Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
174 Cards in this Set
- Front
- Back
|
AV Fistula
|
They may develop after a DEEP penetrating wound=> palpitations + high output heart failure (systolic dysfunction)
*Branham's Sign= pressure on AV fistula stops palpitations |
|
|
Atrial Septal Defect
|
SOB w/ palpitations
Systolic ejection flow murmur S2 is wide DOES NOT change with breading CXR: increase pulmonary vasculature ECHO: paradoxical septal movement *Mid septum= #1 *Low septum= Down's syndrome **Acyanotic= (R <--L) w.o Tx= paradoxical emboli, CHF, infective endocarditis |
|
|
Cardiac Tamponade
|
Hx; stabbing to chest, dyspnea (gasping for air)
1. Hypotension that does not respond to hydration 2. Distant heart sounds: reduced API 3. increased systemic venous pressure Tx: pericardiocentesis = remove fluid or blood from pericardial sac |
|
|
Coarctation of the Aorta
|
-More common in males
-high BP in upper extremities -femoral pulses diminished -systolic ejection murmur ==> between shoulder blades -CXR= rib notching **Ligamentum arteriosum= Distal= adults= #1 proximal= kids |
|
|
Secondary causes of HTN that can be corrected with surgery=?
|
-Conn's Syndrome= too much aldosterone
-Renal artery stenosis -pheochromocytoma -Coarctation of the aorta<=Turner's Syndrome= 45,XO |
|
|
Femoral Hematoma= "coldness of foot"
|
ecchymosis compresses femoral artery which passes very close to the inguinal ligament= high risk of injury during hernia repair
** Femoral Nerve-Artery-Vein (Lateral to medial) |
|
|
How is a hematoma distinguished from a pseudoaneurysm?
|
hematoma= no flow, non-pulsatile
|
|
|
PDA that persists in a child ==>Tx: indomethacin (blocks PGE2)
|
-recurrent pneumonia
-low exercise tolerance -Mother infected with RUBELLA during pregnancy -wide pulse pressure (S/D) -"machinery murmur" + increase JVP -LVH= increase blood into lungs-->LA-->LV ==> increase PMI -CXR= increase pulmonary vasculature =more blood entering PA w/ aortic notch less pronounced |
|
|
Teratology Of Fallot= kids
|
-Dyspnea on exertion relieved by SQUATTING position (=increases blood flow to RA)--> CENTRAL Cyanosis => observe clubbing= lack of proper O2
-Thrill= palpable murmur= VSD -Systolic murmur on L= Pulmonary Stenosis=> A2 sound only -CBC= polycythemia (low systemic O2) -EEG= RVH= dilated RA **overriding aorta= aorta in midline gets blood from RV + LV -CXR= diminished pulmonary vasc. |
|
|
What is the congenital defect in Teratology of Fallot?
|
antero-superior displacement of the INFUNDIBULAR septum = unequal division of the aorta/PA
|
|
|
VSD= membranous is #1
|
-Dyspnea + poor growth + sweating
-PE= pansystolic mumur in lower left sternal boarder + parasternal heave -Bi-ventricular hypertrophy |
|
|
A reversal of the VSD shunt is named what?
|
Eisenmenger's Syndrome
|
|
|
HYPO-parathyroidism= IATROGENIC=follows thyroidectomy
|
-numbness in mouth + legs + fingers=
-Carpopedal spasm= outward/flexion of hands -positive: Chvostek's (face tap) + Trousseau(BP cuff) + Peritoneal Sign=>spasms= HYPOCALCEMIA -PTH absorbs Ca++ in kidney |
|
|
What embryonic origin are the Parathyroid glands from?
|
Endodermal brachial pouches=
Superior= 4th brachial pouch *Inferior= 3rd brachial pouch |
|
|
CHOANAL ARESIA= blocked nose-pharynx
|
Cyanosis that gets worse with eating but better with crying= newborns breath ONLY through nose
-unable to pass catheter through NOSE |
|
|
Sialolithiasis= stone in salivary glands=
|
Mostly submandibular gland=> palpable parotid gland= recurrent parotid gland infections==> pain when eating followed by swelling
**make them suck on lemon= increase salivation through excess saliva production |
|
|
Thyroglossal Duct Cyst= painLESS swelling bellow hyoid bone
|
Mostly fluid that is NOT fixed vs. dermoid cyst that do not move
-Thyroid function Test are NORMAL Cause= REMNANT of the THYROGLOSSAL DUCT (formed as the thyroid migrates from base of the tongue (foramen cecum) --> neck |
|
|
Tonsillitis=Strep throat = elevated ASO
|
- recurrent sore throats, FEVER, swollen glands with productive sputum (bloody green)
-Otitis Media= infection goes up eustachian tube= auditory meatus close proximity to tonsils -Retropharyngeal mass= must be removed |
|
|
Boerhaave's Syndrome= appears after vomiting=> severe retrosternal pain (radiates to the back + abdomen) w/ dyspnea
|
Patient is often either: Bulemic, alcoholic, pregnant==>
-contrast material seeps into mediastinum=> COMPLETE rupture of the esophageal wall -pneumothorax: crackling sounds |
|
|
How is Boerhaave's Syndrome different from Mallory-Weiss Syndrom?
|
Both are due to vomiting=>
-MW= SUPERFICIAL tear of the esophagus=> bleeding |
|
|
What are the 3 anatomic constrictions of the Esophagus?
