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SSC script > Dissection SSC > Flashcards

Dissection SSC Flashcards

1
Q

The muscles in the chest wall and there nerve innervation

A

Pec Major - medial and lateral pectoral nerves C5-T1

  • Lateral pectoral nerve innervates the clavicular head (C5 and C6).
  • Medial pectoral nerve innervates the sternal head (C7, C8 and T1).

pec minor - pectoral nerves C5-T1 (specifcially medial pectoral nerves C8-T1- innervates both as it passess through pec minor)

Serratus anterior - Long thoracic nerve C5-C7

External intercostal muscles - - Intercostal nerves T2-T11

rectus abdominis - Intercostal and subcostal nerves T7-T12

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2
Q

Lung anatomy

A

on the right

  • superior
  • middle
  • inferior
  • horizontal and oblique between

on the left

  • superior and inferior
  • oblique between

anterior

  • on the right superior and middle
  • on the left superior and inferior
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3
Q

structures in the hilum

A
  • pulmonary artery
  • pulmonary vein
  • bronchus
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4
Q

What are the two heads of pec major

A
  • clavicular and sternal head
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5
Q

describe the brachial plexus

A
  • roots are C5 C6 C7 C8 T1
  • trunks are superior, middle, inferior
  • cords are lateral, posterior and medial
  • lateral and medial pectoral nerves come of the lateral and medial cord
  • then the branches are
  • musculotaneous -C5, C6, C7.
  • axillary - C5 and C6.
  • medial - C6 – T1
  • radial - C5-T1
  • ulnar - C8 -T1
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6
Q

when does the subclavian become the axillary vein

A

subclavain continues from the axillary vein and becomes the axillary vein at the outer border of the 1st rib

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7
Q

name the true and false floating ribs

A

1-7 true
8-10 false
11 and 12 floatig

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8
Q

what is the relation of the phrenic nerve and the brachial plexus to the anterior scalene muscle

A

the phrenic nerve is on the anterior surface

brachial plexus is behind it

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9
Q

where is the suprasternal notch found

A

T2

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10
Q

where is the angle between the xiphoid process and sternum

A

T9

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11
Q

where is the angle of louis

A

T4

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12
Q

what innervates the SCM

A

CN XI - spinal accessory nerve

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13
Q

where is the subclavius

A

• Subclavius (between 1st rib and clavicle) = Subclavian nerve.

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14
Q

describe how the branches of the vessels change name in the arm

A
  • The subclavian vessels become known as the axillary vessels after passing over the 1st rib.
  • The axillary artery and vein passes under pectoralis minor, but before this the thoracoacromial branch is given off.
  • After passing over teres major, the axillary vessels become known as the brachial vessels.
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15
Q

where does the internal thoracic artery branch from

A

• The internal thoracic artery branches from the subclavian arteries

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16
Q

what does the intenral throacic artery supply

A

• The internal thoracic artery is also known as the mammary artery, as it supplies the breasts in addition to the anterior chest wall.

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17
Q

what epigastric artery does the internal thoracic artery become

A
  • The internal thoracic arteries form the superior epigastric artery.
  • The internal thoracic vein arises from the superior epigastric vein.
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18
Q

where does the internal thoracic artery drain

A

brachiocephalic veins

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19
Q

what are the 1st choice for coronary artery bypass grafts

A
  • internal thoracic arteries
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20
Q

where does most of the bodies lymphatic drain into and what does it contain

A
  • Most of the body’s lymphatics drain into the thoracic duct.
  • The thoracic duct is about 40cm long, and contains chyle.
  • Chyle is a mixture of emulsified fats and lymph fluid.
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21
Q

where is the cistera chyli found

A

• The cisterna chyli is a dilated sac found at L1/2, forming the beginning of the thoracic duct.

