ana surge 3 Flashcards
Boundary between CNS and PNS
Anterior horn cells
Connects the R and L brain
Corpus callosum
Most inferior part of the brain
Cerebellar tonsils
Broca’s Area
Brodmann 44,45 - opercular/triangular parts of inferior frontal gyrus
Wernicke’s Area
Brodmann’s Area 22 - superior temporal gyrus
Major arteries in 4 vessel angiography
R and L internal carotids, R and L vertebral arteries
White matter and Gray matter: brain vs spinal cord
Brain - white inside, grey outside. Spinal Cord - white outside, grey inside.
Total number of bones in the skeletal system
206
Cube shaped bones that contain mostly spongy bone
Short bones - carpals, tarsals
Shaft of the bone
Diaphysis - compact bone
Ends of the bone
Epiphysis - spongy bone
Decreases friction at joint surfaces
Articular cartilage - made of hyaline cartilage
Gives rise to the bone, cartilages and muscle
Mesoderm
Classification of joints based on mobility
Synarthroses - immoveable. Amphiarthroses - slightly moveable. Diarthroses - freely moveable.
Example of pivot joints
C1 and C2
Examples of fibrous joints
Sutures, syndesmoses
Example of cartilaginous joints
Pubic symphysis, intervertebral joinys
Gomphosis is what kind of joint?
Tooth and socket of mandible and maxilla - synarthrosis/immoveable fibrous joint
Kind of synovial joint: wrist
Ellipsoidal
Synovial joint: carpometacarpal of thumb
Saddle
Synovial joint: shoulder, hip
Ball and socket
Synovial joint: atlantoaxial, radioulnar
Pivot
Structures covered by axillary fascia
Axillary vein, axillary artery, brachial plexus
Weakest area of rotator cuff muscles
Inferior, prone to dislocation - axillary nerve affected
Muscles innervated by suprascapular nerve
Supraspinatus (adbuctor), Infraspinatus (lateral rotator)
Muscles innervated by the axillary nerve
Teres minor (lateral rotator), Deltoid (abductor)
Most commonly inflamed rotator cuffuscle
Supraspinatus - pain during abduction
Medial rotator of the shoulder
Subscapularis - upper subscapular nerve
Borders of Quadrangular space that contains the axillary nerve and posterior circumflex humeral vessels
Above - teres minor, below - teres major, medial - long head of triceps brachii, lateral - surgical neck of humerus
Injury to musculocutaneous nerve
Difficulty flexing arm and supinating forearm
Triceps brachii innervated bu?
Radial nerve
All flexor muscles of the forearm are innervated by the median nerve except?
FCU (superficial) and FDP (deep) - Ulnar nerve
2 innervations of FDP in the arm
Lateral side - median nerve, Medial side - ulnar nerve
Medial epicondyle of humerus: origin of?
FLEXOR tendon - pronator teres, FCR, palmaris longis, FCU, FDS
Lateral Epicondyle of Humerus: origin of?
EXTENSOR tendon - ECRB, ED, EDM, ECU, Anconeus, Supinator
Innervation of extensor muscles of forearm
Radial nerve
Roots of the Brachial Plexus
C5, C6, C7, C8, T1
Innervation of serratus anterior muscle
Long thoracic nerve - C5 to C7 roots of brachial plexus
Origin of musculocutaneous nerve
Lateral cord of brachial plexus (C5-C7) - anterior flexors of arm and supination of forearm
Origin of axillary nerve
Posterior cord (C5 and C6) - supplies deltoid and teres minor
Origin of Radial Nerve
Posterior cord (C5,C6,C7,C8,T1) - supplies extensor muscles of arm and forearm
Origin of thoracodorsal nerve
Posterior cord (C6,C7,C8) - innervates latissimus dorsi
Lesion of C5 and C6 in superior trunk of brachial plexus
Erb Duchenne’s syndrome - “waiter’s tip”
Lesion in the C8 and T1 ventral rami in the inferior trunk of the brachial plexus
Klumpke’s Paralysis - ape hand and a claw hand
Area where long thoracic nerve is commonly injured
Courses superficial to the serratus anterior - lateral wall of thorax (radical mastecty, stab wounds)
Long thoracic nerve injury
Winging of scapula
Lesion results to difficulty elevating the trunk or using a crutch
Thoracodorsal nerve lesions - latissimus dorsi muscle affected
Nerve lesion due to spiral fracture of the midshaft of the humerus
Radial nerve - wrist drop
Proximal median nerve lesion
Hand of Benediction - supracondylar fracture of the humerus
Distal median nerve lesion
Ape hand or weakness in opposition of fingers - carpal tunnel syndrome/lunate dislocation
Ulnar nerve distal lesion
Claw hand or weakness in the ability to abduct and adduct fingers (hold a piece of paper in between fingers) - fracture in hook of hamate
Divides the axillary artery into 3 parts
Tendon of pectoralis minor
Branch of 3rd part of axillary artery that supplies the anterior serratus muscle
Thoracodorsal artery
Most commonly fractured bone in the body
Clavicle - first to begin ossification, last to complete ossification
Colles vs Smith Radial Fractures
Colles - silver fork deformity, distal segment posteriorly displaced. Smith’s - distal segment anteriorly displaced.
