Topic 33. Spinal nerves. Cervical plexus. A. Theoretical questions for the self-check: 1. Formation of the cervical plexus. 2. Topography of the cervical plexus. 3. Classification of branches of the cervical plexus. 4. Skin branches of the cervical plexus, their topography and innervation zone. 5. Muscle branches of the cervical plexus, their topography and innervation zone. 6. Mixed branch of the cervical plexus: phrenic nerve, its topography and the innervation zone. B. Situational tasks. 1. What nerve is mixed branch of cervical plexus? A. Phrenic nerve B. Lesser occipital nerve C. Great auricular nerve D. Supraclavicular nerves E. Suboccipital nerves 2. What anatomical structures form a spinal nerve? A. Posterior funiculus of spinal cord B. Lateral funiculus of spinal cord C. Anterior and posterior roots of spinal cord D. Posterior horn of spinal cord E. Anterior funiculus of spinal cord 3. What anatomical structures form the elementary reflex arch? A. Afferent neuron, intermediate neuron, efferent neuron B. Anterior root of the spinal nerve C. Conductor neuron D. Efferent neuron E. Central nucleus 4. Indicate anatomical structures relating to peripheral nervous system A. Cranial nerves B. Pons C. Mesencephalon D. Medulla oblongata E. Spinal cord 5. Indicate nervous fibres in spinal nerves. A. Postganglionic parasympathetic B. Sensory, motor, postganglionic sympathetic C. Preganglionic sympathetic D. Cranial nerves E. Anterior root of the spinal cord 6. Indicate anatomical structure, supplied by posterior branches of spinal nerves. A. Deep muscles of back B. Skin of the occipital region C. Superficial muscles of neck D. Infrahyoid muscles of the neck E. Scalene muscles 7. Indicate spinal nerves, having white communicating branches. A. Thoracic nerves B. Cervical nerves C. Coccygeal nerves D. Sacral nerves E. Lumbar nerves 8. Indicate sites of passage of greater occipital nerve? A. Foramen magnum B. Between occipital bone and atlas C. Between atlas and axis D. Through deltoid E. Interscalenal space 9. Indicate anatomical structures, innervated by transverse cervical nerve. A. Trapezius B. Sternocleidomastoid C. Skin of anterior and lateral cervical regions D. Skin of posterior cervical region E. Deltoid 10. These are cutaneous branches of cervical plexus, EXEPT. A. Great auricular nerve B. Transverse cervical nerve C. Lesser occipital nerve D. Supraclavicular nerve E. Cervical ansa Cervical plexus Topic 34. Brachial plexus. Intercostal nerves. A. Theoretical questions for the self-check: 1. Formation of the brachial plexus. 2. The structure of the brachial plexus, trunks and their topography. 3. Classification of the nerves originating from the brachial plexus. 4. Short nerves of the brachial plexus, the course and their areas of innervation. 5. Long brachial plexus nerves, the course and areas of innervation of the lateral, medial and posterior cords. B. Situational tasks. 1. After a fracture of the upper third of the humerus the paralysis of the posterior group of muscles of the shoulder and forearm developed. Which nerve was damaged? A. Ulnar. B. Radial. C. Median. D.Musculocutaneous. E. Axillary. 2. Examination of a patient with a knife right hand wound has shown skin sensitivity loss of the lateral part of the hand dorsal surface and proximal phalanxes of the I, II and partially III fingers. Which nerve has been damaged? A. Ulnar. B. Median. C. Radial. D.Musculocutaneous. E. Lateral cutaneous nerve of forearm. 3. Having hurt the elbow against a table a patient felt burning and pricking on the internal surface of the forearm. Which nerve was traumatized in this case? A. Ulnar. B. Radial. C. Median. D. Axillary. E. Musculocutaneous. 4. A patient after a trauma has decreased painful and temperature sensitivity in the site of 1.5 fingers on the palmar surface and 2.5 fingers on the dorsal surface from the side of the little finger. Which nerve was injured as a result of the trauma? A. Ulnar. B. Radial. C. Median. D. Musculocutaneous. E. Medial cutaneous nerve of forearm 5. After an inflammatory process a patient complains of feeling weakness when bending a hand in the site of the I, II, III, and IV fingers, volume reduction of thenar muscles. Examination has shown disorders of pain and temperature sensitivity on palmary surface of the I, II, III fingers and ra¬dial surface of the IV finger. Which nerve has been injured? A. Musculocutaneous. B. Radial. C. Ulnar. D. Median. E. Medial cutaneous nerve of fore arm. 6. A patient appealed to a doctor with complaints of impossibility to abduce the right hand after a trauma. Examination has shown that passive movements are not limited. Deltoid muscle atrophy has been detected. Which nerve has been injured? A. Suprascapular. B. Radial. C. Ulnar. D. Median. E. Axillary. 7. After a trauma in the site of a shoulder a patient can not extend a hand. Examination has also shown a decrease of pain and temperature sensitivity in the site of 2.5 fingers of the hand's dorsal surface from the side of the thumb. Which nerve has been injured as a result of the trauma? A. Radial. B. Median. C. Ulnar. D. Axillary. E. Musculocutaneous. 