do
not
rng.
troug
te
umbcus,
not
•
rng.
te
(Grynet)
ernaton
rng.
anteror
epgastrc
(o
ext
rom
nguna
te
neror
troug
nguna
can
or
te
emora
rng
GAS
Fig.
4.48
pos-
gament.
penetrate
neror
sac
234
resut
deep
penetrate
te
ernas
teroneror
D.
te
trange
te
Umbca
te
commony
ernas
penetrate
B.
ABR/McM
troug
meda
te
291;
ernas
ntestnes
troug
(Pett)
te
umbar
supe-
Inferior
epigastric
vessels
tranges. Deep
(GAS
Fgs.
ring
camped. Peritoneal
GAS
inguinal
posteror
4.48
and
inguinal
ring
4.49)
Extraperitoneal
GAS
298;
N
263;
ABR/McM
235
Parietal
23.
C.
he
omenta
posteror
most
A
to
key
and
B.
te
he
posteror
hs
to
esser
te
sac
or
ocated
tereore
pouc
ver
can
s
pertonts
subepatc
space,
space
and
deveop
rgt
to
or
stomac
space
epatorena
ney.
bursa
and
woud
(aso
be
te
caed
Morson)
anteror
potentay
drecty
ntay.
space
o
to
s
te
rgt
accumuate
te
te
area
kd-
lud
and Conjoint
may
te
partcpate
patent
s
n
n
pertonts
te
supne
but
fascia
peritoneum
prmary
tendon
wen
poston. Superficial
D.
he
rgt
subprenc
dapragm
on
accumuate
Pertonts
patent
E.
te
(GAS
GAS
C.
to
coud
n
te
rgt
rom
sde
a
just
and
n
ts
neror
s
perorated
deveop
supne
es
area
not
to
key
stomac
ony
te
Peritoneal
he
te
stomac
Fg
to
wen
te
poston.
et
s
not
key
to
enter
te
greater
sac
N
gastrc
epatc
T estis
273;
ABR/McM
ven
porta
carres
ven.
241
bood
Above
rom
te
te
stomac
esopagea-gastrc
•
wt
pressure
te
he
et
n
te
te
porta
ven
(porta
(cava
system
te
and
speen
anastomoss.
ven
vens
causng
spenc
rom
gastrc
esopagea
anastomoss,
A.
ring
ucer.
4.102).
304;
juncton,
ses
inguinal
bulge
Fud rom a perorated ucer on te posteror aspect
o
24.
s
te
lud
space
causes
ruptured
ts
and
system)
system).
g
trbutares
do
not
pressure
esopagea
carry
orm
a
GAS
Fig.
4.49
anastomo-
Hg
bood
n
ts
B.
bood
et
wt
away
cava-porta
he
gastro-omenta
gastro-omenta
varces.
D.
he
te
no
et
drect
ven
and
anastomoss
epatc
neror
artery
ven
vena
s
cava.
a
accompanes
jons
wt
cava
te
cava
ven
te
spenc
et
ven
vens.
and
emptes
nto
147
148
C H A P T E R
E.
he
te
not
3
Abdomen
rgt
gastrc
stomac
ave
GAS
and
any
269,
ven
s
cava
354;
N
drans
part
o
te
te
anastomoss
296;
esser
porta
(GAS
ABR/McM
curvature
system
Fg.
but
o
25.
does
C.
he
tra
4.41).
skn
258
to
part
Diaphragm
Subphrenic
recess
o
te
L1
te
and
emora
traves
pes
Liver
gentoemora
ram
as
ner ve
L2.
trange
part
o
cremaster
orgnates
he
area,
te
musce
rom
“emora”
wereas
spermatc
and
aba
te
part
te
cord
or
ven-
suppes
“gento”
and
sup-
scrota
skn
anterory.
A.
he
te
o
B.
onguna
skn
te
he
over
nerve
te
scrotum
root
n
over
bers
te
te
rom
pens
L1
and
and
suppes
anteror
part
maes.
oypogastrc
sby
arses
o
nerve
rom T12)
ypogastrc
and
arses
rom
suppes
regon
and
L1
skn
(and
pos-
nnervaton
anteroatera
gutea
regon.
D.
E.
he
vate
cremaster
te
he
ventra
ower
GAS
296–298;
o
o
N
to
260;
n
T12
te
nnervaton
sexes
but
aso
anteror
te
GAS
Fig.
ABR/McM
aba
s
tssues
musces.
ormed
between
It
by
te
o
te
represents
abdomna
fascia
Transversalis
fascia
Transversus
abdominis
muscle
Internal
abdominal
External
oblique
abdominal
muscle
oblique
muscle
Testis
Processus
Gubernaculum
•
GAS
Fig.
4.41
to
not
te
nner-
assocated
abdomna
cremasterc
4.102
Extraperitoneal
does
maes.
s
wt
wa;
t
relex.
271
a
te
rgt
vaginalis
ntersecton
and
mdne
Kidney
•
peritoneum
musce
contrbute
nea
aponeuroses
Parietal
provdes
bot
26–50
he
abdomns recess
porton
not
aponeurotc
Hepatorenal
or
ramus
does
Answers
E.
nerve
gentaa
te
26.
pudenda
externa
musces.
et
unon
o
rectus
o
te
CHAPTER
A.
he
mdaxary
stragt
B.
ne
he
arcuate
ne
tat
ncson
he
te
D.
dvde
ay
we
Fg.
A.
to
te
n
a
E.
o
te
separate
tus
posteror
te
nppes
rectus
musce
not
An
by
and
28.
252;
o
nto
te
s
ABR/McM
te
tck,
adpose
magnary
usuay
te
paraes
te
rectus
sectons
2
aong
rectus
are
tese
seats
nature
ts
o
B.
(GAS
tc
te
s
anteror
o
te
tssue
typcay
ayer
te
tat
ste
to
deep
abdom-
D.
makes
up
mantan
E.
and
tends
ncreased
sue
asca
not
to
ceuar
ound
n
T ransversas
D.
Extrapertonea
muscuature
te
a
od
asca
and
pareta
atty
we,
te
due
to
connectve
29.
ts-
assocated
asca
s
deep
to
te
deepest
o
te
ayer,
pan
te
orm
duct
te
be
to
ts
to
be
to
enter
C.
he
to
bood
292;
trd
te
N
rom
287;
part
o
te
ead
a
o
to
te
backup
more
o
epatc
superor
wt
te
te
cys-
gabadder
(dranng
s
not
due
two
te
abdomna
mesenterc
aorta).
ver
to
te
ver)
afected
to
a
ack
by
o
an
any
ducts.
te
ABR/McM
neror
artery
(a
Because
and
takes
a
cava.
pat
posteroneror
major
te
vena
256
duodenum
aorta
ventra
trd
part
branc
o
te
ante-
to
o
te
te
duode-
num es n te ange between (“sandwced” between (as
adjacent
abdomna
s
wa.
a
nut
tons
o
n
a
ts
nutcracker)
porton
o
tese
te
External
alba
oblique
two
structures,
duodenum
part
can
muscle
abdominal
muscle
abdominal
of
external
oblique
spine
Inguinal
•
GAS
Fig.
4.27
ligament
constrc-
occur
of
major
Aponeurosis
iliac
cystc
nerory
duct.
duct
te
pectoralis
superior
te
common
muscle
Linea
rec-
posteror
te
untes
duct
duct
Abdominal
Anterior
and
ocated
and
be
be
o
passes
causes
and
s
be
epatc
between
ayer
te
duct.
pancreatc
te
te
to
jaundce.
duct
te
t
enter
ste
duct
and
aows
common
unon
and
gament
pancreas
connectons
abdomna
aponeuroses.
te
to
o
at
epatc
s
233
te
duct,
be
o
ror
abdomna
ead
accessory
superor
ocated
te
obstructon
GAS
te
by
duodenum
obstructon
seat
superca
he proper epatc artery w not be obstructed, or t
(subcutaneous)
ayer.
s
dorsi
as
versus
pertoneum
Latissimus
ayer
sutures
content
Scarpa
C.
to
s
ABR/McM
ormed
resutng
te
carres
Camper
rectus
and
anterory.
epatc
te
reeases
he
reatvey
o
cystc
and
s
troug
duct
he
te
asca
musce
324;
common
te
o
epatoduodena
An
wt
to
N
duct
part
rom
Because
connectve
ayer
te
he
nter-
wa
Scarpa
common
back
duct,
usu-
sutures.
B.
and
rst
229
n
276;
be
pancreas.
abdomns
and
to
abdomns
he
be
membranous
asca
(subcutaneous).
asca,
A.
duct
rectus
seat.
ncson
dvde
an
deep
GAS
seat.
te
anteror
just
orzonta
abdomns
represented
te
te
he
axa.
C.
asca
toug
Scarpa
not
o
and
wtn
s
dened.
N
Camper
wa
tck,
w
curved
edge
rectus
ntersectons
woud
278;
Scarpa
na
a
jont
4.27).
GAS
27.
beow
tendnous
sectons
s
ower
te
ne
ne
edge
musces
not
te
vertcay
souder
Dougas)
o
ts
orented
te
seats.
ne
atera
he
at
semunar
vertca
(o
porton
abdomns
C.
ne
s
to
represents
tendnous
An
ne
neror
149
Abdomen
3
muscle
ready.
150
C H A P T E R
A.
3
Abdomen
he
second
and
to
te
normay
terc
B.
part
n
cose
duodenum
te
es
abdomna
proxmty
to
parae
aorta
te
and
superor
wt,
s
C.
he
not
te
anteror
te
superor
he
rst
abdomna
part
o
he
mesen-
te
te
he
creas
s
s
346;
te
to
contnues
second
rom
part
o
anterosuperor
mesenterc
extenson
and
mesenterc
N
288;
to
D.
o
artery
to
te
to
rom
sma
urter
ABR/McM
te
te
te
creas
te
omenta
te
structures
speen
he
te
rom
and
248
artery
ceac
suppy
s
te
gated.
trunk
pan-
It
rom
n
A.
348;
he
coces
to-
It
es
exbted
tese
superor
rom
anastomose
wt
te
pancreatcoduodena
te
gastroduodena
and
posteror
anteror
arteres
branc
o
and
(wc
te
brances,
posteror
take
common
te
orgn
epatc
he
o
neror
te
mesenterc
tree
man
gastrontestna
te
B.
et
he
coc
et
artera
tract.
lexure
gastrc
artery
It
to
artery
s
te
brances
suppes
te
s
most
te
B.
ndgut
te
branc
o
C.
he
te
esopagus,
he
epatc
esser
wt
he
artery
te
et
proper
It
s
trad
GAS
B.
he
py
to
terc
348;
mdde
te
o
s
te
bot
to
te
ror
rom
tomotc
A.
he
et
coc
or
It
ound
It
and
D.
te
and
E.
badder.
group
ree
and
ormng
edge
o
te
It
and
wt
artery,
te
as
artery
a
o
te
et
greater
by
supe-
artery,
hs
he
a
te
te
curvature
as
te
spenc
o
te
o
te
prenc
o
te
s
occurs
A.
he
at
wc
he
do
not
te
appendx,
drect
rr-
te
to
umbcus
te
ste
o
te
ver
and
abdomna
It
s
s
pos-
quadrant,
not
assoc-
sgn.
te
n
stomac
and
te
te
and
s
pos-
duodenum.
upper
et
It
quadrant
umbcus.
te
pevs
anteverted
and
be
280;
ave
over
meda
afected
to
by
ABR/McM
spread
cose
he
spna
to
souder
and
s
te
te
pos-
urnary
opsoas
lexon
o
psoas
pan.
proxmty
nerve
spna
271
te
dapragm
bateray,
prenc
tat
nerve
hs
to
s
wc
eves
cord
dapragm
and
te
and
because
superor
nnervated
descend
C3,
te
s
C4,
to
and
reerra
somatc
o
by
te
C5.
pan
aferents
eves.
coon
rom
carry
s
lexure.
spancnc
o
because
4.22).
nnervates
coc
te
patent
sgn.
to
wtn
and
n
duodenum
wc
et
nerves
wt
s
te
to
umbcus.
speen
not
N
te
tose
psoas
te
te
te
lexon
and
s
o
he
hs
reated
rgt
neror
te
not
bend
to
descendng
tetc
C.
at
wen
neror
s
psoas
reerred
between
enterng
to
Fg.
rom
probaby
pan.
tat
and
occur.
es
ocated
es
sgn
neror
te
nerves,
o
artery.
ony
assocated
o
attempted.
can
and
kdneys.
duodenum
gastroduodena
no
branc
structure
beneat
es
may
te
psoas
upper
319–320;
cosey
reerra
prmary
es
stomac aong wt te rgt gastro-omenta branc
te
suppes
quadrant,
contact
woud
abscess
dapragm
anas-
It
dapragm
poes
It
s
(GAS
causng
te
artery.
known
o
suppy
coon
margna
aso
rst
suppes
te
coc
artery.
branc
te
and
o
sup-
mesen-
bood
branc
te
artery,
s
one
descendng
coc
to
s
coatera
neror
coatera
mesenterc
reerred
suppes
te
mesenterc
and
GAS
B.
es
and
musce
be
provde
pan-
gastro-
248
key
drecty
antelexed
ver
te
te
et
suppes
musce,
es
superor
common
o
was
postve
uterus
te
248
gated.
rgt
s
he
te
n
arg-
suppes
o
termna
and
ower
most
postve
between
rom
structures
te
es
superor
tereore
anastomoses
a
te
a
most
badder
pancreas
suppy
wen
coon
s
toned
common
suppes
n
wt
he
proper
33.
can
gastro-omenta
and
to
provdes
te
gastroeppoc
artery
arses
tree
coon
neror
s
o
artery
artery
canne
et
s
superor
te
te
s
ts
pevs
wt
toned
ABR/McM
ascendng
mesenterc
branc
one
291;
wt
o
stomac.
te
gament.
coon.
anastomosng
te
trunk.
stomac
artery
bocked
transverse
branc
ascends
descendng
artery
brances
te
N
a
o
rom
artery.
and
epatoduodena
arses
ceac
te
gastrc
and
s
te
o
epatc
gabadder.
curvature
artery
rom
artery
porta
esser
wc
curvature
epatc
te
te
gastrc
artery,
epatc
D.
and
rgt
o
gabadder
ated
s
way
appendx
te
or
wc
ceac trunk and suppes te GE juncton, te neror
C.
It
te
It
and
no
mdgut.
oten
ta
por-
coon,
ndgut.
artery
rgt
postve
urnary
pan
rom
a
t
musce
te
toned
smaest
and
ne -
ave
or
trunk.
stomac.
or
artery
and
gastrc
ABR/McM
te
by
lexon
wtn
rectum.
te
to
he
neror
suppyng
upon
taton
artery) n suppyng te pancreas wt oxygenated bood.
A.
te
te
resstance
opsoas
and
s
n
regon
aganst
anteror
295;
provded,
umbca
p
as
recta
N
aso
wc
to
body,
mdgut
sgmod
ar ter e s
ceac
sort
te
ner or
oregut
ongest
neck,
mesenterc
appendx
dena
artery,
te
te
te
provdes
te
superor
te
rom
brances
neror
nlamed.
arses
te
and
aso
s
te
s g mod
to
rom
te
rectum.
32.
w
he
artery
suppy
coon,
brances
arsng
brances
and
descendng
spenc
artery
are
ar ter y
rectum.
te
ntestne
removed
te
racc aorta. Its rst branc s te neror pancreatcoduo-
and
31.
and
GAS
artery
te
o
he
artery.
mesenterc
neror
s
ton
est
te
ocated
gastroduodena
mmedatey
anteror
E.
an
duodenum
superor
ead
t
traves
aorta.
superor
GAS
but
ar teres
mesenterc
contrbutng
artery.
duodenum
to
superor
jejunum
ater
te
tus,
te
abdomna
E.
o
lexng
duodenum;
orgn
cavty
mesenterc
sgmod
ror
artery.
pyorus,
E.
te
o,
he transverse coon takes a orzonta pat troug
D.
30.
o
rgt
s
S2
s
S4
and
by
parasympa-
vscera
aferents,
pan.
nnervated
te
by
te
vagus
gastrontestna
Sympatetc
provded
nerves,
nnervated
to
rom
by
eves
nerve,
tract
to
te
nnervaton
to
te
te
greater
T5–T9.
toracc
Innervaton
CHAPTER
B.
Intercosta
part
o
nerves
te
aferents
or
abdomen.
pass
by
D.
pan
hereore,
way
o
to
ram,
te
he
prenc
aso
carres
peura
and
wt
any
he
vagus
medua
upper
Left
quadrant
upper
nerve
he
no lower
Left
o
spna
way
o
aferent
but
te
ascends
te
not
te
pancreas
It
and
medastna
does
te
te
roots.
dapragm
t
bran.
to
nay
dorsa
rom
a
te
commun-
nerves,
rom
bers
o
pancreas
nerves
o
te
te
aferents
enters
te
carry
pancreas.
wt
way
as
up
no
para-
to
te
vscera
pan.
quadrant
nerve
s
structures
vscera
aferents
rom
beow
rom
te
te
te
eve
o
pancreas
T12
and
and
carres
pancreas.
lower
GAS
332,
358–364;
N
303;
ABR/McM
247
quadrant
35.
D.
he
aorta
cord,
A.
testcuar
and
s
he
he
deep
ormed) plane
Median
Fig.
as
components
artery
s
o
ocated
testcuar
any
rng
artery
probems
epgastrc
a
te
abdomna
te
spermatc
artery
(were
branc
o
te
“downstream”
rom
n
te
sperm
orgnates
te
aorta
count.
cose
spermatc
externa
to
and
ac
to
te
cord
artery
s
and
plane
s GAS
te
nguna
rom
tests.
cause
neror
orgnates
te
ac
o
not
o
te
externa
orgn
woud
B.
artery
one
suppyng
te
•
t
or
subcosta
nnervates
T ransumbilical
by
way
vscera
muc
rom
by
nnervates
and
and
termna
o
quadrant
E.
Right
ram
nnervates
bers
te
cord
spancnc
percardum,
vscera
bers
bers
ten,
cord
vscera
te
spna
torax
pan
and
nerve
were
aferent
te
ventra
spna
provde
te
toracc
catng
sympatetc
Right
te
trunks
t
to
rom
sympatetc
enterng
C.
T1–T12
patway
151
Abdomen
3
not
assocated
wt
te
testcuar
producton
o
4.22
sperm.
C.
o
te
te
duodenum
eve
and
o
does
aferents
tereore
w
not
enter
rom
not
te
resut
te
spna
souder
n
reerred
cord
at
to
he
speen
ceac
ver
E.
by
does
te
he
pancreas
not
rom
te
te
eve
actate
aferent
racc
cord
not
at
te
resut
n
to
o
te
ceac
o
N
pancreas
spancnc
o
266;
te
eve
souder
pan
to
and
te
ABR/McM
ntay
he
pancre-
te
spna
tereore
A.
wt
and
ead
o
vscera
tures
te
to
nnervate
te
aferent
te
dorsa
bra
eve,
structures
pancreas.
bers
dorsa
orn
wc
tat
orn
are
o
te
Runnng
te
o
reay
te
pan
pan
spna
somatc
medate
oregut
wtn
rom
rom
cord.
aferents
rom
te
tus
te
are
Aso
rom
body
to
to
nterna
dsta
gament),
superor
he
te
ts
vesca
umbca
part
and
te
arteres
artery
pays
te
N
ac
and
nodes,
suc
arses
does
rom
not
te
provde
testes.
266;
dranage
artery
as
o
ABR/McM
te
but
271
scrotum
te
tests
s
nto
drans
te
to
super-
umbar
nodes.
he
nterna
he
ac
portons
ymp
o
D.
te
nodes
dran
perneum,
te
enterng
and
wa.
ac
te
te
and
pevs,
te
gutea
nodes
presacra
ana
part
o
are
and
and
te
or
rom
te
ovares,
uterne
kdneys,
upper
tubes.
common,
postoned
posteror
nodes
cana,
te
rom
ymp
testes
hey
nterna,
por-
aso
and
nodes.
sacrum
cervx,
dran
gands,
uterus,
ymp
Presacra
to
nodes
te
externa
he
verte-
o
receve
struc-
tat
umbar
suprarena
tons
to-
nerves
oregut
suppy
rom
aduts:
producton.
artery
387–389;
nguna
orgn
crcumlex
ac
n
umbca
badder.
sperm
ymp
te
te
spancnc
and
tese
gves
urnary
n
orgnates
dvded
(meda
part
deep
deeper
nerves arse rom sympatetc ganga at te eves o T5–
T9
s
regon.
greater
toracc
he
ymp
B.
C.
te
he
ca
souder.
pan
roe
GAS
can-
270
te
greater
te
enter
te
no
bood
o
nerve,
or
artery
and
obterated
externa
reerred
vagus
and
nerves
medatng
run
nerves.
by
gangon,
tese
te
bers
E.
te
te
36.
o
reerra
he
te
w
nerves
Innervaton
spna
nnervated
None
373–374;
o
te
tereore
s
GAS
ead
enter
nerve.
rom
souder.
pexus.
at
sympatetcay
parasympatetc
vagus
and
to
cord
A.
not
pan
atc
te
te
souder
brances
34.
nnervated
gangon;
are
speen
te
s
artery
proxma
te
souder.
D.
umbca
s
(C4–C5)
pan
he
ac
n
ower
dran
maes
vagna.
mmedatey
te
ymp
te
porton
to
rom
prostate,
o
te
anteror
mesorecta
te
and
uterus,
n
asca.
rectum
emaes
and
upper
152
C H A P T E R
E.
Axary
wa
B.
he
tus
Abdomen
ymp
above
GAS
37.
3
514;
te
N
arteres;
branc
te
o
master
he
pexus
obque
he
o
te
tunca
processus
covers
te
pexus
B.
o
ncude
and
ymp
orgnate
te
te
o
genta
he
te
asca
tests
(rom
anteror
s
abdomna
vagnas
and
he
nterna
E.
he
dartos
cre-
s
a
derved
obque
E.
pose
o
(Camper)
rom
o
pertoneum)
sdes
o
te
te
GAS
38.
A.
275;
o
porta
trc
te
te
te
41.
tat
tests
N
tem
orm
pressure
gastrc
B,
an
n
C,
D,
te
s
way
does
ave
crcuares
are
not
te
ay
A,
n
at
and
GAS
40.
o
te
(Scarpa)
ayers
ven,
he
te
et
gas-
sys-
anastomoss
and
n
turn
vasa
he
based
at.
te
he
te
oter
to
v,
and
te
runnng
n
s
oces
be
are
vsbe,
o
cross
he
or
ramus
te
pec-
nsertons
curved,
te
(covered
or
abdomns
vertca
seat
o
te
ne
rectus
230
n
processes,
psoas
a
asca)
org-
ntervertebra
coumn
contans
at
eves
caced
eongated
and
n
organ
bend
dsks,
T12–L5.
tubercuous
ocated
te
near
rgt
and
es
o
te
neror
to
o
te
t
musce
o
te
duodenum
s
attaced
ascend-
ossa.
eve
tat
he
sgty
speen.
pouc
ac
stomac
te
across
stomac.
orzontay
ends
te
te
265;
o
te
te
he
te
apex
rb.
to
te
s
a
rgt
bro-
crus
o
and
pancreas
t
enters
transverse
rom
It
te
aorta,
descends
and
te
coon.
mesenterc
recta
trd
ven
and
te
root
can
across
trd
o
te
part
mes-
compress
neck
duct
te
ven
s
s
ormed
superor
te
et
by
vens
te
and
unon
t
does
duodenum.
te
te
to
duodenum.
ormed
ormed
epatoduodena
and
te
by
superor
o
and
s
te
s
te
passes
o
sgmod
o
ven
and
te
be
artery
porton
part
porta
to
speen
te
beore
ven
te
arses
pancreas,
duodenum.
te
te
o
267
artery
mesenterc
spenc
te
te
orzonta
epatc
wtn
ABR/McM
mesenterc
process
spenc
bend
te
unon
mesenterc
pancreas.
proper
It
o
ven
ascends
epatc
artery
gament.
by
to
te
te
trbutares
trd
part
rom
o
te
duodenum.
GAS
262
orgn
meda
bnd-endng
te
superor
posteror
te
N
te
wt
E.
at
neck
tan
usu-
et
te
o
neror
te
te
eum.
ABR/McM
he
D.
s
neror
not
he
o
sympyss.
superor
transversus
ABR/McM
an
yng
bend
part
o
naccuratey
dferences
te
he
C.
eum.
coces
an
te
o
abdomen,
band
371;
bend
dstnctons
onger
s
border
extends
duodenum
trd
A.
s
te
eart
uncnate
te
pcae
comparson
to
to
superor
bend
jejunum
ncsed.
te
dapragm.
he
entery
ess
pubc
o
and
and
vertebra
suspensory
GAS
B.
te
as
tg
asca
body
undus
te
te
te
te
provdes
ne
te
cecum
he
et
s
to
eature
obques
te
o
coon,
te
easest
ger
tese
wa
tend
opton
te
jejunum
Atoug
arcades
te
appearance
eum,
rectae
o
wc
t
transverse
ts
muscuar
orms
2/5ts
n
surgery
on
morpoogca
270;
E.
221
ways
ntestna
n
coces
proxma
Durng
Lympatc
gross
N
te
severa
more
te
oter
a
te
254;
pancreas
he
o
o
vascuar
ts
E.
te
eum.
wt
uness
C.
wen
te
s
musces
o
upward
rom
azygos
N
te
back
he
te
two
te
compared
310;
o
283;
taperng
submu-
resut
o
atera
mage,
te
smoot
te
crross.
vens
mesenterc
eum.
te
n
oten
te
bodes
ng
vens
process
bone;
musce
psoas
he
ad-
ABR/McM
dfer.
rape
abscess.
anastomoses.
up
was,
ewer
and
jejunum
o
are
stoogcay,
depct
te
42.
241;
te
tan
and
te
D,
o
pubc
rom
te
278
porta-cava
makes
compared
as
ony
C,
rom
nterspersed
hey
ver
porta
here
tcker
eum,
tose
N
jejunum
vsbe
jejunum
to
porta-cava
356;
amount
mesenterc
due
None
dstngus
reatve
bendng
dated
esopagea
E.
jejunum
and
to
are
epatc
ntestne.
eum
derved
he
nate
and
ncreased.
and
270,
he
sma
a
wt
esopagus.
mportant
mportant
B.
o
ABR/McM
varces
te
ven,
GAS
39.
369;
ower
and
D.
B.
ypertenson
ven
s
membranous
asca,
medan
abdomns.
bers.
Esopagea
cosa
asca
conssts
superca
musce
tendnous,
ne
semunar
GAS
A.
and
a
xpod
abdomna
he
musce.
contnuaton
pareta
atera
spermatc
s
musces.
nterna
asca.
tunc
te
te
In
transversas
te
aong
spermatc
aba
pectnea
tneus
musce.
externa
nea
he
testcuar
vesses.
rom
D.
deerenta
vens;
and
duc-
epddyms.
D.
he
rom
cord
nerve;
aso
asca
vagnas
te
abdomna
278
spermatc
cremasterc,
and
and
externa
asca
anteror
vertcay between te two rectus abdomns musces
gentoemora
musce
te
ABR/McM
o
testcuar,
te
abdomna
dran
pampnorm
sympatetc
C.
268;
components
deerens;
A.
nodes
umbcus.
43.
B.
he
348;
N
omenta
266;
ABR/McM
(eppoc)
245
oramen
(o
Wnsow)
s
te
C. he arcuate ne s a curved orzonta ne tat demar-
ony natura openng between te esser and greater sacs
cates
o
te
ower
mt
o
te
posteror
aponeurotc
porton
te
pertonea
cavty.
o te rectus seat. It s aso were te neror epgastrc
vscera
pertoneum
vesses
caudate
obe
A.
enter
he
te
te
seat
supracrsta
orzonta
crests.
to
ne
pane
suppy
s
at
an
te
te
rectus
magnary
upper
abdomns.
ne
margn
drawn
o
te
n
ac
on
te
edge
by
rst
o
te
o
part
te
te
o
It
s
(ver
ver,
te
bounded
capsue
nerory
duodenum,
epatoduodena
pareta
pertoneum
superory
o
Gsson)
by
te
coverng
and
te
te
te
pertoneum
anterory
gament,
by
on
by
te
ree
posterory
neror
vena
CHAPTER
cava.
most
A.
hereore,
key
he
te
C,
D
aorta
and
E.
GAS
he
tra
on
o
et
epatc
o
be
te
B.
he
N
te
neror
vena
cava
n
C
and
ven,
ven
are
rgt
not
te
ABR/McM
ner ve,
L1
wc
spna
aspect
rena
artery,
o
mons
gentoemora
he
genta
pes
he
or
te
borders
o
te
D.
te
It
rom
te
abum
as
been
ven-
te
skn
majus
njured
o
anteror
he
to
wereas
te
skn
n
n
up
Spna
nerve
dermatome
and
T9
at
nstances
A.
upper
gutea
te
ower
branc
regon,
part
o
n
B
nnervates
ypogastrc
suppes
eve
sensory
o T9,
te
skn
and
over
nnervaton
above
te
eve
45.
D.
he
rory
can
398;
second
by
be
and
o
C.
E.
he
trd
46.
A.
on
he
rgt
te
tay
te
te
te
part
and
te
um
N
278;
C.
he
to
pended
rom
s
te
nnt
costa
rectus
s
cecum
s
cartage
abdomns,
by
and
qute
s
ante-
a
s
ven
part
can-
te
GAS
he
caused
o
unon
386;
N
te
o
by
be
way
or
rng;
ven
pass
ante-
reated
ante-
rgt
organ
kdney,
par-
cava.
reversa
duct,
dranage
o
o
common
t
by
low
eyes
s
o
tat
s
sus-
obstructed,
nguna
o
be
rom
te
dranng
o
as
drans
pan-
duodenum.
256
o
Bood
to
te
anasto-
anastomoses
enarges
or
te
backs
neror
porta-cava
woud
wt
expands
prenc
not
mdde
be
te
coc
system.
umbar
superor
porta
vens
n
are
afected
venous
recta
venous
(he
vens
he
are
same
vens,
by
bot
bot
can
be
compo-
system.
vens
system
porta-cava
are
bot
and
com-
woud
ypertenson
anastomoses
patoogc
cava,
wc
begns
vens.
jaundce
te
no
ver
woud
boodstream.
coatera
or
be
pat-
gabadder.
by
s
not
expe-
between
te
na
a
types
gament,
jont
cana,
beneat
te
te
es
emora
GAS
o
et
are
between
or
a
bend,
cana
present
te
a
te
N
deep
Fg.
264;
te
o
o
to
A
dgt.
ngu-
te
atera
sympyss,
provdes
ernas.
seat,
he
4.50A).
230
s
et
drect
te
he
passes
provdng
pectnea
proxma
ABR/McM
be
te
tg,
erna.
te
patent
bones,
emora
to,
drect
nger
may
pubc
It
te
a
above
types
nto
n
nger.
sde
pubc
emora
or
(GAS
296–298;
o
nto
tte
te
atera
he
two
gament
by
te
occur
dstngusng
eature
taken
examnng
cana.
rng
erna
and
troug
nguna
common
aganst
abdomns.
tract
passes
and
ater-
meday,
abdomns;
examner’s
rng
ernas
bot
ven;
rectus
nguna
te
be
nguna
patway
gament
tp
rectus
normaton
ess
te
nguna
nguna
bordered
superca
superca
w
and
te
o
ndrect
nguna
emora
te
te
tp
te
opubc
te
nguna
deep
o
s
erna
nto
te
varces.)
drect
and
o
te
eature
te
an
very
o
a
edge
and
a
te
trange
artery
by
recta
porton
ndrect
rng
I
nto
erna
hs
troug
coug,
mdne
no
An
abum,
te
ower
atera
o
troug
epgastrc
te
nguna
o
te
as
247
eature
pass
bordered
or
to
not
Hessebac).
neror
t
nserted
ypertenson
ABR/McM
troug
erna.
Bot
te
does
nguna
te
o
t
scrotum
asked
porta
299;
descends
nguna
border
n
gament.
deep
ttng
to
nto
aows
and
crross.
bordered
te
o
268
be
(o
juncton
atera
and
and
dstngusng
tat
te
mesoappendx.
te
ac
ABR/McM
yeow
ver
nabty
low.
superor
porta
and
to
N
passes
trange
s
tube
sma
vena
coc
te
n
key
nerory,
retropertonea
te
and
and
cava-systemc
356;
s
t
oten
anteror
neror
te
324;
symptoms
he
he
border
conluence
A.
A.
ay
D and E. he ovares and uterus are bot neror to te
47.
49.
te
at
epatc
te
It
te
to
bood
and
te
expand
GAS
erna
second
porta
can
tat
jejunum
te
not
oow
ocated
(cava)
te
sgmoda
due
kdney.
vena
narrow,
et
ABR/McM
(porta)
rena
engorge
crossed
te
and
te
ven
to
ead
areas
te
te
mass.
as
o
to
o
249
a
o
neror
a
gabadder
gand
at
vens
et
o
duodenum.
et
aspect
te
appendx
artery
287;
woud
prenc
ponents
superory.
o
epatc
te
te
s
o
duodenum
o
suprarena
posteror
he
o
duodenum.
pancreas
crcuaton,
ven
te
dssecton.
ABR/McM
superomeda
B.
te
some
te
N
ver
gastrc
to
reatonsp
coon
reatonsps
part
o
a
begnnng
transverse
or
rom
superor recta vens and mdde or neror recta vens
duodenum
mesenterc
trd
te
309;
or
he
230
mesocoon,
wtout
superor
to
te
posteror
seen
to
rory
o
wen
ror
GAS
ABR/McM
duodenum
be
he
part
tng
he
te
not
B.
by
260;
transverse
seen
exposed
A
te
he
renced
N
rgt
dranage
ypertenson.
D.
nents
E.
te
or
dranage
crross.
trbutares
regon.
eter
te
poong
systemc
porta
te
ver.
accommodate
neror
bot
cutaneous
to
et
o
to
rom
te
esopagea
he
ver
340–342;
o
wt
he
abum
sup-
o
gabadder
te
aow
systemc
cava,
te
umbcus.
GAS
toward
musce
branc
te
enzymes
330,
sad
nerve
te
te
emora
te
st
bock
rom
gabadder.
rom
system
moses.
trange.
over
te
Crross
porta
wa.
oypogastrc
crest
o
low
he pancreatc duct s not nvoved n te pat o be
or
brances:
cremaster
atera
te
dstrbuton
abdomna
ac
te
a
two
porton
emora
as
nto
te
anteror
nerve
nnervates
spts
suppes
te
scrotum
addton
te
o
subcosta
tat
C.
woud
be
Obstructon
as
GAS
48.
duct
or
woud
creatc
nner vates
tg,
pubs.
241
arses
ner ve,
nerve
branc
skn
E.
we
vena
skn
aow
low
273;
he
te
cystc
but
porta
mesenterc
te
and
majus
E.
woud
patent.
and
D.
cava
oramen.
meda
scrotum,
C.
te
onguna
te
A.
vena
beedng.
duct
301–304;
ramus
ts
to
he
superor
omenta
B.
es
neror
o
abdomen.
and
44.
te
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
buet
coon
ocated
ligament
sgty
ang
erect
posture.
A.
C.
bra
coumn,
to
aorta
and
stomac
s
and
posteror
to
afected
rst
penetrate
most
te
te
superca
umbcus,
toward
te
Fig.
4.50A
trans-
nefectua
structure
atoug
pevc
cavty
nent
t
C.
n
he
by
s
ocated
woud
ocated
te
te
not
deep,
be
more
on
encountered
superor,
transverse
te
coon
to
and
anteror-posteror
verte-
rst.
te
52.
et,
woud
quadrant
te
he
ver.
s
o
pancreas
ead
s
273,
s
craded
te
ocated
N
superory
abdomen,
woud
by
by
320;
ocated
te
hs
penetrated
GAS
B.
te
excude
mdne
deep
to
n
argey
ts
te
A
cover
possbty
o
and
ts
ABR/McM
53.
51.
D.
Surgca
anastomoss
ypertenson
o
a
arge
aows
A,
B
or
a
rooted
epatc
E.
porta
he
are
deay
y
perormed
ven
to
et
te
ven
to
to
o
ven
to
to
o
aow
spenc
ven,
neror
a
te
a
porta
te
te
ven
te
et
rena
venous
rgt
superor
ven
receve
mesenterc
a
be
by
te
380–381;
N
compo-
vens
are
bot
connec-
tat
321;
s
te
te
va
n
te
at
and
reerred
suppy
rom
ureter
T11
upper
umbar
spna
246
nerve,
regon,
T10
a
surgca
and
pan
n
upper
reerred
cromain
are
moded
neura
crest
ces
to
te
T12
tese
gutea
and
partcuar).
te
anteror
orgn
and
and
woud
kdneys.
te T10
dermatome,
s
nerve.
ABR/McM
orgn,
nto
suprarena
o
te
271
suprarena
postgangonc
passes
te
and
te
epneprne
(noradrenane)
suprarena
medua
medua.
sympatetc
receves
(adrenane)
reeased
(adrena)
hese
neurons
by
tese
vens.
stmuaton
rom
pre-
gangonc sympatetc bers carred by te greater
toracc
C
and
te
et
ven
pan
and
medated
pan
umbca
ces
eas-
te
kdneys
subcosta
o
norepneprne
ven,
gastrc
he
are
and
o
system,
woud
o
he
trbutary
ow-resstance,
te
mesenterc
porta
system.
Anastomosng
ven,
or
a
o
connecton
systemc
major
and
or
tat
arge
cava-systemc
anastomoss.
te
symptoms
premse
ven,
system,
te
gastrc
te
te
dranage
ocated
gastrc
aevate
spenc
venous
component
to
n
porta
coatera
and
te
are
te
s
benet.
dermatomes
tgs
gonada
ABR/McM
s
to
vens
system.
B. he mass eads to ncreased stmuaton and secretons
ces
51–75
he
E.
GAS
229
o
Answers
and
no
te
tese
system,
hereore,
eadng
(rom
rgt
299;
neopasm
o
venous
cava
rom
eves.
supped
duodenum.
298;
C.
not
D
stomac
areas
atera
buet.
te
te
cord
and
and
te
provde
pan
dermatomes
upper
under
o
eac
porta
356–357;N
o
spna
o
te
rena
woud
Vscera
pont
not
trajectory
because
just
rgt
GAS
pubc
gabadder
beng
he
o
trbutares
buet.
rgt
E.
te
down
he
o
s
GAS
ton
abdomna
te
probaby
t
superor
varaby
he
be
D.
woud
because
may
deferens
ring
•
50.
vessels
triangle
inguinal
Lacunar
spine
tract
T esticular
Superficial
iliac
D.
suprarena
paton
E.
he
and
spancnc
n
te
pevc
do
GAS
nerves.
Parasympatetc
not
386;
medua
efects
o
spancnc
trave
N
322;
to
neurons
and
te
not
ave
ound
no
n
partc-
tumor.
nerves
te
are
woud
are
suprarena
ABR/McM
268
parasympatetc
medua.
CHAPTER
54.
E.
he
te
spenc
pancreas.
speen,
wc
creatc
ta.
be
artery
he
s
ocated
Bood
afected
n
es
aong
organ
t
at
te
suppy
te
event
te
superor
prncpay
to
o
termnaton
te
a
speen
tumor
border
suppes
o
te
can
n
te
s
o
he
te
pan-
te
tereore
ta
o
A
he
B.
he
dena
artery,
o
wt
he
kdneys
arteres.
te
E.
epatc
ead
by
o
te
artery,
gastroduo-
te
and
s
greater
pancreas.
cystc
artery,
not
n
to
a
E.
con-
pancreas.
are
rena
by
te
artery
tumor,
rgt
es
and
and
deep
bood
et
and
rena
meda
suppy
woud
D.
he
superor
to
he
A.
n
ceac
291;
ABR/McM
mesenterc
te
et
te
rena
artery
ven
neror
artery
compress
rena
s
te
as
vena
are
ocated
rena
es
te
just
superor
ven
passes
and
to
somewat
346;
o
coc
te
te
poston
te
superor
most
GAS
key
348,
Bood
te
te
too
B
n
to
et
et
to
and
occude
woud
be
arter y
An
et
rena
ABR/McM
because
stem
woud
te
C.
et
o
wt
nguna
na
women.
n
he
bot
medated
T11
D.
and T12
rom
toracc
spancnc
presson
o
umbar
Compresson
not
eve
he
o
te
vagus,
ated
by
he
most
undc
eter
area
ror
regon
te
spenc
o
N
296–298;
rom
te
porton,
tereore
be
pancreas.
Duodena
porton
teror
te
and
here
more
o
B.
part
o
superor
spenc
n
te
te
woud
n
be
ts
t
cause
to
and
C.
he
or
um
te
ucer.
aong
stomac,
ar ter y
no
te
te
dsta
woud
o
com-
D.
te
woud
te
ta
o
T7
te
to
not
E.
pan
s
carry
n
porton
te
gastrc
case
brances
arteres
undus,
ts
part
rom
woud
pass
o
rom
suppyng
o
te
te
be
te
A.
ante-
stomac.
he
B.
he
o
o
externa
most
Fg.
to
artery
It
equa
and
nc-
er-
artery
traves
suppyng
te
ead
arse
te
o
te
wtn
makng
artery
te
one
suppes
a
es
rom
o
te
pos-
o
te
s
to
te
te
regon
responsbe
dervatves,
et
coc
artery
and
part
or
gener-
lexure
te
to
rom
te
ds-
duodenum,
counterparts.
responsbe
te
arses
suppes
o
superor
s
o
dervatves
duodenum
rectum.
artery
ts
te
neror
artery
esser
or
suppyng
curvature
o
te
o
te
4.67).
ABR/McM
asca.
he
te
s
externa
asca
obque
s
a
te
coverngs
nterna
spermatc
musce
247
ayer
ayers:
obque
not
common
artery
tus
dsta
asca
and
woud
235
commony
second
abdomna
cremaster
common
regon.
duodenum,
te
wt
tree
musce,
emora
more
ernas
ndgut
artery
291;
spermatc
ndrect
vesses.
te
porton
N
o
tan
exbtng
te
brances
te
te
gastrc
abdomna
not
mesenterc
transversas
externa
muc
pancreatcoduodena
(GAS
consst
greater
nguna
te
ntestne
o
pyorc
cremaster
te
o
rgt
347;
are
mesenterc
anastomoses
cord
gron
commony
pancreatcoduodena
lexure.
and
he
more
ABR/McM
ucers
he
nterna
beedng
ts
D.
o
aspect
neror
GAS
60.
s
duodenum,
most
superor
stomac
med-
trunks.
268
or
dorsa
to
does
abdomen;
gastrc
brances
nerve,
coc
superor
he
common
occurrence
we
are
264;
rom
suppyng
te
occur
te
mesenterc
neror
ay
case.
at
he
most
umbca
te
njured
mdgut
et
to
wt
te
superor
te
suppyng
east
reerra
termnate
sympatetc
stomac
sort
o
ocaton
pancreatcoduodena
requenty
te
canddate
gastrc
posteror
pass
esser
sympatetcs
pan
ABR/McM
te
he
abdomna
compressed.
cord.
313;
o
te
nerves
woud
or
te
woud
va
preaortc
nor
o
o
251
gastroduodena
proxma
occuson
rst
N
bend
reduced
te
and
superor
o
testcuar
beng
kdneys
eves
nerves.
bers
key
sort
artery.
not
parasympatetc
pan
511;
rom
s
spancnc
aferents
brances
GAS
te
te
spna
a
and
cord
pan,
Vscera
vscera
D.
o
produce
pan.
E.
orgnates
spna
te
te
te
women
ernas,
to
rst
s
ernas
sexes,
posteror
te
Pan
area
spenc
to
ernas
pan
uceraton.
nerory
mdpor-
aspect
women.
neror
greaty
te
n
aneur ysm
ven.
et
tan
o
artery
te
men,
n
Epgastrc
to
C.
te
A.
swoen.
more
te
dorsa
courses
o
ABR/McM
Inguna
vesses
aorta
te
artery
body
erna
n
ernas
n
arses
248
or
Drect
tan
drans. hs woud resut n pan as te testcuar venous
testcuar
te
o
emora
o
he
rom
neror
290;
dence
GAS
anteror
N
ven
become
wc
te
woud
mpeded
ven
ven—nto
rom
ven.
arter y
te
295;
testcuar
rena
rena
occude
N
arses
E.
present
superory
mesenterc
et
mesenterc
379;
low
arter y
te
rom
te
women.
men
and
ven.
nerory
superor
o
o
nguna
women
n
ts
59.
mdde
aspect
n
pass
ernas.
cava.
ocated
et
to
undus.
Atoug
244
ven.
he
B.
curvature
man
erna
and C. he neror mesenterc artery and ts et coc
D.
te
removed
gastro-omenta
Indrect
arteres.
N
qute
he
GAS
58.
unnterrupted.
337–346;
arses
passes
uceraton.
supped
et
are
et
nguna
branc
57.
te
te
he
epatc
not
56.
rgt
pancreatc
termnaton
B
near
supped
rom
wc
artery,
undus.
n
anteror
A.
s
bood
artery,
spenc
he ver s aso supped by te common and proper
GAS
55.
te
he
proceed
D.
te
tact
to
ocated
gabadder
branc
C.
receves
gastrc
te
artery
C.
duodenum
o
and B. he common epatc artery and neror prenc
te
pancreas.
A.
dorsa
ton
155
Abdomen
3
s
ts
spermatc
spermatc
an
asca
and
te
spermatc
asca,
asca.
extenson
and
dervatve
musce
source
o
o
te
aponeuross.
o
te
asca.
nterna
156
C H A P T E R
3
Abdomen
Posterior
superior
pancreaticoduodenal
E.
artery
Left
gastric
he
o
Proper
hepatic
epatc
porta
ven,
ormed
by
te
conluence
artery
artery
te
passes
Right
GAS
gastro-
superor
deep
348;
to
N
mesenterc
te
266;
neck
o
ven
te
ABR/McM
and
spenc
ven,
pancreas.
248
Gastroduodenal
omental
artery
62.
artery
A.
he
bned
be
wt
duct
s
occuded.
jaundce
he
ndcates
pattern
bockage
o
o
pan
reease
com-
o
be
Supraduodenal
nto
artery
B.
te
duodenum.
he
cystc
orm
te
badder
duct
be
nto
toknn.
te
ampua
denum.
presence
o
bocked
to
w
te
s
be
coecys-
normay
te
descendng
wt
assocaton
oten
s
o
te
wt
resutng
te
rom
concentraton
precptate
o
duo-
mutpe
nlammaton
n
can
coecystts,
to
epatopancreatc
Increasng
Bockage
to
ga-
te
an
and
duct
te
lows
present
requenty
duct.
rom
response
enter
oten
gabadder
concomtant
n
duct,
and
gastones,
cystc
nlammaton.
Anterior
duct
epatc
reeased
duct
cystc
Vater)
most
common
s
Coecystts
gabadder,
n
be
(o
te
Be
cystc
te
Patents
gastones.
be
te
From
troug
jons
duct.
a
bout
te
cystc
duct,
not
necessary
a
o
o
wt
assoc-
superior
ated
pancreaticoduodenal
Superior
artery
epatc
artery
Posterior
inferior
pancreaticoduodenal
Abdominal
wt
jaundce.
An
obstructon
n
te
common
mesenteric
aorta
duct
tus
prevent
num
and
and
subsequenty
communcaton
te
ver,
causng
te
be
duct
between
obstructve
te
woud
duode-
jaundce.
artery
C
Anterior
and
E.
An
occuson
n
eter
te
et
or
rgt
epatc
inferior
duct mgt cause md jaundce; owever, gastones pancreaticoduodenal
artery
mgt
•
GAS
Fig.
D.
An
he
transversus
nto
te
untes
pubc
wt
abdomna
E.
processus
tat
precedes
cessus
o
te
s
tests.
nguna
medate
part
he
deep
o
superor
te
neck
process
uncnate
tumor
mesenterc
he
by
B.
a
he
der,
D.
he
L3,
o
a
n
te
o
orms
te
te
or
a
porton
remans,
tra
ABR/McM
o
and
te
o
te
tumor
n
neror
wc
pancreas
te
artery
aso
pancreas.
epatc
T10
B.
Nerves
te
can
nter-
orm
part
o
ten
a
te
duodenum.
o
te
s
artery
uncnate
superor
ven,
to
mesenterc
tus
s
te
passes
regon
An
be
te
E.
arses
neror
to
te
te
cord
and
an
passng
afected
tg.
ead
o
o
te
It
s
te
jaun-
te
oypogas-
nerve
and
arses
and
over
rst
runs
te
o
rom
te
te
skn
ven-
transversey
owest
cutaneous
porton
nerve
stu-
pubs.
umbca
T11
te
256
o
nnervaton
nerve
te
mons
and
regon.
te
umbcus
nerve
s
courses
on
te
tereore
musce
spne,
eve
wa
emora
psoas
about
gabad-
branc
or
commony
atera
te
GAS
64.
B.
nc
398;
N
Appendcts
maton
at
onguna
cana,
he
to
pancreas.
te
ABR/McM
hs
te
beow
te
to
pancreas.
artery
stuated
o
to
suppyng
he
287;
spna
te
nor
T12
but
ventra
superor
ram
to
te
troug
atera
sde
typcay
te
o
ngu-
te
neror
sper-
to
te
ncson.
superor
superor
unkey
rom
pancreatc
gastones
pubs.
matc
te
te
nnervates
mons
aorta,
crosses
to
termnate
na
te
seat.
superor
A.
L1
accessory
pancreatts.
pubs.
te
or
neter
cutaneous
abdomna
rectus
o
rom
compresson
and
and
te
N
man
n
responsbe
o
te
te
cause
340;
mons
ramus
ated
230
arses
pancreas,
trd
cause
artery
te
around
pro-
s
congenta
o
t
te
may
330,
n
resut
anteror
nerve
above
7t
part
he
trc
tunca
proxma
C.
D.
264;
present.
woud
but
GAS
63.
artery.
cystc
are
N
can
common
body
I
troug
porton
te
orms
nterna
tendon.
cana
patway
processus
mesenterc
uncnate
A.
o
and
te
dce
pertoneum
descends
retaned
a
o
nserts
ydrocee.
292–293;
to
t
o
conjont
pouc
hat
erna.
te
te
nguna
Retenton
ne
nserton
a
as
and
provdes
ndrect
lud-ed
C.
s
tests
rng
normay
processus
GAS
61.
te
aponeuross
pectnea
orm
deveopment.
tat
vagnas
to
vagnas
nguna
mont
and
aponeurotc
obque
he
deep
abdomns
crest
te
be
occuson
ducts
C.
not
4.67
and
and
s
rebound
pont
es
superor
meda
pan
spne
te
to
over
o
to
rom
anteror
te
wt
te
te
atera
abdomen
superor
aspect
ac
o
te
263
bot
a
McBurney
te
traves
atera
caracterzed
ndcated
one-trd
ac
to
ABR/McM
oten
nerve
emerges
tereater
260;
s
cutaneous
and
dstance
by
acute
postve
pont.
rom
umbcus.
In
nlam-
psoas
test
McBurney
te
anteror
patents
wt
CHAPTER
T aeniae
coli
D.
he
umbar
ute
musce
and
sensory
E.
and
sacra
sympatetc
gands
bers
he
vagus
and
aferent
sympatetc
bers
or
o
trunks
nnervaton
certan
te
nerve
or
pevc
157
Abdomen
3
contrb-
o
smoot
vscera,
but
not
rectum.
provdes
parasympatetc
nnervaton
(excudng
suppy
pan)
to
te
Pre-ileal
ntestne
GAS
Postileal
66.
D.
It
358–364;
Mecke
eum
occurs
about
2
s
about
eet
coc
lexure.
ABR/McM
s
2%
ong,
et
a
o
281
ngerke
remembered
proxma
nces
te
392;
generay
n
2
N
to
dvertcuum
tat
matey
proxma
te
rom
occurs
projecton
by
te
“rue
popuaton,
te
2
eoceca
tmes
as
s
o
o
te
2s”:
approx-
juncton,
oten
n
s
men
Ileum
as
n
and
women,
may
be
condtons.
mucosa
ng
he
and
and
may
contan
conused
two
types
pancreatc
pan,
may
2
oten
o
o
2
hese,
ndcatons
ectopc
dferent
ectopc
tssue.
gve
types
wt
tssue
aong
o
tssue,
cnca
are
gastrc
wt
peptc
beed-
ucer
or
Pelvic
Retrocecal
appendcts.
A
and
B.
Interna
and
externa
emorrods
nvove
Cecum
te
rectoana
wc
area,
bopsy
presence
o
o
not
te
eum,
emorrods
gastrc
n
woud
addton
not
sow
to
te
mucosa.
Subcecal
C. •
GAS
Fig.
Dvertcuoss
or
dvertcuar
dsease
s
a
condton
4.84
n
wc
te
sma
coon
outpoucngs
and
woud
occur
tereore
be
n
te
ned
was
wt
o
coc
mucosa.
appendcts,
McBurney
et
A.
ower
An
rebound
pont
C.
quck,
deep
may
be
et
compresson
over
o
E.
Borborygm
te
passage
quadrant.
ectopc
et
abdomna
over
gabadder
gastrc
woud
pan
McBurney
Coecystts
resuts
and
regon
an
o
te
wt
ocazed
GAS
67.
to
n
te
D.
pan
rgt
over
o
te
te
n
ep-
and
E.
Peroraton
or
stones
possby
on
nguna
o
papaton
namc
wa,
resut
te
o
reerra
reerred
ypocondrac
coud
abdomen,
eus,
o
pan
to
te
togeter
rgdty
pan
to
te
resut
A,
B,
umbar
o
te
n
pan
wt
ady-
(GAS
te
Fg.
4.84).
GAS
65.
B.
he
319–320
vscera
transmtted
wc
aso
N
280;
aferent
by
way
provde
o
te
ABR/McM
nnervaton
te
pevc
261
o
umbar
bers
C.
he
sympatetc
te
(recta)
nerve
pes
te
rom
pudenda
ana
sa
C,
rectum
spancnc
s
o
nerve
nerve,
pens.
nerve
and
o
ne
dorsa
te
and
trunk
body
provdes
te
somatosensory
pectnate
tures
undus
te
tat
occur
contents
to
bers
and
te
nerve
urogenta
o
388;
n
to
te
perana
regon.
ana
ana
skn;
pens
te
and
C
and
rgt
and
sensory
wt
te
troug
te
neror
dor-
nerve
sup-
te
nnervate
struc-
oten
o
pressure,
occurs
te
between
aorta,
creatng
resutng
te
marked
N
remanng
n
reerred
eevated
266;
lud
epatorena
te
o
woud
woud
not
be
pressure.
268
(o
pertonea
te
coces
and
accumuaton
pouc
epatorena
ront
bood
ABR/McM
patent,
n
answer
pan
space
cavty
s
pareta
w
Morson),
n
ocated
oten
wc
te
bend
pertoneum
s
supne
te
coverng
kdney.
ver
D.
and
he
space
te
vescouterne
potenta
areas
o
accumuaton
s
s
n
an
between
te
rgt
obe
o
dapragm.
n
erect
and
lud
rectouterne
spaces
accumuaton;
tese
spaces
poston
occurs
rater
are
owever,
wen
tan
a
te
supne
poston.
E.
he
costodapragmatc
peura
beow
pernea
n
wt
subprenc
lud
242
aneurysm
burcaton
he
space
patent
te
cana
te
owest
te
resut
supne
he
uterus.
or
nerve,
neror
te
te
orgn
pernea
he
receves
o
to
GAS
te
ts
E.
n
nerves,
suppy
and
In
a
ABR/McM
ncrease
he
A.
281;
assocated
aso
he
sounds
bowe
pusaton.
ver
organ.
A.
bowe
and
aortc
beow
poston.
te
te
parasympatetc
B.
occur
abdomna
souder
L4,
key
68.
N
sgncant
regons.
duodenum
te
(paraytc)
and
n
315;
abdomna
be
Kdney
are
gas
Abdomna
L3
nlammaton
resut
stng
assocated
pont.
rom
woud
be
nstead
regon.
D.
o
ntestnes.
pregnancy
generazed
pan
ater
tenderness
GAS
69.
D.
319
N
345;
Descendng
lexure,
recess
s
a
space
n
te
cavty.
ABR/McM
co on.
nner vaton
gastro ntestna
tract
o
s
279
Begnnng
te
at
ndgut
supped
by
te
et
por ton
coc
o
te
parasympatetc
158
C H A P T E R
3
Abdomen
Left
bers
o
te
patet c
coc
o
te
spancnc
nner vaton
lexure
s
spna
nner vat on
vc
pevc
o
te
supped
cord
o
mdgut
te
occurrng
te
spancnc
by
ner ves.
ner ves
arse
up
vagus
beow
descendng
to
te
A
Left
artery
gastric
artery
et
Right
hepatic
artery
Propoer
hepatic
artery
eson
woud
because
sp na
hepatic
par asym -
ner ve.
L4
coon
rom
he
afect
te
ner ve
pe -
eves
S2–S4.
A,
B,
C,
and
and
E.
he
transverse
jejunum,
coon
are
ascendng
a
coon,
nnervated
by
eum,
te
vagus
nerve.
70.
C.
GAS
319;
he
porta
mts
te
N
306;
proper
common
A
menta
because
patcs
tat
A
are
and
n
o
coud
A
be
tumor
as
obstruct
n
a
o
regon
to
a
o
o
and
be
ven,
ymp
most
vesses
tese
trans-
porta
nerves,
woud
o
ver)
epatc
abundance
ead
detr-
and
symptoms
ym-
Cystic
wen
artery
unctonay.
eter
serous
ssure
artery,
autonomc
ts
ts
compromsed
B.
not
duct,
tumor
249
(transverse
epatc
epatc
vesses.
tey
ABR/McM
epats
te
because
tese
rgt
t
or
et
woud
obes
not
woud
competey
vesses. Supraduodenal
D.
he
acorm
gament
does
not
carry
any
artery
vesGastroduodenal
ses
(except
some
sma
paraumbca
vens),
so
Right
tumor
n
ts
area
woud
not
ead
to
te
gastric
artery
symptoms
Abdominal
descrbed.
E.
he
epatogastrc
tonea
gament
connecton
curvature
o
symptoms
te
and
between
stomac
sgns
s
te
te
bamnar
ver
and
s
and
te
unreated
Superior
per-
329;
N
284;
to
E.
he
cystc
•
te
to
artery
te
s
GAS
Fig.
D.
he
te
eococ
ony
gabadder.
It
artery
s
te
ony
artery
sted
epatc
artery
and
artery
s
must
sted
tat
te
oten
a
branc
appendx,
gvng
of
an
appendcuar
s
cut
ree
rom
ts
sup-
be
camped
branc
goes
o
or
rom
one
o
ts
brances.
te
beore
gves orgn
te
to gabadder
tat
255
A, B, C, and E. he superor mesenterc artery rgt
artery
4.106A
ere.
ABR/McM
drecty drecty
artery
Splenic
pes 71.
aorta
mesenteric
esser
73. GAS
artery
a
te
eococ,
rgt
coc,
and
mdde
coc
arteres;
attacments.
owever, te atter 2 e superor to te ste o te appenA,
B,
C,
and
orgn
nto
to
D.
he
te
rgt
common
proper
and
et
epatc
epatc
epatc
artery
artery,
provdes
wc
arteres
dx.
he
te
neror
superor
recta
artery
s
te
termna
branc
suppes
te
o
dvdes
suppyng
mesenterc
artery
and
ower
te
porton o te sgmod coon and superor rectum. ver, gabadder, and bary tree (GAS Fg. 4.106A).
GAS GAS
330;
N
287;
ABR/McM
74. 72.
D.
he
speen
s
a
arge
ympatc
organ
tat
A.
Caput
te
dapragm
and
rbs
9,
10,
and
11
n
te
ar
area.
A
aceraton
o
ts
organ
s
wt
severe
bood
oss
and
was
ormed
porta
to
te
261
to
by
te
snakes)
s
ead
o
caused
Medusa,
by
pressure,
wt
venous
relux
severey
rom
paraumbca
vens,
sma
vens
te
wtn
te
sock.
acorm A.
ABR/McM
(reerrng
oten
ver assocated
294;
et
eevated ypocondrac
N
medusae
rests
wose aganst
350;
256
gament.
he
presence
o
caput
medusae
s
Amost a o te ver s ocated n te rgt ypocon-
usuay
assocated
wt
end-stage
dsease.
Caput
medu-
drum and epgastrum, atoug some protrudes nto
sae te
et
ypocondrum
beow
te
s
dented
radatng B.
he
pancreas
es
bend
te
stomac
and
w
njured
n
ts
he
et
kdney
s
es
retropertoneay
C,
te
and
centra
D.
te
eve
o
te
T11–L3
vertebrae
on
te
et
te
he
o
engorged
he
epatc
vens
porta
connecton
Obstructon
o
o
tese
te
anastomoses.
neror
vena
cava,
and
atera
toracc
vena
ven
cava,
do
porta
ypertenson
and
woud
not
not
produce
body.
tese E.
mbs.
sde
cause o
appearance
ower
approxmatey
superor at
te
te
case.
B, C.
toward
not
ven be
by
dapragm.
um
s
te
upper
porton
o
te
p
bone
E. contrbutes
to
te
bony
pevs.
Ieum
s
te
he
o
te
sma
ntestne
and
s
superca
epgastrc
ven
aso
s
not
assocated
dsta
wt porton
symptoms.
and
pronounced
te
deveopment
o
porta
ypertenson
but
te
coud provde a coatera canne or venous dranage. same
as
“um.”
GAS GAS
337;
N
288;
ABR/McM
245
271;
N
299;
ABR/McM
246
CHAPTER
75.
C.
Coecystts
due
te
to
cystc
rgt
s
ncreased
duct
an
by
gastones.
ypocondrac
T6–T8
carry
bers
as
trave
o
be
s
Lesser
gabadder
obstructon
et
corresponds
aferents
wt
te
or
utmatey
wc
Sensory
tey
o
Pan
regon,
dermatomes.
pan
nlammaton
concentraton
rom
omentum
o
te
to
te
sympatetc
n
159
Abdomen
3
te
Stomach
vscera
axons
n
te greater toracc spancnc nerves. Pan cannot be et
n
te
vscera
and
s
tereore
reerred
to
te
body
wa. Gastrosplenic
A.
he
te
vagus
ead,
pan
nerve
neck,
carres
and
vscera
trunk,
but
sensory
tese
do
bers
not
rom
ligament
ncude
bers.
Spleen
B.
Spna
rom
nerves
o
toracc
T1–T4
vscera,
receve
aferents
ncudng
te
or
eart,
pan
but
not
Visceral
peritoneum
abdomna
organs.
D.
Sympatetc
E.
Aferent
and
neurons
tereore
do
bers
not
o
are
autonomc
carry
te
sensory
dorsa
motor
nerves
normaton.
ram
o
spna
nerves Splenorenal
T6–T8
convey
sensory
bers
rom
te
back
but
not ligament
rom
nterna
GAS
340;
N
organs.
309;
ABR/McM
Left
247
•
Answers
76.
Mc Bu r n e y
ocaton
o
attaces
te
rom
to
pont
te
te
o
cecum.
abdomen,
te
usuay
base
It
about
umbcus
to
c o r re s p o n d s
te
s
appendx
ound
on
t w o - t rd s
te
te
o
anteror
to
rgt
te
D.
t
he
or
sde
ureter
dstance
superor
C,
and
be
E.
he
neror
or
ac
as
a
318;
are
ents
o
appendx
and
ocazed
ence
woud
te
rom
te
ents
upper
to
abdomna,
he
vagus
D.
he
umbar
E.
Spna
he
t
te
ower
trunk
tese
do
porton
anteror
ureter
he
pan
spna
bers
rom
te
B.
afer-
toracc,
o
s
N
nerves
te
or
te
and
constrcted
brm
rom
E.
to
to
degree
mnor
80.
C.
he
ureter
kdney
mnor
and
stones.
and
not
major
typca
cayces
stes
or
are
proxma
obstructon
to
by
te
not
t
s
and
not
s
a
typca
entrance
a
by
muscuar
ste
o
common
compressed
te
o
te
uterne
ABR/McM
s
te
ste
ur-
wa
as
ony
te
o
s
dapragmatc
attaced
artery
te
anteror
tat
to
o
to
contans
te
speen
te
te
te
te
and
te
o
te
bare
relecton
ver
area
o
onto
ver;
speen.
gament
vesses
pertonea
surace
encoses
to
wa
stomac.
gament
tat
271
attacment
gament
spenc
te
cervx.
269,
te
abdomna
te
gastrococ
contans
but
brances
soud
not
be
a
o
te
actor
spenectomy.
he
epatogastrc
gament
connects
te
ver
to
stomac.
he
acorm
te
N
to
273;
spancnc
te
he
gament
ver
abdomna
338;
Pevc
suppy
A.
B.
s
he
GAS
some
s
coronary
anteror
tg.
222
major
and
nectng
abdom-
badder
gament
posteror
dapragm
te
wt
area.
ower
anteror
ABR/McM
D.
s
obque
s.
and
317;
gastro-omenta
not
pan.
assocated
abdomnopevc
perneum,
pevc
are
nnervate
303;
normay
te
aferents
N
curvature
he
n
carry
badder
brances
te
T5–T9,
sensory
to
rom
pass
pevs.
and
A.
o
because
contents
spenorena
greater
afer-
tereore,
nerves
receve
come
not
spancnc
358–364;
crosses
vscera
and,
organs.
nerves
nerves T12–L2
wa,
genera
major
ganga
ureter
ste
urnary
brm
380;
kdney
t
do
pevc
he
et
rom
cord.
T1–T5
but
to
arse
sympatetc
organs
stomac.
spna
pan,
C.
na
o
te
carryng
abdomna
nerves
or
GAS
or
toracc
nerves
te
here are no common stes o obstructon between
speen
231
spancnc
badder
GAS
C.
te
urnary
te
ABR/McM
T5–T9
sympatetc
Spna
te
282;
toracc
te
body
tereater
A
E.
not
nto
o
he
obstructon
te
atera
79.
responsbe
rom
rom
as
te
s
andmark.
N
greater
eves
and
C.
to
gament
umbcus.
he
te
78.
nguna
McBurney pont s two-trds o te dstance rom
GAS
A.
D.
used
te
B.
mdporton
obstructon.
nary
and
77.
kidney
4.113
te
w e re
spne.
A,
Fig.
76–100
B.
o
GAS
vagus
nerve
⅔
de
artery
coc
transverse
o
s
wa
nerves
pertonea
aspect
(GAS
Fg.
o
od
te
con-
upper
4.113).
260
and
te
et
coc
artery
coon.
suppes
te
te
transverse
suppes
coon.
a
nner
ABR/McM
descendng
proxma
te
te
bowe
coon,
same
ony
and
to
te
porton
te
md-
o
te
160
C H A P T E R
B.
he
D.
he
E.
he
3
Abdomen
superor
cecum,
ng
to
E.
he
tra
esser
do
ramus
o
urogenta
usua
can
ac
be
njured
306;
nerve
and
takes
t
wt
te
a
L1.
te
as
It
not-
branc
ven-
te
skn
ratory
te
wc
nner
an
o
tg.
pont,
tents
Its
but
t
appendectomy
B,
and
and
te
C.
Spna
ncson;
does
not
wat
s
are
more,
we
te
not
te
wt
gentoemora
ocated
area
ter
o
n
te
sensory
njury.
nerve,
area
he
be,
o
dect
ncson.
sensory
to
gentoemora
cremaster
scrotum
ony
wa
D.
ar
subcosta
skn
o
agea
te
may
A TEF
and
gea
not
C.
and
E.
an
and
8t
s
te
o
esop-
te
wt
tracea
esopa-
strctures
woud
n
n
225;
o
o
N
to
te
and
o
n
an
A
C.
A
B.
but
tey
are
and
woud
cnca
not
occur
cause
manestatons
n
hs
s
caused
te
stomac
occuson,
Vater)
Lack
o
by
be
duct
ncompete
contents
dsta
were
to
te
wegt
woud
309;
te
n
te
be
gan
because
s
cd
A.
duct
enters
to
C.
not
cause
vomtng
vomtng
pyorc
spncter
wtout
te
woud
presence
cause
o
be.
pro-
not
te
con-
o
to
te
resp-
te
ste
at
246
spncter
pyorc
cana,
contents,
but
duodenum
n
not
and
cases
o
begn
can
and
tere
s
wtout
dsta
to
undus
be.
to
te
V omtng
atresa;
vomtng
necessary
occur
due
cause
because
and
days
woud
mmed-
ater
constant
277;
vomtng
t
s
occurs
added
by
to
a
devery .
vomtng.
not
dsta
produce
o
te
oten
pus
n
n
con-
resp-
ste
at
te
or
duodenum
te
s
par ta
duodenum
ater
constanty
to
te
246
o
por ton
resuts
be
o
contents.
stenoss
te
stomac
proxma
ABR/McM
trd
o
deect
ntestna
duodena
D.
week
and
t
t
o
and
te
ungr y
and
but
occu-
usuay
duodenum.
vomtng
e
may
ton
o
cated
brt,
te
etus
atresa
s
o
te
dd
rom
s
stom-
reason
not
gan
a
seen
wt
drecton.
aure
week
o
o
o
a
and
In
sep-
some
recanaza-
due
aed
duodenum
wtn
poyydramnos,
TEF
and
to
an
lud.
resut
te
a
deveopment
poyydramnos
te
vomtng
esopagea
strctures.
traceoesopagea
amnotc
o
causes
and
posteror
wt
umen
wt
te
egt
swaow
te
webs
generay
by
resut
te
a
to
n
as
s
caused
durng
Duodena
deveopment
atresa
s
as
o
presents
devatng
te
te
reorma-
and
rst
ew
“doube
s
asso-
days
o
bubbe”
sgn.
E.
TEF
s
an
abnorma
esopagus
tng
because
system
ypertropc
stomac
contents.
pyorc
recanazaton
Esopagea
ton
te
be.
N
egt
cases,
te
wt
o
Incompete recanazaton o te esopagus durng
tum
not
constant
s
w as
stenoss
epatopancre-
due
con-
wegt.
be
o
o
not
deect
contents
s
gastrc
occuson
te
te
recana-
contans
o
te
and
umen
te
nabty
vomt
te
brt
gan
system
contents
226
he
entrance
woud
proxma
stomac
does
be
be
presents
ABR/McM
a
stomac
o
stomac
woud
ac
esopagus.
238;
te
te
stomac
ere.
eter
o
occurs
aspraton
woud
to
enters
brt
and
because
stenoss
s
ABR/McM
o
ater
Incompete
and
patent
jecte
GAS
85.
o
seen
ratory
examnaton
stenoss,
279;
vomtng
t
occurs
narrowng
atropc
tents
atresa.
duodenum.
(o
ntestne.
o
atresa
stenoss
te
cases
cases
and
te
n
ound
and
added
wegt
A TEF
te
are
vomtng.
A.
E.
son
o
deveopment,
between
o
sgns
caused
atresa.
and
An
and
12t
cause
because
stenoss
wc
230
aure
assocated
webs
D.
or
regon.
a
week
passage
and
strctures
ntestne
ampua
sma
te
te
nerve
musces
N
ater
Lack
abdomna
beow
ABR/McM
rom
o
nnervatng
Spna
te
te
pubc
to
majus
s
soon
to
atey
regon.
rom
esopagea
tereore,
Duodena
addton
ocaton
te
resuts
abnorma
esopagus
Duodena
zaton
o
nnervates
260;
n
branc
skn
wa
suppy
trange.
motor
branc
abum
umbca
appen-
bot
not
be
vomtng
seen.
seen
GAS
atc
N
cause
pneumona,
be
and
te
above
esopagus
notced
sma
n
to
stenoss
atresa;
te
not
s
be
Webs
o
B.
nerve
317;
aso
te
as
s
te
genta
te
emora
abdomna
posterory
286,
a
nerve
motor
to
emora
musces
recanazaton
wc
and
te
anterory
Esopagea
B.
over
bers
beow
he
provdes
sensory
he
GAS
D
skn
we
pudenda
perneum.
nerve
and
nnervates
as
rb
A.
te
anterory,
te
T10
he
rng,
by
te
A and B. Duodena atresa, ke duodena stenoss, causes
genta
due
nguna
o
o
constrcton.
at
superca
vomt
vomtng
begns
te
ste
te
system
be
because
pyorc
te
be
assocated
branc o te gentoemora nerve eaves te body wa
and
83.
nerve
correate
dectomy
82.
nerve T10,
pudenda
caused
to
ypertropy
projecte
te
s
nng
tereore,
woud
309;
Wt
te
ncson.
A,
C.
antrum
membranous
proxma
duct;
and
GAS
84.
gastrc
te
be.
A TEF
o
porton
McBurney
o
be
tan
E.
o
occurs
te
282
nnervates
upper,
atropc
remova
coon.
ABR/McM
extenson
An
and
nerve
anteror
beow
D.
eum,
coon.
termna
te
rectum.
termna
spancnc
s
crest;
regon;
patway
ascendng
N
nerve
spna
te
te
descendng
358–364;
onguna
overyng
and
te
suppes
suppes
toracc
wt
350,
artery
artery
appendx,
et
GAS
81.
recta
eococ
and
and
t
aso
s
passage
woud
assocated
occurs
between
not
be
a
wt
proxma
GAS
261;
N
279;
ABR/McM
te
to
deect.
246
te
cause
tracea
or
vom-
respratory
te
ste
o
te
CHAPTER
86.
B.
Duodena
ton
o
ated
te
wt
atresa
umen
vomtng
Poyydramnos
o
amnotc
grapc
or
“doube
s
te
o
s
by
te
due
te
utrasound
bubbe”
sgn
o
a
aed
duodenum
wtn
seen
lud
resut
te
rst
to
ew
examnaton
o
s
days
abnorma
ntestnes.
because
reorma-
and
omentum
assoc-
o
woud
brt.
B.
Umbca
In
rado-
sow
dstended,
te
tat
gas-ed
azaton
stenoss
o
vomtng
te
o
s
caused
by
duodenum
stomac
ncompete
and
contents
oten
pus
recan-
resuts
be
ater
n
C.
jecte
D.
An
pyorc
woud
cause
pro-
te
vomtng.
atroped
remova
and
spncter
o
occurs
antrum
membranous
proxma
to
te
s
caused
nng
ste
o
o
te
te
by
te
D.
stomac
entrance
E.
TEF
and
o
s
o
esopagus
symptoms
GAS
87.
C.
309;
Annuar
to
te
and
ventra
cess;
not
A.
o
te
A,
porton
a
tat
te
dorsa
Bot
nvoved
and
E
ton
o
ma
te
335;
an
porton
arses
as
a
s
be
N
remnant
as
o
or
GAS
90.
ventra
be
te
B.
he
C.
he
te
eoceca
superor
nvoved
wt
pro-
and
correct
A.
buds,
ack
o
canaza-
245
ompaoenterc
pouc
border
duct
about
o
te
duct.
3–6
eum
n
It
cm
and
generay
te
arter y
prox-
part
normay
ong
B.
rom
40–50
C.
remnant
he
A
ceca
not
a
remnant
o
te
5
mm
n
turns
nto
dameter
a
by
Mecke
GAS
A.
An
does
o
te
atera
n
wc
cavty,
sur-
a
deect
te
n
te
umbcus
aduts.
te
commun-
and
oop
suc
te
o
as
te
nguna
cecum
rng
urter
rng
perto-
ntestne
nto
nto
descent
te
scro-
ABR/McM
te
n
te
cause
and
epgastrc
te
cases
narcton
t
to
n
te
te
ower
abdomen
rgt
sde
yng
asymptomatc;
superor
and
cavty
ntestne
are
te
erna,
coverng.
te
to
arge
te
deve-
o
amnotc
resuts
passng
o
cosure
o
pane
pertonea
te
Most
ntestne
an
returnng
ntestne
et.
n
mdgut
oop
week
meda
nto
a
233
ncompete
ourt
te
resuts
te
an
mesenterc
gangrene
o
te
suppes.
between
te
umbcus
erna
ernates
not
cose
part
and
resuts
troug
an
competey.
o
te
te
urnary
wen
an
umbca
Suc
greater
a
badder.
abdomna
rng
erna
omentum
tat
oten
and
sma
ntestne.
week
E.
315;
s
te
prmordum
o
te
he
coaca
membrane
dvertcuum
N
270;
s
not
a
remnant
o
te
resuts
appropratey
umbca
cord.
91.
usuay
ruptures
durng
te
In
at
suc
248
wen
te
cases,
ste
o
te
twstng
te
o
part
body
wa
attacment
o
te
greater
261;
te
N
ana
254;
cana
and
ABR/McM
te
amnotc
cavty .
232
A. he nabty to pass meconum denotes an obstruc-
ton
ABR/McM
erna
between
GAS
cord.
cose
ton
appendx.
umbca
not
te
o
umbca
does
pear-
n
possbe
rom
obstructon
te
and
a
o
wen
nguna
wtout
sma
contans
normay
dvertcuum
and
umbca
89.
An
organ
s
artery
about
o
wt
254;
abdomen,
can
s
deep
protrude
te
on
o
A patent uracus occurs wen tere s a communca-
ton
cm
juncton.
vesce
te
te
owever,
dvertcuum
ompaoenterc
mesenterc
o
are
skn.
troug
organ
te
durng
lud
Nonrotaton
o
N
hs
tat
skn.
egt week o deveopment, creatng a communca-
cecum
A.
vscera
amnotc
umb-
by
structures
amnotc
vagnas
cose,
deect
wa.
abdomna
te
erna,
eve
erna
resuts
a
so
majus.
ods
rom
porton
20.
D.
atera
entrey
dvertcuum
umbca
wt
ABR/McM
(Mecke)
ngerke
ea
saped
te
o
cavty
erna
and
commony
superca
298–299
abdomna
dorsa
te
abum
o
cosure
te
te
anoter
cana,
aure
lud.
occurs
not
o
te
tssue
tunca
troug
Gastroscss
opment
pancre-
ventra
D.
o
dur-
ts
or
te
does
nguna
tum
ducts.
te
ea
o
not
BP80;
antmesenterc
rom
a
troug
hs
muc
te
n
cannot
dorsa
or
duodenum
te
due
surrounds
brt
rom
rng.
are
te
obstructon
duodenum.
te
wt
D,
eter
or
ernates
ater
around
between
o
epgastrc
to
more
a
o
ernatng
nto
nguna
or
any
te
an
erna
ar
cavty
rst,
anomay
presents
occurs
ndrect
te
tssue
resut
ormng
to
cause
te
ompaocee.
s
porton
ncompete
n
superor
nea
bot.
A
te
can
buds
a
rom
abdomna
coverng
amnotc
tracea
246
sorty
usng
answers
hs
GAS
88.
and
be
duodena
part
wrappng
reer
not
te
queston.
pancreatc
pancreatc
tey
between
ABR/McM
ound
tereater,
tereore,
because
te
second
be
deveopment
bud,
woud
n
pancreas
bud
and
passage
causes
o
te
can
Annuar
atc
B.
279;
band
constrcts
pancreatc
ng
N
and
cted
pancreas
tck
obstructon
ater.
An
aba
a
protrude
by
rom
ernaton
proxma
s
epgastrc
caton
abnorma
ernate
tere
te
subcutaneous
vscera
and
E.
be.
an
An
to
erna,
resutng
nea
te common be duct; tereore, vomt woud not
contan
by
dfers
apparent
wtout
rounded
gastrc
te
an
te
Gastroscss
ods,
Hypertroped
s
umbca
covered
e.
C.
can
ompaocee,
return
nto
cord,
In
n
to
tere
vscera
ca
Duodena
ntestne
ernaton
congenta
ntestne
stomac.
A.
sma
abdomen.
absorpton
Fnay,
and
161
Abdomen
3
o
B.
te
eta
o
te
sma
bowe.
and/or
Gastroscss
o
te
Mdgut
ntestnes
atera
s
arge
and
resuts
n
te
obstructon
ntestnes.
caused
ods
vovuus
utmatey
by
durng
ncompete
te
ourt
cosure
week
o
162
C H A P T E R
3
Abdomen
deveopment
pane
o
gastrc
te
erna,
amnotc
C.
Faure
50%
and
o
creates
wt
cavty
o
t
abdomna
vscera
and
are
obstructve
s
tat
o
te
esons
caused
deect
hs
by
o
n
te
resuts
by
an
te
te
wt
ntestne.
hs
atresa
o
D.
A
remnant
presents
ong
eum
an
arses
and
o
sma
ompaoenterc
ea
o
ntestne
duct
dvertcuum
ngerke
rom
mdgut
returnng
sttng
on
generay
ompaoenterc
pouc
antmesenterc
cm
te
oop
te
a
te
40–50
te
(Mecke)
o
as
rom
Nonrotaton
ton
te
porton
normay
cm
o
as
proxma
E.
94.
te
te
te
about
border
eoceca
resuts
to
n
te
sde
A.
ower
o
te
C.
D.
owever,
obstructon
323;
N
remnant
eum
proxma
rom
40–50
and,
arge
and
rom
woud
as
as
te
be
te
ea
a
o
cause
o
o
o
te
o
cosure
o
atera
opment
o
te
otc
ods
and
t
caused
wt
cavty
durng
creates
are
ncompete
te
a
wa.
vscera
and
by
ourt
deect
hs
tat
n
week
te
resuts
n
protrude
covered
by
o
C.
te
an
nto
amnotc
obstructve
ton
s
caused
Nonrotaton
porton
o
so
te
tat
rgt
sde
yng
by
te
o
septum
B.
Dorsa
C.
Faure
resut
part
N
Incompete
ta
on
ana
o
externay
ageness.
et.
can
n
to
A
te
amn-
te
te
Most
ana
o
o
n
te
t
te
xed
te
asymp-
and
gan-
E.
urorec-
septum
woud
resuts
ana
n
mperorate
to
anus,
perorate
not
ana
te
and
o
to
resuts
exsts
coon
s
a
no
but
s
resuts
n
connecton
o
te
Mecke
ompa-
dvertcu-
ts
open
te
te
o
wt
te
te
descrbed.
and
woud
not
resut
vtene
duct;
n
a
te
outsde
vtene
can
o
appear
a
n
o
te
due
sma
vascuature.
te
oten
or
to
s-
porton
dferent
stua).
mdgut
to
It
oop
ntestnes
can
and
resut
woud
descrbed.
ABR/McM
s
te
resut
tat
or
o
drecty
persstence
233
abnorma
assocated
rectouterne
proctodeum
to
parttonng
wt
a
rectoure-
stua.
deveop
w
resut
n
anus.
te
a
persstence
connectons
symptoms.
can
symptoms
s
280
te
remnant
o
254;
te
urorec-
cana.
n
by
twstng
ageness
ead
urorecta
stua
but
septum
woud
not
woud
cause
most
anorec-
ageness.
Faure
o
xaton
Premature
A.
cause
stak.
It
s
rom
tcuum
to
498;
Me c k e
ma
membrane
o
Ageness
GAS
97.
urorecta
N
te
perorate
porton
tumor
suspendng
mperorate
not
te
n
o
te
ndgut
can
resut
n
vovuus.
suppes.
by
n
315;
Faure
a
duct
te
by
not
cyst
rectovagna,
ta
C.
248
coaca
resut
key
superor
stenoss.
te
B.
a
marotaton
coaca
an
ntestne
are
te
A.
rst
on
te
s
smpy
as
s
Anorecta
tra,
ower
ageness.
te
o
ntestnes.
arge
cases
o
obstruc-
abdomen
narcton
ntestne
ABR/McM
hs
resuts
descrbed.
s
vtene
ter
by
cana
te
ana
symptoms
cause
s
(suc
Vovuus
not
D.
t
o
caused
can,
woud
not
to
tere
resut
dvertcuum
but
te
GAS
96.
septum
coaca
ABR/McM
s
te
cyst
t
woud
Mecke
rom
lud.
ompa-
dvertcu-
stenoss.
wc
vtene
around
epgastrc
te
becomes
wt
cause
te
o
resuts
obstructon
o
devaton
n
ntestne
separaton
resuts
atresa
mdgut
te
270;
ntestne.
or
abdomen,
artery
te
311;
te
returnng
owever,
mesenterc
grene
te
oop
sma
o
o
stenoss
o
te
entrey
tomatc;
GAS
esons
E.
te
tssue.
and
woud
symptoms
orms
pane
o
Mecke
280
ana
proxma
311;
cause
o
wc
enterocystoma
tua,
deve-
meda
Faure o recanazaton o te eum s seen n 50%
o
A.
s
abdomna
erna,
93.
n
stua
duct,
te
o
Gastroscss
te
An
ayer
rectum
o
N
vtene
so
s
sgns
A
owever,
sma
bowe
te
B.
te
appendcts.
E.
te
Remnants
n
juncton.
eta
o
A.
n
ageness.
he
recanazaton
atresa,
umbcus,
pouc
border
D.
te
Abnorma
vtene
(Mecke)
twstng
obstructon
te
ompa-
ngerke
eoceca
Inarcton
not
o
an
a
rom
utmatey,
suppes.
95.
antmesenterc
resuts
ntestnes.
t
239
porton
arses
te
cm
vovuus
ntestne
presents
normay
ong
and
ntestnes
seen
te
te
ABR/McM
generay
It
cm
Mdgut
and
o
duct
3–6
324;
o
a
membrane
anus.
a
o
ana
by
ana
part
n
urorecta
obstructed
not
te
n
ana
479;
about
C.
te
um,
dvertcuum.
B.
o
mperorate
GAS
o
te
separaton
and
gangrene
resut
resuts
connecton
cana.
porton
ABR/McM
o
resuts
o te superor mesenterc artery can cause narcton
oenterc
A.
asymptomatc;
no
ageness.
311;
duct
A
te
are
septum
between
E.
ana
coon
s
stenoss.
recta
abdo-
and
te
tere
proxma
woud
devaton
Faure
D.
te
N
oenterc
GAS
92.
cases
ana
n
men, and te arge ntestne yng entrey on te et.
Most
not
498;
ta
por-
rst,
um,
Incompete
te
te
GAS
o
wc
rectum
o
duct
Dorsa
It
3–6
o
B.
n
oenterc
ana
te
te
Remnants
juncton.
abdomen
rgt
n
duct.
recanazaton
atresa,
between
E.
te
ntestnes.
Abnorma
recta
lud.
seen
or
s
D.
ep-
nto
amnotc
eum
stenoss
meda
n
protrude
covered
recanazaton
obstructon
a
wa.
s
rupture
anorecta
N
usuay
te
2
to
tat
ana
ABR/McM
s
nces
eoceca
prone
te
membrane
woud
ageness.
dver tcuum
peroraton)
beedng.
311;
o
a
279
re m n a n t
ong
juncton.
uceraton
can
and
re s u t
2
o
Me c k e
(possby
n
te
eet
yok
prox -
dver-
eadng
gastrontestna
CHAPTER
B.
Dupcaton
te
C.
A
patent
o
to
te
GI
subepatc
aure
o
ntestne
does
not
predspose
owever,
beedng.
cecum
an
and
compete
appendx
mdgut
s
due
rotaton
to
woud
durng
E.
he
deveopment.
D.
Nonrotaton
but
E.
s
not
Hernaton
becomes
GAS
98.
D.
ageness
A.
o
te
muttude
o
C.
E.
kdney
Wms
tumor
more
not
373–374;
wt
and
ng
A
s
does
cause
deveopment
a
B.
tons
and
Answers
resuts
s,
n
rena
decent
pro-
wt
may
go
occurs
sma
on
due
and
can
orm
a
cdren
o
o
tan
n
ureter.
te
kdney
t
s
n
can
and
emae
vagna
s
and
rom
46XX
Inguna
a
B.
tose
absence
consstent
ernas
ave
descrbed
genotypes,
o
wt
te
te
n
resut
notng
to
uterus
emae
wt
102.
C.
ypopasa
sstent
GAS
he
na
wt
470;
vagna
bubs,
pate,
deveopment.
Faure
sstent
pate
ymen
s
openng
a
od
o
te
o
te
a
ageness
absence
wc
ta,
o
te
durng
con-
membrane
It
s
tat
oten
snovag-
n
a
torn
E.
he
and
n
te
at-
remnants
n
o
mesoneprc
ncudng
men,
and
te
women.
he
ducts
Gartner
duct
ejacuatory
ony
are
duct,
te
wc
are
eongatons
hese
by
te
tubues
o
are
gomeru
te
subse-
to
orm
a
corpusce.
ducts
uterus,
are
responsbe
cervx,
and
or
uppermost
te
bubs
are
te
orm
te
spongy
aba
uretra
responsbe
vagna
n
or
pate
mnora
men.
te
n
E.
deve-
embryonc
N
371;
B.
or
ypopasa.
or
nasa
are
and
assocated
Atered
ears,
o
te
aca
etc.
a
rare
rena
caracterstcs
mcrogna-
Absence
kdneys
s
wt
mandbuar
or
causes
ack
o
ogoy-
anydramnos.
dyspastc
usuay
tereore
286
syndrome,
s
brdge,
ow-set
possby
are
Potter
trat
Mutcystc
kdney
secondary
not
te
to
cause
and
poycystc
Potter
o
Potter
sequence
sequence
ogoydramnos.
Wms
tumor
presents
s
n
wa;
o
tat
urnary
n
ABR/McM
a
and
te
s
t
Potter
urnary
exposes
badder
tere
reatvey
cdren;
on
no
te
te
common
s
not
tumor
wt
sequence.
badder
posteror
exteror
ndcaton
rena
assocated
o
o
s
a
congenta
surace
te
ts
o
te
abdomna
deect
n
te
patent.
processus
vagnas
pertoneum
cedes
B
or
deect
te
eary
and
ods
and
o
Exstropy
e.
te
te
vagna.
ogoydramnos
he
covers
In
mesoneprc
rena
te
lattened
tat
per-
ymen.
o
deveopment
and
embryonc
resuts
he
deerens
tubues
te
recessve
kdney
or
mperorate
cana.
sed
not
o
maormed
and
D.
rom
canazaton
mucous
s
A
285
arses
tus
and
and
con-
descrbed.
canazaton
and
neck,
o
structures,
dsappears
te
sequence,
autosoma
46XY
genotype
symptoms—and
ABR/McM
vagna
45X
webbed
ympatcs,
symptoms
371;
undergoes
vagna
o
oter
te
N
rom
stature,
o
vesces.
te
474;
dramnos,
resuts
o
Potter
T urner
sort
o
deveopment.
proper
wt
oten
appear
duct.
o
ductus
nvagnated
opment
presenta-
rom
te
urogenta
o te uterus and a negatve sex cromatn pattern.
syndrome
te
deve-
cyst.
women
ncude
do
absence
resut
tubues.
parooporon,
Snovagna
present-
and
dferent
and
or
o
285
oten
te
varety
paramesoneprc
he
gentaa,
te
t
ormaton
respectvey.
ave
a
a
mesoneprc
he
t
C.
externa
to
traces
quenty
tat
nvoves
pseudoermaprodtsm
cest—among
A.
orm
he
are
(Woian)
mesoneprc
263
syndrome
Faure
compete
wc
coectng
component
aduts;
cysts,
orms
wereas
aspect
ABR/McM
n
responsbe
pate.
ABR/McM
vagna,
rse
and
epooporon,
dv-
eter
te
te
gves
ureter
remanng
ageness.
311;
hs
resut
are
vagna
resut
370;
duct
o
eventuay
parts
premature
o
magnancy
rena
to
N
mesoneprc
te
A.
occurs
bud
n
N
wa
te
durng
porton
to
474;
Gartner
era
recessve
kdneys
a
cana
canazaton.
bubs
te
woud
wt
vagna
101–125
D.
GAS
Mae
genta
A.
gangrene.
autosoma
dupcaton
testes
tubes.
presents
100.
an
owever,
pseudoermaprodtsm
E.
tat
GAS
symptoms.
and
D.
any
ducts,
a
a
bnd-endng
uterne
orm
o
present
te
ntestne
101.
spongy
nsenstvty
o
to
mesonepros
tubues
common
Androgen
o
system.
or
GAS
C.
wtout
242
to
s
by
te
ureterc
doube
s
o
dupcaton
te
undergo
woud
because
vagna.
cysts.
urogenta
o
ead
opment
duct
dsease
deveopment;
Ureterc
son
99.
o
mesoneprc
te
oop
vovuus
beedng.
lud.
kdney
Degeneraton
te
exst
can
to
GI
can
bud
caracterzed
norma
t
ead
or
te
ABR/McM
ureterc
amnotc
dsease
ogoydramnos,
Poycystc
B.
270;
coud
cause
ntestnes
owever,
N
o
and
ducton
mdgut
key
stranguated,
315;
Faure
te
most
o
symptoms;
st
dsorder
ymen
snovagna
deveopment
o
te
neter
mperorate
163
Abdomen
3
te
D.
stvty
nto
descent
Bot
o
te
cervca
syndrome
s
te
a
tube-ke
nguna
projecton
cana
tat
o
pre-
tests.
atresa
woud
and
resut
GAS
103.
B.
o
androgen
n
nsen-
amenorrea;
he
te
bud
te
373–374;
ureterc
ureter,
woud
bud
and
resut
psatera
N
s
311;
tus
n
sde.
ABR/McM
responsbe
an
eary
or
268
te
spttng
ormaton
o
a
deveopment
o
te
second
ureterc
ureter
on
164
C H A P T E R
A.
3
Abdomen
Faure
o
te
compete
C.
he
ureterc
absence
urorecta
deveop
D.
stua
patent
tat
anteror
Faure
may
n
runs
GAS
104.
o
stuated
coverng
hs
n
o
o
an
tssue
te
as
urne
an
A,
joned
to
to
ureter.
abnorma
badder
eakng
to
to
branc
occurs
deveopment
and
cavty
A.
bot
s
he
and
toned
C.
not
n
but
t
te
not
ton,
tey
recess
patent
s
resuts
lud
GAS
328;
neror
stomac
B,
o
te
hese
and
n
tese
GAS
E.
he
s
te
s
te
te
n
a
stes
ta
space,
atera
to
houg
lud
to
te
lud
coverng
rec-
A,
or
te
rgt
and
gutters
and
uceraton
te
te
are
n
passage
subprenc
n
ocated
woud
not
traverse
between
te
te
o
ar
space
omenta
te
va
superor
sory
to
cent
te
an
A.
to
te
ar.
ste
B.
he
pevc
cavty;
rectouterne
ar
woud
pouces
not
328;
most
N
key
ere
ovar y
pont
erect.
be
pouc
n
te
or
(o
are
te
lud
accumuate
wen
lud
mesovaran
ocated
on
accumuate
Dougas)
te
because
t
patent
s
a
woud
accumu-
gament
posteror
causes
aspect
o
o
s
ntmate
extends
and
ts
“te
con-
rom
coon.
penetraton
pertonea
wa,
omen-
transverse
o
aso
uterus.
285
stomac
te
te
rom
abdomna
n
te
between
mesentery
te
te
requre
enter
were
separated
omentum
beow
to
s
o
pertoneum
o
cavty
te
and
mesentery”
vesse.
Atoug
relect
te
omenta
apron
or
adequate
expo-
omentum
ordnary
structures
requre
w
an
not
ABR/McM
rom
o
bers
t
woud
ncson.
provde
access
to
are
pan
are
because
239
coecystts
te
toracc
spna
neror
stmuated
o
te
s
ange
generay
spancnc
nerves
generay
o
rom
by
te
te
T5
nerve.
proxmty
provde
souder
spna
prmary
T1–T4
te
T4
E.
to
to
264;
upper
C5–C8
to
254
pevs
Addtonay,
because
to
ABR/McM
ocaton
rectouterne
owest
te
nerves
to
spna
upper
vscera
wt
284;
ayer
te
pouc,
cavty
poston.
ocated
nes
te
suprarena
Morson
ABR/McM
woud
between
rgt
to
hese
T9
sen-
gabadder
o
te
adja-
te
sensory
nnervaton
sensory
nnervaton
area.
provde
upper
mb,
to
te
eve
o
te
and;
C.
and
C3–C5
to
ascendng
o
structures.
to
coons.
vescouterne
or
rom
troug
te
bers
o
regon
greater
Neter
to
accumuaton
and
as
and
gament
angs
pan
hese
nlammaton
bursa.
neror
te
to
atera
vesse.
N
te
posteror
accumuate
atera
to
scapua.
ocated
dapragm
aow
structures
s
285
387;
Reerred
reerred
space
An
D.
hese
afected
s
uterus
greater
greater
not
lud
neror
superor
ocated
pertonea
pertoneum
te
and
stuated
supne
pouc
necessary
woud
GAS
108.
te
350;
he
ocated
coons.
o
known
doube
N
s
kdney
te
trombosed
te
E.
n
pertoneum
o
be
o
C,
te
atoug
s
B,
a
eum
te
probaby
t
n
s
rgt
and
pertoneum
sure,
patent
rectouterne
standng.
aso
curvature
te
ste
recess
broad
porton
to
we
te
communcaton
te
are
descendng
s
vscera
nterrupton
te
by
te
organs.
greater
porton
and
as
te
apron
epatore-
patent,
wen
te
tese
spaces
badder
space
gutters
key
space
381–382;
wt
Access
accumua-
potenta
supne
te
a
te
coect
pareta
pareta
vescouterne
be
ABR/McM
te
woud
te
or
coect
not
t
cav-
regon.
coons.
he
quadrant,
he
tact
s
recess,
ovares
wereas
spaces.
standng
ate
o
ver.
descendng
he
ocated
n
276;
uceraton
paracoc
E.
E.
subprenc
nto
ts
te
pos-
pertonea
grooves
not
predctabe
communcaton
C.
D,
N
wa
n
s
subprenc
neror
woud
recess
can
GAS
D.
and
deepest
known
pertonea
between
or
and
dapragm
paracoc
bot
hs
te
vescouterne
te
ambuatng.
aspect
o
stomac
open
or
rgt
surace
D,
te
rgt
spaces
woud
pouc
provde
uprgt
he
and
ts
te
he
n
o
patent
and
urnary
107.
abdomna
are
ocated
te
ocated
wtn
te
potenta
accumuaton
tey
A.
space
n
D.
gand.
pouc.
s
descendng
are
lud
aows
ovar y
subprenc
sde
he
te
gand.
pertoneum
cavty
te
epatorena
lud
suprarena
hs
o
ocatons
ver
271
pertonea
Atoug
gutters
supne.
touterne
o
ts
accumuate
and
te
space
reac
paracoc
are
n
he
nor-
rgt
ascendng
wen
s
pareta
and
n
approprate
may
ascendng
recesses
coect
deepest
te
kdney
Accumuaton
te
w
and
space
subprenc
te
Fud
na
rgt
dapragm.
ty.
he
ver
owest
ordnary
rgt
ver
s
te
te
patents.
w
te
lud
rgt
ver.
tese
kdney.
ABR/McM
he
te
te
rom
gament.
te
te
te
B.
eac
317;
C.
to
wa.
bud
broad
pouc.
te
structure
addtona
urnary
o
between
ts
acts
te
ureterc
between
recess
supne
106.
a
B. he epatorena pouc (or recess or space o Morson)
s
105.
cause
between
deveops
uracus
373–374;N
woud
secton
n
embryonc
ureter
orm
Faure
rom
resutng
te
a
tat
resut
abdomna
durng
one
not
to
ureter.
s
ndgut.
woud
umbcus,
E.
orgn
and
Persstent
bud
te
septum
mesencyma
aantos
o
bers
reerred
T10–T11
vaton
to
nerves
provde
toracc
or
pan
spna
te
wa
pan
rom
are
te
nerves
abdomna
sensory
and
nnervaton
meda
generay
arm;
T1–
assocated
eart.
provde
wa
at
sensory
te
eve
nner-
o
te
umbcus.
GAS
109.
A.
he
340,
empoyed
gated.
358–364;
Prnge
wen
he
N
309;
maneuver
a
epatc
s
artery
epatoduodena
ABR/McM
a
surgca
as
been
gament
s
246
tecnque
accdentay
camped
of
CHAPTER
to
prevent
proper
te
passage
epatc
artery
o
bood
and
te
low
troug
epatc
porta
bot
Right
te
he
Kocer
maneuver,
n
wc
te
ead
oten
o
te
pancreas
empoyed
to
are
expose
relected
common
and
arrest
iliac
te
neror
vena
to
a
te
et,
inter nal
iliac
ar ter y
s
emorrage
he
Vasava
sage
o
ar
toracc
D.
he
maneuver
wt
Hemc
compressons
oregn
E.
te
pressure,
Puttng
stop
a
major
te
rom
camp
te
ods
to
stoppng
to
cougng
bud
or
te
te
up
inter nal
iliac
ar ter y
pas-
ntra-
sarp,
regon
rapd
to
expe
tracea.
te
porta
but
te
ar ter y
vocazaton.
nvoves
xpsterna
on
beedng
njury
or
maneuver
o
bodes
nvoves
voca
as
rectal
cava.
Right
C.
ar ter y
ar ter y
Superior
rom
iliac
duodenum
Left
and
common
ven. Left
B.
165
Abdomen
3
epats
coud
woud
certany
numerous
not
produce
vascuar
eements
tere.
GAS
110.
A.
he
te
304;
most
et
coc
mesenterc
N
artery.
te
O
ony
o
te
ABR/McM
source
artery,
deveopment
coon.
276;
key
wc
a
emorrage
branc
o
dvertcuar
end
sacs
coces
suppyng
247
ts
s
Coonc
bnd
seected
artery
o
a
rom
te
o
s
wa
coc
te
rom
neror
dsease
te
et
porton
te
s
te
o
te
artery
s
descendng
coon.
B.
he
mdde
mesenterc
C,
D.
he
coc
artery
superor
artery
and
and
s
a
branc
suppes
neror
te
o
te
superor
transverse
recta
coon.
(emorroda) Inferior
arteres
suppy
te
rectum
and
ana
Inter nal
E.
he
et
spenc
te
D.
350;
Murpy
and
na
artery
stomac
GAS
111.
gastro-omenta
o
rgt
costa
deepy.
295;
sgn
te
s
Fg.
It
a
s
specc
n
gabadder:
causes
greater
sarp
te
pan
Middle
o
to
Rebound
deepy
te
under
to
112.
apped
pressure
ton
te
on
body
and
upper
B.
he
s
rgt
te
ects
C.
he
o
not
experenced
qucky
specc
ndcatve
test
o
rom
to
a
areas
probems
n
s
generay
lexng
to
appendx
used
te
te
s
to
te
obturator
a
nternus
postve
test
cecum
to
and
ts
dagnose
musce
wt
te
Coug
s
woud
assocated
assocated
wt
rses
GAS
340;
N
330,
te
and
not
wt
n
309;
be
present
ernas
and
ntra-abdomna
ABR/McM
246
to
te
esser
ts
o
to
area
te
te
and
s
te
te
pont
requre
extends
to
at
transverse
owest
wc
wc
stomac
epatogastrc
occurs
and
woud
gament,
omentum
sac
gament
trave
gastrococ
stomac
vdes
entry
musce
not
appen-
provde
B,
D.
because
t
probems
pressure.
ana
best
and
E.
o
entry
te
por-
rom
te
transverse
epatoduodena
ga-
ng
tat
te
pectnate
te
esser
access
N
o
275;
te
duodenum,
gament
but
because
neror
tese
t
pro-
ts
does
aspect
carcnoma
were
gaments
te
esser
ABR/McM
carcnoma
o
to
nodes.
musce
resuts
ne
te
omentum,
pont
exposure
nguna
te
he
o
o
s
not
te
4.60).
skeeta
tat
cana.
te
part
epatogastrc
T ransectng
300–306;
s
rst
te
exposure
Fg.
adequate
Superca
suggests
te
eicent
(GAS
C,
GAS
113.
troug
te
sac
and
Dvdng
most
provde
not
current
te
esser
pressure
woud
woud
Access
greater
he
o
gastrococ
curvature
spncter
tenderness
generay
te
rrtaton
patent’s
pont
te
o
symptoms.
E.
4.92
te
dagnose
opsoas
nlamed,
used
ar ter y
Fig.
ments attac between te ver and te esser curvature
A,
s
rectal
GAS
te
pan.
sgn
sac.
te
coon.
oca-
o
o
greater
wen
o
Beedng
esser
respectvey.
pressure
te
obturator
ect
s
because
appes
Wen
pan
removed
It
not
s
owest
troug
wt
quadrant.
appendcts
dx.
s
body.
opsoas
group
he
coon.
te
breate
patent
D.
ntersecton
ds-
ton
tenderness
ar ter y
detect
abdom-
dagnose
patent
n
to
rgt
coecystts.
A.
pudendal
te
curvature
desgned
upper
used
asks
ar ter y
249
pressng
one
rom
•
test
te
casscay
margn,
hs
te
arses
4.92).
ABR/McM
probems
quadrant.
eases
suppes
(GAS
N
dagnose
and
artery
rectal
cana.
te
o
s
he
te
most
externa
ana
cana.
support
key
squamous
not
240
orgnatng
bopsy
w
sac.
rom
te
occurred
ces
o
ana
hs
te
nd-
beow
te
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.
superca
A.
he
te
he
he
o
o
pevc,
deep
te
GAS
114.
A.
he
Beow
w
o
te
drans
to
D.
te
E.
nodes
dran
te
pens
superca
ymp
superor
dran
and
te
nto
te
te
ower
115.
te
B.
some
o
o
te
superca
above
ac
te
nguna
pevc,
superor
lows
recta
nto
ac
and
nodes
deep
aspect
o
nodes,
te
prmary
pernea
te
umbar
rom
nodes.
s
draned
wc
Sdng
A
zed
te
ower
anayzng
te
GE
te
te
juncton
ernas
do
ernaton
owever,
s
te
pens,
dran
recevng
nguna
nodes.
281
juncton
esopagus
GE
s
dspaced.
can
juncton.
dspaced
not
be
In
car-
sdng
superory
possess
116.
B.
he
spaces
te
372;
N
ver
rgt
and
te
te
GE
ernas
265;
acorm
nto
erna
o
te
medastnum,
GAS
by
o
paraesopagea
by
tnum;
(or-
eventuay
superca
te
dran
prmary
and
ABR/McM
ernas
GE
nodes
ctors
te
390;
nodes
ne.
nto
medastnum.
C–E.
cana
structures.
rectum
ymp
dran
ymp
te
rom
N
ymp
pectnate
a
norma
GE
juncton.
te
nodes.
ana
te
ernas,
by
te
o
paraesopagea
externa
mdde
sdng
ernas,
te
A.
nterna
aso
514;
acterzed
gands
nodes.
rectum
In
nguna
to
nguna
Dapragmatc
234
ympatcs
te
dran
receve
nguna
neror
nto
ne,
dran
structures.
nodes
ABR/McM
dran
pectnate
prmary
pernea
ymp
o
deep
gands
GAS
nodes
268;
superca
superor
he
te
nodes.
deep
and
he
area
nodes.
he
he
N
ne
prmary
mb,
C.
prmary
nodes.
ymp
nguna
514;
te
zonta)
ac
and
ympatcs
pectnate
B.
cana
4.60
rectum.
ctors
ymp
ac
recta
te
externa
mb,
E.
nterna
mdde
aspect
C.
ana
ymp
Fig.
he neror rectum above te pectnate ne drans
nto
B.
he
nguna
GAS
colon
but
et
te
te
nto
caracter-
te
remans
undus
antrum
medas-
xed.
ernates
does
In
nto
not.
270
separates
recesses
anteror
generay
juncton
ABR/McM
gament
and
s
stomac
and
abdomna
te
subprenc
extends
wa.
between
Because
o
CHAPTER
ts
ocaton
te
oter
A.
and
spread
o
across
he
te
round
remans
margn
te
C.
o
o
te
E.he
te
te
and
te
acorm
to
te
te
to
117.
A.
he
ror
te
to
speen
te
most
B.
he
C.
he
he
pancreas
A
te
te
s
GAS
373–374;
B.
he
rom
urnary
he
na
te
te
umbar
N
o
sde
get
o
rbs
te
rectum,
esser
toug
A.
gaments
stomac,
ver
It
B.
te
twet
rb.
C.
t
o
to
ocated
te
E.
tent
n
te
kdneys
121.
te
ocated
on
n
te
nto
at
dran-
scrotum
cavtes,
te
dran
anteror
o
he
terc
ymp
GAS
119.
C.
he
te
te
and
trd
nate
coud
N
part
o
o
ready
nto
te
neror
390;
o
te
te
across
te
duodenum.
pancreas
afected
and
by
a
at
As
rom
te
te
L1
anteror
te
t
crosses
duodenum,
tumor
n
te
te
mmedate
B.
he
assocated
he
te
curvature
common
te
trd
he
wt
ead
o
o
creas
te
epatc
part
o
te
suppes
pancreas,
artery.
and
hs
s
and
a
artery
porta
ven
E.
over
te
does
greater
o
not
te
cross
bot
porton
te
o
te
artery
dent-
vesses.
te
nterna
uterus
and
te
rom
te
umb-
enters
te
oramen
pevs
and
ateray
at
term-
te
pe-
emaes
near
ABR/McM
te
te
o
passes
wa
o
and
can
te
ovary
ovary
or
brm.
undus
most
o
or
nto
key
te
te
be
o
can
ga-
troug
eadng
ead
vomtng
ndcatve
Gastones
coon,
possby
coud
te
te
pevc
be
gabadder
ten
hs
te
ntestne.
transverse
te
o
271
regon
arge
rom
gament
te
duode-
entrapped
to
an
predctaby
experenced
ntes-
to
by
te
te
and
as
A.
he
te
coud
dstay
unkey
cear
out
te
te
pass
as
reey
te
tat
troug
eoceca
tey
junc-
woud
accu-
jejunum.
resuts
(ndcated
te
be
stes
o
duct
suggest
by
or
duodenum,
tat
te
presence
o
epatc
obstructon.
woud
ts
te
common
gastone
gastones
330,
340;
costa
he
and
pass
woud
te
runs
n
tereater
not
be
te
ste
ocated
s
a
provde
varous
te
te
promnent
o
anteror
wtn
wt
upper
pont
te
o
248
semunars
rgt
te
quadrants
ocaton
nea
te
wt
parae
and
ABR/McM
rgt
wt
undus
vscera
seat
te
cartage
anatomc
semunars
309;
o
typcay
gabadder
rectus
N
ntersecton
nnt
tures
be
potenta
assocated
te
ar
bockage.
GAS
122.
as
are
rue
Because
o
gastones
a
contact
useu
body.
too
or
or
struc-
he
border
andmark
o
abdomna
anatomc
atera
wt
quadrant
nea
o
te
surace
anatomy.
ead
ead
te
rom
be
pevs.
ven,
radograpc
trees
understandng
branc
to
gament,
woud
te
wa.
pancreatcoduodena
te
n
he
te
duode-
n
te
woud
duodenum.
duodenum.
superor
suppes
second
rst
artery
te
posterory
and
te
te
stomac
epatc
part
and
te
o
te
posteror
courses
and
duct
gastroduodena
num,
C.
be
to
surgca
uterne
must
uterne
ven
ac
juncton,
te
troug
s
and
are
B.
D.
unc-
artery
nto
body
t
bary
o
area.
A
and
vertebra
ts
rom
stone
muate
aorta
surace
te
arses
te
suspensory
317;
ntestne
ton,
mesen-
te
ven
crampng,
duct
arses
te
scatc
nterna
obstructon.
te
281
artery
pancreas,
nerory
te
be
ABR/McM
artery
umbca
eoceca
ar)
mesenterc
neck
passes
process
drans
te
Because
nodes.
superor
bend
eve,
514;
coon
meda
patent.
C
sgmod
o
durng
and
arses
pudenda
troug
he
te
exter-
aspect
by
cervx
dorsa
n
greater
N
te
and
o
pan,
and
nto
part
248
gaton
crossed
passes
vesca
te
pan
badder
A.
ocated
o
n
ucerate
prostate,
te
380;
Pan
tna
te
second
mmedatey
gatng
anterory
gonada
md-
aorta.
E.
B.
num.
receve
to
artery
nundbuopevc
263
nodes
and
ABR/McM
te
wen
te
n
way
reerred
dran
te
wa.
he
wa
woud
s
to
recta
nterna
rbs.
at
wt
stuated
ureter
superor
artery
by
rbs.
uterus,
artery
vc
nodes.
ymp
ac
troug
to-
body
295;
subject
atera
avoded
GAS
te
he
so
mdde
he
njured.
sde
N
oten
he
he
be
processes
to
and
353;
structures
are
or
nates
wtn
assocated
rectum.
supe-
woud
respratory
cana
abdomnopevc
nodes
nc
ed
omentum.
te
rb,
te
ureter
ca
ABR/McM
te
o
probems
twet
ymp
area
343,
procedures.
an
and
meda
ac
bare
and
o
rgt
o
ana
rom
ver.
more
duodenum.
Vascuar
te
gaments.
9–11.
beng
te
311;
te
ree
D.
njured.
twet
to
te
te
te
rbs
wt
more
o
120.
badder.
testes,
to
te
254
predomnanty
nterna
te
to
eve
nguna
age
orm
eve
on
eevent
magnancy
superca
tereore
te
te
ascendng
competey
te
n
epatogastrc
et
to
te
te
body
o
and
C.
around
eve
A
te
rom
es
o
te
te
at
ocated
and
de
D.
s
stop
to
obterated
es
duodenum
tey
organ
and
encoses
and
assocated
resut
ver
to
sde
te
surace
ABR/McM
ocated
es
ven
s
gament
adjacent
above
pan
woud
118.
are
cavty
serve
one
tranguar
te
under
common
wt
E.
es
kdney
he
284;
kdneys,
ungs
racc
D.
N
ver
neror
gament
orms
ver
328;
te
umbca
respectvey . T ogeter
GAS
woud
rom
GAS
o
epatoduodena
attac
t
abscess
mdne.
coronary
ver
an
gament
umbcus
he
D,
attacments,
suc
167
Abdomen
3
o
o
te
te
B.
he
ntersecton
o
te
pan-
rgt
ntertubercuar
pancreas
rgt
quadrant;
duodenum.
It
s
cse
ocaton
o
rgt
pane
owever,
te
s
semunars
stuated
ts
s
gabadder.
not
n
te
wt
te
te
upper
most
pre-
168
C H A P T E R
C
and
3
Abdomen
D.
te
he
trc
regon
porton
regon,
te
to
E.
te
he
s
te
not
be
407;
N
o
owever,
te
best
251;
musces
and
nguna
o
te
or
B.
stranng.
A
nguna
rng,
rng,
nguna
D.
not
a
key
ts
t
a
o
or
te
too
rgt
o
N
te
o
w
and
transversus
cose
of
te
contract,
te
te
weakness
as
or
o
vagnas
o
te
te
te
te
wen
nguna
externa
or
asca
o
Answers
126.
nterna
ABR/McM
pouc
he
te
a
or
n
te
Any
lud
or
asca
main
tse
nor
n
te
pouc
drecty
by
because
te
gangonc
te
ow-
wen
undergo
B,
C,
due
127.
D.
ts
ocaton
wc
does
n
not
te
tend
superor
to
et
to
o
E.
he
as
rgt
cavty,
epatorena
te
rgt
rom
te
he
vescouterne
ary
ocated
s
o
te
n
te
sgty
Dougas)
space
te
s
he
lud
broad
o
luds
N
350;
475;
dorsa
to
root
neurons
aspect
rom
s
a
A.
aso
ocated
o
tat
te
n
to
te
but
body
B.
t
(o
E.
C.
N
wa
ower
mb
target
to
adrena-
te
wc
and
are
te
bers.
te
to
send
cro-
nnervated
hs
embryoogcay
to
nor-
s
ten
tssue,
gand
are
wt
cases,
neror
L5
te
he
to
ac
s
post-
medua
and
vena
to
eve,
artery
tat
cava
can
te
n
tromboss
dranage
cause
mb
to
ven
tat,
o
o
extreme
n
te
some
mb
or
to
wc
et
and
s
ormed
common
ac
posteror
woud
be
to
by
te
vens
te
at
rgt
compressed
by
artery.
not
extend
vens
gonada
te
venous
te
passes
qute
wt
superory
te
o
o
venous
hs
woud
vens
et
neror
amputaton
and
testcuar
no
deat.
vens
neror
s,
cava,
o
tese
deep
rgt
ac
rena
o
receves
268
passes
Compresson
tat
ead
gand
nnervaton.
ven
vena
vertebra
because
o
scema
can
eadng
o
suprarena
obstructed.
te
mbs.
runnng
Unke
gangon
ABR/McM
mb;
s
ng
and
n
sympa-
ndcated
durng
sympatetc
types
cause
togeter
he
he
may
te
bodes
bers
cut
mgrate
artery.
te
ce
ound
not
nnervaton,
ces
tat
322;
o
jon
ven
ar
pass
te
compromsed
te
above
kdneys
te
atera
rgt
te
be
rom
to
te
gonada
neror
termnatng
te
area
ven
vena
n
to
bockage.
cava,
te
et
o
pass-
and
rena
ven.
E.
a
s
catecoamne-secretng
te
ac
obstructon,
pouc.
to
common
prevent
285
contan
are
medua.
suprarena
neurons
common
patway
gament
tends
sm-
pouc
te
vescouterne
ganga
te
cromain
394;
et
he
on
pregangonc
et
ower
te
abdomen
uterus,
and
broad
s
te
222
be
sympatetc
bers
enargement
and
t
a
and
unon
abdomna
rectouterne
ABR/McM
rom
te
recess
rom
te
te
o
porton
gament
n
Morson),
s
to
postgang-
cord
sympatetc
synapse
recognzed
gangrene
cavty.
te
by
(o
space,
badder
separated
GAS
sensory
ower
superor
and
coecton
he
pevc
urnary
eakng
uterus.
subepatc
posterosuperor
ar
between
pouc
axons
by
pregangonc
L2–L4
woud
suprarena
o
ocaton
te
te
lud
spna
o
sympatetc
n
common
ts
abdomna
coect
musce.
(T5–T9)
dferentaton.
D,
he
n
space.
o
ces
untreated
o
eart
nerve
ormed
ABR/McM
gand
postgangonc
ndrect
accumuaton
neror
s
te
ganga
306;
te
synapse
GAS
rectouterne
dependent
N
tey
rst
cavty
and
sympatetc
contans
pregangonc
nguna
abdomna
s
o
and
root
suprarena
ectomy
232
Dougas)
abdomnopevc
uprgt.
sette
(o
vscera
spancnc
126–150
A.
route
deects
postgangonc
bodes.
311;
ma
by
dorsa
appendcts
deep
ernaton,
or
ce
dorsa
wtn
te
o
te
neurons.
orn
T1–L2
ces
transversas
ormaton
transversas
o
sympatetc
GAS
attrton
deep
n
part
egress
at
trave
contans
te
wc
atera
n
o
toracc
onc
he
pos-
wen
suc
E.
ax
ower
trunk
gands
he
tetc
and
pertoneum,
emae
most
and
gangon,
pan,
te
o
C.
227
orm
appendx
pregangonc
ceac
eves
and
te
T8–T10.
greater
because
known
D.
he
men-
te pevs wen te body s n te uprgt poston.
125.
musce
B.
anatomc
as
rom
o
sympatetc
he subprenc space woud key not coect lud
and
D.
he
oter
264;
te
bers
ganga
sympatetc ce bodes tat are targeted to smoot
atera
genera
keood
o
to
te
te
sttng
te
cavty,
B
A.
musces.
298;
cavty
beng
A.
o
rectouterne
standng
s
to
expanson
eature
o
aponeuroses
recess
root
ernas.
weakness
est
and
and
Hessebac)
wa
stretcng
s
GAS
te
gabadder
cana
Gradua
contrbute
s
he
to
correct
obque
processus
or
Weakness
obque
te
te
(o
provdes
patent
can
C.
Aferent
erna.
wt
tere,
and
trange
musces
s
down
abdomna
nguna
and
C
te
nguna
cougng
A
ver
superor
aponeuroses
moves
tese
to
epgas-
ypocondrac
stuated
ABR/McM
o
wa
drect
te
rgt
ts
abdomna
wc
o
te
answer.
teror
te
o
superor
o
carres
quadrant
ocaton
earer;
nterna
musces
he
ocated
ngunas,
o
ocated
porton
regon
regon,
rgt
or
abdomns
124.
et
s
contents
gabadder.
woud
GAS
he
stomac.
anatomc
upper
he
te
te
te
toned
E.
are
o
regon
regon.
epgastrc
regon
123.
epgastrc
umbca
he
rgt
aong
mon
te
ac
common
pevc
ven
ac
brm
to
to
orm
ven
unte
te
passes
wt
neror
superory
te
vena
et
com-
cava
and
CHAPTER
woud
not
common
GAS
128.
D.
be
268;
N
bers
are
bodes
taned
295;
B,
C,
aso
run
E.
B.
he superor mesenterc artery does not e drecty
te
organs
te
sympatetcs,
vscera
and
he
bers
ter
D.
he
aferent
gangon.
sympatetc
gangon
are
ce
es
con-
axons
E.
but
do
not
te
131.
E.
A
s
te
ts
na
vaga
No
ganga
eves
nerves
wtn
E
are
te
rom
wa
are
termna
sympatetc
wc
run
GAS
he
359;
N
ureter
sympatetc
310;
s
te
gangon
A,
C.
ocated
Answers
not
bodes
C
ncude
and
ter
o
B.
and
key
at
tese
L1
eves.
ventra
abdomna
anteror
A.
he
ramus
wa
dermatome
B.
he
because
GAS
para-
D.
he
ment
rom
skn
T12.
branc
te
o
ac
te
crest
o
ng
te
t
to
te
be
E.
skn
at
te
It
as
nerve
t
nnervates
to
we
and
as
s
a
aso
abdomna
parae
skn
branc
may
over
wt
te
o
T retz)
pubc
L1
and
he
te
obturator
133.
E.
cord
spna
atera
nerve
eves
cord
contans
and
eves
and
nnervates
tg.
286,
bers
nnervates
rom
te
L2
to
adductors
L4
o
Peroraton
commony
N
o
a
damages
he
posteror
s
branc
orgn
but
rom
321;
posteror
te
o
te
230
duodena
gastroduodena
superor
te
ABR/McM
ucer
pancreatcoduodena
gastroduodena
common
epatc
most
artery
artery.
B.
artery
near
ts
te
duo-
duodenum
pertoneum,
contents
ucers
and
nto
te
perce
penetratng
te
ucers
posterory.
posteror
not
key
artery
superor
E.
artery
he
s
to
be
crosses
duodenum
a
o
he
musce
pan-
damaged.
te
trd
anterory
posteror
branc
o
or
and
s
neror
te
supe-
used
as
and
to
a
duodenum
te
te
(ga-
rgt
crus
o
te
ourt
part
o
te
juncton.
papabe
hs
ga-
andmark
dur-
o
N
o
cecum
te
to
treat
are
hs
respratory
te
cavty
ead
to
he
muscuature
symptoms
o
n
cases
bands
o
as
a
can
te
o
be
ntes-
common
244
contents
erna),
deect
dstress
between
o
te
can
to-
com-
mpar
and
ung
te
most
can
te
ods
nto
ung
cyanoss.
peuropercarda
communcaton
peura
used
abdomna
peuropertonea
abdomna
o
cannot
4.69).
te
sde.
te
hese
not
ABR/McM
o
to
marotaton
dapragmatc
et
arteres,
and
duodenum
ntestne.
Fg.
uson
absence
te
bands
271;
varabe
andmarks.
te
(GAS
mesenterc
gy
obstruct
dvded
te
te
neror
are
connect
causng
te
o
duodenum.
246
duodenojejuna
Ladd
te
te
rom
attaced
reabe
(congenta
on
to
ABR/McM
recta
ernaton
and
artery.
o
surgeres.
can
310;
uncton,
A.
s
te
bands
cause
381;
as
and
Faure
mony
tg.
GAS
a
L3
te
used
GAS
rax
and
over
are
orgnates
vasa
andmark
nguna
sympyss.
stomac
posteror
superor
te
tne,
rom
L2
he
surgcay
bers
musces
te
o
anterory;
te
291;
commony
wa
cause
skn
s
Ladd
T12
te
receve
ayer
damaged.
suspensory
marotaton
atoug
be
N
abdomna
and
majus.
nnervates
he
Peroratng
and
o
passes
312;
o
A–C.
ower
eve.
superor
spna
C.
a
musces
rom
abum
s
tere-
nerves
he atera emora cutaneous nerve contans bers
te
A.
te
skn
nerve
ramus,
gament,
E.
te
Genera
to
246
wa
and
proper
porton
stomac.
ntestna
or
and
ror mesenterc artery and s not key to be damaged
axons,
T11–L2;
reerred
nerve
nnervates
oypogastrc
ventra
D.
o
subcosta
t
be
sac.
pancreatcoduodena
132.
eves
w
onguna
and
and
portons
he
cord
bers
te
te
pyorc
pertonts.
a
artery
artery
rom
te
anteror
mesenterc
to
ment
spna
by
aow
part
patetc
tese
aong
te
cause
duodenum
superor
not
post-
and
pexus.
te
at
rom
be
damaged.
o
gastroduodena
orzonta
or
252
ureterc
he
he
gangon.
sympatetc
to
n
stomac
duodenum
rom
to
creatcoduodena arteres e posteror to te rst part
or
upon,
or
vscera aferent bers n te ureterc pexus oow sym-
bers
te
key
mesenterc
ABR/McM
duodenum
and
pan
n
by
not
brances
runs
ucer
pertonea
te
be
artery
291;
woud
dapragm
ore,
bers
te
perce
parasympatetc
ceac
s
pancreatcoduodena
to
and
anterory
duodenum
passng
para-
do
ABR/McM
nnervated
bers
postgangonc
organs.
ce
troug
wtn
nerve
wtn
tey
and
superor
curvature
N
key
eroson
greater
abdom-
spna
ganga
target
because
gangonc
aso
no
te
esser
covered
an
preaortc
present
at
he
extensons
te
o
cord
Postgangonc
o,
ncorrect
are
a
aferent
spna
runnng
gangon.
are
wtn
bers
vscera
te
bers
troug
te
here
bers
pexus.
arse
n
run
motor
aso
reac
T5–L2.
ceac
and
Runnng
are
to
sympatetc
te
trunks
somatc
gangon.
superory
nerves
parasympatetc
gastrc
artery
312;
s
te
neror
peroratng
gonc
parasympatetc
rgt
GAS
neror
rom
ar
epatc
nerves
synapse
too
he
pass
o
parasympatetc
gangon
duodenum
posteror
brances
(oregut).
Pregangonc
troug
and
ceac
te
damaged.
denum
pexus.
130.
et
wtn te gangon; tereore, tere are no postgan-
rom
C.
te
271
postgangonc
ceac
abdomna
pregangonc
129.
and
wtn
te
and
by
beneat
ABR/McM
postgangonc
wtn
upper
A,
compresson
parasympatetc,
present
o
to
artery.
Pregangonc
pregangonc
to
subjected
ac
169
Abdomen
3
od
woud
percarda
and
woud
sac
not
descrbed.
te
dapragm
s
derved
rom
te trd to t cervca myotomes. Absence o mus-
cuature n one a o te dapragm (eventraton o
te
dapragm)
woud
cause
paradoxca
respraton.
170
C H A P T E R
3
Abdomen
135.
A.
he
eum
suppy
rom
promsed.
rom
te
creas.
It
denum
te
te
to
root
hs
brances:
te
te
o
te
ar ter y
neror
com-
ar ter y
neck
trd
ar ter a
s
o
par t
o
te
pan-
te
duo -
mesenter y
gves
arses
bend
orgn
to
te
pancre atcoduodena
recta
coc
m dde
ar ter y,
coc
and
ar ter y,
eococ
ntestna
ar ter y,
ar teres.
he
rgt
eoc oc
arcades
ar ter y
rgt
A
descends
and
ar ter y,
ends
na
do
eum
not
s
he
(o
arsng
arse
te
rom
he
tc
by
toward
ascend ng
ceca
t e
ea
te
coc
ar te res ,
brances.
anastomoses
rgt
te
speen,
by
rom
atus
GAS
coon
s
te
he
term -
brances,
wc
wt
supped
anoter
354;
neror
N
te
o
and
te
abdomna
te
major
margna
arsng
et
mesenterc
stomac,
te
and
by
possesses
artery
artery
brances
te
o
wc
coc
mesenterc
supped
arcades
ea
Drummond),
o
superor
C–E.
te
posteror
and
supped
transverse
moses
recta
p ertoneum
nto
vesse.
artery
Vasa
and
any
te
dvdng
ar ter y,
ave
source
B.
bend
by
anteror
appendcuar
Ar terial
across
coon.
wen
ar ter y
mesenterc
posteror
enters
scemc
mese nterc
sup eror
aor ta
an d
ar ter y,
Ar terial
he
transverse
become
superor
descends
oow ng Vasa
can
te
anasto-
rom
coc
artery.
duodenum
ceac
aorta
just
te
artery
are
trunk,
beow
a
wc
te
aor-
dapragm.
294;
ABR/McM
248
B
136.
•
GAS
Fig.
4.69
A.
he
troug
te
(o
C.
he
to
te
not
D.
downward
eongaton
key
Faure
woud
te
to
o
C.
ead
te
cause
373–374;
Morgagn
deects
n
erna
te
s
te
xpod
dstress.
sarp,
epgastrc
A.
oter
due
be
B,
D.
to
near
In
patent’s
o
not
N
200;
and
tat
can
t
be
a
ts
can
cause
posteroatera
xpod
case,
deveop
o
wt
270
are
can
s
due
to
Morgagn
just
atera
cause
A
congenta
te
can
o
stomac
be
ta
to
as
wt
te
smar
ernaton
barum
process
woud
and
372;
ata
by
a
he
to
omenta
not
but
and
not
woud
200;
C.
test
rues
out
erna
nto
occurs
te
present
between
part
cavty
esopagus.
hs
te
E.
he
and
o
and
type
as
xpod
vens
te
bood
dated.
woud
270
GAS
s
aong
te
In
pass
gas-
por-
reey
trbutares
he
be
o
wa.
cannot
normay
t
oramen
ocated
parts
anastomose
are
passage
communcate
body
porta-cava
hese
key
te
o
to
be
o
s
and
superor
wt
te
trbutary
te
as
rst
and
para-
to
te
afected
Retzus
suppy
to
serum
woud
ead
due
woud
te
to
porta
not
resut
354–357;
N
s
ven.
artery
coud
te
t
ernaton
n
resut
te
n
concevaby
gabadder
woud
bood
to
Wnsow);
epatc
but
o
n
and
ver.
jaundce
brubn.
jons
te
route
posteror
epatc
proper
compresson
orm
te
s
(o
compressed
gament
o
man
and
oramen
te
vens
duct
te
atrum
oramen
bood
cystc
to
cava
rgt
ncreased
ts
te
become
vena
te
duct
duct
are
and
wt
be
to
an
te
duct.
common
296;
epatc
Compresson
nlamed
(coecystts).
margn.
ABR/McM
wen
toracc
o
porta
(eppoc)
dmns
Be
was
ts
because
(eppoc)
Retzus
vens
wc
Compresson
D.
omenta
o
n
gament
retropertonea
and
epatoduodena
esopagea
compressed
ypertenson.
return
sev-
te
ven.
neror
daton
sortened
not
costa
N
vens,
o
and
ver,
porta
te
vens
epgastrc
porta
B.
a
symptoms
tract
anastomoses
epatc
s
abdomna
ypertenson
ter
n
he
te
te
ven
o
trbutares
troug
process.
ernates
caused
erna
GAS
between
resp-
perceved
conused
border
o
umbca
probems; te negatve HIDA rues out coecystts
E.
sdes
porta
epatoduodena
Wnsow).
troug
erna
te
anteror
neror
ernas
severe,
te
te
trontestna
tendon
membrane.
commony,
pan
s
erna.
ABR/McM
and
assocated
retrosternay
and,
to
centra
normay
Bocdaek
ound
More
te
wa
due
condton.
transversum
absence
s
body
s
maades.
Bocdaek
s
posteror
process
ratory
era
te
peuropertonea
normay
dapragm
ts
dapragmatc
GAS
te
o
and
Bot
o
to
septum
an
dapragm
congenta
134.
mgraton
epatc
ABR/McM
246
o
gabadder
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
snge
spna
vscera
sensory
L1
L2.
and
reerra
A,
B,
o
E.
na
138.
E.
A
or
te
te
o
pan
gastone
306;
eus
rom
to
te
te
te
occurs
wen
4.143
C.
D.
segments
can
he
pancreas
and
portons
o
te
GAS
139.
A.
he
agus
te
by
owest
odged
supped
ceca
cts.
te
juncton
and
wt
were
be
reerred
entrance
woud
be
te
pan
o
to
te
to
te
or
and
eo-
append-
above
be
s
ducts
upper
and
pont.
B.
C.
D.
key
ste
or
gastone
surrounds
rate
te
o
te
pyorc
emptyng
duodenum.
entrance
o
o
orce
te
hs
stom-
ocaton
gabadder
s
contents
ntestne.
N
280;
ABR/McM
ntermedate
bood
o
by
suppy
242
portons
rom
tyrod,
coud
prenc
te
te
easy
Bronc a
te
obstructon
he
tree
o
te
esop-
brances
bronca,
and
et
esopagus,
et
gastrc
njure
ar teres
and
gastrc
beow
artery.
ts
o
te
esopagea
to
te
arteres.
he
dapragm,
Peroraton
to
s
ts
artery.
suppy
neror
ntercosta
do
he
not
rgt
a
te
he
sma
eve
neror
te
te
sect on
o
o
c ar na
t e
te
ntercosta
esopagea
rom
te
pyorc
proper
part
o
suppes
neror
to
te
te
343–344;
suppy.
epatc
te
porton
dapragm
4.143).
GAS
spaces
artera
esser
stomac.
prenc
just
suppy
to
arses
suppes
o
esopagus
Fg.
arteres
contrbute
gastrc
and
curvature
E.
any
and
neror
artery
pan
to
te
neror
part
and
quadrant,
proxma
nto
340;
esopagus
jon
scapua.
s
a
( T4).
te
obstructon
radatng
te
area
obstructon.
Vater)
An
and
rgt
bub,
duct,
ts
te
correcton.
(o
duodenum.
be
to
mmcs
surgca
te
n
exaggerated
ampua
nto
cap,
te
dsta
dsta
jaundce,
ocazed
be
pancreatc
cause
duodena
tat
w
requre
te
enterng
woud
woud
he
absent
woud
Obstructon
pan
sounds
epatopancreatc
beore
ere
regon.
produce
bowe
obstructon
he
ocaton
B.
can
However,
obstructon
hs
A.
eoceca
not
arteres; te ower porton o te esopagus s supped
and nto te duodenum. In ts case, gastones became
te
te
sma
upper
ucerates troug te wa o te body o te gabadder
n
to
330,
receve
aorta:
(coet)
s
spncter
contents
nto
te
abdom-
eum
contros
proxma
bad-
coon.
gastone
pyorc
ac
upper
urnary
he
and
cause
suppy
proxma
obstructon.
ts
101
a
Fig.
dermatomes.
descendng
ABR/McM
GAS
by
receves
spna
rectum,
suppy
supped
coon
T5–T9
ncudng
suppy
s
coon
descendng
segments
L3–L4
N
tat
correspondng
proxma
405;
skn
descendng
uterus. T10–L1
vscera
GAS
to
to
organs,
duodenum.
and
area
he
Spna
abdomna
der,
an
suppy
Injury
pan
D,
s
nerve.
trunk
crus
N
240;
ABR/McM
251
o
te
(GAS
172
C H A P T E R
140.
B.
3
Ker
speen
to
sgn
and
te
A.
Abdomen
top
s
o
s
a
te
et
Mttescmerz
an’s
menstrua
tures
C.
and
Rovsng
te
D.
sgn
der,
aso
he
opsoas
tons
s
o
w
E.
nerves
be
he
he
py
to
most
C,
D,
tons
142.
B.
he
neck.
s
E.
N
te
mdde
graaan
rom
ndcator
reerred
as
to
encountered
pan
pancreas,
s
te
o
tat
age
rup-
A,
D.
may
meda
291;
obe
o
are
te
rea-
contact
major
not
I
C.
ver
tomy
sgn
A,
s
and
spasms
te
o
common
rgt
rests
rse
drecton
pont
o
E.
o
low
o
a
o
a
on
epatc
most
te
he
cystc
cystc
D.
he
ree
epatc
can
upper
he
s
duct.
te
B.
porta
be
duct)
te
porta
he
tat
are
by
and
suc
tat
tres,
o
te
ven
o
330;
ducts
not
te
trad
and
spra
N
te
wt
te
duct.
dicuty
te
be
a
wt
o
as
s
omentum,
ven,
A.
te
epatc
tat
wt
te
artery,
a
to
te
gabadder
separate
te
rgt
te
s
branc
B.
and
and
be
to
tender
o
te
te
As
by
papaton,
rom
bowe
ave
te
pan.
bor-
bockage
usuay
te
mgt
bowe
stomac).
bowe
become
abdomna
bowe.
kdney
ncreased
caused
o
can
te
T ypcay,
by
borborygm
to
wt
tese
vascuar
ncudng
etc.
be
patent
and
as
245
compresson
ts
nterere
partcuary
sounds
te
neurec-
nerves,
vscera
ntay
mmedatey.
te
pan.
causes,
can
transmt
o
an
oow
musce
reduced
or
pertonts,
data
smpy
Crampy
pan
N
270;
ABR/McM
rom
te
262
neror
pancreatcoduodena
he
artery
te
(a
et
(a
branc
gastrc
o
te
te
ead
n
artery
o
hey
te
artery
ceac
o
and
not
and
te
te
common
neror
te
gastro-
epatc
pancreatco-
mesenterc
and
not
do
te
ceac
between
o
artery
artery).
are
derv-
anastomose
artery.
gastroduodena
common
woud
wen
epatc
mesenterc
te
pancreas
occur
te
te
superor
and
trunk
and
te
te
brances
dervatve
o
o
stuatons
anastomoses
trunk)
superor
cystc
trunk.
to
te
Suc
ceac
dervatves
troug
to
duodenum
pancreatcoduodena
o
he
suppy
te
epatc
typcay
rom
provde
artery
te
an
are
ceac
anasto-
moss between te ceac trunk and superor mesen-
terc artery (uness tere s an aberrant rgt epatc
branc
accessory
removed,
duct
tat
parayss
pertonts,
bowe
occuded.
wt
C.
256
ndvduas.
gabadder
epatc
s
o
duodena
and
unkey
many
or
to
ABR/McM
Increased
suppy
atves
conducts
pass
s
surgery
noted.
305;
bood
part
superor
duct.
are
been
Bood
rst
bary
Durng
a
ducts
D.
coe-
usng
rom
et
te
sarp
ver.
epatc
dssecton
Routney,
duct
are
not
he
rom
rgt
margna
cystectomy, te cystc duct and cystc artery are gated
and
not
atera
tckened
t
ntact
artery va te superor mesenterc artery can provde co-
tortuous.
and
gament
ABR/McM
n
te
potenta
ony
et
produce
target
want
essentay
generazed
GAS
146.
s
obstructon
bowe
abdomen
duodena
contact
structures
Luscka
present
artery,
be
to
vave.
hs
cystc
reaton
epatc
partcuary
(porta
oter
cose
tey
eak-
256
vscera
not
sounds,
Atoug
an
he
caracterzed
source.
ndcate
duct
potentay
woud
gament
esser
287;
te
nto
not
epats.
te
and
n
dicuty
comes
s
s
are
te
parasympatetc
njury,
owever,
absent.
nar-
determne
present
ter
eak.
not
bers
nnervaton
obstructons
trunk
te
and
o
compress
143.
not
coud
duct
epatoduodena
GAS
does
woud
310;
(bowe
te
nerve
pan.
rom
s
Mecanca
body
hs
o
durng
ABR/McM
are
and
N
spna
wtn
end
part
neck
unaware
patent,
and
ducts
not
woud
eradcate
eus
resut
obstructon
vara-
body,
coon.
patency
394;
It
stone,
artery
artery.
bnd
cystc
coud
cystc
duct
artery
edge
and
hs
tat
cause
constrcton
C.
be.
porta
key
to
One
Adynamc
externa
he
mantans
vave
o
te
be
E.
borygm
undus,
te
coon.
to
sup-
cateter.
houg
te
a
constrcton
nserton
A,
tat
actuay
D,
287;
vscera
B.
contans te spra vave (o Hester), wc s a redun-
not
o
woud
B,
N
aferents
motor
246
transverse
gves
s
gated
gaton
musce.
anatomca
epatc
te
and
hs
duct
smoot
cases.
rounded,
rowest
od
soud
provde
mesenterc
te
transverse
mucosa
epatc
o
artery
rgt
was
te
pertonts.
and
s
n
cpped
surgery
sensory
145.
epatc
s
18%
te
and
part
334;
Vscera
sensaton
any
psoas
259
n
or
and
proper
GAS
ABR/McM
wt
part
te
gated
be
pyscan
present
duct
cystc
GAS
144.
nodes,
wa.
and
n
be
te
were
pertonts.
appendx,
panu
tg
superor
conssts
undus
been
resut
he
wt
tg.
te
o
291;
gabadder
te
varaton
rom
orgn
N
cause
o
ABR/McM
duodenum
dant
he
sou-
mportant
postve
woud
I
Luscka
ave
durng
gabadder
ymp
not
E.
drecty.
o
sympatetc
sgn
hese
te
ducts
C,
ovary.
cecum,
a
wom-
rgt
abdomna
dseased,
a
rrtaton.
umbar
posteror
o
oce
te
cncay
ureters,
approxmatey
347;
n
te
te
dapragmatc
common
n
he
comes
ruptured
woud
reeased
musces
te
rgt
o
GAS
s
pan
to
te
orgnatng
occurrng
A,
n
342;
te
artery,
a
observed.
dects
B.
o
ntense
n
cnca
structures
adductor
GAS
radatng
wen
kdneys,
obturator
te
a
and
coon,
tese
o
by
occur
musce
te
sgmod
and
can
cyce
owng
to
ndcaton
souder.
ovum
nlammaton
141.
cnca
caracterzed
atera
E.
te
and
artery
suppy
superor
et
coc
o
to
te
te
mesenterc
arteres
coon,
neror
artery).
anastomose
but
ts
va
provdes
mesenterc
te
co-
artery.
he rgt and et gastro-omenta arteres anastomose
and provde coatera suppy to te greater curvature
o
te
stomac
but
are
derved
rom
te
ceac
trunk
CHAPTER
and
te
tus
GAS
147.
B.
he
pont
ncson
to
reac
abdomns
te
pareta
C,
to
D,
to
be
GAS
148.
D.
Iea
ng
n
o
E.
o
te
hese
389;
N
dsta
hus,
not
ve
te
s
as
t
wt
Answers
151–174
151.
he
separates
an
te
pen-
n
tat
n
B,
need
CT
D,
a
coc
men
ror
as
mportant
B.
compcaton
tat
he
Interna
o
te
te
B.
ana
C.
te
vens
o
te
edery
E.
Fg.
aortc
an
can
trbutares
proapse
o
nto
s
and
are
trombosed
externa
recta
ordnary
ntestne.
does
as
are
not
tey
prmary
beedng
created
pass
by
troug
n
te
o
afects
most
gas
A.
pexus.
outpoucng
hs
cause
sounds
an
trbutares
venous
and
315;
3.2
N
a
aneurysm
erect
280;
ABR/McM
CT
scan
wt
poston,
tat
pens
he
emorrage.
te
bood
I
w
te
be
abdomna
man
E.
stands
detected
n
ste
te
GAS
owest
A.
B.
space
he
between
te
superor
part
he
ace
na
te
space
te
ver
men
and
s
te
a
153.
pertonea
and
te
pouc
anteror
B.
to
and
A.
ver.
space
(pouc
pocket
and
n
cavty.
s
dapragm
o
pertonea
o
rectum
pertonea
epatorena
o
between
te
rgt
Morson)
te
posteror
kdney
and
s
a
he
recess
he
(pouc
ormed
te
subepatc
GAS
space
women
between
transverse
o
te
sgn-
expan
te
te
sur-
and
and
one
descendng
wc
most
key
suppes
occuded
rgt
an
coc,
and
coon,
anastomoss
mesenterc
artery
eo-
and
te
between
and
ne-
neror
wa
ower
dsta
ac
ne.
ncudng
umbcus,
mb.
nodes
dran
te
he
pevc
and
gans
and
ymp
externa
nterna
ac
structures
receve
o
receve
nguna
dran
nodes.
neror
te
uretra
nodes
structures
te
scro-
structures
trunk,
te
rst
ke
pectnate
to
superca
ac
te
pens,
dran
te
spongy
ymp
dran
o
o
te
aso
neror
ymp
te
to
nodes
are
structures
prepuce
quadrant
te
nodes
pernea
regon,
te
239
ymp
dranage
and
rom
nodes.
a
ymp
te
te
nodes
above
toracc
are
te
ymp
duct
by
na
nodes
way
dranage
beore
o
te
tey
umbar
trunks.
392;
wte
N
268;
arrows
ABR/McM
n
te
CT
376
scan
n
Fg.
3.6
pont
stomac.
he
speen
t
ocated
s
yng
suprare-
te
ng
more
Aso,
on
tat
woud
te
te
not
be
n
ts
superory
note
tat
sdes
o
secton
s
te
te
n
n
CT
te
psoas
mage
body
musces
vertebra
te
umbar
because
tan
are
body,
ts
seen
mean-
regon
o
te
body.
rectouterne
n
he
to
artery,
ABR/McM
cana
nodes
secton.
gand.
space
E.
te
subprenc
deep
C.
n
te
o
tat
261
coc,
nguna
rom
to
ymp
and
part
musce
not
ascendng
superor
common
or
dran
te
nguna
umbar
te
badder
scan
artery.
nguna
sacra
he
te
superca
pernea
rectovesca space, wc s a pertonea recess between
urnary
ac
one
regon.
pont
coc
mdde
295;
nterna
ymp
te
an
or
deep
nodes.
gastrontes-
N
regon,
and
s
abdomna
dranage
C–D.
scan
et
provdes
neroatera
te
cases.
te
ana
te
ntest-
he
perana
anteror
he
CT
te
suppy
o
ste
and
te
248
sows
E.
350;
deep
s
s
te
are
ts
w
ABR/McM
coon,
superca
te
te
tract.
GAS
D.
te
arge
contents
tna
trombosed
wc
te
artery
te
gutea
o
Borborygm
na
are
ven,
emorrods
Dvertcuoss
wa
recta
ucer.
cana.
Externa
n
n
emorrods
mdde
peptc
n
superca
o
tum,
or
o
umbar
structures
306;
mesenterc
he
quenty
appendcts
N
artery
GAS
152.
may requre emergent surgery. Sgns and symptoms re-
mmc
te
n
body
rgt
scan
scan.
and
skn
s
structures
secton
te
CT
symptoms
hereore,
ng,
obstructon
nto
he
vertebra
rom
hese
descendng
te
outpouc-
cncay
te
cut
arrows
coon.
rom
be
C.
dranage
and
a
E.
brances
s
o
he
T ransverse
407;
because uceraton o te dvertcuum wt pan, beed-
peroraton,
s
margna
prevaent
s
rgt
D,
GAS
231
wc
twce
dvertcuum
tat
progressng
appendcts.
appendx.
patent’s
A,
ayers
te
pan
o
musce.
C,
appendx.
ABR/McM
eum,
ntraper-
must
sgn
wt-
abdomns
correct
dvertcuum,
he
A,
pareta
covered
ayers
to
abdomna
asca
a
nlamed
es
appendx.
te
expose
282;
(Mecke)
s
s
psoas
musce,
bunty,
ocated
t
transversus
nlamed
to
s
tus
Paraumbca
e
te
transversus
nterna
transversas
te
are
dssected
te
he
McBurney
and
separated
B.
an
obque
asca,
appendx
150.
ossa
encounter
musce,
te
be
abdomen,
pertoneum.
access
o
can
he
te
surace
women.
A.
149.
tem.
abdomna
bers
at
usuay
obque
between
artery .
247
separaton
w
transversas
pertoneum.
nterna
A,
externa
Musce
wtn
te
etrated
te
mesenterc
ABR/McM
tssue
transversus
cuttng
vscera
291;
appendx
musce,
and
toneay
N
communcaton
superor
abdomna
pertoneum.
obque
provde
and
and
te
o
nterna
out
not
trunk
344–350;
aponeuross
te
do
ceac
173
Abdomen
3
rectum
space
s
by
and
a
o
Dougas)
N
a
C.
between
te
ver
and
te
ABR/McM
281
duodenum
te
te
A.
stomac
302–303;
Cancerous
rst
to
s
te
structure
n
te
scan
N
276;
and
ocated
s
to
te
rgt
posteroatera
to
aorta.
GAS
154.
373;
he
o
uterus.
coon.
473–474;
s
pertonea-ned
te
ces
ceac
n
te
nodes.
ABR/McM
stomac
229,
woud
238
metastasze
174
C H A P T E R
B.
3
he
Abdomen
spenc
artery
creas;
and
he
ces
he
pancreatc
rgt
statc
but
entre
GAS
Because
es
sow
on
te
obe
a
s
a
extenson
te
an
receve
rst
assocated
expanded
t
te
dranage
woud
not
eaty
ABR/McM
rgt
and
woman,
expected
o
te
obe
extends
te
o
to
B.
ver,
te
upper
rom
te
ems
be
rst
to
te
about
4
ver,
or
5
cm
an
seen
D.
to
te
cyme
te
as
wen
GAS
156.
B.
A
A.
te
328;
te
E.
Peptc
gabadder
C.
A
D.
An
A
segment
troug
near
ater
GAS
on
o
can
ony
N
t
protrude
not
ne
not
o
does
beneat
ca
o
a
te
a
an
a
stran-
A.
or
te
ower
esopa-
esopagea
dscomort
usuay
s
n
accompanes
not
o
woud
s
dened
stomac
assocated
te
aso
and
te
prob-
wt
d-
mucosa
not
nng
contrbute
to
stomac
wc
stomac
te
resut
te
deayed
emp-
woud
and
sow
esopagus
esopagus).
n
pan
duodenum,
n
te
due
to
stomac,
eroson
o
remnant
o
nng.
N
237;
duct
n
ABR/McM
an
te
t
225
embryoogc
embryo
to
nected,
te
s
te
proxma
o
te
ony
mosty
as
parayss,
n
dvertcuum
becomes
ater
at
an
eve
o
te
occur
ocated
cecum.
produces
abdomen,
operatve
nc-
or
n
I
on
ts
pan
n
te
dsta
dvertcu-
te
addton
te
nto
s
ema
to
umb-
possbe
ngs
abdomen,
aso
te
durng
D.
and
remans
nguna
caused
ndrect
wen
te
te
ntestnes
a
scrotum,
but
occurs
onto
generay
a
te
te
ts
does
wen
dorsa
assocated
te
te
sur-
wt
transversas
ernate
GAS
woud
troug
not
te
315;
C.
Pan
by
vscera
nerve
Open
and
te
rom
o
suppy
o
n
are
te
s
gut
te
contact
n
wen
wt
adja-
by
a
te
twsted
bous
bowe,
and/or
sc-
occuded.
tube,
ower
sounds
movng
cause
pan
actvty
A.
N
280;
te
usuay
et
ound
n
quadrant.
produced
troug
n
one
moves
rom
te
specc
te
tat
ABR/McM
gabadder
aferents
bers
and
spna
nerves
gabadder.
rb
aso
provde
coecystectomy
T8
assocated
te
asca
pan
gas
bowes.
area
engt
and
hs
because
o
te
GI
tract.
160.
and
wa
contents
woud
lud,
does
bood
present
perstatc
badder.
to
o
oter
patent
gubernacuum
caracterzed
obstructon
Borborygm
arge
tat
wt
deveopment
opens
s
so
n
wt
abdomen,
te sgmod coon. Pan rom ts condton woud
cana.
by
ed
a
erna.
Epspadas
urnary
o
te
wen
s
te
come
te
pertoneum.
causes
as
presents
o
Dvertcuoss s a condton tat causes outpouc-
erna
E.
occur
vagnas
an
vovuus
usuay
quadrant
processes
pareta
usuay
vagnas
orce
tear,
te
o
appendx
rgt
nectve
wc
229
ernas
reac
erna.
te
A
descence
ncsona
surace
ower
cent
surgery.
cause
pens
o
ruptured
te
te
te
wt
o
ABR/McM
correcty
o
A
ntestna
B.
type
ventra
uretra
cause
o
as
C.
s
processus
not
a
rupture,
not
wa
occurs
ydrocee
not
does
exstropy
A
troug
causes
Acaasa
condtons.
pan
and
and
nvoves
307;
regon
openng.
reopenng)
ernates
testes
cause
externa
ace
tese
hs
commony
vtene
um
mdne.
processus
mgrate
tests
te
presents
occurs
erna
nguna
te
Ectopc
erna
258;
congenta
but
tat
o
erna
and
ntestne
segment
part
te
te
Congenta
o
erna
o
erna
298;
patency
E.
and
semunar
to
ucers
Mecke
te
surgery.
ventra
occurrng
A
a
any
ncsona
ocated
oop
s
paraumbca
son
C.
regon
D.
eum
te
esopagus.
ood
nlammaton
mucosa
GAS
159.
245
aong
te
esopagea
spncter)
beedng.
erna
(breakdown
B.
occurs
woud
examnaton,
nlamed.
ABR/McM
erna
umbcus,
A.
284;
s
coecystts
pysca
te
skn.
Rcter
oop
157.
and
abnorma
umbca
guated
E.
an
N
Spgean
beow
te
examnatons,
cause
233
ower
constrcted
o
overoadng
(acaasa
rb
A–B, D–E. Carcnomas woud present wt abnorma
wt
s
stomac
due
more
present
te
cardac
n
o
A
dgeston
not
swaowng.
te
tyng
cage.
aboratory
o
cronc
Gastroparess
neror
atera
ABR/McM
te
ood
cause
s
woud
dyspaga.
Rede
beow
as
motty
te
wt
tereore
erna.
264;
stomac.
Gastrts
stud-
anomay
o
o
abdomen.
cuty
o
bengn.
oten
s
N
known
Dyspepsa
246
te
te
o
aboratory
be
aure
nto
and
reaxaton
(aso
spncter
cy,
o
accumuaton
gus
esser
csterna
porton
s
ts
rng
nguna
296–298;
Faure
C.
BP79;
be
A.
spncter
meta-
receve
aong
he
ymp
receve
to
nguna
ndrect
GAS
ces.
varaton
tat
E.
examnaton
woud
o
to
deep
pan-
158.
be
may
te
ocated
tereore,
N
norma,
gabadder
rst
woud
be
are
receves
358;
norma
te
spenc
te
cancer.
nodes
not
proxma
pysca
x-ray
be
te
rom
an
stomac.
cancerous
315,
nodes
tey
te
duct,
not
stomac
ymp
abdomen;
receve
C.
o
occasona
toracc
155.
a
aong
dranage
w
woud
because
curvature
ocated
to
carcnoma.
gastrc
ces
ymp
an
tey
rom
suprapancreatc
wt
D.
are
reated
tereore,
metastatc
C.
nodes
are
and
s
pan
to
te
to
te
medated
cause
ter
nerves
aong
237
sent
sensaton
woud
due
hese
s
are
same
a
spna
to
te
rsk
cose
cord
(reerred)
by
scapua.
to
te
T7
proxmty
ocated
beow
orzonta
to
te
pane
as
gabadder.
T5
and
son
T6
and
nerves
tus
are
are
not
ocated
afected.
superor
to
an
nc-
CHAPTER
B.
For
te
not
be
same
te
durng
ts
D.
Nerves
E.
T5–T9
a
340,
to
due
rom
T6
to T6
to
not
T7
woud
beng
at
163.
rsk
not
are
ocated
tat
afected
358–364;
neror
to
te
N
by
309;
te
many
nerves
ncson.
ABR/McM
ayer
evagnates
ues
o
troug
ts
te
troug
te
evagnaton
or
deveopment.
te
processus
between
B.
te
te
deep
cana;
abum
C.
An
D.
A
s
aso
n
227
A,
B,
reerred
not
nguna
rng
and
te
contn-
n
to
a
as
te
dur-
segment
te
cana
and
nguna
not
woud
te
present
nguna
erna
woud
gament
as
a
A
C.
base
be
mass
n
n
o
(usuay)
wtn
te
deect
o
te
aong
ar ter y
te
te
te
265;
most
be
to
te
asca
area
nguna
te
cavty
te
resut
woud
not
because
n
A.
be
known
between
pertoneum
kdney
he
and
rgt
neror
matc
ts
muate
Fnay,
cavty
cates
lud
te
o
te
te
potenta
ts
space
n
to
upper
vscera
o
per-
Morson,
ver
and
poe
s
ocated
te
pareta
o
te
s
It
te
te
space
above
s
te
above
pancreas
coud
te
o
te
wt
m
omenta
(eppoc)
cavty
o
around
and
on
te
304;
abdomen.
te
sp
s
genera
greater
bursa
(o
rgt
drecty
not
A.
tat
reey
ABR/McM
by
aows
aganst
te
te
a
o
to
nto
L andzer t)
ar ter y
te
and
et
te
wt
a
mesenterc
(o
coc
te
s
n
juncton
jejunum.
ar ter y
coon
he
suppy
and
te
coon.
rom
suppes
s
et
er na
to
coc
arses
and
et
re-
p araduodena
desce ndng
artery
artery
a
te
ossa
te
ts
adjacent
et
more
rgt
o
o
te
te
nto
o
s
te
and
on
occurs
te
repar
anastomoses
coc
coc
transverse
coc
te
more
artery
te
te
et
coc
dsta
and
superor
transverse
artery.
branc
suppes
o
te
coon.
coon
artery
te
te
o
o
ea
te
to
and
te
ower segment o
sgmod
te
eum,
coon.
cecum,
and
appendx,
proxma
por-
coon.
arteres
superor
te
te
suppes
ascendng
352–353;
ces
venous
he
are
te
sma
mesenterc
termna
artery
suppy-
eum.
N
295;
because
system
stomac
s
and
he
no
ABR/McM
tey
rom
woud
woud
te
249
not
low
pancreas
receve
communcaton
pancreas
speen
caton
C.
he
but
te
ces
duodenum
as
aton
E.
aso
wt
metastatc
very
anoter
o
te
te
encosng
Hernaton
te
carry
troug
troug
to
tese
te
ces
between
because
te
crcuatory
te
ver.
stom-
or
ducta
patways.
he
organs
one
same
rom
not
( o
ods
brance s
o
porton
bood
he
tese
tey
328,
not
pancreas
ave
and
drect
woud
commun-
not
s
te
ste
not
or
pass
pass
coumn
because
tey
pancreatc
troug
nto
woud
woud
te
N
BP80;
crcu-
duodenum.
not
not
emptyng,
venous
receve
enter
pexus.
354;
receve
rst.
woud
venous
GAS
does
metastases
vertebra
metastases
bra
240
o
Fnay,
ac
accu-
way
o
eococ
tere
commun-
except
tese
238
Landzer t)
duodenum
descendng
metastatc
pertonea
sac)
s
D. he ver woud be te rst structure to receve tese
pancreas;
Wnsow).
notng
wa.
288;
sac
(esser
oramen
lud
reatvey
te
he
contans
serous
body
N
sac
are
hs
presentaton.
resp ectvey,
quadrant,
superor
GAS
165.
B.
greater
te
dermatome
and
woud
os sa
ocaton
artery
and
rgt
he
ng
daprag-
te
o
pan
T8.
tese
he sgmoda arteres suppy te
porta
and
o
aferents
et
durng
se gment
brances
space,
(o
te
mdde
ton
D.
te
ven,
b rances
termna
surace
subepatc
superor
space
C.
space.
te
et
lexure
he
te
te
gand.
ver.
rom
B.
coon.
te
te
a
anteror
w
neror
o
dapragm
o
s
s
tere.
pertonea
GAS
te
pouc
obe
coverng
omenta
tn
te
suprarena
te
bursa
rsk
ascendng
bursa,
o
ernaton
termna
coon
pseudocyst
omenta
drecty
transverse
space
rgt
surace
tereore,
te
te
subprenc
to
and
space
between
as
te
te
extravasatons
epatorena
aso
pancreatc
o
soma
and
pan,
nerves
per tonea
ossa
mesenterc
233
omenta
stomac
and
a
loor
he
subepatc
ver
tat
te
o
ABR/McM
ascendng
at
ascendng
emora
coud
but
gament
ABR/McM
pace
n
Pancreatc
tonea
he
s
stomac.
rgt
te
264;
key
bend
he
o
N
ormed
pancreas.
E.
te
specc
at
patent’s
duodenum.
tan
upper
te
he
te
because
te
ts
303;
b ranc
are
GAS
space
D.
a
s
T7
vscera
spna
or
two
he
he
deep
B.
transversas
n
te
sensaton
o
process
mesenterc
o
Kob).
te
beow
N
paraduodena
o
papated
eve
paraduodena
by
sde
asca ayer s ocated deep to te nguna gament.
w
A.
et
spenc
nlammaton
ocated
358;
o
regon.
be
te
sensatons
hese
he
quenty
te
woud
te
receve
bers
GAS
neror
trange.
E.
E.
erna
uterus
E.
ascendng
majus.
emora
D,
o
competey
at
somatc
ormed
tests.
present
sweng
164.
Normay,
obterated
obterated
woud
case,
s
at
xpod
ner ves
sensory
regon)
and
rng.
deveop
s
ts
rng
contanng
stomac.
(nguna
nguna
can
ydrocee
ectopc
pevs
cyst
processus
Congenta
wa
nguna
outpoucng
A
(wc
ts
deep
superca
ng
Nuck)
abdomna
te
eves
transportng
key
te
or
spna
cord
bers
tan
eves
ncudes
spna
because
A. he processus vagnas s ormed as te pareta per-
toneum
162.
he
sensor y
procedure.
range
be
C.
more
L1
ts
broad
woud
GAS
161.
T9
durng
s
nerves
coce
procedure.
rom
ncson
tat
reason,
rgt
175
Abdomen
3
ABR/McM
258
te
te
verte-
176
C H A P T E R
166.
B.
he
to
be
3
epatc
nto
A.
s
te
o
due
C.
he
E.
epatc
trunk
ceac
B.
juncton
ent
tc
wt
duct
A,
C,
s
E.
o
to
be
te
B.
te
A,
s
C,
o
N
GAS
te
umb cus.
oter
to
dsta
te
tumor.
Smary,
A.
te
te
nor
ceac
B.
duct.
patent
jaundce
n
E.
duct
he
tan
Fg.
and
and
et
at
Wen
w
because
te
and
rgt
postepatc
duct
D.
a
pres-
te
ABR/McM
E.
epatc
duct
rgt
te
n
te
cause
170.
rgt
s
ocated
duct.
duct,
at
It
te
s
te
epatc
duct
a
epatopancreatc
N
to
known
juncton
D.
he
ave
o
be
n
o
n
super or
to
branc
duodenal
Major
n
te
and
passes
wt
newborn
trd
oca
at
babes
trmester
usuay
structure
te
arger
ampua
(o
s
case,
te
o
represents
eve
o
te
dam-
Vater)
257
passes
troug
s
o
te
not
reduced
a
et
tat
assocated
o
et
hs
I
o
stop
branc
o
te
epatc
artery;
and
s
were
te
te
et
GAS
Fig.
4.109
ampulla
an
te
epa-
beed-
gastrc
rater
tereore
hus
te
owever,
gament
maneuver.
ac-
o
artery,
ts
or
unc-
te
area
epatc
(compresson
sow
te
between
te
t
tan
not
beedng
tecnque.
duct
Hepatopancreatic
•
wt
wa.
duct
papilla
com-
ntestnes
228
trunk.
gament
Prnge
by
te
epatogastrc
epatoduodena
cana,
ess
te
segment
ocated
ceac
epatc
te
body
gabadder.
by
(but
o
cavty,
te
woud
te
semunar
emora
serous
meda
maneuver
repace
n
o
ver,
te
te
aure
ABR/McM
supped
aberrant
can
more
te
gament)
artery
te
a
te
and
Prnge
troug
abdomna
258;
te
seat.
gament.
growt
o
branc
toduodena
An
te
N
usuay
te
are
troug
rectus
pass
njured
gament
o
pancreatc
to
obe
occur
te
papilla
duodenal
at
papabe,
aso
Pancreatic Minor
o
a
assocated
erna
representng
proper
298;
et
ndrect
Bile
pancreatic
ner ve
wa
nguna
deect,
kne
te
part
to
ernas
te
return
as
narrowest
duct,
ABR/McM
weakness
causes
common
knd
te
Ompaocees
compressed
287;
a
a
aba
ern at on
deect
can
are
ernas
atera
Femora
ng.
et
epatc
Accessory
Spgean
tona
4.109).
332–336;
n
weakness
ack
system.
be
a
ver
aso
I
t
by
nea
cases,
women
hs
GAS
woud
not
s
ormed
te
te
ernas
pregnancy.
to
due
256
ampua
mass.
pregnant
deep
cys-
jaundce
duct
regon,
most
deect,
Umbca
nes,
system.
pancreatc
be
te
s
o
umbcus.
gabadder
cystc
te
In
troug
paness,
and
253
te
erna
bers
pan.
tumor.
metastases,
tssue
troug
part
orm
287;
Vater
duct
and
(GAS
pan-
emptes
quadrant.
bary
eters
te
epgastrc
nte rsectng
mon)
cause
te
An
te
tumor.
n
area,
no
C.
pancreatcoduode-
tese
te
and
and/or
woud
epatopancreatc
duct,
te
artery.
o
ts
usuay
duct
te
340;
D,
to
ocated
neck
obstructed
pancreatc
o
neror
receve
umbca
ampua
s
superor
pan
he
te
wc
169.
te
but
superor
o
GAS
o
o
occuded.
be
n
structure
neck
most
drans
ABR/McM
n
key
te
ven
ven
and
pane
299;
at
he
spenc
Obstructon
upper
168.
te
most
ven.
never
but
not
A
s
pouc
obstructon
D.
porta
ocated
pan
s
te
pancreatc
N
te
tumor
proxmty.
va
ntestne
great
354;
s
mesenterc
outsde
gastone
ven
arge
posteror
Hartmann
te
ts
woud
te
s
a
trunk
he
GAS
167.
arge
artery
woud
to
neror
te
D,
by
draned
he
na
porta
occuded
pancreas
creas
Abdomen
duct
CHAPTER
A.
he
te
B.
atera
et
he
o
caudate
neror
we
C.
E.
he
o
GAS
E.
te
lexure
o
vaga
trunks
N
o
te
te
ver
s
ocated
to
251;
ocated
porton
s
o
n
te
te
ver,
et
obe
s
s,
epatc
to
174.
and
te
be
Pevc
lexure,
rectum
te
D.
te
te
s
ts
deprve
mdgut)
o
o
te
suppy
vagus
para-
erecte
he
to
nerves
tssues
duct
troug
GAS
s
te
363;
nerves
o
o
306;
te
te
te
carred
pevc
N
and
cana,
B.
Adynamc
actvty
eus
ceases.
s
te
A.
T7
s
B.
T8
and
D.
coon,
te
E.
L1
and
area,
deerens
and
nerve
ejacu-
GAS
suppy
ar
under
pan
bers
prenc
nerve
o
to
pan
sory
A.
an
o
te
(bowe
ts
ar
bowe.
are
absent
175.
nerve
te
by
te
afer-
te
C3–C5.
because
enter
perorated
somatc
carred
eves
occurs
souder
rom
D.
rgt
C.
A
Reerra
somatc
spna
te
sen-
rom
usuay
ndcate
te
suppy
te
penetratng
o
cord
at
presence
o
ar
Acute
der
ucer
prouse
te
woud
bub,
be
beedng,
gastroduodena
duodena
pan
and
A.
he
artera
B.
he
408;
s
not
te
rst
assocated
adynamc
owever,
mdde
suppy
rgt
superor
276;
coc
to
te
coc
asso-
B.
mosty
arter y
part
o
w
eus.
wt
A
p roduce
he
ABR/McM
artery
s
ng
te
acorm
artery,
an
sou-
ower
⅔
porton
skn
306,
in
o
st
te
o
wt
to
two
te
pre-
te
rectus
motor
and
and
onguna
regon,
te
162;
new
te
urogenta
ABR/McM
pubc
regon.
215
(no
edition)
source
o
te
portons
o
artery
branc
suppes
transverse
te
s
o
te
ascendng
o
te
he
A.
te
coon,
pancreas.
ower
he
rotc
ncud-
B.
caracterstc
appearance
anastomoses
vens
tat
teres
wt
he
due
te
vens
between
o
te
vens
o
on
sma
accompany
wa
porta
o
epats)
vens
body
to
body
o
by
te
(wtn
anteror
become
ypertenson.
lud
o
te
356;
opubc
at
te
atera
Hessebac)
and
299;
new
tract
tn-
jonng
tract
ret-
wt
resut
rom
ven
ac
expanson
recta
and
o
trbutares
mdde
recta
ven.
gaments
do
not
recanaze
ypertenson.
ABR/McM
s
a
o
te
border
280
relectve
te
(no
clinical
band
transversus
o
aponeu-
abdomns,
aparoscope.
o
te
provded
ven.
rom
vesses
edition)
orgn
s
esopa-
vens.
transudate
superor
nterna
wt
and
o
gastrontestna
mesenterc
porta
N
in
ven
system
wa.
umbca
to
gastrc
anastomotc
between
te
meda
artery
et
azygos
emorrods
vsuazed
he
te
te
vens
neror
tssue
to
dated
response
GAS
176.
wa.
ormed
and
thumbnails
te
end-stage
rom
between
brances
o
an
gament)
trbutares
Interna
to
o
coon.
suppes
s
(gamentum
anastomoses
per orated
prncpa
and
Asctes
n
nrequent
artery,
mesenterc
to
to
te
body
Esopagea varces resut rom porta-systemc anas-
wen
duodenum
contacts
process.
suprapubc
snakeke
resuts
gament
vens
241
te
transverse
mesenterc
superor
nerve
Wen
adjacent
between
owest
paraumbca
ropertonea
te
symptoms
wa
caed
waed
tat
coon.
C.
body
he
tortuous,
E.
N
N
medusae
tomoses
pertonts.
GAS
e
oypogastrc
thumbnails
dated
C.
appendcts
appendx,
pan
xpod
portons
body
under
duodenum.
E.
and
te
spna
T10.
eves.
te
anteror
crross.
gea
wt
brances
by
abdomna
A.
posteror
o
o
overyng
285–286;
Caput
round
dapragm.
cated
rom
175–199
vens
eves.
woud
s
Perstatc
sounds)
rrtates
dapragm,
spna
te
perumbca
251
te
dapragm
wa;
souder
rom
x-ray
te
D,
to
te
bers
smar
o
te
crosses
respectvey.
suppes
clinical
T10
appendcts
pexuses.
parayss
te
suppy,
and
te
te
and
dstrbuton
nerves
o
nerve
nnervates
sensory
badder,
ste
te
quadrant.
eve
spna
n
ruptures
dermatomes
te
sgmod
apparent
eve
rom
embryoogc
bers
te
suppy
spenc
rst
and/or
to
248
wc
sensory
suppy
coon.
nerve
Pan
o
T9
abdomns
sympatetc
ABR/McM
Borborygm
duodena
at
spancnc
te
ent
173.
T12
swes
abdomna
and
at
eve
appendx,
te
rgt
spna
umbcus.
somatc
cause
ower
s
to
wa,
ABR/McM
o
te
bood
descendng
perceved
te
appendx
ver
due
oten
to
wen ts occurs, as n pertonts. Pan n te souder
anteror
te
provdes
and
295;
suppy
Answers
172.
o
pevc
urnary
ductus
N
relectng
pens.
by
348;
cedng
rom
spancnc
nnervaton
atory
nerves
ana
most
wa
artery
lexure
dermatome
eve
body
spenc
coc
coc
regon,
ost.
descendng
and
C.he
te
woud
eve
te
o
receves
artery.
Parasympatetc
by
t
255
trunks
to
et
et
A, B, C. Dsta to te spenc lexure, te coon receves
nerves.
he
ver,
ocated
segment
and
ABR/McM
carred
parasympatetc
E.
te
(oregut
woud
he eococ branc o te superor mesenterc artery
GAS
rgt
vaga
tat
coon.
D.
suppes te dsta eum, cecum, and ascendng coon.
s
meda
te
te
bot
vscera
and
obe
njury.
o
rom
o
coon
te
upper
s
obe
suppy,
te
ascendng
et
gament.
gabadder.
328–331;
abdomna
o
obe
et
suppy
sympatetc
te
ste
te
Interrupton
te
o
segment
quadrate
artera
o
te
unctona
171.
segment
anteror
rgt
o
acorm
aspect
above
he
te
segment
te
177
Abdomen
3
by
nguna
te
trange
neror
(o
epgastrc
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.
Inants
wt
Hrscsprung
n
te
o
norma Pubic
he
number
rom
symphysis
Lacunar
aure
•
GAS
Fig.
ven
rom
D.
he
te
border
and
te
o
te
te
pectnea
emora
tssue
rng
s
te
coon
ure
o
he
separatng
te
te
ven
B.
cana.
nguna
gament
gament
s
te
tat
acunar
attaces
ra
as
artery
nguna
GAS
177.
E.
298;
hose
can
o
be
even
D.
are
te
wen
he
are
a
to
gament
structures
o
A,
B,
te
C.
GAS
te
and
sted
hese
and
316;
to
s
te
dated
segment
ces.
he
daton
te
resuts
reaxaton
o
movement
te
unctona
crest
to
agangonc
te
segment,
ntestna
obstructon
t.
ces
o
Megacoon
to
mgrate
and
daton
resuts
nto
contents,
te
rom
wa
o
a-
o
te
or
structures
o
te
t
he
coon.
and
appendx,
oten
te
n
to
s
pro-
very
d-
179.
C.
he
ramus
261
te
coaca
ke
n
deveop
n
causes
mperorate
anus
atresa
appens
ments
he
te
ten
be
te
316;
te
to
t,
o
te
oter
and
upper
appendx.
or
and
te
abum
best
rst
and
may
at
te
can
be
ectopc
ma-
anus
or
snus.
abnorma
recan-
mdgut.
be
he
ABR/McM
nerve
assocated
to
tg,
wt
o
and
te
orates
ventra
te
abdomna
atera
and
nguna
skn
te
nerve
ramus
o
obque
n
s
ventra
perces
spermatc
Its
upper
te
root
cord
bers
and
are
meda
mons
o
te
a-
te
pubs
pens
men.
te
spna
superor
nerve
abdomns
musces,
anteror
te
te
te
dstrbutng
over
or
It
rng.
te
skn
scrotum
transversus
an
o
o
(L1).
musce,
women
oypogastrc
te
250
branc
accompanes
te
n
a
nerve
obque
ten
majus
part
s
umbar
superca
dstrbuted
parts
A.
283;
abdomna
and
ocaton
N
onguna
o
nterna
o
vermorm
ABR/McM
to
t.
GAS
o
presence
tssue.
not
ces
resuts
coon.
Ogoydramnos
4.85).
woud
te
rotaton
hs
pexuses.
o
ndgut
recta
te
weeks.
gangon
nsuicent
o
o
te
E.
retroea
artery,
easy
o
D.
cecum
te
atoug
ead
Fg.
sevent
Messner
emo-
te
to
separaton
o
ongtudna
te
o
n
and
anus,
cause
troug
adpose
not
Auerbac
he
t
parasympatetc
Incompete
o
to
base
te
Hrscsprung dsease, but t’s not one o te causes
eature
especay
(GAS
283;
te
porton
retrococ
artery,
muc
ocatng
N
rom
o
azaton
and
235
extend
te
dense
4.29).
appendcuar
do
neura
absent
(o
dden.
qucky,
appendx
tracng
coon
ceca
ess
conspcuous
caracterstc
to
marotaton
Fg.
ABR/McM
appendx
nd
ateray
tree
tereore
orgn
becomes
opectnea
(GAS
nerory
te
and
cut
te
264;
posteror
vdes
traced
ascendng
traced
poston,
N
co
tat
s
gament
T aenae
bands
t
gament
toward
a
ormaton
to
C.
pectnea
tnner
to
or
ces
coon—megacoon—as
gangon
proxma
durng
aure
emo-
Gmbernat).
E.
dsta
gangon
4.29
connectve
emora
part
o
n
te
coon
atera
o
prevents
resutng
ra
megacoon,
autonomc
ligament
wc
he
o
agangonc
ack
pexus
artery
4.85
congenta
enarged
artery
tubercle
Pubic
C.
Fig.
dsease,
myenterc
coon.
GAS
artery
and
cutaneous
L1
branc
tat
and
dvdes
branc.
per-
nterna
nto
a
CHAPTER
C,
E.
hese
mesenterc
GAS
182.
T7
B.
he
o
te
ments
358–364;
te
ten
part
N
to
rst
t,
and
te
te
301;
supped
by
a
ten
to
branc
nerve
obque
te
superor
te
musce,
and
te
o
skn
ventra
ramus
perces
te
dstrbutng
Its
upper
te
a-
spermatc
rng.
te
o
It
te
nguna
skn
244
o
(L1).
accompanes
superca
tg,
ABR/McM
s
umbar
dstrbuted
o
not
nerve
abdomna
troug
are
pexus.
onguna
nterna
T8
regons
179
Abdomen
3
cord
bers
and
mons
are
meda
pubs
and
T9
aba
and
T10
C.
majora
upper
he
women
part
o
genta
w
na
n
te
but
o
te
n
te
abum
te
over
scrotum
branc
suppy
nerve
te
and
root
o
te
pens
men.
gentoemora
majus
onguna
wt
te
nerve
s
nerve
ongu-
more
com-
T11
mony
A,
D,
E.
hese
majus
T12
duce
damaged
and
te
GAS
durng
structures
njury
to
symptoms
398;
N
260;
appendectomy.
do
not
tese
seen
suppy
nerves
n
te
ABR/McM
te
woud
abum
not
pro-
patent.
271
L1
183.
A.
n
he
te
ympatc
abdomen.
trunk,
so
te
dranage
he
oows
stomac
ymp
w
s
te
artera
supped
dran
to
te
by
suppy
te
ceac
ceac
ymp
nodes.
B,
C,
D,
or •
GAS
Fig.
GAS
B.
he
anteror
abdomna
ratng
te
obque
cutaneous
obque,
nguna
rng,
about
and
branc
becomes
aponeuross
musce
s
o
te
cutaneous
te
2.5
perces
cm
externa
above
dstrbuted
to
nterna
by
184.
te
D,
E.
he
nerves
GAS
180.
C.
he
sory
skn
umbar
do
not
398;
N
o
he
a
on
and
gve
260;
unatera
bers
tome.
te
of
snge
anteror
toracoabdomna
te
atera
greater
cutaneous
o
skn
spna
o
o
poe
te
A.
te
B,
nerve
s
caed
branc
suppes
B,
D,
te
a
o
area
py
te
te
GAS
he
ram
area
12t
gastrc
A.
he
pexus.
B,
te
D.
o
te
(GAS
in
oregut
he
as
as
toracc
spna
N
10t
around
te
brances
spna
process,
nerves
o
nerves
we
suppy
te
sup-
tose
te
o
ypo-
185.
E.
s
ABR/McM
he
na
215
(no
clinical
many
mesenterc
spenc
by
pexus
lexure
te
ceac
suppes
and
to
te
ped
terc
by
te
spancnc
coon
neror
pexuses,
as
we
nerves.
not
te
part
nta
nodes
B.
and
te
mesenterc
as
by
pancreas
rectum
te
by
and
brances
ntermesen-
o
te
te
sup-
pevc
C.
he
o
T12–L3
tan
te
te
te
te
posteror
vertebra
vertebrae.
te
11t
on
te
rgt,
and
co-
he
ts
et
upper
rb.
ange
o
stomac,
te
rb
wc
woud
can
be
ave
a
te
descendng
coon
are
at
a
ound
N
cap
te
prmary
311;
or
te
rst
te
part
gastroduodena
epatc
retroduodena
te
on
ABR/McM
o
and
brances.
artery
and
duodenum
arses
supraduo-
gastroduode-
posteror
dvdes
anteror
sde.
wc
ts
he
retropertoneay,
and
te
artery,
artery,
duodenum,
rgt
265
nto
superor
to
te
te
rgt
pancreat-
artery.
porta
ven
s
ormed
bend
te
neck
pancreas.
te
mesenterc
abdomna
approxmatey
trunk,
and
arter y
aorta
w
at
1
te
cm
suppy
usuay
eve
o
neror
te
arses
te
to
L1
te
dervatves
o
mdgut.
be
orm
te
o
and
descends
vertebra,
some
are
s
superor
rom
te
sde
L1.
epatc
he
247
eve.
o
te
eac
ger
common
and
he
o
eve
duodena
te
on
njure
gastro-omenta
A.
one
troug
to
ABR/McM
retropertoneay
373–374;
ceac
descendng
te
ver
artery
rst
pancreas.
he
are
stomac.
BP79;
e
sgty
supped
o
nnervated
he
he
dena
N
racture
GAS
edition)
te
te
eve
coduodena
4.38).
171;
new
s
cutaneous
xpod
Fg.
superor
ar
7t
te
287–288;
ntestnes
o
anteror
o
toracc
area
thumbnails
181.
D.
sen-
derma-
te
es
beow
rom
E.
ventra
E.
eve
te
te
vared
brances.
umbcus.
A,
structures
o
wa,
unkey
tg.
271
by
358;
reaces
A
spancnc
nnervated
cutaneous
nerve
part
toracc
ABR/McM
area
hese
kdneys
at
kdney
superca
skn
he
umn
abdomna
te
C.
abdomna
pero-
ypogastrc regon. Latera emora cutaneous nerve
nnervates
E.
dranage
4.38
te
duct
s
joned
by
epatopancreatc
second
te
part
o
te
te
pancreatc
ampua
(o
duodenum.
duct
to
Vater)
at
180
C H A P T E R
D.
3
he
Abdomen
proper
brances
rom
te
com-
toracc
ta ven and te be duct wtn te epatoduodena
vscera
dvdng
GAS
E.
artery
T11.
gament.
186.
epatc
mon epatc artery and traves wt te epatc por-
he
orm
It
gves
nto
309,
344;
ndrect
o
te
erna
of
te
rgt
N
291;
nguna
and
s
rgt
and
gastrc
et
ABR/McM
erna
beeved
to
artery
epatc
s
be
beore
B.
cs
most
congenta
A.
rng
Drect
atera
nguna
nguna
drecty
te
to
te
ernas
ernas.
he
anterory
nguna
neror
cana
epgastrc
make
sac
o
troug
meda
up
a
te
to
deecate)
nvoved
15%
erna
neror
he
erna
umbca
regon
na
o
scar,
o
te
aduts
umbca
C.
he
D.
he
o
a
buges
wa
GAS
190.
o
epgastrc
te
s
C.
he
teror
a
structures.
mted
ayers
neror
o
te
A,
B.
sac
D.
tat
GAS
he
space
n
pragm
A,
B,
(o
te
et
or
stmuated
racc
emora
cana
emora
trange
(Pett
part
o
N
space
to
Vscera
eng
as
a
dapragm
gament
te
o
superor
tat
es
C,
and
te
te
parts
o
D
te
or
subepatc
ver
rom
te
communcates
rgt
wt
oramen
and
are
e
273;
separated
ABR/McM
at
sac
by
an
cavty,
te
begnnng
pevc
te
rgt
are
a
te
C.
te
te
w
gutter,
coect
n
o
te
te
and
A,
to
nlammaton.
te
spna
cord
appendx
sympatetc
by
s
te
te
per-
patent
w
vscera
traveng
mdgut
suppy
wt
w
afer-
sympa-
structure,
te
greater
rom
T5
experence
a
t
to-
to
T9.
vscera
te
spna
cord
by
trav-
s
rom
te
C3,
dapragmatc
nerve.
rgt
to
C4
te
he
and
C5.
I
dermatomes
sarp
ypogastrum
and
we-
corresponds
B,
n
D,
he
rgt
N
o
te
a
I
to
te
te
rom
te
N
body
wa.
rgt
ower
n
te
hs
wc
te
etus.
and
In
243
cord
tat
connectng
te
some
eadng
entre
to
It
s
te
s
cases
te
a
a
rem-
urnary
nvoved
excreton
uracus
stua
o
n
waste
remnant
o
deveopment
o
umbcus.
hs
at
contacts
resuts
o
n
aows
t
urnary
urne
to
233
te
appendx
McBurney
somatc
patent,
te
orce.
ABR/McM
ocaton
remans
connectng
umbca
324;
appendx
suppy
nerve,
snus.
quadrant
stmuates
ABR/McM
brous
tube
embryo).
persst,
uraca
301;
309;
tck
(a
sympatetc
spancnc
T9.
nutrton
and/or
E.
to
umbcus
can
ower
T5
a
anatomca
nlamed
t
s
major
toracc
te
pareta
aferents
sarp,
pont.
tat
n
te
Wen
s
te
pertoneum,
nnervate
ocazed
pan
n
te
te
quadrant.
A, B, C, D. Vscera aferents are stmuated by nlam-
appendx
hese
a
rom
nnervates
receves
aantos
cyst
GAS
E.
rom
te
umen
escape
da-
238
nnervate
vscera
oregut
orgnates
to
spna
te
greater
processng
uraca
a-
pouc
te
gabadder
hese
correspondng
ts
354–364;
products
192.
areas
a
ntay
orgnates
n
uracus
badder
most
te
rectouterne
paracoc
ABR/McM
tat
te
he
nant
te
cavty.
dependent
lud
wt
not
261
te
traveng
s
suppy
return
pan
by
pan
te
badder
te
by
wc
nerve
and
gabadder
GAS
ora-
te
s
sympatetcs.
neck
orgnates
240
encompasses
Morson,
324;
major
and
rom
greater
between
cord
w
aferents
prenc
orms
te
Snce
he
he
te
spaces
organ
toneum but does not expan te nta epgastrc pan.
E.
ayers
(eppoc
and
are
to te nlammaton spreadng to te abdomna per-
kdney.
te
so
der
pos-
s
and
te
and
space
urge
t were afected, te patent woud compan o sou-
posteror
te
may
te
tr-
recess,
ver,
relexes
ABR/McM
nnervate
sympatetc
nerve,
(tat
and
condton.
vscera
gabadder
patent
parasympatet-
nausea
nlammaton.
spna
a
eve.
nerves.
306;
tat
te T10
pertoneum
adjacent
superor
as
T10–
tr-
191.
space
ver
were
N
te
wt
ocazed
and
N
te
wt
patent’s
a
at
sensatons
suc
s
s
at
experence
pan at te epgastrc regon, wc s at te T7–T9 eves.
235
omentum,
bursa
pertonea
aferents
te
wc
trave
somatc
te
spancnc
hereore
erna.
umbar
standng.
by
return
receves
te
para-
posteror
potenta
subprenc
and
bursa
304;
patetcs.
major
a
te
ABR/McM
omenta
Pouc
sac,
A. Vscera
t
te
Dougas),
GAS
a
te
bursa
endng
E.
supne
ents
by
pertonea
and
omenta
189.
receves
gament.
304;
tonea
as
to
te
Wnsow).
greater
C,
te
esser
separates
and
corm
D.
s
between
troug
Rgt
n
a
troug
umbar
264;
epatorena
o
to
return
by
Snce
er-
by
orgnates
ntay
pysoogca
ts
aferents
tetcs.
omentum.
dapragm
188.
N
omenta
omenta
men
n
and
appendx
nnervated
coronary
recess
he
area
te
creatng
occurs
he
bursa
he
greater
space
E.
aba
umbca
reerred
troug
seat,
stomac,
te
he
nea
stmuated
wa.
superory
o
troug
be
tat
eves,
n
358–364;
Vscera
A.
rare.
weak
omenta
te
te
Acqured
correcty
descends
296–298;
to
protrude
troug
more
erna
s
abdomna
GAS
s
emora
and
ange)
but
not
umbcus.
sac
umbar
ange
does
he
B.
ents
erna.
erna
wtn
187.
sac
E.
nnervated
vesses.
B.
D,
umbcus,
conscous
not
C,
w
unconscous
te
orgn.
wc
patent
aferents
common
posteror
te
te
n
vesses.
about
drect
at
nerve,
te
medate
reac
he erna sac enters te nguna cana troug te deep
nguna
pan
Vscera
arteres.
246
te
spancnc
hereore
rom
wt
be
afer-
sym-
structure,
te
esser
maton,
cord
not
wt
contact.
hey
sympatetcs
trave
o
te
back
T10
to
te
spna
dermatome.
he patent w experence du perumbca pan,
wc
GAS
s
usuay
320;
N
a
306,
preude
N
282;
to
te
somatc
ABR/McM
pan.
231
CHAPTER
Anterolateral
wall
181
Abdomen
3
abdominal
Peritoneum
muscles
Kidney
Perinephric
T ransversalis
fat
fascia
Inferior
Renal
Paranephric
•
Immedatey
muaton
at.
hs
cay
rena
at
abundant
asca
s
woud
A,
rc
D,
A.
E.
and
rena
at
o
rom
n
te
te
kdney
um
N
A
te
na
rena
at
perneprc
(GAS
do
not
s
an
badder.
derved
o
te
o
papae,
D,
espe-
wtn
s
asca
caed
ayer
ascae.
GAS
o
te
s
te
te
te
D.
parynx,
esopagus,
duodenum
ver,
te
derved
up
to
pancreas
rom
te
te
rst
major
te
dorsa
ga-
meso-
he
N
(ever,
or
but
not
here
are
dervatves
o
te
o
ABR/McM
te
duct
and
hereore
eadng
postve
be
te
w
te
common
tere
to
duct
rece ves
w
te
Murpy
be
resut
cystc
epatc
sgn,
duct
backlow
symptoms
pan
o
n
d uct
stass
rom
rom
n to
te
coecyst -
tat
began
at
te
be
n
to
te
rgt
backlow
ser um
w
yp ogas -
nto
te
ver
b r ub n.
nundbuum
duct
o
afect
te
te
gabad-
gabadder
ver.
backlow
n
nto
serum
te
Obstructon
ony
and
te
atc
duct
196.
D.
o
ead
ver,
te
ver
brubn,
obstructon
te
eadng
wc
was
to
te
cannot
soey
o
n
be
te
be
340;
superor
branc
o
enterc
N
to
te
to
te
ampua
w
et
te
pancreas
obstructed
te
epatc
gabadder
as
(GAS
te
Fg.
duct
ABR/McM
pancre-
4.111).
w
ony
256
p a n c re a t c o d u o d e n a
gastroduodena
ceac
arter y
a r t e r y.
occuded,
trunk
be
287;
te
te
w
aso
rom
ver.
GAS
o
epatopancreatc
symptoms
aso
Te
brances
te
to
but
w
Obstructon
vesses
246
o
cystc
te
s
move d
aso
ncrease
te
coduodena
structures
324;
be
gabadder
ver.
der
afect
ower
te
and
E.
Oter
and
te
Obstructon
not
pernep-
oregut.
upper
ten
w
duct.
te
4.152).
a
to
expaned
wc
between
here
ncrease
he
267
rom
epgastrum
was
307;
gabadder
ts
B.
o
stomac.
hese
Obstr ucton
be.
te
A.
te
mem-
oregut.
C.
te
accu-
a
ndcate
ncude
te
te
speen
E.
ABR/McM
oregut
parts
he
gastrum
s
te
system,
second
duodena
195.
4.152
eadng
s
abscess,
at
Fig.
but
at
and
Fg.
GAS
trum).
externa
perneprc
asca
regons
318;
stomac
o
muscle
muscle
perneprc
and
perneprc
extrapertonea
a
te
capsue
caed
rena
te
Gerota).
rena
hese
377;
respratory
C,
te
lumborum
abscess.
he
B,
te
competes
ocated
dervatves
and
(o
suferng
be
GAS
194.
at
capsue
C,
near
Surroundng
paraneprc
patent
to
surrounds
condensaton
rena
rena
externa
extrapertonea
varaby
snus.
branous
te
o
major
fat
Quadratus
B.
cava
fascia
Psoas
193.
vena
I
te
a ow
trunk.
s
a
te
Te
branc
anastomoss
bood
mdgut
to
to
te
superor
between
rom
bood
a re
s
a
p a n c re a t -
mesenterc
ow
p r ov d e
wc
neror
o
superor
arteres
a r t e r y,
mes-
arter y
tese
te
two
ceac
s u p p y.
A, B, C, E. he rgt and et gastrc arteres, te et and
rgt
gastro-omenta
arteres
(ormery
caed
gastro-
eppoc arteres), te sort gastrc arteres a provde
bood
GAS
suppy
to
347–348;
te
N
stomac
291;
(GAS
Fg.
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
trd
ongest
Splenic
aorta,
artery
secton.
and
posteror Left
part
(neror)
o
te
duodenum
s
te
arteries
artery
It
crosses
vertebra
wa
w
over
coumn.
te
neror
Any
jeopardze
vena
peroraton
tese
cava,
to
te
structures.
gastric
B.
It
s
crossed
anterory
by
te
superor
mesenterc
artery
C,
artery
and
D,
hese
E.
tere
trd
GAS
198.
C.
he
te
he
gastrc
rgt
B.
gastro-omental
Anterior
superior
wa
wen
o
te
ABR/McM
branc
o
a
te
branc
anastomose
wt
et
245
ceac
artera
on
te
te
we
proper
esser
curva-
suppy.
gastro-omenta
greater
trunk
o
curvature
vesses
and
anas-
provde
ts
between
te
ceac
trunk
and
te
superor
artery
te
pancreaticoduodenal
afected
he pancreatcoduoduodena vesses orm an anas-
D.
artery
artery
and
suppes
te
pancreas
and
duodenum.
he
te
porta
trad
s
ocated
at
te
porta
epats
o
ver.
artery
E. Gastroduodenal
be
posteror
artery
aorta
pancreaticoduodenal
291;
usuay
and
mesenterc
superior
a
s
te
not
te
suppy.
tomoss
Posterior
N
hey
on
w
at
duodenum
s
t
4.66).
gastro-
omental
Abdominal
te
provde
bood
Right
structures
gastrc
tomose
Left
o
artery.
and
Fg.
(GAS
peroraton
346–347;
rgt
ture
a
part
et
epatc
A.
s
ven
he
sort
gastrc
vesse
suppes
te
undus
o
te
artery
stomac. •
GAS
Fig.
4.115
GAS
199.
A.
he
are
te
duct
344;
N
borders
cystc
meday
291;
o
te
duct
and
ABR/McM
244
cystoepatc
nerory,
te
te
neror
trange
(o
common
border
o
Caot)
epatc
te
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
•
cystc
ormed.
wc
It
one
B,
C,
s
n
s
te
D,
ange
E.
o
used
were
te
te
cncay
o
te
descrbed
o
te
structures
to
ocate
coecystectomy
gabadder.
orgnay
boundares
hese
a
ocaton
drans
Caot
o
GAS
currenty
cases
aso
drecty
Francos
as
It
arter y
node
(O
te
o
s
GAS
te
not
C.
cystc
E.
up
GAS
tr-
A.
347;
N
291;
ABR/McM
t.
s
psoas
By
200.
D.
he
argest
ous
spenc
branc
course
pancreas.
pancreas
ta
A.
o
o
As
t
te
he
to
te
t
s
te
ceac
ongest
trunk.
and
It
oten
takes
a
te
pareta
te
or
superor
border
o
passes
aong
te
superor
border
o
brances
to
te
neck,
coverng
ts
te
of
te
tortu-
aong
body,
and
B,
mesenterc
process
to
te
aorta
o
arter y
and
te
s
runs
a
drect
branc
anteror
pancreas
beore
to
te
gvng
ntestnes.
E.
he
are
artery
excessve
es
suppes
most
te
o
te
to
te
te
tg
appendx
common
to
patent
nlamed
pertoneum
s
r ub
sarp
he
poster or
pareta
resutng
and
cecum.
lexed,
contact
I
on
stomac.
245
to
tg
musce.
nlamed
ocated
te
drecty
underyng
psoas
s
o
( te
posteror
rgt
and
extended,
aganst
somatc
te
pan
patent.
D,
GAS
202.
er
on
stomac.
curvature
musce
te
te
ocated
ABR/McM
pe rtoneum
E.
durng
te
s
te
appendx
major
hese
appendx
abdomna
brances
te
291;
ocated
and
causes
C,
pancreas.
superor
te
te
et
gves
uncnate
B.
artery
o
N
a ny
appendx
200–223
greater
keepng
prevents
Answers
o
gastro-omenta
te
retroceca
poston )
246
artery
curvature
347;
he
rgt
gastrc
et
suppes
arter y
te
et
esser
he
Jean-
201.
make
he
te
Caot,
note:
aorta
4.66
per-
trange.).
do
Fig.
Caot.
331,
part
colon
Abdominal
superory.
colon
Duodenum
Duodenum
Ascending
and
to
tg
cystc
te
are
not
resutng
n
contact
sarp
wt
somatc
te
pan
extenson.
318–319;
borders
te
musces
cause
o
N
te
duct
282;
ABR/McM
cystoepatc
nerory,
te
261
trange
(o
common
Caot)
epatc
he epatc porta ven s ormed by te unon o te
duct meday and te neror border o te ver supe-
spenc and superor mesenterc vens posteror to te
rory.
It
neck
artery
n
o
te
pancreas
beore
ascendng
to
te
ver.
s
currenty
cases
used
were
a
cncay
to
ocate
coecystectomy
s
te
cystc
perormed.
184
C H A P T E R
A,
B,
3
C,
te
D.
A.
he
te
ture
by
by
trunk
rgt
and
py
rom
pass
te
ead
neror
o
D.
ror
mesenterc
tnum,
o
te
coc
coon
344;
passng
superor
vena
aorta
to
pass
te
gus.
to
B,
te
GAS
205.
D.
he
te
B.
racc
C,
he
he
neys
te
and
s
te
trontestna
between
GAS
206.
C.
he
ony
A,
B,
D,
te
B.
aorta.
te
a
gastro-
and
C.
and
va
te
nto
due
ower
ne-
It
o
lexure
medas-
te
arces
ung
coon
vsuazed
N
are
ng
way
o
te
et
te
epatc
o
porta
In
209.
unabe
ven,
to
o
es
ony
ormng
te
te
A.
n
te
pareta
to
covers
wt
o
C.
a
ntrapertonea
273;
te
scope.
ABR/McM
237
E.
subsequenty
nng
o
appearance
te
o
mdabdomen
a
on
congenta
stoo
sampe.
dsorder
and
he
structure
may
bood
w
as
w
not
be
vens
and
n
protrude
to
te
pass
tat
resut
ana
te
o
cana
cana
excessve
stoo.
may
tryng
te
rom
resut
to
pass
rom
stran-
ard
or
dry
N
to-
kd-
D.
A
N
and
and
not
237
te
ony
opton
sted
organ.
organs
be
are
afected
ABR/McM
and
posteror
over
o
te
ntrapertonea
by
a
retroperto-
236
oypogastrc
to
te
te
kdney.
nerves
Muc
oypogastrc
posteroatera
C.
gutea
o
are
te
nerve
and
s
pubc
emora
and,
and
over
tum
n
crest
D.
te
nerve
root
to
skn
te
o
12t
te
sur-
nerve
gves
sensory
tg.
suppes
te
te
skn
upper
over
meda
te
mons
majus
anterory
n
o
pens
anteror
nerve
suppes
N
musce
te
260;
tat
te
s
and
nerve
and
ABR/McM
w
costa
te
musces
abdomns,
women
or
scro-
provde
wc
te
o
anteror
ts
regon.
263
te
runs
margn
o
skn
n
“6-pack”
between
te
ook
te
mdne
s
pubc
o
te
wa.
10–12
rectus
7t
neror
and
cutaneous
atera
abum
398;
Rbs
he
te
speccay,
te
and
and
or
just
musces
men.
abdomna
B.
to
emora
rectus
runs
te
area.
onguna
skn
he
nerve
suppes
atera
GAS
trans-
tereore
s
oter
295;
subcosta
and
tg
te
may
te
dstrbuton
skn
he
gas-
pareta
ABR/McM
coon
tereore
drecty
he
cavty
and
280;
necton.
tg
A,
wt
a
typcay
tears
320;
he
peura.
te
te
posteror
stomac,
may
retropertonea
roundng
B.
260
retropertoneay
jejunum,
te
2-nc
tryng
are
onguna
rb
210.
te
te
te
passng
varcose
are
GAS
he
requre
pertonea
ABR/McM
a
pubs
anteror
t
may
regons.
varces.
tereore,
ocated
are
he
te
asca.
s
s
n
te
wc
we
nnervaton
w
n
boody
and
and
315;
w
sensory
esopa-
assocated
and
so
It
radograpy.
ssures
D,
ocated
ypertenson.
approac
drecty
E.
221
pertoneum
ocated
C,
s
nea
submucosa
esopagea
not
a
descendng
and
trbutares
te
te
B,
arc
bood
porta
systemc
and
o
gve
dsease
excessvey
he
te
ung.
s
A.
wc
te
jon
ncreased
bood
208.
bodes
over
to
te
trd
are
peura
312;
Ana
GAS
causes
subdvson
eum,
easy
E.
matera
eum.
stoos.
to
ormng
to
spenc
sdes
te
bood
te
posteror
rgt
ABR/McM
vscera
s
arge
regress,
te
studes.
red
on
rom
condton
ompaoenterc
nlammaton.
not
dicuty
rectum,
very
coon.
retropertoneay
N
brgt
te
competey
structure
Hemorrods
wc
superor
o
w
produce
present
superor
eca
congenta
o
nlammaton
by
resut
be
artery.
by
s
and
ong
marked
not
resutng
Hrscsprung
rena
dvded.
he
332;
Gastrts
a
projecton
wt
wt
s
porton
does
radograpc
sup-
tem.
s
A.
speen
to
arteres,
system),
pertoneum
verse
GAS
te
244
root
structures
a
vsuazed
E.
te
transversas
374–375;
pertoneum
te
by
by
te
te
smar
te
o
tract
pancreas
be
o
posteror
pareta
and
o
branc
abnormay
ver
at
e
a
rgt
te
low
210;
a
n
venous
dapragmatc
cavty
E.
o
s
vertebrae.
root
(an
varces
N
sted,
o
te
markedy,
kdneys
ayers
transecton
A,
te
ed
obstructed
arteres
gament
supped
descendng
over
hese
356;
to
voume
esopagea
aong
abdomna
suppes
(SVC),
vens
enarge
E.
become
curva-
duct
ngerke
2-nc
supped
ABR/McM
porta
reversa
C,
sup-
a
gastrc
supraduodena
ascends
te
passes
arge
orms
dvertcuum
proxma
stomac
supped
s
te
stranng
toracc
o
cava
azygos
he
vens
A,
a
Mecke
(vtene)
rom
s
esser
and
um
te
wc
te
cose
troug
causng
o
n
s
o
s
te
artery,
ypertenson
pressure
D.
gastro-omenta
gastroduodena
artery,
290;
8
aspect
te
te
kdney
te
ven
neror
porta
sort
at
pancreas
and
N
azygos
superor
o
207.
arteres.
et
he
et
gastrospenc
and
o
he
GAS
204.
wt
246
arses
bood
te
arteres,
and
he
brances
te
Most
aong
gastrc
artery
he
stomac
pancreatcoduodena
brances
te
assocated
ABR/McM
te
rgt
spncter
and
o
et
te
te
artery
mesenterc
E.
n
are
he
not
brances.
arteres.
pyorc
duodena
are
by
B.
291;
o
ormed
spenc
wc
he
D.
ts
and
orward
undus.
arteres,
C.
te
N
suppy
and
curvature
are
were
347;
artera
(gastroeppoc)
arse
structures
Caot.
anastomoses
te
greater
o
330–331,
rc
ceac
ped
hese
trange
GAS
203.
Abdomen
upper
costa
costa
and
te
abdomns
attacment
cartage
cartages
ac
to
s
and
or
crest
attac
a
te
te
to
are
too
ower
border
musce
sort
ar
atera
t.
oten
dstance
o
te
covers
anterory.
CHAPTER
E.
he
but
xpod
does
GAS
211.
C.
at
D.
T8
he
C.
he
attac
a
ror
vertebra
part
responds
A,
D,
B.
and
o
te
wt
11
n
rb.
are
L3
te
musce
213.
