Lec 4 Reading Questions

Question 1

follow a drop of blood from the heart to the superficial muscles on the left side of the back

Answer 1

left ventricle of heart -> ascending aorta -> aortic arch -> left subclavian -> left axillary -> muscular branches

Question 2

follow a drop of blood from the heart to the superficial muscles on the right side of the back

Answer 2

left ventricle of heart -> ascending aorta -> brachiocephalic trunk -> right subclavian -> right axillary -> muscular branches

Question 3

follow a drop of blood from the heart to the middle and deep back

Answer 3

left ventricle of heart -> ascending aorta -> aortic arch -> descending aorta -> thoracic aorta -> intercostal arteries

Question 4

follow a drop of blood going from muscles on the left OR right superficial side of the back , to the heart

Answer 4

muscular branches -> left/right axillary vein -> left/right subclavian vein-> Left/right brachiocephalic -> superior vena cava -> right atrium -> right ventricle

Question 5

follow a drop of blood going from muscles on the middle or deep part of the RIGHt side of the back to the heart

Answer 5

Intercostal veins-> internal thoracic vein -> right brachiocephalic -> superior vena cava - > right atrium -> right ventricle

Question 6

follow a drop of blood going from muscles on the middle or deep part of the LEFT side of the back to the heart

Answer 6

Intercostal veins -> hemizygous vein -> left brachiocephalic -> superior vena cava -> right atrium -> right ventricle

Question 7

follow a drop of blood going from the heart all the way to fingers in the left hand

Answer 7

left ventricle -> ascending aorta -> aortic arch -> left subclavian artery -> axillary artery -> brachial artery -> ulnar artery or radial artery -> superficial (leads to digital) and deep palmar arches (leads to metacarpal?) -> palmar metacarpal and palmar digital arteries ????? UNSURE ABOUT THIS ONE HAVE TO ASK PROF

Question 8

follow blood from left fingers to heart

Answer 8

Palmar digital and palmar metacarpal veins -> superficial or deep palmar venous arches -> radial or ulnar veins ->brachial vein -> axillary vein -> subclavian vein ->left brachiocephalic vein ->superior vena cava -> right atrium

Question 9

superficial venous return from left fingers to heart

Answer 9

lateral side of arm : palmar digital and palmar metacarpal veins -> dorsal venous network ->cephalic vein (radius area) -> subclavian vein (axilla area) -> brachiocephalic vein -> superior vena cava -> right atrium-> right ventricle OR medial side of arm: palmar digital and palmar metacarpal veins -> dorsal venous network -> basilic vein ( ulnar side) -> brachial vein (when it penetrates deep fascia mid humerus area)-> axillary vein -> subclavian vein -> brachiocephalic vein -> superior vena cava -> right atrium -> right ventricle

Question 10

follow a drop of blood to the right hand fingers

Answer 10

left ventricle -> ascending aorta -> aortic arch -> brachiocephalic artery -> right subclavian artery -> axillary artery -> brachial artery -> ulnar artery or radial artery -> superficial and deep palmar arches -> palmar metacarpal and palmar digital arteries

Question 11

(deep ) drop of blood from right fingers to heart

Answer 11

palmar digital and palmar metacarpal veins -> superficial or deep palmar venous arches -> radial or ulnar veins -> brachial vein -> axillary vein -> subclavian vein -> right brachiocephalic vein -> superior vena cava -> right atrium

Question 12

(superficial) drop of blood from right fingers to heart

Answer 12

palmar digital and palmar metacarpal veins -> dorsal venous network -> cephalic vein -> subclavian vein -> brachiocephalic vein -> superior vena cava -> right atrium OR palmar digital and palmar metacarpal veins -> dorsal venous network -> basilic vein -> brachial vein -> aillary vein -> subclavian vein -> brachiocephalic vein -> superior vena cava -> right atrium

Question 13

what blood vessels/nerves go through the Triangular space?

Answer 13

The circumflex scapular artery and vein pass through the gap.

Question 14

what blood vessels/nerves go through the triangular interval?

Answer 14

the radial nerve, the profunda brachii artery (deep artery of arm), and associated veins pass through it

Question 15

what blood vessels/ nerves pass through the quadralangular space?

Answer 15

the axillary nerve and the posterior circumflex humeral artery and vein

Question 16

what passes through the surgical neck of the humerus?

Answer 16

the axillary nerve and the posterior circumflex humeral artery which pass from axilla to deltoid region, do so immediately posterior to the surgical neck. This is significant bc this is a place where humerus commonly fractures and these nerves can be damaged.

