Anatomic/Clinical Correlations Making Anatomy Practical Flashcards
(102 cards)
1
Q
What does SCALP stand for?
A
Skin
Connective Tissue (Dense)
Aponeurotic Layer
Loose connective tissue
Periosteum
2
Q
What is the Aponeurotic Layer (Galea Aponeurotica)?
A
- Dense fibrous tissue that goes from the Frontalis m. to the Occipitalis m (Occipitofrontalis)
- Move scalp, wrinkle forehead, raise eyebrows
3
Q
What is the Frontalis m innervated by?
A
Temporal branches of the Facial n
4
Q
What is the Occipitalis m innervated by?
A
Posterior Auricular branches of the Facial n (NOT part of To Zanzibar by Motor Car)
5
Q
We learned the mneumonic “To Zanzibar By Motor Car” to remember the branches of the Facial n. What are the branches?
A
Temporal
Zygomatic
Buccal
Mandibular
Cervical
6
Q
Where do infections spread in the scalp?
A
Loose connective tissue (where scalp moves)
7
Q
The first 3 layers of the scalp are tightly held together forming a unit called?
A
Scalp proper (what is “scalped”)
8
Q
The skin and dense connective tissue are very ___, so there is a great deal of bleeding
A
Vascular
(dense CT keeps vessels open)
9
Q
Vascularity to the Scalp is supplied by what arteries?
A
-
Internal Carotid Artery
- Opthlamic > Supratrochlear & Supraorbital
-
External Carotid Artery
- Superficial Temporal, Posterior Auricular, Occipital
10
Q
What is the dividing line of sensory innervation of the scalp?
A
Ears and Vertex
11
Q
What nerves are anterior to the dividing sensory line of the scalp?
A
Cranial Nerves
(Trigeminal - Supratrochlear, Supraorbital, Zygomaticotemporal, Auriculotemporal)
12
Q
What nerves are posterior to the dividing sensory line of the scalp?
A
Cervical Nerves
- C2 “Sleep Area” Greater auricular n, Greater & Lesser Occipital nn
- C3 - Third Occipital n
13
Q
Motor innervation to the scalp is via what nerve?
A
Facial N
14
Q
The Lymphatic System mainly collects fluid lost from where?
A
- Vascular capillary beds during nutrient exchange processes
- Drainage of body organs & structures
15
Q
In Small Bowel, certain fats are absorbed and processed by the intestinal epithelium and are formed into ___ that flow into lymphatic drainage of bowel
A
chylomicrons
16
Q
Lymphatic flow occurs secondary to?
A
Motion of adjacent structures
*lymph drainage areas are specific to certain anatomic locations
17
Q
Lymph: Right and Left Jugular trunks (superficial and deep) drain into what structures?
A
Head and Neck
18
Q
Lymph: Right and Left Subclavian trunks drain what regions?
A
- Upper limbs
- Superficial regions of the throacic & upper abdominal wall
19
Q
Lymph: Right and Left Bronchomediastinal trunks drain what structures?
A
- Lungs
- Bronchi
- Mediastinal structures
- Thoracic wall
20
Q
Lymph: The Thoracic duct drains what regions?
A
- Lower limbs
- Abd walls & viscera
- Pelvic walls & viscera
- Thoracic wall
21
Q
Lymph Drainage of Head & Neck: the Jugulodigastric nodes are in the ___ area and the Jugulo-omohyoid nodes are in the ___ area
A
Tonsillar
Tongue
22
Q
How many lymph nodes drain the Upper Limb and adjacent trunk, neck, and anterolateral abd wall?
A
23-30 lymph nodes
23
Q
What lymph nodes drain all the others in the Upper Limb region?
A
Apical nodes
- These join the Subclavian trunks that drain into the R Subclavian V on R and Thoracic Duct on L
24
Q
Lymph: Intrathoracic Drainage goes into the ___ duct on the Left and ___ on the Right
A
Thoracic
Subclavian
25
Lymph: What drains the abd viscera, walls, pelvis, perineum, & lower limbs?
