Netter's High Yield Facts (Applied Anatomy) 2016-1 Flashcards
What is a disc hernia?
Protrusion of the nucleus pulposus through the annulus fibrosis, usually in the posteriolateral direction where the annulus is thinnest.
Most commonly at the L4/L5 or L5/S1 level
What is the consequence of a disc hernia?
Herniation into the vertebral canal may compress the nerve root below the disc and cause pain in the related dermatome
What does age-related deydration of the nucleus proposus do?
Contribute to loss of height and narrowing of the IV foramina
What is McBurney’s point?
A surface landmark that roughly indicates the location of the appendix, located approximately 1/3 of the way along a line from the ASIS to the umbilicus.
What is the clinical presentation of an appendicitis?
Pain first presents in the epigastric region, moves to the umbilical region and localizes in the right lower quadrant.
What is a possible complication of appendicitis?
Rupture of the appendix leads to peritonitis which presents with severe pain, fever and abdominal rigidity.
What are the 5 causes for abdominal distention?
Fat Feces Fetus Flatus Fluid
What is the most common place for an abdominal hernia?
Inguinal region
What is a direct inguinal hernia?
Protrudes through the layers of the wall in Hesselbach’s (the inguinal) triangle, MEDIAL to the epigastric vessel.
What is an indirect inguinal hernia?
Indirect inguinal hearnias leave LATERAL to the epigastric vessel, entering the inguinal canal through its deep ring.
What is the hernial sac?
Consists of peritoneum containing a portion of a viscus (small/large bowel) and is covered by the layers that cover the spermatic cord
What is a Psoas Abscess?
A result of vertebral TB infection that spreads to the psoas sheath that becomes thickened leading to pus accumulation beneath it.
Where does the pus from a Psoas Abscess go?
The pus tracks inferiorly within the sheath, deep to the inguinal ligament, surfacing in the superior part of the thigh.
Pus can also track into the adjacent iliac fascia, forming a recess in the iliacosubfascial fascia, where the large bowel can get trapped in it (painful)
What are the muscles of the abdominal wall?
Transversus abdominus
Internal oblique
Rectus abdominis
External oblique
What supplies blood to the sigmoid colon?
left colic artery
superior sigmoid artery
What is a hiatus hernia?
Herniation of part of the stomach through the esophageal hiatus of the diaphragm, predisposing reflux
What are the two types of hiatus hernias?
sliding hernias - involve the cardiac of the stomach sliding superiorly
rolling hernias - involve part of the fundus extending through the hiatus
What is an intestinal volvulus?
Rotation of a loop of bowel upon its mesentery that may cause bowel obstruction and can compromise the vascular supply leading to ischemia, infarction, and necrosis.
Which parts of the bowel are most likely to undergo intestinal volvulus?
small bowel
sigmoid colon
What are the 5 sphincters of the GI tract?
APE OIL Anus Pyloric Esophageal Oddi Ileocecal
What is choleithiasis?
gallstones that can cause pain in the RUQ if they obstruct the cystic duct after the consumption of a fatty meal
What is the frequency of pain associated with gallstones?
intermittent as the gallstone gets squeezed around but constant pain may be as a result to secondary inflammation
What is a way that the spleen can be injured?
Splenic rupture - trauma causing rib fracture or sudden increases in intra-abdominal pressures
what is the significance of the subphrenic abscess?
Most common site for pus to accumulate, where Right sided abscesses are more common due to the high incidence of perforated appendices.
What is an abdominal aortic aneurysm?
localized enlargement of the aorta as a result of congenitla or acquired weakness of the wall, where common site is just above bifurcation of aorta to common iliac arteries
What is nephrolithiasis?
Renal stones that can be found between urinary bladder and renal calyces.
What kind of pain do you get from nephrolithiasis?
colicky pain radiating from loin to groin due to ureter contractions to try to move the stone
How are nephrolithiasis diagnosed?
CT scan
What is the treatment of nephrolithiasis?
Wait for it to pass, surgical, or lithotripsy
What is a winged scapula?
damage to the long thoracic nerve to serratus anterior causes winging of the scapula as its medial border lifts away from the thorax when arm is raised.
What is the consequence of a winged scapula?
The arm cannot be abducted above the horizontal plane because glenoid cavity cannot be rotated upward without serratus anterior
What is a bursa?
Contains a thin layer of synovial fluid and is located where tendons rub against bone, ligaments or tendons or when skin moves bone directly beneath
What are two examples of bursas?
subscapular bursa
located between subscapularis tendon and neck of scapula and communicates directly with the cavity of the shoulder joint
subacromial (subdeltoid) bursa
located between deltoid, supraspinatous tendon and glenohumeral capsule, does not communicate with cavity of shoulder, facilitates movements of deltoid over joint capsule and supraspinatous tendon under the coracoacromial arch
How is the clavicle usually fractured?
Fall on an outstretched hand or direct trauma to the shoulder, fractures at the middle third (thinnest portion of the clavicle)
In what direction does most shoulder dislocations occur in and why?
anterioinferior direction caused by excessive extension and lateral rotation of the humerus (throwing motion)
the humeral head places stress on the joint capsule, which may be torn anteriorly, with elements of the rotator cuff.
