M Vasculature of the upper limb Flashcards

1
Q

What arteries are involved in the vasculature of the upper limb (in correct order)? (5)

A
  1. subclavian artery
  2. brachiocephallic artery
  3. axillary artery
  4. brachial artery
  5. radial artery and ulnar artery
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2
Q

What are the 3 branches of the aorta?

A
  1. branchiocephalic artery
  2. left common carotid artery
  3. left subclavian artery
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3
Q

What does the brachiocephalic artery divide into?

A
  1. right common carotid artery

2. right subclavian artery

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4
Q

What are the branches of the subclavian artery?

A
  1. inferior thyroid artery
  2. thyrocervical artery
  3. axillary artery
  4. r.subclavian artery
  5. vertebral artery
  6. r common carotid artery
  7. l common carotid artery
  8. l subclavian artery - left upper limb
  9. brachiocephalic trunk
  10. internal thoracic artery
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5
Q

Where does the vertebral artery pass through? (2)

A
  1. transverse foramina of C1-C6

2. foramen magnum

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6
Q

What does the vertebral artery unite with? (2)

A
  1. opposite vertebral artery

2. basilar artery

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7
Q

What is subclavian steal syndrome?

A

a group of signs and symptoms that arise from the following:

  1. retrograde (reversed) flow of blood in the ipsilateral vertebral artery or the internal thoracic artery
  2. this is due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery
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8
Q

What is the stenosis in subclavian steal syndrome usually due to?

A

atheroscelorosis

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9
Q

Why does the blood supply not stop in subclavian steal syndrome and what does this supply?

A

As blood is stolen from the circular vertebral-basilar artery system.

supplies the distal territory of the occluded or stenosed artery

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10
Q

SUBCLAVIAN STEAL SYNDROME SCENARIO

Blockage in left subclavian artery:

  1. What would happen to the blood pressure in the left and right arm?
  2. Would their be a difference in pulses?
  3. Why would the patient experience dizziness?
A
  1. LEFT -lowRIGHT - high
  2. yes - stronger on RIGHT
  3. use of circle of willis
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11
Q

Where does the subclavian artery become the axillary artery?

A

lateral border of rib 1

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12
Q

What muscle divides the subclavian artery into thirds?

A

pectoralis minor muscle

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13
Q

Where is the first part of the subclavian artery in relation to pectoralis minor?

A

superior to pec minor

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14
Q

Where is the second part of the subclavian artery in relation to pec minor?

A

deep to pec minor

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15
Q

Where is the third part of the subclavian artery in relation to pec minor?

A

inferior to pec minor

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16
Q

What is the course of the subclavian artery? (4)

A
  1. subclavian artery
  2. axillary artery
  3. posterior circumflex artery
  4. anterior circumflex artery
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17
Q

Which nerve and arteries loop around the surgical neck of the humerus?

A
  1. axillary nerve
  2. posterior circumflex artery
  3. anterior circumflex artery
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18
Q

What muscle overlies the axillary artery?

A

pec minor

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19
Q

What is the brachial artery a continuation of?

A

axillary artery

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20
Q

At what level does the axillary artery become the brachial artery?

A

inferior border of teres major

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21
Q

What are the 3 main branches of the brachial artery?

A
  1. profunda brachii
  2. superior ulnar collateral artery
  3. inferior collateral artery
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22
Q

In the cubital fossa what does the brachial artery split into?

A
  1. radial artery

2. ulnar artery

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23
Q

What is the profunda brachii artery?

A

deep artery of the arm

can feel pulse

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24
Q

What does the profunda brachia supply?

A

the posterior compartment of the arm

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25
Q

What does the profunda brachii wrap around?

A

posterior surface of the humerus

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26
Q

What groove does the profunda brachii run through and what nerve does it run along with?

A

Radial/sprial groove

Radial nerve

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27
Q

What groove is a potent site for fractures?

A

radial/spinal groove

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28
Q

How are the brachial vessels commonly injured?

A
  1. penetration

2. humeral fractures

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29
Q

Why are the brachial vessels prone to damage?

A

It is quite superficial

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30
Q

What does the degree of ischaemia caused by damage to brachial artery depend on?

A

Whether the damage is proximal or distal to the profunda brachii

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31
Q

What percentage of cases will result in limb loss if ligation of the brachial artery is proximal to profunda brachii?

A

50%

32
Q

What percentage of cases will result in limb loss if ligation of the brachial artery is distal to profunda brachii?

A

25%

33
Q

What is peri-articular anastomoses ?

A
  • network of anastomoses
  • of brachial and profunda brachii arteries in the arm
  • with radial and ulnar arteries in forearm
34
Q

In detail, what arteries are involved n the peri-articular anastomoses?

A
  1. profunda brachii artery
  2. superior and inferior collateral ulnar arteries
  3. radial collateral arteries
  4. radial recurrent artery
  5. anterior and posterior ulnar recurrent arteries
  6. brachial artery
35
Q

What does the radial artery supply?

A

ANTEROLATERAL aspect of the forearm

-flexors and extensors

36
Q

What does the ulnar artery supply?

