Anathomy Flashcards
Where do the uterus, bladder and genitals drain to?
Uterus, superior bladder: External iliac
Inferior bladder, cervix, prostate, upper 2/3 vagina, corpus cavernosum: Internal iliac
Lower 1/3 vagina, vulva, SCROTUM* and anus (bellow dentate line): superficial inguinal. *The scrotum drains to the superficial inguinal, just the testes drain to the paraaortic
Superficial inguinal drain all skin form the umbilicus to the feet except: penis glans, clitoris, posterior calf that drain to the deep inguinal
Testes and ovary, uterus, prostate, corpus cavernosum, cervix, vagina, scrotum, vulva, anus, penis glans and clitoris drain to:
Testes/ ovary: paraaortic lymph nodes
Uterus: external iliac
Prostate and corpus cavernosum/ cervix: internal iliac
Vagina, proximal: internal iliac
Vagina, distal: inguinofemoral=superficial inguinal
Scrotum, vulva and anus: inguinofemoral=superficial inguinal
Penis glans/ clitoris: deep inguinal
Where do different parts of the colon drain to?
Cecum and appendix: Ileocolic
Ascending and proximal transverse: Superior mesenteric
Descending colon, sigmoid and upper rectum: Inferior mesenteric
Middle and lower rectum, and anus ABOVE pectinate: Internal ILIAC A!
Anus below pectinate: Superficial inguinal
Myelination in CNS (including II craneal nerve)
Oligodendrocytes
Myelination in PNS
Schwann cells
Layers that the needle of a lumbar puncture passes through
SSS I LED AS
Skin Superficial and deep fascia Supraspinous ligament Interspinous ligament Interlaminar space (Ligamentum flavum laterally) EPIdural space (anesthesia) Dura ARAchnoid Subarachnoid space (CSF)
- Steroid injection in the intervertebral foramen is used to decrease the pain in disc herniation
Right to left shunt generates
Cyanotic conditions
Left to right shunt generates
Non-cyanotic conditions
SA and AV node get blood supply from
SA node always from the right coronary
AV node from the posterior descending artery (most of the time from the right coronary but depends on dominance) ‘Get to A is more complicated’
Horner’s sd. sings:
Ipsilateral:
Ptosis
Miosis
Anhydrosis
Anterograde axonal transport is mediated by:
Kinesin (used by HSV1)
Retrograde axonal transport is mediated by:
Dynein
Unilateral lesion to the descending hypothalamic fibers generates:
Horner sd
The entire right border of the heart space on the thorax corresponds to:
The right atrium and right ventricle
The left border of the heart space on the thorax corresponds to:
The left ventricle
The entire posterior wall and some left border of the heart space on the thorax corresponds to:
The left atrium
Most of the anterior wall of the heart space on the thorax corresponds to:
The right ventricle!!
In tricuspid stenosis we hear:
A diastolic murmur
In tricuspid insufficiency we hear:
A systolic murmur
In aortic stenosis we hear:
A systolic murmur
In aortic regurgitation we hear:
A diastolic murmur
Tetralogy of Fallot defects:
Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hypertrophy
Lunate most frequent injury:
Anterior dislocation in the carpal tunnel (median n =( )
Scaphoid most frequent injury:
Fracture, vessels are distal so proximal head can undergo avascular necrosis
Causes pain and tenderness!! at the anatomic snuffbox, RADIAL wrist
Tract that carries pain and temperature in the spinal chord:
Spinothalamic tract or ALST (anterior-lateral spinal tract)
It decussates as soon as it gets to the medulla
What goes on the posterio-lateral spinal system?
The spinocerebellar tract
Tract that carries touch and propioception in the spinal chord:
Dorsal column-medial lemniscus tract:
Divided into fasciculus gracilis (medial, lower limb) and fasciculus cuneatus (lateral, upper limb)
Same distribution as cortico-spinal tract
Information carried by the cortico-spinal tract:
There is an anterior and lateral (pyramidal) portion
Carries upper motor neuron information
What is the most frequent location of a berry aneurism?
The brach between the anterior communicating A and the anterior cerebral A.
