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nbme anatomy shelf|Questions With Correct
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Where and why are lumbar punctures performed? - ✔Spinal Block - > Anesthetic (into epidural space) Spinal Tap - > CSF extraction (into subarachnoid space)W B/W L3/L4 or L4/L NB: Posterior to this is cauda equina Where does a herniated intervertebral disk occur? What causes it? - ✔Occurs b/w L4/L5 or L5/S1 and C5/C6 or C6/C NB: affects lower spinal nerve # Degeneration of annulus fibrosis followed by sudden compression of nucleus pulposus What is the difference b/w retrolisthesis and spondylolisthesis? - ✔Retro - backwards movement of vertebral bone Spondylo - forward movement of bone What is lordosis? - ✔exaggerated Lumbar curvature What is kyphosis? - ✔exaggerated thoracic curvature (can be seen w/osteoporosis) What structures will be affected by a fracture of the surgical neck? - ✔axillary nerve and posterior humeral circumflex artery
What structures will be affected by a fracture at midshaft of humerus? - ✔radial nerve and profunda brachii artery What structures will be affected by a fracture at supracondylar region of humerus? - ✔median nerve and brachial artery What are differences b/w Colles' and Smith's Fractures? - ✔Both are distal radial fractures Smith's - flexion fracture (distal segment anterior) Colles' - extension fracture (distal segment posterior/dorsal) - incl. avulced ulnar styloid process What are the carpal bones? - ✔Some Lovers Try Positions That They Can't Handle Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Which carpal bone is most often fractured during a fall (symptoms)? - ✔Scaphoid "deep tenderness in anatomical snuff box" What is a boxer's fracture? - ✔Fracture of necks of metacarpals What are the 4 muscles of the rotator cuff? - ✔Supraspinatus Infraspinatus Teres Minor Subscapularis
brachial a. median n. What two muscles form borders of cubital fossa? - ✔Pronator Teres (medial) and Brachioradialis (lateral) What are subcutaneous structures of cubital fossa? - ✔From lateral to medial: cephalic v. median cubital v. (connects the two; over bicipital aponeurosis) basilic v. What are causes/symptoms of carpal tunnel syndrome? - ✔Causes: lesion that ↓ size of carpal tunnel (dislocation of lunate bone, fluid retention, infection), repetitive movement Effect: median n. affected
- "pins and needles lateral 3.5 digits"
- palm sensation not affected What causes Upper Brachial Palsy? - ✔AKA Erb-Duchenne Palsy Trauma during fall (head away from shoulder) Pulling arm of child Lesion of C5/C6 or Upper Trunk What results from upper brachial palsy? - ✔Waiter's tip hand
Medially rotated arm Adducted shoulder Extended elbow Loss of sensation in lateral upper limb What are the cause/result of klumpke's paralysis? - ✔a. injury of lower root (C8/T1); "grabbing a tree limb"; thoracic outlet syndrome b. combination lesions of ulnar (claw hand) and median nerve (ape hand) What results from lesion to musculocutaneous nerve? - ✔Cause: lesion of lateral cord Effect: weak elbow flexion (biceps/brachialis) and forearm supination (biceps) What are main innervations of arm? - ✔1. biceps brachii, brachialis, coracobrachialis musculocutaneous n.
- back of arm - radial n.
