anatomy block II

Question 0

What is flail chest? What is typical treatment?

Answer 0

flail chest is when a sizable segment of the anterior or lateral thoraciw wall moves freely because of multiple rib fractures. It is very painful and can impede breathing. Treatment involves reattaching the ribs with hooks/wires.

Question 1

How are intercostal spaces named?

Answer 1

for the rib that is just superior to the intercostal space (so, the 2nd intercostal space is below the 2nd rib)

Question 2

Why might I care about cervical ribs?

Answer 2

Because cervical ribs, which would extend from C7, could compress the C8 and T1 spinal nerves and/or the subclavian artery, leading to nerve problems and ischemia.

Question 3

What is the most common sternal fracture? How does it occur? What are the big concerns?

Answer 3

Manubriosternal fracture; can lead to problems with heart and lungs; usually occurs from a crushing injury (think car accident

Question 4

What happens when the diaphram is paralyzed?

Answer 4

One half only can be paralyzed, since each phrenic nerve innervates 1/2 of the diaphram dome. when this happens, the diaphram moves paradoxically (up on inspiration due to pushing from compressed abdominal organs; down in exhalation due to positive pressure in thoracic cavity

Question 5

What is the lymphatic drainage of the breast?

Answer 5

first lymph drains to the subareolar lymphatic plexus. from there, most of it goes to the axillary lymph nodes (esp. from lateral breast, esp. to pectoral nodes), which eventually makes its way to the subclavian lymphatic trunk
Some lymph from the medial breast drains to the parasternal lymph nodes or the opposite breast; from the parasternal nodes it goes to the bronchomediastinal trunks and then the thoracic or right lymphatic duct.
some from the inferior breast goes to the abdominal lymph nodes.

Question 6

What are the accessory muscles for breathing?

Answer 6

pectoralis major, pectoralis mino, serratus anterior (inferior part), scalene muscles (neck to first and second rib that help fix these ribs so that muscles below can be more forceful during inspiration).

Question 7

what arteries supply the intercostal spaces?

Answer 7

pair of small anterior intercostal arteries and a large posterior intercostal artery– this is the one that we saw with the VAN between the innermost and interior intercostal muscles.

Question 8

what up with herpes zoster

Answer 8

aka shingles- a dematomally distributed skin leason. the virus invades the spinal ganglion and goes along the axon to the skin.

Question 9

what do you need to do to get numbing of an area of skin covering the thorax?

Answer 9

anesthitize two or more adjacent intercostal spaces, since there is usally considerable overlap of contiguous dermatomes.

Question 10

Where do you auscultate for the base of the lung (inferior part of the bosterior costal surface of the inferior lobe)?

Answer 10

inferoposterior aspcet of the throacic wall at the levelo f the t10 vertebrae.

Question 11

Where are aspirated foreign bodies most likely to end up? Why?

Answer 11

right bronchus because it is wider and shorter and runs more vertically

Question 12

Which part of the pleura is insensitive to pain? Which part isn’t? Where is pain referred from the part of the pleurae that can detect pain?

Answer 12

Visceral pleura is pain insensitive
parietal pleura can feel pain, expectially the costal pleura. Costal pleura pain results in referred pain along the intercostal nerves to the thoracity and abdominal walls. mediastinal and central diaphragmaitc parietal pleura referrs pain to the root of the neck and over the shulder (C3-C5 dermatomes- sort of runs with phrenic nerve).

Question 13

What is pulmonary emoblism and what happens in a pulmonary embolism?

Answer 13

pulmonary emolism is when part of the lung is obstructed by some sort of clot (ie. blot clot, fat glbule, air bubble). It causes prblems because this clot can block blood flow through the pulmonary artery, which would mean that lots of blood isn’t having the chance to be perfused and causing acute respiratory distress, or by blocking one of the arteries that supplies a bronchopulmonary segment

Question 14

What structure might you see in a bronchoscopy?

Answer 14

The carina, which is a cartilaginous ridge where the trachea branches into the two bronchi. It might be distorted by lung cancer if the lung cancer has entered and enlarged the tracheobronchial lymph nodes.

Question 15

Where is the superior mediastinum? What about the inferior mediastinum and its divisions?

