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HAD Unit I Review

HAD Unit I Review. Tom Eck, ecktw@umdnj.edu. CALM Resources. http:// njms.umdnj.edu/calm I will email you the link again tonight. Today’s review and a number of other resources should be up by tomorrow afternoon. To activate your “clicker”. Press Ch – 52 – Ch. Unit I Priorities.

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HAD Unit I Review

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  1. HAD Unit I Review Tom Eck, ecktw@umdnj.edu

  2. CALM Resources http://njms.umdnj.edu/calm I will email you the link again tonight. Today’s review and a number of other resources should be up by tomorrow afternoon.

  3. To activate your “clicker” • Press Ch– 52 – Ch

  4. Unit I Priorities • Nervous System Principles • Lymphatics • Lungs • Heart • Mediastinum • Back • Upper Limb • Surface Anatomy • Embryology

  5. Nervous System Principles • the second most important content from Chapter 1 • most important: anatomical terms, but they are rarely tested directly • the structure of peripheral nerves as they exit the spinal cord • the anatomical and functional distinctions between the sympathetic and parasympathetic divisions of the autonomic nervous system • dermatomes (T4 = nipple; T10 = umbilicus) • referred pain

  6. To which segments does heart pain refer? 10 Seconds Remaining • C1 – C5 • C3 – C5 • T1 – T4 • T3 – T8 • T6 – T12

  7. Referred Pain • A high-yield topic; especially important in Unit III, but don’t neglect this Remember: In referred pain, start by identifying the visceral nerves involved  Sympathetics From there, identify the spinal segments represented by the nerve(s)  T1 – T4/T5 The pain will refer to the corresponding dermatomes.

  8. Which of the following, if cut, would block sensory perception in the corresponding dermatome? 10 Seconds Remaining • ventral root • dorsal root • ventral ramus • dorsal ramus

  9. Rhizotomy S – Sensory D – Dorsal A – Afferent A – Afferent M – Motor V – Ventral E – Efferent E – Efferent • The dorsal root of spinal nerves can be cut to relieve intractable pain • Alternately, the ventral root may be cut to treat spastic paralysis

  10. Lymphatics • Don‘t forget to study lymph! • You can expect a few lymph questions on every exam (~2-3), often relating to the spread of cancer • These tend to be challenging, detail-oriented questions • Major Topics • Lymph Drainage of the Lung • Lymph Drainage of the Axilla and Breast

  11. Into which vessel does lymph from the right arm empty? • Thoracic Duct • IVC • Right Jugular Vein • Right Subclavian Vein :10

  12. Lymph from the right arm drains to the right lymphatic duct, and to the right subclavian vein (at the venous angle) from there.

  13. Which of the following correctly stages the path of pulmonary lymphatic flow? • Pulmonary TracheobronchialBronchopulmonary • ParatrachealTracheobronchial Deep Cervical • TracheobronchialParatracheal Deep Cervical • Pulmonary Paratracheal Aortic Arch :10

  14. A patient presents with a severe case of pneumonia. When you ask her to lift her arms, you notice that the veins in her upper limbs remain distended. You suspect radical enlargement of which group of lymph nodes: 10 • Right Pulmonary • Left Pulmonary • Right Bronchopulmonary (Hilar) • Left Bronchopulmonary (Hilar) • Inferior Tracheobronchial (Carinal)

  15. SVC Syndrome • Veins of head and upper extremities become distended due to constriction of the SVC by a tumor or grossly enlarged lymph nodes • The bronchopulmonary nodes at the right lung hilus are in close proximity to the SVC SVC Hilar Nodes

  16. The Lungs • Differences between Left and Right Lungs • Lobes, Segments • Pleura, Reflections, Recesses • Pneumothorax: in tension pneumothorax, mediastinum contralateral side • Aspirated Objects  Right Main Bronchus

  17. Upon examining a patient with left-sided ptosis, miosis, and anhydrosis, a physician suspects a growing superior lobe tumor. Which of the following segments is most likely involved? 10 Seconds Remaining • Apical • Posterior • Apicoposterior • Anterior • Superior Lingular • Inferior Lingular

  18. Horner Syndrome Sympathetic Trunk -Interruption of Sympathetics to Head causes IpsilateralPtosis (Lid Lag), Miosis (Pupil Constriction), and Anhydrosis (Lack of Sweating) -often caused by Pancoast Tumor -remember to study lung segments; you can expect a few questions testing their locations, both in the written exam and the practical

  19. Which space is entered when a thoracentesis is performed at the MAL in the 9th ICS? 10 Seconds Remaining • Transverse sinus • Cardiac notch • Costodiaphragmatic recess • Costomediastinal recess • Pericardial sac

  20. The Heart • pathway of blood – valve pathologies • coronary vessels – consequences of blockage • auscultation sites – pathological heart sounds (continuous machine-like murmer = patent ductusarteriosus) • radiographs and CTs especially important

  21. Identify the heart chambers marked B and D: • Right Ventricle, Left Ventricle • Right Atrium, Left Atrium • Right Ventricle, Left Atrium • Right Atrium, Left Ventricle B D :10

  22. CT Scans • Right Ventricle is associated with the anterior (sternocostal) surface of the heart • Left Atrium is associated with the posterior surface of the heart, just anterior to the esophagus • CT’s and Radiographs show up in the written exam and the practical • Be able to identify major structures

  23. Which of the following will result a diastolic murmur at the apex of the heart? • Mitral Valve Insufficiency • Mitral Valve Stenosis • Pulmonary Valve Insufficiency • Aortic Valve Stenosis • Aortic Valve Insufficiency Note: 2 is also correct :10

