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ANATOMY

QuestionAnswer
Intracranial schwannomas are most commonly located at the Cerebropontine angle, between the cerebellum and lateral pons
Adult 1º brain tumors 1) Glioblastoma multiforme 2) Meningioma 3) Hemangioblastoma 4) Schwannoma 5) Oligodendroglioma 6) Pituitary adenoma
Schwannomas arise from CN VIII; Vestibulocochlear (Acoustic neuromas)
The cochlear part of CN VIII mediates Hearing. Compression leads to sensorineural hearing loss and tinnitus (ear ringing).
The vestibular part of CN VIII maintains Balance. Its compression causes vertigo, disequilibrium, and nystagmus.
CN VII involvement leads to Paralysis of the muscles of facial expression, loss of taste in the anterior 2/3 of the tongue, and hyperacusis (paralysis of the stapedius).
Compression of CN V causes Loss of sensation around the mouth and nose, loss of corneal reflex, and paralysis of the muscles of mastication.
Bilateral acoustic neuromas are associated with Neurofibromatosis type 2
Meningiomas are commonly found over the Lateral hemispheric fissure and in the parasagittal aspect of the brain convexity.
On light microscopy, Meningiomas have a Spindle cells concentrically arranged in a whorled pattern; Psammoma bodies (laminated calcifications)
Clinically, meningiomas may manifest with Headache, focal deficit, or seizure.
Meningiomas arise from Arachnoid cells, is extra-axial (external to brain parenchyma), and may have a dural attachment ¨tail
Sensorineural hearing loss, tinnitus, paralysis of facial muscles, and loss of corneal reflex signify the involvement of CN V, VII, and VIII.
Sensorineural hearing loss, tinnitus, paralysis of facial muscles, and loss of corneal reflex signify the involvement of CN V, VII, and VIII. Simultaneous compression of these nerves is caused by tumor of the cerebellopontine angle, most commonly Acoustic neuromas
Most common malignant 1º brain tumor Glioblastoma multiforme (grade IV astrocytoma)
Glioblastoma multiforme (grade IV astrocytoma) are found in Cerebral hemispheres
¨Pseudopalisading¨pleomorphic tumor cells-border central areas of necrosis and hemorrhage Glioblastoma multiforme (grade IV astrocytoma)
Stain astrocytes for GFAP (Glial fibrillary acidic protein)
Can cross corpus callosum ¨butterfly glioma¨ Glioblastoma multiforme (grade IV astrocytoma)
Hemangioblastoma is most often Cerebellar
Hemangioblastoma is associated with von Hippel-Lindau syndrome when found with retinal angiomas
Hemangioblastoma can produce Erythropoietin---> 2º polycythemia
Closely arranged, thin-walled capillaries with minimal interleaving parenchyma Hemangioblastoma
Rare, slow growing adult 1º brain tumor Oligodendroglioma
Oligodendroglioma most often in Frontal lobes
Chicken-wire capillary pattern . Olygodendrocytes= ¨fried egg¨cells- round nuclei with clear cytoplasm Oligodendroglioma
Pituitary adenoma, most commonly Prolactinoma
Pituitary adenoma, produces Bitemporal hemianopia due to pressure on optic chiasm
Sequelae of Pituitary adenoma, Hyper-or hypopituitarism
Schwannomas; TREATMENT Resection or treatment with stereotactic radiosurgery
ONLY nerve that exits the pelvis via the obturator foramen. Obturator (L2-L4)
Obturator (L2-L4) nerve innervates Anterior branch: gracilis, pectineus, and the adductors longus and brevis. Posterior: obturator externus and the adductor magnus. Obturator nerve injury would cause weakness and spasm of the adductor compartment muscles.
Adduction of the thigh Obturator (L2-L4)
Obturator nerve injury would cause Decreased thigh sensation (medial) and adduction
Abduction of the thigh Superior gluteal (L4-S1)
Most important muscle in achieving the increased intraabdominal and intrathoracic pressure of the Valsalva maneuver Rectus abdominis
The parietal pleura lines the inner surface of the chest wall and the diaphragm, and is innervated by Somatic sensory nerves.