Answer 15

superior extends from the superior thoracic aperture to the sternal angle/ T4-T5 vertebrae. The inferior mediastinum estends from the sternal angle to the diaphragm but is divided into the anterior (stuff above the heart part), middle (heart, great vessels, arches of aorta aand azygous vein, bronchi) and posterior mediastinum (stuff below the heart like the esophagus, thoracic aorta, azygous and hemiazygous veins, thoracic duct, vagus nerves, sympathetic trunk, splanchnic nerves etc)

Question 16

waht is the surgical significance of the transverse pericardial sinus?

Answer 16

can be used in cardiac surgery as a site where the aorta and pulmonary trunk are lited off to divert circulation to these arteries.

Question 17

Where is pain from the pericardium felt? what nerve is that from?

Answer 17

Phrenic nerve- C3,4,5 dermatomes.

Question 18

Why is pericardial effusion bad news?

Answer 18

fluid in the pericardial cavity limits expansion of the heart, so it can’t fill withe blood and doesn’t pump blood as effectively

Question 19

What is cardiac tamponade? how do you treat it? Where do you perform this treatment?

Answer 19

tamponade- heart compression. bad news because the fibrous pericardium won’t expand all of a sudden, and so heart really can’t pum well. usually needs to be treated with pericardiocentisis, where you drain the heart by inserting a needl throu ght left FIFTH or SIXTH intercostal spaces.

Question 20

What are the three layers of the heart, superfical to deep?

Answer 20

epicardium (aka visceral layer of the serous pericardium), myocardium endocardium

Question 21

what is the embryonic origin of the right atrium?

Answer 21

primoridail atrium forms the right auricle; the rest comes from the sinus venosis

Question 22

What structures are in the right artrium?

Answer 22

right auricle, crista terminalis (between the parts derived from the primordial atrium and the the parts derived from the sinus venosis), svc and ivc and coronoary sinus, pectinate muscles, fossa ovalis,

Question 23

what are the important structures of the right ventricle?

Answer 23

conus arteriosus/infundibulum, trabeculae carnae, tricuspid valve, cordae tendoneae, papillary muscles, moderator band,

Question 24

Why is the moderator band important?

Answer 24

it helps conduct signal from the av node so that the right ventricle contracts in a coordinated fashion.

Question 25

what structures do we see in the left atrium?

Answer 25

pectinate muscles, valveless pulmonary veins, the mitral valve opening, foramen ovale

Question 26

what structures do we see in the left ventricle?

Answer 26

mitral valve, trabeculae careae, papillary muscles, aortic semilunar valve, cordae tendonae

Question 27

What is stenosis and what is insufficiency?

Answer 27

stenosis- partially clogged/stiffened valves | insufficiency- failure of a valve to close completely

Question 28

what is the most frequent valve abnormality?

Answer 28

aortic valve stenosis

Question 29

what are the four areas of auscultation of the heart?

Answer 29

Aortic valve: 2nd intercostal space to the right of the sternal border (patient's right) pulmonary valve: 2nd intercostal space to the left of the sternal border tricuspid valve: near the left sternal border in the fifth or sixth intercostal space mitral valve: att e apex of the herat in the fifth intercostal spaces in the midclavicular line.

Question 30

what parts of the heart are supplied by the coronary arteries?

Answer 30

the epicardium and the myocardium

Question 31

what are the most important branches of the right coronary artery?

Answer 31

right nodal, posterior interventricular; often supplies AV and SA nodes

Question 32

What is the main venous drainage of the heart?

Answer 32

coronary sinus

Question 33

What are the three most common sites of coronary artery occlusion?

Answer 33

1. The LAD 2. the right coronary artery 3. the circumflex bracnch of the left coronary artery

Question 34

What usually supplies the AV and SA nodes

Answer 34

SA: RCA AV: RCA and LAD

Question 35

What happens in a bundle branch block?

Answer 35

excitation passes only along an unaffected branch, so only one ventricle contracts normally. then the impuse spreads to the other ventricle, but by that time it leads to a late asynchronous contraction.

Question 36

what are the branches of the SVC, and what are the branches' branches?

Answer 36

the svc branches into the right and left brachialcephalic veins. the brachiocephalic veins branch into the sublcavian fveins (right and left) and the internal jugular veins (right and left)

Question 37

What are the branches of the arch of the aorta?

