Back, Pects, Spinal Cord Flashcards
Significance of Sternal angle “Angle of Louis”?
palpable anatomical landmark, attachment of 2nd rib, level of T4-T5 intervertebral disk, beginning of ascending & descending aorta, transition between superior and inferior mediastinum, level of bifurcation of trachea
function of Rhomboids (Minor & Major)?
retract, elevate, and downward rotate scapula, fix scapula to thoracic wall- Dorsal scapular N.
Blood supply and Nerve innervation to Rhomboids (Minor & Major)?
Dorsal scapular n. / a.
function of Trapezius (upper, middle, lower fibers)?
upper elevates, lower depresses, middle and all together retract scapula- Spinal Accessory N.
Nerve innervation and blood supply of Trapezius (upper, middle, lower fibers)?
Spinal accessory n. (CN XI) / superficial branch of transverse cervical a.
function of Latissimus dorsi?
-extends, adducts and medially rotates humerus (2 other muscles also do this)
Nerve innervation and blood supply for Latissimus dorsi?
-Thoracodorsal n. / a.
function of Levator scapulae?
-elevates and downward rotates scapula- dorsal scapular N.
Nerve innervation and blood supply of levitator scapulae?
-Dorsal scapular n. / a.
Name borders of triangle of auscultation
lateral border of traps, superior border of lats,
function of Serratus posterior superior & inferior?
-Connected to ribs, Accessory muscles of respiration
nerve innervation of Serratus posterior superior & inferior?
-Intercostal n. (ventral rami of thoracic nerves)
function of Pectoralis major?
-Adducts, cross-flexes, and medially rotates humerus (same functions as teres major)
Nerve innervation of Pectoralis major?
- medial and lateral pectoral n.
- Pectoral branch of thoracoacromial trunk
function of Pectoralis minor?
-protracts and stabilizes scapula
nerve innervation of Pectoralis minor?
- medial pectoral n.
- Pectoral branch of thoracoacromial trunk
function of Serratus anterior?
-elevation and abduction of scapula beyond horizontal level- Stabilizes the scapula against the thorax (WINGED SCAPULA)
nerve and blood innervation of Serratus anterior?
- Long thoracic nerve (WINGED SCAPULA)
- Lateral thoracic a.
blood supply for breast?
internal thoracic a., lateral thoracic a., pectoral branch of thoracoacromial A.
Function of vertebral column?
- Protects spinal cord and spinal nerves
- Supports the weight of the body
- Posture and locomotion
crush fracture is characterized by?
compression of entire vertebral body (wedge fracture also affects vertebral bodies but involves small fractures around perimeter of vertebral body
location of lumbar puncture and why?
location between L4-L5- for lumbar puncture u take CSF from lumbar cistern (subarachnoid space) below spinal cord- can sometimes be done at L3-L4
spinal cord ends at? this is called? in newborns where is this situated?
L1-L2, conus medullaris
conus medullaris at L3 in newborns
dural sac ends at?
S2
L4 landmark?
iliac crests
deltoids N. innervation?
axillary N.
function of both trees major and pectorals major?
medial rotation and adduction of humerus
rotator cuff muscles comon sites of damage during? these muscles include? SITS
shoulder injuries, supraspinatus, infraspinatus, teres minor, subscapularis
name the neural tube derivatives
Central nervous system (CNS): Brain, Brain stem, Spinal cord
•Peripheral nervous system (PNS): Somatic motor portion, Preganglionic visceral motor portion
name the neural crest cell derivatives.
Ganglion cells of the PNS, Sensory ganglia of cranial nerves, DRG of spinal nerves, Sympathetic ganglion cells, Parasympathetic ganglion cells, Schwann cells (myelin in PNS), Leptomeninges(pia-arachnoid
whats neurulation and when does it start?
formation of neural tube and neural crest cells- starts at beginning of wk 4
myelin in PNS formed by?
Schwann cells
myelin in brain & spin. cord (CNS) formed by?
oligodendrocytes
Give an example of a neural tube defect and explain what it is?