Question 17

what passes by the suprascapular notch?

Answer 17

the suprascapular notch in combo with the superior transverse scapular or suprascapular ligament, which converts the notch into a foramen!

• the suprascapular nerve passes through the foramen, the suprascapular artery and vein are nearby and usually pass superior to the transverse scapular ligament , not through the foramen

Question 18

what passes the greater scapular notch?

Answer 18

the suprascapular nerve and suprascapular artery

Question 19

how is brachial artery used for blood pressure?

Answer 19

a sphygmomanometer and a stethescope. sphygmomanometer inflates a cuff around the midpoertion of the arm to compress the brachial artery against the humerus. the cuff is inflated so it exceeds the systolic blood pressure (greater than 120 mm Hg) the clinician puts a stethescope over the brachial artery in the cubital fossa and listens for the pulse.

-when pressure in the arm cuff of sphygmomanometer is just below the level of systolic blood pressure, the pulse becomes audible as a regular thumping sound. As the pressure continues to drop the sound becomes clearer. when it is less than the diastolic blood pressure, the audible thumping sound becomes inaudible.

Question 20

what are the two main drainage pathways of the upper limb?

Answer 20

two main drainage pathways are right lymphatic duct and the thoracic duct. the right lymphatic is the upper right extremity. the thoracic is everything else in the whole body!

20-30 axillary nodes are generally divided into five groups based on location ; Humeral (lateral) nodes, pectoral (anterior) nodes, subscapular (posterior) nodes, central nodes, and apical nodes (page 738!!)

Question 21

what is the significance of the cubital fossa?

Answer 21

it contains the tendon of the biceps brachii muscle, the brachial artery, and the median nerve. It is where stethescope is placed (over brachial artery in cubital fossa) when taking blood pressure reading.

(page 758!!!!!)

Question 22

which lymph nodes are important in the axilla area

Answer 22

three major ones - humeral, subscapular and pectoral nodes. they all drain into apical nodes. these will also get some from infraclavicular lymph nodes. they take everything to right subclavian branch- lymphatic duct.

Question 23

what are the major lymph nodes that drain the upper limb ?

Answer 23

20-30 axillary nodes are divided into five groups based on location :

• humeral (lateral) nodes : posteromedial to the axillary vein receive most of the lymph drainage from the upper limb
• pectoral (anterior) nodes : occur along inferior margin of pectoralis minor muscle along the course of the lateral thoracic vessels. receive drainage from the abdominal wall, chest, and the mammary gland.
• subscapular (posterior) nodes : on posterior axillary wall, in association with the subscapular vessels. drain the posterior axillary wall and receive lymphatics from the back, shoulder and neck
• central nodes are embedded in axillary fat and receive tributaries from humeral, subscapular, and pectoral groups of nodes.
• apical nodes are the most superior group in axilla. they drain all other groups of nodes. they also receive lymphatic vessels which accompany the cephalic vein as well as vessels that drain the superior region of the mammary gland.
• vessels from the apical group converge to form the subclavian trunk, which usually joins the venous system at the junction between the right subclavian vein and the right internal jugular vein in the neck.
• on the left, the subclavian trunk usually joins the thoracic duct in the base of the neck.

Question 24

what is the brachial plexus, and what are its parts?

Answer 24

It is a somatic nerve plexus formed by the anterior rami of C5 to C8. most of the anterior ramus of T1 also. originates in neck and passes laterally and inferiorly over rib 1, and enters the axilla.

• the parts from medial to lateral are roots, trunks, divisions and cords.
• all major nerves that innervate the upper limb originate from the brachial plexus, mostly from the cords.

Question 25

what are the major terminal branches of the brachial plexus?

Answer 25

axillary , musculocutaneous, median, radial, and ulnar

Question 26

(incase) what is the function of the pectoralis major?

Answer 26

flexion, adduction and medial rotation of the arm at the glenohumeral joint. the clavicular head - flexion of extended arm. sternocostal head - extension of flexed arm

Question 27

(incase) what is the function of the pectoralis minor?

Question 28

what are the superficial muscles of the anterior compartment of the forearm?

Answer 28

flexor carpi ulnaris, flexor carpi radialis, pronator teres, palmaris longus

Question 29

what are the intermediate muscles of the anterior compartment of the forearm?

Answer 29

flexor digitorum superficialis

Question 30

what are the deep muscles of the anterior compartment of the forearm?

Answer 30

flexor digitorum profundus, flexor pollicis longus, pronator quadratus

Question 31

what are the deep muscles in the posterior compartment of the forearm?

Answer 31

supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis