Dissector Info

Question 1

Where is the apex of the heart located?

Answer 1

left 5th intercostal space near the mid-clavicular line

Question 2

Where is the coronary sulcus located on the heart?

Answer 2

in between the right atrium and ventricle

Question 3

What does the right coronary artery arise from?

Answer 3

right aortic sinus (which comes from the ascending aorta)

Question 4

How is the pulmonary artery related to the bronchi in the hilum of the LEFT lung?

Answer 4

it is located superior to the bronchus

Question 5

How is the pulmonary artery related to the bronchi in the hilum of the RIGHT lung?

Answer 5

it is located ventral to the bronchus

Question 6

Where does the esophagus cross over the descending aorta anteriorly?

Answer 6

level of the 8th vertebra

Question 7

Where does the esophagus enter into the diaphragm?

Answer 7

level of the 10th vetrebra

Question 8

What ribs form the costal margin of the diaphragm?

Answer 8

7-10

Question 9

Where is the transpyloric plane located?

Answer 9

It is said to lie roughly a hand’s breadth beneath the xiphoid process of the human sternum.

The plane in most cases cuts through the pylorus of the stomach, the tips of the 9th costal cartilages and at the level of the intervertebral disc between L1 and L2

Question 10

motor and sensory supply to the abdominal wall is provided by what nerves (4 sets)?

Answer 10

7th-11th intercostal nerves, subcostal nerves, iliohypogastric, and iliolinguinal nerves

Question 11

Describe the distribution of the superficial nerves in the abdomen wall.

Answer 11

7th intercostal- level of xiphoid process

10th intercostal- level of umbilical

iliohypogastric- suprapubic

iliolinguinal- exits the superficial ring to enter the scrotum

Question 12

Do the inferior fibers of the internal oblique abdominis and the transverses abdominis contribute to the rectus sheath?

Answer 12

No. they insert on the pubic crest

Question 13

Are inguinal hernias more common in males or females? Why?

Answer 13

males, because the canal and the associated structures are larger and weak following descent of the testis

Question 14

What occupies the inguinal canal in men and women?

Answer 14

men- spermatic cord

women- round ligament

Question 15

What nerve exits the inguinal canal?

Answer 15

iliolinguinal

Question 16

Does the iliolinguinal nerve exit the superficial ring of the inguinal canal in men and women?

Answer 16

Yes. LATERAL to the spermatic cord/round ligament

Question 17

What does the iliolinguinal nerve continue as in men and women?

Answer 17

men- anterior scrotal

women- labial nerve

Question 18

What is the spermatic cord covered by as it exits the inguinal canal?

Answer 18

external spermatic fascia derived from the external abdominal oblique

Question 19

The sides of the superficial ring of the inguinal canal are designated what?

Answer 19

lateral and medial crura

Question 20

What is the inguinal ligament formed by?

Answer 20

fibers of the external abdominal oblique aponeurosis ONLY.

Question 21

At the pubic tubercle, what does the inguinal ligament become?

Answer 21

lacunar ligament

Question 22

What is the floor of the inguinal canal formed primarily by?

Answer 22

inguinal ligament (with some lacunae ligament)

Question 23

What is the deep inguinal ring formed by?

Answer 23

reflection of the transversals fascia

Question 24

What artery and vein would you see just medial to the deep inguinal ring?

Answer 24

inferior epigastric artery and vein

Question 25

What is the roof of the inguinal canal formed by?

Answer 25

combined arching fibers of the internal abdominal oblique and the transverses abdominis muscles (these insert on the medial aspect of the pubic crest as the FALX INGUINALIS)

Question 26

What forms the internal spermatic fascia of the spermatic cord

Answer 26

reflection of the transversalis fascia at the deep ring

Question 27

What are the cremaster muscle and its fascia derived from?

Answer 27

the roof fibers of the internal abdominal oblique in the inguinal canal

NOTE: the cremaster fascia forms the middle fascia of the spermatic cord)

Question 28

Where does the posterior wall of the inguinal canal extend from?

Answer 28

deep inguinal ring laterally to the falx inguinalis medially (at the medial aspect of the pubic crest)

Question 29

What supports/strengthens the posterior wall of the inguinal canal?

Answer 29

medially- falx inguinalis (very strong)

laterally- inferior epigastric vessels

Question 30

Where is the weak area of the posterior wall of the inguinal canal?

Answer 30

between the inferior epigastric vessels (laterally) and the falx inguinalis (medially)– this is what direct hernias would occur

Question 31

Do direct hernias occur medial or lateral to the inferior epigastric vessels?

Answer 31

medial (indirect occur lateral)

Question 32

What is the internal spermatic fascia formed by?

Answer 32

trasversali fascia at deep ring

Question 33

What is the cremaster muscle and fascia formed by?

Answer 33

internal abdominal oblique aponeurosis in the canal

Question 34

What is the external spermatic fascia formed by?

Answer 34

external abdominal oblique aponeurosis in the canal

Question 35

What innervates the cremaster muscle?

Answer 35

genitofemoral nerve

Question 36

Are the phrenic nerves medial or lateral to the vagus nerves?

Answer 36

lateral

Question 37

What rib attaches to the sternal angle?

Answer 37

2nd

Question 38

When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:

Answer 38

above the margin of a rib. VAN triad runs directly BELOW each rib

Question 39

A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?

Answer 39

Costodiaphragmatic recess

Question 40

During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?

Answer 40

The transverse pericardial sinus is an area of the pericardial cavity located behind the aorta and pulmonary trunk and anterior to the superior vena cava. So, the two large vessels lying ventral to his finger are the pulmonary trunk and aorta; the large vessel lying dorsal to his finger is the superior vena cava.

Question 41

While observing in the OR, you see the resident insert a needle through the body wall just above the ninth rib in the mid-axillary line. She was obviously trying to enter the:

Answer 41

costodiaphragmatic recess

Question 42

The ductus arteriosus sometimes remains open after birth requiring surgical closure. When placing a clamp on the ductus, care must be taken to avoid injury to what important structure immediately dorsal to it?

Answer 42

left recurrent pharyngeal.

The left recurrent laryngeal nerve is a branch of the vagus that wraps around the aorta, posterior to the ductus arteriosus or ligamentum arteriosum. It then travels superiorly to innervate muscles of the larynx. It’s important to protect this nerve during surgery! If the left recurrent laryngeal nerve becomes paralyzed, a patient might experience a hoarse voice or even have difficulty breathing due to a laryngeal spasm

Question 43

A 16-year-old male suffered a stab wound in which a knife blade entered immediately superior to the upper edge of the right clavicle near its head. He was in extreme pain, which was interpreted by the ER physician as a likely indicator of a collapsed lung following disruption of the pleura. If that was true, what portion of the pleura was most likely cut or torn?

Answer 43

cupola