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Gross Anatomy USMLE > 100 Concepts > Flashcards

100 Concepts Flashcards

1
Q

What does lumbar puncture (tap) and Epidural Anesthesia mean and where is it performed?

A

Lumbar puncture (tap):

  • Extract Cerebrospinal Fluid (CSF)
  • Enters the Subarachnoid Space
  • Done between L4/L5
  • Level of horizontal line through upper points of iliac crest

Epidural Anesthesia:

  • Inject Anesthetics to epidural space
  • Enters the epidural region
  • Done between L3/L4

Adults -> spinal cord ends as low as L2
Children -> ends at L3 and dural sac extends caudally to the level of S2

Extra info:
- the injection goes through -> skin -> fascia -> supraspinous ligament -> Interspinous ligament -> ligamentum flavum -> epidural space -> subarachnoid space

  • Filum terminale continues past the dural caudal sac all the way to S4 -> but the dural caudal sac is the important part, as it contains the CSF and in children as mentioned earlier, goes all the way until S2
  • You do the test at those parts because you don’t want to injure the filum terminale? because towards the end dural sac is smaller so more chance of needle hitting the nerve…?
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2
Q

What are herniated IV discs and where do they occur?

A
  • Back pain history? -> typically herniated discs
  • Herniated discs happen at C5/C6, C6/C7, L4/L5 or L5/S1 -> age younger than 50
  • Herniated discs INJURE the nerve root one below (traversing root)
    E.G… Herniation at L4/L5 will compress root at L5
  • Pain begins soon after patient lifts something heavy, and lower limb reflexes are decreased on the affected side

Extra Info:
- The herniation breaks through the enclosing ANULUS fibrosus (covers the nucleus pulposus) -> nucleus pulposus (inner core of vertebral disc) herniates past the posterior longitudinal ligament affecting the traversing root, and protruding from the vertebral canal

  • Herniations can be due to DEFECT in anulus fibrosus
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3
Q

What are the different abnormal curvatures of the spine?

A

Kyphosis:

  • Exaggeration of thoracic curvature
  • Result of osteoporosis in older people (multiple compression fracture of vertebral bodies)
  • Results also from disc degeneration
  • Looks like your neck droops and your back is more upwards (looks like that dwarf rejected spartan from 300 movie)

Lordosis:

  • Exaggeration of lumbar curvature
  • Due to pregnancy, pot belly, spondylolisthesis ( forward displacement of vertebra)
  • “Walk like a lord”

Scoliosis:

  • Lateral deviation of spine
  • Due to poliomyelitis, leg length discrepancy, or hip disease
  • “S shaped ish spine”
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4
Q

What is the anatomy of a humerus? What are the different upper limb humerus fractures?

A

Anatomy:

  • starts of with the head, and right after is the anatomical neck
  • Then you have the greater and lesser tubercle
  • Then comes the surgical neck (axillary nerve)
  • Then comes the shaft which has the deltoid tuberosity (radial nerve)
  • Then, the supracondyles
  • Lastly, the medial and lateral epicondyle (ulnar runs through medial epicondyle)

Fractures:

  • Axillary and Posterior humeral circumflex artery at the surgical neck
  • Radial nerve and profunda brachii artery at
    midshaft, also affects the origin of brachialis muscle
  • Brachial artery, Median nerve affected at the supracondylar region (lateral?)
  • Ulnar nerve, at medial epicondyle
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5
Q

What are the different fractures of distal radius?

A
  • Transverse Fracture within 2cm of the distal radius -> most common fracture of forearm (after 50)
  • Smith’s Fracture -> fall or blow on dorsal aspect of flexed wrist -> ventral ANGULATION of wrist -> distal fragment of radius ANTERIORLY displaced
  • Colles’ Fracture -> forced extension of hand, result of trying to ease a fall by outstretching the upperlimb -> distal fragment displaced DORSALLY -> “Dinner Fork Deformity” ulnar styloid process avulced (broken off)
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6
Q

What are carpal bones? What is a scaphoid fructure?