Portion of pleura that covers the surface of the lung is called the Visceral pleura
Thoracentesis should be performed Above 7th rib midclavicular line, 9th rib along midaxillary line and 11th rib along posterior scapular line.
If the needle is inserted higher than 9th rib in a Thoracentesis there is a risk of Lung injury. Insertion of the needle below the 9th rib at the middle axillary line on the right may cause liver injury
Insertion of the needle below the 9th rib at the middle axillary line on the right during Thoracentesis may cause Liver injury
Long-term sequelae of hydrocephalus include Lower extremity spasticity due to stretching of the periventricular pyramidal tracts, visual disturbances, and learning disabilities.
Hydrocephalus in infants presents with irritability, poor feeding increased head circumference and enlarged ventricles on CT.
Enlarged ventricles on CT in an infant Hydrocephalus, cause is usually impaired CSF outflow due to congenital abnormalities
The middle ear cavity contains 3 auditory ossicles: malleus, incus and stapes; 2 skeletal muscles: tensor tympani and stapedius
The stapedius muscle is innervated by The stapedius nerve, a branch of facial nerve (CN VII).
Paralysis of the stapedius muscle allows wider oscillation of the stapes, and leads to Increased sensitivity to sound (hyperacusis).
In the inner ear each frequency leads to vibration at specific location on the basilar membrane (tonotopy): LOW: heard at apex near helicotrema (wide and flexible); HIGH: heard best at base of cochlea (thin and rigid)
In the inner ear vibration is transduced via Specialized hair cells-->auditory nerve signaling -->brainstem
Ipsilateral hyperacusis is a common finding in Bell’s palsy (peripheral facial nerve paralysis)
Findings in Bell’s palsy (peripheral facial nerve paralysis) Ipsilateral hyperacusis,inability to close the eye or to smile on the affected side, ipsilateral increased salivation and loss of taste on the anterior 2/3 of the tongue.
Common peroneal (L4-S2) PED= Peroneal Everts and Dorsiflexes; injured, foot dropPED
Tibial (L4-S3) TIP= Tibial Inverts and Plantarflexes; injured, can´t stand on TIPtoes
The common peroneal nerve divides into DEEP= innervates extensor and great dorsiflexors. SUPERFICIAL= peroneal muscles and skin of most of the toes.
The common peroneal nerve is particularly susceptible to damage as it traces the Lateral neck of the fibula
Most commonly injured nerve in the leg due to its superficial location Common peroneal/Fibular (L4-S2)
Most common causes of injuru to Common peroneal (L4-S2) Trauma or compression of lateral aspect of the leg (e.g,casts), fibular neck fracture
Damage to this nerve will result in loss of knee jerk. Femoral (L2-L4)
Innervates the muscles of the anterior and medial thigh Femoral (L2-L4)
Provides motor innervation for the popliteus and the flexors of the foot. Tibial (L4-S3)
Causes of injury of Tibial nerve (L4-S3) Knee trauma, Baker cyst (proximal lesion); tarsal tunnel syndrome (distal lesion, deep penetrating trauma: popliteal fossa
Inability to curl toes and loss of sensation on sole/plantar aspect of foot Lesion tibial nerve (L4-S3
In proximal lesions tibial nerve (L4-S3) lesions Foot everted at rest with loss of inversion and plantar flexion
Provides the majority of the motor and sensory input to the pelvic floor Pudendal nerve
Difficulty climbing stairs, rising from seated position. Nerved injured Inferior gluteal (L5-S2)
Causes of injury to superior gluteal (L4-S1) Posterior hip dislocation, Polio
Pelvis tilts because weight-baring leg cannot maintain alignment of pelvis through hip abduction Trendelenburg sign/gait (Superior gluteal; L4-S1)
Lesion is contralateral to the side of the hip that drops, ipsilateral to extremity on which patient stands Superior gluteal (L4-S1)
Patients with common peroneal nerve damage present with Inverted and plantarflexed foot, loss of eversion and dorsiflexion.¨Steppage gait. Loss of sensation on dorsum of foot
Muscles mediate foot eversion Peroneus longus and peroneus brevis
Muscle mediates dorsiflexion of the foot Tibialis anterior muscle
The classic finding on gait exam in patients with common peroneal nerve injury is ‘toot drop,” affected leg lifted high off of the ground while walking due to an inability to dorsiflex the foot. The affected foot will also classically slap to the ground with each step.
