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MEDIMAGE 203 > HAL and Pathology > Flashcards

HAL and Pathology Flashcards

1
Q

What creates the suprascapular notch

A

Typically a bony notch is created by passage of a nerve or vessel

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2
Q

Which is more anterior Coracoid process or the acromion

A

Coracoid

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3
Q

Where do the lateral and medial aspects of the clavicle articulate?

A

Lat = Acromion .
Med = Manubrium .

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4
Q

When coupled with the shallow Glenoid Fossa can you think of one pro and one con that arise from their articulation

A

Pro = high mobility .
Con = low stability

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5
Q

Identify the two Tubercles – Greater and Lesser. Which one is more anterior? (Humerus)

A

Lesser tubercle

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6
Q

Which part of the humerus is most likely to fracture

A

Surgical Neck

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7
Q

Why does the capsule of the shoulder sag inferiorly?

A

To facilitate larger range of motion, particularly abduction

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8
Q

What happens if the transverse humeral ligament ruptures

A

Long head of bicep tendon subluxes anteriorly

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9
Q

How is the shoulder joint described?

A

Intracapsular but extrasynovial as it continues through the joint to insert on the supraglenoid tubercle.

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10
Q

Why might you expect to see in these shoulder sheaths/bursae if you suspected shoulder pathology.

A

Inflammation and increased fluid quantity. Degradation and loss of function if damaged

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11
Q

What movement does the supraspinatus elicit on the humerus

A

Abduction (1st 15*)

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12
Q

What movement does the Infraspinatus elicit on the humerus

A

External rotation

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13
Q

What movement does the Teres Minor elicit on the humerus

A

External rotation

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14
Q

What movement does the Subscapularis elicit on the humerus

A

Internal rotation

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15
Q

What is the function of the bursa associated with the rotator cuff?

A

Limit friction/wear of tendons

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16
Q

What is the role of the long tendon of biceps brachii of the shoulder joint

A

Maintains head in Glenoid fossa

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17
Q

What happens to the tendon of the transverse humeral ligament is disrupted

A

Subluxes anteriorly

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18
Q

What is the main artery coming from the Aorta to supply the upper limb

A

Subclavian artery

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19
Q

When does the subclavian change into the axillary artery

A

Once it passes the lateral border of Rib 1 (armpit)

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20
Q

When does the axillary change into the brachial artery?

A

At the inferior border of teres major

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21
Q

What is the main distal tributary of the Axillary Vein?

A

The Basilic Vein, which drains the superficial medial aspect of the arm and forearm.

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22
Q

How do the Brachial Veins compare to the Basilic Vein?

A

The Brachial Veins are smaller, deeper, and follow the artery more intimately.

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23
Q

What is the lateral counterpart to the Basilic Vein?

A

The Cephalic Vein, which drains into the Axillary Vein higher in the shoulder.

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24
Q

What type of injury might put the Radial Nerve at risk, considering its posterior route around the humerus?

A

A mid-shaft humeral fracture.

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25
Q

What is the significance of the Fovea Capitis

A

This is where the ligamentum teres inserts

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26
Q

What is the greater trochanter (Femur) the attachment site for

A

Gluteus Med/Min and Piriformis

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27
Q

What does the lesser trochanter serve as a attachment for?

A

Iliopsoas

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28
Q

The trochanteric fossa is where the … insert

A

Short external rotators of the hip

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29
Q

Do you have more Medial or more Lateral rotation possible at the Hip?

A

Roughly similar – ~30° lat/40° med

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30
Q

How does the range of motion in the hip change during flexion when internally and externally rotating the hip?

A

Medial rotation decreases or stays similar, while lateral rotation significantly increases (~50°).

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31
Q

How does lateral rotation of the hip change during extension?

A

Lateral rotation slightly decreases, especially compared to a flexed hip.

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32
Q

How do abduction and adduction differ in a flexed vs. extended hip?

A

In a flexed hip, there is a greater range of abduction but less adduction. In an extended hip, there is less abduction but slightly more adduction.

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33
Q

What is circumduction, and how is it performed at the hip?

A

Circumduction is a composite movement involving flexion, extension, abduction, and adduction, performed by circling the thigh and leg.

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34
Q

What is the general shape difference between male and female pelvises?

A

The male pelvis is narrower and more heart-shaped, while the female pelvis is wider and more circular or oval-shaped.

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35
Q

Which is contained within the pelvis

A

Abdominal viscera (large & small bowel) and pelvic viscera (rectum, bladder, vagina, uterus and other internal genitalia)

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36
Q

What passes through the obturator foramen

A

Obturator nerve and obturator artery

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37
Q

What happens when there is trauma to the pelvic ring?

