Anatomy Flashcards
pericardium: innervated by?
phrenic N
pericarditis: EKG
diffuse ST elevation
pericarditis: clinical presentation
sharp pain:
- worse when inspire, supine
- better when lean forward
pericarditis: comp
effusion, tamponade
coronary arteries: arise from?
ostia in sinus of valsalva (just distal to aortic valve)
when do the coronary arteries fill?
diastole
LAD: supplies?
- 2/3 IVS
- ant RV, LV
LCX: supplies?
LV –> lat & post
RCA: supplies?
- inf wall of RA, RV
- SA, AV nodes
post descending artery: br of?
usu RCA
SA nodal, AV nodal A: br of?
RCA
what determines heart dominance?
where post descending artery arises
MVP: murmur
mid-systolic click
AR: murmur
diastolic:
- high pitch blowing
- head bob w wide pulse pressure
PR: murmur
diastolic:
- low pitch
- increase w inspiration
MS: murmur
diastolic:
- opening snap
- late rumble
aortic dissection: pathophys
intimal layer –> tear –> false lumen bw intima & media
aortic dissection: assoc dz?
- HTN
- bicuspid aortic valve
- CT disorders
aortic dissection: clinical findings
- sudden tearing chest pain –> radiate to back
- unequal BP in arms
- CXR: mediastinal widening
aortic dissection: classification
Stanford A: proximal dissection
Stanford B: distal
aortic dissection: tx
Stanford A: surg
Stanford B: BB, vasodilator, observe
thoracic aortic aneurysm: comp
- aortic root dilate –> AR
- compress struct: recurrent laryngeal, esophagus
syphilis: vasc comp
thoracic aortic aneurysm
who do you screen for an aortic aneurysm?
65-70yo who have ever smoked
how do you manage an aortic aneurysm?
M:
observe
> –> repair
F: 5.0cm
inf epigastric A: br of?
external iliac A
post pit: hormones
- ADH
- oxytocin
post pit: derived from?
neuroectoderm
ant pit: derived from?
oral ectoderm
islet of Langerhans: location of B cells?
center
islet of Langerhans: location of alpha cells?
periphery
islet of Langerhans: location of delta cells?
interspersed
midgut: what happens wk6?
herniate thru umbilical ring
midgut: what happens wk10?
- return to abd cavity
- rot around SMA
GI dev: fail to close –> rostral fold –> leads to?
sternal defect
GI dev: fail to close –> lat fold –> leads to?
- omphalocele
- gastroschisis
GI dev: fail to close –> caudal fold –> leads to?
bladder extrophy
Down synd: GI comp
- Hirschsprung’s
- duodenal atresia
- annular pancreas
- celiac dz
differentiate: omphalocele vs gastroschisis
- omphalocele: abd contents –> herniate into umbilical cord –> covered by peritoneum
- gastroschisis: abd contents –> extrude lat to umbilicus –> not covered by peritoneum
diaphragm: hiatus? where?
I Ate(8) 10 Eggs At 12:
- T8: IVC, R phrenic N
- T10: esophagus, R/L vagus
- T12: aorta, thoracic duct
what are the branches of the celiac artery?
- L gastric
- common hepatic
- splenic
hepatic A: branches?
- R gastric
- R gastroepiploic
splenic A: branches?
- L gastroepiploic
- short gastric
venous blood from stomach –> drains to?
portal V
what is: falciform lig
lig that divide liver into R & L lobes
what comprises the portal triad?
1) bile ductule
2) portal V
3) hepatic A
how do blood & bile flow in relation to each other?
opp directions
what are the zones of the liver?
zone 1, 2, 3
where is zone 1 of the liver?
periportal
where is zone 3 of the liver?
pericentral V
zones of liver: viral hep
zone 1
zones of liver: ischemia
zone 3
zones of liver: toxin
zone 3
hepatocyte –> bile –> secrete into?
bile canaliculus
what is: bile canaliculus
dilated intercell space bw adj hepatocytes (not a duct)
central V of liver: fx
blood flow out of liver
what forms the common bile duct?
- cystic duct
- common hepatic duct
spleen rupture –> leads to?
massive intraperitoneal hemorrhage
spleen: location in relation to ribs?
ribs 9, 10, 11
appendicitis –> pain at umbilicus: d/t?