Answer 37

brachiocephalic trunk, left common carotid artery, left subclavian artery the cbrachiocephalic trunkdivides into the right common carotid and the right subclavian arteries.

Question 38

Which side has the azygous veins? And the hemiazygous veins?

Answer 38

azygous is on the right side of the thoracic cavity; hemiazygous veins are on the left side of hte thoracic cavity.

Question 39

Into what vein does the azygous vein drain?

Answer 39

SVC

Question 40

What is coarctation of the aorta? What is the most common site for coarctation of the aorta?

Answer 40

coarctation happens when there is abnormal aortic narrowing/stenosis. It most frequently happpens neart he ligamentum arteriosum.

Question 41

What does the thymus do?

Answer 41

pre puberty, it helps develp and mantain the immune system. after puberty it begins to be replaced by adipose tissue, though it still makes t lymphocytes.

Question 42

Which ribs are most commonly fractured?

Answer 42

Ribs 2-10

Question 43

Generally speaking, what is the PRIMARY function of all the intercostal muscles?

Answer 43

Keep intercostal spaces rigid during respiration

Question 44

Where do most breast cancers develop?

Answer 44

Upper outer love and its axillary tail

Question 45

Why do we see dilation of the neck veins in cardiac tamponade?

Answer 45

The heart is compressed, and blood returning to the heart can't be passed into the heart. So neck veins and svc get much higher pressures.

Question 46

What artery is most commonly involved in myocardial infarction?

Answer 46

Lad branch

Question 47

What valve is most commonly prolapsed? Why?

Answer 47

Mitral valve, because of increased mechanical stresses, rheumatic heart disease, infective endocarditis, etc.

Question 48

What region of the parietal pleura is located just superior to the middle third of the clavicle

Answer 48

The cupula, or apex of the cervical pleura

Question 49

After mi a patient has very low left ventricular functioning. Where should we put the leads for his pacemaker?

Answer 49

Right ventricle so that they can stimulate the purkinge fibers of the interventricular septum

Question 50

Why is the sternal angle important?

Answer 50

ODivides the mediastinum, marks the second rib, can be used as a landmark, marks the site of tracheal bifurcation and the beginning of the aortic arch

Question 51

What key structures like in the posterior mediastinu

Answer 51

Esophagus, thoracic aorta, aygous veins, sympathetic trunks, thoracic splanchnic nerves, thoracic duct

Question 52

Which veins would you use to thread a catheter to the ivc if you needed to deploy a filter for catching thrombosis

Answer 52

Right internal jugular to right brachiocephalic to svc to right atrium to the ivc

Question 53

What is the esophageal plexus?

Answer 53

A nerve plexus formed by the vagal trunks as they pass thru the thorax, pass over the esophagus and into the abdominal area. Left vagus forms most if the anterior part of the plexus, right vagus forms most of the posterior trunk.

Question 54

What structures compress the esophagus in the superior mediastinum?

Answer 54

Arch of the aorta and the trachea

Question 55

Imaging through the esophagus revels enlarged heart chamber. Which one?

Answer 55

Left atrium

Question 56

What is the azygous system of veins?

Answer 56

Deep veins that connect both the caval and the portal systems. This system drains the thoracic walls, some thoracic viscera, and drains into the svc.

Question 57

Where would pain from the diaphragm refer?

Answer 57

Well,nremember that c3,4,5 innervate phrenic nerve. So pain goes to these dermatomes- shoulder and neck

Question 58

Defects that affect where the svc and ivc enter the right atrium speak to probs with which part of the primitive heart tube?

Answer 58

The sinus venosis

Question 59

What nerve is most likely involved in aneurysm of the aortic arch?

Answer 59

Left phrenic nerve as it passes over the aortic arch. Will cause dyspnea and pain in the left shoulder

Question 60

What is the carina?

Answer 60

Cartilage nous ridge that runs anetorposteriorily between the two primary bronchi at the site of tracheal bifurcation.

Question 61

what lymph nodes are just below the carina?

Answer 61

inferior tracheobronchial/ carinal nodes

Question 62

describe the venous drainage of the neck/head

Answer 62

we have right and left subclavian veins and right and left internal jugular veins. the right subclavian and right internal jugular veins come together to form the right brachiocephalic vein; the left internal jugular and left subclavian veins together form the left brachiocephalic vein as well, which is much longer than the right brachiocephalic vein. the brachicephalic veins then join with the SVC to enter the right atrium.

