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637 Cards in this Set
- Front
- Back
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Ch. 1 - Vertebral column
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1
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Anatomic references from vertebrae
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2
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Aortic hiatus
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T12
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Arch of aorta
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T2
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Bifurcation of aorta
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L4
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bifurcation of CCA
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C4
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Celiac artery
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T12
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Cricoid cartilage
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C5
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Duodenum
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L1
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End of dural sac
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S2
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End of spinal cord in adult
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L1
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End of spinal cord in newborn
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L3
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Hyoid bone
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C4
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Iliac crest
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L4
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IMA
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L3
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IVC hiatus
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T8
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Jxn of sup & inf mediastinum
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T4
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Pulm hilum
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T5-T7
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Renal artery
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L2
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sacral promontory
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S1
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Seophageal hiatus
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T10
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SMA
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L1
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Start of esophagus
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C5
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Start of sigmoid
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S1
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start of trachea
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C5
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Sternal angle
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T4
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sternal notch
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T2
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Tracheal bifurcation
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T4
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Umbilicus
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L3
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Upper pole of left kidney
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T11
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Upper pole of right kidney
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T12
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Xiphisternal joint
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T9
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Kyphosis is?
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exaggeration of thoracic curve
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Lordosis is?
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exaggeration of lumbar curve
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Scoliosis is?
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lateral deviation/torsion
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2 fxn of atlanto-occipital joint
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Nodding, sideway tilt
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1 fxn of atlantoaxial joint
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Shaking head no
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Subluxation is
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atlantoaxial dislocation
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Caused by 2
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rupture of transverse ligament of atlas, RA
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Denervation by zygapophyseal joints is Tx for?
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RA when spinal nerve impinged
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4 ligaments determining stability of vertebral column
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ant longitudinal ligament, post longitudinal ligament, ligamentum flavum, interspinous ligaments
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3 vertebral routes of mets?
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internal vertebral venous plexus, basivertebral veins, external vertebral venous plexus
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Nucleus pulposus usu herniates in which direction?
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Posterolateral
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Spondylolysis is
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Fx of pars interarticularis
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Appears on radioagraph as
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radiolucent colar around neck of scottie dog
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Spondylolisthesis
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Ant subluxation of vertebral body
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Hangman Fx is
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Subluxation of C2
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3 components of spondylosis deformans
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disc space narrowing, facet joint narrowing, bone spurs
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Teardrop Fx is
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hyperflexion of cervical; shearing off triangle
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Jefferson Fx is
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Compression of cervical region
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Chancce Fx is
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hyperflexion of thoracic/lumbar
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Ch. 2 - Spinal cord
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13
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Gray matter is divided into 3
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dorsal horm, ventral horn, lateral horn
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White matter is divided into 3
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dorsal, ventral, lateral funiculus
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Epidural space is between
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vertebra and dura mater
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Contains
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Interal vertebral venous plexus
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Dura mater is
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outermost layer of meninges
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Arachnoid is connected to pia by
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trabeculations
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pia mater is suspended by
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denticulate ligament
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CSF is in
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subarachnoid space
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Important dermatomes
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17
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Big toe
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L4
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Dorsum of foot
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L5
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Face
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V1-V3
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Genitalia/anal zone
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S2-S5
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Index and middle fingers
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C7
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Inguinal ligament
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L1
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Lateral surface of foot
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S1
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Lateral surface of leg
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L5
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Lateral surface of upper limb
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C5
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Little toe
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S1
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Lower neck
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C4
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Medial surface of leg
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L4
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Medial surface of upper limb
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T1
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Nipple
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T4
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Post surface of lower limb
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S1
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Post surface of upper limb
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C7
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Ring and little fingers
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C8
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Shoulder
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C4
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Thumb
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C6
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Top of head
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C2
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Umbilicus
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T10
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Upper neck
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C3
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Xiphoid process
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T7
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LP is is taken above spinous process of
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L4
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LP pierces thru? 9
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Skin -> superficial fascia -> supraspinous ligament -> interspinous ligament -> ligamentum flavum -> epidural -> dura mater -> arachnoid -> subarachnoid
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Spinal anesthesia up to what level for vaginal birth?
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T10
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Spinal anesthesia up to what level for C-section?
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T4
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Signs of ant spinal artery occlusion?
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B/l spastic paresis, b/l sensation loss, b/l Horner, b/l flaccid paralysis
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Quadriplegia occur with above
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C3
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3 causes of incomplete spinal cord injury
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concussive blow, ant spinal artery occlusion, penetrating blow
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Ch. 3 - ANS
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23
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SNS efferent route?
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CNS -> short preganglionic -> ganglion -> long postganglionic -> effector organ
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Preganglionic sympathetic neuron bodies located?
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T1-L2/L3
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4 fates of preganglionic axons?
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Synapse at same lveel, synapse higher or lower, pass thru as splanchnic to prevertebral ganglia, pass thru as splanchnic to adrena
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NT of postganglionic sympathetic?
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Norepi
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SNS afferent component is
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Visceral pain by nocireceptors
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SNS afferent route?
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Viscera -> Paravertebral organ -> spinal cord -> VPT and reticular formation -> cortex
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PNS efferent rount?
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CNS -> long preganglion -> ganglion -> short postganglionic -> effector
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NT of postganglionic PNS?
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acetycholine
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PNS afferent route?
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CN VII, IX, X or sacral -> ALS, spinoreticular, solitary nuc -> RVLM
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PNS afferents ctrl? 6
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Visceral pressure, PaO2, chemo-R, baro-R, osmo-R, thermo-R
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Ch. 22 - Head
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241
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What pass thru?
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242
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accessory meningeal artery
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foramen ovale
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ant ethmoidal nerve/artery
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ant ethmoidal foramina
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Brainstem medulla
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foramen magnum
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central artery of retina
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optic canal
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central vein of retin
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optic canal
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CN I
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Cribriform plate
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CN II
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optic canal
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CN III
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sup orbital fissure
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CN IV
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sup orbital fissure
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CN IX
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jugular foramen
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CN V1
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sup orbital fissure
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CN V2
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foramen rotundum
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CN V3
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foramen ovale
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CN VI
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sup orbital fissure
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CN VII
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internal acoustic meatus
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CN VIII
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internal acoustic meatus
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CN X
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jugular foramen
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CN XI
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jugular foramen, foramen magnum
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CN XII
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hypoglossal canal
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Emissary vein
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Foramen cecum, condylid foramen
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greater petrosal nerve
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hiatus of facial canal
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ICA
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carotid canal
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lesser petrosal nerve
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foramen ovale
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opthalamic artery
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optic canal
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opthalmic veins
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sup orbital fissure
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post ethmoidal nerver/artery
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post ethmoidal foramina
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sigmoid sinus
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jugular foramen
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symp carotid plexus
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carotid canal
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Vertebral arteries
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foramen magnum
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Crouzon syndrome genetics
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Auto R
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Defective gene
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FGFR2
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Risk of?
