HIGH YIELD ANATOMY FOR COMLEX PREPARATION

BACK:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Exaggerated over-curvature of thoracic area of vertebral column Lateral deviation of vertebral column Major feature of cervical vertebrae Structure which regionally determines vertebral movement Vertebra located at level of iliac crest Ligament that connects internal surface of laminae of vertebrae Ligament that checks hyperextension of vertebral column Ligament affected by whiplash injury Ligament which limits skull rotation Defective portion of vertebra with spondylolisthesis in cervical area Defective portion of vertebra with spondylolisthesis in lumbar area Common direction of all superior articular facets of vertebrae Structure in contact with posterior surface of dens Kyphosis Scoliosis Transverse foramina Facet joints L4 Ligamentum flavum Anterior longitudinal Anterior longitudinal Alar Pedicle Pars interarticularis, Lamina Posterior Transverse ligament of atlas (part of cruciate) 14. 15. 16. 17. 18. 19. 20. 21. 22. Most commonly herniated intervertebral disc Most common nerve compressed with herniated intervertebral disc Spinal nerve affected by protrusion of the disc between C5/6 Spinal nerve affected with herniated disc at L3/L4 Thoracic intercostal space located deep to triangle of auscultation Vertebral level of lumbar puncture Muscles which extend and side-bend the spine Muscles which extend, ROTATE, and side-bend the spine Innervation of suboccipital muscles L4-5 L5 C6 L4 sixth L4 Erector spinae Transversospinae Suboccipital nerve (Dorsal ramus C1) 23. 24. Roof of suboccipital triangle Floor of suboccipital triangle Semispinalis capitis Posterior arch of atlas; posterior atlanto-occipital membrane 25. 26. 27. 28. 29. Major vessel within suboccipital triangle Synonym for dorsal ramus of C2 Inferior extent of dura-arachnoid sac Inferior extent of spinal cord Location of internal vertebral plexus Vertebral artery Greater occipital nerve SV2 LV2 Epidural space

UPPER LIMB:
30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. Most frequently fractured bone of body Most frequently dislocated carpal bone Most frequently fractured carpal bone Osseous structure palpated deep to anatomical snuff box Fracture of distal radius that produces dinner fork appearance Nerve injured with fracture of surgical neck of humerus Nerve injured with fracture of shaft of humerus Nerve injured that results in wrist drop Nerve injured with fracture of medial humeral epicondyle Muscle that is the chief flexor and chief extensor at shoulder joint Muscles innervated by axillary nerve Muscle that initiates abduction of arm Most commonly torn tendon of rotator cuff Two muscles that rotate scapula for full abduction of arm Tendon that courses through shoulder joint Chief supinator muscle of hand Primary (major) flexor of the forearm Orientation of structures located in the cubital fossa-Lateral to Medial Clavicle Lunate Scaphoid Scaphoid Colles fracture Axillary Radial Radial Ulnar Deltoid Deltoid and teres minor Supraspinatus Supraspinatus Trapezius and serratus anterior Long head of biceps Biceps brachii Brachialis Tendon biceps brachii, brachial a., median n. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. Injury to what nerve causes winged scapula Spinal levels of axillary nerve Spinal levels of innervation to muscles of the hand Dermatome of thumb Nerve to thenar compartment Innervation of adductor pollicis Innervation to all interosseous muscles Innervation to nail bed of middle finger Innervation to nail bed of ring finger Region affected by upper trunk injury of brachial plexus (C5-C6) Region affected by lower trunk injury of brachial plexus (C8-T1) Nerve compressed with carpal tunnel syndrome Nerve affected by cubital tunnel syndrome Paralysis of which muscles results in total claw hand Long thoracic nerve C5 and C6 C8 and T1 C6 Recurrent branch of Median Ulnar (deep br.) Ulnar (deep br.) Median nerve Ulnar and median Shoulder Intrinsic hand muscles Median Ulnar Lumbricals

LOWER LIMB:
62. Boundaries of femoral triangle Inguinal ligament, sartorius adductor longus 63. 64. 65. 66. 67. 68. Structure immediately lateral to femoral sheath Structure immediately medial to femoral artery in femoral sheath Contents of femoral canal Medial boundary of femoral ring Structures that course throughout entire length of adductor canal Structures that course through only portion of adductor canal Femoral nerve Femoral vein Deep inguinal lymph nodes Lacunar ligament Femoral artery and vein Saphenous nerve, nerve to vastus medialis, descending genicular vessels 69. 70. 71. 72. 73. 74. 75. 76. Muscle that forms floor of popliteal fossa Muscle that is chief flexor at hip joint Muscle that prevents pelvis from tilting when walking Nerve affected when pelvis tilts to unsupported side during gait Muscles which extend the thigh and flex the leg Muscle that extends leg Specific muscle that holds patella in place First portion of quadriceps femoris to atrophy with injury to femoral nerve 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. Last portion of quadriceps femoris to recover following injury Muscle that unlocks knee joint Muscle affected with foot slap Major spinal cord level of nerve affected causing foot slap Chief invertors of foot Chief evertors of foot Ligament that checks backward displacement of femur on tibia Ligament laxity with positive valgus maneuver Most commonly injured ankle ligament Ligament stretched with flat foot Joints for movements of inversion and eversion Major artery to head of femur in adult Nerve affected with fracture of head and neck of fibula Tendon affected with avulsion fracture of 5th metatarsal Innervation of adductor magnus Nerve affected with tarsal tunnel syndrome
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Popliteus Iliopsoas Gluteus medius Superior gluteal n. Hamstrings Quadriceps femoris Vastus medialis Vastus medialis

