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1
Q

Horiz transection of rectus abdominis should be done carefully because what structure enters the mm at the level of the arcuate line?

A

Inf epigastric aa

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2
Q

Deep peroneal nerve lies in what compartment of the leg? What does it innervate?

A

Anterior
Ant tibial artery and v are here too.
Innervates anterior mm of leg. Injury –> foot drop
Sensation between 1st and 2nd toes
Note: Fibular neck fracture –> Common peroneal = deep + superficial

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3
Q

Superficial peroneal nerve lies in what compartment of the leg?

A

Lateral

Injury causes loss of eversion of the foot. Sensory loss over lateral shin and dorsum of foot

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4
Q

Tibial nerve lies in what compartment of the leg?

A

Deep posterior compartment
Injury causes difficulty getting the heel off the ground –> shuffling gait
Diff to Stand on tip toes

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5
Q

What artery would be penetrated if an ulcer eroded through the posterior wall of the duodenal bulb?

A

Gastroduodenal artery

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6
Q

Irritation of what nerve can cause syncope during inspection of the posterior external auditory canal?

A

Vagus

Sensation to the rest of the ear canal is due to the mandibular division of the trigeminal nerve

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7
Q

name the 3 branches of the trigeminal nerve

A

V1 - ophthalmic
V2 - Maxillary
V3 - mandibular

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8
Q

What nerve innervates the major forearm flexors (eg biceps, brachialis)? This nerve provides sensory innervation to what part of the forearm?

A

Musculocutaneous
sensory - lateral forearm
Derived from C5-C7 of the brachial plexus
Coracobrachialias is deep to biceps brachii and is also innervated by this n

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9
Q

Thenar eminence receives sensory info from what nerve?

A

Palmar cutaneous branch of median nerve
Unlike most of the median nerve innervation of the hand, the palmar branch travels superficial to the Flexor retinaculum of the hand. Therefore, this portion of the median nerve usually remains functioning during carpal tunnel syndrome.

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10
Q

Posterior arm and forearm receive sensory from what nerve?

A

Posterior cutaneous branches of radial nerve

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11
Q

The medial forearm receives sensory from what nerve?

A

Branch of the medial cord of the brachial plexus (medial cutaneous nerve of the forearm)

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12
Q

Which mm pass through the greater sciatic foramen with the sciatic n?

A

Piriformis mm. Helps with external hip rotation

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13
Q

Diverticula of the GI tract can be classified in what 2 ways?

A

Morphology (true vs false)
Pathogenesis (traction vs pulsion)
Pulsion = increased intraluminal pressure due to strained BM
Traction = inflammation and scarring of the gut wall

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14
Q

Most diverticula acquired in adulthood are true/false?

A

False (outpouching of mucosa and submucosa through the muscularis) eg Zenker diverticulum of upper esophagus

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15
Q

Diverticula formed during fetal dev are usually true/false?

A

True (contain all 3 layers of the gut wall) eg Meckel’s diverticulum.

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16
Q

Injury to what nerve can cause atrophy of the deltoid and weakness of shoulder abduction?

A 
Axillary nerve (eg ant dislocation, humeral fracture at surgical neck)
Also innervates teres minor
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17
Q

Thoracentesis should be performed ABOVE which rib in the following areas?

  1. Midclavicular line
  2. Midaxillary line
  3. Posterior scapular/paravertebral line
A
  1. 8
  2. 10
  3. 12
    Note: neurovascular bundle is located UNDER the rib
    Note: there is still risk of penetrating abdominal structures (eg liver if below 9th rib in midaxillary line)
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18
Q

Esophageal dysmotility due to herniation of mucosal tissue between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor. Halitosis. Dx? These tissues are innervated by what?

A 
Zenker diverticulum (false diverticulum)
Motor fibers (pharyngeal plexus) from the vagus nerve
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19
Q

Most commonly fractured carpal wrist bone? Complication?

A

Scaphoid - prone to avascular necrosis due to retrograde blood supply
Falling on outstretched hand

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20
Q

Dislocation of what wrist bone may cause acute carpal tunnel syndrome?

A

lunate

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21
Q

Damage to what wrist bone may cause ulnar nerve injury

A

hook of the hamate

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22
Q

Supracondylar femur fracture compresses which artery?

A

popliteal artery

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23
Q

basal ganglia hemorrhage freq assoc with what cause?

A

hypertension

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24
Q

Pudendal nerve blocks are done using what as the bony landmark in the pelvis?

