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USMLE STEP 1 > Gross Anatomy > Flashcards

Gross Anatomy Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the three main functions of the thorax?

A

Protection, breathing, conduit

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2
Q

Axillary inlet

A

Gateway to the upper limb framed by

superior margin of scapula posteriorly, clavicle anteriorly, lateral margin of rib 1 medially

Vessels entering this inlet pass over rib 1. The brachial plexus also travels through this inlet.

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3
Q

Describe the path of the hemiazygous and accessory hemiazygous veins.

A

Both of these veins eventually drain into the azygous vein and then into the superior vena cava. The accessory hemiazygous vein descends while the hemiazygous vein ascends.

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4
Q

How many lactiferous ducts does an average woman have?

A

15-20

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5
Q

What is the blood supply to the mammary gland?

A

“I’m late to post”

Internal thoracic/mammary

lateral thoracic

thoracoacromial arter/ thoracodorsal artery

posterior intercostal

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6
Q

Describe the lymphatic drainage of the breast.

A

75% goes to the axillary nodes. There is also drainage to the parasternal lymph, subscapular nodes, and abdominal nodes.

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7
Q

What innervates the nipple?

A

T4

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8
Q

What are the clinical signs of breast cancer?

A

Dimpling, vascularization changes, skim edema, nipple retraction, peau d’organe (orange peel texture), hard woody texture of skin (cancer en cuirasse)

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9
Q

Rectomammary Space

A

Loose layer of connective tissue behind the breast that allows for movement of the breat over the other structures

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10
Q

Pectoralis Major M.

A

Insertion: Humerus

Origin: Sternum, clavicle

Innervation: Lateral and Medial Pectoral Nerves

Motions: Adduction, medial rotation, and flexion of humerus at the shoulder joint

(Climbing, breast stroking, chopping wood)

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11
Q

Pectoralis Minor M.

A

Origin: Anterior surface of 3-5 rib

Insertion: Coracoid processs of scapula

Innervation: Medial pectoral nerve

Motion: Depresses shoulder, protracts scapula

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12
Q

Subclavius

A

Origin: Rib 1

Insertion: Clavicle

Innervation: nerve to subclavius

Motion: Pulls clavicle medially to stabilize sternoclavicular joint

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13
Q

Describe a typical thoracic vertebrae’s articulation with ribs.

A

Ribs articulate with the thoracic vertebrae at its level and the vertebrae above it through the superior and inferior costal facets. The transverse costal facet at the end of the transverse process articulates with the tubercle of the rib of its own level.

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14
Q

What are unusual articulations between ribs and thoracic vertebrae?

A

Rib 1 only articulates with T1. TX and sometimes TIX only articulate with ribs at their level. TXI and TXII articulate only with the heads and lack transverse processes and like TX and TIX only articulate with the ribs at their level.

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15
Q

Describe the joints associated with the thoracic vertebrae.

A

Head of rib joint: synovial compartments by an intra-articular ligament

Costcotransverse joints: synovial

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16
Q

Describe ligaments associated with thoracic vertebrae.

A

Costotransverse ligament: medial to joint and attaches neck of rib to the transverse process

Lateral costotransverse ligament: lateral to the joint and attaches the tip of the transverse process to the roughened nonarticular part of tubercle the rib

Superior costotransverse ligament: attaches superior surface of the neck of the rib to the transvese process of vertebra above

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17
Q

Sternocostal Joints

A

joints between upper 7 costal cartillages and the sternum

Rib 1 - not synovial, fibrocartilagionous

Rib 2-7 - synovial

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18
Q

Which ribs are least likely to be broken and why?

A

rib 1 because it is protected by the clavicle

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19
Q

Interchondral joints

A

Forms the costal cartillage

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20
Q

Manubrosternal and xiphisternal joints

A

Sympheses

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21
Q

Cervical ribs

A

Present in 1% of the population, attached with vertebrae CVII. This can lead to thoracic outlet syndrome placing pressure on the brachial plexus.

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22
Q

Identify the following on a thoracic verebrae: vertebral body, laminae, vertebral foramen, superior articular processes, inferior articular process, transverse process

A

Add image

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23
Q

What is flail chest?

