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Anatomy USMLE Flashcards

1
Q

AV Fistula

A

They may develop after a DEEP penetrating wound=> palpitations + high output heart failure (systolic dysfunction)
*Branham’s Sign= pressure on AV fistula stops palpitations

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2
Q

Atrial Septal Defect

A 
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
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3
Q

Cardiac Tamponade

A

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

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4
Q

Coarctation of the Aorta

A

-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

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5
Q

Secondary causes of HTN that can be corrected with surgery=?

A
  • Conn’s Syndrome= too much aldosterone
  • Renal artery stenosis
  • pheochromocytoma
  • Coarctation of the aortas Syndrome= 45,XO
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6
Q

Femoral Hematoma= “coldness of foot”

A

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)

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7
Q

How is a hematoma distinguished from a pseudoaneurysm?

A

hematoma= no flow, non-pulsatile

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8
Q

PDA that persists in a child ==>Tx: indomethacin (blocks PGE2)

A
  • 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
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9
Q

Teratology Of Fallot= kids

A
  • 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.
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10
Q

What is the congenital defect in Teratology of Fallot?

A

antero-superior displacement of the INFUNDIBULAR septum = unequal division of the aorta/PA

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11
Q

VSD= membranous is #1

A
  • Dyspnea + poor growth + sweating
  • PE= pansystolic mumur in lower left sternal boarder + parasternal heave
  • Bi-ventricular hypertrophy
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12
Q

A reversal of the VSD shunt is named what?

A

Eisenmenger’s Syndrome

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13
Q

HYPO-parathyroidism= IATROGENIC=follows thyroidectomy

A
  • 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
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14
Q

What embryonic origin are the Parathyroid glands from?

A

Endodermal brachial pouches=
Superior= 4th brachial pouch
*Inferior= 3rd brachial pouch

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15
Q

CHOANAL ARESIA= blocked nose-pharynx

A

Cyanosis that gets worse with eating but better with crying= newborns breath ONLY through nose
-unable to pass catheter through NOSE

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16
Q

Sialolithiasis= stone in salivary glands=

A

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

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17
Q

Thyroglossal Duct Cyst= painLESS swelling bellow hyoid bone

A

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

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18
Q

Tonsillitis=Strep throat = elevated ASO

A
  • 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
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19
Q

Boerhaave’s Syndrome= appears after vomiting=> severe retrosternal pain (radiates to the back + abdomen) w/ dyspnea

A

Patient is often either: Bulemic, alcoholic, pregnant==>

  • contrast material seeps into mediastinum=> COMPLETE rupture of the esophageal wall
  • pneumothorax: crackling sounds
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20
Q

How is Boerhaave’s Syndrome different from Mallory-Weiss Syndrom?

A

Both are due to vomiting=>

-MW= SUPERFICIAL tear of the esophagus=> bleeding

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21
Q

What are the 3 anatomic constrictions of the Esophagus?

A
  1. stomach cardia 2. aortic notch 3. cricopharyngeal
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22
Q

Congenital Biliary Atresia = no extra-hepatic bile ducts= fibrous chords

A

-Persistent Jaundice not present at birth
-Dark urine + Light stools = obstructive jaundice
==> cirrhosis
-Elevates ALT/AST, low Albumin, No urobilinogen in urine

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23
Q

Dumping Syndrome= hypoglycemia symptoms(=lightheadedness, sweaty palms, palpitations, nausea) ==> diarrhea following meal

A

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.

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24
Q

Hirschprung’s Diseases presents as acute enerocolitis= watery stools, foul smelling diarrhea=> newborns==> FUNCTIONAL obstruction

A

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
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25
Q

Pancreatic Pseudocyst= complication of acute pancreatitis= elevated amylase/lipase= FEVER + epigastric pain

A

Epigastric mass= NO capsule= fluid is retained by: peritoneal surface, large bowel, diaphragm

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26
Q

Perforated PEPTIC ulcer= epigastric pain with FOOD intake if Gastric (vs. Duodenal: no pain with food=tend to gain weight)= causes weight loss to reduce pain

A

-presents with REBOUND tenderness w/o bowel sounds but w/ abdominal rigidity (peritonitis)
-perforation= gastric antrum + lesser curvature ==> spills into lesser/greater sac
Tx: H. Pylori
————————
***Duodenal Ulcer= 100% H. Pylori
Anterior: perforation
Posterior: hemorrhage from erosion of the gastroduodenal artery

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27
Q

What are the boundaries of the LESSER SAC?

A

hepatoduodenal ligament + Caudate lobe of liver + duodenum + IVC

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28
Q

Portal Hypertension=vomits a lot of blood= alcoholic= Hypovolemic (tachycardia/hypotensive/pallor)

A
  • pendulous abdomen= ascitic fluid with spider angiomas on surface, palmar erythema
  • Elevated AST/ALT, Anemia, High bilirubin==> liver cirrhosis=> incrase portal hypertension (mesenteric vein + splenic vein back up)==>
    1. left gastric|| azygous= esophageal varices= vomit blood source
    2. superior||inferior gastric= hemorrhoids=> melena
    3. paraumbilical ||inferior gastric = caput medusae
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29
Q

Tracheoesophageal Fistula= newborn=> chokes, coughs, vomits undigested food=> proximal esophagus ends blindly while distal connected to trachea=> air in stomach

A
  • Excess amniotic fluid= Polyhdroamnios= because of atresia the baby cannot swallow the amniotic fluid= builds up in amniotic sac
  • distended stomach w/o fluid
  • excess salivation
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30
Q

What is the anomaly in a Tracheoesophageal Fistula?

