L9

Question 1

What is the origin of the subclavian artery?

Answer 1

• RHS Brachiocephalic artery

- LHS origin arch of the aorta

Question 2

What is the course of the subclavian artery?

Answer 2

→ (P) to sternoclavicular joint → (P) to scalenus anterior muscle → over lung apex on suprapleural membrane → over 1st rib → Axillary artery

Question 3

What are the three parts of the subclavian artery?

Answer 3

• Medial
• Behind
• Lateral in relation to scalenus anterior

Question 4

What are the branches of the subclavian artery?

Answer 4

• Vertebral
• Internal thoracic
• Thyrocervical trunk in the root of the neck (M) to Scalenus anterior.
• Costo-cervical trunk

Question 5

Where do the highest intercostal and deep cervical arteries arise
from?

Answer 5

From behind scalenus anterior

Question 6

What is the origin of the axillary artery?

Answer 6

From subclavian artery at outer border of 1st rib

Question 7

What is the end of the axillary artery?

Answer 7

Lower border of teres major - brachial artery

Question 8

What are the three parts of the axillary artery?

Answer 8

• Pectoralis minor 1st: (S) thoracic artery
• 2nd: Thoracoacromial & (L) thoracic artery
• 3rd: (A) & (P) circumflex humeral and subscapular artery

Question 9

Scapular anastomosis of the axillary artery

Answer 9

1st part of subclavian artery to brs. 3rd part of axillary artery

Question 10

What is the origin of the brachial artery?

Answer 10

From axillary artery at lower border of teres major

Question 11

What are the branches of the brachial artery?

Answer 11

• Profunda brachii artery
• Superior / inferior ulna
• Collaterals nutrient artery of humerus muscular and articularc branches

Question 12

What is the course of the brachial artery?

Answer 12

Lower border of teres major - ventral surface of the arm - the cubital fossa. Then divides into its terminal branches: the radial and ulnar arteries of the forearm.

Question 13

What is the origin of radial artery?

Answer 13

Terminal branch of brachial artery at apex of cubital fossa

Question 14

What is the course of radial artery?

Answer 14

Anterior forearm → deep to brachioradialis close to radial forearm muscles → lower forearm on anterior radius → (L) aspect of wrist → floor of anatomical snuffbox → 1st web space → 2 heads of 1ST dorsal interosseous → 2 heads adductor policis

Question 15

Where is the radial artery palpated?

Answer 15

At lower forearm on anterior radius

Question 16

Where does the radial artery end?

Answer 16

At the deep palmar arch artery

Question 17

What are the branches of the radial artery?

Answer 17

• Radial recurrent artery.
• Palmar carpal branch.
• Dorsal carpal branch.
• Muscular branches.
• Superficial palmar branch.

Question 18

What is the origin of the ulna artery?

Answer 18

Terminal branch of the brachial artery in cubital fossa along with radial A3

Question 19

What is the course of the ulna artery?

Answer 19

Deep to CFO muscles → then deep to flexor carpi ulnaris with ulnar nerve on medial side → anterior forearm → lying on FDP → crosses anterior to wrist between flexor digitorum profundus and flexor carpi ulnaris tendons → lateral side of pisiform

Question 20

What does the ulnar artery end as?

Answer 20

As superficial palmar arch artery

Question 21

What are the branches of the ulnar artery?

Answer 21

• Common interosseous artery
• Anterior interosseous artery
• Posterior interosseous artery

Question 22

Describe the anterior interosseous artery

Answer 22

• Lies on interosseous membrane between flexor digitorum profundus and flexor pollicis longus → perforating branches supply deep extensors gives nutrient branches to radius / ulna at upper border of pronator quadratus → posterior
  compartment

Question 23

Describe the posterior interosseous artery

Answer 23

• Smaller vessel from ulnar artery /common interosseous artery
  between oblique cord and interosseous membrane → with
  posterior interosseous nerve / supplies deep extensors ends at
  back of wrist → dorsal carpal anastamosis

Question 24

Give details of scapular arterial anastomosis

Answer 24

Between branches of the 1st part of the subclavian artery with 3rd part of axillary artery

Question 25

Give details of arterial anastomosis at the elbow joint

Answer 25

Recurrent branches of radial, ulnar and interosseous artery passing up anteriorly and posteriorly to elbow → anastomose with descending branches of posterior brachial artery and superior and inferior ulnar collateral branches of brachial artery.

