Lufti Review Flashcards
0
Q
Left coronary artery gives off…
A
Circumflex and left marginal artery
Anterior interventricular artery (aka LAD)
1
Q
Right coronary artery gives off…
A
Right atrial branch
Conal branch
Right marginal branch
Posterior interventricular artery (aka PAD)
2
Q
The right coronary artery supplies…
A
AV and SA nodes
Posterior/Inferior 1/3 of septum
Right marginal artery, which supplies RV
Posterior interventricular artery, 1/3 RV and 2/3 LV
3
Q
Left coronary artery supplies…
A
LAD- LV, RV, and 2/3 of septum
AV bundle
Circumflex artery - LA and LV
Marginal artery - LV
4
Q
Where do the branches of the left and right coronary arteries anastomoses?
A
- Nodal anastomoses
- About the conus arteriosus
- Circumflex
- anterior interventricular septum
- posterior interventricular septum
5
Q
Where is the SA node located?
A
Superior to the cristae terminalis
At the junction of the anteromedial aspect of the SVC and the right auricle
Subepicardial
6
Q
What supplies the blood to the SA node?
A
A branch of the Right coronary artery
7
Q
Describe the AV node and it’s location.
A
Smaller smaller collection of nodal tissue located in the interatrial septum, on the ventricular side of the orifice of the coronary sinus.
Submyocardial
8
Q
What supplies the blood to the AV node?
A
A Branch of the Right coronary artery
9
Q
The Atrioventricular bundle of His travels what path and is supplied by what artery?
A
Travels from AV node into septal wall of RA; to upper membranous part of the ventricular septum where it divides.
Right branch goes to RV by passing through the septomarginal trabecula. Left branch goes to LV.
The bundle of His is supplied by the LAD.
10
Q
Describe the conducting system of the heart
A
Consists of specialized cardiac muscle cells and conducting fibers (NOT nervous tissue).
Compartments are specialized for initiating impulses and conducting them rapidly through the heart.
Initiate the normal heart beat and coordinate the contractions of the four chambers- Atria contracting at the same time,as do the ventricles, but atria contract before ventricles.
11
Q
What contributes to the Falx Inguinalis (conjoint tendon) and where does it insert to?
A
IOM (interior oblique muscle) and transverse abdominalis m.
Inserts onto the pubic symphysis
12
Q
What makes up the EOM aponeurosis?
A
Inguinal ligament (Poupart's ligament) Lacunar ligament (Gubernat's ligament) Pectinal Liament (Cooper's ligament) Superficial Inguinal ring External spermatic fascia
I love pretty sexy Emma.
13
Q
The upper 2/3 of the rectus sheath (btwn the costal margins and ASIS) is formed by…
A
- EOM aponeurosis is anterior to the rectus abdominis.
- IOM aponeurosis splits into the anterior layer going above the rectus abdominis and the posterior part going below
- Transversus abdominis is posterior to the posterior part of the IOM
14
Q
What are the superficial vessels in the superficial fascia of the abdomen and where are they derived from?
A
Superficial epigastric arteries (from the femoral artery) and veins
15
Q
The lower 1/3 of the rectus sheath (between the ASIS and the pubic symphysis) is formed by…
A
The aponeuroses of all three wall muscles form the anterior wall of the rectus sheath
The fascia transversalis forms the posterior wall of the rectus sheath.
16
Q
What forms the posterior wall on the lower 1/3 of the rectus sheath?
A
Fascia transversalis
17
Q
What are the boundaries of the the epiploic foramen?
A
Anteriorly: portal hepaticus (portal triad)
Posteriorly: IVC and the right crus of the diaphragm
Superiorly: caudate lobe of the liver
Inferiorly: superior part of the duodenum
18
Q
The portal triad is contained within what?
A
Hepatoduodenal ligament of the lower ligament
19
Q
What are the contents of the the portal triad and what are their relative locations?
A
Portal vein (posterior)
Proper hepatic artery (left)
Common bile duct (right)
21
Q
What is a hernia?
A
An abnormal protrusion of tissue for a cavity in which it belongs
22
Q
Inguinal hernias are more common in males or females?
A
Males
23
Q
What are the two types of hernias?
A
Indirect Inguinal hernias (congenital)
Direct Inguinal hernias (acquired)
24
Q
Describe indirect Inguinal hernias and the path they take.