A

primitive foregut fails to differentiate into trachea + esophagus=> endodermal cells fail to grow causing atresia + the lateral walls of the foregut do not fuse as the trachea/esophagus separate

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31
Q

What is maternal oligohydramnios?

A

bilateral renal agenesis + posterior urethral valves => no fetal urine or an obstruction that prevents the excretion of amniotic fluid

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32
Q

Rupture of an Abdominal Aortic Aneurysm in MALE=> severe TEARING pain that radiates to the back ==> loss of consciousness due to hypovolemia (hypotension/tachycardia)=>

A
  • pulsatile mass in abdomen
  • *Atherosclerosis
  • *Marfan’s Syndrome= cystic necrosis of tunica media
    • Syphilis (vasculitis)
  • *trauma
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33
Q

Femoral Hernia=tender lump in groin that is round and irreducible=STRANGULATION==>FEMALE:

A

groin pain + vomiting + abdominal distention => requires emergent surgery
***Hernia is medial to Femoral Nerve

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34
Q

Where do the Inferior Hemorrhoidal veins drain into?

A

Internal Pudendal veins= cause external hemorrhoids which are PAINFUL due to somatic innervation
Tx: Sitz baths = warm water bath

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35
Q

Which hernias are ABOVE the inguinal ligament?

A

Inguinal hernias=

  • Direct (Men=finger pulp)= weak muscle wall
  • Indirect (young=persistent Tunica Vaginalis=finger tip)
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36
Q

DIRECT Inguinal Hernia= through Hesselbach’s triangle

A

-hernia appears with straining (usually caused from Prostate Hyperplasia= forcing pee out or also from frequent constipation= also increases intra-abdominal pressure)

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37
Q

Relative to the Inferior Epigastric vessels where do hernias come out from?

A

Laterally= INDIRECT= goes inside scrotum

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38
Q

What are the limits of Hesselbach’s Triangle?

A
  • Inferior epigastric artery
  • Lateral Rectus Muscle
  • Inguinal ligament
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39
Q

INDIRECT inguinal hernia==> OUTSIDE Hesselbach’s triangle=>

A

often the intestines get trapped and cause dilation and constipation w/o rebound tenderness= obstruction

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40
Q

Meckel’s Diverticulum= 2’s= caused by persistence of the yolk stalk== belly protrudes due to intussusception=> sausage-like belly==> vomiting = Bright Red Stools=> pallor, anemia

A 
2 inches from ileocecal valve
2 inches long 
2% of population 
2yrs of life onset 
2 types of epithelium= ectopic gastric mucosa=>secrets acid= causes pain= indistinguishable from appendicitis
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41
Q

Mesenteric Anemia= pain is out of proportion to PE (worse than MI)=> Hx of previous cramping after eating ==>

A

infarction==> necrosis (elevated CK/amylase)==>
SMA= jejunum/ilium/ half colon
—————————
IMA= second half of colon/rectum
**Barium Enema shows THUMB-PRINTING due to hemorrhage of submucosa
**Smoker= atherosclerosis risk

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42
Q

Petit’s Triangle Hernia = near iliac crest =

Traingle= Latissimus Dorsi, external oblique, and iliac crest

A

Male, left side, pops up when the child cries

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43
Q

What can become damaged during trauma to the Popliteal Fossa?

A

-Popliteal Artery= no dorsalis pedis pulse
-Popliteal Vein <= Lesser saphenous vein drains into it
-Tibial Nerve = inability to dorsiflex
***
more superiorly coming out of the fossa laterally is the common PERONEAL NERVE

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44
Q

Sigmoid Volvulus = older individuals=

A

most often the sigmoid colon twists= bird’s beak on KUB=>prevents stools from passing=> colicky pain + chronic constipation=> might cause ischemic colon with bloody discharge

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45
Q

Ureter damage in a female=> oliguria, with left flank pain=> follows Hysterectomy for uterine fibroids==> surgical wound is soaked with urine=

A

Ureter is damaged during a hysterectomy because it travels under the uterine vessels ==> intra-abdominal urine leakage= flank pain + low grade fever

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46
Q

Varicose Veins= multiparty, obese, female, long periods of standing, worse at night but alleviated by elevating feet

A

Patients also complain of leg fatigue

**cause= vein valve incompetence= greater saphenous vein= blood buildup= tortuous veins

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47
Q

Gartner’s Duct Cyst

A

Antero-lateral cyst (serous fluid) on the vulva ==> Wolffian Duct remnant that does not close

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48
Q

Uterine Prolapse with Cystocele= frequency of urination increases w/o voiding=> bacterial infection