Question 63

what is one important clinical aspect of the azygous vein?

Answer 63

it arises from the IVC and feeds into the SVC, so it can drain the thoracic and abdominal walls and can help drain the IVC in some cases if the IVC becomes blocked.

Question 64

what is drained by the thoracic duct? Where does it drain into?

Answer 64

the thoracic duct conveys lymph from the lower half of the body and the left side of the thorax. It drains inoth the venous system near the union of the left internal jugular vein and the subclavian veins.

Question 65

What are the borders of the anterior triangle of the neck?

Answer 65

anterior border of the sternocleidomastoid muscle, the midline of the neck, and the inferior border of the mandible

Question 66

What are the borders of the posterior triangle of the neck?

Answer 66

The posterior border of the sternocleidomastoid muscle, the anterior border of the trapezius, and the middle third of the clavicle.

Question 67

Describe the fascia of the neck (hint: 4-5 fascia).

Answer 67

Most superficial: superficial cervical fascia. surrounds the whole neck, just below the skin (covers the platysma), and contains some lymphatics, neurovascular bundles, fat. THREE categories of deep cervical fascia: 1. INVESTING fascia: surrounds the whole neck- encloses the trapezius and the sternocleidomastoid. 2. PRETRACHEAL fascia: a whole collection of fascias that surround the trachea, esophogus, and thyroid. (note that directly behind the trachea we actually see the buccopharyngeal fascia- don't need to the know the name but do need to know that the pretracheal fascia doesn't go all the way around). 3. PREVERTEBRAL: found around the vertebral column and associated muscles

Question 68

What is found in the carotid sheath?

Answer 68

the vagus nerve (CNX), the common carotid artery (and the internal carotid artery), the internal jugular vein

Question 69

going from lateral to medial, what are the three major veins of the neck?

Answer 69

external jugular vein, internal jugular vein (in the carotid sheath), and anterior jugular vein

Question 70

What are the arterial branches that you actually saw in lab? Off of what do they branch?

Answer 70

The external carotid artery, which lies superficial to the internal carotid artery, branches into the superior thyroid artery, the lingual artery, and then forms a trident with the facial and occipital arteries

Question 71

What forms the cervical plexus?

Answer 71

the ventral rami of C1-C4

Question 72

what is the other name for the hypoglossal nerve?

Answer 72

CN12

Question 73

what are the names of the two named lymph nodes of the neck that we care about?

Answer 73

jugulodigastric and the juguloomohyoid

Question 74

What is the main lymphatic drainage of the neck? Where is it?

Answer 74

deep cervical lymph nodes lie deep to the sternocleidomastoid

Question 75

Where do the deep cervical lymph nodes drain?

Answer 75

on the right side, they drain into the right lymphatic duct; on the left side, they drain into the thoracic duct

Question 76

what is the cartilage of the neck?

Answer 76

cricoid cartilage (below), thyroid cartilage (the adam's apple)

Question 77

what is the retropharyngeal space and why do we care?

Answer 77

retropharyngeal space is the area between the prevertebral fascia and the buccopharyngeal fascia that can serve as an important route for the travel of infection from the neck into the thorax

Question 78

what are the infrahyoid muscles? what are their actions and innervations?

Answer 78

omohyoid, sternohyoid, sternothyroid, thyrohyoidd innervated by the cervical plexus branches omohyoid and sternohyoid innervated by c1-c3. sternohyoid by c2 and c3 thyrohyoid by c1 action is to depress the hyoids and to stabilize the attachments of the suprahyoids

Question 79

What are the suprahyoid muscles? What are their actions and innervations? There are two that you might easily confuse- how can you tell them apart?

Answer 79

geniohyoid, anterior and posterior bellies of the digastric , mylohyoid, stylohyoid,

Question 80

What does the 3rd embryonic aortic arch give rise to?

Answer 80

common carotids and proximal internal carotids bilaterally

Question 81

What does the 4th embryonic aortic arch give rise to?

Answer 81

proximal right subclavian and a portion of the aortic arch on the left

Question 82

What does the 6th aortic arch give rise to?

Answer 82

proximal pulmonary arteries and the ductus arteriosis

Question 83

How is the aorta formed?

