Final studying (everything) Flashcards

Lectures 1-12

1
Q

List and describe the 3 approaches to anatomy

A

1) Regional: emphasizes relationships of various systemic structures within the region along with surface anatomy
2) Systemic: study by organ systems
3) Clinical (applied): structure and function of the body important in the practice of medicine; both regional and systemic for clinical application

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2
Q

List the 3 layers of the skin from external to internal

A

Epidermis, dermis, and subcutaneous tissue (hypodermis or superficial fascia)

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3
Q

1) What type of cells make up the epidermis?
2) How thick is the epidermis?
3) What keeps the epidermis from just falling off the body?
4) List some defining characteristics of the epidermis
5) Is there nervous system involvement in the epidermis?

A

1) Stratified squamous epithelium
2) 0.5-1.5 mm thick
3) Epidermal ridges “lock” onto papillary dermis
4) Keratinized, shedding, avascular
5) Some afferent sensory receptors: pain, temp, touch

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4
Q

1) How thick is the dermis?
2) What type of tissue makes up the dermis?
3) What type of testing can be done on the dermis?
4) What feature is it responsible for? What is a pathology of this area?

A

1) Varies in thickness from 0.3 mm (eyelids) to 3.0 mm (back)
2) Connective tissue
3) ID testing; PPD, allergy skin testing
4) Tension lines; stretch marks (collagen + elastic fibers)

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5
Q

1) Give two other names for subcutaneous (SQ) tissue
2) What makes up SQ tissue?
3) What runs through SQ tissue?
4) How is this layer important to medicine?

A

1) The hypodermis or superficial fascia
2) Loose connective tissue (superficial) and adipose tissue storage
3) Vessels, lymphatics, & cutaneous nerves
4) It’s the layer we infiltrate for local anesthesia for minor procedures; suturing, I&D

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6
Q

1) Where can deep (investing) fascia be found?
2) What are two features of deep fascia? [What do they do?]
3) How is deep fascia medically significant? (2 ways)

A

1) Envelops most of the body; deep to skin and SQ
2)
a) Retinacula [hold tendons during joint movement]
b) Bursae [are closed sacs with fluid to prevent friction]
3) Responsible for facial planes and compartments within the extremities

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7
Q

1) What two things allow us to feel touch and pressure?
2) What two things allow us to feel pain, itch, and temperature?

A

1) Meissner’s and Vater-Pacini corpuscles in dermis
2) Papillary dermis/ epidermal ridges

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8
Q

1) What ANS fibers are associated with apocrine sweat glands? What else are they associated with?
2) What ANS fibers are associated with eccrine sweat glands? What is unique about them?

A

1) Adrenergic fibers; vasculature and erector pili
2) Cholinergic fibers (unique neurotransmitter for sympathetic)

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9
Q

List and describe the 3 types of burns

A

1) Superficial: superficial epidermis involved. Ex: sunburn
2) Partial thickness:
Into superficial dermis, sweat glands and hair follicles may provide regenerative cells
3) Full thickness: Entire epidermis and dermis, even SQ and muscle may be involved; requires skin grafting

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10
Q

1) All bone is derived from what?
2) What are the two types of bone formation?

A

1) Mesenchyme
2) Intramembranous and endochondral ossification

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11
Q

1) When does intramembranous ossification happen and how?
2) What type of arteries supply bone marrow, spongy bone, deeper compact bone?
3) What type of arteries supply most of the compact bone?

A

1) During fetal period; bone forms directly from mesenchyme
2) Nutrient arteries
3) Periosteal arteries (periosteum = vital like bark on a tree)

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12
Q

1) List the 3 types of joints
2) What type of joint is associated with DJD, RA, and gout?

A

1) Fibrous, cartilaginous, and synovial
2) Synovial

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13
Q

1) What describes how nerves supplying the joint also supply the muscles moving the joint and the overlying skin?
2) Why can synovial joints be painful?
3) What sense are joints responsible for?

A

1) Hilton Law
2) Pain fibers in fibrous layer joint capsule
3) Proprioception

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14
Q

1) Define motor unit
2) The heart and blood vessels make up the ________ system

A

1) A LMN and the muscle fibers it innervates
2) Cardiovascular

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15
Q

List the 3 layers of blood vessels and what each is made of

A

1) Tunica intima: endothelial lining
2) Tunica media: smooth muscle
3) Tunica adventitia: outer connective tissue

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16
Q

List 4 functions of the lymphatic system

A

1) Interstitial fluid balance
2) Filter system
3) Digestive function (chyle)
4) Immune function

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17
Q

What are the two main ducts of the lymphatic system? What parts of the body do they serve?

A

1) Right lymphatic duct drains upper right quadrant of body
2) Thoracic duct drains the rest

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18
Q

What type of structure secretes hormones?

A

Glands

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19
Q

What illnesses does “chronic lung diseases” include?

A

COPD, asthma, RSV in infants, HMD, lung cancer, interstitial lung disease
CF, bronchiectasis

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20
Q

Name 4 functions of the digestive system

A

1) Breaks down food into absorbable units
2) Immune function
3) Hormonal function
4) Exocrine function

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21
Q

List 4 functions of the urinary system

A

1) Water/electrolyte balance
2) Waste removal
3) Acid base balance
4) Hormonal functions
(EPO and RBCs, renin and blood pressure)

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22
Q

1) Name 3 chronic kidney diseases
2) List 2 other illnesses of the urinary system

A

1) T2DM, HTN, Autoimmune disease (Lupus)
2) UTI (cystitis/pyelonephritis) and post-strep glomerulonephritis

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23
Q

Name 4 functions of the skeletal system

A

1) Protects and supports body organs
2) Framework for muscles
3) Mineral storage
4) Blood cell formation

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24
Q

What are the two divisions of the skeletal system?

A

Axial (main portion) and appendicular (pelvic girdle, clavicle, scapula, and limbs)

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25
Q

List 5 functions of bone

A

1) Protection for vital structures
2) Support for the body and vital cavities
3) Mechanical basis of movement
4) Storage of minerals
5) Manufacture blood in medullary cavities

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26
Q

What’s the difference between radiolucent and radiodense?

A

1) Radiolucent tissues absorb minimal x-rays = blacker appearance on the “film”
2) Radiodense tissues absorb more x-rays = whiter appearance on the “film”

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27
Q

What two types of imaging have transverse sections as their anatomic view?

A

CT scans and MRIs

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28
Q

What two types of imaging don’t use radiation?

A

MRI and ultrasonography

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29
Q

What property does a CT image depend on?

A

Density

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30
Q

1) What units is density expressed in (in regards to CT scans)?
2) What terms are used to compare structures?

A

1)Hounsfield unit (HUs), whichspans from +1000 for bones (bright), 0 for water (gray), to -1000 for air (dark)
2) Hyperdense,hypodenseorisodense

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31
Q

1) What do PET scans evaluate? Why?
2) What 2 things can it detect?

A

1) Physiological function (since they’re dynamic)
2) Increased function and cancer

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32
Q

1) What is Doppler ultrasonography?
2) Give 2 examples of this type of ultrasonography

A

1) Ultrasounds adjusted for examining blood flow through arteries and veins
2) Transcranial ultrasonography and carotid ultrasonography

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33
Q

Give an example of something that crosses tension lines

A

Stretch marks

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34
Q

1) What is another name for the cuticle of a nail?
2) What is immediately proximal to this (but underneath the skin)? What’s behind that?

A

1) Eponychium
2) Root of nail, behind it is the nail matrix

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35
Q

What are the 3 parts of a tooth from superior to inferior?

A

1) Crown
2) Neck
3) Root

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36
Q

1) What is the most external layer of teeth called?
2) What layer is directly below that?
3) What are those layers protecting?

A

1) Enamel
2) Dentin
3) The pulp cavity and root canal

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37
Q

What is the primary function of the sympathetic nervous system?

A

Controlling blood vessels

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38
Q

1) What is plaque?
2) What is a thrombus?

A

1) A buildup of fat (mostly cholesterol) in arteries
2) A blood clot in arteries as a result of platelets, proteins, and RBCs sticking together

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39
Q

What structure is the body’s internal thermostat? (not in the brain)

A

The thyroid

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40
Q

1) What is the endocrine function of the testes?
2) What is their exocrine function?

A

1) Endocrine: secrete testosterone
2) Exocrine: sperm

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41
Q

1) What part of breathing is passive? What part is active?
2) Give an example of a condition that might cause this to change

A

1) Exhaling is passive, inhaling is active
2) Asthma may cause forceful exhaling

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42
Q

Is the urinary system involved in endocrine functions, exocrine functions, or both?

A

Both

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43
Q

When does a UTI become cystitis/ pyelonephritis?

A

When it reaches the kidneys

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44
Q

What are the 5 basic radiodensities?

A

1) Air: Also known as radiolucent, air appears black on a radiograph.
2) Fat: Appears as a darker gray on a radiograph.
3) Water or soft tissue: Appears gray on a radiograph.
4) Bone: Appears less white than metal on a radiograph.
5) Metal: Also known as radiopaque, metal appears white on a radiograph

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45
Q

What are the 5 elements of neurons?

A

1) Cell body
2) Dendrites
3) Axons
4) Myelin sheath around some axons
5) Synapse

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46
Q

What is the mnemonic to help remember the order of the cranial nerves?

A

Oh Once One Takes The Anatomy Final Very Good Vacations Are Heavenly

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47
Q

1) What type of neuron cell bodies tend to be in the CNS?
2) What about the PNS?

A

1) Motor tend to be in CNS (UMN, LMN)
2) Sensory tend to be in PNS (DRG)

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48
Q

1) What do dendrites do?
2) What do axons do?

A

1) Dendrites: impulses from receptors to neuron
2) Axons: impulses from neuron to site of action

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49
Q

What do synapses do?

A

Communicate with neurotransmitters (excite or inhibit)

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50
Q

What are the 3 functions of myelin?

A

1) It acts as an electrical insulator for the neuron
2) Prevents depolarization
3) It speeds up conduction/ transmission of an electrical impulse

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51
Q

Define nucleus and give an example

A

Collection of nerve cell bodies within CNS (lateral geniculate nucleus in thalamus)

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52
Q

1) Define gray matter
2) Where’s it’s located?
3) What are the parts of this location?

A

1) Nerve cell bodies
2) The brain and grey matter horn (H) in spinal cord
3) Parts of horn: anterior (motor), dorsal (sensory), lateral (sympathetic and parasympathetic)

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53
Q

1) What is white matter?
2) What are the 3 layers of meninges?
3) Where is the CSF?

A

1) Fiber tracts
2) Pia, arachnoid, dura mater (split in cranium)
3) Subarachnoid space

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54
Q

1) A collection of nerve cell bodies within CNS is called?
2) A collection of nerve cell bodies outside of the CNS is called?
3) A bundle of nerve fibers (axons) connecting nuclei in CNS is called?

A

1) Nerves
2) Ganglia
3) A tract

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55
Q

List the order of the spinal nerve sections and how many nerve are in each section

A

Cervical-8
T-12
L-5
S-5
Coccygeal-1

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56
Q

What are the functional components of the nervous system? Define each.
What may both have?

A

1) Sensory (afferent): toward brain
2) Motor (efferent): away from brain
3) Somatic (voluntary) and visceral (involuntary) components

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57
Q

What are the two structural categories of the nervous system? Define each

A

1) CNS: brain and spinal cord
2) PNS: cranial and peripheral nerves “outside” the CNS

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58
Q

1) Define the somatic nervous system
2) What does it provide, and what to? What are the exceptions?
3) What 4 things does it transmit?
4) What does it stimulate?

A

1) Somatic parts of CNS and PNS
2) General sensory and motor to all parts of body (soma)
-Except: viscera in body cavities, smooth muscle, and glands
3) Touch, pain, temperature, proprioception
4) Skeletal (voluntary) muscle contraction

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59
Q

1) Define visceral nervous system
2) What does it provide? To where?
3) What are its 3 functions?
4) What 3 things does it stimulate?

A

1) Visceral (autonomic) parts of CNS and PNS
2) Visceral sensory and motor innervation to viscera, smooth muscle, and glands
3) Visceral sensory pain, reflexes, regulates visceral function
4) Smooth muscle in walls of vessels and organs, modified cardiac muscle (intrinsic stimulating and conducting tissue), and glands

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60
Q

What is the mnemonic to help remember whether a cranial nerve is sensory, motor, or both?

A

Some Say Money Matters But My Brother Says Big Brains Matter More

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61
Q

1) What CN nerve(s) arise from the brain?
2) Which CN nerve(s) arise from the spinal cord? What part of the spinal cord and where does it/they go?

A

1) CN I-X and XII arise from brain
2) CN XI (spinal accessory n.) from cervical spinal cord to transverse foramen magnum into skull

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62
Q

1) What are the 2 types of cranial motor nerves?
2) What are the 3 types of cranial sensory nerves?

A

1) Somatic and visceral (aka autonomic)
2) Somatic, visceral, special (vision, hearing, taste, balance)

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63
Q

1) The specific region innervated by each somatic spinal nerve is called what?
2) Where are dermatomes guaranteed to end?
3) Why is this important?

A

1) A dermatome
2) The midline
3) Meningitis sometimes will remain on one side because of dermatomes

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64
Q

1) Are spinal nerve roots sensory, motor, or both?
2) What does is the posterior ramus innervate?

A

1) Both sensory and motor
2) Mid back

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65
Q

What 3 things are found within the anterior ramus of a spinal nerve?

A

1) White ramus communicans
2) Sympathetic truck (also runs through posterior)
3) Gray ramus communicans

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66
Q

1) Where does the anterior ramus go?
2) True or false: Peripheral nerves are mixture of modalities

A

1) Continues to remainder of soma (body)
2) True

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67
Q

What are the 3 types of fibers found within peripheral nerves?

A

Afferent, efferent, and postsynaptic sympathetic fibers

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68
Q

1) If you feel touch just above your mid back, what ramus is this going to?
2) If you feel touch in your arm, what ramus is this going to?

A

1) Posterior ramus of spinal nerve
2) Anterior ramus of spinal nerve

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69
Q

1) What type of ganglia are closer to their target organ?
2) What kind is further?

A

1) Parasympathetic
2) Sympathetic

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70
Q

What is the difference in origin between an upper motor neuron (UMN) and a lower motor neuron (LMN)?

A

1) UMNs: originate in the cerebral cortex, travel down to the spinal cord or brainstem
2) LMNs: begin in the spinal cord.

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71
Q

Sympathetic (thoracolumbar) division of motor innervation:
1) Where does it come from and go?
2) What is its primary function?
3) Is it catabolic or anabolic? Why?

A

1) Outflow from CNS to T1-L3
2) Regulate BP (also has other functions)
3) Generally catabolic; to prepare for flight or fight

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72
Q

What are the two divisions of visceral (autonomic) motor innervation?

A

Sympathetic (thoracolumbar) and parasympathetic (craniosacral)

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73
Q

Parasympathetic motor innervation:
1) Where does it come from and go?
2) Is it catabolic or anabolic? Why?

A

1) Outflow from the CNS to CNs 3,7,9,10 and S2-3-4
2) Generally anabolic, because it’s promoting normal function and conserving energy

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74
Q

1) Where are the visceral presynaptic (preganglionic) neurons located? Where do they terminate?
2) Where are the visceral postsynaptic (postganglionic) neurons located? Where do they terminate?
-Give examples

A

1) Grey matter (nuclei) in CNS; synapse with 2nd neuron
2) Outside of CNS in ganglia (paravertebral ganglia); terminate at effector organs
-Exs: smooth muscle, glands, cardiac conduction tissue, etc

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75
Q

Sympathetic motor division:
1) Where are its presynaptic neurons? Where do their fibers outflow?
2) Where are its postsynaptic neurons? What are they conveyed by?

A

1) Lateral Horn of spinal cord; via thoracolumbar nerves (T1-L3)
2) In paravertebral and prevertebral ganglia; by all branches of the spinal nerves

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76
Q

1) What is the primary function of the sympathetic motor division?
2) What does symp. motor innervate?
3) Are parasympathetic motor fibers related to spinal nerves? If so, how?

A

1) Modulate BP
2) Smooth muscles of blood vessels, sweat glands, erector pili m. of the skin, cardiac conduction tissue
3) Have limited association with spinal nerves (S 2-3-4)

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77
Q

1) Define paravertebral ganglia
2) What is located here?
3) What is the most superior paravertebral ganglia? Where is it?
4) What is the most inferior? Where is it?

A

1) Symp.trunks/ chains on either side of vertebral column
2) Symp. postsynaptic neurons
3) Superior cervical ganglia; base of cranium
4) Ganglion impar; where two chains unite at level of coccyx

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78
Q

1) Where are the sympathetic presynaptic neurons found?
2) What part of the spine is this?

A

1) Paired left and right IMLs (aka lateral horns/ grey matter of cord)
2) T1-L2/L3

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79
Q

What are the two locations of sympathetic postsynaptic neurons? (hint: both ganglia)

A

1) Paravertebral ganglia
2) Prevertebral (preaortic) ganglia

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80
Q

1) Where are prevertebral (preaortic) ganglia found? (4 places)
2) What is found within them?

A

1) In plexuses that surround origins of the main branches of the abdominal aorta (celiac ganglia) and the aortic, hypogastric, and pelvic plexuses that descend from them
2) Sympathetic postsynaptic neurons

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81
Q

1) Where do symp. presynaptic motor fibers that provide autonomic innervation within the head, neck, body wall, limbs, and thoracic cavity go?
2) Where do they exit and go?
3) Where do symp. presynaptic fibers innervating viscera within the abdominopelvic cavity pass through? Where do they synapse?

A

1) Either ascend within the paravertebral ganglia at current level, ascend or descend then synapse
2) Via grey communicans; into the spinal nerves.
3) Sympathetic chain; within the prevertebral (preaortic) ganglia (then to their effector organ)

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82
Q

Describe the path of the symp. postsynaptic motor fibers that innervate below the head (3 steps)

A

1) Paravertebral ganglia of sympathetic trunk, then through Gray rami communicantes
2) To adj. anterior rami of spinal nerves
3) Then enter all 31 spinal nerves (incl. posterior rami)

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83
Q

What fiber innervation controls sweating, goosebumps, and vasomotor tone/ BP?

A

Postsynaptic somatic motor

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84
Q

What is the path of sympathetic motor fibers that go to the head? (3 steps)

A

1) Post synaptic cell bodies in superior cervical ganglion
2) Follow periarterial plexus of nerves (near br. of carotid artery) into cranium.
3) Hitch a ride with CNs to target organ

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85
Q

1) What do splanchnic postsynaptic symp. motor fibers go through to the viscera of thoracic cavity?
2) Where do they terminate? (3 places)
3) What do they form?

A

1) Cardiopulmonary splanchnic nerves
2) Cardiac, pulmonary and esophageal plexuses
3) Peri-arterial plexuses
-(following arterial branches to target organs)

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86
Q

What type of nerves do splanchnic presynaptic symp. motor fibers use to innervate the viscera of abdominopelvic cavities?

A

Abdominopelvic splanchnic nerves

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87
Q

What type of fibers are the suprarenal gland innervated by? Where do these terminate?

A

Presynaptic sympathetic fibers; directly onto adrenal medulla cells

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88
Q

What do adrenal medulla cells act as?

A

Postsynaptic neurons

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89
Q

1) What are the two types of parasympathetic outflow?
2) What are the two places one of these types goes to?

