Anatomy-Surgery BLITZ Flashcards
Blood supply of scalp?
Branches of ECA
Scalping occurs at what layer?
Loose areolar tissue
Dnagerous area of the scalp
Loose areolar tissue
Largest and most constant passes through the mastoid to the lateral sinus
Emissary vessels
Emissary vessels are also known as
Cerebral veins and bridging veins
Classification of subdural hematoma
Acute (up to 48 hours) blood and clot - hyperdense
Subacute (2-14days) clotted blood and fluid - hypodense
Chronic (>14 days) liquifies hematoma - hypodense
Group of disorders that result from the abnormal obliteration if premature fusion of the cranial suture
Craniosynosthosis
Complication of forceps delivery
Facial nerve injury
Structure in the head that is not present at birth and develops during the first 2 years of life
MasTWOid process
Cranial fossa weakest
Middle cranial fossa
Thinnest part of the lateral wall of the skull
Pterion
Artery affect if there’s fracture of the pterion
Anterior branch of the middle meningeal artery
Hematoma that manifests LUCID INTERVAL
Epidural hematoma
Basilar skull fracture affects what part of the cranium?
Petrous portion of temporal bone
Part of the cranial floor that separates the middle and posterior cranial fossa
Petrous portion of temooral bone
What nerve is affected if there is damage in the petrous portion of temporal bone?
CNVIII
Ecchymosis of the mastoid process
Battle’s sign
Hemotympanum, battle’s sign and raccoob eyes are signs seen in what cranial fracture?
Basilar skull fracture
What cranial nerves are seen in the cavernous sinus?
CN III, IV and VI
Mildest form of head injury that results to rotational acceleration of the head in the absence of significant injury
Concussion
Most common site of hypertensive bleed
Putamen
Arteries involved in hypertensive bleed
Lenticulostriate arteries
Most common cause of SAH
Traumatic
Most common cause of spontaneous SAH
Ruptured Aneurysm
ADPKD is associated with aneurysm. T/F
T
Buttresses of the face
Nasomaxillary, alveolar, zygomaticofrontal and maxillary, superior and inferior orbital, pterygomaxillary
Vertical buttress comprises of
Zygomaticofrontal maxillary (lateral)
Nasomaxillary (medial)
Pterygomaxillary (posterior)
Horizontal buttress comprises of
Supraorbital bar
Inferior orbital rim/orbital floor
Alveolus
Type of facial fracture according to location that involves the frontal bone, frontal sinus and supraorbital ridge
Upper third of the face
Type of facial fracture according to location that affects the nasal bone, orbital bones, naso-orbito-ethmoidal complex, zygoma, maxilla and alveolar process
Middle third of the face
Type of facial fracture that involves the alveolar process and mandible
Lower third of face
An opacification in the upper maxillary sinus, which represents periorbital fat and possibly an entrapped EOM in the maxillary sinus
Tear drop sinus
Most common fractures of the facial bone in descending order
Nasal
Zygomatic
Mandible
Artery contained in the cavernous sinus
ICA
Trecher Collins Syndrome is also known as
Mandibulofacial dysostosis
_____week of embryogenesis that cleft lip and palate develop
8th
His (classic theory)
Cleft lip and palate
Failure of fusion theory
Stark
Cleft lip and palate
Mesodermal penetration theory
Incomplete clefts affect only a portion of the lip and contain a bridge of tissue connectinf the central and lateral lip elements referred to as
Simonart’s band
Disorder of unknown etiology, beginning in childhood or adolescence, in which hemifacial atrophy of the skin, subcutaneous fat, muscle, bone and cartilage
Romberg’s progressive hemifacial atrophy also known as Parry-Romberg syndrome
Complete closure of lip and palate can be seen when?
