Ortho + Urology Flashcards
1
Q
Froments sign indicates palsy of what nerve ? and what muscle is affected ?
A
Deep ulnar nerve
Adductor pollicus
2
Q
How are hydroceles surgically managed in adults ?
A
Lords or Jabouley procedure
3
Q
what nerves are commonly damaged during varicose vein surgery ?
A
sural and saphenous nerves
4
Q
what nerves are affected in Erbs palsy ?
A
axillary nerve, suprascapular nerve, and musculocutaneous nerve,
5
Q
Most testicular cancers are germ cell tumours. What are the two types ?
A
Seminoma’s and non seminomatous
6
Q
prostate cancer tends to metastasise to bone - what types of lesions are seen in bone ?
A
reactive sclerotic [osteoblastic] lesions
7
Q
The initial 0-15 degrees of shoulder ABduction is perforemed by the SUPRASPINATOUS muscle. What muscles are reponsible for ABduction past 90 degrees ?
A
Trapezius and serratous anterior
8
Q
Varicose veins commonly affect the short saphenous vein. When managing varicose veins - what is the most common complication ?
A
Sural nerve damage
9
Q
what nerve innervates the ADductor pollicus
A
deep branch of ulnar nerve (root value C8, T1).
10
Q
where are the cords of the brachial plexus formed ?
A
The cords of the plexus are formed in the axilla.
11
Q
what is the main extensor of the fingers ?
A
Extensor digitorum communis
12
Q
How are hydroceles surgically managed in kids ?
A
trans inguinal ligation of PPV.
13
Q
where is sinus Tarsai located ?
A
between the talus and calcaneus
14
Q
what nerve supplies sensation to the anterior scrotum ?
A
ilioinguinal nerve
15
Q
what lymph nodes do testicular cancers metastasise to ?
A
Para-aortic lymph nodes
16
Q
The brachial plexus is encloced by what fascia ?
A
extension of the prevertebral fascia.
17
Q
what two muscles are classiclly affecting in wining of the scapula [long thoracic nerve injury]
A
- serratus anterior
- trapzium
18
Q
what is the origin and insertion point for pec minor ?
A
Origin - Upper margins of third to fifth ribs and intercostal fascia
Insertion - coracoid process
19
Q
C8 and T1 [inferior trunk of brachial plexus] contribute to what nerves ?
A
ulnar nerve and part of median nerve
20
Q
what is your acronym for the muscles innervated by the radial nerve ?
A
B.E.A.S.T
Brachioradialis
Extensors
Abductor pollicis longus
supinator
triceps
21
Q
what is the motor function of the musculocutanous nerve ?
A
Flexion of the upper arm
22
Q
what nerve innervates the posterior compartment of the forearm
A
Radial nerve
23
Q
what is the common cause of hydroceles in kids ?
A
Patent processus vaginalis
24
Q
what muscles pronate the forearm ?
A
Pronator Teres
Pronator quadractus
25
what structures make the boundaries of the anatomical snuff box ?
26
What is Paget–Schroetter disease ?
Upper limb DVT most commonly seen in athletes. Tends to affect axillary or suclavian vein
27
what nerve innervates the ADuctor pollicus muscle
Ulnar nerve
28
Erbs palsy is due to damage to C5-C6. What muscles are affected ?
deltoid, biceps, and brachialis muscles
29
what nerve innervates the suprapsinatous muscle ?
Supracapular nerve
30
what is the spinal level of the psoas major ?
T12 - L5
31
What is the lymphatic drainage of the male spongy urethra
Deep Inguinal
32
what nerve innervates the semimembranosus ?
tibia branch of the SCIATIC nerve
33
what is the attachment of the long head of the triceps muscle ?
Infraglenoid tubercule of the scapula
34
what is the treatment for LA toxicity due to prilocaine ?
methylene blue
35
What muscles make up the posterior compartment of the thigh?
1. Biceps Femoris
2. Semitenenosus
3. semimembrenosus
36
what muscles make up the thenar eminence ?
1. Opponens pollicus
2. Flexor pollicus brevis
3. Abductor pollicus brevis
37
The pectorals major has two head where it originates from - what are these ?
1. Clavicular head
2. Sternocostal head
38
The biceps femoris has two heads (long head and short head) - where do these tendons originate and insert ?
