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Year 2 Session 2 > 3100 - Imaging > Flashcards

3100 - Imaging Flashcards

1
Q

Manubriosternal joint vertebral level

A

T4/5

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2
Q

Costochondral joint type

A

primary cartilaginous

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3
Q

Sternochondral joint type

A

Synovial plane

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4
Q

Chest deformities (cause)

A

Barrel chest - increase AP diameter (emphysema) held inspiration position
Scoliosis - (idiopathic or congenital)
Pectus Carinatum - chest bulges out ant (congenital)
Pectus Excavatum - chest bulges in ant (congenital)
Kyphosis - (compression fractures, osteoporosis)

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5
Q

What is chostochondritis (Tietze Syndrome)

A

inflamed cartilage and costochondral joint from strain or respiratory infection

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6
Q

What is flail chest

A

Fractured ribs allow movement during breathing

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7
Q

What way do ribs move in inspiration

A

outwards

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8
Q

Vertebra prominens is

A

spine of C7

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9
Q

Medial spine of scapula vertebral level

A

T3

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10
Q

Inferior angle of scapula

A

T7

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11
Q

Oblique fissure vertebral level and rib

A

T4 to rib 6

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12
Q

Horizontal fissure vertebral level and rib

A

T4 to rib 5 (axillary) and 4 (ant)

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13
Q

Cause of Clay-shoveler fracture

A

Force from trapezius and rhomboids causes avulsion fracture of lower cervical or upper thoracic spinous processes

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14
Q

What is open pneumothorax

A

puncture > collapses lung > air in and out

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15
Q

What is tension pneumothorax

A

puncture > air goes in not out > pressure buildup pushes mediastinum away from injury side

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16
Q

Where is a liver biopsy done

A

7-10th intercostal space mid-axillary line during expiration

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17
Q

What accumulates in costodiaphragmatic recess

A

Pus, blood, fluid

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18
Q

What/where are triangles of auscultation

A

Sites of easy auscultation of lungs. b/n traps, lat dorsi and scap, on ribs 6-7

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19
Q

Main muscles of inspiration

A

Diaphragm and external intercostals

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20
Q

Accessory muscles of inspiration (5)

A

pecs, scalenes, SCM, muscles that dilate mouth and nostrils, serratus posterior superior

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21
Q

Accessory muscles of expiration (5)

A

Abdominal muscles (ext and int obliques, transverse abdominis and rectus abdominis) and serratus posterior inferior

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22
Q

External intercostals are replaced by membrane where

A

Anteriorly

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23
Q

Internal intercostals are replaced by membrane where

A

Posteriorly

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24
Q

Innermost intercostals have membrane where

A

Throughout the membrane in segments

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25
Q

Where is main intercostal bundle

A

In costal groove

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26
Q

Intercostal nerves branch from and give what branches

A

ventral rami of spinal nerve > intercostal nerve > lateral and anterior cutaneous branches

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27
Q

What is thoracocentesis vs chest drain and what does it pierce

A

Needle vs tube to remove fluid or air from pleural cavity. Pierces skin, superficial fascia, external, internal, innermost ICMs (maybe membrane) and parietal pleura

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28
Q

Brachial plexus vertebral level

A

C5-T1

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29
Q

Axillary sheath a) attachments, b) contents and c) function

A

a) Rib 1 and clavicle. b) contains brachial plexus and axillary artery/vein. c) stabilises axillary vein for subclavian venous catheter and holds local anaesthetic (axillary block)

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30
Q

Dermatome of nipple and umbilicus

A

nipple - T4, umbilicus - T10

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31
Q

What is an axial line? How does this distinguish between peripheral and spinal nerve lesions?

A

Border between two dermatomes that don’t have adjacent spinal cord levels. Peripheral nerve lesions cross axial lines, spinal cord lesions do not

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32
Q

Shingles pathophysiology

A

Herpes Zoster virus enters sensory nerve terminal, travels to dorsal root ganglion via retrograde transport lies dormant. When reactivated travels back down nerve and inflames terminals (red rash)

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33
Q

Horner’s syndrome pathophysiology

A

Inferior cervical (stellate) ganglion and first (T1) sympathetic ganglion (SG) send fibers to head. Damage to these ganglion (apical lung tumour - squash) or brain causes lack of sympathetic innervation to face. Pupil constriction, ptosis, absence of sweating.

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34
Q

Palmar hyperhidrosis treatment

A

upper sympathectomy - removal of T2-4 sympathetic ganglion

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35
Q

Thorax blood supply

A

Posteriorly and laterally: intercostal arteries & veins (from aorta and draining to azygous veins (hemiazygos on left) to SVC
Anteriorly: Internal thoracic artery and vein (from subclavian, into brachiocephalic into SVC)

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36
Q

Breast blood supply

A

Axillary/subclavian branches: thoracoacromial, lateral thoracic, internal thoracic, intercostal arteries
Veins: lateral thoracic, internal thoracic, axillary, SVC

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37
Q

Breast spans ribs

A

2-6

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38
Q

What are the lymph nodes that drain breast

A

Internal thoracic/mammillary (medial), supraclavicular (upwards) and pectoral (in axilla) lymph nodes (upper lat quad)

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39
Q

coronary artery in-situ graft vs coronary artery bypass graft (CABG)

A

distal portion of internal thoracic artery is moved to other side of blocked coronary artery. Internal thoracic or radial artery is grafted to a part of the heart.

