Anatomy Flashcards by Anas Hamdan

What supplies the lateral tip of 4th digits cutaneous nerve

Median

How well did you know this?

Not at all

Perfectly

Tibial nerve blocks ….

Planter surface of foot

How well did you know this?

Not at all

Perfectly

3 nerves blocked for awake intubation are …

Anterior tonsillar pillar (at the base) – blocks glossopharyngeal (only the tonsillar, lingual & pharyngeal branches are blocked here, not the whole nerve)
Inferior aspect of greater cornu of the hyoid bone – blocks the INTERNAL branch of the superior laryngeal nerve
Transtracheal – recurrent laryngeal

How well did you know this?

Not at all

Perfectly

what is the area called between epiglottis and vocal cords? which innervation? how to block it?

Hypopharynx, which is to say the portion of the oropharynx below the level of epiglottis. This area is innervated by the internal branch of the superior laryngeal nerve, which itself is a branch of the vagus nerve. Remember that the external branch caries motor innervation (to the cricothyroid muscle). It is effectively blocked by injecting 3-5 cc of lidocaine at the inferior aspect of greater cornu of the hyoid bone. The block will reliably cover the internal branch and many cases cover both branches (sensory (internal) and motor (external)).

How well did you know this?

Not at all

Perfectly

Why we perform transtracheal block instead of blocking the recurrent laryngeal nerve percetaneous along trachea sides b/l?

To avoid motor blockade and therefore avoid hoarseness or stridor. (recurrent laryngeal not only innervates trachea, but vocal cords as well as larynx, and by blocking it outside trachea, it could cause abduction of vocal cords by losing its motor function and result into hoarseness or stridor).

How well did you know this?

Not at all

Perfectly

Which muscle responsible for vocal cord abduction?

Posterior cricoarytenoid

How well did you know this?

Not at all

Perfectly

There is only one tensor muscle called … and its is innervated by …

Cricothyroid

external branch of laryngeal nerve (the only muscle not innervated by recurrent laryngeal).

How well did you know this?

Not at all

Perfectly

which vocal cord side affected if patient presents with hoarseness with expanding ascending thoracic anyresum?

the left sided vocal lost motor because the left recurrent laryngeal nerve courses under aortic arch before coursing back up to the glottis.

How well did you know this?

Not at all

Perfectly

What is the most sensitive indicator test/exam for difficult intubation?

Mallampati

Second would be reduced thyromental distance

How well did you know this?

Not at all

Perfectly

The most specific indicator test for difficult intubaiton is ..

Thyromental distance (99% specificity)
Followed by neck movement and mouth opening

Even though Mallampati score is the least specific test, it is still relatively specific (80-90% by most estimations).

How well did you know this?

Not at all

Perfectly

The indicator test for difficult intubaiton that has the most PPV is …

History of difficult intubation.

How well did you know this?

Not at all

Perfectly

the narrowest airway area is …

glottic opening in adults
cricoid cartilage in neonates. (meaning passing the tube beyond vocal cords then might be tighter to pass it through cricoid cartilage).

How well did you know this?

Not at all

Perfectly

the takeoff right upper bronchus is located … cm below carina.

In normal individuals the right upper lobe bronchus comes off the right main bronchus 2 cm (slightly less in women) below the level of the carina. In less than 0.5% of individuals, the right upper lobe bronchus takeoff is directly off the trachea, near the level of the carina.
With a right sided double lumen tube, the bronchial lumen would enter the right main bronchus and a special Murphey’s eye needs to be lined up with right upper lobe bronchus takeoff to ensure ventilation of this lobe. This is not possible with an individual with an abnormal location of the right upper lobe bronchus takeoff. This is a common boards topic and more likely to appear in the advanced exam here on out. The anatomy itself, on the other hand, has high basic exam potential.

How well did you know this?

Not at all

Perfectly

the alveolus composed of pneumocytes I participating in … and pnumocytes II participates in …

alveolar capillary gas exchange, where type 2 produce surfactant.

