ANATOMY and HISTOLOGY Flashcards
Macrophage in brain
Microglia/ glial cells
Macrophage in liver
Von kupffer cell
Macrophage in placenta
Hofbauer
Macrophage in lungs
Alveolar macrophage
The bulbus cordis becomes what structure in the adult heart?
Right ventricle
Plane of the abdomen is described as being halfway between suprasternal notch and pubic symphysis (L1 vertebra level in erect position)
Transpyloric
Muscular aponeuroses form the conjoint tendon
External oblique and internal oblique
In which abdominal layer is the opening of the deep inguinal ring is located
Transversalis fascia
Hernias presents as a bulge on the Hesselbach’s triangle
Direct hernia
Muscular aponeuroses contribute to the anterior rectus sheath above the arcuate line of Douglas
External and internal oblique muscles
Supplies cutaneous innervation to the umbilicus
T10
LINES will be directly traversed by an incision passing between 2 rectus abdominis muscles
Linea alba
Type of hernia arises when the bowel and peritoneal sac protrudes through the deep inguinal ring and enter the inguinal canal
Indirect
Spinal nerves will NOT enter the rectus sheath
L1
Muscular valve controls the flow of digestive juice from the pancreatic and common duct to duodenum
Sphincter of Oddi
artery of origin of the vasa brevia or short gastric arteries
Splenic
vertebral level does the esophagus start
C6
direct branch of the celiac trunk
Left gastric
Common hepatic
Splenic
Where are the spiral valves of Heister located
Cystic duct
Which part of the large intestine is the MOST prone to rupture in cases of complete intestinal obstruction
Cecum
artery runs in the superior border of the pancreas
Splenic
surfaces of the rectum is devoid of peritoneum
Lower third, anterior surface
vertebral level corresponds to the start of the rectum
S3
intestinal segments will LEAST likely develop necrosis with superior mesenteric artery thrombosis
Rectum
Most common pituitary gland tumor in adults
Prolactinoma
Most common pituitary gland tumor in children
Craniopharyngioma
Part of the vertebrae that supports majority of the weight
Lumbar
Biggest vertebral body
Fused regions of the vertebrae
Sacral (5)
Coccygeal (4)
Most distinctive feature of each cervical vertebra
Foremen transversarium / transverse foramen
Normal embryology of the breast
Modified apocrine sweat gland
Functional unit of breast
Terminal duct lobular unit (TDLU)
2 cell types that will line the ducts and lobules of the breast
Myoepithelial cells (contractile)
Luminal epithelial cells
2 types of stroma of the breast
Interlobular stroma
Intralobular stroma (hormonally responsive)
Epithelium of nipple and arrows
Stratified squamous epithelium
Functions in nipple lubrication, becoming prominent during pregnancy
Ariel at glands (of Montgomery)
Area of highest density of breast tissue among males
Subareolar area
Area of highest density of breast tissue among females
Upper outer quadrant
Cells in seminiferous tubules
Germ cells
Sertoli cells
Cells in interstitium of testis
Leydig cells
Mature spermatocytes
Presence of Acrosomal cap
Most common birth defect of male genitalia
Cryptorchidism
Phases of testicular descent
- TRANSABDOMINAL PHASE (Mullerian inhibiting substance by Sertoli cells)
- INGUINOSCROTAL PHASE (MC arrest descent) androgen and Hcg of calcitonin related peptide from genitofemoral nerve
Weight of prostate gland
20 grams
Anatomical zone of prostate cancer
Peripheral
Perineural invasion
Anatomical zone of BPH
Transitional and the periurethral
Most common form of prostatitis
Chronic abacterial prostatitis
BPH involves hyperplasia of what type of cells
Stromal and epithelial cells
Main androgen in prostate
Dihydrotestosterone (DHT)
Main arterial vascular supply of spinal cord
Anterior Spinal Artery (ASA)
Ant 2/3 of spinal cord
(From Anterior Radiculomedullary artery)
PSA - Post 1/3
Largest radiculo-medullary artery
Between T9-T12
Artery of Adamkiewics
(Arteria radicularis magna)
Reinforces the circulation in lower 2/3 of spinal cord
2nd largest artery
Enters central canal at the C5-C6 vertebral level
Artery of Cervical Enlargement
Communication of basivertebral veins and the posterior external vertebral venous plexus
Batson’s plexus
Responsible for metastasis of:
Breast CA, prostate CA, vertebral column, brain
Right and left vertebral veins will become …..
