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212 Cards in this Set
- Front
- Back
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Baby vomits milk when fed and has a gastric air bubble.
What kind of fistula is present? |
Blind esophagus with lower segment of esophagus attached to trachea.
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20 yo dancer reports decreased plantar flexion and decreased sensation over the back of her thigh, calf, and lateral half of her foot. What spinal nerve is involved?
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Tibial (L4 to S3)
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Patient presents with decreased pain and temperature sensations over the lateral aspects of both arms. WHat is the lesion?
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Syringomyelia
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Penlight in patient's right eye produces bilateral pupillary constriction. When moved to the left eye, there is paradoxical bilateral pupillary dilation. What is the defect?
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Atrophy of the left optic nerve
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Patient describes decreased prick sensation on the lateral aspect of her leg and foot.
A deficit in what muscular action can also be expected? |
Dorsiflexion and eversion of foot (common peroneal nerve)
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Elderly woman presents with arthritis and tingling over the lateral digits of her right hand. What is the diagnosis?
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Carpal tunnel syndrome - median nerve compression
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Woman involved in a motor vehicle accident cannot turn her head to the left and has right shoulder drop. What structure is damaged?
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Right CN XI (runs through jugular foramen with CN IX and X) innervating sternocleidomastoid and trapezius muscles
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Man presents with one wild, flailing arm. Where is the lesion?
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Contralateral subthalamic nucleus (hemiballismus)
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Pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. When supine, blood pressure drops to 90/50. What is the diagnosis?
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Compression of the IVC
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Soccer player who was kicked in the leg suffered a damaged medial meniscus.
What else is likely to have been damaged? |
Anterior Cruciate ligament (unhappy triad)
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Gymnast dislocates her shoulder anteriorly.
What nerve is most likely to have been damaged? |
Axillary nerve (C5, C6)
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Patient with cortical lesion does not know that he has a disease. Where is the lesion?
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Right parietal lobe
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Child presents with cleft lip.
Which embryologic process failed? |
Fusion of maxillary and medial nasal processes
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Patient cannot protrude tongue toward left side and has a right-sided spastic paralysis.
Where is the lestion |
Left medulla, CN XII
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Teen falls while rollerbladin and hurts his elbow. He can't feel the
medial part of his palm. Which nerve and what injury? |
Ulnar nerve due to broken medial condyle
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24 yo male develops testicular cancer.
Metastatic spread occurs by what route? |
Para-aortic lymph nodes (recall descent of testes during development)
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Field hockey player presents to the ER after falling on her arm during practice. XR shows midshaft break of the humerus. Which nerve and artery are most likely damaged?
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Radial nerve and deep brachial artery, which run together
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Patient cannot blink his right eye or seal his lips and has mild ptosis on the right side.
What is the diagnosis and which nerve is affected? |
Bell's Palsy; CN VII
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Patient complains of pain, numbness and a tingling sensation. On exam, she has wasting of the thenar eminence. What is the diagnosis, and what nerve is affected?
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Carpal tunnel syndrome; median nerve.
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Anisocytosis
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Varying sizes
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Poikilocytosis
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Varying shapes
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Reticulocyte
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Baby erythrocyte
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Granulocytes
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Basophils, eosinophils, neutrophils
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mononuclear cells
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lymphocytes and monocytes
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Basophil
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Bilobate nucleus, densely basophilic, contains heparin, histamine and SRS-A
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Mast cell
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Involved in Type I hypersensitivity Cromolyn sodium prevents mast cell degranulation
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Causes of eosinophilia
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NAACP - Neoplastic, Asthma, Allergic processes, Collagen vascular diseases, Parasites
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Neutrophils
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Multi-lobed nucleus, azurophilic primary granules contain hydrolytic enzymes
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Hypersegmented neutrophils seen in ?
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B12 deficiency
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Monocyte
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Large kidney shaped nucleus, frosted glass cytoplasm. Differentiate into macrophages in tissues
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Lymphocytes
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small, round, densely staining nucleus.
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B Lymphocyte
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Humoral immune response. Arises from stem cell in bone marrow. B cells differentiate into plasma cells to produce antibodies
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Plasma cell
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Off-center nucleus, clock face chromatin. Multiple myeloma is a plasma cell neoplasm
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T Lymphocyte
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Cellular immune response, matures in thymus.
