Anatomy II Gaps - TAPP

Not comprehensive - I created them based off what I didn't know on the golden tickets

Costal Facets are located on which primary bones (include their boney landmarks if applicable)

Costal facets are located on thoracic vertebrae, on both the body and the transverse processes

Which runs longitudinally down the vertebral spinous process

Vertebral spinous processes = vertebral line

Which aperature is typically level with T1

T1 = superior thoracic aperture 

Which aperature will be closed off by the diaphragm at level T12

T12 = inferior thoracic aperture

Along with the ribs, where
will the costovertebral
joint connect

Costal facets of the bodies of the thoracic vertebrae

Along with the ribs, where
will the costovertebral
joint connect

Costal facets of the transverse processes of thoracic vertebrae

Can you describe the
location of the intercostal
neurovasculature (if
dissecting provide the
order at which these
structures will be found)

VAN (Superior to Inferior)
External intercostal muscle
Internal intercostal muscle
Intercostal Vein most superior
Intercostal Artery middle
Intercostal Nerve most inferior
Innermost intercostal muscle

What are the primary arteries that serve the
intercostal area

Anterior intercostal A
Posterior intercostal A
Subcostal A

Where does the subcostal arteries arise from

Thoracic Aorta
Subcostal A is under rib 12

What are the additional branches of the internal thoracic

Pericardiophrenic to pericardium/diaphragm
Medial Mammary Arteries
Musculophrenic to diaphragm

Once the internal thoracic leaves the intercostal area it continues on as the…

superior epigastric a

What will drain into the Azygous Vein?

Azygos: Right sided Posterior Intercostal Veins, Accessor Hemiazygos, and Hemiazygos

Accessory Hemiazygos drains

left upper posterior intercostals

Hemiazygos drains

left lower posterior intercostals

What level does the Accessory Hemiazygos and Hemiazygos cross to drain into the Azygos

~T8-9 (but not together)

What is the function, innervation, and blood supply  of the External Intercostal muscles

Elevate ribs for inspiration
Intercostal N
A/P Intercostal Arteries/veins

Function of the
Subcostalis muscles?

Helps with respiration by aiding in depressing ribs
View when looking in the vertebral side of rib cage;

intercostal n and posterior intercostal a

What is the function, innervation, blood supply of the Internal Intercostal muscles

Depress ribs with forceful expiration
Intercostal N
A/P Intercostal Arteries/veins

What is a lab reference
for your intercostal muscles?

External intercostals will be closest to the vertebrae no matter the view
Internal intercostals will be closest to sternum no matter the view
Innermost intercostals will be best seen looking at the posterior inner view (body of vert. are visible) with the VAN running under it; MOST LATERAL
I mean..this works for me but....

What is the route of milk secretion from the breast tissue?

Mammary gland lobules (created by multiple alveoli) to Lactiferous Ducts to Lactiferous Sinus to Nipple

In lactation male anatomy is the same— ______ –at puberty testosterone and low estrogen halt development in most males

they do not have as many lobules or duct

Lactation is based on the presence of prolactin—
males typically have ____ but ____

very low prolactin, males
can lactate (some good new research in this area
but we won’t go into it now)

Function of the areolar?

Lubricate nipple; sebaceous/sweat gland

What structure will serve as a support for the mammary glands linking them to the pectoral fascia

Suspensory/”Cooper’s” Ligaments = support system to the gland lobes and provide “shape” to breast tissue; fibrous connective tissue; will connect posteriorly to fascia of the pectoralis major

What structure will act similar to a bursa sac allowing movement of breast on chest?

Retromammary space = between the breast and deep pectoral fascia; contains fat to allow movement of breast; acts much like a bursa

What structure will extend the mammary tissue to the axilla and what is its importance

Axillary Tail of Spence = extension of mammary tissue to the axilla to the lateral edge of pectoralis major

• Contains numerous lymph nodes and brachium lymphatic vessels = can get breast cancer there

In terms of blood supply to the breast, what feeds the lateral mammary artery?

The lateral mammary artery stems from the lateral thoracic artery which comes from the subclavian artery 

In terms of blood supply to the breast, what feeds the medial mammary artery?

The medial mammary artery stems from the internal thoracic artery which comes from the subclavian artery

In terms of blood supply to the breast, which artery will branch from the thoracoacromial trunk to contribute?