A
Indirect Inguinal hernias take the indirect route through the abdominal wall. They leave the abdominal cavity LATERAL to the inferior epigastric vessels, traverse the deep Inguinal ring, Inguinal canal, and superficial Inguinal ring.
25
What is the most common type of Herniation? By what percentage?
Indirect Inguinal herniations are more common in 75% of cases
26
What are direct Inguinal herniations and what route do they take?
Direct Inguinal herniations protrude anteriorly through the posterior wall of the Inguinal canal and leave through the abdominal wall MEDIAL to the inferior epigastric vessels.
Direct herniations pass through the Inguinal triangle (Hesselbach's triangle).
27
Where and what are the borders of the Hasselbach's triangle?
The Hasselbach's triangle is located posteriorly to the superficial Inguinal ring and is bounded by
Inferior: Inguinal ligament
Lateral: inferior epigastric vessels
Medial: lateral border of rectus abdominis muscle
28
Where is the gallbladder?
In a fossa on the visceral surface of the liver, in and between the right costal margin and the right linea semilunaris at the transpyloric plane (L1) in the RUQ.
29
What are the parts of the gallbladder? Which part becomes the cystic duct?
Fundus, body and neck (which becomes the cystic duct)
30
What is the blood supply of the gall bladder and bile duct?
Cystic artery ( via the right hepatic artery, which is from the common hepatic artery, which is from the celiac trunk )
31
What is the innervation of the gallbladder and the bile duct?
Vagus (parasympathetic)
| Greater splanchnic nerve (sympathetic)
32
Where is the tricuspid valve? (With ICS space)
On the right, between the RA and the RV, behind the right half of the sternum opposite ICS 4.
33
Where is the bicuspid or mitral valve?
On the left, between the LA and LV, behind the left 1/2 of the sternum opposite costal cartilage 4
34
Where is the aortic semilunar valve?
Connects to the ascending aorta, left 1/2 of the sternum opposite ICS 3
35
Where is the pulmonary semilunar valve?
Connected to the pulmonary trunk, behind the medial end of the 3rd left costal cartilage.
36
The epiploic foramen connects what two spaces?
Lesser sac (lesser omental bursa) and greater sac
37
For auscultation, where would you hear the heart sounds of the aortic valve?
over the Right 2nd ICS
38
For auscultation, where would you hear the heart sounds of the pulmonary valve?
over the Left 2nd ICS
39
For auscultation where would you hear the secondary pulmonic heart sound?
over the left 3rd ICS.
40
For auscultation where would you hear sounds of the bicuspid valve?
Over the apex of the heart, 6-7 cm median from the plane, generally in the LEFT 5th ICS
41
For auscultation, where would you hear heart sounds of the tricuspid valve?
Over the left 1/2 of the lower end of the body of the sternum in the Left 4th ICS.
42
What does the SMA and its branches supply?
The SMA and its branches supply from the 2nd part of the duodenum to the left colic flexure.
43
What are the branches of the SMA and to what organs do they supply?
It's branches are:
Jejunal and ilium branches - Jenjunum and ilum
Ileocolic A - ascending colon, cecum and appendix
Right colic A - right colic flexure
Middle colic A - transverse colon
44
What does the IMA supply?
From the left colic flexure to the rectum
45
What are the branches of the IMA and what organs do they supply?
Left colic A - left colic flexure
Descending branch of IMA - Descending colon
Sigmoidal A - Sigmoids
Superior rectal A. (aka. superior hemorrhoidal arter) as the terminal artery of the IMA. - Rectum
46
What veins flow into the splenic vein?
- Short gastric veins
- Left gastroepiploic v
- Pancreatic V (which receives from the Dorsal pancreatic, Great pancreatic and caudal pancreatic vv)
- IMV (which starts in the rectum as the superior rectal v and receives from the sigmoid vv and left colic c.)
47
What veins flow in the SMV?
- Ileal and jejunal vv.
- ileocolic v
- RIght colic v
- Middle colic v.
- Right gastroepiploic v.
- Pancreaticduodenal v.
48
Where does the pyloric v run?
Along the lesser curvature of the stomach
49
Where does the cystic V run and drain from?
Drains the gullbladder and accompanies the cystic duct
50
What are the direct tributaries of the portal vein?