Answer 83

fustion of two dorsal aortae in midline

Question 84

What is formed by anterior cardinal veins?

Answer 84

internal jugular veins and the superior vena cava

Question 85

what do the posterior cardinal veins form?

Answer 85

portionsof the azygos connections to the SVC and common iliac veins

Question 86

what is formed by the supracardinal veins?

Answer 86

azygos system of veins and some of the inferior vena cava

Question 87

what do the subcardinal veins form?

Answer 87

the inferior vena cava, renal, and gonadal veins

Question 88

what vein carries blood from the placenta to the heart?

Answer 88

the left umbilical vein

Question 89

what are the six lymph sacs of development?

Answer 89

two jugular sacs two iliac sacs one retroperitoneal sac the cisterna chyli (beginning of the thoracic duct)

Question 90

What major nerves, arteries, veins exit in the anterior triangle? Where do the exit?

Answer 90

the axillary artery and the brachial plexus exit the neck between the middle and anterior scalene muscles. In contrast, the axillary vein lies anterior to the anterior scalene muscles to avoid compression.

Question 91

what are the important branches of the subclavian artery? What do they supply?

Answer 91

subclavian artery first branches into the vertebral artery (supply C6-C1), then the thyrocervical trunk (whose branches supply the thyroid and a bunch of other stuff)

Question 92

what are three important branches of the thyrocervical trunk?

Answer 92

inferior thyroid artery, transverse cervical and suprascapular atreries (these both supply the scapula)

Question 93

What drains most of the neck? Is there a route for collateral venous drainage?

Answer 93

internal jugular veins drain most of the neck. there is a route for collateral drainage, since the inferior thyroid veins drain directly into the brachiocephalic vein.

Question 94

where does the thoracic duct drain?

Answer 94

right at the junction of the internal jugular vein and the subclavian vein

Question 95

what forms the ansa cervicalis?

Answer 95

a superior root of c1 and an inferior root of c2 and c3

Question 96

what is the facial nerve (number)? what does it innervate?

Answer 96

facial nerve is cranial nerve VII. Innervates the platysma, the sylohyoid, and the posterior belly of the digrastric muscle. also mediates facial expression

Question 97

what does the vagus nerve innervate in the neck

Answer 97

pharanx, larynx, palate, cricothyroid

Question 98

What does the accessory nerve innervate?

Answer 98

XI. innervates the trapezius and the sternocleidomastoid

Question 99

What is the hypoglossal nerve? What does it innervate?

Answer 99

hypoglossal nerve is the 12th cranial nerve, and innervates the muscles of the tongue.

Question 100

What is the blood supply to and venous drainage from the thyroid gland?

Answer 100

blood supply to: two arteries, the superior and inferior thyroid arteries. the superior is a branch of the EXTERNAL carotid artery, and the inferior is a branch of the subclavian artery three sources of venous drainage: superior, middle, and inferior veins. superior and middle drain to the internal jugular vein, while the inferior veins drain to the brachiocephalic vein directly.

Question 101

Platysma- describe action and innervation

Answer 101

action- muscle of facial expression (frowning in sadness or fright) innervation- facial nerve (CN VII), cervical branch

Question 102

What is the action and innervation of the sternocleidomastoid?

Answer 102

Cranial nerve CNXI and C2-C3 is the innervation of the scm actions: unilateral: flex neck laterally to the same side; rotates head to opposite side; acting together, muscles flex the neck

Question 103

Where do we start to see the brachial plexus in the neck?

Answer 103

between the anterior and middle scalene muscles

Question 104

Where do we normally place a central line? What structures might be in danger during this procedure?

Answer 104

in the subclavian vein. the pleura and subclavian artery are in danger during this procedure

Question 105

What neck structure might be distended during heart failure?

Answer 105

the external jugular vein

Question 106

what is the most important thing to know about the internal carotid artery?

Answer 106

right where it splits from the external carotid artery there is a slight dilation called the carotid sinus. this is the site of the carotid sinus baroreceptor, which is innervated by the hypoglossal and vagus nerves and detects changes in arterial blood pressure.

Question 107

What is tetany? What causes this disorder?

Answer 107

tetany is a severe convulsive disorder that results from raccidental removal of the parathyroid glands during thyroid surgery. this resuslts in a decrease in parathyroid hormone, so there isn't enough calcium in the blood

Question 108

What are the muscles of the posterior triangle?

