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Block I > Things you forget > Flashcards

Things you forget Flashcards

1
Q

Tube thoracostomy

A

Enter the pleural space via the 4th/5th intercostal space (midaxillary approach) to drain fluid from the pleural space between the visceral and parietal pleura.

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2
Q

Parietal vs Visceral

Both parietal and visceral pleura come from where?

A

Parietal - somatic, afferent

Visceral - autonomic/splanchnic afferents

Both come form the lateral mesoderm.

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3
Q

Anterior axillary nodes and parasternal lymph nodes are sentinel (first-line); whereas ____ is nonsentinal

A

supraclavicular nerves.

If cancer’s here, that means prognosis is poor.

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4
Q

The chest wall has a dual supply from the ___ and the ___

A

Internal thoracic artery anteriorly

Aortic branches posteriorly

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5
Q

Intercostal VANs are found between which two muscles?

A

Inner and innermost intercostals

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6
Q

___ pleura covers the innermost intercostal muscles

A

Costal pleura

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7
Q

Why does pain int he diaphragm sometimes get referred to the shoulder region?

A

The phrenic nerve (C3,4,5) also has a cutaneous branch that leads to the shoulder.

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8
Q

Long thoracic nerve

A

Innervates the serratus anterior

Easily cut during mastectomy –> winged scapula (can’t protract scapula)

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9
Q

Serratus anterior __tract the scapula

Rhomboids __tract the scapula

A

Serratus protracts

Rhomboids retract

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10
Q

The 4th intercostal space is between what two ribs?

A

4th and 5th.

Intercostal spaces are named after the rib above them.

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11
Q

Where do you hear the superior lobe?

A

2nd intercostal

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12
Q

Where do you hear the middle lobe/lingula?

A

4th intercostal space; medial to the nipple

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13
Q

Where do you hear the inferior lobe?

A

6th intercostal space; triangle of auscultation

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14
Q

Internal thoracic artery splits into

A 
Superior epigastric artery (toward median)
Musculophrenic artery (lateral)
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15
Q

Silent inspiration depends mostly on the diaphragm descending - what about forced inspiration?

A

Scalenes & pec move the chest out further

External intercostals elevate the rib to increase chest diameter

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16
Q

Silent expiration is due to elastic coil and muscle relaxation; what about forced expiration?

A

Abs
Internal intercostals
Innermost intercostals

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17
Q

Fibrous vs serous pericardium

A

Fibrous pericardium is on the outside; flush to it is parietal serous pericardium

Parietal visceral pericardium is on the actual heart

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18
Q

All other arteries fill in systole, but ___ fills in diastole

A

Coronary arteries

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19
Q

What does the PDA feed?

A

The posterior 1/3 of the septum

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20
Q

The left sinus venosus disappears; the right sinus venosus becomes what two things?

A

Sinus venarum (smooth muscle of the right atrium)

Vena cava

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21
Q

What does the primitive atrium become?

A

Pectinate and auricles

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22
Q

What does the bulbus cordis become?

A

Smooth part of the right ventricle leading to the pulmonary trunk(conus arteriosus)

Smooth part of the left ventricle

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23
Q

What does the primitive ventricle become?

A

the trabeculated parts of the ventricles

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24
Q

Where is the AV node?

A

INteratrial septum above opening of the coronary sinus

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25
Q

What babies are BORN blue?

A

Those with transposition of the great vessels

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26
Q

What babies become blue later?

A

Those with tetralogy of fallot or persistent truncus arteriosus

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27
Q

Prostaglandins

A

Keep the ductus arteriosus open for babies with transposition of the great vessels.

Inhibited by N-saids

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28
Q

Tet spells (squat to force the blood to go into systemic circulation) are associated with what disease?

A

tetralogy of fallot

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29
Q

If coarctation occurs before the left sucblavian, then what happens to pulses?

A

You’ll have two different radial pulses and only one of them will match teh femoral pulse.