A

1) Cranial and sacral
2) Cranial: head and thoracic/abd. viscera

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90
Q

1) List the 3 CNs parasympathetic cranial outflow use to innervate the head
2) List the 4 ganglia parasympathetic cranial outflow uses to innervate the head

A

1) #s 3, 7, 9
2) Ciliary (pupil), terygopalatine (lacrimal gland), otic (parotid gland), submandibular (sublingual and submandibular salivary glands)

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91
Q

What type of innervation does CNX use to innervate the thoracic and abd viscera above the splenic flexure?

A

Parasympathetic cranial

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92
Q

1) Where does parasympathetic sacral outflow (innervates body) come from?
2) Describe the path they take.
3) How many places are innervated by this type of outflow? List them

A

1) S 2-3-4
2) Lateral horn grey matter via anterior S2-4 spinal nerve, anterior rami to pelvic splanchnic nerves
3)
A) Pelvic viscera
B) Erectile tissues of external genitalia and bladder
C) GI from pelvic flexure of colon distal (descending colon, sigmoid colon, & rectum)

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93
Q

1) Does the enteric nervous system rely on the CNS?
2) What modulates the enteric nervous system, just parasympathetic, symp, or both?

A

1) Functions autonomously from CNS
2) Parasympathetic and sympathetic input

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94
Q

What makes up the enteric nervous system?

A

Two interconnected plexuses: myenteric (in smooth musc. wall) and submucosal (deep to mucosa)

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95
Q

What 4 things does the enteric nervous system do?

A

Controls local input and reflex activity for:
1) Exocrine & endocrine secretion
2) Vasomotion
3) Micro-motility
4) Immune activity of the gut

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96
Q

What type of innervation gives input to CNS regarding condition of internal environment and controls visc. and somatic reflexes? Is it usually percieved?

A

Visceral afferent; no, but can be pain/ hunger/ nausea

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97
Q

Referred pain and nausea caused by a heart attack involves what part of the nervous system?

A

Visceral afferent

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98
Q

Define myotome

A

A group of muscles innervated by a single spinal nerve root

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99
Q

What does the corticospinal tract run through in the spine?

A

The lateral column

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100
Q

1) Where does the vertebral column start and end?
2) How many vertebrae are there in each section of the spine?

A

1) Goes from cranium to the apex of the coccyx
2) C7, T12, L5, S5, Co4

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101
Q

Name 6 things the vertebral column does

A

1) Main support of the axial skeleton
2) Protects the spinal cord and nerves
3) Supports weight of body superior to sacrum
4) Rigid-flexible axis for body
5) Pivots the head
6) Posture for body

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102
Q

1) What is a major stress point of the vertebral column?
2) What part(s) of the vertebral column allow for significant amount of motion?

A

1) Lumbosacral angle (L5-S1 junct.)
2) Superior 25 vertebrae, most in cervical

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103
Q

What two sections of the spinal column is most motion in?

A

Cervical and lumbar

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104
Q

What 3 things provide stability to the vertebral column?

A

1) Shape and strength of vertebrae and IV disc
3) Ligaments
4) Muscles

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105
Q

List the 4 curves of the adult spine from top to bottom. Specify whether each is primary or secondary

A

1) Cervical lordosis, secondary
2) Thoracic kyphosis, primary
3) Lumbar lordosis, secondary
4) Sacral kyphosis, primary

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106
Q

1) What is a developmental condition that can cause abnormal spinal curvature (that can be both lateral and rotational)?
2) What is a pathologic condition that can cause abnormal spinal curvature?

A

1) Scoliosis
2) Osteoporosis

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107
Q

An anterior rotation of pelvis, causing an abnormal increase in the lumbar lordosis curve, is defined as what?

A

Lordosis

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108
Q

What are the 3 components of a typical vertebrae?

A

1) Body
2) Arch (contains pedicle & lamina)
3) 7 processes

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109
Q

1) What are the endplates of a vertebral body covered in?
2) What is the epiphyseal rim made of?
3) Where on the column do vertebral bodies increase in size?

A

1) Hyaline cartilage
2) Bone
3) T4-S1

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110
Q

What are the 2 features of a typical vertebral arch? List and describe them

A

1) Paired pedicles: Connect arch to body; form vertebral notches and adjacent vertebral notches for intervertebral foramen
2) Paired lamina: Unite at midline

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111
Q

1) Define vertebral foramen
2) What do vertebral notches form
3) What is typically between vertebral bodies?

A

1) Spinal canal where spinal cord resides
2) Intervertebral (IV) foramina
3) IV disc

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112
Q

List the 7 processes of a typical vertebrae

A

1) Spinus process (dorsal)
2&3) Paired transverse processes
4,5,6,7) Paired superior and inferior articular processes

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113
Q

What do the paired superior and inferior articular processes of the vertebrae form?

A

Zygapophyseal (facet) joints

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114
Q

What are the two foramen found in cervical vertebrae, and what runs through them?

A

1) Large triangular vertebral foramen: spinal cord and cervical nerve roots
2) Foramen transversarium (absent C7): vertebral artery & vein, and sympathetic nerves

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115
Q

What is unique about C7?

A

It doesn’t have a foramen transversarium (unlike the other cervical vertebrae)

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116
Q

Do cervical and thoracic spinal nerves exit via the intervertebral (IV) foramen above or below their same numbered vertebra?

A

1) Cervical: exit IV foramen above the same numbered vertebra
2) Thoracic: exit IV foramen below their corresponding vertebra

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117
Q

1) What is the atlas?
2) What shape is it?
3) What does its transverse ligament do?
4) What does it allow for?

A

1) The first cervical vertebrae (C1)
2) Ring shaped
3) Separates vertebral foramen from foramen for dens (C2)
4) Allows flex/ext. of cranium (nodding yes)

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118
Q

1) What is the axis?
2) What is unique about the axis?
3) What does its dens (odontoid) articulate with?
4) What does this allow for?

A

1) C2
3) Strongest
3) Anterior arch of atlas and transverse ligament
4) Rotation of head and atlas about the axis, as in “NO”

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119
Q

Does the axis itself rotate?

A

No

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120
Q

What vertebrae is most likely to fracture if you dive into shallow water and hit your head?

A

The atlas (C1) (Jefferson’s fracture)

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121
Q

1) Describe the size of the vertebral bodies and vertebral foramens of the lumbar vertebrae
2) Where does the spinal cord end in adults?
3) Describe the length of the cauda equina

A

1) Bodies are massive, vertebral foramens are large
2) L1-2 in adults
3) Extends full length of vertebral canal

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122
Q

1) What exits each intervertebral (IV) foramen of the lumbar vertebrae?
2) What is the preferred site to access epidural space for anesthesia & SA space for CSF collection?
3) A defect in pars interarticularis of neural arch (lamina between the two articular processes) can cause what lumbar condition?

A

1) Spinal nerves
2) Below L2 (since spinal cord ends there), between L3-L4 or L4-L5
3) Spondylolysis

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123
Q

If a patient comes in complaining of radiating leg pain progressing from their upper to lower legs when walking that’s relieved by bending over (like leaning on a shopping cart), what condition might they have?

A

Lumber stenosis

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124
Q

1) What do spina bifida, meningoceles, and meningomyeloceles have in common?
2) What joints transmit body weight to pelvic girdle?

A

1) All result from incomplete closure of the neural tube
2) SI joints

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125
Q

What is the sacral promontory?

A

The anterior edge of the S1 body

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126
Q

1) Describe the texture and shape of the dorsal side of the sacrum
2) What is found on its surface?
3) What are the 3 sacral crests?
4) What is the sacral hiatus? What does it lead to?

A

1) Rough and convex
2) 4 pair of foramina
3) Median, intermediate, lateral
4) Inferior end of vertebral canal that leads into sacral canal

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127
Q

1) What is the coccyx a remnant of?
2) Are its vertebrae fused?
3) What is its clinical significance?

A

1) Vestigial tail
2) Distal 3 vertebrae fuse in mid life
3) Can palpate it rectally

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128
Q

1) What is the Conus medullaris?
2) Where does it terminate in newborns?
3) What about in adults?

A

1) The terminal, inferior end of the spinal cord
2) Newborn: opposite L2/3 IV disc
3) Adult: opposite L1/2 IV disc

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129
Q

What are the 2 potential causes of cauda equina syndrome?

A

Disc herniation or spinal stenosis
-(Can be caused by cancer, trauma, epidural abscess or hematoma)

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130
Q

If a patient with an epidural abscess suddenly complains of loss of bowel or bladder control, what might be the cause? What might be the cause of that?

A

Cauda equina syndrome secondary to disc herniation or spinal stenosis (caused by their epidural absess)

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131
Q

If a patient with a history of lower spinal trauma (below L1/2) suddenly complains of numbness around the anus and radiating pain down their leg, what might be the cause? What might be the cause of that?

A

Cauda equina syndrome secondary to disc herniation or spinal stenosis (caused by their previous spinal trauma)

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132
Q

1) What do superficial [extrinsic] back muscles act on?
2) What innervates them?

A

1) UE
2) Anterior rami or CN XI

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133
Q

1) Trapezius, lat. dorsi, levator scapulae, rhomboid, and serratus posterior are all examples of what type of back muscle?
2) The 3 serratus muscles and the proprioceptive respiratory muscles are examples of what type of back muscle?

A

1) Superficial extrinsic
2) Intermediate extrinsic

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134
Q

1) The splenius group that does lateral flexion and rotation and extension of the head/ neck are what layer of back muscles?
2) What layer of muscles are the erector spinae (main extensors of spine) a part of?
3) What layer are the transversospinalis group a part of?

A

1) Intrinsic superficial
2) Intrinsic intermediate
3) Intrinsic deep

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135
Q

1) What two things are IV discs associated with?
2) What is the more exterior part of the IV discs called? Where does it attach?
3) What is the more interior part of the IV discs called? Where is it located?

A

1) ROM and natural curvatures of spine
2) Annulus fibrosus (85% water); attaches to end plates
3) Nucleus pulposis; positioned more posteriorly

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136
Q

Describe the shape of annulus fibrosus

A

Thinner posteriorly (why herniated discs can happen)

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137
Q

List the 5 types of joints found in the vertebral column

A

1) Vertebral bodies: IV Discs, uncovertebral joints
2) Vertebral arches: Zygapophysial (facet) joints
3) Craniovertebral: occipital condyle with atlas
4) Costovertebral: ribs
5) Sacroiliac: SI joint

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138
Q

1) Describe the joints of the vertebral arches; what type of joints are they?
2) What do they allow for?
3) What are they innervated by?

A

1) Zygapophysial (facet) joints; synovial
2) Gliding movement
3) Medial branch of posterior rami spinal nerves

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139
Q

What are the 3 branches of the median branch of the posterior rami of spinal nerves?

A

Muscular, cutaneous and articular branches

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140
Q

1) What are the 4 movements of the spine?
2) What reduces these movements in some people?
3) Why?
4) What innately limits movement?

A

1) Flexion, extension, lateral flex, rotation
2) Age
3) Primarily from IV-disc compression and elasticity
4) Physical characteristics of the anatomy

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141
Q

Is age the primary cause of reduced spinal movement? Explain

A

No, it’s secondary to degenerative changes in IV disc and other structures

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142
Q

What 3 things allow movement of the spine?

A

1) Back and abdominal muscles (like rectus abdominus and obliques)
2) Gravity
3) Movement between adjacent vertebra (Zygapophyseal joints and IV-disc)

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143
Q

What are the two types things that allow movement between adjacent vertebrae?

A

Zygapophyseal joints and IV-disc

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144
Q

What part of the spine has the greatest degree of flexion ROM?

A

Cervical spine

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145
Q

What two things limit ROM of the thoracic spine?

A

Ribs and sternum

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146
Q

1) What allows for greater flexion and extension of the lumbar spine?
2) Is there a lot of rotation of the lumbar spine? Why?
3) Describe the IV discs of the lumbar spine

A

1) Facet joints
2) Minimal rotation due to interlocking facets
3) Relatively large IV discs

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147
Q

Is extension or flexion greater in the lumbar area?

A

1) Extension > flexion
(spondylosis in gymnast)

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148
Q

What are the 3 longitudinal arteries that supply the vertebral column?

A

1) Anterior spinal artery
2&3) Paired posterior spinal arteries

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149
Q

Describe venous drainage of the vertebral column

A

-Forms venous plexuses:
1) External plexus
2) Internal plexus

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150
Q

Describe the manner in which the venous plexuses that drain the spine communicate

A

Communicate freely

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151
Q

1) Where is the internal vertebral venous plexus?
2) Where does it drain?
3) What does it communicate with?

A

1) In epidural space
2) Drains superiorly into dural venous sinus in cranium
3) With external vertebral plexus on external surface of vertebra

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152
Q

What innervates the vertebral column?

A

Meningeal branches of spinal nerves

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153
Q

1) Where is most body weight in relation to the vertebral column?
2) Where is most muscle support in relation to the vertebral column?
3) What are the two types of back muscles?

A

1) Anterior
2) Posterior
3) Intrinsic and extrinsic

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154
Q

What are the two types of extrinsic back muscles? What does each do?

A

1) Superficial: control limb movement
2) Intermediate: control respiratory movement

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155
Q

What are the 3 kinds of intrinsic back muscles? (bonus: give examples of each)

A

1) Superficial: splenius
2) Intermediate: erector spinae
3) Deep: transversospinalis

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156
Q

1) How are the extrinsic back muscles innervated and what do they do?
2) What is the exception?

A

1) By anterior rami of c-spinal nerves, act on UE (except for trapezius).
2) Trapezius m. innervated by spinal accessory n., CN XI

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157
Q

1) What are the muscles of the back proper?
2) What innervates them?
3) What do they do?
4) Where are they?
5) What are their groups?

A

1) The intrinsic muscles of the back
2) Posterior rami branches of spinal nerves
3) Maintain posture and control ROM of the vertebral column
4) Below investing fascial (“invested” in deep fascia) midline to transverse processes and angle of the ribs
5) Superficial, intermediate, and deep layers

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158
Q

1) Give the brief explanation of what intrinsic muscles are innervated by and what they do
2) What are the enclosed in?

A

1) Innervated by posterior rami of spinal n.; control posture and movement of the spine
2) In deep fascia (thoracolumbar fascia)

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159
Q

1) Where are the suboccipital region and suboccipital triangle?
2) What is it made of?

A

1) Deep to trapezius and semispinalis capitis mm.
2) 4 small muscles

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160
Q

1) What kinds of muscles form suboccipital region/ what do they act on?
-bonus: what are they?
2) What CN innervates these triangle region muscles? Does this CN provide skin sensory?

A

1) Mainly postural muscles, act on head (capitis): ext of head and rotate head b/t C1-2
-2 rectus capitis and 2 obliquus capitis
2) Posterior ramus of C1; suboccipital nerve; no skin sensory

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161
Q

What is the clinical correlation of the greater and lesser occipital nerves?

A

-Can cause occipital neuralgia, which is defined as chronic headaches by the occipital nerves
-Sometimes a nerve block is placed in the greater occipital nerve at the back of the neck

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162
Q

1) What space is spinal anesthesia placed for surgical procedures?
2) What space are CSF samples collected from? What are they also called, and where on the spine do they go?
3) What space is epidural anesthesia placed?

A

1) Spinal anesthesia: subarachnoid space
2) Subarachnoid space; aka lumbar taps. Done on lumbar cistern below L1-2 where spinal cord ends.
3) Epidural space

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163
Q

What is the pathway of epidurals and LPs (lumbar punctures)?

A

1) Skin
2) Spinous ligament
3) Ligamentum flavum
4) Epidural space: epidurals stop here
5) Dura-arachnoid meninges
6) Subarachnoid space: lumbar punctures stop here

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164
Q

Bonus: Describe the origins and courses of the greater and lesser occipital nerves

A

1) Greater occipital nerve: comes from the dorsal rami of C2, goes up the back of head, emerges inferior to obliquus capitis inferior and ascending to posterior scalp
2) Lesser occipital: come from anterior rami of C2-3, goes directly to skin

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165
Q

What makes up the scalp proper? List each part

A

The first 3 layers:
1) Skin
2) Subcutaneous Connective tissue
3) Epicranial Aponeurosis

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166
Q

What are the layers of the scalp (NOT scalp proper)

A

1) Skin
2) Subcutaneous Connective tissue (SQ)
3) Epicranial Aponeurosis
4) Loose connective tissue
5) Pericranium

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167
Q

1) Describe skin of the scalp
2) Describe Subcutaneous Connective tissue of the scalp and its clinical correlation

A

1) Skin: typical with pilosebaceous units and sweat glands, abundant vascular supply
2) SQ: Thick, dense, richly vascularized with cutaneous nerves
-Embedded in dense connective tissue (limited ability to constrict when injured; bleeds a lot)

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168
Q

What is the Epicranial Aponeurosis?

A

A tendonous sheet of fibrous tissue that covers the calvarium
-Connects the 2 bellies of the occipitofrontalis m. & superior auricular m.
-Continuous with the temporal fascia

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169
Q

Describe the jobs of the occipitalis and frontalis

A

1) Occipitalis muscles: pull scalp posterior
2) Frontalis muscles: wrinkles forehead, raises eyebrows, pulls scalp forward

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170
Q

Why can a black eye result from injury to scalp of the forehead?

A

Frontal belly of the occipitofrontalis m. inserts into the skin and SQ tissue, not to the bone
-Loose connective tissue of scalp is a sponge-like layer w potential spaces that may distend w fluid/blood from injury or infection

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171
Q

1) What stops blood and pus from passing from the forehead to the neck?
2) What stops blood and pus from spreading laterally beyond the zygomatic arches?
2) Explain why loose connective tissue of the scalp is such a dangerous area

A

1) Occipital belly of occipitofrontalis m. attaches to the occipital bone and mastoid parts to mastoid bone.
2) Epicranial aponeurosis is continuous with the temporal fascia that attaches to the arches.
3) Infection can pass into cranium via emissary veins

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172
Q

1) What is the BREGMA?
2) What is lambda?
3) Where are sinuses in relation to the orbits? Why is this clinically relevant?

A

1) The intersection of the coronal and sagittal suture lines (soft spot in baby)
2) The intersection of the sagittal and lambdoid suture lines
3) Medial and inferior to orbits; extension of infections can lead to orbital abscess

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173
Q

1) Fractures of floor of middle cranial fossa may result in leakage to where? What does this result in?
2) Fractures of floor of anterior cranial fossa may involve what? What does this result in?
What can both increase risk of?

A

1) External acoustic meatus, CSF otorrhea
2) Cribriform plate of the ethmoid, CSF rhinorrhea
-Meningitis

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174
Q

1) Describe the pericranium
2) What does it form?

A

1) Dense layer of connective tissue
2) External layer of the periosteum of skull

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175
Q

What can scalp stand for?

A

1) Skin
2) subcutanous Connective tissue
3) epicranial Aponeurosis
4) Pericranium

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176
Q

What are the two structural and functional parts of the cranium? Briefly describe each

A

1) Neurocranium: cranial vault or “brain bucket” (made up by calvaria + cranial base)
2) Viscerocranium: facial skeleton

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177
Q

What are the two parts of the neurocranium?

A

1) Calvaria (skullcap)
2) Cranial base

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178
Q

1) What 5 things does the neurocranium contain?
2) What are its two parts?
3) What bones make it up?