Answer 108

splenius capitus, levator scapulae, posterior, middle, and anterior scalene muscles.

Question 109

What nerve in the posterior triangle is most likely to be damaged? What clinical test can you use to detect this damage?

Answer 109

the accessory nerve (CN XI). by the time we get to the posterior triangle, the accessory nerve has already innervated the sternocleidomastoid but not yet gotten to the trapezius, so ask the patient to shrug their shoulders against resistance.

Question 110

What is grave's disease?

Answer 110

Grave's disease is an autoimmune diseases where the body attacks TSH receptors in a way that leads to excess secretion of T3 and T4 (thyrotoxicosis). This has a number of symptoms, including weigh loss, droppy eyelids, nervousnous/excitability, bulging eyes, goiter, tachycardia

Question 111

what are the branches of the subclavian artery?

Answer 111

vertebral, internal thoracic, thyrocervical trunk. costocervical trunk and dorsal scapular branch too.

Question 112

where do the sypathetic preganglionic fibers destined for the head synapse?

Answer 112

superior cervical ganglion

Question 113

what happens to you if you damage the sympathetic trunk?

Answer 113

horner's syndrome, characterized by miosis (pupil constriction), ptosis (eyelid drooping), anhydrosis (not enough sweating), flushed face due to vasodilation

Question 114

Where does blood come from in the fetus?

Answer 114

first five weeks: yolk sac 5th or 6th week: shifts to the liver (mostly) and spleen 6 mo.: shifts to bone marrow

Question 115

What gives rise to the small, variable vascular channels that eventually form the vessels in the neonate?

Answer 115

intraembryonic mesoderm

Question 116

what do the unpaired, paried, and parietal arteries supply?

Answer 116

unpaired: GI tract paired: abdominal glandual structures (which COME IN PAIRS- kidneys, adrenal glans, gonads) paired parietal: body cavity walls of the thorax and abdomen (intercostals, phrenics, lumbars, unpaired medial sacral)

Question 117

what are the three sets of embryonic veins? what do they form?

Answer 117

cardinal (azygous venous system), vitelline (portal venous system), ubilical (basically nothing)

Question 118

What does the portal venous system drain? From what is it dervied?

Answer 118

vitelline veins. drains the gi tract, glands, and spleen, hepatic veins

Question 119

What returns oxygenated blood to the heart in the fetus and embryo for most of gestation?

Answer 119

left umbilical vein

Question 120

what is the ductus venosis? what does it become?

Answer 120

a fetal shut that bypasses the liver and brings blood from the umbilical vein to the inferior vena cava. after birth it becomes the ligamentum venosum

Question 121

What does the left umbilical vein become after birth?

Answer 121

ligamentum teres

Question 122

what is the embryonic origin of the thoracic duct?

Answer 122

cisterna chyli

Question 123

what are the lymph collection points in the adult body?

Answer 123

two deep cervical lymph nodes (palpable), two axillary lymph nodes (palpable), mediastinal lymph nodes, lumbar lymph nodes, iliac lymph nodes, inguinal lymph nodes (palpable)

Question 124

When do the heart and blood vessels begin to develop?

Answer 124

around the third week

Question 125

From what kind of tissue is the heart derived?

Answer 125

mostly splanchnic mesoderm, but also some neural crest cells and paraxial and lateral mesoderm.

Question 126

from what is the primitive heart tube itself derived?

Answer 126

the fusion of endocardial tubes that meet at the midline

Question 127

describe blood flow through the very primitive embryonic heart tube

Answer 127

sinus venosis to the primitive atrium to the primitive ventricle to the bulbous cordis

Question 128

describe the folding of the primitive heart tube

Answer 128

the primitive atrium and sinus venosis, which start out at the bottom (swing to the left, posteriorily and superiorily); the bulbous cordis and primitive ventricle, which start out superior, swing to the right and inferiorily

Question 129

when does the heart tube begin to be partitioned?

Answer 129

around day 30

Question 130

what is formed by neural crest cells in the heart?

Answer 130

the aorticopulmonary septum, the semilunar valves

Question 131

what do the umbilical arteries become post-birth?

Answer 131

medial umbilical ligaments