Basilar veins
Space between dura and wall of vertebral canal
Epidural space (extradural)
Contains internal vertebral venous plexus
Contains FAT
Between arachnoid and pia mater
Spinal cord ends at L1/L2
Dura ends at S2
Subarachnoid space
Contains CSF
Terminal portion of spinal cord
Conus medullaris
Blood supply of spinal cord (3A 1V)
Anterior spinal arteries (ASA)
Posterior spinal arteries (PSA)
Radicular Arteries (RA)
drain into:
Internal Vertebral Venous Plexus
Fibrous extension of the pia mater; anchors the spinal cord to coccyx
Filum terminale
Collection of nerve roots at the inferior end of the vertebral canal
Cauda equina
3 veins that contribute to Batson’s Venous Plexus
Internal vertebral venous plexus
External vertebral venous plexus
Basivertebtal veins
Hemisection of cord
Ipsilateral loss of touch and vibration
Contralateral loss of pain and temp
Brown sequard syndrome
Complete paralysis from the level of trauma
Hyperesthesia at level of the lesion
Loss of pain and temp
Proprioception is preserved
Anterior cord syndrome
Produces greater weakness of the arms than the legs
Sensory sparing is present
Central cord syndrome
Involvement of proprioception - position and vibratory sensation
Retain pain and temp sensation
Posterior cord syndrome
Slow degeneration of the dorsal/ posterior columns of the spinal cord
Loss of vibration and position sense
Tabes dorsalis
Tertiary syphilis
Pathognomonic sign of tabes dorsalis
Argyll robertson pupil
“It accomodates but does not react”
Most common spinal cord syndrome
Disproportionate UE weakness and less severe LE weakness, sensory and bladder dysfunction
Central cord syndrome
Loss of pain and temp in dermatomal distribution
“Suspended sensory level”
Girdle syndrome of central cord syndrome
Best prognosis of the spinal cord syndromes
Brown sequard syndrome
Worst prognosis of the spinal cord syndromes
Anterior corf syndrome
Least common of the spinal cord syndromes
Posterior cord syndrome
Injury to the cord at level of L1 to L2
Early sensory deficit (saddle distribution)
Bladder and bowel dysfunction
Conus medullaris syndrome
Injury that involves the nerve roots of the cauda equina and spares the spinal cord itself
Disc herniation and burst fractures
Bladder and bowel dysfunction later in the course
Cauda equina syndrome
Results from demineralization of bones
Elderly
Postmenopausal
Osteoporosis
Most common affected areas of osteoporosis
Neck of femur
Bodies of vertebrae
Metacarpals
Radius
Findings in osteoporosis
Wedge like lesion
Vertical striations
Collapsed vertebral column
Common in adolescent athletes involved in sports requiring repeated spinal HYPEREXTENSION
L5
Fracture of PARS INTERARTICULARIS
Degenerative/ traumatic defect of POST. NEURAL ARCH
Spondylolysis
“Neck of scottie dog”
Bilateral pars interartucularis defect
Forward displacement of vertebral body
L5-S1
“Slippage of vertebra anteriorly”
Spondylolisthesis
Fracture or dislocation of C1 (atlas)
Vertical compressive force
Jefferson’s fracture
Fractures involving C1, C2 and C3
Quadriplegia
Arrest of respiration
High cervical fracture
Fracture or dislocation of C2 (w/ dens of axis)
Traumatic spondylolisthesis
Sudden hyperextension
Hangman’s fracture
Hyperextension injury
Rear-end automobile collision
Strain/ torn anterior longitudinal ligament
Whiplash injury
Hyperflexion of the neck
Posterior subluxation of vertebral body
Teardrop fracture
Fracture of C7 (cervical prominence)
Clay shoveller’s fracture
Surgical excision of one or more spinous processes and the adjacent supporting vertebral laminae in a particular region of the vertebral column
Laminectomy
Umbilicus
Structures?
Vertebral level?
Dermatomal level?
AOG?
Bifurcation of the aorta
Iliac crest
V —- L4
D —- T10
AOG — 20 weeks
Structures at subcoastal plane L3
3rd part of duodenum
Origin of IMA
Transpyloric plane L1 structures
Pylorus of stomach
Duodenojejunal junction
Neck of pancreas
Hilum of kidneys
Fascial layers
Superficial
- campers (fatty)
- scarpa (membranous)
—– dartos (scrotum)
—– colles (perineum)
Extravasated urine it will be found in?
Superficial perineal space
Rupture of inferior epigastric vein
MCC is trauma
MC on the right side below umbilicus
Rectus sheath hematoma
Palpable abdominal mass that remains unchanged with contraction
Fothergill sign
Rectus sheath hematoma
2-3cm above the clavicle anterior to C6 transverse process
Most superficial passage for the brachial plexus
Erb’s point
Brachial plexus starts at? Ends?
Start - C5
End - T1
Affects C5 and C6
Waiter’s tip
Erb’s palsy
Upper brachial plexus
C8 - T1 lower brachial plexus palsy
Klumpke’s palsy
Wrist drop
Saturday night palsy
Loss of extensuon of fingers, thumb and wrist
Numbness over 1st dorsal intraosseous muscles
Radial nerve
Humeral mid-shaft fracture
Radial nerve
Ape hand
Atrophy of thenar eminence
Median nerve
Carpal tunnel syndrome
Median nerve
Pope’s blessing
Median nerve injury
PE for carpal tunnel syndrome
Tinel’s sign
- tap
Phalen’s sign
- “pray”
Nerve supplies the serratus anterior
Winging of scapula
Long thoracic nerve
Fracture of the surgucal neck of humerus
Axillary nerve injury
Quadrangular space boundaries
Sup - subscapularis
Lat - humerus
Inf - teres major
Med- triceps (long head)
Quadrangulat space contents
Axillary nerve
Posterior humeral circumflex
Axillary nerve injury
Injury to quadrangular space
Ill-fitted crutches
Radial nerve injury
Axillary nerve injury will lead to
Deltoid atrophy
Ulnar nerve injury
Claw hand
Thoracodorsal nerve
Middle subscapular nerve
Latissimus dorsi
Muscles of rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres MINOR
SITS
When pinching a piece of paper between thumb and index finger, the thumb IP joint will flex if the ADDUCTOR POLLICIS muscle is weak
Froment’s sign
Ulnar nerve injury
Finkelstein sign
De quervain’s tenosynovitis
Chest pain referred to medial side of arm and armpits
Intercostobrachial nerve T2
Volkmann’s contracture
Supracondylar fracture
Permanent flexion contracture of the hand and wrist (claw like deformity )
