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PLAB Dra. Sommerhalder > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Musculo-cutaneous nerve

A

C5-C7
Motor: Elbow flexion (biceps brachii) and supination

Sensory: Lateral part of the forearm

Mechanism/notes: Isolated injury is rare.
Usually injured as part of brachial plexus injury

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2
Q

Axillary nerve

A

C5, C6
Motor: Shoulder abduction (deltoid muscle)

Sensory: Inferior region of the deltoid muscle.

Mechanism/notes: Humeral neck fracture/dislocation

Flattened deltoid

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3
Q

Radial nerve

A

C5-T1
Motor: Extension (forearm, wrist, fingers, thumb)

Sensory: Small area between the dorsal aspect of the 1st and 2nd metacarpals

Mechanism/notes: Humeral midshaft fracture.
Palsy= wrist drop

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4
Q

Median nerve

A

C6-T1
Motor: LOAF muscles.
Depends on site of the lesion:
Wrist: paralysis of thenar muscles, opponens pollicis
Elbow: loss of pronation of forearm and weak wrist flexion

Sensory: Palmar aspect of lateral 3 1/2 fingers

Mechanism/notes: Wrist lesion = carpal tunnel syndrome

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5
Q

Ulnar nerve

A

C8, T1

Motor: Intrinsic hand muscles except LOAF. Also wrist flexion.

Sensory: Medial 1 1/2 fingers

Mechanism/notes: Medial epicondyle fracture
Claw hand

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6
Q

LOAF muscles

A

lateral 2 Lumbricalis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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7
Q

Long thoracic nerve

A

C5-C7
Motor: serratus anterior

Sensory: none

Mechanism/notes: During sports> blow to the ribs, lifting weights.
Possible complication of mastectomy

Winged scapula

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8
Q

Wrist drop

A

Radial nerve

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9
Q

Foot drop

A

Common Peroneal Nerve
or
Sciatic nerve

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10
Q

Claw hand

A

Ulnar nerve

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11
Q

Paraesthesia of thumb, index and MIDDLE finger

A

Median nerve

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12
Q

Paraesthesia of little finger and ring finger

A

Ulnar nerve

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13
Q

Paraesthesia of the dorsal aspect of the thumb ± dorsal area between 1st (thumb) and 2nd fingers

A

Radial nerve

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14
Q

Numbness on superior aspect of upper arm just below shoulder joint.
Numbness over deltoid, paralyzed deltoid

A

Axillary nerve

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15
Q

Fibular neck fracture

A

Common Peroneal Nerve

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16
Q

Femur neck fracture

A

Sciatic nerve

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17
Q

Acetabular Fracture

A

Sciatic nerve

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18
Q

Humeral Shaft Fracture

A

Radial nerve

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19
Q

Humeral Neck Fracture

A

Axillary nerve

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20
Q

Winged “prominent” Scapula

More “winging”/dropping on pushing a wall

A

Long Thoracic Nerve

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21
Q

Dropped Scapula

More “winging”/dropping on abducting the arm at the shoulder level

A

Accesory nerve (11th CN)

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22
Q

Monteggia fracture

Anterior Dislocation of the head of radius + Fracture of the proximal 1/3 of the Ulna

A

Radial Nerve

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23
Q

Paraesthesia and impaired sensation in both hands

Glove distribution

A

Peripheral Neuropathy

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24
Q

Saturday night palsy

A

Radial nerve compression

Wrist drop

Can be compressed against the operating table

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25
Q

Crutch palsy

A

Radial nerve compression (or brachial plexus)

Compression against the spiral groove on the medial aspect of the humerus.

Wrist drop

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26
Q

Sensory loss in an injury to the radial nerve

A

Dorsal aspect of the thumb ± a small area over the dorsal aspect between 1st and 2nd fingers

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27
Q

Unable to flex the proximal interphalangeal joints AND metacarpophalangeal (MCP) joint.