GVA fibers to T10 dermatome
appendicitis –> pain at McBurney’s pt: d/t?
appendicitis –> irritate parietal peritoneum –> GSA fibers to RLQ
what is: “hourglass stomach”
sliding hiatus hernia
what is most common diaphragmatic hernia?
sliding hiatus hernia
what is: paraesophageal hiatus hernia?
fundus of stomach –> into chest cavity
sliding hiatus hernia: assoc dz
GERD
differentiate: direct vs indirect inguinal hernia –> location in relation to pertinent vessel?
MD’s LI:
- direct: medial to inf epigastric A
- indirect: lat
differentiate: direct vs indirect inguinal hernia –> location –> protrude thru?
- direct: inguinal triangle
- indirect: internal inguinal ring –> into scrotum
femoral hernia: location
below inguinal lig –> thru femoral canal
what hernia is more common in infant?
indirect
what is the most commonly fractured bone?
clavicle
clavicle fracture: #1 cause?
sports –> fall onto:
- outstretched hand
- shoulder
clavicle fracture: #1 location
mid 1/3
clavicle fracture at mid 1/3: what happens to medial end? lat?
- medial: pull sup (SCM)
- lat: pull inf/med (wt of arm, pec major)
what are the nerves of the brachial plexus?
- musculocutaneous
- median
- radial
- ulnar
- axillary
axillary N: nerve root
C5-6
axillary N: br of?
post cord
axillary N: fx
innervate deltoid & teres minor
axillary N: becomes?
lat brachial cutaneous
radial N: nerve root?
C5-T1
radial N: br of?
post cord
radial N: fx
all muscles of post side of arm, forearm
musculocutaneous N: nerve root
C5-7
musculocutaneous N: br of?
lat cord
musculocutaneous N: fx
innervate all muscles of ant side of arm
musculocutaneous N: becomes?
antebrachial cutaneous N
ulnar N: nerve root
C8-T1
ulnar N: br of?
medial cord
ulnar N: fx
- forearm: flexor carpi ulnaris, flexor digitorum profundus
- hand: most muscles
median N: nerve root
C5-T1
median N: br of?
med & lat cord
median N: fx
- forearm: most ant muscles
- hand: 3 muscles of thenar eminence, 2 lumbricals
what are the UE reflexes?
C5: biceps
C6: brachioradialis
C7: triceps
UE sensory test
C5: lat elbow C6: lat forearm, thumb C7: middle finger C8: pinky T1: medial forearm, elbow
UE motor test
C5: elbow flex C6: wrist extend C7: elbow extend C8: wrist flex T1: finger abduct
Erb palsy: aka?
waiter’s tip
Erb palsy: injury to
upper trunk or C5-6 roots
Erb palsy: cause
- infant: delivery –> pull head away from shoulder
- adult: fall on head & shoulders simultaneously
Erb palsy: presentation
arm at side –> extend, med rot –> pronate
Klumpke palsy: injury to
lower trunk –> C8-T1
Klumpke palsy: cause
- upward force on infant arm
- adult: fall from tree –> grab branch
Klumpke palsy: deficit in
intrinsic hand muscles
Klumpke palsy: presentation
complete claw hand
thoracic outlet synd: injury to
- lower trunk
- subclavian vessels
thoracic outlet synd: cause
- displaced rib
- neoplasm
- scalene issue
thoracic outlet synd: deficit in
similar to Klumpke (intrinsic hand muscles)
thoracic outlet synd: presentation
Adson’s sign: loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration
winged scapula: injury to
long thoracic N (C5-7)
winged scapula: cause
- axillary N dissection
- stab wound
winged scapula: deficit in
serratus ant
winged scapula: presentation
- scapula protrude when press against wall
- can’t raise arms past horizontal
rotator cuff: muscles
SItS:
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
rotator cuff: innervation
C5-6
supraspinatus:
- N
- axn
- buzzword
- N: suprascapular
- axn: abduct arm
- test: empty can test
infraspinatus:
- N
- axn
- buzzword
- N: suprascapular
- axn: ext rot arm
- cause: pitching injury
teres minor:
- N
- axn
- N: axillary
- axn: ext rot arm
subscapularis:
- N
- axn
- buzzword
- N: subscapular
- axn: int rot arm
- buzzword: lift off test
humerus fracture –> surg neck –> leads to?
injure:
- axillary N (C5-6): lose deltoid, arm abduct
- post circumflex A
humerus fracture –> midshaft –> leads to?
injure:
- radial N (C5-T1): “Sat night palsy/crutches” –> wrist drop, decreased extension
- deep brachial A
humerus fracture –> distal end –> leads to?
injure:
- ulnar N: ulnar claw hand
- brachial A
radius fracture: 2 types? which is more common?
