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511 Final > 511 Final > Flashcards

511 Final Flashcards

1
Q

Which cervical vertebrae DO NOT have bifid spinous processes?

A

C1 & C7

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2
Q

Foramen transversarium has what artery?

A

Vertebral artery (Skips C7 and enters through C6)

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3
Q

What does the vertebral artery supply?

A

Supplies 15% of brain blood, upper spinal cord, cerebellum and posterior part of brain

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4
Q

When are you pinching the vertebral artery?

A

Extension+Rotation+LF

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5
Q

Upper cervical structures?

A

Occipital condyles and C1+C2

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6
Q

Lower cervical structures?

A

Vertebrae of C3-C7`

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7
Q

Where does 50% of rotation happen in cervical?

A

Upper cervical

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8
Q

Upper cervical action?

A

Nodding yes

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9
Q

C1+C2

A

Shaking head “no”

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10
Q

What is unique about C1?

A

Has no body, and has the biggest transverse process (easy to palpate)

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11
Q

In C1, what does the ligamentum nuchae attach to?

A

posterior tubercle

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12
Q

What connects the dens?

A

Transverse ligament

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13
Q

What does the transverse ligament do?

A

Prevents axis from sliding posteriorly

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14
Q

What does the alar ligament prevent?

A

Rotation of the head

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15
Q

What does the alar ligament attach to?

A

Foramen magnum

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16
Q

What kind of joint is the upper cervical?

A

True synovial joint

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17
Q

What does the Atlanto-occipital joint do?

A

nods head

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18
Q

Cruciate ligament of Atlas includes?

A

Transverse ligament, superior and inferior longitudinal band

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19
Q

When does the posterior longitudinal ligament become the tectorial membrane?

A

Once it attached to foramen magnum

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20
Q

What does down syndrome cause?

A

Laxity in transverse ligament

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21
Q

How to check for Atlantoaxial instability

A

AAOD: measure space b/w anterior arch and dens (Test cervical flexion)

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22
Q

How do you tear the Alar ligament?

A

Flexion+rotation (contralateral side)

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23
Q

What makes cervical vertebrae unique?

A

-Superior & inferior surfaces of the bodies are not as flat as other vertebrae
-Uncinate processes (batman ears)
-Triangular-shaped vertebral canal is larger

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24
Q

What do unconvertebral joints do for cervical?

A

Gives more stability and limits lateral flexion

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25
Q

Which are atypical cervical vertebrae?

A

C1/C2 & C7

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26
Q

Condition: Cervical osteophytes

A

Wolfe’s law, but it’s bad because it causes bone spurs (compression onto uncovertebral joint and impinges spinal nerves)

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27
Q

Why is the C3-C6 vertebral canal larger?

A

To accommodate the thickening of the spinal cord associated w/ the formation of the cervical & brachial plexus

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28
Q

What is the anterior tubercle on C6 called?

A

Carotid tubercle (landmark for anesthesia for UE)

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29
Q

Why is C7 atypical?

A

It’s similar to thoracic
-Non-bifid spinous process
-Large transverse process
-Has foramen of transverse process, BUT vertebral a. WILL NOT GO THROUGH IT!!!

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30
Q

What do the suboccipital muscles do?

A

Extends and rotates head

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31
Q

What innervates all the suboccipital muscles?

A

Posterior ramus of C1 (Suboccipital n.)

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32
Q

Content of suboccipital triangle?

A

Posterior ramus of C1 (Suboccipital n.)
-Vertebral a & v

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33
Q

Rectus capitis posterior major OIA:

A

O: Spinous process of C2
I: Lateral portion of occipital below inferior nuchal line
A: Extension & rotation of head

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34
Q

Rectus capitis posterior minor OIA:

A

O: Posterior tubercle of C1
I: Medial portion of occipital below inferior nuchal line & dura mater
A: Extension of head

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35
Q

Why does rectus capitis posterior minor insert into dura mater?

A

-To allow CSF circulation from spine to brain. During extension, it prevents dura mater from folding and cutting off the CSF flow.
-Avoids pressure build-up in head

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36
Q

Obliquus capitis superior OIA:

A

O: Transverse process of C1
I: Occipital b/w superior & inferior line
A: Extends and ipsalateral lateral flexion of head

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37
Q

Obliquus capitis inferior OIA:

A

O: Spinious process of C2
I: Transverse process of C1
A: Rotation of head

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38
Q

Why would spinal cord damage cause a pt to stop breathing?

A

-The Phrenic nerve innervates the diaphragm

-Spinal cord injury damages the phrenic nerve

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39
Q

What cervical level did injury occur?

A

Phrenic nerve: C3-C5

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40
Q

Why did they not stop breathing immediately, but breathed erraticly before stopping?

A

Accessory nerve is our LAST life jacket
(Innervated traps and SCM)

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41
Q

If their breathing was unaffected, at which level would the injury be?

A

Brachial plexus (Any below C5)

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42
Q

*Most superficial meninges of the spinal cord?

A

Dura mater

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43
Q

Middle meninges of the spinal cord?

A

Arachnoid

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44
Q

Most inner layer of spinal cord?

A

Pia mater

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45
Q

*Which curvatures of the vertebral column are classified as secondary curvatures?

A

Cervical and lumbar curvatures

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46
Q

*What ligaments prevent excessive rotation of the head?

A

Alar ligaments

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47
Q

*What may a rupture of the transverse ligament of the transverse ligament of the atlas cause a more severe neurological clinical implication than a fracture of the dens?

A

When a rupture of the transverse ligament occurs, the posterior arch of the C1 can compress the spinal cord against the dens. When a fracture of the dens occurs, the dens are set free and would move along w/ the posterior arch of C1 and the spinal cord.

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48
Q

*Where does the vertebral a. enter the transverse foramen of the transverse process?

A

C6

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49
Q

*What thoracic vertebrae are classified as typical vertebra?

