Things you forget Flashcards
Tube thoracostomy
Enter the pleural space via the 4th/5th intercostal space (midaxillary approach) to drain fluid from the pleural space between the visceral and parietal pleura.
Parietal vs Visceral
Both parietal and visceral pleura come from where?
Parietal - somatic, afferent
Visceral - autonomic/splanchnic afferents
Both come form the lateral mesoderm.
Anterior axillary nodes and parasternal lymph nodes are sentinel (first-line); whereas ____ is nonsentinal
supraclavicular nerves.
If cancer’s here, that means prognosis is poor.
The chest wall has a dual supply from the ___ and the ___
Internal thoracic artery anteriorly
Aortic branches posteriorly
Intercostal VANs are found between which two muscles?
Inner and innermost intercostals
___ pleura covers the innermost intercostal muscles
Costal pleura
Why does pain int he diaphragm sometimes get referred to the shoulder region?
The phrenic nerve (C3,4,5) also has a cutaneous branch that leads to the shoulder.
Long thoracic nerve
Innervates the serratus anterior
Easily cut during mastectomy –> winged scapula (can’t protract scapula)
Serratus anterior __tract the scapula
Rhomboids __tract the scapula
Serratus protracts
Rhomboids retract
The 4th intercostal space is between what two ribs?
4th and 5th.
Intercostal spaces are named after the rib above them.
Where do you hear the superior lobe?
2nd intercostal
Where do you hear the middle lobe/lingula?
4th intercostal space; medial to the nipple
Where do you hear the inferior lobe?
6th intercostal space; triangle of auscultation
Internal thoracic artery splits into
Superior epigastric artery (toward median) Musculophrenic artery (lateral)
Silent inspiration depends mostly on the diaphragm descending - what about forced inspiration?
Scalenes & pec move the chest out further
External intercostals elevate the rib to increase chest diameter
Silent expiration is due to elastic coil and muscle relaxation; what about forced expiration?
Abs
Internal intercostals
Innermost intercostals
Fibrous vs serous pericardium
Fibrous pericardium is on the outside; flush to it is parietal serous pericardium
Parietal visceral pericardium is on the actual heart
All other arteries fill in systole, but ___ fills in diastole
Coronary arteries
What does the PDA feed?
The posterior 1/3 of the septum
The left sinus venosus disappears; the right sinus venosus becomes what two things?
Sinus venarum (smooth muscle of the right atrium)
Vena cava
What does the primitive atrium become?
Pectinate and auricles
What does the bulbus cordis become?
Smooth part of the right ventricle leading to the pulmonary trunk(conus arteriosus)
Smooth part of the left ventricle
What does the primitive ventricle become?
the trabeculated parts of the ventricles
Where is the AV node?
INteratrial septum above opening of the coronary sinus
What babies are BORN blue?
Those with transposition of the great vessels
What babies become blue later?
Those with tetralogy of fallot or persistent truncus arteriosus
Prostaglandins
Keep the ductus arteriosus open for babies with transposition of the great vessels.
Inhibited by N-saids
Tet spells (squat to force the blood to go into systemic circulation) are associated with what disease?
tetralogy of fallot
If coarctation occurs before the left sucblavian, then what happens to pulses?
You’ll have two different radial pulses and only one of them will match teh femoral pulse.
If coarctation occurs after the left subclavian, then what happens to the pulses?
You’ll have the same radial pulse, but it will be diff from your femoral pulse.
Two main ducts of the lymphatic system
Thoracic duct drains 75 % of the body; empties at the junction of the left internal jugular & left subclavian veins
The right lymphatic duct drains only the top right portion of the body; empties at the junction of the right internal jugular & right subclavian
While the great, middle, and small cardiac veins all drain into the coronary sinus, which drains into the right atrium, ___ drains directly into the right atrium
Anterior cardiac vein
Stellate (inferior cervical) ganglion innervates what?
Head & upper limb
Where does the dural sac end in the adult?
S2
Filum terminale internum
Anchors the pia the dura; starts at L1/L2 and ends at S2
Filum terminale externum
Anchors the dura to the coccyx; starts at S2 to the coccyx
Denticulate ligaments
Extensions of pia inside the dural sac that provide lateral stability to the spinal cord by
Ends at L2 with the spinal cord/pia
Why would a tumor at L1/L2 cause renal incontinence?
conus medullaris syndrome - it compresses the sacral nerves below, which are responsible for parasympathetic innervation.
Where are vertebral arteries? What do they do and how?
In cervical transverse foramen; feeds the spine with help from the radicular artery of adamkiewicz
Injury to adamkiewicz –> paralyzed lower limbs
where are epidurals performed?
Lumbar or sacral
Hangman’s fracture
Cervical hyperextension that snaps the C2 at the atlanto occiptal joint
What segments of the spinal cord do the sympathetics originate from?
T1 to L2
Where do the parasympathetics come from?
Vagus nerve
S2-S4
Demratomes
Nipple - T4
Xiphoid process - T7
Umbilicus - T10
If you were to stab a friend in the neck, what layers woul dyou hit?
