MJM Anatomy Flashcards
1
Q
What is a Colle’s Fracture?
A
Complete transverse fracture of the distal 2cm of the radius.
Distal fracture displaced dorsally.
The result of forced extension of the hand usually the result of a fall onto an outstretched hand.
Referred to as a dinner fork deformity.
2
Q
What are the boders of the Axilla?
A
Medially: Serratus anterior and thoracic cage
Laterally: Intertubercular sulcus of the humerus
Anteriorly: Pectoralis major, Pectoralis minor and subclavius
Posteriorly: Subscapularis, Lattissimus Dorsi, teres major
Apex: Posterior border of clavicle, Superior border of scapula and lateral border of 1st rib
3
Q
What structures pass through the axilla? Potential pathologies found here?
A
Axillary artery (aneurysm may compress brachial plexus)
Axillary vein (often involved in axillary wound, can cause air emboli)
Brachial plexus (upper, erbs palsy, lower klumpes palsy)
Biceps Brachii
Corocobrachialis
Axillary Lymph nodes (swell with breast cancer metastices)
4
Q
What are the boundaries of the cubital fossa?
A
Medially: Pronator teres
Laterally: Brachioradialis
Superiorly: Imaginary line between Humeral Epicondyles
Floor: Brachialis and supinator
Roof: Skin, Fascia and Median Cubital Vein
5
Q
What are the contents of the cubital fossa? What pathologies may arise here?
A
Median nerve (Thenar atrophy) Brachial artery Biceps tendon Radial nerve (wrist drop from falling on flexed elbow causing supraepicondylar fractures)
6
Q
What are the borders of the carpal tunnel?
A
Medially: Hook of hamate and pisiform
Laterally: Tubercules of trapezium and schaphoid
Flexor retinaculum forms tunnel
7
Q
What are the contents of the carpal tunnel?
A
Flexor pollicis longus
Flexor digitorum superficialis x4
Flexor digitorum produndus x4
Median nerve
8
Q
What happens due to carpal tunnel syndrome?
A
Compression of the medial nerve
Causes thenar atophy
Numbness and tingling in lateral three and a half digits
Can be tested by reverse prayer position (Phalen’s sign test)
9
Q
What is the test for Median nerve damage?
A
Loss of sensation digits 1-3
Thenar wasting
Thumb abduction reduced
Cant oppose thumb and fingers
10
Q
What is the test for Radial nerve damage?
A
Wrist drop, test wrist and forearm extensors (triceps and wrist extensors)
11
Q
How do you test for the ulnar nerve?
A
Weakness in finger abduction (hand on flat surface)
Test adduction with card between fingers
Sensory loss on ulnar side
12
Q
How do you test for the Common peroneal nerve?
A
Causes foot drop so test dorsiflexion and eversion o’f the foot
Also sensory loss over the dorsum of the foot
13
Q
What are the borders of the anatomical snuffox? and contents?
A
Medially: Extensor pollicis longus
Laterally: Abductor pollicis longus and extensor pollicis brevis
Proximally: Styloid process of the radius
Radial nerve, radial artery and cephalic vein
14
Q
What possible pathologies occur in the anatomical snuffbox?
A
If FOOSH can get scaphoid fracture
Often not seen on initial radiographs so diagnosed as severe sprain
Radiographs 2 weeks later reveal fracture as bone resorption has occured
Blood supply is distal to proximal so fracture can cause avascular necrosis of proximal part
this leads to degenerative joint disease later in life
15
Q
What are the borders of the femoral triangle?
A
Lateral border: Sartorius Medial border: Adductor longus Superior border: Inguinal ligament Roof: fascia lata Floor:Iliopsoas
16
Q
What are possible pathologies found in the femoral triangle?
A
Femoral hernia through the femoral canal
femoral pulse found here
Access to the femoral artery for many image guided surgeries
17
Q
What are the suprahyoid muscles and what are their innervations?
A
Mylohyoid- Trigeminal- mandibular branch
Gleniohyoid- C1 roots that run with hypoglossal
Digastric - anterior belly trigeminal, posterior belly facial
Stylohyoid - mandibular branch of facial nerve
18
Q
What are the infrahyoid muscles and their innervations?
