511 Final Flashcards
1
Q
Which cervical vertebrae DO NOT have bifid spinous processes?
A
C1 & C7
2
Q
Foramen transversarium has what artery?
A
Vertebral artery (Skips C7 and enters through C6)
3
Q
What does the vertebral artery supply?
A
Supplies 15% of brain blood, upper spinal cord, cerebellum and posterior part of brain
4
Q
When are you pinching the vertebral artery?
A
Extension+Rotation+LF
5
Q
Upper cervical structures?
A
Occipital condyles and C1+C2
6
Q
Lower cervical structures?
A
Vertebrae of C3-C7`
7
Q
Where does 50% of rotation happen in cervical?
A
Upper cervical
8
Q
Upper cervical action?
A
Nodding yes
9
Q
C1+C2
A
Shaking head “no”
10
Q
What is unique about C1?
A
Has no body, and has the biggest transverse process (easy to palpate)
11
Q
In C1, what does the ligamentum nuchae attach to?
A
posterior tubercle
12
Q
What connects the dens?
A
Transverse ligament
13
Q
What does the transverse ligament do?
A
Prevents axis from sliding posteriorly
14
Q
What does the alar ligament prevent?
A
Rotation of the head
15
Q
What does the alar ligament attach to?
A
Foramen magnum
16
Q
What kind of joint is the upper cervical?
A
True synovial joint
17
Q
What does the Atlanto-occipital joint do?
A
nods head
18
Q
Cruciate ligament of Atlas includes?
A
Transverse ligament, superior and inferior longitudinal band
19
Q
When does the posterior longitudinal ligament become the tectorial membrane?
A
Once it attached to foramen magnum
20
Q
What does down syndrome cause?
A
Laxity in transverse ligament
21
Q
How to check for Atlantoaxial instability
A
AAOD: measure space b/w anterior arch and dens (Test cervical flexion)
22
Q
How do you tear the Alar ligament?
A
Flexion+rotation (contralateral side)
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
24
Q
What do unconvertebral joints do for cervical?
A
Gives more stability and limits lateral flexion
25
Which are atypical cervical vertebrae?
C1/C2 & C7
26
Condition: Cervical osteophytes
Wolfe's law, but it's bad because it causes bone spurs (compression onto uncovertebral joint and impinges spinal nerves)
27
Why is the C3-C6 vertebral canal larger?
To accommodate the thickening of the spinal cord associated w/ the formation of the cervical & brachial plexus
28
What is the anterior tubercle on C6 called?
Carotid tubercle (landmark for anesthesia for UE)
29
Why is C7 atypical?
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!!!
30
What do the suboccipital muscles do?
Extends and rotates head
31
What innervates all the suboccipital muscles?
Posterior ramus of C1 (Suboccipital n.)
32
Content of suboccipital triangle?
Posterior ramus of C1 (Suboccipital n.)
-Vertebral a & v
33
Rectus capitis posterior major OIA:
O: Spinous process of C2
I: Lateral portion of occipital below inferior nuchal line
A: Extension & rotation of head
34
Rectus capitis posterior minor OIA:
O: Posterior tubercle of C1
I: Medial portion of occipital below inferior nuchal line & dura mater
A: Extension of head
35
Why does rectus capitis posterior minor insert into dura mater?
-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
36
Obliquus capitis superior OIA:
O: Transverse process of C1
I: Occipital b/w superior & inferior line
A: Extends and ipsalateral lateral flexion of head
37
Obliquus capitis inferior OIA:
O: Spinious process of C2
I: Transverse process of C1
A: Rotation of head
38
Why would spinal cord damage cause a pt to stop breathing?
-The Phrenic nerve innervates the diaphragm
-Spinal cord injury damages the phrenic nerve
39
What cervical level did injury occur?
Phrenic nerve: C3-C5
40
Why did they not stop breathing immediately, but breathed erraticly before stopping?
Accessory nerve is our LAST life jacket
(Innervated traps and SCM)
41
If their breathing was unaffected, at which level would the injury be?
Brachial plexus (Any below C5)
42
*Most superficial meninges of the spinal cord?
Dura mater
43
Middle meninges of the spinal cord?
Arachnoid
44
Most inner layer of spinal cord?
Pia mater
45
*Which curvatures of the vertebral column are classified as secondary curvatures?
Cervical and lumbar curvatures
46
*What ligaments prevent excessive rotation of the head?
Alar ligaments
47
*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?
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.
48
*Where does the vertebral a. enter the transverse foramen of the transverse process?