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40
Q

Superficial veins in thorax (if IVC is blocked)

A

superficial epigastric drains into thoracoepigastric veins drain into lateral thoracic veins into axillary v
SE > TE > LT > A > SVC

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41
Q

Imaging mechanisms that use ionising radiation

A

X-ray, CT, nuclear medicine

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42
Q

Features of X-ray machine

A

occurs in a vacuum, lead stops x-rays escaping, oil filled sleeve surrounding tube absorbs heat

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43
Q

Energy from electrons in x-ray generation is converted to 99% what and 1% what

A

99% heat and 1% high energy photons (x-rays)

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44
Q

How to tell in x-ray if air and fluid are in contact

A

Forms a straight line between them

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45
Q

Air allows x-rays to pass through so it appears

A

black

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46
Q

Metal stops x-rays passing through so it appears

A

white

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47
Q

Types of x-rays

A

Projection - single plane, cheap
Tomogram (CT) - many planes, $$, detailed images

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48
Q

What chemicals are used to increase contrast in x-ray images

A

Iodine and barium

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49
Q

Scans involved in nuclear medicine

A

SPECT and gamma scan

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50
Q

Risks of x-rays

A

Ionising radiation creates free radicals which cause DNA damage

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51
Q

Units of radiation dose (x-rays)

A

mSv, Bq, Ci, Gy

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52
Q

Effect of x-rays on rapidly dividing cells (5)

A

Embryo (death early on, birth defects later)
Spermatogonia (infertility)
Erthyroblasts (anaemia)
Stem cells in epidermis (ulcers, hair loss)
Stem cell in GI (diarrhoea, ulcers)

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53
Q

Effect of x-rays on some non-dividing cells (3)

A

Ooctyes (infertility, birth defects)
Lymphocytes (infection, cancer)
Lens (cataracts)

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54
Q

How does radiotherapy work?

A

Cancer cells are rapidly dividing cells therefore are highly sensitive to ionising radiation

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55
Q

What is an ultrasound, how are they generated

A

High energy sound waves generated by contraction and expansion of piezoelectric crystals in transducer probe when AC current is passed through. Probe detects reflected ultrasounds.

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56
Q

Bone and air are hyperechoic so they appear (ultrasound)

A

White

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57
Q

Soft tissue is hypoechoic (weakly reflect) appears (US)

A

Grey

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58
Q

Fluid is anechoic appears (US)

A

Black

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59
Q

Types of ultrasound

A

2D (conventional)
3D voxel-rendered
4D (+time dimension)
HD (better resolution)

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60
Q

What reduces the quality of an US image

A

The depth - more scatter

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61
Q

Generation of magnetic resonance imaging (MRI)

A

Patient in magnetic field. H+ aligns on field. Radio pulse shifts H+ 90º. Radio pulse off, H+ shift back, radio signal released, detector converts to image

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62
Q

MRI: T1 vs T2 vs FLAIR vs STIR

A

T1- long relaxation times. Fat is bright, water dark
T2 - short relaxation times. Fat is dark, water is white
FLAIR - fluid of CSF is dark, inflammation is white, fat is dark
STIR - remove fat signal to see blood vessels

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63
Q

What is a diffusion tensor MRI

A

water already aligned in white matter tracts give recognisable signal - can be individually coloured

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64
Q

How does a functional MRI work

A

Active brain regions have more blood flow. Oxygenated/deoxygenated Hb give different signals

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65
Q

Ligaments of diaphragm (3) and muscles attached (medial to lateral/internal to external)

A

Median arcuate created by crura of diaphragm around aorta
Medial arcuate formed by connection of diaphragm to psoas major
Lateral arcuate formed by quadratus lumborum to diaphragm

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66
Q

nerve supply of abdominal muscles

A

T6-L1 ventral rami

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67
Q

Left crus vertebral level
right crus VL

A

L1-L2
L1-3 - forms physiological sphincter

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68
Q

Sliding hiatal hernia

A

portion of stomach slides through esophageal hiatus (where esophagus goes through diaphragm) up esophagus

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69
Q

Paraesophageal hiatal hernia

A

stomach goes through esophageal hiatus into chest cavity

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70
Q

which hiatal hernia leads to Barrett’s osephagus

A

sliding hiatal hernia - laxity of lower oesophageal sphincter - gastrooesophageal reflux disease (GORD) - Barrett’s

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71
Q

Inflammation can spread from pelvis to subphrenic space via

A

right paracolic gutter

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72
Q

Prevertebral and retropharyngeal spaces end at __. DAnger space between them ends at

A

T6. Diaphragm

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73
Q

Danger space is between

A

preverterbal and retropharyngeal spaces

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74
Q

Pericardium of heart fuses with
Supplied by __ nerve

A

central tendon of diaphragm.
Phrenic

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75
Q

Pericarditis and pleurisy are what pain

A

sharp

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76
Q

Fibrous heart pericardium is supplied by

A

phrenic nerve

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77
Q

Parietal pleura (lungs) supplied by

A

intercostal nerve

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78
Q

Mediastinal pleura (centre chest - holds heart) supplied by

A

phrenic nerve

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79
Q

Heart tamponade

A

Fibrous pericardium doesn’t stretch

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80
Q

How to stop blood output

A

transverse pericardial sinus

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81
Q

Right heart hypertrophy indicates

A

Problem with lungs (pulmonary fibrosis)

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82
Q

Left heart hypertrophy indicates

A

Problem with systemic system

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83
Q

Heart appears larger in AP or PA view

A

AP

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84
Q

Left coronary artery branches and supply

A

Left anterior descending (LAD) (ant interventricular) supplies ant 2/3 interventricular septum
Circumflex supplies SAN in 40% and AVN in 10% cases

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85
Q

Right coronary artery branches and supply

A

Right coronary supplies SAN 60% and AVN 90%.
marginal artery.
Posterior descending (interventricular) artery: post 1/3 of interventricular septum

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86
Q

Pulmonary veins are above/below pulmonary arteries

A

below

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87
Q

where are pectinate muscles

A

atrium

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88
Q

papillary muscle function

A

in ventricles attach to chordae tendinae, contract to close valves

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89
Q

trabeculae carneae

A

in ventricles

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90
Q

Right valvular stenosis leads to

A

Leg oedema

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91
Q

Left valvular stenosis leads to

A

pulmonary oedema

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92
Q

How can lung carcinoma cause hoarse voice

A

Lung carcinoma can enlarge lymph nodes, on LHS can compress recurrent laryngeal nerve leading to vocal fold paralysis

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93
Q

which ventricle is thicker

A

Left

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94
Q

9 regions of abdomen

A

R hypochondriac, epigastric, L hypochondriac
R lumbar, umbilical, L lumbar
R iliac, hypogastric, L iliac