A

Risk factors: older female, multiparity, weight bearing=> alters bladder location (usually collapse of Pubocervical fascia which is anchored by pubic symphysis and uterus) vs. rupture which causes the prolapse of the bladder into vagina

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49
Q

Squamous Cell Carcinoma (ulcerated lesion with rolled up edges) of the lower lips drains into what lymphnodes==>

A

middle part of the lip=> submental
lateral parts of the lip=> submandibular
——-
Both drain into the Cervical Lymphnodes that can be found in the Carotid Triangle

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50
Q

What muscles comprise the Carotid Triangle where the INTERNAL JUGULAR VEIN is located==>also DEEP cervical nodes

A
  1. Posterior Belly of the Digastric muscle
  2. Omohyoid
  3. ## SternocleidomastoidWhat is found in the Posterior Cervical Triangle (trapezius, SCM, omohyoid)?
  4. Deep Cervical nodes
  5. accessory nerve
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51
Q

DiGeorge’s Syndrome: infants presents with recurrent oral thrush and URI?

A
  • *Also seizures= low Ca++= no PTH made from absent parathyroid glands
  • *T-cell count is low=> No THYMUS present <== 3rd + 4th Pharyngeal POUCHES not developed = no CMI (viral/fungal infections)
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52
Q

Caput Succedaneum= BENIGN ecchymosis that occurs during delivery= crosses midline/suture lines vs.?

A

-Cephalhematoma= fracture= no suture line crossing

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53
Q

Congenital Diaphragmatic Hernia= often associated with no prenatal care=>

A
  • causes severe dyspnea on newborn
  • Bowel sounds in LEFT POSTERoLATERAL CHEST w/o breath sounds
  • Heart sounds shifted to the right
  • Cause: failure of the Canal of Bochdalek to close properly=> GI move up=> prevents lungs from developing properly
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54
Q

Duodenal Atresia=> premature baby vomiting AT BIRTH (bilious=contains bile)=> distended abdomen= dilated duodenum

  • *Down’ Syndrome= single palmar crease
  • *Mother had Polyhydroamnios
A

vs. Pyloric Stenosis=olive like mass in epigastrium= older infants => no bile in PROJECTILE vomit and full term baby=underweight= visible peristalsis ==> ultrasound shows pylorus muscle thickening
* *genetic component
* *wrinkled skin

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55
Q

Nephrolithiasis= right flank pain (intermittent + excruciating!)=> radiates to inner thigh/scrotum==> N,V=

A 
Dysuria,hematuria, RESTLESS, 
#1= radiopaque calcium oxalate stones 
vs. uric acid stones= translucent
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56
Q

What are some causes of REBOUND tenderness on abdominal palpitation?

A
  1. Peritonitis= patient tries to prevents movement to reduce pain
  2. ## AppendicitisNOT: nephrolithiasis, obstructions
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57
Q

What are some of the complications with a vasectomy?

A 
scrotal hematoma
infection
spermatic granuloma
spermatocele
*spontaneous re-canalization
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58
Q

What are some of the LAYERS one must cut in order to do a vasectomy?

A
  1. skin
  2. superficial scrotal fascia=Dartos Fascia
  3. external spermatic fascia
  4. cremasteric fascia + muscle
  5. Internal spermatic fascia
  6. preperitoneal fat
  7. tunica vaginalis
  8. CUT ductus deferens
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59
Q

Acoustic(CN8) Shwannoma= affects hearing(tinnitus) and balance(vertigo)

A

Positve Nerotest: Webber’s Test (lateralizes OPPOSITE to sensorineural deficit) + Romberg’s Test(patient falls when standing/eyes closed) + Caloric Testing(+ side of ear canal paresis) + CT: CP(cerebellopontine) angle mass

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60
Q

Where do you see bilateral schwannoma’s

A

AD neurofibramatosis 2 (MEN syndromes)

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61
Q

What is Acute Torticollis?

A

inflammation –> muscle spasms of the neck=> muscles involved: trapezius muscle, supraspinatus, rhomboid,

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62
Q

Warnicke’s Aphasia= Left Temporal Lobe deficit=> infarct in Left MCA ==>damage to the SUPERIOR TEMPORAL GYRUS

A

Able to speak but does not make sense + unable to understand spoken/written language
—–VS.—–
Brocca’s Aphasia= cannot form words to speak (not fluent) eventhough he tries too(understanding spoken/written is normal)= damage to the INFERIOR FRONTAL GYRUS

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63
Q

Astrocytoma= slow growing= malignant with poor prognosis=> nueroectoderm origin ==> presents as unilateral headache

A

Kids= Posterior Fossa= Ataxic gait(affects cerebellum), vomiting(brainstem), Papilledema (increase intracranial pressure) + SEIZURES
–VS—
Adults= cerebrum

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64
Q

What structures would be affected by an astrocytoma in a child that is found to encompass the whole Posterior Fossa?

