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514 Cards in this Set
- Front
- Back
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Between what two vertebrae is the lumbosacral angle measured?
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L5 & S1
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Which are the primary curvatures of the spine?
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Thoracic and Sacral/Coccygeal
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Which are the secondary curvatures of the spine?
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Cervical and Lumbar
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What is Dowager's Hump?
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Excessive thoracic kyphosis found in osteoporotic older women
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Why would you do a laminectomy?
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To relieve pressure on spinal cord/nerve roots due to herniated IV disc, tumor or bone hypertrophy
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Where does spina bifida occulta typically occur?
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In the vertebral arch of L5 and or S1
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What is indicitive of its location?
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A tuft of hair- Faun's Beard
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Which is the widest of the cervical vertebrae?
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Atlas (C1)
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Which vertebrae allows an affirmative motion?
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Atlas (C1)
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Which vertebrae allows a negative motion?
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Axis (C2)
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What structure prevents posterior displacment of dens and anterior displacment of CV1?
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The Transverse Ligament of atlas
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Which is more severe- a rupture of the transverse ligament of the atlas or a fracture of the dens?
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Rupture of the ligament
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Which is the largest of all moveable vertebrae?
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L5
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How many pairs of sacral foramina are there?
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Four pairs that run anterior to posterior
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How much of the spinal column's length is made up of IV discs?
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20-25%
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Between which two vertebrae is there no IV disc?
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Between C1 and C2
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The anulus fibrosis (IV disc) is made out of what kind of tissue?
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Fibrocartilidge
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Is the nucleus pulposus more anteriorly or posteriorly placed within the IV disc?
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Posteriorly
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What direction does a herniation of the nucleus pulposus usually happen?
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Posterolaterally
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Where are the unci located?
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Lateral and posterolateral aspects of bodies of C3-C6
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Which ligament prevents hyperextension?
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Anterior Longitudinal Ligament (ALL)
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Which is narrower- the ALL or PLL?
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PLL
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The PLL is mainly attached to what?
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The IV discs of C2- the sacrum
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Zygapophyseal joints
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facet joints
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Zygapopyseal innervation
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medial branches of posterior rami of two adjacent spinal nerves
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Innervation of Extrinsic muslces of the back
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Anterior (Ventral) Rami of spinal nerves- except Traps
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Superficial Layer of Intrinsic muscles of the back
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Splenius cervicis and splenius capitis
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Intermediate Layer of Intrinsic muscles of the back
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Erector Spinae Muscles
-Iliocostalis -Longissimus -Spinalis (from lateral to medial) |
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Deep Layer of Intrinsic muscles of the back
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Transversospinalis
- Semispinalis - Multifidus - Rotatores |
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Innervation of Intrinsic muscles of the back
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Posterior (dorsal) of spinal nerves
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Which is more anterior- the greater or lesser tuberosity?
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The lesser tuberosity
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The ulnar articulation on the humerus
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Trochlea
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The radius articulation on the humerus
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Capitullum
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Fracture of the distal head of the radius
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Colles Fracture- Dinner fork deformity
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Four rotator cuff muscles
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SITS
Supraspinatis Infraspinatis Teres Minor Subscapularis |
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Supraspinatus function
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First 15 degress of humoral abduction
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Infraspinatus and Teres Minor Function
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External Rotation
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Subscapularus Function
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Internal rotation
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Supraspinatus Innervation
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Suprascapular n. (C4,5,6)
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Supraspinatus O/I
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O- Supraspinatous Fossa
I- Greater Tubercle on the humerus |
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Infraspniatus O/I
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O- Infraspinatous fossa
I- greater Tubercle |
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Infraspinatus innervation
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Suprascapular n. (C5,6)
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Teres Major O/I
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O- Lateral border of scapula
I- crest of lesser Tubercle |
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Teres Major Innervation
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Lower subscapular n. (C5,6,7)
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Teres Major Function
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Internal rotation and Adduction
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Teres Minor O/I
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O- Lateral border of the scapula
I- Greater Tubercle |
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Teres Minor Innervation
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Axillary n. (C5,6)
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Subscapularis O/I
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O- Subscapular Fossa
I- Lesser Tubercle |
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Subscapularis Innervation
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Upper & Lower Subscapular n. (C5,6,7)
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Subscapularis Function
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Internal Rotation, Adduction
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Trapezius O/I
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O- External Occiptal Protuberance, Nuchal Ligament, Spinous Processes C7-T12
I- Scapular Spine, acromion, lateral clavicle |
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Trapezius Innervation
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Spinal Acccessory n.
Cranial Nerve 11 (XI) |
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Trapezius Function
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Superior- Elevate Scapula
Middle- Retract Scapula Inferior- Depress Scapula |
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Rhomboids O/I
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O- Spinous Processes C7-T7, nuchal ligament
I- Medial border or scapula |
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Rhomboids Innervation
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Dorsal Scapular n. (C5)
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Rhomboids Function
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Retracts and rotates scapula
Helps serratus hold down the scapula |
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Levator Scapulae O/I
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O- Transverse processes C1-4
I- Supero-medial border of scapula |
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Levator Scapulae Innervation
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Dorsal Scapular n. (C5)
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Levator Scapulae Function
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Elevates and Rotates Scapula
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Pectoralis Major O/I
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O- Clavicle, Sternum, Ribs
I- Crest of greater tubercle |
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Pectoralis Major Innervation
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Medial Pectoral n. (C8,T1)
Lateral Pectoral n. (C5-C7) |
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Pectoralis Major Function
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Adduction and medial rotation
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Action of the Clavicular head of Pec Major
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Flex the humerus
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Action of the Sternocostal head of Pec Major
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Extend humerus from flexed position
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Pectoralis Minor O/I
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O- 3 or 4 Ribs (Ribs 2-5)
I- Corocoid Process of Scapula |
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Pectoralis Minor Innervation
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Medial Pectoral n. (C8-T1)
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Pectoralis Minor Function
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Protract Scapula
Help in deep inspiration Helps flex and reach out |
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Subclavius O/I
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O- 1st Rib
I- Middle Clavicle |
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Subclavius Innervation
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Nerve to subclavius (C5)
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Subclavius Function
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Stabilizes Shoulder
Protects subclavian vessels Protect superior trunk of brachial plexus |
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Borders of the Axillary Region
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Anterior wall- Pec Major/Minor
Posterior wall- Lat Dorsi, subscap, teres major Medial wall- serratus anterior |
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Serratus Anterior O/I
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O- Ribs 1-8
I- Medial Border of Scapula |
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Serratus Anterior Innervation
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Long Thoracic n. (C6,7,8)
*very superficial nerve |
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Serratus Anterior Function
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Protractor of scapula
Rotation of scapula Helps hold the scapula down |
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Long thoracic n. problem
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winging of the scapula
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Deltoid O/I
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O- Scapular Spine & Acromion
Lateral Clavicle I- Deltoid Tuberosity |
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Deltoid Innervation
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Axillary n. (C5,6)
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Deltoid Function
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Ant Part- Flex and medial rotate
Middle- Abd after 15 degrees Post. Part- extent, lateral rotate |
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Parts of the Brachial Plexus
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Roots, Trunks, Divisions, Cords, Branches
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Supra-Clavicular Brachial Plexus
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Rami and Trunks
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Infra-Clavicular Brachial Plexus
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Divisions and Cords
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Anterior compartment of Arm
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Biceps Brachii, Brachialis and Coracobrachialis
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Biceps Brachii O/I
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O- Long head- Supraglenoid Tubercle
Short head- Coracoid Process I- Radial Tuberosity |
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Biceps Brachii Innervation
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Musculocutaneous n.