C6
49
*What thoracic vertebrae are classified as typical vertebra?
T2-T10
50
*What cervical vertebrae are considered typical?
C3-C6
51
*What movements occur at the costovertebral joints (ribs)?
-Rotation around longitudinal axis in UPPER ribs
-Ascends and descends relative to vertebral column in LOWER ribs
52
*What ligaments stabilize the costotransverse joins?
The costotransverse ligaments (medial, lateral and superior)
53
*Name the muscles from the superficial group of the back
Traps, lats, rhomboids and levator scapulae
54
*Define spondolisthesis and its classifications
-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%)
55
*Structures suspended from the abdominal wall
Intraperitoneal structures
56
*3 main functions of abdominal wall?
Protection, breathing and intra-abdominal pressure
57
*What organs are partially protected by the thoracic wall?
Intraperitoneal:
Liver, gallbladder, stomach, spleen and colon
58
*Regions from 9 region organizational pattern
R hypochondrium, R flank, R groin, epigastric, umbillicus, pubic, L hypochondrium, L flank, L groin
59
*List all the abdominal anterolateral layers from the outmost (include flat muscles)
Skin, camper's fascia, scarpa's fascia, external oblique, internal oblique, transverse abdominis, transversalis fascia, extraperitoneal fascia, parietal peritoneum
60
*Subdivisions of peritoneal cavity?
Greater sac & omental bursa (lesser sac)
61
*Where is the sigmoid colon located in the 9 region organizational pattern?
Pubic region
62
*What are the names of the ligaments that make the lesser omentum?
Hepatoduodenal ligament & hepatogastric ligament
63
*4 regions of the stomach?
Cardia, fundus, body, pyloric part
64
*What 2 structures also enter the abdominal cavity w/ the esophagus?
Anterior and posterior vagus trunk
65
*What muscle has an attachment to the dura mater?
Rectus capitis posterior minor
66
What is the mnemonic to remember the 9 regions?
Hector F*s Isabel Every Unceasing Pump
67
Visceral compartment covers?
Parts of digestive & respiratory systems & endocrinal glands
68
Vertebral compartment covers?
Cervical vertebrae, cervical nerves+muscles and spinal cord
69
2 vascular compartments
Major blood vessels & vagus n. (CN 10)
70
Largest compartment?
Vertebral compartment
71
What 2 nerve structures exit at the vertebral compartment?
Brachial and cervical plexus exit
72
What glands are at C6?
Thyroid glands
73
What's a part of the vertebral compartment?
Vertebral column and spinal cord (Prevertebral fascia)
74
What's a part of the visceral compartment?
Organs
75
Where does the brachial plexus exit up from?
Anterior and middle scalene
76
Deep fascia of the neck (surrounds every compartment!)
Investing fascia (surrounds every compartment)
77
Deep fascia
forms a house for the traps
Anteriorly: forms a house for SCM & infrahyoid muscles
78
Platysma
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.
79
Where is the anterior jugular vein located?
Anterior triangle of the neck
80
What does the anterior jugular vein do?
Drains blood to scalp & neck
81
Where does the anterior jugular vein drain to?
External jugular vein
82
Posterior triangle: communication
b/w head and upper limbs
83
What exits on the posterior triangle?
Brachial plexus
84
Anterior triangle: communication
b/w head and toes
85
Anterior triangle boundaries
Anterior border of SCM + inferior border of mandible
86
Posterior triangle boundaries
Posterior border of SCM, anterior border of traps & middle 1/3 of clavicle
87
What triangle houses the facial artery?
Submandibular triangle
88
What's in the submandibular triangle
Facial a+v, submandibular gland, hypoglossal n. (CN12)
89
Submental triangle
Submental lymph nodes
90
Carotid triangle
-Carotid a.
-Internal jugular v.
-Vagus n (CN11)
-Ansa Cervicalis
91
Contents of muscular triangle?
Thyroid and parathyroid glands
92
SUPRAhyoid muscles (anterior triangle)
-Stylohyoid
-Digastric
-Mylohyoid
-Geniohyoid
93
INFRAhyoid muscles (anterior triangle)
-Sternohyoid
-Omohyoid
-Thyrohyoid
-Sternothyroid
94
Which muscle is the only one that does NOT attach onto the hyoid bone?
Sternothyroid
95
What makes the hyoid bone unique?
Not attached to any other bone (free-floating)
96
Hyoid bone action
Supports tongue
97
What happens if you have a lower hyoid bone?