Signs include foot drop and a characteristic high- stepping gait Common peroneal nerve injury
Transduction of mechanical auditory forces into nerve impulses occurs in the organ of Corti by the following steps: 1) Sound reaches middle ear by vibrating tympanic membrane. 2) Vibration transferred to oval window by ossicles-->basilar membrane causes bending of hair cell cilia agains tectorial membrane= nerve impulses from sound
Noise-induced hearing loss results from trauma to the Stereociliated hair cells of the organ of Corti.
Prolonged exposure to extremely loud noises can produce hearing loss due to tympanic membrane rupture. High-frequency hearing is lost first, Noise-induced hearing loss
Rupture of the tympanic membrane causes Conductive hearing loss
The auditory nerve transmits sound impulses to the brainstem via CN VIII (Vestibulocochlear)
The fossa ovalis is located on Right atrial wall
The tricuspid valve separates Right atrium from right ventricle.
The coronary sinus collects blood from the Coronary veins. It is located on the posterior surface of the heart and drains directly into the left atrium
The pulmonic valve is located between Right ventricle and pulmonary artery.
Aortic valve divides Left ventricle and aorta
It´s the remnant of the fetal foramen ovale, a structure that allows right to left shunting of blood in the fetal circulation to bypass the fetal lungs. Fossa ovalis
Puncture of the fossa ovalis is used as a means of gaining access to the Left atrium from the right atrium
There are three types of groin hernias Direct inguinal, indirect inguinal and femoral
Groin hernias that occur ABOVE the inguinal ligament Direct and indirect inguinal hernias
Groin hernias that occur BELOW the inguinal ligament Femoral hernias
Femoral hernias may present with Upper thigh and groin pain.
Femoral hernias protrude through the Femoral canal
Femoral hernias are lateral to and medial to LATERAL: pubic tubercle and lacunar ligament; MEDIAL: femoral vein.
Femoral hernias are more common in Females
Femoral hernias tend to occur on Right side.
As the femoral canal is small, femoral hernias are prone to Incarceration
Transversalis fascia is found between Inner surface of transversalis muscle and the extraperitoneal fat.
Transversalis fascia forms the Posterior wall of the inguinal canal.
A deep inguinal ring is an opening in the transversalis fascia, which is the site of protrusion of Indirect inguinal hernias.
Leading cause of bowel incarceration Femoral hernias
The spermatic cord contains Ductus deferens, cremasteric, testicular arteries, artery of ductus deferens, pampiniform venous plexus, genitourinary nerve, sympathetic and parasympathetic nerves of the spermatic plexus.
Hesselbach triangle Inferior epigastric vessels, lateral border of rectus abdominis and inguinal ligament
Parasagittal meningiomas can cause Contralateral spastic paresis of the leg due to compression of the leg-foot motor area.
The primary mediators of the blood-brain barrier Tight junctions between endothelial cells of CNS capillaries
Tight junctions, also known as zonula occludens, are formed via the interaction of specialized transmembrane proteins with one another, such as Occludens and claudens, on capillary endothelial cells.
