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Anatomy and Physiology - Marianne's Lecture
Anatomy and Physiology - Marianne's Lecture
150
Medical
Graduate
05/30/2015

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Cards

Term
in what operating position is the patient most at risk for a optic nerve injury
Definition
prone position with a head rest. Directly related to ocular pressure.
Term
Ocular pressure and damage to the optic nerve can be result in what problems 3x
Definition
1. increased intraocular pressure
2. retinal artery occlusion
3. stimulation of the oculocardiac reflex
Term
ipsilateral cord adduction is the result of damage to what nerve
Definition
recurrent laryngeal nerve damage during surgery. Effects the same side (Ipsilateral)
Term
what nerve is damaged from shoulder blocks when the patient is placed in a trendelenberg position
Definition
brachial plexus. Most often C5 and C6
Term
if you over abduct the arm with hyperextension, and external rotation and (make this worse with also contralateral rotation of the head) you can suffer injury to what nerves and what Sx will you see
Definition
lower C8 and T1 = paralysis of small muscles of the hands and wrist. (claw hand)
Term
saturday night palsy is associated with injury to what nerve..what Sx is associated with it
Definition
Radial nerve injury resulting in wrist drop. saturday night palsy refers to a common way this injury happens which is falling asleep on a sofa chair watching tv.
Term
most common injury to the upper extremity nerves is?
Definition
ulnar nerve
Term
pressure to the
1. outer aspect of the arm may result in what nerve injury?
2. medial aspect of arm may result in what nerve injury
Definition
1. outer aspect of arm is radial nerve damage
2. medial aspect of arm is ulnar nerve damage
Term
claw hand is associated with what injury
Definition
1. ulnar nerve
or
2. C8, T1
Term
Trauma to the antecubital IV insertion may damage what nerve?
Definition
median nerve
Term
ape hand paresis is a result of damage to what nerve and during what procedure
Definition
IV insertion to AC. Damages median nerve.
Term
what nerves are at risk when the patient is in the lithotomy
Definition
1. obturator nerve
2. saphenous nerve
3. femoral nerve
4. common peroneal nerve
Term
most common:
1. upper nerve damaged
2. lower nerve damaged
Definition
1. upper nerve = ulnar nerve
2. lower nerve = common peroneal
Term
what positioning can cause damage to common peroneal nerve
Definition
1. lithotomy
2. lateral decubitus stirups
Term
foot drop may indicate damage to what nerve
Definition
common peroneal
Term
crossed feet may result in damage to what nerve
Definition
sural nerve and deep peroneal nerve
Term
lower back from being supine for long periods results in damage where
Definition
to lumbosacral nerves due to flattening of a normal lumbar convex joints.
Term
Name the 6x structures in the respiratory system that compose dead space
Definition
1. nasal cavities
2. oral cavity
3. pharynx
4. larynx
5. trachea
6. bronchial tree
Term
what word describes any area of bi-directional flow that does not participate in gas exchange
Definition
dead space
Term
where anatomically does dead space end? AKA where is the first off branching of alveoli
Definition
Level of the terminal bronchioles
Term
name in order as air enters the respiratory tract which cells does it pass and where
Definition
Air starts and enters the front of the nose and oral cavity and meets non-ciliated stratified epithelium... then it enters the back of the nose, nasopharynx and laryngeal mucosa above the cords and meets ciliated pseudostratified squamos epithelium...then below the cords it passes ciliated pseudostratified columnar epithelium until it reaches respiratory bronchioles and terminals where the rest of the cells are nonciliated cuboidal epithelium.
Term
name the four paranasal sinuses
Definition
1. maxillary
2. frontal
3. sphenoid
4. ethmoid
Term
…a musculomembranous tube extending from the undersurface of the skull to the level of C6 and lower border of the cricoid cartilage where it is continuous with the esophagus....
Definition
the pharynx
Term
cervical ______ is the lower border of the cricoid cartilage in a adult
Definition
C6
Term
pharynx gets sensory input via______ and motor innervation via ______
Definition
1. Sensory via glossopharyngeal IX
2. Motor via Vagus X
Term
where does the nasopharynx begin?
Definition
behind the posterior nares and goes to just above the soft palate
Term
where is the location of the oropharynx
Definition
from the soft palate to the base of the tongue
Term
name for babies born with obstructed nasal passages
Definition
choanal atresia
Term
location of the laryngopharynx
Definition
from base of the tongue to the opening of hte esophagus
Term
the epiglottis, aryepiglottic folds and arytenoid cartilages are all found in what compartment of the respiratory tract
Definition
laryngopharynx
Term
when you place a MAC blade into the valecula and lift up you are exerting pressure on what anatomical structure
Definition
median glosso-epiglottic fold which results in lifture of the epiglottis
Term
false cords are also called
Definition
ventricular folds
Term
the upper esophageal sphincter is also known as
Definition
the cricopharyngeus muscle
Term
is the UES voluntary or involuntary
Definition
voluntary
Term
what nerve innervates the cricopharyngeal muscle
Definition
reccurrent laryngeal nerve
Term
the lower esophageal sphincter may be open with how much pressure
Definition
18 cm H20.. so over bagging a patient can cause this to open.
Term
what in the upper GI tract protects against regurgitation into the airway
Definition
upper esophageal sphincter aka the cricopharyngeus muscle.
Term
the adult larynx sits at what Cervical vertebrae?