If patient comes with winged scapula, weakness in abduction of the arm above 100 degrees and NO SHOULDER DROP, the problem is in:
Long thoracic nerve (C5-C7)
Serratus anterior muscle
or Lateral thoracic artery
Serratus anterior muscle lesion will also make the patient unable to push with the affected limb
If patient comes with winged scapula, impossible shrugging of the shoulder, weakness in abduction of the arm above 90 degrees and SHOULDER DROP, the problem is in:
The accessory n. (CN11)
or trapezius muscle
‘To access trabajo’ you need to go above 90deg
Loss of abduction and external rotation of arm (WAITER TIP) indicates injury of and can be caused by:
Upper trunk injury (proximal) caused by big separation of head and shoulder on tx/baby delivery
If patient comes with weakness in extension and MEDIAL ROTATION of the arm, the problem is in:
Thoracodorsal nerve (middle SUBscapular) or Latissimus dorsi muscle
SUPRAscapular nerve/ supraspinatus m. damage causes:
Loss of shoulder abduction between 0-15 DEGREES (initiates)
Weakness of lateral rotation of the shoulder
Loss of abduction of the arm after HUMERUS FRACTURE or dislocation indicates a damaged:
Axilary nerve
Axilary nerve damage causes:
Loss of abduction of the arm to the horizon
Loss of lateral rotation of the arm
LOSS of sensation over the DELTOID muscle
Limits of the femoral triangle:
Above: inguinal ligament
Lateral: sartorious
Medial: adductor longus
The ventral mesentery forms:
Falciform ligament that contains the ligamentum teres Lesser omentum (gastrohepatic + hepatoduodenal ligaments)
Is the gastrohepatic lig the one that needs to be cut to go into the lesser sac because the hepatoduodenal contains the portal triad
The septum transversum gives rise to:
The central tendon of the diaphragm
The time of embryonic development most susceptible to teratogenesis is:
During 3rd-9th weeks when organogenesis occurs
What is the most common ankle sprain? and the second most common?
Inversion (lateral stretch):
Lesion of the ANTERIOR talofibular (1st to break), calcaneofibular (2nd) ligament and posterior talofibular (3rd)
Can fracture the LATERAL malleolus
Eversion:
Can fracture the MEDIAL malleolus ± the fibula: Pott’s fracture
Right shoulder C3-C5 referred pain can come from:
Liver and gallbladder
Left shoulder C3-C5 referred pain can come from:
Heart and diaphragm!
Most frequent lesion in lateral blows to the knee:
The unhappy triad: MAMM
Medial collateral ligament
Anterior cruciate ligament
Medial meniscus (recent studies say that is actually the lateral meniscus the one that gets injured more often)
Ligaments on the visceral surface of the liver:
Ligamentum venosum (ductus venosus remanent) Round ligament/lig. teres (umbilical vein remanent)
What are Nissl bodies?
Rough endoplasmic reticulum in cell body and proximal dendrites of neurons
Aspiration pneumonia is more frequent in:
Supine: SUPERIOR segment of the right lower lobe or
Lateral decubitus: posterior segment of the right UPPER lobe
The fetal allantoic duct becomes:
The urachus or mediaN umbilical ligament
allaNtoid=mediaN; just one in the Niddle
Typical presentation of a fracture of the femoral neck:
One of the legs appears shortened and externally rotated
The umbilical arteries give rise to:
MediaL umbilical ligaments
The umbilical arteries come form the internal iliac A. the proximal portion irrigates the bladder and the other portion gives the MediaL umbilical ligaments (right and left)
The allantois gives rise to:
Urachus or mediaN umbilical ligament
DiGeorge sd. results form a maldevelopment of:
3rd and 4th pharyngeal pouches
3rd gives rise to the inferior parathyroid and thymus and 4th to the superior parathyroid
Structures at risk of injury during thyroideconomy:
In ligation of the superior thyroid artery:
Superior laryngeal n. that innervates the PHARYNX contratrictor M. + the cricothyroid m. + the levator veli palati m. and gives supraglottic sensation (laryngeal mucosa above the vocal folds)
The PHARYNX mucosa is actually ineervated by CN 9
In ligation of the inferior thyroid artery:
Recurrent laryngeal n. that innervates the m. of the LARYNX and the laryngeal mucosa below the vocal folds
Organization inside the femoral region:
From lateral to medial:
NAVEL (nerve-artery-vein-empty-lymphatics)
On the empty space is where femoral hernias come out so the femoral V. is immediately lateral to them
Where is aldosterone secreted:
On the zona glomerulosa of the adrenal cortex
Where is cortisol secreted:
On the zona fasciculata of the adrenal cortex
Where is testosterone secreted on the adrenal?