(B)
w
part
assocated
te
as
tey
hs
tat
margn
wt
consstng
move
o
te
B,
to
poste-
2
are
too
E.
cor-
and
and
correspond
to
s
rc
and
L4
GAS
258,
and
too
269,
5
are
cose
to
te
pevc
area
and
ow.
307;
265;
ABR/McM
225
aor ta
Posterior
medial
segment
Medial
sgn
by
spenc
ar teres
N
VII
a re
and
VIII
segment
Te
ro m
te
carr y
o
te
epatc
te
Te
rc
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
te
te
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
abdomna
t ow a rd
segment
lateral
inferior
and
mesenterc
area)
Lateral
Posterior
o
nutrent
ve r
area)
segment
superior
takes
a re a
epatc
V
VI
segment
inferior
te
area)
segment
inferior
n
VII
Left
Right
enarged
area)
segment
inferior
epatec-
pane.
o
te
et
bood
(Lateral
(Posterior
rgt
4.116).
superor
Lateral
Posterior
seg-
obe
remove
umbca
ve n
brances
ox y g e n
et
te
rgt
prncpa
te
por ta
rgt
obes
s
255
ntestnes
termna
Fg.
rom
p re s s u re
te
te
tereore
appearance
ro m
o
and
ne
obes.
obe
Removng
(GAS
aong
te
IV
et
quadrate
caudate
w
ABR/McM
s
uson
(Medial
III.
obes
n c re a s e d
ve n s .
te
VIII
set
o u t w a rd
o
(Anterior
IV
and
284;
and
Cante
and
and
segment
II
as
rgt
he
resecton
resected
N
ver.
obe
ts
medusae
ve n .
E.
tereore
VI,
wen
bood
ormed
Leves
to
known
caudate
te
Incorrect
338;
a
te ower margn o te 11t and 12t rbs respectvey .
are
V ,
te
segments
radatng
por ta
g
o
aso
unctona
o
quadrate
E.
Caput
ve n s
vertebra.
and
D,
GAS
214.
obe
accordng
C,
pane
nto
makes
et
te
tomy
beng
tereore
I,
segments;
produces
pont
te
tra-
any
ver
dvson
o
ment
dapragm.
anteror
tan
prncpa
te
w
obe
mdne.
costa
troug
esopagus
cava
downward
te
he
hs
pass
(E).
not
A.
dvdes
228
te
troug
ower
he
by
tat
vena
T12
owermost
eves
L1
o T10
at
vertcay
te
V ertebrae
ABR/McM
passng
wt
covered
neror
aorta
sternum
cage
be
attacment.
structures
eve
te
te
sope
an
253;
te
we
and
te
toracc
severa
At
structures
rbs
to
N
may
as
major
eves T7
partcuar
212.
tree
troug,
verse
A,
are
dapragm.
pass
serve
282–283;
here
te
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.
Te
superor
do
not
por ta
contrbute
ve n .
typcay
ve n s
a re
te
A,
to
te
C,
D.
GAS
E.
ary
he
o
trad
(o
do
N
mesenterc
ve n .
take
F g .
not
o
Te
te
wa
spenc,
ve n s
te
and
ve n
bood
o
bood
ro u t e
w
w
te
muncaton
resut
sac.
s
te
vena
are
A
n
omenta
between
gutters
part
bursa.
pertonea
neror
descendng
ate
wen
te
drans
t ow a rd
and
nracoc
epatc
A,
by p a s s
C.
responsbe
or
te
he
by
te
te
ony
esser
to
te
B,
vens
to
ora-
com-
sacs.
he
ascendng
N
to
an
et
E.
he
cava
et
azygos
receves
te
aternatve
GAS
te
N
sac.
spaces
240
or
to
o
jon
te
te
receve
most
drans
L3
or
198;
te
common
and
woud
bood.
wt
neror
emazygos
gonada
patway
390–391;
and
beow
greater
tose
bateray
w
rse
n
ven
et
accumu-
and
te
nto
connects
system
ac
w
to
ven
was
vens
rena
n
low
patway
and
and
above
ocated
not
may
supracoc
aperture.
gve
toracc
superor
are
azygos
to
lud
he
spaces
ABR/McM
common
subcosta
are
umbar
ac
wc
supne.
w
te
285;
addtona
he
and
and
lud
te
respectvey
as
porta
D.
coon
he
301;
posteror
te
beng
(eppoc)
s
and
atera
n
reerred
bounded
wc
bound-
eson
contents
aso
omenta
greater
spaces
anteror
stomac
space
D.
traversng
he
n
s
compartments
common
perorated
coons
patent
ascendng
provde
258
bursa,
cava,
te
o
he
ac
unon
C,
GAS
216.
te
transverse
B,
ater
te
ow
4.132).
ABR/McM
orms
Wnsow)
and
4.132
paraumbca
d re c t o n
orm
Fig.
A.
299;
omenta
nto
paracoc
ormaton
a t e r n a t ve
( GAS
hey
stomac
te
esser
men
Ts
te
por ta
medusa.
posteror
te
tat
nto
epatc
a t e r n a t ve
ear t.
356;
expeed
te
spenc
ones
an
dran
and
neror
te
e n t re y
caput
215.
as
te
ve r
B,
ve n s
to
Te
nto
umbcus
back
gastrc
mesenterc,
GAS
vens
rgt
te
te
rgt
vena
cava.
dran
and
et
ascendng
te
sdes
umbar
nstances.
nto
te
vertebra,
ven
t
neror
and
cannot
bood.
ABR/McM
vena
atoug
221
provde
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
anteror
abdomna
wa
n
te
4.133
A.
rgt
he
rgt
porta
asca, Scarpa asca, externa abdomna obque, nterna
systemc
asca,
D.
he
wa
o
sma
obque,
276;
N
te
he
B.
he
te
between
te
paracoc
D.
he
GE
coon
GAS
Let
work
ces
at
n
o
cases
ower
o
te
juncton
te
te
descendng
and
te
transverse
externa
at
stomac
D.
meda
o
te
te
and
to
te
not
te
ocated
n
ven.
obstructon
wt
te
Dstenson
resuts
n
esopagea
o
ts
net-
esopagea
var-
et
drecty
to
te
epatc
communcaton
wt
a
medusae
jons
te
around
wen
ven
and
s
te
wt
te
umbcus.
dstended.
superor
descrbed
gastro-omenta
ven
anastomose
vesses
mesenterc
ven
dsorder.
drans
nto
tereore
te
not
supe-
nvoved
ematemess.
Pan
durng
te
no
cncay
mesenterc
354,
356;
rom
pan.
appendx
te
hs
area
s
to
a
gut
base
(at
N
299;
pan
rotaton,
t
area
te
te
ts
et
regon)
and
(durng
n
et
as
a
around
te
because
te
embr yoogcay
erna).
appendx,
rests
251
orgnay
ntay
T10
o
cecum,
mantans
embr yoogy).
s
structure
umbca
te
s
about
reducton
o
ABR/McM
appendx
mdgut
te
and
However,
n
no
ror
umbca
at
ven
he
erna
261
caput
orms
reated
ABR/McM
orm
and
vscera
coon.
were
E.
drans
vens
epgastrc
spenc
GAS
220.
coons.
ven
orms
ven.
he
n
coon.
transton
pont
s
between
4.89).
anastomoses
azygos
juncton
ndcates
are
281;
esopagus.
te
n
and
paraumbca
hey
230
E.
ocated
Fg.
N
ven
te
s
te
(GAS
317–318;
gastrc
brances
and
he
gastrc
ven
superca
coon.
gutters
jons
B.
transversas
pertoneum.
narrowng
ndcates
coon
juncton
abdomns,
pareta
ndcates
ascendng
he
esopagus
a
lexure
C.
te
te
lexure
spenc
s
hs
and
transverse
and
ABR/McM
vave
cecum.
epatc
at,
258;
eoceca
ntestne
A.
C.
transversus
extrapertonea
GAS
219.
te
Fig.
ower quadrant rom superca to deep are: skn, Camper
abdomna
218.
o
GAS
pysoogca
Subsequenty
wc
te
rgt
nner vaton
s
ocated
ac
(ts
s
ossa.
a
rue
188
C H A P T E R
3
Abdomen
Liver
Spleen
et
epatc
concavty
te
D.
ead
he
o
cystc
denum
duct
and
he
duct
and
rgt
GAS
E.
he
s
above
cancer
epatc
332;
proxma
be
to
te
obstructed
and
pancreatc
n
duodenum
223.
aso
not
duodena
n
cancer
o
pancreas.
compressed
E.
s
w
and
N
te
s
ead
BP80;
neror
o
artery
te
to
ead
te
rgt
and
ead
not
o
te
proxma
o
te
ABR/McM
o
te
key
duo-
to
be
pancreas.
and
above
te
pancreas.
257
pancreatcoduodena
artery
w
con-
tnue to suppy te pancreas, partcuary te ead o te
pancreas,
hs
A.
artery
he
te
s
a
gastroduodena
branc
spenc
o
artery
te
does
artery
superor
not
s
compromsed.
mesenterc
suppy
te
artery .
ead
o
te
pancreas.
B.
Right
colic
flexure
T ransverse
•
GAS
colon
Fig.
Left
colic
flexure
Somatc
wa
aferent
structures.
carres
hs
pan
w
be
sensaton
te
case
rom
Pregangonc
w
sympatetc
synapse
esser
n
toracc
gonc
bers
te
bers
to
aortcorena
spancnc
w
te
nerve)
accompany
te
GAS
bood
(te
postgan-
vesses
to
Answers
224.
Pregangonc
D.
Postgangonc
secreton
by
he
to
te
358–364;
ureters.
at
te
uretra
and
stones
n
obstr uc ton
te
rupt
appendx
te
exampe,
ABR/McM
s
ave
o
urnar y
ureters
most
n
n
to
o
B.
be
C,
Stones
D.
Stone
ton
and
w
GAS
A.
o
he
te
duct
to
obstructon
ead
n
N
317;
o
nto
te
pancreas
te
he
r are y
pevc
at
urnary
te
D.
at
te
pevc
o
s
te
or
be
duct
te
begnnng
tereore
o
te
te
te
ampua
porton
obstruct
te
C.
he
o
te
be
duodenum
carcnoma
and
o
epatc
not
te
duct
key
to
pancreatc
s
be
pan
ocated
n
Vscera
he
patway
bers.
te
o
artery.
esser
proper
te
ne-
cur-
epatc
ver.
253
rom
ncudng
te
as
prenc
te
pancreas
te
are
sympa-
pancreas,
vscera
are
aferent
he
aortcorena
w
he
to
E.
he
rom
skn
pancreatc
te
duct
o
at
te
ts
226.
to
compressed
Smary,
te
by
te
pancreas
motor
bers
do
not
nnervatons
to
capsue
te
mesenterc
N
o
te
east
suppes
o
te
toracc
sympatetc
gangon
receves
pexus.
hs
bers
gangon
sympatetc
bers
4.137).
310;
te
pubc
ocaton
te
postgangonc
(Fg.
dermatome
beow
te
o
mdgut.
ntermesenterc
suppes
s
bodes
wc
te
358–364;
GAS
second
dsruptng
tese
o T5–T9.
te
gangon
ce
ndgut
onguna
Vater)
by
o
nerve.
suppes
oypogastrc
te
vatng
concavty
ead
te
te
GAS
most
225.
(o
neror
many
junc-
bodes
ganga
rom
vagus
nerve
pancreas
ce
dapragm.
rom
ureters,
root
bers
te
te
nerve
dorsa
pan
wt
rom
he
nerve,
proxma
ead.
te
aferent
ABR/McM
nerve
kdney
over
w
and
te
s
s
sensaton
typcay
pubc
sympyss
245
receve
nner-
sympyss.
nnervated
he
by
te
nerve.
373–374,
394–401;
N
260;
ABR/McM
270
C. he ureter s narrowed at some regons, ence stones
are
more
ton.
common
te
Postgangonc
gangon,
to
regon.
B,
ceac
nnervaton
269
to
o
to
bers
nerves.
oregut,
spancnc
to
badder.
brm
and
Carcnoma
te
te
ead
caycea
ureters.
265,
reated
n
to
postgangonc
ureterovesca
enargement
epatopancreatc
duodenum.
can
te
ABR/McM
ead
duodenum.
at
n
enargement
pancreatc
jon
to
obstructon
resut
381;
open
part
ormed
te
to
curvature
gastrc
suppes
suppy
aferent
stones,
E.
not
key
stone
key
222.
are
esser
rgt
and
ABR/McM
sympatetc
nerves
te
wc
superor.
urnar y
badder
resut
vscera
trave
proxma
propensty
te
te
A.
261
was
enargement.
B.
he
ocated
te
are
nvoved
w
te
or
utrasound
areas
not
tat
306;
te
artery
bood
291;
brances
te
bers. Neurectomy o ts gangon w tereore nter-
to
unctons,
on
juncton
s
to
uncton
stones
narrow
bers
bers
N
of
wt
stomac,
provdes
accompany
te
gands.
N
seen
Rena
3
ureteropevc
he
motor
ntestna
abnormaty
odged
A.
317,
motor
sympatetc
vscera
E.
te
perorm
perorm
GAS
221.
parasympatetc
gastrc
te
348;
gves
suppes
224–244
C.
tetc
C.
and
togeter
rgt
o
artery
mdgut
gangon
beore
he
artery
nlam-
gastrc
stomac
vature
appendx.
appendx
esopagus
D.
body
maton o te appendx spreads to te pertoneum.
B.
et
ror
te
4.89
C,
A.
he
At
rowed
te
key
te
at
te
common
urnary
to
ower
be
pont
ac
badder
at
trapped
part
o
were
artery
te
at
te
t
tese
ureter,
crosses
and
were
vescouretera
areas
te
te
t
o
constrc-
ureter
s
nar-
burcaton
opens
juncton.
nto
o
te
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
arteres.
te
te
E.
t
not
dvdes
he
arteres
ureters
do
tey
4t
are
and
cross
cross
nto
neror
vena
common
ac
nterna
umbar
ocated
te
te
arter y
meda
tereore
are
and
and
n
and
not
externa
act
a
posteror
crossed
by
ureters.
he
neror
unpared
ters
pat;
were
umbar
to
ureters
ts
GAS
are
neror
mesenterc
branc
more
o
te
ateray
mesenterc
artery
s
a
abdomna
ocated
artery.
and
mdne
aorta.
do
not
he
and
ure-
cross
te
Fig.
4.137
GAS
227.
C.
he
332,
structures.
o
358–364;
gabadder
he
ceac
postgangonc
spancnc
tures.
A
branc
o
artery
to
suppy
te
he
neror
rom
spancnc
317;
ts
ABR/McM
bary
gangon
nerve
ts
trees
rom
nnervate
traves
271
are
contans
bers
tat
nerve
oregut
ce
bodes
te
greater
tese
wt
te
struc-
cystc
gabadder.
mesenterc
postgangonc
mosty
N
sympatetc
toracc
A.
and
pexus
sympatetc
te
nerves.
esser
contans
bers
and
to
ten
te
east
mosty
mdgut,
toracc
189
190
C H A P T E R
3
Abdomen
Esophagus
Anterior
and
posterior
vagal
trunks
Celiac
trunk
Superior
Inferior
Pelvic
•
B.
he
superor
gonc
D.
spancnc
nerve
he
pexus
rom
rena
te
kdney
E.
mesenterc
sympatetc
he
east
to
superor
te
te
228.
C.
oca
(GAS
bers
to
pexus
to
contans
te
te
4.137,
post-
pevc
4.138
and
and
o
atresa
bous
te
N
301;
presents
vomtng,
Atresa
ABR/McM
and
resuts
duodenum.
wt
a
256
doube-bubbe
rom
aure
o
E.
a
tanted
sgn
on
ar ter y
ner ves
309;
Batera
s
o
te
N
279;
wt
An
nto
ros
atresa
gonads
or
ts
wereas
vovuus
or
or
pancreas
are
not
to
CNS
to
wt-
present
wt
x-ray.
uropaty
because
tte
or
s
no
cavty.
s
assocated
wt
deects.
duodena
dervatve
dvertcuum.
ead
245
amnotc
causes
a
ods
obstructve
conversey
and
not
above
ABR/McM
te
ead
marotaton
w
te
ogoydramnos
excreted
annuar
he
peuropertonea
ageness
Poyydramnos
septum
vomtng.
ernas
vomtng
rena
esopagea
B.
traceoesopagea
concomtant
assocated
epgas-
recanaza-
splanchnic
nonbous
Deects
be
GAS
229.
A.
dstended
E.
te
out
urne
radograpy.
ton
D,
o
wt
dapragmatc
suppy.
bers
Fgs.
nerve
Deects
TEFs
B,
spancnc
bood
ypogastrc
358–364;
Duodena
trum,
A.
toracc
postgangonc
mesenteric
ar ter y
4.138
postgan-
esser
4.170).
GAS
Fig.
mdgut.
sympatetc
regons
contans
rom
contans
toracc
reguate
gangonc
pernea
to
pexus
bers
GAS
mesenteric
o
obstructon.
te
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
te
D.
te
Batera
s
no
Down
C.
s
urne
amnotc
N
238;
ea
brous
E.
An
rom
te
a
o
drecty
wc
occurs
A
or
obstructve
te
n
because
reated
to
n
t-
A,
become
at
234.
B,
D.
wereas
cyst
te
connected
band,
s
an
te
s
te
eum
A.
N
annuar
bd
ater
te
te
not
be
324;
an
D,
outpoucng
o
border,
C.
B,
235.
wc
a
o
oowng
buds
n
wc
a
E.
eter
nlammaton
wc
deveop
orms
te
may
at
or
at
deveops
brt
bross.
te
second
Snce
cauda
part
or
o
part
te
hey
ABR/McM
answer
can
be
te
s
N
end
nto
te
not
324;
te
he
be
(GAS
nvoved
aure
to
too
sma
passng
scrotum,
ABR/McM
due
be
lud
orm-
gubernacuum
scrotum
congenta
wa
may
pertonea
tests.
nto
245
vagnas
aow
woud
s
o
twstng
o
a
nversus
Fg.
n
ads
4.41).
ydrocee.
278
o
cosure
ncompete
o
te
cosure
o
n
s
te
w
wen
a
opposte
not
present
N
syndrome
duodena
w
around
o
te
bowe
and
may
dvertcuum.
256–257;
atresa
B, C,
obstruct
oter
258;
s
to
as
be
nterna
o
te
sma
but
to
dsta
to
are
ernaton.
237
wt
get
organs
body.
bowe
ABR/McM
assocated
atresa
ave
te
sde
ncreased
bous
te
1st
nc-
vomtng
part
o
te
duodenum.
case.
probaby
o
descent
resut
Down
dence
vtene
may
abdomna
hese
D,
te
bud,
duodenum
a
ts
E.
Stus
A.
237
pancreatc
te
persstent
dagnoss
pancreas,
part
and
BP80;
289–294;
stuated
o
te
te
ods.
be
te
cyst
ABR/McM
ventra
oregut,
s
antemesenterc
E:
abdomna
V ovuus
and
remnant
D,
processus
Gastroscss
and
ompaoenterc
to
wc
abnorma
surace
N
ydrocee
atera
ucerated.
woud
315;
a
GAS
230
umbca
C,
but
testcuar
cavty.
traceo-
335;
troug
uropa-
amnotc
B,
persstent
bowe
ng
stua
te
dvertcuum
pancreatc
te
crcuaton
C.
GAS
ea
second
muc
te
a
Ompaoenterc
artery
C.
a
umen
GAS
233.
stak.
An
can
D,
atre-
anteror
umen,
by
ea
or
nto
(vtene)
umbcus
B.
o
ogoydramnos
between
s
A,
ack
lud,
ABR/McM
cyst
yok
GAS
esopagea
plexus
excuded.
tracts.
excreted
not
duodenum,
syndrome.
267
wt
to
ageness
wt
(vtene)
te
due
Potter
stuae.
connecton
termna
ABR/McM
rena
s
n
assocated
dgestve
Ompaoenterc
patent
sown
deects
syndrome
374;
be
te
assocated
or
GAS
o
and
esopagea
232.
311;
CNS
absorpton
C,
E.
and
respratory
ty
231.
not
Poyydramnos
sa,
B,
woud
hypogastric
4.170
C, D. Marotaton o te gut and batera gonada dys-
geness
ner ve
GAS
236.
C.
E. A te oter condtons occur proxma
major
309;
Mdgut
sma
duodena
N
ntestnes
ton
oowng
tant
twstng
vascuature
279;
vovuus
ABR/McM
occurs
enter
rotaton
o
at
to
te
te
gut
to
papa.
te
o
241
oowng
abdomna
te
mdgut
usuay
oop.
occurs
duodenojejuna
aure
cavty
and
o
or
he
resu-
afects
juncton.
te
xa-
te
192
C H A P T E R
A,
B,
3
D.
Abdomen
hese
syndrome
sma
E.
237.
GAS
309–310;
N
te
onguna
regon,
majus,
D,
GAS
238.
E.
E.
o
reated
as
to
Down
marotaton
te
c re s t ,
perneum
are
n
dsta
neura
te
ower
scrotum
tg,
abdomna
as
or
260;
superca
responsbe
ndrect
structures,
nodes
ro m
te
or
trans-
C.
he
run
badder,
o
te
230
b e ow
back
b e ow
s t r u c t u re s
wt
cervx,
and
receve
te
ac
o
te
ower
te
pens,
receve
o
rom
he
tubes,
aortc
and
body
abdomna
te
and
o
nodes
o
te
ac
vscera
receve
can
239.
E.
he
288,
tat
gves
he
to
C,
D.
tests,
run
E.
he
eve
asca
and
verse
porton
o
artery.
and
wt
o
to
te
te
B.
At
egt
Normay,
an
ange
dmnses
te
superor
Fg.
264;
o
te
te
te
te
A,
C.
are
By
te
gve
artery
te
D.
ess
tan
duodenum
mesenterc
eaves
and
and
E.
sper-
externa
to
te
and
235,
te
rom
lexure.
es
and
nterna
superor
mesenterc
20
can
artery
degrees,
get
aorta
te
A.
At
at
age
to
ong-
edery
greater)
gut
he
gastone
aows
ga-
tssue
stua
nto
te
sma
between
ntestna
tree.
due
ut-
Oten
te
gas
ts
to
gas
x-ray.
cystc
duct
bary
don’t
or
coc,
odge
be
duct
jaundce,
at
about
7–9
14
o
by
and
duodenum
te
and
or
secondary.
or
ram
week
centers
o
growt
portons
pubs
te
ossy.
are
and
at
At
ave
grow
around
13–15
ony
just
acetabuum.
od,
centers,
centers
and
centers
o
years
remanng
rom
hese
nnt
prmary
acetabuum,
base
256
ossed
used.
3
growt
24
240,
s
egt
neror
te
te
ve
tree
competey
or
toward
25–27
te
remanng
22
pbone
and
te
te
prmary
te
ABR/McM
te
prmary
base
3
287;
age
brt
13
te
n
N
rom
remanng
he
versng
osscaton
and
tey
takes
use
wt
bone.
years,
434–435;
tese
te
o
trans-
at
artery
te
I
C.
te
and
between
eadng
to
te
bones
wa
o
soud
to
te
he
to
ave
aready
o
pene
s
part
s
te
s
uretra,
te
459–462;
N
most
part
aso
sortest
wc
eads
te
segment
tra-
caed
and
rom
one
te
ts
passng
segment
runs
349;
troug
eads
to
parencyma.
corpus
w
o
aong
te
engt
o
te
spongosum.
not
traversed
cystoscope.
GAS
te
nta
bub.
prostatc
te
te
badder.
segments,
uretra
troug
Parauretra
part
295
uretra
wt
urnary
Peroraton
te
spongy
te
porton,
uretra
prostate.
ABR/McM
o
uretra,
te
narrowest
Prostatc
pens
E.
te
membranous
damage
D.
o
250;
part
ntermedate
te
te
ts
transverse
part
prostate
mesenterc
ange.
aorta,
at
N
ntramura
he
te
duode-
he
entrapped
and
tssues.
bary
te
to
o
tree
te
te
GAS
243.
278
orzontay
45-degree
te
bowe
usuay
amost
Between
te
B.
coc
superor
or
gastone
wt
used.
tests
te
rse
ntestne
aorta
cm
adjonng
abdomna
o
years
age
puberty
super-
musce
on
and
By
toward
musce.
ABR/McM
et
rom
patents
communcaton
and
eads
appear
e,
proxma
approxmatey
to
es
sma
340–341;
extended
o
o
resutng
gabadder
centers,
scum
umbar
extenson
on
passage
and
16–18
eta
atera
4.47).
te
te
245
2.5
tese
Gastones
centers
deep
230
musce
between
not
“nut-
b e twe en
mdde-aged
and
gastone
GAS
uterne
te
abdomns
duodenum
between
orm
te
N
do
hs
or
jejunum.
artery,
asca.
suppes
aorta
o
an
obque
covers
ound
(GAS
pancreas
L3,
porton
s
mesenterc
and
num
eve
musce
It
289–294;
L1
s
cremaster
structures
superor
o
te
oc ated
n
(oten
gabadder
observed
pace
spermatc
hese
GAS
asca
transversus
to
cord.
spermatc
240.
te
artery,
suferng
occurs
(typcay
Obstructon
D.
te
rom
ovares,
ABR/McM
abdomna
cremaster
nterna
319;
spermatc
orgn
matc
N
obstructon.
coangts.
C,
asca.
nterna
ca
B.
514;
nterna
he
be
B.
years
transversas
A.
te
a
tat
and
ymp
gands,
uterus,
musces
not
pressure
te
te
adductor
ympatcs
and
enter
rom
undus
nterna
pevc
suprarena
are
key
tat
arge
te
te
vens.
GAS
A
separate.
atera
kdneys
bowe
mesenterc
ABR/McM
most
coetass
gabadder
perneum.
D.
par ts
291;
s
condton
te
242.
brances
ymp
N
aows
bowe,
mbs.
ympatcs
prostate,
gans
nodes
a
matey
ymp
tg.
nterna
recevng
nodes
as
348;
persstent
A,
nodes
hese
patent
between
to
re c e ve
wa
super ca
suc
hs
women).
erna.
ABR/McM
ymp
ac
D.
standng
buttock.
externa
sma
superor
stone causes te ormaton o a coecystenterc stua
abdomna
ro m
E.
eus,
and
he
regon
241.
we
obque
parta
caed
syndrome.
C,
GAS
o
anteror
not
an
B,
o
s
superor mesenterc artery and aorta at te eve o L3.
B.
urnary
A,
coon.
he deep nguna nodes receve some o te ymp
deep
condton
250
skn
meda
nguna
te
and
te
o
A.
rom
symptoms
o
musces.
umbcus,
and
aure
ABR/McM
pubs,
nerves
N
to
suppes
nterna
sgna
ro m
n
adjacent
super ca
dranage
ac
hese
pan
398–401;
Te
e ve
mons
and
due
occurs
324;
abdomns
mttng
s
nerve
nerormost
transversus
C,
not
cracker,”
and
abum
are
present
megacoon
mgraton
nguna
B,
not
crest
he
as
w
bowe.
Congenta
C.
condtons
and
ABR/McM
279
by
te
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
et
testcuar
epddyms,
te
A,
neror
B,
C,
jons
vena
D.
tures,
he
so
nvoved
testcuar
cava.
ton
et
ater
dranng
rena
ven,
te
wc
tests
ater
GAS
the
of
the
tunica
layer
Fig.
fascia
of
tunica
rgt
te
ven
vaginalis
vaginalis
the
tunica
vaginalis
4.47
and
sacra
jons
and
cava.
vens
dran
testcuar
dranage
drans
o
he
et
testcuar
wt
te
et
ven
common
ven
te
drecty
psatera
et
nto
as
ac
soud
tests.
te
no
not
neror
he
266,
receves
nto
516;
te
N
bood
et
313;
rom
common
te
sacra
ac
ABR/McM
regon
ven.
271
struc-
he
drect
ven.
ven
drans
GAS
testcuar
te
n
ven,
te
fascia
Internal
Cavity
fascia
be
rgt
vena
connec-
medan
Answers
245.
E.
o
245–246
he
te
above
bony
pubs
pevs.
te
s
descrbed
he
pubs
mons
and
promnence
as
pubs
te
beow.
te
s
pubs
a
anteroneror
atty
can
be
pad
tat
papated
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
termnates
ac
artcuates
spne,
sympyss
B.
he
be
C.
papated
he
he
and
part
GAS
E.
he
part
o
s
te
smar
te
bone.
n
te
up
Its
433–436;
case
N
atera
part
te
te
o
te
te
te
a
pubc
agan
o
t
ve
te
makng
ABR/McM
o
emerges
te
psoas
muscle
4.151
crosses te quadratus umborum to te ac crest runnng
just
posteror
abdomns
A.
to
be
C.
s
posterone-
papaton
he
as
to
he
285
on
major
te
upper
musce
and
to
ts
or
te
GAS
perorates
does
cutaneous
not
gutea
te
te
obque
area
transversus
musces
nnervate
regon,
wt
and
brances.
te
wc
sensory
skn
does
dects
case.
emora
quadratus
cutaneous
nerve
cana
nerve
does
not
umborum.
and
nnervates
anteror
te
part
o
skn
te
over
abum
scrotum.
emora
(GAS
anteror
nerve
onguna
anteror
rom
n
nguna
majus
D.
and
It
abdomna
posteroatera
atera
he
te
kdneys.
correspond
reate
part
eature
atera
descrbed
B.
te
nterna
subcosta
te
not
to
and
nto
he
o
wa.
mpossbe.
nerve
Fig.
wa.
neror
promnent
on
abdominis
sacra
cannot
abdomna
posteror
most
vertebra
structure
abdomna
uson
coccyx,
ocated
250;
border
to
sacrum
superor
muscle
dvdes
posteror
anteror
bone,
ts
atera
anteror
by
to
te
anteror
muscle
lumborum
GAS
mdne.
too
ormed
oypogastrc
te
te
wt
te
ocated
tuberosty
o
as
termna
t
makes
pevc
descrbed
246.
s
troug
sca
ror
te
troug
scum
te
te
s
s
rom
suc,
sacrum
papated
o
away
As
vertebrae
D.
wc
coccyx
coumn.
posterory
anterory
major
XII
nerve
nnervates
compartment
anteror
Fg.
398;
aspect
o
o
te
te
te
tg
4.151).
N
260;
ABR/McM
musces
tg
263
and
and
o
te
te
skn
meda
eg
4 Pelvis
and
Perineum
Q u e st i o n s
Questions
1.
A
1–24
29-year-od
an
uncompcated
tons
sowed
sows
tra
Wc
te
o
te
uretra
use,
Laboscrota
B.
Coaca
C.
Urogenta
D.
Genta
E.
Urogenta
Se
by
gans
and
n
examnaton
te
wt
externa
superor
embryoogc
resutng
va
examna-
pens
te
boy
to
anus.
structures
most
ocaton
Genta
D.
Semnerous
E.
Laboscrota
A
32-year-od
o
as
te
ze
A.
s
ater
brougt
wt
at
to
te
rotng
term
va
a
emergency
and
rapd
vagna
depart-
breatng.
ome
brt.
5.
s
made.
o
o
Insuicent
D.
Kneeter
E.
Persstent
ng
and
dsta
o
te
sgmod
rectum.
vagna,
and
dstress
abdomen
coon,
An
wt
an
jon
no
nto
structures
mperorate
daton
nvertogram
coon
oowng
and
sows
te
sadow
sows
a
s
gas
o
snge
drecty
tat
anus.
An
descend-
seen
te
n
te
urnary
rectum,
canne.
s
Wc
nvoved
n
ts
ts
Laboscrota
B.
Persstent
Urogenta
D.
Genta
E.
Urogenta
A
ods
tuberce
4-year-od
moter
membrane
boy
because
deveopmenta
examnaton
te
a
nonpapabe
men
as
no
sows
cnca
brougt
o
a
mestones
o
a
tat
te
most
key
presentaton?
o
pyscan
te
been
met.
ocated
abdomna
Examnaton
s
an
te
aed
o
ectopc
deveop
s
A
Pysca
externa
obque
te
o
et
te
tests,
oowng
to
by
abdomen.
Utrasonograpy
mass
Wc
n
mass
externa
tests.
te
ave
papabe
te
rgt
to
sweng
abnormates.
nterstta.
structures
s
sows
aponeuross
sows
ods
coaca
C.
to
and
tests
abdo-
cassed
embryoogca
resutng
n
te
scan
te
te
ower
aed
dagnoss
oowng
to
o
s
te
part
vsua-
badder
te
most
streak
mesoderm
to
mgrate
ods
to
use
stmuaton
syndrome
boy
s
o
brougt
cryng
sows
te
and
s
Wc
o
te
and
o
by
te
A
Urne
dagnoss
urter
kdneys
oowng
s
Pysca
tenderness.
ntrtes.
made,
Utrasonograpy
pyscan
urnaton.
suprapubc
necton
ureter.
to
durng
eukocytes
6.
cnca
o
workup
sows
a
embryoogca
condton?
A.
Ureterc
B.
Mesoneprc
bud/metaneprc
C.
Paramesoneprc
D.
Metaneprc
E.
Pronepros
A
31-year-od
1-week
duct
mesoderm
man
story
dvertcuum
duct
o
comes
panu
to
te
pyscan
urnaton
and
because
pan
beow
o
a
te
umbcus. One year ago, e was treated or a urnary tract
necton.
ness
o
and
te
aong
o
examnaton
tender
abdomen
structure
Wc
Pysca
a
te
Hydrocee
B.
Epdermod
C.
Mecke
te
anteror
oowng
A.
sows
nraumbca
sows
te
s
presence
aspect
te
suprapubc
mass.
o
most
tender-
Utrasonograpy
o
te
key
a
1.5
cm
urnary
cystc
badder.
dagnoss?
cyst
dvertcuum
A.
Gubernacuum
D.
Ompaocee
B.
Processus
E.
Uraca
vagnas
n
preg-
o
structures s most key abnormay dvded resutng n
maormaton?
A.
Her
aantos
tract
bd
gestaton
vst.
membrane
androgen
sows
ndcated.
et
mass
he
o
weeks’
Utrasonograpy
prenata
prmtve
because
dpstck
A
Wc
uretra
6-year-od
examnaton
te
wa.
20
prenata
condton?
coaca
Faure
sows
respratory
te
C.
moter
o
ts
te
o
at
er
abdomna
badder.
B.
A
an
abdomna
cause
Faure
or
abnormates.
urnary
around
membrane
prmgravda
sows
exstropy
key
cords
swengs
pyscan
no
eta
te
ods
devered
te
abdomen
ods
gr
to
nancy
o
tuberce
Antenata records are unavaabe. Pysca examnaton
x-ray
3.
C.
comes
ure-
te
ectopc
4.
an
tuberce
er
was
Pysca
mmedatey
b)
Antenata
te
ventray
(9.8
membrane
5-our-od
ment
o
kg
orce?
A.
A
4.5
brt.
curvature
oowng
to
a
abnormates.
openng
aed
devers
vagna
prepuce
orce
key
no
downward
ncompete
2.
woman
cyst
195
196
C H A P T E R
7.
A
4
Pelvis
30-year-od
gestaton
er
o
care.
Her
ean
or
because
o
10
ater
and
secondary
pregnancy
admsson,
se
was
te
embryoogca
8.
patent
an
te
A
C.
Faure
o
te
D.
Faure
o
recanazaton
E.
Regresson
7-year-od
boy
o
as
te
uson
s
an
to
weeks’
no
brt.
emergency
progress.
aed
o
to
cesar-
he
notes
a
key
condton?
ducts
paramesoneprc
ducts
o
uterus
most
paramesoneprc
te
uy,
secton.
and
te
ours
date
cesarean
s
by
an
antena-
vagna
adesons
ts
mesoneprc
te
n
cervx
o
An
o
35
astng
receved
oowng
B.
A
uson
at
department
norma
emergency
A.
ncompete
a
aure
patent
o
2,
unavaabe. T wenty-our
expanaton
compete
was
patent’s
te
Wc
para
contractons
resuted
to
or
3,
emergency
severe
he
were
taken
Intraoperatvey,
ddepys.
te
pregnancy
pregnancy
secton
ts
seconds.
rst
Perineum
gravda
to
Her
second
woman,
brougt
partner
average
ta
s
and
te
to
ducts
degenerate
Müeran
ducts
pronepros
brougt
to
te
pyscan
because
o
an
nabty to contro s urnary badder, despte beng toet
traned at te age o 5. Fve monts ago, e was treated or
a urnary tract necton. Utrasonograpy o te abdomen
sows
a
md
Dagnostc
drecty
made.
deect.
cystoscopy
nto
An
dataton
te
o
te
sows
uretra.
A
o
te
oowng
ty te poston o et ureter
9.
A.
Anteror
B.
Meda
C.
Anteror
to
to
te
te
to
et
et
te
s
common
gonada
Anteror
to
te
et
rena
to
te
et
neror
and
a
te
use,
n
A.
Processus
B.
Laboscrota
Uretra
D.
Urogenta
E.
Genta
a
examnaton
as
are
no
Fg.
structures
was
4.1.
most
by
beng
met.
notced
Wc
key
o
to
te
aed
to
11.
s
brougt
n
no
Spongy
B.
Laboscrota
C.
Coaca
D.
Urogenta
E.
Genta
n
ts
to
te
pyscan
examnaton.
oter
Fg.
structures
A.
25-year-od
tum
mmunzatons
resutng
A
3-mont
Pysca
sows
4.1.
most
cnca
are
up
key
s
Deveopmenta
to
date.
abnormaty
Wc
by
o
te
except
or
abnor-
ods
membrane
tuberce
12.
lud-ed
mass
s
te
B.
Rectocee
C.
Cystocee
D.
Hydrocee
E.
Hypospadas
54-year-od
eeng
rgt
compared
sot
and
accumuaton
o
o
o
s
te
tests
key
(Fg.
sde
to
wt
te
o
tests.
lud
n
te
Wc
scro-
et.
A
On
and
CT
a
scan
cavty
o
a
rgt.
te
te
nontender
te
4.2).
on
te
o
o-
dagnoss?
comes
bood
pyscan
scrotum
to
man
story
te
anteror
most
Varcocee
sows
arger
et
vagnas
A.
sstent
s
to
enarged
scrotum
abnorma
tunca
3-week
comes
an
examnaton
te
A
o
remarkaby
owng
presentaton?
man
story
papaton,
te
oowng
deveoped
s
sows
Pysca
uretra
ods
4.
s
abnormates
currenty
uretra
n
artery
pyscan
maposton?
oow-up
noted
embryoogc
may,
He
te
ods
and
Fig.
artery
ods
boy
•
den-
tuberce
or
deect
to
ods
6-mont-od
te
used
s
te
vagnas
C.
mestones
ts
ureter
correct
artery
epgastrc
te
sown
embryoogca
resutng
moter
as
4.
artery
to
mestones
crcumcson,
Fig.
ven
brougt
crcumcson.
mapostoned
oowng
A
s
deveopmenta
Durng
be
or
boy
ac
s
to
•
procedure?
epgastrc
Anteror
15-day-od
perormed
system.
nsertng
ectopc
andmarks
E.
A
orce
o
durng te
neror
et
uretera
D.
moter
10.
a
pevcaycea
dagnoss
ureteroureterostomy
Wc
et
n
to
s
generazed
te
pyscan
urne.
He
tredness
because
aso
and
as
2.2
kg
a
o
per-
(5
b)
CHAPTER
wegt
bood
ence
oss.
ces.
o
a
Wc
te
anayss
scan
mass
o
wt
Varcocee
B.
Rectocee
C.
Cystocee
D.
Hydrocee
ts
sows
te
te
presence
abdomen
extendng
oowng
A.
E.
nto
condtons
sows
te
s
et
most
o
te
and
197
Perineum
red
pres-
rena
ven.
key
to
be
dsease?
Hypospadas
A
30-year-od
o
nabty
ke
a
bag
man
to
examnaton
o
sows
asked
bear
Fg.
most
4.3.
down.
Varcocee
B.
Rectocee
C.
Cystocee
D.
Hydrocee
et
An
o
sde
x-ray
pyscan
past
ts
Pysca
scrotum
rgt
wen
wt
because
years.
te
he
sde
te
ees
o
te
patent
contrast
oowng
wt
2
o
ndng
te
assocated
te
te
papaton.
smar
Wc
key
A.
E.
a
on
to
or
te
worms
sows
to
comes
conceve
scrotum
n
14.
CT
rena
o
assocated
13.
Urne
A
Pelvis
4
s
condtons
radograpc
s
sown
w
be
pcture?
Hypospadas
A
16-year-od
department
abdomna
woman
because
pan
s
o
and
brougt
te
ever.
to
te
sudden
emergency
onset
Laboratory
o
studes
severe
sow
a
3
eukocyte
nancy
n
count
test.
te
o
Copocentess
pevs
sows
conrmng
ectopc
pregnancy.
was
neede
te
20,000/mm
te
Wc
most
key
and
te
a
postve
presence
dagnoss
o
te
o
a
troug
bood
ruptured
oowng
nserted
o
preg-
structures
to
perorm •
te
A.
pernea
B.
posteror
uterne
C.
body
nto
part
o
te
te
vescouterne
vagna
ornx
te
recto-
experencng
part
vagna
o
te
vagna
ornx
nto
te
endocer-
E.
pernea
nto
te
membrane
greater
nto
vestbuar
te
gand
externa
uretra
spncter
46-year-od
o
1-mont
vc
regon
wom
troug
wen
tocee
story
were
Pysca
o
vagna
asked
made.
responsbe
a
devered
er
s
comes
or
va
bear
A.
Compromsed
B.
Weakened
o
o
Se
a
pyscan
eavness
as
5
vagna
wc
down.
te
A
because
n
te
cdren,
notceabe
openng,
to
te
norma
sows
Wc
ts
to
eeng
constpaton.
examnaton
se
s
woman
and
o
ncreases
dagnoss
s
o
deveres.
buge
oowng
pe-
a
tssue
n
o
most
sze
rec-
key
condton?
rectovagna
superca
and
16.
Parayzed
Loose
E.
septum
deep
Ruptured
scocavernosus
sacrospnous
68-year-od
nabty
to
prostate
Anteror
B.
Medan
C.
Latera
D.
Posteror
E.
externa
man
pass
and
noctura
or
te
past
6
Latera
u
o
pernea
uretra
comes
urne
musce
gament
or
to
spncter
te
te
pyscan
past
2
days.
because
He
as
o
an
been
and
sweng
o
antbotcs
no
efect.
mass
no
most
key
be
ypertroped?
posteror
te
was
ctors
Pysca
arsng
rom
node
o
to
ces
s
ts
te
Superca
B.
Externa
and
ac
C.
Para-aortc
D.
Presacra
E.
Axary
a
o
deep
ymp
ymp
ymp
nodes
nodes
but
a
course
as
ad
tender
studes
aong
te
A
t
rm,
aggressve
o
ave
nguna
nodes
days.
aspraton
excson
to
nodes
sows
an
Wc
key
14
Laboratory
neede
wde
made.
cancer
A.
past
prescrbed,
ctors.
Fne
suggestve
s
te
examnaton
perorm
cearance
or
prevousy
abnormates.
decson
transverse
w
A 19-year-od woman comes to te pyscan wt pan-
nodes
D.
A
17.
te
A.
presence
musces
C.
urnaton
and rreguarty o te uvua. Wc o te oowng obes
o
orce
panu
monts. Utrasonograpy o te pevs sows enargement
cana
D.
A
4.
space
nto
pouc
anteror
vca
15.
Fig.
copocentess?
sow
sows
te
sarcoma.
A
wt
ymp
oowng
ymp
draned
ymp
to
rst?
nodes
198
C H A P T E R
18.
A
4
Pelvis
45-year-od
man
to
te
emergency
depart-
22.
A
24-year-od
ng
ng
expedton.
ower
A
too
Pysca
mbs
o
muc
te
o
orce
s
be
and
sacra
cateter
ruptured. Wc
key
examnaton
bateray
dagnoss
nserton
used,
o
te
traumatzed
a
cord
to
njury
reeve
and
te
made.
urnary
structures
o
bad-
Durng
uretra
3
progress.
retenton,
woud
was
s
owng
most
and
te
Antelexed
Retrolexed
Antelexed
B.
Externa
spncter
D.
Retrolexed
C.
Corpus
E.
In
D.
Iscocavernosus
E.
Openng
o
22-year-od
te
woman
ntermttent
or
o
te
10
monts.
any
o
te
bodes
s
made.
Dorsa
and
root
he
sensory
D.
he
preaortc
S2,
tcuar
S3,
Dorsa
o
wom
tear
te
rom
dagnoss
spna
o
5
eres.
a
to
o
o
te
n
ts
cord
a
pan
9
out
dag-
on
ce
coumn
o
on
spna
at
te
nerves
ste
o
to
contro
s
er
to
tear
or
ts
B.
Iococcygeus
C.
Coccygeus
D.
Pubovescocervca
E.
Externa
Se
s
Her
nto
te
Broad
tes-
deectve
a
Se
and
A
te
o
a
te
rst
C.
Para-aortc
D.
Node
E.
Interna
presentaton?
artery
Questions
25.
asca
spncter
obese
woman
A
spne
nerves
was
sows
tenderness
te
comes
n
mb. T appng
gament
just
reproduces
most
pyscan
o
n
te
te
because
Se
recenty
vagna
uterne
ymen,
ts
dev-
proapse
wc
ncreases
gaments
s
most
condton?
uterus
gament
uterus
comes
o
to
3
and
monts.
examnaton
spread
ymp
pyscan
to
rom
a
as
sows
never
boat-
(10
ad
pevc
b)
any
mass.
batera
nodes.
most
dseased
nguna
kg
sows
ymp
woud
because
and
4.5
a
pevs
te
te
pan
as
Se
and
nodes
deep
te
abdomna
atgued
ymp
and
a
oowng
abdomen
wt
ac
Wc
key
be
te
ovares?
ymp
nodes
nodes
nodes
at
te
eve
o
te
rena
vesses
Coquet
ac
and
nodes
accompanyng
te
uterne
ven
to
te
pyscan
25–49
29-year-od
tes
ospta
metus
body.
ac
uterus?
musce
wc
nguna
receve
o
examnaton
te
masses
Superca
most
o
ast
te
oowng
Externa
musce
uretra
ower
o
B.
s worsened by standng and aevated by sttng. Pysca
rgt
te
sows
(cardna)
Pysca
A.
te
te
a
o-
gament
o
ees
te
IV
Wc
te
mesometrum
story
se
n
scan
to
because o pan n er eg or te past 3 monts. he pan
o
says
oss
ovaran
avods
tus,
CT
and
woman
6-mont
cdren.
grade
to
sows
o
te
dscomort.
te
te
resutng
gament
60-year-od
ng.
because
musce
40-year-od
A
o
pregnancy
a
o
uncompcated
o
o
E.
cord
va
eve
cervca
anus).
deectve
patent’s
n
te
Wc
Latera
cdren,
ast
resuted
to
stranng.
D.
or
to
pevc
examnaton
gament
and
Wc
poston
comes
a
brted
Round
movements
ve
were
Pysca
C.
S3,
T10–L2
as
o
Inundbuopevc
pyscan
embarrassed
and
extendng
structures
responsbe
te
vagnay.
devery
Pubococcygeus
eves
bowe
settngs.
devered
orceps
(pernea
spna
partcuary
soca
were
a
o
comes
woman
story
Mesosapnx
te
vagna
Dougas
B.
o
uterus.
hs
aure
retroverted
o
A.
ce
T5–T9
orgn
and
neura
patent?
spna
te
to
anteverted
key
24.
o
wom
extendng
-
S2,
pregnancy.
due
a
anteverted
nterstta
eves
o
or
screen-
as ad dicuty passng urne. Se as ve cdren, a
requency
Durng
experences
ocaton
because
5-mont
rst
secton
examnaton
and
pouc
pyscan
prevous
retroverted
and
55-year-od
wegt
A.
A
vares
sensaton
o
ganga
ganga
nto
oowng
key
urnary
S4
woman
Se
out
requred
and
ganga
root
nabty
year.
gong
pyscan
arteres
55-year-od
an
A
te
ntermedoatera
eves
past
s
pan
te
and
A
o
S4
C.
o
or
duct
trggers.
woman
ganga
he
A
pan
badder.
Wat
B.
E.
he
te
urnary
responsbe
to
pan
partcuar
cystograpy,
cystts
A.
3
23.
comes
suprapubc
wtout
nostc
ng
past
musce
bubouretra
te
te
Her
er
cesarean
common
and
C.
durng
a
to
screenng.
retrolexed
most
A.
B.
cavernosus
n
Bmanua
musce
A
ocaton?
s
pror,
ended
retroverted
comes
cancer
years
pregnancy
Bubospongosus
uretra
ts
te
s
parayss
urnary
membranous
oowng
at
sows
dstended
woman
cervca
A.
o
21.
brougt
routne
der.
20.
s
Perineum
ment ater ang 4.5 m (15 t) durng a mountan cmb-
te
19.
and
key
A.
Femora
branc
B.
Femora
nerve
C.
Ioypogastrc
D.
Ionguna
E.
Latera
pan.
afected
o
over
meda
te
te
te
to
te
te
Wc
n
ts
atera
o
nerve
cutaneous
nerve
te
tg
aspect
anteror
o
superor
oowng
patent?
gentoemora
nerve
emora
anteroatera
nerve
vagna
key
durng
extends
hree
an
a
rom
damaged
weeks’
was
te
te
epsodes
te
durng
te
rng
s
to
“song
epsotomy
Durng
pernea
te
er
structures
woman
under-
was
eadng
most
to
ts
presentaton?
A.
Superca
B.
Externa
and
ana
deep
transverse
spncter
C.
Iscocavernosus
D.
Sacrospnous
E.
Externa
musce
gament
uretra
spncter
pernea
to
dabe-
perormed
te
devery,
o
oowng
comes
wt
examnaton.
epsotomy
ymen
ater
gestaton
dagnosed
antenata
mdne
requent
o
39
Se
monts
Wc
at
abor.
devery,
experences
wear.”
woman
n
musces
CHAPTER
26.
A
41-year-od
mutpe
monts.
durng
5
Se
deect
tat
o
o
s
uretra.
key
o
Wc
been
resutng
27.
n
ts
T endnous
B.
Coccygeus
C.
T endnous
D.
Obturator
E.
Rectovagna
gery,
o
o
pevc
ts
28.
nodes.
Mucosa
sows
atered
badder
and
as
te
E.
30.
most
deveres
te
ony
o
te
most
porton
past
sacra,
are
Bopsy
at
te
key
o
ana
ne
rectum
50-year-od
a
Enterocee
Urnary
E.
Proapsed
parts
prmary
sows
o
te
31.
gas-
afected
by
tra.
eakage
o
Iscoana
B.
Pernea
C.
Retropubc
D.
Superca
E.
Deep
by
says
tat
3
ton
se
sows
vestbue.
te
musce
s
ten
he
spaces
t
to
opera-
te
n
rectus
a
posteror
vsuaze
wa,
was
32.
and
s
to
pan
te
MRI
to
cet
because
started
a
bues
Incson
a
breast
ew
te
a
emergency
severe,
ours
smar
days.
ago.
s
ymen
epsodes
and
observed
sows
depart-
deep
Her
Pysca
deveopment
membrane
o
o
ew
experenced
astng
norma
a
pevc
moter
or
te
examna-
pubc
ar.
across
te
ematocopos.
33.
woman
says
te
4.4).
to
A
reduce
te
Cuna
D.
Pudenda
E.
Broad
sympatetc
te
o
s
o
ony
er
and
s
s
pe-
nega-
te
most
pyscan
epsodes
sessons.
due
to
because
o
urnary
Se
te
ad
sgncant
norma
te
er
presence
nterna
oowng
o
men-
sows
spnc-
musces
s
to
te
pan
aways
boated
mass
bopsy
o
te
pan
te
past
tat
a
te
ds-
mass.
organ
conrms
ts
because
te
sows
et-sded
n
oowng
rom
or
and
examnaton
papabe
a
pyscan
astng
te
An
at
te
presence
structures
can
magnancy?
gament
trunk
nerve
gament
ater
man
ang
s
brougt
on
to
examnaton
dstress
An
aong
pens,
te
nerves
45-year-od
regon.
a
rozen
C.
Pysca
s
Wc
Inundbuopevc
tra,
MRI
oowng
te
recta
descent
wc
Cystouretroscopy
a
o
sows
Pevc
u
An
causng
Pysca
B.
ment
were
comes
wt
pevs
magnancy.
gated
ago
wt
se
worse.
abdomen
(Fg.
to
abdomna
A.
A
cm
rng
or
a
nternus
Se
gettng
o
arrow
o
te
s
year
Wc
et-sded
monts.
tended
Retzus)
to
du
5
neck?
brougt
parents
a
a
2
rom
dysunctona?
42-year-od
to
ure-
dssected
A
o
space
gr
key
Iococcygeus
te
a
because
pevs
septum
repeated
dysmenorrea.
Coccygeus
to
be
(o
and
E.
treat-
made
te
comes
o
ypermobty
D.
s
away
maneuver.
wc
Prorms
space
vagna
brods
C.
medca
deep
sows
o
vens
pyscan
ymena
wegttng
one
ncontnence
nto
dssected
oowng
pernea
as
removed
Pubococcygeus
Durng
made
er
Obturator
spttng
anteror
badder
space
wc
monts
durng
B.
body
er
bugng
s
sympyss.
neck,
pernea
dscomort
and
te
passed
te
Wc
story
A.
decson
n
te
rectovagna
woman
because
3
uterne
to
pan
ater
te
monts.
past
stress
o
unctonaty.
most
ossa
13-year-od
ment
A
Houston)
pyscan
te
estye
ncson
and
urnar y
A.
te
or
efectve.
sympyss
te
to
coposuspenson.
pubc
badder
ter
(o
artery
uterus
4-mont
uretra
urnar y
wc
asca
Wc
expose
a
mutpe
vave
cremasterc
ncontnence
34-year-od
o
cana
neror
comes
wt
mdne
te
pubc
A
te
examnaton
masses.
D.
nguna
gand
dagnoss?
C.
cana
te
eakage
been
Burc
abdomns
urnar y
or
not
ow
vsuaze
at
urne
ago
as
a
ana
any
rom
Vasava
and
superca
wt
comes
towards
tear
Cystocee
cana
ana
dagnosed
years
ton,
o
woman
worsenng
per orm
o
a
Uretrocee
specmen
oowng
durng
sows
or
wa
B.
or
Her
Pysca
vagna
A.
sent
assoc-
pregnancy
erna
ocazed
monts.
orraga
zone
Pectnate
ment
6
poory
car-
ac,
key
ymen
woman
sur-
and
most
(Barton)
ectopc
beedng
or
nterna
removed
an
nguna
Durng
rectum
Proxma
1.5
du,
key
tract.
vestbuar
rom
Iatrogenc
vs
coectomy
greater
55-year-od
o
asca
groups
was
E.
was
A
te
a
s
199
Perineum
beedng
cancer.
undergoes
ces
D.
A
corrected.
uterus
Dsta
ast
Indrect
an
examnaton.
tract
C.
A
Imperorate
D.
cancer?
Se
29.
C.
tve
rom
Wc
B.
te
vagnay.
mutpe
gastrontestna
node
cancerous
Cutaneous
o
Cyst
and
o
condtons
and
dagnoss?
Beedng
septum
woman
oowng
ts
B.
nternus
dsta
te
A.
evdent
A.
A
o
wt
as
str uctures
te
ated
presentaton?
nodes
trontestna
durng
arc
stopatoogc
ymp
oowng
Wc
2
occur
Se
made,
surgcay
urnar y
evator
ymp
postve
te
s
wt
past
many
cougng.
perneum
te
te
devered
be
o
te
ymp
nguna
to
arc
58-year-od
cnoma
o
pyscan
or
epsodes
we
were
te
o
njured
A.
A
o
neck
te
ncontnence
scedued
te
to
eakage
te
or
wom
stress
Utrasonograpy
poston
comes
urne
actvty
a
dagnoss
te
o
says
pysca
cdren,
A
woman
epsodes
Pelvis
4
wt
MRI
wt
sows
pronounced
o
a
te
pevs
rupture
resutng
n
to
te
o
te
emergency
crossbar
a
man
n
sweng
sows
te
a
o
s
depart-
bcyce.
obvous
n
torn
deep
extravasaton
o
te
pan-
pernea
spongy
(Buck)
urne
ure-
asca
and
o
bood
200
C H A P T E R
4
Pelvis
and
Perineum
He
eard
resuted.
a
ematoma.
o
te
ca.
Wc
urne
te
Iscoana
B.
Rectovesca
C.
Deep
D.
Retropubc
a
An
tate
a
and
Fig.
cae
te
surroundng
most
wc
key
urne
as
Wc
o
boundares
te
or
oowng
te
space
to
as-
Camper
asca
and
B.
Pernea
membrane
and
asca
externa
pernea
asca
o
Gaaudet
MRI
te
superor
asca
o
te
38.
spncter
spncter
and
te
apex
o
ng
a
A
sows
cateter
CT
scan
ower
most
s
s
oss
ana
nserted
sows
umbar
key
o
to
mutpe
spne.
brougt
1.5
mountan-cmbng
naton
(5
to
t)
treat
and
er
o
Pysca
perana
o
te
er
ts
Wc
exam-
nerves
patent’s
msed
Externa
was
C.
Umbca
D.
Interna
E.
Superca
urnary
A
C.
Sacra
spancnc
comort
D.
Lumbar
nodes.
te
perormed
pertonea
troug
te
te
lud.
te
lud?
cavty
Rectouterne
B.
Pararecta
Paravesca
D.
Uterovesca
E.
Superca
36-year-od
e
wt
struck
presence
o
te
must
o
asctes
A
neede
vagna
te
neede
o
A
an
CT
superca
s
ornx
enter
n
to
dran
sow
dran
Wc
a
panu,
s
erect
space
brougt
swoen
pens
to
te
pens.
aganst
emergency
Durng
s
depart-
ntercourse
partner’s
pevs.
40.
prostate
and
pros-
magnancy.
prostatectomy.
ncontnence
secondary
spncter.
key
te
he
B.
Dsta
vuva
40
te
a
years.
10
njured
Wc
durng
o
te
pyscan
story
He
years
was
o
dagnosed
pror.
sows
arteres
Dupex
artera
s
because
most
o
smokng
1
wt
utra-
nsuicency.
key
compro-
condton?
deep
o
crcumlex
a
ana
pevs
nodes
cana
rom
ymp
te
te
ste
body
ony
oowng
o
te
o
te
sacra,
node
stopatoogc
ces
mass
no
te
pevc
prmary
sows
a
nguna
ymp
nterna
groups
nguna
organs
te
ds-
abnormates.
wt
are
examnaton.
n
to
pevc
superca
sow
a
o
examnaton
papabe
sows
comes
story
Pysca
wt
and
te
woman
2-mont
pan.
nguna
and
surgcay
he
bopses
ymp
was
node
ac,
nodes.
more
tan
tumor?
uterus
rectum
C.
One
D.
Proxma
E.
Ana
o
du
o
or
o
to
as
postmenopausa
cancerous
A.
A
and
Lymp
removed
paced
to
pouc
s
he
scan
(lud)
space
pernea
enarged
pudenda
abdomen
spread.
pouc
man
an
radca
because
noctura,
ac
and
examna-
ossa
C.
ment
utrasound
conrmed.
part
space
An
because
key
A.
A
te
s
posteror
Wc
osptazed
abdomen.
and
a
uretra
pens
ts
because
dstended
spancnc
Pudenda
s
as-
nto
epgastrc
58-year-od
pyscan
ton
sows
a
most
He
ast
te
to
Ineror
39.
s
pyscan
dysura,
sows
comes
oowng
B.
spancnc
panu
te
A.
Pevc
enarged,
36.
o
eadng
B.
woman
te
o
A
ypogastrc
34-year-od
or
er
retenton.
and
day
sonograpy
dur-
numbness.
pevs
oowng
to
back
a
man
dysuncton.
Superor
A
pace
gutea
50-year-od
A.
E.
key
gutea
ypercoesteroema
emergency
er
urnary
ractures
eadng
te
onto
expedton.
tone
Wc
traumatzed
m
symptoms?
35.
A
erecte
te
pack
ang
te
urnary
was
spancnc
he
woman
nerves
Pudenda
E.
ater
as
C.
Ineror
34-year-od
pevs
externa
spancnc
Superor
department
e
te
Pevc
E.
A
to
wt
undergoes
Sacra
D.
and
uretra
o
bopsy
B.
Coes asca and externa pernea asca o Gaaudet
uretra
most
rupture
(Buck)
cet
te
A.
Pernea
prostate
34.
oowng
D.
externa
o
e
o
C.
externa
pene
operaton?
Scarpa
membrane
te
preputa
extravasated?
comes
story
neede
parayss
te
nto
extravasated?
A.
s
deep
cm
sows
4.4
area.
provde
exporaton
space
man
Postoperatvey,
nto
detumescence
3
pouc
pernea
Subsequenty,
•
a
space
2-mont
urgency.
ave
rapd
sow
and
oowng
pernea
68-year-od
o
and
ossa
Superca
A
uretra
woud
A.
E.
surgca
spongy
o
sound
examnatons
Durng
dsta
wc
37.
poppng
Pysca
or
bot
cana
34-year-od
pevc
urnaton,
o
er
ovares
rectum
superor
woman
and
and
to
te
comes
abdomna
pectnate
to
te
pan,
constpaton.
A
ne
pyscan
boatng,
CT
scan
o
because
ncreased
er
pevs
CHAPTER
sows
41.
an
ovaran
ymp
nodes
cerous
ces?
Superca
Externa
C.
Lumbar/atera
D.
Deep
E.
Interna
ter
Presacra
E.
Axary
to
past
vagna.
o
A
2
rst
bopsy
ymp
ts
weeks.
o
ce
nodes
wt
te
nodue
Posteror
Isca
D.
Posteror
E.
Coccyx
Cardna
Uterosacra
Levator
E.
Medan
to
46.
se
38
o
er
A
key
er
nerve
papated
a
man
beedng
te
as
and
to
at
pyscan
anus
or
aso
o
ymp
D.
Obturator
E.
Lumbosacra
A
32-year-od
panu
ntercourse.
y
as
and
sows
te
transmsson
o
A.
Sacra
B.
Superor
C.
Pevc
D.
Pudenda
E.
Ionguna
A
o
vagna
ton
week.
o
mtted
naton
ng
s
women
mass
responsbe
rom
ts
or
te
recenty
regon?
te
vagna.
dseases
er
s
te
or
te
pyscan
past
oneymoon.
presence
anatomca
more
to
abnormates.
te
necton
best
are
urnaton
rom
no
and
comes
o
made.
A
Fbroma
ss
trogram
Wc
o
or
to
te
te
oow-
act
tese
tat
knds
woud
A.
vagna
contans
B.
he
prostate
C.
he
uretra
ess
bactera
lora
tan
te
pens
produces
s
muc
antbactera
sorter
n
prostatc
women
luds
te
as
extremey
cronc
te
past
anema
mont,
abdomna
dented.
pan.
Wc
te
wa
on
a
o
ts
pyscan
very
artery?
n
studes
because
conservatve
attempted
key
sexua
or
actvtes.
dagnoss
o
te
ts
n
o
examna-
sexuay
o
o
am-
contractons
manua
Wc
pernea
s
brougt
nvoved
s
n
90/80
and
trans-
oowng
patent?
te
pudenda
te
an
to
a
te
mm
Hg
sows
ntact
o
te
ntay
superor
and
and
grde.
Between
Camper
D.
Between
Coes’
here
o
contrast
te
pevc
E.
Between
Buck
asca
nto
asca.
te
Were
externa
and
and
and
and
Scarpa
te
asca
Gaaudet
te
uretra
dapragm
membrane
asca
s
extravasate?
te
asca
102/
cystoure-
Gaaudet
C.
s
eccymo-
retrograde
te
depart-
coson.
puse
mutpe
superca
aspect
pernea
vece
pevc
extravasaton
beneat
emergency
motor
A
musce
te
body
eccymoss.
contrast
Between
te
nvountary
examnaton
sows
Between
gaton
uterus
man
pevs,
spncter
B.
he
s
compresson
te
peruretra
abdomna
o
nectons?
A.
te
sows
o
In
engagng
negatve.
pressure
Pysca
o
o
beng
bood
mn.
dpstck
dagnoss
o
46-year-od
ater
to
rom
Laboratory
nerve
E.
aso
urne
men
Se
a
cana
Dsrupton
A
s
sows
most
Endometross
exam-
A
tan
days.
te
D.
Pysca
ntrtes.
expanaton
susceptbe
3
because
s
durng
begun
are
C.
Hs
upon
tract
48.
woman
key
nodes
muscuature
(Acock)
ment
sows
te
sensaton
s
ypogastrc
returned
eukocytoss
urnary
pan
bues
nerves
spancnc
burnng
recenty
tender,
spancnc
26-year-od
o
a
oowng
Se
n
artery
comes
Se
examnaton
Pudenda
o
vagna.
tan
trunk
woman
B.
Wc
te
ur-
nerve
peranay.
examnaton
mont.
te
te
more
sgncant
njury
artery
Vagnsmus
1
uter.
resuted
uterne
ac
condtons
past
te
ac
A.
te
o
o
ascae
suppements.
Interna
Pysca
or
ron
atrogenc
epsode
constpaton
wa
s
sows
past
probem?
experenced
He says tat e s generay n good eat, except or an
o
anteror
ave
Interna
andmark
past
proapse
structures
eomyoma
C.
because
te
use
surgery,
Pysca
te
s
or
wc
B.
spne
comes
pan
a
orce
gament
s
te
55-year-od
umbca
bony
spne
ac
examnaton
gament
Ureter
tuberosty
superor
bactera
because
an
perods,
potenta
47.
ac
sows
to
pyscan
vagna
vescocervca
A.
nerve?
neror
te
o te oowng adjacent structures s most susceptbe to
me-
bock
Wc
as
to
devery.
dabetes
approac.
be
comes
scedued
pudenda
transvagna
most
gestaton
er
pregnancy,
uncontroed.
a
weeks’
or
ts
and
ysterectomy
despte
at
te
resstant
A 40-year-od woman comes to te pyscan to undergo
a
nduced
te
201
Perineum
gament
D.
spne
C.
Pubovesca
B.
Durng
be
woud
B.
A.
to
to
and
mucus
luds
Pysca
cystogram
eadng
C.
key
urne.
troug
oowng
s
most
comes
troug
te
s
area?
woman
A
eson
aortc
woman
usng
o
produces
produce
passng
rng.
gand
gands
extendng
badder
eavy
course
ts
dicuty
mass
carcnoma
nguna
to
been
52-year-od
deectve
Pysca
uceratng
squamous
rom
pyscan
ymp
Isca
recta
te
te
ymp
A.
A
or
to
ac
te
bock
comes
erytematous,
te
D.
structure
44.
are
Lumbar/atera
as
an
er
C.
perormed
43.
o
Superca
pyscan
A
parauretra
semna
ymena
beedng
dranage
34-year-od
he
Wc
dagnoss
Wc
ymp
he
E.
nary
Interna
tus
aortc
sows
A
D.
o
woman
vestbue
Durng
can-
ac
B.
te
by
a
A.
A
oowng
nguna
vagna
perormed.
made.
te
nvaded
nguna
examnaton
te
o
become
ac
62-year-od
n
Wc
key
45.
B.
A
tumor.
most
A.
paness
42.
w
Pelvis
4
dartos
asca
ayer
asca
o
202
C H A P T E R
49.
A
a
4
Pelvis
45-year-od
4-mont
vagna
and
woman
story
uness.
o
In
Perineum
comes
ower
te
to
te
back
ast
pyscan
pan
mont
and
se
a
as
because
o
D.
Sacra
sensaton
o
E.
Dorsa
notced
di-
53.
ment
cervx
naton
te
eve
o
te
vagna
orce.
An
abdomna
2
ts
oowng
procedure,
te
promontory
vagna
oowng gaments provdes te natura anatomca sup-
C.
Prostatc
port
D.
Urnary
E.
Ureter
tat
ts
procedure
A.
Uterosacra
B.
Round
C.
Broad
D.
Arcus
E.
Levator
gament
o
tres
te
to
gaments.
Wc
sup-
o
reestabs?
uterus
54.
gament
A
tendneus
ascae
repar.
pevs
an
ower
Questions
A
1-mont
patent
A
man
story
as
monts.
9.1
cancer
(20
s
s
nodes
soud
B.
Externa
C.
Superca
D.
Deep
E.
Gutea
s
ac
A
CT
o
te
durng
urgency.
te
eves
and
scan
because
over
g
o
metastass
Wc
removed
and
oss
sow
perormed
made.
and
pyscan
wegt
ympatc
be
Interna
b)
te
noctura,
studes
perormed.
A.
to
dysura,
bopsy
regona
tomy
A
o
kg
transuretra
sows
comes
Laboratory
prostate
a
past
o
te
a
ton
he
4
an
o
D.
Pudenda
E.
Obturator
A
pan-
o
on
te
te
abdomna
ympatc
s
rgt
scrotum
most
and
key
to
Interna
B.
Externa
C.
Superca
pan
Deep
Para-aortc
nvoved
n
sows
oowng
ts
ner.
Specuum
a
attempt
to
e
ater
was
mantan
postoperatvey,
wtout
nocturna
probaby
pene
te
Pudenda
B.
Pernea
C.
Pevc
s
e
use
durng
spancnc
radca
on
mucopuruent
o
e
s
Sacra
spancnc
Lesser
spancnc
te
Wc
He
o
aso
o-
nerve
n
A
was
o
been
s
te
o-
expe-
rom
et
Pysca
o
a
erna
s
nner
examna-
et
nguna
et
s
sde
s
notced.
responsbe
or
ts
to
te
not
ave
a
te
past
stabe
sows
an
weeks.
sexua
rom
part-
cervx
examnaton
Wc
bers
because
2
nlamed
Bmanua
tenderness.
sensory
pyscan
or
o
ts
te
o-
nlamed
One
ypogastrc
24-year-od
pap
wc
o
te
sowed
rom
er
uterne
ts
Perneum
no
B.
Suprapubc
most
C.
Umbca
D.
Inguna
E.
Epgastrc
57.
cervx
areas
A.
operaton?
no
and
s
to
te
Se
pyscan
ad
abnormaty.
sows
secreton.
oowng
durng
comes
examnaton.
cervx
mucod
pan”
woman
smear
cear
te
pene
as
te
dscarge.
conveys
E.
unctonaty.
sdena.
nerves
comes
moton
D.
(Vagra)
ncapabe
cervca
spancnc
a
on
nerves
examnaton
Pevc
or
scrotum.
as
spreads
aspect
ntercourse
does
C.
nodes
prostatectomy.
sdena
sexua
says
tumescence.
damaged
A.
a
paced
se
Pudenda
metastass?
pyscan
tat
Superor
ton
te
e
wc
or
eectve
gentoemora
sexua
B.
pror
to
weeks
papaton
relex
woman
durng
says
tne
comes
an
nerve
regona
umbar
man
te
on
pyscan
ater
structure?
nguna
or
2
meda
to
o
A.
ymp
te
nerve
An
56.
examnaton
Preoperatvey,
erecton
te
eson.
nguna
50-year-od
mont
o
examnaton
testcuar
examnaton
nod-
ac
E.
an
CT
Wc
be
ntrnsc
te
ruptured?
nerve
Se
wt
ac
D.
ow-up
Utrasonograpy
an
pevc
spread.
A.
A
tests.
sows
papabe
and
o
nerve
branc
19-year-od
owng
nontender,
past
oowng
Ioypogastrc
Pysca
a
te
C.
ymp
sows
sows
to
mont
te
cremasterc
o
Ionguna
nguna
examnaton
key
sensaton
tenderness
Genta
a
1
sometmes
B.
wt
comes
te
to
A.
prostatectomy?
pyscan
and
absent
o
te
or
abdomen
nguna
to
man
burnng
sows
most
Wc
relex?
sacra
comes
s
urne.
exam-
scrotum
uretra
prostatec-
oowng
extravasated
boy’s
badder
says
a
te
depart-
MRI
uretra
abdomen
Wc
55.
man
and
o
bcyce.
regon beow te mdpont o te nguna gament and
PSA.
dagnoss
and
o
ac
22-year-od
He
ess enargement o te rgt gron or te past 3 monts.
ue
52.
tg
50–74
68-year-od
edema
examnaton,
rencng
s
uretra
35-year-od
ow-up
crasng
structures
Spongy
by
anatomca
te
Preprostatc
provded
natura
rom
B.
usuay
te
suspended
wa
A.
s
create
s
pens
severe
te
tat
to
vaut
o
ater
sows
abdomna
port
51.
days
sacrocopopexy s panned to treat ts condton. Durng
sacra
50.
nerve
A 15-year-od boy s admtted to te emergency
cuty vodng. Pysca examnaton sows descent o te
to
spancnc
a
smoot,
Durng
se
most
ees
key
pan.
a
3
rou-
years
examna-
surace
coecton
md
to
or
done
Pysca
pnk
te
a
one
wt
o
Wc
experence
a
ces
o
“reerred
procedure?
posteror
porton
o
te
tg
regon
regon
regon
regon
A 35-year-od man comes to te emergency department
ater
beng
kcked
n
te
gron
we
payng
ootba.
CHAPTER
Pysca
MRI
dranng
tests.
woud
njured
58.
Ineror
B.
Let
vena
rena
Let
neror
Let
nterna
E.
Let
ac
a
by
er
cryng
sweng
n
treated
te
to
nd
Uracus
Suspensory
Uterne
E.
Mesosapnx
a
bood
er
B.
Wa
C.
Uterne
te
te
Mesentery
o
or
se
was
papabe
mass
s
dagnosed
10
o
s
B.
Semna
Cryptorcdsm
D.
Congenta
E.
Cordee
A
te
te
surgeon
ovary
because
started
o
er
1
te
o
ast
mm
wt
ago.
Hg
puse
and
sows
te
s
A.
Uterne
B.
Cervx
s
te
cervca
os
Fundus
o
te
are
Wc
coected
o
te
te
raped
or
emergency
2
ours
DNA
oowng
depart-
ago.
and
organs
s
Hypogastrc
E.
Pevc
sows
nto
g
te
a
n
traumatc
dvng
s
o
ever.
A
porton
te
CT
te
and
be
structures
was
nerves
Pevc
spancnc
nerves
D.
Sympatetc
E.
Vagus
or
devered
br t,
t
pabe.
Pysca
pabe
was
tests
a
va
o ow - up
a
noted
n
n or m a
tat
s
exam n at on
te
e t
e xam nat o n.
vagna
s c rota
e t
tes t s
sow 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 ap ated
65.
abdomen
o
s
are
wt
ntrarec-
papated
o
grade
oowng
1
best
transmsson
a
swmmng
patent
Ater
te
coon
excsed.
C.
mote r
te
nto
he
experences
spancnc
was
te
He
program.
tender,
orce
or
because
12-step
a
Sx
as
o
deveops
sows
and
monts
key
tat
rectum
mpotence.
most
poo
mutpe
reconstructve
patent
examnaton
Sacra
s
nterna
week.
dagnoss
o
descendng
must
patent
oowng
scan
B.
by
A
organs
Bubouretra
pys c an
a
ana
cavty.
abdomna
o
septc
second
abdomna
s
E.
te
n
past
dstended
andng
Pudenda
to
te
pyscan
te
Mutpe
patorm.
te
b rougt
pa-
nerves
A.
s
te
bers
Kdneys
boy
o
ow-
made.
nerve
T ests
6 -mont-od
s
regon?
D.
A
a
te
C.
gands
preva
ceck-
a
pexus
aferent
g
eratvey
(Cowper)
te
Wc
(recta)
spancnc
ater
a
become
gands
sows
A 34-year-od man s admtted to te emergency depart-
ower
producton?
prenata
nerve
Vscera
a
respon-
er
and
wa
or
responsbe
ts
ana
D.
operaton
ructose
to
duness.
nerves
C.
traumas
Fuds
because
ago
abdomna
overappng
acooc
made.
rom
Pernea
any
mpantaton
examnaton.
s
te
Ineror
rom
to
recta
B.
o
brougt
mnutes
pacenta
o
rectum
projectng
A.
ment
beng
stng
bers
o
body,
comes
per
examnaton
postve
10
s
spouse
abdomen
abdomna
recoverng
pos-
bowe
brougt
a
er
uterus
man
bood
most
ovary
s
te
63-year-od
descrbes
os
s
tubes
uterne
emorrods
etoogy?
cervca
(aopan)
red
any
ste
o
dgta
a
key
gestaton
by
denes
te
dagnoss
o
pan
o ow ng
dsorder?
part
masses
te
A
weeks’
Se
to
Mesentery
A
te
o
203
yperpasa
started
o
Dsta
on
sow
been
D.
ta
abdo-
wc
C.
a
112/
not
most
ts
perod.
rgd
and
te
n
35
stopped.
pacenta.
s
studes
oowng
as
at
gand
department
beedng
Se
Pysca
s
respratons
a
Laboratory
woman
Utrasonograpy
currenty
ower
Se
menstrua
eukocytoss
o
nctng
emergency
ntense
our
(100.22°F),
examnaton
Wc
to
suprarena
emergency
vagna
E.
Perineum
ermaprodtsm
38-year-od
centa
nonreducbe.
woud
brougt
95/80
reported
ructose
Prostate
C.
Wat
supe-
64.
vagna
A.
Pseudoermaprodtsm
T rue
yng
years
mass
W c
B.
ups.
bowe
te
se
examnaton.
sbe
s
tenderness.
te
32-year-woman
er
was
can a .
and
dagn os s ?
A.
pan.
notced
tube
Surace
rom
te
37.9°C
test.
o
E.
ater
o
date
s
nterna
D.
ment
a
nconso-
aso
nguna
key
spontaneousy
uterus
emogobn
te
o
wen
he
moter
Pysca
ste
Over
moter
sows
and
moter
structures
wc
pressure
pregnancy
common
vomtng
he
depart-
et
most
brgt
rebound
A.
emergency
cana?
o
woman
reca
decnng
A
te
63.
pan
20/mn.
tve
te
Her
gament.
te
temperature
wt
o
tumor
gament
by
abdomna
men
rom
tube
25-year-od
to
area.
CNS
gament
department
61.
n
to
our.
oowng
D.
are
oowng
rst
te
te
to
because
past
gron
a
C.
mn,
n
62.
brougt
examnaton
te
B.
Her
s
nguna
o
Round
unabe
te
An
te
o
te
or
A.
A
o
pass
n
pudenda
te
Pysca
expect
wc
key
bood
epgastrc
moter
od.
to
Into
most
scrotum.
o
cava
gr
or
and
Wc
et
ven
1-year-od
ror
swoen
ven
D.
abe
60.
te
trombus
C.
ment
59.
a
a
coaguaton
area?
A.
A
sows
sows
vens
vens
examnaton
examnaton
Pelvis
4
te
as
postop-
Wc
njured
o
durng
operaton?
nerve
trunk
nerve
A 27-year-od woman comes to te pyscan or a oow-
up
examnaton.
eectrosurgca
T wo
excson
weeks
ago,
because
o
se
an
underwent
abnorma
pap
a
oop
smear.
204
C H A P T E R
66.
Pelvis
and
Perineum
A bopsy specmen sows an nvasve carcnoma wt pos-
postoperatvey,
tve
puse
margns.
A
CT
scan
o
te
abdomen
sows
oca
ym-
s
patc spread. Wc o te oowng ymp nodes s most
pressure
key to ave receved metastass
pevs
A.
Interna
B.
Externa
C.
Superca
D.
Deep
E.
Sacra
A
rom ts
magnancy?
gency
ac
nguna
te
nguna
o
sows
boy
s
brougt
te
so-caed
oowng
C.
Superor
o
D.
Mdde
E.
Ineror
nated
sde
o
te
troug
oowng
s
o
and
scrotum
most
te
examnaton
otoscope
scrotum
te
te
An
key
s
paced
te
(see
tests
Fg.
dagnoss
4.4).
n
sows
beneat
s
transum-
Wc
ts
no
te
o
70.
te
A
a
patent?
1-mont
man
ejacuaton.
He
C.
Cystocee
postvasectomy
D.
Hydrocee
oowng
E.
Hypospadas
A.
past
s
2
days,
38°C
mn,
e
as
bood
to
te
worsenng
pyscan
perrecta
experenced
(100.4°F),
and
comes
o
cs.
because
pan.
Hs
For
s
83/mn,
respratons
pressure
s
115/86mm/Hg.
are
Pysca
wc
s
nerves
te
t
an
vesse
crossng
descends
deat.”
te
(o
emer-
nto
te
presence
Wc
o
te
njured?
artery
Ionguna
Genta
E.
Vscera
to
te
branc
a
to
most
o
to
pan
and
uness
papaton.
s
key
made.
7
o
A
because
pan
vasectomy
sows
syndrome
aferents
pyscan
testcuar
tender
bers
Ioypogastrc
D.
o
was
Sympatetc
C.
71.
o
key
comes
pan
B.
Laboratory
as
conrmng
crce
underwent
o
16/
stape,
examnaton
te
temperature
puse
surgery,
or
artery
story
deerens,
man
room
te
pouc
vesca
41-year-od
Rectocee
story
bood
o
recta
B.
34-year-od
operatng
most
vesca
ago.
1-week
s
(98.24°F),
and
rectouterne
gament
a
36.8°C
20/mn
Utrasonograpy
te
Durng
by
s
are
artery
Varcocee
a
to
obturator
A.
A
n
“artera
arteres
cuent mass. he testes are papabe on te posteror aspect
remander
Pysca
a
Obturator
abnormates.
week.
o
taken
njured
Aberrant
atera
past
because
was
Hg.
lud
(Cooper)
B.
he
te
pyscan
s
mm
aparotomy.
A.
mass.
or
te
Se
examna-
te
scrotum
to
ree
temperature
respratons
90/80
ton sows an enarged et scrotum wt a nontender loc-
oter
et
s
pectnea
pevs
er
105/mn,
Dougas).
ac
2-year-od
swoen
67.
4
o
upon
monts
te
ductus
dagnoss
Wc
o
o
te
njured?
ductus
deerens
gentoemora
rom
T10
to
L2
A 41-year-od woman undergoes a scedued tuba ga-
3
studes
85%
sows
eukocyte
neutrops).
count
Pysca
o
15,000/mm
examnaton
(wt
sows
an
ton. T wo
days
(98.6°F),
puse
extremey tender, ndurated mass n te scoana ossa.
and
T o
o
actate
son
s
a
made
owng
68.
a
to
nerves
A.
Dorsa
B.
Superca
C.
Pernea
D.
Ineror
E.
Pudenda
A
compete
anestetze
w
nerve
most
o
te
branc
te
key
examnaton
area.
need
Wc
to
be
te
o
dec-
te
o-
anestetzed?
most
ctors
o
pernea
recta
nerve
nerve
nerve
man
1-week
story
o
s
(100.4°F),
comes
to
panu
puse
te
pyscan
deecaton.
s
90/mn,
Hs
because
o
a
72.
temperature
respratons
are
bood
te
16/
key
njured
Ascendng
C.
Descendng
D.
Superor
E.
Ineror
arge
durng
temperature
mm
Hg.
o
te
ts
are
s
37°C
18/mn,
Utrasonograpy
ematoma
Wc
branc
vesca
a
o
branc
vesca
1-mont
sows
96/80
a
er
respratons
adjacent
oowng
to
vesses
te
was
procedure?
arteres
31-year-od
a
s
artery.
B.
ton
mn, and bood pressure s 120/78 mm/Hg. Laboratory
ac
Ovaran
o
100/mn,
sows
A.
A
s
pressure
pevs
externa
nerve
40-year-od
39°C
pysca
postoperatvey,
arteres
uterne
arteres
artery
artery
woman
story
o
comes
o
papabe
Utrasonograpy
uterne
o
to
pevc
mass
te
n
te
pyscan
pan.
te
Pysca
rgt
abdomen
ower
and
because
examna-
quadrant.
pevs
sows
a
3
studes
sow
Pysca
te
ana
posteror
te
pan
69.
te
mdne
oowng
Dorsa
Superca
nerve
C.
Pernea
D.
Ineror
E.
Pudenda
an
o
by
o
o
eve
s
ts
te
o
20,000/mm
peroraton
te
openng
te
branc
count
sows
eve
nerves
experenced
B.
wt
o
most
ana
te
key
patent
o
vaves.
pus
ana
te
partay
o
aton.
Anoscopc
dranng
vaves.
responsbe
upon
wa
.
at
tomy
te
Wc
or
o
te
deecaton?
ctors
o
pernea
nerve
recta
nerve
73.
nerve
or
an
undergoes
nguna
a
tenson-ree
erna
repar.
vagna
T wo
days
dagnoss
perormed
o
njury
te
wen
te
Uterne
artery
B.
Vagna
artery
C.
Ureter
D.
Interna
E.
Pudenda
A
pyscan
sows
s
o
a
wt
posteror
teratoma
and
te
s
vesses
sound
made.
ovaran
structures
ovaran
pudenda
s
An
vesses
most
are
are
attenu-
ovarec-
gated.
key
at
rsk
gated?
artery
nerve
23-year-od
wc
mass
oowng
A.
te
woman
procedure
ecogenc
A
s
Wc
nerve
35-year-od
tape
at
sows
A.
A
eukocyte
examnaton
cana
examnaton
o
a
woman
because
exacerbated
tenderness
at
o
on
over
30
a
weeks’
2-week
wakng.
te
pubc
gestaton
story
o
Pysca
sympyss.
comes
pevc
to
pan
examnaton
An
x-ray
o
CHAPTER
te pevs sows a 20 mm dastass o te pubc sympyss.
Utrasonograpy
A dagnoss o perpartum dastass o te pubc sympyss
ypoecoc
s
tomy
made.
reaxn
jont
he
s
pubc
most
T ransverse
B.
Interspnous
C.
T rue
D.
Dagona
E.
Obque
cs
o
ormone
separaton
Wc
reman
o
o
te
te
caed
sacroac
oowng
s
pevc
dstance
dameter
conjugate
78.
woman
magnancy .
atera
undergoes
Durng
pevc
wa
te
are
an
ovarectomy
procedure,
aso
te
removed.
or
an
Four
Deep
Externa
C.
Interna
D.
Lumbar
E.
Superca
te
days
past
ua
o
te
nnermost
sows
o
a
te
aspect
o
te
sensory
dect
n
oowng
nerves
was
tg.
te
Pysca
dsta
most
exam-
meda
key
tg.
njured?
coatera
C.
Ioypogastrc
A.
Externa
D.
Obturator
B.
Ineror
E.
Lumbosacra
man
Preoperatvey,
an
attempt
mont
pene
e
to
undergoes
was
paced
mantan
s
postoperatvey,
erecton
He
aso
te
ce
denes
bodes
damaged
wtout
durng
te
Sacra
parasympatetc
sympatetc
C.
Ineror
A
to
te
prevous
to
pregnancy
gestatona
Laboratory
eves.
Se
s
te
oowng
patent
rsk
o
requres
B.
Interspnous
C.
T rue
D.
Dagona
E.
Obque
nerve
tat
a
n
sow
gestaton
examnaton.
cesarean
er
Se
a
s
cesarean
cesarean
was
most
due
dagnosed
pregnancy.
bood
secton
dsproporton.
te
Her
secton
prevous
uncontroed
or
comes
key
sugar
due
Wc
reason
o
wc
to
examnaton
s
pyscan
sows
a
ndstngusabe
because
n
s
te
pa-
tests.
most
o
bman-
sows
a
dmensons
s
perormed.
key
gestaton
cervx
s
arrested
vagna
s
made
to
te
structures
uy
as
orce.
uretra
superca
D.
Rgt
scocavernosus
E.
Pernea
A
provdes
te
In
goes
nto
dated,
ead
an
but
as
attempt
to
to
te
na
seconds.
to
ne
Eac
s
descrbes
D.
uy
he
s
ts
Injecton
Injecton
pernea
musce
woman
nerve
near
te
more
wt
sows
o
te
eta
pan
Wc
o
brougt
abdom-
tan
te
strong
uter-
abdomen.
ree.
te
A
10
urge
membranes
sca
te
superomeda
most
sca
and
near
ror
majora
tuberosty
anteror
rom
near
astng
s
severe
assocated
requests
sca
Injecton
aba
was
o
he
ave
pudenda
oowng
best
bock?
and
near
eac
and
gestaton
because
papaton
perormed.
cervx
weeks’
examnaton
on
anestetzes
Injecton
36
mnutes,
dated,
pan
Injecton
at
contracton
pubs
uterus,
E.
3
Pysca
bock
mantaned?
musce
department
contractons
cervx
mdne. Wc
spncter
transverse
woman
every
“pus.”
te
key
spncter
emergency
pan
o
most
body
34-year-od
to
rgt
s
Rgt
rgt
nontender,
rom
o
te
as
Externa
A.
sweng
pevs
mass
weeks’
er
C.
prevents
te
etus
40
B.
B.
paness
at
ater,
ana
C.
a
racng.”
on
organ?
Externa
mons
comes
te
oowng
spne
o
te
For
ntermen-
“eart
mass
embozaton
arteres
A.
dameter
man
woman
o
perneum
te
nerve
conjugate
artery
ts
ours
troug
ruptured.
dstance
story
descent
o
secton?
to
o
ntramura
oowng
er
uterne
because
beedng.
experenced
notced
a
pyscan
mesenterc
Fteen
to
ts
as
te
pudenda
34-year-od
te
was
80.
weeks’
key
rst?
decrease te rsk o tearng, an obque surgca ncson o
are
L2
Superor
dameter
Pysca
mass
te
(Vagra).
Were
most
to
ac
E.
progress
orcec-
semnoma
mesenterc
Ovaran
dameter
20-year-od
pabe
L1,
dsproporton.
conjugate
scrotum.
32
dabetes
a
or
oow-up
dmensons
T ransverse
2-mont
a
o
cepaopevc
A.
a
at
scedued
g
sdena
tumescence.
o
ganga
requred
studes
te
A
or
cepaopevc
wt
ncapabe
aso
sows
uterne
suppy
Interna
A
te
menstrua
Utrasonograpy
te
D.
te
pexus
nuce
woman
pyscan
s
One
o
C.
abor.
gangon
ypogastrc
32-year-od
unctonaty.
n
nuceus
trunk
mesenterc
Superor
o
(Vagra)
79.
procedure?
Sacra
Intermedoatera
prostatectomy.
sdena
ocated
B.
E.
use
pene
A.
D.
on
patent
te
key
radca
sexua
te
nocturna
most
a
se
A
cm.
Ionguna
68-year-od
and
to
eavy
as
7.2
B.
A
se
ypoecoc
Wc
75–98
are
metastasze
comes
o
examnaton
Gentoemora
Questions
woman
story
mont,
A.
trunk
w
omogeneous
testcuar
oowng
cancer
concentrc,
8
o
a
radca
nguna
papaton.
×
A
ac
beedng
ces
dagnoss
te
sows
mass.
205
Perineum
ac
5-mont
strua
scrotum
and
nguna
42-year-od
a
A
o
ts
B.
o
ympat-
Wc
nodes
A.
A
te
ntratestcuar
perormed.
made.
ymp
unafected?
dameter
s
Pysca
Wc
77.
a
postoperatvey , te patent as panu spasms o te mus-
naton
76.
te
key
conjugate
te
or
tat
dameter
63-year-od
ovaran
75.
w
normed
sympyss.
A.
A
s
responsbe
and
dstances
74.
patent
o
Pelvis
4
and
anestetzes
te
majora
tuberosty
anestetzes
and
uterus
to
te
anteror
pernea
spnes
upper
sca
aba
⅔
spnes
superor
ac
skn
prevents
pan
rom
te
vagna
anestetzes
neror
vagna
te
poste-
206
C H A P T E R
81.
A
Pelvis
75-year-od
man
5-mont
story
anorexa.
He
and
sot,
prostate.
most
a
ard,
te
oowng
n
ts
wt
o
wt
ts
o
te
oowng
used
s
condton?
obe
Medan
C.
T ransverse
D.
McBurney
E.
Suprapubc
D.
Latera
zone
te
E.
Latera
capsue
He
86.
A
nabty
says
ang
not
of
egs
s
te
and
te
coud
moter
bcyce
pysca
te
around
te
oowng
Deep
B.
he
membranous
C.
he
attacment
urne
(Buck)
low
were
n
ts
was
pens,
pene
bood
around
CT
t
poston,
and
o
nto
n
te
uretra
o
te
ts
Wc
o
was
was
ntact
njured
pernea
asca
mted
87.
tg
C.
Mdne
Fundorm
Bub
A
35-year
a
ayers
o
cae)
Ater
ton
student
an
he
stood
most
key
B.
Posteror
C.
Isca
D.
Pubc
E.
Isca
sacra
pubc
key
nto
te
asca
te
anorecta
atty
and
(Camper
trange
membranous
and
Scarpa
as-
ours
oca
stragt
o
n
a
(nonradatng)
te
responsbe
resoved
oowng
or
seated
examnaton,
mmedatey
te
a
pos-
pan
n
ac
s
te
most
Ionguna
C.
he
D.
Latera
E.
Pudenda
promontory
sympyss.
by
a
pevc
MRI
and
Wc
te
te
o
te
o
superor
te
a
22-year-od
dstance
between
margn
oowng
o
was
te
most
radoogst?
says
ast
tat
3
ew
se
breast
ts
s
ago
a
Pysca
and
D.
Sagtta
outet
B.
Patent
E.
Bspnous
C.
Faure
o
te
urorecta
D.
Faure
o
te
vagna
E.
Incompete
vagnay
to
a
at
40
macrosomc
weeks’
nant.
gestaton
Se
was
gves
brt
dagnosed
as
or
o
te
a
on
te
te
te
past
o
swoen
serosangunous
s
scro-
lud,
anteroatera
oowng
stmu
nerves
rom
n
emergency
te
perssted.
smar
as
A
wc
moter
or
never
te
ad
norma
bugng
bues
Wc
processes
presentaton?
vagnas
uson
o
septum
pate
te
to
to
deveop
canaze
paramesoneprc
o
most
atresa
processus
a
sows
vestbue.
structures/
ts
Her
epsodes
Se
ar.
te
depart-
dscomort
examnaton
embryoogc
resutng
te
days.
pubc
Cervca
woman
cream
mprovements
pevc
across
A.
net
pan
sows
o
to
ew
net
aed
because
severe
nerve
experenced
astng
observed
oowng
key
was
branc
and
Sagtta
net
structures
pyscan
panu
deep
Maxmum
o
“sngs”
support
organ?
brougt
C.
dameter
tat
eps
(L1)
B.
transverse
o
Durng
(L1)
Bspnous
35-year-od
te
and
(S3)
deveopment
s
o
or
A.
A
outet
a
perod.
membrane
Wc
severe,
as
a
cutaneous
ours
monts
menstrua
gr
o
te
and
no
oozng
cutaneous
nerve
because
a
been
nerve
emora
to
pronounced
nerve
anteror
13-year-od
started
measured
surace
Ioypogastrc
spne
pens
made.
and
does
pens
examnaton
scrotum.
B.
A
He
examna-
dagnoss
structure
antunga
responsbe
A.
ment
and
te
key
stu-
spne
A
oowng
tcng
an
uceratons
te
88.
observed
o
o
ave
partcuary
eatures
tuberosty
woman
tere
Pysca
anteroatera
pan?
te
s
o
weeks.
experenced
own.
Pysca
pens
2
pens
comes
o
tred
bony
student’s
o
because
past
e
ts
noted.
te
te
o
gament
wen
tuberce
measured
s
on
dsrupton
body
o
te
between
aso
tat
te
pyscan
or
urne.
gap
gament
He
but
wt
surace
medca
ramus
superor
ago
wc
o
te
ntercourse
s
gament
story
scrotum.
tum
ast
passng
od-man
symptoms.
abdomen
anatomy
Wc
pubc
radoogst
pregnant
pan
up.
Ineror
te
severa
upcomng
A.
A
ower
experenced
buttocks.
was
te
studyng
or
dent
superca
over
low
between
umbcus
pens
2-week
week
urne
urne
o
o
was
te
rape
E.
ca
te
sympyss
D.
here
to
subsded
Wc
Pubc
E.
o
ncson
damaged?
Suspensory
et
s
observed
B.
he attacment o te superca pene (Coes) as-
beow
erecton
papabe
base
key
an
nstabty
A.
D.
prevented
a
s
Wc
surgca
o
An
ncson
comes
ssues
damaged.
most
patent?
pens
superca
te
scrotum.
s
t
te
perormed.
abdomna
just
wc
suspensory
surgery,
prousey.
ncson
ave
durng
Pene
beed
was
repar
ncson
man
any
to
wc
Ater
procedure?
pont
pan
sows
pubs.
were
A
ave
ton
scrotum,
swoen.
norma
to
urne
scrotum
tere
te
o
were observed. An MRI dented
asca
nto
wa
was
attempted
and
examnaton,
and
between
amounts
pens
meatus,
occurred
A.
e
sma
te
prostate
pens
as
mse
Wen
ony
abdomna
te
and no bony ractures
lud
strkng
bar.
tat
uretra
tat
and
produce
anteror
sowed
seat
notced
Durng
externa
ower
scan
bcyce
wt
e
swoen.
at
s
gestaton,
pregnancy.
ncson
ncson
to
tat
sgncant
s
key
ongtudna
36-year-od
o
er
contnues
ts
subcosta
A 5-year-od boy s companng o pan o te pens ater
weeks
most
perorm
B.
Medan
se
te
Rgt
Fbromuscuar
zone
to
16
ysterectomy
s
A.
C.
zone
at
trougout
epsotomy,
emergency
a
te
organ
dabetes
uncontroed
examna-
papaton
aspect
patent’s
a
and
urnaton.
man
recta
on
o
B.
and
85.
Dgta
nodue
oss,
estancy,
wt
emacated
abdomen.
nontender
o
dysura,
emptyng
an
because
wegt
Posteror
urnate,
84.
urnatng,
sows
mpcated
pyscan
atgue,
A.
te
83.
te
ncompete
Wc
key
to
dicuty
nontender
sows
Perineum
generazed
examnaton
lat
ton
o
and
comes
o
as
eengs
Pysca
82.
4
ducts
CHAPTER
89.
A
60-year-od
o
abdomna
Se
a
says
4.5
kg
does
pevs
a
pevc
durng
Round
B.
Suspensory
C.
Ovaran
D.
T ransverse
E.
Mesosapnx
A
oss
n
s
A
CT
ng
mass
comes
order
o
to
oca
te
3
and
to
te
as
monts.
a
oowng
B.
Superor
C.
Ioumbar
D.
Latera
E.
Superor
excessve
ac
E.
Uterne
Se
examnaton
abdomen
oca
te
o
(10
not
sows
wc
o
Obturator
ureter
te
95.
s
reacng
s
tear.
oow-
dd
examnaton
tona
o
cava
at
not
receve
an
nward
s
B.
V ertebra
C.
Urnary
tract
D.
Cardac
abnormates
E.
Iea
to
o
be
brt
eta
care.
anus
te
gves
o
Pysca
wt
te
Skeeta
n
te
96.
et
weeks’
patent?
a
ram
gravda
dstress
te
oca
A.
S2,
S3,
B.
L4,
L5,
C.
L5,
S1,
nto
spne
anestetc.
dd
anestetc
Se
0,
woman
appears
anestesa.
he
transvagnay
Wc
te
aborta
abor.
requests
sca
segments
by
goes
and
Isca
D.
Posteror
E.
Coccyx
A
nerve
orgnate
o
te
tat
to
and
most
be
pys-
oowng
was
at
ten
ven-
key
rom?
97.
S1
be
man
upon
Sacra
C.
Pevc
D.
Pudenda
E.
Ionguna
done
e
o
rst
and
a
Wc
autogenous
B.
Interna
C.
Deep
D.
Lumbar/atera
E.
Axary
Bot
mastectomy
er
moter
due
and
to
oder
a
recent
sster
BRCA1
ave
been
dagnoss.
dagnosed
posteror
proper
to
a
vagna
adequatey
cosure
o
transvagnay,
determne
to
te
He
Pysca
te
te
wc
proper
pyscan
deecaton
says
red
ste
o
tat
because
wc
n
bood
te
A
by
o
nerves
2
toet
sows
ana
o
asts
past
te
dagnoss
oowng
afected
te
on
examnaton
mucosa.
regon
metastatc
to
te
pyscan
edges.
o
o
ac
ac
nguna
aortc
on
eson
Pysca
nodes
spread
te
eson
roed
dagnoss
propyactc
batera
a
necessary
brgt
comes
ymp
Externa
a
o
musces
spne
panu
wt
rst
ad
oowng
condton?
durng
ana
panu.
A.
batera
ncont-
spne
ac
notced
became
eson
a
S3
se
man
S5
ago,
eca
dysuncton
st-
ana
most
ssures?
ypogastrc
S2,
undergoes
ts?
spancnc
story
tat
ac
Wc
ts
S4,
monts
s
spancnc
69-year-od
says
s
to
comes
te
made.
nnervates
Superor
made.
Sx
te
actate
notced
n
B.
s
woman
o
perormed
pan
wpng.
openngs
2-week
o
S1,
surgery.
arteres
o
to
ncurs
bock
aterward.
aso
A.
A
s
superor
story
s
and
to
neror
S3,
30-year-od
pevc
dented
tuberosty
E.
breast
due
wc
papated
D.
A
te
s
spne
as
ucerated
S2
be
patent’s
nerve
area
mnutes
e
recenty
S4
exts
njecton?
30-year-od
1-week
ssures
0,
o
ts
bock
can
C.
ke
para
te
Isca
key
1,
oowng
companed
to
ospta
ts
Posteror
paper
stua
deects
gestaton
papated
I
B.
days
atresa
panu
te
anestetc
severa
add-
te
and
oramen
ts
umbosa-
nternus
pudenda
A.
a
survey
oowng
ound
ds-
abnormates
20-year-od,
bocked
because
downward.
key
T raceoesopagea
njected
gestaton
antenata
Wc
A.
can
any
and
most
weeks’
secton
mperorate
emvertebra.
deects
25
cesarean
sows
rotated
a
A
anestetze
artery
S1
gu-
A 28-year-od pregnant woman devers er baby beore
andmark
woman
caused
E.
et
ovarectomy
et
key
Iococcygeus
a
te
Dysuncton
Coccygeus
mass.
An
ound
D.
pevc
spread.
woman
was
Pubococcygeus
artery
unpanned
sows
tat
C.
sows
o
te
a
o
gutea
69-year-od
B.
a
between
scatc
utze
arvestng
sacra
dura-
any
o
to
207
Perineum
vesca
wegt
ave
ramus
made
te
courses
greater
Wc
s
Durng
and
gutea
Puborectas
pevs
procedure,
to
b)
tat
te
A.
monts
kg
does
and
meda
6
because
artery
23-year-od
oot
A
decson
lap.
ventra
preserved.
Ineror
pyscan
4.5
and
troug
A.
avod
he
vesse
spread.
ven
ac
vena
Se
trunk
cavty
and
cancer.
bood
wound.
Ineror
an
a
musce.
boatng
and
wtout
Interna
tra
abdomen
wtout
Wc
cra
94.
and
te
D.
tress.
93.
pan
C.
n
te
Se
examnaton
gament
mmedatey
Gonada
38
monts.
lap,
vesses?
Externa
A
o
notced
breast
myocutaneous
most
Durng
B.
va
scan
n
3
as
tea
nence
woman
o
A.
A
ast
Pysca
wt
surgery?
cervca
Pysca
perormed.
papated
gated
and
because
duraton.
gament
ast
scan
ovaran
te
te
mass
perormed.
be
atgued
te
cdren.
atgued
n
CT
monts
gament
abdomna
Se
A
pyscan
6
gament
60-year-od
ton.
oss
ovaran
s
soud
A.
o
92.
et
te
o
cdren.
mass.
a
eeng
any
to
boatng
wegt
ovarectomy
beedng
91.
b)
sows
comes
and
been
ave
structures
90.
as
(10
not
sows
An
se
woman
pan
Pelvis
4
1
te
year
te
ago,
A
bopsy
most
cancer
ce
o
o
pens.
but
examnaton
squamous
w
because
gans
t
ony
sows
te
an
eson
carcnoma
key
occurs?
be
a
He
s
afected
208
C H A P T E R
98.
A
4
Pelvis
4-mont-od
parents
te
because
dorsa
boy
and
s
urne
surace
o
Perineum
brougt
s
to
eakng
te
pens.
te
pyscan
troug
Wat
s
an
by
s
openng
te
most
103.
on
A
48-year-od
ectomy
key
or
dagnoss?
rgt
Epspadas
A
B.
Hermaprodsm
et
C.
Hydrocee
pected
D.
Hypospadas
structure
E.
Ectopc
99.
A
99–105
maase,
botcs
cystc
te
a
s
admtted
panu
urnary
An
vodng.
tract
abdomna
mass
attaced
urnary
to
Se
ospta
s
necton,
CT
to
te
te
badder. Wat
scan
treated
but
te
most
a
and
ever,
wt
te
sows
umbcus
s
wt
ant-
symptoms
104.
ower
rena
Ovaran
artery
Ovaran
gament
C.
Mesosapnx
D.
Round
E.
Uterne
A
o
dagnoss?
A
CT
Ompaocee
tat
s
unabe
were
wc
to
njured
aceve
durng
erecton.
te
prostatectomy
Foowng
he
procedure
te
opera-
nerve
are
bers
carred
by
nerve(s)?
105.
te
scan
D.
e
A.
Ana
B.
Dsta
E.
Ana
A
spancncs
(Fg.
Sacra
spancncs
receve
oow-up
monts
ave
examnaton.
ago
an
or
prostate
erecton
tumescence.
secondary
oowng
A
to
ever
He
snce.
radaton
He
He
o
pyscan
aso
s
been
denes
unabe
te
as
te
rgt,
been
wc
urne
o
output.
matera
and
t
102.
Erecte
Gans
bodes
o
comes
A
B.
B
3
C.
C
D.
D
E.
E
to
bood
a
n
to
te
er
cancerous
mass
tract.
most
neror
to
part
superor
woman
o
undergo
4.5)
A.
o
pyscan
In
stoos.
because
mass
n
wc
key
te
Pysca
te
o
o
rom
Externa
D.
Interna
uretra
uretra
E.
Semna
gand
34-year-od
6-week
ture
s
story
37°C
124/80
man
ocated?
pectnate
ne
wc
dranage
er
to
te
wt
vagna
pectnate
a
s
admtted
cemoterapy.
o
te
rom
In
oowng
ts
ne
magnancy
te
nvovng
to
te
mage
nodes
te
tese
o
a
spncter
panu
(98.6°F),
mm
Hg
and
puse
te
et
s
pyscan
scrotum.
90/mn,
respratons
are
because
Hs
bood
o
B
a
tempera-
pressure
13/mn.
s
Pysca
C
examnaton sows a grossy enarged et scrotum, wc
s
tender
sows
a
to
papaton.
compex
Utrasonograpy
ecoc
mass
connected
o
to
te
te
scrotum
tests.
A
dagnoss o scrota abscess s made. Wc o te oow-
D
ng ymp nodes s most key to be tender and swoen?
A.
Externa
B.
Interna
C.
Latera
ac
ac E
aortc/umbar
D.
Sacra
E.
Superca
nguna
•
Fig.
4.
os-
above
woud
area?
pens
to
part
oowng
spncter
comes
exam
ower
te
pens
C.
A
te
hat
uterus
A
B.
te
sus-
oowng?
nerves?
A.
n
s
damaged.
te
damage
Wc
bers
to
a
nocturna
nerve
made.
eferent
or
radoterapy
as
cavernous
terapy
receve
te
receved
cancer.
dagnoss
structures
to
to
ow
rectum
cana
ower
Pevc
comes
n
a
contrast
coon
35-year-od
C.
man
as
rectum
Sgmod
pta
spancncs
te
Proxma
B.
Lumbar
s
cana
D.
te
ypogastrc
55-year-od
o
woman
sows
C.
Superor
D.
aso
ureter
gastrontestna
A.
A
pro-
artery
story
ocatons
ton,
yster-
te
sows rm, enarged superca nguna ymp nodes.
key
radca
ater
te
apex
5-day
dvertcuum
mass.
gament
55-year-od
cyst
undergoes
day
o
Mecke
prostatc
abdomna
suprapubc
Mecke
man
rgt
neror
B.
C.
cancerous
an
One
sows
none
A.
B.
a
and
te
passes
o
72-year-od
uter.
Se
pyeogram
pevs
tat
Hydrocee
A
quadrant.
retrograde
A.
or
101.
gr
and
or
persst.
100.
ureter
6-year-od
undergoes
cedure, pysca examnaton sows tenderness over te
A.
Questions
woman
eomyomata
rst
CHAPTER
Pelvis
4
and
209
Perineum
A n swe r s
Answers
1.
A.
degree
aso
In
to
o
are
resutng
unused.
s
genta
he
ods.
coaca
te
he
to
reerred
pene
uson
te
o
ment
he
o
uture
te
t
to
as
trd-
ypospadas,
te
urogenta
s
te
t
o
te
o
o
te
te
C.
he
aso
o
ods
E.
wc
ormed
te
body
ts
n
coaca
and
4t
ods.
gans
tuberce
te
he
pens.
resuts
n
ods
and
ruptures
bounded
to
orm
by
at
to
te
B.
GAS
B.
n
urnary,
ated
te
parts.
and
wt
he
a
o
he
uro-
urogenta
o
D.
he
genta
E.
he
te
genta
to
C.
body
ods
are
o
te
D.
A.
he
mae
E.
A
assoc-
and
ormng
te
5.
ony.
te
use
aong
spongy
responsbe
gans
te
ventra
or
te
to
orm
by
te
452;
N
370;
gubernacuum
ABR/McM
arses
n
te
te
uro-
456
B.
ts
wt
regard
te
ectopa;
descent
scrotum.
to
te
a
o
um
testes
passes
descend
or
he
to
279
One
C.
popuar
processus
a
te
traverse
he
vagnas
ts.
porton
Faure
o
s
te
an
te
he
as
processus
te
te
wc
as
to
o
arses
wa
as
tes-
to
he
competey
a
;
N
46
and
reerred
exstropy
mesoderm
and
t
occurs
epspadas.
ods,
by
wt
between
te
a
aure
te
o
externa
two
unused
or
XY
deveopment
Insuicent
etus
resuts
o
te
androgen
n
varyng
s
352;
rom
te
s
assocated
ABR/McM
n
wc
te
a
patent
ura-
279
mesoneprc
rena
bd
kdney
dvertcuum,
duct.
pevs,
Incompete
a
wt
metaneprc
ureter,
tubues.
doube
condton
cyst.
or
te
wt
a
cromosomes.
bud,
n
a
te
It
s
s
pr-
and
resuts
Compete
bd
te
cayces,
dvson
ureter.
wt
duct,
te
n
a
dvson
ureter,
or
sepa-
aso
known
ormaton
o
as
te
te
Woian
mae
nterna
organs.
emae
nterna
gves
to
pronepros
open
nto
duct
rse
te
are
resuts
sexua
to
te
he
components
dsta
convouted
transtory
te
n
organs.
coaca
o
te
nep-
tubues.
structures
and
ormaton
metanep-
regress
wc
by
n-
te
5t
te
vs-
week.
GAS
6.
A.
380,
cera
B.
455;
Hydrocee
and
scrotum.
vagnas
s
streak
membrane,
utero.
aantoc
extendng
te
te
te
279
he
caracterzed
n
aantos
mesoderm
tests.
and
s
paramesoneprc
te
musces.
oter
condton
prmtve
wt
syndrome
resuts
tay
tat
scrotum.
obterates
tunca
E.
o
gubernacu-
extenson
vagnas
roe
eac
badder.
responsbe
mesoneprc
te
ron
testcu-
oterwse
o
and
exst
postuates
abdomna
usuay
retaned
te
s
o
or
skn
scrotum
gubernacuum
dsta
te
vagnas
nto
processus
porton
o
ntegra
teory
poston
to
orgn
te
wa
teores
te
ocated
o
an
o
a
sexua
abdomna
recognze
wen
xed
te
competng
embryoogc
abnorma
become
pertoneum
Severa
exact
occur
an
troug
wc
gubernacuum.
ectopc
B.
te
are
kdney
n
he
rc
n
o
ureters.
te
nto
prmorda
ABR/McM
te
aboscrota
47,XXY
coectng
o
ten
te
pseudoermaprodtsm.
outgrowt
rate
abdomen
paus
scrotum.
ureterc
dvded
urogenta
upper
te
o
GAS
te
deveop-
368;
coaca
gentaa
and
resuts
bounded
te
persstent
he
o
te
orce
o
cus
rom te ower end o te gonada rdge and eps gude
ar
o
mordum
uretra.
pens.
s
ruptures
A.
an
normay
s
n
N
urnary
ypospadas
as
duct,
422,
tests
aure
Kneeter
and
ntestna,
speccay
nvoved
membrane
and
s
resut-
urogenta
o
nguna
prmorda
approac
newborn,
te
combnaton
degrees
orce.
3.
n
or
o
stmuaton
abnorma
utmatey
nto
463;
around
Androgens
278
rom
outet
tracts
orm
tuberce
te
septum,
coaca
orce
ods
pens
urogenta
GAS
etus
rom
aves
coaca.
ods
uretra
sde
ABR/McM
resut
common
persstent
o
te
reproductve
he
ment
370;
urorecta
aboscrota
externa
C.
o
N
anomaes
nondvson
anorecta
A.
512;
anorecta
deveopment
ng
te
exstropy
externa
459–461,
Most
n
Pene
orce.
2.
te
289–298,
uson
urogenta
te
orm
scrotum.
oten
dorsa
cords
swengs
orm
mgrate
deveop-
te
ydrocee
tubues.
to
uretra
s
as
ndrect
epspadas.
aboscrota
as
epspadas.
membrane
an
A. Wen te urnary badder mucosa s open to te out-
to
tuberce
he
te
suc
or
orms
wt
use
sde
and
week
cord
he
resuts
s
condtons
tuberce
assocated
semnerous
GAS
endoderm
proctodeum
n
spermatc
genta
s
he
uro-
4.
rom
te
or
semnerous
ods
te
deect.
ormed
D.
scrotum
aboscrota
aure
ts
o
ods
te
urogenta
or
s
o
resuts
tests
erna.
(ure-
anus.
end
nto
aboscrota
aves
nta
ectoderm
tuberce
urogenta
genta
aure
responsbe
and
dspacement
te
te
membrane
anteror
matures
n
to
hus,
coaca
genta
te
he
secondary
utmatey
orms
E.
Smar
aure
ypospadas,
use
uson
D.
aso
and
pernea
beng
o
rom
s
ods.
a
B.
ypospadas
ypospadas.
resuts
tra)
A.
obterate
1–24
Pernea
trauma
body.
or
ABR/McM
accumuaton
presents
cyst
ectoderma
te
317;
ayers
epdermod
rom
o
t
N
lud
pareta
hus,
An
s
o
as
s
a
a
tssue.
te
tunca
vagnas
nontender
rare
It
Epdermod
surgca
280
between
eson
may
sweng
wc
occur
cysts
mpantaton
tend
o
n
te
o
te
orgnates
any
to
o
ocaton
resut
ectoderma
ater
tssue.
210
C H A P T E R
4
hus,
C.
Pelvis
te
patent’s
A
dvertcuum
Mecke
ntestne.
n
te
patents
present
rage
or
bowe
hs
presents
he
s
can
n
t
GAS
o
A
te
rom
N
A
o
te
Faure
D.
Faure
o
woman
may
o
emae
he
o
GAS
8.
A.
380,
he
can
455;
C,
o
as
a
resuts
te
as
t
D,
s
n
E.
s
n
nng
cyst.
E.
a
cord.
GAS
10.
ocated
o
te
uretra
hs
ods
ura-
he
and
N
B.
A
a
ducts
symptoms
C.
o
to
to
a
te
tubes
pevc
neror
te
ac
E.
he
parts
n
n
a
4
or
te
beng
no
tese
to
D.
a
te
to
as
pene
o
te
te
te
s
durng
te
resut
B.
A
wen
o
te
C.
A
o
te
perto-
apaa,
deect
ods
orce
aves.
to
hs
externa
to
be
s
s
derved
te
genta
tat
s,
con-
278
n
te
rom
spongy
te
use
w
stuated
reerred
ormed
ts
to
by
dor-
cause
between
as
pene
ectoderm
membrane
more
and
covers
te
he
370;
to
an
te
wt
s
drecty
ead
cause
to
ABR/McM
excess
to
ep-
deveop,
o
n
or
by
and
attaced
occurs
o
lud
Hydrocee
retenton
nants.
pareta
budup
279
amount
vagnas.
tests
lud
cosey
lud
woud
dorsay.
N
conssts
use
ods.
contnues
processus
s
to
not
st
rom
njury
wc
tese
woud
507;
resuts
tat
ods
uretra
tuberce
ocated
o
s
typcay
tuberce
o
he
tunca
vscera
ayers,
to
te
wtn
tests
te
and
cavty
ayers.
pexus
and
pressure
n
accumuaton
s
posteror
cystocee
a
s
te
and
s
assocated
testcuar
te
o
wt
ven,
coaguaton
ernaton
vagna
Hypospadas
o
te
ncreased
oowed
venous
rectum
by
bood.
troug
wa.
ernaton
o
te
posteror
wa
o
on
reers
to
te
to
te
ventra
dspacement
surace
o
te
o
uretra
body
o
te
wtn
te
pens.
GAS
12.
A.
463
Varcose
was
extenson
to
te urnary badder troug te anteror vagna wa.
te
ure-
o
expeed
aboscrota
te
rectocee
te
resuts
surace
occurs
pens
ABR/McM
beng
urogenta
te
rom
meatus
ventra
370;
membrane
tests
atter
te
E.
wc
urne
persstent
venous
271
deect
ead
A varcocee conssts o varcosed vens o te pamp-
ure-
use.
an
s
a
between
surgery.
o
te
Faure
n
woud
pens.
N
uretra
te
as
epddyms.
structures.
maormaton
vagnas
artery
o
use
ods.
coaca.
o
processus
hus,
to
ts
te
to
pens.
and
Hydrocee
te
dentcaton
deveopmenta
on
bateray.
assocaton
oter
to
n
459–461,
vagnas
weeks
o
ABR/McM
o
norm
anteror
damaged
reabe
t
wtn
urnary
rst
body
resuts
507;
te
genta
GAS
can
ducts
te
ods
deveopmenta
scrota
spadas,
287
artery
o
coaca
Faure
te
cyst.
bockage
brm
proxmty
o
aure
ageness
orm
o
a
te
endoderm
deveopment
prmorda
n
o
embryonc
degenerate
duct
s
resutng
he
erytema,
(Müeran)
ead
o
competey
processus
reerred
uretra
tuberce.
o
459–461,
two
11.
ABR/McM
openng
to
s
ypospadas.
D.
aure
absence
te
parts
etus,
deveop
regon.
pan.
crana
to
externa
asymptomatc
uterne
te
degenerates
te
382;
s
hs
externa
genta
te
ducts.
part
mae
te
aspect
A.
s
aves.
urogenta
te
Epspadas
uretra
233
Gartner
common
ectopc
a
A.
te
o
sweng
umbca
overyng
te
by
may
o
tuberce
te
te
te
rom
but
n
s
danger
te
pens.
In
ernaton
hs
abnorma
o
caused
371;
o
scrota
ageness
tract.
here
459–461;
Faure
emor-
centray
abdomna
because
andmark
Because
n
o
quenty
N
372;
te
vesses.
date
oss
te
vens
pressure.
retaned
as
n
cord
aure
te
tunca
vagnas
condtons
matc
A
te
or
o
externa
nguna
obterates
suc
an
te
to
as
vagnas
te
ydrocee
o
nguna
aboscrota
orce
ods
to
he
dsta
tests.
competey
ndrect
uretra
musces.
and
be
processus
porton
Faure
obterate
te
tests
o
s
te
resuts
or
sper-
can
te
use
rom
ncreased
B.
erna.
to
arse
testcuar
A
w
cause
between
C.
A
tumor
due
pressure
rectocee
posteror
stuated
a
ven
a
s
A
o
varcocee
te
an
te
tey
conse-
oten
pampnorm
et kdney,
anatomca
dranng
ernaton
te
badder
n
to
vens
vagna
cystocee
urnary
s
n
vens
eastcty
weaken,
occurs
pexus, resutng n a sweng o te vens. hs condton
te
usuay
te
279
o
uum
traverse
o
wt
As
under
varcosty
ABR/McM
occur
wt
vagnas
a
;
vens
neum nto te scrotum wc arses as te gubernac-
processus
B.
D.
and,
umbca
oten
paramesoneprc
te
Hypospadas
A.
oter
Presentng
ABR/McM
cross
C.
tra
te
dvertcuum
suc
o
a
te
are
mesoneprc
N
ters
9.
n
ower
generay
ureters
serve
ureter,
GAS
o
ncden-
deveopment.
ureters.
B,
as
wt
portons
pronepros
burcaton
t
te
te
uraca
cyst
competey
and
eum
ducts.
genta
system
nto
nected.
resut
te
On
eptea
a
mass
tubes
te
recanaze
E.
te
to
and
uterus
two
genta
wt
paramesoneprc
C.
te
Mecke
persstence
mdne
352;
unused
doube
te
sa
uraca
paramesoneprc
B.
o
uson
uterne
ts
deect
te
UTIs
456;
te
te
becomes
compete
n
dscovered
compcaton
brt
papabe
recurrent
be
patents.
contents
rse
wt
ncude
A.
wa
gve
ound
Patents
unt
s
at
persstence
cus
makes
obstructon.
abdomna
abdomna
o
wt
ompaocee
te
ocated
to
symptomatc
to
An
s
tends
majorty
wt
presentaton
ypospadas.
It
tends
o
7.
cnca
unkey.
tay
E.
Perineum
dagnoss
sma
D.
and
o
te
te
wc
venous
occudes
constrcton
and
tests.
rectum
nto
te
wa.
ernaton
nto
te
o
posteror
anteror
vagna
wa
wa.
o
te
CHAPTER
D.
A
ydrocee
wtn
te
s
Hypospadas
uretra
na
GAS
13.
A.
or
swoen
petent
te
n
and
x-ray
norm
s
te
et
B.
A
C.
A
D.
A
o
o
te
te
te
n
o
cavty.
ven
a
as
on
Insertng
pamp-
o
one
a
he
te
N
o
nvoved
nto
rst.
s
te
posteror
wa
vagna
o
o
cavty.
o
ventra
n
o
an
te
exter-
surace
o
te
ABR/McM
pouc,
te
aso
owest
most
he
te
aso
known
pont
gravty
most
to
wc
and
o
as
te
lud
hereore,
to
route
t
ocated
s
s
part
superor
woud
a
to
to
not
be
neede
te
uterne
te
anteror
C.
he
o
aong
te
endocervca
cavty,
wt
cana
te
woud
probabty
consequences.
he
te
E.
gand
enterng
ts
dagnostcay
s
ocated
gand
useu
wt
n
n
a
te
te
neede
presence
uretra
te
lud
n
musce
membrane.
te
pevc
es
postero-
hus,
cavty
by
one
s
examn-
345;
tear
can
rectum
vagna
n
ABR/McM
te
aow
(n
a
wa,
vagna
285
18.
B.
he
nea
by
sma
ntestne
rectocee)
even
orce.
to
septum
to
te
(n
an
ernate
pont
o
(asca
o
entero-
nto
te
protruson
not
atoug
uvua
o
to
s
at
descrbed
ts
obe
s
not
conssts
te
te
uretra
begnnng
most
assocated
requenty
wt
corresponds
N
bengn
to
were
wat
most
s
ade-
ound.
tat
s
most
ready
exam.
366;
te
are
porton
recta
skn
nguna
te
zone,
prostate
te
466;
ABR/McM
o
te
nodes.
gans
he
ctors
281
ctors
dran
deep
and
rst
nguna
receve
ymp
nodes.
nodes
dran
ymp
dranage
wt
te
s
rom
te
te
nodes,
rom
te
uterne
common
upper
ac
or
vagna
umbar
undus
tubes
and
nodes
aso
nodes
dran
495;
N
(or
389;
membranous
o
ts
musce
to
porton
eak
mted
te
and
o
nodes,
te
ovares.
dran
uterus
Lymp
nto
tese
o
nerory
pernea
wa
s
uretra
by
te
s
n
uretra
above
te
s
to
te
deep
to
damage
njured,
retropubc
externa
uretrae)
uretra
uretra.
I
n
urne
uretra
spncter.
te
space
per-
surrounded
(compressor
externa
susceptbe
te
pass
376
te
membranous
nto
structures
ocated
musce
te
can
umbcus).
space,
orm
te
upward
body
te
nodes
nodes.
ABR/McM
ts
s
ymp
ac
uretra
skeeta
coectvey
damage
nous
presacra
nterna
dermatome
seet
hus,
o
o
or
space. Wtn
a
te
event
membra-
and
(o
bood
Retzus)
spncter
and
membrane.
A, C, D. he bubospongosus musce and oter pernea
sus
rectovagna
te
ac
dranage
musces,
N
ocated
cervx.
common
T10
can
spncter
pernea
o
dran
te
Axary
wc
pregnancy.
assess
or
te
D.
te
te
s
t
(or
nodes.
advs-
o
medan
oten
mdde
tssue
perpera
obe
para-aortc
receve
s
dgta
externa
o
s
adjacent
rougy
te
superca
to
accu-
nto
part
obe
as
by
nodes
body
te
obstructed,
te
prostate
he
to
s
o
and
obes,
ganduar
superca
rom
an
gament
ypertropy.
459–461,
te
he
between
unkey
nsert
to
ympatcs
GAS
troug
vestbuar
be
Denonvers)
troug
B.
te
dependent
drect
posteror
s
uterus,
hus,
nto
hus,
to
477;
or
he
nto
278
ts.
posteror
A.
orce
he
badder,
obe
posteror
GAS
17.
regon
wt
yperpasa.
papated
uson
anteror
sacrospnous
badder
dorsa
hs
atera
he
space.
nto
externa
break
D.
te
assocaton
enargement
prostate.
urnary
nocarcnomas
lud
n
211
Perineum
285
uroogsts.
bengn
reerred
an
-dened
anteror
he
te
te
tssue
prostatc
wa.
excess
resutng
troug
ntay
neede
not
superor
GAS
he
te
he
uretra
urnary
ve
te
n
to
most
uretra.
ymp
385;
space,
space.
ectopc
unabe
te
o
pexus
rectum
aure
ods,
on
s
badder
greater
an
o
tests
rom
t
undesrabe
perneum.
woud
te
by
ganduar
meatus
around
o
D.
a
no
and
condton.
nterna
te
are
ave
ABR/McM
due
possessng
rom
ornx
oter
he
o
o
accepted
seectve
te
obe
base
demonstratng
venous
represents
pouc
attempt
cee)
te
anteror
accumuate.
tere
A
ncom-
o
rectouterne
hus,
to
urnary
ead
A.
te
abe
ng
o
ornx.
vagna
15.
522;
vescouterne
to
te
vagnas
Dougas,
vescouterne
E.
te
ts
345;
key
mdde)
varcosty
sows
most
sted
and
rectocee.
to
N
Wen
become
worms”
musces
or
475;
become
o
mage
B.
s
perneum.
muate
o
to
resut
accumuaton
occurs
te
lud
vagna
he
an
openng
rectouterne
D.
can
he
perneum
unreated
GAS
278
vens
a
s
te
C.
aboscrota
rectouterne
o
as
a
testcuar
nto
s
women,
pouc
te
C.
a
te
tey
te
E.
te
enterocee
16.
“bag
ernaton
tunca
and
or
aowng
te
te
exter-
o
C,
o
wa.
te
511–512,
pertonea
A.
s
uretra
GAS
In
o
ernaton
badder
uretra
pens
a
vagna
Hypospadas
te
an
B,
E.
A.
ydrocee
wtn
B.
tortuous,
et
n
o
surace
ABR/McM
pampnorm
s
cystocee
na
resutng
causes
o
uson
ventra
lud
tests.
testes.
rectocee
urnary
14.
te
te
o
eastcty,
appearance
pexus
excess
respectvey.
383;
hs
caracterstc
posteror
E.
he
N
ter
otentmes
venograpy
dataton
522;
date.
venous
te
o
vagnas
aure
ods,
on
perneum,
ose
oten
tunca
rom
openng
te
vaves.
te
aboscrota
vens
and
accumuaton
o
occurs
511–512,
Wen
weak
or
uretra
pens
an
cavty
Pelvis
4
E.
te
musce,
We
deep
ducts
te
cavernosum
ocated
n
te
bubouretra
pernea
perce
proxma
GAS
corpus
are
space,
te
spongy
459–461;
N
te
and
gands
ducts
pernea
te
superca
o
are
membrane
ABR/McM
279
space.
ocated
te
uretra.
367;
scocaverno-
pernea
n
te
bubouretra
to
open
n
te
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.
Conscous
resuts
rom
badder
pevc
o
wa.
he
spna
te
and
hese
were
cord
contan
T10–L2,
are
nto
te
S4.
ganga.
dorsa
parasympatetc
and
preaortc
bers
rom
te
root
soma.
he
are
urnary
we
around
te
te
te
rty
B.
eves
ntermedoatera
eves
S2,
S3,
and
S4
ce
s
coumn
not
o
spna
responsbe
or
are
he
cord
sensory
he
ganga
or
preaortc
testcuar
o
pevc
spna
T5–T9
are
not
at
are
te
ste
o
orgn
responsbe
o
or
te
pevc
pan.
E.
root
responsbe
20.
A.
or
he
p ubococcy ge us
two
n
eca
major
cygeus,
te
n
ep
spna
te
te
m us ce ,
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-tgt
s ou d
d egre es ;
te
te
ke ep
nte g-
m a nte nance
o
n
ts
te
L2)
suppes
atera
a
just
s
te
and
ma n
as c a
re ctum.
uretra
s p ncter
b ut
no t
c an
eca
5.7 ).
sde
o
and
te
psoas
te
eve
ts
rom
277
nerve
troug,
te
n
causng
branc
te
nnervates
case
an .
lo o r
contne nce .
ABR/McM
to
e vator
p e v c
p ub ove s cocer vca
cutaneous
acus
tg
te
p ub ore cta s
e c a
Fg.
and
o
te
n c ont ne nce
340;
atera
jeans)
emora
te
or
te
knee.
“Cavn
patent’s
pan,
o
te
o
L3)
and
bend,
skn
o
case
(L2,
musce
hs
Ken
obesty,
tngng,
or
te
at-
not
burnng
tg.
o
sma
te
area
neror
to
gentoemora
o
te
skn
(over
mdpont
nerve
te
o
(L1,
emora
te
ngu-
gament.
he
ceps
ror
N
te
par t
ex te r n a
constrcted
he
na
B.
n
w t
emora
te
been
or
and
( GAS
te
o
trange),
res s t
w c
90
e e vate
he
urnar y
gament
sensatons
A.
o
p ub ore c -
te
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
nguna
ter
es pe c a y
p ub oc occygeus
s up p or t
m os t
T10–L2
drect
syndrome”
ABR/McM
ntra-ab d om n a
s
eves
pan.
399;
p ub orecta s ,
por tons,
musce
te
N
contne n c e .
wc
ncreases
tas
488;
por ton,
o
pevc
456,
tance
o
ganga
GAS
meda
n
he
or m s
s
coccygeus
Damage
runs
c r t ca
res ponsbe
he
not
E.
aroun d
cana.
ncontnence
21.
s
uncton
anorecta
D.
era
Dorsa
musce
jun c t on,
to
ococcygeus
emerges
not
ange
contrbute
pevc
pan.
ganga
arteres
nerves
anorecta
man
GAS
responsbe
D.
he
are
pan.
C.
ts
musce
C,
E.
he
membrane
orifice
contnence.
te
ocated.
B.
o
Its
S2,
te
anorecta
eca
above
badder
space
orifice
enter
eves
raphe
5.7
ganga
bers
cord
ganga
Fig.
spancnc
Sensory
Spna
n
troug
pevc
GAS
uness
receptors
carred
te
enter
and
badder
stretc
bers
S3,
tese
urnary
o
and
bers
S2,
va
sensory
to
pan
pexuses
sensory
S4
T5–T9,
due
exctaton
nerves
spna
S3,
pan
te
nerve
nerves.
muscle
emora
and
nerve
sartorus
tg
and
te
(L2–L4)
musces
meda
s
motor
and
tg
to
sensory
and
te
to
eg.
quadr-
te
ante-
CHAPTER
C.
he
onguna
part
o
te
upper,
D.
meda
Cutaneous
nnervate
22.
C.
cervx
te
A.
he
and
o
a
n
eary
regon;
perneum;
te
and
oypogastrc
anteroatera
D.
te
te
s
body
te
gutea
nerve
area
An
and
pregnancy.
It
te
at
juncton
te
ndng.
s
uterus
s
now
requenty
been
observed
n
regarded
encountered
persstence
assocated
retrolexed
women
uterus
ts
wo
GAS
nto
wt
Answers
25.
te
B.
E.
retrolexed,
rare.
It
s
e
ave
s
s
dicuty
paton,
and
GAS
23.
D.
he
s
or
asca
A.
he
a
he
a
A.
cesarean
te
gament
and
age
by
pa-
o
pouc
as
vesses
Its
cervca
to
drape
gament,
hese
te
te
s
and
gament
o
rom
o
It
bands
o
pe-
atera
24.
C.
A.
at
he
te
are
parts
uterne
o
tube
te
wa
and
and
he
te
354;
ymp
eve
wa
te
parts
B.
N
o
te
te
s
aso
ovary.
and
s
known
he
ovares
uncton
to
to
o
uterus
attaces
extends
ABR/McM
rst
and
beow
deep
as
te
ac
s
a
rom
rom
to
suspen-
te
te
base
te
he
cervx
te
externa
receve
te
uterne
te
ymp
rom
ovares.
368
uterus
o
to
te
uterus
te
uterus
te
te
deep
te
pernea
susceptbe
transverse
superca
he
and
to
te
deep
extends
to
pernea
deep
superca
support.
o
o
body
damage
t
does
body
musce
not
s
spaces,
pernea
pernea
pernea
ts
musces
pernea
transverse
transverse
te
We
te
te
te
te
wa
externa
musce.
to
cut
uncton
wc
durng
n
eca
scocavernosus
ctors.
crura
t
s
to
not
It
musce
traverses
attac
to
susceptbe
covers
ateray
te
to
rom
scopubc
njury
durng
gament
sacrum
and
attaces
coccyx.
It
rom
s
an
te
sca
ntegra
part
o te esser pevs. hus, t s not at rsk o
uretra
deep
26.
C.
he
space.
durng
n
te
an
s
a
hus,
component
t
s
epsotomy
superca
o
unkey
wc
pernea
to
targets
space
( GAS
5.17).
452–453;
tendnous
connectve
te
spncter
pernea
njured
Fg.
o
n
psatera
351;
tat
o
ABR/McM
pevc
jons
pubocervca
te
sde
N
arc
tssue
etke
wa
A.
he
te
dran
ower
ana
te
vagna.
o
badder
te
and
tendnous
mbs,
cana
and
te
vagna,
drecty
ymp
body
pays
B.
nto
ts
rom
o
te
node.
o
provdes
he
vc
drans
to
ror
para-aortc
nodes
te
receve
and
te
hus,
porton
nguna
upper
to
man-
spncter
I
te
asca
asca
asca
ts
vagna
a
o
tat
asca
as,
uretra,
290
s
dense
te
covers
band
s
carryng
oten
band
evator
te
eadng
ante-
torn,
wt
to
o
an
t
te
te
urnary
ncontnence.
nto
o
be
or
ana
epsotomy.
sacrospnous
to
287
mportant
externa
posteror
woud
epsotomy,
structure
te
remnant
s
he
procedure.
he
be
atera
contan
te
od
umbcus,
nodes
not
spncter
and
woman
crura
te
vesses.
porton
nodes.
nto
te
ga-
njury.
perneum.
externa
and
drans
rena
te
cutaneous
te
nguna
uterus,
In
GAS
te
unctons
te
node
to
nguna
accompany
ABR/McM
ana
overes
te
o
to
gament
superca
body
n
mdne
urnary
475;
Ovaran
nodes
388;
musce
spne
poston.
GAS
D.
uterus.
majora.
broad
ymp
adjacent
te
drans
nodes
but
contnence.
provdes
te
nerve.
gament
gubernacuum.
aba
N
mdne
ramus.
tssues
E.
man
rng,
contnence.
es
Mackenrodt
bromuscuar
vesses.
gament
nodes
mmedatey
ound
t
C.
mesometrum
extends
nguna
beneat
hese
uterus
superca
hs
a
known
support
wc
wa.
round
he
te
uterne
deep
Coquet
ac
tendon)
musce
dysmen-
respectvey.
ovaran
E.
partcuary
and
286
transverse
drect
suspensory
he
te
te
gament
abdomna
C.
495;
a
he
s
rectum.
aso
nundbuopevc
sory
te
eca
durng
requenty
rectouterne
te
condensatons
mesosapnx
uterus,
or
and
or
s
gestatona
ABR/McM
gament,
provde
broad
te
353;
atera
o
accompany
vc
o
ocated
compcatons.
Dougas
uterus
N
cardna
composed
B.
te
471;
gament
tat
o
uterus
dyspareuna
estmatng
obstetrc
pouc
between
wt
and
o
ven.
externa
tanng
uterne
generay
more
undergone
retroverted
assocated
orrea,
he
and
respectvey.
he
a
emora
25–49
he
devery.
D.
node
s
te
ven
nterna
(centra
However,
he
muc
juncton
ac
n
213
Perineum
nodes.
he
o
Coquet
and
cana.
However,
as
at
o
ocated
artery
anteverted
retroverted
anteverted
rare
s
ac
ncarceraton.
B.
node
ment.
and
271
antelexed
cervca
varant.
trmester
he
tat
E.
ABR/McM
uterus
and
norma
second
o
te
395;
antelexed,
as
suprapubc
regon.
te
vagna
te
anteror
externa
brances
N
Normay,
te
o
398;
and
tg.
skn
suprapubc
GAS
suppes
gentaa
Pelvis
4
no
arc
te
part
o
drect
coccygeus
loor
but
o
asca
te
roe
te
o
orgn
n
not
an
s
obturator
o
te
a
tckened
nternus
evator
an,
and
but
t
ncontnence.
musce
s
evator
te
supports
drecty
and
rases
assocated
wt
te
pe-
urnary
ncontnence.
D.
he
ton
obturator
o
te
nternus
tg.
s
nvoved
wt
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
te
rectovagna
subject
as
te
to
Fg.
and
te
rom
28.
C.
495;
he
N
te
posteror
te
patent
rectocee
te
te
or
can
wa
o
te
be
vagna
ne)
(GAS
most
zone
parts
o
nto
o
te
ABR/McM
s p ac e
between
o
nto
te
ana
te
parts
te
te
o
ana
cana
ac
aso
not
( o
te
ossa
ocated
Re tz us)
s
te
surrounds
te
ana
posteror
nodes.
terc
te
nto
deep
na
body
troug
merge.
represents
wc
It
E.
pernea
uretra
GAS
456,
to
Beedng
te
s
a
centra
musces
ocated
n
o
te
te
tendnous
pevs
superca
C.
An
A.
A
space
spncter
te
459;
s
and
musce.
urnary
N
bounded
superor
378;
It
nerory
asca
s
te
tereore
badder.
ABR/McM
o
by
te
exter-
ocated
An
a
te
te
vagna
due
to
ducts
tereore,
cause
te
a
open
cyst
n
ematocopos.
rom
and
ven,
(o
Dougas).
cremaster
but
none
ematocopos.
a
must
sma
be
kept
o
uterne
he
branc
(sometmes
dvson
te
pouc
dmnutve
uterus
wt
N
wa
358;
o
n
te
to
mnd
musce
o
tese
cremas-
te
caed
round
vens
te
s
uretrocee
cystocee
uretra).
wt
tat
round
“Samson’s
durng
a
ys-
gament.
woud
not
low
nto
te
s
te
s
n
te
s
te
or
te
te
by
te
by
by
badder.
vagna
are
asca
and
te
te
o
te
wa.
o
assocated
badder
uretrocee
o
loor.
proapse
usuay
urnary
nto
tear
proapse
anteror
vagna
a
pevc
te
pubocervca
o
urnary
o
It
ntestne
caused
caracterzed
vagna.
wa
285
sma
weakens
troug
(proapse
deects
portng
vagna)
Cystocee
anteror
o
caracterzed
badder
nto
ABR/McM
(ernaton
septum
cystocee
te
279
gand
vagna;
not
artery
wt
wc
474;
urnary
B.
a
provdes
o
enterocee
posteror
and
per-
o
occurs
vagna.
uretra
membrane
nerory
artery
gament
te
pubc
vestbuar
te
rectouterne
assocated
30.
ng
ymen.
woud
ave
are
spncters.
to
te
oten
(above
space.
pernea
nto
cremasterc
and
o
by
commony
Women
drans
e xtrap e r -
s ymp ys s
greater
gand
terectomy,
p ub c
hs
D.
376
mmedatey
or
vestbue
rectovagna
pernea
nea
te
caracterzed
mperorate
Barton
GAS
It
perneum
an
s
bood.
and
drans
sphincter
Bood rom a ruptured ectopc pregnancy most oten
rectum
cana
muscle
B.
superca
te
nterna
rectum
o
Barton
badder.
scoana
he
menstrua
artery”),
388;
he
he
A.
nodes.
N
Hematocopos
presence
288
porton
drans
rom
drans
some
structure
E.
C.
wt
tract
sympyss.
B.
29.
enterocee,
gastrontestna
ABR/McM
ne)
mucosa
retropubc
s
360;
cutaneous
Lymp
space
urnar y
A.
E.
rom
sacra
tonea
torn,
anal
ani
5.17
nto
pectnate
pectnate
GAS
te
o
s
o
Fig.
nodes.
D,
Lymp
te
nto
rom
te
nguna
C,
porton
447–450;
Lymp
(beow
B,
septum
occurrence
GAS
5.34).
GAS
A.
te
ower
proapses
27.
transverse
muscle
te
wt
nto
te
assocated
tat
asssts
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.
Urnary
E.
ncontnence
te
musces
not
be
caused
Proapse
ng
tat
or
o
by
a
tear
te
tearng
uterus
can
resut
surround
o
te
te
uterus
rom
weakenng
uretra
but
rectovagna
s
caused
o
te
gaments
(especay
te
cardna
by
tat
31.
A.
s
O
te
arcus
te
B,
te
ony
C,
D.
any
347;
ABR/McM
answer
coces
musce
tat
he
do
drect
ave
N
and
not
pevc
te
s
septum.
ococcygeus
but
t
s
urnary
te
uterosacra
he
ocated
tereore
weaken-
n
te
urnary
and
o
te
nternus,
parts
to
sted,
asca
obturator
285
te
drecty
support
orm
support
roe
E.
GAS
32.
A.
does
447–448;
he
o
te
ovary);
pubococcygeus
assocated
connectve
urnary
urogenta
an
organs,
ncontnence.
te
tssues
bers
B.
o
badder.
prorms,
evator
wt
and
and
nor
coc-
ovaran
do
tey
orm
pay
to
a
part
te
o
te
evator
pubococcygeus
drect
roe
n
an,
and
mantanng
N
rom
340;
gament
te
ABR/McM
and
nerves
277
e
wtn
(suspensory
cuttng
ts
te
gament
gament
nun-
o
nterrupts
te
pan
ovary.
Cuttng te sympatetc trunk mgt ep to reduce
some
o
suc
a
surgca
C.
not
vesses
tereore,
te
he
vate
wt
pan
rom
procedure
ocatng
provde
does
atera
contnence.
dbuopevc
tendneus
vagna
cygeus
no
474;
5.34
o
gaments).
GAS
Fig.
woud
support
and/or
GAS
te
are
umbar
te
ovary,
rater
but
te
resuts
unpredctabe,
sympatetc
trunk
s
more
o
pus
o
a
caenge.
cuna
parts
te
nerves
o
te
ovares.
are
cutaneous
buttocks.
hey
nerves
are
tat
not
nner-
assocated
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.
te
he
nerve
carry
vesses
nerve
gament
nerve
rom
N
te
346;
superca
pernea
pan
contans
pexus
ovary
pernea
musces
and
te
n
perneum
rom
ony
and
te
te
does
(GAS
and
carry
o
s
asca
s
abdomna
te
deep
te
or
te
wa
superca
and
te
cet
es
D.
ayer
E.
atty
ayer
o
te
o
(GAS
Coes
te
Scarpa
ante-
asca
abdomna
wa.
te
s
deep
te
neror
tat
pernea
GAS
he
ce,
asca
orms
te
o
te
neror
compartment.
way
rom
o
te
border
o
te
anteror
ossa.
between
and
te
te
externa
apex
o
uretra
te
prostate
5.70).
500–507;
t
neror
space
musce
urnary
and
ton
Fg.
te
scoana
no
spncter
B.
te
bounds
o
here
o
pernea
o
o
s
spncter
he superor asca o te externa uretra spncter
musce
between
membrane
uretra
boundary
any
(asca
superca
perneum;
ayer
pernea
recess
membranous
membranous
he
externa
34.
Camper
ror
B.
5.66).
Gaaudet
ar ter y
5.66
ovary.
asca.
A.
Fig.
uterovag-
not
Fg.
GAS
287
space
asca
te
bers
ABR/McM
pernea
compartment)
nnervates
aferent
and
bers
492;
externa
neror
trunk
ligament Vaginal
D.
of
ar ter y
N
378;
badder
receves
bot
ts
parasympatetc
pevc
ABR/McM
wa
ncudes
motor
nerve
spancnc
279
te
and
bers
nerves
detrusor
sensory
mus-
nnerva-
transmtted
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
superor
patetc
resuts
he
te
te
D.
n
pexus
he
It
perneum
GAS
A.
he
pont
lud
ates
to
te
te
rom
te
jon
te
te
n
uretra
ter,
musce.
sacra
te
aspect
neror
o
nnervaton
N
te
arses
rom
nerve
bot
umbar
nnervaton
ypogastrc
to
te
sacra
te
somatc
B.
ABR/McM
he
p ouc
( o
Dougas)
p e r tone a
te
tensor
sen-
E.
s
troug
te
or
te
owe st
h ereore ,
cavty
stand ng
w t
te
It
pos te r or
pat e nt
coect
he
he
te
E.
urnary
a
genta
ornx
o
procedure
te
s
artery
A.
he
es
te
to
C.
nto
te
ts
space
not
E.
pouc
s
an
anatomc
neede
n
Durng
w
not
te
36.
E.
477;
Because
asca
luds
he
te
ABR/McM
spongy
bot
rupture
nto
w
he
n
occur
superca
ossa
trange,
(GAS
and
te
ere,
s
pouc
te
deep
wt
ocated
Fg.
39.
copo-
pene
ts
o
represents
to
ower
he
pernea
externa
D.
and
uretra
retropubc
Retzus,
s
GAS
to
459–461,
space
s
lows
C.
uro-
te
owest
were
aso
urnary
507;
It
Lymp
D.
te
te
Lymp
N
te
te
pont
E.
he
o
te
o
wt
378;
Lympatc
te
erecte
ABR/McM
o
to
bodes
cave
dsta
ana
nodes,
o
sympyss
GAS
40.
C.
he
patcs
279
n
gves
to
te
arses
rse
te
bot
tereore,
pudenda
emora
ower
rom
te
externa
severa
urnary
artery
mb.
abdomna
to
te
deep
dysuncton).
te
umbca
wa.
superor
badder
and
gament.
orgnates
superca
suppy
te
to
te
rom
te
exter-
crcumlex
superca
o
abdomna
ABR/McM
te
wc
ac
o
at
te
cancerous
cancer
te
nodes
eve
ces
must
ower
wa.
280
nguna
uterus
te
Uterne
ower
te
eve
te
be
mb,
two-trds
ac
ymp
ovares
o
te
o
can
te
dran
to
especay
vuva,
and
o
te
rectum
nodes.
lows
to
te
para-aortc
kdneys.
proxma
one
but
uterus.
te
w
tose
trds
o
te
rectum
te
N
to
nto
above
s
aso
coumns
neror
o
te
te
te
te
wc
strated
ne
ana
dran
end
beow
mucosa
te
cana
squamous
assocated
and
ana
pectnate
superca
pectnate
ne
s
ep-
wt
vaves.
ne
o
nguna
low
to
nodes.
388;
ympatc
hese
o
vesses
ac
rom
marks
cana,
pectnate
ends
cana
495;
ne
ana
he
te
badder.
guteus
he
nterna
anteror
nonkeratnzed,
te
deep
te
tssue;
te
artery
te
to
erecte
suppyng
387;
te
te
asca
as
and
norma.
pectnate
te
pubc
rse
pens.
gves
te
nterna
rom
nterna
known
to
te
te
o
artery
tssues
rom
at
N
by
rom
to
te
s
o
suppy
cancer
te
between
superor
nnerva-
medus,
dran to te neror mesenterc group o ymp nodes.
one-trd
space
musce.
posteror
te
a
o
appear
cana
B. Lymp
o
bood
ound.
space,
ocated
anteror
and
s
spncter
pernea
spongy
he
space
membrane
uretra
superca
and
pernea
or
meda
and
regon.
teum.
deep
te
wt
279
gves
rse
tat
present
nguna
ned
te
ABR/McM
artery
or
crcumlex
gaments,
te
and
tat
jon
pevs
motor
artery
te
artery
provde
nng
badder
nerves
te
guteus
(erecte
artery
490–491;
o te pertonea cavty n men. It s ocated between
urnary
suppy
mpotence
suppes
ana
njury.
te
nnerva-
tey
nnervates
artery
epgastrc
It
suspected
rectum.
C.
deep
ndcatve
te
(Buck)
te
ac
arteres
ac
nodes
posteror
Instead,
provdes
nerve
suppy
n
becomes
Cancer
cet.
area
to
nerve
393;
deep
umbca
be
pernea
extravasaton
N
responsbe
A.
round
5.59)
superca
pernea
bend
rectovesca
285
uretra
ocated
scoana
genta
B.
345;
te
are
space,
A.
N
s
artery.
Bot
space.
GAS
te
artery arses rom te begnnng o te emora artery.
uro-
penetrate
resut
neror
na
va
space
te
autonomc
mnmus,
pudenda
man
ac
GAS
membrane
are
nerves
gutea
and
he
he
and
s
o
atae.
485;
externa
ten
sampes.
uterus
spnc-
parayss
parasympatetc
musce.
aterosceross
may
he
vagna.
perneum.
te
te
wc
space
soud
lud
between
pernea
te
neede
pevc
Entrance
o
483,
s
he
te
space
extrapertonea
coect
pernea
trange
centess
to
badder.
te
ts
nerves
skeeta
gutea
nterna
sgncant
p ar t
o
suppy
guteus
ascae
vesca
s
pouc
beow
sde
te
artery
artery
p os t o ned
eter
penetrate
badder.
space
superca
ocated
not
on
uretra
n
nnervaton.
neror
he
space.
space
uterovesca
anteror
ormed
w
urnary
te
he
lud
ts
te
s
neede
pevc
penetrate
he
ossa
paravesca
around
D.
D.
dorsa
ac cum u-
s tt ng.
resut
maxmus.
B.
rectum.
C.
he
nner-
38.
s
cavty.
p e r ton ea
p at e n t
orn x,
pararecta
to
externa
can
ncontnence.
ypogastrc
superor
ton
and
281
suppy
sympatetc
he
te
pevs.
spancnc
not
o
nerve
urnary
te
neror
pevc
and
to
Sacra
segments
motor
ts
spancncs
Pevc
D.
sympatetc
to
A.
sym-
pevs
nnervaton
and
ton
pexus.
o
to
to
te
njury
GAS
399;
transvagn a y
vagna
rom
addton
wt n
te
or
and
spncter
ypo-
uprgt.
B.
C. he pernea branc o te pudenda nerve s respon-
sbe
skn.
woman’s
w en
arse
man
provdng
coecton
accessbe
o
s
rectouterne
ere
detrusor
sympatetc
provde
nerve
486–488;
o
nterna
37.
hs
do
superor
nnervaton,
vaton
35.
provde
and
te
pudenda
sory
te
and
spancncs
trunk
va
S2–24.
te
sym-
badder.
organs.
umbar
organs
o
provdes
urnary
o
arse
trunk
to
pexus
te
reaxaton
spancncs
pevc
he
to
constrcton
and
sacra
patetc
E.
ypogastrc
sympatetc
gastrc
Perineum
nnervaton
spncter
C.
and
te
ABR/McM
vesses
uterne
ascend
to
o
te
tubes
te
rgt
287
ovares
and
and
jon
wt
te
undus
et
umbar
ym-
o
te
(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
aortc)
to
ymp
receve
nguna
nodes
abdomna
ca
nodes.
cancerous
wa
pernea
hese
ces
dran
neror
structures.
ymp
rom
te
to
te
ower
te
nodes
are
ovares.
mb,
umbcus,
te
rst
Superca
te
and
anteror
super-
A.
he superca nguna nodes dran superca
nea
structures,
body
o
near
te
ce
o
ncudng
attacment
perneum
te
o
te
te
(ncudng
vagna
neror
to
superoatera
round
te
te
per-
uterne
gament,
vuva),
and
ymen.
te
skn
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
dran
te
deep
GAS
nguna
5.59
to
sca
te
E.
vagna
he
nterna
and
ac
deep
nodes
pernea
dran
neror
pevc
struc-
structures.
B,
GAS 493–495, 509; N 388; ABR/McM 368, 374–375
B
he
nterna
vagna,
C.
cervx,
he
ac
and
nodes
body
umbar/atera
dran
o
te
aortc
te
mdde
and
upper
uterus.
ymp
D.
he
dran
te
E.
receves
and
te
he
axary
cest
GAS
node
wa,
494-
he
to
admnster
sca
crosses
wc
dranage
prostate
A.
nerve
ocated
artcuate
C.
n
ymp
509;
spne
a
te
s
ound
te
n
te
rectum,
mesorec-
ana
reate
he
te
N
te
pudenda
te
upper
mb
and
correct
nerve
sacrospnous
bony
bock.
gament,
wt
to
376
andmark
he
to
used
pudenda
wc
attaces
te
te
te
sca
te
sca
most
superor
posteror
atera
course
spne
easy
he
tuberostes
nerve
o
emora
te
are
skn
o
and
usng
te
o
te
a
most
sot
nerve.
ac
te
tus
trans-
spnes
pevs
sacrum.
and
hey
do
nerve.
neror
tssues
sensory
pernea
cutaneous
neror
pudenda
and
receve
and
and
aspect
aspect
tuberostes
pevs.
njectons
ABR/McM
done
suppy
brances
o
Injectons
aspect
around
rom
te
nto
o
te
te
poste-
te
area
around te tuberostes are ess certan, owever, tan
breasts.
389;
on
pudenda
ror
dran
s
posteror
bony
sca
cana,
men.
nodes
ncudng
495,
s
rom
Accessng
nerve
approac.
he
te
presacra
tum
D.
not
nodes
spne.
pudenda
are
ovares.
42.
te
nodes tat dran te ctors and superca nguna nodes.
tures
41.
Fig.
E.
at
te
anestetze
he
coccyx
tzng
GAS
te
s
sacrospnous
te
a
ana
poor
pudenda
433–437;
N
gament
trange
target
or
ocatng
nerve.
395;
and
oten
a
we.
ABR/McM
96
and
aneste-
CHAPTER
43.
D.
Hemorrods
na
s
and
medated
wc
A.
by
serves
he
sacra
B.
te
not
bers
anteror
pan
ne
spancnc
he
to
skn
44.
498;
B.
bers
postgangonc
organs
are
tey
to
te
do
pevc
wt
te
at
base
majus;
N
398;
47.
te
B.
he
as
more
provdes
o
te
and
sensory
nnervaton
pens/ctors;
upper
ABR/McM
to
bactera
prostate
not
been
te
nner
te
proven
uterus
D.
he
parauretra
ton
no
a
o
as
mucus
mpact
no
tan
a
t
known
gands
UTI.
tg.
B,
women,
t
com-
48.
pens.
akane
protects
lud,
aganst
sperm
or
te
antbactera
are
responsbe
sexua
E.
ructose-contanng
te
but
t
bactera
C,
A.
he
uterus
badder
ts
by
actvty .
he
lud
journey
to
proapse
or
hs
semna
tat
unctons.
gands
provdes
troug
te
te
secre-
mucus
as
possbe
352;
and
emae
can
nto
D,
te
te
urnary
he
to
base
o
o
te
te
badder
sacrum
D.
Injury
E.
he
nary
to
te
badder
medan
ocated
be
torn,
te
to
te
and
aowng
anteror
but
hs
genta
gament
on
ayer
ernate
ayer.
to
lud
te
B,
to
A.
ureter
vesses
s
ocated
(“water
woud
not
troug
347;
aspect
s
te
pevc
s
te
uterne
te
o
sdewa
te
uterne
ocated
pevc
uterne
on
te
sdewa,
vesses.
288
gynecoogc
dstenson
a
o
and
te
trans-
C.
he
te
D.
uterus
o
te
gaton
reatvey
mmedatey
under
to
or
njur y
because
ts
neror
te
aba;
s
te
broad
arcus
o
te
he
te
288
o
easy
due
nea
E.
and
t
to
s
ocaton.
to
brdge”)
te
n
te
or
and
N
te
to
he
nvade
and
evdent
te
due
between
te
evdence
te
279
transverse
man
cervca
gaments
nbt
te
ay-
present
area.
ABR/McM
te
oter
w
abdomna
two
usu-
asca.
between
and
to
asca
s
abdomen
378;
te
nto
and
n
te
o
s
uterus
nguna
te
te
stab-
uterus
s
not
reated
rom
cana.
pertonea
uterus,
to
and
pevs
te
to
hs
ga-
ovary.
coverng
over
vesses.
jons
te
musce
pubocervca
drecty
te
deveopment
gubernacuum
ascae
an
s
embryoogc
tubes,
evator
assocated
asca
wt
te
gaments.
an
and
does
475;
o
tendneus
evator
pevs
(Buck)
bood
hs
uretra.
begn
exampe
cnca
ovares
uterne
ts
spongy
w
o
space.
vagna.
gament
vagna
te
te
ep
remnant
te
nvo-
durng
not,
te
N
musces
support
o
owever,
vagna
355;
contrbute
a
(GAS
te
prevent
Fg.
ABR/McM
to
pevc
te
loor
vscera
proapse
o
nd-
o
te
5.58).
288
te
te
he
uterne
te
hey
cause
extravasaton
coects
are
not
muscuature
pernea
musce
gaments
te
ovares,
uterus
vagna.
uracus
s
asca
ur-
o
to
te
evator
289
o
pene
perneum
contnues
he
up
and
496–498;
uterus.
round
woud
(urne)
deep
and
dyspareuna.
vagna.
o
lud
to
vagna
te
lud
gament
o
te
te
te
te
extravasaton
B.
ment
vagna.
te
gaments
descent
major
te
n
pervagna
ead
superca
nto
ocated
te
cause
te
or
ABR/McM
structure
passes
and
te
turn
rupture
uterosacra
te
on
gament
ysterectomy,
appen
near
te
bubospongosus
exampe
proapsng
wt
support
I
459–461,
he
o
perneum,
GAS
can
te
trunk
condtons
tssues
GAS
susceptbe
to
gaton
nvovng
o
n
nvadng
nto
most
aong
o
te
ABR/McM
o
hs
D.
te
and
no
ancor
C,
o
can
te
o
t
N
te
burcates
psycosomatc
as
spasms
between
dartos
zng
urnary
wa,
resut
(cardna)
cdbrt
and
ofer
troug
serves
an
posteror
471;
to
panu,
cassc
rom
dferenty
49.
ascae
a
a
uterus
a
ste
ABR/McM
and
353;
recty;
457,
a
hese
te
Durng
s
hs
N
s
s
support.
umbca
te
supravagna
cervx.
sacrum
382;
examnaton
474;
ay
orce.
woud
ernates
evator
to
te
te
te
tssues
E.
urne
ers
urnary
te
vagna
vagna
broad
gament
or
te
proxmty
traves
descrbed
gament s an embryoogc remnant o te aantos.
ureter
on
te
uterus
uterosacra
to
contractons
and
A,
to
285
vescocervca
pregnancy
te
troug
ABR/McM
ancored
and
Durng
tssue
ernate
gament
A.
N
stabzed
surace.
s
subcutaneous
produce
nutrents
he transverse cervca (cardna) gament s
wtn
C.
507;
pubovesca
connectve
badder
B.
s
te
anteror
ts
E.
GAS
459–461,
t
o
proxmty
N
extravasaton
tract.
GAS
cose
472,
musces.
untary
n
te
cear,
tat
durng
on
to
artery
cose
umbosacra
o
nvountary
an
te
he
he
Vagnsmus
te
scro-
279
vestbue
lora
produces
C.
E.
cavernous
nectons.
46.
A.
GAS
contans
atera
ac
n
nerve
cose
sde
n
manua
proxmty
not
dsorder;
pevc
mony eads to nectons o te urnary tract. he vagna
45.
s
GAS
not
vcnty
and
o
cose
te
s
obturator
C. he uretra s sorter n women tan n men. Because
ts
cm
221
Perineum
verse pernea musces, te stmuaton o wc trggers
nerve
te
n
not
organs.
beow
1
nterna
but
he
atera
pregang-
organs
retrogradey
and
he
vesses.
perneum
carry
pevc
D.
C.
brm
vesses
trunk
nerves
promontory
te
and
suppy.
mxed
rom
approxmatey
and
cer vx.
pevc
sympatetc
nerves
te
cavty
nerves.
tum/abum
GAS
te
sacra
rom
trave
onguna
te
transmt
normaton
pan
nter-
emorrods
(somatosensory),
sacra
and
te
categores:
perneum.
nerves
parasympatetc
pevc
nerve
te
spancnc
Addtonay,
E.
to
two
externa
te
nerves
rom
vesses
pan
pevc
onc
o
ypogastrc
medate
he
to
pudenda
majorty
abdomna
ocated
nto
due
spancnc
Superor
C.
dvded
Pan
te
te
sympatetc
to
are
externa.
Pelvis
4
pevc
Answers
50.
50–74
A. he nterna ac ymp nodes and sacra nodes woud
be
nvoved
woud
be
n
a
desred
pevc
n
ympadenectomy ,
surgca
resecton
or
wc
prostate
oten
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
ympatcs
wtn
te
B.
he
can
vertebra
externa
superor
ac
pevc
perneum,
and
communcate
cana
and
tus
nodes
te
body
a
te
wa
o
te
he
D.
he
nguna
structures
deep
beow
nguna
nodes
te
nodes
dran
eve
a
o
D.
o
te
te
gans
te
n
te
he
gutea
and
neror
ts
E.
he
495,
w
testcuar
cose
te
tat
514;
most
cancer
assocaton
testes
s
and
nto
wc
te
are
superor
ound
N
or
390;
ABR/McM
umbar
key
be
because
wt
te
node
at
ntrated
testcuar
he
B.
he
nterna
deep
testcuar
or
sweng
te
by
vesses
te
a
run
and
s
men,
oten
o
metastass
cancer
young
s
eve
a
vc
D.
dran
ntra-
cnca
A.
ac
dran
te
neror
pevs
and
anterosuperor
pe-
structures.
ac
structures.
nodes
nodes
dran
be
spancnc
o
lud
contnuty
superca
body
C,
D.
uretra,
o
te
pens,
te
o
te
superca
368
at
a
as
and
on
medated
spancnc
te
postero-
possbe,
to
tese
avod
mpotence.)
ts
termna
branc,
prmary
skeeta
te
to
contan
398;
te
externa
sympatetc
ABR/McM
uretra
te
Coes
eads
superca
asca
superca
genta-
or
(te
bers.
282
to
accumua-
pernea
(superca
pernea
wa
aows
pevc
bers.
N
n
super-
prostatectomy,
carry
spongy
abdomna
asca)
o
men.
bundes
(In
nnervaton
(edema)
a
more
n
te
known
nerve
510;
te
he
o
aso
nerves
486–488,
ayer
nerve
sympatetc
o
B,
o
va
ntact,
pudenda
receve
pens
ABR/McM
prostate.
et
sensory
Rupture
nous
te
dran
umbcus.
parasympatetcay
devered
nerve
aso
a
troug
o
ton
te
a
he
and
GAS
53.
pass
gans
390;
s
nodes
te
nodes
te
N
dysuncton,
E.
and
Sacra
n
dsease
as
ate
o
a,
s
soud
dorsa
asca
pernea
externa
B,
motor
ympatcs
T estcuar
dangerous
ymp
nodes
281
presentaton.
A.
aspect
A,
514;
tat
tat
erecte
aong
dran
erecton
atera
te
epddyms.
especay
abdomna
subdvded
nodes,
vesses.
para-aortc
kdneys
are
gutea
respectve
GAS
51.
nodes
495,
nerves
bundes
beow
nguna
and
Pene
response
men.
E.
deep
GAS
C.
nguna
structures
vesses
super-
pens
superca
he
and
umbcus.
dran
he
ca
52.
superca
ca
C.
antero-
mb
umbcus.
C.
5.47
cranay .
te
ower
to
Fig.
ympatcs
metastasze
dran
structures,
wt
GAS
asca)
wt
membranous
lud
spread
cet.
membra-
Scarpa
ayer
upward
o
upon
wa.
Rupture
or
o
urnary
te
preprostatc
badder
woud
uretra,
ead
to
prostatc
nterna
lud
CHAPTER
accumuaton
ocated
E.
n
wtn
te
Damage
to
abdomen
rupture
GAS
54.
B.
he
pevs
because
tey
are
not
58.
te
or
ureter
pevs,
(GAS
Fg.
459–461,
cremasterc
woud
manest
dependng
upon
wtn
te
te
eve
a
o
N
relex
Durng
seen
sma,
B.
373;
ABR/McM
aferents
are
by
o-
C.
contans
are
pubc
to
skn
regon,
C.
he
D,
E.
he
troug
anteror
te
GAS
te
rom
mt
pevc
Pan
he
and
obturator
cana
and
and
parts
scrotum.
te
D.
he
supra-
E.
or
he
te
woud
not
pay
be
no
trave
59.
damaged
roe
n
te
N
391;
cervx
ABR/McM
s
C.
he
because
te
pertoneum,
cervx
wc
s
s
va
te
A.
beow
aso
pevc
te
known
te
te
te
pevc
pan
prmary
ypogastrc
upper
ner ves
por tons
ner ves
are
ne
s
carred
sympatetc
o
n
carr y
te
B.
prncpay
pan
va
A.
he
and
sensory
te
D.
n
E.
bers
n
he
esser
Pan
rom
bers
to
te
skeeta
and
externa
motor,
provdes
gentaa,
sen-
prmary
ncudng
nerves
are
ts
area
cord
s
woud
pevc
perneum
D.
397;
tus
aso
carry
trave
suprapubc
by
onguna
va
to
bers.
te
62.
S2–S4
he
sensory
S2,
and
and
nguna
regons
oypogastrc
umbca
rom
sory
In
te T10
te
GAS
B.
he
rena
te
regon
eve.
nnervaton
by
C.
et
receves
In
te
sensory
epgastrc
provded
regon
510;
testcuar
wc
neror
B,
D.
urnary
nerves,
nerves
354;
o
badder.
and
gament
ympatc.
projectons
o
te
o
te
pertoneum
ABR/McM
ectopc
nterna
ead
to
are
ABR/McM
produce
o
285
pregnancy
s
te
cervca
os
pacenta
ess
woud
be
preva.
common
stes
o
287
te
akane
ructose
secretes
are
te
produce
and
porton
o
te
cone.
prostagandns,
366;
proper
wtn
tat
D,
E.
463;
N
Ectopc
te
ctrc
acd,
and
368;
te
tuba
ormones.
pene
produce
bub.
281
as
te
or
aed
scrotum
n
do
ABR/McM
te
sex
gands)
to
descend
and
te
nguna
not
correate
may
be
cana.
wt
te
symptoms.
ste
n
279
o
nterna
pregnancy
n
n
producton.
and
te
tests
condtons
or
denton,
overaps
enter
abdomen
hese
sgns
urne
(Cowper
ABR/McM
ocaton
te
o
gands
secretons
N
stes
spermatozoa
cryptorcdsm,
By
mpantaton
cervca
te
n
pacenta
os.
uterne
(aopan)
tubes
pregnancy.
B.
he cervx s not a notabe ste o ectopc mpantaton.
C.
Impantaton
E.
men
w
he
undus
te
by
nnervaton
regon
te
sen-
GAS
63.
T7–T10.
sensory
vena
ven
ten
cava
N
D.
wtn
resut
471–473;
Interna
nate
nnervaton
s
ne.
o
n
an
te
te
mesenteres
abdomna
uterus
symptom
397;
ABR/McM
drans
crosses
(coce
drecty
over
te
285
nto
mdne
A,
te
to
et
te
enter
A).
B,
C.
ton.
and
et
ac
vens
are
not
nvoved
testes.
266,
493,
n
te
dranage
383;
ABR/McM
271
355;
tssue
s
o
te
abdo-
pregnancy.
te
N
nterna
norma
ste
o
removed
n
285
ocated
nerves.
rom
Pan
above
te
s
te
pect-
ndgut
not
a
and
common
emorrods.
do
not
carry
pan
bers
above
ne.
381;
ABR/McM
spancnc
same
te
are
derved
nerves
parasympatetc
hese
ABR/McM
s
vscera
tese
pevc
ndgut,
N
o
E.
498;
he
da,
te
by
pectnate
GAS
64.
C,
N
emorrods
hs
nnervated
tan
GAS
he
regon.
pospatase.
ts
C, D, E. he et neror epgastrc, et nterna puden-
o
may
oten
overooked.
ts
etus’s
porton
ste
ncudes
prostate
467;
In
are
T7–T10.
486–488,
ven,
s
epgastrc
provded
57.
s
mpantaton.
he
E.
hs
resuts
o
355;
gands
bubouretra
(L1).
C.
n
atera
coces
he
A.
tg.
oter
E.
and
nnervaton
a
and
kdneys
preva
eves
S3,
are
te
testes
GAS
282
at
he
A,
parasympatetc
nerves.
provde
posteror
aferent
easy
t
tube.
he
nto
sympatetc
ABR/McM
medated
spancnc
eves
and
nerves
N
he
supped
N
presentng
510;
uterus
(nundbuopevc)
353,
D.
ound
prncpay
N
C.
GAS
61.
vagna.
spancnc
and
te
spna
B,
o
486–488,
troug
te
trd
spancnc
responses
S4
contans
uncton.
GAS
A.
nnervaton
dsta
Sacra
nerve
sympatetc
te
ovares.
s
uterus
he
mucous
pudenda
sory,
o
atoug
pregnances.
471;
he
uncton.
A.
E.
acd
Sacra
sympatetc
te
common
te
Semna
uncton.
uter us.
te
vesses,
tubes
toward
470–473;
ejacuate.
are
spancnc
D,
GAS
60.
ne.
tat
ovaran
(Faopan)
ectopc
ne-
as
s
ound
suspensory
te
Impantaton
B,
te
te
most
uterne
275
transmtted
tat
not
dran’s
mesosapnx
GAS
not
cana,
te broad gament tat attaces to te uterne tubes.
area.
do
are
wc
uterne
uterus
tg.
sensaton
nerves
tey
o
nner
provdes
suprapubc
and
510;
superor
rom
to
wtn
te
above
ner ves
nerve
addton,
nerves
o
pan
trange
sensory
relex.
486–488,
spancnc
B.
In
emora
s
perneum,
and
nguna
erna.
Pan
ror
wa
pudenda
cremasterc
C.
te
nerve
oypogastrc
abdomna
by
over
onguna
gament
225
Perineum
he ovaran gament connects te ovary to te uterus,
wereas
he
round
nguna
strand
coces
toemora nerve. he sensory bers o te gentoemora
A.
56.
brous
aantos
te
te
te
and
he uracus s a brous remnant embryoogc o te
279
carred
repar,
wtn
remanng
5.47).
507;
A.
be
nguna nerve; te motor (eferent) output s by te gen-
nerve
55.
te
perneum.
Pelvis
4
eferent
nerves
portons
ts
(nerv
bers
nnervate
o
patent.
281
nerves
te
te
arge
ergentes)
tat
medate
dervatves
ntestne
con-
erec-
o
tat
te
were
226
C H A P T E R
A,
B,
ts
E.
Te
o
ymp
to
Lesons
nodes
n vo ve
nodes
do
n
515;
nterna
cer vx.
and
Perineum
tese
structures
woud
not
cause
symptoms.
486–488,
A.
ne
Pelvis
patent’s
GAS
65.
D,
4
N
ac
tat
te
not
398;
ABR/McM
a re
re c e ve
ces
nterna
a ve
te
tumor
ympatc
nodes
C a n c e ro u s
tat
te
rst
ymp
ro m
ac
c a n c e ro u s
te
282
n
ro m
cer vx
nodes
ces,
tmes
rst.
ts
a
te
a re
I
tr unk
uter-
key
tese
ndcates
as
cannes.
n vo ve d
and
not
s p re a d ,
Pre s a c r a
can
be
et
at
east
nodes
a re
durng
a
t ro u g
aso
some-
dgta
re c t a
examnaton.
B,
to
C,
D,
E.
receve
he
structures
are
GAS
514;
495,
nterna
ymp
rom
ac
te
ymp
uterne
nodes
are
cervx,
te
te
rst
oter
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
contans
n
accumuaton
ayers
o
te
accounts
A.
or
o
cear
lud
te
Varcocee
s
pressure
tese
C.
Cystocee,
projects
wen
s
n
te
ts
swoen
ts
5.76
scrotum
ydrocee
vscera
tests,
and
s
wdespread
te
wat
pareta
condton
best
tere
venous
pexus
te
known
urnary
s
te
anteror
an
ncreased
causng
data-
openng
o
te
a
protrudes
congenta
s
on
urnary
te
nto
badder,
te
condton
ventra
surace
o
or
abscess
dranage
he
te
67.
C.
he
te
A.
t
he
dorsa
anteror
he
D.
he
and
te
ABR/McM
woud
area
o
te
need
C.
he
need
to
ana
be
o
te
suppes
skn
best
292
te
around
nerve
to
abscess.
to
externa
te
anus.
anestetze
area.
ctors
te
branc
skn
o
ABR/McM
te
te
o
superluous
o
te
te
does
not
nnervate
perneum.
pernea
abum
anestetzed
n
nerve
majus
te
suppes
and
event
o
woud
a
orse-
abscess.
he pernea nerve suppes a te pernea musces and
o
te
ctors
ana
anus
te
o
skn
te
o
(recta)
and
to
be
perces
ctors
scoana
branc
279
ave as drect a suppy as
anestetzed
abum
nerve
te
not
ana
te
skn
spncter
and
tus
GAS
B.
An
ror
te
majus.
nnervates
externa
suppes
pudenda
510;
perneum
and
nerve
gves
tereore,
rse
s
to
te
a
man
o
anestetzng
te
t
nerve
o
te
aberrant
geres
“corona
aorementoned
reatng
zng
n
to
te
Patents
te
hs
Fg.
artery
be
s
resut
o
serousness
o
ts
aware
s
te
n
n
rom
20%
durng
o
te
to
varaton
as
ts
error.
above
addtona
5.76).
are
o
more
certan
“crown
artery
ne-
30%
presence
aternatvey
transates
cuttng
brances
resut
arsng
damage
not
recta nerve.
te
292
ound
wt
artery
wc
a
woud
(GAS
nadvertent
morts,”
to
can
surgeon
artery.
te
t
neror
of
ABR/McM
obturator
artery
te
gves
efects
395;
popuaton.
woud
resut
sde
N
epgastrc
susceptbe
nerve
anestetzng
unwanted
te
69.
nerve
he
aberrant
pudenda
nerves;
E.
pernea
ossa.
pernea
te
te
and
musce.
E.
not
soe
descrbed.
nnervates
posteror
neror
around
te
nerve
recess
te
369;
nerve
superca
ony
N
suppes
membrane
B.
posteror
ts
o
recess
superca
te
395;
te
be
dranage
nerve
be
n
nerve
posteror
N
and
woud
woud
or
te aba majora, but or te area n queston t does not
463–468;
pernea
because
dorsa
he
s
te
musce
A.
pens.
GAS
spncter
510;
recta
ts
vagna.
were
neror
tat
needed
hereore,
B.
proapsed
efects
actuay
480–488;
he
rectum
vagna.
as
badder
a
wa
D.
ana
s
s
GAS
68.
patent.
wen
te
wen
Hypospadas
uretra
n
te
Snce
Fig.
vens.
towards
te
between
vagnas
caused
ton
Rectocee
lud.
ndngs
venous
o
potograp,
a
tunca
B.
E.
te
mosty
GAS
sur-
o
te
caed
te
o
deat,”
wtout
rea-
228
C H A P T E R
A,
C,
to
be
are
E.
to
GAS
E.
he
stape
na
o
to
te
B.
he
do
n
so
he
te
s
and
and
woud
be
ess
key
woud
assume
care
makng
n
as
he transverse dameter s te ongest dstance extend-
B.
he
ng
sure
wy
a
he
n
nerve
at
s
te
ductus
D
tose
to
te
sp-
root
o
GAS
74.
te
as
te
to
tat
s
nnervates
cutaneous
o
cremaster
to
te
anteror
transverse
suppes
suppy
branc
an
skn
A.
not
te
and
te
atera
musce
and
skn
o
71.
A.
C.
pubs,
nerve
te
aorta,
ac
510;
ovaran
descend
abdomna
o
N
398;
ABR/McM
arteres
arse
and
he
bood
cross
just
ovaran
rom
a
aong
anteror
arteres
are
ematoma
C,
vesca
te
GAS
C.
s
he
o
bood
an
E.
anteror
posteror
te
te
externa
most
oowng
te
n
N
ts
e
burcaton
(aso
ovaran
te
are
and
artery,
not
75.
vesses
to
aorta.
te
he
vagna
and
es
an
t
vesses
nerve
GAS
73.
C.
he
he
E.
tuba
te
to
te
o
aso
to
rom
be
gated.
just
s
does
to
te
be
rsk
he
a
nterna
e
n
N
conjugate
not
branc
o
te
pudenda
artery;
durng
D.
te
perneum
382;
d am e te r
ate re d
and
ABR/McM
by
o
te
s
he
te
most
aong
key
s
by
motor
skn
te
cause
te
to
to
te
atera
or
te
patent.
te
over
nnervates
nner
nerve
cremaster
te
emora
te
skn
over
te
tg.
suppes
regon
trunk
L5
and
contans
and
umbosacra
te
E.
ovar-
510;
N
or
he
and
are
pudenda
not
at
rsk.
o
(antero-
te
pe vc
ce
skn
te
s
area
motor
te
over
te
above
te
and
umbar
sensory
contrbu-
pexus.
392;
ABR/McM
responsbe
parasympatetc
coumn).
or
he
285
o
or
te
or
erecton
nuceus
an
trunk
acton
ejacuaton.
parasympatetcs
nervous
erecton.
ganga
o
are
(nterme-
parasympatetc
producng
sympatetc
woud
erecton
but
not
rater
(Mnemonc:
“Pont
or
sympatet-
erecton,
and
ejacuaton.).
neror
he
mesenterc
superor
he
gangon
woud
or
B.
ce
and
an
he
bers
pexus
and
s
parasympatetc
bodes
o
tereore
not
contan
not
te
neura
nuce
o
L1
pregangonc
woud
o
not
te
contans
ndgut.
ew
prmary
ce
and
any
oca-
bodes.
L2
contans
sympatetc
contrbute
to
neu-
produc-
erecton.
480–488,
510;
nterspnous
te
sca
ay
te
spnes.
sortest
dmenson
he
te
to dervatves
ypogastrc
ntermedoatera
GAS
C.
pev s
bodes
responsbe
acton
ng
o
artery.
ce
sacra
sacra
rons
owever,
gaton
te
responsbe
ton
artery
285
re axat on
dam-
due
290
course
te
upper,
and
parasympatetc
vesses.
uterne
artery
to
ton because tey trave
to
structure
ac
wt
te
obque
parasympatetc neura ce bodes responsbe or erec-
76.
s
a
te
nerve
gutea
L4
neura
n
nerve
uterne
at
and
pregnancy
experenced
nerve
and
480–488,
Soot”:
he
proxma
nterna
anastomose
durng
jonts.
75–98
te
te
ooporectomy)
ureter
to
he
be
ovary.
ascendng
artery
B.
C.
be
s
sensory
majus
rom
domeda
arteres
vesses.
mosty
s
branc
dstay
489–492;
posteror)
jonts.
va
vagna
and
a
artery
ar
ovaran
he
D
too
s
neror
uterne
es
te
B.
artery
we
he
A.
superor
key
must
ureter
and
umbosacra
ocated
285
caed
runs
dect
oypogastrc
he
Answers
key
a
tat s at te most rsk wen gatng te ovaran
A.
he
cs
ABR/McM
anteror
o
umbca
arteres
vesca
arteres
nerve
onguna
bers
stuaton.
382;
te
vesses
neror
ac
rom
hese
ovarectomy
perormed,
ovaran
and
nterna
branc
ac.
489–492;
Wen
uterne
te
arteres
nterna
source
72.
E.
rom
conjugate
durng
oter.
between
dramatcay
te
ABR/McM
nerve
gentoemora
he
system
D,
branc
o
te
abdomna
te
to
canges
to
dstance
pubs.
sup-
gaton.
B,
he
GAS
te
brm
te
reaxn.
336;
motor
anteroatera
279
rom
retropertoneay
wa,
vesses.
source
and
ton
480,
he
obturator
abum
buttocks.
gentoemora
s
trange.
obque
te
ormone
N
pevc
reaxaton
ncreased
obturator
musce
abdomna
above
and
to
dagona
438–445;
te
anteror
pens,
te
one
te skn on te meda aspect o te dsta tg. Damage
nerves
nnervates
te
he
o
dstance
spnes
due
sgty
o
he
B.
nerve
E.
are
sensory
and
we
D.
mdde
pevc wa and nnervates te adductors o te tg and
spancncs.
sympatetc
o
sca
efects
testes
regon
porton
somatc
as
te
nterspnous
and
eters
normaton.
tg
te
o
kck
pevc
to
te
at T10–L2,
perumbca
proxma
sensory
meda
skn
te
te
reers
carry
ganga
orceu
n
o
trunk
scrotum.
GAS
rom
pregnancy
most
te
root
more
bers
285
and
enter
dorsa
musces,
genta
te
A.
tey
deerens.
nerve
pes
to
severey
and
abdomna
he
great
tests
oypogastrc
wa
take
ABR/McM
te
coce
not
upper
ductus
D.
o
sensory
scrotum
sted
surgeon
te
onguna
te
C.
tus
(Wc
answer
wc
te
sympatetcs
urt
as
hs
arteres
382;
abdomen.)
ductus
A.
N
bodes
nerves.
Perineum
tem.
aferents
ce
seems
oter
w
489–490;
he
and
because
and
accompany
wt
Pelvis
njured
present
not
70.
D,
4
dstance
he
te
does
ABR/McM
s
te
tereore
brt
conjugate
and
399;
t
between
dstance
s
te
s
usu-
mnmum
cana.
dameter
not
279
dstance
nterspnous
dstance,
aong
true
N
dstance
s
te
anteroposteror
cange.
A, D, E. he transverse dameter, obque dameter, and
dagona
conjugate
dameter
can
cange
sgty
durng
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.
te
Lymp
superca
o
dranage
B.
te
te
te
spongy
mb,
and
te
nto
ymp
he
nodes
receve
a
nguna
pevc
te
deep
and
deep
C.
Uterne
sma
A,
do
ym-
and
receve
nguna
ymp
rom
te
nodes.
D,
not
GAS
79.
E.
to
musces
o
cdbrt,
keood
45
GAS
damagng
390;
ABR/McM
365
N
receves
perormed
suppy
bengn
externa
and
to
starve
resutng
tumors.
n
Foowng
coatera
ac,
bood
neror
superor
adequate
386;
wc
otomy
N
uterus
he
pernea
vc structures and receve ymp rom te sacra nodes.
514;
E.
provde
he nterna ac nodes dran ymp rom neror pe-
495,
tese
pudenda,
489;
he
tssue
anterosu-
te
o
s
bood
a
te
suppy
mesenterc,
mesenterc
coatera
bood
arteres
suppy
to
te
uterus.
o
gans
B,
nterna
nguna
te
sze
ter
aorta).
and
porton
n
embozaton
o
rom te ovaran artery (a drect branc o te abdomna
um-
wa,
artery
brods
procedure,
dran
deep
nodes,
o
and
uretra.
structures
and
pat
nodes
he externa ac nodes dran ymp rom
superca
78.
uterne
aorta),
abdomna
A.
poptea
superca
oow
nerve
5.15
decrease
drans
ower
structures.
te
Fig.
measured.
(abdomna
testes
canges
GAS
289
nguna
mb,
rom
ower
easy
testes
suppy
ower
ymp
te
and
peror
C.
rom
rom
dstance
more
ABR/McM
superca
te
rom
aso
336;
pernea
dran
patcs
pens,
he
rom
s
bood
ymp
nodes.
nodes
N
nterspnous
t
vesses
testcuar
ymp
te
brt;
438–445;
tereore
bar
but
durng
ligament
levator
s
te
o
ABR/McM
body
te
etus’
pernea
away
ead
hs
pernea
o
288
te
attac.
tears.
rom
283,
condensed
perneum
te
te
a
musces
perormed.
degrees
s
s
te
s
In
mass
pevc
In
ts
tere
done
n
Damage
and
cases
stuaton
mdne
body.
connectve
loor
many
arrested,
usuay
o
n
to
s
a
an
an
order
te
durng
g
eps-
ncson
to
ts
avod
tssue
230
C H A P T E R
4
destabzes
urnary
nary
A,
Pelvis
te
and
C,
D.
80.
E.
451;
he
vates
o
te
and
S2
greater
va
to
S4
scatc
te
esser
spne.
area
hs
o
dstrbuton
anestetze
organs
A,
B,
(GAS
C,
81.
A.
nerve
he
te
urnary
obes,
a
te
not
te
D.
by
eaves
by
t
tat
te
te
nto
te
coursng
bock
w
cervx
te
te
It
are
84.
s
te
not
do
not
descrbe
te
te
posteror
ABR/McM
n
men
and
tat
as
and
a
289
accessory
es
surrounds
prostate
obe,
284,
te
organ
o
mmedatey
te
our
extng
obes:
medan
obe
GAS
85.
uretra.
two
tat
te
beow
atera
drecty
necessary
obstruct
te
uretra
but
t
s
requenty
cancerous.
C
and
Bengn
te
medan
w
be
and
prostatc
atera
obstructed
symptoms
82.
and
ncudng
stream,
a
urnary
to
access
te
sow
urgency.
yperpasa
obes.
Mcturton
patents
dicuty
stream
o
usuay
present
urnary
badder
n
urne,
(urnaton)
margn.
ntatng
urnary
varety
te
o
operate
urnary
requency,
B.
on
can
men,
by
major
te
o
hs
bub
te
tat
o
te
erecte
space.
(Coes)
te
rom
a
pens.
bodes
t,
hs
asca
tear
and
s
can
spreadng
te
s
sp
pene
te
te
pernea
body
te
s
ure-
apped
(Buck)
body
he
to
GAS
C.
urne
459–461;
he
neror
s
te
roug
end
arge
wegt
te
N
on
te
nto
te
posterory,
body
o
te
tuberosty.
at
te
trange.
o
281
and
te
he
te
sory
juncton
wen
o
te
nea
ramus
ment
bends
and
scrota
and
a
o
poste-
porton
o
A,
459;
aba
body’s
t
te
te
by
pubc
dstance
te
on
s
te
arc.
between
dameter
o
brm
96,
o
superor
one
sde
to
233
are
hey
needed.
made
are
Wen
not
tns
begn
te
5
used
cm
wen
perormng
perorate
around
neror
neror
are
te
te
te
urnary
and
eas
just
atera
suppy
nea
o
oss
te
to
aba.
abdo-
he
s
However,
te
procedure,
nerve
costa
sde
nea
mnma,
because
t
sowy.
beow
to
te
engt
bood
avoded.
t
rgt
umbcus.
so
xpod
te
ver.
troug
te
te
to
te
te
woe
around
are
on
and
made
to
parae
used
gabadder
as
to
te
umbcus
umbcus.
t
te
causes
hs
te
abdomna
s
s
east
mus-
we.
o
N
s
to
dstance
mosty
345;
and
o
s
descends
to
te
surround
nerory
n
ABR/McM
asca,
tat
between
used
gament
anteror
spts
B,
te
It
undorm
gament
ts
sttng,
by
ncsons
asca
by
outet)
ateray
s
ater-
sde.
taken
many
used
superca
upper
attacment
musces
D.
te
s
anterory
wdt
te
net)
McBurney ncson s perormed at McBurney pont
GAS
86.
o
be
ncson
te
umbcus).
he
organs
nerves
eas
(one-trd
urne
o
scum
tendnous
(amstrng
magnus).
te
Muc
tuberostes
proxma,
279,
D.
near
scum
300
(sagtta
te
ABR/McM
vascuarzed
to
and
te
transverse
opposte
vascuarzed,
commony
ces,
s
sympyss.
are
neror
damage
o
294,
coccyx,
outet
extended
transverse
a
per-
tg.
ABR/McM
projecton
tese
musces
adductor
378;
bony
o
te
tg
enterng
sca
rests
provdes
ror
rom
A
crest.
projecton
(sagtta
and
anterory
extend
poory
poory
made
pene
attacment o Coes asca to te scopubc ramus pre-
vents
C.
tear
attacment
prevents
anorecta
s
asca
superca
superca
superory.
to
(pene)
accompanyng
nto
by
pernea
posterory
orce
an
deep
bound
te
281
spongy
wen
te
membrane
to
te
tere
nerory,
asca
279,
n
occurs
I
urne
area
pernea
Coes
ABR/McM
as
commony
o
surrounds
nea
and
366;
at
project-
pubc
promontory,
outet
greatest
must
curvng
and
N
patent
sacra
te
mdde
336;
te
be
orward
body
brm
nes,
by
te
ncsons
hey
GAS
467;
does
area.
hey
s
he
te
pevc
ncsons
aba
D.
and
termnatng
te
ABR/McM
pevc
by
te
as
and
Medan
and
338;
or
pubs
badder,
process,
a
N
care
Subcosta
o
and
(Pannenste)
urnary
afects
wt
te
pevc
ncson,
end
Maxmum
on
te
B, E. hese structures are not nvoved n ts condton.
tra.
83.
superor
A.
D.
rom
pont
promnent
ramus
and
across
440–445;
to
lat
spne.
posteromeda
he
spnes.
Suprapubc
ts
surrounds te uretra. A tumor o te posteror obe does
not
E.
a
(nterspnous)
extends
same
and
posterory,
ac
opectnea
tuberostes,
sca
net
N
net
posterory
Bspnous
tn
spne.
sympyss.
sca
vscera
s
atera
te
posterory
bounded
te
o
sca
te
s
te
ponted
pevc
by
pubc
te
coces
wanut-saped
badder
he
ay
on
433–437;
aperture,
395;
a
C.
extends
superor
juncton
te
ramus
tuberce
sma
bounded
sca
w
pubc
GAS
perneum
anestetze
tese
s
crest
tuberce
te
orms
va
ac
he
part
around
to
nerve.
as
E.
pubc
wegt.
posteror
he
onguna
pevs
attaces
nner-
nerve
neror
bear
he
nvove
anteror
pudenda
pudenda
or
answer
system
Anatomcay ,
te
does
nerve
o
enters
nerve
he
not
bock.
N
prostate
reproductve
It
were
o
A.
5.15).
hese
480–488;
he
and
uterus
Fg.
D.
pudenda
GAS
te
to
ur-
ng
excepton
oramen
pudenda
ead
structures.
somatc
ram.
gament
can
uterne,
289
(nnervated
oramen
scatc
sacrospnous
and
as
B.
tese
a
nerves).
ventra
t
we
procedure
o
s
wt
majus
to
as
proapse.
ts
nerve
gentoemora
rom
attac
ABR/McM
perneum
abum
o
ntegrty
360;
pudenda
te
tat
recta
am
te
N
Perineum
ncontnence
and
he
mantanng
GAS
musces
eca
badder,
B,
and
wt
te
te
s
a
to
and
te
tckenng
te
mdne
sympyss.
pens
and
dartos
ten
asca
suspen-
rom
he
te
ga-
untes
and
ormng
te
septum.
C,
E.
hese
structures
are
case.
GAS
pens
superca
n
ASIS
279
te
pubc
te
te
appendectomes.
502;
N
349;
ABR/McM
230
not
damaged
n
ts
CHAPTER
87.
A.
he
nerve
upper
te
and
root
men
ventra
he
and
part
rst
te
and
mons
o
te
o
umbar
skn
te
te
pubs
o
te
atera
te
o
skn
B,
te
s
over
scrotum
and
cutaneous
C,
n
D.
by
rng,
suprapubc
and
branc
wc
o
per-
dvdes
perces
GAS
91.
nto
about
and
s
te
nterna
2.5
te
cm
above
to
n
atresa
septum
mdde
an
te
dameter
o
B.
he
s
C.
are
rom
tan
one
most
patent
Most
n
and
o
te
te
pate
he
sma
to
n
80,000
te
to
te
vagna
arge,
nerve.
resuts
92.
vagna
o
Faure
o
ng
nerve
te
ndrect
te
n
or
te
B,
C,
be
nguna
erna
resut
o
te
rom
septum,
coaca
abnorma
resutng
nto
n
E.
D,
any
474;
ovares
rom
pevc
D,
E.
s
N
brm
At
te
atera
pevc
ovaran
n
vesses
tat
mbra
portons
o
org-
vesses
end
o
B,
gament
to
s
accompaned
remanng
gaments
E.
o
to
te
and
C,
A.
vesses
nterna
runs
nerory
as
ac
o
andmark
t
enters
artery
as
te
te
by
ts
nto
t
org-
te
pevs.
descends
past
suc
ts
as
t
288
here
te
urorec-
coaca
urogenta
tract
and
anus
deects.
ncude
and
no
traceo-
cardac
as
here
s
mperorate
o
mperorate
may
deects.
st
tat
s
deects
between
no
assoca-
assocaton
wt
292
s
ess
used
common
cncay
N
GAS
95.
A.
nous
ts
to
tan
obtan
an
per-
ascae
as
a
eca
and
as
ventra
scatc
does
atae.
te
289,
o
not
ocatng
source
orgnate
t
exts
greater
gutea
runs
te
exts
to
gutea
pevs
scatc
remanng
ac
and
superor
Ineror
te
argest
between
S1
te
ac,
te
nterna
o
oramen
A.
s
passes
ramus
nterna
t
290
te
prorms,
ABR/McM
part
o
te
te
te
mus-
artery,
neror
troug
to
te
oramen.
vesses
281,
traverses
te
deecaton
289
evator
anorecta
ange
proxma
remanng
or
an
group,
ange
and
Reaxaton
between
porton
or
te
o
unctons
s
cru-
tereby
njury
to
ampua
te
ncontnence,
musces
ana
o
cana
respectvey.
n
mantan-
ange.
N
343;
ABR/McM
nerve
sacrotuberous
wt
te
contnence.
pudenda
a
by
he
ram.
wc
dvson
te
te
te
anorecta
and
nerve
pudenda
anestetz-
oramen.
384;
n
ventra
artery,
and
o
te
and
respectvey.
ABR/McM
greater
o
cana
transvagnay
brances
o
ocatng
ocatons.
and
decreases
te
bock
used
395;
nerve
446–448;
he
pudenda
mantanng
adng
or
S2–S4
gutea
part
scatc
s
oter
dvson
by
pudenda
suppyng
None
musce
te
done
tuberosty,
spna
te
sacra
o
s
te
posteror
and
rectum
ng
common
N
tensor
D.
to
It
trunk
va
489;
None
crossng
s
not
at
artery
ncompete
common
bock
but
he
te
mantanng
are
ureter
as
E.
nerve
tese
Puborectas,
tus
retropertoneay,
burcaton
mportant
gonada
te
and
GAS
94.
287
ocated
pevs
cose
ts
s
or
mb,
ABR/McM
or
superor
rst
te
ABR/McM
rena
brm.
he
not
270,
ncudng
urnary
rena,
s
exts
provdes
greater
te
abdom-
t
nraprorm
cross
gament
te
as
syndrome
sadde
spne
anteror
te
suspensory
ovares,
and
an
286
Ovaran
te
uterus
deveop.
vesses.
wc
te
artery.
to
ovaran
as
o
pevs
ca
355;
ureter,
rom
meda
te
tube,
ympatcs.
major
470;
pevc
ac
suppy
he
o
te
by
bcornuate
w
285,
aorta.
descend
a
or
umbosacra
ureter.
devod
nates
to
(Faopan)
and
he
supped
and
one,
(cornu)
ABR/McM
abdomna
brm
ovary
353;
are
te
nerves
GAS
N
oter
orn
376;
480–488;
he
te
te
wt
ac
abnorma
and
transcutaneousy
ces,
wt
nterna
deveopment
n
anorecta
pudenda
artery,
urogenta
or
a
use
N
sca
branc
parts.
rudmentary
artery
brm
abnorma
atresa.
epsotomy.
eter
GAS
93.
urorecta
separaton
anorecta
o
and
te
ABR/McM
resuts
anestesa
n
ng
vagnas.
anomaes
o
an
o
may
to
vertebra,
ea
452;
te
rom
cause
hs
Pudenda
n
tere
uterne
ureter
but
nea anestesa durng te na stages o abor or preced-
orce.
common
A.
resuts
and
te
artery
atresa.
te
vares
to
abnorma
VATER
wt
appearance
orce
or
abnormates
assocaton
epdura
women.
juncton
perorate
n
ts
GAS
transverse
vagna.
Varatons
common.
very
1
at
but
230
pate
cava
ac
231
Perineum
adjacent,
externa
pevc
382;
eadng
urogenta
pudenda
te
N
rom
D.
not
te
te
o
vagna
anorecta
na/pevc
It
trds
A
te
atera
assocated
B,
wt
uterne
A.
ocated
te
vagna
vagna.
occur
usuay
A,
tg.
228,
te
455;
does
he
A,
s
te
nnervates
s
past
anorecta
prorms
nate
te
o
380,
Growt o one paramesoneprc duct s retarded and
GAS
B.
o
approxmatey
processus
ncompete
o
branc
te
ymen.
deveopment
E.
a
part
ABR/McM
o
superor
end
ymen
more
391;
septum
mperorate
te
(S2),
(bockage)
and
neror
N
upper
canazaton
occurs
Usuay,
ureter
s
ea
atera
nerve
o
vena
compartments
te
480–488,
neror
esopagea,
nerve
te
anorecta
ton
Faure
te
septum
he skn o te pens (or ctors) s many supped by
D.
to
separaton.
apo-
dstrbuted
mmedatey
reaton
Most
anus
regon.
cutaneous
C.
ta
peroratng
obque
nguna
L1,
E.
dorsa
to
not
n
he
he
te
Atoug
and
ocaton.
abum
D.
on
E.
meda
cose
brances.
branc
cutaneous
emora
superor
nerve
abdomns,
externa
superca
s
spna
cutaneous
neuross
skn
nerve
o
anteror
becomes
GAS
90.
te
te
to
descends
obque,
skn
89.
o
tg,
anteror
transversus
anteror
te
branc
te
coverng
ramus
te
atera
te
o
and
a
dstrbuted
women.
orates
88.
part
pens
skn
s
are
oypogastrc
te
C.
nerve
bers
te
te
n
he
Its
meda
o
and
majus
B.
onguna
(L1).
Pelvis
4
an
passes
gaments.
nterna
andmark
as
t
s
281
between
approac,
easy
te
Wen
te
papated
sacrosp-
perormng
sca
spne
s
transvagnay.
232
C H A P T E R
C.
he
4
Pelvis
sca
B,
D.
ror
ac
spnes
E.
he
vertebra
and
s
GAS
96.
D.
cana
s
nerves
B.
te
carry
pevc
he
N
te
te
tey
most
be
pudenda
to
procedure
papated
s
n
Answers
99.
cannot
be
te
are
o
te
transvagnay,
nerve.
A.
present
wt
occurs,
t
ture,
289,
A.
290
ncudng
he
sacra
sympatetc
te
nerve
bers
to
B.
Mecke
on
spancnc
nerves
nerves
to
te
ypogastrc
carry
pexus
D.
organs.
s
an
upper
he
onguna
meda
486–488,
te
tg
510;
perneum,
suppy
deep
te
nguna
scrotum
and
N
and
nodes.
woud
te
gans
to
te
to
pens
skn
skn
superca
B.
deep
hese
to
te
pens
Externa
ac
and
nodes
te
receve
nterna
ymp
ac
te
B.
te
as
he
suc
common
he
axary
ac
and
te
externa,
nterna,
C,
nodes.
nodes
dran
te
upper
mb
and
abnorma
N
343;
tuberce
ABR/McM
ectoderm
and
more
ruptures,
te
aspect
te
o
s
a
GAS
nadequate
more
dorsay
pens.
snus
n
wa
te
dorsa
te
to
As
a
open
o
te
tere
te
B.
o
o
luds
rup-
between
tests
o
sur-
nto
deveopment
te
wa
o
were
umbca
cord
abdomen.
233,
285
cranosacra
pevc
outlow
spancnc
rom
and
ormed
anatomca
ndngs.
te
orgn
are
te
abdomna
te
te
ave
deectve
ABR/McM
are
aferent
te
enter
nerves.
ventra
te
ram
sacra
o
pexus.
recta
as
bers.
gentas
provde
nnervaton
reguatng
controng
motty ,
as
spancnc
umbar
on
te
a
C.
dorsa
te
te
we
to
vodng
nterna
as
soud
spancncs
and
n
D.
te
part
vdua
te
reproductve
an
accumuaton
possesses
a
condton
n
wc
organs
te
sexua
pe-
o
te
uretra
unctons
or
not
be
sacra
conused
spancncs
E.
nd-
bot
s
o
serous
lud
Hypospadas
surace
o
te
te
ureter
te
urnary
s
a
uretra
pens.
termnates
E.
at
openng
on
te
Ectopc
ureter
anoter
ocaton
512;
N
363;
ABR/McM
wen
oter
badder.
459–461,
ventra
occurs
278
tan
aferents.
N
rom
ABR/McM
pregangonc
medate
derve
398;
are
pene
te
erecton.
pevc
271,
282
parasympa-
Its
pregan-
spancnc
nerve
he gans pens receves ts suppy rom te puden-
nerve.
he
externa
he
uretra
somatc
nterna
he
are
spncter
nerve
uretra
tetc
GAS
102.
E.
cs
he
tat
caed
s
nnervated
te
spncter
he
dferent
gands
nervous
(GAS
Fg.
scrota
pudenda
receves
by
a
nerve.
parasympa-
w
rst
externa
s
va
N
te
398;
draned
empty
nguna
te
cavernous
nnervated
by
neror
te
nerves.
sympa-
ypogastrc
5.16).
510;
skn
rom
are
system
486–488,
superca
A.
very
semna
pexus
ydrocee
510;
tetc bers aso rom te neror ypogastrc pexus,
o
o
vscera
nerves
tat
bers
vountary,
urnary
deect
genera
486–488,
wc
s
GAS
CT
ernate
spancncs
te
bers
da
membrane
between te tunca vagnas pareta ayer and te tests.
D.
or
(S2–S4).
genta
protrudng.
Hermaprodsm
An
umbcus
vagnas
not
anteror
segments
and
Cavernous
gonc
consequence,
badder
A.
tetc
between
urnary
s
sde
genta
te
urogenta
w
wc
wt
o
nteracton
dorsay.
Exstropy
condton
on
eads
ocated
urogenta
are
uretra
101.
sexes.
C.
te
rom
ter
pevc
and
281
deveopment
mesoderm
abdomna
uretra
te
te
or
deveopng
te
o
Durng
deectve
tuberce
te
openng
pens.
anteror
tey
stuaton
erecton.
wt
A. Epspadas s te correct opton. Epspadas descrbes
badder
cysts
wc carry pre- and postgangonc sympatetcs
446–448;
wen
as
D. he
cest
wa.
te
344;
badder,
spncter,
GAS
B.
pevc
vscera
te
and
te
te
take
he umbar/atera aortc nodes receve ymp rom
organs
n
outsde
spna
urnary
abdomna
I
te
extra-
Uraca
ever.
te
an
nected,
dvertcuum
do
components
vscera
vc
pevc
organs.
o
nerves
as
hey carry bot pregangonc parasympatetc bers
nguna
rom
rom
and
resut
o
N
sacra
S2–S4
we
nguna,
456;
he
and
tunca
Mecke
eum
(parasympatetcs)
arteres
te
B.
pan
te
descrbed
tey
regon.
owever,
te
testes.
and
musces
GAS
100.