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progressive hydrocephalus
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Arnold-Chiari malformation is
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foramen magnum herniation
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Causes of bacterial meningitis? 5
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GBS, e. coli, listeria, pneumoccocus, neisseria
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Causes of viral meningitis? 5
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Mumps, echovirus, coxsackie, EBV, HSV-2
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Kernig sign is
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Unable to extend lower limb when sitting but can when lying down
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Epidural hemorrhage is most commonly caused by
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Rupture middle meningeal artery
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Shape
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Convex
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Opthalmic artery occlusion causes
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monocular blindness
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ACA occulsion causes
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C/l paralysis, c/l anesthesis of leg
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MCA occlusion
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c/l hemiplegia, c/l hemianesthesia, homonymous hemianopia, aphasia
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shape of subdural hemorrhage
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Crescent
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Caused by
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Emissary veins
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Often found in? 2
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elderly, alcoholics
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Subarachnoid hemorrhage described as?
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Worst HA of life
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CN IV lesion results in? 2
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Vertical diplopia that incr when looking down; extorsion of eye
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CN VI lesion results in? 3
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Convergent strabismus, horizontal diplopia, inability abduct eye
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Crocodile tear syndrome is?
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Tearing during eating
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Occurs from?
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CN VII lesion
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Acoustic neuroma Sx? 3
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hearing loss, tinnitis, dizziness
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CN X lesion uvula deviates?
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C/l side
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CN XI lesion means can't turn head?
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C/l
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CN XII lesion deviates tongue?
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i/l
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Ch. 23 - Neck
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258
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U/l damage to recurrent laryngeal nerve causes?
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Hoarseness
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B/l damage to recurrent laryngeal nerve causes?
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Breathlessness
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Crycothyroidectomy inserted b/t?
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Cricoid & thyroid cartilage
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Tracheotomy inserted b/t?
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2nd & 3rd tracheal cartilage rings
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2 risk factors for LMN lesion of CN VII
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Surgery on partoid, bell's palsy
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Causes? 4
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i/l loss facial muscles, loss corneal reflex, loss tastes, hyperacusis
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Frey syndrome is?
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Sweating while eating
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Caused by?
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Damage to auriculotemporal nerve (surgery on parotid)
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Stroke facial Sx often spare?
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Upper face
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Ch. 4 - Lymphatic system
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31
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purpose?
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drain ECF from body and return to venous
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2 parts not contain lymphatic drainage?
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brain, spinal cord
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thoracic duct begins as
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abdominal confluence
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Level?
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L1/2
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4 trunks that drain there?
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R/L lumbar, R/L intestinal
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dilated sac is called?
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cisterna chyli
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thoracic duct leaves thru which diaphragmatic hiatus?
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aortic
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it drains into which vessel?
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L subclavian
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what doesn't drain into thoracic duct? 3
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R side of H&N, R breast, RUL/ supericial thoracoabdominal wall
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Ch. 5 Chest Wall
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34
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Which ribs are "false"?
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Ribs 8-12
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which ribs are floating?
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ribs 11-12
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which is the level of the sternal angle of louis?
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T4
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Which rib does it articulates with?
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R2
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The phrenic nerves provide which time of innervation?
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Motor & sensory
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Sensory innervation of diaphragm periphery provided by
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intercostal nerves
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Lesion of phrenic nerve moves diaphragm which way (inspiration)
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upward
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Which intercostal muscles play a role in inspiration during stress?
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External
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Which intercostal muscles play a role in expiration during stress?
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Internal
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Movement of the ribs during inspiration? 2
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Ribs 1-6 "pump handle"; lower ribs "bucket handle"
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Movement of the ribs during expiration?
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TRICK! It's passive
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Forced expiration requires?
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External oblique, internal oblique, transverse abdominal
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Intercostal arteries supplied by? 4
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Internal thoracic, musculophrenic, costocervical trunk, thoracic aorta
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Intercostal veins empty into? 3
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brachiocephalic, hemiazygos, azygos
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Ligaments that shorten with breast CA, causing dippling or inversion of nipple?
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Cooper ligaments
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A route from breast mets to brain: 4 steps
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intercostal vein -> external vertebral venous plexus -> internal vertebral venous plexus -> cranial dural sinus
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Dermatomes of the breast?
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T4-T6
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Coarctation of the aorta is associated with? 4
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High upper extremity pressure, low lower extremity pressure, rib notching, hypoplastic aortic arch
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Aortic aneurysm associated with? 3
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Compressed trachea, tracheal tug w/ systole, can be palpated at sternal notch
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Thoracic outlet syndrome defined by? 2
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compressed lower trunk, subclavian
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intercostal nerve block admin where?
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posterior lower border of rib
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Ch. 6 - Pleuro, trachea, lungs
|
50
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Pleuritic chest pain is always of which type of pleura
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parietal
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It can be referred to? 2
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thoracic wall, root of neck
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Where does pleura extend past rib cage?
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Right infrasternal angle
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Most common site of spont PTX?
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upper lobe of lung
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Esp prominent in? 2
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Young, tall male, ARDS
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Difference b/t PTX and tension PTX?
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PTX involves collapsed lung; tension will compress c/l lung (inspired air cant leave)
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Sx of tension PTX? 5
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CP, SOB, deviated trachea, absent breath sounds, hypotension
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Level of tracheal birfurcation?
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T4
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2 anatomic causes of compression of trachea?
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enlarged thyroid, aortic arch aneurysm
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When pt standing/sit/supine, aspiration most likely enters?
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Right lower lobe
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|
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When pt lying on side, aspiration most likely enters?
