Key Notes Flashcards
Autonomic nervous system, generally speaking
Sympathetic and parasympathetic
All visceral efferent (motor)
Where does sympathetic nervous system synapse?
between T1 and L2
Where does parasympathetic nervous system synapse?
Craniosacrally
What are paravertebral and prevertebral ganglia
Postsynaptic neurons for sympathetic
Paravertebral ganglia
Only postsynaptic sympathetic ganglia
Motor - sympathetic
Prevertebral ganglia
Also works with sympathetic neurons
celiac, aorticorenal, superior mesenteric, and inferior mesenteric ganglia
What types of nerves are intercostal nerves?
somatic (motor and sensory) that stem from ventral roots of T1-T11
What root do motor fibers use?
Ventral root
What root do sensory fibers use?
dorsal root
What type of nerve is the vagus nerve?
parasympathetic preganglionic nerve
Can the vagus nerve use the paravertebral ganglia?
No because paravertebral ganglia is only for sympathetic nerves
branches of subclavian artery
- thyrocervical
- costocervical
- transverse vertebral branches
- internal thoracic artery
Where do posterior intercostal arteries arise from?
Upper 2 branches from costocervical trunk
Lower branches directly from thoracic aorta
Where do anterior intercostal arteries arise from?
upper 6 branches from ITA
2 lower branches from musculophrenic artery
What does the digastric triangle contain?
submandibular gland
submandibular lymph
hypoglossal nerve
facial arteries / veins
mylohyoid nerve
What does the carotid triangle contain?
HID VACA
hypoglossal, internal jugular vein, accessory nerve, ansa cervicalis, deep cervical lymph, vagus nerve, carotid artery
Difference between phrenic and vagus in the neck
Phrenic is more lateral by the anterior scalenus
Vagus is more medial by the carotid sheath
What does the great cardiac vein run with?
LAD and left circumflex
Where is the coronary sinus?
kind of by the left circumflex
where lots of veins meet
Where do diagonal arteries come off?
LAD
Where does obtuse marginal come off?
left circumflex
What establishes coronary prominene?
Where AV nodal artery and PDA come off
When a question says paralysis / numbness what should you think?
Nerve problem!
Recurrent laryngeal nerves are a branch of what?
vagus nerve
2 fissures in the right lobe
Horizontal (separates middle lobe)
Oblique (separates superior and inferior)
What does the seratus attach to?
Rib 2 at the rough surface
Where should you insert a chest tube?
above rib to avoid the neurovascular bundle
What can be a corresponding nerve problem to having the arch of the aorta damaged?
can damage the L recurrent laryngeal nerve
this can lead to hoarseness or throat problems
What innervates the posterior belly of digastric?
facial nerve
What innervates the anterior belly of digastric?
mandibular branch of trigeminal nerve
What is a clue when the questions says “fell backwards” ?
you know that they fell on their posterior wall
What thoracic vein is on the right side?
azygous vein
What thoracic vein is on the left side?
hemiazygous and accessory hemiazygous
What does the thoracic duct pass between?
aorta and azygous vein
Where does the thoracic duct pass through the diaphragm?
at the aortic hiatus
T12
where does the vagus nerve pass through the diaphragm?
at the esophageal hiatus
T10
where does the phrenic nerve pass through the diaphragm?
it doesn’t because it innervates the diaphragm!
What innervates the carotid sinus / body?
Glossopharyngeal and vagus nerve
Does the vagus nerve pass in front of or below subclavian artery?
in front of
What is a hernia?
organs leave the cavity they are supposed to be in
where does IVC pass through aorta?
T8
What sense pain from pericardium?
phrenic nerve
What sense pain from heart?
cardiac plexus
If a question stem says difficulty swallowing, what should you think of?
the esophagus
What structure can constrict the esophagus?
Left atrium
Endothoracic fascia
deep to intercostal muscles
separates intercostal spaces/ribs from underlying pleura
What does subcostal mean?
lower level intercostal arteries
mostly just artery 12
just have posterior intercostal arteries
What artery can often be damaged when working on the thyroid?
superior thyroid artery that goes down midline of neck
Trabeculae carnae vs. pectinate muscle
Trabeculae carnae is only on the ventricles
Pectinate muscle is only in the atria
Where is the pericardial sac?
