F1 Block 1 Blue Boxes

Front 1

LangerÕs/Tension Lines

Back 1

lines of tension in the dermis caused by directionality of collegen fibers which surgical incisions should follow to decrease wound gaping and increase rate of healing (p. 13)

Front 2

Stretch Marks

Back 2

damage of collagen fibers in the dermis due to increase in skin tension/stretching from pregnancy or weight gain. They fade but never completely go away (p. 13).

Front 3

Accessory/Supernumery Bones

Back 3

develops when there is failure of all ossification centers fusing together to form a single bone. Accessory bones are not part of the main bone. They are common in the skull (wormian bodies) and in the foot (p. 15).

Front 4

Heterotopic Bones

Back 4

formation of bones in improper regions of the body usually due to increased stress in the area especially muscles (riderÕs bones) (p. 15).

Front 5

Bone changes

Back 5

atrophy due to decreased use hypertrophy due to increased use and applied pressure ; reduction of a fracture: bringing of the two side of a fracture together ; collar of callus: ring of collagen secreted by fibroblasts that will eventually calcify ; greenstick fractures: fractures involving an incomplete fracture of the bone and bone bending which is often seen in young children due to increased levels of cartilage in bones (p. 18) ; osteoporosis: reduction in the organic and inorganic components of bone leading to atrophy and brittleness of the bones (p. 18).;

Front 6

Sternal Puncture

Back 6

removal of red bone marrow from the medullary cavity of the manubrium of the sternum used to treat leukemia patients (p. 18).

Front 7

Avascular Necrosis

Back 7

loss of arterial blood supply to the bone resulting in cell death.a. osteochondroses: pediatric conditions involving the avascular necrosis of bone with no known etiology.;

Front 8

Displaced epiphyseal plate

Back 8

separation of the epiphyseal plate sometimes mistaken for a fracture often seen in children.

Front 9

Fontanelles

Back 9

areas of CT on a newbornÕs skull not covered by skull bones or sutures; bulging Ð increased intracranial pressure; sunken Ð dehydration.

Front 10

Satellite Cells

Back 10

potential myoblasts in the skeletal muscle basement membrane which develop into new unorganized regenerated skeletal muscle after serious muscle damage.

Front 11

Compensatory hypertrophy

Back 11

area of cardiac muscle that increases in size due to increase demand on heart.

Front 12

Myocardial infarct (MI)

Back 12

cardiac cell death and formation of scar tissue due to decreased blood flow/oxygenation (myocardial ischemia) to the area.

Front 13

Smooth muscle can hypertrophy

Back 13

uterine smooth muscle can undergo both hypertrophy and hyperplasia in pregnancy.

Front 14

Pericytes

Back 14

undifferentiated cells in the endothelium that may become new smooth muscle cells.

Front 15

Arteriosclerosis

Back 15

thickening and loss of elasticity of arterial walls including atherosclerosis Ð a buildup of fat plaques (atheromas) on the tunica intima which may become thrombi.

Front 16

Varicose veins

Back 16

"distended, swollen, tortuous veins often in the legs due to the loss of elasticity of veinous walls and incompetent pocket valves."

Front 17

Lymphangitis

Back 17

inflammation of the lymph vessels.

Front 18

Lymphadenitis

Back 18

inflammation of the lymph nodes.

Front 19

Lymphedema

Back 19

accumulation of interstitial fluid in the lymphatic system.

Front 20

Brain or spinal cord neural regeneration is limited to

Back 20

the first two weeks post-injury with minimal sprout regeneration.

Front 21

Parasthesia

Back 21

subjective feeling of pins and needles due to nerve compression.

Front 22

Anterograde (Wallerian) degeneration

Back 22

death of axon and myelin sheath distal to itsÕ cell body and point of detachment/injury.

Front 23

Types of peripheral nerve damage

Back 23

"crushing nerve injury (no surgery), cutting nerve injury (requires surgery)."

