ANATOMY Flashcards
A young man presents with increased scapula winging when doing a push-up against the wall and pain induced on contralateral tilting of the head. Which structure was most likely injured?
Long Thoracic nerve
Medial scapular winging; Weakness of the serratus anterior muscle
This condition presents as sudden, unilateral vision loss, described as black curtain coming down, lasting for 5-15 minutes.
Amaurosis fugax
Amaurosis fugax is a painless transient monocular visual loss associated with stroke or transient ischemic attack (TIA) and its risk factors. What causes this condition?
It is caused by RETINAL ISCHEMIA usually associated with platelet emboli passing through retinal circulation or stenosis of the ipsilateral carotid artery.
Anatomical Landmarks:
C6-7
Stellate ganglion
Anatomical Landmarks:
T5-8
Heart position
Anatomical Landmarks:
5th ICS
Apex of heart (midclavicular line)
Anatomical Landmarks:
9th costal cartilage
gallbladder fundus
Anatomical Landmarks:
T3-4
Manubrium
Anatomical Landmarks:
T9-10
Xiphoid process
Anatomical Landmarks:
Kidney position
T12-L3
Anatomical Landmarks:
Transpyloric plane
L1
Anatomical Landmarks:
subcostal plane
L2
Anatomical Landmarks:
Iliac Crest
L4
Anatomical Landmarks:
Intertubercular plane
L5
In adults, at which level does spinal cord extend to ? In children?
Lower border of L1; Lower/upper border of L3
Nerve Injury Pointers (Upper Limb)
Wrist Drop
Radial Nerve
Nerve Injury Pointers (Upper Limb)
Claw Hand
Ulnar nerve
Nerve Injury Pointers (Upper Limb)
Paresthesia: ring + little finger
Ulnar nerve
Nerve Injury Pointers (Upper Limb)
Paresthesia: middle + index + thumb
Median nerve
Nerve Injury Pointers (Upper Limb)
Humeral Neck Fracture
Axillary nerve
Nerve Injury Pointers (Upper Limb)
Humeral Shaft Fracture
Radial Nerve
Nerve Injury Pointers (Upper Limb)
Supracondylar Fracture
Median nerve (anterior interosseous nerve branch)
Nerve Injury Pointers (Upper Limb)
Saturday night palsy
Crutch Palsy
Radial nerve
Nerve Injury Pointers (Upper Limb)
Winging of Scapula
Long Thoracic nerve
Nerve Injury Pointers (Upper Limb)
Dropped Scapula
Accessory nerve
After surgery for varicose veins, a patient complains of numbness on the medial side of his foot. What is the SINGLE most likely nerve involved?
Saphenous nerve
Nerve Injury Pointers (Lower Limb)
Femoral neck fracture
Acetabular fracture
Sciatic nerve
Nerve Injury Pointers (Lower Limb)
Fibular neck fracture
Common peroneal nerve
Nerve Injury Pointers (Lower Limb)
Foot drop
Sciatic/Common & Deep Peroneal nerve
Nerve Injury Pointers (Lower Limb)
Loss of sensation medial side of foot
Saphenous nerve
Nerve Injury Pointers (Lower Limb)
Loss of sensation lateral side of foot
Sural nerve
Nerve Injury Pointers (Lower Limb)
Glove and stocking pattern of paresthesia
Diabetes mellitus
LOAF muscles
Lumbricals (lateral two)
Opponens pollicis
ABductor pollicis brevis
Flexor pollicis brevis
Motor of these muscles are innervated by the median nerve
Winged scapula - what nerve and muscle are affected?
Usual causes?
Long thoracic nerve - innervating the serratus anterior
Caused by lifting heavy objects, trauma or s/p mastectomy
Also take note of:
- Pain is severe on CONTRALATERAL tilting of the head
- increased winging of scapula on WALL PUSH-UP
Dropped scapula - what nerve and muscles are affected?
Common causes?
Accessory nerve (CN XI) which innervates the trapezius muscle is affected. Usually during a surgery of the POSTERIOR triangle of the neck.
Winging increases during arm abduction at the shoulder level.
