Lecture 6

Question 1

How much of a human body is water

Answer 1

60% by weight

Question 2

How much of the water in the human body is intracellular, and how much is extra cellular

Answer 2

2/3 in intra cellular, 1/3 is extra cellular

Question 3

How is the extracellular fluid distributed

Answer 3

1/5 is blood plasma, 4/5 is interstitial fluid

Question 4

How does one determine the IV flow when replacing liquids

Answer 4

4cc/hr/kg for the first 10 kg of body weight, then add 2cc/hr/kg for the next 10 kg of body, and for the remaining body weight add 1cc/hr/kg

Question 5

What is the governing principle of all fluid movement in the body

Answer 5

It flows from areas of high pressure to areas of lower pressure

Question 6

What is the direction of lymphokinetic motion

Answer 6

blood capillaries > interstitial fluid > Lymph capillaries >Lymph veins > lymph ducts > large circ. veins

Question 7

What is the main function of interstitial fluid

Answer 7

Carries cell waste products to the lymph system for purging

Question 8

Where is the subclavian artery located

Answer 8

Between the anterior and middle scalenes, deep to the clavicle, to the lateral border of the first rib

Question 9

Where is the axillary artery located

Answer 9

From the first part of the 1st rib to the lower edge of teres major

Question 10

Where is the brachial artery located

Answer 10

Extends from the teres major down to the bifurcation of radial and ulnar arteries, which normally happens near the elbow, but can happen near the axilla

Question 11

Where is the profunda brachii artery located

Answer 11

It branches from the brachial artery just distal to the teres major and travels along a similar path as the radial nerve in the posterior arm

Question 12

What is collateral circulation

Answer 12

The situation of having multiple pathways for blood to reach a particular organ or region of the body

Question 13

What are anastomosis

Answer 13

Connecting branches formed between adjacent blood vessels

Question 14

Where is the dorsal scapular a. located

Answer 14

It branches from the subclavian and travels along the vertebral border of the scapula.

Question 15

Where is the suprascapular a. located

Answer 15

It branches from the subclavian and travels along the axillary a to the suprascapular notch and then to the infraspinatus. Anastomoses with the scapular circumflex a.

Question 16

Where is the scapular circumflex a. located

Answer 16

It branches from the axillary a. and travels between the teres major, minor and long head of the triceps to the infraspinatus. Anastomoses with the suprascapular a.

Question 17

What is the purpose of the collateral circulation around the scapula

Answer 17

If the axillary artery s occluded, then blood i shunted away from the subclavian artery to the distal axillary artery by reverse flow in the circumflex scapular and subscapular aa. This is all based on pressure

Question 18

Why would the body create new anastomosises

Answer 18

To get around blockages

Question 19

When would creating new anastomosises be deleterious

Answer 19

In diabetic retinopathy repeated blockage and growth of replacement vessels leads to impaired vision

Question 20

What goes through the vertebral transverse foramina

Answer 20

Vertebral artery

Question 21

What is subclavian steal syndrome

Answer 21

occlusion of the subclavian artery causes retrograde flow in the vertebral artery

Question 22

What is Thoracic outlet syndrome

Answer 22

Compression of the brachial plexus and blood vessels where they pass between the scalenes, 1st rib and clavicle, or under pectoralis minor

Question 23

What are cervical ribs and how are they clinically relevant

Answer 23

incomplete ribs off the cervical vertebrae found in .5-1% of the population that greatly increase the risk of developing thoracic outlet syndrome

Question 24

What are common causes of thoracic outlet syndrome

Answer 24

fractures, bad posture, and bone spurs

Question 25

What is the physician's #1 way to test for a nerve problem

Answer 25

They try to make the symptoms worse

Question 26

What is Adson's test

Answer 26

Pt's arm is abducted and externally rotated while his head is turned away from the affected arm and he inhales deeply. This activated scaliness and raises the first rib. If his radial pulse is diminished, then the test is positive

Question 27

Which artery do inflatable blood pressure cuffs utilize

Answer 27

The brachial artery

Question 28

Where is the radial artery located

Answer 28

It travels down the forearm through the anatomical snuffbox and around MC 1 to enter palm and form the deep palmar arch

Question 29

How does the radial artery terminate

Answer 29

anastomoses with the ulnar artery in the deep and superficial palmar arteries

Question 30

Where is the ulnar artery located

Answer 30

It travels down the forearm through the tunnel of Guyon to form the superficial palmar arch

