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The deltoid is supplied by the axillary nerve, a branch of the posterior cord of the brachial plexus that also carries sensation from the regimental badge area over the lateral shoulder. Radial nerve supplies posterior arm and forearm extensors, while the suprascapular nerve supplies supraspinatus and infraspinatus.
The greater sciatic foramen is bounded by the greater sciatic notch and the sacrotuberous and sacrospinous ligaments, with the sacrotuberous forming its major posterior boundary. Structures such as the sciatic nerve and piriformis pass through it.
The first carpometacarpal joint is a saddle synovial joint between the trapezium and the base of the first metacarpal, permitting opposition and circumduction of the thumb. The scaphoid lies proximal to the trapezium and articulates with the radius.
Iliopsoas, formed by psoas major and iliacus, is the strongest hip flexor and is active in activities such as stair climbing and sit-ups. Gluteus maximus is a powerful extensor, while piriformis and adductor magnus contribute to external rotation and adduction respectively.
The dome of cervical pleura covering the lung apex is termed the pleural cupula, reinforced by Sibson's fascia. It extends approximately 2.5 cm above the medial third of the clavicle, and injury here risks pneumothorax.
The mandibular division (V3) of the trigeminal nerve is the motor supply to masseter, temporalis, medial pterygoid and lateral pterygoid, plus mylohyoid and the anterior belly of digastric. The facial nerve supplies muscles of facial expression.
Initiation of abduction (first 15 degrees) requires the supraspinatus, which is commonly torn in rotator cuff injuries. After this range, the deltoid takes over; isolated supraspinatus lesions therefore produce a painful abduction arc with initial weakness.
The common fibular nerve winds around the fibular neck in a superficial position, making it vulnerable to compression and trauma. It supplies the anterior and lateral compartments, so injury causes foot drop with loss of dorsiflexion and eversion.
The artery of Adamkiewicz is the largest radiculomedullary artery, typically arising from the lower thoracic or upper lumbar levels and supplying the anterior spinal artery to the lower thoracic and lumbar cord. Its occlusion predisposes to anterior spinal artery syndrome with paraplegia.
The tarsal tunnel contents from anterior to posterior are remembered as 'Tom, Dick and Harry': tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve and flexor hallucis longus. The tibialis posterior tendon is therefore the most anterior structure, lying immediately behind the medial malleolus.
The long thoracic nerve (C5-C7) supplies serratus anterior, which protracts and stabilises the scapula against the chest wall. Its injury produces medial winging, exaggerated when the patient pushes forward against resistance.
The coronary sinus opens into the right atrium just above and medial to the opening of the inferior vena cava, guarded by the valve of Thebesius. It receives the great, middle and small cardiac veins, draining the majority of the myocardium.
The posterior wall of the inguinal canal is formed by transversalis fascia, reinforced medially by the conjoint tendon. The anterior wall is formed by the external oblique aponeurosis, reinforced laterally by internal oblique fibres.
The radial nerve runs in the spiral groove of the humerus, making it vulnerable in mid-shaft fractures. Injury produces wrist drop, loss of finger extension and sensory loss over the dorsum of the first web space.
The foramen ovale transmits the mandibular division of the trigeminal nerve with the lesser petrosal nerve and accessory meningeal artery. The maxillary nerve passes through the foramen rotundum, and the middle meningeal artery through the foramen spinosum.
The superior gluteal nerve supplies gluteus medius, minimus and tensor fasciae latae, which stabilise the pelvis in single-leg stance. Its injury causes contralateral pelvic drop, the positive Trendelenburg sign.
The femoral triangle is bounded by the inguinal ligament superiorly, sartorius laterally and adductor longus medially, with a floor of iliopsoas and pectineus. The femoral artery and vein lie within it, and their superficial position and palpable pulse make this the standard site for arterial puncture and venous access.
Ribs 1 to 7 are true ribs because each attaches directly to the sternum through its own costal cartilage. Ribs 8 to 10 are false ribs with indirect cartilaginous attachment, and ribs 11 and 12 are floating ribs with no anterior attachment.