A

If the pelvic ring breaks in one place, it usually breaks or dislocates in another, due to the ring structure of the pelvis.

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38
Q

Hip Joint Capsule Attachments:

A

Medially: Attaches to the rim of the acetabulum.
Anterolaterally: Attaches to the intertrochanteric line.
Posterolaterally: Attaches to the greater trochanter and the neck of the femur.

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39
Q

Ligaments of the Hip Joint and Their Functions:

A

Ischiofemoral Ligament:

Limits: Hip extension, adduction, and medial rotation.
Iliofemoral Ligament:

Limits: Hip extension, adduction (superior band), abduction (inferior band), and lateral rotation.
Pubofemoral Ligament:

Limits: Hip abduction and lateral rotation.

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40
Q

Pelvic Stabilizing Ligaments:

A

Sacrospinous Ligament:

Location: Between the sacrum and the ischial spine.
Function: Converts the greater sciatic notch into the greater sciatic foramen.
Sacrotuberous Ligament:

Location: Between the sacrum and the ischial tuberosity.
Function: Converts the lesser sciatic notch into the lesser sciatic foramen.

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41
Q

What is the function of the Ligamentum Teres?

A

Stabilizes the head of the femur in the acetabulum.
During development, it carries an artery that supplies blood to the developing femoral head.

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42
Q

What are the major arteries in the pelvis?

A

The major arteries are the Common Iliac arteries, which divide into the Internal Iliac artery and the External Iliac artery.

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43
Q

What is the primary function of the Internal Iliac artery?

A

The Internal Iliac artery supplies the pelvic contents and the gluteal region.

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44
Q

What does the External Iliac artery become and what is its function?

A

The External Iliac artery becomes the Femoral artery, which supplies the entirety of the lower limb.

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45
Q

How is the Hip joint supplied with blood?

A

The Hip joint is supplied by a rich anastamotic network of arteries principally derived from the Deep Branch of the Femoral artery (Profunda Femoris), which gives off the Medial and Lateral Circumflex arteries. These anastamose with each other and with branches of the Superior and Inferior Gluteal arteries, which come from the Internal Iliac artery.

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46
Q

What is the purpose of having an anastamotic network in the hip joint?

A

The anastamotic network provides collateral blood flow in case of occlusions, whether pathological or non-pathological, ensuring continuous blood supply to the hip joint and lower limb.

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47
Q

What is the source of blood supply to the Head of the Femur?

A

The blood supply to the Head of the Femur comes from the Retinacular arteries, which arise from the anastamotic network and pierce the capsule, running along the Femoral Neck before entering the bone.

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48
Q

What is the role of the artery of the Ligamentum Teres in adulthood?

A

In adulthood, the artery of the Ligamentum Teres provides an insignificant supply to the Head of the Femur.

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49
Q

What scenario can critically compromise the Retinacular arteries, and what would be the result?

A

A Femoral Neck Fracture can critically compromise the Retinacular arteries, leading to avascular necrosis of the Head of the Femur.

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50
Q

What is the general function of the muscles in the anterior compartment of the thigh at the Hip and knee

A

Flexion and extension

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51
Q

The base of the Femoral Triangle is formed by the Inguinal
Ligament. Proximal to this ligament what are the Femoral artery and Femoral vein known as?

A

External Iliac artery/vein

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52
Q

What does the Sciatic Nerve supply?

A

The entire Posterior Compartment of the Thigh (the Hamstrings) and everything below the knee, except for a small amount of sensory innervation on the Medial Shin performed by the Femoral nerve.

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53
Q

From which nerve roots does the Sciatic Nerve originate?

A

L4-S4 nerve roots of the Lumbar and Sacral Plexuses.

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54
Q

What is the relationship of the Sciatic Nerve to the Hip Joint?

A

The sciatic nerve is located posterior to the hip joint, emerging from the pelvis through the greater sciatic foramen and traveling down the back of the thigh.

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55
Q

How does the Sciatic Nerve exit the Pelvis to enter the Gluteal Region?

A

It passes out laterally through the Greater Sciatic Foramen, anterior to the Piriformis.

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56
Q

Where do the Ureters cross the Pelvic Brim?

A

The Ureters cross the Pelvic Brim on the surface of the Psoas Major Muscle and reach the posterior aspect of the Bladder.

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57
Q

What major artery do the Ureters cross at the Pelvic Brim?

A

The Common Iliac artery.

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58
Q

What do you think the function of these fat pads is?