A

Flexor digitorum superficialis

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28
Q

Unable to flex the distal interphalangeal joints

A

Flexor digitorum profundus

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29
Q

Extensor pollicis Longus

A

Extends the Thumb at the Interphalangeal joints

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30
Q

Extensor pollicis Brevis

A

Extends the Thumb at the metacarpophalangeal

(MCP) joints

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31
Q

Midline structure pierced during a laparoscopic cholecystectomy

A

Linea alba

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32
Q

During a laparoscopy, the anatomical structured pierced while inserting a port at the midway point between umbilicus and anterior superior iliac spine is…

A

Internal oblique muscle and external oblique aponeurosis

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33
Q

What can be pierced while inserting a chest drain in the 5th ICS anterior to mid-axillary line?

A

VAN
intercostal Vein
intercostal Artery
intercostal Nerve

AND Intercostal Muscle

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34
Q

Popeye appearance

muscle bunches up in the distal arm

A

Proximal Biceps Tendon Rupture

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35
Q

Single traumatic event (flexion against resistance), sudden sharp tearing sensation, painful swollen elbow, weakness of flexion and supination.

A

Distal Biceps Tendon Rupture

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36
Q

De Quervain’s disease

Washer woman or Mammy thumb

A

Pain under root of thumb

Tenosynovitis

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37
Q

Tennis elbow

A

Lateral epicondylitis

Affected wrist extension, mainly due to overuse (tennis players)

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38
Q

Golfer’s elbow

A

Medial epicondylitis
All flexors to fingers and pronator are affected.
(Baseball players, construction injury, plumber injury)

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39
Q

Nerves of the eye

A

LR 6CN
SO 4CN
O 3CN

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40
Q

Muscles of the eye

A

Lateral Rectus muscle (abducens nerve 6th CN)

Superior Oblique muscle (Trochlear nerve 4th CN)

Oculomotor nerve(3rd CN)

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41
Q

Oculomotor nerve (3rd) injury

A

Most of the eye muscles.
Constricts pupils, innervates the levator palpebrae superioris.

Injury= Mydriasis and Ptosis (same side)

Others> outward gaze, diplopia

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42
Q

Trochlear nerve (4th) injury

A

Diplopia on Downward gaze (Opposite side) = vertical diplopia (while climbing the stairs)

If he looks left and sees double = injury is on the RIGHT

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43
Q

Abducens nerve (6th) injury

A

Diplopia on lateral gaze (same side) = horizontal diplopia

If he looks left and sees double = injury is on the LEFT

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44
Q

REMEMBER OTA

A

Oculomotor 3, Same and ptosis

Trochlear 4, Opposite and Downward gaze

Abducens 6, Same and Lateral gaze

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45
Q

Loss of sensation in Medial foot

A

Saphenous nerve

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46
Q

Loss of sensation in Lateral foot

A

SuraL nerve

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47
Q

Largest Cutaneous branch of the Femoral Nerve

A

Saphenous nerve

Purely sensory

It supplies the medial foot.

Injury during Varicose vein surgery, vein harvest for bypass, knee arthroscopy.

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48
Q

Site of a Chest Drain and Safe Triangle Boundaries

A

5th intercostal space, slightly anterior to the mid-axillary line.

Safe triangle boundaries: 
Anteriorly= Pectoralis Major
Posteriorly = Latissimus Dorsi
Superiorly= Base of Axilla
Inferiorly = 5th intercostal space
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49
Q

Lymphatic drainage of gonads (ovary and testis)

A

Para-aortic LNs

ovarian cancer

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50
Q

Lymphatic drainage of skin (perineum, scrotum and vulva)

A

Superficial inguinal LNs

Includes skin over Medial Malleolus

(non-healing ulcer over the medial malleolus)

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51
Q

Lymphatic drainage of the tip of the tongue

A

Submental LNs

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52
Q

Lymphatic drainage of the anterior 2/3 of the tongue

A

Submandibular LNs

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53
Q

Lymphatic drainage of the posterior 1/3 of the tongue

A

Jugulo-Omohyoid

Deep Cervical LNs

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54
Q

Lymphatic drainage of the posterior oropharynx

A

Deep cervical LNs

Jugular LNs

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55
Q

Lymphatic drainage of the lateral foot

A

Popliteal LNs and then the inguinal LNs

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56
Q

Motor branches of the common peroneal nerve

A

Superficial peroneal nerve: Supplies the lateral compartment of leg (evert the foot)