Question 31

How does the ulnar artery terminate

Answer 31

It anastomoses with the radial artery in the superficial and deep palmar arches

Question 32

What do the palmar arches branch into

Answer 32

Metacarpal, common, and proper digital arteries that parallel the cutaneous nerves

Question 33

Where are the digital aa and nn located

Answer 33

On the sides of the digits so that they don't get squashed during digit movement

Question 34

Where does one inject anesthetic in a digit

Answer 34

Anesthetic is injected on both sides of the affected digit to effectively numb the entire digit

Question 35

When does one NOT use anesthetic with epinephrine

Answer 35

When numbing the fingers, toes, penis, or nose because of the limited blood supply

Question 36

Where is the cephalic vein located

Answer 36

Anterolateral forearm, over biceps and between the deltoid and pectoralis major

Question 37

Where is the basilic vein located

Answer 37

anteromedial forearm, penetrates medial side of arm

Question 38

Where is the median cubital vein

Answer 38

The communicating vein between the cephalic and basilic vv, it is located between them in the elbow

Question 39

What veins are great for blood venipuncture

Answer 39

The median cubital is number one, but the cephalic and basilic vv can be used as well

Question 40

What are venae comitantes

Answer 40

Veins that are paired with major arteries (radial, ulnar, brachial, etc)

Question 41

What is the purpose of venae comitantes

Answer 41

They are an alternate course for blood to return to the heart and serve to capture some of the heat that is lost from arterial blood to reheat venous blood

Question 42

How much of the blood returns to the heart via deep veins

Answer 42

90%

Question 43

What is the cubital fossa

Answer 43

Triangular space bordered by pronator teres, brachioradialis, and imaginary line connecting epicondyles of humerus

Question 44

What structures are in the cubital fossa

Answer 44

Superficial vv, median and radial nn, brachial a, biceps tendon

Question 45

What is the function of lymphatic capillaries

Answer 45

They recover excess fluid from interstitium and transport the lymph to lymph nodes

Question 46

What causes blocked lymphatics

Answer 46

Mostly commonly destruction by surgery, radiation, or infection

Question 47

What happens if lymphatics are blocked

Answer 47

There is a lack of lymph drainage which causes a fluid build up called 'edema' in the affected tissues

Question 48

Can you repair blocked lymphatics

Answer 48

Not really. They are too fragile for angioplasty or other procedures done on blood vessels. Manual therapy can be used to empty some of the fluid buildup

Question 49

How is fluid in lymph vessels propelled

Answer 49

Predominantly by muscle action around the vessels, but a few lymphatics have smooth muscles with rhythmic peristaltic motion

Question 50

What does the right supraclavicular node drain and what diseases is it indicative when swollen

Answer 50

Drains: Mediastinum, lungs, esophagus Disease: Lung, retroperitoneal, or gastrointestinal cancer

Question 51

What does the left supraclavicular node drain, and what diseases is it indicative of when swollen

Answer 51

Drains: thorax, abdomen via thoracic duct Disease: lymphoma, thoracic or retroperitoneal cancer, bacterial or fungal infection

Question 52

What does the axillary node drain, and what diseases is it indicative of when swollen

Answer 52

Drains: arm, thoracic wall, breast Disease: infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma

Question 53

What does the epitrochlear node drain, and what diseases is it indicative of when swollen

Answer 53

Drains: Ulnar aspect of forearm and hand Disease: Infections, lymphoma, sarcoidosis, tularemia, secondary syphilis

Question 54

What is the function of a lymph node

Answer 54

Filters and monitors interstitial fluid to detect antigens

Question 55

Where do lymphatics drain

Answer 55

Lymphatics follow superficial veins and deep arteries and then drain into the venous system

Question 56

What are mammary glands

Answer 56

Modified sweat glands embedded in adipose tissue

Question 57

How are breasts attached to deep fascia

Answer 57

Via suspensory (cooper's) ligaments

Question 58

Which 4 nodes receive lymph from breasts

Answer 58

pectoral nodes in axilla (75% this si the site of metastasis), opposite breast, parasternal nodes, abdominal nodes

Question 59

systemic infection such as the flu often causes enlargement of which nodes

Answer 59

Axillary lymph nodes