Anatomy Flashcards
(139 cards)
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
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
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
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
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
6
Q
LOAF muscles
A
lateral 2 Lumbricalis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
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
8
Q
Wrist drop
A
Radial nerve
9
Q
Foot drop
A
Common Peroneal Nerve
or
Sciatic nerve
10
Q
Claw hand
A
Ulnar nerve
11
Q
Paraesthesia of thumb, index and MIDDLE finger
A
Median nerve
12
Q
Paraesthesia of little finger and ring finger
A
Ulnar nerve
13
Q
Paraesthesia of the dorsal aspect of the thumb ± dorsal area between 1st (thumb) and 2nd fingers
A
Radial nerve
14
Q
Numbness on superior aspect of upper arm just below shoulder joint.
Numbness over deltoid, paralyzed deltoid
A
Axillary nerve
15
Q
Fibular neck fracture
A
Common Peroneal Nerve
16
Q
Femur neck fracture
A
Sciatic nerve
17
Q
Acetabular Fracture
A
Sciatic nerve
18
Q
Humeral Shaft Fracture
A
Radial nerve
19
Q
Humeral Neck Fracture
A
Axillary nerve
20
Q
Winged “prominent” Scapula
More “winging”/dropping on pushing a wall
A
Long Thoracic Nerve
21
Q
Dropped Scapula
More “winging”/dropping on abducting the arm at the shoulder level
A
Accesory nerve (11th CN)
22
Q
Monteggia fracture
Anterior Dislocation of the head of radius + Fracture of the proximal 1/3 of the Ulna
A
Radial Nerve
23
Q
Paraesthesia and impaired sensation in both hands
Glove distribution
A
Peripheral Neuropathy
24
Q
Saturday night palsy
A
Radial nerve compression
Wrist drop
Can be compressed against the operating table
25
Crutch palsy
Radial nerve compression (or brachial plexus)
Compression against the spiral groove on the medial aspect of the humerus.
Wrist drop
26
Sensory loss in an injury to the radial nerve
Dorsal aspect of the thumb ± a small area over the dorsal aspect between 1st and 2nd fingers
27
Unable to flex the proximal interphalangeal joints AND metacarpophalangeal (MCP) joint.
Flexor digitorum superficialis
28
Unable to flex the distal interphalangeal joints
Flexor digitorum profundus
29
Extensor pollicis Longus
Extends the Thumb at the Interphalangeal joints
30
Extensor pollicis Brevis
Extends the Thumb at the metacarpophalangeal
| (MCP) joints
31
Midline structure pierced during a laparoscopic cholecystectomy
Linea alba
32
During a laparoscopy, the anatomical structured pierced while inserting a port at the midway point between umbilicus and anterior superior iliac spine is...
Internal oblique muscle and external oblique aponeurosis
33
What can be pierced while inserting a chest drain in the 5th ICS anterior to mid-axillary line?
VAN
intercostal Vein
intercostal Artery
intercostal Nerve
AND Intercostal Muscle
34
Popeye appearance
| muscle bunches up in the distal arm
Proximal Biceps Tendon Rupture
35
Single traumatic event (flexion against resistance), sudden sharp tearing sensation, painful swollen elbow, weakness of flexion and supination.
Distal Biceps Tendon Rupture
36
De Quervain's disease
| Washer woman or Mammy thumb
Pain under root of thumb
| Tenosynovitis
37
Tennis elbow
Lateral epicondylitis
| Affected wrist extension, mainly due to overuse (tennis players)
38
Golfer's elbow
Medial epicondylitis
All flexors to fingers and pronator are affected.
(Baseball players, construction injury, plumber injury)
39
Nerves of the eye
LR 6CN
SO 4CN
O 3CN
40
Muscles of the eye
Lateral Rectus muscle (abducens nerve 6th CN)
Superior Oblique muscle (Trochlear nerve 4th CN)
Oculomotor nerve(3rd CN)
41
Oculomotor nerve (3rd) injury
Most of the eye muscles.