Deep peroneal nerve: Supplies the anterior compartment of the leg (dorsiflex the foot)

57
Q

Function of the Extensor Digitorum

A

Extends the middle 3 fingers (index, middle and ring)

Extends all fingers at MCP and IP joints)

58
Q

Function of the Extensor digiti minimi

A

Extends the little finger

59
Q

Function of the Extensor indices

A

Extends the index finger

60
Q

Function of the Extensor pollicis

A

Extends the thumb

61
Q

Vein and nerve that run on the lateral aspect of the leg

A

Short saphenous vein
AND
Sural nerve

62
Q

Vein and nerve that run on the medial aspect of the leg

A

Long (great) sapheous vein
AND
Saphenous nerve

63
Q

Fracture of the neck of the Fibula leads to an injury of…

A

Common peroneal nerve

–> foot drop (can’t evert or dorsiflex)

64
Q

Fibular nerve or “common peroneal nerve” supplies what muscle?

A

Biceps femoris (flexes the knee)

65
Q

2 motor branches of the common peroneal nerve (fibular)

A

Superficial Fibular: Innervates the lateral compartment of the leg, and its injury causes inability to evert the foot

Deep fibular nerve: Innervates the anterior compartment of the leg. It extends the digits. Its injury causes inability to dorsiflex the foot.

66
Q

4 sensory branches of the common peroneal nerve

A

Sural communicating–> lower posterolateral leg

Lateral sural cutaneous–> upper lateral leg

Superficial fibular (peroneal) –> skin of anterolateral leg except the skin between 1st and 2nd toes

Deep fibular (peroneal) –> skin between the 1st and 2nd toe

67
Q

C8 radiculopathy effects

A

Affects thumb abduction and extension

Causes ulnar deviation of the wrist and paraesthesia of a thin area on the forearm which runs down to include the little finger

68
Q

T1 Radiculopathy effects

A

Affects fingers abduction and adduction.

Pain and paraesthesia along the affected nerve

69
Q

Thumb movement weakness, wrist ulnar deviation, little finger paraesthesia…?

A

C8 nerve root injury

70
Q

Finger’s abduction and adduction weakness…?

A

T1 nerve root injury

71
Q

Loss of thumb sensation

Loss of elbow flexion…?

A

C5, C6 injury

Erb’s palsy

72
Q

Motor function of the nerve root C5-C8 and T1

A 
C5- Flex elbow
C6- Extend wrist
C7- Extend elbow
C8- Flex fingers
T1- Adduct and abduct fingers
73
Q

Transpyloric plane (Addison’s plane)

A

Transverse line located midway between sternal notch and symphysis pubis

Indicates the level of L1
The tip of the 9th costal cartilage correlates to the Fundus of the Gall Bladder
(The 9th CC indicates many structures, but the TIP indicates the fundus of GB)

74
Q

Structures at the level of L1 (transpyloric plane)

A 
9th costal cartilage
GB fundus
Stomach pylorus
Kidney hilum
Superior mesenteric artery
Celiac trunk
75
Q

What happens in a perforation of a gastric posterior ulcer? (Fundus or body of stomach)

A

Accumulation of pus in the Lesser Sac (behind the stomach)

Abscess formation that passes to the peritoneal cavity through the Foramen of Winslow

Generalized Peritonitis

76
Q

What happens in a perforation of a posterior pyloric or duodenal ulcer?

A

Retroperitoneal abscess

77
Q

Stroke of the Parietal lobe

A

Inferior homonymous quadrantinopias

PiTs! (Parietal-Inferior; Temporal-superior)

78
Q

Stroke of the temporal lobe

A

Long-term memory loss + changes of sexual behaviour + Superior homonymous qudrantinopias

PiTs! (Parietal-Inferior; Temporal-superior)

79
Q

Stroke of the frontal lobe

A

Changes of personality and social behaviour.

No visual field defect.

