Anatomy High Yields Flashcards
Level at which Aorta Crosses Diaphragm
T12
Level at which Aorta Bifurcates into the Iliacs
L4
Blood Supply to Lowe Extremities
Aorta –> common iliac –> external iliac –> common femoral –> profunda femoris (to thigh), superficial femoral –> popliteal –> anterior tibial (perforates superior interosseous membrane to dosalis pedis artery on dorsum of foot), tibiofibular trunk –> posterior tibial (posterior compartment), fibula (lateral compartment) –> lateral and medial plantar arteries
Femoral Triangle
Superior: inguinal ligament
Lateral: sartorius
Medial: adductor longus
Lateral –> Medial: NAVEL (lacunar ligament)
Upper Trunk of Brachial Plexus Injury
Medially rotated because axillary nerve is needed for shoulder flexion and abduction and lateral rotation (teres minor); Forearm extended and pronated because musculocutaneous nerve supplies forarm flexors and supinator (bicepts and brachialis)
Lowe Trunk of Brachial Plexus Injury
Usu when arm is overhead
Loss of sensation and impaired flexion in digits 4 & 5, impaired wrist flexion, hyperextension of MCP, inability to abduct and adduct digits 2 to 5
Posterior Cord of Brachial Plexus Injury
Inability to extend elbow and wrist due to radial nerve injury
Associated with crutches
Carpal Tunnel Syndrome
Medial nerve injury; lateral palm, lateral 3/5 digits, intrinsic thumb muscles (thenar wasting)
Humeral Surgical Neck Fracture
Axillary nerve
Anterior/posterior circumflex humeral artery, axillary branches
Humeral Midshaft Fracture
Radial nerve
Profunda brachii artery (branch of brachial)/Deep brachial artery
Humeral Supracondylar Fracture
Median nerve
Brachial artery
Musculocutaneous Nerve Muscles
Flexor of elbow
Axillary Nerve Muscles
Deltoid, teres minor, long head of tricepts brachi
Radial Nerve Muscles
Extensors of arm/forearm
Ulnar Nerve Muscles
Medial head of flexor digitorum profundus, flexor carpi ulnaris, medial lumbricals, interossei, hypothenar muscles
Median Nerve Muscles
Some of the anterior forearm muscles, lateral lumbricals, thenar muscles
Keeping PDA Opened
Use Alprostadil (PGE1)
Spinal Tap
L4-L5
Skin –> subcutaneous tissue –> spinal ligaments (supraspinous, interspinous, ligamentum flavum) –> epidural space –> dura mater –> arachnoid mater –> subarachnoid space (CSF)
Testicular Cancer Mets
Preaortic/Para-aortic lymph nodes
Scrotal Cancer Mets
Superficial inguinal lymph nodes
Drugs for Erections
Sildenafil, Vardenafil, Taldalafil inhibit phosphodiesterase 5, which breaks down cGMP and does not enable smooth muscle relaxation necessary or erection
Indirect Inguinal Hernia
Lateral to epigastric vessels through deep inguinal ring into inguinal canal; Covered by all of the same layers that cover the spermatic cord; Bulge that appears when lifting heavy objects, but disappears when lying down
Congenital
Direct Inguinal Hernia
Medial to epigastric vessels, bypasses deep inguinal ring into inguinal canal; may tear through the internal spermatic and creamasteric fasciae that cover the spermatic cord; May pass through the superficial inguinal ring but not through deep inguinal ring
Inguinal Canal
Anterior wall: external oblique aponeurosis
Posterior wall: transversalis fascia
Roof: internal oblique/transversus abdominus muscles
Floor: inguinal ligament
Sperm Path
Seminiferous tubules –> epididymis –> vas deferens –> ejaculatory duct –> urethra –> urethral meatus
Porto-Caval Anastamoses
Superior rectal (p) –> inferior/middle rectal (c)
Paraumbilical (p) –> supeficial epigastric (c)
Colic (p) –> retroperitoneal veins of Retzius (c)
Splenic (p) –> L. renal (c)
L. gastric (p) –> Esophageal (c) –> Azygous (c)
Common Fibular/Peroneal Nerve Injury
Due to fibular neck fracture
Leads to foot drop and inversion due to injury to deep fibular and superficial fibular
Sensation to dorsum of foot lost and in webbed space between first and second toe
Deep Fibular Nerve