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i/l upper lobe
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|
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role of PNS efferent innervation on bronchi? 2
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bronchoconstriction, incr glandular secretion
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role of PNS afferent innervation? 2
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touch, stretch sensation
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role of SNS efferent innervation? 2
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dec bronchoconstriction, vasoconstriction
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role of SNS afferent innervation? 1
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pain sensation
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lecithin:sphingomyelin ratio that represents maturity
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> 2:1
|
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Saddle embolus occurs at?
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bifurcation of aorta
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bronchiectasis defined as?
|
permenant bronchodilation
|
|
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obstructive lung dz is defined by
|
incr airway resistances
|
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3 etiologies?
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in airway wall (asthma), outside airway (emphysema), in airway lumen (bronchitis)
|
|
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Key radiograph features of obstructive dz? 3
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hyperinflation, hyperlucency, depressed diaphragm
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|
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Shed epithelium and eosinophilic granules in bronchial wall suggest?
|
asthma
|
|
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restrictive lung dz defined by
|
dec compliance
|
|
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Common findings on radiograph? 3
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honeycomb lung (interspersed clear and interstitium), small lung, raised diaphragm
|
|
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hyperinflated lungs with bronchiectasis suggests?
|
cystic fibrosis
|
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Ch. 7 - heart
|
69
|
|
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paradoxical pulse is associated with?
|
cardiac tamponade
|
|
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Another sign?
|
Superior vena cava syndrome
|
|
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2 approaches to pericardiocentesis?
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sternal, subxiphoid
|
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Posterior surface of heart is mostly
|
LA
|
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Apex is made of
|
LV inferior portion
|
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Anterior surface is mostly
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RV
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Inferior surface is mostly
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LV
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What is it related to?
|
central tendon of diaphragm
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Left surface is mostly
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LV
|
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What does it occupy?
|
Cardiac impression of L lung
|
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Right surface is mostly?
|
RA
|
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Inferior border is
|
RV
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Superior border is 5
|
RA, LA, SVC, ascending aorta, pulm trunk
|
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L intercostal space 5 midclavicular
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Mitral (bicuspid)
|
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Sternum intercostal space 5
|
Tricuspid
|
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L Parasternal intercostal space 2
|
Pulmonary valve
|
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R parasternal intercostal space 2
|
Aortic valve
|
|
|
Which vessel determines the dominant side of heart blood supply?
|
post IV artery
|
|
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What major artery supplies the SA and AV nodes?
|
R coronary
|
|
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Coronary sinus drains directly into?
|
RA
|
|
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What delinates trebulates and smooth parts of RA? 2
|
Crista & sulcus terminalism
|
|
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Valve of the fossa ovalis is a remnant of?
|
septum primum
|
|
|
limbus of the fossa ovalis is a remnant of?
|
septum secundum
|
|
|
conus arteriosus (infundibulum) is a remnant of?
|
bulbus cordis
|
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ch. 13 Spleen
|
136
|
|
|
Spleen is endangered by Fx of which ribs?
|
R9-11
|
|
|
Gastrosplenic ligament contains which vessels 2
|
short gastric artery/vein; L gastroepiplolic artery/vein
|
|
|
Splenorenal ligament contains 3
|
Splenic artery branches, splenic vein, tail of panc
|
|
|
5 terminal branches of splenic artery
|
dorsal panc, great panc, caudal panc, short gastric, L gastroepiploic
|
|
|
Do these have anastomoses?
|
NO -> splenic infarction
|
|
|
splenic artery aneurysm have high incidence of rupture in
|
pregnant women
|
|
|
most common complication of splenectomy
|
atelectasis of L lower lobe
|
|
|
3 organs that can be affected by splenectomy
|
gastric wall (gastric arteries), tail of panc, L kidney (splenorenal ligament)
|
|
|
splenic vein thrombosis most commonly assoc w/
|
pancreatitis
|
|
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Ch. 8/9 - abdominal wall/peritoneal cavity
|
p 89/95
|
|
|
Upper mid and lower quadrants are called
|
R & L hypochondriac, lumbar, inguinal
|
|
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medial quadrants are called
|
epigastric, umbilical, and hypogastric
|
|
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midline paracentesis pass thru: 5
|
skin -> sup fascia -> linea alba -> transversalis fascia -> extraperitoneal fat
|
|
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flank paracentesis pass thru: 7
|
skin -> sup fascia -> ext oblique -> int oblique -> transverse abdominis -> transversalis fascia -> extraperitoneal fat
|
|
|
inguinal hernias pass b/t
|
med to inguinal ligament; lateral to recuts abdominus
|
|
|
indirect hernia passes thru
|
deep & superficial ring
|
|
|
femoral hernias pass behind & between?
