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
Pancreatic Pseudocyst= complication of acute pancreatitis= elevated amylase/lipase= FEVER + epigastric pain
Epigastric mass= NO capsule= fluid is retained by: peritoneal surface, large bowel, diaphragm
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
-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
What are the boundaries of the LESSER SAC?
hepatoduodenal ligament + Caudate lobe of liver + duodenum + IVC
Portal Hypertension=vomits a lot of blood= alcoholic= Hypovolemic (tachycardia/hypotensive/pallor)
- 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
Tracheoesophageal Fistula= newborn=> chokes, coughs, vomits undigested food=> proximal esophagus ends blindly while distal connected to trachea=> air in stomach
- 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
What is the anomaly in a Tracheoesophageal Fistula?
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
What is maternal oligohydramnios?
bilateral renal agenesis + posterior urethral valves => no fetal urine or an obstruction that prevents the excretion of amniotic fluid
Rupture of an Abdominal Aortic Aneurysm in MALE=> severe TEARING pain that radiates to the back ==> loss of consciousness due to hypovolemia (hypotension/tachycardia)=>
- pulsatile mass in abdomen
- *Atherosclerosis
- *Marfan’s Syndrome= cystic necrosis of tunica media
- Syphilis (vasculitis)
- *trauma
Femoral Hernia=tender lump in groin that is round and irreducible=STRANGULATION==>FEMALE:
groin pain + vomiting + abdominal distention => requires emergent surgery
***Hernia is medial to Femoral Nerve
Where do the Inferior Hemorrhoidal veins drain into?
Internal Pudendal veins= cause external hemorrhoids which are PAINFUL due to somatic innervation
Tx: Sitz baths = warm water bath
Which hernias are ABOVE the inguinal ligament?
Inguinal hernias=
- Direct (Men=finger pulp)= weak muscle wall
- Indirect (young=persistent Tunica Vaginalis=finger tip)
DIRECT Inguinal Hernia= through Hesselbach’s triangle
-hernia appears with straining (usually caused from Prostate Hyperplasia= forcing pee out or also from frequent constipation= also increases intra-abdominal pressure)
Relative to the Inferior Epigastric vessels where do hernias come out from?
Laterally= INDIRECT= goes inside scrotum
What are the limits of Hesselbach’s Triangle?
- Inferior epigastric artery
- Lateral Rectus Muscle
- Inguinal ligament
INDIRECT inguinal hernia==> OUTSIDE Hesselbach’s triangle=>
often the intestines get trapped and cause dilation and constipation w/o rebound tenderness= obstruction
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
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
Mesenteric Anemia= pain is out of proportion to PE (worse than MI)=> Hx of previous cramping after eating ==>
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
Petit’s Triangle Hernia = near iliac crest =
Traingle= Latissimus Dorsi, external oblique, and iliac crest
Male, left side, pops up when the child cries
What can become damaged during trauma to the Popliteal Fossa?
-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
Sigmoid Volvulus = older individuals=
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
Ureter damage in a female=> oliguria, with left flank pain=> follows Hysterectomy for uterine fibroids==> surgical wound is soaked with urine=
Ureter is damaged during a hysterectomy because it travels under the uterine vessels ==> intra-abdominal urine leakage= flank pain + low grade fever
Varicose Veins= multiparty, obese, female, long periods of standing, worse at night but alleviated by elevating feet
Patients also complain of leg fatigue
**cause= vein valve incompetence= greater saphenous vein= blood buildup= tortuous veins
Gartner’s Duct Cyst
Antero-lateral cyst (serous fluid) on the vulva ==> Wolffian Duct remnant that does not close
Uterine Prolapse with Cystocele= frequency of urination increases w/o voiding=> bacterial infection
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
Squamous Cell Carcinoma (ulcerated lesion with rolled up edges) of the lower lips drains into what lymphnodes==>
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
What muscles comprise the Carotid Triangle where the INTERNAL JUGULAR VEIN is located==>also DEEP cervical nodes
- Posterior Belly of the Digastric muscle
- Omohyoid
- ## SternocleidomastoidWhat is found in the Posterior Cervical Triangle (trapezius, SCM, omohyoid)?
- Deep Cervical nodes
- accessory nerve
DiGeorge’s Syndrome: infants presents with recurrent oral thrush and URI?
- *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)
Caput Succedaneum= BENIGN ecchymosis that occurs during delivery= crosses midline/suture lines vs.?