Vastus medialis Popliteus Tibialis anterior L4 Tibialis anterior and posterior Fibularis longus and brevis Anterior cruciate Medial collateral Anterior talofibular Plantar calcaneonavicular (spring) Subtalar and transverse Tarsal Medial femoral circumflex Common fibular Fibularis brevis Obturator, tibial portion of Sciatic Tibial

93. 94. 95. 96. 97. 98. 99.

Cutaneous innervation to medial side of foot Cutaneous innervation to lateral side of foot Cutaneous innervation of heel Cutaneous innervation to dorsal aspect of web between toes 1 and 2 Cutaneous innervation of most of dorsum of foot Major dermatome to big toe Dermatome to small toe

Saphenous (L4) Sural (S1) Tibial Deep fibular Superficial fibular L4 S1 L4 S1 Meniscus injury Medial collateral, medial meniscus and anterior cruciate ligament

100. Spinal level of patellar reflex 101. Spinal level of Achilles reflex 102. Locking of knee when walking suggests 103. Major injury triad with lateral impact to knee

THORAX:
104. Dermatome around nipple 105. Vertebral level at inferior angle of scapula 106. Structure that lies immediately posterior to manubrium 107. Vertebral level associated with sternal angle 108. Rib paralleled by horizontal fissure of right lung 109. Inferior extent of lung at mid-clavicular line 110. Inferior extent of pleura at mid-clavicular line 111. Inferior extent of lung at mid-axillary line 112. Inferior extent of pleura at mid-axillary line 113. Inferior extent of lung posteriorly 114. Inferior extent of pleura posteriorly 115. Innervation of costal pleura 116. Innervation of mediastinal pleura 117. Level where ascending aorta is continuous with arch of aorta 118. Level where arch of aorta is continuous with descending aorta 119. Effect of sympathetic nerves on lungs 120. Effect of parasympathetic nerves on lungs 121. Rationale for aspirated small objects to go to right primary bronchus T4 TV7 Thymus Disc between TV4-5 4th 6th rib 8th rib 8th rib 10th rib 10th rib 12th rib Intercostal nerve Phrenic nerve TV4-5 TV4-5 Bronchodilation, Vasoconstriction Bronchoconstriction, Vasodilation Wider diameter, shorter and more vertical 122. Needle location for therapeutic pleural tapping 123. Name given to portion of right ventricle prior to beginning of pulmonary trunk
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Superior to 12th rib, posteriorly conus arteriosum or infundibulum

124. Site for auscultation of pulmonary valve 125. Site for auscultation of aortic valve 126. Site for auscultation of tricuspid valve 127. Site for auscultation of mitral valve 128. Heart chamber with greatest sternocostal projection 129. Chamber that forms apex of heart 130. Major chamber that forms base of heart 131. Heart chamber that contains moderator band 132. Ridge located between sinus venarum and right ventricle

Left 2nd interspace Right 2nd interspace Xiphisternal joint Left 5th interspace, mid-clavicular line Right ventricle Left ventricle Left atrium Right ventricle Cristae terminalis at the root of the SVC

133. Artery that determines coronary dominance 134. Usual origin of SA and AV nodal arteries 135. Location of SA node 136. Major vessel that drains the musculature of the heart 137. Innervation of fibrous pericardium 138. Most common cause of systolic ejection murmur 139. Rib associated with sternal angle 140. Location of ductus arteriosus

Posterior interventricular Right coronary artery Cristae terminalis Coronary sinus Phrenic nerve Aortic stenosis Second rib Between left pulmonary artery and aorta

141. Nerve potentially injured with repair of patent ductus arteriosus 142. Veins that unite to form brachiocephalic 143. Veins that unite to form superior vena cava 144. Termination of azygos vein 145. Structures that lie to right and left of thoracic duct 146. Spinal levels of greater splanchnic nerve 147. Spinal levels of lesser splanchnic nerve 148. Spinal levels of least splanchnic nerve 149. Thoracic structures that can compress the esophagus 150. Disease often associated with thymoma

