Clinical Anatomy Flashcards
What is used as a reference point for accurately identifying rib number or intercostal space and where is it located
Sternal angle (2nd costal cartilage)
Where do crushing injuries tend to break ribs
At the angle
Where will Direct injuries to the rib fracture them
can be anywhere
Which ribs are most commonly fractured and why?
Middle ribs because of exposed position
When might you experience pain with a fractured rib
during respiration coughing or sneezing especially
Where is the needle placed in a thoracentesis or local anesthesia to intercostal space and why?
over superior border of the rib (to avoid damage to vein artery and nerve in costal groove on inferior border)
What will provide collateral circulation in the event of coarctation (narrowing) of the descending aorta
anastomoses between anterior and posterior intercostal arteries
Why are penetrating/nonpenetrating wounds of the superior mediastinum dangerous and when are they common
Because of the number of large vessels there (high speed decelerating injuries)
If a massive knife wound penetrated the back and posterior mediastinum what might be injured? Thoracic duct Arch of aorta Inferior vena cava Left atrium of heart Trachea
Thoracic duct
What aspect of the lung is at risk with wounds to the neck and what does it lie behind?
apical extremity behind sternocleidomastoid
What is a pneumothorax and what does it disrupt or change
Air into the pleural cavity
neutralizes the normally negative intrapleural pressure to atmospheric pressure
What is Pericardiocentesis
Drainage of fluid from the pericardial sac to relieve pressure from around the heart
If you had an accumulation of fluid in the pericardial sac exerting pressure on the heart what might it do?
restrict venous returen (cardiac tamponade
Where would you insert the needle for a pericardiocentesis and why?
5th or 6th intercostal space close to sternum
it is the location of the cardiac notch so you wont hit lung
What initiates the electrical impulse that drives the cardiac cycle
SA node
What can modulate the SA node
parasympathetic and sympathetic input from cardiac plexus
What was the embryonic structure and role of the fossa ovalis
foramen ovalis that shunted blood from right to left
IF the foramen ovalis does not close what is it called
atrial septal defect
If an atrial septal defect is large enough what can occur in the heart
movement of blood from left to right atrium and onto right ventricle, causing increased load and RIGHT SIDE ENLARGEMENT
What is Right dominant heart and what is a left dominant heart
Right coronary artery has the posterior descending and supplies left ventricle and interventricular septum along with right
left coronary artery has the posterior descending and supplies right ventricle and interventricular septum along with left
Which is more common Right or left dominant heart
Right dominant 50%
Left dominant 20%
What section of the right ventricle is smooth
Conus arterious region
Where do parietal and visceral plerua meet
root of lung
How do you get visceral pain in thoracic and abdominal cavity
signal travels back reverse of the pathway that brought sympathetic supply to the organ (returns to same segment supplying preganglionic sympathetic for the organ)
Where is heart pain referred to
1st to 5th intercostal spaces and medial aspect of upper limb
Where is gall bladder pain referred to
7th to 9th intercostal spaces
Where is appendix pain referred to
Umbilical region (T10-T11 level)
What controls peristalsis of the gastrointestinal tract
parasympathetic fibers
What stimulates acid secretion by parietal cells in the stomach
vagal parasympathetic fibers
What may be done to reduce excess acid formation with peptic ulcers
transection of vagal trunks
What is the major fiber component of the greater splanchnic nerve Pregang sym postgang sym pregang para postgang para brachiomotor
Pregang sym (sensory fibers also travel in the greater splanchnic nerve)
Transection of the vagus in the upper thoraax would least affect which of the following organs esophagus heart stomach gall bladder kidney
Heart
Parasympathetic cardiac fibers from vagus arise in the cervical region and travel toward the cardiac plexus independent of vagus proper
What is the most likely location of referred pain from the appendix Right shoulder Umbilical region inferior border of scapula anterior neck inguinal region
Umbilical region
What would rupture of the male urethra lead to and why is this so
accumulation of urine between layers in the abdominal wall
due to continuity of superficial membranous fascia with superficial fascia of the perineum
What would the cremaster reflex test the integrity of
genitofemoral and ilioinguinal nerves
Is the cremaster reflex more active in younger or older males
Younger
What is a hydrocele
Accumulation of fluid in the tunica vaginalis or patent processus vaginalis
What is a varicocele
pampinifiorm plexus of veins is dilated and tortuous
What is cut/ligated in a vasectomy
ductus deferens bilaterally
where is the incision made in a vassectomy
superior wall of the scrotum
What is the name for protrusion of the abdominal visceral through either inguinal ring
inguinal hernia
A hernia that follows the normal rout of the testis before birth is what
indirect inguinal hernia