Differentiate Winged Scapula from Dropped Scapula in terms of : A. Nerve B. Muscle C. Winging exaggeration D. Pain exaggeration E. Cause
Winged Scapula A. Long thoracic nerve B. Serratus anterior C. Wall push-up D. Contralateral tilting of the head E. After lifting heavy objects, trauma, or s/p mastectomy
Dropped Scapula A. CN XI B. Trapezius (and sternocleidomastoid) C. Arm Abduction at the shoulder level D. ***no data E. During surgery of the POSTERIOR triangle of the neck
How does claw hand occur?
- Damage to the ulnar nerve
- you have a hyperextension at the MCP joints and flexion at the proximal and distal interphalangeal joints of 4th and 5th fingers
When this nerve is compressed against this groove on the medial aspect of the humerus, what happens?
Radial nerve at the spiral groove - Crutch Palsy
Differentiate Flexor Digitorum superficialis from Flexor Digitorum profundus.
FDS - unable to flex the PIP and MCP
FDP - unable to flex the DIP
Other term for medial epicondylitis
Golfer’s elbow
Other term for tennis elbow
Lateral epicondylitis
Washerwoman
De Quervain’s tenosynovitis
What is OTA rule for eye muscles?
Remember that LR6SO4 means:
- lateral rectus is innervated by CN VI
- superior oblique is innervated by CN IV
Oculomotor nerve (CN III)
- controls most eye muscles
- it constricts the pupil and innervates the levator palpebrae superioris
- injury results in MYDRIASIS and PTOSIS of the same side
- also causes diplopia and outward gaze
Trochlear nerve (CN IV) - causes downward gaze and diplopia in the opposite side (vertical diplopia) i.e., while climbing the stair, he sees double if he looks left, lesion is in the right
Abducens nerve (CN VI)
- horizontal diplopia
- sees double in the same side of the lesion
OTA - same opposite same
What are the functions of an oculomotor nerve?
Constricts the pupil and innervates the levator palpebrae superioris; hence, injury results in MYDRIASIS and PTOSIS
Two motor branches of the common peroneal nerve
Superficial Peroneal nerve and Deep Peroneal nerve
Superficial peroneal nerve - responsible for foot eversion (foot away)
Deep Peroneal nerve - resposible for dorsiflexion
Thus, injury to the common peroneal nerve causes a inverted plantar flexed foot or FOOT DROP
Affected nerve in a foot drop
Common peroneal nerve
The only vein that runs on the lateral aspect of the leg
Short saphenous vein
***Remember that in the lateral aspect of the leg, you have the SSV and Sural nerve (lateral foot).
In the medial aspect of the leg, you have Saphenous Nerve (medial foot) + Long (Great) Saphenous Vein
Common fibular nerve is also known as:
Common peroneal nerve which has two branches: Deep peroneal nerve (For dorsiflexion) and Superficial peroneal nerve (for foot eversion)
All structures below the umbilicus drain into the SUPERFICIAL INGUINAL LYMPH NODES except
Gonads (testis and ovaries) - Para-aortic LN Lateral Foot (Lateral Malleolus) - popliteal LN
Lymphatic drainage of the tip of the tongue
Submental LN
Lymphatic drainage of the tongue?
Tip - submental
Anterior 2/3 - submandibular
Posterior 1/3 - jugulu-omohyoid of the deep cervical LN
DAD of deep peroneal nerve
Deep peroneal nerve a branch of the common peroneal (fibular) nerve
DAD stands for Deep peroneal nerve, Anterior compartment of the leg, Dorsiflexion
C8 Radiculopathy common presentation
ulnar deviation of the wrist
Thumb: abduction and extension
T1 Radiculopathy presents with:
Finger abduction and adduction
What is the FEEF EWEF of C5-C8?
C5 - flex - elbow
C6 - extend - wrist
C7 - extend - elbow
C8 -flex - fingers
What results in the perforation of an ulcer in the fundus or body of the stomach?
Pus in the lesser sac —> abscess formation —> generalized peritonitis
What results in the perforation of an ulcer in the pylorus or duodenum (duodenal ulcer)?
