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Block 4 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

pericardium supply/drain/innerv? what is the pericardial cavity?

A

pericardiacophrenic a/v; phrenic n/CN10/sympathetic trunk (for vasomotor). phrenic n = C3-5 for shoulder pain. potential space b/w parietal & visceral pericardial layers

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2
Q

transverse vs oblique pericardial sinus

A

b/w inflow sVC & pulm vv and outflow aorta & pulm trunk vs wide pocket-like recess of pericardial cavity post to base of heart

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3
Q

heart in middle mediastinum of pericardial sac & rests on central tendon. base vs apex vs crux of heart?

A

LA w/ lil bit of RA anchored by great vessels vs 5th intercostal space not anchored in pericardial sac vs where all 4 chambers meet

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4
Q

sternocostal vs diaphragmatic vs R pulm vs L pulm surface of heart? sup vs inf vs R vs L border of heart?

A

ant vs inf vs RA vs LA
R/LA & auricles vs RV w/ lil bit LV vs RA b/w sVC & IVC vs LV w/ lil bit L auricle

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5
Q

R/LCA branch off what? 4 RCA branches: sA nodal vs R marginal vs post intervent vs AV nodal. LCA branches: ant intervent vs circumflex (vs L marginal)

A

ascending aorta. RA & sA node vs apex & RV vs R/LV, post 1/3 IV septum, anastomoses w/ IV branch of LCA near apex vs AV node. ant R/LV & ant 2/3 IV septum including IV bundle vs LA vs LV

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6
Q

how to determine dominance of coronary aa? PDA supplies what?

A

if post intervent is coming off of RCA or circumflex (LCA). generally R > L dominance. AV node

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7
Q

great cardiac vs mid cardiac vs small cardiac vs ant cardiac vs L post ventricular vv drain what?

A

LA, both V vs post IV septum vs post RA/V vs ant RA/V vs diaphragmatic surface of LV

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8
Q

lymphatic drainage = crossed –>

A

LA/V -> L coronary trunk -> inf tracheobronchial nodes -> bronchomediastinal trunk -> R venous jxn. RA/V -> R coronary trunk -> ascending aorta -> brachiocephalic nodes -> L venous jxn. pericardium -> sup phrenic nodes & bronchiomediastinal trunks -> R/L venous jxns

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9
Q

heart’s conduxn system innerv by? symph vs parasymph innerv cause? what are visceral sensory fibers?

A

autonomic nn of cardiac plexus. inc rate & force of ctx, thoracic splanchnic nn dil coronary aa vs dec rate of ctx, CN10 constrict coronary aa. carry pain sensation & travels w/ symph CN10 to T1-5 of spinal cord

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10
Q

describe sA node vs AV node vs AV bundle/His vs Purkinje fibers & their locations

A

pacemaker of heart, starts ctx; on external surface of heart in myocardium of RA & sVC vs stimulated by sA node (myogenic conduxn) & transmits impulse to His; base of IA septum above septal cusp of triscuspid vs transmit impulse to vent walls; membranous IV septum -> R/L bundle branches vs where bundle branches end -> subendocardial fibers that ascend in muscular walls of ventricles

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11
Q

cardiac cycle overview

A
  1. initial diastole -> A/V relaxed, AV & sL valves closed
  2. late diastole -> A fill -> AV valves open -> V fill
  3. stim sA node -> A ctx -> force rest of blood to V
  4. V pressure inc -> AV valves close -> LUB
  5. stim AV node -> His init V ctx (vent systole)
  6. inc interventricular pressure -> sL valves open -> RV to pulm trunk, LV to aorta
  7. V relax (ventricular diastole) -> sL valves close -> DUB
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12
Q

3 major spaces & floor of thoracic cavity? perks of having a dome shaped thoracic cage?