Thickening of palmar aponeurosis
Dupuytren’s contracture
Seen in uremia
Lateral epicondylitis
Tennis elbow
Medial epicondylitis
Golfer’s elbow
Cubital fossa boundaries
Base - line connecting lateral to medial epicondyle
Lat - brachioradialis
Med - pronator teres
Axillary artery –> radial artery (anatomical snufbox) —> ulnar artery
Fascial compartment of thigh : Anterior thigh muscles
supplied by FEMORAL N
— flexors of thigh, extensors of knee
Iliopsoas
Tensor fascia lata
Sartorius
Quadriceps femoris
Landmarks of anterior thigh
Anterior superior iliac spine
Anterior inferior iliac spine
Ischial tuberosity
Fascial compartment of thigh : medial thigh muscles
supplied by OBTURATOR N
— adducts the thigh
Pectinus
Adductor longus
Adductor brevis
Adductor magnus
Gracillis
Adductors LBM + P, G
Fascial compartment of thigh : posterior thigh muscles
supplied by SCIATIC NERVE
— Extensors of the thigh, flexor of leg
Hamstring muscles:
Semitendinosus
Semimembranosus
Biceps femoris
Adductor magnus
Landmarks of posterior thigh
Lesser trochanter
Linea aspera —- adductor magnus
Compartment syndrome
MC site - ANTERIOR
Increase production of fluid
Early sign - paresthesia between the 1st and 2nd toes
Treatment:
30-45 mmhg close monitoring
>45 mmhg —- surgery — fascioyomy
Femoral triangle
Triangular fascial space in the superoanterior third of the thigh
Sup - Inguinal ligament
Med - Adductor longus
Lat - Sartorius
Contents of femoral triangle
Femoral Nerve and its branches
Femoral Sheath and its contents
Femoral Artery and its branches
Femoral Vein and its tributaries
Funnel shaped fascial tube formed by inferior prolongation by inferior prolongation of iliopsoas and transversalis fascia of the abdomen
Femoral sheath
Lateral - Femoral A
Intermediate - Femoral V
Medial - Femoral Canal
Appears as a mass, often tender, in femoral triangle
Femoral hernia
Femoral ring is a weak area in anterior abdominal wall that normally admits the tip of 5th digit
MC in females
Neck of sac always LATERAL and BELOW the pubic tubercle
Most common type of hernia
Indirect hernia
Most common type of hernia in females
Indirect hernia
A fascial tunnel in the thigh running from the apex of femoral triangle to the adductor hiatus in the tendon of adductor magnus muscle
Adductor canal / subsartorial canal / hunter’s canal
Boundaries and contents of adductor canal
Ant - Sartorius
Lat - Vastus medialis
Post & Med - adductor longus / magnus
Contents:
- Femoral A/V
- Saphenous N
- Nerve to Vastus Medialis
Gluteal muscles
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Movement of Gluteus Maximus
Nerve supply?
Extension
Inferior gluteal nerve
Movement of Gluteus Medius
Abduction
Action of Adductor Magnus
Adduction
Action of Gluteus Minimus and Tensor Fascia Lata
Nerve supply of Gluteus Minimus?
Medial rotator
Superior Gluteal Nerve
Movement of Obturator Internus
Lateral rotator
Movement of Iliopsoas
Flexion
Most common cause of sciatic nerve injury
Intragluteal Injection
Upper outer quadrant = avoid!!
7 bones of the orbit
Frontal
Lacrimal
Ethmoidal
Zygomatic
Maxillary
Sphenoidal
Palatine
Fracture of the walls or floor of the orbit
Blow out fracture
Opacification in xray
Periorbital fat and possibly an entrapped extraocular muscle in the maxilary sinus
Teardrop sign
Pan-faced deformity in Lefort
Craniofacial dysjunction
High level fractures
Lefort III
Transverse maxillary fractures
Low level
Guerin type fracture
Floating fracture
Le fort I fracture
Pyramidal fractures
Separates maxilla from the face
Le fort II
Zygomaticomaxillary complex fractures
Including lateral orbital wall, inferior orbital floor
Zygomatic arche
**widening of zygomatico frontal suture
Tripod/ malar fractures
Most common part of the mandible fractures
Condylar process
The misalignment of teeth and jaws or more simple a bad bite
Malocclision
Layers of the skin
Epidermins - thin outer layer
Dermis/ corium - thick underlying layer
Hypodermis - fatty layer
Layers of the Epidermis
From basal lamina to free surface:
- S. Germinativum/ basale
- S. Spinosum
- S. Granulosum
- S. Lucidum
- S. Corneum
Carlos Loves Girls in String Bikinis
Most abundant cells in the epidermis
Keratinocytes
Contains keratin
Cells located in the basal cell layer
- Melanocytes
- Merkel cells / merkel ranvier (tactile epithelial cell for light touch)
- Basal cells
Outermost layer of the epidermis
Stratum corneum
W/ mostly DEAD CELLS filled with KERATIN
The “horn layer” of the epithelium
Water resistant
Shed and replaced every 2 weeks
Stratum corneum
The formation of layer of dead, protective cells filled with keratin
Occurs in all exposed skin except EYES
Keratinization
Translucent skin layer
“Clear layer”
May not exist in thinner skin
Dead layer
Covers s. granulosum
Stratum Lucidum
1 or more layers of cells starting to die and become hard. Keratinization…. becoming FIBROUS PROTEIN similar to that in HAIR and NAILS
Stratum granulosum
Layer capable of CELL DIVISION
Innermost layer of epidermis
Contains MELANIN
Stratum germinativum/ basale
The “Grainy layer”
Stops dividing, starts producing:
- Keratin (tough, fibrous, hair and nails)
- Keratohyalin (dense granules-lipids, crosslinking fibers)
Stratum Granulosum
Keratohyaline contains
Histidine and cysteine rich proteins with lipids
The “Spiny layer”
8-10 layers of keratinocytes bound by desmosomes
Cells shrink until cytoskeletons stick out (spiny)
Startum Spinosum
Prevent epidermal cells from separating
Desmosomes or Macula Adherens
Strengten attachment to basal lamina
Hemidesmosomes
Blistering skin disease
Autoimmune disease
Targets the DESMOGLEIN of desmosomes
Pemphigus vulgaris
Where are the LANGERHANS CELLS located
Stratum Spinosum
Deepest layer of epidermis
Layer closest to blood supply
Stratum Germinativum/ basale
Most common acquired disease of hemidesmosomes
Basal Lamina
Bullous pemphigoid
Structures of stratum germinativum
Epidermal ridges (fingerprint)
Dermal papillae (tiny mounds)
4-6 months fully developed fingerprints!