On the zona reticularis of the adrenal cortex
Wrist drop indicates injury of the:
Radial n.
Loss of extension
Impairment of thing adduction and medial thigh sensory loss indicates injury of:
The obturator n.
The obturator adducts (adductor longus) and the gluteus (medius and minimus) abduct!
Impairment of thigh flexion and knee extension and upper thigh and inner leg sensory loss indicates injury of what structure? Where can be injured?
The femoral n, the fEmoral EXTENDS the knee (decreased patellar reflex if injury)
Can get injured during pelvic sx. or passing on to of the psoas (retroperitoneal hematoma, TB…)
The saphenous n. (femoral brach that innervated the skin of the MEDIAL LEG) can get injured at the medial femoral condyle
The lateral femoral cutaneus n. (femoral branch that innervates the skin of the LATERAL tight) can get injured because of lateral pressure (fat, tight clothes, pregnant, pelvic sx, long time in lateral decubitus). DD with fibular n lesion due to marked indentation on the fibular neck, lateral area below the knee
Impairment of foot dorsiflexion (foot drop) and eversion and lateral shin and dorsal foot sensory loss indicates injury of what structure? Where can be injured?
The common peroneal n.
Can get injured at the neck of the fibula
Impairment of foot inversion and plantar flexion and foot sole sensory loss indicates injury of what structure? Where can be injured?
The tibial n.
Injuries:
Proximal:
At the medial malleolus!!! or by a baker cysts
loss of anche flexion and inversion (can’t stand on tiptoes)
Distal: tarsal tunnel sd: loss of sensation of the plantar foot and loss of toe flexion
Impairment of knee flexion, foot dorsiflexion (foot drop) and plantar flexion and lateral shin and foot sensory loss indicates injury of:
The sciatic n.
Optic radiations on the temporal lobe, location, information and destiny:
Lower optic radiations with information form the UPPER visual field.
Travel into the Meyer’s loop to the lingual gyrus.
UP->Temporal, pie in the sky
Associated with Wernicke aphasia
*Remember if they are asking about the retina instead of the visual field temporal becomes nasal and nasal becomes temporal and up-down inverted (here will affect the lower retina)
Optic radiations on the parietal lobe, location, information and destiny:
Upper optic radiations with information form the LOWER visual field.
Travel into Baum’s loop, dorsal optic radiation to the cuneus gyrus.
DOWN-> Parietal, pie in the floor
*Remember if they are asking about the retina instead of the visual field temporal becomes nasal and nasal becomes temporal and up-down inverted (here will affect the upper retina)
Wrist drop indicates injury of and can be caused by:
Radial n. caused by crutch/Saturday night palsy
Midshaft fx of the humerus
Supracondylar humerus fx with lateral displacement
Loss of thumb flexion and opposition indicates injury of and can be caused by:
Median n. caused by compression at the carpal tunnel
Loss of flexion of 2 and 3 fingers (benediction/ preacher’s) and hand ulnar deviation indicates injury of and can be caused by:
Median n. caused by supracondylar humerus fx with medial displacement
Loss of flexion of 4 and 5 fingers, loss of thumb adduction and hand radial deviation indicates injury of and can be caused by:
Ulnar n. caused by n. compression in the humerus epicondyle or at the Guyon’s canal
Loss of flexion of 2-5 fingers (Klumpke’s) indicates injury of and can be caused by:
Lower trunk injury (distal, median + ulnar) caused by upward traction on arm
The phrenic n. arises from and how can be injured?
C3-C5; can be injured when the anterior scalene is incised to treat thoracic outlet sd.
From which arteries do mitral valve papillary muscles receive irrigation?