Traps -> splenius -> semispinalis -> suboccipital triangle
Sensation in the ___ part of the head is supplied by spinal nerves while all other parts of the head are innervated by cranial nerves
occipital
Inferior angle of scapula is at __
T7
Spine of scapula is at __
T3
Iliac crest at
L4
Posterior Superior Iliac Spine (PSIS) at
S2
The atlas has no
Vertebral body
3 types of joints
Fibrous joints: doesn’t move much
Cartilaginous joints: moves a lil
Synovial joints: gliding, hinge, saddle, ball-and-socket
What kind of joint is the acromioclavicular joint and your wrist?
Gliding
What kind of joint is your carpometacarpal joint of the thumb?
Saddle
If somites of the dermatomyotome migrate anteriorly, they become ___ muscles (limbs and trunk).
If they migrate posteriorly, they become ___ muscles (back muscles) and dermis.
Anterior: hypaxial (limbs and trunk) muscles innervated by ventral rami
Posterior: epaxial (back and dermis) innervated by dorsal rami
___ rami forms all the major plexuses and the intercostal nerves.
Ventral rami
Intercostal nerves come form the ventral rami of what spinal cord segment?
What do they innervate?
t1-t12
Innervates:
- Intercostal muscles, abs, anterolaterothorax
- Skin over the thorax via cutaneous branches
- Parietal pleura
- Costal pleura
While dermatomes are an area of skin innervated by a specific spinal nerve, peripheral nerve distribution describe
Axons coming from several different spinal nerves.
Most nerves a mixture of motor and sensory form different layers of the spinal cord.
The post synaptic neurons of the sympathetic system are in the
Ganglia - pre & paravertebral.
Who has more postganglionics - sympathetic or parasympathetic?
Sympathetic! They can also have a systemic effect by synapsing on the adrenal medulla
The ___ ramus is associated only with spinal nerves T1-L2.
the ___ ramus is associated with all spinal nerves.
White ramus is only at T1-L2 (that’s where the preganglionic sympathetics originate)
What structures do splanchnic nerves target?
Organs T5 and below, so it enters the abs, pelvic, renal region.
Also, may pass through the prevertebral ganglia to synapse at the adrenal gland instead.
The cutaneous branches of the 4th intercostal innervates the nipple.
The cutaneous branches of the __ to __th intercostal nerves innervate the rest of the breast.
2-6
____ artery supplies the upper part of the breast and branches into the pectoral branch thoracoacromial artery & lateral thoracic artery.
Axillary artery
PAL
_____ artery innervates the lower part of the breast and branches into the anterior intercostal perforating arteries & intercostal branches of arteries.
Internal Mammary Artery
ImAIb
___ nodes drain most of the body into the thoracic duct, which empties into the ____.
___ nodes drain the upper part of the body into the ___,
Axillary nodes > thoracic duct > Left subclavian vein
Parasternal nodes along the Internal thoracic artery > Bronchomediastinal trunks
Which joint is responsible for rib elevation and depression?
Costo-transverse.
___ enters the diaphragm through the central tendon.
IVC
__, ___, and ___ enters the diaphragm through the aortic hiatus.
Aorta, azygos vein, and thoracic duct
__ & __ enter the diaphragm through the esophageal hiatus.
Esophagus
Vagus nerve
A concern in thyroid surgeries is cutting
the left recurrent laryngeal, which would result in hoarseness
4 places where esophagus is compressed by other structures
Pharynx
Arch of aorta
Left main bronchus
Esophageal hiatus
Elevated diaphragm indicates injury to the
phrenic nerve
Why wouldn’t you do a pericardiocentesis on a bloody cardiac tamponade?
Blood is too thick; have to do a thoracotomy and open up the pericardial sac
Absent left radial pulse indicates injury to..
left subclavian artery –> do a rib thoracotomy
Where do you put in a central line?
In the deltopectoral groove, aiming at an angle towards the sternal notch remembering that the vein is superficial to the artery.
Days later, you may see chyme leak out
The left phrenic nerve pierces and innervates the inferior surface of the diaphragm. What about the right phrenic nerve?
It enters through the central tendon with the IVC?
Critical period for an organ/organ system / organogenetic period
Weeks3-8
The organ is undergoing the most cell division, differentiation, and morphogenesis –> very susceptible to teratogens
Wha t happens to embryos exposed to teratogens in the first 2 wks?
They’ll either die or overcome them; unlikely to form birth defects
Fetal period vs Embryonic period
Become a fetus after week 8.
Embryonic period: wk1-8
Fetal period: 9-birth
Major phases of human development
Fertilization > Cleavage > Compaction > Differentation > Cavitation > Zona hatching > Implantation
Amnioblasts
Epiblastic cells in the amniotic cavity that give rise to teh embryo.
Hyatidiform mole
Overgrowth of trophoblasts
Who produces hcg?
Syncytiotrophoblasts; maintains corpus luteum for progesteron
Sperm fusion triggers cortical reaction
exocytosis of cortical granules that harden the zona pellucida to prevent polyspermy
