Anatomy Flashcards
Musculo-cutaneous nerve Nerve root Motor supply Sensory Injury
C5- C7
Elbow flexion - biceps brachii ; supination
Sensory - lateral forearm
Axillary n Root Motor Sensory Injury
C5, C6
Shoulder abduction - deltoid
Sense - inf region of deltoid
Injury - flattened deltoid ( humeral neck fracture/ dislocation)
Radial n Root Motor Sensory Injury
C5 - T1
Extension forearm wrist fingers thumb
Sens - dorsal aspect b/w 1st & 2nd metacarpals
Wrist drop - humeral shaft fracture
Median n Root Motor Sensory Injury
C6 - T1
LOAF muscles
Palmar aspect lateral 3.5 fingers
Injury - @ wrist - the arm muscle paralysis, opponens pollicis
@ elbow - loss of forearm pronation + weak wrist flexion
Carpal tunnel syndrome - wrist lesion
LOAF muscles and function
lateral 2 lumbricals, MCPJ flexion, IPJ extension
opponens pollicis brevis, - opposes thumb
abductor pollicis brevis - abducts thumb
flexor pollicis - flexes thumb
Ulnar nerve Root Motor Sensory Injury
C8, T1
Intrinsic hand muscles ,LOAF (wrist flexion)
Medial 1.5 fingers
Claw hand -; medial epicondyle frx
Long thoracic n
Root
Injury
C5-C7
Serratus anterior
Injury - blow to rbs, lifting weights , complication of mastectomy
Winged scapula
Pain more severe on contralateral tilting of head
Winged vs dropped scapula
Winged - long thoracic n affected
Dropped - accessory n (CN 11) = supplies trapezius + SCM
Unable to move shoulder
Wrist drop
Saturday night palsy
Crutch palsy
Radial nerve
Crutch - compression against spiral groove on medial humerus
Sat - radial n compressed in medial aspect of arm
Flexor digitorum superficialis
Flexion of PIP and MCP joints
Flexor digitorum profundis
Flexion DIP
Extensor digitorum
Extension - middle 3 fingers - index, middle, ring
@ MCP IP joints
Extensor pollicis longus
Extends thumb @ IP
Full extension of thumb - EPL
Extensor pollicis brevis
Thumb extension @ MCP
Midline structure pierced in lap chole
Lines alba
Structures pierced in laparoscopy
Midway pt b/w umbilicus + sup iliac spine
Internal oblique + external oblique aponeurosis
What is liable to be pierced in chest drain insertion (5th ICS mid axillary)
VAN
Intercostal Vein artery nerve + intercostal muscle
- located @ inferior border of a rib
Popeye arm appearance
Proximal biceps tendon rupture
What is affected in tennis elbow
Lateral epicondylitis
Wrist extension
What is affected in golfer’s elbow
Medial epicondylitis
Finger flexors and pronation
Nerve supply eye muscles
LR6 SO4 rest 3
OTA = same , opposite, same
Occult motor n function
Injury
Pupil constriction
Supplies most eye muscles
N to levator palpebrae
Injury = my crisis, ptosis - same side. ; outward gaze , diplopia
Trochear n
Function
Injury
Superior oblique
Injury = diplopia on downward gaze - opp side
Vertical diplopia
Abducens n
Function
Injury
Lateral rectus
Diplopia on lateral gaze (same side) (horizontal diplopia)
Same side
Saphenous n supplies
Injury in
Medial foot sensation
It is purely a sensory nerve
Injury = varicose vein surgery, vein harvest for bypass, knee arthroscopy
Sural n supplies
Lateral foot sensation
Safe triangle for chest drain
5th IC slightly anterior to mid axillary line
Boundaries - Ant - pect minor Post- latissmus dorsi Superior - base of axilla Inferior - 5 th ICS
Lymphatic drainage of ovaries/testis
Para-aortic LNs
Skin (perineum, scrotum, vulva)
Lymphatic drainage
Superficial inguinal LNs
Lymphatic drainage of tongue
Tip
Ant 2//3
Post 1/3
T - submental
Ant - submandibular
Post - jugular omohyoid ( deep cervical LNs)
LNs of posterior oropharynx
Deep cervical
Skin of medial malleolus drains to
Inguinal LNs
Skin of lateral malleolus drains to
Popliteal LNs > inguinal
Superficial inguinal LNs drain
All below umbilicus excepts gonads and lateral foot
Politeal LNs
Drain lateral foot
Deep lymphatics of glans, clit drain to
External iliac
Branches of common peroneal + fn
Superficial - lateral compartment of leg - everts foot
Deep - anterior compartment leg - dorsiflexes the foot
Vein that runs on lateral aspect of leg
Short saphenous vein
What veins runs on medial aspect of leg
Long/great saphenous v
4 sensory branches of common peroneal n
Sural communicating - lower posterolateral leg
Lateral sural cutaneous - upper lateral leg
Superficial fibular (peroneal) - anteroom the leg except b/w 1st 2 toes
Deep fibular (peroneal) - skin b/w 1st 2 toes
Thumb Abduction + extension weak + ulnar deviation of wrist
Little finger paresthesia
N root injury?