A

T2-T10

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50
Q

*What cervical vertebrae are considered typical?

A

C3-C6

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51
Q

*What movements occur at the costovertebral joints (ribs)?

A

-Rotation around longitudinal axis in UPPER ribs

-Ascends and descends relative to vertebral column in LOWER ribs

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52
Q

*What ligaments stabilize the costotransverse joins?

A

The costotransverse ligaments (medial, lateral and superior)

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53
Q

*Name the muscles from the superficial group of the back

A

Traps, lats, rhomboids and levator scapulae

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54
Q

*Define spondolisthesis and its classifications

A

-DISLOCATION of one of the lower vertebrae in relation to vertebrae under it.

-The angle in b/w the superior inferior articular processes

-L-S1 does NOT move

-Classifications: Grade I (25%), Grade II (25-50%), Grade III (50-75%), Grade IV (75-100%)

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55
Q

*Structures suspended from the abdominal wall

A

Intraperitoneal structures

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56
Q

*3 main functions of abdominal wall?

A

Protection, breathing and intra-abdominal pressure

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57
Q

*What organs are partially protected by the thoracic wall?

A

Intraperitoneal:
Liver, gallbladder, stomach, spleen and colon

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58
Q

*Regions from 9 region organizational pattern

A

R hypochondrium, R flank, R groin, epigastric, umbillicus, pubic, L hypochondrium, L flank, L groin

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59
Q

*List all the abdominal anterolateral layers from the outmost (include flat muscles)

A

Skin, camper’s fascia, scarpa’s fascia, external oblique, internal oblique, transverse abdominis, transversalis fascia, extraperitoneal fascia, parietal peritoneum

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60
Q

*Subdivisions of peritoneal cavity?

A

Greater sac & omental bursa (lesser sac)

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61
Q

*Where is the sigmoid colon located in the 9 region organizational pattern?

A

Pubic region

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62
Q

*What are the names of the ligaments that make the lesser omentum?

A

Hepatoduodenal ligament & hepatogastric ligament

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63
Q

*4 regions of the stomach?

A

Cardia, fundus, body, pyloric part

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64
Q

*What 2 structures also enter the abdominal cavity w/ the esophagus?

A

Anterior and posterior vagus trunk

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65
Q

*What muscle has an attachment to the dura mater?

A

Rectus capitis posterior minor

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66
Q

What is the mnemonic to remember the 9 regions?

A

Hector F*s Isabel Every Unceasing Pump

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67
Q

Visceral compartment covers?

A

Parts of digestive & respiratory systems & endocrinal glands

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68
Q

Vertebral compartment covers?

A

Cervical vertebrae, cervical nerves+muscles and spinal cord

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69
Q

2 vascular compartments

A

Major blood vessels & vagus n. (CN 10)

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70
Q

Largest compartment?

A

Vertebral compartment

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71
Q

What 2 nerve structures exit at the vertebral compartment?

A

Brachial and cervical plexus exit

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72
Q

What glands are at C6?

A

Thyroid glands

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73
Q

What’s a part of the vertebral compartment?

A

Vertebral column and spinal cord (Prevertebral fascia)

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74
Q

What’s a part of the visceral compartment?

A

Organs

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75
Q

Where does the brachial plexus exit up from?

A

Anterior and middle scalene

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76
Q

Deep fascia of the neck (surrounds every compartment!)

A

Investing fascia (surrounds every compartment)

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77
Q

Deep fascia

A

forms a house for the traps
Anteriorly: forms a house for SCM & infrahyoid muscles

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78
Q

Platysma

A

O: Infra & Supraclavicular regions
I: Base of mandible; skin of cheek & angle of mouth
A: Makes EW face, protection of superficial facial drainage (protects superficial major vessels)
N: Facial n.

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79
Q

Where is the anterior jugular vein located?

A

Anterior triangle of the neck

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80
Q

What does the anterior jugular vein do?

A

Drains blood to scalp & neck

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81
Q

Where does the anterior jugular vein drain to?

A

External jugular vein

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82
Q

Posterior triangle: communication

A

b/w head and upper limbs

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83
Q

What exits on the posterior triangle?

A

Brachial plexus

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84
Q

Anterior triangle: communication

A

b/w head and toes

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85
Q

Anterior triangle boundaries

A

Anterior border of SCM + inferior border of mandible

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86
Q

Posterior triangle boundaries

A

Posterior border of SCM, anterior border of traps & middle 1/3 of clavicle

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87
Q

What triangle houses the facial artery?

A

Submandibular triangle

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88
Q

What’s in the submandibular triangle

A

Facial a+v, submandibular gland, hypoglossal n. (CN12)

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89
Q

Submental triangle

A

Submental lymph nodes

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90
Q

Carotid triangle

A

-Carotid a.
-Internal jugular v.
-Vagus n (CN11)
-Ansa Cervicalis

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91
Q

Contents of muscular triangle?

A

Thyroid and parathyroid glands

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92
Q

SUPRAhyoid muscles (anterior triangle)

A

-Stylohyoid
-Digastric
-Mylohyoid
-Geniohyoid

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93
Q

INFRAhyoid muscles (anterior triangle)

A

-Sternohyoid
-Omohyoid
-Thyrohyoid
-Sternothyroid

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94
Q

Which muscle is the only one that does NOT attach onto the hyoid bone?

A

Sternothyroid

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95
Q

What makes the hyoid bone unique?

A

Not attached to any other bone (free-floating)

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96
Q

Hyoid bone action

A

Supports tongue

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97
Q

What happens if you have a lower hyoid bone?

A

Obstructive sleep apnea

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98
Q

How do you prevent lower hyoid bone?

A

Strengthen hyoid muscles to raise hyoid bone higher.