A

Carpal Bones from thumb side to pinky and then back from pinky to thumb:
“So long to pinky” -> Scaphoid, Lunate, Triquetrum, Pisiform
“Here comes the thumb” -> Hamate, Capitate, Trapezoid, Trapezium

Scaphoid Fracture:

  • Fall onto palm when hand is abducted
  • Pain at the lateral side of the wrist during wrist extension and abduction
  • Scaphoid fracture may not show 2-3 weeks, but a deep tenderness will be present at ANATOMICAL SNUFFBOX
  • Proximal fragment may undergo avascular necrosis because blood supply interrupted
  • Anatomical snuffbox -> Radial Artery
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7
Q

What is a Boxer’s fracture?

A
  • Neck of the metacarpal (knuckles?), frequently fractured during fist fights
  • Typical fractures -> 2nd / 3rd metacarpal -> professional boxers
  • 5th and sometimes 4th metacarpal -> unskilled fighers
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8
Q

What is a mallet/ baseball finger?

A
  • Distal interphalangeal joint suddenly has EXTREME flexion (hyperflexion), “when cricketers get hit my ball”,
  • Avulse the attachment of extensor digitorum tendon, base of the distal phalanx
  • Person cannot extend DIP joint
  • Deformity resembles a mallet (hammer), cause the finger bends down and makes the hammer head looking thing
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9
Q

What are the rotator cuff muscles? And what is its’ function?

A
  • Supports the joint by forming a musculotendinous rotator cuff around it
  • Reinforces joint on all sides, except inferiorly -> INFERIORLY is where dislocation mostly occurs
"SItS"
Supraspinatus - Abducts 15 degrees
Infraspinatus - lateral rotation
Teres Minor - lateral rotation
Subscapularis - ?

“too understand the insertion, just picture a hand holding onto the humerus, thumb to ring finger, (thumb on lesser tubercle, first finger on greater) and imagine SItS”

Nerve: For supraspinatus, infraspinatus -> Suprascapularis

Nerve: For teres minor -> Axillary

Nerve: For subscapularis -> subscapular nerve

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10
Q

How do you abduct the upper limb?

A
  • Supraspinatus muscle -> 15 degrees -> Suprascapular nerve
  • Deltoid muscle -> 15-110 degrees -> axillary
  • Serratus anterior (long thoracic nerve) “affected during mastectomy” “can’t comb hair” and Trapezius (CN11 ACCESSORY) -> 110 - 180 degrees
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11
Q

What is subacromial bursitis / tearing of supraspinatus tendon?

A
  • Subacromial bursitis is due to calcific supraspinatus tendinitis. This causes painful arc of abduction.
  • Same symptoms are seen in inflammation or trauma of supraspinatus tendon (MRI -> Torn Tendon)
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12
Q

What is a three elbow’s/ students elbow?

A
  • Subcutaneous olecranon bursitis is another name for three elbows/ students elbow
  • The olecranon is where the tricep attaches distally
  • Easily palpatable, it is seperated from the skin via the olecranon bursa (helps the elbows have mobility)
  • Excessive pressure and friction -> bursa inflamed
  • Thus, friction subcutaneous olecranon bursitis
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13
Q

What is a lateral epicondylitis (tennis elbow)? What are the effects?

A
  • Lateral epicondylitis is due to repeated flexion and extension of wrist, resulting strain attachment of common extensor tendon.
  • Inflamed periosteum of lateral epicondyle. Pain felt on the lateral epicondyle and felt down the forearm (pain in opening door, lifting glass)
  • Origins of muscles affected: extensor carpi radialis longus, extensor carpi radialis brevis, extensor ulnaris, extensor digitorum, extensor digiti minimi
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14
Q

What is a medial epicondylitis (golfers elbow)? What does it affect?

A
  • Inflammation of common flexor tendon of the wrist

- Origins of muscles affect -> Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris

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15
Q

What is the arterial anastomoses around the scapula?

A
  • When subclavian artery or the axillary artery is blocked anastomoses is possible! Via thyrocervical and subscapular branches
  • Subclavian Artery Side:
    From the subclavian artery, thyrocervical trunk comes out and branches to transverse cervical artery and suprascapular artery. These go to the middle and anastomose with the other side, and also transverse cervical goes way below to become dorsal scapular artery and intercostal arteries
  • Axillary artery side
    From the axillary artery, branches out the subscapular artery which goes all the way down as thoracodorsal artery, and before it does that, it branches as circumflex scapular artery and meets in the middle with transverse cervical and suprascapular.
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16
Q

Describe the cubital fossa and its’ contents!

