Professional Documents
Culture Documents
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Preface
Dr. Mavrych
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ACKNOWLEDGEMENT
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CONTENTS
BLOCK 1: conceptions 1-20
BLOCK 2: conceptions 21-52
BLOCK 3: conceptions 53-100
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2. Herniated IV disc
Herniation of disc usually occurs in
lumbar (L4/L5 or L5/S1) or cervical
regions (C5/C6 or C6/C7) of individuals
younger than age 50.
Patients typically have history of back
pain that may radiate down to the lower
limb. The pain begins soon after patient
lifted some heavy thing.
Herniated lumbar disc usually
compresses the nerve root one number
below: traversing root (e.g., the
herniation L4/L5 will compress L5 root).
Lower limb reflexes are decreased on the
affected side:
Patellar tendon reflex - herniation of IV
discs L2/L3 or L3/L4
Achilles tendon reflex - herniation of
L5/S1
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Kyphosis is an exaggeration of
the thoracic curvature that may
occur in elderly persons as a result
of osteoporosis (multiply
compression fracture of vertebral
bodies) or disk degeneration.
Lordosis is an exaggeration of the
lumbar curvature that may be
temporary and occurs as a result
of pregnancy, spondylolisthesis
or potbelly.
Scoliosis is a complex lateral
deviation, or torsion, that is
caused by poliomyelitis, a leglength discrepancy, or hip disease.
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Scaphoid fracture
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Boxers fracture
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Right humerus
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Tennis elbow
(Lateral epicondylitis)
1.
2.
3.
4.
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Golfers elbow
(Medial epicondylitis)
1.
2.
3.
4.
Medial epicondylitis is
inflammation of the common
flexor tendon of the wrist
where it originates on the
medial epicondyle of the
humerus.
Origins of following muscles
may be affected:
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris
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8. Arterial anastomoses
around the scapula
Blockage of the
Subclavian or Axillary
artery can be bypassed
by anastomoses
between branches of
the Thyrocervical and
Subscapular arteries:
Transverse cervical
Suprascapular
Subscapular
Circumflex scapular
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9. Cubital fossa
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PIP FDS
DID - FDP
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adducted shoulder
extended elbow
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Injury to musculocutaneous
nerve
May be accompanied by
anesthesia over lateral
aspect of forearm
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Cutaneous innervation
reality, in case of superficial branch of
of the hand Inradial
nerve lesion it will be skin deficit
between 1 & 2 digits on the dorsum of the
hand ONLY because of nerve overlapping
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A common fracture in
elderly women with
osteoporosis is fracture of
the femoral neck.
Fractures of the femoral
neck cause shortness and
lateral rotation of the lower
limb.
Fractures of the femoral
neck often disrupt the blood
supply to the head of the
femur.
At present time the best way
in case of femoral neck
fracture is hip replacement.
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Avascular necrosis
of femoral head
Transcervical fracture
disrupts blood supply to
the head of the femur via
retinacular arteries (from
medial circumflex femoral
artery) and may cause
avascular necrosis of the
femoral head if blood
supply through the ligament
to the head is inadequate.
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Weakened hip
extension and knee
flexion
Footdrop (lack of
dorsiflexion)
Flail foot (lack of
both dorsiflexion and
plantar flexion)
Cause of injury:
caused by
improperly placed
gluteal injections
but may result from
posterior hip
dislocation
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Right
superior
gluteal nerve
injury
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Hamstrings muscles:
1. Biceps femoris
2. Semitendinosus
3. Semimembranosus
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From lateral to
medial side:
Iliopsoas muscle
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
Femoral hernia
Inguinal lig.
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1.
2.
3.
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Potts fracture
It is fracture-dislocations of
the ankle joint
Reason - forced eversion
(abduction) of the foot
The Deltoid ligament
avulses the medial
malleolus and after that
fibula fractures at a
higher level
Pott's fracture
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Plantar Fasciitis
(calcaneal spur)
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21. Breast
Carcinoma of the Breast
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Carcinomas of the
breast are malignant
tumors, usually
adenocarcinomas
arising from the
epithelial cells of the
lactiferous ducts in the
mammary gland
lobules
1. It enlarges, attaches
to suspensory
(Coopers) ligaments,
and produces
shortening of the
ligaments, causing
depression or dimpling
of the overlying skin.
75%
25%
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It is important because
of its role in the
metastasis of cancer
cells.
Most lymph (> 75%),
especially from the
lateral breast
quadrants, drains to
the axillary lymph
nodes, initially to the
anterior (pectoral)
nodes for the most
part.
Most of the remaining
lymph, particularly from
the medial breast
quadrants, drains to the
parasternal lymph
nodes or to the
opposite breast.