Caused by staph aureus
Exfoliatin
Splitting of the skin
Staphylococcal Scalded Skin Syndrome (SSSS)
Honey crusted lesion
Impetigo
(Strep pyogenes)
Most severe form of SSSS
Ritter’s Disease
Lyell’s disease
TEN (Toxic Epidermal Necrolysis)
Gives the skin the orange-yellow pigment
Can be converted to Vit A
Carotene
Yellow brown or black pigment
Produced by melanocytes in s germinativum
Stored in MELANOSOMES
Melanin
Defective excision repair which leads to production of thymidine dimers
Xeroderma Pigmentosum (XP)
Loss of melanocytes (autoimmune, neurohumoral, or self destruction of melanocytes)
Vitiligo
Absence of melanin pigment in melanocytes (lack of defect in tyrosinase)
Albinism
Macules in lightly pigmented individuals, increased pigment in basal keratinocytes
Freckles
Mask-like zone of facial hyperpigmentation due to enhanced pigment transfer to basal keratinocytes or dermal macrophages
Melasma
Causes:
OCP
Pregnancy
Thyroid disorder
Endocrine disorder
Localized hyperplasia of melanocytes, often seen in infancy and childhood
Lentigo
Bluish tint of skinsevere reduction in blood flow or oxygenation
Cyanosis
Icteric sclerae
2-3mg/dl
Yellow color
Jaundice
Most active form of vitamin D
1,25 dihydroxycholecalceferol
Powerful peptide growth factor used to grow SKIN GRAFTS. Produced by salivary and duodenum
Epidermal Growth factor (EGF)
Has 5 layers keratinocytes
Covers palms of hand and soles of feet
Thick skin
Thickest of the layers
Store water and nutrients. Regulate body temp
Dermis
Hypermobility of joints
Elastic but fragile skin
Elher’s danlos syndrome
Rodent ulcer
Basal cell CA
Dysplastic nevus
Melanoma
MC type: superficial spreading
2 classifications for prognosis:
- Clark and Breslow classification
Thickened tissue resulting from excessive stretching of skin due to pregnancy and weight gain
Stretch mark
Lines of cleavage
Langer’s lines
Components of the Dermis
Outer papillary layer
Deep reticular layer
Consist of areolar tissue
Has DERMAL PAPILLAE projecting between epidermal ridges
Supplies nutrient filled blood
Papillary layer
Provides structure and elasticity
Supports component of skin
Reticular layer
AKA subcutis or subcutaneous layer
Innermost network of fat and collage
Location of hypodermic injections
Hypodermis
Found in deep dermis and wrapped around a dense connective tissue sheath
Base surrounded by sensory nerves (root hair plexus)0
Hair follicle
Smooth muscle responsible for raising of hair (goosebumps)
Arrector pili muscle
Oil gland
Holocrine glands
Secretes SEBUM
Sebaceous glands
Merocrine gland - exocytosis
Watery secretion
Sweat gland
Sweat glands in armpits, around nipples and groin
Apocrine
Widely distributed sweat glands on body surface especially on palms or soles
Merocrine/ eccrine glands
Coiled tubular glands
Excessive sweating
Hyperhidrosis
Most common mintracranial tumor in adults
Metastatic
Most common PRIMARY intracranial tumor in adults
Gliomas/ Glioblastoma Multiforme (GBM)
**Astrocytoma is under glioma
Most common brain tumor in children
Medulloblastoma
Most common pituitary gland tumor in adults
Prolactinoma
(From Ant. Pit)
Most common pituitary gland tumor in children
Craniopharyngeoma
Amenorrhea
Galactorrhea
Infertility
Hypogonadism
Dx?
Prolactinoma
Dopamine receptor agonist
DOC in pituitary adenoma
Bromocriptine
Machine-oil like fluid
Craniopharyngeoma
- limited upward gaze
- accomodative spasm
- light near dissociation of pupils
Parinaud syndrome
Papilledema
Optic atrophy
Anosmia
Foster kennedy syndrome
Most common BENIGN PRIMARY brain tumor
Meningioma
“Dural tail of meningioma”
arachnoid layer
Anosmia
Hypogonadism
Dx?
Kallman syndrome
Meningioma
Schwanoma (CN 8)
Neurofibromatosis 2
Sudden monocular blindness — few minutes thengo back to normal
Amaurosis fugax
warning sign of stroke
occlusion of ophthalmic artery
Most common cause of subarachnoid hemorrhage
Ruptured berry aneurysm
“Thunderclap headache”
Most common solid renal tumor
Renal cell tumor
Most common solid renal tumor of childhood
Wilms tumor
Triad:
Flank pain
Hematuria
Palpable mass
Renal cell carcinoma
Most common benign bone tumor in children
Osteochondroma
Most common primary malignant bone tumor
Multiple myeloma
C3C4C5 keeps me alive!
Phrenic nerve
Caval opening is at??
T8
Esophageal opening is at?
T10
Aortic hiatus is at??
T12
Congenital diaphragmatic hernia: location of Bochdaleck hernia
“Back to the Left” — posterolateral (left)
Congenital diaphragmatic hernia:
Location of Morgagni hernia
moRgagni = Right
SVC syndrome positive to what test?
Pemberton sign
(Raise both hands = facial plethora)
Radiating pain on the tip of the left shoulder
+ kehr sign
= splenic rupture
Distended neck veins
Muffled heart sound
Hypotension
Beck’s triad
=»> Pericardiocentesis
Surfactant starts at?
20-24 weeks (Nelson)
Pulmonary embolism:
Hampton hump
Wedge shaped density
Pulmonary embolism:
Westermark sign
Focal oligemia
Pulmonary embolism:
Palla sign
Enlarged right pulmonary artery
Tumor of the apex of the lung
Pancoast tumor (superior sulcus tumor)
(+) horner syndrome
Volume of pericardial fluid
50ml (snell)
Functional closure of Ductus arteriosus
Immediately —— 100% closure at 96hrs (moore)
Anatomic closure of ductus arteriosus
1 to 3 months
Pharmacologic closure of ductus arteriosus
Indomethacin of Ibuprofen
Murmur of Patent ductus arteriosus
Machinery-like
Functional closure of Foramen Ovale
Immediately!