8. Examining a patient a neuropathologist detected increased pain skin sensitivity on the palmary surface of the I, II, III and the radial surface of the IV fingers, middle part of the palm and thenar. Which nerve was injured? A. Median B. Medial cutaneous nerve of forearm C. Ulnar. D. Radial. E. Musculocutaneous. 9. To a traumatology center there was taken a teenager who pinched his arm in a door above the elbow joint during a game. Examination has shown the loss of skin sensitivity on the anteromedial shoulder surface. Indicate with what nerve damage the loss of skin sensitivity of the mentioned site is connected? A. Axillary. B. Radial. C. Musculocutaneous. D. Ulnar. E. Median. 10. A patient lost skin sensitivity of the little finger. Which nerve is damaged? A. Median. B. Ulnar. C. Radial. D. Musculocutaneous E. Medial cutaneous nerve of forearm Brachial plexus Brachial plexus Brachial plexus Topic 35. The lumbar plexus. A. Theoretical questions for the self-check: 1. Describe formation, branches, topography and responsibility areas of the thoracic nerves. 1. Describe formation, branches, topography and responsibility areas of the intercostal nerves. 2. Describe structural features of the nervous plexuses. 3. Describe the lumbar plexus. 4. Describe the femoral nerve. 5. Describe the obturator nerve. B. Situational tasks. 1. A patient was admitted to a traumatology center with the greater psoas muscle damage. The patient lost possibility to straighten his leg in the knee joint. Which nerve is damaged? A. Femoral. B. Iliohypogastric. C. Ilioinguinal. D. Genitofemoral. E. Obturator. 2. Examining a patient a neuropathologist detected the following symptom complex: cremasteric reflex extinction (reduction of m. cremaster), disorder of skin sensitivity on the anterior and internal surface of the superior third of the thigh and scrotum. Which nerve was injured? A. Ilioinguinal. B. Genitofemoral. C. Sciatic. D. Femoral. E. Obturator. 3. A patient has characteristic gait changes, so-called waddling gait, observed: during walking the patient sways. Besides, hip reduction is impossible. Which nerve has been injured? A. Femoral. B. Sciatic. C. Obturator. D. Tibial. E. Superior gluteal. 4. A patient can not extend a knee joint, knee reflex is not observed, skin sensitivity of the anterior surface of the thigh is damaged. Which nerve is damaged? A. Obturator. B. Superior gluteal. C. Common peroneal. D. Femoral. E. Inferior gluteal nerve. 5. Which of the following statements on the intercostal neurovascular bundle in the right 5th intercostal space is CORRECT? A. The intercostal nerve, which innervates the intercostal muscles in the space, is a posterior ramus (or primary division) of a thoracic spinal nerve. B. The venous drainage of the space is anteriorly to the internal thoracic veins and posteriorly to the hemiazygous vein. C. The two anterior intercostal arteries that supply the space are branches of the musculophrenic artery. D. The space is supplied by two posterior intercostal arteries,which are branches of the aorta. E. At a level just anterior to the angle of the ribs, the neurovascular bundle is located between the innermost and internal intercostal muscles 6. A victim can not extend a knee joint, knee reflex is not observed, skin sensitivity of the anterior surface of the thigh is damaged. Which nerve is damaged? A. Obturator. B. Superior gluteal. C. Common peroneal. D. Femoral. E. Inferior gluteal nerve. 7. Which of the following innervates the tensor fascia lata muscle? A. Superior gluteal N. B. Inferior gluteal N C. Femoral N. D. Obturator N E. Ilio-inguinal N 8. Skeletotopy of the lumbar plexus. A. Th12-L4 B. C8-L2 C. S2-S4 D. L3-L4 E. C1-S4 9. Indicate muscles, innervated by the iliohypogastric nerve. A. Abdominal muscles B. Psoas C. Quadratus lumborum D. Pectineus, gracilis, obturator externus E. Quadriceps femoris 10. Indicate muscles, innervated by the obturator nerve. A. Abdominal muscles B. Psoas C. Quadratus lumborum D. Pectineus, gracilis, obturator externus E. Quadriceps femoris Lumbar plexus and sacral plexus Peripheral nervous system Topic 36. The sacro-coccygeal plexus A. Theoretical questions for the self-check: 1. Formation of the sacral plexus. 2. Topography of the sacral plexus. 3.Short branches of the sacral plexus. 4. Zone innervation of short branches of the sacral plexus. 5. Long branches of the sacral plexus. 6. Zone innervation of long branches of the sacral plexus. B. Situational tasks. 1. A 30-year-old patient appealed to a neuropathologist complaining of skin sensitivity loss of the middle and inferior third of the posterior region of the leg on the right. Which nerve id damaged? A. Sural. B. Posterior cutaneous nerve of thigh. C. Genitofemoral. D. Branches of obturator nerve. E. Tibial. 2 Examination of a patient with a cut wound in the inferior third of the right leg anterior area has shown the absence of extension movements in the right ankle joint.