A
Sternohyoid- C1-C3, carried by a branch of the ansa cervicalis
Thyrohyoid-C1 which runs with Hypoglossal nerve
Omohyoid- C1-C3, carried by a branch of the ansa cervicalis
Sternothyroid- C1-C3, carried by a branch of the ansa cervicalis
19
Q
What are the borders of the anterior neck triangle and what are the smaller triangles within this?
A
Superior- mandible Medial- imaginary sagital line Lateral- SCM medial border Roof- Subcutaneous tissue and Platysma Floor- Pharynx, larynx and thyroid gland carotid, muscular, submental, submandibular
20
Q
What are the smaller triangles that make up the anterior neck triangle and any pathologies that are found here?
A
Carotid- inbetween omohyoid inferiorly and the digastric superiorly then the SCM anteriorly: Common carotid artery, IJV, CN X and XII Muscular- bordered superiorly by hyoid: Submandibular- digastric anteriorly: Facial artery and vein Submental- digastric anteriorly lymph
21
Q
What are the borders of the posterior neck triangle and the smaller triangles?
A
Anteriorly-SCM
Posteriorly-Trapezius
Inferior-Middle third of the scapula
Omohyoid divides the triangle into subclavian and occipital triangles
22
Q
What structures pass through the posterior neck triangle?
A
External jugular vein
Subclavian arterys and veins
CN XI
Suprascapular artery
23
Q
What are the borders of the inguinal ligament and where are the rings located?
A
Roof- transversalis fascia, internal oblique, transversus abdominus
Posterior- transversalis fascia
Anterior- aponeurosis of external oblique
Floor- inguinal ligament
Deep ring- midpoint of inguinal ligament, invagination of transversalis fascia
Superficial ring- above pubic tubercle, invagination of external oblique
24
Q
What are the borders of the popliteal fossa? what passes through it?
A
Superolateral- biceps femoris
Superomedial- semimembranosus
Posteriomedial- medial head of gastrocnemius
Posteriolateral- lateral head of gastrocnemius
Floor- knee joint capsule and femur
Roof- popliteal fascia
Contains:
Deep popliteal artery, popliteal vein, tibial nerve, common fibular nerve
25
What is a potential source of new muscle cells?
Satellite cells
| rebuilds in a disorganised fashion
26
What is arteriosclerosis?
Build up of fat (mainly cholesterol) in the arterial walls
Calcium deposits form a hardened plaque
Can form a thrombus which leads to ischemia
27
What are vasicose veins?
dilation of veins due to loss of elasticity of the walls
Pressure of supporting column above weakens them
Valves do not touch so non functional
28
Where are ribs most likely to fracture?
Just anterior to their angle
| Can puncture chest organs or diaphragm causing a diaphragmatic hernia
29
What is a flail chest?
Multiple rib fractures that allow a sizeable fraction of the rib cage to move in paradoxical motion
30
what is a median sternotomy?
To gain access to the chest cavity for procedures the sternum is divided medially and the flexibility of the ribs allow the chest to be opened
31
What is thoracic outlet syndrome?
structures emerging from the thorax are obstructed, usually obstructed in the lower neck
32
What does damage to the phrenic nerve result in and how is this detected?
Results in paralysis to the half of the diagram that that phrenic nerve supplies
Can be detected radiographically due to it paradoxial motion
33
What can a wound to the base of the neck result in?
A pneumathorax because the apex of the lung projects through the thoraxic outlet into the base of the neck
34
What is pleuritis?
Inflammation of the pleura that causes pleural rub
35
What is a pulmonary embolism and what is a cause of this?
An embolus for example a blood clot moves through the right lung into the pulmonary capillaries and causes a blockage.
A cause of this is an air embolus travelling from the leg from a compound fracture
This results in a V/Q mismatch
36
What kind of pain is pleural pain?
Visceral pleura has no innervation so no pain
| Parietal pleura produces sharp stabbing pain that my be localised or reffered to dermatomes of that spinal nerve root
37
How does an aortic aneurysm present?