A

When a rib is fractured in two places, it can go in instead of out, and can puncture the lung.

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24
Q

Describe the function of intercostals in terms of breathing.

A

External intercostals: elevate during breathing Internal intecostals: depress during expiration Innermost: elevate ribs

Transversus: depress ribs at midline

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25
Q

What fibers are carried in the intercostal nerves?

A

Somatic motor innervation to muscle

Somatic sensory innervation to skin and parietal pleura

Postganglionic sympathetic fibers to periphery

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26
Q

Intercostobrachial nerve

A

Lateral cutaneous branch of the second intercostal nerve (T2)

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27
Q

How should a needle be inserted relative to a rib?

A

Should be inserted above the rib to avoid the “VAN” structure.

28
Q

Describe the fissures of the two lungs

A

Right lung: Oblique fissure seaparates the inferior lobe from superior and middle lobes; Horizontal fissures separates the middle lobe from the superior lobe

Left lung: oblique fissure

29
Q

Eupnea

A

Quiet inspiration

30
Q

Hypernea

A

Heavy breathing that is active during inspiration and expiration

31
Q

Describe the vascular supply of the bronchus.

A

Arterial: right bronchial artery arises from 3rd posterior intercostal artery and two left bronchial arteries from the thoracic aorta

Venous: drain to the pulmonary veins or into the azygous venous system

32
Q

What are the two sinuses surrounding the heart?

A

transverse sinus and oblique sinus

33
Q

Pericarditis

A

Inflammation of the pericardial sac

34
Q

Cardiac temponade

A

Fluid in the pericardial sac that makes it difficult for the heart to pump blood. Signs include the pathognomic sign (increased venous pressure), distant heart sounds, neck veins, decreased arterial pulse pressure. Treatment includes a pericardiocentisis just above the fifth rib and inch to the left of the sternum.

35
Q

What does the phrenic nerve derive from?

A

C3,4,5 “keeps the phrenic nerve alive”

36
Q

Describe the incidence of different types of heart dominance.

A

85% right heart, 15% left dominant

37
Q

What are the contents of the superior mediastinum?

A

SVC, brachiocephalic vein, arch of the aorta, remnant of the thymus, trachea, esophagus, thoracic duct, L recurrent laryngeal nerves, phrenic nerves

38
Q

What are the contents of the middle mediastinum?

A

heart, pericardium, roots of the great vessels, arch of the azygous, main bronchii

39
Q

What are the contents of the posterior mediastinum?

A

Esophagus, thoracic duct, azygous vein, hemiazygous, vagus n, sympathetic trunk, splanchnic nerves

40
Q

Cisterna chyli

A

Where a lot of nodes can drain in the abdomen at the base of the thoracic duct.

41
Q

Sympathetic nervous system

A

T1-L2; short preganglionic fibers and long postganglionic fibers

42
Q

Contrast the splanchnic nerves

A

Greater: 5-9 thoracic ganglia ends in celiac ganglia

Lesser: 9-10 thoracic ganglia ends in aorticorenal ganglia

Least: 12 thoracic ganglia ends in renal plexus

43
Q

What are the layers of skin, fascia, and muscle of the anterior abdominal wall running from superficial to deep?

A

Skin, Camper’s fascia (fatty), Scarpa’s fascia (membranous). external oblique, internal oblique, tranversus abdominus, transversalis fascia, extraperitoneal fat, parietal peritoneum

44
Q

Describe the innervation and function of the external oblique muscles.

A

T7-T12; compress abdomen, active in forced expiration; Run like “hands in pockets”

45
Q

Describe the innervation and function of the internal oblique muscles.

A

T7-T12; compress abdomen, active in forced expiration; opposite orientation to the external oblique muscles

46
Q

Describe the innervation and function of the transversus abdominus muscle.

A

T7-T12, ilioinguinal, and iliohypogastric; compress abdomen

47
Q

Describe the innervation and function of the rectus abdominus.

A

T7-T12; flex abdominals

48
Q

Describe the path of the ilioinguinal nerve and what it innervates.