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Biceps Brachii Function
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Flexor of the Forearm at Elbow
Secondary Supinator of Forearm |
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Coracobrachialis O/I
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O- Coracoid Process
I- Humeral shaft |
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Coracobrachialis Innervation
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Musculocutaneous n.
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Coracobrachialis Function
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Flexor and Adductor of Arm at the Shoulder
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Brachialis Innervation
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Musculocutaneous n.
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Brachialis O/I
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O- Humeral Groove
I- Coranoid Process |
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Brachialis Function
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Flexor of the arm at the elbow
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Posterior Compartment of the Upper Arm
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Triceps Brachii
Medial Head, Lateral Head and Long Head |
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Humoral Shaft Fx may affect this nerve
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Radial Nerve
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Triceps Brachii O/I
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O- Long Head- Infraglenoid Tubercle
Lateral Head- Upper Humerus Medial Head- Lower Humerus I- Common tendon at the olecranon |
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Triceps Brachii Innervation
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Radial n.
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Triceps Brachii Function
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Extensor of Forearm at Elbow
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Where does Rt. Subclavian artery turn into the Axillary a.?
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Between the Clavicle and Rib 1
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1st Part of Axilliary Artery
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Between lateral border of 1st rib & medial border of pec minor
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1st Part of Axilliary Artery- One branch
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Superior thoracic a.
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2nd Part of Axilliary Artery
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Posterior to pec minor
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2nd Part of Axilliary Artery- Two branches
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Thoracoacromial a.
Lateral thoracic a. |
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Largest branch of brachial artery
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Profunda femoriis
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Which is deeper in the forearm- the ulnar or radial artery?
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Ulnar a.
- dives deep between the heads of Flexor digit. super. |
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Where is the common attachment for the forearm flexors?
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Medial Epicondyle
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Where is the common attachment for the forearm extensors?
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Lateral Epicondyle
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Superficial Flexors of the wrist
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Pronator Teres
Flexor Carpi Radialis Palmaris longus Flexor Carpi Ulnaris |
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Intermediate Flexor of the Wrist
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Flexor digitorum superficialis
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Deep Flexors of the Wrist
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Flexor Digitorum profundus
Flexor policis longus Pronator quadratus |
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Pronator Teres- O/I
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O- Coronoid process and medial humeral epicondyle
I- Lateral surface of radius |
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Pronator Teres Function
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Pronates at proximal radioulnar joing and flexes forarm at the elbow
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Flexor Carpi Radialis- O/I
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O- Medial epicondyle of humerus
I- Base of 2nd Metacarpal |
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Flexor Carpi Radialis Function
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Flexes and abducts hand at the wrist joint
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Palmaris longus- O/I
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O- Medial Epicondyle of humerus
I- Distal margin of flexor retinaculum and apex of palmar aponeurosis |
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Palmaris longus- Function
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Flexes hadn at wrist and tenses the palmar aponeurosis
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Flexor Carpi Ulnaris- O/I
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O- Medial epicondyle of humerus and olecranon
I- Pisiform, hook of the hamate and 5th metacarpal |
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Flexor Carpi Ulnaris- Function
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Flexes and adducts hand at the wrist joint
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Flexor Digitorum Superficialis- O/I
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O- CFO and coronoid process (humeroulnar head) and superior anterior border of radius (radial head)
Insertion: Shafts (bodies) of middle phalanges of medial four fingers |
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Flexor Digitorum Superficialis- Function
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Flexes phalanges at the proximal interphalangeal joint (PIP) and MP joint
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Flexor Digitorum Profundus- O/I
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O- Proximal medial and anterior surfaces of ulna and interosseus membrane in forearm
I- Bases of distal phalanges of medial four fingers |
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Flexor Digitorum Profundus- Function
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Flexes distal phalanges of medial four fingers at DIP joint
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Flexor Pollicis Longus- O/I
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O- Anterior surface radius and adjacent interosseus membrane
I- Base of distal phalanx of thumb |
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Flexor Pollicis Longus- Function
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Flexes proximal and distal phalanges of 1st digit (thumb)
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Pronator Quadratus- O/I
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O- Distal anterior surface of ulna
I- Distal anterior surface of radius |
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Pronator Quadratus- Function
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Pronates forearm, and deep fibers bind the radius and ulna
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Lateral Cutaneous vein in the arm
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Cephalic Vein
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Medial Cutaneous vein in the arm
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Basilic Vein
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Median Nerve
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innervates all flexor muscles except flexor carpi ularis and medial ½ of flexor digitorum profundus
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Ulnar Nerve
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flexor carpi ularis and medial ½ of flexor digitorum profundus
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Radial Nerve
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innervates all extensor muscles in posterior compartment
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The sacral curvature of which gender is reduced?
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Females- so the coccyx protrudes less into the pelvic outlet/birth canal
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How many processes does a normal vertebrae have?
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7- Spinous, 2 Transverse and 4 articular processes
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The superior and inferior surfaces of vertebral bodies are covered with what kind of cartilage?
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Hyaline Cartilage
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The ring of smooth bone at the periphery of the vertebrae.
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The Epiphysial rim
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What is the vertebral arch formed by?