Chest pain that radiates to the back
May exert pressure on the trachea and oesophagus causing difficulty breathing and swallowing
Evident on plain film radiograph or Magnetic resonance (MR) angiogram
38
What does stenosis mean?
The abnormal narrowing of a body passage
39
What does the recurrent laryngeal nerve supply and how can it be damaged?
All of the intrinsic muscles of the larynx except one
This can be damaged by any investigative procedures
Can also be damaged by foreign bodies in the piriform recess
Only the left laryngeal nerve is recurrent as it passes under the aorta
40
When obstruction of the IVC occurs what are the alternative routes of return for the thoracic, abdominal and back regions?
Azygous, Hemi-azygous and occasionally the accessory hemi-azygous
41
How is aortic angiogram done?
Catheter inserted through the femoral artery or brachial artery
radiopaque contrast medium is injected into the arch
42
How may the inferior thoracic spinal nerves be injured and what is the result of this?
May be cut during surgical incisions
This results in weakening of the muscles of the abdominal wall due to multiple nerve innervation so there is not complete paralysis
This may predispose the individual to inguinal hernias
43
What is mcburney's point and what is an incision made here for?
Two thirds of the way between the umbilicus and the ASIS
| Common location of caecum of appendix so used to remove appendix
44
What can obstruction of the IVC result in?
Thoraco-epigastric veins provide collateral pathways to bypass the blockage
Causes dilated veins to be visible on the abdominal wall (caput medusae)
45
What are the two main types of hiatal hernia?
Para-oesophageal hernia- cardia remains in normal position but a pouch of peritoneum containing part of the fundus herniates
Usually no reflux as cardial orifice is in normal place
Sliding hernia- cardia and part of fundus slide through eosophageal hiatus into the thorax
Reflux may occur as diaphragm cannot play part in gastroesphageal sphincter
46
What can cause pancreatitis?
Blockage of the ampulla of Vater
| This can cause bile to back up into the pancreas
47
What is the standard procedure for diagnosis of biliary and pancreatic disease?
ERCP (endoscopic retrograde cholangiopancreatography)
| radiopaque contrast medium is injected into the major duodenal papilla
48
What are gallstones composed of?
Primarily cholesteral crystals
49
Where is the most common site for gallstones to lodge?
hepatopancreatic ampulla (ampulla of vater) as it is the narrowest point of the biliary passages
50
What is a cholecystectomy?
Removal of the gall bladder
51
What are hiccups?
involuntary, spasmodic contractions of the diaphragm resulting from irritation to the afferent or efferent nerves
52
Where can diaphragmatic pain be referred to?
Pain of the diaphragmatic peritoneum can be referred to the shoulder region (C3-5) whereas peripheral diaphragm pain is referred to the local skin
53
What is the iliopsoas test and what is it used for?
The iliopsoas is related to the kidneys, cecum, appendix, sigmoid colon and pancreas.
Patients can be asked to extend the hip lying down against resistance
A positive result is pain elicited on that side
54
Due to the nature of the pelvic ring what are most fractures?
Double fractures
55
What are the roots of the lumbar plexus?
L1-L5
56
Which nerve of the lumbar plexus is vulnerable during surgery and what will the result of damage to it be?
Obturator nerve
| Causes painful spasms of the adductor muscles of the thigh and causes sensory deficits in the medial thigh
57
Why are cervical vertebrae more likely to dislocate?
As they have more horizontal articular facets than the other vertebrae they can dislocate more easily
If there is no facet jumping then they may self-reduce resulting in no significant difference on radiographs
58
What is a likely fracture of atlas?
A jefferson fracture- vertical forces cause multiple fractures around atlas causing it to burst outwards
59
What is a hangmans fracture?
double fracture of the pars interarticularis of axis (c2) caused by hyperextension of the neck
fracture of the dens often occurs from horizontal blows to the head
60
What is spinal stenosis and what causes it?
Narrowing of the vertebral foramen that causes compression of the spinal cord
It may be due to a hereditary anomaly
61
In which direction do intervertebral discs tend to herniate? what is the result of this?
