erikpaul
04-16-2009, 11:28 PM
Dr Justin Cutler's quizzes from his anatomy fellowship:
Vertebral Column
1. Know how to differentiate a Cervical from a Thorasic from a lumbar vertebrae.
2. Know which is the atlas and which the axis–know the characteristics
3. Know how to name different abnormal curvatures of the vertebral column.
4. Know which way a vertebral disc will most like’y hurniate and why.
5. Know the directions of the articular facets in each area of the vertebral column
6. Know the ligaments–if you hyperextended your neck, which ligament would you strain? If a patient was stabbed with an ice pick (I don’t know how they all get ahold of ice picks)in the middle of the back, name the layers in order that it would go through.
7. Know blood supply and drainage.
8. Know that the inervation of the facet joints comes from the posterior rami.
Upper Limb
Superficial Limb
From yesterday’s lab (9/18/06), make sure that you can identify:
Medial cutaneous nerve of forearm Lateral cutaneous antebrachial nerve Posterior cutaneous antebrachial nerve (you are still responsible for the other cutaneous nerves for the lecture exam)
Median subital vein basilic vein cephalic vein (know what tributaries create them and what they dump into)
Other items for lecture: Fascia (named for area it is covering) Know what a dermatome is and how it changes embroyonically. Lymphatic drainage Know where cell bodies of different types of nerves are located!!!!!! This will be tested on over and over again!
Shoulder
Points to remember to cover in your studies:
1. Don’t forget to study the bones of the shoulder.
2. Attachment points of the muscles–this should then be self expanatory for the function (action) of each muscle.
3. Innervation of muscles:
Deltoid = axillary
Supraspinatous & Infraspinatous = suprascapular nerve
Teres Minor = axillary
Teres Major = LOWER SUBscapular nerve
Pectoralis Minor = medial pectorial nerve (named because it originates from the medial cord of the brachial plexis)
Pectoralis Major = BOTH medial and lateral pectorial nerves
Subclavius muscle = nerve to subclavius (superior trunk of brachial plexis)
Trapezius = accessory neve (CN XI)
Latissimus Dorsi = thoracodorsal nerve
Levator scapulae = dorsal scapular & Ventral rami of C3 and C4
Rhomboid Major = dorsal scapular
Rhomboid Minor = dorsal scapular
Subscapular = upper and lower supscapular nerveS
Serratus Anterior = Long thorasic (damage = winging of scapula)
4. Blood flow arteries and major veins
Axilla
Self quizing study questions:
Where can you safely ligate the axillary artery without endagering blood flow to the arm?
To control bleed of the upper extremety where can you compress arterial blood flow and against what?
What 3 arteries supply anastomosing blood flow to the acapular region?
What veins create the axillary vein?
Where does the axillary vein end proximally?
Describe the drainage pattern from each group of axillary lymph nodes.
What is the difference between the right and left lymph flow patterns?
The roots of the brachial plexus are made up of what?
Draw the brachial plexus with all of its branches (17).
By the end of the upper extremity unit make sure you come back and really KNOW nerve injury patterns (pages 9 - 11 of Dr. Uray’s packet)!!!!
Arm and Cubital Fossa
1. What portion of the humerus is contacted by the radius?
2. What portion of the ulna is posterior to the humerus?
3. What is the name of the process off the ulna that protrudes into the anterior distal fossa of the humerus when your antebrachia is in complete flexion?
4. Where do the 2 heads of the biceps brachii attach?
5. What muscles make up the anterior compartment of the arm?
6. What nerve inncervates the anterior compartment of the arm?
7. What causes a “Popeye” deformity?
8. What is the name of the tendinous sheath that arises from the medial side of the the distal bicep brachii tendon to protect the brachial artery and median nerve?
9. What makes up the Posterior compartment of the arm?
10. Where are the four attachments of the triceps brachii?
11. What nerve innervates the posterior compartment?
12. What defines the upper extent of the brachial artery?
13. What artery runs with the radial nerve in the proximal part of the arm?
14. What artery runs with the radial nerve in the distal part of the arm?
15. Draw or name all of the branches that provide the collateral circulation of the elbow.
16. Musculocutaneous nerve comes from what nerve roots?
17. Musculocutneous innervates what muscles?
18. What is the terminating branch of the musculocutaneous nerve?
19. What are the nerve roots carried in the median nerve?
20. Describe the relationship of the median nerve to the brachial artery.
21. What does the median nerve innervate in the arm?
22. How does the ulnar nerve pass the elbow joint?
23. What nerve roots are carried in the ulnar nerve?
24. What nerve roots are carried in the radial nerve?
25. In the instance of a proximal humeral shaft fracture, what nerve would you want to test for damage and how?
26. What lies immediately medial to the distal biceps brachii tendon? What lies immediately medial to that?
Wrist and Hand
Which nerves, arteries, and tendons cross the hand outside of the carpal tunnel?
What is found just lateral to the Palmaris Longus tendon?
What are the contents of the carpal tunnel?
What is the arrangement of the flexor difitorum superficiales tendons as they pass through the wrist?
What is contained in the “Ulnar Bursa”?
What is contained in the “Radial Bursa”?
How many extensor compartments are made by the extensor retinaculum?
Cephalic and Basilic veins are derived from what?
What nerve innervates the muscles of the thenar compartment?–be specific
What nerve innervates the muscles of the hypothenar compartment?
Where do the tendons of the flexor digitorum superficialis attach?
Where do the the tendons of the flexor pollicis longus attach?
Where is the attachment of the flexor pollicis longus?