Long head originates at the ischial tuberosity
Short head originates at the line aspera of the femur
Both insert into the head of the fibula
39
what is the sensory function of the musculocutaneous nerve
Gives rise to the lateral cutaneous nerve that provides sensation to the lateral forearm
40
what is the Pes anserinus ?
a group of three tendons that insert into the medial border of the knee:
1. Sartorius
2. Semitendinosus
3. Gracillis
41
What is the gold standard treatment for testicular cancer ?
Orchidectomy via an inguinal approach
42
Spot diagnosis:
shows multiple lytic and lucent lesions with clearly defined borders on XR
Osteoclastamoma/Giant cell tumour
43
what are the deep muscles of the posterior leg ?
1. Tibialis posterior
2. Flexor hallicus longus
3. Flexor digitorum longus
4. Popliteus
44
how are testicular cancers diagnosed ?
Ultrasound is first-line
CT scanning of the chest/ abdomen and pelvis is used for staging
Tumour markers (see above) should be measured
45
There is only one muscle in the intermediate layer of the anterior forearm - What muscle is this ?
Flecor digitorum superificialis
46
where does the majority of the blood supply to the scaphoid come from and what percentage is this ?
dorsal ridge/carpal branch vessels that supply 80%.
47
what muscle and nerves are tested by Froment's sign ?
1. Ulnar nerve
2. Adductor pollicis
48
what is the relevance of the quadrangular space and what structures pass through it ?
- Allows structured to pass from the axilla to the posterior compartment of the upper arm
- contains the axillart nerve and posterior circumflex humeral artery
49
what type of stones have a genetic risk associated ?
cysteine stones
50
Staghorn calculi are composed of struvite. what types of bacteria cause staghorn calculi ?
Proteus and Klebsiella
They do this by making the urine more alkaline
51
Testicular malignancy is always treated with orchidectomy via inguinal approach. Why ?
This allows high ligation of the testicular vessels and avoids exposure of another lymphatic field to the tumour.
52
what nerve innervates the pec minor ?
Medial pectoral nerve
53
at what age can you perfom an orchidoplexy for an undescended testicle ?
6 - 18 months
54
what nerve roots form the long thoracic nerve ?
C5, C6, and C7 (close to their emergence from intervertebral foramina)
55
what is the function of the lumbricals ?
Flex the MCPs and extend the interphalangeal joints
56
where is the femoral canal located and what are its borders ?
Femoral canal is located in the femoral sheath.
Borders are:
**anterosuperiorly by the inguinal ligament
posteriorly by the pectineal ligament
Medially by the lacunar ligament
Laterally by the femoral vein**
57
which type of germ cell testicular cancers have raised AFP ?
Non-seminomatous
(AFP elevated in up to 70% of cases)
58
List the parts of the male urethra
1. Prostatic
2. Membranous
3. Bulbous
4. Penile
59
The plantaris is found in what compartment ?
within the superficial posterior compartment of the lower leg
60
loss of innervation to what muscles causes a claw hand ?
Lumbricals
61
what is a bartons fracture ?
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
62
how many dorsal interossie muscles are there ?
4
63
what type of stones are radiolucent ?
urate
64
what is the anatomical course of the musculocutaneous nerve ?
Passes obliquely between the biceps brachii and the brachialis to the lateral side of the arm
65
what nerve supplies sensation to the posterior scrotum ?
Pudendal
66
What is the lymphatic drainage of the ureters?
The upper ureter drains to the para-aortic nodes, the lower ureter drains to the common iliac nodes.
67
what is the spinal level for the sciatic nerve ?
L4-S3
68
Fracture of which pole of the scaphoid should always be surgical fixed ?
proximal pole of the scaphoid
69
The plantar aspect of the foot is innervated
Tibial nerve [medial and lateral plantar nerves]
70
what does the Mirel score measure ?
Risk of pathological fracture
71
what muscle does the musculocuteous nerve pierce when it leaves the axilla ?
Corochobrachialis
72
In pelvic trauma, what part of the urethra is damaged if you cant palpate the prostate ?
Membranous urethra
73
Through which foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
Deep inguinal ring
74
what is the attachment of the long head of biceps muscles
Supraglenoid tubercle of the scapula
75
what structures are found in the adductor canal ?
femoral artery, femoral vein (posterior to the artery), nerve to the vastus medialis and the saphenous nerve
76
what nerve innervates Flexor Pollicus brevis
Median nerve
77
what nerve innervate the palmar interossei ?