Anterior compartment: tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius
Responsible for dorsiflexion
Sensation in webbed space between first and second toe
Superficial Fibular Nerve
Lateral compartment: fibularis longus and brevis
Responsible for eversion of foot
Sensation to the dorsum of the foot
Tibial Nerve
From Sciatic
Posterior compartment: popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
Responsible for plantar flexion
Trendelenburg Sign
Superior gluteal nerve injury/gluteus medius injury on side opposite hip sag; Could be due to injection in superomedial quadrant of left buttock
Superior glueteal nerve innervates gluteus minimus/medius
Recurrent Laryngeal Nerve
Inferior laryngeal nerve –> all intrinsic laryngeal muscles except cricothyroid, which is innervated by external laryngeal nerve, which is a branch of superior laryngeal off of vagus
Posterior Cricoarytenoid
Only muscle that abducts vocal folds
Right Ventricular Enlargement
Parasternal shift/heave
Left Atrial Enlargement
Dysphagia, compression of recurrent laryngeal
First Pharyngeal Pouch
Auditory tube and middle ear
Second Pharyngeal Pouch
Palatine tonsil
Third Pharyngeal Pouch
Interior parathyroids and thymus
Fourth Pharyngeal Pouch
Superior parathyroids and ultimobrachial body (forms thyroid parafollicular C cells)
First Pharyngeal Arch
Malleus, incus, mandible, maxilla, zygomatic and squamous portion of the temporal bones, muscles of mastication, anterior bely of digastric, mylohyoid, tensor tympani and tensor veli palatini; innervated by CN V2 and V3
Second Pharyngeal Arch
Stapes, styloid, most of hyoid bone, muscles of facial expression, stapedius, stylohyoid and posterior belly of digastric muscle; innervated by CN VII
Third Pharyngeal Arch
Greater cornu of hyoid bone, stylopharyngeus muscle; innervated by CN IX
Fourth and Sixth Pharyngeal Arches
Laryngeal and upper tracheal cartilage, muscles of soft palate, pharynx and larynx, striated muscle of esophagus; innervated by CN X
First Cleft
External acoustic meatus
Fibular Neck Fracture
Peroneal nerve injury (courses laterally around the neck of the fibula)
Supracondular fracture of the femur or posterior dislocation of the knee would also have same result
Tibial Nerve Injury
Loss of plantar flexion, weakness of inversion and lost sensation to sole of foot
Courses through the middle of popliteal fossa
Avascular Necrosis
Due to impaired blood supply to segment of bone; Femoral head is common location
Strongly associated with: Sickle cell disease (thrombotic occlusion of arteries); SLE (injury to vessel wall causing impaired blood supply); High dose steroid therapy; Alcoholism
Presents with groin pain that is exacerbated by weight bearing; Painful and restricted passive and active movement of affected joint; no swelling, erythema or temp change; Use MRI for diagnosis
Posterior Arm and Forearm Sensory Innervation
Radial
Lateral Forearm Sensory Innervation
Musculocuteaneous
Medial Forearm Sensory Innervation
Ulnar (medial cutaneous nerve)
Thenar Eminence Innervation
Median (recurrent branch)
Osteoperosis
Trabecular thinning
Vitamin D Deficiency
Increased deposition of unminieralized osteoid
Hyperparathyroidism
Increased osteoclastic activity -> increased bone resorption of cortical bones –> subperiosteal thinning
Osteopetrosis
Spongiosa filling medullary canal with no mature trabeculae
Rheumatoid Arthritis
Morning stiffness for at least 30 minutes
MCP, PIP, NOT DIP
Adductor Hiatus
Hole in tendon that superficial femoral artery passes through and becomes popliteal artery
Celiac Artery
Comes off aorta at T12;
Supplies foregut structures: pharynx, esophagus, stomach and duodenum up to entrance of bile duct; Spleen is not a foregut structure, but is supplied by celiac artery;
Divides into splenic artery, common hepatic artery, left gastric artery
Splenic Artery
Branch of celiac; supplies the spleen; neck, body and tail of pancreas; l side of greater curvature of stomach, fundus of stomach
