Part 2 Flashcards
9 item format of abdominal sectioning
Left hypochondriac, epigastric, right hypochondriac, left lateral abdominal, umbilical, right lateral abdominal, left inguinal, hypogastric, right inguinal
Mediastinum definition
Wall of organs including heart, esophagus, thymus, trachea, and major blood vessels that separates the right from the left pleural cavity
Most likely place for a hip fracture of an elderly patient
The anatomical neck of the femur
Skier’s fracture mechanism of injury
Fracture of the fibula due to extensive weight being placed on it from confined mobility of boot while twisting and turning and managing skis, individuals can typically still walk down mountain despite pain because THE FIBULA IS NOT WEIGHT BEARING
The part of the talus that interacts with the tibia and fibula
The dome of the talus
The balls of the feet or the balls of the hand correspond to the…
heads of the metatarsals and heads of the metacarpals respectively
Large attachment site vs medium vs small on a bone terms
trochanter, tuberocity, tubercle
Great saphenous vein
Long superficial vein returning blood on medial side from foot, leg and thigh and emptying into the femoral vein at the level of the femoral triangle. Often this is harvested for a CABG
Important thing to remember when using the great saphenous vein in a CABG
Veins have valves, so it has to be oriented properly to allow blood flow
NAVL
The femoral nerve, artery, vein (hugged together within femoral sheath), and lymphatics (in the order lateral to medial) that travel together in the femoral triangle
Borders of the femoral triangle
The inguinal ligament, adductor longus, and sartorius
Saphenous branch of femoral nerve
Goes below knee, must be identified in ACL surgery and avoided cut to protect sensation in pockets on the leg
Femoral nerve origin and muscles it innervates
L2-4, innervates anterior thigh muscles such as quads, sartorius, and pectineus
Why don’t we lose blood flow to the glute area when sitting for prolonged periods?
The arteries perforate through the adductor magnus around to the back side at the adductor hiatus
Blood supply to vastus lateralis and what is the vastus lateralis often used for
Descending limb of lateral circumflex femoral artery, as an injection site IM
Trendelenberg gait
A result of paralysis or pareisis of the gluteus medius on the contralateral side causes swinging of leg around, remember glute medius helps by raising hip girdle on contralateral side
Sciatic nerve origin and components
Arises from L4-S3, tibial nerve which wraps around to innervate posterior leg, and common fibular nerve to innervate the anterior leg
Innervation of biceps femoris long head vs short head
Long head is tibial portion and short head is common fibular portion of sciatic nerve
Common finding on knee aspiration with an ACL tear
Middle genicular artery runs alongside ACL and tears with it so blood will be found, 1 of 6 genicular arteries
Name the 6 deep external rotators of the hip
- Gemelli superior and inferior
- Obturator externus/internus
- Quadratus femoris
- Piriformis
Adductor hiatus
Break in adductor magnus muscle to allow for passage of femoral artery and vein, changing names to popliteal
Pes Anserine
Attachment site of 3 different muscles, sartorius, semitendinosus, and gracilis on the medial lower face of the knee
The gastrocnemius is bi-articulate, meaning…
It crosses 2 joints
What are the 4 major types of laxatives
1) fiber and bulk forming agents
2) surfactants
3) osmotic agents
4) stimulant laxatives
Neuroimaging criteria for mild head trauma
GCS <15, suspected open or depressed or basilar skull fracture, >1 episode of vomiting, neurologic deficit, bleeding diathesis or anticoag use, seizure, >60 y/o, retrograde amnesia, intoxication or abnormal behavior
kidney stone size charting for passage
<5 mm manage at home, between 5-10 mm alpha blocker and outpatient assuming no other complicating factors for 4 weeks total, >10 mm urologic eval
“Natural” skin products will more than 9/10 times contain….
…allergens
Recent studies indicate overuse of SABA (albuterol) is associated with increased risk of …
…asthma exacerbations and increased asthma related mortality.
