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63 Cards in this Set
- Front
- Back
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Varicose veins, thrombosis, thrombophlebitis
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Varicose veins: dilated veins so cusps of valves don't close -> superficial posteromedial veins of leg becomes dilated and tortuous
Venous thrombosis - blood clotting after bone fracture Thrombophlebitis - venous inflammation w/ thrombus formation |
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Saphenous vein graphs
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Saphenous is used for coronary arterial bypasses because it is accessible, long, and has lots of muscular and elastic fibers in walls
Valves myst be reversed before grafting |
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Saphenous cutdown and saphenous nerve injury
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Saphenous cutdown - cannulas are inserted in great saphenous vein anterior to medial malleolus
Saphenous nerve injury can occur during this because the nerve is right next to the vein |
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Enlarged inguinal lymph nodes
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Abrasions and minor sepsis cause enlargement
Inguinal lymph nodes can be enlarged in females due to metastatic cancer |
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Regional anesthetic nerve blocks of lower limbs
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Femoral nerve is blocked 2cm inferior to inguinal ligament, a finger lateral to femoral artery
If saphenous nerve was affected, paresthesia (tingling) radiates to knee over medial leg |
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Palpation, compression, and cannulation of femoral artery
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Femoral pulse - (right hand on right leg) little finger on ASIS and thumb on pubic tubercle
Compression - press directly on superior pubic ramus, psoas major, and femoral head to reduce blood flow distally Cannulation - just inferior to midpoint of inguinal ligament in left cardiac angiography |
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Femoral hernia
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Herniation of abdominal viscera through femoral ring into femoral canal (containing fem a. and v).
Can enlarge by passing through the saphenous opening into subq tissue More common in females |
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Location of femoral vein
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Immediately medial to femoral artery
Don't mistake for saphenous vein in grafts (saph is 3 cm inferior to inguinal ligament) |
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Ischial bursitis (where is pain?)
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Friction bursitis from excessive friction between ischial bursae and ischial tuberosities.
Due to recurrent microtrauma Localized pain over bursa and calcification if chronic |
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Trochanteric bursitis (where is pain?)
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Deep diffuse pain in lateral thigh
Friction bursitis caused by repetitive action like climbing stairs that uses glut max and semitendinosus |
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Hamstring injuries
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In sports
Tear proximal attachments at ischial tuberosity Can be accompanied by muscle contusion resulting in hematoma |
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Injury to superior gluteal nerve - Trendelenburg sign
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Causes gluteus medius limp w/ weakened ABduction of thigh
Positive Tburg sign - when patient w/ superior gluteal nerve lesion stands on one leg, pelvis of unsupported side descends. Identifies lesion in SUPPORTING leg |
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Injury to sciatic nerve
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Pain in buttocks can be due to compression of sciatic nerve by piriformis
Wounds to lateral side are safer than medial side due to likelihood of injury to sciatic nerve |
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Intragluteal injections
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Gluteal muscles provide large surface area for absorption
Safest in superolateral quadrant above line of PSIS and greater trochanter |
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Popliteal pulse
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Best felt inferior of fossa where pop. artery is related to tibia
Weakened pulse is a sign of femoral a. obstruction |
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Popliteal aneurysm
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Abnormal dilation of all or part of artery
Causes edema and pain in popliteal fossa Artery lies to deep to tibial nerve so aneurysm may stretch nerve, referring pain to skin over medial calf, ankle, foot |
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Injury to tibial nerve
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Uncommon due to deep position but can happen by laceration or dislocation of knee joint
Causes paralysis of flexors, inability to flex/feel ankle or foot |
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Compartment infections and syndromes in leg
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Septa and fascia boundaries to leg compartments are strong
So increased volume causes increased pressure Can be caused by trauma to muscles -> hemorrhage, edema, inflammation Fix by fasciotomy |
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Tibialis anterior strain
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Shin splints
Muscles in anterior compartment swell from sudden overuse (exercise) Edema and muscle tendon inflammation reduce blood flow -> pain and tenderness Mild compartment syndrome |
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Deep fibular nerve entrapment (2 causes)
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Caused by excessive use of muscles in anterior compartment -> muscle injury/edema
Or by direct compression to nerve by tight shoes (ski boots) as it passes deep to inferior extensor retinaculum |
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Injury to common fibular nerve
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Most common nerve injured in lower limb
Due to trauma to area, fracture of fibular neck, or stretched by dislocation of knee joint Flaccid paralysis of muscles in lateral and anterior compartments -> loss of dorsiflexion -> foot drop |
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Ruptured calcaneal tendon
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Sustained during forceful push off (plantarflexion)
After injury, no plantarflexion is possible, excessive passive dorsiflexion |
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Calcaneal tendon reflex (which nerve roots?)