Splenic V, SMV, Pyloric, Cystic V, and Paraumbilical VV
51
Beside direct tributaries of the portal vein, what else would be affected by a blockage of the portal vein?
1) Esophageal veins (via the azygos vein (systemic) anastomose with the left gastric vein (portal vein)
2) Superior Rectal vein (portal vein) anastomoses with the inferior rectal vein, which drains into the internal iliac vein (systemic)
3) Paraumbilical veins (poral) anastomose with veins inferior to the umbilicus (superficial epigastric vein) which drain into the external iliac vein (systemic).
4) Veins of the colon, pancreas, liver which drain into the portal vein anastomose with renal, lumbar and phrenic veins (systemic)
52
Direct branches of the Abdominal aorta from superior to inferior are...
celiac trunk
SMA
Testicular/ovarian Arteries
IMA
53
How is the pathway of the left gonadal vein different than that of the right gonadal vein?
The right gonadal vein dumps directly into the IVC while the Left gonadal vein dumps into the left renal vein, which then dumps into the IVC.
54
What tributaries dumps into the renal vein? Where does the Renal vein dump into?
The left supra-renal vein and left gonadal vein dump into the renal vein, which dumps into the IVC.
55
What are the horizontal planes of the abdominal Aorta and what are their landmarks? (There are 4)
Transpyloric plane (TPP): (L1) Midway through xiphosernal join and umbilicus. (Many abdominal viscera are related to it)
Subcostal Plane - (L2-L3) at the inferior margin of 10th costal cartilage
Transumbilical plane (TUP) - L3-L4 intervertebral disc
Transtubercular Plane (TTP) - L5 through the iliac tubercules
56
If I stabbed the middle of the right kidney, where would I feel pain?
In the liver
57
If I stabbed the lower edge of the right kidney, where would I feel pain?
the jejunum
58
If I stabbed the superior tip of the right kidney, where would I feel the pain?
In the adrenal glands
59
If I stabbed midline of the left kidney, where would i feel the pain?
In the pancreas
60
What peritoneal folds can be found superior to the umbilicus? Where do they go and what are their contents?
Large Median Fold (aka. FALCIFORM LIGAMENT) goes to the liver and diaphragm. It's free edge, the LIGAMENTUM TERES contains the remnant of the umbilical vein (obliterated), which ends as the round ligament of the liver
61
What peritoneal folds can be found inferior to the umbilicus? What are their contents?
- Median Umbilical Fold = urachus
- Medial Umbilical Fold = obliterated umbilical artery
- Lateral Umbilical Fold = inferior epigastric artery
62
What are the boundaries and contents of the Hepatocystic Triangle of Calot?
Boundaries:
- The inferior border of the liver
- Common hepatic bile duct
- Cystic duct
Content:
- Lymph Node of Calot
- Cystic Artery
63
What medical complication can occur at the Hepatocystic Triangle of Calot?
The lymph node of Calot can get inflamed in cholecystitis and may be removed during cholecystectomy
64
Where is the Triangle of Calot?
Under the left lobe of the liver
65
The ureters connect from what to what?
The ureters connect from the kidneys to the urinary bladder
66
Are the ureters extraperitoneal or retroperitoneal?
retroperitoneal
67
What is the common pathway of the Ureter?
They descend o the psoas major muscle, and cross the common iliac arteries or external iliac arteries.
68
In what gender is the pathway of the ureter special? What is the pathway?
In females, near the ischial spine, the ureters turn downward, forward and medially below the uterine vessels, about 1.5 to 2 cm away from the cervix.
69
In which clinical presentations will the trachea deviate to the affected side?
- Atelectasis (collapsing of the lung)
- Pneumonectomy (removal of the a lung)
- Large pleural fibrosis (thickening of the tissues of the lung)
70
In which clinical presentations will the trachea deviate to the opposite (unaffected) side?
- Tension pneumothorax (collection of air in the pleural space that separates the lung from the chest wall)
- Pleural effusions (buildup of fluid around the lung)
- Hemothorax (blood accumulation in the pleural cavity)
- Large masses
71
If I stabbed the front side of the chest at the heart, which veins could I hit?
Anterior Cardiac Veins (at the RA)
Small Cardiac Veins (which drains the RV)
Great Cardiac Vein
72
If I stabbed a guy in the back toward the heart, which veins could I hit?