Total number of carpals per hand
8
Pain and tenderness over anatomical snuffbox
Scaphoid fracture - most commonly fractured
Anterior dislocation may cause carpal tunnel syndrome
Lunate - most commonly dislocated
Fracture at the base of the first metacarpal bone
Bennett’s fracture
Fracture at the necks of the 2nd and 3rd metacarpals
Boxer’s fracture
Nerve compressed in carpal tunnel syndrome
Median nerve
Muscle that flexes distal IP joints
Flexor digitorum profundus
Innervation of thenar and hypothenar muscles
Thenar - median nerve. Hypothenar - ulnar nerve.
Lymphatic drainage of R head and neck/R thorax/ R upper limb
Right lymphatic duct that drains to R brachiocephalic. The rest is drained by thoracic duct that drains to L brachiocephalic.
Anterior thigh muscles innervation
Femoral nerve
Posterior thigh muscles innervation
Sciatic nerve
Medial thigh muscles innervation
Obturator nerve
Strongest flexor of thigh and hip joint
Iliopsoas or Psoas major
Tensor fascia lata innervation
Superior gluteal nerve - muscle is part of anterior thigh muscles
Quadriceps femoris muscle that crosses above the hip joint
Rectus femoris - flexes hip joint
Origin of Sartorius
ASIS
Origin of rectus femoris
AIIS
Insertion of iliacus and psoas
Lesser trochanter of femur
Insertion of quadriceps femoris
Patellar tendon
Dual nerve innervation of Adductor magnus (medial thigh muscle)
Medial or adductor part - obturator nerve. Posterior or hamstring part - sciatic nerve.
Insertion of adductor muscles
Linea aspera of femur
Insertion of hamstring part of adductor magnus
Adductor tubercle of femur
Innervation of semitendinosus and semimembranosus (hamstring muscles)
Tibial division of sciatic nerve
Common origin of hamstring muscles
Ischial tuberosity
Contents of Adductor canal (Subsartorial canal/Hunter’s canal)
Femoral artery and vein, saphenous nerve, nerve to vastus medialis
Innervates gluteus medius, minimus and tensor fascia lata
Superior gluteal nerve
Innervates gluteal maximus
Inferior gluteal nerve
Abductor and medial rotator of thigh
Gluteus medius and minimus
Extensor of thigh
Gluteus maximus
Common origin of gluteal muscles
Outer surface of ilium
Insertion of gluteus maximus
Gluteal tuberosity, along iliotibial tract
Insertion of quadratus femoris
Quadrate tubercle
Lateral rotators of thigh
Piriformis, obturator internus, superior and inferior gemelli, quadratus femoris
Formed within the Psoas major muscle by the ventral rami of L1-L4
Lumbar Plexus
From L1, supplies skin on the lower part of anterior abdominal wall
Iliohypogastric nerve - from lateral border of Psoas
From L1, supply skin of the groin and scrotum/labia majora
Ilioinguinal nerve - lateral border of psoas muscle
From L1 and L2, genital branch (cremaster muscle) and femoral branch (skin on thigh)
Genitofemoral - anterior surface of psoas muscle
From L2 and L3, skin over lateral surface of the thigh
Lateral femoral cutaneous nerve - lateral border of psoas
Nerves in lumbar plexus that emerge from the lateral border of the psoas muscle
Iliohypogastric, ilioinguinal, lateral femoral cutaneous, femoral nerves
Largest branch of the lumbar plexus
Femoral nerve
Formed by anterior rami of L4 and L5 and S1-S4. Located in front of the piriformis muscle
Sacral plexus
Branches of the sacral plexus to the lower limb leave the pelvis through the?
