100 anatomy

Where is the needle inserted for an LP

L3/L4, L4/L5 upper point of the iliac crests

Where does the spinal cord end

L2 in adults, L3 in kids, dural sac goes up to S2

Where do herniated discs usually happen in under 50

L4/L5, L5/S1 or C5/C6 C6/C7

What causes herniations

they follow degenerative changes in the anulus fibrosus, with compression to the nucleus pulposus

Causes of kyphosis

exaggeration of thoracic curvature,
can happen in elderly w/ osteoporosis (multiple compression fracture) or disk degeneration

Causes of lordosis

lumbar curve; pregnancy spondylolisthesis, potbelly

Scoliosis

lateral deviation, poliomyelitis, leg length discrepancy, hip disease

What is injured in a fracture of the surgical neck of the humerus

axillary nerve, posterior humeral circumflex artery

Midshaft fracture

Radial nerve, profunda brachii artery

Supracondylar fracture

brachial artery median nerve

Medial epicondyle fracture

ulnar nerve

Transverse fracture?

distal 2 cm of radius, most common fracture of the forearm post 50

Smiths fracture

fall or blow to dorsal side of flexed wrist; distal fragment of wrist anteriorly displaced

Colles' fracture

forced extension, trying to ease a fall; distal fragment displaced dorsally; ulnar styloid often avulced

Scaphoid fracture

fall onto palm w/ abducted; pain on lateral side exten abduct; deep tenderness in anatomical snuffbox; proximal avn

boxers fracture

metacarpal necks, 4/5 in amateur 2/3 in pros

Rotator cuff

Supraspinatus, Infraspinatus,
Teres minor, Subscapularis; reinforces joint except inferiorly

abduction of upper limb

0-15 (supraspinatus muscle, subscap nerve); 15-110 (deltoid muscle, axillary nerve); 110-180 (trapezius/ accessory), (serratus anterior, LTN)

Subacromial bursitis

calcific supraspinatus tendonitis, painful arc of abduction

Medial epicondylitis

common flexor tendon of the wrist at the medial epicondyle (golf)

Lateral epicondylitis

repeated flexion and extension; common extensor tendon periosteum over the lateral epicondyle; pain over lateral down posterior part of arm; opening door/lifting glass

blockage of subclavian/axillary

thyrocervial/ subscap

Cubital fossa

contents: biceps tendon, brachial artery, median nerve

subcut structures: cephalic vein, median cubital vein, basilic vein

Carpal tunnel

dislocation of lunate bone, median nerve most affected, altered sensation on lateral 3.5 fingers; apehand deformity absent of opposition

Upper brachial palsy

Excessive increase of angle between neck and shoulder (C5, C6 superior trunk) affecting axillary, suprascapular, musculocutaneous nerves; waiter's tip hand, loss of sensation in lateral aspect

Lower brachial palsy

(C8/T1 inferior trunk) intrinsic muscles of the hand affected, ulnar nerve (claw) and median nerve (ape). Loss of sensation in the medial aspect of limb and medial 1.5 fingers

musculocutaneous nerve

weakens flexion of elbow and supination of forearm (biceps); may have lateral anesthesia

AVN of femoral head

elderly women with osteoporosis
transcervical fracture disrupts blood supply via retinacular arteries from medial circumflex femoral artery and may cause avn

Unhappy triad

lateral blow to knee, MCL, medial meniscus, ACL

LCL

does not blend with joint capsule, does not attach to meniscus, limits extension and adduction of leg at knee

prepatellar bursa

between superficial patella and skin

suprapatellar bursa

distal end of femur and quadriceps muscle, usual place for intraarticular injections

patellar reflex

femoral nerve (L2-L4) knee jerk -> spinal L2-L4

Sprained ankle

almost always inversion injury, plantarflexed; lateral ligament (anterior talofibular ligament) weaker and more injured, in sever cases lateral malleolus may be fractured

Pott's fracture

forced eversion/ abduction of the foot; medial ligament detaches medial malleolus or the medial ligament tears, and the fibula fractures at a higher level.

ankle jerk

spinal nerves s1-s2 reflex arc limbs are s1,s2

pirifomis

inflammation or spasm -> pain like sciatica, supination of the hip

injury to sciatic nerve

weakened hip extension and knee flexion; footdrop and flail foot; improperly placed gluteal injections or posterior hip dislocation

superior gluteal nerve injury

posterior dislocation, surgery of the hip or poliomyelitis; paralysis of the gluteus medius and minimus, losing ability to lift pelvis and abduct thigh on contralateral side

inferior gluteal nerve injury

weakened hip extension (gluteus maximus)

avulsion of hip bone and hamstrings

biceps femoris, semitendinosus, semimembranosus; extension of the hip and flexion of the knee; supplied by tibial nerve

Femoral sheath

extension of transversalis fascia and iliacus fascia that enters thigh deep to inguinal ligament

contains: femoral artery, vein, canal

Femoral hernia

passes through the femoral ring, swelling inferior lateral to pubic tubercle; may protrude through the saphenous hiatus into superficial fascia; more in females, sac may get strangulated; aberrant obturator artery vulnerable during surgical repair

rupture of achilles tendon and triceps surae

disables gastroc and soleus, cannot plantarflex

injury to tibial nerve in popliteal fossa

can't plantarflex, can't stand on toes

fracture of fibular neck

injures common peroneal nerve, wraps around neck of fibula, cant dorsiflex or evert -> foot drop

breast carcinoma

malignant, usually adenocarcinoma from epithelia cells from lactiferous ducts; attaches to suspensory ligaments, causing dimpling of the skin