Constricts pupils, innervates the levator palpebrae superioris.
Injury= Mydriasis and Ptosis (same side)
Others> outward gaze, diplopia
42
Trochlear nerve (4th) injury
Diplopia on Downward gaze (Opposite side) = vertical diplopia (while climbing the stairs)
If he looks left and sees double = injury is on the RIGHT
43
Abducens nerve (6th) injury
Diplopia on lateral gaze (same side) = horizontal diplopia
If he looks left and sees double = injury is on the LEFT
44
REMEMBER OTA
Oculomotor 3, Same and ptosis
Trochlear 4, Opposite and Downward gaze
Abducens 6, Same and Lateral gaze
45
Loss of sensation in Medial foot
Saphenous nerve
46
Loss of sensation in Lateral foot
SuraL nerve
47
Largest Cutaneous branch of the Femoral Nerve
Saphenous nerve
Purely sensory
It supplies the medial foot.
Injury during Varicose vein surgery, vein harvest for bypass, knee arthroscopy.
48
Site of a Chest Drain and Safe Triangle Boundaries
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
```
49
Lymphatic drainage of gonads (ovary and testis)
Para-aortic LNs
| ovarian cancer
50
Lymphatic drainage of skin (perineum, scrotum and vulva)
Superficial inguinal LNs
Includes skin over Medial Malleolus
(non-healing ulcer over the medial malleolus)
51
Lymphatic drainage of the tip of the tongue
Submental LNs
52
Lymphatic drainage of the anterior 2/3 of the tongue
Submandibular LNs
53
Lymphatic drainage of the posterior 1/3 of the tongue
Jugulo-Omohyoid
| Deep Cervical LNs
54
Lymphatic drainage of the posterior oropharynx
Deep cervical LNs
| Jugular LNs
55
Lymphatic drainage of the lateral foot
Popliteal LNs and then the inguinal LNs
56
Motor branches of the common peroneal nerve
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
Function of the Extensor Digitorum
Extends the middle 3 fingers (index, middle and ring)
Extends all fingers at MCP and IP joints)
58
Function of the Extensor digiti minimi
Extends the little finger
59
Function of the Extensor indices
Extends the index finger
60
Function of the Extensor pollicis
Extends the thumb
61
Vein and nerve that run on the lateral aspect of the leg
Short saphenous vein
AND
Sural nerve
62
Vein and nerve that run on the medial aspect of the leg
Long (great) sapheous vein
AND
Saphenous nerve
63
Fracture of the neck of the Fibula leads to an injury of...
Common peroneal nerve
| --> foot drop (can't evert or dorsiflex)
64
Fibular nerve or "common peroneal nerve" supplies what muscle?
Biceps femoris (flexes the knee)
65
2 motor branches of the common peroneal nerve (fibular)
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
4 sensory branches of the common peroneal nerve
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
C8 radiculopathy effects
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
T1 Radiculopathy effects
Affects fingers abduction and adduction.
| Pain and paraesthesia along the affected nerve
69
Thumb movement weakness, wrist ulnar deviation, little finger paraesthesia...?
C8 nerve root injury
70
Finger's abduction and adduction weakness...?
T1 nerve root injury
71
Loss of thumb sensation
| Loss of elbow flexion...?
C5, C6 injury
| Erb's palsy
72
Motor function of the nerve root C5-C8 and T1
```
C5- Flex elbow
C6- Extend wrist
C7- Extend elbow
C8- Flex fingers
T1- Adduct and abduct fingers
```
73
Transpyloric plane (Addison's plane)
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
Structures at the level of L1 (transpyloric plane)
```
9th costal cartilage
GB fundus
Stomach pylorus
Kidney hilum
Superior mesenteric artery
Celiac trunk
```
75
What happens in a perforation of a gastric posterior ulcer? (Fundus or body of stomach)
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
What happens in a perforation of a posterior pyloric or duodenal ulcer?
