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USMLE Rx > Anatomy [All] > Flashcards

Anatomy [All] Flashcards

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USMLE® Step 1 flashcards
1
Q

Which dermatome lies on the posterior half of the skull cap.

A

C2

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2
Q

Which dermatome is at the high collar area.

A

C3

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3
Q

Which dermatome is at the low collar area

A

C4

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4
Q

What sensory issues would a L5-S1 herniated disk have.

A

Diminished ankle jerk reflex and diminished sensation to posterior and lateral foot

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5
Q

Which directions do most herniations occur in and why.

A

Posterolateral direction because the annulus does not have the support of the posterior longitudinal ligament.

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6
Q

Which dermatome would cause diminished sensation to medial foot.

A

L4

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7
Q

Which bone is usually injured in the anatomic snuffbo.

A

Scaphoid bone.

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8
Q

What might be a complication of the dislocation of the lunate.

A

Carpal Tunnel Syndrome.

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9
Q

What are the smiths and colles fracture.

A

Fractures of distal radius.
Smiths- caused by direct blow on forearm of falling on flexed wrist
Colles- falling on extended wrists

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10
Q

Where in the basal ganglia are the post-synaptic receptors for dopamine located.

A

Striatum

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11
Q

Outline the D1 receptor pathway.

A

Substantia nigra excites striatum which inhibits Gpi so thalamus is uninhibited [excitatory]

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12
Q

Outline the D2 receptor pathway.

A

Substantia nigra excites striatum which inhibits GPe which is unable to inhibit STN. STN will excited GPi which will inhibit thalamus [inhibitory]

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13
Q

Where does the thoracic duct empty.

A

At the junction of the left internal and left subclavian veins

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14
Q

What the muscles involved in arm ABduction.

A

0-15 degrees- supraspinatus
15-90 degrees- deltoid
90-100- trapezius
above 100- serratus anterior

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15
Q

What are the layers and contents of the spermatic cord. What nerve runs superficial in the spermatic cord.

A

Layers- External Fascia [derive from external fascia], cremateric muscle and fascia [from internal oblique], internal spermatic fascia [from transversalis]. Contains structures that run to and from testes.
Ilioinguinal nerve [L1] runs superficial in this cord and supplies sensation to medial thigh and scortum or labia in females.

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16
Q

Dissection of which nerve might cause the loss of cremasteric reflex.

A

Genitofemoral nerves and also ilioinguinal nerve

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17
Q

Damage to what structure might cause testicular edema.

A

Pampiniform plexus [which is in the spermatic cord]

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18
Q

Which receptors are responsible for coarse-touch, high frequency vibrations and pressure and tension.

A

Pacinian corpuscles- commonly damaged in diabetic neuropathy.

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19
Q

The superficial arch of the palm is the continuation of which arter.

A

Ulnar artery.

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20
Q

The deep arch of the palm is a continuation of which artery.

A

Radial artery.

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21
Q

Which arteries ensure adequate supply of blood in hand through anastamoses.

A

Superficial and deep palmar arteries.

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22
Q

What does the dartos muscle of the scrotum do.

A

Wrinkling of the skin of the scrotum.

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23
Q

What nerve will be damaged in the surgical neck fracture of the humerus.

A

Axillary Nerve

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24
Q

Which structures are susceptible in midshaft humeral fractures.

A

Radial nerve and deep brachial artery [structures in the radial groove]

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25
Q

What is the most likely cause of indirect inguinal hernias.

A

Failure of processus vaginalis to close.

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26
Q

Which ligament is most likely injured in a foot inversion injury. [Ligament torn on lateral side]

A

Anterior talofibular

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27
Q

Lateral ankle sprains usually occur in which positions.

A

Inversion of plantar flexed foot

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28
Q

Which is the only gluteus muscle to extend the hip

A

Gluteus Maximum

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29
Q

What is the symptom of a superior gluteal nerve damage.

A

Trendelenburg gait [cannot abduct or medially rotate thigh] and difficulty keeping pelvis level

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30
Q

Which pharyngeal arch does the right recurrent and inferior laryngeal vagus nerve arise from.