First line treatment for genitourinary syndrome of menopause (formerly vulvovaginal atrophy or atrophic vaginitis) in the absence of contraindications
low dose vaginal estrogen cream or insert or ring
4 cardinal features of parkinson disease
-Bradykinesia
-Rigidity (cogwheel), resistance to passive range of motion
-resting tremor
-postural and gait instability
Vibratory angioedema definition
Rare manifestation in a patient with untreated OSA and severe snoring that can result in anaphylaxis if untreated
1st line treatment for parkinson disease
carbidopa/levodopa
To extend the benefit of levodopa between doses in a parkinson disease pt, they can take one of these 3 medication types
-dopamine agonists (pramipexole, ropinorole, rotigitine)
-MAOI’s
-Catechol-o-methyltransferase inhibiors (-capone)
zonisamide (zonegran) drug class
Misc. Antiseizure agent
maxalt (rizatriptan) drug class
Triptan (serotonin 5HT1b1d receptor agonist)
psyllium (metamucil) drug class
Bulk forming laxative similar to fiber
Methylcellulose (citrucel) drug class
Bulk forming laxative similar to fiber
docusate (colace) drug class and MOA
surfactant laxative, lowers surface tension of stool allowing water to enter it and bulk it up
polyethylene glycol (PEG, miraLAX) drug class and MOA
osmotic laxative, pulls water into the colon from intestinal wall allowing for bulking of stool
What class of laxative is most concerning if abused and what consequences can occur
Osmotic laxatives, electrolyte derangement and overload issues in pt’s with cardiac or renal dysfunction
Lactulolose drug class
osmotic laxative
sorbitol drug class
osmotic laxative
List of the saline laxatives (2) and what mechanism do they work by? What is the most serious complication with them?
milk of magnesia, mag citrate, they are osmotic laxatives. Hypermagnesemia in pt’s without renal function
bisacodyl (dulcolax) drug class and MOA
stimulant laxative, alteration of electrolyte transport in intestinal mucosa and increase motor activity of intestines
senna (senoket) drug class
stimulant laxative
Triptan (serotonin 5HT1b1d receptor agonist) MOA
Bind vascular seratonin receptors in the cranial arteries that vasoconstrict reducing blood flow as the dilation of those arteries during migraine attacks often worsens pain
Pectineus muscle function, insertion, nerve, vasculature
Function: Flexion of femur at hip, adduction of femur at hip
Insertion: Pubis to femur
Nerve: Femoral
Vasculature: Obturator artery (branch off internal illiac
Psoas major function, insertion, nerve
Function: Flexion of femur at hip, external rotation of femur at hip
Insertion: T12-L5 to lesser trochanter
Nerve: Femoral
Iliacus Function, insertion, nerve, vasculature
Function: Flexion of femur at hip, external rotation of femur at hip
Insertion: Iliac crest to lesser trochanter
Nerve: femoral
Vasculature; Medial femoral circumflex artery
Sartorius function, insertion, nerve, vasculature
Function: Flexion of femur at hip, flexion of tibia at knee, external rotation of femur at hip
Insertion: Anterior superior Iliac spine to medial tibia
Nerve: Femoral
Vasculature: femoral
Rectus femoris function, insertion, nerve, vasculature
Function: Flexion of the femur at the hip, extension of the tibia at the knee
Insertion: Anterior inferior iliac spine to tibial tuberocity
Nerve: Femoral
Vasculature: femoral artery
Vastus lateralis function, insertion, nerve, vasculature
Function: Extension of tibia at the knee
Insertion: Linea aspera of femur to the tibial tuberocity
Nerve: Femoral
Vasculature: Descending limb of the lateral circumflex femoral artery
vastus intermedius function, insertion, nerve, vasculature
Function: Extension of tibia at the knee
Insertion: Linea aspera of femur to the tibial tuberocity
Nerve: Femoral
Vasculature: Femoral artery