Anterolateral: LAD+LCX
Posteromedial: RCA only, posteromedial muscle ruptures more frequently because it only has one source of blood supply, hence RCA occlusion can cause papillary muscle rupture
Muscles in the thenar eminence that get injured by compression of the median n. at the carpal tunnel:
Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis
(the abductor pollicis longus is on the arm)
In which side is varicocele more frequent? Why?
On the left side because the left testicular vein drains into the left renal vein (not in the IVC)
Esophageal portocaval anathomosis is between:
Left gastric vein and esophageal vein
Anorectal portocaval anathomosis is between:
Superior rectal vein and middle+inferior rectal veins
Caput medusae portocaval anathomosis is between:
Paraumbilical veins and superficial+inferior epigastric veins
Define Chiari I malformation:
Cerebellar tonsils herniate trough the foramen magnum
Define Chiari II malformation:
Cerebellar vermis and tonsils herniate trough the foramen magnum
Define Dandy-Walker malformation:
Cerebellar vermis doesn’t form and the 4th ventricle becomes big
Nerve affected in acromegaly:
Median n. because of wrist overgrowth compressing the carpal tunnel
Nerves in the brachial plexus form above to bellow:
MARMU: Musculocutaneous Axilary Radial Median Ulnar
What nerve passes trough the foramen ovale? where is it blocked?
Mandibular, V3
But it is blocked at the Mental foramen
What nerve passes trough the foramen rotundum? where is it blocked?
Maxillary, V2
But it is blocked at the Infraorbital foramem
What nerve passes trough the superior orbital fissure (made by the sphenoid)? where is it blocked?
3, 4, 5 (V1, ophthalmic), 6 and ophthalmic veins
But it is blocked at the supraorbital foramen
What nerves pass trough the jugular foramen?
9, 10 and 11
Glossopharyngeal
Vagus
Accessory
Name two yolk sac derivatives:
Primordial germ cells
Early blood cells and blood vessels
Name neural crest derivatives:
Adrenal medulla -cortex meso- PNS (Schwann cells, autonomic ganglia, dorsal root ganglia) Melanocytes Pia and arachnoid -dura meso- Odontoblasts Aorticopulmonary septum Endocardial cushions Cartilage, ligaments and bones form arches
Name neuroectoderm derivatives:
CNS (posterior pituitary-anterior ecto-, all glia except microglia -meso-…)
Name ectoderm derivatives:
Skin, hair... Inner and external ear Anterior pituitary-posterior neuroecto- Parotid CN9-submandibular and sublingual endo 7- Anal canal bellow pectinate line
What nerve passes trough the optical canal?
2 and ophthalmic A.
What nerve passes trough the internal auditory meatus?
7, 8
Facial
Vestibulocloclear
All the facial enters the facial canal via the internal auditory meatus. Exits the skull by:
Main: stylomastoid foramen
Greater petrosal branch: pterygoid canal
Chorda tympani: petrotympanic fissure
Anterior wall abdominal layers:
Skin Camper fascia Scarpa fascia External oblique Internal oblique Transversus abdominis Transversalis fascia Extraperitoneal connective tissue Parietal peritoneum
CSOT: Camper Scarpa Obloques Transvers
Which embryological structure gives rise to the glomeruli?
Metanephric mesenchyme or blastema
Which embryological structure gives rise to the ureters, pelvises, collecting ducts (all kidney canaliculi)?
Ureteric bud, metanephric bud or metanephric diverticulum. If fails to develop we get renal agenesis
What is the only laryngeal muscle that is not innervated by the recurrent laryngeal nerve?
Cricothyroid m. (innervated by the superior laryngeal n.). It stretches and adducts the vocal ligaments
The superior laryngeal n. also gives sensory innervation to the supraglottic area, larynx mucosa above the vocal folds
Humeral mid-shaft fracture can lead to:
Wrist extension/ drop due to radial n. injury
What structures cross the diaphragm at T8?
IVC
Right phrenic n.
What structures cross the diaphragm at T10?
Esophagus
Vagus (10)
What structures cross the diaphragm at T12?
Aorta
Azygos v.
Thoracic duct
Course and relationships of the ureter:
Under the gonadal A.
Over the common/ external iliac A. (around the bifurcation)
Over the internal iliac A.
Under the uterine A. and vas deferens
OVER THE ILIAC AND UNDER THE UTERINE!