Obstructive sleep apnea
98
How do you prevent lower hyoid bone?
Strengthen hyoid muscles to raise hyoid bone higher.
99
STYLOhyoid
O: Base of STYLOID process
I: Greater horns
N: Facial N (CN7)
A: Pulls hyoid bone posterior-superior during swallowing
100
Digastric (Anterior and posterior belly)
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
101
Mylohyoid
O: Mylohyoid line on mandible
I: Body of hyoid bone
N: Mylohyoid n.
A: Support & elevation of floor of mouth;
elevation of hyoid
102
Geniohyoid (underbite)
O: Inferior mental spine
I: Body of hyoid bone
N: Anterior ramus from C1
A: Fixation of mandible; pulls mandible inward
103
What nerve innervates ALL the infrahyoid muscles?
Ansa cervicalis (cervical plexus)
104
Sternohyoid OINA
O: Posterior aspect of sternoclavicular joint
I: Body of hyoid bone
N: Ansa cervicalis
A Depresses hyoid bones after swallowing
105
Omohyoid (Anterior and posterior belly)
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)
106
Thyrohyoid
O: Thyroid cartilage
I: Greater horn of hyoid bone
N: Anterior ramus of C1
A: Depresses the hyoid bone and elevates thyroid cartilage
107
Sternothyroid
O: Manubrium
I: Oblique line of lamina of thyroid cartilage
N: Ansa cervicalis
A: Draws larynx (thyroid cartilage)
downwards
108
Internal carotid a. supplies
Everything inside the skull
109
EXTERNAL carotid a. supplies
Everything outside the skull
110
Internal jugular veins receive blood from?
head and neck
111
R side vessels
-R. Subclavian a
-R. common carotid a.
*Comes from brachiocephalic trunk (from aorta)
112
L. side vessels
-L. carotid a. comes directly from arch of aorta
-L subclavian a. from arch of aorta
113
What vein supplies blood to upper limbs?
-Subclavian v.
114
External carotid a. branches?
-Superior thyroid a.
-Pharyngeal a.
-Lingual a.
-Facial a.
115
Anterior triangle nerves
-Vagus n.
-Accessory n.
-Hypoglossal n.
-Glossopharyngeal n.
116
What kind of fibers are CN 11(accessory) / 12?
ONLY motor fibers
117
What does the glossoPHARYNGEAL innervate?
pharyngeal wall
118
What does the vagus n. innervate?
larynx, lungs, heart, liver and abdomen
119
What does accessory n. innervate?
Traps and SCM
120
What does hypoglossal n. innervate? (Say ahhhh)
Tongue
121
What are the prevertebral muscles?
-Rectus capitis anterior
-Rectus capitis lateralis
-Longus capitis
-Longus colli
122
Posterior triangle boundaries
Anteriorly: SCM
Posteriorly: traps
Basally: clavicle
Apex: occipital bone
Floor: prevertebral layer of cervical fascia
123
What do ALL the posterior triangle boundaries have in common?
All covered by investing layer of fascia
124
What muscles do the posterior triangle house?
SCM, traps and omohyoid
125
What muscles have investing fascia (of the neck)? SUPERFICIAL
SCM, traps, omohyoid (inferior belly)
126
What muscles have prevertebral fascia? DEEP
Anterior+middle+posterior scalene, splenius capitis, levator scapulae
127
SCM
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
128
SCM bilateral contraction action?
"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)
129
Splenius capitis (Cap=attached to head)
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
130
What muscles do the posterior rami innervate?
Intrinsic muscles of the back
131
What are the false ribs?
R8-10 (11 & 12 are floating ribs)
132
Anterior scalene OINA
O: Anterior tubercles of vertebrae C3-C6
I: Scalene tubercle of 1st rib
N: Anterior rami of C4-C6
A: Elevation of rib 1
133
Middle scalene OINA
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
134
Posterior scalene OINA
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
135
Where is the external jugular vein?
On top of SCM (goes through subclavian triangle and into investing fascia to join subclavian a.)
136
When does the subclavian a. become the axillary a.?
Rib 1
136
What are the 2 branches of the thyrocervical trunk?
Transverse cervical and suprascapular a. (arises from 1st part of subclavian a.)
137
Where does the thyrocervical triangle come from?
Subclavian a.
138
Cervical plexus (innervates all cervical muscles)
-Formed by anterior rami of cervical nerves 1-4
-Consists of muscular branches (deep) and cutaneous branches (superficial)
139
What muscle does the phrenic nerve innervate? (Only sensory and motor n.)