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The two lamina and pedicles
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Most common way to fracture or dislocate a vertebrae
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Forceful flexion. Like in a car accident.
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Fused spinous processes of the sacrum form...
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The median sacral crest
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Fused articular processes of the sacrum form...
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The intermediate sacral crest
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Fused transverse processes of the sacrum form...
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The lateral sacral crest
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Sacral Hiatus
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Inverted U-shape that results from the absence of the laminae and spinous processes of hte S4,5 vertebrae
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Sacral Cornua
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represents the inferior articular processes of the S5 vertebra, projects inferiorly on each side of the sacral hiatus
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Posterior Median Furrow
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A horizontal line joinging the highest points of the iliac crests passes through the tip of the L4 spinous process and hte L4-L5 disc
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Uncovertebral Joints
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Joints of Luschka
between the uncus of the bodies of the C3-6T |
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What joins the laminae of adjacent vertebral arches?
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The ligamentum flavum
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What arterial brance supplies nutrients to the vertebral bodies?
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The anterior vertebral canal branch
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What veins form within the bodies and emerge from foramina on the surfaces of hte vertebral bodies and drain into the external and internal vertebral venous plexuses?
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Basivertebral veins
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What is the spinal cord innervated by?
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The recurrent meningeal branches of spinal nerves
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What structures protect the spinal cord?
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Vertbrae and associated ligaments and muscles, CSF, and the spinal meninges
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The spinal cord is a continuation of what?
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The medulla oblongata
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At what level does the spinal cord end?
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L1 and L2
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The spinal nerve roots arising from the lumbosacral enlargement and conus medullaris which runs through the lumbar cistern
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Cauda equina
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The lumbar cistern is the most common site of what procedure?
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A lumbar puncture
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The posterior roots of the spinal nerves contain which kind of fiber?
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Sensory (afferent) fibers
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The anterior roots of the spinal nerves contain which kind of fiber?
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Motor (efferent) fibers
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The cell bodies of somatic axons contributing to the anterior roots are located where?
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The anterior horns of grey matter
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The cell bodies of axons making up the posterior roots are where?
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Outside the spinal cord in the Spinal Ganglia
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The posterior and anterior nerve roots untie at their points of exit to form what?
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a spinal nerve
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50% of people lack posterior roots on which nerve?
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C1
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The spinal nerve divides to form what?
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A posterior (dorsal) ramus and an anterior (ventral) ramus
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The posterior rami supply what?
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The skin and deep (intrinsic) muscles of the back
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The anterior rami supplies what?
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The limbs and rest of the trunk
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Which rootlets are the longest?
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The lumbar and sacral nerve rootlets
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The spinal meninges
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Dura Mater
Arachnoid Mater Pia Mater |
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Dura mater
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composed of tough, fibrous and some elastic tissue, the outermost covering of the spinal cord
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Arachnoid Mater
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Delicate, avascular membrane composed of fibrous and elastic tissue that lines the dural sac and dural root sheaths. Encloses the CSF-filed subarachnoid space containig the spinal cord, spinal nerve roots and spinal ganglia
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Pia Mater
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Innermost covering membrane of the spinal cord, consists of flattened cells with long, equally flattened processes that closely follow all the surface features of the spinal cord
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Denticulate ligaments
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suspends the spinal cord in the dural sac, runs longitudinally alone each side of the spinal cord
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A lumbar puncture is done into what space?
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Midline between L3 and L4 into the lumbar cistern
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A lumbar injection of epidural anesthesia is done into what space?
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The extradural (epidural) space
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What joint gives the only bony attachment of the upper limb to the trunk?
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Sternoclavicular joint
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Medial 2/3 of the Clavicle vs the Lateral 1/3 of the Clavicle
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The medial 2/3 of the clavicle are convex anteriorly.
The lateral 1/3 is flattened and concave anteriorly. |
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Functions of the Clavicle
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1) Serves as a strut from which the scapula and free limb are suspended
2) Forms one of the boundries of the cervicoaxillary canal which protects the neurovascular bundle supplying the upper limb 3) Transmits shocks from the upper limb to the axial skeleton (FOOSH) |
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What is the thickest part of the scapula?
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The lateral border with the glenoid cavity
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Which is more anterior the greater tubercle or the lesser tubercle of the humerus?
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The lesser tubercle
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What is another name for the bicipital groove?
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Intertubercular sulcus- seperates the greater tubercle from the lesser tubercle
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Articular surfaces at the distal end of the humerus
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The more lateral capitulum and the medila trochlea
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The head of the ulna is distal and has which superficial landmark?
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The ulnar styloid process
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Pnemonic for rembering carpal bones lateral to medial in two rows
|
Some Lovers Try Positions That They Cant Handle :-)
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What is the most commonly fractured bone in the wrist?
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The scaphoid (very poor blood supply) lies within the anatomical snuffbox
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What is the most commonly dislocated bone in the wrist?
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The lunate
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Most common MOI for a clavicular fx
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FOOSH- fall on out stretched hand
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Weakest part of the clavicle
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The junction of hte middle and lateral thirds
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Fracture of this carpal bone may cause ulnar nerve and artery damage
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The hamate
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Main superficial veins of the upper limb
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The anteriorlateral Cephalic Vein and the more medial Basilic Vein
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Basilic Vein
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runs parallely to the brachial artery and merges with the accompanying veins to form the axillary vein
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Pec major and deltoid form the deltopectoral groove which this vein runs through
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cephalic vein
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This muscle protects the subclavian vessels and the superior trunk of the brachial plexus
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Subclavius
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Vein most commoly used for venipuncture
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Median cubital vein
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Attachment of chest mucles on the humerus from lateral to medial
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Pec Major, Lat dorsi, Teres major
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Third part of the axillary artery
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extends from the lateral border of the pec minor to the inferior border to teres major
Branches 1) Subscapular Artery-largest 2) Anterior circumflex humeral a. 3) Posterior circumflex humeral artery |
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The deep artery of the arm
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profunda brachii artery
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Injury to the radial nerve
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Wrist drop
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Injury to the musculocutaneous nerve
|
paralysis of the anterior chamber of the arm
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Contents of the cubital fossa
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1) Terminal part of the brachial artery; radial and ulnar arteries
2) Accompanying veins of the arteries 3) Biceps brachii tendon 4) Median nerve 5) Radial Nerve; superficial and deep branches |
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Anatomical Snuffbox
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APL and EPB laterally and EPL medially
- Radial artery lies on the floor of the snuffbox - Scaphoid and Trapezium lie in the snuffbox |
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Nontender cystic swelling on the dorsum of the wrist
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ganglion cyst
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Lateral Epicondylitis
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Tennis Elbow
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Medial Epicondylitis
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Golfers Elbow
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What are the intrinsic muscles of the back innervated by?
