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MFSRH part 1 > Arm anatomy > Flashcards

Arm anatomy Flashcards

1
Q

how many osteofascial compartments is the upper arm divided into?

A

two (anterior and posterior)

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2
Q

Name the three muscles of the upper arm that make up the anterior osteofacial compartment

A

Biceps Brachii
Coracobrachialis
Brachialis

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3
Q

name the muscle that is found in the posterior compartment of the upper arm

A

Triceps brachii

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4
Q

Biceps receive innervation from which nerve

A - musculocutaneous nerve
B-radial nerve
C- ulnar nerve
D- median nerve

A

A - musculocutaneous nerve (c5-C7)

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5
Q

Triceps Brachii recieves innervation from which nerve

A - musculocutaneous nerve
B-radial nerve
C- ulnar nerve
D- median nerve

A

B - radial nerve (C5-T1)

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6
Q

what is the name of main arterial supply to the upper arm

A

Brachial artery

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7
Q

What is the name of the artery when it first branches of the aortic arch before it becomes the brachial artery?

A

Subclavian artery

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8
Q

what is the name of the subclavian artery once it passes the first rib to enter the axilla

A

axillary artery

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9
Q

when the axillary artery passes the inferior border of teres major what is the artery now called?

A

brachial artery

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10
Q

the brachial artery runs above the deep fascia in the upper arm
True or False

A

false - the brachial artery runs below the deep fascia (it is sub fascia) but takes a superficial course along the medial aspect of the upper arm

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11
Q

What is the name of the two branches that the brachial artery divides into at the level of the radius

A

ulnar and radial artery

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12
Q

how many branches does the brachial artery have?

1
2
3
4

A

4

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13
Q

what are the names of the two veins that drain the upper arm

A

cephalic and basilic vein

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14
Q

the cephalic vein runs above or below the deep fascia in the upper arm?

A

above the deep fascia for its course in the upper arm

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15
Q

at what point does the bascilic vein thought to lie below the deep fascia

A

it is thought that the basilic vein pierces into the deep facia around the mid shaft of the humerus and then runs below the deep fascia proximally (so approximately 5-8cm above medial epicondyle the basilic vein will be above the fascia and prone to injury here)

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16
Q

what does the basilic vein drain into?

A

brachial vein

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17
Q

what is the origin of the axillary nerve in the brachial plexus

A

C5-C6

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18
Q

which nerve supplies the deltoid, teres major and lateral head of the triceps brachii

A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve

A

axillary nerve

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19
Q

what is the origin of the radial nerve in the brachial plexus

A

C5-T1

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20
Q

what is the name of the ‘groove’ that the radial nerve runs in on the posterior aspect of the humerus

A

radial groove

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21
Q

what area of the hand does the radial nerve supply?

A

dorsal of the hand - lateral 3 and half fingers (thumb, then 2 1/2 fingers)

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22
Q

a patient presents with wrist drop, which nerve is likely to have been injured?

A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve

A

B - radial nerve

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23
Q

what is the origin of the musculoskeletal nerve in the brachial plexus

A

C5-C7

24
Q

what is the role of the musculoskeletal nerve in the forearm

A

supplies the lateral aspect of the forearm

25
Q

what are the nerve roots of the median nerve at the brachial plexus

A

C6-T1

26
Q

what is the sensory nerve supply of the median nerve

A

supplies the lateral 3 and half fingers of the palmar (anterior) surface of the hand

27
Q

what are the nerve roots of the ulnar nerve

A

c8-t1

28
Q

a patient presents with weak thumb adduction and you notice the hand has a clawed appearance. You suspect damage to which nerve?