Front 24

Variations in the number of vertebrae

Back 24

"occur in the thoracic, lumbar, sacral, and coccygeal areas in about 5% of population. The number of cervical vertebrae is almost always constant at seven."

Front 25

Kyphosis

Back 25

exaggeration of the thoracic posterior convex curvature of the spine.

Front 26

Lordosis

Back 26

"exaggeration of the lumbar posterior concave curvature of the spine often seen in obese people, pregnant women, and ovarian tumors."

Front 27

Scoliosis

Back 27

lateral curvature of the spinal cord with or without rotation of the vertebral bodies.

Front 28

Fracture of the dens results from

Back 28

falling on the cranium and can cause posterior dislocation into spinal cord resulting in quadriplegia or superior dislocation into the medulla resulting in death. Note: rupture of the atlasÕ transverse ligament causes the same pathology.;

Front 29

HangmanÕs fracture

Back 29

fracture of the 2 pedicles of the axis between the superior and inferior facets.

Front 30

Epidural anesthesia

Back 30

injection of anesthesia in the sacral canal through the sacral hiatus or transsacrally at S4 sacral foramen in which the spinal nerves and coccygeal nerve are anesthetized.

Front 31

Sacralization of L5

Back 31

L5 is fused to S1

Front 32

Lumbarization of S1

Back 32

separation of S1 from sacrum and fused to L5

Front 33

Lumbar Stenosis

Back 33

decreased size of the vertebral canal in the lumbar region resulting in compression of spinal cord and/or the cauda equina.

Front 34

Spina bifida occulta

Back 34

failure of the laminae of L5 and S1 to fuse with their respective vertebraes. Often occampanied by a tuft of hair at effected area.

Front 35

Spina bifida cystica

Back 35

failure of one or more vertebral arches to develop. Often associated with meningocele (herniation of meninges) and/or meningomyocele (herniation of meninges and spinal cord) and/or myeloschisis (meninges and spinal cord are outside of the body.

Front 36

Neural tube defects

Back 36

congenital abnormalities resulting from the neural tube failing to completely fuse (alpha-fetoprotein is good prenatal determinant of neural tube defects) .

Front 37

Herniation of IV discs

Back 37

"compression of IV discs and anterior, posterior, lateral, or posteriolateral movement of nucleus pulposus. The most common herniations occur at the L4/L5 and L5/S1 levels and are a result of posteriolateral movement of the disc. Severe hyperflexion and hyperextension of cervical region leads to compression fractures, cervical spinal ligament tears, rupture of IV discs, and herniation of IV discs."

Front 38

Zygapophysial joints with osteoarthritis

Back 38

often cause pain in dermatomes and myotomes of the spinal nerve it is closest to.

Front 39

Alar ligaments may tear from

Back 39

simultaneous flexion and rotation of the head.

Front 40

Compression of the C2 ganglion results from

Back 40

combined extension and lateral rotation at the atlantoaxial joint (pivot joint).

Front 41

Back strain/sprain

Back 41

minute stretching or tearing of muscles or the associated tendons.

Front 42

Spasm

Back 42

painful involuntary contraction of a muscle after physical injury or inflammation.

Front 43

The pia mater and arachnoid mater are derived from

Back 43

the same embryonic membrane as evidenced by the arachnoid trabechulae.

Front 44

Lumbar Puncture

Back 44

removal of CSF from the lumbar cistern (enlargement of the subarachnoid space after of the conus medullaris). Patient is sitting or lying in a flexed posture in order to increase the distance b/w the lamina and stretching the ligamentum flavum. The puncture is usually at the L4 spinous process level. Spinal block is the direct injection of anesthetic into the CSF in the subarachnoid space.

Front 45

Colostrum

Back 45

"creamy, white to yellow substance secreted by the mammary glands in the third trimester and shortly after birth which contains protein, immune agents, growth factor."