L. Gastric Artery
Branch of celiac; supplies most of the lesser curvature of stomach and abdominal part of esophagus
Common Hepatic Artery
Branch of celiac; divides into proper hepatic (lesser curvature of stomach, liver-L &R hepatic artery-, gallbladder - cystic artery) and gastroduodenal (foregut part of duodenum, superior part of head of pancreas, right side of greater curvature of stomach)
Diverticulum (false)
most common in sigmoid colon
Penetrating Ulcer of Posterior Stomach Wall
splenic artery
Penetrating Ulcer of Lesser Curvature of Stomach
L. gastric artery
Penetrating Ulcer of Posterior Wall of the First part of Duodenum (bulb)
gastroduodenal artery
Superior Mesenteric Artery
Arises off aorta at L1; Supplies midgut structure - distal 3/4th of duodenum inferior to the entrance of the bile duct; jejunum; ileum; cecum; appendix; ascending colon; proximal 2/3 of transverse colon
Inferior Mesenteric Artery
Arises off aorta at L3; Supplies hindgut structures - distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, canal to the pectinate line
Branches: left colic, superior rectal, middle rectal
Adrenal Veins
R adrenal vein drains directly into the IVC; L adrenal vein drains into the L renal vein
Renal Arteries
Arise form aorta at L2
Gonadal Arteries
Arise from aorta between L2 and L3 - between the origins of the renal arteries and inferior mesenteric
L. Renal Vein
Blood from left gonadal and left adrenal drain into the left renal, which drains into the IVC (on the R the adrenal, gonadal and renal all drain into the IVC); Crosses the anterior aspect of the aorta just inferior to the origin of the superior mesenteric artery; May be compressed by aneurysm of SMA - presents with adrenal and renal HTN and a varicocele in males
Internal Hemorrhoids
painless protrusions of the anal canal covered by mucosa; contain dilated veins of internal rectal venous plexus
External Hemorrhoids
Painful enlargements covered by skin that contain dilated veins of the external rectal venous plexus
BPH
commonly occurs in periurethral zone of prostate –> obstruction of urethra; adenocarcinomas usu develop in the peripheral part and metastasizes to pelvis, vertebrae or ribs
Ectopic Implantation
Most commonly occurs in the ampulla of the uterine tube; PID is most common cause
Pudendal nerve block
for labor pain; palpate ischial spine through lateral wall of vagina
Fractures of the clavicles
Medial two-thirds is elevated by sternocleidomastoid and lateral third is depressed by weight of lim or adducted by pectoralis major;
C8 and T1 in the medial cord of the brachial plexus may be lacerates as a result of the fracture
Flexion of the Humerus
Pectoralis minor, clavicular head - lateral pectoral nerve
Deltoid, clavicular part - axillary nerve
Bicepts, short head - Musculocutaneous n.
Coracobrachialis - Musculocutaneous n.
Extension of the Humerus
Deltoid - axillary n.
Latissimus dorsi- thoracodorsal n.
Teres major - lower subscapular n.
Abduction of the Humerus
Deltoid - axillary n.
Supraspinatus - suprascapular n.
Adduction of the Humerus
Pectoralis major, sternocostal part - meal and lateral pectoral n.
Lats - thoracodorsal n.
Teres major - Lowe subscapular
Flexion of Hand
Flexor carpi ulnaris - ulnar n.
Flexor carpi radialis - median n.
Extension of Hand
Extensor carpi ulnaris - radial (deep branch) n.
Extensor carpi radialis longus - radial n.
Extensor carpi radialis brevis - radial (deep branch) n.
Radial Deviation of Hand
Extensor carpi radialis longus/brevis - radial n.
Flexor carpi radialis - median n.
Lunate Dislocation
Common dislocates anterior into the carpal tunnel –> carpal tunnel sydrome
Scaphoid Fracture
Pain and tenderness in snuff box; Proximal part my undergo avascular necrosis because blood supply to bone supplies distal part first before proximal
Flexion at MP Joints
Lumbricals (Index and Middle) - median n.
