Gray's Review Clarifications

Question 1

Phrenic Nerve and Referred Pain

Answer 1

Phrenic nerve: C3-C5

In the heart, it innervates the pericardium

Pain from any structure that’s innervated by the phrenic nerve can be “referred” to the skin over the tip of the shoulder b/c that area receives cutaneous supply from C4

Question 2

Pericardium of Heart Innervation

Answer 2

Parietal: phrenic nerve
Visceral: vagus, sympathetics

Question 3

Pectoralis Major Innervation

Answer 3

medial & lateral pectoral nerve

Question 4

Pectoralis Minor Innervation

Answer 4

medial pectoral nerve

Question 5

Subclavius innervation

Answer 5

nerve to subclavius

Question 6

Lung innervation

Answer 6

anterior and posterior pulmonary plexus

Question 7

Apex location and main surface

Answer 7

deep to the left 5th intercostal space

mainly formed by the left ventricle

Question 8

Most anterior part of the heart

Answer 8

right ventricle

Question 9

Most posterior part of the heart

Answer 9

right atria

Question 10

Aortic Valve Auscultation

Answer 10

right sternal border of 2nd intercostal space

Question 11

Pulmonic Valve Auscultation

Answer 11

left sternal border in 2nd intercostal space

Question 12

Tricuspid Valve Auscultation

Answer 12

right sternal border in 4th intercostal space

Question 13

Mitral Valve Auscultation

Answer 13

left sternal border of 5th intercostal space

Question 14

Sinu-Atrial Node

f(x)
location

Answer 14

“pacemaker”

f(x) Impulses begin here
location: superior end of the crista terminalis @ junction of SVC and right atrium

Question 15

AV Node

f(x)
location

Answer 15

f(x): forms the beginning of conducting tissue

location: near the opening of the coronary sinus, w/i AV septum

Question 16

AV bundle w/ left and right bundle branches

f(x)

Answer 16

extends excitatory impulse to all ventricular muscle

Question 17

Left Bundle Branch gives off branches that will become

Answer 17

Purkinje Fibers

Question 18

Valve Stenosis

Answer 18

narrowing of the orifice, caused by the valve’s inability to open fully

Question 19

Valve Incompetence (insufficiency)

Answer 19

results from poorly functioning valves

Question 20

Mitral Valve Disease

Answer 20

a mix of stenosis and incompetence

includes:
1. LV hypertrophy
2. increased pulmonary venous pressure
3. pulmonary edema
4. dilation & hypertrophy of LA

Question 21

IVD composition

Answer 21

central nucleus pulposus surrounded by annulus fibrosus

Question 22

Explain how an intervertebral disc herniation happens

Answer 22

tear can occur in the annulus fibrosus, track into the vertebral canal or IV foramen to impinge on neural structures

Question 23

Normal orientation of IV disc herniation

Answer 23

posterolateral

Question 24

Atlantoaxial joint movement

Answer 24

responsible for lateral head rotation

Question 25

Dens location ligament f(x)

Answer 25

projects superiorly from the body of the axis and sits in the arch of the atlas cruciform ligament (transverse and longitudinal bands) acts as a pivot to allow side to side movement

Question 26

Hangman's Fracture

Answer 26

fracture of the pedicles of the axis (C2) cruciform ligament is torn and the spinal cord is crushed (resulting in death)

Question 27

Atlanto-occipital joint f(x)

Answer 27

allows the head to move up and down on the vertebral column

Question 28

List the vertebral column ligaments from most anterior to most posterior

Answer 28

1. anterior longitudinal 2. posterior longitudinal 3. ligamentum flavum 4. interspinous 5. supraspinous (nuchal superiorly)

Question 29

What forms the posterior surface of the vertebral canal?

Answer 29

ligamentum flavum

Question 30

Spondylosis

Answer 30

degenerative changes in the spine such as bone spurs & degenerating intervertebral discs

Question 31

Spondylolistheses

Answer 31

slipping of a vertebrae that usually occurs at the base of the spine

Question 32

Best view for a pars articularis fracture?

Answer 32

Oblique View

Question 33

Describe what spinal nerve would be affected in an L4/L5 herniation

Answer 33

in the lumbar region, spinal nerves exit inferiorly to their named vertebrae in an L4/L5 herniation, the L5 nerve would be affected b/c it descends b/w the L4/L5 vertebrae to exit below the L5 level

Question 34

Rib Articulations

Answer 34

superior costal face on the body of the thoracic vertebrae articulates w/ the head of the rib of the corresponding number inferior costal facet articulates w/ the head of the rib below

Question 35

cupula

Answer 35

alternative wording for cervical pleura of lung

Question 36

Lymphatic Drainage of the Breast

Answer 36

lateral quadrants of breast: drain into the anterior axillary (pectoral) nodes (this accounts for 75% of drainage) all others drain into parasternal nodes

Question 37

Parietal Pleura Innervation

Answer 37

intercostal nerves

Question 38

Klippel Feil Syndrome

Answer 38

reduction, or extensive fusion, of one or more cervical vertebrae manifests as a short, stiff neck with limited motion

Question 39

Chiari II Malformation

Answer 39

herniation of the medulla and cerebellum into the foramen magnum