Anathomy Flashcards
1
Q
Where do the uterus, bladder and genitals drain to?
A
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
2
Q
Testes and ovary, uterus, prostate, corpus cavernosum, cervix, vagina, scrotum, vulva, anus, penis glans and clitoris drain to:
A
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
3
Q
Where do different parts of the colon drain to?
A
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
4
Q
Myelination in CNS (including II craneal nerve)
A
Oligodendrocytes
5
Q
Myelination in PNS
A
Schwann cells
6
Q
Layers that the needle of a lumbar puncture passes through
A
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
7
Q
Right to left shunt generates
A
Cyanotic conditions
8
Q
Left to right shunt generates
A
Non-cyanotic conditions
9
Q
SA and AV node get blood supply from
A
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’
10
Q
Horner’s sd. sings:
A
Ipsilateral:
Ptosis
Miosis
Anhydrosis
11
Q
Anterograde axonal transport is mediated by:
A
Kinesin (used by HSV1)
12
Q
Retrograde axonal transport is mediated by:
A
Dynein
13
Q
Unilateral lesion to the descending hypothalamic fibers generates:
A
Horner sd
14
Q
The entire right border of the heart space on the thorax corresponds to:
A
The right atrium and right ventricle
15
Q
The left border of the heart space on the thorax corresponds to:
A
The left ventricle
16
Q
The entire posterior wall and some left border of the heart space on the thorax corresponds to:
A
The left atrium
17
Q
Most of the anterior wall of the heart space on the thorax corresponds to:
A
The right ventricle!!
18
Q
In tricuspid stenosis we hear:
A
A diastolic murmur
19
Q
In tricuspid insufficiency we hear:
A
A systolic murmur
20
Q
In aortic stenosis we hear:
A
A systolic murmur
21
Q
In aortic regurgitation we hear:
A
A diastolic murmur
22
Q
Tetralogy of Fallot defects:
A
Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hypertrophy
23
Q
Lunate most frequent injury:
A
Anterior dislocation in the carpal tunnel (median n =( )
24
Q
Scaphoid most frequent injury:
A
Fracture, vessels are distal so proximal head can undergo avascular necrosis
Causes pain and tenderness!! at the anatomic snuffbox, RADIAL wrist
25
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
26
What goes on the posterio-lateral spinal system?
The spinocerebellar tract
27
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
28
Information carried by the cortico-spinal tract:
There is an anterior and lateral (pyramidal) portion
Carries upper motor neuron information
29
What is the most frequent location of a berry aneurism?
The brach between the anterior communicating A and the anterior cerebral A.
30
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
31
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
32
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
33
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
```
34
SUPRAscapular nerve/ supraspinatus m. damage causes:
Loss of shoulder abduction between 0-15 DEGREES (initiates)
| Weakness of lateral rotation of the shoulder
35
Loss of abduction of the arm after HUMERUS FRACTURE or dislocation indicates a damaged:
Axilary nerve
36
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
37
Limits of the femoral triangle:
Above: inguinal ligament
Lateral: sartorious
Medial: adductor longus
38
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
39
The septum transversum gives rise to:
The central tendon of the diaphragm
40
The time of embryonic development most susceptible to teratogenesis is:
During 3rd-9th weeks when organogenesis occurs
41
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
42
Right shoulder C3-C5 referred pain can come from:
Liver and gallbladder
43
Left shoulder C3-C5 referred pain can come from:
Heart and diaphragm!
44
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)
45
Ligaments on the visceral surface of the liver:
```
Ligamentum venosum (ductus venosus remanent)
Round ligament/lig. teres (umbilical vein remanent)
```
46
What are Nissl bodies?
Rough endoplasmic reticulum in cell body and proximal dendrites of neurons
47
Aspiration pneumonia is more frequent in:
Supine: SUPERIOR segment of the right lower lobe or
| Lateral decubitus: posterior segment of the right UPPER lobe
48
The fetal allantoic duct becomes:
The urachus or mediaN umbilical ligament
allaNtoid=mediaN; just one in the Niddle
49
Typical presentation of a fracture of the femoral neck:
One of the legs appears shortened and externally rotated
50
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)
51
The allantois gives rise to:
Urachus or mediaN umbilical ligament
52
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
53
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
54
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
55
Where is aldosterone secreted:
On the zona glomerulosa of the adrenal cortex
56
Where is cortisol secreted:
On the zona fasciculata of the adrenal cortex
57
Where is testosterone secreted on the adrenal?
On the zona reticularis of the adrenal cortex
58
Wrist drop indicates injury of the:
Radial n.
| Loss of extension
59
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!
60
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
61
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
62
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
63
Impairment of knee flexion, foot dorsiflexion (foot drop) and plantar flexion and lateral shin and foot sensory loss indicates injury of:
The sciatic n.
64
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)
65
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)
66
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
67
Loss of thumb flexion and opposition indicates injury of and can be caused by:
Median n. caused by compression at the carpal tunnel
68
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
69
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
70
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
71
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.
72
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
73
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)
74
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)
75
Esophageal portocaval anathomosis is between:
Left gastric vein and esophageal vein
76
Anorectal portocaval anathomosis is between:
Superior rectal vein and middle+inferior rectal veins
77
Caput medusae portocaval anathomosis is between:
Paraumbilical veins and superficial+inferior epigastric veins
78
Define Chiari I malformation:
Cerebellar tonsils herniate trough the foramen magnum
79
Define Chiari II malformation:
Cerebellar vermis and tonsils herniate trough the foramen magnum
80
Define Dandy-Walker malformation:
Cerebellar vermis doesn’t form and the 4th ventricle becomes big
81
Nerve affected in acromegaly:
Median n. because of wrist overgrowth compressing the carpal tunnel
82
Nerves in the brachial plexus form above to bellow:
```
MARMU:
Musculocutaneous
Axilary
Radial
Median
Ulnar
```
83
What nerve passes trough the foramen ovale? where is it blocked?
Mandibular, V3
| But it is blocked at the Mental foramen
84
What nerve passes trough the foramen rotundum? where is it blocked?
Maxillary, V2
| But it is blocked at the Infraorbital foramem
85
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
86
What nerves pass trough the jugular foramen?
9, 10 and 11
Glossopharyngeal
Vagus
Accessory
87
Name two yolk sac derivatives:
Primordial germ cells
| Early blood cells and blood vessels
88
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
```
89
Name neuroectoderm derivatives:
CNS (posterior pituitary-anterior ecto-, all glia except microglia -meso-...)