290
drans
o
o
area.
289,
accordng
Superca
dran
te
pernea
ABR/McM
drans
so
suppes
anteror
398;
ymp
area,
nerve
nodes.
te
cyst
presents
accumuaton
o
are
E.
umbca
troug
te
vscera
and
98.
te
Ompaocees
te
autonomc
are
dsta
It
o
between
pertonts.
ayers
reatons
pregangonc
pevc
te
dran
to
Hydrocees
roundng
spancnc
te
abdomna
may
two
n
remnants
occurrng
badder.
asymptomatc;
eadng
te
ana
embryoogca
uracus
urnary
mass
generay
are
te
and
pertonea
papated
pudenda
porton
papated
umbcus
supe-
nerve.
perneum
postgangonc
wt
neror
ABR/McM
te
posteror
o
were
te
E.
cysts
abdomna
tat
D.
Uraca
regon.
In
A,
99–105
E.
organs.
superor
GAS
C.
te
easy
pexus carryng sympatetc nnervaton to te pevc
te
97.
s
pudenda
pevc
he
and
assocated
cannot
parasympatetc
C.
be
epteum
not
393;
suppy
va
wen
can
posteror;
are
te
480–488;
t
neror
coccyx
near
Nerve
te
are
and
coumn,
not
used
as
ossa.
posteror
transvagnay
nerve.
s
externay
scoana
he
Perineum
tuberosty
perormed
te
and
nto
ABR/McM
by
te
291,
superca
orzonta
292
ympat-
group
o
nodes.
ac
nodes
recevng
ympatcs
structures
beow
te
are
rom
deep
deep
umbcus,
ymp
nodes
abdomna
te
pevc
wa
vscera
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
superca
and
deep
nguna
GAS
ymp
nodes.
B.
he
dran
perneum,
and
te
posteror
C.
atera
ymp
he
GAS
495,
are
v s c e r a,
dran
o
n to
nod e s
as o
d ee p er
te
d eep
par ts
uretra.
um bar
d ra n
nodes,
o
he
y mp
te
te
te stes
node s ,
rectum
ovares
nodes
ymp
and
dran
nodes
oter
te
N
390;
rectum
ABR/McM
drans
pevc
wa.
514;
nod e s
an d
103.
E.
376
and
poste-
Durng
ac
A.
B.
gaton
he
artery,
ment
be
ysterectomy,
proper
uterus.
te
organs.
tissue
5.16
wa .
aortc/umbar
sacra
pevc
n od e s
par ts
sacra
ac
ror
pevc
pevc
he
D.
ac
and
ovare s
we
erectile
by
nterna
tat
Fig.
to
o
he
uterne
s
te
gated
o
to
te
n
te
nundbuopevc
suspensory
ses
and
s
a
Durng
mstakeny
te
arteres
artery,
anteror
uterus.
emostass
te
atera
branc
ureter
be
o
ensured
suppy
te
te
nterna
n
te
broad
ga-
surgeres,
te
ureter
may
pace
o
te
gament,
gament,
ocated
may
tat
aso
contans
to
te
uterne
te
ureter
artery.
known
ovaran
n
te
as
ves-
pevs.
he ovaran gament attaces te ovary to te atera
and
superor
tat
s
and
part
contaned
as
no
drect
o
n
te
te
uterus.
broad
reatonsp
It
s
a
gament
wt
te
brous
o
te
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
mesosapnx
tat
stretces
s
te
rom
part
te
o
ovary
te
to
broad
te
gament
uterne
D.
tube
he
ogc
no
E.
round
gament
remnant
drect
o
te
o
te
uterus
s
gubernacuum
reatonsp
wt
te
an
embryo-
ovary
ureters
and
(GAS
as
Fg.
5.12A).
GAS
104.
A.
he
drans
B.
472;
he
N
382;
rom
ABR/McM
te
superca
ymp
sacra
C.
te
rom
neror
nguna
te
dsta
287,
part
288
o
te
ymp
ne
drans
E.
Fg.
he
ana
cana
nodes.
495,
4.5
rectum
drans
to
te
nodes.
mesenterc
ng
and
ten
to
te
umbar
nodes.
answer
te
ana
514;
rectum
groups
at
drans
to
te
part
495,
Fg.
above
te
pevc
are
as
nguna.
o
te
and
376
sowng
nguna
oows
ac,
A=Lumbar,
typcay
nodes,
so
N
388;
ABR/McM
severa
regon.
D=Deep
E
s
5.79).
514,
pectnate
Magnances
vagna
ymp
te
nodes.
ABR/McM
C=Externa
nguna
(GAS
388;
ac
ympangogram
groups
ac,
cana
nterna
N
a
ower
GAS
proxma
te
E=Superca
superca
nodes
rom
to
ympatc
te
5.55
te
depcts
B=Common
and
he ymp rom te sgmod coon drans to te ne-
ror
he
GAS
105.
rom
Fig.
nodes
ympatc
ymp
to
ymp
sacra
above.
D.
he
GAS
376
ac,
nvov-
nvove
te
te
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-od woman s brougt to te emergency depart-
ment
30
mnutes
coson.
njures.
Se
aceratons
o
te
A.
sgns
sows
o
se
appears
Vta
examnaton
ater
over
oowng
to
be
are
no
te
was
nvoved
we
and
wtn
abnormates
nnervates
a
motor
wtout
norma
quadrceps
nerves
n
oter
emors
ts
any
mts.
B:
vece
emors
major
tear
Pysca
tan
a
ner ve.
mus ces
turator
musce?
te
vaton
B.
Femora
branc
C.
Obturator
Sapenous
Third
E.
Tba
3.
te
vece
A:
Ony
rs.
he
emora
scatc
nerve
nerve,
nnervates
speccay
te
te
quadrceps
tba
part,
emo-
suppes
er
wtn
gves
te
A.
Mdde
B.
Latera
C.
Superca
A
Order
22-year-od
er
30
coson
wtn
tat
se
owng
cannot
nerves
Scatc
B.
Femora
C.
Obturator
musces.
s
brougt
ater
er
et
appears
mts.
extend
most
se
er
and
to
to
was
be
rgt
we,
Pysca
rgt
key
te
emergency
nvoved
eg
and
n
a
pnned
er
Wc
o
s
quad r cep s
va
te
s
he
com p ar tme nt
s up p y
a
by
m o to r
s e nsor y
p a-
te
po s te ro r
comp ar tment.
not
te
sup p ed
s up p e s
me d a
b ut
te
tb a
ob-
and
nne r -
(c utane ous )
n e r ve .
cannot
rse
wt
Se
to
er
brougt
mts.
o
se
et
appears
extend
wc
s
ater
er
te
and
to
to
was
be
rgt
we,
Pysca
rgt
emergency
eg
n
a
motor
pnned
and
er
under
vta
examnaton
knee.
oowng
te
nvoved
he
afected
cutaneous
sgns
sows
nerve
nerves?
cuna
emora
cutaneous
buar
D.
Sapenous
E.
Deep
buar
under
vta
examnaton
knee.
motor
sgns
sows
te
o-
afected?
Explanation
D: he sapenous nerve s a cutaneous branc o te emora
nerve
great
o
and
s
rom
emora
nerve
are
suppes
sapenous
posteror
ous
nerve
Sapenous
ram
L2
nerve
brances
te
ven.
to
o
L3
S1
te
to
and
branc.
o
skn
on
Mdde
te
S3.
te
Latera
and
buar
eg
nerves
umbar
Superca
common
meda
cuna
aong
are
emora
pexus
deep
te
brances
but
cutane-
s
buar
not
a
nerves
nerve.
nerve
Q u e st i o n s
Questions
te
1–24
42-year-od
ment
30
man
mnutes
vece
coson.
severa
deep
o
s
brougt
ater
He
s
te
and
great
e
to
te
was
treated
aceratons.
dorsexon
extenson
236
any
nerve
Tba
tat
suppy
nerve
E.
A
Se
s
D.
Main
wt
norma
A.
1.
woman
mnutes
motorcyce.
are
not
Question
department
vece
does
te
d oe s
mnutes
norma
tat
nerve
ner ve
by
te
group
an te r or
woman
30
he obturator nerve suppes te meda compartment and
sapenous
te
emor a
coson
se
s c at c
ner ve
motorcyce.
are
m us c e
out
to
Question
te posteror tg musces not te anteror compartment.
Second
2.
te
carr e d
attaces
musc e s
22-year-od
department
Explanation
s
supp e s
any
o
Order
A
he
not
ne r ve
to
kn e e
w c
hs
sapenous
Scatc
D.
te
gament.
tg
Wc
o
musce,
emora
coupe
musce.
Extenson
nvoved
or
Pysca
nverson
toe
are
very
emergency
a
pevc
n
depart-
a
racture
examnaton
o
te
weak.
motor
et
and
sows
oot
Sensaton
and
rom
dorsum
aspect
o
norma.
o
te
o
te
te
oot
he
oot
oowng
A.
he
B.
L5
oot,
as
s
and
S1
trunk
spna
o
ost
everted
structures
umbosacra
oramna
skn
been
te
and
s
at
nerves
soe,
and
key
nea
torn
at
and
te
patear
pantar
most
te
te
exed.
atera
reex
s
Wc
njured?
termnas
te
ntervertebra
CHAPTER
C.
Fbuar
neck
D.
(peronea)
o
Scatc
te
E.
2.
A
Tba
ment
nerve
Ater
wt
te
sows
a
te
n
beedng
tat
te
o
durng
pysca
Reducton
o
te
te
scatc
poptea
brougt
as
been
ventra
te
greater
at
te
scatc
oramen
ossa
to
te
stab
emergency
wound
stopped,
ramus
oowng
o
w
o
MRI
L4
depart-
te
o
as
most
pevs.
s
pevs
been
key
tran-
be
seen
examnaton?
or
te
oss
o
sensaton
rom
te
meda
eg
B.
Loss
o
sensaton
over
te
rgt
C.
Loss
o
sensaton
over
te
upper
D.
Loss
o
sensaton
over
te
mdde
E.
Loss
o
nerve
regon”)
beedng
rgt
Wc
aspect
s
deep,
at
gutea
te
man
sected.
A.
njury
to
23-year-od
o
237
Limb
bua
nerve
(“doorway
dvson
Lower
5
sensaton
over
te
tte
toe
meda
tg
toe
posteror
aspect
o
te
knee •
3.
A
30-year-od
ment
20
vece
deep
ew
s
te
o
days
o
B.
Saggng
n
o
C.
Droopng
D.
Weakened
E.
Dicuty
A
ce
to
40
ton,
o
et
afected
et
eg
n
a
te
C.
Superca
D.
Sapenous
E.
Deep
tay
te
C.
Deep
D.
Sapenous
E.
Obturator
p.
patent
gat
meda
A
and
rotaton
key
to
6.
sow
rom
a
sttng
A
we
standng
ony
s
on
te
pevs
we
standng
ony
on
s
rom
a
e
was
p
to
te
racture
An
dsta
nerves
In
(Fg.
x-ray
to
a
e
a
depart-
motor
s
5.1).
neck
most
ve-
not
supne
abe
pos-
Everson
examnaton
te
s
n
sows
mb.
pantarexed
ntact.
emergency
nvoved
afected
poston
o
te
key
o
o
s
bua.
njured?
e
o
te
s
most
key
be
Superca
Latera
C.
Deep
D.
Tba
stor y
o
a
examnaton
o
nto
te
o
pass
tg?
te
o
panu
o
abdomna
to
pyscan
ump
o
te
openngs
to
w
rom
te
because
er
sows
beneat
appears
extend
n
abdomen
aspect
bowe
oowng
troug
te
vscera
meda
te
te
te
te
a
er-
nguna
anteror
be
gron.
department
wt
anke
wegt
on
o
sweng
severe
o
anded
because
sows
wc
and
he
te
o
oowng
afected
severe
te
tenderness.
te
wt
roed
I
pan.
meda
a
reated
nerves
woud
buar
te
atera
and
o
sows
o
n
et
An
and
procedure
Wc
pevs
te
se
aspect
sortenng
tssues
mark
woman
ater
o
emur.
A
Guteus
C.
Ineror
D.
Prorms
E.
Quadratus
et
pevs
gemeus
gemeus
emors
and
o
tota
o
p
te
reac
o
s
et
An
racture
o
o
s
and
te
consdered
area?
wt
o
er
te
per-
superca
perormed,
ts
eg
artropasty
neck
ard
Pysca
x-ray
overyng
s
te
musces
emergency
anded
tg.
te
ntracapsuar
exporaton
medus
te
and
poston.
muscuature
to
to
bcyce
rotaton
dvson
oowng
Superor
a
supne
an
contnues
te
te
te
brougt
rom
sow
nta
surgca
s
e
atera
n
gutea
B.
nto
bearng
possbe
pt.
s
ag
Sura
A.
abdomen
payers
by
payng
buar
tg.
n-
oter
pyscan
We
sura
rreducbe.
erna
te
njured?
68-year-od
ormed.
to
anke
to
spran.
unexpected
ten,
ractured,
B.
on
anke
over
an
been
A.
A
brougt
an
examnaton
bone
neck
comes
over
Snce
as
s
o
jumped
oot
not
tg
woman
boy
oot
some
buar
openng
because
rgt
rng
rng
cana
outward.
E.
7.
nguna
nguna
Pysca
jont
standng
examnaton
te
s
rgt
brougt
ater
s
te
rng
16-year-od
moter
poston
buar
ernaton
Wc
Superca
examnaton
2-week
he
and
most
Femora
B.
buar
55-year-od
gament
s
te
waddng
A.
ootba,
at
oowng
Tba
naton
patent
pevs
sttng
oot
Common
Pysca
rgt
te
sows
aspect
on
oot
B.
o
a
abducton
rgt
Pysca
A.
A
te
man
sows
o
et
exon
wegt
te
Wc
te
.
motor
mb
mnutes
te
o
treatment,
exbts
a
beneat
examnaton
part
and
n
caugt
Fig.
depart-
mb
coson.
bear
emergency
nvoved
p
upper
standng
te
45-year-od
ment
he
was
Pysca
e
perorm
ower
et
and
te
oowng?
Dicuty
te
5.
to
A.
rgt
te
to
rgt
stabzaton
tg.
te
e
s
scene.
o
wak,
rgt
ater
te
ater
to
nabty
te
wc
4.
at
brougt
wt
aceraton
asked
s
mnutes
coson
motorcyce
a
man
as
te
emur.
a
and-
238
C H A P T E R
8.
A
Lower
16-year-od
ment
s
ten
te
wound
rst
Poptea
B.
V ertca
Deep
D.
Horzonta
E.
Interna
3-mont
o
and
arge
nerve
man
n
te
o
tat
superca
o
a
n
ump
cystc
Dorsexon
n
o
o
o
ossa
w
te
te
dgts
te
eg
E.
Pantar
exon
o
mb.
he
aspect
o
ymp
no
wound?
department
put
was
tat
oot
Pysca
njured
Meda
B.
Anteror
Latera
D.
Posteror
E.
T endon
ong
ossa
knee
key
n
s
poptea
a
te
e
ts
sows
because
o
artera
to
a
o-
s
o
brougt
knee
atera
s
pan.
sde
ground.
o
He
unabe
structure
woud
te
In
s
et
to
sows
to
to
a
Meda
A
a
just
poppng
key
brougt
15.
to
30-mnute
angograpy
te
emergency
story
sows
occuson
o
o
cest
depart-
pan.
myocarda
te
A
anteror
pan
eg
coronary
and
and
vested.
bypass
oss
oot
o
on
Wc
ven.
bypass
sensaton
te
mb
nerve
grat
procedure
Postoperatvey,
was
on
te
te
meda
rom
wc
most
key
te
usng
surace
grat
njured
part
Frst
D.
Ineror
to
te
er
dorsas
pyscan
rgt
peds
tomograpy
te
provde
o
bood
puse
(CT)
te
adductor
oot.
suppy
and
to
cod
angograpy
emora
cana.
because
Pysca
artery
Wc
te
eg
n
artery
troug
A
Descendng
mb
sows
an
was
seres
at
Ineror
Frst
C.
Meda
D.
Obturator
E.
Superor
rsk
te
Femora
B.
Obturator
most
Common
D.
Tba
Tba
et
to
te
wegt
sorter
o
on
Pysca
te
et
te
patent
afected
and
te
p
neck.
te
examnaton
eg,
tan
emergency
he
te
rgt
sow
an
Wc
et
ower
extra-
artery
s
njury?
branc
o
deep
emora
emora
wt
rgt
advanced
because
sows
tg
mb.
key
wakng
C.
E.
o
emora
ospta
ower
A.
njur y.
emora
batroom.
bear
x-rays
carcnoma
te
Sapenous
to
be
te
examnaton
rgt
D.
to
or
man
te
badder
Latera
emora
gutea
to
o
C.
o
ncdent.
crcumex
o
E.
deep
gutea
56-year-od
Common
o
er
rotated
pan
peroratng
aspect
A
o
racture
B.
Superca
te
brougt
n
abe
te
appears
key
B.
not
ater
mb
te
o
branc
s
ang
externay
A.
A
woman
ater
se
ower
A
branc
gencuar
75-year-od
tat
emora
gutea
ar-
16.
o-
njured?
n
occuson
o
peroratng
s
buar
pan
weak
crcumex
n
te
sows
te
anastomoss?
resut
durng
o
(sprng)
comes
o
computed
key
C.
A.
sura
sows
A
nerve
o
was
Wc
(detod)
woman
story
te
surgery?
buar
coatera
as
patent
atera
anke
Meda
undergoes
a
exam-
te
Descendng branc o te atera crcumex emora
te
sapenous
te
te
avod
B.
Pysca
nter-
key
over
o
sweng.
on
to
A.
ventrcuar (et anteror descendng) artery. he patent
great
most
admtted
narc-
most
x-ray
tryng
Pysca
sweng
An
pyscan
e
pantar
gencuar
most
gament?
tssue
trombotc
capsuar
aso
s
anke.
we
practce.
and
te
e
taobuar
proxma
mb.
va-
n
to
ater
pantar
oot.
ower
wtout
nverted
opponent
sot
comes
anke
cacaneonavcuar
6-week
a
oot
afected
72-year-od
says
mock
postve
most
ts
a
knee
wak
a
emer-
gament
compete
E.
te
gament
s
Sort
w
afected?
semtendnosus
man
Long
D.
te
menscus
o
C.
et
tenderness
gaments
Anteror
payer
s
et
but
department
attacment
crucate
te
Pantar
sows
An
oot
te
an
B.
rgt
supne
te
o
n
s
examnaton
sows
adjacent
o
by
A.
o
story
ossa
Wc
be
13.
tgt-
exed.
an
a
wt
racture
E.
examnaton
crucate
69-year-od
due
to
and
o
ootba
pan
sows
owng
menscus
C.
coronary
ten,
Wc
due
A.
a
compressng
payer
on
on
Snce
test.
as
vertcay.
because
t
assstance.
stress
pan
examnaton
te
te
because
o
tacke
naton
14.
te
ootba
sensaton.
ton
a
oot
o
ment
te
tg
o
e
He
poptea
most
Extenson
A
ground
and
nected
knee
22-year-od
ever
group
pyscan
rgt
te
Extenson
19-year-od
te
structure
te
te
to
wen
D.
be
ater
A
because
nguna
Pysca
C.
gus
12.
o
sutured,
days
g
sde
nguna
wakng.
examnaton
Fexon
e
s
ower
te
superca
dsappears
B.
as
Four
Wc
depart-
atera
wound
wt
rom
posteror
movements
practce,
te
afected
ymp
comes
o
descendng
gency
11.
ospta
nected.
group
A.
A
he
dscarged.
osteoartrts.
pure
owng
o
dicuty
utrasound
a
be
emergency
on
ac
presence
poston
s
te
receve
story
cronc
te
to
te
cut
nguna
45-year-od
ness,
to
ootba.
nodes
group
C.
A
brougt
superca
to
appears
A.
s
a
patent
ymp
w
Limb
payng
returns
swoen
nodes
o
we
patent
10.
boy
because
oot
and
9.
5
beng
dicuty
rgt
ower
te
by
meda
adducton
metastass
mb.
te
sensory
s
wakng.
te
n
sows
afected
and
on
weakness
MRI
te
carcnoma
dicuty
numbness
and
An
n
badder
o
o
Wc
tumor
to
dect?
buar
Scatc
15-year-od
depar tment
An
t ba,
by
boy
s
x-ray
and
a
o
s
b rougt
m ote r
s
eg
kne e - g
to
b e caus e
sow 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
te
Se ver a
CHAPTER
weeks
ate r,
numbness
ty
to
17.
tese
ste
Poptea
B.
Neck
C.
Latera
D.
Anteror
E.
Meda
o
o
o
te
s
s
n e r ve
cas t,
r gt
oot.
te
pat e nt
oot
and
W c
com pre ss on
s
as
woud
contnue
nab -
njur y
occurred?
te
t at
to
e
compartment
A.
Prorms
B.
Obturator
C.
Guteus
medus
D.
Guteus
maxmus
E.
Guteus
man
mnmus
o
eg
te
21.
eg
s
te
to
to
a
to
s
gutea
pyscan
standng
nerve
dsorder.
Autopsy
he
patent
tg,
and
receves
regon.
A
because
poston
most
a
key
rom
a
afected
most
seated
by
te
Ineror
B.
Superor
gutea
he
B.
A
C.
C.
Obturator
D.
Nerve
to
prorms
D.
E.
Nerve
to
quadratus
23-year-od
o
a
oot
nng
he
njur y.
mea,
bade
Pysca
te
web
be
se
emors
comes
dropped
te
o
oowng
web
just
sarp,
web
te
at
sender
a
I
to
o
an
ktcen
eve-
jont
ner ve
wc
s
most
deep
emora
er
were
as
structures
te
son
key
o
s
te
Puboemora
Iscoemora
Ioemora
D.
T ransverse
E.
Lgament
D.
Pantar
exon
and
E.
Pantar
exon
ony
te
ands,
dsta
dspaced
damaged
te
part
n
n
A.
Anteror
B.
Fbuar
ts
te
Tba
D.
Patear
E.
Posteror
and
An
durng
a
te
be
he
oowng
matc.
te
pressed
emur.
Wc
pyscan
soccer
odng
can
30
rgt
Pysca
tba
backward
et
tba
gament
was
wt
te
under
cannot
most
s
rgt
sgncant
sock
te
and
des.
meda
exsangu-
crcuatory
autopsy,
at
te
njured
wat
nguna
at
transected
at
emora
be
a te r
Se
exam n at on
on
te
sow s
an
W c
s e
to
was
was
s
te
te
gament
apex
o
te
ts
juncton
wt
was
severed
at
ts
ateray
ndngs
te
a
arge
o
er
racture
oow n g
br u se
p.
o
te
m us ce s
te
wen
te
on
man
te
e
orgn
patent
te
te
pung
Wc
or
o
te
resstng
a
o-
patent
down
terapy,
n
ts
ad
steps
terapst
er
tg
oowng
yperexten-
gament
s
o
man
te
te
s
by
ead
p
rgt
o
te
te
Intertrocanterc
C.
Intracapsuar
D.
hromboss
E.
Commnuted
abe
wt
p
emergency
to
to
oicer
some
o
aban-
wtout
range
pan
sortenng
Fg.
te
depart-
an
mted
because
o
n
ambuate
sows
sown n
wc
and
n
a
5.2. Based on
oowng
cond-
m?
wt
tearng
o
te
gament
emur
racture
emora
o
te
poce
jont
eg
occurred
o
a
not
emur
to
examnaton
rgt
magng,
key
te
brougt
rescued
he
Dsocaton
te
at
pyscan
ago,
se
possbe.
ead
B.
te
o
neck
te
obturator
racture
o
emur
racture
artery
te
extracapsuar
emora
neck
a
unres tran ed
asp e ct
avu s on
e m er gency
n
monts
pysca
acetabuar
rotated
most
te
gament
at
moton
dvded
to
gament
was
ouse.
T wo
supne poston. An x-ray s
key
nvoved
te
sow s
ater a
o
te
e
was
comes
sgncant
Pysca
a
artery
as
o
tons
b rougt
cos on .
trocanter.
ater
o
mn ute s
p
was
aganst
assstance.
A.
tendernes s
o
te
mb.
e
gament
o
75-year-od
doned
knee?
wom an
Pysca
severe
greater
to
crucate
vece
x-ray
comes
coatera
depar tment
drver.
way.
rgt
A
ment
crucate
2 4-year-od
motor
er
23.
coatera
C.
A
o
nverson
tat
tba
on
depart-
ower
jont?
B.
nverson
bot
cut
were
racture
A.
and
ony
knee
and
o
s
ven
most
Inverson
sows
an
njury?
was
Durng
p
Dorsexon
te
ven
muc
C.
o
artery
resstance
backward
B.
njury
resuts
s
woman
neck
C.
examnaton
rapd
crcumex
garage.
everson
woman
o
emora
and
32-year-od
n
emergency
measures,
aceraton
ypovoemc
examnaton.
provdes
and
o
he
Dorsexon
an
20.
meda
A.
A
te
rom
e-savng
vesses
emora
he
s uc
trange
72-year-od
to
on
toes
A
a
mpared?
19.
or
to
beedng
te
sapenous
ow-up
oot.
aceraton
afected
22.
kne.
rgt
second
orgn,
anke
because
o
er
deep
and
te
ts
te
pyscan
space
rst
space.
dsta
movements
te
preparaton
sows
between
te
njured
a
E.
to
te
rst
examnaton
space
by
on
emora
he
orgn
Durng
perced
numbness
to
woman
brougt
sasng
nature
vesse
te
s
resuted
Based
key
A.
gutea
a
oowed
emora
A.
A
sows
coapse.
as
man
massve
wc
naton
week
e
a
approprate
oow-
medcaton
s
te
or
njecton?
18.
or
norma y
239
Limb
nternus
58-year-od
ment
pyscan
menta
njecton
back
rsng
to
antpsycotc
Wc
A
Despte
comes
o
an
comes
poston.
te
maeous
start
dicuty
o
un c t on
most
bua
compartment
to
re suted
ossa
te
ntramuscuar
ater,
e ve r t
te
examnaton
agrees
an
and
o
32-year-od
up
rem ova
dor s um
symptoms?
A.
A
te
dorslex
probabe
n
upon
o
Lower
5
24.
A
45-year-od
10-day
a
box
pan
and
man
story
o
n
te
o
books.
my
sde
comes
sarp
He
tod
backsde,
o
my
to
back
te
te
oot.”
te
pyscan
pan
we
pyscan
back
o
Pysca
e
tat
my
because
was
e
tg,
“et
my
examnaton
o
tng
te
eg,
sows
240
C H A P T E R
5
Lower
Limb
C.
Abducton
and
adducton
o
te
dgts
(atera
our
toes)
27.
D.
Fexon
o
te
great
E.
Fexon
o
te
dgts
A
22-year-od
to
te
pyscan
dsabty
et
knee
•
Fig.
a
sows
bua.
An
be
28.
tat
n
naton
ture.
man
took
a
o
pace
arge
o
o
te
et
rom
a
bruse
te
our
practces
competton
knee
a
to
ago.
dsta
sows
oowng
pan
kck
week
just
eg
toes)
marta
a
arts
and
te
sde
Pysca
to
te
comes
serous
o
ead
o
commnuted
musces
w
s
exam-
most
te
rac-
key
parayzed?
A.
Tbas
anteror
B.
Tbas
posteror
C.
Soeus
D.
Pantars
E.
Fexor
A
(atera
wo
because
x-ray
Wc
toe
and
and
extensor
dgtorum
ongus
gastrocnemus
and
popteus
dgtorum
24-year-od
ongus
woman
and
comes
exor
to
te
aucs
pyscan
ongus
because
.
o a sweng n er gron and persstent ow-grade ever.
weakened
afected
cause
cacanea
sde.
o
te
(Aces)
Wc
o
te
tendon
oowng
s
jerk
te
on
most
te
Se
was
not
been
ton
key
umbar
uctuant
a
L3–4
B.
Dsc
ernaton
at
L4–5
wc
C.
Dsc
ernaton
at
L5–S1
A.
Abducton
D.
Dsc
ernaton
at
S1–2
B.
Adducton
E.
Gutea
crus
syndrome
o
te
scatc
nerve
or
pr-
syndrome
A
55-year-od
department
vece
30
cannot
s
mnutes
coson.
examnaton
se
woman
Se
sows
easy
ater
was
tat
nvert
brougt
te
was
nvoved
patent’ s
A
te
unrestraned
te
t.
se
to
weakness
n
s
oowng
Extenson
D.
Fexon
Meda
A
because
n
ng
o
motor
dorsexon
ceanup
dentay
cut
a
cutter.
and
posteror
brus
to
owng
don reex s brsk. Knee extenson s amost norma, as are
A.
Cacaneus
a
greaty
B.
Fbua
oow-
C.
Cubod
D.
T aus
E.
Navcuar
reduced
ng
on
nerves
te
s
dorsum
most
L2
and
B.
L4
spna
nerve
C.
L5
spna
nerve
D.
S1
spna
nerve
S2
spna
nerve
A
spna
46-year-od
department
te
tat
te
sarp
oot.
It
ave
been
w
A
s
most
s
o
te
Sensaton
over
B.
Abducton
o
41-year-od
o
aong
s
brougt
on
a
entered
tat
er
Loss
ound
by
o
te
urter
o
botte
wound
pantar
wc
emergency
wne
te
posteror
atera
o
te
broken
observaton
as
to
part
o
nerve
te
on
sows
er
may
er
examnaton
te
te
te
pantar
great
toe
surace
o
te
trd
toe
wt
sows
o
te
n
ts
A.
at
ago
sweng
o
asca
a
a
but
as
examna-
n
arge
o
te
er
et
abscess
musce
at
wt
p?
to
as
s
rgt
a.
o
to
te
and
stfness
causng
taus
te
o
te
o
a
te
pan
ong
o
yng
te
rgt
te
o-
or
now
oot.
evau-
story
A
become
te
bade
o
pyscan
te
dur-
acc-
tendon?
as
as
be
te
e
tendon
Wc
meda
woud
a
tat
cty,
wt
or
patent
pan
te
tat
emergency
says
maeo
nserton
te
Wat
o
obquey.
he
and
ead
atera
te
He
anke
sows
comes
soe
area
rgt
and
an
oot.
tereby
oot
o
to
njury.
resdenta
woman
rgt
te
brougt
anke
transected
sweng
tat
nerory,
CT
scan
dspaced
ongtudna
most
o
comes
key
arc
cause
case?
T earng
o
te
pantar
cacaneonavcuar
(sprng)
gament
oowng
rgt?
A.
A
s
an
meda
serves
actvty-reated
steppng
be
Wc
aton
transected.
key
oot.
s
30.
suspected
assumpton
te
Sensaton
nerves
cose
gass
exon.
njured?
woman
ater
sdewak.
o
key
A.
E.
L3
knee
od
back
severey
bones
o
Examnaton
te
s reduced n quaty , atoug te cacanea (Aces) ten-
and
s
te
anke
movements
an
and
Pysca
everted
te
actons
worker
department
a
spread
year
Pysca
rotaton
32-year-od
nverson o te oot s noted. Her psatera patear reex
p
wtn
emergency
drver.
oot
te
C.
E.
29.
25–47
sows
vertebrae
at
a
medcne.
nontender,
ernaton
o
tubercuoss
wt
scan
Dsc
Questions
26.
a
CT
A.
orms
25.
A
wt
compant
sows
gron.
ndng?
dagnosed
B.
Fracture
C.
Interrupton
o
te
D.
Spran
o
te
anteror
E.
Spran
o
te
meda
o
cubod
te
bone
pantar
aponeuross
taobuar
coatera
gament
(detod)
gament
CHAPTER
31.
A
21-year-od
because
game,
e
aganst
was
te
bocked
by
a
emergency
Durng
nebacker,
wo
trew
mse
owng
abe
a
gaments
Pantar
E.
Long
A.
Fbuar
B.
Anteror
C.
Latera
D.
Fbuar
E.
A
An
te
coatera
te
passng
part
te
o
36.
A
ment
gament
eg.
coatera
and
posteror
crucate
gament
ness
woman
story
tat
routnes
mbs
eg,
oowng
Deep
B.
Poptea
o
pan
mb
te
sows
te
knee
comes
o
er
n
te
to
n
eat
aperture
arteres
s
te
spa.
pyscan
eg
worse
An
ow
and
te
because
A
durng
er
te
te
o
Posteror
Fbuar
E.
Anteror
Wat
proxma
Wc
A.
A
o
afected?
s
arge,
scatc
Superca
An
man
comes
knee
to
jont.
te
he
pyscan
patent’s
because
story
o
a
37.
sows
A
o
approac
te
s
synova
used,
ud.
and
te
A
standard
neede
passes
because
tat
new
te
Adductor
B.
Sort
onstrate
Rectus
D.
Sartorus
E.
Vastus
and
deep
to
musces
te
patea.
woud
te
hroug
neede
pass?
o
emors
wakng
comes
and
examnaton
ntatng
gat
exon
o
ordered.
afected
A.
Common
B.
Deep
C.
Superca
D.
Tba
to
pan
sows
rom
responsbe
te
a
or
eg
Wc
te
at
pyscan
te
tat
te
back
s
te
suspected,
te
te
as
poston.
unockng
o
o
patent
standng
because
knee
and
oowng
an
o
knee.
a
prob-
A
mus-
jont
to
magng
nerves
nner-
musce?
s
buar
emergency
codness
cyanoss
n
an
posteror
gutea
o
depart-
s
and
rgt
tender-
sows
tat
te
unusua,
area
aberrant
branc
rater
compartment
and
appearng
te
te
o
neror
te
o
contnuous
poptea
artery.
artery?
o
te
deep
emora
gutea
meda
artery
crcumex
emora
o
an
spran.
down
Yesterday,
ard
examnaton
tenderness
on
on
sows
te
te
te
s
sot
pyscan
patent,
anke
meda
comes
weakness
e
was
to
e
dropped
soe
gutea
o
te
artery
atera
nverson.
a
to
te
sarp
vece.
sensaton
and
emergency
rgt
rom
et
te
n
te
te
attemptng
automobe
dects
branc
o
marked
Wat
s
38.
ernaton
at
L1–2
ernaton
at
L2–3
C.
Dsc
ernaton
at
L3–4
D.
Dsc
ernaton
at
L4–5
E.
cr-
ower
t
one
ground
pan
n
Pysca
on
te
He
sde
to
n
key
o
dem-
s
back
examna-
mddorsum
weakness
most
depart-
mb.
o
dorsexon
nature
o
s
Dsc
ernaton
at
L5–S1
A 43-year-od woman comes to te pyscan because o
6-mont
as
pan
and
story
n
pan
ton
a
durng
tssue
aspect
o
and
nvoved
er
A
sde
and
s
wt
te
te
o
a
rst
n
says
nerve.
key
space,
everson
o
Weakness
to
C.
Foot
pantar
te
Wc
ound
com-
o
eg
extenson
n
adducton
at
te
knee
drop
and
D.
Weakness
he
E.
Loss
o
sensaton
n
te
o
te
tg
meda
aspect
o
te
te
durng
ex
n
o
entrap-
examnaton?
B.
se
mb
examna-
web
prorms
compresson
most
Se
afected
Pysca
te
weakness
scatc
aso
mb.
o
over
dagnoss
o
eg
ntercourse.
made,
condtons
ower
and
sensaton
dvson
basketba
anke.
s
n
tg,
atera
syndrome
buar
Inabty
matc.
pan
sexua
oot.
A.
te
o
p,
reduced
because
sweng
te
te
durng
sows
pysca
to
man
Dsc
mon
comes
superor
artery
Dsc
ment
buar
man
te
B.
te
Femora
32-year-od
o
A.
oowng
A
severe
o
strengt,
and
anke
dorsum,
buar
came
An
o-
njury?
ateras
man
oot
and
bceps
emors
34-year-od
Pysca
s
magnus
ead
C.
to
oowng
A.
payer,
te
utrasound
descendng
eectrc
sows
proxma
anke
to
and
seen
peroratng
o
we
ton
E.
o
branc
51-year-od
ment
datey
te
s
norma
emora
qucky
vates
a
enarged
and
s
te
njured?
sows
te
te
branc
E.
rom te atera aspect o te tg nto te regon mme-
study
pan
n
n
branc
D.
cumex
cuture
suprapatear
permt
vesse
t
T ransverse
s
bactera
njury
brougt
Dopper
dentty
A
or
ce
s
eg.
wt
te
C.
says
em
eg.
o
(detod)
severe
arsng
B.
tba
swoen
Pysca
afected
Wc
artery
tba
43-year-od
dicuty
key
occuson
arge
tg,
cronc gonococca artrts. A knee aspraton s ordered
A
te
artery
D.
o
most
on
racture.
examnaton
rgt
nerory
artery
emora
C.
wc
o
trombotc
tortuous,
te
wegt
emora artery o te afected mb termnates mdtg.
angograpy
n
Pysca
te
bua.
man
because
o
put
241
Limb
pantar
beow
troug
present
key
afected
rgt
gets
tba
most
be
te
er
pan
mnma
between
w
s
coatera
23-year-od
crucate
troug
panu,
to
posteror
A.
A
subject
knee?
gament
gaments
te
te
and
says
ower
requenty
menscus
3-mont
Se
s
aganst
gament
crucate
82-year-od
a
orce
to
bmaeoar
D.
structures
o
knee.
not
Wc
type
et
s
sows
Sprng
oowng
recever’s
x-ray
meda
ts
te
patent
ootba
C.
te
o
depart-
a
B.
rom
aspect
te
pan.
naton sows sweng and tenderness over te knee jont.
o
atera
to
knee
recever grasped s knee n obvous pan. Pysca exam-
workout
35.
brougt
T aonavcuar
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
musces
on
s
been
te
ad
scans
been
musces
s
by
Rectus
emors
C.
Guteus
D.
Prorms
E.
Quadratus
wt
18t
tat
t
a
adpose
o
tssue.
gutea
nerve
repacement
tat
rom
nerve
o
te
repace-
arger
he
coud
superor
oss
not
o
bood
deat
Dr.
prmary
wt
Jon
can
and
artery
o
te
saey
Hunter
te
be
very
sows
he
patent
and
room.
and
potenta
and
tg
oss
efectvey.
(1728–1793)
s
burst-
o
In
43.
Foot
C.
Dorsexed
D.
Pantar
E.
T ota
ong
er
surgcay,
Fg.
5.3
wt
tat
s
treat
te
saety.
reated
aneurysm
Wat
to
s
n
te
structure
surgca
poptea
s
ossa
ndcated
n
ower
et
owng
ne
cdood
ven
A.
Superor
C.
Femora
artery
B.
Latera
D.
Gracs
C.
A
E.
Adductor
D.
Ineror
E.
Meda
mpactng
sows
on
te
batera
to
ees
stand
and
on
key
s
a
te
o
eet.
wc
aggravates
te
te
emergency
wt
Pysca
o
o
pan
wegt
44.
examnaton
s
ractures.
one
te
s
batera
X-rays
cacanea
o
to
adder,
eet.
sweng
contracton
most
brougt
rom
o
commnuted
te
musces
s
ang
tenderness
nabty
njury,
man
ater
a
and
te
o
te
ossa.
operatng
superca
Suc
to
examna-
an
to
njury
oowng?
knee
on
o
at
says
o
tat
sows
te
great
se
jont
n
ead
ts
pan
n
te
te
er
rgt
a
er
abe
to
ront
ower
sorter
Wc
o
n
not
sows
racture.
te
emergency
was
oor
tat
jont
te
notceaby
p
subcapta
knee
to
posed
and
onger
te
brougt
te
suppyng
no
oot
eg
tan
dsrupted
o
te
emur
n
o-
eary
patent?
gutea
crcumex
o
te
emora
obturator
artery
gutea
crcumex
29-year-od
3-mont
man
emora
comes
story
o
examnaton
to
te
pyscan
dscomort
sows
a
n
te
rater
because
atera
o
tg.
overwegt
man,
wearng a eavy eater bet, to wc numerous objects
te
are
oowng
te
wound
poptea
to
nerve
te
because
son
rotated
by
but
branc
Pysca
sow
Ater
te
n
ees
eet
A
s
son
Her
X-rays
arteres
Sartorus
49-year-od
at
emergency
oot
te
examnaton
mb.
Femora
department
te
ven.
wc
eg
nverted
ex
er
ateray
B.
A
to
sppng
A.
brevs
n
te
woman
by
Pysca
s
to
te
te
buet
Pysca
transerred
everted
and
mb.
ater
Senton
procedure?
and
nabty
rgt
a.
wound
poptea
resut
extend
exed
department
mb
to
to
82-year-od
up
assaant.
severed
te
to
drop
te
com-
key
B.
get
ad
aong
Inabty
An
brougt
sma-caber
drve-by
buet
most
s
a
mmedatey
A.
pressed, bood ow n te poptea artery can be reduced
enoug
he
a
o
penetratng
s
te
dscovered
temporary
a
coursng
woud
woman
because
rom
ton
nerve?
rage,
knee
and
emors
aneurysm
24-year-od
te
musces
gutea
A
department
ave
atroped
oowng
42.
p
opn-
procedure,
ad
te
p
s
atae
artera
century,
man’s
two
maxmus
great
s
tat
by
Wc
nnervaton
B.
eg
by
at.
ascae
ng
te
supped
T ensor
poptea
62-year-od
superor
durng
A.
A
a
ndcated
repaced
tat
repaced
ts
Limb
oowng
CT
ofered
receves
41.
Lower
njured
been
40.
5
attaced,
oug
njured
s
eet?
ncudng
examnaton,
made.
Wc
a
o
s
empty
dagnoss
te
o
oster.
Ater
meraga
oowng
nerves
a
tor-
parestetca
s
most
key
nvoved?
A.
Fexor
A.
Superor
B.
Gastrocnemus
dgtorum
proundus
B.
Femora
C.
Tbas
posteror
C.
Obturator
D.
Tbas
anteror
D.
Fbuar
E.
Fbuars
E.
Latera
ongus
45.
A
te
et
meda
pressed
o
.
te
Fexor
B.
Pantars
racture
oowng
dspaced
aucs
dstance
An
maeous
x-ray
o
se
o
te
structures
s
o
s
brougt
spraned
te
et
dspaced
ragment
ongus
runner
ater
anke
oot
er
sows
wt
te
posteronerory.
most
te
key
com-
bone?
tendon
tendon
C.
Tbas
anteror
D.
Tbas
posteror
E.
Tba
A
ong
runnng.
te
te
by
tendon
tendon
nerve
42-year-od
ater
Pysca
Fig.
o
scatc
department
maeous
A.
ment
•
we
part
Wc
o
cutaneous
emae
emergency
anke
dsta
46.
dvson
emora
23-year-od
to
a
gutea
man
ang
s
brougt
to
examnaton
te
to
te
emergency
sdewak
sows
te
rom
patent
s
s
not
depart-
adder.
abe
to
put wegt on s et eg. here s a sweng and bruses
CHAPTER
around
on
s
te
et
racture
o
te
te
47.
et
o
te
eg.
as
An
proxma
we
sat
arteres
as
x-ray
o
mutpe
o
te
te
suppes
et
te
aceratons
emur
sows
emur.
sweng,
a
te
Wc
afected
part
toe
te
crcumex
B.
Acetabuar
C.
Latera
D.
A
E.
Meda
branc
ater
rgt
ments.
rgt
An
severed
s
s
x-ray
by
ave
s
s
o
te
te
to
eg
Durng
to
put
perorm
sows
a
ound
pysca
wegt
certan
sows
compartment
o
depart-
te
51.
Sensory
oss
o
B.
Sensory
oss
on
C.
Foot
Parayss
Sensory
48.
A
o
te
oss
ce
at
30
o
te
dorsum
te
soe
extensor
te
o
o
te
te
te
pysca
wt
pued
sows
oot
brevs
oot
ng
te
s
e
te
dsta
o
te
most
te
te
emur
and
o
vesses
to
a
o
depart-
motor
sows
te
are
racture.
n
ower
angogram
key
emergency
nvoved
ragment
An
o
was
to
mdde
poptea
ragment
musces
brougt
x-ray
o
te
s
posterory.
tat
A.
Soeus
B.
Gastrocnemus
C.
Semtendnosus
D.
Gracs
E.
Tbas
A
and
oot
ater
pne
a
can
50.
man
ang
a
a
racture
o
te
te
by
te
n
receve
brougt
rom
bone
s
te
o
can
prmary
te
te
be
An
taus.
ost
n
From
vascuar
x-ray
Muc
suc
wat
depart-
ceanng
o
o
an
pantar
D.
Superca
E.
Deep
te
artery
73-year-od
6-mont
he
puse
Dopper
pysca
o
te
Latera
to
Posteroneror
Groove
Meday ,
Young
eg,
as
te
neuroogc
ts
over
o
er
not
toes.
D.
Anteror
D.
Superca
E.
Posteror
E.
Tba
tba
tba
o
batera
bunons.
Pysca
because
because
examnaton
sows
and
s
wound
ater,
dur-
dicuty
no
Wc
te
se
wakng
te
week
great
tere
ater
we
n
namma-
nerve
s
most
se?
te
a
te
and
nontender,
posteror
o
pyscan
cod
tba
eg
w
artery
a
Absence
most
oot.
cyanotc
ndcates
artery.
because
pae
cod
absent.
trombotc
o
key
s
puse
be
dur-
ound
n
ocatons?
bey
o
te
abductor
54.
A
o
meda
emora
te
condye
atera
maeous
and
between
te
meda
maeous
and
te
two
eads
o
te
concerned
tat
yet
wakng.
begun
sayng
tat
tertus,
as
te
Wat
beore
oot
s
and
te
ter
one
to
most
her
te
cd
ts
o
centra
coud
wtout
common
pedatr-
musces
compete
te
wak
o
gastrocnemus
14-mont-od
t
te
stumbng
nerve
suppy
pantar
buar
22-year-od
5-day
Her
te
musce?
Deep
work
o
to
between
tem,
o
C.
er
sows
deveopment
Dorsas
peds
are
buars
corner
ts
to
between
parents
reassures
outer
pyscan
sot,
as
oot.
muscuar
mdway
C.
te
se
se
cacaneus
Sura
to
wt
nserts.
cacaneus
Groove
and
suppy?
durng
pyscan
One
progressve
te
mdway
Latera
pan
comes
o
te
C.
B.
comes
tetanus
te
poptea
B.
A.
o
te
sna
toug
o
oowng
pantar
woman
aso
te
rom
togeter
musce
sutured.
examnaton
pantar
stor y
o
s
Meda
6-mont
a
percng
utrasound
o
Latera
58-year-od
man
examnaton
B.
o
to
sarp
even
soe
story
A.
A
o
buar
A
te
bood
does
te
tssues
reected
buar
o
can
rgt
njury
a
and
te
Sura
daugter
eaves
te
s
o
te
aucs
racture
emergency
we
gutters.
osteonecross.
ts
to
roo
by
C.
A.
53.
s
te
pantar
te
rom
n
damaged
wc
on
toe,
Latera
ng
brougt
examnaton,
great
present
sot
paanx,
wc
receves
Meda
oow-
dsta
oow-up
occuson
mb
Se
B.
A
te
beng
ower
compressed
Wc
dspace
o
s
torougy
er
and
musce
base
Durng
pantae
gr
stepped
beac.
atera
toes.
nterosseous
A.
D.
racture
ts
resut
bone
te
ceaned
E.
needes
o
Quadratus
oot.
racture
trds
te
ve-
anteror
sows
suppy
E.
te
65-year-od
ment
umbrca
Pysca
ragment?
49.
Frst
ton
oot
dgtorum
entre
ater
An
juncton
emur
dsta
man
mnutes
coson.
te
D.
exng
48–71
24-year-od
ment
dorsa
ng
52.
Questions
aucs
Frst
s
drop
E.
Abductor
7-year-od
bony
a
te
243
Limb
ts?
C.
to
sgns
s
at
great
proxma
upon
B.
te
eg
te
aucs
key
A.
musce
te
ten
Adductor
te
te
o
bone,
o
o
and
A.
A
causes
o
protrudng
sde
tat
examnaton?
D.
atera
accdentay
oowng
durng
on
te
sesamod
and
paanx
excsed,
move-
racture
MRI
Wc
key
emergency
abe
An
posteror
most
te
bcyce.
anke.
racture.
been
to
not
unabe
te
te
emora
brougt
are
Wat
emora
rom
and
n
obturator
patent
above
nerve
woud
te
eg
tba
major
man
ang
examnaton,
te
deep
o
emora
crcumex
22-year-od
ment
branc
o
a
ac
crcumex
redness,
proxma
operaton,
o
emur?
Deep
s
and
oowng
A.
A
mdtg,
arm
Lower
5
buar
woman
story
temperature
o
s
comes
g
39°C
to
ever
te
and
(102.2°F),
pyscan
vagna
and
because
dscarge.
puse
s
105/
244
C H A P T E R
mn.
Lower
Laboratory
seres
Into
5
o
te
o
te
Anteror
B.
In
C.
Ineroatera
superor
te
ror
ac
E.
ac
and
te
to
a
to
te
greater
te
A
58.
ordered.
nerve
between
regon
durng
poste-
but
trocanter
anteror
posteror
tons
superor
greater
posteror
supe-
trocanter
tuberosty
and
te
greater
59.
trocanter
55.
A
gency
a
department
tour
He
s
bus
we
abe
to
ront
Wc
56.
o
o
sows
te
mnutes
te
n
ater
wtout
due
oowng
to
brougt
te
“adductor
oter
s
te
crossng
unopposed
most
p
key
emer-
struck
o
assstance.
gat,”
nerves
te
beng
mdde
an
to
by
Inabty
D.
Numbness
E.
Weakness
5-week
nerve
te
n
s
te
Superca
B.
Obturator
B.
Tba
C.
Ineror
C.
Common
D.
Superor
D.
Sura
E.
Femora
E.
Sapenous
nto
a
vagnay,
te
deep
27-year-od
te
perneum
njecton
s
woman
decson
s
made
made
s
to
tryng
nject
because
meda
to
dever
oca
o
te
to
er
60.
anestetc
severe
sca
pan.
A
A
was
tuberosty
se
by
er
payng
as
tenderness
o
An
te
perneum
very
njecton
as
not
and
posteror
ton
s
Wat
suppy
to
most
o
te
te
ew
n
enoug
to
some
A
te
provde
n
mnutes
attendance
perneum.
atera
can
perneum
n
te
o
t
te
centra
separate
sca
muc
ater,
tat
x-ray
most
key
te
C.
Intercondyar
Tba
E.
Anteroatera
An
81-year-od
C.
Ioypogastrc
pan
D.
Ineror
osteoartrts.
Mdde
cuna
undergo
son
o
an
te
operaton
ow
soud
ower
s
oemora
proxma
s
between
Durng
and
man
ac
reabtaton,
be
papated
bypass
aspect
perormed
te
admtted
to
o
to
te
because
te
emora
wc
o
montor
o
emora
successuy
and
and
arteres
te
good
ospta
an
te
causng
bood
te
arteres
crcuaton
o
te
mb?
A.
Anteror
B.
Deep
buar
C.
Deep
pantar
D.
Dorsas
tba
E.
Dorsa
peds
metatarsa
s
62.
o
one
takng
repace
ater
an
area
on
te
o
o
te
Wat
a
te
uncton
s
because
sde
o
deectve
successu
prevousy
skn
atera
nerve
er
cutane-
was
on
te
sde
used
o
n
to
te
ang
Se
s
Pysca
o
emergency
rom
a
tree
abe
depart-
we
to
wak,
examnaton
te
knee
and
bony
sows
sweng.
Osgood-Scatter
oowng
se
but
dsease
structures
s
tba
area
emnence
o
Genu
varus
Genu
vagus
C.
Coxa
varus
D.
Coxa
vagus
E.
Haux
he
te
to
o
s
o
as
a
te
knee
meda
bowed
An
sde
he
o
te
wen
terms
best
o
sweng
x-ray
jonts.
severe
story
sows
outward
oowng
wt
ong
bateray.
te
tuberce)
pyscan
examnaton
on
te
(Gerdy
te
patent
knee
be
to
e
o
te
degen-
knees,
stands
descrbes
knees?
vagus
57-year-od
and
tuberce
comes
severe
knees
Wc
o
tba
o
B.
gan,
to
aso
sows
degeneraton
condton
because
toes
pyscan
grat,
o
aspect
Pysca
A.
A
and
te
o
knees.
more
s
uprgt.
restored.
oowng
s
sows
eraton
he
second
te
monts
here
pan.
man
tenderness
knee
occu-
artery.
s
to
cond-
examnaton?
tuberosty
Ineror
65-year-od
mb
Sx
ntercondyar
B.
gutea
oowng
oot
to
rends.
o
condye
D.
n
cut,
afected?
Meda
61.
and
nerve
brougt
knee
Posteror
cuna
a
ater
er
Wc
B.
ndvduas?
s
dsta
A.
cutaneous
been
toe
parayss
sensaton.
knee
te
Posteror
A
gr
njec-
sensory
ave
accompanyng
pysca
te
restoraton
no
wt
o
5.4).
o
ower
parent
at
(Fg.
o
comes
ateray
tuberosty.
te
te
te
buar
A.
E.
emora
A
tose
efectve
nserted
nerve(s)
cases.
to
been
parts
tereore
oter
n
obvous
o
te
on
torougy,
buar
severe
to anestetze te pudenda nerve, wc suppes muc
becomes
emergency
dog
procedure?
10-year-od
ment
s
as
A.
We
tendons
rst
aca
musces.
eg
gratng
o
te
tere
Tba
gutea
te
stray
ceaned
and
great
te
panned.
aca
tat
te
woman
musces?
gutea
to
a
s
durng
nverson
rom
te
oot
extend
between
surgery
nerve,
parayzed
tese
no
artery
njured. Wc
story
Pastc
o
tat
peds
by
wound
expected
to
31-year-od
back
he
seen
brougt
btten
drop
procedure,
mb
be
C.
a
s
been
Cuboot
aca
adductors.
suppy
ave
Foot
ous
Pysca
one
t
s
beng
oot.
dorsas
woud
ace.
street.
wc
A.
baby
57.
30
man
wakng
ambuate
examnaton
n
ntoxcated
te
B.
A
woman
ater
A.
o
45-year-od
o
te
nerve
supe-
trocanter
te
55-year-od
dorsum
njury?
te
A
department
tuberosty
te
between
ac
are
gutea
avod
te
sca
te
te
between
between
ne
o
ne
and
greater
and
between
a
necton.
njectons
parts
to
ne
ne
te
spne
Haway
a
gonorrea
njected
spne
a
and
to
Ineromeda
ror
o
spne
spne
be
superor
mdde
ac
ac
D.
and
conrm
antbotc
oowng
antbotc
A.
ror
studes
ntramuscuar
wc
soud
Limb
a
dabetc
6-mont
woman
story
constpaton.
o
comes
ow
Pysca
to
te
energy
pyscan
eve,
examnaton
wegt
sows
CHAPTER
•
markedy
neck.
reduced
Fig.
patear
Laboratory
studes
63.
oowng
relex
and
conrm
sgt
sweng
o
ypotyrodsm
s
stretced
durng
te
reex
Quadrceps
emors
C.
Sartorus
worse
wen
D.
Pectneus
sows
constant
E.
Bceps
jonts,
wen
se
65.
emors
emors
ater
e
s
severey
rom
a
A
63-year-od
o
woman
brougt
njurng
trampone.
to
er
Se
te
rgt
s
not
a
1-year
emergency
jonts,
ower
(Fg.
abe
mb
to
put
rate
and
descrbe
Pes
panus
Pes
cavus
X-ray
anke
and
o
te
anke
nvovng
te
owng
posteror
bones
sows
te
process
w
a
atera
aso
anke
o
trmaeoar
maeous,
o
most
te
tba.
key
be
te
rgt
racture
meda
oot.
o
te
maeous,
Wc
o
te
o-
afected?
66.
C.
Hammer
D.
Caw
E.
Haux
A
pan
B.
Cacaneus
examnaton
C.
Cuneorm
s
D.
Cubod
te
E.
T aus
vs
a
72-year-od
3-year
examnaton
Fg.
5.5.
man
story
o
sows
Wat
s
comes
severe
te
te
to
te
pan
probems
most
pyscan
wen
key
n
because
wakng.
s
eet
dagnoss?
as
o
Pysca
sown
n
treatment
reaxaton
oowng
Coxa
varus
A.
L4
vagus
B.
L5
C.
Genu
vagus
C.
S1
D.
Genu
vara
D.
S2
E.
Haux
E.
S3
te
o
because
pan
gets
examnaton
metatarsopaangea
nterpaangea
nterpaangea
oowng
comes
mb
sows
scatc
ower
prorms
Coxa
te
Pysca
proxma
dsta
sgns
man
ower
posteror
B.
vagus
s
greater
A.
o
he
terms
pysca
s
jonts
most
accu-
examnaton?
vagus
Navcuar
and
te
at
te
pyscan
oot.
toes
58-year-od
n
at
te
er
soes.
extenson
o
to
n
toes
A.
A
wears
Wc
B.
te
comes
pan
extenson
A.
around
o
yperexon
5.6).
to
se
sweng
bruses
.6
woman
story
wegt on te afected oot. Pysca examnaton sows
and
Fig.
test?
Quadratus
52-year-od
•
te
B.
A
.
and
A.
department
64.
musces
Fig.
245
Limb
.4
approprate treatment s ntated. he tendon o wc o
te
•
Lower
5
or
pont
aspect
mb
o
o
a
te
nerves
s
sows
pyscan
past
musce.
2
n
pan
tg.
An
tat
te
terapst
te
MRI
He
or
mmcks
regon
s
o
o
s
sufers
pe-
rom
drected
wc
o
down
stretcng
te
o
Pysca
radatng
patent
Entrapment
key
because
monts.
wt
syndrome.
pysca
most
te
tenderness
oramen,
entrapment
by
to
te
o
to
and
te
syndrome?
246
C H A P T E R
67.
5
Lower
Limb
A 22-year-od woman s brougt to te emergency depart-
ment
ater
beng
ound
n
a
comatose
condton,
avng
an or an unknown engt o tme on te te loor o te
courtyard.
Cocane
s
ound
n
er
possesson.
Pysca
examnaton sows sgns o scema n te gutea regon.
Ater
knee
oss
68.
reganng
lexon
n
te
Tba
B.
S1–2
C.
Gutea
D.
Prorms
E.
Femora
nerve
nerve
was
MS
and
ead
(Fg.
key
a
5.7).
Deep
Acetabuar
C.
Descendng
D.
Second
tea
mower.
o
Wc
o
o
branc
an
o
sows
p.
o
oowng
avascuar
and
and
oowng
te
necross
p
(MS)
•
Fig.
.7
•
Fig.
.
an
reduced
An
te
MRI
emora
arteres
s
most
necross?
atera
branc
o
o
obturator
o
woman
Pysca
sceross
ac
branc
by
te
n
emergency
rgt
cortcosterods
avascuar
because
regon
mutpe
te
er
examnaton
peroratng
department
to
at
moton
branc
27-year-od
o
pan
range
crcumlex
Ascendng
A
o
sensory
dagnoss?
Pysca
resutng
B.
brougt
severe
wt
sows
njured,
key
and
syndrome
s
o
story
actve
A.
E.
69.
woman
treated
examnaton
most
parayss
lexon
entrapment
because
as
exbts
njury
exacerbaton.
passve
te
entrapment
nerve
recenty
s
se
pantar
compresson
45-year-od
Se
and
njury
crus
department
tg.
dorsa
mb. Wat
A.
A
conscousness,
and
meda
s
a
crcumlex
o
deep
crcumlex
brougt
to
penetratng
object
trown
examnaton
emora
emora
emora
te
emergency
njury
rom
sows
a
n
te
rdng
no
pop-
awn-
motor
and
sensory oss beow te knee. Durng te operaton, ater
makng
ossa,
a
tssues.
70.
a
mdne
ven
o
Wat
ven
Poptea
B.
Peroratng
C.
Great
sapenous
D.
Sma
sapenous
E.
Superor
A
meda
58-year-od
o
a
artera
Wc
puse,
o
adequate
te
toes
te
and
A.
Anteror
B.
Fbuar
Arcuate
pantar
E.
Latera
pantar
32-year-od
wt
e
s
eard
an
man
a
deep
te
te
at
ts
poptea
superca
ocaton?
emora
no
comes
a
panu
tba
w
rom
pyscan
oot.
Pysca
puse
s
key
pantar
on
perpera
dorsas
most
te
te
as
detectabe
arteres
te
to
patent
posteror
o
peds
provde
to
oot?
brougt
to
s
rends.
poppng
sows
te
oot
at
te
te
nabty
emergency
we
Wen
sound
an
to
payng
njury
anke
to
ootba
occurred,
jont.
stand
depart-
on
tears
eg
An
wt
Navcuar
B.
Cubod
te
Cacaneus
D.
Sustentacuum
E.
T aus
department
er
te
Wc
musce
wt
anke
o
severe
sows
te
sweng
mutpe
oowng
ten-
bones
s
tears?
ta
72–95
18-year-od
ead
tenderness
o
5.8).
C.
An
and
MRI
(Fg.
A.
sot
oot
Pysca
o
te
sows
toes
ee.
assocated
72.
s
afected
te
dnous
strong.
surace
te
near
Questions
njury
coege
examnaton
o
te
suppy
dorsum
Meda
ater
te
o
n
tba
D.
ment
s
oowng
C.
A
tat
te
coatera
skn
sown
expected
patent
here
but
to
story
sows
dsease.
be
te
s
gencuar
dabetc
2-year
examnaton
vascuar
trbutary
n
sze
woud
A.
because
71.
ncson
moderate
te
woman
ater
se
durng
nverted.
atera
an
er
s
brougt
wen
tenns
Pysca
aspect
avuson
e
o
to
practce
oot.
o
te
te
eaped
and
examnaton
te
racture
se
An
emergency
or
an
over-
anded
sows
x-ray
tuberosty
o
o
wt
sweng
te
oot
te
t
CHAPTER
metatarsa.
ng
pan
pung
73.
on
te
te
tuberosty
Wc
ractured
Fbuars
B.
Tbas
C.
Fbuars
brevs
D.
Extensor
dgtorum
E.
Adductor
A
to
key
was
Latera
Patear
emae
o
to
empoyee
te
pan
Pan
o
ouseceanng
wt
n
er
o
oowng
a
2-day
knees.
gets
sows
tenderness
te
a
usuay
examnaton
and
Wc
pyscan
burnng
artrts.
o
severe
te
s-
Se
worse
76.
as
wt
ty
structures
s
sown
most
a
afected?
Prepatear
bursa
A.
and
Semmembranosus
D.
Suprapatear
E.
Subsartora
yet
natons
even
sow
sows
cdood
owng
bursa
o
e
s
unstabe
key
4
cdren
son
years
p
deormty.
most
bursa)
tree
because
od.
jont.
he
An
by
e
x-ray
o
wc
o
te
exam-
o
te
to
cannot
Pysca
stabty
provded
comes
te
jont
te
77.
p
n
32-year-od
Lgament
T ransverse
post
s
brougt
ambuance
wen
a-terran
e
was
vece.
ater
to
s
trown
te
rom
Pysca
emergency
et
eg
a
department
mpacted
poweru
examnaton
a
ence
our-wee
sows
mnor
78.
n
njury
a
severe
pan,
te
B.
1.5
cm
meda
C.
1.5
cm
atera
D.
1.5
cm
meda
E.
Mdway
to
to
Fig.
.9
6
eeng
nab-
monts.
te
to
most
arc,
patent
perorm
common
wt
everson
ongtudna
to
39-year-od
arc
t
and
and
to
te
a
o
nerve
Wat
X-rays
te
o
te
he
proxma
s
a
over
o
emur.
bock
pubc
n
sows
aceratons
andmark
njecton
te
emergency
nvoved
examnaton
mnor
anteror
to
accurate
anestetcs?
tuberce
superor
ac
spne
puse
emora
te
te
was
mdtg.
emora
te
to
se
gament
gament
puse
anteror
superor
ac
spne
sympyss
woman
oot.
wearng
(detod)
racture
or
te
between
pubc
panu
nerve
as
he
comes
pan
been
•
to
soes.
planus
Fig.
te
started
graduay
narrow-toed
Pes
•
te
an
gament
et
admnstered.
superoatera
and
o
tryng
brougt
dsta
cm
wt
s
Pysca
te
ocazng
ago,
eet
meda
ater
bruses,
o
sow
s
s
1.5
a
past
cacaneonavcuar
or
A
te
upon
coatera
A.
o
te
pantar
coson.
aspect
mb
and
caused
oreoot
mnutes
mutpe
atera
E.
te
Wat
o
woman
30
vece
D.
an
egt
pantar
s
over
because
wtout
oot
o
te
as
ongtudna
te
Coapse
patent
45-year-od
o
E.
Iscoemora
by
meda
ong
Puboemora
A
o
meda
C.
pan
pan
test.
pyscan
condton?
o
B.
emur
rse
te
mnutes
sows
o
A
he
and
Coapse
ower
te
5.10
ee
to
5
actvtes
Coapse
Ioemora
o
day
D.
A.
ead
eet.
abducton
sweng,
acetabuar
tan
C.
te
te
ts
te
motor
o-
comes
more
s
Fg.
department
gaments?
o
n
Exaggerated
o
youngest
toug
no
s
er
an
B.
(anserne
moter
wt
bursa
bursa
postve
structures
gament
man
wak
Coapse
bursa
C.
42-year-od
o
and
gament
snge-eg
cause
knee
oowng
gament
examnaton
n
et
te
gament
crucate
perorm
Pysca
knee
o
njured?
coatera
pan
to
te
247
Limb
menscus
cannot
severe
o
test. Wc
crucate
55-year-od
e
sweng,
afected
A
sweng
key
E.
Pysca
pyscan
most
D.
brevs
aucs
Inrapatear
jont
ragment?
and
drawer
Fbuar
B.
wak
posteror
C.
A.
A
aceratons
s
Posteror
touc,
5.9).
(Fg.
produc-
musces
B.
constant
warm
of,
posteror
tory
story
pued
oowng
Anteror
comes
a
s
te
A.
busness
o
o
ongus
58-year-od
actvtes.
75.
o
edema.
A.
no
74.
Part
and
Lower
5
.
a
pyscan
because
coupe
monts
o
worsenng
Se
aso
as
especay
a
tngng
248
C H A P T E R
5
sensaton
Morton
ng
o
te
a
Limb
oot.
neuroma.
sowed
A.
Lower
An
MRI
Pysca
papabe
mass
o
te
oot
examnaton
between
wc
sows
most
o
te
a
reex
key
a
oow-
te
trd
and
ourt
metatarsopaangea
jonts
B.
Between
te
second
and
trd
metatarsopaangea
jonts
C.
Between
te
rst
and
second
metatarsopaangea
83.
jonts
Between
E.
In
te
ourt
and
t
metatarsopaangea
regon
o
te
tarsopaangea
79.
A
34-year-od
1-week
wt
tar
toug
te
tons
80.
s
steps
te
band
o
most
o
te
everson
C.
T arsa
tunne
D.
Pantar
E.
Inverson
oot
terms
te
pyscan
oot.
he
mornng.
and
warm
ndcatng
tssue
meta-
Deep
Tba
Superca
stretcng
Wc
o
o
s
over
o
rom
te
a
ater
s
tc
pan-
eet.
tat
e
o
te
He
anke
s
because
a
care.
nverson
te
and
ndoot
s
dagnostc
ound.
or
boy
o
u-term
prenata
deormty
Motor
D.
Injury
E.
Provdes
te
s
an
brougt
atypca
and
s
moter
Pysca
pantar
Wc
sgns
o
te
te
o
ad
o
te
ore-
exon.
te
observed
ca
No
pysca
te
vagus
D.
Haux
varus
E.
Pantar
85.
A
ng.
te
papatng
because
sows
s
e
jonts.
ton
o
at
bot
Wc
or
te
te
o
ts
wakng.
metatarsopaan-
proxma
te
Pysca
and
oowng
patent’s
atera
dsta
Fg.
descrp-
A.
toes
86.
cavus
to
te
eaty
e
was
sows
a
62-year-od
emergency
an
wt
brsk
man
department
nabty
wakng
very
te
ater
p
a
sensaton
posteror
oowng
s
sows
successu
dmnsed
te
te
ateray
emora
caracters-
superor
aspect
o
te
gu-
nerve
eves
S1,
obturator
S2,
and
nternus
S3
and
o
parestetca
sura
ater
Se
te
and
te
was
sustaned
dsocaton
to
to
se
rgt
Pysca
musces
nerve
brougt
knee
a
drect
by
te
radoogc
o
requres
prevent
te
emergency
nvoved
a
to
dasboard
examnatons
patea.
Wc
strengtenng
uture
n
bow
by
dsocaton
o
pys-
o
te
gament
ootba
payer
to
wak
s
by
dog.
reacton
20
n
s
brougt
mnutes
mse
Pysca
te
by
ater
propery
examna-
deep
tendon
to
examnaton
over
te
te
5.11.
probems.
condton?
vagus
experenced
we
extenson
n
panus
oterwse
son
dicuty
approprate
Pes
An
o
exon
Caw
s
emors
Pysca
aceraton
E.
o
t
depart-
tat
comes
to
te
pyscan
because o a sma cut over te knee e ad durng tran-
ascts
D.
aspect
15-year-od
A 71-year-od man wt a past story o poo comes to
Hammertoes
sows
and
x-ray
o
te
s
coson.
ntermedus
Haux
C.
o
mnutes
ateras
C.
Haux
30
medas
Patear
Pes
te
te
Vastus
E.
B.
eg
as
meraga
o
Vastus
equnovarus
A.
emergency
monts
te
spna
B.
T apes
most
o
o
A.
B.
s
An
patent
woman
reabtaton
Vastus
tons
n
atera
Rectus
nterpaangea
te
rgt
T wo
Wc
orgn
oowng
D.
wt
te
poston.
sacra
vece.
C.
vara
jonts
key
musces
Coxa
gea
to
examnaton
dstrbuton
resuts
examnaton?
examnaton
tan
nnervaton
A.
pyscan
sows
most
patea?
oowng
on
ead
s
buar
Pysca
suppy
rom
meda
te
te
arc?
brougt
te
o
vece
te
sow
examnaton
adducton
and
to
appear-
s
racture.
34-year-od
motor
2-week-od
ater
as
to
Arses
C.
A
o
nerves
regon
geme
84.
scan
nerve?
department
eaty
reguar
ts
deep
supne
nerve.
B.
symptoms?
syndrome
s
a
neck
regon
tea
cond-
e.
Cutaneous
o
cacaneus
oowng
o
A.
e
on
cutaneous
exam-
te
and
repacement,
te
reex
man
sorter
emora
n
ntense
nammaton
te
tese
pan
Pysca
skn
an
because
CT
oowng
buar
72-year-od
eg
te
A
te
buar
E.
A
anke.
o
buar
D.
a
spran
spran
by
s
s
ourt
ascts
reatve
oter
and
neuroma
oterwse
sows
trd,
te
s
caracterstc
Anke
o
n
oot.
B.
receved
to
n
oot
Morton
ance
82.
pan
A.
An
C.
p
comes
tenderness
o
ba
pyscan
81.
ew
sows
surace
te
to
rst
o
second,
jonts
man
story
te
naton
Common
Superca
rotated
te
or
B.
et
jonts
te
A.
ment
D.
o
Wc
responsbe
space?
Between
test
stroke.
te
knee
patent
Wat
s
te
Osgood-Scatter
C.
Norma
D.
Bpartte
E.
Injury
A
48-year-od
ngs.
s
A
2
cm
te
bony
o
te
past
key
ong
et
superca
knee.
We
structure
knee
story
s
o
s
et
sown
any
n
knee
dagnoss?
bursa
dsease
emnence
patea
to
CT
no
most
atera
menscus
woman
because
pan.
o
scan
bood
comes
a
Pysca
dsproportonate
reduced
a
o
sma
x-ray
ntercondyar
department
pan
a
as
prepatear
B.
abdomna
An
sows
aspect
jont,
patea.
he
Enarged
atera
o
ow
te
to
to
30-mnute
te
examnaton
to
pysca
abdomen
te
sows
o
severe
tat
examnaton
wt
superor
emergency
story
contrast
mesenterc
te
nd-
sows
artery.
CHAPTER
Lower
5
249
Limb
L
•
poptea
ton
ng
o
ossa
te
te
sows
meda
poptea
gastrocnemus,
ormed
•
An
s
abdomnopevc
ordered
oowng
puncture
A.
B.
4.5
cm
between
atera
Mdpont
Meda
aspect
E.
Latera
to
ater
he
An
MRI
o
(Fg.
most
te
most
key
anteror
emora
Wc
used
superor
to
access
o
te
5.12).
key
Posteror
B.
Tba
gude
Fbuar
Anteror
E.
ac
spne
89.
Coronary
A
skn
ead
s
s
knee
beng
o
te
te
payng
ocked
a
a
wt
meda
border
ead
o
te
o
te
ossa
s
structures?
and
te
aponeurotc
coverng
te
supped
semmembranosus
band
o
Guteus
mnmus
Guteus
maxmus
D.
T ensor
ascae
E.
Rectus
emors
mensca
gaments
s
90.
A
28-year-od
knee
n
a
comes
to
te
seen
musce
more
o
o
te
ceary
to
An
Semmembranosus
Gracs
o
C.
Popteus
experences
track-and-ed
event.
An
deep
pan
utrasound
n
o
te
atera
gutea
as
part
payer
o
o
MRI
te
s
a
o
ts
te
a
removed
sku.
T o
bran,
aspect
s
used.
nerve,
o
a
te
Wat
nserts
nserton?
brougt
knee
te
o
n
knee
te
most
te
emer-
Pysca
aspect
sows
tuberce
emora
tuberce?
to
njury.
meda
te
knee,
meda
tan
ts
B.
oten
te
musce,
sweng
gament
attaces
o
s
te
o
neror
because
sows
aspect
nvaded
coverng
o
sows
procedure
bran
ateras
tssue
basketba
tenderness.
meda
superor
surgca
te
because
Imagng
atae
department
and
te
as
tssue
te
dense
tat
pyscan
monts.
coverng
tssue
vastus
by
te
2
Durng
tumor
C.
bucket-ande
compettor
te
to
past
mater
mportant
examnaton
traton
bran.
dura
B.
o
comes
te
ootba.
sweng
poston.
oowng
te
te
or
medus
exed
te
n
and
woman
A.
regona
te
meda
por-
compress-
atus
one
a
Above
oowng
ts
ts
gency
e
accessory
pantars
Guteus
be
because
an
emors
ca. A week ago, te pan amost caused m to drop out
pyscan
o
gastrocnemus,
semtendnosus
A.
crucate
man
o
depart-
emergency
we
o
o
musce,
tenderness
sows
o
tg,
crease
nto
to
knee
sows
Wc
o
te
superor
bceps
o
eadaces
tumor
band
ovas
brougt
s
o
45-year-od
togeter
and
coatera
27-year-od
Popteus
a
crucate
D.
Adductor
E.
te
coatera
C.
D.
severe
njured?
A.
T endon
te
tuberce
emora
ossa
knee
pubc
nguna
o
man
C.
porton
te
njurng
knee.
tear
to
te
T endons
repace
examnaton
te
A
o
23-year-od
Pysca
s
va
angograpy.
sympyss
D.
A
cateterzaton
artery?
C.
ment
88.
te
T endon
B.
exstence
o
artery.
te
wc
A.
te
ead
.
.
antegrade
andmarks
o
Haway
pubc
87.
or
Fig.
by
Fig.
o
a
on
te
tear
te
condye
coud
ndvduas.
Wat
250
C H A P T E R
91.
5
Lower
D.
Adductor
E.
Vastus
A
magnus
son
o
an
te
operaton
ow
emora
te
92.
te
emora
bypass
aspect
ac
s
orms
to
an
te
s
he
a
postve
sgns
s
drawer
expected
te
to
sgn.
be
knee
Wc
present
o
he
tba
can
be
sgty
dspaced
anterory
he
tba
can
be
sgty
dspaced
posterory
o
te
te
rom
seat,
oor
C.
he
bua
can
be
sgty
dspaced
posterory
D.
he
bua
can
be
sgty
dspaced
anterory
E.
he
o
tba
and
bua
can
be
sgty
trange?
Sartorus
durng
D.
Pectneus
department. An MRI examnaton sows a
E.
Rectus
around
ongus
emors
woman
prorms
by
surgca
te
was
o
te
troug
two
Part
pan
o
and
a
te
or
wc
te
Wen
ceared,
esser
a
musces
and
96–120
23-year-od
monts
sows
owng
was
te
not
Pantar
Cacaneobuar
o
C. Long
E.
nerves
97.
A
ts
te
oowng
musces
pass
troug
openng?
ead
30
o
coatera
boy
coson.
te
Obturator
nternus
ematoma.
B.
Obturator
externus
key
Quadratus
A.
Deep
mnmus
B.
Acetabuar
E.
Guteus
medus
C. Descendng
o
a
1-year
ower
axs
mb
o
te
Wc
tese
story
sows
te
o
an
emora
o
comes
te
pyscan
osteopoross.
ange
neck
to
oowng
examnaton
to
o
160
te
An
degrees
axs
o
condtons
te
s
x-ray
o
te
made
by
te
emora
sat.
assocated
E.
98.
wt
A
72-year-od
department
ndngs?
scan
o
vara
Neuroogc
vaga
anke
C.
Genu
vagum
D.
Genu
varum
E.
Haux
ton
sows
stretcng
Wc
tese
o
man
o
comes
pan
rom
te
te
to
n
nammaton
te
s
o
te
cacaneus
oowng
pyscan
oot.
to
toug
te
condtons
because
Pysca
band
ba
s
o
Pott
B.
Dupuytren
C.
T arsa
D.
Pantar
E.
Rupture
tssue
te
oot.
caracterstc
o
L3
E.
99.
woman
s
mnutes
se
to
was
te
emergency
nvoved
n
a
te
emergency
nvoved
sows
a
n
depart-
a
motor
racture
examnaton
oowng
atera
o
sows
Wc
responsbe
a
3-mont
and
man
o
sows
arteres
crcumex
atera
a
s
te
arge
most
emora
crcumex
brougt
ost
an
area
te
or
to
te
emora
emergency
conscousness.
sows
o
o
scemc
no
response
oowng
ts
comes
story
meday
o
nerve
A
CT
stroke.
to
te
roots
s
reex?
Wc
o
Rectus
B.
T ensor
te
emors
ascae
atae
ntermedus
D. Semmembranosus
Sartorus
to
te
pyscan
progressve
rotatng
damaged?
A.
E.
s
se
examnaton
o
C. Vastus
brougt
ater
to
S1
key
gament
o-
emora
woman
test.
20-year-od
cmbng.
sprng
te
obturator
o
brances
bran
A
ng
ascts
30
L2
B.
D. L5
o
racture
50-year-od
A.
C. L4
tunne
department
key
o
racture
o
reex
examna-
symptoms?
A.
A
most
vagus
story
te
o
branc
because
te
Coxa
34-year-od
o
ac
branc
Retnacuar
Coxa
1-week
Wc
tear?
arteres
B.
a
ematoma
examnaton
(sprng)
was
MRI
o
crcumex
A.
A
e
x-ray
An
crcumex
D. Meda
because
ater
Wc
Guteus
woman
a
oot
njured?
D.
67-year-od
oot.
s
emergency
(detod)
brougt
An
emur.
C.
A
s
mnutes
A.
emors
Pysca
as
cacaneonavcuar
5-year-od
vece
o
te
te
pantar
meda
tendon
o
key
njured
to
pantar
D. Sort
at
payer
admtted
maeous.
most
B.
coud
s
everson
gaments
A.
ment
wc
meda
excessve
and vesses destned or te regon o te perneum. he
o
te
basketba
and
made
oramen,
severa
mae
tranng
nerve
area
tendon
scatc
A
was
scatc
decson
musce.
and
smaer
n
syndrome,
terapy.
dented
emergng
by
been
prorms,
resecton
dden
ad
entrapment
pysca
troug
entrapment
rst
Questions
96.
37-year-od
seen
dspaced
anterory
C.
be
o-
examnaton?
Iopsoas
or
te
pysca
B.
t
an
examna-
durng
B.
A
sows
Pysca
restored.
emora
o
sows
owng
o
A.
porton
te
ton
MRI
gament.
bood
separated
porton
to
occu-
artery.
and
arteres
genty
atera
ospta
o
emora
proxma
and
Posteror
te
te
emora
te
soated
tssues.
te
successuy
and
procedure
o
to
because
An
crucate
Adductor
passed
95.
admtted
coson.
anteror
A.
reeved
94.
te
artery
musce
rom
93.
s
perormed
surroundng
wat
man
proxma
s
vece
njured
oemora
between
Durng
motor
medas
65-year-od
undergo
Limb
s
tg
dicuty
we
oowng
because
to
ex-
runnng
musces
s
and
most
CHAPTER
100.
A
a
69-year-od
6-mont
pae
oot.
poptea
sows
artery.
an
s
vascuar
andmark
A.
Adductor
B.
Femora
to
o
te
A
o
te
tg
artery
dagnoss
utrasound
emora
at
te
o
patent
o
to
and
artery?
comes
o
ower
o
coatera
mb.
sows
Descendng
o
te
vascuar
to
te
o
because
n
105.
n
te
s
102.
adductor
most
s
cana.
crcumex
Obturator
tg?
te
atera
crcumex
34-year-od
o
a
abdomen
eavy
wegts
maxma
datey
era
to
upper
te
emora
e
s
T wo
upper
at
He
days
te
a
be
as
ago,
wegt
tg,
sows
te
ound
o
been
and
2-our
rgt
oot
An
by
B.
Fbuars
22-year-od
pan.
vta
a
ty
s
te
to
nerve
most
E.
detoxcaton
107.
program.
He
as
been
an
a
ntravenous
he
vta
oot
most
patent
o
group
returns
g
o
s
te
ever
nodes
rst
wound?
nguna
to
te
n
ospta
te
patent
sgns
sows
atera
s
are
wtn
tat
o
emodynam-
te
obterated.
key
because
aspect
afected
norma
base
Wc
by
ts
o
te
o
te
njury?
A
ongus
er
brougt
ater
wt
motorcyce.
are
o
wtn
er
eang
er
key
s
coson
ncdent,
adduct
n
te
er
et
and
Se
pysca
appears
tat
bone
examnaton
o
te
to
be
An
not
Sx
a
eg
we,
x-ray
requre
racture,
caus.
n
rgt
mts.
does
pevc
tg. Wc
emergency
nvoved
norma
te
te
was
pevs
o
to
se
a
nerve
monts
sows
nab-
oowng
nerves
afected?
gutea
D. Superor
or
s
entrapped
C. Ineror
musce
ospta
and
nguna
sot
competey
racture
artery
te
s
mnutes
Durng
Femora
to
s
brougt
beng
te
sgns
B.
admtted
o
30
under
er
ater
at-
musce
Wc
superca
woman
vece
becomes
structures?
s
and
aucs
A
Obturator
man
te
because
nected
buet.
brevs
Extensor
Femora
ongus
o
s
E.
B.
Adductor
ater
superca
o
D. Fbuars
A.
25-year-od
admnstered,
ongus
ven
E.
te
wound
anteror
Femora
A
a
musces
Tbas
A.
D. Femora
man
x-ray
A.
surgery.
Wat
mmedatey
o
story
stabzed,
sows
mak-
n
nodes.
group
metatarsa
and
mme-
erna.
days
posteror
superca
ac
a
pnned
te
tng
we
wrtng
emora
because
area
Four
s
emergency
s
ac
department
pyscan
pan
drops
woud
ernated
te
tg.
years.
efort,
at
to
ncreased
10
structure
C. Pectneus
103.
comes
o
examnaton
reerence
deep
sot
he
te
on
C. Gastrocnemus
106.
o
ago.
to
btten
department
rom
group
19-year-od
motor
and
or
grabbed
Pysca
branc
man
story
ower
a
emora
was
251
Limb
nguna
oowng
pro-
artery
A
ng
ymp
admtted
ours
ymp
o
t
made.
key
2
reeased.
A
mts.
gencuar
peroratng
2-day
s
s
e
antrabes
swoen
cay
emora
emora
E.
an
Interna
te
examnaton
o
dsease
w
o
wakng.
puses
utrasound
arteres
branc
o
occuson
porton
perpera
pyscan
dicuty
absence
An
an
crcuaton
B.
te
sows
oowng
Descendng
to
progressve
proxma
A.
D. Frst
dog
emergency
receves
E.
man
te
C. Meda
te
man
because
D. Horzonta
mb
te
o
a
sutured,
perormed. Wat
te
by
C. Deep
story
dagnoss
vde
aso
puse
a
An
42-year-od
department
Externa
examnaton
o
Wc
te
s
poptea
and
made.
n
A
V ertca
ower
artery
artery
s
arteres
ee
te
puse
104.
B.
49-year-od
arteres
te
o
no
o
and
sympyss
6-mont
Pysca
sows
cod
A.
cana
a
o
dsease
because
worsenng
cana
D. Inguna
A
pyscan
trange
ossa
Pubc
te
utrasound
tba
C. Poptea
E.
101.
An
and
to
progressve
examnaton
occuson
emora
te
comes
o
Pysca
perpera
te
man
story
Lower
5
gutea
Tba
29-year-od
remova
o
racture
o
a
man
cast
te
s
rom
et
brougt
s
ower
et
mb
to
eg.
6
te
He
weeks
pyscan
ad
or
sustaned
pror,
wc
a
was
drug abuser njectng mse wt temazepam (a power-
mmobzed n a cast tat extended rom just beow te
u
knee
ntermedate
epam
actng
[V aum])
resdua
scar
and
tssue
drug
eron
over
n
te
or
ponts
same
5
group
years,
o
as
eavng
vascuar
daz-
muc
access.
he
pan
cast
to
te
but
was
oot.
norma
At
te
tme
strengt
removed,
n
pysca
o
njury,
te
ower
tere
mb.
examnaton
was
severe
Wen
sowed
a
te
pro-
emora vens n s gron are te ony accessbe and pat-
nounced et oot drop wt parestesa and sensory oss
ent
over
vens
or
andmarks
s
ntravenous
te
most
use.
reabe
Wc
to
denty
A.
he
emora
ven
es
meda
B.
he
emora
ven
es
wtn
C. he
emora
D. he
emora
ven
ven
es
es
atera
o
to
te
te
to
drecty
te
tese
vens?
emora
emora
te
oowng
emora
meda
to
artery.
cana.
te
artery.
emora
nerve.
E.
he
emora
te
dorsum
o
ts
patent’s
A.
Common
B.
Superca
C. Deep
es
atera
to
te
emora
nerve.
te
et
E.
Tba
symptoms?
buar
buar
buar
D. Scatc
ven
o
oot
and
atera
eg.
Injury
to wc o te oowng nerves s te most key cause
252
C H A P T E R
108.
A
5
Lower
12-year-od
ater
or
24
oot
te
te
w
oot
and
te
maeous,
te
department
sows
tba
to
o
te
nodes
Tba
Fbuar
sde.
D. Posteror
wc
o
s
area
e
unabe
te
coded
wak.
posteror
n
s
to
te
wt
one
Pysca
drawer
test
reaton
to
conrmed
s
o
s
Fbuar
C. Tba
D. Meda
te
o
A
and
te
patent
Wc
A.
Sapenous
B.
Obturator
te
C. Latera
perormng
ts
E.
A
emora
spran
gament
o
te
er
anke
most
oowng
njecton
mt
easy
He
n
receves
te
rst
nerves
s
n
s
o
o
s
correcton.
key
rgt
te
anestetc
space
and
most
pan
racture
oca
web
manpuaton
oowng
a
o
a
and
to
Wc
by
per-
o
te
E.
115.
te
B.
Cutaneous
branc
o
deep
C. Cutaneous
branc
o
superca
oca
an
buar
buar
buar
patent
cam
m
cuar
njecton
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
wo
aggres s ve . T o
g ven
ate ra
g ven
to
m an
b ecome s
p at e nt
njecto n
prevent
3 0- ye ar-o d
sud d e n y
te
n
a
o
s p ec c
te
te
o ca -
o ow ng
ner ves?
Latera
B.
Scatc
emora
cutaneous
gutea
Ineror
a
ootba
anteror
te
pyscan
o
cass.
an
by
Pysca
tenderness
er
nverson
exam-
over
wc
(sprng)
to
Pysca
to
reex.
te
te
pyscan
examnaton
Wc
tendon
o
tat
te
s
or
sows
a
a
oowng
struck
wen
reex?
Quadrceps
Quadratus
E.
116.
A
emors
emors
Bceps
emors
22-year-od
department
motor
pnned
and
under
er
vta
because
game.
drawer
structures
o
te
s
o
bow
An
knee,
nabty
to
Pysca
sgn.
brougt
te
knee
to
to
sows
ncudng
er
emergency
wak
durng
examnaton
MRI
te
ater
a
sows
njury
meda
se
tacke
n
postve
to
severa
menscus.
oot
n
o
ensure
ts
er
over
poptea
woud
woman
coson
are
wt
wtn
et
knee
artery.
Meda
crcumex
emora
Latera
crcumex
emora
E.
Fbuar
tba
artery
artery
artery
and
appears
and
o
B.
tba
et
sows
A.
D. Posteror
er
Se
bood
emergency
nvoved
an
jont.
severe
te
to
be
x-ray
we,
deor-
sows
racture.
An
compresson
oowng
suppy
to
te
a
eg
Pysca
obvous
An
n
rgt
mts.
supracondyar
patent?
C. Anteror
te
was
knee
Wc
adequate
to
se
norma
brusng,
er
dsocated
te
brougt
ater
motorcyce.
sows
seen
s
mnutes
sgns
posterory
te
atera
s
woman
30
vece
utrasound
gutea
24-year-od
department
a
contrbute
ts
B.
mty
D. Obturator
receved
dance
sows
comes
patear
A.
a
C. Superor
E.
key
(detod)
man
examnaton.
examnaton
A.
A
most
o
and
D. Pectneus
nter ve w,
psycatrc
ton
eg
C. Sartorus
Common
Durng
coatera
58-year-od
testng
to
story
cacaneonavcuar
yperreexve
D. Sura
E.
A
musces
Sapenous
s
er
pantar
meda
routne
anestetc?
A.
nerves
o
pantar
D. Sort
(docane)
oot,
bocked
oot.
rst
aspect
mont
because
gaments?
C. Long
sows
2-day
w
ment
because
brougt
a
durng
key
Pantar
toes.
gament
oot
meda
meda
procedure
One
pyscan
oowng
s
o
Cacaneobuar
parents
strpng
removed.
te
because
te
cutaneous
gr
because
o
naton
menscus
te
on
Femora
16-year-od
gament
o
ven
are
to
pyscan
vens
D. Tba
coatera
s
te
procedure?
B.
by
vens
te
te
A.
x-ray
varcose
over
te
to
varcose
returns
o
durng
comes
o
oot.
sensaton
moter
crucate
er
perormed,
gament
Posteror
second
112.
o
njured
Injury
njured
gament
woman
story
team-
emur.
key
semtendnosus
A 16-year-od boy s brougt to te emergency depart-
An
111.
5-year
crucate
coatera
te
examnaton
perormed
s
by
emergency
114.
B.
a
aso
gament
crucate
o
58-year-od
oot.
brougt
to
backward
structure
Anteror
A
oss
because
wen
A.
E.
113.
s
menscus
T endon
aspect
test?
110.
E.
structures
gament
coatera
C. Latera
sde
oowng
coatera
wt
tg
s
te
B.
ater
man
o
tacke?
A.
atera
n
te
s
atera
te
by
exam-
abrason
te
Wc
posterory
nguna
s
moves
wc
ymp
scraped
Pysca
rom
s
oot
oot
22-year-od
and
on
by
et
ossa
Superca
mates
ad
puruent
spread
s
o
Meda
E.
e
o
dtc.
tenderness
regona
B.
A
a
pyscan
areas?
surace
o
earer
key
Latera
D. Soe
te
sweng
dranage
sows
A.
C. Poptea
109.
oot
a
to
and
days
n
most
to
oowng
brougt
hree
erytema,
Inecton
s
redness
wadng
o
edema,
te
o
ours.
we
naton
o
boy
because
Limb
o
arteres
eg
and
CHAPTER
117.
A
a
68-year-od
6-mont
ng.
man
story
Pysca
ower
mb.
absent.
A
he
ton
s
puse
oowng
sow
te
A.
Femora
B.
Obturator
C. Common
o
eg
artery
A
nerve
te
tg.
120.
E.
A
s
revas-
s
conduc-
B.
Anke
nerve
Wc
tat
o
D. Latera
E.
20
te
and
CT
room
er
eg
ner ves
te
and
n
a
o
oot.
te
key
s
o
wc
n
te
te
oss
o
meda
o
te
te
B.
o
or
122.
te
te
to
deep
anteror
35-year-od
vece
reconstructve
D. Tba
weak
a
6-mont
an
area
o
Pysca
story
o
ncreasng
numbness
on
examnaton
te
sows
pyscan
dicuty
dorsum
a
ard
o
because
wakng
s
mass
at
rgt
te
o
beng
scan
o
bua
ng
or
owng
on
te
and
s
s
eg
sows
tba
tat
te
most
neuroogc
Weakness
o
on
o
te
C. Weakness
sensaton
o
te
o
Gracs
B.
Sartorus
C. Rectus
toes
Wc
o
te
account-
o
te
123.
abnormates
aspect
at
sensaton
o
te
rst
o
knee
aspect
te
reex
te
and
te
and
second
te
o
pantar
exon,
te
exon
decreased
oot
at
te
te
decreased
te
rst
anke,
sensaton
o
tat
Wc
sen-
toes
at
3-day
anke,
and
sec-
weakness
te
pantar
arm
o
extensor
te
ongus
dorsum
o
just
dsta
to
te
s
ater
te
tg.
to
he
eg
a
woman
an
Wc
ts
to
emergency
nvoved
s
autograt
a
usng
supercay
musce
n
undergong
s
on
most
a
te
key
reconstructon?
and
paced
a
et
nodes
te
pyscan
et
unwttngy
sows
o
to
panu
buttock.
se
on
w
sat
er
named
rst
on
a
because
Se
s
a
tumb-
car.
Pysca
panu
buttock.
receve
ymp
rom
wound?
Superca
nguna
orzonta
nguna
vertca
C. Superor
and
D. Externa
ac
neror
group
group
gutea
nodes
nguna
25-year-od
2-week
te
was
patent
wt
comes
o
student
group
nected
Deep
to
e
ocated
perorm
meda
maeous
brougt
surgery
and
maeous
meda
Superca
a
ts
pens
B.
E.
artery.
typcay
sympyss
te
A.
A
stockng
peds
aucs
on
ongus
meda
te
te
story
examnaton
eg
decreased
dorsexon
between
decreased
o
te
to
medas
Vastus
39-year-od
a
s
examna-
and
dorsas
a
and
emors
scooteacer,
oot
anke
and
and
to
E.
A
Pysca
ongus
pubc
ven
ateras
o
o-
124.
Weakness
o
between
nerve,
te
D. Vastus
tack
jerk
te
nverson,
decreased
toe
at
everson
ond
aspect
meda
pantar
and
o
a
descrpton
knee
exon
between
D. Weakness
tumor
o
A.
examnaton?
B.
sensaton
bone
symptoms.
key
Decreased/absent
E.
arge
compressng
neuroogca
A.
saton
a
s
sde
and
antero-
te
or
dabetc
gove
ocatons
coson.
arvested
oot.
atera aspect o s rgt eg just beow te knee. A CT
years.
o
pyscan
been
cassc
o
mnutes
adductor
meda
te
te
as
aucs
man
20
C. Obturator
to
to
dorsa
posteror
motor
comes
puse
exor
cm
Sapenous
man
a
dgtorum
cm
2
to
20
n
tendons
E.
B.
Fbuar
and
condtons
tunne
department
57-year-od
tptoeng
oowng
oot
Femora
E.
tn-
exercse.
symptoms?
He
oowng
extensor
A.
A
tese
past
ow
D. 2
A
troube
te
comes
te
and
Superor
te
te
durng
syndrome
man
C. Ineroatera
o
oowng
repar
o
tarsa
sensa-
sde
ee
spran
parestesa
Between
te
T wo
o
o
because
and
papated?
and
operat-
s
sows
examnaton.
sows
artery
wt
o
pyscan
numbness
121–143
Wc
A.
aspect
o
gament
tunne
50-year-od
meda
te
neuroma
dstrbuton
ypovo-
emur
to
as
a
caugt
str uctures.
and
njured
n
racture?
119.
A
ton
utrasound
n
te
taken
tg
s
An
o
patent
Brances
most
sock.
damaged
p
Se
ematoma
Se
te
anteromeda
were
a
scene.
emergency
nvoved
rgt
racture
ar ter y.
repar
postoperatvey,
to
be
te
was
er
te
massve
sows
emora
or
at
to
se
wt
motorcyce
to
brougt
ater
coson
appears
r uptured
s
mnutes
scan
ton
T arsa
to
bouts
sgn. Wc
nverson
ypertensve
tg.
days
meda
o
253
Limb
ascts
C. Morton
te
comes
caracterstc
Pantar
121.
woman
sows
ng
most
man
story
examnaton
A.
ts?
examnaton
a
te
ac
Questions
vece
A
on
oow-up
depar tment
emc
3-mont
postve Tne
Scatc
beneat
a
Pysca
a
buar
30-year-od
motor
60-year-od
gng
D. Tba
118.
A
o
cod
common
n
o
wak-
ndcates
artery.
te
actvty
te
tba
te
emora
o
wt
nontender,
Postoperatvey,
decreased
s
a
posteror
s
because
dicuty
nvovng
adductors
nerves
pyscan
sows
te
o
perormed.
nnervates
o
procedure
studes
te
utrasound
occuson
cuarzaton
to
progressve
examnaton
Dopper
trombotc
artery
comes
o
Lower
5
man
story
o
comes
pan
at
to
te
s
pyscan
knee
jont.
because
He
o
exercses
reguary, and 2 weeks ago e njured mse as e was
runnng
n
te
open
stadum.
Pysca
examnaton
254
C H A P T E R
sows
s
a
Lower
“tearng”
knee.
owng
Based
actons
A.
Fexon
B.
Extenson
o
are
o
afected
p
te
and
p
as
e
symptoms
due
to
ts
extenson
and
s
tryng
wc
o
to
lex
rgt
te
o-
extended
njury?
o
te
te
knee
ments
was
o
te
p
A.
Fbuar
o
te
p
B.
Tba
Hp
extenson
24-year-od
Se
and
because
was
suddeny
and
tg
movement.
Adducton
sows
an
Wc
key
A.
been
B.
pectneus,
Bceps
sus,
C. Iacus
n
and
medus
E.
Guteus
maxmus
F .
Iacus,
6-year-od
parents
y
or
story
a
standng
uses
and
s
ten
ease
s
te
to
Quadratus
posteror
129.
exon.
arge
tuberosty.
most
adductor
mag-
bar
knees
semtendno-
and
pyscan
He
to
to
sows
He
up
as
a
am-
se
as
ton
er
orward,
te
Wc
by
o
oor,
or
o
ts
te
ds-
dsease.
dicuty
rgt
Wc
most
key
ts
past
Se
drops
te
or
Durng
every
oowng
correspond
wt
ntramuscuar
tme
to
er
a
se
sexuay
doctor
pysca
er
rgt
ocatons
pysca
tat
examna-
rases
njecton
te
o
w
presentaton
patent?
A.
Superomeda
B.
Superoatera
C. Ineromeda
D. Ineroatera
Posteror
quadrant
quadrant
quadrant
o
o
o
o
te
te
te
te
buttock
Wc
ts
B.
Psoas
buttock
tg.
te
cosey
oowng
s
because
o
admtted
a
to
30-mnute
te
emergency
In
story
o
acute
It
ncreased
anteror
ten-
superor
most
wc
a
um-
o
key
te
o-
te
sows
ower
s
made.
te
T o
te
te
A
rgt
suspcon
conrm
patent’s
patent
oowng
and
quadrant.
n
tenderness.
stragten
causes
te
rgt
depart-
vomtng,
tenderness
rebound
to
emergency
to
musces
ts
exed
wnce
most
wt
key
nternus
man
story
to
pan
Pysca
aspect
te
on
te
pyscan
te
pan
meda
to
be
examnaton
o
nvoved
nto
ascent
arces
wt
te
n
a
s
n
eg
ts
because
aspect
constant
sows
and
wt
o
and
numbness
meda
patent’s
structure
to
n
to
poptea
te
te
te
te
posteror
assocated
zonta
comes
o
descrbes
ascent
anteror
s
n
te
nausea,
maxmus
posteror
ts
to
pantar
numbness
wc
o
s
te
caracterstcs?
B.
E.
hs
nerve
Emptes
D. It
man
rgt
and
magnus
He
A.
es
taken
pan
assocated
ts
s
appendcts
meda
he
C. In
aong
year,
atera
nvovement
anorexa,
wt
o
nonradatng.
buttock
te
s
emors
3-day
es
o
ast
sows
psatera
trackng
attempt
60-year-od
arc.
over
progres-
n
major
Guteus
s
mass
symptom?
Adductor
on
o
made.
A.
buttock
tg
22-year-od
department
quadrant
man
o
an
s
a
te
examnaton
pan.
o
growng
ound
emergency
o
nternus
quadrant
tg
A
te
story
tubercuoss
was
pattern
abdomna
C. Bceps
treatment
compans
wakng.
p
o
week
deep
and
or
to
to
2-mont
ongus
because
dagnoss
E.
te
ga-
maxmus
Obturator
dagnoss,
mnmus
receves
tba
major
23-year-od
ower
131.
oot.
Prorms
D. Obturator
woman
te
musces?
Pysca
n
brougt
a
examnaton
abscess
Psoas
A
mass
hs
an
s
o
treated
meda
B.
severe
gastrocnemus
guteus
o
oowng
njured?
coug
Pysca
just
spne.
ment
weecar
bends
nvoved
130.
s
dicuty
rom
stand.
by
Iopsoas
transmtted
spne.
A.
E.
sartorus
Hamstrngs
43-year-od
was
D. Guteus
and
eadng
key
te
an
tat
coatera
man
occuent
suggests
emors
maxmus
njectons
He
derness
magnus
te
pus
dspacement
o
to
sowed
coatera
because
worsenng
gron.
x-ray
as
emors,
poston.
m
njury
mb
crucate
51-year-od
svey
mnmus
to
kck
poptea
department
severe
An
A
owng
dsease
and
medus
E.
te
ac
ongus,
adductor
most
D. Guteus
A
on
orceu
knee
musces
examnaton
s
s
C. Guteus
o
Obque
caused
B.
F .
F .
process?
Tbas
A
se
sows
weak.
examnaton.
seated
stragtens
A.
E.
and
C. Adductor
brougt
ep
musces
a
sca
o
Posteror
process?
rectus
muscuar
rom
oowng
and
Pysca
ands
te
guteus
key
a
ower
crucate
E.
magnus
and
te
anteror
(atera)
D. Anteror
gracs
oow-up
o
dependency.
and
sgty
o
o
emur. Wc
(meda)
er
sweng
oowng
group
ts
major,
boy
aso
s
most
n
major
D. Guteus
A
gym,
semmembranosus,
psoas
psoas
and
emergency
pan
examnaton
adductor
adductor
and
pan
racture
emors,
and
s
oowng
te
oca
extenson
tg
brevs,
te
appened
p
nvoved
Adductor
nus,
te
te
at
to
sustanng
MRI
C. Patear
to
excrucatng
Pysca
avuson
o
o
hs
rgt
o
exon
brougt
deveoped
buttock.
o
s
exercsng
rgt
weakness
knee
woman
ater
An
caused
respect
rotaton
A
pan
eg.
trauma
wt
dorsexon
knee
rotaton
e
128.
sensaton
tese
D. Latera
tg.
127.
pan
on
te
department
126.
Limb
C. Meda
E.
125.
5
group
o
meda
meda
meda
meda
to
wt
te
ven
aspect
o
condye
aspect
o
condye
meda
nodes
superca
tat
te
o
te
o
eg,
te
eg,
te
t
trav-
emur
t
trav-
emur
maeous
dran
nguna
to
te
nodes
or-
CHAPTER
132.
A
56-year-od
ow-up
man
comes
examnaton
s
great
te
past
toe.
10
He
years
soes
because
easy
wear
weekends
as
and
te
o
te
ound
examnaton
two
Wc
o
t
used
Pysca
toes.
te
dabetes
He
as
to
repeated
nds
tps
down.
but
o
and
soes
to
t
a
o-
ucers
te
payng
dicut
to
nerves
utrasound
o
on
Superor
B.
Ineror
C. Deep
gutea
gutea
buar
D. Superca
E.
133.
Common
o
a
ng
story
makng
Dorsexon
B.
Fexon
a
tat
or
10
at
tg.
e
s
examnaton
radatng
wc
upon
at
te
as
te
tg,
pan
nsde
tg
most
o
been
ago,
Femora
B.
Superca
we
wegt
and
o
and
key
A
et
erna
nguna
ovas
Obturator
to
ers
s
o
dscarged.
te
oowng
B.
Superca
A
Interna
taar)
pace
Pantar
B.
Inverson
D. Pantar
E.
superca,
days
o
stab
ater
area
ymp
wound
sutured
se
tat
are
wt
and
o
te
and
an
t
5
maase.
metus,
nsect
and
2
a
n
A
ater.
tender,
aspect
o
oowng
panu
and
patent
se
Pysca
ndngs
s
te
ud
exam-
sweng
trd
o
Se
to
puruent
mdde
was
ago.
acoo
amounts
pysca
o
he
uctuant
te
copous
emergency
week
apped
days
cm
te
story
ncreased.
durng
o
te
puruent
most
examnaton
key
o
ts
s
a
ts
and
exon
se
brougt
e
down
racture
o
te
E.
ac
A
Enarged
22-year-od
department
wound
motor
dran-
Wc
o
ts?
and
o
to
te
te
te
An
taocrura
oowng
x-ray
(tbo-
movements
are
tere
and
nverson,
and
everson
mnutes
x-ray
nguna
ymp
ater
wt
te
and
Urnary
B.
Weak
se
was
nvoved
er
et
and
n
rgt
a
eg
E.
Weak
ton
are
nguna
te
nodes
te
pevs
te
er
et
and
Se
appears
o
te
sows
rgt
te
rgt
an
and
o
oowng
to
be
to
mb,
nerory
neror
n
and
ds-
pubc
jont
conrms
pysca
ncontnence
we,
scopubc
rgt
seen
be
a
eg
Pysca
ower
sacroac
te
n
rgt
mts.
examnaton
key
emergency
nvoved
superor
te
te
norma
rupture
eca
to
was
over
MRI
o
and
te
obturator
examna-
ts
patent?
dmnsed
perneum
o
ower
te
p
meda
o
and
dmnsed
sensa-
tg
te
p
and
postve
sgn
o
anteror
extenson
te
ymp
se
deormty
o
An
most
over
exon
over
wt
rgt
abducton
te
brougt
ater
wtn
te
te
sows
and
over
s
no
adducton
C. Weak
over
are
dsocaton
A.
emergency
superca
nodes
motorcyce.
o
o
T rendeenburg
to
o
nguna
ymp
tenderness
ndngs
D. Weak
brougt
er
sgns
membrane. Wc
ton
deep
mnutes
sympyss.
ton
everson
coson
An
wt
group
coson
racture
dagnoss
nverson
s
superca
nodes
sows
s
sensaton
dorsexon
dorsexon,
and
vta
examnaton
emergency
stars.
30
under
er
o
woman
vece
pnned
jont?
and
woman
30
vece
poptea
everson
exon,
Dorsexon
138.
orzonta
group
pubc
a
o
nodes
D. Enarged
ram
s
group
C. Enarged
ramus.
woman
vertca
Enarged
paced
Wc
at
T ender
but
exon
department
×
draned
present
patent
receve
enarged.
nodes
er
ay-
te
deveops
rst
to
two
ac
22-year-od
motor
s
ympatcs
because
A.
A
and
wound
sows
jont.
C. Pantar
136.
deep
emergency
ac
oot
takng
a
te
nguna
69-year-od
er
o
wound
to
nguna
department
o
comes
ac
D. Common
135.
te
group
Externa
E.
hree
deep
A.
C. Deep
he
deep
and
te
B.
woman
sutures,
rom
5
anteroatera
aso
by
area
rom
wc
nerve.
nodes
rng
because
age
rng
cana
tg.
necton,
eg
to
2-day
dabetes
sweng
a
tba
dmnsed
movements?
brougt
a
ever,
2
prurtc
Wc
be
eg,
et
te
An
oot
s
o
type
dran
ymp
22-year-od
posteror
te
et
o
sows
eg,
ud.
ts
te
te
to
te
woman
te
wen
over
A.
nguna
D. Fossa
department
on
naton
tg
cause
to
o
because
story
began
n
tngng
s
a
ste
rng
C. Deep
E.
exon
50-year-od
knee.
ematoma
patent?
A.
A
eg
scratced
presentaton?
134.
dgts
A
we,
oot
te
Pantar
be
Pysca
tg
te
btten
t-
te
er
sow
oowng
o
as
te
wrtng
movement.
woud
because
area
days
dropped
upper
te
He
T wo
sows
down
openng
pan
years.
efort,
exacerbated
troug
upper
grabbed
Pysca
s
and
maxma
sensaton
ncreased
pyscan
w
rgt
arge
255
Limb
to
mts.
er
a
compressng
o
sweng
te
o
te
o
sows
D. Extenson
department
njury
to
o
te
appears
norma
sweng
C. Extenson
E.
137.
a
Se
wtn
artery
o
A.
njury
comes
o
wegts
mmedatey
nerve
wc
rst
njury
are
examnaton
key
njury
motorcyce.
sows
poptea
strengt
njury
nerve
man
abdomen
eavy
pan.
nerve
buar
34-year-od
ower
nerve
buar
A
2-day
nerve
te
er
sgns
examnaton
Neuroogc
afected?
A.
vta
examnaton
area
te
most
under
er
s
nvoved.
o
s
and
or
soccer
be
numbness
toe
pnned
to
mantanng
around
enjoy
oowng
or
and
ypertenson
dicut
sows
te
pyscan
njury
Lower
5
te
p
tg
o
te
posteror
and
and
p
dmnsed
meda
and
tg
sensaton
eg
dmnsed
sensa-
256
C H A P T E R
139.
A
5
Lower
32-year-od
pan
n
te
a
e
runnng
was
ootba
Pysca
and
He
s
maeous
o
descrbes
Weak
B.
Weak
sum
and
E.
A
te
and
under
nabty
a
jont
te
o
s
seen
pysca
o
o
te
te
tba
s
to
over
ee
a
ater
se
wt
er
and
on
et
sde
te
et
Se
te
pn
et
te
te
varus
knee
prck
over
Inabty
to
ex
nvoved
et
and
appears
and
be
a
te
te
mmedate
wegt
rgt
te
knee
wen
swoen
te
o
oot
and
A
A
to
s
w
x-ray
correct
A.
Posteror
B.
Pantar
o
and
here
o
te
knee
s
examnaton
bers
te
to
swoen,
o
te
quad-
oowng
s
te
structure?
neura
crest
o
ces
condrcaton
wakng
and
te
and
game,
te
o
te
o
te
s
up
anke.
wt
sowed
were
sweng
se
a
a
Se
knee.
be
a
gt
o
wak-
ractures.
taobuar
cacaneonavcuar
to
key
te
rgt
to
spke
soe
wt
“pop”
and
unabe
An
mesoderm
boy
at
pregnancy.
37
weeks’
Pysca
ges-
exam-
ray
te
or
neura
sows
o
te
14
patent’s
te
crest
trd
ce
apoptoss
paanges
oowng
ter
deormty?
toe
dd
not
mgraton
o
n
embryoogc
tssue
deveop
nto
te
between
oot
dgta
o
sgna
rom
te
zone
o
poarzng
actvty
(ZPA)
E.
Fauty
Questions
144.
A
deveopment
o
condrcaton
centers
144–148
22-year-od
and
under
er
vta
nabty
to
Wc
o
ror
poe
most
A.
a
o
te
te
o-
o
key
Bood
eus
B.
o
wtn
pan
5-cm
extend
te
te
be
et
and
Se
te
he
appears
aso
knee
An
superor
o
and
over
x-ray
o
te
te
Bood
C. Jont
te
Se
o
te
te
ne-
o
te
anteror
oowng
may
occur?
and
at
rom
te
njury
can
enter
te
popt-
and
at
rom
te
njury
can
enter
te
supra-
bursa
ud
can
enter
te
subcutaneous
nrapatear
bursa
D. he
deep
E.
gastrocnemus
he
an
acera-
ragment
over
we,
patea.
racture
rdng”
be
a
eg
Pysca
severa
te
knee.
Wc
to
aceraton
exposes
n
rgt
mts.
rgt
are
obque
“g
emur.
er
transverse
patea.
to
emergency
nvoved
norma
rgt
te
was
here
wc
dspaced
te
n
to
se
bursa
patear
teared?
are
knee,
appears
wt
wegt.
deep,
a
brougt
ater
motorcyce.
sows
to
sows
patea
er
sgns
bear
a
s
mnutes
coson
rgt
unabe
surace
neror
x-ray
and
et
bear
to
anteror
knee
woman
30
vece
er
sows
tenderness
maeous.
most
emergency
examnaton
maxma
no
was
oot
Wc
expans
dgta
D. Lack
stress
gt
jumped
oud
a
rays
over
key
down
te
rgt
C. Incompete
negatve.
dicuty
opponent’s
Pysca
atera
to
paraxa
devers
dsrupton
most
wakng
rom
uneventu
poston.
condtons
motor
knee
earng
te
anke,
anke
te
deveopment
woman
an
Excessve
vagus
test
ater
B.
eg
o
23-year-od
Pysca
mb.
compete
brougt
pan
on
recas
gaments
s
soccer
anded
to
o
a
pan
mp
mesoderm
mesoderm
s
subsequenty.
anteror
owng
o
woman
because
and
sows
Extenson
o
ony
utrasound
n
because
partcpat-
onset
coud
afected
ces
Mgraton
pnned
o
pan
te
E.
he
knee
wen
Se
sudden
and
Wc
D. Intermedate
An
eg
knee
knee
extenson
ten
oot.
An
mgraton
te
department
te
recent
a
We
examnaton
deect
o
pyscan
naton sows te rgt second and trd toes are used.
a
downstars
ba
rgt
pate
examnaton
department
te
Latera
Dorsoatera
A.
and
structures
o
22-year-od
a
orgn
B.
et
area
pan.
musce.
te
tg.
anterory.
o
sows
emors
A.
tons
In
tg
se
Pysca
tg
we,
tenderness
jont.
symptoms
rgt
to
mts.
knee
n
stars
anke.
143.
eg
stars
ng
te
race,
to
et
mdtg
because
C. Preceded
emergency
examnaton?
B.
A
rgt
comes
anteror
ne.
embryoogc
dorsum
was
stress
sows
support
oowng
extend
Excessve
woman
te
100-m
ns
rceps
dor-
meda
te
afected
knee,
o
te
to
norma
panu
te
over
brougt
wtn
wegt
to
D. Instabty
141.
o
numbness
te
a
mted
njury?
over
to
anteror
tender
oowng
ts
n
te
te
oot
numbness
a
Inabty
E.
n
neck
te
te
pan
ng
meda
o
30-year-od
o
swoen
te
A
taobuar
Cacaneobuar
taton
are
A.
o
o
and
numbness
motorcyce.
gament
o
C. Instabty
o
s
x-ray
racture
numbness
nabty
atera
Wc
n
o
and
o
te
te
142.
eg
sows
and
mutpe
and
coson
bear
o
was
E.
eg
and
and
er
postve,
MRI
An
wakng
D. Anteror
as
twsted
rgt
racture
Wc
C. Tbonavcuar
subsequenty.
te
eg.
oe
anke
anke
over
a
knee
wegt
consequences
mnutes
efuson
meda
test
An
to
n
o
tat
centers
gat
sgns
examnaton
recas
he
te
rgt
atera
we
woman
30
vta
te
dspaced
key
gat
vece
er
ed.
commnuted
space
gat
22-year-od
pnned
a
anded
we
bear
maeous.
anteroatera
department
drt
because
patent
oot
web
Swng-out
oot
tenderness
everson
steppng
rst
motor
to
pyscan
he
everted
posteromeda
D. Waddng
te
a
most
anke
o
C. Hg
et
sows
“pus-of”
te
s
proxma
and
te
uneven
sows
meda
te
to
knee.
unabe
te
mb
and
over
an
and
exquste
bua
paond
A.
was
and
ower
rgt
on
examnaton
tere
rgt
and
game,
rotated
meday.
comes
anke
durng
externay
140.
man
et
Limb
nrapatear
bursa
bursa
w
w
be
not
afected
be
afected
CHAPTER
145.
A
53-year-od
o
a
woman
6-mont
wakng.
Pysca
T rendeenburg
er
rgt
afected
to
A.
Scatc
B.
Rgt
sgn
produce
neror
D. Let
superor
A
back
down
era
to
s
et
oot.
to
s
postve
a
asked
to
et
mb.
as
on
anke,
been
sgn?
o
tere
s
a
te
as
he
tg,
on
o
atera
absent
te
dorsexon
wc
o
o
te
o
o
decreased
te
et
oot.
anke,
te
oowng
tese
sde
et
nerve
148.
and
and
a
bua.
Forceu
B.
Drect
pantar
Extreme
15-year-od
s
s
anke
ton
ndngs?
s
C. L4
n
Deep
B.
Femora
and eg.
to
pan
te
to
emergency
te
et
meda
et
surace
mb
sows
meda
trd
descrbes
ma-
o
te
te
most
anke
te
taus
nto
te
tba
te
s
o
everson
te
tat
s
an
anke.
anke
to
ater
s
eastc
Wc
n
te
e
te
and
Pysca
mdy
o
anke
emergency
as
he
boy
oowng
pan
njures
examna-
spraned,
bandage.
carr yng
te
oot
brougt
parents
o
oot
and
st
t
as
perpera
sensaton
rom
te
jont?
A.
brougt
et
ower
s
swoen
atera
dsta
skateboardng.
nvoved
E.
severe
et
te
o
te
te
and
o
exon
s
wt
s
s
D. S1
S3
by
sows
rotaton
boy
we
wrapped
anke
s
a
ed.
on
njury?
rom
E.
A
ner ves
o
et
o
te
orce
dorsexon
pan
man
o
over
o
drt
wegt
sows
oowng
ts
nverson
atera
T12
because
o
te
D. Forceu
L2
32-year-od
te
racture
o
upward
o
uneven
bear
trd
racture
C. Forceu
B.
department
dsta
x-ray
spra
mecansm
A.
A.
A
An
Wc
an
to
tenderness
te
dspaced
department
oot.
roots
over
eg.
nerory
on
examnaton
exquste
and
et
runnng
subsequenty
257
Limb
paond
posteroat-
et
o
o
was
Pysca
wt
te
radates
atera
sows
sde
at
because
pan
and
te
examnaton
te
are
cause
pyscan
days.
posteror
over
weakness
o
2
numbness
reexes
key
past
te
e
unabe
maeous
key
to
as
postve
eous
comes
or
oe
was
et
Pysca
Compresson
147.
a
He
stand
nerve
n
n
gutea
man
pan
tendon
most
sows
oowng
because
dicuty
gutea
aso
Deep
te
se
te
te
buttock,
He
sensaton
wen
o
pyscan
gutea
pan
te
eg.
te
gutea
neror
55-year-od
severe
to
progressve
an
superor
Rgt
o
examnaton
Wc
C. Let
E.
146.
eg.
comes
story
Lower
5
buar
C. Obturator
anke
D. Posteror
Durng a game o ootba, s et oot anded
E.
emora
cutaneous
Sura
A n swe r s
Answers
1.
A.
ton
umbosacra
o
ramus
bar
te
o
and
suppy
torum
o
te
te
are
s
dorsum
o
by
trunk
woud
Ner ve
root
sensaton
njur y
o
te
o
and
abducton.
by
posed
are
o
te
woud
at
a
L5
pantar
he
o
n
te
oss
o
L5,
dvson
uncton
o
o
a
n
and
p
and
s
te
upper
second,
S2;
scatc
musces
te
and
B.
tese
and
ner ve
o
te
N
Injury
acterstc
to
bze
te
guteus
te
eg.
te
te
rom
Injur y
to
In
pevs.
and
ner ve
275
bot
stab
an
L4
sensory
wound
area
o
suppes
s
te
and
coud
supped
skn
te
medus
sup-
meda
aspect
L5.
(GAS
by
and
S2
o
te
o
S1.
L3.
atera
E.
Fg.
by
aspect
provdes
tg,
te
knee,
6.16).
293
nerve
parayss
to
ter
and
o
resuts
te
roe
te
we
te
n
guteus
n
mnmus
exampe,
contract
toes
aspect
gutea
wt
atera
nnervated
nnervated
by
eg
and
are
ourt
posteror
For
tba
nverson.
dermatome
s
toe
ee
tg
addton
guteus
a
te
tte
te
superor
oss,
te
oot.
ABR/McM
mnmus
rom
nerve;
te
o
to
mpared
contans
nnervated
a
motor
te
o
trd,
398;
mnmus.
tg,
and
meda
to
Injur y
and
dermatome
spna
are
upper
35;
com-
S1).
eg
o
ABR/McM
L4
Injury
ncudng
sensaton
3.
eg
he
GAS
A
sensaton
he
o
sup-
te
o
sensaton
D.
motor
are
o
snge
oot
487–489;
bers.
C.
o
extenson
brevs
a
o
he
te
te
oss
(especay
te
B.
oss
N
knee.
exon
ramus
segment.
by
aspect
n
patear
by
nerve
n
te
pantar
ventra
ts
ped
symptoms.
wc
S1,
oot
by
compartments
w afect amstrng musces and a o
beow
o
486–487;
he
resut
o
umbosacra
oot
and
L4
A.
oss
motor
afect
to
te
resut
ner ve,
te
dg-
nner vaton
devered
o
GAS
2.
unctons
woud
atera
musces
causes
receves
dorsexon
te
te
um-
te
and
te scatc ner ve
ventra
te
Injur y
te
ongus
o
man
L4
woud
por-
extensor
patent’s
weakness
segments
buar
o
S1
to
a
suppes
afect
are
te
buar
everson
to
not
aspect
buars
rom
or
and
te
and
njur y
o
wt
superca
bers
resut
n
It
cutaneous
bers
an
te
ner ve
S1.
anteror.
woud
o
anteror,
Injur y
tese
exon,
responsbe
T ransecton
oot.
a
rom
between
buar
and
toes
or
bers
and
tertus,
te
tbas
trunk
resut
pantar
o
hereore
oss
ped
te
because
ner ve.
L5,
tbas
buars
te
L4
deep
L4,
responsbe
umbosacra
reex
o
o
contnuty
he
o
ongus,
and
nverson
emora
ramus
extenson
L5
conssts
provdes
pexuses.
ongus,
tendon
trunk
segments
aucs
anke.
oot
and
sacra
wc
te
ventra
L5
rom
extensor
o
anteror
1–24
he
a
car-
medus
abductng
uncton
guteus
to
medus
contraatera
te
sta-
and
oot
s
258
C H A P T E R
5
Lower
Limb
4.
E.
he
ng
deep
te
eg,
L2
buar
musces
wc
are
dorsexon,
L1
resut
S3
L1
rst
n
a
and
s
responsbe
anteror
and
between
(pantar)
toe
Injury
aso
oss
te
exors
or
nnervat-
compartment
or
nverson.
drop
space
Unopposed
te
responsbe
oot
web
nerve
o
o
to
o
rst
o
extenson,
ts
te
nerve
sensaton
and
w
o
second
oot,
te
oot
te
toes.
nnervated
S4
by
brances
pantar
L2
o
exon
te
o
tba
te
oot
nerve,
n
ts
w
resut
patent.
n
he
te
abty
L2
to
evert
ca
A.
L3
Injury
S2
te
buar
to
afected
nerve
te
partment
s
tba
musces
posteror
oot
ndcates
tat
te
super-
ntact
nerve
o
afects
te
compartment
eg.
are
te
posteror
he
musces
responsbe
or
com-
n
te
pantar
L3
S2
exon
L3
B
and
and
C.
superca
era
toe
he
exon.
common
and
deep
compartment
ces
n
bot
respectvey.
o
te
he
buar
buar
te
atera
oot,
and
superca
nerve
nerves
as
and
spts
t
tese
anteror
buar
nto
enters
te
te
suppy
at-
mus-
compartments,
nerve
nnervates
te
L4 L4
buars
ongus
everson
o
and
te
buars
brevs,
wc
provde
L5
L5
njured
ost
D.
n
n
te
ts
oot.
case,
addton
he
to
pes
s
a
te
te
common
o
dorsexon
sapenous
nerve,
I
everson
nerve,
cutaneous
meda
sde
a
te
buar
oot
and
o
sensory
te
eg
were
aso
be
nverson.
contnuaton
pure
nerve
woud
and
o
te
nerve
emora
tat
sup-
oot.
S1
GAS
627,
660;
N
531;
ABR/McM
344
S1
5.
S1
A.
In
te
dvded
L4
L5
and
aso
subnguna
nto
meda
tree
space,
compartments:
compartment.
known
as
te
te
he
emora
emora
atera,
meda
cana.
seat
s
ntermedate,
compartment
he
cana
s
contans
L4
ymp
nodes
and
adpose
tssue.
he
emora
rng
s
L5
te •
GAS
Fig.
openng
te
acunar
anterory
preventng
Wen
asked
te
to
te
patent
stand
contraatera
wt
on
te
a
superor
afected
pevs
rom
gutea
mb,
te
droppng.
nerve
pevs
njury
s
descends
on te opposte sde. hs s caed postve T rendeenburg
sgn.
over
In
ground.
A.
steppng
te
he
njured
he
standng
C.
Tppng
ng
on
Spna
E.
he
are
ng
o
oot
569,
to
te
a
te
te
sde
te
part
poston
njury
to
or
te
aow
scatc
564,
are
L2
and
te
C.
emora
a
person
responsbe
to
nnervated
st
by
down
te
N
489;
rom
tba
ABR/McM
ex-
325
a
dv-
te
superca
s
he
by
rng
may
te
and
s
connectve
meday
emora
ven,
posterory
cosed
by
becomes
protrude
anteroatera
he
o
nguna
tuberce
openng
o
te
wc
te
deep
ses,
et
aspect
by
connec-
weakened,
troug
o
te
te
pubc
te
nguna
wc
pubc
s
ocated
nguna
end
spermatc
o
te
cord
superor
gament.
nguna
or
It
to
s
cana
round
ga-
exts.
rng
atera
s
rng
te
meda
uterus
and
and
s
to
ocated
te
approxmatey
tuberce
and
te
above
neror
a
te
mdpont
anteror
nguna
epgastrc
ves-
between
superor
ac
spne.
nerve
or
nerve.
579;
bounded
gament,
ntestne
wc
pubc
gament
D.
many
gament.
rng,
ment
a
exon.
musces,
to
cana,
ateray
nguna
sma
troug
or
to
gament,
te
Wen
te
he
te
and
p
emora
tuberce.
B.
stand-
te
o
te
p).
we
tssue.
emora
neror
responsbe
exed
rgt
eans
of
by
pectnea
tve
orward.
sttng
te
mb
by
musce
rom
ndcates
L1
poston,
492,
swung
supped
man
ndvdua
good
te
nerve.
roots
knees
te
ten
(extendng
et
gutea
te
s
rse
pevs
amstrng
son
to
te
responsbe
te
mb
te
poston
o
nerve
standng
GAS
s
person
te
superor
D.
a
afected
tng
maxmus,
nerve,
aowng
te
wen
unnjured
guteus
gutea
orward,
sde
te
6.6
by
ted,
o
he
ata
ng
to
sapenous
on
s
te
just
openng
anteror
atera
to
s
aspect
te
nguna
gament.
passes
troug
te
ven.
o
aperture
te
pubc
te
emora
an
he
sapenous
o
tg.
tuberce
great
te
he
and
asca
open-
neror
sapenous
openng
to
ven
jon
te
CHAPTER
E.
he
tor
obturator
oramen
he
obturator
tg
GAS
6.
D.
298;
N
abducton
may
ous
orces,
be
o
eous.
tunne,
tba
most
A.
te
he
atera
buars
B.
sum
o
he
atera
he
te
atera
te
deep
te
musces
n
te
web
branc
jon
GAS
D.
o
scatc
te
te
rom
teror
tus
under
te
superor
o
A.
te
s
a
branc
downward
It
s
te
o
A.
orm
to
te
guteus
deep
426,
wc
E.
oot
and
nerve
and
to
te
te
dran
Deep
tg
te
border
o
medus
cs
over
sura
te
anteror
greater
te
te
he
to
scatc
to
can
nerve,
te
E.
t
te
border
o
te
posteror
to
te
prorms.
eg
oot
poptea
te
superca
and
ymp
deep
and
te
superca
oot
takes
deep
group
nguna
te
ymp
ympatcs
nguna
nto
anterome-
vertca
nodes.
and
deep
dran
group
group
es
ower
regon
562;
N
nodes.
externa
and
te
parae
descends
o
can
te
Baker
Most
mb
ac
nto
n
he
vertca
to
and
te
te
deep
nodes.
group.
beow
te
cystc
jont
can
te
ormaton
termna
nto
te
te
te
a
and
crest.
o
te
ympat-
group
nodes
exon
and
o
structure
and
group.
o
ts
s
suc
and
musce
by
te
exon
key
artrts
ud
s
responsbe
most
as
as
It
posteror
nerve
oot
ound
excessve
te
are
nerve
ossa.
ntrnsc
te
condtons
tba
n
musces
semmembranosus
o
part
vertca
poptea
musces
exon,
n
ac
orzonta
key
hese
resut
te
poptea
Compresson
pantar
te
superca
te
troug
eg.
perneum,
o
348
most
pantar
oot.
he
n
s
o
nto
ABR/McM
te
Knee
tears
nto
te
eve
te
dran
nnervatng
o
afect
typcay,
te
o
toes.
cartage
aong
dranng
exon,
cyst.
es
vertcay
compartment
te
ven.
nerve
or
umbcus,
beow
dranng
475;
afected
knee
beow
group
gutea
he
or
wa
tose
a
and
producton,
bursa,
eadng
to
cyst.
A.
Dorsexon o te oot woud be compromsed te
B.
Fexon
deep buar nerve were compressed by ts Baker cyst.
ped
C
and
by
D.
extenson
GAS
598;
o
te
tg
umbar
he
o
responsbe
es
te
325
atera
nto
nto
wereas
te
sapenous
responsbe
trave
wereas
superor
to
gemeus.
te
he
ac
te
buttocks
except
GAS
pos-
quadra-
nternus
prorms,
o
gutea
regon
nerve,
nerve
te
sur-
greater
trocanter
key”
gutea
obturator
over
te
node.
orzonta
vertca
great
te
nerve
and
ymp
rst,
nto
te
and
unctons
troug
pudenda
te
courses
atera
o
nodes
abdomna
anteror
buar
tg
externa
orzonta
he
cutaneous
musce
nguna gament, recevng ymp rom te anteror
cyst
“anatomc
n
he
te
atera
obtu-
emors.
neror
neror
ymp
emur.
te
neror
s
ABR/McM
te
dran
nodes
dran
groups:
D.
back
364
rom
nerve,
to
te
te
Superca nguna ymp nodes are dvded nto two
nerve.
te
to
nodes.
nguna
nto
most
and
nto
te
to
quadratus
superca
rst
carry
dranage
poptea
te
nerve.
prorms.
te
sura
common
sura
o
eg
superca
nerve
skn
rom
o
neror
te
te
te
492;
te
dran
Superca
and
nnervates
and
N
s
to
regon
and
rom
B
com-
nto
575;
w
pro-
troug
It
arses
trocanter
ocated
superor
nternus
554,
s
emors
nguna
nodes
eg
enters
te
anteroneror
gemeus
greater
gutea
superca
C.
9.
ateray
nerve
nerve
enters
meda
te
nerves
nerve,
t
buar
septum.
nerve
nserts
major
neror
gutea
quadratus
te
te
and
nodes,
te
oot.
arses
passes
te
dvdes
deep
coursng
ABR/McM
cutaneous
and
by
he
musce
and
and
te
t
buar
buar,
nerve
te
o
common
eg
and
rom
535;
gutea
nternus
eg
dor-
atera
o
posteroatera
cutaneous
and
upper
branc
te
te
a
nerve,
compartment
tba
N
te
s
neror
gemeus
Lympatcs
o
n
prorms.
he
GAS
8.
te
enters
nnervates
te
cutaneous
consdered
emora
emors,
a
te
aspect
obturator
to
nerve
nnervatng
nerve
a
o
te
te
reatve
neror
s
o
area.
to
because
ocated
te
s
o
neror
he
n
te
njury
tba
brevs.
and
s
eg
ca
sacrum,
It
o
te
branc
oramen,
emur.
eg,
buar
neck
anteror
prorms
te
te
E.
pos-
hereore
cause
courses
over
buar
space
togeter
anatomy
be
te
635–645;
he
ace
tarsa
nerve.
base
rator
cose
te
just
o
trocan-
he
exor
ongus,
ocated
surace
greater
meda
ma-
n
s
externa
te
co-
te
wc
ntermuscuar
nerve
cutaneous
s
It
te
to
he
contnu-
meda
emur.
rom
attaces
prorms.
he
gaments
wt
te
arses
and
upper sde o te sca tuberosty and attaces to te
posteror,
may
te
o
spne
259
Limb
and
da
asca
nerve
o
crura
o
o
Ater
te
hen
sura
meda
njured.
tba
aucs
nerve,
nerve
nerve.
buar
he
and
troug
optons,
skn
compartment
aspect
7.
to
buar
compartment
E.
ter
case.
common
superca
rst
everson
te
tbas
cutaneous
sensory
around
anteror
te
gemeus
sca
nguna
sura
buar
courses
o
te
buars
deep
to
te
oot.
o
deep
o
nerve,
and
percng
te
mon
buar
wt
wc,
tba
te
ts
buar
ongus
by
vdes
C.
n
pevs
(detod)
passng
compartment
oot
branc
bone,
o
Superor
te
become
maeous
Among
B.
C.
avuson
te
te
maeous
exor
and
njured
common
te
and
ext
obtura-
membrane.
cana.
may
tendons
superca
te
n
meda
nerve.
key
te
te
235
maeous
vesses,
o
nerve
coatera
structures
ongus,
tba
racture
te
tan
o
obturator
outward
meda
resut
ncudng
dgtorum
roed
te
meda
o
and
meda
may
proxmty
teror
te
he
s
openng
te
obturator
gaments
stronger
orce,
an
by
ABR/McM
oot
(detod)
strengt
te
256;
te
s
vesses
troug
Wen
atera
cana
bordered
Lower
5
or
N
deep
te
s
nerves
buar
dgts
uncton
te
o
te
ABR/McM
te
eg.
352
o
musces
emora
nerve
wereas
extenson
507;
a
and
s
sup-
nerve.
responsbe
emora
or
nerve
s
260
C H A P T E R
10.
A.
he
5
postve
njury
to
te
menscus
ment.
Lower
s
vagus
tba
rmy
Damage
causes
Limb
attaced
to
te
concomtant
because
o
ts
stress
test
coatera
to
tba
te
te
knee
tba
coatera
damage
reatonsp.
o
gament.
to
te
ndcates
he
coatera
gament
meda
12.
meda
B.
ga-
A.
oten
cck
te
meda
test
C.
he
ong
B.
cubod
anteror
capsue
durng
te
be
but
s
o
te
n
njury
damaged
to
es
nsde
te synova
knee
yperextended.
postve
were
gament
outsde
extenson
knee
ts
crucate
and
aong
cavty.
may
Anteror
anteror
wt
be
It
knee
s
torn
drawer
crucate
te
te
taut
gament.
meda
te
w
D.
I
te
and meda crucate gament, an “unappy trad” (o
O’Donogue
rect];
C.
he
aso
atera
atera
to
D.
synova
w
E.
a
spengs
njury
attaced
receves
to
are
woud
te
muscuar
cor-
E.
resut.
tba
co-
to
and
te
mts
aso
attacment
outsde
yperexon
posteror
postve
es
crucate
posteror
drawer
o
o
13.
te
B.
deep
gament
te
A.
pes
ansernus,
gracs
wt
makng
up
te
te
tendons
oter
o
te
sartorus
two-trds.
he
pes
o
te
tba
surgca
GAS
D.
607–609;
he
great
coronary
te
rom
te
s
meda
oot.
ton
A
neck
can
anke
te
can
B.
o
wc
anteror
great
C.
o
and
ower
te
grats
E.
he
s
o
tat
ment
o
560;
N
w
te
on
o
dsta
te
te
meda
n
a
eg,
n
a
cutaneous
te
E.
s
aspect
te
a
contnues
s
o
te
tat
buar
and
hese
wt
te
oten
arses
common
nnervates
te
eg
te
and
buar
skn
atera
arvested
or
he
GAS
14.
C.
or
by
deep
n
ABR/McM
branc
te
347
o
te
posteror
compart-
3
to
5,
o
te
and
t
arc
s
o
ocated
and
and
s
arc
aso
o
It
te
out
s
(supe-
rom
nvoved
attaces
ans
anke.
deep
extends
n
oot.
proxmay
to
renorce
nvoved
n
an
te
superor
not
te
rom
and
o
meda
te
te
sends
emur
gencuar
a
to
artery
artery.
emora
to
arses
artery
engt
gencuar
bood
does
artery
emors)
down
te
359
emora
artery
ead
s
and
anastomose
responsbe
neck
wt
o
te
dsta
ves-
knee.
peroratng
tat
artery
anastomoses
sends
wt
te
an
ascendng
meda
crcumex
t
as
gutea
artery
mportant
s
a
branc
anastomotc
o
te
suppy
nterna
to
te
p
typcay
emora
sma
artery
be
N
490;
meda
suppyng
a
o
te
artery
gven
of
emora
s
dsta
gencuar
just
artery
to
te
branc
proxma
as
te
to
o
te
poptea.
occuson,
t
w
epu.
592;
he
te
descendng
s
number
ABR/McM
crcumex
bood
o
to
te
brances
gament.
327
emora
ead
tat
hs
artery
and
pass
under
artery
s
neck
s
responsbe
o
te
most
te
emur
edge
key
o
at
te
rsk
or njury n an extracapsuar racture o te emora neck.
A.
he
neror
ac
greater
B.
he
rst
artery
D.
he
and
n
te
oramen,
te
ent
n
ent
by
artery
te
artery
te
nter-
troug
te
prorms.
sends
wt
o
arses
troug
suppes
te
person
te
beow
rom
regon
te
an
ascendng
neror
gutea
buttock.
passes
ead
a
arses
gutea
anastomoses
obturator
and
artery
te
peroratng
tat
commony
o
gutea
enters
scatc
branc
sde
scatc
pantar
ran.
atera
t
s
and
te
crcumex
neror
artery
termna
te
scoemora
on
nerve
wt
contnuaton
rom
body.
eg.
513;
he
te
sensa-
te
te
jont.
te
at
te
ongtudna
(detod)
ABR/McM
branc
rst
not
atera
assocated
nerve
rom
and
at
ac;
te
area.
o
sp
517;
and
te
burcates
deep
anke
meda
o
te
te
gament
maeous
suppyng
Because
o
n
coatera
superor
he
na
nerve
n
te
te
sde
rom
tuberosty
metatarsas
ongtudna
(prounda
on
respectvey.
not
te
essen
oss
and
o
o
emora and te neror gutea artery n te buttock.
D.
sapenous
dysestesas
nerve
te
strpped
ven
and
he
nnervate
te
s
nnervatons
superca
to
part
ven
nerve
resut
buar
nerve
hs
nerve
te
te
cronc
brances
esewere
tba
te
n
o
supports
depresson
te
cubod
emora
ses
C.
used
brances
patents.
and
or
ven.
tba
oot.
commony
te
tereore
posteror
nerve
GAS
nerve
and
s
n
used
gament.
te
te
capsue
N
branc
Strppng
o
be
jont
emur,
339
cutaneous
eg
nto
nerve
juncton
nerve
te
or
contnue
sapenous
te
knee.
common
atera
sura
ven
can
crucate
Because
protect
compartments
are
he
te
create
bua
porton
ven
grats.
te
ts
can
he
te
o
a
ABR/McM
dscomort
to
aso
and
anteror
damaged
to
Injury
nerves
be
drecton
surace
nerves,
cross
responsbe
and
and
498;
bypass
nerve
postoperatve
nerve
te
sapenous
nerve
opposte
o
N
artery
sapenous
eg,
tuberosty,
repar
commony
gament
passes
to
gament
crcumex
he
o
pantar
atera
or
ansernus (goose oot) s ocated at te meda border
bases
to
meda
anastomose
and
aso
anke.
ressts
gament
cacaneus
ong
meda
descendng
test.
and
mantanng
cacaneus
638;
he
s
te
oot.
pantar
te
everson
he tendon o te semtendnosus orms one trd o
and
to
te
te
GAS
gament
n
sort
he
to
taus
te
te
mantanng
musce.
cavty
n
[bot
knee”)
not
crucate
Damage
resut
s
but
popteus
knee.
“bow
menscus
posteror
te
Donaue
a
gament
te
he
or
caed
and
o
oot.
he
ror)
menscus
o
te
mportant
wen
test
te
pantar
o
gament
spran
cacaneonavcuar
o
arc
surace
he
nverson
pantar
ead
w be postve n njury to meda and atera menscus.
jont
11.
cacaneobuar
n
he
te
menscus
ABR/McMurray
he
njured
o
teenage
te
but
s
agesnce
years.
te
nterna
obturator
artery
emur
ts
rom
te
wtn
te
It
gament
not
key
t
usuay
s
ac
oramen.
to
be
pat-
not
pat-
CHAPTER
E.
he
superor
ac
artery
oramen
GAS
15.
B.
and
cana.
te
partment)
tg.
te
A.
he
or
C.
p
scatc
tba
common
or
B.
o
486,
he
te
ror
ror
o
meda
resut
and
n
o
C.
tat
o
are
te
o
eg,
D.
o
te
common
N
to
o
te
deep
respon-
atera
com-
everson
o
p,
te
pos-
wc
exon
o
are
te
ng
superca
te
te
and
atera
and
he
nverson
deep
o
part
o
ante-
ton
ony.
responsbe
or
ts
and
A.
n
dects
n
tese
he
ment
nerve
hs
o
resut
n
es
nerve
te
a
eg,
oss
supercay
nnervates
so
o
te
compresson
pantar
n
te
posteror
n
exon
ts
and
poptea
C.
compart-
area
woud
weakness
o
nnervated
by
D
he
n
everson
o
asca
suppy
he
te
n
anteror
te
he
deep
meda
jecton
tba.
te
and
GAS
A.
oot.
o
o
nerve
maeous
many
cutaneous
emerge
aspect
nvoved
brances
troug
o
te
eg
N
gutea
nerve
and
n
an
te
s
eg
s
many
o
runs
oss
o
te
near
drected
te
groove
compresson
o
toe
end
A.
at
n
B.
exon,
C.
te
D.
oca-
and
he
he
ABR/McM
s
adducton,
ts
346
s
and
and
abducts
te
he
courses
atera
deep
are
hese
neror
o
te
buar
by
ntermuscuar
oot
over
key
afected
rst
ts
as
and
web
space
te
dsta
sensory
occurs
o
septum.
compartment
njured
at
ts
unc-
orgn,
we.
carred
everson
ten
cours-
dorsexon,
te
te
nerve
nerve
eg
anteror
nerve
s
around
compartment
buar
afectng
te
oot
emors
emors.
by
te
te
deep
oot
s
bu-
by
te
nerve.
buar
nerve
and
at
ts
nverson
medates
pantar
orgn
o
te
w
oot.
exon
o
te
he
words,
te
anteror
Patear
GAS
D.
te
gament,
N
500;
te
to
gament
drawer
coatera
pusng
o
gament
reatve
emur
on
te
test
knee
wt
te
responsbe
emur
prevents
te
xed
prevents
tba,
and
knee
gament
te
s
te
te
gament
pusng
stragten
606;
te
coatera
knee,
tba
te
tba
346
gament
sdng
crucate
o
(ence
knee,
ABR/McM
orward
o
buar
511;
crucate
on
posteror
emur.
posteror
muc
drawer
prevents
or
te
ke
a
sgn).
varus
orces
ateray.
resst
vagus
orces
on
meday.
quadrceps
emors
mus-
knee.
ABR/McM
339
he guteus maxmus nserts nto te gutea tuberos-
ty and te otba tract. Atoug te guteus maxmus
nnervated
musce
prorms,
superca
skn
be
te
nerve
N
te
oter
te
ce,
20.
531;
te
most
to
deep
posteror
In
te
bend
ts
to
emur.
nerve
he
dorsexon
Tba
drawer
pro-
o
bre-
musces
324
nerve
w
o
te
dspacement
nnervated
dsta
and
njury
buar
622–623;
he
tba.
and
nvoved
or
compart-
adductor
ateray.
crura
patent
dspacement
nerory
sde
and
maxmus
nerve,
E.
oot.
o
E.
mn-
tg.
exed
extenson,
owever,
bot
preventng
te
abducton.
guteus
19.
on
s
meda
resut
s
s
oot.
maeous,
woud
he
te
eg
and
anteroatera
te
te
te
nerve
compartment
tba
538–541;
he
ror
he
te
o
nerve
buar
buar
rom
meda
ton
17.
te
dorsum
dorsexon
E.
buar
superca
deep
by
compartment
superca
te
D.
GAS
atera
te
nerve;
and
meda
quadratus
te
n
buar
te
to
to
oot.
nverson.
C.
he
uncton
Injury
nto
nerve.
oot
Dorsexon
afect
pr-
used
guteus
ateray
compartment
toe
deep
I
te
anteror
te
superca
tba
ossa.
motor
ar
movements.
A.
te
te
tg
enters
musces
or
oot.
ante-
respectvey,
dvdes
te
o
te
responsbe
quadratus
buar
t
buar
anteror
responsbe
are
resut
and
troug
s
adductor
nerve
and
ABR/McM
buar,
neck
oot,
395;
nnervates
te
te
te
te
te
he
tg
to
abducts
common
deep
by
te
nerve
te
eg
te
enters
271
around
te
and
It
respectvey.
te
woud
eg,
ABR/McM
nto
eg,
o
o
s
te
are
ongus,
rotate
gemeus
by
rotate
N
It
and
emur.
aso
572;
nnervates
magnus.
rotates
neror
Ater
p
tat
adductor
nnervated
gemeus
neck
o
wnds
nnervate
B.
tg.
nnervates
medus
meday
s
musces
GAS
18.
oot.
529;
nerve
te
nerves
and
and
te
te
and
exed
he
nerve
adductor
musce
te
E.
buar
te
nerve
musces
tg
o
o
dvdng
on
nto
buar
anteror
te
exon
and
te
exed
tg.
ncudng
Prorms
ante-
responsbe
te
obturator
adduct
on
nerve
guteus
o
nnervated
brances
te
compartments
and
tese
te
gutea
and
o
te
261
Limb
poston.
te
vs,
respectvey.
buar
go
o
seated
mus
ments
o
dect
a
rotaton
extends
Superor
he
com-
sde
rom
atera
tat
abducton
weakened
sensory
musces
nto
nerve
563–565;
atera
to
nnervaton
(adductor
te
can
obtura-
extenson.
extenson
compartments
njury
on
te
pexus
and
musce
te
nnervates
beore
tat
and
umbar
or
tg
tg
brances
te
or
500,
dorsexon
skn
brances
pantar
bua
te
te
buar
common
brances
mary
tg.
eg
compartment
and
extenson
scatc
B.
te
troug
nnervates
and
nerve
responsbe
eg,
o
nerve
o
nnervaton
tba
teror
nterna
nerves.
partments
GAS
nerve
superca
he
tg
wakng
te
nerve
te
greater
327
rom
responsbe
ts
o
exon
and
sbe
16.
s
dicuty
aspect
he
he
arses
te
compartment
and
D.
to
rom
te
rse
ABR/McM
nnervates
emora
ror
E.
491;
Injury
arses
troug
prorms.
nerve
nerve
and
meda
te
compartment
and
adducton
artery
enters
enters
hs
meda
te
N
obturator
(L2–L4)
tor
above
589–592;
he
gutea
and
Lower
5
by
te
ne-
responsbe
or
woud
ter
contnue
orentaton
to
contract
woud
be
at
te
regons
dspaced
by
te
o
nserton,
racture.
262
C H A P T E R
A,
B,
C,
5
and
obturator
aspect
GAS
21.
B.
o
te
apex
o
te
adductor
ts
e
o
N
trocanter
479;
te
medus,
prorms
emora
and
(subsartora,
emora
te
deep
on
bood
some
ment
te
occurs
to
at
te
cana)
ts
junc-
musces.
anatomc
deep
overyng
emora
one
A.
o
to
te
te
ead
gament
o
x-ray
rare
pont
B.
n
te
damage
a
butcer’s
ocaton
Fata
are
oss
pressure,
A.
he
C.
he
at
te
n
but
bood
C.
he
deep
oss
564;
A.
and
he
occur
N
s
te
and
te
s
a
ton,
ra
s
not
D.
woud
atera
E.
artery
ra
te
to
emora
aso
ven
at
known
usuay
as
GAS
24.
near
o
arses
3
te
emora.
any
oten
to
5
orgn
te
o
to
gament
t
te
te
ead
It
resst
Y
mus
and
te
wt
te
te
by
a
ga-
artery
o
nsgncant.
racture
vascuar
o
not
te
njury
bood
suppy
not
o
te
ordnary
woud
o
because
or
artery
atoug
racture
emur
ead
ste
obturator
he
vesses,
S1
root
o
te
gament
bot
o
A.
renorcng
n
te
s
not
emur
te
greater
severa
gutea
coud
tere
are
te
resut
severa
n
co-
tg.
extracapsuar
mper
yperexten-
te
B.
A
jont
ne-
D.
te
jont
E.
rotaton.
brdges
te
pos-
dsc
notc
at
on
an
GAS
te
emo-
vascuar
gutea
a
ard
N
two
a
nsert
n
S1
surace
or
dsc
at
at
te
under
or
nerve
te
S1
L5–
tenson,
parayss
o
exors.
te
L4
spna
te
probems
wt
L5
extenson).
sacrum
o
s
te
usuay
unconscous
an
cacaneus.
spna
pantar
cause
and
extended
ABR/McM
te
afect
trceps
extenson);
syndrome
yng
gastrocne-
coumn
root
te
umbarzaton
been
te
by
weakness
woud
woud
S1–2
on
ernated
te
o
o
eads
prmary
knee
nverson
at
531;
puts
and
crus
as
but
335
uncton
vertebra
L3–4
was
a
especay
L4–5
eson
619;
at
oot
tat
possbe
exon
tere
patent
across
nto
he
and
eson
eson
A
space
s
te
te
sacrum,
musces,
(p
uness
meda
gament
dsc
nerve
ABR/McM
provded
eaves
pan
(afectng
renorces
and
A
o
musces
s
ntervertebra
n
495;
reex
composed
soeus
S1
N
tendon
nnervaton
oramen
jont.
renorces
o
te
emur
connects
acetabuar
branc
te
ossa.
o
suppy
ABR/McM
key
te
te
to
s
a
decate
ovea
he
on
band
obturator
te
emora
te
car-
artery
ead
n
an
be
te
arteres
and
reaces
most
emora
retnacuar
gament
surace
ndcatng
as
te
tat
te
o
approxmatey
25.
C.
mprobabe,
S1
vertebra.
occurs
and
wen
a
unmovng
perod
o
tme.
355
25–47
Wt
ened,
L5
and
parta
denervaton
o
te
n
te
6
te
add-
A.
L4
years
sco-
o
nous
and
Unt
an
age,
o
he
are
o
It
wc
oot
s
superca
B.
L2
An
s
to
eg
aso
everted
buar
be
L3,
te
L4
woud
o
eg.
o
com-
cause
cutaneous
he
prmary
wereas
patear
te
rom
derved
sensory
L4.
dermatome
by
te
weak-
ntegrty.
s
L4
oot,
way
o
on
te
quadrceps
he
te
sape-
emors
knee.
because
nerve)
te
be
because
anteror
oss
prncpay
te
suppes
he
o
te
to
and
reex
and
extends
o
nerve
and
suppes
te
unopposed.
sde
woud
weakened
njury
L4
te
L2
sad
s
reex
to
o
nerves
arc
sde
nverson
musces
meda
test
nerve
nerve.
musce
D.
te
te
patear
sde
spna
spna
o
eg.
te
to
motor
meda
avas-
to
used
he
sde
racture
te
s
rom
necross.
te
neck.
10
reex
meda
beneat
to
neck,
anke
dorsexon
weakness
emo-
te
damage,
oot
partment
ntracapsuar
caused
emora
In
rgt
because
pass
te
te
avascuar
key
ead
emora
racture.
o
tat
brances
perce
Answers
nnervaton
o
ntracapsuar
concuded
racture
o
333
racture
artcuar
attened,
can
crcumex
ndvdua
musce,
resutng
gament
convertng
band.
te
sows
necross
te
to
attacment
670;
Aces
S1-supped
p
extenson
bood
477;
s
o
suppy
te
woud
surae
yperabducton.
acetabuar
tssue
major
N
o
558–561,
he
S1.
Serous
tese
C.
he
ata.
(“nverted
woud
at
neck
s
neck
addton,
racture
symptoms,
sources
emur
compcatons
an
Commnuted
In
provded
hereater
te
emora
p.
s
runs
dsocaton.
cause
s
o
emur
tat
emur.
te
bood
hromboss
muscuar
329
gament
acetabuar
neck
damages
emora
te
gament,
njury
s
notc,
superor
ead
atera
tat
mts
ead
most
hereore
cuar
emora
p
te
oramen.
x-ray
te
emora
mnutes
peope.
553;
wc
te
emora
mportant
rotaton
gament
young
he
ts
njury.
mmedatey.
approxmatey
rom
gament
prevents
and
emora
C.
ew
atus,
artery
wt
most
anterory
connectve
tat
or
crcumex
tem
transverse
res
jons
ABR/McM
acetabuar
he
a
at
bock”
te
ead
te
o
artery
suppy.
ven
artery
scoemora
he
GAS
to
475;
acetabuar
E.
just
apped
becomes
nguna
puboemora
he
te
te
emora
can
terory
D.
to
atera
rory
B.
n
not
openng
oemora
jont
son
njures
(suc
gament.
emora
njury
Bgeow”)
te
artery
meda
neror
he
s
reason,
objects
“butcer’s
occur
sapenous
deep
atoug
GAS
te
sarp
ovas.
E.
te
ts
as
can
ac
nguna
te
nces
For
to
tournquet,
sapenous
and
rom
bood
a
great
ossa
o
o
or
externa
te
D
kne).
reerred
andng
o
te
musces.
we
o
te
Intertrocanterc
artery,
caused
sppng
ead
sows
trocanter
by
te
obturator
dsocaton
at
anoter
o
he
he
begns
suppy
branc
emur.
sartorus
ven,
oten
mnmus,
nsert
305
Hunter
emora
ven,
guteus
a
trange
ongus
artery,
o
ABR/McM
Immedatey
emora
deep
guteus
and
adductor
cana
Limb
tat sequence. hs as storcay been a ste o njures
as
23.
he
greater
ocaton.
te
and
22.
E.
nternus,
566–567;
he
ton
Lower
te
S1-supped
buars
Aces
ongus
reex
s
(by
and
aso
te
brevs
prmary
CHAPTER
supped
mary
by
by
S1.
L5-
Hp
and
movements
S1-supped
are
produced
musces,
as
s
pr-
he
knee
lexon.
E.
S2
o
spna
ower
obturator
ongus,
s
dect
GAS
26.
C.
so
woud
m,
atera
trd,
absent
over
o
te
A,
B,
D
and
sensaton
te
and
aucs,
531;
te
o
lexor
o
drect
aucs,
abductor
te
a
musces
o
o
te
meda
pantar
te
o
knee
te
dgt
27.
A.
Sensaton
te
and
te
mn-
te
te
In
651;
pantar
surace
ourt
toe
musces:
aucs
532;
ts
o
as
rst
brevs,
ABR/McM
gves
(L5,
case
are
o
te
B,
and
te
te
C,
D,
and
B.
buar
and
nnervated
by
E.
deep
nerve
te
we
and
provdes
rst,
as
exor
C.
o
D.
A
dgtorum
taus
te
and
oot,
are
bot
o
are
by
nnervated
GAS
31.
B.
(o
te
oter
musces
sted
o
te
not
an
o
te
rom
28.
D.
621–622;
T ubercuoss
tebrae
an
N
(wc
abscess.
sgns
o
cay
ound
can
s
he
acks
531;
spread
abscess
acute
wen
te
o
arc
te
tat
surace
supports
meda
resstance
te
oot.
may
and
te
vertebrae
to
T earng
seat
resut
n
sweng
o
no
upon
s
caed
s
eve
o
spna
tubercuoss)
cod
nammaton
nvoved,
te
te
psoas
tenderness.
exor
o
te
esser
he
p
at-
o
te
bone
te
te
pantar
ts
unke
not
dsrupt
aponeuross
aponeuross
te
anteror
sprng
te
njury
meda
s
not
provdes
te
ony
gament.
taobuar
nverson
te
woud
oot.
gament
o
te
woud
anke
ongtudna
and
arc
o
Fg.
N
type
meda
te
coatera
o
meda
te
(detod)
anke
jont
ongtudna
gament
and
arc
o
woud
te
oot
6.103).
518;
o
ABR/McM
njury
O’Donogue)
coatera
can
359
resut
njury,
n
wt
gament
te
“unappy
damage
(MCL),
to
trad”
te
anteror
tba
crucate
s
beng
and
collateral
ligament
abscess
(red
because
and
ormed.
ver-
orm
t
ot)
typ-
Wen
um-
Tibiocalcaneal
part
abscess
major
to
can
ts
spread
nserton
wtn
Tibionavicular
part
wt
Posterior
trocanter,
opsoas
presentng
musce
s
tere
te
part
te Anterior
acus
o
destabzes
346
any
spna
abscess
are
ong-
aganst
tibiotalar
bar
s
anteror
pantar
gament
gament
stfness,
gament
te
nerve.
ABR/McM
caed
o
everson
Medial
GAS
and
sprng
provdng
cubod
dsrupt
dsrupt
(meda)
o
te
arc
because
rom
635;
hs
(sprng)
oot.
(GAS
dgtorum
supped
o
spran
not
ta
arc
pan,
tendon
tendon.
connects
mantans
by
meda
support,
spran
resuts
suppy
nerve.
tba
A
respectvey.
extensor
tat
and
nerves
E.
b-
and
gastroc-
he
355
and
he
oot
wt
answer
resut
neck o
superca
two
te
sted
brances,
Eac
te
he
o
anteror
musces
and
bone.
ongtudna
racture
te
band
and
263
Limb
oot.
passve
abductor
cacanea
cacaneonavcuar
deormty
best
te
ABR/McM
te
Interrupton
second,
uncton
umbrca,
(L4–5)
evertors
nerve
o
meda
wt
soeus
tuberosty.
cacaneonavcuar
te
o
te
cacanea
sustentacuum
pantar
A
361
brances.
tbas
ony
tese
deep
of
S1–2)
dorsexors
eter
by
N
nerve
ongus
o
woud
bua
uar
te
arc
afected
and
506;
navcuar
ead
oot
woud
t
he common buar nerve passes around te
te
o
te
te
and
nserts
pantar
depresson
dorsa
mnm,
soe,
N
connects
te
brocartagnous
brevs.
GAS
616;
he
to
ongtudna
he
o
pantars
aspect
S2’s
337
exor
te
A.
tendon
musces
tudna
dgt
umbrcas.
o
GAS
30.
oot.
nnervates
sde
te
aucs
efect
extenson
te
ABR/McM
nerve
atera
LAFF
exor
none
No
n
prorms,
te
toes.
te
a
so-caed
N
ourt
E.
over
on
adductor
te
ourt
S2.
ound
pantae,
and
musces
maxmus,
owever,
by
nverson
657;
nterosse,
a
trd,
be
pantar
quadratus
second,
on;
and
many
guteus
semtendnosus,
nnervated
626–627,
pantar
be
nternus,
everson
he
nnervates
ncudng
and
soey
or
nerve
mbs
cacanea
nemus
Lower
5
tibiotalar
part
wt
prncpa
Medial
jont.
tubercle
A.
Abducton
o
te
ps
s
perormed
by
te
guof
teus
medus
and
mnmus
wt
assstance
talus
rom
prorms.
B.
Adductor
ongus,
adductors
C.
Extenson
maxmus,
E.
o
o
te
brevs,
and
magnus
are
major
tg.
te
p
togeter
Interna
(meda)
adductor
musce
s
wt
a
uncton
te
o
amstrng
rotaton
s
te
guteus
musces.
perormed
by
te Tuberosity
navicular
GAS
29.
A.
535–536;
he
tendon
maeo
s
N
486;
yng
most
of
Sustentaculum
tali
group.
ABR/McM
posteror
key
te
to
bone
of
calcaneus
335
te
cacanea
atera
and
(Aces)
meda
tendon.
Plantar
calcaneonavicular
•
GAS
Fig.
6.103
ligament
bone
264
C H A P T E R
5
gament
atera
s
tensed
to
te
A,
C,
(ACL),
sde
wc
durng
D,
and
on
E.
606;
he
anteror
aperture
te
tba
ts
dvson
posteror
artery,
eg.
or
teror
A,
B,
nto
C,
ACL
o
s
te
artery
are
dvdes
he
Pott
o
te
ated
beore
nto
te
hs
o
pantar
between
te
eg,
arteres.
or
te
provdes
brances
tat
orgn
suppy
do
not
33.
E.
620,
he
aspect
es
o
vastus
o
nserted
etrates
te
he
C.
ead
o
tba
ceps
te
584;
Wen
o
atera
cartage
knee
(e.g.,
by
te
Wen
to
te
on
a
t
course
as
not
runners)
A
to
patear
neede
s
on
n
may
ts
emora
s
resut
gate.
or
on
pes
o
he
as
te
condye
hs
he
It
aso
gdes
se
aows
to
A.
damage
o
to
te
te
s
are
a
C.
te
E.
oten
break
tears.)
he
rotaton
aso
be
or
dev-
racture.
atera
te
It
o
racture
capsue
passes
o
drect
known
rom
te
o
te
navcu-
contact
or
and
runs
o
wc
oot
a
wt
te
woud
not
anke.
composed
supports
and
woud
te
ca-
o
te
s
everson
rom
pantar
te
part
gament
gaments,
or
te
rom
s
nverson
te
as
extends
hs
o
te
te
o
at-
tereore
oot.
cacaneus
he
to
te
o
vesse
scatc
cases,
vesse
359
o
te
ts
to
enarged
o
common,
as
mb
te
s
mb,
te
scatc
beedng)
o
vesse
te
deveopment
te
ower
branc
s
emora
n
te
tere
artery.
te
o
gu-
as
weren
rupture
are
retaned
retaned
artery
tey
s
neror
gutea
te
exposed
n
ves-
te
brances
branc
emors
artery
to
suc
te
as
or
deep
usuay
posteror
tat
emora
provdes
branc
tree
o
perorat-
compartment
but
not
descrbed.
he transverse branc o te meda crcumex em-
anastomoses
te
he
deep
by
582;
afected
expans
te
N
489;
dects
oot
n
wt
o
peroratng
anastomoses
L5
branc
wt
te
brances.
crcumex
atera
genc-
artery.
325
mddorsum
spna
or
atera
superor
ABR/McM
te
branc
te
te
poptea
on
ndcate
weakness
artery
branc
o
rst
superca
anastomoses
branc
491,
a
te
artery.
gutea
gutea
descendng
Sensory
wt
emora
superor
he
GAS
D.
some
prounda
uar
37.
ABR/McM
axa
reatvey
emora
ros
popteus.
o
gament
prouse
neror
ts
popteus
be
gament
aspect
bone
arc.
nverson
tny)
emora
ora
draws
nner-
to
to
per-
area.
he
ng
unockng
popteus
aso
pantar
proxma
(wt
gutea
dsta
and
used
tba,
tba.
no
gament,
arc
by
ypopastc
regon
te
proxma
protectng
as
gament,
everson
517;
In
Aneurysms
D.
drecton.
w
can
jont.
posteror
navcuar
sort
(usuay
s
superor
te
N
artery.
o
rotates
dsta
racture
(detod)
Dupuytren
and
a
and
oot
renorces
gament
pantar
orgna
te
musce.
t
n
afected
te
to
and
635;
B.
ansernus,
te
to
te
here
te
gament,
ongtudna
be
as
or
oten
bua
(detod)
gament
te
he
te
quadr-
ateray
E.
prmary
on-
on
te
maeous.
afected
ong
GAS
te
ateray
anteror
te
Overuse
n
passes
o
s
maeous
everson.
taus
sprng
and
musce.
tereby
exed.
nerve.
on
to
bua.
328
atera
ntate
ts
wt
nserts
tendon,
aspect
posterory,
knee
and
nserted
contracts,
a
emors
te
o
meda
neede
ABR/McM
tba
n
coson,
njury
coatera
abducton
aspect
he
cacaneobuar
te
orgn
nserts
nserted
penetrate
part
ts
merges
and
emur
penetrate
dsta
te
te
A
rectus
te
te
popteus
te
musce
as
emur,
emors,
he
to
te
emur
deepest
te
o
aowng
known
rom
ongtudna
not
pen-
to
aso
term
term
meda
meda
meda
era
aspect
neede
racture
to
te
musce
patea,
ts
emors
te
orms
on
menscus
jont
C.
not
tba.
529;
te
as
backward,
vated
ts
atera
atera
he
caneus
tea
orgnates
woud
N
o
tendon.
and
te
te
bceps
va
woud
nserts
o
s
bceps
bua.
spne
patea
te
te
sartorus
part
te
o
te
te
atera.
o
tuberosty,
wc
porton
o
knee.
musce
magnus
anteror
emors
ac
D.
ateras
on
anke.
coatera
extreme
o
he
D
porton
part
ateray
aspect
o
patea
he
GAS
te
and
ead
gtudnay
34.
o
not
posteror
ead
D.
dsta
345
ocated
vece
acute
339
arcac
cacaneonavcuar
36.
tg,
sort
ong
te
s
proxma
capsue
vastus
musce
he
te
adductor
he
te
to
ABR/McM
an
rater
te
(he
s
bone.
meda
te
capsue.
meda
B.
tg.
superory
nterna
A.
te
jont
503;
ateras
superca
te
N
motor
n
taocacaneonavcuar
ar
be
617;
n
meda
posteror
neck
descrpton.
GAS
te
te
pos-
matc
(e.g.,
resut
gament,
T aonavcuar
to
te
te
tear
racture
te
A.
tg.
optons
a
ateray.
oot
a
bmaeoar
n
te
or
te
a
te
he
o
knee
can
ABR/McM
s
at
resuts
buar
compartment
bua
racture
o
artery
500;
coatera
te
tba
N
wt
te
tba
te
racture
ndcate
troug
membrane
orgn
atera
oter
617;
B.
o
anteror
posteror
atera
o
atus
compartment
te
artery
te
GAS
aps
contnuaton
to
wegts)
popteus.
descrbe
wc
orce
tng
tba
arteres.
and
te
knee,
great
and
subsequent
coces
compartment
te
A
trauma.
troug
provdes
emora
A
te
MCL,
he
tear
te
nterosseous
artery
D.
te
wereas
peroratng
and
o
anteror
posteror
compartment
to
te
339
poptea
suppes
deep
our
s
tba
meda
tba
o
type
passes
te
te
te
wc
he
tree
t
bua,
n
can
answer
surace
ts
he
nto
n
and
contnues
by
posteror
courses
bow
menscus.
and
remanng
artery
magnus.
and
A
tears
35.
ABR/McM
ater
and
MCL.
atera
500;
meda
extenson
he
njured
N
menscus.
stretces
te
te
te
artery
adductor
te
to
poptea
emora
artery
o
meda
knee
knee
E.
Limb
and
te
rupture
usuay
GAS
32.
o
attaced
structures
not
Lower
nerve
dorsexon
and
njury,
and
soe
o
wc
anke
te
aso
nverson
CHAPTER
due
to
ror
dsc
L5
parta
eg
denervaton
compartment.
at
L4–5
spna
resuts
nerve.
ntervertebra
under
L5–1
A.
L4
but
o
n
spna
passes
te
te
te
compresson
nerve
te
o
L5
ante-
E.
nerve.
exts
at
spna
ernaton
o
te
nerve
to
te
s
put
at
L1–2
Sensory
most
dect
key
w
afects
GAS
40.
te
be
just
te
beow
A.
he
hs
L2
and
te
he
gament.
(Hunter
and
Dsc
eson
at
spna
L3–4
nerve.
and
o
at
woud
Sensory
patear
aspect
regon,
te
w
toe
te
sde
afect
te
o
S1
over
te
eg
E.
spna
te
te
and
anteror
expected.
afect
sensory
tg.
key
over
s
ound
body,
o
most
meda
w
be
sde
dect
great
L5–S1
dect
vertebra
ee
GAS
C.
te
and
N
by
529;
te
te
ABR/McM
n
mb,
and
be
nerve
te
and
gutea
anteror
te
o
by
te
te
area,
possbe
Parayss
can
Hunter
nerve.
te
emora
o
arter y
te
prorms
pan
n
dvson
o
o
te
buar
Foot
dvson
posteror
te
o
B.
o
eg.
scatc
wt
nerve
a
or
eson
te
o
C.
E.
Skn
n
ra
GAS
obturator
o
N
nerve
te
at
te
emora
njury
knee
s
assocated
he
resuts
D.
n
weakness
n
nerve
o
te
wc
s
eg
a
s
nnervated
and
te
rm
o
by
n
te
te
emors
and
atae
branc
o
te
sa
emo-
te
tensor
o
and
B.
and
he
t
upon
anteror
te
atera
two
nserts
tea
nerve.
D.
he
o
supped
by
te
and
rotators
te
quadratus
o
sacra
te
p
pexus.
and
are
eg
and
as
oot.
exposng
te
poptea
wc
poptea
o
sen-
coud
arter y
be
was
buars
o
upon
tat
passes
te
ractured
te
gastroc-
bone,
te
oot,
kewse,
compex
cuneorm
va
te
anke
were
med-
t
nserts
passes
bend
nsertons
bones,
te
upon
metatarsa
te
bases,
bone.
anteror,
a
nserts
musce
upon
and
wt
te
te
Aces.
o
wt
cuneorm
o
on
because
paanges.
bone,
and,
pan
ongus
soe
posteror,
cubod
bone,
te
tendon
te
328
te
te
o
te
base
tbas
te
anteror
meda
o
te
sde
rst
posteror,
eg
o
te
metatar-
s
a
strong
oot.
ongus
te
s
a
eg.
It
te
soe
enterng
musce
passes
o
o
te
bend
te
oot
atera
te
by
com-
atera
ma-
crossng
te
prmary
o
te
te
p
rst
p
emors
and
jonts.
spne
te
It
GAS
42.
C.
tea
s
615;
he
ven
poptea
bot
supped
by
most
njury
ntact
n
te
te
to
t
te
cuneorm
tba
te
to
nerve.
one
o
te
gastrocnemus
o
n
and
o
and
o
ts
case
by
te
te
musce,
te
te
oot
eg.
It
wc
nerve;
tba
A
ossa
and
woud
exes
te
severe
o
te
evertor
resut
o
te
nerve
woud
because
because
pop-
nerve
enters
buet.
(anteror)
exon
tba
t
poptea
everted
knee
te
as
te
buar
te
ateray
extensor
compartments
weakenng
n
aong
common
ven
severed
nerve
dorsexed
runnng
he
courses
hereore
te
base
350
and
poptea
tba
and
ateray.
ABR/McM
typcay
ossa.
a
meda
bone
superca
musces
some
te
511;
key
o
(atera)
n
s
adjacent
quadr-
are
N
nerve
owever,
gu-
nto
metatarsa
and
neror
emors
provdng
tereby
atus),
cana
sde
crest,
o
resut
prorms
atera
s
te
meda
te
contnues
soeus
dgtorum
tbas
eous,
s
maxmus
o
sartorus,
adductor
rom
ac
tendon.
guteus
te
te
ts
passng
atera and neror surace o te cubod, and nserts
major
nto
on
by
mus-
te
ac
troug
ner ve,
nto
atae
rectus
exes
neror
guteus
aspect
abducton
nerve;
actng
te
ascae
rom
te
tg.
emora
te
te
he
te
or
dsta
partment
nnervates
ongus
borders.
pass
cana
gastrocnemus
augment
maeous,
nverter
325
arses
tract
acetabuum
he
brances
nerve
exon
o
tus
rom
C.
sort
ascae
knee,
part
ABR/McM
gutea
rotaton
nnervated
te
490;
otba
asssts
meda
n
te
te
compartment,
by
a
5.3.
subsar-
sapenous
emerges
sde
Fg.
or
adductor
te
aneur ysma
wt
enter
meda
sde
meda
n
muscuar
tereater
ABR/McM
o
tbas
he
tg.
mnmus,
tensor
tg,
extends
to
and
nerve.
E.
482,
guteus
nto
ceps
te
meda
superor
nserts
arses
extenson
o
nerve.
444;
medus,
and
o
te
sapenous
he
ces.
eg
patoogy
adducton
te
exor
ay
navcuar
Weakness
he
496;
tendon,
meda
nerve.
wt
N
he
he
tba
te
te
sartorus
adductor
an
arrow
medas
ner ve
te
poste-
neror
emors.
adductor
oter
eaves
(wc
te
nserts
upon
occurs
arter y
woud
cacanea
A.
te
te
te
surgcay.
585;
nemus
te
to
Contracton
atera
wt
proxmay,
we
cacaneus
pont
part
n
41.
nvove-
produce
musces
te
exon
nerve
may
te
o
ernaton.
buar
common
weakness
pantar
dsc
GAS
te
te
te
atus,
mobzed
beyond
treated
wt
compartments
o
tba
D.
brances
Dr.
101
mmc
antcpated
Compresson
scatc
pan
prorms
woud
ment.
mb
camped
80;
drop
beneat
ower
sor y
Dsc
Entrapment compresson o a or part o te scatc
nerve
rom
by
ven,
arter y
o
wt
265
Limb
328
o
vastus
sapenous
L3
meda
musce
aong
quadratus
cana),
te
emora
roo
adductor
and
te
he
to
a
ormng
arter y
ner ve
to
ndcated
te
medas
emora
te
s
orms
te
L2
over
oot.
te
cana
nerve
ABR/McM
he
Sensory
s
sartorus
musce
vastus
and
te
496;
magnus.
be
ernaton
A.
by
N
s
nnervated,
troug
between
w
meda
39.
485;
emors
s
naton
tg
B.
tat
cana.
L4
A.
p
gemeus,
L3–4
reac
quadratus
ror
Wen te L3 spna nerve s compressed by dsc er-
dects
38.
he
ntervertebra
tora
ernaton
nguna
C.
t
musces
oramen.
Dsc
spna
B.
as
te
typcay
he
oramen,
tenson
o
Hernaton
Lower
5
aso
oss
knee
o
and
266
C H A P T E R
pantar
knee,
A.
Lower
lexes
so
he
te
B.
5
ts
uncton
drop
partment
nerve.
drop
I
o
E.
43.
C.
amstrngs
he
nnervaton
be
ntact.
621;
on
514;
or
to
ra
ead.
ment
ton.
ead
In
s
s
es
tat
py
44.
te
GAS
549;
E.
he
vs
ror
te
N
any
on
to
A.
he
te
buar
nerve
s
te
GAS
45.
D.
wen
s
o
te
made
ter
te
knee.
o
by
upon
Ken
superor
guteus
1
bet,
or
o
deep
wt
eaves
meda
to
beneat,
I
t
s
o
sensatons
n
or
s
avng
extended
panu
provdes
mnmus
te
aong
regon
tat
o
oss,
are
too
someone
st-
o
tme
atera
motor
and
nguna
wegt
perod
gutea
he
gament
obturator
or
nerve
and
s
not
suppy
tensor
46.
usuay
te
pevs
te
tected
ocaton.
It
nnervates
te
adductor
musces
es
t
takes
tte
o
tendon
ts
N
to
to
cana
520;
he
to
te
o
be
to
tbas
Fgs
ABR/McM
te
content
or
tun-
pantar
resut
and,
Fascotomy
and
te
to
anteror
and
to
dranage
pace.
6.110
tarsa
nondstensbe;
requred
take
o
ncreased
aponeuross
o
regon.
oot
key
meda
tssues
to
pantar
ud
te
“T om,
te
te
venous
te
can
te
(GAS
o
restrct
aucs
processes,
n
reatvey
te
anterory
te
due
tssues
o
most
o
wtn
usuay
contents
be
eang
nor
s
ragment
ncrease
eg
most
s
poste-
among
mnemonc:
As
te
t
posteror
exor
tendon,
osseous
soe
tendon,
and
o
hroug
tbas
nammatory
te
asca
te
aow
te
Harry.”)
oot,
now
and
te
posterory
pressure
and
area
artera
and
o
dspaced
adequate
skn
ongus
o
Lasty,
roo.
to
te
surace
suraces
a
tar-
o
surace
meda
posteror,
posteror
te
as
nerve,
meda
tba.
course
syndrome).
ts
te
most
bass
o
o
dorsum
aspect
neror
posteror
to
tba
afect
brous
arge
A.
to
te
emur,
oramen
o
posteror
reduce
te
Neter
te
tendon
pass
6.115).
356
to
passes
aso
around
he
te
tat
passes
proxma
troug
part
o
te
a
rater
sat.
he
to
neck
GAS
and
592;
N
te
aspect
atera
o
p
crcumex
te
ead
o
o
part
te
o
ac
te
495;
te
te
te
suppes
o
obturator
o
usuay
ead
emora
suppes
regon
te
socket,
crcumex
artery
and
branc
gament
artery
meda
ature
n
te
atera
emora
meda
ower
crest,
anteror
wa.
tssues
branc
he
te
acetabuar
pes
E.
vesse
te
suppyng
abdomna
B.
a
enter
he deep crcumex ac branc o te externa ac
emora
troug
aso
te
o
dgtorum
o
te
te
cacaneus,
and
emorrage,
meda
artery
ascae
obturator cana and enters te tg deepy n a pro-
te
Nervous
aspect
can
by
anteror
te
or
posteromeda
structures
te
te
rs (deep emora) artery commony provdes te nutrent
to
afected
s
suppes
D. he second peroratng branc o te prounda emo-
can
tg.
compresson.
eaves
te
compartments
bers
retnacuum
vens,
tunne
645;
o
wc
by
pressures
GAS
C.
tracton
o
330
maeous
tbas
cause
troug
o
ta
nerve
atera
maeous,
ormed
Increases
oter
pantars
te
meda
V ery
rom
pressure
ante-
ste
pan
te
sudden
te
nguna
a
tereater,
pe-
on
s
exor
and
te
tereore
te
musces.
smar
and
surace
sup-
afected,
trousers
or
aspect
oot.
meda
rom
(hs
(tarsa
and
troug,
ts
te
tus
wc
meda
scatc
and
sensory
te
exor
tendon,
pantar
ne
sup-
te
te
or
o
wearng
and
and
crcumex
and
artery
nectons,
arter-
some
tendon,
ud
musces.
Obesty,
nerve
te
meda
te
severa
are,
compartment
nerve
compresson
an
neck
o
ound
te
maeous.
acetabu-
te
emora
ateras
ga-
60%
nterven-
emora
atera
parestetca,
medus
te
consequence
syndrome),
ap
he
cm
tg,
nerve.
te
to
compressed
335
nerve.
te
o
brances
and
te
hey
ocated,
acetabuar
surgca
emur,
te
te
ABR/McM
meda
tunne,
Dck,
emo-
sde
tunne
by
o
provdes
cacaneus,
contents.
dsrupts,
te
wtn
crcumex
te
burnng
gun
te
on
anteror
486;
s
and
ongus
subcapta
o
hereore
passng
or
te
o
te
anoter’s
te
te
tba
bood
dvson
sustentacuum
ror
an
N
he
covered
rac-
approxmatey
suppy
te
a
by
te
coursng
n
he
atera
tunne
taus,
w
sufers
neck
cdood,
cutaneous
As
neck.
necross
arteres.
rom
subcapta
patent
emora
atretc.
o
and
sensaton
te
and
398;
anke.
proxma
uncton
eg
o
Posteror
te
te
(n
buar
and
oot
he emora nerve emerges rom beneat te mdde
o
C.
o
meraga
atae
B.
deep
te
sa
dsrupted
te
atera
spne,
ee
eavy
(Cavn
ead
o
s
suppes
he
com-
njured,
exors
ne
emur
neck
afect
aspect
tng
s
tba
emora
ABR/McM
ac
te
tgt
and
emora
may
a
D.
oot.
tat
te
ntermedus
ndvdua
wearng
as
355
artera
gament.
can
dstrbuton
te
observed
tereore
retnacuar
arses
tenson
atera
ntact
case.
s
major
approxmatey
superor
gament
by
amstrngs
artery
gutea
495;
atera
nguna
ext,
s
njured.
concern
te
by
te
vastus
ateray,
and
tg.
anteror
nerve
ts
avascuar
te
east
te
artery
pes
s
durng
o
emora
rom
emora
n
adut
perce
aso
te
musces
te
te
anke
ead
becomng
a
provded
crcumex
o
obturator
ead
te
n
Senton
racture
resut
ater
branc
but
ndcate
emora
te
te
cases),
ar
te
Prmary
o
o
o
buar
ABR/McM
racture
te
may
branc
o
o
ntracapsuar
wc
oss
te
te
ossa;
magng
ntracapsuar
suppy
are
o
ex
ts
N
te
te
aso
ost.
emors
nnervated
nerve
poptea
Dsrupton
ture
eg,
buar
te
rom
at
be
afected.
afected
exon
to
not
observed,
one
amstrngs
not
quadrceps
s
common
he
GAS
te
te
be
common
he
woud
resuts
key
Pantar
o
nerve
te
w
most
oot.
uncton
emora
Foot
D.
te
Limb
te
p
ABR/McM
330
o
ateras
branc
proxma
emur.
te
branc
vastus
emora
o
artery
o
a
emur.
te
deep
musce.
te
adductor
jont,
sup-
ncudng
deep
muscu-
ncudng
te
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
tba
pantar
two
A.
nerves
te
drop
common Superficial
transverse
metatarsal
ligaments
to
te
sura
woud
motor
E.
spna
Anterior
part
of
48.
656;
B.
aponeurosis
coud
s
N
te
to
end
o
process
te
te
entre
to
s
nerve,
sensaton
nerve.
pro-
wt
or
te
rom
njury
to
o
Sensory
extensor
buar
oot
oot
toes.
resuts
te
hese
oot.
oss
te
oss
o
te
dgtorum
te
termna
nerve.
woud
resut
rom
te
356
te
dsta
n
surace
aceraton
n
emora
rom
hs
ragment
addton,
structure
artery.
arses
condyes.
dsta
In
poptea
to
musce
emora
te
o
ts
te
te
dsta
scenaro
s
ractured
emur)
as
te
just
musce
ossa
pued
surgeons
emur
poptea
poptea
ragment
Ortopedc
o
te
te
strong
artery
(rgt
and
s
ractured
aganst
aways
ook
te
or
of
damage calcaneal
te
deepest
poptea
to
te
poptea
artery
n
a
patent
wt
a
supra-
tuberosity
condyar
A.
he
racture.
soeus
efect 6.115
deep
ABR/McM
posterory.
susceptbe
Fig.
531;
dspace
aganst
GAS
o
te
te
nterrupton
buar
oot
atera
njury.
gastrocnemus
emur
•
te
o
buar
by
and
anke.
48–71
he
proxma
Medial
te
o
second
caused
deep
te
soe
provdng
and
attrbuted
o
o
dorsum
Parayss
be
te
te
retinaculum
Answers
Plantar
oss
cord
be
o
or
meda
o
inferior
GAS extensor
sde
branc
Sensory
rst
or
te
sde
superca
nerve
te
D.
te
te
woud
atera
brevs
to
by
buar
nerve.
nto
meda
sensaton
buar
between
Foot
dvdes
te
suppy
mosty
deep
skn
on
provde
Sensory
vded
C.
nerve
nerves
arses
upon
te
rom
emur.
te
tba
and
woud
ave
no
268
C H A P T E R
C.
he
ty
5
pes
nserts
D.
he
gracs
E.
he
tbas
orm
GAS
E.
ra
tssues
or
o
te
A.
te
te
on
andmark
va
edge
proxma
transverse
eads.
te
tba.
taus
sura
pass
around
cune-
away
te
are
arte-
te
he
provde
atera
pantar
dstrbuted
puse
to
GAS
53.
te
at
te
ante-
o
anke
supped
by
on
great
ts
te
te
toe
atera
abductor
te
bone
proxma
o
wtn
assst
gea
are
C
te
t
n
ts
D.
he
he
gus
te
musce.
meda
GAS
51.
B.
te
651;
he
A.
te
he
N
ormed
exor
rst
pantar
buar
C.
sura
and
atera
sde
he
brevs
musce
te
exor
and
te
pes
atera
cacaneus
and
supped
quadratus
54.
on-
D.
o
exor
and
532;
nnervates
he
to
scatc
abductor
o
te
nerve
brevs,
nvertors
o
artery
approxmatey
ntrnsc
posteror
and
buar
buars
a
eg
nerve
eg.
55.
te
dorsexors,
toe
oot.
659;
passes
bend
between
te
meda
tat
bony
neror
te
can
n
I
n
obturator
nerve,
common
eg
and
te
nerve
te
s
It
aucs,
s
sensory
tree
and
suppes
te
tba
te
a
quadratus
atera
ne
te
te
skn
nerve
on
sup-
meda
and
avod
gutea
are
n
nerve
te
nerve
gutea
to
te
ess
te
ts,
te
te
s
or
gutea
stay
gest
too
can
near
ntrate
oowng
neura
scatc
usuay
must
oter
nerve
area
“orgvng”
te
eements.
nerves,
are
n
n
espe-
babes.
babes.
324
te
pectneus,
suppes
pantar
te
te
suppes
adductor
and
ca
porton
nnervates
nerve
t
nerve,
to
cutaneous
one
rom
te
vesses.
ts
matera
nnervates
gracs,
but
and
supe-
avod
and
atera
nerves,
te
nsut
ABR/McM
tba
te
njected
motor
to
nerves
nerve,
o
anteror
posteror
Certany,
trauma
nerve
te
dropped
seat
to
gven
trocanter
encounter
njectng
te
musces
superor
and
te
ever-
357
between
major
cause
474;
he
rom
o
and
adductor
nto
mportant
dmensons
ncudng
ntrnsc
base
pantar
he
be
greater
oter
tssue
resut
N
te
nerve
tat
oter
(extensor)
cutaneous
te
dvdes
te
orgn
nnervates
oot.
probem.
or
mportant
he
ces,
can
Precautons
externus.
361
away
B.
te
um.
nerve
reduced
a
te
ABR/McM
oter
vertca
connectve
GAS
o
tba
buar
oypogastrc
te
he
te
ts
nterosse.
and
soud
drawn
and
one
scatc
neede
te
and
te
and
512;
ne
te
and
N
serous
te
o
o
or
tertus
tnk
wt
nnervates
soe
brevs
s
te
toe,
o
artera
buars
posteroatera
t
between
mdne.
extenson
atera
superca
and
and
a
te
tte
te
n
nerve
be
nerves.
te
pont
cay
nner-
n
no
kewse.
common
nerve
o
o
musces
a
to
he
comb-
brevs
te
o
can
te
anteror
dorsum
he
a
njectons
anteror
nerve,
rom
nerve
suppes
ABR/McM
oter
ca
ac
te
te
rom
nerve;
dorsum
Occasonay,
oot.
atera
arses
tba
and
te
te
t
superca
ongus
tba
o
ongus
spne
ror
aucs
he
to
te
te
aspect
passes
to
caca-
emora
puse
were
te
named
asssts
sura
and
n
s
te
and
oot.
o
4,
sde
pantar
causes
nnervates
to
superor
te
s
suppes
tba
622–625;
by
nnervated
2
Gutea
pantae,
are
no
compartment
It
upon
he
te
te
te
branc
regon
te
A.
t
o
atera
te
t
eg.
bone
musces
o
te
te
ven
354
suppes
atera
nserts
dgts.
o
dgtorum
nterosse
oot;
a
GAS
te
s
te
most
sde
o
te
o
nerves;
sde
buars
360
sensory
o
buar
posteror
maeous,
s
buars
extensors,
D.
a
toe.
brevs,
nerve
compartment
N
a
nerve
pantar
brances
deep
656;
he
to
nerve.
meda
rom
te
ABR/McM
nerve
nerve.
GAS
52.
te
buar
he
te
and
nerve.
dgtorum
o
atera
E.
pantar
umbrca
and
pantar
naton
te
o
aucs
ABR/McM
te
meda
artery
just
aucs.
meda
usuay
meda
meda
approxmatey
and
te
proxma,
nerve
he
papated
sapenous
oot,
maeous
deepy,
contrbutons
umbrcas
metatarsopaan-
exor
second
rst
4,
on
arses
nerve.
pantar
n
he
vates
te
pantar
and
brevs
(esser)
poptea
513;
be
abductor
gastrocnemus,
very
oot.
by
pantae,
are
It
te
branc
sesamod
bones
aucs
rst
sde
umbrca.
atera
musces
to
te
meda
sesamod
te
bend
te
musces,
o
son
and
meda
can
te
ansernus;
he
N
n
metatarsa
aso
te
nterosseous
nsert
o
te
exor
meda
tendon
524;
meda
aucs,
and
2
at
dorsa
he
atera
and
te
pantae
pantar
umbrcas
by
te
bot
expanson
on
o
upon
he
abductor
by
rst
quadratus
nserts
toe.
uncton
he
umbrca
nserts
paanx
great
tendons
jont.
extensor
E.
te
nnervated
and
rst
aucs
s
t
atera
he
o
bua.
and
atera
on
buar
buars
obque
nerve.
B.
653;
o
atera
te
et
deep
musce
two
te
o
by
620,
be
compartment
nserts
te
may
o
o
sma
sde
passes
pes
tere.
eads
he
ts
354
way
C.
te
cacaneus.
musce. Atoug ts name mgt ead one to
oot.
te
two
te
nsert
va
te
bey
te
atera
sartorus
to
or
aponeuross
and
te
between
ceary
te
ee,
muscuar
nerve
he
tba
et
a
oot.
o
te
he
bone.
aso
and
o
to
te
pantar
nserts
artery.
musce
by
o
and
te
condye
most
te
ends
peds
ABR/McM
s
te
and
meda
contnuaton
paanx
It
o
neus.
artery
dorsum
bone,
te
artery
artery
aucs
to
tba
309
meda
o
te
te
509;
sesamod
o
o
tba
tba
s
tba
N
body
surace
bone
te
provdes
he
dorsas
adductor
atera
and
B.
peds
te
653–654;
o
tuberos-
tba,
metatarsa.
ABR/McM
posteror
anteror
he
sde
and
artery
becomng
50.
sca
proxma
pubc
surace
rst
anteror
pantar
tba
he
te
te
rom
artery
neck
A
dorsas
ror
506;
te
te
arses
te
tba
and
te
rom
meda
o
N
suppy.
n
he
GAS
te
base
artery
brances
D.
onto
and
suppy
vascuar
C.
arses
posteror
buar
rom
on
meda
anteror
621–623;
he
arses
meday
ansernus.
mosty
49.
Limb
semtendnosus
and
te
Lower
o
musces
te
guteus
te
mus-
obturator
oot.
and
he
maxmus;
guteus
medus
CHAPTER
and
mnmus
nerve
rs,
and
provdes
sartorus,
gat
pattern
mb.
As
a
degrees,
tgt
and,
s
ascae
suppy
n
most
resut
gvng
tese
te
N
o
areas
488;
atae.
te
he
te
become
o
extreme
emo-
pectneus.
n
exed
te
to
Anterior
hs
A.
he
ous
pernea
nerve
ous
provdes
nnervaton
and
can
tesa
o
requre
cdbrt
or
are
a
o
varous
croucng,
we
327
posteror
sgncant
te
used.
n
surgery,
o
cutane-
Anterior
ar ter y
durng
o
Dorsalis
posteror
emora
cutaneous
nerve
brances
suppy
te
o
te
branc
or
o
te
skn
te
o
te
buttocks.
oypogastrc
anteror
superor
he
nerve
aspect
o
atera
o
gutea
musce.
he
nerve
mdde
nnervates
cunea
te
nerves
area.
guteus
arse
lateral
sensaton
gutea
he Arcuate
neror
and
branches
cutaneous
provdes
te
pedis
ower tarsal
part
ar ter y
ar ter y
anes-
Medial
te
medial
malleolar
ndvduas
types
cuna
lateral
malleolar
cutane-
bockade
oter
neror
te
some
anestetc
he
emora
porton
perneum
separate
pernea
not
te
ar ter y
adducton.
ABR/McM
branc
tibial
ower
Anterior
56.
269
Limb
emora
quadrceps
ypertona
appearance
produce
556–557;
to
cases,
caracterstc
adductors
GAS
tensor
motor
Lower
5
Dorsalis
arter y
maxmus
rom
te
pedis
ar ter y
dorsa Extensor
ram
o
S1
to
S3
and
suppy
skn
over
te
mdde
o
te hallucis
gutea
GAS
57.
D.
(buttock)
485;
he
N
regon.
531;
dorsas
longus
ABR/McM
peds
s
289
te
First
contnuaton
o
te
dorsal
metatarsal
ante-
ar ter y
ror
tba
end
o
artery
nto
te
oot,
as
t
passes
te
dsta
Deep
te
tba
and
te
anke
jont.
he
puse
o
plantar
te ar ter y
dorsas
peds
can
be
et
between
te
tendon
o
te
Extensor
extensor
aucs
ongus
and
te
tendon
o
te
extensor hood
dgtorum
postve
ongus
to
ndcator
te
o
second
toe.
crcuaton
A
strong
troug
te
puse
mb.
s
a
First
he
dorsal
interosseous
buar
artery
s
a
branc
o
te
posteror
tba
artery muscle
and
passes
n
and
tbas
te
ca
between
te
exor
aucs
ongus Dorsal
deep
posteror,
pantar
artery
makng
passes
t
dicut
deep
to
te
to
papate.
he
aponeurotc
Tendon
digitorum
ts-
to
sues
and
centra
unkey.
he
musces
dorsa
o
te
metatarsa
oot,
makng
brances
o
of
toe
extensor
digital
longus
ar teries
II
papaton
te
dorsas •
peds
gus
pass
and
oter
cut
brevs
dorsa
to
D.
te
o
N
Injury
oot
te
oot,
rst
torum
(GAS
te
can
ts
o
tendons.
521;
to
deep
and
cover
metatarsa
detect
GAS654;
58.
under
coud
second
brevs
Papabe
Fg.
cause
toes
and
o
te
tereore
rst
be
n
In
to
te
te
oss
o
te
sensaton
o
dorsum
termna
proxma
parayss
extensor
on
te
aucs
o
porton
part
o
te
between
te
extensor
brevs
dg-
musces.
In te dsta part o te oot, ony te sensory oss mgt
be
apparent.
observed
pantar
Neter
n
exon,
ongus
o
oot
o
nerve
GAS
nor
tese
654;
N
o
te
parayss
nverson)
muc
s
a
congenta
patents.
nverson,
extenson
cs
bot
Cuboot
pedatrc
musces
and
great
o
woud
are
hs
te
adducton
toe
by
tbas
occur
maormaton
syndrome
by
proxmay
n
te
533;
ABR/McM
358
by
o
te
oot.
au-
(weakness
njury
te
eg.
combnes
extensor
anteror
ts
nnervated
more
te
because
deep
Fig.
6.125
or
di-
59.
D.
he
te
tba
nerve.
artery
trauma
and
te
puses
can
GAS
on-
354
peds
nerve.
resut
dgtorum
6.125).
ABR/McM
buar
extensor
arteres
dorsas
aso
te
buar
ton
oten
or
nerve
nerve
as
ca
te
used
end”
nerve
sura
wtn
t
anastomosed
were
o
t
surgcay
t
seats
Growt
woud
(due
and
to
In
te
to
to
ts
te
te
grow
a
s
o
case
to
opposte
sde
te
troug
te
usuay
to
te
te
o
a
occur
te
sur-
branc
rennervate
woud
te
te
at
con-
aca
ace,
empty
to
“v-
nto
parayzed
now
s
severed
dsta,
rom
to
It
bopsed
unctona
degeneraton)
rennervaton
oot.
grow
surgeon
te
o
por-
ma-
te
grow
te
nerve
to
axons
can
atera
and
nerve,
rom
buar
atera
te
nerve
brances
waeran
te
grated
gude
hus
nerve
sura
t
sensory
as
ower
nerve
“vng”
t
nerve.
motor
musces.
tunne
te
usng
te
common
procedures
Wen
or
contrbutons
te
beneat
cutaneous
motor
seat,
portons
or
contnues
purposes.
cut
by
rom
nerve-gratng
unctona
nerve,
jon
a
ormed
branc
sensaton
and
processes
parayzed
nect
s
a
atera
or
o
nerve
gcay
a
and
provdes
te
dagnostc
ng
o
It
o
eous
sura
and
nerve,
nerve
musces.
a
rate
o
270
C H A P T E R
1
5
mm/day
beore
bers
musces
te
and
to
o
GAS
60.
te
based
traverse.
te
N
te
te
he
te
ca
buar
o
te
oot.
tme
and
and
te
te
ABR/McM
L3
te
rectus
te
nerve
wtn
a
gutea
area
on
emur
348
te
It
s
not
boys
age.
V ery
are
at
ste
gament
o
a
attacment
GAS
s
and
578,
tba
o
te
tba
660;
te
he
o
or
o
tat
growt
ead
tat
occur
to
t
te
480;
a
ton,
he
or
s
te
teror
connects
te
not
342
a
nstabty
o
tvey
ts
s
between
120
te
genu
te
and
sat
hs
135
and
can
genta
deect
vaga
resuts
vaga
cuature.
In
resut
wc
Coxa
neck
s
ts
or
o
n
can
ead
Haux
coxa
bone
vara
s
to
p
rom
te
n
o
ange
tan
subuxaton
o
te
between
te
120
degrees.
or
coxa
angua-
dsocaton.
known
ponts
In
adductor
as
toward
dstay
hs
mus-
bunon.
te
tte
GAS
64.
E.
toe,
sa
ead,
cated
tends
due
to
mony
metatarsa
te
metatarsopaangea
te
dsta
aso
not
Bunons
routney
GAS
A.
protrudng
occur.
546;
he
N
478;
patear
connects
te
te
nserton
te
tba.
bone
ceps
te
or
bre
to
te
te
bony
n
sac
growt
metatarsa
rarey
bone
peope
at
s
a
te
very
tba
can
be
wtn
musce.
gament,
t
emors
tougt
te
Wen
te
n
o
tendon
reex
stretces
resutng
strong
gament
te
reex
t
as
o
a
tat
upon
quadr-
ammer
gament
strkes
sgty
contracton
o
great
bunon.
te
meday,
aso
te
protrudng
occur.
Bunons
routney
bowegs,
outward.
knee.
or
he
he
neck
vara
ange
te
ess
oter
tan
s
ng
and
o
ange
or
mpng.
o
n
120
sat
hs
In
deect
coxa
aso
vagus
s
te
genu
te
and
resuts
aso
are
tere
or
s
o
te
mb
an
to
knock
In
te
do
bowed
sat
rom
at
o
can
wo
reerred
degrees.
o
rst
sac
bone
vagus,
n
great
growt
peope
neck
ten
com-
te
bursa
knees
resut
asso-
te
emora
135
be
s
o
metatarsa
n
great
metatar-
wc
bony
sotness
vaga
te
can
base
varus
can
t
swoen
rarey
and
congenta
hs
a
s
wt
artcuates
deormty
wc
ts
te
rea-
cacaneus
o
toe,
Excess
Genu
to
are
dstay
bone
and
te
te
ony
te
degrees.
neck.
ts
between
between
between
njures,
emora
egs,
opposte
120
te
soes.
bandy
norma
emora
s
wear
part
occur
sted
s
o
orced
artcuates
Haux
toe;
jont.
be
promnent
second
wt
type
357
soes,
In
tte
pos-
bones.
te
toe.
te
addng
dspacement
te
te
por-
artcuar
ts
he
taus
navcuar
rom
dsta
sesamod
te
ponts
te
and
paond
can
artcuates
over
o
n
ractures.
o
anke
nvoves
as
te
bones
ABR/McM
te
provdes
tendon
as
te
and
pan
te
o
racture,
oter
he
can
as
tuberosty;
o
rubbng
toward
ts
te
everson
to
taus
metatarsopaangea
do
on
Henderson
dsta
he
n
atera
as
(te
reerred
part
a
posteror
anke.
te
wo
ong
sort
maeous);
te
way
o
339
quadrceps
patea
tme,
Excess
bursa
not
ABR/McM
gament
o
o
ony
swoen
soes.
deveops
emors
part
occur
patea
he
tat
patear
a
wear
jont.
a
to
(atera
cuneorm
deormty
known
metatarsa
wt
or
overrde
ponts
a
a
nsert
njury
ts
ead
517;
by
hs
and
paond
taus
tree
N
comes
wt
to
wen
caed
acts
bone.
vagus,
usuay
toe
meday,
te
629–640;
bua
he
ste
he
navcuar
Haux
unte
caused
taus.
tba;
but
te
te
be
posteror
anke.
te
aso
sometmes
he
bone.
wt
as
ten-
oot).
342
te
tba
o
te
rom
toe and may overrde te second toe; te base o te rst
ponts
o
o
poston
beneat
te
may
te
maeous
cubod
wt
con-
neck.
neck
or
ar
resdes
mpng.
sat
ange
between
njures,
and
emora
toe
s
emora
commony
great
norma
neck
te
oter
te
weakness
s
he
ess
sortenng
vagus
deormty
knee.
emora
emur
ncrease
resuts
and
ractures,
te
mb
an
In
te
rom
o
knock
sat
degrees.
sotness
tere
ton,
vagus,
emora
te
norma
A. he patent as bowegs, or genu varus. he opposte
tree
and
te
prox-
(goose
tg
tey
rom
te
te
tuberosty
externay
racture,
dsta
tba,
racture
ts
emur;
rotated
o
maeous).
truy
rom
te
o
te
posteror
o
ansernus
sca
ABR/McM
be
racture
o
p,
te
te
dspacement
o
twstng
ABR/McM
can
maeous
porton
one
on
te
nserts
bua.
482;
he
as
pes
o
and
arses
nserts
bone
deveops
musce
tuberosty
sartorus
and
ncudes
ntermedus,
tat
emors
and
ected
sesamod
bone
te
te
trmaeoar
racture
meda
wc
N
a
s
emors
ateras,
sca
tba
arc
component
argest
s
he
te
o
rom
te
taus
bone
spne
o
rom
arses
578;
he
posteror
pos-
o
emors
te
quadratus
ac
aspect
arses
o
racture.
ateray.
N
E.
sustans
and
attaced.
tuberce,
tus
te
nter-
te
ead
GAS
63.
emnence
pateau
are
s
gament
o
te
he
eang
condye
orgn
bceps
vastus
te
reex
nput
quadrceps
s
proxmay.
components
ead
posteror
Gerdy
tract;
a
meda
he
he
rom
superor
o
gament.
ntercondyar
tba
years
tat
perod
emora
mensc
otba
12
durng
coatera
te
tuberce,
typcay
to
sweng
jont.
he
on
overuse,
10
ong
ocaton
and
tuberos-
patear
a
tba
te
tba
usuay
and
meda
gament.
te
o
grs
n
knee
gaments
anteroatera
o
te
te
protuberance
crucate
emur
o
emnence
crucate
or
resutng
he
o
probem
pan
attacment
o
area
grs,
te
treatment.
bony
te
a
and
to
tear,
te
years
boys
menscus
condyar
s
o
but
14
attacment
meda
teror
to
subject
can
oowng
area
dsease
12
actve
spurt,
te
a
o
afects
te
patea
sesamod
arses
hs
sensory
he
and
he
tendon.
anteror
(L4
output).
