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77 Cards in this Set

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What are the branches of the subclavian artery?
1) Superior thoracic artery
2) Thoraco-acromial artery
3) Lateral thoracic artery
4) Subscapular artery
5) Anterior circumflex
Humoral
6) Posterior circumflex
Screw The Lawyers Save A Patient
Major branches off of the aortic arch
- Coronary arteries
1) Brachiocephalic trunk
2) Left Common Corotid
3) Left Subclavian
Know your ABCs
- Aortic Arch gives rise to:
B
CC
S
Where is the brancial artery located
Brachial artery is medial to bicepts in elbow
BAMBI
Branches of the right subclavian artery
1) Vertebral artery
2) Thyrocervical trunk
3) Inferior thyroid
4) ---
5) ---
6) Costocervical artery
7) ---
8) ---
Thoracic cage: relations to the important venous structures:
- Behind the STERNOCLAVICULAR JOINTS: the BRACHIOCEPHALIC VEINS begins

- Behind the 1st COSTAL CARTILAGE: the SUPERIOR VENA CAVA begins

- Behind the 2nd COSTAL CARTILAGE: the AZYGOS VEIN ends

- Behind the 3rd COSTAL CARTILAGE: the SUPERIOR VENA CAVA ends
External jugular vein tributaries
- Posterior external jugular vein
- Anterior jugular vein
- Suprascapular vein
- Transverse cervical vein
PAST
Structures of the Superior Mediastinum
1) Phrenic nerve
2) Vagus nerve
3) Thoracic duct
4) Left recurrent laryngeal nerve
5) Brachiocephalic veins
6) Aortic arch & its 3 branches
7) Thymus
8) Trachea
9) Lymph nodes
10) Esophagus
PVT Left BATTLE
Structures of the Posterior Mediastinum
1) Descending aorta
2) Azygos and Hemiazygos veins
3) Thoracic duct
4) Esophagus
5) Sympathetic chain/trunk / Ganglia
DATES
Heart valve sequence
1) Tricuspid
2) Pulmonary
3) Mitral
4) Aorta
Jugular notch
at top of manubrium of sternum
Components of the sternum
1) manubrium
2) Angle of Louis/Manubriosternal notch
3) Body
4) Xiphoid process / Xiphisternum
Breast

- Ribs
- Quadrants
- Ribs 2-6
- 4 quadrants (3 in the subcutaneous & axillary tail in the deep fascia)
Dermatomes
T4 - Breast
T7 - epigastric / xiphisternum
T10 - umbilicus
T12 - suprapubic

Brachial plexus: C5-T1
Pectoralis major

- Attachments
- Innervation
- Function
Attachments:
- medial 1/3 of clavicle
- sternum (ribs #1-6)
- humerus (lateral lip of the intertubercular groove)

Innervation: lateral & medial pectoral nerves

Function: ADducts & medially rotates humerus
Pectoralis minor

- Attachments
- Innervation
- Function
Attachments:
- Ribs 3-5
- Coracoid process

Innervation: Medial & Lateral pectoral nerves
Serratus anterior

- Attachments
- Innervation
- Function
Attachments:
- ribs 1-8
- medial border of scapula

Innervations:
- long thoracic nerve
(C5,6,7 raise your arms to heaven)

Function:
- protracts scapula
Diaphragm

- Innervation
- Function
Innervation:
- Phrenic nerve
(C3,4,5 keeps the diaphram alive)

Function:
- Contracts to push down to increaes the area of the rib cage
Components of the right and left lung
1) RIGHT lung:
- oblique fissure
- horizontal fissure
- impressions

2) LEFT lung:
- oblique fissure
- lingula
- impressions
Relationship of pulmonary artery to the bronchus
Right pulmonary artery is anterior to the bronchus

Left pulmonary artery is superior to the bronchus
RALS
Pleural cavities of the lung
1) Parietal pleura (Lines wall)
- diaphragmatic
- costal surfaces
- mediastinal

Innervation: Phrenic and intercostal nerves

2) Visceral pleura (lines lung)
- No innervation
Pneumothorax
Cavity is ruptured by air
Hemothorax
Cavity is ruptured by blood
Muscles of inspiration/expiration
Inspiration:
- Diaphragm
- Intercostal muscles
- SCM/Scalene muscles (Accessory)

Expiration:
- Elastic recoil of lung
Mediastinum

- Boundaries
- Subdivisions
Boundaries:
- sternum
- thoracic vertebrae
- thoracic inlet
- diaphragm
Subdivisions
- superior mediastinum
- inferior mediastinum (Anterior, middle - pericardium*heart, posterior)
Superior mediastinum

- Contents
- Boundaries
Contents:
- Great vessels
- Arch of aorta
- trachea
- esophagus

Boundary:
- Imaginary line of angle of louis to T4
Anterior mediastinum

- Contents
Contents:
- Thymus
- Fat
- Small vessels
- Lymph nodes
Middle mediastinum

