Anatomy Flashcards
1
Q
Dermatomes
A
2
Q
Pharynx innervation
A
IX: glosopharyngeal
XII: hypoglossal
3
Q
cartilages of the larynx
A
hyoid
thyroid
cricoid
aretynoid (attached to cricoid and have attached to them the VCs)
epiglottic
4
Q
Larynx Innervation
A
CN X
- SLN
- RLN
5
Q
SLN
A
- internal laryngeal branch: pierces thyrohyoid membrane–sensation from epiglottis to vocal cords
- external laryngeal branch: cricothyroid muscle (tensor of vocal cords)
6
Q
RLN
A
- sensation below vocal cords, motor to all laryngeal muscles except cricothyroid
- bilateral injury–adduction of vocal cords and rapid, severe respiratory obstruction
- enters larynx psoterior to cricothyroid articulation–blocked by transtracheal approach
- RLN runs in a groove between trachea and esophagus–blocked by stellate ganglion block
7
Q
Tracheal Innervation
A
Vagus CN X
8
Q
Roots of brachial plexus
A
anterior primary divisions C5-8 +T1, with contributions from C4 and T2
9
Q
Division of brachial plexus
A
Robert Taylor Drinks Cold Beer
Roots
Trunks
Divisions
Cords
Branches
10
Q
Roots
A
-anterior primary division of C8-T1, emerge from intervebral foramina, fuse above first rib
11
Q
Trunks
A
-above first rib
12
Q
Divisions
A
-Each trunk forms anterior and posterior divisions
13
Q
Cords
A
- 3 cords: medial, lateral, posterior
- medial/lateral:flexor surfaces of UE
- posterior cord: extensor surfaces of UE
14
Q
Branches-Terminal nerves
A
Lateral/medial cord: lateral/medial head of median
medial cord: ulnar
lateral cord: musculocutaneous
posterior cord: axillary, radial
15
Q
axillary nerve block
A
- prevertebral fascia forms axillary perivascular sheath, which envelopes the brachial plexus and axillary artery
- median nerve: above ax artery
- ulnar nerve: below ax artery
- radial nerve: posterior/inferior to artery–needle passes posterior wall of ax artery
- misses musculocutaneous b/c came off already
16
Q
interscalene block
A
- at level C6/cricoid cartilage
- between anterior and middle scalene muscles
- brachial plexus and subclavian artery run together
- needle enters skin posterior to posterior border of sternocleidomastoid muscle behind the EJ
- anterior scalene is just posterior to the posterior aspect of sternocleidomastoid at the level of the cricoid
17
Q
supraclavicular block
A
- enter skin 1-2 cm above midpoint of clavicle and elicit paresthesias as needle advanced toward 1st rib
- when first rib contacted, needle moved in anteroposterior direction until paresthesias elicited
18
Q
cutaneous nerves of the hand
A
19
Q
radial nerve block at elbow
A
-between brachioradialis and biceps tendon
20
Q
radial nerve block at wrist
A
- nerve is lateral to radial artery
- NA/N/AN-lateral to medial
- breaks for flexor carpi radialis and palmaris longus
- both radial and ulnar located outside
21
Q
ulnar nerve at elbow
A
- between olecranon and medial epicondyle of humerus
- usu blocked above elbow to avoid direct nerve trauma
- loss of all muscles of hand except thenar eminence and 1st/2nd lumbricals
22
Q
ulnar nerve at the wrist
A
-medial to ulnar artery
23
Q
median nerve at the elbow
A
=blocked medial to brachial artery between two heads of pronator teres
24
Q
median nerve supplies
A
-thenar eminence, 1st and 2nd lumbricals
25
median nerve at the wrist
-between flexor carpi radialis and palmaris longus
26
injury to nerves
- direct needle or other trauma, or ischemia from positioning
- supplied by arteries called vasa nerovrum
27
Cutaneous nerves of leg : back
28
Cutaneous nerves of leg: front
29
nerve supply to LE
- Lumbar plexus: T12, L1, L2, L3,L4-femoral, obturator, lateral femoral cutaneous, ilioinguinal, iliohypogastric, genitofemoral
- sacral plexus: L4, L5, S1, S2-Sciatic nerve
30
Femoral nerve block
- passes under inguinal ligament, dividing into anteiror and posterior divisions
- sensory to anteiror and medial thigh and leg
- sensory to medial ankle (saphenous)
- NAVL
31
lateral femoral cutaneous nerve
-sensory to anterolateral spect of thigh down to knee
32
meralgia paresthetica
-compression of lateral femoral cutaneous nerve by inguinal ligament, producing pain, numbness, paresthesia over anterolateral aspect of thigh
33
obturator nerve
-adductors of the thigh
34
sciatic nerve
- sacral plexus--\>greater sciatic notch--\>popliteal region--\>divides into tibial and common peroneal nerves
- sciatic nerve: hammstrings and all msucles of leg and foot
- sciatic nerve: snesory to front (superficial/deep peroneal), back (posterior tibial), lateral (Sural) ankle
35
sciatic nerve block
- lateral position with hip and knee flexed
- line drawn between posterior superior iliac spine and greater trochanter
- at midpoint of this line, a perpendicular (bisecting line) drawn 3 cm downward
- surgery for sole of foot
- if surgery involves lE--combine with femoral, obturator or lateral femoral cutaneous nerve
36
superficial peroneal nerve
- line connecting medial and lateral malleolus--place a cuff of anesthesia along it
- sensory to dorsum of foot and toes except great and 2nd toes
37
deep peroenal nerve
- lateral to ex hallucis longus to great toe
- flexors of toes and provides sensation between great and second toes
38
sural nerve
- posterior to lateral malleolus
- sensory to posterolateral leg, lateral foot, 5th toe
39
posterior tibial
- posterior to medial malleolus
- sensory to sole of foot, plantar surface of foot
40
saphenous nerve
- from femoral nerve
- anterior to medial malleolus
- sensory to anteromedial side of leg and medial side of the foot
41
ankle block
42
sole of foot innervation
43
gasserian ganglion
- a trigeminal nerve block
- anesthesia to ipsilateral face, cornea, sclera, anterior tongue
- used for trigeminal neuralgia
- posterior tongue is covered by CNIX
- middle cranial fossa, close proximity to dural fold and meckel's cave containing CSF
- if needle goes too far, can enter cranial CSF--produce other nerve involvement (facial) or total spinal
44
superficial cervical plexus block
- anterior branches of first 4 cervical nerves
- superficial at lat border of SCM, blocked with 10 cc 1% lido subq
- success=horner's syndrome and hoarsenes (RLN block)
- complications: phrenic nerve paralysis, subarachnoid block
45
intercostal nerve block
- anterior rami of first 11 Thoracic nerves
- neurovascular bundle below each rib (VAN--nerve inferior)
46
branches of intercostal nerves
1) sympathetic ganglion
2) posterior cutaneous branch--skin and muscle oin paravertebral region
3) lateral cutaneous branch--skin of medial arm for T2--intercostobrachial nerve