A
meda
musces.
nerve
emors
body.
dnous
and
motor
medas.
ma,
apopysts
emors
emora
L2,
n
oot.
531;
te
and
sensa-
sapenous
on
by
surace
nnervates
ven
quadrceps
regen-
suppes
pantar
musces
he
te
nerve
nerve
sapenous
estmated
dstance
tba
compartment
great
and
658;
to
common
so
on
ty
n
62.
to
dorsum
eg
624,
s
D. Osgood-Scatter dsease s aso caed tba tuberos-
ty.
61.
nc/mont)
anteror
te
Limb
sensaton
he
accompanes
sde
1
need
and
oot.
atera
ton
(or
rennervaton
eratng
o
Lower
and
coxa
emur
ractures,
bone
o
sorten-
ncrease
n
CHAPTER
emora
sat
subuxaton
weakness
GAS
65.
C.
he
mony
toe,
or
ta
paanx
panu
te
ponts
can
In
caw
te
tary
exed
motor
because
GAS
66.
C.
o
In
hese
and
be
sensory
N
te
dorsa
weaken
nerve
sensory
and
surace
pantar
dvson
prorms
nerve
GAS
woud
n
n
be
te
Pes
te
te
on
te
te
oot.
or
cus
s
and
S1
te
pernea
nerve
passes
eadng
to
Incapactaton
s
489;
and
ABR/McM
esser
o
most
emora
te
GAS
E.
tomoses
o
tme
nerves
hs
can
and
can
tssues
o
te
wt
ra
cause
oss
n
oss
oss.
nerve
o
te
gutea
te
oot.
nor
oss
o
posteror
o
he
o
te
oot
nerve
o
and
oss
nor
wt
exon
or
oter
and
te
te
eg,
eg
and
not
generazed
oss
emo-
o
neck
artery
age
by
te
reaces
traveng
o
brances
te
and
rom
te
wtn
can
gutea
te
o
emora
emur
brances
to
o
as
crcumex
arses
arse
arteres.
te
externa
um,
te
abdomna
a-
wa.
C.
s
n
as
653;
te
te
te
N
oot,
and
cubod
n
to
some
te
o
gutea
wt
te
tba
and
pantar
exon
GAS
627–640;
N
te
te
up
tba
ossa
nerve,
to
te
o
te
trbutares
ven
tereater
gencuar
by
ven.
wc
deep
emora
te
maeous,
poptea
structures
513;
ABR/McM
te
o
he
at
orgn
o
te
nto
te
ven
s
a
te
peds,
to
te
te
atera
he
repaces
arcuate
orgn
artery,
or
te
toes.
361
njured
te
gament
bone,
ocated
wt
ongtudna
te
te
cuneorm
cacaneus.
n
by
artery
jont.
branc,
he
deep
anas-
peds
tba
anke
provdes
te
arc
dorsas
anteror
te
344
to
vascuar
ndvduas.
posterory
518;
deep
o
330
atera
peroratng
wt
bua
te
poptea
provdes
peds
a
atera
te
o
artery
ascends
te
tg,
navcuar
artcuates
o
N
ABR/McM
he
te
deep
porton
o
te
meda
artery.
wc
wt
to
Meday,
arteres
513;
at
te
artery
dorsas
anterory
bone
posterory
way
te
anastomoses
ven.
655;
dsta
ven
jonng
te
superor
dorsas
by
te
bone
o
n
branc
peroratng
to
descendng
suppes
ABR/McM
major
he
pantar
cacaneus.
te
taus
deep
o
tat
ony
6.31).
495;
and
dran
arc.
metatarsa
he
es
he
nutrent
beneat
poptea
peds
o
te
artery
suppes
emora
partcpates
Fg.
N
t
capts.
sapenous
asca
609,
tat
peroratng
rom
pantar
artery,
dorsa
GAS
71.
and
termnatng
he
deep
ovea
so
crcumex
670.e3;
te
e,
suppes
asca.
560,
te
branc
dorsa
com-
te
nor
a
sot
musces
woud
entrapment
assocated
knee
tg
nerve
wc
and
exors
perods
compressed.
compartments
prorms
s
n
are
musces
knee
Tba
dorsexon
Neter
njury,
area
compresson.
atera
n
te
crus
gutea
parayss
entrapment
muscuature,
o
nerve
and
oss
n
gutea
o
oss
scatc
can
sensory
sensory
to
n
anteror
sensory
resut
resut
and
presson
ead
vesses
extended
suc
Smar
emora
n
(GAS
ven
wt
buar
or
n
suppy
(varaby,
suppy
capts
vesses
brances
second
ven
artera
contnues
supne
te
artera
artery
meda
te
te
superca
atera
pantar
o
to
542,
he
o
oten
deep
ven.
trbutary
o
we
o
compartment
ous cases o te “gutea crus syndrome.” Compresson
regon
ts
artera
ovea
portons
musce
ca
poptea
te
way
gutea
by
te
ac
(sma)
te
te
cocane and oter poweru narcotcs ave ed to numer-
te
gets
he
jont.
atera
commony
posteror
he
area
550–553,
he
emora
use
o
eary
emur
deep
S1–S3
rom
te
woud
325
unconscousness
emur
te
ater
ower
he
artery
poptea
70.
N
D.
he
Pudenda
L5,
oss
325
approxmatey
obturator
at
suppes
te
deep
regon.
te
p
regresses
on
troug
sensory
ABR/McM
unt
crcumex
and
knee.
percng
te
oss
compresson
te
ateras
o
most
oot
o
te
oramna
o
and
o
mdde
weakness
sensory
everson.
GAS
69.
woud
sde
by
te
sat
nerve.
but
o
branc
mmedate
emora
mb.
extenson,
meda
at
con-
eson
genera
vdes te branc to te ead o te emur, an
posteror
dsc
to
he acetabuar branc o te obturator artery oten pro-
a
scatc
spna
ndcated
ndvduas,
a
489;
emora).
repaced
musce,
te
area,
o
crcumex
artery
panu
s
s
deep
ac
s
ower
unusua
oot
afect
scatc
te
S1
knee
te
be
and
n
gutea
nverson,
woud
557;
he
normay
te
N
emur
atera
ered-
prorms
te
nto
te
vastus
resembng
o
pass
branc
te
o
o
It
branc
capsue
o
as
ead
ascendng
rom
dsta
cavus
ead
cdren
crcumex
suppy
te
o
compresson.
524.e1,
o
te
toe
tey
566;
and
te
drect
ead
tat
patent
resut
a
Causes,
resut
nants
years,
ammer.
and
do
wtn te gament o te ead o te emur. hs source
358
rater
oss
oot
some
te
8
te
ds-
surace
entrapment,
emors
exon
o
canges.
sensatons
woud
o
entrapment
buar
or
wen
pan
compresson
dorsexon
a
ammer
a
are
nor
527–528,
meda
am-
te
te
probems.
requenty
quadrceps
and
ke
exed,
as
tat
and
dorsa
case
by
oot,
271
Limb
mb.
In
com-
toes.
In
E.
o
extended,
proxma
ABR/McM
compresson
compresson
L5
ts
most
soes
s
Eter
neura
panu
most
te
te
te
am-
ourt
bunon.
te
occurs
syndrome
nvove
wt
te
515;
to
o
compresson.
compressed
eg,
L5–S1,
eg.
C.
t
metatarsa
and
nverson,
67.
arc;
eadng
nvove
n
pantar
a
o
g.
exed,
o
artrtc
In
but
too
ookng
oot.
oot.
usuay
tg,
rom
p
rom
68.
case
or
jont
strongy
te
toe
are
s
on
bot
er
wearng
resut
at
prorms
can
tracted,
L4
o
a
are
n
to
360
trd
tat
orm
toe,
jonts
occur
632–635;
nerve
at
can
opposte
g,
can
mbaance
toe
rom
jont
as
to
any
te
downward,
caw
nterpaangea
musce
due
afect
ees
occur
corns,
jonts.
s
metatarsopaangea
toe
ead
resuts
GAS
ABR/McM
ten
commony
wt
can
vaga
muscuature.
can
toe,
wc
Coxa
515;
nterpaangea
Hammer
or
toe
soes
te
proxma
N
compant
second
most
sort
mer
adductor
640;
Hammer
resuts
too
te
629,
te
anguaton,
dsocaton.
patent’s
mertoes.
It
o
625,
neck
or
Lower
5
he
anke
ABR/McM
355
ead
o
bones.
arc
taus
jont
attaces
meday
te
he
artcuates
artcuates
mortse.
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
tuberosty
o
te
o
te
te
s
oot.
t
rom
base
oten
hs
wen
anke.
arses
at
attacment
overooked
spran
brevs
s
he
te
o
bua
te
t
nvoved
common
n
wt
ongus
nserts
o
metatarsa
an
can
an
oten
rom
ts
rods
ar
nverson
arses
patea,
ud.
but
nverson
racture
combned
buars
and
may
need
ntroduced.
bursa
tme
te
resutng
T reatment
n
(as
posteror
crucate
meday
dspacement
nto
upon
bones.
he
posteror
meda
dorsay
rom
atera
GAS
n
and
mad’s
o
ayers,
workng
patea
constant
sma
on
te
bone
642,
o
N
bended
move
rcton
ubrcatng
peope
knees.
o
sac
tese
te
jon
te
ras
and
tarsa
paanx
and
363
74.
D.
n
pan
a
ot
normay
under
te
and
ouse-
pumbers,
spend
as
o
car-
tme
enabes
an
stabty
strengt
crucate
(te
he
anteror
rrtates
ts
o
n
ront
o
te
te
o
te
and
te
upon
knee
to
be
njured
patear
tssue
tat
vastus
ate-
menscus
atera
o
he
posteror
he
o
te
atera
te
perods
knee.”
wt
emur.
ste-
nrapate-
can
bands
tendon
he
te
ong
knee,
te
cuson
dranage,
occasonay
o
“parson’s
te
between
502;
o
ABR/McM
te
or
ead
suppy
and
jont
ts
roe
It
n
o
jont.
bone
as
s
condyes
a
o
te
te
he
and
o
s
te
o
gament
o
stabzng
pedatrc
s
an
he
bone
ocated
on
to
stretced
to
jont
p
ncrease
n
deveop-
te
he
anteror
gament
Bgeow”)
ressts
on
te
yperextenson
gament
te
p
nant’s
oemora
o
a
emur
popuaton.
comparabe
gament
conveys
te
te
potenta
puboemora
s
emur
ead
rotaton
te
knee.
p
342
te
reconstructon
te
gament
o
n
p
n
o
he
atera
“Y-saped
aspect
p
n
tendnous
musces.
dyspasa
gament
pubc
o
o
emors
wakng.
nverted
skn.
just
o
p
tba
mportant
beore
requent
cdood).
abducton
as
menta
N
vesse
n
and
rrtaton
resut
tense
smpe
tba.
gament
bood
or
structure
and
(prmary
jont
te
requres
repeated
can
strong,
598–603;
sma
be
exon
medas
emur
he
to
quadrceps
and
GAS
and
bursa,
so-caed
afects
ocated
te
o
are
deormabe
gament
strong
cartagnous
arses
aucs
te
durng
occupatons
(bursa)
retnacua
prox-
transverse
resut
te
bursa
smooty
te
prepatear
can
wo
he
brevs
upon
ABR/McM
bursa,
bursts
t
toe.
te
knees,
prepatear
under
adductor
and
n
navcuar
proxma
510;
were
metatarsa
tba
passes
he
great
o
te
te
nserts
te
te
t
oot,
rst
dgtorum
metatarsas
664;
oter
rom
eg;
toes.
upon
te
and
upon
and
atera
atera
ter
to
te
extensor
Prepatear
and
on
o
compresson
te
knee.
he
o
arses
nserts
cacaneus
nserts
622–623,
workng
te
o
te
Excessve
pet
te
sesamod
sweng
and
bones.
surace
cuneorm
posteror
compartment
rom
gament
A.
tbas
paanges
arses
pantar
meda
maeous
metatarsa
ma
te
te
sudden,
a
Excessve
prayer)
n
n
usuay
kneeng
n
bua, passes under te atera maeous, and ten turns
nserts
tuberosity
6.
te
buars
te
bone.
73.
GAS
Ischial
72–95
he
be
membrane
B
•
72.
femur
foramen
arses
neror
sde
rom
o
te
CHAPTER
p
jont;
mora
arses
over
t
ressts
gament
rom
te
te
he
te
margns
or
te
but
B.
gament
regarded
he
o
te
as
o
seated,
by
s
rupture
hs
crucate
te
rom
It
knee
o
oter
It
76.
A.
Fat
to
bones.
te
an
sve
meda
oot
s
Occasonay,
ess
o
(uson
te
oot
te
s
a
passve
pantar
bones.
n
It
can
te
cubod
buars
ment
tba
s
ment
s
te
t
s
mbs.
In
appears
ure
o
GAS
he
a
to
te
534,
to
o
needed
a
anomaes
n
n
te
wt
ong
a
ong
cana
ead
N
s
be
arc.
coatera
n
and
orces
te
gradua
ABR/McM
ng,
ong
batera
s
te
te
he
ga-
te
te
pes
weakenng
ower
panus
and
a-
cases
ext
ac
o
spne.
artery
or
cm
te
externa
puse
te
ante-
atera
can
rom
n
s
are
o
te
ma
usuay
get
used
o
n
everson
maeous
An
or
nverson
cacaneobuar
bed
wo
reerred
common
or
nam-
rom
are
on
he
n
Morton
between
te
te
anke
meda
or
at-
pan
te
begn
ter
n
o
morn-
to
wak.
antnammatory
A
o
te
aponeuro-
neuroma
nterconnecton
spran
gament
s
a
engaged
and
and
te
In
wt
njectons.
pantar
sgncant
spran
tear
s
jumpng.
nerves
to
wear-
eased
tearng
or
treatment.
pantar
to
oreoot.
be
stretcng
peope
neura
te
men
361
(te
spnts,
te
te
cortsone
carrers,
rom
due
aponeuross
and
pan-
ourt
and
tan
can
rom
most
up
on
tssue
to
te
compressed
key
ascts
oot
runnng
ngt
atera
gament.
resuts
band
as
you
An
pantar
Pantar
tat
o
or
be
can
sensaton
gament
pan
pantar
pan
atera
o
key
stress
soes
he
te
a
com-
anastomos-
atera
toes.
can
most
te
an
and
toes;
more
nvoves
o
and
ABR/McM
te
ba
eson
toes.
meda
tod)
sprng,
tereby
ater
panu
ourt
te
o
trd
can
break
coatera
commony
anteror
te
and
(de-
njures
taobuar
gament.
ongtudna
and
ascts
and
4
to
abdomen
provdes
metatarsa
requenty
ortotcs,
meda
ga-
ts
a
o
o
suc
medcatons
converts
o
te
day,
just
Rest,
to
nerve
toe
excessve
toug
especay
he
cubod
te
ourt
probem,
ascts.
appens
pantar
or
troug
a
gament
bones.
beore
It
eet
etcs,
aponeuross
taus
ss).
errors.)
o
te
te
utra-
328
meda
a
tmes
532;
condton
cacaneus
and
N
Inammaton
soes.
(detod)
bone
320
put
80%
as
pantar
a
tte
10
ts
to
GAS
80.
B.
or
647;
he
N
cd
cuboot.
observed
and
hs
519;
wt
te
and
and
te
are
tat
o
at-
sympyss
meda
nterconnecton
D.
pysca
pubc
commony
pantar
(ess-connng)
maton
arc
tendon
meda
taus
exerted
case,
o
te
79.
n
eter
te
between
enargement)
transverse
656–657;
nten-
nterconnects
racture
te
tarsa
artrod-
and
gament
tat
soes
GAS
tree
Women
alcted
te
or
cose
ste
emora
ABR/McM
trd
meda
neura
te
dferent
be
deormty
pantar
te
te
rased
te
o
a
cacaneonavcuar,
o
te
meda
pantar
or
cacaneus,
usuay
n
orm
cavus
g
te
o
o
may
ootprnts
cacaneus
gament
resut
te
pantar
t
ncude
worn
arces.
644;
emo-
(normay
may
Pes
he
wet
soe
very
meda
present
te
oor.
rom
rom
Mdway
most
connects
suppes
he
very
superor
te
and
cm
490;
te
meda
between
strong,
attenng
ongtudna
eement
te
vertca
be
te
pantar
key
te
by
nto
w
to
seen
bones).
he
he
toe.
N
tat
he
nerve
1.5
possbe
approxmatey
congenta,
te
te
tar
spne
neuroma
between
severe.
anteror
ven.
cm
atrogenc
vesses
nerve
to
1.5
ntersect
approxmatey
and
273
Limb
artery.
(and
branc
or
te
emora
666;
Morton
ng
supports
toes.
navcuar,
supports
subject
s
strong
maeous
tears.
gament
arc;
groove
very
o
arc
nvoved
ongus.
a
wt
meda
be
be
meda
quadrceps
660,
nerves
capsue
te
A.
ng
o
crcuar
te
emora
te
w
approxmate
meda
ac
avod
epgastrc
to
cm
approxmatey
presson
te
wtn
jont
s
78.
tat
o
superor
GAS
b-
ead
neary
te
te
339
due
be
connects
ascts.
te
T reatment
te
gament
gament
pantar
can
tarsa
o
s
structura
caracterzed
yperextenson
o
band
tan
to
he
capsue
gament
Oten
surace
surgery
o
patear
arc.
or
anteror
te
ateray
njured
ABR/McM
vsbe.
exercses
a
to
te
te
to
tuberce
he
t
(Fuoroscopc
ocated
cutaneous
meda
1.5
s
pubc
ven.
emora
cm
enter
vary
because
he
1.5
rng
neror
puse,
cases.
advsabe
te
and
approxmatey
emora
most
s
to
te
atera
ror
tuberosty.
condton
arc)
te
s
attaced
panus)
mnor
to
ocated
nserton
500;
(pes
wt
hs
wc
he
under
cordke
menscus
not
tba
drawer.
condye
patent
sgn
o
nserted
nguna
artery
w
n
gudance
Injectons
demonstrated
drawer
tck,
s
be
exon
te
posterory
externa
tat
s
o
N
a
te
dspace-
yperextenson.
requenty
t
ongtudna
assocated
n
te
oot
meda
ess
band
576–578;
s
Wt
can
desk
emora
atera
gaments.
musce
GAS
s
a
knee
ocated
because
gamentous
rs
s
he
jont.
n
gament
atera
tba
ac
s
maxma
nerve
deep
orgn
s
posteror
emur.
posteror
ressts
brocartage
menscus
te
te
trans-
abrum.
n
neede
te
superoatera
cartagnous,
tgtens
by
gament
pusng
te
jont.
band
pus
gament
bua.
knee
or
to
coatera
passes
te
te
he
334
gament
te
to
sound
to
orgn
he
I
emora
pos-
attaces
C.
era
ateray
provdes
not
77.
tat
capsue
emur.
acetabuar
damaged
upon
caed
te
ABR/McM
be
o
to
s
smar
uar
can
o
te
and
scoe-
bers
and
gament
brous,
te
crucate
tba
abty
emur.
t
te
a
te
It
s
he
strong
upward
notc
ead
o
477;
jont.
o
strengtenng
te
part
N
wnds
acetabuar
o
te
band
acetabuar
gament
posteror
knee.
ment
neck,
te
GAS550–553;
75.
and
transverse
o
o
tranguar
scum
acetabuar
s
abducton
a
emora
terory.
verse
s
Lower
5
and
rst
n
523;
as
ABR/McM
te
Cuboot
s
a
approxmatey
appears
syndrome
adducton
n
te
te
1
oot.
o
tapes
congenta
n
rst
combnes
o
361
probem
1000
pedatrc
trmester
pantar
he
equnovarus,
maormaton
o
exon,
ee
s
patents
pregnancy.
nverson,
drawn
upward
274
C H A P T E R
by
s
te
Lower
tendo
aso
tan
emora
degrees,
nvoves
great
o
a
to
great
meda
It
coxa
can
aso
aso
resut
oreoot
usuay
ange
ess
o
te
known
adductor
rom
te
metatarsa
rst
rom
artrts
saton
bunon,
or
or
GAS
D.
muscuar
caw
angea
jonts
mbaance
extensors
by
te
o
tra
but
t
wearng
too
jont
s
s
t
and
may
Hammer
or
a
toe
Haux
and
rst
may
oot;
cavus
sory
to
toe
overrde
bone
a
orm
on
patent
occurs
as
a
a
resut
probems.
It
soes
o
wt
a
be
a
any
82.
D.
he
nea
s
534,
ten
te
anke
medated
nerve
jerk
by
suppes
te
toe.
cavus
a
ammer.
reerred
he
s
exed
base
and
te
s
arc.
motor
because
o
and
te
te
te
anteror
ected
tendon)
tba
oot
te
o
te
oot
wt
nerve.
evertor
eg
and
oot.
extensor
compartment
o
by
te
he
he
te
reex
musces
and
o
deep
and
D.
u
te
sen-
atera
suppy
buar
nerve
musces
dorsum
o
n
te
tar
o
nerve
te
meda
GAS
B.
toe,
pantar
he
o
emora
S1
to
and
ABR/McM
It
exor
musces
and
sensaton
a
a
o
pan-
exor
or
te
toes.
arses
neror
rom
cuna
can
o
atera
superor
tg,
te
325
he
oot,
nerve
emora
ABR/McM
pan
com-
atera
tba
and
cuna
o
nerve.
and
posteror
pop-
arses
rom
cutaneous
ca
and
sen-
te
occurrence
nerve
patea
ast
does
and
quarter
o
papabe
musce
s
(VMO).
essen
te
emors
and
and
cutane-
not
nner-
superor
draws
n
atera
to
as
te
te
upward,
hs
te
te
vas-
strengt
dsocaton
rom
o
med-
contracton.
Increasng
rm
t
extenson—dur-
reerred
arses
vertcay
511;
ABR/McM
s
a
o
anteror
acetabuum
as
does
te
te
ne-
and
vastus
337
norma
secondary
or
te
varant
osscaton
ton
o
GAS
D.
te
578;
ror
to
te
y
te
o
an
center,
unused
wc
to
na
are
o
can
spne
and
atera
or
be
can
o
as
n
an
te
A
to
dsta
presentng
o
he
and
gas
to
more
centmeters
te
o
age.
por-
patea.
at
at
te
s
te
rsk
atera
not
or
to
o
s
s
s
and
artera
mdngu-
eter
ac
meda
dependabe
te
can
te
tat
cateter-
superor
a
eas-
di-
ere
or
were
o
ead,
orgn
It
he
be
eve
It
puse
be
edge
structures
ste
anteror
and
ne-
can
meda
emur.
te
anayss.
can
ocazed
just
artery
artery
a
common
be
puse
toracc
emora
te
tba
most
patent.
aso
te
artery
te
pan-
years
can
te
emora
s
te
emora
o
obese
nserted
s
te
expanded
emora
sympyss,
emora
neede
neror
Four
or
14
artery
ead
It
to
on
toward
utrasound
te
crawng
dsease
an
assstance
between
pubc
one
te
te
nto
obtaned
te
s
or
Dopper
s
enarged
n
342
emora
gament.
away
10
tendon
angograpy.
artery
artery,
njury.
he
eeng
suc
as
gament
cdren
abdomnopevc
to
andmark.
n
puncture
passed
antegrade
pont,
patear
retnacuum
porton
detect,
panuy
Osgood-Scatter
te
uoroscopc
by
become
compresson,
ABR/McM
nguna
upper
zaton
ra
artery
wt
can
medas
498;
smpy
cateters
or
vastus
ocazed
cut
o
procedures.
by
accessed
o
knees.
patear
N
Femora
oten
bursa
cronc
commony
meda
emora
nerve
provdes
on
crease,
355
cutaneous
S3.
unctons
meda
musce,
provdes
tree
te
he
and
umbrca
and
and
514;
combnes
brances.
abductor
rst
musce
N
posteror
ram
te
surace
615–619;
ventra
te
brevs
nerve
deep
nnervates
great
dgtorum
and
(.e.,
rom
te
te
prepatear
he
bood
buar
eve
nnervaton
te
ower
he
especay
nvovement
he
common
o
te
patea
acute
or
superca
N
tuberosty,
Pes
buar
n
patea
582;
about
o
caca-
te
531;
rectus
Bpartte
wt
te
ammer,
sensory
nvertor
eg
te
te
(sensory)
obquus
spne
te
neous
metatarsa
superca
provdes
he
vascuar
tappng
L3
s
regon
suppes
easy be mstaken or a racture on a x-ray. he subcuta-
as
318
N
o
musce
ac
oot and suppes skn between te rst and second toes.
te
83.
o
ABR/McM
s
superoatera
subject,
opposte
ts
GAS
85.
tte
o
te
emora
to
and
ntermedus.
te
to
te
pantar
eredtary
o
t
porton
draws
Causes,
surace
on
nerve.
aspect
medas
ror
jont
554;
especay
patea.
dorsexed,
toward
meday
panu
515;
reex,
te
dorsum
nnervates
N
(Aces
compartment
or
o
tat
to
to
contrbutons
cutaneous
wc
tus
rom
L1
atera
buar
480,
ower
86.
636–641;
tendon
ng
toe,
o
gutea
regon
parestetca
sensory
meda
ay,
neu-
te
tg
gutea
ram
te
B. he ower porton o te vastus medas nserts upon
te
s
posteror
o
perneum
musces.
GAS
84.
occur
ees
bunon.
dorsa
second
o
toe,
commony
g,
s
afect
ke
anguated
Pes
n
can
commony
may
te
drected
as
be
toe
can
te
jont
nterpaangea
resut
s
te
s
musce
overpowered
can
ookng
more
toe
o
compresson.
GAS
o
rom
a
te
sensatons
nerve,
s
vate
metatarsopaangea
paanx
as
s
great
or
proxma
occur
are
second
te
downward,
can
toe
ous
nterpa-
mbaance,
caw
most
sort
compresson.
te
neura
too
t
or
te
resuts
dsta
vagus
he
metatarsa
panuy,
at
can
toe
toe
afects
te
te
corns,
bunon.
toe
are
resut
jonts
Hammer
It
te
364
dsta
metatarsopaangea
ammer
pont
panu
jonts.
tat
In
extended,
exed,
or
toes.
and
muscuar
ammer
commony
ourt
ABR/McM
exed,
ammer
canges.
soes
516;
Wt
he
n
Eter
g.
N
proxma
nterpaangea
wereas
most
or
oot.
exors.
artrtc
trd
are
te
te
strongy
te
poston.
rom
656;
bot
are
n
ong
extended,
628,
toe,
porton
to
Superor
dorsa
burnng
arses
ower
Meraga
common
534–535,
In
te
sura
probems.
81.
te
presson
correcton
or
to
te
branc
ossa.
nerves).
varus
to
pernea
tea
as
attempted
a
120
Haux
o
brances
s
between
tan
ateray.
o
resut
te
oot
to
actvty
ponts
te
te
reduced
s
devaton
he
vara,
s
excessve
toe
nward;
nward.
vagus
sometmes
bunons.
turned
neck
Haux
te
toe,
In
and
due
and
turned
norma.
oten
wc
or
sat
muscuature.
n
Limb
cacaneus
adducted,
smaer
te
5
nguna
enter
deep
te
emo-
accdenta
vascuar
te
tuberce
pubc
CHAPTER
overes
te
spermatc
s
te
te
openng
great
GAS
87.
D.
660,
s
and
seen
ay
n
to
dagnosed
o
te
ande
o
ment.
A
rupture
wc
te
cck
o
te
operaton,
ss
reparng
B.
to
treated
GAS
o
party
poptea
but
sma
and
be
tears.
n
and
s
are
usu-
presentng
or
a
ock-
bucket-
cartage
wedges
urter
move-
assocated
wt
o
ansernus
he
te
band,
te
on
just
quadrceps
and
ten
GAS
91.
B.
ke
te
oor
N
nserts
te
481;
porton
meda
o
he
Fg.
564;
N
poste-
nserts
598;
N
500;
o
provde
ossa.
s
Mensca
some
ABR/McM
te
components
branosus
nserts
o
superor
to
rom
rom
nsert
GAS
C.
te
on
590,
he
s
usuay
cysts
o
te
can
atera
trange.
oor.
or
emors
emors,
he
he
te
atera
305
porton
a
o
to
by
te
nserts
and
507;
tract
75%
s
te
te
just
te
as
supped
ceps
482;
ABR/McM
wt
90.
D.
s
te
by
570;
o
te
pes
Inguinal
te
a
dense,
atera
nsert
Femoral
as
te
te
ony
tensor
guteus
one
o
Adductor
ead
on
te
Gracilis
and
are
te
by
te
and
wt
aponeuross
ascae
musces
nerve;
n
ascae
emora
tendon
on
Adductor
magnus
a
Sar torius
muscle
tat
atae
gu-
sted
tat
t
Adductor
and
he
act,
he
and
te
s
rectus
va
te
tba
hiatus
te triangle
nerve.
greater
superor
nserts
patea
gutea
on
te
atae.
nerve,
te
nsert
by
N
490;
tendnous
nserts
on
der
o
meda
te
passes
te
ABR/McM
dsta
gutea
emors,
quadr-
tuberosty.
condye
troug
329
porton
adductor
te
o
te
tuberce
o
te
on
adductor
te
emur.
adductor
atus
muscle
muscle
ateray
emur,
neror
mnmus
nnervated
tensor
muscle
longus
popteus
maxmus.
te
gutea
symphysis
triangle
Pectineus
pan-
345
wde
ligament
bceps
ossa,
he
he
superory
o
te
menscus.
neror
nus
artery
tran-
aso
semmem-
he
o
to
tendon.
passes
o
o
he
te
dstay
ABR/McM
nnervated
and
emors
he
emora
orm
te
mag-
upper
he
bor-
emora
proxma
to
•
GAS
Fig.
6.4
canal
at
contrbutor
329
Adductor
GAS
and
trange,
semmem-
bua.
above
condye
s
tba.
border
on
passng
atera
N
medus
trocanter
nerve,
orms
ongus
6.42).
Femoral
musce
Guteus
troug-
trange
te
superca
atera
te
adductor
emora
border
s
o
pectneus
suc-
can
border
posterory.
atera
cacanea
nserton
maxmus
tba
emur
atera
te
610;
supped
ony
patea
empa-
tese
and
meda
meda
nserton
te
te
to
approxmatey
s
to
tba
otba
receves
teus
te
superor
te
besde
connecton
89.
on
te
gastrocnemus,
cacaneus
arses
te
o
oter
339
semtendnosus
proxma,
passes
arses
te
te
orms
tendon
tars
ead
wt
on
te
te
porton
atera
nserts
Pubic
on
te
atera
te
o
Sometmes
greater
semtendnosus
te
he
ansernus
emors
wt
aspect
dsta
o
medas
ts
te
rectus
te
ABR/McM
border
sartorus,
artery.
tuberosty.
te
emora
poptea
proxma,
meda
orgn
musce
tba
te
te
gracs
on
te
vastus
orms
quadrceps
(GAS
GAS
a
te
apex.
te
ge
o
mdde
meets
to
te
opsoas
provdes
te
to
he
as
on
proxma,
above
he
586–590;
he
te
emors
on
nserts
tba.
popteus
emur,
contnung
exon/extenson
tere
and
tears
suggests
Menscectomy
tears
attaced
Commony
gament.
eard
tendnous
gastrocnemus.
separated
he
oten
o
gament
sweng,
nbtng
s
s
s
jont.
knee
currenty
mensca
tendons
branosus
can
knee.
t
to
mens-
gament
detaced
tear
porton
o
pes
meda
mensca
crucate
ror
subject
coatera
knee
te
emur,
are
menscus
pan
semmembranosus
ven.
because
artroscopy.
be
he
275
Limb
artroscopcay.
579,
he
a
and
anteror
cessu
secondary
88.
or
may
Lockng
tba
momentary
be
MRI
ts
tba.
he
coatera
knees,
to
ovas
328
tba
te
entry
ossa
termnaton
emora
njury
o
te
torn.
te
he
mensc
atera
payers’
by
or
te
be
buar
bucket-ande
o
movements
on
he
tearng
n
te
to
o
capsue
knee.
tear,
between
a
te
ootba
symptoms
ng
ayer
or
ata
atera
may
potenta
artery.
ABR/McM
abe
deep
wt
or
nto
and
and
more
atera
asca
490;
capsue.
te
externa
N
rng,
ven,
ven
meda
used
jont
rom
te
njures
muc
te
n
667;
te
rotatona
to
nguna
emora
sapenous
Bot
cus
deep
cord,
Lower
5
muscle
276
C H A P T E R
92.
A.
he
vc
5
Lower
tendon
cavty
by
wrappng
o
Limb
te
passng
around
obturator
troug
te
nternus
te
esser
esser
scatc
eaves
scatc
te
pe-
notc,
te
tem
he
o
superor
on
te
te
he
ty
quadratus
crest
mnmus
nsert
B.
genera,
te
arses
togeter
oramen
rom
emur.
te
ne
he
on
trocanter.
externa
and
surace
sca
beow
guteus
te
atera
aspect
N
te
a
on
o
te
ABR/McM
ange
o
ncnaton
GAS
between
te
neck
98.
E.
degrees.
Wen
reerred
dton
Genu
to
as
by
a
emur
D.
o
wt
546,
to
oot
s
are
o
bua
racture
caton
sudden
GAS
A.
Wen
tba
o
645;
he
can
te
upon
s
a
be
GAS
wt
N
Pott
te
o
crucate
patent
drawer
500;
oot.
as
100.
B.
Rest,
a
seated
te
bma-
wt
be
tans
o
to
A.
te
torn,
rom
te
bot
poston.
te
gencuar
339
96.
o
te
anke.
everson
can
he
gament
cause
te
s
meda
so
o
excessve
strong
tat
maeous
to
extenson
excessve
be
pued
artery
suppy
s
crcumex
te
as
s
N
n
It
a
L2–
com-
tese
be
best
by
to
motons.
he
te
he
knee.
meday
o
rotates
and
te
atera
knee.
to
o
to
and
te
te
common
papated
te
and
ossa
contans
s
ven,
anteror
tereore
te
buar
ere.
and
ngu-
ossa
poptea
he
nguna
wa.
round
at
artery
nerve.
he
abdomna
men
te
respectvey).
between
tg
te
musce
emora
atera,
te
papate
sartorus
meday,
n
tg,
semmembra-
pace
te
contans
anteror
cord
te
Damage
exon
exon
deep
and
he
and
poptea
and
o
329
meda
he
ABR/McM
artery
atera
artery
s
aso
s
a
be
a
s
It
con-
gament
329
occuded,
crcumex
crcuaton
artery
not
women.
482;
te
eves.
s
exon
n
n
te
es
ower
S2
L5
extends
exes
ongus
nerve,
n
asssts
we
cannot
and
knee.
bounded
knee
330
to
te
branc
tg.
o
occuded.
proxma
te
emora
descendng
w
he
te
emora
he
meda
branc
o
te
provde
descendng
and
tere-
crcumex
deep
emo-
ead
te
deep
te
emur.
te
ay
artery
a
558,
peroratng
a
tg.
sma
part
durng
553,
rst
suppes
very
proxma
ony
GAS
he
posteror
most
preventon
torson
ts
o
tod)
te
at
te
te
suppes
s
o
ra artery and suppes retnacuar brances to
E. One mportant uncton o te meda coatera (de-
gament
emur
o
abducton.
and
te
and
cana
te
woud
emora
o
96–120
te
emora
afect
p
(rom
emora
o
area
hs
obtu-
emora).
repeated
reex.
and
compartments
uterus
coatera
ore
s
spermatc
te
ands
as
papated.
n
564;
I
te
gament
artery,
years
suppy
355
ABR/McM
It
tba
te
GAS
o
source
S1
asssts
superory.
puse
s
te
trange
nerve
o
ven,
emora
Answers
atae
adductor
back
cana
dso-
due
p,
puse.
emora
maeous,
8
reex.
sartorus
484;
meda
and
end
sgn.
ABR/McM
patear
adversey
te
te
and
cannot
medca-
to
te
ts
nvoves
rotaton
exes
adductor
and
o
te
meda
ABR/McM
ascae
gament
he
just
101.
wt
te
woud
N
ateray,
Pantar
on
ABR/McM
tendon
532;
emora
emora
artery,
a
o
branc
anterory
n
deep
he
570;
he
engaged
dsta
s
495;
reex
meda
knee.
na
occurs
gament
a
N
musce
te
o
oot.
rmy
n
we
Dupuytren
bua
ractures
te
ba
wak.
s
tat
360
pung
te
dsta
as
band
mornng,
te
N
jerk
tensor
appens
or
meda
te
tese
dspaced
by
and
o
he
rotaton
jumpng.
o
te
p
te
racture
o
extends
toug
to
brances
ead
due
turn,
nosus
usuay
te
racture
ABR/McM
anteror
605–608;
o
o
n
o
615;
GAS
to
In
extends
condton
begnnng
A
a
everson
anteror
jont
eg,
postve
Eac
sgty
knee
te
523;
and
maeous)
racture
It
e.
emors
tat
meda
artera
crcumex
wtn
tereore
ntermedus
between
te
Probaby
vastus
toe.
te
reaces
ts
branc)
meda
rectus
302
o
n
te
approxmatey
gets
acetabuar
te
traveng
and
nvoved
B.
ts
by
to
emur
carac-
ange
arge
99.
by
anke
are
GAS
te
(te
emur.
eary
tearng
359
up
Q-ange,
antnammatory
dspacement
oot.
te
and
and
treatment.
orceu
N
bed
con-
condton
a
s
ncnaton.
requenty
panu
a
te
cacaneus
eet
s
t
s
pysca
runnng
most
(atera
te
and
ter
spnts,
nvoves
o
te
o
ncreased
te
ABR/McM
speccay
outward
o
vara
deormtes
to
vagus
aponeuross).
rom
n
reers
rom
especay
used
are
predcted
ncreases,
ange
and
condtons
te
coxa
nammaton
on
usuay
racture,
te
wt
are
up
vagum
common
or
pantar
ngt
decreased
devaton
a
rom
contrast,
Haux
s
patoogc
ncnaton
Q-ange
478;
tearng
gettng
eoar
N
ascts
wo
a
Q-ange
stretcng
ortotcs,
tons
In
tba.
576;
atetcs,
ascts
ater
vaga.
atera
(te
peope
n
a
rom
tssue
te
o
by
n
decrease
ange
genu
he
and
Pantar
resuts
and
or
decreased
respectvey.
GAS
coxa
varum
comes
te
caracterzed
terzed
te
However,
ncrease
te
tan
prmary.
ponent
120
eter
o
suppy
capts
551–554;
matey
can
ABR/McM
cdren
(varaby,
gament
repaced
289
and
rater
gament.
branc
artera
ovea
occudes
te
518;
ead
artery
artery,
485;
te
drect
ead
and
o
by
te
ntertro-
medus
age,
he
ossa.
tuberos-
te
o
N
nants
rator
obturator
ntertrocanterc
quadrate
te
greater
te
wt
In
racture)
(detod)
634;
B.
L4
vaue.
95.
n
nserts
GAS
97.
trocanter.
440–443;
In
obturator
te
o
te
on
and
avuson
and sat o te emur n oder age decreases to approx-
t
94.
on
canterc
GAS
te
o
arses
nserts
emors
nserts
greater
93.
o
and
geme
surace
externus
margns
and
neror
meda
obturator
membrane
and
(an
coatera
cangng
drecton by approxmatey 90 degrees. It s joned tere
by
of
oramen,
te
574;
sma
o
te
eary
N
porton
Fnay,
artery
and
ead
years
495;
branc
te
o
o
te
obturator
vascuarzes
o
o
musces
te
emur
e.
ABR/McM
330
artery
ony
and
te
usu-
CHAPTER
102.
A.
In
a
emor
troug
acunar
te
te
gament
emora
te
n
emora
artery
adductor
ce
564;
A.
he
n
te
nto
N
artery.
cana
nguna
medate
n
n
as
deep
seat.
atera
meda
and
and
contans
te
o
o
to
te
emora
ymp
cor-
peope,
ta
te
seat
contans
te
encoses
ymp
ymp
broken
areoar
tssue
tssue.
105.
and
nserts
emo-
a
he
he
atera
emora
and
D.
pevc
562;
tarsa.
deep
on
ven.
w
te
oot.
and
tbas
tuberce
njury
to
present
Fbuars
anteror
at
te
te
wt
a
Inguinal inguinal
saphenous
on
o
•
GAS
Fig.
6.9
receve
he
ymp
6.39).
iliac
n
nodes
t
ts
nodes
nodes
(deep)
te
and
meta-
musce.
everson
meda
ligament
knee)
rom
bua
aucs
vein
(behind
Fg.
te
afect
te
inguinal
Popliteal
and
te
nodes
Deep
Great
w
o
weakness
Exter nal
Superficial
and
nguna
nodes).
orgnates
sat
extensor
nsert
regons
receve
(GAS
base
area
ongus,
receves
orzon-
deep
ata
te
376
musce
o
ts
a
he
structures
brevs
te
gutea
rst
near
superca
group
(poptea
nodes
ABR/McM
te
and
asca
vesses
ac
two-trds
te
wa.
te
ocated
vertca
tg,
rom
to
pernea
475;
te
Any
deep
ymp
nterna
buars
ower
Patents
nter-
ymp
277
Limb
329
are
dran
he
abdomna
e
and
N
and
superca
deep
and
nodes
perneum.
te
nodes
ABR/McM
nguna
receves
rom
externa
GAS
490;
juncton
anteroatera
he
artery
te
N
and
rom
group
te
erna.
s
mb
mus-
ntermedate,
575;
superca
sapenoemora
ower
bot
emora
560,
he
ound
trange.
te
to
B.
s
pectneus
to
104.
rom
to
atera,
emora
be
GAS
te
235
ympatc
pus
to
hs
majorty
te
orced
meda
woud
emora
compartment
node,
just
erna.
meda
meda
he
are
atera
meda
as
compartment
conssts
ymp
te
ABR/McM
es
and
te
we
just
ven
more
compartments:
he
he
nerve
ven
s
emora
ound
musce
256;
emora
tree
emora
te
because
ound
emora
meda.
ra
be
to
s
and
ongus
woud
GAS
103.
cases
ven
contents
wc
Gmbernat)
he
atera
most
emora
abdomna
rng,
(o
ven.
mmedatey
rect
erna,
emora
Lower
5
o
ongus
sde
o
te
278
C H A P T E R
oot
5
and
Lower
w
trocnemus
on
te
GAS
106.
posteror
622–625;
surace
N
506;
n
ts
patent.
cacanea
o
te
he
(Aces)
gas-
nnervates
tendon
ony
cacaneus.
ABR/McM
web
351
pevs,
were
pevs,
above
o
nto
te
ror
te
GAS
ossa
and
It
ten
space.
sde
njured
just
te
(va
venous
o
dranage.
nto
hereore
to
te
a
meda
n
we
s
he
and
buar
and
atera
hs
sdes
te
deep
buar
o
o
oot,
te
o
te
tested
bua.
tat
o
t
te
and
te
o
an
te
and
eas-
run
s
te
o
oot
ger
te
knee
o
s
te
to
te
113.
A.
drawer
te
meda
respectvey.
brocartage
he
tat
tba.
o
motor
te
com-
nerve
tat
to
te
eg
and
sensory
nerve
s
ony
tba
runs
te
s
gament
on
gament
sgn”
and
meda
sde
gament
on
te
a
tese
s
stron-
damaged
o
a
exed
meda
to
te
sde
oter
type.
330
wt
te
removed
areas
o
o
great
rom
oss
by
te
te
tg.
to
woud
emora
orgn
skn
he
tba
posteror
aso
produce
s
te
on
cutaneous
te
nerve
o
s
sapenous
emora
nnervaton
sape-
patent.
descrbed
te
nnervates
Latera
te
te
are
tgty
because
stran
cosey
damaged
s
are
tuberosty
s
he
gament
typcay
carred
he
and
to
crucate
aspect
put
bow
nerve
dysuncton.
gament,
drawer
a
tro
hs
gament.
damaged
not
a
trad.”
crucate
tg.
atera
produces
coatera
be
njury
cutaneous
quadrant
njectons.
tey
buar
beng
wc
meda
te
GAS
114.
B.
596;
N
513;
Lgaments
jonts.
Wen
ament
s
orce
s
oot
gament
te
ABR/McM
act
a
to
jont
stretced
severe
s
gaments
o
was
he
meda
crucate
ABR/McM
nerve
hs
a
motor
sapenous
nerve.
te
339
branc
and
ts
te
tuberosty.
coatera
attaced
499;
obturator
suppes
muscuar
anteror
meda
root,
he
aspect
n
N
wc
neror
nerve
t
taut
not
o
mdway
quadrants.
coatera
semtendnosus
s
pont
posteror
te
by
andmarks.
“posteror
and
on
our
oten
not
durng
nnervaton
nnervates
drawer
he
and
te
as
o
sapenous
L4
te
sura
oot.
quadrants
gest
because
posteror
but
or
nerve
te
to
o
part
he
and
bony
“unappy
woud
postve
anteror
598–605;
nerve.
to
te
dspace
posteror
knee
Sensory
pos-
he
te
person
he
a
damaged
T endon
te
nous
prevents
to
a
knee
meda
324
tba
he
Its
rst
branc
orzontay
anteror
woud
te
oot.
eg
ntragutea
tba
eg.
te
anteror
nto
ower
te
te
te
te
sca
knee
as
oter.
Damage
knee.
tan
GAS
backward
prevents
emur.
a
It
tba
te
to
to
atera
produce
te
togeter
eac
te
structures
It
w
tba
posteror
emur
many
te
te
stabze
a
o
ossa.
reatve
te
jont,
te
ts
ossa.
oot
rom
attempt
ABR/McM
s
to
te
durng
to
menscus
typcay
skn
eg.
to
atera
woud
(va
drans
te
ossa.
damage
structures.
dor-
oows
o
bow
te
runs
ABR/McM
reerred
damaged
bow
by
runs
postve
on
o
area
gament
nerve
It
atera
knee.
poptea
ntracapsuar
500;
buar
wt
te
artcuaton
njures
attaced
te
s
poptea
tba
gaments
te
A
o
oten
365
puses
n
tba
an
nerve.
te
ntercondyar
caed
o
sde
gament
crucate
s
n
te
ABR/McM
exed
A.
485;
and
posteroatera
n
avoded
N
menscus
space
ven
be
573;
o
346
nto
troug
meda
(wc
oot
runs
o
o
te
dvded
rom
and
te
nnervates
papabe
regon
poptea
325
te
nerve
be
ne
crests
and
suppes
web
ac
gutea
menscus,
te
dorsum
ntercondyar
te
s
o
te
sde
usng
meda
nerves
casts
can
o
skn
cutaneous
dorsum
nerory
te
nnervates
ABR/McM
second
to
he
atera
scatc
course,
rst
te
and
atera
pyscan
N
eg
te
nodes
coatera
605–608;
he
mon
o
menscus
mproves
GAS
o
s
te
deep
nerve
te
ven
te
475;
anteror
dspacement
meda
on
usuay
knee
and
te
compartments
sapenous
and
crucate
te
o
o
te
te
regon
he
te
must
wen
sma
oot
te
wa
posterory.
sgn.
o
wc
eg
dranage
he
N
o
112.
and
512;
runs
nvoves
ead
ABR/McM
dspacement
hs
te
te
poptea
posteror
posteror
skn
evertors
poptea
aspect
emur.
te
sde
ong
he
te
271
superca
wt
o
nerve
s
nerve
oot.
postoned
ne
GAS
oot.
N
crest.
scatc
and
and
eg
gutea
dvdes
tba
sapenous
buar
626;
compartment
nnervaton
eg
ower
between
mn-
he
he
te
nes
ac
ante-
anteror
nnervates
he
One
buar).
eson
te
ts
531;
te
562–563;
he
test,
o
pantar
sup-
we
guteus
atae.
B.
two
gutea
musce,
branc
te
anteror
to
o
N
a
superca
te
sde
s
around
te
compartment
te
GAS
111.
cana
to
neror
te
ascae
atera
knee).
ympatc
drans
te
eg,
superca
sde
teror
te
he
esser
It
te
nerve
adductors
nnervates
nnervates
te
te
maxmus
nerve
te
to
te
vesses.
obturator
and
ABR/McM
and
Due
buar),
atera
dran
on
nto
624–626;
he
GAS
te
nerve
o
o
nto
membrane)
tg.
posteror
meda
and
wa
te
musce
musces
patents
atera
te
GAS
C.
o
deep
te
n
va
tensor
486;
jont,
obturator
obturator
buar
atera
beow
tg
nerve
wndng
dvdes
te
sexors
B.
N
descends
atera
te
guteus
te
It
to
te
and
te
respectvey.
rom
o
descends
beore
te
emora
te
common
suppy
y
te
gutea
555–558;
he
nerve.
E.
he
medus
mb
aong
externus
nnervates
ower
o
above
L4.
sacroac
anteror
obturator
and
to
te
meda
nnervates
nerve
eg
te
superor
mus
It
runs
and
tg.
L2
over
compartment
nerve
A.
t
openng
te
rom
major,
te
cutaneous
o
orgnates
psoas
py
110.
te
tat
(an
109.
afected
va
superca
enters
108.
be
nserts
A. he obturator nerve s a branc o te umbar pexus
te
107.
not
Limb
tat
s
bua
on
and
s
orced
and
enoug.
turned
te
w
be
excessve
nto
ts
atera
and
s
or
s
tat
rupture
wen
he
and
It
movement
poston,
tereore
acton.
sde
cacaneus.
a
tender
Inverson
meday
oppose
te
356
prevent
te
w
o
g-
te
soe
o
stretc
cacaneobuar
stretces
te
ony
between
gament
CHAPTER
tat
woud
pantar
gaments
oot
and
res.
durng
ocated
not
be
and
on
suc
ong
te
an
and
pantar
damaged
acton.
sort
surace
durng
and
w
634–643;
he
patear
not
N
be
518;
reex
he
o
nverson
te
nju-
ocated
afected.
ABR/McM
causes
359
extenson
o
te
knee
and Superior
s
produced
wc
by
consst
te
o
quadrceps
rectus
emors
emors
and
musce
and
era
rotator
p
and
exor
ntermedus.
vastus
o
te
knee,
o
te
tg.
and
te
Quadratus
he
sartorus
pectneus
s
s
a
s
exor
a
o
adductor
gluteal
116.
B.
578,
te
and
Lateral
p.
he
598;
atera
N
490;
ABR/McM
femoral
te
gves
te
deep
crcumex
a
branc
tg
superor
ex
emora
emora
and
tat
emora
runs
jons
atera
descend
artery
te
down
artery
artery
does
te
to
s
a
not
atera
he
provde
he
p
branc
jont.
aspect
anastomoss
artery.
knee.
te
te
gencuar
gencuar
toward
cose
meda
any
va
and
arteres
are
te
termna
brances
artery
poptea
te
s
and
woud
damaged.
posteror
tba
not
he
artery
receve
Deep
te
ar ter y
buar
(GAS
artery
Fg.
te
bood
s
a
tat
First
117.
B.
558,
he
ton
574;
495;
obturator
o
te
te
o
s
perforating
tg.
compartment
anteror
te
o
tba
te
118.
A.
and
are
brances
480,
he
oot
s
nerve
s
or
orm
emora
and
s
D.
o
o
o
aspect
deep
te
rst
nverson
ped
or
by
te
pantar
o
te
ocated
deep
GAS
te
o
te
611,
he
he
te
te
N
o
s
a
and
suppes
N
271
te
ace
s
te
oot,
te
not
between
te
exon,
superor
wt
and
be
te
damaged.
tba
and
533;
ABR/McM
357
most
and
and
he
te
o
and
tba
te
s
a
he
te
nerve
tbas
compresson
compresson
tarsa
maeous,
cacaneus,
are
te
tunne.
meda
posteror
n
te
be
tba
area
most
sgncant.
w
te
te
exor
and
o
tunne
neu-
te
s
tba
ocated
neromeda
retnacuum.
ts
pantar
posteror,
hs
story
and
retnacuum
te
skn
over
615–622;
te
N
Tne
nerve.
sgn
ects
cacaneus
520;
on
exor
sur-
he
brances,
dgtorum
s
nammaton
tese
he
compressed,
pysca
te
GAS
Any
syndrome
a
exor
postve
vesses.
compress
tba
easy
ncudng
n
ocaton
bua
6.
syndrome
sgncanty
w
patent’s
sup-
responsbe
te
te
sweng
sensaton
everson,
to
Fig.
rom
tarsa
te
tendons
ven
musces
nerves
GAS
ongus, and te exor aucs ongus musces togeter
sup-
Dorsexon
by
he
knee
ocated
w
oot.
or
te
te
contents
328
responsbe
n
o
tunne
resutng
between
suppes
eg
T arsa
nerve
ower
nerve
te
E.
ropaty
and
ony
anke,
buar
o
eg
te
nerve
atera
aspect
•
tba
sapenous
suppes
nerve.
626;
and
meda
ABR/McM
nerve.
reex,
space
we
120.
he
tba
produced
buar
are
eg
most
529;
space
jerk
and
superca
nerve
anke
deep
te
or
suppes
oot.
615;
web
and
eg,
atera
nner-
compartments
ABR/McM
obturator
tg.
o
buar
nerve.
emora
he
te
tg
ar ter y
meda
nerve
nerve.
486;
emora
te
oot.
te
te
buar
o
buar
tumor
scatc
N
posteroatera
o
knee
n
te
over
exon
te
perforating
nnerva-
te
responsbe
posteror
common
anteror
by
o
te
skn
te
he
o
oot.
537–541,
he
over
te
and
aspect
te
GAS
o
compartments
555–557;
branc
eg
soe
dorsa
119.
a
skn
pes
494,
skn
meda
and
tg.
supped
meda
te
atera
suppes
eg
nerves
GAS
and
nerve
ar ter y
te
branc
extenson o te knee. Common buar nerve
te
ar ter y
perforating
330
wc
he
ar ter y
6.51).
responsbe
adductors
te
anteror
ABR/McM
nerve
tg
compartment
vates
N
thigh
pop-
Third
GAS
of
posteror
o
any
ar ter y
o
Second
tea
femoral
circumflex
crcum-
brances
anteror
It
Femoral
tba
ar ter y
332
Medial
o
ar ter y
at-
circumflex
GAS
ar ter y
ateras,
emors
an
gluteal
group
Inferior
medas,
279
Limb
pantar
he meda coatera (detod) gament s
GAS
A.
damaged
are
w
meday
115.
be
cacaneonavcuar
Lower
5
posteror
but
te
dagnosed
examnaton
(gty
numbness
and
te
ABR/McM
tba
nerve
wt
and
o
s
te
ndngs
tappng
soe
or
structures,
over
tngng
te
oot).
355
nerve
s
te
Answers
121–143
121.
Dorsas
A.
peds
puse
s
papated
at
te
promnent
arc o te top o te oot between te rst and second
280
C H A P T E R
5
Lower
metatarsa
aucs
second
GAS
122.
A.
bones
ongus
te
tonng
E.
nto
B.
he
te
N
rests
strng
as
are
he
musce
p.
te
o
are
exon.
at
te
and
o
o
wen
ts
te
sttng,
attacment
musces
magnus).
wt
te
juncton
Muc
(amstrng
582,
p
te
and
gaments
te
he
by
te
o
tendon
N
476;
a
It
starts
cd
runnng,
te
unctons
(stragt)
te
a
s
t
te
aspect
am-
and
w
o
te
be
o
sttng
poston,
poston,
wakng
GAS
485;
ABR/McM
(buttocks)
njecton
o
njecton
scatc
B.
s
drugs,
arge.
nerve,
on
te
(superoatera
s
te
a
tat
ntervertebra
and
t
umbar
canter
te
sgn.
te
pus
o
present
as
o
tg,
te
seat
quadrant).
T rendeenburg
gat
te
njury
to
soud
be
quadrant
o
he
pattern
patent
(or
s
guteus
B.
It
to
derved
he
te
te
te
meda
attaced
poptea
rom
te
te
to
te
sem-
gament
patea
o
s
ga-
posteror
patear
o
tuberosty
o
to
te
consequenty
strengtens
border
to
coatera
above
rmy
obque
capsue.
s
not
psoas
te
wt
tba.
quadrceps
te
umbar
canter
o
p
jont
te
trunk
poston.
s
part
wt
N
and
It
emors
dscs,
on
he
o
te
o
te
rom
and
he
trunk,
or
tg,
named
nserts
as
te
n
tg
sttng
s
but
n
te
tat
a
asca.
at-
asca.
te
transverse
and
toracc
nto
exes
appendx
may
vcnty
encosed
bodes,
twet
psoas
tro-
retans
umbar
o
te
276
rom
vertebra
te
esser
te
asca,
ayer
ABR/McM
arses
s
te
to
psoas
(n
te
umbar
and
tubercuoss
psoas
anteror
te
te
gron
rom
transverse
toracc
nto
o
spna
te
he
musce
emur.
te
and
derved
vertebrae
te
nserts
339
te
bodes,
twet
seat
n
te
rom
vertebra
te
he
486;
sdes
te
on
rom
ABR/McM
arses
te
abscess,
major
ntervertebra
t
o
abscess
tat
bends
processes,
500;
trocanter).
582–583;
he
N
emur.
cod
seat
edge
130.
dscs,
psoas
a
era
avod
outer
a
he
or
he
ower
vertebrae
esser
brous
and
ste
s
and
ds-
coatera
overapped
tba
beow
It
sorter,
proxmay
bua
s
te
anterory.
Fbuar
he
and
tba
anteror
attaced
tba.
musce
sdes
te
stragten-
njecton
upper
o
605;
major
te
up
partcuary
T o
psoas
processes,
extenson
common
s
te
part
exed,
stronger,
attaced
emors.
on
jont
prevents
te
to
condye.
te
pued
s
menscus
jont
on
knee
beng
o
and
te
emora
are
emur
te
te
buttock.
posteror
tba.
ead
te
attaced
te
contnuaton
300
326
te
expanson
convexty
578–580,
he
GAS
N
and
s
emur
and
on
o
te
atera
te
rom
musce.
knee
te
and
te
njured.
connects
n
tendon.
standng
te
te
smoot
becomes
te
between
o
o
(tendon)
be
te
324
gament
meda
tendnous
and
Gower
prmary
to
nerve
gament
o
band
o
njecton
quadrant
area
te
sat
o
guteus
key
o
te
te
most
bceps
o
te
membranosus
cdood
postons
a
o
te
rest
requres
edge
te
ment
and
condton
cassc
o
prone
porton
dicuty
surace
more
ABR/McM
n
as
wc
as
s
condye
mme-
s
emur
o
between
scatc
obque
at
meda
body’s
129.
586;
a
o
jont
te
s
and
border
he
tba
o
prorms
L5,
notc
key
cordke
sde
te
he
amstrng
te
te
(L4,
scatc
posteror
te
most
ACL. Wt
te
o
musces
s
crucate
are
atera
te
ABR/McM
ess
o
ramus
extenson
p
atoug
dystropy
patent
586;
prevents
posteror
pacement
pase
te
nerve
Intramuscuar
dspacement
by
hese
greater
orward
crucate
surace
gutea
te
neromeda
485;
meda
broader,
norma
ntact.
wen
orward
te
knee
N
prevented
espe-
mdstance
scum
tendnous
afected,
regon
te
buttock
sowng
Posteror
but
nerve.
te
weakness
(superomeday)
ntercondyar
o
are
runs
by
musces.
te
o
beneat
quadrant
anteror
ngu-
runnng.
underyng
we
s
te
rom
border
and
ts
caused
superor
mnmus.
n
573;
he
mbs,
and
her
and
nner
anteror
superor
te
upper
damage
D.
by
s
mnmus
emerges
medus
damaged
327
te
adducton
rom
582,
gutea
voume
te
runnng,
and
adductor
bendng
ntramuscuar
gven
te
regon
ower
jonts
njured.
assocated
maxmus
and
567,
o
standng
te
gutea
nto
two
tuberostes
because
or
rsng
rom
o
weakness.
hs
guteus
he
te
to
not
o
wc
and
dsappears
medus
are
superca
troug
tuberosty.
567,
notced
upstars,
A.
o
upper
surgery
te
te
gracs.
he
o
projecton
muscuar
cmbng,
GAS
te
wc
gament
musces
sgty
wen
ng
supped
guteus
376
easy
body
porton
Ducenne
o
cross
swng
tese
tg
and
medus
datey
unc-
adductors
o
te
dran
pases
proxma,
543–545,
exed
127.
on
musces
he
ree
musces
drans
extenson
sca
adductor
te
urc),
guteus
ACL
ABR/McM
te
magnus
be
a
bony
o
exon.
causes
medus
above
very
p.
adductor
o
a
mpor-
used
128.
n
group
group
are
482;
musces
afected
up,
s
nodes.
p
te
te
amstrng
may
te
332
njures
ate
tey
end
posteror
D.
oter
remanng
amstrngs
te
roug
provdes
126.
te
reconstructve
ABR/McM
durng
arge
wegt
GAS
more
as
absence
nammaton
gutea
rotate
590;
knee
te
orzonta
ncudes
not
neror
s
te
vertca
te
durng
GAS
or
and
suppy,
surgery
ABR/McM
475;
runnng,
do
or
S1),
sze,
addton,
durng
gutea
N
cruca
acton
125.
te
he
Because
o
In
490;
deep
514;
cay
extensor
GAS
neror
very
sape,
reconstructve
superca
wereas
GAS
te
ongus
358
neurovascuar
reasons
N
nodes.
and
o
mb.
drans
124.
n
ts
o
compensate
586;
Any
na
to
canddates
GAS
A.
due
smar
upper
tendon
dgtorum
ABR/McM
autograt.
tg
good
123.
521;
nature
commony
For
te
extensor
are
N
Gracs,
te
between
and
toe.
654;
tanty
Limb
te
te
s
esser
tg
xed,
up
to
rom
pused
up
t
a
at
te
te
tro-
te
exes
yng
aganst
CHAPTER
te
t
pertoneum
s
ng
n
touc
acute
pan.
puruence
may
s
encosed
te
umbar
bar
asca
o
GAS
131.
o
present
ayer
B.
as
tat
te
brous
te
and
te
ven
s
N
GAS
and
C.
to
he
deep
cs
o
Wen
ar
t
skn
GAS
E.
te
amost
a
and
ment
he
o
nodes.
It
as
upper
s
te
A
tey
s
obque
meda
to
superca
nguna
na
te
o
oot.
and
emur
te
deep
a
It
to
te
te
on
and
o
te
te
te
web
rst
and
t
s
o
o
and
suppes
eg
to
area
suppy
so
nverson
nerves,
most
o
s
caed
obturator
o
to
sma
or
0.5
te
n
ramus
ymp
o
n
es
he
ong,
It
te
te
te
deep
s
ven.
above
nguna
and
as
rng
te
s
an
615;
he
oot
oot
and
ten
to
and
te
(1.3
pubc
cm)
te
above
te
anteror
sympyss.
Fossa
nguna
superor
ovas,
gament,
ac
aso
spne
dran
caed
te
are
ongus,
perormed
buars
by
ongus,
dgtorum
movements
te
transverse
to
te
o
tar-
te
by
te
poptea
w
oot
s
anteror
tba
ossa
soeus
vesses.
artery
te
gastrocnemus
and
poptea
o
n
te
supped
eaves
te
508;
by
musces
hereore
aso
due
a
compress
to
contrac-
compartment
o
deep
te
o
a
dran
te
te
(except
sde
nodes
o
wa
suc
oot,
receves
dran
n
men
ana
te
and
an
rst
group
o
ym-
and
a
orzonta
ymp
te
te
to
w
eg,
he
o
te
as
superca
beow
o
n
nodes
vertca
te
tat
sde
patent
wc
tg.
pens
trd
eventuay
hs
he
te
gans
ower
poptea
receves
rom
s
ympatcs
njury,
ympatcs
te
and
te
nodes.
nodes.
abdomna
eg
anteroatera
deep
mdeg
meda
te
te
nodes
ymp
o
nto
poptea
women),
poptea
on
nguna
superca
anteror
n
and
nguna
rom
344
dranage
ympatcs
superca
group
ABR/McM
anteroatera
nto
patcs
N
rst
superca
rs
s
359
due
poptea
musces
eg
perneum
n
pan-
anteror,
exor
at
oter
tbas
he
gastrocnemus
to
te
eg
matey
between
wc
Dorsexon
te
nected
te
mosty
nerve
te
and
te
0.5
pace
and
possbe.
pantars,
take
tan
dgtorum
ongus.
te
between
are
exon
ABR/McM
s
ympatc
ova openng n te transversas asca and es approx-
mdway
te
tat
wt
eg.
te
te
to
o
te
and
abdom-
known
o
superca
meday
emora
externa
hs
as
C.
518;
posteror
nerve.
GAS
137.
wegt
posteror,
aucs
everson
tba
deep
and
gament;
pubs;
te
meda
soeus,
tree
jont
bua
upward)
extensor
tbas
nge
downward)
by
ver-
exter-
o
artcuaton
more
Pantar
and
te
groups
and
pontng
ongus,
musces,
he
es
ton
nerve
compart-
rng.
te
te
tba
he
perormed
exon
ematoma
eav-
vesses
cm)
mmedatey
tuberce.
te
nguna
ateray
deect
enter
meda
emora
tat
ramus,
obturator
(1.3
te
seet
oramen,
pubc
te
pevs
and
brous
superor
te
and
357
a
te
te
376
synova
pontng
exor
N
soeus
passng
s
te
634;
nerve.
oot.
n
vesses).
bears
(toes
aong
te
to
nguna
orzonta
e
to
n
nguna
te
atera
taus.
tertus.
and
Pantar
and
te
and
o
necton
superory
o
sgn
jont.
GAS
E.
s
nto
aong
mportant
beow
nodes
a
e
presence
arranged
s
ocated
and
superca
ABR/McM
taus
(toes
brevs,
skn
136.
end
gastrocnemus,
ongus,
nto
te
buars
buars
sa
475;
te
aucs
skn
skn
dvdes
cutaneous
te
second
te
exon
and
jonts.
nerve,
and
o
are
and
an
he
es
284
are
he
an
asca
ac
jont
Dorsexon
extensor
au-
N
ven.
dran
dvded
tey
dsta
Dorsexon
te
be
taocrura
tba
ten
te
It
tuberce.
nodes
ndcate
n
tg.
ABR/McM
s
281
Limb
openng
te
crbrosa)
nodes
nodes.
Externa
end
(asca
hey
o
pubc
477;
emora
may
meday,
te
N
ova
ata
ymp
ymp
can
an
te
superca
vesses;
proxma
extensor
musces
and
connects
ends
te
ymp
562–563;
he
tar
sma
dorsa
te
ac
A.
o
te
groups.
GAS
135.
passes
and
n
(anterory,
338
nerve
o
te
rng.
o
cutaneous
anterory
pubc
tca
sapenous
tarsometatarsa
passage
aponeuross
te
a
seat
gament;
gament
eg
sde
ac
to
572;
asca
sweng
gves
ven
deep
to
asca
nguna
extremtes.
e
te
557,
nguna
rom
te
ven
dgtorum
ony
te
superor
It
o
great
te
ABR/McM
cana
emora
te
o
not
486,
meda
nodes
reers
o
neroatera
te
externa
t
part
deep
swoen
wdey
nerve;
knee.
maeous
anke
te
eave
tranguar-saped
na
te
te
most
dorsa
ntrnsc
sdes
approxmatey
acunar
anteror
he
jonts.
and
as
coses
borders:
posterory
o
or
openng
oowng
te
mb
arc
passes
te
membrane
emora
te
te
sapenous
he
te
ABR/McM
beneat
cana,
vesses
tg.
ts
gap
o
buar
533;
competey
obturator
um-
te
C.
cm
433,
beneat
o
134.
ven.
aspect
dorsum
N
4
rom
aspect
nnervaton:
across
obturator
sma
eg.
ntermedate
625–626;
he
ng
and
to
GAS
derved
and
great
condye
contguous
contnue
on
3
ower
te
meda
meda
tat
or
anteroatera
wc
te
psoas
emora
ower
venous
tarsa
superca
meda
retan
openng,
superomeda
he
wt
te
te
(extensors
oot
and
te
sapenous
277
beyond
te
emerges
te
o
te
nerve
te
between
te
resut,
tubercuoss
part
ongest
unon
suppes
avaabe
on
o
529;
oot
and
n
he
n
te
te
buar
and
remans
toes.
te
emora
N
nay
dsta
to
meda
te
ongus)
s
dorsa
to
te
658;
retnacuum
dorsum
s
not
bends
branc
te
te
te
jons
615,
s
may
gron.
tat
ABR/McM
extend
sde
by
anteror
t
edge
branc
to
meda
posteror
te
seat
accompanes
ormed
ascends
n
t
spna
a
produc-
because
486;
nerve
nerve
It
toe
wen
atera
nnervatons
over
cases
seat
As
asca.
nerve
oot.
great
he
psoas.
pertoneum,
and
abscess
cutaneous
ony
scatc
oter
abscess,
cod
a
582–583;
sensory
133.
a
contracted
pareta
some
asca.
but
te
te
psoas
hesapenous
te
132.
In
a
n
dstrbuted
s
rom
wt
Lower
5
rom
umbcus,
and
cto-
cana.
deep
he
nguna
282
C H A P T E R
nodes
deep
ca
B.
but
Lower
are
and
not
are
papabe.
not
be
he
ac
papabe
nodes
durng
are
cmbng,
pys-
ror
examnaton.
562–563;
he
part.
nto
ng
ate
N
obturator
covers
te
he
te
475;
obturator
meda
troug
key
ead
nerve
tor
musces
ton
to
eca
tg
meda
te
medus
tors.
and
durng
aso
superor
gutea
te
greater
ce.
Fexors
ment
o
wc
te
as
brane.
tg
no
he
posteror
most
o
486,
eep
o
te
te
p
eaves
n
te
te
tg
572;
nerve
skn
It
rom
N
s
te
te
477;
a
o
500;
te
s
as
njury
and
sde
o
634–641;
away
te
N
paraxa
musces
somtes
rom
s
deepy
s
response
(GAS
atera
sde.
anteror
njury.
Fg.
are
te
on
he
te
6.104).
359
te
to
o
and
ocated
deveops
rom
gaments
te
to
maeo-
jont,
ocated
pont
ABR/McM
deveop
at
gament
oot
518;
te
ga-
neror
atera
anke
s
crucate
ocated
te
gament
mesoderm
n
te
tenderness
tbobuar
jont,
o
dicuty
339
s
tbonavcuar
meda
no
acton.
he
te
surace
te
wc
cacaneus.
cacaneonavcuar
he
s
gament,
ts
ABR/McM
te
wc
posteror
gament
puses
gt,
patent
durng
te
mus-
nto
ventra
somtes.
myotome
moecuar
sgnas.
n
te
sends
posteror
regon.
ABR/McM
o
o
he
stars;
knee
crucate
a
te
by
tg
Gravty
down
o
posteroat-
te
gutea
branc
E.
knee.
ante-
cruc-
cmbng
many
connects
anke
Lmb
nerve,
aso
te
GAS
142.
case.
done
posteror
and
on
o
te
wakng
norma
dicuty
maeous
anteror
te
o
s
he
a
anteror
dspacement
wt
knee
by
te
mem-
musces
enters
mus-
te
tba
te
cacaneobuar
pantar
compart-
emora
and
te
te
to
posteror
musce.
ts
N
to
opposed
posteror
603–608;
pantar
troug
obturator
tg
oot.
pevs
by
n
down
atera
he
to
te
te
pont
abduc-
prorms
te
te
rea-
by
s
Injury
te
we
stabzes
ocated
swng-sde
anteror
by
us
guteus
p
te
te
te
no
he
and
o
exon
orward
he
te
nerves
supped
te
suppes
to
ave
man
on
are
wt
o
te
557,
buar
are
nnervated
nerve
Urnary
E.
n
to
emors
damaged
GAS
141.
nnerva-
autonomc
nerves
above
ound
nnervatons
and
433,
he
are
scatc
compartment
GAS
wc
reatonsp
sensory
te
reaton
provde
ment
externus,
o
Extenson
wakng
adduc-
porton
tg.
by
musces
compartment
cutaneous
eg
p
a
stars.
not
obtura-
te
obturator
and
most
resuts
n
stabzed
tat
gament.
gament
emur
obturator
acton
emur
ces
pass-
w
an
crucate
quadrceps
enters
by
he
to
membrane.
te
oramen
te
damage.
Bot
and
te
tat
superor
tg
membrane
te
musces
nerve,
scatc
o
o
ts
pevs
te
provdes
obturator
hese
at
wt
brevs
aso
stabze
moton.
te
medated
mnmus
hey
te
(gracs,
nerve.
te
membrane
nnervatons
aspect
s
pudenda
wt
It
tn
o
nerve
adductor
magnus).
te
tonsp
C.
te
365
except
cana
to
motor
ncontnence
and
era
o
a
exts
njures
obturator
ongus,
adductor
nerve
obturator
suppes
adductor
s
oramen
compartment
te
to
tor
ABR/McM
membrane
obturator
vesses. T raumatc
139.
Limb
usuay
structures
GAS
138.
5
te
284
Malleolar
fossa
Anterior
talofibular
ligament
common
Posterior
buar
nerve
and
begns
at
about
te
eve
o
te
neck talofibular
o
te
bua,
between
t
and
te
buars
ongus.
hs ligament
nerve
suppes
torum
gus,
ongus,
tbas
extensor
space
te
o
extensors
buars
anteror,
aucs
te
te
tertus,
extensor
brevs).
oot.
o
It
Fracture
oot
(extensor
extensor
aucs
dgtorum
nnervates
o
te
dg-
te
ead
on-
brevs,
o
and
rst
te
web
bua
Calcaneofibular
can
damage
ts
nerve,
resutng
g
steppng
gat,
as
sum
and
web
space
posteror
tar
rst
compartment
exon.
nerve,
sura
hese
wc
s
a
cutaneous
o
musces
are
branc
sde
eg.
at
anteroatera
o
oot.
eg
are
o
over
nvoved
scatc
suppes
te
drop
by
nerve;
sensaton
gat
eg
are
a
te
pan-
te
tba
ts
ligament
A
dor-
n
n
to
and
and
te
Musces
nnervated
te
Waddng
sde
oot
numbness
te
te
branc
te
as
o
o
teror
te
we
n
Tibia
Fibula
meda
te
pos-
numbness
assocated
T alus
wt
Malleolar
te
superca
buar
and
te
atera
sura
fossa
cutaneous
Posterior
nerves. process
GAS
625–626;
N
533;
ABR/McM
of
talus
Posterior
346 talofibular
140.
D.
te
A
postve
tba
vagus
coatera
stress
test
gament.
ndcates
Injures
to
njury
ts
to
gaB
ment
he
usuay
emur
s
nvove
usuay
te
anteror
pused
crucate
posterory
gament.
durng
star
•
GAS
Fig.
6.4
ligament
CHAPTER
Embryoogc
ncude
and
not
te
derms.
ncude
cated
dervatves
crcuatory
Dervatve
te
wt
and
and
C.
neura
and
eventuay
te
mesoderm
wa
crest
not
s
out
wc
gves
nng
o
stabty
asso-
toward
he
sde
crcua-
body
cae
et
te
apoptoss
may
may
ncude
n
ces
oot.
he
te
n
bone.
Faure
o
do
not
ZPA
and
dd
and
tus
o
te
te
or
patternng
te
not
any
he
paanges,
ave
rom
been
o
or
144.
o
te
a
mb
auty
o
In
and
at
bursa.
rom
rom
tear
bursa
te
he
as
GAS
B.
coce.
cae
s
knee
ste
and
o
te
eve
o
a
n
te
he
at
te
(pevc
under
o
te
ts
te
bursa.
te
patea
o
nrapa-
on
one
mnmus,
stabze
tt).
s
between
gament.
te
knee,
hese
te
eg
and
te
s
te
as
342
nerve
ture
correct
or
waks,
tensor
p
as-
jont
musces
by
receve
o
A.
pevs
he
te
ts
and
te
orceuy
opposte
drecton.
resuts
to
he
psatera
tensor
n
a
as-
postve
droppng
on
te
o
to
Pott
due
spne
as
N
nerves
tat
jont.”
A
move
to
GAS
a
hs
“a
aw
n
jont
s
626;
It
and
and
S3
posteror
oot.
te
anke
bony
s
com-
commony
maeous
coatera
ateray,
egt
o
and
a
extreme
cause
orce
s
(de-
causng
Inverson,
a
rup-
te
w
taus
dam-
te
359
Law
a
by
woud
moded
nnervated
musces
o
2013.
tat
he
533;
deep
346
to
be
same
move
aw
ts
can
te
et a.,
nnervates
ABR/McM
by
tat
Hebert-Boun
sted
ead
orm,
ts
jont.
N
do
regon
oot
te
o
te
meda
upward
expanaton
27:548–555,
611,
as
meda
great
p
te
o
tb-
355
dorsexon
Drect
te
oot;
everson
moves
Hton’s
artce
anke
o
o
musces
maeous).
rom
te
receves
roots
buttocks,
(te
strong
ABR/McM
o
nerve
sde
T12
oot
cacaneus.
518;
as
reac
te
and
orceu
a
coce.
orceuy.
taus
nnervate
an
ony
te
and
compete
Anatomy
te
te
It
njury
racture
te
atera
and
answer.
n
by
gaments.
remembered
ound
rotaton
te
va
nvertors
sma
apart
te
exes
roots
and
o
o
te
reex.
ABR/McM
type
pused
te
te
533;
ts
a
area
o
to
jerk
w
te
sdes
nnervaton
nerve
correct
roots
nnervaton
atera
pantar
S2
anke,
and
te
motor
anke
S1,
te
eg,
N
exon,
637;
te
L2
anke,
and
326
cutaneous
wc
te
externa
as
ABR/McM
te
sttng
Knowedge
correct
s
same
nnervates
te
nerve.
mantan
pevs
mnmus,
nnervates
aba,
are
te
te
GAS
148.
to
causng
musces
oot,
D
oot;
te
or
usuay
age
o
o
rom
gament
pantar
knee,
te
tat
provdes
musce,
orceuy
racture
nrapatear
njury,
back
tod)
bood
between
deep
te
pued
493;
durng
L4
eads
reerred
suprapatear
bend
superca
he
o
te
eg,
nerve
wt
root
meda
Forceu
ponents
superor
njury.
stands
to
anteror
condton,
patea,
te
gutea
guteus
synergy
p
s
nto
and
ABR/McM
person
ts
te
ste
tba
bursa
medus,
act
exposure
skn.
te
te
emur
ocated
njury.
te
te
s
n
g-rdng
enter
beow
superor
Wen
abductng
o
beow
502;
rgt
atae
bursa
ocated
part
guteus
te
can
te
N
to
te
A
te
beow
602;
he
te
eads
gastrocnemus
we
o
oowng
ocated
upper
part
ound
epsodes
gament
s
s
musce.
poptea
away
bursa
145.
ragment
he
patea
neror
emors
traumatc
bursa
soe
537–542;
oten
te
quadrceps
patear
over
GAS
N
aspect
te
nnervates
C.
gutea
contract
draw
n
tese
sgn
makng
tg;
scrotum
suprapatear
surace
and
reac
skn
by
atera
nerve,
and
by
tt
guteus
nerve
contracts
abnormaty
sown
jont,
to
o
567;
S1
nnervaton
as
caused
557,
he
not
14
he
Loss
and
te
superor
tey
283
Limb
sde.
te
ts
te
as
gutea
ray
144–148
B.
pevs
gastrocnemus
147.
Answers
p
medus,
atae.
dorsum
Neura
rom
p,
weg-bearng
te
te
dgta
toe.
ormaton
dameter.
nvove
coud
to
o
aone
D.
to
condrcaton.
GAS
te
superor
GAS
146.
(syndactyy).
orm
nger
apop-
ncompete
tssues
rays
a
or
dgts
deveopment
moduates
undergoes
sot
Dgta
contrbute
not
rays
Faure
used
skn
anteroposteror
descrbed
x-ray
te
dgta
orm.
underdeveopment
crest
te
to
resuts
nvove
pate.
resuts
between
dgts
usuay
hs
and
te
T rendeenburg
Mesencyme
or
o
guteus
wa
o
te
o
rgt
ateray
te
te
nnervaton
abductors
does
musces.
tns
ter
nng,
ces
Condrcaton
ormaton
pus
pate
body
29–32
toss
n
te
mesoderm,
was,
wa,
derms.
GAS
143.
te
gut
atera
gut
o
mesoderm
becomes
tory
te
musces.
cartage
ntermedate
and
mb
o
and
Lower
5
tat
can
be
Pysca
buar
nerve
musces
tat
6 Upper
Limb
I n t ro d u c t i o n
First
1.
Order
A
Question
25-year-od
ment
rgt
over
because
upper
s
nerves
A.
Second
man
e
e
mb.
trceps
s
brougt
on
te
te
sppery
Pysca
brac
nnervates
a
to
emergency
tra
and
examnaton
musce.
trceps
njured
sows
Wc
brac
o
depart-
te
3.
s
A
Order
ment
abrasons
oowng
over
a
man
because
rgt
musce?
Question
25-year-od
upper
s
e
mb.
trceps
racture
at
s
e
brougt
on
oowng
musces
s
most
B.
Axary
A.
T rceps
C.
Medan
B.
Bceps
D.
Unar
C.
Coracobracas
E.
Muscuocutaneous
D.
Bracas
E.
Detod
te
emergency
tra
examnaton
musce.
md-body
Rada
to
sppery
Pysca
brac
te
a
o
An
te
key
x-ray
and
sows
o
s
umerus.
depart-
njured
s
abrasons
arm
sows
Wc
o
te
parayzed?
brac
brac
Explanation
A:
he
nerve
most
nnervates
nar
te
nerves
axary
key
trceps
do
not
nerve
nnervate
nnervates
muscuocutaneous
s,
bceps
afected
brac
brac,
compartment
o
and
te
any
te
nerve
s
te
musce.
rada
he
musces
detod
and
nnervates
bracas
nerve
medan
n
te
teres
te
musces
wc
and
u-
Explanation
A:
he
he
nerve
2.
Order
A
mnor.
he
surace
rada
n
wrst
te
anteror
arm.
ment
rgt
over
a
because
upper
s
at
oowng
e
mb.
trceps
racture
A.
e
s
brougt
on
a
s
most
te
emergency
tra
examnaton
musce.
md-body
nerves
to
sppery
Pysca
brac
te
o
o
An
te
key
x-ray
and
o
s
umerus.
musces
s
abrasons
arm
Wc
Third
4.
sows
o
Order
mb.
njured?
o
Axary
most
A.
D.
Unar
B.
Inabty
E.
Muscuocutaneous
C.
Inabty
key
Wrst
es
n
te
surace
runs
te
around
nerve
te
o
rada
passes
musces
n
o
te
nerve
usuay
runs
284
umerus
te
ward
groove
to
surgca
te
te
meda
between
and
arm,
te
neck
te
te
he
and
te
and
bceps
t
runs
trav-
posteror
axary
te
compartment
nerve
as
te
umerus,
meda
meday
musce
brac
orearm),
nerve
nnervated
te
te
te
te
musces
and
by
to
rada
posteror
musce
bceps
are
he
(and
brac,
nnervated
detod
axary
te
orearm.
brac
wereas
bracas
s
te
and
teres
by
m-
nerve.
An
te
be
x-ray
sows
o
s
umerus.
present
abrasons
arm
sows
Wc
durng
o
pysca
over
a
te
s
trceps
racture
at
oowng
te
w
examnaton?
to
lex
to
s
lex
wrst
te
nterpaangea
(PIP)
and
ndex
oss
and
(DIP)
o
pronaton
mdde
and
ngers
proxma
at
te
nterpa-
jonts
D.
Inabty
to
lex
E.
Parayss
o
te
te
rng
and
umbrcas
tte
and
ngers
at
nterosseous
DIP
musces
nerve
medan
to
to-
muscuocutaneous
coracobracas
bracas
nerve
aong
orearm.
o
unar
epcondye,
te
rada
descends
neurovascuar
perces
te
te
trceps
x-ray
aong
drop
angea
Explanation
s
te
and
descends
te
examnaton
musce.
Medan
afected
are
Pysca
brac
C.
key
n
te
Question
md-body
most
and
n
groove
A 25-year-od man s brougt to te emergency department
B.
nerve
umerus
rada
because e e on a sppery tra and njured s rgt upper
te
Rada
he
afected
te
nnervates
extensors
dsta
A:
te
nerve
n
depart-
njured
sows
key
traves
muscuocutaneous
nor
man
most
t
coracobracas,
Question
25-year-od
as
coracobraca-
te
First
nerve
arm.
and
ten
musces.
Explanation
A:
he
n
ner ve
te
surace
o
nner vates
tese
key
rada
te
te
musces
afected
groove
umerus
wrst
are
s
and
to
te
rada
descends
te
extensor
parayzed
ner ve
aong
orearm.
musces
because
he
o
te
as
te
t
traves
posteror
rada
te
ner ve
orearm.
rada
ner ve
I
s
CHAPTER
njured,
as
B:
wrst
te
Inabty
key
to
pronaton
nervated
C: Inabty
by
and
te
cannot
be
extended.
hs
s
reerred
to
D: Inabty
as
o
o
by
to
jonts
lex
coce
nervaton
ma
wrst
drop.
and
lexon
musces
te
te
lex
DIP
te
te
o
wrst
pronaton
s
medan
aso
s
an
perormed
and
perormed
unar
by
va
un-
E:
n-
nerves,
musces
a
and
Parayss
te
and
uncton
o
ngers
at
musces
te
prox-
s
by
unar
wc
mdde
o
and
nervated
n-
nerve.
ndex
s
oss
te
te
s
medan
jonts
medan
by
and
and
o
to
x-ray
lex
descrbes
te
an
te
an
(GAS
umbrcas
brances
2
key
Fg.
and
nerve
ncorrect
(unar
were
rng
unar
o
tte
and
te
tese
and
durng
at
te
te
2
njury
sown
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-
umbrcas)
nterosse)
7.69).
Triangular
DIP
musces
musces
(rada
a
285
Limb
njury.
nterosseous
as
medan
umbrcas
spared
ngers
branc
coce
Upper
6
arm
forearm
nerves
on
te
286
C H A P T E R
Fourth
Order
6
Upper
Limb
Question
Anterior
view
Greater
5.
A
25-year-od
man
s
brougt
to
te
emergency
Superior
depart-
facet
on
tubercle greater
ment
because
e
e
on
a
sppery
tra
and
njured
Inter tubercular
rgt
upper
sons
over
mb.
s
Pysca
arm.
An
examnaton
x-ray
o
s
arm
s
sows
sown
abra-
Wc
o
te
oowng
dects
w
most
n
(supraspinatus)
sulcus
Head
Fg. Lesser
6.1.
tubercle
s
key
tubercle
be (subscapularis)
encountered
durng
pysca
examnaton?
Anatomical
Inter tubercular
A.
Inabty
to
make
a
neck
st sulcus
B.
Inabty
C.
Inabty
to
lex
D.
Inabty
to
lex
E.
Parayss
o
te
to
s
lex
wrst
te
and
ndex
oss
and
o
pronaton
mdde
Surgical
ngers
at
Lateral
te
and
DIP
and
PIP
lip,
neck
floor,
medial
lip
of Lateral
jonts
view
inter tubercular
rng
and
tte
ngers
at
te
DIP sulcus
umbrcas
and
nterosseous
(pectoralis Attachment
musces
major,
latissimus for
o
te
dorsi,
and
and
pectoralis
teres major
major,
respectively)
Explanation
A:
he
nerve
key
afected
s
te
rada
nerve
as
t
traves
n
Deltoid
tuberosity
Deltoid
(deltoid)
te rada groove as t descends aong te posteror surace
tuberosity
o
te
umerus
to
te
orearm.
Atoug
te
rada
nerve Attachment
does
a
not
st,
t
provde
does
and
brevs
and
are
nnervaton
nnervate
musces.
necessary
te
hese
or
to
musces
extensor
musces
makng
a
carp
act
st,
tat
as
as
ep
radas
wrst
tey
make
for
(deltoid)
coracobrachialis
ongus
extensors
contract
syn-
Greater
ergstcay
wt
te
lexors
o
te
ngers
to
keep
te
wrst tubercle
extended,
acton.
makng
he
t
ndspensabe
“poston
o
uncton”
we
o
te
perormng
and
s
ts
wt
Superior
te
facet
(supraspinatus)
wrst
B:
extended
Inabty
key
to
about
lex
coce
te
as
30
degrees.
wrst
lexon
and
o
oss
te
o
wrst
pronaton
s
s
perormed
an
un-
va
o
musces
Pronaton
o
by
te
medan
and
unar
neck
nerves. Inferior
te
and
s
aso
perormed
by
a
musce
nervated
by
te
to
medan
lex
te
and
DIP
jonts
and
s
a
mdde
ngers
uncton
o
te
at
te
ner ve.
descrbes
E:
Parayss
to
lex
an
o
te
unar
te
rng
nerve
and
tte
branc
umbrcas
and
ngers
at
te
DIP
o
musces
s
an
n-
correct coce as tese musces are nnervated by brances
Main
A
naton
mary
woman
breast
od
eter
at
te
te
eve
structure(s)
s
he
to
te
consutaton.
areoa
o
luctuance,
breast.
comes
surgery
tat
as
te T8
sweng,
ntegrty
GAS
o
pyscan
Pysca
beow
te
dermatome.
dmpng,
wc
o
or
a
.
te
and
njury
unar
nerves,
sown
on
te
wc
x-ray
were
(see
key
Fg.
spared
7.22
rom
3e).
ture
exam-
te
nramam-
here
or
te
s
umps
Scarpa
B.
Pectoras
major
C.
Pectoras
mnor
D.
Suspensory
no
s
ness
Serratus
department
musce
man
ater
e
gaments
musce
was
was
brougt
nvoved
x-ray
atera
and
o
comes
n
on
Wc
to
te
actvtes.
pan
te
border
rgt
o
te
rgt
te
pyscan
souder
Pysca
meda
o
te
souder
scapua.
and
oowng
a
rac-
weeks
ater,
because
we
examnaton
rotaton
sows
Sx
o
sows
adducton
nerves
s
pan
perormng
weak-
o
most
te
key
njured?
musce
anteror
27-year-od
day
umerus.
asca
(Cooper)
An
te
weakness
on
oowng
o
patent
and
compromsed?
A.
A
medan
coson.
sows
erytema,
E.
te
durng
1–25
45-year-od
cosmetc
2.
Fig.
Q u e st i o n s
Questions
1.
GAS
jont
dect.
nterosse
view
medan
•
D: Inabty
minor)
nerve.
ndex
Posterior
proxma
facet
n(teres
C: Inabty
facet
(infraspinatus)
neck
Surgical
nervaton
Middle
Anatomical
n-
to
n
te
a
emergency
motor
vece
3.
A.
Lower
B.
Axary
subscapuar
C.
Rada
D.
Accessory
E.
Suprascapuar
A
o
48-year-od
a
1-year
woman
story
o
comes
pan
to
and
te
pyscan
parestesa
n
because
er
rgt
CHAPTER
sows
o
a
md-body
structures
A.
Medan
B.
Axary
s
racture
most
nerve
and
nerve
o
key
te
umerus.
njured
braca
and
Upper
6
at
te
287
Limb
Wc
racture
par
ste?
artery
posteror
crcumlex
umera
artery
6.
C.
Rada
D.
Suprascapuar
E.
Long
An
nerve
toracc
18-year-od
department
we
sows
a
nerves
s
broken
most
bone
A.
Axary
B.
Medan
3-day
er
ncreased
pan
outstretced
naton
o
as
he
er
tes.
sows
rgt
Wc
as
exercse
o
and.
n
severty
one
musce(s)
et
s
durng
persstent
year
sensaton
Her
ago.
n
and
most
ater
and
4.
B.
Lumbrcas
no
nerves
on
C.
henar
D.
Pamar
E.
Hypotenar
A
or
C.
Deep
D.
Medan
weakened
n
ts
a
bcyce
et
race.
ebow.
ng,
and
over
s
te
musces
B.
Bceps
C.
Bracoradas
D.
Fexor
E.
Supnator
A
arm
carp
te
od
te
pan
et
1½
et
and
sows
ebow
dgts.
INSERT
most
s
An
o
warmt,
x-ray
o
te
Wc
atera
swe-
decreased
o
mb
se
oss
o
and.
er
on
x-ray
to
wet
rgt
sensaton
An
x-ray
umerus
te
o
an
njury
sows
o
about
te
jagged
sg-
te
1
arm
nc
oowng
edges
o
te
te
pyscan
rgt
atetc
arm
because
ater
tournament.
extenson
o
te
o
strenuous
Pysca
wrst
te
te
and
Pysca
upper
and
aert
puse
sows
weakened
o
and
te
mutpe
oowng
Medan
Latera
cord
E.
Latera
antebraca
ater
beng
te
but
wound
ore-
sweng
mb
graspng
te
and
s
as
90/mn,
s
no
at
te
o
oss
te
te
o
rgt
oowng
as
most
on
wt
An
o
Hg.
te
are
over
orearm
o
16/
Pysca
sensaton
x-ray
te
to
on
te
umerus.
te
are
te
upper
Wc
njured?
nerve
te
er
emergency
and
copous
te
coson.
temperature
pexus
progressvey
pncng
o
key
examnaton
base
emergency
brusng
o
oss
cutaneous
comes
Her
mm
and
o
te
vece
respratons
118/72
braca
btten
wound
Pysca
at
te
woman
wased
te
o
to
arrva.
orearm.
D.
ours.
s
x-ray
motor
ractures
Muscuocutaneous
24-year-od
s
se
nerves
o
a
supnaton
C.
6
An
Wc
tenderness
and
B.
e
here
brougt
upon
pressure
Fexon
surace
s
ater
Rada
exam-
posteror
rgt
woman
o
emergency
pavement
arm.
o
o
te
mb.
ractures.
A.
A
strengt.
njured?
our
bood
sows
te
no
te
parayzed?
brougt
spped
njurng
An
Wc
by
to
o
grp
et
9.
s
arm.
te
s
afected
(98.6°F),
and
severey
s
wt
awake
arm.
ment
ater
dorsa
s
37°C
et
durng
supercas
woman
examnaton
rada
1
examnaton
depart-
sweng
IMAGE.
key
arm
unars
curb,
sows
and
as
emergency
to
brac
department
naton
s
dgtorum
24-year
aganst
o
meda
Fexor
te
examnaton
sown.
A.
to
njury
patent
Pysca
mb
oowng
5.
comes
tenderness
sensaton
upper
he
emergency
ater
nterosseous
department
IV
an
oss
key
32-year-od
mn,
man
pan
rada
Superca
A
s
sustanng
n
major
sows
abnorma-
nterosse
ater
comes
pan
a
te
most
Unar
Se
45-year-od
ment
s
Anteror
8.
and
mb
B.
exam-
3½
nterosse
III
o
sows
n
A.
rada
sows
upper
past
E.
Dorsa
njured
artery
te
ocaton?
decreased
dgts
Pysca
te
key
te
ang
condton?
A.
o
to
6.1
been
and
oss
ts
man
story
et
racture
Unar
52-year-od
arm
epcondyes.
E.
A
et
te
Muscuocutaneous
sensaton
tat
over
toracc
brougt
Pysca
Rada
wrst
mont.
o
key
at
examnaton
and
atera
D.
ed
Fig.
and
s
C.
a
•
nerve
rugby.
te
artery
artery
transverse
to
braca
and
man
brusng
proxma
deep
nerve
because
payng
ncant
7.
and
by
a
amounts
worsened
sows
tumb,
o
n
te
dicuty
he
Se
water,
tenderness
and
movements.
depart-
dog.
ast
and
wt
necton
288
C H A P T E R
6
eventuay
wc
10.
spreads
musce
to
w
Limb
te
most
rada
key
bursa.
be
he
tendon(s)
o
14.
afected?
2
dgtorum
proundus
durng
B.
Fexor
dgtorum
supercas
atete
C.
Fexor
pocs
D.
Fexor
carp
E.
Fexor
pocs
ongus
studes
24-year-od
woman
bood
a
te
outpatent
ncuded
Wc
assessment
o
te
o
oowng
key
crcuat-
proundus
cubta
D.
Anteror
E.
Rada
nterosseous
anoma
ng
nterosseous
He
as
30
a
ong
years.
consstent
wc
ymp
as
nodes
A.
Deep
B.
V ertca
C.
Horzonta
D.
Axary
E.
stor y
A
punc
wt
a
o
sun
dagnoss
most
over
o
to
be
as
te
skn
a
Deep
group
superca
group
o
superca
man
Medan
D.
Recurrent
E.
Deep
worsenng
atgue
and
day
due
to
cest
test,
a
tasks
tve
stress
and
sows
te
ses
a
w
coronary
anteror
part
o
pan
artery
key
te
te
ncreasng
artery
toracc
most
to
coronary
coronary
nterna
nguna
on
dicuty
angograpy
stenoss.
upper
to
He
grat
artery. Wc
contnue
o
because
Ater
a
pos-
as
dicuty
bood
spaces
he
upper
he
ste
to
te
ater
te
ar
E.
A
toracc
rada
te
and
puse
patent.
owng
bood
s
pressure
cecked
hs
puse
to
s
to
motor
s
Her
te
atera
to
emergency
vece
coson.
respratons
100/50
determne
et
mm
te
Hg.
eart
wc
o
are
he
rate
te
Pamars
B.
Fexor
Fexor
dgtorum
D.
Fexor
carp
E.
Fexor
dgtorum
proundus
radas
supercas
te
grp
oss
pad
a
o
depart-
On
o
pys-
s
ndex
o
paper
seet
sensaton
oowng
te
on
nerves
pyscan
axa
rgt
by
s
te
most
arm
ater
durng
above
sows
a
recev-
a.
te
He
eve
te
o
neror
protruson
aganst
o
te
s
most
braca
s
a
more
wa.
key
prom-
Wc
o
njured?
pexus
nerve
te
o
te
s
way
ventra
boy
s
braca
mdde
recas
an
sows
cd
extend
extremty
sows
Wc
te
o
wt
on
no
s
ts
e
pexus
and
C8,
te
ower
subscapu-
er
to
son’s
car
move
ebow.
o
out
and
ts
sweng
and
or
An
te
gaments
T1
emergency
screamed
dsocaton
oowng
C7,
to
reusa
oncomng
examnaton
cannot
or
tat
voenty
o
ram
brougt
moter
n
to
pu
brusng,
ead
o
o
most
depart-
et
pan
mornng.
x-ray
s
s
arm.
ater
m
out
Pysca
but
te
te
key
te
upper
radus.
assoc-
njury?
A.
Annuar
B.
Jont
C.
Interosseous
D.
Rada
E.
Unar
18.
cord
o
nerve
tugged
te
he
puses
trunk
o
ongus
C.
to
orgn
o-
ongus
pocs
o
moter
ated
tendon?
A.
and.
nerves
Spna
o
horacodorsa
30/mn,
no
te
structures
toracc
4-year-od
Latera
brougt
neura
D.
D.
a
can
emergency
s
examnaton
patent
C.
ves-
se
ater
o
rgt
te
scapua.
usng
ntercosta
unconscous.
most
medan
s
te
posteror
Posteror
s
to
et
ong
C.
mnutes
o
comes
te
he
Hs
se
as
o
wen
he
epgastrc
30
ourt
s
rada
Pysca
B.
Superor
arrva,
te
musces
unar
o
man
A.
B.
On
o
eevatng
oowng
ment
department
te
touc
but
and
trauma
to
oowng
suppy
o
Muscuoprenc
s
bunt
souder.
te
perormed
scedued
procedure
te
ntercosta
woman
to
pam
cannot
branc
branc
a
nent
17.
22-year-od
o
a
examna-
nterosseous
55-year-od
A.
A
te
Wc
branc
ng
part
perormng
s
s
o
procedure?
E.
jonts
te
n
ange o s rgt scapua protrudes more tan te ower
pyscan
exerton.
bypass
resutng
njured?
C.
A
e
ngers
oow-
ts
comes
to
tumb
and.
Anteror
nguna
comes
a
s
B.
s
and
o
s
me-
n
man
wound
Deep
nguna
superca
wt
key
16.
o
a
A.
papabe
and
wen
unars
examnaton,
between
ceuar
magnant
o
o
xpod
sows
Wc
key
because
s
exposure
bopsy
metastaszed.
are
pyscan
moe
nguna
49-year-od
undergo
wt
nger
a
carp
24-year-od
ca
patent?
A
A
ment
o
canges
15.
te
DIP
depart-
et
Pysca
oowng
supercas
Unar
o
te
te
dgtorum
Common
to
o
dgtorum
C.
sape
lex
s
occurred
dgt.
Fexor
B.
comes
to
lexed
Fexor
Interosse
and
s
to
jersey
B.
E.
man
njury
A.
Braca
sze
o
emergency
njury
afected?
A.
n
te
opponent’s
nabty
Lumbrcas
52-year-od
to
an
s
arteres
te
he
dgts. Wc
Fexor
armer
n
a
sows
brougt
s
extenson
t
s
sustanng
game.
grpped
D.
process.
venpuncture
on
rugby
C.
cange
durng
cnc
ater
ossa?
A
at-rsk
and
n
cemstry.
key
ton
brevs
man
ours
orceu
radas
Laboratory
a
13.
20-year-od
Fexor
most
12.
A
ment
A.
ng
11.
Upper
capsuar
coatera
coatera
A 28-year-od nugravda woman gves brt to a 3500
g
(7
b
11
oz)
baby
boy
by
orceps
devery.
he
preg-
nancy was compcated by gestatona dabetes. Pysca
CHAPTER
examnaton
ay
rotated
part
ng
19.
o
te
te
braca
B.
Meda
cord
C.
V entra
ram
D.
V entra
ramus
E.
V entra
ram
35-year-od
2
cm,
red,
dgt.
ocazed
by
cod
son
s
ave
to
Common
Superca
D.
Deep
E.
Recurrent
ment
poe
vaut.
te
wrst.
key
med-
souder
Wc
njured
musces
dur-
trunk
upper
to
te
nodue
as
o
trunk
pyscan
and
severe
eson,
tat
pressure.
Wc
o
or
na
attacks
are
T ota
te
because
te
o
o
o
man
o
surgca
oowng
paness
exc-
o
dorsa
s
branc
remova
wrst
key
Scapod
C.
Captate
D.
Hamate
n
s
o
rgt
medan
and
a
emergency
wrst
we
examnaton
An
racture
o
ours
md
upon
x-ray
s
2
depart-
ater
perormng
sows
tenderness
snufbox.
I
te
and
Supraspnatus
E.
T eres
A
te
sweng
papaton
s
and
suspected,
o
sows
wc
ead
o
3-day
a
trceps
man
story
comes
rgt
gament.
he
severe
a
damage
T ransverse
D.
Genoumera
E.
Coracoacroma
depar tment
on
te
meda
Neuroogc
od
oss
and
a
sde
o
on
most
o
paper
sensaton
meda
s
1½
on
key
Axary
B.
Medan
n
te
years
Muscuocutaneous
D.
Rada
E.
Unar
19-year-od
ater
soccer
der
s
ton,
te
game.
as
A
A
nds
s
s te
s
comes
meda
(Fg.
to
tree
graspng
ater
examnaton
6.2).
key
Wc
cause
o
o
njur y
te
s
s
o
te
a
and
e xtre me y
o ow ng
s
brougt
dagnoss
o
reducton
Pysca
but
magnetc
to
te
onto
pan
a
o
te
ne r ve s
s
unabe
rgt
dorsa
sows
to
no
n
sou-
dsoca-
regon
abduct
magng
depart-
souder
souder
te
examnaton
e
rgt
dsocated
over
resonance
emergency
s
o
obvous
te
(MRI)
arm
o
te
Wc
most
•
Fig.
pyscan
dgts
sows
to
as
te
objects
gt.
and
years
graduay
musce.
pyscan
workng
bone
unab e
nge rs
asp e ct
o
o
e
a
as
sou-
te
key
gament
w ound
n
over
sagtta
a
gament
e m er gency
kn e
ore arm
m ed a
he
te
tat
b e twe e n
panuy
Ater
deormtes
normay.
to
de ep
d s ta
W c
persstent
souder.
bone
man
ang
made.
e
a
o
o
part
gament
earer,
Pysca
most
(AC)
njured ?
C.
ment
s
te
dgts .
papaton .
A.
b rougt
sus ta n n g
examnat on
pece
o
tender
man
ater
gament
te
because
takng
obque
tat
underyng
s
nvoved?
36-year-od
te
expans
T rapezod
A
n
ater
gament
man
dicuty
emnence
te
te
pyscan
pan
gament
scapuar
79-year-od
numbness
s
oowng
to?
C.
years.
to
gaments
Coracoumera
9
te
njury?
ypertropy
souder
Acromocavcuar
as
te
MRI
and
pyscan
tenns,
oowng
retred
o
ts
brac
to
An
tckenng
B.
He
by
souder
competton.
sows
payng
o
A.
A
Wc
major
tenns
te
te
musce.
damaged
289
Limb
mnor
32-year-od
reerrng
24.
to
D.
o
o
medan
brougt
pan
abnormates.
B.
o
Pectoras
caused
nerves
unar
outstretced
anatomca
most
dgta
C.
o
rada
branc
Coracobracas
der
exacerbated
torn
key
Long
pane
pan
a
most
B.
n
s
sows
s
A.
a
under
sudden
te
23.
trunk
anestetzed
Pysca
Lunate
a
most
mdde
comes
branc
an
A.
A
was
adducted,
at
rada
on
te
te
22.
te
area
be
because
ang
s
o
pamar
25-year-od
E.
an
tumor?
C.
s
nds
lexed
ower
te
temperatures
B.
no
o
patent
te
Superca
on
te
man
he
to
o
bancabe
A.
A
s
pexus
recommended.
woud
te
tat
devery?
cord
A
neonate
arm
Latera
t
21.
te
A.
a
20.
o
et
Upper
6
6.2
te
o
wt
as
a
s
because
rgt
tat
atropy
o
oowng
probems
and.
carpenter
n
s
te
o
and.
or
He
50
tenar
condtons
and?
290
C H A P T E R
A.
6
Upper
Compresson
Limb
o
te
medan
nerve
n
te
carpa
28.
tunne
B.
Formaton
C.
Hypertropy
D.
Osteoartrts
nerve
at
E.
aert,
ma
and
wrst.
ay.
o
most
te
et
s
te
s
body.
o
and.
njured,
to
He
te
sgns
n
te
Wc
and
s
n
s
te
wat
He
are
unabe
atera
o
emergency
sows
ebow
s
nor-
severa
cuts
to
extend
o
te
te
bater-
te
oowng
o
awake,
wtn
norma
a
part
x-ray
most
te
coson.
vta
on
carpa
nerve
brougt
examnaton
ost
saton
com-
s
s
te
key
Scapod
D.
T rapezod
E.
T rquetrum
45-year-od
vta
Medan
nerve,
arm
Rada
nerve,
md
umerus
ganga
D.
Rada
nerve,
md
atera
sory
E.
Unar
A
26–50
17-year-od
s
sustanng
gt.
te
dsc
regon
Pysca
proxma
lexon
and
brougt
a
kne
wound
arm.
supnaton
ebow
ng
addtona
te
examnaton
meda
te
to
and
wrst
s
o
emergency
to
He
te
et
woud
et
a
as
norma.
ndngs
s
sows
4
arm
cm
n
and.
a
street
wound
weakness
Wc
be
department
o
on
ebow
Extenson
o
present
Meda
B.
Long
Latera
Deep
E.
Anteror
te
n
a
pysca
as
se
adduct
and
B.
Inabty
to
lex
s
ngers
structures
C.
Inabty
to
lex
s
tumb
A.
D.
Sensory
oss
over
E.
Sensory
oss
over
A
52-year-od
ment
o
wt
s
been
rgt
upon
tered.
A.
wt
Pysca
Wc
o
to
pan
For
te
te
cm
dsta
n
oowng
s
o
orearm
s
orearm
depart-
posteror
severa
aspect
days
orcestra
sows
and
s
petey
emergency
te
past
Intramuscuar
te
o
surace
te
sympony
examnaton
2
epcondye.
o
meda
orearm.
papaton
atera
te
comes
excrucatng
reearsng
ductor.
nsm
man
surace
e
as
sterods
most
are
by
pan
o
te
unar
nerve
o
te
medan
by
te
o
Compresson
nerve
by
te
Compresson
dgtorum
D.
o
te
medan
nerve
by
o
te
superca
rada
nerve
Compresson
supnator
o
te
deep
rada
nerve
over
te
T wo
te
te
nger
DIP
te
days
end
seet.
s
to
he
ce
and
sows
T1
md
dorsa
bodes
oowng
jont.
dgt
pyscan
o
ago,
o
te
se
te
o
root
sen-
nerves?
and
was
most
dgta
was
makng
nger
s
one
o
key
branc
unabe
te
o
paanx
a
n
examnaton
se
Wc
because
termna
ndex
Pysca
swoen
pamar
te
base
a
bed
od
sows
to
com-
oowng
njured?
o
te
medan
nerve
B.
he
C.
he
vncuum
nserton
onto
te
base
ongum
o
o
te
te
tendon
dsta
as
te
lexor
by
neuroogc
C8
spne
aert
exam-
nerve
comes
te
bracoradas
E.
and
nerve
carp
by
te
s
nerve
supercas
Compresson
a
s
depart-
patent
te
cutaneous
pronator
te
o
nerve
teres
C.
o
bones
Pysca
cutaneous
unars
B.
scap
contan
meca-
lexor
he
and T1–T2.
njury?
Compresson
sen-
dgts.
dsocaton
emergency
cervca
admns-
key
3½
oowng
mts.
te
te
wc
unar
caugt
wtn
te
dect
woud
woman
proper
o
pan
to
out-
restrcted
nerve
o
te
to
norma
C7–T1
nger.
and
extend
he
te
pan
er
decreased
atera
anteror
o
wt
onto
sows
and
te
coson.
con-
excrucatng
posteromeda
te
a
o
o
nterosseous
ndex
to
an
sensory
and T1
stragtened
Inabty
atera
ngers
ndex
rgt
orce
pan
o
brougt
antebraca
severe
ote
s
vece
x-ray
branc
23-year-od
o
to
Wc
antebraca
D.
sudden
sows
aceratons
carred
C.
A
due
wtn
toracc
A.
te
s
C8
A.
te
abduct
o
bers
at
examnaton?
sows
ernatons
oow-
te
on
30.
are
An
C.
mdpamar
sgns
dermatomes.
B.
nerve,
man
motor
nds
anteror
orearm
a
examnaton
nerve,
pyscan
examnaton
aspect
6.3).
te
wt
dsocated?
Lunate
ater
wrst
wrst
(Fg.
to
ang
Pysca
pamar
C.
A
comes
ater
te
te
B.
naton
wrst
o
bone
Captate
and
ocated?
o
te
A.
ment
dor-
ner ves
arm
29.
woman
wrst
and.
movement
musce
spne
unar
rgt
stretced
An
motorbke
s
unar
er
Medan
ater
27.
30-year-od
A.
Questions
26.
on
te
pexus
and
Extenson
key
njur y
a
compress
brac
cervca
s
Pysca
Sensaton
sum
to
man
ater
bruses
et
trceps
te
trauma
tat
epcondye
te
o
orented
mts.
and
o
braca
20-year-od
department
osteopytes
meda
te
Repeated
A
o
te
pressng
25.
A
n
te
•
Fig.
6.3
o
extensor
paanx
dgtorum
CHAPTER
D.
he
nserton
o
te
lexor
dgtorum
proundus
35.
tendon
E.
he
nserton
o
te
lexor
dgtorum
supercas
A
wt
ang
An
te
s
o
he
bones
te
s
and
onto
orearm
carpa
most
B.
T rapezum
a
o
emergency
s
lexed,
sows
bone
te
a
rgt
n
o
depart-
wrst
outstretced
racture
dspaced
resutng
tunne. Wc
key
Scapod
to
sweng
ractured
A.
a
o
carpa
nerve
te
o
dsta
bone
aspect
pan
and
naton
wt
ng
er
rgt
sweng
sows
severe
and
ts
o
er
symmetrc
pan
sows
o
and.
no
on
Se
rgt
to
as
woud
on
o
he
ncude
Parayss
o
abducton
A
emergency
te
te
njured
o
severe
rst
te
Wc
deep
B.
he
rada
oow-
C.
he
superor
D.
he
neror
E.
he
anteror
Extensor
dgtorum
ment
D.
Extensor
ndcs
s
butcer’s
E.
Extensor
carp
ts.
Pysca
ment
a
ater
atered
and.
An
owng
s
ang
rom
o
MRI
cord
brougt
routne.
sensaton
meda
unars
gr
gymnastc
o
spna
37.
to
uneven
parae
te
meda
braca
1½
dgts
nds
pexus.
njury
Wc
o
rgt
be
to
te
te
o-
ater
1½
An
unar
kne.
o
and
o
te
te
o
wrst
o
te
ts
PIP
t
tumb
E.
Opposton
38.
A
ment
depart-
e
axa.
s
on
abducton
weakness
angea
on
Pysca
and
extenson
extenson
(MCP)
abnormates.
jonts.
An
centra
aspect
o
owng
musces
carp
Fexor
B.
Extensor
C.
Bracoradas
D.
Extensor
E.
Supnator
o
te
An
te
x-ray
o
sot
and
te
spared
weakness
here
s
aso
o
metacarpopa-
arm
tssue
umerus.
key
sows
tumb.
wrst
sows
atera
most
A.
o
MRI
te
s
examnaton
o
carp
dorsa
no
depart-
wrst
wt
norma
sensaton
strengt
oter
woud
o
te
t
o
m-
on
te
te
et
abnorma-
most
key
dgt
(tte
e
dgt
tumb
comes
s
unabe
car
to
wt
examnaton
ngers
aspect
nerves
s
and
o
te
most
te
to
emergency
move
a
book
sows
afected
o
and.
Latera
cord
o
te
braca
pexus
Meda
cord
o
te
braca
pexus
te
o-
C.
Rada
pectora
nerves
Medan
E.
Latera
o
te
extend
atera
Wc
sde
o
te
nerve
and
32-year-od
meda
woman
Pysca
upper
to
s
nerve
D.
er
e
nto
compressed?
B.
A
te
depart-
ater
wedged
A.
njury?
arm
nabty
numbness
key
s
no
39.
ongus
o
te
dayss.
radas
to
most
tumb
te
s
and
oowng
unars
ndcs
et
wtn
to
njury
Wc
rom
sows
o
Pysca
wrst
te
n
te
man
because
aseep
a
game.
o
23-year-od
ment ater se was struck n te arm by a ne drve durng
sotba
was
emergency
actons
jont
te
emergency
wc
suppy
njury?
o
te
bood
s
grp
sows
oowng
Abducton
to
meda
artery
arteres
te
oss
decreased
D.
comes
te
was
artery
are
sows
C7
woman
an
Hs
nerve
artery
to
sgns
examnaton
resut
Fexon
Vta
C6,
21-year-od
bend
sased
B.
A
major
rom
sustaned
ebow.
artery
recurrent
brougt
accdentay
dgts
a
s
te
T1
e
te
artery
o
C8,
A
passed
coatera
Adducton
E.
arm
depart-
nger)
afected?
T1
mts.
coatera
unar
man
x-ray
as
unar
Extenson
C8
te
artery
coatera
e
Wc
ost
A.
o
oowng
C.
C8,
key
er
tes.
wc
suppyng
B.
C7,
most
an
o
and.
nds
n
te
braca
60-year-od
meda
durng
roe
t
n
o
emergency
sde
stopped
C6
C7,
s
bars
examnaton
was
C5,
D.
eves
depart-
te
robbery
A.
C.
nerve
emergency
Neuroogc
examnaton
te
te
A
to
meda
norma
o
and
adducton
repared?
n
brevs
te
and
were
mportant
he
pocs
te
ste
A.
brevs
extensor
to
ebow
o
brougt
Beedng
C.
and
and
an
s
wtn
te
Extensor
17-year-od
ongus
at
Abductor
ongus
man
opposton
te
attempted
are
nerve.
key
te
tendons
te
sgns
pays
dgt
o
an
tumb
wound
epcondye.
exam-
x-ray
ater
buet
repared
dorsoat-
o
58-year-od
B.
A
radas
pysca
E.
A.
pocs
on
pronaton
musces?
carp
present
te
Wc
o
An
wc
suspected.
Parayss
Pysca
extenson.
be
rac-
o
D.
ncreasngy
and.
woud
s
a
Injury
extend
te
dog
enargement
passve
abnormates.
compartment
a
groove
nabty
sows
to
vta
by
sgns
umerus.
sus-
base-
Inabty
carpa
Lunate
brougt
oowng
rada
sows
x-ray
a
C.
oowng
E.
bte
te
te
An
ater
wt
Weakness o tumb abducton and tumb extenson
a
was
n
arm
examnaton
wrst.
o
pyscan
Weakness
ment
severe
te
te
B.
Captate
a
at
to
proxma
A.
dsocated?
gr
Pysca
and
md-body
nerve
et
n
Hamate
ater
gt.
comes
er
compresson
36.
15-year-od
o
291
Limb
examnaton?
D.
A
a
er
te
te
woman
njury
n
o
rada
and.
te
bat
ture
ater
an
extend
C.
era
34.
brougt
drecton,
department
33.
s
bke
te
pamar
wtn
man
pan
rom
x-ray
radus.
32.
to
16-year-od
ment
21-year-od
ba
tendon
31.
A
tanng
Upper
6
mb
major
to
examnaton
was
ven
comes
te
unexpectedy
on
te
atera
ospta
sows
dicut
aspect
or
venous
er
as
emo-
access
te
arm
n
caber
was
too
292
C H A P T E R
sma.
tat
A
Upper
ven
passed
jon
vens
owng
40.
6
besde
vens
s
te
te
braca
most
meda
superca
key
sde
and
artery.
o
deep
Wc
te
arm
asca
o
te
a
to
4
cm
te
o-
et
noted.
ocated?
aceraton
sde
he
sgty.
s
ocated
neck.
superor
Neuroogc
Latera
Cepac
A.
Suprascapuar
D.
Medan
cubta
B.
he
termna
E.
Medan
antebraca
C.
he
upper
D.
he
accessory
E.
he
toracodorsa
29-year-od
te
woman
ater
part
o
norma
ourt
unabe
to
lex
Sensaton
te
s
pamar
oowng
te
absent
nerve(s)
B.
Unar
and
C.
Unar
nerve
D.
Rada
and
E.
Rada
nerve
der
o
te
atera
rst
key
unabe
o
sde
3½
t
MCP
dgts
o
dgts
to
and
rgt
te
44.
at
pam
An
excrucatng
arm
ater
tat
rotated.
s
a
te
he
at
o
te
te
pan
emergency
n
wrestng
arm
s
patent
attempted.
x-ray
umerus
oowng
45.
te
Rada
souder
te
most
key
depart-
rgt
matc.
sgty
ressts
puses
o
n
te
o
te
nerve
n
woman
te
rada
key
to
te
MCP
jont
te
MCP
jont
C.
Inabty
to
extend
MCP
Inabty
to
extend
te
MCP ,
E.
Inabty
to
extend
te
PIP
A
27-year-od
man
because
rom
more
to
a
15
he
rgt
and
o
He
s
degrees
te
s
An
x-ray
racture
Fracture
o
te
meda
Fracture
o
te
genod
ossa
neck
umerus
s
dspaced
posterory
D.
Fracture
o
te
anatomca
C.
he
ead
o
te
umerus
s
dspaced
nerory
E.
Fracture
o
te
mdde
47-year-od
breast.
o
and
a
breast
ard
o
nodue
er
te
rgt
tssue
expose
o
ump
te
breast.
around
te
te
dye
Anteror
B.
Rotter’s
C.
Parasterna
and
Centra
E.
Apca
n
A
te
rom
above
and
radoactve
and
vesses
o
te
nterpectora
mont
ago
s
to
te
nodes
a
te
s
cm
noss.
to
te
Wc
be
rst
A.
aong
te
axary
axary
1
our
neck.
souder
ater
He
and
or
as
upper
sustanng
neck
back.
pan
te
o
arm
most
rotaton
sensaton
sows
key
wc
an
cause
o
te
o
o
te
umerus
te
te
pyscan
breast.
s
prmary
o
warmt,
breast
condton
umerus
umerus
canges
sows
rgt
ndngs
te
A
te
rgt
erytema,
mammogram
cancer
to
because
er
and
a
u-
conrm
te
resut
wc
o
dag-
o
ta
Bockage
Contracton
o
(o
Spence)
cutaneous
o
te
o
te
ympatc
retnacua
cancer n
breast
vesses
cuts
o
te
areoa
and
nppe
nterna
nracavcuar
to
to
skn
perormed
axary
toracc
artery
D.
Invason
E.
Ipsatera
skn
comes
te
o
s
C.
nodes
man
hs
o
o
neck
bopsy
B.
nodes
rgt
oowng?
te
nodes
o
he
ater
s
atera
oss
Sortenng o te suspensory gaments by
to
tumor?
dmpng
skn
o
examnaton
suspcous
tckness
a
depart-
arm
abduct
afectng
trd
comes
story
Pysca
skn
sows
nto
made
area.
w
se-
1
areoa
njected
ncson
dranng
on
sows
atera
dye
an
ymp
(pectora)
nodes
1
examnaton
tumor,
groups
axary
45-year-od
te
notced
ven
D.
ment
just
ympatc
oowng
receve
se
Pysca
ocated
A.
A
tat
examnaton.
woman
3-mont
he 35-year-od woman comes to te pyscan because
to
rgt
epcondye
te
a
jonts
ocatons?
B.
A
DIP
jonts
s
ressts
umerus.
a
and
emergency
o
as
A.
o
te
and
aso
o
breast
to
ony
DIP
unabe
ead
46.
PIP ,
and
sweng
patent
symptoms
oowng
brougt
souder.
racture
tese
s
pan
adder.
tan
pan.
te
o
he
superory
jonts
D.
o
o
te
B.
meday
pysca
at
surgca
dspaced
Wat
durng
at
te
dspaced
cosed
dgts
o
s
ater
racture.
dgts
Fracture
s
present
a
dag-
te
C.
umerus
pasy
or
was
te
ateray
umerus
se
abduct
dspaced
te
pyscan
ago,
adduct
s
te
trange
to
umerus
o
te
nerve
te
o
cervca
umera
o
ead
nerve
axa
to
be
ossa
pexus
monts
ead
ead
te
comes
he
he
bat-
oowng
scapuar
posteror
n
A.
he
power
te
to
obque
njury?
E.
s
protrudes
Inabty
over
papated
D.
5/5
o
dorsa
braca
md-body
most
nds
supraspnous
te
nerve
ate-onset
are
scapua
Wc
o
njured?
segment
a
trange
souders
Inabty
due
passve
Wc
o
ead.
nerve
trunk
o
et
te
B.
arm
dsocaton
jont.
mecansm
sou-
abducted
are
a
te
o
A.
ang
Pysca
wen
sows
genoumera
s
s
te
key
posteror
examnaton?
te
njured?
to
o
examnaton. T wo
wt
ndngs
nerves
brougt
most
reducton
and
o
turnng
65-year-od
nosed
s
and.
Wc
A
s
oow-up
extend
jonts
er
dgts.
te
examnaton
and
s
n
nerves
s
sows
rotaton
bateray.
te
emergency
ment
man
externay
meda
te
unar
proxma
examnaton
and
most
medan
because
and
s
tree
te
Se
at
te
aceraton
Pysca
ourt
jonts.
te
to
deep
nerve
25-year-od
ment
on
o
a
te
dgts
rst
suraces
Medan
brougt
orearm.
o
(IP)
t
A.
o
te
lexon
and
s
sustanng
nterpaangea
te
A
nerves
te
examnaton
C.
cubta
wen
n
Asymmetry
ange
B.
A
eray
o
Basc
sows
43.
on
te
A.
proxma
42.
ound
troug
department
41.
was
Limb
te
a
nodes
saow
tat
Pysca
47.
emergency
stab
radates
to
depart-
wound
te
examnaton
et
sows
A
o
rom
pectoras
sde)
ductuar
29-year-od
department
te
(same
2
Pysca
examnaton
brusng
over
tus
on
te
papaton,
s
ater
brougt
ang
sows
cavce.
and
by
te
o
cancer
te
perareoar
cancer
woman
ours
major
nverson
to
te
rom
notceabe
here
decreased
s
emergency
er
bacony.
sweng
tenderness,
range
o
moton
and
crep-
o
er
CHAPTER
et
upper
racture
mb.
o
te
suspected.
to
48.
be
njured
n
Subcavan
B.
Cepac
C.
Latera
a
Subcavan
Interna
ome.
te
Wc
Coes
Scapod
C.
Bennett
D.
V okmann
E.
Boxer’s
brougt
se
Pysca
o
wrst
o
te
te
e
to
on
te
te
et
dsta
an
types
batroom
sows
wrst
obque
oowng
emergency
wet
examnaton
sows
ts
a
and
and.
racture
o
o
racture
52.
te
wt
most
contracture
sweng
as
on
and
et
cavce
et
souder
occurs
s
to
Dspacement
B.
Parta
type
o
o
An
te
or
te
x-ray
Wc
et
and
te
ours
ater
Parta
compete
or
souder.
a
he
“step-of”
a
o
tearng
compete
50.
Rupture
E.
Dsrupton
A
o
22-year-od
ment
ater
upper
mb
to
te
et
most
te
transverse
te
umerus
o
te
o
typ-
s
rom
te
coracoacroma
rom
a
na
s
and.
key
gun.
s
jonts
An
o
te
njury
mm
ourt
no
Hg.
and
37.6°C
s
Wat
s
te
unar
nerve
near
B.
T rauma
to
te
unar
nerve
at
C.
Medan
damage
Medan
nerve
E.
T rauma
to
damage
spna
te
te
te
trocea
to
te
te
root
51.
A
pronator
wrst
C8
44-year-od
a
crossbow
cm
man
comes
penetratng
bot.
aceraton
Scapod
54-year-od
Pysca
o
te
to
wound
te
to
pyscan
s
examnaton
anteror
ater
souder
sows
souder
and
a
wound
to
te
tran-
orgn
artera
pat-
njury?
scapuar
artery
artery
wt
deep
bra-
artery
wt
a
bang
to
toracoacroma
nerves
Medan
Deep
C.
Rada
D.
Recurrent
E.
Anteror
s
s
to
s
o
te
to
touc
pad
o
s
o
key
depart-
s
orearm
temperature
mm
sows
te
Hg.
te
to
tps
tumb.
o
out-
be?
to
Hs
tumb
abe
s
respratons
100/70
mb
on
emergency
njury
armng.
upper
most
ts
te
common
e
s
22/
Pysca
patent
te
o
are
tp
te
Wc
o
rng
o
te
s
te
and
o-
njured?
rada
medan
story
worsens
woman
o
story
naton
o
te
o
te
arm
souder
sows
o
s
a
te
a
overead.
o
consstent
tendon
wtn
oowng
rgt
o
he
as
a
exam-
test
sou-
tendnopa-
rgt
te
tendons
Se
Yergason
te
wt
te
pan.
Pysca
postve
utrasound
o
because
souder
artrts.
examnaton
o
pyscan
ted
sows
An
ndngs
Artroscopc
eroson
er
batera
reumatod
souder.
Wc
vsts
worsenng
wen
40-year
an
woud
117/mn,
tp
e
nterosseous
62-year-od
jont
s
te
te
branc
rgt
we
te
He
to
B.
comes
pressure
o
nger.
bone
most
wen
penetratng
puse
oppose
ngers
te
a
ook
bood
A.
A
o
te
bones
Wc
(98.6°F),
and
sufered
man
because
A.
Genoumera
B.
Long
ead
o
trceps
C.
Long
ead
o
bceps
D.
Inraspnatus
E.
Coracobracas
A
26-year-od
1-week
51–75
tanng
te
sows
souder
genoumera
was
most
key
observed?
55.
Questions
E.
sows
wrst
proxma
at
nerve
Hamate
ty.
teres
D.
Psorm
D.
jont.
to
o
artery
braca
artery
carpa
and.
Lunate
A
boy
te
C.
der
o
njury?
T rauma
o
B.
o
unabe
dgts
umera
wt
toracc
T rapezum
pan
et
22/mn,
t
ractures.
s
s
are
He
depart-
to
temperature
A.
nerve
54.
emergency
toracc
A.
3-year
respratons
sows
s
te
Hs
108/65
o
x-ray
cause
to
penetratng
107/mn,
pressure
DIP
a
gament
ste
toracodorsa
crcumlex
17-year-od
owng
abrum
brougt
A
ndex
coracocavcuar
te
scapuar
genod
sustans
puse
bood
lex
o
man
e
(99.68°F),
and
te
Superor
tte
te
tearng
Latera
E.
unabe
njury?
ead
dsta
coatera
te
crcumlex
wt
on
artery
examnaton
g-grade
oowng
paced
angogram
just
Wat
bypass
wt
s
An
artery
artery.
to
scapuar
D.
mn,
o
gament
D.
Dorsa
37°C
gament
C.
Suprascapuar
B.
rom
cavty
or
avaabe
Posteror
compress
apped.
axary
A.
ment
examnaton
sows
o
emergency
2
Pysca
papaton
o
te
to
pan
sope.
brusng
noted.
ts
A.
genod
sk
separaton.
n
brougt
souder
a
tenderness
te
s
te
A
s
subscapuar
are
stretced
53.
et
tree
o
ractures
racture
woman
artery.
pressure
293
Limb
artery
racture
a
te
pos-
patent?
scemc
rada
deep
secton
racture?
racture
struck
cay
key
racture
department
patent
most
te
and
ca
s
ater
n
34-year-od
sows
o
C.
o
occurred
B.
se
s
a
strongy
artery
ours
A.
A
vesses
sows
s
artery
dspacement
key
souder
beedng
ways
woman
loor
radus.
oowng
cavcuar
3
o
et
ven
68-year-od
x-ray
te
nterna
artery
department
An
te
toracc
er
o
and
ven
E.
o
x-ray
o
toracc
D.
teror
49.
Wc
A.
A
An
cavce
Upper
6
sus-
rom
a
deep,
4
asymmetry
der
ater
a
movement.
Durng
rom
man
story
o
He
s
surgery,
ts
bed.
comes
pan
tenns
brac
brac
to
and
matc.
reerred
te
te
pyscan
weakness
he
to
pan
an
artery
s
te
because
rgt
was
o
musce
seen
s
a
sou-
exacerbated
ortopedc
supraspnatus
Wc
n
by
surgeon.
relected
crossng
te
294
C H A P T E R
6
gament
o
56.
te
Upper
tat
Limb
brdges
te
notc
o
te
superor
border
esons
scapua?
te
o
ead
te
Subscapuar
tures
B.
T ransverse
A.
Subscapuar
B.
Inraspnatus
C.
Genoumera
D.
Subacroma
E.
T eres
C.
Dorsa
D.
Posteror
E.
Suprascapuar
A
scapuar
crcumlex
61-year-od
department
a
crcket
He
s
2
bat.
180
man
ours
Hs
cm
(5
umera
s
ony
t
brougt
ater
e
was
to
t
medcaton
11
n)
ta
te
n
s
and
emergency
te
et
arm
by
60.
acetamnopen.
wegs
82
kg
A
key
od
rgt
te
extendng
oowng
over
struc-
nlamed?
musce
jont
cavty
bursa
musce
woman
ntermttent
er
o
bursa
mnor
60-year
o
(180
most
nlammaton
umerus. Wc
A.
cervca
s
ntermuscuar
o
comes
numbness
and,
wc
to
te
and
oten
pyscan
tngng
wakes
because
sensaton
er
up
at
o
ngt.
2
b);
BMI
ma
s
te
et
to
o
dgts.
he
wrst.
57.
Wc
te
over
sgns
s
s
puses
over
a
proxma
unabe
to
are
tra
area
te
o
seat
et
orgn
terapy
an
s
wc
o
A.
Rada
C.
Buccoparyngea
B.
Posteror
D.
Cavpectora
C.
Latera
E.
Prevertebra
A
nterosseous
cutaneous
antebraca
cutaneous
cutaneous
45-year-od
n
wt
et
a
woman
2-week
souder.
wrst
extenson
and
orearm.
ated
dsc
n
te
nerves
s
comes
and
emergency
neck
parestesa
cervca
most
te
o
pan
examnaton
MRI
on
Wc
te
45-year-od
back
te
a
o
because
tomograpy
to
an
weakness
nds
o
depart-
radatng
sows
examnaton
regon.
key
A
ment
to
story
An
61.
unar
Pysca
arm
spna
o
er
ern-
rreguar
oowng
(CT)
cervca
to
T wo
ymp
and
C5
was
B.
C6
A.
Suprascapuar
nerve
C.
C7
B.
Long
nerve
D.
C8
C.
Accessory
E.
T1
D.
C5
E.
Rada
because
rgt
o
wrst
and.
te
wrst
An
x-ray
te
scapod
mended.
wc
pan
Pysca
and
o
tenderness
te
wrst
bone.
Wen
artery
ater
n
te
sows
brusng
dspaced
23-year-od
ment
3
ketba
o
recom-
tota
exposed,
wt
at
s
ater
s
te
o
Rada
C.
T endon
C.
Anteror
D.
AC
A
78-year-od
worsenng
Se
as
ead
severe
bookse
combng
paton
An
o
MRI
er
o
pan
at
pan
wen
work
mb
te
over
pan
musce
upper
to
pacng
and
Abducton
detod
te
comes
souder
ar.
te
63.
woman
rgt
E.
arc
o
te
pyscan
past
books
n
te
er
sows
on
monts.
te
over-
souder
we
rgt
produces
6
wt
arm
and
exquste
yperntense
A
o
o
cm
er
as
o
tumor
ora
perormed
and
te
and
reated
te
weakness
te
radca
A
te
tssues
patent’s
on
oowng
wt
cavty.
turnng
structures
neck
surgery?
to
te
s
emergency
souder
Pysca
examnaton
papaton.
souder
most
(Fg.
key
An
depart-
payng
x-ray
a
sows
a
6.4). Wc
been
bas-
sows
o
te
torn?
gament
ead
o
bceps
brac
gament
T ransverse
scapuar
2-week
man
story
gament
comes
o
posteroatera
rgt
by
actvtes.
overead
enarged
souder
pan.
quadranguar
space
here
and
umerus.
te
he
tat
s
pan
pont
MRI
s
because
pan
o
te
sze
tenderness
on
atera
te
o
te
exacerbated
examnaton
reduces
weakness
An
pyscan
ntermttent
Pysca
musces
space.
abducted
to
du,
souder.
quadranguar
te
se
on
as
pa-
oca
7
depart-
computed
gament
ong
30-year-od
a
s
nodes,
brougt
te
B.
nterosseous
×
o
A
postoperatvey
njurng
structures
Genoumera
pamar
emergency
nerves
rends.
Coracoacroma
nterosseous
5
sde
durng
souder
separaton
oowng
bone?
man
ours
step-of
spna
B.
Posteror
ractured
s
s
A
C6
A.
Deep
te
snufbox
62.
o
snufbox.
racture
nterventon
anatomca
crossng
outstretced
anatomca
a
surgca
s
sows
ts
structures?
nerve
Unar
E.
seen
on
takes
nerve
A.
D.
s
A
te
ang
examnaton
njured
toracc
and
axar y
seat
monts.
snge
et
rgt. Wc
key
te
2
procedure
A.
A 22-year-od man comes to te emergency department
most
Durng
te
asca
to
or
a
te
monts
droops
te
comes
on
deep
souder
ant-nlam-
neck
pan
sows
tumor,
ead
60
asca
neck
surgca
er
or
3-mont
pan.
nto
axar y
nvestng
woman
o
neck
et
te
A
asca
border
removed.
reeve
oowng
te
wrst
asca
radca
are
njured?
o
te
non-steroda
not
he
te
o
symptoms.
njecton
admnstered.
asca
antebraca
and
anestetc
rom
lexon
panu
dd
cervca
Meda
key
spntng
drugs
surger y,
sows
te
Superca
Dorsa
most
wrst
mator y
atera
te
o
examnaton
reproduces
Superca
E.
s
seconds
regon
sma
to
Pysca
and
papabe
extend
ner ves
nor-
B.
D.
oowng
wtn
brusng
md-umera
mb
and
are
sows
decreased
et
te
te
Upper
patent
o
vta
A.
te
59.
Hs
njured?
ment
58.
mb.
Sensaton
dorsum
two
.
examnaton
papaton
upper
bateray.
te
kg/m
Pysca
tenderness
o
25
mts.
sows
o
te
over
te
rotaton
souder
o
sows
CHAPTER
66.
C.
Recurrent
D.
Deep
E.
Anteror
A
ater
upper
mn,
abe
Hs
te
and
key
Fig.
6.4
B.
Medan
C.
Unar
D.
Deep
a
atropy
o
structures
64.
te
teres
woud
A.
Axary
B.
Anteror
Cepac
Rada
E.
Subscapuar
nerve
a
pece
o
o
wc
Weakness
umera
s
o
o
er
er
comes
paper
ndex
tumb.
te
hs
because
er
tumb
wtout
s
a
wt
specc
oice
between
nger
consstent
wc
to
postve
unar
musce
lexng
se
and
te
68.
causes
ts
sgn
Fexor
pocs
B.
Adductor
C.
Fexor
dgt
D.
Fexor
carp
E.
Extensor
A
o
a
1-mont
tngng
rom
n
seep
and.
A
was
scopc
nerve
as
opposton.
te
A.
he
te
to
was
common
pyscan
by
compresson
and
pamar
an
wt
s
oss
norma.
durng
dgta
te
o
nerve
wa.
E.
horacoacroma
1
our
game.
arm
s
dgta
due
He
to
o
te
Sensaton
o
s
te
most
One
to
year
breast.
lap
to
breast.
s
nerve
te
pyscan
ago,
Se
se
s
scedued
cosmetcay
Durng
orms
te
to
a
or
augment
surgery,
advanced
or
underwent
te
part
o
anteror
vascuar
base
o
bood
pressure
sows
An
surgca
x-ray
o
brougt
ang
a
te
o
o
128/76
and
te
te
dsta
most
te
ebow
range
o
s
mm
Hg.
eccymoss
souder
umerus
caused
37°C
at
te
sows
a
18/mn,
exam-
proxma
racture
eevaton
Wc
o
a
s
te
o
and
oow-
adducton
o
te
ragment?
mnor
Pectoras
major
mnor
74-year-od
woman
s
brougt
to
te
department because o pan and sweng o
ater
o
(98.6°F),
are
Pysca
wt
te
depart-
durng
moton
respratons
ragment.
key
emergency
s
temperature
reguar,
s
to
onto
restrcted
Hs
sweng
neck
musces
artery
artery
s
and
Supraspnatus
te
te
jonts
artery
pan.
90/mn
D.
o
medan
artery
as
endo-
o
o
artery
ater
Pectoras
operaton?
branc
man
C.
A
te
et
cervca
toracc
31-year-od
E.
te
IP
nerves
s
n
jonts
te
s
artery
scapuar
carpa
69.
weak.
oowng
comes
et
Wc
Bracas
te
IP
e
orearm
musce
Latera
stumbng
and
ang
over
er
pet
emergency
er
dog.
orearm
Pysca
examnaton o te orearm sows no open wounds and
te
pamar
dors
T eres
nerve
common
absent
B.
Wc
branc
er
A.
tumb
s
nds
ngers
o
92/
nerve
musce
er
postoperatvey,
tumb,
njured
te
underwent
weeks
te
n
o
er
awake
sakng
o
woman
D.
dsta
and
te
s
pressure
wrst
md
unar
T ransverse
ng
because
numbness
symptoms
reeved
patent
T wo
Sensaton
second
medan
te
n
te
he
are
nerve
reease.
to
ntermttent
and.
and
nerves
o
and
o
weakness
rst
medan
B.
made,
oowng
he
rgt
ngt
dagnoss
tunne
patent
story
er
at
comes
o
dors
er
adducton
woman
te
C.
te
ndcs
48-year-od
o
souder.
mnm
radas
n
horacodorsa
naton
pocs
s
rgt
broken
ebow
te
Dorsa
and
ongus
a
a
puse
bood
examnaton
o
depart-
s
onto
(98.6°F),
extenson
te
o
lap?
puse
A.
te
at
B.
et
to
at
A.
A
e
and
extend
dgts
o
examnaton.
atssmus
ockey
neuropaty.
appear?
65.
ste
ment
Froment
trd
branc
mastectomy
ts
artery
to
and
Wc
branc
atssmus
te
37°C
jonts
unabe
nerve
Recurrent
te
oowng
artery
woman
sde
jont
sgn,
te
ven
od
atera
dsta
o
compressed?
nerve
43-year-od
te
Wc
be
MCP
emergency
and
18/mn,
dgts,
nerve
41-year-od
toracc
crcumlex
D.
cannot
key
nerve
C.
A
mnor.
most
stumbed
s
te
aceraton
njured?
Rada
a
to
deep
Neuroogca
and
norma.
nerve
nerve
a
are
295
Limb
nerve
brougt
e
s
t
second
oow-up
•
s
te
He
and
A.
A
Hg.
extend
s
medan
unar
temperature
mb.
ourt
E.
wen
mm
to
rgt
o
man
respratons
128/75
o
te
sustanng
mb
botte.
o
nterosseous
19-year-od
ment
67.
branc
branc
Upper
6
neurovascuar
he
ton
patent
and
s
ods
examnaton
er
unabe
to
et
s
orearm
supnate
wtn
n
te
te
et
norma
mts.
pronated
and.
An
pos-
x-ray
296
C H A P T E R
6
o
te
rgt
o
te
radus.
ateray.
orearm
he
Wc
responsbe
70.
Upper
or
Limb
sows
a
proxma
o
te
te
racture
end
o
oowng
atera
o
te
te
upper
racture
musces
s
trd
caugt
devates
prmary
aspect
devaton?
s
jont
nto
Supnator
MCP
Pronator
atera
D.
Bracoradas
Wc
E.
Bracas
A.
De
B.
Navcuar
C.
Boxer’s
Hs
D.
Gamekeeper’s
res-
E.
Bennett
quadratus
12-year-od
30
o
boy
s
wrst
s
we
are
mm
Pysca
Hg.
te
are
s
ntact.
to
te
o
te
payng
and
wt
a
cut
most
sur-
kne.
116/mn,
pressure
he
depart-
pamar
sarp
s
sows
he
wound.
tendon
te
puse
bood
wrst.
te
emergency
acerated
examnaton
wtn
Wc
e
(98.6°F),
20/mn,
mdne
exposed
brougt
ater
37°C
pratons
at
s
mnutes
a
2
ends
lexor
s
100/70
cm
o
a
74.
and
n
Pamars
B.
Fexor
tes.
ongus
carp
Abductor
D.
Fexor
carp
E.
Fexor
pocs
A
pocs
22-year-od
ment
o
because
s
rgt
macne
drnk
ton
o
sows
te
one
n
ater
o
s
o
te
knuckes
key
A.
Fracture
o
te
B.
Fracture
o
te
C.
Coes
D.
Smt
E.
Bennett
neck
o
racture
meda
o
racture
te
t
dd
x-ray
MRI
w
s
et
not
te
o
Wc
o
t
te
s
o
a
st,
te
o-
Pan
D.
s
te
skn
and
be
rgt
on
te
extensor
Pan
E.
Pan
te
75.
deormty?
s
et
una
Wc
o
o
metacarpa
s
te
o
er
a
A
1-week
dgts,
o
te
s
rgt
te
and
te
patent
tumb,
abduc-
IP
jont
n
and
mts.
rb
Long
wrst
An
te
Mdde
C.
Rada
nerve
structures
to
s
C.
to
o
o
oowng
D.
Lower
trunk
sows
D.
scooss.
E.
T1
A
ventra
23-year-od
department
er
and
n
4
a
te
te
most
key
braca
over-
abnorma-
te
o
ong
te
present
braca
s
pexus
ater
brougt
se
sk-sope
souder
abducton
and
and
on
ead
oow-
pysca
durng
durng
orced
orced
lexon
o
adducton
souder
comes
ebow
rgt
Pysca
o
te
durng
te
o
te
lexon
pyscan
Se
tat
extensor
o
conrm
to
over
te
te
pos-
tenderness
radas
made.
perormed
te
studes
s
because
pan
sows
carp
epcondyts
be
as
radates
examnaton
soud
to
to
pan.
ebow
te
atera
Observng
te
rng
aganst
o
pan
te
brevs.
Wc
durng
o
pys-
dagnoss?
(nerve
te
experenced
ebow
conducton
veoc-
te
lexon
and
o
pan
wen
te
wrst
s
resstance
presence
and
durng
jont
presence
aganst
tte
o
numbness
ngers
wen
te
and
tngng
wrst
s
lexed
resstance
Evauaton
o
pan
durng
76.
A
et
over
bracoradas
te
styod
process
o
contracton
76–100
29-year-od
department
woman
dry
arm
a
du
pexus
ramus
ours
o
souder
atera
atera
o
te
o
Observng
n
te
tests
Evauaton
Questions
o
s
o
s
test)
radus
o
pan
no
Wc
extenson
conducton
extended
nerve
trunk
ts
sows
be
because
he
jont
orgn
extenson
lexor
appear
x-ray
due
B.
o
E.
B.
dagnoss?
oice
pan.
patent
anteror
woman
orearm.
to
ty
exten-
anestesa
orearm.
rst
neura
he
notabe
and
norma
te
o
and.
mpared?
Medan
te
key
te
story
aspect
dagnoss
te
rgt
here
sde
oowng
A.
te
musce.
durng
et
43-year-od
teror
tumb
te
o
wtn
eevaton
to
souder
durng
souder
A
atera
radus
n
and.
meda
unctonng
marked
co-
repar.
jont
o
dsta
opposton
musces
unar
jont
to
pen
adducton
key
tendnopaty
te
n
et
souder
radus
te
et
souder
dorsum
make
knucke
C.
examna-
te
to
dgt
vendng
receve
s
s
te
most
te
surgca
o
te
contracton
Nerve
o
te
most
n
examnaton
and
wen
sows
ca
son
o
or
at
(tenosynovts)
souder
brac
A.
ton
te
comes
et
o
odng
perorm
rupture
axty
extenson
tumb
o
dicuty
unabe
ncreased
and
unar
Ldocane
racture
man
A 14-year-od gr s brougt to te pyscan because o
a
dgt.
tumb
ndngs
Pan
depart-
t
a
Pysca
seen.
te
te
asked
process
o
te
o
be
o
e
aspect
s
expans
styod
racture
e
twce.
patent
cannot
best
ago,
wen
te
emergency
sweng
money
te
te
ours
ospta
o
and
lexon
Pysca
te
tumb
bceps
Pan
B.
to
and
T wo
Wen
rst
scedued
s
e.
at
contracton
pan
sweng
most
A.
comes
nsertng
and.
owng
ongus
ongus
and.
bone
te
a
se
examnaton?
unars
man
s
as
sweng
jont
syndrome
exacerbated
An
o
sows
Se
oowng
stor y
An
te
ng
radas
C.
s
ead.
ts
te
26-year-od
o
A.
o
and
durng
MRI
Quervan
tendon
es
An
mattng
MCP
noted
gament.
2-week
poston?
s
jont.
wound
retnacuum
commony
A
tumb
te
C.
temperature
73.
MCP
te
njected
te
te
pan
B.
A
teres
o
n
sows
Pronator
ace
72.
tumb
A.
ment
71.
er
examnaton
ad
to
a
te
emergency
panu
competton.
njury
he
to
patent
Hs
temperature
respratons
mm
man
ater
Hg.
are
He
a
s
s
37.5°C
18/mn,
as
brougt
panu
du
a
(99.5°F),
and
pan
to
n
te
aganst
bood
te
a
emergency
rocky
puse
s
pressure
atera
edge.
95/mn,
s
118/70
souder
wt
CHAPTER
radaton
sows
a
to
te
proxma
arne
umerus.
assessng
racture
Wc
te
o
status
arm.
o
te
o
An
te
x-ray
surgca
oowng
te
nerve
o
te
neck
tests
s
arm
o
best
assocated
wt
79.
te
or
to
ts
Have
B.
Have
C.
T est
4.5
kg
(10-b)
o
T est
patent
te
or
sde
E.
te
abduct
we
odng
a
o
te
skn
souders
sensaton
te
atera
te
sensaton
over
te
meda
skn
o
axa
Have
te
object
patent
ke
a
pus
wa
and
aganst
assess
an
te
mmovabe
poston
o
te
scapua
77.
A
27-year-od
department
wtn
te
et
ater
norma
brusng
on
on
te
ost.
An
wt
te
made.
era
x-ray
and
s
Batera
rb
oss
Lower
Dupuytren
D.
Let
E.
he
was
o
o
s
sows
te
ater
a
sows
but
severe
a
he
C.
he
D.
he
E.
he
to
s
t
te
at-
dgts
81.
and
o
ooked
njury,
parestesa
unar
te
or
nerve
medan
ater
a
tendon
te
te
patent
cawng
s
abe
o
a
o
to
tese
nerve
comes
been
and
unar
s
o
are
ebow
and
te
at
nerves
ave
unar,
and
md-umerus.
rada
te
te
An
Wc
racture
and
n
x-ray
wt
o
o
te
ts
pres-
sows
te
voar
er
puse
bood
examnaton
radus
and
Dupuytren
on
a
bapayer
s
Maet
A
t
ngertp
bare-anded.
mdde
E.
nger
te
wrst
angua-
oowng
s
patent?
we
Pysca
cannot
o
most
s
key
attemptng
examnaton
stragten
rgt
and.
te
DIP
Wc
o
dagnoss?
deormty
deormty
deormty
contracture
nger
31-year-od-woman
department
oowng
draw
a
rom
gure
catcng
grasped
DIP
s
s
et
wrst.
o
He
te
afected
s
most
te
n
s
oss
Medan
B.
Anteror
Rada
ror
s
an
brougt
njury
skatng
er
er
D.
rom
to
tat
te
orced
competton.
an
orearm
te
overead
poweruy .
emergency
er
to
Her
wt-
partner
poston
Pysca
and
exam-
E.
82.
A
been
njured
at
nerves
ave
been
nger
termna
sensaton
nerve
over
njured
nterosseous
on
caspng
paanx
te
o
tenar
te
te
ands
tumb.
aspect
o
te
wtn
nerve
te
cubta
njury
at
ossa
te
pronator
Unar
nerve
department
te
njury
at
ts
entrance
nto
te
poste-
compartment
nerve
19-year-od
njury
ater
Hs
at
te
proxma
e
He
vta
and
or
sgns
A.
Ineror
B.
Muscuocutaneous
Intercostobraca
D.
Meda
at
skn
crease
E.
Medan
cf
a
by
te
o
orearm
te
emergency
we
kng
graspng
norma
IP
te
n
jonts
o
te
cutaneous
nerve
nerve
cutaneous
nerve
n
tree
te
ourt
nerves
afected
nerve
o
te
oowng
a
mts.
yperextenson
te
o
a
to
wtn
dects
antebraca
nerve
are
braca
C.
s
sows
Wc
atera
rom
broke
sensory
aong
brougt
e
lexon
dgts.
responsbe
away
s
examnaton
jont
t
trauma
man
mountans.
MCP
te
o
ndex
te
wrst
te
at
te
lex
nerve
Medan
Pysca
damaged
o
to
orearm
wrst.
carpa
jont
unabe
A.
C.
py-
regon.
medan,
njured
unar
was
ba
D.
hree
wrst.
medan
e
a
tat
o
branc.
at
njured
nerves
o
o
racture
oowng
and
medan
ragment.
step
(98.6°F),
racture
ater
catc
examna-
mecansms
severed
wrst.
dsta
ast
teres
gunsot
to
dgts
dgts
16/mn,
Pysca
dsta
te
te
37°C
and. Wat s te most key mecansm o er njury?
and
ndngs?
been
as
a
mb.
Pysca
te
are
s
A 27-year-od-man s brougt to te emergency depart-
and
te
tunne.
te
Boxer’s
emergency
upper
extend
ve
oowng
as
te
sustanng
o
examnaton.
patent
o
Smt
E.
mssed
compart-
bateray;
ke
to
mssed
naton sows brusng o te orearm. Se s unabe to lex
posteror
absent
emergency
racture
Swan-neck
ractures
te
racture
C.
trauma
brougt
surace
compete
te
D.
te
n
was
mnutes
responsbe
B.
deep
boy
te
Bennett
here
ongus
oow-up
Wc
he
trunk)
njury
ventra
C.
Caw
oppos-
to
racture
Boutonnère
te
se
Hg.
type
B.
orearm
30
te
Coes
te
s
o
dsta
A.
sensory
wt
te
key
Scapod
nstead
(ower
normay
to
or
A.
T1
te
B.
jont
cut
monts
and.
nerve
o
racture
oter
tree
tumb
o
o
mm
tendons
on
rst
o
no
a
sows
te
orearms
absent
cause
tssue
o
brougt
temperature
respratons
A.
to
tendons
tose
bot
te
parayss
key
spna
nerve
te
department
key
mbs
o
sot
brevs
repace
sensaton
aso
and
tendons
te
unctons
s
wen
Her
138/75
most
ment
contracture
15-year-od
wound
o
pamars
nerve
as
to
suraces
most
pexus
rada
ment
and,
ongus
o
are
sows
bateray
C.
ton
ongus
s
te
B.
scan
oss
he
upper
Vtas
80.
dects?
rst
A
te
emergency
examnaton
and
radas
te
coson.
and.
decson
here
Wat
motor
78.
body
et
pamar
to
Pysca
Postoperatvey,
bateray.
A.
s
o
A
brougt
motorcyce
upper
o
pamars
pam
ton.
a
carp
abnormates.
s
mts.
dorsum
extensor
are
man
woman
a
deormty
ton
souder
norma
s
sows
over
er
80/mn,
sure
a
srug
presence
or
mb
wegt
patent
te
te
break
motorome.
s
A.
te
68-year-od
297
Limb
department ater ang on a lexed wrst n an attempt
njury?
D.
A
Upper
6
mb?
s
298
C H A P T E R
83.
A
6
Upper
52-year-od
nvasve
te
excsed.
Sx
or
a
a
te
deep,
cause
te
Part
o
he
n
he
atera
meda
he
atera
and
o
to
te
neror
as
to
no
major
n
te
T rocod
Gngymus
pyscan
C.
Enartroda
D.
Synartross
E.
Sear
or
a
sensory
87.
key
bke
cut
and
o
spna
musce
nerve
was
o
te
removed
entrey
and
On
s
s
sows
was
er
s
most
to
Spne
mm
are
Hg.
absence
wc
o
o
a
emer-
at
s
n
respratons
pae,
arm
and
o
tracture
te
s
Surgca
B.
Rada
C.
Supracondyar
Pysca
D.
Oecranon
bra-
oow-
responsbe
or
E.
88.
te
groove
Latera
A
se
e
C5
conductng
B.
C6
sows
C.
C7
te
D.
C8
te
E.
T1
o
department
sustaned
ture
are
s
a
ater
18/mn,
oss
o
extenson
te
dsc
trceps
te
n
spna
On
s
to
te
nerves
arrva,
s
n
s
cervca
e
as
we
T rquetrum
Hamate
Hg.
absence
an
o
nterverte-
regon.
Wc
o
afected?
C.
Radus
D.
Radus
E.
89.
and
Psorm
A
wakng
C5
examnaton
B.
C6
a
C.
C7
sde
D.
C8
o
E.
T1
oowng
A
29-year-od
o
2-day
he
patent
apped
sows
a
derness
sows
and
o
a
te
te
man
story
an
e
ce
comes
of
a
meda
oowng
adder
to
and
te
te
pan
2
An
ste.
ebow
aspect
jont
o
x-ray
wt
te
pyscan
o
days
s
ago
Pysca
dscoored
papaton.
dsocated
to
worsenng
pack
swoen
to
o
rgt
o
te
at
dsta
ebow
et
work
wt
upper
o
te
umerus.
best
ebow.
and
ten-
mb
Wc
te
a
o
a
arm
o
sows
a
arge
scemc
con-
oowng
o
s
swo-
movement
te
ormaton
te
100/
pressure
ocatons
umerus
comes
a
nto
te
dsta
at
to
panu,
te
Pysca
o
wrst
An
styod
racture.
compex
wrst
wt
pt
ater
we
examnaton
wrst.
te
rada
emergency
orcestra
meda
te
te
swoen
x-ray
o
process
o
Dsrupton
s
suspected.
wc
o
te
unate
trquetrum
woman
er
te
dog
nds
and,
ebow
comes
ang
te
on
a
oss
and
sows
ocatons
o
o
te
beore.
lexon
o
te
te
nerve
o
te
on
At
wrst
te
n
meda
An
wc
njury
and
Neuroogc
ngers.
abnormates.
as
emergency
outstretced
sensaton
cawng
no
to
an
evenng
weakness
drecton,
A.
Bend
B.
Between
most
x-ray
o
te
key
te
meda
te
epcondye
psorm
bone
and
te
lexor
retnacuum
C.
Wtn
D.
At
una
descrbes
Any
sou-
s
occurred?
examnaton
separaton
casscatons
because
rgt
o
et
puse
occurred?
racture
ater
A.
er
o
brocartage
and
department
meda
te
motor-
sows
V okmann
reearsa.
n
as
67-year-od
we
er
bood
x-ray
a
andebars
bones?
B.
mm
o
artcuates
A.
extenson,
o
stage
a
tranguar
oowng
te
umerus
durng
sows
una
and
o
key
ne
te
tempera-
and
key
he
arm.
emergency
umerus
because
respratons
ebow
sows
most
wc
140/82
o
jonts,
MRI
s
emergency
110/mn,
oss
MCP
An
te
coson
pressure
sows
relex.
ernaton
oowng
puse
bood
o
vece
njury.
(98.6°F),
and
brougt
motor
examnaton
psatera
bra
a
s
wpas
37°C
Pysca
man
una
o
and
An
wc
o
tenderness
te
nvoved
epcondye
rom
wrst
over
examnaton
pan.
55-year-od-woman
department
relex?
43-year-od
o
te
rom
(98.6°F),
15/mn,
most
to
pont
proxma
At
37°C
er
te
37°C
umerus
16/mn,
te
s
dagnoss
neck
A.
A
te
racture
A.
bones
njures
propeed
on
severe
made.
a
two
brougt
Pysca
coo
A
s
was
are
Hg.
causes
racture
as
Se
andng
mm
te
sustanng
temperature
ematoma.
njur y
mmobzed
temperature
key
njured
te
unconscous
respratons
unatera
was
to
coson.
142/84
Injur y
pexus
ound
neck
arrva,
te
brougt
vece
120/mn,
en,
cut
braca
beng
er
relex.
ts
bke,
Her
mn,
cut
was
was
ater
motor
was
nerve
woman
ner ves
o
er
der.
woman
ater
coson.
145/87
pressure
coradas
45-year-od
department
examnaton?
was
A
between
njury?
B.
most
musce
ormed
patent
A.
meda
te
ts
were
examnaton
motor
s
artcuaton
centra
groups
Pysca
pysca
mnor
cord
a
examnaton
absence
pectora,
comes
or
Durng
mastectomy
pectora
puse
bood
ng
breast.
node
oowng
on
pectora
coar.
(98.6°F),
86.
te
suspected,
cer vca
area
te
department
scene
was
85.
o
54-year-od
te
te
ymp
patent
mastectomy
et
surgery
he
gency
and
se
pectoras
n
D.
A
he
te
C.
E.
84.
oow
pectoras
te
ater
ndngs
removed
B.
tumor
te
examnaton.
Wc
o
o
axary
monts
cavce.
dects.
A.
te
apca
oow-up
sows
underwent
carcnoma
procedure
and
o
woman
ducta
axary,
Limb
te
eads
E.
At
o
te
tear
te
carpa
cubta
orgn
rada
(HCA)
tunne
ossa,
o
between
lexor
neck,
jont
1
cm
te
unar
dgtorum
dsta
to
and
rada
supercas
te
umerocap-
CHAPTER
90.
An
18-year-od
ment
ater
ature
s
are
e
37.5°C
14/mn,
Pysca
dsta
sues
A.
to
B.
o
ound
here
te
te
on
tps
woud
meda
C.
he
D.
here
be
sde
patent
oss
be
s
emergency
Hs
82/mn,
s
depart-
temper-
respratons
120/72
2.5-cm
wrst
mm
aceraton
wt
at
underyng
oowng
sgns
s
94.
Hg.
touc
be
here
a
91.
A
to
woud
te
to
on
o
te
te
lex
abty
on
et
s
and
and.
sutured.
cts
o
man
was
A
nger.
wereas
A.
Maet
B.
Boutonnère
Dupuytren
D.
Swan-neck
E.
Dnner
a
tumb
dorsum
o
o
te
to
IP
jonts
extend
te
IP
ton
wc
te
key
93.
s
jonts,
lexon
o
Dupuytren
Swan-neck
E.
Dnner
oow-up
er
95.
breast
most
o
to
nger
nto
n
a
key
te
wt
a
wen
o
te
DIP
was
o
because
oss
e
s
sows
te
Ape
and
C.
Caw
and
D.
Wrst
drop
E.
Maet
A
procedure.
skn
wrst
te
range
a
PIP
Wat
o
o
oss
o
sows
B.
Rada
pan
unc-
pantng.
o
base
o
moton
atera
E.
Muscuocutaneous
bceps
ng
s
man
a
Pysca
at
te
brac
s
rng
o
s
n-
te
lex
and
extend
dagnoss?
and
B.
Mdporton
C.
Juncton
o
wt
o
te
to
emergency
er
souder
souder
Pysca
o
s
exter-
examnaton
te
souder.
dsocaton. Wat
n
ts
brougt
(Fg.
key
most
rgt
et
te
6.5).
ocaton
type
to
arm
examnaton
relex
most
s
to
njury
contour
panu
anteror
Intertubercuar
he
njured
Medan
wt
an
souder
Unar
A.
jonts,
te
te
D.
brusng
uy
key
brougt
abducted.
anteror
o
lexon
s
and
85-year-od
s
game.
C.
wne.
to
most
sustanng
commony
Axary
o
te
woman
ater
basketba
A.
An
unabe
o
ebow
o
te
emergency
tng
a
sweng
and
Wc
o
An
nerve
njury?
te
ater
sows
oss
te
o
case
and
te
oow-
rupture?
groove
te
te
bceps
sort
brac
ead
Proxma
end
o
te
o
musce
te
combned
musce
E.
comes
One
o
nodes
wen
s
nerve
Wat
A.
he
upper
B.
he
posteror
C.
V entra
s
was
te
trunk
o
Bony
nserton
o
te
musce
te
vst
to
njured
o
o
te
braca
and
te
er
Pysca
a
wa.
surgeon,
te
njured
o
et
accentu-
aganst
er
te
pan
ar.
durng
braca
or
rasng
pus
a
treatment
wngng
wt
or
under-
axa
er
scapuar
se
and
weakness
dicuty
orgn
dvson
o
rgt
combng
er
pyscan
ago,
stagng
asked
consut
te
er
as
as
meda
patent
to
mont
or
Se
and
ead
sows
ram
te
nger
rotated
most
s
deormty
cancer.
a
at
contracture
24-year-od
D.
dssecton
er
tat
te
n
s
Dupuytren
s
o
He
B.
deormty
subsequent
tod
nger.
A.
x-ray
constant
worsenng
we
jonts.
decrease
ngers. Wat
sows
de-
poston
oice
ands
pexus
pexus
bceps
brac
musce
woman
te
rng
nay
dagnoss?
gradua
promnent
o
rng
department
progressvey
extenson
souder
above
gradua
durng
sammed
unctona
ed
o
96.
comes
te
ymp
examnaton
was
mdde
dgt
deormty
examnaton.
o
rgt
a
was
pued
s
a
contracture
ork
surgca
remova
In
s
s
ater
door
sows
braca
braca
deormty
32-year-od
ated
a
on
jont
te
oice
nger
D.
a
te
dagnoss?
C.
arm
at
deormty
more
Maet
er
cut
jont
s
assocated
Boutonnère
o
Wat
man
B.
went
wen
PIP
DIP
wrst
A.
A
he
examnaton
MCP
sgt
te
examnaton
stor y
ands
Pysca
probem
contracture
ork
6-mont
s
unctona
deormty
67-year-od
n
to
te
gers. Pysca examnaton o bot ands sows ocazed
nger
C.
A
comes
te
tckenng
department
superca
yperextenson.
92.
serous
njured
Pysca
te
lexon,
no
o
te
A 72-year-od man comes to te pyscan because o an
te
unabe
o
and rm rdges n te pamar skn tat extend to te base
tp
sensaton
cord
cord
as
patent
45-year-od
s
be
atera
ts-
most
jonts
E.
posteror
he
ngers over te past year. He as no pan n s and but
and
decreased
he
E.
abnorma
dgts
o
te
te
D.
Limb
te
examnaton?
oter
o
a
te
not
woud
woud
puse
o
pysca
te
te
aceraton.
pressure
meda
coud
o
to
wrst
sows
Wc
patent
te
a
bood
examnaton
crease
he
comes
(99.5°F),
and
exposed.
key
man
sustaned
Upper
6
se
surgca
nerve?
pexus
mdde
pexus
trunk
•
Fig.
6.5
bceps
brac
299
300
C H A P T E R
97.
A
6
55-year
o
a
Upper
od
2-week
souder
man
tat
te
to
te
weakness
dsturbs
nternay
o
o
sows
mon. T enderness
MRI
comes
story
examnaton
and
Limb
s
pyscan
and
seep
at
ected
rotates
s
souder
wen
arm
sows
beow
te
s
te
Compresson
and
E.
supraspnatus
true
98.
about
te
It
nserts
B.
It
ntates
C.
It
s
nnervated
onto
supped
It
s
E.
It
orgnates
5-year-od
ater
njured
he
cdren
te
te
and
te
o
abducts
s
te
by
das
a
An
to
tree.
are
treated
bones
was
umerus.
te
o
patent
ter
most
key
6.6.
key
pexus
pexus
son’s
D.
Medan,
E.
Upper
n
Wc
o
102.
A
n
er
weakness
as
dicuty
parestesa
pam.
wt
aong
Pysca
ne
te
motor
meda
tasks
surace
examnaton
pyscan
sows
upper
o
o
te
te
tat
rgt
gr
rgt
ater
se
rada
trunks
comes
and
takng
ad
and.
Se
and
and
orearm
and
musces
wen
er
Adson
test).
te
s
and.
he
rotated
Wat
s
te
to
most
Erb-Ducenne
parayss
B.
Aneurysm
te
o
rada
te
A.
pexus
100.
o
neck
puse
psatera
key
s
emnence
and
and
atro-
(postve
dagnoss?
bracocepac
trunk,
wt
compresson
C.
horacc
D.
Carpa
E.
Injury
outet
tunne
to
te
syndrome
syndrome
meda
cord
o
te
braca
pexus
A 25-year-od man comes to te pyscan wt numb-
ness
s
and
tngng
pone
ours.
we
Pysca
adducton,
te
and,
owng
te
and
s
o
sensaton
cawng
s
o
ater
ebows
examnaton
mecansms
patent’s
A.
oss
and
o
eanng
te
most
payng
aganst
sows
on
game
desk
weakness
te
dgts.
key
a
a
meda
Wc
o
on
or
responsbe
6
wrst
aspect
o
o
te
o-
or
ts
presentaton?
Compresson
umera
and
o
a
unar
nerve
eads
passng
o
orgn
between
o
lexor
te
carp
unars
B.
Compresson
between
C.
te
Compresson
tunne
o
a
nerve
psorm
o
a
passng
bone
nerve
and
passng
at
Guyon
lexor
cana
retnacuum
troug
te
carpa
•
Fig.
braca
pyscan
past
arts
6
sown
was
n
most
6.6
o
cass.
concrete
te
he
sows
o
patent
a
and
er
o
wc
bocks
rgt
adducton
pexus
because
monts
examnaton
dmnsed
sde
te
marta
Pysca
abducton
te
te
breakng
py o grppng musces (“ong lexors”) and te ntrn-
sc
s
presen-
consder-
nerves
o
to
or
a
been
ypotenar
o
and
ower
because
mb.
weakness
unar,
and
17-year-od
pan
wt
was
abor.
cdbrt?
braca
Cavce
et
te
gestaton
preterm
nerve
braca
ractured?
te
unar
bracora-
structures
te
E.
to
to
newborn
te
tened
er
durng
he
oowng
o
Scapod
n
te
dgtorum
ootng
o
D.
comes
te
breec
vagnay
trunk
er
pan
a
o
n
trunk
Una
o
sows
devered
tracton.
o
weeks
ospta
Lower
C.
woman
o
32
te
Upper
says
story
s
at
to
C.
worsened
ong
deep
B.
Humerus
a
passng
no
Radus
22-year-od
lexor
rac-
B.
o
baby
njured
Rada
A.
A
nerve
G1P0,
Wc
A.
racture
nonoperatvey.
a
examnaton
he
s
nds
tat
occurrng
o
urgenty
amounts
Fg.
depart-
non-dspaced
normed
22-year-od
abe
scapua.
crades
examnaton
a
A
taton.
nerve.
emergency
he
between
o
musce
admtted
nerve.
te
passng
orgn
101–125
Pysca
spna
border
commony
be
C5
subscapuar
sows
parents
most
can
oowng
x-ray
te
o
s
101.
o
nerve
o
oowng
souder.
te
atera
brougt
rom
te
a
An
tendon
musce?
upper
te
o
tuberce
Neurovascuar
cd’s
s
by
boy
arm.
racture
esser
cely
rom
ang
abnormates.
ture.
te
adducton
D.
A
Wc
supraspnatus
A.
ment
99.
musce.
o
eads
Compresson
Questions
te
rada
supercas
acro-
resstance.
to
D.
et
Pysca
te
patent
aganst
njury
because
n
ngt.
pont-tenderness
s
pan
wt
lat-
and
ngers.
CHAPTER
Se
s
abe
decreased
ourt
and
descrbes
A.
to
lex
te
sensaton
t
te
dgts
over
dgts.
nature
Compresson
o
o
normay.
te
pamar
Wc
er
te
o
here
s
suraces
te
Upper
6
301
Limb
aso
o
oowng
te
best
njury?
medan
nerve
n
te
carpa
tunne
B.
Fracture
sa
C.
o
branc
te
o
Dsocaton
trquetrum,
te
o
unar
a
bone
wt
njury
to
te
dor-
nerve
n
te
proxma
row
o
te
carpus
103.
D.
Fracture
E.
Injury
A
o
o
te
te
10-year-od
department
mon
lexor
bursa)
o
body
unar
boy
ater
s
a
te
t
n
bte
seat
orearm.
to
tat
(aso
he
metacarpa
Guyon
brougt
dog
synova
s
o
nerve
cana
te
emergency
entered
known
wound
was
te
as
com-
te
unar
ceaned
and •
dressed,
serum.
and
e
T wo
days
ospta
wt
sweng
o
typca
ng
was
a
s
s
ater,
treated
te
pam.
o
seat,
susceptbe
te
to
anatomy
o
te
te
wound
and
oow-
o
Frst
and
B.
Second
trd
C.
hrd
ng.
D.
Fourt
vdes
E.
Ft
ment
2
and.
days
He
Pysca
on
te
te
o
pamar
te
a
sows
o
he
most
o
key
a
emergency
kne
a
te
red
wound
o
38°C
and
t
necton
dgtorum
wc
te
temperature
aspect
paanx.
lexor
to
sustanng
deveops
dsta
necton
te
dgt
oowng
spread
to
at
s
et
(100.4°F).
swoen
spreads
proundus
depart-
te
to
wound
base
te
tendons.
spaces
o
107.
I
coud
T ransverse
C.
Suprascapuar
Supreme
E.
Latera
A
penetratng
s
Hypotenar
C.
Mdpamar
D.
henar
compartment
pysca
E.
henar
space
make
36-year-od
(Fg.
pan
rest.
because
6.7).
s
venous
swoen
man
o
Vta
a
days
comes
sgns
ne
was
rgt
patent’s
ago,
are
wt
e
Axary-subcavan
Compresson
C.
Dsc
D.
Impngement
E.
Injury
o
ernaton
1
souder
norma
actvty
and
s
osptazed
Pysca
s
emergency
s
te
a
examnaton
most
key
B.
by
cause
o
ven
a
te
o
spna
unar,
woman
our
s
ater
and
MCP
o
to
sustanng
te
a
D.
he
rst,
he
A
kne
most
and
and
beed-
key
pro-
deep
braca
scapuar
toracoacroma
to
sustanng
te
o
te
wen
wound
examnaton
orearm.
and
Sensaton
te
emergency
kne
orearm
tumb.
on
te
a
proxma
pamar
oowng
IP
s
here
te
s
a
s
patent
decreased
key
patent
to
sows
surace
most
te
jonts
and
lexed
MCP
o
axa.
meda
ss
o
w
s
o
te
seen
on
asked
to
o
w
te
be
second
n
a
and
trd
condton
o
IP
and
man
ater
and
trd
jonts
w
s
be
sgty
dgts
o
n
o
sde
te
a
w
abducted.
be
te
scapua
te
to
bunt
examnaton
o
second
condton
brougt
sustanng
Pysca
rgt
lexed
and
ed
n
a
poston.
and
te
wngng
te
be
second,
55-year-od
rgt
emergency
severe
te
poston.
tumb
department
brougt
second
contro
he trd and ourt dgts w be ed n a sgty
dgts
nerves
and
he
E.
108.
medan
deto-
proxma
scapua?
brougt
dgts
te
te
C.
nerve
C4–C8
o
te
exam-
st?
sgty
tromboss
C5–C8
3½
te
apped
and
Pysca
te
examnaton
lexed
centra
sows
atera
he
s
pronaton
at
suprascapuar
ater
on
Pysca
suprascapuar
toracc
gt.
oppose
Wc
a
a
36.9°C
16/mn,
extenson.
he
reeved
to
dgts
axa
mts.
and
A.
depart-
and
syndrome
rada,
22-year-od
department
te
presentaton?
B.
A
n
wtn
was
arm. Wat
A.
to
to
ace
paced.
current
te
and.
du
exacerbated
Four
n
man
ours
te
umera
and
wound
o
unabe
B.
compartment
2
to
crcumlex
(superor)
toracc
durng
weakness
and
are
arteres
to
and
Hg.
s
are
wound
between
artery
oowng
cervca
mm
entry
njury
crcumlex
24-year-od
arm
o
temperature
respratons
camps
crcuaton
Posteror
D.
deep
axary
te
B.
te
space
ste
A.
te
to?
o
Her
115/72
Vascuar
te
coatera
s
3-cm
te
o
Wc
Centra
A
to
parts
et
compartment
a
cest.
82/mn,
pressure
department
seat
s
groove.
dsta
A.
ment
106.
ater
comes
examnaton
untreated,
105.
man
upper
sows
pectora
23-year-od
te
puse
bood
naton
te
A.
A
to
(98.4°F),
te
necton?
104.
6.7
te
and
o
spread
Fig.
ant-
(100.4°F)
wc
to
rabes
returns
38°C
Foowng
lexor
most
wt
patent
temperature
common
dgts
urter
te
emergency
to
s
pronounced
parta
dapragm.
trd
lexon.
trauma
sows
and
and
o
paray-
Wc
o
te
302
C H A P T E R
6
oowng
been
109.
Upper
parts
o
Limb
te
braca
pexus
as
most
key
orearm.
njured?
tender
A.
Cords
ton.
Passve
B.
Dvsons
pan.
An
C.
V entra
D.
T ermna
E.
T runks
A
a
jont
3½
seep
as
a
s
He
carpenter
key
A.
o
ngt.
atropy
tumb
comes
story
dgts
at
sows
o
man
3-mont
rst
between
brances
rgt
30
te
opposton
cause
o
ts
Compresson
to
and
9
years.
(see
te
pyscan
and
wc
years
tenar
ater
Pysca
6.2).
because
pan
o
Wat
s
te
n
te
C.
Syncondross
D.
T rocod
E.
Gngymus
113.
most
C.
pressng
at
te
o
Osteoartrts
E.
Repeated
A
tes
and
ours
and
carpa
and
pamar
and
tat
o
ago,
te
aspect
n
te
anteror
wt
oowng
te
bones
musce
com-
two
s
spne
to
er
nerve
te
pyscan
rgt
spped
on
er
nds
wrst
on
3½
radus
a
(see
An
a
Fg.
x-ray
carpa
6.3).
commony
Bracoradas
114.
A
59-year-od
Wc
T rquetrum
symptoms
ts
and
der.
A.
are
occur
Pysca
arm.
An
more
wen
o
ture.
Wc
a
dgts
severe
e
o
cervca
o
te
and
o
pan,
s
te
s
sows
rgt
rb
te
n
rases
examnaton
x-ray
ence
ntermttent
ourt
arm
accessory
oowng
and
over
weakness
souder
and.
s
o
sows
scaene
structures
s
t
te
In
C.
Beow
dg-
D.
Between
Axary
B.
Upper
rgt
nerve
braca
Subcavan
D.
Lower
E.
Bracocepac
pexus
o
artery
pexus
23-year-od
T wo
vece
115.
A
and
ower
trunk
o
braca
woman
because
days
coson
o
ago,
and
comes
severe
se
was
to
pan
te
n
nvoved
sustaned
a
emergency
er
n
et
a
contuson
ore-
ongus
dgtorum
ongus
and
lexor
dgtorum
s
brougt
and
puse
s
were
emergency
pae.
aceratons
18/mn,
jont,
te
coson.
markedy
severa
rada
to
vece
on
bood
absent.
can
te
Se
s
Pysca
er
body.
pressure
Ater
rada
s
cross-
artery
dented?
two
eads
o
te
snufbox
te
o
tendon
te
te
adductor
numbness
rst
te
and
two
te
rst
lexor
dorsa
pocs
second
nterosse-
ongus
dorsa
nterosse
pocs
atera
s
most
A.
Unar
B.
Rada
Recurrent
motor
D.
Medan
o
E.
Posteror
comes
o
to
brevs,
key
and
sows
te
and.
pamar
Wc
o
medan
nterosseous
or
and
because
te
weakness
pocs,
Sensaton
compressed?
branc
musce
pyscan
and
opponens
musces.
rgt
te
er
examnaton
pam
er
nterosseous
ongus
tngng
umbrca
o
dorsa
woman
Pysca
dgts
nerves
rst
pocs
and
C.
te
pocs
anatomca
69-year-od
o
3½
pexus
arm.
te
over
braca
ongus
lexor
are
Her
te
Between
rst
artery
trunk
department
E.
abductor
o
C.
A
te
monts.
trunk
oowng
musces
pres-
key
te
to
between
musce
B.
compressed?
A.
be
he
muscua-
most
o
es
and
appears
radocarpa
key
ous
sou-
te
te
Hg.
Between
a
parestesa,
rgt
lexor
motor
sows
respratons
mm
a
and
examnaton
E.
te
attempted
artery
Wc
he
coapsed
ongus
woman
ater
unconscous
most
o
and
pocs
department
ng
o
wrsts.
er
tendons?
pocs
Fexor
Scapod
story
pyscan
rada
arm.
se
pamars
Psorm
numbness
et
bracoradas
D.
and
er
mnutes
n
substerna
proundus
bone
wt
was
and
Fexor
o
emergency
and
D.
type
pan
radas
E.
dsocated?
pyscan
A
pan
and
10
te
radas
C.
te
he
he
to
severe
carp
80/60
to
ater
te
o
C.
severe
membrane
te
carp
Lunate
comes
o
Fexor
B.
man
causes
compartment
Fexor
Her
32-year-od
Wc
brougt
mandbe
puse.
par
a
B.
Captate
A
s
wegts.
and
near
wrst
sows
and
dscrmna-
nterosseous
una.
unconscous.
correct
te
experencng
te
rada
swoen
A.
n
o
er
o
te
a
supercas
and.
sensaton
dgts.
o
a.
to
dzzy
tendons
te
batroom
outstretced
dsocaton
most
wet
decreased
atera
because
ater
et
became
A.
3-mont
112.
and
s
unar
comes
patent
o
te
woman
tng
radated
at
and
sows
two-pont
afected?
ater
we
ocate
brac
cervca
te
orceuy
sows
compress
pexus
examnaton
artcuates
te
to
tat
condye
trceps
te
woman
e
te
o
numbness
Neuroogc
te
osteopytes
unar
te
trauma
54-year-od
pan
te
te
braca
D.
T wo
111.
o
nerve
Hypertropy
o
28-year-od
woman
Formaton
unar
A
department
tunne
B.
key
s
cest
nerve
most
Synartross
atropy?
medan
radus
Sympyss
weakness
o
orearm
orgnatng
te
B.
workng
oss
te
A.
examnaton
and
o
te
nterrupts
ago
emnence
Fg.
patent’s
o
te
numbness
retred
or
o
o
s
examnaton
wt
dorslexon
MRI
syndrome
ram
69-year-od
o
110.
Pysca
orearm
was
aspect
o
te
past
o
and
3
te
te
decreased
o
te
rst
oowng
CHAPTER
116.
A
32-year-od
operatve
motor
tpe
ca
vece
rgt
to
extend
n
andgrp
surgca
nerves
A.
Posteror
B.
Rada
nerve
C.
Rada
and
D.
Rada,
E.
Rada
A
cord
x-rays
s
tat
extenson
te
sows
aganst
most
key
te
and
mu-
120.
norma
and
o
at
te
te
braca
dsta
o
te
unar,
and
and
ater
ang
on
to
wet
T1
E.
C7,
C8,
T1
A
56-year-od
ua.
durng
te
compensate
emergency
jonts
o
te
dgts.
or
Dorsa
C.
Posteror
D.
Latera
E.
Superor
Dorsa
ater
awake,
mted
te
te
ractured
te
oowng
A.
Anteror
B.
Deep
C.
Rada
Deep
Medan
Se
An
o
porton
and
rada
te
key
musce.
radus
between
Wc
key
o
njured?
nerve
unar
nerve
122.
s
x-ray
Superor
B.
Mdde
C.
Ineror
du
aso
brougt
nvoved
pan
norma
s
n
o
arm
braca
te
te
a
et
to
ntate
atera
sows
arm,
lex
pexus
s
te
ebow
abducton
no
edema,
ractures.
most
key
Latera
cord
Meda
cord
1
our
coson.
no
He
as
and
te
posteror
te
he
rom
wc
A.
C5,
C6
B.
C5,
C6,
beng
severe
an
nerve
te
C7
nvoved
pan
n
brusng
ngers.
o
te
er
Wc
te
cd’s
o
o
te
most
entre
scap-
key
scapua?
artery
et
te
2
Se
years
a
Se
sweng
sows
carpa
as
ago.
examnaton
and
and
ts
emergency
bones
type
o
a
o
Coes
are
most
racture?
arm
to
car.
ressts
oowng
te
n
tat
to
emergency
er
se
s
upper
voenty
er
ted
rom
and
movement
te
depart-
extrem-
most
te
wakng
examnaton
pronated
any
s
et
prevent
Pysca
orearm
se
scapod
pan
recas
movng
and
te
and.
Pysca
n
and
brougt
severe
rased
a
to
psorm
sows
extended
due
key
to
cause
at
pan.
o
te
pan?
ema-
A.
Compresson
o
Wc
B.
Separaton
te
njured?
sur-
unate
s
o
patent’s
ebow
te
et
oowng
dsocated
and
moter
er
uaton
o
wt
Separaton
te
te
o
medan
ead
o
trocea
te
wt
Separaton
te
orearm
damaged
te
o
unate,
gr
because
o
D.
sows
and
3-year-od
te
be
ead
te
o
una
nerve
te
o
radus
te
te
and
rom
ts
artc-
ts
artc-
umerus
radus
te
rom
captuum
o
te
umerus
wounds.
and
arm
T rquetrum
C.
sows
open
s
o
E.
uaton
ater
examnaton
wt
Scapod
T rquetrum,
te
A 22-year-od man s brougt to te emergency depart-
ment
o
D.
trunk
E.
x-ray
or
C.
trunk
D.
An
scapod
ront
o
w
tenderness,
unate
tat
trunk
orented.
and
n
and
and
er
and
by
to
dagnosed
movement,
ractured
o
momentum
marked
and
Vta
wrst.
Her
border
brougt
on
T rquetrum
gr
examnaton
s
ang
T rquetrum
ty.
vece
souder.
unabe
to
emergency
motor
Pysca
unabe
te
to
n
mts.
estabsng
proxma
te
A.
s
suppy
to
muscuo-osseous
arteres
B.
A
needed
a
meda
A.
ment
patent
rst
te
o
o
ematoma
supnator
most
beng
as
te
wtout
toma
s
woman
wtn
tat
o
ater
sgns
mb.
racture
nerve
coson.
arm
o
branc
34-year-od
souder
and
nerves
a
nterosseous
department
sows
sows
expandng
nerve
E.
are
an
radus
branc
D.
A
orearm
sows
et
wa
wt
umera
osteopoross
racture. Wc
o
emergency
artery
woman
An
MRI
te
artery
toracc
te
an
to
toracc
o
aert,
cest
te
crcumlex
56-year-od
story
er
repaced
bood
scapuar
and rada devaton s noted on extenson o te wrst.
x-ray
brougt
oowng
te
B.
sows
MCP
te
Suprascapuar
A
o
and
A.
s
te
s
nvovng
o
department
Pysca
area
grat
Wc
and
o
arge
scapuar
pavement.
T1
woman
removed
te
examnaton sows weakened abducton o te tumb
extenson
A
as
umerus
te
C8,
C8,
o
121.
brougt
C7,
C7,
son.
medan
s
C6,
C6,
gcay
muscuocutaneous
man
C5,
D.
He
pexus
trd
C.
303
Limb
department ater beng nvoved n a motor vece co-
orearm
Wc
njured
a
surg-
and.
gravty
supnaton.
post-
sowed
o
orearm
wrst
and
a
nvoved
requred
examnaton
and
or
beng
unar
52-year-od
and
119.
Prevous
o
were
pyscan
ater
procedure?
department
118.
arm
sensaton
unabe
te
ractures
Pysca
te
to
monts
mb
weakness
oowng
117.
o
norma
5
coson.
nterventon.
and
comes
up
upper
abducton
s
man
oow
Upper
6
he
s
most
s
oss
oowng
arm.
mb
extend
sensaton
and.
o
te
eves?
An
over
x-ray
umerus.
composed
spna
Pysca
to
E.
vece
upper
unabe
o
racture
key
motor
rgt
dorsoatera
obque
s
a
rgt
te
patent
here
and
te
o
n
o
bers
123.
A
o
trocea
o
epcondye
meda
Pysca
te
man
ater
and
o
x-ray
body
Wc
rada
s
beng
examnaton
wrst
dorsum
te
o
te
o
o
te
Medan
B.
Unar
et
ts
nerve
o
te
artcuaton
wt
by
sows
a
and
to
bat
oss
to
sows
umerus
t
just
nerves
passes
te
on
weakness
proxma
arm
oowng
as
bend
umerus
brougt
t
jonts,
and
te
te
A.
MCP
rom
umerus
te
61-year-od
An
una
te
Stretcng
department
te
te
o
o
te
a
o
et
sensaton
rst
to
most
arm.
extenson
arne
dsta
s
emergency
te
ts
two
on
at
te
dgts.
racture
o
mdpont.
key
njured?
304
C H A P T E R
6
Upper
Limb
te
oowng
grapc
A.
A
eson
crease
B.
A
expected
o
o
te
te
IP
be
present
durng
rado-
o
te
Avuson
unar
nerve
at
te
dsta
lexor
o
te
extenson
expanson
over
te
jont
Compresson
ton
D.
to
wrst
separaton
mdde
C.
s
examnaton?
o
te
unate
deep
unar
nerve
by
dsoca-
bone
racture
o
te
dorsum
o
te
dsta
paanx
E.
127.
A
Fracture
o
42-year-od
te
ourt
woman
or
t
comes
metacarpa
to
te
bone
pyscan
or
a
oow-up ater njurng er et souder. T wo monts
ago,
se
branc
•
Fig.
Se
6.8
was
and
as
Rada
condtons
Muscuocutaneous
ca
Axary
A
34-year-od
motor
ma
Pysca
over
te
et
6.8).
ater
coson.
e
s
tat
act
Wc
Vta
wrst,
was
emergency
nvoved
are
aert,
and
and
and.
te
IP
oowng
n
wtn
numerous
extend
te
te
sgns
sows
to
o
e
awake,
orearm,
to
a
nor-
orented.
aceratons
Parayss
jonts
s
ner ves
128.
o
noted
s
A.
Unar
B.
Recurrent
to
ateray
C.
Parayss
o
ntrnsc
D.
Parestesa
E.
Loss
A
te
Rada
o
ts
E.
Anteror
tory
o
n
mm
and
nerves
An
MRI
cervca
s
most
brougt
are
neck
20/mn,
Pysca
key
o
a
pan.
and
range
extenson
examnaton
regon.
te
Wc
o
o
nds
o
te
emergency
2-week
Her
bood
examnaton
restrcted
on
to
because
ncreasng
weakness
ebow.
te
s
usband
Hg.
mobzaton,
neck,
te
er
respratons
128/32
wt
by
progressvey
80/mn,
s
nterosseous
a
s
pressure
sows
moton
te
s-
puse
pan
o
te
orearm
ernated
oowng
129.
te
dsc
ater
o
transverse
o
teres
quadratus
C.
Bracas
D.
Supnator
E.
Bracoradas
ater
er
atera
beng
and
2
oter
sde
o
C7
A.
Centra
C8
B.
Humera
E.
T1
C.
Pectora
D.
Subscapuar
E.
Parasterna
department
coson.
as
Vta
severe
Pysca
ater
pan
beng
sgns
and
examnaton
nvoved
are
wtn
n
a
mobty
sows
maet
a
motor
norma
mted
emergency
o
vece
mts.
te
nger.
Se
nger.
Wc
o
130.
A
vta
er
D.
te
a
o
te
oowng
durng
pys-
and
te
o
o
to
te
n
a
most
and
emergency
motor
norma
o
te
radus
teres
prox-
orearm
proxma
musce.
key
ve-
mts.
devated
x-ray
te
arm
te
ateray
An
group
o
by
ago.
examnaton
C.
to
s
btten
days
be
brougt
te
to
Wc
responsbe
or
A 45-year-od woman comes to te emergency depart-
Wc
s
musces
o
wtn
pronator
Pronator
C5
woman
o
te
aspect
are
racture
Pronator
Pysca
126–150
mted
arm
o
nvoved
sows
te
te
dorsum
radus.
B.
C6
34-year-od
and
racture
present
brougt
sgns
te
oowng
s
beng
Vta
B.
A
be
musces
te
woman
A.
Questions
n
examnaton
(102.9°F);
compressed?
Wc
rotate
meda
A.
o
spna
no
tree
pasy.
devaton?
ment
at
te
sensaton
porton
a
n
attacment
Muscuocutaneous
woman
o
coson.
D.
45-year-od
to
ang
scapua
41-year-od
C.
A
expected
Wnged
Pysca
medan
aso
Inabty
sows
o
s
a
pan
sowed
grde.
by
Erb-Ducenne
worsenng
B.
ma
branc
souder
souder
wt
x-rays
A.
ce
most
et
examnaton?
department
njured?
department
126.
brougt
mnutes
and
musces
key
s
examnaton
s
(Fg.
30
vece
mts
man
te
Prevous
te
D.
department
125.
o
C.
E.
124.
on
dagnosed
progressvey
movement.
bones
t
was
et
a
sgns
and
te
wtn
an
and
nodes
on
atera
temperature
are
sows
ymp
dog
Her
most
wound
mts.
on
ymp
key
sde
39.4°C
norma
open
swoen
s
s
te
te
nodes.
rst
to
nvoved?
axary
25-year-od
department
coson.
arm
Pysca
appears
absent
woman
ater
and
beng
brougt
nvoved
examnaton
swoen,
any
s
pae,
movement
and
o
to
n
te
a
sows
coo.
te
emergency
motor
tat
Rada
arm
vece
te
rgt
puse
causes
s
severe
CHAPTER
pan.
te
An
hree
er
arm.
ater
Wc
expan
se
as
severe
o
te
te
C.
Compartment
D.
Raynaud
dsease
E.
Injury
te
on
sows
and
pan
oowng
ndngs
V enous
a
a
racture
cast
over
s
te
condtons
pysca
at
paced.
engt
w
o
135.
most
outet
o
examnaton?
Smt
E.
Boxer’s
A
syndrome
nerve
s
unar
tumb.
brougt
norma
D.
Smt
E.
Boxer’s
o
ractured
te
oowng
A.
Medan
B.
Recurrent
Rada
D.
Anteror
E.
Deep
a
on
can
w
amate
most
tenderness
o
te
bones.
key
be
and
Wc
136.
njured?
A
o
medan
man
comes
o
a
reacng
rgt
to
s
beow
postve.
Wc
s
wen
te
pyscan
rgt
ead
Pysca
papaton
present
te
panu
over
sde.
to
because
souder.
and
examnaton
te
o
te
A.
Panu
abducton
0
to
15
B.
Panu
abducton
0
to
140
he
oowng
abducts
s
ts
A.
C5
B.
C6
ten-
s
most
arm?
137.
degrees
C.
C7
D.
C8
E.
T1
A
arm
and
Panu
abducton
70
to
140
degrees
sgns
D.
Panu
abducton
15
to
140
degrees
sows
E.
Panu
abducton
40
to
140
degrees
tra
54-year-od
department
as
severe
ton
An
bones.
key
ater
pan
sows
x-ray
o
te
er
and
o
s
ang
n
tenderness
Wc
be
woman
te
brougt
on
an
rgt
over
to
te
sows
te
emergency
outstretced
wrst.
and.
Pysca
anatomca
dsocaton
oowng
carpa
te
o
bones
o
C5
B.
C6
snufbox.
C.
C7
D.
C8
E.
T1
carpa
most
A
55-year-od
coson.
Se
C.
Hamate-unate
sgns
wtn
D.
Psorm-trquetrum
ton
E.
Hamate-captate
o
department
pan
n
mts.
te
te
ater
et
Pysca
ang
and.
x-ray
te
rst
jont.
o
te
and
metacarpa
Wc
A.
Coes
B.
Scapod
C.
Bennett
o
Vta
wet
sgns
examnaton
carpometacarpa
An
on
te
sows
bone
tat
oowng
racture
racture
racture
are
jont
a
wtn
a
o
extends
most
He
te
at
nto
key
s
a.
te
to
6,
er
o
te
emergency
he
temperature
respratons
129/79
te
te
unconscous.
mm
bceps
Hg.
are
s
19/
Pysca
brac
aferent
brougt
Se
o
as
relex.
component
te
mts.
to
spna
te
pan
et
o
Pysca
nerve
s
emergency
aong
upper
bracoradas
te
mb.
et
Vta
examnaton
relex.
he
responsbe
s
key
ven-
or
ts
Coes
and.
B.
Scapod
C.
Bennett
CMC
dagnoss?
139.
V okmann
and
Wc
te
xed
lexor
decreased
o
te
musces
lexon
o
te
sensaton
oowng
s
o
te
scemc
contracture
racture
62-year-od
because
te
o
Vta
examna-
racture
Boxer’s
o
noted.
Pysca
and
vece
orented.
racture
E.
ment
cyanoss,
emergency
motor
racture
D.
A
tenderness
te
a
and
mts.
papaton
to
n
dagnoss?
A.
o
aert,
norma
on
aso
brougt
nvoved
awake,
exquste
Sweng,
s
beng
s
orearm
and
most
ater
o
base
te
sows
te
te
norma
et
te
are
dgts.
as
dsocaton
racture
s
emergency
pavement.
sows
(CMC)
te
s
o
woman
T rapezod-trapezum
to
a
wc
B.
brougt
eve
norma
o
department
s
o
relex?
138.
man
s
absent
mobty
Scapod-unate
62-year-od
ound
97/mn,
an
woman
A.
A
s
pressure
ater
wtn
ramus
A.
w
jont
dagnoss?
brougt
score
puse
spna
absence
Se
nvoved?
scae
mted
are
examna-
te
s
beng
sows
54-year-od
C.
A
woman
bood
department
degrees
key
MCP
relex?
as
empty
most
te
tumb
rupture
tumb
ater
coma
and
seep-
sows
acromon.
patent
He
dicuty
o
te
o
swoen
o
racture
examnaton
s
gament
sows
we
Pysca
and
weakness
and
a
racture
(98.6°F),
Wat
rgt
a
mts.
tender
and
emergency
racture
54-year-od
37°C
te
te
rom
norma
severey
and,
to
tumb
racture
department
nterosseous
story
s
test
key
and
sows
x-ray
mn,
wen
derness
nerves
An
unar
2-week
ng
psorm
branc
43-year-od
pan
wrst.
Gasgow
C.
A
examnaton
pan
s
Gamekeeper’s
Bennett
et
as
Wat
A.
Scapod
te
Se
o
coatera
C.
Pysca
tree.
emergency
brougt
er
wtn
a
rgt
MRI
B.
o
a
te
te
and
mts.
rom
to
are
sows
o
s
njurng
sgns
mted mobty o er et wrst. Vta sgns are wtn
sweng
ang
dgt
woman
ater
Vta
abducton.
te
rada
racture
examnaton
rst
305
Limb
racture
23-year-od
skng.
syndrome
woman
ater
D.
department
tromboss
22-year-od
sows
134.
arm
umerus
horacc
A
rgt
te
B.
and
133.
te
o
A.
department
132.
o
groove
days
key
131.
x-ray
rada
Upper
6
rgt
man
o
a
and
comes
3-our
ater
a
to
te
story
a.
emergency
o
pan
Vta
and
sgns
depart-
sweng
are
wtn
306
C H A P T E R
6
norma
ness
mts.
to
and.
Upper
Pysca
papaton
An
x-ray
te
psorm
ng
area.
Limb
and
o
te
bone
Wc
rgt
and
o
examnaton
sgncant
a
te
sows
sweng
and
sows
ematoma
oowng
o
o
a
s
Pysca
rgt
racture
te
nerves
tender-
te
sgty
o
musce
surround-
most
rgt
key
most
afected?
140.
key
Anteror
AC
Rada
C.
Cavcuar
C.
Medan
D.
Spra
D.
Deep
unar
E.
Rotator
E.
Deep
rada
A
ment
s
1
our
er
ton
bcyce.
njurng
Vta
examnaton
wt
and
ton.
ater
te
te
rst
tree
ourt
Wc
o
sgns
sows
and
te
er
ebow
are
a
wtn
n
te
ngers
oowng
se
norma
Benedcton
dgts
t
wen
mts.
sgn
o
extended
n
nerves
e
te
lexed
are
most
here
pos-
te
key
Injury
to
medan
and
B.
Injury
to
medan
nerve
C.
Injury
to
rada
D.
Injury
to
unar
Injury
to
medan,
E.
A
54-year-od
department
cest
pan
and
ton.
Wc
durng
wt
surgery
o
s
o
an
te
nerves
and
n
s
rada
or
2
eads
rada
oowng
ours.
An
ECG
and
te
and
soud
beore
s
be
te
sows
Aen
B.
T rceps
artery
Tne
Bracoradas
E.
Bceps
A
grat
146.
wt
he
pan
ton
s
n
patent
ness.
ourt
owng
A.
te
ater
ead
t
te
a
o
s
most
Compresson
s
key
o
te
a
onto
or
sows
te
a
department
concrete
oss
o
Fexon
pamar
decreased.
n
loor.
B.
Injury
C.
Compresson
between
D.
E.
A
te
te
rada
o
two
Compresson
Injury
o
te
65-year-od
department
he
patent
Rada
E.
Unar
A
o
te
Wc
o
nerve
n
o
te
unar
o
rada
nerve
s
te
o
on
ractured
nerve
by
a
s
severe
as
pronator
nerve
brougt
ang
compans
rom
medan
eads
man
ater
nerve
te
dgts
s
sgns
are
sows
by
te
te
te
ractured
to
te
s
at
s
pronated.
sweng.
key
by
extrem-
arm
orearm
or
he
Wc
njured
norma
o
n
o
ts
Fracture
o
te
md-body
D.
Fracture
o
te
surgca
E.
Laceraton
o
22-year-od
routne
te
ven.
deep
to
and
as
o
Pysca
exam-
contour
o
te
depresson
oowng
se
te
neck
o
njures
to
o
to
te
pyscan
wtdraw
te
te
er
or
venpuncture,
bood
neede
ven
rom
te
and
competey
oowng
cubta
prevented
umerus
cord
passed
medan
umerus
te
Durng
Wc
te
te
njur-
process
comes
unabe
tat
and
responsve.
appearng
posteror
woman
s
and
jont
examnaton.
reazes
barrer
te
aert
norma
o
coronod
souder
emergency
sustan?
C.
A
te
Wc
te
mts.
te
key
to
motorcyce
s
abnorma
most
o
a
patent
oss
an
brougt
rom
Avuson
structures
as
acted
puncturng
as
an
arter y?
Bcpta
carpa
souder
s
depart-
ted
upper
ods
and
most
Dsocated
C.
outstretced
rgt
rgt
He
B.
Fexor
147.
retnacuum
teres
musce
aponeuross
D.
Bracoradas
E.
Bceps
A
brac
21-year-od
department
ror
psorm
beng
gament
acromon.
Pronator
emergency
s
emergency
ater
gament
wtn
patent
B.
supnator
te
s
pan.
ang
te
and
A.
teres
md-body
tendon
man
souder.
o-
passes
te
membrane
ater
te
t
o
extended
coatera
te
umerus
to
to
pan
ematomas
coatera
o
te
arm
A.
a
dagnoss?
medan
te
s
gament
brac
35-year-od
ocated
tunne
o
D.
troug
abduc-
surace
over
umerus
umera
structures
Interosseous
qucky
conscous-
weakness
ngers.
over
ngers
emergency
trauma
examnaton
Sensaton
and
s
arm
te
te
brougt
et
vsbe
C.
a
comes
adducton
norma.
no
pebotomst
man
denes
Pysca
and
relex
relex
34-year-od
s
due
Annuar
dd
perormed
test
te
ebow
Bceps
beow
proposed.
relex
D.
s
souder
test
C.
o
Movement
B.
naton
operaton?
A.
o
o
A.
Vta
narc-
bypass
boy
oowng
ng
patent
coronary
grat
absent
oowng
tear
restrcted
department
substerna
myocarda
artery
tests
145.
emergency
severe
wa
examnaton
nerves
te
V1–V3
perormed
a
to
constant
anteror
usng
pysca
nerves
brougt
sweatng
Angograpy
bypass
unar,
man
eevaton
dagnosed
unar
aso
te
and
detod
patent?
nerve
because
ST -segment
s
and
rada
cuf
because
are
s
o
te
racture
racture
wt
pos-
njured?
A.
s
sde
Wc
rotated
o
subuxaton
parents.
ty
te
jont
4-year-od
ment
externay
Fattenng
sensaton
dsocaton
B.
144.
and
an
arm.
dagnoss?
A.
A 32-year-od woman comes to te emergency depart-
sows
rgt
musce.
B.
and
143.
noted
Unar
Pysca
142.
s
detod
A.
rom
141.
examnaton
abducted
crease.
ng
man
ater
surace
o
wte
and.
or
tngng
pan.
or
te
te
and
and.
brougt
et
a
wrst
examnaton
structure
o
s
sustanng
s
Pysca
extenson
musce
tendon
deep
wrst.
no
oss
Sensaton
to
he
o
to
to
te
aceraton
dsta
sows
te
a
te
broad,
as
o
pnprck
any
s
te
skn
superca
patent
moton
to
emergency
on
no
o
ante-
od
gsten-
asca
on
numbness
te
norma
ngers
n
a
o
CHAPTER
te
ngers
as
148.
te
and
Fexor
retnacuum
B.
Fexor
carp
C.
Pamar
te
and. Wc
tendon
skn
dgtorum
supercas
proundus
o
te
tumb
norma.
er
s
Pysca
to
o
te
te
Wc
o
te
medan
o
te
pamar
C.