  24. Aortic Valve Insufficiency • blood rushes back into the left ventricle as the ventricle relaxes • murmur is heard at the apex (not at the right upper sternal border) because the blood flow causing the murmur is reversed (APTM 2245 does not always apply) • associated with a collapsing pulse • causes left ventricular hypertrophy, as the heart attempts to compensate for decreased pumping efficiency • Insufficiency = Backflow of Blood • a.k.a. incompetence, regurgitation

  25. A patient is diagnosed with left atrial hypertrophy. Which of the following valve defects is most likely to have caused this condition? • Tricuspid Valve Insufficiency • Mitral Valve Stenosis • Pulmonary Valve Insufficiency • Aortic Valve Stenosis • Aortic Valve Insufficiency :10

  26. Mitral Valve Stenosis • Causes left atrial hypertrophy; the left atrium grows larger to generate the force necessary to push past the obstruction • Stenosis is often associated with hypertrophy of the preceding chamber

  27. Following an acute myocardial infarction, necrosis develops at the apex of the heart. Which vessel was likely occluded? 10 Seconds Remaining • Left Circumflex • Coronary sinus • Anterior Interventricular • Posterior Interventricular • Right coronary

  28. The Anterior Interventricular Artery (LAD) supplies the anterior two-thirds of the interventricular septum, the apex, and the anterior left and right ventricles. It is the most commonly occluded coronary artery.

  29. The Mediastinum • be able to trace the course of the major structures that pass through the mediastinum • localize structures to each mediastinal compartment

  30. At which level does the trachea bifurcate? • T2/T3 • T3/T4 • T4/T5 • T5/T6 • T6/T7 10

  31. Transverse Thoracic Plane • divides the mediastinum into superior and inferior compartments • passes through the T4/T5 intervertebral disk posteriorly and sternal angle anteriorly • bifurcation of the trachea • boundary between cardiopulmonary and abdominopelvicsympathetics (greater, lesser, and least splanchnic nerves) • Remember: cardiopulmonary = postsynaptic; abdominopelvic = presynaptic

  32. You see a patient with a hoarse voice and a detectable suprasternal pulse. Which of the following diagnoses might explain these symptoms? • Coarctation of the Aorta • Aortic Aneurysm • Tumor Impinging on the Left Subclavian Artery • Lung Abscess :10

  33. Aortic Aneurysms • Localized dilation of the aorta • If in the vicinity of the aortic arch, it may impinge on the left recurrent laryngeal nerve, causing hoarseness • If the aneurysm grows large enough, it may lead to a detectable pulse suprasternally

  34. A patient has been diagnosed with an esophageal hernia, a condition in which part of the stomach passes through an enlarged esophageal hiatus. At which spinal segment has the herniation occurred? 10 Seconds Remaining • T8 • T9 • T10 • T11 • T12

  35. Structures that pass through the Diaphragm • I Ate Ten Eggs AT Noon • I 8 10 E A2T 12 • T8: IVC (“Caval Opening”) • T10: Esophagus (Vagus too) (“Esophageal Hiatus”) • T12: Aorta, Azygos Vein, Thoracic Duct (“Aortic Hiatus”)

  36. In which compartment of the mediastinum is the IVC located? 10 • Superior • Anterior • Middle • Posterior

  37. Mediastinal Compartments Bolded structures are exclusive to that compartment.

  38. The Back • Morphological distinctions between cervical, thoracic, lumbar, sacral, and coccygeal vertebrae • Curvatures • Spinal Cord Structure • Vascular Supply: vertebral arteries, segmental medullary arteries (especially the artery of Adamkiewicz)

  39. Which of the following prevents posterior displacement of the dens? • Posterior arch • Anterior arch • Lateral masses • Vertebra prominens • Transverse ligament 10

  40. In a case of suspected meningitis where should a lumbar puncture be performed? • L1/L2 • L2/L3 • L3/L4 • L4/L5 • L5/S1 10

  41. Lumbar Puncture Spinal Cord ends at L1/L2

  42. What landmarks are used to find the location for a spinal tap? • Anterior superior iliac spines • Posterior superior iliac spines • Iliac crests • Spinalis parts of erector spinae muscles 10

  43. High points of iliac crest correspond to L4 spinous process

  44. A patient is suffering from a herniation of the L4/L5 IV disc. Which nerve root is most likely compressed? • L2 • L3 • L4 • L5 10

  45. Herniated Discs • In a herniated disc of the lumbar vertebrae the nerve that exits at that level is spared, while the nerve root one segment below is often compressed • For lumbar roots, that means a herniation of IV disc L2/L3 will compress the L3 root • The rule applies the same for cervical vertebrae: C5/C6  C6 root • For cervical vertebrae, however, it is the nerve exiting at that level is actually compressed; it is only because there is one “extra” cervical nerve that the rule still applies

  46. The Upper Limb • questions almost entirely neuromuscular (nerve deficits are BIG) • BRACHIAL PLEXUS • know the spinal segments represented by major nerves (e.g. long thoracic, suprascapular, dorsal scapular, radial, axillary, median, ulnar, musculocutaneous, phrenic) • know major actions of each muscle (groupings and locations help) • memorize the innervation of each muscle • Innervation gives clues about action, vice versa • attachments

  47. A young man notices that following a stab injury he has difficulty doing push-ups, noting that his right shoulder blade tends to “stick out.” Which nerve was most likely injured to cause this deficit? • Dorsal Scapular • Long Thoracic • Subscapular • Vagus • Phrenic 10

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