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Terms in this set (82)
Describe the subarachnoid space.
Is it real or potential?
What is it filled with?
What is it between?
IT is real, filled with CSF, and between arachnoid and pia mater
right recurrent laryngeal nerve is found where? What about left recurrent laryngeal nerve?
right is subclavian and left is arch of aorta
What nerve is most vulnerable to injury with a thyroidectomy
recurrent laryngeal nerve
recurrent laryngeal nerve innervates what?
all laryngeal muscles except cricothyrooid
Where do you perform a cricothyrotomy?
When you perform subclavian vein puncture what is at risk?
subclavian artery, lung apex and/or pleura, and proximal brachial plexus
no spinal ganglion associated with what type of neurons
If you have a herniated disk between L5/S1 which spinal nerve is compressed?
S1 - compresses inferior
In which direction do most IV disk herniate? and Why?
because the PLL is MUCH smaller than the ALL
What causes it and how does it present?
It is caused by injury to upper trunk of brachial plexus - at birth or falling on neck/shoulder
medially rotated arm
extended elbow and waters tip hand at flexed wrist
erb duchenne - which nerve injury will result in each of the following?
medially rotated arm
waters tip hand at flexed wrist
axillary and suprascapular
lower trunk of brachial plexus injury?
upper trunk of brachial plexus injury?
Erb Duchenne syndrome
Describe Klumpke's paralysis and what causes it
lower trunk of brachial plexus injury
clawhand with impairment of short intrinsic hand muscles
damage to what leads to dysfunction of short intrinsic hand muscles in klumpkes paralysis
which rotator cuff muscle is most torn -- what movement will be impaired/cause pain?
abduction of the shoulder
what muscles makeup the rotator cuff
what artery and nerve may be compromised with a fracture or injury at the surgical neck of the humerus bone
axillary nerve and posterior humeral circumflex artery
Whcih artery and nerve may be compromised with a fracture to the humerus that includes the radial groove
deep brachial artery
What is at risk with elbow dislocation and proximal ulna fractures?
Injury to this would affect what?
intrinsic hand muscles
What is the most commonly dislocated carpal bone ?
What is the most commonly fractured carpal bone?
What can this lead to?
scaphoid may undergo avascular necrosis
What is a common symptom that can happen with a herniated c6/c7 disc in neck?
tingling in hand because ulnar is C7-T1
The sternal angle is an important landmark for what structures?
bifurcation of trachea into 2 bronchii
arch of aorta
azygous vein empties into SVC
Divison between superior and inferior mediastinum
What are 4 symptoms of thoracic outlet syndrome and what are they caused by?
compression of subclavian vessels leads to decreased radial pulse
recurrent laryngeal nerve -- dysphagia and hoarseness
inferior trunk of brachial plexus -- parasthesia in forearm and hand -- weakness and atrophy of hand muscles
sympathetic trunk -- horners syndrome
patient with adenocarcinoma of the R breast - breast tumor metastasis occurs through which nodes ...
but they can also spread where?
axillary nodes (75%)
parasternal = allows bilateral breast cancer to occur
what can be a complication of a mastectomy if nerves are not avoided?
long thoracic nerve -- C5-C7 innervating serratus anterior
Rupture of emphysema blebs can cause ?
what is the most common site?
visceral pleura of superior lobe
Describe tension pneumothorax
a lung will collapse but air will not be allowed out and rather just in causing a build up of pressure in the thorax which becomes a MEDICAL EMERGENCY as there is a mediastinal shift which can cut off systemic blood flow
Are objects more likely to be frequently aspirated in the right or left bronchus? Why?
right - because it is shorter, wider, and more vertical
what are the layers of the pericardial sac
which layers do you go through to drain fluid in it
fibrous pericardium externally
then serous pericardium which more externally is called parietal pericardium then there is the pericardial cavity and underneath that is visceral pericardium
for cardiac tamponade, you insert needle through fibrous pericardium, parietal pericardium, then drain the pericardial cavity
When there is too much fluid in pericardial cavity, what layer makes this life threatening
the fibrous pericardium as it does not distend well
Where do you auscultate heart valves?
