Sector 2- "Do you know" Flashcards
What is Batson’s venous plexus and what is its clinical significance?
It is a network of valveless veins that connect the deep pelvic and thoraic veins to the internal vertebral plexuses. It provides a route for hematogenous spread of breast, bladder, and prostate cancers to the vertebral column and/or brain.
What is the significance of the great anterior segmental artery (of Adamkeiwicz)?
Occlusion by atherosclerosis or surgical trauma can cause spinal cord ischemia with paraplegia and loss of bladder and rectal control. It arises from a left posterior intercostal artery and supplies the lumbar and sacral cord.
What is the importancs of popliteal artery aneurysms?
They rarely rupture but often embolize clot distally, threatening the viability of the lower leg and foot. They are oten bilateral and associated with abdominal aortic aneurysms. They can cause tibial nerve pressure and popliteal vei npressure leading to DVT. Treatment is surgical ligation & bypass or endovascular stenting.
What is the location and clinical significance of the sural nerve?
The sural nerve is formed by the junction of the medial sural cutaneous with the fibular anastomotic branch of the lateral sural cutaneous nerve. It lies close to the lesser saphenous vein and runs down to the interval between the lateral malleolus and calcaneus. It is cutaneous and its removal results in a relatively trivial deficit. It is often used for nerve biopsy to diagnose several diseases as well as a donor nerve for nerve grafting.
The anatomical landmarks for lumbar puncture?
With the patient in the lateral decubitus position ( i.e., lying on their right or left side ) with the back flexed, extend & adduct all your fingers. Place tip of 5th finger on top of iliac crest and your thumb will be at approximately L3 or L4. Since cord in adults ends at L2, this is a safe place for needle entry through the dura.
What is piriformis syndrome?
Muscle shortening or spasm of the piriformis can compress the sciatic nerve beneath it. In 17% of population, the common fibular nerve actually passes through the muscle. Gluteal weakness can also cause piriformis to hypertrophy. Can also be due to overuse in rowing or cycling. Suspect when sciatica occurs without spine pathology. Treatment is NSAIDS, stretching and physical therapy.
What is the clinical significance of the small saphenous vein?
Valvular incompetence here can cause posterior calf varicosities and it can also be harvested for arterial bypass purposes if the great saphenous is unavailable or phlebitic.
How do you visually diagnose a hip fracture?
Lower limb externally rotated ude to unopposed action of the external rotators. Limb also shortened due to muscle spasms.
How do you examine axillary lymph nodes?
Best done with patient sitting upright & then examiner supports patient’s arm so it hangs down in a relaxed way. Then palpate for nodes with other hand running fingers along chest way. Be aware that the bundles of the serratus anterior muscle on lateral chest wall are not lymph nodes.
The clinical usefulness of the axillary sheath?
Since it encases the neurovascular bundle, local anesthetics can be injected into the sheath using sterile technique. The anesthetic solution diffuses throughout the sheath, anesthetized all 5 major branches of the brachial plexus enabling upper extremity surgery.
What a standard axillary dissection for breast cancer ( and occasionally melanoma ) entails from an anatomic perspective?
There are 3 levels of axillary nodes: Level 1= nodes lateral to pectoralis minor, Level 2= nodes beneath pectoralis minor, Level 3= nodes medial to pectoralis minor. Usually Level 1 &2 are removed en bloc as a part of a modified radical mastectomy or in conjunction with breast preserving surgery. Level 3 occasionally removed if nodes are palpably suspicious. The long thoracic, thoracodorsal & intercostobrachial nerves are at risk in axillary dissection. Can get axillary numbness or winged scapula.
The difference between a shoulder dislocation and separation?
In dislocation, humerus separates from scapula at glenohumeral joint; over 95% are anterior and inferior glenohumeral ligament is torn. Usually treated with closed reduction; surgery for chronically recurrent cases. Shoulder separation is a tear of the coracoclavicular &/or the acromioclavicular ligaments; not a true shoulder “joint” injury. Basically treated with a sling.
The cause and signs and symptoms of biceps rupture?
Long head of biceps tendon, which travels through the shoulder joint to its proximal attachment on the supraglenoid tubercle, can rupture due to tendonitis, shoulder impingement or rotator cuff injuries. Patient notices a bulge in upper anterior arm ( “Popeye muscle” ) above elbow after sudden sharp pain in upper arm sometimes with an audible pop or snap. The short head is still intact so many patients have little functional problems.
The relevant anatomy of a femoral hernia?
From lateral to medial the anatomy is: Femoral nerve, artery, vein, empty space, lacunar ligament ( “NAVEL” ). The femoral canal is the “empty space” ( actually contains a few lymph nodes ) & is the site of femoral hernia occurrence. Can repair by suturing pectineus fascia to inguinal ligament. If need to incise lacunar ligament to reduce hernia, must be aware of an aberrant obturator artery in 40% from inferior epigastric or external iliac or aberrant large vein; called the “corona mortis” ( circle of death ) since they can cause significant occult bleeding.
The clinical usefulness of the great saphenous vein?
Often removed ( “stripped” ) to treat varicosities; also commonly used as a conduit in coronary or peripheral vascular bypass operations. At ankle, it is a good site for an urgent venous cutdown for IV fluids since it is always 1 cm anterior & 1 cm superior to the easily palpable medial malleolus; take care not to injure adjacent saphenous nerve.