90
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
```
91
What nerve passes trough the optical canal?
2 and ophthalmic A.
92
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
93
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
94
Which embryological structure gives rise to the glomeruli?
Metanephric mesenchyme or blastema
95
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
96
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
97
Humeral mid-shaft fracture can lead to:
Wrist extension/ drop due to radial n. injury
98
What structures cross the diaphragm at T8?
IVC
| Right phrenic n.
99
What structures cross the diaphragm at T10?
Esophagus
| Vagus (10)
100
What structures cross the diaphragm at T12?
Aorta
Azygos v.
Thoracic duct
101
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!
102
Function of the infraspinatus and teres minor muscles:
Lateral (external) rotation
103
Function of the subscapularis muscle:
Medial (internal) rotation
104
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)
105
What structure is at greatest risk of injury during radical prostatectomy?
The pelvic parasympathetic nerves
106
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)
107
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
108
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
109
Which are the only excitatory neurons in the cerebellum?
Granule cells, they produce glutamate
110
Witch is the most anterior structure of the heart?
The right ventricle
111
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.
112
Atresia of the vagina +- uterus in XX woman:
Paramesonephric duct agenesis (Mullerian duct) called Mayer-Rokitansky-Kuster-Hauser sd
Ovaries and hormones are normal
113
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
114
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)
115
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
116
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
117
Uvula pointing away from the affected side indicates a lesion of which nerve?
Vagus, CN10
118
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
119
Where is the atrioventricular node located?
At the lower back section of the interatrial septum near the coronary sinus
120
Which artery do you have to ligate in heavy vaginal bleeding?
Internal iliac artery
For example in postpartum hemorrhage (after oxytocin doesn't work)
121
Fiber distribution inside CN3:
Parasympathetic are in the periphery; blown pupil (affected by compression)
Motor are medial; down and out (affected by DM)
122
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
123
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
124
Structures that go trough the greater sciatic foramen from above to below:
Superior gluteal nerve, artery and vein (above the piriformis → gluteus medius and minimus → hip abduction)
Piriformis muscle
Inferior gluteal nerve (below the piriformis → gluteus maximus → hip extension and lateral rotation)
Sciatic nerve (below the piriformis)
Pudendal nerve (below the piriformis → perineum sensation and movement)
Posterior femoral cutaneous nerve (below the piriformis → posterior thigh sensation)
125
Where are the primary oocytes arrested?
| Where are the secondary oocytes arrested?
Prophase 1, until ovulation. 2N
| Metaphase 2, until fertilization. 1N
126
DD of neck cysts:
Lateral cervical cyst that doesn't move with swallowing: persistent cervical sinus; due to incomplete obliteration of the 2nd, 3rd and 4th CLEFT! (ectoderm). Anterior to the sternocleidomastoid m!!!
CLEFT-CYST
Medial cervical cyst that moves with swallowing: thyroglossal cyst; from endoderm. It shows up at the foramen cecum and migrates down. (It can be lined by squamous or respiratory epithelium).
If it moves with swallowing it is a thyroglossal cyst!!
127
Which part of the brachial plexus can be compressed by an axillary A. aneurism?
Any of the cords (lateral, medial and posterior) because they are in the axillary sheath with the axillary artery
Not the trunks, they are in the neck
128
Problem with which A. leads to avascular necrosis of the femoral head?
Medial circumflex branch of the deep femoral A.
129
Segmental innervation of the arm:
Upper trunk C5-C6: proximal muscles (Erb waiter tip)
Lower trunk C8-T1: distal muscles (thoracic outlet sd and Klumpke)
Down is distal
130
Which is the best palpable landmark for pudendal n. transvaginal block?
The Ischial Spine and supraspinous ligament. IS-Spine
Anesthetic should be injected through the supraspinous ligament very close to the ischial spine because the pudendal n. passes behind the ischial spine to exit the pelvis trough the greater sciatic foramen
131
Which artery is compressed by a femoral supracondylar fracture?
Popliteal A.
132
Which nerve crosses trough the two heads of the pronator teres?
The median nerve
133
Retroperitoneal organs:
```
SAD PUCKER
Suprarenal
Aorta and ICV
Duodenum's end
Pancreas head and body and PROXIMAL splenic vein. Proximal is retro!
Ureters
Colon (descending and ascending)
Kidneys
Esophagus thoracic
Rectum
```
PRIMARY: kidneys, adrenal glands, ureters, aorta, inferior vena cava, lower rectum, and anal canal (they never had a mesentery)
* The spleen is peritoneal. Peritoneal organs have mesothelium all around
134
Where do the gonadal arteries come from?
The right testicular/ovarian come from the Aorta and drain into the IVC
The left testicular/ovarian come form the renal A. and drain into the renal V.
The testicles originate in the abdomen
135
Where do you do an intercostal nerve block?
In the intercostal space BEKLOW the rib corresponding to the nerve you want to knock out and LATERAL to the rib angle because it is more accesible
136
The meSonephric or Wolffian duct generates:
SEEDU: Seminal vesicles, Epididymis, Ejaculatory ducts, Ductus deferens and URETER (male internal structures except the prostate). Men are wolfs
The ureteric bud induces the meTanephric mesechyma for kidney development
In the female forms the Gartner duct; the distal part of female and males also forms the trigone of the bladder
137
The urogenital sinus generates:
Prostate ♂ and Skene ♀ glands
Cowper ♂ and Bartholin ♀ glands
Bladder
Urethra
138
Where does the recurrent laryngeal n. arrises?
The left arises at the aortic arch and pases between the Aorta and the pulmonary A.
The right arises at the right subclavian and pases under it
139
CN innervation of auditory muscles:
```
The CN 7 innervates the Stapedius (Seven, Stapedius)
The CN5 (V3) innervates the tensor tympani
```
140
What artery can be injured during percutaneous arterial access?
External iliac artery (actually you want to access in the femoral A. because you can control the bleeding compressing against the femoral head)
141
When does the notochord form?
On the 3rd week as a result of gastrulation. The embryo becomes 3 layers!
142
Where is the highest and lowest oxygen concentration on the fetal circulation?
Highest: umbilical vein and ductus venosus 85%
Lowest: IVC (before joining the ductus venosus) 26%
143
Where is the highest and lowest oxygen concentration on the adult circulation?