|
1. stomach cardia 2. aortic notch 3. cricopharyngeal
|
|
|
Congenital Biliary Atresia = no extra-hepatic bile ducts= fibrous chords
|
-Persistent Jaundice not present at birth
-Dark urine + Light stools = obstructive jaundice ==> cirrhosis -Elevates ALT/AST, low Albumin, No urobilinogen in urine |
|
|
Dumping Syndrome= hypoglycemia symptoms(=lightheadedness, sweaty palms, palpitations, nausea) ==> diarrhea following meal
|
Follows SURGERY involving the stomach--duodenum (e.g. unrelenting ulcers) => food enters jejunum and bypasses the GI's ability to absorb nutrients such as glucose.
|
|
|
Hirschprung's Diseases presents as acute enerocolitis= watery stools, foul smelling diarrhea=> newborns==> FUNCTIONAL obstruction
|
Cause: Crest Cells fail to migrate to distal parts of the bowls==> no parasympathetic ganglia is present(Meissner's + Auerbach's plexus) => constriction of those segments= Colon dilates behind that area==> distended abdomen/palpable bowels
***No meconium is passed in infant **Down's Syndrome association |
|
|
Pancreatic Pseudocyst= complication of acute pancreatitis= elevated amylase/lipase= FEVER + epigastric pain
|
Epigastric mass= NO capsule= fluid is retained by: peritoneal surface, large bowel, diaphragm
|
|
|
Perforated PEPTIC ulcer= epigastric pain with FOOD intake if Gastric (vs. Duodenal: no pain with food=tend to gain weight)= causes weight loss to reduce pain
|
-presents with REBOUND tenderness w/o bowel sounds but w/ abdominal rigidity (peritonitis)
-perforation= gastric antrum + lesser curvature ==> spills into lesser/greater sac Tx: H. Pylori ------------------------ ***Duodenal Ulcer= 100% H. Pylori Anterior: perforation Posterior: hemorrhage from erosion of the gastroduodenal artery |
|
|
What are the boundaries of the LESSER SAC?
|
hepatoduodenal ligament + Caudate lobe of liver + duodenum + IVC
|
|
|
Portal Hypertension=vomits a lot of blood= alcoholic= Hypovolemic (tachycardia/hypotensive/pallor)
|
-pendulous abdomen= ascitic fluid with spider angiomas on surface, palmar erythema
-Elevated AST/ALT, Anemia, High bilirubin==> liver cirrhosis=> incrase portal hypertension (mesenteric vein + splenic vein back up)==> 1. left gastric|| azygous= esophageal varices= vomit blood source 2.superior||inferior gastric= hemorrhoids=> melena 3. paraumbilical ||inferior gastric = caput medusae |
|
|
Tracheoesophageal Fistula= newborn=> chokes, coughs, vomits undigested food=> proximal esophagus ends blindly while distal connected to trachea=> air in stomach
|
-Excess amniotic fluid= Polyhdroamnios= because of atresia the baby cannot swallow the amniotic fluid= builds up in amniotic sac
-distended stomach w/o fluid - excess salivation |
|
|
What is the anomaly in a Tracheoesophageal Fistula?
|
primitive foregut fails to differentiate into trachea + esophagus=> endodermal cells fail to grow causing atresia + the lateral walls of the foregut do not fuse as the trachea/esophagus separate
|
|
|
What is maternal oligohydramnios?
|
bilateral renal agenesis + posterior urethral valves => no fetal urine or an obstruction that prevents the excretion of amniotic fluid
|
|
|
Rupture of an Abdominal Aortic Aneurysm in MALE=> severe TEARING pain that radiates to the back ==> loss of consciousness due to hypovolemia (hypotension/tachycardia)=>
|
*pulsatile mass in abdomen
**Atherosclerosis **Marfan's Syndrome= cystic necrosis of tunica media ** Syphilis (vasculitis) **trauma |
|
|
Femoral Hernia=tender lump in groin that is round and irreducible=STRANGULATION==>FEMALE:
|
groin pain + vomiting + abdominal distention => requires emergent surgery
***Hernia is medial to Femoral Nerve |
|
|
Where do the Inferior Hemorrhoidal veins drain into?
|
Internal Pudendal veins= cause external hemorrhoids which are PAINFUL due to somatic innervation
Tx: Sitz baths = warm water bath |
|
|
Which hernias are ABOVE the inguinal ligament?
|
Inguinal hernias=
-Direct (Men=finger pulp)= weak muscle wall -Indirect (young=persistent Tunica Vaginalis=finger tip) |
|
|
DIRECT Inguinal Hernia= through Hesselbach's triangle
|
-hernia appears with straining (usually caused from Prostate Hyperplasia= forcing pee out or also from frequent constipation= also increases intra-abdominal pressure)
|
|
|
Relative to the Inferior Epigastric vessels where do hernias come out from?
|
Medially = DIRECT
--------------------------- Laterally= INDIRECT= goes inside scrotum |
|
|
What are the limits of Hesselbach's Triangle?
|
-Inferior epigastric artery
-Lateral Rectus Muscle -Inguinal ligament |
|
|
INDIRECT inguinal hernia==> OUTSIDE Hesselbach's triangle=>
|
often the intestines get trapped and cause dilation and constipation w/o rebound tenderness= obstruction
|
|
|
Meckel's Diverticulum= 2's= caused by persistence of the yolk stalk== belly protrudes due to intussusception=> sausage-like belly==> vomiting = Bright Red Stools=> pallor, anemia
|
2 inches from ileocecal valve
2 inches long 2% of population 2yrs of life onset 2 types of epithelium= ectopic gastric mucosa=>secrets acid= causes pain= indistinguishable from appendicitis |
|
|
Mesenteric Anemia= pain is out of proportion to PE (worse than MI)=> Hx of previous cramping after eating ==>
|
infarction==> necrosis (elevated CK/amylase)==>
SMA= jejunum/ilium/ half colon --------------------------- IMA= second half of colon/rectum **Barium Enema shows THUMB-PRINTING due to hemorrhage of submucosa **Smoker= atherosclerosis risk |
|
|
Petit's Triangle Hernia = near iliac crest =
Traingle= Latissimus Dorsi, external oblique, and iliac crest |
Male, left side, pops up when the child cries
|
|
|
What can become damaged during trauma to the Popliteal Fossa?