If the “ulnar bursa” got infected, would flexor digiti minimi be affected?
Name the three thenar muscles.
Name the three hypothenar muscles.
Where are the proximal attachments of the lumbricals located?
What are the actions of the dorsal interosseous muscles?
What are the actions of the palmar interosseous muscles?
What muscles of the hand does the median nerve innervate?
What nerve innervates the adductor pollicis?
What areas of the hand would you contact to check the sensation of the radial nerve? Ulnar nerve?
Median nerve?
What areas of the hand would you contact to check dermotomes?
*Study and recognize Paralysis Patterns!!!!!!!!!!! Which areas would lack sensation? What position would your hand be in? What muscles would atrophy? What could cause the injury (think about brachial plexis injuries)? How would you differentiate a brachial plexis injury from a peripheral nerve injury? especially recognize ulnar vs. median nerve injuries.
Forearm
1. Make sure you look at the landmarks and configuration of bones in Netter.
2. Bones of the Wrist: Some Lovers Try Positions That They Can’t Handle = Scaphoid, Lunate, Triquitrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
3. What Flexor muscles in the forearm are NOT innervated by the Median nerve?
4. What interphalangeal joint do the flexor digitorum superficialis muscles flex?
5. What interphalangeal joint do the flexor digitorum profundus muscles flex?
6. What tendons lie deep to the flexor retinaculum?
7. What tendons lie superficial to the flexor retinaculum?
8. Besides the obvious, why is attempting suicide by cutting your wrist a bad idea?
9. What flexor of the forearm is innervated by the radial nerve?
10. What defines the anatomical “snuff box”?
11. What would tenderness in the “snuff box” after a fall could indicate a fracture of what bone?
12. What structure lies on the floor on the “snuff box”?
13. Which arteries do each of the recurrent arteries around the elbow anastomes with?
14. The recurrent interosseous artery branches from what?
15. What nerve passes through the cubital tunnel? Where is the cubital tunnel?
16. What kind of fibers are carried in the superficial radial nerve?
17. The deep branch of the radial nerve pierces what muscle?
18. Deep branch of the radial nerve has a name change. Where does this occur and to what name?
Joints of Upper Limb
1. Where is the only bony joint connecting the upper limb with the axial skeleton?
2. What is the most important ligament of the A.C. (acromiaclavicular) joint?
3. What is a shoulder seperation?
4. What exactly does the Transverse Humeral Ligament transverse?
5. What structures make up the corocoacromial arch?
6. What is the chief stabilizer of the glenohumeral joint?
7. What is the most common direction of dislocation of the glenohumeral joint?
8. The head of the radius articulates with what on the humerus? 9. What is the “carrying angle” of a typical woman? of a typical man?
10. How many joints are between the radius and ulna?
11. What ligament stabilizes the radial head to the ulna?
12. What direction do most of the interosseus membrane fibers run? why?
13. What structure attaches the neck of the radius to the tuberosity of the ulna and what direction does it run?
14. Which bones of the wrist does the radius directly articulate with?
15. Which bones of the wrist does the ulna articulate with?
Chest
Cardiovascular Embryology
STUDY YOUR NOTES WITH IMAGES (PICTURES) TO HELP YOU PICTURE WHAT AND WHERE THINGS ARE HAPPENING!!!!
1. Where is the original location of the “heart” as compared to the buccopharyngeal membrane?
2. The early heart tube receives venous blood at what pole and pumps blood out at what pole?
3. What space is created by the resorbtion of the dorsal mesocardium?
4. How many layers does the heart develop? What are they?
5. (To clarify the notes, the epicardium is resposible for the formation of the coronary arteries).
6. The cranial part of the heart tube bends what direction? (This should help you understand what the bulbus cordis becomes).
7. The trabeculated (latin = beam) right ventricle develops from what?
8. What 2 structures does the truncus arteriosus form?
9. What structure does the left ventricle develop from?
10. What veins feed blood into each of the sinus horns?
11. What does the left sinus horn become?
12. What forms the smooth wall of the right atrium?
Septum primum grows from where?
Where does the ostium primum develop?
Where and why does the septum secondum form?
The foramen ovale comes from where?
The valve of the foramen ovale is a remnant of what? –Notice what side it is on, so the direction of blood flow it allows in an embryo.
The original separation of the right ventricle form the left ventricle opening is created by what?
In what directions do the superior and inferior truncus swellings grow? What happens happens if they don’t twist around each other?
What cell type forms a major contribution to the formation of both truncus and cordis cushions? (To help separate the aorta from the pulmonary trunk.
How is the directional development of the interventricular septum different from the direction of the interventricular membrane?
What is the difference in tissue origin of the semilunar valves vs. the aortic and pulmonary valves?
What occurs for an embryo to develop dextrocardia?
What is the most common cardiac malformation?*
What are the 4 alterations that make up Tetrology of Fallot?
What duct normally stays patent when a new born has transposition of the great vessels?
Posterior Mediastinum
1. What are the boundaries of the posterior mediastinum?
2. What are the structures that are generally found in the posterior mediastinum?
3. At what vertebral level does the aorta leave the thoracic cavity?
4. Through what opening does the aorta leave the thoracic cavity?
5. What are the principal branches of the aorta in the thoracic cavity?
6. How many intercostal brnaches are given off by the aorta? 7. What are the last branches the aorta gives off before exiting the thoracic cavity?