A

6

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31
Q

Which muscle is the only abductor of the laryngeal vocal cords.

A

Posterior cricoaretynoid.

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32
Q

Which pharyngeal arch does the superior laryngeal vagus arise from.

A

4th

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33
Q

What is the unhappy triad.

A

Combination of MCL injury, ACL injury and medial meniscus injury

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34
Q

Weakness in pronating the forearm indicates injury to which nerve.

A

Median nerve

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35
Q

Where are the renin section JXG cell located in a nephron.

A

Affarrent arteriole tunica media

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36
Q

Where is the macula densa located.

A

Distal tubule

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37
Q

What is the anatomical defect in a congenital diaphramatic hernia

A

Failure of closure of the pleuroperitonial canal causing bowel to be shifted into the thorax

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38
Q

Why do congenital diaphramatic hernias usually occur on the left side.

A

Because the right side has liver and left pleuroperitonial usually fuses with the septum transversum later

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39
Q

Why are bag masks contraindicated in babies with pulmonary hypoplasia.

A

Because they can force air into intestines and further reduce lung capacity

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40
Q

In a baby with cyanosis, how do you know if its Tetrology of fallot and not transposition of the great vessels or patent truncus arteriosus.

A

Tetrology of fallot maybe present weeks later with cyanosis while the others will be immediate blue baby

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41
Q

How does squatting help relieve onsets of ‘tet spells’

A

Squatting increases afterload or systemic pressure allowing less shunting of deoxygenated blood from right to left ventricles.

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42
Q

What are the four portosystemic anatamosis.

A

Esophagus, umbilicus and anal anastamoses

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43
Q

Which is the only muscle of mastication that lowers the jaw. Which nerve innervates it.

A

Lateral pterygoid. V3, mandibular branch of trigeminal

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44
Q

Which is the only motor component of CNV.

A

V3

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45
Q

What does the greater petrosal branch of CNVII do.

A

Supply parasympathetics to lacrimal gland

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46
Q

What vessels to the infundibulopelvic/suspensory ligamens contain.

A

Ovarian vessels.

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47
Q

Which ligaments of the uterus do not contain any vessels.

A

Round ligament and ovarian ligaments.

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48
Q

Which ligaments of the uterus are derived from the gubernaculum.

A

Round ligament and ovarian ligaments.

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49
Q

What are the typical causes of acute appendix inflammation.

A

Obstruction through lymphoid hyperplasia or faecalith impaction

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50
Q

What are some symptoms of intussussception.

A

Vomiting, palpable mass, bloody diarrhea, hyperactive bowel sounds.

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51
Q

What age group usually has midgut volvulus and sigmoid volvulus.

A

Midgut- babies and kids

Sigmoid- elderly

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52
Q

What is contained inside the carotid sheath from lateral to medial.

A

Internal jugular vein, [vagus a little posterior too], common carotid artery

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53
Q

What are the most common veins for central line placements.

A

Internal jugulars, femoral, subclavian

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54
Q

What is the virchow triad.

A

Triad of hypercoagulibility, stasis and endothelial injury

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55
Q

What is the strongest ligament of the ankle.

A

Deltoid ligament

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56
Q

Name the ligaments in the lateral ligament complex. Which is the most commonly injured.

A

Anterior talofibular [most commonly injure], calcenofilbular and posterior talofibular

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57
Q

Bilateral Intraocular opthalmoplegia is very indicated of which neural disease.

A

Multiple Sclerosis

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58
Q

What is the Uhthoff phenomenon.

A

Heat causes slowed conduction through demyelinated nerves so symptoms of MS are worsened.

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59
Q

Where do the interneurons of the abducens and oculumotor cross to communicate.

A

Medial Longitudinal Fasciculus

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60
Q

What does the Edinger-Westphal nucleus do.

A

Supplies parasympathetics to pupil and ciliary muscles

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61
Q

What is spinal muscular atrophy Type 1

A

It is a autosomal recessive inherited disorder in the SMN1 gene causing anterior horn neuron degeneration and LMN defects.