Greater sciatic foramen
Largest nerve in the body. From L4-S3.
Sciatic nerve
Lesion: difficulty climbing stairs or rising from a sitting position
Inferior gluteal nerve - gluteus maximus
Nerve that can be damaged with an abscess in the psoas major
Femoral nerve - dimished patellar tendon reflex
Nerve lesion: pain and paresthesia in the medial aspect of the leg and foot, no weakness
Saphenous nerve
Femoral neck shaft angle changes
Coxa vara - decreased. Coxa valga - increased.
Major supply of femoral head that prevents avascular necrosis
Medial femoral circumflex artery
Thigh is shortened and externally rotates
Fracture of the neck of the femur
Thigh is shortened and internally rotated
Posterior dislocation of the femoral head - sciatic nerve may be compressed
Innervation of anterior leg muscles
Deer peroneal nerve - dorsiflexion and extension
Innervation of lateral leg muscles
Superficial peroneal nerve - plantar flexion and eversion
Innervation of posterior leg muscles
Tibial nerve - plantar flexion and flexion
Muscles that invert the foot
Tibialis anterior (deep peroneal nerve), Tibialis posterior (tibial nerve)
Innervated by tibial nerve that unlocks the knee
Popliteus
Innervation of muscles of the sole
Lateral plantar nerve
Muscles of the sole innervates by medial plantar nerve
Abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, 1st lumbrical
External iliac artery crosses the inguinal ligament to become the?
Femoral artery
Landmark for dorsalis pedis pulse
Between malleoli or 1st intermetatarsal space
Nerve lesion: foot drop
Common peroneal nerve or common fibular nerve - cannot dorsiflex foot while walking
Leg muscle that everts the foot
Peroneus - superficial peroneal nerve
Most frequently injured nerve in the lower limb
Common peroneal / Fibular nerve
Nerve lesion: cab’t stand on tip toes
Tibial nerve
Knee joint: synovial gliding joint
Between patella and femur
Knee joint: synovial hinge joint
Between femur and tibia
Prevents posterior displacement of the femur on the tibia
ACL - lax during flexion, from anterior aspect of tibia to lateral condyle of femur
Prevents anterior displacement of the femur on tibia
PCL - lax during extension, from posterior aspect of the tibia to the medial condyle of femur
Injury to ACL, MCL, and medial meniscus
Unhappy triad of O Donoghue - violent blow on lateral side of knee, leg is abducted and laterally rotated
Rupture of the medial/tibial collateral ligament
Knock knee or genu valgum
Rupture of the lateral or fibular collateral ligament
Bowleg or genu varum
Injured ankle ligament in inversion injury
Anterior talofibular ligament
Avulsion of the tuberosity of the 5th metatarsal
Jones Fracture
Eversion injury or Pott Fracture
Avulsion of medial malleolus, fracture of the fibula due to the lateral movement of the talus
Total number of bones in the skull
22
Skull fracture at pterion
May lacerate middle meningeal artery (epidural hematoma), medial part of temporal lobe herniation (compress brainstem)
Fracture on petrous portion of temporal bone
Blood or CSF escapes from ear
Fracture on anterior cranial fossa
Fracture of cribriform plate (CN 1) - anosmia, raccoon eyes, CSF leakage from nose
General term for premature closure of suturs
Craniosynostosis
Premature closure of sagittal suture
Scaphocephaly - long and narrow skull
Premature closure of coronal suture
Oxycephaly or Acrocephaly - short, high skull “tower skull”
Premature closure of coronal and lambdoid sutures on 1 side of the skull
Plagiocephaly
Primary brain vesicles
Forebrain - Prosencephalon. Midbrain - Mesencephalon. Hindbrain - Rhombencephalon.
Division of prosencephalon and rhombencephalon
Happens on 5th week
Derivatives of brain vesicles: Telencephalon
Cerebrum
Derivatives of brain vesicles: diencephalon
Thalamus
Derivatives of brain vesicles: mesencephalon
Midbrain
Derivatives of brain vesicles: metencephalon
Pons, cerebellum
Derivatives of brain vesicles: myelencephalon
Medulla
Closure of neural tube happens on the?
