BRS anatomy review Flashcards
locate apex of heart? blood supply?
left fifth intercostal
anterior intraventricular arter
expiration achieved by what muscle?
elastic tissue in lungs and thoracic wall
what kind of fibers do greater splanchnic nerves have
GVA and preganglionic sympathetic GVE
General visceral afferent and pre-gangl - sympthatic efferent
white rami communicantes severed at 6th thoracic - degen of what nerve bodies?
preganglionic sympathetic (which I undestand) from lateral grey horn -
and - don’t understand - dorsal root ganglion
Posterior anterior chest x ray - what part of heart do you see mostly?
right ventricle (sternocostal surface main structure)
Because looking at xray as if at front of patient
Posterior-Anterior (PA) projection
The standard chest radiograph is acquired with the patient standing up, and with the X-ray beam passing through the patient from Posterior to Anterior (PA). The chest X-ray image produced is viewed as if looking at the patient from the front, face-to-face.
atrial septum defect?
failure of foramen ovale to close
pacemaker of heart?
SA node
circumflex branch of left coronary artery supplies?
posterior left ventricle
laceration of phrenic (right)
loss of sensation of pericardium and mediastinal pleura - important for INHALATION - not for exhalation
drainage of cardiac veins into heart?
anterior cardiac drains to right atrium,
middle small oblique into coronary sinus,
right and left pulmonary into left atrium
lack of blood to left ventricle? - thrombosis in circumflex branch of left coronary artery
mitral valve insufficiency
cardiac notch?
near superior lobe of left lung
thoracentesis?
7 - 9 ribs - to aspirate pleural effusion
occlusion of descending thoracic aorta?
lower six intercostal arteries affected
which lung has a middle lobe?
right- it has a groove for the horizontal fissure, SVC, and larger capacity than left
which lung has a lingula?
LEFT - tongue shaped, left lung upper lobe
major muscles of expiration?
abdominal
posterior mediastium - what’s there?
descending aorta
hemiazyogos vein -
Posterior Mediastinum:
Organs: esophagus.
Arteries: descending thoracic aorta.
Veins and lymphatics: azygos hemiazygos veins, thoracic duct.
Nerves: vagus, splanchnic, sympathetic chain
what’s in superior mediastum?
bracheocephalic veins, trachea, arch of aorta,
Superior Mediastinum:
Organs: thymus, trachea, esophagus.
Arteries: aortic arch, brachiocephalic trunk, left common carotid artery, left subclavian artery.
Veins and lymphatics: superior vena cava, brachiocephalic veins, the arch of the azygos, thoracic duct.
middle mediastium
arch of azygos
heart, pericardium, great vessels, trachea, bronchi, esophagus, and lymph nodes. Esophageal tumors, tracheal tumors, and lymph nodes are typically located in this compartment. The posterior mediastinum contains autonomic nerves, vessels, and lymph nodes.
tumor superior to root of right lung?
arch of azygus vein
lacerate right vagus nerve near recurrent laryngeal?
parasymp nerve fibers will affect bronchial lumen, bronchial smooth muscles decrease heart rate etc - also affect pain, cough reflex and stretch of lung during inspiration
cystic fibrosis in child blocks which lung structures?
terminal brochioles (and alveolar ducts) viscose mucus - larger ducts not so affected
left primary bronchus is?
longer than right - right receives more foreign bodies, shorter, larger diameter
venous drainage of right third intercostal spaces ?
superior intercostal vein - to azygos on right, and brachiocephalic on left
Cardiac silhouette
right border is SVC
ascending aorta would be seen in middle of heart
refers to the outline of the heart as seen on frontal and lateral chest radiographs and forms part of the cardiomediastinal contour. The size and shape of the cardiac silhouette provide useful clues for underlying disease.
systole, dystole?
systole: contraction of the ventricles of the heart aortic and pulmonic valves open
dystole? mitral and tricuspid valves are OPEN to fill
sternal angle?
Bifurcation of the Trachea.
Boundary between the superior and inferior portion of the mediastinum. Passage of the thoracic duct from right to left behind esophagus Aortic Arch.
third rib articulates w?
body of sternum, body of second thoracic vertebra, transverse process of third thoracic vertebra
to aspirate pericardial fluid - insert needle?
left fifth intercostal space
first heart sound?
The “ lub” is the first heart sound, commonly termed S1, and is caused by turbulence caused by the closure of mitral and tricuspid valves at the start of systole. The second sound,” dub” or S2, is caused by the closure of aortic and pulmonic valves, marking the end of systole.
tricuspid and mitral valves close
Valves of the Heart
Toilet Paper My Ass
tricuspid
pulmonary
mitral
atrial
The right atrioventricular valve is the tricuspid valve. The left atrioventricular valve is the bicuspid, or mitral, valve. The valve between the right ventricle and pulmonary trunk is the pulmonary semilunar valve. The valve between the left ventricle and the aorta is the aortic semilunar valve.
chordae tendinae?
colloquially known as the heart strings, are tendon-resembling fibrous cords of connective tissue that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart.
Patent ductus arteriosus
(PDA) is a persistent opening between the two major blood vessels leading from the heart. The opening, called the ductus arteriosus, is a normal part of a baby’s circulatory system before birth that usually closes shortly after birth.
Tracheoesophageal fistula
what structure in fetus closes these two structure correctly
Tracheoesophageal septum formed by fusion of Tracheoesophageal folds in midline
is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs).
what structures branches into the bronchial arteries?
descending thoracic aorta
hirschsprung disease - megacolon - what nerve?
parasympathetic postganglionic - absense of enteric ganglia - NC
round ligament of liver?
left umbilical vein
excruciating peritonial pain from lesser sac - what nerve carries?
lower intercostal nerves
intercostal nerves?
run from spine - ventral rami become the intercostal nerve - running between innermost and intercostal muscles -
under rib in groove w/ artery
branch two
Lateral cutaneous branch and Anterior cutaneous branch
intercostal arteries?
internal thoracic arteries also called internal mammmary arteries (supply breasts of men and women)
posterior intercostal also supply some branches to back
2 sets - one from aorta - posterior intercostal - - branching to lateral cutaneous
posterior anastamoses with anterior intercostal artery that comes from internal thoracic artery decending down -from subclavian in intercostal muscles - betwe transversus thoracis mus and?
cremasterie muscle?
genitofemoral nerve
shunt around portal system?
splenic vein to left renal to IVC
supra renal gland arteries?
aorta, inferior phrenic, renal
gastrosplenic ligament (ligamentum gastrosplenicum or gastrolienal ligament)
is part of the greater omentum. Embryonically the gastrosplenic ligament is derived from the dorsal mesogastrium. The gastrosplenic ligament is made of peritoneum that connects the greater curvature of stomach with the hilum of the spleen.
inferior pancreaticoduodenal artery?
SMA - anastamose with celiac artery branches
during apendectomy at mcburney’s point - what structure is most likely to be injured?
iliohypogastric nerve
jejuenum vs ilium?
jejeunum - fewer mesenteric arterial arcade - more and taller plicae circulares - less fat (more digestion occurs here)
right colic vein?
part of portal system - SMA
retriperitoneal infection?
could be the dorsal pancreatic artery - (it is retroperitoneal
remnant of fetal ARTERY?
medial umbilical fold -
mediAN umbilical fold - urachus remnant
lateral umbilical fold (ligament) inferioror epigastic artery and vein which are adult vessels
ligamentum venosum - fibrous remnant of umbilical VEIN
scrotal lymph? “S” scrotum, skin penis, shit (anal cavity lower) - all go to SUPERFICIAL
superficial inguinal - from scrotum, penis, buttocks and lower part of anal canal
deep inguinal lymph?
upper part of vagina, anal canal to external iliac nodes
The lymphatic drainage of the prostate primarily
drains to the obturator and the internal iliac lymphatic channels. There is also lymphatic communication with the external iliac, presacral, and the para-aortic lymph nodes.
ovarian lymph?