Diaphragm (breathing)
140
Transverse cervical n.
Innervates lateral & anterior part of neck
141
Supraclavicular n.
Innervates the skin over the clavicle & shoulder
142
Lesser occipital n.
Innervates skin of neck & scalp (posterior to ear)
143
Great auricular n.
Innervates skin of parotid region, ears and mastoid area
144
What do IV discs limit?
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.
145
What nerves innervate the extrinsic muscles?
Anterior rami of spinal nerves (moves upper limbs and thoracic wall)
146
What nerve innervates the intrinsic muscles?
Posterior rami of spinal nerves (moves head)
147
Where is CSF stored in the body?
Subarachnoid space
148
What does the anterior root transmit?
Motor signals
149
What does the posterior root return?
Returns sensory signals
150
Is the anterior or posterior ramus bigger?
Anterior rami because it innervates EVERYTHING, BUT the head and intrinsic back muscles
151
Why does the spinal cord ONLY go to L1?
The bones grow faster than the cord
152
Where do people collect CSF at?
Caudate equina
153
What makes thoracic vertebrae special?
-Angle of thoracic articular facets
-Coastal facets (for the articulations of the ribs)
154
What are the atypical thoracic vertebrae? (SELFISH)
T1, T11, T12
(They are selfish because they want to articulate w/ a WHOLE rib by themself)
155
What makes atypical thoracic vertebrae?
-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
T11 + T12 do not have?
T11 + T12 DO NOT have costovertebral transverse joints
157
What 2 muscles are ONLY used during high intensity aerobic activity (Forced respiration)?
-Serratus posterior superior (Inhaling)
-Serratus posterior inferior (Exhaling)
Intercostal nerves & arteries
158
What makes lumbar vertebrae unique?
-Vertical facets
-SUPERIOR facets directed posteromedially
-INFERIOR facets directed anterolaterally
-Mammillary process
159
Pars Interarticularis (Spondolythesis)
L5-S1
A region of the lamina located between the facet joints
160
*Atypical lumbar vertebrae?
L5 (Body is taller anteriorly "Lumbosacral angle"
161
What ligament limits extension of lumbar?
Anterior longitudinal ligament (strongest thickest ligament)
162
What ligament limits flexion?
Posterior longitudinal ligament
163
What is the Ligamentum Flava?
-Most ELASTIC ligament in the whole body!
"Rubber-band ligament"
-Ligamentum flava help keeps you upright
-Also limits extension
164
What does the Supraspinous ligament limit?
Forward flexion
165
Do iliolumbar & lumbosacral ligaments have a lot of movement?
NO, because the hips have to be stable!
166
Why is spondylothesis so common in the lumbar?
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
What does the peritoneal cavity communicate with?
The pelvic cavity
168
Parietal vs. visceral peritoneum
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
What does the thoracic wall protect?
Intraperitoneal:
Liver, gallbladder, stomach, spleen & colon
170
What does the abdominal wall protect?
big & small intestine
171
Skeletal elements of the "Bony Wall"?
-Lumbar vertebrae
-Pelvic bones
-Inferior thoracic wall (Costal margin, R12, end of R11, xiphoid process
172
"Muscular wall"
-Anterior: Rectus abdominis
-Lateral: External/internal oblique & TA
-Posterior: QL, Illiacus & Psoas major
173
What is the Mesentary?
Consists of double layer of peritoneum that attaches the viscera to the abdominal wall
174
Retroperitoneal
Structures not suspended in the abdominal wall by the mesentery
that lie b/w the parietal peritoneum & abdominal wall (Kidneys & ureters)
175
Intraperitoneal
Structures suspended from the abdominal wall by the mesentary (GI system)
176
Diaphragm
Separates abdomen from the thorax
-Each side has crus that anchors diaphragm to the anterolateral surface (R side is stronger+longer than left)
177
Posterior diaphragm ligaments
-Medial & Lateral Arcuate ligaments cross over posterior abdominal wall & attach to TRANSVERSE PROCESSES of L1 & R12
178
Pelvis inlet
-Continuous w/ abdominal cavity
-Infections can also freely spread into pelvic to abdominal (vice versa)
179
Abdomen communicates directly w/ thigh through what?
Through an aperture formed anteriorly b/w inferior margin of abdominal wall MARKED BY THE INGUINAL LIGAMENT & PELVIC BONE
180
What structures pass through the abdomen-thigh apeture?