Highest: pulmonary vein, left heart and Aorta 95%
Lowest: coronary sinus (myocardial consumption) 30%
144
Name mesoderm derivatives:
```
Muscle
Bone
Adrenal cortex
Gonads and uterus
Kidney and ureter
Spleen
Microglia (macrophages)
Dura mater
```
145
Location of the main 4 decussations
Lower midbrain: superior cerebellar peduncules
Pons: pontocerebellar fibers
Lower medulla: pyramids (UMN) + internal arcuate fibers of the medial lemniscus (touch)
Spine: Spinothalamic tract or ALS (pain)
146
What causes hypospadias, epispadias and bifid scrotum?
Hypospadias: abnormal fusion of urethral/urogenital folds
Epispadias: faulty position of the genital tubercle
Bifid scrotum: abnormal fusion of labioscrotal folds
147
Which nerve lies in the tonsillar fossa?
CN 9, glossopharyngeal
148
Rotator cuff muscles innervation and function:
SITS:
Supraspinatus m-Suprascapular n: abduct 0-15
Infraspinatus m-Suprascapular n: external rotation
Teres minor m-Axillary n: external rotation
Subscapular m-Subscapular n: internal rotation+adduction
149
Complication of falling with stretched hands:
You can break the hook of Hamate and cause a distal ulnar n. lesion
150
What passes trough the foramen spinosum? What gives rise to it? In which bone is the foramen spinosum?
Middle meningeal A. that is a branch of the Maxillary A.
Injured in a fracture of the pterion, region where the frontal, parietal, temporal and sphenoid bones meet
151
Main muscle that opens the mouth:
Lateral pterygoid. Pulls mandible forward, protracts it and moves it side to side
If does not work mandible deviates to the opposite side
152
Highly and badly vascularized brain areas:
Gray-white matter junction: highly vascularized and small vessels so high risk of metastasis
Watershed: badly vascularized end capillaries, high risk of ischemia, also metastasis
153
Which muscles elevate the tongue?
Which muscle protrudes the tongue?
Which muscle retracts the tongue?
Elevation, swallowing: PAStYto a pasito subo
Styloglossus (sides elevation, innervated by CN 12, elevates sides w style)
Palatoglossus (posterior elevation, innervated by CN 10, PA-TEn)
Protrusion, say 'la': genioglossus (innervated by CN 12, Einstein)
Retraction+depression: hyoglossus (innervated by CN 12)
154
Where do you do a median n. block?
Before enters the carpal tunnel while it runs between the Plantaris Longus and the Flexor Carpi Radialis
You also inject corticoids here to treat carpal tunnel sd.
155
Nuclei involved in direct and indirect basal ganglia pathways in order of activation:
Direct+; SuPuPiTa
Substantia nigra→Putamen→Pallidus internus→Thalamus
Indirect-; SuPu-PeSu-PiTa
Substantia nigra→Putamen→Pallidus externus→Subthalamic→Pallidus internus→Thalamus
* You can do ablation of the pallidus internus to improve movement in parkinson
156
Which nerve do you injure in an attempt of suicide cutting your veins?
Median n. that passes through the palmaris longus and the flexor carpi radialis m.
157
Ear canal innervation:
Back to the ear canal: vagus
Front of the ear canal: V3
Upper and lower auricle: C2-C3; lesser occipital is upper and back and greater auricular is lower
158
What can get damaged by a fx of the surgical neck of the humerus? What other lesion can damage those structures?
Axillary nerve and posterior circumflex humeral A. They can also get damaged by anterior dislocation of the shoulder.
If anatomical neck gets damaged you can have avascular necrosis of the humeral head
159
Which deficit do you get if you lesion the angular gyrus?
Gerstmann sd: agraphia, acalculia, right-left disorientation and finger agnosia
Dominant inferior parietal lobe
160
Derivates and congenital defects arising from the genital tubercle, urogenital folds and labioscrotal swelling:
```
Genital tubercle (epispadias, dorsal): glans of penis♂clitoris ♀
Urogenital folds (hypospadias, ventral): shaft ♂labia minora ♀
Labioscrotal swelling (bifid scrotum): scrotum ♂ labia majora ♀
```
161
Which heart artery is the closest to the coronary sinus?
The circumflex A.
The coronary sinus traverses the epicardium along the circumflex so the circumflex can be injured when a pacemaker is inserted in the coronary sinus
162
Which A. runs within the rectus abdominis m. sheath?
The superior epigastric A that supplies the diaphragm, peritoneum and anterior abdominal wall
163
Nerve injured and symptoms of anterior and posterior hip dislocation:
Anterior (rare): Femoral n. and A; no KNEE extension + no sensation in medial leg
Posterior: Sciatic n (peroneal+tibial): foot drop + no foot flexion or tiptoes + no HIP extension; leg will look short and internally rotated (vs femoral head)
164
Which injuries lead to external and internal rotation of the leg? and of the shoulder?
External: femoral head fracture and anterior femur dislocation
* Aber: anterior dislocation causes abduction and external rotation
Internal: posterior hip dislocation; can injure the Sciatic n so no HIP extension
*Adair: posterior dislocation causes adduction and internal rotation
165
Which areas drain to the thoracic duct?
Both legs and left arm; suspect rupture if you see a lot of TGs on exudate
All body EXCEPT for: Right arm, Right Thorax, Right Kidney and Right Side of Head and Neck (drain to the Right Lymphatic Duct)
166
Which muscles do you need to sit up form a supine position without using your arms?
```
Hip flexors (Iliopsoas, rectus femoralis, tensor fascia lata)
External abdominal obliques
Rectus abdominis
```
167
Muscles that insert at the greater and lesser trochanters:
Greater: Gluteus medius and minimus (can be affected in greater trochanter pain sd pain when sits crossing legs)
Lesser: Iliopsoas
168
Where do we find simple cuboidal epithelium?
Renal tubule, collecting duct
| Salivary gland acini
169
Where do we find simple columnar epithelium?
Small intestine, with microvilli
170
Where do we find simple squamous epithelium?
Endothelium
Mesothelium
Glomerulus: epithelium lining of the glomerular capsule
171
Where do we find stratified squamous epithelium?
Nonkeratinized: esophagous
Keratinized: skin
172
Where do we find ciliated pseudostratified columnar epithelium?