The para-aortic nodes, also known as the lumbar aortic nodes, drain lymph from the kidneys, suprarenal glands, testes, ovaries, uterus, and uterine tubes.
appendectomy - ligate what artery?
iliocolic artery - be careful of…iliohypogastric nerve!!
severe pain from stomach - what nerve carries this terrible message?
greater splanchnic -
vagus only reflex = no pain
lower intercostal carries pain but not from stomach but from diaphragm, abdom wall and peritneum
processes vaginalis persists?
hydrocele
porta hepatis? doorway into liver
doorway- contains hepatic ducts, arteries, and branches of portal vein
The porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver
The epiploic foramen (also called the foramen of Winslow)
is a passage between the greater sac (peritoneal cavity proper) and the lesser sac (omental bursa), allowing communication between these two spaces.
What is contained in the Hepatoduodenal ligament?
The hepatoduodenal ligament is the distal portion of the lesser omentum, that connects the liver to the cranial part of duodenum. It forms the free right border of the lesser omentum and the ventral boundary of the epiploic foramen. It contains the portal vein, hepatic artery and bile duct.
meckle’s diverticulum is remnant of ? vitalline
yolk stalk - rule of 2s
2 feet proximal to iliocecal junction
growing tumor of uncinate process compresses?
SMA
direct hernia?
develops after birth
pituitary?
near cavernous sinus - behind and above it sphenoid sinus
number of sinuses? four pairs
There are four paired sinuses – named according to the bone in which they are located – maxillary, frontal, sphenoid and ethmoid.
The mucus from the sinuses drains into your nasal passages and then down the back of your throat to be swallowed.
number of dural venous sinuses?
11 -
Anterior
Sphenoparietal sinuses
Cavernous sinuses
Superior and inferior petrosal sinuses
Midline
Superior sagittal sinus Typically becomes right transverse sinus or confluence of sinuses
Inferior sagittal sinus Straight sinus
Typically becomes left transverse sinus or confluence of sinuses
Posterior
Occipital sinus
Confluence of Sinus
Right and Left transverse sinuses
Lateral Superior petrosal sinus Transverse sinuses Sigmoid sinus Inferior petrosal sinus Internal jugular vein Sigmoid sinuses
lesion of optic nerve?
blindness
if pituitary tumor large enough?
bitemporal hemianopia
partial blindness where vision is missing in the outer half of both the right and left visual field. It is usually associated with lesions of the optic chiasm, the area where the optic nerves from the right and left eyes CROSS near the pituitary gland.
binasal hemianopia - vision is missing in the inner half of both the right and left visual field.
bilateral atherosclerosis or aneurysms of the internal carotid arteries simultaneously compressing the adjacent NON‐CROSS fibres of both optic nerves.
abduct vocal cords
posterior cricoarytenoid - only muscle that does this - all other ADDUCT
The posterior cricoarytenoid muscles are the only muscles to open the vocal cords. By rotating the arytenoid cartilages laterally, these muscles abduct the vocal cords and thereby open the rima glottidis. Their action opposes the lateral cricoarytenoid muscles.
Intrinsic and extrinsic muscle of larynx?
Cricothyroid muscle lengthen and tense the vocal folds.
The intrinsic laryngeal muscles are responsible for controlling sound production.
Cricothyroid muscle lengthen and tense the vocal folds.
Posterior cricoarytenoid muscles abduct and externally rotate the arytenoid cartilages, resulting in abducted vocal folds.
Extrinsic The extrinsic muscles act to move the larynx superiorly and inferiorly. They are comprised of the suprahyoid and infrahyoid groups, and the stylopharyngeus (a muscle of the pharynx). The supra- and infrahyoid muscle groups attach to the hyoid bone.
What is the main function of the pharynx?
It is commonly referred to as the throat. The pharynx is part of both the digestive and respiratory systems. For the digestive system, its muscular walls function in the process of swallowing, and it serves as a pathway for the movement of food from the mouth to the esophagus.
cricopharygeaus act as a sphincter - preventing air from entering esophogus
is a semi-circular muscle located in the neck about three inches below the Adam’s apple. To prevent the reflux of foods from the esophagus into the throat, the cricopharyngeus remains contracted and tight at most times.
The oblique arytenoid muscle and aryepiglottic muscle?
prevent food from entering larynx
Great cerebral vein of galen is direct tributary of?
dural venous sinus
parasymptethic to eye?
pupil constricts, ciliary m contracts = accommodation THICKER LENS – enhanced vision for near objects
tympanic nerve branch of?
continues to lesser petrosal - with symphatheitc = to OTIC ganglion for synapse
glosspharyngeal -
Jacobson’s nerve is a tympanic branch of the glossopharyngeal nerve, arising from its inferior ganglion. It enters the middle ear cavity through the inferior tympanic canaliculus, runs in a canal on the cochlear promontory and provides the main sensory innervation to the mucosa of the mesotympanum and Eustachian tube.
otic ganglion?
glossopharyngeal nerve and innervates the parotid gland for salivation.
Parotid POTIC/D
The otic ganglion below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. It is functionally associated with the glossopharyngeal nerve and innervates the parotid gland for salivation.
Four parasympathetic ganglia located within the head –
the ciliary, otic, pterygopalatine and submandibular. They receive fibres from the oculomotor, facial and glossopharyngeal nerves (the vagus nerve only innervates structures in the thorax and abdomen).
Which cranial nerve carries parasympathetic fibers?
oculomotor, facial, glossopharyngeal, and vagus nerves. 5 Special somatic afferent (SSA).
Special somatic afferent fibers (SSA) 2,8 SSA
are the afferent nerve fibers that carry information from the special senses of vision, hearing and balance. The cranial nerves containing SSA fibers are the optic nerve (II) and the vestibulocochlear nerve (VIII).
special visceral efferents.
Acronym: SVE. The term special visceral efferents (SVE) refers to nerve fibers that innervate the voluntary striated muscles of the larynx and pharynx and the muscles of facial expression and mastication.
dura in cranium - which CN innervate?
V (mid brain) - v2 and v3
v1 - anterior
X and XII (via C1) - posterior
carotid sinus? S = Stretch
stretch - at internal carotid IX
fracture optic canal ? enter orbit thru SOF
can
opthalamic artery and optic nerve
ENTER orbit thru SOF
The superior orbital fissure is the largest opening that connects the orbit with the middle cranial fossa. [1] The optic canal connects the orbit to the middle cranial fossa and transmits the optic nerve, ophthalmic artery, meningeal sheaths, and sympathetic nerve fibers
digastric posterior belly? VII
elevates hyoid bone
anterior? V
these can affect speech
The stylopharyngeus muscle - innervation - (CN IX)
act as a significant dilating muscle of the nasopharynx. During breathing, the contraction of this muscle pulls the nasopharyngeal wall dorsally. This action prevents the dynamic collapse of the dorsal wall of the nasopharynx by supporting the wall during inspiration
What do the pharyngeal muscles do? V Vagus - except sylophyngeus
Pharyngeal muscles. The pharyngeal muscles are a group of muscles that form the pharynx, which is posterior to the oral cavity, determining the shape of its lumen, and affecting its sound properties as the primary resonating cavity. The pharyngeal muscles (involuntary skeletal) pushing the food into the esophagus.
tensor tympani muscle V
connects to the malleus bone. Its role is to dampen loud sounds, such as those produced from chewing, shouting, or thunder.
stapideus? VII
The stapedius is the smallest skeletal muscle in the human body. At just over one millimeter in length, its purpose is to stabilize the smallest bone in the body, the stapes.
pupil doesn’t get larger even when light dims?
superior cervical ganglion damage SYMPATHETIC problem
The pupillary light reflex
neural pathway on each side has an afferent limb and two efferent limbs. The afferent limb has nerve fibers running within the optic nerve (CN II). Each efferent limb has nerve fibers running along the oculomotor nerve (CN III). The afferent limb carries sensory input.
common tendinous ring?
The tendinous ring, also known as the annulus of Zinn, is the common origin of the four rectus muscles (extraocular muscles). The tendinous ring straddles the superior orbital fissure and through it (from superior to inferior) pass: superior division of the oculomotor nerve (CN III)
The annulus of Zinn, also known as the annular tendon or common tendinous ring, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit. It is the common origin of the four rectus muscles (extraocular muscles). … Superior division of the oculomotor nerve (CNIII)
Which structure passes through the tendinous ring of the orbit?