80
Q

Facial deviation
uvular deviation

jaw deviation
tongue deviation

A

10+7 OPPOSITE side
12+5 SAME side

7- facial
10-Vague- uvular deviation

5- Trigeminal - jaw deviation
12- Hypoglossal - tongue deviation

81
Q

The common bile duct (CBD) connects with the pancreatic duct to form…

A

Ampulla of Vater (hepatopancreatic ampulla) at the middle of the 2nd part of duodenum

82
Q

Injury to the tibial nerve

A

Can’t invert and make plantar flexion.

83
Q

70% of patients with head of pancreas cancer have….?

A

Jaundice due to the obstruction of Common Bile Duct (CBD) –> in close proximity to the head of pancreas.

84
Q

Trigeminal nerve branches

A

Ophthalmic
Maxillary
Mandibular

85
Q

Mucosa affected in HZV along the dermatome of the maxillary nerve

A

The Palate

The maxillary nerve supplies:
Sinuses–> ethmoid, maxillary. sphenoid

Mucosa–> palate, roof of the pharynx and nasal mucosa

Other–> lower eyelid, upper lid, upper teeth and gum, nares, parts of the meninges.

86
Q

Where is the deep inguinal ring located?

A

2.5cm (1 inch) ABOVE the midpoint of the inguinal ligament.

87
Q

Left Anterior Descending Artery

A

Continuation of the left coronary artery, and it runs inside the Anterior Interventricular groove

88
Q

What will be opened in a Glioma surgery?

A

Glioma= tumour arising from the glial cells in the brain or spinal cord

The dura matter is to be opened during the surgery.

DAP= Dura, Arachnoid, Pia

89
Q

Ataxic hemiparesis (same side) + dysarthria

….. infarct?

A 
Lacunar infarct
(internal capsule; a part of lacunas)
90
Q

Contralateral hemiplegia or sensory loss + dysphagia + homonymous hemianopia

…… infarct?

A

Cerebral infarct

91
Q

Quadriplegia, vertigo, diplopia and locked-in syndrome

…… infarct?

A

Brainstem infarct

Locked-in syndrome or Pseudocoma = damage to the pons, a part of the brainstem that contains nerve fibers that relay information to other areas of the brain.
The px is aware and cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles EXCEPT vertical eye movement and blinking.
(cognitive function unnafected)

92
Q

The central retinal artery is a branch of…

A

The ophthalmic artery which is a branch of the internal carotid artery.

93
Q

What is amaurosis fugax?

A

Painless, temporary and recurrent loss of vision that lasts from a few seconds to a few minutes due to an embolism of the Central retinal artery
(usually unilateral and resolves quickly; 5-30 mins)

“A black curtin coming down”

94
Q

What injury causes a loss of sensation to the lower lip and chin

(often injured during a dental procedure or mandibular trauma)

A

Inferior alveolar nerve, which innervates the lower teeth.

It gives the mental nerve that supplies the chin and lower lip (skin and mucosa)

It is a branch of the mandibular nerve which is the 3rd division of the Trigeminal nerve (5th CN)

95
Q

Which nerve injury causes hoarseness of voice?

A

Unilateral injury to the recurrent laryngeal nerve (branch of the 10th CN)

18% of lung cancer patients experience hoarseness of voice due to compression

96
Q

Which nerve injury causes aphonia ± airway obstruction?

A

BILATERAL injury to the recurrent laryngeal nerve

97
Q

Which nerve injury causes loss of high-pitched sound?

A

Injury to the external branch of the (superior) laryngeal nerve.

Dysphonia=mono toned voiced

98
Q

During surgery, where do the surgeon needs to ligate the thyroid artery in order to avoid injury of a nerve?

A

Just near the superior pole of the thyroid gland to avoid injury to the external laryngeal nerve (ELN)

The superior artery is closely related to the ELN at its origin.