Mastectomy
Radical mastectomy, a more extensive surgical
procedure, involves removal of the breast, pectoral
muscles, fat, fascia, and as many lymph nodes as
possible in the axilla and pectoral region.
1. During a radical mastectomy, the long thoracic
nerve may be lesioned during ligation of the lateral
thoracic artery. A few weeks after surgery, the
female may present with a winged scapula and
weakness in abduction of the arm above 90
because serratus anterior m. paralysis.
2. The intercostobrachial nerve may also be
damaged during mastectomy, resulting in skin
deficit of the medial arm.
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Breast infection
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Most vulnerable
structures intercostal
nerve and posterior
intercostal artery
because they are not
covering by ribs.
Diaphragm
Paralysis of half and ruptures
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Phrenic nerve
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Diaphragmatic ruptures
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P-A projection
Cardiac Shadow
Right border is formed by:
1. SVC,
2. Right atrium
Left border is formed by:
1. Aortic arch
2. Pulmonary trunk
3. Left auricle
4. Left ventricle
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Left 2 ICS
PSL
Left 5 ICS
PSL
Left 5 ICS
MCL
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8%
90%
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SA node RCA
AV node RCA
AV bundle (and
moderator band)- LCA
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Ventricular Septal
Defect (VSD)
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28. Bronchopulmonary
segments
Aspiration of foreign bodies
Aspiration of Foreign Bodies:
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Right lung:
10 bronchopulmonary segments
Superior lobe:
1. Apical
2. Anterior
3. Posterior
Middle lobe:
4. Lateral
5. Medial
Inferior lobe:
6. Superior
7. Anterior basal
8. Posterior basal
9. Lateral basal
10. Medial basal
1
3
2
6
4
5
8
10
9
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Left lung:
9 bronchopulmonary segments
Superior lobe:
1. Apicoposterior
2. Anterior
3. Superior lingular
4. Inferior lingular
Inferior lobe:
5. Superior
6. Anterior basal
7. Posterior basal
8. Lateral basal
9. Medial basal
1
2
5
9
6
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Pneumonia is an inflammation
of the lung, caused by an
infection or chemical injury to the
lungs.
Three common causes are
bacteria, viruses and fungi.
Symptoms: cough, chest pain,
fever, and difficulty in breathing.
Chest x-rays: areas of opacity
(seen as white) of the lung
parenchyma and enlargement of
bronchomediastinal lymph
nodes (mediastinal widening).
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Bronchogenic Carcinoma
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Bronchogenic carcinoma
may lead to:
1
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Bronchogenic carcinoma
may lead to:
3. Superior vena cava
syndrome, which causes
dilation of the head and
neck veins, facial swelling,
and cyanosis
4. Dysphagia as a result of
esophageal obstruction
5. Hoarseness as a result of
recurrent laryngeal nerve
involvement
6. Paralysis of the
diaphragm as a result of
phrenic nerve involvement
3
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Qs about Auscultation
and penetrated wounds
4
6
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2. Costodiaphragmatic Recess is
deepest place in pleural cavity, around
the chest wall, there are two rib
interspaces separating the inferior
limit of parietal pleural reflections from
the inferior border of the lungs and
visceral pleura:
Midclavicular line - between ribs 6-8
Midaxillary line - between ribs 8-10
Paravertebral line between ribs 10-12
1.
2.
3.
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31. Mediastinum
Superior mediastinum
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Improperly done
sternal puncture
may affect
structures related
to the posterior
surface of the
manubrium
sternum:
In upper part
Left
brachiocephalic
vein
In lower part
Aortic arch
Thoracic duct
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33. Herniations
Hernia consist of 3 parts:
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Posteriorly: IVC
Superiorly: Caudate
lobe of the liver.
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Rectouterine pouch
(pouch of Douglas):
deeper point of
peritoneal space in
vertical position of the
female body between the
rectum and the cervix of
uterus.
It is space of the pelvic
abscess location.
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Culdocentesis
Culdocentesis is
aspiration of fluid from
the cul-de-sac of
Douglas (rectouterine
pouch) by a needle
puncture of the
posterior vaginal
fornix near the midline
between the uterosacral
ligaments
Because the
rectouterine pouch is
the lowest portion of
the female peritoneal
cavity, it can collect
inflammatory fluid
(pelvic abscess).
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Esophagus
Stomach
Duodenum (1st and
2nd parts)
Liver
Pancreas
Biliary apparatus
Gallbladder
MIDGUT
HINDGUT
Transverse colon
(distal 1/3)
Descending colon
Sigmoid colon
Rectum (anal canal
above pectinate line)
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FOREGUT
MIDGUT
HINDGUT
Artery: CA
Artery: SMA
Artery: IMA
Parasympathetic
innervation:
Preganglionic: vagus
nerves, CNX
Postganglionic:
Terminal gg.