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62
Q

Which nerves do the triceps reflex test.

A

C7, C8

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63
Q

Which nerves do the biceps and brachioradialis nerves test.

A

C5, C6

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64
Q

What defect does a C4-C5 slip disc cause.

A

partial loss of arm flexion and abduction

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65
Q

From where are the pudendal nerve fibers derived and what do they supply.

A

Dervied from S2-S4 and supply the sensation most of perineum and genitals with motor control of external urethral and anal sphincter

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66
Q

Where is the common fibular nerve derived from.

A

L4-S2

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67
Q

Where is the tibial nerve derived from

A

L4-S3

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68
Q

Which nerve do the L4-S1 nerves form.

A

Superior gluteal nerve

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69
Q

Erbs-duchenne palse is seen in which root lesion

A

C5-C6, waiter tip

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70
Q

Which structure is tied in a vasectomy.

A

Ductus deferens

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71
Q

What would be the defect in an L5 radiculopathy.

A

Decreased medial foot sensation and decreased toe extension

72
Q

What is the vitelline duct.

A

It connects the developing midgut lumen to the yolk sac

73
Q

What does the infraspinatus muscle do.

A

Lateral rotation

74
Q

What does the teres minor do.

A

Lateral rotation and adduction

75
Q

What is the most common congenital esophageal atresia in neonates.

A

Esophageal atresia with distal tracheoesophageal fistula

76
Q

In order of most frequent to least frequent, where do ectopic pregnancies in fallopian tube occur.

A

Ampulla, isthmus, fimbriae, interstitium

77
Q

A patient with a coarcted aorta is most likely to develop which complication.

A

Aortic dissection

78
Q

What are the nerves that exit foraman ovale.

A

CNV3

79
Q

What nerves exit superior orbital fissure.

A

CN III, CNIV, CNV1, CNVI,

80
Q

What nerves exit foramen rotundum.

A

CNV2

81
Q

Which foramen does CNVII use to exit the skull.

A

Stylomastoid foramen

82
Q

What structures go through the jugular foramen.

A

CNIX, CNX, CNXI, jugular vein

83
Q

How do you distinguish hirschsprung’s disease from idiopathic volvulus in neoborns.

A

Hirschsprung’s disease will become obvious in the first 24 hours.

84
Q

Who is most likely to have a femoral hernia.

A

Women, more concerning because of risk of strangulation

85
Q

What are the borders of the hasselbach’s triangle. What is this triangle’s significance.

A

Lateral border- inferior epigastric vessels
Medial border- rectus abdominus
Inferior border- inguinal ligament
Direct hernias pass through this

86
Q

Where is the direct hernia located in relation to the inferior epigastric vessels.

A

Medially

87
Q

What does pain in inguinal hernias suggest.

A

Incarceration or strangulation

88
Q

Which veins drains the upper two thirds of the esophagus. Lower one-thirds.

A

Esophageal vein, left gastric vein

89
Q

What are the most common type of renal stones.

A

Calcium stones which are radioopaque [envelope, dumbell or prism shaped]

90
Q

Which type of stones are radiolucent.

A

Uric acid stones, rhomboid or rosettes shaped

91
Q

What are struvite stones and how would they appear on x-ray.

A

Radioopaque stones with magnesium ammonium phosphate. Coffin-lid shaped

92
Q

Which stones are hexagonal and moderaly radioopaque.

A

Cysteine stones

93
Q

Damage to the levator ani would result in what symptom.

A

Urinary incontinence

94
Q

Which foramen does CNIX use to enter the skull. And to exit.

A

Enter- foramen magnum

Exit- Jugular foramen

95
Q

What foramen does CNVII use to enter the skull.

A

Internal acoustic meatus

96
Q

Which structures course through the foramen magnum

A

CNIX enters, vertebrain arteries and brainstem

97
Q

What is the lateral and medial borders of the anatomic snuffbox.

A

Medial- extensor pollicis longus

Lateral- Abductor pollicis longus, extensor policis brevis

98
Q

What structures course through the central tendon of the diaphgram and at which level.