Trachea: contains cilia and microvilli
Bronchi: clean particles bigger than 3μm
Epididymis
173
Where do we find transitional epithelium?
Ureter
| Bladder
174
Where do we find stratified cuboidal epithelium?
Salivary gland duct
175
Where do the upper, middle and lower esophagus drain to?
Upper 1/3: cervical
Middle 1/3: mediastinal or tracheobronchial
Lower 1/3: celiac and gastric lymph nodes
176
Which are the 2 main pelvic diaphragms? which muscles do they contain? which sphincter do they contain? how are those sphincters innervated? what happens if they get injured?
Pelvic floor or pelvic diaphragm:
m: levator ani m. (S3-S4)
s: external anal sphincter (pudendal, S2-S4)
n: pudendal n.
i: prolapse, cystocel, stress incontinence
Urogenital diaphragm or deep perineal space:
m and s: external urethral sphincter
n: pudendal n.
i: urinary inconticnence
177
Describe the drawer sing, which injury does it diagnose?
When you bend the knee is the tibia moves anteriorly you have injured the anterior CRUCIATE, if it moves posteriorly you have injured the posterior cruciate
178
Describe the passive abduction test, which injury does it diagnose?
You feel widening with almost no force, if widening is valgus (medial) you have injured the medial COLLATERAL lig, if widening is varus (lateral) you have injured the lateral collateral lig
179
Describe the McMurray test, which injury does it diagnose?
If you feel popping or pain when rotating the knee internally (varus force) you have lesioned the lateral MENISCUS, if you feel it when rotating the knee externally (valgus force) you have lesioned the medial meniscus
180
Which CN palsy causes problems reading or going down stairs?
Superior oblique muscle or trochlear nerve
181
What is the clavicle's fragments position after fracture?
Distal, lateral fragment: Deltoid pulls it Down and out
| Proximal, medial fragment: Sternocleidomastois pulls it up
182
Which layers will the cannula penetrate during suprapubic cystotomy?
Aponeurosis of the abdominal wall muscles, superficial fascia, transversalis fascia and extraperitoneal fat
Does not penetrate the peritoneum, less risk of peritonitis and hemoperitoneum
183
Which muscle is perforated by the musculocutaneous nerve?
Coracobrachialis muscle, overuse in bench pressing can lead to musculocutaneous n. entrapment
184
Tight junctions characteristics:
Tight junctions
Zonula occludens: made by Claudins and occludins
Blood-brain-barrier and blood-testes-barrier (don't led cross anything)
Close to microvilli
Tight Occludens BBB!
185
Adherens intermediate junction characteristics:
```
Adherens intermediate junction
Zonula adherens
Made by cadherins (Ca dependent)
Belt
Lost in ca. metastasis
```
A: Adherens B: Belt C: Cadherins Ca
186
Which A. irrigate the superior, middle and inferior parts of the ureter?
Upper: renal A. (joined with external iliac A. of the recipient so well irrigated after transplant)
Medium: illiacs+gonadal+aorta+uterine...
Lower: superior vesical A. (most susceptible to ischemia after transplant)
187
What is the function of the cricothyroid m?
Only tensor of the vocal cords of the larynx and helps with phonation
188
Which intercostal space corresponds to the right middle lobe?
4th intercostal space at the midclavicular line because the horizontal fissure of the right lobe follows the 4th rib
189
Which brain areas have increased activity in OCD?
Frontal lobe, cingulate gyrus (obsessions) caudate and thalamus (compulsions)
190
Which is the largest carpal bone?
Capitate, it is the largest and it's in the middle
191
Limits of the carpal tunnel and tendons that go inside:
Up: traverse carpal ligament or flexor retinaculum (cut in decompression surgery)
Down: carpal bones
Inside: flexor digitorum superficialis and profundus and flexor pollicis LONGUS (long goes through the tunnel)
192
Which part of the auditory pathway recieve info from just one ear?
```
Ear
Hair cells
Spiral ganglion
Cochlear nucleus!
Then some of the fibers decussate
```
193
What do you have to cut in circothyrotomy?
Skin
Superficial cervical fascia+fat+platysma m.
Deep cervical fascia
Circothyroid mb.
194
Which muscles open and which ones close the mouth?
Lateral pterigoid: lowers the jaw, OPENS the mouth
Medial masseter and medial phterigoid: CLOSE mouth
Lateral opens (like Maria Alos)
195
Which structures can be affected due to manipulation of the internal jugular vein?
Thoracic duct: chylothorax, due to manipulation of the LEFT internal jugular vein
Common carotid A
Lung
Vagus
196
What is the Froment's sign and which injury indicates?
Patient is unable to hold a piece of paper between the thumb and the index
Indicates ulnar nerve palsy, specifically, the action of adductor pollicis due to lesion of the deep brach of the ulnar at the hook of hamate
197
Which kind of brain herniation is associated with an epidural hematoma? Why?
```
Uncal herniation (CN3 injury)
Because is the herniation of the medial temporal lobe
```
198
What CN deficits can you have after parotidectomy?
CN7 causing ipsilateral palsy of upper and lower face
Will not cause hyperacusis because the stapedius nerve leaves the CN7 as soon as it exits the skull!
199
What is the appendix testis or hydatid of Morgagni?
Remnant of the Müllerian duct on the superior pole of the testis, can torsion
It involutes because of the Sertoli cells that secrete MIF
200
Which artery irrigates the superior and inferior parathyroids? and the thyroid?
Superior parathyroids: superior thyroid artery or sometimes superior thyroid artery that arises form the E!!!!XTERNAL CAROTID artery
Inferior parathyroids: inferior thyroid artery that arises from the thyrocervical trunk (branch of the SUBCLAVIAN that on the left will come from the brachiocephalic)
Thyroid: both
Both can be injured due to thyroid surgery or excision of squamous cell ca. of the esophagus (around the upper esophageal sphincter)
201
Which part of the renal tubular system is part of the uriniferous tubule?
Collecting duct. All of the other structures (PCT, henle, DCT) are parts of the nephron
202
Where do the Gartner ducts come form?
Gartner ducts are remnants of the mesonephric ducts (male) in females, which degenerate in the absence of testosterone
203
Where does the bladder come form?
The UPPER part of the urogenital sinus
204
Which vessel could be compressed by a superior mesenteric artery aneurism?
The left renal vein! because it crosses the aorta inferior to the superior mesenteric artery
205
Which ribs will hurt the kidneys? and the spleen and liver?