The optic canal and adjacent part of the fissure are surrounded by the common tendinous ring, from which the four recti arise. The lacrimal, frontal, and trochlear nerves enter the orbit above the ring. The superior and inferior ophthalmic veins leave the orbit usually above and below the ring, respectively.
part of v1? lacrimal, frontal and nasociliary
lacrimal, frontal and nasociliary branches of ophthalmic (V1).
After leaving the cavernous sinus, the ophthalmic nerve goes through the superior orbital fissure, where it is usually already divided into its three terminal branches:
Lacrimal nerve.
Frontal nerve.
Nasociliary nerve.
cranial nerves near styloid process
VII, IX, XII
Significant vessels and nerves surround the styloid process. The internal jugular vein, internal carotid artery, and glossopharyngeal nerve (CN IX), vagus nerve (CN X), and accessory nerve (CN XI) lie medial to the styloid process. The occipital artery and hypoglossal nerve (CN XII) run along its lateral side
lesion of vagus causes deviation to uvula?
hoarseness?
on opposite side
damage to recurrent laryngeal of vagus
front and isthmus of thyroid gland associated with
inferior thyroid vein
numbness in anterior cervical triangle?
transverse cervical nerve
The transverse cervical nerve is also formed by fibres from C2 and C3. It curves around the posterior aspect of the sternocleidomastoid, and supplies sensation to the anterior neck.
phrenic nerve may be there too - but doesn’t have cutaneous fibers
The cervical plexus
is a plexus of the anterior rami of the first four cervical spinal nerves which arise from C1 to C4 cervical segment in the neck. They are located laterally to the transverse processes between prevertebral muscles from the medial side and vertebra
What are the branches of cervical plexus?
Its branches consist of a superficial and deep set. The superficial branches are the great auricular nerve, lesser occipital nerve, transverse cervical, suprasternal, and supraclavicular nerves. The deep branches are the phrenic, communicantes cervicales, communicating, and muscular.
Nerves formed from the cervical plexus innervate
the back of the head, as well as some neck muscles. The branches of the cervical plexus emerge from the posterior triangle at the nerve point, a point that lies midway on the posterior border of the sternocleidomastoid
.
What muscles does the cervical plexus innervate?
Located in the posterior triangle of the neck, halfway up the sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.
C1-C2: Rectus capitis anterior and lateralis. C1-C3: Longus capitis. C2-C3: Prevertebral muscles and sternocleidomastoid. C3-C4: Levator scapulae, trapezius and scalenus medius.
The cervical plexus is a network of nerve fibres that supplies innervation to some of the structures in the neck and trunk. It is located in the posterior triangle of the neck, halfway up the sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.
cervical fascia I PT2 PV
cervical plexus in PV
By this classification system, the deep cervical fascia of the neck can subdivide into the investing layer, pretracheal and prevertebral layers, also known as the external, middle and deep layers respectively. The pretracheal, or middle layer, can be further subdivided into the muscular and visceral divisions
superior nasal meatus drains?
posterior ethmoidal sinus
what drains into middle nasal meatus - a lot
The middle meatus is an air passage of the lateral nasal cavity located between the middle nasal concha and lateral nasal wall. The anterior ethmoid air cells, maxillary and frontal sinuses all drain into the middle meatus.
VI run thru what?
cavernous sinus
crichoid ligament at same level as?
inferior laryngeal nerves
severed III nerve?
paralysis of ciliary muscle - and sphincter pupillae
what carries sympathetic fibers to eye ? NOT on III
Many of the fibers destined for the eye form the sympathetic root of the ciliary ganglion, which runs along with the ophthalmic artery to enter the orbit. These fibers then traverse the ciliary ganglion to enter the eye via the short ciliary nerves
The pharyngeal arches (branchial arch,
are a series of externally visible anterior tissue bands lying under the early brain that give rise to the structures of the head and neck.
what innervates the stylopharngeus?
GLOSSOpharangeus XII
nose punch, nasal septum broken, what is damaged?
vomer and perpendicular plate of ethmoid
what goes thru internal auditory meatus?
VII and VIII
what goes thru foramen lacerum?
triangular hole in the base of skull located between the sphenoid, apex of petrous temporal and basilar part of occipital. It is the juncture of the petroclival, sphenopetrosal, and pterygosphenoidal sutures.
nothing = the greater petrosal nerve passes medially to enter the foramen lacerum and fuses there with the deep petrosal nerve, forming the Vidian nerve or pterygoid nerve, which passes from the pterygoid canal to the pterygopalatine fossa
carotid sheath?
internal jug, vagus, internal and common carotid NOT sympathetic (w/ superior and middle cervical ganglia)
costocervical trunk gives rise to
deep cervical and superior intercosta
eye reflex blink carried by? v and VII
nasociliary V1- afferent, efferent VII
what lies in wall of cavernous sinus?
The cavernous sinus is a blood space containing endothelium, trabeculae, and ligaments. Each cavernous sinus contains the internal carotid artery (and sympathetic plexus), oculomotor nerve, trochlear nerve, abducens nerve, and the V1 and V2 branches of the trigeminal nerve. NOT the MANDIBULAR
adenoid? aka pharangeal tonsil
a mass of enlarged lymphatic tissue between the back of the nose and the throat, often hindering speaking and breathing in young children.
Greater petrosal nerve
Lacrimal gland. Oral mucosa
The deep petrosal nerve innervates the blood vessels and secretomotor aspects of the. Lacrimal gland. Oral mucosa
lesser petrosal?
paratoid
needle cricothyrotomy - open into
infraglottic cavity
what nerves are involved in swallowing?
many - 5, 7, IX, X
what opens the eye? orbicularis oculi or leavator palpebrae superiororis
levator - oculi closes
dry mouth?
chordae tympani - secretions of submandibular glands
What is the function of the FALX cerebri?
cerebellar tentorium
The falx cerebri is a double-fold of dura mater that descends through the interhemispheric fissure in the midline of the brain to separate the two cerebral hemispheres.
The cerebellar tentorium or tentorium cerebelli (Latin for “tent of the cerebellum”) is an extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes.
pupillary light reflex?
afferant - II optic nerve
The pupillary light reflex compensates for changes in illumination level, whereas the accommodation responses compensate for changes in eye-to-object-viewed distance. … Consequently, a light directed in one eye elicits responses, pupillary constriction, in both eyes.
The frenulum of tongue
or tongue web (also lingual frenulum or frenulum linguæ; also fraenulum) is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue.
nosebleed?
sphenopalantine artery
a terminal branch of the internal maxillary artery originating from the external carotid artery system. [4] The SPA is the major blood vessel to the nasal cavity mucosa: supplying the superior, middle, and inferior turbinate; lateral nasal wall; and nasal septum.
ptosis
drooping or falling of the upper eyelid.
miosis
pupil constriction
ptosis and miosis?
loss of sympathetic fiber to head HORNERS T1 - T3 - Thoracic Anterior Roots
these fibers must follow blood vessels to get to their location
arytenoid cartilage
either of a pair of cartilages at the back of the larynx, used in the production of different kinds of voice quality
wide skull?
premature coronal suture closure
XIi innervates all tongue muscles except?
palatoglossol (in the back - ) XXXXXXXX
infection spreading from parotid, neck to mediastrium?
retrophayngeal space
The most commonly entrapped material following a blowout fracture
inferior rectus muscle.
keyhole pupil?
failure of fusion of retinal fissure
hair cells damages in hearing?
longer they have to travel - lower the sound - so if can’t hear high sounds, hair cells at base of cochlea travels the least to reach apex
CSF not flowing - blocked in brain?
“non-communicating” hydrocephalus aka obstructive
branchial cyst vs thyroid nodule?
branchial (2nd arch) needs to be on sternocleidomastoid- anterior border
dentist - blocking nerves on maxillary area - near canine - and lots of things put to sleep
infraorbital nerve - eyelid, cheek, nose etc -
lesser block would be anterior superior alvelolar
sore throat - palantine tonsils swollen - what nerve
IX
What Innervates the angle of the mandible?