- Contents
Contents:
- Fibrous pericardium
- Heart
- Roots of the great vessels (especially the ascending aorta)
Posterior mediastinum

- Contents
Contents:
- Esophagus
- Bronchi
- Descending aorta
- Thoracic duct
Components of the right atrium:
- Inflow: from SVC, IVC, coronary sinus
- Outflow: to RV via tricuspid valve
- Right auricle/atrial appendage: embryonic derivative
- Crista terminalis: ridge, runs from SVC to IVC openings
- Pectinate muscles
- Fossa Ovalis: formerly foramen ovale
- IVC and coronary sinus “valves”
- Right heart border on CXR (chest X-ray)
Components of the right ventricle:
- Inflow: from RA via tricuspid valve
- Outflow: to pulmonary artery (deoxy blood) via pulmonary valve
- Trabeculae carneae: ridged muscle
- Papillary Muscles (ant, post & septal): prevent valve prolapse during systole
- Chordae tendineae: fibrous cords
- Moderator band: transmits AV bundle
- Thinner walled (normally)
- Most anterior part of heart
Components of the left atrium:
- Inflow: from pulmonary veins (usually 4)
- Outflow: to LV via mitral valve
- Auricle: embryological remnant (only part with pectinate muscle)
- Other side of the fossa ovalis
- Most posterior part of heart
Components of the left ventricle
- Inflow: from LA via mitral valve
- Outflow: to aorta via aortic valve
- Trabeculae carneae
- Papillary muscles (ant. & post): prevent prolapse during systole, larger then RV
- Chordae tendineae
- Heart apex
Heart conduction
1) Sinoatrial (SA) node: pacemaker (normally), RA close to SVC inlet
2) Atrioventricular (AV) node: in IAS close to tricuspid valve
3) Atrioventricular bundle/bundle of His: in IVS
4) Right & left bundle branches (note: left has 2 parts): in IVS
5) Purkinje fibers: ventricular muscle
Azygos vein

- location
- Right side of the bodies of the thoracic vertebrae
- Passes behind right lung hilum (lung impression)
- Drains posterior thorax and dumps into SVC
- Sometimes: hemiazygos vein and accessory azygos vein on left hand side (begins @ 4th IC space)
- Connect to azygos vein
Thoracic duct
- Carries lymph from the cisterna chyli (abdomen) and thoracic cavity
- Between the esophagus and abdominal aorta
- Empties into the venous circulation, junction of left internal jugular vein and left subclavian vein
- Hard to see
Subclavian relationships
- Anterior to posterior
1) Subclavian vein
2) Anterior scalene (with Phrenic nerve)
3) Subclavian artery
4) Brachial plexus
5) Middle scalene
6) Posterior scalene
** Phrenic lies on top of Ant. Scalene
** Vagus nerve runs in carotid sheath
Thyrocervical trunk
Branch of the subclavian artery

Branches:
- inferior thyroid
- transverse cervical
- suprascapular
Internal thoracic artery
Branch off of the part 1 of the axillary artery

- go to the intercostal arteries
Vertebral artery
1st branch off of both the right and left subclavian arteries
Trapezius

- Attachment
- Innervation
- Function
- Attachment:

- Innervation: Accessory nerve (CXI)

- Function:
Latissimus dorsi

- Attachment
- Innervation
- Function
- Attachment: Spine, iliac crest, intertubercular groove

- Innervation: Thorocodorsal nerve

- Function:
Rhomboid

- Types
- Attachment
- Function
- Types: major and minor

- Attachment: spine & medial border of the scapula

- Function
Levator scapulae

- Attachment
- Function
- Attachment: superior angle of the scapula

- Function: shrug shoulders
Deltoid

- Attachment
- Innervation
- Function
- Attachment: clavical, acromion, spine of scapula & distally 1/3 down of humerus

- Innervation: axillary nerve

- Function: ABduction after 1st 15 degrees
Terres major

- Attachment

- Function
- Attachment: inferior angle of the scapula, intertubercular groove

- Innervation

- Function: medial rotation
Tricepts:

- Attachment
- Innervation
- Function
- Attachment:
3 heads: long- infraglenoid tubercule; lateral & medial-humerus; Distally to the alecronon of the ulna

- Innervation: radial nerve (innervates the posterior compartment of the arm)

- Function: Extension of the elbow
Subscapularis

- Attachment

- Function
- Attachment: subscapular fossa, lesser tubercle

- Innervation:

- Function: median rotation
Rotator cuff muscles:
1) terres minor
2) subscapularis
3) supraspinatus
4) infraspinatus
Supraspinatus

- Attachment

- Function
- Attachment: suprasinous fossa, greater tubercule

- Innervation:

- Function: lateral rotation & 1st 15 degree ABduction
Infraspinatus

- Attachment

- Function
- Attachment: infraspinous fossa & greater tubercle

- Function: lateral rotation
Teres minor

- Attachment
- Innervation
- Function
- Attachment: lateral border scapula and greater tubercle