After 12th week
Mkst common cleft palate that has a trid deformities of bifid uvula, diastasis of velum (thin membrane) and palpable posterior notch
Submucous cleft palate
Cheiloplasty (primary cleft lip repair) rule of 10’a
At least 10 weeks age
10 lbs
Hgb 10g/dL
Palatoplasty
Timing of operation:
Controversial:
Timing of operation: before 1 y/o
Controversial: early closure, improved speech, midface retrusion
1st step in the NB tx with a complex cleft lip and palate
Nasoalveolar molding, prosthesis in infancy, followed by stages repair
2-3 cm above the clavicle anteriorbto C6 transverse process, most superficial passage of brachial plexus
Erb’s point
Ill-fitted crutches affects what nerve?
Radial nerve
Muscles innervated by Radial Nerve
Abductor pollicis longus Brachioradialis Anconeus Triceps Extensors Supinator
Mishaft humeral fracture and nerve in spiral groove, wristdrop
Radial nerve (C5-T1)
Saturday night palsy and honeymooner’s palsy
Radial nerve damage
Tennis elbow
Lateral epicondylitis
Golfer’s elbow
Medial epicondyliis
Nursemaid’s elbow aka as pulled elbow
Annular ligament displacement
Radial head subluxation
Indicative of child abuse
Fractures of the forearm
Colle’s
Smith
Galeazzi
Monteggia
Fracture of the distal end of the radius with the distal fragment displaced dorsally
Posterior dislocation
Dinner fork deformity
Colle’s fracture
Fracture of the distal end of the radius with the distal fragment displaced volarly
Anteriorly displaced
Reverse colle’s
Smith’s fracture
Fracture of the proximal end of the radius with dislocation of radio-ulnar joint
Galeazzi’s fractre
Fracture of the shaft of ulna with anterior dislocation of the radial head and rupture of annular ligament
Monteggia’s fracture
GRIMUS
Galleazzi - radial fracture, inferior dislocation
Monteggia - ulnar fracture, superior dislocation
Weakest part of the clavicle
Junction of its middle and lateral thirds
Treatment of clavicular fracture
Figure of 8 splint
Classic history of clavicular fracture
Fall on the shoulder or outstretched hand
Direction of clavicular fracture
Distal fragment goes downward, medial and forward by pectoralis major
Medial end pulled upward by SCM
Artery that divides the clavicle
Subclavian artery
Scapular fractures
Result of severe trauma
Run-over accident victims, VA
Require little treatment
Delayed ossification of midline structures, particularly membranous bone
Partly missing/absent clavicle
Cleidocranial dysostosis
Muscle that divides the subclavian artery into three part
Scalenus anterior
3 parts of the subclavian artery divided by scalenus anterior
- First part: vertebral artery, thyrocervical trunk and internal thoracic
- Second part
- Third part
Axillary artery is the continuation of what artery?
Subclavian artery
Axillary artery
Begins at lateral border of the first rib until lower border of teres major (brachial artery)
Related to the cords of the brachial plexus
Enclosed with them in the axillary sheath
Muscle that divides the axillary artery into 3 parts
Pectorialis minor
3 parts of the axillary artery
Screw The Lawyer Save A Patient
1st part: supreme or highest thoracic artery
2nd part: thoracocacromial, lateral thoracic
3rd part: subscapular, anterior and posterior humeral circumflex artery
Small branches of the axillary artery
Brachial
Radial/ulnar
Palmar arch
Course of brachial artery
Begins at lower border of teres major (from axillary artery)
Descends through anterior compartment of arm on brachialis muscle
Enters cubit fossa
Ends at level of neck of radius divides into radial and ulnar artery
Boundaries of radial pulse
Laterally: tendon of brachioradialis
Medially: tendon of FCR
Radial artery is ________than ulnar artery
Smaller
Course of ulnar artery
Descend through the anterior compartment
Enters palm in front of flexor retinaculum with the ulnar nerve
Ends by forming superficial palmar arch gives rise to superficial palmar branch of radial artery
Palmar arches
Radial artery -> deep palmar arch
Ulnar artery -> superficial palmar arch
Allen test
Should return in 7 seconds
Prior to radial artery cannulation
Prior to heart bypass surgery
Most mobile yet unstable joint
Shoulder joint
Rotator cuff muscles
SITS muscle - supraspinatus (superior) - infraspinatus (posterior) - teres minor (posterior) - subscapularis (anterior) Supports the humeral head to the glenoid fossa Inferiorly: no support
Boundaries of quadrangular space
Superior: subscapularis
Lateral: humerus
Inferior: teres major
Medial: triceps (long head)
Contents of quadrangular spaces
Axillary nerve
Posterior humeral circumflex
Volkmann’s ischemic contracture
Occurs in supracondylar fracture
Permanent flexion contracture of the hand and wrist (clawlike deformity)
Compressed brachial artery
Most common carpal bone fracture
Scaphoid
Most common dislocated carpal bone
Lunate
Artery injured in scaphoid fracture
Radial artery
Nerve injured in hamate fracture
Ulnar nerve
Froment sign is a test of what nerve?
