100 Concepts (1-10)

Fertilization occurs in the

ampulla of the uterine tube

Zygote is created when there is

fusion of male and female pronucleotide

What is the order of forms a zygote undertakes in the first few days after fertilization

Morula

Blastocyst

Which part of the blastocyst becomes the embryo

Inner mass

What part of the blastocyst becomes the placenta

Outer mass

Where does the blastocyst normally implant

Within the anterior and posterior walls of the uterus

Where does an ectopic tubal pregnancy usually occur

ampulla of the uterine tube

Where does an ectopic abdominal pregnancy usually occur

Rectouterine (Pouch of Douglass)

Clinical signs of an ectopic pregancy

Bleeding

Abdominal pain

Last menses 60 days ago

Positive pregnancy test

Culdocentesis showing intraperitoneal blood

Major events in the first week of pregnancy

Implantation

Major events in the second week of pregnancy

Forming bilaminar disk

Pregnancy test

What does the embryoblast differentiate into

Epiblast

Hypoblast

What becomes the mouth of the embryo

Pochordal plate

What is hCG

Human chorionic gonadotropin (glycoprotein) produced by syncytiotrophoblast

Function of hCG

Stimulates the production of prgesterone by corpus luteum

When can hCG be assayed in maternal urine

10 days

T/F: hCG is detectable throughout pregnancy

True

Critical events occurring in the 3rd week of pregnancy

Gastrulation

Early development of the nervous and cardiovascular systems

Process that establishes the 3 primary germ layers

Gastrulation

What causes the craniocaudal and lateral body folding of the embryo

Organ system developments

When does the embryo begin to have a distinct human appearance

week 8

What is produced by the ectoderm

Epidermis, hair, nails, tooth enamel

Parotid gland

Mammary glands

Neuroectoderm: All CNS neurons, Retina

Neural Crest: Adrenal medulla, all neual ganglia, Pia & arachnoid mater, endocardial cushions, Aorticopulmonary septum

What is produced by the Mesoderm

Muscles

Dermis of the skin

Bone, cartilage

Blood & lymph vessels

Heart

Adrenal cortex

Spleen, Kidneys, Testes/Ovaries

Dura mater

Notochord:

Nucleus pulposus

What is produced by the endoderm

Epithelium of GI tract

Epithelium of Respiratory system, biliary apparatus, Urinary bladder, urethra, vagina

Liver, pancreas

Submandibular gland

Sublingual gland

Thyroid and parathyroid gland

What does the needle enter in a lumbar puncture

Subarachnoid space

What layer does the needle enter in an epidural to administer anesthesia

Epidural space

What level does the spinal cord end in adults

L2

What level does the spinal cord end in children

L3

The dural sac extends caudally to what level

S2

What level is the needle inserted for a lumbar puncture

L3/L4 or L4/L5

Horizontally: Upper points of iliac crest

Intervertebral disc herniations typically occur at what level

L4/L5 and L5/S1

C5/C6 and C6/C6

History in patients with herniated discs

Back pain that may radiate down to the lower limb

Pain begins after lifting something heavy

In a herniated disc, what nerve is impinged

One below (L4/L5 herniation will compress the L5 nerve root)

What happens to lower limb reflexes in a herniated disc

Decreased on affected side

What level is there a herniated disc if the patellar tendon reflex is diminished

L2/L3 or L3/L4

What level is there a herniated disc if the achilles tendon reflex is diminished

L5/S1

Exaggeration of the thoracic curvature usually due to osteoporosis or IV disc degeneration

Kyphosis

Exaggeration of the lumbar curvature that may be temporary and occurs as a result of pregnancy, spondylolisthesis or potbelly

Lordosis

Complex lateral deviation or torsion, that is caused by poliomyelitits, a log-length discrepancy, or hip disease

Scoliosis

Age related process characterized by a decrease in the density of bone, decreasing its strength and resulting in bones fractures

Osteoporosis

Weakest part of the clavicle

Junction of medial 2/3 and lateral 1/3 of the bone

How does a patient present with a clavicle fracture

Opposite hand supports sagging limb

High risk regions with a clavicle fracture

Subclavian vessels

Trunks of brachial plexus

What do the subclavian vessels and brachial plexus lie posterior to in a clavicular break

Subclavius muscle

Surgical neck fracture of the humerus risks injury to what structures

Axillary nerve

Posterior humeral circumflex artery

Midshaft fracture of the humerus risks injury to what structures

Radial nerve

Profunda brachii artery

Origin of brachialis muscle

Fracture of the supracondylar region of the humerus risks injury to what structures

Median nerve

Brachial artery

Medial epicondyle fracture of the humerus risks injury to what structure

Ulnar nerve

Most common fracture of the forearm after 50

Transverse fracture within the distal 2cm of the radius

Which fracture results from a fall or a blow on the dorsal aspect of the flexed wrist and produces a ventral angulation of the wrist