|
-Popliteal Artery= no dorsalis pedis pulse
-Popliteal Vein <= Lesser saphenous vein drains into it -Tibial Nerve = inability to dorsiflex *** more superiorly coming out of the fossa laterally is the common PERONEAL NERVE |
|
|
Sigmoid Volvulus = older individuals=
|
most often the sigmoid colon twists= bird's beak on KUB=>prevents stools from passing=> colicky pain + chronic constipation=> might cause ischemic colon with bloody discharge
|
|
|
Ureter damage in a female=> oliguria, with left flank pain=> follows Hysterectomy for uterine fibroids==> surgical wound is soaked with urine=
|
Ureter is damaged during a hysterectomy because it travels under the uterine vessels ==> intra-abdominal urine leakage= flank pain + low grade fever
|
|
|
Varicose Veins= multiparty, obese, female, long periods of standing, worse at night but alleviated by elevating feet
|
Patients also complain of leg fatigue
**cause= vein valve incompetence= greater saphenous vein= blood buildup= tortuous veins |
|
|
Gartner's Duct Cyst
|
Antero-lateral cyst (serous fluid) on the vulva ==> Wolffian Duct remnant that does not close
|
|
|
Uterine Prolapse with Cystocele= frequency of urination increases w/o voiding=> bacterial infection
|
Risk factors: older female, multiparity, weight bearing=> alters bladder location (usually collapse of Pubocervical fascia which is anchored by pubic symphysis and uterus) vs. rupture which causes the prolapse of the bladder into vagina
|
|
|
Squamous Cell Carcinoma (ulcerated lesion with rolled up edges) of the lower lips drains into what lymphnodes==>
|
middle part of the lip=> submental
lateral parts of the lip=> submandibular ------- Both drain into the Cervical Lymphnodes that can be found in the Carotid Triangle |
|
|
What muscles comprise the Carotid Triangle where the INTERNAL JUGULAR VEIN is located==>also DEEP cervical nodes
|
1. Posterior Belly of the Digastric muscle
2. Omohyoid 3. Sternocleidomastoid ----------- What is found in the Posterior Cervical Triangle (trapezius, SCM, omohyoid)? 1. Deep Cervical nodes 2. accessory nerve |
|
|
DiGeorge's Syndrome: infants presents with recurrent oral thrush and URI?
|
**Also seizures= low Ca++= no PTH made from absent parathyroid glands
**T-cell count is low=> No THYMUS present <== 3rd + 4th Pharyngeal POUCHES not developed = no CMI (viral/fungal infections) |
|
|
Caput Succedaneum= BENIGN ecchymosis that occurs during delivery= crosses midline/suture lines vs.?
|
-Cephalhematoma= fracture= no suture line crossing
|
|
|
Congenital Diaphragmatic Hernia= often associated with no prenatal care=>
|
-causes severe dyspnea on newborn
-Bowel sounds in LEFT POSTERoLATERAL CHEST w/o breath sounds -Heart sounds shifted to the right -Cause: failure of the Canal of Bochdalek to close properly=> GI move up=> prevents lungs from developing properly |
|
|
Duodenal Atresia=> premature baby vomiting AT BIRTH (bilious=contains bile)=> distended abdomen= dilated duodenum
**Down' Syndrome= single palmar crease **Mother had Polyhydroamnios |
vs. Pyloric Stenosis=olive like mass in epigastrium= older infants => no bile in PROJECTILE vomit and full term baby=underweight= visible peristalsis ==> ultrasound shows pylorus muscle thickening
**genetic component **wrinkled skin |
|
|
Nephrolithiasis= right flank pain (intermittent + excruciating!)=> radiates to inner thigh/scrotum==> N,V=
|
Dysuria,hematuria, RESTLESS,
#1= radiopaque calcium oxalate stones vs. uric acid stones= translucent |
|
|
What are some causes of REBOUND tenderness on abdominal palpitation?
|
1. Peritonitis= patient tries to prevents movement to reduce pain
2. Appendicitis ------------ NOT: nephrolithiasis, obstructions |
|
|
What are some of the complications with a vasectomy?
|
scrotal hematoma
infection spermatic granuloma spermatocele *spontaneous re-canalization |
|
|
What are some of the LAYERS one must cut in order to do a vasectomy?
|
1. skin
2. superficial scrotal fascia=Dartos Fascia 3. external spermatic fascia 4. cremasteric fascia + muscle 5. Internal spermatic fascia 6. preperitoneal fat 7. tunica vaginalis 8. CUT ductus deferens |
|
|
Acoustic(CN8) Shwannoma= affects hearing(tinnitus) and balance(vertigo)
|
Positve Nerotest: Webber's Test (lateralizes OPPOSITE to sensorineural deficit) + Romberg's Test(patient falls when standing/eyes closed) + Caloric Testing(+ side of ear canal paresis) + CT: CP(cerebellopontine) angle mass
|
|
|
Where do you see bilateral schwannoma's
|
AD neurofibramatosis 2 (MEN syndromes)
|
|
|
What is Acute Torticollis?