#1) colle's fx #2) smith's fx
colle’s fracture: type of injury?
FOOSH –> fracture distal radius –> distal part –> displace post
smith’s fracture: type of injury?
fall on back of hand –> distal part –> displace ant
medial epicondylitis: cause? pain where?
- cause: elbow –> repetitive flexion
- pain: medial aspect
lat epicondylitis: cause? pain where?
- cause: elbow –> repetitive extend
- pain: lat aspect
what is the most commonly fractured carpal bone?
scaphoid
what is the most commonly dislocated bone?
lunate
lunate dislocation –> leads to?
acute carpal tunnel synd
scaphoid fracture: comp
avascular necrosis: primarily served by retrograde blood flow from radial A branches
scaphoid: palpated where?
anatomic snuff box
how do you test for carpal tunnel synd?
- Phalen’s test
- Prayer test
- Tinel’s test
carpal tunnel synd: cause
median N compressed –> numb, pain
carpal tunnel synd: affects what muscle?
thenar muscles
hand: motor innervation
C8-T1: all muscles
hand: sensory innervation
by dermatome:
- C6: thumb, index
- C7: middle
- C8: ring, pinky
by cutaneous N:
- median
- ulnar
- radial
median N: innervates what part of hand
- lat thumb
- dorsal hand: thumb to mid-ring
ulnar N: innervates what part of hand
mid-ring to pinky
radial N: innervates what part of hand
thumb to mid-ring: palmar, fingertips
median N –> distal to wrist –> injure –> #1 loss?
thumb opposition
what N can be injured with hernia repair?
ilioinguinal N (L1) –> courses thru superficial inguinal ring
lumbar plexus: N roots? N?
T12-L5:
- iliohypogastric (L1)
- ilioinguinal (L1)
- genitofemoral (L1-2)
- lat femoral cutaneous (L2-3)
- femoral (L2-4)
- obturator (L2-4)
- lumbosacral trunk (L4-5)
iliohypogastric N: nerve root? fx?
L1
- rectus abdominis
- cutaneous: small area of thigh
genitofemoral N: N roots? fx?
L1-2
- cremaster
- cutaneous: small area of thigh
femoral N: N roots? fx?
L2-4
ant thigh
obturator N: N roots? fx?
L2-4
medial thigh
lumbrosacral trunk: N roots? fx?
L4-5
join sacral plexus in pelvis
L1: fx
- sensory: proximal 1/3 ant thigh
- motor: hip flexors
L2: fx
- sensory: medial, ant thigh
- motor: hip flexor, adductor
L3: fx
- sensory: ant thigh just above knee
- motor: knee extensor
L4: fx
- sensory: medial leg
- motor: ankle dorsiflexion
- patellar reflex
L5: fx
- sensory: lat leg, dorsal foot, big toe
- motor: toe extensor
S1: fx
- sensory: lat malleolus
- motor: ankle flexor
- achilles reflex
obturator N injury: presentation
decreased:
- sensory to medial thigh
- adduction
femoral N injury: presentation
decreased:
- thigh flex
- leg extend
common peroneal (fibular) N injury: presentation
foot drop
tibial N injury: presentation
- can’t curl toes
- decrease sensation to sole
sup gluteal N injury: presentation
impair gluteus medius, minimus –> Trendelenburg sign –> pelvis drop to opp side
inf gluteal N injury: presentation
impair gluteus maximus –> difficulty:
- rise from chair, climb stairs
- hip extend
ACL injury: cause
- hyperextend
- twist knee jt
ACL injury: test
- ant drawer
- Lachmans
PCL injury: cause
car accident, severe fall –> blow to flexed knee
MCL injury: test
valgus force
LCL injury: test
varus force
knee meniscus injury: test? good for?
- McMurray: posterior meniscal tears
- Bounce home: more general tears
unhappy triad: what is? cause?
lat force to planted leg:
- ACL
- MCL
- med meniscus
ankle –> lat –> ligaments?
1) ant talofibular
2) calcaneofibular
3) post talofibular
ankle –> medial –> ligaments?
deltoid
how do you grade an ankle sprain?
of lig involved