A

1) Brain, meninges, CSF, proximal CN, vessels
2) Calvaria and cranial base
3) Formed by 8 bones
-4 unpaired: frontal, ethmoid, sphenoid, occipital
-2 paired: temporal and parietal (bilateral)

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179
Q

1) What two things are behind the pterion?
2) What is its clinical significance?

A

1) Temporal lobe and MMA
2) Can fracture with trauma (and mess with the MMA)

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180
Q

What makes up the facial aspect of the cranium (viscerocranium)? List all parts

A

15 bones:
-Three unpaired midline bones: mandible, ethmoid, vomer
-Six paired or bilateral bones: maxilla, inferior nasal concha (turbinate) zygomatic, palatine, nasal, lacrimal.

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181
Q

What are the two primary sources of blood to the brain? List the basic path of each

A

1) Anterior circulation: Internal carotids > middle and anterior cerebral aa. of circle of Willis.
2) Posterior circulation: Vertebral arteries > basilar artery > circle of Willis

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182
Q

What supplies blood to the meninges? (bonus: Describe the basic path)

A

External carotids
(via maxillary artery through foramen spinosum to middle meningeal artery)

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183
Q

What are the two sources of blood supply to the face and viscera of the head? Describe where each goes

A

1) External carotid: to major branches to face and viscera
2) Internal carotid: to supra orbital/trochlear vessels for frontal region of scalp (mostly brain tho)

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184
Q

What is the clinical correlation of the meningeal arteries?

A

-The middle meningeal artery (off the maxillary artery) is in groove of the pterion (the meeting of 3 skull bones)
-Trauma to area/fracture can cause epidural bleed

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185
Q

What artery is at risk if the infratemporal fossa is injured? What CN? What veins?

A

MMA; CNV2; pterygoid venous plexus

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186
Q

Describe the general vascular supply of the tongue

A

External carotid and lingual arteries, lingual veins drain into IJV

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187
Q

What are the 3 salivary glands?

A

Parotids, submandibular, sublingual

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188
Q

1) Where is the submandibular duct?
2) Where do the sublingual glands’ ducts open? What innervates them?

A

1) Opens onto sublingual papilla opposite of 2nd molar
2) On floor of the mouth; CN8 parasymp. (same as submandib.)

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189
Q

What are the 2 nerves of the face? Describe them

A

1) CN VII: facial nerve, mostly motor (for facial expression)
2) CN V: trigeminal nerve, mostly sensory, has three named branches called V1-2-3

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190
Q

1) What 2 areas does CNVII innervate?
2) What does it travel? Why is this unique?
3) Where does it exit the face?
4) Where is it located?

A

1) Internal acoustic meatus and muscles of facial expression
2) Goes through facial canal, which is the longest boney canal any nerve must traverse, so it’s at risk
3) Styloid mastoid foramen
4) Deep to parotid gland

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191
Q

1) What nerve innervates the top half of the head?
2) What does it transmit?

A

1) CNV (has 3 branches, V1-3. )
2) Just somatic sensory

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192
Q

What does CNI do?

A

Doesn’t really do much to skin, just to muscles in suboccipital triangle

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193
Q

List what’s embedded in the parotid gland from superficial to deep

A

1) Parotid plexus of facial nerve
2) CN VII
3) Retromandibular vein
4) External carotid artery + lymph nodes

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194
Q

What are the 3 parts of CNV?

A

1) V1 - ophthalmic (cornea, nose, forehead)
2) V2 - maxillary (cheeks, tiny piece of nose and top of teeth)
3) V3 - mandibular (mandible, some temporal)

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195
Q

What are the afferent and efferent components of the corneal touch reflex?

A

Afferent component is V1, motor component is CVII

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196
Q

What are the afferent and efferent components of the light reflex?

A

Optic nerve is afferent, constriction would be CNIII’s sympathetic division

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197
Q

Where does each part of the trigeminal nerve exit?

A

V1: supraorbital foramen or notch
V2: infraorbital foramen
V3: mental foramen via mandibular canal

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198
Q

When contracted unilaterally, the lateral and medial pterygoid muscles do what?

A

Cause a lateral chewing motion, grinding motion

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199
Q

1) What are most arteries to the face branches of?
2) What are most external facial veins drained by?
3) Does this vary? If so, what are the alternate routes?

A

1) External carotid a.
2) Veins that accompany the arteries
3) Varies; alternate route include superficial and deep drainage

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200
Q

1) Where does the facial artery arise from?
2) What does it supply?
3) Can you palpate its pulse?

A

1) External carotid a.
2) It’s the major artery to superficial face
3) Yes

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201
Q

1) What does the superficial temporal artery arise from?
2) What is one of its characteristics?

A

1) External carotid a.
2) Can palpate its pulse

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202
Q

1) What is an inflamed temporal artery called? (2 names)
2) What causes it?
3) What are its symptoms?

A

1) Temporal arteritis (Giant Cell Arteritis)
2) The cause of the blood vessel inflammation is unknown; maybe autoimmune?
3) Headaches, jaw pain, vision loss, fever, and fatigue

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203
Q

1) What 3 arteries arise from the external carotid artery?
2) What 2 arteries arise from the internal carotid artery?

A

1) External: Occipital, posterior auricular, and superficial temporal arteries
2) Internal: Supratrochlear and supra-orbital arteries

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204
Q

Do arteries of scalp and face anastomose?

A

Yes, they anastomose freely with each other

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205
Q

1) What is the primary vein that drains the face?
2) Do facial veins drain anastomosis? Elaborate.
3) What vein drains the cranial sinuses?

A

1) Facial vein
2) Variable, frequent anastomosis between internal/external jugular vv.
3) Internal jugular vein

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206
Q

1) What area doesn’t have lymph nodes? What is the exception?
2) Where does lymph drain into? Name each place and where they’re located.

A

1) No lymph nodes in scalp or face except for parotid/buccal region
2) Lymph drains into superficial cervical ring of nodes, which are: Submental, submandibular, parotid, mastoid and occipital nodes
-Located at junction of head and neck; deep cervical along the IJV

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207
Q

What is the one muscle of mastication that’s not supplied by the anterior trunk of the mandibular nerve/ V3?

A

Buccinator; supplied by CN VII (facial nerve)

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208
Q

Slide 39
1) What artery does CNIII follow? What do they do?
2) What type of innervation controls the constriction muscles of the eye? What else does it do?
3) What does the sympathetic part of CNIII control?

A

1) Internal carotid and CNIII run together; helps with eye dilation
2) Parasympathetic does constriction muscles of iris and interacts w ciliary body
3) Sympathetic only works on the iris (not ciliary body)

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209
Q

List all of the 6 clinical implications to injury to the infratemporal region

A

1) Disruption of zygomatic arch, TMJ, mandible
2) Blood loss to region to include teeth, meninges, etc.
3) V3 somatic motor (muscles of mastication)
4) Parasympathetic via Submandibular ganglia to lingual n. to SM and SL salivary glands
5) Special sensory (taste anterior 2/3 of tongue via chordae tympani branch of CN VII)
6) Parasympathetic via Otic ganglion to parotid gland

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210
Q

What two parts of the tongue are mobile?

A

Body and apex

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211
Q

What are the 2 categories of muscles that control the tongue? Describe each

A

1) 4 Extrinsic muscles alter position: Originate from bony formations outside the tongue (more anchored to floor)
2) 4 Intrinsic muscles alter shape: Confined to tongue

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212
Q

What control the gag reflex? (afferent and efferent)

A

1) Afferent (sensory): Glossopharyngeal n. (CN 9)
2) Efferent (motor): Vagus n. (CN10)

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213
Q

1) What allows you to generally sense with the anterior 2/3rds of your tongue? (also name specific branch)
2) What allows you to taste with the front of your tongue? (also name specific branch)

A

1) General sensation = CN V3; lingual n.
2) Taste = CN VII; tympani nerve

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214
Q

1) Does the tongue’s lymphatics drain bilaterally or unilaterally?
2) What are the lymph nodes of the tongue?

A

1) Posteriorly and midline area drain bilaterally
2) Lateral and front drain to mental and submandibular nodes; posterior drains to cervical nodes

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215
Q

Where is the submandibular duct?

A

Opens onto sublingual papilla opposite of 2nd molar

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216
Q

What allows you to sense with the posterior 1/3 of the tongue?

A

1) General and special sensory = CN IX
2) Minor contribution from CN X

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217
Q

List the 5 branches of the external carotid artery that supply the face

A

1) Lingual a.
2) Facial a.
3) Occipital a.
4) Posterior auricular a.
5) Maxillary a

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218
Q

What two arteries that supply the face don’t originate from the external carotid? Where do they come from?

A

Supratrochlear and supra-orbital arteries are from internal carotid branches

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219
Q

What two arteries of the face can you palpate the pulses of?

A

Facial arteries and temporal arteries

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220
Q

What supplies the 4 muscles of mastication?

A

The anterior trunk of the mandibular nerve (V3)

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221
Q

What sinuses make up the paranasal sinuses? List each and whether they’re paired or unpaired

A

Frontal: Paired
Ethmoid: midline/paired
Sphenoid: midline
Maxillary: paired

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222
Q

1) What nerve innervates the frontal sinuses?
2) What sections of ethmoid sinus cells drain to the middle meatus? What other sinus drains to the middle meatus?
3) What section(s) of the ethmoid sinus drain to the superior meatus?

A

1) CN6
2) Anterior and middle; maxillary sinus [via maxillary osteum]
3) Posterior

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223
Q

1) Where are the sphenoid sinuses?
2) Do they open into the nasal cavity?

A

1) Occupy the cavity in delicate sphenoid bone, drain into. 2) No real opening into the nasal cavity.

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224
Q

What is the rich plexus where all the arteries supplying the septum anastomose? What is the clinical significance of this area?

A

Keisselbach; profuse epistaxis (nosebleeds)

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225
Q

What nerves innervate the nose? (2)

A

1) Posterio-inferior ½ to 2/3 of cavity is primarily: CN V2 (maxillary n.)
2) Anterior superior cavity (both septum & lateral wall) is primarily: anterior ethmoidal nerves from CN V1 (ophthalmic n.)

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226
Q

True or false: Mucosa of the oral cavity is continuous with the gingiva

A

True

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227
Q

Where can you find gingiva?

A

Around the neck of teeth

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228
Q

True or false: There’s both ipsilateral and contralateral drainage of cheeks, lips, and chin lymphatics

A

True

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229
Q

True or false: infections don’t easily spread from one side of the face to another

A

False; infections and cancers can spread easily because there’s both ipsilateral and contralateral lymphatic drainage

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230
Q

What covers the roots of teeth?

A

Cementin

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231
Q

Describe the path of V3 through the lower face

A

Into mandible at mandibular foramen; provides alveolar nerves
Then comes out mental foramen for skin

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232
Q

Where is lidocaine placed to numb an entire side of the bottom teeth?

A

V3

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233
Q

1) What does the hard palate separate?
2) What does the soft palate separate?

A

1) Oral cavity from nasal cavity
2) Oral cavity from nasopharynx

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234
Q

Where are the lingual tonsils found?

A

Posterior 1/3 of tongue

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235
Q

1) What is the soft palate?
2) What is it made of?
3) How is it attached?

A

1) Movable posterior 1/3rd of the palate
2) Mainly muscular
3) Palatine aponeurosis; attached to hard palate anteriorly

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236
Q

What does the soft palate do?

A

Assists in swallowing and prevents bolus entering nasal cavity (by moving/ closing while swallowing)

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237
Q

Which cranial nerve provides:
1) Motor innervation for tongue protrusion?
2) Taste sensation?
3) Somatic sensory innervation to the oral cavity?

A

1) CN 12
2) CN 7 chordae tympani
3) CN V3 (lingual n.)

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238
Q

1) Where are the sphenoid sinuses?
2) Do they open into the nasal cavity?

A

1) Occupy the cavity in delicate sphenoid bone, drain into. 2) No real opening into the nasal cavity.

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239
Q

What is the rich plexus where all the arteries supplying the septum anastomose? What is the clinical significance of this area?

A

Keisselbach; profuse epistaxis (nosebleeds)

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240
Q

What nerves innervate the nose? (2)

A

1) Posterio-inferior ½ to 2/3 of cavity is primarily: CN V2 (maxillary n.)
2) Anterior superior cavity (both septum & lateral wall) is primarily: anterior ethmoidal nerves from CN V1 (ophthalmic n.)

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241
Q

True or false: Mucosa of the oral cavity is continuous with the gingiva

A

True

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242
Q

Where can you find gingiva?

A

Around the neck of teeth

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243
Q

True or false: There’s both ipsilateral and contralateral drainage of cheeks, lips, and chin lymphatics

A

True

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244
Q

True or false: infections don’t easily spread from one side of the face to another

A

False; infections and cancers can spread easily because there’s both ipsilateral and contralateral lymphatic drainage

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245
Q

What covers the roots of teeth?

A

Cementin

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246
Q

Describe the path of V3 through the lower face

A

Into mandible at mandibular foramen; provides alveolar nerves
Then comes out mental foramen for skin

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247
Q

Where is lidocaine placed to numb an entire side of the bottom teeth?

A

V3

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248
Q

1) What does the hard palate separate?
2) What does the soft palate separate?

A

1) Oral cavity from nasal cavity
2) Oral cavity from nasopharynx

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249
Q

Where are the lingual tonsils found?

A

Posterior 1/3 of tongue

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250
Q

1) What is the soft palate?
2) What is it made of?
3) How is it attached?

A

1) Movable posterior 1/3rd of the palate
2) Mainly muscular
3) Palatine aponeurosis; attached to hard palate anteriorly

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251
Q

What does the soft palate do?

A

Assists in swallowing and prevents bolus entering nasal cavity (by moving/ closing while swallowing)

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252
Q

How are the palates innervated with sensory nerve fibers?

A

Branches of CN V2 (maxillary n; foramen rotundum) (that pass through pterygopalatine ganglia)

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253
Q

What two nerves supply the palates with motor fibers?

A

1) CN V3: Tensor veli palatini (forms palatine aponeurosis)
2) Pharyngeal plexus from vagus n. CN X: All other (motor) muscles of soft palate (& much of oral pharynx)

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254
Q

1) What nerve does the pharyngeal plexus of nerves come from?
2) What does this nerve do?

A

1) Vagus n.
2) Acts as motor arm of GAG reflex

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255
Q

True or false: Only way CNV conveys motor is via V3, mandibular n., (foramen ovale)

A

True

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256
Q

1) What term do you use to refer to both ears?
2) What term do you use to refer to the left ear?
3) What term do you use to refer to the right ear?

A

1) AU(bilateral)
2) AS (left)
3) AD(right)

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257
Q

What are the 3 parts of the external ear?

A

1) Auricle (Pinna)
2) External acoustic meatus of Auditory Canal (EAC)
3) Tympanic membrane (TM) (separates outer and middle)

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258
Q

What two nerves provide primary innervation to skin of auricle?

A

1) Great auricular n.
2) Auriculotemporal n. (CN V3)

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259
Q

What two nerves have a minor contribution to innervation of skin of auricle?

A

1) CN7
2) CN10

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260
Q

What two nerves innervate the auditory canal and external TM?

A

CN V3 & CN X

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261
Q

What does it mean if the tympanic membrane is in a neutral position?

A

The pressure is equal between the middle ear and outside

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262
Q

What are the two openings of the middle ear?

A

1) Posterosuperior with mastoid antrum (i.e. to mastoid air cells)
2) Pharyngotympanic tube (aka Eustachian tube)

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263
Q

What is found within the middle ear/ tympanic cavity? (4 things)

A

1) Auditory ossicles
2) Tendons of stapedius and tensor tympani m.
3) Chorda tympani n. (br. of CN VII )
4) Tympanic plexus of nerves

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264
Q

Is the carotid plexus sympathetic or parasympathetic?

A

Sympathetic

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265
Q

1) What is the stapes (stirrup)?
2) How are sound waves converted from air to mechanical force?

A

1) Base or footplate occupies the oval window
2) At TM through ossicles

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266
Q

What allows for 10x vibratory amplification in the middle ear?

A

Base of stapes is considerably smaller than TM

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267
Q

Two muscles of middle ear slide 43
1) What do the two muscles of the middle ear collectively do?
2A&B) Name the two muscles of the ear, describe what each does, and what each is innervated by

A

1) Resist or dampen movement of auditory ossicles
2a) Tensor tympani: Inserts into handle of malleolus
-CN V3
2b) Stapedius: Pyramidal eminence that inserts onto stapes
-CN VII (nerve to stapedius)

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268
Q

What equalizes pressure between the middle ear cavity and external atmosphere?

A

Eustachian tube; opens into nasopharynx

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269
Q

What does the vestibulocochlear organ do? (2 things)

A

Sound and balance

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270
Q

What are the two labyrinths of the inner ear? Describe each

A

1) Boney labyrinth: fluid filled space of the surrounded by otic capsule
2) Membranous labyrinth: sacs and ducts suspended in the boney labyrinth

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271
Q

What are the two parts of the membranous labyrinth? What does each contain?

A

1) Cochlear labyrinth
-Cochlear duct
2) Vestibular labyrinth
-Utricle and saccule

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272
Q

What are the 3 symptoms of Meniere’s disease (CN7)? Are these bilateral or ipsilateral?

A

1) Tinnitus
2) Vertigo
3) Hearing loss
-Often unilateral symptoms

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273
Q

What is an acoustic neuroma? Are its symptoms bilateral or ipsilateral?

A

1) Peripheral lesion (cerebellopontine angle) of CN7
2) Ipsilateral symptoms

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274
Q

1) What two muscles open the eyelid?
2) What innervates these?

A

1) Levator palpebrae superioris and superior tarsal mm. opens lid
2) CN 3 somatic and visceral motor

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275
Q

When the sclera of someone’s eye becomes red, what is occurring?

A

Subconjunctival hemorrhage

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276
Q

True or false: the lacrimal gland is above the rim of the orbit and can’t usually be palpated

A

True

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277
Q

1) What do the lacrimal canaliculi terminate as? What do they lead to?
2) What do they do?

A

1) The lacrimal punctum (openings of canaliculi); lead to lacrimal lake w papillae [elevation in eyelids].
2) Convey fluid to nasolacrimal duct [then goes to nasal cavity]

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278
Q

1) What leads to the nasolacrimal duct?
2) Where does it drain?

A

1) Lacrimal sac
2) Into nasal cavity into inferior meatus (lateral to the inferior concha)

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279
Q

Where is the apex of the orbit?

A

Optic canal in the lesser wing of sphenoid

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280
Q

What produces aqueous humor?

A

Ciliary body

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281
Q

1) What is periorbital (pre-septal) cellulitis?
2) Where does venous blood here flow?

A

1) A skin and soft tissue infection around that eye that is anterior to the orbital septum
2) Into the cavernous sinus

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282
Q

1) What is orbital cellulitis?
2) What can cause it?
3) How is it diagnosed?
4) What are some complications it can cause?

A

1) Infection of the orbital tissue posterior to the orbital septum.
2) An external focus of infection (e.g., a wound), infection that extends from the nasal sinuses or teeth, or metastatic spread from infection elsewhere.
3) CT/MRI
4) Can become an orbital abscess, which can easily become a subperiosteal abscess, which can become cavernous sinus thrombosis

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283
Q

1) What is the limbus?
2) How large is it, what color, and what does it contain?

A

1) Angle formed at junction of sclera and cornea
2) 1mm, grey, with numerous capillary loops to nourish the cornea

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284
Q

1) Name 2 attributes of the cornea.
2) What two things keep it moist?