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99
Q

STYLOhyoid

A

O: Base of STYLOID process
I: Greater horns
N: Facial N (CN7)
A: Pulls hyoid bone posterior-superior during swallowing

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100
Q

Digastric (Anterior and posterior belly)

A

O: Anterior-digastric fossa
Posterior: Mastoid process
I: Tendon b/w 2 bellies to body. of hyoid bone
N: Mylohyoid N.
A: Elevates the hyoid bone & depresses the mandible

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101
Q

Mylohyoid

A

O: Mylohyoid line on mandible
I: Body of hyoid bone
N: Mylohyoid n.
A: Support & elevation of floor of mouth;
elevation of hyoid

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102
Q

Geniohyoid (underbite)

A

O: Inferior mental spine
I: Body of hyoid bone
N: Anterior ramus from C1
A: Fixation of mandible; pulls mandible inward

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103
Q

What nerve innervates ALL the infrahyoid muscles?

A

Ansa cervicalis (cervical plexus)

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104
Q

Sternohyoid OINA

A

O: Posterior aspect of sternoclavicular joint
I: Body of hyoid bone
N: Ansa cervicalis
A Depresses hyoid bones after swallowing

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105
Q

Omohyoid (Anterior and posterior belly)

A

O: Superior border of scapula
I: Body of hyoid
N: Anterior rami of C1 to C3
A: Depresses hyoid bone
(*Can move scapula superiorly too)

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106
Q

Thyrohyoid

A

O: Thyroid cartilage
I: Greater horn of hyoid bone
N: Anterior ramus of C1
A: Depresses the hyoid bone and elevates thyroid cartilage

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107
Q

Sternothyroid

A

O: Manubrium
I: Oblique line of lamina of thyroid cartilage
N: Ansa cervicalis
A: Draws larynx (thyroid cartilage)
downwards

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108
Q

Internal carotid a. supplies

A

Everything inside the skull

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109
Q

EXTERNAL carotid a. supplies

A

Everything outside the skull

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110
Q

Internal jugular veins receive blood from?

A

head and neck

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111
Q

R side vessels

A

-R. Subclavian a
-R. common carotid a.
*Comes from brachiocephalic trunk (from aorta)

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112
Q

L. side vessels

A

-L. carotid a. comes directly from arch of aorta
-L subclavian a. from arch of aorta

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113
Q

What vein supplies blood to upper limbs?

A

-Subclavian v.

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114
Q

External carotid a. branches?

A

-Superior thyroid a.
-Pharyngeal a.
-Lingual a.
-Facial a.

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115
Q

Anterior triangle nerves

A

-Vagus n.
-Accessory n.
-Hypoglossal n.
-Glossopharyngeal n.

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116
Q

What kind of fibers are CN 11(accessory) / 12?

A

ONLY motor fibers

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117
Q

What does the glossoPHARYNGEAL innervate?

A

pharyngeal wall

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118
Q

What does the vagus n. innervate?

A

larynx, lungs, heart, liver and abdomen

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119
Q

What does accessory n. innervate?

A

Traps and SCM

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120
Q

What does hypoglossal n. innervate? (Say ahhhh)

A

Tongue

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121
Q

What are the prevertebral muscles?

A

-Rectus capitis anterior
-Rectus capitis lateralis
-Longus capitis
-Longus colli

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122
Q

Posterior triangle boundaries

A

Anteriorly: SCM
Posteriorly: traps
Basally: clavicle
Apex: occipital bone
Floor: prevertebral layer of cervical fascia

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123
Q

What do ALL the posterior triangle boundaries have in common?

A

All covered by investing layer of fascia

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124
Q

What muscles do the posterior triangle house?

A

SCM, traps and omohyoid

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125
Q

What muscles have investing fascia (of the neck)? SUPERFICIAL

A

SCM, traps, omohyoid (inferior belly)

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126
Q

What muscles have prevertebral fascia? DEEP

A

Anterior+middle+posterior scalene, splenius capitis, levator scapulae

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127
Q

SCM

A

O: manubrium (clavicular head), 1/3 of clavicular head
*I: Mastoid process
N: Accessory n.
A: Unilaterally flexes head and neck laterally and rotates head to opposite side

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128
Q

SCM bilateral contraction action?

A

“Computer neck posture”
Ext: A-O joint
F: Inferior cervical vertebrae
(If you contract both at the same time, you’ll extend the upper and flex the lower)

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129
Q

Splenius capitis (Cap=attached to head)

A

O: Spinous process of C7-T3 & nuchal ligament
*I: Mastoid process
N: Posterior rami (middle)
A: Ipsalateral rotation of head, ext+LF of spine and head

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130
Q

What muscles do the posterior rami innervate?

A

Intrinsic muscles of the back

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131
Q

What are the false ribs?

A

R8-10 (11 & 12 are floating ribs)

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132
Q

Anterior scalene OINA

A

O: Anterior tubercles of vertebrae C3-C6
I: Scalene tubercle of 1st rib
N: Anterior rami of C4-C6
A: Elevation of rib 1

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133
Q

Middle scalene OINA

A

O: Posterior tubercles of the transverse processes of vertebrae C2-C7
I: Upper surface of 1st rib
N: Anterior rami of C3-C8
A: Elevation of rib 1

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134
Q

Posterior scalene OINA

A

O: Posterior tubercles of transverse processes of vertebrae C5-C7
I: Lateral surface of 2nd rib
N: Anterior rami of C6-C8
A: Elevation of 2nd rib & LF

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135
Q

Where is the external jugular vein?

A

On top of SCM (goes through subclavian triangle and into investing fascia to join subclavian a.)

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136
Q

When does the subclavian a. become the axillary a.?

A

Rib 1

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136
Q

What are the 2 branches of the thyrocervical trunk?

A

Transverse cervical and suprascapular a. (arises from 1st part of subclavian a.)

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137
Q

Where does the thyrocervical triangle come from?

A

Subclavian a.

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138
Q

Cervical plexus (innervates all cervical muscles)

A

-Formed by anterior rami of cervical nerves 1-4
-Consists of muscular branches (deep) and cutaneous branches (superficial)

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139
Q

What muscle does the phrenic nerve innervate? (Only sensory and motor n.)