The tight junctions between endothelial cells in the capillary beds of the CNS form the Blood-brain barrier
The head of the caudate lies in the Inferolateral wall of the anterior horn of the lateral ventricle
The head of the caudate it´s separated from the globus pallidus and putamen by the Internal capsule
Eye adduction depends on Oculomotor nerve (CN Ill) and the medial rectus muscle
Posterior cranial fossa (C  VII-XII)-through temporal or occipital bone: • Internal auditory meatus (CN VII, VIII) • Jugular foramen (CN IX, X, XI, jugular vein) • Hypoglossal canal (CN XII) • Foramen magnum (spinal roots of CN XI, brain stem, vertebral arteries)
Exit through Cribriform plate CN I
Middle cranial fossa (CN II-VI)-through sphenoid bone: • Optic canal (CN II, ophthalmic artery, central retinal vein) • Superior orbital fissure (CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers) • Foramen Rotundum (C  V2) • Foramen Ovale (CN V3) • Foramen spinosum (middle meningeal artery)
Enter the orbit via the superior orbital fissure The oculomotor nerve (CN Ill), ophthalmic nerve (CN VI) branches, trochlear nerve (CN IV), abducens nerve (CN VI), and superior ophthalmic vein
The prostate is located between the Pubic symphysis and the anal canal
Superior mesenteric artery (SMA) vertebral level L1
Inferior mesenteric artery (IMA) vertebral level L3
Superior mesenteric artery (SMA) supplies Distal duodenum and pancreas to proximal 2/3 of transverse colon
Inferior mesenteric artery (IMA) supplies Distal 1/3 of transverse colon to upper portion rectum; splenic flexure is a watershed region
Celiac artery (T12) supplies Pharynx to proximal duodenum; liver, gallbladder, pancreas, spleen
Bifurcation of abdominal aorta L4
Occurs when the transverse portion (3rd segment) of the duodenum is entrapped between the SMA and aorta causing symptoms of partial intestinal obstruction. Superior mesenteric artery syndrome
What structure is entrapped or obstructed in Superior mesenteric artery syndrome Transverse portion (3rd segment) of the duodenum
Apical lung tumors Pancoast tumors
Pancoast tumors can cause Horner syndrome (ipsilateral ptosis, miosis and anhidrosis) SVC syndrome, arm weakness, arm paresthesias, and hoarseness.
The rotator cuff is made up of the tendons of the following muscles: supraspinatus, infraspinatus, subscapularis, and teres minor
Most commonly affected in rotator cuff syndrome Supraspinatus muscle
Innervation of the tongue Taste: CN VII,IX, X (solitary nucleus) Pain: CN V3, IX, X Motor: CN XII
Motor innervation of the tongue is provided by the Hypoglossal nerve (CN XII)
General sensory innervation of the tongue (including touch pain, pressure, and temperature sensation) is provided by • Anterior 2/3: mandibular branch of trigeminal (CN V3) • Posterior 1/3: glossopharyngeal (CN IX) • Posterior area of the tongue root: vagus nerve (CN X)
Gustatory innervation (taste buds) is as follows: • Anterior 2/3: chorda tympani branch of facial nerve (CN VII) • Posterior 1/3: glossopharyngeal nerve (CN IX) • Posterior area of the tongue root and taste buds of the larynx and upper esophagus: vagus nerve (CN X)
Tongue develops from 1st and 2nd branchial arches: anterior 2/3 3rd and 4th branchial arches: posterior 1/3
Muscles of the tongue are derived from Occipital myotomes
Gustatory innervation of anterior 2/3 of the tongue is provided by Chorda tympani branch of the facial nerve
Composes the majority of the anterior surface of the heart Right ventricle
Makes up most of the heart’s posterior surface Left atrium
A penetrating injury at the left sternal border in the fourth intercostal space would puncture the anterior surface of the heart. Damaging which structure Right ventricle; composes most of the heart’s anterior surface
Is the muscle of the urinary bladder wall Detrusor muscle
The ureters cross Over: external iliac vessels; under: gonadal vessels. Lateral: internal iliac vessels; medial: gonadal vessels
Aspirated or inhaled particles are most likely to become lodged in the Right main bronchus
Right main bronchus is compared to left main bronchus shorter, wider and more vertically oriented
Aspirate a peanut while UPRIGHT LOWER portion of the right inferior lobe