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Macrophage
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Phagocytizes bacteria, cell debris. Macrophages differentiate from circulatingblood monocytes
Activated by y-interferon |
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Airway cells
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Type I (97%)
Type II (3%) form the surfactant A lecitihin, sphingomyelin ratio of >2.0 in amniotic fluid is indicative of fetal lung maturity |
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Microglia
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CNS phagocytes. Mesodermal in origin. HIV infected microglia fuse to form multinucleated giant cells in the CNS
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Oligodendroglia
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Myelinate multiple CNS axons
Destroyed in multiple sclerosis |
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Schwann cells
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Each schwann cell myelinates only 1 PNS axon. Promotes axonal regeneration. Acoustic neuroma is an example of a schwannoma.
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Day 0
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Fertilization by sperm, initiating embryogenesis
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Within week 1
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Implantation (as a blastocyst)
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Within week 2
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Bilaminar disk
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Within week 3
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Gastrulation, primitive streak, notochord, and neural plate begin to form
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Weeks 3-8
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Neural tube formed. Organogensis.
Extremely susceptible to teratogens |
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24 yo male develops testicular cancer.
Metastatic spread occurs by what route? |
Para-aortic lymph nodes (recall descent of testes during development)
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Field hockey player presents to the ER after falling on her arm during practice. XR shows midshaft break of the humerus. Which nerve and artery are most likely damaged?
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Radial nerve and deep brachial artery, which run together
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Patient cannot blink his right eye or seal his lips and has mild ptosis on the right side.
What is the diagnosis and which nerve is affected? |
Bell's Palsy; CN VII
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Patient complains of pain, numbness and a tingling sensation. On exam, she has wasting of the thenar eminence. What is the diagnosis, and what nerve is affected?
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Carpal tunnel syndrome; median nerve.
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Anisocytosis
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Varying sizes
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Poikilocytosis
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Varying shapes
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Reticulocyte
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Baby erythrocyte
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Granulocytes
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Basophils, eosinophils, neutrophils
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mononuclear cells
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lymphocytes and monocytes
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Basophil
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Bilobate nucleus, densely basophilic, contains heparin, histamine and SRS-A
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Mast cell
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Involved in Type I hypersensitivity Cromolyn sodium prevents mast cell degranulation
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Causes of eosinophilia
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NAACP - Neoplastic, Asthma, Allergic processes, Collagen vascular diseases, Parasites
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Neutrophils
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Multi-lobed nucleus, azurophilic primary granules contain hydrolytic enzymes
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Hypersegmented neutrophils seen in ?
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B12 deficiency
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Monocyte
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Large kidney shaped nucleus, frosted glass cytoplasm. Differentiate into macrophages in tissues
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Week 4
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Heart begins to beat
Upper and lower limb buds begin to form |
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Week 10
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Genitalia have male / female characteristics
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Ace - inhibitors during fetal development
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Renal damage
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Cocaine during fetal development
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Abnormal fetal development and fetal addiction
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DES during fetal development
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Vaginal clear cell adenocarcinoma
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Iodide during fetal development
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Congenital goiter or hypothyroidism
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13-cis-retinoic acid
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Extremely high risk for birth defects
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Thalidomide
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Limb defects (Flipper Limbs)
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Warfarin, x-rays
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Mutiple anomalies
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Umbilical cord vessels
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2 umbilical arteries, 1 umbilical vein
1 umbilical artery associated with congenital and chromosomal anomalies |
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Embryologic derivatives - surface ectoderm
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Adenohypophysis, lens of eye, epithelial linings, epidermis
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Embryologic derivatives - Neuroectoderm
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Neurohypohysis, CNS neurons, oligodendrocytes, astrocytes, pineal gland
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Embryologic derivatives - Neural crest
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ANS, dorsal root ganglia, melanocytes, chromaffin cells of adrenal medulla, enterochromaffin cells, pia, celiac ganglion, Schwann cells, odontoblasts, parafollicular cells of thryoid and laryngeal cartilage
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Embryologic derivatives - Mesoderm
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Dura connective tissue, muscle, bone, cardiovascular structures, lymphatics, blood, urogenital structures, and serous linings of body cavities, spleen, adrenal cortex
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Embryologic derivatives - endoderm
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Gut tube epithelium and derivatives (lung, liver, pancreas, thymus, thyroid, parathyroid)
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Embryologic derivatives - Notochord
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Induces ectoderm to form neuroectoderm (neural plate)Its postnatal derivative is the nucleus pulposus of the intervertebral disk
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Early development - Rule of 2's for 2nd week