A

The nerve arises from L1 then travels in between the transversus muscle and the internal oblique muscle through the inguinal canal and gives cutaneous sensory innervation of the penis/labia majora.

49
Q

Describe the rectus sheath and how it changes above and below the arcuate line.

A

The arcuate line is located about 3/4 between the xiphoid process and the pubic sympheses, or about 1/2 between the umbilicus and the pubic sympheses. Above the line, the external oblique and half the internal oblique pass in from of the rectus abdominus with the other half of the internal oblique passing behind with the transversus abdominus. Below the line, all of these muscles pass in front of the rectus abdominus. Thus, below the arcuate line there is no posterior rectus sheath.

50
Q

What is the superficial blood supply to the superior abdominal wall?

A

Internal thoracic arteries with two branches including the superior epigastric and musculophrenic arteries.

51
Q

What is the superior blood supply to the inferior abdominal wall.

A

Inferior epigastric, which branches off of the external iliac artery. There are also branches off of the deep and superficial iliac arteries. Superficial epigastric arteries also supply it as well.

52
Q

What happens to the abdominal wall blood supply when internal thoracics are used fora bypass heart surgery?

A

Because the superior epigastric and the inferior epigastric anastamose, the blood supply will only rise from the inferior epigastric.

53
Q

Where does the abodomen drainage go to?

A

Below the umbillicus, the drainage to the superficial inguinal lymph nodes. (BALL SAC = buttocks, anal canal, lower vagina, labium majorus, scrotum (not testis), abdominal wall, cock). Posterior will drain to posterior axiallary nodes. Anterior will drain to anterior axillary nodes.

54
Q

Describe the dermatomes of the abdomen.

A

The abdomen is innervated by T7-L1. T7 = xiphoid process, T10 = umbillicus. L1 = inguinal canal. While there is sensory innervation of the skin and parietal peritoneum, there is no sensory innervation of the visceral perioteneum, thus, there will be referred pain.

55
Q

What part of the abdomen is continuous with Dartos fascia?

A

Scarpa’s; thus if there is a fluid between Scarpa’s and the abdominal wall, the fluid will accumulate in the scrotum not in the leg.

56
Q

What passes through the inguinal canal?

A

The genital branch of the genital femoral nerve, the round ligament of the uterus/spermaticord, and the ilioinguinal

57
Q

What forms the ilioinguinal canal?

A

Remember “2 MALT.” Roof = internal oblique, transversus m., Anterior = internal and external aponeurosis, L = lower boarder, ilioginuinal ligament, T = conjoint tendon (I & T join at the pubic sympheses) and tranversalis fascia

58
Q

Contract the direct and indirect hernias.

A

Direct hernias pass through the Hesselbach’s triangle (lateral inferior epigastric artery, medially rectus abdominus, inferiorly inguinal ligament) Indirect hernias perforate the deep and superficial inguinal ring lateral to the inferior epigastric artery

59
Q

Describe the layers of the scrotum in terms of the layer of the abdomen it derives from.

A
60
Q

What are the retroperitoneal structures?

A

Mneumonic: “SAD PUCKER”

S = suprarenal

A = aorta/IVC

D = duodenum (2,3)

P = pancers

U = ureter

C = colon (ascending/descending)

K = kidney

E = esophagus

R = rectum

61
Q

What forms the greater omentum?

A

The visceral peritoneum folds over from the stomach and the transverse large intestine. There are four layers of peritoneum that form the greater omentum.

62
Q

Describe the lesser sac.

A

The lesser sac is located behind the gastroduodenal ligament and the hepatogastroligaments. The entry is formed by the hepatogastric ligement forming the omental foramen.

63
Q

If someone placed their finger through the omental foramen, what would be lying anterior and posterior to their finger?

A

Posterior: IVC

Anterior: Directly anterior would be the portal vein, then would be the hepatic artery and the bile duct. Otherwise known as the hepato triangle

64
Q

Douglass pouch

A

Where fluid collects in women between the uterus and the rectum. The lowest part of the peritoneal cavity in women.

65
Q

Rectouterine pouch

A

Between the bladder and the rectum, the lowest point of the peritoneal cavity in men where fluid can collect.

USMLE STEP 1 (15 decks)

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