A

Ischial spine

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25
Locked-in syndrome is caused by a lesion where?
Ventral pons (supplied by basilar artery)
26
Testicular torsion is due to compromised flow through a direct branch of which of vessel?
Aorta (testicular arteries originate directly from the aorta)
27
Which testicular vein drains directly into the IVC?
Right | Left - drains into L renal vein
28
What is the pathway to access the lesser sac (eg to help visualize the head of the pancreas)
Open abdomen --> greater sac --> cut GASTROHEPATIC ligament --> lesser sac
29
Mid-humeral fracture is associated damage to what nerve? What is another common cause of damage to this nerve and what does it innervate?
Radial. Deep brachial artery lies with this n Also can be caused by crutches or Saturday night palsy Innervates posterior arm compartment mm (triceps, forearm extensors, supinator)
30
What nerve passes through the middle ear cavity? Postganglionic fibers from this ganglion innervate what salivary glands?
Chorda tympani of CN 7. Submandibular and sublingual glands. Note: Parotid innervated by otic ganglion (assoc with CN 9)
31
How does paralysis of the diaphragm cause paradoxical inward movement during inspiration?
Only intercostal mm contract, sucking diaphragm up and abdominal wall in. Normal inspiration: diaphragm and external intercostal mm contract, abd pushed out
32
Hernias: what type of hernia passes through the deep inguinal ring?
indirect - lateral to inf epigastric a | Direct do not pass through the deep
33
Demyelination of peripheral nerves, foot drop, pes cavus, stork-like appearance of legs, loss of light touch and proprioception are characteristic of what disease? What nerve is most commonly affected?
Charcot-marie tooth | Deep peroneal
34
Kidney, ureter | Intraperitoneal vs retroperitoneal organ?
Retro SAD PUCKER U and K E - esophagus
35
tail of pancreas | Intraperitoneal vs retroperitoneal organ?
intra | note: head and body retro
36
Proximal portion of first part of duodenum | Intraperitoneal vs retroperitoneal organ?
intra
37
adrenal gland | Intraperitoneal vs retroperitoneal organ?
retro SAD PUCKER Suprarenal (adrenal) glands
38
IVC | Intraperitoneal vs retroperitoneal organ?
retro SAD PUCKER Aorta and inferior vena cava
39
ileum | Intraperitoneal vs retroperitoneal organ?
intra
40
ascending and descending colon | Intraperitoneal vs retroperitoneal organ?
retro SAD PUCKER colon (ascending and descending)
41
rectum, anal canal
retro SAD PUCKER Rectum (mid-distal)
42
transverse colon, sigmoid colon
intra
43
MC site of ulnar nerve entrapment
cubital tunnel (near medial epicondyle) ulnar n can also be compressed at wrist (guyon's canal), but spares dorsum of hand) - hook of hamate injury
44
What structure lies posterior to the esophagus and left atrium?
Descending thoracic aorta - can be clearly visualized by TEE
45
Unilateral face and arm swelling with engorgement of subcutaneous veins on the same side of the neck indicates which is obstructed?
Brachiocephalic vein
46
Bilateral face and arm swelling with engorgement of subcutaneous veins on the same side of the neck indicates what is obstructed?
SVC
47
The obturator nerve goes through the obturator canal and allows for what function?
ADDuction of the thigh
48
Anterolateral humeral fracture injures what nerve?
Radial
49
Anteromedial humeral fracture injures what nerve?
``` Median nerve (anteroMEDIAL) Brachial artery also injured. ```
50
Plane passing through the superior aspect of the iliac crest passes through what vertebra, making it a good landmark for LP?
L4 - no risk of damaging the spinal cord
51
Being stabbed in the 8th intercostal space of the posterior R chest can injury what structures?
Thoracic duct - see elevated triglycerides in pleural fluid | Azygous and hemiazygous vein - inc RBC and WBC
52
Damage to the common peroneal nerve results in what?
Foot drop and loss of sensation of the dorsum of the foot and lateral aspect of the leg. Deep peroneal and superficial peroneal arise from this.
53
Damage to L5 nerve root is characterized how?
L4 disk compresses L5 root - weak extension of big toe, foot drop. Numbness/pain on top of foot and radiates to butt. Knee and ankle reflex normal
54
Damage to L4 nerve root is characterized how?
L3 disk compresses L4 root - sensory loss over anterolateral thigh, medial leg, posterior foot, quad weakness, no knee jerk
55
Damage to S1 nerve root is characterized how?
L5 disk compresses S1 root - atrophy of glutei, hamstrings and calf. Diminished sensation of lateral foot. No ankle reflex