8. Describe the location of the esophagus in the thoracic cavity?
9. At what vertebral level does the esophagus pass through the diaphragm?
10. Through what opening does the esophagus pass through the diaphragm?
11. (Remember that the esophagus lies directly posterioir to the heart. One of the functional questions on the last lab quiz asked for what structure is found directly behind the left atrium. This is important to know because trans-esophageal ultrasounds are used regulary in diagnosing various heart problems.
12. What 3 strucutures often compress the esophagus on it’s route through the thoracic cavity?
13. Where does the azygos vein run?
14. What vessel does the azygus vein drain into?
15. Through what vessel does the most superior part of the posterior thoracic cage on the left drain?
16. What area of the body does the thoracic duct drain?
17. Where does the thoracic duct begin? (through what opening of the diaphram does it pass)?
18. Where does the thoracic duct drain into the venous system? 19. The splanchnic nerves carry what type of nerve fibers? (be specific)
20. What kind of nerve fibers are carried in the cardiac nerves?
21. Describe the innervation of the different parts of the esophagus.
Middle Mediastinum
What topographical structures define the borders of each mediastinum?
What is contained in the anterior mediastinum?
What is the relationship of the fibrous pericardium to the serous pericardium?
The epicardium is actually what layer of the pericardium?
What is contained in the pericardial cavity?
The transverse sinus separates what structures?
If you reach under the apex of the heart and then move the tips of your fingers superiorly, in to what space would your fingers be placed?
Blood supply to the pericardium comes from where?
Nerve supply to the pericardium comes from where?
What forms the major portion of the sternocostal surface of the heart?
What forms the major portion of the diaphragmatic surface of the heart?
What forms the major portion of the pulmonary surface of the heart?
What forms the major portion of the base of the heart?
Correction in the notes the lower border of the heart is formed mostly by the RIGHT ventricle.
Where is the apex of the heart located topographically?
Where is the superior border of the heart located topographically?
*Don’t confuse the base of the heart with the diaphragmatic surface! Where is the coronary sulcus located? Describe blood flow through the heart–include chambers, valves, and great vessels. What is the normal thickness of the left ventricle compared to the right? What is the term for contraction of the heart? What is the term for relaxation of the heart? What is the “roughened” internal surface of the right atrium called? What part of the atrium is it in? In what chamber of the heart is the SA node located? The AV node? How many cusps make up the right A-V valve? What keeps the right A-V valve from collapsing into the atrium? What veins normally drain directly in to the right atrium? In what chamber of the heart is the valve for the foramen ovale found? How many cusps make up the left A-V valve? Where are the openings of the right and left coronary arteries found? Where is the membranous septum found? Where is the best location for auscultating the closure of the pulmonary valve? Where is the best location for auscultating the closure of the aortic valve? Where is the best location for auscultating the closure of the tricuspid valve? Where is the best location for auscultating the closure of the bicuspid valve? For the coronary circulation, KNOW what areas of the heart each vessel supplies. What is the difference between left and right sided dominant hearts? What is most common? Know the location of each of the cardiac veins. What is forms the moderator band (septomarginal trabecula)? Where is the cardiac plexus located? In what nerve are the parasympathetic fibers carried to the heart? What action will they cause? Free sensory nerve endings in the heart are stimulated by what? *Why does a patient experiencing a myocardial infarction often have referred pain to the left upper limb, neck, and jaw?
Lung and Pleura
What composes the thoracic wall?
What are each of the lung surfaces and there borders?
What impressions do you see in the right fixed lung?
What impressions do you see in the left fixed lung?
What structures are contained in the root of the lung?
What are the relationships of the structures that enter the hilum of the lungs?
What fissure separates the superior lobe from the inferior lobe in the right lung?
What structures does the horizontal fissure seperate?
Where is the apex of the lung located topographically?
Where are the inferior margins of the right lung located anteriorly, laterally, and posteriorly? What is the location of the horizontal and oblique fissures as compared to the ribs?
At what vertebral level is the carina located?
Where are aspirated foreign objects most likely to lodge?
What vessel arches over the right main stem bronchi?
What vessel arches over the left main stem bronchi?
How many segmental bronchi (tertiary bronchi) do each lobar bronchi (secondary bronchi) branch into–be specific to which secondary bronchi you are talking about?
Where is the most proximal location where gas exchange can occur?
What structures must the right pulmonary artery pass posterior to to enter into the right lung?
What is the most inferior structure at the hilum?
What are the origins of the Bronchial arteries?
Where do the Bronchial veins drain?
What types of sympathetic fibers will be found in the pulmonary plexus?
What types of parasympathetic fibers will be found there?
Where are preganglionic sympathetic cell bodies found?
Where are postganglionic sympathetic cell bodies found?
Sensory input from the trachea and lungs pass through what nerve?
At what rib levels does the costodiaphrgmatic recess exist?
In what nerves are the sensory fibers from the parietal pluera contained?
Where is the blood supply to the parietal pluera from?
Why can’t disease of the viseral pleura be localized well by the patient?
What is the lymphatic drainage patterns of the lungs and pleura?