Ulnar nerve
Artery traverses the anatomic snuffbox
Radial artery
2nd most commonly fractured carpal bone
Lunate fracture
Nerve compressed in lunate fracture
Median nerve
Boundaries of anatomic snuffbox
EPoL
APoL
EPB
Floor of the anatomic snuffbox
Scaphoid bone
No man’s land
Flexor tendon injuries at zone 2 have poor prognosis
Osteoarthritis
Heberden nodes
Bouchard nodes
Heberden nodes: distal
Bouchard nodes: proximal
Injury to the extensor digitorum tendon
Mallet finger
Contracture of palmar aponeurosis seen in Uremia
Dupuytren contracture
Action of the lumbricals
Flex MCP and extend IP
Contents of the middle mediastinum
Heart Roots of great vessels Primary bronchi Phrenic nerve Arch of azygous
Contents of the posterior mediastinum
Thoracic aorta Esophagus Azygos and hemiazygos vein Vagus nerve Thoracic duct Sympathetic trunk
Immediate management of tension pneumothorax
Needle thoracostomy (2nd ICS)
Definitive management of tension pneumothorax
CTT (4th or 5th ICS AAL)
- may be done at a lower ICS but not lower than 5th rib on either side (dome of diaphragm)
Sternal space of Burns
It is where the deep infection in the neck and esophageal perforation affects the mediastinum causing mediadtinitis
Mediastinoscopy (procedure) used to obtain samples of tracheobronchial lymph nodes through thensubsternal space
Chamberlain procedure
Apical lung tumor that causes Horner syndrome
Pancoast tumor or superior sulcus tumor
Right brachiocephalic + left brachiocephalic =
SVC
Structure formed behind the lower border of the 1st costal cartilage
SVC
SA node location
Sulcus terminalis
Pemberton sign is seen at what disease entity?
SVC syndrome
Sign used to denote flushing of head when hands are raised
Pemberton sign
Branches of the arch of the aorta
Brachiocephalic trunk
Left common carotid
Left subclavian
2 branches of the pulmonary trunk
Right and left pulmonary artery
Most sensitive CXR finding suggesting tear of the aorta
Widened mediastinum
Best screening test for aortic tear
Dynamic spiral CT
Definitive test for aortic tear
Aortography
Aortic tear or disruption is caused by
Deceleration injury
Location of injury in aortic tear
Distal to subclavian artery at level of ligamentum arteriosum
CXR finding of aortic tear
Widened mediastinum
Pleural capping
1st and 2nd rib fracture
Loss of aortic knob
Atypical rib that is the broadest, shortest, most sharply curved, groove for subclavian artery
Rib 1
Site of intercostal nerve block
Lower border of the robins
Site of needle thoracentesis
2nd or 3rd ICS MCL, upper border of rib
Weakest part of the rib where most fractures occur
Anterior to the angle usually rib 5-10
Paradoxical chest movement caused by Two separates fractures in >3 contiguous ribs ( junction and angle)
Flail chest
Major cause of respiratory compromise
Pulmonary contusion
Cervical prominence
C7