Lumbricals (ring and little) - ulnar n.
Interossei - ulnar (deep branch) n.
Flexor digiti minimi - ulnar n.
Flexion at PIP Joints
Flexor digitorum superficialis - median n.
Lumbricals - median and ulnar n.
Flexion at DIP Joints
Flexor digitorum profundus - index and middle (median); ring and little (ulnar)
Extension at MP Joints
Extensor digitorum - radial n.
Extensor indicis- radial n.
Extensor digiti minimi - radial n.
Abduction of Fingers
Dorsal interossei - ulnar n.
Abductor digiti minimi - ulnar n.
DAB
Adduction of Fingers
Palmar interossei - ulnar n.
PAD
Thumb Flexion
Flexor pollicis longus - median n.
Flexor pollicis brevis - median n.
Thumb Extension
Extensor pollicis longus/brevis - radial n.
Thumb Abduction
Abductor pollicis brevis longus - radial n.
Abductor pollicis brevis - median n.
Thumb Opposition
Opponens pollicis - median n.
Thumb Adduction
Adductor pollicis - ulnar n.
Axillary Nerve Injury (C5,C6)
Causes: Lesioned by fracture of surgical neck; dislocation of humerus; intramuscular injections
Cutaneous sensation: altered over deltoid insertion
Weakness: abduction at shoulder
Inferior Trunk of Brachial Plexus Injury
Klumpke’s Paralysis
Compressed by cervical rib or by pancoast tumor of lung; Can also injure by reaching above head in attempt to catch self on tree branch when falling
Difficulty making fist - combination of ape and claw hands
Arm bent at elbow and shoulder elevated
Radial Nerve Injury (C5,C6,C7,C8)
Causes: In spiral groove- lesioned by mid-shaft fracture of humerus; Compressed in axilla by incorrect use of crutches; Stretched by subluxation of radial head; Dislocated humeral head
Cutaneous Sensation: Over fist dorsal interosseous, anatomic snuffbox
Weakness: extension at wrist; extension of all fingers at MCP; supination; thumb extension and abduction
Sign: wrist drop
Ulnar Nerve Injury (C8,T1): Distal Lesion
Causes: Lesioned by trauma to heel of hand or fracture of hook of hamate
Weakness: abduction and adduction of fingers; adduction of thumb; extension of fingers
Sign: claw hand
Median Nerve Injury (C6-T1): Distal Lesion
Causes: Compressed in carpal tunnel syndrome and by dislocated lunate; Recurrent branch lesioned by superficial laceration on lateral side of palm (by thumb)
Cutaneous: Lateral 3.5 digits
Weakness: opposition of thumb
Sign: Ape hand
C5 Lesion
Cause: upper trunk compression (Erb Duchenne syndrome); Herniation of disk between C4-C5
Dermatome: posterior shoulder, upper lateral arm
Muscles: Deltoid, rotator cuff, biceps, brachioradialis,
Reflex: biceps tendon
T1 Lesion
Cause: lower trunk compression by cervical rib or pancoast tumor (Klumpke’s paralysis)
Dermatome: medial arm and medial forearm to wrist
Muscles: intrinsic muscles of hand
Median Nerve Injury: Proximal Lesion
Cause: fracture of supracondylar humerus; compression between head of pronator teres
Cutaneous: lateral 3.5 digits, thenar eminence
Weakness: opposition of thumb; flexion at wrist; flexion of lateral fingers; flexion of thumb; pronation
Sign: ulnar deviation of wrist; hand of benediction
Ulnar Nerve Injury: Proximal Lesion
Causes: fracture/trauma at medial epicondyle of humerus; fracture of clavicle
Cutaneous: medial 1.5 digits; hypothenar eminence
Weakness: abduction and adduction of fingers, adduction of thumb, extension of fingers, flexion of medial fingers, flexion at wrist
Sign: Radial deviation of wrist
Musculocutaneous Injury (C5-C7)
Causes: upper trunk compression
Cutaneous: lateral forearm
Weakness: flexion at elbow, supination
Superior Trunk of Brachial Plexus Injury
Erb-Duchenne Syndrome
Waiter’s tip position - loss of abduction and weakness of flexion and lateral rotation and glenohumeral joint; Arm is adducted, extended and medially rotated
Long Thoracic Nerve Lesion
Courses superficial to serratus anterior;
“Winged scapula” and difficulty raising arm above head
Could be caused by masectomy
Fracture of Neck of Femur
Thigh laterally rotated by short lateral rotators of the thigh at the hip and by gluteus maximus
Can lead to avascular necrosis because disruption of medial circumflex femoral artery - main source of arterial blood to the head and neck of femur
Flexion of Femur
Iliacus and psoas major - lumbar ventral rami n
Rectus femoris - femoral n.