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30
Q

If coarctation occurs after the left subclavian, then what happens to the pulses?

A

You’ll have the same radial pulse, but it will be diff from your femoral pulse.

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31
Q

Two main ducts of the lymphatic system

A

Thoracic duct drains 75 % of the body; empties at the junction of the left internal jugular & left subclavian veins

The right lymphatic duct drains only the top right portion of the body; empties at the junction of the right internal jugular & right subclavian

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32
Q

While the great, middle, and small cardiac veins all drain into the coronary sinus, which drains into the right atrium, ___ drains directly into the right atrium

A

Anterior cardiac vein

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33
Q

Stellate (inferior cervical) ganglion innervates what?

A

Head & upper limb

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34
Q

Where does the dural sac end in the adult?

A

S2

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35
Q

Filum terminale internum

A

Anchors the pia the dura; starts at L1/L2 and ends at S2

36
Q

Filum terminale externum

A

Anchors the dura to the coccyx; starts at S2 to the coccyx

37
Q

Denticulate ligaments

A

Extensions of pia inside the dural sac that provide lateral stability to the spinal cord by

Ends at L2 with the spinal cord/pia

38
Q

Why would a tumor at L1/L2 cause renal incontinence?

A

conus medullaris syndrome - it compresses the sacral nerves below, which are responsible for parasympathetic innervation.

39
Q

Where are vertebral arteries? What do they do and how?

A

In cervical transverse foramen; feeds the spine with help from the radicular artery of adamkiewicz

Injury to adamkiewicz –> paralyzed lower limbs

40
Q

where are epidurals performed?

A

Lumbar or sacral

41
Q

Hangman’s fracture

A

Cervical hyperextension that snaps the C2 at the atlanto occiptal joint

42
Q

What segments of the spinal cord do the sympathetics originate from?

A

T1 to L2

43
Q

Where do the parasympathetics come from?

A

Vagus nerve

S2-S4

44
Q

Demratomes

A

Nipple - T4
Xiphoid process - T7
Umbilicus - T10

45
Q

If you were to stab a friend in the neck, what layers woul dyou hit?

A

Traps -> splenius -> semispinalis -> suboccipital triangle

46
Q

Sensation in the ___ part of the head is supplied by spinal nerves while all other parts of the head are innervated by cranial nerves

A

occipital

47
Q

Inferior angle of scapula is at __

A

T7

48
Q

Spine of scapula is at __

A

T3

49
Q

Iliac crest at

A

L4

50
Q

Posterior Superior Iliac Spine (PSIS) at

A

S2

51
Q

The atlas has no

A

Vertebral body

52
Q

3 types of joints

A

Fibrous joints: doesn’t move much

Cartilaginous joints: moves a lil

Synovial joints: gliding, hinge, saddle, ball-and-socket

53
Q

What kind of joint is the acromioclavicular joint and your wrist?

A

Gliding

54
Q

What kind of joint is your carpometacarpal joint of the thumb?

A

Saddle

55
Q

If somites of the dermatomyotome migrate anteriorly, they become ___ muscles (limbs and trunk).

If they migrate posteriorly, they become ___ muscles (back muscles) and dermis.

A

Anterior: hypaxial (limbs and trunk) muscles innervated by ventral rami

Posterior: epaxial (back and dermis) innervated by dorsal rami

56
Q

___ rami forms all the major plexuses and the intercostal nerves.

A

Ventral rami

57
Q

Intercostal nerves come form the ventral rami of what spinal cord segment?

What do they innervate?

A

t1-t12

Innervates:

  • Intercostal muscles, abs, anterolaterothorax
  • Skin over the thorax via cutaneous branches
  • Parietal pleura
  • Costal pleura
58
Q

While dermatomes are an area of skin innervated by a specific spinal nerve, peripheral nerve distribution describe

A

Axons coming from several different spinal nerves.

Most nerves a mixture of motor and sensory form different layers of the spinal cord.