99
Q 
What lies at 
T8
T10
T12
L1
L3-4
and L4
A

T8- Inferior Vena Cava
T10- Oesophegus (umbilical dermatome)
T12-Aorta
L1- transpyloric plane (9th costal cartilage, Gall Bladder fundus, Stomach pylorus, kidney hilum, superior messenteric artery, celiac trunk)

L3-4 - umbilicus level

L4- iliac crest

100
Q

deep tendon reflexes

Achilles reflex (ankle)

101
Q

deep tendon reflexes

Patellar reflex
knee

102
Q

deep tendon reflexes

Biceps and brachio-radialis reflexes

A

Biceps C5, C6

Brachioradialis C6, C7

103
Q

deep tendon reflexes

Triceps reflex

104
Q

deep tendon reflexes

Cremasteric reflex

A

L1 and L2

Elevation of the testes on a light stroke of the inner thigh and downwards towards the knee

105
Q

deep tendon reflexes

Anal wink reflex
External sphincter contraction

A

S2-S3 and S4

106
Q

Facial Nerve Lesion (7th CN)

A

Facial Weakness + loss of taste of the anterior 2/3 of tongue

107
Q

Vagus Nerve Lesion (10th CN)

A

Weak cough, vocal cord paralysis with dysphonia, uvular deviation.

Also parasympathetic loss of respiratory, gastrointestinal tract (GIT), and cardiovascular system.

108
Q

Trigeminal nerve lesion (5th CN)

A

Weakness of the muscles of mastication

Deviation of jaw towards the same side of the weak pterygoid muscle

Loss of facial sensation

109
Q

Glossopharyngeal nerve lesion (9th CN)

A

Loss of gag reflex

Loss of taste from the posterior 1/3 of the tongue

Loss of general sensation from posterior pharynx, tonsils and soft palate

110
Q

Hypoglossal nerve lesion (12th)

A

Deviation of the tongue to the same side of the injury

Innervates the muscles of the tongue

111
Q

Px unable to extend and straighten his 4th and 5th fingers, a firm nodule was found on the distal palmar crease in the same line with the ring finger. His father has a Hx of a similar condition.

Diagnosis, physiopathology, etiology and treatment.

A

Dupuytren’s contracture.

Formation of thickened fibrous tissue within the palmar fascia. (Connection between the finger tendons and the skin of the palm)

More common in older male pxs.
60-70% have + family Hx
Prevalence of 5%

Causes: Manual labour, phenytoin tx, Alcoholic liver disease, trauma to the hand, DM, Smoking

112
Q

Sensory loss

Groin and pelvic girdle

Anterior thigh

Medial thigh and distal anterior thigh

A

L1 (groin and pelvic girdle)

L2 (anterior thigh)

L3 (Medial thigh and distal anterior thigh)

“3 in the thigh”

113
Q

Sensory loss

Medial shin

Lateral shin and dorsum of the foot

A

L4 (inner shin)

L5 (lateral shin and dorsum of the foot)

“2 in the shin”

114
Q

Sensory loss

Lateral foot

A

S1

“1 in the foot)

115
Q

A swelling behind the knee (in the popliteal fossa), usually asymptomatic, round, smooth, non tender.

Most likely diagnosis?

A

Baker cyst

popliteal cyst

116
Q

Numbness and tingling of the thumb, index and middle fingers.

Dx?

A

Carpal Tunnel Syndrome (median nerve)

Pregnancy= due to fluid retention

Tinel test is not always positive (low sensitivity)

117
Q

What happens in Carpal Tunnel syndrome and tx?

A

The transverse carpal ligament compresses the median nerve

Tx= Cut the transverse carpal ligament to release pressure.

(TCL also called Flexor retinaculum or anterior annular ligament)

118
Q

Radiculopathy that affects thumb abduction and extension, and ulnar deviation of the wrist.
Causes paraesthesia of a thin area on the forearm which runs down to include the little finger.

A

C8 radiculopathy.

Median nerve- LOAF muscles
Lateral 2 lumbricallis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis.
119
Q

Radiculopathy that affects fingers abduction and adduction, and has pain and paraesthesia along the affected nerve.