- forearm muscles (8) - median n. Exception: f. digitorum profundus/f. carpi ulnaris ulnar n. What are the eight flexor muscles of the forearm? - ✔Think 4 - 1 = 3 (superficial to deep)
- FPFP (f. carpi ulnaris, palmaris longis, f. carpi ulnaris, pronator teres)
- F. Digitorum Superficialis
- avascular necrosis of femoral head What is the unhappy triad for knee joint injuries? - ✔Cause: lateral trauma to knee
- Tibial Collateral Ligament
- Medial Meniscus
- Anterior Cruciate Ligament What is the function/structure of the fibular/lateral collateral ligament? - ✔b/w lateral epicondyle of femur/head of fibula does not blend w/joint capsule or attach to lateral meniscus limits extension/adduction of knee What is a sign of ACL rupture? - ✔anterior drawer sign excess forward movement of tibia What is a sign of PCL rupture? - ✔posterior drawer sign excess backward movement of tibia [less common] What does the patellar reflex test? - ✔"knee jerk reflex" both limbs carried by femoral nerve Tests spinal nerves L2 - > L
What structures are injured in a lateral ankle sprain? - ✔"inversion injury" lateral ligament ("anterior talofibular ligament*) is injured severe cases - > fracture of lateral malleolus of fibular bone What structures are injured in a medial ankle sprain? - ✔"eversion injury"; abduction of foot medial ligament injured What does the ankle jerk reflex test? - ✔"achilles tendon reflex" tap calcaneal tendon both limbs carried by tibial nerve tests spinal nerve S1 - > S What causes piriformis syndrome? - ✔inflammation/spasm of piriformis muscle produces pain like that of sciatica Func'n of Piriformis: supination of hip What are cause/effect of injury to sciatic n.? - ✔c: posterior hip dislocation/bad butt injection e: weak hip extension/knee flexion; foot drop or flail foot What causes hip drop? - ✔posterior hip dislocation, surgery, polio
Prevents plantar flexion What is result of lesion to tibial n. in popliteal fossa? - ✔Loss of plantar flexion of foot (triceps surae), weakened inversion (tibialis post. m.) What are effects of fibular neck fracture? - ✔injury to common peroneal n. paralysis of ant/lat compartment muscles (dorsiflexors/evertors) foot drop What is the origin of breast carcinomas? - ✔typically adenocarcinomas - from epithelial cells of lactiferous ducts in mammary glands What causes dimpling of skin in breast cancer? - ✔attachment of cancer to cooper's (suspensory) ligaments What is a common neural complication of radical mastectomy? - ✔Lesion to long thoracic n. - > leads to winged scapula and a difficulty in abducting above the horizontal (paralysis to serratus anterior) loss of sensation to medial arm due to lesion of intercostobrachial nerve (from T2) What are cause/effect of hemiparalysis to diaphragm*? - ✔Ipsilateral lesion to phrenic n. paradoxical mvmnt - dome of injured diaphragm pushed up during inspiration by abdominal viscera instead of down What are effects of mitral valve failure? - ✔Results in left atrial enlargement - > compression of esophagus (dysphagia)
Where is the esophagus constricted? - ✔1. where laryngopharynx meets w/esophagus behind the cricoid cartilage
- crossed in front by left main bronchus and aortic arch
- esophageal hiatus in the diaphragm at T10 What are the areas of auscultation? - ✔a. aortic valve - > 2nd right ICS PSL b. pulmonary valve - > 2nd left ICS PSL c. tricuspid valve - > 4th left ICS PSL d. mitral valve - > 5th left ICS MCL What are sites of auscultation for mitral and aortic murmurs? - ✔a. aortic stenosis (systolic) right 2nd ICS/PSL b. mitral insufficiency (systolic) right 3rd ICS/MAL c. tricuspid insufficiency (systolic) left 5th ICS/PSL d. mitral stenosis/aortic insufficiency (diastolic) right 5th ICS/MCL NB: areas of stenosis are the same as normal auscultation What does right coronary artery supply and what are its branches? - ✔right atrium/ventricle branches: a. anterior cardiac branches - > right atrium b. nodal branch - > SA/AV nodes c. marginal a. - > right ventricle d. post. interventricular a. - > diaphragmatic surface of both ventricles
early metastasis to thoracic lymph nodes persistent, productive cough at apex = pancoast tumour What is open pneumothorax? - ✔pleural cavity open to outside inspiration - air enters chest wall - > mediastinum shifts to opposite side (compress other lung) expiration - air exits wound - > mediastinum shifts back What is innervation of the parietal pleura? - ✔paint, temp, touch, pressure a. costal - > intercostal n. b. mediastinal - > phrenic n. c. diaphragmatic - > phrenic n. (over domes); intercostal n. around periphery What is innervation of visceral pleura? - ✔sensitive to stretch only autonomic nerve supply from pulmonary plexus What organs are in the right upper quadrant? - ✔liver, gallbladder What organs are in the left upper quadrant? - ✔spleen, stomach What organs are in the right lower quadrant? - ✔appendix, cecum What organs are in the left lower quadrant? - ✔descending colon, sigmoid colon