|
behind lacunar ligament, b/t coopers & femoral vein
|
|
|
complication of surgical hernia repair
|
damage to iliohypogastric nerve or ilioinguinal nerve
|
|
|
which would cause anesthesia to penis/scrotum/medial thing
|
damage to ilioinguinal nerve
|
|
|
which would cause anesthesia to abd wall and inguinal region
|
damage to iliohypogastric nerve
|
|
|
CA of scrotum mets to
|
superficial inguinal node
|
|
|
CA of testes mets to
|
deep lumbar nodes
|
|
|
extravasated urine collects b/t
|
Colles fascia/dartos muscle & external spermatic fascia
|
|
|
cremasteric reflex tests
|
ilioinguinal nerve
|
|
|
rebound tenderness v. guarding
|
tenderness = pain on palpation; guarding = abd wall spasms
|
|
|
Ch. 10 - abd vasc
|
p 97
|
|
|
celiac trunk is at what level
|
T12
|
|
|
celiac supplies? 5
|
foregut: esophagus, stomach, duodenum, liver, GB, panc
|
|
|
3 arteries of celiac trunk
|
L gastric, splenic, common hepatic
|
|
|
sup mesenteric trunk is what level
|
L1
|
|
|
Sup mesenteric supplies? 7
|
midgut: duodenum-ileum, cecum, appendix, ascen/transverse colon
|
|
|
inf mesenteric trunk is at what level
|
L3
|
|
|
inf mesenteric supplies 4
|
hindgut: transverse/desc sigmoid colon, upper rectum
|
|
|
most common site of AAA
|
below renal arteries
|
|
|
first step for AAA
|
above celiac trunk
|
|
|
severe abd pain out of proportion w/ no evidence of peritonitis
|
acute mesenteric ischemia
|
|
|
acute mesenteric ischemia most often occurs in
|
sup mesenteric artery
|
|
|
gradual occlusion at AA birfurcation may result in 2
|
claudication, impotence
|
|
|
azygous vein is collateral pathway for
|
IVC & SVC
|
|
|
100% mortality with ligation of IVC where
|
above kidney
|
|
|
R v. L gonadal vein
|
R drain directly into IVC; L thru renal vein
|
|
|
R-sided hydronephrosis may indicate thrombosis where in F
|
R ovarian vein (constricts ureter)
|
|
|
L-sided varicocele can be occlusion of which veins 2
|
L testicular or L renal vein
|
|
|
Collateral path from IVC to int jugular 5
|
IVC -> lumbar -> vertebral venous plexuses -> cranial sinuses -> int jugular
|
|
|
Portal vein is the jxn of which 2 veins
|
splenic & sup mesenteric
|
|
|
3 portal IVC anastomosis
|
esophagus, umbilicus, rectum
|
|
|
Ch. 11 abdominal viscera
|
p 103
|
|
|
Esophagus
|
p 103
|
|
|
5 main sites where esophagus constricted
|
jxn w/ pharynx; aortic arch/ tracheal bifurcation; LA; esophageal hiatus
|
|
|
Muscles of UES v. LES
|
UES = sk; LES = SM
|
|
|
3 arterial supplies of esophagus
|
inf thyroid, desc thoracic aorta, L gastric
|
|
|
3 venous drainages of esophagus
|
inf thyroid, esophageal plexus (to azygous), L gastric
|
|
|
opening UES muscle innervated by
|
CN XII
|
|
|
closing UES muscle innervated by
|
CN X
|
|
|
esophageal sk muscle innervated by
|
CN X
|
|
|
Malig tumors of esophagus mets below diaphragm to
|
celiac LN
|
|
|
Mallory-Weiss v. Boerhaave syndrome tears
|
MW thru sub/mucosal layers; Boerhaave thru all layers
|
|
|
sliding hiatal hernia is
|
stomach + GE jxn herniates thru diaphragm into thorax
|
|
|
paraesophageal hiatal hernia is
|
only stomach herniates thru diaphragm
|
|
|
bird beak of LES (distal stenosis)
|
achalasia
|
|
|
Achalasia in S. America
|
Chagas
|
|
|
zig zag line at distal esophagus
|
Barrett's
|
|
|
Stomach
|
p 106
|
|
|
Cardiac stomach is
|
near GE jxn
|
|
|
fundic stomach is
|
above GE jxn
|
|
|
body of stomach is
|
b/t fundus & antrum
|
|
|
pylorus is
|
distal stomach + pyloric canal
|
|
|
arteries supplying lesser curvature
|
R/L gastric
|
|
|
arteries supplying greater curvature
|
R/L epiploic
|
|
|
arteries supplying fundus
|
short gastric
|
|
|
Which gastric veins drain into portal vein
|
R/L gastric, L gastroepiploic
|
|
|
Which gastric veins drain into SMV
|
R gastroepiploic
|
|
|
2 location for stomach mets
|
Supraclavicular node (Virchow), ovaries (Krukenberg)
|
|
|
burning epigastric pain soon after eating v. 1-3 hr after eating
|
DDx for gastric v. duodenal ulcer
|
|
|
post wall duodenal ulcers can erod which artery
|
gastroduodenal
|
|
|
2 parts of duodenum that are retroperitoneal
|
descending, horizontal
|
|
|
Vasa rectae supply 2
|
jejunum, ileum
|
|
|
McBurney's point is
|
halfway b/t umbilicus & ASIS
|
|
|
gallstones in GB is called
|
cholecystolithiasis
|
|
|
gallstones in bile duct is called
|
choledocholithiasis
|
|
|
PNS postganglionic neuronal bodies for SI and colon are located in
|
Enteric nervous sys
|
|
|
PNS postganglionic neuronal bodies for GB are located in
|
GB wall
|
|
|
SNS postganglionic neuronal bodies for SI are located in
|
celiac and sup mesenteric ganglion
|
|
|
SNS postganglionic neuronal bodies for colon are located in
|
same as SI for prox to splenic flexure; distal in the inf mesenteric ganglion
|
|
|
SNS postganglionic neuronal bodies for GB are located in
|
celiac ganglion
|
|
|
Mirizzi syndrome is
|
when large stone in cystic duct obstruction nearby common hepatic duct
|
|
|
Harmann pouch is
|
small pouch extending from neck of GB; common site for stone
|
|
|
Ampulla of Vater is
|
where common bile duct meets panc duct
|
|
|
Sphincter of Oddi is
|
thickened SM surrounding bile duct in ampulla
|
|
|
relation of panc to common bile duct
|
CBD is post to panc
|
|
|
annular panc is
|
ring of panc tissue surrounding duodenum
|
|
|
double bubble sign
|
annular pan causing dilation of stomach & distal duodenum
|
|
|
Newborn constipation + gushing of fecal material on rectal exam
|
Hirschsprung's dz
|
|
|
Signs of colostomy 4
|
lose ejaculation, erection, retain urine, dec peristalsis
|
|
|
lymphatic drainage of upper anal canal
|
Deep nodes
|
|
|
lymphatic drainage of lower anal canal
|
superficial inguinal node
|
|
|
Pt complain of pain if tumor/hemorrhoid is in which part of anal canal
|
lower
|
|
|
portal hypertension manifests as which type of hemorrhoids
|
internal
|
|
|
defecation reflex is supplied by which spinal level
|
S2-S4
|
|
|
Kidney, Ureter, Bladder, Urethra
|
Ch. 14
|
|
|
true capsule of kidney
|
renal capsule
|
|
|
false capsule of kidney
|
perirenal fascia of Gerota
|
|
|
false capsule of kidney contain
|
kidney, adrenal gland, ureter, gonadal artery/vein, perirenal fat
|
|
|
