rca1

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amycykho
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rca1
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2013-10-17 17:03:49
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  1. intercostal neurovascular bundles
    between internal and innermost intercostal muscles in posterior along lower border costal groove but also collateral neurovascular bundle at upper border
  2. breast arterial supply
    perforating arteries of internal thoracic, lateral thoracic, intercostal and thoracoacromial arteries
  3. clinical significance of pleural recesses
    costodiaphragmatic and costomediastinal recesses are potential spaces into which lungs can expand and fluid can accumulate in pleural effusion
  4. contents of lung hilum and arrangement
    main bronchus posteriorly (divides within hilum in R lung forming R upper lobar eparterial bronchus), pulmonary arteries superior, pulmonary veins inferior, bronchial arteries and tracheobronchial lymph nodes surrounding bronchi
  5. lymphatic drainage of lung
    pulmonary (within lung), bronchopulmonary (hilum), inf tracheobronchial (carina), sup tracheobronchial (tracheal bifurcation), bronchomediastinal trunk, right lymphatic duct, subclavian vein
  6. bronchopulmonary segment
    segment of lung supplied by segmental bronchus, segmental pulmonary artery: functionally independent unit
  7. thoracocentesis
    chest drain inserted into pleural cavity to prevent atelectasis in pneumothorax (air), haemothorax (blood), pleural effusion/empyema (pus) +/underwater seal if air
  8. thoracocentesis incision
    intercostal space careful not to hit neurovascular bundles on either borders of ribs; if air high and if fluid low (usually patient lies on side)
  9. lung and pleura borders surface markings at midclavicular, midaxillary and posterior
    • midclavicular: 6th rib lung 8th rib pleura
    • midaxillary: 8th rib lung, 10th rib pleura
    • posteriorly: 10th rib lung, 12th rib pleura
  10. median sternotomy
    dividing the sternum along its length for surgical access to the anterior thoracic cavity
  11. thoracic anatomical differences between left and right
    • Lungs: R lung has middle lobe and horizontal fizzure
    • RLN: L recurrent laryngeal N emerges under aortic arch and behind ligamentum arteriosum while R emerges at carotid bifurcation
    • bronchi: R main bronchus is more vertical and wide, divides within hilum
    • posterior veins: R azygos vein, L hemiazygos
  12. pericardiocentesis
    drain inserted into pericardial cavity to prevent cardiac tamponade in pericardial effusion usually by blood
  13. cardiac tamponade pathophysiology
    tough outer fibrous layer of pericardium cannot expand as fast as the bleed, causing pressure compression of pulmonary veins and atria of the heart restricting cardiac output
  14. pericardiocentesis incisions/sites
    • intercostal parasternal approach: 5ICS LSB
    • subxiphoid approach: on lateral border of xiphoid process (more popular)
  15. pericardial sinuses
    • oblique sinus: reflection of pericardium where pulmonary veins enter heart (J shaped)
    • transverse sinus: separates great vessels into arteries and veins
  16. ligamentous continuations of fibrous pericardium
    • sternopericardial ligament: anteriorly
    • central tendon of diaphragm: inferiorly
  17. surface markings for heart sounds
    • aortic: 2ICS RSB
    • pulmonary: 2ICS LSB
    • tricuspid: 5ICS LSB
    • mitral: 5ICS MCL
  18. blood supply and drainage of left atrium
    • left coronary artery, anterior interventricular artery (anterior wall), circumflex artery, left marginal artery (posterior wall)
    • drained by great cardiac vein (anterior wall) and posterior cardiac vein (posterior wall) which into great cardiac vein which drains into coronary sinus
  19. blood supply and drainage of left ventricle
    • left coronary artery, anterior interventricular artery (anterior wall), circumflex artery, left marginal artery (posterior wall)
    • drained by great cardiac vein (anterior wall) and posterior cardiac vein
    • (posterior wall) which into great cardiac vein which drains into coronary sinus
  20. blood supply and drainage of interventricular septum and why is it important
    • holds main conduction pathway bundle of his/AV bundle and is supplied by branches of left coronary artery
    • drained by great and posterior cardiac veins which drain into coronary sinus
  21. blood supply and drainage of right atrium
    • right coronary artery, right marginal artery
    • drained by small cardiac vein into coronary sinus
  22. blood supply and drainage of right ventricle
    • right coronary artery, posterior interventricular artery (usually, but may be a branch of LCA)
    • drained by middle cardiac vein which drains into coronary sinus
  23. blood supply of sinoatrial node
    right coronary artery, sino atrial branch
  24. hiatuses in diaphragm level and contents
    • T8: IVC "caval hiatus"
    • T10: esophagus
    • T12: aorta, thoracic duct
  25. surface marking for brachiocephalic veins bifurcation from SVC
    sternoclavicular joints
  26. surface marking for arch of aorta
    midpoint between jugular (suprasternal) notch and sternal angle (of Louis)
  27. sternal angle is a surface marking for...
    • tracheal bifurcation
    • 2nd rib
  28. narrowings of esophagus
    UES: behind cricoid cartilage (C6) thickening of circular muscle and reinforced by lower fibres of cricopharyngeus (inferior constrictor muscle)