Right kidney: 12 (L1-L4 level)
Left kidney: 11, 12 (T12-L3 level, the splenic flexure is situated anteriorly)
Right liver: 8, 9, 10, 11
Left spleen: 9, 10, 11
206
Cause, location, muscles and nerve that may be affected by tennis and gold elbow:
```
Tennis:
Lateral epicondylitis
Repetitive wrist extension (supination)
Radial n. impingement
Muscles that can be affected: EXTENSORS
```
```
Golf:
Medial epicondylitis
Repetitive wrist flexion (pronator)
Median n. impingement
Muscles that can be affected: FLEXORS
```
207
Which nerve can be affected by pronators overuse and which one by supinators overuse?
Median: Pronator; pronator teres syndrome because the median n. goes between the 2 pronator heads, then goes between the flexor digitorium superficialis and profundus in the forearm and finally it also passes through the palmaris longus and the flexor carpi radialis m. in the carpal tunnel
Radial: Supinator; because the radial n. passes between the supinators
M.c.Pons
The MEDIAN n. is a PRONATOR and the radial n. is a supinator
208
DD. and area affected between noise-induced and presbycusis hearing loss:
All are high frequency, bilateral
Noise-induced:
Sterociliated CELLS of the organ of Corti: a little loud for years
Tympanic rupture: extremely loud once
Presbycusis:
Cochlear base: age
209
The medial meniscus is attached to which of the following?
Tibial collateral ligament
210
Which parts of the foot drain to inguinal and popliteal lymph nodes?
Plantar and Medial: inguinal lymph nodes (saphenous v.). La Puta Madre va cerca del pene
Lateral and dorsal: popliteal
211
Which n. lies on the anterior surface of the anterior scalene muscle? Which n. lies on the superficial to the posterior triangle of the neck?
Anterior scalene: Phrenic n. that can be injured when the anterior scalene is incised to treat thoracic outlet sd.
Posterior triangle of the neck: Accessory n. that can be injured in cervical node dissection
212
Which problems can an orbital blowout fracture cause?
Entrapment of the inferior rectus muscle; you CANNOT LOOK UP because the muscle will be held firmly in a lower position (~ CN3 for different reasons). You will have doble vision looking up
Infraorbital n. injury: paresthesia of the upper cheek, lip and gingiva
213
What are three possible porto canal anastomosis for TIPS?
Portal V ↔ Hepatic V
Splenic V ↔ Left renal V
Lumbar V ↔ IVC
214
Nerves that can be affected by the dentist and what to they innervate?
Chorda timpani from CN 7. Carries taste from the anterior tongue
Mylohyoid n. from CN V3 in the mandibular canal. It carries sensation of the LOWER TEETH, LIP and CHIN
215
What is the epithelium of the true vocal cords?
Stratified squamous epithelium with submucosal glands
The glands lubricate the cords
216
What do the flexor digitorum profundus and superficialis flex?
Flexor digitorum profundus: flexion at the DIPs and PIPs (the tendon attaches at the tip of the finger)
The produndus is long!
Flexor digitorum superficialis: flexion at the PIPs (attaches at the PIPs)
217
How does breast ca. metastasize to the vertebral spine?
Intercostal veins (paravertebral plexus of Batson) that communicates with the azygos vein in the chest
218
What structure is behind the liver?
IVC that connects with the hepatic veins
219
What do you cut on an midline episiotomy?
Is an incision from the posterior vaginal opening to the perineal body
It cuts the vaginal lining and submucosal tissue
(on a mediolateral episiotomy you will cut the transverse perineal m.)
220
Is you see urine in the peritoneal cavity, which part of the bladder ruptured?
Bladder dome (the bladder is extraperitoneal but the bladder dome is covered by peritoneum)
221
How do you access the saphenous vein to make a graft?
The saphenous vein is accessed under the femoral ligament close to the pubic tubercule, where it joins the femoral vein
222
Which N. and A. are in the anterior, lateral and posterior leg compartments?
Anterior: deep peroneal N. + anterior tibial A. DAT
Lateral: superficial peroneal N.
Posterior: tibial n. + posterior tibial A. + peroneal A. TPTP
223
From which veins to PEs come from?
From deep veins in the legs: popliteal and femoral veins
224
Which A. gets injured due to supracondylar fracture of the femur?
Popliteal A. in the popliteal fossa
225
What is the equivalent of the bartholin glands in the male?
Cowper glands
226
Through which sinus do you access the pituitary transnasally?
Sphenoid sinus, transsphenoidally
227
Which part of the brachial plexus can be compressed within the axilla?
The cords
```
Randy-Roots
Travis-Trunks: on the neck
Drinks-Divisions
Cold: Cords: on the axilla, injured by axillary aneurism
Beer: Braches
```
228
Where does the fibular n. can get injured?
At the neck of the fibula (lateral leg just below the knee) by fracture or marked indentation: lying on the side, cast, crossing the legs...
229
What is the vertical gaze center? and the horizontal?
Vertical: Superior colliculus (damaged in Parinaud sd, pineal tumor). Rakesh goes vertical!!!
Horizontal: frontal eye field, PRPP is just a relay for the FEF pathway
230
What is the drainage of internal and external hemorrhoids?
Internal → Superior rectal V. → Inferior mesenteric V!!!!. (result of portal HT)
External → Inferior rectal V. → Internal pudendal V. → Internal Iliac V. (Thrombose and cause pain)
You need to cut one of these structures for rubber band ligation removal
231
How do you treat spasticity surgically?
Dorsal rhizotomy: cuts dorsal (sensory) roots of spinal nerves that are the afferents of the reflex arc so you can decrease muscle tone (spasticity) without decreasing motor innervation
232
Functions and common site of injury of Iliohypogastric, Ilioinguinal and Genitofemoral nerves:
Iliohypogastric (T12-L1): sensory suprapubic region, transversus abdominis and internal oblique. Burning/tingling. Injured during abdominal sx.
Ilioinguinal (L1): sensory anterior scrotum, pubis, labia majora and thigh. Goes on the superficial inguinal rig of the inguinal canal, not trough the deep. On top of the spermatic cord.
Genitofemoral (L1-L2): medial thigh below inguinal lig. and motor cremasteric reflex. Injured during laparoscopic sx.
233
Where do the ciliated cells disappear distally in the airway? cartilage? gland? and globlet cells?