A

Diaphragm (breathing)

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140
Q

Transverse cervical n.

A

Innervates lateral & anterior part of neck

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141
Q

Supraclavicular n.

A

Innervates the skin over the clavicle & shoulder

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142
Q

Lesser occipital n.

A

Innervates skin of neck & scalp (posterior to ear)

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143
Q

Great auricular n.

A

Innervates skin of parotid region, ears and mastoid area

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144
Q

What do IV discs limit?

A

Limit movement, so if you have degeneration in the discs, you’ll have herniations in the disc (because the nucleus pulposus is always trying to get out.

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145
Q

What nerves innervate the extrinsic muscles?

A

Anterior rami of spinal nerves (moves upper limbs and thoracic wall)

146
Q

What nerve innervates the intrinsic muscles?

A

Posterior rami of spinal nerves (moves head)

147
Q

Where is CSF stored in the body?

A

Subarachnoid space

148
Q

What does the anterior root transmit?

A

Motor signals

149
Q

What does the posterior root return?

A

Returns sensory signals

150
Q

Is the anterior or posterior ramus bigger?

A

Anterior rami because it innervates EVERYTHING, BUT the head and intrinsic back muscles

151
Q

Why does the spinal cord ONLY go to L1?

A

The bones grow faster than the cord

152
Q

Where do people collect CSF at?

A

Caudate equina

153
Q

What makes thoracic vertebrae special?

A

-Angle of thoracic articular facets
-Coastal facets (for the articulations of the ribs)

154
Q

What are the atypical thoracic vertebrae? (SELFISH)

A

T1, T11, T12
(They are selfish because they want to articulate w/ a WHOLE rib by themself)

155
Q

What makes atypical thoracic vertebrae?

A

-T11+T12 only have single “FULL” costal facet
Neck of R11+12 don’t form articulations w/ corresponding transverse processes

-T1 has a “full” and “partial” costal facet

All articulate w/ corresponding ribs

156
Q

T11 + T12 do not have?

A

T11 + T12 DO NOT have costovertebral transverse joints

157
Q

What 2 muscles are ONLY used during high intensity aerobic activity (Forced respiration)?

A

-Serratus posterior superior (Inhaling)
-Serratus posterior inferior (Exhaling)
Intercostal nerves & arteries

158
Q

What makes lumbar vertebrae unique?

A

-Vertical facets
-SUPERIOR facets directed posteromedially
-INFERIOR facets directed anterolaterally
-Mammillary process

159
Q

Pars Interarticularis (Spondolythesis)
L5-S1

A

A region of the lamina located between the facet joints

160
Q

*Atypical lumbar vertebrae?

A

L5 (Body is taller anteriorly “Lumbosacral angle”

161
Q

What ligament limits extension of lumbar?

A

Anterior longitudinal ligament (strongest thickest ligament)

162
Q

What ligament limits flexion?

A

Posterior longitudinal ligament

163
Q

What is the Ligamentum Flava?

A

-Most ELASTIC ligament in the whole body!
“Rubber-band ligament”
-Ligamentum flava help keeps you upright
-Also limits extension

164
Q

What does the Supraspinous ligament limit?

A

Forward flexion

165
Q

Do iliolumbar & lumbosacral ligaments have a lot of movement?

A

NO, because the hips have to be stable!

166
Q

Why is spondylothesis so common in the lumbar?

A

Because the facet joints hold up the weight of the entire body. This leads to a lot of pressure on the PARS ARTICULARIS of lumbar.

*The lumbar holds the most bodyweight because of the lumbosacral ANGLE and also LORDOSIS

167
Q

What does the peritoneal cavity communicate with?

A

The pelvic cavity

168
Q

Parietal vs. visceral peritoneum

A

Parietal is outer layer (covers abdominal wall), visceral is inner (covers organs)

If you don’t have enough fluid the peritoneum will stick together and be very painful

169
Q

What does the thoracic wall protect?

A

Intraperitoneal:
Liver, gallbladder, stomach, spleen & colon

170
Q

What does the abdominal wall protect?

A

big & small intestine

171
Q

Skeletal elements of the “Bony Wall”?

A

-Lumbar vertebrae
-Pelvic bones
-Inferior thoracic wall (Costal margin, R12, end of R11, xiphoid process

172
Q

“Muscular wall”

A

-Anterior: Rectus abdominis
-Lateral: External/internal oblique & TA
-Posterior: QL, Illiacus & Psoas major

173
Q

What is the Mesentary?

A

Consists of double layer of peritoneum that attaches the viscera to the abdominal wall

174
Q

Retroperitoneal

A

Structures not suspended in the abdominal wall by the mesentery
that lie b/w the parietal peritoneum & abdominal wall (Kidneys & ureters)

175
Q

Intraperitoneal

A

Structures suspended from the abdominal wall by the mesentary (GI system)

176
Q

Diaphragm

A

Separates abdomen from the thorax
-Each side has crus that anchors diaphragm to the anterolateral surface (R side is stronger+longer than left)

177
Q

Posterior diaphragm ligaments

A

-Medial & Lateral Arcuate ligaments cross over posterior abdominal wall & attach to TRANSVERSE PROCESSES of L1 & R12

178
Q

Pelvis inlet

A

-Continuous w/ abdominal cavity
-Infections can also freely spread into pelvic to abdominal (vice versa)

179
Q

Abdomen communicates directly w/ thigh through what?

A

Through an aperture formed anteriorly b/w inferior margin of abdominal wall MARKED BY THE INGUINAL LIGAMENT & PELVIC BONE

180
Q

What structures pass through the abdomen-thigh apeture?