Function of the infraspinatus and teres minor muscles:
Lateral (external) rotation
Function of the subscapularis muscle:
Medial (internal) rotation
Which aneurysms tend to compress the CN3?
Which aneurysms tend to compress the optic chiasm? Which visual defect would you have?
Posterior communicating aneurysms, the posterior cerebral and superior cerebellar can also compress it because it comes out between the two very close to the basilar (can also compress it)
Internal carotid aneurysms compressing the non crossing fibers of the IPSI nasal visual field (ipsi temporal retina)
What structure is at greatest risk of injury during radical prostatectomy?
The pelvic parasympathetic nerves
Muscles that flex the elbow and innervation:
Biceps; musculocutaneous n: flexor+supinator (if injury you can still flex the elbow with the other 2 muscles but you won’t supinate)
Brachialis; musculocutaneous n.
Brachioradialis; radial n.
The biceps brachii has 2 heads and 2 fx: flexion and supination! (if broken waiter’s tip)
Where does a foreign body enter in upright, supine and lying on the right?
Always right
Upright: inferior or basilar segments of the lower lobe (trough the right intermediate bronchus that ends up into middle and lower bronchi)
Supine: superior segment of the lower lobe
Lying on the side: posterior segment of the upper lobe
Pharyngeal arches associations with cranial nerves and arteries:
1: 5 (V3, mandibular) + maxillary A.
2: 7 (facial) + stapedial and hyoid A.
3: 9 (glossopharyngeal) + carotid and anterior brain circulation
4: 10 (vagus) + proximal right subclavian, aortic arch and posterior circulation
6: 10 (recurrent laryngeal n.) + pulmonary arteries and ductus arteriosus
Which are the only excitatory neurons in the cerebellum?
Granule cells, they produce glutamate
Witch is the most anterior structure of the heart?
The right ventricle
Which artery do you want to ligate in a nosebleed? is it a brach of which artery?
The sphenopalatine A. branch of the maxillary A.
Atresia of the vagina +- uterus in XX woman:
Paramesonephric duct agenesis (Mullerian duct) called Mayer-Rokitansky-Kuster-Hauser sd
Ovaries and hormones are normal
Conjugate horizontal gaze palsy:
Just one eye can look out so the opposite eye comes back with a nystagmus
Interocular opthalmoplegia due to medial longitudinal fasciculus lesion
Lesion is on the side of the eye that doesn’t move well not on the nystagmus one
Nuclei of the trigeminus:
Mesencephalic: proprioception, jaw jerk reflex (upper)
Motor
Main/principal: touch (middle); touch is the main thing…
Spinal: pain and temperature (longest)
Muscle that goes trough the greater sciatic foramen:
Piriformis muscle goes through the greater sciatic foramen, can lead to pseudociatalgia when the sciatic nerve is compressed and/or irritated by the piriformis because it is very close to it
Which nerve supplies the lower teeth area?
Inferior alveolar nerve (inferior mental nerve) branch of the mandibular V3
Gives the mylohyoid n. right before it enters mandibular canal and then finishes in the mental n. (mental foramen)
Blocked in the mandibular foramen and can be injured by the dentist in the mandibular canal
Carries sensation of the LOWER TEETH, LIP and CHIN
Uvula pointing away from the affected side indicates a lesion of which nerve?
Vagus, CN10
Where is the sinoatrial node located?
At the junction of the RA and the superior vena cava
Behind the 3rd intercostal space near the sternal border
Where is the atrioventricular node located?
At the lower back section of the interatrial septum near the coronary sinus
Which artery do you have to ligate in heavy vaginal bleeding?
Internal iliac artery
For example in postpartum hemorrhage (after oxytocin doesn’t work)
Fiber distribution inside CN3:
Parasympathetic are in the periphery; blown pupil (affected by compression)
Motor are medial; down and out (affected by DM)
Timing of the divisions of the ovum in identical twins:
0-4: all good
4-1st week: shared chorion
2nd week: shared chorion and amnion, this happens after implantation
After 2nd week: shared body
Where does the smell information go into the cortex?
To the piriform cortex or uncus (primary olfactory cortex)
Seizures normally originate here causing bad smell aura
Can herniate and compress CN3