A

Foramen magnum + Jugular Foramen + internal acustic meatus

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65
Q

Bell’s palsy=>Lower motor Neuron==affect CN7=comes out of the Stylomastoid foramen=> FACIAL paralysis=> mouth droops and unable to close eye voluntarily

A

complication of: Diabetes, AIDS, Lyme disease, tumors, sarcoidosis = possible viral cranial neuropathy
—VS—–.
half of the face paralysis= UMN pathology of opposite side of brain= stroke related

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66
Q

What muscles are affected by Bell’s Palsy (LMN CN7)?

A

inability to close eye= obicularis oculus + inability to smile=obicularis oris + no wrinkles in forehead= frontalis muscle

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67
Q

Brown-Sequard Syndrome=Hemisection damage from trauma=>hematoma in area of SC damage

A
  • Paralysis below the lesion= corticospinal tracts
  • Inability to sense position/vibration on same side of lesion= dorsal columns
  • inability to sense pain/temperature on contralateral side of the lesion= Spinothalamic
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68
Q

Cavernous Sinus Thrombosis= facial and ophthalmic VEINS do not have valves=> infections of the skin(pimple) around the nose travel up un-impeded into the cavernous sinus==>high risk: Immunocompramised individuals (diabetics, Cancer patietients, HIV)==>

A

CT: no enhancement of the cavernous sinus

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69
Q

Common Peroneal Nerve Damage= Trauma=common due to SUPERFICIAL location LATERAL to FIBULA head=> Also damamged with knee casts

A

Cannot Dorsiflex, extension of the toes, loss of eversion= Peroneal Nerve (deep + superficial)***Loss of sensation of anterolateral aspect of the leg + Dorsum of foot

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70
Q

DEAFNESS: how can the Rinne’s test and Webber’s test discriminate Conductive vs. Sensorineural ?

A

Conductive= no nerve invovled=> Affected ear (e.g. damaged tympanic membrane=recurrent ear infections)=> Webber’s + Positive Rinne’s=> BAD ear
—— VS——
Sensorineural= CN8=> Webber lateralizes to GOOD ear w/ Negative Rinne’s test

71
Q

Erb-Duchenne Palsy= Damage to C5/C6= dystopic and prolonged delivery in baby or shoulder trauma => Waiter’s tip=>

A

shoulder abductors paralysed, arm medially rotated(paralysis of lateral rotators), pronated(loss of bicepts), **Sometimes the phrenic nerve can be damaged aswell=ipsilateral diaphragm paralysis

72
Q

What nerve is often cut while attempting to remove the Parotid gland due to andeocarcinoma?

A

Facial Nerve crosses through there=> recieves TASTE from anterior 2/3 of tongue==>muscle inntervation of all facial muscles <== comes out from the Stylomastoid Process in the cranium

73
Q

Femoral Nerve Damage=> hip fracture

A

Patient cannot walk because he cannot flex his hip, cannot extend his knee, and loss sensation of his anterior thigh + medial foot

74
Q

Deviation of tongue to the side of atrophy and fasciculations=>LMN damage

A

CN12=hypoglossal nerve damage <= caused by Parotid/Carotid tumors, tuberculous adenitis, metastatic neck tumors

75
Q

How does the injury develop and what part of the brachial plexus is damaged with Erb’s palsy vs. Klumpke’s Palsy?

A

Erb’s= hyper-ADDUCTION=> lower plexus
—– VS—–
Klumpke’s= hyper-ABDUCTION=upper-plexus

76
Q

Klumpke’s Palsy= also a result from shoulder Dystocia==> hyper-abduction=> C7,C8 + T1

A

Subclavian Artery becomes compressed aswell==> so if you turn away the head from the injured side ther radial pulse disappears

77
Q

Long Thorasic Nerve Injury= C5,C6,C7,C8,T1=> common in women with previous Mastectomy

A

Cannot abduct arm beyond shoulder level + Winged Scapula (failure of Serratus Anterior to fix scapula against chest wall)

78
Q

Mass in Jugular Foramen= CN 9,10,11 come out

A

Damage to CN11 => atrophy of sternocleidomastoid + trapezius muscle

79
Q

What can the Uvula tell us about CN 9/10 ==>

A

Normal: elevates in midline
Plegia= unilateral=> always deviated to normal side
Paresis: deviates to normal side w/ahh
Plegia=bilateral=> does not deviate or elevate
—–
Plegia= paralysis
Paresis= incomplete paralysis

80
Q

Where does Prostate CA metastases?

A

Axial skeleton

81
Q

ARNOLD-CHIARI SYNDROME=

A

Hydrocephalus=obstruction
Syringomyelia
platybasia
myelomeningiocele

82
Q

What to rule out in Parkinsonian Differential?

A

Problem: increase ACh decrease DA= Substantia Nigra(LEWEY BODIES), Locus Ceruleus, Striatum
1. Cerebellar Tremor= tremor only with intentional movement
2. Wilson’s Disease= Parkinsonian symtpoms
3.