A

1) Transparent, avascular
2) Bathed in lacrimal fluid and aqueous humor on surface

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285
Q

What are the 3 parts of the fibrous layer of the eyeball?

A

Sclera, limbus, and cornea

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286
Q

1) What nerve provides sensory innervation for the corneal touch reflex?
2) What provides motor innervation for the corneal reflex?

A

1) CN V1 (afferent)
2) CN 7 (efferent)

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287
Q

What are the 3 parts of the vascular layer of eyeball?

A

1) Choroid (uveal tract)
2) Ciliary body/processes (involved w aqueous humor and fibers)
3) Iris/pupil

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288
Q

1) What is the choroid?
2) What does it do? Where is it attached?
3) What is it continuous with?
4) What does it cause? [hint: red]

A

1) Vascular bed between sclera and retina
2) Nourishes retina; attached to retina’s pigmented layer
3) Continuous anterior with ciliary body and iris
4) Red reflex in infant

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289
Q

1) What part of the ciliary body is constricted? By sympathetic or parasympathetic?
2) What part of the ciliary body is dilated ? By sympathetic or parasympathetic?

A

1) Parasympathetic constricts sphincter papillae m,
2) Sympathetic dilates pupil dilator pupillae

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290
Q

1) What does ciliary body provide attachment for? How? What does this allow for?
2) What does it fold on? What does this form and what does that do?
3) Where does it get its innervation from?

A

1) The lens via zonular fibers; allows for fine focus & accommodation
2) On internal surface of body; ciliary process, secretes aqueous humor
3) Parasympathetic from ciliary ganglia (from CNIII)

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291
Q

Are ciliary ganglia sympathetic or parasympathetic and motor or sensory? What do they do?

A

Parasympathetic motor ganglia; allow for constriction of the iris, pupil, and accommodation

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292
Q

1) What does the iris control?
2) What innervation causes it to constrict the pupil?
3) What innervation causes it to dilate the pupil?

A

1) Aperture (pupil) for light regulation
2) Parasympathetic via ciliary ganglia to sphincter pupillae
3) Sympathetic to dilator pupillae

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293
Q

What cranial nerve parasympathetically stimulates the iris? How?

A

CN III; postsynaptic fibers from ciliary ganglia

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294
Q

What two nerves are involved in pupillary response?

A

1) CN II (afferent/ sensory)
2) CN III (efferent/ motor)

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295
Q

What are the two parts of the optic part of the retina? What does each do?

A

1) Neural layer: sensitive to visual light
2) Pigment layer: absorbs light, reduce scatter

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296
Q

What are the two parts of the retina?

A

1) Optic part
2) Nonvisual part

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297
Q

1) What is the nonvisual part of the retina?
2) What does it extend anteriorly over?

A

1) Anterior extension of pigmented layer of retina
2) Ciliary body and iris

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298
Q

What is the ocular fundus?

A

Part of eye light strikes when entering eye; what you can visualize during fundoscopic exam

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299
Q

1) What happens at the optic disc/papilla?
2) Why is this location unique?

A

1) Optic n. enters and radiates to periphery
2) No receptors; our vision’s blind spot

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300
Q

What is lateral to the optic disc? What does it do?

A

Macula/fovea; specialized for acuity vision

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301
Q

1) What is at the center of the macula? What is this in our vision?
2) What is unique about the center of the macula?

A

1) Fovea centralis; area of most acute vision
2) Fovea lacks capillary network visible elsewhere deep to retina

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302
Q

What are the important parts of the ocular fundus?

A

1) Optic disc/papilla
2) Macula/fovea

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303
Q

Where does most refraction of the eye occur?

A

Cornea

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304
Q

What 5 parts of the eye are reflective?

A

1) Tear film
2) Cornea
3) Aqueous humor
4) Lens (accommodation)
5) Vitreous humor

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305
Q

What is the pathway of light from the environment to the retina? (8 steps)

A

1) Environment
2) Cornea
3) AC (aqueous humor)
4) Through pupil
5) PC (aqueous humor)
6) Lens
7) Vitreous
8) Retina/optic nerve

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306
Q

Aqueous humor:
1) Where is it produced
2) Where does it flow through?
3) What does it do?

A

1) By ciliary process in posterior chamber
2) Flows thru pupil into anterior chamber
3) Nourishes lens and cornea

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307
Q

1) What drains the aqueous humor? Where does it go?
2) What removes it?
3) What is this similar to?

A

1) Drains thru trabecular meshwork at iridocorneal angle into scleral venous sinus (canal of Schlemm)
2) Removed by limbal plexus
3) Like CSF: production – flow – absorption

308
Q

1) What are the types of glaucoma?
2) What is it a common cause of?
3) What typically accompanies it?
4) What causes it?

A

1) Chronic or acute
2) Blindness
3) Increased IOP
4) Compression of retina and retinal arteries causing damage to optic nerve

309
Q

What does absence of the tarsal muscle cause?

A

Ptosis or droopy upper lid

310
Q

True or false: The orbital axis is different from the visual axis

A

True

311
Q

If someone had complete CN III palsy (an injury due to increased intracranial pressure from bleed), what would this cause? Why? (5 things)

A

1) Ptosis: unopposed orbicularis oculi
2) No pupillary light reflex
3) Dilated pupil (“blown pupil”): unopposed dilator pupillae m. due to loss of parasympathetic input
4) No accommodation
5) Eyeball (pupil) fully abducted and depressed: unopposed LR and SO

312
Q

What would a CN 6 (Abducent n.) injury cause? (2 things)

A

1) Affected abduct pupil on ipsilateral side
2) Space occupying lesion, increased intercranial pressure

313
Q

What 3 nerves traverse the superior orbital fissure?

A

1) CN 3, Oculomotor n. (AO)
2) CN 4, Trochlear n. (SO)
3) CN 6, Abducens n. (LR)

314
Q

1) What kind of vision loss does central retinal artery occlusion (CRAO) cause? Is it abrupt? Is it painful?
2) What usually causes it?

A

1) Acute, painless, vision loss, ipsilateral lesion
2) Temporal arteritis (autoimmune d/o); emboli from carotid stenosis

315
Q

1) What kind of vision loss does central retinal venous occlusion (CRVO) cause? Is it abrupt? Is it painful?
2) What usually causes it?
3) Where can it extend to?

A

1) Less abrupt, painless, vision loss ipsilateral
2) Emboli or infection
3) Cavernous sinus

316
Q

1) What is the primary blood supply to the eye?
2) What is the only supply to the neuronal layer of the retina?
3) What do the choroid vessels supply blood to?
4) Where do the veins of the eye drain?

A

1) Internal carotid via ophthalmic artery
2) Central artery of retina
3) External aspect of retina
4) Cavernous and pterygoid sinuses

317
Q

Name an afferent pupillary light defect

A

“Marcus Gunn” pupil

318
Q

Define presbyopia

A

Loss of accommodation

319
Q

Define accommodation and what innervation is involved

A

Active process of changing shape of lens for near vision; CN3, parasympathetic postganglionic fibers

320
Q

What are the two main layers of fascia in the neck?

A

1) Superficial fascia
2) Deep cervical facia (which has 3 compartments itself)

321
Q

What are the 3 compartments of the deep cervical facia?

A

1) Investing
2) Pretracheal
3) Prevertebral

322
Q

1) What is the superficial fascia of the neck made of?
2) What does it contain?

A

1) SQ tissue
2) Contains nerves, vessels, nodes, adipose, and Platysma muscle

323
Q

1) What does the deep cervical facia allow for?
2) What does it contain, and how is this medically significant?

A

1) Slippery for movement (swallowing and turning head)
2) Natural cleavage planes; used in surgical contexts and kept in mind as infection spreads

324
Q

Describe the investing fascia of the deep cervical fascia of the neck; what does it surround and invest in?

A

1) Surrounds entire neck deep to skin and Superficial fascia
2) “4 corners” “invests” in SCM (sternocleidomastoid) and Trapezius mm.

325
Q

What innervates the SCM (sternocleidomastoid) and Trapezius mm?

A

CN11

326
Q

Name 5 groups of structures found within the carotid sheath

A

1) Common and internal carotid a., carotid sinus n.
2) Sympathetic nerve plexus
3) IJV
4) CNs 9, 10, 11, 12
5) Deep cervical nodes

327
Q

1) What does the retropharyngeal space permit?
2) Where is it?

A

1) Movement of neck visceral relative to the cervical vertebrae during swallowing
2) Between pre-vertebral facia and pre-tracheal (buccopharyngeal) fascia

328
Q

1) What is the the largest and most clinically important interfascial space in the neck? Why?
2) Where is it?
3) How is the alar fascia related to it?

A

1) Retropharyngeal space; major pathway for spread of infection in the neck
2) Between pre-vertebral facia and pre-tracheal (buccopharyngeal) fascia
3) Forms the anterior extent of the retropharyngeal space

329
Q

1) Where is the platysma muscle?
2) What does it do?

A

1) Covers anterolateral aspect of the neck
2) Muscle of facial expression

330
Q

What is a major landmark of the lateral-posterior region of neck?

A

Trapezius muscle

331
Q

What are the 3 superficial structures of the Neck?

A

1) Platysma muscle
2) SCM muscle
3) Trapezius muscle

332
Q

List the 4 regions of the neck from medial to lateral

A

1) Anterior cervical
2) SCM region: visibly divides the anterior + lateral regions 3) Lateral cervical
4) Posterior cervical

333
Q

What nerve is very superficial on the neck?

A

Spinal accessory nerve (CN11)

334
Q

What are the nerves of the lateral cervical region?

A

1) Spinal accessory n., CN XI
2) Root of the brachial plexus (made of anterior rami of C5-8, T1)

335
Q

1) Where is the spinal accessory nerve (CN11) in the neck?
2) What innervation does it provide to the neck?

A

1) Passes deep to the SCM into the lateral cervical region 2) Motor to the trap and SCM

336
Q

1) What does the root of the brachial plexus contain?
2) Where does it appear?
3) Where does it descend? Into what?
4) What does it provide innervation to?

A

1) Anterior rami of C5-8, T1
2) Between anterior & middle scalene muscles
3) Between the 1st rib, clavicle and superior boarder of the scapula (cervico-axillary canal) into the axilla
4) Innervation to most of the UE

337
Q

1) What forms the cervical plexus? What do they form?
2) What are the superficial branches of this plexus?
3) What are the deep branches?

A

1) Anterior rami C1-4; form series of loops
2) Cutaneous sensory nerves
3) Motor

338
Q

1) Name a nerve that comes from the cervical plexus that does motor innervation
2) What does it do?

A

1) Phrenic nerve
2) Traverses entire thoracic cavity to allow diaphragm to contract (somatic motor)

339
Q

What is the “nerve point of the neck”? What does it provide?

A

The superficial branches of the cervical plexus; provides cutaneous sensory information

340
Q

What is the clinical significance of the nerve point of the neck?

A

Anesthesia Cervical block for procedures in neck and upper arm; infiltrate along posterior boarder of the SCM jct superior and middle 3rds

341
Q

Name two deep nerves of the deep branches (passing anteromedially) of the cervical plexus

A

1) Phrenic
2) Ansi Cervicalis (anterior cervical region) is made of branches of C1-3 [of the plexus]

342
Q

1) What part of the cervical plexus is the phrenic nerve?
2) What innervation does it provide?
3) Where is the accessory phrenic nerve?

A

1) C3-4-5
2) Mixed somatic motor, sensory, sympathetic to mediastinum
-Sole motor to diaphragm
3) C-5

343
Q

1) What would disruption of phrenic nerve cause?
2) Give an example of this

A

1) Paralysis of the ipsilateral diaphragm
2) Local anesthesia via phrenic nerve block paralyses ipsilateral diaphragm for thoracic surgery
-Infiltrate around the nerve where it lies on the anterior surface of the anterior scalene muscle.

344
Q

When is jugular venous distention seen, where, and on which side?

A

When a patient is in their bed around 30 degrees, their right IJV (between heads of SCM) can be seen distended with visible pulsations when IJV has high pressure.

345
Q

Why is the EJV (external jugular v) often “full”?

A

Due to volume overload in HF (heart failure)

346
Q

1) What may the EJV serve as?
2) What does it look like when pressure is normal?
3) What about when pressure rises (like in HF)?

A

1) An “internal barometer.”
2) EJV is usually visible superior to the clavicle for only a short distance.
3) The vein is prominent throughout its course along the side of the neck.

347
Q

1) What are the two clinically relevant veins in the lateral cervical region?
2) Where are central lines placed?
3) What is at risk of puncture when that’s done?

A

1) Brachiocephalic and subclavian veins
2) Subclavian vein
3) Pleura and subclavian artery at risk of puncture

348
Q

Where is the carotid artery in comparison to the IVJ?

A

Runs medial to IJV

349
Q

What are the two types of muscles that attach to the hyoid bone?

A

1) Suprahyoid muscles - superior
2) Infrahyoid muscles - inferior
hyoid

350
Q

1) What do the muscles of the anterior cervical region (aka extrinsic muscles of the pharynx) do?
2) What are they innervated by?

A

1) Steady or move the hyoid and larynx
2) CNs (9&10) and cervical plexus

351
Q

What forms the Adam’s apple?

A

Anterior aspect of thyroid cartilage

352
Q

1) Where are the suprahyoid muscles?
2) What do they make up?
3) What do they support?
4) What do they do?

A

1) Superior to hyoid bone connecting the hyoid to head/jaw
2) Floor of the mouth
3) Supports hyoid bone; providing a base from which the tongue functions
4) Elevating hyoid and larynx in relation to swallowing and tone production

353
Q

1) Where are the infrahyoid muscles?
2) What do they anchor? To where?
3) What are they generally innervated by?

A

1) Inferior to hyoid bone
2) Anchor hyoid to sternum, clavicle, & scapula, depressing the hyoid and larynx during swallowing & speaking
3) Cervical plexus

354
Q

1) What does the internal carotid not have branches to?
2) What does it enter? Via what?
3) What does it supply? Using what branches?
4) How does it provide the central retinal artery?

A

1) No branches in the neck
2) Cranium via carotid canal
3) Main blood supply to brain and orbits; supratrochlear and supraorbital arteries
4) Via ophthalmic artery

355
Q

What carotid artery has branches in the neck?

A

External

356
Q

What 7 arteries come from external carotid?

A

1) Superior thyroid
2) Lingual
3) Facial (pulse)
4) Occipital
5) Posterior auricular
6) Maxillary
7) Superficial temporal (pulse)

357
Q

1) When is an IJV stick done?
2) Which side is better? Why?
3) How is it done?
4) Where is the needle directed?
5) What artery do you need to be careful to avoid?

A

1) Diagnostic or therapeutic purposes.
2) The right IJV is preferable because it is usually larger and straighter.
3) Palpate the common carotid artery and inserts the needle into the IJV just lateral to it at a 30-degree angle, aiming at the apex of the triangle between the sternal and clavicular heads of the SCM.
4) The needle is then directed inferolateral toward the ipsilateral nipple
5) Carotid artery; just anterior to IVJ

358
Q

Name 3 structures within the carotid sheath

A

1) Common carotid artery
2) IJV
3) Vagus n., CN X

359
Q

1) What provides visceral afferent innervation to the carotid body?
2) What does low PO2 cause the carotid body to do?

A

1) CN IX (Glossopharyngeal n.) & CN X (Vagus n.)
2) Increase rate and depth of respiration & HR, BP

360
Q

1) What does the carotid sinus do?
2) What kind of receptor is it? What stimulates it?
3) What provides its visceral afferent stimulation?

A

1) Monitors Systemic BP
2) Baroreceptor; increases in BP
3) CNs 9 & 10 (Glossopharyngeal & Vagus)

361
Q

What part of the head does not have lymph nodes?

A

The scalp

362
Q

What structure is only parasympathetic?

A

Ciliary body (is constricted by parasympathetic for accommodation)
*probably on quiz

363
Q

What innervates the iris?

A

Sympathetic
*probably on quiz

364
Q

Name a structure that is only sympathetically innervated

A

Smooth muscle of arteries

365
Q

What causes Horner’s syndrome?

A

Lesion to sympathetic trunk in the neck

366
Q

If you can’t shrug your shoulders, what nerve could be malfunctioning?

A

CN11 (spinal accessory)

367
Q

1) What do the intrinsic laryngeal muscles do?
2) What nerve(s) supply them?

A

1) Move laryngeal parts for voice
2) All but one (cricothyroid m. supplied by external laryngeal n.) are supplied by recurrent laryngeal nerve (br. of CN X, Vagus n.)

368
Q

What muscles are responsible for Voice change and abnormal efferent GAG reflex? What do they give clues to?

A

Intrinsic laryngeal muscles; vagus n. function

369
Q

What is the afferent pathway for the cough reflex to the brain? (3 steps)

A

1) Internal laryngeal n.
2) Via superior laryngeal n.
3) Via Vagus n. to medulla then on to cortex ( no identified cough center)

370
Q

What is the efferent pathway for the cough reflex from the brain? (3 steps)

A

1) Vagus n.
2) To superior laryngeal n. and nerves
3) To glottis and respiratory/expiratory muscles

371
Q

1) What is a tracheotomy?
2) Is it temporary or permanent?

A

1) An O.R. procedure for airway placement
2) Permanent

372
Q

What two things are found in the nasopharynx?

A

Pharyngeal tonsils (adenoids)
Eustachian tube

373
Q

1) What is the oropharynx responsible for?
2) What can you find within it?

A

1) Swallowing function
2) Tonsils (palatine)

374
Q

What are the two layers of pharyngeal muscles? What do they do?

A

1) External layer: constricts wall during swallowing
2) Internal layer: elevate pharynx and larynx during swallowing and speaking

375
Q

1) What does the cervical plexus provide the most innervation to?
2) What nerves are involved with the cervical plexus?

A

1) Motor to infrahyoid
2) Mostly spinal, but some hypoglossal nerve involvement

376
Q

What are the two main parts of the pulmonary cavity?

A

1) Viscera: primarily lungs, vessels, airways
2) Pleura: Pleural cavity

377
Q

What are the two main types of pleura found in the thoracic cavity?

A

Parietal and visceral

378
Q

1) What is the sternal angle (manubriosternal joint)?
2) What spinal level is it at?
3) What is found here?

A

1) 2nd rib articulation and connection between manubrium and body of sternum
2) T5
3) Bifurcation of the trachea; base of the heart/root of the ascending aorta

379
Q

What property is conveyed by the costochondral cartilages? Why?

A

Flexibility, prevent traumatic fx,

380
Q

Describe the thoracic inlet and thoracic outlet

A

1) Thoracic inlet: trachea, esophagus, vessels and nerves
2) Thoracic outlet: closed by diaphragm; IVC, esophagus pass through diaphragm, aorta passes posterior to diaphragm

381
Q

1) Describe flail chest
2) Is it painful? What does this cause?

A

1) Multiple rib fractures cause paradoxical wall movement
2) Painful to breathe in, which causes poor ventilation & leads to atelectasis

382
Q

What causes thoracic outlet syndrome?

A

Compression of structures between 1st rib and clavicle

383
Q

List the 8 parts of the sternum

A

1) Manubrium: upper section of sternum
2) Clavicular notch: superior lateral notches of manubrium
3) Jugular notch: superior medial notch of manubrium
4) Costal cartilage: lateral part of manubrium
5) Costal notches: lateral notches of body
6) Sternal angle: The manubriosternal joint
7) Body: general longer part
8) Xiphoid process: inferior small piece attached to body

384
Q

What 3 types of muscles can be involved with inhalation?