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95
Q

indirect inguinal hernia

A

through deep inguinal ring and inguinal canal, lateral to epigastric vessels

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96
Q

Direct inguinal hernia

A

through abdomen layers, medial to epigastric vessels

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97
Q

sites for herniation

A

inguinal canal, lumbar triangles

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98
Q

abdominal muscle nerve supply

A

T6-L1

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99
Q

muscles for trunk rotation

A

ext obliques and opposite internal oblique

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100
Q

muscles for trunk flexion

A

retcus abdominis and gravity

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101
Q

muscle for Trunk extension

A

erector spinae

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102
Q

muscle for Bracing core

A

transversus abdominis

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103
Q

what is Meralgia paraesthetica

A

tingling, numbness, burning of lateral thigh from compression of lateral cutaneous nerve (pregnancy, obesity)

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104
Q

arteries in rectus sheath

A

superior and inferior epigastric

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105
Q

what is caput medusa

A

veins in umbilical region from portal hypertension

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106
Q

Portal hypertension leads to

A

left umbilical vein which
can recanalise > caput medusa, oesophageal varices, haemorrhoids

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107
Q

inguinal canal transmits (male v female)

A

spermatic cord and round lig of uterus

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108
Q

Inguinal canal travels through what abdominal layers (form the walls of canal)

A

external oblique, internal oblique, transversus abdominis and transversalis fascia

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109
Q

Components of a hernia

A

Sac (peritoneum), contents (bowel), coverings (abdominal wall)

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110
Q

Coeliac trunk, sup mesenteric, inf mesenteric VL

A

T12, L1, L3

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111
Q

lesser omentum contains what ligaments

A

hepatoduodenal and hepatogastric

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112
Q

what is angular incisure

A

notch in stomach

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113
Q

Order of anatomical features from stomach to intestine (pylorus, duodenal cap, pyloric antrum, duodenum)

A

Pyloric antrum > pylorus > duodenal cap > duodenum

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114
Q

portal triad

A

hepatic artery, portal vein, bile duct

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115
Q

portal triad can be compressed at

A

epiploic foramen

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116
Q

Which kidney is lower

A

right

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117
Q

Lesser curvature stomach blood supply

A

Left and right gastric from coeliac trunk and hepatic artery

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118
Q

Coeliac trunk branches into

A

left gastric, splenic and hepatic

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119
Q

Hepatic artery splits into

A

Right gastric and gastroduodenal

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120
Q

Greater curvature stomach blood supply

A

Gastroduodenal and splenic

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121
Q

Stomach blood drainage

A

Lesser curvature: left and right gastric into portal vein
Greater curvature: gastroepiploic veins into sup mesenteric + splenic into portal vein

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122
Q

oesophageal varicosities are of what anastomoses

A

Left gastric and azygous

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123
Q

What artery can be embolised for obesity treatment

A

left gastric > ischaemia of fundus and reduce ghrelin

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124
Q

what arterey is most at risk from duodenal ulcers

A

gastroduodenal artery

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125
Q

Whipple’s procedure for pancreatic cancer puts what vessels at risk? why

A

Uncinate process of pancreas is under superior mesenteric vessels. Most of duodenum is removed with head of pancreas. Sup mes vessels at risk

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126
Q

Falciform ligament contains

A

remnant of left umbilical vein (round ligament/ligamentum teres). Recanalisation causes caput medusae.

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127
Q

what ligament extends from liver to umbilicus

A

falciform ligament

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128
Q

what ligament surrounds bare area

A

coronary ligament formed by left and right triangular lig

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129
Q

what ligament contains portal triad

A

hepatoduodenal

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130
Q

Sites of fluid accumulation near liver

A

Hepatorenal (liver - kidney) and subphrenic (live to diaphragm)

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131
Q

Blood supply to liver

A

hepatic artery, portal vein

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132
Q

Liver blood drainage

A

central vein > hepatic vein > IVC

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133
Q

What structure allows liver to be cut surgically into left and right halves

A

Middle hepatic vein

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134
Q

Cancers in GI tract can metastasise where

A

Liver

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135
Q

How to detect splenomegaly

A

Dull percussion over Traube’s space

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136
Q

Liver failure manifestations

A

Jaundice (no clearing of bilirubin), brain damage (toxins not cleared) > asterixis (hand flapping)

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137
Q

What structure in rectum marks transition from autonomic to somatic nerves

A

Dentate line

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138
Q

what suspends duodenojejunal flexure

A

ligament of Trietz

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139
Q

Volvulus is what and puts what at risk

A

Twisting of the sml intestine around root of mesentery puts superior mesenteric artery and vein at risk > ischaemia

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140
Q

Jejunal vs ileal mesentery:

A

Jejunal: long vasa recta, few arcades, less fat
Ileal: short vasa recta, more arcades, more fat

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141
Q

what is Ileal (Meckel’s) Diverticulum

A

Out-pouching of ileum congenital from remnant of vitelline duct (connects yolk sac to midgut)

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142
Q

What prevents reflux of caecum contents

A

ileocaecal valve

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143
Q

What is diverticulosis, most common spot

A

outpouching of gut common with age, sigmoid colon

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144
Q

Blood supply of rectum

A

upper 1/3: inferior mesenteric branches
Lower 2/3: int iliac
> anastomose

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145
Q

Dentate line marks (embryologically)

A

where primitive endoderm meets ectoderm

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146
Q

Most common pouch for fluid accumulation

A

rectouterine

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147
Q

Parasympathetic supply to foregut and midgut

A

Vagus nerve

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148
Q

Parasympathetic supply to hindgut

A

S2-4

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149
Q

Orientation of aorta to IVC

A

aorta is on the left of the IVC
IVC on right

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150
Q

Renal colic gives pain where

A

in testes/groin

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151
Q

Corpus cavernosum function

A

erection

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152
Q

Corpus spongiosum function

A

Prevent urethra from closing during erection (for ejaculation)

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153
Q

what is tunica albuginea

A

inflexible fascia around penis – tear = bent

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154
Q

What nerve provides sensation for penis (from sacral plexus)

A

Pudendal nerve

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155
Q

ischiocavernosus function

A

helps maintain erection

156
Q

dartos muscle location and innervation

A

in skin of scrotum, sympathetic T12-L1 via genitofemoral n

157
Q

Cremaster muscle location and innervation

A

around spermatic cord - pulls testis up, genitofemoral n (L1, L2)

158
Q

Veins of penis

A

pampiniform plexus

159
Q

What is testicular varicocele

A

Enlargement of pampiniform plexus

160
Q

What causes testicular hydrocoele

A

accumulation of fluid between 2 tunica vaginalis layers

161
Q

Greater vestibular gland also called

A

Bartholin’s gland

162
Q

Lesser vestibular gland is also

A

Skenes/paraurethral glands

163
Q

AnteVersion with resepct to

A

Vagina

164
Q

anetFlexion with respect to

A

Fundus of uterus

165
Q

blood supply of female reproductives

A

Ovarian art from aorta, branches of internal iliac: internal pudendal, vaginal, uterine.