Sartorius - femoral n.
Tensor fasciae latae - superior gluteal n.
Pectineus - femoral n.
Extension of Femur
Gluteus maximus - inferior gluteal n. Semimembranosus - sciatic/tibial n. Semitendinosus - sciatic/tibial n. Bicepts femoris, long head - sciatic/tibial n. Adductor magnus - obturator n.
Adduction of Femur
Adductor longus/brevis/magnus - obturator n.
Gracilis - obturator n.
Abduction of Femur
Gluteus minimus/medius - superior gluteal n.
Tensor fasciae latae - superior gluteal n.
Flexion of Tibia/Fibula
Semimembranosus/Semitendinosus/Bicepts Femoris - sciatic/tibial n.
Gracilis - obturator n.
Sartorius - femoral n.
Popliteus/Gastrocnemius - tibial n.
Extension of Tibia/Fibula
Vastus medialis/lateralis/intermedius/rectus femoris - femoral n.
Plantar Flexion of Foot
Gastrocnemius/Soleus/Plantaris/Tibialis Posterior/Flexor Digitorum Longus/Flexor Hallucis Longus - tibial n.
Dorsiflexion of Foot
Tibialis anterior/Extensor hallucis longus/extensor digitorum longus - deep peroneal n.
Eversion of Foot
Peroneus longus/brevis - superficial peroneal n.
Peroneus tertius - deep peroneal n.
Femoral Nerve Damage
May be damaged in abdomen by abscess in psoas major; Weakness in ability to flex thigh at hip, ability to extent leg at knee and diminished patellar reflex
L4 lesion
Dermatome: medial leg
Muscles: quads, iliopsoas, hip adductors
Reflex: patellar
L5 lesion
Dermatome: dorsum of foot; great toe, toe 2 and 3
Muscles: foot dorsiflextors, toe extensors
S1 lesion
Dermatome: Posterior leg, lateral foot, toes 4, 5 and sole
Muscles: plantar flexors
Reflex: achilles
Obturator Lesion (L2,L3,L4)
Cause: pelvic neoplasm, pregnancy
Cutaneous: medial thigh
Weakness in adduction at the hip
Femoral Lesion (L2,L3,L4)
Causes: diabetes, pelvic neoplasm, psoas abscess
Cutaneous: anterior thigh, medial leg to medial malleolus
Weakness in flexion of hip and extension of leg at knee
Common Fibular Lesion (L4-S2)
Causes: compression at neck of fibula, hip fracture, dislocation of femur, piriform syndrome
Cutaneous: anterior and lateral leg, dorsum of foot
Weakness in dorsiflexion and eversion of foot
Sign: foot drop; steppage gait
Tibial Lesion (L4-S3)
Causes: dislocation of femur, diabetes, hip fracture
Cutaneous: posterior leg, sole and lateral foot
Weakness in leg flexion, plantar flexion, flexion of toes
Sign: can’t stand on tiptoes
Superior Gluteal Lesion (L4-S1)
Causes: misplaced gluteal injection, pelvic neoplasm
Weakness in abduction at hip
Sign: waddling gait, pelvic tilt
Inferior Gluteal Lesion (L5-S2)
Causes: pelvic neoplasm
Weakness in extension at hip from flexed position
Sign: cannot get up from chair
Superficial Fibular Lesion
Pain and parasthesia in the dorsal aspect of foot
Deep Fibular Lesion
Footdrop and parethesia in the skin of the webbed space btw great and second toe