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2 germ layers (bilaminar disk): epiblast, hypoblast
2 cavities: amniotic cavity, yolk sac 2 components to placenta: cytotrophoblast, syncytiotrophoblast |
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Early development - Rule of 3's for 3rd week
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3 germ layers (gastula):
Ectoderm Mesoderm Endoderm |
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Fetal Erythropoiesis
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Yolk sac (3-8 weeks)
Liver (6-30 weeks) Spleen (9-28 weeks) Bone Marrow (28 weeks+) Young Liver Synthesizes Blood |
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Embryonic structure Truncus Arteriosus gives rise to
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Ascending aorta and pulmonary trunk
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Embryonic structure Bulbus cordis gives rise to
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Smooth parts of left and right ventricle
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Embryonic structure Primitive ventricle gives rise to
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Trabeculated parts of left and right ventricle
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Embryonic structure primitive atria gives rise to
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Trabeculated left and right atrium
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Embryonic structure left horn of Sinus Venosus gives rise to
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Coronary Sinus
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Embryonic structure right horn of sinus venosus gives rise to
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Smooth parts of right atrium
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Embryonic structure right common cardinal vein and right anterior cardinal vein gives rise to
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SVC
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Fetal-postnatal derivatives
Umbilical vein -> |
Ligamentum teres hepatis
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Fetal-postnatal derivatives
Umbilical arteries -> |
medial umbilical arteries
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Fetal-postnatal derivatives
Dutus venosus -> |
ligamentum venosum
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Fetal-postnatal derivatives
Foramen Ovale -> |
Fossa Ovalis
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Fetal-postnatal derivatives
Allantois -> urachus -> |
median umbilical ligament
Urachal cyst or sinus is a remnant of the allantois |
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Fetal-postnatal derivatives
Notochord -> |
nucleus pulposus
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Aortic Arch derivatives
1st aortic arch |
Part of Maxillary artery
1st arch is MAXimal |
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Aortic Arch derivatives
2nd aortic arch |
Stapedial artery and hyoid artery
Second = Stapedial |
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Aortic Arch derivatives
3rd aortic arch |
Common Carotid artery and proximal part of internal carotid artery
C is third letter of alphabet |
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Aortic Arch derivatives
4th aortic arch |
L = Aortic arch
R = Proximal part of right subclavian artery 4th arch = systemic - limbs |
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Aortic Arch derivatives
6th aortic arch |
Proximal part of pulmonary arteries and (L only) ductus arteriosus
Pulmonary |
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Branchial apparatus
CAP = |
Clefts = ectoderm
Arches = mesoderm Pouches = endoderm |
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Branchial Arch 1 derivatives
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Meckel's cartilage = Mandible, malleus, incus, sphenoMandibular ligament
Muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, tensor veli paltini CN V3 |
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Branchial Arch 2 derivatives
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Reichert's cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles: Facial expression, Stapedius, Stylohyoid, posterior belly of digastric CN VII |
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Branchial Arch 3 derivatives
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Greater horn of hyoid
Muscles= Stylopharyngeus CN IX |
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Branchial Arch 4 derivatives
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Cartilages: Thryoid, cricoid, arytenoids, corniculate, cuneiform
Muscles: most pharyngeal constrictors, cricothyroid, levator veli palatini CN X |
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Branchial Arch 6 derivatives
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Muscles: all intrinsic muscles of larynx (except cricothryoid)
CN X (recurrent laryngeal branch) |
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Branchial arch innervation
Arch 1 Arch 2 Arch 3 Arch 4 Arch 6 |
Arch 1 = V2 and V3
Arch 2 = VII Arch 3 = IX Arch 4 & 6 = X |
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Branchial cleft derivatives
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1st cleft = external auditory meatus
2nd through 4th clefts = Temporary cervical sinuses |
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Branchial pouch derivatives
1st pouch = |
Middle ear cavity, eustachian tube, mastoid air cells
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Branchial pouch derivatives
2nd pouch = |
epithlial lining of palatine tonsil
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Branchial pouch derivatives
3rd pouch (dorsal wings) = |
Inferior parathyroids
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Branchial pouch derivatives
3rd pouch (ventral wings) = |
develops into thymus
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Branchial 3rd pouch contributes to 3 structures
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Thymus, left and right inferior parathyroids
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Branchial pouch derivatives
4th pouch = |
Superior parathyroids
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Aberrant development of 3rd & 4th pouches =
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DiGeorge Syndrome
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Cleft lip =
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Failure of fusion of the maxillary and medial nasal processes
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Cleft palate =
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failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process
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Diaphragm is derived from
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Septum Transversum
Pleuroperitoneal folds Body wall Dorsal mesentery of esophagus Several Parts Build Diaphragm |
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Bone formation
Intramembranous = Endochondral = |
Intramembranous = Spontaneous bone formation without preexisting cartilage
Endochondral = Ossification of cartilagenous molds |
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5 2's of Meckel's diverticulum
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2 inches long
2 feet from ileo-cecal valve 2% of population Commony presents in first 2 years of life May have 2 types of epithelia |
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Pancreas is derived from
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Foregut
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Spleen arises from
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Dorsal mesentery but is supplied by artery of foregut
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Mesonephric (Wolffian) duct develops into
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SEED
Seminal vesicles Epidydmis Ejaculatory duct Ductus deferens |
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Paramesonephric (mullerian) duct develops into