Anatomic closure of Foramen Ovale
1 year
Auscultation areas
Mitral (bicuspid) valve - L 5th ICS
Tricuspid valve - 4th ICS to L of sternum
Pulmonary valve - 2nd ICS to L of sternum
Aortic valve - 2nd ICS to the R of sternum
Continuous machinery like murmur
PDA
Opening snap
MS
Midsystolic click
MVP
Pistol-shot murmur
Austin Flint murmur
AR
Tachycardia + Hypertension in anterior wall MI
What reflex?
James reflex
Bradycardia + Hypotension in inferior wall or posterior wall MI
What reflex?
Jarisch Bezold Reflex
_____ supplies the anterior wall of the heart
Left anterior descending (LAD)
____ supplies the inferior wall, posterior wall, right ventricle and SA node
Right coronary artery
Smallest cardiac vein
Thebesian vein
—abundant in Right Atrium
Pacemaker of the heart
SA node
Fastest conduction of the heart
Purkinje fibers
Slowest velocity in heart conduction system
AV node
AV node is located within what triangle?
Triangle of Koch
-septal leaflet of tricuspid valve
-opening of coronary sinus
-tendon of TODARO (in RA)
Inguinal canal boundaries
Clue: M-A-L-T
Roof- 2M (muscle) - Internal Oblique & Transversus Abdominis
Ant Wall - 2A (aponeurosis) - External and Internal Oblique Aponeurosis
Floor - 2L (ligaments) - Inguinal & Lacunar
Post Wall - 2T - Transversalis fascia & Conjoint Tendon
Bag of worms
Varicocele
MC on the left side
Torsion due to poor gubernacular fixation
Bell clapper deformity
Processus vaginalis in females
Canal of Nuck
Boundaries of Hesselbach/Inguinal triangle
Inferior Epigastric Vessels
Rectus abdominis muscle
Inguinal ligament
MC type of hernia
Indirect hernia
MC type of hernia in females
Indirect hernia
Co-existing direct and indirect hernia
Pantaloon hernia
When the appendix is trapped within an inguinal hernia
Amyand hernia
The only natural communication between the greater peritoneal cavity and the lesser sac
Epiploic foramen of Winslow
Compression of the hepatoduodenal ligament
Pringle maneuver
Most dependent portion of the abdominal cavity in the SUPINE position
Morrison pouch aka hepatorenal recess
Most dependent area in the UPRIGHT position
Cul-de-sac of Douglas aka Rectouterine pouch
Most common esophageal diverticulim
Zenker diverticulum
Normal resting pressure in upper esophageal sphincter (anatomic sphincter)
50-70 mmHg
Lower esophageal sphincter (functional sphincetr) pressure
10-20mmHg
Gold standard in diagnosis of GERD
24hr pH monitoring
Most effective surgical treatment for GERD
Nissen Fundoplication
Bird’s beak
Achalasia
Achalasia triad
Hypertensive LES
Aperistalsis of Esophageal body
Failure of LES to relax
Treatment of achalasia
Heller’s myotomy +/- partial fundoplication
Cork screw esophagus
Diffuse esophageal spasm
Most common site of zenker diverticulum
Killian’s triangle
Most common site of esophageal perforations
Killian’s triangle
Failure of LES to relax due to abnormality of the auerbach plexus
Achalasia
Most common benign tumor of the esophagus
Leiomyomas
Columnar metaplasia of esophageal squamous epithelium
Barrett’s esophagus
Hallmark of intestinal metaplasia
Intestinal goblet cell
Linear lacerations of esophagus due to strong retching
Mallory weis tear
Spontaneous pressure rupture of esophagus in the left pleural cavity or just above the gastoesophageal junction with pain as the most striking and consistent symptom
Boerhaave’s syndrome
A bulge of posterior pharyngeal wall that meets the soft palate
Passavant’s ridge
A ring of tissue that forms inside the esophagus, the tube that carries food and liquid to stomachs
Schatzki’s ring
Squamous cell CA
Esophageal webs
Atrophic glossitis
Iron deficiency anemia
Plummer vinson syndrome aka Patterson-Brown-Kelly syndrome
Esophageal carcinoma treatment where they avoid thoracotomy and results to less morbidity
Orringer’s procedure aka TransHiatal Esophagectomy
The more invasive is Ivor Lewis procedure or transthoracic esophagectomy
Projectile, non-billous vomiting
Palpable olive in epigastrium
Dx?