They tend to herniate in the posteriolateral direction
This is due to the annulus fibrosus being relatively thin here and receiving no support from the anterior or posterior longitudinal ligaments
Can cause compression of spinal roots causing referred pain
62
What is sciatica and what causes it?
Pain in lower back and hip radiating down leg
Often caused by L5 or S1 IV disc herniation causing compression of the sciatic nerve
Narrowing of IV foramina may also explain why sciatica is so common
63
What is the general rule for which nerves are compressed by which IV discs?
The IV disc usually compresses the IV disc that is one inferior to the disc e.g. L4/L5 disc compressed L5 nerve
64
What can forceful extension of the neck cause?
Crush or compression of vertebrae
fracture of posterior arch
Tear of anterior longitudinal ligament
This can tear off part of the vertebral body
65
How is a lumbar puncture done and what is it used for?
patient lies on side with hips flexed
Lumbar puncture obtains CSF by puncturing between L3 and L4
Used for diagnostic purposes
66
What is an avulsion fracture?
A small part of bone is torn away by a tendon or ligament
| Commonly occurs on the ischial tuberosities from high impact sports
67
What is the most common fracture site of the femur?
```
The femoral neck
Either transcervical (middle of neck)
Or Intertrochanteric
```
68
What can happen to the limb during healing of a femoral neck fracture?
Muscles spasm can shorten the limb
| Foreshortening can also occur in spiral shaft fractures
69
How can the popliteal artery be damaged?
Runs directly down the posterior surface of the femur after the adductor hiatus
This means distal femoral fractures can cause haemorrhage
Should always be considered in knee fractures or dislocations
70
Where does the tibia most commonly fracture and what does this result in?
Most commonly fractures at junction of its middle and inferior thirds
This is due to this being the thinnest point
Also often results in a compound fracture as its anterior surface is sub-cutaneous
71
Where do fibular fractures commonly occur?
2-6CM proximal to the distal end of the lateral malleolus
| Often associated with fracture dislocations of the ankle
72
What are the compartments of the thigh? and innervations?
Anterior: Vastus Lateralis, vastus medialis, rectus femoris, vastus intermidius, sartorius
femoral nerve L2-L4
Medial:Adductor Magnus, Adductor brevis, Adductor longus, gracilis
Obturator Nerve L2-L4
Posterior:Biceps femoris (long and short heads), Semimembranosus, semitendinosus
Sciatic nerve L4-S3
73
What are the compartments of the leg? and innervations?
```
Anterior: Tibialis anterior, Extensor hallucis longus, Extensor digitorum longus, fibularis tertius
Deep fibular (peroneal) nerve
Lateral: fibularis longus, fibularis brevis
Superficial fibular (peroneal) nerve L4-S1
Posterior: Tibialis posterior, flexor digitorum longus, flexor hallucis longus, soleus, medial and lateral gastroneumius
Tibial nerve
```
74
What are the compartments of the forearm?
Anterior superficial: Pronator teres (M), flexor carpi ulnaris (U), palmaris longus (M), flexor carpi radialis(M), flexor digitorum superficialis (M)
Anterior deep: Flexor digitorum profundus (M), flexor pollicis longus (M), Pronator quadratus (M)
Posterior deep: Supinator (R), abductor pollicis longus (R), extensor pollicis longus (R), extensor pollicis brevis (R), extensor indicis proprius (R)
Posterior superficial: Brachioradialis (R), extensor carpi radialis longus and brevis (R), extensor digitorum (R), extensor digiti mini (R), extensor carpi ulnaris (R)
75
What are the compartments of the arm?
Anterior: BBC Biceps brachii, Brachialis, Coracobrachialis
Musculocutaneous nerve C5 and C6 (mainly C6)
Posterior: Triceps brachii
Radial nerve C7 and C8 (mainly C7)
76
How would you test for quadriceps damage?
Won't be able to extend the leg against resistance
77
Why is a patellar fracture pulled apart?
Proximal fragment is pulled superiorly by the quadriceps tendon.
78
How would you test for integrity in the femoral nerve and L2-L4 spinal segments?