A

1) Intercostals
2) Diaphragm
3) Accessory

385
Q

1) How many pairs of thoracic spinal nerves are there?
2) What do their posterior rami innervate?

A

1) 12
2) Bones, joints, intrinsic back mm., and over lying skin (dermatomes)

386
Q

What are the two things formed by the thoracic spinal nerve anterior rami?

A

1) Anterior rami T1-11: forms intercostal nerves
2) Anterior rami T12: forms subcostal nerve

387
Q

What is the order of the vessels and nerve in each rib from superior to inferior?

A

V.A.N (vein, artery, nerve)

388
Q

1) Where should thoracentesis be performed? Why?
2) What is done during this procedure?
3) Why?

A

1) To avoid injury to intercostals, go over top of rib, high enough to avoid collaterals.
2) Collect pleural fluid sample for analysis
3) Therapeutic

389
Q

What space is the chest tube once
appropriately placed?

A

4th intercostal space, at the mid clavicular line

390
Q

What are the 4 main arteries that supply the thoracic wall?

A

1) Posterior intercostal arteries
2) Internal thoracic artery
3) Anterior intercostal arteries (2)
4) Subcostal arteries

391
Q

1) Where does the internal thoracic artery come from?
2) What two things does it divide into?

A

1) Subclavian artery
2) Musculophrenic and superior epigastric arteries

392
Q

Where does the subcostal artery come from?

A

Aorta

393
Q

What provide blood to the intercostal space?

A

1) Posterior intercostal arteries + collateral br.
2) Anterior intercostal arteries + collateral br.

394
Q

How many thoracic veins are there?

A

1) 11 pairs intercostal veins
2) 1 pair subcostal veins

395
Q

1) What do the posterior IC veins anastomose with?
2) What do most posterior IC veins drain into?

A

1) Anterior IC veins.
2) Azygos/hemi-azygos venous system to SVC

396
Q

1) What are the lactiferous ducts?
2) What is the lactiferous sinus?

A

1) Drains each lobule, open independently on the nipple
2) Dilated portion of each lactiferous duct just deep to areola

397
Q

List all 6 mammary gland structures

A

1) Nipple
2) Areola
3) Lobules
4) Lactiferous duct
5) Lactiferous sinus
6) Suspensory ligaments

398
Q

With mastitis, what directions can infection spread?

A

Superiorly, laterally, or medial to the breast

399
Q

Where does most drainage from the lymphatic plexus of the breast go? What %?

A

75% to axillary nodes (pect., central, & apical nodes)

400
Q

1) Where do the medial breast quadrants drain?
2) Where may the inferior quadrants pass?

A

1) Parasternal nodes or contralateral breast
2) Deeply to abdominal lymph nodes

401
Q

What are some visual symptoms of BC

A

1) Skin dimpling
2) Edema
3) Nipple retraction and deviation
4) Abnormal contours

402
Q

1) What do the right and left pulmonary cavities contain?
2) What is between the parietal and visceral pleura?

A

1) Lungs and pleura
2) Pleural cavity

403
Q

What 6 things are found within the mediastinum?

A

1) Heart
2) Great vessels
3) Trachea
4) Esophagus
5) Thymus
6) Lymph nodes

404
Q

What are the 4 parts of the parietal pleura?

A

1) Apical or cervical pleura
2) Costal pleura
3) Diaphragmatic pleura
4) Mediastinal pleura

405
Q

What does the parietal pleura cover?

A

Endothoracic fascia/wall

406
Q

What do the parietal and visceral pleura of the visceral cavity create?

A

Pleural “space” or sac

407
Q

List the lobes of the right lung and what separates each

A

1) Superior lobe
-Horizontal fissure
2) Middle lobe
-Oblique fissure
3) Inferior lobe
-Has costodiaphragmatic recess

408
Q

List the lobes of the left side of the lung and what separates them

A

1) Superior lobe: lingula
-Oblique fissure
2) Inferior lobe

409
Q

What muscles are recruited during times of increased respiratory effort?

A

Scalenes and SCM

410
Q

What separate the breast from the underlying pectoral muscles?

A

1) SQ tissue
2) Retromammary space (bursa)
3) Pectoral fascia

411
Q

1) What ribs articulate directly with the sternum?
2) What about via the costal arch?
3) What ribs are floating?

A

1) First 7 ribs (“true ribs”)
2) 8-10
3) Ribs 11 & 12

412
Q

Where does most blood supply to the breasts come from? Know where the branches come from.

A

1) Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery: originate from the subclavian artery
2) Mammary branches of lateral thoracic and thoraco- acromial arteries: branches of the axillary artery
3) Posterior intercostal arteries: branches of the thoracic aorta that run in the intercostal spaces

413
Q

Describe the dermatomes of the neck and trunk

A

1) C1: inferior neck
2) C3: clavicle
3) C4: includes top of shoulder
4) T2: below C4 on thorax
5) T3-12 until L1
>T5 is where the male nipple is

414
Q

Describe the basic process of lactation

A

1) Lobules of mammary gland grow and fill up
2) Lactiferous ducts confer milk to the nipple, passing through the lactiferous sinus just before reaching it

415
Q

Normally lungs are radio_________ and vessels will be more radio________

A

radiolucent; radiopaque

416
Q

What supply each segment of the lungs with air, blood to oxygenate, and drainage of blood?

A

1) Segmental bronchus (air)
2) Tertiary branch of pulmonary artery (blood)
3) Intersegmental parts of pulmonary vein (blood drainage)

417
Q

What are the bronchopulmonary segments important for?

A

Lung segment resection (cancer, copd, etc)

418
Q

What part of the lungs can you find superior to the clavicle?

A

Cervical pleura and apices of lungs

419
Q

1) List how many costal cartilages there are on the right side
2) List how many there are on the left side

A

1) 2-6 on right
2) 2-4 on left

420
Q

1) What fissure does the right lung have that the left doesn’t?
2) Where is it?

A

1) Horizontal fissure
2) Extends from oblique fissure along 4th rib and costal cartilage anteriorly

421
Q

What are the two main vessels involved in pulmonary circulation?

A

1) Pulmonary artery
2) Pulmonary vein

422
Q

1) What does the pulmonary artery arise from?
2) What does it divide into within each lung?
3) What does that divide into after that?
4) What kind of blood does it carry?

A

1) Pulmonary trunk (left and right)
2) Lobar arteries
3) Segmental arteries
4) Poorly oxygenated blood

423
Q

Describe the route of the right pulmonary artery

A

Passes underneath aortic arch and posterior to SVC

424
Q

1) What pleura is insensitive?
2) What pleura is sensitive? What condition is this associated with?

A

1) Viscera pleura
2) Parietal pleura very sensitive to pain; “pleuritis”

425
Q

1) What arteries supply the lung tissues and structures?
2) Is the blood deoxygenated or oxygenated?
3) Where does the left one arise from?
4) Where does the right one arise from?

A

1) Bronchial arteries
2) Oxygenated
3) Aorta
4) Right varies

426
Q

1) What do bronchial veins drain? Where do they drain into?
2) What do pulmonary veins drain?

A

1) Only proximal parts [of lungs] into azygos vein
2) More distal tissue

427
Q

What is the significance of one main stem bronchi being shorter and wider than the other? (2 reasons)

A

1) Right main stem is a common place for foreign body or GI aspiration
2) Right main E-tube placement

428
Q

Most post ganglionic sympathetic nerves are ______adrenergic/ cholinergic__________

A

adrenergic (relating to epinephrine)

429
Q

Most pre ganglionic neurons are ______adrenergic/ cholinergic__________

A

cholinergic (relating to acetylcholine)

430
Q

1) What is the primary muscle of respiration?
2) Which part descends during respiration?
3) Which part is higher on one side than the other?
4) How many openings does it have?

A

1) Diaphragm
2) Central portion
3) Right dome higher than left dome
4) 3 hiatal openings

431
Q

1) Where is the caval opening?
2) What adheres to the opening?
3) What nerve is here?

A

1) Right of median plan in central tendon
2) Inferior vena cava (IVC) adheres
3) Right phrenic nerve’s terminal branch.

432
Q

What are the 3 openings in the diaphragm? List their locations.

A

1) Caval opening (in central tendon)
2) Esophageal hiatus (right crus forming sphincter)
3) Aortic hiatus (posterior to diaphragm)

433
Q

1) What 3 things go through the esophageal hiatus?
2) Where is it?

A

1) Vagus nerve trunks, esophageal vessels, & lymphatics
2) In right crus (forming sphincter) at about T10 level

434
Q

What two things go through the aortic hiatus posterior to diaphragm?

A

Azygos vein & thoracic duct

435
Q

Where does gas exchange occur?

A

The last 3 parts of the trachea:
1) Bronchioles
2) Alveolar ducts
3) Alveolar sacs

436
Q

__________ is slightly on left side of vertebral bodies, __________ is on the right side.

A

Aorta; SVC

437
Q

There’s a gap in the diaphragm for what muscle?

A

Psoas

438
Q

1) What is just inferior to the aortic hiatus?
2) What’s just inferior to that?

A

1) Celiac trunk
2) Superior mesenteric artery

439
Q

1) What muscle does the phrenic nerve cross over?
2) Where does it go after the diaphragm?

A

1) Anterior scalene m.
2) Enters thorax anterior to subclavian artery and posterior to subclavian vein

440
Q

Why do we care about the phrenic innervation of the diaphragm?

A

Right phrenic nerve may be responsible for paralysis of right hemidiaphragm

*might be on quiz

441
Q

What is within the central mediastinal cavity?

A

Pericardium, pericardial cavity, heart & great vessels, trachea, esophagus

442
Q

What two things are within the right & left pulmonary cavities?

A

Lungs and the pleural cavities

443
Q

1) What is the central compartment of the thoracic cavity?
2) What pleura are found here?
3) What thoracic viscera does this compartment contain?

A

1) Mediastinum
2) Mediastinal pleura
3) All the viscera in thorax except lungs

444
Q

What are the inferior and superior borders of the mediastinum called? What makes up the inferior part?

A

1) Superior thoracic aperture
2) Inferior thoracic aperture: diaphragm

445
Q

1) Where are the anterior and posterior boundaries of the superior mediastinum?
2) Where is the transverse thoracic plane?

A

1) Superior thoracic aperture (first rib, clavicle, & jugular notch) to sternal angle anteriorly; to T5 posteriorly.
2) Runs anterior-posterior horizontally, from sternal angle anteriorly to superior endplate of T5 posteriorly

446
Q

1) What are the boundaries of the inferior mediastinum?
2) What further divides the inferior mediastinum?

A

1) Transverse thoracic plane anteriorly, to diaphragm
2) Pericardium

447
Q

What are the 3 divisions of the inferior mediastinum, and what do they contain?

A

1) Anterior mediastinum: clear space
2) Middle mediastinum: heart
3) Posterior mediastinum: esophagus and descending thoracic aorta

448
Q

Describe the esophageal plexus of nerves:
1) What is it made up of?
2) What does it modulate?

A

1) Made up of postsynaptic sympathetic and presynaptic parasympathetic fibers
2) Gives branches to the esophagus to modulate the enteric nervous system (smooth muscles of GI viscera)

449
Q

What does the cardiopulmonary plexus supply?
Where does it go?

A

1) To the heart itself and smooth muscles of airways
2) Follow vessels through the hilum as part of the root of the lung

450
Q

What does the vagus nerve do once it gives off the left and right recurrent laryngeal nerves? (3 things)

A

1) Forms net around trachea as a part of pulmonary plexus and around esophagus as part of esophageal plexus
2) Then anterior and posterior vagus nerves form vagal trunk at the esophageal hiatus (along with sympathetic fibers)
3) Goes into esophagus, bronchial smooth tissue, and cardiac muscle

451
Q

What are the two layers of the serous (inner) layer of the pericardial sac, and what are they attached to?
What is between them?

A

1) Outer parietal layer: adhered to the fibrous layer
2) Inner visceral layer: adhered to the heart, aka epicardium
Pericardial cavity is between them

452
Q

1) What is the pericardial cavity?
2) What is the transverse pericardial sinus?
3) What is the other pericardial sinus?

A

1) Potential space with thin film of serous fluid
2) Reflection of pericardium
3) Oblique pericardial sinus

453
Q

What structure of the heart is similar to the pleura of the lungs?

A

The pericardium

454
Q

What does the pericardium fuse with?

A

Tunic adventitia

455
Q

How does blood enter and exit the right side of the heart?

A

Enters: SVC and IVC
Exits: Pulmonary artery

456
Q

How does blood enter and exit the left side of the heart?

A

Enter: Pulmonary veins
Exit: Aorta

457
Q

What are the 3 layers of the pericardium?

A

1) Fibrous (gray)
2) Parietal serous
3) Visceral serous (aka epicardium)

458
Q

What are the major branches of thoracic aorta?

A

1) Coronary arteries
2) Right brachiocephalic trunk
3) Arch of aorta
4) Posterior intercostals

459
Q

What are two branches of the right brachiocephalic trunk?

A

1) Right common carotid
2) Right subclavian

460
Q

What two things come off the arch of the aorta?

A

1) Left common carotid
2) Left subclavian

461
Q

What is inside the aortic SL valve?

A

Lateral sinuses contain the right and left coronary arteries

462
Q

Describe the anatomy of the left and right coronary arteries

A

1) Left coronary artery is usually the main/ dominant one, has 2 branches: left anterior descending/ anterior IV septal branch (descends along anterior margin of AV septum) and the circumflex branch.
2) Right coronary artery supplies blood to right ventricle, then goes behind and forms right septum and they meet on the posterior side of the apex.

463
Q

Which recurrent laryngeal nerve has a longer course? Why is this important?

A

Left recurrent laryngeal nerve; more prone to injury

464
Q

What provides autonomic innervation to the heart?

A

Cardiac plexus’s sympathetic and parasympathetic components

465
Q

1) What forms the sympathetic part of cardiac plexus?
2) What do the fibers innervate?

A

1) Presynaptic cell bodies: thoracic lateral horn T1-5(6)
Postsynaptic cell bodies: cervical and superior thoracic paravertebral ganglia
2) SA + AV nodes and cardiac muscle cells

466
Q

1) What forms the parasympathetic part of cardiac plexus?
2) Where are the postsynaptic cell bodies?

A

1) Presynaptic fibers of the CN10 (vagus).
2) Postsynaptic cell bodies (intrinsic ganglia) located near SA and AV node, along coronary arteries.

467
Q

What does sympathetic stimulation do to the heart? What does it dilate?

A

Increases rate and force, dilates coronary arteries

468
Q

The electrical cells of the heart pause everything to allow contraction of ________, then goes to bundle of his (anterior and posterior) and Purkinje fibers

A

atria

469
Q

What are the two main divisions of the two coronary arteries?

A

1) RCA (right coronary artery) & posterior IV branch
2) LCA (left coronary artery), Anterior IV branch (LAD) & circumflex branch

470
Q

What are two branches of the left coronary artery (LCA)?

A

Anterior IV branch (LAD) & circumflex branch

471
Q

1) What are the most important sinuses of the coronary arteries?
2) When during cardiac cycle are coronary arteries perfused?

A

1) Right and left aortic sinus
2) Diastole

472
Q

Why is the left coronary artery involved in more arrythmias than right coronary artery?

A

Anterior 2/3 of the IV septum is perfused by the anterior IV septal branch of LCA; happens to be where the bundle of His branches run. If you have an occlusion here, you’re likely to affect the conduction system of the heart and see rhythms early on.

473
Q

A complete occlusion of a left coronary artery is often called what?

A

“widowmaker’

474
Q

Where do the coronary veins empty?

A

Into coronary sinus in posterior sulcus OR directly into cardiac chambers

475
Q

The number one cause of death in Americans is?

A

CAD (coronary artery disease)

476
Q

Atrial cardiac muscle cells propagate impulse as they do what?

A

contract

477
Q

What does the bundle of His do? What do its branches supply?

A

Course down IV septum; dividing into right and left bundle branches to supply the papillary muscles and wall of ventricles.

478
Q

How many leaves do the valves on the left side of the heart have?

A

1) Mitral valve (2 leaves)
2) Aortic valve (3 leaves)

479
Q

List the path of blood through the heart including valves

A

R atrium
Tricuspid valve
R ventricle
Pulmonic valve
L atrium
Mitral valve (2 leaves)
L ventricle
Aortic valve (3 leaves)

480
Q

What is the most common valvular heart disease that’s brought to clinical attention?

A

Aortic stenosis

481
Q

What path does blood take in fetal circulation?

A

-Shunts blood from right side of heart to left or general circulation
-Blood flows through the ductus arteriosis to the left side
-Foramen ovale connects left and right atria

482
Q

What 2 parts of fetal circulation becomes no longer patent or open shortly after birth?

A

Ductus arteriosus (becomes ligamentous arteriosus) and foramen ovale

483
Q

What system is bypassed in fetal circulation?

A

Hepatic portal system

484
Q

What 6 things do the LCA’s anterior IV br. (LAD) & circumflex br supply?

A

1) Left atrium
2) Most of left ventricle
3) Part of right ventricle
4) Anterior 2/3 IV septum
5) AV bundle conducting system
6) SA node 40%

485
Q

What are the 4 main parts of the abdomen?

A

1) Abdominal wall
2) Abdominal cavity
3) Peritoneal cavity
4) Viscera

486
Q

What innervates the viscera pre-splenic flexure?

A

Vagus nerve

487
Q

What does the pelvic brim separate?

A

Greater pelvis of abdominal cavity and lesser pelvis of pelvic cavity

488
Q

What is the superior part of the ilium bones called?

A

Iliac crest

489
Q

1) What is the most medial anterior part of the pelvis called?
2) What is superior and slightly lateral to this?

A

1) Symphysis
2) Pubic tubercle

490
Q

What is the importance of the linea alba?

A

If you cut vertically down it you won’t cut through muscle.

(goes from xyphoid process, through umbilicus, to pubic symphysis)

491
Q

What are the layers of the anterolateral abdominal wall? (from superficial to deep)

A

1) Skin
2) Superficial fascia (SQ)
3) Investing (deep) fascia
4) Endo-abdominal fascia
5) Extraperitoneal fat
6) Parietal peritoneum

492
Q

What covers external aspects of 3 muscle layers of abdominal wall and their aponeurosis?

A

Investing (deep) fascia

493
Q

What are the two layers of the superficial fascia of the anterolateral abdominal wall? Describe each

A

1) Camper fascia: fatty layer
2) Scarpa fascia: deep membranous layer

494
Q

Where is the superficial fascia of the abdomen found? How many layers does it have?

A

Inferior to umbilicus; 2 layers

495
Q

What does the parietal peritoneum line?

A

Abdominal cavity

496
Q

Where in the abdomen is there a potential space for fluid/infection to spread?

A

Between scarpa fascia and deep fascia covering abdominal muscles

497
Q

What does the Scarpa fascia attach and fuse to?

A

Attaches to pubic bone and fuses with deep fascia of thigh

498
Q

List the 5 paired muscles of the abdominal wall

A

-3 flat muscles: External oblique, internal oblique, transversus abdominis mm.
-2 vertical muscles: Rectus abdominis, pyramidalis mm.

499
Q

What forms the aponeurosis anterior?

A

Flat muscle

500
Q

1) What encloses the rectus abdominis?
2) What does enclosing structure then form at the midline?