Which nerves are endangered during a shoulder dislocation?
axillary and musculocutaneous nerves
An epileptic seizure or electrocution can cause a _____ dislocation.
posterior
What tendon of the rotator cuff is most likely affected in degenerative tendonitis?
supraspinatus
What are the four rotator cuff muscles?
SITS
supraspinatus
infraspinatus
teres minor
subscapularis
What is the most common spot for a humeral fracture?
surgical neck, common in elderly with osteoporotic bone and fall on an outstretched arm
What is the nerve that is endangered in a humeral fracture at the surgical neck?
axillary nerve
What is the nerve that is endangered in a humeral fracture at the mid shaft?
radial nerve
what is the nerve that is endangered in a humeral fracture at distal end?
median nerve
What causes subluxation of the radial head (Nursemaid Elbow)?
caused by sudden pulling on the upper limb with the forearm pronated
What is the Nursemaid’s elbow?
distal attachment of the annular ligament is torn and radial head slips out, trapping the ligament between it and the capitulum
What is Student’s elbow?
repeated pressure or friction on the subcutaneous olecranon bursa causes it to become inflamed,
What is the tennis elbow and what causes it?
caused by repetitive movements of the wrist, causing lateral epicondylitis. the pain is felt over the lateral aspect of the elbow.
What is the golfer’s elbow?
medial epicondylitis from repeated wrist flexion
What does the radial nerve innervate?
BEST Brachioradialis Extensors Supinator Triceps
What are the muscles that flex the elbow?
Brachialis
Biceps
Brachioradialis
What forms the superficial palmar arch?
SU dr
main terminal branch of ULNAR artery that enters between the hook of hamate and pisiform bone that is superficial to the flexor retinaculum
What forms the deep palmar arch?
su DR
formed from terminal branch of the RADIAL artery and passes from the anatomical snuff box on the hand dorsum, runing between heads of first dorsal interosseus muscle to reach palm
What are the structures in the floor of the anatomical snuff box?
radial artery
radial styloid process
base of first metacarpal
scaphoid and trapezium
What are the borders of the anatomical snuff box?
anterior - abductor pollicis longus tendons and extensor pollicis brevis
posterior - extensor pollicis longus
What is the Dupuytren’s Contracture?
progressive fibronodular thickening of hte palmar fascia leads to a fixed flexion deformity of all fingers.
usually bilateral, treated surgically
What is the most commonly fractured bone of the carpus?
Scaphoid bone
Takes a long time to heal because the proximal part of the bone has poor blood supply
What is the Colle’s Fracture?
complete transverse fracture within the distal 2cm of the radius, where distal fragment displaced dorsally, giving the classic dinner fork deformity.
What results in a Colle’s Fracture?
forced dorsiflexion of the hand, such as breaking a fall with an outstretched, pronated hand. most common in adults >50yo elderly women
What are the functions of the palmar interossei and dorsal interossei muscles?
Palmar interossei adducts
(PAD)
Dorsal interossei abducts
(DAB)
What nerve is affected by Carpal Tunnel Syndrome and what is the presentation?
Median nerve
pain/paraesthesia in lateral 3.5 digits, worse at night, may radiate to elbow
What nerve is affected when you hit your “funny bone” and where do you feel the tingling??
Ulnar nerve at the level of the medial epicondyle of the humerous
Pain/paraesthesia felt at the medial aspect of the lebow radiating to the medial forearm and medial 1.5 digits + weakness of hand muscles
What are the muscles supplied by the median nerve in the hand?
LOAF lumbricals opponens abductor pollicis brevis flexor pollicis brevis
What are the deep back muscles?
I LOVE SPAGHETTI - SOME MORE RAGU Illiocostalis Longissimus Spinalis - Semispinalis Multifidus Rotatores
What is the erector spinae group?
I LIKE STANDING
Ilicostalis
Longissimus
Spinalis
What is one of the most common sites for carcinoma of the breast?
axillary tail (upper outer quadrant)
At what landmark is the level of the heart at?
T5-T8
At what level is the esophageal hiatus in the diaphragm?
T10
Where is the sternal angle of Louis?
Level of the bifurcation of the trachea, arch T4/T5 of aorta
When attempting thoracocentesis, you must avoid damage to the intercostal vein, artery and nerve in the ________ on the ____ surface of each rib by inserting ________ the rib?
costal groove
inferior
below
What is thoracic outlet syndrome and what causes it?
ischemic pain and numbness in the shoulder and upper limb as a result of compression of the subclavian artery or inferior trunk of the brachial plexus by an uncommon cervical rib
What is the order of the contents of the NVB in the costal groove?
VAN
Vein, artery, nerve
What is a pneumothorax?
The entry of air into the pleural cavity because of a penetrating wound or a fractured rib
What is a hydrothorax?
escape of fluid into a pleural cavity (pleural effusion)
What is pleural adhesion?
inflamed pleurae that stick together and can be heard with a stethoscope (very painful)
What nerve innervates the parietal pleura?
phrenic nerve
3 p’s
Cardiac tamponade
inflammation of the pericardium (pericarditis) which results in pericardial effusion
can result in stab wounds
symptoms: collapsed pulse, distention of neck veins