Pulmonary = Left second ICS
Aortic = right second ICS
Mitral = left 5th ICS
Tricuspid = xiphosternal jxn
what carries pain back to the spinal cord - T1-T4/5 levels - from the heart?
sympathetic nerves via cardiac plexus
pacemaker of heart
How can pain from pericarditis arise in the neck and upper shoulder?
phrenic nerve provides sensory innervation to the pericardial sac - referred to C3-C5 dermatomes
most commonly occluded coronary artery
anterior interventricular artery
Where do SA nodal and AV nodal arteries usual arise from
Why is right dominant heart sometimes considered "better"
Bc in a left dominant heart, the posterior interventricular also arises from the left coronary artery when in a right dominant heart it arises from the right coronary artery -- if the left coronary artery becomes occluded in a left dominant person, more will be affected
in relation to epigastric vessel - wher eis inguinal indirect inguinal hernia
medial to epigastric vessel
artery of foregut
artery of midgut
artery of hindgut
midgut starts where and ends where
distal duodenum to proximal transverse colon
history of heartburn -- severe pain in epigastric region - ulcer ruptured through posterior wall of stomach -- blood vessel subject to erosion is
patient with ruptured spleen - it is removed along with significant portion of splenic artery -- removal of distal part of splenic artery might disrupt blood supply to what structure
fundus of stomach
3 arteries that come off of SMA
3 arteries that come off of IMA
which artery proides a point of anastomoses?
right colic artery
middle colic artery
left colic artery
superior rectal artery
which artery must be watched out for when removing an appendix
where should you look for it
appendicular artery - otherwise it will be absorbed up into mesentery when appendix is removed
posterior to the terminal ileum
what anatomical location tells you where appendix is?
McBurney's Point - 2/3 the way from umbilicus to hip
3 complications of portal hypertension
caput medusa (because of increased pressure in hepatic tributaries)
What are 3 portal-caval shunt options?
splenic vein to left renal vein
portal vein to IVC
transjugular intrahepatic portosystemic shunt (TIPS)
Describe Transjugular intrahepatic portosystemic shunt (TIPS)
it is a nonsurgical method of portal caval shunting - the shunt is passed down the internal jugular vein and inserted between portal and hepatic vein tributaries within the liver
What happens in the GI with PS NS?
increase secretion and motility and vasodialtion
SNS - decrease motility and vasoconstriction
What 3 things go through diaphragm and at what level do they pass through /
caval aperture -- for IVC at T8 level
esophageal aperture -- for esophagus at T10 level
Aortic aperture -- for aorta at T12 level
Aorta passes in what relation to the diaphragm?
Why is the left kidney higher than the right kidney
liver pushes R kidney down
What are most common sites of kidney stones getting lodged?
junction of renal pelvis and ureter
crossing over pelvic brim
passing into wall of bladder
Where do the gonadal veins feed into?
left gonadal vein feeds into left renal vein
right gonadal veins feed into IVC
What is the most likely site for an aortic aneurysm?
bifurcation of aorta into common iliac veins
What can lead to a testicular varicocele
SMA crosses L renal vein -- aneurysm may cause L testicular varicocele
swelling due to extravasated urine from a penile urethra injury can be seen around the penis, scrotum, and the anterior abdominal wall, but NOT where?
not the thigh
Colles fascia is continuous with
Where do testis drain vs. where does scrotum drain?
testis drains to paraortic nodes and scrotum drains to superficial inguinal nodes
what is the lowest point in pelvis and why is this relevant?
rectouterine pouch - inflammation can collect there -- closer proximal to posterior fornix so can withdrawal fluid there
What adjacent structure to the uterine artery is at risk for injury when this artery is ligated?
where do you administer a pudendal nerve block ?
inferior aspect of obterator internus
What does the pudendal nerve control motor-wise?
urinary and fetal continence via external urethral sphincter and external anal sphincter
What can get injured in hip fracture?
avascular necrosis can result from medial femoral circumflex artery damage
force of hip dislocation is transmitted through ?
which way does femoral head typically go in a sudden dislocation
what position does leg take when a femoral hip dislocation occurs?
it gets shorter and is internal rotated because femoral head goes superior and posterior
what nerve is most vulnerable with femoral hip dislocation ?
What muscle action will be decreased or lost in a patient with a torn hamstring?
decreased knee flexion
where do hamstring muscles most likely tear?
where they are attached to the ischial tuberosity
pain and tingling in lateral thigh as a result of tight clothing or things such a tool bag
name of this and what nerve is injured
meralgia paresthetica and lateral femoral cutaneous nerve
What is most vulnerable to injury with surgeries in the pelvis?
What movement do you lose?
loss of adduction at thigh
thigh master nerve
trendelenburg sign is caused by damage to what
superior gluteal nerve
what muscle is damaged in trendelenburg sign ?
if patients left hip is falling downwards, which muscle R or L is damaged?
right GM is injured because it is not contracting to even out both sides
what are the nerves you can damage in injections in the glut area
superior or inferior gluteal nerve and sciatic nerve
how do you determine safe spot for injection in glut region
put pointer finger on anterior superior iliac spine and can inject between there and middle finger
what can cause sciatica (2)
what are symptoms
herniated disc or hypertrophied piriformis
loss of sensory and motor function in leg - also pain here
What causes footdrop
loss of ability to dorsiflex becaues of damage to common fibular nerve
what can result from a broken fibula
damage to common fibular nerve which can lead to footdrop
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