Retroperitoneal abscess
What is the PiTs of stroke?
Posterior lobe - inferior homonymous quadrantinopsia
Temporal Lobe - superior homonymous quadrantinopsia
What are the common presentations of a patient who suffers from temporal lobe stroke?
Long-term memory loss + changes of sexual behavior + visual field defect (superior homonymous quadrantinopsia
(PiTs)
Differentiate the visual field defect of a temporal lobe lesion versus a parietal lobe lesion.
Remember PiTs
Posterior lobe - inferior homonymous quadrantinopsia
Temporal lobe - superior homonymous quadrantinopsia
An elderly with a history of stroke presents with impaired long-term memory, altered sexual behavior and visual defect. What is the possible visual defect elicited by the patient?
Superior homonymous quadrantinopsia
Explain the rule of 17 for side of deviation.
10 + 7 = Opposite
12 + 5 = Same side
Why is jaundice the most common manifestation of a patient with tumor in the head of the pancreas?
Because head of the pancreas is situated proximal to the common bile duct and obstruction of which results in jaundice
Lymphatic drainage of the posterior oropharynx
Deep cervical Lymph node
The posterior oropharynx and the posterior 1/3 of the tongue are both draining into the deep cervical lymph node
Branches of the trigeminal nerve
Ophthalmic
Maxillary
Mandibular
What are being innervated by the maxillary branch of the trigeminal nerve?
Sinuses and Mucosa
MESS of Maxillary Nerve: Maxillary, Ethmoid, Sphenoid Sinuses
Location of the deep inguinal ring
It is located about 1 inch above the midpoint of the inguinal ligament
Imagine Inguinal ligament (singit) and its midpoint. 1 inch above it, you can find the deep inguinal ring.
The stretch of the deep inguinal ring down to the superficial inguinal ring makes up the inguinal canal
Quadriplegia + Vertigo + Diplopia + Locked-in syndrome
Brainstem infarct
Ataxic hemiparesis + Dysarthria
Lacunar infarct (internal capsule)
What nerve is often injured during dental procedures and mandibular trauma?
Inferior alveolar nerve (a branch of mandibular nerve)
- also gives off to mental nerve (supplies the chin and lower lip)
Extensor pollicis brevis and extensor pollicis longus, obviously, extends the thumb at their respective joints. Which joints and which muscle?
EP Brevis - at the MCP joint
EP Longus - at the IP joints
Extends all fingers at the MCP and IP joints
Extensor digitorum
What are the structures at the transpyloric plane?
9th costal cartilage GB fundus Pylorus Renal hilum Coeliac trunk Superior mesenteric artery
Umbilicus in terms of dermatoma and vertebral level
T10 dermatome
L3-L4 vertebra
Paresthesia of the:
LIttle finger + Ring Finger (both dorsal and palmar)
Ulnar nerve
Paresthesia of the:
Middle finger, index finger and thumb
Median nerve
A blow or a trauma to the lateral aspect of the area BELOW the knee results in what condition and due to lesion in what nerve?
Foot drop
Common peroneal nerve
A blow or a trauma to the lateral aspect of the area ABOVE the knee results in what condition and due to lesion in what nerve?
Foot drop
Common peroneal nerve still
Most common type of knee bursae inflammation, commonly seen in housemaids and plumber who kneel a lot
Prepatellar bursitis
Treatment for prepatellar bursitis
Rest
Achilles reflex
S1-S2
Patellar reflex
L3-L4
Biceps reflex
C5-C6
C7-C8
Triceps reflex
Cremasteric reflex
L1-L2
S3-S4
Anal wink reflex
Nerve root responsible for the sensory loss in the groin and pelvic girdle
L1
Remember 3 in the thigh, 2 in the shin, 1 in the foot
L1-L3, L4-L5, S1
Nerve root responsible for sensory loss in the anterior thigh
L2
Transpyloric plane is located at what level of vertebra?
L1
Erb’s palsy is a result of an injury to what roots of the brachial plexus? Manifestation?
C5-C6 roots
Klumpke’s Palsy is injury to which roots?
C8-T1