Retroperitoneal abscess
77
Stroke of the Parietal lobe
Inferior homonymous quadrantinopias
PiTs! (Parietal-Inferior; Temporal-superior)
78
Stroke of the temporal lobe
Long-term memory loss + changes of sexual behaviour + Superior homonymous qudrantinopias
PiTs! (Parietal-Inferior; Temporal-superior)
79
Stroke of the frontal lobe
Changes of personality and social behaviour.
No visual field defect.
80
Facial deviation
uvular deviation
jaw deviation
tongue deviation
10+7 OPPOSITE side
12+5 SAME side
7- facial
10-Vague- uvular deviation
5- Trigeminal - jaw deviation
12- Hypoglossal - tongue deviation
81
The common bile duct (CBD) connects with the pancreatic duct to form...
Ampulla of Vater (hepatopancreatic ampulla) at the middle of the 2nd part of duodenum
82
Injury to the tibial nerve
Can't invert and make plantar flexion.
83
70% of patients with head of pancreas cancer have....?
Jaundice due to the obstruction of Common Bile Duct (CBD) --> in close proximity to the head of pancreas.
84
Trigeminal nerve branches
Ophthalmic
Maxillary
Mandibular
85
Mucosa affected in HZV along the dermatome of the maxillary nerve
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
Where is the deep inguinal ring located?
2.5cm (1 inch) ABOVE the midpoint of the inguinal ligament.
87
Left Anterior Descending Artery
Continuation of the left coronary artery, and it runs inside the Anterior Interventricular groove
88
What will be opened in a Glioma surgery?
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
Ataxic hemiparesis (same side) + dysarthria
..... infarct?
```
Lacunar infarct
(internal capsule; a part of lacunas)
```
90
Contralateral hemiplegia or sensory loss + dysphagia + homonymous hemianopia
...... infarct?
Cerebral infarct
91
Quadriplegia, vertigo, diplopia and locked-in syndrome
...... infarct?
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
The central retinal artery is a branch of...
The ophthalmic artery which is a branch of the internal carotid artery.
93
What is amaurosis fugax?
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
What injury causes a loss of sensation to the lower lip and chin
(often injured during a dental procedure or mandibular trauma)
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
Which nerve injury causes hoarseness of voice?
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
Which nerve injury causes aphonia ± airway obstruction?
BILATERAL injury to the recurrent laryngeal nerve
97
Which nerve injury causes loss of high-pitched sound?
Injury to the external branch of the (superior) laryngeal nerve.
Dysphonia=mono toned voiced
98
During surgery, where do the surgeon needs to ligate the thyroid artery in order to avoid injury of a nerve?
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
```
What lies at
T8
T10
T12
L1
L3-4
and L4
```
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
deep tendon reflexes
Achilles reflex (ankle)
S1 and S2
101
deep tendon reflexes
| Patellar reflex
knee
L3 and L4
102
deep tendon reflexes
Biceps and brachio-radialis reflexes
Biceps C5, C6
Brachioradialis C6, C7
103
deep tendon reflexes
Triceps reflex
C7 and C8
104
deep tendon reflexes
Cremasteric reflex
L1 and L2
| Elevation of the testes on a light stroke of the inner thigh and downwards towards the knee
105
deep tendon reflexes
| Anal wink reflex
External sphincter contraction
S2-S3 and S4
106
Facial Nerve Lesion (7th CN)
Facial Weakness + loss of taste of the anterior 2/3 of tongue
107
Vagus Nerve Lesion (10th CN)
Weak cough, vocal cord paralysis with dysphonia, uvular deviation.
Also parasympathetic loss of respiratory, gastrointestinal tract (GIT), and cardiovascular system.
108
Trigeminal nerve lesion (5th CN)
Weakness of the muscles of mastication
Deviation of jaw towards the same side of the weak pterygoid muscle
Loss of facial sensation
109
Glossopharyngeal nerve lesion (9th CN)
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
Hypoglossal nerve lesion (12th)
Deviation of the tongue to the same side of the injury
| Innervates the muscles of the tongue
111
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.
