Anatomy Flashcards
Caput Medusae
Portosystemic shunt through paraumbilical vins into the small epigastric veins of anterior abdominal wall
Hematemesis/Esophageal varices
Dilation of submucosal veins in lower esophagus. Anastamosis between left gastric vein (portal) and azygos vein via esophageal v (systemic)
Anal varices
Distinct from hemorrhoids. Between superior rectal and middle/inferior rectal veins.
Shunts used to treat portal hypertension
Portacaval - portal vein to vena cava
Mesocaval - SMV with vena cava
Splenorenal - splenic vein with renal vein
Trasnjugular intrahepatic portosystemic shunt - metal stent connecting portal v with hepatic v
Hesselbach’s triangle
Site of direct inguinal hernias.
Lateral: inferior epigastric a.
Medial: lateral portion of rectus abdominis
Inferior: inguinal ligament
Direct inguinal hernia
Emerge through inguinal triangle, and may exit through superficial inguinal ring. Rarely enter scrotum or labium
Indirect inguinal hernia
Pass through the deep inguinal ring, transmitted by inguinal canal into scrotum or labium majus following path of spermatic cord. Most common type of hernia, lateral to inferior epigastric a. and v.
Boutonnière deformity
PIP joint flexed toward palm, DIP is hyperextended. Can occur in rheumatoid arthritis
Culdocentesis
Needle inserted in posterior fornix of vagina, accessing rectouterine pouch (pouch of douglas). If needle too high: puncture cervix or uterus, too low enter rectum
Rectouterine pouch - where fluid collects in upright /supine position
Blood supply of the lesser curvature of the stomach
Right gastric - from hepatic artery proper
Left gastric - from celiac trunk
Anastamoses
Blood supply of greater curvature of stomach
Right and left gastroepiploic
Right from gastroduodenal a, and left from splenic a
Blood supply to the fundus of the stomach
Short gastric arteries from splenic artery en route to spleen
Nutcracker syndrome
Left renal vein is compressed by SMA and the aorta as the vein travels from left kidney to IVC. Present with flank pain, groin pain, left sided varicoceles, lower extremity varicosities.
Intermittent hematuria and anemia.
Layers pierced in a lumbar puncture and level performed
Skin, subcutaneous fat, supraspinous ligament, ligamentum flavum, epidural space, dura mater, subdural space, arachnoid mater/membrane, subarachnoid space.
L3/L4 - approximated by horizontal level of superior border of iliac crests.
Epidural space
Superficial to dura mater, deep to vertebral wall and ligamentum flavum. Contains vertebral venous plexus, spinal arteries, lymphatics, and spinal nerve roots. Site of development of hématomes and abscesses.
Crista Terminalis
Interior border between right atrium and right atrial appendage. Smooth muscular ridge, separates smooth RA and pectinate portion
Surface of the heart in contact with the posterior mediastinum
The majority of the posterior surface is the Left Atrium (and small part of RA). Esophagus is posterior
Erb’s Palsy
Tear of upper trunk - C5-C6 roots.
Loss of abduction (arm hangs at side), latral rotation (arm is medially rotated), loss off flexion, supination (arm of extended and pronated)
Klumpke’s Palsy
Lower trunk C8-T1 Root. Grabbing a tree falling.
Loss of intrinsic hand muscles, lumbricals, interossei, thenar, hypothnar. Claw hand. (lumbricals normally flex MCP and extend DIP and PIP)
Thoracic Outlet Syndrome
Compression of lower trunk and subclavian vessels. Caused by cervical rib, or pancoast tumour. Intrinsic hand muscles lost, atrophy - ischemia pain and edema.
Winged Scapula
Lesion of long thoracic nerve. From axillary node dissection after mastectomy, or stab wounds. Serratus anterior lost, cannot abduct arm past horizontal.
Common Peroneal (fibular) Nerve - injury
L4-S2. Injured by trauma/compression of latral leg, fibular neck fracture. Foor drop, inverted and plantarflexed at rest. Steppage gait. Loss of sensation to dorsum of foot.
Tibial Nerv - Injury
L4-S3, Knee trauma, baker cyst (proximal), tarsal tunnel (distal). Inability to curl toes, loss of sensation to sole of foot.