Patellar tendon reflex
| Afferent impulses travel up femoral nerve to L2-L4 and then efferent impulses travel back down the femoral nerve
79
Which leg muscle is used to replace damaged muscles?
Gracilis as it has it has relatively little function
| Can be transplanted along with its nerves and vessels to replace damaged muscles in the hand for example
80
What can cause compartment syndrome?
Hemorrhage, oedema and inflammation
81
What is the result of compartment syndrome and how can it be treated?
May compress structures in the compartment
Small vessels of muscles and nerves tend to be compressed first
Structures distal to the compressed area may become ischemic and permanently injured.
Obvious sign is loss of the distal leg pulse
Fasciotomy may be required
82
What are varicose veins and what causes them?
Dilated veins in which the cusps of the valves do not work.
Common in the great saphenous vein and its tributaries
Caused by valves not functioning properly or increased pressure due to a blockage further up
83
What is a DVT and what is its cause?
Deep vein thrombosis of one of the deep veins of the lower limb shows swelling, warmth and erythema (swelling and infection)
Can be caused by lose fascia failing to resist muscle expansion
External pressure e.g. hospital bed
84
What should be examined when enlarged inguinal lymph nodes are found?
The trunk inferior to the umbilicus and the entire lower limb as this is their field of drainage
May be enlarged by minor sepsis from abrasions or from metastasis of cancer
May be from a malignant melanoma or in females a uterine cancer
85
What is dupuytrens contracture
Fibrous contraction of the palmar aponeurosis causing flexion of the metacarpalphalangeal joints
86
Where would a femoral nerve block be administered?
Perineural injection close to the femoral nerve
| this is 2cm inferior to the inguinal ligament, approximately a fingers breath lateral to the femoral artery
87
What are the borders of the superior mediastinum?
```
Superior – Thoracic inlet.
Inferior – Continuous with the inferior mediastinum at the level of the sternal angle.
Anterior – Manubrium of the sternum.
Posterior – Vertebral bodies of T1-4.
Lateral – Pleurae of the lungs.
```
88
What are the borders of the anterior mediastinum?
Lateral borders: Mediastinal pleura (part of the parietal pleural membrane).
Anterior border: Body of the sternum and the transversus thoracis muscles.
Posterior border: Pericardium.
Roof: Continuous with the superior mediastinum at the level of the sternal angle.
Floor: Diaphragm.
89
What are the borders of the middle mediastinum?
Anterior: Anterior margin of the pericardium.
Posterior: Posterior border of the pericardium.
Laterally: Mediastinal pleura of the lungs.
Superiorly: Imaginary line extending between the sternal angle (the angle formed by the junction of the sternal body and manubrium) and the T4 vertebrae.
Inferiorly: Superior surface of the diaphragm
90
How is the fermoral artery commonly injured?
Laceration of the femoral artery in the femoral triangle (butchers triangle)
Often lacerates vein also
When it is necessary to ligate (tip or bud artery) the artery then blood supply can be provided to the lower limb through anastomosing branches of the femoral artery to other arteries
91
What are the borders of the femoral canal?
Medial border – Lacunar ligament.
Lateral border – Femoral vein.
Anterior border – Inguinal ligament.
Posterior border – Pectineal ligament, superior rami of the pubi and the pectineus muscle
92
What can cause a dipping gait?
Damage to the gluteal nerve results in the abductors of the thigh to be weakened
This causes a dipping gait as the pelvis will tip as not held up by abductors when on one leg
93
What can damage the sciatic nerve?
Trauma to the buttocks, more medial is more likely to damage nerve
Complete section results in useless leg as cant extend at the hip or flex at the knee
Incomplete section can cause weakness and is slow to heal
94
How does a popliteal aneurysm present?
As referred pain to skin as it likes deep to the tibial nerve
Medial aspect of calf, ankle or foot
95
What nerve does a posterior knee dislocation commonly damage?
Tibial nerve
| Unable to plantarflex foot, loss of sensation on bottom of foot
96
How is the common fibular nerve often damaged and what does this result in?