A

-External iliac a & v (later changes to femoral a & v)
-Femoral n.
-Lymphatics
-Psoas major & iliacus muscles

181
Q

Four-quadrant pattern

A

-Transumbilical plane: umbilicus & intervertebral discs (L3&4)
-Vertical plane: xiphoid process & pubic symphysis

182
Q

Boundaries of 9-region organizational pattern

A

-Superiorly: xiphoid process & costal margins
-Inferiorly: upper parts of pelvic bone
-Posterior: thoracolumbar fascia/lumbar vertebrae

183
Q

9-region organizational pattern planes

A

-Subcostal plane: inferior to costal margins
-Transtubercular plane: tubercles of iliac crests
-Vertical planes: middle clavicles to a point b/w ASIS & pubic symphysis

184
Q

What and when does superficial fascia split into?

A

Camper’s fascia and Scarpa’s fascia (at umbilical region)

185
Q

What common attachment do the abdominal muscles have?

A

Linea alba (“White line”)

186
Q

What does the pyramidalis do?

A

Tension for Linea alba

187
Q

Where is the transversalis fascia?

A

-b/w inner surface of TA and Extraperitoneal fascia

188
Q

Extraperitoneal fascia

A

-DEEP to transversalis fascia
-Separates transversalis fascia and peritoneum

189
Q

Where are the thorabdominal nerves?

A

b/w 2nd and 3rd layer of muscles
(internal oblique and TA)

190
Q

What is in the inguinal canal?

A

Spermatic cord and round ligament of uterus (helps tilt uterus)

190
Q

Where does inguinal canal enter and exit?

A

Enters: Deep inguinal ring
Exit: Superficial inguinal ring

191
Q

Spermatic cord many structures?

A

-ductus deferens
-sympathetic and afferent nerve fibers

192
Q

What is an inguinal hernia?

A

Is the protrusion or passage of the peritoneal sac through a weakened part of the abdominal wall in the groin

193
Q

How does the peritoneal sac enter the inguinal canal? (Both directly and indirectly)

A

Directly: Through the posterior wall of inguinal canal
vs.
Indirectly: Through the deep inguinal ring

194
Q

What is a branch of the femoral a.?

A

Superficial circumflex iliac a.

195
Q

What is a branch from internal thoracic a.?

A

Superior epigastric a.

196
Q

What are 2 branches of the external iliac a.?

A

inferior epigastric a.
&
deep circumflex iliac a.

197
Q

GREATER omentum

A

-Attaches to GREATER curvature of stomach & first part of duodenum & transverse colon
-Has a and v

198
Q

LESSER omentum: HepatoDUOdenal ligament
Which organs?

A

-DUOdenum & liver

199
Q

Where does the esophagus come out from?

A

R. Crus (T10)
Has anterior & posterior vagus trunk

200
Q

What region is the stomach located in?

A

L hypochondrium, Epigastric, and umbilical

201
Q

Stomach: Cardia part

A

Surrounds opening of esophagus

202
Q

Stomach: Fundus

A

Area above level of cardial orifice

203
Q

Stomach: Body

A

Largest part

204
Q

Stomach: Pyloric part

A

Distal end-divided into: pyloric antrum & pyloric canal

205
Q

Small intestine

A

-Goes from pyloric orifice to ileocecal fold
-Consists of: duodenum, jejunum and then ileum

206
Q

Duodenum

A

-C-shaped (adjacent to pancreas)
-Mainly retroperitoneal (2nd, 3rd, 4th part)

207
Q

Duodenum: 2nd part

A

ENTRANCE FOR BILE AND PANCREATIC DUCTS

208
Q

Where does duodenum end?

A

@duodenojejunal flexure

209
Q

Ligament of TRIETZ?

A

Suspensory muscle of DUODENUM

210
Q

Jejunum

A

-Makes up first 2/5 of small inestines

(Unique characteristics of jejunum:
Thicker wall, less prominent arterial arcades & longer vasa carta than ileum)

211
Q

Ileum (last part of small intestine)

A

-Makes up distal 3/5 of small intestines

(Unique characteristics of ileum: has thinner walls, shorter vasa recta, more mesenteric fat, & more arterial arcades)

212
Q

What is the opening of the large intestine (colon)?

A

Ileocecal fold flaps

213
Q

Colon: Ileocecal fold flaps job?

A

-Prevent acid reflux from cecum into ileum
-Regulates passage of contents from ileum into cecum

214
Q

Large intestine (Colon)

A

-Goes from distal end of ilium to anal canal

Job: Absorb fluid & salt from gut

215
Q

What is the appendix connected to?

A

Cecum

216
Q

How do you find your appendix (McBurney’s point?

A

Middle 1/3 from your ASIS to umbilicus

217
Q

Appendicitis symptoms

A

-Localized tenderness in R GROIN REGION

-Starts at central periumbilical then localizes at R iliac fossa

218
Q

Accessory organs of digestion

A

Liver, pancreas and gallbladder

219
Q

Liver

A

-Largest visceral organ in the body

Job: Produce bile, cholesterol metabolism, urea cycle, protein production (ex: albumin), clotting factor production and detoxification of blood

220
Q

Liver: Caudate lobe

A

-Bounded by ligamentum venosum
-Groove for inferior vena cava

221
Q

Liver: Quadrate lobe

A

-Bounded by ligamentum teres
-Fossa for gallbladder

222
Q

Gallbladder

A

-Located on visceral surface of R lobe of liver

Consists of:
-Fundus
-Body
-Neck

Job: Receives, concentrates and stores bile from liver

223
Q

Pancreas

A

-Located behind stomach
Goes from duodenum to spleen

Consists of:
-Head
-Neck
-Tail

Job:
-Produces and secretes enzymes
- produces and secretes hormones (insulin and glucagon)

224
Q

What does the ansa cervicalis innervate?

A

All the hyoid muscles (except mylohyoid)

225
Q

What cervical spinal nerves are in the cervical plexus?

A

C1-C4

226
Q

What does Median Arcuate Ligament cross?