-Cephalhematoma= fracture= no suture line crossing
Congenital Diaphragmatic Hernia= often associated with no prenatal care=>
- 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
Duodenal Atresia=> premature baby vomiting AT BIRTH (bilious=contains bile)=> distended abdomen= dilated duodenum
- *Down’ Syndrome= single palmar crease
- *Mother had Polyhydroamnios
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
Nephrolithiasis= right flank pain (intermittent + excruciating!)=> radiates to inner thigh/scrotum==> N,V=
Dysuria,hematuria, RESTLESS, #1= radiopaque calcium oxalate stones vs. uric acid stones= translucent
What are some causes of REBOUND tenderness on abdominal palpitation?
- Peritonitis= patient tries to prevents movement to reduce pain
- ## AppendicitisNOT: nephrolithiasis, obstructions
What are some of the complications with a vasectomy?
scrotal hematoma infection spermatic granuloma spermatocele *spontaneous re-canalization
What are some of the LAYERS one must cut in order to do a vasectomy?
- skin
- superficial scrotal fascia=Dartos Fascia
- external spermatic fascia
- cremasteric fascia + muscle
- Internal spermatic fascia
- preperitoneal fat
- tunica vaginalis
- CUT ductus deferens
Acoustic(CN8) Shwannoma= affects hearing(tinnitus) and balance(vertigo)
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
Where do you see bilateral schwannoma’s
AD neurofibramatosis 2 (MEN syndromes)
What is Acute Torticollis?
inflammation –> muscle spasms of the neck=> muscles involved: trapezius muscle, supraspinatus, rhomboid,
Warnicke’s Aphasia= Left Temporal Lobe deficit=> infarct in Left MCA ==>damage to the SUPERIOR TEMPORAL GYRUS
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
Astrocytoma= slow growing= malignant with poor prognosis=> nueroectoderm origin ==> presents as unilateral headache
Kids= Posterior Fossa= Ataxic gait(affects cerebellum), vomiting(brainstem), Papilledema (increase intracranial pressure) + SEIZURES
–VS—
Adults= cerebrum
What structures would be affected by an astrocytoma in a child that is found to encompass the whole Posterior Fossa?
Foramen magnum + Jugular Foramen + internal acustic meatus
Bell’s palsy=>Lower motor Neuron==affect CN7=comes out of the Stylomastoid foramen=> FACIAL paralysis=> mouth droops and unable to close eye voluntarily
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
What muscles are affected by Bell’s Palsy (LMN CN7)?
inability to close eye= obicularis oculus + inability to smile=obicularis oris + no wrinkles in forehead= frontalis muscle
Brown-Sequard Syndrome=Hemisection damage from trauma=>hematoma in area of SC damage
- 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
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)==>
CT: no enhancement of the cavernous sinus
Common Peroneal Nerve Damage= Trauma=common due to SUPERFICIAL location LATERAL to FIBULA head=> Also damamged with knee casts
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
DEAFNESS: how can the Rinne’s test and Webber’s test discriminate Conductive vs. Sensorineural ?
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
Erb-Duchenne Palsy= Damage to C5/C6= dystopic and prolonged delivery in baby or shoulder trauma => Waiter’s tip=>
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
What nerve is often cut while attempting to remove the Parotid gland due to andeocarcinoma?
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
Femoral Nerve Damage=> hip fracture
Patient cannot walk because he cannot flex his hip, cannot extend his knee, and loss sensation of his anterior thigh + medial foot
Deviation of tongue to the side of atrophy and fasciculations=>LMN damage
CN12=hypoglossal nerve damage <= caused by Parotid/Carotid tumors, tuberculous adenitis, metastatic neck tumors
How does the injury develop and what part of the brachial plexus is damaged with Erb’s palsy vs. Klumpke’s Palsy?
Erb’s= hyper-ADDUCTION=> lower plexus
—– VS—–
Klumpke’s= hyper-ABDUCTION=upper-plexus
Klumpke’s Palsy= also a result from shoulder Dystocia==> hyper-abduction=> C7,C8 + T1
Subclavian Artery becomes compressed aswell==> so if you turn away the head from the injured side ther radial pulse disappears
Long Thorasic Nerve Injury= C5,C6,C7,C8,T1=> common in women with previous Mastectomy
Cannot abduct arm beyond shoulder level + Winged Scapula (failure of Serratus Anterior to fix scapula against chest wall)
Mass in Jugular Foramen= CN 9,10,11 come out
Damage to CN11 => atrophy of sternocleidomastoid + trapezius muscle
What can the Uvula tell us about CN 9/10 ==>
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
Where does Prostate CA metastases?
Axial skeleton
ARNOLD-CHIARI SYNDROME=
Hydrocephalus=obstruction
Syringomyelia
platybasia
myelomeningiocele
What to rule out in Parkinsonian Differential?