- Function: lateral rotation
Components of the brachial plexus
1) Roots
2) Trunks
3) Divisions
4) Cords
5) Branches
"RT drinks cold beer"
How are the chords named?
in relation to the axillary vein
What nerve(s) come off the roots?
1) Long thoracic nerve (C5,6,7 raise your arms to heaven) to the serratus anterior

2) Phrenic nerve (C3,4,5 keeps the diaphragm alive)
What nerve(s) come off the chords?
Posterior chord:
- Thoracodorsal nerve to the latissiumus dorsi muscle

Lateral & Medial chord:
- Lateral and medial pectoral nerves to the pectoralis major and minor muscles
What nerve(s) come off the branches?
Posterior chord:
- Axillary nerve to the deltoid and teres minor
- Radial nerve to the extensor compartment of the arm and forearm(Tricepts)

Lateral chord:
- Musculocutaneous nerve to all flexors in the anterior compartment of the arm

Medial chord:
- Ulnar nerve to flexor carpi ulnaris (FCU), 1/2 flexor digitorum profundus, some muscles of the hand (hypothenar, palmaris brevis, dorsal, adductor pollicis and palmar interossei and 3rd & 4th lumbricals)

Lateral & Medial chords: Median nerve to forearm flexor muscles, thenar compartment, & lateral two lumbricals
Radial nerve innervates the BEST (Brachioradialis, extensors, supinator, tricepts)
What does the radial nerve innervate?
Radial nerve innervates the BEST (Brachioradialis, extensors, supinator, tricepts)
Radial nerve innervates the BEST (Brachioradialis, extensors, supinator, tricepts)
Where does the ULNAR NERVE come from? & What does it innervate?
- From the medial chord

- Ulnar nerve to flexor carpi ulnaris (FCU), 1/2 flexor digitorum profundus, some muscles of the hand (hypothenar, palmaris brevis, dorsal, adductor pollicis and palmar interossei and 3rd & 4th lumbricals)
Where does the THORACODORSAL NERVE come from? & What does it innervate?
- From the posterior chord

- Thoracodorsal nerve to the latissiumus dorsi muscle
Where does the LONG THORACIC NERVE come from? & What does it innervate?
- From the roots of the brachial plexus, C5,6,7 raise your arms to heaven

- Innervates the serratus anterior
Where does the MEDIAL & LATERAL PECTORAL NERVEs come from? & What does it innervate?
- From the medial and lateral chords of the brachial plexus

- Innervates pectoralis major and minor muscles
Where does the PHRENIC NERVE come from? & What does it innervate?
- From C3,4,5 keeps the diaphragm alive
- Only 5 from the brachial plexus

- Innervates the diaphragm
Where does the RADIAL NERVE come from? & What does it innervate?
- From the posterior chord

- Innervates the extensor compartment of the arm and forearm
--> Radial nerve innervates the BEST (Brachioradialis, extensors, supinator, & tricepts)
Where does the AXILLARY NERVE come from? & What does it innervate?
- From the posterior chord

- Innervates the deltoid and teres minor muscles
Where does the MEDIAN NERVE come from? & What does it innervate?
- From the Lateral and Medial chords

- Innervates forearm flexor muscles, thenar compartment, and lateral 2 lumbricals
Where does the MUSCULOCUTANEOUS NERVE come from? & What does it innervate?
- From the lateral chord

- Pierces the coracobrachialis to supply the flexor muscles of the arms
What muscles comprise the first anterior layer of the forearm (Superficial flexors)?
1) Flexor carpi ulnaris
2) Flexor carpi radialis
3) Palmaris longus
4) Pronator teres
5) Brachioradialis
What are the muscles of the 2nd anterior layer?
Flexor digitorum superficialis
Flexor carpi ulnaris

- Attachment
- Innervation
- Function
- Attachment:
- Innervation: ulnar nerve
- Function
Flexor carpi radialis

- Attachment
- Innervation
- Function
- Attachment: medial epicondyle to the base of the 2nd metacarpal

- Innervation: median nerve
Brachioradialis

- Attachment
- Innervation
- Function
- Attachment: lateral supracondyle to the lateral surface of the distal radius

- Innervation: radial nerve
Pronator teres

- Attachment
- Innervation
- Function
- Attachment: Medial epicondyle and coronoid process of the ulna
to the middle of the lateral suface of the radius

- median nerve
Palmaris longus

- Attachment
- Innervation
- Function
- Attachment: medial epicondyle to the palmar aponeurosis

- median nerve
What muscles comprise the 3rd layer of the anterior forearm?
1) Flexor pollicis longus
2) Flexor digitorum profundus
3) Pronator quadratus
Flexor pollicis longus

- Attachment
- Innervation
- Function
- Attachment:

- Innervation: median nerve
Flexor digitorum profundus

- Attachment
- Innervation
- Function
- Attachment

- Innervation: digits 2&3 -> Median and digits 4&5 ulnar

- Function: flexor
Brachioradialis

- Attachment
- Innervation
- Function
- Attachment

- Innervation: radial nerve

- Function