A
  • Lateral to medial
    Biceps brachii tendon
    Brachial Artery
    Median Nerve

-Subcutaneous Lateral to Medial
Cephalic vein
Medial cubital vein
Basilic vein

  • Sites of venipuncture (blood sample?) -> medial cubital vein
    Overlies bicipital aponeurosis, therefore deep structures protected AND ALSO not accompanied by nerves
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17
Q

What is carpal tunnel syndrome?

A
  • Lesion that causes the carpal tunnel to reduce in size or narrow (fluid retention, infection, lunate bone dislocation)
  • Median nerve most sensitive structure in the carpal tunnel and mostly affected
  • Clinical -> Pins and needles, anesthesia, of lateral 3.5 digits, PALM sensation not affected because superficial palmar cutaneous branch runs superiorly to the carpal tunnel
  • Ape hand deformity -> Absence of opposition
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18
Q

How do you test for the proximal and distal interphalangeal joints?

A
  • Proximal
    You test the flexor digitorum superficialis (FDS), this is done by extending all your fingers and letting the middle finger flex via the proximal joints only

-Distal
You test the flexor digitorum profundus (FDP), done by holding the middle finger and letting the patient flex just the top “distal phalangeal joint” part of the finger

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19
Q

What are the lesions of upper limb nerves, upper brachial palsies and lower brachial palsies?

A
  • Erbs Palsy
    Injury to the c5,c6 roots, upper brachial palsy causes ERB’s Palsy. Due to increased angle between neck and should, “break dancing head injury” -> Also can occur during birth, if gynecologist pulls baby via head and injures. Usually causes WAITERS TIP hand, due to absence of axillary, supra-scapular and musculocutaneous nerves -> adducted shoulder, medially rotated, extended elbow -> also loss of sensation to lateral aspect of upper limb
  • Klumpke’s Palsy
    Injury to the c8, t1 roots. Known as the Lower Brachial palsy. Occur due to upper limb pulled superiorly (stretched, when falling of branch, grabbing supporting during falling from flight). Also, it can occur during birth if you are pulling the baby via his/her arms -> known as THORACIC OUTLET SYNDROME. Usually claw hand is seen due to lesions in the ulnar nerve and median nerve (ape hand) -> ALSO MAY INCLUDE HORNERS SYNDROME (constricted eye)
20
Q

What happens during an injury to the musculocutaneous nerve?

A

Lesion of lateral cord
Flexion problems of elbow (biceps and brachialis)
Supination of forearm (biceps)
Lateral sensation loss in the forearm

21
Q

What are the cutaneous innervation to the hand?

A
  • Anterior part of hand
    Pinky and half of ring finger -> Ulnar -> 1.5
    thumbs to half of ring finger -> Median -> 3.5
  • Posteriorly
    Thumb to half of ring finger, and upto the PIP -> Radial Nerve
    Pinky to half of ring finger -> Ulnar
    Above the PIP in the 1-3.5 digits -> Median
  • Superficial lesion of Radial
    Skin deficit between 1/2 digits on the dorsum hand only because of nerve overlapping
22
Q

How do you do a cardiac catheterization?

A
  • Femoral Artery used to do a cardiac catherization
  • Cannulated for left cardiac angiographies and visualize coronary arteries
  • Long slender catheter -> percutaneously -> goes up from Femoral -> external iliac -> common iliac -> aorta -> left ventricle
23
Q

What are the injuries to the gluteal region and fractures of the femoral neck?

A
  • Fractures to the neck of the femur common in elderly women with osteoporosis
  • Fractures to the femoral neck -> shortness of lateral rotation of lower limb
  • Also disrupts blood supply to the head of the femur -> Transcervical fracture disrupts blood supply to the head via Retinacular arteries (medial circumflex femoral artery) -> avascular necrosis of femoral head
  • For now, best treatment is hip replacement
24
Q

What happens during an injury to the sciatic nerve?