Left recurrent laryngeal nerve Subclavian and internal jugular Right and left brachiocephalic Superior vena cava Azygos vein, aorta T5-9 T10-11 T12 Left bronchus, aorta and diaphragm Myasthenia gravis

ABDOMEN:
151. Dermatome to umbilical area 152. Dermatome to suprapubic area 153. Vertebral level associated with origin of celiac artery 154. Vertebral level associated with origin of SMA 155. Vertebral level associated with origin of renal arteries
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T10 L1 T12 L1 L2

156. Vertebral level associated with origin of gonadal arteries 157. Vertebral level associated with origin of IMA 158. Vertebral level of umbilicus 159. Vertebral level of aortic bifurcation 160. Vertebral level for formation of IVC 161. Spinal levels to muscles of anterior abdominal wall 162. Structure that forms superficial inguinal ring 163. Structure that forms deep inguinal ring 164. Structure that forms floor of inguinal canal 165. Bony attachments of inguinal ligament 166. Structures that form conjoint tendon

L2 L3 Disc L3-4 L4 L5 T7 L1 Aponeurosis of external oblique Transversalis fascia Inguinal ligament ASIS and pubic tubercle Internal oblique and transversus abdominis

167. Abdominal layer continuous with external spermatic fascia 168. Abdominal layer continuous with cremasteric fascia 169. Abdominal layer continuous with internal spermatic fascia 170. Structure that lies between protrusion sites of direct and indirect inguinal hernias 171. Type of hernia that enters deep inguinal ring 172. Most common type of hernia 173. Most common side for indirect inguinal hernia 174. Type of hernia that protrudes through Hesselbachs triangle 175. Boundaries of Hesselbachs triangle

External oblique Internal oblique Transversalis fascia

Inferior epigastric vessels Indirect inguinal Indirect inguinal Right Direct inguinal Inguinal ligament, rectus abdominis, inferior epigastric artery and vein

176. Type of hernia that traverses both deep and superficial rings 177. Condition in which fluid accumulates in processus vaginalis 178. Communication between greater and lesser sacs 179. Superior border of epiploic foramen 180. Inferior border of epiploic foramen 181. Posterior border of epiploic foramen 182. Ligament that contains portal vein, hepatic artery and bile duct 183. Structure that limits spread of ascitic fluid superiorly from left paracolic gutter 184. Structure that limits spread of ascitic fluid inferiorly from right infracolic compartment 185. Superior extent of right paracolic gutter 186. Most inferior portion of peritoneal cavity in females
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Indirect inguinal Hydrocele Epiploic foramen Caudate lobe of liver Part one of duodenum IVC Hepatoduodenal (lesser omentum) Phrenicocolic ligament

Root of the mesentery

Hepatorenal recess Rectouterine pouch

187. Structures supplied by celiac artery

Stomach, duodenum, liver, spleen, gallbladder, pancreas

188. Branches of celiac artery

Left gastric, common hepatic and splenic

189. Blood supply to stomach

Right and left gastroepiploics right, left and short gastrics

190. Major structures of bed of stomach

Pancreas, spleen, left kidney and suprarenal gland, diaphragm

191. Ducts that join to form common bile duct 192. Structure that separates right and left lobes of liver 193. Remnant of umbilical vein 194. Origin of cystic artery 195. Ribs directly related to spleen 196. Organs related to spleen

Cystic and common hepatic Falciform ligament Round ligament of liver Right hepatic artery Ribs 9-11 (left) Stomach, colon, left kidney, tail of pancreas

197. Artery to small intestine 198. Organs supplied by both celiac and SMA 199. Organ supplied by both SMA and IMA 200. Vessel located posterior to head of pancreas 201. Vessel located posterior to neck of pancreas 202. Veins that unite to form portal vein 203. Clinically important organs for portacaval anastomoses 204. Two structures that lie posterior to SMA near its origin 205. Three distinguishing features of the large intestine

SMA Duodenum, pancreas Transverse colon IVC Portal vein Splenic and SMV Esophagus, rectum, liver, spleen Left renal vein, duodenum Tenia coli, haustra, epiploic appendages

206. Termination of left ovarian/testicular vein 207. Termination of right ovarian/testicular vein 208. Location of initial pain of appendicitis 209. Motor innervation of diaphragm 210. Sensory innervation of diaphragm 211. Spinal levels of phrenic nerve 212. Vertebral level that inferior vena cava traverses diaphragm 213. Vertebral level that esophagus traverses diaphragm 214. Structures that traverse diaphragm with esophagus 215. Vertebral level that aorta traverses diaphragm 216. Structure that traverses diaphragm with aorta 217. Structures that traverses diaphragm through crura
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Left renal vein Inferior vena cava Umbilical region Phrenic Phrenic + intercostal C3-5 T8 T10 Vagal trunks T12 Thoracic duct Greater, lesser and least

splanchnic nerves

PELVIS AND PERINEUM:

218. Structure that separates pelvis from perineum 219. Two major components of pelvic diaphragm 220. Two major components of levator ani 221. Two muscles which close lateral pelvic wall 222. Means by which obturator internus exits pelvis 223. Means by which piriformis exits pelvis 224. Innervation of detrusor 225. Innervation of trigone Pelvic diaphragm Levator ani and coccygeus Pubococcygeus and iliococcygeus Obturator internus and piriformis Lesser sciatic foramen Greater sciatic foramen Pelvic splanchnics (S2-4) Sympathetics (Pregang. T11-L2; lesser, least, lumbar splanchnic nn.) 226. Innervation of sphincter urethrae 227. Remnants of umbilical arteries 228. Provides major vasculature to pelvic organs 229. Chief artery to rectal mucosa 230. Chief artery to rectal muscular wall 231. Most common type of pelvic inlet in females 232. Two remnants of gubernaculum in females 233. Ligament that contains ovarian vessels 234. Cavity into which ova immediately escape the ovary 235. Lymphatic drainage for ovary and testes 236. Normal position of uterus 237. Name given to orientation where uterus and vagina intersect at angle of 90 degrees 238. Name given to orientation where uterine body and cervix intersect at angle of 10-15 degrees 239. Chief uterine support 240. Ligament that contains uterine vessels 241. Structure potentially injured with hysterectomy 242. Relation of ureter to uterine artery 243. Structure that separates deep and superficial perineal spaces 244. Bony landmarks between anal and UG triangles 245. Structure forming lateral wall of ischioanal fossa 246. Structure that forms the pudendal canal 247. Structure that separates internal and external hemorrhoids
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Pudendal n. (S 2,3,4) Medial umbilical ligaments Internal iliac Superior rectal Middle rectal Gynecoid Ovarian and round ligament Suspensory ligament of ovary Peritoneal Lumbar nodes (para-aortic) Anterverted, anteflexed Anteversion

Anteflexion

Pubococcygeus Lateral cervical Ureter Inferior and posterior Perineal membrane Ischial tuberosities Fascia of obturator Internus Fascia of obturator Internus Pectinate line

248. Lymphatic drainage for area superior to pectinate line of anal canal

Internal iliac, inferior mesenteric nodes

249. Lymphatic drainage for area inferior to pectinate line of anal canal 250. Lymphatic drainage for glans penis 251. Muscle which compresses the bulb of penis 252. Muscle which compresses the crus of penis 253. Nerves of erection

Superficial inguinal nodes Deep inguinal nodes Bulbospongiosus Ischiocavernosus Pelvic splanchnic, nervi erigentes (S 2,3,4)

254. Muscles which meet at the perineal body

Superficial and deep perineal, bulbospongiosus, external anal sphincter, pubococcygeus

255. Major structure of deep perineal space

Sphincter urethrae

HEAD AND NECK:

256. Vertebral level of hyoid bone 257. Vertebral level of thyroid cartilage 258. Vertebral level of cricoid cartilage 259. Muscles that are innervated by CN XI 260. Structures that course between anterior and middle scalene CV3 CV4,5 CV6 Trapezius, SCM Brachial plexus, subclavian artery 261. Innervation of omohyoid, sternohyoid and sternothyroid 262. Innervation of digastric Ansa cervicalis (C1-3 ventral rami) Anterior belly = CN V Posterior belly = CN VII 263. Innervation of carotid sinus and carotid body 264. Major structures to pass through pharyngeal wall superior to superior constrictor 265. Nerves of pharyngeal plexus CN IX (mucosa), CN X (musculature), Sympathetics (vasomotor) 266. Only muscle innervated by CN IX 267. Structures that pierce thyrohyoid membrane Stylopharyngeus Internal laryngeal nerve, superior laryngeal artery 268. Only muscle to abduct vocal cords 269. Innervation of cricothyroid 270. Innervation of laryngeal muscles exclusive of cricothyroid
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CN IX, CN X Auditory tube, levator veli palatini

Posterior cricoarytenoid External laryngeal nerve Recurrent laryngeal

271. Muscle that increases tension on vocal cords 272. Sensory nerve to larynx superior to vocal cords 273. Sensory nerve to larynx inferior to vocal cords 274. Site of aspirated lodged fishbone 275. Afferent and efferent limbs of gag reflex 276. Afferent and efferent limbs of cough reflex 277. Nerve at risk when performing thyroidectomy 278. Nerve injury that causes hoarseness following thyroid surgery 279. Chief structures that traverse internal acoustic meatus 280. Foramen where CN VII exits skull 281. Major arterial supply to calvaria and supratentorial dura 282. Major cutaneous nerve of face 283. Major artery to internal structures of head 284. Spinal levels of sympathetic fibers to head 285. Autonomic ganglia for CN III 286. Sensory ganglia for CN VII 287. Autonomic ganglia for CN VII 288. Autonomic ganglia for CN IX 289. Muscle attached to disc of TMJ 290. Muscle that retracts mandible 291. Major nerve to TMJ (pain) 292. Specific nerves that elicit secretion from the parotid gland