83
Q

Recurrent Laryngeal Nerve Lesion: CN X=cut during Thyroidectomy=

A

LEFT= under aortic arch= possible large lymphnode

Right: under Subclavian Artery

84
Q

Spina Bifida= Caudal Neuropore does not close

A

measure maternal alpha-fetoprotein which should be high because of failure of the Dorsal Vertebral Arches to close= lack of Folic Acid

85
Q

Trigeminal Neuralgia= often compression of arteries=old women BUT if Young think= Multiple Sclerosis

A

EXTREEM PAIN=> worse with Cold temperature=>
V2=Foramen ovale
V3=Foramen rotundum

86
Q

Lateral Medullary Syndrome= Wallenburg’s Syndrome=>

A

PICA occlusion

87
Q

Ectopic Pregnancy= Lower Abdominal Pain= N,V, syncope(hypotensive)=> History of PID=>

A

Usually unable to do Pelvic Exam=> remove fluid from “cul-de-sac” via the vagina=> non-clotted blood(rupture of supply: uterine artery, internal iliac artery, ovarian artery, aorta

88
Q

What are some RISK FACTORS for ectopic pregnancies=>

A

-PID
-Prior ectopic pregnancy
-tubal pelvic surgery
-DES exposure
——-
Types:
-Tubal:#1 @ ampulla>isthmus, >fimbrae >interstitium
-abdominal:
-boad ligament:

89
Q

Pudendal Block=>typical during pregnancy

  • natural birth=no anesthesia-analgesia
A

Pudendal Nerve comes out of the Greater Sciatic foramen –> goes over ISCHIAL SPINE–> crosses Sacrospinous ligament–> enters Lesser Sciatic foramen(with Obturator nerve)=> splits:
1. perineal nerve
2. inferior rectal nerve
3. dorsal nerve of clitoris

90
Q

Which ligament is the most commonly injured in hyper inversions of the ankle?

A

Lateral Ligaments= calcaneofibular, posterior talofibular
—-VS—-
Medial ligaments=>
-Broad Deltoid

91
Q

Why is Radial Nerve palsy (wrist drop) last a long time?

A

location of fracture in humerus=> osseous callus + scar tissue formation

92
Q

Where is the most common Clavicle Fracture location ?

A

middle 1/3 of the clavicle => pulled up by the sternocleidomastoid and the distal part pulled down by the weight of the arm

93
Q

TENNIS ELBOW gives you pain when you try to extend your hand because?

A

Entrapment of the Posterior Interosseous Nerve=> has similar symptoms as Tennis Elbow

94
Q

Median Nerve Palsy=NOT CARPAL related=>Median Nerve damage was higher==> Wrist Flexion => ulnar deviation

A

Forms benediction hand CANNOT form “F” in ASL=> fist formation=>damage= “C” in ASL
——-VS——
damage due to Carpal Tunnel Syndrome entrapment=> inability to use thumb with palmar sensation

95
Q

Radial Head Subluxation @ the Elbow=> also called nursemaid’s elbow=> Pain in elbow in kids typically=> Extended arm + pronated is PULLED by parent==>

A

Damages the annular ligament that keeps the radial bone in place=>
kids show up:
1. arm is pronated plus flexed

96
Q

Monteggia’s Fracture=> Fracture to the Ulna midway=> patient unable to pronate or supinate arm=>
***Child Abuse

A

Damage:

  1. dislocates the head of Radial head because fracture pushes it out
  2. Possible RADIAL NERVE damage because blow typically occurs in that area
97
Q

What is damaged in the hand when something hard is hit with a CLOSED FIST?
**Boxer’s Fracture

A

5th metacarpal=> inability to FLEX PINKIE + head of MCP is depressed

98
Q

Hip-Leg-Calve-Perthes= avascular necrosis in KIDS==> occurs in the femoral heads of kids (small femoral head epiphysis)==> groin pain that radiates to inner thighs

A

Femoral Circumflex Arteries (Medial + Lateral) feed the head= absence= necrosis

99
Q

What nerve exits above the piriformis muscle of the gluteal area exiting the Sciatic Foramen?

A

Below= Inferior Gluteal Nerve + Artery + Sciatic Nerve ==> gluteus maximus

100
Q

Hip Dislocation = CONGENITAL= affects girls more= dislocation of the hip= breech birth=> may progress to avascular necrosis of the femoral head

A

Presentation: asymmetry of legs, knees=> Abduction is limited==> early diagnosis yields better results

101
Q

Hip Dislocation= TRAUMA=> Posterior disslocation is the most common=>knee inpact against something

A

Presentation= affected leg=> shortened, internally rotated, adducted => slight flexion= complications include: avascular necrosis (goal in Tx: reduction) => might also cause early degenerative arthritis

102
Q

Hip Fracture: follows fall in OLDER lady(osteoporosis)=> inability to move leg: EXTERNALLY rotated, ADDUCTED and one leg shorter than the other=> tenderness in femoral triangle => Femoral neck fractures

A

lateral rotators=> Superior Gluteal Nerve: piriformis, obturators, gemellus, quadratus, gluteus maximus ==> high risk that Sciatic Nerve might get damaged + HIGH RISK of DVT (requires proper stockings, anticoagulants)

103
Q

What is the common triad when the knee recieves a blow laterally?