A
  • Weak hip extension and knee flexion (due to hamstring -> semimembranous (medial), semitendinous (lateral), bicep femoris (middle of memb and tend))
  • Foot drop -> lack of dorsiflexion
  • Flail Foot -> lack of dorsi and planter flexion
  • Common cause -> improper gluteal injections and also posterior Hip dislocations
25
Q

What is posterior hip dislocations?

A

Caused due to head on collisions in a car, knee hitting the dash board, femoral head forced posteriorly out of the ACETABULUM

Ruptures inferiorly and posteriorly (fracture of ischium), femoral head passes through the tear in capsule of the ishiofemoral ligament and over the posterior margin of acetabulum onto the lateral surface of ilium, shortening and medial rotation of limb

26
Q

What happens during superior gluteal nerve injury? What is a Trendelenburg sign?

A
  • Superior gluteal nerve Injured during surgery, posterior dislocation of hip, or poliomyelitis
  • Paralysis of GLUTEUS MEDIUS and GLUTEUS MINIMUS -> muscles used for pulling the pelvis up and abduct the thigh -> these are lost during the injury to SUPERIOR gluteal nerve
  • Trendelenburg Sign
    Right side superior gluteal nerve injury, then the left pelvis falls downwards when patient lifts left foot off of the ground
    CONTRALATERAL NERVE INJURY
27
Q

What happens during inferior gluteal nerve injuries?

A

Cause due to posterior hip dislocation, surgery

Weak hip extension, due to injury to the GLUTEUS MAXIMUS

Problem climbing stairs, standing from seated position

28
Q

What happens during obturator nerve injury?

A
  • Causes due to anterior hip dislocation, radical retropubic prostatectomia (prostate removing technique through incision in the abdomen)
  • Adducting thighs problem (cross legs while sitting)
  • Decreased sensation to the upper medial thigh
  • Muscles affect -> Gracilis, Adductor Magnus, Adductor Longis, Adductor Brevis, Pectineus (femoral and obturator nerve both)
29
Q

What are avulsion fractures of hip bone and hamstring muscles?

A
  • Avulsion occurs at the ischial tuberosity, where you attach muscles
  • Hamstring muscles -> Lateral to medial
    Semitendinosus
    Bicep femoris
    Semimembranosus

Flexion of knee, extension of hip
Nerve -> Tibial nerve -> short head of bicep femoris by common fibular nerve

30
Q

What are the structures under the inguinal ligament?

A 
Medial to lateral
Femoral Ring
Femoral Vein
Femoral Artery
Femoral Nerve
- All covered by iliopsoas muscle
- Directly under Inguinal ligament, is the iliac fascia, then iliopsoas,
31
Q

What is a femoral hernia?

A
  • Femoral hernia passes below the inguinal ligament through the femoral ring into the femoral canal. Swells up in the upper thigh, inferior and lateral to the pubic tubercle.
  • Hernia protrudes out of the saphenous hiatus, medial, upper thigh, and goes to the superficial hiatus
  • Femoral hernia more common in females, DANGEROUS because hernial sac can be strangulated
  • An aberrant obturator artery is vulnerable during surgical repair
32
Q

What is the most common knee joint injury and what is the unhappy triad?

A
  • Lateral side of knee is more often struck (football tackle), the tibial collateral ligament is usually broken (imagine what pearl explained with the ac remote and tissue)
  • THE unhappy triad -> most common athletic knee injury

Tibial collateral ligament
Medial meniscus
Anterior cruciate ligament

33
Q

Describe the tibial collateral ligament!

A
  • Broad, flat, band extending from the medial epicondyle of femur, to the medial condyle and shaft of tibia
  • blends with capsule and attaches to medial meniscus
  • Limits extension and abduction of leg
34
Q

Describe the fibular collateral ligament!

A
  • Round cord between lateral epicondyle of femur and head of fibula
  • Does not blend with capsule and does not attach to the lateral meniscus
  • Limits EXTENSION and adduction of the leg
35
Q

Describe the ruptures of the cruciate ligaments!