Cricothyroid Internal laryngeal Recurrent laryngeal Piriform recess CN IX CN X CN X CN X Lt & Rt recurrent laryngeal nerves Recurrent laryngeal CN VII and VIII Stylomastoid foramen Middle meningeal CN V Maxillary T1 2 Ciliary Geniculate PPG and submandibular Otic Lateral pterygoid Temporalis Auriculotemporal (V3) Tympanic branch of CN IX and lesser petrosal

293. Branch of CN V that carries parasympathetics to parotid 294. Structure that opens into superior meatus of nasal cavity 295. Structures that open into middle meatus of nasal cavity

Auriculotemporal (V3) Posterior ethmoid sinus Frontal, maxillary, anterior and middle ethmoid sinuses

296. Structure that opens into inferior meatus of nasal cavity 297. Major artery to nasal cavity 298. Most common site of nose bleed 299. Innervation of levator veli palatini 300. Muscle that opens auditory tube 301. Innervation of tensor veli palatini 302. Nerve that provides taste to anterior 2/3 of tongue 303. Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue 304. Specific nerve that elicits secretion from submandibular gland 305. Branch of CN V that carries parasympathetic to submandibular
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Nasolacrimal duct Sphenopalatine Kiesselbachs plexus CN X Tensor veli palatini CN V3 Chorda tympani Geniculate ganglion Chorda tympani Lingual

306. Nerve injured when tonsilar pillars sag and uvula deviates 307. Nerve potentially injured with tonsillectomy 308. Muscle that protrudes tongue 309. Nerve injured when deviation of protruded tongue 310. Specific nerve that stimulates tear production 311. Sensory nerve to cornea 312. Muscle that elevates and abducts eye 313. Muscle that depresses and abducts eye 314. Site of preganglionic nerve cells that elicits dilation of pupil 315. Site of postganglionic nerve cells that elicits dilation of pupil 316. Site of preganglionic nerve cells that elicits constriction of pupil 317. Site of postganglionic nerve cells that elicits constriction of pupil 318. Innervation of external surface of tympanic membrane 319. Innervation of internal surface of tympanic membrane

CN X CN IX Genioglossus Ipsilateral CN XII Greater petrosal CN VII CN V1 (nasociliary) Inferior oblique Superior oblique Lateral horn, T1 - 2 Superior cervical ganglion Edinger-Westphal Ciliary ganglion Auriculotemporal(V3),CN X CN IX

HIGH YIELD GROSS ANATOMY SUBJECTS FOR COMLEX

BACK

Articulations orientation of zygapophyseal joints at each segment; actions permitted Ligaments of vertebral column and their function IV discs herniation and part of PNS affected Abnormal curvatures of the vertebral column Layering of Meninges; layers punctured in aspiration of CSF from lumbar cistern Spinal cord extent and blood supply Innervation and action of back muscles

UPPER AND LOWER LIMB

Surface anatomy / palpable structures General Osteology Dermatomes and distribution of cutaneous nerves Cord levels of muscle stretch reflexes and cord levels in major peripheral nerves Boundaries of axilla, cubital fossa, femoral triangle, popliteal fossa and carpal tunnel Lesions of nerves at: axilla, elbow and wrist; hip, knee and ankle Ligamentous structure of: shoulder, hip, knee and ankle Course and patterns of: major superficial veins, deep veins, arteries and nerves

HEAD

General osteology of skull Layering of scalp, cranial meninges Cranial nerves components, course and targets; lesions along their path; contributions to parasympathetic ganglia Innervation and action of all muscles (extrinsic eye muscles, muscles of mastication, facial muscles, muscles of the pharynx and larynx, extrinsic muscles of the tongue) Afferent and efferent limbs of cranial nerve associated reflexes (jaw-jerk, gag, blink, etc.) Origin, course and distribution of major blood vessels and veins Temporomandibular joint structure and innervation
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Generally, the route of lymphatic drainage of deep spaces of the head Structure of the eye, middle ear (nerves traversing the middle ear)

THORAX
TV4-5 (sternal angle) = tracheal bifurcation / aorta arches / azygos v. into SVC Main lymphatic drainage site for breast = axillary nodes Pneumothorax Lymphatic drainage of lungs Thoracentesis Pericadiocentesis Atrial/Ventricular septal defects Referred pain from heart

