Ortho + Urology Flashcards
Froments sign indicates palsy of what nerve ? and what muscle is affected ?
Deep ulnar nerve
Adductor pollicus
How are hydroceles surgically managed in adults ?
Lords or Jabouley procedure
what nerves are commonly damaged during varicose vein surgery ?
sural and saphenous nerves
what nerves are affected in Erbs palsy ?
axillary nerve, suprascapular nerve, and musculocutaneous nerve,
Most testicular cancers are germ cell tumours. What are the two types ?
Seminoma’s and non seminomatous
prostate cancer tends to metastasise to bone - what types of lesions are seen in bone ?
reactive sclerotic [osteoblastic] lesions
The initial 0-15 degrees of shoulder ABduction is perforemed by the SUPRASPINATOUS muscle. What muscles are reponsible for ABduction past 90 degrees ?
Trapezius and serratous anterior
Varicose veins commonly affect the short saphenous vein. When managing varicose veins - what is the most common complication ?
Sural nerve damage
what nerve innervates the ADductor pollicus
deep branch of ulnar nerve (root value C8, T1).
where are the cords of the brachial plexus formed ?
The cords of the plexus are formed in the axilla.
what is the main extensor of the fingers ?
Extensor digitorum communis
How are hydroceles surgically managed in kids ?
trans inguinal ligation of PPV.
where is sinus Tarsai located ?
between the talus and calcaneus
what nerve supplies sensation to the anterior scrotum ?
ilioinguinal nerve
what lymph nodes do testicular cancers metastasise to ?
Para-aortic lymph nodes
The brachial plexus is encloced by what fascia ?
extension of the prevertebral fascia.
what two muscles are classiclly affecting in wining of the scapula [long thoracic nerve injury]
- serratus anterior
- trapzium
what is the origin and insertion point for pec minor ?
Origin - Upper margins of third to fifth ribs and intercostal fascia
Insertion - coracoid process
C8 and T1 [inferior trunk of brachial plexus] contribute to what nerves ?
ulnar nerve and part of median nerve
what is your acronym for the muscles innervated by the radial nerve ?
B.E.A.S.T
Brachioradialis
Extensors
Abductor pollicis longus
supinator
triceps
what is the motor function of the musculocutanous nerve ?
Flexion of the upper arm
what nerve innervates the posterior compartment of the forearm
Radial nerve
what is the common cause of hydroceles in kids ?
Patent processus vaginalis
what muscles pronate the forearm ?
Pronator Teres
Pronator quadractus
what structures make the boundaries of the anatomical snuff box ?
What is Paget–Schroetter disease ?
Upper limb DVT most commonly seen in athletes. Tends to affect axillary or suclavian vein
what nerve innervates the ADuctor pollicus muscle
Ulnar nerve
Erbs palsy is due to damage to C5-C6. What muscles are affected ?
deltoid, biceps, and brachialis muscles
what nerve innervates the suprapsinatous muscle ?
Supracapular nerve
what is the spinal level of the psoas major ?
T12 - L5
What is the lymphatic drainage of the male spongy urethra
Deep Inguinal
what nerve innervates the semimembranosus ?
tibia branch of the SCIATIC nerve
what is the attachment of the long head of the triceps muscle ?
Infraglenoid tubercule of the scapula
what is the treatment for LA toxicity due to prilocaine ?
methylene blue
What muscles make up the posterior compartment of the thigh?
- Biceps Femoris
- Semitenenosus
- semimembrenosus
what muscles make up the thenar eminence ?
- Opponens pollicus
- Flexor pollicus brevis
- Abductor pollicus brevis
The pectorals major has two head where it originates from - what are these ?
- Clavicular head
- Sternocostal head
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
what is the sensory function of the musculocutaneous nerve
Gives rise to the lateral cutaneous nerve that provides sensation to the lateral forearm
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
What is the gold standard treatment for testicular cancer ?
Orchidectomy via an inguinal approach
Spot diagnosis:
shows multiple lytic and lucent lesions with clearly defined borders on XR
Osteoclastamoma/Giant cell tumour
what are the deep muscles of the posterior leg ?