Smith's fracture

Where are fragments displaced in a Smith's fracture

Anteriorly

Fracture results from forced extension of the hand, usually as a result of trying to ease a fall by outstretching the upper limb

Colle's fracture

"Dinner fork deformity"

Colle's fracture

Where are fragments displaced in a Colle's fracture

Dorsally

What structure is usually avulsed (broken off) in a Colle's fracture along with a fracture of the distal radius

Ulnar styloid process

Fracture occurs as a result of a fall onto the palm wen the hand is abducted

Scaphoid fracture

Pain occurs primarily on the _____ side of the wrist, especailly during wrist extension and abduction in a scaphoid fracture

lateral

in a scaphoid fracture, where is there pain

Snuff box

Which fragment in a scaphoid fracture may undergo avascular necrosis

Proximal

Structures at great risk of injury in a scaphoid fracture

Radial artery

Superficial branch of the radial nerve

Fracture occurs during fistfights where the necks of the metacarpal bones are fractured

Boxer's fracture

Which metacarpal bones are typically fractured in Boxer's fractures of professional boxers

2nd and 3rd

Which metacarpal bones are typically fractured in Boxer's fractures of unskilled boxers

4th and 5th

Deformity results from the DIPJ suddenly being forced into extreme flexion (hyperflexion) when jammed

Mallet or Baseball finger

What structure is avulsed in a mallet or baseball finger

Extensor digitorum tendon at the base of the distal phalanx

Most frequently dislocated large joint

Glenohumeral joint with an anterior dislocation

The rotator cuff reinforces the glenohumeral joint on all sides except

inferior

What structures attach to the greater tubercle of the humerus

Supraspinatus

Infraspinatus

Teres Minor

What structure attaches to the lesser tubercle of the humerus

Subscapularis

Function of the rotator cuff muscles

Supraspinatus = Abduction

Infraspinatus = Supination

Teres Minor = Supination

Subscapularis = Pronation

Abduction of the upper extremity from 0-15˚ is initiated by what muscle and nerve

Supraspinatus muscle

Suprascapular nerve

Abduction of the upper limb from 15-110˚ is due to action of what muscle and nerve

Deltoid muscle

Axillary nerve

Abduction of the upper limb from 110-180˚ is due to action of what muscle and nerve

Trapezius muscle (CN 11)

Serratus anterior (long thoracic nerve)

What causes subacromial bursitis

Calcific supraspinatus tendinitis

Differential for subacromial bursitis

Supraspinatus tendon tear

"Student's elbow" is another name for

Subcutaneous olecranon bursitis

The triceps tendon attaches distally to

Olecranon

What cushions the olecranon from the skin

Olecranon bursa

"Pulled elbow" is also known as

Dislocation of the head of the radius

In adults, the head of the radius is not dislocated without tearing

Anular ligament

In young children, dislocation of the head of the radius can occur due to

Sudden traction on an extended forearm

"Tennis elbow" is also known as

Lateral epicondylitis

Lateral epicondylitis is due to

Repeated forceful flexion and extension of the wrist resulting strain attachment of common extensor tendon and inflammation of periosteum of lateral epicondle

Where is there pain in tennis elbow (lateral epicondylitis)

Lateral epicondyle radiating down posterior aspect of forearm

In tennis elbow (lateral epicondylitis) Origins of what muscles may be affected

Extensor carpi radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

"Golfer's elbow" is also known as

Medial epicondylitis

What is affected in medial epicondylitis

Flexor tendon of the wrist where it originates

Origins of what muscles may be affected in Golfer's elbow

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Blockage of the subclavian or axillary artery can be bypassed by anastomoses between branches of

Thyrocervical trunk superiorly (transverse cervical and suprascapular)

Subscapular arteries inferiorly (thoracodorsal and circumflex scapular)

Sites of venous puncture usually occur at what vein in the arm

Median cubital

Contents of the cubital fossa from lateral to medial

Biceps brachii tendon

Brahial artery

Median nerve

Subcutaneous structures of the cubital fossa from lateral to medial

Cephalic vein

Medial cubital vein

Basilic vein

Carpal tunnel syndrome is caused by

Lesion reducing the size of the carpal tunnel either from fluid retention, infection, or dislocation of the LUNATE bone)

Most sensitive structure in the carpal tunnel and is most affected

Median nerve

Clinical manifestation of carpal tunnel syndrome

Pins and needles/anesthesia of lateral 3.5 digits (Hand of Benediction)

Palm sensation intact

Apehand deformity

Why is the palm not affected in carpal tunnel syndrome

Superficial palmar cutaneous branch passes superficially to the carpal tunnel

What causes ape hand deformity

Absent of opposition due to median nerve being impinged, inability to use the thumb resulting in palmar pad atrophy