ABDOMEN
Blood supply, autonomic innervation and lymphatic drainage of organs Ascites Varicocele and inguinal hernias

PELVIS AND PERINEUM

Blood supply, autonomic innervation and lymphatic drainage of organs Extravasated urine location

HIGH YIELD NEUROANATOMY SUBJECTS FOR COMLEX

HISTOLOGY OF THE NERVOUS SYSTEM
General features and functions of neurons, oligodendrocytes, microglia, astrocytes and Schwann cells Gray matter versus white matter Mechanism of synaptic transmission Components of the blood-brain barrier

NEUROEMBRYOLOGY
Origin of neural tube, dates of neuropore closure, neural crest cells Primary and secondary brain vesicles and their derivatives, relation to ventricular system Derivatives of the alar and basal plate

NEUROANATOMY
Identify parts of the ventricular system and the parts of the CNS related to each Formation and flow of CSF; hydrocephalus Structure, innervation and blood supply of the dura mater Structure of dural foldings and dural venous sinuses Subdural versus epidural hematomas; subarachnoid hemorrhages Subarachnoid space and associated cisterns; major structures traversing the cisterns Regional differences of the spinal cord, somatotopy of the ventral horn; tracts traversing the funiculi Origin, components, decussation and termination of: o Dorsal column, medial lemniscus (how does this info get to the cortex?) o Anterolateral system (spinothalamic + spinotectal + spinoreticular; how does this info get to the cortex?) o Dorsal and ventral spinocerebellar tracts (What information is in these tracts? Crossed? Synapses?) o Lateral and anterior corticospinal tracts o Rubrospinal Tracts, Vestibulospinal Tracts, Reticulospinal Tracts and MLF o Descending Hypothalamospinal fibers Components, level of location and contributions of all cranial nerve nuclei. Visual and auditory pathways Vestibular pathway, nystagmus
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Olfactory and taste pathways; visceral pathways Spinal cord reflexes, muscle stretch reflexes, function of the muscle spindle and Golgi tendon organs Causes of decerebrate and decorticate rigidity Origin, course and terminations of cortiospinal tract Origin, course and terminations of corticobulbar tract Somatotopic organization of the primary motor cortex; contributions of premotor and supplementary motor cortex Components of the basal nuclei Direct and Indirect pathways and their neurotransmitters through the basal nuclei (ganglia) How are the basal nuclei affected in: o Huntington Disease o Parkinson Disease o Wilson Disease o Tardive Dyskinesia General circuitry of the cerebellar cortex Components, input, output, function and effects of lesion to: o Vestibulocerebellum o Spinocerebellum o Cerebrocerebellum Nuclei for control of oculomotor muscles, role of MLF Centers for horizontal and vertical saccades Circuitry for accommodation, and pupillary light reflex General organization and functions of the hypothalamic nuclei, results of pituitary tumors General organization, components and function of the limbic centers Layering, functional areas, connections with the thalamus and lateralization of the cerebral cortex Spinal cord lesions: Brown-Sequard, Syringomyelia, Tabes dorsalis, Guillain-Barre syndrome Brainstem lesions: o Medial and Lateral Medullary Syndromes o Medial and Lateral Pontine Syndromes o Weber Syndrome o Benedikt Syndrome o Parinaud Syndrome o Uncal Herniation General patterns of blood supply to: spinal cord, medulla, pons, midbrain, cerebellum, striatum (lenticulostraite arteries!), and areas of cerebral cortex (what deficits with stroke of left middle cerebral artery?) What is a watershed infarct? What are the deficits with stroke of: o Anterior spinal artery (cord versus medulla [MEDIAL MEDULLARY SYNDROME]) o Posterior spinal artery o Posterior inferior cerebellar artery [LATERAL MEDULLARY SYNDROME] o Basilar artery [MEDIAL and LATERAL PONTINE SYNDROMES] o Posterior cerebral artery [WEBER SYNDROME] o Lenticulostriate o Posterior cerebral artery o Middle cerebral artery o Anterior cerebral artery