The child larynx sits at what cervical vertebrae
Definition
adult: C4-C6
Child: C3-C5
Term
trace the arterial supply to the larynx
Definition
subclavian artery -> inferior thyroid artery -> inferior laryngeal artery
Term
trace the venous return from larynx
Definition
Inferior laryngeal vein to brachiocephalic vein to SVC
Term
Name all 9 cartilages of the larynx. Identify which are paried and which are sinuglar
Definition
Singular
1. thyroid cartilage
2. cricoid cartilage
3. epiglottis cartilage

Paired:
1. Artenoids 2x
2. corniculates 2x
3. Cuneiforms 2x
Term
the largest cartilage of the larynx is
Definition
the thyroid cartilage
Term
The thyroid cartilage is held in place by what membranes
Definition
thryohyroid membrane up top and the cricothyroid down below
Term
what is the narrowest portion of the pediatric airway
Definition
cricoid cartilage
Term
only complete ring in the larynx is
Definition
the cricoid cartilage
Term
cricoid cartilage AKA....
Definition
the signet ring
Term
childs larynx is ___ in shape
Definition
ellipsoid
Term
first cartilage of the larynx encountered during laryngoscopy is
Definition
the epiglottis
Term
describe the shape of the artenoid cartilages
Definition
pyramidal in shape
Term
what three things attach to the arytenoid cartilages
Definition
1. posterior cricoartenoid muscle
2. lateral cricoartenoid muscle
3. vocal cords
Term
is the cuneate or corniculate cone shape
Definition
CO = COrniculate is cone shaped
Term
narrowest portion of the adult airway is?
Definition
the glottis
Term
glottis is also called the
Definition
1. rima glottis
2. rima
3. rimaglotidisc
Term
what muscle opens the vocal cords ( widens the rima)
Definition
posterior cricoarytenoids (2x)
Term
When you open the vocal cords you abduct or adduct?
Definition
Abduct
Term
What muscles close the vocal cords
Definition
Lateral cricoartenoids (2x)
Term
what hypercloses the vocal cords
Definition
transverse arytenoids (1x)
Term
deeper voice is a result of what muscle
Definition

thyroarytenoids (2)

 