Spina bifida- varying degrees of failure of neural tube formation with accompanying defects in formation of meninges and neural arch of
describe spin bifida occulta:
occulta- unfused vertebral arch, No bulge over the bony defect, No neurological deficits, A tuft of hairs or skin dimple may be present (most common in lumbosacral area)
describe spin bifida cystica w/ meningocele.
Bulge seen over the defect, Contains meninges & CSF in the subarachnoid space
describe spin bifida cystica w/ meningomyelocele:
Bulge is seen over the defect, Contains meninges, cord & nerves, membranous sac on outer layer, displaced spinal cord
describe spin bifida cystica w/ myeloschisis:
Skin and bony defect with “open” spinal cord, seen as a mass of neural tissue
Describe Anencephaly:
Failure of rostral neuropore to close, Absence of a large part of brain and skull, Usually don’t make it to full term (miscarriage), if born short survival (days), Exact cause unknown –environmental toxins, lack of folic acid
somatic= parietal=body wall
somatic= parietal=body wall
visceral=splanchnic=internal
visceral=splanchnic=internal
end of spinal cord changes: at 8 wks goes all the way down, then 24 wks it ends where? in newborn? adult?
after S1, ends under L3, ends under L1
Between L2 & S2 of vertebra there is CSF filled arachnoid space w/ what? describe
cauda equina & filum terminale
- fil. terminale- pia mater- anchors spinal cord inferiorly to coccyx
From where can u do spinal tap or CSF collection?
L2-S2 but should be done between L3-L4
dorsal (posterior) ramus supplies what areas?
intrinsic back muscles (splenius muscles, erector spine muscles, transversospinalis muscles) (motor) & skin over that area (sensory)
ventral (anterior) ramus supplies?
all other muscles besides intrinsic back muscles (motor) and the skin over those areas (motor)
majority of lymph esp. from lateral quadrants of breast drains into?
pectoral nodes
medial quadrants of breast drain into?
parasternal nodes
herpes zoster (shingles) will affect which dermatome? where does it stay latent?
T9, in DRG of sensory nerves- presents as painful skin lesion- only associated with sensory N. fibers
Mastectomy Procedure affects what N. and A.?-
LTN and Lat. Thoracic A.
Shoulder droop affects which N. which innervates?
spinal accessory N. (CN XI)→ innervates traps
Lumbar puncture at what level? list layers penetrated by needle.
level of L4, L5
needle penetrates ligamentum flavum, dura mater, and arachnoid matern to reach subarachnoid space (w/CSF)
somatic afferents are responsible for conveying what?
pain, pressure, touch, temp, & proprioception to the CNS
afferent N. fibers carry only? while efferent N. fibers carry?
only sensory stimuli
convey motor info
visceral innervation is associated w/ autonomic NS. visceral afferents gen. carry info regarding? while visceral efferents deliver?
visc. aff’s- info regarding physiologic changes of internal viscera
visc. eff’s- deliver autonomic motor function to 3 kinds of tissues: smooth muscle, cardiac muscle, and glandular epithelium
the epidural space, btwn dura mater & periosteum is characterized by fat deposits and contains?
the internal vertebral venous plexus (of Batson)
intervertebral disk herniation associated with which ligament that protects spinal cord from direct compression?
posterior longitudinal ligament
what part of NS primarily responsible for vasoconstriction?
sympathetic division of autonomic NS
diaphragm is innervated by phrenic N. which arises from?
C3-C5
rhomboid, serratus ant., supraspinatus, and lats are innervated by?
the ventral rami of the brachial plexus (C5-T1)
the vertebral A.’s run through? And are therefore most closely associated w/ injury to the?
the transverse foramina of cervical vertebrae C6 thru C1
- transvcerse processes
the spinal accessory N. is CN XI innervates what 2 muscles? Loss of CN XI results in?
trapezius and sternocleidomastoid muscles
drooping of the shoulder due to paralysis of traps (can test this by shoulder shrug against resistance or turning head against resistance)
A stabilizing ligament found in C1/C2 that attaches to the pedicles and helps anchor the dens in situ
the cruciform (AKA cruciate) ligament
Which arteries supply the deep back muscles that are responsible for extending and laterally bending the trunk?
posterior untercostal A.’s
lumbar puncture needle must penetrate? (list layers from outside to inside) whats the lumbar cistern?
penetrates ligamentum flavum, the dura mater, and finally arachnoid krater to reach subarachnoid space where CSF is located
- its a continuation of the subarachnoid space below the conus medullar is
epidural space contains epidural fat & Batson’s venous plexus & is preferred site for aspirating CSF for what?
diagnostic purposes (and epidural aesthesia)
the deltoid muscles & supraspinatus muscles receive motor supply from which vertebral level?