-External iliac a & v (later changes to femoral a & v)
-Femoral n.
-Lymphatics
-Psoas major & iliacus muscles
181
Four-quadrant pattern
-Transumbilical plane: umbilicus & intervertebral discs (L3&4)
-Vertical plane: xiphoid process & pubic symphysis
182
Boundaries of 9-region organizational pattern
-Superiorly: xiphoid process & costal margins
-Inferiorly: upper parts of pelvic bone
-Posterior: thoracolumbar fascia/lumbar vertebrae
183
9-region organizational pattern planes
-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
What and when does superficial fascia split into?
Camper's fascia and Scarpa's fascia (at umbilical region)
185
What common attachment do the abdominal muscles have?
Linea alba ("White line")
186
What does the pyramidalis do?
Tension for Linea alba
187
Where is the transversalis fascia?
-b/w inner surface of TA and Extraperitoneal fascia
188
Extraperitoneal fascia
-DEEP to transversalis fascia
-Separates transversalis fascia and peritoneum
189
Where are the thorabdominal nerves?
b/w 2nd and 3rd layer of muscles
(internal oblique and TA)
190
What is in the inguinal canal?
Spermatic cord and round ligament of uterus (helps tilt uterus)
190
Where does inguinal canal enter and exit?
Enters: Deep inguinal ring
Exit: Superficial inguinal ring
191
Spermatic cord many structures?
-ductus deferens
-sympathetic and afferent nerve fibers
192
What is an inguinal hernia?
Is the protrusion or passage of the peritoneal sac through a weakened part of the abdominal wall in the groin
193
How does the peritoneal sac enter the inguinal canal? (Both directly and indirectly)
Directly: Through the posterior wall of inguinal canal
vs.
Indirectly: Through the deep inguinal ring
194
What is a branch of the femoral a.?
Superficial circumflex iliac a.
195
What is a branch from internal thoracic a.?
Superior epigastric a.
196
What are 2 branches of the external iliac a.?
inferior epigastric a.
&
deep circumflex iliac a.
197
GREATER omentum
-Attaches to GREATER curvature of stomach & first part of duodenum & transverse colon
-Has a and v
198
LESSER omentum: HepatoDUOdenal ligament
Which organs?
-DUOdenum & liver
199
Where does the esophagus come out from?
R. Crus (T10)
Has anterior & posterior vagus trunk
200
What region is the stomach located in?
L hypochondrium, Epigastric, and umbilical
201
Stomach: Cardia part
Surrounds opening of esophagus
202
Stomach: Fundus
Area above level of cardial orifice
203
Stomach: Body
Largest part
204
Stomach: Pyloric part
Distal end-divided into: pyloric antrum & pyloric canal
205
Small intestine
-Goes from pyloric orifice to ileocecal fold
-Consists of: duodenum, jejunum and then ileum
206
Duodenum
-C-shaped (adjacent to pancreas)
-Mainly retroperitoneal (2nd, 3rd, 4th part)
207
Duodenum: 2nd part
ENTRANCE FOR BILE AND PANCREATIC DUCTS
208
Where does duodenum end?
@duodenojejunal flexure
209
Ligament of TRIETZ?
Suspensory muscle of DUODENUM
210
Jejunum
-Makes up first 2/5 of small inestines
(Unique characteristics of jejunum:
Thicker wall, less prominent arterial arcades & longer vasa carta than ileum)
211
Ileum (last part of small intestine)
-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
What is the opening of the large intestine (colon)?
Ileocecal fold flaps
213
Colon: Ileocecal fold flaps job?
-Prevent acid reflux from cecum into ileum
-Regulates passage of contents from ileum into cecum
214
Large intestine (Colon)
-Goes from distal end of ilium to anal canal
Job: Absorb fluid & salt from gut
215
What is the appendix connected to?
Cecum
216
How do you find your appendix (McBurney's point?
Middle 1/3 from your ASIS to umbilicus
217
Appendicitis symptoms
-Localized tenderness in R GROIN REGION
-Starts at central periumbilical then localizes at R iliac fossa
218
Accessory organs of digestion
Liver, pancreas and gallbladder
219
Liver
-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
Liver: Caudate lobe
-Bounded by ligamentum venosum
-Groove for inferior vena cava
221
Liver: Quadrate lobe
-Bounded by ligamentum teres
-Fossa for gallbladder
222
Gallbladder
-Located on visceral surface of R lobe of liver
Consists of:
-Fundus
-Body
-Neck
Job: Receives, concentrates and stores bile from liver
223
Pancreas
-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
What does the ansa cervicalis innervate?