|
inflammation --> muscle spasms of the neck=> muscles involved: trapezius muscle, supraspinatus, rhomboid,
|
|
|
Warnicke's Aphasia= Left Temporal Lobe deficit=> infarct in Left MCA ==>damage to the SUPERIOR TEMPORAL GYRUS
|
Able to speak but does not make sense + unable to understand spoken/written language
-----VS.----- Brocca's Aphasia= cannot form words to speak (not fluent) eventhough he tries too(understanding spoken/written is normal)= damage to the INFERIOR *FRONTAL* GYRUS |
|
|
Astrocytoma= slow growing= malignant with poor prognosis=> nueroectoderm origin ==> presents as unilateral headache
|
Kids= Posterior Fossa= Ataxic gait(affects cerebellum), vomiting(brainstem), Papilledema (increase intracranial pressure) + SEIZURES
--VS--- Adults= cerebrum |
|
|
What structures would be affected by an astrocytoma in a child that is found to encompass the whole Posterior Fossa?
|
Foramen magnum + Jugular Foramen + internal acustic meatus
|
|
|
Bell's palsy=>Lower motor Neuron==affect CN7=comes out of the Stylomastoid foramen=> FACIAL paralysis=> mouth droops and unable to close eye voluntarily
|
complication of: Diabetes, AIDS, Lyme disease, tumors, sarcoidosis = possible viral cranial neuropathy
---VS-----. half of the face paralysis= UMN pathology of opposite side of brain= stroke related |
|
|
What muscles are affected by Bell's Palsy (LMN CN7)?
|
inability to close eye= obicularis oculus + inability to smile=obicularis oris + no wrinkles in forehead= frontalis muscle
|
|
|
Brown-Sequard Syndrome=Hemisection damage from trauma=>hematoma in area of SC damage
|
-Paralysis below the lesion= corticospinal tracts
-Inability to sense position/vibration on same side of lesion= dorsal columns -inability to sense pain/temperature on contralateral side of the lesion= Spinothalamic |
|
|
Cavernous Sinus Thrombosis= facial and ophthalmic VEINS do not have valves=> infections of the skin(pimple) around the nose travel up un-impeded into the cavernous sinus==>high risk: Immunocompramised individuals (diabetics, Cancer patietients, HIV)==>
|
Fever + edema of the vein affected: (ophthalmic= swollen eye) + facial edema around abscess ==> meningitis + pulmonary septic thrombi
------- CT: no enhancement of the cavernous sinus |
|
|
Common Peroneal Nerve Damage= Trauma=common due to SUPERFICIAL location LATERAL to FIBULA head=> Also damamged with knee casts
|
Cannot Dorsiflex, extension of the toes, loss of eversion= Peroneal Nerve (deep + superficial)***Loss of sensation of anterolateral aspect of the leg + Dorsum of foot
|
|
|
DEAFNESS: how can the Rinne's test and Webber's test discriminate Conductive vs. Sensorineural ?
|
Conductive= no nerve invovled=> Affected ear (e.g. damaged tympanic membrane=recurrent ear infections)=> Webber's + Positive Rinne's=> BAD ear
------ VS------ Sensorineural= CN8=> Webber lateralizes to GOOD ear w/ Negative Rinne's test |
|
|
Erb-Duchenne Palsy= Damage to C5/C6= dystopic and prolonged delivery in baby or shoulder trauma => Waiter's tip=>
|
shoulder abductors paralysed, arm medially rotated(paralysis of lateral rotators), pronated(loss of bicepts), ****Sometimes the phrenic nerve can be damaged aswell=ipsilateral diaphragm paralysis
|
|
|
What nerve is often cut while attempting to remove the Parotid gland due to andeocarcinoma?
|
Facial Nerve crosses through there=> recieves TASTE from anterior 2/3 of tongue==>muscle inntervation of all facial muscles <== comes out from the Stylomastoid Process in the cranium
|
|
|
Femoral Nerve Damage=> hip fracture
|
Patient cannot walk because he cannot flex his hip, cannot extend his knee, and loss sensation of his anterior thigh + medial foot
|
|
|
Deviation of tongue to the side of atrophy and fasciculations=>LMN damage
|
CN12=hypoglossal nerve damage <= caused by Parotid/Carotid tumors, tuberculous adenitis, metastatic neck tumors
|
|
|
How does the injury develop and what part of the brachial plexus is damaged with Erb's palsy vs. Klumpke's Palsy?
|
Erb's= hyper-ADDUCTION=> lower plexus
----- VS----- Klumpke's= hyper-ABDUCTION=upper-plexus |
|
|
Klumpke's Palsy= also a result from shoulder Dystocia==> hyper-abduction=> C7,C8 + T1
|
C7,C8= Ulnar Nerve= Claw Hand and T1= Sympathetic Nerves=> Horner's Syndrome= Miosis, Ptosis, Anhidrosis
--------- Subclavian Artery becomes compressed aswell==> so if you turn away the head from the injured side ther radial pulse disappears |
|
|
Long Thorasic Nerve Injury= C5,C6,C7,C8,T1=> common in women with previous Mastectomy
|
Cannot abduct arm beyond shoulder level + Winged Scapula (failure of Serratus Anterior to fix scapula against chest wall)
|
|
|
Mass in Jugular Foramen= CN 9,10,11 come out
|
Damage CN 9/10 => Dysphagia (cannot swallow) + Dysarthria (cannot speak)
-------- Damage to CN11 => atrophy of sternocleidomastoid + trapezius muscle |
|
|
What can the Uvula tell us about CN 9/10 ==>
|
Normal: elevates in midline
Plegia= unilateral=> always deviated to normal side Paresis: deviates to normal side w/ahh Plegia=bilateral=> does not deviate or elevate ----- Plegia= paralysis Paresis= incomplete paralysis |
|
|
Where does Prostate CA metastases?