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The dorsal ramus
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The plexuses are made by what?
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The ventral rami
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General Somatic Afferent
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Pain, temp, touch, pressure, proprioception
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General Somatic Efferent
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skeletal muscle
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General Visceral Afferent
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distention, blood pressure, from hollow vicera and blood vessels
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General Visceral Efferent
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smooth muscle, cardiac muscle, glands, adipose tissue
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Cell bodies for the sensory nerves live here
|
Dorsal Root Ganglia
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Sympathetic Division
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Thoracolumbar Outflow
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Parasympathetic
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Craniosacral Outflow
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Thoracolumbar outflow
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Located in interomedial lateral cell column of cord from T1-L3
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Synapse Locations for Preganglionic Sympathetic Fibers
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Paravertibral ganglia of sympathetic chain
Great vessels off the aorta (celiac, superior mesenteric) Chromaffin cells of adrenal medulla |
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Splanchnic Nerves
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Innervate the viscera
cardiac/smooth muscle/glands |
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Postganglionic sympatheic fibers of cervical cardiac nerves and thoracic visceral nerves
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have synapsed in the chain already
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|
Cell bodoes of General Visceral Efferent neurons are in two locations only
|
brainstem and sacral spinal cord
|
|
|
GVE Neurons in the brainstem can only leave the brain at what nerve roots?
|
Cranial nerves 3,7,9,10
|
|
|
GVE Neurons in the sacral spinal cord can only leave the brain at what nerve roots?
|
Exits cord via ventral rami of spinal nerves S2, S3, S4 then branch to form pelvic splanchnic nerves
|
|
|
Synpase locations for Preganglionic Parasympathetic Nerve Fibers
|
Four parasympathtic ganglia of the head
Otic, Submandibular, pterygopalatine, ciliary May sinapse in or near wall of the organ innervated |
|
|
Pelvic Splanchnic Nerves
|
looking for postganglionic synapse on or near the wall of the organ
|
|
|
CN 10- Vagus
|
Distributed to heart and thorax
|
|
|
Main blood supply to the body of the vertebrae
|
Basivertebral vein
|
|
|
quadrangular space
|
axilliary nerve and posterior circumflex humeral artery
|
|
|
triangular interval
|
radial nerve and profunda brachi artery
|
|
|
Structures in the carpal tunnel
|
Palmaris longus tendon
4 tendons of Flex. Digit. Sup. 4 tendons of Flex. Digit. Prof. afferent median nerve |
|
|
Tunnel of Guyon
|
Ulnar nerve and artery
Made by pisiform/hamate |
|
|
Branches of the Thoracoacromial Artery
|
Pectoral
Clavicular Acromial Deltoid |
|
|
Ulnar Artery splits to form
|
Common Interosseus artery
|
|
|
Ribs 1-7 that attach to sternum
|
True ribs
|
|
|
Ribs 8-10 with indirect attachment to the sternum
|
False ribs
|
|
|
Ribs 11-12 with no attachment to the sternum
|
floating ribs
|
|
|
Rib articulation
|
Ribs articulate with the vertebre they are named for and the rib superior to it
|
|
|
Broadest, shortest and most sharply curved of the ribs
-Has two grooves for subclavian vein and artery |
Rib 1
|
|
|
Manubrium level at spine
|
T3-T4
|
|
|
The manubrium and the body lie in slightly different planes
|
sternal angle of Louis
|
|
|
Sternal angle level at spine
|
IV disc at T4-T5
|
|
|
Body of the sternum level at spine
|
T5-T9
|
|
|
Xiphoid process level at spine
|
T10
|
|
|
Sternum movement during inspiration and expiration
A/P movement |
pumphandle movement
|
|
|
transverse movement of the ribs
|
bucket-handle movement
|
|
|
weakest part of the rib
|
just anterior to its angle
|
|
|
most commonly fractured ribs
|
middle ribs
|
|
|
when a sizeable segment of the anterior or lateral thoracic wall moves freely becaue of multiple rib fracture
|
flail chest
|
|
|
extra rib that may compress spinal nerves C and T1 or the inferior trunk of the brachial plexus
|
Cervical rib
|
|
|
Bone used for bone marrow biopsies
|
sternal body
|
|
|
Paralysis of a branch of the phrenic nerve
|
paralysis of the hemidiaphragm
|
|
|
displacement of a costal cartilage from the sternum
|
rub dislocation
slipping rib syndrome dislocation of sternocostal joint |
|
|
dislocation of a costochondral junction between the rib and its costal cartilidge
|
rib seperation
|
|
|
Vasculature of the breast
|
medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery
lateral thoracic and thoraco-acromial arteries |
|
|
Veinous drainage of the breast
|
axillary vein
|
|
|
lymphatic drainage of the breast
|
lymph goes to the subareolar lymphatic plexus and drains to the axillary lymph nodes
|
|
|
creamy white to yellowish premilk fluid produced during the last trimester of pregnancy
|
colostrum
|
|
|
supernumerary breasts (more than 2)
|
polymastia
|
|
|
supernumerary nipples
|
polythelia
|
|
|
thoracic wall innervation
|
anterior rami of T1-T11
|
|
|
external intercostal muscle direction
|
down and forward
|
|
|
internal intercostal muscle direction
|
up and forward
|
|
|
right lung lobes
|
3 lobes
right middle lobe will be in the front |
|
|
seperation of upper and middle lobe of right lung
|
horizontal fissure
|
|
|
seperation of the upper/middle and lower lobes
|
oblique fissure
|
|
|
Parietal pleura
|
sticks close to thoracic wall
|
|
|
Visceral pleura
|
close to the lungs
|
|
|
Pleural cavity (space
|
potential space between the visceral and parietal pleurae
Contains serous fluid that allows lubrication Provides cohesion that keeps lung surface in contact with the thoracic wall |
|
|
Parietal pleura that articulates with the ribs
