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1

Retroperitoneal hematoma in STABLE patient most likely due to?

Pancreatic injury

2

Most common duodenal ulcer location and presentation?

Anteriorly - perf; If posterior, more likely to erode gastroduodenal artery -> hemorrhage

3

Femoral neck fx frequently damages what vessel?

MEDIAL femoral circumflex artery -> avascular necrosis of femoral head

4

Rotator cuff muscles?

SITS - supraspinatus, infrapinatus, teres minor, subscapularis

5

Most commonly injured rotator cuff syndrome structure?

Tendon of supraspinatus muscle - empty can test

6

Nursemaid's elbow affects what structure?

Radial head subluxation b/c of sudden traction of outstretched and pronated arm. Annular ligament is torn and displaced. Deep branch of radial nerve is often damaged --> wrist drop

7

ACL and PCL in relation to fibula?

ACL attaches from fibula(lateral)-side of femur to medial part of tibia. Lateral impact ACL! PCL attaches from medial-epicondyle of femur to middle-part of tibia.

8

Trendelenburg gait?

Hip drops when ipsilateral foot lifted. Injury to contralateral superior gluteal nerve or gluteus medius muscle (outside hip can't contract)

9

Transverse spinal cord sections

Higher cervical cord is ovoid.
Thoracic cord and L2 has intermediolateral cell columns (lateral grey matter horns)
Lower cord has LARGE ventral horns and less white matter.

10

What neves go through the jugular foramen?

CN IX, X, XI, and jugular vein

11

Pharyngeal pouch III

Parathyroid gland (inf.) and thymus

12

Pharyngeal pouch IV

Parathyroid gland (sup.) and ultimo-branchilal body

13

Pharyngeal pouch II

Palatine tonsil

14

Pharyngeal pouch I

Epithelium of middle ear and auditory tube. Membrane -> tympanic membrane. Groove -> epithelium of external ear canal

15

Housemaid's knee

Prepatellar bursa (btwn patella and skin and tendon).

16

Anserine bursitis

Pain along MEDIAL aspect. Overuse injury or chronic trauma. I PROLLY had this when running.

17

Cleft lip vs. cleft palate dvpt?

Cleft lip - maxillary prominences fail to fuse w/ intermaxillary segment. Cleft palate when palatine shelves of maxillary prominence fail to fuse with one another or with the primery palate.

18

Sites of ulnar nerve injury

Medial epicondyle of humerus OR Guyon's canal near hook of hamate + pisiform bone of wrist

19

Superior thyroid artery close to nerve at risk during surgery

External branch of superior laryngeal nerve, which innervates the crycothyroid muscle. Recurrent laryngeal innervates the arytenoids and aryepiglotticus)

20

Direct vs. indirect inguinal hernias

Direct in Hesselbach's triangle (rectus abdominis, inf. epigastric, inguinal ligament). Less prone to incarceration and don't go down scrotum. Indirect are lateral to inf. epigastric arteries and are 2/2 to failure of obliteration of processes vaginalis --> protrusion in deep inguinal ring --> scrotum.

21

Sympathetic output to viscera how?

Two neuron set-up. Preganglionic synapse in chain w/ ACh-N. Postganglionic neurons releases NE in cleft of target organs. Adrenal glands are directly innervated and sweat glands innervated w/ post-ganglionic w/ Ach-Muscarinics.

22

Ectoderm derivatives

Neural tube -> CNS, POSTerior pituitary, pineal gland, retina. Neural crest -> ganglia, Schwann, pia and arachnoid, aorticoopulmonary septum and endocardial cushions, branchial arches, skull bones, melanocytes, adrenal medulla. Surface ectoderm -> Rathke's pouch (ANT. pituitary), lens and cornea, inner ear, olfactory epithelium, nasal and oral epithelium, epiderms, salivary, sweat, and mammary glands.

23

Common cardinal veins?

Embryological structure that drain into sinus venous. Become SVC and other parts of venous circ.

24

Cough reflex

Afferent mediated by INTERNAL laryngeal nerve (CN X).

25

Taste mediated by what cranial nerves?

Base = IX. Ant. 2/3 = VII.

26

Ventromedial nuclei of hypothalamus

Involved with satiety signaling. Lesion -> hyperphagia and obesity, aggressive, savage behavior.