What are the three regions for referred abdominal pain? - ✔a. foregut structures - epigastric b. midgut structures - umbilical c. hindgut structures - hypogastric Which fascia make up layers of abdominal hernias? - ✔innermost - > outermost a. transversalis fascia b. internal oblique fascia c. external oblique fascia Where does the indirect inguinal hernia pass through? - ✔lateral to inferior epigastric vessels congenital deep inguinal ring - > inguinal canal - > superficial inguinal ring - > scrotum Where does the direct inguinal hernia pass through? - ✔medial to inferior epigastric vessels acquired through hesselbach's triangle inguinal canal - > superficial inguinal ring What are the contents of the lesser omentum - ✔portal triad (portal v., bile duct, proper hepatic a.) - hepatoduodenal ligament R./L. Gastric Vessels What two ligaments make up the lesser omentum? - ✔a. hepatogastric b. hepatoduodenal
What will a gastric ulcer of the distal lesser curvature affect? - ✔corrosion of left gastroepiploic a. branch of splenic a. What will be the effect of a penetrating gastric ulcer of the posterior wall? - ✔corrosion of splenic a. What area is affected in a congenital diaphragmatic hernia? - ✔posterolateral How does a sliding hiatal hernia occur? - ✔hernia of stomach cardia through esophageal hiatus (T10) can cause damage to vagal trunk How does meckel's diverticulum develop? - ✔congenital; remember "story of 2's" persistent portion of vitelline duct forming fistula can cause inflammation if contains ectopic, pancreatic, gastric, endometrial tissue Describe first pain of appendicitis? - ✔referred pain around umbilicus afferent fibers to T10 (dermatome) Describe second pain of appendicitis? - ✔sharp, localized pain at mcburney's point occurs when pain shifted to parietal peritoneum What is the cause of hirschsprung's disease? - ✔failure of neural crest cells to migrate congenital absence of parasympathetic postganglionic neurons dilation occurs proximal to affected region
What are branches of aorta (include vertebral level) - ✔Celiac Trunk - T SMA - L Renal A. - L IMA - L Common Iliac A. - L Where does the celiac trunk emerge near? - ✔passes above superior border of pancreas three branches
- left gastric a.
- splenic a.
- common hepatic a. What is the origin of the cystic a.? - ✔right hepatic artery What are branches of gastroduodenal artery? - ✔descends behind 1st part of duodenum branches to form:
- right gastroepiploic a.
- superior pancreaticoduodenal a. What is a complication of cholecystectomy? - ✔mistakenly ligate right hepatic a. leads to right lobe necrosis What is the liver's collateral circulation when hepatic a. is ligated? - ✔left/right gastric a. left/right gastroepiploic a.
leads to obstructive jaundice What forms posterior to the neck of the pancreas? - ✔portal vein What happens when ventral/dorsal pancreatic buds form ring around duodenum? - ✔annular pancreas What ribs must fracture to cause laceration of spleen? - ✔Left 9th/10th ribs What are contents of gastrosplenic ligament? - ✔-connects spleen to upper/greater curvature
- contains short gastric & left gastroepiploic vesels What are contents of splenorenal ligament? - ✔-connects left kidney/spleen
- contains tail of pancreas, splenic vessels, lymph/nerve What are the two main types of kidney stones? - ✔1. calcium oxalate
- calcium phosphate What are staghorn calculi? - ✔renal stones that develop in the calyx gives impression of antlers from magnesium ammonium phosphate (MAP) result from recurrent urinary tract infection Left Renal Vein - > Anterior/Posterior to aorta? - ✔Anterior What causes varicocele? - ✔Engorgement of pampiniform plexus
Leads to left testicular vein What causes internal hemorrhoids? - ✔dilation of tributaries of superior rectal veins (above pectinate line) not painful; visceral afferent fibers What causes external hemorrhoids? - ✔dilation of tributaries of inferior rectal veins (below pectinate line) painful; somatic afferent fibers What are contents of deep perineal pouch? - ✔think "such a deeb bouch"
- sphincter urethrae muscle
- deep transverse perineal muscle
- bulbourethral glands What are contents of superficial perineal pouch? - ✔all muscle (think: irritable bowel syndrome)
- ischocavernosus
- bulbospongiosus
- superficial transverse perineal What facilitates bladder emptying? - ✔a. parasympathetic (pelvic splanchnic n.) (+) detrusor m. contraction and internal sphincter relaxation b. pudendal nerve causes voluntary relaxation of external sphincter What inhibits bladder emptying? - ✔sympathetic fibers (sacral splanchnic n.) inhibit detrusor muscle and stimulate internal sphincter