A

Protection – Kidneys are somewhat exposed posteriorly as they hang below the last two ribs so extra fat pads and protects
them and stops them moving too much .

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59
Q

Estimate the position of the Left and Right Kidneys.

A

Left Kidney: Behind Ribs 11 & 12.
Right Kidney: Behind Rib 12.

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60
Q

How can the position of the Ureters be estimated on plain film?

A

The Ureters descend roughly in line with the Transverse Processes of the Lumbar Vertebrae.

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61
Q

Major differences in the Bladder and Urethra between males and females.

A

Male: Bladder sits on top of the Prostate; Urethra is long with two bends.
Female: Uterus lays on top of the Bladder; Urethra is very short and straight.

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62
Q

Where may kidney stones commonly get stuck between the Kidney and the Bladder?

A

At the Renal Pelvis (start of Ureter).

As it crosses the pelvic brim (over the Common Iliac artery bifurcation).

Where it enters the Bladder.

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63
Q

Which organ is located
within the inner curvature of the Duodenum?

A

Pancreas (head)

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64
Q

What are the subdivisions of the Small Intestine?

A

Duodenum
Proximal Jejunum
Distal Ileum

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65
Q

Why is the Small Intestine convoluted and suspended?

A

Allows for greater length to fit in the abdominal cavity, increasing absorption.

Provides mobility for the passage of food.

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66
Q

What are Plicae Circularis or Valvulae Conniventes?

A

They are ring-like structures traversing the inner walls of the Small Intestine, aiding in nutrient absorption.

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67
Q

What is the appendix attached to?

A

Attached to the Caecum and found in the Right Groin

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68
Q

Teniae Coli

A

longitudinal bands of muscle

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69
Q

Haustra

A

Sac-like out-pouchings of the intestinal wall

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70
Q

Which intestine is there no gas?

A

Large

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71
Q

Which structure transects the whole bowel?

A

Valvulae conniventes

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72
Q

how far superiorly does the Liver extend?

A

Rib 5/6

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73
Q

Where is the gallbladder located

A

Costal cartilage of the right 9th Rib in the midclavicular line

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74
Q

Which part of the gut is the head of the pancreas connected to?

A

Desceding duodenum

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75
Q

Where does the spleen get the its blood supply from?

A

Splenic Artery

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76
Q

At which vertebral level does the Celiac Trunk arise, and what does it supply?

A

Level: Around T12-L1 vertebral level
Supplies: FOREgut structures (Distal Esophagus to ½ Duodenum, Liver, Spleen, and Pancreas)

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77
Q

At which vertebral level does the Superior Mesenteric Artery (SMA) arise, and what does it supply?

A

Level: L1 vertebral level
Supplies: MIDgut structures (Distal ½ Duodenum to 2/3 Transverse Colon, including Jejunum and Ileum)

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78
Q

At which vertebral level does the Inferior Mesenteric Artery (IMA) arise, and what does it supply?

A

Level: L3 vertebral level
Supplies: HINDgut structures (Distal 1/3 Transverse Colon to Rectum)

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79
Q

What are the three main branches of the Celiac Trunk, and their directions?

A

Common Hepatic artery: To the right
Left Gastric artery: Superior
Splenic artery: To the left

80
Q

At which vertebral level does the Abdominal Aorta bifurcate, and what are the resulting arteries?

A

Level: L4 vertebral level
Resulting Arteries: Common Iliac arteries, which further bifurcate into Internal Iliac and External Iliac arteries

81
Q

What major artery does the External Iliac artery become?

A

Femoral artery

82
Q

What are Pre-aortic and Para-aortic branches?

A

Pre-aortic: Branches off the front (midline) of the Aorta
Para-aortic: Branches off the sides of the Aorta

83
Q

Why is the Left Renal vein longer than the Right Renal vein?

A

The Left Renal vein is about 3 times longer because the IVC is located more to the right side of the body, while the Aorta is more midline.

84
Q

Where does the Left Renal vein cross and what is the associated risk?

A

Path: Crosses over the Aorta and beneath the Superior Mesenteric Artery (SMA)
Risk: May be clamped off during procedures or due to SMA aneurism

85
Q

Which veins form the Portal Vein?

A

Splenic vein and Superior Mesenteric vein

86
Q

Which vein does the Inferior Mesenteric Vein (IMV) drain into?

A

Splenic vein

87
Q

Why does the IMV drain into the Splenic vein instead of directly into the Superior Mesenteric Vein (SMV)?

A

The IMV must cross the midline, so it is safer to drain into the Splenic vein first.