Parasympathetic
innervation:
Preganglionic: vagus
nerves, CNX
Postganglionic:
Terminal gg.
Parasympathetic
innervation:
Preganglionic: pelvic
splanchnic nerves, S2-S4
Postganglionic:
Terminal gg.
Sympathetic
innervation:
Preganglionic: greater
splanchnic nn., T5-T9
Postganglionic:
celiac ganglion
Sympathetic
innervation:
Preganglionic: lesser
splanchnic nn., T10-T11
Postganglionic:
superior mesenteric
ganglion
Sympathetic
innervation:
Preganglionic: lumbar
splanchnic nn., L1-L2
Postganglionic: inferior
mesenteric ganglion
Sensory Innervation:
DRG T5-T9
Sensory Innervation:
DRG T10-T11
Sensory Innervation:
DRG L1-L2
Referred Pain:
Epigastrium
Referred Pain:
Umbilical
Referred Pain:
Hypogastrium
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Hernia of stomach or
intestine through a
posterolateral defect
in diaphragm
(foramen of
Bochadalek).
It is seen in infants
and the mortality rate is
high because of left
lung hypoplasia.
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Appendices epiploic
Sacculations
(haustrations)
Taeniae coli
The taeniae coli meet
together at the base of
the appendix where they
form a complete
longitudinal muscle coat
for the appendix.
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Colon
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Mc Burney's point
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It is a point at the
junction between the
lateral 1/3 and
medial 2/3 of a line
joining the right
anterior superior iliac
spine with the
umbilicus.
42. Volvulus
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3
2
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2
1
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4
3
1
2
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Gastroduodenal artery
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Splenic artery
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Splenic artery
Splenic (1) a. is retroperitoneal
5
until it reaches the tail of the
pancreas, where it enters the
2
splenorenal ligament to enter
the hilum of the spleen.
4 Branches:
Branches to the spleen (2)
Branches to the neck, body, and
tail of pancreas (3)
Left gastroepiploic (4) artery that
supplies the left side of the
greater curvature of the stomach
where it anastomoses the right
gastroepiploic
Short gastric (5) branches that
supply fundus of the stomach
1
3
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6
2
SMA
branches
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(1) Inferior
pancreaticoduodenal
arteries
(2)Jejunal and
(3)
Ileal branches
(4) Ileocolic artery
Ascending branch
Anterior cecal artery
Posterior cecal artery
(5) Appendicular
artery
(6) Right colic artery
(7) Middle colic artery
IMA Branches:
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Mesenteric ischemia
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Biliary system
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Cholelithiasis (gallstones)
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Gallstones
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Portal hypertension is a
common clinical condition, and
for this reason portal-systemic
anastomoses should be
remembered.
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Esophageal anastomosis
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Umbilical anastomosis
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Rectal anastomosis
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48. Pancreas
Head and uncinate process
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Pancreatic adenocarcinoma
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Posterior to the
neck of the
pancreas is the site
of formation of the
PORTAL VEIN.
(1)Splenic vein
joins with (2)
superior
mesenteric vein to
form (3) portal vein.
3
1
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1
3
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3
1
2
(1) Superior
pancreaticoduodenal arteries branches of gastroduodenal
artery.
(2) Inferior pancreaticoduodenal
arteries - branches of SMA
This region is important for
collateral circulation because
there are anastomoses between
these branches of the CA and
SMA.
pancreas:
Pancreatic branches of the (3)
Splenic artery.
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Annular Pancreas
1.
2.
3.
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49. Spleen
Rapture of the Spleen
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50. Kidneys
Dimensions and position
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Perinephric abscess
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51. Nephrolithiasis
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3 constrictions of ureter
1
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Staghorn calculi
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3
2
1
4
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53. Varicocele
It is enlargement of the
pampiniform plexus that
produces a wormlike scrotal
mass and enlargement of the
spermatic cord. Varicocele
may be reason of low sperm
count.
Varicocele formation is usually
on the left side and may
disappear in supine position
of the body.
Varicocele may indicate
kidney disease or may signal
a retro peritoneal malignancy
obstructing the testicular
vein.
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Pampiniform plexus
the left.
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54. Hydrocele
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55. Hemorrhoids
Venous drainage from rectum
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External hemorrhoids
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Internal hemorrhoids
2
2
2
2. Internal hemorrhoids
are dilated tributaries of the
superior rectal veins
(SRV) ABOVE THE
PECTINATE LINE and are
not painful because the
mucosa is supplied by
visceral afferent fibers.
Internal hemorrhoids
frequently develop in
chronic alcoholics
because of liver cirrhosis
and portal hypertension
syndrome.