Superior gluteal nerve - injry
Iatrogenic injury during intramuscular injection - Trendelenburg sign - Lesion contralateral to side of hip that drops, ipsilateral to extremity on which patient stands ie stand on right foot, right gluteal injured, hip drops to left.
Common Peroneal Nerve
L4-S2. Ie common fibular. Branch of sciatic nerve. Everts and dorsiflexes, if injured, foot drop.
Osteoporosis
Decreased bone mass, no change in other lab values
Osteomalacia/rickets
Decreased Ca2+ and PO43-, increased ALP and PTH. Soft bones, vitamin D deficiency also causes 2ndary hyperparathyroidism.
Treatment for acute gout
NSAIDs (indomethacin) glucocorticoids, colchicine
Skin layers and epidermis layers
Epidermis (corneum, lucidum, granulosum,spinosum (desmosomes), basale (stem cells)), dermis, subcutaenous fat.
Pemphigus vulgaris
Autoimmune, IgG antibodies against desmoglein (component of desmosomes). Acantholysis, fishnet Immunofluorescence. Positive nikolsky sign.
Bullous pemphigoid
IgG antibody against hemidesmosomes. Eosinophils in blisters, spares oral mucosa. Linear pattern at epidemal-dermal junction. negative nikolsky sign. less severe than vulgaris.
Basal Cell carcinoma
Most common skin cancer. Pink, pearly nodules. Basal cell tumours with palisading appearance.
Squamous cell carcinoma
Second most common skin cancer. Excessive exposur to sunlight, keratin pearls.
Melanoma
SIgnificant risk of metastasis. Depth of tumour correlates with metastasis risk. ABCDEs: Assymetry, border irregularity, color variation, diameter>6mm, Evolution.
Acetominophen
Reversible inhibitor of COX mostly CNS. Antipyrretic, analgesic, but NOT anti inflamm. Acetominophen metabolite (NAPQI) depletes glutahione stores, forms toxic tissue byproducts. N-acetylcysteine is the antidote - regenerates glutathione
Aspirin
Irreversibel inhibition of COX 1 and COX 2. Covalent acetylation. Decreased TXA2 and PG. Increased bleeding time but no change in PT or APTT. Effects until new platelets prod. Low dose, decreases platelet aggregation (endothelial cells can still regen), intermediate: antipyrretic and analgesic. High dose: anti inflamm
Wrist drop
Associated with midshaft fractures of th humerus - damage radial nrve. Or compression of radial nerve in axilla - ie crutches. Sensory on dorsolateral hand.
Pancoast Tumour
Tumour at the apex of the lung - can cause horner’s syndrome by invasion of sympathtic ganglia.
Hook of hamate fracture
Can cause ulnar nerve injury - Guyon’s canal , ulnar n between hook of hamate and pisiform.
Potter Sequence
Pulmonary hypoplasia, Oligohydramnios, Twisted face ,Twisted Skin, Extremity defects, Renal failure (in utero). Causes incl bilateral renal agenesis, ARPKD, etc.
Horshoe Kidney
Inferior poles of both kidneys fuse abnormally. During ascent, trapped under IMA. Remain low in abdomen. Assot with hydroneprhosis (UPJ), renal stones, infection, aneuoplodieis.
Measuring Extracell volume and Plasma vol
Plasma vol: radiolabeled albumin
Extracellular volume: inulin or mannitol
Jefferson / Burst fracture
Of C1/Atlas. Compression from above, jump out of window, head on injury. Anterior and posterior thin arches - fracture of one or both. Want to avoid movement of transverse ligament of axis - st it doesn’t compress spinal cord - spinal cord injury more likely if transverse ligament of atlas is ruptured.
Hangman’s Fracture
C2 - axis
The pars inter-articularis - traumatic spondylolysis of C2 - result of hyperextension of head and neck. With or without subluxation of axis, injury of spinal cord/brainstem likely.
Fractures of the dens
Type I, II, III odontoid fractures
About 40% of axis fractures.
Type I and III usually stable
II: at the base, junction of body and axis, most common
Often unstable bc transverse ligament of the atlas becomes interposed - separated dens fragment no longer has blood supply - avascular necrosis. (Drunk man falling backwards against hard wall)
Diagnose: X ray through open mouth. Odontoid process (dens) of axis.
Atlantoaxial joints
Between C1 and C2 - allow shaking of head (right and left). Cranium and C1 rotate on C2 as a unit.