A

T1 radiculopathy

Flexor digitorum superficialis and profundus
Flexor pollicis longus
Lumbricals
Interossei
Pectoralis major.
120
Q

Femoral nerve injury

stab injury to inguinal area

A

Weakness on hip flexion
Weakness on knee extension
Paraesthesia over the medial side of the thigh

121
Q

Femoral nerve

Motor, sensory and mechanism

A

Knee extension, thigh flexion

Anterior and medial aspect of the thigh and lower leg

Hip and pelvic fractures (stab/gunshot wound)

122
Q 
Obturador nerve
(Motor, sensory and mechanism)
A

Thigh adduction

Middle part of the medial thigh

Anterior hip dislocation

123
Q

Lateral cutaneous nerve of the thigh

Motor, sensory and mechanism

A

Motor> none

Lateral and posterior surfaces of the thigh

Compression of the nerve near the Anterior Superior Iliac Spine –> meralgia paraesthetica (pain, tingling and numbness in the distribution of the lateral cutaneous nerve)

124
Q

Tibial nerve

Motor, sensory and mechanism

A

Foot plantar flexion and inversion

Sole of the foot

Not commonly injured (deep and well protected)
Popliteal lacerations, posterior knee dislocation

125
Q

Common peroneal nerve

Motor, sensory and mechanism

A

Foot dorsiflexion and eversion AND extensor hallucis longus

Dorsum of the foot and the lower lateral part of the leg

Injury often occurs at the neck of the fibula
Tightly applied lower limb plaster cast

Foot drop

126
Q

Superior gluteal nerve

Motor, sensory and mechanism

A

Hip abduction

Sensory> none

Misplaced intramuscular injection
Hip injury
Pelvic fracture
Posterior hip dislocation

Injury results in a positive Trendelenburg sign

127
Q

Inferior gluteal nerve

Motor, sensory and mechanism

A

Hip extension and lateral rotation

Sensory> none

Generally injured in association with the sciatic nerve

Injury results in difficulty rising from seated position. Can’t jump, can’t climb stairs.

128
Q

Artery supply of the lower limbs

A

Common iliac
Internal iliac

  • External iliac
  • Common femoral artery (groin crease)
  • Superficial femoral artery
  • Popliteal artery (knee crease)
  • Tibio-peroneal trunk> peroneal artery and posterior tibial artery
  • Anterior tibial artery (branch of the popliteal artery with the tibio-peroneal)
129
Q

Elderly px with hx of smoking and uncontrolled DM presents with pain on calf muscles after walking. He has to rest for a while to be able to continue walking. Popliteal artery and dorsalis pedis cannot be felt.

Which is the most likely occluded artery?

A

The obstructed artery is always one level proximal (above) the affected muscle group
OR
One level above the artery that cannot be felt.

Femoropoplliteal artery.

130
Q

Px with caludication whose femoral and popliteal pulses are not felt.

The most likely occluded artery is…?

A

External iliac artery

One level above affected muscles or the artery that cannot be felt.

131
Q

Pain in buttocks, thighs ± Erectile dysfunction (Leriche Syndrome)

A

Aorto-iliac artery occlusion.

132
Q

Pain extends to just above the inguinal ligament

A

Common iliac artery occlusion

133
Q

Pain in the leg (below inguinal ligament). Femoral pulse is present but the pulses below are not.

A

Femoral artery occlusion

134
Q

Pain below the knee

A

Femoro-popliteal artery occlusion

135
Q

Px who fell on outstretched arm and was treated surgically. 6 months later he presents with decreased sensation of the little and medial half of the ring finger + wasting of the interosseous muscles + inability to cross 2 fingers (little and ring) or abduct his little finger.

What structure is affected?

A

Lower brachial plexus (inferior trunk of the brachial plexus)

Injury to C8 and T1 (ulnar nerve)

136
Q

Meralgia paresthetica

A

Burning numbness or tingling sensation of the lateral thigh due to injury to

Lateral femoral cutaneous nerve

137
Q

Neck injury followed by asymmetrical chest movements.

A

Phrenic nerve injury

controls diaphragm

138
Q

What is Parkinson’s disease?

What structure is affected?

A

A progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the SUBSTANTIA NIGRA

139
Q

Classic triad of Parkinson’s disease

A

Bradykinesia
Resting tremors
Rigidity

Caused by low levels of dopamine

Symptoms are characteristically asymmetrical

PLAB Dra. Sommerhalder (7 decks)

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