list ant->post: renal artery, pelvis, vein
|
vein -> artery -> pelvis
|
|
|
which kidney is higher
|
L (T11)
|
|
|
renal hilum at what level
|
L1 (transpyloric)
|
|
|
pain from kidney patho referred to
|
T12-L2 dermatome
|
|
|
4 causes kidney trauma
|
lower rib Fx, lumbar Fx, penetrating wound on lower rib, MVC w/ seat belt marks
|
|
|
absolute indication for renal exploration
|
pulsatile/expanding retroperitoneal hematoma
|
|
|
in male, ureters related to
|
ductus deferens
|
|
|
in female, ureters related to
|
uterine artery
|
|
|
3 norm ureter constriction
|
at the ureteropelvic jxn, where ureters cross pelvic inlet, at ureterovesical jxn
|
|
|
u/l hydronephrosis
|
renal calculi
|
|
|
calculi that are colorless, small squares crossed by diagonal lines
|
Ca oxalate
|
|
|
calculi that are colorless, rectangular, prism-shaped
|
MgNH4 sulfate
|
|
|
calculi that are yellow/red-brown diamond-shaped
|
Uric acid
|
|
|
calculi that are colorless, hexagonal w/ layers
|
cystine
|
|
|
post bladder related to
|
rectovesical pouch (M), ant vaginal wall (F)
|
|
|
ant bladder related to
|
pubic symphysis
|
|
|
sup bladder related to
|
peritoneal cavity, uterus (F)
|
|
|
ANS innervation of which bladder muscle
|
detrusor
|
|
|
PNS afferent limb of bladder
|
micturition reflux
|
|
|
SNS afferent limb of bladder
|
pain referred to T12-L2 dermatomes
|
|
|
external urethral sphincter innervated by
|
pudendal nerve
|
|
|
rupture of bladder superior wall leaks urine into
|
peritoneal cavity
|
|
|
rupture of bladder superior wall caused by
|
compression force on full bladder
|
|
|
rupture of bladder anterior wall leaks urine into
|
retropubic space
|
|
|
rupture of bladder anterior wall leaks caused by
|
fractured pelvis
|
|
|
what else can fractured pelvis cause
|
post urethra torn above urogenital diaphragm, ruptured neck of bladder,
|
|
|
tear of ant urethra below urogenital diaphragm leaks urine into
|
superficial perineal space
|
|
|
tear of ant urethra below urogenital diaphragm caused by
|
straddle injury
|
|
|
tearing of penile urethra leaks urine
|
beneath deep fascia of Buck (but if tears will continue to superficial perineal space)
|
|
|
why is stress incontinence in F > M?
|
external urethral sphincter does completely surround urethra (b/c ant vag wall)
|
|
|
what can make stress incontinence worse in F?
|
childbirth
|
|
|
Ch. 15 - Suprarenal/Adrenal gland
|
158
|
|
|
L suprarenal vein drains into
|
L renal vein
|
|
|
R suprarenal vein drains into
|
IVC
|
|
|
3 layers of adrenals from sup->inf
|
zona glomerulosa, zona fasciculata, zona reticularis
|
|
|
Ch. 16 - Female reproductive system
|
163
|
|
|
is the ovary covered by peritoneum?
|
no, simple cuboidal epithelium
|
|
|
R ovarian vein drains into
|
IVC
|
|
|
L ovarian vein drains into
|
renal vein
|
|
|
thrombosis of R ovarian vein can result in
|
R side hydronephrosis b/c R ureter constriction
|
|
|
ovarian pain reffered to
|
inner thigh
|
|
|
sensory to ovary
|
obturator nerve
|
|
|
4 parts of uterine tube
|
infundibulum, ampulla, isthmus, intramural division
|
|
|
where does fertilization take place
|
ampulla
|
|
|
which part opens to peritoneum
|
infundibulum
|
|
|
which part opens to uterus
|
intramural division
|
|
|
4 parts of uterus
|
cervix, body, cornu, fundus
|
|
|
which part is by the uterine tubes
|
cornu
|
|
|
which part is the main contribution during pregnancy
|
fundus
|
|
|
cervical os in nulliparous woman is
|
round
|
|
|
cervical os in parous woman is
|
transverse
|
|
|
which ligament contains uterine artery
|
transverse cervical ligament
|
|
|
which ligament contains overian artery/vein
|
broad ligament
|
|
|
which part of broad ligament supports uterine tube
|
mesosalpinx
|
|
|
which part of broad ligament supports ovaries
|
mesovarium
|
|
|
which part of broad ligament supports uterus
|
mesometrium
|
|
|
mnemonic for broad ligametn contents: BROAD
|
Bundle (ovarian neurovasc), Round ligament, Ovarian ligament, Artifacts (vestigial), Duct (oviduct)
|
|
|
herniation of bladder into ant wall of vagina
|
cystocele
|
|
|
which ligament helps prevent a cystocele
|
pubocervical ligament
|
|
|
ant vaginal fornix related to
|
vesicouterine pouch
|
|
|
post vaginal fornix related to
|
rectouterine pouch
|
|
|
Culdocentesis is
|
pass needle thru post fornix to collect fluid from peritoneum
|
|
|
herniation of rectum into post wall of vagina
|
rectocele
|
|
|
Ch. 17 - Male Reproductive System
|
172
|
|
|
3 layers convering testes (superficial -> interior)
|
tunica vaginalis, tunica albuginea, tunica vasculosa
|
|
|
mnemonic for scrotal layers: Some Damn Englishman Call It The Testis
|
skin, dartos, external spermatic fascia, cremasteric, internal spermatic fascia, tunica vaginalis, testis
|
|
|
R testicular vein drains into
|
IVC
|
|
|
L testicular vein drains into
|
L renal vein
|
|
|
L side testicular varicocele indicate occlusion of 2
|
L testicular vein or L renal vein
|
|
|
Difference b/t cryptochidism and ectopic testes
|
cryptochidism = incomplete descent; ectopic = abnormal path
|
|
|
undescended testis usu found within 2
|
inguinal canal or abd cavity nar deep inguinal ring
|
|
|
b/l cryptochidism result in
|
infertility
|
|
|
cryptochidism assoc w/ inc risk of 2
|
CA, torsion
|
|
|
hydrocele patho
|
small patency of processu vaginalis -> peritoneal fluid flow into
|
|
|
varicocele patho
|
dilation pampiniform plexus & testicular vein
|
|
|
varicocele most common on
|
L side (sigmoid colon block testicular vein)
|
|
|
bag of worms scrotal swelling
|
varicocele
|
|
|
torsion patho
|
rotation of testes about spermatic cord
|
|
|
bell clapper deformity
|
high attachment of tunica vaginalis to spermatic cord
|
|
|
2 risk factor for torsion
|
horizontal testis, bell clapper deformity
|
|
|
torsion result in ischemic necrosis in
|
6 hours
|
|
|
sperm maturation & storage occur in
|
head & body of epididymus
|
|
|
fxn of principal cells in epididymis: 3
|
resorb testicular fluid, phagocytose degenerating sperm, secrete gp that inh capacitation
|
|
|
3 layers of tail of epididymis
|
inner longitudinal, middle circular, outer longitudinal
|
|
|
SM that contral in sexual excitation to contribute to emission 2