Thoracic Wall
1. Don’t forget to review the bones of the vertebrae column, ribs, and sternum.
2. Ribs 2-10 each have how many articulations with vertebrae?
3. At what vertebrae levels does the sternum lie?
4. At what vertebrae level does the angle of Louis lie?
5. How many ribs articulate with the manubrium?
6. Where does rib 2 articulate?
7. Where is the costal groove?
8. Ribs 11 & 12 each articulate with how many vertebrae?
9. Which ribs articulate with the body of the sternum?
10. What are “floating” ribs?
11. Which ribs are “floating” ribs?
12. What are the boundaries of the superior thoracic aperture?
13. What are the boundaries of the inferior thoracic aperture?
14. What structures make up the infrasterna langle?
15. What is the difference in “pump handle” motion of the thoracic cage vs. “bucket handle”?
16. What are the dilations of the lactiferous duct called?
17. Where are the attachments of the suspensory ligaments?
18. What is the difference in locaiton fo the external vs. internal intercostal MEMBRANES?
19. Where do you find the innermost intercostal muscles?
20. Where do you find the subcostal muscles?
21. Where do you find the transversus thoracis?
22. What forms intercostal nerves?
23. Where are the blood supplies to the thoracic cage originating?
24. Into what structure do intercostal veins drain?
25. What dermotome supplies sensation to the nipples?
26. What are the different lymphatic drainages of the breast?
27. In a radical massectomy and even in a modified radical, the Pectoralis Major muscle is removed. What lymph pattern of drainage would explain the need for this?
28. How can disease spread from one breast to the other (don’t say a sexual partner!)?
Head and Neck
Development of the Head and Neck
Which cervical vertebrae is not completely from a cervical somite?
Occipital myotomes form what major muscle group?
The Nerves in the occipital fuse to form what nerve? That nerve then obviously inervates what muscle group?
What is the difference between a pharyngeal pouch and cleft?
What is contained in each pharyngeal arch?
Look at which nerve is associated with each brachial arch. Which muscles come from the same arch? What bones? Use an atlas (pictures and try and corrilate these together–certain muscles are attached to certain bones that are from the same arch, and they are innervated by the nerve from that arch.
For the pouches...correlate them with the arches. ie. notice how the first pouch originates between arches 1 and 2. The first pouch develops into the middle ear cavity were as the 1st and 2nd arches develop structures around it (some of the ear bones).
the 2nd pouch develops into what structure (in what cavity)? Notice what muscles and structures the 2nd and 3rd arches form around it. Get the idea. Try to make as much sense out of this as possible. More understanding will come as we learn more structures.
The Thymus develops from what pouch? What about the parathyroid? Notice how the parathyroid develops completely different from the thyroid.
What does the first cleft develop into?
The skeletal structures of the face are derived from what? Use pictures (like what Uray used for the embryo lect.) to go through the development of the nose and associated structures. What kind of problems would be formed if any of them didn’t fuse (go through each of them)?
The nasolacrimal duct is a result of the fusion of what?
What part of the nose does the frontal prominence help develop?
The incisive foramen marks the site of fusion of what structures?
Draw out or write out the sensory, taste, and motor functions of the different areas of the tongue.
Look at the development of the thyroid gland. Why would this be important to know? (other than for a test question)
Go through all of the cranial fascial defects and try to understand them–go back through the anatomy and development if you don’t understand the syndrome.
Skull, Face, Scalp
Look at Netter to learn the bones, suture lines, and junctions. Sarah did a great job on page 3 of her handout of breaking down the fascial muscles into “compartments”. Great way to learn and remember the names. Again, use netter to see where they are so that you can put them together with their function of what fascial feature they create. Great job Sarah on a fantastic presentation of this. (Don’t forget to add Playsma in the neck region)
What provides motor inervation of the fascial expression muscles?
What nerve supplies sensation to the face? What are its three divisions?
What nerve comes through the infraorbital foramen? What does it do?
What division of the trigeminal has a motor component? (What brachial arch does is come from?) What is it motor to? (What brachial arch do those muscles come from)?
What other nerve provides a small amount of cutaneous innervation (sensory) to the face?
What type of fibers are in the fascial nerve?
What branch provides taste to the tongue? What part of the tongue?
What foramen does the fascial nerve leave the skull through?
What is the primary blood supply to the face?
What branches come off the Fascial artery?
Where does the transverse fascial artery branch from? (Trace it back to the carotid artery)
What arteries of the face are supplied by the Internal carotid artery?
In what two directions can venous blood flow from the skin just medial to the eye?
Where does the fascial vein drain into?
Where does the fascial arterybranch from? Notice the difference! (internal jugular vs. external carotid)
What forms the retromandibular vein? What does it drain into?
What forms the external jugular vein?
What direction does blood flow in the fascial veins?
Make sure you know the lymph drainage of the face. Note where nodes are at and what area they drain and then where they drain to.
What are the layers of the scalp?
What nerves provide cutaneous innervation to the scalp?
Triangles of the Neck Part 1
What important muscle attaches to the Mastoid process?
At what vertebral level is the hyoid bone located?
What arches does the hyoid develop from?
What layer of fascia is the SCM and Trap. enclosed in?
What does the prevertebral fascia enclose?
Where is the retropharyngeal space located?
What is found in the carotid sheath?
What fascia is found connecting the two carotid sheaths?
What are the attachments of the SCM?
What motion does the SCM cause?
What is the SCM innervated by?
What are the attachments of the Trapezius? Movements it causes? Innervation?
What are the boundaries of the Anterior triangle?
What are the boundaries of the Posterior triangle?
What triangles does the post. triangle divide into? What are their boundaries?
What is the roof and floor of the post. triangle?
What are the attachments of the 3 scalene muscles?
Subclavian artery passes bewteen what scalene muscles?
What seperates from the suclavian artery fro the subclavian vein while they arch over the first rib?
What lies just superficial to the SCM muscle?
Through what foramen does CN XI exit the skull? –notice how superficial it is = danger.
What passes with the carotid artery over the 1st rib?
The cervical plexis is formed by what?
what nerves come off the cervical plexis?
Pain from piercing your ear passes through what nerve?