vastus medialis function, insertion, nerve, vasculature
Function: Extension of tibia at the knee
Insertion: Linea aspera of femur to the tibial tuberocity
Nerve: Femoral
Vasculature: femoral arter
adductor longus function, insertion, nerve, vasculature
Function: Adduct femur at hip
Insertion: Pubis to linea aspera of femur
Nerve: Obturator
Vasculature: Profunda femoral artery
adductor brevis function, insertion, nerve, vasculature
Function: Adduct femur at hip
Insertion: Pubis to linea aspera of femur
Nerve: Obturator
Vasculature: Profunda femoral artery
adductor magnus function, insertion, nerve, vasculature
Function: Adduct femur at hip
Insertion: Pubis to linea aspera AND adductor tubercle of femur
Nerve: Obturator and sciatic
Vacsulature: Profunda femoral artery
Gracillis function, insertion, nerve, vasculature
Function: Adduct femur at hip, flex tibia at knee
Insertion: Pubis to medial tibia
Nerve: Obturator
Vasculature: Medial circumflex branch of femoral artery
Tensor fascia lata function, insertion, nerve, vasculature
Function: Flexion of femur at hip, abduction of femur at hip, internal rotation of femur at hip
Insertion: Iliac crest to lateral tibia
Nerve: Gluteal nerve
Vasculature: Superior gluteal artery
gluteus maximus function, insertion, nerve, vasculature
Function: Extension of femur at hip, external rotation of femur at hip
Insertion: Iliosacrum to IT tract
Nerve: inferior gluteal nerve
Vasculature: Gluteal arteries
gluteus medius function, insertion, nerve, vasculature
Function: Abduction of femur at hip
Insertion: Ilium to greater trochanter
Nerve: Superior gluteal nerve
Vasculature: superior gluteal artery
gluteus minimus function, insertion, nerve, vasculature
Function: Abduction of femur at hip
Insertion: Ilium to greater trochanter
Nerve: Superior gluteal nerve
Vasculature: superior gluteal artery
Piriformis function, insertion, nerve, vasculature
Function: Abduction of femur at hip
Insertion: Sacrum to greater trochanter
Nerve: Superior gluteal nerve
Vasculature: superior gluteal artery
obturator internus/externus function, insertion, nerve, vasculature
Function: Lateral rotation of femur at hip
Insertion: Obturator foramen to greater trochanter
Nerve: Obturator
Vasculature: Obturator artery
superior and inferior gemelli function, insertion, nerve, vasculature
Function: Lateral rotation of femur at hip
Insertion: Ischial spine to greater trochanter
Nerve: Obturator
Vasculature: Inferior gluteal artery
quadratus femoris function, insertion, nerve, vasculature
Function: Lateral rotation of femur at hip
Insertion: Ischial spine to greater trochanter
Nerve: Obturator
Vasculature: Inferior gluteal artery
semimembranosus function, insertion, nerve, vasculature
Function: Flexion of the tibia at the knee, extension of femur at the hip
Insertion: Ischial tuberosity to medial tibia
Nerve: Tibial nerve (sciatic)
Vasculature: Profunda femoral artery
semitendinosus function, insertion, nerve, vasculature
Function: Flexion of the tibia at the knee, extension of femur at the hip
Insertion: Ischial tuberosity to medial tibia
Nerve: Tibial nerve (sciatic)
Vasculature: Perforating arteries
Biceps femoris long head function, insertoin, nerve, vasculature
Function: Flexion of tibia at knee, extension of femur at hip
Insertion: Ischial tuberosity and femur to fibula
Nerve: Tibial nerve(sciatic)
Vasculature: Perforating arteries
Tibialis anterior function, insertion, nerve, vasculature
Function: Dorsiflextion of the foot at the ankle, Inversion of foot at the ankle
Insertion: Tibia to the medial cuniform
Nerve: Deep fibular nerve
Vasculature: Anterior tibial artery
Extensor digitorum longus function, insertion, nerve, vasculature
Function: Dorsiflection of foot at ankle, Extension of toes at MTP joint