27

Lateral nuclei of hypothalamus

Hunger signaling. Lesion -> loss of desire to eat -> FTT/starvation

28

Supraoptic and paraventricular nuclei of hypothalamus

Produce ADH and oxytocin down to posterior pituitary where hormones are released

29

Anterior nuclei of hypothalamus

Temperature control. Coordinate cooling by stimulating parasympathetic. Lesions -> hyperthermia and death

30

Posterior nuclei of hypothalamus

Temperature control. Control heat production when cold. Lesion -> hypothermia

31

What border of rib for thoracentesis?

Upper border. Above 7th for midclavicular, 9th for midaxilary, and 11th for posterior scapular line.

32

Obstruction of Foramena of Magendie or Luschka would cause?

Enlargement of ALL ventricles

33

What's so special about Left Renal vein?

Well it's longer. Second, the left gonadal vein drains it directly (Right drains into IVC). Any obstruction -> left-sided variocele in males.

34

Superficial vs deep inguinal LN drainage in males

Scrotum vs. glans penis and superficial nodes. Para-aortic does testis.

35

Wrist drop?

Radial nerve injury - arises near lateral epidcondyle of humerus where it articulates with head of radius. Deep branch often gets caught.

36

First pharyngeal arch

Trigeminal nerve and 1st aortic arch (regress except maxillary a.)

37

Second pharyngeal arch

Facial nerve, muscles of facial expression. Second aortic arch - not much.

38

Third pharyngeal arch

Glossopharyngeal nerve. Stylopharyngeas. Third aortic arch -> common and proximal IC arteries.

39

Fourth pharyngeal arch

Superior laryngeal branch of vagus. Muscles of pharynx, soft palate, some laryngeal. Fourth aortic rage -. TRUE aortic arch and subclavian arteries.

40

Fifth pharyngeal arch

Obliterated

41

Sixth pharyngeal arch

Recurrent laryngeal branches of vagus. Most muscles of larynx. 6th aortic arch -> pulmonary arteries an ductus arterioles.

42

Winged scapula

Long thoracic nerve. Serratus anterior.

43

Ventral pancreatic bud vs. dorsal pancreatic bud

Dorsal pancreatic bud stays in place and makes the pancreatic tail, body, most of the head, and the small accessory pancreatic duct. Ventral bud rotates (connected to bile duct) and becomes the uncinate process, portion of pancreatic head, and proximal portion of main pancreatic duct. Fuse at Wk 8

44

Pancreas divisum

Accessory duct becomes dominant dorsal duct (of Santorini) and open to duodenum via minor papilla. Small ventral duct (of Wirsung) from ventral side opens into major papilla. 5% of pop and usu. clinically silent.

45

Blood supply to ureters

Proximal 1/3 receives blood from renal artery, and are therefore preserved during transplantation. Distal 2/3 from iliac, gonadal, and vesicle arteries.

46

Watershed areas of the colon?

Splenic flexure (SMA vs. IMA) and distal sigmoid colon (IMA and hypogastric)

47

Obturator foramen

Obturator nerve is only nerve that exits pelvis via this foramen. Adductor opponent of this after dividing into branches. Anterior - gracilis, pectinous, adductors longus and brevus. Posterior - obturator externs and adductor magnus. Injury -> weakness of adduction

48

Abduction of thigh by what muscles?

Tensor fascia lata (superior gluteal), sartorius (femoral)

49

Hip flexors

Iliopsoas (psoas major, iliacus, psoas minor), rectus femoris, tensor fascia lata

50

Hip extensors

Gluteus maximus, semitendinosus, semimembranosus, biceps femoris - long head

51

Hip abductors

Gluteus medius and minimus

52

Hip adduction

Adductor brevis, adductor longus, adductor magnus

53

Somatic sensory innervation of tongue?

Ant 2/3 = CN V3. Post. 1/3 = CN IX.

54

Dislocated knee -> what injury?

Popliteal artery injury

55

Thin person with small bowel obstruction?

SMA syndrome. Decreased mesenteric fat leads to dec. angle between SMA and aorta. Compression Left renal vein and duodenum.

56

AV fistula presentation?

Often high-output cardiac failure. Distal to fistula, limb is cold to touch. Tachycardia diminishes when PRESSURE is applied to site of fistula = BRANHAM sign.

57

Sialolithiasis

Salivary gland stones. 80% of them are founding submandibular gland. Lithotomy. Inc. salivation.