The angle of the jaw is innervated by the auricular branch of the superficial cervical plexus (SCP). Cervical cutaneous nerves of the CP carry the sensation from the antero-lateral cervical skin
what runs thru the parotid gland
The external carotid artery (ECA) ascends through the parotid gland. Within the gland, the ECA gives rise to the posterior auricular artery. The ECA then divides into its two terminal branches - the maxillary artery and superficial temporal artery.
bifurcation of common carotid?
C4
The chorda tympani
is a branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain.
SSA? 28, ssa
II (optic) VIII (hearing/balance)
SVA? (4) - 1,7,9, 10
smell, taste - 1,7,9, 10
SVE (5) 5, 7, 9, 10 , 11
5, 7, 9, 10 , 11
facial nerve - how many holes
2 - internal meatus
styloid mastoid (digastric and..?)
facial - lacrimal and
nasal
tensor veli palantini
elevate the soft palate
There are five muscles which give the actions of the soft palate. They are all innervated by the pharyngeal branch of the vagus nerve (CN X) – apart from Tensor veli palatini – which is innervated by the medial pterygoid nerve (a branch of CN V3).
Like other structures derived from the first pharyngeal arch, tensor veli palatini is innervated by the mandibular division of trigeminal nerve (CN V), that gives off the nerve to medial pterygoid.
outside common tendinous ring of SOF?
symmetry
IV, v1 (IV VI) see the symmetry?
The Stylopharyngeus
is the only muscle in the pharynx innervated by the glossopharyngeal nerve (CN IX) through branchial motor fibers that originate in the rostral part of the nucleus ambiguus.
styloglossus function?
brings tongue back into mouth
maxillary air sinus?
open into middle meatus, innervated by superior alveolar nerves, rudimentary at birth, infra-orbital nerve on its roof
ganglia containing NO post ganglionic parasympathetic?
Trigeminal
Geniculate
These are just regular ganglia
ganglia w/ post ganglionic parasympathetic?
ciliary
submandibular
pterygopalatine
otic
constrictor muscles?
anterior to cervical vertebrae, stacked drinking cups, have a cricopharyngeus part which opens at rest
The pharyngeal plexus is the main nervous plexus that supplies the pharynx. The sensory branches originate from the glossopharyngeal nerve (CN IX) which runs into the plexus. … The inferior constrictor muscles are supplied by the external and recurrent branches of the vagus nerve (CN X).
nerves that act on the palate include?
pharyngeal plexus, mand v2,
max v3,
external carotid artery?
branch supplies upper thyroid gland, hypoglossal nerve passes lateral to it
. Sphenomandibular ligament
plays a part in opening of the mouth
Thyrohyoid membrane
is perforated by the superior laryngeal artery
Stylomandibular ligament
is the fused lower edge of the parotid fascia
auditory tube
opening of the auditory tube in the middle ear is located in its anterior wall, and from here the
extends forward, medially, and downward to enter the nasopharynx, opening in the lateral wall of the nasopharynx just posterior to the inferior meatus of the nasal cavity.
What is nervus intermedius?
same fibres as in chorda tympani
The chorda tympani is a branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain.
The nervus intermedius, also known as intermediate nerve of Wrisberg, is a part of the facial nerve (CN VII) which contains somatic sensory, special sensory, and visceral motor (secretomotor) fibers
Pseudounipolar nerve cells
Pseudounipolar neurons are sensory neurons that have no dendrites, the branched axon serving both functions.
sensory ganglia in V, VII, IX and X
A bipolar neuron,
RARE: olfactory epithelium, the retina of the eye, and ganglia of the vestibulocochlear nerve.
or bipolar cell, is a type of neuron that has two extensions (one axon and one dendrite). Many bipolar cells are specialized sensory neurons for the transmission of sense. As such, they are part of the sensory pathways for smell, sight, taste, hearing, touch, balance and proprioception.
TOSS
all infrahyoid except T are supplied by Ansa cervicalis - (ansa lies in carotid triangle C1 - C3)
omo/sterno/sternothyroid
THYROhyoid - C1 thru XII
recurrent laryngeal nerve - laryns except?
all intrinsic muscles of the larynx except cricothyroid
nerve supply of geniohyoid and thyrohyoid
. C1 fibres via hypoglossal nerve
external laryngeal nerve
. cricothyroid
superior thyroid artery? SUPER SUPEX EXTRACLOSE
near external laryngeal nerve
inferior thyroid artery?
near recurrent laryngeal nerve - which course up near common carotid
venous drainage of thyroid
TRUE capsule is REMOVED
venous plexus lies DEEP
Venous drainage is carried out by the superior, middle and inferior thyroid veins, which form a venous plexus. The superior and middle veins drain into the internal jugular veins, whereas the inferior drains into the brachiocephalic vein
safe place to ligate inferior thyroid artery to avoid injury to the recurrent laryngeal nerve
Inferior is Away
away from the thyroid gland
vice versa with ligation of SUPERIOR thyroid artery
The pretracheal fascia,
The pretracheal fascia, which covers the trachea and few other structures in the neck, also encapsulates the thyroid gland. It is labeled as the false capsule or the visceral layer of the pretracheal fascia.
What are the branches of mandibular nerve?
The Mandibular Nerve (V3)
On its extracranial course, it divides into three main branches: the buccal, mental, and auriculotemporal nerves. The buccal nerve pierces the skin on the face behind the ramus of the mandible, passes in front of the masseter, and innervates the skin anteriorly of the buccinator muscle.
buccal nerve vs buccal branch
The buccal nerve is the only purely sensory branch of the anterior division of the mandibular division of the trigeminal nerve. It is not to be confused with the buccal branch of the facial nerve.
The buccal branch of the facial nerve innervates the buccinator, levator labii, anguli oris, and orbicularis oris. Resection margins can also affect drainage of saliva from Stensen’s duct, accessory ducts, and the parotid gland, which may create salivary leaks, fistulae, and sialoceles.
The buccal nerve is the only purely sensory branch of the anterior division of the mandibular division of the trigeminal nerve. It is not to be confused with the buccal branch of the facial nerve.
mumps?
swells parotid - may affect
what runs thru parotid gland?
The facial nerve (cranial nerve VII), gives rise to five terminal branches within the parotid gland. These branches innervate the muscles of facial expression.
What runs through the parotid gland?
The facial nerve and its branches pass through the parotid gland, as does the external carotid artery and retromandibular vein. The external carotid artery forms its two terminal branches within the parotid gland: maxillary and superficial temporal artery. The gland usually contains several intraparotid lymph nodes.
vertebral arteries arise from?
Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline basilar artery.
forceps injury during childbirth- hurts styloidmastoid foramen?
can’t close eyes -
Will have taste because VII exits thru middle ear -
The chorda tympani is a branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain.
inferior nasal meatus receives?
tear duct
tears are caused by which cranial nerves
The trigeminal V1 (fifth cranial) nerve bears the sensory pathway of the tear reflexes. When the trigeminal nerve is cut, tears from reflexes will stop, while emotional tears will not. The great (superficial) petrosal nerve from cranial nerve VII provides autonomic innervation to the lacrimal gland.
taking pulse near tragus of external ear?
superficial temporal - branch of external carotid
vocal cords controlled by?
exc - cricothyroid (external superior laryngeal
inferior laryngeal nerves, branch of recurrent, branch of X
contralateral two things in neck, head - plus eyes
Uvula deviates to the opposite side, SCM pulls head in opposite direction of paralysis
The usual branches of the subclavian
on both sides of the body are the vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk and the dorsal scapular artery, which may branch off the transverse cervical artery, which is a branch of the thyrocervical trunk. The subclavian becomes the axillary artery at the lateral border of the first rib.
subclavian three parts?
The first portion extends from the origin of the vessel to the medial border of the Scalenus anterior.
The second lies behind this muscle.