Insertion: Tibia to distal phalanx digits 2-5
Nerve: Deep fibular nerve
Vasculature: Anterior tibial artery
Extensor hallucus longus function, insertion, nerve, vasculature
Function: Dorsiflexion of the ankle, extension of digit 1 at MTP joint
Insertion: Tibia to distal phalanx digit 1
Nerve: Deep fibular nerve
Vasculature: Anterior tibial artery
Fibularis tertius function, insertion, nerve, vasculature
Function: Dorsiflexion of foot at ankle, eversion of the foot at the ankle
Insertion: Fibula to inferior side of 5th metatarsal underside
Nerve: deep fibular nerve
Vasculature: anterior tibial artery
Fibularis longus function, insertion, nerve, vasculature
Function: plantarflexion of foot at ankle, eversion of foot at ankle
Insertion: Fibula to inferior side of first metatarsal
Nerve: Superficial fibular nerve
Vasculature: Anterior tibial artery
Fibularis brevis function, insertion, nerve, vasculature
Function: Plantarflexion of foot at ankle, eversion of foot at ankle
Insertion: Fibula to superior side of 5th metatarsal
Nerve: Superficial fibular nerve
Vasculature: Anterior tibial artery
Gastrocnemius function, insertion, nerve, vasculatur
Function: plantarflexion of foot at ankle, flexion of tibia at knee
Insertion: Condyle of the femur to achilles tendon
Nerve: Tibial nerve
Vasculature: sural arteries
Soleus function, insertion, nerve, vasculature
Function: Plantarflexion of foot at ankle
Insertion: Tibia to achilles tendon
Nerve: Tibial nerve
Vasculature: Sural arteries
Plantaris function, insertion, nerve, vasculature
Function; Plantarflexion of foot at ankle
Insertion: Femur to achilles tendon
Nerve: Tibial
Vasculature: Popliteal artery
Flexor Hallucis longus function, insertion, nerve, vasculature
Function: Dorsiflexion of foot at ankle, flexion of 1st toe at MTP
Insertion: tibia to distal phalanx of toe one
Nerve: Tibial
Vasculature: Posterior tibial artery
Flexor digitorum longus function, insertion, nerve, vasculature
Function: Dorsiflexion of foot at ankle, flexion of 2-5 toes at MTP
Insertion: tibi to distal phalanges of toes 2-5
Nerve: tibial
Vasculature: posterior tibial artery
Tibialis posterior function, insertion, nerve, vsaculature
Function: Plantarflexion of foot at ankle, Inversion of foot at ankle
Insertion: Tibia to navicular
Nerve: Tibial
Vasculature: Posterior tibial artery
Biceps femoris short head function, insertoin, nerve, vasculature
Function: Flexion of tibia at knee
Insertion: Femur to fibula
Nerve: Common fibular nerve
Vasculature: Perforating arteries
calcium and albumin relationship
calcium in serum is principally bonded to protein, mainly albumin, therefore serum calcium levels in patients that also have hypo or hyperalbuminemia might not reflect accurate levels, thus ionized calcium remains gold standard for assessing status esp. if diagnosis of hypocalcemia is in doubt
HCV virus transmission
Primarily blood such as sharing needles or maternal to child, can be sexually transmitted mostly M2M if there is blood exposure such as through anal
Lomotil (diphenoxylate and atropine) drug funciton
antidiarrheal
Embryonic 3 germ layers and what they form
Ectoderm - forms epidermis and nervous sytem
Mesoderm - Muscle, bone, blood and other connective tissue
Endoderm - mucus lining of GI and respiratory tracts
Examples of simple cuboidal epithelium
Found in Liver, thyroid, mammary, salivary and other glands, bronchioles, and most kidney tubules
Examples of simple columnar epithelium
Inner lining of GI tract, uterus, kidney & uterine tubes
Pseudostratified epithelium location
Found in respiratory system, not all cells reach surface
Keratanized stratified sqamous epithelium location
The skin
Nonkeratanized stratified squamous epithleium location
oral mucosa, esophagus, vagina
Transitional epithelium location and function