|
epididymis tail, ductus deferens
|
|
|
ejacultory duct made up of 2
|
ductus deferens, seminal vesicles
|
|
|
ducts in spermatic cord 2
|
ductus deferens, lymphatics
|
|
|
arteries in spermatic cord 3
|
testicular artery, artery of ductus deferens, cremasteric artery
|
|
|
veins in spermatic cord 1
|
pampiniform venous plexus
|
|
|
nerves in spermatic cord 3
|
SNS, PNS, genitofemoral nerve
|
|
|
fascia in spermatic cord 4
|
Colles, external spermatic, cremasteric, internal spermatic
|
|
|
muscle in spermatic cord 2
|
dartos muscle, cremasteric muscle
|
|
|
mnemonic for spermatic cord contents: piles don't contribute to a good sex life
|
pampiniform plexus, ductus deferens, cremasteric artery, testicular artery, artery ductus deferens, genital branch of genitofemoral, sympathetic nerves, lymphatics
|
|
|
venous drainage of prostate that explains mets to heart & lungs
|
prostatic venous plexus -> internal iliac veins -> IVC
|
|
|
venous drainage of prostate that explains mets to vertebral column & brain
|
prostatic venous plexus -> vertebral venous plexus -> cranial dural sinuses
|
|
|
layer of erectile tissue transmitting urethra
|
corpus spongiosum
|
|
|
layer of erectile tissue dorsal
|
corpus cavernosa
|
|
|
layer of erectile tissue ventral
|
corpus spongiosum
|
|
|
mnemonic for erection v. ejaculation neuronal stim
|
point and shoot (PNS = erection; SNS = ejaculation)
|
|
|
which spinal nerve injury would affect erection
|
pelvic splanchnic S2-S4
|
|
|
which spinal nerve injury would affect secretion
|
pelvic splanchnic S2-S4
|
|
|
which spinal nerve injury would affect emission
|
lumbar splancnic L3-L4
|
|
|
Ch. 18 - pelvis
|
182
|
|
|
wing of hip bone
|
ala of ilium
|
|
|
greater sciatic foramen transmits which veins 3
|
sup gluteal, inf gluteal, internal pudendal
|
|
|
greater sciatic foramen transmits which arteries 3
|
sup gluteal, inf gluteal, internal pudendal
|
|
|
greater sciatic foramen transmits which nerves 4
|
sup gluteal, inf gluteal, pudendal nerve, sciatic nerve
|
|
|
greater sciatic foramen transmits which muscle 1
|
piriformis
|
|
|
lesser sciatic foramen transmits which vein, artery, nerve 1
|
internal pudendal vein & artery; pudendal nerve
|
|
|
false pelvic cavity is located in
|
abdominal cavity
|
|
|
true pelvic cavity is located in
|
b/t pelvic inlet & outlet
|
|
|
pelvic inlet shape in M
|
heart-shape
|
|
|
pelvic inlet shape in F
|
oval-shape
|
|
|
true conjugate diameter
|
sacral promontory to sup margin of pubic symphysis
|
|
|
diagonal conjugate diameter
|
sacral promontory to inf margin of pubic symphysis
|
|
|
true conjugate diameter measured how
|
radiographically on lateral projection
|
|
|
diagonal conjugate diameter measured how
|
pelvic exam
|
|
|
pelvic outlet shape (both M & F)
|
diamond
|
|
|
pelvic outlet closed by 2
|
pelvic & urogenital diaphragm
|
|
|
pelvic outlet divided into anal & urogenital triangle by
|
line b/t ischial tuberosities
|
|
|
transverse diameter
|
distance b/t ischial tuberosities
|
|
|
interspinous diameter
|
distance b/t ischial spines
|
|
|
which OB diameter can be barrier to fetus if too small
|
interspinous diameter
|
|
|
Who has deeper pelvic cavity - M or F
|
M (narrow and deep)
|
|
|
7 arteries of ant division of internal iliac
|
inf gluteal, internal pudendal, umbilical, obturator, vaginal/vesicular, uterine/ductus, middle rectal
|
|
|
3 arteries of post division of internal iliac
|
iliolumbar, lateral sacral, sup gluteal
|
|
|
3 venous plexuses M v. F
|
rectal venous plexus + vesical/prostatic or + uterine/vaginal
|
|
|
sacral plexus rami
|
L4-S4
|
|
|
mnemonic for lumbar plexus: Interested in getting laid on Fridays
|
iliohypogastric, ilioinguinal, genitofemoral, lat femoral cutaneous, obturator, femoral
|
|
|
3 complications of pelvic relaxation
|
cystocele, rectocele, uterine prolapse
|
|
|
Sx of pelvic relaxation 3
|
lower abd heavy sensation exacerbated by heavy lifting/prolonged standing, inc freq w/ burning sensation, stress incontinence
|
|
|
keystoen of femoral-sacral arch
|
sacrum
|
|
|
2 routes of pudendal nerve block
|
transvaginally, lateral to labia majora
|
|
|
pudendal nerve block landmarks
|
around tip of ischial spine, thru sacrspinous ligament
|
|
|
pain of childbirth transmitted thru
|
S2-S5 pudendal nerve
|
|
|
3 nerves blocked to complete anesthesized perineal region
|
ilioinguinal, genitofemoral, perineal branch of post femoral cutaneous
|
|
|
deep perineal space is b/t
|
sup & inf fascia of UG diaphragm
|
|
|
superficial perineal space is b/t
|
inf fascia of UG diaphragm & superficial perineal fascia (Colles)
|
|
|
Structures in deep perineal space - M & F 3
|
IUS, artery & nerve of penis/clitoris, urethra
|
|
|
structures in deep perineal space - M v F 2
|
Cowper glands (M), vagina (F)
|
|
|
structures in superficial perineal space - M & F 7
|
bulbiospongiosus, ischiocavernosus, dorsal & deep arterie of penis/clitoris, dorsal nerve of penis/clitoris, crura, bulb, perineal body,
|
|
|
structures in superficial perineal space - M v F 4
|
M: post scrotal nerves & arteries, duct of Cowper; F: post labial arteries & nerve, Bartholin glands
|
|
|
mediolateral epistotomy cuts where
|
skin -> vaginal wall -> bulbospongiosus muscle
|
|
|
Para/Thyroid Glands
|
265
|
|
|
3 complications of thyroidectomy
|
thyroid storm, hypoparathyroidism, damage to recurrent/sup laryngeal nerve
|
|
|
aberrant thyroid tissue occur where
|
base of tongue to sup mediastinum (path of descent)
|
|
|
thyroglossal duct systs is
|
cystic remnant of thyroid descent
|
|
|
sup parathryoid glands where in thyroid
|
post surface of upper thyroid lobes (near inf thyroid artery)
|
|
|
inf parathyroid glands where in thyroid
|
lateral surface of lower thyroid lobes (but more variable than sup)
|
|
|
overlapping blood supply of thyroid & parathyroid
|
inf thyroid artery
|
|
|
Ch. 20 - upper limb
|
202
|
|
|
patho subclavian steal syndrome
|
subclavian stenosis -> low subclavian pressure -> flow: c/l vertebral->basilar->i/l vertebral-> arm
|
|
|
Allen test is to see
|
if radial or ulnar artery occluded
|
|
|
Allen test
|
make tight fist; compress radial or ulnar artery; if blood not return when open, other artery occluded