Hypertrophic pyloric stenosis
Surgery for pyloric stenosis
Ramstedt pyloromyotomy
Persistence of the vitelline duct, which is also a true diverticulum
Meckel diverticulum
Rule of 2s in Meckel diverticulum
2% of population
2 year old
2 inches long
2 feet from ileocecal valve
2 types of heterotropic tissue (gastric &/ pancreatic)
Most common congenital anomaly of GI tract
Meckel diverticulum
Hernia containing the meckel’s diverticula
Littre hernia
Strangulation and necrosis can occur in the absence of intestinal obstruction
Hernia contains antimesenteric border of bowel
Richter hernia
Hernia contains 2 adjacent loops of small intestine
Maydl’s hernia
Hernia contains the appendix
Amyand’s hernia
Superior lumbar triangle hernia
Grynfeltt-Lessahft hernia
Inferior lumbar triangle hernia
Petit hernia
Coffee / kidney bean sign
Sigmoid volvulus
Target / donut sign
Intussusception
Double bubble sign
Duodenal atresia
Most common cause of intestinal obstruction during pregnancy
Volvulus
Currant jelly stool
Intussusception
Sigmoidoscopy length reaching the rectal ampulla
1.5 inches
Sigmoidoscopy length reaching the sigmoid colon
6.5inches
Direct, short connection between IMA and SMA at the base of the mesentery
Arc of Riolan aka
Meandering mesenteric artery
Connection of the IMA and SMA found along the mesenteric border
Marginal artery of Drummond
MC site of volvulus
Sigmoid colon
Most common site of diverticulosis
Sigmoid colon
Anatomic division of liver
Falciform ligament
Physiologic division of the liver
Divides the liver using a plane from the gallbladder to the IVC
Cantlie line
Ventral pancreatic duct abnormally encircles the 2nd part of the duodenum
Annular pancreas
2nd MC congenital pancreatic anomaly
Most common congenital pancreatic anomaly
Failure of fussion of the ventral and dorsal ducts
Pancreas divisum
Associated with pancreatitis
Grey turner sign
Flank discolration
Severe acute pancreattits
Umbilical discoloration
Cullen sign
Triad:
Gastrin over secretion
Pancreatic or duodenal ulcers
Peptic ulcer
Zollinger-Ellison syndrome
Gastrinoma (Passaro) triangle boundaries
Junction of cystic and CBD
Junction of 2nd and 3rd part duodenum
Junction of neck and body of pancreas
Pancreaticoduodenectomy
Procedure to remove the entire tumor in the head or neck of the pancreas
Whipple procedure
Anastomoses in whipple procedure
PancreaticoJejunostomy
HepaticoJejunostomy
GastroJejunostomy
Weight loss
Hyperpigmentation
Infection with Tropheryma whippeli
Positive PAS granules in macrophage
Poly arthritis
Lymphadenopathy
Steatorrhea
Whipple disease
Whipple triad
Low blood glucose
Symptoms of hypoglycemia
Relief of symptoms after glucose intake
Most common cause of endogenous hyperinsulinemia
Insulinoma
—hyper production of insulin
Spleen sizesssss
Size - 1 x 3 x 5”
7 oz
Between ribs 9 and 11
“Spleen is a very ODD organ”
Most common inherited hemolytic anemia
Hereditary spherocytosis
Mutation in spectrin
Diagnosis by Osmotic Fragility Test
Treatment is Splenectomy
Hereditary spherocytosis
Organisms responsible for Overwhelming Post-Splenectomy Infection (OPSI)
S. Pneumonia (80%)
Meningococcus
H. Influenza type B (HiB)
Encapsules adrenal gland and kidney
Gerota’s fascia
A rare vein compression disorder where the abdomina aorta and SMA compresses the Left Renal vein
Nutcracker syndrome
Most common fusion anomaly of the kidney
Horseshoe kidney
Becomes entrapped behind the IMA
Dilatation of the pampiniform plexus of the spermatic cord results to….
Varicocele
Palpitation
Headache
Excessive sweating
Pheochromocytoma
Pheochromocytoma rule of 10
10% extra- adrenal
10% malignant
10% bilateral
10% in children
10% familial
10% recurr
10% discovered incidentally
How to diagnose pheochromocytoma?
Tx?
Diagnosis: Vanillymandelic Acid (VMA)
Tx: PHEnoxybenzamine pre-op
Most common extra adrenal site of pheochromocytoma
Organ of Zuckerkandl
— derived from neural crest cells
Blood supply of ureters
Upper - Renal A.
Middle - Gonadal A.
Lower - Superior Vesical A.
Constrictions of ureter
Ureteropelvic junction
External iliac A. &/ pelvic brim
Bladder wall
Compression of the 3rd part of duodenum by the Superior Mesenteric Artery
Superior Mesenteric Artery Syndrome
Most common site of aneurysm
Abdominal aortic aneurysm (AAA)
Most important risk factor of Abdominal Aortic Aneurysm
Atherosclerosis
Hepatic portal system
Portal vein = SMV + Splenic vein
—— behind the neck of the pancreas
—- drain the lower 1/3 of esophagus to upper 1/2 of anal canal
Tributaries of Splenic Vein (“SLIP”)
Short gastric V.
Left gastroepiploic V.
IMV
Pancreatic V.
What are the primary (fetal) curvatures of the vertebral column?
Thoracic
Sacral
What are the secondary curvatures of vertebral column?
Cervical (from head lifting)
Lumbar (from acts like walking)
Parts of vertebral column
Cervical
Thoracic
Lumbar
Sacral
Coccyx
Exagerated POSTERIOR curvature
Affects THORACIC vertebrae
Kyphosis
Exagerated ANTERIOR curvature
Affects LUMBAR vertebrae
Lordosis
Lateral deviation of the spine
Scoliosis
Dextroscoliosis – Right
Levoscoliosis – Left
Vertebral canal contents
Spinal cord
Dorsal and ventral nerve roots
Meninges
Spinal nerve (located OUTside the vertebral canal and exit thru intervertebral foramen)
Joint found between C1 and occipital condyles
“YES Joint”
Atlanto Occipital
(Oo joint)
Joint found between C1 and C2
“No Joint”
Atlanto Axial joint
Ligaments of vertebral column that contributed to its stability
Anterior and posterior longitudinal lig.
Ligamentum flavum
Interspinous lig.
Congenital defect of the spine in which part of the spinal cord and its meninges are exposed through a gap in the backbone
Absent vertebral arch, covered by skin & tuft of hair
Spina bifida occulta
Most common spondyloarthropathy
Inflammatory osteoarthritis
“BAMBOO SPINE” - ossification of annulus fibrosus leading to severe spine immobility
(+) HLA-B27
(+) sacroilitis
Ankylosing spondylitis
Fish mouth vertebrae
Sickle cell anemia
Central depressions of vertebral body
Bacterial infection within vertebral bodies
Osteomyelitis
Most common cause of osteomyelitis in immunosuppressed and IV drug users
S. Aureus & P. Aeruginosa
Most common cause of osteomyelitin in patients with sickle cell anemia
Salmonella typhi
Intervertebral disk consists of:
Annulus fibrosus —- fibrocartilage
Nucleus pulposus —- remnant of notochord
Spinal cord ends in what level in adults?