thyROOOOOOO (deep) id

Term
Sharp voice is the result of what muscle
Definition
Cricothyroids (2)
Term
sensory above the cricoid supplied by
Definition
superior laryngeal nerve
Term
what nerve is stimulated that precipitates laryngospasms
Definition
what nerve is stimulated that precipitates laryngospasms it is the SUPERIOR laryngeal nerve INTERNAL Branch
Term
the superior laryngeal nerve has two branches..name them and their function
Definition
1. internal branch = sensory above vocal cords
2. external branch = motor innervation to cricothryoid muscles = Tenses and elongates
Sharp Voice
Term
the recurrent laryngeal muscle supplies motor innervation to all laryngeal muscles except for the
Definition
cricothyroid muscles
Term
what nerve supplies sensory below the cords and which above
Definition
above = internal superior laryngeal nerve
Below = recurrent larygenal nerve
Term
If this damage then this Sign to recurrent laryngeal nerve
1. hoarseness from?
2. complete airway obstruction from?
3. flaccid vocal cords
Definition
1. hoarseness = one sided transection
2. obstruction = ischemia to bilateral nerves
3. flaccid vocal cords = bilat transection
Term
print out laryngeal nerve picture
Definition
Term
carina is around what landmark
Definition
carina = T5
Term
incisor to carina in male and female adults is
Definition
female: 24-26 cm
male: 26-28
Term
mercedes sign describes the right main stem or left main stem
Definition
right mainstem
Term
angle of the
1. right main stem
2. left main stem
Definition
1. right mainstem = 25 degree
2. left mainstem 40-60 degree
Term
From carina name components of the airway
Definition
carina -> segmental bronchi -> small bronchi -> bronchioles -> terminal bronchioles -> respiratory bronchioles
Term
does ETT add or take away dead space to:
1. child
2. adult
Definition
1. child: adds dead space
2. adult: decreases
Term
equation for dead space in adult is?
Definition
1 cc/lb in adults and children
Term
what is the dead space for a 40 lb child
Definition
40 cc
Term
what is the deadspace for a 202 lb adult
Definition
202 cc
Term
thickest muscle to airway ratio is in what part of the lung
Definition
respiratory bronchioles
Term
greatest effect of bronchospasms on airway is at the
Definition
respiratory bronchioles due to its largest muscle to airway ratio
Term
muscle in the airway stops after
Definition
stops after the respiratory bronchioles
Term
fetus starts secreting surfactant at week ____ and has enough surfactant at what week__
Definition
starts at 26 weeks but not sufficent till week 35-36
Term
at what subdivision do respiratory bronchioles begin
Definition
17
Term
how many subdivisions of the lung are there
Definition
23
Term
generation of airway chart on test=print
Definition
Term
picture on slide 48 on test
Definition
Term
lungs only attach at the
Definition
hilum
Term
each lung has a concave or convex base
Definition
concave
Term
right or left apex rises slightly higher than the clavicle..why
Definition
right due to liver pushing up on lung
Term
perfusion without aeration is called
Definition
shunt
Term
aeration without perfusion is called
Definition
dead space
Term
is dead space or shunt an area of bi-directional air flow
Definition
dead space
Term
name all 7 accessory muscles of inspiration
Definition
1. sternocleidomastoid
2. pectoralis major
3. pectoralis minor
4. serratus anterior
5. serratus posterior superior
6. upper iliocostalis
7. scalenes
Term
name all 6 accessory muscles of expiration
Definition
1. external oblique
2. internal oblique
3. rectus abdominus
4. lower iliocostalis
5. lower longissimus
6. serratus posterior inferior
Term
brachial plexus composed of what roots
Definition
C5 C6 C7 C8 T1
Term
mneumonic for remembering divisions of brachial plexus
Definition
Real Teenagers Drink Cold Beer
Roots Trunks Divisions Cords Branches
Term
sub divisions of each main division of brachial plexus are
Definition
Roots: C5-T1
Trunks: Tree trunk upper, middle, lower
Divisions: Front line or rear line (posterior or anterior)
Cords: Spinal cord has nerves that run posterior, medial and lateral.
Branches:
Term
what branches arise off the lateral cords of the brachial plexus
Definition
1. musculocutaneous 2. median
Term
what branches arise off the posterior cords
Definition
1. axillary
2. radial
Term
what branches arise off the medial cord of the brachial plexus
Definition
1. median 2. ulnar
Term
Name the four approaches for a brachial plexus block and their biggest risk
Definition
1. interscalene - intravascular injection
2. Supraclavicular-pneumo
3. Infraclavicular-pneumo,hemo
4. Axillary - incomplete block missed the musculocutaenous nerve
Term
which brachial plexus block is at high risk for an incomplete block missing what nerve?
Definition
axillary block, may miss the msuculocutaneous nerve.
Term
lumbar plexus involves what nerve roots
Definition
T12
L1
L2
L3
L4
Term
sciatic nerve comes from what roots
Definition
L4, L5, S1, S2, S3
Term
sciatic nerve come from what branches
Definition
comes from tibial and common peroneal nerve
Term
what drains into the superior vena cava
Definition
the right and left brachiocephalic vein (Aka the innominate vein)
Term
where does the thoracic duct enter central venous circulation? What risks does this impose during an intervention
Definition
Thoracic duct enters central circulation at the left subclavian where it meets the left brachiocephalic vein. This in just above the left clavicle. Cannulation of the internal jugular is a high risk for hitting this. IF so will see milky yellow fluid.
Term
First, second, third branch of the right brachiocephalic trunk
Definition
1. 1st is common carotid
2. 2nd is vertebral artery
3. 3rd is the right subclavian artery
Term
what are the three main branches off the aortic arch in order from heart
Definition
1st = right brachiocephalic
2nd = left common carotid artery
3rd = left subclavian artery
Term
the the left vertebral artery come off the aortic arch, subclavian or common carotid
Definition
OFF THE LEFT SUBCLAVIAN
Term
most common nerve injury at the AC? Second most common injury?
Definition
1st = median nerve
2nd = brachial artery
Term
cerebral perfusion pressure =?
Definition
MAP - ICP or whichever is higher
Term
What is the CPP for a patient who's
ICP = 15
MAP = 80
CVP=10
Definition
Since ICP > CVP use that.
CPP = MAP - ICP
CPP = 65
Term
total CSF volume at any given time is?
Definition
150 mL
Term
how much CSF made daily?
Definition
400-500 mL/day
Term
what structure is the CSF reabsorbed
Definition
Arachnoid villi
Term
Trace the flow of CSF from start to finish
Definition
1. created at choroid plexus
2. lateral ventricles
-Thru foramen of monroe
3. 3rd ventricle
-through adequate of sylvius
4. 4th ventricle
-thru foramina of luschka
-thru foramina of magendie
5. Subarachnoid space
6. reabsorbed via the arachnoid villi.
Term
max amount of csf drained in one hour
Definition
20mL
Term
largest interspace in vertebral column to access spinal cord is? Another name for this?
Definition
L5-S1 (Taylor's space)
Term
when we check the line across some one's hips this imaginary line is called
Definition
Tuffier's line
Term
tuffier's line on adult is approximately what interspace?
Definition
Adult = L4
Term
will obese people have a tuffier's line that is lower or higher than normal
Definition
lower. Because they're fat and compression of the vertebrae pulls cord down.
Term
how many arteries supply the spinal cord? Which are front and which are back
Definition
3x arteries.
1x anterior
2x posterior.
Term
which spinal arteries supply the most amount of blood to spinal cord
Definition
anterior spinal artery (1x) supplies 2/3 of blood. Comes from the vertebral artery
Term
where do the spinal cord arteries arise from
Definition
Anterior (1x) spinal artery arises from the vetebral artery.