The median nerve at the wrist supplies the thenar muscles (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis) and the palmar cutaneous branches to the lateral three and a half digits. Carpal tunnel syndrome therefore causes thenar wasting, weak opposition and numbness in this distribution, sparing the little finger.
The thoracic duct ascends in the posterior mediastinum, crossing the midline at approximately T4 to T6, then arches laterally to drain into the junction of the left subclavian and internal jugular veins. Its right-to-left crossing is important in surgical and oncological staging contexts.
Depolarisation of the presynaptic terminal opens voltage-gated calcium channels, and the resulting calcium influx is the direct trigger for vesicular fusion and acetylcholine release. Sodium entry causes the depolarisation itself but does not drive exocytosis. Potassium efflux and chloride influx do not initiate transmitter release.
The phosphagen system uses stored ATP and creatine phosphate to regenerate ATP almost instantly, dominating the first 5 to 10 seconds of maximal effort. Anaerobic glycolysis becomes prominent after this initial burst, and oxidative metabolism contributes little at maximal sprint intensity.
Residual volume is the air remaining in the lungs after a maximal expiration, so a spirometer cannot record it because it is never exhaled. Tidal volume and the inspiratory and expiratory reserve volumes are all directly measurable by spirometry.
Glucose is reabsorbed almost entirely in the proximal convoluted tubule via sodium-glucose cotransporters, so none normally appears in urine. The descending limb is water-permeable but not a site of glucose reabsorption. The distal tubule and collecting duct handle fine-tuning of sodium, water and acid-base balance.
Antidiuretic hormone, released from the posterior pituitary, inserts aquaporin-2 channels in the collecting duct, increasing water reabsorption. Aldosterone acts mainly on sodium reabsorption, atrial natriuretic peptide promotes sodium and water loss, and ACTH controls adrenal cortisol secretion.
Platelets adhere to exposed collagen, become activated and aggregate to form the primary haemostatic plug within seconds of injury. Erythrocytes are oxygen carriers, neutrophils are phagocytes, and lymphocytes mediate adaptive immunity; none of these forms the initial platelet plug.
The motor pathways decussate, so a right hemisphere lesion produces contralateral, that is left-sided, motor deficit. Ipsilateral weakness would indicate a lesion below the decussation or a peripheral nerve problem. Bilateral and isolated facial patterns do not fit a single unilateral hemisphere lesion.
Hyperventilation lowers arterial carbon dioxide, raising pH and delaying the carbon dioxide-driven urge to breathe. The dangerous consequence is that oxygen may fall to critical levels before the breath-hold breaks. Raised carbon dioxide or lowered pH would shorten the breath-hold.
Cardiac output equals heart rate multiplied by stroke volume, so 50 times 80 mL gives 4000 mL, or 4.0 L per minute. This falls within the normal resting range and reflects a well-trained or vagally dominant individual. The other values arise from arithmetic errors.
Raised temperature, 2,3-DPG, carbon dioxide and hydrogen ion concentration shift the curve to the right, reducing haemoglobin affinity and favouring oxygen unloading to tissue. A leftward shift would mean tighter oxygen binding and reduced delivery. Haemoglobin concentration does not change acutely in this setting.
Cerebellar lesions produce ipsilateral incoordination, including intention tremor, dysmetria and dysdiadochokinesia. Resting tremor with rigidity is typical of basal ganglia disease such as Parkinsonism. Spasticity and hyperreflexia indicate upper motor neuron lesions, and sensory loss indicates a somatosensory pathway lesion.
Closure of the atrioventricular valves marks the start of systole and is followed by isovolumetric contraction, during which pressure rises with no change in volume. The aortic valve opens only once ventricular pressure exceeds aortic pressure. Ventricular filling and atrial systole occur before this point.
Airway resistance rises when the bronchial lumen narrows, which in asthma results from smooth muscle constriction, mucosal oedema and mucus plugging. Compliance changes affect the work of expansion rather than airway calibre. Surfactant reduces surface tension and does not narrow airways.