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.
Recurrent Laryngeal Nerve Lesion: CN X=cut during Thyroidectomy=
LEFT= under aortic arch= possible large lymphnode
Right: under Subclavian Artery
Spina Bifida= Caudal Neuropore does not close
measure maternal alpha-fetoprotein which should be high because of failure of the Dorsal Vertebral Arches to close= lack of Folic Acid
Trigeminal Neuralgia= often compression of arteries=old women BUT if Young think= Multiple Sclerosis
EXTREEM PAIN=> worse with Cold temperature=>
V2=Foramen ovale
V3=Foramen rotundum
Lateral Medullary Syndrome= Wallenburg’s Syndrome=>
PICA occlusion
Ectopic Pregnancy= Lower Abdominal Pain= N,V, syncope(hypotensive)=> History of PID=>
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
What are some RISK FACTORS for ectopic pregnancies=>
-PID
-Prior ectopic pregnancy
-tubal pelvic surgery
-DES exposure
——-
Types:
-Tubal:#1 @ ampulla>isthmus, >fimbrae >interstitium
-abdominal:
-boad ligament:
Pudendal Block=>typical during pregnancy
- natural birth=no anesthesia-analgesia
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
Which ligament is the most commonly injured in hyper inversions of the ankle?
Lateral Ligaments= calcaneofibular, posterior talofibular
—-VS—-
Medial ligaments=>
-Broad Deltoid
Why is Radial Nerve palsy (wrist drop) last a long time?
location of fracture in humerus=> osseous callus + scar tissue formation
Where is the most common Clavicle Fracture location ?
middle 1/3 of the clavicle => pulled up by the sternocleidomastoid and the distal part pulled down by the weight of the arm
TENNIS ELBOW gives you pain when you try to extend your hand because?
Entrapment of the Posterior Interosseous Nerve=> has similar symptoms as Tennis Elbow
Median Nerve Palsy=NOT CARPAL related=>Median Nerve damage was higher==> Wrist Flexion => ulnar deviation
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
Radial Head Subluxation @ the Elbow=> also called nursemaid’s elbow=> Pain in elbow in kids typically=> Extended arm + pronated is PULLED by parent==>
Damages the annular ligament that keeps the radial bone in place=>
kids show up:
1. arm is pronated plus flexed
Monteggia’s Fracture=> Fracture to the Ulna midway=> patient unable to pronate or supinate arm=>
***Child Abuse
Damage:
- dislocates the head of Radial head because fracture pushes it out
- Possible RADIAL NERVE damage because blow typically occurs in that area
What is damaged in the hand when something hard is hit with a CLOSED FIST?
**Boxer’s Fracture
5th metacarpal=> inability to FLEX PINKIE + head of MCP is depressed
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
Femoral Circumflex Arteries (Medial + Lateral) feed the head= absence= necrosis
What nerve exits above the piriformis muscle of the gluteal area exiting the Sciatic Foramen?
Below= Inferior Gluteal Nerve + Artery + Sciatic Nerve ==> gluteus maximus
Hip Dislocation = CONGENITAL= affects girls more= dislocation of the hip= breech birth=> may progress to avascular necrosis of the femoral head
Presentation: asymmetry of legs, knees=> Abduction is limited==> early diagnosis yields better results
Hip Dislocation= TRAUMA=> Posterior disslocation is the most common=>knee inpact against something
Presentation= affected leg=> shortened, internally rotated, adducted => slight flexion= complications include: avascular necrosis (goal in Tx: reduction) => might also cause early degenerative arthritis
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
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)
What is the common triad when the knee recieves a blow laterally?
Lesions=
- ACL
- Medial Meniscus
- MCL
Painfull Knee= Osgood-Shlatter’s Disease=
swelling in the tibial tuberosity= repeated trauma can cut off vascular supply=> avascular necrosis=> self-limited disease
Leg Compartment Syndrome=pain in anterolateral aspect of the leg=> radiates to ankle=>
increase pressure in limited space=> leg is swollen, tense, warm and anterior tibial pulse is weak=> sensory deficits following exercise = treated by removing fascia
Pelvic Fracture= follows severe trauma=> tenderness over: iliac crest + tronchaters bilaterally=>
Bladder and urethral lesions are common with compound fractures to the pelvis= often conceal a lot of blood
What does blood in the urethral meatus contradict?