A

Anterior Cruciate Ligament (ACL):
If torn, tibia can move forward excessively on the femur when knees are bent -> ANTERIOR DRAWERS SIGN
Also, ACL protects the knees against hyperextension and sliding the femur posteriorly, also limits medial rotation of the femur (when foot grounded and leg flexed)

Posterior Cruciate Ligament (PCL): (less common)
If torn, tibia can move excessively backwards on the femur -> POSTERIOR DRAWERS SIGN
Also, PCL prevents femur from sliding anteriorly on the tibia, when knee is flexed

36
Q

What are the bursa’s around the patellar?

A
  • Pre patellar bursa
    Between the superficial surface of the patella and the skin. May become inflamed and swollen (prepatellar bursitis)
  • Supra patellar Bursa
    Superior extension of synovial cavity, between distal end of femur and quadriceps muscle and tendon. Place for intra-articular injection, also may become inflamed/ swollen (supra patellar bursitis)
37
Q

What is the knee jerk reflex?

A

Patellar reflex, tested by tapping the patellar ligament with a reflex hammer. Both afferent and efferent runs from the femoral nerve (L2-L4)

Tests spinal nerves L2-L4 (femoral)

38
Q

Describe ankle sprains and the causes!

A

Sprained ankles are almost always due to inversion of the ankle. The lateral ligament (anterior talofibular ligament) is injured in this process, because it is much weaker than the medial ligament.

Severe sprains -> lateral malleolus of the fibula may be fractured

39
Q

What is a potts fracture?

A

Fracture - dislocation of the ankle joint. Due to forced eversion (abduction) of the foot. The deltoid ligament avulses the medial malleolus and after that fibula fractures at a higher level.

40
Q

What is the ankle jerk reflex?

A

It is done at the achilles tendon, and is known as the achilles tendon reflex. You tap the calcaneal tendon to make the patient get a plantar reflex at the ankle!

Both afferent and efferent carried out by the tibial nerve (S1, S2).

41
Q

Describe injuries to the leg and foot, specially fractures at the fibula (lateral)!

A

Fractures at the fibula causes damage at the common peroneal nerve (common fibular?), because it usually winds laterally around the neck of the fibula!

Injury to the common peroneal nerve causes paralysis of the muscles in the anterior and lateral compartments of the leg (dorsiflexors and evertors) and you also loose sensation to the dorsum of the foot. (Dorsum of the foot means the top of the foot, makes sense?)

Causes FOOT DROP

42
Q

Describe the ruptures of the tricep surae muscles and the link it has with the achilles (calcaneal) tendon.

A

The tripcep surae muscles are the 2 heads of the gastrocnemius, 1 head of soleus, plantaris (small, long tendon string like).

When the achilles tendon (calcaneal tendon) is ruptured, these muscle are injured and the patient cannot PLANTER FLEX. (try doing calf ups you’ll know what I am talking about)

Sometimes, the plantaris can be hypertrophed due to achilles tendon ruptures.

43
Q

What is a plantar fasciitis? (calcaneal spur)

A

Most common problem in runners. Causes pain at the plantar surface of the foot and heel. Point tenderness at the proximal attachment of the plantar aponeurosis to the medial tubercle of the calcaneus and on the medial surface of the bone.

44
Q

What happens when there is an injury to the tibial nerve?

A

Tibial nerve injuries occur in the popliteal fossa. This causes loss of plantar flexion, loss to the gastrocnemius, soleus and weakened inversion (tibialis posterior muscle)

Causes calceneovalgus (inabilitiy to stand on toes)

Loss of sensation and paralysis to the intrinsic muscles of the sole of the foot.

POLITEAL FOSSA SUPERFICIAL TO DEEP:
Tibial Nerve
Popliteal Vein
Politeal Artery

45
Q

What are the terminal branches of tibial nerve at the sole of the foot?

A

Medial Planter Nerve
Lateral Planter Nerve

Medial Planter Nerve supplies:
Abductor hallucis
Flexor hallucis brevis
Flexor digitorum brevis
1st Lumbrical Muscles
Skin of medial 3.5 digits

Lateral Planter Nerve supplies:
All intrinsic plantar muscles which are not innervated by medial plantar nerve
lateral 1.5 digits

Gross Anatomy USMLE (1 decks)

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