166
Q

Innervatiion of vagina

A

lower 1/5: pudendal
Upper 4/5: T12-L2, S2-4

167
Q

broad ligament of uterus contains the mesometrium, mesosalpinx, and mesovarium - what are each of these roles

A

Mesometrium - support uterus, contains blood vessles/nerves for uterus
Mesosalpinx - support fallopian tubes, contains vessels/nerves for tubes
Mesovarium - supports ovaries, contains vessels/nerves for ovaries

168
Q

What ligament contains ovarian artery, vein and nerve

A

Suspensory ligament of ovary

169
Q

round lig of uterus function

A

maintain anteflexion

170
Q

cervical ligaments:

A

pubocervical, transverse (cardinal), uterosacral

171
Q

Weakness of cervical ligaments leads to

A

prolapse uterus

172
Q

Lymphatics: fundus of uterus and round ligament drains to

A

superficial inguinal lymph nodes

173
Q

blood supply to M and F reproductive

A

internal pudendal from int iliac

174
Q

which viscera can be heard in the triangle of auscultation

A

apex of lower lobe of lung

175
Q

Axillary sheath is derived from what fascial layer

A

prevertebral fascia

176
Q

Arteries supplying breast are

A

lateral thoracic, internal thoracic, intercostal arteries and thoracoacromial

177
Q

Which breast quadrant are most carcinomas found

A

upper left - pectoral lymph nodes

178
Q

Why is xray risky

A

x rays can ionise atoms, breaking chemical bonds and creating free radicals. This can break DNA stands, causing cell
death/cancer/developmental abnormalities

179
Q

Why are nerves, bone muscle and cartilage relatively resistant to
ionising radiation damage

A

Because theyre not dividing

180
Q

4D ultrasound has what added

A

time

181
Q

What can cause hiccups

A

Can be triggered by inflammation of organs near the diaphragm (e.g. liver, kidneys) or
accumulation of pus/fluid around the diaphragm. involves phrenic/vagus nerves

182
Q

Impaired valve closure leads to
Impaired valve opening leads to

A

regurgitation
stenosis > back pressure

183
Q

Irritation of which part of the pleura gives shoulder pain

A

Diaphragmatic pleura from phrenic n

184
Q

Which structures are compressed and what are the symptoms of thoracic outlet syndrome?

A

Brachial plexus, subclavian artery and vein. Pain, numbness, swelling of arm

185
Q

through diaphragm: IVC, esophagus, aorta

A

T8, T10, T12

186
Q

Which bronchus are things more likely to pass into

A

right main bronchus as it is wider and more vertical

187
Q

what is atelectasis

A

collapsed lung from blockage of bronchi

188
Q

Lub and dub sounds are from

A

AV valves and semilunar valves

189
Q

Congenital ventriculoseptal defects are common. Which blood circuit (pulmonary or systemic) becomes congested

A

hole in septum (sep ventricles) > pulmonary circuit becomes congested because so much blood going through pulmonary

190
Q

What has the arcuate line got to do with the rectus sheath

A

Above arcuate line internal oblique splits around rectus abdominis. Below all layers run anteriorly

191
Q

is proper or common hepatic branch from celiac trunk

A

celiac > common > proper + gastroduodenal

192
Q

If a stomach ulcer perforates posteriorly:
(i) Name the peritoneal compartment into which gastric contents would leak.
(ii) Name two arteries that may bleed

A

i) retroperitoneal space
ii) gastroduodenal and splenic

193
Q

structures along transpyloric plane (L1)

A

pylorus of stomach, part 1 duodenum, hilum of kidney,

194
Q

what separates into supra and infra colic compartments, left and right infracolic

A

transverse mesocolon, root of mesentery

195
Q

A ruptured spleen can be associated with left shoulder pain. Why?

A

bleeding from spleen may irritate phrenic nerve

196
Q

what nerve innervates external anus

A

pudendal (branch of sacral plexus)

197
Q

To where is renal pain referred and to where is ureteric pain referred

A

renal pain to back and ipsilateral flank. Ureteric to lower abdomen/groin

198
Q

On which side do most testicular varicocoels occur?

A

left scrotum, The left testicular vein (gonadal vein) drains into the left renal vein, which can create higher pressure in the left.

199
Q

Right testis drainage

A

Right gonadal vein > IVC

200
Q

What is the most common cause of a reduced urine stream in ageing men

A

Larger prostate

201
Q

How does CNS develop (embryology)

A

sonic hedgehog gene > ectoderm invaginates > neural tube > CNS

202
Q

Notochord forms

A

nucleus pulposus of IVD

203
Q

Closure of neural tube dependant on what vitamins

A

B9 (folate)

204
Q

What is spina bifida and types

A

Incomplete closure of neural tube.
Spina Bifida Occulta - small gap in 1+ vertebral bones (sometimes unnoticed)
Meningocele - meninges protrude through gap in spine
Myelomenigocoele - Spinal cord and coverings bulge
Anencephaly - incomplete skull (rostral end)

205
Q

What joint do articular processes form in spine

A

Facet/zygapophysial

206
Q

What induces the neural tube to form

A

The notocord

207
Q

What angle are the facet joints in different regions and movements

A

Cervical - 45º - flexion, extension, lateral flexion and rotation
Thoracic - 60º - rotation
Lumbar - 90º (parasagittal) - flexion, extension, small rotation