88
Q

How does blood from the liver return to systemic circulation after processing?

A

Blood from the liver drains into the Inferior Vena Cava (IVC) via the Hepatic veins after passing through the Portal Vein system.

89
Q

What is the superior articulation of the C1 (Atlas)?

A

The Base of the Skull (Occiput).

90
Q

What is the joint between the C1 and the Base of the Skull called?

A

Atlanto-Occipital Joint.

91
Q

What movements are permitted at the Atlanto-Occipital Joint?

A

Extension/Flexion (nodding) and slight lateral flexion.

92
Q

What does the C1 (Atlas) lack that other cervical vertebrae have?

A

A Vertebral Body.

93
Q

How do the Superior Articular Facets of C1 compare to those of other vertebrae?

A

They are much larger, broader, and flatter.

94
Q

Is the Articular Facet for the C2 Dens on the Anterior or Posterior Arch of C1?

A

Anterior Arch.

95
Q

What is the function of the Transverse Atlantal Ligament?

A

It maintains the Dens Process in articulation.

96
Q

How many joints make up the Atlanto-Axial Joint?

A

Three – two between Articular Facets + Dens & Anterior Arch of C1.

97
Q

What type of movement is primarily permitted between C1 and C2?

A

Rotation mostly.

98
Q

Where do the C1 and C2 nerve roots emerge in relation to their respective vertebrae

A

Cervical nerve roots emerge superior to their respective vertebrae. (Note: Thoracic & Lumbar nerves emerge beneath their respective vertebrae, hence the extra C8 nerve).

99
Q

What distinguishes a Cervical Vertebra from a Thoracic or Lumbar Vertebra?

A

Presence of a Transverse Foramen.

100
Q

Why are the Transverse Processes of Cervical Vertebrae gutter-shaped?

A

The gutter shape allows space for the Spinal nerves and important arteries to run through.

101
Q

What is distinctive about the Spinous Process of C7 on a radiograph?

A

The Spinous Process of C7 is very long, usually not bifid, and is more thoracic in form. It is also the first spinous process visible externally on the skin, making it a good surface landmark.

102
Q

What movements do the synovial joints in the cervical region permit and limit?

A

Permit: Flexion / Extension
Limit: Lateral flexion / Rotation

103
Q

How many Intervertebral (IV) Discs are there in the Cervical region, and why?

A

Number of IV Discs: 6
Reason: There is no disc between C1 & C2 because C1 lacks a body, and the Dens of C2 must project upward.

104
Q

How are Intervertebral Discs named in the Cervical Spine?

A

IV Discs are named after the Vertebrae above and below them (e.g., the disc between C5 and C6 is the C5-6 Disc).

105
Q

Describe the appearance of the Intervertebral Discs on an X-ray.

A

The IV Discs appear radiolucent (dark) on an X-ray.

106
Q

Through which space does the Spinal Cord run in the Cervical Vertebrae?

A

The Spinal Cord runs through the Spinal Canal in the Cervical Vertebrae.

107
Q

Why might the Intervertebral Foramina be of clinical interest?

A

Narrowing of the Intervertebral Foramina due to inflammation, arthritis, or trauma may lead to neurological symptoms by compressing nerve roots, particularly in the neck and upper limb.

108
Q

What are the three parts of the Pharynx?

A

Nasopharynx (behind the Nasal Cavity)
Oropharynx (behind the Oral Cavity)
Laryngopharynx (behind the Larynx)

109
Q

What do you notice about the passage of food and air in the Pharynx region?

A

They cross each other.

110
Q

What are the main structures of the Larynx in order from superior to inferior?

A

Hyoid Bone
Thyroid Cartilage
Cricoid Cartilage

111
Q

What potential consequences might arise from the crossing of food and air passages

A

Food is at risk of going down the airways.

112
Q

How does the Cricoid Cartilage differ from the other structures in the Larynx?

A

It is a full ring, whereas the others are “C-shaped.”

113
Q

Which cartilage creates the “Adam’s Apple”?

A

Thyroid Cartilage

114
Q

What is the function of the Epiglottis, and how does its form help it achieve this?

A

Depresses when food is passing down to prevent it from entering the Larynx.
Form: Made of elastic cartilage and anchored by ligaments to the Hyoid and Thyroid, allowing it to spring back open after food passes.

115
Q

Why is the Laryngopharynx primarily muscular while the Larynx and Trachea have cartilage?

A

The Pharynx must expand to accommodate food, while the Larynx needs structure to prevent collapse, similar to how a straw collapses when sucked too hard.

116
Q

Why are the airways mostly made of C-shaped structures?