A

2 pulm cavities, 1 central mediastinum, diaphragm floor. rigidity; protect organs, resist neg internal pressure, attach, support, maintain wt of UE, abd, neck, back, respiration

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13
Q

where/how do rib fx occur? costochondral vs sternocostal vs costovertebral joints

A

typically at rib angle; from blunt trauma, hard to see on plain film. b/w bone & cartilage 1-10 vs b/w sternum & cartilage 1-7 (1 = fibrocart, 2-7 = synovial) vs b/w ribs & vertebrae

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14
Q

typical vs atypical ribs. pump handle vs bucket handle ribs

A

2-6 b/c facets vs 1, 11-12 b/c diff facets. 1-6 have convex articular surfaces -> transverse rotation; oblique ribs = horiz during inhal -> inc AP diameter vs 7-10 have flat articular surfaces -> glide -> inc lat diameter

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15
Q

external vs internal intercostal vs innermost mm. which thoracic spinal n vs branches make up intercostal n?

A

elev ribs in inhal, cont w/ external obliques vs fibers perpend to ext; dep ribs in forced exhal, cont w/ internal obliques vs same action as int, separated by intercostal a/n. ant rami of T1-11, T12 subcostal n vs collateral, lat cutaneous, ant cutaneous branches

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16
Q

what’s flail chest? thoracic outlet syndrome and tx?

A

many ribs broken –> chest wall moves inward on inspiration & impairs ventilation. n/a/v compressed in sup thoracic aperture/root of neck (broken clavicle, supernumerary rib, tumor, aneurysm); surg decompression

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17
Q

sup vs inf thoracic aperture borders & contents

A

thoracic inlet by T1, R1, manubrium; esophagus, trachea, n/a/v of head & UE vs thoracic outlet by T12, R11/12, costal cartilage, xiphoid process; structures to/from abd/thorax thru openings of diaphragm (esophagus, IVC, aorta)

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18
Q

what’s the diaphragm? borders?

A

musculotendinous sheet separating thorax from abd primarily for inspiration; insert onto central tendon; costal margin, vert bodies L1-3, med/lat arcuate lig, xiphoid process, R&L crura attach to lumbar

19
Q

cardiothoracic ratio. cardiomegaly? wide mediastinum?

A

max horiz cardiac width/max horiz thoracic width. >50% on PA film. >9cm on PA CXR at lvl of aortic arch

20
Q

acute vs chronic mediastinitis; complication & tx?

A

rapid inflamm from trauma, necrotic tumor, iatrogenically from invasive procedures; CXR wide mediastinum, pneumo/hydrothorax vs slow illness either idio or granulomatous infxn (TB, histoplasmosis), neoplasm, rads; SVC & surgical debridement of fascial planes

21
Q

sxs vs dx vs tx vs complications of mediastinal mass

A

retrosternal pain, cough, dyspnea, choking; SVC -> inc ICP, periorbital & facial edema, proptosis, UE swell vs incidental CXR -> CT w/ IV (best) vs surg removal x/ lymphoma -> chemo vs pneumothorax, perforation great vessels/pericardium, nerve injury (phrenic most risk -> paralyze diaphragm)

22
Q

pericarditis & sxs. tx?

A

pericardial layers inflamed –> CP; pericardial friction -> superficial scratchy/squeaking sound over L sternal border; EKG changes; pericardial effusion vs NSAIDS but some cases = idio or viral (Coxsackie)

23
Q

fibrinous pericarditis

A

shaggy fibrinous exudte on epicardial surface, bread/butter pericarditis; fibrin from friction rub b/w epicardium & pericardium

24
Q

acute cardiac tamponade

A

life threatening heart compression d/t pericardial accum of pus/blood/gas from effusion/trauma/rupture/high ventilatory pressures -> RA/V collapse in diastole -> impaired fill -> dil IVC, dec blood return & CO; more common in stab > GSWs

25
Q

sxs vs tx of acute cardiac tamponade

A

CP, tachy/dyspnea; Beck’s 3ad (jugular v distension, muted heart sounds, HoTN) vs remove pericardial fluid (US guided pericardiocentesis, open surgical dmg, pericardiectomy), tx underlying cause

26
Q

hemo vs pneumopericardium

A

blood in pericardial cavity -> compressing chambers; not txed –> pt dies w/in min vs air in pericardial sac, assoc w/ intub & receiving high airway pressure; tx ASAP b/c compressing heart & limiting lung fxn

27
Q

emergent vs nonemerg pericardiocentesis. complications?

