CLINICAL ANATOMY EXAM 1

If the first rib is broken what internal injuries may occur

Injury to brachial plexus and subclavian veins

If low rib fractures occur what can be injured

spleen and liver or tear of diaphragm

What are the most commonly fractured ribs and from what

middle ribs from blow or crushing injury

What part of the rib is most commonly fractured?

anterior to its angle

What makes rib fractures so painful?

The broken parts move during respiration coughing laughing or sneezing

The partial ossification of the xiphoid process usually manifests itself as

a lump in the pit of the stomach

People who are unaware of their xiphoid process ossifying will think they have…

a tumor or stomach cancer

What is the typical site for harvest of bone marrow and why

sternum bc its subcutaneous

a sternal foramen happens bc of

incomplete fusion of fetal sternal plates,

what does a sternal foramen get mistakened for in imaging

a bullet wound

Why do clinicians call the superior thoracic aperture the thoracic outlet

because of the arteries and T1 spinal nerves that come through the aperture

What is thoracic outlet syndrome

the structures through the superior thoracic aperture are affected by obstructions in the root of the neck and are manifested in the upper limb

What does an intercostal nerve block do

anesthesia of the intercostal space by introducing an anesthetic agent

where are surgical incisions of the breast most commonly made and why?

inferior quadrants because they are less vascular

What fluid is released from the nipples during the last trimester of pregnancy and during the initial episodes of nursing?

colostrum

How does a carcinoma of the breast present?

deviation of nipple, thick leathery skin, puffy skin with dimples, inversion of nipple

What does each phrenic nerve innervate?

half of the diaphragm each

What is hemiparalysis of the diaphragm?

Phrenic nerve injury resulting in the paralyzed half ascending during inspiration when it should be descending

The cervical pleura and apex of the lung can be injured from wounds to the…

base of the neck bc they extend through the thoracic inlet

The costal and diaphragmatic pleurae can be injured where they…

extend below the costal margin

What can cause a lung collapse

If the surface tension holding the visceral and parietal pleura are compromised

What is pneumothorax

air in pleural cavity

What is hydrothorax

Fluid in the pleural cavity

What is hemothorax

Blood in pleural cavity

What procedure is needed to remove fluid blood or pus

Insertion of hypodermic needle through intercostal space into pleural cavity

What is the most common accessory lung lobe

Azygous lobe, appearing in the right lung in one percent of people

Where is ingested foreign material most likely to enter and lodge itself

right bronchus bc it’s wider and shorter and runs more vertically

How many tertiary bronchi/ bronchi pulmonary segments are in each lung

Ten

Where do bronchial and pulmonary disorders like tumors and abscesses often localize?

In a bronchopulmonary segment

Superficial lymphatic drainage of the lung drains to…

The bronchopulmonary nodes

Deep lymphatic drainage passes to the root of the lung to the..

Tracheobronchial nodes then to bronchomediastinal to right lymphatic nd thoracic ducts

What node is an early indicator for tumor metastases in bronchogenic carcinoma that causes the supraclavicular nodes to enlarge

Bronchopulmonary nodes

What are sentinel nodes

Bronchopulmonary nodes that alert physicians that a metastatic cancer can be present in the thorax or abdomen

What part of the lung pleura is sensitive to pain

Parietal pleura

What are the symptoms of pericarditis

Chest pain and pericardium friction rub detected on auscultation

What procedure can relieve cardiac tamponade

Pericardiocentesis

What are the three most common sites of coronary artery occlusion

Anterior interventricular, right coronary, circumflex branch

Blockage of the coronary arteries is sometimes relieved by what procedure

Transluminal coronary angioplasty, where a catheter is passed with inflatable balloon into obstructed artery

What procedure do some pts go through that have obstruction of coronary circulation and angina

Coronary bypass surgery, where a segment of an artery or vein is linked to the proximal and distal portion of the obstructed coronary artery to detour around do the stenosis

What is compensatory hypertrophy

Myocardium increases the size of its muscle fibers

In which part of the heart do thrombi mostly form?

The walls of the left atrium

Occlusion of an artery supplying the brain results in a..

Stroke, or cerebrovascular accident

Atrial septal defect is also most common in people with

Down’s Syndrome

A VSD causes what type of shunt

Left to right

Valvular heart diseases produce either

Stenosis or insufficiency

What is stenosis

Failure for a valve to open properly

What is regurgitation

Failure of valve to close fully

What is the pacemaker of the heart

Sinoatrial node

Damage to AV node results in what

Heart block bc atrial excitation wave doesn’t reach ventricles

Where are pacemakers connected to in the heart

Trabeculae carneae of right ventricle

What is coarctation of the aorta

Abnormal narrowing that allows for obstruction of blood flow in lower part of body,

What is the most common site for coarctation of the aorta

Ligamentum anteriorsum

Any diagnostic procedure or disease in the superior mediastinum may injure

Recurrent laryngeal nerves and affect the voice

What can affect the left recurrent laryngeal nerve?