The third extends from the lateral margin of the muscle to the outer border of the first rib, where it becomes the axillary artery.
contetns of carotid triangle? crowded
common carotid internal jugular vein vagus hypoglossal nerve ansa cervicalis deep cervical lymph
muscular triangle houses?
infrahyoid strap, larnyx, thyroid, parathyroid
what forms the roof of the inguinal canal
?
eye test - look toward nose and then upward = what ?
inferior oblique - first have patient look inward (testing medius) but then from there is in pathway to test others
adducting eye tests medius rectus
wisdom tooth - lower - extracting - may damage?
paresthesia of lower lip - inferior alveolar nerve may be damaged
crescent hematoma?
superior cerebral veins - bridging veins - may be torn
stone in parotid? what muscle causing problem?
buccinator - may block the drainnage by squeezing the ducts
cushings disease - pituitary problem ( behind eye on scan
leads to rapid weight gain in trunk sparing limbs, double vision, sweating, thinning of skin, and hirsutism (facial male pattern harir growth
tympanic - middle ear cavity -
relationship with many structures - posterior - facial nerve,
hammer to head at pterion?
greater wing of sphenoid
TMY stuck open - what muscle returns it to normal after clearing articular eminence?
temporalis
fracture of hyoid bone?
middle constrictor - big for swallowing this muscle
10 muscles attach to hyoid
middle ear, tympanic cavity sensation
IX hypopharangeal
confluence of dural venous sinuses - what area?
faxl cerebri, falx cerebelli, tentorium cerebelli
middle ear infection - pain, tender, inflammation posterior to right auricle?
mastoiditis
22q11.2 Degeorge
3rd pouch
parafollicular C cells of thyroid?
fourth pouch
soft palate - and uvula - what arch?
4
6 is larynx
Surface ectoderm
Epidermis; adenohypophysis (from Rathke pouch); lens of eye; epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium; anal canal below the pectinate line; parotid, sweat, mammary gland
Endoderm - liver, etc
Gut tube epithelium (including anal canal above the pectinate line), most of urethra and lower vagina (derived from urogenital sinus), luminal epithelial derivatives (eg, lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular and parafollicular [C] cells
Ventral wall defects
Developmental defects due to failure of rostral fold closure (eg, sternal defects [ectopia cordis]), lateral fold closure (eg, omphalocele, gastroschisis), or caudal fold closure (eg, bladder exstrophy).
constrictor mus - what arch?
4
male internal genitalis - but on outside unclear
5α-reductasedeficiency
5α-reductasedeficiency—inability to convert testosterone intoDHT male internal genitalia, ambiguous external genitaliauntil puberty (when testosterone levels cause masculinization)
In the testes:
Leydig Leads to male (internal and external) sexual differentiation.
Sertoli Shuts down female (internal) sexual differentiatio
Cytotrophoblast
Syncytiotrophoblast SYNthesizes hormones
makes Cell
What part of tongue formed by 1st and 2nd phar arches?
1st and 2nd
Anterior 2/3 (arches associated with CNs V3 and VII)
Genie comes out in STYle
3rd and 4th pharyngeal arches form posterior 1/3(thus sensation and taste mainly via CN IX, extreme posterior via CN X)
genioglossus (protrudestongue), and styloglossus (draws sides of tongue upward to create a trough for swallowing).
Motor innervation is via CN X to palatoglossus (elevates posterior tongue during swallowing)
pancreas and spleen embryology
In a patient who has a malformed accessory pancreatic duct, what pancreatic bud will not have formed correctly?
dorsal pancreatic bud
Pancreas—derived from foregut. Ventral pancreatic bud contributes to uncinatep rocess and main pancreatic duct. The dorsal pancreatic budalone becomes the body, tail, isthmus, and accessory pancreatic duct. Both the ventral and dorsal buds contribute to pancreatic head.
Annular pancreas—abnormal rotation of ventral pancreatic budforms a ring of pancreatic tissue encircles 2nd part of duodenum; may cause duodenal narrowing (arrows in ) andvomiting.
A
Pancreas divisum—ventral and dorsal parts fail to fuse at 8 weeks. Common anomaly; mostly asymptomatic, but may cause chronic abdominal pain and/or pancreatitis.
Spleen—arises in mesentery of stomach (hence is mesodermal) but has foregut supply (celiac trunk splenic artery)
AB / O Blood
Anyone can receive O - The universal blood type is O negative (O-). Donors with type O- blood have the unique power to help anyone in need of a blood transfusion. Red blood cells from O- donors can be transfused to anyone, regardless of the person’s blood type.
AB - universal donor
intestinal atresia
Presents with biliousvomiting and abdominal distension within first 1–2 days of life.
Duodenal atresia—failure to recanalize. Abdominal x-ray shows “double bubble” (dilated stomach, proximal duodenum). Associated with Down syndrome.
Jejunal and ileal atresia—disruption of mesenteric vessels (typically SMA) ischemic necrosis of fetal intestine segmental resorption: bowel becomes discontinuous. X-ray shows dilated loops of small bowel with air-fluid levels
universal recipient?
People with type AB+ blood are universal recipients because they have no antibodies to A, B or Rh in their blood and can receive red blood cells from a donor of any blood type.
twinning 4, 8, 12, 13+ unlucky number
SCAB
chorion = placenta
SCAB):
Cleavage 0–4 days: Separate chorion and amnion -
Cleavage 4–8 days: shared Chorion
Cleavage 8–12 days: shared Amnion
Cleavage 13+ days: shared Body (conjoined)
Gubernaculum vs Processus vaginalis
Gubernaculum
Band of fibrous tissue
Anchors testes within scrotum
Ovarian ligament + round ligament of uterus
Processus vaginalis
Evagination of peritoneum
Forms tunica vaginalis
Persistent patent processus vaginalis hydrocele
Describe the pathway by which deoxygenated blood travels from the SVC to the placenta. Don’t forget the shunt(s).
SVC → right atrium → right ventricle → pulmonary artery → ductus arteriosus (shunt) → descending aorta → internal iliac arteries → umbilical arteries → placenta
What germ layer gives rise to the spleen?
What germ layer gives rise to the spleen?
What internal and external genitalia will be seen in an XY male who lacks müllerian inhibitory factor (MIF)?
Both male and female internal genitalia with male external genitalia (streak gonads)
blood donors?
AB is universal DONOR of PLASMA
O is universal DONOR of RBCs - and a person w O blood is a universal recipient of plasma
right or left heart dominance
Heart dominance is described by which coronary artery branch gives off the posterior descending artery and supplies the inferior wall, and is characterized as left, right, or codominant. … It is at the apex where it meets the left anterior descending artery that is traveling along the anterior surface of the heart.
vagina more acidic when?
first two weeks of menstral cycle - when sperm come in - alkaline
babinski reflex
a reflex action in which the big toe remains extended or extends itself when the sole of the foot is stimulated, abnormal except in young infants.
means nerve problems
The myenteric plexus (or Auerbach’s plexus)
provides motor innervation to both layers of the muscular layer of the gut, having both parasympathetic and sympathetic input (although present ganglion cell bodies belong to parasympathetic innervation, fibers from sympathetic innervation also reach the plexus), whereas the submucous plexus has only parasympathetic fibers and provides secretomotor innervation to the mucosa nearest the lumen of the gut.
meissner
Myenteric and Submucosal Plexuses
1). The myenteric plexus, also known as Auerbach’s plexus, is located between the longitudinal and circular muscle layers of most of the digestive tract. The submucosal plexus, also known as Meissner’s plexus, is situated in the submucosal region between the circular muscle and mucosa.
Cystitis
is an inflammation of the bladder. Inflammation is where part of your body becomes irritated, red, or swollen. In most cases, the cause of cystitis is a urinary tract infection (UTI). A UTI happens when bacteria enter the bladder or urethra and begin to multiply.
foot muscles?
Lateral plantar has more investment of the intrinisc foot muscles
P wave
atrial contraction
QRS
ventricle contraction
PR (other PR)
this is a pause - right before Ventrical contraction to finish the filling
T
ventricles repolarizing
The superior ulnar collateral artery forms a collateral circuit with which of the following arteries?
The superior ulnar collateral artery anastomoses with the posterior ulnar recurrent artery from the ulnar artery that is posterior to the medial epicondyle.
The parietal peritoneum covering the inferior surface of the diaphragm transmits its sensory information via the phrenic nerve. In the case of peritonitis in the parietal peritoneum on the inferior surface of the diaphragm, pain may be referred through which of the following nerves?