Posterior Spinal Arteries (2x) arise from the cerebellar artery
Term
another name for the artery of adamkiewicz 2x
Definition
AKA
1. great ventral radicular artery
2. arteria radicularis magna
Term
substantia gelatinosa is found where
Definition
dorsal horn of the spinal cord
Term
substantia gelatinosa is also know as
Definition
rexed's lamina II
Term
widest epidural space is
Definition
L2-L3
Term
dermatone for ass is
Definition
S3,4,5
Term
groin is what deramtones
Definition
S2,3
Term
facial nerve TOF illicits motor response from what
Definition
1. orbicularis oculi
2. corrugator supercilli (eyebrow over nose)
Term
TOF goal for patient's readiness to extubate is
Definition
4th twitch is at least 90% in strength to 1st twitch
Term
for periheral nerve stimulation..which site is best for evaluating if..
1. pt ready to intubate
2. pt ready to extubate/reversal
Definition
1. intubate - check facial nerve
2. extubate/reversal check adductor pollicis/ulnar nerve
Term
putting an a line into the brachial artery has what risk
Definition
nerve damage to median nerve
Term
which artery is good to cannulate in low flow states
Definition
femoral
Term
a pedal arterial line will have falsely high or lower BPs
Definition
Falsely high
Term
two mechanisms for nerve injury in the or patient
Definition
1. compression
2. pressure
both resulting in ischemia
Term
are more male or female patient suffer from upper extremity nerve injuries
Definition
MALE. They are bigger and more muscle ect so more compression/pressure per area. 70-90% get this
Term
#1 cofactor for nerve injuries related to lithotomy position is
Definition
Obesity
Term
opening a chest predisposes patient to what nerve injury
Definition
brachial plexus injury
Term
If a patient is in prone position what position will predispose them to brachial plexus injury
Definition
IF shoulders prolapse too far forward
Term
femoral nerve more commonly injuried from what types of surgery? or movement of thigh in what way
Definition
deep, lower abdominal retraction or prounced ABDUCTION of thigh
Term
legs crossed does what to the upper leg over the lower leg.
Definition
upper leg: sural nerve
lower leg: peroneal nerve

Sural SUPERIOR (upper leg)
Peroneal POSTERIOR (lower leg)
Term
what sign indicates billowing chemosis of pt eyes
Definition
Increase ICP 3x from baseline
Term
what is the patients intraocular pressure
MAP 70
ICP 14
CVP 10
Definition
intraocular pressure = MAP - ICP
70-14 = 54
Term
retinal artery occlusion is possible in what position
Definition
prone due to pressure. Its even more likely if you over hydrate patient.
Term
Major risk factors for retinal artery occlusion and possible blindness intra op for prone cases
Definition
1. excess crystalloid
2. prolong periods of hypotension
3. direct pressure to orbits
4. EBL >2.5 L
5. prlonged surgery
Term
Is FRC decreased in prone position
Definition
NO. UN LESS intra abdominal pressure present.!!But normally no loss in FRC in prone.
Term
#1 complication from sitting position for surgery is
Definition
venous air embolism
Term
MAP for your CPP is how many points lower than your MAP at the NIBP
Definition
20-30 mm Hg lower
Term
Pt lays on left lateral side for case. Which side has a shunt and which has dead space
Definition
1. Right side = dead space (side up)
2. Left side = shunt (dependent side)
Term
where do you place the pulse oximeter for a lateral position case
Definition
on dependent side
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