Aspirate a peanut while SUPINE SUPERIOR portion of the right inferior lobe
Fluid-filled site encased in bone that houses the cochlea, the semicircular canals, and the vestibule. Inner ear
At the base of the cochlea, the basilar membrane is thin and rigid and best responds to HIGH frequency sound
The basilar membrane at the apex of the cochlea, near the helicotrema, is large and flexible so it best responds to LOW frequency sounds
LOW frequency heard at Apex near helicotrema (wide and flexible)
HIGH frequency heard at Base of cochlea (thin and rigid)
The parasympathetic innervation of the ovary is derived from the Vagus nerve
The nerves and vessels supplying the ovary are delivered through the Suspensory ligament of the ovary
Structure that runs retroperitoneally, close to gonadal vessels. At risk of injury during ligation of ovarian vessels Ureter
Structures contained in the suspensory ligament of the ovary Ovarian vessels
Components of the broad ligament Mesosalpinx, mesometrium and mesovarium
Female remnants of the gubernaculum (band of fibrous tissue) Ovarian ligament + round ligament of uterus
Male remnants of the gubernaculum (band of fibrous tissue) Anchors testes within scrotum
Male remnants of the processes vaginalis (evagination of peritoneum) Forms tunica vaginalis
Female remnants of the processes vaginalis (evagination of peritoneum) Obliterated
Causes of injury ulnar nerve (C8-T1) Fracture of medial epicondyle of humerus ¨funny bone¨(proximal lesion); fractured hook of hamate ( distal lesion)
Presentation of ulnar nerve (C8-T1) lesion ¨Ulnar claw¨. Radial deviation wrist upon flexion (proximal lesion) Loss flexion wrist and medial fingers, abduction and adduction fingers (interossei), actions medial 2 lumbricals. Loss sensation over medial 1 1/2 fingers including hypothenar eminence.
Loss sensation over medial 1 1/2 fingers including hypothenar eminence. Ulnar nerve (C8-T1) lesion
Wrist bones ¨So Long To Pinky, Here Comes The Thumb¨ Scaphoid; Lunate; Triquetrum; Pisiform; Hamate; Capitate; Trapezoid; Trapezium
Can be palpated in anatomical snuff box Scaphoid
Is the most commonly fractured carpal bone and its prone to avascular necrosis owing to retrograde blood supply Scaphoid
Dislocation of lunate may cause Acute Carpal Tunnel syndrome
A fall on an outstretched hand that damages the hook of hamate can cause Ulnar nerve injury
Entrapment of median nerve; compression--> paresthesia, pain and numbness Carpal Tunnel syndrome
Compression of the ulnar nerve at the wrist or hand, classically seen in cyclists due to pressure from handlebars Guyon´s cannal syndrome
Most commonly fractured carpal bone Scaphoid
Innervates the flexors of the lower leg, the extrinsic digital flexors of the toes, and the skin of the sole of the foot. Tibial nerve (L4-S3)
Taste sensation from the anterior two-thirds of the tongue is mediated by Chorda tympani branch of the facial nerve (CN VII).
Protrusion of the tongue is mediated by motor efferent fibers carried by Hypoglossal nerve (CN XII).
Language deficit; higher-order inability to speak Aphasia
Movement deficit; motor inability to speak Dysarthria
Fluent speech aphasias 1)Wernicke 2)Conduction 3)Transcortical sensory
NON-Fluent speech aphasias 1)Broca 2)Global 3)Transcortical motor 4)Mixed transcortical
Aphasia with INTACT comprehension 1)Broca 2)Conduction 3)Transcortical motor
Aphasia with IMPAIRED comprehension 1)Wernicke 2)Global 3)Transcortical sensory 4)Mixed transcortical
Broca area Inferior frontal gyrus of frontal lobe
Wernicke´s area Superior temporal gyrus of temporal lobe--> auditory association cortex
Poor repetition but fluent speech, intact comprehension. Can be caused by damage to left superior temporal lobe and/or left supramarginal gyrus Conduction aphasia
Aphasia causes word salad Wernicke’s aphasia
Wernicke’s area receives its blood supply from the Middle cerebral artery
When the midshaft of the humerus is fractured, there is significant associated risk of injury to Radial nerve and deep brachial artery
The deep brachial artery and radial nerve course along Posterior aspect of the humerus
Supracondylar fractures are associated with injury to Brachial artery.