A
Greater occipital
B
Lesser occipital
C
Superior division of the ansa cervicalis
D
Supraclavicular
The phrenic nerve consists of contributions from spinal nerve levels C3 to C5. Therefore, when sensory information comes from the parietal peritoneum on the inferior diaphragmatic surface, it may refer through spinal nerves at the same levels. Therefore, the supraclavicular nerve shares levels with the C3 and C4 levels. The greater and lesser occipital nerves both originate at the C2 level, and the superior division of the ansa cervicalis originates from the C1 level.
6-year-old boy is stung by a wasp between his shoulder blades. Identify the pain sensation pathway the axons would travel to course from the skin of his back to the spinal cord.
Dorsal ramus, dorsal root, dorsal horn
Which of the following structures serves as a common attachment for the external rotator muscles of the hip?
Five of the six external hip rotator muscles attach to some aspect of the greater trochanter of the femur. The quadratus femoris attaches near the greater trochanter on the intertrochanteric crest.
A surgeon dissects through subcutaneous fat in the neck and identifies lobulated, slightly paler glandular tissue that will be surgically removed. A vein coursing superficial to the gland and an artery coursing deep to the gland are isolated. The hypoglossal nerve is retracted to avoid risk of damage during the procedure. This surgery is most likely occurring in which of the following cervical triangles?
hypoglossal nerve (CN XII) courses within the submandibular triangle
The question outlines the course of the facial vessels in relation to the submandibular salivary gland (the vein is superficial and the artery is deep). The hypoglossal nerve (CN XII) courses within the submandibular triangle. Therefore, the relation of the facial vessels to the submandibular gland and identification of CN XII indicate the location of the surgery within the submandibular triangle.
A newborn infant is diagnosed with hydrocephalus, a condition where cerebrospinal fluid (CSF) builds up within the ventricular system of the brain. The skull bones have not yet fused because of the fontanelles; therefore, when the brain swells, the cranium swells as well. One cause of hydrocephalus would be a blockage of the flow of CSF within the ventricular system. Identify the most likely location of blockage that would result in this infant’s hydrocephalus.
A
Choroid plexus
B
Cerebral aqueduct
The cerebral aqueduct serves as the only drainage of CSF from the lateral and third ventricles. The choroid plexus continually filters plasma to create CSF, and therefore, a block in the aqueduct would result in CSF buildup in the lateral and third ventricles and result in hydrocephalus. A blockage in choroid plexus would result in a decrease in CSF production. A blockage in one of the apertures would not result in hydrocephalus because CSF could exit through another aperture. The central canal of the spinal cord would not result in hydrocephalus.
A surgeon is performing an endarterectomy on a 64-year-old man who has stenosis of the carotid artery. In approaching the internal carotid artery, the surgeon severs a nerve embedded within the fascia of the carotid sheath. As a result of this complication, which muscle would most likely be paralyzed?
A Digastric muscle (anterior belly)
B Digastric muscle (posterior belly)
C
Masseter muscle
D
Mylohyoid muscle
E
Sternohyoid muscle
F
Stylohyoid muscle
ansa cervicalis of the cervical plexus is embedded within the fascia of the carotid sheath and, as such, infrahyoid muscles would be affected if a nerve is severed within this fascia. The only infrahyoid muscle in the list of choices is the sternohyoid muscle. The anterior belly of the digastric muscle and mylohyoid muscle is innervated by the mandibular nerve (CN V-3); the stylohyoid and posterior belly of the digastric muscles are innervated by the facial nerve (CN VII). The masseter is a muscle of mastication and is innervated by CN V-3.
blue dye is placed into the right eye of a patient to assess the patency of the tear duct system. Assuming the lacrimal system is patent, at which structure would the physician see the eventual flow of the dye?
A
Inferior nasal meatus
B
Oral cavity
C
Pharynx
D
Sphenoethmoidal recess
E
Superior nasal meatus
he nasolacrimal duct drains into the nasal cavity, into the space inferior to the inferior nasal concha called the inferior nasal meatus.
Which of the following arteries supplies blood to the deep extensor muscles of the forearm?
A
Anterior interosseous artery
B
Posterior interosseous artery
C
Radial collateral artery
D
Radial recurrent artery
The posterior interosseous artery branches from the common interosseous artery, courses along the anterior surface of the interosseous membrane, and pierces the membrane to supply the deep extensor muscles.
38-year-old man is admitted to the emergency department after being involved in an automobile accident. He is unable to abduct or adduct his toes. If this patient has a deficit from a spinal cord lesion, which of the following spinal cord levels is most likely affected by this injury?
The intrinsic muscles of the feet are innervated by the lateral plantar nerves. The lateral plantar nerve primarily carries motor innervation from the S2–S3 spinal cord levels. L1–L2 would result in weak hip flexion. L3–L4 would result in weak knee extension. L5–S2 would result in weak hip extension and knee flexion, and S1–S2 would result in weak dorsiflexion and plantar flexion.
During thoracocentesis, the needle is pushed in the intercostal space superior to the rib to prevent damage to the intercostal nerve, artery, and vein. Beginning with the external intercostal muscles and ending with the pleural space, which thoracic wall layers, from superficial to deep, does the needle penetrate?
The layers of the lateral thoracic wall in the intercostal spaces that the needle would pass through during thoracocentesis are skin, superficial fascia, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, endothoracic fascia, parietal pleura, and pleural cavity.
Branches of the maxillary artery gain entrance to the pterygopalatine fossa via
Pterygomaxillary fissure
The maxillary artery branches off the external carotid artery and courses through the infratemporal fossa. The infratemporal fossa communicates with the pterygopalatine fossa via the pterygomaxillary fissure.
A 19-year-old man is admitted to the emergency department after being stabbed in the chest with a pocketknife with a 5-cm-long blade. The stab wound was in the left intercostal space just lateral to the sternal body. Which part of the heart is most likely injured?
The anterior surface of the heart is formed primarily by the right ventricle. Therefore, a stab wound such as the one that occurred in this patient would injure the right ventricle of the heart.
An indirect hernia
results from bowel protruding through the deep inguinal ring, and through the inguinal canal and into the scrotum via the superficial inguinal ring. Therefore, during the physical examination, the physician will attempt to feel for herniation by digitally palpating the superficial inguinal ring through the scrotal sac.
Radiographic imaging of the brain of an 84-year-old woman reveals a berry aneurysm in the anterior communicating cerebral artery. Rupture of this aneurysm would most likely result in what type of hemorrhage?
subarchnoid
When the corneal reflex in a patient is examined, sensory information is conducted from the cornea to the brain via the long ciliary nerve, a branch of CN V-1. The sensory input causes a motor response resulting in the closure of the patient’s eyelids. Which motor nerve is being tested when the corneal reflex is being examined?
The orbicularis oculi muscle, the muscle that closes and blinks the eye, is innervated by CN VII, the facial nerve.
Ebstein’s anomaly is a congenital heart defect where one or two of the tricuspid valve leaflets forms abnormally low because of misalignment. The heart becomes less efficient. What type of murmur would most likely be associated with this type of anomaly?
Systolic murmur with regurgitation
The function of the tricuspid valve is to ensure unidirectional flow of blood from the right atrium to the right ventricle. Therefore, when the right ventricle contracts (systole), blood flows into the pulmonary trunk and not back into the right atrium. If the tricuspid valve is malformed and does not function correctly (as in Ebstein’s anomaly), blood will regurgitate back into the right atrium during systolic contraction of the right ventricle.
spasms of the coracobrachialis muscle, which impinges the nerve that courses through it. Which movement is most likely affected by this muscle spasm?
elbow flexion
A 56-year-old man who is diagnosed with rectal cancer is undergoing biopsy of several lymph nodes. The nodes most likely to be sampled from this patient will be from the inferior mesenteric nodes, inguinal nodes, and the:
ymphatics in the abdomen generally follow their associated arteries. Clusters of lymph nodes, which are important in monitoring the immune system, are found along the course of the regional arteries. The rectum is supplied by the following:
Superior rectal artery—branch off the inferior mesenteric artery.
Middle rectal artery—branch off the internal iliac artery.
Inferior rectal artery—branch off the internal pudendal artery.
Therefore, if the rectal cancer spreads, it can potentially do so parallel to all three arterial origins. The lymph nodes for the superior and inferior rectal arteries are provided in the stem of the question. The only nodes not mentioned are the internal iliac nodes for the origin of the middle rectal artery.