C5 & C6
rhomboid muscles are innervated by which muscles at which vertebral level?
dorsal scapular N. (C5)
latissimus dorsi muscles innervated by which N.’s? that receive contributions esp. from which spinal N. level?
thoracodorsal N.’s- receive esp. from C7 spinal N.’s
lumbar triangle of petit is bordered by? the floor od this triangle formed by? whats its significance?
medically by lats, laterally by ext. abdom. oblique, and inferiorly by iliac crest
- internal abdominal oblique- possible site of herniation
this type of herniation occurs when the nucleus pulpous of the intervertebral disk protrudes thru the annulus fibrosis into the intervertebral foramen or vertebral canal- wheres the most common protrusion?
intervertebral disk herniation
- posterolaterally where the annulus fibrosis isn’t reinforced by post. longitudinal ligament
caudal anesthesia into sacral canal is used to block the spinal N.’s that carry sensation from perineum- administration of local anesthetic to epidural space most commonly uses what landmark for the caudal epidural block?
the sacral hiatus which opens between the sacral cornua
congenital defect in which there’s reduction or extensive fusion in # of cervical vertebrae- often manifests as short, stiff neck w/ limited motion- Sx’s–> abnormal fusion of C5 & C6 vertebrae, high riding scapula
Klippel-Feil syndrome
condition in which the region btwn superior & inferior articular facets (on post. arch of L5 vertebra) is damaged or missing- associated w/ vertebral dislocation
Spondylolysis
congenital malformation in which cerebellum & medulla oblongata herniate inferiorly into foramen magnum of vertebral canal
Arnold-Chiari malformation
a collapse of vertebral bodies as result of trauma
crush vertebral fracture
neck hyperextension causing fractured dens (odontoid process) is called what? and where is the fracture located?
hangman’s fracture- associated w/ C2 (axis) and injury is at anterior arch of the atlas because the dens projects sup. from body of axis & articulates w/ ant. arch of atlas
whiplash & hyperextension of cervical spine injure which ligament?
ant. long. ligament
lateral extensions of pia mater btwn dorsal & ventral roots of spinal nerves that attach to dura mater & function to keep spinal cord in midline position
denticulate ligaments
which nerve passes thru quadrangular space and which muscles does this innervate? what does denervation of these muscles cause?
Axillary N. inervates deltoids & teres minor - quadrangular space syndrome
scoliosis can be a secondary conditions in disorders such as? in which abnormal muscles doesn’t keep the vertebral column’s normal alignment & results in lateral curvature
muscular dystrophy & polio
transection of all dorsal rootlets of nerves from hip area is called? this type of procedures is performed to? what do dorsal rootlets contain?
dorsal rhizotomy
- to eliminate pain sensation from whichever dermatome level is transected
- general sensory afferent fibers (eliminate sensation & thus pain)
this ligament prevents superior displacement of head of humerus-its very strong and will rarely be damaged; instead the ligament can cause inflammation or erosion of the tendon of the supraspinatus muscle as the tendon passes back and forth under the ligament
coracoacromial ligament
MC N. innervatse these 2 muscles, which are the main flexors at the elbow?
brachialis & biceps brachii muscles
medial epicondyle associated with which compartment? which N.’s specifically?