    Crossover: where is it passed by the aorta and left main bronchus (T4)

    LES: where is passes through diaphragm (T10), thickening of circular muscle, reinforced by right crus of diaphragm - contracts during inspiration to prevent reflux with increased intraabdominal pressure
  29. What is Raynaud's phenomenon and how is it treated?
    Excessive stimulation of the SNS causing peripheral vasoconstriction which is experienced by the patient as cold intolerance in the extremeties. May also present with excessive sweating (hyperhydrosis). Treated by removing inferior cervical (stellate) ganglion, part of sympathetic trunk at C7 level
  30. phrenic nerve origin and path
    • origin: C3-5 (C4 mainly)
    • pathway: forms at superior lateral border of scalenus anterior and descends across muscle, enters thorax after passing in between subclavian artery and vein, descends on anterolateral aspect of fibrous pericardium (gives off some pericardial branches) before piercing and innervating diaphragm
  31. pericardial branches of phrenic nerve
    symphathetic motor, sensory afferent (fibrous pericardium and parietal pericardium) giving rise to referred pain
  32. regions of the abdomen
    RL hypochondrium, epigastrium, RL lumbar/flank, umbilicus, RL iliac fossa, hypogastrium/suprapubic
  33. planes of the abdomen
    • horizontal lines between the regions:
    • subcostal between epigastrium and umbilicus
    • transtubercular between umbilicus and suprapubic
  34. What is Scarpa's fascia and which other fascia is it continuous with?
    membranous fascia overlying epimysium of rectus abdominus or external oblique which is continuous with Colle's fascia or the superficial perineal fascia which lines the scrotum (as dartos muscle fascia) or labia majora
  35. attachments of membraneous (Scarpa's) fascia of abdominal wall
    • linea alba
    • fascia lata below inguinal ligament
    • ischiopubic ramus
    • superficial perineal fascia and continuity with dartos fascia
  36. layers of abdominal wall cut in midline (median) incision for access to stomach, intestines
    • skin
    • campers fascia (fatty layer)
    • scarpas fascia (membraneous layer)
    • linea alba
    • tranversalis fascia
    • extraperitoneal fat
    • parietal peritoneum
  37. layers of abdominal wall cut in paramedian incision above the level of the arcuate line (T11) for access to stomach, intestines
    • skin
    • campers fascia (fatty layer)
    • scarpas fascia (membraneous layer)
    • anterior rectus sheath
    • rectus abdominis
    • posterior rectal sheath
    • tranversalis fascia
    • extraperitoneal fat
    • parietal peritoneum
  38. arcuate line
    termination of posterior rectal sheath at midway point between umbilicus and pubic symphysis (T11), marker where inferior epigastric vessels enter the posterior rectal sheath
  39. layers of abdominal wall cut in McBurney's  incision for access to appendix
    • skin
    • campers fascia (fatty layer)
    • scarpas fascia (membraneous layer)
    • fascia of external oblique muscle (deep fascia)
    • external oblique
    • internal oblique
    • transversus abdominis
    • transversalis fascia
    • extraperitoneal fat
    • parietal peritoneum
  40. which vessels are involved in spider nevi?
    • superficial epigastric vein which drains into great saphenous vein, dilation of which is commonly seen in liver failure and pregnancy due to increased venous pooling
    • nb superficial epigastric artery is a branch of femoral artery
    • these vessels run within the cutaneous fat (Camper's fascia)
  41. what forms the anterior rectus sheath
    • upper 3/4: aponeurosis of external and internal oblique muscles
    • lower 1/4: aponeurosis of external, internal obliques and transversus abdominis
  42. what forms the posterior rectal sheath?
    aponeurosis of internal oblique and transversus abdominis, discontinued at arcuate line
  43. blood supply of superficial anterior abdominal wall
    • branches of femoral artery: superficial epigastric and superficial circumflex
    • musculophrenic artery (from internal thoracic)
  44. blood supply to rectus abdominis
    anastomoses of superior (branch of internal thoracic) and inferior (branch of external iliac) epigastric arteries
  45. layers of abdominal wall cut in Pfannensteil's  incision for access to uterus (C section)
    • skin
    • campers fascia (fatty layer)
    • scarpa's fascia (membraneous layer)
    • deep fascia
    • rectus sheat
    • rectus abdominis
    • transversalis fascia
    • extraperitoneal fat
    • parietal peritoneum
  46. anaesthetics indicated for which layers postoperatively in abdo surgery
    skin, parietal peritoneum

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