Front 46

Breast is divided into

Back 46

four quadrants when talking about cancerous locations. Note: do not forget to assess the axillary tail (Tail of Spence).;

Front 47

Breast cancer

Back 47

"almost always adenocarcinoma (derived from the glandular tissue).Interference of the lymphatic drainage of the breast: may cause edema leading to offset nipples and orange peel looking skin.; Inversion of the nipple is associated with: subareolar carcinomas.; Invasion of the retromammary space and pectoral fascia by cancerous cells cause: elevation of breast tissue with pectoral muscle contraction.; Cancer cells often metastasize to: axillary nodes, parasternal nodes, subclavicular nodes, cervical nodes, opposite breast, vertebrae, spinal cord, and abdomen.; Simple mastectomy: removal of the breast tissue down to the retromammary space.; Radical mastectomy: removal of the breast, retromammary space, pectoral fascia, pectoralis major, pectoralis minor, and the associated pectoral/axillary lymph vessels and nodes.; "

Front 48

Polymastia

Back 48

more than two breasts.

Front 49

Polythelia

Back 49

more than two nipples.

Front 50

Amastia

Back 50

failure of breast to form.

Front 51

Mammary ridge Òmilk lineÓ

Back 51

embryonic line on which breasts and nipples form extending from axilla to the groin.

Front 52

% of men develop breast cancer

Back 52

1.5.

Front 53

Gynecomastia

Back 53

"enlargement of breast tissue in men due abnormal androgen metabolism at the liver, diethylstilbesterol (drug for prostate cancer), or additional androgen intake (steroid abuse/bodybuilding)."

Front 54

Biceps tendonitis

Back 54

inflammation of the tendon of the long head of the biceps in the intertubercular groove with the transverse humeral ligament above it.

Front 55

Dislocation of the long head of Biceps Brachii

Back 55

tendon separates from the intertubercular groove and often assoc. with biceps tendonitis.

Front 56

Tearing of the long head of the Biceps Brachii

Back 56

rupture of the tendon of the long head of the biceps brachii in the intertubercular groove due to high weight resistance and sometimes swimming.

Front 57

Compression of the Brachial Artery

Back 57

should be done in the middle of the arm so that collateral blood flow continues in the deep artery of the arm and into the collateral radial arteries which anastomoses with the radial recurrent artery that distributes blood to rest of arm through anastomosing including the radial and ulnar arteries.

Front 58

Ischemic compartment syndrome

Back 58

permanent flexion deformity caused by the ischemic damage to skeletal muscle and replacement by scar tissue with over 6 hours of restricted blood flow.

Front 59

Midhumeral fracture

Back 59

"due to direct blow to humerus and may cause damage to the underlying radial nerve in the radial groove, as well as, the brachial artery."

Front 60

Supracondylar fracture

Back 60

increased vascularity of the region lends itself to damage in this type of fracture especially with the triceps and the brachialis pulling the inferior fracture posterior and superior.

Front 61

Injury to Musculocutaneous Nerve

Back 61

"results in the loss of flexion and supination of the forearm due to loss of motor innervation of the coracobrachialis, brachialis, and the biceps brachii muscles, as well as, loss of sensation on the lateral arm b/c it becomes the lateral antebrachial cutaneous nerve."

Front 62

Radial Nerve Injury

Back 62

"if superior to its branches cause paralysis of the triceps brachii, brachioradialis, supinator muscles, and extensor muscles of wrist and digits with loss of sensation b/c of its posterior cutaneous branch. Paralysis of the extensor muscles leads to wrist-drop."

Front 63

Venipuncture

Back 63

"often occurs at the median cubital vein or basilic vein and is used in blood sample withdrawal, as well as, cardioangiography."

Front 64

Axillary Nerve Injury

Back 64

"results in the loss muscle tone and atrophy in the deltoid muscle. Flattened shoulder appearance results and a hollow inferior to the acromion. Also, there can be loss of sensation on lateral proximal arm. Injury can result from humeral fracture or dislocation of shoulder joint."