59
Q

The post synaptic neurons of the sympathetic system are in the

A

Ganglia - pre & paravertebral.

60
Q

Who has more postganglionics - sympathetic or parasympathetic?

A

Sympathetic! They can also have a systemic effect by synapsing on the adrenal medulla

61
Q

The ___ ramus is associated only with spinal nerves T1-L2.

the ___ ramus is associated with all spinal nerves.

A

White ramus is only at T1-L2 (that’s where the preganglionic sympathetics originate)

62
Q

What structures do splanchnic nerves target?

A

Organs T5 and below, so it enters the abs, pelvic, renal region.

Also, may pass through the prevertebral ganglia to synapse at the adrenal gland instead.

63
Q

The cutaneous branches of the 4th intercostal innervates the nipple.

The cutaneous branches of the __ to __th intercostal nerves innervate the rest of the breast.

A

2-6

64
Q

____ artery supplies the upper part of the breast and branches into the pectoral branch thoracoacromial artery & lateral thoracic artery.

A

Axillary artery

PAL

65
Q

_____ artery innervates the lower part of the breast and branches into the anterior intercostal perforating arteries & intercostal branches of arteries.

A

Internal Mammary Artery

ImAIb

66
Q

___ nodes drain most of the body into the thoracic duct, which empties into the ____.

___ nodes drain the upper part of the body into the ___,

A

Axillary nodes > thoracic duct > Left subclavian vein

Parasternal nodes along the Internal thoracic artery > Bronchomediastinal trunks

67
Q

Which joint is responsible for rib elevation and depression?

A

Costo-transverse.

68
Q

___ enters the diaphragm through the central tendon.

A

IVC

69
Q

__, ___, and ___ enters the diaphragm through the aortic hiatus.

A

Aorta, azygos vein, and thoracic duct

70
Q

__ & __ enter the diaphragm through the esophageal hiatus.

A

Esophagus

Vagus nerve

71
Q

A concern in thyroid surgeries is cutting

A

the left recurrent laryngeal, which would result in hoarseness

72
Q

4 places where esophagus is compressed by other structures

A

Pharynx
Arch of aorta
Left main bronchus
Esophageal hiatus

73
Q

Elevated diaphragm indicates injury to the

A

phrenic nerve

74
Q

Why wouldn’t you do a pericardiocentesis on a bloody cardiac tamponade?

A

Blood is too thick; have to do a thoracotomy and open up the pericardial sac

75
Q

Absent left radial pulse indicates injury to..

A

left subclavian artery –> do a rib thoracotomy

76
Q

Where do you put in a central line?

A

In the deltopectoral groove, aiming at an angle towards the sternal notch remembering that the vein is superficial to the artery.

Days later, you may see chyme leak out

77
Q

The left phrenic nerve pierces and innervates the inferior surface of the diaphragm. What about the right phrenic nerve?

A

It enters through the central tendon with the IVC?

78
Q

Critical period for an organ/organ system / organogenetic period

A

Weeks3-8

The organ is undergoing the most cell division, differentiation, and morphogenesis –> very susceptible to teratogens

79
Q

Wha t happens to embryos exposed to teratogens in the first 2 wks?

A

They’ll either die or overcome them; unlikely to form birth defects

80
Q

Fetal period vs Embryonic period

A

Become a fetus after week 8.

Embryonic period: wk1-8
Fetal period: 9-birth

81
Q

Major phases of human development

A

Fertilization > Cleavage > Compaction > Differentation > Cavitation > Zona hatching > Implantation

82
Q

Amnioblasts

A

Epiblastic cells in the amniotic cavity that give rise to teh embryo.

83
Q

Hyatidiform mole

A

Overgrowth of trophoblasts

84
Q

Who produces hcg?

A

Syncytiotrophoblasts; maintains corpus luteum for progesteron

85
Q

Sperm fusion triggers cortical reaction

A

exocytosis of cortical granules that harden the zona pellucida to prevent polyspermy

Block I (4 decks)

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