Lymph drainage of the breast

pectoral to axillary for most, rest to parasternal or opposite breast

mastectomy

ltn may be lesioned, winged scapula, cant abduct above 90, serratus anterior paralyzed; intercostobrachial nerve can be damaged, numbness in the medial arm

mastitis

most during breastfeeding; swelling redness, increased temp, bacteria from babies mouth enter milk duct

diaphragm paralysis

paralysis due to lesion on phrenic nerve; injured side pushed up during inspiration

diaphragm rupture

blunt, mvc left side, large radial tears on poserolateral aspect

cardiac hypertrophy

Left atrial enlargement secondary to mitral valve failure may compress the esophagus; seen with barium swallow

cardiac shadow

RA, SVC; Aa, PT, LA, LV

RCA

right atrium and right ventricle, anastamoses with the marginal branch of the left coronary artery;
anterior cardiac branches supplies right atrium, nodal branch supplies SA and AV node, marginal artery supplies right ventricle, posterior IV artery supplies diaphragmatic of both ventricles and posterior of IV septum

LCA

Anterior IV artery, anterior heart wall, anterior septum, bundle of his, apex of heart;
circumflex, left atrium and left ventricle

foreign bodies

more likely to enter right primary bronchus and pass into middle or lower lobe bronchi; usually falls to the posterior basal segment of the right inferior lobe

pneumonia CXR

opacity of lung parenchyma, and enlargement of bronchomediastinal lymph nodes

bronchogenic carcinoma

from the mucosa of large bronchi, early mets to thoracic lymph nodes,
pancoast tumor, apex of the lung causes TOS

open pneumothorax

during inspiration, air will compress, pushing healthy side

nerve supply of pleura

parietal- somatic sensory
costal -intercostal nerves
mediastinal - phrenic nerve
diaphragm- phrenic over the domes/ lower 6 intercostal on the periphery
visceral - auto from pulmonary plexus

abdomen quadrants

referred pain

foregut referred to epigastric
midgut referred to umbilical region
hindgut referred to hypogastric

indirect inguinal hernia

most common form, congenital; through the deep inguinal ring lateral to the inferior epigastric vessels, inguinal canal, superficial inguinal ring, and descend into scrotum; 20x more men; more common on right, processus vaginalis obliterated later, right testis descends later

Direct inguinal hernia

abdominal contents through weak area of posterior wall of inguinal canal medial to inferior epigastric vessels in inguinal triangle, though superficial ring

lesser omentum

epiploic foramen

pouch of douglas

deeper in peritoneal space vertically, pelvic abscess location;
vesicouterine pouch, between uterus and bladder

Foregut

Midgut

Hindgut

Posterior gastric ulcer

may erode to pancreas, causing referred pain, may also erode splenic artery

congenital diaphragmatic hernia

through posterolateral defect in diaphragm. high mortality rate because of left lung hyperplasia

Sliding hiatal hernia

hernia of cardia of stomach into thorax; can damage vagal trunks, causing hyposecretion of gastric juice

Meckel's diverticulum

persistent portion of vitellointestinal duct; asymptomatic but can ulcer; diverticulitis can mimic appendicitis

appendicitis pain

Hirschsprung's disease

common in downs; inadequate motility as a result of aganglionic section (absent of postganglionic parasympathetic neurons, causing megacolon); failure to pass meconium; remove portion to treat.

AA branches

Celiac trunk

passes above superior border of pancreas, splits; left gastric, common hepatic, splenic

left gastric

lesser curvature of stomach; branches to esophageal, gastric, anastomosis with right

common hepatic

superior surface of duodenum, branches into proper hepatic and gastroduodenal

proper hepatic artery

gives off right gastric, reaches porta hepatis, splits into right and left hepatic; right hepatic gives rise to cystic artery;

gastroduodenal

posterior to first part of duodenum, erosion by penetrating ulcer; right gastro epiploic anastamoses with LGEP; superior pancreaticoduodenal arteries (head), anstamoses w/ ipd of SMA

Hepatic artery

collateral circulation through the left and right gastric , gastroepiploic, and gastroduodenal arteries

splenic artery

tortuous horizontal course to the left, is retroperitoneal until the tail of the pancreas, where it enters the splenorenal ligament to enter the hilum of the spleen; branches to the spleen, neck body and tail of pancreas, left GEP, short gastric which supplies the fundus

SMA branches

IMA branches

biliary system

gallbladder lies in a fossa on the visceal surface of the right of quadrate lobe; common bile duct descends in the heptaoduodenal duct, posterior to the first part of the duodenum; forms hepatopancreatic duct/sphincter of oddi at the major duodenal papilla

gallstones

cystic duct obstruction causes biliary colic, does not produce jaundice; stone in the body of the gallbladder may ulcerate into intestine and obstruct at ileocecal jxn

spleen ligaments

kidney location

Right kidney

Left kidney

varicocele

ureter

in women, crossed anteriorly and superiorly by the uterine artery in the broad ligament

PC mets

BPH

median lobe vs posterior

hydrocele

lymph drainage of male viscera

lymph drainage of male viscera