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Fallopian tubes, uterus and part of vagina
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Bicornuate uterus
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incomplete fusion of the paramesonephric ducts
Associated with infertility and UTI's |
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Middle (neck) of sperm contains:
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Mitochondria
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Sperm food supply is
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fructose
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Meiosis I is arrested in prOphase until
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Ovulation
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Meiosis II is arrested in METaphase until
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Fertilization
An egg met a sperm |
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Polyhydramnios is associated with
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esophageal/duodenal atresia
anencephaly |
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Oligohydramnios is associated with
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bilateral renal agenesis
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Potter's syndrome
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Bilateral renal agenesis -> oligohydramnios -> limb deformities, facial deformities, pulmonary hypoplasia
Babies with Potter's can't PEE |
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C2 dermatome =
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Posterior half of "skull" cap
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C3 dermnatome =
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High turtleneck shirt
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C4 dermatome =
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low collar shirt
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T4 dermatome =
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Nipple
T4 is at the teat pore |
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T7 dermatome =
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Xiphoid process
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T10 dermatome =
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Umbilicus
T10 is at the belly butten |
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L1 dermatome =
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Inguinal ligament
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L4 dermatome =
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Kneecaps
Down on all 4's |
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S2,3,4 dermatome =
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keep the shit off the floor
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Rotator cuff muscles
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SItS
Supraspinatus Infraspinatus teres minor Subscapularis |
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Supraspinatus muscle =
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helps deltoid abduct arm
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Infraspinatus muscle =
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lateral rotation of arm
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Teres minor muscle =
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adducts and medially rotates arm
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Subscapularis muscle =
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medially rotates and adducts arm
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Thenar / Hypothenar muscles
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OAF
Oppose Abduct Flex |
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Thenar eminence =
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Opponens pollicis
Abductor pollicis bravis Flexor pollicis brevis |
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Hypothenar eminence =
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Opponens digiti minimi
Abductor digiti minimi Flexor digiti minimi |
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Unhappy triad of knee injuries
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MCL, medial meniscus, and ACL
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SCALP =
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Skin
Connective tissues Aponeurosis Loose connective tissues = vascular layer Pericranium |
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Mastication muscles
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M's Munch / Lateral Lowers
Masseter, TeMporalis, Medial pterygoid Lateral Pterygoid Lowers |
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3 structures inside carotid sheath
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VAN
Internal jugular Vein Common carotid Artery Vagus Nerve |
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Pulmonary artery to Lung relations =
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RALS
Right anterior to bronchus Left superior to bronchus |
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Femoral triangle contents
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N (AVEL)
Nerve - outside of femoral sheath Artery Vein Empty space Lymphatics |
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Abdominal Hernias
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MD's don't Lie
Medial to inferior epigastric arteries = Direct Lateral to inferior epigastric arteries = Indirect Indirect = Internal ring Indirect = Infants |
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Celiac artery supplies forgut =
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Stomach, duodenum; liver, gallbladder, pancreas
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SMA supplies midgut =
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Duodenum to proximal 2/3 of transverse colon
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IMA supplies hindgut =
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Distal 1/3 of transverse colon to upper portion of rectum
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Ureters pass under artery
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Water is under the bridge
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Ligaments of the uterus - Suspensory ligaments
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Contains ovarian vessels
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Ligaments of the uterus - Transverse cervical (cardinal) ligament
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contains uterine vessels
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Ligaments of the uterus - Round ligament of the uterus
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No important structures
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Ligaments of the uterus - Broad ligament
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Contains the round ligaments of the uterus and ovaries and the uterine tubules and vessels
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Peripheral nerve layers - Endoneurium invests
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single nerve fiber
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Peripheral nerve layers - Perineurium invests
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fascicle of nerve fibers
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Peripheral nerve layers - epineuriuim invests
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surrounds entire nerve (fasciles and blood vessels)
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Meissner's corpuscle
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small, encapsulated sensory receptors for light discriminatory touch of glaborous (hairless) skin
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Pacinian corpuscles
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Large, encapsulated receptors for pressure, coarse touch and vibration
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Collagen type I