Middle cardiac vein
Oblique vein
Coronary sinus (drains into the right atrium)
73
Which veins drain into the coronary sinus? (i.e. what veins are tributaries of the coronary sinus)
Great Cardiac Vein
Small Cardiac Vein
Middle Cardiac Vein
Oblique Vein
74
Which veins DO NOT drain into the coronary sinus? Where do they drain into?
The Anterior Cardiac Veins (which drains directly into the RA) and
The Venae cordis minimae (which drains mainly into the atria)
75
Which veins are the smallest cardiac veins? Where do they travel and what are so special about them?
The Venae cordis minimae are minute veins that begin in the capillary beds of the Myocardium and open directly into the chambers of the heart, chiefly the atria. The venae Cordis Minimae are NOT tributaries of the coronary sinus.
76
Where is the esophagus? (vertebrae range and general location)
C6 to T10 from the lower end of the pharynx to the cardiac opening of the stomach. It is a median structure that lies BEHIND the trachea and BEHIND the left atrium.
The esophagus is the main posterior relationship of the base of the heart (LA). It deviates to the left, posterior to the left main bronchus and it enters the diaphragm at T10 anterior to the aorta.
77
Where is the esophagus hiatus and what goes through the hiatus?
At T10. The contents are the esophagus, the vagus and the esophageal branch of the left gastric artery and vein.
78
What are the blood supplies of of the esophagus?
```
Inferior thyroid artery
Bronchial arteries
Esophageal arteries
Phrenic arteries
Esophageal branch of the left gastric artery
```
79
Where the does the blood from the esophagus drain to?
The Azygos (adjacent) veins and to the anastomoses between the esophageal veins via the left gastric veins.
80
What are the innervations of the esophagus?
- The Vagus (from the esophageal plexus)
- Anterior branch - left vagus nerve
- posterior branch - right vagus nerve
- Sympathetic fibers
- Pain fibers (sympathetic)
81
What vessels lay posterior/under the lesser omentum?
The common bile duct, portal vein and proper hepatic artery
82
What makes up the Gastrosplenic ligament?
Short gastric and left gastric epiploic vessels
83
What makes up the splenorenal ligament?
Splenic vessels and Tail of the pancreas
84
What ligament divides the liver into right and left lobes? What does it give off?
Falciform Ligament, which gives off the Ligamentum teres
85
On what surface is the bare area of the liver? What vessel is associated with it?
The bare area is on the visceral surface on the posterior aspect of the right lobe. the IVC is associated with the bare area.
86
Which ligament connects to the liver on the anterior abdominal wall and to the diaphragm, and what spaces does it create?
The Falciform ligament creates the right and left subphrenic spaces.
87
When the falciform ligament gets to the visceral surface, it changes names to:
Coronary Ligaments: Anterior/Posterior
| Triangular ligaments: Right/Left
88
What ligament is a continuation of the right coronary ligament and that connects to the right margin of the epiploic foramen?
hepatorenal ligament
89
The ligamentum Venosum accompanies what vein and is a remnant of what?
The ligamentum Venosum accompanies the left branch of the portal vein and is remnant of the fetal ductus venosus
90
Name the four locations where the portal vein and systemic system anastamose.
1- Esophageal (azygos) w/ Left Gastric
2- Superficial epigastric w/ Paraumbilical
3- Renal w/ Colon
4- Inferior rectal w/ Superficial rectal
91
If you were stabbed posterior to the 7th left costal cartilage, 2-4 cm from the median plane at the level of T11, what would you hit?
The cardiac part of the stomach
92
If you were stabbed posterior to the 5th rib in the mid clavicular plane, what would you hit?
The fundus of the stomach
93
If you were laying down taking a nap and some one stabbed you at the 9th costal cartilage, 1.25 cm left of the midline, what did the person hit? What vertebrae does this line up with?
The pylorus of the stomach (at the level of L1)
94
If you were at the grocery store and someone stabbed you at L3, costal cartilage, 1.25 cm left of the midline, what did the person hit? What vertebrae does this line up with?
Pylorus of the stomach (L2-L4)
95
What is the path of urine drainage in the kidney?
minor calyx --> major calyx --> renal pelvis --> ureter --> urinary bladder
96
The hilium of the kidneys is located in the medial border and contains from anterior to posterior...