Ureters, bladder, able to contract and expand with distension
6 cells of connective tissue
1) Fibroblasts - produce fibers and ground substance
2) Macrophages - WBC phagocytose foreign material
3) Neutrophil - suicide bomber
4) Plasma cells - release antibodies
5) Mast cells - secrete histamine and heparin inhibit clotting and dilate blood vessel
6) Adipocytes - store triglycerides
3 types of cartilage, characteristics and where they are found
1) Hyaline - tracheal rings, glass matrix layout
2) Elastic - external ear, elastic fibers to bounce back
3) Fibrocartilage - Meniscus, parallel collagen fibers
Tight junction
Completely encircle the cell joining it to surrounding cells, zipper like pattern that prevents any substances between the cells such as in the GI and urinary tract
Desomosomes
Patch between 2 cells holding them together against mechanical stress
Gap junctions
Communicating junctions to allow for small solutes to pass from cell to cell
3 mixed organs with endo and exocrine function
1) Liver
2) Gonads
3) Pancreas
Holocrine glands definition
Secretory cells that disintegrate in order to deliver accumulated product and some cell fragments, such as oil producing cells of scalp
Metaplasia definition
Changing one type of mature tissue into another
Neoplasia definition
Growth of a tumor (benign or malignant)
Atrophy vs necrosis vs apoptosis
Atrophy is shrinkage of cells and number of cells
Necrosis is pathological death of tissue
Apoptosis is planned cell death, cells shrink and are phagocytosed WITHOUT inflammation
Simple squamous epithelium location
Alveoli, glomeruli, endothelium and serosa
Mitosis
Asexual reproduction, forms 2 identical daughter cells with no mechanism for genetic diversity, undergoes Interphase, prophase, etc
Meiosis
Sexual reproduction, forms 4 haploid gametes with diverse spread of genes through crossing over and homologous recombination to create egg and sperm
Sex hormone release pathway
Hypothalamus -> GnRH -> pituitary gland -> gonadotropins (FSH/LH)
Embryonic age definition
Number of days since fertilization
Gestational age definition
Number of days since start of ovarian cycle (embryonic age + 2 weeks)
Zygote
One cell stage of fertilized ovum before first cleavage occurs
Morula
Ball of cells composing the early embryo that produces both the embryo and the placenta and membranes - each cell is totipotential
Blastocyst
The stage that follows the morula stage. It consists of a fluid filled cavity surrounded by trophoblasts with embryoblast cells at one pole.
Trophoblast
Cells outside the blastocele, becomes the placenta
Embryoblast
Inner cell mast inside blastocele, becomes the embryo
Fertilization occurs in the…
…distal third of the fallopian tube
What occurs 3-4 days after ovulation
Entrance in the uterine cavity
What occurs 5-6 days after ovulation
HCG levels rise, tropoblast releases enzymes that erode the uterine lining for implantation
What occurs 7-12 days post ovulation
Trophoblast cells engulf and destroy cells of the uterine lining to create blood pools, stimulate capillary growth and develop placenta
Where do ectopic pregnancies occur?
Implantation in the distal third of the fallopian tube, sometimes elsewhere as well
Sacrococcygeal teratoma
Leftover primary streak containing all 3 cell types, easily removed without issue
Why do dermatomes form the way they do?
They are lined up linearly on the neural fold, but projection of the limbs causes distortion of them
Exposure to toxins within first ___ weeks causes greastest damage during development, exposure beyond that causes…
9…minor or small changes in the infant
Meconium
product of cell loss, digestive secretion and swallowed amniotic fluid in an embryo (essentially feces)
By how many weeks can a fetus live outside the body?
24-26