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
Sensory loss
Groin and pelvic girdle
Anterior thigh
Medial thigh and distal anterior thigh
L1 (groin and pelvic girdle)
L2 (anterior thigh)
L3 (Medial thigh and distal anterior thigh)
"3 in the thigh"
113
Sensory loss
Medial shin
Lateral shin and dorsum of the foot
L4 (inner shin)
L5 (lateral shin and dorsum of the foot)
"2 in the shin"
114
Sensory loss
Lateral foot
S1
"1 in the foot)
115
A swelling behind the knee (in the popliteal fossa), usually asymptomatic, round, smooth, non tender.
Most likely diagnosis?
Baker cyst
| popliteal cyst
116
Numbness and tingling of the thumb, index and middle fingers.
Dx?
Carpal Tunnel Syndrome (median nerve)
Pregnancy= due to fluid retention
Tinel test is not always positive (low sensitivity)
117
What happens in Carpal Tunnel syndrome and tx?
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
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.
C8 radiculopathy.
```
Median nerve- LOAF muscles
Lateral 2 lumbricallis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis.
```
119
Radiculopathy that affects fingers abduction and adduction, and has pain and paraesthesia along the affected nerve.
T1 radiculopathy
```
Flexor digitorum superficialis and profundus
Flexor pollicis longus
Lumbricals
Interossei
Pectoralis major.
```
120
Femoral nerve injury
| stab injury to inguinal area
Weakness on hip flexion
Weakness on knee extension
Paraesthesia over the medial side of the thigh
121
Femoral nerve
| Motor, sensory and mechanism
Knee extension, thigh flexion
Anterior and medial aspect of the thigh and lower leg
Hip and pelvic fractures (stab/gunshot wound)
122
```
Obturador nerve
(Motor, sensory and mechanism)
```
Thigh adduction
Middle part of the medial thigh
Anterior hip dislocation
123
Lateral cutaneous nerve of the thigh
Motor, sensory and mechanism
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
Tibial nerve
| Motor, sensory and mechanism
Foot plantar flexion and inversion
Sole of the foot
Not commonly injured (deep and well protected)
Popliteal lacerations, posterior knee dislocation
125
Common peroneal nerve
Motor, sensory and mechanism
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
Superior gluteal nerve
Motor, sensory and mechanism
Hip abduction
Sensory> none
Misplaced intramuscular injection
Hip injury
Pelvic fracture
Posterior hip dislocation
Injury results in a positive Trendelenburg sign
127
Inferior gluteal nerve
Motor, sensory and mechanism
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
Artery supply of the lower limbs
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
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?
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
Px with caludication whose femoral and popliteal pulses are not felt.
The most likely occluded artery is...?
External iliac artery
One level above affected muscles or the artery that cannot be felt.
131
Pain in buttocks, thighs ± Erectile dysfunction (Leriche Syndrome)
Aorto-iliac artery occlusion.
132
Pain extends to just above the inguinal ligament
Common iliac artery occlusion
133
Pain in the leg (below inguinal ligament). Femoral pulse is present but the pulses below are not.
Femoral artery occlusion
134
Pain below the knee
Femoro-popliteal artery occlusion
135
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?
Lower brachial plexus (inferior trunk of the brachial plexus)
Injury to C8 and T1 (ulnar nerve)
136
Meralgia paresthetica
Burning numbness or tingling sensation of the lateral thigh due to injury to
Lateral femoral cutaneous nerve
137
Neck injury followed by asymmetrical chest movements.
Phrenic nerve injury
| controls diaphragm
138
What is Parkinson's disease?
| What structure is affected?
A progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the SUBSTANTIA NIGRA
139
Classic triad of Parkinson's disease
Bradykinesia
Resting tremors
Rigidity
Caused by low levels of dopamine
Symptoms are characteristically asymmetrical