A

The Pharynx/Oesophagus can expand into the airways slightly as food passes down, since the vertebral column behind is rigid.

117
Q

What is the consequence of the Cricoid Cartilage being a full ring rather than C-shaped?

A

It can be a potential site of constriction or blockage as things pass down.

118
Q

Which Laryngeal structure approximates the location of the Carotid Bifurcation?

A

The Hyoid Bone (anterior aspect).

119
Q

What vertebral level corresponds to the Hyoid Bone?

A

C3 / C3-4.

120
Q

At which vertebral level does the Oesophagus begin?

A

C6 / C5-6.

121
Q

At which vertebral level does the Trachea begin?

A

C6 / C5-6 (same as Oesophagus).

122
Q

Which artery primarily supplies the Brain?

A

The Internal Carotid artery.

123
Q

What does the External Carotid artery do?

A

It supplies structures external to the Cranium, including the neck, face, mouth, nose, and ears.

124
Q

Describe the course of the Vertebral arteries in relation to the Cervical Vertebrae.

A

The Vertebral arteries course through the Transverse Foramina of C1-6 (not C7).

125
Q

Which large veins run with the Carotid vessels in the Carotid Sheath?

A

The Internal Jugular veins (IJV).

126
Q

Where do the IJVs join the Subclavian veins?

A

The IJVs join the Subclavian veins to form the Brachiocephalic Trunks at the root of the Neck, behind the Sternoclavicular Joints.

127
Q

Where is the Thyroid Gland located in relation to the Thyroid Cartilage?

A

The Thyroid Gland sits atop the Trachea, mostly around the Trachea, but its lateral parts may extend up to the level of the Thyroid Cartilage.

128
Q

Which arteries do the Left and Right Recurrent Laryngeal (RL) nerves hook around?

A

Left RL nerve: Arch of the Aorta
Right RL nerve: Right Subclavian artery

129
Q

What is the consequence of damaging the RL nerves?

A

Laryngeal pathology, leading to a hoarse voice or airway obstruction.

130
Q

What does the Phrenic nerve innervate and what is its root value?

A

The Phrenic nerve innervates the Diaphragm and has a root value of C3-5

131
Q

What do the Cervical Plexus (C1-4) and Brachial Plexus (C5-T1) supply?

A

The cervical plexus supplies sensory and motor innervation to the neck, including the skin and some muscles (e.g., the diaphragm via the phrenic nerve from C3-5).

The brachial plexus supplies sensory and motor innervation to the upper limb, including the shoulder, arm, forearm, and hand muscles.

132
Q

What differences do you notice in the Bodies and Spinous Processes between T1 and T12? Why is this?

A

T12 looks more like a Lumbar vertebra: it has a big, squared body and a thick, short Spinous Process.
This change in form is because T12 needs to support more weight further down the spinal column, showing a continuum of size increase and form change from T1 to T12.

133
Q

What passes through the Intervertebral Foramina?

A

Spinal Nerves.

134
Q

How many Typical Vertebral Bodies does each Rib articulate with? (and vice versa)

A

Two

135
Q

How many individual Synovial Joints does a Typical Rib form with the Vertebral Column?

A

Three

136
Q

Why do the ribs have so many small joints with the Vertebrae?

A

Stability and movement. Many small joints permit movement while maintaining stability.

137
Q

Which specific parts of the Vertebrae do the Ribs articulate with?

A

Body (Superior Hemi-facet)
Transverse Process (TP) of their own Vertebra
Body of the Vertebra above (Inferior Hemi-facet)

138
Q

What is atypical about Rib 1 and T1?

A

Rib 1 has only one facet on its head and articulates with T1 only.
T1 has a complete facet instead of a hemi-facet, due to the absence of a vertebra above it.

139
Q

Why are T10-T12 considered atypical?

A

The vertebrae below T9 are large like lumbar vertebrae.
Ribs T10-T12 articulate only with their own vertebrae, not with the vertebrae above.

140
Q

What effect does the morphology of T12 have on the 12th Rib?

A

T12’s morphology with one facet on the body and no TP facet allows for more movement and less stability.
This design makes the 12th Rib less likely to fracture and more flexible, protecting the kidneys.

141
Q

What type of joints are the Zygapophyseal Joints? What does this morphology allow for?

A

Type: Synovial
Function: Allows small sliding movements in limited planes.

142
Q

What structures form the Zygapophyseal Joints between adjoining vertebrae?

A

The Superior and Inferior Articular Facets of adjoining vertebrae.