Cartilage and glands: small bronchi
Globlet cells: terminal bronchioles
Ciliated cells: respiratory bronchioles, last ones to disappear
234
Which kidney structures derive from the ureteric bud and which ones from the metanephric blastema?
Ureteric bud: collecting ducts, callices, pelvises, and ureters
Metanephric blastema: bowman's space, proximal tubule, Henle, distal convoluted tubule
235
Relationship of the ureter with arteries on the pelvis
Ureter passes under ovarian/uterine A. and the over the Illiac A.
236
Where do you do a femoral n. block?
Below the inguinal ligament, will anesthetize all the anterior thigh, femur and knee
237
Which nerve goes through the obturator canal? What is its function?
Obturator nerve, adducts the thigh
238
Which brain area is on the posterior rostral pons near the 4th ventricle? what does it secrete?
Locus ceruleus, secretes NE
| It is involved on arousal (reticular activating system)
239
Which nerve is lodged in the piriform recess? What if it's function?
Internal laryngeal n. that is a brach of the vagus
Cannot cough: piriform recess problem
Afferent limb of the cough reflex above the vocal cords
240
What is spondylolisthesis? What is it's cause?
Anterior displacement of the vertebral body due to fracture of the posterior vertebral arch normally at the pars interauricularis
241
Name the 2 most important ganglia of the sympathetic chain and the region they innervate:
Superior cervical sympathetic ganglion: head and neck; affected in neck surgery, pancoast and carotid dissection
Stellate (cervicothoracic) ganglion: hands and arm. No synapse, pancoast
Thoracic sympathetic trunk: axila
In terms of the pupillary dilation pathway all are 2nd neuron components and the final synapse is at the Superior cervical ganglion
242
Name 4 types of unmyelinated nerve fibers:
Sensory afferent; called C fibers:
1) Slow dull burning and visceral pain
2) Heat sensation
3) Olfaction (1st bipolars)
* All the ones that have names are myelinated (pacinian...)
Efferent; normally myelinated but:
4) Postganglionic autonomic
* Makes sense that the preganglionic are myelinated because they just come out the spinal cord
243
What is the irrigation of the Meyer’s loop and the lower optic radiations:
Middle meningeal A. so you can get homonymous hemianopsia due to due to a Middle meningeal A. infarction
244
Which is the most common pediatric elbow fracture?
Supracondylar; can injure the median nerve ± brachial A
It can also injure the ulnar n. (medial displacement) and the radial n. (lateral displacement)
245
What is below Guyon's canal?
Transverse carpal ligament
The Guyon's canal (and ulnar n.) is above the transverse carpal ligament while the carpal tunnel (and median n.) is below the ligament
246
How do you differentiate a Supracondylar vs Carpal median n. injury:
Supracondylar facture: cannot flex the 2nd and 3rd finger because the hand flexors come from the elbow
Carpal tunnel: Flexion is spared but there is thenar atrophy
247
What is the difference between a sprain and a strain?
Strain: injury to a muscle (tear in tendon) in which the muscle fibers tear as a result of over-stretching. Strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone.
Sprains injure the bands of tissue that connect two bones together.
248
What are the relationships of the internal jugular V. important to place a central line?
The internal jugular V. is:
LATERAL to the common carotid A.
ANTERIOR to the vagus
WITHIN the carotid sheet
249
Which is the first sinus where CSF drains?
Drains through the arachnoid granulations into the superior sagittal sinus
250
Which cells make the blood brain barrier?
Astrocytes
251
What is the function of the cerebrocerebellum? and of the spinocerebellum?
Cerebrocerebellum=neocerebellum: lateral hemispheres; motor planning of arm/leg movements
Spinocerebellum=paleocerebellum: vernis; balance and regulates movement
252
Which arteries ensure good collateral flow to the hand?
```
Superficial arch (continuation of the ulnar A.)
Deep arch (continuation of the radial A.)
```
253
Under which structures do the aorta and the IVC enter the thorax?
Aorta, thoracic duct and azygos: under the median arcuate ligament
ICV and phrenic: under the central tendon of the diaphragm
254
Which modalities are sensed by Free nerve endings, Meissner, Pacinian, Merkel and Ruffini corpuscles
Free: pain, Ta
Meissner: light touch
Pacinian: vibration (masturbation)
Merkel: pressure, deep touch (Merkel is deep because she is german)
Ruffini: slippage, joint angle (slippery dog)
255
How cocaine and amphetamine affect pupil diameter on a denervated eye?
Amphetamine is a releaser and cocaine is a reuptake inhibitor
A denervated eye will never respond to cocaine because there is no NE released from that eye to start with
A denervated eye will respond in 2 different ways to amphetamine:
Postganglionic lesion: no effect because doesn't matter that you increase NE in the synapse, the postsynaptic cell cannot respond
Preganglionic lesion: dilation because the problem is solved by adding NE at the synapse
256
What is injured by a penetrating wound on the second intercostal space at the midclavicular line?
The superior lobe of the left lung, not the heart, a major vessel, or nerve
257
Which structure gives rise to the smooth part of the RA?
Sinus venosus
258
Key features of colles and smith's fractures:
```
Colles:
forced extension of the hand
displaced DORSALLY: dinner fork
Ulnar styloid avulsion
Median n. affected
```
Smith's:
forced flexion of the hand
displaced ANTERIORLY
Radial n. affected
259
What are the main branches of the aortic arch?
BCS:
Right Brachiocephalic:
→Right Subclavian→ Axillary→ Brachial
→Right carotid
Left Carotid
Left Subclavian→ Axillary→ Brachial
Isthmus of ligamentum arteriosum (tx injury)
260
Contents of the cubital fossa lateral to medial:
MBBR:
Median n. (injured by supracondylar medial displacement)
Brachial A. → radial A. (causing absent radial pulse)
Biceps brachi
Radial n. (injured by supracondylar anterolateral displacement)
CMB:
Cephalic V.
Median cubital V. (venipuncture)
Basilic V.