```
Renal veins (anterior)
Renal Arteries (in between)
Ureter (posterior)
```
Sympathetic and Parasympathetic Nerves
97
If you feel pain in the RLQ 1.5 inches to 2 inches on an imaginary line from the ASIS to the umbilicus (L3/L4), what organ is in pain? What is this point known as?
Appendix at McBurney's point
98
What folds are inferior to the umbilicus and what are the contents of each fold?
Median Umbilical Fold - Urachus
Medial Umbilical Fold - Umbilical artery (obliterated)
Lateral Umbilical Fold - Inferior Epigastric Arteries
99
If you were to sever the fold above the umbilical cord, what ligaments and vessels would this have an affect on?
Falciform Ligament, Ligamentum Teres (Round Ligament), and the umbilical vein (obliterated) within the Ligamentum Teres.
100
What are the contents of the spermatic cord and where do they come from?
- Vas Deferens
- Testicular Artery (abdominal aorta)
- Testicular Veins = pampiniform plexus
- Lymphatic vessels
- Autonomic Sympathetic nerves (runs with the arteries)
- Remnant of the processus vaginalis
- Cremasteric artery (inferior epigastric a)
- Genital branch of the genitofemoral nerve (L1-L2)
- Arteries to the vas Deferens form the inferior vesical artery
101
What is a content of the inguinal canal but not a content of the spermatic cord?
Ilioinguinal Nerve
102
Where does the right testicular vein drain? Where does the left testicular vein drain into? Which one is bigger?
Right testicular vein => IVC at L1
Left testicular vein => Left Renal Vein at L1
The right testicular vein is bigger than the left.
103
What is the path of the ilioinguinal nerve and what does it innervate?
It bypasses through the inguinal canal, exits through the superficial inguinal canal, exits through the superficial inguinal ring to supply the skin of the penis, groin (lower portion), anterior part of the scrotum or labia majora, and the root of the clitoris.
104
From superficial to deep, name the layers of the scrotum and where they are derived from.
Skin
Superficial (Dartos) fascia <= Peritoneum
Visceral layer of tunica vaginalis
Tunica Albuginea
105
What does the lack of the Cremasteric or abdominal reflex indicate? How would you test it?
Corticospinal tract injury.
To elicit, strike the abdominal skin gently. The musculature will contract locally to deviate the umbilicus in the direction of the stimulus.
The male, striking the skin of the upper inner thigh will cause the testis on the stimulated side to retract by contracting the cremaster muscle
106
What is the afferent arm of the abdominal reflex?
aka. cremasteric reflex.
The afferent arm is the femoral branch of the genitofermoral nerve (L1-L2) that supplies the anterosuperior skin of the thigh
107
What is the efferent arm of the abdominal reflex?
aka. cremasteric reflex.
The EFFERENT arm is the genital branch of the genitofemoral nerve (L1-L2) through the superficial inguinal ring.
108
What innervates the cremaster muscle?
The genital branch of the genitofermoal nerve supplies the cremaster muscle.
109
When you test the abdominal reflex, lack of reaction to the muscles above the transumbilical line indicates what?
A lack of T8,T9,T10 sensory
110
When you test the abdominal reflex, lack of reaction to the muscles below the L4/L5 line on the anterior aspect of the abdomen indicates what?
Lack of T10,T11, and T12 muscles
111
What are the contents of the foregut? What are autonomic innervations and blood supply of the foregut?
Esophagus, Stomach, Duodenum (1st and 2nd), Liver, Pancreas, Biliary passages, and Gallbladder
Parasympathetic innervation: Vagus
Sympathetic: Greater splanchnic (T5-T9)
Blood supply: Celiac Trunk
112
What are the contents of the midgut? What are autonomic innervations and blood supply of the midgut?
Duodenum (2nd, 3rd and 4th), Jejunum and Ileum, Cecum and Appendix, Transverse Colon (Proximal 2/3)
Parasympathetic: Vagus
Sympathetic: Lesser Splachnic (T10-T11)
Blood: SMA
113
What are the contents of the hindgut? What are autonomic innervations and blood supply of the hindgut?
Transverse colon (distal 1/3, descending colon, sigmoid colon, rectum, anal canal (upper part)
Parasympathetic: Pelvic splanchnic (S2,3,4)
Sympathetic: Lumbar splanchnic (L1-L2)
Blood supply: IMA