208
Q

Main features of cervical vertebrae

A

transverse foramen in transverse process for vertebral artery (C6-C2) and vertebral vein (C1-C7)
bifid spinous process
uncinate processes

209
Q

Joint articulations for nodding (C1)

A

superior articular facet with occipital condyles

210
Q

Features of C1

A

Lateral masses, ant and post arches, groove for vertebral artery, post and ant tubercle

211
Q

Lamina is between
Pedicle is between

A

Lamina - spinous to transverse processes
Pedicle - transverse to body

212
Q

What joint for ‘yes’
what joint for ‘no’

A

yes - atlantooccipital (condyloid/ellipsoid)
no - atlantoaxial (pivot j)

213
Q

what forms atlantoaxial joint

A

superior articular surface of lateral mass of C2 with inferior articular surface of lateral mass of C1
dens to anterior arch held by transverse ligament

214
Q

Hangmans fracture

A

fracture of pars interarticularis at C2 from hyperflexion and hyperextension e.g car crash

215
Q

Pars interarticularis fracture where verterbra slips forward

A

spondylolisthesis

216
Q

where does spinal cord end

A

L1/L2

217
Q

Is fractured odontoid process concerning

A

yes because vertebrae can move ant and post and slice spinal cord

218
Q

compression of sacral nerve roots in cauda equina (acute cauda equina syndrome) can lead to

A

saddle anaesthesia, bladder/bowel incompetence, back/leg pain
> not decompressed in 24 hours > permanent

219
Q

Pain of lateral foot is compression of which spinal nerve

A

S1

220
Q

Ligaments of spine

A

supraspinous, interspinous, ligamentum flavum, posterior longitudinal, anterior longitudinal

221
Q

What usually prevents a
posterior disc prolapse?

A

posterior longitudinal ligament

222
Q

Thickening of which ligament
can cause spinal stenosis?

A

posterior longitudinal ligament (sometimes flavum)

223
Q

What ligaments connect spine to skull

A

Cruciform ligament: superior longitudinal, inferior longitudinal and transverse
Posterior longitudinal lig > tectorial membrane
Deep part of tectorial
Alar ligaments

224
Q

What type of joint is IVD

A

secondary cartilaginous

225
Q

What type of joint is zygapophyseal/facet

A

synovial

226
Q

what is scapulohumeral rhythm

A

scapula moves 1º for every 2 of humerus

227
Q

where do 80% of clavicle fractures occur

A

middle

228
Q

what ligament holds in place biceps long head tendon

A

transverse humeral ligament

229
Q

Acromioclavicular fracture involves which ligaments

A

acromioclavicular and coracoclavicular

230
Q

Which side of intertubercular groove is pec major insertion

A

Lateral - under greater tubercle

231
Q

Innervation of serratus anterior - damage results in

A

long thoracic - winged scapula

232
Q

rhomboids action

A

retraction of scapula

233
Q

Latissimus dorsi action

A

adduct, medially rotate and extend arm at GHJ

234
Q

What is a SLAP lesion

A

tendon of long head of biceps slips out of groove or tears labrum in overhead activity. e.g. throwing a javelin

235
Q

What is adhesive capsulitis

A

‘Frozen shoulder’ - inflammation of shoulder joint capsule

236
Q

Which direction does humerus commonly dislocate and what structure is commonly at risk

A

Anteroinferiorly, axillary nerve

237
Q

Rotator cuff muscle insertions

A

Subscapularis - lesser tubercle
Supraspinatus, infraspinatus, teres minor - greater tubercle

238
Q

Rotator cuff muscle actions

A

Subscapularis - internal rotation
Supraspinatus - early abduction
Infraspinatus and teres minor - external rotation

239
Q

Rotator cuff tear partial v full

A

Often involves supraspinatus
Partial - can abduct but not against resistance
Full - 45º abduction from deltoid action

240
Q

Function of subacromial bursa

A

reduce friction of supraspinatus tendon in coracoacromial arch

241
Q

What is painful arc syndrome

A

Pain from 50-130º abduction

242
Q

What can be compressed at apex of axilla

A

Divisions of brachial plexus

243
Q

What causes enlargement of axillary lymph nodes

A

Breast cancer, upper limb and breast infections

244
Q

Why might pt wake up with weakness or paraesthesia of upper limb after axillary clearance

A

Removal of axilla lymph nodes may affect brachial plexus. May also cause oedema of upper limb

245
Q

What forms posterior cord of brachial plexus

A

posterior divisions

246
Q

what is innervated by dorsal scapula nerve

A

levator scapulae

247
Q

thoracodorsal innervates

A

lat dorsi

248
Q

suprascapular innervates

A

supra and infra spinatus

249
Q

what does musculocutaneous nerve innervate/supply

A

anterior arm: biceps brachii, coracobrachialis, brachialis
becomes lateral cutaneous of forearm for sensation

250
Q

What does ulnar nerve innervate

A

flexor carpi ulnaris, M 1/2 flexor digitorum profundus, intrinsic muscles of hand: palmaris brevis, lumbricals, hypothenar and interossei

251
Q

What is scalenus anticus syndrome

A

Brachial plexus and subclavian artery compressed between scalenus anterior and medius

252
Q

What structures are at risk in a clavicle fratcure

A

Divisions of brachial plexus, subclavian artery and vein

253
Q

what is Klumpke’s palsy

A

Damage to C8/T1 > paralysis of intrinsic hand muscles (lumbricals and interossei). Loss of flexion at MCP and extension at IPJ Median nerve still active for flexor digitorums + radial nerve for extension
> claw hand

254
Q

What is Erb-Duchenne palsy

A

Damage to C5/6 (axillary and musculocutaneous) > paralysis of deltoid, biceps, brachialis > arm extended, forearm pronated, wrist flexed ‘waiters tip hand’