- Tibialis posterior
- Flexor hallicus longus
- Flexor digitorum longus
- Popliteus
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
There is only one muscle in the intermediate layer of the anterior forearm - What muscle is this ?
Flecor digitorum superificialis
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%.
what muscle and nerves are tested by Froment’s sign ?
- Ulnar nerve
- Adductor pollicis
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
what type of stones have a genetic risk associated ?
cysteine stones
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
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.
what nerve innervates the pec minor ?
Medial pectoral nerve
at what age can you perfom an orchidoplexy for an undescended testicle ?
6 - 18 months
what nerve roots form the long thoracic nerve ?
C5, C6, and C7 (close to their emergence from intervertebral foramina)
what is the function of the lumbricals ?
Flex the MCPs and extend the interphalangeal joints
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
which type of germ cell testicular cancers have raised AFP ?
Non-seminomatous
(AFP elevated in up to 70% of cases)
List the parts of the male urethra
- Prostatic
- Membranous
- Bulbous
- Penile
The plantaris is found in what compartment ?
within the superficial posterior compartment of the lower leg
loss of innervation to what muscles causes a claw hand ?
Lumbricals
what is a bartons fracture ?
Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
how many dorsal interossie muscles are there ?
4
what type of stones are radiolucent ?
urate
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
what nerve supplies sensation to the posterior scrotum ?
Pudendal
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.
what is the spinal level for the sciatic nerve ?
L4-S3
Fracture of which pole of the scaphoid should always be surgical fixed ?
proximal pole of the scaphoid
The plantar aspect of the foot is innervated
Tibial nerve [medial and lateral plantar nerves]
what does the Mirel score measure ?
Risk of pathological fracture
what muscle does the musculocuteous nerve pierce when it leaves the axilla ?
Corochobrachialis
In pelvic trauma, what part of the urethra is damaged if you cant palpate the prostate ?
Membranous urethra
Through which foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
Deep inguinal ring
what is the attachment of the long head of biceps muscles
Supraglenoid tubercle of the scapula
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
what nerve innervates Flexor Pollicus brevis
Median nerve
what nerve innervate the palmar interossei ?
Ulnar nerve
what is the arterial supply of the triceps
Profunda brachii artery
The greater sciatic Forman is divided into two parts by what muscle ?
Pirifomis
what structure seperates the ulnar artery from the median nerve ?
Pronator teres
What is the most superficial structure in the popliteal fossa ?
The tibial and common fibular nerves are the most superficial
Spot diagnosis
Low calcium, low phosphate, raised ALP
Osteomalacia/Rickets
what is the treatment for hydrocele in kids ?
Trans inguinal ligation of PPV
what bone malignancy has a classic soap bubble appearance on XR ?
Osteoclastoma/Giant cell tumours
what muscle forms the medial border of the cubital fossa
pronator teres
Brahcial artery cords are named based on their anatomical relationship to what structure ?
Axillary artery
what sign associated with a varicocele will make you worry about an abdominal pathology
A swelling that does not reduce when lying supine
At what age can you diagnose an undescended testicle ?
3 months
what is the narrowest part of the male urethra ?
membranous urethra
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
what is the spinal level of the ureters ?
L2 - L5
Over what Mirel score is prophylactic nail advised
9
The genitofermoral nerve originates at what spinal level ?
L1/2
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)
what is the innervation for pec major ?
medial and lateral pectorial nerves
which drug is known to cause non infective epidididymo-orchitis ?
Amiodarone
what are the borders of the adductor canal ?
Anteromedial – Sartorius.
Lateral – Vastus medialis.
Posterior – Adductor longus and adductor magnus.
what nerve supplies the nail beds on the first two fingers ?
Median nerve
what is the action of the lumbricals on the IP joints ?
Extension
where do the superficial muscles of the anterior forearm originate ?
Medial epicondyle of the humerus
The genital branch of the genitofemoral nerve innervates what structure ?
Scrotum
what is the longest part of the male urethra ?
Penile [AKA Spongy] urethra
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
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
what is the most medial structure in the cubital fossa ?