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Urine leaks
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3
1
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58. Cystocele
(hernia of bladder)
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M
A
P
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Prostatectomy
1
2
3
Transurethral
resection of the
prostate = TURP
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1
2
1. Internal urethral
sphincter is made of
smooth muscles in the
neck of the bladder
and has sympathetic
innervation
2. External urethral
sphincter has skeletal
muscle fibers and
surrounds the
membranous part of
urethra, supplied by
the perineal branch of
the pudendal nerve
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1
2
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Micturition reflex
Facilitating emptying:
Parasympathetic fibers (pelvic
splanchnic nn.) stimulate
DETRUSOR MUSCLE [1]
contraction and involuntary relax
internal sphincter [2].
Somatic motor fibers (pudendal
nerve) cause voluntary
relaxation of external [3] urethral
sphincter.
Inhibiting emptying:
Sympathetic fibers (sacral
splanchnic nn.) inhibit detrusor
muscle [1] and stimulate
internal sphincter [2].
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66. Cryptorchism
Undescended testes
(cryptorchism) when the testes
fail to descend into the scrotum.
This normally occurs within 3
months after birth.
The undescended testes may be
found in the abdominal cavity or
in the inguinal canal.
If neglected, malignant
transformation may occur in the
undescended testis.
Note: In case of cryptorchism,
spermatogenesis is arrested
and the spermatogenic tissue is
damaged leading to permanent
sterility in bilateral cases.
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Hysterectomy
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Uterine part
Isthmus
Medial continuation of
infundibulum comprising
about half of uterine tube
Usual site of fertilization
Infundibulum
Ampulla
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Funnel-shaped expansion
of lateral end, fringed with
fimbriae
Overlies ovary and
receives oocyte at
ovulation
Hysterosalpingography
4
2
1
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The instillation of
viscous iodine
through the
external os [1] of
the uterine cervix
allows the lumen of
the cervical canal
[2], the uterine
cavity [3], and the
different parts of
the uterine tubes
[4] to be visualized
on X-ray.
Posterior Division
1. Obturator
1. Iliolumbar
2. Umbilical
2. Lateral sacral
3 Inferior gluteal
3. Superior gluteal
4. Internal pudendal
5. Inferior vesical (males)
or
Vaginal (females)
6. Middle rectal
7. Uterine (females)
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Septicemia leads to
meningitis and cavernous
sinus thrombosis, both of
which can cause neurological
damage and are lifethreatening.
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Infraorbital
foramen
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Manifestations:
unable to close lips and eyelids on affected side
eye on affected side is not lubricated (dry eye)
unable to whistle, blow a wind instrument, or chew effectively
facial distortion due to contractions of unopposed contralateral facial
muscles
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80. Epistaxis
Epistaxis (nosebleed)
most often occurs from
the anterior nasal septum
(Kiesselbach's area),
where branches of the
sphenopalatine,
anterior ethmoidal,
greater palatine, and
superior labial (from
facial) arteries converge.
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81. Sinusitis
Sphenoiditis
Relationships of the
sphenoidal sinus are clinically
important ; because of potential
injury during pituitary
surgery and the possible
spread of infection.
Infection can reach the sinuses
through their ostia from the
nasal cavity or through their
floor from the nasopharynx.
Infection may erode the walls to
reach the cavernous sinuses,
pituitary gland, optic nerves,
or optic chiasma
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Ethmoiditis
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83. Cheeks
1
2
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All 4 muscles of
mastication are
innervated by V3:
1. Temporalis
elevation &
retraction
2. Masseter elevation
3. Medial
pterygoid elevation
4. Lateral
pterygoid protrusion
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Tonsillitis
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3.
4.
5.
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Muscle
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
Levator pulpebra superior
Action
Elevates and adducts
pupil
Depresses and adducts
pupil
Adducts pupil
Abducts pupil
Depresses and abducts
pupil
Elevates and abducts
pupil
Elevates upper eyelid
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Innervation
CN III
CN III
CN III
CN VI
CN IV
CN III
CN III
92. Strabismus
Oculomotor nerve palsy (CNIII)
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1
3
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Anterolateral
infrahyoid muscles
Posterolateral
COMMON CAROTID
ARTERY [1]
Medial larynx,
TRACHEA [2],
pharynx, esophagus,
cricothyroid muscle,
recurrent laryngeal
nerve [3]
Posterior
parathyroid glands
[4]
CS of the neck
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96. Larynx
3
1
2
1
2
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97. Cricothyrotomy
A cricothyrotomy is an emergency
procedure that relieves an airway
obstruction (e.g. swallowed foreign
bodies or abnormal tissue growths).
A hollow needle is inserted into the
midline of the neck, just below the
thyroid cartilage (needle
cricothyrotomy).
More frequently, a small incision is made
in the skin over the Cricothyroid
membrane, and another one is made
through the membrane between the
cricoid and thyroid cartilage. A tube
that enables breathing is inserted through
the incision.
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CN XI
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GOOD LUCK !
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