|
costal pleura
|
|
|
Parietal pleura that articulates with the cervical region
|
cervical pleura
|
|
|
Parietal pleura that articulates with the diaphragn
|
digphragmatic pleura
|
|
|
Parietal pleura that articulates with the mediastinum
|
mediastinal pleura
|
|
|
condition where there is air within the pleural space which makes hte pleuras seperate
|
pneumothorax
|
|
|
treatment for a pneumothorax
|
chest tube inserted between the 5th and 6th rib which releases the air within the pleural space
|
|
|
costal pleura seperated fro mthe wall by
|
endothoracic fascia
|
|
|
Cervical pleura is reinforced by
|
the suprapleural membrane (Sibsons fascia)
|
|
|
costal pleura becomes continuous with mediastinal pleura anteriorly
|
Sternal line of reflection
causes Costomediastinal recess |
|
|
Costal pleura becomes continous with diaphragmatic pleura
|
Costal line of reflection
causes Costodiaphragmatic recess |
|
|
Costal pleura becomes continuous with mediastinal pleura posteriorly
|
Vertebral line of reflection
|
|
|
the line of pleural relflection is slightly deviated on the right side because of the
|
hearts placement under the ribs
|
|
|
the bare area of the pericardium is where you take pericardial samples from
|
so you dont damage the lungs
|
|
|
if youre trying to differentiating between pleural effusion and consolodation
|
do both an A/P film and a lateral decubitus film and see if the fluid moves
|
|
|
lungs are attached to the mediastinum by
|
the root of the lung
|
|
|
components of the pulmonary root
|
main bronchi
pulmonary artery sup/inf pulmonary veins pulmonary plexus |
|
|
Root of the lung
|
formed by the structures entering and emerging from the lung at its hilum
connects with the heart and the trachea |
|
|
Hilum of the lung
|
the area on the medial surface of each lung at the point at whith the structres forming the root can entere and leave the lung
|
|
|
Most posterior aspect of the root of the lung
|
the bronchi
|
|
|
Most anterior section of the root of the lung
|
sup/inf pulmonary veins
|
|
|
middle part of the root of the lung
|
pulmonary artery
|
|
|
the pulmonary arteries supply what part of the lung
|
the respiratory portion (alveoli)
|
|
|
The bronchial arteries supply what part of the lung
|
non-respiratory tissue (pleura, root, supporting tissues)
|
|
|
how many bronchial arteries are in each side of the lung
|
2 in the left 1 in the right
|
|
|
where does the trachia bifurcate
|
the sternal angle
Bifurcates into mainstem/primary bronchi |
|
|
Which bronchus is wider, shorter and runs more vertical
|
the right main bronchus
|
|
|
which bronchus is inferior to the arch of the aorta, longer and anterior to the esophagus
|
the left main bronchus
|
|
|
the lung tissue and visceral pluera as well as the bronchopulmonary nodes make up which plexus
|
superficial (subpleural) plexus
|
|
|
the bronchi & peribronchial connective tissue as well as the pulmonary nodes to bronchopulmonary nodes make up which plexus
|
deep lymphatic plexus
|
|
|
lymph from both plexues drains into
|
to the superior and inferior trachobronchial lymph nodes
|
|
|
the deep plexues eventually drain into the
|
right lymphatic duct or left thoracic duct
|
|
|
What drains into the lymphatic duct (right side)
|
the right lung and left lower lobe
|
|
|
The thoracic duct drains
|
all the body and upper lobe of the left lung
|
|
|
Why can tumors move from one lung to the other?
|
because the lymphatics will carry the tumor to the contralateral side
|
|
|
pain that affects the lung itself is felt by
|
visceral afferents from the dorsal root ganglia
|
|
|
parietal pain is somatic pain felt by
|
the intercostal and phrenic nerves
|
|
|
arteries of the thoracic wall are derrived by
|
the thoracic aorta
subclavian artery axillary artery |
|
|
which structure lies most superiorly in the costal grooves
|
the veins of the thoracic wall
|
|
|
which system carries blood to the superior vena cava
|
azygos/hemimazygos venous system
|
|
|
A viral disease of spinal ganglia
Dermatomally distributed skin lesion |
Herpes zoster (Shingles)
|
|
|
Visual clues of dyspnea (difficulty breathing)
|
using accessory muscles
lean on a table to stabilize pectoral muscles to act on the ribcage |
|
|
bony landmark that demarcates the division between the sup/inf mediastina and the begining of the arch of the aorta
|
sternal angle of louis
|
|
|
What type of cartilage makes up the C-shaped rings of the trachea?
|
Hyaline Cartilage
|
|
|
How many alveolar ducts does each repiratory bronchiole provide?
|
2-11
|
|
|
Each of the alveloar ducts gives rise to how many alveolar sacs?
|
5-6 alveolar sacs
|
|
|
Carries poorly oxygenated blood to hte lungs
|
pulmonary arteries
|
|
|
Carries well oxygenated blood from the lungs to the left atrium of the heart
|
pulmonary veins
|
|
|
right bronchail vein drains into
|
the azygos vein
|
|
|
the left bronchial veins drains into
|
the accessory hemiazygos vein
|
|
|
the nerves of the lungs and visceral pleura
|
contain parasympathetic fibers from the Vagus nerve and sympathetic fibers from the sympathetic trunks
|
|
|
parasympathic nerve functions of the lungs (vagus nerve)
|
bronchoconstrictor, vasodilator, secretomotor
|
|
|
sympathetic nerve functions of the lungs
|
bronchodilator, vasoconstrictor, inhibitory for the glands
|
|
|
accumulation of fluid in the pleural cavity
|
hydrothorax
|
|
|
blood that has entered the pleural cavity
|
hemothorax
|
|
|
lymph from a torn thoracic duct in the plural cavity
|
chylothorax
|
|
|
inflammation of the pleurae
|
pleuritis (pleurisy)
resulting friction can be heard with a stethascope |
|
|
which bronchus is more prone to obstruction
|
the right bronchus because it is shorter and runs more vertically
|
|
|
which pleura cannot feel pain
|
the visceral
|
|
|
the ridge between between the two orifices of the main bronchi
|
carina
|
|
|
Vertebral level that seperates mediastinum
|
T4-T5
|
|
|
which division of the mediastinum contains the heart
|
the middle inferior mediastinum
|
|
|
Which division of the mediastinum is between the pericardium and the sternum
|
anterior inferior mediastinum
|
|
|
where is the thymus located in little kids
|
the anterior mediastinum
|
|
|
What division of the mediastinum houses the thoracic aorta, thoracic duct, azygos and hemiazgos veins, esophagus, thoracic sympathtic trunks and thoracic spanchnic nerves
|
Posterior medastinum
|
|
|
Which division of the mediastinum holds the great vessels and the aortic arch?