261
Limits and contents of the anatomic snuff box:
Radial, lateral: Abductor pollicis longus
Ulnar, medial: Extensor pollicis brevis+longus
Contents: radial A. superficial radial n. cephalic vein
262
Course and branches of the median nerve:
Medial and lateral cords, C6-T1
In the axilla travel with the brachial artery
Crosses trough the two heads of the PRONATOR (pronator teres syndrome) the passes between the FLEXOR DIGITORUM superficialis and profundus in the forearm
In the forearm divides in Anterior interosseous (MUSCLES in the anterior forearm) and Palmar cutaneous (SKIN of the lateral PALM)
Then, passes through the PALMARIS LONGUS and the FLEXOR CARPI RADIALIS m. in the carpal TUNNEL
The divides in Recurrent branch (THENAR MUSCLES) and Palmar digital branch (palmar and fingertips of the lateral FINGERS and lateral two lumbricals)
263
Course and branches of the ulnar nerve:
Medial cord, C8-T1
At the elbow, it passes posterior to the MEDIAL EPICONDYLE (humerus) and supplies the elbow joint.
In the forearm goes between the two heads of the FLEXOR CARPI ULNARIS
In the forearm divides in Muscular branch (MUSCLES in anterior forearm as part of the FLEXOR DIGITORUM PROFUNDUS) Palmar cutaneous branch (SKIN of the medial PALM) and Dorsal cutaneous branch (dorsal medial FINGERS)
At the wrist travels superficially to the flexor retinaculum with the ulnar artery and enters the hand via Guyon’s canal
Then in the hand terminates into superficial and deep branches
264
Course and branches of the radial nerve:
Posterior cord, C5-T1
In the axilla region goes with the axillary artery and innervated the triceps (triceps reflex just lost on axillary lesion)
Then goes on the radial groove with the deep branch artery innervating the triceps again
Gives the posterior interosseous branch that can be injured in radial head dislocation and causes motor problems
Enters the forearm through the cubital fossa close to the lateral epicondyle (humerus) then passes between the brachioradialis and supinators innervating both
It end on the Deep motor branch (MUSCLES in the posterior forearm) and the Superficial sensory branch (SKIN of the DORSAL hand)
265
Course and branches of the musculocutaneous nerve:
Lateral cord, C5-C7
It leaves the axilla and pierces and innervates the coracobrachialis, the goes between the brachialis and biceps innervating both
Then continues into the forearm as the lateral cutaneous nerve (SKIN of LATERAL forearm)
266
Where is the pain and which m. are involved in Pes anserine bursitis?
Pain is on the medial lower tibial side
Gracillis
Semitendinous
Sartorious
267
Where is the pain and which m. are involved in iliotibial band syndrome?
Pain is on the lateral upper femural side, typical in runners
Tensor fascia lata
268
Hamstrings names, origin, function and innervation:
Biceps femoris (innervated by the tibial n. and common fibular n.)
Semimembranosus (tibial n.)
Semitendinous (tibial n.)
Adductor hiatus muscle (innervated by the tibial n. and obturator n.)
Attach to the ischial tuberosity, Semitendinous finishes on the Pes anserine (medial tibia) Biceps femoris and Semimembranosus finish higher on the tibia and the Adductor hiatus on the femur
Extend the hip and flex the knee
269
Borders of the popliteal fossa:
Upper lateral: biceps femoris
Upper medial: Semitendinous + Semimenbranous
Lower: gastrocnemious
270
Quadriceps names, origin, function and innervation:
Rectus femoralis
Vastus lateralis, medialis and intermedius
Attach to the anterior superior iliac spine and finish on the patellar tendon
Flex the hip and extend the knee
* Illiopsoas is the main hip flexor and attaches to the lumbar vertebrae and finishes on the lesser trochanter
271
Which muscles are affected in Erb palsy and which part of the waiter's tip posture contribute to?
Deltoid and supraspinatus injury: adduction
Infraspinatus injury: medial rotation
Biceps brachii injury: extension and pronation
Those muscles do the opposite function and their injury leads to the mentioned posture
272
What makes the glomerular basement membrane negative?
Heparan sulfate
273
What is the key question and answer for facial CN lesion?
Is the forehead affected?
Yes: LMN→ ipsi
No: UMN→ contra
274
Which sounds test which CN?
Ku: 10, raise palate
Mi: 7, lips
La: 12, tongue
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Which is the most lateral nuclei in the cerebellum that can be injured in lateral lesions?
Dentate
Lateral to medial: Dentate, Emboliform, Globose, Fastigial, 'Don't eat greasy foods'
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Where do lenticulostriate and choroidal A come from?
Lenticulostriate: MCA
Choroidal: Internal carotid
Irrigate the basal ganglia and thalamus, cause lacunar strokes by lipohyalinosis and microatheroma
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Where is the Subarachnoid space?
Between the arachnoid and pia, contains CSF
278
What is the key question and answer for CN3 lesion?
Is the pupil dilated?
yes: can be PCA aneurism! that compresses the outer part
no: normally due to DM that just affect the middle motor part
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Glasgow coma scale
3-15
Eye: no open 1 / open 4
Verbal: cannot talk 1 /talk 4
Motor: no movement 1 /decerebrate, extended 2 /decorticate, mummy 3 /moves 4
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Name main herniations and symptoms:
Sulfalacine: cingulate gyrus under falx cerebri; ACA awake+contralateral hemiparesis
Uncal: uncus under tentorium; Early: ipsi blown pupil+contra/ipsi hemiparesis
Trasntentorial: structures under tentorium; somnolence and coma
Tonsilar: tonsils in foramen magnum; compression medulla and death
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Key differences between cauda equina, conus medularis and spinal shock:
Cauda equina:
LMN lesion (radiculopathy), normal Babinski
Lumbar lesion, both L4 and S1 lost
Tends to be more unilateral
Conus= clonus medularis:
UMN lesion (spinal cord lesion), affected Babinski
Sacral, just S1 lost
Tends to be bilateral ± impotence
Both have saddle anesthesia, low back pain and involve the sphincters causing incontinence
Spinal sock:
Acute loos of spinal cord reflexes that come back
Post-traumatic
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Branches of the femoral A:
Femoral:
Deep femoral: femur
Superficial femoral→ popliteal →posterior tibial and anterior tibial → dorsalis pedis (on the 1st metatarsal space)
283
Which are the differences in elevation of the eye deficit with a CN3 or CN4 lesion?
CN3: cannot elevate the eye when abduced
CN4: cannot elevate the eye when adduced
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Face sinuses form top to bottom:
Frontal and anterior ethmoidal sinuses: superior to the superior concha
Middle and posterior ethmoidal sinuses: posterior to the lacrimal bone
Sphenoid sinus: posterior to the middle concha
Maxillary sinus: the most inferior of the nasal cavity
Piriform sinus: where the pharynx meets the larynx
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Which muscles are foot evertors? What is their innervation?