L1*** - L2
Spinal cord ends in what level in newborn?
L3
Largest radicular artery
Sensitive to injury, very close to aorta
Artery of Adamkiewics (Great Anterior Segmental Medullary)
Fracture due to hyperflexion of the thoracic or lumbar region
Seat belt injury (lap seatbelt)
Chance fracture
Damage or ligation of the great radicular artery of Adamkiewicz will result to?
Anterior Spinal Artery Syndrome
(Paraplegia, impotence, incontinence, loss of pain and temperature, with intact vibration and proprioception)
How many spinal NERVES are present?
31 pairs
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
Largest knee bursa
Always communicate with the knee joint
SupraPatellar Bursa
Housemaid’s / Prostitute’s knee
PrePatellar Bursa
Clergyman’s / Vicar’s knee
InfraPatellar Bursa
The Lateral Collateral Ligament of the knee is separated from the lateral meniscus by the ??
Popliteus muscle
Most common hemarthrosis
Rupture of ACL
Unhappy triad of O’ Donoghue
MCL
ACL
Medial meniscus tear
Maneuver for ACL tear
Lachman sign (Noulis test)
- stabilizing the femur while the tibia is pulled forward
This may be a continuation of (Medial head) gastrocnemius or SEMIMEMBRANOSUS bursa, communicating with the synovial cavity of the knee joint
Aka Popliteal cyst
Baker’s cyst
Lack of development of acetabulum and femur
Developmental Dysplasia of the Hip
aka Congenital Dislocation of the hip
Maneuver for developmental dysplasia of the hip where the examiner ADDUCTS the hip while applying a POSTERIOR force on the knee to promote DISLOCATION
Barlow maneuver
Maneuver for developmental dysplasia of the hip where the examiner ABDUCTS the hip while applying ANTERIOR force on the femur to REDUCE the joint
Ortolani maneuver
Avascular necrosis of a child’s femoral head due to disruption of blood supply (medial circumfle and obturator artery) to the head of femur
Legg-Calve-Perthes disease
Structures preventing patellar dislocation
Lower horizontal fibers of vastus medialis
Larger size of lateral femoral condyle
Calcaneal bone fracture
Lover’s fracture / Don Juan fracture / Casanova fracture
Most common fractured tarsal bone
Calcaneal fracture
Most common site of tibial fracture
Between middle and inferior thirds
A condition that causes pain and swelling. Below the knee joint, where the patellar tendon attaches to the top of shinbone (tibia) / tibial tuberosity
“Knobby knees”
disease affects the bottom (the distal end) of the tendon
Osgood Schlatter disease
An injury to the top of the tendon (the proximal end).
Fragmentation of the inferior patellar pole
Sinding-Larsen-Johansson Syndrome
Fracture of the distal third of one of the 2nd, 3rd, and 4th metatarsals occurring because of recurrent stress
Metatarsal fracture
March fracture
Fracture of the proximal 5th metatarsal bone
Jones fracture/ Dancer’s fracture
Most common site of compartment syndrome of the leg
Anterior compartment
Early sign of compartment syndrome of the leg
Paresthesia between the 1st and 2nd toes
“Freshman’s muscle”
Often missing
Plantaris muscle
Muscle that unlocks the knee joint
Popliteus muscle
What are the 3 Lateral Collateral Ligament of the ankle
Anterior Talofibular lig.
CalcaneoFibular lig.
Posterior Talofibular lig.
Most common Lateral Collateral Ligament involved in ankle sprain
Anterior Talofibular lig.
Midway between ASIS and pubic symphysis
What artery can you palpate?
Femoral artery
Continuation of Femoral artery and will eventually divide into anterior and posterior Tibial artery
Goes out of the opening of adductor magnus then to the lower border of popliteus muscle
Popliteal artery
Dorsal pedal pulse found between extensor hallucis longus & extensor digitorum tendons
Dorsalis Pedis Artery
Deep tendon reflexes: S1-S2
Achilles tendon reflex
Deep tendon reflexes: L3-L4
Patellar Tendon reflex
Knee jerk reflex could be blocked by?
Femoral nerve damage
Segment L2, L3 to L4 spinal cord damage
Extension of the lower leg
(+) Trendelenburg sign
Superior gluteal nerve injury
disorder characterized by tingling, numbness, and burning pain in the outer side of the thigh
The disorder occurs when the LATERAL FEMORAL CUTANEOUS NERVE is compressed or squeezed by inguinal ligament as it exits the pelvis
Meralgia paresthetica
most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve
Affects S1, S2, S3, L4 and L5
(-) sensort below the knee EXCEPT the area supplied by SAPHENOUS nerve
Sciatic nerve injury
Most common mononeuropathy of the LE
Common peroneal (fibular) nerve injury
front of the foot might drag on the ground when walking
Steppage gait
foot to slap down onto the floor with each step. In some cases, the skin on the top of the foot and toes feels numb.
Foot drop
Common peroneal (fibular) nerve injury L5
Ski boot syndrome
DEEP Peroneal (fibular) nerve injury
Superficial peroneal (fibular) nerve injury
Rare
(-) motor lateral compartment
All the muscles in the posterior leg and the sole of the foot are paralyzed.
Tibial nerve injury
pain, burning or tingling in the bottom of your feet and toes
Tarsal tunnel syndrome
Abnormal abduction ofhipduring ambulation resulting in a circumduction, wide-basedgait
Wasting of medial thigh
Obturator nerve injury
Hx of
Anterior dislocation of hip
Obturator hernia
Parturition
Most common cause of sciatic nerve injury (snell)
Intragluteal injection
–UPPER OUTER quadrant of buttocks injection site of choice
(+) Babinski sign indicates
Upper motor neuron lesion
Present until a child is 4y.o.