|
Axial skeleton
|
|
|
ARNOLD-CHIARI SYNDROME=
|
Hydrocephalus=obstruction
Syringomyelia platybasia myelomeningiocele |
|
|
What to rule out in Parkinsonian Differential?
|
Problem: increase ACh decrease DA= Substantia Nigra(LEWEY BODIES), Locus Ceruleus, Striatum
1. Cerebellar Tremor= tremor only with intentional movement 2. Wilson's Disease= Parkinsonian symtpoms 3. |
|
|
Recurrent Laryngeal Nerve Lesion: CN X=cut during Thyroidectomy=
|
LEFT= under aortic arch= possible large lymphnode
Right: under Subclavian Artery |
|
|
Spina Bifida= Caudal Neuropore does not close
|
measure maternal alpha-fetoprotein which should be high because of failure of the Dorsal Vertebral Arches to close= lack of Folic Acid
|
|
|
Trigeminal Neuralgia= often compression of arteries=old women BUT if Young think= Multiple Sclerosis
|
EXTREEM PAIN=> worse with Cold temperature=>
V2=Foramen ovale V3=Foramen rotundum |
|
|
Lateral Medullary Syndrome= Wallenburg's Syndrome=>
|
PICA occlusion
|
|
|
Ectopic Pregnancy= Lower Abdominal Pain= N,V, syncope(hypotensive)=> History of PID=>
|
Usually unable to do Pelvic Exam=> remove fluid from "cul-de-sac" via the vagina=> non-clotted blood(rupture of supply: uterine artery, internal iliac artery, ovarian artery, aorta
|
|
|
What are some RISK FACTORS for ectopic pregnancies=>
|
-PID
-Prior ectopic pregnancy -tubal pelvic surgery -DES exposure ------- Types: -Tubal:#1 @ ampulla>isthmus, >fimbrae >interstitium -abdominal: -boad ligament: |
|
|
Pudendal Block=>typical during pregnancy
----- *natural birth=no anesthesia-analgesia |
Locate: Ischial Spine => inject through sacrospinous ligament (between baby head and vagina)
---- Pudendal Nerve comes out of the Greater Sciatic foramen --> goes over ISCHIAL SPINE--> crosses Sacrospinous ligament--> enters Lesser Sciatic foramen(with Obturator nerve)=> splits: 1. perineal nerve 2. inferior rectal nerve 3. dorsal nerve of clitoris |
|
|
Which ligament is the most commonly injured in hyper inversions of the ankle?
|
anterior TALOFIBULAR ligament => occurs when the foot is plantarflexed
----------------- Lateral Ligaments= calcaneofibular, posterior talofibular ----VS---- Medial ligaments=> -Broad Deltoid |
|
|
Why is Radial Nerve palsy (wrist drop) last a long time?
|
location of fracture in humerus=> osseous callus + scar tissue formation
|
|
|
Where is the most common Clavicle Fracture location ?
|
middle 1/3 of the clavicle => pulled up by the sternocleidomastoid and the distal part pulled down by the weight of the arm
|
|
|
TENNIS ELBOW gives you pain when you try to extend your hand because?
|
Extensors attach to the lateral epicondyle of the humerus
------ Entrapment of the Posterior Interosseous Nerve=> has similar symptoms as Tennis Elbow |
|
|
Median Nerve Palsy=NOT CARPAL related=>Median Nerve damage was higher==> Wrist Flexion => ulnar deviation
|
Forms benediction hand CANNOT form "F" in ASL=> fist formation=>damage= "C" in ASL
-------VS------ damage due to Carpal Tunnel Syndrome entrapment=> inability to use thumb with palmar sensation |
|
|
Radial Head Subluxation @ the Elbow=> also called nursemaid's elbow=> Pain in elbow in kids typically=> Extended arm + pronated is PULLED by parent==>
|
Damages the annular ligament that keeps the radial bone in place=>
kids show up: 1. arm is pronated plus flexed |
|
|
Monteggia's Fracture=> Fracture to the Ulna midway=> patient unable to pronate or supinate arm=>
***Child Abuse |
Damage:
1. dislocates the head of Radial head because fracture pushes it out 2. Possible RADIAL NERVE damage because blow typically occurs in that area |
|
|
What is damaged in the hand when something hard is hit with a CLOSED FIST?
**Boxer's Fracture |
5th metacarpal=> inability to FLEX PINKIE + head of MCP is depressed
|
|
|
Hip-Leg-Calve-Perthes= avascular necrosis in KIDS==> occurs in the femoral heads of kids (small femoral head epiphysis)==> groin pain that radiates to inner thighs
|
FOVEA= supplies the articular cartilage of the Femur
----- Femoral Circumflex Arteries (Medial + Lateral) feed the head= absence= necrosis |
|
|
What nerve exits above the piriformis muscle of the gluteal area exiting the Sciatic Foramen?