|
|
|
deep lacerations at MC that also cuts deep palmar arch causes
|
inability to flex fingers (palmar arch deep to flexor digitorum)
|
|
|
midshaft Fx affects which artery
|
deep brachial artery
|
|
|
supracondylar Fx of humerus affects which artery 2
|
brachial artery; Volkmann ischemic contracture
|
|
|
Mnemonic for order of brachial plexus
|
Randy travis drinks cold beer: rami, trunk, division, chord, branches
|
|
|
upper trunk made from
|
C5, C6
|
|
|
middle trunk made from
|
C7
|
|
|
Lower trunk made from
|
C8, T1
|
|
|
what happens at division level
|
trunks split into anterior & posterior
|
|
|
Lateral cord made from
|
upper & middle trunks ant divisions
|
|
|
medial cord made from
|
lower trunk ant division
|
|
|
posterior cord made from
|
post division of upper, middle, lower trunk
|
|
|
musculocutaneous comes from
|
lateral cord
|
|
|
axillary nerve comes from
|
post cord
|
|
|
radial nerve comes from
|
post cord
|
|
|
ulnar nerve comes from
|
medial cord
|
|
|
median nerve comes from
|
lat & med cords
|
|
|
musculocutaneous nerve rami
|
C5-C7
|
|
|
axillary nerve rami
|
C5, C6
|
|
|
radial nerve rami
|
C5-T1
|
|
|
median nerve rami
|
C5-T1
|
|
|
ulnar nerve rami
|
C8, T1
|
|
|
upper trunk palsy called
|
Erb-Duchenne
|
|
|
Erb-Duchenne cause by
|
violent stretch b/t head & shoulder
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nerves damaged in Erb-Duchenne 3
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Musculocutaneous, suprasculpular, axillary, (phrenic)
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Erb-Duchenn presentation 4
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waiter's tip: arm is pronated, medially rotated, adducted, extended; maybe i/l diaphragm paralysis
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muscles affected in Erb-Duchenne
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intrinsic shoulder, ant arm
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sensory loss in Erb-Duchenne
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lateral forearm to base of thumb
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lower trunk palsy is called
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Klumpke's paralysis
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Klumpke's caused by
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sudden upward pull of arm
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nerves damaged in Klumpke's
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median, ulnar, (T1 sympathetics)
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Klumpke's presentation
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claw hand (ulnar nerve) + ape hand (median nerve); maybe Horner's
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muscles affected in Klumpke's
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hand, wrist
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sensory loss in Klumpke's
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medial forearm, medial 1.5 digits
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radial lesion @ axilla, midshaft, lat epicondyle - motor loss 4
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elbow/wrist/MCP extension, weakened supination
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radial lesion @ axilla, midshaft, lat epicondyle - sensory loss 3
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post arm/forearm, thumb dorsum
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radial lesion @ axilla, midshaft, lat epicondyle - digital sign
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wrist drop
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|
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radial lesion @ wrist - motor loss
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none
|
|
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radial lesion @ wrist - sensory loss
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thumb dorsum
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Saturday night palsy
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radial nerve lesion @ axilla
|
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crutches palsy
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radial nerve lesion @ axilla
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|
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mid-shaft Fx at radial groove 1
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radial nerve lesion @ midshaft
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Lateral elbow Fx
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radial nerve lesion @ lateral epicondyle
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lateral wrist laceration 4
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radial nerve lesion @ wrist, radial artery, median nerve, flexor carpi radialis
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|
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median lesion @ elbow - motor loss 6
|
thenar atrophy, pronation, flexion lateral 3 digits, thumb opposition, 2 lumbricals, wrist flexion
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|
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median lesion @ elbow - sensory loss 2
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lateral palmar surface, palmar lateral 3.5 digits
|
|
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median lesion @ elbow - digital sign 2
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hand of benediction, ape hand
|
|
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median lesion @ wrist - motor loss 3
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thenar atrophy, thumb opposition, 2 lumbricals
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|
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median lesion @ wrist - sensory loss 1
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palmar lateral 3.5 digits
|
|
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supracondylar Fx of humerus