The pectoral artery stems from the TAT trunk to contribute to the breast

What is the name of the plexus for which lymphatic drainage begins from the breast tissue

areolar plexus

Lymph drains from tissue into lymph vessels (much like veins-most have valves) which, in turn, drain into _____ - lymph nodes will empty into lymph trunks (collecting vessels), which then _____ to a VEIN (there is a valve at the end of the ducts so to prevent___

lymph nodes while adding more lymphocytes; drain into the ducts (right lymphatic duct and thoracic duct; backflow of the lymph once in the vein

The medial breast lymph will drain from the plexus
to which vessel

Parasternal lymph nodes

Parasternal lymph nodes will empty into

Right/Left Bronchomediastinal Lymphatic Trunk

Right Bronchomediasinal Trunk drains into

right lymphatic duct

Right Lymphatic Duct to

Right brachiocephalic vein

The lateral areolar plexus will drain into which structures

Axillary lymph nodes

Axillary lymph nodes will drain into which additional nodes as lymph travels more proximal

Supra and infraclavicular nodes

The supra and infraclavicular nodes will drain into …

Subclavian Lymphatic Trunk

The Right Subclavian Trunk will drain into..

Right lymphatic duct @ Junction of IJV, Right Subclavian V, Brachiocephalic Vein
Brachiocephalic V to
Superior Vena Cava

The Left Subclavian Trunk
will drain into ...

Thoracic Duct
@ Junction of IJV, Left Subclavian V, Brachiocephalic Vein
Brachiocephalic V to Superior Vena Cava

Which pleura layer is adhering the lung surface, including the fissures?

Visceral pleura

Which pleura layer is lining the pleural cavity

Parietal pleura

What are the subdivisions of the parietal pleural

Cervical
Mediastinal
Costal
Diaphragmatic

Which aspect of the thoracic cavity contains the heart, great vessels, trachea, esophagus, and lymph nodes and lies in between the lungs?

mediastinum

Which fissure will divide each lung into left and right lobes (or superior, inferior depending on how you interpret)

Oblique fissure

What are the Hilums of the Lung

Pulmonary arteries and veins
Bronchi

Which bronchial segment is usually not present in the left lower lobe?

Medial basal segment

What are the boundaries
of the posterior inferior
mediastinum

Posterior pericardium
Vertebral bodies
Superiorly by Sternal Angle
Inferiorly by diaphragm

What level is the Caval
opening found?

T8 - inferior vena cava

Besides the Abdominal
Aorta, what other
structures run through the
aortic hiatus?

Thoracic Duct
Splanchnic N
At level T12

What is the blood supply for the diaphragm and
where do these arteries branch from

Musculophrenic from internal thoracic
Pericardioprhenic from internal thoracic
Superior phrenic from thoracic aorta
Inferior phrenic from abdominal aorta

What is the nerve supply
to the diaphragm

Phrenic nerve (C3-C5)

Do you know the
identifying characteristics
of the Pericardial layers?

Fibrous  tough, outer shell

Parietal  under fibrous, serous

Visceral  cannot separate from heart; AKA epicardium

Pericardial cavity between P and V

What are the neurovasculature structures for the pericardium?

Pericardiophrenic A (from internal thoracic A) Phrenic N (to outer aspects of pericardium) Vagus N (to visceral pericardium) Sympathetic trunk (to visceral pericardium)

Do you know the characteristics for of the heart layers?

Epicardium—outermost (visceral pericardium)

Myocardium- muscle layer –electroconductivity

Endocardium- lines chamber and valve

Which structure will bind the Pulmonary trunk to the Aortic Arch? What was it called during fetal development?

Ligamentum Arteriosum; ductus arteriosus

What two structures will help expand the blood filling capacity of the atria?

Auricles, pectinate muscles

Which opening of the right atrium will enable venous return from the coronary sinus? What was it called during fetal development?

Fossa or ostium  to Coronary sinus

Fossa ovalis

Do you know the placement of the valves and how the valves work?

Right Atria-Tricuspid Valve-Right Ventricle-Pulmonary Valve to Pulmonary Artery to Lungs   Left Atria-Mitral Valve–Left Ventricle-Aortic Valve to Aorta to Body   Tricuspid-Mitral work via Papillary muscle contraction closing the valves; relaxation opening the valves   Semilunar valves on pressure system

What structure will add some turbulence to the blood movement in the ventricles

Trabeculae carnae

What are the branches of the right coronary artery?

Acute Marginal Arteries right ventricle -apex

Posterior Interventricular Aventricles and septum

From where do the right and left coronary arteries begin

Base of ascending aorta

What structure collects most of the venous blood supplying the myocardium?

Coronary sinus

What structure collects the most deoxygenated blood in the body?

Coronary sinus hW

What is the most anterior part of the heart?

Right ventricle

Sympathetic effect  at heart

Increase HR due to Nor/Epi release at SA node, AV node, and some resources suggest at the Purkinje fibers also

Increase Force of Contraction

Via Cardiac Plexus

Parasympathetic effect?

Decrease HR via ACH release at SA node and AV node via Cardiac Plexus

What is the general pathway for normal electroconductivity in the heart

SA node (pacemaker; sinoatrial)

AV node (atrioventricular)

AV bundle (Bundle of His)

Rt and Left Bundle branches (septal)

Purkinje fibers (ventricles)

What are the boundaries of the triangle of Koch?