Fibularis longus and brevis: pure evertors (superficial fibular)
Fibularis tertius: dorsiflexion and eversion (deep fibular)
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What is the epithelium of the different components of the female genitourinary tract?
Vulva: Stratified squamous keratinized
Vagina: Stratified squamous
Cervix: Stratified squamous → simple columnar (endocervix, cervical canal)
Uterus: Simple columnar with tubular (proliferative) or coiled (secretory) glands
Fallopian tubes: Simple columnar ciliated
Ovaries: Simple cuboidal
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Name the 3 neurons of the pupillary dilation pathway:
1: hypothalamus to center of Budge at T1; affected in spinal cord lesion, syringomyelia
2: T1 passing trough stellate ganglion to superior cervical ganglion; goes trough the pleura and close to the subclavian so affected in pancoast, neck surgery and carotid dissection
3: superior cervical ganglion to dilator pupillae trough the long ciliary nerve; goes next to the carotid and trough the cavernous sinus so affected in carotid dissection and cavernous sinus pathology
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Which molecule forms the 2D inner surface of the nuclear membrane?
Nuclear LAMINS that are intermediate filaments that provide support to the cell nucleus and separate it form the cytoplasm; they are in the outer, inner and intermembrane space
On the other hand, fibronectin, collagen and lamiNIN are EXTRAcellular matrix glycoproteins
289
What is the blood flow to bypass an aortic coarctation?
Aorta precoarctation → Subclavian → Internal thoracic (mamary) → Intercostals → Aorta postcoarctation
290
Which arteries are in the spermatic cord and therefore can irrigate the testes?
DGT→ DCT
Ductus deferens a.
Cremasteric a.
Testicular a.
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How does pleural fluid moves in and out of the pleura?
Enters trough the intercostal microvessels and leaves trough the parietal pleural lymphatics
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Which nerves innervate the Intercostal, Diaphragmatic and Mediastinal pleuras:
Intercostal pleura: intercostal nerves
Diaphragmatic and mediastinal pleura: phrenic n.
Phrenic nerve also innervates the fibrous pericardium
Visceral pleura: vagus and sympathetics
293
Which fascias do the deep and superficial inguinal rings transverse?
Deep: transversalis fascia= internal spermatic fascia
Superficial: external spermatic fascia= external oblique fascia
Indirect go trough both direct go trough the inguinal triangle (Hesselbach triangle) and then the superficial inguinal ring
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Which are the branches of the SMA and IMA?
SMA: Iliocolic (gives the appendical A), right colic and middle colic
IMA: left colic, sigmoid A and superior rectal
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Parotid duct course:
Starts at the anterior edge of the parotid
Pierces trough the buccinator
Turns medially towards the masseter
Enters the mouth lateral to the second upper molar
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Which CN can be injured by a fracture of the sphenoid bone?
Nerves passing trough the superior orbital fissure
| CN 3, 4, 5 (V1, ophthalmic), 6 and ophthalmic veins
297
Name two voluntary muscles of the pelvic floor? get strengthened with Kegel exercises:
LEVATOR ANI S3-S4 (external anal sphincter), that has 3 parts:
Puborectalis
Iliococcygeus
Pubococcygeus: improves urine retention in both sexes
* Ischiocavernosus, bulbospongiosus, deep transverse perineal and external urethral sphincter are also strengthened with Kegel exercises in men but not part of the pelvis floor
Kegel may also help in premature ejaculation
298
Which ligaments provide true support for the uterus?
True:
Uterosacral, from the uterus to the sacrum, the most important, it looses integrity in uterine prolapse
Cardinal: CUT, from the cervix to the lateral pelvic wall
False:
Round: from the uterine horn to the labia majora, helps in uterine anteroversion, goes into the inguinal canal
Broad: from the uterus to the lateral pelvic wall
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The retinal A is brach of which arteries?
Internal carotid → Ophthalmic → Retinal A
300
Which nerves mediate psychogenic and reflex erection?
Psychogenic: T11-L2 (thoracolumbar erection center)
| Reflex erection: S2-S4 (pudendal nerve arch reflex)
301
Which muscle controls the vocal cords movement?
The pitch of the voice is heightened by contraction of the vocal cords. This function is carried out by the cricothyroid muscle
302
Which genes are important to form the 3 planes of the limbs?
PDA:
FGF (fibroblast growth factor) gene: Proximal to distal
Wnt-7a: Dorsal to ventral
Sonic Hedgehog and HOX genes: Anterior to posterior
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How many Ns and Cs have the spematogonia/oogonia, primary and secondary spermatocyte/oocyte, spermatids, sperm, eggs, zygote and embryo?
```
N: number of centromeres
C: number of chromatids
Spematogonia/oogonia: 2N2C
Primary spermatocyte/oocyte: 2N4C→ undergoes meiosis I splitting form single cell (XXYY; 2N4C) → 2 cells (XX + YY; 1N2C)
Secondary spermatocyte/oocyte: 1N2C→ undergoes meiosis II splitting into two cells split (→ X + X, Y + Y; 1N1C)
Spermatids, sperm and eggs: 1N1C
Zygote: 2N2C
Embryo: 2N4C
```
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What are the stem cells of the bone? and of the cartilage?
Bone: osteoblasts in the periosteum
Cartilage: undifferentiated cartilage precursor cells in the perichondrium
305
Where is the saphenous vein located on the knee?
Medial to the medial condyle of the femur, it can get injured at the medial femoral condyle
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Where do you have to place a chest tube in tension pneumothorax in adults? and in kids?
Where can you do thoracentesis?
Pneumothorax:
Adult: 5th left intercostal space along the midaxillary line
Kid: 2nd left intercostal space along the midclavicular line
Thoracentesis: CAP
6-8th mid-Clavicular
8-10th mid-Axillary
10-12th Paravertebral
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Resistance sensed right before reaching the epidural space in lumbar puncture, and before reaching the arachnoid?
Ligamentum flavum before the epidural space
| Dura before the dura
308
What do you have to cut on a cricothyroidotomy?
Vertically incise the skin and superficial cervical fascia
Invest (da la vuelta) the layer of deep cervical fascia
Horizontally incise the cricothyroid membrane