All the hyoid muscles (except mylohyoid)
225
What cervical spinal nerves are in the cervical plexus?
C1-C4
226
What does Median Arcuate Ligament cross?
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
How many sacral vertebrae are there?
5 sacral vertebrae
228
Does the coccyx have a vertebral arch?
NO
229
How many facet joints does the lumbosacral joint have?
2 facet joints (zygapophysial joints)
230
What ligaments stabilize the lumborsacral joints?
-iliolumbar ligaments
-lumbosacral ligaments
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What are the kidney's external layers?
-Renal capsule (deepest)
-Adipose capsule-perirenal fat
-Renal fascia (superficial)
232
Blood supply of kidney?
-Renal artery (a lateral branch of the abdominal aorta)
233
Hilum of kidney
-Deep vertical slit through which renal vessels, lymphatics, & nerves enter and leave the kidney
234
Where are the 3 points where the ureters are constricted?
-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)
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Where are the kidneys located?
b/w T12 & L3
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Which kidney is more superior?
L. kidney
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Pattern of blood flow through the nephrons?
Renal a.,Segmental a., Arcuate a., Interlobular a.
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Where is the bladder the most "fixed?"
At the neck (most inferior part of bladder)
239
What ligament help support the bladder?
Pubovesical ligament (Fibrouscular bands)
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Where does the urethra start and end?
In the pelvic cavity it begins at the neck of the bladder & ends with an external opening in the perineum
241
*What is the male urethra divided into?
-Preprostatic
-Prostatic
-Membranous
-Spongy parts
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What does the female urethra pass through?
Passes through the deep perineal pouch and perineal membrane before opening in the vestibule that lies between the labia minora
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What does the male urethra pass through?
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
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What is in the Posterior Abdominal region?
Abdominal aorta & its associated nerve plexuses, the inferior vena cava, the sympathetic trunks, & lymphatics
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What are the bones of the Posterior Abdominal Wall?
-Lumbar vertebrae
-Sacrum (upper margin)
-Pelvic bones (medial side of each ilium)
-Ribs (11&12)
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What's Rib 12's job?
Place for muscle and ligament attachment
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What are the muscles of the Posterior Abdominal Wall?
Superiorly: diaphgram
Medially: Psoas major and minor
Laterally: quadratus lumborum
Inferiorly: Iliacus
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What muscles insert at the lesser trochanter of femur?
-Psoas major (APT)
-Iliacus
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Psoas Major origin?
T12-L5 & intervertebral discs
250
What can a Psoas muscle abscess cause?
-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
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Why is the QL important?
-Important for respiration: attach to floating Rib 12
(Allows diaphragm to move rib w/o moving too much)
252
What is unique about the QL attachment?
Attached to every lumbar segment except L5
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What ligament connects the L and R crus?
Medial arcuate ligament
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What are the main structures that pass through diaphragm?
-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)
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What is the R and L domes formed by?
-R dome: liver
-L dome: stomach and spleen
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Where does expiration happen in the L and R dome? (Important for percussing thorax!)
-L dome: Intercostal space 5
-R dome: rib 5
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Diaphragm innervation
-Phrenic n. (motor to diaphragm and sensory to central part)
-Intercostal n. (peripherally sensory)
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What is the central tendon attached to?
Liver
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Is the thoracic wall segmental?
YES, everything will be in b/w the ribs (For every 2 ribs, there will be a different set of muscles, nerves and vessels.
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What are the boundaries of the superior thoracic aperture?
Vertebra T1, rib 1 & manubrium
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What are the boundaries of the inferior thoracic aperture?
Vertebra T12, rib 12, end of rib 11, costal margin & xiphoid process of sternum
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Where is the superior thoracic aperture? And what is important to know about it?
-Everything in b/w rib 1 is the thoracic aperture
-There isn't a lot of space, so impingement can easily happen
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What are the diff classifications of ribs?
True ribs, false ribs, typical, atypical and floating ribs
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What ribs attach to the sternum?
Ribs 1-7
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What is a part of the skeletal framework?
Thoracic vertebrae, IV disc, ribs and sternum
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Which ribs are true ribs? Why?
Ribs 1-7 (Indirectly articulates w/ sternum through costal cartilage)
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Which ribs are false ribs? Why?
Ribs 8-12 (Directly articulates w/ sternum through costal cartilage)
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Which ribs are floating ribs? Why?