Fractures of the humerus midshaft risk injury to these structures Deep brachial artery and radial nerve
As they ascend from pelvis during fetal development, horseshoe kidneys get trapped under Inferior mesenteric artery
Horseshoe kidneys are associated to Turner syndrome
Horseshoe kidneys increase the risk of Ureteropelvic junction obstruction, hydronephrosis, renal stones, and rarely renal cancer (Wilms tumor)
Poles of both kidneys fused, but NORMAL functioning Horseshoe kidneys
Shooting pain down the posterior thigh and leg that typically results from impingement of one of the spinal nerves as it leaves the vertebral column. Sciatica
Compression results specifically in pain purely in the posterior thigh and leg as well as diminution of the ankle jerk reflex. S1 root
Posterior thigh, splits into common peroneal and tibial nerves Sciatic nerve (L4-S3)
Travels in close approximation to the inferior thyroid artery and can be injured in surgical procedures of the anterior neck (e.g. thyroidectomy), resulting in laryngeal muscle paralysis, hoarseness and dyspnea. Recurrent laryngeal nerve
Together these nerves innervate all of the intrinsic muscles of the hand Lower trunk of the brachial plexus carries nerve fibers from the C8-T1 spinal levels that ultimately contribute to the median and ulnar nerves.
Lower trunk C8-T1
Upper trunk C5-C6
Sudden upward stretching on the arm at the shoulder can damage the Lower trunk of the brachial plexus (C8-T1)
Injury to the lower trunk of the brachial plexus would cause Hand weakness
Klumpke palsy Total claw hand; injury to Lower trunk (C8-T1)
Lower trunk of the brachial plexus (C8-T1) causes of injury Infants- upward force on arm during delivery Adults- trauma (e.g, grabbing a tree branch to break a fall)
Improperly fitted crutches can cause Radial nerve injury resulting in weakness of all forearm, wrist and finger flexors (“Wristdrop”).
1st-arch neural crest fails to migrate --> mandibular hypoplasia, facial abnormalities Treacher Collins syndrome
Meckel's cartilage (1st arch) Mandible, Malleus, incus, spheno­ Mandibular ligament
Reichert's cartilage (2nd arch) Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Cartilage: greater horn of hyoid 4th-6th arch derivative
Cartilages: thyroid, cricoid, arytenoids, corniculate, cuneiform 3rd arch derivative
Muscles of Mastication (1st arch derivatives) (temporalis, Masseter, lateral and Medial pterygoids), Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini
Muscles of facial expression (2nd arch derivatives) Stapedius, Stylohyoid, platySma, belly of digastric
Stylopharyngeus (CN IX) innervated by glossopharyngeal nerve is derived from 3rd branchial arch
4th-6th branchial arch muscle derivatives 4th arch: most pharyngeal constrictors; cricothyroid, levator veli palatini 6th arch: all intrinsic muscles of larynx except cricothyroid
CN V2 and V3 chew; derive from 1st branchial arch
CN VII (facial expression) smile 2nd branchial arch
CN IX (stylo­ pharyngeus) swallow stylishly 3rd branchial arch
4th arch: CN X (superior laryngeal branch) simply swallow 6th arch: CN X (recurrent laryngeal branch) speak 4th-6th branchial arches
Persistence of cleft and pouch--> fistula between tonsillar area an lateral neck Congenital pharyngo­ cutaneous fistula
Muscles of Mastication derive from 1st branchial arch
Form posterior 1/3 of tongue Arches 3 and 4
‘bag of worms’ appearance Varicocele
Dilated veins in pampiniform plexus as a result of increased venous pressure Varicocele
Most common cause os scrotal enlargement in adult males Varicocele
Varicocele is most common on Left side; left venous pressure>right venous pressure
LEFT gonadal vein drains into Left renal vein
RIGHT gonadal vein drains into the Inferior vena cava (IVC)
Lymphatic drainage ovaries/testes Para-aortic lymph nodes
Lymphatic drainage distal vagina/vulva/scrotum Superficial inguinal nodes
Lymphatic drainage proximal vagina/uterus Obturador, external iliac and hypogastric nodes
The pleura is divided into segments, as follows: 1. Visceral pleura: cover all surfaces of lungs, including does within the pulmonary fissures. 2. Parietal pleura: remainder not in contact with lungs
Parietal pleura can be subdivided as • Costal: thoracic wall including ribs, sternum, intercostal spaces, costal cartilages, and sides of thoracic vertebrae. • Mediastinal • Diaphragmatic • Cervical: Extends with the apices of the lung into the neck.