Insertion of the Foley Catheter= indication of rupture of the membranous urethra ==> suprapubic cystostomy
In a shoulder dislocation (anterior displacement= falling on arm while abducted) what is common?*complaint: no sensation on lateral aspect of arm + flexion problems
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
Shoulder Seperation=> FULL= both ligaments rutpure
ACROMIOclavicular ligament rupture (only in partial) = prevents anterior-posterior displacement of clavicle
–VS—-
CORACOclavicular Ligament=prevents Vertical displacement of the clavicle
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
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
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=>
Diminished radial pulses, sometimes a bruit over subclavian artery which is caused by a poststenotic dilatation**prolonged abduction of arm can precipitate these symtpoms
What are the boundaries of the Anatomical Snuff Box?
Extensor pollicis longus + extensor pollicis brevis=> bottom: scaphoid + trapezium bones
What structures would be cut in someone who slashes their wrist?
-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
When will axillary nodes from a lung cancer be affected?
When there is pleural adhesions since most lung lymphs drain into the supraclavicular nodes
What is Pancoast’s Syndrome? Tumor invades thoracic inlet: Apex of lung=>
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
How is Taste and Sensation and Movement of the tongue seperated by each of the cranial nerves?
Sensation (P:9. A:5) --vs-- Taste (P:9 A:7) --vs-- Motor (12 except for Palatoglossis which is 10)
Which nerves are associated with the Superior Orbital Fissure in the Calvaria?
CN 3,4,6 V1 of 5
What nerves exit or enter in the Internal Acustic meatus in the calvaria?
CN 7,8
Which nerves are Mixed?
also think Vit K clotting factors=2,7,9,10= long PT
What nerves innervate the various salivatory glands?
7= submandibular + sublingual
–vs–
9= parotid
Things that point away or to the same side of injury SIDE of nerve damage?
10=uvula=away, 4=head=away ----vs---- 11=neck/head=same, 12=tongue=same,
What nerves are found in the Cavernous Sinus and thus are suceptipble to infections coming up via the ophthalmic vein(no valves)?
CN V1,V2,3,4,V,6
What do you find inbetween the common carotid artery and the internal jugular vein?
Vagus nerve
What is made from the Pharyngeal Arches? ***all cartilageous bones are Neural Crest origin
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
What are the nerves grow into the pharyngeal archs?
V3, 7, 9, 10, ==> actual origin is ectoderm
—-VS—–
the rest wich derive from MESODERM from OCCIPITAL SOMITES
How does the tympanic membrane develop?
GROOVE 1||Arch 1 ---------- GROOVE 1= external ear ---vs--- Arch 1= internal ear
What do the ENDOdermal pharyngeal POUCHES form?
***DiGeorge’s Syndrome= pouch 3= no thymus
1= middle ear, 2= tonsils, 3= inferior parathyroid glands + THYMUS 4= superior parathyroid glands,+ Ultimobrachial Body(neural crest cells= calcitonin cells)
What is an astrocyte marker?
GFAP
What is the only thing that originates from mesoderm in the CNS?
microglia CD1-> w/HIV they fuse and form multinucleated giant cells in the CNS
Where is the most common site of an acustin Schawnnoma?
Internal acustic meatus=> 7,8=> Neurofibramatosis 2
What maintains the PERMEABILITY integrity of the peripheral nerve?
Perineurium= also what must be micro-attached in surgery for regeneration of nerve
Where do you find the sensory Corpuscles of the PNS?
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
What are the different functions of the inner ear bony structures?
Utricle/Saccule=>Macula=> linear acceleration
——VS—-
Semicircular canals=> Ampullae=> angular acceleration
What is the order by which older people loose their hearing?
High frequency (narrow/stiff) —-> Low frequency(wide/floppy)
What is the order of bones in the inner ear?
M-I-S
How do you develop Hyperaccusis?
Damage to the Facial nerve 7 => paralysis of the stapedius= leads to uninhibited stapes movement
What is Meniere Syndrome?
Reccurent: Vertigo, Tinitus (semicircular canals), hearing loss=> increase endolymph pressure
Most of the BBB is non-fenestrated cappilaries except certain areas which include?
Area Posterna= during chemo=> stimulate vomiting
———-
Neurohypophysis allows hormones to enter circulation
Where do you see Blood-tissue barriers?
- BBB 2. Blood-testis barrier 3. Maternal-fetal blood
What nucleus in the HYPOTHALAMUS when damaged causes anorexia and starvation?
Lateral Nucleus
—-VS—-
Ventromedial Nucleus =satiety= when destroyed=> obesity
What nucleus in the Hypothalamus regulate the autonomic nervous system?