255
Q

Arm compartments and motor innervation

A

Posterior: radial
Anterior: median, ulnar, musculocutaneous

256
Q

Action of biceps brachaii

A

Flexion of elbow and shoulder, forearm supination

257
Q

Brachialis O, I, action

A

shaft of humerus to coronoid process of ulnar
elbow flexion

258
Q

Coracobrachialis O, I, action

A

coracoid process to shaft of humerus shoulder flexion and adduction

259
Q

biceps insertions

A

Long head: supraglenoid tubercle
Short head: coracoid process
> biceps tendon on radial tuberosity

260
Q

Tricpes insertions

A

Long head: infraglenoid tubercle
Medial head: medial to spiral groove
Lateral head: lateral to spiral groove
> olecranon

261
Q

Where is spiral groove and what runs in it

A

Posterior humerus, radial nerve and profunda brachii artery

262
Q

Would fracture of mid humerus damage tricep innervation

A

Radial nerve is damaged but branches to triceps occur early so no loss of innervation

263
Q

Sensory innervation of anterior and posterior arm/forearm

A

Anterior: medial and lateral cutaneous
Posterior: superficial radial

264
Q

Blood supply for anterior and posterior upper arm

A

Anterior: brachial artery
Posterior: profunda brachii artery

265
Q

Venous drainage of arm

A

Cephalic - lateral over biceps > subclavian
Basilic - medial > axillary v > subclavian

266
Q

What ligament holds radial head in radial notch

A

annular ligament

267
Q

Supinator innervation

A

Radial nerve

268
Q

Muscles of pronation and innervation

A

pronator teres and pronator quadratus
median nerve

269
Q

cubital fossa borders and contents L>M

A

brachioradialis, pronator teres, condyles of humerus
(TAN): biceps Tendon, brachial Artery, median Nerve

270
Q

What nerves are affected in a supracondylar fracture

A

Median, ulnar and radial nerves

271
Q

what nerve pierces supinator muscle

A

posterior interosseous nerve from radial

272
Q

Which nerve can be entrapped at the elbow by flexor carpi ulnaris?

A

ulnar nerve

273
Q

Blood supply of forearm

A

brachial > ulnar and radial > ulnar to ant and post interosseous arteries

274
Q

Brachial artery obstruction damages which structures

A

forearm flexors > Volkman’s ischaemic contracture

275
Q

Brachioradialis O, I, action, innervation

A

lateral supracondylar ridge to styloid process (radius), elbow flexion + supination, radial nerve

276
Q

What tendon is pisiform bone inside

A

flexor carpis ulnaris

277
Q

Flexor digitorum superficialis and profundus insertions

A

Superficialis splits at middle phalanx and flexes at proximal PIP joint
Digitorum inserts base of distal flex distal PIP joint

278
Q

Wrist drop is caused by

A

damage to radial nerve > superficial extensors of arm impaired

279
Q

Muscles for supination (innervation)

A

Brachioradialis (radial n), biceps (musculocutaneous n), supinator (radial n)

280
Q

Golfers elbow vs tennis elbow

A

Golf: medial epicondylitis
Tennis: lateral epicondylitis

281
Q

Colle’s fracture

A

Fall on outstretched hand can result in fracture of distal radioulnar joint - radius moves dorsally

282
Q

Contents of carpal tunnel

A

4 flexor digitorum superficialis tendons.
4 flexor digitorum profundus
1 flexor pollicis longus
Median nerve > compression = thenar atrophy

283
Q

What is Guyon’s canal

A

Thickened part of flexor retinaculum contains ulnar nerve > compression = hypothenar atrophy

284
Q

Snuff box borders and contents

A

Extensor pollicis longus, extensor pollicus brevis, abductor pollicis longus
radial artery

285
Q

What is Dupuytren’s contracture

A

Flexion of 4th and 5th fingers from palmar aponeurosis contraction

286
Q

Can infections spread from palmar spaces

A

No they are distinct from each other

287
Q

Lumbricals origin and insertion, action

A

Radial side of flexor digitorum profundus to dorsal digital extensor expansion
Flex at MCP, extend at interphalangeal joints (PIP/DIP) > pincer grip italian hand

288
Q

Can infections spread through synovial sheaths

A

yes only from thumb or little finger

289
Q

Blood supply to hand

A

Ulnar > superifical palmar arch > digital arteries
radial > deep palmar arch

290
Q

What is Allens test

A

Compress both ulnar and radial arteries then release one palm should go pink

291
Q

Which nerves are affected in following:
Claw hand
Wrist drop
Ape hand

A

Claw - ulnar from interossei and lumbricals
Wrist - radial
Ape - median from thenar atrophy

292
Q

How do wrist extensors improve a power grip

A

Wrist extension stretches the finger
flexors, allowing them to generate more
force
> radial nerve injury affects power grip

293
Q

What muscles insert on coracoid process

A

pect minor, coracobrachialis, short head of biceps

294
Q

Three ligaments of hip joint

A

Iliofemoral
Iliopubic
pubofemoral

295
Q

Blood supply to head of femur

A

Artery of ligament of head of femur (branch of obturator)
Retinacular arteries from lateral and medial femoral circumflex from profunda femoris

296
Q

Gluteus maximus OIAN

A

posterior gluteal line to iliotibial tract, extension (stepping up), inferior gluteal nerve

297
Q

gluteus medius and minimus

A

middle and inferior gluteal lines to greater trochanter, superior gluteal nerve
Medius - abduction
Minimus - int rotation

298
Q

Trendelenberg gait is from damage to what muscle

A

Gluteus medius

299
Q

Where is intragluteal injection
What nerve/vessel may be affected by this

A

upper lateral quadrant to avoid sciatic nerve.
superior gluteal n + a

300
Q

Lateral rotators of hip (6)
Insertions
Innervation

A

Piriformis, superior and inferior gemellus, obturator internus and externus, quadratus femoris
> greater trochanter
> sacral plexus exc obturator externus - lumbar plexus

301
Q

piriformis passes through

A

Greater sciatic foramen
sciatic nerve and inferior gluteal nerve below piriformis

302
Q

Nerves at hip joint - clinical significance

A

Femoral, obturator, sciatic - cross hip and knee, knee pain may be hip problem vice versa

303
Q

Why does neck of femur fracture result in externally rotated and shortened leg

A

Ext rotate: contraction of lat rotators and psoas
Shortened: contraction of m linking hip to femur - hamstrings, adductors, quads

304
Q

The hip joint ligaments primarily limit which hip movement

A

leg extension

305
Q

Overuse of which muscle is associated with trochanteric bursitis?