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22
Q

what is the clinical signfiicance of the throacic duct

A

• The clinical significance of the thoracic duct is the presence of Virchow’s node, a lymph node in the left supraclavicular space indicating the first sign of malignancy

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23
Q

where is the other part of the bodies lymph drainage

A
  • The only regions NOT drained by the thoracic duct are the right side of the head/neck and the right arm.
  • These regions are drained by the right lymphatic duct.
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24
Q

what does the thoracic duct cross

A

• The thoracic duct cross the azygos and hemiazygos veins anteriorly.

25
Q

what is the safe zone

A
  • The anatomical safe zone is a region on the lateral chest wall, that is deemed safe to enter tubing into the thoracic cage for drainage.
  • It is found in the 5th intercostal space between T4 and T5.
26
Q

what are the borders of the safe zone

A
  • Anterior = Lateral pectoralis major.
  • Posterior = Anterior boarder of latissimus dorsi.
  • Superior = Apex below the axilla.
  • Inferior = Horizontal line corresponding to the height of the nipples.
27
Q

what are the external intercostal muscles used as

A
  • Used for forced and quiet inhalation.

- Fibres run downwards and forwards (as if putting hands in pockets).

28
Q

what are the internal intercostal muscles used as

A
  • Used for forced exhalation (as quiet expiration is passive).
  • Fibres run downwards and backwards.
29
Q

where is the neurovascular bundle in terms of intercostal muscels

A

• The neurovascular bundle is between the internal and innermost layers.

30
Q

what are the roots of the intercostal nerves

A

T1-T11

31
Q

WHERE DOES THE AZYGOUS VEIN RUN

A
  • A vein running up the vertebral column on the right side between the SVC and IVC.
  • It drains into the superior vena cava.
32
Q

Where does the hemiazygous run and where does it cross into the azygous

A
  • The hemiazygos veins run in the left side and drains into the azygous vein.
  • The hemiazygos and accessory hemiazygos cross to the azygos at T8 and T9.
33
Q

describe the pathway of the phrenic nerve

A
  • The phrenic nerve descends with the internal jugular vein.
  • It descends and passes over the anterior scalene muscle.
  • The left phrenic passes over the subclavian artery, but under the subclavian vein.
  • But the right phrenic nerve passes over the brachiocephalic artery, and under the brachiocephalic vein.
  • The right phrenic then passes anterior to the lung root and over the RA, piercing the diaphragm.
  • The left phrenic nerve passes over the pericardium and inserts into the diaphragm.
34
Q

what is the difference between the position of the phrenic and vagus nerve

A

• The phrenic nerves are more lateral and anterior than the vagus nerves.

35
Q

describe the pathway of the vagus nerve

A
  • The vagus nerves leave the skull via the jugular foramen.
  • Both travel between the internal carotid artery and internal jugular vein while passing through the carotid sheath.
  • The right vagus nerve passes over the right subclavian artery, but posterior to the superior vena cava.
  • It passes posterior to the right main bronchus before it innervates the organs.
  • The left vagus nerve enters the thorax between the left common carotid artery and left subclavian artery.
  • It passes over the aortic arch and posterior to the left main bronchus.
  • Both vagus nerves enter the abdomen through the oesophageal hiatus.
36
Q

describe the nerve supply of the viseral and parietal pleura

A

• The visceral pleura (autonomic nerves), covers the lung, while the parietal pleura (somatic nerves) covers the inner thoracic wall.

37
Q

what happens if fluid enters the pleural cavity

A

have a pneumothorax

38
Q

how many bronchopulmonary segements are there

A

• There are 10 bronchopulmonary segments on the right lung, and 8-9 on the left lung

39
Q

what are the bronchopulmonary segemnets

A

• A bronchopulmonary segment is a portion of the lung supplied by the same bronchus and arteries.