Cisterna Chyli
26
Lymph: What does the Thoracic duct drain?
* Cisterna Chyli
* L Jugular Trunk (Head & Neck)
* L Subclavian Trunk (L Upper Limb)
* Thoracic wall
* Posterior mediastinum & diaphragm
27
Lymph drainage of the breast is 75% to what nodes?
Axillary
28
Lymph: Deep Pelvic structures drain into?
Internal & External Iliac chains
\*Deep Perineal drain into Internal
29
Lymph: Superficial Perineal structures (Penis, Scrotum, Clitoris, Labia majora) drain into the?
Superficial Inguinal nodes
30
Lymph: Superficial Perineal structures (Glans penis/clitoris, Labia minora, inferior Vagina) drain into the?
Deep inguinal nodes & External Iliac chain
31
The Ovaries, related Uterine structures, and Testes (accompany gonadal arteries) drain into the?
Lateral and Pre-Aortic nodes
32
Lymph: Where do the lower extremities and Perineal structures drain into?
Superficial & Deep Inguinal Nodes
33
The Greater Saphenous V (thigh and medial leg) joins the ___ \_\_\_ V
Common Femoral
34
The Lesser Saphenous V (posterior leg) joins the ___ V
Popliteal V (in popliteal fossa)
35
The Lateral Cutaneous V of the thigh joins the ___ \_\_\_ V
Greater Saphenous
36
What are the Deep Veins of the Lower Extremity?
* Common Femoral
* "Superficial" Femoral
* Profunda Femoris (Deep Femoral)
* Popliteal
* Posterior Tibilal - posterior to tibia
* Anterior Tibial - anterior to tibia
* Peroneal (Fibular) - posterior to fibula
37
In Varicose Veins what does normal flow depend on?
Competent valves in both the Superficial and Deep systems
38
In Varicose Veins what contributes to venous varicosities in the Superficial Venous system?
Valvular incompetence
39
In Vericose Veins what can damage valves?
Deep venous thrombosis (DVT)
40
What sx can occur with Varicose Veins?
* Brown pigmentation (RBC breakdown)
* Venous eczema
* Stasis dermatitis
* Skin ulceration
41
What is Virchow's Triad?
1. Endothelial injury
2. Stasis
3. Hyper-coagulability
42
Lack of compressability of veins on US should make you think of what Dx?
DVT
43
Sensory Innervation of the Outer and Deep Auricle of the ear?
* Outer Auricle - **V3** (Auriculotemporal), **C2, C3** (Lesser Occipital, Great Auricular)
* Deep Auricle - Facial **VII**, Vagus **X**
44
What nerve supplies the majority sensory innervation to the External Auditory Canal (Meatus)?
* Trigeminal V3 (Auriculotemporal) &
* Vagus X (Auricular branch - **Arnold's or Alderman's n**)
* Minor sensory = Facial VII
45
What supplies sensory innervation to the External surface of the skin of the Middle Ear?
* Trigeminal V
* Facial VII
* Vagus X
46
The Middle Ear communicates with the ___ \_\_\_ ___ and the Nasopharynx (Pharyngotympanic tube)
Mastoid Air Cells
47
What is the relationship of the Facial n and Chorda Tympani?
* Medially Tympanic Plexus is part of IX
* Greater Petrosal n - PS to all glands above the oral fissure (lacrimal, mucous, salivary)
48
Extensive anastomoses create what plexus in the nasal cavity?
Kiesselbach's Plexus (medial wall - Septum)
49
Epistaxis - other arterial supply
* Internal Carotid Artery
* Posterior, **Anterior Ethmoid** (branches of Ophthalmic)
* External Carotid Artery
* **Sphenopalatine**
* **Greater Palatine**
* **Superior Labial**
* Lateral nasal
50
Epistaxis: Venous supply - ___ \_\_\_ are routes of infection intracranially
Emissary Veins
51
What is the major artery of epistaxis?