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BONE - tendon, skin, dentin, fascia, cornea, late wound repair
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Collagen type II
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carTwolage - cartilage, vitreous body, nucleus pulposus
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Collagen type III
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Skin, blood vessels, uterus, fetal tissue, granulation tissue
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Collagen Type IV
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Type IV lays the floor (basement membrane)
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Collagen Type X
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epiphyseal plate
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Epidermal layers
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Californians like girls in string bikinis
Corneum Lucidum stratum Granulosum Stratum spinosum Stratum Basalis |
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Kartagener's syndrome
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Dynein arm defect resulting in immotile cilia
Infertility |
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RER produces
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proteins
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SER produces
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lipids
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Lymph node follicles
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Site of B cell localization and proliferation
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Lymph node medulla
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medullary cords and sinuses
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Lymph node paracortex
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Houses T cells
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Lumbar punctures structures
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Skin, ligaments, epidural space, Dura mater, subdural space, arachnoid, CSF
PIA is not pierced |
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Peroneal nerve
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PED - Peroneal Everts and Dorsiflexes
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Tibial nerve
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TIP - Tibial Inverts and Plantarflexes
Cannot stand on tip toes |
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Blood Brain Barrier is guarded by:
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CIA
Choroid plexus epithelium Intracerebral capillary endothelium Arachnoid |
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Hypothalamus functions
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TAN HATS
Thirst and water balance Adenohypohysis Neurohypophysis Hunger Autonomic regulation Temperature regulation Sexual urges |
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Hunger area of hypothalamus
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If you zap your ventromedial nucleus, you grow ventrally and medially
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Heat regulation of hypothalamus
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Zap posterior become poikilotherm (cold-blooded)
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A/C area of hypothalmus
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Anterior = A/C (cooling)
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Functions of thalamic nuclei
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Lateral = Look
Medial = Music |
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Limbic system functions - 5 F's
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Feeding, fighting, feeling, flight and sex
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Chorea =
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Dancing (choreography)
Basal Ganglia lesion - huntington's chorea |
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Athetosis =
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writhing movements of fingers
Basal ganglia lesion |
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Hemiballismus =
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Half - ballistic
Contralateral subthalamic nucleus lesion |
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Brain lesions - broca's area
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Expressive aphasia with good comprehension
Broken speech |
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Brain lesions - wernicke's area
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Fluent aphasia with poor comprehension
Word salad makes no sense |
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Brain lesions - Arcuate fasiculus
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Conduction aphasia - poor repetition with good comprehension, fluent speech
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Brain lesions - amygdala
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Kluver-Bucy syndrome (hyperorality, hypersexuality, disinhibited behavior)
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Brain lesions - frontal lobe
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Personality changes - deficits in concentration, judgement, inhibitions
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Brain lesions - right parietal lobe
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Spatial neglect syndrome
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Brain lesions - reticular activating system
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coma
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Brain lesions - mammillary bodies
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Wernicke - Korsakoff's encephalopathy (confabulations, anterograde amnesia)
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Brain lesions - basal ganglia
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tremor at rest
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Brain lesions - Cerebellar hemisphere
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Intention tremor, limb ataxia
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Brain lesions - Cerebellar vermis
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Truncal ataxia and dysarthria
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Nerves passing through cavernous sinuses
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CN III, IV, V1, V2 and VI
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Contents of Optic canal
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CN II, opthalamic artery, central retinal vein
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Contents of Superior orbital fissure
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CN III, IV, V1, and VI, opthalmic vein
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Contents of Foramen Rotundum
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CN V2
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Contents of Foramen Ovale
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CN V3
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Contents of Foramen spinosum
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middle mengingeal artery
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Contents of internal auditory meatus
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CN VII, VIII
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Contents of jugular foramen
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CN IX,X, XI, jugular vein
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Contents of hypoglossal canal
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CN XII
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Contents of Foramen Magnum
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Brain stem and vertebral arteries
Spinal roots of CN XI |
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Bell's Palsy seen as a complication in what diseases?
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ALexander Bell with STD
AIDS, Lyme disease, Sarcoid, Tumors, Diabetes |