A

gluteus maximus

306
Q

motor innervation and action
ant thigh: quadriceps + pectineus and sartorius
medial thigh: adductors + pectineus
post thigh: Hamstrings (biceps femoris, semitendinosus, semimembranosus)

A

ant: Femoral nerve - knee extension, hip flexion
med: obturator nerve - adduction at hip
post: sciatic nerve - knee flexion/hip extension
Hamstring part of adductor magnus - sciatic
bicep femoris short head - fibular n
Biceps femoris long head - tibial n
pectineus - femoral (80%), obturator (20%)

307
Q

Femoral triangle borders and content
femoral sheath contents
femoral canal contents

A

sartorius, adductor longus, inguinal canal
Femoral nerve, artery, vein, lympathics,
great saphenous pierces fascia lata (roof) > femoral vein
femoral sheath: not nerve
canal: only lymph and fat - femoral hernia occurs here

308
Q

Is a lump below inguinal canal always a femoral hernia

A

No, could also be enlargement of saphenous vein (varix) or enlarged lymph node

309
Q

which muscle of anterior compartment of thigh arises from anterior femur

A

vastus intermedius

310
Q

rectus femoris O and I

A

Reflected head: acetabulum
straight head: AIIS
> via quadriceps tendon to patella to patella tendon to tibial tuberosity

311
Q

iliopsoas insertion

A

lesser trochanter

312
Q

pectineus O I

A

pectine of pubis to pectineal line on post femur

313
Q

adductor canal borders and contents

A

sartorius, adductor longus and vastus medialis. Contains femoral artery and vein, saphenous nerve

314
Q

anaesthetic into adductor canal blocks which nerve

A

saphenous

315
Q

posterior thigh compartment origin and insertion

A

ischial tuberosity to
biceps: head of fibula
semitendinosus: pes anserinus
semimembranosus: medial condyle of tibia

316
Q

adductor muscle origin and insertions

A

ischiopubis to linea aspera
adductor magnus inserts on linea aspera (adductor part) and adductor tubercle on medial femoral condyle (hamstring part)

317
Q

popliteal fossa contents

A

sciatic > tibial and common fibular
popliteal artery and vein

318
Q

which collateral ligament at knee attaches to meniscus

A

medial

319
Q

Damage to ACL and PCL causes

A

difficulty walking upstairs, and downstairs

320
Q

Which bursa can become inflamed with prolonged kneeling

A

Prepatellar

321
Q

Which bursa can become inflamed with repeated standing and kneeling

A

infrapatellar

322
Q

What happens if sudden articular pain (e.g cartilage gets squashed in knee joint)

A

Relax reflex - all leg muscles go weak / locks to prevent further movement

323
Q

weakness of oblique running vastus medialis can lead to

A

lateral patella tracking in knee extension

324
Q

Fracture of neck of fibula >

A

Damage to common fibular n > deep and superficial fibular nerves affected > ant and lat compartment muscles > foot drop > steppage gate

325
Q

What structures are at risk if anterior leg compartment increases (anterior compartment syndrome)

A

Anterior tibial artery, deep fibular nerve. Check sensation between toes 1+2.
Dorsalis pedis pulse affected

326
Q

Inversion sprain

A

Can avulse fibularis brevis, tear EDB, damage anterior talofibular ligament

327
Q

Rupture of Achilles

A

Can’t stand on tip toes but can plantar flex from tibialis posterior + FHL + FDL.
During repair - sural n at risk

328
Q

pes planus

A

Flat foot - from tibialis post, intrinsic foot muscles, stretch of plantar aponeurosis

329
Q

what causes leg varicosities

A

Failure of valves in superficial veins (greater saphenous - medial, ant to medial malleolus > femoral v + lesser saphenous - post leg > popliteal v) leads to build up of blood + pressure > distension of vein > varicosities

330
Q

how does DVT form
What can it lead to

A

Blood in deep veins is pushed to heart via muscle pump - inactivity leads to blood pooling > DVT > oedema
Clot can embolise and cause pulmonary embolism

331
Q

Where at foot does plantar/dorsi flexion occur
where does inversion and eversion occur

A

Ankle joint - hinge - talocrural - talus with fibula and tibia

subtalar (talus - calcaneus) and transverse tarsal joints

332
Q

tarsal tunnel contents

A

T - tibialis posterior
D - flexor Digitorum longus
A - post tibial artery
V - post tibial vein
N - tibial nerve > splits into lat and med plantar n
H - flexor Hallucis longus
> sensation to sole of foot

333
Q

Emergency venous access can be obtained at the ankle. Where at the ankle and to which vein?

A

Great saphenous, ant to medial malleolus

334
Q

What gait disorder is associated with damage to the common fibular nerve?

A

foot drop - steppage gait

335
Q

adductor hallucis can compress

A

medial plantar nerve creating medial toe plantar pain

336
Q

scalp layers

A

Skin
subCutaneous tissue
Aponeurosis - continuous with supraspinous ligament
Loose areolar tissue
Pericranium

337
Q

How do infections spread from scalp to meninges/dural venous sinus

A

via emissary veins

338
Q

Where does scalp avulsion occur

A

at loose areolar tissue

339
Q

Scalp blood supply

A

External carotid branches (post), internal carotid branches (ant), anastomose A-P and transversely

340
Q

Scalp pain can be from neuralgia of which nerves

A

trigeminal > Vc - mandibular branch (at ear) + Va - ophthalmic (ant head)
C2 > occipital (post head)

341
Q

Why can a blow to side of head cause death

A

Pterion is weak point where temporal, frontal, parietal bones join - middle meningeal artery passes under here > extradural haematoma (oval shaped)

342
Q

what can rupture of bridging veins cause e.g in shaken baby

A

subdural haematoma (banana shaped) (along side edge of skull)

343
Q

What can a ruptured aneurysm cause

A

subarachnoid > thunderclap headache (squiggly white line following contours of brain)