Ribs 11/12 (NO articulation w/ sternum)
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Which ribs are atypical ribs and why?
-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
What does the costal cartilage do?
Gives stability & flexibility to thoracic
271
Why are the ribs so easily fracturable?
They do not have any weight bearing (No Wolfe's Law)
272
What does the costal groove do?
Accommodates all vessels
273
Why does only rib 1 have a fibrocartilaginous joint?
To prevent compression of all the structures that are passing through (YOU DO NOT WANT RIB 1 TO MOVE)
274
When does the Subclavian v. become the axillary v.?
After passing outer border of rib 1
275
What pair of ribs can be classified as false, BUT also typical ribs?
Ribs 8/9
276
Which ribs are not synovial joints?
Manubrium and Rib 1
277
What movement do the Interchondral joints allow?
Gliding
278
**What movement does the Manubriosternal joint allow? and important landmarks?
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
Angle of Louis/Sternal angle clinical landmark importance
-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
Why would the Angle of Louis/Sternal angle be bigger?
-If you are a chest breather or if you started aerobic activity last an early age
281
What happens when something punctures the Intercostal space?
The artery and veins will be protected because of the bone. BUT, the nerve will be injured
282
Where are the intercostal veins, arteries and nerves located?
In the costal groove (along the inferior margin of the superior rib & pass in the plane between the inner two layers of muscles)
283
Function of external intercostal muscle?
Inspiration, moves ribs superiorly and supports intercostal space
284
Function of internal intercostal muscle?
Expiration, moves ribs inferiorly and supports intercostal space
285
Why doesn't the innermost intercostal move much?
It forms a wall b/w pleura and thoracic wall
286
What are the deepest layers of muscles? What do they do? When are they used?
Subcostal
-Depresses ribs
-Used during forced respiration
287
Transversus Thoracis function?
Depresses costal cartilages
288
Are Intercostal nerves motor or sensory?
Both; motor innervation to muscles in the intercostal space and sensory innervation to parietal pleura and overlying skin
289
What innervates the thoracic wall?
Intercostal nerves (anterior rami of spinal nerves T1-T11)
290
What innervates the abdominal wall?
Anterior rami of spinal nerve T12 (the subcostal nerve) is inferior to rib 12
291
Which intercostal nerves are sensory?
Lateral cutaneous, lateral, anterior cutaneous, anterior, medial and posterior branch
292
What is considered the Upper respiratory?
Mouth, nasal cavities, pharynx and larynx
293
What is considered the Lower respiratory?
Trachea & bronchial tree, lungs & pleural membranes and alveoli
294
What does the epiglottic cartilage do?
Opens and closes larynx (keeps food away from trachea)
295
Why does the Arytenoid cartilage move so much? And what does it do?
The vocal cords attach there
-It applies tension or loosens vocal cords and allows for speech
296
What does the Recurrent Laryngeal n. do?
Supplies intrinsic muscles (ramification of vagus n.)
-Allows for swallowing, breathing, and the movement of the vocal cords.
297
Why is the intercostal muscle so stiff?
Because parietal pleura attaches to it (parietal attaches to thoracic wall)
298
What is in b/w the parietal and visceral? And what can you find in it?
Pleura cavity; Serous fluid
299
What does the pleura cavity extend into?
Above rib 1 into root of neck and above the costal margin
300
Innervation of parietal pleura?
-Costal and Cervical:
Intercostal nerves
-Diaphragmatic & Mediastinal:
Phrenic nerve
301
What can the visceral detect and not detect?
-Can detect (sensory fibers only) detect stretch.
(It receives autonomic innervation from the pulmonary plexus.)
-Can't detect pain, temperature, or pressure.
302
Pleura recesses
To accommodate the lungs expansion during forced inspiration
303
What attaches to the Suprapleural membrane?
-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
Costomediastinal recess
-L side is bigger because that is where the cardiac notch is
(Cardiac notch is not covered by the sternum)
305
**Most clinically important recess?
Costodiaphragmatic recess (Most fluid here)
-Ribs 8-10
306
What is the largest surface?
Costal surface
307
Where is the ONLY place the lungs attach to?
Hilum/root (because they need to have a lot of movement)
308
Structures that pass through hilum?
-A pulmonary artery
-2 pulmonary veins
-A main bronchus
-Bronchial vessels
-Nerves
-Lymphatics
309
Which nerve passes anteriorly to the roots of the lungs?
Phrenic n.
310
What vessels supply blood to lungs?