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Ankle (jerk) reflex) for S1-S2
Strike calcaneal tendon proximal to calcaneus -> Plantarflexion of ankle joint |
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Posterior tibial pulse
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Palpate posterior tibial artery between medial malleolus and medial border of calcaneus tendon
Invert foot to relax retinaculum Absence of pulse suggests peripheral arterial disease |
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Palpation of dorsalis pedis pulse
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Palpate immediately lateral to EHL tendon
Diminished or absent suggests vascular insufficiency from arterial disease |
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Fractures of femoral neck
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Most common in women > 60 yo, can be due to car accident in head-on collision
Disrupts blood flow to head of femur via medial circumflex femoral artery -> aseptic vascular necrosis |
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Dislocation of hip joint (congenital vs acquired)
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Congenital - femoral head is not properly located in acetabulum, inability to abduct thigh, + Trendenlenburg
Acquired - posterior most common in car accidents, can lesion sciatic nerve; anterior dislocation usually occurs w/ acetabular margin fractures |
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Genu valgum and varum
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Q angle - line from ASIS to middle of patella angles w/ extrapolated line thru middle of patella and tibial tuberosity
Genu varum - medial angulation of leg in relation to thigh reduces Q angle, streches LCL Genu valgum - lateral angulation, large Q, stretch TCL |
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Patellar dislocation
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Usually dislocates laterally
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Knee joint injuries
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Ligament sprains are most common (MCL and LCL)
Meniscal tears are usually medial, but can often heal on their own due to generous blood supply |
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Unhappy triad
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Blow to lateral extended knee tears MCL and medial meniscus because MCL is attached to medial meniscus
When ACL also tears -> unhappy triad |
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Bursitis of knee joint (3)
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"Housemaid's knee" (people who work on knees) irritate bursa -> prepatellar bursa
Subcutaneous infrapatellar bursitis - excessive friction b/w skin and tib. tuberosity -> edema over proximal end of tibia Suprapatellar bursitis - abrasions or penetrating wounds |
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Popliteal (Baker cysts)
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Abnormal, fluid-filled sacs of synovial membrane
Usually result of chronic knee joint effusion |
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Ankle injuries (most common ligament?)
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Usually ankle sprains (torn ligaments) due to inversion
Lateral ligaments are weaker than medial Most common is anterior talofibular |
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Pott's fracture
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Dislocation of ankle due to extreme foot eversion
Medial ligament is torn -> tears medial malleolus -> talus moves and shears off lateral malleolus -> carries tibia anteiorly Tri malleolar fracture: medial + lateral malleolus + posterior distal tibia |
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Tibial nerve entrapment
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Heel pain around medial malleolus resulting from compression of tibial nerve by flexor retinaculum
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Caudal epidural anesthesia
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Inject into epidural space either via sacral hiatus or posterior sacral foramina
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Herniation of nucleus pulposus
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Nucleus pulposus herniates into vertebral canal posteriorly at thinnest part of anulus fibrosus
Localized pain at site from local irritation at ligaments Chronic pain from compression of spinal nerve roots is referred - eg Sciatica due to compression of L5 or S1 Always compression of nerve 1 below the herniated disc |
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Back pain (3 types)
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Localized pain is muscular, joint, or fibroskeletal
Muscular pain - ischemia Zygopophysial joint pain - aging, joint disease Periosteal bone pain |
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Abnormal curvature of vertebral column
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Thoracic kyphosis - hunchback due to osteoporosis
Lumbar lordosis - hollow back can be due to weakened trunk musculature or obesity |
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Compression of lumbar spinal roots
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IV foramina decrease in size from sup to inf but lumbar spinal nerves increase.
So L5 spinal nerve is most susceptible by compression due to herniation |
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Lumbar spinal puncture
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To extract CSF to test for CNS diseases like Meningitis
Below L4 puncture dura mater and arachnoid mater to enter the lumbar cistern in subarachnoid space |
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Steps of gastrulation
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3rd week
Primitive streak complex -> invasion of epiblast -> first cells displace hypoblast and become endoderm -> rest spread between epiblast and endoderm to become mesoderm -> epiblast becomes epiderm |
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Somitomere development
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From solid rod of paraxial mesoderm
Begins at eventual posterior skull and progress caudally |
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Development lateral to paraxial mesoderm
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Immediately lateral: mesoderm -> GU
Further lateral: somatopleure -> inner body wall; and splanchnopleure -> connective tissue covering abdomen and thoracid organs |
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Neural induction
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Neuroectoderm is induced by secrete proteins
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Segmentation
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Derives from somites
Epithelial somite consists of myotome, dermatome, and sclerotome (bone) Sclerotome gives rise to vertebrae |
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Relationship b/w spinal nerves, somites, and vertebrae
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Each vertebrae arises from caudal half of one somite and rostral half of the next posterior one
IV discs arise from center of somite and notocord Vertebrae are INTERSEGMENTAL Spinal nerve remain aligned w/ somites so emerge below vertebrae |
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Segmentation of dermamyotome
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Remain segmental so are between the transverse processes
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Neurulation
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Process by which neural plate roles up into neural tube
Proceeds rostrally so brain can close first |
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Spina bifida occulta
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Posterior neuropore closes but the vertebral arch doesn't form properly. Associated w/ back problems
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Spina bifida cystica: meningocele and meningomyelocele
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Meninges are not covered by skin and cyst forms in lumbar
If spinal cord remains in vertebral canal -> meningocele If spinal cord is suspended in cyst -> meningomyelocele |
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Rachysthesis
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Neural tissue xposed to environment w/out meningeal coverings -> severe
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Regionalization
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Specifying distinct AP parts of the body
Determined by HOX genes |
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Hox genes: null mutation vs adding a gene
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Null: cranializes
Adding in (overexpressing): caudalizes |
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Neurogenesis
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CNS comes from neural tube
PNS comes from neural crest |
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Neural crest
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Cells migrate ventrally or laterally
Level of origin, route, and destination determine differentiation |
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Branching of spinal nerve
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When myotome splits into epimere (dorsal) and hypomere (ventral),rami go with
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Disorders of neural crest development
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DiGeorge
Sipple Hirschsprung - faulty crest migration into distal gut |
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What inserts on greater trochanter? (7)
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Gluteus medius + minimus
Obturator internus/externus Piriformis Superior/inferior gemelli |
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What inserts on lesser trochanter?
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Iliopsoas
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Where does the iliotibial band insert?
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Gerdy's tubercle
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Action of obturator externus?
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Lateral rotator
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