Flexor compartment- Ulnar N. crosses behind medial epicondyle and is covered by FCU
lateral epicondyle associated with which compartment? which N.’s specifically?
extensors origin is here- Extensor compartment- Radial N. goes in spiral groove of humerus, cross elbow anteriorly to lateral apicondyle and supplies extensors in arm, forearm, and digits
deep radial N. courses between the 2 heads of what muscle and courses where?
btwn 2 heads of supinator mm and is located just medial & distal to lateral epicondyle
whats most commonly dislocated carpal bone?
lunate
in this injury, the distal fragment of the radius deviates palmarward, often displacing the lunate
smith fracture
What 2 muscles are the occupants of the first dorsal compartment of the wrist?
abductor pollicis longus & extensor pollicis brevis
injury to the posterior cord of brachial plexus would usually involve spinal nerve? This is a typical?
C7, Klumpke paralysis
dislocation of humerus @ glenohumeral joint causes what? and why?
head of humerus displaced inf. cuz in that spot its not supported by rotator cuff m tendons or coracoacromial arch- its also pulled ant. beneath coracoid process by pec. and subscapularis mm’s
left shoulder droop & superior angle of scapula juts out slightly- strength in turning head to L. or R. is symmetric. What N. injured?
L. spinal accessory N. injured distal to the sternocleidomastoid mm, resulting in paralysis of trapezius, allowing shoulder droop & sup. angle to push out posteriorly
head of surgical neck of humerus results in what sx’s? why?
unable to abduct arm more than 15 degrees, cant laterally rotate arm (oblique fracture of humerus)- associated sensory loss over shoulder area- cuz injury to axillary N.–> innervates a deltoid and trees minor- abduction of humerus between 15 degrees and horizontal is performed by deltoid- lat. rotation of humerus mostly deltoid, teres minor, and infraspinatus
fracture of the glenoid fossa would lead to?
drooping of the shoulder
a fracture of the distal end of the radius- proximal portion of radius displaced anteriorly w/ distal bone fragment projecting posteriorly. whats name of this fracture?
Colles’ fracutre (dinner fork deformity)
What is torn in a shoulder separation?
either or both the acromioclavicular & coracoclavicular ligaments can be partially or completely torn through- the AC joint can be interrupted & the distal end of clavicle may deviate upward in compete separation, while supper limb droops away inferiorly, causing a step off- this can be palpated and sometimes observed
displacement of head of humerus is a? not a separation?
a shoulder dislocation
most commonly fractured carpal bone? usu occurs how?
scaphoid bone- fall w/ outstretched hand
recurrent median branch innervates which muscles?
OAF muscles
Anterior interosseous N. is a branch of? that supplies? if injured, what is compromised?
median N., supplies the FPL, the lateral half of the FDP, and the pronator quadrates, flexion of interphalangeal joint of thumb is compromised
Describe Froment’s test.
tests for ulnar N. palsy- and more specifically tests the action of adductor pollicis muscle- patient asked to hold sheet of paper between thumb and flat palm- FPL innervated by ant. interosseous branch of median N.
fracture of upper third of radius lies between?
the bony attachments of the supinator and the pronator trees muscles
boxer’s fracture describes?
broken neck of fifth metacarpal (will see absence of knuckle)- injury is on medial side of the hand
fracture that involves dislocation of the carpometacarpal joint of the thumb
Bennett’s fracture
rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb
Gamekeeper’s thumb
Long head of biceps origin at? action? during tendonopathy where would pain be felt?
supraglenoid tubercle- assists in shoulder flexion- anterior compartment of the shoulder
common extensor tendon originates where? inflammation of this tendon is called?
lateral epicondyle. lateral epicondylitis or tennis elbow
shrugging shoulders can asses what muscle’s function?
Traps- testing spinal accessory N.
intact sensation on the medial side of the arm or axilla is an indication that what N.’s are functional?
Radial or Intercostobrachial N.’s
extensor tendons of fingers insert distally on distal phalanx of each digit- if tendon is avulsed or proximal part of distal phalanx is detached, the DIP joint is pulled into total flexion by the unopposed FDP- what is this named?
The mallet finger
central portion of extensor tendon expansion is torn over the PIP joint, allowing tendon to move palm ward, causing tendon to act as flexor of PIP joint- this causes DIP joint to be hyperextended- this is called?
Boutonniere deformity
slight flexion of MCP joints, hyperextension of PIP joints, and slight flexion of DIP joints- this is called and whats it most often caused by?