A 46-year-old woman undergoes surgery to fuse (stabilize) the C4–C5 vertebrae due to a herniated disc that is compressing spinal nerves in the neck. The surgeon approaches the cervical vertebrae laterally between the sternocleidomastoid and trapezius muscles. After dissection through the skin and superficial fascia, which of the fascial layers of the neck, from superficial to deep, is the surgeon most likely to dissect through to reach the cervical vertebrae?
Investing to prevertebral
After surgery, a 62-year-old patient began experiencing complications. After examination, the physician determined that an important structure located immediately behind the ligamentum arteriosum was damaged during surgery. Which of the following symptoms was the patient most likely experiencing?
Hoarseness of voice
The left vagus nerve gives rise to the recurrent laryngeal nerve, located immediately behind the ligamentum arteriosum. The recurrent laryngeal nerve innervates laryngeal muscles that are associated with speaking. Therefore, if the recurrent laryngeal nerve is damaged, the patient will experience a raspy voice or hoarseness.
The ligamentum arteriosum (or arteriosus) is the small fibrous remnant of the fetal ductus arteriosum, located between and connecting the proximal left pulmonary artery and the undersurface of the junction of the aortic arch and descending aorta, at the aortic isthmus.
Compression of the median nerve in the carpal tunnel leads to weakness in the thenar muscles and the first and second lumbricals as well as cutaneous deficits in which of the following regions?
Palmer surface of digits 2 and 3
paralabral cyst arising from a detached inferior glenoid labrum tear compresses neurovascular structures coursing through the quadrangular space. If this condition were to become chronic, which of the following findings would most likely be revealed on an MRI?
A
Atrophy in the deltoid muscle
Atrophy in the deltoid muscle
The axillary nerve courses through the quadrangular space with the posterior humeral circumflex artery. Therefore, compression of the axillary nerve would weaken the deltoid muscle and thus weaken shoulder abduction.
Inflammation in Guyon’s canal will most likely result in weakness in which of the following movements?
Adduction of digits 2 to 5
The suprascapular and dorsal scapular arteries form a collateral circuit on the posterior side of the scapula with which of the following branches of the axillary artery?
The circumflex scapular artery courses through the triangular space to form a collateral circuit with the suprascapular and dorsal scapular arteries.
femoral triangle NAVeL
The contents of the femoral triangle are, from lateral to medial, the femoral nerve, femoral artery, femoral vein, and femoral lymph nodes. The acronym NAVL may be helpful in remembering the order where the first letter of each word represents the femoral nerve, artery, vein, and lymphatics.
Sweat glands within the S2 dermatome along the posterior region of the thigh most likely receive innervation via preganglionic sympathetic neurons originating from which of the following central nervous system levels?
L2 spinal cord level
Preganglionic sympathetic neurons originate between the T1 and L2 spinal cord levels. Dermatomes within the sacral region, such as the S2 dermatome described in this question, are supplied by sympathetics from the L2 spinal cord level, the lowest of all sympathetic innervation origin.
The biceps femoris muscle receives its name because it has two origins. One attachment is to the linea aspera of the femur. The other attachment is to the
The biceps femoris muscle is a part of the hamstring group. Each hamstring muscle originates on the ischial tuberosity, which includes the long head of the biceps femoris muscle.
Which of the following arteries courses through the proximal part of the interosseous membrane?
The anterior tibial artery branches from the popliteal artery, then courses through the proximal part of the interosseous membrane to enter the anterior compartment of the leg.
The interosseous membrane of the leg (middle tibiofibular ligament) extends between the interosseous crests of the tibia and fibula, helps stabilize the Tib-Fib relationship and separates the muscles on the front from those on the back of the leg.
A 44-year-old woman is suspected of having meningitis. To confirm the diagnosis, a lumbar puncture is ordered to collect a sample of the cerebrospinal fluid (CSF). Identify the last layer of tissue the needle will traverse in this procedure before reaching CSF.
Arachnoid mater
A lumbar puncture collects cerebrospinal fluid and, therefore, the needle has to enter the subarachnoid space, which is located between the arachnoid and pia mater. Therefore, the last layer of tissue the needle would traverse to enter the subarachnoid space is the arachnoid mater.
Which of the following muscles can flex, extend, and abduct the glenohumeral joint?
deltoid
The greater, lesser, and least splanchnic nerves are examples of which of the following nerves?
Thoracic splanchnic nerves
The greater, lesser, and least splanchnic nerves all arise from thoracic spinal nerves (T5–T9 form the greater splanchnic nerves; T10–T11 form the lesser splanchnic nerves; and T12 forms the least splanchnic nerves). The cervical sympathetic nerves course from the superior, middle, and inferior cervical ganglia and course to the pulmonary and aortic plexuses. The lumber and sacral splanchnics are located in the abdominal cavity and serve the abdominal viscera. The pelvic splanchnics originate from the S2–S4 ventral rami and transport preganglionic parasympathetic neurons.
During a subclavian venipuncture procedure, the cannula is inserted into the patient’s neck just superior to the clavicle. Which of the following is the relative position of the subclavian vein in the root of the neck?
Anterior to the anterior scalene muscle
The opening of the coronary sinus is located in which of the following structures?
A
Left atrium
B
Left ventricle
C
Right atrium
The coronary sinus collects venous blood from the coronary circulation and returns the blood to the right atrium. Therefore, the coronary sinus opens into the right atrium.
Which of the following structures most likely converts the greater sciatic notch to the greater sciatic foramen?
A
Obturator membrane
B
Obturator internus muscle
C
Piriformis muscle
D
Sacrospinous ligament
Sacrospinous ligament
Which of the following nerves courses between the brachialis and brachioradialis muscles?
radial
radiologist is conducting a contrast study of the pulmonary circulation on a 41-year-old man. What is the most likely number of veins observed entering the left atrium?
A
Two
B
Three
C
Four
There are two pairs of pulmonary veins (four veins) that enter the left atrium of the heart.
A 50-year-old man is diagnosed with flaccid paralysis limited to the right arm, without pain or paresthesias. No sensory deficits are noted. Laboratory studies reveal that the patient is infected with West Nile virus. The target that the virus has infected resulting in this patient’s symptoms is most likely the
A
Ventral horn of spinal cord gray matter
The patient has no sensory deficits and presents with only motor deficits. Therefore, the virus affects the ventral horn of the gray matter because that is the location of the motor neuron cell bodies.
Which of the following structures typically arises from the musculophrenic arteries?
The musculophrenic artery supplies the anterior intercostal arteries for intercostal spaces 7 to 9.
The phrenic nerve in the cervical region courses along the anterior surface of which of the following muscles?
A
Anterior scalene muscle
A 49-year-old woman presents with loss of sweet sensation on the right side of the anterior part of the tongue. Which additional findings may also be seen on the right side of this patient?
Loss of corneal reflex
The maxillary artery gains entrance to the pterygopalatine fossa and eventually the nasal cavity and infraorbital canal via which of the following structures?
Pterygomaxillary fissure
20-year-old woman stepped on a nail and it penetrated the plantar surface of her bare foot, injuring the lateral plantar nerve. Which of the following muscles would most likely be rendered nonfunctional?
Dorsal interossei muscles
The dorsal interossei are muscles innervated by the lateral plantar nerve. The other muscles listed as choices (i.e., first lumbrical, abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis muscles) are all innervated by the medial plantar nerve.
55-year-old man who has been diagnosed with colon cancer is noted to have a probable metastatic mass in the neck at the thoracic duct. In which region is the metastasis most likely to be located?
Left supraclavicular region
The thoracic duct collects lymph from all regions of the body (including the colon), except for the right side of the head, neck, and right upper limb. Therefore, if a mass is present, it could manifest in the root of the neck where the thoracic duct enters the junction of the left internal jugular and subclavian veins in the supraclavicular region.
Which of the following muscles flexes the glenohumeral and elbow joints and supinates the radioulnar joints?
Biceps brachii muscle
A 42-year-old man is admitted to the emergency department in shock and requires a saphenous cut down to receive an infusion. To isolate the great saphenous vein in the ankle region, you would most likely determine its location in which of the following areas?