Transmit weight of the body from vertebral column to pelvis
Sacroiliac joint
Strongest sacroiliac joint
Interosseous
What is the STRONGEST ligament in the body
IlioFemoral Ligament or Ligament of Bigelow
It limits the extension of hip joint
Shape and insertion of Ileofemoral ligament of bigelow
Inverted Y or V
Base: Anteroinferior Iliac spine
Limbs: Upper and Lower part of Intertrochanteric line of femur
Ligaments relaxed during pregnancy
Sacrococcygeal joint
Maintains anorectal flexure - “sling”
Puborectalis muscle
Smallest diameter of pelvic outlet
Intertuberous diameter
Landmark for introducing catheter into ureter
Interureteric fold
Most common type of bladder cancer
Transitional Cell CA
Painless hematuria
Smoker
Aniline dyes
Transitional Cell Carcinoma
What passes through the Greater Sciatic Foramen?
Piriformis muscle
What passes through the Lesser Sciatic Foramen?
Pudendal nerve
Internal Pudendal vein
In piriformis syndrome, what nerves are affected causing buttocks pain after bicycling or rowing?
Sciatic nerve and pudendal nerve
How to diagnose piriformis syndrome?
FAIR test (Flexion - Adduction - Internal Rotation) produces pain
Gluteal muscles
“Gods Greatest Gift To People iS Outstanding IQ”
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia latae
Piriformis
Superior gemellus
Obturator internus
Inferior gamellus
Quadratus femoris
Gluteal muscle EXTENSOR and Lateral Rotator
Gluteus MAXimus
Gluteal muscles ABDUCTORS and MEDIAL rotators
Gluteus MEDIUS
Gluteus MINIMUS
Tensor Fascia LATA
All other are lateral rotators
Gluteal muscles innervated by SUPERIOR GLUTEAL nerve
Gluteus medius
Gluteus minimus
Tensor fascia lata
Gluteal muscle innervated by INFERIOR GLUTEAL nerve
Gluteus MAXIMUS
Only gluteal muscle innervated by OBTURATOR Nerve
OBTURATOR EXTERNUS
The femur is pushed out of the socket in a backward direction. This leaves the lower leg in a fixed position, with the knee and foot rotated in toward the middle of the body
Posterior hip dislocation
After a motor vehicular accident, a patient was found lying on the ground with the hip minimally flexed, leg externally rotated and markedly abducted
Anterior hip dislocation
Hamstring muscles
SemiTendinosus
SemiMembranosus
Biceps Femoris
Joins the ductus deferens to form the ejaculatory duct
Produces seminal fluid (prostaglandin, ascorbic acid, fructose and amino acids)
Seminal vesicle
Sperm duct - 18 inches long
Vas deferens / ductus deferens
Vas deferens + seminal vesicle
Ejaculatory duct
Blood supply of prostate gland
INFerior VEsical artery
Middle REctal artery
Homologue of uterus and proximal vagina
Prostatic utricle
Semen contained in…?
Seminal vesicle - 60%
Prostate gland - 30%
Vas deferens - 10%
Small amount from bulbourethral gland
Semen pH and lifespan and temp and volume?
pH 7.5
Lifespan 1 to 2 days
2 C° below internal temp
3.5mL (120mil sperm/mL) — normal fertility = >20 mil sperm/mL
Median lobe of the prostate gland enlarges, resulting in obstruction of the internal urethral orifice
Benign Prostatic Hyperplasia
Most common site of prostate cancer
Peripheral or posterior zone
Corresponds to the prostate in males
Paraurethral glands
Skene gland / Lesser vestibular gland
Longest segment of fallopian tube
Ampulla
Most common site of fertilization
Ampulla of fallopian tube
Narrowest part of the fallopian tube
Isthmus
Most important ligament supporting uterus and vagina
Cardinal ligament of Mackenrodt / Transverse Cervical Ligament
Dark bluish or purplish-red vagina and cervix
Increased vascularity
8weeks
Chadwick/ jacquimier sign
Softening of the isthmus
6 to 8 weeks
Hagar sign
Softening of cervix
6 weeks
Goodell sign
Branches of Posterior division of Internal ILiac artery
“SILL”
Superior Gluteal a
ILiolumbar a
Lateral Sacral a
What are the contents of Pudendal (Alcock) canal?
Pudendal nerve
Internal Pudendal Vessels
Partial failure of fusion of mullerian ducts
2 uterine horns (1 uterus)
1 or 2 cervix
Bicornuate uterus
Complete failure of fusion of mullerian ducts
2 uterus
2 cervices
Uterine didephysis
Mayer-Rokitansky-Kuster-Hauser syndrome
(-) uterus
(-) cervix
Mullerian duct agenesis
MC cause is Congenital adrenal hyperplasia
46XX
Musculinization of female genitalia
Female pseudohermaphroditism
46XY
Stunted develpoment of male exteranal genetalia
MC cause is 5-a reductase deficiency which lowers DHT
Male pseudohermaphrodism
MC cause is mutation in the androgen receptor (male pseudohermaphrodism)
46XY
Normal appearing females
Testis may be in labia major
Complete androgen insensitivity syndrome
Disruption of auriculotemporal nerve during parotid surgery and subsequent cross-reinnervation with branches of sympathetic supply to the skin results in
Frey’s syndrome (post-op gustatory sweating)
Hx shoveling snow
Acute onset of severe low back pain
Bilateral weakness of feet on dorsiflexion
Loss of sensation on inner thigh and perineal region
Distended bladder
Dx?
Cauda equina syndrome
Infant
Subdural hematoma
Retinal hemorrhages
Shaken baby syndrome
Reflex affected by L5-S1 herniated disc
The ankle jerk
Level can a patient with normal reflexes, diminish grip strength, and numbness over the 4th and 5th digits be expected to have a herniated disc
C7 - T1
MC cause of chance fracture
High lap belt worn during MVA