Type 2, far more numerous than type 1 and can differentiates to type 1 (where type 1 cant be differentiate to type 2).

How well did you know this?

Not at all

Perfectly

sensory innervation to lungs provided by …

Vagus Nerve.

Essentially all respiratory sensation distal to the vocal cords is ultimately vagal. The vagus nerve also supplies the parasympathetic innervation to the lung, which mediates bronchoconstriction and bronchial secretions

How well did you know this?

Not at all

Perfectly

Sympathetic fibers originating from T1-4 supply …

the sympathetic innervation to the lung and mediate bronchodilation.

Also supply the sympathetic stimulation to the heart and are referred to as the cardioaccelerators, where they increase heart rate and contractility. Loss of T1-4 (by way of high spinal, for example) can result in bradycardia. Of very high importance, the T1-4 sympathetic fibers travel up through the stellate ganglion first before coursing to the heart as the cardiac nerves (very high potential for an exam question and something that you might miss when you only study the explanations of questions you got wrong!!!).

How well did you know this?

Not at all

Perfectly

Coronary Blood Supply?

You can think of the LV as 6 walls: anteroseptal, inferoseptal, inferior, inferolateral, anterolateral, and anterior walls (the term posterior wall has fallen out of favor). Some walls have have dual supply, but in general the below list should be adequate for the anesthesia boards 
anteroseptal	LAD
inferoseptal	RCA &amp; LAD
inferior	RCA
inferolateral	RCA &amp; LCx
anterolateral	LCx
anterior	LAD

How well did you know this?

Not at all

Perfectly

Ventricular septum supplied by

LAD

anteroseptal	LAD
inferoseptal	RCA &amp; LAD
inferior	RCA
inferolateral	RCA &amp; LCx
anterolateral	LCx
anterior	LAD

How well did you know this?

Not at all

Perfectly

RCA supplies …

All the inferior part of heart

anteroseptal	LAD
*inferoseptal	RCA &amp; LAD
*inferior	RCA
*inferolateral	RCA &amp; LCx
anterolateral	LCx
anterior	LAD

LAD supplies …

All septum and anterior portion, except AnteroLateral

*anteroseptal LAD
*inferoseptal RCA & LAD
inferior RCA
inferolateral RCA & LCx
anterolateral LCx
*anterior LAD

LCx supplies

All Lateral wall

anteroseptal	LAD
inferoseptal	RCA &amp; LAD
inferior	RCA
*inferolateral	RCA &amp; LCx
*anterolateral	LCx
anterior	LAD

the site of ablation for atrial flutter is at …

Cavotricuspid isthmus (between IVC & tricuspid annulus)

Which Bronchus would be obstructed if having a dilatation of the aortic arch, where they might present with recurrent pneumonia?

Left main bronchus (the aortic arch crosses up, over, and behind the left main bronchus).

Subclavian vein and artery relation to each other, to scalenes, and first rib?

The subclavian vein runs anterior to the artery and is preferentially entered before the artery at this angle.

At the scalenes, the subclavian vein courses anterior to the anterior scalene whereas the subclavian artery courses between the middle and anterior scalene muscles.

Both the subclavian vein and artery then course over (superior to) the 1strib and then enter the thorax.

The highest risk for chylothorax with central line insertion is?

Left subclavian vein

Relationship of IJ to SCM, clavicle and carotid artery?

It predictably lies between the two heads of the SCM just superior to the clavicle, lateral to the carotid artery.

The spinal cord blood supply is derived from ...