A

Lesions=

  1. ACL
  2. Medial Meniscus
  3. MCL
104
Q

Painfull Knee= Osgood-Shlatter’s Disease=

A

swelling in the tibial tuberosity= repeated trauma can cut off vascular supply=> avascular necrosis=> self-limited disease

105
Q

Leg Compartment Syndrome=pain in anterolateral aspect of the leg=> radiates to ankle=>

A

increase pressure in limited space=> leg is swollen, tense, warm and anterior tibial pulse is weak=> sensory deficits following exercise = treated by removing fascia

106
Q

Pelvic Fracture= follows severe trauma=> tenderness over: iliac crest + tronchaters bilaterally=>

A

Bladder and urethral lesions are common with compound fractures to the pelvis= often conceal a lot of blood

107
Q

What does blood in the urethral meatus contradict?

A

Insertion of the Foley Catheter= indication of rupture of the membranous urethra ==> suprapubic cystostomy

108
Q

In a shoulder dislocation (anterior displacement= falling on arm while abducted) what is common?*complaint: no sensation on lateral aspect of arm + flexion problems

A

humoral head is anterior to the coracoid process(part of the scapula)=> musculocutaneous nerve damage is possible
——VS—–
Where do you see posterior shoulder dislocations= electric shock injuries/grand mal seizures

109
Q

Shoulder Seperation=> FULL= both ligaments rutpure

A

ACROMIOclavicular ligament rupture (only in partial) = prevents anterior-posterior displacement of clavicle
–VS—-
CORACOclavicular Ligament=prevents Vertical displacement of the clavicle

110
Q

In a herniated disc in the L4/L5 region how would you distinguish which nerve is impinged?
**made worse by movement, coughing, sneezing–> radiates to butt, calves

A

Central= L5 impinged=> numbness in lateral aspect of leg + weakness extending toe
—–VS——
Lateral= L4= abnormal patellar DTR, numbness in medial aspect of the leg all the way down to the foot, weakness in dorsiflexion

111
Q

Cervical Rib Syndrome= impingment of the subclavian artery or the lower brachial plexus (ulnar n.) between the free Cervical Rib (C7) and the Scalenus anterior muscle=>

A

Diminished radial pulses, sometimes a bruit over subclavian artery which is caused by a poststenotic dilatation**prolonged abduction of arm can precipitate these symtpoms

112
Q

What are the boundaries of the Anatomical Snuff Box?

A

Extensor pollicis longus + extensor pollicis brevis=> bottom: scaphoid + trapezium bones

113
Q

What structures would be cut in someone who slashes their wrist?

A

-superficial radial artery= bleeding
-Palmaris longus tendon= no digit flexing
-Median Nerve= no thumb opposition, loss of sensation on lateral/dorsal aspect of hand
————
Thumb ABduction still possible: radial nerve

114
Q

When will axillary nodes from a lung cancer be affected?

A

When there is pleural adhesions since most lung lymphs drain into the supraclavicular nodes

115
Q

What is Pancoast’s Syndrome? Tumor invades thoracic inlet: Apex of lung=>

A

Involvement:

  • Reduced radial pulse= arterial blood flow blocked= subclavian artery damaged
  • face, neck edema=> engorgement of the Jugular vein= venous return blocked
  • Horner’s Syndrome= sympathetic chain compression
  • wasting of 1st dorsal interosseous muscle= T1 compression
  • Pain= brachial plexus involvement
  • hoarseness of voice= recurrent laryngeal nerve damage
116
Q

How is Taste and Sensation and Movement of the tongue seperated by each of the cranial nerves?

A 
Sensation (P:9. A:5)
 --vs-- 
Taste (P:9 A:7) 
--vs--
Motor (12 except for Palatoglossis which is 10)
117
Q

Which nerves are associated with the Superior Orbital Fissure in the Calvaria?

A

CN 3,4,6 V1 of 5

118
Q

What nerves exit or enter in the Internal Acustic meatus in the calvaria?

A

CN 7,8

119
Q

Which nerves are Mixed?

A

also think Vit K clotting factors=2,7,9,10= long PT

120
Q

What nerves innervate the various salivatory glands?

A

7= submandibular + sublingual
–vs–
9= parotid

121
Q

Things that point away or to the same side of injury SIDE of nerve damage?

A 
10=uvula=away,
 4=head=away
----vs---- 
11=neck/head=same, 
12=tongue=same,
122
Q

What nerves are found in the Cavernous Sinus and thus are suceptipble to infections coming up via the ophthalmic vein(no valves)?

A

CN V1,V2,3,4,V,6

123
Q

What do you find inbetween the common carotid artery and the internal jugular vein?

A

Vagus nerve

124
Q

What is made from the Pharyngeal Arches? ***all cartilageous bones are Neural Crest origin

A

1= muscles of mastication + Tensor Tympanic muscle + Maxilla, mandible + INCUS
——VS—–
2= STAPES + muscles of mastication -
—-VS—–
3= common carotid arteries + stylopharyngeus w/CN9
- —VS—
4= superior laryngeal nerve of CN 10, thyroid cartilage + cricothyroid muscle, palate, aortic arch
- —VS—
6= reccurent laryngeal nerve, DUCTUS ARTERIOSIS, intrinisc muscles of the pharynx, venous trunks

125
Q

What are the nerves grow into the pharyngeal archs?