Injury
o
medan
Injury
te
te
te
o
te
22-year-od
s
ts
most
Rada
C.
Anteror
D.
Posteror
Deep
meda
norma
on
most
and
n
C6–C8
s
C.
C4
D.
C2–C4
E.
C5–C7
A
a
accounts
carpa
te
tunne
medan
pamar
unar
payer
s
s
o
a
o
s
exposed
o
o
te
a
te
s
key
nerve
at
strengt
key
brougt
to
Durng
and
te
njury
an
tat
emer-
ater
a-
surgery,
artery
orms
oowng
s
te
te
153.
Inraspnatus
Pectoras
C.
Subscapuars
D.
Supraspnatus
E.
T eres
A
vsu-
o
weakness
loor
e
grabbed
arteres
was
Pysca
s
brougt
o
dsta
a
deep
te
kne
orearm. Vta
and
o
paper
dgt
and
Wc
o
wound
o
te
s
te
wtn
154.
weak-
dgts.
meda
te
on
are
sows
between
te
emergency
sgns
examnaton
adducton
pece
t
to
He
s
tumb
oowng
o
o
was
A.
Lower
B.
Medan
te
mus-
nnervated
nerve
pyscan
ago,
er
was
souder
o
hs
wc
o
or
a
sustaned
reduced
rotaton
n
se
we
n
examnaton
vst.
E.
Upper
A
te
sows
er
arm
ndng
te
at
was
oowng
trunk
o
te
and.
ater
Wc
Lumbrca
D.
Pamar
E.
Extensor
155.
ater
ang
s
rgt
puse
s
x-ray
a
souder.
s
te
te
poe
Hs
emergency
and
on
rgt
and-
temperature
respratons
109/79
tenderness
o
street
68/mn,
pressure
sows
of
to
mm
Hg.
are
Pysca
movement
souder
s
12/
o
te
sows
a
A
two
n
o
tree.
abducton
unabe
Wc
ago,
a
to
te
oppose
oowng
pexus
braca
s
an d
te
or
ton
sows
o
te
te
sow s
d g ts
te
os s
n
os s
at
te
nge rs
o
e m er ge ncy
an d
kn e
e xte n -
IP
jo nts,
o
te
musc es
IP
a
o
r gt
s
e xte ns o n
most
o
te
musces
dgtorum
musces
nterosseous
dgt
72-year-od
as
t
to
r gt
o ow ng
nterosseous
Se
s
exam n at on
o
pexus
b rougt
ngers?
department
tendon,
s
rom
njured?
nj ur n g
responsbe
C.
brougt
weakness
because
weeks
nerve
abduct on
Rada
s
ew
ang
He
braca
te
our t
o
Unar
man
o
man
Pysca
oss
pyscan
A
nerve
2 8-year-od
key
151–175
key
te
was
and.
te
Muscuocutaneous
and
nerves
o
e
dgts.
rgt
most
to
and.
sows
s
Unar
E.
An
tear
as
D.
D.
souder.
s
o
he
nerve
Dorsa
bood
o
Pysca
rgt
C.
son
te
o
trunk
Extensor
(98.6°F),
jont
comes
s
s
B.
examnaton
loor
oowng
te
souder
a
examnaton
A.
and
te
to
meda
branc
adducton
gt.
ngers.
sde
a
Muscuocutaneous
mn,
racture
o
week
today’s
by
man
o
depar tment
njured?
on
te
mnor
29-year-od
Medan
drecty
o
umerus.
major
C.
37°C
on
caused
B.
ng
te
durng
B.
meda
department
and
A.
and
absent.
28-year-od
One
department.
Axary
A
comes
genoumera
A.
Questions
woman
soccer
souder
most
nerves
bone
te
Pysca
od
dgt
te
wc
appontment.
dsocated
te
arc
man
abducton
o
by
o
rgt
C5
21-year-od
decreased
nerve
branc
medan
wrst
and.
ractured
because
o
engt
te
C4
and
payng
nterosseous
mts.
to
and
oow-up
nterosseous
pamar
Sensaton
s
te
best
152.
C3
B.
structures
sde
o
afected
composed
A.
te
department
ourt
te
o
branc
and
Wc
36-year-od
unabe
base
vsuazed?
B.
ness
acera-
te
weakness
n
njures
n
and
because
te
space.
key
Unar
E.
rada
snufbox
A.
A
recurrent
ootba
crossng
entre
musces?
outstretced
anatomca
or
nerve
branc
recurrent
department
on
azed
and
Sensaton
a
rom
was
wrst
Injury
ng
se
sows
pam
bones,
emergency
we
nerve
o
key
nerve
emergency
Injury
gency
te
ndngs?
Injury
A
er
oowng
B.
E.
o
psorm
te
to
and
examnaton
aspect
A.
D.
er
tumb.
o
tendons
tendons
brougt
njurng
proxma
opposton
or
woman
ater
wood.
te
a
te
sucus
307
Limb
roots?
dgtorum
34-year-od
troug
most
by
Fexor
on
racture
ce
unars
Fexor
A
structure
ntertubercuar
E.
ton
151.
o
D.
carvng
150.
pam
ocated?
A.
department
149.
te
pyscan
Upper
6
woman
ater
a
sgncant
a
and
a
s
brougt
on
ebow
papabe
pan
musces
mnm
er
pan.
deect
durng
to
te
emergency
outstretced
over
ebow
Pysca
er
et
bceps
lexon
arm.
examna-
brac
wtout
any
restrcton on movement. An x-ray o te et arm does
not
sow
wt
ractures
rupture
o
te
or
dsocatons.
bceps
brac
Se
s
tendon.
dagnosed
Wc
o
308
C H A P T E R
te
6
oowng
contnue
to
Bracas
B.
Fexor
C.
Fexor
D.
Pronator
E.
T rceps
A
Se
carp
teres
a
te
o
a
dect
o
Adducton
B.
Extenson
C.
Fexon
o
o
Pysca
te
o
te
ndex
te
s
a
He
at
most
o
a
rst
B.
Fracture
o
te
trapezum
E.
Frst
A
o
CMC
bat
at
te
rgt.
te
rgt
here
son.
s
s
o
part
C8
D.
C8
and
T1
E.
C5–T1
key
to
161.
and
o
s
on
o
o
pan
as
a
to
a
outstretced.
C.
henar
D.
Fexor
E.
Hypotenar
te
atera
metacarpa.
A
emergency
rom
a
wt
te
pexus
s
tat
e
ond
and
s
and.
A.
Deep
B.
Anteror
arm.
C.
Medan
D.
Recurrent
E.
Deep
key
163.
A
B.
Dvsons
Pysca
V entra
E.
T runks
A
a
ram
1-week
ater
and
a
story
game
extends
atera
wrst
woman
o
o
rgt
tenns.
nto
te
sows
A.
Rada
B.
Unar
C.
Fexon
w
devaton
devaton
he
md
to
ebow
te
o
most
because
pan
at
te
orearm.
and
one
key
he
begns
te
sweng
Wc
cnc
pan.
pan
dorsum
epcondye.
movements
comes
te
exacerbate
o
extended
te
o
rotated
and
te
a
da-
Pysca
pro-
oowng
rm.
and.
pyscan
rgt
wrst.
te
sgn
w
works
examna-
wrst
poston
Tne
because
Se
Pysca
o
musces
wt
te
reproduces
s
postve.
most
key
be
nterosse
IV
I
and
II
to
a
and
te
buttonng
seet
and
o
srts.
are
o
tenderness
oowng
because
Vta
examnaton
paper
tere
proundus
pyscan
s
Pysca
te
because
te
between
no
and
sgns
sows
s
sensory
sec-
dects
nlammaton
nerves
s
mosty
are
key
lexor
on
man
comes
o
and
a
o
pysca
Weakened
sows
te
o
abduct
Weakened
lexon
Weakened
opposton
E.
Inabty
23-year-od
pan
he
n
te
pan
s
o
adduct
man
rgt
deep
dects
depart-
broken
aceraton
transverse
wrst.
here
Durng
o
te
D.
to
a
emergency
rom
crease
s
no
pysca
w
gass.
across
on
njury
examna-
most
key
be
examnaton?
pronaton
to
te
dsta
te
C.
A
to
njury
retnacuum.
Inabty
164.
medan
neuromuscuar
B.
pan?
o
rada
surace
A.
over
o
engt
ebow
oowng
unar
examnaton
wc
ound
o
branc
branc
Pysca
te
mts.
o
nterosseous
anteror
ton
started
tenderness
o
to
lexon
mts.
grp
o
branc
entre
te
to
examnaton
te
te
brances
55-year-od
aw
comes
ngers
22-year-od
ment
T ermna
story
meday
Wc
supercas
wt
Sgns
o
Cords
D.
to
s
te
umbrcas
man
Wc
A.
C.
abe
and
abducted
and
norma
trd
a
afected?
excur-
most
wtn
te
III
dgtorum
te
asymmetry
dapragmatc
braca
on
and
as
because
oowng
condton?
pamar
dicuty
absent.
baseba
and
24-year-od
as
and
rgt
ts
Dorsa
souder
orward
durng
by
n
arge
arm
njured?
comes
oowng
Lumbrcas
te
sows
te
te
B.
on
key
pyscan
norma
lexed.
maxma
A.
e
and
n
o
a
lexed
days
2
162.
bow
pan
s
woman
n
moter
orearm
numbness
tat
a
weakened
n
neck
n
Wc
perorm
pan.
rst
to
sows
ebows
pan
and
secretary
ton
weakened
njured?
159.
48-year-od
are
pusng
te
A
te
te
te
brougt
asymmetry
Wc
s
examnaton
scapua
aso
C7
and
extensors
sustanng
juncton
Pysca
and
C7
te
rgt
adducted
rgt
most
C6
emergency
abe
to
s
C.
worsenng
been
ram
to
te
wtn
an
wrst
B.
artrts
man
ater
o
te
ten-
dgts
te
and
Her
dgto-
nger
sgty
arm.
o
Her
are
sows
C6
metacarpa
tumb
sgns
and
scapod
jont
55-year-od
department
o
te
most
devaton
brougt
devery.
Vta
ventra
s
movement
C5
dagnoss?
te
T enosynovts
mted
unar
gr
A.
ngers
to
due
base
o
Fracture
wrst.
te
lexor
tenderness
Fracture
D.
be
tte
and
not
wt
te
er
nger
te
car
and
newborn
nated
examnaton
between
te
te
trd
A.
C.
o
tte
sows
key
w
because
as
drve
examnaton
and
brougt
we
cuttng
depart-
nger
and
s
adder
wrst
A
compcated
oowng?
tumb
second
man
or
Fexon
o
dgto-
emergency
wound
patent
base
of
te
te
te
te
Extenson
E.
rgt
Pysca
radas
abducton
wrst.
te
s
hs
o
dutes
e
o
over
by
rgt
work
by
and
36-year-od
Wat
lexor
D.
examnaton
sucde
rng
Sensaton
o
radas
and
te
te
Opposton
sde
carp
to
depresson.
wc
o
E.
e
160.
lexor
brougt
carp
and
D.
ago
to
coracobracas
part
lexor
A.
s
patent
supnator
and
s
deepest
te
ave
s
te
betes.
o
supercas.
n
and
attemptng
rum
A
aow
supercas
and
gr
story
department
158.
unars
brac
lexon
157.
key
bracoradas
dgtorum
ater
dons
most
ebow?
proundus
as
sows
er
and
16-year-od
ment
Limb
musces
lex
A.
rum
156.
Upper
sarp,
te
comes
orearm
tumb
o
te
upper
te
tumb
te
tumb
tumb
to
te
pyscan
extremty
exacerbated
by
or
because
severa
movement,
o
weeks.
and
s
CHAPTER
progressvey
ng
o
or
te
te
rgt
pan
s
ton
o
te
upper
te
rgt
rgt
durng
arm,
resstance.
snce
e
basketba
extremty
reproduced
aganst
o
worsenng
upcomng
souder.
s
sows
te
and
here
ncreased
season.
no
nta
wen
Wc
arm
nerve
tran-
deormty.
n
309
Limb
Examnaton
pase
te
weakness
s
Upper
6
o
s
abducted
atera
was
he
abduc-
rotaton
most
key
njured?
165.
A.
Lower
B.
Axary
subscapuar
C.
Rada
D.
Suprascapuar
E.
Upper
A
subscapuar
35-year-od
man
comes
to
te
pyscan
or
a
o-
•
ow-up
examnaton.
aceraton
ever
part
ts
o
and
nodes
s
rom
and
ad
a
to
tenar
Wc
key
ts
sustaned
be
te
njured
te
rst
168.
25-year-od
Her
s
a
oow-
to
A
because
Durng
emnence
o
te
rst
pece
motor
receve
asked
njury?
o
o
axary
to
B.
Subcavan
openng
C.
Latera
aong
D.
Anteror
E.
Centra
axary
by
moter
et
o
ca
et
arm
An
and
sown
Jont
C.
Interosseous
Rada
E.
Unar
son
arm
was
s
s
he
n
toys.
extremty
axty
ts
o
wc
woman
because
potograp
o
examnaton
wrst
unar
sows
or
key
and
Numbness
to
worsenng
D.
Ineror
trunk
o
te
braca
E.
Posteror
169.
voa.
“stuck”
er
te
and
sows
s
pan
and
racture
arne
cana. Wc
durng
weakness
te
n
o
o
te
te
o
Fg.
te
An
by
er
6.9.
numbness
strengt.
pysca
o
pyscan
sown
a
and
no
Wrst
C.
Atropy
D.
Postve
E.
Weakness
te
te
Tne
n
tenar
musces
test
wrst
a
neck
o
and
cosng
to
and
reproduced
rom
te
axa
s/are
most
te
dsta
to
or
te
ndex
nger
wen
sound
te
o
Wat
s
to
nger
extend
and
eard.
te
payng
ndex
asked
be
because
wen
extenson
can
aspect
atropy.
pexus
pyscan
sows
passve
pamar
pexus
braca
poston
Durng
radus
tunne
examnaton
snappng
erytema
te
er
epcondye
o
comes
o
lexed
nger.
over
x-ray
amate
oowng
at
w
examnaton?
ourt
and
t
170.
T enosynovts
B.
Dupuytren
lexon
Se
nger.
te
as
here
most
key
Maet
D.
Boutonnere
E.
Boxer’s
A
an
great
era
er
s
dstress.
tree
used
to
are
adducton
nger)
deormty
racture
woman
unsgty
and.
(trgger
nger
25-year-od
o
stenosans
contracture
C.
ump
Se
and
a
as
a
Durng
A.
Neurobroma
B.
Gangon
cyst
a
er
o
to
te
wrst
tngng
dgts
te
wc
Wc
dagnoss?
comes
on
pysca
umnate
draned,
symptoms.
drop
o
te
A.
ump
dgts
B.
woman
“ockng”
n
meda
te
dvsons
nger
on
te
at
Pysca
ndex
te
at
nerve
sudden
er
per-
nerve
50-year-od
o
and
o
A
no
Wen
compressed?
carpa
s
degrees
structure(s)
te
o
deormty
pnc
present
ner ve
sows
mb.
are
mb,
n
te
90
and.
carr yng
dagnoss?
brougt
er
te
nerve
ndng?
decreased
Guyon
be
s
o
o
pyscan
rgt
we
upper
symptoms
border
Wc
ago
to
Medan
pys-
s
te
er
repeatedy
C.
o
lexed
and.
mb
we
s
movng
On
ands,
meda
te
Unar
ours,
not
sgty
upper
out
ew
upper
poston,
te
n
examnaton
n
Rada
tugged
m
next
Pysca
dects
er
weeks
B.
s
dgt
A.
pu
er
our
A.
membrane
er
most
to
wt
resuted
se
te
er
et
beow.
Pysca
te
te
ater
ts
to
tngng
Hs
depart-
pan.
coatera
daugter
te
as
arm
coatera
62-year-od
o
road
emergency
et
capsue
D.
te
pan
B.
t
o
Over
cd’s
o
structures
Annuar
A
te
car.
te
te
started
payng
x-ray
A.
and.
pan
worred
we
to
because
crossng
became
oowng
er
te
examnaton,
ormed
brougt
oncomng
pronated.
A
s
moter
wen
an
moter
s
boy
s
abduct
te
key
axary
expans
arm
way
to
axary
uggage.
comes
and
was
sensor y
mantan
Posteror
4-year-od
6.9
woman
numbness
epsode
or
A.
A
Fig.
a
ow-grade
examnaton.
swoen.
most
He
e
ocazed
pysca
and
ago,
tumb.
tumb
w
dranage
days
sweng
on
entre
erytematous
ymp
ment
167.
tp
tumb
te
ympatc
166.
te
redness
te
vst,
aso
ng
and
o
to
hree
o
s
te
ump.
a
s
te
te
er
at-
aspect
pen
contents
mmedate
oowng
on
pamar
he
because
causng
sensaton
examnaton
cause
te
pyscan
tat
o
torc
o
ree
most
o
te
er
key
310
C H A P T E R
6
Upper
Limb
tumb
and
weakness
on.
ndex
n
nger.
pronaton
Wc
o
te
Pysca
o
te
examnaton
orearm
oowng
and
ner ves
s
sows
wrst
most
lex-
key
afected?
A.
Unar
B.
Medan
C.
Anteror
ead
D.
nerve
o
Deep
at
nerve
Guyon
n
te
cana
carpa
nterosseous
pronator
branc
tunne
nerve
beneat
te
unar
teres
o
te
rada
nerve
beneat
te
supnator
E.
174.
A
Medan
nerve
2 4-year-od
depar tment
coson.
compex
ture
are
s
He
ton.
6.10
171.
s
te
norma.
D.
Osteoma
wc
E.
Osteopyte
apparent
19-year-od
te
o
as
made.
Wat
n
been
two
and.
comes
pan
Pysca
meda
s
ca
and
and
terran.
man
s
ngers.
tranng
a
a
dagnoss
oter
sgns
Sensory
te
o
He
ong
s
on
be
o
on
roug
oss
dorsa
to
aspect
neuropaty
ected
durng
oss
s
pamar
te
aspect
meda
o
te
Weakness
n
abducton
C.
Weakness
n
extenson
D.
henar
E.
Tne
musce
sgn
at
20-year-od
an
practce.
naton
ty
to
He
sows
IP
jonts
a
dgts
on
and
o
o
s
any
tumb
o
o
te
to
te
pyscan
trauma.
tenar
and
dgts.
because
racquetba
Pysca
emnence,
dicuty
Wat
s
n
te
exam-
nab-
lexng
Hypertropy
B.
Pronator
C.
Meda
D.
T enns
E.
Goer’s
most
abe
to
A
o
tps
a
A.
ngers.
tumb
togeter
successuy
as
od
to
He
and
attempts
ndex
sown
a
pyscan
pece
n
o
to
nger
Fg.
paper
because
make
by
6.10.
He
between
s
s
x-ray
11 0 /7 8
mm
sow s
s
we aknes s
o
abduc-
te
m e da
and
t
our t
njur y
s
mos t
an d
and
a ong
te
d g ts.
an d
not
t
rep are d,
ke y
ove r
H g.
rep ar
t e
b eco me
ne xt
e w
emnence
at
at
te
te
wrst
MCP
bone.
brougt
ater
a
te
“gutterng”
and
sgns
orearm
Wc
te
He
o
sows
te
pan
most
over
norma
ractures
and
stars
constant
wtn
o
bot
dsocaton
oowng
are
te
as
burnng
are
processes
ndngs
emergency
down
and.
tngng
Vta
styod
motor
nto
stumbng
outstretced
and
o
wt
metacarpas
s
unar
jonts
bones
abnorma
key
to
be
examnaton?
te
and
weakness
tumb,
n
(tngng
meda
Dysestesa
over
tte
nger
over
te
mdde
Numbness
tumb,
pam
and
te
and
to
and
o
and
mdde
te
dorsum
te
aspect
and
te
and
meda
gt
and
te
touc)
tte
n-
tumb
pamar
ngers
border
weakness
dorsa
over
o
te
adducton
te
ngers
ndex,
adducton
n
response
o
aspect
and
o
weak-
opposton
aong
Numbness
n
border
ndex,
tumb
Numbness
and
E.
s
and
ncudng
a
brng-
o
te mpe r a-
re s p rat o ns
s urgc a
our t
w
tenar
man
Dysestesa
ger
te
mnutes.
and
on
te
te
Her
add ucton
n e r ve
af e c te d
ours
wrst,
carpa
aong
C.
3
30
An
ness
comes
te
adjacent
on
s
rada
ound
D.
s
s
n
past
and
man
n
ang
sensory
supnator
ebow
jo n ts
metacarpa
30-year-od
key
racture
s
and
n ge r
an d
devaton
department
syndrome
between
te
te
I
devaton
between
ebow
weakness
ng
o
supracondyar
54-year-od
rng
Promnent
B.
A.
o
E.
te
dagnoss?
A
Rada
Unar
te
durng
p re s s ure
oow n g
o
D.
te
te
w r st.
ve ce
ncud n g
drop
C.
pan
tumb
racquet
recent
tumb,
Wrst
and
te
te
Fattenng
B.
mts.
comes
atropy
te
a
scapod
grp
denes
oppose
mdde
to
and
atropy
te
man
nabty
one
an d
e m er ge ncy
m oto r
1 1 5/ m n,
exam n aton
DIP
te
A.
pys-
175.
o
s
a
monts?
proessona
sensory
te
andebar
may
a
because
dstances
sows
dgts
B.
o
pyscan
examnaton?
A.
A
te
examnaton
and
A
to
te
n
r gt
te
dgts
A
te
aponeuross
te
njur es
and
te
o
m u t p e
s e n sat on
Condroma
s
n
decreas e d
o
cycst
173.
o
n voved
stab ze d
adducton
bcpta
to
p u s e
bo od
are
Fexon
numbness
172.
and
Pysca
here
border
C.
o
(98.6°F),
te
b rougt
sustane d
njures
tumb
Fig.
s
be n g
ractures
7°C
panned.
•
ater
19/mn,
Hs
beneat
man
n
o
o
te
te
weakness
pam
and
mdde
tumb
o
wrst
and
n
grp
ndex,
strengt
aspect
and
and
ateray
tumb,
pamar
ngers
te
extenson
o
te
weakness
n
CHAPTER
Questions
176.
A
176–186
ment
ater
ebow
sons
o
over
te
and
te
comes
on
and.
a
Pysca
weakness
meda
o
adducton,
one
nger
and
te
a
a
abducton
and
was
nerve
at
meda
B.
Unar
nerve
at
C.
Medan
nerve
n
te
cubta
D.
Medan
nerve
n
te
carpa
E.
Meda
Guyon
o
rng
key
s
ness
sows
and
s
te
key
B.
Opponens
C.
Adductor
njured?
181.
pocs
ongus
brevs
43-year-od
axary
net
naton
Wc
ater
ang
sde
o
ndex,
wt
te
and
mdde
outstretced
on
carpa
o
bones
a
s
compressng
B.
Hook
te
C.
Scapod
amate
Lunate
E.
T rapezod
compressng
bone
o
te
Pysca
te
on
te
te
te
wrst
rada
medan
compressng
cated
Carpa
B.
De
wrst
sows
o
te
182.
artery
nerve
rada
A
54-year-od
woman
ater
coson.
Vta
examnaton
around
owng
te
md-body
areas
w
brougt
nvoved
sgns
brusng
a
s
beng
Pysca
sows
are
sows
neck.
umera
most
to
te
n
a
wtn
sot
An
norma
tssue
x-ray
emergency
motor
o
key
ave
Latera
aspect
o
te
orearm
B.
Meda
aspect
o
te
arm
C.
Meda
aspect
o
te
arm
D.
Posteror
Latera
aspect
and
52-year-od
department
mts.
arm
are
sows
ematoma
key
numbness
mpared
and
et
o
a
a.
a
o
te
racture
te
Vta
and
sgns
and
IP
neck
ste.
C.
Medan
nerve
n
D.
Ineror
trunk
o
E.
Dvsons
wtn
o
o
x-ray
te
Wc
te
te
o
norma
o
et
ngers.
o
radus
nerve
and
tumb,
te
s
rgt
and
Anteror
B.
Deep
C.
Rada
D.
Unar
E.
Superca
and
te
sows
C.
Captate
D.
Hamate
E.
T rapezod
21-year-od
a.
because
Vta
ts
because
te
rgt
exam-
and
a
a
retnacuum.
most
key
a
neck
asso-
snufbox.
comes
are
te
border
Wc
o
nerve
radus
to
n
te
a
et
emergency
motor
and.
tenderness
mm
carpa
Hg.
bone
Wc
o
vece
Pysca
temperature
respratons
ractured
pan
and,
meda
90
pexus
and
Her
129/79
o
te
to
repeat-
tunne
te
sweng
key
o
upper
pexus
n
97/mn,
a
te
brougt
wrst.
we
and.
nvoved
pan
te
mb
epcondye
o
braca
s
te
and
examna-
compressed?
te
s
n
upper
because
and
Pysca
dgts
carpa
beng
arm
dects
te
key
man
sgns
te
to
pyscan
poston
aong
braca
most
T rquetrum
a
s
anatomca
Scapod
A
te
pressure
B.
ment
rada
puse
s
tree
rgt
er
te
dorsa
A.
184.
te
as
a
rada
at
sows
bones
sensory
meda
woman
most
nterosseous
te
ater
te
bood
carpa
afected?
A.
o
(98.6°F),
wrst
o
at
te
er
abduct
most
absent
nerve
Se
s
n
Pysca
lexor
uggage.
axa
Rada
paton
weakness
o
s/are
examnaton
or
to
n
extendng
B.
emergency
o
to
te
nerve
55-year-od
pyscan
atera
te
condtons
reproduced
rom
department
te
over
mantan
and
orearm
jonts
An
to
te
are
extenson
te
racture
to
sows
dects.
at
te
motor
o-
A
o
te
numbness
trauma.
comes
pece
Unar
coson.
o
a
asked
are
to
o
tngng
A.
orearm
brougt
MCP
sensory
at
aspect
s
no
structure(s)
183.
and
mb,
sgn?
damage
and
Wen
lexng
Froment
musce
syndrome
woman
carryng
and
o
syndrome
arm
te
or
te
orearm
examnaton
abducton
no
te
posteror
ater
extenson
here
o
man
Pysca
extenson,
and
nerve
symptoms
mts.
edema
te
racture. Wc
A.
E.
Rada
sows
most
tenosynovts
outet
25-year-od
edy
ve-
sensaton?
A
E.
degrees
department
ce
nger
mb.
nerve
tunne
Quervan
horacc
ton
superca
sgn.
musces
sgn?
Maet
we
Vta
examnaton
Froment
and
story
oowng
ts
D.
o
artery
no
C.
A
Pysca
numb-
and.
oowng
comes
pan
tenderness
te
A.
dsocated?
te
o
o
percusson
wt
rada
Wc
unar
wt
tumb,
nerve
compressng
te
o
o
bone.
key
unar
compressng
D.
tngng
aspect
X-ray
most
Psorm
o
and
carpa
A.
and.
movement
pamar
ngers.
dsocaton
oowng
an
pan
numbness
pam
and
anteror
on
sows
s
sows
ment
woman
story
here
et
pocs
pocs
2-week
er
emergency
and
pocs
Fexor
and.
te
presence
nterosseous
te
311
Limb
ncudng
te
Fexor
o
tunne
te
dorsa
o
to
tngng
o
mts.
E.
A
as
border
D.
dgts
assocated
179.
expans
tumb
tte
brougt
Se
norma
wc
Frst
and
s
a.
abnormates
o
A.
A 29-year-od woman comes to te emergency depart-
examnaton
178.
severa
a
meda
wtn
aso
cana
n
are
woman
ater
te
Weakness
ossa
pexus
aong
pam
epcondye
(unar)
braca
te
42-year-od
department
sgns
o
here
adducton,
o
most
Unar
and
A
abra-
“pns
border
dgts.
DIP
A.
cord
te
te
sows
wt
unar
depart-
njurng
epcondye,
decreased
and
structure
and
examnaton
s
at
emergency
tra
aong
lexon
Wc
te
meda
Sensaton
(parestesa)
and
to
sppery
oecranon,
and.
ngers.
man
ang
and
needes”
177.
180.
25-year-od
Upper
6
are
to
s
19/mn,
X-ray
n
te
pa-
37°C
o
te
te
loor
oowng
ractured?
to
n
wtn
te
te
emergency
rgt
norma
depart-
souder
mts.
ater
Pysca
312
C H A P T E R
6
Upper
Limb
•
Fig.
6.11
•
examnaton
sve
sows
adducton
x-ray
o
Wc
te
o
o
te
te
rgt
te
stretced/torn
reproducton
rgt
arm
souder
oowng
resutng
s
ts
pan
te
sown
structures
n
o
across
most
key
jont
capsue
and
coracocavcuar
B.
AC
jont
capsue
and
coracoacroma
C.
Sternocavcuar
capsue
and
gament
gament
Unar
D.
Medan
Muscuocutaneous
A
14-year-od
department
Pysca
coracoacroma
gament
185.
C.
E.
186.
AC
jont
An
6.11.
njury?
A.
te
D.
Coracocavcuar and transverse scapuar gaments
ton,
E.
Coracocavcuar
and
A
67-year-od
department
Se
as
sows
arm
An
a
ater
story
brusng
wt
x-ray
Wc
woman
o
brougt
er
et
osteopoross.
and
te
te
s
njurng
o
exquste
o
coracoacroma
dmpng
o
tenderness
et
souder
oowng
nerves
to
te
souder
Pysca
te
over
s
s
gaments
emergency
rom
upper
te
part
a.
o
afected
sown
most
a
examnaton
n
key
Fg.
te
6.12.
te
on
sows
ossa.
lexon,
te
brougt
epcondyes
cubta
wrst
o
s
ang
examnaton
opposton
jonts
are
ourt
to
s
pont
and
here
a
s
grp
mpared.
strengt.
dgts
and.
tenderness
weakness
aso
t
emergency
pusate
and
and
te
outstretced
just
on
prona-
humb
lexon
Fexon
s
above
mass
at
norma.
te
An
DIP
x-ray
sows a supracondyar racture o te umerus. Wc
o
te
A.
area.
njured?
boy
ater
umera
above
and
6.12
pas-
cest.
Fg.
n
were
on
Fig.
oowng
Axary
structures
nerve
and
are
most
posteror
key
njured?
crcumlex
umera
artery
B.
Rada
C.
Medan
nerve
and
nerve
A.
Rada
D.
Superca
B.
Axary
E.
Unar
A.
Scarpa
rada
nerve
deep
and
and
braca
braca
nerve
unar
and
artery
artery
rada
artery
artery
A n swe r s
Answers
1.
1–25
D. he suspensory gaments o te breast, aso known
as
Cooper
te
pectoras
te
ay
be
gaments,
derms
te
major
breasts
due
o
to
repared
brous
to
musce
aganst
te
are
skn
and
gravty.
stretcng
wt
te
pastc
bands
deep
are
prmary
Ptoss
o
o
tese
surgery.
tat
asca
te
run
rom
coverng
supports
breast
gaments
s
B
and
te
are
or
te
usu-
and
can
asca
superca
C.
breast
structure
ments
ng
he
musces
o
te
tat
but
o
te
o
membranous
te
pectoras
move
do
te
te
s
asca
te
not
breast,
breast
pectoras
anteror
major
and
upper
provde
major
to
drect
te
musce.
o
pectoras
mb
atoug
attac
ayer
abdomna
te
and
e
mnor
deep
support
to
suspensory
pectora
te
wa.
asca
to
te
ga-
cover-
CHAPTER
E.
he
serratus
te
anteror
movements
o
musce
te
s
nvoved
scapua,
or
n
A.
te
protracton.
GAS
2.
A.
he
and
o
133,
B.
140–142;
ower
C6
nerves.
subscapuars
scapuars
sbe
or
eson
and
and
ts
188;
It
te
teres
adductng
o
N
subscapuar
spna
nerve
teres
major
meday
woud
resut
are
C5
weakness
arm.
n
he
axary
5
mnor
te
trbutes
mnor
to
arm
o
rada
D.
n
he
te
GAS
5.
A
te
he
nous
o
te
te
responsbe
GAS
te
he
crana
o
and
teres
and
nerve
ormed
and
te
N
and
drome
s
417;
and
and
attac
Bot
and
t
mus-
D,
te
to
he
o
or
ABR/McM
(and
nner-
and
ongus,
are
nner-
atera
rotaton
te
by
a
nerve
he
bones.
Carpa
contans
lexor
n
te
te
carpa
tendons
dgtorum
supercas
s
syn-
musces
are
a
III
nnervated
and
by
te
and
unar
Fracture
damage
to
nner vates
on
to
and.
o
one
N
te
and
unars
a
ABR/McM
ner ve
te
and
most
due
musces
te
to
te
he
ts
he
n
meda
musces.
o
168
epcondye
epcondye.
a
proundus
nner vate
455;
meda
unar
bend
carp
dgtorum
799;
te
groove
lexor
neck
te
a
can
poston
unar
orearm,
o
ner ve
ntrnsc
te
n
ner ve
te
lexor
contnues
musces
n
te
artery
and
nerve
at
artery
tat
and
o
te
te
can
occurs
partay
umerus
posteror
can
crcumlex
nerve
can
be
njured
t
artery,
te
n
es
and
nerve
meda
by
to
s
to
te
troug
te
te
wnds
Injury
axary
nerve
posteror
around
to
te
te
surg-
nerve.
perces
te
between
musce.
atera
njury
musce.
descends
bracas
artery
procedure.
medan
posterory
umerus.
and
te
resuts
te
accompaned
damage
as
o
ebow
passes
te
toracc
152
oten
bracas
space,
o
atera
mastectomy
course
te
te
musce
and
a
racture
umera
may
and
durng
nerve
orearm
he
rada
he
unar
duces
GAS
ner ve
o
It
coraco-
te
bceps
contnues
antebraca
courses
te
C. he
ong
and
anteror
umerus,
passes
around
o
te
to
nto
cutaneous
te
troug
nerve
eads
and
It
te
atera
cubta
o
te
o
nterosseous
o
radus
te
dsta
to
and
nto
te
on
te
nerve.
trceps
te
and
ep-
pro-
to
enter
rada
te
and
Some
ateray
two
te
te
as
com-
ossa,
brances.
wnds
to
trceps
cubta
nnervates
reer
umerus
anteror
te
te
musce
te
deep
nerve
musce
te
o
te
between
and
supnator
o
eads
enters
between
brac
back
atera
runs
musce
orearm.
meda
151
posterory
superca
te
and
te
njured
symptoms.
eventuay
branc
easy
ABR/McM
descends
dvdes
bend
s
descends
meda
supnator
musces
438;
nerve
musce.
t
bone”
and
neroateray
te
deep
descends
groove
N
atera
partment
he
ts
752;
rada
and
were
nerve
n
“unny
750,
brac
cause
braca
and
on
umerus.
racture
neck
and
muscuocutaneous
between
788–789,
on
neck
condye
ter
and
and
ocated
te
njury
because
ossa.
E.
lexor
IV ,
nerve
o
n
artery
groove
nerve
he
and
epcondye
tunne.
and
bra-
nerve.
D.
medan
o
spra
ABR/McM
nerve.
artery
he
te
and
proundus,
musces
umbrcas
422;
axary
brac
7.
nterosse,
toracc
N
medan
ca
II)
tunne
tunne
o
te
752;
surgca
o
te
dsocaton.
supracondyar
he
te
153
resut
braca
md-body
surgca
damaged
crcumlex
runs
retnacuum
compresson
space
and
wc
carpa
lexor
be
bracas
I
te
axary
quadranguar
abducton,
nerve.
te
A.
by
artery.
ong
braca
supraspna-
arm
o
te
anteroatera,
greater
seats.
ypotenar
A
can
outstretced
souder
he
150
medan
carpa
tunne
E. he
B.
an
bot
ABR/McM
supracondyar
n
GAS
6.
on
nnervated
nnervates
deep
medan
a
s
racture
or
suprascapuar
a
by
musces.
437;
te
he
may
nrasp-
te
umbrcas
tunne.
by
reduced
dgtorum
synova
D.
E.
musces
te
to
musces
nerve.
aows
te
carpa
by
carpa
lexor
by
caused
due
pocs
4.
D.
N
and
o
by
racture
njure
o
nnervated
ebow.
umera
cord
eevates
nraspnatus
ntaton
musces
te
A
orearm.
XI,
wc
supraspnous
or
anterory
posterory
GAS
B.
a
musces.
anconeus
o
ang
lexed
nerve
rada
te
by
he
branc,
to
and
con-
arm
te
surace
caused
C.
nnervated
he
n
Injury
te
suprascapuar
tenar
nerve
e
musce
umera
nerve
be
and
posteror
argest
musce,
nraspnatus
troug
B,
te
753–758;
rada
s
nerve.
supnator
md-body
te
A.
rada
and
teres
souder.
703–706;
are
s
umerus.
by
te
te
spna
arge
pane.
o
extensors
respectvey,
te
any
group
te
s
brac
he
741,
A
tey
scapua.
tus
s
n
brac
te
nerve
vated
and
A,
and
rom
ossae,
tuberce
C.
te
s
trceps
supraspnatus
orgnate
3.
te
It
trapezus
depresses
E.
C.
to
tese
and
souder,
rotator
rom
cervca
detod
musce
te
cuf
arses
pexus.
accessory
vates
atera
rotator
arm
o
movement
a
rom
te
detod
surace
s
te
arses
nnervates
he
nerve
nnervates
aso
and
entre
braca
ces
6
musce
member
te
nerve
and
musces.
covers
he
E.
posteror
nerves
C.
and
supercas
313
Limb
nerve.
bceps
coradas
sub-
respon-
te
C
border
he
bot
rotatng
n
te
ower
musces.
musces
dgtorum
muscuocutaneous
rom
te
lexor
medan
he
185
arses
nnervates
major
and
nerve
ABR/McM
motons.
B.
he
exampe,
Upper
6
deep
te
eads
extensor
rada
posteror
314
C H A P T E R
B.
6
he
Upper
anteror
medan
pronator
to
D.
be
to
ton
n
te
ts
ts
njury
lexor
nerve
o
te
does
skn
arses
rada
pocs
none
rom
a
o
te
ongus,
o
wc
o
causes
not
may,
and
8.
B.
he
te
as
resut
he
atera
a
caracterstc
n
oss
mb,
o
t
njured
be
abe
rada
C
sensa-
to
proxma
777,
to
11.
prox-
extend
to
te
were
antebraca
orearm
brac
musce.
te
n
N
435;
suppes
wc
to
s
ts
and
are
sde
Injury
te
orearm
A
rom
and
te
eferents
B,
most
te
bceps
lexors
te
wc
orearm
poston).
resut
and
te
he
supnator
n
at
weakness
atera
to
Injury
te
n
orearm
te
rada
to
and
te
nerve
a
medan
dgtorum
woud
resut
caracterstc
nerve
causes
supercas
n
wrst
weak-
and
o
he
atera
to
nerves.
or
cord
te
o
te
braca
muscuocutaneous
here
weakness.
s
no
ndcaton
Injury
to
te
pexus
and
o
atera
gves
atera
pectora
cord
can
orgn
B.
pectora
atera
branc
not
o
antebraca
te
suppy
muscuocutaneous
any
motor
muscuocutaneous
oow
GAS
9.
749;
penetratng
N
465;
can
synova
o
tumb
lexor
may
spread
pocs
aone
and
Injury
unusua
be
to
te
but
can
to
te
tendon,
and
B.
he
supercas
te
D
common
and
pocs
E.
tendons
and
synova
Neter
brevs
lexor
te
tendons
T enosynovts
n
te
atera
te
te
synova
seat
known
as
te
o
rada
te
lexor
seat
carp
are
or
unar
radas
contaned
792–793;
dgtorum
enveoped
n
n
bursa.
13.
D.
451;
ABR/McM
145
and
N
te
te
ngu-
perneum
ymp
nodes
tssues
o
185
deep
and
are
sx
s
upper
wt
one
a
crcumlex
s
o
anastomoses
as
oter
and
te
te
ower
It
anas-
artery.
artery,
pertoneum,
branc
te
wa.
ac
te
jons
artery.
suppes
musces
abdomna
artery
usuay
known
t
yng
posteror
termna
(aso
toracc
sma
spaces
artery
te
ntercosta
and
and
tweve
ntercosta
ower
artery
te
and
termna
and
te
wt
n
t
sup-
anteror
te
tendon
artery
can
rada
pocs
brevs
neror
accompanes
te
be
can
o
te
tora-
atssmus
te
dors
et
tendons
puse
radas,
aganst
be
pocs
be
rada
carp
aso
te
can
pec-
189
lexor
extensor
artery
te
compressed
between
atera
wa.
papaton
o
te
major,
anteror.
toracc
puse
and
rada
artery
aong
pectoras
suppyng
ABR/McM
or
runs
te
serratus
atera
197;
artery
suppes
nerve
snufbox
o
te
n
te
ongus
compressed
s
were
dsta
te
ana-
extensor
musces,
aganst
te
scapod.
nor
lexor
A, B, C, E. Pamars ongus, lexor pocs ongus, lexor
synova
lexor
dgtorum proundus, and lexor dgtorum supercas
tendons
N
and
ctors.
superca
posteror
artery),
toracc
and
he
te
n
he
artery
nterna
and
tomca
were
te
toracc
wa
mnor,
te
rada
radus.
o
epgastrc
ocaton
to
or
superca
anastomoss
toracodorsa
he
some
nodes,
artery.
wa
156;
te
wa
eferents
mb,
pens
superca
borders.
dapragm,
codorsa
o
musces
lexor
are
he
GAS
an
seats.
GAS
E.
o
te
vens.
cest
receve
ower
o
te
resut
wtn
nodes.
nguna
upper
wereas
te
te
atera
toras
necton
aso
o
proundus
he
musce
dgts.
troug
te
cest
does
bursa.
A
D.
a
150
due
o
epgastrc
njures.
te
ongus
s
superor
abdomna
s
te
arteres
dapragm,
wt
resut
nerve
nerve
nnervaton.
nerve
ABR/McM
C. T enosynovts
seats
cutaneous
te
anteror
nodes
group
o
are
deep
ymp
gans
o
nterosseous
superca
structures
te
an
spaces
pes
weakened adducton and meda rotaton o te arm.
he
o
mammary
parayss
n
te
160
ABR/McM
ower
nterna
branc
weakened lexon and supnaton n te orearm, and
416;
muscuoprenc
he
te
o
te
most
eac
percardum,
emnence.
o
group
branc
tomoses
tenar
nvoves
ntercosta
arteres,
lattenng
te
artery
axary
rom
orms
ntercosta
o
skn
drans
N
and
space
nterna
oter
are
medan
ossa.
arteres
nguna
rom
n
lexors n te orearm and resuts n a caracterstc
bot
E.
upper
te
anteror
superca
vertca
two
he
rada
orzonta
nodes
coatera
o
parayss
musce
A.
ossa
and
mb.
ntercosta
drop.
and
cubta
ympatcs
anteror
eac
cubta
artery,
ABR/McM
te
dranage
737–738;
arteres,
te
to
te
he
te
braca
438;
deep
ymp
C. he
and
te
N
rom
te
te
V enpuncture
he
ower
GAS
12.
o
deep
E.
to
unar
rom
ymp
receve
contnues
poweru
woud
lexon
E.
wereas
common
drans
te
C,
te
extenson
lexor
Lymp
tr-
ABR/
nerve,
o
anatomca
nerve
ossa.
prmary
oss.
ened
D.
he
o
braca
meda).
dsta
758–760;
er
te
nerve
cutaneous
atera
te
musce
Injury
supnaton
sensory
to
E.
to
he
arse
ympatc
792;
nerve
musces,
D.
contents
tendon,
burcaton
GAS
groove.
752,
(atera
cubta
key
ce
brac
and
te
s
very
nerve
muscuocutaneous
sensaton
te
bceps
D.
750,
not
arse
rada
bracas
ebow.
(wt
C.
te
were
te
tree
and
na
and
te
A.
o
muscuocutaneous
suppes
o
woud
musce
n
B
161
brac
o
runs
nerve
emnence.
upper
nerve
brances
733–745,
McM
rada
woman
he
brac
nerve
GAS
te
te
ebow.
ceps
I
he
arteres
tenar
te
A.
bceps
seem
tat te superca branc o te rada nerve s not
njured.
10.
lexor
exampe.
medan
te
te
musces,
(atropy)
over
nerve
suppes
proundus,
lattenng
Because
and
quadratus
njured
Injury
E.
nterosseous
nerve
dgtorum
Limb
GAS
are
772,
not
818;
used
N
to
437;
ocaze
te
ABR/McM
rada
169
puse.
CHAPTER
14.
A.
he
lexor
nnervated
gers
and
ngers.
te
t
woud
resut
ts
B.
s
medan
and
assst
he
dgtorum
he
can
o
GAS
and
o
an
DIP
te
he
to
njury
o
D.
tumb
lexes
lex
IP
acts
lexes
te
ngers.
te
MPtop
te
and
to
by
te
by
and
a
te
meday
te
ngers
movng
te
IP
to
te
emnence,
jonts
te
GAS
o
o
te
s
on
te
an
era
o
te
o
controed
nerve,
te
by
dgts
wc
s
not
njured
C.
Medan
neous
E.
he
ay
GAS
16.
B.
he
deep
te
he
to
he
ong
posteror
nerve
meda
as
easy
sub-
rom
te
ventra
contrbute
to
te
nerve.
wt
to
rom
band
ormng
capsue
a
te
o
te
encr-
te
o
tat
coat-
ebow.
he
dspacement
umerorada
o
body
tat
coar
rada
prevent
te
ead
te
to
te
149
uses
te
o
radus
te
s
jont.
amost
bone,
so
te
dsocate.
C.
he
s
jont
and
ng
D.
ts
does
not
nterosseous
between
te
tese
he
uncton
membrane
radus
two
rada
atera
not
trave
E.
vertca
wa
bones
and
unar
n
ts
s
a
tat
stabzaton.
brous
asssts
ayer
n
od-
togeter.
coatera
epcondye
gament
to
te
extends
annuar
rom
gament
te
o
te
he unar coatera gament s a tranguar gament
cord
and
nerve,
n
s
nerve
does
not
usu-
18.
E.
ts
o
patent
te
te
axary
nerve
rom
o
he
o
s
te
ts
aganst
serratus
te
caed
he
te
njury
by
asssts
pane
of
nerve,
does
C5
and
not
to
C7
te
n
A,
ong
beng
nerves,
rada
arse
to-
nerve.
rom
ventra
rse
te
spna
he
o
D.
or
te
spna
resuts
lexon,
aso
and
ventra
any
o
an
a
to
te
wt
rotaton
braca
ram
s
dicut
njury
atera
Erb-
and
presentng
te
tese
as
and”
ater
rom
o
7.72).
known
tp
pexus,
trunk
nerve
to
s
and
154
cdren
braca
superor
Injury
7.73A
“water’s
n
usuay
o
abducton,
arm.
C,
descrbed
common
hs
Fgs.
ABR/McM
o
pexus
C5–C6.
structures
woud
pasy.
te
GAS
19.
gves
B,
(GAS
428;
not resut n te cassc presentaton o Erb-Ducenne
rotaton
tat
o
una
N
parayss
trunk
conssts
aganst
te
so
pexus
subscapuar
oss
ress-
superory.
braca
upper
anteror
scapua
nnervated
devery.
scapua
scapua
puses
anteror
more
o
753–755;
reatvey
orzonta
ower
but
ranon
GAS
168
wa.
and
o
cuta-
Ducenne
border
te
o
dgts.
“Wngng”
serratus
drected
cord
rada
patent
meda
3½
oss
wrst.
border
te
toracc
roots.
te
te
descrbed
he
upper
racodorsa
o
to
above
posteror
te
does
nvove
rada
ABR/McM
cest
s
nerve
woud
te
scapua.
a
te
nerve.
ossa
on
wen
as
scapua
genod
A.
te
wa
posteror
te
dsta
463;
ods
toracc
radus
age,
not
brous
radus,
and
aspect
nerves,
braca
tat extends rom te meda epcondye to te oec-
damage
branc
o
suc
musce
o
N
wen
cest
tance,
te
nterosseous
condton
occurs
a
artcuar
dameter
reatvey
s
te
major.
ormed
toracc
subscapu-
spna
o
aso
he jont capsue unctons to aow ree rotaton o
wrst.
nerve
trave
“wngng”
te
te
sensaton
808;
s
ower
w
unctons
te
ts
s
C6
te
s
nnervates
ower
cord
teres
rom
It
te
ong
radus.
anteror
to
same
ong
una
and
o
nerve
te
gament
o
te
te
ABR/McM
o
to
posteror
gament
te
C5
and
rse
o
te
pexus.
he
com-
B.
hese
n
to
rom
to
brances
nerve
s
gves
trunk
bers
braca
C8–T1
te
417;
ead
ead
te
branc
o
nerve
musce.
and
upper
suppy
te
nnervates
toracc
N
cd
ead
does
ngers
deep
a
te
te
trape-
ngers.
te
te
In
te
C5–C7.
gament
I
nerve
te
te
o
dors
musce
annuar
annuar
oppose
medan
716;
he
lexor
oppose
oter
can
between
adducton
are
brevs,
cannot
tat
te
paper
A.
attaces
dstrbuton.
o
o
pads
motor
musces.
one
metacarpa
branc
pece
pocs
s
wc
pocs
musce
rst
nerve
o
not
and
315
Limb
pexus
roots
he
toracodorsa
rom
ong
braca
nerve
nerve.
does
orgnates
and
te
C6
subscapuar
te
ormaton
ces
medan
parayzed,
cutaneous
unar
te
abductor
ony
recurrent
test
o
as
nerve
he
and
169
opponens
s
te
a
E.
o
and
dvson
atssmus
pexus,
patent.
dsta
nerve.
mdde
ram
extendng
tenar
te
tumb
s
smpe
he
toracc
scapuars
lex
abduct
we
branc
o
movements
B.
pexus
brances
jonts
C5
braca
ar
jonts.
trunk
te
suprascapuar
known
wrst.
ABR/McM
and
te
ts
he
o
te
MP
to
te
o
musce
o
posteror
17.
pocs
Hodng
a
te
caused
o
ave
at
adduct
437;
brevs,
pad
te
he
dgto-
tat
upper
prsed
unar
jonts
lexor
musce
C.
n-
ndex
te
Suc
te
ony
jonts
unars
and
lex
N
opponens
because
IP
uncton
carp
musces
pocs
A.
lex
because
te
extendng
recurrent
te
not
course
duay
two
ngers.
771;
zum.
n
te
aso
eevaton
te
mdde
supercas
dsta,
nterosse
te
D. he
not
lexor
devate
to
s
to
s
meda
aceraton.
dgts
musce
umbrcas
and
15.
te
superca
to
musce
te
te
lexor
he
E.
to
or
nabty
t
proundus
proxma,
D.
nerve
te
an
nerve
jont.
he
C.
o
n
proundus
unar
vunerabe
ourt
rum
te
Because
nerve,
te
dgtorum
by
Upper
6
727–736;
C. he
te
skn
rng
A.
N
superca
o
te
420;
ABR/McM
branc
tte
o
nger
te
and
145
unar
te
nerve
meda
suppes
sde
o
te
nger.
he
superca
cutaneous
sum
ts
o
over
branc
nnervaton
te
te
and
and
proxma
o
te
to
te
rada
te
rada
and
nerve
rada
two
mdde
provdes
(atera)
and
a
a
paanges.
dor-
dg-
316
C H A P T E R
6
Upper
Limb
dgts,
te
D.
and
te
second
part
o
he
deep
te
radas
dsta
ourt
brevs
jont
nterosseous
rada
Radial
dsta
as
we
paanges
as
te
o
atera
dgt.
suppes
supnator
musces
nterosseous
wrst
o
nger
nerve
and
extensor
aspect
trd
rada
posteror
te
dorsa
and
(note:
nerve
beore
nerve,
some
as
te
extensor
musces
and
a
contnung
wc
s
consder
synonymous
carp
o
te
as
te
sensory
te
to
posteror
wt
te
deep
nerve).
collateral
E.
he
recurrent
branc
o
te
medan
nerve
suppes
ligament
te
abductor
pocs
brevs,
lexor
pocs
brevs,
Ulnar
and Anular
ligament
collateral
of
ligament
GAS radius
20.
B.
of
683–687;
he
dons
Sacciform
opponens
synovial
gus.
N
463;
anatomca
o
te
abductor
recess
pocs
he
loor
s
ABR/McM
snufbox
extensor
pocs
musces.
pocs
ongus,
s
brevs
and
ormed
by
169
ormed
te
te
by
te
ten-
accompanyng
extensor
scapod
pocs
bone,
te
on-
and
t
membrane
s
ere
tat
scapod.
pan
o
Wtn
at
greatest
te
GAS
Fig.
A.
.A
C,
he
unate
n
te
D,
E.
GAS
E.
he
s
o
to
6
possbe
weeks
n
wt
te
te
a
most
ractured
ater
njury,
detecton
scapod
bone
o
racture
avascuar
scapod
retrograde
te
a
deveopng
o
captate,
necross
due
to
an
vascuature.
commony
amate,
commony
791–792;
he
unar
wc
Fat
ts
2
mted
Patents
part
or
dsocated
bone
wrst.
as
21.
to
rst
are
rsk
proxma
papate
te
ractures.
nterrupton
•
can
radograps
scapod
are
one
N
434;
nerve
adduct
as
ABR/McM
nnervates
te
and
ractured
are
not
scapod.
174
te
ngers.
trapezod
te
pamar
hs
s
te
nterosse,
movement
pads
tat
A.
woud
he
te
B.
nerve
te
paper
does
not
between
nnervate
te
ngers.
musces
o
and.
he
Synovial
mantan
axary
medan
nerve
umbrcas,
te
cs
and
brevs,
None
o
tese
suppes
opponens
te
lexor
musces
te
rst
pocs,
pocs
woud
and
second
abductor
brevs
afect
te
po-
musces.
abty
to
membrane
od Annular
a
pece
o
paper
between
te
ngers.
ligament
C and D. of
not
suppy
GAS
22. Sacciform
799;
D. he
muscuocutaneous
musces
N
455;
o
te
and
rada
nerves
do
and.
ABR/McM
supraspnatus
musce
171
s
one
o
te
our
rotator
recess
cuf of
he
radius
musces—te
oter
tree
beng
te
nraspnatus,
synovial
teres
mnor,
and
subscapuars
musces.
he
tendon
membrane
o
s
te
supraspnatus
oten
musce
woud
A.
GAS
Fig.
he
te
s
reatvey
souder
abducton
ts
o
te
s
avascuar
dsocated.
arm,
and
and
hs
damage
movement.
coracobracas
coracod
body,
.
wen
ntates
mpar
te
•
njured
musce
process
unctons
n
musce,
to
te
wc
umerus
adducton
and
runs
near
rom
ts
lexon
md-
o
te
arm.
B.
he
common
medan
pamar
nerve
and,
pamar
dgta
nnervate
te
pamar
te
brances
atera
surace
o
aspect
te
o
te
o
te
rada
3½
B.
he
s
ts
to
man
uncton
extend
ong
ead
te
can
o
te
orearm
aso
trceps
at
ep
te
n
brac
ebow,
arm
musce
atoug
extenson
and
CHAPTER
adducton.
afect
C.
he
pectoras
sory
and
E.
not
E.
706;
he
major
rotate
N
415;
o
ment
te
te
s
A.
tendon
te
ead
woud
not
can
and
AC
o
te
t
te
acces-
to
scapua
to
adduct
and
rarey
contrbutes
superor
wt
te
coracoumera
te
te
te
he
nstead,
te
n
n
te
anteror
subscapuars
te
contrbute
D.
he
ar
notc
natus
GAS
24.
A.
a
wt
o
o
wt
E.
sensory
nerve
nger.
ar
te
sory
scapu-
brances
wc
te
o
orms
he
te
tese
musces
te
roo
te
o
nerve
to
GAS
Answers
26.
to
te
s
te
lexor
carpa
not
aso
n
Compresson
be
because
to
o
attrbuted
te
toms
ts
to
musce
pexus.
woud
rater
tan
te
braca
pressure
In
s
ocated
addton,
ncude
te
rom
and
te
oca
posteror
braca
oter
upper
symptoms
A.
B.
to
GAS
25.
ncreasng
788;
C. he
ments
ceps
N
o
te
brac
te
cervca
compexty
452;
rada
o
ABR/McM
nerve
arm
o
proxma
te
to
te
rada
It
te
and.
nerve
and
ter-
deep
o
te
ts
sensory
te
te
brances.
1½
does
te
not
carp
dgtorum
Addtonay,
on
key
dvson
lexor
lexor
meda
dgts
It
most
to
ts
dgts
dorsa
suppy
sen-
on
te
aspect
extensor
422;
ABR/McM
152
brac
nerve
s
by
o
o
he
on
ts
te
te
te
case,
atera
t
ore-
contnuaton
as
te
name
“muscuar”
nerve
o
and
brevs
te
n
o
atera
“muscuo-
te
ngers
woud
musce
nnervated
arm
and
not
are
be
med-
afected
te
by
te
lexes
te
tumb
recurrent
branc
nerve.
te
ngers
s
ngers,
perormed
nnervated
by
by
te
te
ong
medan
nerves.
te
a
braca
meda
drect
o
te
meda
antebraca
branc
o
te
orearm
s
cutaneous
meda
cord
pro-
nerve,
o
te
pexus.
N
421;
deep
between
dsta
bra-
man
Because
n
to
(known
nerve).
s
nnervaton
by
735;
te
nerve
t
pocs
medan
unar
he
damaged
te
te
nserts
supnator.
abducton
unar
many
te
brac
are
orearm.
and
te
and
GAS
te
s
wc
percepton
supped
n
bceps
mportant
sensory
nnervates
nstance.
usuay
E.
he
nerve
musces,
te
ABR/McM
branc
two
parts
o
o
151
te
te
rada
nerve
supnator
courses
musce
and
s
ocated just meda and dsta to te atera epcondye.
compart-
suppes
groove,
patent
ony
a
2½
cutaneous
lexor
Ater
extensor
ts
vded
ts
ead
by
Sensory
symp-
aso
o
wrst.
ndcates
he
and
E.
dsta
symptoms.
orearm.
te
woud
oca-
sensory
pamar
rada
superca
superca
to
and.
an
s
Fexon
not
169
nnervates
and
spne
and
N
o
wc
lexors
27.
Osteoartrts
and
te
ts
orearm.
s
muscuocutaneous
n
C.
tese
n
oss
ated
be
case.
D.
descrbed
lexors
proxma
suppes
meda
ebow.
Adducton
dects,
descrbed
and
te
te
s
“cutaneous”
brac
pexus
mb
to
o
and
te
cutaneous”
nerve
coud
trceps
o
antebraca
tunne.
pexus
te
n
bceps
at
arm,
te
w
n
te
nerve
muscuocutaneous
and
radus
symptoms. It does not provde sensaton to dgts 1 to 3.
C.
te
750;
lexors
retnacu-
mpcated
as
up
26–50
D. he
tunne.
rada
are
provdes
dgts
mpared,
nerve
meda
735,
eads
tenar
pam
te
s
muscuocutaneous
nnervated
carpa
proxma
o
to
te
conjuncton
are
ngers
mdumera
and
ossa
nto
rada
(motor)
aspect
te
cas
compartment
te
branc
proxma
unar
lexor
te
nerve
n
to
nerve
o
medan
dects
proxma
n
medan
musces
te
o
pamar
of
he
te
nner-
orearm
mdde
nnervates
3½
cubta
dstrbuton
musces
suprasp-
aso
atera
te
and
pamar
te
nnervaton
and
and
sensory
and
not
musce.
te
arm
Symptoms
to
nerve
dvdng
unar
unars
142
ngers
to
tese
nnervaton
usuay
E.
rng
because
medan
and
wt
to
due
musces
te
nerve
deep
he
ocated
woud
crosses
sensory
mdde
unctonng
because
B
suppes
and
nnervaton
norma
um
contact
te
by
njured
deep
and
supraspnatus
gament
ABR/McM
expans
orearm
te
te
n
Compresson
norma
Aso,
nerve
te
tunne
te
by
not
415;
ndex,
motor
emnence.
carpa
s
N
medan
provdes
o
scapuar
to
extng
rada
tendon.
tumb,
atera
njury
and
693–694;
he
te
to
transverse
capsue,
prmary,
are
mb
medan
as
supraspnatus
bands
ndex,
ngernas.
tenar
proundus
or
genoumera
musce
he
and
te
too
provdes
eson.
tendon
contact
ocated
aso
posteror
317
Limb
branc. Because bot motor and sensory uncton o
nto
not
te
o
acromon
s
s
upon
gaments
B.
It
te
tumb,
dsta
mnates
o
genoumera
te
Upon
ga-
eroson
as
D.
tendon.
C.
o
o
te
ere.
o
dorsa
eve
n
ntact
nnervaton
tendon.
gament
mpnge
te
and
gament.
cavce,
supraspnatus
or
to
ts
damaged;
musce
connectng
he
as
ton
dspace-
Because
be
te
to
orearm
nlammaton
te
muc
A
under
o
s
vaton
we
143
supraspnatus
to
an
extenson
ony
unctons
umerus.
w
ort
as
stabze
gament
cause
end
anterory
to
preventng
gament,
atera
unctons
arm.
arc,
te
and
musce
strong,
o
back
te
ong
abducton.
ABR/McM
ead
very
he
B.
te
gament
moves
n
coracoacroma
coracoacroma
ment
ts
musce
musce
nvoved
teres
meday
23.
to
mnor
respratory
s
he
GAS
Damage
abducton.
Upper
6
te
so
tr-
ebow
te
te
nerve
posteror
ypertropy
nerve,
emerges
rom
nterosseous
o
causng
te
pan
te
nerve.
supnator,
and
supnator
It
can
wc
weakness.
be
t
s
caed
rrtated
compresses
by
te
318
C H A P T E R
A.
6
he
Upper
unar
meda
lexor
B
and
lexor
D.
nerve
courses
epcondye
carp
C.
Limb
and
unars
he
ateray
contnues
bend
anteror
te
to
32.
te
nerve
he
brevs
musce.
medan
B.
te
passes
nto
te
orearm
A.
era
superca
aspect
cause
o
pan
te
rada
te
due
nerve
posteror
to
courses
orearm
pressure
apped
down
and
to
te
at-
woud
not
te
C
GAS
28.
B.
782;
he
pa
and
ments
N
C
s
ABR/McM
te
o
anterory.
te
and
trum
469;
because
entrapment
wtn
are
most
ts
posteror
E.
hs
161
he
GAS
commony
sape
and
dsocated
reatvey
dsocaton
neuropaty
carpa
E.
may
nvovng
te
weak
resut
car-
ga-
n
medan
33.
an
o
te
GAS
29.
A.
reatvey
dsta
783;
he
B.
he
C.
he
N
te
D,
o
te
scapod
and
trque-
he
motor
nerve
deep
o
731;
contracton
extenson
o
extensor
paanx,
te
dgt
s
attaced
son
A.
s
roots
and
jont.
te
torn
and
n
te
dgta
te
rada
B.
respectve
Vncua
rom
can
D
onga
te
carry
and
E.
supercas
o
te
act
to
GAS
31.
E.
o
lex
A,
A
IP
racture
te
unate
B,
C.
dspaced
GAS
te
suppy
te
proundus
are
te
dsta
to
te
o
t
te
s
an
medan
te
n
he
a
C,
N
te
o
te
on
te
nerve
pamar
761–764;
GAS
36.
connectons
N
dsta
dsta
radus
o
and
n
n
brevs
are
te
trd
com-
n
te
sxt
te
s
tr unk
175
njured
by
tracton
pexus.
neror
ormed
typcay
B.
he
C8
eve
and
tus
on
meda
(ower)
by
assocated
sted
bones
trunk
and
T1.
wt
te
by
te
atera
GAS
ABR/McM
173
to
racture.
be
te
te
and
te
o
ateray.
arses
rom
te
rada
rada
te
w
ts
s
w
bot
ead
to
Weakness
s
not
lexed,
men-
nger
because
tenson.
s
and
aso
ncreased
t
groove
wrst).
weakened
s
nner-
groove.
musce
wrst
under
grp
radas
a
158
njury
are
are
rada
ongus
wen
Note
wen
te
ow
your
lexed.
ABR/McM
passes
152
down
unar
and
coatera
N
o
te
nerve
te
D.
te
arm
are
artery
braca
nto
recurrent
wt
t
dgt
s
by
to
coatera
and
accom-
te
rom
te
te
neror
ebow.
158
produced
nterosseous
nnervated
proxma
arses
wt
to
deep
rada
orearm.
artery
anteror
te
te
unar
artery
te
ABR/McM
pamar
rom
wt
neror
anastomoses
artery
te
arses
rada
he
nerve
438;
trd
nterosse
artery
anastomoses
te
medan
artery
o
unar
te
te
te
artery
rada
lexor
carp
musces
atoug
not
coatera
branc
C. Adducton
o
n
hs
I
te
he
by
extensor
to
extend
o
431;
artery
745–747;
tracton
are
versus
N
anteror
unar
dspaces
to
n
nerve.
nerve.
pocs
strengt
braca
rada
panes
devaton
rada
ABR/McM
occur,
strengt
145
nnervated
nerve
to
spna
pasy.
umerus
dsta
tumb.
grp
ebow
he
not
queston.
809;
te
njury
C7
nerve.
artery
and
422;
aso
An
te
supnator
rada
te
deep
rada
te
N
extended
752,
te
unar
nerve
tendons
your
unar
unkey
Smt
and
s
and
(nabty
lexor
to
s
te
abductor
te
o
bracoradas,
te
woud
n
by
trunk.
nvove
ABR/McM
njury
rada
o
braca
175
oten
are
te
mdde
usuay
Kumpke
420;
racture
n
777;
drop
he
surace
N
musce
recurrent
lexor
typca
he
to
te
woud
brevs,
te
767,
he
dgtorum
wt
segment
drecton
442;
A.
tat
respectvey,
ABR/McM
by
grp
E.
454;
E.
and
muc
37.
oter
o
ocated
braca
wc
are
rater
Injury
ong
avu-
paanx
lexor
paanges,
D,
lexon
dsta
bone.
D.
A.
a
resuts
toned
lexor
s
but
tendons.
te
hs
unars
o
dsta
jonts.
o
pam
to
o
799;
s
been
te
orms
md-body
wrst
tendon
te
by
bandke
tendons
nsertons
and
777–778,
toward
te
and
mdde
o
cord
nerve
te
sender,
lexor
bood
he
s
ABR/McM
as
(upper)
C7
extensors
te
rom
pece
A
GAS
35.
dgts.
are
deep
435;
exus,
729–736;
vated
pro-
suppy umbrca musces and carry sensaton rom
ter
N
cord
C6
carp
B,
157
tendon,
brances
D.
parayze
Wen
a
A.
wrst
pamar
pocs
compartment
ndcs.
unars
contnuaton
and
ongus
predomnanty
lexon
I
ds-
racture.
he
te
groove
nerve,
mecansm
torn
nto
arses
eves.
nerve
ABR/McM
s
34.
eves.
extensor
DIP
GAS
C5–C7.
s
C7
coursng
C5–C8
463;
te
carres
eves.
nerve
carry
musce.
to
T1
ner ve
unar
bers
pued
paanx
and
C6,
te
dgtorum
proundus
te
C5,
o
te
te
nerve
muscuocutaneous
te
N
dgtorum
C8
nerve
o
extensor
ongus
dgtorum
extensor
carp
trunk
posteror
nerve.
cutaneous
te
sensory
rom
and
dorsa
compartment.
braca
C,
te
caracterstcay
o
B,
173
te
te
branc
derved
683–687,
te
ram
rom
he
te
meda
s
radas
extensor
s
superor
bones.
cutaneous
ner ve
nterosseous
are
duces
o
bers
bers.
C. he
rom
antebraca
contnuaton
E.
GAS
ABR/McM
antebraca
anteror
rst
cord.
carpa
toracc
atera
anteror
30.
te
derved
ong
carryng
as
carp
extensor
C5
rare.
o
442;
bers
rom
ta
row
meda
sensory
he
ower
te
A.
ongus
te
compartment.
775–780;
he
cord
nerve
tunne.
Dsocatons
E.
te
A and D. he trapezod and captate bones are ocated
n
D.
dorsa
unate
bone
extensor
second
partment,
orearm.
pocs
occupy
wrst.
he
compartment.
he
abductor
musces
te
by
con-
musce.
deep
A
branc
o
CHAPTER
B.
Compete
te
deep
D.
vs.
he
te
deep
tor
branc
pocs
branc
te
te
s
s
a
uncton
o
abductor
and
by
te
extended
(by
o
te
pocs
bre-
supped
posed);
a
uncton
abductor
ongus
rada
s
nerve
nnervated
medan
nnervated
and
by
te
te
ntact
medan
by
PIP
abduc-
te
nerve.
medan
799;
N
pressed
to
pasy
oten
or
edy
tereby
he
ebow,
c
wrst,
woud
nerve
te
hs
ngt
back
It
a
o
n
o
type
a
on
a
car
te
so
te
and
ous
atera
n
te
oss
atera
cord
nerves
cord
o
o
o
o
te
D
te
patent
braca
and
or
musces
he
medan
arm
and
E.
he
atera
te
pectoras
not
extend
basc
te
ts
sde
o
ven
as
te
he
t
te
can
and
be
mnor
nerves
ven
s
or
judged
ven
troug
can
te
to
be
be
especay
too
sma,
eevated
asca
on
rom
te
as
ts
meda
(bracum).
cepac
ven
more
ateray
up
cuf
s
aso
It
and
woud
It
D.
he
medan
ne
o
GAS
A.
688,
he
tude”
to
he
748,
te
exbts
tumb
s
N
te
and
nerve
o
te
ven
cubta
courses
(antebracum)
758–760;
medan
tumb
eve
antebraca
orearm
patent
o
te
te
te
E.
A
405;
A.
te
rom
tat
N
rst
proxmay
somewat
extended
n
rom
he
breast
and
te
(rada
he
supped
nerves
lexon
o
a
woud
o
mosty
te
te
ourt
nterosse-
ourt
and
t
woud
tumb,
cause
and
MCP
he
E.
he
te
ary
GAS
te
158
dspaced
nerory
supported
by
rota-
coracoacroma
te
to
te
coracod
arc.
tendon
process
o
by
musces.
teres
posterory
mnor
and
because
t
nraspnatus
dspaced
superory
and
because
supraspnatus
te
ren-
drecton.
s
ressted
ABR/McM
axary
(or
nodes
by
te
subscapu-
to
artery
centra
te
or
o
ven
te
apca
axary
aong
N
ymp
407;
From
apca
sequence.
e
between
speedng
ymp
posteror,
te
an
te
te
ater-
rate
nterna
ymp
nodes
and
group
vesses
o
o
to-
rom
receve
atera
ymp
rom
nodes.
737;
nppe.
unortunatey,
receve
nodes
ymp
te
ymp
group
o
nodes.
axary
eferent
te
breast.
anteror,
ymp
e
and
n
o
axary,
nodes
patents,
nodes
and
centra
nodes
are,
pectora)
most
areoa,
Rotter
and
some
and
part
receve
troug
musces
n
142
anteror
parencyma,
lows
parasterna
axary
orearm.
pro-
MCP
medan
o
nerve
(reatve
supracavcuar
route
rom
att-
te
second
o
te
not
gament
nterpectora
racc
D.
s
s
dspaced
te
be
410;
ymp
meda
njury
be
ymp
pectora
157
“benedcton
ngers
o
ABR/McM
umerus
dsocaton
anteror
axary,
and
md-
o
tendon.
te
tere,
te
n
701;
he
are
ventray.
ABR/McM
cassc
atera
te
a
wrst,
beneat
by
not
meda
ars
ossa.
up
438;
coracoacroma
C.
at
tumb,
tendons.
woud
he
vens
te
and
DIP
rada
te
subscapuars
supported
C.
basc
afect
te
o
anterory
not
metastass.
te
o
brac)
nate
jons
o
nerve
te
umbrcas
te
pued
trceps
mb.
ven
N
o
he atera cubta ven s a trbutary to te cepac
cepac
40.
808;
ead
B.
cubta
te
eson
he
medan
woud
extenson
C.
ven.
te
supercas
(rst
and
te
o
dgtorum
parayss
o
or
B.
passes
A
musce
42.
dayss,
dgts
are
ter
o
lexon
lexon
unar
tendons
do
145
te
musce
ore-
and
o
lexon
and
and
n
774,
s
nnervate
musces
n
tor
contro
te
eson
t
GAS
used
E.
orce
pectora
ABR/McM
basc
passes
arm
o
A
ocaton
B.
arm.
419;
cepac
case.
poston
N
lexors
jont
(lexor
unar
or
tat
musces.
medan
major
nto
750–752;
he
nnervates
tenar
and
te
wen
n
nerve
te
n
D.
D.
bot
because
Neter
tat
IP
3
trd
weakness
dgts
pectoras
extenson.
GAS
and
te
brances
nerve.
D.
C. he
It
not
and.
pexus
unar
nnervates
pexus
do
te
and
(by
eson
dgtorum
weakened
and
A
3
unop-
dgts.
musces
GAS
41.
muscuocutaneous
wc
o
cause
o
2
and
lexed
weakened
(lexor
dgts
second
n
2
ndcs
jonts.
of
can
resut
and
partay
proundus).
lexon
o
weakness
weakness
bra-
comes
braca
nerve,
orearm
te
nerve
te
te
pectora
te
t
are
dgts
and
319
Limb
dgts.
groove.
o
and
5
dgts
musce),
te
cause
benc,
trceps
typcay
C
rea-
Saturday
or
rada
te
nerve
suppos-
extensors
nnervates
compresson,
o
o
eson
o
a
oss
o
A
com-
One
woud
te
branc
nerve
pasy.”
peope
nerve
motor
medan
tese
key
ntoxcated
te
te
extenson
te
most
tat
over
o
te
meda
nto
o
ebow.
resut
medate
he
s
ngers.
te
ste
o
and
branc
and
woud
jonts
woud
symptoms.
nnervates
and
te
Parayss
te
beng
arm
but
to
extend
o
ater
nerve
musce
recurrent
171
“Saturday
compressng
proxma
st
s
nckname
ter
rada
te
B.
tese
caed
aseep
wt
by
ABR/McM
nerve
cause
ts
a
ngt
A.
DIP
undus
nerve.
455;
rada
s
supped
4
dgtorum
dgtorum
o
umbrcas).
son
39.
jonts
unopposed);
extensor
nerve
musce),
recurrent
extensors
dgts
lexor
jonts
pocs,
C. he
B.
o
s
s
and
pocs
brevs
It
nerve.
tumb
ongus
abductor
o
rada
te
tumb
nens
te
A.
te
te
ongus.
Opposton o te tumb s a uncton o te oppo-
GAS
38.
o
o
pocs
o
pocs
branc
Abducton
abductor
E.
extenson
extensor
Upper
6
ABR/McM
185
a
nodes
te
receve
oter
ax-
320
C H A P T E R
43.
D.
he
6
et
posteror
n
and
te
o
A
ead
he
to
and
atera
B.
here
te
devaton
meda
N
extensor
sor
dgt
nerve,
a
A
are
esser
B.
are
and
E.
ormed
by
te
te
to
are
n
patent
ntact,
C.
ducts
parayss
lexors
o
te
D
(supra-
nerve
resuts
n
scapua
te
and
n
a
te
woud
musce,
an
n
paray-
extensor
47.
and
jonts.
he
tendons
ndcs,
o
proxma
and
by
te
and
o
o
te
unar
GAS
45.
and
782,
adducton
o
and,
B.
and
te
teres
between
te
o
a
te
o
and
PIP
and
A.
N
nerve,
and
DIP
jonts
nterosse.
by
te
he
deep
degrees
musce.
ost
n
ts
unar
msed
n
and
te
s
are
C.
per-
rst
rotaton
detod
he
s
o
and
detod
teres
teres
s
mnor,
mnor
are
case.
Fracture
ng
D.
o
w
but
racture
o
o
be
te
potentay
meda
compro-
epcondye
o
te
o
woud
most
GAS
46.
te
o
N
ossa
and
cancer
te
te
o
te
o
by
s
not
te
caused
pectoras
cancer
upon
major.
can
eevaton
ven
key
s
on
tat
courses
rom
resut
o
te
o
te
deep
to
rom
te
682,
t
s
not
s
artery
runs
n
be
te
to
te
cavce.
te
sub-
approprate
damaged
to
te
sde
too
and
near
because
axary
o
te
ven
arm.
superca
te
and
cavce
artery
ts
meda
Its
at-
N
419;
ts
Its
te
rst
orgn
cavcuar
te
cavcuar
ABR/McM
or-
man-
descent.
o
to
bend
te
o
descendng
pont
atera
ax-
mnor.
not
rom
beore
s
te
pont
does
durng
course
to
ts
t
arses
artery
artery
rom
pectoras
rom
and
cartages.
Furtermore,
725–736;
branc
meda
te
costa
a
to
artery,
toracc
qute
s
atera
subcavan
s
o
posteror
atera
subcavan
te
racture
te
struc-
poston.
body
axary
poston
nterna
between
superca
njury.
neror
te
a
trbutary
te
te
o
a
most
runs
anatomca
ste
anterory
te
toug
woud
wtn
te
s
oowng
artery
he
anterory,
wrst
proxma
wt
oten
Coes
te
he
porton
dsta
o
te
s
te
bone
dspacement
gves
racture
woud
ead
to
droop-
B.
A
s
te
a
qute
mdde
te
neck
o
droopng
necessary
njure
409;
to
aso
scapod
afect
te
o
umerus
te
abducton
o
te
unusua.
trd
rada
ABR/McM
o
te
ment
souder
te
costa
racture.
135
oten
radus
s
ragment
o
appearance
C
and
rom
umerus
woud
nerve.
te
o
reerred
a
to
dspaced
projectng
radus
dnner
as
a
rom
ork,
“dnner
te
tus
ork”
E.
V okmann
deormty
tumor
lexor
te
skn
becomes
edematous,
except
te
musce
pany
te
an
term
overa
peau
resembance
d’orange.
to
an
orange
and
o
boxer’s
a
not
racture
racture
cause
usuay
te
(rst
o
te
dspace-
occurs
scapod
ractures
metacarpas
GAS
scemc
tat
can
wt
o
contracture,
ts
contracture
oow
compartment
hs
skn
hs
rom
tus
(“wast”)
te
umerus,
were ar oces cause sma ndentatons o te skn.
te
o
resuts
woud
radus.
aspect
Bennett
ractures
by
embo,
te
and
bot
and
at
bone.
resut
t,
re-
spectvey).
D.
146
o
racture
bone
narrow
o
ence
185
es
and
ary
Wen cutaneous ympatcs o te breast are bocked
pee,
nto
major
artery
ascendng
B.
gves
t
scapod
anatomca
ead
not
It
key
693;
genod
te
smary
Fracture
rb
toracc
radus.
a
te
A Coes racture s a racture o te dsta end o te
souder.
umerus.
E.
A.
ntensed
(o
o
ead.
nvovement
breast
seen
ven
atera
GAS
48.
pttng
deormty.
te
Fracture
ven,
posterory.
woud
rst
cartages
by
umerus
to
nvovement
to
ABR/McM
damaged
njury.
umerus
perormed
te
musce,
detod
te
te
190;
deeper
a
o
breast,
to
he
oten
umerus.
B.
E.
164
o
te
era
tan
o
s
er
wt
due
pectoras
cepac
gn
skn
cancer
he
It
two
branc
umerus
nnervates
orzonta
te
nerve
a
o
Abducton
Latera
by
ABR/McM
neck
wc
musces.
nraspnatus.
he
454;
surgca
perormed
te
bot
te
axary
15
ts
ater
MCP
wc
te
subcavan
part
mnor
detod
many
o
be
he
dsta
nerve.
nterosse,
805–809;
N
ocaton,
nerve.
C. Fracture
njures
te
o
cavan
umbrcas are supped by te medan nerve; te oter
umbrcas
te
ocaton
nterosse,
te
umbrcas
to
tat
above
be
orange
o
and
rada
MCP
(PIP)
d’
cavce
exten-
te
aso
gaments
eads
mb.
737;
he
arm
areoar
subcavan
A.
cuts
cuts.
Peau
o
suspensory
pttng
er
D. he
ture
138
extenson
unar
E.
xaton
GAS
resut
nnervated
and
deep
o
nvason
psatera
souder.
extensor
te
skn,
woud
Invason
MCP
te
and
by
te
retnacua
rases
Inverson
turnng
o
or
overyng
protrude
jonts.
o
Extenson
by
Sortenng
Cooper)
umerus.
or
degree,
Abducton
nnervated
te
musces,
unctons
o
ebow
psatera
dors
dgtorum,
responsbe
or
njury
te
nterpaangea
and
jonts
te
te
extend
to
musces
A.
retnacua
ABR/McM
mnm
muc
(DIP)
o
souder
strengt
scapuar
nerve
417;
to
te
o
atssmus
njured
resutng
trunk).
retractng
rotator
703;
C. Inabty
D
n
te
scapua
ndcaton
dorsa
horacodorsa
te
te
n
souder
upper
atera
GAS
to
or
to
o
o
been
et.
no
te
Injury
ss
44.
and
as
musce,
aowng
ange
symmetry
s
o
nerve
weakness
E.
by
rgt
rotators
scapuar
XI)
sternocedomastod
te
C.
(CN
trapezus,
superor
demonstrated
te
nerve
sternocedomastod
te
te
posterory.
Limb
accessory
to
parayss
droop
as
Upper
a
artera
te
wt
s
N
442;
muscuar
aceraton
orearm.
extreme
racture.
761–764;
a
supracondyar
ABR/McM
130
racture
nto
Iscema
pan,
te
and
accom-
CHAPTER
49.
B.
In
souder
separaton,
coracocavcuar
petey
and
n
a
troug.
dsta
compete
away
and
C.
(but
torn
he
E.
t
s
nes
he
and
process
N
cant
B.
te
o
nterosse,
and
ead
and
52.
com-
upward
mb
tat
be
pa-
te
o
te
umerus
s
sou-
A.
s
used
not
n
torn
te
n
repar
o
te
gament).
gament
s
not
nvoved
abrum
oten
unar
oss
trocea
a
woud
o
te
resut
o
near
te
o
te
lexor
(among
lexon
o
na
te
and
nerve
jonts,
at
ypotenar,
damage
afect
PIP
2
E.
T rauma
afect
GAS
to
a
D.
pocs
3
as
2
lexon
we
and
as
54.
cause
774,
805;
but
not
ong
nerve
nger
N
wt
ore,
t
51.
o
te
axary
ne
between
te
braca
lex
as
438;
lexors
ventra
braca.
suppy
hs
te
A.
he
B.
he
and
s
cumlex
o
te
ramus
he
jont
B.
o
te
toracodorsa
D.
he
atera
E.
he
te
braca
artery)
as
D.
7.39
GAS
and
te
to
s
oten
part
can-
artery
o
and
crcum-
te
deep
nadequate
to
mb.
medan
but
moton
466;
superca
o
nerve
any
te
woud
and
deep
and
efect
nerve
s
suppes
o
o
te
ong
troug
synova
te
ong
te
s
not
te
deep
branc,
assoc-
nerve;
on
aso
te
tumb
ABR/McM
tere-
lexors
o
a
branc
tenar
o
te
emnence
ead
te
Fg.
o
te
7.89.
bceps
genoumera
gaments
genoumera
ead
(GAS
160
brac
jont,
sur-
membrane.
o
nragenod
he
te
or
jont
trceps
tuberce,
te
te
cr-
nraspnatus.
(passng
scapua)
te
artery
wt
bands
are
capsue
brac
beneat
tcken-
anterory.
arses
te
rom
genod
as
no
scope
as
epu
no
te
(rst
coracobracas
anastomoses
o
424;
695;
verse
o
wt
axary)
te
to-
Fgs.
145
421;
passes
to
and
on
posteror
nsert
nerve
on
te
to
te
greater
ten
tereater,
passes
notc
te
pass
t
te
coracod
pro-
143
passes
under,
hs
n
to
and
over,
te
upper
to
te
and
superor
gament
te
notc
deep
suppyng
scapuar
rom
umerus.
artery
gament.
convertng
nerve
arses
te
ABR/McM
scapuar
brdges
border
oramen.
ten
passng
notc
te
o
he
supraspnatus
(spnogenod)
te
trans-
te
artery
musce
troug
to
suppy
te
te
nraspnatus.
he
o
subscapuar
te
axary
scapuar
B.
he
ts
ste.
he
dorsa
meda
D.
and
he
GAS
artery
wt
te
708–709;
s
a
t
cervca
scapuar
border
posteror
axary
artery
artery;
branc
dvdes
toracodorsa
transverse
space
ABR/McM
N
scapuar
scapua,
axary
(GAS
nserts
suprascapuar
superor
anastomoses
part
tendon
umerus
and
suprascapuar
te
njury.
te
cess
he
C.
artery
part
E.
anastomoss
o
o
tuberce.
A.
beneat
nraspnatus
he
neror
artery.
(second
N
trd
posteror
branc
7.50).
708–710;
by
ead
woud
artera
axary
anastomoses
wtn
toracc
no
racoacroma
te
artery
toracc
superor
te
pat
o
deep
wt
wt
N
o
te
ngers.
C8
te
coatera
o
artery
scapuar
border
nteros-
nerve
nterosseous
ave
genoumera
he
158
beyond
ascendng
needs
scapuar
dorsa
meda
ony
between
te
suprascapuar
just
part
anastomotc
artera
to
contnuaton
not
nerve
passes
E.
ABR/McM
he
trd
artery
umera
774;
ngs
lexors.
occurred
artery.
te
ts
lexors.
rse
anteror
recurrent
rounded
55.
njury
compromsed.
anteror
orearm.
tendon
lexon
51–75
C. he
and
lex-
dects.
nterosseous
woud
musce
GAS
Answers
not
gves
te
te
C. he
A.
DIP
orearm,
and
opposabe
pronator
tumb
to
njured,
musces, and ts njury woud resut n probems wt
umbrca,
te
wdespread
nerve
posteror
medan
musces.
to
te
ated
he
o
woud
woud
more
s
be
te
njury
proundus,
t
w
to
te
ossa.
spna
ong
n
However,
rse
o
ongus,
rada
opposton.
musces
resut
te
Medan nerve njury at te wrst woud cause oss o
tenar
nerve.
tumb
gves
I
branc
pocs
dgtorum
musces.
te
a
n
sgn-
wrst
t
meda
proxma
jont
and
te
atoug
adductor
dgts
seous
GAS
unar
IP
o
nerve
s
lexor
sors
gun
jonts
jont
s
173
nerve
te
lexor
bone
bone.
he
dgtorum
DIP
te
quadratus
medan
brances
umerus.
suppes
navcuar)
carpa
C.
coronod
oter
te
IP
o
term,
ABR/McM
nterosseous
tat
a
oder
ractured
he deep branc o te rada nerve suppes exten-
accompa-
te
nerve
te
te
nerve
te
o
te
321
Limb
B.
n
142
rom
442;
pronator
he
separa-
N
anteror
atera
on
(or
commony
787;
he
medan
dgts.
nerve
o
E.
scapod
most
te
exposvey
and
te
woud
he
GAS
53.
droops
can
E.
te
nterrupted
devate
upper
of”
gament
meda
te
o
Medan
lexon
be
AC
or
separaton.
genod
te
wt
afect
teres
“step
ABR/McM
una
t
parayss
D.
te
not
red
te
T rauma
C.
can
may
te
te
dsocaton.
musce
and
not
a
bot
partay
observed.
te
415;
dects),
ourt
o
was
o
proundus
jont
we
scapuar
perced
o
Parayss
or
be
separaton.
na
ten
AC
sometmes
souder
699;
can
cavce
coracocavcuar
Dsrupton
GAS
o
transverse
souder
A.
causng
coracoacroma
ton
D.
te
sometmes
dsocaton,
he
he
o
separaton,
Dspacement
der
50.
end
nerory,
pated
A.
torn
te
eter
gaments
Upper
6
N
o
trd
part
crcumlex
and
courses
nerve
anteror
pass
aong
to
te
scapua.
crcumlex
passes
axary
418;
te
nto
brances.
artery
artery
te
o
umera
troug
te
nerve.
ABR/McM
139
branc
o
te
quadranguar
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
te
patent
sensaton
tumb
te
B.
and
rada
he
to
te
ndex
he
s
he
te
te
to
te
nerve
and
rada
tat
te
pes
te
meda
meda
to
atera
o
dorsa
nerve
normaton
sde
o
meda
o
suppes
rom
te
cutaneous
750,
o
te
te
te
cord
wrst
782;
s
nerve
and
a
con-
B.
and
suppes
a
skn
o
branc
te
unar
422;
ABR/McM
C8
E.
T1
152
nerve
GAS
58.
B.
ace
te
to
major
s
dermatome
runs
over
down
dgts
souder
contrbu-
te
o
te
2
prme
C7
s
n
posteror
and
3.
movement
and
detod.
o
afect
te
woud
on
and
afect
a
nerve
te
woud
arm
upper
afect
orearm
meda
afect
lexon
and
skn
on
te
mb.
sde
and
o
musces
te
prmary
upper
musces
and
mb.
skn
o
te
meday.
734,
As
and
ts
he
wc
woud
woud
skn
oss
and
te
sde
oss
and
te
and.
artery
artery
makes
and
extenson.
C5
over
oss
arm
o
o
nerve
nerve,
descrbed,
orearm,
atera
drect
cervca
rada
wrst
regon
C6
sup-
D.
s
n
skn
orearm.
cutaneous
te
Loss
jont.
orearm.
cutaneous
N
A.
sevent
to
mover
propro-
nerve
muscuocutaneous
antebraca
te
sde
C. he
ton
te
branc
suppes te meda a o te dorsum o te
GAS
57.
provdes
proxma
superca
nerve
ar ter y
.
arm,
nterosseous
antebraca
o
he
he
o
nger
sensory
atera
branc
E.
njury
regon.
Fig.
nerve.
tnuaton
D.
sufered
dorsum
posteror
ceptve
C.
as
md-umera
GAS
scapular
777,
780;
rada
te
N
artery
dorsum
o
420;
ABR/McM
passes
te
rom
wrst,
t
162
te
ventra
crosses
sur-
troug
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
•
te
anatomca
snufbox
and
passes
over
te
GAS
scapod
bone.
A.
he
unar
bone
to
carpa
te
E.
he
GAS
o
but
on
te
beneat
cana
n
meda
te
between
retnacuum.
not
59.
D. he
sde
lexor
te
psorm
Guyon
communcaton
o
carp
cana
wt
s
te
te
Fg.
rom
unar
pamar
two
anastomose
nterosseous
arse
te
artery
between
extensor
te
and
and
te
pass
radus
compartments,
branc
eads
wt
te
o
o
N
457;
posteror
common
te
patent
te
rada
n-
proxma
una,
can
artery
adductor
artery
n
176
a
wen
woud
to
as
te
te
te
may
mb
bursa,
not
subacroma
papaton
s
more
or
ess
sub-
wen
te
bur-
subacroma,
supraspnatus
be
drawn
tendon
back
under
abducted.)
beneat
present
wt
s
orzonta,
beng
wt
bursa
communcate
he
man
tus
uncton
rotaton
as
te
te
subscapuars
superca
pan.
genoumera
It
jont
musce
s
o
not
o
te
te
nraspnatus
souder.
nvoved
n
he
musce
s
nraspna-
overead
souder
movements.
C.
Inlammaton
genoumera
ABR/McM
more
subscapuar
atera
passes
pam
o
on
cavty.
B.
pocs
te
rom
pan
eevated
suc
acromon
he
te
tougt
assocated
or
suferng
(I
been
be
musce,
to
n
s,
peraps,
nterosse-
and
as
may
tat
s
bursts.
arm
sts
respectvey.
unar
te
7.88 ).
801–805;
te
A.
anteror
orearm
and
deep
(GAS
Guyon
lexor
arteres
between
to
to
te
lexor
te
he
branc
n
reac
ocated
rom
tunne.
D.
terosseous
dsta
s
passng
and
adjacent
and
artery
wrst,
unars
ous
.
detod
te
C
Fig.
souder
pan
or
artrtc
jont
tan
present
tat
canges
as
present
more
ere.
wtn
te
generazed
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
neror
GAS
60.
696,
E.he
to
axary
te
cuar
A
between
contans
It
o
o
te
gands.
te
C.
he
te
tendon
marked
a
asca
deep
upper
and
asca
o
te
o
te
neurovas-
deep
te
connectve
nvestng
nerves,
parynx
pretracea
61.
tra
asca.
asca
and
ympatcs,
asca
s
tssue
covers
te
contnuous
an-
te
and
710,
C. he
wt
730;
o
magnum
juguar
ead
.
C6
N
oow
416;
ten
and
(CN
tat
ext
It
trapezus
and
nnervates
te
te
te
and
con-
dors
as-
367
arses
rom
troug
crana
cavty
te
te
te
ven-
ora-
troug
sternocedo-
wc
uncton
n
souders.
receves
C4
s
armpt.
ascend
musces,
nerve
rom
XI)
cavce
asca
atssmus
te
nnervates
eevatng
suprascapuar
and
o
te
axary
ABR/McM
nerve
C1–C4
to
nvests
he
pectora
te
(occasonay
and
musce
musce.
oramen.
rotaton
he
te
accessory
mastod
A.
mnor
orms
rootets
men
oose
vesses,
GAS
te
extendng
mb.
s
cavpectora
tnuous
ca
contnuaton
nerves
he
pectoras
ocated
dscomort.
buccoparyngea
and
are
142
cervca
te
asca
cutaneous
musces
wt
s
encoses
derms
at,
o
and
ABR/McM
te
Superca
buccnator
terory
424;
seat
axa.
B.
musce
pont
N
ayer
bunde
and
and
te
713;
prevertebra
nto
mnor
Fig.
.
D.
E.
GAS
arch
te
bers
pexus
supraspnatus
rom
s
C5
to
“prexed”)
musce,
wc
s
CHAPTER
responsbe
Erb
pont
C5–C6
B.
he
D.
ong
C6,
he
accessory
Rada
62.
D.
he
known
to
renorces
gament
ments
as
o
separated
superor
GAS
A.
he
ong
by
mnor
ce.
B,
C,
te
o
te
be
te
E.
s
o
routes
anteror.
te
ventra
space
he
te
by
ts
coracocavcuar
anteror
are
be
and
not
bordered
njured
gament,
tendon
key
meday
musce,
ateray
superory
by
te
and
by
teres
to
o
be
by
te
by
te
te
teres
major
posteror
structures
sted
mus-
crcumlex
n
te
ong
are
space.
detopectora
and
to
ga-
dsoca-
space.
ocated
atera
wt
wc
142
s
nerve
te
assocated
gament
genoumera
an
te
souder,
souder.
umerus,
n
neck.
and
te
key
quadranguar
s
s
gament,
brac
oter
o
te
he
not
nerory
te
te
cavce
AC
brac
te
o
coracoacroma
ABR/McM
traverse
te
te
are
he
o
rotaton
orms,
scapuar
axary
ner ve
and
but
te
ocated
between
pexus
rom
Separaton
trceps
and
wtn
rada
unon
serratus
arses
n
njured
trceps
o
vesses
D,
taned
ven
may
410;
neck
Bot
abducton.
te
rom
separaton,
souder.
musce,
umera
arm
at
138
damaged.
quadranguar
surgca
o
s
te
connects
severe
be
separaton
o
XI)
nvoved
jont
umerus
N
ead
(CN
jont
more
ead
694;
arses
suppes
scapua.
transverse
ong
njured
not
AC
bands
te
pexus
ABR/McM
aso
by
te
s
AC
In
ton
a
nerve
and
nerve
te
te
t.
degrees
C1–C4.
may
or
C7,
gament
o
15
not
he
con-
trange,
tranguar
eads
o
•
GAS
B.
718–720,
speccay
musce.
A.
C.
te
s
tests
patent
tumb
lexor
od
he
a
o
dgt
te
seet
lexor
s
pocs
asked
unar
o
to
lat
ongus
te
A.
he
s
s
nerve
te
s
pasy.
adductor
od
a
seet
he
by
medan
nnervated
and
woud
te
by
not
65.
C.
(Fg.
not
by
and
te
E.
deep
used
s
nnervated
by
te
GAS
826;
recurrent
D.
n
467;
branc
ABR/McM
o
te
te
166
medan
nerve
nner-
s
tor
te
s
not
responsbe
Damage
medan
o
brevs,
to
or
te
sensory
n
o
or
nerve
te
uncton.
lexor
any
pamar
unar
opposton
and
pocs
cutaneous
cutaneous
woud
tumb
or
not
brevs)
nnervaton.
brances
cause
tey
and
are
o
te
weakness
prncpay
musces
MCP
rada
vates te tenar musces (opponens pocs, abduc-
pocs
oss
to
be
o
B.
s
te
to
5,
and
branc
or
te
o
o
te
movement
te
o
extenson
te
oss
o
present
umbrcas
medan
rada
ts
o
te
t
te
deep
mus-
responsbe
unar
te
a
te
ourt
or
two
resuts
umbr-
Extenson
and
o
t
weak
and
IP
trd
ngers
are
o
te
dgts
umbrcas
Some
second
te
uncton
respectve
tese
nerve
and
dgts.
s
musces.
n
o
not
musces
wc
ter
nterosseous
n
o
and
ntact,
does
168
branc
ourt
s
and
musces.
nterosseous
te
s
te
mus-
brevs.
suppes
It
suppes
abductor
pocs
pocs
nerve
ABR/McM
deep
nerve
and
adductor
abductor
tenar
IP
he
unar
o
st
te
o
movement
dgta
adductor
orearm.
a
o
a
ntact
pamar
lexor
jonts
te
by
and
o
te
466;
due
o
because
vated
2
te
nerve.
absent,
extenson
A
N
to
branc
or
responsbe
nterosseous
te
parayss
ca
N
817;
Injury
not
musces,
dgts
movement
pam.
rada
o
s
branc
nnervate
ces
medan
deep
o
dgta
responsbe
musces.
deep
Anteror
to
6.13).
814–816,
he
ndcs
he
pamar
not
common
nerve
tenar
ces
ante-
te
be
tumb
nnervated
te
nerve.
66.
extensor
nerve
GAS
D.
paper
nerve.
E.
te
s
musces.
second
medan
pocs
o
tenar
he
More
common
nerve
ypotenar
nnervated
te
between
radas
B.
144
nerve
rst
medan
trceps
pam.
o
mnm
paper
carp
a
branc
unar
o
ABR/McM
or
acton
and
nterosseous
lexor
417;
te
ror
he
N
postve
he
branc
D.
t
he
between
730;
sgn
6.13
and
nter va
te
Froment
Fig.
cepac
brac.
64.
325
Limb
nerves.
422;
AC
damage
63.
o
N
acromon
aso
and
nerve
703;
rst
braca
toracc
C5,
GAS
te
te
spna
rootets
E.
or
o
Upper
6
and
jont
dgts
nner-
nerve.
nerve
case.
and
te
medan
nerve
appear
326
C H A P T E R
C.
I
te
6
unar
regon,
dgts
E.
he
Upper
and
tenar
67.
A.
he
on
o
te
he
te
o
t
n
te
oss
dorsum
te
not
ts
md-orearm
n
o
te
te
medan
does
o
vde
D
GAS
suppes
ave
artery
te
arses
atssmus
71.
aong
and
artery
GAS
are
and
provde
he
no
te
subscapuar
N
he
and
adducted.
neck
major,
te
he
o
te
to
es
bceps
major,
due
and
to
s
te
and
s
tyro-
can
(n
o
a
te
GAS
72.
E.
dors.
to
GAS
B.
693;
he
es
N
417;
racture
between
and
te
ment
ne
te
tracton
and
o
o
musces.
ay
by
te
te
bony
teres
are
he
musces.
nerve
te
s
s
prox-
not
teres
(A)
proxma
unopposed
and
o
o
dsta
to
te
te
rada
rag-
unopposed
con-
pronator
ragment
contracton
radus
quadratus
devates
o
te
ater-
supnator
musce.
he
bracoradas
E.
he
bracas
una
ton
GAS
A.
lexor
B.
o
te
te
he
N
te
o
be
te
on
te
coronod
nvoved
n
radus.
process
te
atera
o
te
deva-
o
435;
ABR/McM
te
passes
orearm
161
aong
he
and
carp
te
radas
orearm
to
s
passes
seen
mdne
dstay
n
te
supercay,
nsert
at
te
border
he
n
o
te
te
lexor
pated
on
pocs
wrst,
were
anatomca
carp
te
ongus
unars
meda
t
o
base
atera
o
te
por-
tendon
eps
s
orm
o
te
5t
st.
meta-
hs
type
racture.”
te
unar
o
styod
te
dsta
nor
a
radus
can
be
seen
and
pa-
n
cord
o
he
te
te
trunk
o
o
nerve
te
te
T1
braca
sde
pexus.
to
a
o
dysuncton
te
Long
medan
he
te
sensory
n
te
T1
te
afects
lexors
nerve
extensors
rada
o
cutaneous
braca
dgts.
njured.
tereore,
nor
ascends
meda
suppy
Its
te
wrst,
spne)
o
te
te
tereore,
ony
te
antebraca
pam.
not
as
motor
o
njury
not
o
or
meda
te
are
he
compresson
observed
o
pexus
woud
n
patent.
ts
744–745;
“Gamekeeper’s
by
te
and
N
tumb”
and
te
s
o
(A)
o
nerve
dsturbance
mdde
not
gve
170;
was
a
seen
n
braced
and
rse
te
(C)
tat
ower
to
te
ABR/McM
term
s
o
trunk
symp-
98
coned
a
jont
sk
he
ts
and
poe,
suc
te
because
njury
njury
vagus
to
s
te
rab-
te
te
orce
unar
more
com-
wt
ter
awkwardy
causng
as
ground,
resutng
caused
days
wo
anmas
between
nger.
hese
skers
on
sma
necks
MCP
gament.
vagus
orce
on
tumb.
De
Quervan
o
wrst
A
navcuar
A
o
a
key
te
(tenosynovts)
aspect
upon
o
turnng
te
te
It
wrst,
te
presents
graspng,
racture
s
scapod
to
be
tumb
aso
s
known
te
as
carpa
a
scapod
bone
wc
s
ractured.
s
a
racture
dsocaton
at
te
base
tumb.
Bennett
tumb
metacarpa
reers
to
bone.
racture
It
o
785–786;
N
443;
te
contnues
jont.
GAS
afects
wrst.
st.
he
boxer’s
atera
pan
makng
most
syndrome
te
or
racture.
E.
ked
ter
ndex
abducted
wt
B.
wo
breakng
tendons
ateray
ventray.
te
ntact;
683–687,
rst
wrst
ower
movements
braca
mony
over
atera
te
CMC
te
stretcng
rb
sensaton
te
173
or
rst
o
tat
wrst.
curvature
te
source
nerve
and,
or
ABR/McM
meda
are
te
are
dermatome.
coatera
second
te
by
unctona;
D.
tumb,
super-
passng
T1
bts
te
snufbox.
tendon
sde
te
dsocaton
and
atera
orm
musces
gamekeepers
C.
abductor
deep
ts njury was most commony assocated wt Scotts
retnacuum.
trapezum
ocated
D.
D.
A.
te
metacarpa.
C.
73.
te
parayzed.
GAS
te
ongus
lexor
lexor
ton
not
on
dstay
radus.
pamars
surace
to
nserts
woud
762–764;
he
ca
and
nserts
o
compresson
va
motor
are
te
on
D.
s
racture
o
te
443;
ramus
prncpa
unar
toms
supnator
N
(severe
rom
and
o
due
o
wt
Indcatons
sde
o
causng
ngers
wrst
umerus.
trd
s
ne
and
dors.
sde
orearm,
te
pectora-
meda
nerve
te
a
coracobracas
o
te
ntrnsc
eevated
contracton
acton
he
neck
“boxer’s
nvoves
provdes
o
148
upper
a
tumb.
and
nsertons
dors
te
C8
te
rom
attacments
passes
167
te
racture
T1
o
abducts
ragmented
pronated
pronator
(C)
te
ABR/McM
pronator
and
o
tendon
macne
Smt
jon
B
aspect
as
pexus.
te
dsta
a
nor
783–784;
spna
ton
te
te
racture
o
Scooss
A, B, D, E. hese answer coces w not resut n adduc-
o
Neter
atera
patent
axary
atssmus
and
on
ste
ragment
atssmus
ractured
known
racture
te
pro-
30%).
typca
te
and
te
ABR/McM
as
ttng
s
Bennett
scapua.
atssmus
resuts
D.
jont
149
musce
brac,
s
E.
toracoacroma
above
dsta
eevaton
te
part
te
437;
ongus
tunne.
woud present wt te absence o a knucke as observed
rombod
rom
neck
and
major,
te
deep
branc
umerus
ne
teres
o
te
ABR/McM
adducton
teres
o
second
suppy
wereas
detod,
he
no
418;
racture
carpa
ere.
arses
scapuar
supraspnatus
ragment,
te
root
N
wen
C,
pocs
te
patent
Coes
ten
border
toracc
o
major,
ma
musces.
te
and
767;
he
o
dors.
artery
dorsa
racture
pectoras
o
meda
atera
surgca
musces.
a
brances
709–710;
ractures.
at
or
he
pexus
cervca
trunk
E.
he
te
te
B.
carpa
168
rom
lexor
troug
umbrcas.
woud
he
A,
ABR/McM
braca
orgn
arteres
70.
E.
and
and.
nerve
suppy
nerve
pam
jonts.
467;
transverse
cervca
s
IP
N
provdes
musces
69.
te
njured
sensory
he dorsa scapuar artery passes between te ventra
C.
C.
on
branc
toracodorsa
It
ram
68.
and
parayss
805–807;
artery.
B.
5
be
musces;
Moreover,
efect
were
woud
recurrent
te
GAS
nerve
tere
4
Limb
ABR/McM
172
to
base
te
o
te
CMC
CHAPTER
74.
A.
he
n
ong
ead
souder
cause
der,
pan
on
te
B.
n
were
Forced
o
lexon
te
t
tendon
w
anteror
orced
te
w
be
contracton
eads
genod
o
te
te
n
o
te
and
a
n
te
bceps
tuberce
musce
o
greater
more
te
bceps
can
woud
te
sou-
B.
tenson
brac
orce
coracod
Intact
te
te
as
process
o
are
te
E.
C.
Pan
te
w
ton
D.
not
o
te
lexon
te
E.
arm
he
bceps
C.
721;
he
atera
a
423;
common
ts
uncton
o
o
extensor
and
ts
a
o
unc-
GAS
77.
te
musce
and
w
resut
adducton
o
musce.
experence
ABR/McM
epcondye,
lexon
not
E.
pan
n
souder
te
atera
jont.
tendon
orgnates
o
rom
ts
te
tendon
tendons.
te
ventra
as
tenns.
part
son
o
o
Because
te
te
te
extensors
common
wrst
extensor
w
o
te
wrst
tendon,
exacerbate
te
ressted
pan
Nerve
and
tes
(e.g.,
carpa
B.
In
conducton
on
sor
or
te
are
used
to
consstent
and
parestesa)
sgns
suc
as
ebow,
tere
woud
extenson
radas
brevs
o
be
te
ony
no
pan
ebow
abduct
as
on
te
and
he
are
te
w
not
and
tngng
present
consstent
wt
n
n
te
tenns
meda
ourt
ebow.
and
hese
epcondyts
t
sgns
(goer’s
ebow).
E.
process
o
w
te
te
orearm
te
proxma
o
757,
radus
be
musce
N
et
n
over
tenns
extensor
orearm.
atera
775;
not
common
extensor
toms
GAS
GAS
C.
he
and
te
dsta
ebow.
he
tendon
s
orgn
o
ocated
at
bracoradas
w
styod
contrbute
s
a
to
ore-
symp-
epcondyts.
431;
161
76.
sors
te
he
te
ca
neck
o
crcumlex
te
te
s
provdes
era
aspect
not
be
o
abe
because
o
te
artery)
sensaton
at
to
souder.
abduct
njury
dorsay
besde
(accompaned
ractured
te
to
passes
umerus
umera
umerus
nerve
nerve
te
(A),
a
by
and
can
tat
ocaton.
te
skn
over
Atoug
arm
rom
smpe
be
te
15
test
o
te
te
on,
he
te
90
resuts
skn
sensaton
4
o
n
rb
not
o
o
o
te
e
te
n
te
ser-
medan
pamars
te
oten
he
tendon
s
on-
mdne
and
ongus
te
s
o
ave
nerve
s
present.
absent,
anatomca
ractures.
expan
te
te
poston
T1)
Addtonay,
o
sensaton
woud
musces
sensory
oss
o
s
5
oss
a
on
pam.
(C8,
lexor
and
njury
jont
N
bot
n
a
and
over
te
te
resut
a
n
ntrnsc
meda
dor-
and.
lexon
rom
n
te
contracture
connectve
posteror
extenson,
tssue
o
ds-
orearm
tumb
woud
extenson,
and
dsturbances.
437;
to
ABR/McM
te
tota
I
medan
cawng
II
are
deep
159
and
o
te
I
o
unar
nerves
ngers.
te
IP
te
capabe
o
at
he
te
MCP
was
n
te
te
o
umbrcas
te
and
o
degree
tey
nner-
responsbe
are
nto
and
and
parayzed,
a
poston
medan
woud
mdde
tose
o
motor
are
by
parayzed,
appearance.
damaged
o
ndex
some
ter
are
o
umbr-
nnervated
IV
ngers
“caw”
ony
are
and
branc
nterosse;
and
Wen
te
nterosse
deep
umbrcas
pu
te
tey
III
A
te
te
as
jonts.
cawng
ntact.
provdes
and
tendons
nerve
because
be
nerve
competng
unar
a
umbrcas
unar
lexor
s
because
parayzed,
nterosse
extenson
lexon,
nerve
suppes
nerve;
he
ong
rada
parayzed
nerve
and
te
te
are
medan
s
at-
mgt
be
te
nerve.
145
dameter.
pamars
to
tests
toracc
orearm
and
suraces
pamar
promnent
wen
degrees
o
pam.
not
spared,
axary
patent
to
surg-
upper,
object
ong
segments
wen
contracture
774–775;
vaton.
posteror
njured
te
dsta
te
and
dgts
te
because
snce
A.
axary
tat
aspect
nerves
structures
trauma
pamar
MCP
unar
cas
te
76–100
C.
meda
jonts o a dgts are extended by te unopposed exten-
or
ABR/McM
te
ntercostobraca
nstead
coor
orearm
nerve
T rauma
wrst
o
Answers
n
umbrcas
T enderness
arm
so
n
woud
musces
afect
78.
numbness
dgt
ease
exten-
extend
o
and
Rada
lex-
o
meda
dsta
tendon,
porton
Dupuytren
D.
trapezus
te
and
te
o
pexus
(usuay)
n
wrst.
D.
C.
assess
te
ABR/McM
evdence
rb
atera
and
neuropa-
on
mmovabe
te
appears
no
atera
conrm
wt
s
parayss
syndrome.
passve
carp
are
numbness
tunne
tenns
studes
tat
o
tendon.
sum
symptoms
njury
perormance
ndcaton
and
te
o
te
tendon
Lower
epcondyts.
A.
to
nerve
exten-
o
o
surace
te
here
B.
ep
te
skn
an
orearms,
Bot
ractured
orgnate
s
468;
deep
te tendon s oten rrtated durng te backand stroke
te
an
took
appearance
atera epcondyts, ncknamed “tenns ebow” because
n
N
ocated
te
nerve
XI).
musce
smar
A.
o
arm
bot
gus
o
s
(CN
aganst
anteror
rom
medan
nlammaton
can
testng
cutaneous
surgeon
Wen
142
and
707–709;
he
nerves
brac
extenson
lexon
and
s
musce.
bceps
not
abducton
movement
brac
arm;
w
durng
N
durng
as
te
te
not
patent
souder
GAS
o
o
s
et
jont
Contracton
n
75.
be
assocated
unctona.
ratus
souder
s
souders
sensaton
Pusng
scapua.
te
nerve
axa
braca
supra-
tere
tereby
accessory
durng
musce
rom
weter
327
Limb
nerve.
uncton,
D.
souder
ndcate
axary
Sruggng
tuberce.
pan.
atera
orgnates
te
asssts
tendnopaty
supragenod
cause
resut
et
brac
a
compartment
at
woud
tat
not
bceps
durng
orgnates
contracton
Pan
te
and
Upper
6
nerve
be
ngers.
dgts
extenson
ess
hs
woud
o
st
tose
IP
jonts.
B.
I
te
medan
tunne,
not
tere
cawng.
nerve
woud
aone
be
oss
s
o
njured
tenar
n
te
carpa
opposton
but
328
C H A P T E R
D.
I
6
te
medan
at
te
o
te
te
Upper
ebow,
oss
o
and
te
ntrnsc
79.
D.
te
774,
racture
dsta
ragment
s
o
woud
805–809;
N
s
nerves
a
n
te
be
bot
totay
addton
and.
ntact
438;
n
E.
racture
o
n
a
reerred
te
Rada
to
as
nerve
at
patent.
166
radus
wt
te
B.
n
C.
E.
racture
dsta
he
a
racture
ragment
scapod
te
s
wrst
s
tumb
te
base
o
te
CMC
boxer’s
te
o
dspaced
te
and
Bennett
A
E.
most
does
reverse
rst
dsta
nvove
Coes
radus
tumb)
metacarpa
GAS
wt
bone
reers
to
It
o
case
contnues
to
tree
a
racture
o
te
5t
metacarpa
80.
E.
he
N
extensor
443;
ABR/McM
tendons
o
te
162
ngers
te
dstay
on
he
te
te
proxma
DIP
posed
gves
A.
jont
lexor
te
Caw
unar
te
te
and
IP
te
ngers,
arm
are
by
at
te
dsta
jonts.
rada
o
a
In
s
te
musce.
to
ts
hs
te
cnca
MCP
and
te
nerves,
ngers
are
te
te
E.
B.
In
te
extensor
PIP
te
o
jont,
tendon
aowng
pamar,
te
deormty,
PIP
jont.
centra
expanson
te
causng
te
te
hs
s
tendon
tendon
causes
torn
to
to
te
porton
over
move
te
upper
act
as
DIP
a
GAS
83.
C.
jont
to
Swan-neck
MCP
jonts,
sgt
lexon
most
oten
ntrnsc
D.
sue
GAS
81.
A.
Because
te
pocs
aso
B.
o
te
ong
ongus
ony
jonts.
as
4
n
medan
jonts,
condton
o
te
te
o
causng
ts-
nerve
rreversbe
ABR/McM
s
njured
Loss
wou d
o
162
wtn
te
atera
pamar
cubta
E.
no
nger,
N
o
we re
case
te
C8
and
and
te
T1
te
a
ventra
ram,
orearm
and
ventra).
ower
trunk.
braca
wc
o
ts
or
trunk
meda
sde
and
n
ower
te
nerve,
as
and
(dorsa
o
njures.
reaced
arm
o
patent
cdren
and
o
meda
C5
te
o
o
B.
to
te
o
and
suppes
bracum
no
Loss
on
Injury
a
to
o
713,
o
o
suppy
o
te
atrogenc
nodes
and
C7
sensory
tumb,
ndex,
nger.
I
t
s
ony
ead
njured
wen
removed),
atropy,
te
cavcuar
njury
pectora
te
ts
eavng
or
o
ead
cord
an
(as
o
n
apca
part
o
nraca-
te
o
ead
nerve
atera
n
ABR/McM
woud
to
but
oss
aso
bceps
ave
not
te
ony
mus-
brac
and
sensory
dstrbuton
149
no
major.
antebraca
proxma
major
examnaton
pectoras
woud
motor
dects.
nerve
nerve.
419;
provdes
pectoras
Pysca
resutng
and
te
sensory
pectora
nerve,
parayss
nerve
o
pectora
atera
atera
part
mnor.
motor
meda
N
sup-
dect.
te
731;
and
arm.
typcay
te
were
cutaneous
144
s
to
atera
bers.
pam,
rng
te
cutaneous
ramus
te
arses
pexus.
atera
C6
te
musce.
pectoras
oss
sde
arses
tse
rom
prmary
nerve
cavcuar
te
te
ABR/McM
te
and
medan
a
meda
te
s
dstrbutes
undergoes
obvous
o
arses
dermatome
part
nerve
wc
antebraca
nerve
sternocosta
te
C6
braca
nerve
C6
major
cosmetc
he
te
atera
meda
420;
an
cutaneous
and
ventra
and
ymp
musce
oss,
GAS
and
motor
cuocutaneous
s e nsor y
to
cases
nerves,
tree
meda
pectora
sensaton
ner ve
oder
T1
eson
braca
te
atera
o
cutane ous
te
nerve
te
bracas
nteross eous
brt
a
to
ts
wt
extenson
trunk
te
te lexor
njury.
be
on
atera
efect
ncudng
te
o
Most
n
cutaneous
T2
pectoras
a
reveas
D.
parayzed,
nerve
and
and
te
orgn
o
n
te
729–734;
suppy
connectve
to
vcuar
A
o
an
a
te
nerve,
C5
medan
te
resuts
tendons
o
axary
and
artrts.
rom
usuay
o
5.
anter or
tere
resuts
454;
are
musce.
medan
hs
lexon
PIP
reumatod
pam,
and
N
lexors
o
sortenng
te
802;
te
damaged,
dects.
n
dgts
conrms
I
DIP
contracture
777–780,
ossa,
o
rom
dsorder
lexon
sgt
yperextenson
musces,
Dupuytren
nvoves
wt
skn
ts
deormty
or
on
ntercostobraca
te
yperextended.
C.
endng
source
be
In
muscuocutaneous
he
lexor
nerve
158
pasy.
and
rom
a.
atera
rom
mdde
te
toward
occur
C8
e
gves
rada
he
o
a
s
te
bers
boutonnère
can
te
sde
cord
neror
pes
“caw”
pocs
medan
sensaton
ndngs
assocated
oss
cord
branc
appearance.
lexor
te
suppy
ABR/McM
pexus,
rom
he
and
break
dermatome
nerve,
C.
he
antebracum.
cord,
o
not
Kumpke
patent
meda
he
ore-
ntact
nto
B.
sup-
lexors
n
a
exten-
extensors,
ong
proxmay
unar
pung
te
te
D.
he
nnervaton
wrst.
438;
are
sensory
he
and
probem
jont
and
A.
and.
ong
extensors.
cutaneous
examnaton
antebraca
T1
and
resut
medan
he
more
unop-
maet.
ncudng
nerve,
detaced,
by
parayzed,
supped
unopposed,
lexon
esons
wrst.
are
medan
paanx
tota
proundus
wt
te
musces
te
by
te
nto
appearance
occurs
nerves
o
ped
o
pued
dgtorum
dgt
ntrnsc
sors
part
s
extensors,
jont
parayzed
does
njury
to
meda
or
te
njure
te
meda
meda
te
be
wt
braca
s
te dsta paanx o eac dgt. I te tendon s avused,
te
te
tey
te
he
nsert
N
pasy
branc
and
761–764;
795;
were
tere
o
nerve
pysca
suppes
not
at
wrst
MCP
pam.
consstent
racture
o
s
unar
757,
aduts
jont.
racture
njured
he
suppes
and
aso
woud
However,
neck.
GAS
D.
are
radus.
bone.
dorsum
te
Kumpke
ractured
te
to
atera
dorsay.
commony
not
(boxer’s
te
nerve
he
Smt
nerve
abductor,
rada
were
drecton.
a
rada
ongus
82.
Coes
he
tumb
o
racture.
A.
C.
because
parayss
dsta
voar
transected
lat
to
ts
ABR/McM
dspaced
sometmes
are
appears
lexors,
musce
Smt
racture
unar
and
ong
md-umerus
GAS
Limb
o
te
CHAPTER
84.
B.
he
C6
spna
bracoradas
A
and
B.
brac
te
C5
and
relex;
relex
nerve
C5
arc;
s
prmary
responsbe
or
te
88.
relex.
C6
s
are
bot
motor,
te
key
nvoved
C6
or
spna
te
n
te
bceps
sensory
nerve
n
part
te
a
o
85.
trceps
C8
s
responsbe
E.
T1
s
not
744;
he
nerve
o
B.
86.
B.
relex
any
he
o
C8
te
a
(lexon
nerve
deep
jerk
relex.
tendon
tage
relexestop.
E.
tat
brac
s
ndcatve
to
te
C7.
o
a
rada
te
Absence
C7
radcu-
GAS
89.
relex
spna
420;
s
more
GAS
87.
C.
tan
19,
A
753;
condyes
most
he
(or
s
sarp
oter)
nvoved
n
ment
nerves
are
not
nvoved
It
n
a
correct
aows
te
tecnca
moton
case
unaxa
on
o
te
term
n
one
to
oss
umerounar
and
n
te
te
pressure
ten
racture
tat
opened
te
nto
paced
te
te
a
cast
dgts,
ts
compartment
cast
be
removed
ten
reducng
scemc
unt
and
A
o
Fracture
not
o
te
Fracture
pressure
te
great
type
den
o
o
tracton
755;
te
E.
dsta
N
on
424;
n
and
te
or
endangers
te
deep
to
tssue
are
vascu-
te
ax-
artery,
does
racture
GAS
90.
D.
common
due
to
ABR/McM
s
as
a
158
te
o
orgn
trauma.
at
o
outstretced
n
ts
oecranon
at
te
te
t
passes
umerus.
Unar
n
oss
aso
as
meda
o
te
resuts
parayss
nerve
oss
o
n
te
cawng
at
te
carp
on
te
lex-
lexor
sensory
nterosse
especay
to
te
passes
o
te
o
medan
n
te
eads
bone
woud
and
te
unar
nerve
unc-
wrst.
ts
meda
o
nor
o
branc
afect
ndcated
psorm
unars,
dorsum
cutaneous
te
te
he
to
patent’s
te
lexor
o
passes
to
wrst
meda
A.
two
te
case.
cubta
carp
lexor
n
and
he
ossa
unars,
dgtorum
unar
te
sud-
meda
neous
te
te
te
nerve
a
branc
unar
dsta
o
⅓
o
o
te
as
te
te
te
adductor
njury
n
a
to
te
jonts.
n
add-
njury
nterosse
n
ter
ngers,
tese
nerve
s
o
and
at
te
pocs.
manestaton
te
opponens
mdne
he
ndngs
o
te
patent’s
are
ncon-
njury.
and
ourt
cutaneous
dorsum
dgt.
unar
orgnates
te
o
retnacuum.
nerve
te
o
Unar
es
resut
musces
manner
extenson,
opposton
or
dvson
not
patent.
axes
IP
a
suppes
te
nerve)
o
nerve
surace
o
n
o
153
examnaton
medan
pamar
ts
expanson
we
lexor
ste
woud
mportant
jonts.
njury
pysca
wt
to
as
tumb
te
transverse
parayss
medan
to
most
assst
MCP
nerve
he
deep
sstent
o
n
because
te
musces
te
afect
parayss
seen
extensor
to
umbrcas
medan
ts
ABR/McM
te
jonts
te
Imparment
njury
are
IP
resuts
pocs.
B.
467;
dorsa
lexng
neck
and
probems
N
te
umbrca
ton
rada
nerve,
784;
nto
wc
n
te
o
bone.
orearm,
nerve
rom
lexor
eads
nterosse
hs
by
te
not
cnca
757,
he
wrst
una.
te
te
weakness
wt
he
tat
129
te
njury
and
probems
s
rada
nserton
brac
rare.
resut
extensor
drect
o
qute
nerve
te
brocar-
prmary
on
unar
wrst,
proxma
nerve
o
can
resut
trceps
o
wt
rom
trquetrum.
s
navcuar)
a
cause
unar
te
extenson
artery.
not
te
ragment
epcondye
occurs
groove
s
te
umbrcas,
between
Injures
o
rada
can
dorsa
of
te
troug
on
separated
tranguar
radus
name
supnaton.
artcuate
dgts.
tunne
unar
te
pan
umera
braca
atoug
usuay
musces
ony
radus.
wt
te
up
sensory
wc
n
demand-
and
Carpa
te
te
and
not
s
ABR/McM
te
afect
te
and
woman’s
and
te
produce
mus-
contracture.
oecranon
atera
racture
extensor
GAS
nerve
te
te
neck
o
he
o
t
by
epcondye
at
two
not
t
tracton
t
does
nstead,
dsocaton
Unar
woud
te
compartment
reducton
crcumlex
umerus
contracture,
dspace
Fracture
scemc
te
o
surgca
posteror
rada
V okmann
can
te
and
artcuates
supercas.
te
nerve
una
pronaton
bones
442;
ebow
Injury
not
umera
major
and
o
repar.
Fracture
te
una
od
te
meda
meda
as
souder
syndrome,
and
te
between
compart-
bockng
rom
D.
mb
N
meda
unars.
ton,
compart-
(te
n
te
brances
C.
braca
compartment
he
scema
nsensate
te
because
te
rst
contracture.
n
s
dsta
te
ep-
racture.
te
te
nto
eves.
hs
lexor
to
compartment,
artera
or
te
pressure,
troug
te
scemc
acerates
Beedng
unreeved
Cod,
o
njure
E.
to
conceang
atoug
D.
and
(“reeased”)
ary
B.
te
nto
to
racture.
suppy
ncreased
sometmes
occurs.
oten
artera
rom
rses
o
artcuates
o
puttng
n
t
proxma
V okmann
scema.
low
oten
a
beedng
o
undergo
s
warnngs
A.
wt
greaty
outlow
B.
unate
transmtted
at
n
te
between
resutng
ourt
126
just
supracondyar
o
was
carp
jont.
ABR/McM
ragment
artery,
artera
ar
a
part
bones;
(adducton)
axs
o
artcuaton
orce
around
152
and
753–754;
trauma
umerus
cause
bony
te
ng
445;
te
caed
causes
venous
wrst,
carpa
psorm
he
case
axs.
Dmnuton
resuts
oss
N
o
common
ment.
ces
one
racture
A.
ead
scapod
ebow,
ABR/McM
te
jont.
tereore
are
mb.
N
jont
nerves
patway.
and T1
upper
spna
A, C, D, E. he oter types o jonts sted aow moton
n
dsta
partcpates
compex
carpa
contrbutes
trceps
C6
extenson
s
te
he
te
he
151
usuay
and
nge
and
and
te
s
756;
Gngymus
jont)
tat
C.
o
and
C5
734–735,
descrbe
nger
or
njury.
brac
relexes
GAS
spna
he
bceps
te
ABR/McM
nnervates
or
D and E.
n
437;
trceps
and
te
N
and
te
or
responsbe
man
opaty
A
B,
trquetrum
D.
C.
jont
A,
relex.
GAS
Normay
329
Limb
wt te radus at te dsta radounar jont at te wrst,
or
C7
D.
Upper
6
nnervaton
te
However,
nerve
rom
orearm
o
(dorsa
te
wc
t
te
branc
unar
s
and
cuta-
nerve
proxma
o
at
to
330
C H A P T E R
te
6
wrst.
woud
C.
Upper
An
not
te
deep
MCP
ped
o
by
medan
poston.
he
ts.
Loss
o
recurrent
E.
hs
GAS
91.
B.
In
ng
te
causes
te
tendon
tendon
te
paanx
C,
cause
GAS
92.
D.
may
D,
ts
MCP
sgt
most
jonts,
oten
so
and
te
A,
neck
B,
C,
cause
GAS
93.
C.
o
ts
eve
meda
C6,
o
te
obvous
C7
arm,
te
te
a
o
caus-
jont.
he
C.
oss
E.
o
o
te
hs
te
PIP
nger
jonts,
condton
tendons
s
and
asked
to
te
oter
answer
GAS
95.
nerve
he
o
was
n
to
to
do
one
n
oss
(“wngng”
puts
rom
te
mportant
te
n
arm
wc
resstance.
ventra
ram
o
musces
or
o
dvson
posteror
and
n
A.
souder
o
cord
and
cord
o
motor
extensor
w
suppes
te
to
and
mdde
ebow
trunk
extensor
suppes
rotator
ts
o
D,
te
nerve
braca
nnervaton
respectvey.
not
resut
orgnate
n
pexus.
to
hus
wng
te
and
an
hese
stc
to
a
resut
In
o
resutng
o
to
te
50%
o
n
te
dgts,
cases,
t
a
resut
te
o
ebow,
ngers
can
and
aso
and
a
oss
o
wt
be
te
paray-
a
ntrn-
specc
lattened
or
tenar
parayss
o
IP
umbrcas,
jont
exten-
nnervated
pr-
wt
rada
carp
rom
te
lexon
a
parayss
ongus
detacment
dsta
o
ABR/McM
s
nerve
radas
tat
and
o
paanx
DIP
te
o
and
brevs.
exten-
a
nger
jont.
166
drect
branc
o
te
posteror
te
teres
to
mnor
E.
on
te
te
hese
and
te
arrangement,
proxma
s
nerves
musces.
axary
umerus.
dsocated
axary
detod
te
nerve
Wen
anterory,
t
s
te
oten
nerve.
are
not
njured
n
an
anteror
N
tendon
musce
417;
o
runs
n
umerus
to
attac
hs
as
to
type
caed
o
canges
te
n
te
to
overuse
wear
te
presents
“Popeye
sgn”
and
an
wt
a
te
turns
o
te
osseous
and
bceps
ater
bra-
on
tuberce
wtn
tendon
wo
bceps
groove
drecton
supragenod
njur y
te
o
drecton
te
peope
150
ead
ntertubercuar
t
predsposes
hs
sgn
ong
te
cange
n
ABR/McM
te
tear,
brac
caracter-
te
cartoon
caracter.
GAS
97.
C.
720–721;
he
pay
A.
o
by
he
o
te
te
421;
at
te
s
sad
souder.
musce
esser
supraspnatus
ton
o
arm
and
120
nserts
It
on
to
s
te
greater
ntate
abduc-
supped
prnc-
C5.
he
te
musce
te
nerve
subscapuars
on
ABR/McM
umerus
arm
spna
nserts
B.
N
supraspnatus
tuberce
detod
njury
scapua.
s
dsocaton.
partcuary
rom
ere
osses.
nerve.
rom
nerve
707–708;
scapua.
ton
rada
and
umerus
structure
te
sted
attacments
te
term
rom
resuts
449;
te
C5,
o
o
njury
occurs
“tetered”
he
ke-
nerve.
144
dgts.
s
he
anatomca
meday
s
contans
extensors
N
proxma
lexors.
musces;
to
patent;
dermatome
contracton
at
extensors
axary
he
c
o
and.
nerve
provde
nerves
te
C6)
dstrbuton
posteror
arm
(C5,
eements
asca
and,
unar
unopposed
musce.
trunk
ts
aponeuross,
t
lexors
resuts
te
tracton
C,
GAS
96.
above
protruson
scapua),
aganst
te
ax-
serratus
medan
n
deormty
nerves
nerve
nger
nnervate
tgty
woud
te
te
s
rasng
resuts
o
puses
arses
o
anteror
scapua
Its
durng
te
and
lat
mecansm
souder
njured
o
nterosse
te
791;
he
Wt
168
parayss
serratus
te
wen
orearm,
tese
A.
B,
ABR/McM
or
orgn
cord and wraps around te surgca neck o te umerus
resembes
coces
nerve
ABR/McM
gradua
unar
ong
drop
o
and
ntrn-
unabe
somewat
te
resuts
o
Wen
patent
o
te
mb
specc
pamar
musces.
by
Maet
sor
artrts.
te
Wrst
woud
lexon
or
and
by
mary
176
sgt
a
o
te
gves
muscuocutaneous
occurrence.
medan
son
proxma
coces
and
Caw
D.
answer
o
wt
C7)
te
emnence.
n
buttonoe
te
te
and
sc
n
oter
417;
ourt
n
and,
just
hs
tear
N
causes
te
ss
ead
o
nerve
axary
nerves
and
pam,
PIP
te
jont,
oe.
jonts.
resutng
posteror
bers
he
te
ead
nvoves
te
souder.
upper
wse,
D.
te
o
PIP
te
tckenng
batera
Ape
o
and
root
oss
contracture
o
wc
especay
C7.
he
he
te
oter
nger,
454;
border
abductor
B.
te
resembe
ABR/McM
o
toracc
toracc
and
te
porton
over
o
te
reumatod
N
rotaton
te
ong
or
swan.
musce.
te
more
skn,
appearance.
ong
upward
centra
toward
to
sortenng
None
dssecton,
anteror
A.
a
rreguar
dg-
medan
715–716;
medan
yperextended.
and
DIP
curvature
E.
medan
tese
atera
assocated
Dupuytren
C6,
nerve,
sensory
any
be
bromatoss
appearance.
te
n
st
B.
168
torn
lexor
sad
454;
njured
784–786;
he
ary
as
te
te
a
troug
o
te
s
yperextenson
o
rom
GAS
94.
te
no
to
woud
A.
be
deormty
rom
musces,
stragten
as
to
s
dstnctve
lexon
are
te
on
njury
te
“caw”
s
(C5,
pectora
and
here
(sup-
cord
atera
nerve,
s
move
Frenc),
N
by
3
atera
te
te
n
te
and
muc
resut
ABR/McM
to
act
None
784–786;
woud
deormty,
stck
E.
2
he
extenson
ngers
nto
E.
by
o
proxmay
supped
as
n
te
dgts
seen
expanson
jont
n
o
are
ed
lexed
wrst
nnervated
extenson
o
nerves
be
te
ands.
ase.
tendon
Swan-neck
sc
s
454;
to
DIP
extensor
to
not
be
at
te
parayss.
tendon
(boutonnère
A,
N
boutonnère
te
unar
opposton
statement
aowng
s
to
n
are
lexors
umbrcas
nerve
799–800;
extensor
tem
tey
nerve
dects
jonts
ong
and
cawng
unar
Unopposed
tem
because
so
te
MCP
nerve.
causes
cause
nerve,
o
sensor y
unopposed
orearm)
ntact
n
te
rada
jonts
wereas
njury
resut
Extensors
Limb
musce
but
s
te
ony
musce
tat
tuberce.
rater
does
not
ntate
abducton.
adduc-
CHAPTER
D.
E.
he
subscapuars
and
ower
he
teres
border
E.
border
706;
N
te
are
o
are
B,
C,
tured
GAS
99.
C.
at
to
D.
bone
699;
he
N
te
atera
musce
ange
B.
takes
and
te
upper
and
o
te
to
s
mb,
up
bones
compressve
orces
jons
jont.
te
wt
he
sternum,
resutng
n
neura
most
E.
tat
rac-
eements.
te
rada
GAS
767,
Answers
B.
rb,
accessory
sue
bands
toms
aong
te
n
te
A.
or
rater
nerve.
he
to
syn-
mbs
hs
cana.
dmen-
as
a
hs
orearm
and
probem
tan
a
eson
atera
pam
out
o
as
medan
artery
puse
proxma
o
hs
unctons,
C,
by
ts
o
ong
com-
trunk
or
probem,
GAS
102.
(C8,
unar
as
arm
eson
s
coud
not
sde
compress
Carpa
o
lexor
soated
te
atropy
does
tcs.
he
et
sde,
nvoved
aortc
braca
te
o
rotaton
t
arses
moreover,
and
meda
t
rom
not
meda
o
not
a
ong
expan
scemc
pan
eson
lexors
te
n
A.
100.
A.
151;
he
N
unar
between
and
nerve
te
two
descends
carp
lexor
ABR/McM
unars
te
eads
between
(or
dgtorum
Injurng
enters
and
not
ntrnsc
puse
arm
or
te
B.
te
o
o
and
meda
proundus
unar
nerve
s
musces
te
te
woud
pas-
amate
not
pres-
symptoms.
carpa
te
tunne
and
te
bracoradas.
between
deep
to
te
to
do
ABR/McM
devery
s
as
to
unar
and
bracoradas
wt
te
patent’s
153
tracton
descrbed
te
orcby
can
on
oten
te
a
I
te
te
upper
te
trunk
tracton
rom
down-
and
rom
upper
recover.
avused
ere,
souders
extracted
causng
nerves
N
420;
are
not
brt
o
te
njury
rom
ventra
ram
spna
cord,
commony
njured
te
te
njured
te
tunne
te
two
ormed
hs
one
and
njury
and
a
by
a
te
te
psorm
to
pamar
resut
te
dgts
o
cana.
attacng
te
and
sde
Guyon
woud
pam
musces,
meda
n
retnacuum
meda
meda
te
nerve
ateray,
ypotenar
35
wt
unar
lexor
amate
to
bocks
te
tranguar
anterory.
te
ABR/McM
concrete
te
carpa
n
oss
pamar
sur-
and
nterosse,
motor
and
te
umbrcas.
medan
nerve
musces
to
dorsa
ma
to
D.
vascuar
lexor
here
te
s
and
te
n
a )
caw
not
nvoved
atera
s
no
o
pamar
t
most
unar
ndcaton
boxer’s
because
te
sensatons
are
o
nerve
not
arses
be
requenty
t
nerve
t
woud
at
te
prox-
ost.
dsocated
not
cause
wrst.
metacarpa
racture,
racture.
N
lexor
lexor
unar
woud
dsocated,
te
805–806;
and
te
(te
were
common
ong
o
tus
bone
bone)
so-caed
tunne
lexor
452;
ABR/McM
seat
tendons
proxma
o
or
te
pam.
unar
168
bursa
ngers
hs
n
seat
encoses
te
s
carpa
usuay
contnuous wt te lexor seat o te tte (t)
and
nger,
wc
musces.
connecton
and.
C,
It
enters te and superca to te lexor retnacuum
branc
wrst,
unate
774,
he
te
unars
devaton)
(meda
E.
passng
carp
nnervates
wrst
by
te
te
compresson
caracters-
due
orearm
resuts
passes
apped
are
te
te
carpa
103.
te
passes
oten
736;
he
I
expan
144
te
o
o
GAS
192;
te
to
notng
hese
as
tenar
compresson.
GAS
E.
te
he
woud
expan
and,
woud
rada
te
C6
meday,
meda
C.
cord
ere
o
ntact.
woud
orearm
deep
467;
baby
baby
sensaton
ace
bracocepac
because
arc;
t
cana,
ook
mecansm.
gament
woud
pexus.
syndrome
te
so
s
ook
atropy.
An
and
be
te
te
tunne
probems
ong
o
te
D,
and
oss
on
vuner-
permanent.
729,
bone
s
exerts
Strkng
hs
wc
Canges
trunk
E.
er
compresson.
upper
N
pexus,
s
A,
medan
suc
njury
symp-
possbe
vascuar
te
ts-
C5
Parestesa
nvovement.
to
o
case,
ower
te
cervca
atropy
a
sensory
nerve
pont
ts
and.
to
a
connectve
and
te
eter
parayss
mb
pont
no
In
and
and
tracton
rgt
not
E.
neck.
o
as
breec
te
braca
abducton.
trunk
D.
te
resut
atypca
orearm,
musces
rada
te
o
arm,
Erb-Ducenne
and
and/or
ntrnsc
rue
afect
B.
root
te
meda
and
presson
tends
te
nvove
lexors
T1)
at
musces,
a
nerve
tracton
and
be
s
101–125
Durng
te
coud
Guyon
and
to
enters
nerve
774;
o
It
nerve
and
wc
outet).
damage
passes
medan
o
toracc
enters
psorm
aorementoned
nerve
sons o te superor toracc aperture (te orma name
te
t
presentaton.
com-
outet
decreases
aso
te
but
te
medan
musce
ward
vascuar
were
bone.
common
toracc
nerve
wrst,
wt
he
orces
te
bone,
s and does not gve rse to te symptoms observed.
te
118
rom
condton
te
psorm
rada eads o orgn o lexor dgtorum superca-
101.
and
between
he
causng
sgmoda-saped
te
D.
te
unar
rada
troug
to
331
Limb
damage.
sage
he
te
tese
skeeton
orce,
ts
on
Oten
sternocavcuar
te
to
he
at
C.
te
transerred
atera
ent
pass
suferng
nvovng
and
121
ABR/McM
s
any
upper
scenaro.
465;
rom
neror
successon.
cavce
ts
patent
drome,
resuts
he
n
n
racture
rom
major
outstretced
rater
te
orgn
te
troug
absorb
pedatrc
o
appendcuar
suicenty
cavce
mon
but
te
scapua.
an
mb
he
skeeton
not
te
te
racture
proxmay.
axa
on
by
abe
teres
ABR/McM
a
conducted
bones
not
te
nnervated
takes
te
regon
o
415;
a
musce
te
s
nerves.
scapua;
rom
orces
A,
te
atera
Durng
do
mnor
o
orgn
GAS
98.
musce
subscapuar
Upper
6
GAS
D),
wc
791–793;
N
contnues
wt
do
451;
wtn
seats
not
o
te
te
pam,
oter
extend
nto
ABR/McM
167
te
avng
dgts
dgts.
(A,
no
B,
332
C H A P T E R
104.
C.
6
he
te
seat
nger.
nlammatory
uness
agent
o
te
was
space
ntroduced
ong
Proxmay,
mdpamar
space
Limb
nectous
synova
(t)
Upper
(or
o
seat
runs
ts
centra
processes
treated
te
te
rupture
wt
te
tereby
tte
ces
troug
compartment),
typcay
aggressvey
nto
tendons
nto
by
n
ts
unar
B,
te
E.
D.
ong
he
tendons
tenar
gus
wtn
ndex
mar
105.
A.
ts
dgta
te
synova
vesses
o
N
extensve
451;
cronc
ss
s
wt
or
o
wt
as
n
he
dramatc;
wtn
ty.
most
24
souder
Conversey,
pan.
Patents
cavan
te
deep
arm
hey
axa,
rest
wt
ven
or
o
atera
s
E.
rotaton
o
and
te
are
du
eevaton
oten
cateter-assocated
ave
arm,
o
C,
C3–C5
te
reeve
A,
te
symptoms
centra
GAS
106.
C.
E.
hese
venous
748;
The
N
condtons
ne
419;
are
not
B,
ong
GAS
109.
ndweng
compcatons
injury
is
at
o
artery.
The
second
part
of
suprascapular
is
exerted
extended
medan
trd
can
on
ad
by
te
sze
to
ngers.
oowng
njury
nerve,
DIP
dgt
and
w
tere
w
be
opposton.
be
extended
o-
njury.
jonts
extended
N
466;
o
due
te
to
second
and
unopposed
nerve,
hs
above
rom
nerve,
ABR/McM
scapua
pexus.
D,
resuts
wc
musce
trd
acton
o
te
he
s
comes
4
eson
he
ram
s
rom
and
o
5
or
rotatng
ong
toracc
supped
te
o
te
by
ventra
keep
te
ante-
abducton
C5–C7
te
o
serratus
durng
orzonta.
ventra
C3,
a
te
responsbe
occurs
dapragm
wc
157
rom
suppes
wc
te
E. hese
716;
o
N
te
ram
o
dapragm
stes
are
dsta
to
te
orgn
o
te
nerve.
417;
ABR/McM
135
ndex, and mdde ngers as we as to te atera
te
rng
nger.
nnervaton
to
Compresson
o
expans
dects
tonng
the
artery
musces
nnervated
nsuicent
orces
mus-
A. he medan nerve suppes sensory nnervaton to te
B
axillary
o
te
nnervated
nerve.
toracc
motor
218
the
are
are
abducton
nerve
(mnemonc:
tumb,
pacement.
ABR/McM
and
to
are
ave).
actv-
a
D,
arm
be
te
upward,
arses
braca
axary-sub-
te
te
usuay
n
and
be
musce.
nerve
o
and
wnged
scapua
tey
power”
wc
and
extensor
tumb
731–735;
prenc
ace
smar
wt
te
w
o
o
ntrnsc
jonts
w
medan
toracc
ror
arm
n
a
nerve.
parayss
rada
ary
upon
dgt
MCP
he
ong
coppng
prompty,
a
oter
C.
te
second
he
GAS
108.
souder
stenoss
pan
sde
o
or
te
trombo-
te
baseba,
o
o
cateter.
B,
he
he
However,
medan
owng
becomng
domnant
worsenng
te
D.
te
because
te
rotaton
compan
on
and
Efort-nduced
tromboss
souder
tumb
patents
present
and
te
pa-
dgt
years
subcavan
wt
te
o
te
“baance
dgts,
MCP
or
weakness
167
cancer
voeyba,
o
and
te
trd
te
Wt
on-
nger.
use
patents
ours.
and
n
and
symptoms
o
pocs
tendons
tromboss
downward
crcket,
te
musce,
recent
strenuous
and
payng
wood.
ven
to
te
te
nerve.
o
nerve.
he
wt
C.
lexor
nerves
condtons.
yperabducton
backward
te
ABR/McM
n
correate
nger.
ndex
cateters
medca
seen
not
seat,
and
te
common
use
do
umbrca
Axary-subcavan
more
t
contans
rst
porton
800–801;
muc
at
o
space
nger,
atera
GAS
compartments
rada
lexon
B.
hese
extend
compensate
antbotcs
A,
te
and
approprate
swngng
tat
tese
o
and
te
E.
te
lexor
he
he
medan
musces
medan
n
o
nerve
nerve
s
o
not
aso
tenar
n
conjuncton
compartment
unar
nerve
te
te
carpa
wt
te
provdes
emnence.
tunne
norma
unc-
orearm.
mpcated
n
tese
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,
Compresson
attrbuted
ceps
te
giv-
brac
pexus.
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
arteres
do
734,
he
817;
unate
bone.
not
provde
o
te
around
709–710;
N
te
424;
A.
hs
proxma
ABR/McM
njury
to
te
medan
nerve
te
a
o
meda
te
a
ong
o
D,
tat
lexes
lexors
te
te
dects
rater
dsta
woud
tan
to
ncude
n
ts
te
oca
nstance.
o
te
cervca
compexty
N
466;
bone
s
o
spne
ABR/McM
te
most
Dspacement
s
woud
aso
ead
symptoms.
168
commony
anteror
n
dsocated
te
cases.
Dsocaton
o
te
unate
major-
bone
te
sgns
typcay
assocated
wt
can
carpa
lexor
o
syndrome.
te
dgts,
dgtorum
E.
do
DIP
jonts
o
hese
not
bones
artcuate
are
wt
not
te
commony
dsocated
radus.
except he
scapod
artcuates
wt
te
radus
proundus more
musce
ocated
be
tr-
woud
C. or
s
te
140
and parayze
t
symptoms
not
o
scapua.
A, 107.
coud
coatera
tunne GAS
mb
pexus
ypertropy
because
addton,
descrbed
ncreasng
precptate crcuaton
rom
injury. ty
A,
musce
In
Osteoartrts
carpa
supplying
braca
the D.
suprascapular
te
circumflex symptoms
scapular
o
pressure
dgts
4
and
commony
ractured
tan
dsocated.
5, GAS
783–785;
N
446;
ABR/McM
128
but
s
CHAPTER
111.
D.
A
cervca
toracc
by
weak
puse
te
tone
te
he
(usuay
he
axary
nerve
B.
he
upper
pes
nnervaton
sow
a
at
C7)
may
cause
condton
caracterzed
and
oss
te
mb
s
and
abducted
suggest
a
ower
o
D.
te
njury
no
oss
o
trunk
unafected
souder
te
te
based
te
musces,
he
pexus
musces,
patent’s
sup-
wc
GAS
115.
presentng
t
E.
pexus
passes
he
o
artery
unt
under
braca
te
mdne
GAS
112.
A.
151;
A
N
192,
mted
supnaton
membrane
s
420;
to
nto
(D)
not
due
s
a
s
te
bra-
cords
are
ts
as
te
radus
bones;
te
and
tat
so
pronaton/
age
tat
T rocod
rada
E.
GAS
B.
at
te
between
bone
pvot
made
typcay
o
ater
jonts,
nge
junctons
s
jonts
n
te
te
an
an
as
te
te
puse
s
just
N
429;
best
ABR/McM
ocated
proxma
rada
lexor
artery
carp
to
on
te
tose
traves
radas
on
te
te
and
dsta
At
radus
bracoradas
pamars
ay
to
te
ongus
rada
tendon
artery
traves
and
more
above
te
med-
lexor
E.
he
structure
meday
GAS
114.
B.
he
te
te
N
he
and
s
s
a
aso
deeper
ocated
artery.
ABR/McM
artery
artery
eads
enter
he
lexor
on
rada
tendon
enters
te
B.
troug
te
ana-
gests
aspect
te
o
te
moves
te
pocs
o
dorsa
rst
deep
te
on
dorsa
aspect
ongus
and
aspect
to
o
o
perce
nterosseous
te
te
te
te
musce
pam.
tendon
and
troug
runs
rada
and
o
te
and
rst
po-
o
to
te
most
o
orearm;
aspect
o
te
sec-
atera
pam;
and
musces:
pocs
brevs,
wrst
on
rst
and
opponens
te
te
o
te
be
to
o
tese
o
te
musces,
s
wrst.
com-
Because
tunne,
ts
te
rst
compressed.
nerve
te
carpa
ead
and
tenar
to
medan
provdes
acton
nnervaton
proundus
hese
musces
o
te
and
N
carpa
on
or
and
are
te
part
lexor
not
cutaneous
orearm
o
carp
weakened
as
suppy
we
as
to
te
exten-
orearm.
nerve
provdes
466;
can
appears
s
a
sensory
as
branc
nerve
branc
o
te
nnervaton
o
posteror
ost
te
o
o
te
cord
provdng
rada
nerves.
hs
nerve
nnervaton
te
rada
rada
te
tat
nerve
does
not
te
oss
te
supna-
tat
te
he
rom
te
umerus.
te
ave
o
te
o
ntact.
pexus
o
does
s
grasp
o
sensaton
separates
o
braca
nnervaton
no
te
ndcatng
nerve
and
and
part
nnervaton
to
sug-
weakened.
However,
trd
patent
wc
not
wt
brances
ntact,
dsta
o
aong
orearm.
te
te
te
s
s
ndcate
beow
and
166
orearm,
musce
weak
above
n
at
be
woud
been
and
s
brac
to
and
ABR/McM
extend
hs
branc
or
and
nterosseous
extensors
rada
provdes
and
trceps
orearm
he
te
key
te
opponens
branc
weakenng
sakng
coud
nerve
drop.
superca
A.
recurrent
as
traverses
brevs,
musces,
jont.
brac
and
te
te
smpy
tat
nerve
784;
nerve
trceps
pocs
most
dgtorum
patent
Supnaton
rada
s
vgorous
nerve
734,
tat
by
not
musces.
wrst
sbe
ten
and
posteror
he
deep
and
te
adductor
170
pamar
brevs
patent
nerve
musces
superca
170
snufbox.
and
mar
ongus
antebracum
437;
rada
two
C.
to
818;
tomca
A.
n
pocs
te
patent.
rada
he
GAS
116.
tor
lexor
artery.
patent.
unar
ts
sor
E.
orearm
jont.
pocs
he
nerve
lexor
he
and
he
D,
he
te
retnacuum.
C,
B.
154
wrst
te
dorsum
tendons.
A.
o
rada
774–775;
te
nnervaton
and
abductor
ndcaton
s
unars
oot
te
lexor
medan
te
growt
and
te
ntrnsc
te
cart-
umero-
suc
o
abductor
part
exampe.
and
rst
can-
between
compartment
dgts
nnervated
medan
n
and
jont
ve
compresson
pate).
ebow
are
IP
jont
o
ABR/McM
lexor
tunne
DIPs).
rada
pont,
to
te
jonts
(antebracum)
ts
are
o
te
and
17–19,
he
temporary
eppysea
jonts
Gngymus
(PIPs
113.
(.e.,
porton
ocated
a
transtons
competes
D.
s
te
tereore
denty
run
te
tendon.
between
and
and
provdes
ourt
umbrcas
te
A.
Syncondross
to
not
tereore
ts
run
musce
musce
457;
te
nerve.
pressed
una.
s
does
nerve
and
are
Anoter
nterosseous
sympyss
not
andmark
nnervaton
and
medan
brocartagnous
pubc
n
contans
musces
two
case,
by
permanent
two
te
sternum.
ts
N
umbrcas,
pocs,
exampe.
C.
812;
trd,
ment
135
aowed
a
and
beow
pocs, and lexor pocs brevs. he tenar compart-
assocated
connecton
as
artery
medan
nnervaton
te
near
does
nterosseous
musces
ond,
trunk
correct;
ocaton
brous
te
ower
drecty
to
In
te
partay
ABR/McM
between
jonts
and
bend
jont
between
separates
ony
movement.
jont
anteror
pam,
run
333
Limb
ongus.
second
s
pexus
movement
Sympyss
usons
artery
body
synartross
aows
B.
te
pexus
artery
braca
o
ocated
te
not
nterosseous
used
791,
he
te
cavce.
pexus
bracocepac
wt
s
te
te
bracocepac
te
D.
o
does
artery
rada
cutaneous
subcavan
ca
be
dorsa
abnormates.
C.
second
cs
braca
souder
on
rada
and
he
uncton.
o
to
te
aspect
artery
he
not
E.
suppes
deep
rada
rada
above
trunk
te
pexus.
A.
are
n
upper
symptoms
braca
wc
ound
syndrome,
musce
wen
souder.
to
rb
outet
Upper
6
s
respon-
axary
and
some
rada
axary
nerve
uncton.
on
te
artery
beore
pa-
runs
enterng
C and D.
ton
o
he
te
njured.
patent
wrst,
ndcatng
ave
tat
te
weakened
unar
adduc-
nerve
s
not
334
C H A P T E R
E.
I
6
Upper
bot
te
njured,
te
supnator
supnaton
117.
rada
are
GAS
Limb
and
muscuocutaneous
supnaton
and
o
750–752,
te
785;
woud
bceps
not
brac
be
nerves
possbe
musces
121.
as
468;
he
provde
Coes
dsrupted
ABR/McM
151
A,
B,
dsta
ocaton;
to
te
severa
o
te
aspect
MCP
eray
o
te
A.
and
he
deep
a
ematoma
and
lexor
quadratus
te
s
tus
between
te
te
te
at-
GAS
122.
two
key
and
to
ractured
pocs
s
te
a
branc
lexor
ongus,
and
o
te
te
rada
prona-
tnct
A.
nerve
gves
rse
to
ts
deep
te
precse
njured
branc
o
te
rada
B.
ea
D.
A.
he
superor
469;
trunk
ABR/McM
o
te
s
E.
pexus
nnervates
supraspnatus
n
abducton
detod
arm
B.
he
C.
D
15
te
ncudes
t
E.
s
not
he
meda
729,
GAS
120.
A.
D,
o
It
te
as
artery
to
by
degrees.
C5,
C7
and
n
as
GAS
123.
he
abducts
notng
nta
s
N
o
None
composed
te
to
do
abducton
o
te
s
to
correct
C8–T1
musce;
brancng
neter
nerve
s
son
by
to
te
te
te
B.
rom
cord
o
te
a
te
oter
answers
ncude
a
420;
tyrocervca
rc
and
provde
dorsa
None
709;
trunk
anastomoses
coud
he
grat.
ABR/McM
artery
o
N
418;
rom
wt
te
oter
suppy
te
D.
te
ABR/McM
31
branc
subcavan
sted
scapuar
suppy
woud
be
s
scapua.
n
artery.
to
ost
te
wt
poston
s
n
key
be
do
not
a
more
as
key
common
dsocated
wc
and
but
n
a
be
ave
dsta
to
be
t
sps
n
young
as
out
pace,
captuum
gament
n
cdren
and
ods
te
deveoped,
o
te
medan
poston
n
not
o
a
te
good
cdren
eadng
nerve
te
s
cubta
artcuate
te
not
E.
124.
A.
una
nerve
to
an
te
nds-
not
key
due
ossa.
wt
te
troc-
artcuates
at
ts
o
body
o
o
because
as
ony
t
te
bend
nerve
te
does
meda
ts,
so
answer.
428;
ABR/McM
nerve
can
be
because
te
te
umerus.
oss
o
sensaton
wrst
n
an
154
caused
he
and
area
o
by
a
nerve
bow
wnds
symptoms
nger
skn
exten-
supped
nerve.
medan
nerve
atera
and.
3½
he
provdes
dgts
medan
on
sensory
te
nerve
s
nnervaton
pamar
not
aspect
responsbe
o
or
extenson.
nerves
1½
te
provde
dgts
meda
and.
he
on
2½
sensory
te
nnervaton
to
he
nerve
axary
detod
752;
N
te
regon
468;
unar
ngers
lexng
te
and
assst
te
MCP
te
and
aspect
responsbe
provdes
sensory
o
or
sensory
nnervaton
to
152
n ne r vates
te
dorsa
not
to
te
souder.
ABR/McM
w c
o
orearm.
provdes
o
aspect
te
s
nerve
atera
ner ve
nterosse,
on
nerve
extenson.
nnervaton
pamar
dgts
unar
muscuocutaneous
he
wc
pass
unar
regon
te
dsocated
support.
not
te
N
rada
be
radus,
ts
correct
775;
te
oss
or
does
rater,
te
to
te
wrst
pamar
te
key
tan
he
GAS
major
bood
vesses
te
a
crcumlex
artery
to
as
a
meda
100
te
essenta
scapuar
adequate
arses
drect
129
annuar
neck,
uy
ncude
Unar
te
N
to
te
te
extenson
s
rada
he
and
derved
una
te
gament
te
and
te
28
or
te
mdumera
around
answer.
responsbe
radus
does
755–757,
te
tere-
atera
ave
not
s
gament,
stabe
not
to
C5–T1.
o
s
Injury
and
o
most
sted
and
woud
umerus;
rada
wrst
te
ABR/McM
hs
una
C.
answer.
dsta
tereore,
420;
o
supraspnatus
rgt
are
suprascapuar
provde
GAS
15
he
nvoved
ram.
scapua.
te
te
nerve
ram
E.
te
ngers.
734–735;
he
to
te
descrbed
just
s
musce;
cord
and
ventra
B,
s
trunk
cords
736;
rada
and
ventra
0
prmary
nvoved
suppy
supraspnatus
A,
rom
musce.
musce
degrees.
trunk
neror
ore,
C. he
90
prmary
meda
more
ts
A.
not
GAS
arm
musce
does
nor
te
te
not
epcondye;
arm.
he
and
te
supraspnatus
s
supped
to
mdde
wt
te
o
musce,
rom
te
musce
a
racture.
ABR/McM
rada
s
radus
he
C5 and C6, wc gve rse to te suprascapuar nerve,
wc
tey
aduts
te
annuar
161
braca
woud
bones
radus
dsocaton
wt
In
o
he
lexor compartment o te arm (GAS Fg. 7.92).
N
ave
ractured
poston.
o te arm, respectvey . hese nerves prmary suppy te
782;
ts
he
nerve.
medan nerve traverse te meda and anteromeda aspect
775,
o
annuar
at
s
neck.
to
D and E. Bot te deep branc o te unar nerve and te
GAS
442;
wen
ead
bones
wc
tey
carpa
te
Coes
Compresson
branc,
ts answer coce s too genera and woud not nd-
cate
te
“grp”
musces.
rada
N
artcuatng
dgtorum
a
type
resuts
rom
oter
wt
tereore,
764;
hs
carpa
radus,
ractured.
wt
umerus.
nerve
suppes
C.
unate
te
tereore,
he
contact
njured
extenson
courses
between
and
o
musce.
nterosseous
nerve
nerve
passes
musce
nnervaton
ncudng
rada
and
or
compartment
orearm,
he
radus
by
anteror
houg
te
responsbe
extensor
supnator
proundus,
C.
s
te
supnator
te
medan
tor
o
te
compressed
radus
n
jonts.
around
eads
be
supnator,
musces
or
E
drect
posteror
119.
D,
and
wt
racture;
B. he deep branc o te rada nerve, ater t emerges
o
118.
scapod
artcuaton
orearm.
N
C.
act
to
te
umb r cas
jo n ts
do r s a
ab duct
and
n
and
a nd
adduc t
te r
act ons
exte nd ng
te
IP
jonts.
B.
he
recurrent
vates
te
te
branc
tenar
movement
o
o
musce
te
te
medan
group
tumb.
tat
nerve
nner-
unctons
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
rada
nerve
s
responsbe
muscuocutaneous
musces
n
anteror
te
ongus
we
te
as
orearm
or
nterosseous
pocs
and
rada
or
nerve
te
a
wrst
does
extenson.
not
nnervate
and.
te
te
lexor
quadratus
lexor
as
dgtorum
proundus.
GAS
125.
C.
799–800;
he
rada
spna
trceps
nerve
.
A and B. As
trceps
467;
brac
ABR/McM
musce
C7),
s
wc
168
comes
suppy
ventra
te
ram
of
by
te
C5–T1
patent’ s
musces,
bers
and
E.
we
and
One
ram
meda
as
woud
souder
ventra
nnervated
te
brac
to
ony
one
te
motor
can
dect
rue
axary ,
out
nvoves
C5
and
te
C6,
muscuocutaneous,
and upper subscapuar nerves. Damage to eter o tese
D
N
(prmary
nerves.
Fig.
wc
nner vates
pronator
o
GAS
ar ter y
can
orm
braca
as
medan
te
resut
lexor
aso
te
and
unar
nerve.
n
addtona
compartment
rue
out
meda
and
te
to
te
C8–T1
pectora
antebraca
Damage
motor
o
dsta
tese
dects
because
nerve
tese
and
cutaneous
ram
te
nerves,
dstrbuton
ventra
o
arm.
o
te
woud
336
C H A P T E R
6
Upper
resut
n
neous
sensaton
mb,
GAS
oss
and
o
oss
734,
pectora
over
o
750;
Limb
te
and
N
musce
meda
uncton
surace
and
o
te
cuta-
D.
upper
teror
uncton.
420;
Subscapuar
Answers
100
E.
Parasterna
Maet
nger,
deormty
te
DIP
extensor
GAS
127.
GAS
126–150
D.
n
wc
jont
due
tendon
793;
aso
N
te
to
at
446;
known
nger
as
s
avuson
te
dsta
baseba
nger,
permanenty
o
te
s
lexed
nserton
o
a
at
and
nerve
and
atera
A
axary
rotaton
cutaneous
A.
gong
muscuocutaneous
scapuar
and
bers
nerve
wnged
te
ong
ormed
te
te
scapua
serratus
rom
te
woud
te
toracc
ntrnsc
woud
spna
cord
anteror
be
eves
C5
o
te
to
C5,
C6,
are
be
Parestesa
be
caused
neous
E.
Loss
woud
GAS
D.
te
caused
747;
to
(C8–T1;
sensaton
be
C7,
by
N
and
te
D.
s
420;
te
by
te
arm
E.
he
to
E.
eter
te
epcondye
nserts
teres
and
onto
to
te
cause
orgnates
coronod
te
and
n
or
B.
radus
a
process
mdde
o
te
on
C.
atera
o
te
te
he
pronator
anteror
te
C.
surace
anteror
radus
he
atera
sde
and
o
o
te
surace
o
musce
dsta
te
orgnates
bracas
surace
coronod
causng
o
process
an
te
and
una
dsta
and
radus,
acton
on
orgnates
umerus
unar
te
pung
n
and
te
767,
Lymp
drecty
ten
C.
he
he
te
rdge
o
rada
nserts
tuberosty,
132.
te
n
ence
te
A.
he
to
rom
nto
te
Pectora
ror
N
te
atera
eptrocear,
centra
nodes
toracc
430;
and
process,
receve
wa,
ABR/McM
sde
ten
axary
o
ar
nserts
beow
at
te
ncudng
127
te
atera
nodes
ymp
dsta
to
te
axary,
and
(A).
many
most
drans
o
rom
te
te
ante-
breast.
afects
n
oss
wt
nerves
artery
bood
to
rada
njury
437;
o
te
trauma
n
and
low
te
or
bra-
bood
to
temperature
groove
but
ves-
te
mbs
canges
probaby
woud
ABR/McM
o
te
or
not
resuted
be
respon-
o
and
te
nerve
151
unar
bone
medan
nerve
wen
as
s
nerve
arses
passes
amate;
most
nerve
at
between
ence
key
enters
dvdes
t
enters
nto
te
nterosseous
te
atter
pronator
anteror
te
to
te
be
pam
teres
o
superca
cubta
arses
courses
aspect
ongus
N
455;
empty
o
te
te
deep
njured
troug
te
rom
It
and
deep
ossa.
between
musce.
te
te
medan
two
contnues
nterosseous
ead
on
to
membrane
C,
not
GAS
A.
musce,
E
o
N
ts
o
he
and
and
o
te
racture
a
unate
are
to
te
styod
C,
E.
A
te
be
afected
GAS
ts
783–784,
uncton
te
resut
n
o
te
rst
papaton
te
empty
s
o
pan
15
te
rom
responsbe
rst
can
15
a
caused
te
by
two
process
oter
degrees
test.
a
a
wrst
o
wrst
te
bones
on
N
442;
an
out-
racture;
bones
te
most
radus.
are
ess
njury.
797;
or
and
138
scapod-unate
B,
by
arm;
musce
ABR/McM
s
te
ntates
woud
beyond
proxma
D,
te
detod
durng
amark
scapod
wc
supraspnatus.
arm
415;
171
assesses
pase
te
te
assessed
he
test
abducton
D,
706;
musces.
ABR/McM
can
durng
stretced
and
resut
tunne.
tendnopaty
B,
umerus
not
subcavan
ook
anteror
805;
tendon
not
133.
777–778;
a
suppy,
symptoms.
N
te
rada
te
degrees
radus.
styod
puses
assocated
afects
te
unar
carpa
pocs
GAS
ower
racture.
B.
ater
s
o
bood
by
o
between te lexor dgtorum proundus and lexor
on
te
at
te
te
supracondyar
GAS
129.
o
abducton
base
space
patent.
te
te
nserts
and
he bracoradas musce orgnates on te atera
te
caracterzed
compartment.
psorm
supraspnatus
musce
ower
7. 5 7 ).
he recurrent branc o te medan nerve brances
o
te
on
not
exposed
branc
te
nerve
meday.
anteror
E.
quadratus
te
Fg.
conned
o
woud
s
te
nerve
763;
brances
meda
una
are
tese
deep
o
ts
radus, pung te radus meday beow te racture.
B.
582,
te
woud
t
dsease
tey
or
psorm
31
attaces
musce
pos-
scapuar
371
mpars
oss
syndrome
and
rada
eve
cuta-
unar
outet
racture
a
he
D.
pronator
and
rom
(GAS
s
te
wc
musce
n
GAS
131.
woud
te
a
pexus
sbe
devaton.
A.
ymp
b re ast
ABR/McM
wtn
and
he
branc
o
to
Raynaud
of
ractured
te
and
stress.
trunk).
ABR/McM
musce
wen
te
syndrome
tromboss
puse
wen
so
o
braca
dorsum
damage
rom
wa
ses between te neck and te axa, ar above te cast.
musce
Most
te
meda
neror
on
o
ca
weakened
te
nnervated
aspect
te
407;
paeness
horacc
(C6–T1).
supnator
proxmay
meda
damage
nerves
729,
he
by
nerve
o
rada
n
B.
to
nerve
unar nerve, wc woud most key reman ntact.
D.
n
njury
orearm.
and
but
C.
supra-
damage
C6,
parayzed.
and
re c e ve
o
compartment,
V enous
muscuo-
toracc
woud
and
N
pressure
rada
abducton
te
by
A.
axary ,
te
te
o
caused
ong
musce
to
to
mpared
lexon
be
competey
musces
suprascapuar,
Damage
he
nodes
quadrant
737–738;
resutng
Damage
mpared
ymp
toracc
compartment.
causes
arm.
nerve.
damage
not
te
receve
te
Compartment
asca
175
nerves.
nerves
o
causes
rom
to
C.
ncreased
B. Injury to te superor trunk o te braca pexus can
damage
128.
130.
paanx.
ABR/McM
o
regon.
ABR/McM
meda
126.
nodes
aspect
ABR/McM
128
key
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.
te
A.
Bennett
racture
a
CMC
racture
at
te
base
o
Fig.
mammary
135.
A.
to
suc
D.
Smt
te
racture
anatomca
ture
s
Boxer’s
GAS
ndcated
aso
by
pan
n
wen
te
a
reverse
dsta
Coes
ragment
rac-
o
te
reers
bone,
to
usuay
racture
te
t
o
or
te
neck
ourt
o
a
meta-
poe,
ts
442;
ABR/McM
128
mon
njury
te
to
sad,
s
more
wt
vagus
on
te
orce
te
on
te
term
“gamekeeper’s
anmas
ndex
abducted
coatera
and
seen
n
s
MCP
skers
on
tumb,
“sker’s
te
n-
gament.
braced
tumb”
term
between
and
commony
ter
a
Scotts
sma
necks
tumb
unar
was
among
ked
ter
orce
te
Wereas
used,
usage.
s
vagus
njury
patent.
sometmes
N
t
tumb”
common
breakng
awkwardy
causng
njury
gamekeeper’s
resutng
and
ts
by
te
caused
T oday
n
and
an
wo,
rabbts
he
jont
wo
a
as
ground
ger.
caed
bone.
783–786;
posterory.
orward.
racture
metacarpa
carpa
s
caused
anges
be
dspaced
snufbox.
racture
and
radus
woud
s
“gamekeeper’s
descrbe
gamekeepers
ragment
gland
Interestngy,
because
dsta
wall
par t
.
Coes racture s aso caed “dnner ork deormty”
te
body
centrolateral
coned
Scapod
E.
s
GAS
tumb.
B.
of
gland
limb
Anterolateral
134.
337
Limb
scalene
Right
Infraclavicular
Upper
6
a
as
sk
seen
tumb”
st
n
s
com-
338
C H A P T E R
B.
6
Upper
Scapod
stretced
Limb
racture
and,
occurs
ater
nvovng
te
a
a
on
scapod
an
and
out-
A.
te
bones.
B.
C.
Bennett
D.
Smt
racture
s
a
racture
at
te
base
o
te
and
tured
s
aso
caused
and
orward.
s
te
caed
wen
dsta
Coes
a
te
dsta
rada
racture
s
reverse
Coes
radus
ragment
aso
caed
s
s
rac-
E.
dspaced
Boxer’s
dnner
ork
and
s
a
(and
o
te
necks
sometmes
o
te
te
t)
136.
B.
783–786;
he
te
bceps
tendon
radus.
spna
te
he
aferent
C5
C,
D,
E
brac
GAS
137.
B.
o
sde
D,
E
and
te
N
motor
C5
on
poston.
C6
te
C6
unar
te
bceps
nvoved
n
te
bceps
C7.
he
major
not
nvoved
n
te
s
te
s
s
a
te
lexor
aso
wrst
dnner
ragment
Smt
racture
o
racture
and
ractured,
an
scemc
s
wt
ork
te
s
radus
aso
caused
te
deor-
and
wen
rada
s
te
E.
N
and
ater
nvove
a
a
te
on
an
out-
scapod
and
unar
te
It
s
a
racture
Boxer’s
at
racture
and
trd
two
enters
eads
between
enters
vunerabe
and
to
E.
te
s
base
a
(and
o
te
racture
rst
te
or
te
o
o
and
hese
o
te
atera
and
to
damage
orearm
te
lexor
carp
te
proundus
superca
te
and
psorm
provdes
by
passng
unars
s
te
N
o
were
deep
t
unar
a re
and
n-
medan
supped
rada
te
n e r ve
o
te
extended
e xe d
because
supped
by
out
te
4
te
o
and
s
to
te
rada
lexed
Pressure
to
te
te
I
5.
arteres
wt
te
does
s
to
or
te
and
artery
pam
artery
arvested
s
succes-
anastomoses
rada
te
suicent
do
o
suppy
o
te
unar
ngers
pam.
o
rada
not
te
unar
patency
to
te
166
te
and
due
we
dgts
wt
assessed.
s
3,
compresson
neuroogca
vascuature.
438;
reeased,
suppy
a
or
not
te
grat.
patency
he
o
te
tunne
enters
te
and
and
are
and
and
atera
hese
due
te
not
s
to
a
assess
cnca
compres-
a
by
superca
te
and
o
because
rada
ts
to
o
te
te
te
te
to
psorm
adductor
musces
abducton
spared
nnervated
by
do
test
169
te
nterosse
branc.
s
and
Tne
syndrome
ABR/McM
a
tests
D.
nerve.
nerve
tunne,
te
te
B
prox-
are
po-
responsbe
ngers.
lexor
lexor
medan
te
bone
Fexon
dgtorum
dgtorum
nerve,
wc
njury.
Had te medan nerve been compressed n te car-
pa
bone,
ps-
tte
te
spared
to
o
useuness
notng
are
deep
unafected
a )
te
s
degree
te
artery
carpa
ngers
(meda
lexor
n
a re
1
wrst
rada
wen
medan
adducton
carp
te
te
extensors
be
ABR/McM
bood
artery
nnervates
lexor
to
te
nerve
dgts
te
be
retnacuum
te
A.
ps-
ndex
and
to
sgty
lexon
te
he
te
unar
proundus
te
nnervates
dgtorum
te
159
at
and
ave
805;
va
o
te
rng
dgts
to
a re
nvoves
rada
assess
o
lexor
sometmes
te
jonts
o
to
te
bood
te
E.
he
cs
to
arses
unopposed
tem
5
wt
njur y
suppy
466;
tereby
supercas
ABR/McM
nerve
lexor
retnacuum
142.
te
artery.
to
son
to
atera
nerve
te
an
o
rada
te
on
unar
tests
GAS
occur
second
437;
te
C,
N
test
tem.
oter
test
tan
158
and
te
PI P
due
vesse
can
ntegrty
ragment
rada
and
by
and
determne
B,
4
he
move
and
and
racture
te
to
to
rada
caed
atera
ocated
te
n e r ve
te
807;
wt
ten
musces.
caed
dsta
rom
o
o
e xo r s
arteres
eter
lus
deormty
te
extenson
Aen
between
159
lexon
o
reeased
svey
bra-
o
causng
spared
unar
ten
by
are
s
tgty
relex
metacarpa.
and
branc.
and
ABR/McM
ractures
descends
musces.
C6,
tappng
he
bones.
o
764;
between
437;
orearm
metacarpa.
he
C5,
by
musce.
orward.
Bennett
t)
ected
3,
E.
774,
bypass
Coes
stretced
necks
s
C6.
posterory.
Scapod
unate
relex
not
n e r ve ;
D g t s
D,
he
and
njured
n e r ve .
C,
A.
s
caused
unar
unopposed
157
key
ocated
ABR/McM
sgn
ong
e xo r s
GAS
not
extended
s
to
te
A,
o
1
on
arc.
467;
medan
deep
dgts
more
orearm.
ngers
and
component;
component
not
sometmes
radus
anged
s
nserton
nvoves
ABR/McM
nerves
racture
reverse
unars
are
contracture
because
dsta
and
tappng
relex.
dspaced
D.
relex
nerves
hese
o
Coes
mty
139.
ts
bracoradas
rom
775–777;
necross
GAS
te
eferent
421;
te
s
ngers
C.
near
by
N
Te
te
nerve
N
spna
te
B.
te
nerves
o
V okmann
a
o
ected
relex
provdes
te
s
branc
te
e xe d
and
141.
D.
A.
bceps
brac
bracoradas
coradas
GAS
relex
173
relex.
tendon
C,
ABR/McM
relex.
contrbuton
138.
C5
hese
nvoves
A,
te
720–721;
he
te
brac
provdes
brac
445;
bceps
nerves.
A.
by
N
n
774;
n e r ve .
s
nerve
Be n e d c t o n
gers
metacarpas.
GAS
B.
s
bone.
deep
mdde
racture
trd
he
GAS
140.
nerve
medan
may
posterory.
racture
second
E.
branc
bone.
orm
anged
deormty because te dsta ragment o te radus
s
he
rac-
unar
nerve.
rada
orm
C.
racture
deep
unar
he
rst
metacarpa.
ture
he
unate
and
re s u t s
and.
one
tumb
tenar
D.
n
An
woud
as
a
ave
resut
o
dicuty
a
ack
o
wt
moton
nnervaton
o
musces.
njur y
extenson
o
te
rada
dect
n
ner ve
te
n
te
o re a r m
arm
and
CHAPTER
C.
he
medan
abducton
provdes
o
GAS
143.
A.
te
jont
wt
te
ma
s
to
o
tere
te
musce),
axary
ead
s
mnor
to
B.
to
sde
and
C.
superor
he
n
D.
A
a
s
rada
some
GAS
A.
s
s
y
N
B.
o
a
s
to
s
bow
at
a
te
It
s
te
cavce.
but
bone
ractures
here
rarey
any
s
racture
ractured
usuay
te
D
njury
up
o
as
oca
resut
he
rada
t
runs
teres
ebow”),
te
te
s
n
te
supnaton
he
rota-
tendons.
most
we
te
or
and
te
ts
panu
te
rada
cuf
but
ong
t
te
ead
acterstc
extremey
bey
E.
te
ans
o
s
uncommon
most
te
bceps
deormty
te
s
brac.
wen
promnent
caed
or
common
buge
“Popeye
musce
te
arm
he
It
produces
lexng
o
sgn.”
te
o
a
car-
ebow:
unattaced
to
an
musce
n
atera
te
te
meda
unou-
154
and
promnence
te
acromon
s
and
te
occurs,
te
ead
nerory,
eadng
umerus.
and
o
assocated
Wen
anterory
o
dsocaton
usuay
ncdent.
acromon,
coronod
te
sope
depressed
here
o
te
and
as
N
process
o
yperextenson,
te
una
wc
can
afects
md-body
o
te
umerus
dam-
nerve.
a
a
racture
not
428;
wc
be
any
te
o
surgca
te
neck
posteror
nnervates
depresson
te
o
cord
detod
beneat
te
case.
ABR/McM
cubta
ven
s
aponeuross.
brosus
rom
to
aceraton
nerve,
eter
out
s
a
te
lat
142
a
superca
he
ven
bcpta
seet
meda
o
sde
o
tat
es
aponeuross
connectve
te
D.
bceps
tssue
brac
E.
covers
te
and
and
ead
sde
o
te
teres
una.
rom
runs
to
carpa
tus
bceps
te
and
It
te
meda
te
te
as
two
te
and
t.
bones
orms
on
te
757–758;
N
attacments:
umerus
meda
braca
musce
artery
es
on
te
tendon
sde
atera
mt
bcpta
braca
lexes
dependng
atera
brac
he
o
and
coronod
runs
o
o
te
on
te
pro-
atera
nserts
to
te
407;
on
bceps
es
ABR/McM
o
and
poston
te
cubta
aponeuross
artery
ebow
te
sde
te
te
ore-
ossa.
rada
orgnates
brac
underneat
aponeuross.
GAS
ossa
deep
musce.
supnates
orearm.
tuberosty.
musce
he
teres
and
ormng
rom
te
epcondye
bracoradas
he
don,
o
arsng
pronator
te
cubta
retnacuum
meda
pronates
o
te
wc
tunne.
te
he
renorces
artery,
pronator
unar
It
braca
pamar
he
to
musces.
te
carpa
B.
te
te
on
Anteror
contour
te
te
w
lexor
te
eas-
tendons
to
axary
lexor
protects
te
tendon
te
radoum-
tendon to bend wt te antebraca asca o te ore-
cess
o
te
and
tere
acertus
tat
o
compresson
es
ABR/McM
detod
o
bcpta
to
tssue.
on
te
renorcng
dspaced
rada
te
ead
be
ste
jont.
on
under-
o
es
gament
traumatc
Atoug
695;
axty
can
and
attacment
renorcng
moton.
ebow
medan
orearm
he
o
wt
he
common
resuts
seet
radus
appearance.
te
arm
Atoug
atera
umerus
GAS
subux-
oten
an
gament
common
norma
C.
jont.
rupture,
and
o
s
o
ebow
musce,
146.
as
te
orearm.
jont
428;
most
te
te
racture
afect
A.
ead
extended.
and
s
suprasp-
and
njur y
rom
extremey
tere
142
rada
ead
aows
dsocate)
s
mnor
and
rada
tendons.
te
he
ebow
gament
wt
and
te
wen
subscapuars,
ABR/McM
on
te
o
to
te
cdren.
(par tay
treated
A
te
neurovas-
may
and.
occur
experencng
pu
condton
o
o
Avuson
C.
typ-
s
soated
occur
occur
N
umerus
“dented”
A.
or
ebow
range
protruson
not
njures
ractured
outstretced
428;
s
and
an
oss
or
n
sarp
wde
te
sweng
cavce.
nerve
Most
md-body
an
tears
422,
annuar
ebow
rom
arm
produces
te
a
acromon
made
deveopment
hs
te
expansve
jont.
lattenng
suppy
serves
jont
coatera
753–755;
souder
resuts
It
o
trauma.
commony
njur y
subux
cutaneous
wen
commony
trd
on
patent
a
o
teres
te
ebow
te
umerus
wt
njured
o
It
an
B. he genoumera jont s an extremey mobe jont
te
umera
te
o
wt
te
anteror
te
commony
major
tenderness
cuf
pronated
te
a
(“nursemad’s
ebow
rom
s
nraspnatus,
695;
aton
(due
on
unar
sde
mera
145.
bodes.
s
connects
339
Limb
jont.
ages
degeneratve
cuf
he
ner-
tat
coatera
te
he
GAS
musce.
typcay
specc
s
te
groove.
natus,
144.
detod
and
o
nnervates
provdes
adducted.
umerus
a
Rotator
tor
aso
pung
acromon,
most
and
promnence
umerus
wc
arm
rada
membrane
tssue
musces
o
era
E.
abnor-
te
anterory
movement
he
te
drect
and
spra
nerve
E.
te
te
ds-
ter
te
sde
dsocatons
we
at
he
mobe
were
nterosseous
connectve
una
damage.
rom
he
o
surace
rotated. Wen
detod
te
dspacement
mdde
sweng
cuar
C.
dects.
ater
te
te
o
souder
wt
cavce
cay
and
te
njures
souder
nerve,
sgty
assocated
sensory
o
subuxaton
and
o
ony
Anteror
Anteror
dspaced
to
overyng
o
pamar
extremey
externay
ocaton).
tp
It
D.
an
oow
o
(due
axary
jont
te
te
movement.
te
wegt
detod
skn
AC
s
lattenng
ts
and
te
to
protruson
te
o
and
umerus
uness
nto
nerve
apped
s
to
musces
ngers.
167
s
common.
usuay
ncreased
te
or
jont
range
most
abducted,
te
nnervate
o
dgts.
ABR/McM
wde
te
umerus
orce
ory,
a
s
extended,
ead
tree
455;
not
nnervaton
genoumera
ocaton
o
N
does
adducton
sensory
rst
805;
he
nerve
and
Upper
6
157
ten-
te
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
te
B,
lexor
tat
sdes
o
don,
and
lexor
osses
n
he
and
GAS
148.
D.
te
a
tunne.
to
tck
te
It
connectve
te
meda
protects
and
GAS
Fig.
not
Fg.
tssue
and
A
at-
stabzes
carp
unars
tendons,
resut
n
and
rom
margn
tree
pocs
made
as
a
o
oose
sny,
lexor
o
atera
o
te
tenar
brevs,
te
sde
lexor
musces:
and
median
nerve
brevis
o
Injury
we
te
E.
tssue
medan
o
te
Injury
GAS
nerve
retnacuum.
te
abductor
B.
t
medan
It
opponens
pocs
usuay
nerve
at
to
pocs,
B.
te
njury
medan
o
te
nerve,
Injury
resuts
two
A.
C
te
and
n
o
nerve
n
recurrent
causes
te
oss
N
to
eads
te
o
te
and
bot
pamar
o
te
and
enters
and
D.
arteres
rst
artery
te
he
are
Fg.
enters
posteror
unar
and
carpa
pamar
sensory
branc
sensaton
unar
dects
ony
and
o
te
o
te
on
anteror
ound
resuts
n
dstrbuton
anatomca
o
te
and
nterosseous
courses
and
nerves
te
o
166
te
aspect
dorsa
n
7.107).
ABR/McM
artery
he
ous
(GAS
466;
rada
rada
motor
nerves
808;
he
passes
nner-
brevs.
o
medan
nerve
teses
appearance
167
as
pam.
unctona
connectve
gstenng
ABR/McM
branc
pollicis
dects.
medan
149.
452;
te
C.
branc
ten-
7.107).
N
and
tunne,
motor
lexor
tendons
ave
of
.
t.
supercas
s
branch
ner ve
sensory
skn
pollicis
retinaculum
and.
recurrent
te
s
between
beneat
proundus
does
dsta
lexor
run
Damage
788–790;
he
vates
carpa
pamar
orgnates
space
dgtorum
te
(GAS
te
tat
E.
dgtorum
C.
te
tendons
D
retnacuum
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
te
te
orearm
surace.
posteror
anterory
as
te
musce.
anteror
pamar
and
snufbox
between
and
nterosse-
posterory,
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
•
respectvey,
wc
E.
s
he
on
deep
pamar
branc
150.
E.
772,
he
vaton
to
o
te
are
responsbe
te
acton
he
tat
te
axary
mnor
te
o
te
unar
s
or
radus
s
an
and
membrane,
on
and
by
te
te
musces
n
B.
te
N
o
and
te
a
ABR/McM
or
a
adducton
used
he
o
to
cas.
nner-
dgts
motor
and
musces
nterosse
te
od
dgts,
a
pece
o
lex
C.
te
ton
musces
wc
o
s
paper
he
te
arm.
te
hs
detod
nerve
and
aso
teres
carres
o
te
s
atera
part
MCP
jonts,
te
anteror
souder
te
and
a
and
or
and
ngers,
emnence.
atera
oppose
te
musce.
cutaneous
a
te
to
jont
detod
tenar
uncton
It
two
te
nner-
and
te
nner-
umbr-
tumb
and
respectvey.
muscuocutaneous
o
te
musces
musces
te
o
responsbe
tree
ncudng
tenar
hese
te
nerve
te
pam
rom
neror
nerve
s
responsbe
compartment
o
te
or
arm,
nnerva-
endng
as
te atera antebraca cutaneous nerve beow te ebow.
D.
he
It
o
nnervates
te
medan
atera
170
cutaneous
ntrnsc
nterosse.
be
he
vates
457;
normaton
over
vaton
deep
nger
nerve
sensory
skn
ormed
artery
.
una.
anastomoss
s
Fig.
artery.
one
woud
and
tat
responsbe
most
te
nterosseous
te
rada
801–806;
meda
to
te
arc
o
nerve
ncudng
between
A.
te
791,
nnervaton
and
pamar
part
unar
near
between
surace
termna
GAS
or
ocated
GAS
view
te
ead
GAS
rada
aso
nerve
carres
and.
to
ts
N
o
467;
te
extensors
normaton
hereore,
array
805–806;
nnervates
sensory
damage
symptoms
to
rom
ts
(GAS
ABR/McM
168
o
te
te
nerve
Fg.
and.
dorsum
w
7.113).
not
342
C H A P T E R
Answers
151.
6
he
ar
te
o
some
he
Nerve
C4
tons
not
C5
te
te
N
nerves
and
s
te
ts
and
s
E.
uncton
B.
he
153.
A.
15
700;
he
te
sbe
unar
or
ormed
by
to
o
tat
man
C5
nerve
o
are
o
toracodorsa
to
te
wt
as
C6
or
can
cause
tears
and
n
teres
n
ts
o
oss
E.
te
not
musce,
GAS
mnor
musces
155.
o
responsbe
rotaton
a
souder
s
or
and
te
not
or
or
s
s
o
te
deep
musces
va
o
ventra
o
te
te
Bot
trunk
w
not
produce
nerve
damage
wrst,
except
except
or
gers.
w
It
tumb.
te
musces
C.
o
te
tese
ram,
te
or
bceps
C.
nter-
atera
w
resut
atera
he
C5
te
t
n
o
wc
D.
or
E.
com-
two
two
o
te
dgts,
t
te
n-
entre
lexon
upper
C6
trunk
receves
ventra
cuocutaneous,
lexor
te
o
o
te
musces
at
te
ts
nerve
ebow
sensaton
jont,
n
te
contrbutons
nto
rom
ram
and
dvdes
te
medan,
and
suprascapuar
te
mus-
nerves.
are
dgts
as
we
responsbe
are
or
responsbe
aso
assst
n
ead
to
woud
dgts.
s
responsbe
and
s
or
damaged
w
168
aceved
bracas,
musce
te
s
by
and
major
te
te
contracton
bracoradas
te
wt
ebow
unars
lexon
or
and
o
lexor
o
bracoradas
bceps
radas
te
brac
s
o
are
prmary
wrst.
supercas
lexon
teres
and
421;
Opposton
wt
te
te
and
and
dgts
supnator
supnaton,
tay
rst
nvoves
jont.
te
he
medan
te
prncpa
te
orearm
te
supercas,
tenar
proundus
at
te
MCP
are
responsbe
respectvey.
he
C.
he
s
and
(C8,
o
te
te
o
ourt
and
two
cas
(supped
two
undus
(supped
o
by
lexon
lexor
medan
at
te
te
te
te
pocs
branc
nerve
compartment
musces
o
te
wt
te
proundus,
lexor
ongus
extends
t
tendons
meda
he
pocs
acton
recurrent
n-
o
jont,
by
and
te
begns
and
to
and.
s
o
It
tendons
dgtorum
suppy
te
and.
ndcs
meda
te
ten
tunne
tat
rotaton
CMC
anteror
tenar
te
and
by
T1).
carpa
lexor
te
by
pocs
te
dgtorum
and
extensor
at
extensor.
poston
meda
produced
supped
nerve
ebow
movement
and
opponens
are
te
159
extended
musce,
nerve
musces
B.
te
musce
brevs
musces
s
compex
hs
pocs
pocs
brevs
a
n
abducton
metacarpa.
opponens
brac
ABR/McM
s
tumb
lexor
to
our
togeter
trceps
N
o
rom
te
respon-
respectvey.
pronator
pronaton
te
te
o
E.
o
jonts,
troug
bracas.
are
two
o
dgt.
dgtorum
passes
normaton
te
Interosse
ABR/McM
lex
or
coracobraca-
njury
oss
156.
MCP
umbrcas)
IP
744;
(ourt
ntrnsc
jonts
extenson.
nterosse
dgt,
ebow
carp
lexor
we
GAS
lexor
orearm.
and
to
o
IP
mnm
t
and
IP
dgtorum
te
bracas
jont
and
nerve,
meda
he coracobracas does not cross te ebow jont
o
weakness
nnervates
most
and
o
n
as
te
sensory
hereore,
pronaton,
and
o
umbrcas.
nerve
and
most
proundus
we
namey
carres
oss
as
and
resut
Medan
o
ourt
responsbe
he
are
pexus.
lexors
uncton
w
meda
arm,
te
he
and
recurrent
braca
ourt
dgtorum
atera
orearm.
supnaton,
E.
oss
he
unar
nterosse
nterosse
dgt
te
te
dgts.
brac,
contnue
are
respon-
nerves
symptoms.
o
unars,
lexon),
and
a
te
damage
brac,
Addtonay,
te
n
lexor
anteror
tese
o
muscuocutaneous
te
s,
o
(nterosse
except
he
resut
jont
o
carp
jonts
nerve
a
IP
a
nvove
lexor
IP
aso
Unar
t
and,
te
te
meda
and
woud
bceps
he
branc
B and D. Damage to eter te medan or unar nerves
aone
o
te
and
te
adducton
extensor
te
te
n
oss
extenson.
BP105;
responsbe
tumb
T1
o
dects
exampe
damaged.
te
B.
nnervaton
o
N
ebow
w
dsocaton.
responsbe
te
to
extend
pamar
IP
te
afect
musces.
lexon,
woud
o
extensor
805;
te
te
to
or
nterosse
lexon
dorsa
ead
166
damage
we
and
w
nerves,
jont.
umbrcas
extenson
Fexon
142
nerve.
and
A.
te
and
extenson
patent.
bot
MCP
to
o
he
te
as
we
lexon
ebow
key
he
Injury
damage
rotaton
n
trunk
tese
ABR/McM
abducton
D.
o
ngers,
adducton
B.
souder
weakened
neror
or
and
or
te
he
tte
abducton,
orm
upper
420;
afected
assstng
A
nerve.
prenc
at
N
patent
and
sbe
does
abducton.
te
he
rng
root
subscapuars
musce
arm
C.
te
lexon
805;
umbrcas.
te
contrbu-
o
Innervaton
C8
te
te
meda
durng
medan
te
154.
musces.
or
ABR/McM
nerve.
orm
wt
121
s
responsbe
te
part
are
mpared
meda
opposton
o
are
he
axa
major
and
415;
C7–C8
GAS
te
rotators.
degrees
N
C4
“strap”
te
nraspnatus
musces
branc
bne
te
damaged
nerve
osseous
o
be
and
togeter
Interna
supraspnatus
rst
GAS
o
uncton
atera
o
MCP
acton
as
key
C8
prmary
he
roots
o
nnervated
nerve.
n
ony
s
branc
to
dstrbuton
wc
te
ABR/McM
pectoras
he
to
te
adducton,
D.
and
musces.
a
contrbutes
dsocaton
ocated
cuf
te
roots
root
C7
420;
C3,
nerve.
contrbute
we
717;
rotator
arm
nerve
toracodorsa
Anteror
C2,
suppy
nerve
o
s
te
ntertubercu-
possbe.
roots
C5
up
te
musce
wc
made
prenc
usuay
nerve,
GAS
te
nto
hs
nerve,
s
and
and
to
he
C.
and
pexus
attaces
umerus.
nvovement
D.
cervca
E.
cord
C6
and
C.
te
dors
toracodorsa
posteror
A
Injury
atssmus
sucus
by
152.
Limb
151–175
B.
A
Upper
by
tendons
by
o
te
ngers
te
te
o
te
ndex
are
lexor
lexor
unar
by
dgtorum
medan
te
nger.
lexed
nerve)
and
dgtorum
nerve).
te
super-
te
pro-
CHAPTER
D.
he
te
GAS
157.
D.
unar
base
808;
he
nerve
o
N
te
455;
scapod
carres
t
sensory
rom
te
most
168
te
across
te
occurs
cay
I
prmary
te
ony
A.
on
te
rom
ragment
metacarpa
axa
atera
bow
and
suppy
degeneratve
te
(“wast”)
avascuar
resutng
Frst
an
part
bood
proxma
produce
abducted,
dorslexon
dstay,
bone
te
s
narrow
durng
bone
o
and
ractured
to
racture
o
te
sde
car-
o
te
jont
dsease
drected
o
te
aganst
te
te
acton
te
A.
occur
te
o
B.
C.
partay
ts
lexed
E.
B.
An
soated
mon
aongsde
ton
s
ave
te
jont
afectng
787;
he
ventra
ong
wc
dapragm,
A.
te
ng
rst
o
te
movng
te
te
te
nnervaton
n
te
te
dgta
upper
synova
ncude
jont
te
pan,
jont
te
An
njury
wngng
ram
he
te
te
nnervates
C3,
C4,
te
pexus
excurson
o
do
not
te
musces
braca
tat
here
D.
T ermna
are
no
braca
motor
brances
uncton
Nerves
nerves
grde.
o
o
arsng
te
te
arsng
pexus
A
C.
nerves
pexus
stabze
te
rom
te
An
te
to
braca
te
njury
braca
upper
to
any
pexus
o
te
w
to
te
729;
upper
mpar
suprascapuar
o
nerve
te
and
bra-
te
o
not
exacerbate
cana.
o
epcondy-
meday
meda
occurs
te
te
oowng
ange
between
extensvey
Stretcng
te
devate
epcondyts.
153
wc
superor
tat
n
Lumbrcas
D.
lexor
pa
tunne.
he
o
or
te
roots
te
neck
o
te
o
te
o
roots
sma
w
o
mus-
present
7.52A).
pexus
upper
w
resut
mb.
168
s
a
reatvey
numbness,
ngers.
tenar
tp
pexus
Injury
te
he
Fg.
hs
water’s
patents
entre
compresson
te
o
avuse
cord.
wt
graspng
braca
common.
braca
pan,
water
te
may
and
te
and
a
rotated,
pronated.
name
o
(GAS
syndrome
by
to
ess
spna
ABR/McM
and
nerve
ypotenar
and
Carpa
o
te
musces
common
a
tngng
tunne
medan
and
te
syn-
nerve,
rst
and
IV
are
o
nnervated
te
beore
orearm
t
musces
traves
are
by
are
unar
nerve.
supped
by
troug
te
car-
nnervated
by
te
nerve.
788–789;
Recurrent
answer.
s
troug
te
gven
452;
s
ABR/McM
o
te
branc,
of
carpa
wc
we
N
branc
hs
musces,
tumb
o
most
III
medan
used
muc
te
musces
te
rect
trunk
and T1)
and
caused
wrst
smar
afected,
causes
te
s
meday
te
deormty
455;
he
unar
162.
are
sde,
and
are
rom
tunne
D.
o
termna
exacerbate
umbrcas.
musce,
trunk
N
Carpa
B.
souder
not
and
aternatve
(C8
to
suppes
and
a
not
meda
ncreased
ower
njury
parayss
wc
dapragm.
te
C5–T1
te
ars-
extremty
o
commony
ter
te
and
s
provde
w
ABR/McM
bers
at
te
and
caw
drome
dvsons
lex
s
mb
trunk
C5
provde
pexus
to
nerves
te
a
GAS
o
rom
are
o
sensaton
pexus.
brances
nnervaton
souder
ca
spna
E.
B.
E.
te
condton
grde.
te
neror
GAS
161.
te
contrbute
he
n
epcondye,
ebow).
pan
brt
parayss)
te
second
dapragm.
o
and
te
Injures
n
hus
or
to
te
extended
ence
tp
E.
ong
scapua.
restng
a
wt
dapragm.
o
mb
o
anteror,
(C3–C5).
o
reducng
to
o
wc
ram
tree
(C5–C7).
serratus
pan
durng
nerve
posturng
sgn.
dsease
upper
te
souder
te
w
wrst
goer’s
431;
te
orearm
musces
ebow.”
wrst
te
newborns
transt
orearm
ces
rom
N
tose
atera
extensor
te
braca pexus (C5–C6). Inants w ave te afected
wrst
partcuar
and
sear
as
devery
(Kumpke
pexus
nerve,
ventra
cords
to
can
njury
168
ventra
braca
nnervaton
tumb
he
to
n
te
o
epcondyts.
patent
757;
pasy
dicut
baby
jont.
scapua.
resut
te
te
degeneratve
arses
dapragm,
o
jont.
741,
common
musces
on
te
o
worsen
tese
serratus
epcondyts.
exacerbates
te
to
te
149
te
“tenns
o
atera
known
s
Puttng
pan
atera
o
w
neck
area.
devaton
(aso
Erb
te
occurs.
a
braca
rom
a
racture
te
wt
tenosynovts
s
prenc
presenta-
A.
te
o
nnervates
te
w
te
part
rom
o
nerve
nerve
and
necton
ABR/McM
arses
o
te
o
GAS
160.
devated.
CMC
nvovng
mpar
Cords
an
artrts
nerve
psatera
s
447;
Addtonay,
can
on
dicuty
protracts
njury
a
toracc
ram
toracc
an
base
raday
occur
CMC
tumb.
nlammaton
toracc
te
te
te
N
ong
o
uncom-
can
on
te
and
were
GAS
nvovement
Symptoms
CMC
depends
at
a
an
Cnca
o
T enosynovts
E.
njures.
and
s
trapezum
pan
and
sweng,
trapezum
te
movement
wt
seats.
o
varabe
Patents
may
te
carpa
and
extended
C.
oter
restrcted
o
racture
gy
occurs
158.
A
dspacement
or
C.
racture
njury.
o
pan
wrst
ts
o
343
Limb
dapragm.
extensor
devaton
Askng
metacarpa.
te
trauma
uncton
ABR/McM
epcondye
o
hus,
te
te
ncknamed
Fexon
by
or
417;
exacerbate
pan
te
N
rom
Unar
and
caused
Most
Rada
deat
afect
musce
atera
w
subcavus.
not
730;
condton
wrst.
usuay
he
orgnate
and.
suppy)
may
D.
te
w
716,
orgn.
Pan
enters
bood
o
are
159.
espe-
(patoogca
scapod
ractures
wrst,
scapod
nadequate
te
te
GAS
occurrng
scapod.
abducton
necross
o
to
anteror
requenty
pa bone. Fracture oten resuts rom a a on te pam
wen
nerve
nerves
ABR/McM
s
normaton
dgt.
Upper
6
te
tunne.
part
buttonng
opposton.
wc
ater
o
a
168
medan
te
medan
he
an
s
cor-
tenar
nerve
musce
acton
te
te
opponens
tenar
srt,
nerve
suppes
passes
pocs
group,
tat
s
requres
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
te
except
umbrcas.
B.
a
It
one
and
and
a
he
patent
te
vated
he
by
by
and
te
te
deep
E.
Inabty
because
lexor
deep
to
o
te
ong
te
unar
musce,
Pronaton
o
by
B.
Abducton
o
nnervated
by
C.
he
pocs
lexor
musce
nerve
sparng
te
te
nerve
and
te
te
s
by
o
o
are
te
per-
nner-
nerve.
te
te
motor
ar
perormed
rada
a
A.
by
to
te
te
o
te
to
te
a
(C5,
neror
up
he
to
he
te
C.
medan
retnacu-
retnacuum.
rst
he
rotate
notc
to
axary
nerve
musces
sde
o
arm
beyond
a
rada
and
te
20
o
te
Snce
lexor
by
te
retnacu-
wt
lexor
a
acera-
retnacuum.
166
by
te
suprascapu-
contnues
nnervates
ntates
troug
te
abducton
nra-
o
te
degrees.
superor
and
te
teres
and
neror,
neror
major.
sup-
subscapuar
Bot
musces
arm.
suppes
aso
degrees,
nerve
te
nerve
a
souder.
atera
perormed
nerve.
njured
and
20
te
te
to
be
o
te
nerves,
nnervates
era
he
and
15
aso
nnervated
supraspnatus
compartments
he
aceraton
C6)
s
medan
ABR/McM
s
subscapuars
atoug
hs
455;
subscapuar
te
mnor
musces
N
not
ntegrty
scapuar
meday
B.
te
te
deep
woud
supraspnatus
nerve
tumb
by
traves
nerve
sparng
nerve
musces
nerve.
lexor
wt
lexor
by
te
805–806;
he
py
adductor
tumb.
nterosseous
njured
nerve
arm
nerves.
te
branc
medan
te
answer
tumb.
out
D.
te
nnervated
ton
164.
o
musces
spnatus.
wrst.
correct
superca
lexes
deep
be
two
between
provdes
te
carred
and
ongus
anteror
and
Opposton
um,
nerve.
s
medan
ntegrty
unar
traves
s
two
meda
argey
wc
nerve
adducts
D.
te
GAS
paper
nnervates
tumb
not
te
extensors
medan
courses
woud
o
uncton
tumb
and
nnervated
caed
medan
um
s
te
o
rada
orearm
nnervated
a
sde
.A
sde.
pece
musces,
nerve
wc
te
a
te
Fig.
motor
o
atera
to
pamar
dorsa
dgts,
te
te
sensaton
te
branc
adduct
te
te
nterosse
retnacuum
pocs
A.
to
on
suppes
musces
musces
grp
trd
branc
nnervaton
163.
on
st
nerve
ntrnsc
suppes
ngers
can
unar
te
tenar
ngers
second
te
a
aso
a
a
ormed
C.
o
nnervatons
GAS
arm
detod
o
skn
detod
te
does
suppes
te
he
and
rotator,
te
patc
teres
not
at-
abducts
te
mnor
n
teres
te
abduct
musces
and
and
on
te
te
orearm,
musce,
arm.
posteror
wc
are
extensors o te ebow , wrst, and ngers n tat order.
E.
he
upper
uars,
GAS
706,
a
subscapuar
meda
731;
N
rotator
417;
nerve
o
suppes
te
arm.
ABR/McM
144
te
subscap-
CHAPTER
165.
C.
Wt
ymp
ten
te
to
A.
he
B.
he
D.
he
te
te
A.
te
N
n
pu
gament,
ax
u
s
tus
te
attaced
C.
to
te
nod
process
o
te
he
sde
o
te
s
te
pa
caused
te
subux
he
unabe
a
annuar
n
E.
to
to
ead
te
adut
ts
addng
to
rater
t
to
jont
passes
attac
s
te
te
coatera
bnds
radus
and
radus
attaces
te
te
atera
o
te
unar
gament
ead
to
te
attaces
atera
meda
o
167.
A.
hs
age
a
755;
o
N
patent
te
unar
or
musces.
back
o
ood
anx.