A

Median Arcuate Ligament crosses aorta @diagphragmatic opening
& continues w/ crus on each side
(This is why infections in the abdominal cavity can spread (because it is continuous w/ esophagus)

227
Q

How many sacral vertebrae are there?

A

5 sacral vertebrae

228
Q

Does the coccyx have a vertebral arch?

A

NO

229
Q

How many facet joints does the lumbosacral joint have?

A

2 facet joints (zygapophysial joints)

230
Q

What ligaments stabilize the lumborsacral joints?

A

-iliolumbar ligaments
-lumbosacral ligaments

231
Q

What are the kidney’s external layers?

A

-Renal capsule (deepest)
-Adipose capsule-perirenal fat
-Renal fascia (superficial)

232
Q

Blood supply of kidney?

A

-Renal artery (a lateral branch of the abdominal aorta)

233
Q

Hilum of kidney

A

-Deep vertical slit through which renal vessels, lymphatics, & nerves enter and leave the kidney

234
Q

Where are the 3 points where the ureters are constricted?

A

-1st point is at the ureteropelvic junction
-2nd point is pelvic inlet: where the ureters CROSS the common iliac vessels
-3rd point is where the ureters ENTER the wall of the bladder
(Kidney stones can become lodged at these constrictions)

235
Q

Where are the kidneys located?

A

b/w T12 & L3

236
Q

Which kidney is more superior?

A

L. kidney

237
Q

Pattern of blood flow through the nephrons?

A

Renal a.,Segmental a., Arcuate a., Interlobular a.

238
Q

Where is the bladder the most “fixed?”

A

At the neck (most inferior part of bladder)

239
Q

What ligament help support the bladder?

A

Pubovesical ligament (Fibrouscular bands)

240
Q

Where does the urethra start and end?

A

In the pelvic cavity it begins at the neck of the bladder & ends with an external opening in the perineum

241
Q

*What is the male urethra divided into?

A

-Preprostatic
-Prostatic
-Membranous
-Spongy parts

242
Q

What does the female urethra pass through?

A

Passes through the deep perineal pouch and perineal membrane before opening in the vestibule that lies between the labia minora

243
Q

What does the male urethra pass through?

A

Beginning at the base of the bladder and passing inferiorly
through the prostate, it passes through the deep perineal pouch & perineal membrane & enters the root of the penis, sequentially entering the body of the penis

244
Q

What is in the Posterior Abdominal region?

A

Abdominal aorta & its associated nerve plexuses, the inferior vena cava, the sympathetic trunks, & lymphatics

245
Q

What are the bones of the Posterior Abdominal Wall?

A

-Lumbar vertebrae
-Sacrum (upper margin)
-Pelvic bones (medial side of each ilium)
-Ribs (11&12)

246
Q

What’s Rib 12’s job?

A

Place for muscle and ligament attachment

247
Q

What are the muscles of the Posterior Abdominal Wall?

A

Superiorly: diaphgram
Medially: Psoas major and minor
Laterally: quadratus lumborum
Inferiorly: Iliacus

248
Q

What muscles insert at the lesser trochanter of femur?

A

-Psoas major (APT)
-Iliacus

249
Q

Psoas Major origin?

A

T12-L5 & intervertebral discs

250
Q

What can a Psoas muscle abscess cause?

A

-Tuberculosis goes into IV discs
-Pus is stuck because of the ligaments
-Pain presents as pain on one side during hip flexion
-Can cause scoliosis

251
Q

Why is the QL important?

A

-Important for respiration: attach to floating Rib 12
(Allows diaphragm to move rib w/o moving too much)

252
Q

What is unique about the QL attachment?

A

Attached to every lumbar segment except L5

253
Q

What ligament connects the L and R crus?

A

Medial arcuate ligament

254
Q

What are the main structures that pass through diaphragm?

A

-Aorta (anterior to vertebral bodies at T12)

-Thoracic duct

-Esophagus (through R crus at T10)

  • Anterior & posterior vagal trunks (passes w/ esophagus)

-Inferior vena cava (passes from abdominal cavity to thoracic cavity)

-Right phrenic n. (passes w/ IVC)

-Left phrenic n. (passes through diaphragm anterior to central tendon on L side)

255
Q

What is the R and L domes formed by?

A

-R dome: liver
-L dome: stomach and spleen

256
Q

Where does expiration happen in the L and R dome? (Important for percussing thorax!)

A

-L dome: Intercostal space 5

-R dome: rib 5

257
Q

Diaphragm innervation

A

-Phrenic n. (motor to diaphragm and sensory to central part)

-Intercostal n. (peripherally sensory)

258
Q

What is the central tendon attached to?

A

Liver

259
Q

Is the thoracic wall segmental?

A

YES, everything will be in b/w the ribs (For every 2 ribs, there will be a different set of muscles, nerves and vessels.

260
Q

What are the boundaries of the superior thoracic aperture?

A

Vertebra T1, rib 1 & manubrium

261
Q

What are the boundaries of the inferior thoracic aperture?

A

Vertebra T12, rib 12, end of rib 11, costal margin & xiphoid process of sternum

262
Q

Where is the superior thoracic aperture? And what is important to know about it?

A

-Everything in b/w rib 1 is the thoracic aperture

-There isn’t a lot of space, so impingement can easily happen

263
Q

What are the diff classifications of ribs?

A

True ribs, false ribs, typical, atypical and floating ribs

264
Q

What ribs attach to the sternum?

A

Ribs 1-7

265
Q

What is a part of the skeletal framework?

A

Thoracic vertebrae, IV disc, ribs and sternum

266
Q

Which ribs are true ribs? Why?

A

Ribs 1-7 (Indirectly articulates w/ sternum through costal cartilage)

267
Q

Which ribs are false ribs? Why?

A

Ribs 8-12 (Directly articulates w/ sternum through costal cartilage)

268
Q

Which ribs are floating ribs? Why?

A

Ribs 11/12 (NO articulation w/ sternum)

269
Q

Which ribs are atypical ribs and why?