|
Above: Superior gluteal Nerve=> Abducts Hip=> damage==> Trendelenburg Gait=> hip sags on side of injury
--------------------- Below= Inferior Gluteal Nerve + Artery + Sciatic Nerve ==> gluteus maximus |
|
|
Hip Dislocation = CONGENITAL= affects girls more= dislocation of the hip= breech birth=> may progress to avascular necrosis of the femoral head
|
Presentation: asymmetry of legs, knees=> Abduction is limited==> early diagnosis yields better results
|
|
|
Hip Dislocation= TRAUMA=> Posterior disslocation is the most common=>knee inpact against something
|
Presentation= affected leg=> shortened, internally rotated, adducted => slight flexion= complications include: avascular necrosis (goal in Tx: reduction) => might also cause early degenerative arthritis
|
|
|
Hip Fracture: follows fall in OLDER lady(osteoporosis)=> inability to move leg: EXTERNALLY rotated, ADDUCTED and one leg shorter than the other=> tenderness in femoral triangle => Femoral neck fractures
|
lateral rotators=> Superior Gluteal Nerve: piriformis, obturators, gemellus, quadratus, gluteus maximus ==> high risk that Sciatic Nerve might get damaged + HIGH RISK of DVT (requires proper stockings, anticoagulants)
|
|
|
What is the common triad when the knee recieves a blow laterally?
|
Lesions=
1. ACL 2. Medial Meniscus 3. MCL |
|
|
Painfull Knee= Osgood-Shlatter's Disease=
|
swelling in the tibial tuberosity= repeated trauma can cut off vascular supply=> avascular necrosis=> self-limited disease
|
|
|
Leg Compartment Syndrome=pain in anterolateral aspect of the leg=> radiates to ankle=>
|
increase pressure in limited space=> leg is swollen, tense, warm and anterior tibial pulse is weak=> sensory deficits following exercise = treated by removing fascia
|
|
|
Pelvic Fracture= follows severe trauma=> tenderness over: iliac crest + tronchaters bilaterally=>
|
Bladder and urethral lesions are common with compound fractures to the pelvis= often conceal a lot of blood
|
|
|
What does blood in the urethral meatus contradict?
|
Insertion of the Foley Catheter= indication of rupture of the membranous urethra ==> suprapubic cystostomy
|
|
|
In a shoulder dislocation (anterior displacement= falling on arm while abducted) what is common?*complaint: no sensation on lateral aspect of arm + flexion problems
|
humoral head is anterior to the coracoid process(part of the scapula)=> musculocutaneous nerve damage is possible
------VS----- Where do you see posterior shoulder dislocations= electric shock injuries/grand mal seizures |
|
|
Shoulder Seperation=> FULL= both ligaments rutpure
|
ACROMIOclavicular ligament rupture (only in partial) = prevents anterior-posterior displacement of clavicle
--VS---- CORACOclavicular Ligament=prevents Vertical displacement of the clavicle |
|
|
In a herniated disc in the L4/L5 region how would you distinguish which nerve is impinged?
**made worse by movement, coughing, sneezing--> radiates to butt, calves |
Central= L5 impinged=> numbness in lateral aspect of leg + weakness extending toe
-----VS------ Lateral= L4= abnormal patellar DTR, numbness in medial aspect of the leg all the way down to the foot, weakness in dorsiflexion |
|
|
Cervical Rib Syndrome= impingment of the subclavian artery or the lower brachial plexus (ulnar n.) between the free Cervical Rib (C7) and the Scalenus anterior muscle=>
|
Diminished radial pulses, sometimes a bruit over subclavian artery which is caused by a poststenotic dilatation****prolonged abduction of arm can precipitate these symtpoms
|
|
|
What are the boundaries of the Anatomical Snuff Box?
|
Extensor pollicis longus + extensor pollicis brevis=> bottom: scaphoid + trapezium bones
|
|
|
What structures would be cut in someone who slashes their wrist?
|
-superficial radial artery= bleeding
-Palmaris longus tendon= no digit flexing -Median Nerve= no thumb opposition, loss of sensation on lateral/dorsal aspect of hand ------------ Thumb ABduction still possible: radial nerve |
|
|
When will axillary nodes from a lung cancer be affected?
|
When there is pleural adhesions since most lung lymphs drain into the supraclavicular nodes
|
|
|
What is Pancoast's Syndrome? Tumor invades thoracic inlet: Apex of lung=>
|
Involvement:
-Reduced radial pulse= arterial blood flow blocked= subclavian artery damaged -face, neck edema=> engorgement of the Jugular vein= venous return blocked -Horner's Syndrome= sympathetic chain compression -wasting of 1st dorsal interosseous muscle= T1 compression -Pain= brachial plexus involvement -hoarseness of voice= recurrent laryngeal nerve damage |
|
|
How is Taste and Sensation and Movement of the tongue seperated by each of the cranial nerves?
|
Sensation (P:9. A:5)
--vs-- Taste (P:9 A:7) --vs-- Motor (12 except for Palatoglossis which is 10) |
|
|
Which nerves are associated with the Superior Orbital Fissure in the Calvaria?
|
CN 3,4,6 V1 of 5
|
|
|
What nerves exit or enter in the Internal Acustic meatus in the calvaria?
|
CN 7,8
|
|
|
Which nerves are Mixed?
|
CN 5,7,9,10
-------------- also think Vit K clotting factors=2,7,9,10= long PT |
|
|
What nerves innervate the various salivatory glands?
|
7= submandibular + sublingual
--vs-- 9= parotid |
|
|
Things that point away or to the same side of injury SIDE of nerve damage?
|
10=uvula=away,
4=head=away ----vs---- 11=neck/head=same, 12=tongue=same, |
|
|
What nerves are found in the Cavernous Sinus and thus are suceptipble to infections coming up via the ophthalmic vein(no valves)?
|
CN V1,V2,3,4,V,6
|
|
|
What do you find inbetween the common carotid artery and the internal jugular vein?