Front 65

Rotator Cuff

Back 65

"includes the supraspinatus, infraspinatus, teres minor, and the subscapularis. Degenerative tendonitis of the rotator cuff in old people or injury like hard throwing in baseball can damage the rotator cuff especially the supraspinatus tendon which is the most commonly torn rotator cuff tendon."

Front 66

Subacromial Bursitis

Back 66

inflammation of the subacromial bursa that separates the supraspinatus tendon from the coracoacromial ligament cause extreme pain in abduction of arm. Pain may radiate into the hand.

Front 67

Ligations of the Axillary Artery

Back 67

ligations should be superior to the subscapular artery and the deep artery of the arm to ensure that the blood flow enters the collateral vessels around the scapula and the arm (mainly by way of the scapular circumflex and the radial and ulnar collateral arteries).

Front 68

Axillary Vein

Back 68

injury to proximal axillary vein (basilic vein) has increased risk for severe bleeding and formation of air emboli.

Front 69

The humeral/lateral lymph nodes are the first

Back 69

to become swollen with infection of that region.

Front 70

Axillary Node dissection

Back 70

removal of a lymph node to test for malignancy risks severing of the long thoracic nerve (goes to serratus anterior Ð will cause winged scapula) or the thoracodorsal nerve (weakness in adduction and medial rotation of arm).

Front 71

Prefixed Brachial Plexus

Back 71

plexus made of ventral rami of C4 Ð C8.

Front 72

Postfixed Brachial Plexus

Back 72

plexus made of ventral rami of C6 Ð T2.

Front 73

Brachial Plexus injuries

Back 73

"Injuries can be partial or complete paralysis, or anesthesia.C5 and C6 injured when the angle b/w the shoulder and head are increased. WaiterÕs tip sign is prevalent and occurs with delivery of babies that undergo excessive neck stretching. ; Paralysis of C5/C6 supplied muscles: deltoid, biceps, brachialis, and brachioradialis. (Erb palsy, Erb-Duchanne palsy, upper radicular syndrome); Acute brachial neuritis: neurological disorder of unknown origin accompanied by severe shoulder pain, muscle weakness, and sometimes muscular atrophy (neurologic amyotrophy). Often preceeded by something like respiratory infection, vaccination, etc.; "

Front 74

Hyperabduction syndrome

Back 74

"Compression of cords results from persistent abduction of the arm over the shoulder. Can involve compression of the axillary artery and nerve which result in ischemia.Injuries to the inferior aspect of brachial plexus usually involve the inferior trunk (C8, T1) with forceful superior movement of the arm or breech births. Often results in the clawhand effect due to short muscles in the hand being effected.; "

Front 75

early branch brachial artery

Back 75

"In a small percentage of the population the brachial artery may branch early (about mid-arm) into the radial and ulnar arteries. In addition, 3% of the population has a superficial ulnar artery (there are also superficial radial arteries)."

Front 76

Palpation of the radial artery

Back 76

done my compression of the artery against the distal end of the radius.

Front 77

Median cubital vein divions

Back 77

can be divided into the median basilic and median cephalic cubital vein (good area for blood withdrawal).

Front 78

Median and Ulnar nerve communication

Back 78

Sometimes the median and ulnar nerves communicate resulting in collateral innervation of involved muscles. A lesion in one of the nerves may not result in full muscle paralysis.

Front 79

Median nerve injury

Back 79

"results in the loss of flexion of the second and third digits bc the median nerve innervates lumbricals 1 and 2. Flexion of distal digits 4 and 5 is unaffected b/c their associated lumbricals (3 and 4) are innervated by the ulnar nerve. Also, median nerve injury results in the paralysis of the thenar muscles of the thumb. Clinical sign: hand of benediction.; "

Front 80

Ulnar nerve injury

Back 80

caused by fracture of the medial epicondyle or by ulnar nerve entrapment (tingling). Injury leads to extensive motor loss in the hand (intrinsic muscles of the hand) and loss of sensation in the palmar cutaneous branch of the ulnar nerve (portion of palm and ? digit 4 and all of digit 5). Patient will loss motor function to 4 and 5 digits b/c the ulnar nerve innervates the 3rd and 4th lumbricals. Results in a ÒclawhandÓ due to opposed action of FDP and extensors.