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median nerve lesion @ elbow
|
|
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carpal tunnel
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median nerve lesion @ wrist
|
|
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medial elbow Fx
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ulnar nerve lesion @ elbow
|
|
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medial wrist laceration 3
|
ulnar nerve lesion @ wrist, ulnar artery, flexor carpi ulnaris
|
|
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Fx of hook of hamate
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ulnar nerve lesion in hand
|
|
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midshaft clavicle Fx
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ulnar nerve lesion @ arm
|
|
|
ulnar lesion - motor loss 4
|
hypothenar atrophy, 2 lumbricals, interossi, thumb adduction
|
|
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ulnar lesion - digital sign
|
claw hand
|
|
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ulnar lesion - sensory loss 1
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medial 1.5 digits
|
|
|
Fx humerus surgical neck
|
axillary nerve lesion
|
|
|
inf dislocation of shoulder
|
axillary nerve lesion
|
|
|
axillary lesion - motor loss 1
|
abduction arm to horizon
|
|
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axillary lesion - sensory loss 1
|
over deltoid
|
|
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musculocutaneous lesion - motor loss 2
|
elbow flexion, supination weakness
|
|
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musculocutaneous lesion - sensory loss 1
|
lateral forearm
|
|
|
radical mastectomy
|
long thoracic nerve injury
|
|
|
stab wound lateral to chest
|
long thoracic nerve injury
|
|
|
long thoracic lesion motor loss 1
|
loss abduction arm above horizon to above head
|
|
|
long thoracic lesion sign
|
winged scapula
|
|
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suprascapular nerve motor loss 2
|
shoulder abduction 0-15o, weak shoulder lateral rotation
|
|
|
most common shoulder dislocation
|
ant-inf
|
|
|
Sx ant-inf shoulder dislocation 3
|
lose round contour, palpable depression under acromion, head of humerus palpable in axilla
|
|
|
rotator cuff tear usu inv 2
|
supraspinatus tendon, subacromial bursa
|
|
|
presentation rotator cuff tear
|
pain lifting arm above head
|
|
|
downward blow at tip of shoulder 2
|
shoulder separation; acromioclavicular subluxation
|
|
|
signs of acromioclavicular ligament tear 3
|
injured arm lower, bulge at tip of shoulder, rebound lateral clavicle
|
|
|
midclavicular Fx displaces clavicle how
|
prox moves up (SCM), distal down (deltoid + gravity)
|
|
|
distal traction of radius
|
nursemaid's elbum; head of radius sublux out of annular ligament
|
|
|
tennis elbow is
|
infl common extensor tendon on lateral epicondyle
|
|
|
golfer's elbow is
|
infl common flexor tendon on medial epicondyle
|
|
|
Fall on forearm w/ elbow flexed Fx
|
olecranon
|
|
|
tenderness is anatomic snuff box indicate Fx of
|
scaphoid
|
|
|
fall on outstreched hand w/ wrist extended
|
Colles Fx of distal radius
|
|
|
Ch. 21 - lower limb
|
220
|
|
|
ant thigh compartment inv 2
|
femoral artery, femoral nerve
|
|
|
ant leg compartment inv 2
|
ant tibial artery, deep fibular nerve
|
|
|
trauma at femoral triangle
|
femoral nerve injury
|
|
|
pelvic Fx
|
femoral nerve injury
|
|
|
loss of knee jerk reflex
|
femoral nerve injury
|
|
|
anesthesia on ant thigh
|
femoral nerve injury
|
|
|
femoral lesion motor loss 2
|
thigh flexion, leg extension
|
|
|
femoral lesion sensory loss 2
|
ant thigh, medial leg
|
|
|
ant hip dislocation
|
obturator nerve injury
|
|
|
radical retropubic prostectomy
|
obturator nerve injury
|
|
|
obturator lesion motor loss 1
|
thigh adduction
|
|
|
obturator lesion sensory loss 1
|
medial thigh
|
|
|
post hip dislocation
|
sup or inf gluteal nerve injury
|
|
|
poliomyelitis
|
sup gluteal nerve injury
|
|
|
waddling gait
|
sup gluteal nerve injury
|
|
|
Trendelenburg sign
|
sup gluteal nerve injury
|
|
|
sup gluteal lesion motor loss 2
|
pull pelvis down, thigh abduction
|
|
|
lean trunk backward at heel strike
|
inf gluteal nerve injury
|
|
|
inf gluteal lesion motor loss 3
|
rise from sitting, climb stairs, jump
|
|
|
blow to lateral leg
|
common fibular nerve injury
|
|
|
Fx at neck of fibula
|
common fibular nerve injury
|
|
|
foot drop w/ inversion
|
common fibular nerve injury
|
|
|
common fibular lesion motor loss 3
|
foot eversion, dorsiflexion, toe extension
|
|
|
common fibular lesion sensory loss 2
|
anterolateral leg, foot dorsum
|
|
|
trauma at popliteal fossue
|
tibial nerve injury
|
|
|
foot dorsiflexed & everted
|
tibial nerve injury
|
|
|
tibial lesion motor loss 3
|
foot inversion, plantar flesion, toe flexion
|
|
|
tibial lesion sensory loss 1
|
foot sole
|
|
|
high energy MVC can resut in which Fx in driver 2
|
acetabular Fx, post hip dislocation
|
|
|
post hip dislocation lower limb is 3
|
internally rotated, adducted, shorter
|
|
|
ant hip dislocation lower limb is 2
|
externally rotated, abducted
|
|
|
femoral neck Fx lower limb is 2
|
externally rotated, shorter
|
|
|
unhappy triad knee is 2
|
abducted, laterally rotated
|
|
|
calcaneal Fx assoc w/ 2
|
lumbar Fx, neck of femur Fx
|
|
|
Inversion injury causes 3
|
Fx fibula, avulsion 5th metatarsal, torn ant talofibular ligament
|
|
|
eversion injury causes 2
|
Fx fibula, avulsion medial malleolus
|
|
|
Ch. 24 - eye
|
267
|
|
|
Mnemonic of obliques v. retctus
|
Obliques do Opposite; Rectus to Right way
|
|
|
to test inf oblique ask pt to look
|
up and in
|
|
|
to test sup oblique ask pt to look
|
down and in
|
|
|
to test inf rectus ask pt to look
|
out then down
|
|
|
to test sup rectus ask pt to look
|
out then up
|
|
|
Ch. 25 - ear
|
277
|
|
|
hyperacusis caused by lesion of
|
CN 7 - facial
|
|
|
elderly loss which frequency of sound
|
high frequency
|
|
|
conductive hearing loss patho
|
sound transmission thru external/middle ear ineffective
|
|
|
sensorineural hearing loss patho
|
loss hair cells in Organ of Corti up
|
