Things you forget Flashcards by Lauren Nguyen

Tube thoracostomy

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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Parietal vs Visceral

Both parietal and visceral pleura come from where?

Parietal - somatic, afferent

Visceral - autonomic/splanchnic afferents

Both come form the lateral mesoderm.

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

supraclavicular nerves.

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

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

Internal thoracic artery anteriorly

Aortic branches posteriorly

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Intercostal VANs are found between which two muscles?

Inner and innermost intercostals

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___ pleura covers the innermost intercostal muscles

Costal pleura

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

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

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Long thoracic nerve

Innervates the serratus anterior

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

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Serratus anterior __tract the scapula

Rhomboids __tract the scapula

Serratus protracts

Rhomboids retract

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The 4th intercostal space is between what two ribs?

4th and 5th.

Intercostal spaces are named after the rib above them.

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Where do you hear the superior lobe?

2nd intercostal

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Where do you hear the middle lobe/lingula?

4th intercostal space; medial to the nipple

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Where do you hear the inferior lobe?

6th intercostal space; triangle of auscultation

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Internal thoracic artery splits into

Superior epigastric artery (toward median)
Musculophrenic artery (lateral)

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

Scalenes & pec move the chest out further

External intercostals elevate the rib to increase chest diameter

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

Abs
Internal intercostals
Innermost intercostals

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Fibrous vs serous pericardium

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

Coronary arteries

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What does the PDA feed?

The posterior 1/3 of the septum

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

Sinus venarum (smooth muscle of the right atrium)

Vena cava

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What does the primitive atrium become?

Pectinate and auricles

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What does the bulbus cordis become?

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

Smooth part of the left ventricle

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What does the primitive ventricle become?

the trabeculated parts of the ventricles

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Where is the AV node?

INteratrial septum above opening of the coronary sinus

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What babies are BORN blue?

Those with transposition of the great vessels

What babies become blue later?

Those with tetralogy of fallot or persistent truncus arteriosus

Prostaglandins

Keep the ductus arteriosus open for babies with transposition of the great vessels. Inhibited by N-saids

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

tetralogy of fallot

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

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

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

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

Two main ducts of the lymphatic system

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

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

Anterior cardiac vein

Stellate (inferior cervical) ganglion innervates what?

Head & upper limb

Where does the dural sac end in the adult?

Filum terminale internum

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

Filum terminale externum

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

Denticulate ligaments

Extensions of pia inside the dural sac that provide lateral stability to the spinal cord by Ends at L2 with the spinal cord/pia

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

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

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

In cervical transverse foramen; feeds the spine with help from the radicular artery of adamkiewicz Injury to adamkiewicz --> paralyzed lower limbs

where are epidurals performed?

Lumbar or sacral

Hangman's fracture

Cervical hyperextension that snaps the C2 at the atlanto occiptal joint

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

T1 to L2

Where do the parasympathetics come from?

Vagus nerve S2-S4

Demratomes

Nipple - T4 Xiphoid process - T7 Umbilicus - T10

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

Traps -> splenius -> semispinalis -> suboccipital triangle

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

occipital

Inferior angle of scapula is at __

Spine of scapula is at __

Iliac crest at

Posterior Superior Iliac Spine (PSIS) at

The atlas has no

Vertebral body

3 types of joints

Fibrous joints: doesn't move much Cartilaginous joints: moves a lil Synovial joints: gliding, hinge, saddle, ball-and-socket

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

Gliding

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

Saddle

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

Anterior: hypaxial (limbs and trunk) muscles innervated by ventral rami Posterior: epaxial (back and dermis) innervated by dorsal rami

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

Ventral rami

Intercostal nerves come form the ventral rami of what spinal cord segment? What do they innervate?

t1-t12 Innervates: - Intercostal muscles, abs, anterolaterothorax - Skin over the thorax via cutaneous branches - Parietal pleura - Costal pleura

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

Axons coming from several different spinal nerves. Most nerves a mixture of motor and sensory form different layers of the spinal cord.

The post synaptic neurons of the sympathetic system are in the

Ganglia - pre & paravertebral.

Who has more postganglionics - sympathetic or parasympathetic?

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

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

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

What structures do splanchnic nerves target?

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.

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.

2-6

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

Axillary artery P*A*L

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

Internal Mammary Artery *Im*AIb

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

Axillary nodes > thoracic duct > Left subclavian vein Parasternal nodes along the Internal thoracic artery > Bronchomediastinal trunks

Which joint is responsible for rib elevation and depression?

Costo-transverse.

___ enters the diaphragm through the central tendon.

IVC

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

Aorta, azygos vein, and thoracic duct

__ & __ enter the diaphragm through the esophageal hiatus.

Esophagus | Vagus nerve

A concern in thyroid surgeries is cutting

the left recurrent laryngeal, which would result in hoarseness

4 places where esophagus is compressed by other structures

Pharynx Arch of aorta Left main bronchus Esophageal hiatus

Elevated diaphragm indicates injury to the

phrenic nerve

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

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

Absent left radial pulse indicates injury to..

left subclavian artery --> do a rib thoracotomy

Where do you put in a central line?

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

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

It enters through the central tendon with the IVC?

Critical period for an organ/organ system / organogenetic period

Weeks3-8 The organ is undergoing the most cell division, differentiation, and morphogenesis --> very susceptible to teratogens

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

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

Fetal period vs Embryonic period

Become a fetus after week 8. Embryonic period: wk1-8 Fetal period: 9-birth

Major phases of human development

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

Amnioblasts

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

Hyatidiform mole

Overgrowth of trophoblasts

Who produces hcg?

Syncytiotrophoblasts; maintains corpus luteum for progesteron

Sperm fusion triggers cortical reaction

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

Things you forget Flashcards

(85 cards)