Front 81

Radial nerve injury

Back 81

usually results from a fracture of the humerus in which the radial nerve is effected (Clinical sign: wrist-drop). Injury may occur at the deep branch of the radial nerve in the forearm resulting in loss of ability to extend the thumb and MP joints. Injury to the superficial branch of the radial nerve results in little sensory loss due to overlap of cutaneous nerve fibers.;

Front 82

DupuytrenÕs Contracture of Palmar Fascia

Back 82

"progressive shortening, thickening, and fibrosis of the palmar aponeurosis. Involves flexion of the 4th and 5th digit at the metacarpophalangeal joints and the interphalangeal joints. The cause is unknown and there seems to be a hereditary predisposition. Treatment: surgical excision of fibrosis.; "

Front 83

Hand infections

Back 83

"Potential fascia spaces in the hand include the hypothenar, thenar, and the adductor compartments. Spaces determine the spread and direction of pus/infection. If untreated, infection can spread into carpal tunnel and into the forearm."

Front 84

Tenosynovitis

Back 84

"inflammation of palmar tendon and associated tendon synovial sheath (i.e. Common flexor synovial sheath, digital synovial sheath). Second, third, and forth digit have their own digital synovial sheath; however, fifth digit is usually continuation of the common flexor synovial sheath (can lead to spread of infection). The continuous flexor pollicis longus synovial sheath allows lends hand to infection spread. "

Front 85

De QuervainÕs tenovaginitis stenosas

Back 85

"fibrous thickening of the tendinous sheath around abductor pollicis longus and extensor pollicis brevis, which rub against one another in their common sheath."

Front 86

Digital tenovaginitis stenosans

Back 86

thickening of the fibrous digital sheath causing stenosis of the osseofibrous tunnel of finger or thumb.

Front 87

Laceration of palmar arterial arches

Back 87

requires compression of the brachial artery proximal to elbow to prevent collateral blood flow.

Front 88

RaynaudÕs disease

Back 88

idiopathic vasoconstriction of the digital arteries leading to ischemia and pallor. Possible treatment: presynaptic sypathectomy to dilate the blood vessels. ;

Front 89

Lesions of the median nerve most common at

Back 89

"wrist and in forearm (particularly in the carpal tunnel). Carpal tunnel syndrome results from anything that reduces size of the carpal tunnel (i.e. fluid retention, excessive finger exercise, synovial sheath inflammation). Symptoms include hypoesthesia and/or anesthesia of the cutaneous area of lateral three and one half digits. Hindrance of the thenar/recurrent branch of the median nerve may decrease function of the abductor pollicis brevis and opponens pollicis (inability to oppose thumbs and ape hand [flexion and extension only in thumb in plane of hand]). Treatment: may include carpal tunnel release involving cutting of flexor retinaculum.; "

Front 90

Wrist laceration

Back 90

often involves injury to the median nerve causing paralysis of thenar muscles and loss of sensation over thumb and adjacent two and half digits.

Front 91

Ulnar nerve injury

Back 91

"most common on the posterior aspect of the medial epicondyle. Symptoms: impaired adduction of hand and thumb, flexion of wrist accompanied by abduction, paralysis of intrinsic hand muscles, hyperextended metacarpophalangeal joints, loss of flexion at the 4th and 5th digits at DIP, loss of extension of IP joints. ; "

Front 92

GuyonÕs Canal Syndrome

Back 92

compression of the ulnar nerve by the pisohamate ligament forming entrance of osseofibrous tunnel (GuyonÕs canal) leading to intrinsic hand muscle weakness and hypoesthesia of medial one and a half digits.

Front 93

CyclistÕs Palsy

Back 93

extended extension at wrists putting pressure on hook of hamate and thus the ulnar nerve.