Phrenic nerve passes inferiorly on the suface of what structure?
Vertebral Column
1. Know how to differentiate a Cervical from a Thorasic from a lumbar vertebrae.
2. Know which is the atlas and which the axis–know the characteristics
3. Know how to name different abnormal curvatures of the vertebral column.
4. Know which way a vertebral disc will most like’y hurniate and why.
5. Know the directions of the articular facets in each area of the vertebral column
6. Know the ligaments–if you hyperextended your neck, which ligament would you strain? If a patient was stabbed with an ice pick (I don’t know how they all get ahold of ice picks)in the middle of the back, name the layers in order that it would go through.
7. Know blood supply and drainage.
8. Know that the inervation of the facet joints comes from the posterior rami.
Upper Limb
Superficial Limb
From yesterday’s lab (9/18/06), make sure that you can identify:
Medial cutaneous nerve of forearm Lateral cutaneous antebrachial nerve Posterior cutaneous antebrachial nerve (you are still responsible for the other cutaneous nerves for the lecture exam)
Median subital vein basilic vein cephalic vein (know what tributaries create them and what they dump into)
Other items for lecture: Fascia (named for area it is covering) Know what a dermatome is and how it changes embroyonically. Lymphatic drainage Know where cell bodies of different types of nerves are located!!!!!! This will be tested on over and over again!
Shoulder
Points to remember to cover in your studies:
1. Don’t forget to study the bones of the shoulder.
2. Attachment points of the muscles–this should then be self expanatory for the function (action) of each muscle.
3. Innervation of muscles:
Deltoid = axillary
Supraspinatous & Infraspinatous = suprascapular nerve
Teres Minor = axillary
Teres Major = LOWER SUBscapular nerve
Pectoralis Minor = medial pectorial nerve (named because it originates from the medial cord of the brachial plexis)
Pectoralis Major = BOTH medial and lateral pectorial nerves
Subclavius muscle = nerve to subclavius (superior trunk of brachial plexis)
Trapezius = accessory neve (CN XI)
Latissimus Dorsi = thoracodorsal nerve
Levator scapulae = dorsal scapular & Ventral rami of C3 and C4
Rhomboid Major = dorsal scapular
Rhomboid Minor = dorsal scapular
Subscapular = upper and lower supscapular nerveS
Serratus Anterior = Long thorasic (damage = winging of scapula)
4. Blood flow arteries and major veins
Axilla
Self quizing study questions:
Where can you safely ligate the axillary artery without endagering blood flow to the arm?
To control bleed of the upper extremety where can you compress arterial blood flow and against what?
What 3 arteries supply anastomosing blood flow to the acapular region?
What veins create the axillary vein?
Where does the axillary vein end proximally?
Describe the drainage pattern from each group of axillary lymph nodes.
What is the difference between the right and left lymph flow patterns?
The roots of the brachial plexus are made up of what?
Draw the brachial plexus with all of its branches (17).
By the end of the upper extremity unit make sure you come back and really KNOW nerve injury patterns (pages 9 - 11 of Dr. Uray’s packet)!!!!
Arm and Cubital Fossa
1. What portion of the humerus is contacted by the radius?
2. What portion of the ulna is posterior to the humerus?
3. What is the name of the process off the ulna that protrudes into the anterior distal fossa of the humerus when your antebrachia is in complete flexion?
4. Where do the 2 heads of the biceps brachii attach?
5. What muscles make up the anterior compartment of the arm?
6. What nerve inncervates the anterior compartment of the arm?
7. What causes a “Popeye” deformity?
8. What is the name of the tendinous sheath that arises from the medial side of the the distal bicep brachii tendon to protect the brachial artery and median nerve?
9. What makes up the Posterior compartment of the arm?
10. Where are the four attachments of the triceps brachii?
11. What nerve innervates the posterior compartment?
12. What defines the upper extent of the brachial artery?
13. What artery runs with the radial nerve in the proximal part of the arm?
14. What artery runs with the radial nerve in the distal part of the arm?
15. Draw or name all of the branches that provide the collateral circulation of the elbow.
16. Musculocutaneous nerve comes from what nerve roots?
17. Musculocutneous innervates what muscles?
18. What is the terminating branch of the musculocutaneous nerve?
19. What are the nerve roots carried in the median nerve?
20. Describe the relationship of the median nerve to the brachial artery.
21. What does the median nerve innervate in the arm?
22. How does the ulnar nerve pass the elbow joint?
23. What nerve roots are carried in the ulnar nerve?
24. What nerve roots are carried in the radial nerve?
25. In the instance of a proximal humeral shaft fracture, what nerve would you want to test for damage and how?
26. What lies immediately medial to the distal biceps brachii tendon? What lies immediately medial to that?
Wrist and Hand
Which nerves, arteries, and tendons cross the hand outside of the carpal tunnel?
What is found just lateral to the Palmaris Longus tendon?
What are the contents of the carpal tunnel?
What is the arrangement of the flexor difitorum superficiales tendons as they pass through the wrist?
What is contained in the “Ulnar Bursa”?
What is contained in the “Radial Bursa”?
How many extensor compartments are made by the extensor retinaculum?
Cephalic and Basilic veins are derived from what?
What nerve innervates the muscles of the thenar compartment?–be specific
What nerve innervates the muscles of the hypothenar compartment?
Where do the tendons of the flexor digitorum superficialis attach?
Where do the the tendons of the flexor pollicis longus attach?
Where is the attachment of the flexor pollicis longus?
If the “ulnar bursa” got infected, would flexor digiti minimi be affected?