MCP
ost
extends
suppes
B.
gvng
he
Injury
o
(rng
to
wrst
and
musces
te
deep
IP
branc
jonts
orearm
to
nerve
he
te
rada
extensor
and
as
te
te
rom
wt
as
cronc
t
courses
compartment
patents
wt
car-
a
cnca
te
o
musce
nerve
a
tunne
o
o
s
at
at
aso
te
nd-
carpa
postve Tne
syndrome.
nnervated
ts
te
(e.g.,
tat
nerve
atropy,
carpa
devaton)
unar
sgn
medan
musce
wrst.
te
by
aows
Proxma
regon
o
te
a
ractured
807;
D. In
N
o
cervca
rb
ram
or
as
a
o
trave
by
neror
a
pexus.
te
a
dsta
be
te
o
njury,
rb.
he
o
to
he
pexus
meda
braca
te
arm)
be
axa.
anteror
te
caused
com-
In
s
ts
beng
dvson
cord
o
cutaneous
and
by
band—ven-
can
te
braca
as
meda
nerve
tus
mpared.
pexus
neck
te
contnues
n
patent
168
braca
cervca
cutaneous
s
not
dect
ts
brous/muscuar
rom
trunk
trunk
sensory
However,
syndrome—sometmes
cervca
neror
cause
wc
w
ABR/McM
trunks
tey
aso
and.
wrst
outet
or
may
te
amate
te
467;
toracc
te
and
o
te
nerve
meda
ante-
are
brances
o
te
meda
cord
o
te
pexus,
te
o
te
sown
te
dsta
te
on
n
meda
te
produces
nerve
te
te
by
C.
aso
a
to
te
Medan
sgns.
worsen
E.
o
o
te
and
ebow
pan
and
reumatod
trunks
o
and
present
tte
as
ngers.
lexon.
o
at
te
at
te
te
neck
te
are
te
o
te
dorsora-
exacerbated
orearm.
wrst
w
parestesas
ourt
postve
ncude
epcondye,
n
dgt.
Tne
ead
te
Pysca
and
ypotyrodsm,
to
rst
Paen
obesty,
artrts.
te
anteror
a
on
and.
meda
rng
pexus,
parestesa
and
Symptoms
at
braca
and
sensaton
and
sow
actors
te
syndrome,
nerve
pronaton
rada
w
te
te
rada
orearm.
as
he
sons:
n
compresson
suc
o
at
decreased
and
o
orearm,
tunne
wt
te
cause
nerve
Rsk
arm,
cubta
lexon
dgts
te
cord
numbness
numbness
examnaton
motor
te
aspect
wrst
tree
sde.
o
w
o
neror
wt
compresson
and
symptoms
cnca
provdes
nnervaton
da
te
as
Compresson
radus
te
and
nerve
Symptoms
B.
s
po-
part
known
tngng
nerve
nerve
compartment
sensory
te
Unar
o
presents
meda
aso
pa-
o
one
A.
hs
lex
pamar
te
te
uncton
unar
tereore,
and
ood.
unar
Compresson
he
at
extenson
tere s a meda cord contrbuton to te medan nerve.
by
tenar
nsert
hs
and
o
ngers)
occurs
n
occur
braca cutaneous nerve (meda cutaneous nerve o te
dam-
cana.
musces
jont.
branc
rada
to
te
appearance
tte
and
te
caused
o
(extensor)
jont
IP
nnervaton
drop.
to
te
to
Guyon
nterosse
dorsa
MCP
te
te
and
te
nnervaton
arm
te
o
superca
cutaneous
ngers
sgn
to
lexon
jont,
tograp.
a
damage
or
mecansm,
extend
due
nerve
umbrcas
and
te
te
ts
and
ntrnsc
nerve
wt te unar nerve as ts termna branc. Addtonay ,
unar
unar
two
va
rom
and
n
te
te
atera
ngers
jont
at
te
s
unars
njury
orearm
(meda
154
caw
o
umbrcas
hroug
wt
MCP
te
te
cassc
suppes
he
resutng
a
branc
amate
nerve
except
ABR/McM
as
deep
ractured
proxma
orearm)
428;
o
sensory
car.
henar
Contractons
(unar
te
meda
condye
carp
nerve.
to
compressed
condye
te
a
nerve,
ndng
musce
sgn
te
pressed
umerus.
GAS
lexor
unar
braca
coatera
eve
or
rada
may
over
musces
tunne.
o
tenar
damage
case,
to
he
tat
medan
test
adducton
tra
not
umerus.
unar
cnca
a
axa
angng
common
Lke
GAS
168.
and
does
te
syndrome.
Tne
adducton
jont.
gament
te
te
bodes
on
motor
mpared.
te
te
compresson
s
te
a
ter
a
n
arm
carpa
test
A
te
coro-
eter
ebow) can resut n te nabty to adduct te wrst.
not
around
to
be
tenar
o
tunne.
as
radounar
s
postve
te
n
provde
ead
Dependng
nerve,
may
te
te
te
tunne
he
pace,
(dsocate)
rada
ossed
by
una.
o
A
commony
s
radus
rada
membrane
o
nodes
subuxaton.
te
aong
ead
te
to
uy
nerory
te
stabty
rada
o
o
radus;
radus
togeter
he
sde
rada
nterosseous
mantan
E.
te
o
una
D.
o
to
age,
cdren,
o
ead
gament
capsue
o
o
troug
cates
dstay.
not
support
neck
he
as
sde
D.
condton
In
wt
atropy
axary
bot,
compresson
nodes.
ead
rada
and
rsk
jont
and.
pued
annuar
o
ncreased
he
te
upper
rada
compresson
Atropy
receve
371
years
te
te
te
or
seepng
C.
posteror
a
5
receve
nodes
and
dermatomes.
o
345
Limb
s oten njured wt md-body umera ractures or
wa.
ebow,”
s
rom
nodes.
axary
cd’s
sma
capacty
te
B.
and
njury
rom
breast
and
beow
ods
aows
te
cdren
te
wc
and
wen
sze,
o
te
ABR/McM
cdren
C5–C8
and
dects,
ymp
nodes
(pectora)
cest
centra
“Nursemad’s
sarp
o
atera,
407;
musces,
nodes
nodes.
receve
axary
axary
anteroatera
to
nodes
axary
most
anteror,
737;
ound
s
rom
tenar
(umera)
apca
te
te
eptrocear
souder.
or
a
anteror
dran
166.
and
o
te
axary
back
rom
to
axary
subcavan
te
A
GAS
atera
upper
ymp
o
ntay
posteror
ymp
E.
nvovement
drans
Upper
6
braca
and
pexus
posteror
gve
rse
dvsons
o
to
sx
te
dv-
upper,
346
C H A P T E R
6
mdde,
unte
vde
and
to
151;
te
N
or
ntereres
duces
B.
a
snap
or
deormty
te
C.
te
rng
Maet
and
ater
nger.
ng
at
D.
o
o
te
presents
Boxer’s
pa
caused
Pysca
ton
GAS
B.
793;
te
N
anywere
gt
are
s
occur
be
C.
Condromas
D.
Osteomas
orgn.
mosty
E.
GAS
A.
s
a
hey
ound
791–792,
term
pressure
te
n
o
te
actve
o
he
can
t
to
a
nerve
C.
be
t
neck
D.
to
papa-
dorsa
and
hey
jont
may
occur
contan
On
papaton,
hey
and
are
A
deep
a
and
sod
tey
commony
may
tumor
tumor
tat
o
ebow
GAS
C.
443;
ong-dstance
becomes
upper
at
causes
a
and
due
wegt
wrst,
tus
oss
te
o
unar
to
te
restng
to
te
on
oss
andebar
te
pamar
o
abduc-
nerve.
by
te
tenar
near
te
te
rada
musce
o
te
eads
It
w
o
medan
a
yper-
present
tenar
and
at
168
two
te
amate
scapod.
damage
rada
wt
musces,
sensory
oss
musce
nerve
and
o
te
wrst
w
tat
nterosseous
te
afect
contnues
nerve
and
aso
jont.
racture
ony
w
o
te
o
mgt
afect
te
aso
and
causes
between
lexors.
extensor
or
oppos-
tumb,
It
respec-
lexor
to
te
as
ebow,
te
meda
myo-
epcon-
tenderness
wt
ebow
lexon.
160
nerve
runs
membrane
te
weakness
dstay
suppyng
proundus
ourt
and
n
ected
dgtorum
ongus,
goer’s
presents
wrst
ABR/McM
as
pan
te
pan
nterosseous
te
lexor
known
tat
ressted
tendons
unar
dgts
epcondye,
Fg.
common
cause
7.85).
wrst
te
te
not
nterosseous
ence
and
t
pronator
n
and
te
musce,
ngers),
quadratus
pronaton
and
wrst
7.89).
nerve
D.
medan
tngng
suppes
he
deep
E.
nerve
and
medan
wrst
tat
n
supnator
te
afects
466;
(GAS
he
not
he
correspond
sensory
N
to
a
he
as
167
condton
compressed
te
jonts
pocs
te
te
meda
aspect
o
te
and.
outgrowts
cycsts.
body
symptoms
uncton
neuropaty
A.
te
rom
and
and
pocs
te
ABR/McM
te
sends
cartagnous
te
o
juncton
lexor
B.
at
te
dgts.
njury
anteror
lexon
to
dgts
epcondyts,
meda
767;
rada
a
Fg.
overuse
and
anteror
degeneraton.
s
(GAS
te
he
te
dicutes
Meda
te
projectons
and
medan
at
musce.
posteror
orgn
wc
bony
and
dgts.
abductor
supped
resut
due
supracondyar
and
draned.
dgts
a
nerve.
sur-
be
te
observed
atropy
o
te
extenson,
ead.
neuropaty
te
o
a
te
ABR/McM
s
sensaton
be
tumors.
peces
cartagnous
N
as
tumors
neuroeptea
cannot
tumors
sod
bony
he
o
are
a
nerve
ateray
teres
branc
musce
at
173.
a
T enns
an
be
not
467;
o
and
meda
s
syno-
wen
by
by
can
between
Hypertropy
dye
te
N
passes
tree
tvey
E.
but
syndrome
tendnous
o
s
tumb
a
and
rada
supped
mgt
dicuty
ton
st.
and
te
pasy
pronator
unar
metacar-
transumnated
te
sgn
cana
dstay
patent
cosed
and
two
tumb
te
opposton,
te
racture.
tem.
bengn
wt
o
A.
rest-
dsrupton
hs
tenderness
eet.
be
o
atera
extenson.
te
tendons
or
as
musce,
te
wrst
andebars.
unar
o
o
one
meda
by
brevs
805–807;
lexon
166
bengn
aso
afects
n
unar
DIP
trauma
te
te
bengn
807;
drect
or
a
are
are
nerve
o
to
jont.
aceraton.
and
oters
andebar
commony
te
s
are
assocated
he
due
PIP
crcumscrbed.
sod
are
Osteopytes
are
ack
oss
most
to
te
nerve
Pronator
troped
ngertp
and
B.
nerve
Patent
njury
A Tne
GAS
172.
termna
jont
Medan
Guyon
parta
draned.
Neurobroma
It
to
can
he
DIP
outpoucngs
dorsum
A.
orgn.
171.
te
te
pocs
provdes
sows
troug
treated.
cannot
or
and
we
E.
ncude
jont.
sows
metacarpa
o
and
o
o
te
supped
Extensors
o
metus.
DIP
occurs
drect
are
actors
meda
o
atropy.
and
afects
te
nerve.
D.
surace
mosty
dabetes
C.
pro-
brotc
permanent
It
tor
wc
and
tckenng
Rsk
te
te
o
aspect
Abducton
ater
lexon.
pamar
swoen
ABR/McM
te
and
on
gcay
n
sned
rm
by
seat
lud
to
racture
proxma
cysts
or
va-ke
a
t
451;
Gangon
capsue
s
o
degrees
lexon
examnaton
over
anguaton
170.
trauma
racture
dorsa
jont.
over
PIP
or
mpacton
45
DIP
sp
to
wt
neck
and
tendon,
puey
damage
to
deormty
centra
secondary
E.
te
Boutonnère
by
occurs
progressve
te
examnaton
approxmatey
extenson
te
jonts.
and
traumatc
Pysca
nger
resut
on
PIP
dsta
aspects
pro-
ongus
lexor
a
ngers.
panu
a
a
use
not
B.
extenson
eadng
caused
tendon
wt
as
and
acoo
s
te
s
asca
tte
nger
presents
oten
te
MCP
and
extensor
o
troug
occurs
o
dvsons
does
nerve.
trgger
actve
eventuay
o
tobacco
on
posteror
wc
149
or
contracture
tat
and
unar
growt
gdng
cck
contractures
lexon
te
stenosans
t
Dupuytren
te
to
he
cord
ABR/McM
noduar
wt
trunks.
posteror
419;
A. T enosynovts
sweng
Limb
ower
orm
contrbutons
GAS
169.
Upper
nerve
branc
extensors.
pronator
acterzed
supped
weakness
by
by
o
nterosseous
GAS
te
carpa
n
o
te
te
Wrst
n
tunne
te
areas
w
present
supped
by
and.
rada
nerve
extenson
nnervates
w
be
te
weakened,
lexon.
Compresson
te
at
numbness
774;
N
o
te
teres
pan
te
te
medan
causes
and/or
dsta
nerve
pronator
numbness
medan
musces
nerve
nnervated
nerve.
466;
at
ABR/McM
160
te
ebow
syndrome
n
as
by
te
we
te
by
car-
areas
as
te
anteror
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
Unar
nerve
stc
devaton
o
damage
GAS Ulnar
Radial
te
to
te
805–807;
unar
N
MCP
artrts
467;
jont
and
s
not
a
caracter-
as
a
resut
o
nerve.
ABR/McM
153
nerve
nerve
175.
B.
he
bone.
Humeral
of
at
reumatod
head
unate
It
Wen
s
eps
t
s
te
to
most
orm
dsocated,
commony
te
t
loor
o
dspaces
dsocated
te
nto
carpa
te
carpa
tunne.
carpa
tun-
pronator
ne,
potentay
compressng
te
medan
nerve.
he
teres
patent
pam Flexor
Deep
of
branch
radial
w
and
ten
present
pamar
wt
aspect
o
dysestesa
te
tumb,
over
ndex,
te
and
car pi
ulnaris
mdde
(cut )
ngers,
and
weakness
n
tumb
opposton.
nerve
A.
Dysestesa
aong
te
meda
border
o
te
and
s
Supinator Ulnar
head
pronator
a
of
C.
o
nerve
Flexor
to
te
unar
nerve.
aong
weakness
unar
and
o
te
meda
wrst
rada
border
extenson
nerves,
are
o
te
and
caracterstcs
respectvey.
digitorum
D. superficialis
Pronator
damage
Numbness
and
branch
radial
o
teres
Superficial
of
resut
Weakened
grp
strengt
s
due
to
damage
to
te
(cut )
unar
nerve.
Numbness
and
ateray
over
te
dorsum
o
te
to
te
o
te
teres
(cut )
medan
E.
Anterior
rst
interosseous
Flexor
nerve
nerve
Sensory
digitorum
s
a
and
resut
rada
nnervaton
tree
Adductor
and
a
pocs
o
o
compromse
nerve.
te
dgts
pamar
s
adducts
by
te
te
aspect
medan
tumb
and
nerve.
s
nner-
profundus
vated
GAS
Answers
by
te
782–785;
deep
N
branc
442;
o
te
ABR/McM
unar
nerve.
128
176–186
Brachioradialis
176. tendon
A. he dects descrbe unar nerve damage cose to ts
(cut )
entry
te Dorsal
(of
te
orearm.
he
epcondye
unar
and
s
nerve
passes
reatvey
bend
unprotected,
branch
ulnar
ner ve)
makng
ts
arm,
ts
va
carp Flexor
area
prone
muscuar
unars
musce
to
nerve
brances,
and
te
njury.
t
In
nnervates
meda
a
o
te
ore-
te
lexor
te
lexor
car pi
Flexor radialis
nto
meda
car pi
dgtorum
tendon
ulnaris
proundus
musce.
In
te
and,
te
deep
tendon
(cut )
branc
o
te
unar
nerve
nnervates
te
ypotenar
(cut )
musces,
Palmar
branch
(of
Palmar
median
(of
lexor
branch
ulnar
ner ve)
cas,
adductor
dgt
and
pocs,
mnm
opponens
brevs,
dgt
abductor
trd
dgt
and
mnm.
mnm,
ourt
he
umbr-
sensory
nner-
ner ve)
vaton
dgts
s
and
expan
B.
to
te
t
correspondng
te
dects
Entrapment
Guyon
n
te
and
rng
part
o
experenced
o
cana
meda
te
unar
eads
and
to
tte
a
te
by
te
and,
te
nerve
tngng
ngers
o
ourt
wc
can
patent.
n
te
and
unar
or
numbness
wtout
te
oter
symptoms. •
GAS
Fig.
.
C.
Compresson
ossa
174.
A.
Snce
tenar
B.
I
te
medan
nerve
s
ntact
tere
w
be
no
te
rada
Rada
wrst
extensors,
ner ve,
are
wc
ntact,
no
are
wrst
supped
drop
w
by
carp
extenson
(unar)
te
and
sde.
rada
s
not
unars
pus
wc
te
Extensor
nerve.
seen
due
acton
contrbutes
and
carp
to
toward
unars
s
o
to
te
te
wrst
and
by
to
te
medan
symptoms
dects
n
te
nterosseous
medan
nerve
nerve
o
n
musces
nerve
beore
te
pronator
supped
wc
te
cubta
syndrome
atter
by
brances
enters
te
tunne.
Medan
causes
meda
supped
te
carpa
o
te
anteror
rom
be
D.
devaton
extensor
addton
te
obser ved.
C.
n
atropy.
causes
nerve
te
compresson
symptoms
afects
sensaton
o
o
n
carpa
te
te
carpa
tunne
atera
tunne
syndrome
border
o
te
and.
E.
he
and
meda
cord
antebraca
gves
rse
to
cutaneous
te
meda
nerves,
braca
unar
nerve,
CHAPTER
and
aso
patent
GAS
177.
774;
D. he
A.
N
as
te
one
he
s
aso
a
ncorrect.
te
te
artery
tat
hs
D.
te
unar
o
not
te
exst
nerve.
nerve
te
s
skn
te
te
E.
ncor-
on
unar
te
180.
C.
produce
te
te
rada
he
te
B.
he
and
artery.
C.
lex
nerve
s
not
because
rada
artery
occuson.
compressng
te
te
superca
te
superca
branc
o
D.
at
rada nerve suppes te rada aspect o te tumb
and
rada
meda
GAS
782,
D. In
te
808;
runs
umerus
te
aong
he
te
atera
rom
he
not
bone
by
t
te
te
to
o
te
sor
aso
afect
deep
A.
he
te
te
deep
cts
o
s
cussng
nerve
dect
B.
nnervated
nerve.
md-body
we
by
wc
racture
separated
(C)
o
nerve
nerve
te
orearm
tat
and
braca
makng
t
durng
s
te
te
D.
ts
E.
md-body
t
tree
mentoned,
so
bone
nerve
but
ocated
are
not
must
atera
152
nerve
mnm,
best
not
nnervates
ongus,
and
ave
extensor
any
te
exten-
po-
cutaneous
answer.
nerve
lexors
te
no
does
gve
cutaneous
rada
nerve
rse
to
sensory
proper
te
de-
was
not
n
te
te
tested
s
te
dagnoss
uncton
by
o
abductng
evauated
squeeze
musce
s
a
nstructng
s
aganst
ed
brevs
s
n
tested
usng
test.
lexor
te
o
te
patent
resstance
to
we
extenson.
musce
proxma
455;
used
te
lexes
by
te
askng
paanx
ABR/McM
to
ad
It
s
carpa
n
o
tumb
te
te
nd-
tumb
168
te
dagnoss
perormed
tunne
tenosynovts
or
contro
tunne
te
brevs.
were
te
vdua
beng
horacc
Maet
Rada
by
were
s
o
car-
gty
per-
te
medan
tested
grps
and
nlammaton
o
surrounds
tendons
exampe,
extensor
or
tested
examner
s
tat
tumb,
It
outet
usng
te
Fnkesten
tumb
unary
syndrome
nger
182.
D.
descrbes
dgtorum
s
nerve
damage
testng
extensor
788–789;
N
Compresson
pexus
ram.
braca
and
test,
o
te
nd-
devates
te
and
tested
usng
Adson
to
rada
o
cervca
te
te
nerve
hs
rada
nerve
motor
here
729,
n
o
te
te
or
by
166
o
te
rom
T1)
to
T1
te
meda
te
meda
hey
aso
pectora,
unar,
toracc
outet
as
compresson
by
to
T1).
meda
braca
C8
and
(C8,
oten
nerve
and.
trunk
patent
no
o
736;
o
nerve
te
dects
are
dvsons
GAS
to
o
te
te
neror
presence
o
a
rb.
epcondye,
te
(C8,
pexus
due
evauatng
contrbute
nerve
causes
by
rada
derved
nerves
braca
te
neror
medan,
nerves.
wc
tested
ABR/McM
cutaneous
deormty
njury.
musces
te
hese
nger
o
nerves
cutaneous
syndrome,
trunk
452;
on
compresses
ventra
E.
s
dstrbuton
te
a
tendon
cutaneous
medan
nerve
are
and
tumb
A, B, C. Compresson
nnervates
by
and
te
N
s
seat
contrbute
pocs
jont
Quer van
antebraca
dgts.
rada
tere
dspaced
rada
rada
does
te
orearm
te
s
musce
ongus
syndrome.
extensor
pexus
nerve.
abductor
It
te
supercay
te
De
GAS
o
ad
test.
extremey
a
to
nerve.
sarpy.
te
takes
cutaneous
161
resstance.
pocs
paanx
lex
sgn
pocs
hese
and
unar
ocated.
tat
s
aganst
pocs
above
s
te
resstance.
tunne
te
nerve,
are
aspects
nterosseous
te
branc,
afected.
on
dgt
musces.
Atoug
te
drecty
sensory
and
nerves
ABR/McM
wrst,
atera
a
arm
cord
bot
very
branc
makng
a
o
pa
a
evauates
nterosseous
tested
o
805–807;
Tne
C.
te
cutaneous
anteror
by
tey
cutaneous
mpnge
te
racture
rada
A.
orearm.
orearm
because
extensor
ongus
o
C.
o
ndcs,
brances,
o
posteror
to
cs
aganst
umerus.
and
468;
te
te
mpnge
cutaneous
afected
meda
as
he
te
o
supercay,
ony
N
key
ntercostobraca
coces
extensors
and
musce.
njure
antebraca
B.
atera
umerus
groove;
because
by
runs
atera
752;
ts
181.
muscuocutaneous
be
unkey
GAS
va
177
producng
o
aspect
rom
racture
179.
te
te
w
aspect
antebraca
dicut
he
nerve,
umerus
meda
o
rada
pont
aspect
may
supped
E.
regon
te
rom
te
were
nger
ABR/McM
antebraca
meda
orgn
ndex
GAS
posteror
atera
te
te
455;
ts
rada
nerves
B.
N
n
at
te
derved
o
o
to
test
test
opposton
s
MCP
vdua
brances.
md-body
nerve
on
sde
te
n
noted
musce.
proxma
lexor
s
ABR/McM
he
pocs
tp
were
349
Limb
out.
nerve
speca
nger
and
te
he
te
a
dorsa
lexor
because tere s coatera crcuaton rom te pamar
trapezod
s
lexors
dects
rued
469;
opponens
he
be
pasy.
pup-to-pup
tumb
he
A.
rst
nnervates
rada
N
pocs
ndex
aso
sensory
can
test
nerve
he scapod compressng te rada artery s ncorrect
rada
178.
775–777;
Froment
A.
dects
crcuaton
njury
adductor
orms
no
superca
unar
compresson
nerve
snce
he
GAS
artery
amate
cana;
coatera
wt
unar
but
o
ook
w
o
he
orearm.
nerve
Guyon
arces to compensate or
E.
or
medan
compressng
or
because
nerve.
arm
160
nnervates
he
unar
unar
te
dgts.
amate
anastomoses
C.
nerve
a
medan
n
te
compressng
o
descrbed
te
oss
ABR/McM
unar
o
to
sensory
compressng
and
ook
part
o
s
psorm
meda
B.
no
466;
unate
he
rect
contrbutes
as
Upper
6
present
te
n
nerve
neck
tunne
ts
o
at
te
te
woud
meda
radus,
not
or
cause
patent.
orgnatng
braca
420;
unar
te
carpa
nerves
N
te
at
drecty
pexus.
ABR/McM
135
rom
te
350
C H A P T E R
183.
B.
he
carpa
scapod
a
at
and
he
te
te
hs
snuf
snuf
te
te
part
o
orces
to
orearm.
wt
and
assocaton
te
argest
artcuates
scapod
as
trd,
no
he
scap-
transmtted
ment
te
te
unate
amate
wt
te
ater-
ton
dstay.
B.
s
te
carpa
proxmay
and
and
o
dstay
ourt
assocatons
aso
and
a
wt
wt
te
te
o
te
te
s
he
he
te
orented
loor
o
te
carpa
s
anatomca
457;
a
ateray
artcuaton
s
orented
wt
artcuaton
not
snuf
te
wt
assocated
second
te
wt
bone
E.
bone
o
te
ar
128
Acromioclavicular
T rapezoid
Conoid
ligament
ligament
ligament
cavity
Suprascapular
•
GAS
to
wc
410;
neck.
te
space
or
sows
he
resut
and
on
Fig.
.
notch
(o
te
ga-
cavce.
dsoca-
between
o
exsts
te
te
cause
extends
te
o
njury
te
or
te
es
converts
t
suprascapuar
te
scapua.
between
end
gament
te
cavce.
x-ray.
process
jont
and
a
te
cavce
x-ray.
above
nto
te
a
ora-
nerve
runs
rom
wraps
way
ts
passes
a
umerus
he
te
o
te
axary
termna
troug
provde
tubercle
te
dmpng
njury.
as
around
to
o
and
pexus
It
B.
142
racture
brusng
cord.
ts
A
ABR/McM
braca
posteror
te
and
te
to
woud
proxma
notc
on
cora-
wegt-
coracocavcuar
gament
eter
te
acromon
process
on
o
crtca
te
7.24).
Conoid
process
Glenoid
N
te
coracod
ligament
Acromion
Coracoid
Fg.
x-ray
umerus
Coracoclavicular
seen
te
scapuar
troug
woud
eaves
and
scapuar
expanaton
he
arm
box.
ABR/McM
B.
and
mb
te
gaments
as
te
unreated
694;
surgca
meta-
loor
See
GAS
scapod.
te
jont
and
upper
are
partcuar,
muc
attaces
coracod
tese
transverse
men
anatomca
carpa
te
o
AC
superor
anatomca
te
sternocavcuar
and
D.
or
gaments
In
provdes
cavce
manubrum
bases
souder.
coracoacroma
he
bones.
metacarpas.
wt
meday
orm
dsta
trapezod
te
acromon
185.
proxma
N
to
te
capsue
attaces
he
anatomca
coracocavcuar
o
gament
jont
(GAS
not
and
support
AC
scapua)
box.
787;
AC
stabty
bearng
process,
te
he
te
cocavcuar
queston,
styod
A.
box.
carpa
GAS
o
artcuates
s
trapezod
wt
resut
ts
184.
te
Interrupton
no
second,
does
he
(“wast”)
dsta
n
te
wt
C.
amate
and
he
a
te
aganst
proxmay,
as
and
captate
E.
unar
captate
te
he
as
n
descrbed
pused
ractured
reatonsp
box.
unate
snuf
radus
as
commony
te
bones.
captate
he
D.
as
most
o
narrowest
bone
he
o
te
trquetrum
ay,
C.
o
ractures
troug
te
resut
gets
te
Limb
s
a
person
scapod
usuay
A.
as
process
Wen
od
Upper
bone
styod
te
6
te
surgca
at
te
upper
nerve
branc
o
quadrangu-
neck
nnervaton
to
o
te
te
teres
CHAPTER
mnor,
ower
geant’s
A.
te
te
rada
body
te
o
D.
he
medan
ere
and
unar
at
GAS
C.
body
o
coud
nerve
be
cubta
and
692–693;
o
skn
known
Injur y
weakness
N
arter y
or
s
and
te
be
rada
over
as
te
te
“ser-
groove
woud
be
aong
njured
n
umerus.
njured
be
njured.
tte
n
a
racture
ner ve
o
deep
at
te
be
to
te
be
njured
carpa
carr y
out
te
kewse
by
ts
B.
tunne
ndcates
te
s
DIP
tat
a
jonts
te
unar
supracondyar
te
regon
n
o
te
ner ve
rng
s
te
and
ntact.
racture
wc
351
o
te
medan
passes.
racture
at
te
nerve
surgca
and
neck
posteror
woud
njure
crcumlex
te
umera
ner ve
wrst
s
ndcated
lexon,
nner vates
tese
movements.
medan
ner ve
and
te
and
by
grp
musces
he
bra-
can
aso
te
o
te
rada
body
nerve
o
and
te
deep
umerus
braca
woud
artery.
he superca rada nerve and rada artery woud
damaged
by
njury
over
or
n
te
anatomca
snufbox.
E.
were
racture
be
njury.
arter y
A
njure
wtn
142
braca
medan
ner ve
s
afected
and
pronaton,
medan
A
at
ndcates
wc
axary
D.
nerve
ABR/McM
ner ve
near
too
ossa.
not
x-ray
umerus,
A.
Fexon
ngers
Limb
artery.
traves
422;
to
o
he
govern
te
compressed
w
medan
strengt.
ca
s
epcondye.
coud
tssue
he
tat
n
muscuocutaneous
njured.
te
te
traves
umerus
te
nerve
meda
he
te
porton
tat
he
he
or
te
detod
nerve
C.
E.
and
te
o
racture
te
186.
o
patc.”
he
a
detod,
aspect
Upper
6
Unar
and
nerve
pasy
deormty.
dsrupt
artery
te
s
GAS
te
745,
a
unar
750,
woud
dsta
present
supracondyar
ntegrty
Supracondyar
to
A
o
te
branc
racture
unar
o
w
te
not
wt
a
racture
nerve.
he
braca
cause
drect
nerve.
757;
N
438;
cawed
w
ABR/McM
158
not
unar
artery.
njury
7 Head
and
Neck
Q u e st i o n s
Questions
1.
A
4.
1–25
2-mont-od
routne
sma
pt
at
te
A
key
o
CT
to
te
brougt
wt
he
scan
te
n
area
ts
ossa
arc
B.
Second
paryngea
pouc
C.
hrd
hyrogossa
Second
A
parents
he
we
a
oter
gr
say
s
and
neck
sows
branca
structures
n
to
te
stua.
s
most
groove
an
rom
and
to
s
te
er
te
cet
and
by
Latera
B.
Medan
paate.
cd
porton
o
oowng
5.
Intermaxary
D.
Medan
A
s
nasa
Frontonasa
sows
wt
because
mssng.
eye
rgt
o
eye
Wc
te
pa-
ts
te
te
ca
cause
Faure
B.
Abnorma
C.
Abnorma
B.
Mastod
se
o
a
brougt
notced
norma
and
a
to
sma
te
area
sows
cary
rgt
deect
eye.
te
oice
o
s
by
rgt
body,
most
s
rs
age-approprate
and
macuar
Examnaton
consstent
s
wt
a
key
o
te
cooboma.
embryoog-
condton?
te
crest
ssure
to
cose
ormaton
nteractons
D.
Posteror
E.
Weak
adeson
o
optc
te
norma
sagtta
and
a
a
by
spontaneous
depresson
and
tat
w
corona
wc
te
s
Pysca
o
cose
ontanees
typcay
ontanee,
boy
compcatons.
moter
oowng
ontanee
te
sku.
depresson
at
a
certan
ocated
sutures
and
at
at
te
wat
cose?
coses
wc
ontanee,
Spenoda
E.
Anteror
A
at
about
coses
wc
between
te
optc
vesce
ontanee,
ontanee,
3-year-od
ater
6.
boy
se
recenty
coses
wc
at
at
coses
wc
cervca
s
8
at
coses
s
te
B.
Deect
C.
Branca
D.
Cystc
E.
Deect
he
Pysca
and
A
n
2
years
about
16
monts
to
1
about
at
3
years
about
18
no
key
o
o
ts
by
he
respratory
a
sot,
tender
to
tongue,
upward.
s
cd
tract
anteror,
papaton.
te
mass
Wc
o
n
te
dagnoss?
cyst
te
trd
arc
paryngea
paryngea
woman
sows
cet
p
oowng
a
gr
devery
maormatons
was
arc
arc
devers
and
examnaton
te
neck.
sows
s
move
pyscan
s
upper
s
paryngea
o
rst
oter
o
an
wc
to
duct
pregnancy
dagnoss
wc
rom
te
n
cyst
stua
n
to
ump
protrude
most
sxt
25-year-od
ton.
to
observed
hyrogossa
a
examnaton
mass
asked
s
brougt
recovered
A.
A
s
notced
Pysca
e
neck
cause
retna/corod
neura
sows
ontanee,
D.
oowng
examnaton
oowng
ts
o
a
et
s
s
te
Lambdod
a
gap
or
by
were
n
er
dects
made.
structures
cesarean
te
upper
are
Faure
s
sec-
uncompcated.
o
most
p,
observed.
uson
key
o
te
condton?
A.
Latera
nasa
and
B.
Meda
nasa
promnences/processes
C.
Latera
ectoderm
te
does
Posteror
Wen
segment
Pysca
A.
and
age
mdne
embr yonc
process
boy
sows
o
te
necton.
promnences
movements,
sparng
o
ad
no
emnence
3-mont-od
moter
juncton
moter
process
paatne
C.
E.
352
paatne
sku
A.
boy
reassures
o
te
A.
boy’s
te
any
monts
structures?
3.
te
er
eedng
examnaton
eaty
major
o
pyscan
or
Pysca
he
snus
deveopng
oter wse
wc
pyscan
age. Wc
C.
cervca
examnaton
deect.
and
o
devers
wtout
year
pouc
cd
abnormates.
deveops
he
woman
devery
monts
brougt
up
te
te
paate
a
examnaton
duct
oow
despte
cet
ate
or
parents
as
a
ntermttenty
tender
28-year-od
vagna
sternoce-
sgty
and
sows
A
a
pouc
paryngea
6-mont-od
et
or
anomay?
paryngea
E.
s
embryoogc
Second
D.
pyscan
drppng
ead
A.
paryngea
o
appears
te
tonsar
te
examnaton
border
mucus
o
oowng
nvoved
to
Pysca
anteror
musce
extendng
Wc
2.
te
openng.
papaton.
pt
s
examnaton.
domastod
rom
boy
nasa
maxary
and
promnences/processes
meda
nasa
promnences/
processes
camber
cavtaton
between
vesce
te
nner
and
outer
ayers
D.
Latera
E.
Maxary
ary
promnences/processes
promnences/processes
segment
and
te
ntermax-
CHAPTER
7.
A
30-year-od
cated
ton
sows
deects
o
ateray
sows
o
8.
on
no
te
o
key
Frst
B.
Second
C.
hrd
D.
Fourt
E.
Sxt
ead
te
9.
paryngea
Rbolavn
B.
Inectous
examnaton
C.
Mutant
D.
Cortsone
E.
Irradaton
deveopment
arces
woud
symptoms?
12.
o
woman
te
boy
sacrum.
daton
o
te
(o
C.
D.
Meroanencepay
E.
Hooprosencepay
s
o
care
te
and
te
s
aso
most
ew
seen.
te
Frst
B.
Second
ventrces,
C.
hrd
D.
Fourt
E.
Ft
te
Wc
o
13.
1-mont-od
moter
says
Obstructve
s
naton
cear
because
se
tymc
key
to
o
ave
Juguodgastrc
B.
Lngua
C.
Paratyrod
D.
Submandbuar
E.
hyrod
mass
neck
mass.
on
A
ectopc
te
by
Lung
bopsy
he
to
to
te
orgn
are
o
s
ocaton?
node
14.
gand
s
brougt
to
te
examnaton
sow
a
no
ypopasa,
o
or
and
and
absence
wc
arces
or
o
w
a
o
ow
oow
brt
up.
abnormates.
ypocacema
deveopment
story
pyscan
sows
o
utrasound
te
te
Frst
and
B.
Second
C.
hrd
most
key
Pysca
D.
Fourt
E.
Fourt
and
sows
pcated
neonate
matons
Abnorma
was
Second
D.
hrd
E.
produce
tese
15.
Fourt
o
sows
a
gap
dects
made.
n
are
Wc
a
term
Pysca
er
upper
observed.
o
sows
no
ypocacema.
neck
sows
absence
gands.
pouces
s
s
ess
te
act
o
we.
te
Wc
most
key
pyscan
durng
nosy
Pysca
neck
o
to
sounds
yod
wen
te
oowng
were
as
swaowng.
he
te
te
he
aure
o
embryonc
er
he
nant
sows
greater
bone
musce
by
breatng.
examnaton
sows
assocated
a
cornua
absent
at
potenta
gr
appears
deveopment
structures
most
deects?
promnence
paryngea
paryngea
arc
arc
paryngea
woman
te
gr
an
uncom-
examnaton
p,
A
by
no
oter
dagnoss
oowng
s
o
te
maor-
o
a
cet
consdered
to
er
neck.
Pysca
tat
s
o
ange
arc
comes
paness
te
o
te
musce.
B.
Inlamed
C.
Accessory
D.
hyrogossa
E.
Latera
to
te
ton
emergency
depart-
no
te
cause
duct
An
was
sma
te
most
o
utrasound
we-dened
anteror
bgger
area
to
cystc
te
key
and
swe-
exam-
mass
at
sternocedo-
dagnoss?
boy
o
suc
a
kept
ead.
or
nant
wt
An
an
MRI
observaton
he
uncompcated.
sma
Wc
s
enarged
were
a
tssue
cyst
5-day-od
an
gand
cyst
abnormates.
7.1).
o
s
a
a
node
tyrod
dagnoss
(Fg.
Wat
ymp
devery
oter
sweng
sows
cyst
because
sows
te
papaton.
sows
mandbe
cervca
preterm
says
on
neck
Dermod
A
Se
examnaton
A.
and
devers
devery.
te
s
twtc-
promnence
22-year-od
mastod
paryngea
sxt
vagna
or
C.
te
trd
woman
te
Maxary
naton
ty-
ourt
and
an
tese
Mandbuar
brt
31-year-od
part
eed
B.
A
te
te
and
o
o
n
A.
ng
second
and
o
sow
ater
and
examnaton
paratyrod
brougt
breatng
x-ray
to
was
ars
stomac.
neror
ed
tender.
Laboratory
tymus.
oowng
wegt
deects?
A.
te
er
deect
wc
sde
wt
pyscan
ment because o 1-week story o a sweng on te rgt
gand
boy
A
respre
key
te
structures
pregnancy
te
studes
paryngea
o
compromse
o
mass
on
An
te
brt.
exam-
sounds
o
addtona
er
neck.
Pysca
embryonc
oowng
ymp
n
swaowng.
Based
an
pyscan
gand
3-mont-od
pouces
a
te
tons
A
rod
to
bateray.
te
A.
resuts
n
mdne
tssue.
wc
and
notced
dicuty
a
ayng
strdor.
brougt
auscutaton
tymus,
most
no
sows
to
sows
ydrocepaus
s
to
Pysca
neror
gr
Anencepay
as
ydrocepaus
A
because
gr
produc-
nvoved?
A.
dagnoss?
te
musce-jerkng
examnaton
and
durng
brougt
Laboratory
oowng
a
o
s
unusua
occasons.
tymus
s
o
boy
moter
5-year-od
p
admnstraton
wtnessed
a
n
genes
utrasound
te
o
or
sows
Stenoss
key
wo
unt
boy
trd
ventrce.
Syvus)
condtons
preterm
Utrasonograpy
atera
ourt
at
ntensve
examnaton
te
aqueduct
a
neonata
Pysca
over
devers
B.
A
on
actor
decency
5-mont-od
An
Nonobstructve
cd
11.
A
causatve
353
Neck
dsease
abnormates.
to
a
mportant
and
anomay?
A.
arc
oowng
moter
10.
te
ts
and
ound
ng
A.
A
o
Abnorma
most
o
un-
were
paate,
te
ton
parents
norma-szed
cerebra
cet
be
examna-
arc
ar
a
rest
uncomp-
arc
sows
wt
deects
he
an
arc
observaton.
o
suc
by
Pysca
mandbe,
A
oowng
produce
boy
arc
brougt
tut
te
ear.
sde.
a
devery.
abnormates.
te
28-year-od
was
o
and
rgt
oter
A.
A
eye
devers
vagna
ypopasa
te
wc
most
woman
spontaneous
Head
7
o
Pysca
enarged
te
noncommuncatng
o
te
condton?
oowng
prenata
s
ead
ater
course
examna-
ead
and
conrms
ydrocepaus
te
most
key
354
C H A P T E R
7
Head
and
Neck
18.
A
68-year-od
depar tment
pan
a
over
te
stor y
hree
o
dton,
ago,
Gencuate
C.
Ineror
D.
Otc
E.
Pterygopaatne
gr
o
n
“danger
ernous
•
Fig.
on
or
he
(t c
o
as
douo ure ax).
medcaton
o d ay.
ke y
bouts
pat e nt
we
In
t s
er
co n-
resp o ns b e
or
Gasseran)
area”
brougt
eyes.
o
snus
trgemna
o
m os t
ntense
wt
MRI
snus
s
an
er
potopoba
cavernous
s
(semunar
because
An
w as
e m e r ge ncy
gossoparyngea
17-year-od
eyes.
md ace .
out
te
pan?
T rgemna
sensaton
to
e xcr uc at ng
ne ur ag a
ran
gangon
te
B.
ment
e r
pysc an
wc
b rougt
s ud de n,
o
se
A.
A
s
o
trgem n a
care
medatng
19.
area
monts
prmar y
wom an
because
to
Pysca
dicuty
te
ead
o
o
te
ace
nvove
nerve.
I
ts
emergency
and
depart-
“bugng”
gaze
te
sows
n
easy
spread
optamc
occurs,
wc
to
n
te
branc
o
bot
dagnoss
hrombopebts
can
te
a
examnaton
atera
conrms
tromboss.
and
te
eadace
te
o
te
cav-
o
te
oowng
.
symptoms
w
most
key
be
present
durng
pysca
examnaton?
A.
Obstructon
lud
B.
16.
n
Excess
producton
C.
Increased
D.
Dsturbances
E.
Faure
A
were
o
at
1
sows
sde.
crcuaton
te
and
and
an
o
te
cerebrospna
te
or
pt
s
tube
wegt
o
Hs
dd
o
and
CSF
20.
cose
to
prenata
te
Appearance,
(APGAR)
egt.
and
Puse,
scores
He
s
Pysca
acoustc
oowng
pyscan
course
respectvey.
externa
te
ts
to
brougt
he
mnutes,
atretc
o
ead
resorpton
neura
boy
CSF
Respraton
5
Wc
cause
o
te
uncompcated.
percente
te
o
n
examnaton.
Actvty,
9
sze
1-mont-od
routne
te
(CSF)
meatus
condtons
were
8
te
s
Otc
not
B.
Deveopment
te
rst
paryngea
17.
Meata
D.
Aurcuar
pug
E.
he
dd
not
ocks
was
tubotympanc
not
recess
over
Tngng
21.
deveop
Genoyod
C.
Paatogossus
D.
Genogossus
A
oss
te
woman
abnormates,
returns
wt
and
anagescs.
sma
vesces
A
over
se
was
sent
ew
days
ater,
te
same
area,
o
as
an
cause
tese
ave
erupted.
Se
s
dagnosed
wt
a
der-
o
te
most
o
tumor.
key
A.
Aurcuotempora
B.
Lesser
B.
Bucca
C.
Faca
C.
Lesser
D.
Ineror
D.
Menta
E.
Pterygopaatne
E.
Inraorbta
petrosa
to
contan
te
vrus?
te
P y s c a
o
te
An
te
dzzness,
o
c ro n c
tongue
cana.
ace
examnaton
MRI
be
o
emergency
stor y
key
brougt
severe
nasa
oss
o
An
o
and
te
Wc
aected
petrosa
been
nerve
nerve
nuceus
gangon
and
taste
o
te
no
ead
o
by
te
ts
emergency
dzzness,
sows
tat
paranasa
rom
o
te
afected
nerve
savatory
to
eadace,
MRI
Wc
symptoms?
oowng
key
a
examnaton
te
and
Aurcuotempora
most
a
tongue.
te
s
s
o
Pysca
A.
nerves
most
regon
to
eadace,
as
ypogossa
w
woman
dryness
ntracrana
matoma erpes zoster nlammaton (snges). Wc o
wc
s e ve re
p ro t r u s o n
te
acrmaton,
two-trds
as
o
a
abnormates.
because
vomtng.
tures
some
bucca
hyroyod
45-year-od
examnaton
no
at
o
te
b ro u g t
monts.
n
musces
Myoyod
patent
sows
mass
s
patent
6
or
B.
burnng pan n te area o er cn and ower p. Pysca
over-te-counter
Te
or
p
eyed
over
man
we a k n e s s
and
wt
ower
because
dects
A 65-year-od woman comes to te pyscan because o a
ome
te
upper
eyeba
sensaton
vo m t n g .
a
paate
te
te
4 0 - ye a r - o d
department
degenerated
ard
o
A.
E.
canaze
dd
te
mass?
afected
C.
Pan
E.
o ow n g
key
pouc
D.
s ow s
orm
o
rom
oter
deect?
A.
Pan
s ow s
and
rgt
most
C.
A
n
eadaces
90t
te
Anestesa
and
examnaton
on
Pan
B.
depar tment
or
devery
Grmace,
at
A.
te
te
te
snuses,
anteror
bran
sows
oowng
struc-
by
te
tumor
to
CHAPTER
22.
A
17-year-od
symptoms
or
te
we
se
An
B.
Reduced
bood
C.
Reduced
venous
n
ts
low
to
return
te
upper
te
nterna
31-year-od
ace.
A
te
as
beng
a
s
CT
te
on
Questions
26.
a
pressure
scan
brougt
o
te
neror
oowng
to
n
a
Coma
sows
and
ead
te
and
neck
sows
emergency
vece
(GCS)
pupary
o
a
te
27.
afected
by
Externa
C.
Maxary
D.
Deep
E.
Mdde
ay
ematoma?
eyed,
A.
Submandbuar
ng
B.
T rgemna
C.
Superor
D.
Gencuate
E.
Cary
A
because
descrbes
s
o
rgt
te
eye
genera
tongue,
te
ead
Wc
te
A.
man
o
taste
te
be
tmes.
sows
o
to
a
to
bouts
on
rom
and
o
te
Pysca
te
tumor
emergency
severe
rgt
sde
anteror
wtn
nerves
are
te
s
depart-
eadaces.
and
examnaton
savaton
oowng
te
nvovng
sows
two-trds
ntact.
An
a
key
28.
oss
o
s
MRI
nratempora
most
He
Lngua
proxma
to
ts
juncton
wt
te
a
er
as
depart-
bat.
exam
a
be
o
te
ractured
Brances
to
He
sows
regon
sows
key
o
wc
njured?
Faca
nerve
Cary
E.
Superor
he
to
story
n
er
wt
s
most
o
seem
rgt
dated.
uncon-
eadaces
gettng
worse
abnormates.
Wen
eye
compete
emergency
ound
be
no
bran.
key
te
cronc
to
sows
er
to
beng
s
Wc
o
o
by
er
te
te
ater-
upper
oow-
tumor
cervca
man
gangon
s
brougt
sustanng
patent
person,
severe
wound
s
tssue
and
s
but
conscous
Pysca
prouse
sutured.
and
necton
durng
and
or-
examnaton
beedng.
Ater
panu.
most
depart-
key
3
he
days,
Between
ocated?
A.
he
perosteum
Corda
tympan
B.
he
aponeuross
C.
Ineror
aveoar
C.
he
dense
connectve
tssue
and
te
aponeuross
D.
Lesser
D.
he
dense
connectve
tssue
and
te
skn
he
derms
A
department
enarged
avng
to
st
tons
te
o
E.
Gossoparyngea
60-year-od
wt
ymp
sudden
or
a
e
bouts
o
sows
a
oowng
s
brougt
cronc
nodes.
down
eeng
ead
te
woman
tumor
patent
dzzness
cose
uness
woud
epsodc
he
o
and
n
at
er
er
te
be
to
se
causng
eyes.
rgt
most
emergency
eadaces
says
as
er
Se
ear.
juguar
te
te
A
to
aso
CT
oramen.
key
and
been
ave
men-
scan
o
Wc
neuroogc
29.
A
36-year-od
department
son.
and
he
tme,
Pysca
CT
to
patent
any
te
scan
most
dect?
te
beng
s
says
o
key
te
se
No
to
Let
Rgt
vagus
C.
Rgt
ypogossa
earng
D.
Let
gag
E.
Rgt
o
tongue
Loss
o
aca
movements
C.
Loss
o
sensaton
D.
Loss
o
E.
Loss
o
expresson
relex
rom
te
ace
and
te
scap
as
gossoparyngea
gossoparyngea
to
a
te
motor
orented
to
uvua
s
no
n
ts
n
over
ound
ractures.
emergency
vece
person,
pan
tenderness
abnormates
resut
vagus
n
sgncant
he
oter
B.
Loss
B.
brougt
sows
sows
A.
A.
s
conscous,
ead
afected
perosteum
nvoved
aceratons.
rgt.
te
epderms
woman
ater
and
bone
and
examnaton
wtout
ated
and
and
ead
and
swoen,
te
te
and
ceaned
nlamed,
ayers
emergency
to
tme.
aceratons
qucky
te
njury
dstraugt,
pace,
scap
were
s
an
(SCG)
to
B.
E.
to
nerve
tympan
petrosa
A
woman
drected
ptoss
afected
te
gangon
55-year-od
work.
ater
symptoms?
D.
ater
brougt
tey
tumor
pup
C.
ment
a
says
was
nerve
wc
corda
sows
tese
s
examnaton
Ocuomotor
te
tumor?
ead
most
amy
patent
and
wounds
by
er
Optc
sows
ossa.
afected
baseba
tempora
te
are
a
Pysca
ematoma.
woman
by
B.
ented
o
rgt
o
emergency
menngea
A.
A
te
scan
arteres
downward,
n
te
wt
tempora
structures
resut
Gasseran)
brougt
sudden
pan
at
s
sensaton
but
or
cervca
35-year-od
ment
(semunar
on
conscousness,
and
to
ead
unresponsve.
CT
daugter
scan
te
tempora
Pysca
regans
te
355
Neck
carotd
he
er
brougt
on
epdura
48-year-od
CT
arge
A
an
Superca
atey.
o
oramen. Wc
key
and
B.
and
moss,
and
ead.
A.
A
and
oowng
scous.
12.
sde
te
s
t
ematoma
department
co-
o
rgt
racture
juguar
most
te
motor
rgt
rgt
s
ven
Scae
andross
ganga
wa
to
arge
o
on
man
beng
unconscous
pteron
o
ead
juguar
ater
patent’s
woud
and
26–50
34-year-od
s
te
mb
Gasgow
eyed,
te
A
ment
dagnoss
symptom
toracc
nvoved
examnaton
ematoma
o
woman
ater
te
o
and
symptoms
takng
because
rom
o
o
rgt
te
conrms
Wc
te
n
ptoss
or
because
er
nerve
Numbness
Pysca
o
syndrome?
Dstenton
Se
ar
respraton
E.
A
pyscan
notced
neck
D.
son.
25.
rst
er
te
present
wt
prenc
te
syndrome.
Probems
department
24.
Se
o
A.
te
23.
MRI
be
to
dscooraton
brusng
outet
key
comes
and
mont.
was
toracc
most
gr
pan
past
pone.
o
o
Head
7
er
er
to
were
neck.
neck
dev-
ound.
Wc
devaton?
be
co-
pace,
nerve
A
s
356
C H A P T E R
30.
A
man
gen
ater
s
not
by
s
s
Neck
brougt
ound
responsve
passng
and
te
breatng
dangerousy
an
to
emergency
unconscous
ow
endotracea
on
very
and
tube
te
depart-
street.
sowy .
Hs
ntubaton
troug
an
s
he
oxy-
nt-
35.
openng
C.
Maxary
D.
Optamc
and
ocuomotor
E.
Optamc
and
aca
A
a
experenced
sows
B.
V estbue
cornea
C.
V entrce
rms
D.
Vaecua
ocaton
E.
Rma
any
e
s
relex
an
comes
o
recent
unabe
on
te
te
Ineror
B.
Optc
ment wt et-sded toot pan n s upper jaw. Pysca
C.
Superor
examnaton
D.
Foramen
rotundum
E.
Foramen
ovae
he
maxary
condtons
Spenod
B.
Anteror
teet
as
w
no
be
to
te
on
emergency
te
wen
et
tappng
aerges.
te
most
sde
Wc
key
o
s
on
o
ace
s
et
te
o-
36.
dagnoss?
Posteror
D.
Maxary
E.
Fronta
snusts
etmoda
snusts
man
o
worse
s
brougt
severe
sonne
durng
naton
sows
s
Wc
o
te
key
ears.
or
Accessory
Vagus
E.
Gossoparyngea
ng
a
crana
nerve.
Wc
dicuty
ead
nerve
sows
s
cougng
a
most
tumor
key
and
afect-
afected?
A.
Mandbuar
B.
Maxary
o
C.
Gossoparyngea
patent
D.
Vagus
e
E.
Hypogossa
Pysca
A
7-year-od
ment
says
as
tympanc
any
made.
o
a
tympanc
o
A.
Coanae
B.
Interna
C.
Externa
D.
Audtory
E.
Paryngea
department
responsve
cecked
ntact
te
emergency
g
and
ever.
troat.
nlamed
and
o
oowng
or
depart-
he
transucent
vra
structures
necton
to
most
spread
tc
asked
necton
we
C.
T rgemna
D.
Faca
E.
Accessory
A
29-year-od
ow-up
ang
and
but
beedng.
ts
te
ttng
er
breatng.
Pysca
gt
o
to
te
relex?
test
emergency
ead.
here
examnaton
relex
oowng
s
s
no
sows
bateray.
nerves
he
a
con-
key
because
securty
te
but
exam-
tympanc
he
e
patent
as
yperacuss
nerve’s
o
per-
s
njury
some
made.
s
most
to
n
te
s
pyscan
rgt
precedng
n
an
an
and
o
nearby.
acoustc
te
rom
te
te
condton,
ake
meatus
resuts
area
s
te
because
Wen
externa
externa)
acoustc
coug
ear.
s
patent
nspected
rrtaton
externa
to
acous-
meatus?
V estbuococear
38.
brougt
he
nner vatng
Vagus
te
most
Pysca
wt
reguary
(otts
as
meatus.
o
sows
externa
specuum.
ner ve
notced
but
er
Wc
durng
woman
examnaton,
dsease.
s
te
B.
to
acks
ead
symptoms?
events
swmmng
key
meatus
woman
about
A.
ear)?
pan
examnaton
rodectomy.
wc
durng
a
te
pyscan
earng,
crana
comes
o
s
recess
o
s
man
stor y
mentons
wc
wt-
tube
ater
1-week
wt
he
paryngts
34-year-od
cougs
Pysca
parynx.
A
meatus
boy
meatus
pupary
o
ear
and
are
unresponsve
sgn
ntegrty
rgt
red
(mdde
acoustc
33-year-od
obvous
te
acoustc
te
o
dagnoss
patway
cavty
s
A
to
story
s
a
membranes
Wc
patent
brougt
n
sows
exudate.
provded
A
s
2-day
pan
examnaton
out
boy
because
e
37.
and
te
symptoms?
works
acoustc
tese
D.
as
te
s
o
not
examnaton
eye
o
estvas.
dagnoss
C.
aso
and
oowng
responsbe
te
He
troube
A
s
o
descrbes
n
Hypogossa
MRI
He
pro-
rngng
ave
Faca
patent
weeks.
depart-
gotten
externa
not
B.
An
ew
ave
tese
abnormates
A.
he
past
emergency
tat
no
te
vson.
te
te
MRI
Were
to
sound.
concerts
or
does
comes
to
pan as severe and as no story o trauma or canges to
swaowng.
n
to
eadaces
et
as
ssure
man
senstvty
e
An
s
because
patent
ssure
orbta
34-year-od
says
snusts
because
orbta
he
cana
membrane
snusts
70-year-od
A
recent
snusts
etmoda
C.
gressvey
brougt
tenderness
patent
A.
ment
s
sows
psatera
owng
A
man
sde.
causng
A.
55-year-od
pyscan
Pysca
adduct
eson.
eson
te
vson.
trauma.
to
et
ntracrana
o
to
doube
depart-
A
gottds
tat
aca
man
story
Prorm
recess
and
48-year-od
2-week
between te voca ods. Wat s te name o ts openng?
maxa.
34.
and
A.
and
33.
man
beng
saturaton
ated
32.
Head
22-year-od
ment
31.
7
Se
a
Se
says
as
te
te
dagnosed
he
A.
Interna
B.
Externa
C.
Recurrent
become
oowng
aryngea
aryngea
aryngea
A.
Optc
and
aca
D.
Superor
aryngea
B.
Optc
and
ocuomotor
E.
Gossoparyngea
te
as
pyscan
ater
wt
oarse
nerves
ntractabe
n
and
was
or
undergong
eaed
mprovement
operaton?
beng
to
weeks
wound
sgncant
voce
o
was
er
comes
two
we
er
as
and
o-
ty-
Graves
se
as
symptoms,
not
most
a
a
mproved.
key
njured
CHAPTER
39.
A
48-year-od
we
eye.
recenty
Pysca
tat
te
mm,
mm
s
a
man
rgt
respectvey;
and
6
eson
mm,
to
te
sometng
examnaton
patent’s
norma.
comes
notced
under
and
wen
et
te
ndngs
nvovng
wc
norma
pup
gts
respectvey.
hese
pyscan
strange
Hs
are
o
te
2
and
tey
n
key
s
rgt
sows
mm
of,
vson
most
s
gtng
are
are
because
wt
are
bot
Ocuomotor
B.
SCG
C.
Nervus
Ednger-Westpa
55-year-od
tomy
o
rgt-sded
and
o
41.
and
a
Corda
C.
Greater
D.
Lesser
E.
Nasocary
says
or
ater
et
scan
o
o
te
o
te
a
tat
te
e
te
Maxary
D.
Nasa
and
amy
or
by
or
a
patent
seeng
ose
Pterygod
B.
Superor
C.
Fronta
s
Faca
D.
Maxary
E.
Mandbuar
A
to
mastodts.
was
s
s
ora
A
te
o
to
treat
boy
eye,
was
and
key
ot-
mastodec-
te
deveops
examnaton
sows
droopng,
tere
vestbue.
most
emergency
perormed
mout
rgt
rgt
was
te
compcaton
Pysca
o
was
out
most
punced
o
s
et
sows
sot
a
(bow-out)
key
be
durng
45.
sunken
tssue.
ectopcay
n
eye.
A
o
sows
racture
ound
n
Anteror
Posteror
C.
Mdde
D.
Interna
E.
Posteror
ear
te
was
Wc
njured
e
ood
o
te
durng
te
eadace.
he
ypertenson.
n
te
te
nerve
emergency
A
CT
cerebra
oowng
depart-
patent
as
scan
o
artera
vesses
a
te
crce
does
not
communcatng
cerebra
woman
or
te
past
deveoped
te
ts
o
can
mastod
occurs,
troug
venous
te
to
3
ten
necton
necton
I
comes
te
md
se
an
between
ossa.
te
crce?
ntay
sku
o
to
carotd
sows
bone
and
nerve
trgemna
cerebra
yesterday
todts,
severe
trgemna
te
communcatng
pan
was
ead
a
aneurysm
45-year-od
and
wc
to
te
o
comes
Wc
B.
pan
postoned.
an
A.
A
o
smokng
Ws).
o
dvson
man
because
severe
CT
dvson
55-year-od
story
depart-
conscousness
neror
gobe
er
amy
tat
se
week
se
brougt
because
as
tat
seemed
ad
as
dp.
te
te
to
A
rom
venous
pexus
venous
ven
pexus
te
worsenng
case
ever,
sow
o
snus.
te
ace
and
examna-
eukocytoss
ead
A
sows
dagnoss
tromboss
most
to
ever.
snus-
tacycarda,
te
snus
o
better
Pysca
scan
cavernous
emergency
gotten
studes
s
te
severe
not
cavernous
optamc
o
a
wt
CT
oowng
necton
to
conused.
woman
Laboratory
urne
o
s
snus?
A.
n
cose
C.
oowng
wtn
o
to
Gossoparyngea
te
secondary
spread
corner
Vagus
na
etargc
Wc
a
a
postoperatvey,
B.
ment
passage?
emergency
examnaton
an
woud
te
edematous
et
woman
past
negatve
made.
acrma
spaces?
tacypnea.
sepss
44.
snus
by
trombus
o
a
days
or
a
ever.
says
A
ces
te
and
tn
te
necton
venous
s
most
o
In
ayer
o
spread
Wc
key
te
te
mas-
te
posteror
can
system.
te
worse,
scan
ces.
wt
tat
got
CT
mastod
erode
structures
pyscan
Se
progressvey
te
te
te
days.
cra-
nto
o
te
route
o
necton?
says
te
sows
a
tumor
snus
mornng
and
te
cavty
department
ton
a
te
nasa
o
ces
Spenoda
ts
by
at
rgt
snus
35-year-od
or
te
structures
C.
ts
not
sows
wt
oowng
he
Pysca
ead
to
dicuty
surrounded
Etmoda
a
dd
gt.
Fronta
Her
gt.
avng
became
ner ves
contrbute
brougt
brougt
parents
dects.
rgt
unabe
ead
s
s
A.
(o
street
s
B.
A
rom
er
er
Wc
compressed
o
tumor
notced
dry.
secreton
membrane
man
A.
E.
key
ee
wors-
petrosa
orbt
Orbta
rgt-sded
recenty
or
tympan
and
orbt
pyscan
petrosa
ater
He
a
gangon
petrosa
24-year-od
eye
te
constanty
most
mucous
Deep
te
as
decreased
B.
ment
42.
n
s
to
rom
Se
nostr
A.
A
sku.
nerves
resut
gand
eadaces
ven
was
myrngotomy
aca
te
357
Neck
surger y?
Gasseran)
comes
by
Fve
oowng
nuceus
woman
te
rgt
oowng
to
wt
severa
boy
wc
necton.
was
(semunar,
cronc
eye
meda
coecton
T rgemna
base
7-year-od
and
pexus
emssary
ts
ntermedus
E.
te
venous
2
nerve
D.
enng
A
tat
A.
A
Pareta
department
structures?
40.
Basar
E.
4
eyes
because
oowng
43.
D.
Head
7
drect
te
s
route
cavernous
46.
A.
Superor
B.
Ineror
sagtta
sagtta
C.
Stragt
D.
Cavernous
E.
Sgmod
A
snus
been
says
s
e
ood
a
oowng
A
comes
troube
doesn’t
catces
mout.
pressng
man
avng
tat
tmes
snus
snus
63-year-od
as
snus
snus
seem
mse
CT
nerve
scan
o
wtn
openngs
s
Foramen
ovae
B.
Foramen
rotundum
Interna
D.
Juguar
E.
Superor
acoustc
to
pyscan
rom
taste
s
te
rom
te
sows
ead
sku.
nerve
meatus
oramen
orbta
te
droong
te
te
A.
C.
to
earng
ssure
a
ear.
same
te
hroug
most
because
et
et
and
at
sde
o
tumor
wc
key
e
He
com-
o
passng?
te
358
C H A P T E R
47.
7
Head
and
Neck
A 70-year-od man comes to te pyscan or a scedued
bopsy
past
o
6
rettes
a
growt
monts.
day
or
e
he
40
as
ad
patent
years
and
on
as
ost
s
ower
smoked
9
kg
1
(20
p
or
pack
b)
o
over
te
cga-
te
ast
3 monts. A bopsy o s ower p sows a squamous ce
carcnoma.
wt
p
wc
48.
ymp
A.
Occpta
B.
Parotd
nodes
w
Retroparyngea
D.
Juguodgastrc
E.
Submenta
A
54-year-od
s
and
as
an
cavernous
most
afected
Ocuomotor
C.
Optamc
D.
Maxary
nerve
E.
T rocear
nerve
s
tetc
any
ng
a
A
artery
te
o
pan
•
examna-
o
aneurysm
o
te
nsde
nerves
examnaton
ead
trgemna
te
Wc
teet
to
te
pyscan
extracted
rom
2
bot
te
n
tat
ront
e
two-trds
was
patent
te
as
o
most
Aurcuotempora
B.
Corda
C.
Lngua
D.
Menta
E.
Ineror
s
ost
s
key
A.
notced
o
tat
tongue.
s
sense
tongue.
njured
e
weeks
sdes
dd
ater
o
not
Pysca
o
taste
Wc
durng
o
te
T rgemna
Gencuate
Superor
D.
Otc
pace
ave
to
pass
o
te
te
wc
te
B.
Subaracnod
C.
Subdura
procedure?
53.
pexus
Superor
sagtta
and
A
22-year-od
eye.
aveoar
are
Se
o
a
3-mont
reumatod
story
artrts
o
tat
ear
pan.
afects
er
Se
as
a
temporo-
dd
wtn
er
CSF ,
te
key
te
te
tumor.
damaged?
dranage
not
be
beng
o
te
abe
and
snus
CSF
keep
produced,
aow
oowng
superor
and
o
to
and
CSF
spaces?
space
cavernous
woman
ound
to
sown
key
n
Fg.
7.2.
responsbe
Wc
or
te
o
te
pan
oowng
sensaton?
sagtta
snus
snus
juguar
ven
space
s
brougt
to
be
te
Faca
C.
Nasocary
Aurcuotempora
D.
Ocuomotor
Lesser
V estbuococear
petrosa
E.
Corda
E.
54.
tympan
A
te
emergency
as
area
56-year-od
man
resecton
patent
durng
s
beow
admtted
te
notces
eatng
tan
base
tat
to
o
s
beore
te
s
ospta
sku.
mout
s
s
Ater
or
a
ea-
somewat
surgery.
An
MRI
he
Wc
aferent
eye
cornea
o
te
mb
o
and
er
vta
examnaton
movements
relex
s
are
tested
oowng
ts
sgns
sows
a
and
nerves
s
relex?
Optc
21-year-od
department
51–75
Pysca
extraocuar
norma.
or
B.
D.
conscousness
mts.
and
A.
C.
ose
uncanged.
Fronta
s
most
not
vson
and
Lacrma
te
o
may
subdura
subdura
norma
B.
drer
and
Epdura
A.
ng,
wt
most
CSF
two
space
space
E.
MRI
tumor
o
and
D.
responsbe
A
v
amount
between
mandbuar jont. he patent as no oter symptoms. An
Questions
s
o
durng
Gasseran)
overproducton
aracnod
oow-
ntact
s
nvovement
ganga
dvson
key
cervca
Corod
tat
scan
ts
most
department ater se was t by a soccer ba n er rgt
because
nerves
51.
case
wt
ment
o
o
(semunar,
A.
tympan
mandbuar
ydrocepay may resut. he aracnod v
exam-
rom
te
te
troug
s
te
Submandbuar
In
A 56-year-od woman s brougt to te emergency depart-
story
.
damaged,
oowng
B.
C.
tat
s
because
te
A.
E.
52.
o
sows
nerve
procedure
woud
rst?
comes
Fig.
mgranes
Pysca
oowng
te
epsodes
o
scan
rst?
because
tat
story
CT
te
nerve
man
of,
sows
nerves
says
ntermttent
ave
oterwse.
o
nvoved
pyscan
He
excson
metastasze,
nerve
wsdom
wore
anteror
be
to
Rgt ater te procedure wen te oca anes-
sensaton
naton
te
surgca
was
nerve
24-year-od
ad
wt
carotd
B.
ower jaw.
to
not
Wc
Abducens
e
key
eadaces.
eaty
A.
A
most
or
cancer
abnormates.
snus.
be
te
does
nterna
key
evauated
I
nature
He
no
s
comes
o
been
sows
sows
n
vson.
e
ton
man
story
trobbng
doube
50.
patent
C.
5-mont
49.
he
reconstructon.
stopped,
known
common
area
s
Wc
man
because
and
as
o
te
a
area
te
to
were
to
brougt
severe
patent
Kessebac
exposed
anastomoses
was
o
(or
s
ts
Ltte)
epstaxs
area?
te
pexus
orgnates
arteres
canges
most
emergency
he
oterwse
envronmenta
oowng
to
nosebeed.
beedng
stabe.
s
he
te
most
rom.
hs
and
key
trauma.
provde
CHAPTER
A.
Ascendng
B.
Posteror
paatne
C.
Latera
D.
Septa
E.
Descendng
superor
brances
and
ascendng
aveoar
o
and
posteror
paryngea
accessory
etmoda
te
menngea
and
mdde
o
te
spenopaatne
and
superor
be
paatne
and
tonsar
brances
o
te
paryngea
12-year-od
because
days.
Pysca
ts
6
As
tese
A.
Levator
B.
Paatogossus
C.
Styogossus
ts
ve
and
and
Paatoparyngeus
ar
tube
nserted
te
top
Under
by
o
te
wc
par
A.
Posteror
an
B.
Latera
ew
swoen
o
tons-
o
te
te
comes
mask
to
T rapezus
s
67-year-od
te
rgt
tat
and
hs
or
te
te
been
ensure
mask
s
te
keep
rma
te
as
most
D.
Hypogossa
to
It
o
E.
60.
s
arway
open.
20-year-od
not
te
crcoarytenods
A
CT
o
a
scan
o
any
te
patent
ange
te
ost
jaw.
key
Supracavcuar
E.
Crcotyrods
B.
T ransverse
C.
Great
D.
Greater
E.
Lesser
a
3-day
he
story
sweng
worse
ee
a
durng
sot,
o
s
a
panu
ocazed
meas.
tn
at
he
rdge
o
sweng
te
patent
tssue
o
rgt
says
aong
s
rgt
ower
tat
te
jaw
e
can
nsde
o
ceek.
and
s
aso
o
te
key
emergency
sweng
utrasound
wt
abscess.
and
Wc
exam-
yperecoc
he
cervca
recovery,
droop
abscess,
trange,
pysca
nabty
o
te
exam-
to
rase
oowng
njured?
brougt
n
61.
s
A
to
te
te
emergency
superor
regon
o
sows
tat
structures.
pysca
o
te
te
wound
Foowng
examnaton
rom
te
oowng
sows
skn
as
surgca
tat
over
nerves
s
te
most
njured?
cervca
aurcuar
occpta
occpta
2-year-od
tne
neck
sensaton
Wc
A.
arytenods
because
an
wound
te
wound,
as
hyroarytenods
pyscan
was
stab
o
T ransverse
te
An
posteror
ead.
been
major
D.
to
te
er
to
structure
Durng
man
wt
afected
repar
comes
most
Suprascapuar
A
mts.
opened
musces?
man
w
to
po-
s neck durng a bar gt. Vta sgns are wtn norma
crcoarytenods
32-year-od
order
erytematous
neck.
wt
o
key
C.
A
n
restore
cervcas
department
aganst
and
musces
brougt
souder
above
Faca
cuf.
s
and
Ansa
rests
gottds
rgt
C.
oxy-
er
mdde
B.
paced
o
surgcay.
sows
s
consstent
a
or
anastomosed
nerve
arynx
panu,
lud-ed
operat-
composed
cuf
s
te
draned
rgt
a
Accessory
proper
se-seang
unt
eps
as
In
n
a
sde
A.
pyscan
te
359
Neck
surgery?
woman
wt
sows
nerves
constrctors
o
s
and
Crcotyrod
A
er
te
arway
mout
and
Sternoyod
D.
naton
coecystectomy.
nlatabe
te
C.
cervcas
aryngea
oowng
te
Sternocedomastod
debrs
sapngoparyngeus
te
Patysma
naton
paatn
o
B.
on
oowng
musces
ater
department
anteror
ansa
A.
E.
59.
recommended.
ve
paryngea
condtons,
o
case
s
past
and
between
tensor
surgery.
gotts
norma
trd
Wc
anestesa
te
troug
te
rgt
recurrent
te
parayzed
ocated
and
and
aryngea
wt
or
ever
paatoparyngeus
woman
durng
s
ocated
mdde
contnuous
genaton
an
a
sows
pars.
aparoscopc
room,
dever
swaowng
depart-
styoparyngeus
Superor
35-year-od
emergency
tonsectomy
paatn
and
te
pars?
E.
A
a
to
was
are
D.
ng
boy
examnaton.
s
brougt
He
was
to
te
born
va
pyscan
or
spontaneous
a
rou-
vagna
ceek, runnng orward rom s rgt ower jaw toward
devery wc was compcated causng s ead posture
s
to
rgt
never
m
upper
et
tat
ng
s
tat
te
nlamed
58.
troube
examnaton
tonsar
orm
scedued
57.
brougt
tonss
posteror
musces
s
monts,
paatne
and
o
tonss.
wtn
he
56.
boy
ment
paatne
te
rgt
naton. Wc
brances
aba
A
te
rennervate
menngea
55.
surgery,
wt
Head
7
because
te
most
Faca
B.
Maxary
Parotd
D.
Margna
E.
Faca
he
norma
because
pyscan
and
t
as
necton. Wc
structure
se
s
as
reassures
just
o
e
become
te
oow-
branc
o
aca
sore
man
troat
he
comes
and
patent
cnoma.
A
surgca
tumor
successuy
s
to
te
pyscan
te
nerve
worsenng
ound
to
procedure
s
removed
or
oarseness
ave
a
te
or
aryngea
perormed,
rom
a
and
arynx.
per-
te
car-
te
Durng
s
s
A
cd
tted.
ed
cose
superory
dagnoss
o
s
on
started
consderng
medca
ng
was
musces
A.
Anteror
B.
Omoyod
a
to
s
te
tra
key
examnaton
rgt
et.
o
souder
No
neck
tortcos
pysca
management.
most
s
masses
are
made,
terapy
Wc
damaged
s
o
durng
sows
and
te
and
beore
oow-
brt?
scaene
Sternocedomastod
D.
T rapezus
A
Pysca
to
congenta
C.
E.
62.
ear
turned
vsbe.
eeng?
te
contnuousy
rgt
ace
duct
mandbuar
be
s
ven
year.
s
beore.
s
te
concerned
artery
43-year-od
past
o
key
s
artery
C.
sstent
He
structure
structure
A.
A
moars.
Patysma
35-year-od
department
son.
On
woman
ater
beng
arrva,
te
s
brougt
nvoved
patent
n
s
a
to
te
motor
emergency
vece
unconscous
co-
wt
an
360
C H A P T E R
upper
be
and
gand
Wc
present
Neck
obstructed
suctonng,
tyrod
arway.
to
Head
arway
vacuum
te
7
o
at
a
by
stmus
te
te
bood
mdne
s
o
mucus.
perormed
oowng
ste
and
traceostomy
vesses
ncson
to
are
and
Ater
A.
Rgt
gossoparyngea
to
B.
Rgt
ypogossa
er
C.
Let
ypogossa
D.
Let
ngua
E.
Let
vagus
neror
secure
most
w
key
need
to
be
cauterzed?
63.
66.
A.
Mdde
tyrod
ven
B.
Ineror
tyrod
artery
C.
Ineror
tyrod
ven
neror
and
and
neror
tyrod
tyrodea
ma
ven
se
artery
ment
because
o
a
arge
Pysca
examnaton
a
o
tumor
tumor
but
ectomy
te
te
because
s
cuty
ng
n
te
ts
was
at
most
center
Bopsy
arge
te
sze
neror
deveops
on
te
key
o
er
suggests
a
Wc
durng
Hypogossa
tyrod-
C.
Interna
D.
Lngua
E.
Recurrent
artery
as
was
d-
te
oow-
te
surgca
67.
A
arge
at
a
nucear
Ansa
cervcas
tumor
C.
Ansa
subcava
tomy
D.
Recurrent
aso
as
cuty
as
branc
because
been
and
monts.
tumor
oramen.
tures
s
o
to
atgue
o
CT
Invovement
most
key
Se
exam
te
o
as
te
wc
and
lud
oss
9
te
kg
o
te
Ansa
B.
Cervca
sympatetc
C.
Externa
aryngea
D.
Hypogossa
A
Vagus
hyroarytenod
D.
Arytenod
E.
Crcotyrod
68.
A
struc-
tumor.
artery
te
nerve
department
ater
eeng
dzzy
and
te
ang.
emergency
Recenty,
se
69.
mm
Hg,
naton
and
sows
undergong
n
bot
ectomy
are
carotd
an
s
nerves
carotd
perormed,
tat
was
er
asked
was
are
bruts
arterogram
common
removed.
sows
se
respratons
and
bood
18/mn.
tat
tongue
most
arge
devated
protrude
key
sows
arteres.
t.
njured
A
s
190/110
Pysca
bateray.
Postoperatvey,
to
pressure
he
90%
carotd
toward
Wc
endarter-
durng
te
paques
examnaton
te
o
s
occuson
ateroscerotc
pysca
exam-
patent
rgt
te
wen
o
oowng
aryngea
pyscan
neck.
says
as
he
tat
ump
parta
ours
a
o
does
swa-
bengn
tyrodec-
oowng
te
Wc
patent
o
te
denervated
a
works
dicuty
conrms
a
sows
cords.
because
patent
te
some
and
key
Externa
Ineror
D.
Interna
E.
Recurrent
A
a
ater
cd
tat
can
A.
o
branc
te
coud
oow-
durng
te
gr
s
as
key
te
a
to
a
ospta
tyrod
superor
andmark
nerve.
order
Wc
ts
o
n
externa
mgt
te
superor
ansa
te
aryngea
cervcas
superor
aryngea
te
membrane
been
te
Wc
taste
te
emergency
penc
o
wt
njury
te
or
te
nto
depart-
er
examnaton
meatus.
externa
ceck
n
a
Pysca
acoustc
ave
to
to
nsertng
pan.
nnervates
perormed
Ceck
to
te
artery?
a
ew
here
to
te
surace
oowng
njury
anteror
to
drops
s
te
tat
tym-
cnca
ts
te
sensaton
to
te
and
tests
nerve?
two-trds
parynx
o
concern
nerve
o
ear.
sows
o
tongue
B.
a
tyrod
n
accompany
or
gand
trunk
brougt
tympanc
membrane.
Ceck
o
te
aryngea
cryng
te
tere
be
o
te
to
remove
companon
most
branc
root
s
prncpay
panc
s
to
used
accdentay
ruptured
n
brougt
procedure,
sympatetc
3-year-od
bood
s
and
sma
nerves
C.
oowng
procedure?
ts
B.
he
100/mn,
voca
te
dented
Cervca
zness.
s
te
tat
od
paryngea
examnaton
woman
Durng
s
A.
ment
puse
He
e
tyrodectomy
damage
as been avng requent epsodes o eadaces and dz-
Her
sows
voca
s
er
crcoarytenod
46-year-od
n
nerve
to
o
and
aed
crcoarytenod
scedued
nerve
brougt
te
gand
most
C.
b)
trunk
s
to
T wenty-our
true
was
luds
oowng
woman
te
Posteror
cervcas
55-year-od
superor
examnaton
Latera
not
A.
but
perormed.
pysca
B.
juguar
ndngs
te
Wc
superor
pant.
tyrod
A.
turgor
oowng
tese
above
anteror
utrasound
di-
sku
te
comes
pan,
ntake
a
examnaton
recess
te
ower
power
musces
lud
patent
a
room,
operaton?
patent?
E.
s
man
s
te
abduct
ng
Se
(20
skn
sows
bend
o
or
oss.
aspratng
ost
ead
space
responsbe
emergency
eadaces
patent’s
sows
o
not
te
wegt
requenty
scan
occupyng
to
and
te
drnk.
Pysca
A
aryngea
brougt
recurrng
because
dyspaga.
base
s
Recenty,
attemptng
3
superor
avng
decreased
over
o
An
drnkng
he
or
recovery
njured?
o
o
pyscan
te
aryngea
any
o
surgery,
woman
swaowng.
wen
owng.
aryngea
65-year-od
department
aryngea
branc
n
cause
Interna
Externa
superor
mass
key
branc
38-year-od
B.
A
o
most
B.
oowng
Pysca
te
In
ungs.
anestetzed.
bengn
not
branc
was
was
er
prorm
Externa
A.
E.
65.
arynx
nerves
procedure?
64.
evauaton.
te
to
dicutes
nto
o
A.
and
o
avng
asprate
te
area
comes
tyrodectomy.
swaow
te
neck.
been
to
woman
parta
sow
a
parta
ours
tyrod
njured
depart-
utrasound
oarseness
exerton.
ven
emergency
T wenty-our
wc
patent
breatng
nerves
o
te
subsequent
gand.
perormed.
surgery,
gated,
mass
and
tyrod
to
as
noted
Crcotyrod
comes
tyrod
34-year-od
scedued
Let bracocepac ven and neror tyrod artery
woman
neror
artery
E.
34-year-od
and
tyrod
D.
A
artery
and
A
paate
te
CHAPTER
C.
Ceck
dbuar
70.
tere
s
parestesa
at
te
temporoman-
severa
jont
ng
D.
Ceck
or
sensaton
n
te
arynx
Wc
E.
Ceck
or
sensaton
n
te
nasa
to
A
27-year-od
department
wtout
neck
woman
ater
se
wearng
sows
a
a
s
brougt
was
I
to
trown
emet.
type
cavty
An
LeFort
te
rom
MRI
racture
a
o
patent
and
s
recoverng
up
examnaton,
ty
to
most
71.
underwent
oud
patent
Wc
Lngua
Ineror
C.
Bucca
D.
Menta
E.
Myoyod
ead
and
commnuted
te
surgery
subsequent
experences
o
g
oowng
74.
oow-
tng
s
e
pan
aways
ad
D.
Styoyod
temporomandbuar
E.
Crcotyrod
o
ng
ve
43-year-od
racture
sows
toms
n
A.
B.
to
to
dryness
gands
dryness
o
gand
Loss
o
Loss
o
o
o
a
38.9°C
CT
s
te
wt
scan
sku.
o
te
durng
mout
te
a
bat.
te
An
petrosa
MRI
nerve
sgns
o
depart-
o
as
a
o
o
te
mout
rom
te
rgt
cornea
because
parotd
A.
T emporas
B.
Meda
C.
Masseter
Latera
E.
Buccnator
o
62-year-od
patent
sa-
o
subn-
ack
o
sa-
because
o
most
ack
o
acr-
sensaton
rom
te
rgt
anteror
two-
tongue
o
sensaton
te
gr
ever
s
te
rgt
anteror
brougt
mdde
pexus
rgt
ear
to
emergency
ear
pan.
nectons.
puse
s
Se
Her
101/mn,
dtons
w
be
n
te
been
ound
ost,
Dmnsed
mucus
n
B.
Dmnsed
mucus
on
C.
Dmnsed
sava
D.
Dmnsed
sava
E.
A
and
subngua
Dmnsed
38-year-od
acute
toot
sweets
and
tear
pan.
department
as
a
story
Optc
C.
Abducens
D.
T rocear
E.
Fronta
Questions
76.
temperature
bood
te
nasa
te
sot
producton
cavty.
tat
te
pysca
A
e
te
been
pont
jaw
as
e
e
as
moves
o
be
to
grnd-
jaw.
artrts.
key
ead-
used
a
s
o
get-
were
constant
nlammaton
most
ts
because
as
o
An
te
Wc
afected
by
jont?
brougt
ne
Pysca
se
o
a
to
te
lgt
and
se
just
examnaton
attempts
sows
wc
or
no
o
ts
to
emergency
o
stars.
e
sows
ook
te
worsen-
downward.
ntracrana
process
oowng
patent’s
he
because
A
or
nerves
s
compant?
76–100
65-year-od
experencng
doube
pressure
Snce
pass
te
troug
oowng
examnaton?
e
vson
nose
paate
te
by
te
gand
submandbu-
comes
woman
seeng
a
to
by
te
te
denta
admts
dentst.
acrma
to
he
gand
cnc
eatng
a
dentst
wt
ot
o
ound
77.
s
and
o
te
patent
ook
Wc
or
patent
to
turn
nerve
e
s
s
most
Nasocary
Ocuomotor,
neror
D.
Ocuomotor,
superor
E.
T rocear
woman
he
been
to
e
on
as
as
to
not
examnaton
nward
ook
o
tat
gong
dpopa,
eye
says
patent
Pysca
key
and
wen
toward
nward
s
but
not
or
o-
nvoved?
dvson
dvson
comes
Se
as
because
He
wonderng
abe
C.
examnaton.
vson.
and
rgt
B.
44-year-od
pyscan
experences
s
down,
s
dzzness.
Abducens
ow-up
te
gasses.
A.
A
to
doube
ntermttent
he
eadaces
tat
comes
prescrpton
asked
down.
parotd
s
any
s
man
epsodes
monts.
sows
cavty
by
3
ad
con-
gands
producton
he
o
producton
woman
rarey
ear
bers
wc
durng
A.
ar
mdde
parasympatetc
ave
s
because
down
eeng
eson
Ocuomotor
cange
te
to
sows
acute
o
tat
gettng
wt
w
s
a
responsbe
B.
te
pregangonc
jont
ead
A.
or
pexus
a
wen
te
A
key
125/80 mm Hg. Pysca examnaton sows a eson n
tympanc
need
toot?
tongue
and
(102°F),
rom
s
wen
an
process
s
vson.
o
racture.
gand
teet.
dentst
pyscan
pan
examnaton
woman
se
dpopa
scan
te
ncreased
troube
sows
ater
says
doube
ng
te
tat
penetrat-
moar
pterygod
department
njury?
and
A
n
a
361
Neck
pterygod
D.
75.
to
and
musces
nlammatory
been
ack
o
oowng
ead
symp-
cares
sensaton
ead
te
examnaton
submandbuar
te
aso
nerve
because
brus-
sows
and/or
ts
te
Pysca
aca
ead
pysca
dagnoss
rom
emergency
aceraton,
oowng
te
o
ead
sku
greater
genera
recurrent
s
te
te
12-year-od
because
o
te
secreton
taste
o
A
to
Pysca
cckng
o
te
CT
secretons
two-trds
A
o
te
deep
dented
gua
trds
E.
be
conrm
Dryness
D.
base
secretons
ma
n
a
rgt
vary
vary
C.
te
Wc
Parta
brougt
t
sows
te
need
Parta
s
and
MRI
ematoma.
at
order
man
beng
tat
njured.
paatn
boxer.
as
propery
T ensor
a
a
he
eat
Stapedus
and
be
te
beng
woud
mandbuar
C.
ng,
dgastrc
He
worst
mandbuar
nerves
comes
o
B.
ater
o
worse.
aces.
man
story
cannot
te
and
aveoar
59-year-od
3-mont
senstv-
musces
A
treat
Posteror
A
bey
to
B.
reconstructve
te
anestetze
te
o
oowng
A.
parayzed?
examnaton
73.
te
Durng
te
wt
one
A.
ment
72.
we.
sounds.
key
extensve
o
emergency
racture o te mandbe and temporomandbuar jont.
he
cares,
afectng
motorcyce
te
and
denta
cavty
Head
7
s
to
te
beng
pyscan
treated
or
Raynaud
362
C H A P T E R
dsease
Head
and
systemc
regmen
tat
admnstered
s
occur
as
an
A.
Exoptamos
B.
Enoptamos
C.
Dry
D.
Wde
E.
Ptoss
A
and
open
and
MRI
nvovng
to
be
age.
ask
age
In
te
o
s
ead
7.3).
be
o
drug
te
o-
expected
to
drug?
80.
pup
eye
to
and
s
o
by
oss
o
dept
to
a
to
or
readng
Constrcted
B.
Dry
C.
Exoptamos
Pae,
E.
Sweaty
A
snus,
rgt
emergency
gand
A
te
rgt
te
nerve
compete
was
tumor
key
beore.
parayzed
orbta
papebra
C.
Levator
exam-
dam-
D.
Superor
obque
most
key
E.
Superor
tarsa
or
dam-
81.
C.
Downward
te
because
he
past
2
Down
and
out
pustues,
E.
Down
and
n
and
o
because
7.4).
Horner
ter
te
as
at
ospta
owng
ound
a
droopng
a
or
te
rgt
examnaton
he
age.
urter
amy
he
on
s
te
te
(ptoss)
o
s
sgns
anxous
story
o
sde
o
as
te
or
years.
and
ead
as
never
notced
er
musces
on
ap-
eyed
s
most
part
part
Müer)
te
ever,
drowsness,
awake
He
nodues
as
a
on
routes
be
and
not
story
te
o
rgt
snus
entry
o
severe
sows
around
sde.
A
te
or
menta
to
or
papues,
s
CT
nose
scan
o
Wc
cavernous
te
per-
acne
tromboss.
to
responsbe
atered
orented
examnaton
cavernous
key
but
predomnanty
edema
oowng
most
s
Pysca
sows
snus
necton
and
tromboss?
A.
Carotd
to
B.
Mastod
o-
C.
Mdde
D.
Superor
E.
Pareta
woud
te
superors
(o
tme.
perorbta
woud
strokes
admtted
Wc
rgt
depart-
cassca
very
patent
evauaton.
sgns
eyed
sows
moter
sgncant
young
addtona
n
a
syndrome.
amy
occurrng
o
Pysca
emergency
o
patent
pace,
D.
te
tat
andross
A 16-year-od boy s brougt to te emergency depart-
son,
(Fg.
papebrae
eadaces
ptoss?
ocu,
nerve
assess
er
ocu,
eye
ts
tat
emergency
o
sows
oowng
Orbcuars
Outward
ment
cause
potenta
to
sster
te
Orbcuars
ment
to
to
pyscan
eye
er
o
te
and
says
B.
nerve?
brougt
was
Se
A.
B.
s
It
ace.
moss,
nta
state.
boy
ptoss,
er
to
onset
examnaton
appears
Inward
9-year-od
o
brougt
sudden
Pysca
parta
sde
s
o
droopng. Wc
A.
A
woman
because
as
rgt
ace
ace
dzzness.
pened
tromboss.
conrmng
denty
er
te
abducens
to
w
banced
32-year-od
patent
pup
eye
D.
and
percepton
snus
ptutary
tumor.
turn
abducens
brougt
cavernous
te
drecton
patent
A.
department
accommodate
sows
he
conducted
te
dry
cavernous
(Fg.
wc
te
med-
te
sgns
compressed
naton
o
Her
bockng
Wc
key
dated
and
woman
te
te
dagnoss
and
doses.
most
efect
eyeds
erytematosus.
sympatetc
g
nabty
wt
o
n
a
moss
47-year-od
An
upus
w
adverse
eye
Neck
contans
condtons
department
79.
and
caton
owng
78.
7
be
patent?
82.
A
emssary
he
wak
emssary
man
ater
patent
on
artery
optamc
68-year-od
ness.
ven
menngea
department
to
artery
s
a
ven
ven
s
brougt
sudden
as
own.
onset
dicuty
A
CT
to
o
te
speakng
scan
o
emergency
one-sded
te
and
ead
s
weak-
unabe
sows
an
acute cerebra vascuar accdent n te anteror neror
•
Fig.
.
•
Fig.
.
CHAPTER
cerebear
te
te
at
ts
oowng
afected
A.
83.
artery,
artery
by
Optc
nerves
te
Ocuomotor
T rocear
T rgemna
E.
Abducens
s
5-year-od
by
s
to
It
s
reeve
te
he
o
patent
mmedatey
up
s
te
n
to
te
or
anteror
and
and
best
et
pan.
meda
te
ocaton
and
to
make
he
o
te
superor
quadrant
o
87.
mem-
D.
he
A
anteror
panc
o
te
ste
neror
o
te
o
openng
o
rm
o’cock
84.
A
ncson
crana
te
patent
s
owng
o
ossa.
s
pars
te
comes
an
te
Durng
to
12
uvua
ead
to
te
te
o’cock
pyscan
tumor
pysca
to
n
tym-
te
poston
to
te
by
6
rm
protrude
musces
made
membrane
extradura
devates
o
be
tympanc
o
asked
tongue
rom
te
man
dagnoss
ror
out,
o
poston
56-year-od
recent
soud
te
because
n
te
examnaton,
s
tongue
rgt. Wc
and/or
nerves
are
o
poste-
wen
stragt
o
te
most
o-
85.
Rgt
B.
Let
C.
Rgt
yogossus
D.
Rgt
genoyod
E.
Contraatera
A
6
ypogossa
ypogossa
62-year-od
rst
tme
or
monts.
o
poor
ous
o
He
says
te
and
and
et
and
cervca
to
te
worsenng
as
Rgt
D.
Let
a
dagnoss
oowng
secreted
by
spaces
te
o
or
drvng
sows
sows
a
receves
epteum
A
o
and
Hs
n
we
te
aque-
cary
et
o
te
pa-
par yngea
CT
key
te
wa
wa
scan
cana.
or
exam-
depressor,
o
Gven
examnaton,
most
past
asted
par yngea
A
juguar
brougt
a
be
te
sweng
neary
ower
tat
week
worse
jaw
e
been
s
te
te
wc
key
n
o
afected
emergency
te
totay
e
day.
examna-
loor
o
occuded
upper
ad
and
tat
te
Pysca
and
just
ago
snce
most
to
dyspnea.
wt
s
says
extracted
one
ad
neck
o
been
Wc
s
s
o
s
ar-
aso
ower
eeng
te
o-
dagnoss?
Qunsy
paatnus
D.
Ranua
E.
Ludwg
angna
5-year-od
parents
Her
gr
because
moter
s
s
o
brougt
ever
and
concerned
to
te
coug
se
pyscan
or
may
be
te
ast
avng
by
2
er
days.
troube
breatng and says tat te patent may ave decreased
Anteror
B.
Posteror
C.
Pup
troug
D.
Vtreous
key
E.
Lacrma
camber
camber
sac
17-year-od
ued
parynx
w
s
sgncant
sweng
A.
A
a
T orus
te
ave
sde
et
smar.
te
severe
Ankyogossa
A
n
man
wt
C.
89.
te
s
t
av-
te
Pysca
tongue
te
dzzness
been
or
tme
rgt
and
as
dzzness
a
emergency
o
vagus
because
made.
sur-
mandbuar
B.
s
te
te
se
vomt.
pysca
ner ves
A.
ntra-
to
Wen
er
to
rst
wt
et
tumor
te
mted
te
wen
te
past
g
gaucoma
rst
or
te
ypogossa
sows
owng
te
o-
gossoparyngea
progressvey
nerves
as
te
gossoparyngea
Rgt
moars
pyscan
examnaton
a
45-year-od
noted.
body?
86.
C.
way.
nerve
vson
dicuty
ed. T onometry
and
genogossus
genogossus
ypogossa
comes
e
rgt
et
styogossus
rst
and
Pysca
vsua
umor
and
vagus
man
pressure,
Wc
nerve
nerve
graduay
vson.
perpera
ocuar
Let
mout
A.
ssues
se
tumor?
B.
ton
njured?
o
durng
bout
says
and
er
response
oowng
Rgt
A
to
rom
department
key
Wc
brougt
was
touced
upward.
te
sows
te
ts
tat
s
devates
A.
E.
88.
any
surgery,
njured
sudden
patent
caused
sows
wa
s
o
eadaces
wc
naton
tympanc
he
However,
touced,
te
woman
because
recurrent
year.
tympanc
key
ear.
he
oow-
tympan
vomtng.
ng
umbo
quadrant
most
er
ad
a
petrosa
49-year-od
ndngs
membrane,
te
A
contracts
troug
vertca
Vagus
and
membrane
E.
Lesser
C.
department
tympanc
te
was
n
not
te
or
Aurcuotempora
B.
ours
quadrant
pan
as
ater
363
Neck
compcaton.
week
snce
and
procedure?
r yngea
posteror
Drecty
experencng
Gossoparyngea
membrane
C.
been
a
patent
owever,
Corda
dranage?
superor
tonss,
E.
Wc
an
he
er
wtout
cnc
D.
membrane
B.
appontment.
nerves
done
te
ts
membrane
lud.
to
he
exam-
tympanc
tympanc
dran
depart-
Otoscopc
nlamed
te
ear
otts
monts.
ncse
pressure
s
6
emergency
o
recurrent
bugng
decded
te
because
o
epsode
to
was
returns
wt
A.
brougt
story
a
procedure
owng
nerve
(myrngotomy)
he
be
o
gca
parents
a
oowng
A.
key
Wc
nerve
s
ad
sows
brane.
most
emorrage
trunk.
nerve
boy
ourt
naton
sma
man
nerve
D.
patent
w
a
te
nerve
C.
ment
n
rom
emorrage?
B.
A
resutng
orgn
Head
7
gr
earng.
Pysca
ear
a
te
comes
tonsectomy
to
te
because
o
pyscan
recurrent
or
a
wt
te
drect
upper
examnaton
goden-brown
tympanc
route
or
respratory
sced-
A.
Audtory
nectons.
B.
Coanae
tube
lud
sows
tat
membrane.
te
spread
tract
to
te
a
can
tender
be
Wc
o
an
te
most
necton
rom
mdde
s
rgt
observed
ear
cavty?
364
C H A P T E R
90.
7
Head
C.
Nostrs
D.
Faca
E.
Interna
A
94.
pan
tey
rst
wtout
ntense
tory
a
o
mass
started,
n
Ineror
D.
Nasoparynx
E.
Spenoetmoda
o
te
most
A.
key
to
Cavernous
Fronta
Maxary
oow-up
o
te
n
te
team
repar.
access
D.
Superor
E.
Uvua
te
to
a
recent
artery,
cavty
routes
crana
s
s
te
nerves
pan.
an
s
brougt
ater
a
te
sensory
was
most
te
A
ear
A.
wtout
Second
hrd
D.
Fourt
E.
Sxt
A
sows
absence
posteror
porton
key
part
o
o
o
te
wc
o
te
burnt
or
s
te
stngng
Ineror
C.
Lngua
D.
Greater
E.
Lesser
Gossoparyngea
C.
Mandbuar
scedued
D.
Maxary
gand
E.
Hypogossa
says
56-year-od
scedued
woman
tota
comes
tyrodectomy
to
te
pyscan
because
o
a
or
arge
a
A
as
ost
sa,
owng
to
experence
oarseness
tat
asted
or
te
te
te
abty
te
adducted
rgt
s
most
voca
key
to
be
od?
A.
Aryepgottc
B.
Posteror
C.
hyroarytenod
e
D.
T ransverse
boy
E.
V ocas
crcoarytenod
arytenods
98.
A
s
te
patent
to
wc
te
md-
embryonc
nerves
to
was
not
pyscan
1
te
day.
mout
o
te
wt
he
wen
burnt
e
was
parts
ate
o
te
caused
oowng
o
a
patent
wc
nnervaton
te
nerves
tat
pyscan
because
o
postoperatvey,
se
sows
te
key
s
area?
tat
Wc
o
o
a
patent
or
te
or
tyrod
te
eatng
presence
vestbue.
drnk-
patent
oregn
te
o-
njured?
superor
o
superor
aryngea
aryngea
nerve
nerve
nerve
nerve
aryngea
boy
to
to
wen
detect
o
branc
ound
dd
pyscan
or
rus
s
comes
most
branc
1-year-od
was
te
aveoar
aryngea
Recurrent
te
musces
o
examnaton
Hypogossa
or
oowng
a
tat
cokes
E.
responsbe
te
n
monts
oten
D.
o
boy
because
paryngts.
spread
o
tyrodectomy
Gossoparyngea
wc
trauma
and
severe
may
Wc
woman
parta
C.
to
Surgca
he
paatne
Externa
sde.
o
paatne
Interna
rgt
structures
dranage
tonss.
postve
to
sensory
B.
te
te
ear
tumor.
aveoar
se
n
roo
A.
on
postnasa
swaowng
wt
mout
beeves
adducted
od
was
dervatve
s
3 weeks. Subsequent examnaton sows a permanenty
voca
swoen
comes
n
superor
Pysca
objects
started
test
yesterday
cancer. T wo
tat
rod gand tumor. Ater se recovered rom te aneste-
se
monts.
mdde
oowng
dicuty
te
man
or
32-year-od
ng.
ty-
a
3
as
and
musce
and
sensaton.
Posteror
B.
A
97.
te
nasoparynx
He
responsbe
B.
njured?
sows
ast
te
nose
pouc?
scratced
tongue
Faca
te
n
compromse
dagnosed
aong
toast
A.
o-
ever
strep
te
cass.
gag
te
o
to
avng
sensaton
ate
s
o
25-year-od
toast
compca-
wc
or
lud
s
ear,
e
Frst
C.
tonsectomy.
any
n
B.
a
ead
troug
tat
tons
s
cavty
cosen.
or
te
constrctor
rapd
surgeon
pyscan
scedued
perormed
wen
to
oss
sows
says
because
one
tons
and
paryngea
cavty?
wegt
key
subsequenty
de
approac
patent
n
tons
because
Inecton
rup-
he
pyscan
earng
A 10-year-od boy s brougt to te emergency depart-
s
cose
o
recommended
anteror
nasa
te
or
te
tube?
Paryngea
te
96.
week
he
audtory
C.
rsk
as
o
Paatne
o
o
most
Lngua
basar
te
scan
B.
o
An
oowng
examnaton
et
be
stngng
was
Pysca
CT
to
dicuty
breatng
examnaton
A.
snus
1
unexpaned
sows
atus
pyscan
Because
troug
te
te
dicuty
oowng
o
to
surgery
gr
vst
surgery
depressed.
A.
te
te
snus
10-year-od
owng
bock
ead
te
snus
Spenoda
on
te
o
s-
snus
E.
s
o
or
woud
comes
pan,
nosebeeds.
Hypertropy
pate
D.
relex
trauma
away
more
recess
comes
gan
C.
tons.
scan
wc
went
cavty.
ment
snus.
turcca
wc
Crbrorm
he
no
Wen
become
ad
Pysca
95.
aneurysm
B.
A
In
year.
and
ave
as
CT
aneurysm
vascuar
sea
hroug
past
e
avng
man
ear
recurrng
atgued
man
an
endovascuar
to
He
and
meatus
cavernous
te
cavty.
nosebeeds
meatus
54-year-od
eadace,
been
meatus
Mdde
ture,
te
tey
emergency
nasa
occasona
carcnoma
Superor
te
A
s
or
Patent
cavty.
te
n
te
recurrng
atey
nose.
C.
A
were
but
B.
to
93.
s
pan
to
snus?
dagnoss
92.
tey
nasa
woud
maxary
91.
s
brougt
cavty
requent.
pckng
45-year-od
and
avng
nasa
treatment,
ocatons
A.
been
s
and
s
severe
as
wtn
meatus
man
or
e
A
o
acoustc
department
tat
Neck
cana
54-year-od
says
and
s
ave
ave
reerred
nerve
brougt
an
any
m
to
te
probems
or
pyscan
ankyogossa
possbe
wt
at
because
brt.
eedng.
surgery
he
he
because
s
CHAPTER
congenta
o
te
abnormaty
oowng
approprate
99.
or
A.
Remova
B.
Resecton
C.
Cuttng
Repar
E.
Remova
o
te
o
boy
mastod
ad
ar
antbotcs,
perormed.
tat
te
upward
eye.
Sava
drbbe
was
to
A.
ace
key
B.
Parotd
C.
Vagus
e
te
o
damaged
te
te
mastod
dd
mastod
Hs
unabe
s
n
durng
to
s
te
o
a
not
artera
cose
rgt
D.
Basar
E.
Superor
103.
rgt
te
and
operaton?
to
duct
as
te
A.
nerve
o
te
Frey
Be
D.
Qunsy
E.
Pancoast
on
worse
ora
or
te
cavty
and
s
ng
musces
Orbcuars
D.
Levator
E.
Orbcuars
Questions
A
symptoms
he
sava
rom
Be
most
te
te
was
persstenty
patent
pysca
n
pasy.
key
patent
te
examnaton
vestbue
corner
o
s
Wc
o
te
o
papebrae
anopa).
An
tures
superors
because
o
vson
MRI
key
o
s
brougt
o
dicutes
sows
n
to
a
bot
te
oss
ead
Wc
o
compressed
te
D.
Nuceus
E.
SCG
baseba
eyed.
o
rom
Wc
nerve
A.
Orbta
Optc
casm
B.
Lamna
C.
Optc
tract
C.
Orbta
pate
D.
Crbrorm
E.
Greater
stars.
he
brusng
o
nerve
patent
er
as
arms
a
brougt
down
a
contuson
and
egs.
to
te
lgt
on
emergency
o
er
Pysca
te
bodes
n
he
o
te
musce
o
te
evator
ces
supped
oowng
tese
a
dator
bers
o
are
o
(atera
te
and
orn)
to
te
rgt
o
by
struc-
bers?
C1
to
C4
wt
examnaton
turn
s
possbe
oowng
emergency
eye
dscooraton
not
ndcatng
te
concrete
ead
wt
examnaton
106.
A
s
57-year-od
n
o
o
an
ronta
o
man
te
te
o
bones
o
te
pup
ba
rgt
ateray
musce
was
a
sows
entrap-
most
key
s
o
etmod
spenod
bone
bone
bone
brougt
dzzness
examnaton
abducted
bone
etmod
maxa
te
te
because
Pysca
xed
te
pate
wng
department
ace.
o
surace
Ocuomotor
s
body
o
because
ce
part
smoot
Pysca
coud
papyracea
Abducens
ang
cnc
vson.
brougt
t
practce.
o
E.
woman
ce
s
beng
gaze,
D.
ater
pa-
Wc
ractured?
Optc
45-year-od
torax.
cear
to
dagnoss?
te
te
nuceus
sweng
orward
B.
department
Cardac
are
gangon
patent
A.
A
eye.
ungs
tenderness
musce
Wc
man
ater
consderabe
tumor?
says
examna-
sotarus
em-
ment.
rgt
exces-
amy
gangon
22-year-od
he
to
cary
nerve
Gencuate
aves
te
emergency
been
he
rgt
Müer,
and
bers.
te
C.
durng
structures
as
and
s
wt
(o
te
Intermedoatera
s
tumor
o
Pterygopaatne
atera
a
nerve
nerve
Pysca
te
key
smoot
B.
department
oowng
te
nerve
contans
emergency
vson.
te
A.
A
o
upper
comes
musce
vesses
(btempora
sows
te
by
wt
o
eyes
te
most
nerve
te
tmes.
here
dicutes
superors),
bood
eferent
parayzed?
105.
adenoypopyss.
most
te
man
and
tarsa
papebrae
oow-
at
to
wegt.
most
s
tumor
musce,
superor
mout.
arteres
com-
tento-
dsease
32-year-od
pupae
s
ors
man
A
eadace
major
examnaton
eds
104.
underwent
101–125
Pysca
was
days.
he
ocu
32-year-od
department
o
wt
was
Buccnator
o
drbbe
Zygomatcus
C.
7
s
Postoperatvey,
dagnosed
B.
necton.
but
next
accumuaton
He
A.
ear
antbotcs,
mastodectomy.
sows
an
te
te
nerve
se
murmurs,
te
to
syndrome
ment
o
s
n
cerebra
beng
pasy
An 8-year-od boy s brougt to te emergency depart-
because
cest
A
and
ead
nerve
because
moss
no
te
(PCA)/optamc
brougt
bateray.
oowng
C.
s
gaze.
nerve?
artery/trocear
osng
and
sows
Raynaud
B.
artery
amy
been
ptoss
neror
oowng
unresponsve
auscutaton
o
nerve
er
nerve
artery/ocuomotor
woman
and
sows
paton
te
a
assocated
cerebear
examnaton
nerve
Faca
tred
patent
ton
structure
o
o
365
Neck
meda
ractures.
sow
artery/optamc
by
or
and
eadaces
scan
artery/abducens
cerebra
72-year-od
svey
CT
aneurysm
te
cerebra
department
drawn
s
A
MRI
Wc
carotd
A
avng
beedng
an
compressng
Posteror
nerve
Gossoparyngea
cerebe.
C.
ceek
Wat
an
week,
notced
s
by
downward
been
recenty.
pressed
Mdde
was
se’s
and
Interna
and
patent’s
ntracrana
B.
respond
was
no
A.
antrum
t
probems
rgt
te
o
admts
arterograpy
key
emergency
o
mout
mout.
bone
operaton
operaton,
s
yod
course
patent
accumuate
corner
E.
got
102.
te
o
to
antbotc
to
weakness
patent
sows
bateray
necton
dstorted.
D.
started
101.
severe
radca
and
to
Mandbuar
rape
amuus
segment
he
a
s
et,
te
he
vson
brougt
a
te
ces.
tends
rom
most
s
o
Foowng
te
sows
most
rum
spread
and
boy’s
Wc
be
renuum
centra
Wtn
to
speec.
woud
paate
te
mdde
necton
pterygod
ngua
because
te
100.
te
8-year-od
te
s
condton?
department
ear.
afect
procedures
pterygomandbuar
o
te
D.
An
ts
o
may
surgca
Head
7
sows
poston,
to
te
and
te
a
emergency
severe
patent’s
sgty
ead-
eyeba
depressed,
366
C H A P T E R
te
7
pup
te
Head
s
dated
patent
nose,
te
relexes
tumor
s
oowng
nerves
A.
T rocear
B.
Ocuomotor
C.
Abducens
s
Optamc
Superor
e
man
s
te
ater
ace
o
on
te
oowng
durng
te
Entrapment
C.
Hyperacuss
D.
Tnntus
a
made.
te
cornea
sows
Wc
o
o
sort
nerve
A.
s
brougt
rom
A
as
CT
a
e
was
scan
pate
w
to
tree.
Ineror
Aurcuotempora
tvey,
ace
o
te
ang
te
(Fg.
most
emergency
patent
but
ead
7.5).
key
as
Wc
be
bate
no
te
te
opens
te
he
sde
o
neede
patent
comes
prousey
o
came
Frey
to
er
bopsy
te
ace
to
wen
te
se
syndrome
or
2
conrmed
undergoes
hree
cnc
tumor
monts
pyscan
tastes
or
(gustatory
Posteror
Arytenods
because
smes
er
sweatng)
hyroarytenods
Latera
An
ever
and
tonss
bout
o
a
wt
rsks
moter
durng
arteres
B.
Faca
C.
Lngua
Descendng
E.
Superor
55-year-od
open
event
need
order
oowng
wen
sensory
panc
A.
o
n
1
te
to
to
pars
te
tat
ntu-
prevent
o
musce
he
o
te
te
wt
s
a
sev-
rec-
dscusses
parents.
sgncant
bood
o
sows
patent’s
s
Wc
te
because
pyscan
pyscan
tere
most
s
and
surgery
oice
examnaton
hs
year
procedure.
o
to
te
te
te
he
rsk
o
oow-
tonss?
paatne
s
e
s
was
severe
tympanc
suddeny
patent
te
brougt
o
examnaton
te
Wc
asks
te
to
Pysca
te
man
pck
as
brougt
exudate.
because
punctured
te
arad
oowng
nnervaton
o
to
nerves
te
te
pan.
started
sows
was
to
ear
by
ear
s
a
t
accden-
wt
st
out
o
ear
nose.
n
s
mse.
responsbe
surace
an
oud
pck
pu
nner
emergency
He
membrane
or
te
te
tym-
membrane?
Gossoparyngea
B.
Aurcuar
branc
o
aca
C.
Aurcuar
branc
o
vagus
D.
Great
E.
Lngua
aurcuar
45-year-od
ment
10
years
gt
and
te
nerve
man
because
dagnosed
to
te
a
s
tyrod
tay
A
be
n
e
osng
bateray.
tat
n
o
paryngea
D.
ear
o
suppes
Ascendng
A
s
troat.
tonsts
beedng
Pysca
.
te
tonsectomy.
and
department
Fig.
boy
sore
patent’s
A.
112.
may
arway
rsk
njured
tat
batera
crcoarytenods
11-year-od
ng
s
o
a
musces
tere
te
s
s
a
process,
crcoarytenods
E.
benets
ood.
open
D.
ommends
resecton
key
Crcotyrods
ent
postopera-
o
normed
esoned,
undergo
tere
nerve
par
s
to
consentng
surgery
a
Wc
C.
parotd
most
arway?
B.
111.
•
are
A.
monts.
te
partcuar
patent
o
because
a
a
surgcay
te
scedued
durng
present
110.
patent
dagnoss
he
nerves
or
s
Durng
contros
aspyxaton.
a
eyeba
woman
nerve
bot
says
sows
man
tat
arway
hs
examnaton?
compcatons.
sweats
54-year-od
enarged
on
tumor.
wtout
Lngua
te
te
was
aveoar
tyrodectomy.
Deaness
gand
Faca
E.
a
45-year-od
sweng
D.
A
nerves
Bucca
C.
nerve
he
oowng
procedure?
te
pexus
and
te
te
B.
normed
nerve
o
durng
a
artery
cary
Wc
njured
afected?
ocuomotor
branc
Utrasound-guded
A
and
o
ang
pysca
Anosma
o
ead
ssure.
optamc
crbrorm
B.
E.
te
sympatetc
condtons
A.
A
Consensua
o
Wen
toward
arway.
conscousness.
racture
108.
nerve
dvson
57-year-od
o
droopy.
109.
and
te
nerve
t
orbta
s
pup
nerve
nasocary
oss
scan
key
d
te
meday.
CT
most
nerve
E.
department
upper
move
nerve
D.
A
A
superor
accompanyng
107.
te
to
rotates
norma.
te
Neck
and
asked
pup
are
n
and
o
wt
ago.
comes
trgemna
Pysca
touc
upper
o
p.
nvoved
by
to
te
excrucatng
te
A
emergency
aca
neuraga
examnaton
skn
between
treatment
njectng
(tc
te
s
nto
depart-
He
was
dououreux)
sows
opton
acoo
pan.
tenderness
ower
to
eyed
eson
t.
T o
te
reac
CHAPTER
te
nerve,
nserted
113.
te
o
most
te
key
oowng
need
to
be
over
openngs?
tracea.
key
Wc
o
te
oowng
vesses
was
cut?
Foramen
ovae
A.
Ineror
Foramen
spnosum
B.
Crcotyrod branc o te superor tyrod artery
C.
Inraorbta
C.
hyrodea
D.
Mandbuar
D.
Mdde
tyrod
E.
Foramen
E.
Juguar
arc
A
wegt
s
a
to
ods
to
o
pass
ost
te
nerves
s
Interna
key
branc
Externa
Gossoparyngea
D.
Hypogossa
E.
Recurrent
o
man
te
s
area
te
o
regarded
A.
Loose,
B.
Skn
C.
Gaea
as
te
areoar
department
pressure
s
to
no
sgns
te
Wc
o
a
emergency
e
oss
are
sows
o
te
wen
spped
o
he
o
tat
spreadng
oowng
to
118.
ayers
D.
A
E.
he
A
zone”?
and
are
a
pressure
te
a
o
a
20/mn.
cest
T o
x-ray
Hg,
An
te
ocated
border
o
te
o
te
no
to
emergency
sows
atra
te
cartage
s
to
br-
o
o
te
A.
by
te
B.
C.
Let
snus
D.
Rgt
Carotd
body
E.
Let
C.
hyrod
D.
Paratyrod
E.
Ineror
department
ng.
On
open
gency
ater
arrva,
ractured
an
gand
jaw,
tba
ang
te
broken
suddeny
s
rom
patent
racture.
traceotomy
beedng
119.
teet,
T o
a
s
perormed
rom
te
emergency
tree-story
scafod-
unconscous
aca
secure
occurred
to
an
aceratons,
arway,
were
te
wt
an
brsk
mdne
a
and
emer-
artera
ncson
key
was
perormed
n
te
CSF .
dagnoss?
torn,
wt
to
burstng
anteror
as
gand
a
resutng
njury
to
te
(o
te
e
o
a
pre-exst-
communcatng
trombus
to
cancer.
by
way
Batson).
o
he
a
and
rom
te
o
oow-
MRI
te
exam-
pevs
to
verte-
examnaton
ower
wen
patent’s
to
ago
nterna
Pysca
droops
because
story
years
CT
weakness
attempts
ospta
as
2
spread
souder
et.
te
He
tumor
as
ossa
nerves
rgt
are
most
accessory,
ypogossa
tan
te
tongue
protrude
t
te
patent
ponts
rom
s
key
and
afected?
rgt
ypogossa
A
eye
and
ter
and
et
trgemna,
and
rgt
ypogossa
accessory,
boy
or
an
s
rgt
brougt
rrtabty
examnaton
and
sows
optamoogst
evauaton.
te
es
n
An
te
oowng
o
te
gos-
nerves
accessory,
MRI
te
to
nant
consut
sows
te
and
emergency
nconsoabe
a
s
as
a
eson
at
pterygopaatne
structures
pregangonc
contans
axons?
gangon.
te
cryng.
dry
caed
ce bodes o te pregangonc axons o te
termnate
et
nerves
3-mont-od
Pysca
nerves
rgt
nerves
accessory
department
brougt
ntracrana
crce
consderabe
wen
te
brougt
cancer
rgt
aca,
vagus
was
an
aso
bood
pteron
eadaces.
ypogossa,
Carotd
man
n
prostate
pexus
te
vagus,
et
B.
59-year-od
most
noted
weeks
torn
s
crana
soparyngea
gangon
was
s
severa
Let accessory, rgt gossoparyngea, rgt vagus,
A.
A
o
te
oowng
and
te
gand
sows
or
equbrum
nerves
massage?
cervca
o
wound
game
artery
te
snus
and
ead
Rgt
massaged.
targeted
s
prostate
s
rgt
a
court
examnaton
mout. here are no oter sgncant ndngs. Wc
border
eve
s
s
te
te
te
cerebra
man
sow
tere
turns
and
pressure,
anteror
at
bood
a
tat
n
o
ven
pan
venous
et,
cardopumo-
bood
te
structures
Her
115/mn,
acute
musce
tyrod
oowng
s
patent’s
deep
sternocedomastod
superor
te
eadace.
puse
ECG
sows
reduce
pont
severe
mm
to
te
dagnoss
sows
n
vens
emergency
basketba
ack
necton
resuted
cavernous
posteror
bra
comes
o
o
te
3-cm
ead
s
juguar
te
Pysca
puncture
o
racture
cerebra
remova
te
menngea
aneurysm
back
to
vascuature
63-year-od
o
trunk
ematoma
njury
artery
norma
ematoma
te
he
ng
conscous-
wtn
scap,
C.
ng
woman
a
on
A
njury
o
sgns
mdde
s
an
oowng
epdura
anteror
demonstrates
umbar
no
te
here
and
ayer
because
events.
Wc
A.
ayer
190/100
respratons
te
nerve
aponeurotca
45-year-od
o
Wc
te
brougt
dzzness.
scan
A
sowed
natons
Percranum
a
as
zone”
CT
adjacent
ead
vta
“danger
Subcutaneous
nary
s
He
eyeds.
E.
aton
nerve
aryngea
A
s
mparment.
rom
ematoma.
tyrocervca
ven
coapsng
patent
scap
earer.
oowng
n
examnaton
D.
A
aryngea
brougt
Hs
“danger
te
aspra-
te
s
nerve
s
pavement.
n
te
on
tat
superor
ttng
drowsness.
Pysca
causng
o
severe
memory
o
artery
man
ater
o
branc
connectng
because
and
voca
ma
department
B.
e
ormed
te
tyrod
21-year-od
sows
as
nerve
ater
mts.
patent
patent
rom
s
to
A
nerve
aryngea
55-year-od
wet
te
he
arynx
Se
scedued
surgery,
arynx,
superor
department
or
s
117.
njured?
C.
on
because
ntoerance.
and
test.
te
te
pyscan
arway. Wc
o
branc
o
nto
te
B.
ness
eat
swaow
sensaton
nto
most
and
te
Foowng
er
entrance
quds
to
ypertyrodsm
tyrodectomy.
key
A
comes
darrea,
wt
most
A.
oramen
woman
oss,
unabe
ton
oramen
magnum
32-year-od
ave
116.
te
most
367
Neck
B.
dagnosed
115.
w
wc
and
A.
o
114.
neede
troug
Head
7
rgt
or
te
ur-
neura
bers
tat
Wc
neura
ce
o
bod-
368
C H A P T E R
120.
7
Head
A.
SCG
B.
Ednger-Westpa
C.
Superor
D.
Ineror
E.
Nuceus
A
te
s
as
rgt
38°C
savatory
says
a
woman
as
because
o
te
age
o
s
te
oowng
A.
sent
to
A
C.
Superor
D.
Ascendng
E.
branc
Descendng
severe
o
he
or
may
bran.
key
A.
ror
n
acne.
ocazed
mm
s
procedure,
rsk
o
and
te
cary
A.
he
dran-
124.
njury?
examnaton
on
te
wc
to
sows
er
warned
sweng
can
not
to
w
to
optamc
to
ven,
a
Dorsa
Faca
gea
E.
nasa
122.
A
ven
ven
eye.
to
to
because
he
ookng
cavernous
supraorbta
ven,
ten
examnaton
o
ven
ven
man
o
te
superor
ven
cavernous
a
patent
to
to
maxary
aca
emssary
73-year-od
ment
ven
optamc
T ransverse
to
an
to
to
to
to
te
e
sde
rgt
as
eye
te
structures
cause
tese
125.
A.
Subaracnod
B.
Centra
artery
C.
Centra
ven
D.
Optc
E.
Cary
w
ed
s
o
o
te
te
casm
gangon
retna
o
te
nto
te
o
o
vson.
were
te
scera
eyeba.
te
o
type
venous
o
o
sows
system.
te
o
In
he
e
s
venous
a
norma
oowng
qucky
or
a
spaces?
to
sent
urter
compete
he
oowng
a
to
te
evaua-
daton
treatment
pace
cnca
sunt
team
or
condtons
s
con-
most
pcture?
troug
aracnod
granua-
system
cerebra
te
s
admtted
ead
absorpton
nto
patent
weter
Wc
ts
aqueduct
atera
(o
aperture
Syvus)
(o
Luscka)
o
ventrce
Congenta
A
ten
absence
o
54-year-od
ater
te
man
beng
patent
as
as
droopng,
o
te
csterna
magna
nterventrcuar
oramna
(o
a
no
s
brougt
struck
GCS
by
o
obvous
Arm
a
10
s
te
and
sgns
weakness,
examnaton
to
movng
o
stabe
A
CT
arrva,
sgns.
and
dicutes
negatve.
depart-
On
vta
beedng
Speec
aso
emergency
vece.
a
he
Faca
and
scan
Tme
o
te
ead sows a racture troug te crsta ga o te ante-
ven
o
n
and
eye.
depart-
s
rgt
te
dicuty
Pysca
perorbta
o
te
ead
ts
contan
patent?
a
oowng
Mdde
s
te
most
menngea
B.
Great
C.
Superor
D.
Stragt
E.
Superor
cerebra
ven
sagtta
key
source
o
beedng?
artery
(o
Gaen)
snus
snus
optamc
ven
edema,
sows
te
trom-
A
126–150
55-year-od
o
woman
deteroratng
ton
eye
to
retna
and
Cosure
A.
rgt
key
space
to
ourt
(FAST)
tempora
vson
sweng
n
he
E.
te
menn-
emergency
o
sows
most
o
wc
MRI
D.
ment
snus
te
MRI
symptoms
perpera
unt
vsua
Monro)
ten
trombopebts o te cavernous snus. Wc o
to
surgery.
te
Questions
bus
propery
ange
nto
evauatng
Occuson
126.
An
dran
ventrcuar
Bockage
te
optamoscope.
o
A
o
and
ror crana ossa, resutng n sow, oca beedng. Wc
oss
wt
oss
oss
repeatedy .
optamoogst
ead.
MRI
entre
C.
snus
mdde
superca
cavernous
comes
says
ten
an
vson
pan
ange
an
B.
cavernous
ven,
te
urnture
because
no
sac
to
snus
notce
as
body
ts
mted atera movement, and macuar edema troug
oowng
he
tons
snus
to
progressve
rgt
petrosa
cavernous
ven,
or
Lack
supe-
ven,
pyscan
patent
camber
enarged
te
A.
most
to
te
A 2-mont-od gr s brougt to te pyscan because
patent
neror
D.
Vtreous
Lacrma
nose.
as
spread
patways
anguar
ten
ven
o
to
drecty
E.
key
necton?
trbutary
ven,
sde
and
nlamed
o
because
snus
C.
body ,
D.
o
pyscan
not
Posteror
te
ddn’ t
nto
rdoscera
Irdoscera
sder
te
oowng
spread
optamc
neror
te
currenty
antbotcs
arge,
te
venous
does
Pup
o
to
he
sgncant
reerred
C.
o
eson
sows
s
B.
artery
necton
o
at
ton.
to
actuay
a
wc
comes
vson.
bumpng
wc
utrasound.
ncson
s
eye, te aqueous lud s secreted by te epteum o te
eat
sows
sde,
snus
Se
to
test
umor
are
Hg.
unabe
rgt
wt
or
to
temperature
examnaton
Pysca
gven
te
e
tat
started
man
dagnosed wt open ange gaucoma, were te aqueous
artery
comes
Retromandbuar
to
and
te
pan
artery
panu
an
Wc
resut
Nasa
B.
n
says
patent
artery
paatne
at
wt
ospta
gr
was
pck
resut
he
respratons
110/84
on
ts
paryngea
and
patent
press
s
greatest
aca
aca
promnent
at
and
Her
80/mn,
ospta
aryngea
17-year-od
o
s
days.
conrmed
s
pan.
because
artery
B.
A
2
Pysca
Durng
pyscan
ntensed
(qunsy)
te
arteres
te
swaowng
pan.
eson.
Lngua
to
pressure
abscess
67-year-od
dicuty
e
troat
past
puse
on
subsequenty
patent
but
te
bood
pan
pertonsar
was
ace
over
A
ed
comes
worsenng
du
sde
and
se
nuceus
nuceus
ambguus
(100.4°F),
16/mn,
nuceus
savatory
progressvey
started
Neck
123.
22-year-od
o
121.
and
tests
and
ensure
ments,
s
wtout
gobe,
te
extraocuar
u
and
oowng
patent
te
a
comes
vson.
range
o
retna,
eye
abe
to
upward
must
be
abduct
or
te
pyscan
and
te
unctonng
te
eye
downward
are
smootness
bateray.
because
examna-
cornea
movements
moton,
syncroncty
nerves
to
Optamoogc
o
o
Wc
move-
o
propery
wtout
eac
observed
dicuty
devaton?
te
te
and
CHAPTER
A.
Superor
nerve,
dvson
abducens
o
ocuomotor,
optamc
A
nerve
B.
T rocear nerve, abducens nerve, nasocary nerve
C.
Ineror
dvson
o
ocuomotor,
Ocuomotor
E.
Superor
A
A.
he
no
man
because
patent
scan
a
evdence
wc
te
mted
o
as
sows
comes
a
ong
o
to
trocear,
most
In
growng
o
to
past
3
and
s
Wc
o
a
A
arynx
te
caracterzed
contan
depart-
te
tumor
131.
monts.
smokng.
n
addton,
s
dranage.
key
emergency
te
growt
metastass.
s
te
or
story
cancerous
tumor
s
ocuomotor,
oarseness
ympatc
ocatons
o
nerves
nerves
45-year-od
ment
optamc
dvson
abducens
127.
and
CT
by
128.
Anteror
B.
Interarytenod
C.
Laryngea
D.
Crcotyrod
E.
Mdde
A
commssure
n
very
are
sows
te
neck.
o
as
Fracture
B.
A
Leakage
A
tear
te
E.
o
a
A
“berry”
man
resecton
o
Postoperatvey,
psatera
te
parynx
wen
uvua
te
motor
130.
te
w
suppy
et
te
comes
to
n
patent
A.
Nuceus
B.
T rgemna
C.
Dorsa
D.
Nuceus
E.
Superor
wa
ven
sows
patent?
artery
by
to
cot
133.
te
te
s
et
no
gag
a
gag
was
and
neura
sced-
wen
et
o
ce
voca
te
motor
he
C.
Faca
V estbuococear
nerve
Gossoparyngea
nerve
65-year-od
ead
ave
any
te
pan
as
cerebra
Intracerebra
D.
Subdura
E.
Beedng
jaws
te
most
te
mandbe?
coson.
aceratons
and
Pysca
abrasons
examnaton
n
te
ower
boxng
and
and
tested.
severa
n
and
ace.
porton
because
he
an
gr
to
and
te
due
key
to
depart-
te
acc-
and
dd
Currenty,
Pysca
poor
ead
pys-
sows
eakage
cerebra
most
te
an
rom
emspere.
key
dagnoss?
bran
parencyma
system
pyscan
He
o
says
ees
examnaton
n
n
oowng
protruson
and
o
pan
sows
openng
strengt
te
because
e
o
te
openng
musces
s
depressng
temporas
ad
er
an
te
and
he
no
here
pyscan
about
o
pyscan
toot
uncompcated
devery.
Wc
rst?
to
growt
deays.
norms
o
jaw
brougt
moter
ventrcuar
te
Pysca
uneventu
appear
to
matc.
sow
deveopment.
expected
tme.
worsenng.
asymmetry
o
s
o
deveopmenta
teet
ad
urnture
tat
o
nto
Wc
mportant
and
te
symmetry
Patysma
sows
jaw
a
6-mont-od
moter
He
conuson
cerebra
movement.
te
and
at
rgt
s
comes
E.
motor
most
emergency
ead.
probaby
te
te
man
pterygod
a
a
cerebear
beedng
strengt
are
te
scan
beedng
nto
ater
jaw
pan
CT
Masseter
durng
w
tat
wt
beedng
Strengt
nancy
accdent,
beedng
27-year-od
o
vece
A
over
Epdura
A
metus
sows
superor
movng
menta
oowng
C.
opment.
njures
ven
B.
pan
ead
nerves
progressvey
trombus
Subaracnod
moter
aca
been
A.
A
dabetes
te
te
s
we
sows
te
to
ttng
sgncant
coordnaton.
ment
sustanng
ater
comes
bump
not
A 65-year-od man s brougt to te emergency depart-
ater
man
weeks
o
o
emergency
unconscous
nerve
Meda
vagus
s
musces
nerve
D.
134.
o
nerve
nerve
C.
te
by
E.
3
o
te
ound
vascuar
D.
A
to
beng
oowng
pterygod
musces?
ganga
aveoar
oowng
ematoma?
Anteror
nuceus
neror
te
te
Latera
nuceus
te
story
produced
B.
or
o
scan
cerebra
oowng
ambguus
or
Abducens
a
CT
A.
bodes
neror
brougt
ater
as
A
cord
sotarus
motor
T rocear
jaws.
resuted
s
son
a
o
by
B.
decreased
atoug
relex
Wc
durng
cana.
stmuated.
te
Wc
a
relex
stmuated,
and
parayzed
or
juguar
ad
ematoma
afected
jaw
pyscan
s
patent
A.
a
ven
a
he
patent
Wc
entrance
te
Wc
man
by
ypertenson.
ntracrana
njury
ts
ome.
ca
oowng
menngea
at
carotd
wa
rgt
mdne.
te
mdde
as
upward
contan
o
ts
vascuar
64-year-od
examnaton
atrum
tumor
te
te
o
snus
nterna
paryngea
to
toward
te
cerebra
paryngea
rgt
structures
a
moved
devated
drted
te
n
vta
examnaton
and
A
denta
aneurysm
sagtta
n
o
s
Paatogossus
ment
Hs
movement
perormed
wt
bone
te
passve
occurred
depart-
eadaces.
oterwse
Wc
o
o
emergency
Pysca
s
brances
superor
te
key
pteron
132.
severe
on
tempora
55-year-od
ued
CSF .
superor
Occuson
te
mts.
pan
puncture
te
te
o
te
generated
129.
and
most
o
to
Styoyod
E.
be
gaments
cord
(100.4°F),
norma
n
ruptured
wtn
D.
38°C
bood
voca
progressvey
umbar
A.
te
comes
stfness
A
condtons
C.
s
wtn
neck
traces
o
o
D.
artery.
tese
gament
man
because
sgns
voca
Myoyod
sma
od
segment
temperature
te
Hyogossus
C.
te
ventrce
55-year-od
ment
o
tat
orgn.
369
Neck
Genoyod
and
oowng
wt
sows
ts
B.
at
wt
area
at
department
caracterstcs?
A.
scan
and
woud most key be parayzed as a resut o ts njury?
trocear,
abducens
D.
CT
njured
Head
7
te
te
s
no
by
preg-
story
reassures
expected
oowng
er
deve-
te
age
or
teet
are
370
C H A P T E R
A.
7
Head
Superor
and
meda
Neck
ncsor
teet
at
8
to
12
monts
o
138.
age
B.
meda
ncsor
teet
at
6
to
10
monts
o
snus
age
Superor
atera
ncsor
teet
at
8
to
10
monts
o
atera
ncsor
teet
at
12
to
14
monts
o
be
age
E.
135.
A
Frst
moar
severe
eadaces
rngng
and
n
s
patent
o
te
s
owng
sows
troug
structures
he
cocea
B.
he
nterna
C.
he
sgmod
D.
he
superor
E.
he
te
A
adtus
aca
ower
n
jaw.
te
are
a
venous
present
s
patent
te
key
A
mdde
Wc
be
as
B.
ear
o
o-
139.
cana
s
sustanng
ossa.
and
tongue.
Wc
a
o
te
and
pan
s
a
buet
sensaton
n
savary
s
te
te
oss
te
he
o
A
54-year-od
B.
Receptors
absent
C.
he
te
D.
E.
n
or
te
was
transected
dsta
to
te
ot,
preerred
pan,
and
A.
Into
te
ante-
B.
been
orgn
ered
by
ngua
aryngea
nerve
was
obvousy
n
and
sev-
A
he
was
njured
at
ts
orgn
near
te
are
ovae
a
sows
determne
puncture
s
woud
neck
and
te
a
eevated.
Papedema
B.
Separaton
C.
he
ora
and
Wc
o
neck
patent
o
be
Pysca
was
puncture
necton.
perormed
o
ndcate
te
an
examna-
tenderness
wt
te
dagnosed
wt
s
However,
wen
oowng
eevated
pars
optca
retnae
D.
Obvous
E.
Pttng
opacty
or
exbts
emorrage
brances
o
te
compresson
rom
atera
swoen,
ens
te
dsc
to
te
(upper
o
drect
A
emergency
motor
scan
nserton
vece
mutpe
scera
CT
te
relex
pup
te
a
te
by
Anteror
Genoyod
E.
Genogossus
o
to
area
ac-
contans
o
te
suture.
ace
Wat
anestetze
o
sweng
a
ture
o
sac
oramen
eyed
te
and
and
eyed
aso
aso
and
aso
troug
nto
beneat
nto
te
s
mts.
te
to
te
cn
Pysca
skn
tendneus
as
woud
most
depart-
protrudng
pan.
Vta
examnaton
overyng
he
te
wound
sows
submenta
s
stopped.
key
na.
sgns
be
nlamed
Wc
te
ast
o
to
na?
te
dgastrc
comes
sde
parotd
resecton.
sows
anuus
a
moderate
mdne.
patent’s
te
septum
emergency
on
beedng
te
toward
orbta
ateray
te
te
o
te
ssure
o
to
te
er
utrasound-guded
tumor
deepy
between
ees
woman
on
An
te
acrma
comes
te
magnant
or
regon
te
bey
55-year-od
rms
mbc
muscuature
musces
D.
examnaton
optc
to
but
oowng
ued
o
te
conjunctva
aso
e
norma
C.
A
te
on
penetratng
monts.
centras
retna
says
Myoyod
pressure?
te
orbta
man
B.
to
o
sows
gass.
ten
upper
ang
umbar
anteror
on
oramen
and
superor
Patysma
pres-
n
posterory
penetrated
141.
te
oss
cornea
n
and
neede
and
papebra
A.
condtons
CSF
or
or
te
be
CSF
and
rontozygomatc
supraorbta
to
perormed
serrata
ovea
meda
not
key
A.
te
he
atgue.
umbar
etoogy
soud
most
and
stfness
movement.
menngts
sure
ever
te
ste
apex
te
wtn
na
and
o
com-
snus?
carunce
patent
trange
passve
te
ater
ment
because
eyed
broken
at
bubar
45-year-od
ment
buet
nerve
nerve
papebra
abducton
examnaton
o
ossa
Drecty
A 12-year-od boy s brougt to te emergency depart-
ton
te
hroug
and
140.
superor
te
D.
are
njured
consensua
o
brougt
scera
atera
Into
E.
as
cav-
key
ateray
superor
nvoved
contents
te
Into
C.
tongue
nerve
te
s
an
most
cavernous
and
s
nraorbta
te
key
pressure
w
but
sows
njury?
orbta
cod,
patent’s
te
beng
upper
racture
orbta
o
parynx
he
he
te
ragments
te
tympan
gossoparyngea
oramen
137.
nerve
corda
ead
examnaton
te
te
man
Pysca
n
a
o
ater
acrma
aca
te
te
accommodaton
oss
dagnoss?
A.
o
parayss
uncton
most
cavernous
relex
Ipsatera
te
wound
unatera
and
oowng
n
emergency
eadaces
oowng
wtn
o
Ipsatera
sows
emergency
wound
sows
here
T aste
te
to
buet
examnaton
pressure,
te
brougt
ptoss
E.
s
man
o
downward
D.
sma
regon
te
pysca
gaze
oss
department
bub
mastod
to
Batera
eratons
te
scan
as
te
wt
sde
pupary
snus
o
patent
o
suspected
Compete
C.
cavty,
te
to
eyed)
scan
afected?
semcrcuar
afected
he
CT
brougt
dagnosed
CT
Wc
Inabty
eaty
mts.
cancer.
loor.
aso
oterwse
norma
o
A.
o
coson.
antrum
Pysca
ntact.
age
because
he
A
durng
was
artery
juguar
ater
o
most
atera
carotd
ad
he
wtn
n
o
pyscan
He
story
bony
w
monts
te
pan.
tumor
te
nratempora
⅔
8
to
nerve
temperature,
ror
are
and
52-year-od
department
to
ear
amy
A.
6
(tnntus).
sgns
no
ead
at
comes
and
ears
vta
as
nvadng
136.
toot
man
stabe.
snus.
presson
56-year-od
s
beng
aneurysm o te nterna carotd artery wtn
ernous
Ineror
woman
ater
tromboss.
oterwse
age
D.
65-year-od
department
Ineror
C.
A
tumor.
he
Wc
n
past
bopsy
patent
o
because
te
surgery,
weakness
p.
or
neede
Foowng
marked
ower
pyscan
ace
te
te
s
2
con-
sced-
pysca
muscua-
oowng
CHAPTER
nerves
to
most
ts
Margna
B.
Zygomatc
C.
Mandbuar
D.
Bucca
branc
Bucca
nerve
A
past
4
o
te
te
o
ead
oramna
s
trgemna
brougt
a
day
a
to
nerve
du
te
o
sows
btemporay.
cranoparyngoma
nvovng
oowng
s
te
te
most
eyes
sma
atera
wa
s
n
te
oactory
te
caosum
Vta
most
o
o
a
ebear
MRI
o
te
MRI
Car
C.
Smt-Lem-Optz
D.
Sczencepay
E.
Exencepay
pouc
147.
pates
A
ment
tat
te
Wc
ead
o
neona-
norma
camber
tracts,
and
te
audtory
ta
or
boy
because
abnorma
he
deaness.
Inecton
B.
Faure
s
C.
Faure
pres-
tat
te
o
s
and
D.
Exencepay
because
o
te
E.
Menngoencepaocee
been
he
devery
sows
patent
wt
an
te
o
te
oowng
A.
Squamous
B.
Petrous
Squamous
D.
Spenod
E.
Etmod
A
nos.
bran
part
o
term
CT
and
s
o
by
norma
Pysca
scan
o
ventrcuar
most
te
course
was
Cytomegaovrus
149.
bone,
oped
eavng
and
te
ss
exencepay
te
embryoogca
s
cause
T oxopasmoss
B.
Faure
o
vaut
o
te
maormed
A.
A
newborn
he
made.
o
te
boy’s
bran
Wat
ts
wt
sows
sku
te
he
s
care
most
o
te
o
s
sows
a
Cooboma
Anoptama
neura
wt
bony
congen-
ead
arc
to
rst
to
ts
orm
paryngea
aurcuar
o
ocks
rst
paryngea
te
emergency
to
tey
was
he
An
ound
not
wte
vaccnated
patent
as
not
optamoscopc
cataract.
ts
Wc
o
condton?
vrus
to
cose
artery
(CMV)
necton
transerred
ndngs
C.
common
or
te
ocuar
are
bot
o
to
n
te
te
ens
pedatrc
aed
adopted
story.
mutaton
B.
te
sows
and
arc
congenta
condtons
undeve-
dagno-
brt.
amy
A.
150.
part
depart-
respond
necton
parents
ter
oowng
examnaton
condton?
cepac
te
o
te
regon.
as
because
patent’s
o
patent
rubea
yaod
nant
unt
aware
wt
ssure
a
A
o
necton
cosure
o
poyydram-
absence
exposed.
s
a
T oxopasmoss
boy.
Wc
ead
can
o
because
responsbe
E.
afected?
stborn
compcated
s
D.
system. Wc
newborn
examnaton
sows
Persstent
sve
a
not
te
dagnosed
brougt
snce
C.
bone
devers
parent’s
Corod
sows
s
he
Inecton
bone
does
o
porton
parents’
eyes.
osptazed
oowng
not
woman
s
B.
bone
occpta
by
A.
ead
emergency
e
membranous
paryngea
boy
vagna
te
te
porton
dorsa
examnaton
commony
tempora
3-mont-od
examnaton
bone
Pysca
tube
at
tempora
part
nasa
o
o
A
unt
bone
28-year-od
prenata
ead.
bones
part
C.
born
care
menngoydroencepao-
compcatons.
enarged
protruson
o
was
no
neonata
te
cer-
vrus
dorsa
second
s
cee.
A
department
te
spne
o
te
magnum.
paryngea
te
n
to
rubea
deveopment
o
patces
syndrome
wt
te
MRI
dagnoss?
oowng
Abnorma
cet
148.
brougt
te
Faure
Sczencepay
s
was
E.
C.
boy
o
to
te
D.
dagnoss?
dagnosed
An
and
enarged
cet
corpus
Smt-Lem-Optz
beng
key
MRI
o
second
te
B.
1-day-od
an
troug
cystca.
notced
An
patent
wt
o
Hooprosencepay
ater
emergency
rrtabty,
sows
oramen
brougt
Wc
A.
A
te
condton?
A.
oowng
to
syndrome
parents
stmu.
mts.
te
s
te
deveopment
vesce;
sows
sku
structures
maormaton
1-year-od
abyrnts.
teencepac
o
oactory
te
most
Hooprosencepay
pyscan
nasa
te
B.
cause
II
te
371
Neck
a cauda dspacement o
troug
s
o
eedng,
extendng
A.
nterventrcuar
wtn
a
verms
oowng
brougt
bda
occupyng
dencepaon
are
sac
spna
te
key
aar
a
bones
cerebear
poor
suprasear
Ratke
te
te
snge
ypopastc.
key
o
to
sows
An
bubs,
o
sma
as
tat
An
te
o
examnaton
ead and neck sows
tuberas
te
a
s
o
te
dencepaon
sgns
and
mdne.
are
o
pars
because
Pysca
and
n
and
abuse
gr
or
to
brougt
used,
ent
o
deveopment
examnaton
are
porton
acoo
6-mont-od
dentyng
Monro)
examnaton.
Pysca
a
deveopment
gr
Materna
A
deect
dspacement
department
emergency
eadace
examnaton
mted
deveopment
Abnorma
1-day-od
Cauda
seepness.
prmary
te
(o
te
Osscaton
D.
E.
146.
te
deveopment
Abnorma
orm
145.
o
Abnorma
te
aca
tumor?
C.
te
o
Pysca
ed
sows
Abnorma
ta
o
C.
ead
turcca,
Persstence
E.
procedure
aca
o
B.
A
o
because
A.
D.
te
aca
dvson
s
Wc
ts
durng
branc
o
boy
vsua
sea
space.
144.
branc
monts.
patent’s
njured
mandbuar
15-year-od
department
143.
key
symptom?
A.
E.
142.
was
cause
Head
7
and
Genetc
te
can
PAX6
expan
to
tey
study
gene.
te
nten-
deveop.
o
are
te
Wc
pysca
newborn?
Cycopa
D.
Apaka
E.
Mcroptama
and
anrda
A 2-mont-od gr s brougt to te pyscan because
o
aca
sma
asymmetry.
and
lat
Pysca
maxary,
examnaton
tempora,
and
sows
a
zygomatc
372
C H A P T E R
bones,
on
Head
anota,
te
key
7
rgt
and
and
sde.
a
Neck
dermod
Wc
o
tumor
te
n
te
oowng
s
eyeba
te
A.
ourt
dagnoss?
A.
Hemaca
B.
T reacer
mcrosoma
C.
Robn
D.
DGeorge
E.
V eocardoaca
Cons
Faure
most
o
B.
CMV
C.
Faure
Questions
A
syndrome
syndrome
155.
o
D.
Faure
E.
Abnorma
A
because
o
born
Gana
1
n
mont
set
ears,
152.
abnorma
ago.
and
sows
a
and
wdt
an
sowed
te
eart
te
oowng
eatures.
eye
nose
tp.
ypopasa
a
s
he
a
pyscan
patent
Unted
sows
o
basc
was
o
te
Hg.
an
cose
n
are
rgt
ead
lud
coecton
Wc
to
o
most
o
asca
deectve?
te
te
posteror
key
ocated
te
days
s
tons
CT
Hs
102/mn,
pressure
s
and
scan
o
o
te
sows
neck
space
he
o
extend-
te
ayers?
A.
Between
aar
and
prevertebra
B.
Between
aar
and
pretracea
C.
Between
pretracea
2
D.
Between
buccoparyngea
and
aar
D.
PAX
6
E.
Between
buccoparyngea
and
prevertebra
E.
47XXY
156.
boy
as
examnaton
ower
eyeds,
deveopment
A.
Second
hrd
D.
Fourt
E.
Sxt
n
ton
deormed
wc
tese
te
o
bones
ssures,
externa
te
te
o
te
deects
ears.
paryngea
man-
ace,
o
mn,
te
wt
most
o
A.
arc
wt
s
ever.
Hs
parents
say
payground
suspected.
stf
A
Wc
te
day
and
scan
te
to
te
emergency
vaccnaton
tat
te
neck
CT
o
brougt
o
beore.
Kerng
te
ead
oowng
story
boy
e
s
Pysca
sgn.
s
up
a
to
157.
tmes
examna-
Menngts
sows
snuses
depart-
severa
snus
present
s
oowng
s
An
Supratrocear
D.
Ineror
E.
Optc
A
67-year-od
o
progressve
s
background
probems”
s
ocaton
bone
T empora
B.
Fronta
C.
Mastod
process
D.
Externa
occpta
E.
V ertex
A
newborn
mates.
s
nant
Pysca
deectve
num.
ng
A
and
ound
tssue
meroencepay.
cause
o
to
ave
examnaton
te
bran
rudmentary
neura
key
s
ces
are
sows
branstem
o
A
te
condton?
and
bran
tat
protrudng
present.
Wc
ts
s
severe
te
rom
some
dagnoss
oowng
cavara
te
cra-
uncton-
s
s
abnor-
made
te
o
most
158.
A
rgt
Pysca
te
ead
s
25/
rgt
eye
sows
orbt.
an
Wc
vunerabe
wt
we
o
swaowng.
te
s
he
pyscan
n
s
patent
current
says
o
tat
wen
e
as
ncudes
examnaton
te
tunng
because
ear
medcaton
pysca
te
rgt
oowng
ork
to
be
s
te
te
paced
man
sows
A
most
protuberance
ead
comes
or
key
to
te
x-ray
o
3
o
te
groove.
afected
te
past
oarseness
atera
traceoesopagea
nerves
te
bone
cewng
examnaton
te
to
bone
55-year-od
pan
s
or
A.
ces
Hg.
o
are
conducton?
snus
etmoda
te
te
earng
Durng
snus
etmoda
o
o
perormed. Wc
Maxary
Mdde
mm
partcuary
nose.
Spenod
Posteror
128/79
comes
and
asprn.
test
key
test
man
dicuty
C.
E.
s
respratons
movement
x-ray
emergency
temperature
aveoar
B.
D.
s
te
Hs
56/mn,
mted
nerves
to
gt.
njury?
Fronta
to
brougt
racture
C.
Rnne
snus
o
prevertebra
Inraorbta
most
Fronta
s
pressure
sows
bow-out
ow-dose
age?
A.
bood
and
street
puse
B.
“eart
ts
a
enoptamos.
type
tere
nec-
at
and
te
ts
boy
(98.6°F),
neror
symptoms?
man
ater
examnaton
Abnorma
arces
24-year-od
37°C
arc
sows
ton.
o
papebra
o
A
department
arc
Hs
te
ypopasa
mandbe.
arc
1-year-od
date.
sows
sma
arc
C.
ment
and
o
caused
Frst
B.
A
notceaby
underdeveopment
downward-santng
key
a
s
oowng
PAX
3-day-od
te
necton
C.
(SHH)
mm
droong,
sweng
retroparyngea
wc
tem-
respra-
140/79
excessve
medastnum.
between
emergency
accompaned
swaowng.
sows
paatne
A
to
4
puse
bood
parynx.
n
or
dicuty
and
deveop
brougt
ever
examnaton
posteror
to
Sonc
A
to
ormaton
(104°F),
25/mn,
Pysca
enarged
ng
s
o
and
40°C
arc
crest
man
because
pan
s
neura
B.
Hedgeog
te
dvertcuum
22q11
dbe,
154.
ypopysea
neura
rgt
metaboc
deect.
te
cet
ecocardogram
septa
tons
ow-
ace,
troat
perature
States
sma,
ong
x-ray
a
An
te
te
An
and
ventrcuar
genes
to
openngs,
ypocacema.
sows
to
examnaton
o
to
A.
Pysca
153.
aca
enarged
tymc
brougt
mmgrated
Pysca
sort
paate,
pane
s
te
55-year-od
by
151–175
gr
neuropore
deveop
syndrome
sequence
3-mont-od
rostra
necton
department
151.
te
week
oice
voce
neck
Wc
by
te
because
monts.
and
sows
o
te
mass?
o
Pysca
pan
a
on
mass
at
oowng
CHAPTER
159.
A.
Recurrent
B.
Interna
C.
Vagus
D.
Externa
E.
Prenc
A
163.
aryngea
34-year-od
motorbke.
mm
he
eratons
venous
ater
puse
cerebra
D.
Superor
sagtta
E.
Supraorbta
Hs
o
s
s
Supratrocear
Inraorbta
become
coud
most
transmsson
underyng
164.
dura
mm
n
Anteror
A
s
be
to
a
MRI
Wc
o
compressed
and
te
ead
PCA
puse
s
pressure
sows
and
oowng
te
A.
scemc
bood
te
te
by
emergency
(99.32°F),
o
between
te
transent
37.4°C
25/mn,
An
regon
o
an
supe-
nerves
aneurysm?
165.
7.6).
An
bone.
Inraorbta
C.
Anteror
D.
Fronta
E.
Optc
A
34-year-od
department
rgt
E.
Optc
te
eye
sows
orbt.
s
a
ater
unabe
bow-out
Wc
njured
beng
Pysca
or
o
B.
Meda
and
C.
Meda
rectus
D.
Meda
rectus
E.
Ineror
ater
er
o
er
ead
te
most
gr
beng
te
orbta
et
x-ray
s
regon
eye
o
meda
musces
sows
te
wa
vece
eye
An
MRI
te
most
a
key
Ineror
B.
Meda
C.
Ineror
s
brougt
n
te
to
eye
Se
te
as
examnaton
be
turned
bow-out
o
a
tenns
vertca
sows
upward.
racture
te
emergency
o
te
oowng
and
tat
An
most
patent
and
and
neror
o
te
te
says
tat
pup
ead
common
musce(s)
te
s
rectus
and
neror
neror
obque
te
gt
mts.
swoen
racture
orbt.
be
sows
to
n
o
pan,
a
an
Wc
o
anestetzed?
s
a
at
te
a
emergency
motor
was
coson
n
A.
As
t
te
perces
tentora
te
dura
o
notc
At
te
cavernous
C.
At
te
sea
snus
turcca
dur-
te
o
(are)
njured?
and
to
and
a
severe
s
se
te
se
pup
s
street
norma
sows
nto
tat
ocaton
B.
wa
o-
or
emergency
a
dscoored
key
aganst
te
o
te
n
wtn
brougt
torsona
te
to
nvoved
durng
eye
sows
wen
s
depart-
x-ray
te
responsbe
patent’s
njected
s
beng
key
ba
a
te
obque
wt
dorsum
o
te
se
t
er
dasboard.
unabe
te
to
severed
te
poston.
nerve.
ts
rgt
Pysca
depress
adducted
wc
vece
passenger
Wat
nerve
w
s
be
njured?
ead
o
most
Pysca
te
eye?
ead
rect
superor
practce.
Wc
A.
and
t
cannot
sows
orbt.
o
An
oowng
neror
Pysca
eye
racture
et
te
te
rectus
tenns
dpopa.
abduct.
te
o
sows
o
s
are
rectus
16-year-od
ng
n
te
trapped?
Latera
ment
to
te
A.
A
struck
examnaton
te
he
examnaton
ba.
be
over
Wc
njured
sgns
woman
ater
Vagus
a
eye.
emergency
nose.
etmoda
Ocuomotor
by
esons
to
te
te
Optamc
D.
department
to
o
brougt
was
o
nerves
B.
coson.
emergency
to
s
vta
souton
C.
te
key
e
x-ray
oowng
ceekbone
to
ras
rgt
vrus
Because
n
brougt
te
examnaton
eye.
Abducens
s
brougt
erpetc
man
Hs
T rocear
woman
obque
etmoda
ater
B.
36-year-od
neror
etmoda
A.
A
te
22-year-od
anestetc
brougt
are
artery.
key
Posteror
E.
te
s
Hg.
te
cerebear
D.
department
snus
o
s
most
C.
wounds
and
373
Neck
Nasocary
aca
epsode
s
B.
Pysca
temperature
170/100
nerves
A.
ac-
rectus,
panu
on
res-
ven
an
and
100/70
s
vens
man
a
sows
transmsson
rgt
ater
nose
owng
man
wt
97/mn,
vens
te
s
te
neror
and
rectus
Hs
mutpe
necton
to
of
ven
respratons
most
rectus,
36-year-od
o
vens
65-year-od
aneurysm
A
(Fg.
Anteror
97/mn,
Ineror
emet.
pressure
oowng
scap
a
sows
I
emergency
ang
wearng
bood
bone.
te
snuses?
C.
w
njury
not
and
te
Dpoc
ror
to
(98.78°F),
patway
o
Supratrocear
s
was
te
B.
A
ead
ronta
o
a
vens
brougt
examnaton
A.
attack.
162.
te
wc
department
161.
o
patent
Pysca
te
s
37.1°C
provde
rom
Meda
E.
department
25/mn,
over
nected,
key
s
are
Hg.
man
because
temperature
pratons
D.
examnaton
department
160.
aryngea
aryngea
Head
7
obque
rect
•
Fig.
.
te
tentorum
cerebe
n
374
C H A P T E R
166.
7
Head
D.
At
te
neror
E.
At
te
superor
A
56-year-od
department
are
wtn
redness
te
o
rgt
te
te
eye
ead
naton
A.
or
he
B.
sows
eye.
an
te
he
musces
zed
are
he
nasocary
he
optamc
newborn
ntensve
devery.
are
he
care
ead
conducted.
o
te
te
most
sgns
sows
pan
n
An
MRI
rgt
optc
key
(o
as
Znn)
tan
o
usua
s
expa-
oc
te
wtn
te
nerves
because
dd
to
o
nner-
neonata
receve
Hs
vta
Utrasound
wt
mutpe
surroundng
te
vagna
most
bran
key
pre-
Inecton
B.
Corod
wt
C.
Persstent
D.
T oxopasmoss
E.
Epsten-Barr
rubea
ssure
sgns
yaod
to
matter.
cause
o
ts
necton
necton
A 2-mont-od boy s brougt to te emergency depart-
ment
by
s
vta
sgns
ton
sows
o
te
ace,
and
parents
are
bruses
nasoaba
droopng
te
key
o
absence
pace
te
ater
wtn
or
on
te
At
B.
Ineror
C.
Anteror
D.
Proxma
E.
Mandbuar
et
to
te
to
stroer.
ace.
sde
te
n
te
woman
earng
comes
oss,
171.
Pysca
te
rgt
s
Wc
by
o
te
te
patent’s
mout,
s
te
edema
Endoympatc
C.
Semcrcuar
D.
Cocea
E.
Hecotrema
55-year-od
o
sweng
ma
n
mts.
mass
on
hree
woman
er
rgt
bopsy
Se
days
sows
most
key
o
o
ar
te
te
o
eson
A
6-year-od
ment
(Fg.
wt
7.7).
bend
s
tender
s
and
to
pan
scedued
and
gands.
Wc
o
te
sensatons
emergency
te
te
ar
s
Injury
to
neror
tyrod
Injury
to
neror
and
C.
Injury
to
superor
tyrod
D.
Injury
to
superor
and
E.
Injury
s
mdde
vens
bateray
dagnoss
oowng
te
o
mm
enarged
mumps
nerves
regon
gand
s
respratons
120/90
s
o
Hg.
and
parotts
responsbe
te
parotd
•
Fig.
te
dsease?
a
because
wtn
nor-
non-tender
An
utra-
tyrod
gand
tyrod
gand
tyrodectomy.
CT -scan
o
oowng
.
tyrod
artery
mdde,
bucca
e
s
key
s
te
te
artery
superor
temperature
100/mn,
pressure
rom
Hs
ear-
bubbes?
B.
superor,
o
a
a
a
most
owever
most
neck.
sows
tyrodectomy,
Wc
are
sows
a
depart-
parotd
norma,
vaccnes.
sows
A
te
over
s
puse
bood
examnaton
panu
gand?
brougt
deveopment
s
parotd
made.
or
s
ever
(101.0°F),
18/mn,
Pysca
boy
Hs
wt
38.3°C
are
a
s
pyscan
sgns
sows
A.
to
te
patent’s
neck
brances
169.
and
dsease
Ménère
undergoes
bubbes.
cause
to
vta
te
te
oramen
and
decreased
Ménère
wt
examnaton
sde
o
Her
subsequenty
ater
ead
comes
neck.
nant?
zygomatc
because
ear,
sac
Pysca
te
A
o
structures
assocated
gand
o
rgt
canas
examnaton
cancer.
oowng
gand
nvovement
te
sows
dagnoss
oramen
styomastod
pyscan
o
ear
B.
A
A
oss
nant’s
te
examnaton
ear.
Hs
te
to
rngng
examna-
here
o
creases. Were
parotd
te
o
s
Pysca
and
et
sde
parotd
te
to
te
njury
styomastod
rom
mts.
ead
on
oreead
nerve
A.
te
od
o
ang
norma
tympan
o
Mdde
mass.
te
cose
(EBV)
n
o
brgt
artery
vrus
monts.
sound
vrus
aed
epsodes
sows
condton?
A.
Corda
petrosa
55-year-od
afected
genera-
examnaton
bateray.
te
te
not
pregnancy.
Pysca
s
E.
A
made.
uncompcated
ventrces
oowng
Lngua
4
nlamed
brougt
an
te
eyes
enarged
D.
eeng o uness or pressure n er rgt ear or te past
constrcted
moter
mts.
Lesser
o
afected
s
s
ater
neonate’s
Aurcuotempora
C.
A.
s
boy
Faca
B.
ng
afected
artery
unt
norma
ecogenc
168.
170.
symptoms?
nerve
trougout
sows
Wc
experences
contractng
preterm
care
wtn
smaer
vta
nlammaton
E.
nata
s
Her
examnaton
aso
s
emergency
musces
D.
A
te
pan.
Pysca
Se
oowng
tendon
eye
eye
H-test
patent’s
te
to
nlammaton
nlammaton
vatng
C.
o
rgt
te
A.
ssure
comes
mts.
we
annuar
he
o
rgt
te
ssure
orbta
woman
norma
o
Neck
orbta
because
nerve. Wc
167.
and
and
tyrod
and
arteres
ven
vens
neror
tyrod
CHAPTER
172.
A
32-year-od
department
coson.
s
an
s
arway
mm
bood
s
key
te
o
te
sgns
An
oowng
pres-
sows
aceratons
o
puse
bood
on
s
emergency
crcotyrotomy.
sows
An
artery
procedure.
aspraton
arteres
T wo
pneu-
was
most
njured?
A.
Superor
B.
Ineror
tyrod
C.
Crcotyrod
tyrod
D.
Superor
E.
Suprayod
aryngea •
173.
A
22-year-od
woman
s
brougt
to
te
Questions
he patent ost conscousness n te ed. Her tempera-
176.
26/mn, and bood pressure s 140/90 mm Hg. Pysca
ng
examnaton
wtn
ead.
An
s
most
te
to
B.
Second
C.
hrd
D.
Fourt
E.
Ft
ncson
s
ate
o
A.
Wat
wc
br uses
a
T e re
perormed?
patent?
trd
ourt
to
t
sxt
woman
ater
Her
s
beng
brougt
nvoved
temperature
respratons
mm
aceratons
Hg.
on
s
are
musces
evator
ve
B.
Let
tensor
C.
Rgt
evator
D.
Rgt
tensor
ve
s
te
a
emergency
motor
vece
(99.32°F),
and
examnaton
and
ace,
toward
te
puse
bood
and
pa-
Wc
ve
A
45-year-od
department
tabe
n
mts.
durng
te
a
man
ater
restaurant.
Potograps
neuroogc
oowng
s
and
brougt
Hs
and
vta
were
et
to
te
to
et
njured?
te
ttng
sgns
taken
examnaton
nerves
Nervus
D.
Ednger-Westpa
E.
T rgemna
A
evator
ve
o
are
eye
ead
wtn
te
(Fg.
emergency
s
7.8).
a
norma
patent’s
was
on
eyes
Wc
most
o
key
178.
or
mts.
man
o
3
examnaton
on
te
rgt
o ow n g
te
sde.
re e x
s t r u c t u re s
patoogy
o
ts
nuceus
comes
te
Hs
te
o
vta
by
sows
te
te
emergency
vomtng,
sgns
examnaton
ead
Wc
compressed
to
an
and
are
depart-
a
severe
wtn
sows
nor-
nystagmus.
acoustc
oowng
neuroma
nerves
s
most
tumor?
Ocuomotor
C.
Vagus
D.
Hypogossa
E.
Abducens
3-year-od
parents
Pysca
to
te
boy
because
s
o
brougt
sweng
examnaton
superor
musce
(Fg.
tender
to
7.10).
he
papaton.
key
sows
one-trd
o
to
o
a
mass
te
sweng
Wc
te
te
o
pyscan
sde
o
o
tssue
s
luctuant
te
T rocear
A.
Branca
cet
B.
Abducens
B.
Ruptured
sternocedomastod
C.
Ocuomotor
C.
Lymp
D.
Optc
D.
T ortcos
E.
Ocuomotor
E.
Externa
cyst
musce
nlammaton
carotd
artery
s
neck.
anteror
aneurysm
and
oowng
dagnoss?
node
by
s
sternocedomastod
A.
abducens
te
a re
s ow s
Faca
most
and
coaps-
sgns
nuceus
days.
B.
A
vta
accommodaton
n
nausea,
Pysca
o
7.9).
o
emergency
and
gangon
because
MRI
te
ntermedus
32-year-od
A.
paatn
stumbng
C.
key
paatn
Wc
savatory
to
He r
ead
te
n vo ve d
Superor
(Fg.
paatn
and
SCG
An
paatn
e ye .
s t re e t .
P y s c a
o
B.
ma
parayzed?
ace
key
eadace
paatn
ve
rgt
b ro u g t
conscousness
te
absence
A.
ment
sows
er
rgt.
177.
pres-
paatn
ve
tensor
37.4°C
ead
asymmetrcay
oowng
n
22/mn,
Pysca
er
to
o
mts.
te
an
s
osng
mdde
on
s
to
to
Rgt
at
woman
ater
norma
te
Let
E.
eve
er
most
to
eevates
te
o
perormed.
cartage
be
sde
s
130/70
severa
soud
s
rgt
te
o
105/mn,
sure
tracea
te
n
second
36-year-od
coson.
on
traceotomy
common
Frst
s
aceraton
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), puse s 70/mn, respratons are
sows
Fig.
emergency
department by ambuance ater ang rom er bcyce.
traceotomy
174.
375
Neck
vece
examnaton
crcotyrotomy
patent
Wc
and
cavty.
and
emergency
motor
(99.32°F),
25/mn,
ora
a
te
a
37.4°C
mutpe
te
wt
te
to
n
Pysca
wt
wtn
durng
ater
mona.
man
s
are
Hg.
estabsed
njured
days
brougt
nvoved
respratons
90/70
and
s
beng
temperature
unconscous
ace
s
Hs
105/mn,
sure
man
ater
Head
7
non-
s
te
376
C H A P T E R
7
Head
and
•
Neck
Fig.
.
•
vesse.
Wc
o
Fig.
te
.
oowng
vesses
s
most
key
nvoved?
180.
A.
Externa
B.
Interna
C.
Common
D.
V ertebra
E.
Superor
A
carotd
carotd
tyrod
9-year-od
wt
ratons
Hg.
and
gr
panu
perature
s
are
carotd
38.3°C
owng
te
and
bend
s
most
s
Her
s
ear.
to
An
mm
sweng,
MRI
Wc
be
tem-
resp-
120/90
erytema,
7.12).
key
department
ear.
110/mn,
pressure
rgt
(Fg.
rgt
puse
sows
te
mastodts
structures
emergency
er
bood
examnaton
tenderness
sows
to
bend
(101.0°F),
15/mn,
Pysca
ead
comes
sweng
o
o
te
afected
te
o-
by
te
nlammaton?
•
179.
A
68-year-od
o
cronc
o
mutpe
and
and
Her
80/mn,
pressure
s
angograpy
to
te
eadaces.
scemc
metus.
s
.
comes
and
transent
puse
bood
cervca
woman
dzzness
dabetes
(98.6°F),
Fig.
Se
attacks,
as
temperature
mm
7.11)
because
a
story
ypertenson,
respratons
145/90
(Fg.
pyscan
Hg.
sows
s
are
37.0°C
15/mn,
Crana
an
and
occuded
181.
A.
Sgmod
B.
Petrous
snus
C.
Inner
D.
Occpta
E.
Interna
part
o
te
tempora
bone
ear
snus
carotd
artery
A 34-year-od woman comes to te emergency depart-
ment
wt
norma
te
o
a
a
panu
mts.
ower
eyed
caazon
et
Pysca
s
o
te
made.
eye.
Her
vta
examnaton
et
An
eye
(Fg.
sgns
sows
7.13).
obstructon
o
are
a
A
wtn
ump
on
dagnoss
wc
o
te
CHAPTER
•
•
Fig.
A.
Spenod
snus
B.
Maxary
snus
C.
Etmoda
Fronta
E.
Nasoacrma
A
progressve
afected
vta
sgns
ton
sows
te
ead
Wc
A.
Fig.
182.
ocuar
most
key
responsbe
or
Hypogossa
D.
Gossoparyngea
E.
T rgemna
A
newborn
tes.
unt
Hs
vta
Scera
arteres.
D.
Pup
accumuate
E.
Nasoacrma
Pysca
ton
o
o
te
sde
te
ead
o
wc
te
o
mpared
sde
duct
dicuty
arway
sows
nasa
a
nasa
oowng
rom
te
on
cavty
to
te
wt
examnaton
nasa
te
comes
breatng
sows
te
sgns
rgt
poyp
(Fg.
emergency
troug
an
A
obstructng
7.14).
structures
obstructon?
o
sde.
depart-
te
Dranage
te
4
pyscan
oss
monts
mts.
te
te
and
duraton.
Pysca
rgt
because
rngng
ear.
examna-
An
MRI
cerebeopontne
nerves
s
most
n
Hs
key
o
ange.
afected?
w
most
rgt
key
be
was
sgns
a
Between
Between
wtn
bood
skn
o
rom
neonata
by
rupture
o
dense
mts.
o
on
sma
w
tssue
dabe-
Pysca
te
most
key
tssues?
tssue
ayer
rgt
perostea
oowng
connectve
connectve
orceps.
materna
eson
te
ntensve
requrng
norma
te
wc
and
oose
te
cepaoematoma
because
between
B.
to
devery
compcated
are
sows
ead
he
brougt
dicut
ayer
and
gaea
aponeurotca
scan
rom
s
A.
s
obstruc-
CT
o
s
a
pregnancy
C.
nose.
boy
ater
examnaton
ducts
gands
o
n
at
oowng
V estbuococear
T arsa
because
tumor
C.
Lacrma
ment
a
o
norma
oss
B.
he
te
patoogy?
man
wtn
to
earng
(tnntus)
earng
te
B.
45-year-od
comes
unatera
ear
are
A.
A
duct
Vagus
care
patent’s
nasoacrma
duct
man
sows
o
and
.
184.
s
.
snus
58-year-od
te
structures
377
Neck
ces
D.
o
oowng
and
.
183.
•
Fig.
Head
7
185.
C.
Between
gaea
D.
Between
percranum
E.
In
A
te
subcutaneous
54-year-od
department
and
aponeurotca
woman
because
vomtng.
Pysca
and
percranum
cavara
ayer
s
o
and
brougt
a
severe
to
te
emergency
eadace,
examnaton
sows
nausea,
tat
se
378
C H A P T E R
s
7
Head
unconscous.
rgt
aso
eye
s
daton
sows
a
s
186.
most
n
o
er
er
bran
o
te
afected
by
and
conscousness,
nerory.
upper
afected
Wc
key
regans
eye.
eyed
An
te
and
a
s
s
Optamc
B.
Nasocary
transtentora
C.
Anteror
D.
T rocear
obes
o
pup-
te
te
bran
tumor?
E.
190.
Optc
department
C.
Occpta
ome.
D.
Fronta
scap.
E.
Pareta
and
54-year-od
because
vta
sgns
ton
o
are
te
te
a
severe
a
crana
or
te
to
te
emergency
eadace
norma
sows
sows
anteror
responsbe
o
comes
wtn
eye
bran
tempora
man
batera
tumor
ossa.
and
mts.
occupyng
sensaton
o
o
pan
a
te
n
ts
Menngea
brances
o
te
maxary
Menngea
brances
o
te
mandbuar
C.
Menngea
brances
o
te
etmoda
D.
T entora
E.
C2
55-year-od
naton
ness
o
acute
s
because
sows
te
a
anteror
myocarda
ntrogycern.
s
most
o
cest
te
to
be
pan.
wa.
A
o
te
route
An
o
Deep
B.
Submandbuar
C.
Subngua
D.
Lngua
E.
Subngua
A
ngua
ment
because
Pysca
n
te
snus.
Wat
an
structures
o
on
te
sows
a
submandbuar
rgt
ard,
s
sde
o
s
regon.
A
bopsy
o
te
as
a
and
pus.
n
ts
type
oowng
o
key
rst
Bucca
B.
Lngua
C.
Ineror
D.
Nerve
E.
Gossoparyngea
o
ace.
a
Parotd
C.
Juguodgastrc
Submenta
E.
Retroparyngea
A
45-year-od
a
to
o
te
nasa
s
to
njury
red
was
and
man
nose,
ever,
examnaton
mucosa
snuses
to
A
wc
pyscan
progressve
oss
o
bateray
bateray.
Injury
and
sows
te
te
oss.
transumnaton
and
dagnoss
o
because
vson
o
sweng
acute
oowng
o
CT
superor
uncon-
s
oss
o
aqueduct
(o
Syvus)
artery
pate
wt
CSF
o
te
snusts
structures
ever
o
a
to
and
a
genetc
Pysca
te
pyscan
sore
troat
by
or
2
mmunodecency
examnaton
paatne
o
artery
te
tonss
oowng
vsby
sows
wt
pete-
ymp
nodes
enarged
durng
man
dagnosed
s
rst
wt
Wc
to
Submenta
Superca
o
et
examnaton
E.
A
comes
vra
o
o
te
te
become
to
eye.
te
Hs
pyscan
conjunctvts
3
et
an
eye
sows
oowng
nvoved
because
3-year-od
groups
te
daug-
days
ago.
njected
o
ymp
necton
were
Submandbuar
45-year-od
dicuty
patent
rom
to
te
becomes
cause
te
spread?
he
comes
o
cerebra
become
panu
D.
o
myoyod
maxary
made.
removed.
prone
o
depressed
non-contrast
menngea
brougt
o
D.
nodes
te
aveoar
to
runny
most
one-story
Submandbuar
conjunctva.
mass
193.
22-year-od
Pysca
s
s
to
B.
Pysca
procedure?
A.
A
nerves
mdde
Wc
Preaurcuar
te
sma,
patent
key
emergency
s
resorpton
tonsts.
Juguodgastrc
o
are
te
erytematous
C.
Wc
duct
A
o
aceraton
a
crbrorm
story
B.
ts
sku.
mdde
boy
because
recurrent
most
A.
ts
o
o
A.
and
sows
cerebra
te
he
gand
a
tromboss
most
te
mass sows a magnancy o te submandbuar gand.
submandbuar
te
roo
tonsts?
depart-
non-tender
He
cae
medcatons
oowng
parents
enarged
ter
ump
te
ater
te
o
11-year-od
wt
ven
a
o
to
te
sows
ead
sows
day
s
Aneurysm
An
days.
exam-
sows
emergency
A
Fracture
E.
subngua
te
vertex
ead
scous.
o
to
ts
rnorrea
192.
comes
te
sagtta
D.
duct
examnaton
rgt
te
te
Laceraton
duct
o
o
scan
o
C.
ven
man
x-ray
racture
o
examnaton
te
ven
35-year-od
An
brougt
rom
CSF
tender-
absorpton
Pysca
s
ang
o
ncudng
o
man
ater
o
emergency
ECG
n
nerve
Obstructon
drug?
A.
55-year-od
nerve
no
vson
nerve
Obstructon
case?
Pysca
etmoda
B.
nerves
wt
o
artery
A.
nerve
te
seres
patent,
te
to
woman
narcton.
to
Wc
key
cest
daporetc
admnstered
A
s
brougt
oss
nerve
s
bers
s
te
conscousness?
191.
woman
n
o
nerve
C3
department
MRI
porton
B.
A
An
oowng
A.
and
Hs
examna-
papedema.
Wc
depart-
vomtng.
Pysca
resut
nerve
T empora
A
to
A.
o
B.
te
189.
key
Pareta
o
188.
most
patent?
ead
MRI
producng
oowng
er
here
A.
ment
187.
te
se
ateray
ptoss
o
tumor
ernaton.
Neck
Wen
drected
compete
ary
and
a
ow
o
mea
a
esopagus
Between
ocated?
tat
se
2
to
pyscan
regurgtated
days
sweng
coectng
te
ngt-tme
ago.
nectons.
esopagus
wc
and
se
ad
cest
papabe
te
comes
swaowng
says
repeated
sows
parotd
woman
n
sows
an
musces
s
n
ts
neck.
ood
as
Pysca
er
contrast
stae
Se
because
cougng
a
stor y
examnaton
Barum
outpoucng
te
ts.
tems
cer vca
pouc
swa-
o
te
regon.
most
key
CHAPTER
A.
Between
styogossus
B.
Between
paatogossa
gottc
and
styoparyngeus
arc
and
medan
198.
gossoep-
od
Between upper and mdde paryngea constrctors
tons
Between
tyroparyn-
Hg.
constrctor
wt
te
crcoparyngea
portons
Between
A
5-year-od
ment
o
te
neror
mdde
and
paryngea
and
neror
paryngea
Durng
beedng
key
B.
Mdde
C.
Let
D.
Ineror
A
norma
a
to
te
te
depart-
An
dark
mdne
oowng
venous
Anteror
venous
C.
Maxary
D.
Mdde
E.
Nasoacrma
ncson
was
ven
s
ven
woman
and
A
n
oowng
n
ear
CT
gament
comes
pan.
scan
te
te
s
pyscan
vta
ead
styod
eongated
nerves
ts
te
Her
o
wc
are
to
most
and
sgns
jugu-
and
process
key
afected
te
sty-
A.
by
ts
patent?
a
te
most
s
we
eatng.
nosed
ma
wt
mts.
dects.
a
eson
to
B.
Greater
nerve
Lesser
D.
Lacrma
E.
Corda
ts
o
aneurysm
te
s
over
ped
te
s
by
by
proxma
oowng
n
An
posteror
ts
s
o
sensaton
o
Cervca
Great
C.
Mandbuar
D.
Margna
E.
T ransverse
acrma
x-ray
bone
to
te
wa
o
unctons
patent?
brougt
mse
te
te
branc
aurcuar
ace
gand
gand
to
te
we
te
ts
a
2
he
s
to
cm
s
save
acera-
area
wound
area
oowng
emergency
tryng
sows
mandbe.
and
over
o
o
eyed
examnaton
ange
wc
a
pres-
sows
tempora
submandbuar
te
anestetzed
B.
gangon
te
te
ower
te
o
cuttng
Pysca
A.
Questions
comes
eds
arteres
beard.
deveoped
gencuate
o
mbs.
te
nerve
ntact
n
by
boy
ater
neuroogc
as
upper
n
puse
bood
examnaton
o
aca
reman
cosure
15-year-od
Cutaneous
nor-
201.
to
wt
te
er
sows
bateray.
o
compressng
Mdde
dag-
te
tympan
producton
aceraton
nerve
dicuty
sows
A.
to
examnaton
vsua
oowng
no
A
ton
condton?
woman
Pysca
an
sows
nerves
was
wtn
tympan
because
bran
are
and
and
o
te
sutured.
normay
sup-
nerves?
aca
nerve
branc
o
mandbuar
cervca
trgemna
branc
o
nerve
aca
nerve
nerve
nerve
tempora
te
patent
sgns
o
occurs
nerve
54-year-od
days.
te
vta
oowng
proxma
petrosa
ago,
Hs
examnaton
te
petrosa
C.
5
o
cause
Faca
ment
weeks
pasy.
Pysca
Wc
A.
A
hree
Be
because
Pysca
vece
(99.5°F),
secretons
V estbuococear
tat
16/mn,
emergency
motor
o
E.
eye
37.5°C
racture
o
te
a
Contro
department
pyscan
are
cest,
a
s
to
n
T aste sensaton rom anteror two-trds o tongue
Hypogossa
rgt
s
and
C.
Gossoparyngea
te
nlammaton
B.
D.
te
meatus.
structures
musces
C.
to
brougt
nvoved
Hg.
ace,
key
T ear
o
nasa
o
V ountary
comes
ts
mm
Contro
E.
man
neror
oowng
by
120/90
nlammaton
te
cavty. Wc
D.
200.
mm
corda
Faca
acrmaton
s
oca
te
temperature
eson
tympanc
woud
Wc
n
o
s
beng
sows
Vagus
62-year-od
pressure
sows
tem-
respra-
ces
woman
te
ead
B.
A
96/mn,
duct
ater
A.
spontaneous
s
because
Her
ces
respratons
on
te
orgn
sows
and
caced.
weeks.
snus
130/90
resutng
wtn
neck
s
bruses
because
are
pyscan
2
379
Neck
duct
etmoda
Her
96/mn,
sure
anteror
o
etmoda
40-year-od
o
troat
syndrome
A
coson.
te
n
te
puse
bood
obstructed
Frontonasa
department
connectng
be
B.
ven
arc
and
wc
A.
ven
tyrod
to
to
asted
(101.0°F),
edema
rom
an
vesses
as
examnaton
mucosa
key
comes
tat
and
edema?
emer-
estabs
prouse
rom
o
tree.
199.
syndrome
te
procedure,
bracocepac
mts.
oyod
o
emergency
rom
38.3°C
15/mn,
Dranage
vens
sore
Eage
te
perormed
Wc
tyrod
Juguar
a
s
occurs
tyrod
55-year-od
o
to
ang
cut?
Superor
ar
te
tracea.
A.
E.
brougt
ater
suddeny
te
most
s
traceostomy
arway.
over
boy
s
are
woman
necton
Pysca
most
unconscous
gency
197.
snus
perature
constrctors
196.
a
D.
gea
195.
22-year-od
o
C.
E.
194.
A
Head
7
one
te
most
o
key
oss
over
o
MRI
arteres
casm.
be
cerebra
vson
An
te
optc
emergency
depart-
te
vson
o
at
te
te
te
ead
base
Wc
nvoved?
past
n
o
o
te
A
201–225
72-year-od
abdomna
Pysca
a
mass
papated
sows
magnant
o
ymp
magnant
sows
n
te
te
tumors
A.
Let
neror
supracavcuar
Anteror
communcatng
B.
Let
C.
Anteror
cerebra
C.
Rgt
neror
D.
Superor
cerebear
D.
Rgt
supracavcuar
E.
Posteror
E.
Juguodgastrc
cerebear
seen
deep
cervca
pyscan
s
bowe
cacectc
ower
are
man
ts
and
quadrant.
o
te
requenty
n
wt
abts.
consstent
Wc
most
cervca
B.
neror
a
rgt
tat
s
as
te
n
cecum.
nodes
deep
to
canges
ndngs
tumor
cervca
wt
comes
and
examnaton
s
CT -scan
ng
man
pan
A
wt
oow-
assocated
patent?
380
C H A P T E R
202.
A
7
Head
60-year-od
enng
man
oarseness
smoked
two
and
Neck
comes
and
packs
to
te
pyscan
dicuty
o
cgarettes
wt
swaowng.
or
te
past
wors-
He
30
as
years.
Pysca examnaton sows a mass on te rgt sde o
te
neck
pated.
nto
te
and
rm
Drect
te
regona
aryngoscopy
prorm
prorm
xed
recess
recess
o
must
ymp
sows
te
be
a
nodes
mass
arynx.
mucosa
or
o te tumor. Wc o te oowng nerves
sbe
or
tumor
A.
s
sensaton
to
te
mucosa
o
o
superor
ater
ss
a
Ineror
A.
Frst
Gossoparyngea
B.
hrd
D.
Hypogossa
C.
he
Interna
branc
25-year-od
o
arrva.
te
At
be
A.
B.
o
bone,
o
e
autopsy,
te
but
ntact.
cause
superor
s
aryngea
brougt
was
apartment.
mdne
yod
to
ater
s
o
man
ound
He
was
te
Wc
An
cavara
o
te
te
emergency
unconscous
pronounced
examnaton
neck.
to
sows
x-ray
and
oter
s
a
207.
on
over
cet
key
te
deat?
narcton
A
a
rom
egt
tat
resuted
n
ata
nterna
beedng
C.
Subdura
D.
Stranguaton
E.
Ingeston
A
zness.
o
necrotc
n
te
cerebra
noma.
ton
n
o
no
te
2
B.
Spenoda
Retna
D.
Ptutary
E.
hymus
Pysca
ror
png
te
o
sows
ater.
and
a
ead
an
o
o
o
o
most
er
brougt
sgns
to
te
drppng
are
sows
rom
embryoogc
Persstence
B.
Persstence
A
rgt
cus.
mea-
and
examna-
or
scap.
source
a
ts
pyscan
rom
wtn
sma
pt
on
wt
openng.
structures
s
te
norma
paryngea
o
te
second
te
groove
gr
paryngea
nto
wc
pouces
pouc
trd
s
paryngea
brougt
consutaton.
rgt
sde.
structures
o
to
he
Se
te
arces
pyscan
nant
as
sows
Faure
s
te
o
most
was
norma
a
key
o
a
at
deveop-
unatera
uson
or
born
upper
wc
cause
o
o
ts
and
meda
nasa
promnences/
A.
by
er
sde
o
mts.
part
o
o
te
arc
te
ntermax-
o
egt
pyscan
Pysca
18
exam-
te
umb-
poyydramnos
oowng
te
at
examnaton.
above
sows
te
durng
te
condtons
utrasound
s
examna-
etus?
Batera
D.
Hydrocepaus
E.
rena
Ompaocee
o
neonata
weeks’
wt
gr
va
and
a
er
brougt
o
optamoogst.
sows
pupary
te
a
A
etoogy
A.
Faure
o
B.
Abnorma
te
Se
rgt
n
te
te
o
crest
Se
norma.
n
body,
nant’s
and
o
ormaton
to
cose
to
6
an
exam-
te
te
condton?
ssure
te
reerred
sector
38
scedued
been
deect
s
or
at
devery
optamoogc
retna/optc
neura
a
as
neror
cary
te
born
vagna
sma
rs.
pyscan
was
receved
a
detaed
margn,
te
spontaneous
sows
te
deect
to
Se
deveopment
examnaton
poston
s
s
oow-up.
compcatons.
vaccnatons
naton
vagna
weness
gestaton
no
ageness
te
4-mont-od
Wat
second
Wc
ound
Ageness
o’cock
te
te
prenata
mts.
undus
examnaton
C.
drp-
ts
to
routne
norma
uterne
be
comes
a
wtn
a
bda.
to
or
B.
A
and
Anencepay
mucus
o
are
Utrasound
Pysca
n
woman
gestaton
sows
ante-
Wc
promnences/processes
promnence/process
segment
spna
ton
te
nasa
sgns
te
nvoved
paryngea
proxma
o
expected
te
o
mgrate
condton?
eart
examnaton
prmgravd
naton
anomay?
A.
Latera
Maxary
Vta
te
skn
key
sternocedomastod
ntermttenty
anay-
cromosome
arc
and
nasa
E.
weeks
ces?
mucus
vta
to
patent’s
o
deect?
D.
a
Her
ces
Laboratory
Rgt and et meda nasa promnences/processes
eson
advanced
autopsy,
208.
209.
s
examnaton
cromosome
arm
wt
repared
Latera
sows
sotary
bopsy
At
esons
te
dz-
te
and
A
and
nstabty
eye
gr
A
a
C.
ary
snus
examnaton
oowng
MRI
gat
gand
because
border
s
te
ncudes
Pysca
depart-
term
B.
emergency
snus
3-mont-od
neck.
eson
monts
sagtta
o
An
te
vomtng,
sows
emspere.
meanoma
C.
eadaces,
pgmented
Superor
to
cerebeum
oowng
A.
er
te
cerebra
des
sows
parents
severe
substance
comes
examnaton
emspere
magnant
A
posonous
emnegect.
Se
Wc
a
wt
esons
rgt
on
at
processes
woman
Pysca
et-sded
p
crest
born
mandbe.
ong
compcatons.
Pysca
was
Latera nasa and maxary promnences/processes
ematoma
40-year-od
department
no
sma
pouc
emergency
story
te
te
ourt
surgery
wt
a
n
neura
te
murmur.
and
paryngea
oowng
A.
Medca
eart
second,
congenta
Myocarda
a
p
ment.
He
expans
2-mont-od
term
appear
most
Second
A
sezure.
deveopng
Frst,
pouc
paryngea
to
a
ears
and
E.
cet
ractured
bones
te
te
dead
creptus
sows
oowng
on
a
ourt
brougt
paryngea
D.
paryngea
ypocacema.
o
best
trd
te
s
deeton
Faure
C.
A
and
sow
sows
area(s)
aryngea
o
boy
ow-set
studes
aryngea
te
duct
avng
paate
sows
te
o
compcatons.
B.
loor
205.
Persstence
3-year-od
22.
branc
department
204.
E.
A
cet
respon-
were
hyrogossa
no
remova
s
Persstence
D.
ment
ocated?
Externa
E.
203.
genera
pa-
protrudng
he
anestetzed
are
206.
C.
rs,
retna.
CHAPTER
C.
Abnorma
and
210.
Posteror
E.
Weak
A
optc
a
norma
and
te
mts.
te
deveoped
onc
structures?
CT
dsc
coud
rom
paryngea
C.
Frst
paryngea
arc
D.
Frst
paryngea
cet
E.
Second
a
contans
te
boy
An
MRI
Wat
Crana
B.
Encepaocee
C.
Meroencepay
te
ead
part
o
te
key
30-year-od
years.
mass
o
(Fg.
ture
n
man
s
Pysca
about
te
2
neck
7.15).
most
cm
C.
hyrogossa
D.
hrd
E.
Cervca
unt
s
wc
boy
and
s
a
te
e
.
•
Fig.
.
ncudng
te
pyscan
gnored
sows
n
o
te
wc
or
ts
bony
a
sot,
neck.
because
or
severa
mdne
A
CT
lud-ed
embryoogca
scan
mass
struc-
mass?
cet
pouc
brougt
to
spontaneous
devery
sows
te
were
pedatrc
vagna
eyeds,
and
papebra
deormed
wt T reacer
arc
ntensve
devery.
uncompcated.
dysostoss).
paryngea
te
down-santng
ower
dagnosed
syndrome?
Fig.
duct
(mandbuoaca
o
bran
•
deect
snus
examnaton
He
te
cecum
ater
o
tat
correc-
(cranum
troug
we-dened,
paryngea
paryngea
pregnancy
ears.
a
accounts
Second
newborn
to
tat
dameter
Persstence
key
Foramen
deects
n
sows
B.
care
comes
neck
examnaton
A.
A
embry-
menngocee
Menngoydroencepaocee
mass
o
musce
dagnoss?
Mcrocepay
a
uy
severe
neck
a
or
bone
sows
E.
o
ospta
occpta
D.
A
te
to
oowng
protrudng
most
A.
to
te
te
and
te
o
njury
te
to
sows
arc
system
s
n
sweng
pouc
n
o
mennges
ead
out
wtn
unabe
racture
o
admtted
deect
ventrcuar
deect.
s
and
resut
are
sows
s
te
emergency
pouc
paryngea
arge
ayers
knocked
sgns
He
o
wc
paryngea
2-day-od
vta
jaw.
scan
Second
bdum).
213.
A
Frst
o
vesce
outer
te
beng
examnaton
B.
A
and
to
ater
Hs
et
A.
ton
212.
te
hs
tat
nner
brougt
Pysca
artcuar
mandbe.
te
pan
matc.
over
mout.
to
s
ace
boxng
s
trauma
optc
cavtaton
between
man
wt
brusng
open
te
381
Neck
cup
26-year-od
department
211.
camber
adeson
te
durng
between
and
ectoderm
D.
o
nteractons
Head
7
w
Cons
Abnorma
most
he
Pysca
ssures,
externa
syndrome
deveopment
key
produce
ts
214.
A
28-year-od
devce
was
examnaton
era
o
swengs
suture
woman
used
nes
to
te
on
(Fg.
gves
assst
nant
te
appears
to
B.
Second
norma.
Wc
C.
hrd
sbe
D.
Fourt
A.
Intracrana
beedng
E.
Sxt
B.
Bockage
te
ts
norma
o
te
patent’s
o
a
boy.
and
brt
ead
tat
neuroogc
oowng
s
A
devery.
not
o
te
bat-
cross
sku
examnaton
most
key
symptoms?
nterventrcuar
vacuum
Pysca
sows
do
7.16). T ransumnaton
Frst
or
to
te
ater
nant’s
A.
be
brt
n
oramen
s
respon-
382
C H A P T E R
7
Head
C.
Faure
D.
Coecton
o
and
Neck
ceavage
o
o
bood
o
edema
te
prosencepaon
beneat
te
perosteum
o
te
bone
E.
Coecton
te
215.
A
2-mont-od
department
wtn
ead
crana
A.
s
o
above
brougt
a
mts.
cororetnts
sows
tese
gr
because
norma
severe
lud
te
perosteum
o
bone
Pysca
and
Wat
s
te
Her
emergency
vta
sgns
examnaton
bateray.
ydrocepaus
caccatons.
to
sezure.
A
CT
severa
te
scan
areas
most
o
o
key
are
sows
te
ntra-
cause
o
symptoms?
he
moter
was
treated
wt
tetracycnes
durng
pregnancy
B.
C.
he
moter
rst
trmester
he
moter
rst
D.
was
nected
o
was
trmester
wt
rubea
durng
te
durng
te
pregnancy
o
nected
wt
CMV
pregnancy
he moter was nected wt T reponema pallidum
durng
E.
he
pregnancy
moter
was
exbtng
nected
congenta
wt
syps
T oxoplasma
gondii •
durng
216.
rst
trmester
o
a
ma
ump
n
mts.
tssue
on
ectopc
reated
s
neck.
Pysca
te
neck
tymus
Hs
and
tssue.
structure
coud
Lngua
tons
C.
Ineror
paratyrod
ymp
Submandbuar
E.
Paatne
probems
mts.
gr
wo
A.
te
wtn
sot
nor-
mass
mass
contnuous
o
owng
sows
A.
ectopc
n
was
s
.
ocaton?
B.
concerned
Her
vta
examnaton
o
te
most
key
he
moter
cd’s
cause
o
te
about
er
normay
sgns
sows
are
a
daugter’s
and
as
wtn
teet.
219.
no
to
smoke
he
te
C.
s
te
treated
caccaton
decency
D.
was
wt
tetracycne
he
durng
moter
was
o
te
dentn
because
o
E.
pregnancy
nected
wt
rubea
durng
te
he
220.
moter
contnued
to
use
acoo
durng
te
pregnancy
A
23-year-od
he
te
moter
vta
care
batera
woman
not
he
unt
sgns
examnaton
sown
boy
or
are
sows
cataracts.
gves
seek
s
to
evauaton
sma
Cardac
o
to
ow
norma
ead
a
preterm
care
transerred
wtn
a
brt
prenata
boy.
trougout
te
neonata
brt
mts.
wegt.
Pysca
crcumerence
auscutaton
and
sows
a
o
te
o-
ndngs?
tadomde
CT
n
durng
to
at
te
durng
te
pregnancy
T .
gondii
scans,
te
term
devery.
cranoaca
durng
are
an
te
Pysca
te
obtaned
3D
to
abnormates
approprate
nvestgaton?
a
examna-
and
a
reconstruc-
gude
are
or
uncomp-
abnormates
ncudng
7.17
pyscan
va
oter
surgca
key
to
be
Hypertyrodsm
Hypopasa
Maormaton
o
D.
Hypopasa
te
E.
Hearng
a
mass
ed
wt
o
a
brougt
cartages
ture
key
to
o
3
s
te
sde
4-cm
rm
made.
neck.
weeks
o
neck
CT
7.18).
Wc
to
He
tat
sows
te
A
ago
a
because
ad
sot
lud-
te
eve
o
te
neck
lud-ed
mass
A
dagnoss
embryoogca
ts
an
resoved
at
scan
dameter,
(Fg.
contrbutes
pyscan
s
examnaton
et
promnence.
outer
cyst
sde
necton
te
branca
most
bone
tymus
et
we-dened,
tn
yod
aryngea
Pysca
on
aryngea
a
s
te
respratory
te
te
boy
on
mass
sows
o
oss
14-year-od
uneventuy.
o
born
vagna
C.
o
CMV
durng
wt
brougt
was
B.
A
durng
pregnancy
s
Fg.
rubea
wt
cocane
nected
o
He
wt
nected
used
was
Wc
wt
upper
dd
pregnancy.
ntensve
Hs
A.
cacum
pregnancy
takng
Wc
tese
pregnancy
mutpe
paate.
pannng.
durng
o
spontaneous
ound
moter
o
pregnancy
was
boy
vst.
sows
cet
ton
durng
murmur.
cause
nected
o
trmester
1-year-od
ton
pregnancy
Poor
moter
moter
cated
pregnancy
B.
he
he
A
was
moter
oow-up
norma
Wat
was
trmester
E.
rst
dscooraton?
contnued
moter
trmester
D.
by
yeows-brown
decduous
ts
pyscan
key
moter
he
rst
to
most
rst
he
gand
brougt
macne-ke
te
pregnancy
node
deveopng
scoo.
Pysca
s
he
deveopmentay
gand
was
cd
dscooraton
te
an
a
tons
6-year-od
he
o
oter
ave
are
sows
C.
D.
moter
sgns
bopsy
aso
B.
teet.
a
Wc
Juguodgastrc
A
vta
examnaton
A.
er
218.
Fig.
pregnancy
A 3-mont-od boy s brougt to te pyscan because
o
217.
te
mass?
o
a
struc-
CHAPTER
223.
A
22-year-od
department
coson.
Hs
temperature
s
mm
100/90
ractures
taste
bers
o
Gencuate
Ineror
D.
Submandbuar
E.
Pterygopaatne
221.
hrd
D.
Cervca
E.
Ectopc
A
newborn
devery
tyrod
wt
te
no
ton
o
and
zygomatc
detected
smar
devered
sows
bones,
externa
on
spontaneous
n
ears.
s
Pysca
ypopasa
santed
auscutaton.
ndngs
va
compcatons.
neonate
maormed
pouc
gand
was
No
cardac
here
ater.
o
mm
222.
B.
DGeorge
C.
Feta
D.
Car
E.
T reacer
A
Robn
I
s
a
Wat
te
are
story
most
225.
and
murmurs
amy
s
mandbe
ssures,
department
apartment
(99.5°F),
mn,
and
Anestesa
C.
Panu
n
ater
bood
Se
p
s
ang
s
(FAS)
brougt
rom
Her
pressure
s
undergoes
and
cn.
te
te
9t
emergency
loor
mm
ractures
surgca
se
Wc
s
respratons
140/90
mutpe
Postoperatvey,
to
temperature
103/mn,
sows
CT
eson
emergency
severe
16/mn,
A
and
scan
o
taste
depar t-
eadace.
puse
bood
te
compressng
Hg.
o
Hs
106/
pressure
ead
te
s
s
sows
a
optamc
are
ner ve
numbness
was
20/
Pysca
te
most
Wc
woud
te
o
te
patent
o-
most
ard
o
paate
te
upper
p
Pan
Tngng
over
te
ower
sensaton
eyed
over
te
bucca
regon
o
te
A
72-year-od
man
dicuty
wen
sgns
wtn
are
a
te
be
or
norma
cacexc
o
comes
eatng
man.
cana.
pyscan
past
ew
o
suc
o
a
te
te
te
because
weeks.
Pysca
MRI
afectng
Wc
by
te
mts.
An
branstem
afected
to
te
Hs
o
vta
examnaton
ead
sows
contents
oowng
o
a
te
musces
tumor?
Genoyod
B.
Myoyod
C.
Paatogossus
D.
Genogossus
E.
Styoyod
an
37.5°C
reconstructon
as
o
ner ve.
symptoms
man-
Questions
226.
A
226–250
71-year-od
tcy
rgt
reeve
te
o
te
resectabe
o
te
naton
key
Wc
man
eye
comes
to
nose.
He
and
dryness.
bran
sows
a
crana
He
tumor
red
4
dry
was
Aurcuotempora
A.
Ineror
B.
Bucca
B.
Dorsa
savatory
C.
Lesser
C.
Superor
D.
Menta
D.
Ednger-Westpa
E.
Inraorbta
E.
Nuceus
vaga
wt
nuceus
nuceus
nuceus
nuceus
ambguus
uses
dagnosed
nuceus
savatory
pyscan
oten
monts
eye
nerve
te
nvove?
A.
petrosa
Wc
te
eyeba
E.
key
njured?
te
a
(102.02°F),
trgemna
te
D.
woud
syndrome
woman
puse
mandbe.
ower
te
B.
A.
syndrome
Cons
ost.
o
te
experence?
tumor
key
syndrome
compex.
examnaton
dbe.
o
Pan
sows
o
maormaton
22-year-od
s
bodes
to
surgery,
ace
syndrome
acoo
are
to
and
38.5°C
addtona
ypogossa
Perre
taken
Foowng
tongue
ce
severe
mut-
tongue?
comes
ever
Hg.
A.
examna-
te
papebra
vagna
dagnoss?
A.
s
enancng
key
arc
snus
boy
te
sows
sows
s
s
pressure
.
pouc
paryngea
o
respratons
owng
C.
bood
gangon
man
because
branc
paryngea
o
te
He
repar.
vece
puse
gossoparyngea
21-year-od
rng
paryngea
bones.
emergency
(99.5°F),
ead
383
Neck
motor
examnaton
neuron
o
te
a
and
te
and
T rgemna
130/90
Second
part
C.
A
aca
tp
37.5°C
o
surgca
te
to
n
22/mn,
scan
te
B.
mn,
Frst
at
ts
temperature
B.
or
contans
are
s
Pysca
CT
te
room
rom
ment
A.
A
sensaton
gangon
A.
Hg.
trauma.
operatng
Fig.
brougt
nvoved
respratons
pe
•
s
beng
105/mn,
aca
224.
man
ater
Head
7
ago.
no
te
a
dry
drops
wt
Pysca
vsua
w
wt
eye
a
to
non-
exam-
mparment.
tumor
most
384
C H A P T E R
227.
A
Head
23-year-od
arm
pan
ma
ng
on
and
mts.
rgt
scan
o
man
and
rgt.
s
consstent
Probems
te
s
prenc
patent
wt
s
te
Reduced
bood
venous
D.
Numbness
n
te
upper
E.
Dstenson
o
te
nterna
a
se
In
ump
ng
o
er
o
te
a
neck.
te
most
to
te
return
o
toracc
rom
A
CT
musces
toracc
symptoms
pressure
on
Pysca
eyed,
eye.
te
by
and
neck
ven
pyscan
toroug
te
to
remove
patent
wt
te
tumor.
deveops
sows
pupary
symptoms
swe-
parta
constrcton
o
compresson
because
nvestgaton,
examnaton
he
caused
wa
ead
juguar
to
Ater
perod
te
extremty
comes
neck.
rgt
key
wt
oowng
nor-
appear-
and.
scaene
because
tyrodectomy
psatera
oowng
A.
er
postoperatve
ptoss
are
low
woman
undergoes
te
o
on
pae
et
rgt
nerve
Reduced
o
wt
wtn
dagnoss?
respraton
C.
29-year-od
te
a
dagnosed
o
ts
are
sows
tan
B.
A
pyscan
sgns
ypertroped
Wc
wt
te
vta
cooer
sows
he
to
Hs
examnaton
tat
neck
syndrome.
aso
Neck
comes
Pysca
s
te
and
weakness.
outet
A.
228.
7
o
ts
patent
wc
o
te
gangons?
Submandbuar
B.
T rgemna
C.
Superor
•
229.
D.
Gencuate
E.
Cary
A
26-year-od
department
mdace
norma
taste
ton
A.
ater
a
mts.
and
nerves
man
durng
te
was
Lngua
brougt
sustanng
but
anteror
to
te
traumatc
Hs
vta
tere
s
oss
emergency
njury
sgns
o
to
te
are
wtn
sows
ntact
genera
sensa-
examnaton
tongue. Wc
key
nerve
a
gt.
Pysca
most
corda
s
street
savaton,
rom
o
te
Corda
tympan
C.
Ineror
aveoar
D.
Lngua
E.
Gossoparyngea
dsta
to
ts
An
oow-up
tumor
ead
o
woud
ton
231.
te
o
ater
to
ts
at
te
juncton
wt
be
te
beng
wt
te
te
corda
pyscan
dagnosed
ossa.
spread
juguar
to
to
crana
perneura
expected
(Fg.
o
An
te
oramen.
ound
on
MRI
tumor
Wc
pysca
or
wt
o
ts
te
oowng
spnosum
ovae
C.
Juguar
Hypogossa
E.
Foramen
er
n
bood
examnaton
neroateray.
aracnod
B.
Loss
o
aca
C.
Loss
o
sensaton
D.
Loss
o
earng
A.
Ocuomotor
E.
Loss
o
gag
B.
Optc
nerve
A 25-year-od man s brougt to te emergency depart-
C.
Faca
nerve
ment
D.
Cary
E.
SCG
ater
says
rom
te
ace
and
te
scap
ng
relex
njurng
tat
mse
te
durng
patent
t
a
s
soccer
ead
game.
Hs
aganst
te
ead
vesse
sows
tat
enters
A
s
te
s
he
Se
a
was
ba.
con-
payng.
n
te
emor-
ruptured
sku
o
te
rgt
troug
gangon
emergency
was
a
temperature
mm
rgt
eye
are
o
s
16/
rgt
devated
sows
most
o
Pysca
and
aso
scan
s
Hg.
eye
s
wc
ound
story
respratons
CT
compressng
nerve
Her
Angograpy
structures?
te
se
as
175/100
non-contrast
ematoma
to
ater
90/mn,
ptoss
emorrage.
structure
brougt
ome.
puse
mydrass.
patent?
a
s
pressure
tongue
sow
he
resumed
unconscous
ypertenson.
sows
o
expresson
s
usband
ter
Loss
movements
o
was
openngs?
woman
by
(99.5°F),
pupary
ater
but
cana
controed
and
oncomng
acerum
55-year-od
mn,
te
oramen
D.