A

V3, 7, 9, 10, ==> actual origin is ectoderm
—-VS—–
the rest wich derive from MESODERM from OCCIPITAL SOMITES

126
Q

How does the tympanic membrane develop?

A 
GROOVE 1||Arch 1  
----------
GROOVE 1= external ear
 ---vs---
Arch 1= internal ear
127
Q

What do the ENDOdermal pharyngeal POUCHES form?

***DiGeorge’s Syndrome= pouch 3= no thymus

A 
1= middle ear, 
2= tonsils, 
3= inferior parathyroid glands + THYMUS 
4= superior parathyroid glands,+ Ultimobrachial Body(neural crest cells= calcitonin cells)
128
Q

What is an astrocyte marker?

A

GFAP

129
Q

What is the only thing that originates from mesoderm in the CNS?

A

microglia CD1-> w/HIV they fuse and form multinucleated giant cells in the CNS

130
Q

Where is the most common site of an acustin Schawnnoma?

A

Internal acustic meatus=> 7,8=> Neurofibramatosis 2

131
Q

What maintains the PERMEABILITY integrity of the peripheral nerve?

A

Perineurium= also what must be micro-attached in surgery for regeneration of nerve

132
Q

Where do you find the sensory Corpuscles of the PNS?

A

Meissner’s= light but specific touch=hairless skin
||||||
Pacinian=large=deep layers= pressure + vibration = found in skin and joints
||||||||
Merkel’s= cup-shaped= hard palate + hair follicle= light/crude touch

133
Q

What are the different functions of the inner ear bony structures?

A

Utricle/Saccule=>Macula=> linear acceleration
——VS—-
Semicircular canals=> Ampullae=> angular acceleration

134
Q

What is the order by which older people loose their hearing?

A

High frequency (narrow/stiff) —-> Low frequency(wide/floppy)

135
Q

What is the order of bones in the inner ear?

A

M-I-S

136
Q

How do you develop Hyperaccusis?

A

Damage to the Facial nerve 7 => paralysis of the stapedius= leads to uninhibited stapes movement

137
Q

What is Meniere Syndrome?

A

Reccurent: Vertigo, Tinitus (semicircular canals), hearing loss=> increase endolymph pressure

138
Q

Most of the BBB is non-fenestrated cappilaries except certain areas which include?

A

Area Posterna= during chemo=> stimulate vomiting
———-
Neurohypophysis allows hormones to enter circulation

139
Q

Where do you see Blood-tissue barriers?

A
  1. BBB 2. Blood-testis barrier 3. Maternal-fetal blood
140
Q

What nucleus in the HYPOTHALAMUS when damaged causes anorexia and starvation?

A

Lateral Nucleus
—-VS—-
Ventromedial Nucleus =satiety= when destroyed=> obesity

141
Q

What nucleus in the Hypothalamus regulate the autonomic nervous system?

A 
PNS=>  Anterior (also cools)
----VS----
 SNS=>Posterior (keeps you warm) 
-----VS--- 
Circadian Rhythem= suprachiasmatic
142
Q

What hypothalamic nucleus causes rage when damaged?

A

Septal Nucleus

143
Q

What recieves information in the THALAMUS from music/sight?

A

music= MGN
—VS—
sight/light= LGN

144
Q

What nucleus recieves sensory input from the face vs. the body in the THALAMUS?

A

Body= VPL (dorsal columns, spinothalamic)
—–VS—–
Face= CN 5=> VPM

145
Q

What part of the THALAMUS recieves information from motor pathways?

A

VA/VL

146
Q

In the basal ganglia the Striatum (caudate nucleus/nucleus acummbens= pleasure) + the Gpi are both what type of circuitry?

A

Inhibitory via GABA

147
Q

Stimulation of the Striatum causes what NET effect on the Cortex?

A

Stimulation and vice versa with inhibition

148
Q

What 2 structures comprise the Limbic System= emotion + memory?

A

HPC + Amygdala

149
Q

What does the DIRECT Pathway facilitate when stimulated by the Substantia Nigra Dopamine NT?

A

D1 Receptors =Facilitates movement
——VS——
INDRECT pathway:D2 Receptors inhibits movement

150
Q

What gets damamged in Parkinson’s Disease?

A

Substantia Nigra —> Striatum influence (D1 or D2) => loss of DA ==> inability to destroy alpha-synuclein via ubiquination (mutations: PARKIN/E3 Ubiquin Ligase)= forms LEWY bodies in cells => apoptosis
***also caused by Paraquat toxicity

151
Q

Where does surgery play a role in Parkinson’s Disease?

A

Cut the Indirect pathway=> Hemiballismus (proximal and contralateral) limbs is a side effect of surgery

152
Q

In unconcious patients how can brain stem damaged be assessed?

A

Caloric Nystagmus => COLD water in ear= no fast nystagmus but slow moves towards side with water ==> NO BRAIN DAMAGE
——–VS——–
Lesion= bilateral MLF damage= ipsilateral fast nystagmus to side with COLD water
—–VS—-
BRAIN STEM (low) DAMAGE= NO EYE MOVEMENT
**EVERYTHING OPPOSITE WITH WARM WATER***

153
Q

What is the most obvious sign of Frontal Lobe damage?