|
The superior medastinum
|
|
|
The blood flows from the hemiazogus vein into the accessory vein across the midline into what
|
the azogus vein which drains into the superior venacava
|
|
|
Picks up lymph from the lower limbs and pelvic region
|
Cisterae chylli which carries lymph from everything except the head and neck and R upper limb
|
|
|
which nerve innervates the chest but also innervates the voice box
|
Vagus Nerve
|
|
|
Growth in what structures can cause narrowing of the esophagus
|
distal pharynx
aortic arch left mainstem bronchus diaphram |
|
|
what was the pericardial cavity formed from
|
intraembryonic coelom
|
|
|
what is the fibrous pericardium attached to
|
the diaphragm
|
|
|
what layer is inside the fibrous pericardium
|
the partietal pericardium
|
|
|
where does the visceral layer of the pericardium lay?
|
directly on the heart
|
|
|
innervation of the pericardium
|
phrenic nerve- fibrous and parietal pericardium
fibers from the sympathetic trunk (muscle and vessels) |
|
|
The arterial supply of the pericardium
|
comes mostly from the paricardiaphrenic artery
|
|
|
Less important areriolar contributions to the pericardium
|
Musculophrenic artery
Bronchial, esophageal and superior phrenic arteries Coronary Arteries |
|
|
Movements of the diaphragm are controled by which tendon
|
central tendon of the diaphragm
|
|
|
what ligament attaches the anterior surface of the pericardium to the sternum
|
sternopericardial ligament
|
|
|
what ligament attaches the outer walls of the great vessels leaving the heart
|
adventitia of the great vessels
|
|
|
Condition where fluid is rapidly accumulating in the paricardial cavity
|
cardiac tamponade
|
|
|
most of the sternocostal surface is the wall of what chamber
|
the right ventricle
|
|
|
the Brachiocephalic branch of the aorta turns into what vessel
|
Subclavian artery and common carotid artery
|
|
|
what is the fibrous cord that connects the pulmonary trunk to the aortic arch
|
ligamentum arteriosum
|
|
|
brachiocephalic veins spit to form
|
the jugular and subclavian veins
|
|
|
In reference to midline where does the heart sit
|
1/3 to the right of midline
2/3 to the left of midline |
|
|
the internal thoracic vessels are branches of what artery
|
subclavian artery
|
|
|
Where is the phrenic nerve in relation to the root of the lungs
|
anterior
|
|
|
where is the vagus nerve in relation to the root of the lungs
|
posterior
|
|
|
What are the two branches of left main coronary artery
|
left anterior descending and the circumflex branch
|
|
|
What is the most commonly obstructed branch
|
LAD- left anterior descending
Called the widowmaker |
|
|
What are the four main branches of the right main coronary artery?
|
Right marginal branch
Posterior interventricular artery SA nodal artery (60% of people have one) AV nodal artery (80% of people have one) |
|
|
What seperates the left atrium and left ventricle and emptys into the right atrium?
|
the coronary sinus
|
|
|
What vein accompanies the LAD?
|
the great cardiac vein
|
|
|
what vein accompanies the posterior interventricular artery
|
middle cardiac vein
|
|
|
what vein accompanies the R marginal branch of the R main coronary artery?
|
The small cardiac vein
|
|
|
What is the important pericardial cavity clincially
|
Transverse pericardial sinus
|
|
|
Enlargement of what chamber may put pressure on the structures behind the heart
|
the L atrium
|
|
|
What is the thumbprint like structure that is on the interarterial septum?
|
the oval fossa
used to be a valve in the fetus |
|
|
The valve from L atrium to L ventricle
|
AV valve- tricuspid
|
|
|
Where do you ascultate the aortic valve?
|
right 2nd intercostal space
|
|
|
Where do you ascultate the pulmonaryvalve?
|
left 2nd intercostal space
|
|
|
Where do you ascultate the tricuspid valve?
|
near left sternal border in 5th or 6th costal space
|
|
|
Where do you ascultate the mitral valve?
|
apex of the heart in 5th intercostal space at midclavicular line
|
|
|
How many cusps does the R AV valve have?
|
3 (A/P/S)
|
|
|
How many cusps does the pulmonic valve have?
|
3; R/L/Anterior
|
|
|
How many cusps does the Left AV valce have?
|
2; A/P
|
|
|
How many cusps does hte aortic valve have?
|
3; L/R/P
|
|
|
The interventricular septum has two parts
|
membranous and muscular
|
|
|
Where is the SA node?
|
near junction of SVC with right atrium
|
|
|
Where is the AV node?
|
posterioinferior aspect of interarterial septum near opening of cororany sinus
|
|
|
Where is the atrioventricular bundle of His
|
in the membranous IV septum
|
|
|
The bundle of His splits into the right and left bundle brances where?
|
where membranous meets muscular IV septiim
|
|
|
lubb sound
|
blood is transferred from the atria to the ventricles
|
|
|
dubb sound
|
ventricles contract and expell blood from the heart
|
|
|
lubb sound
|
closure of mitral and tricuspid valves
|
|
|
dubb sound
|
closure of aortic and pulmonary valves
|
|
|
Causes of heart murmer
|
stenosis of valce orifice and failure of valve to fully close
|
|
|
Most frequently diseased valve
|
mitral valve
|
|
|
Locaiton of the appendix
|
Right lower quadrant
|
|
|
External oblique muscles direction
|
down and forward
(same as external intercostal) |
|
|
internal oblique muscles direction
|
down and back
(same as internal oblique) |
|
|
horizontal muscle fibers of the abdomen
|
transverse abdominus
|
|
|
Which of the three folds of the periteneum is more lateral?