The diaphragm is innervated by C3,4 and 5 (phrenic nerve)
Pain from diaphragm can be referred to Shoulder (C5) and the trapezius ridge (C3,4)
The clavicle is anchored laterally to the scapula at the shoulder by two major ligaments: SUPERIORLY: Acromioclavicular; INFERIORLY: Coracoclavicular
At risk of injury during thyroidectomy due to its proximity to the superior thyroid artery and vein External branch of the superior laryngeal nerve
This nerve innervates the cricothyroid muscle External branch of the superior laryngeal nerve
ONLY muscle innervated by the external branch of the superior laryngeal nerve Cricothyroid muscle
Pathway that connects the hypothalamus and the pituitary gland and is responsible for dopamine-dependent prolactin tonic inhibition. Tuberoinfundibular dopaminergic pathway
Pathway primarily involved in regulating behavior Mesolimbic-mesocortical pathway
Hyperactive dopaminergic pathway associated to schizophrenia Mesolimbic-mesocortical pathway
This dopaminergic pathway primarily regulates coordination of VOLUNTARY movements Nigrostriatal system
Degeneration of the substantia nigra thus causes decreased dopamine and subsequent increased acetylcholine; this leads to hyperkinetic disorders such as Parkinsonism
Afferent limb of the light reflex pathway is the optic nerve
Efferent limb of the light reflex pathway is the Parasympathetic fibers of the oculomotor nerve.
On the pupillary light reflex test; When an optic nerve is damaged, light in that eye will cause NEITHER pupil to constrict (the nerve can’t sense the light); however, light in the contralateral eye will cause BOTH pupils to constrict (because the motor function of the iris is conserved).
Pupillary light reflex test Light on either retina--> via CN II-->Pretectal nuclei in midbrain aactivates Edinger-Westphal nuclei--> bilateral pupil contraction (consensual reflex)
Abnormal passive aBduction (valgus stress) MCL injury
Abnormal passive aDduction (varus stress) LCL injury
McMurray test; pain on EXTERNAL rotation MEDIAL meniscus injury
McMurray test; pain on INTERNAL rotation LATERAL meniscus injury
Common injury in contact sports due to LATERAL force applied to a planted leg. Classically consists of damage to ACL+MCL+ medial or lateral meniscus
ACL+MCL+ medial or lateral meniscus injury Unhappy triad
Eesults from an inability of the serratus anterior to hold the medial border and inferior angle of the scapula against the posterior chest wall. Winged scapula (paralysis of serratus anterior muscle due to long thoracic nerve injury)
Patient unable to abduct the arm higher than the horizontal position. Paralysis of serratus anterior muscle due to long thoracic nerve injury
Injury to this nerve causes winging of the scapula and inability to abduct the shoulder past 90 degrees. Long thoracic nerve injury
Most posterior part of the heart Left atrium
Left atrium enlargement can cause Dysphagia (compression esophagus)+ hoarseness (compression recurrent laryngeal nerve)
Blocking this nerve provides anesthesia to the majority of the perineum; used as method of providing anesthesia during childbirth Pudendal nerve block
Gallstone ileus results from the passage of a large gallstone (typically greater than 2.5 cm) through a cholecystenteric fistula into the small bowel where it ultimately causes obstruction at the Ileocecal valve
Cholelithiasis can cause fistula between gallbladder and small intestine, leading to AIR in the biliary tree. Gallstone may obstruct ileocecal valve causing Gallstone ileus
Gas is seen within the gallbladder and biliary tree on abdominal X-ray due to the presence of the fistula Gallstone ileus
Repeated and prolonged kneeling can cause Prepatellar bursitis
Dubbed “housemaid’s knee,” today it is most commonly seen in roofers, carpenters and plumbers. Signs and symptoms of prepatellar bursitis include knee pain, erythema, swelling and inability to knee on the affected side. Prepatellar bursitis
Created by: heidy39