A

Lack of social judgement

154
Q

What limbs are affected by the different cerebral arteries?

A 
ACA= lower limbs 
----VS---
MCA=aphasias, hands, face, throat
----Vs----
PCA= vision loss 
---VS----
Anterior Communicating Artery= is susceptible to Aneurysms which can press on the optic nerves and cause vision problems
155
Q

What nerve runs below the PCA?

A

CN 3 but the posterior communicating artery can also cause an Aneurysm which can cause CN3 Palsy

156
Q

What artery branch of the MCA supplies the internal capsule, caudate, putamen, and GP?

A

Lateral Striate= highly susceptible to strokes

157
Q

How do strokes in the anterior vs. the posterior Circle of Willis manifest?

A

Anterior= sensory/motor deficits, aphasia,
——VS——-
Posterior= CN deficits=> vertigo, visual deficits, coma, ataxia

158
Q

What is the pathway of the CSF in the brain?

A

Lateral Foramen of Monro –> 3rd Ventricle –> aqueduct of Sylvius—> 4th Ventricle:
—> Lateral: Foramina of Luschka
—>Medial: Foramina of Magendie
======> subarachnoid space
————————-
most occlusions occur at the Tentorial Notch

159
Q

At what level do you need to perform a Lumbar Puncture?

A

Layers the needle passes through to get to the CSF?
——
the skin, sub-
cutaneous tissue, supraspinous ligament, interspinous ligament between the spi-
nous processes, ligamentum flavum, epidural space including the internal vertebral
venous plexus, dura, and arachnoid, into the subarachnoid space and between the
nerve roots of the cauda equina.
***NOT THE PIA + Pop sound= ligamentum flavum

160
Q

From medial to lateral what is the orientation of the tracts of the Spinal Cord?

A
  • Dorsal Columns= G(arm) –> C(leg)
  • CST= arm–> Leg
  • —-VS——-
  • Spinothalamic= LEG –> ARM
161
Q

What is the order of the Dorsal Column pathway for vibration/touch/proprioception?

A

Sensory organ –> DRG==> goes up the SC ipsilaterally –> NUCLEUS CUNEATUS (medulla) ==> crosses and goes up with the Medial Lemniscus–> VPL of thalamus==> Sensory Cortex

162
Q

What is the pathway for the Spinothalamic Tract?

A

Sensory=>SC and crosses(white commissure) ==> VPL of Thalamus ==> sensory cortex

163
Q

What nerves in forearm pass through muscles?

** possibility of muscle entrapment

A 
Radial= supinator 
Medial= Pronator Teres 
Ulnar= Flexor Carpi Ulnaris 
Musculocutaneous= coracobrachialis
164
Q

What is the difference between Muscle Spindles and Golgi tendon organs?

A

Muscle Spindle= 1a=>monitor muscle length= help you pick up heavy stuff
———–VS——
Golgi Tendon Organ= 1b=> Muscle tension= make you stuff that is too heavy

165
Q

How would you test the whether the spinal cord is intact or not in a neuro exam?

A 
DTR=>
----
C5= biceps reflex
----
C7= triceps reflex 
----
L4= Patella reflex 
----
S1= Achilles reflex 
----
Babinski Reflex= UMN lesions= dorsiflex/toes fan out is positive
166
Q

What type of lesions can make some primitive lesions return like before when you were 1 year old?

A

Frontal Lobe lesions=> Moro (startle=extension of limbs), Rooting(looking for nipple), Palmar(grasping), Babinski

167
Q

Where are Cranial Nerve Nuclei located?

A 
midbrain= 3,4
Pons= 5,6,7,8
medulla=9,10,11,12 
------
Nucleus Solitarius= visceral sensory= 7,9,10
nucleus Ambiguus= throat motor= 9,10,11
168
Q

Where does the Ophthalmic Artery and the Vein enter/exist in the calvaria?

A

Vein= Superior Orbital Fissure (also: 3,4,V1,6)

169
Q

What can develop in the cavernous sinus?

A

Maxillary sensory loss + Ophthalmoplegia= V1/V2 compression

170
Q

What Trigeminal branch can prevent you from masticating (masseter, temporalis, medial pterygoid) when damaged?

A

V3
—-VS—-
what opens the mouth= LATERAL pterygoid

171
Q

What nuclei is responsible for the Pupillary Light Reflex Consensually i.e contriction of the pupil (circular muscle)?

A

Damage to the Posterior Commissure would STOP the consensual pathway

172
Q

What kind of visual problems would you get with damage to the?

A

-optic chiasm= Bitemporal
———-
hemianopia= tunnel vision
———-
-optic tract= inability to see one side of visual field
———-
-unilateral Calcarine fissure= one sided vision loss= with Macular sparing

173
Q

Projections from the LGN to the visual Cortex run either through the Temporal Lobe and the Parietal Lobe can become damaged and present?

A

Temporal=Meyer’s Loop= cannot see the opposite UPPER quadrant
——-VS——-
Parieteal Lobe= Dorsal optic radiation= opposite LOWER quadrant vision loss

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