C8
Fingers abduction + adduction w/ pain and paresthesia
N root injury?
T1
Loss of thumb sensation and elbow flexion
N root injury
C 5,6 - Erbs palsy
Motor function of C5 6 7 8, T1
5-flex elbow
6- extend wrist
7- extend elbow
8- flex fingers
T1 - addict + abduct fingers
Nerve roots for thumb , middle 3 fingers, pinky
Thumb - C6
Middle 3 - C7
Pinky - C8
What is addisons plane
Importance
Transphobic plane
Transverse line midway b/w sternal notch & symphysis pubis
L1 level , 9th rib level (ant end)
Level of pylorus = fundus of gall bladder
**tip of 9th costal cartilage - GB fundus
Structures @ L1 level (6)
9th costal cartilage - GB fundus
Stomach pylorus- kidney hilum
SMA , celiac trunk
Posterior gastric ulcer perforation ( fundus /body of stomach)
Pus accumulates where?
What occurs
Lesser sac
Abscess formed - passes thru peritoneal cavity (thru winds low foramen)
= generalised peritonitis
Perforation of posterior pyloric / duodenal ulcer causes
Retropperitoneal abscess
Stroke of temporal lobe results in
Memory impairment , changes in sexual behaviour
Visual defect = Superior homonymous quadrantinopias
PiTs =
parietal - inferior homonymous quadrantinopias
Temporal = (see above )
Frontal lobe lesion
Results in
Personality and social behaviour changes
No visual field defect
Rule of 17- for side of deviation
10 + 7 + opposite side of lesion
- facial (7), uvular (10)
12+5 = same side of deviation
15- jaw , 12- tongue
5 trigeminal 7 facial 10 vagus 12 hypoglossal
Hepatopancreatic ampulla is
Where CBD connects to pancreatic duct @ 2nd part of duo
Aka - ampulla of vater
Nerve for inversion and plantar flexion of foot
Tibial n
TIP
Nerve for version and dorsiflexion of foot
PED
Peroneal n
70% of head of pancreas patients initially present with jaundice
Why?
Head of pancreas- close to CBD
Obstruction = jaundice
Erbs palsy
C5,6 palsy
Loss of thumb sensation and elbow flexion
Maxillary n supplies
Sinuses - ethmoid , maxillary , sphenoid
Mucosa - palate, roof of pharynx , nasal mucosa
Lower lids, upper lip & gum/teeth, nares,
Parts of meninges
Palate = mucous membrane
Location of deep inguinal ring
Above mid pt of inguinal ligament approx 1 inch/2.5 cm
Where does the LAD run
Inside the anterior interventricular groove
It’s a continuation of Left coronary a.
Extensor digitorum communis fn
Extends phalanges 1st, then wrist , then elbow
Separates fingers during extension
Features of lacunae infarct (internal capsule)
Ataxic hemiparesis (same side) + dysarthria
Features of cerebral infarction
Contralateral hemiplegia or sensory loss
Dysphasia
Homonymous hemianopia
Brainstem infarct
Features
Quadriplegia, vertigo, diplopia, locked in syndrome (pseudo coma)
Locked in syndrome caused by
Damage to pons (brainstem)
Branch of internal carotid that supplies eye
Internal carotid > ophthalmic a. > central retinal a.