A

-Ribs 1/2 & 10-12

-Rib 1=Groove for subclavian vessels and only 1 articular facet in the head (T1 vertebra))
-Rib 2=Flat & tuberosity for SA
-Ribs 10-12=Only 1 articular facet on head
-Ribs 11/12=no tubercles and no articulation w/ sterum

270
Q

What does the costal cartilage do?

A

Gives stability & flexibility to thoracic

271
Q

Why are the ribs so easily fracturable?

A

They do not have any weight bearing (No Wolfe’s Law)

272
Q

What does the costal groove do?

A

Accommodates all vessels

273
Q

Why does only rib 1 have a fibrocartilaginous joint?

A

To prevent compression of all the structures that are passing through (YOU DO NOT WANT RIB 1 TO MOVE)

274
Q

When does the Subclavian v. become the axillary v.?

A

After passing outer border of rib 1

275
Q

What pair of ribs can be classified as false, BUT also typical ribs?

A

Ribs 8/9

276
Q

Which ribs are not synovial joints?

A

Manubrium and Rib 1

277
Q

What movement do the Interchondral joints allow?

A

Gliding

278
Q

**What movement does the Manubriosternal joint allow? and important landmarks?

A

Allows chest to expand anteriorly

-Where rib 2 articulates
-Pulmonary valve (2nd intercostal space on L side)
-Aortic valve (2nd intercostal space on R side)

279
Q

Angle of Louis/Sternal angle clinical landmark importance

A

-Located at level of T4-T5 IV discs
-Aortic arch on L side and SVC on R side

-Level of the bifurcation of trachea and pulmonary trunk
-Trachael carina is deep to Angle of Louis
-Pericardum goes from superior angle to xiphisternal joint
-Marks the level of the transverse thoracic plane which divides the mediastinum into the superior and inferior mediastinum

280
Q

Why would the Angle of Louis/Sternal angle be bigger?

A

-If you are a chest breather or if you started aerobic activity last an early age

281
Q

What happens when something punctures the Intercostal space?

A

The artery and veins will be protected because of the bone. BUT, the nerve will be injured

282
Q

Where are the intercostal veins, arteries and nerves located?

A

In the costal groove (along the inferior margin of the superior rib & pass in the plane between the inner two layers of muscles)

283
Q

Function of external intercostal muscle?

A

Inspiration, moves ribs superiorly and supports intercostal space

284
Q

Function of internal intercostal muscle?

A

Expiration, moves ribs inferiorly and supports intercostal space

285
Q

Why doesn’t the innermost intercostal move much?

A

It forms a wall b/w pleura and thoracic wall

286
Q

What are the deepest layers of muscles? What do they do? When are they used?

A

Subcostal
-Depresses ribs
-Used during forced respiration

287
Q

Transversus Thoracis function?

A

Depresses costal cartilages

288
Q

Are Intercostal nerves motor or sensory?

A

Both; motor innervation to muscles in the intercostal space and sensory innervation to parietal pleura and overlying skin

289
Q

What innervates the thoracic wall?

A

Intercostal nerves (anterior rami of spinal nerves T1-T11)

290
Q

What innervates the abdominal wall?

A

Anterior rami of spinal nerve T12 (the subcostal nerve) is inferior to rib 12

291
Q

Which intercostal nerves are sensory?

A

Lateral cutaneous, lateral, anterior cutaneous, anterior, medial and posterior branch

292
Q

What is considered the Upper respiratory?

A

Mouth, nasal cavities, pharynx and larynx

293
Q

What is considered the Lower respiratory?

A

Trachea & bronchial tree, lungs & pleural membranes and alveoli

294
Q

What does the epiglottic cartilage do?

A

Opens and closes larynx (keeps food away from trachea)

295
Q

Why does the Arytenoid cartilage move so much? And what does it do?

A

The vocal cords attach there

-It applies tension or loosens vocal cords and allows for speech

296
Q

What does the Recurrent Laryngeal n. do?

A

Supplies intrinsic muscles (ramification of vagus n.)

-Allows for swallowing, breathing, and the movement of the vocal cords.

297
Q

Why is the intercostal muscle so stiff?

A

Because parietal pleura attaches to it (parietal attaches to thoracic wall)

298
Q

What is in b/w the parietal and visceral? And what can you find in it?

A

Pleura cavity; Serous fluid

299
Q

What does the pleura cavity extend into?

A

Above rib 1 into root of neck and above the costal margin

300
Q

Innervation of parietal pleura?

A

-Costal and Cervical:
Intercostal nerves

-Diaphragmatic & Mediastinal:
Phrenic nerve

301
Q

What can the visceral detect and not detect?

A

-Can detect (sensory fibers only) detect stretch.
(It receives autonomic innervation from the pulmonary plexus.)

-Can’t detect pain, temperature, or pressure.

302
Q

Pleura recesses

A

To accommodate the lungs expansion during forced inspiration

303
Q

What attaches to the Suprapleural membrane?

A

-Muscles that attach here:
scalenes
(The scalenes need to pull up ligament)

-Attach to transverse process of C7
And medial border of Rib 1

304
Q

Costomediastinal recess

A

-L side is bigger because that is where the cardiac notch is
(Cardiac notch is not covered by the sternum)

305
Q

**Most clinically important recess?

A

Costodiaphragmatic recess (Most fluid here)
-Ribs 8-10

306
Q

What is the largest surface?

A

Costal surface

307
Q

Where is the ONLY place the lungs attach to?

A

Hilum/root (because they need to have a lot of movement)

308
Q

Structures that pass through hilum?

A

-A pulmonary artery
-2 pulmonary veins
-A main bronchus
-Bronchial vessels
-Nerves
-Lymphatics

309
Q

Which nerve passes anteriorly to the roots of the lungs?

A

Phrenic n.

310
Q

What vessels supply blood to lungs?

A

Bronchial vessels

311
Q

Which lung is bigger?