Median nerve
List the intrinsic shoulder muscles
Deltoid
Teres major
Rotator cuff
Teres minor
supraspinatous
infraspinatous
subscapularis
What muscle forms the inferior border of the quadrangular space ?
Teres major
which muscles are reponsible for lateral rotation of the upper limb ?
Teres minor
infraspinatous
posterior fibers of the deltoid
what muscles medially rotate the upper limb ?
Anterior fibers of the deltoid
teres major
subscapularis
what is the innervation to the teres major and minor ?
Teres major - subscapular nerves
teres minor - axillary nerves
where does the teres major originate ?
Inferior border of the scapula
what is the innervatin to the dorsum of the foot ?
what is the deepest structure in the popliteal fossa ?
Popliteal artery
what do seminoma’s show in histology ?
Sheet like lobular patterns of cells with substantial fibrous component. Fibrous septa contain lymphocytic inclusions and granulomas may be seen.
What test is used to assess kindey FUNCTION ?
MAG3 renogram
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
what is the most common type of prostate cancer ?
ACINAR adenocarcinomas
The majority of prostate cancers (>95%) are adenocarcinomas. What area of the prostate are these most commonly found ?
The peripheral zone
What is gold standard imaging for prostate cancer investigation ?
MRI
What is the lowest gleason score someone with prosate cancer can have ?
3+3
how is a gleason score calculated ?
sum of the most common growth pattern + the second most common growth pattern seen.
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.
what is the CNS distribution for the knee jerk reflex ?
L3-L4
where does the cephalic vein form ?
in the anatomical snuffbox
What structure is at risk in olecranon fractures or damage to the medial epicondyle ?
Ulnar nerve
the lower leg contains anterior, posterior and perineal compartment. what structure is located in the peroneal compartment ?
Peroneus Longus and Brevis
what is used to investigate a child with vesicoureteric reflux in whom there are concerns about the potential of renal scarring ?
DMSA scan
what muscles make the floor of the femoral triangle ?
Iliopsoas, adductor longus and pectineus
extensor hallicus longus nerve root supply
L5
Flexor digiti minimi brevis originated from where ?
Hamate
what muscles attach to the lesser trochanter ?
Psoas major
Illiacus
What muscles attach to the greater trochanter ?
what nerve innervates the sartorius muscle ?
Superficial branch of the femoral nerve
what muscles make up the pet anserenius and where is it located ?
Sartorius, Gracillis and Semitendinosus
Located medial tibia
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.
which lower limb compartment is peroneus terminus located ?
Anterior
what muscle originates from the lateral border of the scapula ?
Teres major and minor
*teres major is from the lower lateral border
patient cant lift their thumb off the table - what nerve is affected ?
PIN [radial nerve]
what muscles is used to lift thumb off the table ?
EPL
what is the blood supply to the ureter ?
Proximal third - branches from renal artery
Middle third - ureter artery from aorta
Distal third - Internal iliac
what nerve innervates the tibias anterior ?
deep peroneal nerve
the quadrants lomborum is located posterior to what important structure ?
lower pole of the kidney
what structure forms the roof of the tarsal tunnel ?
Flexor retinaculum
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.
Describe the dermatomal segmentation of the forearm
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.
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.
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.
which artery is palpated lateral to the extensor hallicus longus tendon
Dorsalis pedis artery
what is the name of the fascia surrounding the kidneys ?
Gerota’s fascia
what is first line medical treatment in priapism ?
Phenylephrine injection
*not epinephrine
what type of hyperparathyroidism is linked to renal transplants ?
Tertiary
klumpke’s paralysis affects what nerve roots ?
C8 - T1
what nerves stimulate urinary excretion
Pelvic splanchnic nerves [S2-S4]
what is perkins line ?
used for assessment of hip dysplasia
post op dropping shoulder classically means damage to what structure ?
Spiral accessory nerve
what is the ulnar paradox ? and what muscle is affected
Flexor digitorum profundus
Distal lesions of the ulnar nerve are worse than proximal
what is the site of termination of the femoral nerve ?
Femoral triangle
what two nerves are found in the adductor canal ?
Saphenous nerve
nerve to the vests medialis