Tendon of Todaro, septal leaflet of tricuspid valve, coronary sinus

**also AV node location

What is the function of the right ventricle moderator band

To bring right bundle branch electroconductivity to the anterior papillary muscle

**AKA septomarginal trabeculae

Generally, what are the names of the 9 abdominopelvic regions?

R/L Hypochondriac R/L Lumbar Epigastric Umbilical R/L Iliac(Inguinal) Hypogastric

In terms of the abdominopelvic regions, which plane passes horizontally through the 10^th rib

Subcostal plane

In terms of the abdominopelvic regions, which plane passes horizontally through the iliac tubercles?

Transtubecular Plane

In terms of the abdominopelvic regions, which plane passes vertically through the mid clavicles to mid-inguinal

Mid-Clavicular (Left and Right)

Do you know what abdominal viscera are located in the Quadrants and Abdominopelvicregions

Review the regions/quadrants  1-2x so you know names and locations and then just plug and chug (as you know where the viscera is located in most people)

Can you provide the layers of the abdominal region starting at the skin?

Skin Superficial Fascia:     Campers (outer)     Scarpa’s (inner) Abdominal muscle (each with investing fascia) Endoabdominal Fascia (transversalis fascia; under tranversus abdominis) ) Extraperitoneal Fat Layer Parietal Peritoneum Peritoneal Cavity Visceral Peritoneum

Which structure will allow the viscera to stay suspended in the peritoneal cavity; 

Mesentery

Connects Visceral Peritoneum to Parietal Peritoneum

Double-layered Peritoneum containing neurvasc./lymphatic structures to and from viscera

Lesser vs Greater Omentum

Lesser Omentum found liver to lesser curvature of stomach

 

Greater Omentum hangs from the greater curvature of the stomach to the transverse colon

Which lumbrosacral plexus  nerve is best found by referencing the last rib

Subcostal (T12)

Which LS plexus nerve is best referenced by coming out the anterior psoas major before branching into 2 primarily cutaneous branches

Genitofemoral (L1-L2)

Which LS plexus nerve is best referenced by arising from the lateral border of the psoas major-running over quadratus lumborum and heading to the external oblique

Iliohypogastric (L1)

Which LS plexus nerve is best referenced by arising from the lateral border of the psoas major-runs over the QL and heads to the iliac crest, ASIS and inguinal ligament

Ilioinguinal (L1)

Which two LS plexus nerves will be derived from L2-L4

Femoral (lateral in reference to Psoas)

Obturator (medial in reference to Psoas)

Which branches of the internal thoracic artery help perfuse deeper abdominal muscles

Superior epigastric

Which branches of the aorta help perfuse the abdominal muscles

Posterior

Intercostal

Lumbar

Which branches of the External Iliac will help perfuse the abdominal muscles

Inferior Epigastric (deeper muscles)

Deep iliac circumflex

What is one branch of the internal iliac that helps perfuse the abdominal muscles

Iliolumbar (not a big contributor)

What is the best way to travel on a mound of potatos and gravy

Kayak

External Oblique N&A

N: Intercostal, Subcostal, Iliohypo, Ilioinguinal A: Intercostals, Subcostal, Deep circumflex

Internal Oblique N & A

N: Intercostal, Subcostal, Lumbar, Iliohypo, Ilioinguinal A: Intercostals, Deep circumflex iliac, Lumbar

Rectus abdominis N & A

N: Intercostal, Subcostal

A: Epigastrics

Transverse Abdominis N&A

N: Intercostal, Subcostal, Iliohypo, Ilioinguinal A: Inferior Epigastric, Deep circumflex iliac

Which structure is found as an opening to the inguinal canal via the external oblique aponeurosis

Superficial inguinal ring

Where is the opening for the deep inguinal ring

Transversalis fascia Lateral to the inferior epigastric artery

What is space between the deep and superficial inguinal rings

Inguinal canal

In males, the inguinal canal leads to

spermatic cord; houses testicular N/A/V, ilioinguinal n

In females, the inguinal canal houses

round ligament

Think of your abdominal aorta which starts just below its opening in the diaphragm, can you provide the primary branches serving the viscera? (superior to inferior)

R/L inferior phrenic

Celiac Trunk

Middle suprarenal

Renal

Superior mesenteric trunk

Lumbar

Gonadal

Inferior Mesenteric trunk

Which hernia is found medial to the epigastric and what are outcomes (in general)

Direct Compression possible but does not enter the inguinal canal Due to weakened abdominal wall

Which hernia is found lateral to the epigastric and what are outcomes (in general

The Indirect hernia will occur lateral to the epigastric and therefore be able to enter into the deep inguinal ring and follow to the labia or scrotum if able to progress; congenital (esp in males)