4th week
Neural crest derivatives
Pigment cells of retina, cells of adrenal medulla
Meninges of brain and spinal cord
Dura mater, arachnoid mater, pia mater
Arterial supply of dura mater
Middle meningeal artery
Danger area of the scalp
Loose connective tissue - contains emissary veins where infection can spread
Sickle shaped fold of dura mater that lies in the midline between 2 cerebral hemispheres
Falx cerebri
Crescent shaped fold of dura mater that roofs over the posterior cranial fossa
Tentorium cerebelli - supports the occipital lobes
Inmervation of dura mater
Above the tentorium - trigeminal nerve. Below the tentorium - first 3 cervical nerves.
Vascular membrane that closely invests the brain covering the gyri and descending into the deepest sulci
Pia mater
Lobes of the cerebrum
Frontal - motor. Parietal - somesthetic. Occipital - visual. Temporal - hearing.
Pyramidal System: voluntary control of skeletal muscles
Corticobulbar, Lateral corticospinal, Anterior corticospinal
Signs of UMN lesions
Spastic paralysis, (-) atrophy, (-) fasciculations, (+) clonus, (+) pathologic reflexes, increased muscle tone
Signs of LMN lesion
Flaccid paralysis, (+) atrophy, (+) fasciculations, (-) clonus, (-) pathologic reflexes, decreased muscle tone
Cerebellar lobe: coordination of limb movements and regulation of muscle tone
Anterior lobe - Paleocerebellum or Spinocerebellum
Cerebellar lobe: coordination of voluntary movements
Posterior lobe - Neocerebellum or Cerebrocerebellum
Cerebellar lobe: coordination of para-axial muscles associated with equilibrium
Floculonodular lobe - Archicerebellum
Signs of lesions in posterior lobe
Ataxia, Dysmetria, Dysdiadochokinesia
Failure to recognize stimuli perceived by senses
Agnosia - visual, tactile or auditory
Motor disability, inability to carry out learned or purposive movements
Apraxia
Production of CSF found in subarachnoid space
Choroid plexuses
Dopamine is secreted by the?
Substantia nigra in the basal ganglia
Movement disorders: negative vs positive signs
Negative - actions that the patient wants to perform but cannot. Positive - actions the patient does not want to perform but cannot prevent.
Abnormalities here will result to movement disorders
Basal ganglia
Another name for Parkinson’s disease
Paralysis agitans - degeneration of substantia nigra
Degeneration of striatal neurons and depletion of Acetyl CoA
Chorea - involuntary, irregular, jerking movements
Results from damage to the contralateral subthalamic nucleus
Hemiballismus
“Kissing muscle”
Orbicularis oris - CN VII
Loss of taste and common sensation of tongue posteriorly
CN IX - glossopharyngeal
Hemiparalysis of the tongue, deviation towards the weak side
CN XII - hypoglossal nerve
Muscle that divides the subclavian artery into 3 parts
Scalenous anterior
Most common locations of berry aneurysms
Circle of Willis - ACA, PCA, MCA
Development of facial muscles
Mesoderm in the 2nd pharyngeal arches
Smiling muscle
Zygomaticus - CN VII
Grinning muscle
Risorius - CN VII
Blowing or “trumpeteer’s muscle”
Buccinator - CN VII
Formed by the union of the superficial temporal and maxillary veins
Retromandibular vein
Anterior branch of retromandibular vein
Joins the facial vein to form the common facial vein
Posterior branch of retromandibular vein
Joins the posterior auricular vein to form the external jugular vein
Innervation of muscles of mastication
CN V - Trigeminal nerve
Muscle of mastication that opens the jaw
Lateral Pterygoid
Muscle that closes the eyelids
Orbicularis oculi - CN VII facial nerve
Nerve lesion: jaw deviates to the weak side
CN V - trigeminal nerve
Divides the tongue into R and L halves
Median groove or median sulcus
Divides the tongue into anterior and posterior parts
V shaped sulcus terminalis
Remnant of thyroglossal duct thats marks the apex of the tongue
Foramen cecum
Only muscle of the tongue innervated by Vagus nerve
Palatoglossus
Innervation of extraocular muscles
CN III, except LR 6 and SO 4
Lesion in oculomotor nucleus and nerve
Eyeball down and out
Lesion in abducent nucleus and nerve
Medial deviation or esotropia and paralysis of abduction of the ipsilateral eye
Lesion in trochlear nucleus and nerve
Outward rotation of the superior part of eye, compensated by tilting of the head