|
Vagus nerve
|
|
|
What is made from the Pharyngeal Arches? ***all cartilageous bones are Neural Crest origin
|
1= muscles of mastication + Tensor Tympanic muscle + Maxilla, mandible + INCUS
------VS----- 2= STAPES + muscles of mastication - ----VS----- 3= common carotid arteries + stylopharyngeus w/CN9 - ---VS--- 4= superior laryngeal nerve of CN 10, thyroid cartilage + cricothyroid muscle, palate, aortic arch - ---VS--- 6= reccurent laryngeal nerve, DUCTUS ARTERIOSIS, intrinisc muscles of the pharynx, venous trunks |
|
|
What are the nerves grow into the pharyngeal archs?
|
V3, 7, 9, 10, ==> actual origin is ectoderm
----VS----- the rest wich derive from MESODERM from OCCIPITAL SOMITES |
|
|
How does the tympanic membrane develop?
|
GROOVE 1||Arch 1
---------- GROOVE 1= external ear ---vs--- Arch 1= internal ear |
|
|
What do the ENDOdermal pharyngeal POUCHES form?
***DiGeorge's Syndrome= pouch 3= no thymus |
1= middle ear,
2= tonsils, 3= inferior parathyroid glands + THYMUS 4= superior parathyroid glands,+ Ultimobrachial Body(neural crest cells= calcitonin cells) |
|
|
What is an astrocyte marker?
|
GFAP
|
|
|
What is the only thing that originates from mesoderm in the CNS?
|
microglia CD1-> w/HIV they fuse and form multinucleated giant cells in the CNS
|
|
|
Where is the most common site of an acustin Schawnnoma?
|
Internal acustic meatus=> 7,8=> Neurofibramatosis 2
|
|
|
What maintains the PERMEABILITY integrity of the peripheral nerve?
|
Perineurium= also what must be micro-attached in surgery for regeneration of nerve
|
|
|
Where do you find the sensory Corpuscles of the PNS?
|
Meissner's= light but specific touch=hairless skin
|||||| Pacinian=large=deep layers= pressure + vibration = found in skin and joints |||||||| Merkel's= cup-shaped= hard palate + hair follicle= light/crude touch |
|
|
What are the different functions of the inner ear bony structures?
|
Utricle/Saccule=>Macula=> linear acceleration
------VS---- Semicircular canals=> Ampullae=> angular acceleration |
|
|
What is the order by which older people loose their hearing?
|
High frequency (narrow/stiff) ----> Low frequency(wide/floppy)
|
|
|
What is the order of bones in the inner ear?
|
M-I-S
|
|
|
How do you develop Hyperaccusis?
|
Damage to the Facial nerve 7 => paralysis of the stapedius= leads to uninhibited stapes movement
|
|
|
What is Meniere Syndrome?
|
Reccurent: Vertigo, Tinitus (semicircular canals), hearing loss=> increase endolymph pressure
|
|
|
Most of the BBB is non-fenestrated cappilaries except certain areas which include?
|
Area Posterna= during chemo=> stimulate vomiting
---------- Neurohypophysis allows hormones to enter circulation |
|
|
Where do you see Blood-tissue barriers?
|
1. BBB 2. Blood-testis barrier 3. Maternal-fetal blood
|
|
|
What nucleus in the HYPOTHALAMUS when damaged causes anorexia and starvation?
|
Lateral Nucleus
----VS---- Ventromedial Nucleus =satiety= when destroyed=> obesity |
|
|
What nucleus in the Hypothalamus regulate the autonomic nervous system?
|
PNS=> Anterior (also cools)
----VS---- SNS=>Posterior (keeps you warm) -----VS--- Circadian Rhythem= suprachiasmatic |
|
|
What hypothalamic nucleus causes rage when damaged?
|
Septal Nucleus
|
|
|
What recieves information in the THALAMUS from music/sight?
|
music= MGN
---VS--- sight/light= LGN |
|
|
What nucleus recieves sensory input from the face vs. the body in the THALAMUS?
|
Body= VPL (dorsal columns, spinothalamic)
-----VS----- Face= CN 5=> VPM |
|
|
What part of the THALAMUS recieves information from motor pathways?
|
VA/VL
|
|
|
In the basal ganglia the Striatum (caudate nucleus/nucleus acummbens= pleasure) + the Gpi are both what type of circuitry?
|
Inhibitory via GABA
|
|
|
Stimulation of the Striatum causes what NET effect on the Cortex?
|
Stimulation and vice versa with inhibition
|
|
|
What 2 structures comprise the Limbic System= emotion + memory?
|
HPC + Amygdala
|
|
|
What does the DIRECT Pathway facilitate when stimulated by the Substantia Nigra Dopamine NT?
|
D1 Receptors =Facilitates movement
------VS------ INDRECT pathway:D2 Receptors inhibits movement |
|
|
What gets damamged in Parkinson's Disease?
|
Substantia Nigra ---> Striatum influence (D1 or D2) => loss of DA ==> inability to destroy alpha-synuclein via ubiquination (mutations: PARKIN/E3 Ubiquin Ligase)= forms LEWY bodies in cells => apoptosis
***also caused by Paraquat toxicity |
|
|
Where does surgery play a role in Parkinson's Disease?
|
Cut the Indirect pathway=> Hemiballismus (proximal and contralateral) limbs is a side effect of surgery
|
|
|
In unconcious patients how can brain stem damaged be assessed?