Swanneck deformity- mostly caused from shortening of tendons of intrinsic muscles, as in rheumatoid arthritis
results from CT disorder in palm, usu causing irreversible flexion of digits 4 and 5- called?
Dupuytren contracture
occurs w/ lesions to median and ulnar N.’s at the wrist- all instrinsic muscles paralyzed, including extensors of interphalangal joints- MCP joint extensors from radial N. and long flexors of fingers, supplied more prox in forearm by Median N and ulnar N, are intact and unopposed, pulling fingers into this position
clawhand
which spinal N. primarily responsible for brachioradialis reflex?
C6 spinal N.
which spinal N.’s involved in biceps brachia reflex?
C5 and C6 spinal N.’s; C5 for motor, C6 for sensory part of the reflex arc
Key Spinal N. involved in triceps reflex?
C7
dislocated elbow w/ ulna and medial part of distal humerus become separated- whats the name of the type of joint between these 2 bones?
Ginglymus joint AKA a hinge joint cuz allows motion in one axis (felxion & etension for elbow) and therefore tis a uniaxial joint
A fracture of humerus just prox. to epicondyles is what type of fracture? this type of fracture is the most common cause of what other condition?
supracondylar fracture, Volkman ischemic fracture in which sharp bony fragment often lacerates brachial A. w/ bleeding into flex. compartment, cause inc presssure , reduces arterial flow and ischemic muscles that undergo unrelieved contracture
With which bone does ulna articulate at wrist?
Radius
what are most important muscles in extension of IP joints and why?
interossei cuz of manner of their insetion into extensor expansion of finger which passes dorsal to transverse axes of these joints- lumbricals also assist in IP extension
on examining palms, there are localized and firm ridges in the palmar skin that extend from middle part of palm to base of ring and little fingers- its a result of fibromatosis of the palmar fascia, resulting in irreg. thickening of fascial attachments to the skin, which causes gradual contraction of the deigits, esp. digits 4 and 5- half the people have it bilaterally- its called?
Dupuytren contracture or deformity
This is a result of loss of median and ulnar N.’s at the elbow w/ paralysis of all long flexors of fingers and all intrinsic hand muscles
Ape hand
this results from paralysis of IP joint extension by interossei and lumbricals innervated mostly by the ulnar N.
clawhand
results from detachment of extensor mechanism from distal phalanx of finger and unopposed flexion of that DIP joint
Mallet finger
most commonly injured N. in shoulder dislocations? (head of humerus dislocated here)
Axillary N
Long head of biceps brachii muscle runs in the ? on the prox. humerus as it changes direction and turns medially to attach to? this change in direction predisposes tendon to wear and tear- this type of injury is characteristic and called?
intertubercular groove, supraglenoid tubercle of scapula, Popeye sign
supraspinatus mm inserts on the? and supplied principally by spinal N.?
greater tubercle of humerus, C5
sybscapularis mm is innervated by?
upper and lower subscapular N.’s
teres minor takes origin from?
lateral border of scapula
teres major takes origin from?
region of inferior angle and the lateral border of the scapula
most common fracture in children? results from?
fracture of the clavicle from fall on outstretched upper limb- forces are conducted thru hand on up thru bones of limb in succession- often these bones dont fracture but rather pass the compression forces proximally- appendicular skeleton joins axial skeleton at sternoclavicular joint- forces not sufficiently transferred to the sternun, causing clavicle to absorb the force, resulting in fracture of this sigmoidal-shaped bine
during breech delivery, downward traction applied to shoulders and upper limbs as baby is forcibly extracted from birth canal- what is the damage often associated with this?
structure injured is upper trunk of brachial plex, Erb-Duchenne palsy
injury to ulnar N. in Guyon’s canal results in?
loss of sensation to the medial palm and the palmar surface of the medial 1 and a half digits and motor loss of the hypothenar mm’s (Abductor digit minimi, Flexor digiti minimi brevis, Opponens digit minimi), the interossei, and medial 2 lumbricals
the common flexor sheath AKA ulnar bursa is a synovial sheath in carpal tunnel- it contains? the sheath surrounds? whats the rest of the pathway to the hand? On tendons of which finger is it prolonged?