Subcutaneous and wraps around the neck of the fibular so is therefore damaged by direct trauma
May be damaged in fibular fracture or stretched by dislocation
Causes foot drop as there is loss of dorsiflexion of the foot
97
What is the result of a femoral neck fracture?
Often tears arteries coming off the median circumflex femoral artery
These arteries supply the head of the femur so results in avascular necrosis
Artery in ligamant of the head of the femur doesnt supply enough blood to keep it alive
98
What is damaged in a hip dislocation?
Fairly uncommon as is such a stable joint but can occur in automobile accidents
Causes posterior dislocation
Ruptures joint capsule
The limb shortens and medially rotates when it sits on the ilium posteriorly
Sciatic nerve has close relation to the hip joint so may be damaged (stretched or compressed)
Would paralyse hamstrings and all of muscles distal to knee supplied by common peroneal and tibial
99
How do you test the ACL and PCL?
Push or pull knee, get post or ant drawer sign
100
What does forceful eversion of the foot cause?
A Pott fracutre-dislocation
The extremely strong strong medial ligament often pulls off the medial maleolus
this allows the foot to further evert and fracture the tibia
101
How does a clavicle tend to fracture?
Can be a result of direct force of more commonly a fall onto the outstretched arm or the shoulder
The weakest part is the junction between the middle and lateral thirds
The sternocleidomastoid lifts the medial fragment causing a prominence superiorly that can be palpated
The weight of the arm is too much for the trapezius muscle so the lateral fragment moves posteriorly
The strong coracoclavicular joint usually prevents dislocation at the acromioclavicular joint
Lateral fragment may also be pulled medially overlapping bones due to pectoralis major
102
Which parts of the humerus are in direct contact with which nerves?
Surgical neck: Axillary nerve
Radial groove: radial nerve
Distal end of humerus: Median nerve
Medial epicondyle: Ulnar nerve
103
How do avulsion fractures of the greater tubercle of the humerus typically occur?
Commonly occurs with a fall onto the acrimion
The greater tubercle is avulsed by the supra and infraspinatus muscles
The humerus is then medially rotated by subscapularis
104
What happens to the bony fragments after a humeral shaft fracture?
Deltoid abducts proximal segment
| Biceps pull distal segment upwards causing foreshortening
105
What causes winging of the scapula?
Damage to the long thoracic nerve as this innervates serratus anterior
inferior angle of scapula pulls markedly away from chest wall when patient asked to press on wall
Also cant rotate scapular so incomplete abduction of the arm
106
What is the result of injury to the axillary nerve?
Deltoid atrophy
Regimental badge loss of sensation
Struggle to abduct arm after 15 degrees
Winds around surgical neck so damaged in surgical neck fractures
107
What does upper brachial plexus injury cause?
Erbs palsy (waiters tip)
Deltoid damage causes medial rotation
Biceps and brachialis paralysis causes extended arm
108
What does lower brachial plexus injury cause?
```
Klumpes palsy (claw hand)
Short muscles of the hand are affected
```
109
What does median nerve at the elbow result in?
Often from a supraepicondular fracture
Causes hand of benediction
Cant make fist with index and middle fingers
110
What does ulnar nerve damage result in?
Claw hand
| Medial two didgits extended at the MCP joint and flexed at the pharangeal joint
111
Where can irritation occur in the rotator cuff from repetitive use?
Where the supraspinatus tendon becomes inflamed
Degenerative tendonitis of the rotator cuff can be tested by asking the patient to slowly lower the arm from fully abducted
At around 90 degrees the arm will suddenly drop
112
What nerve does glenohumeral dislocation commonly damage?
Axillary nerve due to its close anatomical relation to the humeral head
Passes just inferior to the joint capsule
Results in regimental badge and deltoid paralysis
113
What does tear of the glenoid labrum often result in?
Instability and subluxation
114
What does an avulsion fracture of the medial epicondyle result in?
Damage to the ulnar nerve as it passes posterior to the medial epicondyle
also occurs in elbow dislocation
115
How does a pulled elbow present?
Flexed at elbow and forearm pronated
This is due to a damage annular ligament
Subluxation treated by supination of the forearm in the felxed position