37.5°C
He
ound
emorrage
Foramen
poory
examna-
arrows).
or
conscousness
scan
Foramen
A
reac
was
B.
a
aong
e
A.
unconscous
dect
to
ose
CT
7.19,
a
te
A
A.
coac
ts
.
mnutes.
ater,
room.
o
not
severa
produce
wc
juncton
comes
posteror
tssue
be
man
or
tryng
dd
department
examnaton
sows
nervous
to
we
ours
rage
232.
82-year-od
patent
ocker
tympan
B.
post
he
Four
njured?
proxma
goa
used
oowng
tympan
230.
Fig.
cervca
a
sub-
key
te
to
oow-
CHAPTER
233.
A
20-year-od
ment
wt
a
examnaton
o
te
scap.
ment
because
ton
and
s
te
ead.
occpta
sutured.
te
as
spread
o
te
as
on
te
ocuomotor
C.
Maxary
D.
Optamc
and
ocuomotor
E.
Optamc
and
aca
connectve
tssue
and
te
aponeuross
connectve
tssue
and
te
skn
E.
he
derms
6-mont
s
oss.
deep
papaton
perormed
o
te
pass
te
story
true
and
voca
troug
name
o
o
a
neck
te
arge
tumor
he
openng
ts
pan,
anteror
A
oarseness,
sows
neck.
s
because
vson
aryngoscope
te
and
o
s
on
Wat
superor
rom
beng
A.
B.
T rgemna
C.
Faca
V estbue
C.
V entrce
D.
Vaecua
o
E.
Rma
Pysca
239.
gottds
D.
Vagus
E.
Abducens
An
rgt
a
enarged,
A
te
ocated
sde
o
te
goscope
neck.
sows
Perormng
to
avod
a
a
examnaton
cervca
Vsuazaton
mass
bopsy
njurng
ymp
ocated
o
te
wc
o
wt
n
mass,
te
sows
node
a
te
an
on
lexbe
aryn-
prorm
care
must
oowng
rgt
be
ts
sown
nerves?
te
by
te
vson
and
scan
and
te
ead
wc
most
o
key
Ineror
B.
Optc
orbta
Gossoparyngea
E.
Foramen
ovae
D.
Interna
E.
Hypogossa
brougt
to
te
pyscan
because
pan
n
suddeny
od
(101.0°F),
too
oud.
te
et
bood
naton
puse
sows
membrane.
structure
te
tat
Second
B.
Frst
C.
Second
D.
Frst
E.
hrd
102/60
bugng
s
te
and
te
respratons
mm
Hg.
erytematous
embryoogc
te
mdde
are
necton
ear
26/mn,
Pysca
tympanc
orgn
to
exam-
o
spread
te
rom
A.
cavty?
pouc
groove
241.
pouc
Hs
110/mn,
was
beng
temperature
respratons
90/60
brougt
nvoved
mm
Hg.
s
are
to
n
te
a
37.5°C
27/mn,
Pysca
emergency
motor
vece
(99.5°F),
and
puse
bood
examnaton
pres-
sows
2
et
t
brances
te
crana
nerve
nerve
days
pone
ago
away
Pysca
ear
and
past
nabty
a
crana
and
o
te
dura
to
says
s
rom
pasy
nerve
to
Se
so
er
examnaton
Be
resut
s
6
to
because
monts.
abduct
cornea
mass.
A
growt
structures
or
te
s
relex.
o
te
symptoms
o
s
o
most
n
te
pyscan
tat
ts
severe
ear
tat
et
key
a
t
must
sounds
yperacuss
sde
to
started
se
because
sows
te
because
pan
be
o
te
o
ace.
afected
by
yperacuss?
Hypogossa
Faca
C.
Spna
D.
Vagus
E.
Gossoparyngea
accessory
70-year-od
o
wax)
n
removed
Durng
man
sudden
examnaton
he
pyscan
te
oowng
comes
ear.
B.
A
A
aneurysm
ssure
woman
er
necton
aton
man
ater
te
Wc
te
pouc
coson.
s
s
aowed
to
35-year-od
sure
100/mn,
groove
department
s
a
Wat
parynx
A.
A
s
pressure
orbta
72-year-od
o a severe troat necton. Her temperature s 38.3°C
and
ater
tat
gt.
ssure
C.
was
to
cana
rotundum
o
because
patent?
A.
A
te
or
responsbe
Superor
gr
beng
sows
arge
Wc
an
sows
Foramen
240.
a
just
absence
te
D.
3-year-od
are
pyscan
compressng
to
sows
C.
A
sde
gt
aneurysm?
comes
Maxary
aryngea
artery
eadace
psatera
o
n
s
man
Mandbuar
superor
te
sows
symptoms.
B.
o
te
constrcts.
unresponsve
ead
A.
branc
to
artery,
examnaton
eye
CT
sku
recess.
te
88-year-od
burry
An 82-year-od man comes to te pyscan because o
Pysca
verba
et
Ocuomotor
Prorm
mass.
pup
nerves
examnaton
and
cerebear
or
s
recess
o
basar
to
openng?
non-tender
te
comes
Pysca
dated
compressed
B.
neck
s
angograpy
A.
ard,
woman
pup
responsbe
one
unabe
ods.
or
te
aca
probems.
rgt
te
of
Laryngoscopy
dented
between
CT
tenderness
and
27-year-od
te
examnaton
ods.
te
epderms
o
Pysca
238.
o
pyscan
on
te
crana
aca
dense
te
and
and
dense
to
eye
two
and
he
tacte
385
Neck
tested?
perosteum
comes
rgt
oowng
and
examnaton
Optc
he
patent
te
neuroogc
Optc
D.
te
nto
te
to
observed
B.
C.
and
o
Durng
was
A.
aponeuross
te
drected
Wc
bone
and
ead.
unresponsve
aceraton
te
he
73-year-od
and
s
patent
A
nec-
B.
a
s
tat
perosteum
A
o
days
wound
comatose
eedback.
depart-
anterory
scap
a
regon
hree
emergency
erytematous
ayers
depart-
Pysca
he
on
237.
tender,
wc
n
was
to
emergency
o
spread?
wegt
236.
returns
a
te
back
aceraton
nected
Between
to
te
A.
o
235.
o
on
wound
patent
become
comes
a
he
te
scap.
234.
sows
ater,
as
man
wound
Head
7
te
to
ts
coug
comes
earng
sows
rgt
uy
a
arge
externa
evauate
process
resuts
te
rom
to
oss
te
n
pyscan
s
rgt
amount
acoustc
te
o
patent
begns
o
evau-
Pysca
cerumen
meatus
tympanc
stmuaton
or
ear.
an
(ear-
wc
s
membrane.
to
area
coug.
o
te
386
C H A P T E R
meatus
7
Head
tat
s
and
Neck
nnervated
by
wc
o
te
oowng
acoustc
nerves?
242.
A.
V estbuococear
and
B.
Vagus
unabe
to
C.
T rgemna
crana
nerves
D.
Faca
E.
Accessory
A
A.
30-year-od
o
oarseness
rodectomy
ago.
ca
o
er
or
Pysca
scar.
woman
a
te
Interna
s
Externa
C.
Recurrent
abe
tetc
or
a
tests
o
man
B.
Bnk
C.
Pupary
D.
H-test
E.
Vson
key
te
an
Hs
te
and
V2
E.
V3
taste
75-year-od
panu
sows
to
vta
sgns
sows
are
s
wtn
ansocora.
Wc
o
dferentate
a
nerve
te
o-
248.
sympa-
eson?
s
made.
to
te
key
route
te
Pterygod
and
te
and
cavernous
Wc
a
ocatons
postopera-
o
because
snus,
te
rotundum
D.
Juguar
E.
Superor
acoustc
te
eadng
venous
orbta
50-year-od
o
a
p
and
o
ts
ong
optamc
petrosa
D.
Basar
spread
An
an
because
D.
D
E.
E
3-year-od
o
a
savary
key
A.
surgery
(tumor
at
to
te
sows
et
a
ossa.
o
oss
sde
o
o
s
tumor
on
te
Wc
o
te
n
te
woud
te
a
o
30
resut
o
pyscan
pack-year
acoo
ucerated
te
p.
squamous
rased
o
eptea
wt
are
Pysca
wt
Bopsy
cytopasm
nodes
because
smokng
abuse.
eson
ower
dagnosed
tumor
man
comes
doube
to
abduct
most
n
and
keratn
squamous
rst
to
be
te
ces
ce
afected
ces?
n
to
te
vson.
s
te
key
resutng
boy
panu
(Fg.
structure
ven
te
a
emergency
Pysca
rgt
eye.
arterogram
be
ocated
tese
to
In
depart-
examnaton
wc
(Fg.
o
7.20)
cause
te
te
w
nerve
symptoms/sgns?
A
s
A
to
as
ymp
ndcated
aneurysm
ntra-
250.
because
patent?
arge,
s
te
o
nabty
compresson
B
nectous
oice
baance,
rom
eosnopc
o
84-year-od
Imagng
underwent
o
patent
Juguodgastrc
C
ven
scwannoma
he
an
sde
nests
Submenta
C.
snus
woman
et
E.
necton
pexus
emssary
te
He
story
sows
D.
B.
snus?
surgery?
Occpta
A.
pexus
Superor
on
te
tumor
comes
Parotd
te
s
meatus
eson.
a
sows
te
oroa-
to
Se
oowng
ssure
man
abundant
oreead
structure
te
oramen
A
ocatons
o
vestbue.
o
te
poor
ead
ts
Interna
ower
to
crana
te
by
Retroparyngea
because
te
o
observed
C.
examna-
dagnoss
esons
o
C.
sows
pyscan
durng
ear,
posteror
B.
249.
Pysca
scan
te
to
nerve
ora
Wc
droong
most
gangon
transmsson
Superor
vestbuar
to
and
ovae
A.
gangon
cary
oreead.
ras
C.
Pareta
CT
o
et
Foramen
by
rgt
eye.
comes
s
Foramen
ment
cary
man
n
B.
s
Injury
woud
te
A.
bat.
nerve
abducens
and
B.
87-year-od
move
objects.
structures
treatment
venous
baseba
to
n
rgt
njured
carcnoma. Wc
nerves
and
cavernous
venous
cose
Herpetc
o
a
depart-
condton?
s
compcatons.
by
nabty
on
comes
on
emergency
eye
abducens
nerve
expedtous
spread
te
cary
man
te
nerve
and
vescuar
s
A
sde
pears.
to
was
sensaton,
story
cart)
sows
nerves
ras
a
erpes
oss
oowng
by
te
51-year-od
eson
n
nerve
ong
cary
to
D.
et
pyscan
ocuomotor
ocus
o
nerve
Sort
process
to
ntact.
used
comes
to
cause
Inratrocear
most
are
oowng
E.
a
durng
relex
t
and
te
D.
crana
VII
A
cose
examnaton
beng
Ocuomotor
E.
njured
X
C.
earng
aryngea
examnaton
be
man
SCG
requre
vst.
(readng
C.
An
247.
B.
margns
B.
ton
examnaton
IX
wt
test
T rocear
a
brougt
examnaton
o
be
s
rom
gt
normay
wc
A.
surg-
wtout
relex
ater
Pysca
can
key
water
relex
22-year-od
ment
Pysca
coecton
symptoms
musces
eson
Starte
ca
o
ty-
weeks
aryngea
superor
Pysca
soud
nerve
superor
oow-up
mts.
A.
o
3
we-eang
sps
most
tota
nodue
aryngea
extraocuar
owng
A
a
a
because
aryngea
82-year-od
he
246.
branc
Superor
A.
undergong
tyrod
sows
was
pyscan
ood
mout.
o
Gossoparyngea
eye
te
swaow
nerve
E.
norma
245.
to
D.
A
ater
cancerous
branc
B.
daugter
244.
voce
to
operaton?
A.
An
comes
examnaton
Se
dicuty. Wc
243.
meatus).
tvey sows droopng o te rgt corner o te mout
s
brougt
sweng
7.21)
(arrows)
gand.
sows
wt
Wc
responsbe
on
or
Faca
B.
Aurcuotempora
nterna
C.
Lngua
an
te
pyscan
rgt
te
sde
obstructed
nlammaton
o
te
remove
to
te
o
oowng
pan?
o
and
te
because
s
ace.
enarged
assocated
nerves
s
most
CHAPTER
Head
7
and
387
Neck
A
B
C
D
E
•
•
Fig.
.
Decreased/absent
sensaton
above
B.
Decreased/absent
sensaton
beow
C.
Poory
coordnated
Batera
E.
A
59-year-od
aspect
ead
man
sows
o
s
sows
ydrocepaus.
sorpton
253.
Fig.
.
Vagus
E.
Corda
C.
Subdura
251.
A
o
251–275
persstent
went
ton
a
wt
sows
tat
a
woud
o
be
wt
4
meet
n
te
njury
te
o
wt
et
pyscan
speec.
ago.
scar
sows
te
te
er
mdne.
oowng
expected
to
days
we-eang
aryngoscopy
surgca
Wc
comes
tyrodectomy
Fberoptc
ods
woman
dicuty
on
Pysca
te
and
52-year-od
patent
superor
addtona
to
s
aryngea
nerve?
posteror
mage
oice
crco-
crcoaryte-
te
2
scar
on
ater
Pysca
te
CT
poste-
scan
o
(communcatng)
s
maab-
7.22),
and
to
et
juguar
te
sde
snus
ven
pyscan
o
he
Based
wc
a
sagtta
snus
space
w
as
space
superor
cavernous
weeks.
examnaton
weeks
structures
subdura
monts.
abnormates
2
tumor.
postoperatve
and
comes
on
past
(Fg.
te
wc
snus
severa
te
to
A
Contraatera
o
te
o
most
drect
devaton
sot
s
ump
on
be
o
n
te
neu-
sown
te
o
neck
become
mass
oowng
key
resut
and
as
te
te
because
ace
on
growng
B.
Ipsatera
devaton
voca
C.
Ipsatera
pupary
D.
Ipsatera
weakness
n
E.
Ipsatera
weakness
n
nerve.
254.
A
s
55-year-od
brougt
to
man
te
o
te
uvua
durng
eeva-
paate
neck.
ndngs
et
branstem
subdura
man
ump
past
n
ton
dagnosed
abnorma
ts
A.
examna-
anteror
posteror
mass?
under-
norma-appearng
he
njury
because
Se
ods
occur?
and
sagtta
pysca
44-year-od
space
Superor
growng
to
and
Epdura
CT
te
we-eang
space
E.
roogc
Questions
pexus
D.
te
te
a
Between
Subaracnod
panu
ods
voca
relex
nonobstructve
key
Corod
a
tympan
a
B.
or
D.
most
a
o
ead.
A.
A
o
comes
resecton
examnaton
te
voca
te
musce
undergong
ror
o
te
musces
Weakness/parayss
nod
swaowng
weakness/parayss
arytenod
•
.
A.
D.
252.
Fig.
on
protracton
constrcton
wt
eevaton
tgt
a
o
o
te
tongue
parta
te
cosure
story
emergency
o
and
o
te
eyeds
cocane
department
ptoss
mandbe
abuse
because
o
388
C H A P T E R
severe
7
Head
and
uncontroed
Neck
beedng
rom
s
nose.
Pysca
as
o
et
nerve
nasa
beedng
cavty.
ts
A.
n
nasa
endoscopy
Kessebac
between
wc
area.
arteres
sows
te
Anastomotc
are
nvoved
n
Posteror
and
superor
ascendng
aveoar
one
accessory
B.
Latera
de
D.
anteror
o
department
s
superor
md-
aba,
tonsar
brances
and
o
te
bood
a
durng
past
week.
s
te
te
and
coug
44-year-od
te
nerve
paatne
tonsar
ossa
Wc
needs
to
be
surgery?
may
resut
260.
A
49-year-od
Externa
aryngea
naton
sows
ment.
open
sows
no
nodues
Wc
te
obvous
on
o
rma
te
te
dicuty
te
tan
ndngs.
voca
cords
oowng
because
Pysca
A
wt
move-
unctons
to
gottds?
E.
Rgt
Crcotyrods
daugter.
ness.
srug
to
Sorty
Pysca
s
te
souder
et.
arge
A
CT
aneurysm
responsbe
or
ng
s
arteres
A.
Superor
B.
Posteror
C.
Anteror
D.
Posteror
E.
Basar
A
department
arrvng,
te
scan
o
s
te
on
an
rgt
o
e
sows
te
artery
symptoms.
aneurysm
emergency
regans
tat
sde
e
and
ead
wc
sows
te
s
neck
o
te
te
to
et
ead
se
sows
nerve
oow-
ocated?
neror
because
ated
cerebear
s
o
and
A.
brougt
an
acute
dicuty
to
te
onset
wt
o
emergency
uncoord-
ponaton.
Se
s
a
te
voca
te
voca
to
te
pyscan
ods
ods
because
examnaton
te
te
et
gag
rgt
rgt.
sde
sde
to
te
s
s
sows
Pysca
o
relex
njured
er
area
teet
wde
o
A
spasm
sows
pa-
weaker
touced.
cause
et
s
tese
Masseter
Myoyod
D.
Posteror
E.
Latera
bey
o
pterygod
o
musces
te
noted
s
dgastrc
te
wen
to
a
on
per-
ndcatve
mandbuar
most
to
sows
dicut
tgtness.
are
se
condye
tgtness
et
area
wen
sgty
s
se
concerned
examnaton
s
regon
tat
examnaton
mandbuar
condton?
C.
s
because
te
says
panu
sound
Buccnator
B.
Se
devates
here
te
n
Pysca
depresson
oter
oowng
ts
jaw
pyscan
pan
patent
t
sng.
Pysca
te
aong
no
he
and
to
te
pan.
te
and
cckng
mout.
o
to
(bruxsm).
snger,
around
te
wt
ear.
Mandbuar
musce
o
comes
eadace
et
sde
because
wc
cerebear
er
et
papaton.
a
and
mout
opens
orm
o
eevaton.
Papaton
woman
swaowng
on
panu
o
cerebra
neror
se
conscous-
compressng
In
because
woman
jaw
grnds
er
turn
and
et
opens
unabe
ptc
gossoparyngea
stor y
s
s
by
cerebear
64-year-od
nated
ater
examnaton
te
poor
vagus
A 40-year-od
oten
to
wt
V3
E.
unconscous
on
Let
er
ound
te
te
key
D.
o
brougt
most
gossoparyngea
T ransverse
261.
was
mucosa
s
to
wen
touced,
Rgt
D.
s
te
tat
s
C.
3-day
e
sows
vagus
o
man
ts
symptoms?
relex
devates
Let
hyroarytenods
because
uvua
Let
C.
a
crcoarytenods
61-year-od
njury
to
od
voce
Pysca
B.
Latera
department
sows
njury
oowng
voca
comes
A.
Posteror
A
woman
nerve
B.
arytenods
te
te
atgued
swaowng.
mucosa
A.
crcoarytenods
easy
o
An
weeks
bengn
symptoms?
aryngoscopy
musces
abduct
patent’s
wen
Wc
exam-
norma
wc
nerve.
2
mutpe
examnaton
aryngea
n
pyscan
or
coug
E.
oarseness.
te
Decreased/absent
ryngea
o
to
E.
examnaton
aryngea
story
expresson
oroparynx
beow
Interna
1-mont
comes
Pysca
te
above
Gossoparyngea
a
to
n
sensaton
D.
pyscan
on
relex
sensaton
C.
te
aca
Decreased/absent
tat
to
o
Decreased/absent
Hypogossa
comes
patent
oowng
mastcaton
D.
B.
man
o
C.
o
39-year-od
ts
te
probems
tyrodectomy
externa
Vagus
A
scan
crana
n
o
CT
he
contro
tonss
perormed.
a
nodues.
et
baance
woman
Monotone,
Hg.
and
undergong
Inabty
s
musces
Decreased/absent
B.
swoen
o
E.
A
oss
A.
mm
musces
sensaton
to
di-
o
Decreased/absent
respratons
139/80
wc
Hearng
temperature
s
A
stroke.
dysuncton
D.
ater
emergency
troat,
te
produce
C.
Her
pressure
sows
te
dabetes.
sde
100/mn,
tonsectomy
wtn
to
sore
puse
examnaton
and
brougt
ever,
te
one
tyrod
s
or
aso
II
branstem
sde
A.
o
258.
and
o
or
and
coursng
spared
257.
woman
(100.4°F),
bateray
nerve
and
259.
paatne
because
19/mn,
Pysca
256.
spenopaatne,
swaowng
38°C
are
etmoda
paryngea
49-year-od
cuty
posteror
etmoda
Descendng
ascendng
A
o
menngea
Brances
E.
on
brances
key
type
a
Weakness/parayss
menngea
C.
responsbe
most
o
sows
Weakness/parayss
paryngea
and
story
ead
symptoms?
A.
paatne
ong
te
w
condton?
Descendng
B.
Fexbe
orgnates
connectons
255.
a
examnaton sows brgt red bood drppng rom s
ramus.
Spasms
key
o
assoc-
CHAPTER
262.
A
62-year-od
woman
comes
to
te
pyscan
or
Head
7
and
Neck
a B
routne
examnaton.
se
naes
ces
tat
Bockade
w
ar
w
contanng
adere
o
most
Durng
to
aferent
key
a
o
dferent
mucus
ts
te
n
coug
amounts
prmary
neurons
suppress
test
n
wc
woman’s
relex,
o
te
part-
tracea.
crana
coug
nerve
relex? A
A.
Gossoparyngea
B.
Hypogossa
C.
Externa
D.
T rgemna
E.
Vagus
aryngea
C
263.
Durng
neuroogca
examnaton
woman,
te
strokes
patent’s
ten
nea
pyscan
et
cornea
strokes
and
te
bot
wtout
cotton
eyes
a
a
wsp
a
o
he
te
27-year-od
cotton
response.
across
bnk.
o
he
patent’s
most
key
across
a
pyscan
rgt
cor-
expanaton E
o
tese
crana
A.
264.
ndngs
nerves
on
damage
te
to
wc
o
te
oowng
et?
D
Optc
B.
Ocuomotor
C.
T rgemna
D.
Abducens
E.
Faca
A
s
12-year-od
parents
temperature
ratons
gr
because
are
s
s
o
a
brougt
sore
37.7°C
20/mn,
to
neck
(99.9°F),
and
te
or
bood
pyscan
te
past
puse
s
pressure
4
by
days.
95/mn,
s
•
Fig.
.
•
Fig.
.
er
Her
resp-
120/80
mm
Hg. Pysca examnaton sows a tender sweng ante-
ror
An
to,
and
aong
tract
wc
tssue
owng
265.
above,
te
must
two
tyrod
be
tyrod
to
ts
patent’s
Rgt
obe
o
tyrod
C.
Rgt
obe
o
tyrod
D.
hyrod
stmus
and
oramen
cecum
E.
hyrod
stmus
and
prorm
recess
wen
story
readng
Pysca
a
te
A.
o
arge
posteror
nerve
o
a
n
(Fg.
or
eye.
n
A
CT
one
o
7.23)
s
te
down
o
scan
te
tat
symptoms.
In
because
becomes
weakness
crcuaton
te
tat
o-
bone
pyscan
wakng
sows
et
cerebra
resutng
dagram
yod
vson
te
te
ossa
and
te
tract
o
condton?
tonsar
gand
newspaper
te
o
epgotts
doube
aneurysm
A
and
to
neck.
te
gand
comes
examnaton
movement
sows
man
and
te
n
wc
B.
34-year-od
gand
o
cyst
descended.
between
treat
tyrod
a
Let
A
o
notc
sows
gand
removed
structures
obe
te
examnaton
A.
2-week
266.
just
utrasound
te
stars.
downward
o
te
arteres
ead
o
compresses
wc
aneurysm
o
worse
te
te
artery
n
ocated?
compressng
Wc
A
o
nerve
responsbe
oowng
descrbes
or
te
te
symptoms.
ocaton
o
te
aneurysm?
B.
B
A.
Interna
C.
C
B.
Dvson
D.
D
E.
E
and
C.
A 63-year-od woman comes to te emergency depart-
ment
te
te
because
examnaton
o
droopng
sows
depressed
wt
sows
aneurysm
an
an
te
o
et
absent
te
eye
gt
(arrow,
et
s
relex.
Fg.
eye.
Pysca
abducted
7.24)
o
an
D.
and
Angograpy
artery
Let
ar
o
te
anteror
artery
cerebra
vertebra
n
nterna
artery
te
cavernous
carotd
artery
snus
nto
mdde
arteres
at
te
juncton
wt
te
bas-
artery
Unon
basar
E.
carotd
Basar
and
o
et
and
rgt
vertebra
arteres
ormng
artery
artery
posteror
between
cerebra
te
et
arteres
superor
cerebear
389
390
C H A P T E R
7
Head
and
Neck
C
D
B
E
A
•
Fig.
.
•
267.
ment
because
sows
te
te
ocatons
an
nerve
doube
to
ndcated
aneurysm
PCA
B.
Interna
C.
Externa
carotd
D.
Anteror
cerebra
E.
Posteror
sows
An
or
a
carotd
by
.
examnaton
eye.
In
arterogram
key
resutng
be
n
wc
(Fg.
ocated
tese
to
o
270.
A
10-year-od
past
puse
s
te
past
2
at
ts
resutng
ndngs
on
to
abduct
B.
Inabty
to
depress
Loss
o
E.
Vsua
cornea
A
te
te
te
emergency
eadaces
CT
scan
(Fg.
woud
n
s
to
o
o
o
and
te
7.26,
most
wc
neuroogc
Inabty
Ptoss
artery
aneurysm
ocaton
A.
D.
n
monts.
(berry)
compresson
C.
here
brougt
5
days.
te
s
te
tympanc
s
nected,
most
ed
A.
Cavernous
B.
Pterygod
C.
Sgmod
D.
Stragt
E.
Superor
cause
oowng
eye
271.
eye
A
sensaton
s
s
37.2°C
te
brougt
to
te
emergency
depart-
examnng?
baseba
bat
grap
scan
o
arrow
ng
(Fg.
te
n
to
s
sows
7.27B)
ead
te
s
et
wen
sows
mage
most
eye
eyes
(Fg.
a
durng
move
asked
to
racture,
7.27A).
practce.
seen
gaze
as
n
Pysca
te
poto-
upward.
ndcated
Wc
o
te
A
by
T ransverse
te
C.
Fronta
Spenod
E.
Etmod
Levator
papebrae
B.
Ineror
obque
s
C.
Ineror
rectus
sgns
D.
Meda
E.
Superor
rectus
272.
A
are
o
te
a
and
te
tat
arrow
ts
venous
drect
area
can-
resut
o
bone?
pexus
snus
brougt
puse
and
s
nto
a
te
te
area
patent’s
areas
te
ever.
90/mn,
examnaton
s
oice
Hs
and
sows
respratons
tenderness
sgty
superor
eyebrows.
te
because
o
temperature
to
Wc
pyscan
most
are
wen
te
o
te
key
snus
snus
snus
boy
was
because
wtn
examnaton,
cess
as
red
efuson.
snus
12-year-od
moter
oowng
by
Pysca
a
snus
D.
A.
ndcated
Assumng
tromboss
nose,
anatomc
Maxary
oow-
s
taps
o
B.
afected?
superors
boy
A.
s
te
wt
puruent
nected/nlamed
petrosa
CT
musces
rectus
key
as
area
7.28).
o
boy
wt
(102.5°F),
18/mn.
snus
pyscan
by
39.16°C
snus
(99°F),
oowng
a
depart-
snus
Pysca
mdporton
or
te
runny
ment because o pan and burred vson ater e was t
examnaton
emergency
are
appearng
te
wc
venous
12-year-od
eadaces,
(Fg.
rsk
to
ead
dects
boy
at
proxmty
an
over
CT
s
respratons
membrane
tenderness
18/mn.
16-year-od
te
temperature
and
sows
corona
now
nes
dz-
examnaton?
adducted
te
Hs
98/mn,
arrow).
key
to
te
bugng
because
brougt
cause
symptoms?
artery
s
s
ment because o severe ear pan, eadace, and ever or
artery
we
boy
7.25)
artery
man
s
saccuar
addtona
A
te
communcatng
aneurysm
nerve
n
Pysca
rgt
examnaton
49-year-od
zness
er
most
A.
A
vson.
abduct
compresson
department
269.
o
nabty
woud
268.
Fig.
A 75-year-od woman comes to te emergency depart-
te
o
brougt
pan
norma
pyscan
adoescent
wt
to
bend
mts.
papates
te
s
pyscan
ear.
Durng
te
tenderness
Hs
by
vta
pysca
mastod
ected
pro-
upon
CHAPTER
274.
C.
Sort
D.
Optamc
E.
Anteror
A
posteror
cary
and
391
Neck
artery
artery
cary
16-year-od
Head
7
gr
artery
s
brougt
to
te
pyscan
because
o
oss o sensaton on te et sde o er ead. Se says tat
we
at
a
party
ast
ngt,
se
asked
er
rend
to
perce
te tragus o er et ear. We attemptng to pass a nee-
de
troug
deepy
Pysca
Wc
275.
tragus,
te
sde
o
te
Lesser
o
te
skn
examnaton
tempora
A.
te
punctures
er
sows
scap
oowng
oss
up
to
nerves
s
sps
and
anteror
o
to
te
neede
te
tragus.
sensaton
te
vertex
most
on
o
key
te
er
et
ead.
damaged?
occpta
B.
Greater
C.
Aurcuotempora
occpta
D.
Zygomatcotempora
E.
Great
A
rend
drecty
aurcuar
27-year-od
woman
s
brougt
to
te
emergency
department because o rngng n s ear and a droopng
A
sme. Pysca examnaton sows oss o et nasoaba
od
er
and
acoustc
s
asymmetry
ead
most
A.
sows
a
meatus.
key
o
te
sma
Wc
beng
patents
tumor
o
te
sme.
ocated
at
oowng
compressed
by
te
An
te
MRI
o
nterna
crana
nerves
tumor?
V
B.
VI
C.
VII
D.
IX
E.
X
B
•
Fig.
7.27
Questions
AB
276.
A
276–300
62-year-od
s
we
canges.
Pysca
Hs
sows
crbrorm
oowng
ts
•
papaton.
can
273.
Wc
o
Fig.
te
.
oowng
bones
s
te
pys-
papatng?
patent
Loss
C.
Dicuty
D.
Loss
o
sme
Loss
o
earng
C.
T empora
department
D.
Pareta
guardra.
E.
Spenod
tne
examnaton.
ton
sows
brancng
hese
te
s
cear
An
macua
arteres
arteres
comes
are
to
te
optamoscopc
utea,
emanatng
most
key
optc
Centra
B.
Long
retna
posteror
dsc,
rom
derved
te
or
a
rou-
examna-
and
severa
optc
rom
dsc.
wc
o
artery
cary
artery
o
s
scan
o
Wc
o
aged
ts
n
man
s
s
an
MRI
crsta
bone.
o
ga
Wc
addtona
brougt
mm
ead
te
Spenod
B.
T empora
C.
Occpta
and
a
oowng
patent?
are
Hg.
sows
to
motorcyce
temperature
aceratons
s
be
An
te
mts.
memory
o
te
and
te
symptom
musces
respratons
100/80
mutpe
gat.
etmod
key
aca
ater
Hs
110/mn,
sure
te
norma
nattentveness,
near
by
beavora
swaowng
20-year-od
A.
oowng?
A.
pyscan
wtn
pyscan
and
vson
Zygomatc
man
tumor
te
experences?
Occpta
45-year-od
o
most
B.
E.
are
sows
to
wakng
broad-based
Parayss
o
brougt
sgns
bran
pate
B.
A
and
a
A.
A
s
dicuty
vta
w
A.
277.
o
examnaton
mparment,
ead
man
because
s
te
37.5°C
27/mn,
Pysca
bruses
racture
bones
emergency
sammed
nto
(99.5°F),
and
bood
examnaton
on
o
was
te
te
ace.
sea
most
a
puse
pres-
sows
A
CT
turcca.
key
dam-
392
C H A P T E R
278.
Head
Neck
Etmod
C.
Parayss
o
E.
Fronta
D.
Parayss
o
E.
Parayss
o
A
21-year-od
days
ago,
e
s
ead
medca
ture
s
tons
CT
sagtta
wt
o
snus.
ead
Intercavernous
Ineror
sagtta
C.
Dpoc
ven
D.
Basa
E.
Emssary
department
ton
Hs
to
cose
V ertebra
B.
Common
C.
Parotd
necton
oowng
patent’s
o
te
vens
current
mm
man.
A
Latera
s
cut
sgns
n
te
ts
te
ace
most
and
sme
structures
He
on
was
te
most
musce
man
s
puse
pressure
s
sows
a
5-cm
sows
a
racture
s
on
a
bow
arrva.
80/mn,
130/60
scap
n
to
te
Hs
emergency
back
mm
Hg.
are
CT
bone
depart-
te
s
A.
B.
scan
o
te
extendng
ead
C.
A.
281.
s
transmtted
Crana
nerve
Crana
nerve
IX
C.
Crana
nerve
X
Crana
nerve
XI
Crana
nerve
XII
upper
se
era
te
ror
7
to
tat
te
Loss
s
brougt
Se
most
Se
a
to
on
pyscan
story
and
s
te
repeated
snce
bat-
te
ossa
rom
posteror
a
tonsts
damaged.
resut
o
or
undergoes
perormng
tonsar
tons
sensaton
as
te
subsequenty
te
key
to
nectons
We
n
paatne
s
o
es
procedure,
deep
and
Wc
ts
one
ne-
o
te
njury?
Loss
o
tongue
A
te
er
was
30
bood
saturaton
he
wt
parynx.
A
made
puse
s
s
approx-
a
swoen
patent
oxy-
bag-mask
ven-
because
o
massve
decson
Ater
s
papaton
andmarks,
at
try-
mnutes
pressure
s
sows
mout.
mprove
be
emergency
Se
(99.68°F),
28/mn,
approprate
key
te
town
examnaton
er
te
n
37.6°C
oxygen
o
membrane,
te
he
wc
wc
and
membrane,
cartage
te
made
o
an
o
te
nc-
te
o-
s
ocated
at
sternum
wc
and
membrane,
tyrod
bone
sterna
te
he
cavce
tyrod
te
yod
te
s
ocated
crcod
car-
cartage
wc
(Adam’s
s
ocated
appe)
and
above
notc,
cavce
tracea,
26-year-od
trd
o
s
wc
and
te
wc
s
te
90/60
Pysca
and
an
s
s
ocated
at
te
juncton
sternum
ocated
touces
most
on
te
anteror
two-trds
o
te
s
brougt
beng
nvoved
temperature
respratons
mm
Hg,
and
examnaton
ntubaton
nserted
te
man
ater
Hs
110/mn,
te
key
rom
beow
oxygen
a
te
te
te
crcod
s
A.
Vagus
B.
Gossoparyngea
bood
n
and
oowng
sense
s
82%.
dstress
he
and
puse
pressure
acute
ntated.
pan
vece
(99.68°F),
anestesa
to
emergency
motor
saturaton
patent
patent
procedure?
te
a
28/mn,
causng
o
to
n
37.6°C
wtout
Wc
te
are
sows
epgotts
aows
s
procedure
mmedatey
patent.
comort
taste
o
to
unsuccessu
tyroyod
coson.
to
tongue
B.
s
musce?
beow
department
tract
od.
tonsectomy.
nerve
284.
examnaton.
years
oowng
A.
gr
respratory
was
D.
ts
o
cartage
E.
oow-up
oramen?
E.
D.
11-year-od
ts
te
o
B.
An
troug
oowng
to
breatng.
crcotyrotomy.
most
between
I
s
crcotyrod
he
super-
neck.
mucosa
musce
brougt
s
not
crcotyrod
tage
ory rom te oramen magnum. Wc o te oowng
structures
edema
between
examnaton
s
rom
does
juncton
he
and
te
te
Pysca
te
ocatons?
te
39.5°C
n
as
years.
musce
are
and
Intubaton
soud
o
atera
restaurant
Pysca
denty
he
ead.
15/mn,
Pysca
A
occpta
o
temperature
respratons
ematoma.
te
te
to
new
protrudng
owng
brougt
sustanng
a
Hg,
a
mts.
overyng
He
45
musce
respratons
tssue
because
musce
temperature
perorm
past
nodes
Wc
dicuty
tongue
son
musce
wt
saturaton
te
norma
poyp
woman
at
pyscan
oarseness.
or
ymp
crcoarytenod
mm
to
a
arytenod
80%.
neck
wtn
parynx
paate
musce
matey
to
day
crcoarytenod
ood
te
mmedatey
hyroarytenod
sot
per
musce.
ocated
to
progressve
rm
sows
E.
Her
o
are
Obque
out
comes
sows
Posteror
taton.
artery
tongue
D.
gen
patent?
te
C.
120/80
s
o
Latera
105/mn,
acera-
ceek.
musces
Aryepgottc
ago.
mts.
te
B.
ng
broken
10-cm
rgt
cannot
oowng
a
norma
deep,
s
emergency
sot
cgarettes
34-year-od
te
te
A.
A
o
o
vocas
key
musces
musces
sgns
rgt
most
necton?
wt
wtn
a
across
eye
to
te
are
sows
rgt
o
n
unconscous
(103.1°F),
brougt
beng
vta
pterygod
25-year-od
ater
te
constrctor
te
story
12
vta
te
man
Laryngoscopy
superor
was
2-mont
examnaton
gand
T emporas
bood
s
carotd
E.
s
etargc
o
Hs
respra-
90/60
70-year-od
smoked
artery
D.
He
a
s
not
tempera-
110/mn,
pressure
sows
dd
A
department
obquey
damaged
ment
Hs
we
snus
examnaton
A.
A
s
man
282.
snus
man
sde. Wc
key
he
scap
Fve
ven
runnng
rgt
s
njury.
depart-
nausea.
283.
ater
botte.
unabe
ts
te
ts
on
bade.
puse
an
and
ven
20-year-od
Pysca
o
or
emergency
cut
bood
sows
Wc
responsbe
B.
gass
or
examnaton
s
te
deep
razor
and
A.
A
a
a
to
eadace
(103.1°F),
27/mn,
Pysca
scan
comes
severe
attenton
39.5°C
are
key
o
sustaned
seek
Hg.
man
because
savng
280.
and
D.
ment
279.
7
tube
te
s
tube
dscomort
crana
pan
nerves
and
ds-
CHAPTER
285.
C.
V estbuococear
A.
Weak
abducton
and
D.
Hypogossa
B.
Weak
adducton
o
E.
Faca
C.
Weak
adducton
and
D.
Weak
abducton
o
te
rgt
Weak
abducton
o
te
et
A
a
55-year-od
3-mont
man
story
strange
buzzng
naton
sows
sme,
CT
and
scan
Wc
ton
A.
o
o
n
s
rgt-sded
te
te
te
to
ead
te
earng
nose
decreased
o
o
comes
oss
rgt
and
ear.
earng
cornea
sows
oowng
pyscan
arge
w
n
exam-
E.
289.
asymmetrc
s
rgt
ntracrana
most
o
contnuous
Pysca
oss,
relex
a
a
because
key
be
eye.
A
eadaces.
pressure
oca-
ratons
tumor?
Between
ma
te
medua
and
te
cerebear
286.
Above
C.
Over
D.
Between
te
cerebeum
E.
Between
te
cerebear
A
te
atera
28-year-od
o
pan
mts.
n
tact
er
ear.
nto
te
ts
te
to
vta
meatus.
externa
posteror
te
te
sgns
sows
As
te
acoustc
wa,
pons
pyscan
are
te
eatures
because
wtn
meatus
n
at
s
Burred
te
te
C.
con-
nerves
287.
was
most
stmuated
by
te
specuum?
vson
Inabty
Loss
o
290.
A
to
rom
o
et
detect
ceek,
and
man
bood
and
te
o
no
te
artery
on
descrbes
nor-
sows
basar
mgt
resp-
sows
angograpy
mdbran
best
severe
te
te
at
rgt
cnca
sow?
eye
rgt
eye
and
u
ptoss
o
atera
eds
o
rgt
eye
and
eye
odors
o
troug
te
skn
te
over
rgt
te
nostr
rgt
ore-
mandbe
comes
T rgemna
sensaton over te scap n te posteror tempora regon
D.
Faca
and skn over te aurce anterory . here s weak atera
E.
Accessory
devaton
weeks
artery
an
e
nnervated
A.
te
gated.
adjacent
s
a
s
te
pyscan
tyrod
tota
a
Wc
ts
to
procedure,
here
nerve.
by
o
undergoes
Durng
s
comes
examnaton
ater
cedure.
man
te
superor
te
about
oowng
a
oter
pro-
A.
njury
te
to
B.
nerve?
crcoarytenod
C.
Inabty
D.
Decreased
Latera
Posteror
D.
Crcotyrod
department
E.
V ocas
sde
55-year-od
eadaces.
poba.
pressure
s
pratons
woman
ment
no
te
at
as
155/95
are
te
bran
sde.
ment
and
n
neck
sows
best
patent
s
no
comes
a
s
on
a
o
descrbes
mgt
Hg,
and
neck
te
to
te
sow?
stfness,
or
s
examnaton
dstress.
and
A
and
Range
o
basar
medua
on
neurosurgeon
cnca
Wc
eatures
o
wt
or
te
rgt.
A
CT
oss
scan
o
o
er
key
te
afected
corner
over
sense
to
te
te
o
n
ts
te
upper
o
over
te
n
patent?
rgt
p
te
sde
o
and
to
te
et
a
rgt
eye
gand
eye
to
and
te
emergency
pan
over
sows
mandbe
wc
cnca
a
te
mass
was
et
tender,
anteror
yperecoc
duct,
oter
te
to
te
wtn
dstended
eatures
are
most
patent?
a
A.
Weak
B.
Compete
sows
C.
Numbness o te skn over te et ower mandbe
D.
Excessve
tearng
E.
Pan
te
o
arter y
rgt
assess-
oow-
wc
ts
devaton
n
parotd
examnaton
sows
ts
rgt
sweng
parotd
Wat
body
te
comes
Pysca
utrasound
present
rom
woman
because
o
oregn
abduct
ace.
umen
a
secreton
sweng
An
key
o
move-
te
te
o
proxmay.
res-
angograpy
te
te
bood
sows
o
undoscopy
CT
ear.
poto-
and
Inabty
to
40-year-od
warm
severe
99/mn,
management.
te
o
puse
branc
pons
emergency
(99.32°F),
retna.
dated
te
stor y
37.4°C
norma,
te
reerred
urter
s
Pysca
pan
to
2-week
ever,
mm
20/mn.
s
juncton
Se
o
temperature
abnormates
te
ng
Se
wo
o
woman
because
Her
E.
A
most
sensaton
C.
department
to
nsde
sows
teet
B.
291.
are
eevaton
o
upper
hyroarytenod
A
mandbe
examnaton
te
mout
Loss
s
crcoarytenod
te
unctons
Weak
tyrod
musces
o
and
te bran sows a mass n te nratempora ossa. Wat
hree
tyrodectomy
concern
o
cancer.
or
jaw
numb-
C.
Pysca
ower
wt
o
60-year-od
te
pyscan
Vagus
ceek.
o
te
B.
rgt
sde
to
ness
A
rgt
o
(96.8°F),
V estbuococear
te
te
o
rgt
te
emergency
Fundoscopy
patent
te
eye
eyed
sensaton
60-year-od
to
o
rom
upper
eds
E.
ead,
ts
te
story
110/mn,
CT
and
eye
A.
oow-up
288.
key
o
A
oowng
vson
D.
and s eeng dzzy. Irrtaton o wc o te oowng
te
wc
rgt
examnaton
branc
pons
abducton
meda
cougng
o
te
to
puse
retna.
te
36°C
movements.
te
rgt
eye
s
Pysca
dated
o
rgt
Loss
ntro-
cose
starts
Weak
B.
o
a
wt
A.
norma
erytema
specuum
patent
sows
juncton
sde. Wc
atera
pedunces
comes
Her
ssure
and
examnaton
acoustc
wt
seae
emsperc
woman
Pysca
externa
duced
dapragma
neck
o
2-week
Hg,
te
393
Neck
eye
comes
a
o
and
eye
eevaton
o
mm
16/mn.
o
et
temperature
160/89
range
bran
B.
Her
are
depresson
te
woman
because
abnormates
emspere
te
65-year-od
department
tumor.
te
A
Head
7
over
o
ptoss
te
o
mandbe
te
anteror
et
to
te
rgt
eyed
aurce,
tragus,
and
anteror
ex
292.
A
40-year-od
man
department
ater
te
5
ground
norma
mts.
s
ang
eet
brougt
troug
beow.
Pysca
Hs
to
a
vta
te
gass
sgns
examnaton
emergency
wndow
are
sows
to
wtn
mutpe
394
C H A P T E R
7
Head
superca
tes
o
aceratons
bones
or
ongtudna
o
te
CT
scan
A.
te
to
be
Weak
devaton
Numbness
et
s
cavty.
ead
o
to
te
te
and
body
B.
Latera
pterygod
C.
Savaton;
D.
rgt
tragus
and
sde
and
o
s
te
o
e
te
cear
E.
ex
te
o
ante-
te
and
w
regans
a
A
o
ace
root
o
was
sons
6
a
te
body.
nose
a
ossa.
patent
A
and
rom
n
6
aert
s
cm
ear.
A
ossa
te
owng
conscousness?
n
B.
Postsynaptc
o
C.
a
eye
te
taned
man
ater
s
puse
severa
n
ts
B.
Abty
C.
Sensaton
over
D.
Sensaton
to
E.
Abty
abduct
A
rom
coson.
da.
sve
patent
body.
were
te
He
Pysca
here
as
s
s
te
n
Hs
posteror
ceek
and
o
rgt
sde
te
ber
o
skn
emergency
rgt
te
te
o
te
te
s
a
a
bone
and
o
te
mnmay
mdde
are
abra-
tender
ex
Wc
tat
and
vta
examnaton
sows
cana.
gt
Hs
mutpe
here
o
a
ncdent
ead
tempora
ead
types
wt
knee.
wt
mbs.
loor
o
Pysca
aspect
te
te
rgt
man
ower
te
to
and
pterygod
a
tempora
coded
events
mts.
o
o
crana
te
most
o-
key
parasympatetc
sympatetc;
Postsynaptc
presynaptc
sympatetc;
are
23/
One
postsynaptc
key
o
nar-
man
man-
te
body
te
gand
on
te
dsta
scap
eye
brougt
nvoved
bood
severa
a
aceratons
o
aong
te
a
o
te
te
emergency
motor
pressure
sows
deormty
mobty
to
n
and
tacycar-
poory
on
te
s
rgt
bone
ramus.
s
A
vece
respon-
ace
and
mandbe
noted
CT
wen
scan
o
298.
a
to
24
n
s
to
n
wound
e
open
was
was
te
cana.
o
ts
B.
Movements
C.
Secretons
rom
te
submandbuar
D.
Secretons
rom
te
subngua
E.
Secretons
rom
te
20-year-od
department
and,
ng
and
rom
scousness.
rgt
woman
wt
ebow,
er
te
pan
as
orse.
Pysca
two-trds
sde
acrma
s
Se
te
as
says
te
o
te
te
oowng
te
tongue
ace
gand
gand
gand
brougt
on
we
o
con-
troug
eson?
T aste
o
over
receved
ndngs
passng
by
and
he
exam-
sweng
patent
Wc
spared
anteror
rrgated
Pysca
sows
nerve
co-
racture
dscarged.
dstress.
were
swe-
eadace.
motorcyce
erytematous
te
be
a
emergency
ever,
and
A.
A
te
o
ead,
examnaton
o
te
dspaced
panu
aca
key
rom
he
bone
neurts
te
s
ours
tender
Neuroogc
o
o
to
story
nvoved
bone.
tempora
part
5-day
was
be
a
o
parasympatetc
brougt
mnmay
ater
sows
unctons
eyed
and
wt
s
tempe
e
ad
tempora
rgt
sstent
cornea
ago
appears
naton
sutures.
acrma
anteror
rgt
debrded
Wc
be
and
man
rgt
parasympatetc
postsynaptc
because
te
week
son
ead
wt
area.
over
postsynaptc
sensory;
20-year-od
ng
body.
te
A
sensory;
department
90/83
and
o
orbt
te
297.
responsve
ace
scan
most
s
papated
poory
s
o
beng
bony
abnorma
bone
rgt
examnaton
a
pressure
CT
orbt
oregn
ow
a
on
w
scafod.
respratons
a
apex
te
upper
man
wt
s
a
te
te
ater
and
emergency
patent?
te
detect
30-year-od
department
to
unctons
Secretons
to
te
te
budng
sows
stabzed,
near
to
bood
aceratons
s
openng
spared
a
(96.8°F),
A.
to
rom
110/mn,
oowng
or
brougt
examnaton
patent
te
s
ang
36°C
racture
o
anteror
parasympatetc
30-year-od
rowng
sde
te
parasympatetc
Speca
sows
te
njury?
Presynaptc
Genera
and
et
rom
anteror
a
ebow,
over
te
ts
te
superor
scan
A.
E.
te
CT
descrbes
afected
key
reca
and
racture
D.
Once
over
orented
te
nvovng
Dry
patent
o
Wc
afected?
te
brougt
norma
and
to
to
on
sweng
Bndness
Pysca
to
motorcyce
rgt
upper
aceraton
dspaced
o
Wc
most
×
to
rgt
te
CT
racture
crana
ow
wtn
an
E.
Hg,
be
taste
rom
s
s
pan
back,
D.
mn.
racture
mandbe.
ear
man
unabe
ees
are
sows
te
ater
was
ower
sgns
examnaton
dranng
a
as
e
and
and
stabzed,
sows
te
He
He
Dpopa
mm
jaw
and
skn
sensaton
Anosma
temperature
rom
tragus
C.
department
te
key
te
Savaton;
B.
A
o
sensaton
20-year-od
vson
et
o
jaw
and
ace,
motor
seatbet
seat.
s
anteror
sgns
transverse
ange
most
te
devaton
department
emergency
ead-on
Pysca
lud
patent
perormed
regon
Burred
aso
a
drver’s
about
over
n
te
wearng
tacycarda.
aceratons
Once
once
not
te
te
w
o
Sensaton
and
to
nvoved
n
dspaced,
to
tongue
sava
was
here
was
Eevaton
are
a
oowng
A.
ndngs
mucosa
brougt
beng
He
oowng
descrbe
A.
cnca
te
A
oregn
atera
o
sows
proxma
tongue
o
skn
s
papated
gabea.
te
cm
body.
patent?
jaw
skn
unconscous
severa
mdde
o
ater
pressure
“step-of”
te
Exporaton
oregn
ead
ramus
poe.
coson.
ound
nasa
2
te
te
5-cm
ceek
department
te
ts
a
a
jaw
te
te
man
sows
×
o
jaw.
o
deorm-
was
296.
over
voume
bood
3
no
ear
Decreased
was
n
but
here
et
oowng
te
30-year-od
vece
a
eads
te
o
over
Numbness
E.
A
sows
ound
C.
te
presence
two
o
mbs,
evdent.
over
te
te
B.
ror
295.
o
eevaton
te
294.
te
te
were
ead
Weak
D.
293.
sows
Wc
key
on
jonts
between
musce.
most
o
Neck
aceraton
wound
odged
and
to
et
doube
se
emergency
o
vson
ad
examnaton
te
sde
no
sows
er
ater
oss
o
ace,
a-
con-
perorbta
CHAPTER
edema
here
et
and
s
eye
a
wt
Pupary
sows
ead
ronta
orbt.
key
Weak
Dpopa
C.
Burred
D.
Decreased
E.
Parta
a
over
aong
CT
ture
te
o
ca
o
te
man
te
Parta
Compete
C.
Inabty
o
severe
orbta
o
te
o
o
to
te
C.
racture
o
D.
Corda
E.
T ympanc
descrbes
te
302.
eevate
te
te
depress
produce
acrma
Se
and
aso
et
eye.
Pysca
Paget
o
gand
areas
s
and
aso
loor
a
s
an
eye
rgt
and
te
bone
papated.
orbt
and
A
rac-
addtona
pys-
compans
Her
bones
most
eyeba
te
vta
dry
sgns
CT
o
te
scan
are
et
and
Petrous
B.
Inratempora
tempora
C.
Faca
D.
Mdde
E.
Inner
D.
Optc
cup
E.
Lens
A
to
o
produce
301.
woman
days.
Her
cae.
tenderness
here
o
te
s
nose
Se
was
necton.
structure
tat
Nasoacrma
ts
D.
Spenoetmoda
E.
Superor
and
o
te
here
A
nto
te
sows
bone
te
to
Pysca
cotted
meatus.
wt
ear.
no
A
bood
o
rgt
ear.
rgt
n
gt
was
Weber
ear.
s
tte
swab
te
test
Wc
tympanc
tan
sows
o
te
te
externa
vsuazed.
greater
On
ar
tat
bumped
was
deect
n
eye
a
maxary
otoscope
C.
Mgraton
n
aterazes
descrbes
Fuson
Fuson
o
te
above
sde
an
con-
te
o
te
respratory
s
te
te
most
spread
o
te
at
says
term
se
pregnancy.
connectng
te
rgt
o
te
meda
corner
oowng
n
te
an
aco-
Pysca
te
dscarge
resuted
ater
used
o
te
rom
te
deveop-
deormty
processes
nasa
to
eac
promnences
ectoderm
between
oter
to
eac
oter
maxary
and
promnences
te
o
maxary
305.
o
nasa
E.
or
gr
watery
key
meda
D.
upper
res-
nant?
o
test,
to
wc
most
a
moter
cear,
o
atera
an
eter
oowng
and
o
2
bood
sows
oreead
on
passage
groove
Fuson
membrane
best
a
Fuson
Rnne
sound
he
B.
acoustc
sweng
te
wt
te
99/mn,
wt
or
(101.5°F),
examnaton
devered
A.
conducton
oowng
n
o
pyscan
eadace
recess
deepy
penetrate
wt
rgt
rgt
s
broter
to
examnaton
peary-wte
cone
conducton
te
te
cean
te
and
areas
trougout
rgt
ts
swab,
ens
surace
meatus
sows
processes
causng
to
duct
woman
seen
cotton
space
patent?
pregnancy.
tobacco
p.
groove.
a
te
nundbuum
nasa
20-year-od
cantus
ebow,
by
deveopng
puse
over
te
aowed
C.
A
ts
to
wt
dagnosed
o-
ear
wt
at
Wc
menta
s
oow-
observed?
ssure
38.5°C
mucosa
and
ment
ear
te
he
mpar-
te
ectoderm
te
nose,
Pysca
nasa
tube
301–308
nto
o
connected
Hg,
A 15-year-od boy s brougt to te emergency depart-
s
a
examnaton
ntraretna
comes
mm
18/mn.
examnaton
to
te
overap
erytematous
o
attemptng
va
preg-
tat
vsua
deect
corod
136/87
are
Etmoda
304.
We
sows
Wc
te
term
neroateray.
surace
s
s
uneventu
pan.
o
temperature
Audtory
ossa
ear
at
uneventu
pysca
sma.
runny
B.
ear
rgt
not
A.
cana
wt
o
te
n
bone
gr
an
sgncant
remans
congeston,
upper
Questions
does
nasa
te
sows
te
o
vesce
30-year-od
key
symptoms?
A.
obteraton
necton
conss-
ead
te
any
o
cosure
tract
dry-
ndngs
te
nducton
a
ater
deect
expanaton
Faed
gabea.
or
norma
Wc
afected
wt
ear
wtn
o
sku.
er
mout
sows
A
key
o
pyscan
n
petrosa
examnaton
a
very
Faed
root
to
best
s
vagus
aurcuar
esser
tat
C.
pratons
eyeba
earng
ad
cause
deect
aurcuar
and
devered
pysca
eye
B.
pressure
tears
comes
great
devery
reassured
te
te
rom
ectoderm
303.
eyed
adducted
vagna
key
Faed
aong
maxary
s
as
pan
gossoparyngea
and
woman
et
s
o
395
Neck
neuroectoderm
tenderness
o
te
A.
per-
dspaced
o
ng
eyed
examnaton
was
te
not
percepton
great
and
pexus
Newborn
o
and
and
tympan
20-year-od
woud
emergency
rgt
deect
adducted
reduced
dsease.
te
te
skn
A
upper
te
woman
nausea,
tckenng
A
occpta
spontaneous
zygomatc
upper
o
to
patent’s
Lesser
o
nvov-
te
gossoparyngea,
scan
patent?
to
owng
CT
sows
sows
and
te
Inabty
40-year-od
te
oowng
ts
ptoss
o
ace
margn
Inabty
wt
Faca,
bone
or
and
area?
Aurcuotempora
te
to
margn
and
E.
tent
et
to
pan
margn.
D.
mts.
te
responsbe
B.
nancy.
examnaton
between
ptoss
te
njured
A.
eye
brusng
ead
ne
monts.
nerves
te
papaton.
njury?
brougt
orbta
neror
Wc
o
er
te
undoscopy
depressed
oowng
rom
s
Pysca
examnaton
ness
A
te
ment,
and
B.
3
retna.
zygomatc
te
to
and
eye.
o
moter
neror
o
te
vertgo,
te
et
o
secretons
because
A.
A
o
o
tender
te
ptoss
suture
bones.
s
norma,
o
aspect
vson
neror
te
tat
are
te
skn
rs
edema
scan
o
abducton
vson.
te
neror
superoatera
commnuted,
Wc
30-year-od
orbta
deect
consequence
B.
doube
te
te
relexes
process
department
300.
bony
sows
A.
A
o
over
abnormates
te
most
299.
no
te
a
gt
te
ng
brusng
sweng
Head
7
maxary
te
and
atera
ntermaxary
nasa
segment
processes
wt
te
processes
A 20-year-od woman devered a boy at term by sponta-
neous
vagna
devery.
Newborn
pysca
examnaton
396
C H A P T E R
sows
and
As
tat
as
oten
te
Wc
te
Faed
Lack
C.
Faed
E.
and
306.
A
a
Se
atera
gt.
o
Vta
te
se
botte
nose.
he
aca
most
D.
notes
tat
eedng
moter
E.
ton
307.
abnormates.
key
cause
o
promnences
o
nasa
neura
promnences
crest
ces
to
o
neura
o
rst
ectoderm
comes
o
te
are
sows
ces
to
between
to
s
neck
te
trd
maxary
pyscan
worse
on
norma
motor
because
worsenng
stfness,
wtn
no
te
constant,
pan
ever,
sgns
crest
pouces
te
or
rgt
examnaton
cm
(norma
key
o
upper
or
Wc
o
durng
A.
te
oowng
pysca
Lack
o
rgt
superor
w
examnaton
most
on
accommodaton,
cerebear
key
ts
be
artery.
dented
adducton
o
te
rgt
B.
Burred
rgt
C.
compete
ptoss,
abducton
o
te
te
ptoss,
rgt
adducton,
and
downward
rotaton
eye
to
mbs.
te
te
36
A
CT
ventrces.
cause
o
rota-
atera
D.
Lack
E.
Increased
A
o
bood
64-year-od
man
aca
medca
ago
a
He
sweats
excessvey
says
was
eaed
tat
removed.
surgca
observed.
nerve
te
bers
te
te
Were
tat
e
sows
oowng
o
sees
because
o
te
te
s
rgt
appetzng
sde
now
sde
parotdectomy
here
are
ventrces
arteres
pyscan
Pysca
are
40
condton?
atera
rgt
a
rgt
scar.
ead
te
cerebra
tumor
wen
te
o
o
decreased
granuatons
te
ncudes
on
s
aperture
to
magnant
o
nant’s
te
on
here
aperture
n
n
comes
story
or
tumor
low
sweatng
gand.
we
pexus
pys-
crcumerence
scan
aracnod
corod
sowed
Neonata
Wc
te
te
o
utrasound
cm).
o
gands
eye
Parta
o
vson,
rotaton
downward
bran.
ead
Narrowng
te
eye
be
a
Abnormaty
dects
patent?
te
a
34
eta
C.
a
te
o
trmester
te
sows
range,
o
to
o
B.
te
o
second
medan
a
aneurysm
and
te
ower mbs. A CT scan angograpy o te bran sows
berry
abducton,
upward
eye
o
year
Pysca
te
and
Narrowng
Hs
to
he
ventrces
excessve
sde.
averson
mts.
weakness
308.
ead-
rgt
ca
s
promnences
story
tat
secton.
dataton
te
abducton,
eye
ptoss,
te
movement
meda
woman
o
enarged
and
ptoss,
rgt
A 20-year-od woman devered a boy at term by cesar-
ean
te
nant?
nasa
te
Compete
te
says
Compete
o
A.
nasa
avng
examnaton
s
paryngea
says
not
s
atera
mgraton
Se
s
eedng,
smar
santng
underdeveoped.
arc
4-mont
aces.
o
mgraton
40-year-od
o
downward
were
processes
ourt
Faed
ad
ts
mgraton
Faed
and
are
breast
troug
n
uson
paryngea
D.
eyes
suckng. Wen
oowng
uson
o
te
mandbe
ater
seen
maxary
B.
Neck
attempts
reluxed
deormtes
A.
o
and
dicuty
cd’s
o
and
corners
pnnae
moter
boy
mk
Head
te
te
te
te
7
o
over
a
parotd
ood,
e
ace
were
examnaton
sows
are
s
o
ace.
no
nerve
crana
ce
nerve
bodes
nnervatng
s
or
sweat
ocated?
A.
Cary
B.
Pterygopaatne
gangon
C.
Otc
D.
Submandbuar
E.
Superor
gangon
gangon
gangon
savatory
nuceus
A n swe r s
Answers
1.
E.
2.
1–25
he
cd
ndcates
te
bot
an
ca
te
resuts
and
s ufe rs
rom
m a or m at on.
b e c aus e
and
an
rom
snus
troug
externa
c as e
par yngea
cer vca
and
be
nterna
stua
second
t s
open
must
second
te
A
an
deect
n
o
te
te
beng
our t
h s
a ure
e xte rna
and
te
s tua
tat
mp es
tat
o
co s ure
s tr ucture.
a ure
p ouc
a
o
A
co sure
te
cons o d ato n
p ar yn gea
ce ts,
a
te
o
B.
bo t
C.
trd
hs
te
b e ng
D.
excudes
par yngea
ourt
snus.
te
pouc
paryngea
Faure
woud
he
not
o
second
rom
te
present
tongue
n
995;
an
N
wt
o
and
te
an
duct
par yngea
beng
to
te
open
o
ts
deect.
ABR/McM
orm
second
extends
aure
externa
77;
grooves
cosure
tyrogossa
resut
GAS
he
arc
rse
answers
E.
he
28–35
te
cervca
groove
aone
stua.
rom
paatne
paate
p,
woud
and
ormed
by
te
derved
sec-
rom
gves
rse
to
te
smaer
anterory.
segment
te
nasa
wt
part
gves
o
rse
te
promnences
te
maxary
ntermaxary
rontonasa
nose,
to
te
maxa,
mdde
and
te
N
te
o
wt
eac
to
gve
gves
rse
to
parts
o
te
o
te
eyes.
73,
retna ssure to cose
merge
promnences
segment.
emnence
and
1059–1060;
not
s
paate.
cooboma
tyrod
process
ocated
premaxary
medan
to
paate
embryoogcay
processes.
A.
A
te
s
paatne
GAS
B.
te
cosure
3.
o
wc
ntermaxary
oter
he second paryngea groove merges wt te trd
to
he
part
medan
oreead,
and
D.
atera
he
prmary
aone.
B.
paate
upper
str uctures.
C.
argest
prmary
s nus ,
o
he
ondary
b ran -
o
c er v ca
A.
77;
rs
s
ABR/McM
caused
by
1,
te
9
aure
durng te sxt embryonc week.
Abnorma
neura
abnorma
deveopment
crest
ormaton
o
woud
corod,
ead
scera,
to
and
cornea.
C.
Abnorma
ectoderm
nteracton
woud
ead
between
to
te
abnorma
optc
vesce
and
deveopment
o
CHAPTER
te
entre
deveop
D.
he
rs
E.
pacode
may
a
to
B.
not
be
afect
afected
posteror
by
abnorma
deve-
and
camber.
C.
congenta
925–926;
N
anteror
sagtta
and
corona
o
A.
posteror
detacment.
ABR/McM
ontanee
monts
he
94;
retna
s
51
D
ocated
sutures
and
at
te
coses
juncton
at
around
o
18
o
te
sagtta
at
suture
around
2
to
s
and
3
ocated
at
ambdod
te
juncton
suture,
and
C.
ar
squamous
suture
D.
A.
not
te
a
852;
N
13,
by
opment.
he
te
B.
and
to
3
s
and
cysts
te
n
a
and
ambdod
at
te
corona
juncton
suture
te
te
sxt
duct
o
aong
and
we
pat
durng
deve-
B
cecum
o
ay,
te
na
arc
provdes
orgn
to
te
poston
connected
to
te
and
stapes,
trd
paryngea
musce
bone.
varous
parynx
o
te
musces
and
ourt
and
woud
not
caracterstc
and
cartages
o
produce
rst
arc
s
case
te
n
te
te
ventrce
(o
CSF
s
condton
te
resuts
Syvus).
and
n
ventrcu-
rom
hs
te
eads
rom
trd
te
ventrces
unafected.
producton
woud
a
upstream
atera
ydrocepaus
hs
to
wtn
obstructon
aqueduct
expandng
CSF
reers
obstructed
ncreasng
ourt
D.
a
or
ead
s
because
nefectve
to
o
eter
CSF
enargement
reab-
o
a
cambers.
Anencepay,
parta
bran
GAS
9.
s
absence
cosure
o
te
aso
o
known
te
as
bran
anteror
meroanencep-
and
s
because
o
neuropore.
Hooprosencepay s a aure o ceavage o te ore-
musces
tongue.
woud
te
C.
and
woud
865–866;
Bot
te
N
resut
157;
neror
n
a
snge
ABR/McM
paratyrod
used
72,
ventrce.
81
gands
and
te
tymus
C.
A branca cyst woud not be present n te mdne,
are derved rom te trd paryngea (branca) pouc.
t
hereore,
D.
he
woud
be
trd
present
E.
he
rst
GAS
998;
he
uson
N
77;
most
o
and
te
te
te
atera
arc
musce
paryngea
mastcaton
E.
on
paryngea
styoparyngeus
and
arc
ABR/McM
to
te
wt
bone.
rse
and
orgn
to
musces
o
A.
ncus.
B.
o
process
cet
and
p
te
A.
s
aure
nences
ocated
and
te
deveopment
B.
Faure
woud
o
between
maxary
o
te
uson
produce
a
te
atera
processes
nasoacrma
o
te
meda
medan
cet
nasa
woud
afect
p,
a
E.
rare
te
congenta
he
te
quent
D.
he
not
atera
rom
and
nasa
medan
pacodes
nasa
and
processes
do
not
bot
undergo
arse
subse-
uson.
atera
GAS
musces
N
sted
(branca)
o
C.
tyrod
o
te
N
te
89;
s
o
arses
o
te
nodes
are
tymus.
aggregaton
s
not
o
assocated
rom
stomodeum
o
te
an
ora
out
tyrogossa
te
o
endoder-
and
s
not
tymus.
pocketng
cavty,
deveopment
n
te
an
and
rom
ABR/McM
key
abnorma
ymp
o
deveops
te
prmtve
wt
assocated
an
tymus.
deveopment
route
deect
te
be
pouc.
rom
tongue
gand
loor
gand
o
assocated
nasa
promnences
do
not
use
wt
eac
rod
gands
53;
ABR/McM
symptoms
arc
are
syndrome
mastcaton,
as
14
pouc.
typca
te
o
rst
myoyod,
rst
arc
anteror
paryngea
gves
bey
rse
o
to
te
mus,
derved
A
In
and
are
derved
and
addton,
te
rom
B.
dgastrc, tensor tympan, tensor ve paatn, maeus, and
membrane
te
te
ncus.
te
wt
loor
1011;
he
te
to
o
descendng
duct,
te
and
t
s
tymus.
30
deveopment
o
trd
and
rom
te
ourt
pouc,
wereas
te neror paratyrod gands are derved rom te trd
1066;
he
GAS
10.
deveops
on
deveopment
n
paryngea
deveopment
submandbuar
buds
key
ndcatng
juguodgastrc
tons
nodues
s
tssue,
ourt paryngea pouces because te superor paraty-
oter.
A.
ngua
aong
anomay.
C.
he
he
promnences
trd
o
assocated
duct.
nasa
te
wt
ma
te
o
assocated
wt
prom-
tymus
not
ymp
ntermaxary
ectopc
paratyrod
Deveopment
he
o
D.
Deects
an
ectopc
deveopment
33
cause
maxary
yod
gves
maeus
common
neck.
provdes
segment.
7.
te
deectve
and cartage o te neck and woud produce a mdne
mass
te
deveopment
cerebra
ventrcuar
gand
to
arc
styoparyngeus
ydrocepaus
ts
sorpton.
oramen
mdne
o
te
mandbe
Nonobstructve
retenton
te
ony
afect
CSF
te
pressure
E.
paryngea
In
o
excessve
because
second
expresson,
bone.
yod
and
o
obstructon
tyrod.
he
low
system.
A.
tyrod
at
woud
arynx
stenoss
14
occur
descendng
descends
suture,
s
to
ocated
tyrogossa
begns
here
monts.
ABR/McM
te
ambdod
year.
ontanee.
suture
2
duct
pat
te
rst
ontanee
16;
o
te
and
te
ambdod
around
remnant
tongue
o
squamous
at
oowed
o
a
hyrogossa
o
suture
end
spenoda
coses
GAS
te
but
he
o
at
te
Obstructve
o
te
o
te
397
Neck
GAS 950, 966, 998; N 55–56, 105; ABR/McM 35, 39, 57
8.
wc
coses
afect
ypopastc
B and C. he mastod ontanee s ocated at te juncton
t
yod
Abnorma
arc
o
aca
deveopment
woud
E.
te
o
and
syndrome.
t
monts.
o
parts
te
te
ontanee
musces
parts
and
sxt
age.
deveopment
te
Abnorma
and
to
coses
6.
Abnorma
eads
o
5.
te
ens
arc
he
te
o
a
abnormay.
Weak adeson between te ayers o te optc vesce
GAS
4.
because
deveop
woud
opment
E.
eye
or
Head
7
te
he
and
paatne
te
trd
paraocuar
ourt
rst
tonss
and
o
he
gves
rse
to
tyrod
te
ty-
gand
are
pouc.
rse
second
tonsar
gves
te
paryngea
pouc
cavty.
pouc
ces
to
te
pouc
snus.
tympanc
gves
rse
to
398
C H A P T E R
D
and
sxt
o
E.
Head
and
Abnorma
arc
te
te
7
woud
arynx
deveopment
afect
and
ypopastc
Neck
varous
parynx
mandbe
o
te
musces
and
ourt
and
woud
not
caracterstc
and
B.
Excess
cartages
o
o
produce
rst
GAS
C.
arc
C.
An
1011;
N
89;
a
mutactora
a
studes
A,
D,
B,
pay
a
remans
GAS
12.
C.
te
1066;
te
A.
he
because
pouc
second
and
tonsar
he
ourt
ror
paratyrod
te
maton
pouc,
as
been
ave
seems
a
E.
to
actors
o
a
may
cet
p,
or
may
but
not
genetcs
GAS
16.
actor.
C.
GAS
D.
gves
deectve
ter
deveopment
norma
to
paratyrod
cornua
to
te
N
te
ste
o
o
and
rse
to
pouc
orgn.
tympanc
te
gands
and
gves
te
meata
mem-
n
he
B.
he
paatne
rse
to
tonss
te
supe-
paraocuar
contrbutes
he
o
he
and
GAS
14.
E.
A
te
o
te
n
te
ces
ces
o
to
te
te
atera
or-
yod
to
tyrod
bone,
te
n
greater
E.
addton
ceeks
and
s
mportant
upper
n
te
part
arc
o
te
pay
gves
arces,
o
no
rse
yod
n
A
dermod
te
cyst
and
part
we
n
esser
near
te
atera
B.
A
swoen
C.
Accessory
route
o
D.
extensvey
te
and
C.
mus-
deveopment
ymp
tyrod
s
cystc
tongue
o
node
tssue
o
te
or
A.
1005;
s
77;
low
o
s
caused
by
present
teratoma
te
remnants
anteror
to
o
te
to
oten
occurs
wt
stuated
duct,
mdne
o
aong
eter
te
pan.
n
wtn
te
an
as
a
resut
causatve
to
cose
may
woud
s
he
because
ventrcuar
o
a
18.
B.
o
actor
ead
on
not
te
to
por-
resut
n
an
tat
a
buton
and
neck.
o
te
cd
taste
(Appearance,
o
An
atretc
aure
normay
o
te
occurs
te
petrosa
not
dorsa
ower
N
n
and
s
nerve
n
not
ead
supped
by
te
nerve,
men-
wc
dvson
o
te
suppes
te
regon,
temporo-
te
parotd
s
gangon,
s
o
(aso
externa
and
erpes
aso
and
sensory
nose,
known
a
nerve
dsease
nnervaton
and
as
ocaton
trgemna
know
occurs
nerve
zoster,
upper
p.
38
as
tc
over
te
o
semunar
te
nerve
sensory
(CN
dououreux)
te
area
V).
s
a
o
dstr-
te
aca
brances.
gangon
transmts
te
parasympatetc
te
te
te
pan
a
by
provdes
sde
ABR/McM
o
to
ceek.
ganga.
VII)
woud
aveoar
sensory
nerve
gangon,
(CN
are
tempora
nerve
trgemna
resuts
meatus.
mandbuar
root
wc
deveop
).
afected
neuraga
to
deveop-
meatus.
3
be
bodes
tympanc
acoustc
recess
neror
te
eyed,
59;
te
anterory.
nerve
o
to
57
area
te
ear
absent
deveop.
acoustc
te
V
an
abnorma
externa
to
n
abyrnt.
rse
an
ocks
ear
p
o
jont,
resuts
gves
and
te
te
(CN
gencuate
ner ve
as
o
surace
ce
he
tat
orm
ABR/McM
branc
nerve
to
afect
ower
trgemna
condton
event
tubotympanc
nraorbta
neuron
breatng
because
pouc
externa
branc
Gasseran
A.
obstructon
system.
81
Respraton).
membranous
aurcuar
106;
esser
975;
he
pt
externa
and
woud
te
te
known
te
bucca
te
he
an
aurcuotempora
he
and
and
cavty,
not
te
N
s
he
GAS
s
ound
receves
on
sensor y
pregangonc
bers
or
parasympatetc
bers.
C.
aso
72,
ndcates
occurs
te
and
atretc
cn
turn
te
28–35
ydrocepaus,
o
T rgemna
present
normay
te
tat
eyebrow.
key
ABR/McM
ydrocepaus,
CSF
a
dependng
but
score
paryngea
o
945;
to
tyrogossa
aong
Noncommuncatng
obstructve
to
N
tube
tone,
otc
degenerated
o
tons smar to were accessory tyrod tssue s ound.
15.
A
and
A cyst o te tyrogossa duct woud be ound n oca-
GAS
Faure
nterna
48
woud
aspect
descent
posteror
B.
or
a
occur
be
ABR/McM
cana
and
woud
nerve,
E.
ABR/McM
s
can
not
bda,
Actvty,
te
rst
ta
body.
cartage
157;
canaze,
mandbuar
bone.
cyst
nonob-
e.
he
he
deve-
te
to
vesce
D.
A.
to
N
musce
otc
gand,
paryngea
snus
ead
afected,
APGAR
o
trgemna
p.
mportant
sternocedomastod.
A.
17.
n
s
eta
aure
mandbe.
cervca
cervca
rse
pug
ment
musce.
deveopment
22;
spna
tube
acoustc
Faure
GAS
gves
promnence
arynx,
N
te
paryngea
yod
1080;
o
te
upper
ourt
nvoved
o
te
second
cornu
ces
o
te
membrane
30
arc
promnence
mandbuar
opment
E.
part
maxary
deveopment
C.
ABR/McM
paryngea
styoparyngeus
A.
ate
D.
pouc
paraocuar
ower
te
woud
neura
or
Grmace,
externa
gand.
89;
o
relexes,
Puse,
B.
paryngea
trd
o
but
te
norma
to
1011;
he
o
865–866;
A
puse,
neror
snus.
te
resorpton
or
appeared norma and eaty at brt, based on skn coor,
14
and
rse
paryngea
o
dsturbed
ydrocepaus.
ton
gand.
13.
sze
anencepay
determned
or
communcatng
ydrocepaus.
ncreased
Faure
A.
pouc
tyrod
t
partcuar
determnng
o
gves
D.
o
to
cavty.
he
he
sted
tymus
B.
E.
n
hs
ABR/McM
te
be
and
consdered
CSF
to
ydrocepaus.
mportant
53;
o
rst
or
are
p
factor.
oter
paryngea
brane
cet
deveopment
most
woud
trd
he
te
N
30
cets
twns.
E.
n
Absence
gands
genetic
o
and
roe
o
etoogy,
strong
usng
ABR/McM
orms
o
rse
ydrocepaus
Wereas
ave
gves
structve
syndrome.
11.
producton
CSF
he
te
neror
gossoparyngea
gossoparyngea
gemna
nerve,
medatng
te
and
pan.
s
nerve
not
gangon
(CN
te
ste
IX),
o
s
not
te
part
te
ce
o
tr-
bodes
CHAPTER
D.
he
otc
gangon,
te
ocated
son
o
trgemna
onc
parasympatetc
on
te
nerve,
ce
mandbuar
contans
bodes
or
dv-
parotd
he
te
gand
secreton.
E.
snuses,
postgang-
GAS
22.
pterygopaatne
gopaatne
ossa,
gangon,
aso
ocated
contans
n
te
ptery-
postgangonc
sympatetc ce bodes or acrmaton and
GAS
C.
V1)
to
910;
he
tve
para-
mucosa
o
133;
suppes
pan
A.
N
B,
ABR/McM
sensory
wen
and
branc
o
81
nnervaton
trgemna
to
te
nerve
eyeba,
(CN
Pan
n
te
ard
paate
and
eadng
ower
E.
Parestesa
woud
te
GAS
20.
branc
D.
N
61;
tumor
a
he
te
at
bucca
by
nerve
te
te
(CN
t
nerve
A.
eyed,
(CN V
o
V
B.
ace
o
).
C
and
woud
afect
compress
te
ypogossa
ypogossa
nerve
cana,
by
C1,
ater
and
t
wc
passes
woud
runs
be
he
a
C.
he
he
C2
GAS
21.
C.
nerve
te
(CN
s
by
te
nerve
mandbuar
V
to
dvson
vagus
carred
by
ypogossa
1086–1087;
superor
nnervated
N
70;
by
rom
nerve
C1
te
to
A.
s
aca
carred
ner ve
gand
he
or
and
by
are
snuses,
gencuate
taste
carred
te
rom
by
hs
suppy
or
v a
cord a
pe trosa
or
auto nomc
o
te
p ter ygopaatne
te
tw o-t rd s
ty m p an
a s o
b ranc
s up p y
contans
an te r or
branc
te
te
gan g on
te
te
ner ve.
gre ater
respo n s b e
c ar r es
B.
submandbuar
and
te
te
to ngue
o
te
he
vaton
ead,
to
sensaton
externa
B
and
petrosa
bers
tat
D.
skn
o
te
provdes
tempora
temporomandbuar
rom
nerve
carred
E.
te
regon
jont,
anteror-most
and
porton
o
o
te
provde
by
n
te
te
savatory
nuceus
pregangonc
gangon,
esser
parasympatetc
gossoparyngea
otc
and
nerve
(CN
provdng
IX)
parotd
nnervate
ony
gangon
acrmaton
ncudes
and
te
bers
tat
paranasa
vesses
te
to
ocated
braca
te
upper
on
te
o
prenc
C3
to
C5
coumn.
reducton
o
tat
rom
o
and
o
bood
extensve
suppy
te
ead
juguar
toracc
o
anas-
bood
woud
and
ven
to
be
s
woud
syndrome.
ven
not
neck
and
outet
te
ABR/McM
to
run
nerves
s
near
te
occuded
or
ead
and
s
neck.
ptoss,
and
upper-
sympa-
he
usua
known
as
andross
Postgangonc
arteres
te
suppes
commony
moss,
te
wc
trunk,
njury,
regon.
on
218
gangon,
te
are
to
and
te
gangon
eadng
by
n
sympatetc
nto
te
ead
rom
ony
te
ncudes
anteror
aca
to
sympa-
ce
bodes
ead.
ce
bodes
two-trds
nerve;
nnervaton
carry
neck.
t
aso
many
or
o
te
transmts
sectons
o
ace.
gangon
to
bers
not
and
ncudes
te
te
does
ead
nerves
gangon
rom
carred
cary
t
o
sensory
sensaton
ead
gangon
areas
gencuate
te
coursng
woud
not
provdes
eye,
and
troug
account
parasympatetc
aso
or
as
but
te
some
not
sympa-
synapsng;
symptoms
o
te
ace.
GAS
24.
A.
1025;
he
N
142;
corda
nratempora
t
account
to
te
B.
I
s
or
te
oss
sense
corda
present
ducton
savary
o
jons
and
joned
te
speca
woud
ABR/McM
tympan
ossa,
two-trds
pterygopaatne
dmensons
on
ram
because
sympatetc
neck
aferent
he
beore
neror
te
regon.
tetc
te
genera
ncude
ocaton
SCG
nnervaton
nner-
stmuaton.
he
he
te
savar y
sensory
te
parasympatetc
ac a
ear.
he
synapse
gand
E.
te
te
nerve
by
connec-
usuay
eeng
ventra
nterna
195;
trgemna
tus,
aurcuotempora
or
wa.
cervca
or
tongue,
gands.
A.
s
vertebra
wa
submandbuar
taste
paras ympate t c
subngua
o
and
neck
he
D.
gang o n.
b od e s
not
te
body
syndrome,
rom
acrma
ce
o
br an c
te
o
te
191,
usuay
he
nuceus or te aca ner ve (CN VII). Parasympatetc
bers
mted
rb
mpnge
te
return
nnervaton
tetc
te
musces,
te
some
te
because
te
N
part
ead
and
48
nuce us
caracterzed
mpngement
wt
te
superor
symptoms
nerve.
ABR/McM
sa vator y
bers
o
151;
he
nerves
s
o
toracc
because
tetc
te
3
te
can
no
between
afected
Horner
by
s
cervca
eaves
does
Venous
myo-
).
nnervated
he
toracc
troug
o
X).
tyroyod
he
supped
o
paatogossus
(CN
E.
s
branc
trgemna
C.
most
myoyod
yod,
E.
s
GAS
23.
unafected.
B.
o
dstended.
troug
tereore
te
anteror
be
hs
t
parae
to
mdne
supped
two-trds
39
constrct
oss
be
syndrome
and
not
geno-
suppes.
s
woud
many
cana
anteror
accessory
and
n
because
te
3
XII)
vertebra
tomoses
81
(CN
tat
nerve
low
dvson
rb,
outet.
here
he
).
te
te
399
Neck
8.87 ).
syndrome
cervca
resutng
on
Fg.
ABR/McM
outet
bands
drecty
2
porton
mandbuar
ypogossa
nerve
musce
te
te
trgemna
ABR/McM
genoyod
wt
te
medated
ypogossa
gossus,
A.
over
trgemna
903;
A
te
be
o
134;
a
C7
taste
and
mb.
and anestesa o te upper p woud be carred by te
maxary
te
damaged.
D.
o
not
( GAS
toracc
pexus,
te
N
tssue
te
on
optamc
900;
horacc
presence
secreton.
19.
D.
but
tongue
Head
7
a
by
o
o
te
a
tongue)
te
te
o
and
tympan
sava
njured,
taste
a
be
wt
n
te
nerve
woud
no
oss
producton.
(rom
decrease
submandbuar
woud
nerve
ngua
sensaton,
were
oss
ngua
to
corda
and
tympan
because
gands
eson
genera
taste
wt
47
te
te
te
n
and
denervated.
patent
anteror
sava
pro-
subngua
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
neror
vaton
to
aveoar
te
nerve
mandbuar
provdes
teet,
sensory
but
no
GAS
Fig.
8.87
nner-
suc
oss
sku
s
he
E.
to
ton
reated
te
he
ven)
Nerve
oss
rom
te
o
he
o
present
na
oss
o
nerve
te
taste
tongue
but
tere
nnerva-
and
s
no
route
one
cavty.
and
he
nput
nerve
no
(CN
(CN
woud
VII)
not
rom
tere
te
motor
te
X],
gag
relex,
ead
to
relex.
wc
exts
by
te
cana.
afected
ace
and
te
woud
te
musces
ts
scap
nvovement
dua
nerve
be
present
vestbuococear
vestbuococear
858;
A.
o
o
njury.
woud
te
but
nerve
was
wt
o
nerve
(CN
ormay
vestibulocochlear
20;
26.
E.
ary
artery
menngea
be
te
B.
njury
te
and
courses
between
a
branc
te
o
dura
te
max-
mater
to
n
a
resutng
arter y
te
arteres,
afects
te
by
(GAS
or
ac-
n
ends
an
bend
maxar y
and
and
neter
mennges
o
o
te
w
(CN
cause
he
o
te
nerves
nner-
rectus
aso
or
te
va
provdes
tus,
nabty
pup
te
(CN
mus-
superors;
ptoss
o
woud
musces
nerve
papebrae
constrcton
parasympatetc
an
because
abducens
atera
ocuomotor
III)
ateray
and
and
compete
(CN
and
IV)
obque
evator
te
to
8.33).
nerve
downward
he
te
penetrate
contrbute
42
contractons
(superor
not
not
Fg.
ocuomotor
trocear
to
do
woud
ABR/McM
pont
eyed.
he
optc
aspect
he
and
o
aca
eyed
D.
he
or
oss
GAS
te
o
d
bnk
s
to
pro-
ocuomotor
neck
oss
or
te
sensory
eye.
te
ocu,
coud
aca
wc
be
musces,
coses
te
tarsa
s
damaged
parasympatetc
ncudng
64;
te
ptoss
sympatetc
sympatetcs
N
o
expan
(superor
ony
te
relex.
gangon
te
n
nnervates
provdes
889–890;
retna
orbcuars
adequatey
and
responsbe
te
nerve
but
SCG
s
va
te
cary
patent,
he
nerve
gt
ncudng
E.
s
artery
nto
arteres
tus
te
respectvey).
vded
to
11
artery
and
to
te
upper
mdde
racture
resuts
nerve.
26–50
he
Any
typcay
carotd
tempora
unopposed
ead
Answers
pteron.
dvdng
drecty
112;
eye
by
not
ABR/McM
N
nerves
any
VIII).
reers
externa
by
ematoma
nnervaton
com-
caed
ceary
te
menngea
tempora
sku
te
te
VI)
uncton.
N
deep
njury
vated
trgem-
any
he
arteres
979;
An
cause
C.
earng
auditory
GAS
27.
rase
by
mdde
C.
epdura
ces,
supped
o
ocaton
bran.
and
jugu-
output.
woud
entrey
nnervates
be
was
or
te
XII),
ypogossa
[CN
ts
superca
he
tree
gossoparyngea
gag
amost
or
(nterna
oramen
tus
are
ext
vagus
ven
provdes
ts
o
area
to
mandbe
tese
dect
te
and
te
sensa-
te
ematoma.
bony
IX],
and
wtn
sensaton
o
B,
82
te
sensory
te
o
[CN
nerve
systems
ony
o
A.
D.
s
crana
te
and
presson
he
no
nerve.
Loss
ts
te
troug
aca
but
provdes
relex,
nerves)
movements
ace
Loss
GAS
XI]
ypogossa
te
D.
gag
ABR/McM
vagus
bot
T ongue
sku
C.
[CN
gand,
o
epdura
patent.
compresson
te
B.
trd
oramen
provdes
wereas
a
53;
te
nerve
(gossoparyngea
nerve
A.
to
ts
N
parotd
postgangonc
te
posteror
juguar
accessory
ar
n
1090;
nerves
te
nnervates
present.
gossoparyngea
present
25.
s
ton
GAS
nerve
suppyng
savaton
he
petrosa
to
trauma
eraton
esser
neurons
E.
cose
mpact
present.
D.
canal
fibers
•
he
plexus
fibers Ner ve
C.
ar ter y
te
te
evdent
n
o
52–54
to
musce
Müer),
ts
ts
w
eyed.
nnervaton
smoot
musce
ABR/McM
o
n
suppy
n
but
patent.
te
te
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
scap
nectve
and
dvded
A
tssue,
perosteum).
between
oose
te
ts
zone”
ere
can
vens,
hs
o
te
be
ten
s
scap
oose
s
and
va
w
be
o
te
te
many
because
nto
te
o
to
scap
sku
te
bone
A.
An
cause
tat
te
n
In
“dan-
perosteum
togeter;
between
C
and
sue
and
but
E.
D.
and
te
he
skn
seen
ton
911;
B.
crana
to
areas
provdes
separated,
10,
are
key
C.
te
he
tgty
to
nd
bound
D
nectons
and
do
tese
31;
not
very
and
te
dense
between
vens
a
and
ncude
o
te
strong
and
tus
areas
te
5,
connectng
vens
barrer
aganst
ayers
keood
woud
ABR/McM
4
ts-
tssue
ead.
derms
te
connectve
connectve
be
rare.
are
o
an
sde
ntact
te
te
uvua.
(CN
te
ony
te
te
contraatera
o
te
unnjured
ve
paatn
w
sde
s
musce
sde
vagus
s
uvuae
one
actve
to
evator
woud
hs
muscuus
I
o
X)
rgt.
o
te
nerve).
pu
te
sde.
rgt
vagus
nerve
woud
pu
te
uvua
sde.
and
et
musces
he
ypogossa
and
woud
te
oroparynx
82,
137;
to
tese
ner ves
not
gossoparyngea
to
nnervaton
N
o
to
nner vate
afect
nerve
and
te
te
uvua.
suppes
sensory
nasoparynx,
but
areas.
ABR/McM
47
E. he rma gottds s te openng between te voca ods
and te arytenod cartages
A.
he
prorm
ynx
atera
B.
he
nec-
rarey
889;
nerve
devated
contracton
uvua
te
vagus
nnervates
core
ntact
to
motor
GAS
30.
te
rgt
E.
et
nerve
te
te
et
nnervaton
not
between
epderms
between
bone
not
up
te
Injury
to
ayers.
ayers,
te
N
s
superca
skn
tons;
GAS
tese
and
t
aponeuross,
many
he
tus,
ar ter y
ar ter y
become
(psatera
tongue
he
phar yngeal
ar ter y
nnervated,
addton,
uvua
te
to
vagus
devate
njury
cavty.
A.
te
makes
w
wc
to
uvua
efectvey
emssary
te
njury
te
because
nectons
va
to
29.
tssue,
te
carotid
ar ter y)
8.33
(skn,
ocated
as
Fig.
ocated
wt
vens
reerred
con-
wtn
ease
GAS
tssue,
SCALP
perosteum,
usuay
vens
dense
connectve
nectons
many
dpoc
skn,
connectve
mnemonc
because
spread
area
ayers:
oose
T ypcay,
transmtted
va
ve
aponeuross,
tssue,
agents
regon.
andy
aponeuross
connectve
nectous
nto
aponeuross,
perosteum.
and
ger
s
tssue,
connectve
branch
ver tebral
Ascending
B.
ar ter y)
ar ter y (from
28.
branch
occipital
nec-
and
C.
he
recess
to
vestbue
rma
s
on
te
te
aryngea
te
rgt and
recess
n
te
et sdes.
aryngopar-
openng.
regon
between
te
epgotts
gottds.
ventrce
voca
te
s
cords.
s
te
area
between
te
true
and
ase
402
C H A P T E R
D.
7
he
vaecua
ynx
anteror
tongue
GAS
31.
D.
N
snus,
ar y
s
Neck
batera
te
recess
epgotts
s
s
aryngopar-
posteror
to
C.
D.
ne cton
n
c an
he
te
be
o
b ody
a
s
o
major
d fe ren ce
c o c e s
te
te
max -
te
ocat on
o
GAS
35.
te
te
B
and
rory
E.
D.
to
he
te
snus
s
ocated
posterosuperor
to
nasa
snus
anteror
he
vagus
o
part
s
o
N
te
s
n
ocated
te
aterosupe-
he
a
ronta
ower
aso
or
43,
bone
n
B.
he
o
relex
n
te
ony
regon
he
ace
and
dvson
te
nnervaton
and
a
o
A.
surroundng
to
motor
motor
o
te
te
te
nerve
mout
nnervaton
trgemna
to
maxary
te
n er ve
B.
and
to
to
nerve
te
te
ypogossa
o
coug
GAS
33.
D.
ear
ng
A.
and
(gag
s
not
36.
rele x)
and
C.
82;
(eustacan)
and
nasoparynx,
most
o
te
ABR/McM
tube
s
meatuses
but
a re
a re
not
he
but
d re c t y
assocated
te
condut
tey
and
te
mdde
or
spread-
are
not
pod
GAS
B.
or
tssue,
945,
he
te
he
947,
optc
gt
optc
but
te
not
afect
recess
te
s
a
to
Adenods,
can
949;
and
sensory
pupary
A.
E.
and
aca
te
and
tat
te
nasocary
nerve;
aows
trocear
brances
te
o
abducens
wt
nner
te
and
mdde
outer
e a r,
deveop
N
st-ke
te
audtory
enarged
ocated
tube
masses
n
o
115;
ocuomotor
nerves
portons,
are
responsbe
o
pup.
te
cornea
relex
eye
orbta
ssure
te
mparment
nerve,
a
o
contans
contans
nerve,
te
to
because
are
trans-
ssure.
te
maxary
nraorbta
pterygopaatne
addton
s
wc
vesses,
gangon.
optamc
sympatetc
artery
and
bers.
dvson
o
te
trgemna
nerve,
te
acces-
923;
N
BP26;
ABR/McM
23,
25
te
ntensty
he
accessory
he
vagus
sound
te
nerve
suppes
does
te
trd
mdde
enterng
te
te
tongue
nner
ear.
musces.
trapezus
and
ster-
not
provde
any
nnervaton
ear.
gossoparyngea
posteror
sound
nnervates
musces.
nerve
n
o
nerve
o
ear
nerve
te
ony
tongue,
cavty ,
and
suppes
te
sensaton
oroparynx
tympanc
to
(gag
membrane,
884,
acoustc
coug
to
be
o
te
A.
D.
107;
and,
wen
20%
“reerred
wc
nner
s
te
te
a
part
57–58
o
stmuated,
o
peope.
sensaton”
nnervated
nerve
s
hs
rom
by
te
can
te
externa
trgger
s
te
vestbue
vagus
assocated
a
tougt
nerve.
ony
wt
ear.
trgemna
to
ABR/McM
nnervates
vestbuococear
he
he
N
about
o
arynx,
afect
te
n
because
he
nerve
meatus
relex
te
C.
887–888;
vagus
nerve
externa
coug
aurcuar
does
provde
acoustc
relex
branc
as
o
does
te
some
meatus
te
but
vagus
aca
nnerva-
does
not
nerve.
nerve
ony
pro-
vdes a sma amount o genera sensory suppy to te
externa ear; t s not assocated wt te coug relex.
woud
nerve
n
ypogossa
he
57–58
respectvey,
o
cana
nerve,
889,
ton
ABR/McM
te
trgemna
he
GAS
B.
te
ym-
orbta
optc
he
tere.
BP29,
motor
openng
o
and musce nnervaton to te styoparyngeus musce.
relex.
nerve
and
components
wereas
te
he
te
nvoved
acoustc
o
brances
or
externa
assocated
wt
entrance
nasoparynx.
openng
trgemna
ocuomotor
nocedomastod
37.
nterna
paryngea
bend
34.
C.
te
re s p e c t ve y.
E.
te
nerve
B. he aca nerve nnervates te stapedus musce, wc
45
connects
te
te
neror
reducng
mus-
wt
necton.
Te
s
s responsbe or mtng movement o te stapes, tereby
styopar yngeus
assocated
nerve,
to
relex),
te
te
relex.
sory mdde menngea artery , and an emssary ven.
D.
N
nasoparynx
spreadng
nerve
or
he oramen rotundum contans te maxary nerve.
nectons.
n
ear
nnervates
and
1041–1042;
te
ronta,
te
cornea
51
ocuomotor
o
trgemna
te
he oramen ovae contans te esser petrosa nerve, te
he coanae are te openngs between te nasa cav-
ty
B
nerve
tongue
audtory
and
gt
ssure
motor
and
GAS
s ens o r y
and
mandbuar
relex.
892,
he
te
te
to
E.
A.
ces
o
te
ABR/McM
te
ony
surround-
D.
pro-
bone.
te
eson
optc
mdaca
p rov de s
orop ar ynx
nner vat on
he
not
orbta
dvson
dvson
musce.
E.
but
acrma,
sensory
he
swaowng
trgemna
to
nnervaton
gossopar ynge a
and
o
nnervaton
sensory
nner vaton
dvson
nnervaton
mtted troug te superor
mastcaton.
maxary
vdes
C.
atera
o
o
nerve
skn
are te optamc dvson o te trgemna nerve and te
82
sensaton
motor
coug
dvson
sensory
and
musces
te
ocuomotor
ABR/McM
and
ntate
mandbuar
provdes
97;
te
ven; and te sympatetc bers rom te cavernous pexus.
ace.
responsbe
arynx,
tat
are
he
ocated
49–51;
nerve
te
musces
snuses
(motor).
A.
passage
optamc
septum.
1063–1064;
N
trgemna
to
bone.
sensory
superor
te
nerve; te superor and neror dvsons o te optamc
etmoda
ronta
mucosa
te
889;
he
te
nasoparynx.
C.
te
32.
spenoda
he
GAS
C.
nerve;
he
maxary
relex,
o
nnervaton
optamc
cornea
s ympto m
te
te
he
dvson
sensory
provdes
max -
b e twe en
maxary
provdes
snus.
A.
he
te
ng
an
p a n
snust s .
answer
te
49
oc ate d
Sarp
n
just
8.221).
ABR/McM
snus t s
maxar y
remanng
a
Fg.
91;
wc
bone.
and
to
(GAS
1049;
Max ar y
ar y
o
Head
ncude
ony
coses
te
te
sensory
eyed
porton,
and
does
E.
he
te
GAS
accessory
externa
945;
N
nerve
does
not
provde
ear.
106;
ABR/McM
57–58
nnervaton
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
te
recurrent
motor
beow
te
ar y n ge a
nner vat on
tr ue
voca
to
ner ve
te
o d s.
s upp es
ar ynx
he
and
ty rod
GAS
most
Fig.
o
sens ato n
g an d
recurrent
ar ynge a
n e r ve
are
n
c os e
fold
8.221ABC
brances
tus
te
ner ve
s
te
mos t
ke y
to
a
tyrodectom y.
gea
ner ve
In jur y
to
te
o
sympatetc
nterna
tese
resu t
n
sp e ec
nerves
response
s
artery,
to
date
and
te
one
resut
pup
o
(“lgt
or
durng
gt”).
he
ocuomotor
re curren t
d e ec ts,
nerve
woud
not
afect
te
daton
nj ured te
pup;
rater,
ts
stmuaton
resuts
n
te
ar y n constrcton
can
carotd
p rox m ty
be
o wt
te
stmuaton
A. and
o
and a
te
glottidis
tubercle
Corniculate
38.
vestibuli
fold
(parasympatetc
nerves).
nc ud ng
C.
he
nervus
ntermedus
s
te
parasympatetc
oarseness.
A,
B,
and
brances:
mucous
and
D.
te
he
nterna
membranes
te
superor
externa
o
aryngea
aryngea
te
aryngea
nerve
nerve
arynx
above
nerve
as
two
nnervates
te
voca
nnervates
te
component
te
ods,
maton
D.
he
tyrod
musce,
gossoparyngea
wc
tenses
te
nerve
voca
s
true
voca
ods
and
woud
superory
bodes
39.
B.
ony
acr-
te
nuceus
s
te
pregangonc
ocaton
o
te
parasympatetc
not
be
afected
tat
are
carred
by
te
ocuomotor
nerve
sympatetcs).
by he
trgemna
gangon
ony
provdes
sensory
procedure.
1010;
he
ace
afects
eye.
o
nnervaton GAS
and
to
E. ts
nerve
ods.
ocated
(not te
aca
Ednger-Westpa
neurons he
te
te
crcoce
E.
o
to
N
SCG
and
89;
ABR/McM
provdes
neck
te
ace
and
eye
but
49
sympatetc
regons.
to
nnervaton
Sympatetcs
trave
to
te
aong
te
efect
GAS
on
920,
te
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 parasympatetc branc
o
o
damaged
te
aca
gand
A.
n
he
nerve,
te
provdes
B.
te
he
te
D.
deep
te
and
esser
he
we
d
to
to
te
as
nerve
o
gands
te
carres
vesses
and
to
aso
te
taste
GAS
sympatetc
and
mucous
nner-
gands
nerve
te
ne r ve
nner vaton
as
provdes
parotd
44.
o
41.
C.
s n us e s
to
we
te
as
parasympatetc
s k n
te
se ns or y
o
te
py
te
s up e r or
n ne r va -
cor ne a
upp e r
nos e
A,
as
he
w
n
most
te
tan
A.
snus
to
dspace
to
te
peope
orbta
s
te
te
o
ABR/McM
ocated
te
space
o
e ye-
te
actuay
D,
E.
orbta
beow
so
te
a
neror
wa
structures
te
o
bony
anteror
te
orbt
n
s
to
te
te
(maxary
eyeba
bow-out
o
com-
snus).
stronger
racture
s
te
orbt
more
tan
GAS
45.
he
o
te
N
very
basar,
are
rarey
ocated
njured,
descrbed.
atera
(o
artera
te
carotd,
ts
not
bood
Ws),
crce
nterna
crce
arteres.
contnua-
tereore
t
part
sup-
does
crce.
posteror
ABR/McM
not
and,
receves
te
rom
nterna
151;
t
te
and
crce
o
actua
communcatng
871;
s
artery
cerebra
he
be
61
artera
part
ear
symptoms
artery
suppy
can
sted
mdde
Atoug
any
bood
ner ves
te
carotd
cerebra
arteres.
burcaton
te
wt
nerve
meda.
oter
cerebra
orm
aca
ABR/McM
crce.
and
ts
te
otts
to
nterna
artera
vertebra
rego ns
he
110;
mdde
rom
B,
E.
present
N
te
receves
51–54
drecty
neror
scera
loor,
rupture
he
134;
trauma
key
partment
In
N
maxary
Any
not
he
not
and
and
o
proxmty
875;
te
proxmty,
because
communcatng,
921–922;
orbt.
C.
ton
gand.
p rovd es
D,
woud
tongue.
ateray.
GAS
cose
cose
o
etmod a
meday
ts
n
neck.
nasocar y
ton
acrma
nnervaton
subngua
bood
petrosa
nnervaton
E.
and
provdes
two-trds
petrosa
to
ead
he
te
A, B,
tympan
anteror
vaton
to
orbt.
corda
submandbuar
to
nnervaton
s
(o
ormed
cerebra,
anteror
(GAS
Ws)
carotd
te
posteror
cerebra,
Fg.
and
by
and
8.38A).
67
E. he sgmod venous snus emptes nto te nterna jug-
uar
ven
posteror
ra
and
and
drans
crana
occpta
te
ossa
bran
near
bones
just
te
and
sku.
suture
atera
to
It
runs
between
te
aong
te
mastod
te
tempo-
ces.
key
eyeba.
etmoda
ces
are
ocated
meda
to
te Anterior
communicating
orbt. Anterior
B.
he
ronta
snus
s
ocate d
s up er ory
to
cerebral
Cerebral
ar terial
circle
te Middle
cerebral
orbt.
D.
he
nasa
cavty
s
toward
te
mdne
and
s
not
Ophthalmic
Posterior
neror
to
te
orbt. Posterior
E.
he
but
GAS
42.
B.
s
not
1063,
he
te
spenoda
snus
neror
1065;
superor
cavernous
N
to
s
deeper
te
ABR/McM
optamc
he
te
aca
regon
ven
18
drans
“danger
area”
Basilar
drecty
o
te
nto
ace
s Right
ocated
n
te
tranguar
communicating
cerebral
orbt.
49–51;
snus.
nto
regon
rom
te
atera
inter nal
ange Left
carotid
o
te
and
eye
s
to
draned
muncates
te
A.
te
te
by
ven,
ernous
o
but
te
aca
wt
t
s
p,
he
near
aca
cavernous
te
ven
snus
nose,
com-
troug
pexus
troug
not
communcates
te
drecty
neror
connected
wt
opta-
to
te
cav-
snus. Right
C
and
sary
E.
he
vens
ernous
D.
do
GAS
43.
C.
venous
pexus
communcate
venous
snuses
vertebra
876;
A
not
basar
petrosa
na
ronta
and
drecty
pareta
wt
ems-
te
common
carotid
cav-
snus.
he
N
eson
symptoms
84;
o
and
venous
pexus
connects
communcates
te
wt
neror
te
Right
ver tebral
Right
subclavian
Left
ver tebral
Left
subclavian
Left
common
nter-
pexus.
ABR/McM
te
aca
descrbed
59
nerve
s
(droopng
key
to
ead
mout,
to
unabe
te
to
Brachiocephalic
carotid
cose
rgt
bue)
because
eye,
and
ood
coecton
n
te
ora
vestAor tic
yzed.
here
ocated
inter nal
carotid
ven.
venous
snus
upper
ven.
te
optamc
pterygod
cavernous
mc
te
drecty
superor
he
mdde
on
te
s
te
a
musces
bony
meda
o
aca
promnence
wa
o
te
expresson
over
te
mdde
are
aca
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
•
superor
aspect
o
cerebra
sagtta
te
snus
ongtudna
es
wtn
ssure,
te
GAS
superor
between
te
two
to
te
cerebr
and
sinus
Fig.
Pterygoid
venous
plexus
8.44
T rochlear
ner ve
[IV]
he
superor
sagtta
sagtta
te
great
snus
snus
runs
wtn
cerebra
ven
neror
te
(o
ax
Gaen)
to
orm
ner ve
C.
he
Pituitar y
D.
he
nto
ven,
ossa
te
vesses
GAS
46.
C.
N
drans
snus
s
Fg.
110;
troug
s
ABR/McM
nterna
nerve.
te
sensaton
to
te
A.
aca
he
o
te
taste
corda
musces,
wtn
snus,
ven
(o
te
and
mdde
optamc
oter
venous
61
te
te
aca
he
te
aca
and
o
te
wc
aong
nerve
o
wt
provdes
two-trds
aso
musces
oramen
nerve,
meatus
anteror
branc
troug
te
tympan
except
mandbuar
courses
cerebra
superor
acoustc
vestbuococear
va
o
medates
te
a
o
mastcaton.
trgemna
ovae
and
nerve
medates Sphenoidal
motor
pan,
sellae
8.44).
te
tongue
to
te
tensor
musces
ve
o
paatn,
mastcaton,
myoyod,
tensor
and
te
(paranasal)
bey
ower
B.
he
o
trd
o
dgastrc
te
maxary
as
we
as
sensaton
ante-
to
(venous)
sinuses
te
Ophthalmic
ace.
branc
sinuses
tym-
Caver nous
ror
Dura
snuses.
te
compressng
te
great
o
ocated
receves
spenopareta
tumor
te
conluence
and
(GAS
875;
he
runs
snus
te
cavernous
crana
gland
te
snus.
stragt
Gaen)
division
of
trigeminal
ner ve
te
trgemna
branc division
of
trigeminal
ner ve
[V
] 2
sory
troug
to
te
te
mdde
oramen
trd
[V
] 1
o
Maxillar y
passes
ner ve
[VI]
ar ter y
[III]
Diaphragma
stragt
carotid
emsperes.
neror
jons
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
te
ace.
and
s
sen-
•
GAS
Fig.
8.45
mater
405
406
C H A P T E R
D.
he
7
juguar
vagus,
E.
and
and
Neck
oramen
accessory
as
te
nerves
gossoparyngea,
coursng
troug
acoustc
t.
E.
A.
he
te
beow
ocuomotor,
887–888;
105;
submenta
ncudng
A.
he
B.
he
o
N
trocear,
occpta
te
ymp
ower
abducens
ABR/McM
two-trds
te
and
nodes
o
approxmatey
mout
and
te
neroposteror
C.
were
D.
nodes
e
anteror
to
te
ear
and
he
serve
he
and
anteror
ynx
and
dran
te
E.
nodes
e
posteror
posteror
aspect
o
to
te
te
he
and
he
to
parotd
mandbe.
scap,
It
and
node
gand
and
receves
s
a
just
ymp
oroparynx
and
arge
node
beow
rom
s
te
posteror
ange
muc
commony
o
o
te
48.
A.
909;
he
o
N
GAS
ace,
enarged
n
Answers
51.
wtn
B,
te
te
nerve
and
o
trgemna
ous
snus
GAS
C.
N
suppy
tere
to
te
nnervated
as
A.
been
he
te
by
t
te
GAS
o
te
te
o
o
te
n
te
ascends
te
te
artery
A.
he
wa
o
B.
artery
owever,
te
he
C.
he
cavern-
afected
Fg.
(GAS
taste
and
o
by
E.
an
es
nerve,
o
at
wc
ts
GAS
52.
pont
s
te
a
B.
trgemna
anterory
as
branc
nerve
we
as
ony
taste
to
menta
te
and
a
key
does
not
s
te
and
N
133;
mandbuar
te
to
ABR/McM
space
oter
a
te
up
near
o
s
A,
C,
skn
o
o
te
menngea
posteror
trgemna
artery
temporomandbuar
te
aurce.
temporomandbuar
Because
jont
and
branc
and
jont
ts
skn
courses
and
nerve
o
nerve.
te
ten
te
te
o
rom
nerve
crana
and
te
ovae,
cavty
nnervates
aca
te
nerve
mandbuar
anteror
to
te
tem-
29
ocaton
ce
es
o
o
te
bodes
on
te
postgang-
nnervatng
te
meda
trgemna
contans
sensory
gangon
rom
te
te
ce
ce
aspects
o
contans
anteror
bodes
nto
o
te
te
surace
nerve
near
bodes
te
te
or
ace.
nerve
two-trds
postgangonc
ead
ganga
and
contan
upper
te
parasympatetc
subngua
GAS
53.
C.
A
he
te
neous
but
s
n
and
ce
o
te
sympa-
neck.
ce
bers
submandbuar
E.
bod-
nner-
savary
te
he
suppy
te
cornea.
o
by
do
to
cosng
not
o
te
o
nnervate
mb
bot
o
te
eyes
n
o
te
subarac-
hese
proper
te
o
v
are
ntracrana
pexus
te
prmary
subaracnod
oter
te
te
spaces
upper
te
cornea
nerve.
It
s
trgemna
acrma
te
te
sted.
62
mb
o
superor
dranage
rom
wtn
nasocary
and
aracnod
te
CSF .
wtn
dvson
parts
proper
corod
lows
low
te
as
crcuates.
te
te
ABR/McM
ronta
eferent
externa
CSF
aferent/sensory
B.
or
o
suc
mantanng
CSF
not
113;
snuses
boodstream
te
n
33
extensons
aow
houg
optamc
suppes
v
crcuaton
does
N
ABR/McM
are
venous
wc
carred
tey
te
v
venous
CSF ,
CSF
and
145;
he
and
864;
s
N
eement
and
D,
produces
o
a
branc
gangon
traveng
dura
te
cruca
space.
branc
as
snus.
nod
te
35
nerve
dvson
mdde
te
nto
and
medate
s
dvson
aracnod
nto
ow-
nnervates
ts
prmary.
te
CSF
coce;
termna
a
neura
postgangonc
o
tongue.
nerve
nerve
be
te
n
oramen
meatus
ABR/McM
submandbuar
pressure
woud
and
troug
nvoved
te
exts
nerve
gangon
taste
877–892;
he
sagtta
posteror
he
bers
o
mater
tympan.
nerve
ear
wc
be
man-
gands.
sensory
tongue,
jont
te
musce
ear.
s
nnervatng
SCG
he
8.45).
damaged
genera
te
o
ovae.
or
vatng
nerve
be
jont.
133;
gencuate
tetc
59
key
N
trgemna
tongue,
o
ramus
masseter
not
nerve
trgemna
mandbuar
brances
nerves,
te
te
troug
nner
gangon
oramen
optamc
was
can
gangon.
ngua
te
gand.
bodes
tese
most
corda
tympan
aveoar
encrces
te
te
o
otc
trocear
atera
two-trds
aurcuotempora
meday
te
te
to
acoustc
tympan
parasympatetc
relex
1090;
he
jons
nerve,
mmedatey
dvson
o
and
carotd
ngua
sensaton
he
neror
to
o
case
cn.
B.
It
E.
a
artery
regon.
carres
genera
te
be
bot
te
skn
corda
ever,
and
te
aurcuotempora
tempora
D
by
mandbuar
he
s
runnng
ocuomotor
ABR/McM
te
n
otc
nterna
n
corda
neurons
Eac
not
oss
rst
carotd
proxmty
nerves
te
nterna
s
afected
nterna
cosest
maxary
nerve
joned
n
be
jont
51–75
parotd
te
oter
anteror
nnervates
B.
te
974–975;
he
snus.
nerve.
115;
ngua
o
wtn,
may
te
13
woud
are
te
or
and
o
876;
he
because
s
bot
aong,
aneurysm
50.
he
snus
nerve,
te
runs
cavernous
cavernous
courses
nerve
daton
C, D, and E.
te
49.
ABR/McM
abducens
aneurysma
because
D.
onc
86;
te
te
tonsts.
GAS
over
woud
exts
te
poromandbuar
juguodgastrc
te
and
jons
dvson
parynx.
D.
and
vestbuococear
and
par-
troat
courses
rom
case.
temporomandbuar
ossa
t
structures
ear.
retroparyngea
pan
ts
superca
gand,
troug
te regon o te atera aspect o te eye, te parotd
gand,
ear,
n
he esser petrosa nerve courses troug te mdde
aspect
ead.
parotd
nerve
te
crana
serve
as
probem.
tongue,
ps.
nodes
and
ear
passng
parotd
58
dran
te
nerves.
te
aca
dbe,
anteror
C.
to
o te trgemna nerve coursng troug t, aong wt
he
te
meatus
reerred
he superor orbta ssure as te optamc branc
GAS
47.
Head
nerves
eyed
cornea.
cornea
response
to
(bnk)
branc
nerve.
provde
and
he
relex
a
aca
and
cuta-
oreead,
nerve
medates
rrtaton
o
te
CHAPTER
D.
he
ocuomotor
te
eyes
by
nerve
medates
contracton
o
te
te
reopenng
evator
o
A,
papebrae
superors.
E.
he
aso
N
97;
Kessebac
he
o
our
ABR/McM
pexus
our
arteres
paatne
he
te
septa
maxary
te
externa
B,
ute
and
E.
987–988;
mucosa)
pars
sense
56.
A.
anteror
are
te
ror
par,
etmoda
artery,
and
contrbutors,
spenopaatne
aba
n
turn
arteres
s
a
s
nasa
an
artery,
B.
C.
te
o
te
D.
pars
47;
ormed
part
o
and
e
Fg.
n
te
posteror
tonsar
pars
o
te
posteror
s
contrb-
he
(covered
wt
te
arc,
par,
ormed
by
hese
57.
te
provded
te
GAS
ante-
contans
openng
cartage
and
ethmoidal
o
and
cause
processes
te
s
and
space
o
on
te
cartage.
atera
te
rota-
arytenod
between
nvoved
cosng
musces
are
aso
arytenod
and
te
wt
te
e
te
voca
adductng
rma
gottds.
aongsde
nvoved
musce
aso
musce
crcod
tensng
voca
C.
cords
1048–1050;
he
parotd
crosses
by
to
paatopa-
te
te
bue
o
to
ora
N
ads
n
eter
adductng
connects
n
s
bot
cosng
ocated
cartage
te
voca
vbrate
65;
duct,
masseter
cavty
opposte
anterior
artery
Septal
Middle
concha
posterior
Posterior
ethmoidal
Superior External
or
on
and
te
te
ads
ods,
rasng
te
ABR/McM
aso
known
musce
were
upper
n
tus
te
ary-
rma
anteror
eonga-
preparng
ptc
o
t
te
Stensen
opens
nto
moar.
and
te
hs
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
te
47
as
transversey
second
nasal
artery
lateral
tey
e
crcod
ods.
cartages
Septal
Alar
te
musce.
Anterior
ethmoidal
orm
voce.
anterory,
he
voca
musces
o
contract,
te
crcotyrod
ton
arc,
not
gottds.
E.
ossa.
do
49
amna
crcoarytenod
transverse
wt
te
musces
407
Neck
gottds.
gament
voca
ossae
posterory.
paatogossa
arc,
not
o
tereby
rma
aspect
paatogossa
arc,
do
8.243AB).
42
boundares
te
te
musce;
arteres
ABR/McM
te
by
o
(GAS
te
tyroarytenod
he
o
crcoarytenod
musces
atera
voca
te
pars
ABR/McM
o
arytenod
he
(brances
branc
te
te
owever,
(rom
tese
he
hese
67;
(abducton)
ods,
greater
N
aspect
cartages,
sep-
E.
and
arces.
posteror
tenod
pexus.
paatoparyngea
ryngeus
aba
superor
paatoparyngea
paatogossus
anteror
te
area)
anteror
and
1033;
he
ton
Ltte
te
argest
o
tonss
ormng
and
te
wc
hese
N
paatne
muscuar
te
te
artery).
Kessebac
he
two
and
artery,
carotd
C,
to
GAS
B.
or
51–52
caed
on
superor
brances
artery)
aca
(aso
are
artery,
artery.
44,
arteres
spenopaatne
A,
eye
Wen
889;
tum.
o
te
relex.
D.
are
nnervates
posteror
anastomoss
55.
GAS
nerve
D,
tonsar
o vson and s te aferent mb o te pupary gt
GAS
54.
optc
C,
te
Head
7
8.243AB
Septal
from
branch
superior
from
labial
nasal
artery
s
408
C H A P T E R
typcay
o
Head
not
bockage
A.
he
B,
to
te
te
ps,
but
te
masseter.
and
GAS
900;
N
Because
does
s,
te
o
65;
ascend
oter
n
te
because
he
groove
aca
aurce
n
ven
es
he
aca
D.
he
s
he
proxmty
to
te
w
are
w
o
most
ocated
te
ansa
key
he
be
more
B.
s
cervca-
GAS
A.
cervcas
te
E.
ocated
o
GAS
nnervated
be
most
by
musce
nerve
nvoved
by
te
wt
61.
ts
te
supercay
cervca
on
branc
o
ge
o
tod
and
branc
s
aso
pays
no
m us c e
o
and
nnervated
roe
n
ansa
by
te
s
on
38;
neck
musce
te
wo u d
n ot
be
afe cte d
ABR/McM
nerve
ater
and
sde
nnervates
o
te
te
psatera
and
B.
te
he
souder.
souder
ansa
w
especay
te
he
te
te
trapezus
Upon
he
trapezus
musce
surgca
aso
B,
tranges
C.
he
te
does
not
neck;
woud
strap
pass
musces
troug
owever,
resut
gossus,
resut
E.
he
o
te
and
n
n
and
te
t
were
o
o
souder
GAS
py
89;
Four
to
N
te
skn
39;
te
by
te
nerve
he
te
area
great
rom
to
te
cer-
C3
o
to
te
neror
C4
neck,
to
te
ange
o
o
30,
o
A.
o
he
to
B.
yo-
N
te
not
C2
C3
and
It
D.
he
mus
beow
E.
umerus.
o
te
nnervates
posteroneror
s
rom
to
cutane-
o
ead
s
t
te
31,
s
to
et
durng
neck
more
durng
Wen
turn
te
te
most
area
33
njured
and
toward
te
te
poston
s
musces,
n
occput.
dicut.
musce
bend
s
30,
musce
te
bot
skn
te
psatera
ead
key
act-
ead
w
lex
musce
to
sternocedomastod
he
njury
he
to
t
most
tese
s
musces
unkey
ttng
presentaton
and
s
or
coud
t
most
to
be
com-
te
sternoce-
ABR/McM
key
a
mdne
gand
woud
ma
to
ma
te
woud
encounter
or
et
oter
32
one
ncson
be
artery.
just
artery
31,
structures
beow
te
neror
tyrod
ven
he
neror
tyrod
ven
bracocepac
neror
arses
rom
source
stmus
te
but
to
te
s
te
ven,
wc
stmus.
aortc
arc,
present
n
he
verte-
ess
tan
mdde
tyrod
nterna
dran
ven
and
te
are
tyrod
gand
superor
to
te
ste.
neror
tyrod
artery
ange.
and
hey
arteres
meet
branc
te
woud
rom
tyrod
not
be
eter
gand
gated
at
an
wt
a
ncson.
crcotyrod
o
vens
juguar
te
artery
tyrod
courses
superor
to
te
st-
gand.
bracocepac
vens
are
neror
to
te
ste
o
ncson.
sup-
jaw
ascends
neck.
peope.
te
he
GAS
ange
nerve.
29,
vunerabe
ts
ts
supercay,
obque
many
cutaneous
te
provde
posteror
presentaton,
36;
subcavan
suprasp-
we
te
o
not
nnervates
devery
ere
causng
typcay
artery,
10%
32
te
jaw,
te
arm
provdng
over
te
te
rotaton
and
rom
musce.
mdne
wc
and
We
tyrodea
tyrodea
te
E.
tyrod
crosses
ntrnsc
woud
aspects
and
hereore,
ts
most
te
symptoms.
aurcuar
C2
njured,
musces,
29,
n
te
nerve
and
usng
contrbutor.
te
aca
genogossus,
nnervates
externa
ABR/McM
segments
over
and,
abducton
and
te
patent’s
partcpate
neck.
nnervated
spna
to
eve
nerves
he
neck.
o
sde
perormng
te
and
dvded,
o
and
1013;
we
tone
o
any
musces
nnervates
pus
nraspnatus
contrbutes
C.
o
suprascapuar
natus
60.
nerve
tongue,
styogossus
any
skn
does
ABR/McM
te
njured
ncson
ypogossa
musces
rom
aspects
orgnates
atera
nerve
musces
cest.
njury
he
expresson.
D.
soe
bra
nerve
o
parayss
and
aso
neck
sze
Wen
te
D,
drans
nnervates
9;
acton
opposte
been
GAS
62.
dv-
ose
te
domastod
abty to rase
w
oter
contrbute
tran-
cut, woud not produce droopng o
aca
aurce.
transverse
musce.
A,
souder.
C.
aone,
toward
droop.
cervcas
neck and,
te
orgnate
sternocedomastod
ng
sternocedomas-
te
body.
posteror
N
brt
souder.
te
te
ts
te
mon
te
o
te
33
across
nnervatng
ten
respectve
31,
passes
o
973–974;
te
to
occpta
back
tan
ne r ve ,
by
esser
and
occpta
oten
te
by
ar y nge a
son o te nerve, te patent w ose te
te
o
neror
regon,
cervca
anteror
sensaton
te
brt,
cervcas
nn er vate d
s up e r or
te
Because
te
accessory
te
C.
ave
N
most
nerves
more
detod
greater
he
sternoy-
to
vagus,
1005;
he
te
transverse
he
ous
musces.
s
not
D.
surger y.
59.
he
parayzed
ansa
ncudng
omoyod
and
crcotyrod
rom
upper
as
supracavcuar,
occpta.
supracavcuar
nerve.
externa
esser
nnervate
unctons.
E.
te
we
te
and
vate
resecton.
nnervated
trapezus
accessory
as
he
40
musces,
and
nerve
and
and
ear,
ncude
to C3 spna segments but passes anterory to nner-
dvson
musce
strap
patysma
neck
vca,
A.
surgery.
B.
te
nerves
o
te
cose
ante-
o
oter
ange
toward
vesses
sternocedomastod
accessory
enarged
papated.
surgca
sternotyrod,
he
te
tumor
te
ange.
ABR/McM
te
ts
nnervates
papated
passng
not
be
sternoyod
oowng
be
become
necton.
cavces.
A
o
can
artery,
cannot
C.
od,
te
E.
and
can
gand
mandbuar
to
D,
A.
artery
Neck
but
parotd
anteror
deepy
and
papabe
or
aca
ror
58.
7
McM
63.
D.
1008;
30,
he
nerve
te
cose
te
easy
N
32,
38,
37,
recurrent
damaged
or
87–89,
aryngea
durng
proxmty
njured
84,
204,
215,
241;
ABR/
218
to
te
te
nerve
surgery
neror
transected
wt
s
te
most
because
tyrod
te
t
artery
artery
key
runs
and
n
s
extreme
CHAPTER
care
s
not
recurrent
exercsed
aryngea
durng
nerve
operatve
nnervates
procedures.
te
majorty
he
o
n
musces
addton
tat
to
open
and
provdng
cose
sensory
te
rma
te
voca
ods.
Even
suppy
reatvey
to
gottds,
te
md
•
nerve
can
A.
he
s
te
resut
n
oarseness
and
mandibular
lingual
dicuty
Special
not
n
artery
enter
B.
te
ansa
cervcas
does
not
woud
ansa
tetc
van
superor
te
to
te
aryngea
neror
tyroyod
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
tyrod
membrane
to
tat
t
s
part
orms
does
and
any
to
te
ste
structures
o
surgery
tat,
para-
a
not
tus
o
te
oop
cervca
around
contrbute
woud
not
to
cause
sympa-
te
subca-
voca
cord
oarseness
Motor
njured.
he
externa
te
crcotyrod
Damage
woud
]
oarseness.
subcava
artery;
atera
nnervate
cause
trunk
movement,
E.
[V
aryngoparynx.
and
he
te
proxmty
perces
he
yzed,
C.
cose
and
o
ner ve
ner ve
n
chorda
branc
(oral)
3
gotts.
nterna
thirds
sensation
to
facial
openng
two
General
arynx
trauma
•
te
409
Neck
Sensory
via
beow
and
te Anterior
voca
Head
7
to
not
branc
ts
o
superor
musce,
nerve
cause
aryngea
tensng
woud
dicuty
n
te
cause
nnervates
voca
cords.
oarseness
Hypoglossal
ner ve
[XII]
but
Intrinsic
muscle
Genioglossus
breatng.
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
tve
137,
s
ner ve
n
par ynx,
35–36,
e x ts
responsb e
musces
tract,
213–216,
o
addton
ar ynx,
or
te
47,
te
230,
49–50,
s ku
an d
at
motor
tr ace a,
to
te
235–236,
Palatoglossus
84
te
j ugu ar
nne r vato n
b ronc,
mus c es
s upe r or
243,
to
and
o
te
two- t rd s
•
or a-
he
o
ansa
te
cervcas
neck,
wt
nnervates
te
te
excepton
o
strap
te
sde),
paate ,
et
o
A.
te
he
cervca
sympatetc
te
juguar
oramen;
seat,
parae
nterna
te
C.
carotd
carotd
deep
areas
as
D.
parayss
an
Injury
to
and
runs
bend
nterna
enter
te
carotd
accompanes
carres
not
te
sympatetc
C.
carotd
artery;
artery
GAS
64,
82–83,
141–142,
304–307,
84,
crcotyrod
voce
tongue
146,
321;
890,
wt
woud
D.
to
173,
te
afected
n
1023;
115,
210,
ABR/McM
N
124,
19,
33,
213–215,
29–30,
231,
34–35,
he
ypogossa
musces
n
o
nerve
te
devaton
provdes
tongue,
Injury
o
to
to
236,
GAS
49,
70,
71,
te
te
wt
motor
te
ypogossa
tongue
nnervaton
excepton
nerve
toward
sde wen te tongue s protruded (n ts
te
case
o
te
woud
afected
te
rgt
te
unatera
ner ve
[X]
te
ner ve
trd
sensaton,
sde.
tssues
contracton
o
dysartra.
posteror
afected
et
devate
66.
C.
nerve
bers
to
o
te
paate,
o
woud
o
te
and
he
cn
resut
tongue,
oss
neror
te
ypogossa
to
te
et
o
gag
aveoar
and
woud
wen
ower
cause
te
te
tongue
44,
(GAS
s
resuts
at
entrance
n
o
o
te
and
anteror
cause
uvua
dicuty
to
n
saggng
te
o
te
unafected
swaowng
and
8.261).
te
N
19,
40–41,
128–129,
and
he
te
was
49,
68,
59,
139–140;
o
n
and
te
lud
paryngea
nterna
njured.
sensaton
arynx,
sensaton
aspraton
tumor,
nerve
o
te
precptate
ungs.
or
64,
ABR/
85
oss
to
bers
woud
te
124,
aryngea
nerve
o
and
Fg.
remova
Loss
nerve
115,
70,
taste
pregan-
gangon
tongue.
890–892;
86,
66,
superor
gotts.
te
parasympatetc
submandbuar
and
vagus
oarseness,
Durng
conveys
te
devaton
883–884,
te
to
sensaton
82–84,
McM
243,
66,
n
te
to
ngua
sde,
te
paatogossus.
resut
suppes
sot
136–138,
47,
te
two-trds
and
39–41,
127–128,
te
gossopar yngea
taste
ner ve
Injury
pro-
sde
o
moderate
oropar yngea
genera
E.
219
te
o
te
and
on
he
presentng
resut
vagus
protruded.
oarseness.
nerve
toward
musce,
because
relex
speakng
892,
87–89,
o
oss
gonc
ypogossa
te
to
n
Injury
nto
bers
Injur y
tongue
ts
dysartra.
883–884,
66,
te
–
8.261
teet.
nto
ead.
atgued
te
o
moderate
to
te
o
easy
truson
B.
branc
cana
o
t
te
does
Damage to te externa aryngea nerve woud resut
n
65.
wt
trunk
many
genogossus,
oss
musces
tyroyod
musce.
B.
Fig.
te
dges -
esopagus.
A.
GAS
above
oss
o
te
nto
nerve
te
rom
to
voca
taste
aryngea
branc
Injury
on
o
ts
cords,
te
ep-
vestbue
can
arynx,
te
tracea,
vagus
nerve
410
C H A P T E R
7
Head
and
Neck
suppes motor nnervaton to te musces o te parynx,
except
A.
te
styoparyngeus
Injury
to
ryngea
o
te
te
externa
woud
voce,
(gossoparyngea
cause
branc
an
eadng
o
nabty
to
a
te
to
superor
cange
monotone
D.
Sensory
nerve).
voce,
te
as
vagus
pa-
E.
he
ptc
we
te
oarseness.
B.
Injury
to
truson
moderate
D.
he
te
to
nerve
to
o
arynx
o
toward
woud
te
resut
afected
n
pro-
sde
te
te
and
parasympatetc
submandbuar
and
taste
bers
pregan-
gangon
or
te
aryngea
te
voca
musces
o
sensory
and
cords
te
and
arynx
motor
except
137;
67.
A.
C,
tat
D,
musces
47,
78,
acuss.
to
te
75,
80,
crcoarytenods
E.
act
1050–1051;
te
he
n
82,
87–89,
voca
bers
75,
80,
o
91,
te
ony
93,
B.
externa
courses
muc
togeter
o
A.
he
C.
he
ts
A
he
to
voca
92,
and
te
coces
69.
C.
he
n
N
o
te
panu
because
o
are
E.
aryngea
n
ocated
or
ts
n
surace
92,
or
71.
qute
pos-
o
by
mandbuar
ts
jont
s
ocated
aryngea
externa
and
but
952,
to
he
A.
o
te
receves
woud
N
9,
tensor
be
cavty
s
sup-
dvsons
unafected
25,
53,
56–57,
tympan
t
be
o
and
te
te
o
by
59,
normay
mdde
preventng
source
receves
bey
o
nnervaton
woud
ve
not
paatn
mandbuar
does
not
ts
o
ear
yper-
yperacuss
nnervaton
te
dgastrc
rom
cause
rom
dampen
te
and
aca
te
nerve,
yperacuss.
receves
motor
dvson
B.
tympanc
47,
membrane
aurcuotempora
o
te
D
temporomandbuar
rom
te
jont
as
we
as
parynx.
o
nnervaton
te
trgemna
movements
o
te
crcotyrod,
branc
resut
107,
nerve
n
As
o
n
129,
a
te
ear
wc
superor
yperacuss.
134,
160;
ABR/
corda
be
gand
E.
aca
T aste
to
nerve
to
te
te
te
to
to
te
ac-
nose,
rgt
resut
n
eye.
gands
te
ngua
receve
aca
nerve
nerve.
hey
eson.
ts
rom
parasympatetc
te
gossoparyngea
and
aurcuotempora
unafected.
tongue
corda
anteror
o
ts
anteror
te
dvson
te
petrosa
be
te
va
rgt
rom
receves
esser
woud
and
by
te
and
njury
te
o
o
expected
bers
tympan
nerve
va
an
be
or
gands
submandbuar
unafected
parotd
and
resut,
parasympatetc
te
parasympatetc
nnervaton
mucosa
secretons
and
carres
te
woud
nnervaton
gua
te
not
64,
te
nerve
acrma
mandbuar
same
N
petrosa
subngua
sensaton
resut
woud
secretory
te
trgemna
addtonay
nnervaton
s
o
externa
nvoved
petrosa
nerves
nerve,
are
and
he
84
te
nerve,
gand,
va
neror
by
greater
he
be
nnervaton
958–960;
tat
ter
nerory,
te
ABR/McM
woud
nasa
57–58
greater
nerve
T aste n te anteror two-trds o te tongue s sup-
by
te
ts
njury.
but
ts
he
oro-
sory
aca
(he
superor
tympanc
and
he
be
and
corda
woud
tympan
ocaton
on
woud
te
te
dvson
unafected
coud
be
ts
o
by
and
te
ts
o
ter
are
and
te
sen-
vagus
supped
trgemna
njury.
njured,
sde
receve
paate
n
unkey.)
gossoparyngea
nasoparynx
unafected
be
meda
make
aryngoparynx
rom
maxary
woud
nerve
membrane
bers
nerves.
te
C.
branc
woud
termnates
dvson
nerve
te
membrane.
sound
posteror
supped
woud
reaton
te
te
by
tongue
te
s
provded
tympan,
s
trgemna
and
provded
nerve
by
genera
by
va
te
te
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
ped
B.
nerve
rma
nerve.
A.
te
McM
case.
137;
provded
maxary
woud
1093;
and
because
parayss
Damaged
brances.
87–89,
to
te
artery
nerve
te
movements
mutng
receve
tensor
decreased
superor
ts
he
aryngea
nerve
artery
cervcas
o
and
tympanc
dampen
rom
s
neck.
tat
arynx
movements
ts
te
to
tyrod
prmary
Damage
o
aryngea
te
ansa
anteror
njured
82,
externa
branc
nerve.
be
artery
1057;
nnervated
a
to
nto
tyrod
GAS
ter
he
ABR/McM
tyrod
s
D.
paate,
te
superor
recurrent
passng
te
superor
unkey
he
n
o
branc
route
trunk
s
nerve.
C.
cords.
160;
superor
superor
nerve
stapedus
92,
ocaton.
root
nterna
a
te
A
and
bers
ts
ateray
takes
te
sympatetc
neror
more
E.
wt
o
and
974–975,
probem
91,
route.
cervca
terory
D.
branc
o
optamc
tereby
aca
GAS
he
arynx
nnervaton
stapedus
to
styoyod
musces
te
ossces.
answer
te
te
te
cords.
remanng
adducton
N
are
te
904,
or
47–49
68.
ts
84
abduct
and
tat
Bot
but
BP25,
posteror
arynx
GAS
N
ABR/McM
he
te
B,
1057;
to
901,
ossces,
anteror
bers
te
trgemna
uncton
crcotyrod.
GAS
B.
n
provdes
to
82–83, 133, 136, 145; ABR/McM 29, 39–40, 56, 82–81
tongue.
beow
te
GAS
70.
conveys
sensaton
recurrent
a
nerve
dysartra.
two-trds
he
tongue
bers
genera
E.
ypogossa
te
ngua
gonc
by
njury
te
o
sensory
ped
as
nnervaton
nerve.
nerve
by
and
72.
C.
Pa r a s y m p a t e t c
gand
s
p r ov d e d
par yngea
ner ve
o
Tese
p re g a n g o n c
pes
te
at
mdde
synapses
te
n
s e c re t o r y
parotd
axons
tat
pexus
nate
te
nner vaton
by
emerge
ear
as
o
carred
te
rom
esser
otc
gosso-
tympanc
petrosa
bers
gangon,
parasympatetc
parotd
te
te
parasympatetc
te
te
by
ner ve.
term-
wc
sup-
nner vaton
to
gand.
A, B and E. Ganduar secretons o te nasa cavty, sot
paate,
and
acrma
gand
a
receve
parasympatetc
CHAPTER
nnervaton
and
woud
rom
te
reman
bers
ntact
o
te
greater
oowng
a
petrosa
tympanc
nerve
D.
pexus
o
Axons
and
or
secretory
nnervaton
submandbuar
nerve,
ten
beore
synapsng
wt
gands
course
troug
n
te
postgangonc
gands
va
te
are
te
carred
te
subngua
by
eventuay
nerve
te
corda
submandbuar
bers
ngua
to
(GAS
E.
aca
tympan,
8.120
73.
953,
136,
145;
B.
he
son
o
978;
te
he
to
te
tetc
C.
abos
te
he
bucca
It
97,
branc
nerve
bers,
does
106–107,
74.
and
te
dsta
t
does
nerve
anteror
bey
contnuaton
exts
not
myoyod
aveoar
te
as
menta
afect
s
tat
o
te
a
te
te
133–134,
woud
o
te
provdes
and
sensory
woud
dv-
nner-
B.
taste
te
taste
and
sensaton
provde
and
and
to
C.
parasympa-
sensory
nnerva-
and
outer
surace
sensory
o
te
nnervaton
to
he
and
ceek.
GAS
Prominence
of
lateral
semicircular
canal
Prominence
of
facial
and
masseter
atera
branc
te
dgastrc.
966,
10,
972,
19,
margn
o
on
te
te
o
ts
jont.
coronod
mandbuar
te
unctons
extends
o
musce
atera
n
te
extends
pterygod
eevaton
rom
te
ramus
o
rom
pate
te
te
Aditus
arc
mandbe
te
pus
back
te
ange
o
te
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
ceek.
Pharyngotympanic
Oval
te
te
jaw.
zygomatc
o
to
jaw.
Tensor
mastoid
pro-
ramus
42–44
Tegmen
canal
o
buccnator
lattens
nlammaton
nserts
Promontory
Facial
o
myoy-
jaw.
surace
te
te
pterygod
surace
eevates
E.
provdes
he
te
meda
by
musce
anteror
retracts
he
te
teet.
nerve
and
mandbe
carres
afected
cess
meda
tongue
bers,
most
temporas
and
requre
sensaton.
o
not
mandbuar
be
he
McM
Pyramidal
te
teet.
motor
suppes
o
oramen
D. Part o te atera pterygod musce as ts nserton on
A.
teet
provdes
two-trds
bers.
to
nner
59,
panu
nerve
sensory
ton
te
and
te
59, 69, 66, 82, 133, 142, 145; ABR/McM 42, 59, 81–82
and
84–85
mandbuar
anteror
genera
44,
aveoar
ngua
te
19–20,
trgemna
te
anestesa
A.
N
ABR/McM
to
to
s
nerve
411
Neck
te artcuar dsc wtn te temporomandbuar jont and
neror
vaton
mandbe
nerve
neror
od
nerve
aveoar
and
GAS 883, 885, 886–887, 889–890, 978; N 25, 68, 56–57,
8.125).
GAS
te
he
te
gangon,
reacng
Fgs.
menta
neror
eson.
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
trocear
musce,
wc
ateray.
wen
It
te
s
downstars,
resuts
A.
he
t
s
sed
B.
he
nerve
or
and
he
n
a
not
can
obque
downward
depress
an
te
ndvdua
ntated,
and
he
stars,
sory
GAS
n
pup
B.
rectus
as
o
and
ts
ndvdua
a
C
ner ve
nduce
te
an
o
ts
nerve
dmn-
superor,
we
as
te
nward
te
d p op a
te
te
ne-
o
te
a
branc
trgemna
nnervaton
883–884,
s
neror
886,
to
te
nerve
movements
not
In
o
te
eye,
96,
ater a
and
rec -
dam age
p res e nted
n
t s
E.
te
and
optamc
provdes
sen-
E.
N
64,
96,
97,
ward
ts
rom
te
moton,
obque
adducted
n
musce
turns
poston.
conjuncton
wt
56,
resuts
tarsa
A
rectus,
resutng
sensory
o
nerve
nerve
te
orgnatng
trgemna
suppes
te
nerve.
superor,
te
pup
Inabty
dpopa
to
down-
perorm
wen
wak-
ng downstars, ndcates damage to te trocear nerve.
gand
cay
886,
(o
o
waks
nduce
te
In
adducted
nerve
woud
o
dp-
downstars.
n
ocuomotor
889–890,
damage.
be
respon-
932–933;
127–129,
occur
ack
Dry
132,
N
156;
64,
ABR/
response
nnervaton
and
to
(droopng
o
moss
unopposed
bockng
o
te
te
o
eye-
superor
(pupary
con-
parasympatetc
pup.
woud
acton
o
not
te
occur
because
sympatetcay
ts
nner-
pupae.
eye
woud
but
bers,
same
medated
o
rom
pup
dator
n
Ptoss
Müer),
te
te
he
not
downward
nerve
ocuomotor
movements
movement.
nsuicency,
case.
ndvdua
gaze
te
woud
ocuomotor
moss
parasympatetc
ts
nerve
ndcate
resuts
C.
rom
downward
80
dated
and
to
te
rom
requres
ts
nnervaton.
musce
strcton)
B
superor
a
and
124–125,
and
sympatetc
A.
not
115,
61,
Ptoss
to
afected
883–884,
nnervaton
932–933;
76–100
he
an
upward
vated
76.
atera
nnervaton
upward
nabty
does
97,
McM
77.
n
poston
or
GAS
115, 124–125, 127–129, 132, 155; ABR/McM 60, 56, 80
Answers
s
branc
ocuomotor
Damage
wen
ts
sbe
nduce
oreead.
889–890,
he
te
eye.
nerve
Overa,
poston
downstars.
o
te
optamc
resuts
eye.
d)
nerve
D.
addton,
ocuomotor
woud
n n er vates
te
musces.
afected
rater
rom
nerve
a b d uc ts
t e
and
nnervates
o
nasocary
rom
dpopa
eson
wen
but
wakng
abducens
abducton
he
waks
opa
suppes
upward
he
neror, and meda rectus as we as te neror obque
and
dpopa
nnervaton
wc
ronta
dvson
A.
and
probem.
E.
8.125
propery.
te
nerve
eson
abducens
woud
s
superor
Fig.
bndness.
n
an
musce,
tat
vson,
n
down
meda
resuts
eye,
tus
resut
Overa,
dpopa
C.
not
te
pup
Wen
provdes
waks
and
obque.
musce
unctonng
nerve
vson
te
moton
ocuomotor
ror,
te
eye
woud
nnervates
move
adducted.
not
ndvdua
to
ony
s
ts
optc
nerve
te
eye
nerve
acts
GAS
t
ods
occur
because
woud
true
s
reman
or
accommodaton
because
ts
te
o
acrma
medated
unafected
by
n
parasympatet-
patway.
CHAPTER
D.
Dept
s
GAS
78.
B.
not
percepton
medated
918–920;
he
rgt
rectus,
ton)
te
Inward
C.
Downward
D.
and
trocear
Down
and
o
are
te
s
128,
132;
Horner
ng
suppy
o
o
te
te
meda
nerve.
mdne
accom-
superor
obque
by
te
by
ocuomotor
te
combned
secretes
and
s
te
ent
n
Loss
cate
o
wt
abdu-
pup
rectus
neror
be
66,
933;
80,
nvoves
te
response
s
hs
N
py
83,
64,
resuts
n
pup),
96,
by
97,
ptoss
sympa-
(droop-
andross
ace.
by
he
rom
to
acrma
gand,
parasympatetc
o
te
wc
stmuaton,
gobe)
and
t
te
to
oten
ace,
to
Neck
resut
processes
wc
te
move
superor
te
rom
ocated
ncudes
nose.
hs
nectous
snus.
agents
he
ven,
ptery-
he
suppy
because
cavernous
and
E.
he
C.
he
and
ts
cay
te
s
s
not
re-
pres-
GAS
be
do
s
a
te
not
area
o
a
pro-
drect
sup-
anguar
and
low
possess
ofer
route
bood
and
nose
can
a
pat
more
receves
ead
not
te
vens
te
ower
n
eter
vaves.)
route
necton
n
o
com-
and
vasodataton
o
rater
nnervaton
te
tan
vesses
to
eads
te
to
and
(GAS
909,
916;
N
spread
courses
caed
te
te
carotd
artery,
provdes
Fg.
between
scap
and
o
eadng
to
necton
between
veins
artery,
traverses
orgn
to
spec-
troug
te
op-
8.68).
20,
84,
99,
104,
115;
ABR/
Caver nous
sinus
paeness.
Horner syndrome resuts n ack o sweatng o te ace.
GAS
E.
917–920;
he
superor
N
94,
tarsa
142;
ABR/McM
musce
(o
37
Müer),
nnervated
by
sympatetcs, s smoot musce tat asssts n eevatng te
eyeds and mantanng ts poston. Loss o sympatetc
nnervaton
A
and
nerve,
bra
B.
s
to
part
coses
wen
ncreased
low
C.
Damage
ear
eye
trocear
or
ptoss
ocu,
s
o
te
nnervated
cosure
eyeds
eye
te
o
te
ordnary;
cosed
more
across
evator
eyed.
by
eye.
te
te
he
aca
pape-
orbta
orcby,
te
papebrae
ocuomotor
rater
superor
gazes
parta
part
resutng
gobe
(peraps
ceeks).
te
nerve,
adducted
n
movement
te
to
by
compete,
he
te
te
tear
down
vated
D.
resut
orbcuars
responsbe
contracts
n
w
he
tan
parta,
obque,
moves
poston
down
nerve,
te
(or
woud
te
by
te
downward
exampe,
te
nner-
resut
n
ptoss.
nnervated
pup
toward
ask
superors,
nerve,
as
et
patent
wen
oot).
to
te
T o
ook
troc-
rom
wt
te
rgt
test
Infra-orbital
vein
Facial
vein
te Pter ygoid
eac of
eye
GAS
toward
te
917–920;
N
tp
94;
o
te
Deep
nose.
ABR/McM
37,
80
facial
vein
•
GAS
Fig.
te
precranum
59
Ophthalmic
te
woud
unopposed
ace,
te
snus.
artery
carotd
snus
artery.
te
te
(oten
wereas
nterna
o
cavernous
menngea
cavernous
communcate
vens
nvoved
and
oacaton)
te
47,
vens
perosteum,
875–876,
McM
and
nose
mdde
dura
te
woud
emssary
not
te
ven
around
n
between
ven
ofer
te
snus.
snuses
between
tese
but
supratrocear,
area
bood
artery
tereore
optamc
optamc
te
(V enous
and
necton,
supraorbta,
carotd
venous
o
syndrome.
sympatetc
te
pys-
optamc
cavernous
snus
spread
superor
tamc
ypertyrodsm
te
potenta
nto
superor
te
tat
n
te
o
can
nectous
surroundng
cavernous
te
tereore
o
and
te
te
muncaton
o
80
nterrupton
(protruson
by
A.
musces,
dvson
20,
area
carres
or
drecton
a
unafected.
caused
lusng
te
respectvey .
te
as
te
trave
vded
B
ace.
o
Horner
o
o
meda
(constrcted
Exoptamos
quenty
nerves
te
889–890,
ubrcated
woud
and
by
ABR/McM
to
n
trocear
movement
by
nerve.
moss
eye
nnervated
oter
drecty
pmpe
ten
tromboss
or
danger
ace
pressure
route.
medated
te
te
wc
snus
pmpes
and
god venous pexus and optamc ven bot commun-
s
supped
are
neror
887,
sweatng)
he
and
syndrome
eyed),
(ack
wc
nnervated
124,
tetc
80.
te
by
respectvey.
moton
nward
883–884,
E.
n
musce,
nerves,
ocuomotor,
ocuomotor
D.
ca
o
oreead.
GAS
C.
(abduc-
area
vens
wc
B.
ocuomotor
actvaton
musces,
Down
A.
atera
obque
uncton
79.
Cavernous
around
rgt
movement
accompsed
te
rectus
out
D.
squeezng
53
te
81.
actons o te atera rectus, neror rectus, and superor
cens,
E.
and
s
by
jont
neror
and
rom
movement
and
37,
nnervates
outward
patway
system.
eye.
supped
by
vsua
ABR/McM
nerve
movement
psed
te
sympatetc
142;
medates
rgt
A.
rectus,
94,
te
abducens
wc
o
N
nvoves
by
Head
7
8.68
veins
plexus
413
414
C H A P T E R
82.
E.
he
o
nerve
by
s
rage
o
he
D.
GAS
83.
D.
any
N
no
A
tat
B.
to
be
nerve
ar
a
s
ony
or
adjacent
Incson
n
to
154,
an
n
GAS
juncton
59,
be
and
s
B,
nerves
te
a
n
te
wt
67
C.
tympanc
mem-
mnma
and
or
te
superor
C.
he
de
maeus,
and
meday
umbo
o
wc
s
te
to
stuated
maeus
te
n
s
stuated
tympanc
cose
and
mgt
be
E.
te
damaged
duct
durng
woud
amost
mdde
ear.
ncson
ton
be
GAS
certany
Damage
woud
troug
avoded
945–947,
to
te
nterere
te
to
damage
960;
N
maeus
maeus
wt
mdde
prevent
te
ear
te
audtor y
cavty,
conductve
105–107,
rom
and
109;
86.
te
D.
and
conduc-
soud
to
A.
ypogossa
tongue
o
and
sape
nerve
te
n
te
tongue
on
one
one
he
rom
to
and
te
causng
nonmovng
sde.
B.
to
Damage
gossus
te
C.
et
te
musce
tongue
ments.
wen
te
t
tey
as
to
a
pont
ts
ypogossa
cause
te
nerve
and
tongue
et
te
to
devate
to
o
musce
te
nor
s
responsbe
tongue.
te
rst
D.
or
Neter
cervca
nerve
retracton
te
geno-
contrbute
does
Damage
tongue
to
to
a
contrbute
ypogossa
devate
to
te
to
tongue
nerve
psatera
move-
woud
sde.
cause
N
camber
n
umor;
ts
s
te
tere-
ocaton
can
pressure.
between
smpy
drecty
upper
opens
te
o
an
anteror
lud
does
aperture
connected
do
dated
up
to
end
nto
cavty.
wt
he
te
to
te
o
te
neror
nasoacrma
ncreased
to
te
ntraocuar
vagus
he
to
66,
te
tat
right
te
et
toward
because
as
nerve
A.
Even
o
woud
genera
can
te
anter-
not
be
operaton.
pregangonc
te
beore
externa
888,
gossopa-
synapsng
n
somatc
aferent
acoustc
meatus;
trgger
214;
are
te
o
o
a
gag
relex
devates
musces
pu
o
paryngea
te
a
te
paate,
tensor
or
anteror
66,
te
are
sde
o
ve
he
a
and
uvua
paryngea
unopposed
constrctor
are
ndcat-
unafected,
te
41,
84
et,
propery.
te
N
136–137,
evator
musces,
nnervated
by
as
te
paatn—mandbuar
nerve).
tumor
te
134,
44,
to
workng
unafected
te
afect
or
932–933;
127–128,
ABR/McM
not
trgemna
toug
potentay
taste
889–890,
124,
uvua
(except
te
medates
paata
he
musces
dvson
n
o
scap
tongue.
886,
musces
we
te
musces
paatn.
run
nerves
and
te
te
reerred
skn
and
nerve
n
be
tonsectomy.
contans
tat
meatus
82–83,
devates
ve
te
tympan
o
case,
te
hs
medates
144–146,
ts
membrane
nerve
o
suppes
ndrecty
aurce
o
ts
nerve
can
tube,
rom
relex.
883–884,
141–142,
ng
case
n
genera
audtory
sensatons
as
bers
nerve
te
tube,
tympanc
te
corda
64,
In
Panu
51
medates
parynx,
aurce.
gangon.
otc
ABR/McM
nerve
audtory
petrosa
two-trds
E.
ear.
or
te
49,
te
nerve,
and
GAS
100–101;
te
ryngea
vagus
not
pro-
ncrease
nadequate.
coecton
nasa
to
tympanc
esser
he
E.
te
geno-
te
rom
drecty
cougng
pued
to
an
umor.
and
mdde
stmuaton
restrant
s
secre-
umor
Increased
cause
aqueous
s
not
te
939;
and
suppy
pass
movement.
nerve
C.
protruson.
tongue
tongue
te
tongue.
pu
s
s
parasympatetc
musce
and
te
n
acts
te
he
genogossus
o
mout,
B.
ts
protruson.
eevaton
Vagus
o
woud
and
te
by
nvoved
protruson
mandbe
aspect
contract,
te
parayzed,
tp
et
styogossus
to
E.
te
deep
n
toward
major
he
te
ateraton
eson
upon
te
o
s
body
retna.
aurcuotempora
aurce
87.
he
yod
s
o
s
n
A
tongue
tongue.
musces
out
tongue
te
musce
on
te
o
musces
nvoved
observed
te
te
te
tongue.
o
nsde
nto
genogossus
orward,
te
be
o
genogossus
o
o
genogossus
te
nsert
orward,
sde
drecty
coud
protruson
arse
posterory
nnervates
devaton
wc
tongue.
musces
I
cause
sde,
nvoved
Wen
tereore
movement
woud
njured
o
s
and
nerve
o
ncudng
ear
he
44,
te
osuperor
he
sac
a
ts
aqueous
sensaton
rom
te
A.
57–58
84.
te
gossoparyngea
parynx,
oss.
ABR/McM
te
notng
936–937,
he
somatc
surgca
ts
earng
o
68,
pressure.
GAS
A vertca ncson troug te tympanc membrane
49,
139–140;
aqueous
anteror
dranage
or
duct
meatus
as
te
connecton
body
o
acrma
nasa
an-
o
camber;
onto
vtreous
woud
dranage
o
o
ere,
gt
cary
camber.
ste
ntraocuar
te
nasoacrma
ncson.
E.
occur
he
membrane.
to
s
producton
mmedatey
proxmty
bockage
pup
he
ts
dranage
posteror
40–41,
produces
posteror
ange
ncreased
aow
supe-
te
and
19,
128–129,
receves
body
pressure
o
N
124,
85
rom
he
not
D.
posteror
n
115,
camber
cary
lud
a
889–890;
86,
rdoscera
ore,
ror quadrants o te tympanc membrane woud key
damage
he
s
structures.
anteror
o
cause
tympanc
ncson
ocated
ntraocuar
A.
66,
he
ocaton
and
ABR/McM
o
44,
rst.
s
892,
82–84,
posteror
ducton
key
pons
70,
he
and
and
are
woud
B.
tons
emor-
A,
883–884,
64,
ABR/McM
85.
afected.
te
mportant
te
key
abducens
artery
176;
o
major
cerebe-
emorrage.
be
quadrant
porton
aow
he
and
possbe
stuated
a
woud
trocear
regon
rostray
149–152,
te
to
wt
s
te
oowng
cerebear
and
o
artery.
damaged
neror
neror
woud
proxmty
ts
mdbran
too
artery
porton
pontomeduary
damage
147,
s
damage
and
te
anteror
membrane
o
ocuomotor,
wt
870;
cose
te
key
ocated
he
brane
at
trgemna
tus
cerebear
neror
n
anteror
optc,
he
neror
ocated
most
sufer
Neck
emorrage
te
assocated
and
anteror
stuated
tereore
not
te
Nerves
afected
C.
Head
anteror
supper
um.
7
o
te
juguar
cana
gossoparyngea,
coud
vagus,
and
CHAPTER
accessory
a
eson
nerves,
on
te
paryngea
te
patent’s
vagus
nerve
nerve.
woud
presentaton
A
eson
produce
oss o taste rom te posteror
o
gag
relex,
patent
B.
he
mparment
does
not
present
paryngea
upward
ped
by
by
te
te
wa
o
on
et
C.
or
suc
or
as
D
coug—te
sde
s
gossoparyngea
aso
nerve;
drawn
to
sup-
tus,
t
he
ar
mandbuar
o
trgemna
nnervaton
to
te
musces
he
o
et
and
to
GAS
64,
s
67,
uvua
E.
An
ay
moar
I
te
te
or
146,
321;
resut
area
mandbu-
provdes
motor
does
sensory
suppy
not
90.
to
o
nnervates
te
o
et
ts
sde
nerve
te
o
te
woud
n
o
a
te
patent
s
paryngea
1023;
115,
210,
ABR/McM
o
te
loor
and
N
124,
19,
213–215,
47,
33,
61,
Qunsy,
o
te
n
mout
wt
236,
84,
ed
243,
snus
s
Fg.
o
(Ludwg
sweng
angna).
16,
91.
prompty,
can
ead
to
a
torus
o
and
a
o
te
tonss
te
abscess,
tat
s
a
can
woud
not
wc
he
ranua
s
a
wt
owever,
977,
te
age
a
necton
1092;
are
n
a
B.
o
o
te
ead
te
resprator y
he
wt
tract
on
nto
coanae
cavty
C
N
nto
te
and
as
ound
rom
on
It
can
be
are
loor
caused
35;
o
n
te
by
acute
oca
asymptomatc.
ABR/McM
GAS
o
18,
30,
47,
92.
(eustacan
tube
or
tat
nasopar ynx
necton
to
te
are
te
te
provdes
to
can
te
trave
oropar ynx
mdde
pared
ear
tube
or
va
te
and
a
drect
mdde
rom
or
te
openngs
nasoparynx
audtory
par yngotympanc)
te
cav-
upper
nasopar ynx
audtor y
rom
do
mdde
con-
ear
te
not
ear.
or
tract
43,
49,
136;
56,
ABR/
va
te
middle
semunar
nasal
atus.
atus
are
he
ocated
drans
te
acrma
drans
duct,
te
secre-
wereas
posteror
snuses
dran
et-
nto
te
and
spenoetmoda
proxmty
not
nvoved
to
n
ts
te
recess
maxary
dranage
(GAS
43–44,
50–51;
ABR/McM
3,
12,
snus
provdes
wc
s
te
most
stuated
drect
access
drecty
above
entry
atera
ste
and
te
aso
woud
nerve,
ead
but
subaracnod
potenta
ocated
snus
to
te
ar
to
t
dam-
woud
space,
menngts.
too
te
s
stuated
ptutary
entrance
Neter
drect
tat
ces
nto
and
are
to
te
wt
he
crb-
anterory
rom
ronta
and
potenta
woud
access
N
snus
pont
to
te
t
te
s
crana
not
a
ste
cavty.
nor
wt
tereore
45–46;
wtn
gand;
crana
communcaton
1064–1065;
55,
at
gand.
cavernous
cavty
a
entry
maxary
te
not
nteror
aow
ptutary
ABR/McM
12,
snus
o
te
te
sur-
gand.
17,
25,
43,
79
B. he gag relex s composed o bot an aferent and an
eferent
mb.
paryngea
te
hese
and
contracton
relexes
vagus
and
o
are
nerves,
vagus
te
medated
by
te
gosso-
respectvey. T ogeter,
nerves
musces
o
are
te
responsbe
parynx
was
te
A.
njured
oss
he
ror
nasa
o
wen
te
aca
te
sensory
nerve
two-trds
medate
tonss
te
s
o
gag
sde
o
were
te
nvoved
te
excsed,
or
nerve
resutng
n
relex.
wt
tongue;
te
nvoved
n te gag relex. In ts case te gossoparyngea
tube.
connect
cose
N
CSF
pates
D.
any
geon
oder
(nspssaton)
usuay
31–32,
te
deydraton
to
o
surgca
crana
tey
mucosa-ned
rom
ten
or
a
ste
recesses.
oactory
ptutary
cavty
te
ave
N
BP29,
nasoacrma
meatus
gand,
cranum;
he
sortened
usuay
1079;
109,
spenoda
tereore
spenoda
te
tongue-te,
movement
w
on
usuay
pan.
as
n
gossoparyngea
audtor y
resprator y
and
growt
key
he crbrorm pate coud ofer a pont o entry nto
occur
40
he
A
resuts
coaguaton
secretons.
ty.
cause
restrcts
resutng
trauma;
s
smar
growts
known
person
mucocee
savary
tube
aso
tat
tat
afected
oten
ndvduas,
32–33,
a
a
respratory
snus.
pus-
mpedment.
mout,
GAS
s
Suc
typcay
s
deect
renuum
speec
A
mandbe.
s
conca.
meatus
nasoparynx
ptutary
aso
mandbuars
te
congenta
tongue.
B.
he
to
tonsts.
Ankyogossa,
ngua
A.
E.
rorm
s
89.
pertonsar
acoustc
55
paate;
bengn
D.
as
nterna
upper
semunar
te
he
1058–1060;
44,
ts
tube
8.239).
GAS
usu-
he
eakage
nsde
nasa
nasa
ces.
are
audtory
vestbuococear
tese
te
and
by
stuated
and
o
te
drans
nto
nasa
carred
T orus paatnus s a bengn bony growt on te ard
te
C.
known
nlammaton
because
B.
snus
mdde
E.
not
rom
te
and
1035–1037,
meatus
superor
and
are
mandbuar
antbotcs
submandbuar
D
219
space
te
49,
te
57–58
neror
moda
A.
aso
te
and
aca
105–107,
speccay
nasa
te
136–138,
231,
66–71,
necton
treated
39–41,
127–128,
submandbuar
denta
not
955,
spenoetmoda
892,
173,
55,
tons
ead
cana
or
Neter
77–80,
maxary
he
tongue.
not
60,
wt
415
Neck
ear.
950,
75,
he
ntrnsc
aspyxaton.
A.
72,
connect
necton
mdde
under
aca
passages
o
943,
mdde
te
not
respectvey.
meatus,
te
nnervate
B.
A.
nerve
njury
87–89,
necton
te
and
and
musces
890,
82–83,
306–307,
nerve)
te
devaton.
883–884,
141–142,
(or
parynx.
ypogossa
extrnsc
66,
ace
musces
te
Compresson
88.
nerve
dvson
mastcatory
D.
te
GAS
do
and
ear.
he
are
spread
McM
rgt
E.
nerves,
ntact.
C.
and
te
styoparyngeus,
nostrs
mdde
meatus
symptoms.
et
he
gosso-
symptoms
swaow
te
ndcates
te
⅓ o te tongue, oss
tese
non-parayzed
on
Head
7
taste
o
owever,
t
te
ante-
does
not
relex.
C and D. he mandbuar and maxary nerves are part
o
te
trgemna
nerve
and
are
tus
argey
assocated
416
C H A P T E R
wt
te
7
Head
sensory
and
Neck
suppy
o
te
ace,
snuses,
and
ora
E.
he
cavty.
E.
he
ypogossa
ces
GAS
93.
B.
o
te
1089;
he
66;
nnervates
most
o
te
mus-
does
or
GAS
ABR/McM
aryngea
durng
transected
nerve
tongue.
N
recurrent
damaged
a
29,
nerve
35,
s
oten
tyrodectomy .
damaged
36,
recurrent
44,
at
66,
rsk
Patents
o
wo
aryngea
84
95.
A.
beng
ave
w
1036;
a
bot
oten
or
ear
B.
damage
ony
crcoarytenod
nerve
to
te
musce
and
woud
nerve.
he
responsbe
s
supped
tus
be
posteror
or
by
te
mpared
recurrent
oowng
crcoarytenod
abducton
o
te
voca
s
ar
te
C.
cords,
A,
C,
tors
o
ead
cosure
o
and
tons
B.
he
o
taned
wtn
and
ngua
te
nvoved
oter
cords,
te
ts
s
n
or
te
adduc-
woud
E.
not
n
tons
st-ke
can
bend
tube,
ead
to
space,
and
a
96.
D.
te
pa-
bockage
te
o
A.
s
ossa
n
paatne
between
arces.
An
tons
o
te
posteror
tons
te
s
w
not
not
paatogos-
enargement
B.
he
ncudng
occude
te
to
nvoved
t
s
n
ocated
occuson
more
o
te
audtory
tube
not
be
because
C.
posterory.
Frontal
process
Lacrimal
te
te
do
are
process
Major
alar
mdde
as
te
nto
orms
te
s
not
contrbute
to
we
ne-
te
superor
body.
dened
and
deveopment
45–47,
nerve
ard
s
49
responsbe
paate,
or
te
or
te
ard
ngua
to
te
posteror
nerve
suppy
to
nerve
menta
nerve,
and
suppy
portons
posteror
te
sen-
part
as
o
o
t
s
brances,
nerve
branc.
hese
te
mout
and
nvoved.
nerve
suppes
anteror
taste
two-trds
and
o
te
genera
tongue.
bone
concha
nasal
concha
process
of
ethmoid
bone
of
cartilage
pterygoid
bone
cartilage Perpendicular
of
Inferior
gums,
branc,
maxilla
nasal
te
paate.
severa
denta
roo
o
However,
ard
ncsve
neror
te
teet.
cartilage
alar
ear
tons-
te
utmobranca
sphenoid
A
perssts
pouc
te
Medial
Minor
and
deveops
aveoar
not
not
he
of
n
Uncinate
septal
to
responsbe
tymus,
pouc
upper
myoyod,
Middle
Lateral
te
tube.
te
te
ton
Superior
Nasal
and
ABR/McM
o
neror
te
woud
not
ncudng
and
o
tus
constrctor
tube
s
to
opens
mout.
nvoved
nerves
paryngea
pouc
and
paatne
te
ceeks,
con-
t
he posteror superor aveoar nerve suppes mutpe
audtory tube because o ter ocaton n te oroparynx.
superor
105;
nnervaton
D.
he
audtory
N
pouc
paryngea
gand
tereore
greater
roo
and
crypts.
gand
paryngea
structures,
ocated
te
te
he
sory
tube.
wereas
paatne
a
sxt
950;
wc
pouc
audtory
tonsar
paryngea
ourt
woud
nasoparynx
tube,
paryngea
te
degutton
nasoparynx;
366
te
audtory
paryngea
and
trd
he
GAS
nasoparynx
ocaton
tonsar
te
tese
a
o
te
tube.
60,
rom
te
rst
paratyrod
he
o
(eustacan)
paatoparyngea
tons
are
ABR/McM
bot
paratyrod
47–49
stuated
audtory
tongue,
o
D.
cord.
sted
parayss
ABR/McM
tons
ngua
te
musces
and
audtory
te
voca
arway.
recess,
n
o
aspect
sa
he
o
te
dranage
te
91–93;
paryngea
ryngea
A
N
o
paryngea
openng
te
E.
voca
1051;
he
te
and
te
to
GAS
C.
D,
poston
he
second
he
audtory
spread
o
durng
enterng
cavty.
snus
ror
and parayss o ts musce woud resut n a permanenty
adducted
he
te
way
ormaton
upward
rom
43;
can
spaces.
he
posteror
N
by
(tympanc)
drawn
bock
Inecton
mdde
s
ood
not
present wt a caracterstc oarseness oowng surgery .
aryngea
94.
uvua
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
nvoved
97.
GAS
984,
133,
142;
A.
to
wt
te
B
n
nerve
te
woud
nerve
o
te
to
te
te
to
suppes
paatne
ard
46,
te
sot
tons
paate
but
s
not
66,
82,
62–64,
67,
branc
voca
detect
Answers
101.
a
o
genera
cords,
ood
superor
oss
o
eavng
or
sensaton
te
oregn
aryn-
patent
objects
B.
branc
aryngea
nerve
musces
patent
cords.
gea
nerve
o
o
superor
nerve
and
D.
parayss
a
oss
o
externa
ead
to
to
n
te
oss
ear,
o
are
o
t
n
at
bers
comng
a
sensaton
parayss
te
C.
beow
o
o
te
superor
te
gossoparyngea
and
posteror
te
o
⅓
to
te
o
te
weakness
or
parayss
o
nerve
parynx,
musce
woud
GAS
movement
o
o
n
te
98.
C.
te
66,
tongue.
range
hs
o
A,
D,
GAS
D.
1057;
O
te
and
te
N
patent
s
styomastod
cess.
A
te
musces.
coud
65;
descrbed
te
137;
can
te
o
cause
as
to
te
a
o
n-
tp
probems
Ankyogossa
o
wt
te
can
te
te
A,
to
B,
be
GAS
100.
C.
resut
upon
psateray
and
E.
damaged
N
B,
43,
procedures
te
47,
et
o
49,
te
to
te
as
we
te
durng
va
mastod
key
o
to
te
te
o
o
a
oss
o
savary
nerves
gases
te
aca
aca
sted
unctons
o
not
58,
tonus
o
te
accumuaton
o
sava
39,
40,
and
te
D,
and
o
very
cose
woud
cause
com-
woud
cause
om-
and
musces
o
lgt
o
te
pupae).
o
te
ABR/McM
nerve
As
a
stars.
te
rom
be
woud
he
59,
66
weakness
patents
ave
wt
dicuty
superor
artery
cerebe-
just
beore
arteres.
dorsa
aspect
compressed
cerebear
to
eye.
cerebra
te
cause
eadng
causes
resut,
basar
posteror
easy
ts
and
musce,
commony
rom
by
papebrae),
nerve
rectus
woud
(parayss
nnervated
evator
constrctor
gaze.
nerve
down”
by
artery
o
he
te
an
aneu-
t
wraps
as
Aneurysms
key
te
154;
to
o
te
compress
nerves
down
sted
oter
te
are
arteres
trocear
not
key
men-
nerve,
to
cause
stars.
ABR/McM
59,
66,
66–67
n
te
n
to
part
A.
key
s
not
n
manner
hese
moss,
are
(hs
te
sympatetc
sted
tumors
ganga
and
because
te
o
nvove
cause
andross).
key
to
cause
rgt
brancng
can
and
naed
upper
o
te
Horner
he
oter
symptoms
o
syndrome.
Raynaud
te
o
bronc.)
(ptoss,
condtons
ung.
preerentay
because
toracc
Horner
rgt
coect
dsease,
extremtes,
patetc
Frey
s
a
vascuar
caused
by
dsorder
excessve
tat
tone
afects
o
sym-
vasoconstrcton.
syndrome,
a
rare
maady
resutng
rom
parot-
dectomy , s caracterzed by excessve aca sweatng
musce
n
pre-
n
te
C.
te
Be
presence
pasy
s
o
ood
or
wen
caracterzed
by
a
tnkng
eson
about
o
te
t.
aca
nerve, wt weakness or parayss o mmetc musces.
E.
parayze
“out
118;
emerges
D.
N
syndrome
B.
oodstufs
n
eye.
tract
trocear
superor
o
tertary
upper
83
buccnator
a
can
not
tend
ung,
gands.
are
nerve
gand.
nerve
(adducton)
117,
wakng
870;
btem-
o
E. A Pancoast tumor s ocated n te pumonary apex,
usuay
patent
te
103.
te
mastodectomy.
ABR/McM
57,
mdbran.
and
are
cause
ocated
abducens
esons
nto
te
te
C,
te
pro-
cause
o
njury ,
branc
as
subngua
59,
emretnas
ocuomotor
o
te
meda
and
esons
GAS
nerve
sku
parayss
ste
tympan
oter
durng
and
56
aca
damaged
s
B,
toned
vestbue.
woud
te
te
and
he
107;
Normay,
ora
s
C,
959;
vents
A,
tongue
submandbuar
A,
te
atera
te
nerve
probems
exts
nerve
o
around
be
nerve, eadng to oss o taste rom te anteror two-trds
o
rysm
ow
o
brances
mdbran
s
optc
(parayss
115,
burcates
can
compresson
afected
devate
te
o
down
trocear
renuum.
oter
te
anteror
aca
corda
to
resut
ngua
be
nerve
just
a
a
te
sted,
key
as
way
by
an
devaton
N
te
o
to
nerve
artery
n
(parayss
downward
ar
condton.
aca
te
te
ABR/McM
most
oramen,
ose
ts
coces
Dependng
aso
91–92,
caracterzed
tongue.
None
treat
he
o
87–88,
ygene
cuttng
E.
53,
eson
symptoms
te
by
answer
mastodectomy .
ora
s
a
condton
moton
woud
82,
t
extends
and
surgcay
B,
80,
(tongue-te)
treated
descrbed
78,
53–55,
(meda)
optc
extraocuar
o
eson
trocear
84
tat
eedng,
o
75,
49–50,
renuum
speec,
99.
N
Ankyogossa
gua
878;
A
wakng
1057;
ABR/McM
E.
nasa
casm
an
o
ptoss
meda
(taste
resut
our
parayss
tongue.
GAS
31,
casm
o
ptutary
o
Compresson
woud
tongue
te
eye
mydrass
102.
ypogossa
N
emanopa.
te
nerve),
optc
te
te
Compresson
crcotyrod
tonss,
above
bndness
cause
voca
sensaton).
Injury
D.
te
te
optc
Compresson
aryn-
nerve
he
onymous
E.
n
1081;
4
because
rom
Compresson
pete
aryngea
render
eyes.
proxmty
rsk
o
emanopa
aryngea
bot
woud
branc
sensaton
900,
39–40,
pora
bot
oarseness.
Damage
mdde
n
crcotyrod;
wt
te
woud
and
resut
resut
te
oarse,
Loss
musce
C.
woud
except
898,
101–125
durng tyrodectomy. Damage to te recurrent aryn-
gea
893,
ABR/McM
Compresson
A.
externa
recurrent
GAS
78;
paate.
48,
55
n
G
vestbue.
he
and
44,
resut
nabty
E.
N
nterna
above
aryngea
and
suppy
to
arynx
an
paatne
porton
ABR/McM
nerve
te
Neck
1112–1113;
Damage
gea
and
Atoug
te
predomnant
oter
a
eson
musces
musce
o
te
o
te
sted,
ceek.
aca
te
nerve
buccnator
D.
Qunsy
s
caracterzed
nlammaton
ABR/McM
218
o
te
by
tonss.
panu,
pus-ed
CHAPTER
104.
E.
he
and
dator
smoot
body
a
receve
synaptc
ce
nnervate
A,
C,
B.
D.
ce
he
B.
A
at
s
A
vesses
superors,
n
te
nnervaton.
sympatetc
are
ocated
structures
do
he
post-
neurons
n
not
te
a
cary
tat
spna
o
key
an
cord
N
te
ce
to
o
A
te
T1
to
te
gaze
t
s
pre-
o
te
etmod
rectus
musce,
A,
ateray.
orbta
pate
te
musce,
o
te
ronta
superor
but
ts
bone
obque
woud
be
or
ces,
D.
A
very
A
106.
B.
tus
o
(nterna
he
patent
he
te
C,
w
ead
990;
he
te
and
A
to
racture
te
and
cause
GAS
C.
E.
A
n
eakage
o
wt
nerve
out”
CSF
assoc-
eyeba,
a
o
reman
(oss
GAS
110.
te
s
can
te
wt
a
u
or
N
te
o
tat
111.
44,
59,
run
n
sense
A.
par-
B
pate
s
not
key
to
oowng
parayss
o
te
vestbuococear
nerve
can
E.
by
C.
wen
aurcuotempora
11–12,
26,
59
parasympatetc
nerve
are
cut
durng
E.
te
or
and
aurcuo-
and
sweatng
taste
savary
nerves
o
ood,
secreton
sted
39–40,
opens
o
te
ter
te
93,
by
do
not
cor-
42,
musce
te
te
56,
s
rma
81–82
te
ony
gottds
arytenod
by
cartages
92;
by
oter
sted
uncton
musces
and
tus
ave
are
not
arway.
ABR/McM
are
gy
te
47–49
vascuar
tonsar
care
ts
he
te
s
taken
arter y
paatne
and
branc
to
we
tons
ascendng
esser
s
by
are
o
te
denty
and
perormng
te
but
most
906–907;
N
aso
receves
paryngea,
paatne,
ar
a
te
te
arte-
dorsa
suppy
rom
sgncant.
72;
he
C.
nerve
ABR/McM
28–32,
parotd
nnervate
te
948;
te
orbt
N
te
w
o
o
te
externa
arses
s
aca
and
branc
o
te
surace
o
te
and
C3
rom
aurce
exts
te
not
te
129;
branc
C2
and
pass
ave
skn
te
over
te
ront
te
o
23,
te
maxary
do
57
dvson
sku
oramen.
oramen
to
membrane.
maxary
nraorbta
nto
anytng
tympanc
ABR/McM
o
nraorbta
A
and
o
beow
neede
drected
dvson
o
te
nerve.
mandbuar
te
sku
mdde
enter
nerve
does
107,
nerve
troug
nto
posterory
he
te
posteror
suppy
nraorbta
pora
brances
aurcuotempora
nerve
sensory
946,
he
membrane
nerve.
gand.
ngua
trgemna
B.
te
aurcuar
te
A.
tympanc
membrane.
suppes
he
te
aurcuar
and
great
he
o
gossoparyngea
he
GAS
112.
surace
te
and
exts
ABR/McM
occurs
o
o
tonss
te
nerves
wt
deaness.
15;
tat
tereore,
artery
tympanc
bub.
sme).
A
91,
rom
and
trgemna
80
axons,
N
nner
and
troug
nerve
E.
1001–1002,
vagus
oss
56,
oter
ABR/McM
mantan
and
aca
he
sted
oactory
te
o
52,
norma
processes
cauterze
D,
te
61,
drecty
te
damage
or
supped
nner-
nerves
sme,
can
nerve
39–40
D.
oter
by
lusng
crcoarytenod
supped
suppy
GAS
papebrae
because
9;
part
arter y;
ngua,
tertary
not
n
nerves
connectons
nnervated
tougt,
arynx
paatne
trgemna
te
as
1051;
C,
ra
rec-
s
perpera
aurcuotempora
resuts
he
voca
and
to
nserted
occur
o
A,
s
parayzed.
evator
bers
te
ntorson
tat
s
te
con-
normay
tonsectomy.
superor
he
cause
26
hs
atera
te
nerve
17,
te
syndrome.
N
te
te
D,
he
descrbed.
crbrorm
and/or
B.
aca
musce.
to
te
C,
gate
cause
uncton
dated
synapse
o
w
and
to
te
nerves
can
12,
poston.
nerve).
s
present
ABR/McM
to
spenod
E.
Frey
o
requred
musces.
unopposed
obque
to
te
ABR/McM
nerve)
condtons
syndrome
te
te
pupae
pate
1061–1062;
axons
and
Damage
eson
A,
dam-
musce.
tnntus
Frey
coud
upon
gand
ateray.
mus-
eyeba.
Hyperacuss
stapedus
108.
o
o
parasympatetc
pate
ts
15;
trocear
oactory
anosma
entrap
D
o
wng
parayss
w
te
can
As
co-
parotd
nnervated
419
Neck
gand.
979;
prmary
ocuomotor
key
96–97;
crbrorm
causng
C.
to
N
axons
Damage
E.
te
te
o
by
n
extraocuar
13,
o
te
o
pup
pate
resut
abducens
by
aso
maxa
obque
te
ater
aberrant
usuay
hs
posteror
adducton
ocuomotor
constrctor
D,
not
GAS
A.
s
11,
superor
because
te
rnorrea),
any
“down
te
uness
stmuaton
A,
B.
te
and
greater
actons
by
rotaton)
ptoss
vate
107.
o
seen
musce.
o
te
(supped
uncton
usuay
N
a
o
neror
necton.
te
n
te
(supped
obque
ta
o
reman
because
838,
he
te
prevous,
and
abductor
gaze.
(CSF
entrap
1062;
eson
to
o
to
or
crbrorm
nerves
nose
surace
rectus
te
menngea
1061,
A
eye
te
key
orbta
upward
o
racture
not
GAS
te
neror
oactory
troug
E.
o
te
mtng
ated
B.
D,
to
te
wt
rotatng
racture
age
B,
GAS
109.
o
parotd
reate
(not
nerve).
are
bers.
and
postgangonc
synapses
wc
between
response
te
estabs
connectons,
gands
nstead
tese
perperay
sympatetc
ormed
n
Wen
grow
gands,
new
tempora
36
meda
by
sweat
ocated
L2.
papyracea
entrap
rectus
racture
entrap
tey
sweat
make
unusua.
C.
surgery,
ony
sympa-
contans
but
ABR/McM
entrap
peraps
superor
eves
143;
to
coumn
neurons,
amna
nabty
racture
coud
axons
ergc
SCG.
contan
parotdectomy.
nergc
be
sympatetc
racture
causng
A.
te
structures
hese
1024–1025;
bone
o
papebrae
bood
sympatetc
ntermedoatera
ony
105.
evator
o
bodes.
synaptc
GAS
ces
bodes
tese
and
tetc
pupae,
musce
Head
7
ossa
te
dvson
troug
menngea
troug
crana
o
te
artery
te
cavty.
te
trgemna
oramen
exts
oramen
nerve
ovae.
te
nratem-
spnosum
to
420
C H A P T E R
D.
7
he
Head
neror
dvson
ten
and
Neck
aveoar
passes
descend
nto
n
te
branc
te
jaw
o
te
mandbuar
mandbuar
to
suppy
oramen
te
116.
to
o
mandbuar
he
be
oramen
exts
te
ascends
ca
GAS
113.
A.
I
sku
nto
spna
923;
N
tere
s
11,
an
aryngea
te
voca
ed
to
he
can
be
Injury
o
more
and
D.
Injury
cts
E.
n
to
n
oss
GAS
o
ABR/McM
114.
A.
he
as
te
easy
sary
te
rom
tat
o
21,
o
sensaton
te
superor
a
te
38
B.
o
o
most
we
D
operatve
damage
gand
aryngea
te
ar
75,
nerve
but
117.
ts
D.
posteror
woud
aryngea
voca
connectve
zone”
ayer
pass
because
nto
nto
te
and
toma
resut
and
o
n
s
C,
D,
and
A.
be
E.
as
None
te
911–912;
he
N
carotd
targete d
pressure.
to
to
canges
tongue,
cause
nerve
A.
woud
musces,
wt
s
B.
91–92,
tssue
ayer
nectons
sku
by
s
137;
means
te
known
can
C.
spread
o
bones
carot d
te
unconscousness
or
ts
c arotd
d e at
scap
ayers
E.
sted
as
to
de crease
are
re ason,
s n us es
te
he
to
C
and
carotd
D.
tyrod
o
bood
he
pressure
toracc
upper
136,
to
s
a
not
te
tyrod
anytng
because
cervca
te
to
and
to
pus e
s
e ad
to
relex ve y
o
gand
orm
neror
postgangonc
nor
wt
te
uses
te
nerve
suppy
mb.
141–142,
It
and
to
te
214;
ABR/McM
35,
45
n
te
t
tracea
te
10%
gand
woud
wt
n
superor
crcotyrod
a
suc
a
tyrod
gament,
ncson.
woud
not
tyrod
ven
87,
oss.
resut
or
o
rom
te
jugu-
a
a
artery
ucd
o
te
artery
s
te
te
ema-
hs
o
te
cumsness,
o
te
bood
subdura
woud
t
te
resuts
o
more
an
ep-
acute
n
and
unconscousness
and
can
proceed
to
untreated.
aso
can
te
resut
n
mdde
vascuature
anteror
a
case.
muc
et
reatvey
sgn
nto
rupture
s
because
adjacent
o
s
no
s
perod
pteron
ematoma
be
nterva
beedng
a
Suc
compresson
space.
ts
wc
bre
dura
Rupture
woud
n
29–32
n
dzzness,
beedng
subaracnod
by
resuts
gradua
symptoms
te
Fracture
n
te
menngea
ABR/McM
ematoma.
here
because
te
89;
oten
conuson,
ncudes
In
GAS
118.
D.
a
be
bood
nerve
tose
te
N
s
an
ep-
menngea
mentoned.
communcatng
because
ness
n
and
111;
o
tat
o
run
snus,
as
njury
ts
a
to
accessory
turnng
te
artery
te
ead
ped
by
ts
B,
C,
crana
toms
nerve.
te
snce
nnervates
A,
o
te
and
nerves
te
rgt
E.
883–884,
44,
te
tongue
rgt
he
wa
mandbuar
and
ypogossa
aso
et,
o
a
o
te
o
s
s
to
te
te
o
aso
te
et
nerve
o
weak-
te
sup-
rgt
tongue
(wc
afected.
combnatons
produce
rgt
Loss
n
uncton
devaton
actvty
te
trapezus
nerve.
resut
wc
musces)
oter
not
te
and
ypogossa
tongue
woud
descrbed
32–33,
he
n
ocuomotor,
accessory
musce,
unopposed
or
Droopng
woud
to
be
te
parayss
rgt
nerve
sternocedomastod
because
o
woud
compresson
62
accessory
resut
o
puncture.
nerves.
patent.
rgt
s
because
(maxary
rgt
tere
troug
ABR/McM
n
umbar
ncudng
abducens
te
upon
tromboss
trgemna
occurs
rgt
CSF
nvovement
nerves
present
souder
te
snus
cavernous
874;
nerves
n
cavernous
Parayss
GAS
147,
o
ven
oten
musces
rst
gangon.
cardac
sympatetc
para-
contro
stmu.
wt
steate
cervca
te
acute
mecanca
gangon
responsve
doxde.
83,
nvoved
dvsons),
b oo d
se ns t ve
can
carbon
do
tereore,
traceostomy
o
o
te
mdde
ematoma,
o
can
s us ta ned
cemoreceptor,
oxygen
gangon
rse
provdes
N
as
neror
gves
o
Neter
gand
E.
body
baance
ront
beedng
dura
te
te
te
subdura
trocear,
tat
reduced.
B.
CSF
Mdde
o
re cep tors
For
about
tyrod
tracea.
branc
te
41,
resutng
woud
te
5
m as s age
pressure .
o
oter
b arorec ep to r
s n us
tracea;
n
te
woud resut n a subaracnod ematoma, and tere
ems-
o
N
be
deat
zone.”
a
te
ste
cerebra
oowed
and
cords.
troug
te
present
arc.
memory
space,
de-
oarseness,
87–89,
ABR/McM
carot d
n
compresson
10;
sn us
or
he
o
“danger
s
suppes
te
across
te
eter
crana
reerred
GAS
115.
to
can
te
sku.
B,
t
emergency
aong
Artera
torn
bran,
oss
above
E.
1008;
A
tongue.
82,
run
sow-beedng
crcotyrod
woud
aryngea
te
80,
o
an
over
passes
venous
8
areoar
ts
and
GAS
ncudng
obstructon,
beow
n
crcotyrod
artery
above
tyrod
nerve
nerve
recurrent
78,
49–50,
not
he
supe-
voce/oarseness.
te
ront
ncson
does
aryngea
tyrodectomy,
parayss
o
artery
he neror tyrod branc o te tyrocervca trunk
cerv-
membrane.
ypogossa
66,
tat
12,
nterna
oroparynx,
actvty
te
“danger
vens
o
1,
branc
o
or
symptoms,
respratory
oose
A.
n
ma
present
njured
descrpton
parayss
N
oss
poston
n
te
sensaton
1057;
nerve
te
ascends
mdne
ear.
to
possbe
a
gossoparyngea
motor
Damage
resut
te
s
durng
rom
rom
cord
wen
poston tat a mdne ncson coud damage t.
concude
weakened
mdde
spna
accessory
nterna
tyroyod
wdespread
sensaton
te
arsng
case,
must
resut
te
te
ABR/McM
te
branc
woud
and
42;
to
ts
above
te
njured
musce
n
o
ater
tere
one
were
tyrodea
easy
branstem.
21,
In
externa
njury
C.
13,
nerve,
occur,
eve
and
s
were
sku
njury
cords.
extended
te
B.
to
and
te
cord
ror
njury
magnum
he
peope;
and
teet.
E.
C.
o
afected
specc
symp-
ere.
889–892;
66–67,
N
84–85
138–139;
ABR/McM
29,
CHAPTER
119.
C.
he
neura
ce
pterygopaatne
savatory
provdes
te
A.
nuceus,
te
aca
he
bodes
nerve
or
s
B.
he
te
o
D.
o
o
wc
are
va
to
n
te
te
te
te
aca
ts
to
E.
te
GAS
bers
otc
parotd
contans
musces
o
o
te
N
62,
artery
te
te
te
o
te
he
gangon
or
work,
te
ce
bodes
te
sot
paate,
assocated
caed
A.
134,
144;
C.
be
woud
suppy
o
be
te
artera
o
prmary
to
woud
rom
be
surgca
artery
to
s
D.
ess
neror
key
to
te
njury
by
te
menngea
to
be
artery
GAS
ower
o
te
o
be
but
te
paatne,
A.
n
te
te
artery
vesse
at
te
man
936;
N
a
n
te
poe
te
surgca
B,
C,
here
o
ton
39–40,
nto
B,
te
C,
nasa
N
68,
65,
67,
71–72,
77,
79;
ABR/
43
C.
venous
superor
and
E.
because
trbutary
to
optamc
necton
te
ven,
spreads
anguar
wc
ven,
passes
he
51,
907–908;
59
by
structure
te
eye,
cause
tat
snus
pup
by
a
59,
cary
just
scera
s
te
does
gan-
woud
79
body
bend
nto
nto
te
te
rs.
anteror
trabecuar
venous
ange
were
openng
mes-
snus
ormed
te
(aso
between
scera
venous
resdes.
n
te
rs,
camber
not
s
aqueous
to
wc
te
no
n
umor,
nvoved
eads
anteror
s
ound
n
a
E.
condton
(GAS
N
Fg.
157;
te
no
obv-
obstructon,
communcatng
troug
superor
obstructon
o
sagtta
CSF
low
system.
sted
are
ydrocepaus
a
exam-
tat
overproducton
resut
or
tra-
8.35).
ABR/McM
sagtta
o
te
coces
just
and
absorpton
nto
o
oter
not
not
80
ventrcuar
ventrcuar
he
tears,
enarged
nadequate
evdence
te
51–54,
compete
be
wt
umor.
ventrces
wt
superor
he
mdde
snus
snus.
None
o
N
99,
he
because
be
oter
routes
sted
woud
te
115,
147,
151;
ABR/McM
47,
rgt
dsr upt
D.
he
ts
te
72
woud
o
not
cerebra
n
sow
artery
ocaton
aspect
prouse,
great
posterory
te
o
menngea
tempora
woud
B.
be correct or dranage rom te danger area o te ace.
GAS
not
parasympatetc
Scemm
crsta ga and because
A.
tromboss
cavernous
D,
o
865–866;
te
snus
te
te
ABR/McM
obstructon,
cavernous
te
assocated
cavernous
te
granuatons
s
and
answer
to
be
woud
ABR/McM
te
noncommuncatng
A. Inecton n te “danger area o te ace” can ead to
ten
te
most
key
be
te
source o te beedng because t attaces anterory to te
1034–1037;
rom
a
scera,
sac
must
probems
GAS
125.
D,
o
rom
ves-
ere.
s
tered
aqueous
te
ste
somewere
s
treat-
o
ange
te
89;
o
aracnod
snus.
paatne
o
s
occuded,
body.
o
probem
pes
upper
stem
ven
s
Scemm).
o
acrma
snge
te
neror
hs
neura
secreted
by
umor,
vtreous
Wt
ous
surgery.
descendng
endangered
n
carotd
brances.
ste
encountered
tons,
arses
not
artery
te
posteror
ydrocepaus,
externa
te
s
te
secreton
be
surgery
a
n
s
te
cana
pup
he
to
124.
ocated
o
and
Vtreous
te
procedure.
aso
paryngea,
brances
not
woud
a
subject
to
and
coud
t
o
s
ten
cana
or
t
camber.
oroparynx
suppy
artery
paryngea
rse
paatne
28,
he
s
troug
draned
rs
ven
patent
t.
s
rdoscera
te
oroparynx.
nerory
T ermna
ment
he
wt
centra
camber
and
te
centra
and
woud
103–104;
lows
ten
te
he
trombopebts.
gangon
umor
umor
centra
tromb.
100,
posteror
camber
gand.
127–128,
ngua
and
trange
tympanc,
artery
te
aryngea
not
o
gves
ocated
Aqueous
n
te
troug
N
te
snus.
421
Neck
experenced.
trombus
pass
937;
retna
space
casm
cary
snus
source
event
ascendng
and
B.
o
snus
optc
not
c-
because
te
bndness
a
troug
cavernous
and
ensue.
transmt
gon;
E.
woud
carotd
te
he
n
spncter
va
ocated
GVE
te
te
brances
prmary
superor
he
w
rom
o
n
area
te
to
s
he
not
respon-
synapse
te
D.
pass
te
bndness
dranng
hrombus
GVE
may
reac
subaracnod
wt
B.
to
sufer
ven
he
wt
parasym-
ocated
pup
arynx—argey
oroparynx
and
McM
s
suppy
orgn
887–890;
ocaton
he
A.
tons.
njured
GAS
a
trombus
retna
bndness
85
te
he
te
ony
swaowng.
because
s
se
s
bodes
nuceus
ambguus
and
branc
paatne
121.
gves
sava
883–884,
concern
E.
concerned
he
te
woud
o
contanng
accommodaton
nnervatng
and
ABR/McM
D.
ce
te
and
and
savatory
nuceus
nerves
t
nuceus
bers
C.
o
123.
and
parynx,
C.
gangon
neror
speec
122.
secreton.
wc
nerve,
o
rom
and
te
musce.
he
A.
ocuomotor
nerve
A
not
nuceus
te
secreton
GAS
ts
(GVE)
gangon
s
n
superor
cavernous
gossoparyngea
o
B.
and
te
pons;
savary
gangon,
contans
musce
medua
120.
neurons
constrcton
cary
he
E.
and
te
or
pupae
ary
te
eferent
and
Ednger-Westpa
sbe
n
synapse
n
gangon.
mdbran
bers
axons
ocated
sympatetc
pterygopaatne
patetc
s
vscera
acrma
a
postgangonc
te
are
wc
genera
SCG
wose
gangon
Head
7
te
ocaton
o
woud
s
te
near
sku
te
not
te
but
beed.
be
a
good
pteron
ts
on
beedng
sow.
ve n
(o
c r an a
or
nature
an
Ga en)
c avty
njur y
s
and
o
s
t s
o cate d
no t
n
typ e
to
t.
stragt
recevng
dura
bood
venous
rom
te
snus
s
neror
aso
posteror,
sagtta
snus
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
te
great
posterory
torcuar
E.
he
te
to
te
nerory
reated
to
852,
(o
Gaen).
o
snuses
It
8.35
drans
A,
(eponym:
cavernous
to
te
te
47,
snus;
crsta
superor
ven
drans
urter,
ga
and
sagtta
rom
t
s
s
te
ocated
not
N
GAS
128.
111–112,
114;
B.
126.
he
vesses
wt
neror
dvson
o
te
abducens
ocuomotor
nerves).
nnervates
te
C.
Latera movement o te eye s ntated by te atera rec-
bood
(abducens
obque
ror
nerve),
(trocear
dvson
(neror
o
and
ocuomotor
dvson
upward
asssted
nerve)
o
devaton
te
tereater
te
nerve).
ocuomotor
exerted
by
te
by
neror
he
te
superor
obque
neror
nerve)
superor
rectus
baances
rectus
D.
A
superor
te
dura
E.
he
o
actate
CSF .
A.
B,
and
nerve,
te
tor
GAS
E.
key
ymp
he
papebrae
or
926–929;
he
ave
nnervates
requred
E.
Incude
wc
eye.
nerve
D.
excurson.
mdde
ocaton
dranage
brances
no
roe
superor
te
superors
N
96,
te
o
103;
o
o
ocuomotor
and
te
musces
eva-
are
not
eye.
GAS
129.
D.
51–54
be
bers
gea
s
A.
te
tere
s
most
poor
sagtta
n
and
te
nterrupted,
and
he
and
gag
s
te
te
te
CSF
wt
wen
o
to
te
tese
ematoma,
mdde
bone
CSF
te
to
nterna
to
to
eak,
ven
as
ead
bood
entry
carotd
wc
ndvdua
a
coects
rse
I
t
to
o
jons
te
subdura
n
te
to
artery
bood
ABR/McM
musces.
cause
wtout
sub-
CSF .
eakage
gves
menngea
woud
lud.
woud
nerve,
branc
damage
bone
cerebra
ead
sotarus
responsbe
and
lows
mxes
suppy
way
te
67
eferent
suppy
oses
by
nto
to
te
motor
te
aryn-
ts
regon
swaowng,
relexes.
nuceus
sensaton
gea,
an
bood
epdura
te
te
147–154;
paryngea
nodes.
367
bran.
o
ambguus
vagus
and
an
te
snus
not
N
nuceus
o
to
wc
o
n
anteror
tempora
wtout
woud
873–874;
he
coug,
woud
because
regon.
trgemna
movement
rectus
tese
te
cord
tumor
ts
te
ABR/McM
voca
te
rom
and
o
o
motor
dvson
superor
abducton
o
n
te
superor
space,
cot
n
o
wtn
occuson
(superor dvson o te ocuomotor nerve) must reax to
atera
a
ematoma,
(supe-
ror dvson o te ocuomotor nerve). he meda rectus
te
o
te
resut
connecton
tear
te
tereore
present
vesses,
brances
vesses
drect
(ne-
o
365,
and
nodes
perormed.
overes
wtn
nodes,
cervca
are
cords
pretracea
deep
and
voca
cervca
to
ruptures,
be
mentoned
te
ABR/McM
space
menngea
Leakage
artery
deep
neror
woud
s
above
dran
85–86;
compresson
neror rectus, te meda rectus, and te neror obque.
tus
cords
aneurysm
woud
ocatons
Areas
te
N
puncture
requred
and
nto
pteron
na nerves tat nnervate te extraocuar eye musces are
trocear,
oter
superor
voca
bood
mdde
(ocuomotor,
te
berry
tus,
C. For proper movements o te eye to occur, a te cra-
he
127.
a
A
subaracnod
umbar
A.
by
te
dranng
te
CSF;
126–150
D.
ympatcs.
1038–1039;
Wen
nto
60–62
and
by
beow
beore
drecty
snus.
1072–1073;
C,
draned
areas
a
Answers
B,
draned
are
optamc
875–876,
ABR/McM
ven
conluence
Fig.
Heropus).
superor
orbt
GAS
cerebra
to
GAS
space
and
taste
vagus
s
or
rom
nerves.
ocated
recevng
te
n
te
branstem
genera
aca,
vscera
gossoparyn-
CHAPTER
B.
he
trgemna
neurons
ton,
tat
te
tensor
myoyod,
C.
he
es
dorsa
o
genera
gangon
n
GAS
and
te
gands
o
and
ce
bers
eart
o
o
arynx,
o
o
te
vagus
aferent
vagus
s
concernng
panu
884–886;
te
somatc
and
rse
te
teet
to
te
and
te
spere
and
A.
A
respratory
N137;
contans
bers,
cely
rom
ABR/McM
myoyod
mylohyoid
A.
he
and
rom
he
eart,
B.
D.
he
a
bey
musce
s
nerve
o
nerve
nerve
te
tat
C.
s
by
s
nnervated
by
te
s
nnervated
by
ypo-
te
E.
he
aca
GAS
975–978;
ABR/McM
131.
A.
he
rom
nerve,
te
o
ear
B.
n
o
D.
and
144,
neror
146;
can
upper
nto
PCA
a
easy
aongsde
te
te
GAS
B.
orbt
wnds
surace
arteres.
he
and
te
njure
te
nterna
troug
supe-
o
A.
te
passes
and
nerve
pons,
tus
sku
te
and
va
bone
oramen,
orward
nterna
868–871;
anteror
59,
he
66–67
te
not
cerebear
nerve
as
acoustc
ave
t
passes
exts
te
an
artery.
rom
nterna
te
te
sku
juguar
t
ven
artery.
147,
149–152,
he
176;
ABR/
cases
rom
and
eson
te
bran
vesse
caused
T ypca
cerebra
tear-
ts
can
rap-
cause
parencyma
nto
by
te
bran
ypertenson
symptoms
or
ncude
acts
te
o
tose
may
bood
reated
to
pexus.
ABR/McM
s
atera
o
system
emorrage
musce
to
conscousness.
especay
150–154;
by
o
ventrcuar
corod
dvson
te
a
66
musce
o
pterygod
trgemna
protrude
porton
rom
o
te
mas-
nerve
o
nerve.
he
mandbe
and
temporas
nnervated
te
nerve
meda
rom
te
nerve.
te
by
te
mandbuar
tat
eevates
pterygod
s
a
deep
dvson
te
musce
mandbuar
hs
D.
he
ccay
he
jaw
masseter
nnervated
E.
musce
contraatera
musce
tempora
o
te
mandbe
tr-
wen
s
a
musce
o
mast-
te
asssts
te
o
jaw
te
and
pterygod
n
trgemna
works
wt
sde-to-sde
movements.
dvson
patysma
meda
musce
by
dvson
coses
o
n
s
a
s
a
musce
masseterc
te
o
branc
trgemna
mastcaton
o
te
nerve
man-
tat
spe-
cewng.
tn
musce
o
aca
expresson
tat es wtn te superca asca o te neck and
o
te
ace.
an
GAS
160;
It
aca
wrnkng
o
obque
draws
154,
N
anteror
ower
troug
sub-
caton nnervated by te nerve to meda pterygod
nerves
meatus
te
contracted.
C.
vcnty
ntmate
key
pterygod
mastcaton
dbuar
nterna
do
between
wtn
bross
jaw.
gemna
troc-
te
resut
CSF .
artery,
mparment
te
pterygod
nerves
artery.
superor
and
not
rom
vestbuococear
te
and
carotd
N
s
cerebear
aca
wt
orgnates
membrane
may
troug
te
most
bood
trauma
nnervated
te
o
carotd
superor
atera
mandbuar
open
te
te
nto
a
arteres,
o
891–893;
he
atera
o
tat
rom
te
o
nearby
suppy
tcaton
trocear
ematoma
te
ter-
brances
cerebear
te
te
mmedatey
to
te
tereore
artery
near
eventuay
cose
dvde
between
and
arses
passes
toward
w
gossoparyngea
juguar
McM
te
tempora
he
GAS
139,
n
o
o
surround-
ours.
and
nto
(grndng)
he
reatonsp
E.
on
enters
superor
enter
te
artery
artery,
nerve,
t
runs
abducens
te
and
bot
artery,
ten
surace
C
te
ssure.
he
o
te
passes
wc
and
136–137,
pedunce,
were
cerebear
nerve,
orbta
basar
wt
nerve
cerebear
artery
cerebear
contnues
anastomose
superor
by
te
cerebra
t
trocear
133–134,
te
cerebeum
ror
N
ocuomotor
te
as
nnervated
81–85
te
around
s
133.
superor
mnaton
beow
musce
nerve.
n
em-
rupture
subsequent
low
menngea
most
nausea,
because
te
paatogossus
vagus
or
CSF
aterosceross.
Beedng
nerve.
E.
o
aracnod
dranage
beedng
beedng
gradua
resut
cerebra
space
space-occupyng
12
n
dura
oca neuroogc dects, wt abrupt onset o ead-
be
musce
te
resuts
mdde
wtn
oca
ace,
musce
beedng
expandng,
rgt
Hydrocepaus
to
a
may
because
beedng
or
tears
te
progresson.
s
between
space
te
and/or
te
nerve.
styoyod
o
o
te
cause
423
Neck
rom
and
subaracnod
obstructons
parencyma,
motor
wt
rate
mater.
Intracerebra
dgastrc.
run
pa
over
and
between
may
pressure
beed
te
bran,
te
deat
gves
suppyng
nnervated
C1
nto
resuts
space,
beedng
bood
subaracnod
dy
aveoar
motor
te
Epdura
84
hs
varabe
artery
ng
nerve.
yogossus
gossa
nerve,
spna
ypogossa
neror
anteror
genoyod
bers
B.
te
a
aracnod
tract.
usuay
subdura
ntracrana
venous
creates
(wt
te
n
wt
te
vscera
te
aracnod.
o
and
te
beedng
cross
subaracnod
an
ce
and
sensatons
sensaton)
amentary
cn,
te
eakage
C. Just beore t passes nto te mandbe to suppy te
ower
tat
ncrease
bod-
musce
te
Subdura
paatn,
dgastrc.
te
D.
ng
uncton
excuson
826,
contans
132.
vens
ve
te
motor
mastca-
tract.
aferent
ungs,
o
o
parasympatetc
gangon
neror
te
130.
o
tensor
bey
nuceus
contans
musces
tympan,
muscuature
superor
bodes
te
nnervatng
ntestna
he
nuceus
anteror
motor
nerve
smoot
and
and
pregangonc
vagus
E.
motor
nnervate
Head
7
s
nnervated
nerve.
te
he
surace
drecton,
down
977–978,
ABR/McM
te
ower
983;
N
42–44
by
te
patysma
o
te
depresses
p
13,
and
49,
cervca
produces
skn
te
ange
o
te
ower
o
56–57,
sgt
neck
jaw,
te
59,
branc
a
n
and
mout.