Name the three thenar muscles.
Name the three hypothenar muscles.
Where are the proximal attachments of the lumbricals located?
What are the actions of the dorsal interosseous muscles?
What are the actions of the palmar interosseous muscles?
What muscles of the hand does the median nerve innervate?
What nerve innervates the adductor pollicis?
What areas of the hand would you contact to check the sensation of the radial nerve? Ulnar nerve?
Median nerve?
What areas of the hand would you contact to check dermotomes?
*Study and recognize Paralysis Patterns!!!!!!!!!!! Which areas would lack sensation? What position would your hand be in? What muscles would atrophy? What could cause the injury (think about brachial plexis injuries)? How would you differentiate a brachial plexis injury from a peripheral nerve injury? especially recognize ulnar vs. median nerve injuries.
Forearm
1. Make sure you look at the landmarks and configuration of bones in Netter.
2. Bones of the Wrist: Some Lovers Try Positions That They Can’t Handle = Scaphoid, Lunate, Triquitrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
3. What Flexor muscles in the forearm are NOT innervated by the Median nerve?
4. What interphalangeal joint do the flexor digitorum superficialis muscles flex?
5. What interphalangeal joint do the flexor digitorum profundus muscles flex?
6. What tendons lie deep to the flexor retinaculum?
7. What tendons lie superficial to the flexor retinaculum?
8. Besides the obvious, why is attempting suicide by cutting your wrist a bad idea?
9. What flexor of the forearm is innervated by the radial nerve?
10. What defines the anatomical “snuff box”?
11. What would tenderness in the “snuff box” after a fall could indicate a fracture of what bone?
12. What structure lies on the floor on the “snuff box”?
13. Which arteries do each of the recurrent arteries around the elbow anastomes with?
14. The recurrent interosseous artery branches from what?
15. What nerve passes through the cubital tunnel? Where is the cubital tunnel?
16. What kind of fibers are carried in the superficial radial nerve?
17. The deep branch of the radial nerve pierces what muscle?
18. Deep branch of the radial nerve has a name change. Where does this occur and to what name?
Joints of Upper Limb
1. Where is the only bony joint connecting the upper limb with the axial skeleton?
2. What is the most important ligament of the A.C. (acromiaclavicular) joint?
3. What is a shoulder seperation?
4. What exactly does the Transverse Humeral Ligament transverse?
5. What structures make up the corocoacromial arch?
6. What is the chief stabilizer of the glenohumeral joint?
7. What is the most common direction of dislocation of the glenohumeral joint?
8. The head of the radius articulates with what on the humerus? 9. What is the “carrying angle” of a typical woman? of a typical man?
10. How many joints are between the radius and ulna?
11. What ligament stabilizes the radial head to the ulna?
12. What direction do most of the interosseus membrane fibers run? why?
13. What structure attaches the neck of the radius to the tuberosity of the ulna and what direction does it run?
14. Which bones of the wrist does the radius directly articulate with?
15. Which bones of the wrist does the ulna articulate with?
Chest
Cardiovascular Embryology
STUDY YOUR NOTES WITH IMAGES (PICTURES) TO HELP YOU PICTURE WHAT AND WHERE THINGS ARE HAPPENING!!!!
1. Where is the original location of the “heart” as compared to the buccopharyngeal membrane?
2. The early heart tube receives venous blood at what pole and pumps blood out at what pole?
3. What space is created by the resorbtion of the dorsal mesocardium?
4. How many layers does the heart develop? What are they?
5. (To clarify the notes, the epicardium is resposible for the formation of the coronary arteries).
6. The cranial part of the heart tube bends what direction? (This should help you understand what the bulbus cordis becomes).
7. The trabeculated (latin = beam) right ventricle develops from what?
8. What 2 structures does the truncus arteriosus form?
9. What structure does the left ventricle develop from?
10. What veins feed blood into each of the sinus horns?
11. What does the left sinus horn become?
12. What forms the smooth wall of the right atrium?
Septum primum grows from where?
Where does the ostium primum develop?
Where and why does the septum secondum form?
The foramen ovale comes from where?
The valve of the foramen ovale is a remnant of what? –Notice what side it is on, so the direction of blood flow it allows in an embryo.
The original separation of the right ventricle form the left ventricle opening is created by what?
In what directions do the superior and inferior truncus swellings grow? What happens happens if they don’t twist around each other?
What cell type forms a major contribution to the formation of both truncus and cordis cushions? (To help separate the aorta from the pulmonary trunk.
How is the directional development of the interventricular septum different from the direction of the interventricular membrane?
What is the difference in tissue origin of the semilunar valves vs. the aortic and pulmonary valves?
What occurs for an embryo to develop dextrocardia?
What is the most common cardiac malformation?*
What are the 4 alterations that make up Tetrology of Fallot?
What duct normally stays patent when a new born has transposition of the great vessels?
Posterior Mediastinum
1. What are the boundaries of the posterior mediastinum?
2. What are the structures that are generally found in the posterior mediastinum?
3. At what vertebral level does the aorta leave the thoracic cavity?
4. Through what opening does the aorta leave the thoracic cavity?
5. What are the principal branches of the aorta in the thoracic cavity?
6. How many intercostal brnaches are given off by the aorta? 7. What are the last branches the aorta gives off before exiting the thoracic cavity?
8. Describe the location of the esophagus in the thoracic cavity?
9. At what vertebral level does the esophagus pass through the diaphragm?
10. Through what opening does the esophagus pass through the diaphragm?
11. (Remember that the esophagus lies directly posterioir to the heart. One of the functional questions on the last lab quiz asked for what structure is found directly behind the left atrium. This is important to know because trans-esophageal ultrasounds are used regulary in diagnosing various heart problems.