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HIGH YIELD EMBRYOLOGY

EARLY EMBRYOLOGY Capacitation pruning of the sperm glycocalyx; permits the sperm-oocyte interaction Ectopic pregnancy implantation occurs outside of the uterine cavity; can occur in the uterine tubes or in the pelvic cavity Placenta previa implantation occurs near the cervix; provides a high risk of bleeding Placental abruption placenta becomes detached Placenta accreta abnormal adherence of the chorionic villi to the myometrium Placenta percreta villi penetrate the full thickness of the myometrium Hydatidiform moles can give rise to choriocarcinomas or persistent trophoblastic disease Complete a cystic swelling of the uterus that forms when an embryo dies and the chorionic villi fail to vascularize; diploid Partial derives from a poorly developed embryo; produces moderately high levels of hCG; triploid, with two sets of paternal chromosomes Dizygotic (fraternal) twins arises from multiple ovulations (high levels of FSH) Monozygotic (identical) twins arise from splitting of a single zygote Human chorionic gonadotrophin (hCG) secreted by syncytiotrophoblast Progesterone secreted by corpus luteum for five months, then by placenta; contraceptive pill and RU-486 are anti-progesterones Gastrulation process where the epiblast gives rise to mesoderm, endoderm and ectoderm Notochord derived from both endoderm and mesoderm; forms the nucleus pulposus Sirenomelia caudal dysgenesis from inadequate mesoderm; lower limb defects Sacrococcygeal teratoma persistence of primitive streak, forms multi-tissue tumor Alpha-fetoprotein liver glycoprotein; leaks into amniotic fluid with neural tube or ventral wall defects Spina bifida occulta incomplete neural arch, patch of hair over defect Hemolytic Disease of the Newborn (HDN) or Erythroblastosis fetalis: mother is Rh- and fetus is Rh+; mother produces antibody that results in hemolysis of fetal red cells. Giving mother Rh immunoglobulin prevents HDN. fertilization of empty oocyte (contains only paternal chromosomes); produces very high levels of hCG;

Cardiovascular
Splanchnic mesoderm forms the primitive hear tube; beats on day 22 Pleuropericardial membranes form the pericardium and pleura (somatic parts)

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Tetralogy of Fallot a combination of four heart defects: 1. pulmonary stenosis 2. right ventricular hypertrophy 3. ventricular septal defect 4. over-riding aorta Undivided truncus arteriosus neural crest defect where the bulbar regions fail to form Patent ductus arteriosus common defect; most common defect associated with Rubella virus (German measles), low (fetal) oxygen, and mother living in high altitudes during her pregnancy; frequency in females is 2 3 X that in males; often seen with other heart defects Atrial septal defect patent foramen ovale, common, can involve defect in septum primum or septum secundum Ventricular septal defect common; involves the membranous part of the interventricular septum Transposition of the great vessels most common cause of cyanosis in newborn Coarctation of aorta - most commonly (90%) constriction is juxtaductal (opposite ductus arteriosus); more common in males (2X) and often associated with bicuspid aortic valve Retroesophageal right subclavian artery - fairly common; forms vascular ring around trachea and esophagus, but usually no problem clinically; forms as variation involving right seventh intersegmental artery Veins Vitelline left disappears, right forms portal system Umbilical right disappears, left drains placenta Cardinal: Subcardinal drains kidneys Sacrocardinal common iliac Supracardinal drains body wall (azygos veins) Ductus venosus between left umbilical and right vitelline veins; forms ligamentum venosum

Nervous System
Early development notochord induces formation of neural plate which gives rise to neural crest and neural tube Notochord persists as the nucleus pulposus of the intervertebral disc Neural tube alar plate is dorsal (sensory); basal plate is ventral (motor) Neural crest gives rise to all ganglia, Schwann cells, meninges, melanocytes, cartilage, bone and blood vessels of the head Spina bifida cystica incomplete closure of the neural tube caudally (caudal neuropore on day 27); can be detected by alpha-fetoprotein and includes a sac containing CSF meningocele sac includes meninges and CSF meningomyelocele includes nervous tissue Anencephaly result when the anterior neuropore fails to close (day 25); forebrain is poorly developed Arnold-Chiari malformation cerebellum herniates through the foramen magnum; seen in conjunction with spina bifida cystica accompanied by hydrocephalus Hydrocephalus most often due to stenosis of the cerebral aqueduct secondary to a fetal viral infection
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Mental retardation most commonly caused by maternal alcohol abuse

Gastrointestinal
Omphalocele occurs when the intestines do not return to the abdominal cavity following normal herniation; the guts are covered by the amniotic sac Umbilical hernia guts protrude outside of the abdominal cavity but covered with skin and connective tissue Congenital pyloric stenosis characterized by projectile vomiting in a newborn Atresia interruption of the gastrointestinal tract; at esophagus vomit contains uncurdled milk; at gastric region the vomit contains curdled milk; at the duodenum the vomit contains bile Meckels diverticulum outpocketing of distal ileum; portion of bowel that was continuous with the vitelline stalk and yolk sac. This portion of the ileum is the central portion for the preaxial and postaxial limbs of intestinal rotation (axis of rotation is superior mesenteric artery). Present on the antimesenteric wall (opposite the mesentery) about two feet from the ileocecal junction in an adult. Diverticulum may present as a cyst, ligament, fistula or simple outpocketing; it often contains gastric tissue or pancreatic tissue Rule of 2s: May be involved in case studies on COMLEX: 2% of population Discovered by age of 2 yrs. Located approx. 2 ft. from ileocecal junction 2 in length Contains 2 types of ectopic tissue (gastric or pancreatic) Hirschsprungs disease occurs when the hindgut fails to be invaded by migrating neural crest cells, results in hypomobility, constipation and congenital megacolon. Imperforate anus the anal membrane does not regress