- tendons of FDS & FDP but not the FPL
- it surrounds FD, extends downward about halfway along metacarpal bones, where it ends in blind diverticula around tendons to digits 3,4,5. - prlonged on tendons to little finger and usu. communicated w/ mucous sheath of these tendons
Condition charcterized by weak mm tone in hand and loss of radial pulse when upper limb is abducted above shoulder- a cervical rib usu. causes this?
thoracic outlet syndrome
a fibrous connection that allows minimal to no movement- for e.g. by the interooseous membrane joint between the radius and ulna
Synarthrosis joint
pivot joints, an e.g is the median atlantoaxial joint
trochoid joint
hunge joints located at the interphalangeal junctions in the hand and foot (PIPs and DIPs)
Ginglymus joints
Radial A. lies between 2 tendons near the wrist that are useful landmarks to find radial A. What are they?
Between tendons of the brachioradialis and FCR mm.’s
Radial pulse can be felt in anatomic snuffbox btwn tendons of?
EPL and EPB mm’s
pleuroperitneal folds are embyologic origin for?
posterolat, aspect of diaphram
pleuropericardial folds are embyologic origin for?
fibrous pericardium
cervical myotomes are embyologic origin for?
musculature of diaphragm C3-C5
crura is origin of?
dorsal mesentery of esophagus
incomplete div. of trachoesophageal septum results in? which is?
esopahgeal atresia (absence or blind end of esophagus)
What causes ectopic cordis?
lateral folds dont fuse in forming thoracic wall
problem with formation of trachealesophageal septum leads to?
TEF
pleuroperitoneal folds lead to? if not developed correctly, leads to?
pleuroperitoneal membranes–> CDH
What does the central tendon of diaphragm do?
separates heart from liver
absence of musculature of half ur diaphragm results in?
eventration of diaphragm- where weak muscle wall so contents bulge up into thoracic space
What is polyhydramnios and name conditions that its associated with?
Excess amounts of amniotic fluid in amniotic sac-fetus doesnt have ability to swallow normal amounts of amniotic fluid–> can lead to esophageal atresia and TEF
Oligohydramnios is what? and is closely associated with what problems?
Deficiency of amniotic fluid during pregnancy- pulmonary hypoplasia and stunted lung development
to avoid damage to lungs, chest tube should be inserted below level of lungs in what space? At what intercostal space should tube be inserted?
At midclavicular line, costodiaphragmatic recess is where? At midaxillary line? At paravertebral line?
- costodiaphragmatic recess @ 8th or 9th intercostal space
- midclavicular–> btwn intercostal spaces 6 and 8
- midaxillary–> btwn 8 & 10
- paravertebral–> btwn ribes 10 & 12
Common symptoms of this include inversion of nipple and dimpling of the overlaying skin, changes that are due to?
This is inflammatory breast cancer and those changes are due to retraction of the suspensory ligaments (of Cooper)
Intraductal cancerous tumors show symptoms including?
breast enlargement, breast lump, breast pain, nipple discharge
a pathological condition that presents as hard “wood like” texture of skin over a mass of tissue in right upper quadrant of breast?
cancer en cuirasse
When multiple rib fractures produce a flail segment of thoracic wall, what is commonly experienced with the flail segment upon inspiration? Explain this mechanism.
Paradoxical motion of flail segment–> flail area sucked in rather then expanding out w/ inspiration and the reveres movement occurs in expiration- cuz ribs are fracture, they cant facilitate normal pump handle motion during inspiration
Lymph from lower third of esophagus drains into?
post. mediastinal & L. gastric LNs
Lymph from middle third of esophagus drains into?
post. & superior mediastinal LNs
Lymph from upper third of esophagus drains into?
deep cervical nodes
Landmark used to place tip of catheter of central venous line?
Carina (@ level T4-5-sternal angle of Louis)- commonly used to guide placement of central venous line
Auscultation over 6th intercostal space at midaxillary line associated with what structure?
the lower lobe of the right lung- below oblique fissure (here u can hear rales–> crackling noises due to buildup of fluid, usu. migrates to inf. portion of lung cuz of gravity)
Oblque tissue runs from where post. to where anteriorly?
level of T2 post. to 6th costal cartilage anteriorly
bronchial constriction induced by? supplied by? which when blocked results in?