12. What 3 strucutures often compress the esophagus on it’s route through the thoracic cavity?
13. Where does the azygos vein run?
14. What vessel does the azygus vein drain into?
15. Through what vessel does the most superior part of the posterior thoracic cage on the left drain?
16. What area of the body does the thoracic duct drain?
17. Where does the thoracic duct begin? (through what opening of the diaphram does it pass)?
18. Where does the thoracic duct drain into the venous system? 19. The splanchnic nerves carry what type of nerve fibers? (be specific)
20. What kind of nerve fibers are carried in the cardiac nerves?
21. Describe the innervation of the different parts of the esophagus.
Middle Mediastinum
What topographical structures define the borders of each mediastinum?
What is contained in the anterior mediastinum?
What is the relationship of the fibrous pericardium to the serous pericardium?
The epicardium is actually what layer of the pericardium?
What is contained in the pericardial cavity?
The transverse sinus separates what structures?
If you reach under the apex of the heart and then move the tips of your fingers superiorly, in to what space would your fingers be placed?
Blood supply to the pericardium comes from where?
Nerve supply to the pericardium comes from where?
What forms the major portion of the sternocostal surface of the heart?
What forms the major portion of the diaphragmatic surface of the heart?
What forms the major portion of the pulmonary surface of the heart?
What forms the major portion of the base of the heart?
Correction in the notes the lower border of the heart is formed mostly by the RIGHT ventricle.
Where is the apex of the heart located topographically?
Where is the superior border of the heart located topographically?
*Don’t confuse the base of the heart with the diaphragmatic surface! Where is the coronary sulcus located? Describe blood flow through the heart–include chambers, valves, and great vessels. What is the normal thickness of the left ventricle compared to the right? What is the term for contraction of the heart? What is the term for relaxation of the heart? What is the “roughened” internal surface of the right atrium called? What part of the atrium is it in? In what chamber of the heart is the SA node located? The AV node? How many cusps make up the right A-V valve? What keeps the right A-V valve from collapsing into the atrium? What veins normally drain directly in to the right atrium? In what chamber of the heart is the valve for the foramen ovale found? How many cusps make up the left A-V valve? Where are the openings of the right and left coronary arteries found? Where is the membranous septum found? Where is the best location for auscultating the closure of the pulmonary valve? Where is the best location for auscultating the closure of the aortic valve? Where is the best location for auscultating the closure of the tricuspid valve? Where is the best location for auscultating the closure of the bicuspid valve? For the coronary circulation, KNOW what areas of the heart each vessel supplies. What is the difference between left and right sided dominant hearts? What is most common? Know the location of each of the cardiac veins. What is forms the moderator band (septomarginal trabecula)? Where is the cardiac plexus located? In what nerve are the parasympathetic fibers carried to the heart? What action will they cause? Free sensory nerve endings in the heart are stimulated by what? *Why does a patient experiencing a myocardial infarction often have referred pain to the left upper limb, neck, and jaw?
Lung and Pleura
What composes the thoracic wall?
What are each of the lung surfaces and there borders?
What impressions do you see in the right fixed lung?
What impressions do you see in the left fixed lung?
What structures are contained in the root of the lung?
What are the relationships of the structures that enter the hilum of the lungs?
What fissure separates the superior lobe from the inferior lobe in the right lung?
What structures does the horizontal fissure seperate?
Where is the apex of the lung located topographically?
Where are the inferior margins of the right lung located anteriorly, laterally, and posteriorly? What is the location of the horizontal and oblique fissures as compared to the ribs?
At what vertebral level is the carina located?
Where are aspirated foreign objects most likely to lodge?
What vessel arches over the right main stem bronchi?
What vessel arches over the left main stem bronchi?
How many segmental bronchi (tertiary bronchi) do each lobar bronchi (secondary bronchi) branch into–be specific to which secondary bronchi you are talking about?
Where is the most proximal location where gas exchange can occur?
What structures must the right pulmonary artery pass posterior to to enter into the right lung?
What is the most inferior structure at the hilum?
What are the origins of the Bronchial arteries?
Where do the Bronchial veins drain?
What types of sympathetic fibers will be found in the pulmonary plexus?
What types of parasympathetic fibers will be found there?
Where are preganglionic sympathetic cell bodies found?
Where are postganglionic sympathetic cell bodies found?
Sensory input from the trachea and lungs pass through what nerve?
At what rib levels does the costodiaphrgmatic recess exist?
In what nerves are the sensory fibers from the parietal pluera contained?
Where is the blood supply to the parietal pluera from?
Why can’t disease of the viseral pleura be localized well by the patient?
What is the lymphatic drainage patterns of the lungs and pleura?