A

IVC at T8

99
Q

At which level do the common carotid bifurcate.

A

C4

100
Q

What is one complications that male offsprings of mothers who took diethystilbesterol during pregnancy have.

A

Spermatocele or epidydymis cyst

101
Q

What is cryptorcidism.

A

When the testes fail to drop into the scrotum

102
Q

What does cyrtocidism put the testes in risk for.

A

Testicular germ cell tumors.

103
Q

What happens to the androgens in unilateral crytorchidism. Bilateral.

A

Unilateral- mostly normal levels.

Bilateral- decreased inhibin, increased FSH, LH, decreased testosterone

104
Q

If the left superior gluteal nerve was injured, which side hip would drop in the stance phase.

A

The right side hip and the patient would try to lean to the left to swing his legs forward

105
Q

Which nerve innervates the brachioradialis.

A

Radial nerve

106
Q

Name all the deformities in turner’s syndrome.

A

HEENT- webbed neck and cystic hygromas as well as lymphedema
Cardiovascular- bicuspid aortic valve, coarctation of aorta
GU- streak ovaries, amenorrhea, horseshoe kidneys
Overall- short stature

107
Q

What heart conditions can cause electrical alternans.

A

Cardiac tamponade and pericardial effusions.

108
Q

Which type of twinning causes the most complications in utero. What is the most important complication.

A

Monochorionic monoamniotic monozygotic twins

Twin/twin transfusion syndrome- because they share a placenta

109
Q

If cleavage of a twin pregnancy occur around 0-4 days, which type of twin pregnancy is likely.

A

Dichorionic, diamniotic twins

110
Q

What is the time period of cleavage for dichorionic, monoamniotic twins.

A

4-8 days during the morula to blastocyst phase

111
Q

If it takes greater than 13 days for cleavage to occur, what type of pregnancy results.

A

Monochorionic, monoamniotic conjoined twins

112
Q

What is the difference in the path to the liver taken by the fat soluble and water soluble vitamins.

A

Water soluble vitamins get to the liver through the portal system, whereas the fat soluble vitamins [D,E,A,K] are first absorbed in the intestines through lacteals that drain into the lymphatics. The lymphatics of the intestines drain into the thoracic duct which drains into the left jugular angle before reaching the liver.

113
Q

Where is vitamin A stored.

A

In the ito cells of the liver [perisinusoidal cells]

114
Q

Which lymphatic channel drains the face and neck.

A

Right lymphatics [which also drains the right arm and back and chest]

115
Q

To which lymph nodes do the prostates drain.

A

Internal iliac

116
Q

Which abnormality will develop from the incomplete fusion of the paramesonephric ducts in development.

A

Bicornuate Uterus

117
Q

What behavior characterizes conduction phasia

A

poor repetition with fluent speech and intact comprehension

118
Q

Which nerve supplies the cricothyroid muscle and what does it do.

A

Superior laryngeal nerve. It varies the length and tension of the vocal cords

119
Q

What are some defects that will be associated with congenital duodenal atresia.

A

VACTERL [Vertebral defects, Anal atresia, Cardiac defects, tracheoesophageal fistula, renal defects, limb defects]

120
Q

What is the medical radioisotope technetium-99m test used for.

A

To detect gastric tissue, especially if its ectopic

121
Q

What are the nerves responsible for erection, emission, and ejaculation.

A

Erection- parasympathetics from S2-S4 of pelvic splanchnics,
Emission- Sympathetics from T11-L2 of hypogastric plexus
Ejaculation- somatic nerves and visceral nerves from pudendal nerves
Point, squeeze, shoot

122
Q

At what level are the abdominal aortic aneurysms most common.

A

Just below the level of the kidneys

123
Q

Where does the IMA branch in relation to the common iliac bifurcation and renal arteries.

A

Below renal arteries and above the common iliac bifurcations

124
Q

Which levels of the lumbar nerves cause the cremateric reflex and anal wink.