143
Q

How do the Thoracic and Lumbar Zygapophyseal Joints compare in terms of movement?

A

Thoracic: Limited flexion/extension; allows more twisting and lateral bending.
Lumbar: Greater flexion/extension; minimal twisting or lateral bending.

144
Q

What type of joint is the Intervertebral (IV) Disc? (Hint: All midline joints share this in common)

A

Symphysis (Fibrocartilaginous / 2ndary Cartilaginous).

145
Q

What are the primary components of an Intervertebral Disc and their functions?

A

Annulus Fibrosus: Concentric layers of collagen running in opposing directions; provides structural support and absorbs compressive forces.
Nucleus Pulposus: Jelly-like center; absorbs shock and allows slight movement between vertebral bodies.

146
Q

What can you tell about the functions of the Intervertebral Discs based on their morphology?

A

They are designed to absorb compressive forces and allow slight movement between vertebral bodies.

147
Q

What structures do the Longitudinal Ligaments run anteriorly and posteriorly to, and where do they attach?

A

They run anterior and posterior to the Vertebral Bodies and Intervertebral Discs, attaching to both.

148
Q

What is the primary role of the Anterior Longitudinal Ligament?

A

Restricts Extension of the Spine.

149
Q

What is the primary role of the Posterior Longitudinal Ligament?

A

Restricts Flexion of the Spine.

150
Q

What secondary function do the Longitudinal Ligaments provide?

A

Help prevent anterior or posterior herniation of Intervertebral Discs.

151
Q

How can Diffuse Idiopathic Skeletal Hyperostosis (DISH) be distinguished from Ankylosing Spondylitis (AS) on X-rays?

A

DISH shows a fusion line across vertebrae on the anterior aspect (visible on lateral radiographs). AS shows lateral and posterior fusion across bodies with involvement of the IV Disc periphery and Sacroiliac Joints, and may present as a “Bamboo Spine” or “Squaring” of the Bodies on X-rays.

152
Q

What differences in appearance might you see on X-rays between DISH and AS?

A

DISH typically shows anterior fusion lines and is visible on lateral X-rays, while AS may present as “Bamboo Spine” in PA views and “Squaring” of Vertebral Bodies in lateral views.

153
Q

How many Lumbar Vertebrae are there?

A

Five.

154
Q

What features generally differentiate Lumbar Vertebrae from Thoracic Vertebrae?

A

Lumbar Vertebrae have larger, squarer bodies, short and squared spinous processes, smaller transverse processes, and lack rib articulations. They are specialized for supporting weight.

155
Q

Why is the morphology of the Lumbar Spinous Processes clinically significant?

A

The morphology creates access to the Spinal Canal, making it easier to perform procedures like Lumbar Punctures.

156
Q

How many Sacral Vertebrae are there, and what do they form?

A

Five fused Sacral Vertebrae, which form the Sacrum. The Sacrum also has lateral bodies called Alae (“wings”).

157
Q

What are the clinical uses of the Sacral Hiatus?

A

It provides access to the Sacral Canal for procedures like Sacral Nerve Blocks.

158
Q

Which part of the Pelvis do the Sacral Alae articulate with, and what is the joint called?

A

The Sacral Alae articulate with the Iliac Bones of the Pelvis, forming the Sacro-Iliac Joint.

159
Q

Where does the Spinal Cord end, and what continues below this point?

A

The Spinal Cord ends at around L1/L2, and below this point, the Cauda Equina (a collection of Spinal Nerves) continues down to the Sacral Hiatus.

160
Q

Why are Lumbar Punctures performed in the lower Lumbar region rather than the Thoracic region?

A

Lower Lumbar regions are preferred because there is less risk of damaging the Cauda Equina compared to the Spinal Cord. The Thoracic region is not used due to the presence of the Spinous Processes.

161
Q

How many Thoracic and Lumbar Spinal Nerves are there?

A

Thoracic: 12; Lumbar: 5.

162
Q

How do Spinal Nerve Roots emerge in relation to their respective vertebrae?

A

Each Spinal Nerve emerges inferior to its respective Vertebra.

163
Q

What are the two plexuses supplying the Lower Limb and Pelvis, and what are their nerve roots?

A

The Lumbar Plexus (T12, L1-4) and the Sacral Plexus (L4-5, S1-4).

164
Q

What regions does the Lumbar Plexus mostly supply, and what symptoms might result from nerve root compromise?

A

The Lumbar Plexus supplies the anterior thigh muscles and the skin on the anteromedial thigh and medial leg. Symptoms of nerve root compromise may include burning, numbness, muscular pain, and weakness in these regions.