A

1) Rectus sheath
2) Linea alba

501
Q

Where does the linea alba run from and to?

A

Xyphoid to pubic symphysis

502
Q

What are the anterolateral abdominal muscles? (6)

A

1) Obliques: EO, IO, TA
2) Rectus: rectus sheath, linea alba
3) Pyramidalis

503
Q

1) What encloses the pyramidalis muscle? Where is it?
2) What does it arise from and insert into?
3) When does it tense?

A

1) Rectus sheath; pyramidalis is anterior to inferior part of rectus m.
2) Arises from pubic crest, inserts into linea alba
3) During Valsalva maneuver

504
Q

What is the aponeurosis of flat abdominal muscles?

A

Rectus sheath

505
Q

What are the 3 sections of the rectus sheath?

A

1) Superior to arcuate line
2) Arcuate line
3) Inferior to arcuate line

506
Q

Superior to the arcuate line:
1) What makes up the anterior rectus?
2) What makes up the posterior rectus?

A

1) Anterior: EO fascia + anterior lamina of IO
2) Posterior: Posterior lamina of IO + TA fascia

(eo is external oblique, io is internal oblique, TA is transversus abdominis

507
Q

1) Where is the arcuate line?
2) What does it demarcate?

A

1) 1/3 distance from umbilicus to pubic symphysis
2) The transition between the posterior rectus sheath covering the superior ¾ of the rectus abdominis proximally, and the transversalis fascia covering the inferior ¼

508
Q

At the arcuate line, what pierce the posterior rectus sheath to provide blood to rectus muscle?

A

Inferior epigastric arteries and veins

509
Q

1) What 2 muscles are contained within the rectus sheath?
2) What vessels are enclosed within it?
3) What nerves are enclosed within it?

A

1) Rectus abdominis m. and pyramidalis m.
2) Anastomosing inferior and superior epigastric vessels, lymphatics
3) Thoraco-abdominal and subcostal nerves (anterior rami of distal T7-12 spinal nerves)

510
Q

What are the 5 peritoneal folds that pass toward the umbilicus?

A

1) Median umbilical fold (ligament) (remnant of urachus, which is the apex of fetal bladder to umbilicus)
2&3) R & L medial umbilical fold (ligament) (umbilical arteries remnant)
4&5) R & L lateral umbilical fold over Inferior Epigastric a

511
Q

What is the urachus? What is a remnant of it?

A

The apex of fetal bladder to umbilicus; median umbilical fold (ligament)

512
Q

What is the remnant of the umbilical arteries?

A

Right and left medial umbilical folds (ligaments)

513
Q

The right and left lateral umbilical folds are over what?

A

Inferior epigastric arteries

514
Q

1) Where are indirect inguinal hernias found?
2) Where are direct inguinal hernias (straight through inguinal triangle) found?

A

1) Lateral inguinal fossa
2) Medial inguinal fossa

515
Q

There’s a small amt of peritoneal fluid in abdominal cavity; abnormal accumulation is called what?

A

Ascites

516
Q

Visceral pain tends to be with _____________ of GI tract

A

distention

517
Q

Describe the associated organs of the abdominal cavity

A

1) Liver: produces bile which helps digest fats
2) Pancreas: secretes pancreatic enzymes to help with digestion via exocrine process
3) Spleen: immune and hematological functions, can add RBCs

518
Q

Superficial to the pelvic diaphragm and deep to the skin is the ________________.

A

perineum

519
Q

List the 4 dermatomes of the abdomen. Where are they, and what does each innervate?

A

1) Thoracoabdominal: T7-11
-Lateral and anterior branches (of intercostal segmental nerves)
2) Subcostal: T12
-Lateral and anterior branches
3) Iliohypogastric: L1
-Skin over iliac crest, upper inguinal and hypogastric region
4) Ilioinguinal: L1
-Skin of scrotum or labia majorus, mons, adjacent medial aspect of thigh (afferent for cremaster reflex)

520
Q

Infection below umbilicus will infect ___________ nodes first, chest infection will affect the ______________ lymph nodes

A

inguinal; axillary

521
Q

What vein runs up the lateral side of the abdomen? What does it come from and turn into?

A

Thoraco-epigastric vein from superficial epigastric (from femoral) turns into lateral thoracic vein

522
Q

1) Where does the inguinal ligament run from?
2) What forms the inguinal ligament?

A

1) ASIS to PUBIC tubercle
2) Inferior margin of EO

523
Q

1) What does the inguinal canal do?
2) What is responsible for much of the structural features of the inguinal canal/ region

A

1) Allows structures to travel between abdominal cavity and scrotum
2) Descent of testis from abdomen into perineum during development; “vascular and nerve follow the bouncing ball”

524
Q

What structures are inferior (not to be confused w deep) to the inguinal ligament? What can one of them cause?

A

1) Lateral cutaneous nerve of the thigh (compression can cause meralgia parasthetica)
2) Femoral canal with: femoral n., fem art, fem vein (VAN)

525
Q

1) The internal surgical landmark corresponding to the inguinal ligament is the ____________________
2) What does the EO form?
3) Which is important to surface anatomy, inguinal ligament and iliopubic tract?

A

1) Iliopubic tract
2) Inguinal ligament
3) Inguinal ligament

526
Q

VANs are __________to inguinal ligament, and inferior epigastric nerves are _____________ to deep ring

A

inferior; lateral

527
Q

1) What makes up the inguinal triangle? (3 things)
2) A direct hernia pushed through triangle medially to what?

A

1) Rectus, inguinal ligament, inferior epigastric vessels
2) Inferior epigastric vessels

528
Q

What is the clinical application of the fact that the ligament follows spermatic cord from internal ring?

A

Direct hernias don’t go all the way into scrotum usually, but indirect hernias that follow the spermatic cord can go into the testicles

529
Q

What’s the difference between a direct and indirect hernia?

A

1) Direct hernia: hernia sac pushes MEDIAL to inferior epigastrics thru peritoneum, transversalis fascia and inguinal triangle, parallels spermatic cord, weakness in anterior abd wall, usually > 40 y/o
2) Indirect hernia: hernia sac inside spermatic cord, younger men, patency of processus vaginalis

530
Q

Inferior epigastric vessels follow what?

A

Arcuate line

531
Q

1) What is a hydrocele? What side is it more common on?
2) What is a varicocele? What side is a pampiniform plexus varicocele usually on?

A

1) Buildup of fluid in scrotum; equally common bilaterally
2) Varicose vein in scrotum; benign usually on left side because the right comes out of IVC at a different angle.

532
Q

1) What is the cremaster muscle a continuation of?
2) What does its contraction do?
3) What innervates it?
4) What reflex is it involved in? Explain this reflex.

A

1) IO muscle
2) Raises the testicle
3) Genital branch of the genitofemoral nerve
4) Cremaster reflex: reflex is elicited (very active in kids) by stroking the inner thigh, afferent via ilio-inguinal n., efferent genitofemoral n.

533
Q

What is the Dartos muscle and what does it do?

A

1) Smooth muscle in the wall of the scrotum (gentofemoral nerve innervates?)
2) Contraction of skin of scrotum; wrinkles

534
Q

What muscles (2) and veins (1) help keep the testicle close to body in cold temps?

A

1) Cremaster muscle and dartos muscle
2) Pampiniform venous plexus

535
Q

What do the parietal and visceral layers of the tunica vaginalis make up?

A

1) Parietal: Cavity of the tunica vaginalis
2) Visceral: Testis

536
Q

What do the testicular arteries arise from?

A

Abdominal aorta (L2)

537
Q

-What do the left and right testicular veins empty into?
-In which testicular vein are varicoceles more common. Where are they concerning?

A

1) Left testicular vein empties into left renal vein
-Varicocele more common
2) Right testicular vein empties into IVC
-Varicocele concerning for IVC mass; renal cell carcinoma

538
Q

What are the endocrine and exocrine functions of the testes?

A

1) Endocrine function: Testosterone
2) Exocrine function: Sperm

539
Q

Where is fluid located in the scrotum?

A

Tunica vaginalis

540
Q

List the nerves of the scrotum and what each innervates

A

1) Genital br. of the genitofemoral n: to anterolateral surface
2) Ilioinguinal n: to anterior surface
3) Perineal br of Pudendal nerve: to posterior surface
4) Perineal br of posterior cutaneous nerve: of the thigh

541
Q

1) Where does vascular supply and drainage of the scrotum come from?
2) Where do the scrotal lymphatics drain? How is this different from testicular lymphatics?

A

1) Pudendal vessels
2) To superficial inguinal nodes
-Testicular lymphatic drainage: goes to midline (pre-aortic) nodes

542
Q

What provide the afferent and efferent parts of the Cremaster reflex?

A

1) Afferent: ilio-inguinal nerve
2) Efferent: genital br. of the genitofemoral nerve

543
Q

1) Where does lymph from the scrotum drain?
2) Where does lymph from the testes drain?
3) What does this explain?

A

1) To the inguinal lymph nodes and veins
2) To the pre-aortic lymph nodes
3) Difference in area at risk from cancer and infection of testes vs. scrotum

544
Q

1) What makes up the abdominopelvic cavity?
2) What makes up the thoracic cavity?

A

1) Peritoneum and viscera
2) Pleura, mediastinum, viscera

545
Q

What are the two layers of the peritoneum? What does each line?

A

1) Parietal peritoneum: lines internal surface of the abdominopelvic wall
2) Visceral peritoneum: covers viscera; retro peritoneal and intraperitoneal visceral

546
Q

slide 46
1) What is the peritoneal cavity (space)?
2) What does it contain?
3) Is it closed or open in men and women?

A

1) Potential space between the parietal and visceral peritoneum
2) Thin fluid; peritoneal fluid, but NO ORGANS in this cavity??
3) Closed in males; open in females (fallopian tubes into uterus, cervix and vagina to exterior)

547
Q

1) What is the mesentery? Describe it.
2) What type of communication does it provide the means for?
3) What property does it provide?

A

1) Double layer of peritoneum, occurs from invagination of peritoneum by organ, continuity of parietal and visceral peritoneum
2) Means for neurovascular communication between organ and body wall
3) Mobility (also allows torsion)

548
Q

1) What is the peritoneal ligament?
2) What is the omentum? Where does it go from and to?

A

1) Double layer of peritoneum that connects organs or organ to body wall (falciform ligament connecting liver to anterior abdominal wall)
2) Double layered extension of peritoneum from STOMACH or proximal DUODENUM to adjacent organs

549
Q

1) What organs are retroperitoneal?
2) What organs are intraperitoneal?

A

1) Retroperitoneal: kidneys, aorta, IVC
2) Intraperitoneal: stomach and spleen

550
Q

Where is the lesser omentum? What is deep to it?

A

Lateral to the curve of the stomach, continues behind greater omentum to portal triad; lesser sac

551
Q

What 3 ligaments make up the greater omentum?

A

Gastrophrenic ligament
Gastrosplenic ligament
Gastrocolic ligament

552
Q

What are the two ligaments that form the lesser omentum? What does one contain?

A

1) Gastrohepatic ligament
2) Hepatoduodenal ligament: contains portal triad: Portal vein, hepatic artery,& bile duct

553
Q

1) What is the portal triad?
2) What does the lesser omentum’s omental foramen open into?

A

1) Portal vein, hepatic artery, & bile duct
2) Into omental bursa (lesser sac of peritoneal cavity)

554
Q

1) What divide the greater sac?
2) What two compartments does this form?

A

1) Greater omentum (gastrocolic ligament) and transverse mesocolon (mesentery of transverse colon)
2) Supracolic and infracolic compartments

555
Q

What do the supracolic and infracolic compartments contain?

A

1) Supracolic compartment – stomach, liver, spleen
2) Infracolic compartment – small intestines, colon

556
Q

1) Where is the infracolic compartment?
2) What spaces are in this compartment?
3) What allows for free communication between the infracolic and supracolic compartments?

A

1) Lies posterior to Gr Omentum
2) Right and left infracolic spaces
3) Right and left Paracolic gutters

557
Q

1) What is an omental bursa hernia (internal hernia) of the peritoneal cavity?
2) What can it cause?

A

1) Abdominal contents from infracolic region cause internal herniation; where a piece of omentum or small intestine goes through the bursa to the lesser sac
2) Can cause strangulation of herniated tissue.

558
Q

Fluid from a ruptured appendix can do what?

A

Go up right paracolic gutter up into hepatorenal recess, subphrenic recess, or subhepatic space

559
Q

1) What supplies the midgut? Be specific about the boundaries of this area
2) What supplies the hindgut? Be specific

A

1) Superior mesenteric
-second part of duodenum to splenic flexure of colon (transition point)
2) Inferior mesenteric
-splenic flexure of colon to the sigmoid colon & superior rectal aa

560
Q

1) What supplies the thoracic esophagus with blood?
2) What supplies the foregut? Be specific about the boundaries of this area

A

1) Esophageal arteries
2) Celiac trunk
-Abdominal esophagus to the descending (2nd part) of duodenum where bile duct enters (transition point)

561
Q

Where does the aorta bifurcate?

A

About L4-5; sacral plane (iliac crests); 2-3 cm inferior and to the left of the umbilicus

562
Q

Is McBurney’s point somatic or visceral pain?

A

Somatic

563
Q

Initial pain around T10 dermatome (periumbilical) that transitions to RLQ pain is likely what?

A

Appendicitis

564
Q

What is the esophageal hiatus also called?

A

(Distal) esophageal sphincter

565
Q

1) What is the esophagogastric junction/ where is it?
2) Is the esophagus retroperitoneal or intraperitoneal in the abdomen?
3) What is the difference between the gastric mucosa and esophageal mucosa?

A

1) It’s the “Z” line; abrupt transition in mucosa; left of the midline, 7th costal cartilage/T11
2) Retroperitoneal in abdomen
3) Esophageal mucosa is not well-suited to high-acidity like gastric juices, gastric mucosa is because it has tight junctions and lots of mucous cells.

566
Q

1) What makes up the esophageal muscle layers?
2) What are the 3 esophageal muscle layers?

A

-Somatic blended into visceral muscle
1) Superior 1/3: voluntary m.
2) Middle 1/3: transition
3) Inferior 1/3: smooth m.

567
Q

What part of the stomach does the esophagus enter? What is right next to that area?

A

Cardia; cardial notch

568
Q

The bile and main pancreatic duct enter the posteromedial wall via hepatopancreatic ampulla at what part of the small intestine?

A

Descending (2nd) part of the duodenum

569
Q

What part of the small intestine is between aorta and SMA?

A

Inferior (horizontal/ third) part of the duodenum

570
Q

What are the first 2cm of the duodenum called? What is unique about it?

A

Ampulla or duodenal cap; it’s “free” suspended by mesentery

571
Q

What does the hepatoduodenal ligament containing the portal triad demarcate?

A

The end of the ampulla or duodenal cap (first 2cm of duodenum) being suspended freely be mesentery; it’s intraperitoneal after this point

572
Q

1) Suspensory ligament of duodenum (ligament of Treitz aka suspensory muscle of the duodenum) is located where?
2) What is its significance?

A

1) Duodenojejunal flexure
2) Clinically divides “upper GI” from “lower GI” tract

573
Q

1) What artery has branches that runs between layers of mesentery in the jejunum and iliac regions?
2) Where does it go?

A

1) Superior mesenteric artery (SMA)
2) Sends many branch arteries to jejunum & ilium, unite to form loops or arches called arterial arcades which gives rise to vasa recta

574
Q

Semilunar folds and haustra are characteristics of what part of the intestine?

A

Cecum

575
Q

1) Is the ascending colon retroperitoneal or intraperitoneal?
2) What is its feature? What artery supplies this pt of the colon?
3) What flexure is here?

A

1) Retroperitoneal
2) Right paracolic gutter; SMA
3) Right colic or hepatic flexure

576
Q

1) Describe the mobility of the transverse colon. Why is it this way?
2) What supplies this part of the colon?
3) What flexure is here?

A

1) Mobile due to transverse mesocolon, often swings inferior to umbilicus or below
2) Mostly SMA
3) Left colic or splenic flexure

577
Q

1) Is the descending colon retroperitoneal or intraperitoneal?
2) What is its feature?
3) What supplies this part of the colon with blood?

A

1) Retroperitoneal
2) Left paracolic gutter
3) IMA

578
Q

All lymph drainage of the abdomen ultimately goes where?

A

To thoracic duct

579
Q

True or false: the abdomen has a rich supply of lymph nodes and spread of infection and or metastatic spread of cancer can be vast

A

True

580
Q

All the lymph vessels, arteries, and nerves that supply the large intestine are where?

A

Within the mesentery/ retroperitoneal

581
Q

1) What is ischemic colitis?
2) What is the area most affected by this called?

A

1) Reduced blood flow
2) “Water shed” area.

582
Q

What are the two anatomical arterial transitions in the gut

A

1) Duodenum has artery supply from 2 different vessels
-1st and 2nd part via celiac trunk via supraduodenal and gastroduodenal aa.
-3rd and 4th part of the duodenum to splenic flexure of colon via SMA via pancreaticoduodenal a.
2) Splenic or left flexure of the colon
-SMA and IMA

583
Q

Duodenum has artery supply from 2 different vessels; what are they?

A

1) 1st and 2nd part via celiac trunk via supraduodenal and gastroduodenal aa.
2) 3rd and 4th part of the duodenum to splenic flexure of colon via SMA via pancreaticoduodenal a.

584
Q

What two things supply the splenic or left flexure of the colon?

A

SMA and IMA

585
Q

1) What type of gland is the pancreas?
2) Where is it? Is it retroperitoneal or intraperitoneal?
3) What are its three parts?

A

1) Accessory digestive gland
2) Retroperitoneal (almost all) against posterior wall
3) Head, body, tail

586
Q

1) Describe the mobility of the spleen
2) What type of organ is it?
3) Is it intraperitoneal or retroperitoneal?
4) Where is it normally located? Where does it not descend below?
5) What vein drains it?

A

1) Mobile
2) Lymphoid organ
3) Intraperitoneal; suspended via mesentery
4) Normally rests on the left colic flexure and does not descend below costal arch
5) Drains via portal vein

587
Q

1) Where is the tail of the pancreas and what’s unique about it?
2) Where does the pancreas drain lymph?

A

1) Adjacent to splenic hilum; only part of pancreas that’s intraperitoneal
2) Towards the midline

588
Q

1) What forms the posterior wall of the omental bursa?
2) What about the anterior wall?

A

1) Pancreas
2) Lesser omentum and the stomach.

589
Q

1) What does the sphincter of the bile duct do?
2) What does the sphincter of the pancreatic duct do?
3) What is the hepatopancreatic sphincter also called?

A

1) Controls flow of bile
2) Prevents reflux of bile into pancreatic duct
3) “Sphincter of Oddi”

590
Q

Name two organs that are mobile because they have mesentery.

A

Spleen and stomach

591
Q

1) What two things form the left sagittal fissure?
2) What does this fissure do?

A

1) Round ligament (umbilical vein) & ligamentum venosum (ductus venosus)
2) Separates the right and left livers (portal lobes)

592
Q

1) What uses ductus venous to bypass the fetal liver?
2) What does this turn into after birth?

A

1) Umbilical vein
2) Round ligament & ligamentum venous

593
Q

1) What bypasses the fetal lungs?
2) What does it turn into after birth?

A

1) Ductus arteriosus
2) Ligamentum arteriosus

594
Q

-What two main things supply the liver with blood
Describe the oxygenation and origin of the blood in each, and how much of the liver each supplies.