Ribs 2-6
Vertebrae T5-T8
The acute marginal artery brings blood to what?
the right ventricle
Where is the accessory hemiazygous vein located?
left side of body
spans intercostal spaces 5-8
Where is the hemiazygous vein located?
left side of body
spans intercostal spaces 9-11
When draining a costodiaphramatic recess why would you not have to go through external intercostal muscles?
Because when the intercostal muscles wrap around from the back, they stop before the costocartilage
Carotid sinus
detects blood pressure
What lies posterior to fingers in transverse pericardial sinus?
the SVC
Where does bloodflow reverse in coarctation of aorta?
posterior intercostal arteries
what can an aneurysm in the arch of the aorta indicate?
can mean damage to the L recurrent laryngeal nerve and paralysis of the L side of the larynx
Which nerve gives sensation to skin at angle of mandible?
greater auricular
Which nerve gives sensation to skin at front of neck?
transverse cervical
What are the adrenal glands supplied by? Where do they arise?
superior suprarenals (branches of the inferior phrenic artery)
middle suprarenal (from abdominal aorta)
inferior suprarenal (from renal artery)
What are retroperitoneal organs? (6)
kidneys
adrenal glands
pancreas
abdominal aorta
inferior vena cava
2nd part of duodenum
Where do right retroperitoneal organs drain?
directly into the IVC
Where does the SMA cross?
anterior to the 3rd segment of the duodenum and the left renal vein
What empties directly into portal vein?
cystic vein
gastric vein
superior mesenteric vein
splenic vein
What joins the splenic vein?
the inferior mesenteric vein
Where does the liver get most of its blood from?
the portal vein
What drains directly into para-aortic nodes?
gonads (testes / ovaries)
kidneys
upper uterus
What type of fibers do splanchnic nerves carry?
preganglionic sympathetic and visceral afferent (sensory) fibers
exception is the pelvic splanchnic
What types of fibers does the pelvic splanchnic carry?
preganglionic parasympathetic fibers from S2-S4
What supplies the fundus of the stomach?
splenic artery branches
specifically, short gastric arteries
What opens for the deep inguinal ring?
transversalis fascia
What opens for the superficial inguinal ring?
external abdominal oblique muscle
What is the floor of the inguinal canal?
the inguinal ligament
What is an exception of parasympathetic innervation?
Parasympathetic actually stimulates the detrusor muscle (bladder)
makes sense, when you are relaxed, you pee
What do most visceral afferent (pain sensation) fibers travel with?
sympathetic nerves
Where are the superior and inferior epigastric vessels?
in the rectus sheath
What causes a direct inguinal hernia?
weak conjoint tendon
What causes an indirect inguinal hernia?
processes vaginalis is still open
Where are the testicular artery and pampinoform plexus?
in the spermatic cord
How do the SMA and celiac trunk anastomose?
by way of the superior and inferior pancreaticoduodenal arteries
What is not included in the mesentery?
second part of the duodenum
What do you have to cut through to get to the SMA?
mesentery
What supplies the lesser curvature of the stomach?
left gastric artery
What type of rami does pain sensation go through?
white communicating rami
Anterior 2/3 of tongue sensation
facial nerve
What is confusing about facial nerve?
one of its parasympathetic ganglion is called the mandibular (trigeminal) ganglia
Posterior 1/3 of tongue sensation
glossopharyngeal
What travels through the optic canal
Optic nerve, opthalmic artery and sympathetic fibers from the carotid plexus
Where does external carotid plexus recieve postganglionic sympathetic fibers from?
superior cervical ganglion
Why does tongue deviate to same side as hypoglossal nerve lesion?
due to paralysis of genioglossus on same side as lesion
Is the cremasteric muscle in the inguinal canal?
no
How do splanchnic nerves pass into the abdominal cavity?
piece the cruca of the diaphragm
What controls the levator of the palate?
vagus nerve
What is one test of the vagus nerve?
see if the uvula raises
What is behind the first segment of the duodenum?
gastroduodenal artery, portal vein and common bile duct
Where does pain from the stomach go?
to celiac ganglion since it follows sympathetic pathways
greater splanchnic (sympathetic nerve) goes to the celiac ganglion
What does the gastroduodenal artery split into?
right gastroepiploic a
superior pancreaticoduodenal artiers
What supplies the greater curvature of stomach?
gastroepiploic arteries
Where does breast normally first drain into (lymph)?
axillary nodes
What does posterior wall of stomach touch?