165
Q

Where do the Sacral Nerve Roots contributing to the Sacral Plexus emerge from?

A

Anterior Sacral Foramina.

166
Q

Which muscle does the Sacral Plexus form anterior to, and through which space do its nerves exit the Pelvis?

A

The Sacral Plexus forms anterior to the Piriformis muscle and exits the Pelvis through the Greater Sciatic Foramen.

167
Q

Which are more common, Lumbar or Sacral nerve root injuries/compressions, and why?

A

Lumbar nerve root injuries/compressions are more common because the Lumbar Spine is more mobile and prone to changes or injuries compared to the more stable Sacral Spine.

168
Q

What does normal alignment look like in a lateral view of the shoulder, and how is it described?

A

The Glenoid is fully surrounded by the head of the humerus.
The Spine of the Scapula, Coracoid, and Blade of the Scapula form a “Y” (similar to an upside-down Mercedes logo).

169
Q

How can you identify a posterior dislocation of the humerus on an X-ray?

A

The head of the humerus is displaced posteriorly (towards the back).
The humeral head may appear to be sitting below the glenoid or overlap with the scapular body.
The “lightbulb sign” may be visible on the Y-view (the head of the humerus appears rounded like a lightbulb).

170
Q

How can you identify an anterior dislocation of the humerus on an X-ray?

A

The head of the humerus is displaced anteriorly (towards the front).
The humeral head may appear to be positioned below or in front of the glenoid.
The “squared off” appearance of the humeral head may be noted, and the anterior rim of the glenoid may be visible.

171
Q

What is the risk associated with Subcapital / Transcervical Fractures?

A

Risk: Damage to the retinacular arteries that supply the head of the femur.
Consequence: Potential for avascular necrosis if blood flow is not restored to the femoral head.

172
Q

What are common causes of Posterior Hip Joint Dislocation?

A

Causes:
Car crashes
Falls from height
Sports injuries

173
Q

What are the serious concerns associated with Posterior Hip Joint Dislocation?

A

Serious Injury Risks:
Soft tissue damage
Risk of avascular necrosis from arterial damage
Condition: Femoral head no longer in articulation with acetabulum
Prevalence: ~85% of hip dislocations are posterior.

174
Q

How does air appear on a plain film X-ray?

A

Air appears BLACK on X-ray.

175
Q

How can you identify the small bowel on a plain film X-ray?

A

Small Bowel:
Location: More centralised
Features: Valvulae Conniventes – lines that transect the entire width of the bowel

176
Q

How can you identify the large bowel on a plain film X-ray?

A

Large Bowel:
Location: More peripheral (“Picture Frame”)
Features: Haustra/Teniae Coli – lines do not transect the whole bowel

177
Q

What does barium look like on X-ray, and what does it help visualize?

A

Barium: Radio-opaque (WHITE)
Helps visualize: Bowel structures in more detail

178
Q

What structures can you identify in a Barium Swallow meal/upper GI study?

A

Structures Identified:
Oesophagus
Stomach
Duodenum (1st-4th Parts)
Duodeno-jejunal Flexure (DJF)
Jejunum

179
Q

Where would you expect to find the pancreas in relation to the duodenum?

A

Location: Posterior to the 3rd part of the Duodenum, near the Duodeno-jejunal Flexure (DJF)

180
Q

What is shown by a Barium Enema?

A

Caecum
Ascending Colon
Hepatic Flexure
Transverse Colon
Splenic Flexure
Descending Colon
Sigmoid Colon

181
Q

What does Pneumoperitoneum indicate, and how is it identified on an X-ray?

A

Pneumoperitoneum = Air in the abdominal cavity.
Identification on Erect Chest X-ray:
Air (black) rises to the top of the abdomen.
Air contrasts well against abdominal viscera and diaphragm.
Normally, the only gas should be within the gut tube.
Gas outside the bowel may indicate perforation of the abdominal wall or bowel.

182
Q

How is bowel obstruction identified on imaging, and what are key indicators?

A

Imaging Techniques:

Plain Film X-ray: Used initially.
CT Scan: For finer diagnosis.
Key Indicators:

Valvulae Conniventes (Plicae Circularis): Helps distinguish Small Bowel from Large Bowel.
Dilated Loops:
Small Bowel: >3 cm.
Large Bowel: >5 cm.

Fluid Levels: May be present.
Collapsed/Normal Bowel: Distal to the expanded region.

183
Q

What is the “Coffee Bean Sign” and what does it indicate?

A

Definition:
Volvulus: Twisting of the bowel and mesentery.