A- Axillary nerve
B-Radial Nerve
C- Ulnar nerve
D- Musculocutaneous nerve

A

c- ulnar nerve

29
Q

what is another name given to the brachial fascia

A

deep fascia

30
Q

what is the maximum dose of lidocaine per kg without adrenaline based on the emu

A

4.5mg/kg

31
Q

what is the maximum dose of lidocaine with adrenaline (mg/kg)

A

7mg/kg

32
Q

what type of local anaesthetics are lidocaine and mepivircane

A

amides

33
Q

local anaesthetics work to block which type of voltage gated ion channels

A

sodium voltage gated ion channels

34
Q

where is the binding site located for LA on the sodium voltage gated channels

A

domain 4, loop S of sodium voltage gated ion channels

35
Q

local anaesthetic action is dose dependent - true or false

A

true - with increased LA doses the peak action potential is reduced and firing threshold of the nerve increases, refractory period lengthens

36
Q

what type of nerve fibres innervate the muscle

A

myelinated A gamma fibres

37
Q

what type of nerve fibres transmit nocioception

A

A-sigma fibres

38
Q

Sympathetic or parasympathetic nerve fibres most easily blocked by LA

A

sympathetic nerve fibres

39
Q

why can we increase the maximum dose of lidocaine when combined with adrenaline

A

adrenaline is a vasoconstrictor and therefore when LA is combined with adrenaline this allows for less systemic absorption resulting in less toxicity

40
Q

Name the co-morbidities and medications that we should avoid using LA in combination

A

patients taking beta blockers
heart block
TCA
MOIs

41
Q

What is the treatment used in LA toxicity that causes a sustained bradycardia?

A

atropine 500mcg IV or IM can be repeated every 3-5 minutes with a max dose of 3mg

42
Q

how many milligrams of lidocaine does 1ml of 3% lidocaine contain

A

30mg per ml

(% times 10 - therefore 1% = 10mg/ml, 2%= 20mg/ml, 3%=30mg/ml)

43
Q

what is the maximum dose for kg of mepivircaine

A

6mg/kg

44
Q

what nerve is most vulnerable to damage during nexplanon insertion

A

ulnar nerve

45
Q

if looking at a coronal view of an arm when a patient is lying with the hand behind their head (in the recommended position) for nexplanon insertion. Starting at the biceps moving down the arm list the structures in order that you would find them within the neuromuscular bundle in the upper arm

A

biceps muscle
Median nerve
Basilic vein
Brachial artery
Ulnar nerve
triceps muscle

46
Q

out of the following list of local anaesthetics which are classed as amides

  1. lidocaine
  2. xylcocaine
  3. procaine
  4. mepivocaine
  5. cocaine
  6. prilocaine
  7. benzocaine
A

Amides are:
1. lidocaine
2. Xylocaine (this contains lidocaine)
4. mepivocaine
5. prilocaine

47
Q

out of the following list which anaesthetics are esters

  1. lidocaine
  2. xylcocaine
  3. procaine
  4. mepivocaine
  5. cocaine
  6. prilocaine
  7. benzocaine
A

procaine
cocaine
benzocaine

48
Q

which type of local anaesthetics have a higher rate of causing anaphylaxis?

esters or amide LA

A

esters

49
Q

what metabolises esters

A) liver
B) kidneys
C)pseudocholinesterase
D) phosphodiesterase

A

c - pseudocholinesterase

50
Q

where are amide LA metabolised

A) liver
B) kidneys
C)pseudocholinesterase
D) phosphodiesterase

A

A - liver

51
Q

what types of LA does EMLA cream contain

A

emla cream contains lidocaine 2.5% and prilocaine 2.5%

52
Q

how many milligrams of LA in total are contained in EMLA 5%

A) 20%
B) 25%
C) 50%
D) 100%

A

C - 50%

1% = 10mg per ml
so 5% = 50mg per ml

53
Q

EMLA cream contains differing quantities of prilocaine and lidocaine

True or false

A

false - contains equal amounts 2.5% of both

54
Q

which type of LA has a longer duration of action

A) esters
B) amides

A

B - amides

55
Q

Local anaesthetics are structurally related to what recreational drug

A

cocaine

all LA are synthetic LA structurally related to cocaine

MFSRH part 1 (20 decks)

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