Sphenopalatine!
52
"Some Anatomists Like Freaking Out Poor Medical Students" is to help remember the branches of the External Carotid Artery. What are they?
**S**uperior thyroid
**A**scending pharyngeal
**L**ingual
**F**acial
**O**ccipital
**P**osterior auricular
**M**axillary
**S**uperficial Temporal
53
What are some major indications for a Lumbar Puncture/Spinal Tap?
Eval CSF for:
* Microbiological (infx)
* Cytological (CA)
* Biochemical
* CSF pressure status
* Meningitis - esp infants' w/u for fever
* Inflamm (MS, Guillain-Barre, Sarcoid)
* Subarachnoid Hemorrhage
* Epilepsy
* Leptomeningeal carcinoma
* Myelography (introduce contrast media)
54
Local and spinal anaesthetics can be injected into what spaces to anaesthetize the lumbar or sacral roots?
Extradural or Subarachnoid spaces
\*pts are placed erect afterwards
55
What is a "Blood Patch"?
A small amount of blood is placed in the epidural area for Spinal Headache 2/2 to Lumbar Puncture
56
Contraindications for a LP/Spinal Tap
* Inc intracranial pressure (may cause herniation of brain stem into Foramen Magnum & death)
* Coagulopathy
* Dec Platelets
* Kyphoscoliosis (technically difficult, need experienced hand)
57
What imaging is used to determine if there is a significant intracranial mass lesion or cerebral edema that could be causing inc CSF pressure?
CT or MRI
58
What should you do if an elevated CSF pressure is found (2/2 mass lesions, cerebral edema, infx, tumor infiltration, benign intracranial HTN)?
Only the smallest amount of CSF should be drawn off for analysis
\*Caveat: **do not** attempt to reduce CSF pressure by letting out CSF through a spinal tap - sudden downward flow of released fluid pulls brainstem into foramen magnum causing death
59
T/F: A Lumbar Puncture can be used under certain circumstances to relieve increased intracranial pressure
True (Benign Intracranial HTN - Pseudotumor cerebri)
60
At what level do you access the Spinal Canal for a LP?
L4-L5
61
What level is the Conus Medullaris in adults?
L1-2
62
In infants the Conus Medullaris can be much lower than in adults - it can be as low as what level?
L3
63
What structures of the spine does the needle for a LP pass through?
Between adjacent _vertebral spinous processes_ through the _supraspinatous & interspinous ligaments_, then past the _Ligamenta flava_
64
What key equipment is in a Lumbar Puncture kit?
Atraumatic needle and stylus (piece of metal inside needle to make it solid)
65
What position is a patient usually placed in for a Lumbar Puncture?
Horizontal decubitus position, body flexed in fetal position, spine horizontal to the floor
66
When performing a LP the needle/stylus should be kept _horizontal_ and directed where?
Between the intraspinous spaces (parallel to spinal process - angle upwards NOT straight in)
67
What color is normal CSF?
Crystal clear
68
What is the normal pressure of CSF?
80-180 mm H2O
\*Elevated \>220 (tumors, meningitis)
69
LP Considerations: What do Polymorphonuclear leukocytes suggest?
Meningitis with bacteria or viral origin or vasculitis
70
LP Considerations: Xanthochromic fluid suggests?
Subarachnoid hemorrhage within the last several days or weeks
71
LP Considerations: High protein in CSF suggests?
* Infx
* Tumor
* Demyelinating polyneuropathies
* Spinal block above the spinal tap
72
LP Considerations: Bright green CSF suggests?
Pseudomonal meningitis
73
CSF Glucose levels should be about ___ percent of blood glucose levels
60%
74
What does a low glucose level in CSF suggest?
* Bacterial infx
* Infiltrative tumors
* Leptomeningeal carcinomatosis
75
What are complications of a LP?