Sign:
“Coffee Bean Sign”: Characteristic appearance on imaging.
Implications:

Common Cause: Bowel obstruction and constipation.
Complications: If blood supply is compromised, it can lead to ischemic bowel.

184
Q

What is Splenomegaly and what are its common causes?

A

Definition:

Splenomegaly: Enlargement of the spleen.
Common Causes:

Infections: Viral (e.g., mononucleosis), bacterial (e.g., tuberculosis).
Hematologic Disorders: Leukemia, lymphomas, anemia.
Liver Diseases: Cirrhosis, portal hypertension.
Metabolic Disorders: Gaucher’s disease, Niemann-Pick disease.
Others: Autoimmune diseases, congestive heart failure.

185
Q

What are the key features of Spinal Osteoarthritis?

A

Bony Spurs (Osteophytes):

Growth of bony projections along the edges of vertebrae.
Vertebral Height Loss:

Decrease in the height of the vertebrae.
Intervertebral Disc Height Reduction:

Narrowing of the space between vertebrae due to disc degeneration.
Nerve Root Entrapment:

Compression of nerve roots, leading to pain, numbness, or weakness.

186
Q

What are the effects of Osteoarthritis on the Spine?

A

Bulging Discs:

Discs may protrude outward, potentially compressing the spinal cord.
Spinal Cord Impingement:

The bulging discs can press on the spinal cord, leading to pain, numbness, or other neurological symptoms.

187
Q

What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

A

DISH is characterized by abnormal calcification and bone formation (“hyperostosis”) of soft tissues surrounding spinal joints and the peripheral skeleton.

188
Q

Key features of DISH

A

Bone formation along the anterior and possibly posterior longitudinal ligaments.
May result in partial or complete fusion of adjacent spinal levels.
Facet and sacroiliac joints are typically uninvolved.
The thoracic spine is the most commonly affected area.

189
Q

What is Ankylosing Spondylitis?

A

Systemic Disorder:
Involves inflammation of the axial skeleton, large peripheral joints, and digits.
Symptoms:
Nocturnal back pain and stiffness.
Accentuated kyphosis.
Diagnosis:
Requires showing sacroiliitis on X-ray. (Bamboo spine)

190
Q

What is a Jefferson Fracture (unstable)?

A

Description:

Compression fracture of the C1 (atlas) bony ring.
Involves lateral masses splitting and transverse ligament tear.
Mechanism:

Caused by an axial blow to the head (e.g., diving).
Imaging:

Displacement of the lateral masses of C1 beyond the margins of the body of C2.

Bilateral Facet Joint
Dislocation
* Anterior displacement of
C5 > 1⁄2 width of the VB

191
Q

Trauma: Teardrop Fracture (Unstable)

A

Description: Posterior ligament disruption and anterior compression fracture of the vertebral body (VB).
Mechanism: Hyperflexion and compression (e.g., diving into shallow water).
Radiographic Features:

Prevertebral Teardrop fragment (avulsion fracture).
Posterior portion of the vertebral body displaced into the spinal canal.
Spinal cord compression.

192
Q

Trauma: Hangman’s Fracture (Unstable)

A

Description: Fracture through the pars interarticularis of C2.
Mechanism: Hyperextension.
Radiographic Features:

Prevertebral soft tissue swelling.
Avulsion of the anterior inferior corner of C2 (often with rupture of the anterior longitudinal ligament).
Anterior dislocation of the C2 vertebral body.
Bilateral C2 pars interarticularis fractures.

193
Q

Degeneration: Disc Herniation

A

Description: Protrusion or extrusion of the intervertebral disc material beyond its normal confines.
Common Locations: Lumbar and cervical regions.
Symptoms: May cause pain, numbness, or weakness due to nerve root compression.

194
Q

Degeneration: Spinal Stenosis

A

Description: Narrowing of the spinal canal or neural foramen, which can compress the spinal cord or nerve roots.

Causes: Often due to degenerative changes in the spine, such as disc herniation, facet joint hypertrophy, and ligamentum flavum thickening.

Symptoms: Includes back pain, leg pain, numbness, weakness, and difficulty walking. Symptoms often worsen with standing or walking and improve with sitting or bending forward.

195
Q

Ischiofemoral Ligament:

A

Limits: Hip extension, adduction, and medial rotation.

196
Q

Pubofemoral Ligament:

A

Limits: Hip abduction and lateral rotation.

196
Q

Iliofemoral Ligament:

A

Limits: Hip extension, adduction (superior band), abduction (inferior band), and lateral rotation.

MEDIMAGE 203 (3 decks)

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