A

R lung

312
Q

Where does the trachea start and end

A

From vertebral level C6 to vertebral level T4/5 where it bifurcates into a right and a left main bronchus

313
Q

How many bronchopulmonary segments are there?

A

10 segments
(the smallest, functionally independent region of a lung and the smallest area of lung that can be isolated and removed WITHOUT affecting adjacent regions)

314
Q

What is the Carina cartilage?

A

-Last cartilage in trachea (split of primary bronchus)

315
Q

Which primary bronchus is more vertical and bigger?

A

R primary bronchus (This is why food gets stuck on R side)

316
Q

Pulmonary veins blood pathway

A

Each side: superior pulmonary vein and an inferior pulmonary vein carry OXYGENATED blood from the lungs back to the left atrium

317
Q

Pulmonary arteries blood pathway

A

The right and left pulmonary arteries originate from the pulmonary trunk and
carry DEOXYGENATED blood to the lungs from the right ventricle of the heart

318
Q

Which pulmonary artery is longer?

A

R pulmonary artery

319
Q

What plexus innervates the lungs?

A

Pulmonary plexus

320
Q

Arterioles vs arteries?

A

Arterioles: less elastic, but has more smooth muscle.
Major sight of blood flow resistance (pressure reduction valves)

-Narrow lumens
-Thick muscular walls
-They regulate the degree of pressure within the system

321
Q

What order do the venules and veins change from periphery to the heart?

A

Capillaries
Venules
Veins
Superior and inferior vena cava
Right atrium

322
Q

Do veins or arteries have more smooth muscle?

A

Arteries

323
Q

Where are the great veins and arteries located in the heart?

A

Base

324
Q

What are the deep 2-layer serous pericardium? And what separates the 2?

A

Parietal pericardium and visceral pericardium (epicardium)

-Pericardial cavity (fluid)

325
Q

What does the pericardium do?

A

-Protects and anchors the heart
-Prevents overfilling of the heart with blood
*Allows for the heart to work in a relatively friction-free environment

326
Q

What are the heart walls?

A
  1. Epicardium
  2. Myocardium (thickest)
  3. Endocardium
327
Q

What structure gets deoxygenated blood? From where?

A

-R. Atrium
-IVC/SVC

328
Q

What structure gets oxygenated blood? From where?

A

-L. Atrium
-4 pulmonary veins

329
Q

What structure pumps deoxygenated blood to pulmonary circuit? And where does it pump to?

A

-R. Ventricle
-To the Pulmonary artery

330
Q

What structure pumps oxygenated blood to systemic circuit? From where?

A

-L. Ventricle
-To the Aorta (systemic circulation)

331
Q

What do the heart valves do?

A

-Make sure blood flows in ONE direction through the heart

332
Q

When does the Tricuspid and Mitral valve valve close?

A

-Closes during ventricular contraction

333
Q

Coronary artery disease

A

-Inadequate oxygenation of an area of myocardium

334
Q

What is a part of the cardiac conduction system?

A

-SA node
-AV node
-Bundle of His
-Purkinje fibers

335
Q

Where is the superficial part of the cardiac plexus?

A

-Inferior to
the aortic arch & between it & the pulmonary trunk

336
Q

Where is the deep part of the cardiac plexus?

A

-Between the
aortic arch and the tracheal bifurcation

337
Q

What do the visceral afferents do?

A

-Associated with the vagal cardiac nerves sense alterations in blood
pressure and blood chemistry

-Associated with the SNS conduct pain sensation
from the heart, which is detected at the cellular level as tissue-damaging events
(i.e., cardiac ischemia)

338
Q

Where is the hepatorenal recesses located?

A

Is located on the right side between the liver and the right kidney

339
Q

Which of the following ligaments prevent excessive rotation of the head?

A

Alar ligament

340
Q

Select the correct statement about the subclavian artery.

A

It emerges between the anterior and middle scalene muscles

341
Q

Posterior sacro-iliac ligament located?

A

See picture

342
Q

T/F: The left kidney is located slightly superior in comparison to the right kidney

A

True

343
Q

What muscle overlaps with the renal hilum on the posterior abdominal wall?

A

Psoas major (most medial)

344
Q

T/F: Ribs 11 and 12 articulate only with their own vertebrae and have no tubercles.

A

True (They’re selfish)

345
Q

T/F: The tricuspid valve is also known as the mitral valve.

A

False

346
Q

Where do the Purkinje fibers are ramifications that directly root from?

A

Left and right bundles

347
Q

The parasympathetic innervation of the heart is responsible for all of the following EXCEPT:

A

Increases heart rate

348
Q

T/F: The spleen is located superior to the right kidney and adrenal gland

A

False (Spleen is inferior)

349
Q

T/F: The right common carotid artery branches from the arch of the aorta

A

False: R side has brachiocephalic trunk off the aorta

350
Q

The psoas major muscle passes from the abdominal cavity to the thigh through:

A

The aperture between the pubic bone and inguinal ligament

351
Q

What structure emerges into the abdominal cavity passing through the right crus of the diaphragm?

A

Esophagus

352
Q

T/F: The right crus of the diaphragm is longer than the left crus

A

True

353
Q

Blood supply to the diaphragm occurs directly through the following arteries EXCEPT:

A

Gonadal

354
Q

Which of the following is the primary innervation of the diaphragm?

A

Phrenic nerve

355
Q

What nerve does the Recurrent Laryngeal n. branch from?

A

Vagus n.

356
Q

What is the Recurrent Laryngeal n. important for?

A

Speech!

357
Q

What does the Recurrent Laryngeal n. innervate?

A

Our vocal cords (larynx)

358
Q

What is special about the pleural parietal?

A

It is sensitive to pain

359
Q

What structures pass through rib 1?

A

Subclavian a+v and brachial plexus

360
Q

What vein does the azygos drain deoxygenated blood to?

A

Superior vena cava

361
Q
A

511 Final (2 decks)

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