A hernia that protuedes directly through the abdominal wall in the ingunal triangle and through the superficial ring is what
Direct inginal hernia
Where would an indirect hernia occur relative to the inferior epigastric vessels
Lateral
Where would an direct hernia occur relative to the inferior epigastric vessels
Medial
Which type of inguinal hernia is more common in adult males
direct
Which type of inguinal hernia is more common in young males
indirect
Why are inguinal hernias more common in males than females and which ones are rarest in females
Because they have fewer and smaller structures passing through abdominal wall
Direct inguinal hernias are more rare
What forms the anterior wall of the rectus sheath at the umbilicus
- superficial membranous fascia and external oblique aponeurosis
- External oblique and internal oblique aponeurosis
- Internal oblique and transversus abdominus aponeuroses
- transversus abdominis aponeurosis and transversalis fascia
- transversalis fascia and peritoneum
External oblique and internal oblique aponeurosis
The cremaster muscle is derived from which of these exeternal oblique internal oblique superficial membranous fascia tranversus abdominis transversalis fascia
internal oblique
external oblique: external spermatic fascia
Transversalis fascia: internal spermatic fascia
Superfical membranous fascia: dartos and fascia of scrotum
What is a hiatal hernia
protrusion of part of the stomach through the esophageal haitus of the diaphragm
What can cause a hiatal hernia
Weakening of musculature around haitus in midle aged individuals
In a common hiatal hernia what specifically slides through the hiatus and when
cardia and parts of fundus of stomach
especially when idividual lies down or bends over
What is appendicitis and what causes it
acute inflammation of appendix
from obstruction of the lumen of the organ
What is the is the pain progression of appendicitis
dull pain in paraumbilical region to serious pain in posterior abdominal wall due to irritation of the sensitive parietal peritoneum
What may result from a ruptured appendix
Peritonitis (infection of the peritoneum)
What are the two common locations for gallstones to lodge
distal end of hepatopancreatic ampula (ampula of Vater)
junction of gallbladder neck and cystic duct
What could result from blockage of the hepatopancreatic ampulla (from a gallstone)
Pancreatitis
What are 2 things that could cause pancreatitis
blockage of the hepatopancreatic ampulla (from a gallstone)
blockage of pancreatic duct (from swelling of pancreatic head)
If you obstruct the ampulla of vater (hepatopancreatic) what can happen
Reflux of bile into pancreatic duct
If you fracture the lower ribs on the left side what may result
rupture of the spleen
What are 2 ways to rupture the spleen
fracture of lower ribs on left
blunt trauma causing sudden increase in intraabdominal pressure
What is the benefit of the greater omentum when one organ is inflamed
it is higly mobile and can wrap itself around and inflamed organ thereby protecting other viscera from infection
what specific part of the intestine would receive a gallstone that passed through the common bile duct 1st part of the jejunum ascending (4th) part of duodenum horizontal (3rd) part of duodenum descending (2nd) part of duodenum superior (1st) part of duodenum
Descending (2nd) part of duodenum
The posterior boundary of the omental (epiploic) foramen is formed by what duodenum inferior vena cava lesser omentum stomach transverse colon
Inferior vena cava
Anteriorly: hepatoduodenal ligament
Superiorly: caudate lobe of liver
Inferiorly: 1st part of duodenum
In resection of parts of the gastrointestinal tract why must the vessels in peritoneal structrures be identified?
to retain blood supply to the portions not removed
if the superior mesenteric artery is occluded slowly over many months what happens to the involved bowl
it is nourished by blood of the inferior mesenteric artery by way of marginal artery
What is the major pathway for a venous emoli from the lower extremity, pelvis and perineum and where would it go
Inferior vena cava
to right heart and the lungs
What is Nutcraker syndrome also called and what is it commonly caused by
renal vein entrapment syndromee
compression of left renal vein between superior mesenteric artery and the abdominal aorta
What are symptoms of nutcracker syndrome
Blood in urie and abdominal left flank pain
What would the clinical manifestations of portal hypertesion include
Varicosities of rectal veins (hemorrhoids)
Esophageal varices
varicosities of cutaneous veins around the umbilicus (caput medusae)
What clinical manifestation of portal hypertension is often most severe and possibly fatal
bleeding from esophageal varices
Occlusion of the ileocolic artery could result in ischemia of which of the following organs descending colon pacnreas transverse colon rectum appendix
appendix
ileocolic supplies appendix ileum and seum
pancreas: grecieves from branches of celiac and proximal superior mesenteric
transverse colon: middle colic from SMA
Colon/rectom: branches from IMA
Which of the following is a tributary of the hepatic portal venous system common iliac vein suprarenal vein superior rectal vein renal vein inferior phrenic vein
superior rectal vein
crosses over the common iliac vessels to become the inferior mesenteric vein
all others drain into inferior vena cava