|
lateral umbilical fold made by the inferior epigastric vessels
|
|
|
The line where all three connective tissue aporneurosis comes together at midline
|
linea alba
|
|
|
Lateral border of rectus abdominus belly
|
semilunar line
|
|
|
Lower margin of the aporneurosis of hte external oblique
|
inguinal ligament
|
|
|
potential space around the testes
|
tunica vaginalis
|
|
|
fatty superficial fascia covering above the arcuate line
|
Camper's layer
|
|
|
membranous superficial fascia covering below the arcuate line
|
Scarpa's layer
|
|
|
fluid within the peritoneal cavity
|
ascites
|
|
|
Removal of paritoneal fluid with a needle
|
paracentesis
|
|
|
scar tissue formed after surgery where bowel sticks to abdominal wall
|
adhesions
|
|
|
Retroperitoneal structures
|
Pancrease
2,3,4th sections of the duodenem Kidneys and adrenal glands Large vessels from the heart |
|
|
Every organ with a mesentary will be
|
intraperitoneal tissue
|
|
|
umbilical vein becomes
|
round ligament of the liver
|
|
|
Compartment above the transverse colon
|
supracolic compartment
|
|
|
made by artery that communicates the lower part of the truck to the upper part of the truck
|
lateral umbilical fold
|
|
|
Compartment below the transverse mesocolon that allows infracolic space for fluid to travel
|
infracolic compartment
|
|
|
Erect movement of fluid/pus/tumor cells
|
from abdominal region to pelvic region viw paracolic gutters
|
|
|
Supine movement of fluid/pus/tumor cells
|
from pelvic region to subprenic recess
|
|
|
disease that usually causes sever acities
|
chronic liver disease
|
|
|
The lateral fold of the periteneum is made by
|
the inferior epigastric vessels
|
|
|
The medial mbilical fold is made by the
|
umbililcal artery
|
|
|
the median umbilical fold
|
is directly midline from the apex of the urinary bladder
|
|
|
Aporenous that the abdominal muscles connect into
|
the linea alba
|
|
|
the abdominopelvic cavity is a continuous cavity that extends from
|
the thoracic diaphragm and the pelvic diaphragm
|
|
|
Right upper quadrant
|
Liver (right lobe)
Gallbladder Stomach Duodenum Pancreas Kidney Ascending colon Transverse colon |
|
|
Left upper quadrant
|
Liver
Spleen Stomach Jejunum and proximal ileum pancreas kidney transverse colon descending colon |
|
|
Right lower quadrant
|
Cecum
Appendix Most of ileum Ascending colon Right ovary Right uterine tube Right ureter Right spermatic cord Bladder |
|
|
Left lower quadrant
|
Sigmoid colon
descending colon left ovar left uterine tube left ureter left spermatic cord uterus urinary bladder |
|
|
Firm attachment of the skin to the subcutaneous tissue in the abdomen
|
the umbilicus
|
|
|
lining of the internal aspect of the abdominal wall
|
endoabdominal fascia
|
|
|
Innervation of the External oblique
|
Thoracoabdominal nerves (T7-T11 spinal nerves) and subcostal nerve
|
|
|
Innervation of the interal oblique and transversus abdominus
|
Thoracoabdominal nerves (anterior rami of T6-T12 spinal nerves) and first lumbar nerves
|
|
|
Innervation of Rectus abdominis
|
Thoracoabdominal nerves (anterior rami of T6-T12 spinal nerves)
|
|
|
Terminal branches of the inferior thoracic artery that supplies the rectus
|
Superior and Inferior epigastric arteries
|
|
|
Arterial supply to the obliques
|
posterior intercostal arteries
|
|
|
Lines of deliniation between the rectus muscle
|
tendinous intersections
|
|
|
small, insignificant triangular muscle that lies anterior to the inferior part of the rectus abdominis
|
pyramidalis
|
|
|
rectus sheath
|
formed byt he descussation and interweaving of the aponeuroses of the flat abdominal muscles
|
|
|
arcuate line
|
demarcates the transitions between the aponeurotic posterior wall of hte sheath covering the superior three quarters of the rectus and transversalis fascia covering the inferior quarter
|
|
|
as fetus what organ develops outside the peritoneum and pushes its way in
|
the stomach
|
|
|
Nerve for T12
|
subcostal nerve
|
|
|
Nerve root at the level of the ubilicus
|
T10
|
|
|
umbilical hernia
|
common in newborns
increaed intraabdominal pressure |
|
|
aquired umbilical herneas
|
most common and women and obese people
extraperiotoneal fat and peritoneum protrude into the hernail sac |
|
|
epigastric hernia
|
hernia in the epigastric region through the linea alba
|
|
|
Spigelian hernias
|
occurs along the semilunar lines
older then 40 and common in diabetics |
|
|
Indirect inguinal hernia
|
follows the pathway of the inguinal canal and directs the inguinal canal
|
|
|
If you stick your finger inside you'll fee some protrusion of hte abdomen take him to the docor
|
he said so
|
|
|
inguinal region
|
runs between the ASIS and the pubic tubercle
|
|
|
as fetus what organ develops outside the peritoneum and pushes its way in
|
the stomach
|
|
|
Nerve for T12
|
subcostal nerve
|
|
|
Nerve root at the level of the ubilicus
|
T10
|
|
|
umbilical hernia
|
common in newborns
increaed intraabdominal pressure |
|
|
aquired umbilical herneas
|
most common and women and obese people
extraperiotoneal fat and peritoneum protrude into the hernail sac |
|
|
epigastric hernia
|
hernia in the epigastric region through the linea alba
|
|
|
Spigelian hernias
|
occurs along the semilunar lines
older then 40 and common in diabetics |
|
|
Indirect inguinal hernia
|
follows the pathway of the inguinal canal and directs the inguinal canal
|
|
|
If you stick your finger inside you'll fee some protrusion of hte abdomen take him to the docor
|
he said so
|
|
|
inguinal region
|
runs between the ASIS and the pubic tubercle
|
|
|
Inguinal canal
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apporx 4 cm long
deep inguinal ring-enterrance superficial inguinal ring-exit |
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the serous sheath around the scrotum
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tunica vaginalis
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umbilicus level on spine
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L3 L4
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the linea alba in a pregnant woman
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the linea nigra
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slightly curved, linear impressions in the skin that extend from the inferior costal margin near the 9th costal cartilages to the pubic tubercles
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semilunar lines
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site of the inguinal ligament- a skin crease that is parallel and just inferior to the inguinal ligament
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the inguinal groove
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undescended testes
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cryptorchidism
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protrusion of parietal peritoneum and viscera through a normal or abnormal cavity in whihc they belong
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inguinal hernia
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weakness fo the anterior abdominal wall in inguinal triangle and viscera passes through or around the inguinal canal; exits via the superficial ring, lateral to spermatic cord
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direct (aquired) inguinal hernia
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patency of processus vaginalis (young males) ; peritoneum of persistent processes vaginalis plus all three fascial coverings of the cord/round ligament; commonly passes into the scrotum or labium majus
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indirect (congenital hernia)
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supplies 74-80% of blood flow to the liver
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portal vein
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lightly stroking the skin on the medial aspect of the superior part of the thigh with an tongue depressor
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cremaster reflex
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continous, glistening and slippery transparten serous membrane that lines the abdominopelvic cavity and invests the viscera
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pertioneum
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abdominal peritonenum that has more localized pain
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parietal pleura
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visceral pleura pain
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is poorly localized and generally referes to the dermatomes of the psinal ganglia providing the sensory fibres
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which gender is the peritoneal cavity completely closed
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males- females have the vaginal opening
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a double layer of peritoneum that occors as a rsult of the invaginations of the perioneum by an organ and constitutes a continuity of the viscerl and parietal peritoneum
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mesentary
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What connects an intraperitoneal organ to the body wall
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a mesentary
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prominent, four layer peritoneal fold that hands down like an apron from the greater curvature of the stomach
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greater omentum
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double layred peritoneal fold that connects the lesser curvature of hte stomach and proximal part of hte duodenum to the liver
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lesser omentum
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liver is connected to the anterior abdominal wall by the
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falciform ligament
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stomach is connected to the anterior abdominal wall by the
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hepatogastric ligament
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duodenum connected to the anterior abdominal wall by the
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hepatoduodenal ligament