Ulnar nerve
78
what is the arterial supply of the triceps
Profunda brachii artery
79
The greater sciatic Forman is divided into two parts by what muscle ?
Pirifomis
80
what structure seperates the ulnar artery from the median nerve ?
Pronator teres
81
What is the most superficial structure in the popliteal fossa ?
The **tibial and common fibular nerves** are the most superficial
82
Spot diagnosis
Low calcium, low phosphate, raised ALP
Osteomalacia/Rickets
83
what is the treatment for hydrocele in kids ?
Trans inguinal ligation of PPV
84
what bone malignancy has a classic soap bubble appearance on XR ?
Osteoclastoma/Giant cell tumours
85
what muscle forms the medial border of the cubital fossa
pronator teres
86
Brahcial artery cords are named based on their anatomical relationship to what structure ?
Axillary artery
87
what sign associated with a varicocele will make you worry about an abdominal pathology
A swelling that does not reduce when lying supine
88
At what age can you diagnose an undescended testicle ?
3 months
89
what is the narrowest part of the male urethra ?
membranous urethra
90
The Nottingham Prognostic Index can be used to give an indication of breast cancer survival. what is the most important factor in predicting prognosis ?
Lymph node involvement/nodal status
91
what is the spinal level of the ureters ?
L2 - L5
92
Over what Mirel score is prophylactic nail advised
9
93
The genitofermoral nerve originates at what spinal level ?
L1/2
94
what are the layers that you pass through during a lumbar puncture ?
skin ➡️ subcutaneous tissue ➡️ supraspinous ligament ➡️ interspinous ligament ➡️ ligamentum flavum ➡️ epidural space ➡️ dura mater ➡️ arachnoid mater ➡️ subarachnoid space (contains CSF)
95
what is the innervation for pec major ?
medial and lateral pectorial nerves
96
which drug is known to cause non infective epidididymo-orchitis ?
Amiodarone
97
what are the borders of the adductor canal ?
Anteromedial – Sartorius.
Lateral – Vastus medialis.
Posterior – Adductor longus and adductor magnus.
98
what nerve supplies the nail beds on the first two fingers ?
Median nerve
99
what is the action of the lumbricals on the IP joints ?
Extension
100
where do the superficial muscles of the anterior forearm originate ?
Medial epicondyle of the humerus
101
The genital branch of the genitofemoral nerve innervates what structure ?
Scrotum
102
what is the longest part of the male urethra ?
Penile [AKA Spongy] urethra
103
How does the genital branch of the genitoinguinal nerve reach the scrotum to innervate the scrotal fascia ?
Passes through the deep inguinal ring into the inguinal canal
104
The sural nerve is a cutaneous nerve of the lower limb - what two nerves contrinbute to forming the sural nerve ?
Tibial nerve and common peroneal nerve
105
what is the most medial structure in the cubital fossa ?
Median nerve
106
List the intrinsic shoulder muscles
Deltoid
Teres major
Rotator cuff
Teres minor
supraspinatous
infraspinatous
subscapularis
107
What muscle forms the inferior border of the quadrangular space ?
Teres major
108
which muscles are reponsible for lateral rotation of the upper limb ?
Teres minor
infraspinatous
posterior fibers of the deltoid
109
what muscles medially rotate the upper limb ?
Anterior fibers of the deltoid
teres major
subscapularis
110
what is the innervation to the teres major and minor ?
Teres major - subscapular nerves
teres minor - axillary nerves
111
where does the teres major originate ?
Inferior border of the scapula
112
what is the innervatin to the **dorsum** of the foot ?
113
what is the deepest structure in the popliteal fossa ?
Popliteal artery
114
what do seminoma's show in histology ?
**Sheet like lobular patterns** of cells with substantial **fibrous** component. Fibrous septa contain l**ymphocytic inclusions and granulomas** may be seen.
115
What test is used to assess kindey FUNCTION ?
MAG3 renogram
116
First line treatment of priaprism is corporeal aspiration. what is the next option if this does not work ?
intracavernosal injection of a sympathomimetic agent e.g **phenylephrine**
117
what is the most common type of prostate cancer ?