A

Cremasteric- L1, L2 testicle move

Anal Wink- S3-S4 winks galore

125
Q

Which muscle in the thenar compartment is innervated by the ulnar nerve.

A

Adductor policis

126
Q

What does a lesion affecting the adductor pollicis cause as symptoms.

A

Thumbs extension over time so that the patient is unable to grib a piece of paper between thumb and forefinger or between adjacent fingers

127
Q

What is froment’s sign

A

Injury of adductor pollicis will cause exaggerated thumb flexion at the Interphalangeal digit between of inability to flex MCP

128
Q

Which nerve innervates the palatal arches, levator veli palatini and uvula.

A

Vagus nerve

129
Q

Which nerve innervates the tensor veli palatini and the intrinsic soft palate muscles.

A

CN V

130
Q

Which branch of the median nerve is spared in carpal tunnel syndrome.

A

The palmar cutaneous branch so sensation is intact

131
Q

Which dermatome lies at the umbilicus

A

T10

132
Q

What is the difference between femoral triangle and femoral sheath.

A

Femoral triangle contains NAVEL from lateral to medial [femoral nerve, artery, vein and lymphatics]
Femoral Sheath contains SHAVE [Femoral artery, vein, and empty space and also deep inguinal nodes]- NO NERVE OR LYMPHATICS.
Femoral sheath is derived from transversalis and iliopsoas fascia

133
Q

What is the nerve, artery, vein and lymphatic system supplying above the pectinate line.

A

Nerve- visceral
Artery- superior rectal branch of IMA
Vein- drains from superior rectal vein to IMV to splenic vein
Lymphatics- internal iliac lymph nodes

134
Q

What is the nerve, artery, vein and lymphatic system supplying below the pectinate line.

A

Nerve- somatic
Artery- inferior rectal branch of INTERNAL PUDENDAL ARTERY
Vein- inferior rectal to internal pudendal, to internal iliac to Inferior vena cava
Lymphatics- superficial inguinal lymph nodes

135
Q

What are hemorrhoids.

A

Prolapse of tissue into anal canal due to straining

136
Q

How are external hemorrhoids different from internal hemorrhoids.

A

External hemorrhoids are painful due to somatic innervation and will most likely not bleed

137
Q

What is pseudocryptorchidism and what causes it.

A

Hyperactive contraction of cremasteric muscle drawing the testicles into the abdomen.

138
Q

What does the tensor tympani muscle do and what innervates it.

A

Moves tympanic membrane medially, innervated by V3 [lies in close proximity to middle meningeal artery]

139
Q

Where are the ito cells [hepatic stellate cells or perisinusoidal cells] located.

A

In the space of disse in the liver

140
Q

What is the psoas sign and which nerves innervate the muscles involved.

A

Psoas sign is pain upon passive extension of hip or upon active resistance against hip flexion.
Hip extension causes pain as psoas and illiacus hit the appendix, cecum or sigmoid colon or pancreatic tumor.
Psoas muscle- lumbar plexus
Illiacus- femoral nerve

141
Q

Duodenal ulcers, unlike gastric ulcers, are always associate with hypersecretion of —-

A

Gastric acid

142
Q

Why does BPH occur.

A

Excess dihydrotestosterone with advanced age

143
Q

Which dermatome covers the forefinger and middle finger as well as the triceps

A

C7

144
Q

A duodenal ulcer is at risk of perforation of which artery

A

Gastroduodenal artery

145
Q

What is the largest branch of the celiac trunk.

A

Splenic artery

146
Q

What lobe does the PCA supply.

A

Occipital lobe

147
Q

What are the defects in Di-George’s syndrome.

A

CATCH-22

Cardiac anomolies, Abnormal facies, Thymus aplasia, Cleft palate, Hypocalcemia

148
Q

Which T-cell markers will be decreased in DiGeorge’s syndrome

A

CD3, CD4, CD8

149
Q

What is subacute combined deficiency and which tracts in the spinal cord does it effect.

A

SCD is due to Vit B12 deficiency causing neural symptoms, It affects the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts

150
Q

Which parts of spinal cord are degenerated in ALS.