Bronchial vessels
311
Which lung is bigger?
R lung
312
Where does the trachea start and end
From vertebral level C6 to vertebral level T4/5 where it bifurcates into a right and a left main bronchus
313
How many bronchopulmonary segments are there?
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
What is the Carina cartilage?
-Last cartilage in trachea (split of primary bronchus)
315
Which primary bronchus is more vertical and bigger?
R primary bronchus (This is why food gets stuck on R side)
316
Pulmonary veins blood pathway
Each side: superior pulmonary vein and an inferior pulmonary vein carry OXYGENATED blood from the lungs back to the left atrium
317
Pulmonary arteries blood pathway
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
Which pulmonary artery is longer?
R pulmonary artery
319
What plexus innervates the lungs?
Pulmonary plexus
320
Arterioles vs arteries?
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
What order do the venules and veins change from periphery to the heart?
Capillaries
Venules
Veins
Superior and inferior vena cava
Right atrium
322
Do veins or arteries have more smooth muscle?
Arteries
323
Where are the great veins and arteries located in the heart?
Base
324
What are the deep 2-layer serous pericardium? And what separates the 2?
Parietal pericardium and visceral pericardium (epicardium)
-Pericardial cavity (fluid)
325
What does the pericardium do?
-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
What are the heart walls?
1. Epicardium
2. Myocardium (thickest)
3. Endocardium
327
What structure gets deoxygenated blood? From where?
-R. Atrium
-IVC/SVC
328
What structure gets oxygenated blood? From where?
-L. Atrium
-4 pulmonary veins
329
What structure pumps deoxygenated blood to pulmonary circuit? And where does it pump to?
-R. Ventricle
-To the Pulmonary artery
330
What structure pumps oxygenated blood to systemic circuit? From where?
-L. Ventricle
-To the Aorta (systemic circulation)
331
What do the heart valves do?
-Make sure blood flows in ONE direction through the heart
332
When does the Tricuspid and Mitral valve valve close?
-Closes during ventricular contraction
333
Coronary artery disease
-Inadequate oxygenation of an area of myocardium
334
What is a part of the cardiac conduction system?
-SA node
-AV node
-Bundle of His
-Purkinje fibers
335
Where is the superficial part of the cardiac plexus?
-Inferior to
the aortic arch & between it & the pulmonary trunk
336
Where is the deep part of the cardiac plexus?
-Between the
aortic arch and the tracheal bifurcation
337
What do the visceral afferents do?
-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
Where is the hepatorenal recesses located?
Is located on the right side between the liver and the right kidney
339
Which of the following ligaments prevent excessive rotation of the head?
Alar ligament
340
Select the correct statement about the subclavian artery.
It emerges between the anterior and middle scalene muscles
341
Posterior sacro-iliac ligament located?
See picture
342
T/F: The left kidney is located slightly superior in comparison to the right kidney
True
343
What muscle overlaps with the renal hilum on the posterior abdominal wall?
Psoas major (most medial)
344
T/F: Ribs 11 and 12 articulate only with their own vertebrae and have no tubercles.
True (They're selfish)
345
T/F: The tricuspid valve is also known as the mitral valve.
False
346
Where do the Purkinje fibers are ramifications that directly root from?
Left and right bundles
347
The parasympathetic innervation of the heart is responsible for all of the following EXCEPT:
Increases heart rate
348
T/F: The spleen is located superior to the right kidney and adrenal gland
False (Spleen is inferior)
349
T/F: The right common carotid artery branches from the arch of the aorta
False: R side has brachiocephalic trunk off the aorta
350
The psoas major muscle passes from the abdominal cavity to the thigh through:
The aperture between the pubic bone and inguinal ligament
351
What structure emerges into the abdominal cavity passing through the right crus of the diaphragm?
Esophagus
352
T/F: The right crus of the diaphragm is longer than the left crus
True
353
Blood supply to the diaphragm occurs directly through the following arteries EXCEPT:
Gonadal
354
Which of the following is the primary innervation of the diaphragm?
Phrenic nerve
355
What nerve does the Recurrent Laryngeal n. branch from?
Vagus n.
356
What is the Recurrent Laryngeal n. important for?
Speech!
357
What does the Recurrent Laryngeal n. innervate?
Our vocal cords (larynx)
358
What is special about the pleural parietal?
It is sensitive to pain
359
What structures pass through rib 1?
Subclavian a+v and brachial plexus
360
What vein does the azygos drain deoxygenated blood to?
Superior vena cava
361