|
Caloric Nystagmus => COLD water in ear= no fast nystagmus but slow moves towards side with water ==> NO BRAIN DAMAGE
--------VS-------- Lesion= bilateral MLF damage= ipsilateral fast nystagmus to side with COLD water -----VS---- BRAIN STEM (low) DAMAGE= NO EYE MOVEMENT *********EVERYTHING OPPOSITE WITH WARM WATER****** |
|
|
|
|
|
|
What is the most obvious sign of Frontal Lobe damage?
|
Lack of social judgement
|
|
|
What limbs are affected by the different cerebral arteries?
|
ACA= lower limbs
----VS--- MCA=aphasias, hands, face, throat ----Vs---- PCA= vision loss ---VS---- Anterior Communicating Artery= is susceptible to Aneurysms which can press on the optic nerves and cause vision problems |
|
|
What nerve runs below the PCA?
|
CN 3 but the posterior communicating artery can also cause an Aneurysm which can cause CN3 Palsy
|
|
|
What artery branch of the MCA supplies the internal capsule, caudate, putamen, and GP?
|
Lateral Striate= highly susceptible to strokes
|
|
|
How do strokes in the anterior vs. the posterior Circle of Willis manifest?
|
Anterior= sensory/motor deficits, aphasia,
------VS------- Posterior= CN deficits=> vertigo, visual deficits, coma, ataxia |
|
|
What is the pathway of the CSF in the brain?
|
Lateral<Posterior Ventricles --> Foramen of Monro --> 3rd Ventricle --> aqueduct of Sylvius---> 4th Ventricle:
---> Lateral: Foramina of Luschka --->Medial: Foramina of Magendie ======> subarachnoid space ------------------------- most occlusions occur at the Tentorial Notch |
|
|
At what level do you need to perform a Lumbar Puncture?
|
L3 and L5: around the iliac crest
-------- Layers the needle passes through to get to the CSF? ------ the skin, sub- cutaneous tissue, supraspinous ligament, interspinous ligament between the spi- nous processes, ligamentum flavum, epidural space including the internal vertebral venous plexus, dura, and arachnoid, into the subarachnoid space and between the nerve roots of the cauda equina. ***NOT THE PIA + Pop sound= ligamentum flavum |
|
|
From medial to lateral what is the orientation of the tracts of the Spinal Cord?
|
-Dorsal Columns= G(arm) --> C(leg)
-CST= arm--> Leg -----VS------- -Spinothalamic= LEG --> ARM |
|
|
What is the order of the Dorsal Column pathway for vibration/touch/proprioception?
|
Sensory organ --> DRG==> goes up the SC ipsilaterally --> NUCLEUS CUNEATUS (medulla) ==> crosses and goes up with the Medial Lemniscus--> VPL of thalamus==> Sensory Cortex
|
|
|
What is the pathway for the Spinothalamic Tract?
|
Sensory=>SC and crosses(white commissure) ==> VPL of Thalamus ==> sensory cortex
|
|
|
What nerves in forearm pass through muscles?
**** possibility of muscle entrapment |
Radial= supinator
Medial= Pronator Teres Ulnar= Flexor Carpi Ulnaris Musculocutaneous= coracobrachialis |
|
|
What is the difference between Muscle Spindles and Golgi tendon organs?
|
Muscle Spindle= 1a=>monitor muscle length= help you pick up heavy stuff
-----------VS------ Golgi Tendon Organ= 1b=> Muscle tension= make you stuff that is too heavy |
|
|
How would you test the whether the spinal cord is intact or not in a neuro exam?
|
DTR=>
---- C5= biceps reflex ---- C7= triceps reflex ---- L4= Patella reflex ---- S1= Achilles reflex ---- Babinski Reflex= UMN lesions= dorsiflex/toes fan out is positive |
|
|
What type of lesions can make some primitive lesions return like before when you were 1 year old?
|
Frontal Lobe lesions=> Moro (startle=extension of limbs), Rooting(looking for nipple), Palmar(grasping), Babinski
|
|
|
Where are Cranial Nerve Nuclei located?
|
midbrain= 3,4
Pons= 5,6,7,8 medulla=9,10,11,12 ------ Nucleus Solitarius= visceral sensory= 7,9,10 nucleus Ambiguus= throat motor= 9,10,11 |
|
|
Where does the Ophthalmic Artery and the Vein enter/exist in the calvaria?
|
Artery= Optic Canal
------- Vein= Superior Orbital Fissure (also: 3,4,V1,6) |
|
|
What can develop in the cavernous sinus?
|
Maxillary sensory loss + Ophthalmoplegia= V1/V2 compression
|
|
|
What Trigeminal branch can prevent you from masticating (masseter, temporalis, medial pterygoid) when damaged?
|
V3
----VS---- what opens the mouth= LATERAL pterygoid |
|
|
What nuclei is responsible for the Pupillary Light Reflex Consensually i.e contriction of the pupil (circular muscle)?
|
Edinger-Westphal nucleus which is stimulated by the pretectal nucleus on the side of light stimulation
------ Damage to the Posterior Commissure would STOP the consensual pathway |
|
|
What kind of visual problems would you get with damage to the?
|
-optic nerve= Anopia= eye blindness
---------- -optic chiasm= Bitemporal ---------- hemianopia= tunnel vision ---------- -optic tract= inability to see one side of visual field ---------- -unilateral Calcarine fissure= one sided vision loss= with Macular sparing |
|
|
Projections from the LGN to the visual Cortex run either through the Temporal Lobe and the Parietal Lobe can become damaged and present?
|
Temporal=Meyer's Loop= cannot see the opposite UPPER quadrant
-------VS------- Parieteal Lobe= Dorsal optic radiation= opposite LOWER quadrant vision loss |