**ACINAR adenocarcinomas**
118
The majority of prostate cancers (>95%) are adenocarcinomas. What area of the prostate are these most commonly found ?
The peripheral zone
119
What is gold standard imaging for prostate cancer investigation ?
MRI
120
What is the lowest gleason score someone with prosate cancer can have ?
3+3
121
how is a gleason score calculated ?
sum of the most common growth pattern + the second most common growth pattern seen.
122
what is this injury ?
Hill-Sachs lesion
A Hill-Sachs lesion is a dent in the head of the upper arm bone (humerus) that occurs when the shoulder is dislocated.
123
what is the CNS distribution for the knee jerk reflex ?
L3-L4
124
where does the cephalic vein form ?
in the anatomical snuffbox
125
What structure is at risk in olecranon fractures or damage to the medial epicondyle ?
Ulnar nerve
126
the lower leg contains anterior, posterior and perineal compartment. what structure is located in the peroneal compartment ?
Peroneus Longus and Brevis
127
what is used to investigate a child with vesicoureteric reflux in whom there are concerns about the potential of renal scarring ?
DMSA scan
128
what muscles make the floor of the femoral triangle ?
Iliopsoas, adductor longus and pectineus
129
extensor hallicus longus nerve root supply
L5
130
Flexor digiti minimi brevis originated from where ?
Hamate
131
what muscles attach to the lesser trochanter ?
Psoas major
Illiacus
132
What muscles attach to the greater trochanter ?
133
what nerve innervates the sartorius muscle ?
Superficial branch of the femoral nerve
134
what muscles make up the pet anserenius and where is it located ?
Sartorius, Gracillis and Semitendinosus
Located medial tibia
135
What vein does the brachial vein drain into ?
Basilic vein
*Remember the brachial vein drains into the basilic vein BEFORE the axillary vein is formed.
136
which lower limb compartment is peroneus terminus located ?
Anterior
137
what muscle originates from the lateral border of the scapula ?
Teres major and minor
*teres major is from the lower lateral border
138
patient cant lift their thumb off the table - what nerve is affected ?
PIN [radial nerve]
139
what muscles is used to lift thumb off the table ?
EPL
140
what is the blood supply to the ureter ?
Proximal third - branches from renal artery
Middle third - ureter artery from aorta
Distal third - Internal iliac
141
what nerve innervates the tibias anterior ?
deep peroneal nerve
142
the quadrants lomborum is located posterior to what important structure ?
lower pole of the kidney
143
what structure forms the roof of the tarsal tunnel ?
Flexor retinaculum
144
List the contents of the tarsal tunnel from anterior to posterior
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery and vein
Tibial nerve
Flexor hallucis longus tendon
The mnemonic Tom, Dick and a Very Nervous Harry can be used to aid recall of these structures.
145
Describe the dermatomal segmentation of the forearm
146
describe O'Donoghue's triad/unhappy triad
ACL, MCL and medial meniscus
*there is immediate swelling from the ligament injuries and then locking due to the meniscal injuries.
147
The obturator nerve (L2 - L4) has anterior and posterior divisions. what muscles are supplied by this nerve ?
The anterior branch innervates the adductor longus, adductor breves and gracilis
The posterior branch innervates the obturator externus and the adductor magnus.
148
The obturator nerve does NOT innervate the obturator internus.
What nerve supplies this muscle ?
obturator internus is innervated b y the nerve to the internus.
149
which artery is palpated lateral to the extensor hallicus longus tendon
Dorsalis pedis artery
150
what is the name of the fascia surrounding the kidneys ?
Gerota's fascia
151
what is first line medical treatment in priapism ?
Phenylephrine injection
*not epinephrine
152
what type of hyperparathyroidism is linked to renal transplants ?
Tertiary
153
klumpke's paralysis affects what nerve roots ?
C8 - T1
154
what nerves stimulate urinary excretion
Pelvic splanchnic nerves [S2-S4]
155
what is perkins line ?
used for assessment of hip dysplasia
156
post op dropping shoulder classically means damage to what structure ?
Spiral accessory nerve
157
what is the ulnar paradox ? and what muscle is affected
Flexor digitorum profundus
Distal lesions of the ulnar nerve are worse than proximal
158
what is the site of termination of the femoral nerve ?
Femoral triangle
159
what two nerves are found in the adductor canal ?
Saphenous nerve
nerve to the vests medialis