Urogenital
Derivatives of the genital ducts: male high level of testosterone stimulates development of the mesonephric duct; Mullerian inhibiting factor prevents development of paramesonephric ducts female low level of testosterone prevents development of mesonephric ducts and no Mullerian inhibiting factor permits development of the paramesonephric ducts Mesonephric ducts: male: epididymis, ductus deferens, seminal vesicle and ejaculatory duct female: epoophoron, paroophoron, Gartners duct Paramesonephric duct: male: appendix of testes and prostatic utricle female: uterine tube, uterus and superior part of vagina Horseshoe Kidney occurs when the inferior poles of the kidneys contact each other before ascent; the kidneys fuse and ascent to the lumbar region is prevented by the inferior mesenteric artery
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Bifid ureter involves the ureteric bud Epispadias rare; seen with exstrophy of the bladder Hypospadias common; opening on the ventral aspect of the penis; results from a failure of urethral folds to completely meet Turners syndrome 45 XO; infantile female genitalia, ovarian streaks and webbed neck Klinefelters syndrome 47 XXY; common (1/500); gynecomastia, infertile males

External Genitalia:
MALE UG folds Genital swellings Genital tubercle UG sinus floor of urethra scrotum penis urethra/prostate FEMALE labia minora labia majora clitoris urethra/vagina

Gonads develop from epiblast and migrate along the yolk sac and mesentery to the lumbar region Hydrocele fluid in the cavity of the tunica vaginalis from a patent processus vaginalis

HEAD AND NECK

Pharyngeal Apparatus Clefts (Grooves) four pairs; ectoderm that forms only epithelium The first cleft gives rise to the external auditory meatus The second through fourth clefts typically regress; may form a cervical sinus Pharyngeal Arches There are five pharyngeal arches; mesoderm forms skeletal muscle; neural crest grows into each arch and forms all connective tissue (cartilage, bone and blood vessels)
Derivatives of the Pharyngeal Arches First Second Nerve CN V3

Third

Fourth

Sixth

CN VII CN IX CN X CN X facial muscles, Stylopharyngeus muscles of muscles of larynx, muscles of stapedius, palate, pharynx inferior constrictor, mastication, anterior belly of posterior belly and cricothyroid cricopharyngeus and digastric, of digastric and superior portion of Muscles mylohyoid, tensor stylohyoid esophagus tympani and tensor veli palatini maxillary Artery hyoid and stapedial common and internal carotid left: portion of Pulmonary trunk (left arch; right: part - ductus arteriosus) one of subclavian laryngeal cartilage laryngeal cartilage

malleus and incus stapes, styloid greater horn and process, lesser inferior portion of horn and body of hyoid Cartilage superior portion of body of hyoid

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Pharyngeal Pouches four pairs; endoderm that forms only epithelium The first pouch gives rise to the auditory tube, mastoid antrum and tympanic cavity. The second pouch forms the palatine tonsil. The third pouch gives rise to the thymus and inferior parathyroid gland. The fourth pouch gives rise to the superior parathyroid

Torticollis This is a condition characterized by a shortening of the sternocleidomastoid muscle and results in an elevation of the chin to the opposite side; can be caused by damage to the muscle, spinal accessory nerve or can be congenital. Cysts of the Neck Lateral cervical cysts (branchial fistula) arises from the second through fourth pharyngeal clefts Midline cysts most often arise from a remnant of the thyroglossal duct (thyroglossal duct cysts) Cleft Lip Results from failure of the maxillary prominence to join the medial nasal prominences to form the intermaxillary segment (primary palate derives from intermaxillary segment) Cleft Palate Anterior cleft anterior to incisive foramen; lateral palatine process fails to fuse with primary palate Posterior cleft occurs through the secondary palate where lateral palatine process does not fuse or meet nasal septum Complete cleft involves both the primary and secondary palate

Miscellaneous
Situs inversus reversal of organs; can involve all organs or just single organs (heart dextrocardia) Diaphragm develops from the septum transversum, pleuroperitoneal membranes, paraxial mesoderm and dorsal mesentery of the esophagus Congenital diaphragmatic hernia results from a failure of the pleuroperitoneal fold to close the pericardioperitoneal canal; most common on the left side Stem villi - form from trophoblast and somatic layer of extraembryonic mesoderm Intervillous space contains maternal blood

Changes at Birth
umbilical arteries umbilical vein urachus foramen ovale ductus arteriosus ductus venosus paired medial umbilical ligaments round ligament of liver median umbilical ligament fossa ovalis ligamentum arteriosum ligamentum venosum

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