* Traumatic tap: blood
* Spinal HA - pulsatile HA exacerbated by standing & valsalva maneuvers, eased by laying down
* Nerve root trauma
* CNS infx in immunocompromised pts
* Subdural Hematomas
* Discitis, venous air introduction, CN 4 & 6 palsies
76
Central or paracentral Herniated Discs can impinge on the ___ \_\_\_ and give a false impression of where the herniation may be
Cauda Equina
\*ie a L3-4 central disc can encroach on the L4 root
77
A ___ \_\_\_ disc at a given disc level will most often encroach on the nerve root emerging at that level
Lateral herniated
\*ie a L3-4 lateral disc will encroach on the L3 root
78
The nerve roots in the lumbar spine emerge from the spinal canal ___ their pedicle
**below**
79
Nerve roots in the Lumbar Canal can be centrally located and encroached upon by what?
Herniated Discs
80
Knee Jerk Reflex dermatome
L2-4 (Quadriceps)
81
Ankle Jerk Reflex dermatome
S1 (Gastrocnemius)
82
Foot Drop dermatome
L5
83
What is the French System for catheter size?
* The higher the number, the thicker the catheter
* Fr = 3x outside Diameter in mm
* Used for internal caths, angiographic, and urinary
84
Examples of Angiogram Catheters
1. Flush - aorta or IVS - bolus of fluid
2. Headhunter - through groin \> descending aorta
3. Sidewinder
85
What is the rule of thumb for Hypodermic Needle guage?
The higher the number, the _thinner_ the needle
\*21 used for drawing blood, 16/17 blood transfusions, 25-27 immunizations
86
CT evaluation can pick up ___ within cardiac vascular structures that correlate with atherosclerosis
calcifications
87
What is a marker for a diseased artery?
Calcium
88
Often ___ \_\_\_ are 2/2 to a degenerative process attributed to ASCVD
Aortic Aneurysms
\*atherosclerotic changes in the aorta can lead to this
89
PVD: What can occur 2/2 to chronic HTN?
Aortic dissection
90
A widened mediastinum on CXR should make you think of what Dx?
Aortic dissection
91
An aortic dissection occurs when an intimal tear connects the ___ with the ___ lumen
Media
Aortic
92
In an aortic dissection a ___ & ___ lumen are established and there is obstruction of branching vessels and weakening of the aortic wall with rupture
True
False
93
What condition usually involves both a curvature and also a rotational component of the spine?
Scoliosis and Rotoscoliosis
94
Causes of Scoliosis and Rotoscoliosis
* Idiopathic MC
* 2/2 neurological, (polio, cerebral palsy) musculodystrophy, or bone and spinal cord tumors/abnormalities
* Scoliosis at birth (congenital) occurs with other abnormalities of the chest wall, GU tract, and heart
95
Metastatic Prostate CA can involve?
* The Spinal Canal, Spinal Cord, or Nerve Roots
* Present with neurological signs
96
Prostate CA most commonly metastasizes to?
BONE
97
Signs of Child Abuse
* Rib fractures - Battered Child Syndrome
* Multiple fractures found in children \< 5yo, particularly \< 1yo
* In different stages of healing
* Metaphyseal corner fx in femur, humerus, wrist, ankle
* Spiral fx \< 1yo
* Rib fx, Skull fx - Occipiral bone fx with abundant callus formation
* Beware there are other entities that can mimic Battered Child Syndrome
98
Rib fractures in child abuse can be associated with?
* Pneumothorax
* Hemothorax
* Other intrathoracic trauma - Pulmonary Contusion
* Aortic Tears
* Other soft tissue injury
99
In certain infections, the Intervertebral Disc is infected (TB, Salmonella) and can spread to what muscle?
Psoas
100
What Dx can sometimes mimic a Psoas abscess?
Appendicitis
101
What is a positive Psoas Sign?
During movement of flexing the right leg with the knee extended, if the appendix is inflamed, the patient will feel pain/spasm in the psoas muscle/RLQ
102
What is the size of a RBC?
8 microns