Atlantooccipital Joint
Between C1 and occipital bones - nodding movement.
Whiplash
hyperextension-hyperflexion fractures
Rear-end vehicle accident - thrown backward is hyperextended anterior longitudinal ligament stretched and potentially torn.
Recoil to extreme flexion - tear of interspinous ligaments. Vertebral fractures and disc herniation may occur.
Chance Fracture
Dislocation of cervical vertebrae - At T12-L1 is called chance. Anterior dislocation. Caused by sudden forward flexion
Wedge fractures
- Often compression from a fall. Vertebral compression fracture occurring anteriorly or laterally. Ie a burst fracture in the front part of the spine - becomes wedge shaped. Commonly in thoracic spine - stable without neurological involvement.
Spondylolisthesis
Vertebra slips anteriorly upon inferior counterpart - with or without a fracture of pars interarticularis.
Spondylolysis
Fracture of the column bones connecting the superior and inferior articular processes. (Pars interarticularis). Scotty dog decapitation.
Prolapsed IV disc ie “slipped disc”
Most commonly at L4/L5. Normally unilateral, due to posterior longitudinal ligament forcing herniation to one side or the other.
Between C2 C3 - C3 exits and herniates
T4/T5 - T4 exits and herniates
At L4/L5 - L4 exits BUT L5 herniates.
Caudal to L2 - herniation always affects the nerve below.
Lymphatic Drainage of Upper limb - superficial and deep
Superficial drainage: medial hand, forearm, and arm: lateral –> central –> apical
Lateral hand: forearm and arm. Direct to APICAL nodes.
Deep drainage: lateral–> central–> apical
Then all passes from apical to subclavian trunk to lymphatic/thoracic duct.
Axillary Nerve overview
From posterior cord, exits through quadrangulaire space with posterior huméral circumflex a.
Posterior to surgical neck of humerus.
Supplies deltoid and trees minor
Sensory : upper lateral part of arm
Antero-inferior dislocation of humerus
Most common because where there is weakness of rotator cuff - no SITS.
INJURY: Axillary nerve and posterior humeral circumflex
DEFICITS: Decreased lateral rotation of arm, loss of abduction from 15-90, sensory loss in upper lateral arm
Most common rotator cuff injury
Injury of supraspinatous - passes beneath acromion and Acromioclavicular ligament.
Susceptible to impingement and calf incitation. Pain on ABDUCTION.
Shoulder separataion
Step deformity
Acromioclavicular +/- coracoclavicular ligament. (Lateral cc)
Mid shaft fracture of clavicle
Pneumothorax possible
And damage to subclavian vein and artery.
SCM pulls the clavicule up - reducing chance of pneumothorax. Weight of limb pulls lateral part down.
Erb’s palsy
Upper brachial plexus injury - obstetric trauma/motorcycle accident. C5/C6.
Waiters tip - arm adducted internally rotated, forearm extended and probated.
Sensory loss along lateral limb C5/6 +-7 dermatomes.
Nerves involved: suprascapular - no initiation of abduction
Axillary - loss of abduction to 90 and external rot
Musculocutaenous - loss of forearm flexion and weakened supination
klumpke’s palsy
C8/T1. Arm and tree, obstetrical injury (pulling arm), cervical rib could be an underlying cause.
Loss of flexor carpi ulnaris and medial 1/2 of FDP.
Loss of intrinsic hand muscles
Sensory loss along medial border of hand (C8/T1 dermatomes)
Saturday night palsy - axilla injury
Injury in axilla - radial nerve
Loss of ability to extend elbow join
Wrist drop (loss of posterior compartment)
Impaired grip strength. - can grip stronger if wrist is extended.
Sensory loss to arm posterior and lower lateral, dorsum of hand
Mindshaft fracture of humerus
Damage to radial nerve and deep brachial artery. More distal than saturday night palsy, so only lose innervation to posterior compartment of forearm - maintain ability to extend elbow joint.
Loss of sensory to dorsum of hand.
Impaired grip strength and wrist drop.
Posterior dislocation of elbow joint
Ulnar and median nerves, brachial artery can be injured.
Superacondylar fracture of humerus
Median nerve and brachial artery. Lateral three and a half digits, anterior aspect of palm. Test thenar éminence - farthest away from other nerves.