Thoracic Wall
1. Don’t forget to review the bones of the vertebrae column, ribs, and sternum.
2. Ribs 2-10 each have how many articulations with vertebrae?
3. At what vertebrae levels does the sternum lie?
4. At what vertebrae level does the angle of Louis lie?
5. How many ribs articulate with the manubrium?
6. Where does rib 2 articulate?
7. Where is the costal groove?
8. Ribs 11 & 12 each articulate with how many vertebrae?
9. Which ribs articulate with the body of the sternum?
10. What are “floating” ribs?
11. Which ribs are “floating” ribs?
12. What are the boundaries of the superior thoracic aperture?
13. What are the boundaries of the inferior thoracic aperture?
14. What structures make up the infrasterna langle?
15. What is the difference in “pump handle” motion of the thoracic cage vs. “bucket handle”?
16. What are the dilations of the lactiferous duct called?
17. Where are the attachments of the suspensory ligaments?
18. What is the difference in locaiton fo the external vs. internal intercostal MEMBRANES?
19. Where do you find the innermost intercostal muscles?
20. Where do you find the subcostal muscles?
21. Where do you find the transversus thoracis?
22. What forms intercostal nerves?
23. Where are the blood supplies to the thoracic cage originating?
24. Into what structure do intercostal veins drain?
25. What dermotome supplies sensation to the nipples?
26. What are the different lymphatic drainages of the breast?
27. In a radical massectomy and even in a modified radical, the Pectoralis Major muscle is removed. What lymph pattern of drainage would explain the need for this?
28. How can disease spread from one breast to the other (don’t say a sexual partner!)?
Head and Neck
Development of the Head and Neck
Which cervical vertebrae is not completely from a cervical somite?
Occipital myotomes form what major muscle group?
The Nerves in the occipital fuse to form what nerve? That nerve then obviously inervates what muscle group?
What is the difference between a pharyngeal pouch and cleft?
What is contained in each pharyngeal arch?
Look at which nerve is associated with each brachial arch. Which muscles come from the same arch? What bones? Use an atlas (pictures and try and corrilate these together–certain muscles are attached to certain bones that are from the same arch, and they are innervated by the nerve from that arch.
For the pouches...correlate them with the arches. ie. notice how the first pouch originates between arches 1 and 2. The first pouch develops into the middle ear cavity were as the 1st and 2nd arches develop structures around it (some of the ear bones).
the 2nd pouch develops into what structure (in what cavity)? Notice what muscles and structures the 2nd and 3rd arches form around it. Get the idea. Try to make as much sense out of this as possible. More understanding will come as we learn more structures.
The Thymus develops from what pouch? What about the parathyroid? Notice how the parathyroid develops completely different from the thyroid.
What does the first cleft develop into?
The skeletal structures of the face are derived from what? Use pictures (like what Uray used for the embryo lect.) to go through the development of the nose and associated structures. What kind of problems would be formed if any of them didn’t fuse (go through each of them)?
The nasolacrimal duct is a result of the fusion of what?
What part of the nose does the frontal prominence help develop?
The incisive foramen marks the site of fusion of what structures?
Draw out or write out the sensory, taste, and motor functions of the different areas of the tongue.
Look at the development of the thyroid gland. Why would this be important to know? (other than for a test question)
Go through all of the cranial fascial defects and try to understand them–go back through the anatomy and development if you don’t understand the syndrome.
Skull, Face, Scalp
Look at Netter to learn the bones, suture lines, and junctions. Sarah did a great job on page 3 of her handout of breaking down the fascial muscles into “compartments”. Great way to learn and remember the names. Again, use netter to see where they are so that you can put them together with their function of what fascial feature they create. Great job Sarah on a fantastic presentation of this. (Don’t forget to add Playsma in the neck region)
What provides motor inervation of the fascial expression muscles?
What nerve supplies sensation to the face? What are its three divisions?
What nerve comes through the infraorbital foramen? What does it do?
What division of the trigeminal has a motor component? (What brachial arch does is come from?) What is it motor to? (What brachial arch do those muscles come from)?
What other nerve provides a small amount of cutaneous innervation (sensory) to the face?
What type of fibers are in the fascial nerve?
What branch provides taste to the tongue? What part of the tongue?
What foramen does the fascial nerve leave the skull through?
What is the primary blood supply to the face?
What branches come off the Fascial artery?
Where does the transverse fascial artery branch from? (Trace it back to the carotid artery)
What arteries of the face are supplied by the Internal carotid artery?
In what two directions can venous blood flow from the skin just medial to the eye?
Where does the fascial vein drain into?
Where does the fascial arterybranch from? Notice the difference! (internal jugular vs. external carotid)
What forms the retromandibular vein? What does it drain into?
What forms the external jugular vein?
What direction does blood flow in the fascial veins?
Make sure you know the lymph drainage of the face. Note where nodes are at and what area they drain and then where they drain to.
What are the layers of the scalp?
What nerves provide cutaneous innervation to the scalp?
Triangles of the Neck Part 1
What important muscle attaches to the Mastoid process?
At what vertebral level is the hyoid bone located?
What arches does the hyoid develop from?
What layer of fascia is the SCM and Trap. enclosed in?
What does the prevertebral fascia enclose?
Where is the retropharyngeal space located?
What is found in the carotid sheath?
What fascia is found connecting the two carotid sheaths?
What are the attachments of the SCM?
What motion does the SCM cause?
What is the SCM innervated by?
What are the attachments of the Trapezius? Movements it causes? Innervation?
What are the boundaries of the Anterior triangle?
What are the boundaries of the Posterior triangle?
What triangles does the post. triangle divide into? What are their boundaries?
What is the roof and floor of the post. triangle?
What are the attachments of the 3 scalene muscles?
Subclavian artery passes bewteen what scalene muscles?
What seperates from the suclavian artery fro the subclavian vein while they arch over the first rib?
What lies just superficial to the SCM muscle?
Through what foramen does CN XI exit the skull? –notice how superficial it is = danger.
What passes with the carotid artery over the 1st rib?
The cervical plexis is formed by what?
what nerves come off the cervical plexis?
Pain from piercing your ear passes through what nerve?
Phrenic nerve passes inferiorly on the suface of what structure?