-What do these two things divide into?

A

1) Hepatic Portal Vein (HPV) -75%
-Poorly oxygenated, nutrient dense blood from GI track
2) Hepatic Artery (HA) – 25%
-Oxygen rick blood from systemic circulation

-Both divide into right and left branches at or near portal hepatis then form Segmental branches

595
Q

Describe the “in” and “out” of the liver

A

1) IN: Hepatic portal veins and hepatic artery
2) OUT: Hepatic veins + bile collecting system

596
Q

1) What skips the liver?
2) What drains the liver of blood?

A

1) Systemic IVC
2) Hepatic vein (NOT the hepatic portal vein)

597
Q

What make up the interlobular portal triads between liver lobules?

A

Hep artery, portal vein, bile duct

598
Q

Portosystemic anastomosis:
1) What anastomose with the left gastric vein (portal)?
2) What is it called when this anastomosing area is dilated?

A

1) Esophageal veins via azygos v. (systemic)
2) Esophageal varices

599
Q

Portosystemic anastomosis:
1) What anastomose with superior rectal veins continuing as the IMV (portal)?
2) What is it called when this anastomosing area is dilated?

A

1) Inferior and middle rectal veins via IVC (systemic)
2) Hemorrhoids

600
Q

1) What is the hepatic nerve plexus derived from?
2) What do the hepatic nerve plexus nerves accompany?
3) Where do the sympathetic fibers here come from?
4) What about the parasympathetic fibers?

A

1) Celiac plexus
2) Branches of vessels
3) Celiac plexus
4) Parasympathetic fibers from CN X, Vagus n. via anterior and posterior Vagal trunks (from esophageal plexus)

601
Q

1) What is cholelithiasis?
2) What is cholecystitis?

A

1) Stones in gall bladder
2) Inflammation/ infection of gall bladder often due to blockage of cystic duct

602
Q

1) What is cholangitis?
2) What is pancreatitis?

A

1) A redness and swelling (inflammation) of the bile duct system that results from bacterial infection.
2) Inflammation of pancreas, often related to blocked duct by stone or alcohol use

603
Q

1) Gallstones can occur in biliary passages; what is the most common location for impaction?
2) What is a cholecystectomy?

A

1) The narrowest site, the ampulla sphincter.
2) Removal of the gall bladder due to biliary colic

604
Q

1) What artery should you keep in mind during a cholecystectomy?
2) What anatomically define the cystohepatic triangle?

A

1) Cystic a. most commonly arises off the right hepatic a. in the cystohepatic triangle (Calot triangle)
2) Cystic duct, common hepatic duct, and inferior surface of the liver
-Must be ID’d early in procedure to safeguards these structures, especially with anatomic variations

605
Q

1) Where are the kidneys?
2) Where is the inferior pole of the kidneys? What varies between the two kidneys?

A

1) Lie posterior abdominal wall T-12 to L3 (umbilicus ~L3)
2) About level of umbilicus; right kidney a bit lower

606
Q

Portosystemic anastomosis:
1) What anastomose with the superficial epigastric veins (systemic)?
2) What is it called when this anastomosing area is dilated?

A

1) Para umbilical veins of anterior abdominal wall (portal)
2) Caput medusa

607
Q

1) Are the kidneys intraperitoneal or retroperitoneal?
2) What is the renal hilum (vertical cleft)?
3) What does the renal sinus contain?

A

1) Retroperitoneal
2) Entrance to the renal sinus
3) Mostly fatty tissue embedding renal pelvis, calices, vessels and nerves

608
Q

1) What two things traverse the renal columns?
2) What is the apex of the renal pyramid (loops of Henle) called?

A

1) Renal artery and veins
2) Renal papilla

609
Q

1) Are the ureters intraperitoneal or retroperitoneal?
2) What do they cross? Where?
3) What are its 3 important areas?

A

1) Retroperitoneal
2) Inferiorly cross external iliac just after bifurcation of common iliac and lateral wall of pelvis to bladder
3) The 3 areas of “constriction”

610
Q

List the 3 areas of “constriction”/ potential sites of obstruction of the ureters.
What is the significance of these?

A

1) Ureteropelvic junction
2) Crossing external iliac vessels at sacrum
3) Ureter traverses bladder wall
-Most likely places to find a kidney stone stuck

611
Q

1) What protects the adrenal/ supra renal glands?
2) What is the second layer of the adrenal glands? What two things does this structure secrete?
3) What is the thick inner layer of the adrenal glands called? What does this structure secrete?

A

1) Fibrous capsule
2) Cortex: secrets corticosteroids and androgens
3) Medulla: secrets catecholamines (epinephrine and norepinephrine)

612
Q

What two things are different about the right renal artery when compared to the left one?

A

1) Longer
2) Passes posterior to IVC

613
Q

1) Superior suprarenal arteries come from where?
2) Middle suprarenal arteries come from where?
3) Inferior suprarenal arteries come from where?

A

1) Inferior phrenic artery
2) Abdominal aorta near origin of SMA
3) Renal artery

614
Q

1) Where does the renal artery divide? Into how many things?
2) Then what do those turn into?

A

1) Close to Hilum divides into 5 segmental a.
2) End arteries

615
Q

What are the 3 ureter vascular supply sources?

A

1) Renal artery
2) Testicular or ovarian artery
3) Abdominal aorta

616
Q

What are the 3 blood supply sources for the suprarenal glands? Were does each come from?

A

1) Superior suprarenal (6-8): from inferior phrenic a.
2) Middle (1+): from aorta near origin of SMA
3) Inferior (1+): from the renal artery

617
Q

What does each renal vein of the kidneys drain into?

A

The IVC (NOT the hepatic portal)

618
Q

Describe the route of the left renal vein. Is it longer or shorter than the right?

A

Left renal vein longer, passes anterior to aorta but under the SMA

619
Q

What is the vein of suprarenal glands?

State whether the left or right one is shorter and which drains directly into the IVC

A

Large suprarenal vein;
1) Shorter right into IVC
2) Longer left into the left renal vein, then into IVC

620
Q

1) Define cisterna chyli
2) What flows into here?

A

1) A dilated sac at the lower end of the thoracic duct (in most mammals)
2) Lymph from the intestinal trunk and two lumbar lymphatic trunks flow.

621
Q

1) What vertebral level are the kidneys at?
2) What about the renal arteries?
3) What about the infra renal aorta?

A

1) T12-L3 (umbilicus ~ L3)
2) ~L1/2 (RAS)
3) ~L2/3 (AAA)

622
Q

1) Generally, kidneys not palpable; why?
2) Where are the ureters? What is the significance of this?

A

1) Retroperitoneal and under ribs except for inferior poles
2) Occupy sagittal plane that intersects tips of transverse processes of lumbar vertebrae
-important radiographic landmark

623
Q

1) Where is CVA tenderness?
2) Where is the transpyloric plane?
3) What is the scapular line?

A

1) Just below last rib
2) ~T-12: hilum of left kidney, superior pole right kidney
3) The sagittal line passing thru inferior angle of scapula

624
Q

What are the veins of the posterior abdominal wall?

A

1) IVC (from two common iliac veins)
2) Portal venous system

625
Q

What does the IVC drain blood from? (4 places)

A

LE, most of the back, the abdominal walls, pelvic viscera

626
Q

What are the 8 tributaries of the IVC?

A

1) Common iliac veins
2) 3rd and 4th lumbar veins
3) Right testicular or ovarian veins (left via the left renal vein)
4) Right and left renal veins
5) Ascending lumbar veins + azygos/hemi-azygos veins – connect the IVC with SVC
6) Right suprarenal vein (left via the left renal vein)
7) Inferior phrenic veins
8) Hepatic veins

627
Q

Which testicular/ ovarian veins are direct tributaries of the IVC, left or right? Where does the other one come from?

A

Right testicular or ovarian veins; left via left renal vein

628
Q

What connect the IVC with SVC?

A

Ascending lumbar veins + azygos/hemi-azygos veins

629
Q

1) Which suprarenal vein are direct tributaries of the IVC, left or right?
2) Which lumbar veins are tributaries of the IVC?

A

1) Right suprarenal vein (left via the left renal vein
2) 3rd and 4th

630
Q

1) What part of what muscle is the lumbar plexus on?
2) What nerves does it come from?
3) Where does it supply motor innervation to?

A

1) Posterior part of psoas m.
2) L1-4 spinal nerves
3) Iliopsoas

631
Q
A
632
Q

What are the two main parts of the pelvic cavity? What marks where each begins?

A

1) Greater; Supracristal plane
2) Lesser; pelvic brim

633
Q

What are the two main parts of the lesser pelvic cavity? What structures are located at each?

A

1) Pelvic inlet: Superior pubis to sacral promontory
2) Pelvic outlet: Inferior rami of pubis and Ischial tuberosities anterolaterally; tip of coccyx posterior

634
Q

1) What do the Sacrospinous and sacrotuberous ligaments prevent?
2) What can they be responsible for?

A

1) Excessive lumbar lordosis during weight bearing
2) “Back pain”

635
Q

1) What form the anterior inferior wall of the pelvis?
2) What form the lateral wall?

A

1) Body and rami of pubic bone; pubic symphysis
2) Boney hips, obturator foramen, membrane, muscle, vessels and nerves

636
Q

1) Compare the pubic arches of male and female pelvises
2) Compare the thickness and heaviness of bones of male and female pelvises

A

1) Males have a narrower pubic arch < 70 degrees; females have a wide pubic arch > 80 degrees
2) Male pelvises have thick and heavy bones; females have thin and light boney structure

637
Q

1) Compare the deepness of male and female greater pelvises
2) Compare the deepness of male and female lesser pelvises

A

1) Males’ greater pelvis is deep, females’ is shallow
2) Males’ lesser pelvis is narrow and deep; females’ is wide and shallow

638
Q

1) Compare the inlet shapes of male and female pelvises
2) Compare the outlet shapes of male and female pelvises

A

1) Males’ inlet is heart-shaped; female inlet oval or rounded
2) Males’ outlet is smaller, female outlet larger

639
Q

What is the pelvic floor also called?

A

Pelvic diaphragm

640
Q

What 3 things cover the pelvic diaphragm?

A

Levator ani + coccygeus muscles + fascia

641
Q

1) What forms the tendinous arch of levator ani? Where?
2) What are the two primary muscles that make up the levator ani?

A

1) Obturator fascia (thickened); ~ L5-S4
2) Pubococcygeus and iliococcygeus

642
Q

What provide the blood and innervation to the perineal compartment? Where does the blood flow come from?

A

Pudendal vessels (come off anterior internal iliac) and pudendal nerves (lumbo-sacral nerves)

643
Q

List the 4 main muscles of the pelvic walls.
Which makes up the lateral wall? What about the posterior wall?

A

1) Levator ani
2) Coccygeus m.
3) Obturator internus – lateral wall
4) Piriformis – posterior wall

644
Q

What two main nerves are formed by the sacral plexus? What does each innervate?

A

1) Sciatic n.– posterior thigh and leg below knee
2) Pudendal n. – nerve to perineum

645
Q

Besides the two main nerves of the sacral plexus, what else does it form? What does each innervate?

A

1) Superior gluteal n. – glut min, medius, TFL
2) Inferior gluteal n.– glut max

646
Q

Where is the coccygeal plexus?

A

S4-5, Co1 to pelvic floor

647
Q

1) Where does the sciatic nerve come from and where does it exit?
2) Where does the superior gluteal n come from and exit? What 3 muscles does it innervate?

A

1) L4 -S3, exits thru greater sciatic foramen, inferior to pyriformis m.
2) L4-S1, exits via greater sciatic foramen, supplies 3 muscles in glut region: gluteus Medius and Minimus mm., & TFL

648
Q

1) Where does the pudendal nerve come from? What is the it main nerves of?
2) Where does it enter?

A

1) S2-S4, main nerve to the perineum and chief sensory nerve of the external genitalia
2) Enters perineum via lesser sciatic foramen

649
Q

1) Where does the obturator nerve come from?
2) Where does it pass through?
3) What is it the primary nerve to?

A

1) L2-L4
2) Passes thru the pelvis BUT is not a pelvic nerve
3) Medial (adductor group) thigh

650
Q

1) What do structures do at the greater sciatic foramen?
2) What muscle is located here?
3) What 4 nerves are here?
4) What else is located here?

A

1) Exit pelvis
2) Piriformis m. to femur
3) Sciatic nerve, pudendal nerve, superior/inferior gluteal n.
4) Vessels

651
Q

1) What do structures do at the lesser sciatic foramen?
2) What muscle is located here?
3) What nerve is here?

A

1) Exit pelvis and re-enter perineal compartment
2) Obturator internus m.
3) Pudendal nerve

652
Q

What does sympathetic innervation of the pelvis do? (3 things)

A

1) Vasomotion
2) Inhibit peristalsis of rectum
3) Stimulates contraction of genital organs during orgasm (ejaculation in males)

653
Q

What does parasympathetic innervation of the pelvis do? (2 things)

A

1) Stimulate contraction of bladder and rectum
2) Supply erectile bodies of genitalia resulting in erection

654
Q

What are the 3 main parts of pelvic autonomics?

A

1) Sympathetic
2) Parasympathetic
3) Periarterial plexuses

655
Q

1) Reflex visceral afferents (not aware consciously) of the pelvis are conducted how? Where to?
2) How do pain visceral afferents (aware consciously) differ?

A

1) Via parasympathetic to spinal ganglia S2-3-4
2) Diff. based on “pelvic pain line” that corresponds to the inferior limit of the peritoneum

656
Q

What are the pelvic viscera?

A

1) Distal parts of GI (rectum)
2) Distal Urinary tract
3) Reproductive system

657
Q

What structures pass through the pelvic diaphragm to reach the perineal compartment? (3)

A

Rectum
Vagina
Urethra

658
Q

1) Where is the rectum found?
2) Where are the vagina and urethra found?

A

1) Posterior triangle
2) Anterior urogenital triangle

659
Q

1) _______________________ thru bladder wall acts as sphincter to prevent retrograde urine flow from ureters during voiding along with ___________________ at ureteral orifice at trigone
2) In males the ___________________ is related to the ureters

A

1) Oblique passage; circular m.
2) ductus deferens

660
Q

1) What is the urinary bladder inferior to?
2) Where does it rest?
3) Where is the apex of the urinary bladder?

A

1) Peritoneum (subperitoneal)
2) Rests on pelvic floor
3) Anterior toward pubis

661
Q

1) What is the trigone of the bladder?
2) What is the uvula of the bladder?

A

1) Triangle region with ureters and urethra orifice
2) Slight elevation of the trigone in the internal urethral orifice

662
Q

1) What do the detrusor muscle fibers do near the neck of the male bladder? What does this do?
2) What do some of these detrusor muscle fibers do?

A

1) Form the involuntary internal urethral sphincter which contracts during ejaculation (sympathetic stimulation)
2) Run radially & assist in opening the internal urethral sphincter.

663
Q

1) What are detrusor muscle fibers in the neck of the bladder continuous with in males?
2) What about in females?

A

1) Fibromuscular tissue of prostate
2) Muscle fibers of urethra

664
Q

What are at the angles of the trigone of the bladder?

A

Ureteric orifices and internal urethral orifice

665
Q

1) What supplies the bladder with blood?
2) Describe venous drainage of the bladder and include where they drain

A

1) Branches of the internal iliac aa.
2) Veins draining bladder correspond to arteries and drain into the internal iliac veins (Caval system)

666
Q

Lymphatics from superior surface of bladder drain into _______________________, while those from the fundus drain into ________________________.

A

external iliac nodes; internal iliac nodes

667
Q

1) What innervates the bladder sympathetically?
2) Sympathetic innervation that stimulates ejaculation simultaneously causes what? Why?

A

1) Sympathetic fibers from T11-L2 to pelvic plexus
2) Contraction of the internal urethral sphincter to prevent reflux of semen into the bladder

668
Q

1) What innervates the bladder parasympathetically? (what fibers and plexus?)
2) What do they provide motor innervation to? What do they do in males?
3) When visceral afferent fibers stimulated by stretching, what happens in males? What suppresses this reflex?

A

1) Parasympathetic fibers from S2-3-4 via pelvic splanchnic n. to inferior hypogastric plexus
2) Motor to detrusor muscle & inhibitor to internal urethral sphincter in males
3) Detrusor m. contracts & the internal urethral sphincter relaxes and urine flows into the urethra; toilet training suppresses this reflex (along with external urethral sphincter)

669
Q

Urethral glands homolog to ______________, common paraurethral duct bilaterally near external urethral orifice.

A

prostate

670
Q

1) What somatically innervate the female urethra? (plexus and nerve)
2) What nerve viscerally innervates the female urethra? Where?

A

1) Vesicle nerve plexus and pudendal nerve (somatic)
2) Pelvic splanchnic n; most below pelvic pain line

671
Q

1) The intramural part of the male urethra is surrounded by what?
2) What is this area’s innervation?
3) What does this area prevent?
4) ____________________ fibers are inhibitory to internal urethral sphincter resulting in relaxing of sphincter during voiding

A

1) Internal urethral sphincter
2) Sympathetic innervated smooth muscle
3) Retrograde ejaculation
4) Parasympathetic fibers

672
Q

1) What part of the male urethra is surrounded by external urethral sphincter?
2) What primarily controls continence?

A

1) Intermediate (membranous)
2) Tonic and phasic contraction of external urethra sphincter

673
Q

What are the 4 parts of the male urethra?

A

1) Intramural
2) Prostatic urethra
3) Intermediate (membranous)
4) Spongy urethra

674
Q

1) What does parasympathetic stimulation do during micturition?
2) The _______________________ is under somatic control and is inhibited during micturition

A

1) Causes the detrusor muscle to contract & inhibits the internal urethral sphincter.
2) external urethral sphincter

675
Q

To gain voluntary control over micturition, infants must learn to suppress and stimulate what?

A

1) Suppress: the visceral afferent urge to void
2) Stimulate: the somatic motor of external urethral sphincter

676
Q

1) What muscle is in the wall of the bladder and is involved in micturition?
2) What form the “involuntary” internal urethral sphincter?
3) What is the “voluntary” (Somatic) sphincter and where is it?

A

1) Detrusor muscle in wall of bladder
2) Neck of bladder muscles
3) External urethral sphincter; above perineal membrane

677
Q

1) What is stress incontinence?
2) What causes it?
3) Who is it more common in?
4) How is it treated?

A

1) Leakage when cough, sneeze, run, jump
2) Weak external sphincter/pelvic floor
3) Older parous women - post vaginal deliveries
4) Manage with PT

678
Q

1) What is urge incontinence?
2) What causes it?
3) How it it managed?

A

1) “GOTA GO NOW!!!!”
2) Detrusor instability
3) With Rx

679
Q

1) What is the ductus deferens?
2) Where does it ascend? Where does it pass through?
3) Where does it cross over to enter the pelvis? What does it pass retroperitoneally?
4) Where does it end?

A

1) Continuation of the duct of epididymis from inferior pole of testis
2) In the spermatic cord; passes through the inguinal canal
3) External iliac vessels; passes along the lateral pelvic wall
4) By joining the duct of the seminal gland to form the ejaculatory duct

680
Q

1) Where are the seminal glands (vesicles)?
2) What fluid do they secrete? What does it do?
3) What part of the seminal glands is covered in peritoneum?