Anterior to the medial malleolus
The great saphenous vein is formed from the dorsal venous arch on the dorsum of the foot. The great saphenous vein then courses anterior to the medial malleolus of the tibia, up the medial aspect of the leg.
he azygos vein is located in which division of the mediastinum?
posterior mediastinum.
he azygos system of veins, along with the thoracic duct, thoracic aorta, esophagus, vagus nerves, sympathetic trunk, and the greater and least splanchnic nerves are located within the posterior mediastinum.
In a healthy person, blood from the pulmonary trunk will flow next into which of the following structures?
Pulmonary arteries
Deoxygenated blood from the right ventricle is pumped into the pulmonary trunk, which bifurcates into the right and left pulmonary arteries before coursing to the lungs.
The suprascapular and dorsal scapular arteries form a collateral circuit on the posterior side of the scapula with which of the following branches of the axillary artery?
Circumflex scapular artery
The upper subscapular, lower subscapular, and thoracodorsal nerves branch from which cord of the brachial plexus?
Posterior cord
The upper subscapular, lower subscapular, and thoracodorsal nerves branch off of the posterior cord in the axilla, just anterior to the subscapularis muscle.
Which of the following nerves perceived pain in the area around the umbilicus and most likely carried the pain sensations to the central nervous system?
lesser splanchnic
The T10 dermatome is associated with the umbilical region. Sensory neurons course from the umbilical skin to the T10 spinal cord level. Visceral sensory neurons course from the appendix to the T10 spinal cord level as well as via the lesser splanchnic nerves. Therefore, the referred pain comes from the lesser splanchnic nerve
The ischiopubic or conjoint ramus is formed when the ischial ramus joins which of the following structures?
Inferior pubic ramus
During surgery of a 60-year-old man, the anterior rectus muscle sheath between the xiphoid process and the umbilicus is incised. In this region, the rectus sheath is derived from which of the following muscles?
he rectus sheath superior to the arcuate line is composed of the aponeuroses from both the external and internal oblique muscles.
For general surgical procedures, anesthetics and muscle relaxants are used routinely. However, anesthetics and muscle relaxants may decrease nerve stimulation to skeletal muscles, including the intrinsic muscles of the larynx, which results in closure of the vocal folds. Therefore, tracheal intubation is necessary. Which of the following intrinsic muscles of the larynx may be unable to maintain an open glottis because of the anesthetics?
Posterior cricoarytenoid muscles
The posterior cricoarytenoid is the only muscle in the list of choices, which, when stimulated to contract, will open the vocal folds and therefore open the glottis. The other muscles (i.e., cricothyroid, lateral cricoarytenoid, thyroarytenoid, and the transverse arytenoids) will either tense or close the vocal folds.
A 5-year-old boy is brought to the pediatrician with a complaint of severe pain, swelling, and redness around his right eye. He is diagnosed with periorbital cellulitis. The pediatrician tells the boy’s parents that there is a possibility that the infection could spread to the boy’s brain. The most probable route of spread to the brain would be through which of the following structures?
he facial vein drains blood from the orbital region down to the internal jugular vein. However, blood from the orbit also spreads from the orbit via the superior ophthalmic vein through the superior orbital fissure to the cavernous sinus within the skull.
The posterior compartment of the thigh primarily receives its blood supply from branches of which of the following arteries?
Deep femoral artery
The deep femoral artery gives rise to perforating arteries, which pierce through openings in the adductor magnus muscle insertion and provide the primary vascular supply to the posterior thigh compartment. The inferior gluteal artery provides some vascular supply but not as much as the deep femoral artery.
A 34-year-old man is diagnosed with a left internal iliac artery aneurism. As a result, he presents with a left superior gluteal nerve lesion and an accompanying gait disorder. While walking, this patient would most likely compensate by flexing his trunk to the
Left, to lift his right lower limb so that his right foot can be lifted off the ground
A 52-year-old man undergoes surgery to biopsy iliac lymph nodes. The physician tells the patient that it is important to identify the peripheral spinal nerves to protect them from being damaged during the surgery. The most likely location to find the genitofemoral nerve is coursing along which of the following surfaces?
A
Anterior surface of the psoas major muscle
When performing gastric bypass surgery on a 36-year-old woman, the surgeon identifies the hepatogastric and hepatoduodenal ligaments. Together, both ligaments create which of the following structures?
lesser omentum
The hepatogastric and hepatoduodenal ligaments are the two components of the lesser omentum. They are named for their attachments to the liver, stomach, and duodenum.
trochlear nerve injury During the examination, the patient was most likely unable to accomplish which of the following movements?
Adduction and depression
This patient is complaining of double vision, or diplopia. The superior oblique muscle is innervated by the trochlear nerve (CN IV). To clinically test the superior oblique muscle, the patient adducts his eye and then looks inferiorly. Therefore, Choice E (adduction and depression) is the correct answer. Choice B (abduction and depression) is the position for the anatomic action of the superior oblique muscle; however, outward and downward is the location for clinically testing the inferior rectus muscle.
During a physical examination, a 24-year-old woman is instructed to lie supine on the examination table. During the procedure, she is instructed to resist allowing the health care provider to pull her feet downward into plantarflexion. The patient presents with right-sided weakness in this task. Which of the following nerves is most likely responsible for this muscle weakness in this patient?
Deep fibular (peroneal) nerve
When the feet are pulled downward, the dorsiflexion muscles in the anterior compartment of the leg are being tested. If the patient exhibits weakness in this task, the most likely explanation then is lack of innervation from the deep fibular (peroneal) nerve.
While eating popcorn, a child inhaled a kernel into her laryngeal cavity. The popcorn kernel touched the top of her vocal folds, initiating her cough reflex. Which sensory nerve is responsible for relaying the message to the brain that a popcorn kernel has touched the top of the vocal folds?
Internal laryngeal nerve
The internal laryngeal nerve is the branch of the vagus nerve (CN X) that provides general sensory innervation to the laryngopharynx and mucosal lining superior to the vocal folds. As such, when a stimulus touches the superior element of the vocal folds, the sensory stimulation is conducted along the internal laryngeal nerve to the brainstem, initiating the cough reflex. The external laryngeal nerve innervates the cricothyroideus muscle. The facial nerve (CN VII) innervates muscles of facial expression. The glossopharyngeal nerve (CN IX) provides sensory innervation for the oropharynx and the posterior third of the tongue. The recurrent laryngeal nerve provides visceral sensory innervation for the mucosal lining inferior to the vocal folds.
To Zanzibar by Motor Car
facial nerve branches
temporal zygomatic bucal marginal mandibular cervica
in cranium - there are two types of ganglia - sensory (afferant) and autonomic - the sensory are -
sensory are most often affected by shingles
no sypapses
psuedunipolar
trigeminal geniculate VII vestibular and spiral VIII superior and inferior glossophyngeal IX superior and inferior vaga X
autonomic ganglia in cranium
herpes zoster doesn’t like autonomic
otic - postganglionic para to parotid - near v3 from IX lesser petrosal nerve
ciliary - orbit III
submandibular - VII - for submandibular and sublingual glands
lack of emotional tearing VII -vs tear reflex (v)
greater petrossal nerve of VII
The trigeminal V1 (fifth cranial) nerve bears the sensory pathway of the tear reflexes. When the trigeminal nerve is cut, tears from reflexes will stop, while emotional tears will not. The great (superficial) petrosal nerve from cranial nerve VII provides autonomic innervation to the lacrimal gland.
horner’s syndrome?
superior cervical ganglion- eyelid droop, eye constricted, flushing of face, slit in eye
can’t swallow?
v3 - mylohyoid and anterior belly of digastric
dilation in one eye
III
if shine light in one eye - and it doesn’t constrict but the other does? shows which eye isn’t working - because both should constrict at the same time - even though light is only going to one -
reflex - afferant - II, efferent III
cutaneous facial nerve distribution re herpes - where find it?
auricle of external ear
superior cervical ganglion
the fight or flight sympathetic ganglion in head - located at based of skull around c2 control vasomotion, pilomotin and sudomotion
VI travels with internal carotid in cavernous sinus -
so if carotid has plaque, etc, may affect VI
even though a variety of structures in the cavernous sinus
loud sounds?
could be VII - stapedius loud low sounds - vs VIII