pancreas
can damage the splenic artery
State the terminal ganglia of the splanchnic nerves
Greater= celiac trunk
Lesser - superior mesenteric
Least= aorticorenal
Lumbar = inferior mesenteric plexus and hypogastric
Sacral = hypogastric plexus
Hypogastric plexus
scattered in the pelvis
postganglionic
Where does cavernous sinus get blood from?
opthalmic vein
Where does the cavernous sinus drain into?
superior and inferior petrosal sinuses
Where does inferior petrosal sinus drain into?
internal jugular vein
Where does superior petrosal drain into?
sigmoid sinus at the continuation of the transverse sinus
Where does the transverse sinus drain to?
internal jugular veins
What does the lingual artery run with?
the hypoglossal nerve
comes off the external carotid
Hypoglossal nerve path
loops up to the angle of mandible
passes across the submandibular gland
What does the facial artery run with?
submandibular gland to the angle of mandible
what are the nerves of the retroperitineal space in descending order?
Subcostal (hard to see)
Iliohypogastric
Ilioinguinal
Lateral cutaneous
Femoral nerve (beefy)
Genitofemoral (over the psoas major, splits)
What nerves supply parasympathetic control to the abdomen and pelvis?
vagus nerve
pelvic splanchnic nerve (S2-S4)
Where does obturator artery normally arise from?
anterior division of the internal iliac artery
Where does an aberrant obturator artery arise from?
external iliac artery / inferior epigastric artery
When can an aberrant obturator artery be at risk?
during an inguinal hernia repair
What is Hirschsprung’s disease?
megacolon, lack of enteric neurons in distal colon
failure of neural crest cells to migrate to the distal colon
Where do uterine vessels pass to the sides of the uterus?
mesometrium
Obturator and ovary relationship
the obturator passes close to the ovary
it is separated from the ovary by peritoneum
Is the ovary in the retroperitoneal space?
yes
suspensory ligament
attaches ovary to posterior abdominal wall
ovarian vessels travel to ovary through the suspensory ligament
ovarian ligament
attaches ovary to the uterus
What is true of the male vs. female pelvis?
in general, the male pelvis is narrower and deeper
the female pelvis is shallower and wider
Nerves relation to the kidneys
Subcostal + iliohypogastric = posterior
lateral cutaneous nerve = anterior
What is the principal blood supply of the rectum?
the superior rectal artery from the IMA
Inferior rectal artery
weird because it doesn’t supply the rectum
just supplies the lower anal canal
is a branch of inferior pudendal artery
Middle rectal artery
does supply a portion of the rectum
What separates S2/S3?
inferior gluteal artery
What separates lumbosacral trunk / S1?
superior gluteal artery
What does the axillary nerve provide sensation to?
lower half of deltoid muscle
What are the cords of the brachial plexus named after?
their relationship to the middle segment of the axillary artery
Which nerve can a dislocated shoulder damage?
the axillary nerve
Symptoms of Erb-Duchenne’s
pronated forearm
extended forearm
medial rotation
Where does lateral cord come from?
formed from the anterior division of the superior trunk of the brachial plexus
Where does the medial cord come from?
formed from the anterior division of the inferior trunk of the brachial plexus
Fracture of the humerus normally indicates what?
Radial injury
wrist drop
*other nerves can be injured as well
What are the ovarian and testicular arteries branches of?
the abdominal aorta
they are gonadal arteries
What nerve is foot drop a symptom of?
common fibular nerve
Which nerve does lateral rotation of the thigh?
superior / inferior gluteal
definitely the inferior if between the two
Which nerve does knee extension?
femoral
Which nerve does knee flexion?
sciatic
mostly the tibial sciatic
Where do the subscapular nerves originate?
the posterior cord
Superficial palmar arch of hand
direct continuation of ulnar artery
Which nerve medially rotates the thigh?
superior gluteal nerve
Eversion of the foot
common fibular - sciatic
Dorsiflexion of the foot
common fibular - sciatic
Plantar flexion of the foot
tibial - sciatic
Sciatic - tibial sensation
posterior lower leg and foot
sensation innervated by Sciatic - common fibular
anterior lower leg and foot
Which nerve adducts the leg?
obturator
Where does the uterine artery cross the ureter in females?
within the cardinal ligament, below the base of the broad ligament, near the lateral fornix of the vagina
crosses the ureter SUPERIORLY
bridge OVER water
What is the uterine artery in men?
the inferior vesical
Weakening of thenar eminence indicates what?
a median nerve injury