(1) one anterior spinal artery and (2) two paired posterior spinal arteries. The superior origins of the anterior (as well as posterior) spinal artery are from the vertebral arteries. In the upper thorax the anterior spinal artery is supplied from numerous posterior intercostal arteries. The anterior spinal artery at the level of the lumbar and sacral spinal cord derives the majority of its blood flow from the Artery of Adamkiewicz, which arises from a single posterior intercostal artery, usually between the levels of T8 and L1 and most often only on the left side.

where dose the spinal cord ends?

``` L1 adults L3 Neonates (migrates to L1 by age 2 months) ```

the spinal nerve roots and their relation to vertebrae?

Cervical roots -> passes above vertebrae Thoracic, Lumber, & Sacral roots -> below vertebrae one exception is C8 -> below C7 vertebrae.

How to count desired thoracic vertebrae by know 2 bony landmarks?

most prominent cervical process is C7 and inferior tip of scapula is T7 can count spinous process in between.

The superior iliac spine at which vertebrae level?

The posterior iliac spine at which vertebrae level?

The interlaminar foreman and their relation to interspace between spinous processes

Thoracic -> 1-3 cm cephalad to interspace | Lumber -> at the same level of spinous process space

Plantar surface of the foot is supplied by

Tibial nerve

Interspace between 1st & second tie innervated by

deep peroneal

Lower leg nerve innervation

The thigh is primarily innervated by the femoral nerve, with the exception of portions of the medial thigh having obturator innervation and the lateral thigh having lateral femoral cutaneous innervation. The lower leg is innervated by the sciatic nerve with the exception of the medial leg, which is in the saphenous distribution (remember that the saphenous nerve is a branch of the femoral nerve). The sural nerve innervates the posterior lateral lower leg and is a branch of the tibial nerve. The remainder of the lower leg is innervated by either the common or superficial peroneal nerve. Since a sciatic or popliteal nerve block will not include coverage of the saphenous nerve, a common boards scenario is pain following sciatic block along the medial lower leg, ankle, and foot.

The median, radial, and ulnar relationship to brachial artery ?

The median nerve runs just medial to the brachial artery in the the antecubital fossa. Remember this when placing brachial arterial lines. The brachial artery pulse is also an easy landmark for placing a median nerve block at this location. The radial nerve is well lateral to the artery and is located just lateral to the biceps tendon. The ulnar nerve enters the elbow on the medial posterior side and tunnels under the arcuate ligament. This is a fixed space and an area where positioning injuries often occur. Local anesthetic is placed just proximal to the arcuate ligament, and never inside the tunnel (to avoid high pressure injury resulting in ischaemia).

The passage of the brachial plexus through the ... and ... scalene muscles

The passage of the brachial plexus through the anterior and middle scalene muscles in the location where an interscalene block is placed.

Which part of the arm that might not be blocked with axillary block?

The classic question regarding the musculocutaneous nerve is the absence of adequate blockade following an axillary block. The musculocutaneous nerve is derived from the lateral cord of the brachial plexus and carries C5, 6, & 7. The terminal portion of the musculocutaneous nerve is termed the lateral antebrachial cutaneous nerve and is responsible for innervation of the lateral forearm. The medial forearm is innervated from cutaneous nerves derived from the ulnar nerve.

The lateral 4th finger tip supplied by ...

Median

The coeliac (solar) plexus is located at vertebral level ...

L1 Just lateral to aorta bear coelic artery takeoff. It supplies sumpathetic to foregut (stomach, ossophagus, duodenum), lover, kidneys, spleen, pancreas, gallbladder Injection at this area not only blunts sympathectomy but also blocks pain fibers, treating visceral pain.

The stellate ganglion is located at the ... vertebral level

C7 However, the reference for injection is at C6 chassaignac’s tubercle).1

Injection of local atC6 transverse process can result in ...

Ipsilateral Horner’s syndrome The Chassaignac’s tubercle just cephalad to actual stellate ganglion at C6, which is the one supplies sympathetic innervation to ipsilateral head, neck and arm

Horner’s Syndrome manifests as

Unopposed parasympathetic - flushing - nasal stuffiness - arm vasodilation and increased pulse - pros is - enopthalmos - miosis - anhydrosis

What is the medial branch block?

Blocking the medial branch of posterior division of spinal nerves that supplies Facet Joint (which is a common source of back pain) Must block both above & below the joint to block both nerves to the facet joint