A

Ventral horn, precentral gyrus, Lateral corticospinal tract

151
Q

What structures make up a bronchopulmonary segment. What is there relationship to the airways

A

A tertiary bronchus, two pulmonary arteries, veins and lymphatics. Arteries run centrally with the airways while veins and lymphatics run peripherally

152
Q

Symmetric palate elevation confirms that CN– is intact.

A

CNX

153
Q

What is neurophysin I. What happens if its lost.

A

Carrier protein responsible for oxytocin transport from PVN

Absent let down reflex

154
Q

What is neurophysin II.

A

Carrier protein for ADH from hypothalamus

155
Q

Which tract is used to transport Oxytocin and ADH to posterior pituitary.

A

Supraoptic hypophyseal tract.

156
Q

Which tract is used to transport releasing hormones from hypothalamus to anterior pituitary.

A

Hypothalamic-hypophyseal portal system

157
Q

Which muscle of the pharynx does CNIX innervate.

A

Stylopharyngeus

158
Q

Which muscle of the tongue does the vagus innervate.

A

Palatoglossus- only tongue muscle under vagus control

159
Q

Which rotator cuff muscle laterally rotate the arm. Which is more likely to be injured.

A

Infraspinatus and teres minor. Infraspinatus is more likely to be injured

160
Q

What is the function of the teres major.

A

Medial rotation and adduction

161
Q

The MCA supplies sensory feeling to which parts of the body

A

The upper parts

162
Q

What are the symptoms of the medial medullary syndrome. Occlusion of which artery causes it.

A

Tongue protrusion to ipsilateral side
Medial leminiscus lesion- contralateral proprioception loss
Corticospinal tract lesion- contralateral weakness and paralysis
Due to loss of blood supply to anterior spinal artery

163
Q

What are two most common locations for ulnar nerve lesions.

A

Hook of hamate or medial epicondyle of humerus

164
Q

What are the two types of sweat glands. What is the difference between them.

A

Eccrine and apocrine.
Eccrine is found all over the body, most common in palm and soles and secretes watery sweat with exercise- thermoregulatory
Apocrine is found in genitals etc and secretes oily sweat- stimulated by catecholamines

165
Q

What is kernig’s sign and what does it indicate.

A

Pain on flexion of the hip with knee extended- meningisit

166
Q

What is murphy’s sign and what does it indicate.

A

Shortened inspiration with palpation of RUQ- acute cholecystitis

167
Q

What does the subscapularis muscle do.

A

Medial rotation and adduction

168
Q

What is the difference between neurofibramatousis I and neurofibramatoses II.

A

Type 1- ch 17 mutation with optic gliomas, pigmentationa nd freckling.
Type 2- ch 22 mutation with juvenile cataracts, schwanomas, acoustic neuromas due to mutation in NF2 gene [tumor suppressor] and merlin protein

169
Q

What mutation does von hipple lindau have and what does it present with.

A

Ch 3, renal cell carcinomas, impaired balance and hemangiomas

170
Q

Which dermatome provides sensation around the inguinal crease.

A

L1

171
Q

What syndrome does infarction of PICA present. And AICA

A

Aica- lateral pontine syndrome

PICA- lateral medullary [wallenburg syndrome]

172
Q

Which dermatome is at the level of the nipples.

A

T4

173
Q

What are the main watershed areas of the body

A 
Splenic flexure of the colon
ACA, MCA, PCA junctions, 
heart subendocardium
straight segment of proximal tubule
TAL of nephron
central vein [zone III] of liver
174
Q

What causes diverticulitis

A

Inflammation of diverticula due to obstruction and retention of material.
This is due to attenuation of muscularis propria creating a false diverticulum through herniation of mucosa and submucosa

175
Q

What causes the following fractures.

Bowing, spiral, buckle, greenstick, stress

A

Bowing- bending, cortex deformed without injury to periosteum
Spiral- twisting force, child abuse
Buckle- Compression, buckling of periosteum
Greenstick- periosteal tearing at the convex side
Stress- use over time, hairline fractures

USMLE Rx (3 decks)

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