PNS=> Anterior (also cools) ----VS---- SNS=>Posterior (keeps you warm) -----VS--- Circadian Rhythem= suprachiasmatic
What hypothalamic nucleus causes rage when damaged?
Septal Nucleus
What recieves information in the THALAMUS from music/sight?
music= MGN
—VS—
sight/light= LGN
What nucleus recieves sensory input from the face vs. the body in the THALAMUS?
Body= VPL (dorsal columns, spinothalamic)
—–VS—–
Face= CN 5=> VPM
What part of the THALAMUS recieves information from motor pathways?
VA/VL
In the basal ganglia the Striatum (caudate nucleus/nucleus acummbens= pleasure) + the Gpi are both what type of circuitry?
Inhibitory via GABA
Stimulation of the Striatum causes what NET effect on the Cortex?
Stimulation and vice versa with inhibition
What 2 structures comprise the Limbic System= emotion + memory?
HPC + Amygdala
What does the DIRECT Pathway facilitate when stimulated by the Substantia Nigra Dopamine NT?
D1 Receptors =Facilitates movement
——VS——
INDRECT pathway:D2 Receptors inhibits movement
What gets damamged in Parkinson’s Disease?
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
Where does surgery play a role in Parkinson’s Disease?
Cut the Indirect pathway=> Hemiballismus (proximal and contralateral) limbs is a side effect of surgery
In unconcious patients how can brain stem damaged be assessed?
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***
What is the most obvious sign of Frontal Lobe damage?
Lack of social judgement
What limbs are affected by the different cerebral arteries?
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
What nerve runs below the PCA?
CN 3 but the posterior communicating artery can also cause an Aneurysm which can cause CN3 Palsy
What artery branch of the MCA supplies the internal capsule, caudate, putamen, and GP?
Lateral Striate= highly susceptible to strokes
How do strokes in the anterior vs. the posterior Circle of Willis manifest?
Anterior= sensory/motor deficits, aphasia,
——VS——-
Posterior= CN deficits=> vertigo, visual deficits, coma, ataxia
What is the pathway of the CSF in the brain?
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
At what level do you need to perform a Lumbar Puncture?
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
From medial to lateral what is the orientation of the tracts of the Spinal Cord?
- Dorsal Columns= G(arm) –> C(leg)
- CST= arm–> Leg
- —-VS——-
- Spinothalamic= LEG –> ARM
What is the order of the Dorsal Column pathway for vibration/touch/proprioception?
Sensory organ –> DRG==> goes up the SC ipsilaterally –> NUCLEUS CUNEATUS (medulla) ==> crosses and goes up with the Medial Lemniscus–> VPL of thalamus==> Sensory Cortex
What is the pathway for the Spinothalamic Tract?
Sensory=>SC and crosses(white commissure) ==> VPL of Thalamus ==> sensory cortex
What nerves in forearm pass through muscles?
** possibility of muscle entrapment
Radial= supinator Medial= Pronator Teres Ulnar= Flexor Carpi Ulnaris Musculocutaneous= coracobrachialis
What is the difference between Muscle Spindles and Golgi tendon organs?
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
How would you test the whether the spinal cord is intact or not in a neuro exam?
DTR=> ---- C5= biceps reflex ---- C7= triceps reflex ---- L4= Patella reflex ---- S1= Achilles reflex ---- Babinski Reflex= UMN lesions= dorsiflex/toes fan out is positive
What type of lesions can make some primitive lesions return like before when you were 1 year old?
Frontal Lobe lesions=> Moro (startle=extension of limbs), Rooting(looking for nipple), Palmar(grasping), Babinski
Where are Cranial Nerve Nuclei located?
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
Where does the Ophthalmic Artery and the Vein enter/exist in the calvaria?
Vein= Superior Orbital Fissure (also: 3,4,V1,6)
What can develop in the cavernous sinus?
Maxillary sensory loss + Ophthalmoplegia= V1/V2 compression
What Trigeminal branch can prevent you from masticating (masseter, temporalis, medial pterygoid) when damaged?
V3
—-VS—-
what opens the mouth= LATERAL pterygoid
What nuclei is responsible for the Pupillary Light Reflex Consensually i.e contriction of the pupil (circular muscle)?
Damage to the Posterior Commissure would STOP the consensual pathway
What kind of visual problems would you get with damage to the?
-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
Projections from the LGN to the visual Cortex run either through the Temporal Lobe and the Parietal Lobe can become damaged and present?
Temporal=Meyer’s Loop= cannot see the opposite UPPER quadrant
——-VS——-
Parieteal Lobe= Dorsal optic radiation= opposite LOWER quadrant vision loss