56
What structure may be injured by a procedure that penetrates the manubrium?
L brachiocephalic vein - crosses the midline immediately posterior to the manubrium
57
A posterior hip dislocation would likely stretch what nerve and cause what sx?
``` Sciatic nerve (gives rise to tibial and common fibular nerves) Weakness in extending the thigh at the hip ```
58
Injury to the superior gluteal nerve would cause what sx?
Weakness in ability to abduct the thigh at the hip
59
GSW through abdomen in midline and bullet lodged bw L1 and L2 likely penetrates what structure?
L renal vein. It crosses the midline at approx level of the disk bw L1 nd L2 on its way to drain into the IVC on the R side of the midline
60
What arteries anastomose with the subscapular artery to enable collateral circulation?
Suprascapular artery (arises from thyrocervical trunk of subclavian a) can anastomose with subscapular a (arises from axillary a)
61
Injury to the recurrent branch of median nerve causes what?
MUSCULAR branch with no cutaneous distribution - Nerve innervates thenar eminence mm that flex, abduct, and oppose the thumb. Weakness in thumb opposition.
62
Why doesnt blockage of the celiac trunk affect the head of the pancreas?
Has dual blood supply from superior and inferior pancreaticoduodenal branches of the gastroduodenal artery and superior mesenteric artery respectively
63
What 3 arteries branch off the celiac artery?
Splenic artery L gastric artery Common hepatic artery
64
ACL originates where and courses which direction?
Originates laterally (lateral condyle) and courses anteriorly and medially to insert on the tibia.
65
Ureter lies anterior to what vessel?
Internal iliac artery | Note: ureters are posterior to the ovarian artery and vein (water under the bridge)
66
Repetitive promation/supination of the forearm can cause what symptoms?
Finger drop - weakness of finger and thumb extension | D/t injury to superficial radial nerve in supinator canal
67
Tennis elbow affects what part of the humerus? What actions is performed by the affected mm?
``` Lateral epicondyle of the humerus Wrist extension (externsor carpi radialis) - originate on lateral epicondyle ```
68
During skeletal mm contraction, Ca is released from the SR and binds ___, thereby allowing ____.
Troponin (Ca binds troponin!) | Actin to myosin binding
69
What mm attaches on the medial portion of the clavicle? | What mm attaches to the lateral portion of the clavicle?
Medial - SCM, pec major, sternohyoid | Lateral - trapezius, deltoid, subclavius
70
Inability to ______ the shoulder after trauma indicates what? 1. externally rotate 2. abduct 3. adduct and external rotate 4. adduct and internal rotate
rotator cuff injury 1. infraspinatous (responsible for external rotation) 2. supraspinatous 3. teres minor 4. subscapularis
71
Foreign bodies lodged in the piriform recess may cause damage to what nerve?
Internal branch of superior laryngeal nerve - impairs cough reflex.
72
Abdominal surgery (eg appendectomy) can damage what nerve and cause dec sensation and/or burning pain at the suprapubic region?
Iliohypogastric nerve - sensation to suprapubic and gluteal regions and motor to anterolateral abdominal wall mm Note: ilioinguinal nerve goes through spermatic cord and through superficial inguinal ring, providing sensation to upper and medial thigh and parts of external genitalia
73
labor can result in fecal and urinary incontinence by damage to what nerve?
stretch injury to PUDENDAL nerve
74
What can get trapped between the SMA and aorta, causing sx of partial intestinal obstruction?
3rd portion of duodenum
75
Femoral nerve block should be performed in the femoral ring or at the inguinal crease?
Inguinal crease Note: femoral canal has lymphatic vessels and LN. Femoral n lies laterally to fem a and fem canal (not in the femoral sheath) Anesthetizes the skin and mm of the anterior thigh, femur and knee
76
Patellar fx sx?
Cant EXTEND knee against gravity | Note: inability to flex knee against resistance is due to hamstring mm problem
77
Last rib? What organ lies immediately deep to the tip of this rib?
12 - Kidney | Note: the L 9th, 10th and 11th ribs overlie the spleen
78
What type of hernia is assoc with incomplete obliteration of the processus vaginalis?
Indirect hernias - similar to MOA of hydroceles. Lateral to epigastric vessels Note: direct hernias are acquired rather than congenital, and medial to inf epigastric vessels
79
Damage to the orbital floor of the eye can injury what nerve? Sx?