Transient occlusion of central retinal a. Results in
Amaurosis fugax
- resolves quickly
RF of amaurosis fugax
Atherosclerosis
HTN
Innervation of. Lower teeth
Inferior alveolar n
- branch of mandibular n
Nerve supply of chin and lower lip (skin + mucosa)
Mental nerve
Trigeminal > mandibular > inf alveolar > mental
Unilateral injury to recurrent laryngeal n causes
Hoarseness of voice
RLN is branch of vagus
Bilateral recurrent laryngeal nerve injury
Aphonia +/- airway obstruction
Aphonia = inability to speak
External branch of superior laryngeal n injury
Dysphonia
Loss of high pitched sound > monotones voice
Where should superior thyroid artery be ligated
Near superior pole of thyroid gland
= to avoid External br of superior laryngeal nerve damage
Umbilicus is @ what level
What is the umbilical derma tome
L3/4
Derma - T10
Iliac crest is at what level
L4
What lies at level of T8
IVC
What lies at T10 level
Oesophagus
What lies @ T12
Aorta
Peroneal strike
Blow/trauma to lateral aspect below knee
Causes foot drop
Common peroneal n affected
Features of prepatellar bursitis
Tx
Redness swelling ability to flex knee
Rest usually resolves symptoms
Housemaids plumbers
Clergyman or jumpers knee =
Infrapatellar bursitis
Nerve root achilles reflex
S1 S2
Nerve root patellar reflex
L3 L4
Nerve root biceps/brachioradialis reflex
C5 C6 - biceps
C6 C7 - brachioradialis
Nerve root triceps reflex
C7 C8
Nerve root cremasteric reflex
L1 L2
Nerve root anal wink reflex
S3 S4
Facial n palsy =
Facial weakness
Loss of tast ant 2/3 tongue
Vagus n lesion =
Weak cough
Vocal cord paralysis + dysphonia
Uvular deviation
Parasympathetic loss - resp , GIT, CVS
5th n lesion
Trigeminal
Weakness of mastication muscles
Jaw deviation same side
Loss of facial sensation
9th n lesion
Glossopharyngeal
No gag reflex
No taste post 1/3 tongu e
No sensation posterior pharynx, tonsils, soft palate
Loss of taste nerves
Ant 2/3 - facial
Post 1/3 - glosspharyngeal
Hypoglossal n injury
Deviation of tongue to same side as lesion
Claw hand
Which movement against resistance helps confirm n injury
Ulnar n - supplies dorsal + palmar interossei = fingers adduction + abduction
Dorsal - abduction
Palmar - adduction
Abduction and adduction of fingers affected
N injury?
Ulnar
Femoral n injury =
Weak hip flexion
Weak knee extension
Paresthesia medial side of thigh
= L234
Femoral n
Root
Motor
Sensory
L234
Knee extension , hip flexion
Ant + medial aspect of thigh and lower leg
Hip+ pelvic frx / stab or gunshot wounds
Obturator n
Motor
Sensory
Injury
Thigh adduction
Middle part of medial thigh
Anterior hip dislocation
Lateral cutaneous n of thigh
Motor
Sensory
Injury
None
Lateral + posterior surface of thigh
Compression of nerve near ASIS
-meralgia paresthetica; pain tingling numbness in n distribution
Tibial n
Motor
Sensory
Injury
Foot plantarflexion + inversion (TIP)
Sole of foot
Deep and well protected so not commonly injured
-popliteal laceration , posterior knee dislocation
Common peroneal
Motor
Sensory
Injury
PED - eversion + dorsiflexion
Dorsum of foot + lower part of lateral leg
Injury @ neck of fibula ; tightly applied lower limb cast
- foot drop
Superior gluteal n
Motor
Sensory
Injury
Hip abduction None Misplaced IM injection Hip surgery Pelvic frx, post hip dislocation Injury = +ve trendelenburg sign
Inferior gluteal n
Motor
Sensory
Injury
Hip extension + lateral rotation
None
Injured w/ sciatic n
Injury = difficulty rising from seated position , can’t jump or climb stairs
Arterial supply of LL
External iliac > femoral > popliteal > ant tibial > dorsalis pedis
What is seen in aorto-iliac occlusion
Leriche syndrome
Pain in buttocks , thigh + erectile dysfunction
Common iliac artery occlusion
Pain extends to just above inguinal ligament
Femoral artery occlusion
Pain in leg below inguinal ligament
Femoral pulse felt - ones below it are not
Femoral-popliteal occlusion
Pain below knee
Guyon’s canal syndrome
Predisposed by pregnancy
Ulnar nerve compression at wrist
Upper brachial plexus
Lower
C 567
C8 T1
Bradykinesia + resting tremors + rigidity
Classic triad seen in ?
Parkinson’s
It is a result of low dopamine due to degeneration of dopamine rigid neutrons in substantia nigra
Most likely affected anatomical structure in Parkinson’s
Substantia nigra