Question 26

Give details of arterial anastomosis at the wrist joint

Answer 26

Dorsal and palmar carpal branches of radial and ulnar arteries above the wrist joint freely anastomose.

Question 27

Give details of arterial anastomosis at the deep and superficial palmar

Answer 27

Radial and ulna arteries giving their deep and | superficial arch arteries eventually unite with one another

Question 28

Give the organisation of venous drainage

Answer 28

Organised into deep and superficial systems.

Question 29

Give the perforating vessels of the venous drainage.

Answer 29

``` Pass venous blood to deep veins which accompany arteries. Important perforators at the mid medial biceps (basilic vein) and in cubital fossa (median cubital vein) ```

Question 30

Give the venous drainage of the arm

Answer 30

Similarly named vessels to arteries in the drain proximally to axillary vein.

Question 31

Give the venous drainage of the forearm

Answer 31

Distal to the elbow main | arteries have venae commitantes a dual set of veins in close proximity.

Question 32

Give clinical importance of venous drainage

Answer 32

Superficial veins of the upper limb are very important sites for IV access for drug delivery and fluid and blood replacement. NB cephalic vein and pacing wires

Question 33

Why are artery and veins proximal to eachother?

Answer 33

To pump venous blood back to heart

Question 34

What is the function of superficial lymph vessels?

Answer 34

To drain the skin

Question 35

Give details of superficial lymphatic drainage.

Answer 35

- Medial vessels drain with basilic vein to epitrochlear and axillary nodes. - Lateral vessels drain with cephalic vein to infraclavicular and axillary nodes

Question 36

Give details of deep lymphatic drainage

Answer 36

They drain with | arteries to lateral axillary nodes

Question 37

Where do epitrochlear nodes lie?

Answer 37

At medial elbow

Question 38

What are the 5 groups of axillary nodes?

Answer 38

- Pectoral - Lateral - Central - Apical - Infraclavicular

Question 39

What do pectoral nodes drain?

Answer 39

Lateral and anterior chest wall, breast ad anterior abdominal wall

Question 40

Where do lateral axillary nodes receive efferents from?

Answer 40

From upper limb

Question 41

What does the subscapular node drain?

Answer 41

The back of the trunk

Question 42

Where is the central axillary node situated?

Answer 42

Around axillary vessels

Question 43

Give details of the apical axillary node.

Answer 43

Receive from other groups, blockage → | lymphoedema

Question 44

Where are the infraclavicular nodes present?

Answer 44

They lie around end of cephalic vein → apical group

Question 45

Cephalic vein details

Answer 45

Pierces the clavipectoral fascia at upper end of the deltopectoral groove to enter axillary vein

Question 46

Where is the radial artery pulse?

Answer 46

Lateral to the tendon of flexor carpi radialis

Question 47

What is the course of the basilic vein

Answer 47

Pierces the fascia in the medial mid arm to jon the venae commitantes which together, at the inferior border of teres major, become the axillary vein

Question 48

Where is the brachia; artery pulse?

Answer 48

In the cubital fossa, lateral to the median nerve

Question 49

What should be performed before taking an arterial sample?

Answer 49

An Allen test

Question 50

What are the steps in the Allen test?

Answer 50

- Patient clenches fist - Use finger to obstruct blow flow at ulnar and radial arteries - Release the ulnar artery - if hand flushes - good blood flow, if not bad blood flow

Question 51

What is the radial artery used for?

Answer 51

Radial cannulation