Intraorbital nerve - paresthesia of upper cheek, upper lip, and upper gingiva Inferior rectus mm can also get trapped, limiting vertical gaze.
80
Cricothyrotomy involves cutting through what structures?
Superficial cervical fasia, pretracheal fascia, and cricothyroid membrane Note: below thyroid cartilage (adam's apple) and above thyroid gland
81
Interscalene nerve block anesthetizes the brachial plexus to provide anesthesia to the shoulder and upper arm. What is one common consequence of this block?
Transient ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve roots as they pass through the interscalene sheath
82
Mastectomy with axillary LN removal can injury what nerve?
Long thoracic nerve - paralysis of serratus anterior (wing scapula)
83
Damage to what nerve causes hyperacusis (inc sensitivity to sound)?
Facial n branch (stapedius n). Innervates stapedius mm
84
Incision of what structure is used to treat carpal tunnel?
Transverse carpal ligament (flexor retinaculum) Note: tunnel contains flexor digitorum profundus tendons, flexor digitorum superficialis tendons, flexor pollicis longus tendon, and median nerve
85
Supracondylar fractures of the humerus may injure what artery?
Brachial artery. Branches into the radial and ulnar arteries | Note: axillary a gives off the posterior circumflex humeral a --> brachial a
86
The venous component of internal hemorrhoids drains into the middle and superior rectal veins, which communicate with what 2 veins?
Middle rectal vein --> internal iliac | Superior rectal vein --> inferior mesenteric vein
87
What nerve descends through the fibers of the psoas major mm? Compression from hematoma or abscess can cause what sx?
Femoral nerve | Weakness of quad mm, loss of patellar reflex, loss of sensation over anterior and medial thigh and medial leg
88
When placing a suprapubic cystostomy, the trocar and cannula will pierce what?
Bladder is EXTRAperitoneal - abdominal wall will get pierced and will not enter the peritoneum
89
Where should catheters be inserted to drain pleural effusions?
Between 8th and 10th ribs to avoid lung injury. | ABOVE the rib. Vessels and n lie below.
90
What part of the bone assists in healing fractures by producing new bone?
Periosteum The periosteum is divided into an outer "fibrous layer" and inner "cambium layer" (or "osteogenic layer"). The fibrous layer contains fibroblasts, while the cambium layer contains progenitor cells that develop into osteoblasts. After a bone fracture, the progenitor cells develop into osteoblasts and chondroblasts, which are essential to the healing process.
91
hip adductor muscles that are weak in duchenne muscular dystrophy attach where on the pelvis?
ischium
92
Tendon in the forearm that is absent in about 14% of the population?
Palmaris longus Can be useful for tendon repairs of other muscles because absence of the palmaris longus does not have any known effect on grip strength
93
In order to place a band around the upper portion of the stomach, what must the band pass through?
Lesser omentum
94
Tricuspid valve lies where in the heart compared to the mitral and aortic valve
Posterior to aortic valve and ventral to the mitral valve
95
Describe vocal cord position when food irritates the larynx and causes cough during the following stages: - while swallowing - immediately after laryngeal irritation - while coughing
- while swallowing: closed - immediately after laryngeal irritation: closed - while coughing: open
96
When doing an LP, what ligament must be traversed to reach the spinal canal?
Ligamentum flavum
97
Hip pain in adult with full range of hip motion. Pain worse with flexion and internal rotation of the hip and by direct palpation over lateral aspect of the hip. Structure involved?
Trochanteric bursa | Note: iliopsoas bursitis would present with pain at the front side of the hip
98
Patient with acute esophageal bleeding from esophageal varices. In order to dec portal venous pressure in the esophageal veins, it is most beneficial to join the portal vein to which vein?
Inferior vena cava (bypasses the liver) | renal vein is also an option
99
What nerve must be servered in a total esophagectomy ?
Vagus
100
Space behind the stomach but in front of the retroperitoneal structures (eg pancreas)
Lesser sac (omental bursa)
101
Most pancreatic cancers arise from what part of the pancreas?
epithelium (>80%), possibly due to long term exposure to lots of potent secretions. Note: Acinar epithelium is responsible making exocrine secretions. Islet cells can form neuroendocrine tumors (insulinomas).*

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