40
Q

describe the thymus

A
  • A primary lymphoid organ of the immune system, where T cells mature.
  • It is found in the anterior mediastinum, anterior to the heart but posterior to the sternum.
  • The thymus begins to atrophy by the early teens.
41
Q

how many pulmonary veins carry blood back to the left atrium in the heart

A

4

42
Q

describe the pericardium

A
  • The outer fibrous pericardium is made of dense CT that helps protect the heart.
  • The serous pericardium is divided into visceral and parietal layers.
  • In between these 2 layers is the pericardial cavity, filled with pericardial fluid.
43
Q

what is the pericardium innervated by

A

• The pericardium is innervated by the phrenic nerves, with the right passing lateral to it while the left passes over it.

44
Q

what is cardiac tamponade

A
  • Fluid may collect within the pericardial cavity in pericardial effusion.
  • This can result in cardiac tamponade; compression of the heart within the pericardial sac.
  • Because the pericardium has a fibrous outer layer, it prevents expansion when the fluid collects.
  • This means that the pressure inside the sac is increased, and so the heart is compressed
45
Q

what can cardiac tamponade result in

A

• Cardiac tamponade may result in cardiogenic shock (inadequate circulation of blood), presenting as shortness of breath, light-headedness and a cough.

46
Q

How do you treat cardiac tamponade

A

• Cardiac tamponade is treated by draining the fluid from the sac; pericardiocentesis.

47
Q

what is the transverse pericardial sinus

A

• The transverse pericardial sinus is found anterior to the SVC, and posterior to the ascending aorta and pulmonary trunk.

48
Q

what are the 5 main veings that drain into the coronary sinus

A
  • Great cardiac vein (anterior ventricular sulcus).
  • Middle cardiac vein (posterior ventricular sulcus).
  • Small cardiac vein (right atrioventricular sinus).
  • Posterior vein of the LV.
  • Oblique vein of the LA.
49
Q

what is the coronary sinus

A
  • The coronary sinus is a collection of veins that join together to collect blood from the heart muscle (myocardium).
  • It delivers deoxygenated blood to the RA, at the coronary sinus orifice.
50
Q

where is the coronary sinus found

A

RA, at the coronary sinus orifice.

• The orifice is found between the inferior vena cava and the tricuspid valve

51
Q

describe the chest leads on an ECG and what part of the heart they look at

A
  • V1 and V2 = Septal heart.
  • V3 and V4 = Anterior heart.
  • V5 and V6 = Lateral heart.
52
Q

what is the symapthetic trunk

A

• The sympathetic trunk is a collection of nerve fibres that runs from ribs 2-9.

53
Q

what is the differnece between preganglia and paraganglia fibres

A

• It transmits preganglionic fibres of the sympathetic NS to ascend to spinal levels >T1, and also spinal levels

54
Q

what is ramus used for

A

• Ramus communications are used to connect spinal nerves to the sympathetic trunk ganglia.

55
Q

what is the difference between white and grey ramus

A
  • White rami communicans transport preganglionic fibres to the sympathetic trunk from T12 – L2, they appear white as they are more myelinated than grey rami.
  • Grey ramus communicans transport postganglionic sympathetic fibres from the sympathetic trunk, they appear grey as they are less than myelinated.
  • The white rami are found more lateral than the grey rami.
56
Q

name the splanchnic nerves and there nerve levels

A

• Greater splanchnic nerve:

  • T5-T9.
  • Synapses in the coeliac ganglion and innervates the foregut.

• Lesser splanchnic nerve:

  • T9-T11.
  • Synapses in the SMA ganglion and innervates the midgut.

• Least splanchnic nerve:

  • T12.
  • Synapses in the IMA ganglion and innervates the hindgut.
57
Q

what are the right and left crura

A

• The left and right crura are tendons that blend with the anterior longitudinal ligament of the vertebral column.

58
Q

describe each of the hiatus of the diaphrgam

A
  • The IVC passes through the caval opening at T8.
  • The oesophagus passes through the diaphragm at T10 with the vagus nerve.
  • The abdominal aorta passes through the diaphragm a T12, but rather than piercing through it blends between the 2 crura.

SSC script (4 decks)

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