Injury at or above elbow - weakened wrist flexion, ulnar deviation , loss of flexion of index and middle fingers at DIP and PIP, loss of pronation, loss of thumb opposition, weakened abduction and loss of flexion of thumb, sensory loss palmar thumb,
BENEDICTION HAND/ POPE’s BLESSING - WHEN ATTEMPTING A FIST
Volkman’s ischemic contracture
Consequence of supracondylar fracture if not recognised and repaired - injury to brachial artery lead to ischemic flexor contracture of muscles of anterior cpt.
INjury of median nerve at wrist
Slashing, carpal tunnel, or LUNATE dislocation.
Flexor muscle NOT paralysed so no Benediction hand.
LLOAF muscles are paralysed - atrophy of thenar muscles, sensory loss.
Ulnar nerve injury at or above elbow (proximal)
Ie medial epicondylitis fracture.
Hand deviates radially. Claw hand when making a fist (lateral 1/12 are extended). Lose flexion of ring and little fingers at DIP. Interosseuse muscles paralysis
Froment’s test
Ulnar nerve damage - can’t hold on to paper with adductor muscle - but FPL and FBP are intact (median n), so hold on to the paper by FLEXING the interphalangeal joint of the thumb. Compensating for loss.
Hook of hamate fracture
Ulnar nerve and artery at risk. Also can injure ulnar nerve distally by entrapment in guyon’s canal. Claw hand. Pinky etc flexed when trying to extend hand.
Colle’s fracture
(Fork)
Fracture of distal radius with posterior displacement of distal fragment.
Smith’s fracture
Fracture of distal radius with anterior displacement of distal fragment.
Scaphoïd fracture
In floor of anatomical snuff box. One of only two bones attaching wrist to arm. RADIAL ARTERY most likely injured.
Avascular necrosis of proximal segment - losing 1/2 of articulation of upper limb to wrist if delay treatment.
Allen’s test
Testing radio-ulnar collateral circulation
Ulnar - superficial palmar arch
Radial artery - deep palmar arch
Anastamoses test
Depuytren’s contracture
Thickening and contraction of palmar aponeurosis
Nodule formation
Unable to extend fingers
Thoracentesis
Insert needle at superior edge of rib (collateral branches of less significance)
Needle into pleural cavity to obtain fluid.
Pfannestiel Line
Above pubic symphysis (bikini line through external abdominal oblique and rectus abdominus) landmark for C section
McBurney’s point
2/3 between umbilicals and ASIS on R side - appendectomy.
Avoids ilioinguinal and iliohypogastric nerve)
Kocher’s line
Subcostal landmark (R side) for access to the gall bladder.
AP Compression diastasis (separation) “open book” fracture
Separation of symphisis pubis and right SI joint
Result from head on motor vehicle.
Hémipelvis - externally rotated, opened like a book.
If enough force can disrupt sacrotuberous and sacrospinous.
Derivatives of aortic arches
1st - maxillary a
2nd - stapedial a
3rd - common carotid and proximal intrnal carotid
4th - aortic arch on the left, proximal subclavian on the right
5th regresses
6th - pulmonary trunk and ductus arteriosus
Branchial/pharyngeal apparatus
Clefts - ectoderm
Arches - mesoderm & neural crest
Pouches - endoderm (CAP out to in)
Branchial Cleft derivatives
1st - EAM
2nd-4th - form temporary cervical sinuses, obliterated by prolif of second arch mesenchyme – persistent cervical sinus leads to branchial cleft cyst in lateral neck
1st arch derivatives
Muscles of mastication - medial ptery, temporalis, masster, CN V2, V3 - treacher collins syndrome
Mandible, malleus incus, sphenoMandibular lig
2nd arch
Muscles of facial expression, CN VII
Stapedius, stylohyoid, platySma, post belly digastric
Stapes styloid process lesser heorn hyoid, stylohyoid lig
3rd arch
STylopharyngeus, CN IX
4th arch
thryoid cricoid arytenoids corniculate, cuneiform
Pharyngeal constrictors, cricothyroid, levator veli palatini, CN X superior laryngeal branch
6th arch
thryoid cricoid arytenoids corniculate, cuneiform
CN X recurrent laryngeal - speak all intrinsic muscles of larynx except cricothyroid