A

for life threatening hemodynamic changes or cardiac tamponade vs diagnostic, palliative, prophylactic. pneumothorax, heart perforation

28
Q

AAA. risk factors vs sx vs dx vs tx

A

weak aorta -> bulge, usually below renal aa & above iliac aa. smoke, men, white, h/o vasc dz, genetics vs asx, pulsatile bulge under navel vs PE vs semi annual US if <5.5cm & asx; surg if >5.5cm, sx, enlarges >0.5cm in 1yr

29
Q

open surg for AAA steps. advantages vs disadvantages? complications?

A

aorta & iliacs clamped -> plaque removed -> graft sutured to prox seg then to distal seg -> aneurysm wall sutured around graft. been around forever vs morbidity of open procedure. 2-4% death rate; bleed, renal fail, bowel ischemia, MI, graft infxn, limb loss, ED

30
Q

advantages vs disadvantages of AAA endovasc repair

A

less invasive procedure precluding lg incision; for mult comorbidities vs $$$, potential leak around graft & mig of graft

31
Q

CAD/carotid stenosis. risk factors vs sxs vs dx vs tx

A

narrow of aa d/t buildup of fatty deposits/chol -> plaques. age, smoke, HTN, high chol, obese vs TIA -> stroke (loss vision, aphasia, facial weak/droop, loss coord, confused) vs PE vs warfarin, ASA, blood thinners; stop smoke, lose wt, ctrl DM

32
Q

carotid endarterectomy CI vs complications

A

neuro deficit from cerebral infarction, complete occlude carotid from stroke, concurrent mental illness limiting pt’s life expectancy vs MI, periop stroke, graft closure, CN dysfxn

33
Q

fem popliteal bypass. indic vs risk factors

A

arterial reconstruction reest blood flow to LE -> bypass obstruction. severe limb ischemia d/t atherosclerosis or dec flow, leg pain at rest, nonhealing wounds d/t poor vasc inflow vs smoke, DM, high chol

34
Q

what’s the ankle brachial index?

A

best indicator for PAD or arterial occlusive dz. highest ankle systole bp/highest arm systole bp -> <0.40 = severe obstruction

35
Q

other tx for PAD, arterial occlusive dz? complications?

A

antiPLT, stop smoke, endograft stent vs MI, infxn esp artificial graft for bypass, amputation

36
Q

indic for central line

A

emerg resuscitation, central venous pressure, caustic meds (like NE for sepsis), hemodialysis cath, pulm a cath, can’t get periph access, 3rd degree heart block, submassive PE, ROsC, mult noncompatible meds

37
Q

absolute vs relative CI for central line

A

infxn, thrombosis of target vein vs coag, trauma/prior surg/rad, obese, vasculitis, mult previous caths at site/scar, pacemaker/AICD/location

38
Q

best site to do central line? how to do it? how to avoid air embol?

A

R IJV b/c bigger & straighter. palpate common carotid -> insert needle lat to it at 30degree angle & aim for apex of triangle b/w SCM heads & clavicle -> jxn b/w RA & SVC. pt in Trendelenburg, rotate head 45degrees away, US

39
Q

how to do subclavian central line? up/downside of subclavian?

A

infraclavicular approach: thumb on mid clavicle, index on jugular notch –> needle inf to thumb and advance medially to index till needle enters R venous angle (post to sternoclav joint). easy to secure but more common complications

40
Q

3 errors in central line placement

A

wrong landmark, insertion position, needle trajectory

41
Q

thoracostomy vs thoracentesis vs thoracotomy

A

hole in pleural cavity to drain air or fluid vs draw fluid out of pleural cavity for sx relief/dx vs open chest wall surg

42
Q

indic vs CI vs complications for thoracostomy

A

pneumo/hemo/chylothorax, lg pleural effusion, empyema, malig exudate vs coag, infxn, empyema, loculated pleural effusion, rib fx at site, sig adhesions, emphysematous blebs vs improper placement, subq emphysema, hemothorax/peritoneum, organ perforation, intercostal neuralgia, infxn, tube blocked

43
Q

triangle of safety?

A

ant = lat pec major
post = mid axillary line
inf = nipple line

Block 4 (18 decks)

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