344
Q

What can happen if base of skull is fractured

A

damage to ant cranial fossa:
periorbital ecchymosis - racoon eyes
CSF rhinorrhea - runny nose

Damage to middle cranial fossa:
CSF ottorhea - fluid in ears

Damage to posterior cranial fossa:
mastoid ecchymosis - bruising at mastoid

345
Q

frontalis and occipitalis are connected via

A

epicranial aponeurosis

346
Q

Foramen ovale transmits

A

mandibular division of trigeminal n

347
Q

Foramen spinosum

A

Middle meningeal artery

348
Q

forceps in baby delivery can

A

compression of facial nerve as no mastoid process to protect
damage of SCM > torticollis

349
Q

Nerves of face

A

Motor; facial n for facial muscles,
mandibular division of trigeminal for mastication
Sensory: trigeminal and great auricular n (C2,3)

350
Q

How to examine inner eyelid

A

eversion of superior tarsal plate (flipping upper eyelid)

351
Q

Blow out fracture

A

Fracture of maxilla affects inferior oblique muscle, infraorbital nerve

352
Q

Extraocular muscles

A

take origin on common tendinous ring (exp inferior oblique - maxilla)

353
Q

why do you get a runny nose when crying

A

lacrimal fluid runs down nasolacrimal duct

354
Q

Blood supply to nose

A

Internal and external carotids anastomose at Little’s area/Kiesselbach’s plexus. Following vessels: ant+ post ethmoidal, greater palatine, sphenopalatine, facial

355
Q

How to treat intractable (chronic) rhinorrhoea

A

Cut the nerve of the pterygoid canal (vidians nerve) as it provides parasympathetic stimulation of mucus glands

356
Q

causes of hearing loss

A

blocked ear canal
damage to ossicles - otosclerosis
damage to hair cells or cochlear nerve - loud sound, aging, drugs, infections

357
Q

Cause of hyperacusis

A

Stapedius muscle (supplied by facial n) contracts to reduce ossicle movement)
> paralysis of stapedius - hyperacusis

Also acoustic neuroma lowkey

358
Q

what causes a depressed eardrum

A

Blockage of eustachian tube (connects middle ear to nasopharynx) causes -ve pressur in ear, pulls eardrum in

359
Q

What is an acoustic neuroma

A

tumour at internal acoustic meatus - schwannoma on vestibular part of vestibulocochlear nerve damages nerve > tinnitus (cochlear part), vertigo (vestibular part) , facial palsy, hyperacusis (if facial nerve also compressed)

360
Q

Otitis media can cause

A

middle ear infection >
superior spread - meningitis
medial spread - facial n palsy, vertigo (damage to semicircular canal)
posterior spread - mastoiditis, facial palsy,

361
Q

why are balance problems (labyrinthitis) often associated with hearing problems

A

because fluid in semicircular canals and cochlear are connected (utricle, saccule)

362
Q

Soft palate raised by muscles innervated by

A

vagus nerve (CNX)

363
Q

extrinsic tongue muscles supplied by

A

CN12 - hypoglossal exc palatoglossus (X - vagus)

364
Q

genioglossus function

A

protrudes tongue. Affected in a hypoglossal lesion

365
Q

at dentist what nerves are anesthetised

A

lingual and inferior alveolar nerves

366
Q

parotid gland is pierced by

A

horizontally: facial nerve
vertically: retromandibular vein, superficial temporal artery, great auricular nerve (sensation)
> do not cut vertically

367
Q

muscles of mastication

A

supplied by mandibular branch of trigeminal:
masseter
lateral pterygoid - can cause uneven jaw opening
medial pterygoid
temporalis

368
Q

Which structure is most likely to
block the posterior concha with
allergy/common cold?

A

inferior concha - covered by mucoperiosteum - erectile tissue + engorgement of vessels

369
Q

which gland opens into vestibule of mouth:
submandibular
parotid
sublingual

A

vestibule of mouth is gap between lips and teeth > parotid

Submandibular and lingual into oral cavity

370
Q

how does branchial cleft cyst form

A

remnant of pharyngeal cleft - along border of SCM

371
Q

what is thyroglossal fistula

A

thyroglossal duct opens in neck

372
Q

what is torticollis

A

birth injury > SCM scars and contracts > twisted head

373
Q

what is at risk in posterior triangle surgery

A

accessory nerve which lies on levator scapulae

374
Q

Where to get emergency airway access

A

through cricothyroid cartilage > trachea

375
Q

cough from post nasal drip caused by

A

superior laryngeal nerve

376
Q

pharyngeal pain can be referred to

A

ear by CN9 - glossopharyngeal and CN10 - vagus

377
Q

Cricopharyngeus forms physiological sphincter

A

in muscle wasting disease > swallowing problems

378
Q

Name two major pelvic ligaments that prevent forward tipping of the sacrum (sacral nutation)

A

Sacrotuberous and sacrospinous ligaments

379
Q

Along which plane do the ASIS and pubis align in the pelvis of an erect individual?

A

Coronal/frontal

380
Q

The posterior superior iliac spines are marked by 2 dimples on the back. For which joint are they a surface landmark?

A

sacroiliac joint

381
Q

Apart from the testicular artery, which other artery is found in the spermatic cord

A

cremasteric artery

382
Q

Which nerve in the spermatic cord is responsible for the pain felt on direct pressure over the spermatic cord?

A

ilioinguinal nerve

383
Q

Explain how a tear in the tunica albuginea and subsequent scarring can lead to curvature of the erect penis (Peyronie’s disease).

A

scarred tunica albuginea is not elastic, does not expand during an erection

384
Q

Which nerve would be at risk if the posterior portion of deltoid were injected?

A

axillary

385
Q

Which anterior thigh muscles can flex the hip as well as extend the knee?

A

rectus femoris crosses both joints

386
Q

A football player kicks the ground instead of the ball and immediately gets a pain in the groin.
Which muscle may have avulsed?

A

Rectus femoris - hip flexion is suddenly stopped

387
Q

type of joint is tibiofibular

A

proximal tibio-fibular joint is plane
distal - syndesmosis

Year 2 Session 2 (4 decks)

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