82,
133,
424
C H A P T E R
134.
B.
he
10
ton
neror
and
to
12
9
D.
and
Neck
meda
qute
ncsor
tend
a
to
range
teet
erupt
exsts
erupt
earer
n
te
n
rst
grs
norma
6
to
tan
at
n
B.
C.
dstrbu-
superor
to
13
and
meda
superor
ncsor
atera
teet
ncsor
erupt
at
8
teet
erupt
atera
ncsor
teet
erupt
at
to
10
16
D.
monts.
E.
he
GAS
135.
D.
rst
he
sgmod
transverse
known
ton
as
o
nate
te
ear.
on
52,
juguar
ocated
13
to
t
paragangoma
s
ces
to
te
o
genera
oss
bub.
n
rom
or
Injury
to
loor
tat
te
may
GAS
tat
te
te
29,
137.
A.
35,
CSF
org-
te
rom
eart
te
rom
bran
ste
sgmod
te
opposte
date
A.
afected
he
ror
to
by
suc
o
afected
te
bran.
dverted
to
Bood
toward
juguar
expand
returnng
te
bub,
and
low
wt
oppo-
B.
te
n
nner
a
ear
are
not
a
ear
tumor
s
reated
cavty
to
and
s
penetratng
not
key
te
he
sgmod
te
(S-saped)
he
at
te
Beow
bone,
ped
GAS
E.
te
by
ngua
mucous
te
tongue
te
ror
te
A.
N
64,
nerve
and
va
part
o
te
he
corda
responsbe
ror
n
by
resut
rom
te
parasympatetc
nerve,
n
oss
te
53,
a
o
branc
sensaton
arynx
68,
above
56–57,
144–146;
o
te
59,
65,
ABR/McM
te
or
and
lud
bran
s
can
may
retnae
or
n
a
wt-
become
be
com-
anteror
detacment,
meda
to
te
may
to
resut
retna
ovea
brances
centras
may
and
can
degeneraton.
ens
and
(cataracts)
may
Cataracts
vson
perormed
bndness.
te
coors.
te
tonss.
optca
retna
rom
macuar
o
te
o
ntracrana
branstem
cerebear
pars
or
(“edema
s
pressure
cstern,
and
te
sweng
ncreased
puncture
CSF
damage
oss
or
aca
vary
Injury
nerve
uncton.
mas-
n
ces
te
open.
eevaton
s
o
occu-
taste
reduce
typcay
and
two-trds
bers
tat
to
resut
n
te
bers
te
hereore,
abducens
yss
o
are
rom
t
to
oss
nerve
w
te
cause
grad-
percepton
progress
potentay
te
ante-
submandbuar
o
branc
taste
and
an
o
sa-
o
n
apparent
C.
o
sowy
to
bndng
te
o
te
lud
te
ead
n
te
tssue
n
exces-
space.
nerve
carotd
s
artery.
carotd
compresson
resut
rom
an
abducens
nterna
or
to
79
nterna
te
woud
resutng
w
artery
on
psatera
te
para-
pup.
downward
trocear
and
nerve,
ateray
wc
s
woud
not
n
be
te
snus.
ptoss
te
woud
be
a
ocuomotor
resut
o
nerve,
a
compete
wc
s
not
ere.
Batera oss o accommodaton and oss o pupary
woud
omotor
D.
o
gaze
te
tenson
hs
dsc,
43–44,
snus,
wt
cause
to
Compete
serous
ABR/McM
aneurysm
abducton
Inabty
o
optc
pressure,
cavernous
nerve.
eson
s
pregangonc
tympan
o
te
contact
cavernous
B.
ante-
bers
te
because
to
103;
qucky
relex
aca
and
te
corda
jon
N
ntmate
coud
o
ntrabubar
accumuaton
931;
Wtn
n
gands.
o
tongue
or
E.
71
nnervaton
parasympatetc
branc
te
ABR/McM
sensaton
subngua
bers
w
te
wc
anteror
taste
sve
GAS
A.
tympan
and
te
to
were
juguar
cavty
an
sensory
te
carryng
parasympatetc
gangon.
ossa,
o
s
114–115;
o
corda
and
to
mastod
Compresson
ncreased
138.
stapes,
suppes
tympan
two-trds
te
E.
bood
musce.
110,
tongue,
submandbuar
oramen
common
antrum
o
membrane
nratempora
te
and
142,
dsc
ernated
oss
n
cause
tortuous
nterna
entrance
wc
ad
stapedus
te
a
bub.
te
te
venous
oows
juguar
wt
s
s
nto
pyramd
te
and
juguar
wc
adtus
874–876;
he
te
antrum
process
te
te
n
ad
coects
bone
to
superor
antrum,
mastod
snus
contnuous
adtus
tod
venous
tempora
course
becomes
ven
E.
woud
bers
untreated.
beneat
t
and
resut
N
umbar
umbar
yeowng
bue
mdde
a
serrata,
Opacty
ua
ear.
C.
te
vson
resut
ante-
optc
caused
emorrage
drecty
te
s
I
te
ora
resut
D.
artery
o
8.150A).
1103;
cauday
by
are
tumor.
mdde
by
and
canas
A
nerve
taste
aryngea
133–134,
s
Separaton
causng
accommo-
semcrcuar
key
ack
gand.
w
Fg.
eevated
rom
pressed
C.
atera
carotd
te
o
bood
low.
and
te
bock
superor
system
bood
n
wa
be
and
venous
nterna
sde
graduay
cocea
ocated
B.
tat
snus
ncreased
he
s
efectvey
1101,
pressure.
patent
tongue
parotd
nerve,
82,
tat
dspaced
may
s
tan
81–82
papa”)
ear
te
superor
(GAS
Papedema
drawn
and
sensaton
rater
and
aryngoparynx
ods
66,
entre
bub
tongue
sensory
o
te
te
vagus
1098,
69–70,
org-
mdde
T umors
te
por-
o
te
voca
cavty
neror
o
damage
gossoparyngea
trd
suppy
nate rom te superor juguar bub can grow to te
to
136.
Injury
rom
13
sma
bony
tumor
ound
juguar
a
te
te
a
monts.
bood
nto
bub,
beneat
19
ABR/McM
venous
emptes
superor
superor
at
73–74;
coects
and
paraganga
te
erupt
12,
snus
s
A
rom
teet
N
snuses
wc
mdde
and
moar
oss
nerve
n
o
1114–1119;
o
posteror
monts.
neror
patent’s
receptors.
C.
he
monts
he
hs
because
curve.
and
at
Head
monts. T eet
boys,
A
7
be
nerve,
Ipsatera
oss
a
oss
resut
te
ng
o
trgemna
te
te
resut
wc
o
o
te
and
o
not
batera
oss
key
ts
n
consensua
bot
nerve
aferent
s
te
and
te
aca
respectvey.
GAS
876;
N
115;
ABR/McM
47,
59,
80
o
ocu-
relex
dvson
nerve,
mbs
te
stuaton.
cornea
optamc
eferent
o
s
o
suppy-
te
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
erng
necessary
o
branc
te
o
te
anestetze
wc
s
optamc
te
conjunctva
cov-
supped
by
te
nasocary
dvson
o
te
trgemna
Fig.
141.
A.
s
he
aca
tereore
Snce
ts
musces
te
tat
upper
orbta
to
eyed
te
septum
anestetze
nerve
and
o
te
A
and
te
to
te
and
by
s
tese
te
to
te
answers
he
te
acrma
ab
maxary
dvson
resut
key
n
cause
puncturng
urter
te
s
up
44,
a
C,
tysma,
and
te
eye.
n
20,
acrma
por ton
wereas
sac,
o
te
Injectons
o
61,
97,
wc
te
s
te
132–133,
as
descrbed
28,
205
899,
one
oca-
cn,
te
na
ts
woud
n
ve
he
te
bot
woud
bey
o
rst
te
genoyod,
perce
te
dgastrc,
and
pa-
te
te
E.
he
ower
995–997;
N
32,
36,
38;
ABR/McM
ceek
GAS
aveoar,
branc
contros
but
te
mentas.
runs
across
orbcuars
woud
trgemna
sensory
o
te
tensor
he
te
cause
te
ocu
weak-
te
s
musces
anteror
sensory
o
bey
tympan
te
consst-
nnervaton.
te
bucca
aca
severa
o
nerve
nerve,
and
he
mas-
o
component
n-
nerves.
nerve
musces
wc
te
tensor
aurcuotempora,
and
none
and
njury .
depressor
s
a
used
drecty
motor
n
aca
contro
p.
bucca
dvson,
and
or
ncude
nerve
te
nerve
mandbuar
atrogenc
trgemna
conssts
musces.
neror
tat
o
and
brances
ors,
o
aca
tgty.
myoyod,
musce,
expressons,
ten
nay
te
p
nerve
eye
te
motor
ower
aca
te
and
gand.
parayss
o
te
gand
parotd
margna
suppy
dvson
o
nvoved
te
ts
parotd
te
branc
angu
to
o
sufered
o
to
component
bucca
te
te
one’s
dvson
paatn
gua,
D.
bone
te
surgery
as
branc
Damage
dgastrc
nerve
na
fibers
ganglion
troug
musces,
depressor
Mandbuar
o
p,
tat
cosng
tcaton,
case,
perce
parasympathetic
submandibular
controng
nerors,
motor
142–143;
n
fibers
[VII]
symptoms
ower
Zygomatc
ng
scera.
genogossus.
896,
musces
argest
nasoac-
eter
o
parasympathetic
nerve
durng
tese
te
ncudes
te
anteror
ten
s
ness
ast.
he
te
musce.
damage
supraorbta
nto
anestetzng
wound
beow
D.
myoyod,
GAS
B.
80–81
puncture
rom
ten
te
N
sac
meda,
resut
51,
genogossus
te
acrma
too
not
or
facial
passes
rsk
patent’ s
o
suppes
branc,
ateray
rom
nerve
at
zygomatc
most
ossa
931–935;
Durng
te
apex
between
muscuature
suppy
rom
orbta
aso
nerve.
above
woud
B,
sensory
woud
he
duct,
passng
A,
papebra
twgs
te
and
C.
C.
ABR/McM
te
toward
nerve,
eye.
oramen
E.
atera
Bot
and
occuped
GAS
te
(peraps)
E.
B
ton
and
trgemna
scera
rma
deepy
nasocary
fibers
8.150A
nerve. T o do tat, te neede soud be paced troug
ntrate
140.
to
scera,
GAS
parasympathetic
Postganglionic
from
fibers
[IX]
ganglion
Preganglionic
from
nerve
nerve
wc
and
te
900–901;
N
s
a
branc
provdes
mucosa
54;
o
sensory
o
te
ABR/McM
ora
40
te
to
mandbuar
te
skn
vestbue.
o
te
425
426
C H A P T E R
142.
A.
7
Durng
tary
ynx
an
(Ratke
(pars
n
o
te
te
B.
Pars
C.
o
te
s
he
trd
o
aar
a
somatc
s
tat
to
te
growng,
more
common
tat
o
s
te
not
(o
A.
te
s
atera
not
te
It
s
te
anteror
C.
s
porton
to
s
not
assocated
N
52;
s
n
neura
orm
n
mpuses
are
woud
E.
n
maormatons
teencepac
camber.
oactory
Aso,
bubs,
Cdren
ave
tube
N
146.
genera
and
te
embryonc
resut
n
durng
sze.
orebran
or
vaut
as
embryoogc
deve-
hese
patents
usuay
ave
to
an
acoo
ABR/McM
neu-
ave
ypotaa-
severe
wt
or
o
o
te
cerebear
sku
s
structures
cavara
eads
(IUGR),
s
caused
dvde
ts
suc
as
s
to
or
vaut.
ntrauterne
causng
mcrocepay
by
aure
nto
two
one
In
te
pros-
em-
wt e,
presented
bran
abnormates.
o
cerebra
ncompatbe
te
near-norma
aca
te
undeveoped
abuse
propery
cases,
norma
tmes
bones
60
speres. In severe cases,
ess
te
retardaton.
Hooprosencepay
to
n
ydrocepaus.
restrcton
encepaon
not
ead
menta
120;
B.
deect
o
dspacement
not
growt
wt
cranoparyngomas.
oss
o
tere
wt
o
te
vesce,
oactory
s
47
A.
mdne
bran
used
oten
tracts,
and
ace.
eyes,
and
corpus
Smt-Lem-Optz
cranoaca
and
mb
a
ypopasa
and
deects
Sczencepay
arge
cets
some
n
cases
o
sku
does
te
cause
Exencepay
part
s
here
are
snge
nto
o
te
C.
te
s
cerebra
oss
caused
neura
not
and,
n
cose,
o
cases,
magnum.
ernaton
te
117;
or
ventrcuar
ABR/McM
It
a
o
cose;
te
bran
dect
part
o
o
te
te
posteror
can
ncude
protrudng
te
n
s
cepac
exposed.
te
aspect
te
bone
o
te
mennges
ncudes
N
147.
part
system.
but
ere,
babes
deveopment,
some-
ts
case,
te
cd
as
neura
te
externa
ear
Rubella
te
B.
stapes,
woud
o
However,
part
ton
te
aspect
occpta
o
protrudng
(most
bone
and,
te
oramen
bran
ncudes
key
te
posteror
n
some
magnum.
part
orn
o
I
te
o
cases,
te
te
ernaton
ventrcuar
te
poste-
atera
or
C.
gea
ventrces),
occurs
B,
at
D,
typcay
GAS
te
posteror
and
E.
nvoved
856–857;
N
ontanee
hese
n
portons
crana
15;
o
te
o
deects.
ABR/McM
27
ness,
D.
sku.
te
sku
are
not
o
N
(As
105;
o
wom
cerebra
te
aure
o
carac-
emsperes.
were
o
s
by
ave
te
sku
bran
to
cepac
cose.
s
It
porton
s
because
system
n
a
oss)
a
mdde
madeveop-
mdde
or
o
crtca
maormed
te
tme
earng
arc
a
deaness,
ear
organ
o
oss.
paryngea
congenta
o
xaton
ear
wtout
and
nner
spra
congenta
conductng
second
a
a
te
structures
durng
to
o
o
to
orm
stapes
bone.
tere
s
a
xa-
stapes.
te
dorsa
woud
hese
are
porton
ead
to
not
o
te
undeveoped
afected
n
rst
paryn-
maeus
congenta
and
dea-
owever.
not
potenta
E.
to
n
Abnorma
does
te
te
cet
ncus.
ten t s reerred to as menngoydroencepaocee. he
dect n te squamous part o te occpta bone usuay
o
Faure
system
ead
earng
ead
caracterzed
66
resutng
Faure
46
and
cose.
infection
(neurosensory
te
neurosensory
can
s
5%
Sczencepay
n
o
magnum
cana.
deects;
conductng
deveopment
cerebear
branstem
oramen
aure
deaness
or
te
assocated
condton
o
to
ABR/McM
o
a
because
tube
Congenta
ear.
s
and
spna
D.
cets
II maormaton.
were
syndrome
mb
because
C. Usuay , dects o te cranum nvove te squamous
o
arge
typcay
116;
A.
ment
cranum
occpta
bran
te
by
s
te
cervca
and
Exencepay
o
tereore,
troug
upper
exposed
tssue.
aure
to
te
terzed
by
wc
ernated
ventrce,
ooprosencepay.
ave
caracterzed
emsperes,
eavng
s
s
bran
by
squamous
some
oramen
te
te
n
tube
Menngoencepaocee
nvovng
and
ourt
cranoaca
syndrome
5%
maormaton
Smt-Lem-Optz
caosum.
and
II
verms,
E.
rare
a
Car
structures
ooprosencepay.
A.
sma
Materna
or-
sensory
a
Cauda
a
n
taamus,
ABR/McM
ooprosencepay,
snge
ror
te
cavara
condton ave a concomtant Car
It
854–855;
nasa
144.
occur,
te
gand.
resuts
N
not
and
necton
osscaton
and
nvoved
o
te
does
a myeomenngocee. Amost a o tese patents wt ts
In
E.
An
oten
ventrces
nvoved
dorsa
sensory
rse
ts
mus, pnea gand, and posteror obe o te ptutary
GAS
D.
T oxopasmoss
cavara
cranoparyngomas.
gves
I
abnorma
opment eads to mcrocepay , n wc te bran and
assocated
Monro)
eventuay
cord.
s
deveop.
D.
tat
w
vscera
wt
Dencepaon
C.
deveopment.
prmordum
gand.
rom
B. he rostra neuropore coses durng te ourt week
o
te
sow
wraps
t
between
part
spna
and
tube
s
145.
menta retardaton because o an undeveoped bran.
oramen
porton
te
assocated
ra
par-
orms
derved
and
gand;
ventrce
pate
o
ptu-
te
cranoparyngomas.
cauda
axons
B.
seat
ptutary
connecton
te
and
te
ptutary
It
ocaton,
o
cdren.
nterventrcuar
and
a
a
tumor
o
roo
te
pouc.
cranoparyngomas.
maton
A.
n
o
he
and
E.
a
te
cepaad
wt
batera
D.
s
Ratke
tumor
tuberas
obe
rom
tuberas)
suprasear
supratentora
deveopment
grows
cranoparyngoma
ound
s
Neck
outgrowt
pouc)
obe
epteum
143.
and
embryoogc
gand,
anteror
A
Head
deveopment
ead
to
deaness
congenta
expaned
n
ABR/McM
B
57
o
te
but
s
anomaes.
and
C)
aurcuar
a
marker
ocks
or
oter
CHAPTER
148.
A.
Wt
and
by
congenta
grays
wte
teratogenc
meases)
can
can
afect
crtca
sevent
B.
agents
cause
te
perod
mates
ssure
tat
but
on
can
rubella
virus
te
hs
ens,
between
woud
to
a
congenta
opaque
ma
(German
N
as
ourt
a
and
149.
a
cet
to
cooboma,
and
woud
reey
nterpreted
optc
ead
by
eye
a
abnor-
ead
A
woud
ead
to
a
B.
to
eye
o
te
and
SHH
o
and
menta
a
sa
Cooboma
to
s
a
absence
typcay
by
oss
te
a
o
tere
n
te
anrda
s
a
ton
suc
as
CMV
1063–1064;
emaca
tat
lat
and
corod
by
dsorder
n
a
usuay
N
eye.
te
eye
tan
usuay
and
102;
o
tssue
and
ssure
te
ton.
and
as
mutaton
o
abnormates
te
ncude
n
ts
ts
rom
B.
to
s
and
occur
tumors
ts
153.
sma
zed
by
Cons
maar
zygomatc
santed
and
C.
ypopasa
papebra
most
normay
wt
normay
(caused
mandbuar
ssures,
s
A.
by
2
undeveoped
eyed
and
ca
and
E.
deect
coobomas,
an
atered
deveopment
Inants
wt
o
te
Robn
cet
rst
arc
mand-
Sequence
paate,
s
ncudes
conotrunca
s
a
severe
veocardoaca
anomaes
ace
arm
o
o
deveopmenta
A.
It
s
cycopa.
to
maor-
are
respon-
a
E.
caracterze
T urner
webbed
syndrome
neck
and
sma
30
or
deveopment
E.
o
te
Mecke
o
gves
o
te
rse
to
te
Recert
yod
sta-
cart-
bone.
It
s
nerve.
arc
s
responsbe
and
te
nnervated
te
maxary
vagus
snus
snus
ronta
sxt
or
ower
by
te
paryngea
cartages,
ABR/McM
ony
man-
mastca-
caracterstc
cornu,
cornu
and
aryngea
o
a
s
te
o
or-
a
o
gosso-
nerve.
ourt
by
eatures
arc
aca
and
musces
rst arc.
esser
greater
speccay
te
wt
te
upper
by
bone
he
105;
te
n
process,
te
yod
nerve,
paryngea
n
arces
addton
to
gve
beng
nerve.
21
arses
ate
present
snus
at
n
eta
deveopment
brt.
deveops
at
approxmatey
7
age.
E.
o
he
etmod
ces
deveop
at
approxmatey
age.
1063–1064;
Meroencepay
tra
neuropore
he
to
N
87;
oten
cose
cavara
ABR/McM
resuts
durng
(.e.,
rom
te
47
a
aure
ourt
skucap)
s
o
week
te
o
absent,
ros-
deve-
wt
a
resutant extruson o te bran rom te cranum. Deects
are oten ound aong te
B.
and
syndrome
to
ead
he spenoda snus deveops durng adoescence.
GAS
154.
CMV
necton
can
vertebra
cause
coumn
as
we.
mcrocepay,
n
wc
bot te bran and cranum are drastcay reduced
cranoa-
syndrome.
ead
mutatons
nnervates
paryngea
o
te
and
n
syndrome
by
presents
te
trd
opment.
by
mcrognata,
DGeorge
tat
to
years
gossoptoss.
D
and
he
C.
o
down-
can
anrda.
trgemna
patent
styod
years
caracter-
ypopasa,
ower
caused
te
afected.
ave
s
ts
ong
mutatons
PAX6
and
tat
second
he
and
bones.
ears.
Sequence
structure,
be
syndrome
bones),
maormed
Robn
B.
syndrome.
dermods
PAX2
and
responsbe
te
he
11,
D
T reacer
by
pes,
and
rse
eyeba.
B.
te
mutatons
ABR/McM
s
paryngea
D
nec-
anoma-
gene
gene
caracterzed
215;
maton
N
and
o
causes
ypopasa,
caracterstcs
eye.
apaka
nnervated
zygomatc
wt
tymc
are
deeton
SHH
Speccay,
s
hs
he
a
deve-
nvove
te
nnervated
51
and
te
dvson
age,
te
norma
an
cranoaca
unateray
aso
tere
two-trds
resuts
deects,
(22q11)
deveopmenta deects
toxopasmoss.
tempora,
anomaes
sma
A
PAX6
o
mandbe,
te
s
cardac
cooboma,
43,
dbuar
rontona-
wc
ABR/McM
mcrosoma
occur
maxary,
eye
te
30
cartage, maeus, ncus, and mandbe. Addtonay , t s
snge
mutaton
mdne
orebran
te
ess
condton
Ear
wc
caused
o
hs
Ear
resuts
and
11,
C.
s
sze.
and
te
usuay
mcroptama,
opment,
In
ens)
gene.
compete
es
a
o
occurs
Anoptama
GAS
n
caused
eadng
wc
PAX2
In
usuay
te
abnor-
A. he rst paryngea arc, wc s oten assocated wt
promnence.
use,
A.
D.
or
o
and
nnervated
condton
usuay
gene,
gene
o
deects,
ypocacema.
stature.
rs).
s
s
PAX6
(absence
underdeveopment
150.
and
sbe
152.
te
cardac
and
ypocacema
22
deect
matons
mcro-
51
apaka
Cycopa
E.
A
project-
N
mutaton
ace,
syndrome.
PAX2
bran.
mcrocepay
ABR/McM
and
cromosome
C
cause
ABR/McM
(absence
C.
paate,
(47XXY)
undeveoped
paate,
151–175
Abnorma
congenta
an
congenta
B.
215;
o
102;
A.
A.
wormke
patent)
woud
43,
DGeorge
dsc.
necton
cet
ypopasa,
427
Neck
deect.
not
movng,
te
by
tymc
cepay and eventuay menta retardaton because
CMV
D.
11,
Answers
151.
retardaton.
N
ace,
and
necton
wc
te
caracterzed
Inecton
cataracts.
artery
rater
T oxopasmoss
E.
appears
resut.
cataracts.
o
ead
yaod
(as
te
aure
not
but
structure
ng
as
deveopment
persstent
cataract
D.
ens
w
cet
condton
A
suc
congenta
deveopment
o
te
bndness
week.
Corod
C.
cataracts,
and
Head
7
sze.
rom
C.
he
wt
However,
te
tere
ypopysea
te
s
no
extruson
o
te
bran
cranum.
ptutary
dvertcuum
gand
and
s
usuay
assocated
regresses
to
428
C H A P T E R
7
eave
Head
ony
tcuum
a
to
and
Neck
remnant
deveop
stak.
woud
Faure
not
be
o
ts
dver-
assocated
te
wt
te
meroencepay.
D.
Faure
te
E.
o
vertebra
Neura
and
crest
N
113;
D.
n
ts
vscera
par ynx
and
merges
asca
constrctor
s
ormed
and
te
tr ue
to
raton
o
r yngea
at
asca
te
toward
asca
and
or
space
o
he
asca
and
he
prevertebra
umn
and
back.
te
tyrod
te
he
te
tere
s
no
o
o
GAS
157.
te
s
s
te
to
te
o
tr ue
as
te
anteror
te
ayer
o
nvests
te
asca
te
s
aar
spaces
o
space
neck.
to
te
base
te
he
GAS
A.
aar
age
te
resuts
loor
te
o
neror
or
sku
te
ater
te
a
a
traveng
nerve
superory
nto
te
orgnates
trgemna
tereore
te
o
s
over
supra-
rom
nerve
not
te
so-caed
87;
te
te
and
key
D,
and
areas
A.
he
to
s
be
te
n
B.
ABR/McM
o
te
te
to
o
C.
he
D.
nerve.
A
orbta
can
wa.
margn,
troug
he
va
te
and
oten
te
to
te
ts
nerve
neror
nraorbta
loor
o
case,
te
orbt
wtn
to
te
ar
te
be
pysca
paced
near
te
detect
ear-
on
te
externa
vbratons.
conducton
Rnne
Weber
ork
test
test
w
s
to
be
oten
rue
out
s
ABR/McM
hese
groove
s
paced
4,
7,
9,
on
any
16
aryngea
artery
aryngea
o
a
a
to
o
o
supe-
arynx.
resut
te
ack
nerve
a
tumor
render
o
te
as
oop
arc
trave
to
nerve
presence
woud
te
ten
groove
because
nerves
and
nerves
aryngea
te
not
test.
recurrent
or
te
a
nterna
sensaton
oss
nerve
cup
47,
159.
B.
o
gves
aryngea
above
taste
on
rse
damage
te
te
to
to
n
o
te
patent
nnerva-
most
o
te
numerous
te
externa
nerve
voca
woud
cords,
n
epgotts.
te
ts
n
49,
recurrent
nerve,
symptoms
voca
oten
or
relex
not
1000,
50,
to
te
aryn-
owever,
beyond
wt
wt
just
atgued
te
prenc
and
swaowng
1058;
N
or
wc
resut
Patents
a
breatng
panu
1023,
o
nerve,
w
crcotyrod
weakness.
present
compresson
probems
aryngea
tyrodectomy,
nnervaton
w
Dpoc
te
durng
resutant
999,
between
o
to
Irrtaton
GAS
eaves
aspect
and
paced
subcavan
o
resut
o
cause
te
oramen,
to
occur
eson
racture
n
49;
et
nerves;
wt
E.
nraorbta
neror
and
47
bow-out
wa,
durng
conducton
onger
Rnne
recurrent
oss
Damage
o
dam-
te
to
oarseness.
nerory
key
unkey
arynx.
vagus
woud
space
superory
no
te
recurrent
te
a
danger
woud
and
enter
oss.
oarseness
te
ten
traceoesopagea
te
hs
by
s
respectvey.
Damage
8.163).
orbt
N
and
rgt
addton
muscu-
buccoparyngea
struck
tunng
nterventon
musces
asca
eve
s
wt
he
1110;
aorta,
ton
posteror
te
eyeba
to
80–82
conducton.
durng
rgt
gea
to
te
orbt
tereore
possbe
patent
bone
E.
B,
tese
oss
Fg.
te
A,
retroparyn-
contnues
te
empoyed
can
conjuncton
Damage
rom
It
patent
eaty
tan
n
rory
tereore
skeeta
te
ork
structures.
oarse.
more
bend
rom
are
determne
traceoesopagea
contnuous
and
to
and
tese
ocated
away
oten
co-
separated
medastnum
(GAS
mmedatey
orbta
s
sku
racture
neror
te
separates
dspaced
nerve
o
nerves
tunng
norma
around
esopa-
neck
s
earng
dapragm.
nraorbta
n
as
space
ascae
N
courses
dvdng
ABR/McM
s
vertebra
asca,
te
porton
posteror
asca
991–992;
An
o
respratory
prevertebra
to
hs
and
63;
te
between
coverng
reerred
te
te
156.
asca
asca
troug
E.
aar
nerve
test
te
GAS827,
158.
retropa-
tracea,
musces
by
neror
o
ts
nerves.
orbt
sensorneura
o
aar
sepa-
ear
surgca
asca
ature
gea
te
hese
N
A
unt
used
te
te
n
oss.
better
posteror
resut
te
In
contnuous
reerred
asca
ear
asca
o
904;
nner
par yngea
Attacments
s
ntrnsc
potenta
te
hus,
mastod process or maxmum bone conducton to te
gand.
prevertebra
s
nerve
dvson
posterory
Rnne
ng
beore
extensons
provdes
encoses
asca
te
cana.
beore
aveoar
to
optc
cause
Between
ronta
supraorbta
cose
examnaton
sku
aar
C.
ayers.
A.
and
damaged.
damaged.
space
te
he
asca
rom
prevertebra
vscera
and
cranum.
buccopa-
superor
wat
space.
tat
gus,
be
contents
neror
he
te
pretracea
he
traves
or
ayer
esopagus
musces.
aar
E.
med -
wa
base
cavty.
te
te
buccopar yngea
anteror
he
danger
groove
to
mandbuar
space.
he
he
be
necton
trave
te
o
nvests
seat
posteror
An
he
buccopar yngea
te
vscera
C.
te
posteror
asca.
boundar y
te
te
batera
carotd
not
retropar yngea
toracc
retropar yngea
asca
B.
te
asca.
neror
D.
types,
rom
buccopar yngea
buccnator
rom
prever tebra
wt
aar
aso
and
ce
kewse
extends
tus
he
te
te
to
coud
superory
nto
o
not
esopagus.
coverng
wt
contnung
woud
space
sku
te
te
begns
r yngea
te
between
and
varety
C.
orbta
trocear
cranum.
a
and
te
key
damaged.
space
asca
afect
62
medastnum.
encosed
te
to
woud
meroencepay.
o
bend
posteror
asca
not
rse
ormaton
wt
aspect
astnum
abscess
gve
deveopment
retropar yngea
neror
s
coumn,
ABR/McM
he
arc
ces
abnorma
assocated
155.
B
neura
nraorbta
most
n
a
musce,
wt
ts
voce.
nerve
trggered
can
c-
oarseness
234–235;
ABR/McM
84
vens
te
are
vens
bran.
o
responsbe
te
Dpoc
scap
vens
or
and
are
communcaton
te
venous
stuated
snuses
wtn
te
CHAPTER
Buccopharyngeal
(posterior
Infrahyoid
of
layer
muscles Prevertebral
Pretracheal
Pretracheal
layer
fascia
space Retropharyngeal
Manubrium
of
•
o
bone
between
o
two
sgncance
provde
vens
te
o
way
o
are
by
he
to
te
he
te
as
874;
near
t
and
ter
a
ems-
cnca
ts
vens.
161.
more
not
te
dsta
o
by
woud
an
vens
o
o
te
nerve
a
o
bood
patway
te
woud
rom
arses
te
tus
at
tese
not
atera
key
A.
by
be
n
te
postovary
nerves
s
pons,
sucus
key
ere
to
because
be
o
te
meda
932;
o
te
bone.
o
teter
N
9,
42,
wa
meda
eye,
but
ancor
n
on
orbt
and
te
responsbe
or
non-
te
ormed
rectus
ts
te
(abducton)
ere,
te
between
meda
he
o
musce
musce
te
or
wa
rectus
cracked
damage
te
and
eye
ateray
and
dects
GAS
orbt.
927–929;
A.
he
are
tus
and
ever,
or
rotates
N
13;
s
case
eyeba,
o
te
musce
eye.
s
not
n
neror
movement
te
broken
entrapped
ocated
or
at
te
ocated
abducts,
52–53,
neror
ter
move
te
eye
loor
move-
at
te
roo
depresses,
and
Normay,
te
o
musces
parts
In
ts
maxa
and
o
superor
responsbe
te
rectus
te
te
eyeba.
pate
neror
are
80
obque
between
obque
o
or
to
eye.
ssure
orbta
te
musce
and
loor.
musces
nabty
o
eye-
patent.
musce
te
te
respectvey.
s
responsbe
ABR/McM
te
an
abducton
rotates
tese
n
musce
ts
rectus
orbta
te
upward
n
to
nerory,
obque
hs
neror
entrapped
and
be
rectus
resut
rectus
seen
nternay
Damage
w
superor
te
neror
woud
Ineror
orbt
s
te
suppy
E.
he
o
162.
rectus
downward.
ractured
ocated
te
mentoned
or
case,
as
neror
te
rec-
an
ow-
snared
obque
musces, causng tem to act as ancors on te eyeba,
near
nterna
prevent
te
o
poste-
pons.
a
ba
and
cerebear
and
te
excurson
eye,
te
B
com-
PCA.
s
he
nerve
compressed
as
te
ment
superor
acts
no
o
889–890,
meda
adducton
nerve
D.
be
musce
o
te
etmod
or
here
A.
scap.
te
layer
80
entrapment
atera
ven
vens;
o
by
rage
s
886,
racture
render
preventng
commu-
emssary
884,
ragments
te
scap.
between
te
t
near
arteres
te
mdbran
nerve
bran.
drect
prevertebral
parayzed.
11
coud
artery,
o
a
o
and
te
and
te
receves
passes
(PCA)
o
commun-
ntracrana
key
responsbe
mmedatey
not
within
ABR/McM
bow-out
racture
vens
ocaton.
to
aneurysm
artery.
nerve
nerve
cose
s
provde
vens
Neter
do
snuses
snus
stuated
te
and
ABR/McM
abducens
scap,
dpoc,
aneurysm
by
optc
Ws
ton
to
s
A
883,
84;
unctona
pat-
supraorbta
mantan
sagtta
cerebra,
and
te
ven
not
cerebear
he
on
externa
juncton
an
C.
woud
emssar y
vascuar
838,
61–64,
te
snuses
he
GAS
ayer
between
space
8.163
ocated
o
venous
potenta
venous
trocear
medua.
he
an
te
artery
vagus
compressed
E.
emssar y
eyed,
does
does
te
by
D.
te
te
te
32–33;
te
superor
damaged
n
N
cerebra
and
o
ocuomotor
Atoug
B
s
wtn
Fig.
te
superor
superor
he
te
underyng
cerebra
wt
muncaton
artery
and
upper
suc,
owever,
ror
dpoe
vens
te
snuses
communcaton
provde
wt
ncaton
C.
he
dpoc
o
connect
venous
supratrocear
anteror
and,
160.
dura.
supercay
drecty
GAS
o
and
te
GAS
necton.
he
D.
sku
to
te
means
dpoe
E.
superor
cate
tat
scap
ocated
C.
ayers
n
te
and
and
te
scap
patway
bran,
vens
A
a
o
te
space
sternum
Fascial
vens
429
Neck
layer)
Investing
sar y
and
fascia
portion
pretracheal
ayers
Head
7
PCA
te
artera
carotd
artery.
crce
Its
o
oca-
preventng
are
not
compresson
oowng
nerve
and
cerebear
te
superor
upward
necessary
njury
bone
barrng
n
w
any
movement
damaged
ts
aow
oter
patent.
ree
njury.
o
and
te
eye.
tere
Freeng
movement
s
te
o
he
no
musces
apparent
musces
te
eye
rom
agan,
430
C H A P T E R
B.
7
Head
Damage
resut
C.
D,
te
or
damage
ts
to
GAS
wt
A.
A
as
Hutcnson
ocated
te
nerve
ton
dorsa
B.
n
ta
C.
te
Posteror
GAS
82,
92,
o
a
woud
rectus
eye,
to
to
s
D.
te
nose
tat
nerve
tat
carry
E.
nnervate
te
GAS
gves
orgn
165.
of
te
nerve
to
s
a
sensory
te
branc
o
te
nnervaton
ron-
rom
te
nerve
te
s
a
branc
trgemna
rom
and
te
tat
nerve
te
skn
upper
nerve
s
a
snus
te
and
o
ps.
sensory
and
te
(a
nnerva-
posteror
te
nerve
nasa
cavty
anteror
te
provdes
and
N
te
etmoda
nasocary
1075;
sensory
111,
nner-
dorsum
nerve
s
o
aso
a
GAS
166.
nerve.
113;
ABR/McM
44,
51,
Anestetcs
o
decate
contans
wt
te
njected
(areoar)
o
“danger
can
wt
space.
are
nerves
oreead
eye,”
he
to
te
te
te
eyed.
zone”
n
passage
Inectons
te
connectve
te
resut
nto
can,
a
o
tssue,
hs
te
o
scap.
bood
te
space
ematoma
kewse,
submuscuar
s
A
nto
te
ayer
tat
B.
bow
as
to
a
te
ts
rectus
D.
o
he
mc
te
orbta
brances
nerve,
o
te
he
ary
o
he
te
ts
deepy
ten
dvson
nasocary
o
nerve
te
o
toward
ntrate
te
branc,
brances
trgemna
exts
te
nraorbta
near
te
orbta
nerve.
can
t
te
trgemna
resutng
E.
cana.
margn
s
rom
nerve
Injecton
ess
te
ater
key
o
to
ater
anestesa
afect
ts
N
167.
supra-
nerve
pays
nerve
a
and
roe
rom
woud
njecton
n
te
not
at
te
be
toward
as
o
n
te
on
te
te
oss
(te
opposte
an
s
bran
not
to
te
unusua
n
easy
an
torn
cerebe
and
te
pr-
he
on
dasboard
s
o
sde
object
tentorum
wt
n
musce).
nerve
te
most
ater
a
at
branstem
orce
te
common
ste
traumatc
dura
160;
o
o
o
o
mpact
njury
njury
te
s
at
to
te
tentorum
ABR/McM
te
optc
wc
tereore,
nerve,
cer-
s
wen
as
59–61
s
connected
te
tere
contractons
s
orgn
an
o
o
nlam-
te
rectus
pan.
afectng
eye
44,
nerve
serves
a
nerves
gy
nlammaton
and
N
downward
poston
nerve
t
decate
severe
te
It
1075;
njury).
tendon
s
resuts
drected
obque
trocear
132,
ong
roe
nerve
to
because
optc
o
1074,
nnervatng
te
unkey.
causng
ocuar
musce
unkey.
nerve
gves
of
cary,
s
a
a
branc
number
posteror
nratrocear
eye
o
o
and
nerves
te
opta-
brances
suc
anteror
et-
and
does
not
movement.
Constrcton or occuson o te optamc artery
n
max-
te
and
above.
nasocary
a
optc
converge
dura
he
evoke
nerve.
te
pay
area.
nraorbta
branc
anestetc
optamc
ncudng
anestesa
B.
apex.
drect
to
coverng
te
can
moda,
ten
It
margn
backward
musces;
te
and
95,
Generazed
space.
anes-
optamc
crana
eye.
adducted
ead
perces
annuar
as
margn,
E.
t
N
One can nsert a neede troug te upper eyed, near
orbta
and
contracton
submuscuar
wtn
te
Inlammaton
C.
be
81
eye
te
te
expaned
musces
“back
te
933–936,
56,
ead
nerve
dura
musces
contnuous
known
pass
ayer
o
normaton
superor
er
notc
and
862;
A.
maton
A.
n
o
perces
were
as
he
cras—te
trocear
ebe
te
trocear
te
patent’s
D,
oramen.
not
supraorbta
vsua
904,
44,
pups
orward
C,
te
te
nerve
njecton.
second
o
orbta
“coup-contrecoup”
B,
et-
s
tt
two
tentora
move
rom
o
an
te
Parayss
t
o
nasocary
woud
branc
te
sensory
dorsum
etmoda
nerve
te
afected
o
must
were
te
a
back
902,
pup
carres
80–81
164.
acton
a
te
margn
to
bran.
by
o
te
automobe
ace
s
te
te
te
mary
pont
he
or
max-
te
branc
provdes
spenoda
rom
nerve
at
887,
wen
wen
s
rse
provdes
and
eyed.
Parayss
loor.
orbt.
nerve
o
anteror
orbta
ABR/McM
te
cavty
nerve.
to
838,
aow
an
afected
abty
nasa
o
A.
te
transmsson
96–97;
nasa
etmoda
gves
optc
upper
naso-
superor
te
be
o
nnerva-
aso
by
tat
retna
nasocary
sensory
enters
ocated
te
s
a
ronta
he
known
vrus
nto
he
nerve
provdng
carres
nerve
935–936,
he
243
dvson
brances
brances.
s
te
t
trocear
sym-
236,
s
anteror
nerve
patent
o
rom
contnuaton
It
te
nerve
nose.
tetzed
and
etmoda
to
he
superory
141,
anteror
nnervaton
ater
resut
upward
optamc
nasocary
etmoda
nose.
branc
eye
ces.
Anteror
vaton
te
tat
orbt
te
moda
te
n
gaze
ndcates
hs
etmoda
nasocary
te
o
he
nerves
and
between
E.
to
dorsum
hs
nnervaton
to
58,
brances
dvson
ton
neror
resut
he
somewat
woud
o
C.
s
acrma
nraorbta
sensory
D.
te
nerve.
superor
ary
woud
te
musce
rectus
he
woud
eye.
nerve.
nerve
he
ts
movement
nabty
supratrocear
skn
rotates
drected
meda
eyeba.
40,
addton
nasa
he
on
and
to
be
rect
devated
eyes.
33,
eye.
etmoda
mucosa,
an
sgn.
drect
te
te
bodes
ronta,
as
or
N
ce
rom
to
te
musce
ras
trgemna
cary,
te
n
o
bot
927–929;
erpes
to
neror
obque
Damage
downward
eyeba
metrcay
and
superory
pup
Damage
devaton
and
neror
ateray.
responsbe
devated
meda
he
cause
downward.
atera
te
Neck
ateray
E.
and
tereore
163.
a
and
upward
n
to
n
and
can
cause
ts
patent
96,
D.
ste
132,
oss
160;
o
ABR/McM
T oxopasmoss
T oxoplasma
undercooked
person
s
vson
exposed
and
to
s
not
observed
n
54
necton
gondii,
meat
wc
s
caused
wc
te
s
eces
by
te
assocated
o
toxopasmoss,
cats.
para-
wt
Once
mmunty
a
s
CHAPTER
deveoped.
exposure
prevous
as
However,
occurs
n
exposure.
A.
on
to
te
Congenta
a
Meases,
pror
to
can
concern
woman
s
wo
wen
as
maormatons
occur
te
asca
no
ayer
suc
necton
tat
s
be
necton
woman
Mumps,
acks
and
pregnancy .
s
key
Rubea
he
to
occur
mmunzaton
MMR
(MMR)
vaccne
wen
wt
s
A.
B.
u
te
and
o
sst
te
yaod
artery
as
s
ng
N
20,
A.
At
te
te
pont
In
te
nerve
s
Injury
gand
C.
te
o
regresses
yaod
resut
te
pror
artery
n
aca
to
t
brt.
per-
Injury
s
njury
a
sku
vrus
dur-
racture
wtn
te
n
as
t
oss,
te
te
sstent,
es
patysma
to
te
and
parotd
peraps
aevate
te
A,
p.
a
gand.
t
o
woud
to
aca
tympan.
o
ave
aso
type
aca
te
nerve
ante-
mecansm
unkey
aca
or
nerve
te
o
te
te
GAS
171.
styo-
uncton
mecansm
aca
nerve
o
o
not
key
presented
Mandbuar
to
n
occur
te
brances
wt
te
o
te
usuay
s
an
o
o
and
bucca
A,
brances
GAS
133,
B.
858,
he
can
959;
dvson
te
be
efects
N
9,
ABR/McM
aurcuotempora
dbuar
nto
910,
parotd
o
due
n
9,
61,
14,
nerve,
a
trgemna
gand,
assocated
are
te
59,
and
ts
wt
severe
arge
part
64,
23,
97,
branc
o
te
te
(CV V3)
he
n
man-
o
te
drans
be
132;
ven
vertcay
vens.
torn
bubbe
and
114–115,
81–82
accumuaton
sac.
s
known
n
epsodc
are
dzzness
About
or
treated
o
as
earng
vomtng.
o
o
Labyrntne
per-
wt
stmuants
body
luds
and
dsease.
Ménère
dsease
accumuaton
oter
n
s
te
structures
are
ABR/McM
57–58
s
te
superor
typcay
a
tyrod
sort,
drect
artery .
trbu-
n
downward
he
tyrod
(because
o
to
superor
surgery ,
negatve
one
and
or
bot
mdde
peraps
pressure
n
o
te
tyrod
admttng
te
vens)
C.
s
or
eta
he
an
GAS
172.
resuts.
most
njury
key
to
te
cause
o
superor
ar
or
bubbes
mdde
n
ty-
ven.
he neror tyrod ven usuay drans nto te et
ess
mumps
contnuty
not
nerves.
accumuaton.
accompanes
bracocepac
eads
compressve
t
tyrod
patent
rod
E.
compresson
to
132–
57
nerve
pan.
115,
97,
reducton
tese
two-
nerve.
woud
tese
resut
above,
o
anteror
56–57,
oters
Ménère
None
te
and
nterventon
voume
stated
rom
cana
ngua
N
and
endoymp
96–97,
deeterous
B,
ts
142–146;
N
ven;
can
ar
wt
zygomatc
sac.
and
o
aca
o
42,
and
It
tat can ascend n te nterna juguar ven nto te sku,
patent.
nvovement
As
ear,
vertgo;
te
nnerva-
gand
can
nausea
ntake,
sensory
ydrops
surgca
endoymp
bracocepac
aca
mecansm
te
ower
excessve
mdde
vens
termna
n
wt
bers
gand.
te
rom
dsease
patent
secretory
te
1093;
38–40,
t
parotd
ts
to
as
pan-
gand.
endoympatc
requre
E.
n
va
resuts
te
orgnates
parotd
975,
by
no
tary to te nterna juguar ven. he neror tyrod ven
te
njury
parotd
compresson
29,
symptoms
n
957;
te
o
hs
sat
to
and
o
te
sensory,
D. he superor tyrod ven s a trbutary to te nterna
he
occur.
specc
D,
resut
juguar
to
te
nvoved
njury
anteror
ow
endoympatc
o
occurred.
proxma
mpar
Gven
ts
be
te
nerve
w
te
Gven
C,
over
te
te
tympan
tongue
ncapactatng
cafene
can
sted
nerve.
generazed
nnervaton
noses
patents
ayer
swes,
and
ence
carres
nerory
te
assocated
duretcs,
ke
neror
o
toug
a
nerves
not
ts
to
endoympatc
roarng
10%
mas-
nerve
or
(vertgo)
o
(edema)
dsease.
rapdy,
gand,
o
nerve
974,
n
te
gand
oter
experenced
any
ABR/McM
lud
Ménère
te
o
904,
te
431
Neck
neck,
te
nerve,
pexus
passes
because
Hydrops
ydrops
cana,
exts
aca
sty-
searng
aca
wom
te
te
B.
t
sensory
901,
motor
corda
sensatons
excessve
skn.
brances
gand
to
as
o
parotd
be
regon
he
porton
155–156;
a
petrosa
te
te
Wen
compresson
provde
observed
GAS
54
wereby
te
njured
nerve
branc
te
exts
to
E.
s
te
tympanc
not
provdes
be
patterns
ABR/McM
nerve
nants,
afect
njury,
njury,
to
te
specc
susceptbe
deveoped,
ower
oramen
to
o
te
wt
o
trggered
None
w
to
are
gand
asca
and
gand.
nerve
troug
nerve
trds
170.
aca
most
In
yet
ony
parotd
and
opta-
may
parotd
esser
ton
maormatons,
any
143;
commony
ndvdua
unkey
te
o
parotd
corda
yed
142,
s
aca
te
o
ocuar
damaged
severa
te
patent’s
nerve
w
D
reactvaton
not
beneat
te
o
njury
te
or
t
not
just
to
mastod
169.
he
Panu
oramen.
nant’s
An
cose
branc
te
133,
be
most
are
to
to
a
wt
were
woud
here
an
o
absence
as
musces
to
to
maormatons
132,
can
process
te
ssure
s
does
oramen
unprotected,
E.
ave
arterosus.
usuay
necton
styomastod
E.
to
cooboma.
peces
97,
ror
a
wc
61,
nerve
tod
o
artery
congenta
omastod
aca
corod
pregnancy
orces.
ductus
assocated
owever
D.
key
“loaters.”
EBV
o
patent
ormaton
Sometmes
C.
more
does
he
B.
are
ear.
sensaton
mates,
mc
168.
n-utero
parotd
nvestng
pan
te
secondary
rom
Faure
E.
vrus
or
to
aca
symptoms suc as sensorneura deaness, eye abnor-
te
C.
to
te
passes
vac-
te
nondstensbe.
bers
he
cne and soud not be gven n pregnancy . Neonates
exposed
amost
suppy
te
ve
s
o
superca
reerred
vaccne
a
capsue
o
sensory
etus.
rubea
pregnant
bggest
pregnant
Congenta
mcroptama
passed
te
a
Head
7
key
1008,
to
be
1009;
ven.
a
N
An
cause
87;
o
njury
ar
to
ts
bubbes
ABR/McM
structure
on
28–30,
CT
s
scan.
32–33
C. he crcotyrod artery s a sma branc o te supe-
ror tyrod artery. It anastomoses wt te crcotyrod
432
C H A P T E R
artery
7
o
Head
te
and
Neck
opposte
sde
at
te
upper
end
o
te
175.
B.
I
medan crcotyrod gament, a common ste or estab-
a
sng
te
an
emergency
arway.
he
crcotyrod
artery
can be pused nto te arway durng a crcotyrotomy.
he
vesse(s)
can
go
tay
A.
he
na
superor
carotd
It
te
te
D.
he
surace
o
tyroyod
ateray.
to
It
s
be
te
o
o
perce
ts
gand.
and
te
key
be
to
te
hs
to
arses
s
rom
te
ess
orgnates
pup
pos-
rom
he
a
and
musce.
rotomy
GAS
837,
McM
173.
C.
artery
runs
It
s
s
a
branc
supercay
not
te
D.
n
te
to
o
te
vcnty
o
N
17,
19,
54,
BP29,
134,
cea
at
cartages
tons
durng
te
eve
usuay
a
o
te
resuts
trd
n
traceostomy
te
(or
and
superor
cause
te
obque
patent
to
to
ook
downward
o
are
optc
make
tey
t
dicut
ave
nerve
“down
te
or
trocear
atera
nnervated
were
and
te
pasy .
njured,
out”
rectus
by
ndvduas
nerve
te
because
and
o
superor
abducens
and
respectvey.
nerve
bndness
n
were
te
abducens
njured,
afected
nerves
te
eye.
were
patent
I
te
njured,
woud
ocuomo-
te
patent
and
te
outward
883–884,
92,
204,
80,
83,
215,
eye
rom
887,
241;
woud
te
be
drected
poston
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-
compca-
traceotomy).
he
176.
176–200
D. he accommodaton relex s perormed by constrc-
ton
o
hs
te
pup
uncton
tryng
controed
a
near
object.
parasympatetc
ts
n
tares
a
o
te
surgca
A,
just
B,
eve
o
as
externa
procedure
D,
nature
neror
suc
and
te
mgt
E.
a
to
juguar
to
be
tyrod
However,
vens
ma
make
perormed
Because
cause
tat.
tyrodea
o
gand,
njury
to
te
a
at
vas-
trbu-
care.
gy
mportant
or
traceostomy
wt
ncson
oter
artery
any
oter
neurovascuar
structures.
1054;
145;
ABR/McM
he
hs
s
N
uvua
9,
25,
53,
56–57,
36,
37,
209
woud
because
unopposed
ens
ng.
by
move
59,
D,
ntact
te
opposte,
133,
136,
evator
te
ve
ntact
rgt
paatn
parayzed
et
sde.
woud
evator
be
durng
equazaton
C.
do
A
not
10,
834,
47
te
sot
between
o
971,
ve
paatn
paate.
wc
a
rgt
te
te
roe
hs
to
paate
1096,
tere
o
aso
to
open
and
o
te
tense
te
or
5
n
he
te
paatn
te
1098;
N
w
cause
ack
cary
gets
o
te
musce
o
o
to
evoked
or
ocuomotor
nerve
Ednger-Westpa
savatory
t
cary
wose
te
ocus-
means
he
te
cary
by
post-
gangon
ce
bodes
by
are
nuceus.
nuceus
savaton,
te
pup
reaxaton
nnervaton
te
on
n
near
compromsed.
rom
te
aowng
accommodaton,
s
act
cause
ens,
sape
parasympatetc
and
axons
rom
reducton
te
sperca
musce
not
s
nvoved
te
cary
wt
musce
accommodaton.
SCG
s
a
axons
wc
sympatetc
nnervate
causes
C.
he
nervus
gangon;
te
dator
mydrass,
ntermedus
contans
speca
secretomotor
bers.
submandbuar,
ABR/McM
cary
cause
nerve
but
ts
postgan-
pupae
not
te
mus-
moss
o
accommodaton.
tat
et.
109;
he
ce,
pressure
ear.
a
to
gament
more
superor
gonc
aud-
mdde
a
acrmaton
B.
te
ocuomotor
Postgangonc
musce
neurons
bers
ocated
A.
on
s
te
gangonc
ve
eevaton.
ve
on
one
act
aows
parynx
paata
evator
sot
1033,
n
are
hey
eps
swaowng.
pay
parayzed
eevaton
GAS
o
tensor
aponeuross
tube
hey
he
musces
paatne
tory
E.
and
adopt
and
and
pared
I
GVE
toward
te
82–83,
gangon.
pupae
suspensory
to
acton
paatn.
B,
te
musce
GAS
A.
cary
dameter
o
vascuarzed
te
te
spncter
te
on
te
Ednger-Westpa nuceus o te mdbran tat synapse
s
n
ocus
by
nerve
structures
carred
to
s usuay at te eve o te second tracea cartage and
ncson
bers
wen
s
stmus o te tyrod gand (a rcy vascuar structure)
cuar
174.
GAS
Answers
ncson
actons
and
and
crcoty-
34
An
so
te
woud ave ony te actons o te superor obque
ngua
136;
drected
nerves,
te
tor
yogossus
te
te
ocuomotor
be
wc
ave
mdne
te
turn
can
stars
te
woud
I
te
procedure.
1046;
I
musce,
suprayod
artery
E.
obque,
membrane
by
not
decency
unopposed
key
beneat
coud
descend
and
crcotyrotomy.
E.
to
to te et te rgt trocear nerve were parayzed.
trocear
njured
eye
patent
suppy
procedure.
tyroyod
to
et
eye.
te
woud
be
n te adducted poston. As an exampe, te afected
nto
courses
njured
s
w
musce
exter-
ocaton.
artery
rgt
suppes
tere
rectus
abduct
unafected
nerve
wc
to
njured,
atera
yod
C
It
unabe
te
s
et
te
ateray
ascends
be
nerve
te
te
bood
typcay
as
o
trocear
musce,
njured.
tyrod
artery
ess
o
w
degree
he
poten-
abducens
uncton
ose te abty to turn te pup downward wen t s
of
eve
ocated
and
aryngea
tyrod
te
artery
because
superor
wt
A.
et
o
patent
same
wc
patent.
brances
at
s
to
trunk
te
tracea
crcotyrotomy
tyrod
njured
superor
and
te
te
te
majorty
key
tyrocervca
be
by
artery
te
o
nto
personne,
typcay
gand
ess
neror
teror
to
s
bood
tyrod
pont
t
medca
artery
tyrod
Hence,
drecty
o
provdes
ncson
he
by
aspraton
bone.
B.
beed
unnotced
ata
to
can
te
oss
roe
n
te
and
s
a
part
sensory,
It
o
nnervates
acrma
accommodaton
te
somatc
te
ducts
relex.
aca
nerve
sensory,
and
subngua,
and
pays
no
CHAPTER
E.
he
trgemna
gangon
s
a
sensory
gangon
and
Sensor y
not
ave
parasympatetc
bers
and
does
te
(GAS
8.107).
Fg.
cary
musce
or
433
Neck
ner ve
not Long
nnervate
and
root
Nasociliar y
does
Head
7
ciliar y
ner ve
accommodaton
Sympathetic
N
83,
87;
ABR/McM
79 root
177.
A.
An
acoustc
neuroma
neuroemmoma)
s
a
(vestbuar
bengn
tumor
scwannoma
o
te
or
vestbuoco-
Parasympathetic
(motor)
cear
nerve
(CN
VIII),
wc
causes
compresson
root
o Ciliar y
te
aca
nerve
(CN
VII).
he
vestbuococear
nerve ganglion
eads
rom
te
nner
ear
to
te
bran.
Atoug
many Oculomotor
suc
can
tumors
n
w
some
not
cases
grow
resut
or
grow
very
utmatey
n
sowy ,
ner ve
Shor t
[III]
branstem
Sensor y
com-
(as
n
ts
exampe),
ydrocepaus,
contrast
nto
rgt
te
te corona
o
te
tc
nterna
tumor
s
te
and
o
30
most
peope
scwannoma)
and
ncudng
cocear
can
neuroma
be
seen
•
GAS
60.
Because
ntraoperatve
uncton,
te
rsks
wt
are
o
acous-
advances
montorng
o
E.
dagnosed
aca
n
n
o
An
N
179.
parayss
externa
ts
49,
C.
case
56,
he
carotd
artery
67,
78,
72,
angograp
o
can
kne).
he
romas
are
2.5
outcomes
better,
cm
are
D,
and
compresson
GAS
838,
958–960,
te
onc
o
as
o
and,
N
sma
wt
wt
(e.g.,
bot
gamma
acoustc
neuromas
sgncant
neu-
arger
neuroma
tese
te
nlamed,
cause
resutng
parynx.
o
ruptured
w
tey
a
become
some
Many
may
s
be
no
vded
by
GAS
910,
to
124,
a
cet
trd
n
arc
and
become
ts
a
tender,
abscesses
dranng
n
snus
tese
musce
cn
he
to
C.
resut
D.
enarged,
te
E.
w
skn
GAS
present
181.
B.
o
w
domastod
afected
s
an
abnorma
musce.
sde
and
hs
ead
contracture
causes
rotaton
te
to
o
te
ead
A
te
opposte
to
sde.
te
unkey
carotd
st
tat
patent
artery.
arteres
o
dd
32
te
not
Portons
are
“back
ed
”
However,
compromsed
pro-
vascu-
n
ts
vesses
are
not
te
cause
o
te
angograpy.
N
20,
o
te
tempora
otts
ces
bone,
mastodts
Necross
oten
o
96–97,
115,
wtn
oten
te
caused
meda.
o
w
64,
224
te
o
te
afect
s
te
tempora
nlammaton
bone
because
sgmod
bone
s
o
snus.
unkey
nlammaton.
te
mdde
ear
mastodts
occpta
mastod
o
not
te
carotd
ABR/McM
sows
s
usuay
rater
tan
te
preced-
occurrng
as
a
t.
be
snus
s
process
ts
ocated
and
poston,
afected
N
by
127,
s
ar
posteromeda
unkey
te
ts
to
nterna
be
to
afected.
carotd
artery
nlammaton.
128,
132,
143;
ABR/McM
16
caazon
te
be
sternoce-
ttng
o
nto
necton
part
947–953;
57–58,
contraateray.
event
Because
rup-
cases.
nlammaton
he
te
s
caused
by
an
obstructed
tarsa
gand
eyed.
Swengs
te
tender to papaton wc s not observed n ts patent.
T ortcos
petrous
experence
an
A.
node
necton
160;
ceary
because
s
te
snus.
n
are
an
o
acute
to
tract
te
s
Inecton
ep-
gy
symptoms.
compcaton
sgmod
137,
999–1000;
process
untreated
B.
s
crcuaton.
ABR/McM
ng
tat
w
860,
132;
er
hese
n
process
cysts
to
136,
te
externa
carotd
bran
to
E.
seen
128,
untreated
cav-
te
and
known
o
grows
present.
ymp
by
o
to
81,
njected
coatera
Mastodts
ourt
snus
cet
A.
A
embry-
orms
wt
branca
are
aure
D,
75,
common
and
eadng
mastod
trd
ectoderm-ned
cases
te
hey
te
suppy
B,
te
common
occuson
most
superor
rom
remnant
ndcated
te
mass.
te
te
deveop
pontng
mass
secondary
are
Occasonay
sternocedomastod
wt
cause
nerves
paryngea
covers
may
to
branca
puruent
Surgery
dicuty
mass
n
neck
musce
entrapped
skn.
a
second
cets
oters
n
not
905–906,
cysts
anteror
nvoute.
cyst,
or
crana
901,
cet
second
te
overyng
does
nterna
te
patent,
180.
arse
he
bured
oter
887–892,
utmatey,
and
te
above
ar
earng
208
te
normay
arrested
here
A
o
884,
tat
asymptomatc;
A
tose
(branca)
cysts
he
tat
ture,
any
1002;
teum-ned
or
wt
experence
Acoustc
deveopment.
arces.
or
to
sternocedomastod
cauday
to
tose
efectvey
terapy
A,
883,
obteraton
s
treated
wereas
congenta
eptea
tes
or
key
E.
Paryngea
common
o
be
radaton
postsurgery .
C,
A.
now
targeted
aneurysm
provded
tc
and
fibers
8.107
presentaton.
neuromas
Fig.
fibers
on
medum
B.
D.
postganglionic
competey
oss
C.
unknown;
ages
meatus
te
Parasympathetic
radopaque
tan
B.
acoustc
o
preganglionic
and earng oss ave been greaty reduced. Many acous-
surgery
178.
Extenson
fibers
Parasympathetic
arrow n Fg. 7.9). he exact cause
(vestbuar
mcrosurgery ,
aca
sown.
MRI (see
neuromas
between
as
postganglionic
branstem
ernaton, and deat. It s dagnosed on MRI wt gad-
onum
ner ve
fibers
Sympathetic
presson
ciliar y
growt
upper
o
te
atera
acrma
eyed
gand
and
are
usuay
not
present
ndcatve
on
o
a
caazon.
C and D.
eye,
so
ts
A
caazon
excudes
rect answers.
s
scera
not
and
an
necton
pup
rom
wtn
beng
te
te
cor-
434
C H A P T E R
E.
7
he
Head
Neck
nasoacrma
ocated
te
and
acrma
nose
and
duct
sac
to
woud
runs
te
be
rom
neror
te
meday
nasa
unafected
n
meatus
te
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;
poyp
aso
spenoda
nasoparynx,
s
nvoved
atera
to
snus,
te
te
maxary
nasa
ocated
unkey
to
be
snus,
afected
to
by
a
C.
he
etmoda
atera
he
are
ces,
te
by
cannot
ocated
he
nasa
be
be
hey
and
are
te
nasa
te
by
ducts
to
te
orbt
unkey
183.
C.
tumor
acoustc
at
gea
GAS
ts
204,
D.
te
te
to
are
ronta
te
nasa
eyes
o
and
bony
obstructed
(A),
are
GAS
by
te
a
236,
underneat
between
te
B,
N
10,
ar
E.
o
185.
C.
obe
nasa
and
wen
oramen
ested
A
and
unkey
N
suc
afect
as
rst
nerve.
seen
as
and
n
beavora
memory
ts
ABR/McM
oss.
patent.
9
njury
s
n
te
and
optamc
to
cause
anteror
sensory
aspects
pan
crana
mandbuar
provde
posteror
te
key
dv-
rom
ossa.
dvsons
o
nnervaton
o
te
to
mennges,
an
he
te
to
11,
147,
17,
arteres
as
a
On
64,
149,
196,
23
resutng
coecton
te
82–84,
ead,
t
o
o
s
n
a
bood
ocated
te
sku)
are
a
ocated
a
to
and
superca
areo-
to
te
t
part
w
hs
to
s
as
be
te
te
te
n
te
to
a
tempora
obe
ts
obe,
aganst
symptoms
pareta
te
n
tempora
ocuomotor
symptoms
secondary
o
te
man-
observed
n
compresson
o
obe
woud
compresson.
not
cause
ocuomo-
te
and
N
9,
ven
o
o
nerve,
ax
C3
te
optamc
suppes
te
ten-
cerebr.
bers
do
not
provde
132–133;
ABR/McM
s
most
te
or
ocated
tongue.
absorpton
submandbuar
uncton
as
It
o
s
44,
tereore
te
61
supercay
te
admnstered
ngua
wtn
most
N
70;
ngua
te
ror
to
deep
and
speccay
mandbuar
tereore
ng
s
o
and
o
suppy
taste
savary
to
he
te
to
o
he
te
te
atera
reac
bers
o
te
neror
to
are
absorb
a
to
o
te
atera
and
te
he
o
aso
genera
gand
te
gand
ceek
or
aveoar
to
gve
rse
to
ngua
to
te
nerve
musce
and
traves
o
s
te
mandbuar
suppes
not
n
te
cose
skn
prox-
duct.
nerve,
submandbuar
cana
mandbuar
tse
nerve,
and
tongue
sensaton
he
a
bers
nvoved
subsequenty
branc
trgemna
te
V3)
pterygod
and
atter
o
te
nerve
trgemna
axons
o
s
dur-
tympan,
hese
(CN
tongue.
a
ngua
te
sub-
nerve
trauma
corda
Fbers
supe-
gand,
te
hs
or
two-trds
nerve
not
under-
and
beneat
tongue.
duct.
atera
do
drecty
mout
(CN VII).
mandbe
pterygod
mandbuar
te
dvson
te
te
ocated
35
dvson,
suppy
are
and
absorpton.
parasympatetc
and
o
to
and
anteror
ven
submandbuar
te
secreton.
te
o
rom
nerve
nerve,
mucosa
to
ducts
to
mout
courses
te
submandbuar
bucca
mty
o
te
29,
loor
trgemna
bot
dvson
and
te
gand
te
nerve
te
subngua
uncton
or
ntay
gaton,
two-trds
ramus
deep
C.
to
aca
te
deep
route
mandbuar
gand
o
ngua
passes
te
o
pregangonc
anteror
A.
te
o
ABR/McM
or
carres
branc
n
o
te
drect
passes
rsk
excson
part
and
not
subngua
loor
porton
duct
at
do
and
te
nerve
mucosa
te
and
ntrogycern.
he
te
mty
tumors
883;
ngua
he
1089
neat
ts
te
and
C2
route
n
E.
he
gy
nerve.
nerve
GAS
B.
nerve.
s
branc
nnervaton.
838,
deepy
provde
te
descrbed
resut
o
nearby
o
not
5
compressed
resuts
te
a
C.
dvson
ABR/McM
ernaton
occur
does
tssues
a
trgemna
undersde
and
more
and
cepaoematoma
uncus
produce
are
skn,
nerves
suc
nerve
aponeurotca,
nerve,
te
cerebe
drect
and
D
te
ematoma.
Hernaton
wc
40–41,
te
drug,
hs
beng
o
ntrogycern.
gossoparyn-
rom
(perosteum
105–111;
key
Occpta
tor
(B),
144–145,
subcutaneous
damage
ocuomotor
C.
and
enarged,
E.
patent
gaea
magnum.
by
present
rom
nerve
nerve
and
deep
excretory
(sku).
tentora/unca
most
tumor.
37–38,
perosteum.
rom
te
911–914;
s
33,
dened
tssue
beedng
he
case
to
913,
he
most
16
aca
nerves
perostea
s
he
Beedng
B.
(E)
12,
ange,
te
ypogossa
percranum
cavara
nvove
GAS
3,
key
ten
ABR/McM
te
te
connectve
ste
most
and
141–142,
240;
o
te
and
A.
on
orbt.
188.
cepaoematoma
A,
s
nerve
139,
Rupture
and
ABR/McM
trgemna
959;
136,
214,
orgnate
maxary
menngea
187.
between
te
Spna
snuses
poyp.
ocated
bones
cerebeopontne
vagus
and
942,
nerve
tentora
torum
E.
te
be
he
pos-
answers.
87–89,
184.
63;
scwannoma,
(D),
correct
N
te
vestbuococear
excudes
not
117–118;
tat
he
dvson
B
1063–1065;
A
and
B.
mdde
D.
poyp.
GAS
are
trgemna
trgemna
to
out.
maxary
unkey
to
aso
atoug
dranng
afected
nasoacrma
are
poyp,
rued
ducts
meday
cavty,
superomeday
to
acrma
ocated
nasa
a
rontonasa
unkey
E.
to
afected
sbty
D.
N
can
judgment,
respectvey.
and
be
te
and
te
poyp.
856;
nerves
o
pressure
A
superor
symptoms
850,
moda
cavty.
tumors
mpared
C. A tumor nvovng te menngea brances o te et-
son
mmedatey
he
57,
52–54
nasa
ocated
GAS
20,
obe
canges,
caazon.
GAS
Fronta
o
toug
gand,
musce
suppy
and
te
cose
n
traves
ater
ower
prox-
deep
enters
teet.
to
te
CHAPTER
D.
he
ror
nerve
and
s
to
aveoar
te
te
musce
on
n
te
or
posteror
189.
A.
he
orbta
na,
te
B.
artery
s
w
an
era
sensory
efect
he
on
pes
te
nasa
te
skn
na
nerves
he
te
optc
te
s
and
car-
te
te
no
tereore,
a
o
ts
o
te
eye
and
relex;
It
s
t
opta-
s
te
te
as
on
te
septum,
brdge
s
te
sx
C.
te
anteror
te
atera
te
s
te
second
ocaton
was
or
ead
o
not
ndrecty
to
o
te
menngea
w
Injury
most
key
to
12
cause
te
crbrorm
owever
ts
pate
njury
can
w
12
A
o
A.
te
w
artery
N
mdde
ocuomotor
artery
orm.
w
ymp
node,
tongue,
an
patent’s
artery
a
oss
ABR/McM
aso
It
190.
A.
o
923;
CSF
te
he
s
N
147–149;
mosty
atera,
CSF
ourt
trd,
enters
ventrce,
(oramna
crcuates
o
n
and
te
va
rom
s
as
rom
ourt
atera
and
and
space
oten
he
o
submandbuar
te
p,
tongue,
and
cervca
he
deep
parotd
to
ceek,
o
sdes
te
o
group
te
te
o
space
he
unt
nodes
externa
nodes
upper
ace.
p,
hey
dran
parts
dran
o
are
acoustc
and
ocated
gand
and
s
troug
back
te
nto
te
aracnod
venous
sde
o
granuatons
te
meatus,
posteror
te
atera
orbt.
o
te
te
ten
nay
snus
snus.
can
ead
A
to
trombus
an
o
te
nto
obstructon
o
te
superor
superor
CSF
nodes
crcuaton
Submandibular
sagtta
nodes
sagtta
absorpton Pre-auricular
(communcatng
ydrocepaus)
n
wc
a
o
and
te
•
te
aspects
o
Submental
resorbed
back
ower
deep
supercay
dran
bran.
CSF
te
te
nto
apertures
t
dur-
nodes.
parotd
eyeds,
ymp
gums,
pexuses
rom
tons-
paatne
enarged
artera
te
medan
Magende).
subaracnod
o
te
tonsts.
necton,
corod
ventrces
com-
o
mdde
te
te
53–54
te
subaracnod
te
Luscka
te
ABR/McM
secreted
can
te
suppy.
GAS
n
72–76
known
dranage
parynx.
o
he
by
CSF
resut
ydrocepaus.
owever,
o
ep-
subaracnod
crana
drecty
an
aneurysm
aneurysm
cause
node,
receves
and
I
ruptures,
An
not
119–121;
cerebra
nerve.
cra-
eson
w
mdde
cause
not
gt.
te
(o
artery
te
obque
musces.
o
o
te
aqueduct
sup-
movement
bndness;
te
by
te
vson.
afected
was
aso
superor
n
et-
ntracra-
non-communcatng
nose.
ourt
percepton
te
woud
te
t
te
a
mdde
juguodgastrc
tonss,
gen-
o
875;
he
ar
drect
branc
extraocuar
responsbe
but
a
and
o
te
uncton
not
nerve
necton
te
nerve
s
suppes
nnervates
o
nerve
optc
nerve
anterosuperory;
musces
s
GAS
191.
aferent
no
te
cerebra
cerebra
ng
nerve.
te
ematoma
ret-
o
cerebra
n
ydrocepaus.
artery
o
Aneurysm
and
anastomoses
occuson
branc
te
E.
press
te
te
ydrocepaus.
motor
artery
and
ematoma.
Fracture
nterna
o
enarged
te
resut
o
n
rnorrea;
and
ocuar
centra
as
resut
mdde
artery
he
D.
35
o
to
o
w
menngea
musce.
29,
are
435
Neck
ncreased.
Laceraton
not
responsbe
oroparynx
bran
and
ydrocepaus.
C.
nerve
nerve
s
Obstructon
sub-
vson.
and
nerve
and
and
optc
based
It
centra
bnk
nasa
and
one
eyeba
nerves
te
te
Syvus)
passes
te
mxed
branc
tat
s
B.
B.
on
trocear
extraocuar
E.
te
or
cavty
he
te
a
etmoda
nerve
ces,
musce,
t
vson.
nasocary
te
t
o
pressure
dura
tongue
trgemna
cornea
anteror
mod
a
orgn
retna.
nerve
te
nerve
te
s
o
na
myoyod
beow
te
te
artery
oss
o
s
ABR/McM
sources;
n
nasocary
o
te
as
te
ventrces
excson
trange,
bers.
to
provdes
artera
resut
duct
o
angs
nerve
artery
We
durng
and
ne-
musce
trange.
o
70;
end
dvson
o
N
te
dgastrc.
styoparyngeus
ncudng
mc
mb
D.
te
suppes
oter
he
C.
to
and
vesses,
retna
artery
te
motor
one-trd
optamc
wc
wt
and
1089–1090;
carotd
usuay
wtn
nnervaton
nnervaton
te
o
myoyod
submandbuar
sensory
sensory
branc
damage
gand
gossoparyngea
ryng
o
or
a
te
undersurace
gand
myoyod
he
bey
rsk
te
mandbuar
GAS
at
suppes
submandbuar
orward
to
myoyod,
anteror
somewat
o
E.
te
nerve,
Head
7
GAS
Fig.
8.69
parotid
nodes
o
and
te
aspects
436
C H A P T E R
D.
7
he
Head
submenta
bateray,
E.
he
Fg.
192.
B.
nodes
ower
nasa
dran
p,
te
and
ymp
cavtes,
tp
loor
nodes
and
o
o
te
dran
audtory
tongue
te
constrctor.
mout.
te
tubes
naso-
o
(GAS
musces
preaurcuar
deep
parotd
parotd
gand
85–86;
ymp
nodes.
and
ABR/McM
nodes
hey
dran
are
are
32
aso
ocated
ymp
rom
known
deep
te
to
as
submandbuar
ceek
C.
he
a
te
A,
posteror
to
he
193.
D.
parotd
eyeds,
ay
909,
he
nodes
nodes
ymp
o
Fg.
superca
acoustc
GAS
o
o
te
te
nose
receve
te
sde
and
o
and
194.
ps.
dranage
ace
te
aso
te
B,
D.
o
rom
ora
dran
cavty
te
tp
anterory,
o
te
and
te
aspects
and
at
ymp
and
o
N
dran
te
nodes
te
nose,
85;
e
A.
E.
neror
tyrod
tat
b e twe en
Stas s
e ad
h s
com mo n
to
s te
s te
d ve r tc uu m
o
te
p ar yn ge a
mate r a s
w tn
nlamm at o n,
s
a so
or
be caus e
known
as
n ec -
K an
A
jon
N
gand
88;
ABR/McM
vens
and
dran
oten
anteror
ven,
te
dvertcuum
s
most
key
trange.
tyrod
descends
may
Zenker
to
unte
te
atoug
rgt
49,
te
to
orm
tracea
te
rgt
bracocepac
60
neror
to
a
jon
neror
ven
aspects
mdne
te
et
tyrod
separatey .
he superor tyrod vens dran te superor aspects
o
superca
atera
and
ABR/McM
( Ze nke r)
te
por to n s
can
Kan
te
tyrod
anges
te
B.
he
o
mdde
tons
externa
te
o
gands
and
39–41
d ver t cu um
c r cop ar yn ge a
o
te
n e r or
s
and
C.
jon
et
ror
ty -
s
E.
te
he
to
nodes
s
nterna
juguar
Occipital
nodes
vens
to
just
juguar
te
and
te
mdde
aso
ateray,
por-
termnate
superor
to
n
te
ste.
ven
orm
to
te
te
venous
vens
s
typcay
es
arc
o
rgt
vena
te
notc
and
o
o
te
supe-
bracoce-
cava,
wc
mdne.
connectng
varabe
source
wtn
te
superor
rgt
qute
a
ven
jonng
suprasterna
not
dran
gands
bracocepac
ocated
juguar
Mastoid
juguar
medastnum,
pac
par y nge a
vens
tyrod
nterna
he
usu -
tyrod
te
ncson
between
ropar yngea
ocat on .
abscess.
bracocepac
meatus.
par yngea
mos t
vens bateray and superory to te ste o ncson.
parotd
gand
te
par y n ge a
weakn e s s
ts
1031–1034;
te
ven
dran
C,
he
8.75).
1027–1028;
ocated
nodes
and
occur
ven
loor
(GAS
te
te
superor
submenta
cn
to
aspects
dran
tonss.
he
tongue,
E.
atera
juguodgastrc
o
te
D.
and
nodes
nerent
n
s
a
trange.
te
GAS
he
o
dver tcuum
ton,
orbt.
A.
te
ts
N
hs
deveopment
8.69).
1027–1028;
he
te
te
Neck
retroparyngea
parynx,
GAS
and
te
es
te
anteror
just
superor
manubrum
concern
and
encountered
surgcay.
GAS
195.
C.
135,
he
158,
posteror
oyod
gament
ts
o
te
nerve
A
genera
posteror
rom
A.
te
he
by
trd
o
o
ts
sensaton
te
36–37
enters
between
gament
or
carres
trd
IX)
te
and
tongue
musce.
can
ready
nerve
tongue
and
coud
taste
sty-
compresson.
sensory
nerve
te
te
styoparyngeus
rrtaton
o
ABR/McM
(CN
coursng
te
nerve
eson
nerve
styoyod
by
posteror
parynx.
bot
215–216;
and
te
gossoparyngea
rom
N
oroparynx
Caccaton
afect
172;
gossoparyngea
and
te
cause
sensaton
he
bers
oro-
oss
rom
genera
o
te
sensaton
oroparynx.
vagus
nerve
sympatetc
carres
bers
sensory,
and
s
not
motor,
cose
to
and
te
para-
styod
process.
B.
he
and
D.
aca
s
not
nerve
cose
he
ypogossa
ton
to
te
carres
to
te
nerve
ntrnsc
motor
styod
and
provdes
and
sensory
bers
process.
motor
extrnsc
nnerva-
musces
o
te
tongue.
Submental
nodes
E.
T o
upper
deep
cer vical
he
GAS Submandibular
vestbuococear
about
nodes
earng
887–888;
N
and
nerve
carres
normaton
baance.
127–128;
ABR/McM
35–36
nodes
196.
Pre-auricular
and
parotid
A.
here
GAS
Fig.
8.75
a
eson
o
te
aca
nerve
(CN
VII)
prox-
nodes
ma
•
s
to
gon,
te
te
gencuate
greater
gangon.
petrosa
At
nerve
te
gencuate
brances
gan-
rom
te
CHAPTER
aca
nerve
gangon
gangonc
here
ts
be
and
s
a
te
gands
arses
tat
dsrupton
branc
tat
o
te
actors
nnervated
rom
te
aows
by
te
te
nerve
te
nto
to
C.
he
va
199.
greater
at
paatne
as
C.
he
mucous
te
he
te
te
to
te
te
nasa
aca
cavty
hs
pre-
at
pterygo-
acrma
carres
pexus
parotd
gand
and
nvoved
A.
he
to
te
gand.
It
otc
s
bers
atera
he
and
vdes
and
rom
cerebra
common
superor
artery
te
ste
to
woud
as
we
B.
as
te
opta-
It
and
skn
atera
C.
Leson
o
o
ore-
va
te
N
to
rom
just
te
ngua
oramen.
nerve
nnervaton
to
It
E.
pora
carres
te
two-trds
but
te
aso
pro-
GAS
200.
subngua
crce
(o
ABR/McM
artery,
Ws),
aneurysm.
and
compress
B.
ram
an
te
s
It
44,
a
te
es
up
mdde
nterna
cerebr a
carotd
and
ar ter y
s
most
he
carotd
cerebra
and
n ot
artery
suppes
C.
he
superor
E.
he
of
GAS
198.
E.
ore
cerebear
and
posteror
te
869;
he
may
artery
151;
woud
nto
be
B,
br anc e s
c os e
arses
te
to
te
known
as
conssts
are
te
o
te
he
duct
artery
tree
as
suppyng
styomastod
VII)
corda
to
be
descrbed.
te
aca
musces
nerve
oramen,
as
beow
nerve
proxma
woud
aca
savary
nerve
tympan
to
denervate
two-trds
orgn
o
subman-
gands.
proxma
woud
te
te
cause
o
te
to
a
te
oss
orgn
o
tongue
taste
on
te
o
te
aca
suppy
nerve
te
arsng
orbcuars
beow
ocu
te
tat
tem-
coses
135;
ABR/McM
aurcuar
second
nerve
and
s
44,
58,
derved
trd
85
rom
cervca
te
nerves
ventra
and
sup-
eve
and
te
optc
artery
o
cervca
te
temporomandbuar
branc
patysma
o
te
aca
jont.
nerve
nnervates
musce.
of
t e
we
D.
he
nter-
It
pareta
of
as
nerve.
te
It
teet,
provdes
te
skn
sensory
over
te
nnervaton
mandbe,
to
and
skn anterosuperor to te ear on te psatera sde.
op t c
te
brances
to
cerebear
s
neror
by
margna
motor
te
nerors,
depressor
and
branc
nnervaton
te
angu
mentas
o
to
te
te
ors,
aca
ower
p.
depressor
musces.
he transverse cervca nerve s a cutaneous branc
te
o
te
cervca
vaton
brances
mandbuar
suppes
nnervates
ab
casm.
a
67
te
GAS
Answers
ony
nasa
oca
etmoda
etmod
anteror,
te
unkey
ner ve
te
(CN
to
s
aca
gand.
te ceek skn and ora mucosa va te bucca nerve
te
rom
ronta
cose
ABR/McM
afected
D:
ner ve
ner ve
ater
te
ts
duct
meatus
tat
and
nlammaton
nor-
tere-
n
ts
201.
B.
to
te
943–944;
pexus
skn
N
9;
o
and
te
provdes
anteror
ABR/McM
sensory
cervca
nner-
regon.
29–32
201–225
he
pared
snus.
sets
mdde,
o
and
ces
he
sma
are
coectvey
etmoda
cambers,
posteror
snus
wc
etmod
ces.
supracavcuar
assocated
receves
te
and
o
acrma
n
regon.
A,
aca
aca
55
artery.
nasoacrma
drans
not
neror
vertebra
N
s
te
proxma
arse
te
51,
branc
he mandbuar branc s te argest dvson o te
E.
basar
a
trgemna
obes.
D.
max-
meatus
ts
as
o
te
nerve
anteror
na
te
te
casm.
C.
s
brances
anteror
N
great
he
as
he
he
nasa
eyed.
o
to
A.
drecty
aneurysm
casm,
58
porton
patent.
A.
te
subngua
te
bone
1095;
he
ces
sde.
Brances
at-
structure.
mdde
ABR/McM
te
aca
corda
te
te
petrosa
o
tympan
and
onto
etmoda
bone.
te
o
etmoda
dran
pes te skn over te ange o te mandbe and aurce
134–136;
casm,
key
te
gands.
ntracrana
te
rom
mastod
to
anteror
communcatng
optc
te
pror
rom
corda
pared
suppes
expresson
o
dbuar
provdes
greater
tempora
Leson
a
ner ve
of
nerve
te
ces
posteror
gangon
eson
aca
afected
styomastod
artera
o
te
te
conjunctva
nerve
bers
958–959;
anteror
te
o
nerve.
orgnates
aca
sensory
tongue
dervatve
a
aca
te
nvoved
cantus.
secretomotor
910,
to
tympan
te
a
trgemna
eyed
submandbuar
he
te
atera
o
ext
aferent
te
s
te
upper
corda
ter’s
o
nerve
o
he
n
nto
437
Neck
atus.
95;
comes
emerged
gangon,
not
s
petrosa
gencuate
te
nto
utmatey
branc
te
tympan.
as
para-
secretory
greater
te
nnervaton
segment
o
o
nerve
tympanc
branc
ead
GAS
petrosa
acrma
te
B.
gands
bers
serves
te
provdes
snus
N
open
etmoda
and
meatus.
drans
semunar
tat
o
serves
sensory
197.
wc
rom
and
acrmaton.
mc
E.
orgnates
gangon
parasympatetc
gangon,
esser
wc
D.
nerve
gencuate
and
nasa
maxary
snus
ces
mdde
bua
superor
te
he
snuses.
rom
n
petrosa
te
gangonc
nasa
D.
he
1066–1068;
ner ve
nerve
we
he
GAS
gangon.
B.
te
ary
tat
gencuate
etmod
etmoda
to
hese
tympan
to
te
stmu-
gands.
corda
dsta
nerve
anteror
nundbuum.
gand.
normay
subngua
he
post-
proxma
petrosa
woud
te
on
acrma
nerve
greater
and
pterygopaatne
synapse
te
aca
tat
va
aca
to
bers
nnervate
submandbuar
are
runs
pregangonc
neurons
stmuated
ate
utmatey
were
Head
7
up
wt
ymp
te
rom
gastrontestna
te
toracc
beow
tract.
duct
supracavcuar
ymp
Vrcow
or
ound
on
node
ymp
toracc
are
te
(GAS
on
he
te
known
to
ces
sgn
wen
8.196).
sde
s
duct
ncudng
tat
nvove
Hstorcay
Fg.
et
toracc
dapragm,
Magnant
node.
T roser
papaton
node
duct.
ts
trave
te
s
et
caed
enargement
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
cervca
ymp
nodes
GAS
receve
Fig.
duct
8.196
a Phar yngeal
ymp
dranage
rom
te
ead
vein
cava
Thoracic
te
trunk
vein
Left
A
and
neck
branch
Vagus
or
ndrecty
va
te
superca
ymp
eferent
ympatc
ror
D.
deep
he
vesses
trunk
cervca
rgt
he
GAS
E.
ungs,
te
tongue,
136–137;
he
oten
nterna
caed
N
te
cest
ymp
te
rom
o
nterna
te
node
on
nodes
tonss,
ABR/McM
branc
orm
ymp
te
paatne
85;
to
vesses
jugular
vein
ganglion
juguar
te
supe-
nodes.
and
juguodgastrc
rom
202.
ymp
wt
supracavcuar
esopagus,
E.
converge
togeter
[X]
nodes.
Inferior
her
ner ve
eter Inter nal
drecty
vein
vein
drans
te
rgt
receve
and
te
sde.
ymp
parynx.
30
superor
aryngea
aryngea
nerve,
nerve,
suppes
te
mucosa o te arynx above te voca ods (wc ncudes
te vestbue o te arynx) and te prorm recess.
A.
he
externa
nerve
nnervaton
ryngea
B.
he
o
C.
to
arynx
o
te
aryngea
te
superor
nerve)
crcotyrod
constrctor
neror
te
he
branc
(externa
aryngea
provdes
and
motor
neror
pa-
musces.
aryngea
beow
nerve
te
gossoparyngea
suppes
voca
nerve
te
mucosa
ods.
(CN
IX)
suppes
senInter nal
saton
to
te
posteror
trd
o
te
tongue
and
exter nal
te
D.
oroparynx.
he
ypogossa
and
nnervates
te
GAS
D.
A
and
A
N
and
A
a
key
E.
Fg.
wc
s
Wereas
s
a
motor
muscuature
nnervated
a
ABR/McM
bone
egt
and
by
myocarda
te
48,
suggests
accompaned
possbtes,
XII)
nerve
except
by
te
branches
superior
lar yngeal
ner ve
or
vagus
8.173).
yod
rom
be
(CN
tongue
141–142;
ractured
C.
man
(GAS
1057;
woud
a
paatogossus
nerve.
203.
of
nerve
and
to
subdura
ractured
narcton
medca
Cardiac
84
stranguaton.
ematoma
bones.
or
examner
branch
B
poson
woud
Carotid
re-
body
Exter nal
a
g
ndex
o
suspcon
or
stranguaton
because
o •
te
ractured
GAS
833,
yod
837;
N
bone.
53,
68;
ABR/McM
31,
33
branch
ave
GAS
Fig.
8.173
carotid
ar ter y
CHAPTER
204.
C.
Meanocytes
are
a
potenta
he
tumor
bran
A,
as
D,
and
B,
GAS
205.
B.
A
ond
N
It
te
and
n
E.
A
32–33,
B.
yod
te
ra
to
te
n
structures
te
o
o
snus
aong
te
to
te
sec-
obt-
or
snuses
o
open
te
anteror
to
ro m
c re s t
or
resuts
rom
branca
o
te
B.
Frst
C.
aryn-
C
retenton
cets
2–4,
o
t rd
o
because
and
poor
o
s
n
a
te
norma
o
rst
and
o
and
d e ve -
A.
Howe ve r,
o
neu-
par yngea
mandbuar
eart
arc
deveops
nto
te
rom
te
ayer
he
he
pouc
orms
te
o
te
tymus
and
211.
D.
N
E.
p
n
te
to
use.
paatne
on
tere
cet
and
o
C.
GAS
A.
s
A
and
te
844;
Se v e re
paratyrod
wt
rom
he
B.
as
s
te
o
deec-
sxt
week
body.
eye
orm
processes
between
o
musce
te
ncudng
rst
te
te
corod,
nvoved
ayers
retna
n
te
o
te
optc
detacment.
ABR/McM
njure
79
attaces
to
te
temporomandbuar
condye
te
te
and
musce.
atera
as
he
artc-
jont,
suc
any
musces
pterygod
paryngea
pouc
cet
orms
gves
arc
N56–57,
o
musce
o
are
arc.
rse
te
to
tonsar
te
snus.
externa
acoustc
gves
rse
to
te
musces
o
aca
59;
ABR/McM
bdum,
te
te
ventrcuar
42–44
protrudng
system
te
bran
con-
condton
s
menngoydroencepaocee.
a
It
s
crana
menngocee
encepaocee
prom nen ces
te
a s
we reas
us on
a ure
b ot
me d a
o
21,
52;
o
neura
nasa
te
n
conjuncton
C.
promnences
ABR/McM
bda
because
tube.
wt
o
types
26,
72;
te
o
oten
act
descends
te
nonuson
Anencepay
s
tey
duct
poyydramnos
seen
because
o
o
he
B.
he
o
s
t
a
ony
contans
an
te
bran
ony
cysts
nstead
mennges
matter
as
te
and
and
woe
bran.
ead,
beow
cet
mdne
o
o
wc
te
duct
n
usuay
s
tongue
may
te
yod
structure
aure
o
tyrogos-
prmordum
te
ound
s
te
he
gand
aspect
usuay
just
wc
bran.
duct.
tyrogossa
are
a
sma
because
tyrod
paryngea
oter
o
n
unctonng
93
are
posteror
he
deect
mnor
sma
tyrogossa
wc
neck
tube
or
abnormay
ABR/McM
ocaton.
second
an
duct
te
cysts,
bran
abnormay
ormed
te
neura
present
s
te
rom
orm
A.
to
persst
medan
bone.
obterated.
te
oramen
cecum, wc s a persstence o te proxma part o
deects
usuay
s
usua
and
a
o
307;
obteraton
sa
assocated
tat
N
orm
14
a re
resut
n as a
orm
tssue
hyrogossa
pane
spna
d e re n t
n
GAS
212.
a
s
rudmentary
Mcrocepay
s
c et
s de s .
or mat o n
p roces s es
E.
w t
b ater a
te
n as a
use
a
neura
m ax ar y
to
on
o
rom
ater a
Meroencepay
ony
ts
meda
cases
rom
o
s de
segment.
anencepay
occur
not
mandbuar
second
part
It
mes enc y me
max ar y
s e gm e n t
D.
te
occur s
s e gm e nt,
a ure
o
nose.
he
N
an d
af e c te d
occurs
ntermaxary
208.
because
ernate.
C.
a ure
cet
te
ntermaxar y
aa
te
s
durng
cooboma.
w
cranum
known
14
o
nasa
Unatera
processes.
B
resu t
meda
Medan
te
a
ntermaxar y
occurs
te
ABR/McM
s
promnence
te
retna
mennges.
234–235;
Cet
nonuson
endoteum.
pterygod
te
rom
93
cary
congenta
te
rst
966;
In
gands.
207.
to
second
he
A.
ormaton
ead
amnotc
expresson.
he rst, second, and trd arces are not nvoved
te
te
meatus.
tans
paryngea
o
rom
D.
maxary
germ
com-
absorpton
condtons
n
occur
ssure
te
102–103;
ere
not
and
n
are
a
capsue
neck
GAS
mesoderma
N
dsc,
B.
a rc
processes.
derves
Tese
eves
and
or
he rst pouc gves rse to te tubotympanc recess.
E.
paryngea
he
n
hese
atera
derved
ces
cornea
o
do
retna
nvove
crest
mastcaton
ypocace-
ack
ntate
ud
439
Neck
tube.
rs
adeson
936;
damage
te
te
may
eads
he
pouces
re s u t
t rd
ormone.
C.
uar
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
mmunty
p a r a t y ro d
o
our t
gands
mgraton
Ab s e n c e
to
second
and
E.
neura
307;
cosure
and
E.
210.
occurs
te
c re s t
and
he
N
Neura
not
ces.
D.
te
scera,
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
dmorpsm
ce
D,
Cooboma
GAS
o
and
ack
aca
snus
s y n d ro m e
eads
A.
tve
usuay
and
tract.
apa-etoproten
patogeness
ABR/McM
neura
C,
GAS
209.
neror
are
neck
to
amnotc
and
ud.
sternocedomastod.
pane
or
aure
contro
o
gastrontestna
g
deects
cervca
neuroogc
s w a ow n g
te
to
sted
o
pete
pouces.
pouces.
opment
ma
te
cysts
paryngea
91;
o
our t
ack
ces.
79
rom
border
branca
tymus
a u re
drecty
oter
anywere
medan
d e re n t a t o n
nto
te
and
opens
te
D Ge o r g e
o
o
resuts
duct
te
o
paryngea
206.
retna
cartages.
porton
N
te
B,
groove
anteror
beow
gea
a
snus
hyrogossa
just
o
meanoma
prognoss.
ABR/McM
typcay
o
poor
None
103;
branca
ound
C
E.
ayer
magnant
ematogenousy
very
paryngea
trd
D.
a
pgmented
o
meanocytes.
936;
erate.
te
spreads
and
contans
n
source
Head
7
te
D.
tyrogossa
he
trd
duct
and
paryngea
paratyrod
gands
and
s
above
pouc
te
te
yod
orms
tymus.
te
bone.
neror
440
C H A P T E R
E.
he
7
cervca
2nd,
GAS
213.
A.
3rd,
1009;
he
and
N
rst
oaca
wc
bra
and
snus
and
Neck
s
4t
71,
77;
o
neura
s
ssures,
arc
crest
ces
o
te
mergng
o
te
D.
Eary
rse
to
ere
te
or
eads
Cons
maxary
nsuicent
to
syndrome)
eyeds,
N
216.
mandbu-
down-santng
ower
and
n
111;
C.
In
o
te
C,
te
D,
N
71,
and
77;
E.
hese
o
te
arces
are
maxary
rupture
trast,
ayer
he
and
externa
A.
not
nvoved
and
E.
rom
B.
he
B,
a
Caput
911–914;
he
T .
N
te
eyes
111;
gondii
and
n
nects
(cororetnts)
Feta
deat
eary
stages
may
In
s
con-
E.
pasa
Rubea
suc
dac
s
o
N
217.
cepaoe-
n
te
as
vrus
s
great
s
edema
o
te
teet
decency.
dorsa
nto
ventra
n
te
regon
regon
neror
orms
te
te
mucosa
o
te
lud
to
causng
pacenta
n
menta
and
s
destructve
caccatons)
wt
o
C,
te
D.
caccaton,
wt
s
durng
te
most
Most
menta
de-
common
n
rst
approx-
wen
trmester.
may
IUGR,
resut
n
durng
eta
218.
13;
end
te
deaness,
Prmary
B.
7
and
hese
ts
great
and
brt
sxt
n
te
te
second
o
teet
terapy
or
age;
and
durng
permanent
trd
ence,
cdood
aso
yeow
dmnsed
te
te
stes
may
ypopasa),
o
and
at
moars,
ong-term
can
afect
te
vrus
wt
varous
growt
te
symp-
cataract,
anomaes
retardaton,
car-
mcrocepay,
mcroptamos,
retnopaty,
menta
de-
epatospenomegay,
deects.
(German
suc
meases)
as
IUGR,
and
great
s
a
potent
eature
mbs)
sort
necton
brt
epatospeno-
teratogen.
s
he
meromea,
(absence
stages
to
cataract,
retnopaty,
deects.
amea
ntermedate
wt
growt
abnorma-
deaness,
beedng,
toot
rom
assocated
postnata
pgmented
neonata
and
s
vesse
sensorneura
gaucoma,
range
and/or
wt
abnormates,
toot
presentng
tama,
assocated
beedng,
cardac
severe
not
62
sma
CMV
te
membrane
and
teet,
except
years
vesse
and
cerebra
n
te
durng
neonate
troug
C.
o
deaness,
(rudmentary
neary
n
buds
pregnancy
ename
pgmented
hadomde
deects
materna
8
o
assocated
osteopaty,
severe
bones
postnata
decency,
terstc
pacenta
Caccaton
are
s
mcroptamos,
A.
o
case.
anomaes
CMV
ate
rom
T etracycne
and,
to
mcrocepay,
megay,
derved
te
(e.g.,
IUGR,
retardaton,
menta
s
monts
brt
vrus
as
Rubea
appear
endoderma
embryo’s
bones.
cerebra
pregnancy)
necton
te
ABR/McM
varous
mcroptama,
mcrocepay,
decency,
vra
pregnances
(mscarrage)
te
E.
n
osteopaty,
N
aggregaton
tongue.
46
crosses
terapy
Rubea
tes,
occurrng
bndness,
serous
mcroptamos,
epatospenomegay,
pregnancy
(acqured
car-
an
te
teet.
cency,
mcrocepay,
rom
tons
sensorneura
anomaes
deects.
etus,
menta
and
seen
dac
ypo-
retardaton,
retnopaty,
epatospenomegay.
cause
varous
cataract,
ncudng
cororetnts,
pregnant
and
by
gaucoma,
growt
aborton
n
teet
abnormates,
neonates.
ater
deects,
staned
a
at
o
pouc.
nnt
ong
rom
root
gands
dscooraton
o
begns
toms
te
stomodeum.
deects
compete
baby.
beedng,
te
o
to
to
toot
brown
A,
n
caccaton.
ourt
permanent
decency,
durng
n
tetracycne
and
ydrocepay.
especay
te
ABR/McM
growt
ces.
deveops
deveop
paatne
actve
teet
te
hey
o
suc
er
CMV
necton
deects.
te
deveop
tons
nodues
deposted
te
5
tetracycne
toot
occurs
aways
resut
deaness,
wt
and
we
nodues
T etracycne
o
ormaton
bones.
crosses
etus,
postnata
and
1%
nectons
o
crana
necton,
vesse
spontaneous
pasy,
coecton
te
assocated
necton
brt
n
neonata
necton
n
tat
pgmented
osteopaty,
Inecton
a
o
te
o
IUGR,
gaucoma,
matey
s
ABR/McM
assocated
sensorneura
cency,
88;
B.
cause
(ntracrana
oow
ename
and
gand
paryngea
aponeurotc
n
he
em-
pregnancy.
Admnstraton
woman
materna
abnorma
menta
dferentates
submandbuar
loor
emorrage.
mcroptama,
o
and
epteum
pouc
mesencyma
week.
by
compcatons.
nes
nvoved
organsm
bran
mcrocepay,
C.
not
te
more
suture
subgaea
are
perosteum
canges
B.
n
succedaneum
te
untreated
34
week,
ngua
he
te
bones
emorrage
and
wt
cross
crana
perosteum.
perosteum
not
hese
membrane
A.
te
between
cepaoematoma.
GAS
E.
o
te
extensve
does
C.
emorrage
crossng
te
does
but
and
D.
s
(subaponeurotc)
more
sweng
above
215.
vesses
s
trd
Lymp
n
mandbuar
49
perosteum
between
and
matoma
o
te
subgaea
orrage
A,
ABR/McM
o
t
ymp
Cepaoematoma
cranum
ydrocepaus,
ABR/McM
te
o
deaness,
respratory and amentary systems and are derved
ormaton
D.
bones,
congenta
tymus.
promnences.
214.
manestatons
are
paratyrod
pape-
deormtes.
B,
eta
syps
and
Faure
ypopasa,
deects
te
grooves.
60
gves
(T reacer
maar
by
ABR/McM
promnences.
dysostoss
tere
ormed
paryngea
paryngea
mandbuar
mgraton
ear
Head
o
carac-
but
o
te
mbs)
deveopment
mcromea
(abnormay
mbs).
ater
deects
n
pregnancy
suc
cororetnts,
as
may
IUGR,
bndness,
resut
mcrop-
mcrocepay,
CHAPTER
D.
cerebra
caccaton,
cerebra
pasy,
he
efects
ton,
o
T .
and
gondii
brane
and
canges
and
cocane
eyes
D.
te
bran
etus
te
pacenta
causng
tat
N
222.
mem-
destructve
resut
n
219.
103;
E.
In
T reacer
dysostoss),
nant
opment
eyeds,
o
s
o
cear
s
te
te
tat
syndrome
22;
D.
ears,
and
s
bones
ssures,
externa
mdde
no
menta
GAS
220.
D.
rom
ca
1063–1065;
autosoma
o
parts
snus,
cysts,
o
or
te
te
22;
te
nterna
externa
ace)
o
te
sometmes
ears.
From
acoustc
ABR/McM
snuses,
second
second
he
and
3,
paryngea
B.
he
te
C.
second
wt
o
ower
tymus
paryngea
ormed
gea
E.
An
abnor-
te
B.
E.
942,
In
may
pouc
n
Cons
te
o
te
Perre
s
dbe,
cet
Patents
out
a
s
te
a
to
te
paate,
wt
ourt
to
E.
ectopc
ganduar
o
mcrocepay,
and
wen
ears,
GAS
o
B.
rom
are
sort
o
ts
an
are
te
ste
te
o
A.
o
C.
dom-
troug
menta
membrane
It
to
s
comes
dvson
te
D
wt
o
te
syndrome
ower
In
ssure.
and
some
ear.
wt-
ave
cases,
ound.
menta
anomaes,
man-
and
born
gands
tracts.
been
eye
are
jont
N
aca
decency,
abnorma-
o
s
C3
we
a
a
te
te
te
te
ner ve
o
te
mdne,
branc
of
o
rom
and
spna
as
te
branc
o
nerve,
and
te
nerve
te
te
o
te
posteror
trgemna
mandbuar
great
aurcu-
nerves,
nnervate
overyng
te
wc
mucosa
skn.
anteror
dv-
suppes
nng
s
te
te
parasympatetc
to
te
parotd
nerve
exts
vscera
gossoparyngea
upper
te
ora
and
motor
nerve
bers
(CN
rom
te
gand.
nnervates
p,
te
117–119;
part
(sensory)
o
nraorbta
not
te
nasa
oramen
te
ves-
o
te
hs
and
224.
sensaton
gangon
E.
he
are
rom
te
ncudng
brances
moda
ossa
upper
N
scap.
9,
d,
eye,
rom
va
part
rom
n
te
suppy
(anteror
vaate
te
papae,
mandbuar
(wt
ce
responsbe
ts
o
two-
s
by
dvson
bodes
n
te
or
te
taste
sen-
case.
and
presynaptc
tympan
132–134;
pterygopaatne
parasympatetc
and
greater
ABR/McM
nerve
CN
te
V1)
carres
ax
gand.
nasa
cerebr,
superor
o
part
o
te
and
It
petrosa
dura
o
n
te
nose,
orbta
te
anteror
are
sensory
snus,
anteror
te
contents,
tentorum
nerve
o
brances
receves
ronta
and
nerves.
51
dvson
sensory
aso
cavty,
optamc
nasocary
44,
(optamc
conjunctva,
dorsum
and
n
acrma
Brances
ronta,
sensory
ora
te
bodes
respectvey.
nerve,
te
s
not
corda
ces,
and
o
nerve
te
Optamc
trgemna
te
submandbuar
were
synapse,
rom
s
descrbed
958;
o
tympan,
ce
gangon).
nerves
he
ter
genera
regon
trgemna
bers
C.
ave
17
corda
nerve.
Genera
te
te
va
he
membrane
but
s
wc
gangon.
ngua
ABR/McM
sensaton
nerve,
mucous
GAS
te
as
ceek
pexus
taste
ganga
abnor-
recessve
nerve,
nerve,
and
petrosa
and
saton
ears.
o
te
trgemna
ace)
sometmes
ypopasa
as
24
(underdeve-
te
autosoma
IUGR,
papebra
17,
deects
paratyrod
ocuar
cn.
wc
mandbuar
eyed,
gencuate
tyrod
autosoma
and
deects
tssue
11,
nerve
nraorbta
904;
he
te
(mandbuoaca
an
nterna
outlow
FAS
vertebra
maxa.
paryn-
te
C2
seat
carryng
tbue
wt
par
o
te
esser
he
tym-
gands
pars
ypopasa
wt
and
cardac
by
ssures,
and
and
n
Symptoms
resuts
bones
DGeorge
tymus
te
trgemna
rom
tympanc
223.
trd
o
over
IX),
tube.
assocated
te
syndrome
sequence,
deects
tes,
o
he
cerv-
tons.
ABR/McM
externa
assocated
o
troug
vestbue.
o
maar
mdde
pass
he
oramen
mandbuar
bucca
skn
deveop
audtory
competey
caused
papebra
Robn
dsorder,
s
o
ner ve,
component
tat
paratyrod
and
zygomatc
deormed
mates
C.
s
rom
gand
87–89;
tere
o
down-santng
B.
trd
descend
wc
te
mucous
menta
aurcuotempora
son
tongue.
N
mm
cervca
vesses
mandbe.
and
skn
parotd
trds),
to
960;
gene,
opment
A.
te
te
T reacer
eyeds,
pouc
he
rse
and
paatne
derved
tyrod
as
dysostoss),
nant
o
he
CT
pouces.
orgn
221.
te
pouces.
rom
ectopc
gand
GAS
s
o
te
bers
te
17
groove,
gves
antrum,
paryngea
deveopment
he
pouc
mastod
te
5
ar nerve, a branc o te cervca pexus composed
meatus.
12,
stuas
paryngea
paryngea
cavty,
dspacement
tan
nto
and
te
te
aveoar
ower
rst
panc
n
skn
rom
dvson
obterate.
A.
te
p
he
(underdeve-
deects
and
A.
dom-
C.
N
neror
13
ner ve
oramen
neror
syndrome.
Cervca
menta
ncudng
and
A, B, C, and D. hese are not assocated wt T reacer
Cons
s
more
magnum
ABR/McM
he
ower
(mandbuoaca
an
ypopasa
zygomatc
tere
by
maar
papebra
tonss
441
Neck
ner ve.
caused
s
deormed
mates
t
Cons
tere
down-santng
oramen
suppes
52–55
wc
gene,
te
dvson
ABR/McM
maormaton
cerebear
menta
caccatons)
mcroptama,
I
te
and
cana.
neurobeavora
(ntracrana
mcrocepay,
abor-
ydrocepay.
N
Car
cerebra
abnormates.
crosses
(cororetnts)
decency,
spontaneous
anomaes,
organsm
te
deaness,
mcrocepay,
neuroogc
nects
n
decency,
ncude
IUGR,
urogenta
dsturbances,
he
menta
epatospenomegay.
prematurty,
narcton,
E.
and
Head
7
cerebe,
part
te
et-
crana
o
te
acrma,
442
C H A P T E R
A,
B,
7
D,
dbuar
rom
D.
and
904;
he
70;
by
GAS
C,
nerve
carry
te
nerve
A
and
and
E.
are
N
and
man-
pexus,
normaton
35
(CN
nus
XII)
passes
musces
supped
o
by
ypogossa
ncude
te
o
musces
musces
w
not
ABR/McM
be
genogos-
29,
afected.
te
A,
228.
35
and
one
C,
226.
C.
ts
GAS
29–31;
C.
he
to
Superor
nuceus)
nerve
o
savatory
te
nuceus
Pregangonc
nuceus
VII
to
axons.
te
sa
and
nerve
te
ocated
hen
(va
cana)
te
and
corda
o
he
tympan
ts
te
aso
to
te
trave
oter
nerves
to
w
and
to
te
te
s
gossoparyngea
B.
he
or
dorsa
va
o
B.
va te
te
parasympatetc
nput
vagus
to
s
te
abdomen
and
E.
D.
he
parasympatetc
and
E.
te
he
cary
nuceus
tat
te
onc
to
rs
responsbe
spncter
or
contans
musces
paate.
It
parasympatetc
n
te
aso
motor
musce
ar ynx,
contans
neurons
tat
neurons
par ynx,
pregang-
nner vate
te
eart.
GAS
227.
D.
to
923;
he
as
te
GAS
A.
N
147–150;
toracc
Obstructon
ABR/McM
toracc
net
actuay
54–56
aperture
as
we
occurs
as
s
pan
cary
te
outsde
reerred
toracc
te
outet.
aperture
n
te
ngua
to
te
It
suppes
wt
to
ower
cm
te
connecton
rb
rst
te
may
rb
extendng
eevate
and
rom
structures
pace
subcavan
upper
(extra
pressure
artery
or
mb
troug
cervca)
ts
tp
to
normay
on
tese
neror
rb
te
ts
or
a
rst
yng
o
toracc
above
structures,
trunk
aper-
brous
te
te
notaby
braca
s
eye
CN
open);
(droop-
III
causes
responsbe
te
a
ora
or
mucosa,
gand.
sensory
gangon
o
contans
bers
or
taste.
s
a
by
rom
bers
bers
te
te
B,
n
o
te
te
ngua
mout.
parasympatetc
o
C,
D,
rejon
he
and
909,
E.
GAS
t e
by
b ase
te
gan-
pup
and
ty mp an
he y
o
w c
re ay
gand ,
and
n gua
s a var y
as o
loor
n
s k u,
te
o
he
are
s
n
dee p
to ngue
med-
s e cre to -
g ve n
of
s us pe nd e d
te
or
te
g an g on
pos tgan -
tr ans p o r t
lo or
supp e s
te
tym -
mus ce .
atter
s om e
ne r ve
g and s
ne r ve
te
o
te
tymp an .
gan g on ,
co rda
p te r y go d
tas te ,
c ord a
33
te
tw o-trds
c ord a
te
te
o
ater a
an d
ng ua
gngva
ABR/McM
jo ne d
te
ner ve .
membrane
ngua
GAS
o
submandbu ar
mucous
te
s
submandbuar
te
te
85–87;
anter or
sub ngua
te
s
to
constrcton
sensat on
to
nvove
or
be ow
border
genera
te
or
2
N
et
supernumerary
and
ner ve
bers
A
mantans
ptoss
subngua
gangon
gangon
gonc
syndrome
te
da-
constrc-
tat
te
gangon
and
te
tereore
pupar y
te
and
sympa-
nerve.
root o te neck, and te manestatons o toracc out-
ture.
nner vate
pupae);
o
con-
erec-
8.194).
gangon
responsbe
about
motor
varaby
Parayss
Fg.
and
(pomotor),
par ta
o
pexus.
Postsynaptc
nnervaton
sensaton
1027–1029;
he
ated
superor
d).
( GAS
number
contrbutes
stmuate
(odng
causes
anteror
neurons
cer vca
musce
es
and
accommodaton.
229.
ambguus
sot
te
s
musce.
nner vate
and
nput
nuceus
upper
d
a
(vasomotor)
aso
te
to
It
ar ter y
and
aso
te
(dator
upper
cranum.
bers
compete
gencuate
gon
Ednger-Westpa
te
trgemna
he
te
assocated
contans
ars
cranum
rs
causes
ptoss.
somatc
torax.
not
carotd
and
to
wt
nner vates
trgemna
he
responsbe
o
weakness
71
te
It
ead
vesses
submandbuar
he
D.
te
te
te
submandbuar,
or
are
seat),
(sudomotor).
parasympatetc
nerve.
nuceus
te
he
scae-
medus).
tngng.
nterna
sympatetc
bood
n
aso
compete
A.
te
and,
nner vaton
te
assocated
o
o
musce.
o
o
n
dscooraton
ABR/McM
(carotd
compresson
gands.
responsbe
te
tereore
ng
sub-
It
o
eevaton
savary
parasympatetc nput to te parotd gand
te
compresson
hereore,
reduced
o
musce
ton.
and
base
communcantes
bers
nose,
te
ven
postsynaptc
musces
tor
subman-
to
ram
at
wtn
tetc
party
etooges
scaenus
oter
symptoms
sympatetc
organs
as
te
te
musces,
capts
sweatng
gan-
ncude
tan
119–122;
cause
te
subngua
nuceus
tor
(e.g.,
scke-saped
hese
es
petro-
pregangonc
gand.
be
pass
N
juguar
tracton
nnervate
o
bers
subngua
patent
motor
known
gands
he
arm
seat
suppy
gray
abnormates
a
coder
E.
ongus
target
te
bers
dstrbuted
ngua
savatory
wt
greater
aso
bers
submandbuar
neror
te
postsynaptc
and
n
pons
rom
Oter
condton.
SCG
te
tat
crana
pterygopaatne
mucosa
are
and
va
te
wereas
and
gand
rom
te
te
cana,
n
savary
tegmentum.
arse
pregangonc
eferent
bers
gangon,
secreton
pontne
ext
te
superor
vsceromotor
bers
gangon
and
parynx,
symptoms
to
synapse
gand
mandbuar
(or
a
te
pterygod
and
Postgangonc
dbuar
A.
ateray
some
parasympatetc
oter
n
s
parasympatetc
pass
acrma
paate,
te
nuceus
nerve
pterygopaatne
Vdan
gon.
aca
symptoms.
symptoms
and
and
wt
deep
226–250
muscuar
and
and
B,
nterna
Answers
cause
musce,
common
ands,
tongue,
tongue
may
anteror
Most
troug
te
te
Extrnsc
nerve
70;
and
coud ncude an eongated transverse process o te C7
styogossus.
hese
1089–1091;
V2)
vertebra
29,
te
ypogossa
(CN
sensory
ace.
paatogossus).
yogossus,
B,
o
extrnsc,
(except
supped
A,
V3)
ABR/McM
cana.
and
Neck
Maxary
(CN
ypogossa
ntrnsc
sus,
and
regons
N
ypogossa
nerve
E.
nerve
oter
GAS
225.
Head
a
mo ut
o
te
an d
(gum s ).
hese
nerves
1027–1029;
are
N
not
91;
nvoved.
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.
Perneura
aong
a
s
metastass.
mony
ound
In
case
ts
te
oramen,
IX),
vagus
IX
A,
B,
son,
mb
C,
s
XII,
Bood
ects
VII,
he
cranum.
an
V ,
occurs,
ness)
nerve)
o
s
more
bengn
tssue
at
nerves
woud
be
motor
mb
a
te
he
N
w
94;
and
de
are
he
IX,
jugu-
D.
by
E.
ABR/McM
troug
he
GAS
232.
A.
coma
te
(GAS
s
o
crana
61
135,
a
(oss
o
and
dura
bow
ten
co-
te
rom
to
te
orms.
conscousness)
o
(proound
s
or-
menngea
dura
te
ard
nterva
n
spnosum
te
some
ours.
unconscous-
not
reeved
te
8.47).
ocated
bone.
he
hus,
body
te
greater
accessory
wng
menngea
nerve
artery
175;
N
pass
troug
ts
to
ts
troug
nerves
te
te
ypo-
arger,
by
sape
and
te
te
o
te
ens.
te
o
ens
va
gets
eye
dspaced
by
nerve,
te
wtn
In
cary
absence
reaxed
or
ar
or
o
o
muscu-
vson.
ocuomotor
contracton
at-
CN
trocear
te
te
latter
tcker
te
unopposed
te
te
36–37
movements.
abducens
dameter
ens
n
musce
spncter-ke
musce
pass
suppes
eye
(nnervated
(CN
causes
III)
resut
te
o
makng
cana
ABR/McM
(CN
a
cary
te
pterygod
resuts
as
obque
he
te
controng
nerve
(nnervated
IV).
o
stmuaton
ary
crana
oramen.
acerum.
Parasympatetc
III)
te
ts
215–217;
downward
superor
s
and
passes
nerve
musces
stmuaton,
rng
ven
troug
oramen
te
and
CN
nerve
te
near
c-
vson.
hese bers aso nnervate te spncter pupae. hus,
nterrupton
o
tese
bers
causes
daton
o
te
pup
because o te unopposed acton o te sympatetcay
nnervated
motor
on
o
canges
nerve
ar
158,
rectus
and
pass
and
te
damage
nerve,
juguar
XI
ocuomotor
outward
VI)
artera
ematoma
pressure
Fg.
ovae
spenod
ucd
expres-
by
ven
cana.
nerve
he
era
mdde
strps
oows
concusson
and
a
ayer
bood
ts
a
o
s
oramen
(epdura)
by
49,
emorrage
perostea
aca
medated
emssary
ypogossa
troug
CN
X
and
gossa
he
CN
an
nterna
X,
he
(CN
respectvey.
brances
Usuay
oramen
te
VIII
extravasated
bre
movements,
earng
torn
oowed
occur,
C.
because
by
and
oramen.
com-
XI).
afected
predomnanty
and
artery
o
esons.
te
(CN
8.194
tumor
orms
gossoparyngea
accessory
(epdura)
drowsness
patent
o
tan
aong
te
relex)
and
extradura
T ypcay,
Later,
spreads
T ongue
passes
between
ead;
spread
rater
medated
and
rom
wc
cavara.
te
D.
1031–1034;
artery
o
spread
nsdous
Fig.
majorty
and
Extradura
gn.
orm
and
(gag
(or
more
nerve).
nerves
B.
X),
sensaton,
GAS
tumor
te
nvovng
(gossoparyngea
(vagus
A.
hs
tumor
relex
sensory
a
o
magnant
tus
(CN
paryngea
te
n
o
one
tumor
ar
231.
spread
nerve)
GAS
subclavia
eson
dator
nerve
tere
cannot
rase
pupae
suppes
causes
te
te
musce.
evator
parayss
superor
o
eyed
Because
papebrae
te
musce;
(cannot
te
ocuo-
superors,
te
open
a
patent
te
eye).
444
C H A P T E R
Parta
tarsa
B.
7
Head
ptoss
s
musce,
and
reated
wc
s
Neck
more
to
parayss
sympatetcay
o
te
superor
C.
nnervated.
he optc nerve carres sensory bers rom te retna.
Connected
as
a
rom
contains
te
sagittal
s
aca
responsbe
expresson
anteror
two-trds
or
and
o
controng
taste
te
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
te
sensaton
sinus
tissue:
major
and
the
nerve
o
unit
Superior Connective
of
aca
together
structural
nerves
he
musces
CSF.
CHAPTER
D.
he
cary
tetcs
E.
he
SCG
and
s
a
responsbe
o
te
sympatetc
or
parasympa-
mastcaton.
eye.
mennges
gangon
near
te
sec-
B.
N
requrng
o
te
ABR/McM
52–53
tve
s
because
tssue
composed
ter
o
n
te
ts
easy
te
to
E.
D,
tese
voca
A.
rma
he
he
sde
by
te
he
ase
gottds
te
te
he
or
and
N
and
te
mucosa
o
Eac
ess
or
oose
scap
bood
aso
te
are
one
E.
te
vens,
to
27;
te
o
wc
tube
s
te
saow
ace
s
It
s
te
space
between
neck
te
regon
cavtes
o
on
te
B,
tan
true
above
te
voca
te
te
o
bend
od
rma
te
body,
premature
or
root
o
ntaton
o
te
hs
nterna
nerve
arynx
above
Owng
to
prorm
n
o
te
areas
cords,
t
coud
epgot-
ocaton
be
prorm
nnervates
sen-
n
damaged
ossa
and
wt
oss
o
o
optc
te
somatc
motor
trgemna
sensaton
nnervaton
to
nerve
rom
te
musces
o
by
A.
o
and
trd
eferent
to
tympanc
tongue,
XII)
o
and
nnervates
te
te
tongue.
remans
te
gves
te
te
paatne
structures
do
te
con-
te
o
parynx
tube.
obterates
tonsar
mesencyme
o
cavty,
usuay
ormng
to
audtory
Inectons
rom
audtory
pouc
tympanc
rse
he
parynx.
spread
te
to
tympanc
te
can
rse
antrum.
te
to
troug
C,
te
D,
by
was
te
snus
ormng
te
tons.
not
orm
te
(CN
to
te
gt
pck
E.
musce
hs
wc
cary
he
as
te
aud-
132;
ocuomotor
and
s
gt
te
te
te
efer-
III).
because
sensaton
contracton
rs
s
tat
resuts
speccay
component
ts
o
pregangonc
nuceus
46
aferent
(CN
sone
musce
o
gt
te
and
(CN
relex
oter
ABR/McM
nerve
an
nerve
te
o
57–58,
by
te
ce
postgan-
gangon.
pupary
combnaton
N
up
parasympatetc
te
II)
medates
Ednger-Westpa
at
and
te
ABR/McM
medated
nerve
nerve
pupae
te
s
ocuomotor
wen
abe
nerve,
943–945;
he
optc
by
43;
relex
constrcton.
bers
by
BP29,
ocuomotor
spncter
at
N
gt
constrcts
pupary
GAS
238.
part
hese
nerve
te
III)
s
not
med-
nerves.
54
s
te
eferent
mb
o te pupary relex. It carres parasympatetc nerve
bers
wt
pregangonc
ce
bodes
n
te
Ednger-
Westpa nuceus and postgangonc ce bodes n te
cary
te
gangon
rs.
superor
te
one
te
te
tse
mastod
cavty
nodues
carred
pup
ated
superor
somatc
superca
te
t
voca
te
sensory
arynx.
dvson
suppes
and
te
ts
o
suppes
ossa,
nvovng
te
branc
aso
receves
gvng
recess
remanng
E.
carred
bodes
A,
ossa
tny
ocuomotor
49–50
prorm
(CN
paryngea
pupary
gonc
te
ear
te
nnervated
ubrca-
te
a
1093–1096;
we
o
and
(paryngts)
ts
mb
he
mdbran
te
sava
o
musces
tympanc
second
and
he
ent
n
depresson
to
B.
mb
and
produced.
serves
o
gand,
snus
tube.
GAS
ods.
uman
C,
tory
te
o
net
nerve
extrnsc
tympanc
ympod
ater-
by
somatc
part
trd
membrane
cavty
mdde
he
sound.
porton
te
te
A.
wt
ound
ts
he
parynx
reguated
meday
wder
te
wt
o
aryngea
wt
true
bounded
upper
te
muc
ABR/McM
te
relex
V3)
ptc
orce
and
s
62
237.
a
mandbuar
ower
openng
and
(eustacan),
nects
spread
te
parotd
carotd
posteror
genera
suppes
D. he rst paryngea pouc gves rse to te tympanc
tympanc
and
44,
between
moduate
between
s
procedures
(CN
ts
cartage
are
o
sensaton
he
to
a
ABR/McM
te
nterna
posteror
ypogossa
membrane.
mennges.
key
and
ear,
to
IX)
te
ossa.
styopar yngeus
te
te
nerve
oropar ynx.
he
recess,
nto
cavara
sensor y
to
te
o
prorm
(CN
te
to
to
meatus.
GAS 1067–1070; N 136, 139, 237; ABR/McM 49–45
236.
spreads
pass
aferent
bers
trgemna
te
445
Neck
component
ner ve
to
and
acoustc
te
nnervate
eferent
tongue,
ntrnsc
con-
s
speca
externa
te
not
o
sensory
parasympatetc
membrane,
et-
relex.
vaecua.
protectve
A.
or
te
as
openng
o
preventon
rom
to
s
space
tat
nerve.
ts,
oss
he
te
can
n
s
wc
does
a
sensory
externa
dvson
vscera
te
te
aponeuross,
emssary
suc
aryngea
ods.
CSF
mucosa
bers
te
vestbue
and
vaecua
aryngea
durng
pus
134–137;
s
te
te
ead
nnervaton
sory
o
o
scap
od.
voca
te
869;
he
N
arway,
degutton
GAS
sma
o
unt.
body,
connec-
he
mnemonc
ayer
necton
tyrod
tongue
ton
D.
a
tssue,
oramna
ossa
o
ventrces
were
te
ts
musces
aryngea
aryngea
D.
because
dameter
aryepgottc
In
a
ayer)
structures
gottds
prorm
ay
C.
as
genera
dense
tree
as
musce,
acer-
sends
te
atoug
vscera
abundant
wen
aso
gossopar yngea
perpery
scap.
percranum.
n
he
rst
he
speca
to
aryngea
te
scap
957–960;
atera
B.
and
te
te
C.
beed
ayers.
cords.
te
serves
troug
E.
by
o
move
(ourt
pareta
and
910,
he
by
cavty
ntracrana
C,
GAS
te
te
to
retract
connectve
Inecton
troug
reac
skn,
not
open
te
owng
V2),
trgemna,
wounds
enterng
ayer
and
SCALP
ayer
o
t.
crana
pass
A,
area
n
ed
hese
ends
do
ayers,
tssue,
tssue
danger
ve
ayers,
areoar
nectve
are
second
ntmatey
word
ve
oose
o
bot
arteres
tey
te
care.
arteres
rom
he
n
connected
te
beed
anastomoses.
ated
surgca
It
ncudng
maxary
(CN
127–129;
because
scap
he
vertebrae.
B. Scap aceratons are te most common type o ead
prousey
235.
s
musces
trd
888–889;
njury
234.
gangon
te
ond
GAS
233.
to
Head
7
te
on
he
cerebear
superor
te
ton
and
suppes
ocuomotor
artery
cerebear
ocuomotor
(because
o
te
nerve
and
artery
nerve
spncter
s
te
ound
PCA.
can
resutng
unopposed
pupae
between
Aneurysm
tereore
n
o
compress
pupary
sympatetc
o
te
data-
nnervaton
446
C H A P T E R
o
te
7
dator
afected
B,
C,
D,
and
E.
nerves
GAS
136–138;
he
o
and
te
V1),
te
te
o
te
because
A.
o
he
B.
and
o
te
D.
vagus,
te
he
and
no
pupary
E.
nerve,
to
o
orbta
te
cana
and
o
tese
ssure
te
242.
wngs
wt
and
ocated
N
240.
E.
n
he
te
141–143;
B.
Herpes
te
or
t
(CN
et),
ng
ssure
te
eye
as
can
s
com-
done
nerve
te
unctons
and
sup-
to
nerves.
ocated
nerve
nsde
and
o
te
brances
te
te
part
o
anteror
crana
oramen
ABR/McM
can
rotundum
crana
11,
afect
and
o
A.
resdes
a
sensory
mmunosuppresson
wc
may
dysuncton.
n
te
In
case,
resutng
branc
suppes
o
te
he
stapes
dampen
tenson
te
on
n
are
nerves.
a
n
neck
te
B.
he
It
te
and
nerve
o
te
musce
nserts
ear
stapes
stapes.
and
by
n
te
neck
unctons
o
to
puttng
Denervaton
o
ts
are
nerve
neck
at
te
bers
pared
ooks
o
upon
to
hereore,
to
o
aorta
groove
te
te
te
te
and
emerg-
rgt
recurrent
posteror
a
crco-
(recurs)
arc
under
ter
te
to
(rgt
ooks
te
nadvertenty
GAS
243.
C.
to
o
arynx
te
o
pat
mdde
recurrent
damaged
te
durng
E.
he
tense
te
o
a
mus-
o
te
monotonous
te
voca
nerve
voca
te
hs
Parayss
n
cord.
w
cord
arynx
gossoparyngea
motor
pupary
to
causes
cord.
aryngea
musce.
aryngea
above
relex
voca
cord.
mucosa
nerve
superor
resuts
nabty
ts
te
te
voca
nerve
anestesa
and
o
aryngea
to
above
superor
protectve
te
crcotyrod
tense
te
to
Injury
branc
1008–1009;
he
bers
aryngea
n
te
sory
nerve
te
nerve
cord.
te
because
8.180).
been
to
serves
resut
o
n
suppes
Parayss
necton
aca
way
D.
sensory
(nerve
voca
externa
voce
stress,
as
sensory
te
externa
dormant
erpes
aca
musce
te
te
motor
domnant
mdde
o
o
bot
stapedus
te
Iness,
reactvate
o
stapedus
bone
gangon.
be
o
traceoesopagea
gand.
may
sensory
te
course
nerves
tyrod
nerve
n
84
branc
nnervaton
Beng
arterosum
te
sternocedo-
excudng
aryngea
rgt
In
tese
anestesa
ce
dysuncton
te
vbratons
te
n
gangon
reactvated,
tat
can
resut
ts
gencuate
stapedus).
aso
and
oss
(GAS
nerve
Fg.
carres
sen-
bers.
N
87–89;
gt
relex
ABR/McM
s
used
to
84
test
te
abty
o
te eyes to perceve gt sensaton. he aferent mb o
ts
s
a
relex
te
arc
s
eferent
pengt,
te
mb.
eac
optc
By
eye
s
nerve
snng
tested
we
gt
te
nto
ocuomotor
te
ndvduay
eye
or
a
rom
drect
musce resuts n te percepton o oudness o sound n
constrcton o te pup on te psatera sde and ten
te
or
A,
ear
C,
te
N
241.
n
te
above
80
crana
he
artery.
arynx
te
a
motor
suppes
wtn
te
nerve,
cord.
nerve
gamentum
nerve
and
aso
recurrent
neck,
te
voca
to
ABR/McM
suppes
vagus
traves
motor
he nterna branc o te superor aryngea nerve
ossa.
spna
and
te
te
as
musces.
137;
o
to
meatus,
tyrodectomy.
ossa
ovae
X),
te
suppes
te
N
contrbutes
acoustc
relex.
s
aryngea
musces
arynx.
nto
gangon.
n
nerve
trapezus
(CN
aso
externa
coug
et
te
ten
aryngea
nraorbta
and
te
wc
te
892;
musce
subcavan
ost
and
beow
rom
under
by
aferent
were
nerve
arynx
ven.
te
recurrent
tyrod
brances
nerve
zygomatc
ound
mdde
zoster
wc
vrus,
n
o
accessory
ntrnsc
usuay oows reactvaton o a dormant varcea nec-
ton,
nerve,
885–886,
he
optamc
serves
s
C.
vagus
te
structures,
III),
optamc
and
maxary
s
oter
trgemna
hese
te
greater
(CN
orbta
te
relex.
transmttng
optc
o
VI),
cornea
compresson
o
nerve
n
and transmts te optc nerve and optamc artery .
D
aca
roe
he
GAS
openng
and
Abducton
and
te
67
an
Among
(CN
pterygopaatne
he
n
communcates
superor
cornea
brances
te
te
s
esser
dvson
nerve
neror
orbt,
te
snus.
structures.
sensaton
mb
ssure
ocuomotor
around
tese
aca,
partcpate
ABR/McM
bone
maxary
abducens
pes
132;
orbta
optamc
T umors
trgemna,
not
between
abducens
press
N
spenod
transmts
o
unresponsveness
mastod
ound
orbt
he
do
superor
te
and
nnervatons
relex.
sku
Neck
pupae)
gt
C.
and
eye.
abducens
239.
Head
D,
and
55,
he
58;
vagus
contrbuton
aurcuar
te
t
vagus
hese
Fg.
8.124).
nerves
are
not
responsbe
or
A.
he
ABR/McM
nerve
to
s
te
te
83
(CN
B.
X)
externa
aso
caed
aferent
te
nteror
o
a
acoustc
te
mb
vestbuococear
makes
o
te
meatus
nerve
te
sma
o
sensory
(va
Arnod)
coug
relex
ts
and
earng
n
n
eye.
aca
and
he
te
contrbutes
aurcuotempora
acoustc
coug
relex.
to
meatus,
te
t
branc
nnervatons
does
not
o
o
te
te
partcpate
n
E.
he
s
hs
o
s
a
to
s
etters
N
te
rom
97,
a
relex
o
by
tat
te
te
(aferent
relex
tat
stmuaton.
s
pro-
cornea
o
optamc
mb)
and
te
mb).
are
and
aso
audtory
s
sde.
acoustc
medated
maneuver
test,
883–886;
relex
wc
assess
o
stmuaton
trgemna
trocear,
vson
contraatera
knd
sudden
to
(eferent
musces,
used
to
relex
te
a
cornea
te
H-test
denty
GAS
or
on
s
reacton
nerve
ocuar
relex
relex
reacton
bnk
omotor,
Atoug
te
starte
branc
D.
medate
he
te
snce
arynx.
nerves
trgemna
externa
consensua
he
duced
baance.
C.
a
occurs
branc,
nnervates
A.
E.
(GAS
yperacuss.
53,
B.
(yperacuss)
used
abducens
known
abty
as
o
dferent
132;
to
test
nnervated
te
by
extra-
te
ocu-
nerves.
vsua
te
eye
acuty
to
dstances.
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
sort
correct
tat
te
nvoves
and
cary
answer
probem
pup
and
as
It
es
and
s
cary
cear
wt
suc
Eye
gangon
rom
te
ens
movements
te
wc
accommodaton,
were
parasympatetc
s
vgnette
accommodaton,
accommodaton,
convergence.
msed
nerves
opton.
not
dect
s
compro-
te
key
Superior
cause thyroid
o
s
condton.
Pregangonc
axons
rom
te
ar ter y
Ednger-Westpa
nuceus
are
carred
by
te
ocuo-
Superior Posterior
motor nerve. hese parasympatetcs trave
parathyroid
to te
c-
glandular gland
ary
gangon
ocated
n
te
posteror
orbt
and
rom
branch
ere
postgangonc
axons,
carred
by
te
sort
cary
Inferior
nerves, Inferior
thyroid
go
on
to
nnervate
te
spncter
pupae
mus-
parathyroid
ar ter y
ce,
gland
wc
ary
constrcts
musce.
tenson
more
and
on
te
pup
Contracton
te
convex.
zonuar
Absence
spncter
o
te
bers,
o
pupae
and
cary
musce
aowng
acton
resuts
nnervates
o
n
te
oss
te
te
c-
reeves
ens
cary
o
te
to
be
musces
abty
to
Thyrocer vical
ocus
on
near
objects.
trunk
A, Right
Left
B,
C,
and
nerves lar yngeal
nnervate
tus
musces,
unafected,
recurrent
lar yngeal
answer
245.
Fig.
8.180
nerve
obque
and
and
abducens
atera
respectvey.
ts
opton
Snce
combnaton
mmedatey.
eye
can
movements
rec-
be
Oter
emnated
were
as
combnatons
an
are
ncorrect.
GAS
GAS
trocear
superor
ner ve
aso
•
he
te
ner ve
ar ter y
Left
E.
recurrent
subclavian
B.
to
864;
he
N
111–113;
erpetc
ABR/McM
necton
supratrocear
vens,
o
te
wc
61,
72
oreead
jon
to
key
orm
a
spread
snge
448
C H A P T E R
trunk
7
tat
oreead
he
two
orm
runs
vens
o
ernous
te
A.
to
caed
t
ven
to
te
te
anteror
te
cavernous
te
te
ace
pterygod
root
nasa
te
ven
can
va
snce
o
arc.
t
o
nose,
te
te
wt
and
te
C.
sde.
by
a
meda
ven
ts
deep
as
D.
s
to
aca
two
not
dran
he
GAS
nto
246.
pexus.
snus
o
s
te
drans
C.
he
carres
venous
above
neror
to
ocated
n
petrous
te
te
part
cavernous
dran
cvus,
nto
te
te
snus
and
transverse
s
wt
made
te
were
up
ayers
t
o
mutpe
o
te
ven
connects
trbutares
o
N
64,
nerve
motor
component
85–86,
s
a
and
o
99;
mxed
te
te
superor
superca
ABR/McM
crana
(speca)
te
aca
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
wc
bers.
arses
cer vical
47
nerve,
sensory
Mastoid
Submandibular
te
ven.
Occipital
nodes
dura
nterconnects
nodes
Submental
supe-
o
snuses.
emssary
snus
aca
bot
te
pexus
between
petrosa
pareta
875–876;
motor
Pre-auricular/parotid
It
cannes
tempora
danger
drecty
sucus
bone.
basar
sagtta
communcates
te
he
mater
E.
not
petrosa
posteroateray
venous
communcaton
and
petrosa
snus.
cav-
way
superor
traves
to
superor
te
he
ror
tempora
snus.
but
does
At
make
aca
ven
snus
te
nto
aso
pexus
aca
ne
opposte
supraorbta
drans
cavernous
wt
te
communcates
venous
wt
o
te
mdde
o
te
necton
pterygod
area
at
and
optamc
te
ven
jons
wc
he
spread
he
near
te
joned,
orbt,
ven,
snus.
neror
vens
are
anguar
optamc
Neck
wt
branc,
te
te
and
down
parae
transverse
ange
Head
vein
he
te
CHAPTER
aca
nerve
we
te
aca
nerve
dus.
he
enter
te
nterna
nuceus
sensory
and
and
emerge
motor
rom
and
petrous
te
te
aca
bran
sensory
part
acoustc
orms
nerve
parasympatetc
o
parts
te
meatus,
as
nervus
o
te
tempora
wc
s
proper,
parts
aca
t
passes
ve
troug
major
sensory
motor
to
247.
B,
te
E.
or
GAS
883–887;
C.
he
(CN
te
contro
nterna
part
VII)
he
o
o
aca
o
aca
nerve
va
te
to
te
cose
o
135;
te
t
o
te
o
are
aca
meatus
s
bone.
vestbuococear
key
aneurysm
GAS
250.
nto
speca
to
respon-
expresson.
as
cana
n
te
he
aca
nerve
nerve
(CN
VIII)
earng,
or
baance
speca
aca
and
D,
nerves
E.
and
taste
and
VII
he
mout
nodes.
te
he
carryng
sgnas
aca
anteror
tat
sensory
nerve
te
o
and
o
N
he
20;
nvove
ABR/McM
nodes
te
ower
te
Eferent
te
not
te
B.
apex
are
dgastrc
p
o
te
ympatc
ymp
node
occpta
o
rom
nodes
te
nodes
anteror
tongue
deep
te
o
go
to
to
o
occpta
te
eyeds,
na
te
nodes
part
te
he
te
rontotempora
acoustc
nasa
dran
meatus,
o
nasa
te
and
a
parynx
root
o
regon,
deep
and
te
and
group
te
nose,
te
o
posteror
are
ound
n
nasa
he
part
mary
GAS
249.
D.
o
909,
(GAS
915;
Aneurysms
cause
te
parynx,
juguodgastrc
drect
emerges
Fg.
N
o
buc-
te
audtory
dran
te
te
o
ts
rectus
neror
nerve
musce
abduct
te
C,
on
neror
te
branstem
at
cerebear
abducens
te
as
cerebear
eads
to
oss
psateray,
eye.
he
artery
o
uncton
resutng
anteror
n
to
te
te
atera
nabty
communcatng
to
artery
not
te
s
as
to
we
provde
somato-
gand.
33,
are a
o
s up p ed
an d
abo ut
to
be
ne r ve
te
39,
te
by
40
ar ynx
te
te
s up p es
voca
supe-
s ens at o n
cords .
gos s op ar yngea
te
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
ydrocepaus
reabsorpton
E.
he
pexus
o
subdura
and
space
snus
N
ocaton
CSF
nerve
te
occurs
va
as
te
a
resut
aracnod
te
te
s
t
s
wc
aracnod
s
te
responsbe
CSF .
lows
ump
key
nto
nto
te
60–61
s
cose
to
te
compressng
styomastod
or
are
he
v.
ABR/McM
and
spaces
contan
reabsorbed
growng
exts
epdura
not
CSF ,
and
va
meatus
as
nerve
and
do
111–115;
o
acoustc
aca
tese
produces
sagtta
D.
Protracton
o
te
A.
tgt
on
oramen.
cosure
o
te
D.
te
te
tongue
nerve
mandbuar
constrcton
damage
889–890;
Brances
and
anteror
nasa
A,
o
ypogossa
to
te
s
because
and
o
eevaton
nner-
o
te
nerve.
and
parta
ocuomotor
ptoss
resut
nerve.
Vagus nerve nnervates evator ve paatn musce.
GAS
254.
by
Pupary
rom
t
Impngement
to
X)
87–89;
874–876;
vaton
pontomeduary
beow.
(CN
brng
spaces,
aca
artery
nerve
brances
aurce
ABR/McM
to
o d s
ar ynge a
subaracnod
he
C.
anteror
D,
mandbe
juncton between te abyrntne artery above and te
anteror
E.
B,
pr-
85–86
te
of
te
of
posteror
eyeds.
tubes.
tonss
N
decreased
he
8.197).
mpngement
rom
and
nodes
1057;
externa
coparyngea asca and dran te nasa cavtes, te
D.
do
parotd
145;
neror
nonobstructve
GAS
253.
parts
te
gves
o
mand-
gves
damage.
o
te
nodes
area
w oud
superor
cavtes.
retroparyngea
voca
Weakness
corod
te
te
t
aurce.
te
134,
te
superory,
and
nerves
to
o
(to
nerve.
ner ve.
vagus
potenta
exter-
drans
te
neck
gament,
porton
nner vat on
A
te
parotd
N
te
B.
A,
nodes.
scap.
he
to
hese
postgan-
bers
aurcuotempora
turns
condye,
nerve.
67
vsceromotor
te
aso
artery
v.
jugu-
regon
te
ten
anteror
E.
ner ves
E.
GAS
252.
tese
te
group
te
ypogossa
somatosensory
between
and
recurrent
he
ner ve
centra
nto
nodes
party
cervca
dran
he
loor
dran
tese
and
to
te
IX)
te
and
nerve.
w
V ertebra
ABR/McM
receves
rom
nnervaton
he
crana
between
musces.
and
and
musces
ocated
te
906–908;
to
83
gand
passes
ar yngea
D,
18,
o
te
and
do
D,
te
Aneurysm
artery
nerve.
spenomandbuar
Sensor y
o
VIII.
bees
oomoyod
o
hese
afect
nerve.
449
Neck
ocuomotor
cerebear
149–154;
and
251–275
A.
ror
te
musces
o
superor
carres
two-trds
contro
C,
C.
E.
submandbuar
C.
to
bers
submenta
portons
B.
nerve,
equbrum.
motor
958–960;
anteror
A.
vestbuar
speca
N
mandbuar
skn
GAS
expresson.
B,
GAS
te
sensory
tongue
A,
and
carryng
key
brances
sensory
Answers
nerve,
te
te
ocuomotor
anterosuperor
A,
251.
cocear
te
superor
capsue)
nerve
and
te
conssts
te
te
parotd
musces.
te
parotd
abducens
afect
parasympatetc
te
sty-
te
key
te
w
parotd
As
course troug ts cana. he vestbuococear nerve
o
he
te
o
869–870;
gonc
83
a
B.
to
w
afect
be
not
reate
PCA
tongue,
and
dgastrc
nerves
not
te
Aneurysm
and
dvdes
provdes
ABR/McM
tempora
oramen
expresson
musces
acoustc
were
two-trds
crana
110,
te
and
gand,
bey
hese
N
styomastod
anteror
posteror
and
te
parotd
musces
sbe
petrous
248.
te
to
te
and
D,
rom
brances.
bers
oyod
A,
emerges
o
nerve
nner ear; t ten courses troug te aca cana, ater
wc
does
te
nterme-
bone
very
o
Head
7
E.
gea
17,
te
and
are
descendng
arteres
110,
are
135;
ABR/McM
spenopaatne,
etmoda
septum
he
N
o
anastomose
prone
to
paatne
ocated
58
superor
anterory
aba,
on
te
beedng.
and
posterory
ascendng
n
te
paryn-
parynx.
450
C H A P T E R
B.
7
he
Head
posteror
wtn
artery
C.
GAS
255.
te
s
do
superor
wtn
suppy
N
47;
aveoar
and
etmoda
not
1072;
Neck
maxa
ound
Posteror
es
and
te
te
and
te
crana
mdde
nasa
ABR/McM
artery
accessory
traves
B
menngea
cavty.
arter-
D.
septum.
GAS
261.
o
vagus
te
B.
or
nerve
suppy
carotd
he
orms
o
te
wc t nnervates.
part
o
parynx
te
and
paryngea
contnues
n
ypogossa
s
ound
neror
to
te
te
D,
E.
te
he
GAS
A.
he
ce
s
B,
D.
nto
abduct
he
or
on
te
voca
B,
te
artery
C,
E.
870,
he
o
te
aso
nerve
arynx
B.
he
are
or
A.
a
he
ABR/McM
crcoarytenod
84
n
mus-
C.
te
and
voca
stretces
to
atera
cords,
te
GAS
B.
artery
oter
te
cords
ptc
D.
wc
te
arteres
150,
152,
or
parynx
coug
musces
supped
superor
C,
D,
o
te
sted
te
voce.
njury
A.
to
154;
s
te
te
rom
260.
888;
are
not
ng
cer-
GAS
262.
nerve.
cose
E.
o
to
damage
a
paate
damaged,
te
o
not
pro-
ABR/McM
on
te
sur ace
teet
can
o
o
te
ead
ramus
o
to
te
yper-
especay
dicuty
spasms
84
zygomatc
eevator
mastcaton,
ave
to
mucus
ABR/McM
te
32
A.
n
o
eson.
and
ocated
Its
te
depressng
ts
enarged
between
man
te
and
acton
teet.
It
speec
runs
orms
bey
o
s
te
max-
to
com-
s
aso
nvoved
producton.
rom
part
va
te
te
o
mandbe
te
dgastrc
process
te
loor
o
musce
and
to
te
o
are
pays
te
org-
connects
ntermedate
openng
temporas
tendon.
jaw
wen
to
It
te
reaxed.
a
roe
n
mout
open-
protruson.
N
55–56;
nerve
mbs
te
mastod
pterygod
jaw
vagus
o
ABR/McM
medates
te
membranes
he
musces
nerve,
coug
and
39–41
bot
te
relex:
eferent
N
nerve
137;
B.
he
and
and
aca
expres-
aca
or
medates
s
earng
supped
ABR/McM
nerve,
te
C.
and
by
te
to
tensng
te
N
D.
te
te
voca
woud
o
crcotyrod
cords.
not
resut
263.
C.
o
to
aferent
aferent
te
and
to
musces
te
o
te
voca
recurrent
87–89;
ods
woud
aryngea
ABR/McM
resut
nerve.
49
aryngea
(except
tensor
uvua
ve
woud
paatn).
devate
rom
te
sde
by
aryngea
nerve,
motor
crcoparyngeus
889,
he
te
te
he
and
he
te
n
te
gag
o
te
vagus
nerve
s
most
te
nerve.
a
vagus
to
paatogossus
branc
nerve,
te
o
supe-
tat
pro-
crcotyrod
musces.
provdes
sensory
nnervaton
ace.
1003;
ace.
on
nerve
N
137;
trgemna
and
te
or
nnervaton
trgemna
te
nvoved
nnervates
rom
he
eferent
A.
ony
s
except
and
ect
B
nerve
nnervated
ror
ton
te
s
nerve
mb.
muscuature
externa
ary,
rom
aferent
he
GAS
branc
te
ypogossa
vdes
84
externa
suppes
sensaton
as
wc
nerves,
to
nerve,
gossoparyngea
relex
wc
nerve.
te
s
musce
n
and
966–967;
he
It
as
te
tree
optc
D.
s
te
s
s
aca
va
nerve
te
te
trgemna
nerve
sensory
optamc,
was
aferent
(cosng
responsbe
or
and
tryng
mb
nerve
te
nerve
max-
to
(sensa-
and
te
eye).
vson.
abducens
nerves
musces.
pays
relex,
84
major
neuroogst
were
ocuomotor
extraocuar
cornea
te
brances:
aca
nerve
he
s
he
relex
eyeba)
mb
ABR/McM
nerve
mandbuar.
cornea
E.
o
136–137;
te
aganst
bone
roe
and
to
sot
o
smng,
te
atera
nnervate
woud
power u
musce
bone
rom
tongue
mucosa
abduct
1008–1009;
te
a
mandbe.
posteror
A. he vagus nerve s responsbe or motor nnervaton
C.
re-
but
cavty.
eferent
nerve.
aryngea
motor
Inabty
GAS
nerve
atera
s
w
myoyod
yod
he
are
sku
neror
accessory
vagus
trgemna
aryngea
Loss
a
te
It
ceek
masseter
E.
enters
nnervatng
mastcaton
by
responsbe
E.
te
pays
relex.
oroparyngea
externa
musce
mb
arynx.
N
and
he
te
ten-
musces
posteror
nearest
o
ts
or
49
trapezus
he
taut
reduce
ABR/McM
nerve,
responsbe
885–886,
he
coud
aferent
symptoms.
orgnates
because
te
yod
ora
tem
nerve.
te
he
crcoaryte-
brngng
voca
musces
and
magnum.
gossoparyngea
259.
66,
musces
wstng,
nates
adjust
91–93;
vestbuococear
he
on
buccnator
te
baance.
D.
N
musce
Patents
and
press
136;
respectvey.
C.
te
oter
damage
te
symptoms.
Grndng
mandbe
he
superor
ponaton.
N
te
nerves,
te
cords.
accessory
888–890;
ntates
son
s
o
neck.
82,
arytenod
cords
he
accessory
E.
A,
te
oramen
ebear
A,
by
te
80,
tyroarytenod
1050–1051;
te
n
posteror
Sternocedomastod
va
GAS
te
aryngea
brances
72,
voca
Crcotyrod
supped
258.
o
N
adducts
and
nterna
ound
transverse
ponaton
GAS
are
te
apposton
son
and
nterna
890–891;
musce
E.
D.
and
uncton
to
nod
C,
externa
nerve,
877,
o
s
trgemna
tese
nser ts
nerve
t
musce.
externa
aryngea
o
mandbe.
masseter.
nerve
te
te
840–841;
and
tropy
tongue.
to
masseter
te
because
produce
mandbe.
seat.
relex
any
834,
he
bone
pexus
257.
B.
to te styoparyngeus
he
not
duce
55
Gossoparyngea
gag
Damage
o te tonsar ossa ater t passes bend and ten atera
musce,
E.
te
woud
menngea
C. he gossoparyngea nerve s ocated n te ower part
A.
256.
and
duce
a
but
roe
snce
n
te
bot
eferent
eyes
mb
bnk
o
wen
CHAPTER
te
rgt
appear
cornea
to
be
s
stroked,
bot
aca
nerves
A.
An
ntact.
GAS 838, 887, 890; N 97, 132–134, 142; ABR/McM 81
264.
D.
he
te
tyrod
loor
nected
o
to
rogossa
te
te
gand
deveops
prmtve
tongue
duct,
at
wc
as
parynx.
te
a
dvertcuum
It
s
oramen
ten
cecum
degenerates.
It
by
resuts
rom
temporary
B.
An
con-
te
an
n
C.
s
n
B,
te
C,
o
te
pat
E.
o
he
tyrogossa
te
descent
tyrogossa
duct
o
can
te
duct
ead
tyrod
passes
to
a
cystc
gand.
rom
ror
oramen
D.
B.
1007–1008;
he
tmate
pared
N
71,
superor
brances
ABR/McM
C.
nerve
nnervates
responsbe
te
or
adducted
readng
GAS
E.
a
tor
te
nerve,
te
s
wc
abducens
trocear
aneurysm
or
te
and
near
te
te
resut
n
te
and
te
eye
a
beng
n
to
wt
ocuomo-
eye
(done
nerve
abducted
by
te
patent
musces
by
D,
GAS
270.
te
an
tod
(atera
and
eye.
cerebear
s
to
or
because
orbta
musce
te
te
o
ocu-
by
an
poste-
damage
to
anteror
an
bone.
orgnates
part
njur y
o
67
(bow-out)
tendnous
to
o
te
te
te
hs
resutng
n
o
and
te
rectus
te
oss
racture.
te
eyeba.
neror
experence
rom
rng
loor
teters
o
Wt
orbt
an
may
musce
neror
uncton
dpopa
ne-
nserts
wen
by
rectus
o
te
attempt-
gaze.
E.
hese
resutng
musces
racture
or
woud
cause
not
te
be
afected
symptoms
ts
experencng.
927;
N
96;
ABR/McM
C. he area ndcated by te
by
obque).
an
common
bone,
and
s
can
nerve
compressed
ABR/McM
sows
Patents
upward
B,
sensaton
entrapment
o
artery
nerve.
rectus
neror
be
wc
arteres.
te
ragment
A,
cere-
o
trocear
adducted
can
cerebe-
eye.
compresson
superor
150–152;
racture,
musce
artery
(nnervated
ts
te
ng
obque
o
part
te
451
Neck
nerve,
cerebear
te
te
o
wc
te
scan
neror
resut
wen
posteror
o
rectus
superor
(superor
s
n
n
abduct
o
and
neror
abducens
superor
resut
nerve,
N
te
to
depress
a
cornea
CT
musce.
basar
extraocuar
Compresson
depressed
vson
s
67
te
orgn
atera
te
t
876;
orbta
downstars.
cerebear
s
ts
hs
wc
wen
proper
In
nerve.
musce,
eyeba
ABR/McM
ocated
o
nerve)
w
and
aows
nnervates
nerve).
te
wakng
ocaton
cerebeum.
trocear
obque
o
149–154;
excepton
te
or
superor
hs
te
rectus)
N
et
arteres.
wt
hs
aneurysm
between
bra
state.
te
te
superor
newspaper
o
to
depresson
869–870;
he
te
parts
cose
to
as
trgemna
he
on
meda
very
artery
269.
te
and
Eac
penu-
ror
traves
artery.
te
nates rom te basar artery and runs ateray to suppy
t
basar
GAS
are
he
superor
te
36
arteres
org-
course,
o
77;
cerebear
te
o
o
anteror
te
nabty
cerebra
Loss
te
compresson
nabty
aneurysm
GAS
mastod
process.
emssary
vens,
oramen
o
sgmod
snus
te
he
necton
wc
tempora
begns
51
arrow s te mastod ces o
key
passed
bone
to
beneat
spread
troug
te
te
va
te
sgmod
mas-
mastod
snus.
he
bone
and
tempora
A, B, C, and D. None o tese oter ocatons descrbe
traves to te juguar oramen, at wc pont t jons te
te
neror
orgn
woud
GAS
B.
not
o
be
te
he
parts
N
nterna
o
ocuomotor
mpcated
869–870;
majorty
te
ts
149–154;
carotd
bood
ncudng
n
te
s
artery
to
cervca,
and
tereore
A.
ABR/McM
te
suppy
nerve
dect.
te
67
tat
bran.
petrous,
petrosa
he
tons
suppes
It
as
acerum,
te
B.
severa
he
to
te
cavern-
he
men
snuses
are
pared
dura
snuses
tat
are
(o
ocated on te atera wa o te spenod bone on eter
acerum.
sde
or
o
o
and
te
C,
nerve
GAS
D,
as
te
asm.
troug
to
not
a
stuated
115;
s
suferng
aneurysm
and
et
n
vsua
o
n
te
rom
artery.
ts
area
eds
n
to
ts
and
part
D.
nerve
eye.
o
an
oter
te
arteres
E.
abducens
snus.
bone.
aneurysm
artery
to
te
compresses
(btempora
te
te
connects
begnnng
te
outer
o
optc
te
a
o
c-
optc
bot
emanopsa).
GAS
271.
C.
above
A.
te
cavernous
spenoda
oramen
reaton
te
te
te
snus,
emssary
ovae,
to
n
wt
and
by
ora-
oramen
mastod
process
vens.
s
ax
petrosa
te
ocated
cerebr
953;
bood
wtn
meets
te
te
dura
mdne
o
N
110,
ocated
part
rom
and
o
te
n
te
te
petro-
tempora
cavernous
ateray
to
dran
snus
nto
114,
are
115;
ocated
ABR/McM
n
te
36
ronta
bone
margn.
snus
te
maxary
s
snus.
snuses
orbta
beow
snus
petrous
backward
maxary
nose
no
receves
ronta
he
ocated
te
te
snus
transverse
te
s
and
te
on
passes
876,
he
It
pexus
rea-
ces.
cerebe.
superor
sucus
and
across
te
he
sa
drect
mastod
ven
emssary
were
or
ven.
any
communcates
as
stragt
ave
and
V esaus),
tentorum
cavernous
hs
he
juguar
not
process
venous
troug
It
te
does
ossa
aca
mastod
mater,
67
superor
bndness
artery
abducens
te
te
arteres
ssure
n
Damage
te
ABR/McM
cerebra
resutng
carotd
compresson
communcatng
An
t.
afect
abduct
N
anteror
nterna
Aneurysms
n
ongtudna
casm,
rgt
are
875;
patent
two
E.
he
woud
abty
resut
tey
869,
anteror
o
and
not
run
carotd
patent’s
he
te
turcca.
nerve
nterna
woud
E.
sea
abducens
te
A,
te
orm
mastod
pterygod
anteror
to
snus
nratempora
brances
cavernous
snus
cavernous
ous, cnod, optamc, and communcatng segments.
te
268.
cause
degeneraton
cecum o te tongue to te stmus o te tyrod gand.
267.
an
omotor
A,
266.
n
Ptoss
o
compresses
aneurysm
aso
ty-
descends
artery
te neck, passng anteror to te yod bone. Incompete
mass
265.
aneurysm
ar
Head
7
s
ceeks
bone.
ocated
and
on
above
te
te
sdes
teet,
o
te
wtn
452
C H A P T E R
B.
7
he
Head
transverse
drans
te
D.
E.
te
nner
cannot
he
etmod
he
part
A.
he
te
and
te
D.
te
te
te
B.
ntma
artery
he
dbuar
teror
skn
ce,
he
o
a
he
deep
to
to
at
s
11,
16,
te
17
te
A,
back
o
te
as
upper
reerred
o
te
upper
n
to
as
te
part
mdde
o
Answers
276.
occpta
and
tempora
o
or
artery
te
te
arse
and
ony
to
pexus
and
severa
o
as
o
and
te
te
op-
GAS
277.
te
branc
nerve,
gand,
te
o
rom
jont
o
atera
anteror
te
te
te
skn
surace
o
o
te
nerve,
skn
nerve,
pos-
aso
overyng
gand,
te
te
and
exter-
porton
occpta
parotd
suppes
part
superor
esser
suppes
te
te
as
aurce.
part
are
not
or
reated
to
depresson
o
82,
n
nerve
133;
te
and
aca
ABR/McM
nterna
vestbuococear
nerve
unatera
remander
83
acoustc
suppes
aca
o
te
orentatons
aca
parayss.
crana
wt
te
nerves
nterna
18,
20;
ABR/McM
58
a
te
we
he
aress
patc
tempora
ossa.
E.
he
not
1074;
N
on
supe-
te
nasa
te
pate
eter
oac-
and
sde
be
key
end
o
compresses
w
not
te
(ormng
ere
sme
are
o
afected.
to
be
vestbuococear,
te
tese
he
afected.
and
aca
proxmty.
remander
sare
46,
composed
spenod
and
he
tempora
base
o
te
spata
130;
o
te
crana
orentatons
ABR/McM
mdde
o
te
arge,
bones
sku
ras,
mastod
part,
zygomatc
part
nerves
wt
te
55
crana
sea
ossa
turcca
depressed
he
855;
s
on
as
te
atera
wc
a
body
parts
on
he
te
pass
he
are
compact
o
n
te
t.
snuses
are
and
tympanc
process.
te
perced
bones
11,
back
by
a
and
arge
are
ound
n
12
(ayer
scap
Inecton
as
snus
n
and
ound
n
te
nner
ts
ayer
can
emssary
cavara,
te
neror
te
dura
te
dpoc
and
te
and
mennges.
wtn
te
o
puruence
sma
te
te
ormed
dran
n
troug
suc
our)
because
marrow-contanng
between
bone.
at
and
tempo-
magnum.
oramna
structures
te
s
ayer
cavty
troug
vens
4,
tssue
crana
vaut
n
bone
sdes
porton,
styod
ronta
ntercavernous
dpoc
ound
area
venous
crana
ous
and
te
squama
ossa.
easy
te
ntracrana
snus
and
at
te
stuated
ABR/McM
danger
o
and
oramen
connectve
nto
A and B.
s
18;
s
sku
etmod
spreads
pass
reac
N
te
te
stuated
petrous
process,
te
crana
oose
are
consst
bone
o
openng,
E.
and
porton,
occpta
anteror
vens,
C.
o
cose
E.
e
tumor
butterly-saped
bood
tta
sense
vagus,
do
part
he
aso
a
n
crbrorm
wc
casm
n
te
ces
ces
was
sde.
scap
or
te
rom
septa
tese
troug
bubs,
and
and
arse
and
o
hereore,
not
897,
GAS
278.
nerves
atera
ga
and
te
te
aur-
tragus
C,
ova
D
pos-
posterory.
o
N
te
are
he
poste-
te
he
te
and
ower
superor
suppy
on
te
aurcuar
suppes
nerve
o
tereore
he
great
o
to
regon
skn
pexus,
he
B.
man-
emergng
59,
te
spata
pass
tract
te
arteres
te
57,
ound
processes
ga.
he
above.
and
anterory
and
skn
o
E.
oactory
centra
nterna
passes
mandbe
and
A.
C.
a
o
nerve)
B,
cavernous
smaer
53,
cause
oactory
mentoned
musces.
te
te
occpta
meatus.
he
te
crsta
corod,
descrbed
tempora
capsue
zygomatcotempora
A.
to
eye.
arses
ndcated
responsbe
aca
can
and
part
nerves
53
parotd
to
of
oter
nerve,
te
branc,
cose
te
rectus
rarey
suppy
te
rom
exts
arteres
membrane.
te
majorty
he
eac
trgemna
cervca
o
te
276–300
nerves,
opta-
scera,
brances
aurce
aurce.
te
are
two,
sare
Smary,
nerve
te
958–960;
crsta
6
bood
retna
te
atter
aurce
o
D,
N
te
and
not
D.
n
arteres.
ramus
skn
7,
o
optc
processes,
te
4,
major
branc
te
arteres
ABR/McM
meatus
over
a
suppy
cary
te
te
arteres
tat
nerves
are
O
cavty.
te
maxary
ntma
te
dstrbutes
te
s
artery
as
o
two
acoustc
o
and
s
suppes
and
promnence
centra
te
ABR/McM
It
and
te
o
B,
GAS
te
he
974–975;
he
do
etmod,
te
cary
o
te
to
C.
musces
process
E.
nerves
nerve.
bone.
nerve
gaze.
GAS
275.
petrous,
mastod
at
aso
most
temporomandbuar
ex
mandbe
skn
It
wtn
te
rse
te
tympanc
cervca
o
ces
te
D,
crana
sku.
ocated
17;
cary
part
te
we
branc
te
ar
between
tempora
ocated
artery
retna
103;
to
C,
occpta
scap.
optc
cary
dvson
deep
acoustc
teror
as
N
nerve
te
s
aurcuotempora
adjacent
na
s
ace.
eye.
to
gves
anteror
as
sma
mastod,
he
te
te
ronta,
13,
artery
It
931;
te
o
ocated
o
and
optamc
ncudng
he
te
te
posteror
snus.
to
s
bone
artery
carotd
rory,
portons.
orms
traves
centra
A,
tory
get
E.
te
ror
N
o
to
and
te
GAS
o
bone
ncude
orms
retna
and
eyeba
he
C.
bone
greater
o
te
ABR/McM
parts
te
bone
conjunctva,
274.
coecton
51;
bone
anterory
tamc
D.
surace.
spenod
posterory.
centra
C,
he
externay.
porton
and
between
961–962;
he
mc
tat
aong
meatus
part
o
spenod
bones
to
bone
te
snus
runs
ceek.
bones
GAS
wtn
and
cranum.
he
A.
a
49,
bone
ower
pareta
sku
273.
venous
snuses
etmod
tympanc
aspect
te
he
E.
N
bone
“ceekbone”
o
dura
occpta
s
s
te
zygomatc
atera
te
papated
mastod
and
a
o
eye.
occpta
he
o
snus
tempora
o
s
snus
wtn
and
sku
B.
be
1063–1068;
squamous,
s
aspect
and
nose
C.
snus
spenoda
GAS
Neck
conluence
he
ocated
272.
and
bones
space.
area
o
outer
sag-
mater.
o
hs
cance-
ayers
o
CHAPTER
D.
he
basa
dran
GAS
279.
C.
874,
he
te
te
878;
aca
and
gves
gand
rom
bucca,
Motor
emerges
to
pared
te
tat
282.
neror:
are
gand.
te
tempora,
T o
A,
Zanzbar
B,
GAS
283.
C,
B.
te
suppes
o
te
bran
D
and
by
(CN
atera
musces
mandbuar
913–915;
he
te
te
ace
cord
we
and
te
te
vertebra
posteror
part
branstem.
he
are
and
spna
o
pter ygo d
and
m as t cat on
d v s on
o
and
te
temp or a s
are
s up p e d
tr ge m na
area
N
bend
squamous
men
s
o
n
margns
te
posteror
mater,
te
spna
o
te
ower
ner ves,
ossa.
te
te
t
wt
s
te
n
he
te
te
roots
oramen
o
occpta
down
tube
te
te
te
B.
CN
C,
sory
I
passes
he
bone
GAS
A.
and
and
C.
o
pass
to
nerve,
rom
nerves
te
N
20,
a
te
It
154;
o
ear
branc
and
to
across
te
11,
te
emerges
E.
ateray
n
tympanc
orms
te
te
nnervate
285.
o
te
esser
te
sur-
branc
and
provdes
te
taste
we
as
B
tongue
o
te
C
and
E.
s
84
te
T aste
D.
o
and
o
nerve
he
te
te
834,
bers
te
by
(CN
vagus
sot
te
he
jugu-
o
ngua
te
ay
corda
mucosa
Snce
as
te
branc
VII).
constrctor
(except
musces
66,
136,
X)
or
o
nner vates
tensor
te
137;
ve
te
paa-
par ynx.
ABR/McM
o
B,
to
te
286.
B.
C,
and
s
cartage
and
te
are
te
s
crcod
ncor-
ocated
cartage
made.
48,
49
nnervaton
branc
nerve
nerve
o
rom
superor
does
not
medates
suppes
we
motor
taste
te
aryn-
nnervate
earng
motor
perormng
suppy
n
not
te
to
bers
and
to
suppy
many
musces
anteror
te
unc-
o
aca
two-trds
sensory
patetc
s
an
ce
ts
nerves
to
o
te
o
o
te
o
taste
te
vertgo,
oss
o
oss
o
o
on
nose,
n
ves-
cose
aso
o
usu-
symp-
baance
and
expresson,
te
cornea
and
tat
eventu-
are
are
aca
sensaton
mout
t
manestaton
anteror
relex
and
and
parayss
mastcaton.
he
oter
and
vestbuococear
N
VIII
nerves
musces
te
cerebeopontne
and
tese
tumor
grows,
te
VII
tongue,
84
nvestng
tumor
subsequent
earng,
49,
ntracrana
seat
porton
nerves
ocaton,
oss
150,
patent
wa
ocatons
154;
o
specuum.
outlow
n
syncope
er
va
te
ater
externa
In
sted
ABR/McM
descrbed
vasovaga
otoscope
As
arge
around
954;
renced
nerve.
wt
o
ABR/McM
Scwann
ts
o
aca
he
137;
parayss
E.
posteror
44,
by
membrane,
optons
ABR/McM
neuroma
mpared
musces
A,
GAS
(CN
perormed
membrane
sensory
nerve
does
92,
a
afected,
sensaton
o
a
s
tyrod
oter
nterna
crana
to
two-trds
gands.
tympan,
and
te
yperacuss,
sensaton
o
N
occupes
proxmty
tonsar
two-trds
te
90;
nerve,
acoustc
rom
ange.
body,
tongue,
te
tongue,
1057;
An
ay
petrosa
tonsar
common
trd
or
ner ve
N
or
anteror
te
paate
840–841;
branc.
conveys
posteror
nnervated
aca
musces
GAS
rom
bers
branc
secretomotor
and
tn)
aferent
ngua
and
tonsar
te
ncson
N
ncudng
nystagmus,
a
va
aca
toms
and
It
procedure
ventaton
musces.
a
branc,
49
arway
crcotyrod
cartage
te
ypogossa
te nerve to te styoparyngeus, paryngea brances,
ngua
te
A
receves
tbuococear
wc
carotd
D.
arses
pontne
nerve,
cosey
epgotts.
GAS
te
anmated
not
arway
obstructon.
crcotyrod
1046;
expresson
obon-
te
are
ABR/McM
mmedate
vestbuococear
he
occpta
rom
sted
emergency
gossoparyngea
he
acces-
61
durng
epgotts.
he
D.
oramen.
compartment
te
and
medua
ABR/McM
traves
of
vagus,
te
juguar
nerve
anteror
gves
o
ateray
te
and
mdde
carotd
sde
run
troug
enter
te
pate
par ts,
baance.
subaracnod
crbrorm
gossoparyngea,
medua
oramen.
suppes
te
seec-
posteror
nerve.
tons
gossoparyngea
te
cstern
ar
arse
890–892;
he
ace
he
tree
and
troug
an
at
tyrod
arynx
nerve
te
bone.
E.
nerves
gata.
1041,
he
accessor y
91–93;
s
E.
te
were
tongue
etmod
B,
ts
he
gea
produce
gaments,
and
musces
between
and
s
space.
A.
D,
because
and
dura
vertebra
o
to
N
ncson
between
A.
gaments
cartage.
C,
vagus
rom
o
s
tyroar y-
voca
musces
voca
ods
te
453
Neck
musce
aryngea
ocated
GAS
284.
o
wc
rect
o
ora-
attaced
sweeps
Wtn
conssts
oter
ensure
an
A,
n er ve
40
bone.
mater
as
spna
39,
magnum
part
dura
medua,
and
traverse
basar
he
34,
occpta
oramen
crana
arteres
oramen
te
te
(basoccput).
te
ABR/McM
te
part
magnum
bone
145;
cases
to
makng
crcod
V3).
GAS
D.
and
E.
te
neck
te
to
te
vocas
te
voca
vocas
1050–1051;
n
suppy
to
anteror
te
Crcotyrotomy
es
meda
he
o
te
he
te
perormed
to
ods.
o
e
atera
and
sngng.
D.
to
A and B. he common carotd artery provdes branc-
artery
voca
and
reated
By
and
reaxng
speec
un
musces
adjustments
respectvey,
zygomatc,
A
te
tvey
he
Car.
musces
281.
vocas
musces
mnute
parotd
cervca.
s
he
wtn
by
styomastod
wtn
brances
5
supped
te
and
E.
tenod
parotd
brances
ve
vens
ABR/McM
rom
mandbuar,
tese
are
Gaen.
113;
troug
superor
or
o
expresson
major
margna
mnemonc
111,
wc
ve
ven
aca
passes
of
Rosenta
10,
o
nerve,
nerve
o
great
N
musces
oramen
280.
vens
nto
Head
7
ts
te
vagus
not
reated
61
queston
as
stmuaton
acoustc
orm
are
nerves.
o
meatus
syncope,
nerve
(CN
expe-
o
te
by
an
parasym-
X)
eads
to
454
C H A P T E R
7
decreased
o
te
sma
Head
puse
te
o
nnervated
nerve
surace
te
te
ts
te
pressure.
meatus
o
te
externa
porton
va
o
bood
branc
te
by
Neck
acoustc
aurcuar
externa
na
and
externa
remander
and
o
vagus
nerve.
nerve
(CN
o
te
s
IX)
ts
musces.
s
o
GAS
D.
nner
carotd
o
te
te
945;
artery,
137;
artery,
ABR/McM
tyrod
and
te
tyrocervca
tyrod
rod
N
superor
and
artery,
neror
trunk,
tympanc
ng
tyrod
tyrod
ven,
artery,
te
gands.
te
bood
he
and
externa
a
suppy
externa
to
rovascuar
gand
and
externa
cose
to
durng
GAS
288.
D.
trad
tat
atera
branc
te
o
superor
basar
two
at
te
ten
juncton
neror
be
GAS
289.
B.
he
are
artery,
I
t
s
te
Because
rsk
ts
III).
VI)
posteror
brances
te
basar
te
ocuomotor
150,
s
passes
te
154;
between
rse
vdua
beng
afected
eye
outward
rectus
meda
ocaton
crana
obque
a
te
te
s
te
te
down
eye
te
n
w
t
s
sxt
comparson
downward
musce
(nnervated
nerve)
rectus,
s
not
neror
o
D.
te
o
te
tongue
GAS
293.
C.
patent
Presentatons
rectus,
and
or
te
ack
nratempora
152,
ossa
154;
s
a
ABR/McM
67,
wedge-saped
It s ocated neror to te tempora ossa and
68
regon.
between
varety
nvoved.
postsynap-
be
nner-
afected
nratempora
o
afected.
te
and
te
p
and
te
he
and
dvde
p
o
cn
mar-
and
Compresson
correspondng
ex
over
s
wc
ascends
externa
membrane,
te
because
nerve,
and
te
bucca
mout),
aurcuotempora
tympanc
tempora
sensaton
gand
te
musces),
musces),
afects
anteror
o
cervcoa-
nto
musce).
suppyng
passng
musces),
corner
Pan
parotd
trunk
supraorbta
and
parotd
te
o
nerves
just
acoustc
and
arge
o
54,
53,
145;
are
brances
nerve.
o
59;
rm
o
te
s
pan
o
tat
bucca
mandbuar
branc
brances
provde
two-trds
adjacent
sen-
o
gums,
te
ceek
44
nvoved
a
brusng
up
o
around
cause
to
te
rm.
te
oten
te
eyes.
anosma,
damage
troug
te
“step-of”
ractures
may
due
racture,
bony
ossa
pate
sme,
pass
te
papaton
crana
and
n
papabe
wt
crbrorm
sense
40
skn.
rnorrea
nerves
39,
and
anteror
ABR/McM
anteror
te
ngua
te
sensaton),
N
o
o
hese
te
ABR/McM
te
to
te
crbrorm
pate.
GAS
294.
A.
885,
he
wtn
150,
CSF
oactory
te
neror
are
compan
racture
gand,
upper
at
demonstrate
and
ourt
by
te
nvov-
a
9
brances
overyng
he
A
te
ngua,
gand
w
umen
urter
nvoved
orbta
may
ncude
by
and
he
parayzed
o
mucosa
te
atera
antagonzed
n
te
unctons.
ear,
N
974–977;
I
and
te
(genera
mucosa,
te
nd-
because
te
gand
(patysma
o
nerves
to
wc
te
man-
tempe.
wc
te
s
ossa.
te
str uctures
temporoaca
ten
te
trgemna
saton
nto
tragus,
te
913–915;
he
nerve),
to
ocaton
te
poston.
because
crana
n
normay.
out
o
surace
te
nerves,
arteres
o
to
n
(ower
ter
troug
o
GAS
cerebear
Bot
resut
area
ocuomo-
aneurysm
eye
and
a
compresson
meatus,
68
at
brances
wt
parotd
ner ves
be
musces
brances
anteror
292.
67,
te
ts
T umors
carres
or
parotd
can
(orbta
and
or
passes
can
sde,
te
ts
oreead,
mandbuar
any
o
nearby
rgt
superor
An
o
ante-
eye.
on
n
aveoar,
present
ABR/McM
wc
tempe,
p
cervca
musce,
a
te
dvdes
dvsons,
gna
arteres.
musces.
N
nerve
(upper
artery
nerve
by
o
pterygod
and
ncude
ner ves.
ner ve
mass
gand
aurce,
rgt
(above).
hs
move
te
tone
superor
869–870;
he
to
by
trocear
te
anteror
rectus
wa
meda
ound
ossa
ossa
o
dstended
pontomedu-
anteroateray
artery.
pasy.
n
o
he
obque
or
parayzed
D.
musce
rectus.
superor
290.
be
(nnervated
mantans
GAS
unabe
w
and
te
and
ABR/McM
te
arteres
gves
te
te
pexus
neror
bers
82–85;
o
musces
o
on
te
N
abducens
between
atera
occurs
o
te
abyrntne
mdbran
basar
he
compressed
152,
and
at
uncton
emergng
pons
nerve
961;
zygomatc
PCA coud resut n compresson o te nerve and ead
to
ca
vertebra
At
te
dependng
to
and
aso
tympan
secretons
Because
aca
njury
cerebear
artery.
te
abducton
te
so
troug
49
two
artery
neror
te
hs
nerve
48,
te
branstem.
ound
and
suppes
cerebra
o
by
emerges
usuay
nerve
It
o
te
condton
N
E.
duct
courses
o
corda
compresson
GAS
291.
tyrod
nerve
at
ABR/McM
part
eyes.
weak
te
92;
anteror
s
te
crana
(CN
and
aryngea
abyrntne
te
n
o
te
nerve
869–870;
juncton
tor
cartage.
ormed
juncton,
and
abducts
resut
s
cerebear
mpared
can
to
are
aurcuotempora
(suppes
87,
nerve
abducens
aneurysm.
N
te
(crana
ror
wc
tyrod
neror
brances:
and
ary
he
tyrod
superor
artery
pontomeduary
nerve
te
te
1050–1051;
he
rst
to
superor
and
ossa.
tyrodectomy.
arteres
to
orgnates
atera
venous
troug
parasympatetc
by
branc
o te superor aryngea nerve course togeter n a neu-
artery
nratempora
vaton,
ty-
and
pterygod
symptoms
tc
branc
superor
ateray
aurcuotempora,
and
te
he
o
masseter,
he
passng
bucca,
84
branc
provde
paratyrod
superor
a
mandbe
maxary
dbuar,
by
o
838,
he
te
Ner ves
branc.
287.
te
temporas,
nnervated
va
o
te
trgem-
he
ramus
parynx meday. he contents o te ossa ncude te
ncudng
branc.
membrane
o
te
te
membrane,
dvson
aurcuotempora
part
by
Most
meatus,
tympanc
mandbuar
gossoparyngea
posteror
nnervated
acoustc
te
tympanc
he
s
1061,
nerves
te
1074;
tat
N
18,
contro
zygomatc
nerve,
46,
130;
acrma
rom
te
ABR/McM
secreton
maxary
12
pass
nerve
and te pterygopaatne gangon, troug te neror
orbta
greater
ssure,
wng
wc
o
te
s
ound
spenod
n
te
and
orbt
te
between
orbta
te
surace
CHAPTER
o
te
maxa.
afected
by
abducens
o
te
part
are
E
295.
A.
te
process
god
B.
A,
E.
and
C,
te
D,
N
E.
o
he
aca
gangon,
te
deep
E.
he
troug
te
and
984;
nerves
te
orbt
and
N
te
tat
wng
contro
orbta
te
o
te
12
to
as
are
te
(Vdan
greater
be
a-
do
Fg.
bers
A,
ner ve,
o
s
bers
te
987;
te
was
te
N
te
afected
te
n
20,
63,
te
were
or
te
oter
patent
trapped
B.
sde
o
by
to
BP
te
26,
te
te
pass
to
t
damage
133;
E.
to
Deep
parta
ower
to
te
An
to
te
superor
superor
obque
cana
bone.
11
because
te
n
o
dam-
neror
transmt
nerve
secreto-
woud
a
damaged
obque
superomeday
n
nabty
ts
not
nerve
musce
s
to
produce
damage
carotid
and
obque
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
te
an
resut
musce.
musce
tereore
w
w
ner ve
Sympathetic
w
he
tse
not
be
patent.
Geniculate
ner ve
petrosal
resuts
and
and
Inter nal
GAS
aca
orbt.
]
•
te
aca
resutng
ptoss
eyed
]
nerves
aso
tese
pass.
eter
neror
upper
1
of
are
sted.
ner ve
Zygomatic
Parasympathetic
te
ABR/McM
wtn
gand
rom
te
or
te
Greater
branch
o
te
bone,
tat
gland
of
ace
tempora
zygomatc
symptoms
te
damage
damaged
maxa
Ner ve
n
Inabty to depress te adducted eyeba w resut
run
n
[V
n
orbt
nerves
acrma
sufers
sympatetc
[V
te
and
ter
because
brances
runnng
to
ocated
te
decent
zygomatc
te
musce;
Compete
nerve
bone.
[V
because
cana
mpnged
dstorted
Damage
te
rom
Lacrimal
o
bone.
or
racture
structures
bers
aca
rgt
key
to
key
Inter nal Lacrimal
o
ssure,
he
a
rom
D.
25
ound
n
tempora
nnervated
racture
nabty
synapse
secreton
wc
key
two-trds
submandbuar
deectve.
8.157A).
ABR/McM
surace
spenod
C.
or
pter ygopa-
not
te
455
Neck
GAS 927, 986; N 61, 63, 96, BP 26; ABR/McM 11, 52
299.
( Vdan
petrosa
acrma
orbta
to
motor
artery,
sympatetc
ssure,
983,
he
o
are
resut
orbta
cana).
cana
te
wc
63;
D.
age
te
te
wc
A, B. C. E.
cana
( GAS
a
GAS
298.
rgt.
not
anteror
rom
compromsed
nerve,
ptery-
on
te
te
were
nerve
o
Movements
resut
n
aca
musces
ee-
mandbe,
woud
cana
gands
proxmty,
jaw
rom
secretons
part
key
coronod
parasympatetc
62,
te
petrous
55
synapse
gangon
neror
jons
weaken
meda
te
pter ygod
ner ve,
61,
D,
ramus.
te
to
o
te
T aste
and
and
nerve sgnas are carred by te corda tympan, wc
tey
jaw
pterygod
te
postsynaptc
46,
between
greater
te
to
and
sensaton
va
on
petrosa
pter ygopaatne
982,
o
woud
D.
subngua
jaw.
pterygod
o
C,
as
11,
poweru
atera
pterygod
ner ve
go
ramus
te
presynaptc
eventuay
rom
te
te
B,
C,
tongue
B.
most
ABR/McM
ner ve
contans
te
82;
troug
nerve
te
o
A,
mdde
njury
ABR/McM
eevators
devaton
and
be
he
dvsons
te
optons
te
Masseter
two
o
n
o
not
orbt.
and
troug
attaces
eevate
r a c t u re
atne
GAS
te
musce,
acton
cause
975–977;
wc
n
snce
to
Sa va t o n
by
ner ve)
297.
uncton
woud
133;
mandbuar
jaw,
te
orbt.
26,
oter
Coursng
rom
te
racture.
D,
ven,
o
BP
te
ected
296.
63,
woud
o
nerve,
pass
resuts
te
Unopposed
GAS
wc
temporas
st
nerve
apex
consequences
above
et
C,
a
musces,
coud
te
nasocary
nerve
te
te
near
apex
20,
o
o
te
te
N
Fracture
vator,
key
to
923;
zygomatc
te
ssure,
beng
eevaton
B.
nerve,
coser
GAS
he
racture
ocuomotor
o
and
a
Head
7
from
T1
ganglion
resut
ony
rom
resut
para-
rom
456
C H A P T E R
7
Head
and
Neck
Ner ve
of
pter ygoid
canal
A.
Faure
ace Inferior
orbital
Pter ygopalatine
eye
Faed
n
D.
I
to
to
dferentate
nduce
resuts
n
te
sur-
aure
o
orm.
obteraton
E.
I
303.
N
102;
B.
he
te
optc
te
te
ace
ens
etmod
Preganglionic
parasympathetic
nerves
Postganglionic
parasympathetic
nerves
nasa
Preganglionic
sympathetic
ner ves
Postganglionic
sympathetic
ner ves
te
space
resuts
pgmented
and
meatus
by
te
paranasa
separate
cavtes
are
here
nto
w
groups
are
te
te
and
deveopng
rom
not
way
o
te
sur-
orm.
snuses
nto
tract
meatus),
te
at
te
mdde
nectons
cavty,
n
ces:
nundbuum
spread
nasa
o
meatus
nto
etmod
te
ocated
nasa
nasa
(dran
can
ces
groups
superor
te
hs
o
tree
mdde
anteror
atus).
respratory
te
entrey.
41
nto
bua),
overap
orm
not
eye
snuses
(dran
(dran
semunar
upper
ntraretna
not
to
does
te
bone.
te
a
vesce
ABR/McM
etmod
te
between
does
w
etmod
posteror
nerve
cup
rs
ectoderm,
mdde
o
separaton
ayers.
te
ens,
Fig.
to
retna
neura
GAS
neuroectoderm
fossa
B.
•
te
fissure
te
Infra-orbital
o
ectoderm
at
rom
eadng
to
nectons.
8.157B
A.
he
audtory
tube
runs
rom
te
mdde
ear
to
te
nasoparynx.
damage
te
to
tempora
GAS
300.
A.
927,
he
B.
zygomatc
branc.
929;
N
petrous
mdde
aca
te
pterygopaatne
and
nner
nerve
earng
to
or
Fg.
96;
te
and
as
traveng
ts
rom
ABR/McM
te
52,
bone
aca
53,
54
ouses
cana
wt
D,
te
w
te
D,
E.
ng
oss,
but
not
GAS
he
and
te
1030;
w
produce
not
E.
cause
D.
he
addtona
te
te
ear
nner
ear
pasy
110;
coud
or
or
account
earng
ack
ABR/McM
o
or
oss
te
and
ear-
spenoda
1061;
N
vertgo,
hs
acrmaton.
te
301.
B.
o
ducts
acrma
o
wc
vagus
A.
s
o
he
he
te
esser
aca,
membrane,
gossoparyngea,
aure
and
te
great
aurcuar
jont
and
nerves
305.
externa
947;
nant’s
rom
E.
s
o
suppy
sku
te
bend
responsbe
te
and
tongue
skn
te
or
and
on
te
are
nerve
and
nnervaton
are
not
107;
to
aure
s
taste
to
te
de
to
D.
and
pexus
troug
an
wt
te
o
te
A,
exter-
N
306.
s
57
known
corod
tat
nto
and
rom
te
In
o
ts
grooves
te
oten
te
acr-
sde
o
speno-
wt
p
condton,
te
uson
process
batera
upper
dranng
ubrcates
te
to
te
tears
conjunctva.
o
te
te
mesen-
atera
nasa
as
B.
B,
Cons
63;
Te
coloboma
ssure
to
use.
and
It
g ve
o
te
arc
and
n
a
nasa
prom-
paate,
we
segment
unatera
(cranoaca
caracterzed
mandbe,
deects
o
wt
cet
p.
dysosto-
by
maar
downward
te
abnormates
syndrome
to
mgrate
week
ower
o
te
eye-
md-
o
s
because
nto
te
o
rst
aure
arc
o
dur-
deveopment.
not
seen
n
ts
case.
16
c e re b e a r
te
atera
bood
dsorder
cetng
superor
b e o re
passes
resuts
ssures,
ces
ourt
Faca
and
ears.
rst
crest
meda
p
ntermaxary
syndrome
ears,
ABR/McM
datey
te
underdeveoped
a
te
E.
o
cet
16
autosoma
s
te
processes
nterna
hs
uson
medan
o
externa
and
o
a
papebra
and
ng
te
n
uson
T reacer
ds
sensaton
tympanc
assocated
ABR/McM
condton
te
atera
5
rare
orbt.
open
aure
ABR/McM
santng
ear.
meatus.
N
o
neura
petrosa
drans
are
te
maxary
resuts
maxary
31;
ss)
ear.
acoustc
944,
resuts
tympan
autonomc
ear
nerves
te
two-trds
esser
mdde
he
o
snus
extend
ake
rom
te
ypopasa,
occpta
aspect
mdde
he
na
and
temporomandbuar
corda
carry
C.
tympanc
N
te
anteror
302.
te
respectvey.
he
GAS
te
n
aurcuotempora
posteror
E.
by
s
nerves.
ear,
D.
damage
supped
suppy
C.
nences
area
drans
te
process.
301–308
he
on
ABR/McM
tat
A, B, C. E. Faure
Answers
ndrecty
ocated
cets
margn
resuts
cyme
57
43–44;
aca
anomaes
meda
rom
s
recess.
Obque
aca
duct
wc
orbt.
nasoacrma
mdde
aca
N
gand,
GAS
symptoms.
C,
nasoacrma
ma
etmoda
304.
ossa
he
te
t.
but
C.
zygomatco-
8.157B).
nratempora
vertgo
or
tempora
troug
te
oss
26,
o
ear
passng
Damage
(GAS
BP
part
nerve,
gangon,
ar ter y
termnaton
b e ow
suppy
to
c e re b e u m .
te
te
An
o
orgnates
te
basar
ocuomotor
anteror
and
aneur ysm
o
mme-
a r t e r y.
n e r ve
meda
te
to
par ts
superor
CHAPTER
c e re b e a r
p a s y.
te
car y
ng
n
ors
o
ar ter y
Ts
and
e ye
(abducton)
A,
C,
cause
D,
GAS
C.
o
o
n
o
age
B,
tat
no
te
D,
o
ts
ng
In
baby
n
adducton,
s
abor.
an
super-
atera
rues
o
devaton
a
ng
and
nerve
woud
compete,
not
308.
C.
low
154;
caused
ts
te
was
o
te
nant
apped
because
However,
tat
Communcatng
reabsorpton
arac-
dran-
te
864;
hs
N
ventrces
cesarean
secton
ydrocepaus,
Some
Juus
s
s
o
te
te
peope
Caesar
moter
probaby
was
te
bodes
hese
tey
o
o
bers
are
appetzng
A.
B.
dev-
dur-
apocrypa.
to
e
Juus
a
o
to
a
seres
tese
woman
te
Caesar
ssued
One
mdwe)
s
ABR/McM
gustatory
s
n
attempt
moter
tat
parotd
gand
rues
abor
devery
ded
dur-
caed
Frey
72
aso
was
nnervated
gand
nerves,
61,
sweatng,
parotd
nerves
trave
were
wc
gands
tat
ood
removed,
te
cut,
are
te
ganduar
but
ocated
n
ts
n
epteum.
te
case),
skn
o
nduce
te
n
nerve
te
te
nerve,
he
otc
occurs
cary
and
cosest
ace.
savaton
sweatng
contros
pupae
mucous
aurcuotempora
normay
gangon
Under
(seeng
nstead.
musce
and
musce.
gangon
secreton
o
contros
nasa
acrmaton
cavtes
and
para-
snuses.
Submandbuar
submandbuar
E.
te
ganduar
Pterygopaatne
nasa
D.
wt
out”
sweat
Cary
and
tnk
ded
as
tose
crcumstances
n
term
a
mmedatey
Wen
“sougt
gands
act
s
codes.
attendng
111–113;
patent
spncter
atoug
Cesarean
to
wen
Neck
gangon, were undamaged and abe to regenerate bers.
system.
by
story
o
or
a
ater
or
te
nterestng.
ncson
cere-
o
venous
te
te
be
responsbe
Incdentay,
or
n
can
tat
Empre,
and
cdbrt.
syndrome.
ce
s
Roman
equvaent
vabe
epteum
reabsorpton,
unctonng
devered
s
CSF .
are
hs
bockage
mpared
condton,
dated.
an
by
68
accumuaton
bran.
mpared
abnorma
nto
te
(oten
wc
ABR/McM
te
somebody
(probaby
re c t u s
expanaton
o
caed
requred
musces
atera
abnorma
o
Syvus),
secton”
troug
152,
s
responsbe
term
ered
CSF
E.
“cesarean
te
te
ocuomotor
producton
s
o
become
way
extrnsc
o
o
key
emperor
GAS
to
150,
granuatons,
bran
te
re s u t n g
ventrces
excessve
because
o
and
re s u t -
papebrae
more
was
e ye .
abnorma
ydrocepaus
nod
e va t o r
e xc e p t o n
not
N
te
aqueduct
CSF
constrctor
A
to
postgangonc
869–870;
rarey,
n e r ve
ptoss.
CSF
bra
te
Damage
Hydrocepaus
because
A,
te
ocuomotor
parasympatetcs
pupar y
obque,
E.
n
te
ptoss,
te
abducton,
parta,
307.
n
wt
superor
and
vson,
re s u t n g
re s u t
aect
body
burr y
te
woud
w
Head
7
Superor
gangon
and
savator y
parasympatetc
ner ve.
contros
subngua
nuceus
bers
tat
savaton
savary
contans
are
rom
gands.
presynaptc
carred
by
aca
457
8 Neuroanatomy
Q u e st i o n s
1.
A
28-year-od
ment
40
veice
coision.
patent
s
Pysca
ace
and
tere
s
wc
key
aert
njures
o
be
te
Loss
o
trd
o
C.
Devaton
D.
Loss
E.
Loss
o
a
te
o
te
in
unrestrained
to
pace
severa
te
sku
racture
nerve
emergency
invoved
at
driver.
person
sows
ndngs
he
te
te
max-
te
I
taste
on
te
te
sensaton
to
toward
te
te
ower
eyed,
aferent
man
by
s
nsde
to
and
(CT)
o
scan
o
te
bood
oowng
ouse
pace,
to
a
1
he
te
cnca
rgt
A
s
Hs
mm
pup
a
typca
D.
Meda
ongtudna
E.
Cerebra
and
B.
Let
C.
Let
Let
upper
ower
o
8-year-od
a
moter
says
eadace
vomted
no
awake
puse
37.1°C
mn,
tat
458
te
t
tred
te
s
pyscan’s
s-
ed.
and
bot
98/
puse
s
Se
s
eyes
aert.
nds
t
wc
responsbe
o
or
mdbran
s
brougt
2-mont
Her
te
to
n
te
te
pons
ew
cecks
pyscan
story
scoo
past
nger
abe
to
durng
structures
o
by
monts.
ave
Her
been
er
par-
eadaces
perormance
s
te
most
n
er
track
“H
key
et
te
as
and
been
growt
norma.
test.”
ower
and
Pysca
Wc
afected
n
n
te
pareta
devates
B.
Optc
radaton
n
te
tempora
tomograpy
C.
Optc
nerve
D.
Optc
tract
E.
Optc
casm
co-
ts
o
patent’s
5.
A
62-year-od
by
s
man
we
s
brougt
because
o
to
o
ts
radaton
Wc
tempora
pyscan’s
Optc
wt
macuar
to
te
pyscan
e
2
wakes
te
Pysca
to
because
Hs
day.
He
Hs
o
mm
Hg.
are
he
examnaton
mantan
s
a
as
temperature
respratons
120/70
dicut
up
entre
days.
because
eadaces.
he
swaowng.
et
80/mn,
s
conrms
to
ndngs?
A.
ton
persstent
asts
past
pressure
but
patent
days
typcay
over
bood
o
key
tumor
nger
te
vsua
usng
oowng
patent?
obe
obe
te
emergency
numbness
and
depart-
tngng
on
te et sde o s ace and over s rgt upper and ower
brougt
most
(98.8°F),
and
appears
and
s
a
Bopsy
Damage
Pysca
obe.
emanopsa
story
are
sows
te
as
rom
quadrantanopsa
boy
s
He
examnaton sows tat te patent s unabe to denty
t)
quadrantanopsa
tat
twce
over
extremtes.
4-mont
ossa.
asccuus
a
we-cd
soundng
Let
ead
ne.
II–XII
emergency
sparng
E.
te
stragt
nerves
(7
anopsa
D.
o
probems.
prevous
emanopsa
omonymous
gr
because
vson
crana
n
a
aqueduct
7-year-od
ment
Btempora
An
A
te
examnaton
pyramds
condton?
A.
pysca
emnscus
ents
o
structures
Meda
ceek
tat
o
bran
Meduary
one
n
crana
meduobastoma.
C.
bconvex-saped
tempora
posteror
o
and
scan
B.
njury
Hg.
computed
sows
s
He
patent
person.
rgt
sgns
ago.
m
CT
most
reex
te
2.13
100/85
rgt.
ead
n
nto
our
and
s
cornea
ang
dated
te
te
brougt
ater
pressure
sows
and
s
o
condtons.
tme,
downward
mb
we
ter
bood
examnaton
patent’s
decnng
te
te
oowng
ts
A
verms
posteror
o
n
ee-to-toe
Cerebear
woud
sde
ntact.
dagnoss
wak
probems
A.
4.
tongue
to
vson
ovae,
tongue
o
medca
orented
3.
ocated
reex
and
asked
no
grossy
te
ovae.
oramen
as
ony.
on
mnor
oramen
te
wen
motor
abrasons
te
wtn
cnca
and
depart-
a
p
o
scafod
te
x-ray
jerk
31-year-od
ecton
te
sows
sensaton
department
mn
to
was
orented
oowng
jaw
o
upper
o
was
and
to
e
seen?
B.
tory
He
An
njury
Loss
a
brougt
ater
and
cest.
A.
A
is
examnaton
oaca
2.
man
minutes
more
sows
pup
a
s
oarse
as
we
tan
nondstressed
voce
Pysca
wt
parta
avng
s
norma.
man
wt
been
says
an
dicuty
as
ataxc
droopng
been
examna-
gat,
o
te
te
eye-
d, and tere s a oss o te gag reex. here s decreased
sensory
and
pan
sensaton
on
te
et
sde
o
te
ace,
and rgt sde upper and ower extremtes. Wc o te
oowng
arteres
A.
Anteror
16/
B.
Posteror
boy
C.
Anteror
D.
Mdde
E.
Basar
sows
aso
patent’s
constrcted
s
baance
patent
he
woud
spna
neror
neror
cerebra
artery
most
key
be
occuded?
artery
cerebear
cerebear
artery
artery
artery
(MCA)
(PICA)
(AICA)
CHAPTER
6.
A 65-year-od man comes to te emergency department
by
because
te
He
o
as
never
a
a
istory
been
incude
severe
tis
type
day.
His
mm
He
n
entre
s
te
ower
mb
ead
and
sows
Injury
key
an
area
Anteror
B.
Mdde
o
ts
cerebra
cerebra
artery
artery
Posteror
cerebra
communcatng
E.
Basar
2
wt
a
3
a
on
man
pack
mm
ng
redness
tssue
wtn
access
te
D.
V entromeda
E.
Latera
beers
150/90
et
eg
n
s
sensaton
Hs
s
n
vson
CT
scan
rgt
9.
and
Fronta
6-week
o
er
and
ron-
probems
and
Hs
te
day
and
bood
bend
te
externa
cnca
acoustc
pcture
parencyma
s
usng
Externa
D.
Interna
Pareta
E.
A
o
Se
vsua
a
tumor
te
s
a
a
eds
Meda
gencuate
nuceus
o
te
taamus
10.
s
56-year-od
department
durng
→
Interna
→
ear
Interna
→
→
ear
Interna
Externa
woman
story
no
Etmod
→
ear
ear
a
and
weeks.
day
he
o
he
a
→
te
A
sea
A
tube
Mastod
ces
Maxary
snus
scan
te
Hg,
and
ead
s
symptoms
te
te
o
brougt
sudden
s
to
evdence
emergency
o
s
a
o
eadace
conused
bood
are
stroke.
aso
te
Se
respratons
woud
taamus
onset
103/mn,
scemc
taamus
te
taamus
mornng.
sows
an
o
a
ts
puse
conrmng
owng
→
A.
→
B.
→
→
n
o
o
s
kg
mpar-
Pysca
tempora
ead
says
Se
symptoms
can
tat
eats
b)
n
be
nto
adenoma
scedued.
(10
sows
extenson
ptutary
patent
4.5
er
te
wt
because
vson
probems.
appette.
ganed
new
and
scan
turcca
te
pyscan
vson
CT
resecton
ncreased
patent’s
te
medca
dagnoss
surgca
as
to
decreased
examnaton,
and
Her
mm
o
o
breakast
156/93
PCA
te
ces
Audtory
→
eadaces
oter
sows
sgncanty
tmes
comes
bateray.
ypotaamus.
made,
er
woman
because
dsorented.
gan
o
A
o
nuceus
nuceus
sensory
structures?
16/mn.
A
occuson
Wc
present
and
pressure
o
durng
s
CT
o
te
te
o-
pysca
Contraatera
parayss
and
oss
o
sensaton
o
te
extremtes
Broca
apasa
sensaton
C.
Contraatera
D.
CN
E.
Quadrpega
IV
wt
to
te
contraatera
ace
and
emanopsa
parayss
upper
wt
and
oss
extremtes
macuar
sparng
pasy
wt
oss
o
aca,
tongue,
and
mout
movements
wtn
oow-up
symptoms.
V entra
atera
nuceus
er
examnaton?
→
as
examnaton
oowng
er
o
Lgty
provdes
E.
to
11.
A newborn gr s beng evauated n te neonata nten-
sve
4-mont
ects
patent
D.
2
Interna ear → Externa ear → Fronta snus → Fronta
ment.
te
drnk
Inspecton
taamus
obe
44-year-od
sde
ts
day
and
16/mn
asymmetry.
te
obe
8.
o
rgt
n
Hg.
or
o
obe
ear
wc
mm
rases,
or
are
nuceus
o
ear
T empora
te
respratons
sec-
yperten-
smoke
gencuate
Cerebeum
C.
on
nerve
ncude
not
te
teet,
Latera
ower
ear
ace
er
C.
meatus.
wc
nto
s140/90
severa
type
swe-
to
te
afected
does
sde
stabbng
durng
brusng
76/mn,
esons,
asts
because
rgt
posteroatera
granua-
key
no
tat
te
sarp,
ponts
probems
Se
n
severe,
jaw
cewng,
s
pressure
a
mutpe
medca
puse
as
pyscan
pan
posteromeda
Otoscopc
and
wt
t
and
at
osteoartrts.
Her
te
V entra
39.1°C
sows
ceek
occurs
oter
to
V entra
pressure
ear.
dranage
s
comes
ntermttent
B.
drnks
temperature
and
puruent
ts
a
nuceus
A.
ypercoesteroema.
durng
nuceus
rgt
ncude
examnaton
area
depart-
severe
Her
sows
he
and
rgt
pan
bood
tappng
o
descrbes
worsened
and
ace
emergency
structures
nuceus
woman
Se
er
acoo.
obe
Externa
s
son
condton?
oowng
nuceus
ypotaamc
story
he
smng.
woud
te
nuceus
ace.
n
onds.
o
o
ypotaamc
51-year-od
o
and
ever
cgarettes
te
bran
ear
A
pan
s
routes?
Externa
B.
a
3
is
arteres
current
te
o
101/mn
sows
causng
A.
to
Pysca
o
patogen
to
Anteror
artery
medca
o
s
Hg.
examnaton
oowng
comes
weekends.
puse
128/80
ton
C.
as
(PCA)
stor y
oter
te
(102.5°F),
and
artery
ypertenson,
smokes
beers
a
He
nput
4-day
Hs
dabetes,
He
Posteror
artery
68-year-od
pan.
Supracasmatc
B.
(ACA)
Posteror
ear
n
wc
A.
to
A
to
procedure?
ave
(MCA)
D.
ment
ntact.
damage
probems
sensaton
sensory
ago.
Neuroogic
is
oowng
patent’s
C.
A
in
bateray.
are
te
2
oriented.
ypodensty
o
tey
pressure
3/5
and
5/5
II–XII
wc
expan
A.
was
but
drinks
decreased
Motor
ace
CNs
to
and
and
a
ours
medica
bood
strengt
s
2
ypertension.
and
here
mb.
and
oter
and
aert
is
started
eadaces,
istory
awake,
eg.
tat
His
110/min
sows
mpared
most
7.
et
obe.
is
rgt
upper
not
ta
s
diabetes
is
examination
5/5
tension
smoking
puse
Hg.
o
intense.
2
25-pack-year
eadace
459
Neuroanatomy
8
care
devered
od
he
mm
g).
Hg.
at
he
sezures.
weeks’
devery
necesstatng
weged
Puse
30
s
Pysca
2100
180/mn
g
he
gestaton
was
patent
to
a
compcated
orceps-asssted
at
and
examnaton
brt
(ow
bood
sows
an
by
devery.
brt
pressure
was
22-year-
wegt
s
60/40
rrtabe
nant
wt bugng ontanees. Imagng o te bran conrms
patent
past
new-onset
ago
abor
patent