Parasymp. innervation of airways, vagus N.’s, relaxation of airways
Phrenic N. supplies what to where?
Phrenic N.–> motor & sensory innervation to diaphragm
Intercostal N.’s provide what to where?
Intercostal N.s–> sensory & somatic innervation to their respective intercostal spaces
Stim. of sympathetic innervation results in what in respiratory system?
bronchodilation
the sensory innervation provided to intercostal spaces and to underlying parietal pleura is supplied via?
the corresponding intercostal N.’s
Provides motor innervation to diaphragm and sensory innervation to diaphragmatic & mediastinal parietal pleura & pericardium
Phrenic N.
provides parasympathetic innervation to thoracic viscera & to gastrointestinal tract as distal as left colic flexure
Vagus N.
Carries sympathetic innervation from T1 to T4 levels to thoracic organs and pain fibers from these organs
cardiopulmonary N.’s
Carry sympathetic innervation to the abdomen
thoracic splanchnic N.’s
Hemothorax caused by rib fracture, parietal pleura torn, and blood flows into pleural space. Which vessels responsible for blood?
intercostal vessels
What is the syndrome that involves a lesion of cervical sympathetic chain and sympathetic chain ganglia w/ clinically imp. constellation of sympptoms including miosis, partial ptosis and anhydrosis? and often a result of?
- Horner syndrome
- Result of A Pancoast tumor AKA a superior pulmonary sulcus tumor of the apex of the lung
blockage of cutaneous lymph vessels results in edema of skin surrounding hair follicles describes?
peau d’orange
shortening of suspensory ligaments leads to?
dimpling of the overlying skin
contraction of the retinacula cutis results in?
retraction and inversion of the nipple and/or areola
Which structure responsible for division of truncus arterioles and what does it become?
truncus arteriosus + bulbus cordis–> aorta + pulm. trunk by the aorticopulmonary septum
rare obstruction of upper fetal airway- distal to site where this occurs, the airways dilate, lungs enlarge and become echogenic, diaphragm flat terns or inverts, and fetal ascites and/or hydrous develop- what is this?
Laryngeal atresia- AKA congenital high airway obstruction syndrome
are obstruction of trachea, commonly found w/ TEF, prob resulting from unequal division of foregut into esoph. and trachea
Tracheal atresia
excess amniotic fluid- often associated w/?
polyhydramnios
- esoph. atresia or TEF
lung hypoplasia is what? what is it usually associated with?
reduced lung V, often seen in infants w/ CDH
Oligo hydramnios is? Associated with?
dec. in amniotic fluid- stunuted lung dev. and pulm. hypoplasia
tetraology of fallot characterized by what 4 defects? what leads to these 4 problems?
pulm stenosis, VSD, overriding aorta, and these in turn lead to right ventricular hypertrophy
- superior malalignment of the sub pulmonary infundibulum causes stenosis of the pulm trunk which leads these symptoms
in what case will the Ao arise from the R. ventricle and the plum trunk arise from the L. ventricle? what defect leads to this? What condition of the mother is associated w/ this?
- transposition of great vessels
- dfect in formation of aorticopulmonary septum
- associated w/ maternal diabetes
whats associated w/ membraneous ventricular septal defects?
endocardial cushion defect
Where will murmur at S2 be localized?
atrioventricular valve so tricupsid valve (RA–> RV) or mitral valvue (LA–>LV)
ASD causes what type of murmur where?
diastolic murmur in tricupsid valve
VSD would cause what type of murmur?
cause a pansystolic murmur
which conditions will cause murmur at S1?
transposition of great A.’s and aortic stenosis
Down syndrome commonly associated with what cardiac abnormalities?
arrhythmias, ASD and VSDs
Which 2 congenital heart abnormalities are associated w/ 22q11 DiGeorge syndrome?
Tetraology of ballot and truncus arteriosus
coarction of the Ao associated w/ which other syndrome?
Turner syndrome
What other syndrome is sometimes present in individuals w/ aortic atresia?