A

MEDIAL side of the forearm

  • flexors and pronators
37
Q

What does the ulnar artery run through and what nerve does it run with?

A

foramen

ulnar nerve

38
Q

What branch does the ulnar artery give off and what branches does this branch off into?

A
  1. common interosseous artery
  2. anterior interosseous artery
  3. posterior interosseous artery
39
Q

What does the anterior and posterior interosseous arteries supply?

A

deep muscles of the posterior and anterior compartments

  • middle of the flexor and extensor compartments
40
Q

What crosses the floor of the anatomical snuffbox dorsally?

A

radial artery

41
Q

What does the radial artery pierce?

A

1st dorsal interosseous muscle

42
Q

What does the radial artery pass through in order to enter the palmar surface of the hand?

A

through the transverse and oblique heads of adductor pollicis

43
Q

Through which canal does the ulnar artery enter the hand and where is it in relation to the flexor retinaculum?

A

Guyons

Superificial

44
Q

What test is carried out to test the collateral blood supply to the lateral aspect of the hand through the ulnar artery?

A

Allen’s test

45
Q

When can Allens test be carried out and why?

A

prior to surgery

to check if the superior palmar arches are formed

46
Q

How do you palpate pulses?

A

push them against humerus

47
Q

What do the 6 pulse points in the upper limb allow localisation of?

A

localisation of potential blockages in these arteries

48
Q

Where can you apply pressure to to stop blood loss?

A

6 pulse points

49
Q

Upper limb pulse points (4)

A
  1. Axillary pulse: located inferiorly of the lateral wall of the axilla
  2. Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery)
  3. Radial pulse: located on the lateral of the wrist (radial artery). It can also be found in the anatomical snuff box.
  4. Ulnar pulse: located on the medial of the wrist (ulnar artery).
50
Q

Where can you palpate the brachial pulse?

A

mid arm

medial side of the arm

between biceps brachii and triceps brachii

51
Q

Where can you palpate the radial pulse?

A

lateral to the tendon of flexor carpi radialis

52
Q

Where can you palpate the ulnar pulse?

A

lateral to the tendon of flexor carpi ulnaris

53
Q

Why is it not easy to feel the ulnar pulse?

A

as it is covered by flexor carpi ulnaris

54
Q

What can be palpated in the anatomical snuffbox?

A

radial artery

55
Q

How do you palpate the radial artery in anatomical snuffbox?

A
  1. fully extend thumb
  2. palpate in depression

between EXTENSOR POLLICIS LONGUS and ABDUCTOR POLLICIS LONGUS and EXTENSOR POLLICIS BREVIS

EPL - Radial artery - APL + EPB

56
Q

Where does superficial venous drainage begin and where does it receive blood from?

A

With in dorsal venous arch.

digits

57
Q

Where does the cephalic vein drain?

A

laterally

58
Q

Where does the basilic vein drain?

A

medially

59
Q

What are the most superficial veins of the dorsal aspect of the hand?

A
  1. basilic vein

2. cephalic vein

60
Q

What is the course of the cephalic vein?

A
  1. lateral side of forearm and arm in subcutaneous fat
  2. through deltopectoral triangle
  3. pierces clavipectoral fascia
  4. drains into the axillary vein
61
Q

What makes up the deltopectoral triangle? (2)

A

pec major

deltoid

62
Q

Where does the basilic vein run?

A

medial side of forearm

63
Q

Where does the basilar vein receive venous drainage from?

A

median cubital vein

64
Q

What vein lies superficial to the bicipital aponeurosis and what is it useful for?

A

median cubital vein

venepuncture

65
Q

What does the joining of the deep veins and the basilic vein form?

A

axillary vein

66
Q

What are venae comitantes?

A

2 veins that closely accompany an artery.

the pulsations of the artery help venous return.

67
Q

Where are venae comitantes most commonly found and why?

A

found - at peripheries (fingers and toes)

as bp is lowest

68
Q

Which arteries of the upper limb are venae comitantes found at?

A

all the major arteries

69
Q

Where do the venae comitantes drain blood to and from?

A

TO

vessels accompanying the radial and ulnar arteries

FROM

superficial and deep palmar arches

70
Q

What happens to the venae comitantes in the cubital fossa?

A

unite to form the venae comitantes of the brachial vein

71
Q

How is the axillary vein formed?

A

brachial venae comitantes merge with basilic vein in axilla

72
Q

What is the venous drainage of the upper limb venae comitantes?

A
  1. superficial palamar arches venae comitantes
  2. deep palamar arch venae comitantes
  3. ulnar and radial venae comitantes
  4. brachial venae comitantes
  5. basilic vein
  6. axillary vein
73
Q

What are the deep veins? (2)

A
  1. subclavian

2. axillary

74
Q

Where does the axillary vein receive blood from?

A

cephalic vein

75
Q

What is the axillary vein called after it passes the clavicle?

A

subclavian vein

76
Q

Which vein joins with the internal jugular vein to form the brachiocephalic vein?

A

subclavian vein

77
Q

What is the superior vena cava made up?

A

2 brachiocephalic veins