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areas in the visceral peritoneum that is not covered to allow the exit of neurovascular structures
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bare area
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which structure is more posterior the aorta or the esophagus
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aorta
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prevertebral ganglia
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celac or superior mesenteric
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intraperitoneal viscera
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stomach, spleen, small intestine,
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Transverse abdominus innervation
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T7-T11
Subcostal L1 |
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Lies between the internal oblique and the transversus abdominis
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neurovascular plane
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What stops at the level of the arcuate line?
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the rectus sheath
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Rectus sheath below arcuate line
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does have a postior rectus sheath only anterior
the muscles lie directly ont eh transversalis fascia |
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Venous drainage from liver to IVC
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portal system
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Venous drainage only going to the IVC
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systemic systems
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what vein links the porto-systemic circulation
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paraumbilical vein
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What artery enters the rectus muscle at the level of the arcuate line?
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inferior epigastric
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Arterior perfusion to the abdomen
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Subclavian artery--> internal thoracic--> musculophrenic--> superior epigastric-->inferior epigastic--> superficial gastric
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what passes through the inguinal canal
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spermatic cord and round ligament of the uterus and ilioinguinal nerve
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Inguinal canal reinforced medially by
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the lacunar ligamnet
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The deep inguinal ring is located lateral to what vessel
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inferior epigastric vessels
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boundries of the Inguinal (Hesselbach's Triangle)
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Inferior epigastic vessels-laterally
Border of the rectus abdominin- medially Inguinal ligament- inferiorly ***Site of a direct hernia |
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What is differnet between a direct and indirect hernia?
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the direct hernia does not go through the deep ring
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retroperitoneal/extraperitoneal structures
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kidneys, bowel, vertebre, great vessels, 2,3,4th sections of the duodenem, adrenal glands, pancreas
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Mesentary in the colon
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transverse colon
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mesentary in the sigmoid colon
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Sigmoid mesocolon
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secondarily retroperitoneal
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only one wall will have a layer of peritoneum
ex: ascending and decending colon |
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What runs through the omental foramen of Winslow
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IVC, hepatoduadenal ligamnet, liver, duodenum
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Lesser peritoneal sac
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beind the stomach
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lesser omentum
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connects stomach to liver and gallbladder
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Structures running through the hepatoduodenal ligament
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hepatic duct, portal vein, hepatic artery and bile duct
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what is the structure that divides the abdominal cavity into the supracolic and infracolic compartments
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transverse colon
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allows free communication between supracolic and infracolic compartments
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paracolic gutters
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May form after surgery and limit the normal movement of the viscera
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adhesions
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Which of the great vessels lies more laterally?
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the aorta
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Structure that lies closest to the spine in a transverse cut
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aorta
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structure immediately anterior to the aorta in a transverse cut
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esophagus
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structure anteriolateral from the aorta in a transverse cut
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inferior vena cava
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What three structures run together anterior to the spine and lateral to the aorta?
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The thoracic duct, azogus vein and splanchnic nerve
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Which lobe of the left lung has the cardiac notch?
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Cardiac notch
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Which nerve runs more medially- the vagus or the phrenic
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the vagus is medial and posterior
the phrenic is more lateral and stays anterior |
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What is the level of the apex of the lung
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Level of the 1st rib
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How are the lungs attached to the mediastinum?
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by the roots of the lungs
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Roots of the lungs
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bronchi and vessels, pulmonary arteries, superior and inferior pulmonary veins, the pulmonary plexuses of nerves and lymphatic vessels
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Location of the pulmonary artery before the branching of main bronchi
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superiormost on the left
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Location of the pulmonary veins before the branching of main bronchi
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anteriormost and inferiormost respectively
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wedge shaped area on the mediastinal surface of each lung through which the structures forming the root of the lung pass to enter or exit the lung
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the hilum of hte lung
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Splanchnic nerves from medial to lateral
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Greater, lesser. least
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Lungs and visceral pleura gets sympathetic contribution from
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the right and left paravertebral ganglia of sympathetic trunk
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Lungs and visceral pleura gets parasympathetic contribution from
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the right and left vagus nerves (CNX)
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Costal pleura and peripheral part of the diaphragmatic pleura innervated by
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intercostal nerves
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central part of the diaphragm and the mediastinal pleura innervated by
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phrenic nerves
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Thoracentesis
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Obtain sample of fluid or remove blood of pus
Done in the 9th intercostal space in the midaxillary line during expiration |
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Chest tube
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inserted between the 5th and 6th intercostal space in teh midaxillary line
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Arterial supply to the pericardium
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branch of the pericardiacophrenic artery
-musculophrenic artery -bronchial, esophageal, superior phrenic arteries (branches of thoracic aorta) -Coronary arteries (first braches of aorta) |
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Pericardium innervation
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phrenic nerve (C3-C5)
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Thumbprint size depression in the interatrial septum of the right atrium
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oval fossa
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