Standing reduces venous return and arterial pressure, unloading the baroreceptors and triggering sympathetic outflow with tachycardia and vasoconstriction. Vagal discharge would slow the heart further and worsen the fall in pressure. Reduced renin and increased atrial natriuretic peptide would both promote rather than oppose hypotension.
Ventilation rises abruptly at exercise onset before arterial carbon dioxide changes appreciably, pointing to neural drive from higher motor centres and feedback from moving limbs. Arterial carbon dioxide and oxygen are tightly regulated and do not explain the immediate rise. Body temperature rises rather than falls during exercise.
The knee-jerk is a monosynaptic stretch reflex: tap-induced stretch of the quadriceps excites muscle spindles whose Ia afferents synapse directly on alpha motor neurons. Golgi tendon organs sense tension and mediate inverse stretch reflexes. Joint and cutaneous receptors do not produce this monosynaptic reflex.
In metabolic acidosis the fall in plasma bicarbonate lowers pH, and the respiratory system compensates by hyperventilating to blow off carbon dioxide, raising pH toward normal. Hypoventilation would retain carbon dioxide and worsen the acidosis. Changes in oxygen consumption do not compensate for a pH disturbance.
The thick ascending limb actively transports sodium chloride out of the tubule but is impermeable to water, so the medullary interstitium becomes hypertonic while the tubular fluid becomes dilute. The descending limb is water-permeable and does not actively reabsorb sodium chloride. The unequal permeabilities of the two limbs are essential to the countercurrent multiplier.
The pump maintains the sodium and potassium gradients over time but contributes only a small direct electrogenic component, so blocking it causes the gradients and resting potential to run down gradually rather than instantly. The immediate resting potential depends mainly on potassium permeability through leak channels. Threshold and repolarisation are not immediately reversed or enhanced.
According to the Starling relationship, net filtration depends on the balance of hydrostatic and oncotic pressures. Lowering capillary hydrostatic pressure and raising plasma oncotic pressure both favour movement of fluid back into the capillary. The other combinations increase filtration or protein leakage and would promote oedema.
Terminal stance begins when the heel rises off the ground, driven by the plantarflexor moment, and the ankle is already plantarflexing toward push-off. Peak plantarflexion near 20 degrees at heel-off is the accepted kinematic marker of this event.
Normal knee flexion in the supine position is approximately 135 degrees, with extension to 0 degrees. The axis is the lateral epicondyle and the stationary arm follows the greater trochanter while the moving arm follows the lateral malleolus.
The hamstrings, particularly biceps femoris, contract eccentrically in terminal swing to slow the extending knee and prepare the limb for loading. This prevents the knee from snapping into full extension at heel strike.
When the two ASIS are level in the frontal plane and the symphysis pubis lies in the same plane, the pelvis is described as neutral. Lateral tilt would show one ASIS higher than the other.
The anterior cruciate ligament resists anterior tibial translation and limits internal rotation, and it is most reliably tested near 30 degrees of flexion. The posterior cruciate ligament addresses the opposite direction of translation.
As the knee approaches full extension, the tibia externally rotates about 10 degrees on the femur, locking the joint and improving stability. This coupled rotation is the screw-home mechanism.
Tight hip flexors pull the pelvis into anterior tilt, which increases the sacral base angle and exaggerates lumbar lordosis. This is a common compensatory posture in shortened iliopsoas or rectus femoris.
The gluteus medius abducts the hip and stabilizes the pelvis in the frontal plane during single-leg stance. When it is weak, the contralateral hemipelvis drops, producing a positive Trendelenburg sign.
In normal walking, stance occupies roughly 60 percent of the gait cycle while swing occupies about 40 percent. The overlap of stance between limbs creates the double-support periods.
The classic scapulohumeral rhythm is approximately 2:1, meaning 2 degrees of glenohumeral elevation for every 1 degree of scapular upward rotation. This yields about 120 degrees glenohumeral and 60 degrees scapular motion in total elevation.