Bronchogenic or esophageal carcinoma, enlargement of mediastinal lymph nodes, or an aneurysm of the arch of the aorta

The esophagus is compressed by

Arch of aorta, left primary bronchus, diaphragm

What happens if you lacerate the thoracic duct

Lymph escaping into the thoracic cavity that is either removed by needle in thoracocentesis or ligation

If superior or inferior vena cava is obstructed how does venous drainage occur

Azygos system of veins drains the thoracic, abdominal and back regions

What is one of the most commonly fractured bones

Clavicle

How can you tell if someone has fractured their clavicle?

you can feel elevation of the medial portion pulled up by the sternocleidomastoid and the distal part drops down with the shoulder bc there is now unsupported weight from upper limb

What people are clavicle fractures most common in

Children and contact sports athletes

How can clavicle fractures happen

Indirect force fram an outstretched hand starting at the forearm going up to the clavicle. Or from direct fall on the shoulder

What is the weakest part of the clavicle

Junction of its middle and lateral thirds

How to treat fractured scapula

Little treatment bc it’s covered in muscles

Whee do most humoral fractures occur

Surgical neck

A fall on the acromion results in

Avulsion fracture, where greater tubercle is pulled away from the humerus

A direct blow to the arm can cause what kind of fracture

transverse or spiral fractures of the shaft of the humerus. Spiral fractures assumed to be man made

What causes an intercondylar fracture

Fall on a flexed elbow

What is a Colles fracture

Transverse fracture of distal radius, accompanied by avulsed styloid process of the ulna

How does a Colles fracture occur

Attempting to break a fall with outstretched limb

What is the result of a Colles fracture

Posterior angulation of the forearm proximal to the wrist, aka dinner fork deformity

What is the most frequently fractured carpal bone

Scaphoid

How do scaphoid fractures occur

Fall on the palm with wrist abducted

Why is scaphoid fractures so long to heal

Bc of poor blood supply to proximal scaphoid

What happens if the hamate carpal bone is fractured

Disunion of fractured parts bc of traction of the attached muscles and can involve ulnar nerve and artery

fracture of the fifth metacarpal is aka

Boxers fracture

How does boxers fracture occur

When unskilled person punches someone causing head of bone to rotate over distal shaft

What is a good place to examine the posterior aspect of the lungs

Triangle of auscultation

When does Injury to thoracodorsal nerve occur

Surgery on scapular lymph nodes or axilla

Injury of thoracodorsal nerve causes paralysis of what

Latissimus dorsi, person can’t raise the trunk with the upper limbs or use axillary crutch

What are the rotator cuff muscles

Supraspinatus infraspinatus teres minor subscapularis

Calcific supraspinatus tendonitis is caused by what

Inflammation and calcification of subacromial bursa and tendon of supraspinatus

are your rotator cuff muscles most commonly injured in

Sports

What happens when the serratus anterior is paralyzed when the long thoracic nerve is injured?

The medial border of the scapula moves laterally and posteriorly away from thoracic wall, creating winged scapula

What can damage the axiliary nerve?

Fracture of proximal humerus, dislocation of glenohumeral joint, or incorrect use of crutches.

What happens to the deltoid when the accolade nerve is damaged?

Atrophies

When the axillary nerve is damaged and the deltoid atrophies, what else can occur in the proximal arm?

Loss of sensation

What artery can be compressed to control profuse bleeding of an upper limb?

The axillary artery against the humerus or the first rib

Aneurysm of the axillary artery can do what to the body

Compress the trunks of the brachial plexus leading to pain and anesthesia in the area where the affected nerves are

Sounds in the axilla usually involve what vessel

Axillary vein bc it’s large and superficial

What can occur if there is an injury to the proximal axilla

Profuse bleeding and risk of air embolism

What occurs in a subclavian vein puncture

Passing a catheter into the proximal aspect of axillary vein bc it’s so superficial it’s easily accessible

An infection of the upper limb can cause what

Axillary lymph nodes to enlarge (lymphangitis)

Dissection of the lymph nodes is needed to determine what malignancy

to see how far a cancer has metastasized

When removing axillary lymph nodes make sure not to damage

Long thoracic or thoracodorsal nerves

What are the parts of the brachial plexus

5 roots (C5-T5), 3 trunks, 3 anterior divisions 3 posterior divisions, 3 chords, 5 terminal branches

What are the terminal branches of the brachial plexus

Musculocutaneous nerve, axillary nerve, median nerve, radial nerve, ulnar nerve

How does the superior brachial plexus get injured

Excessive increase in angle b/w neck and shoulder, usually during a fall or excessive stretching of baby during delivery.

What is characteristic of injury to the superior part of the brachial plexus

Waiters tip position

What is characteristic of injury to the inferior part of the brachial plexus

Claw hand

How does injury to the inferior part of the brachial plexus occur

When upper limb is pulled superiorly, like when grabbing something to break a fall or baby’s upper limb is used during delivery