Anatomy USMLE Flashcards
AV Fistula
They may develop after a DEEP penetrating wound=> palpitations + high output heart failure (systolic dysfunction)
*Branham’s Sign= pressure on AV fistula stops palpitations
Atrial Septal Defect
SOB w/ palpitations Systolic ejection flow murmur S2 is wide DOES NOT change with breading CXR: increase pulmonary vasculature ECHO: paradoxical septal movement *Mid septum= #1 *Low septum= Down's syndrome **Acyanotic= (R <--L) w.o Tx= paradoxical emboli, CHF, infective endocarditis
Cardiac Tamponade
Hx; stabbing to chest, dyspnea (gasping for air)
1. Hypotension that does not respond to hydration
2. Distant heart sounds: reduced API
3. increased systemic venous pressure
Tx: pericardiocentesis = remove fluid or blood from pericardial sac
Coarctation of the Aorta
-More common in males
-high BP in upper extremities
-femoral pulses diminished
-systolic ejection murmur ==> between shoulder blades
-CXR= rib notching
**Ligamentum arteriosum=
Distal= adults= #1
proximal= kids
Secondary causes of HTN that can be corrected with surgery=?
- Conn’s Syndrome= too much aldosterone
- Renal artery stenosis
- pheochromocytoma
- Coarctation of the aortas Syndrome= 45,XO
Femoral Hematoma= “coldness of foot”
ecchymosis compresses femoral artery which passes very close to the inguinal ligament= high risk of injury during hernia repair
** Femoral Nerve-Artery-Vein (Lateral to medial)
How is a hematoma distinguished from a pseudoaneurysm?
hematoma= no flow, non-pulsatile
PDA that persists in a child ==>Tx: indomethacin (blocks PGE2)
- recurrent pneumonia
- low exercise tolerance
- Mother infected with RUBELLA during pregnancy
- wide pulse pressure (S/D)
- “machinery murmur” + increase JVP
- LVH= increase blood into lungs–>LA–>LV ==> increase PMI
- CXR= increase pulmonary vasculature =more blood entering PA w/ aortic notch less pronounced
Teratology Of Fallot= kids
- Dyspnea on exertion relieved by SQUATTING position (=increases blood flow to RA)–> CENTRAL Cyanosis => observe clubbing= lack of proper O2
- Thrill= palpable murmur= VSD
- Systolic murmur on L= Pulmonary Stenosis=> A2 sound only
- CBC= polycythemia (low systemic O2)
- EEG= RVH= dilated RA
- *overriding aorta= aorta in midline gets blood from RV + LV
- CXR= diminished pulmonary vasc.
What is the congenital defect in Teratology of Fallot?
antero-superior displacement of the INFUNDIBULAR septum = unequal division of the aorta/PA
VSD= membranous is #1
- Dyspnea + poor growth + sweating
- PE= pansystolic mumur in lower left sternal boarder + parasternal heave
- Bi-ventricular hypertrophy
A reversal of the VSD shunt is named what?
Eisenmenger’s Syndrome
HYPO-parathyroidism= IATROGENIC=follows thyroidectomy
- numbness in mouth + legs + fingers=
- Carpopedal spasm= outward/flexion of hands
- positive: Chvostek’s (face tap) + Trousseau(BP cuff) + Peritoneal Sign=>spasms= HYPOCALCEMIA
- PTH absorbs Ca++ in kidney
What embryonic origin are the Parathyroid glands from?
Endodermal brachial pouches=
Superior= 4th brachial pouch
*Inferior= 3rd brachial pouch
CHOANAL ARESIA= blocked nose-pharynx
Cyanosis that gets worse with eating but better with crying= newborns breath ONLY through nose
-unable to pass catheter through NOSE
Sialolithiasis= stone in salivary glands=
Mostly submandibular gland=> palpable parotid gland= recurrent parotid gland infections==> pain when eating followed by swelling
**make them suck on lemon= increase salivation through excess saliva production
Thyroglossal Duct Cyst= painLESS swelling bellow hyoid bone
Mostly fluid that is NOT fixed vs. dermoid cyst that do not move
-Thyroid function Test are NORMAL
Cause= REMNANT of the THYROGLOSSAL DUCT (formed as the thyroid migrates from base of the tongue (foramen cecum) –> neck
Tonsillitis=Strep throat = elevated ASO
- recurrent sore throats, FEVER, swollen glands with productive sputum (bloody green)
- Otitis Media= infection goes up eustachian tube= auditory meatus close proximity to tonsils
- Retropharyngeal mass= must be removed
Boerhaave’s Syndrome= appears after vomiting=> severe retrosternal pain (radiates to the back + abdomen) w/ dyspnea
Patient is often either: Bulemic, alcoholic, pregnant==>
- contrast material seeps into mediastinum=> COMPLETE rupture of the esophageal wall
- pneumothorax: crackling sounds
How is Boerhaave’s Syndrome different from Mallory-Weiss Syndrom?
Both are due to vomiting=>
-MW= SUPERFICIAL tear of the esophagus=> bleeding
What are the 3 anatomic constrictions of the Esophagus?
- stomach cardia 2. aortic notch 3. cricopharyngeal
Congenital Biliary Atresia = no extra-hepatic bile ducts= fibrous chords
-Persistent Jaundice not present at birth
-Dark urine + Light stools = obstructive jaundice
==> cirrhosis
-Elevates ALT/AST, low Albumin, No urobilinogen in urine
Dumping Syndrome= hypoglycemia symptoms(=lightheadedness, sweaty palms, palpitations, nausea) ==> diarrhea following meal
Follows SURGERY involving the stomach–duodenum (e.g. unrelenting ulcers) => food enters jejunum and bypasses the GI’s ability to absorb nutrients such as glucose.
Hirschprung’s Diseases presents as acute enerocolitis= watery stools, foul smelling diarrhea=> newborns==> FUNCTIONAL obstruction
Cause: Crest Cells fail to migrate to distal parts of the bowls==> no parasympathetic ganglia is present(Meissner’s + Auerbach’s plexus) => constriction of those segments= Colon dilates behind that area==> distended abdomen/palpable bowels
- **No meconium is passed in infant
- *Down’s Syndrome association