Quiz 3 Flashcards
Which nerve provides sensory innervation to the little finger?
ulnar nerve
A shoulder dislocation would likely cause a loss of sensation to which area?
deltoid area
Which nerve is affected by a shoulder dislocation?
axillary nerve
Thenar atrophy is due to which nerve?
median nerve
A person unable to extend their wrist has an issue with which nerve?
radial nerve
The radial nerve innervates which muscles?
Triceps and all extensors and supinators of the wrist and fingers
Which nerve provides motor innervation to the biceps brachii?
musculocutaneous nerve
The lateral aspect of the forearm receives sensory innervation from which nerve?
the lateral antebrachial cutaneous nerve (terminating branch of musculocutaneous nerve)
Nodules in the palm and aponeurosis can lead to what? What is this called?
lead to fascial thickening and shortening on the medial side of the hand; affects 4th & 5th digits; called Dupuytren contracture
What is the difference between Heberden’s nodes and Bouchard’s nodes?
Herberden’s are @ distal interphalangeal joint
Bouchard’s are @ proximal interphalangeal joint
Describe the mechanism of a trigger finger
a finger or thumb becomes locked in a flexed position due to inflammation of a tendon; sometimes the inflamed area must be forced back into the sheath causing a popping sensation
What is tennis elbow?
lateral epicondylitis; inflammation at the insertion of the extensors on elbow
What is golfer’s elbow?
medial epicondylitis; inflammation at the insertion of the flexors on elbow
The long tendon of the biceps brachii is most frequently ruptured at which location?
intertubercular groove
What bone is most commonly fractured in children?
radius
The ulnar nerve innervates which muscles of the upper extremity?
flexor carpi ulnaris
1/2 of flexor digitorum profundus (digits 4 & 5)
Describe the contents of the cubital fossa from lateral to medial
Tendon of biceps brachii
Artery (brachial)
Nerve (median)
Which 2 arteries provide arterial blood supply to the hand?
radial and ulnar arteries
Describe the Allen’s test
method of assessing blood flow to the hand; simultaneously occlude the radial and ulnar arteries, then slowly release one artery to assess patency; used before arterial cannulation to determine if the opposing artery is sufficient to maintain blood flow
What causes carpal tunnel syndrome?
compression of the median nerve (which passes deep to the flexor retinaculum through Guyen’s Tunnel) due to repetitive wrist motion
Which carpal bone is fractured most frequently?
scaphoid
Where do wrist dislocations most commonly occur in carpal bones?
lunate
Which artery supplies blood supply to the superficial palmar arch?
ulnar artery
(remember: pRofundus in Latin = deep; Radial artery = deep)
Which tubular structure is located behind the left atrium?
esophagus
Enlargement of the left atrium can cause compression of which structure?
esophagus
Which portion of the heart lies in closest proximity to the sternum?
right ventricle
Visualization of the mitral valve via ultrasound is best accomplish by placing the probe at what location?
left 5th intercostal space at the midclavicular line
Which artery provides the majority of the blood supply to the left ventricle?
left anterior descending (LAD) artery
A ventricular septal defect in the upper portion of the interventricular septum could affect which part of the heart’s conduction system?
Bundle of His
Insertion of a chest tube into the thoracic rib area should be placed where in proximity to the rib?
above the rib (vasculature and nerves run on inferior portion)
The body of the manubrium connects to which rib number?
2nd rib
Aspiration of a foreign body is most likely to enter which lobe?
right lower lobe
What happens during a tension pneumothorax?
A defect in the chest wall leads to air becoming trapped in the lung space with each inhalation. No way for air to escape. Injured side begins to compress the healthy lung side leading to significant reduction in lung tissue.
At which landmark does the subclavian artery become something else?
becomes the axillary artery at the lateral border of the 1st rib
What structures make up the axillary sheath? Which structures lie outside?
inside: axillary artery, axillary vein, brachial plexus
outside: axillary lymph nodes, axillary fat
Where is the angle of Louis? What is its significance?
T4/T5, divides body into superior/inferior parts; location of: 2nd rib articulation, aortic arch, left recurrent laryngeal nerve, bifurcation of the pulmonary trunk/trachea
Where is the apex of the heart? Where is the base?
apex at the bottom
base at the top
What is the importance of the transverse sinus?
During cardiac surgery, a surgeon passes a ligature through the transverse sinus to clamp the ascending aorta and pulmonary trunk
What are the components of Beck’s Triad?
hypotension
JVD
muffled heart sounds
signs of a cardiac tamponade
How is the mitral valve best visualized?
via TEE; the esophagus is located behind the heart and slightly to the L
Where is the tip of a Swan-Ganz catheter most commonly placed?
right pulmonary artery
Where does the left marginal artery originate, run, and what does it supply?
originates from the left circumflex, runs down the left border of the heart, supplies the LV
What important feature does the left coronary artery supply?
conduction system of the heart
Where should an incision be made to prevent injury of the LAD during surgery?
midline longitudinal incision of the pericardium
The left subclavian artery marks what?
termination of the aortic arch, beginning of descending aorta
During insertion of a central line, you must be certain not to cause damage to which vessel?
left brachiocephalic vein
The AV bundle lies within what structure, requiring extra caution during cardiac surgery?
cardiac skeleton
What is sick sinus syndrome and what is the treatment?
irregular HR through the SA node; treatment = pacemaker
Interruption of the AV node-Bundle of His conduction system can result in what?
fatal arrhythmia (3rd degree AV block)
(especially likely during cardiac surgery if the cardiac skeleton is injured)
What is the rate of a junctional rhythm?
40-60bpm
What is the intrinsic rate of the Purkinje fibers?
15-30bpm
Describe what happens with noxious stimuli originating from the heart?
often perceived as pain arising from somewhere else (referred pain); medial UE, neck, shoulder, jaw
Describe the difference between true, false, and floating ribs
-true ribs (1-7) attach directly to the anterior sternum through costal cartilage
-false ribs (8-10) attach indirectly to anterior sternum via cartilages that are joined to cartilage from the superior rib
-floating ribs (11-12) have no attachment to the sternum
Thoracic wall muscles (contract/relax) during inspiration
contract
Which intercostal muscles are active during inspiration?
external intercostals (elevate ribs, expand chest cavity)
Which muscles are active during expiration?
trick question: expiration is typically passive
BUT during forced expiration, the internal intercostals and innermost intercostals are active
Intercostal spaces are numbered according to what?
the superior rib (there is no intercostal space below the 12th rib)
What is the order of structures in the neurovascular bundle of the ribs?
from superior –> inferior (runs just inferior to each rib)
vein
artery
nerve