Marfan syndrome
ASD is a communication between R. and L. atria. The ASD usually forms from?
incomplete closure of the foreman secundum AKA foramen oval or foramen primum- in formation of partition btwn 2 atria, the opening in the foramen secundum, the foreman oval, typically closes at birth and if it doesn’t u get an ASD
bulbus cords forms what?
the conus cords or conus arterioles (smooth part of RV) and aortic vestibule (smooth part of LV @ the root of the Ao)
coarctation occurs when the Ao is abnormally constricted, just inferior to ductus arteriosus- which embryological structures affected to create this problem?
portion of Ao arch that is constricted arises from 3rd, 4th, and 6th pharyngeal arches
Ao arch 3 forms?
common carotid A.’s, and the pros. part of internal carotid A.’s
Ao arch 4 forms?
the Ao arch on L. and the brachiocephalic A. and the prox. subclav. A. on R.
Ao arch 6 forms?
the prox pulm. A,’s and ductus arteriosus
ectopic cords results from?
failure of fusion of the lateral folds in forming the thoracic wall
R. horn of the sinus venous has 2 divisions: what are they? Abnorm. septation of sinus venosus can lead to?
- dev. into sinus venarum (smooth interior part of R. atrial wall)
- other half dev. into pulm. V.’s
- inappropr. pulm, connections, as in totally anomalous pulm. connections
severe retrosternal pain radiating to L. shoulder- pericardial friction rub leading to pericarditis. Whats pericarditis and what N.responsible for radiating pain?
pericarditis- inflammation of pericardium- often causes pericardial friction rub w/ surface of pericardium getting more coarse- Phrenic N. solely responsible for innervating pericardium- it transmits pain fibers radiating from pericardial friction rub- Phrenic has sensory N. fibers from C3-C5 that also supply skin of shoulder area- referred pain to shoulder from phrenic
N. responsible for radiation of pain during myocardial infarction- severe chest pain radiating to L. arm
intercostobrachial N.- lat. cut. branch of 2nd intercostal N.- serves sensory function in both thoracic wall and medial aspect of arm
Cutaneous branches of ventral rami contain what?
both sensory & motor fibers and also sy,mpathetics to body wall, supplying all areas of body wall except for tissues of the back
distal part of proc. vag. contributes to? thats related to?
tunica vag.
- related to testis
if interned part of proc vag persists, results in?
often fills w/ fluid and creates hydrocele
if entire proc vag pelrsists, patient develops?
likely to dev a congenital inguinal hernia
undescended testis is result of? and called?
cryptorchism- result of incom migration of gonads from abd to location in scrotum- prone to dev cancer there so needs to be removed
failure of lateral folds to form can cause?
lateral folds key structures to form muscular part of ant abd wall- can cause umbilical hernia or gastroschisis
septum transversum forms in what region?
cervical region, gainging innervation from C3-C5
myoblasts migrate in from body wall to form?
muscular part of diaphragm- 2 bilateral hemidiahragms- these mm’s innervated by phrenic N.’s
plueroperitoneal folds contribute to?
portion of diaphragm posteriorly
what part of GI tract most likely to be attached to inner surface of umbilical hernia?
ileum because infant has umbilici hernia w/ mass protruding thru umbilicus and this is meckel diverticulum- this out pouching is a persistence od vitelline duct and it can be attached to umbilicus
greater splanchnic N. carries what type of fibers where?
carries general visceral afferent fibers from abdominal organs and can be involved in referred pain
pain from indirect inguinal hernia results from what N. in inguinal canal?
- ilioinguinal N. runs w/ spermatic cord and can be compressed
- with indirect inguinal hernia you have loops of bowel entering spermatic cord thru deep inguinal ring (lateral to inferior epigastric vessels)
direct hernias penetrate what and where?
penetrate ant. abd wall medial to inf epigastric vessels thru the inguinal triangle (hesselbach) and do not perpetrate deep inguinal ring
- commonly result from herniation of intestines thru deep inguinal ring?
indirect inguinal hernia
where is the most likely place for peritonitis to develop initially and why?
omental bursa or lesser sac because its located posterior to the stomach.