A

1) Lie obliquely between the fundus of bladder and rectum
2) Alkaline fluid, mixes with sperm, major contributor to volume of semen ~ 75%
3) Superior aspect

681
Q

1) What are ejaculatory ducts?
2) Where do they pass through?
3) Where do they open and how?

A

1) Tube arising from union of vas deferens and seminal gland duct
2) Posterior prostate
3) By slit like apertures on or within the prostatic utricle

682
Q

What are the two divisions of the prostate? Define each.

Which one incorporates the prostatic plexus?

A

1) Glandular part 2/3
2) Fibromuscular 1/3: dense fibromuscular capsule
-Incorporates the prostatic plexus of nerves and veins

683
Q

1) What part of the prostate contributes to the external urethral sphincter?
2) What part of the prostate is palpable via DRE?

A

1) Muscular anterior surface (AMZ)
2) Posterior surface related to the ampulla of the rectum

684
Q

1) How many prostatic ducts open into prostatic sinuses?
2) Where are the prostatic sinuses?

A

1) 20+
2) On either side of seminal colliculus on posterior wall of the prostatic urethra

685
Q

1) Prostatic fluid accounts for ~____% of volume of semen
2) Where are the Bulbourethral glands (Cowper’s glands)?
3) Where do the Bulbourethral glands open to?

A

1) ~25%
2) Lie posterolateral to the intermediate part of the urethra embedded in external urethral sphincter
3) Proximal spongy urethra

686
Q

What are the 2 categories of LUTS (lower urinary tract symptoms)? List what’s in each

A

1) Irritative symptoms
-Frequency
2) Obstructive symptoms
-Dribbling
-Push harder
-Nocturia
-Repeat voiding

687
Q

What is BPH?

A

Middle lobe (CZ) hormonally induced enlarged prostate & uvula projects into bladder which impedes urination by distorting the prostatic urethra

688
Q

1) Where are most adenocarcinoma of the prostate cases?
2) Are they palpable via DRE?
3) Where does metastatic disease go?

A

1) Posterior PZ
2) Yes
3) To iliac and sacral nodes

689
Q

What are the 4 female internal genital organs?

A

1) Uterus
2) Uterine tubes
3) Ovary
4) Vagina

690
Q

List and define the 3 parts of the body of the uterus

A

1) Fundus: rounded part superior to orifices of uterine tubes
2) Isthmus: just superior to the cervix
3) Uterine horns: where uterine tubes enter

691
Q

1) The rounded part of the uterus superior to orifices of uterine tubes is called what?
2) What part of the uterus is just superior to the cervix?

A

1) Fundus
2) Isthmus

692
Q

List and define the 3 layers of the wall of the uterus

A

1) Perimetrium: outer serous coat, peritoneum + connective tissue
2) Myometrium: middle muscular coat of smooth muscle – majority of vessels and nerves course within this coat
3) Endometrium: inner mucous coat, firms adheres to myometrium

693
Q

1) What part of the wall of the uterus is actively involved in the menstrual cycle? What does it do?
2) Where does implantation occur with conception?

A

1) Endometrium differs in structure with each stage of cycle, inner surface is shed during menstruation
2) Endometrium (within fundus of uterus)

694
Q

1) What does the ligament of the ovary do? Where?
2) What does the the round ligament of the uterus attach?
3) What does the round ligament enter and where does it end?

A

1) Connects the ovary to the uterus; near the uterotubal jct.
2) Attaches close to above, vestiges of the ovarian gubernaculum related to decent of ovary from the posterior abdominal wall
3) The internal/deep inguinal ring and ends within the inguinal canal

695
Q

1) What is prolonged laterally over ovary vessels as the suspensory ligament of the ovary?
2) What keeps uterus relatively centered in the pelvis?

A

1) Broad ligament of the uterus
2) Broad ligament of the uterus

696
Q

What 3 things make up the broad ligament?

A

1) Mesovarium
2) Mesosalpinx
3) Mesometrium

697
Q

What 4 things are found between layers of the broad ligament bilaterally?

A

1) Uterine tubes
2) Ligament of the ovary
3) Round ligament of the uterus
4) Suspensory ligament of the ovary

698
Q

1) What extend laterally and open into the peritoneal cavity near the ovaries?
2) What part of this is intramural?

A

1) Oviducts or fallopian tubes
2) Uterine part

699
Q

1) Where are the oviducts or fallopian tubes?
2) Define and describe the infundibulum
3) List the last 3 parts of the fallopian tubes

A

1) Lie in mesosalpinx of the free edge of the broad ligament
2) Funnel shaped distal end of fallopian tube, fimbriae spread over the surface of the ovary, one large ovarian fimbria is attached to the ovary
3) Ampulla, isthmus, and uterine part (intramural, uterine ostium)

700
Q

1) What are the ovaries near?
2) What are they suspended by?

A

1) The attachment of the broad ligament to the lateral pelvic walls
2) Mesovarium (both peritoneal folds) and the suspensory ligament of the ovary

701
Q

What is the significance of “fill and spill”?

A

How to tell if the fimbriae open into the peritoneal cavity

702
Q

1) Is the vagina retroperitoneal, intraperitoneal, or something else?
2) Where does it extend from and to?

A

1) Mostly subperitoneal
2) From posterior fornix to the vestibule of the vagina

703
Q

1) Superior end of vagina surrounds what?
2) The recess around the protruding cervix is called what?
3) What are the 3 recesses called?
4) Which recess is deepest? What is it related to?

A

1) Cervix
2) Vaginal fornix (3)
3) Anterior, postural, and lateral recesses
4) Posterior fornix is deepest, related to rectum

704
Q

What other vessel is near the ureter and uterine artery?

A

Internal iliac

705
Q

What 6 structures can be palpated vaginally?

A

1) Uterus: Size and position, composition (fibroids), gravid, cervix & CMT
2) Bilateral “adnexa”: Ovaries, uterine tubes
3) Bladder
4) Anterior rectum
5) Sacral promontory (pelvic inlet)
6) Ischial spine (for pudendal nerve block)

706
Q

1) Where is lymph drained from female pelvic viscera to?
2) Where is it drained from the female perineum to?

A

1) Internal, external, common iliac nodes & sacral node
2) Perineum to superficial inguinal nodes

707
Q

1) Where is the rectum?
2) What shape is it in lateral views?
3) What can be seen in A-P view?

A

1) Sigmoid colon to anal canal
2) S-shaped
3) 3 lateral flexures

708
Q

1) 3 _________________ of rectum are formed in relation to 3 Transverse rectal folds.
2) Puborectalis m. helps create what? At what angle? What does it perforate?
3) Resting state is by what?

A

1) lateral flexures
2) Anorectal flexure; ~ 80-degree, perforates the pelvic diaphragm as the anal canal
3) Tonus of the puborectalis m

709
Q

What are the two main arterial supplies of the rectum and anus?

A

1) IMA’s superior rectal artery
2) Branches of internal iliac

710
Q

What does the superior rectal artery from the IMA do?

A

Supplies proximal rectum

711
Q

1) What do the middle rectal arteries drain?
2) What branch off the internal pudendal arteries? What do they supply?

A

1) Middle and inferior rectum
2) Inferior rectal arteries; anorectal jct. and anal canal

712
Q

What are the 4 main venous supplies of the rectum and anus? List what each drains to

A

1) Rectal venous plexuses:
-Internal (just deep to epithelium)
-External (to muscular wall of rectum)
2) Superior rectal veins
-Drains into portal veins
3) Middle rectal v.
-Drain into systemic veins
4) Inferior rectal v.
-Drains into systemic veins

713
Q

1) What causes internal hemorrhoids?
2) What causes external hemorrhoids?

A

1) Prolapses of rectal mucosa
2) Thrombi

714
Q

1) What veins are involved in internal hemorrhoids?
2) What veins are involved in external hemorrhoids?

A

1) Veins of internal rectal venous plexus
2) External rectal venous plexus

715
Q

1) What do internal hemorrhoids do?
2) What do external hemorrhoids do?

A

1) Strangulate, ulcerate, bleed
2) Increase portal or abdominal pressure

716
Q

1) Are external hemorrhoids painful or painless? Why?
2) What innervation is responsible in this area?

A

1) Painful, b/c they’re below pectinate line
2) Somatic fibers from inferior rectal nerves

717
Q

In the intrinsic defecation reflex:
1) What is the stimulus?
2) What are the receptors?
3) What are the afferents?
4) What center is involved?
5) What are the efferents?
6) What are the effectors?
7) What is the response?

A

1) Feces enters the rectum, distention of rectal wall
2) Stretch receptors in the rectal wall
3) Sensory fibers terminating in the MYENTERIC plexus
4) MYENTERIC plexus
5) Motor signals to smooth muscles
6) Smooth muscle cells of descending, sigmoid colon, and rectum
7) Peristaltic waves forcing feces towards rectum; relaxation of internal anal sphincter.

718
Q

What are the 6 palpable structures rectally? (in males)

A

1) Posterior prostate: CZ and PZ*
2) Seminal glands
3) Pelvic surface of sacrum and coccyx*
4) Ischial spines and tuberosities
5) Enlarged Internal iliac LN
6) Inflamed appendix

719
Q

1) Where is the pelvic compartment?
2) What is the perineal surface/ region? What shape is it with the legs abducted/ in lithotomy position?
3) What is the perineal body?

A

1) Inferior to pelvic diaphragm (levator ani and coccygeus mm.)
2) Narrow area between the thighs with legs adducted, diamond shaped
3) Fibromuscular “center of” mass of perineum

720
Q

What are the 3 layers preventing the abdomen/ pelvis from the outside?

A

1) Pelvic floor
2) Pelvic compartment
3) Perineal body

721
Q

What are the triangles of the perineum connected by?

A

Transverse line connecting anterior ends of ischial tuberosities

722
Q

1) What triangle does the perineal membrane cover?
2) What part of the pelvic outlet does it cover?
3) What perforates it in males and females?

A

1) Covers UG triangle
2) Covers anterior part of pelvic outlet
3) Urethra and vagina in females, urethra in males

723
Q

What muscle of the perineum is NOT involved in the perineal body?

A

Ischiovernosus muscle

724
Q

List 2 perineal muscles that meet at the midline

A

1) Bulbopspongiosus m.
2) Ischiocavernosus m.

725
Q

1) The perineal body receives smooth and voluntary slips of muscle from what 3 places?
2) List 2 muscles involved in the perineal body
3) What sphincter does it contain?

A

1) Ext urethral sphincter, levator ani, and muscular coats of rectum
2) Bulbospongiosis m. and Superficial and deep transverse perineal m.
3) External anal sphincter

726
Q

1) What is the ischo-anal fossa?
2) Where is it?
3) What 2 things is it filled with?

A

1) Fascia lined wedge-shaped space between the skin of the anal region and the pelvic diaphragm
2) Around the wall of the anal canal
3) Fat and loose connective tissue

727
Q

What exit to the perineum at the pudendal canal?

A

Internal pudendal vessels and nerve

728
Q

What is the pudendal canal and what does it contain? (2 vessels and 2 nerves)

A

Canal in obturator fascia containing:
1) Internal pudendal artery and vein
2) Pudendal nerve
3) Nerve to obturator internus m.

729
Q

What does the pudendal canal provide neurovascular supply/innervation for?

A

Perineum

730
Q

1) What does the internal iliac artery branch into? Where?
2) What does that divide into?
3) What supplies most of the perineal viscera?

A

1) Internal pudendal artery thru canal
2) Divide into posterior and anterior branch
3) Anterior branch

731
Q

After the Pudendal nerve (S2-3-4) enters canal, what 3 things does it branch into?

A

1) Inferior rectal/anal n.
2) Perineal nerve (has 2 branches)
3) Dorsal n. of the penis/clitoris

732
Q

1) As the internal pudendal vessels and pudendal nerve enter [pudendal] canal, they give rise to what artery and nerve?
2) What do these supply?
3) What happens at the distal end of the canal?

A

1) Inferior rectal a. & n.
2) External anal sphincter and perianal skin
3) Both vessels and nerves bifurcate

733
Q

At distal end of the pudendal canal, both vessels and nerves bifurcate into what?

A

1) Perineal nerve and artery
2) Dorsal artery and nerve to penis/clitoris
3) Central vein of the penis and clitoris (drains the erectile tissue)

734
Q

Describe the 2 perineal nerve branches; what does one give rise to and where does the other go?

A

1) Superficial perineal n.: give rise to posterior scrotal and labial cutaneous branches
2) Deep perineal n.: to muscles of the deep and superficial pouches, vestibule of vagina, mucosa of inferior most part of vagina

735
Q

1) What is the anal canal?
2) What are its two sphincters?

A

1) Continuation of rectal ampulla & anorectal flexure/puborectalis sling
2) Internal and external anal sphincter

736
Q

1) Is the external anal sphincter voluntary? What does it surround and what does it blend with?
2) What innervates it?

A

1) Voluntary; surrounds inferior 2/3 of anal canal, blends superiorly with puborectalis
2) S4 via inferior anal (rectal) nerves (from pudendal nerve)

737
Q

1) What makes up the internal anal sphincter? What does it surround?
2) What stimulates its tone?
3) What inhibits (relaxes) it?

A

1) Smooth muscle; superior 2/3 of anal canal
2) Sympathetic fibers from hypogastric plexus
3) Parasympathetic fibers

738
Q

Voluntary control can usually override the involuntary reflex caused by what?

A

Fecal distention of rectal ampulla

739
Q

1) What structures do the anal columns contain the terminal branches of?
2) Where is the anorectal junction?
3) What forms the pectinate line?

A

1) Superior rectal artery and vein (IMA)
2) At superior ends of anal columns
3) Inferior limit of anal sinuses form

740
Q

1) What do anal valves join?
2) What do they form?
3) What do these do when compressed?

A

1) Inferior ends of anal columns
2) Anal sinuses
3) Exude mucous (anal glands in dogs)

741
Q

1) What is the mons?
2) What is the labia majora? What is it bound to?
3) What does the labia major protect?

A

1) Fatty eminence anterior to pubic symphysis, fat increases at puberty and covered in hair
2) Prominent folds of skin, bound the pudendal cleft (between labia majora)
3) Urethral and vaginal orifice

742
Q

What structure of the labia major often disappears after vaginal birth?

A

Anterior commissure from mons pubis to posterior commissure or fourchette

743
Q

1) What are the labia minor? What do they contain a core of?
2) What encloses the labia minor?
3) What does it surround?

A

1) Fat free folds, hairless, core of erectile tissue and vessels
2) Pudendal cleft/labia majora
3) The vestibule into which the urethra, vagina, & vestibular glands open

744
Q

The labia minor anteriorly form 2 lamina; what are they? What do they each unite to form?

A

1) Medial laminae unite to form frenulum of the clitoris
2) Lateral laminae unite to form the prepuce of the clitoris

745
Q

1) What type of tissue makes up the clitoris?
2) What make up its root and body? What 2 things do these transition into?

A

1) Erectile tissue
2) 2 crura; corpora cavernosa and glans

746
Q

1) What are the bulbs of the vestibule?
2) What are they deep to?
3) What are they covered by?

A

1) Paired masses of elongated erectile tissue
2) Deep to the vestibule of the vagina
3) Bulbopspongiosus m.

747
Q

List and define the two types of vestibular glands

A

1) Greater (Bartholin gland): each side of vestibule, open on each side of the vaginal orifice, secrete mucous during sexual arousal
2) Lessor glands: smaller, bilateral, between urethral and vaginal orifice, secrete mucous

748
Q

1) What artery supplies the vulva? What does it supply specifically?
2) What is the venous drainage of the vulva?
3) What does venous engorgement during sexual arousal cause?

A

1) Internal pudendal; most of skin, external genitalia, perineal m.
2) Tributaries of internal pudendal veins
3) Increase in size and consistency of clitoris and bulbs of the vestibule

749
Q

1) Where do the vulva lymphatic drain initially?
2) What innervates the vulva anteriorly, laterally, and posteriorly?
3) What is the main nerve of the perineum?

A

1) To superficial and deep inguinal nodes
2) Anteriorly: ilio-inguinal and genitofemoral nerves,
-Laterally: pudendal nerves
-Posteriorly by posterior cutaneous n. of the thigh.
3) Pudendal nerve

750
Q

1) What is the anatomic position of the penis?
2) What are its 3 parts?
3) What does it contain 3 cylinders of?

A

1) Anatomical position is erect
2) Root, body, glans
3) Erectile tissue (corpora)

751
Q

List and describe the 3 cylinders of erectile tissue (corpora) of the penis

A

1+2) Paired corpora cavernosa: Fused in median plane, except posteriorly where they separate and form crura of penis
3) Single corpora spongiosum ventrally: Contains spongy urethra

752
Q

1) What forms the crura of penis?
2) What contains spongy urethra?

A

1) Corpus cavernosa are fused in median plane except posteriorly where they separate and form crura of penis
2) Single corpora spongiosum ventrally

753
Q

What does the root of the penis contain? What 3 things does this contain?

A

Paired Crus (Crura) and unpaired Bulb:
1) Proximal parts of corpora
2) Crus attached near ischial tuberosities
3) Bulb pierced by the urethra

754
Q

What 2 muscles and 1 covering cover the root of the penis?

A

1) Ischiocanvernosus and Bulbopspongiosus muscles
2) Tunica albuginea (fibrous covering)

755
Q

1) What is the glans of the penis?
2) What is a distinct structure of the glans? Describe this structure
3) What does the neck of the glans delineate?

A

1) Expanded corpus spongiosum
2) Corona; projects beyond end of corpora cavernosa and over hangs the neck of the glans
3) Glands from body

756
Q

What opening does the glans of the penis contain?

A

External urethral opening of spongy urethra

757
Q

1) What supplies the anterior scrotum with blood?
2) What about the posterior scrotum?

A

1) Anterior scrotal arteries via External pudendal artery
2) Posterior scrotal arteries via terminal br. Internal pudendal artery

758
Q

The pudendal n and posterior femoral cutaneous n. are both involved in innervating what?

A

Posterior scrotum

759
Q

1) What is the arterial supply of the penis?
2) What does the venous plexus drain? What does this plexus become?

A

1) Branches of internal pudendal artery
2) Blood from cavernous spaces of the corpora cavernosa; becomes dorsal vein of penis

760
Q

What make up the perineal body? (4 groups of things)

A

1) Superficial and deep transverse perineal m
2) Ext anal sphincter
3) Bulbospongiosis
4) Slips of muscle

761
Q

1) Where would you block the pudendal nerve for the lateral perineum?
2) What type of nerve block works for the anterior perineum?

A

1) Near ischial spine
2) Ilioinguinal nerve block

762
Q

1) What is the landmark for local infiltration of anesthetic for the perineal region?
2) What part wouldn’t be blocked from this type of nerve block? Why?

A

1) Ischial spine
2) Anterior perineum; innervated by ilioinguinal nerve

763
Q

List 4 results of parasympathetic stimulation during female sexual response

A

1) Increased vaginal secretions
2) Erection of the clitoris
3) Engorgement of erectile tissue in the bulbs of the vestibule
4) Bulbospongiosus and ischiocavernosus muscles reflexively contract to decrease venous drainage

764
Q

What 3 things cause ejaculation?

A

1) Sympathetic stimulation closes the internal urethral sphincter
2) Parasympathetic stimulation contracts urethral muscles
3) Pudendal n. stimulation contracts the bulbospongiosus muscles

765
Q

What does the Central vein of the penis and clitoris do?

A

Drains the erectile tissue