surface anatomy (notes)

Question 1

vein most commonly used in hospital setting venous cannulation

Answer 1

cephalic vein

Question 2

Primary gateway for venipuncture and intravenous access.

Answer 2

Cubital fossa

Question 3

recognizable pattern of cubital fossa

Answer 3

-median cubital vein crosses obliquely
-between cephalic and basilic veins
-lying superficial to the bicipital aponeurosis

Question 4

what does the bicipital aponeurosis protect

Answer 4

-brachial artery
-median nerve

Question 5

location of brachial artery in relation to biceps tendon

Answer 5

-brachial artery runs medial
-to biceps tendon in cubital fossa

Question 6

Korotkoff sounds

Answer 6

-5 phases
-stethoscope detects Korotkoff sounds
-as cuff pressure falls below arterial pressure

Question 7

ABI

Answer 7

-ankle brachial index
-taking bp from both arms, both legs
-indicator of peripheral vascular health

Question 8

radial artery use

Answer 8

-palpable lateral to: flexor carpi radialis tendon
-used for pulse assessment
-arterial blood sampling
-provides access point for arterial catheterisation eg: coronary angiography, angioplasty, stenting
-in suitable individuals: can be harvested and used as: autograft in coronary bypass procedures

Question 9

Allen’s test confirms what?

Answer 9

-ulnar artery
-palmar arches
-provide sufficient collateral supply

Question 10

femoral triangle

Answer 10

bounded by:
-inguinal ligament superiorly
-sartorius laterally
-adductor longus medially

Question 11

contents of femoral triangle

Answer 11

-NAVEL (lateral to medial)
-femoral NERVE
-femoral ARTERY
-femoral VEIN
-empty space
-lymphatics

Question 12

femoral triangle catheterization

Answer 12

-arterial catheter: access the coronary arteries in the heart
-femoral vein access when central venous catheters are required and upper limb venous access is impaired

Question 13

dorsalis pedis artery

Answer 13

-continues from anterior tibial artery
-can be palpated between the tendons of extensor hallucis longus + tibialis anterior (on the dorsal surface of the foot)

Question 14

where can the posterior tibial pulse be felt

Answer 14

-posterior to the medial malleolus (bone)

Question 15

absence/ presence of the dorsalis pedis artery

Answer 15

-key sign in peripheral arterial disease
-pressure measured when computing ABI

Question 16

when is evaluation of blood flow to the foot important

Answer 16

-diabetics
-individuals with right side heart failure
-geriatric patients

Question 17

Nowadays, palpation and auscultation of the pulses is supplemented by what?

Answer 17

-POCUS(point-of-care ultrasound)
- Handheld scanners in Doppler mode.

Question 18

What defines the contour of the shoulder?

Answer 18

The deltoid muscle.
- 3 parts: anterior, middle, and posterior.

Question 19

What part of the deltoid are intramuscular injections given into?

Answer 19

-The middle part of the deltoid
-2-3finger breaths below the easily palpable acromion process of the scapula.

Question 20

What winds posteriorly around the surgical neck of the humerus?

Answer 20

-Axillary nerve
- Posterior circumflex humeral artery.
-(Positioning of the deltoid IM injection avoids these structures. )

Question 21

carotid triangle

Answer 21

-sternocleidomastoid posteriorly
-omohyoid inferiorly
-digastric superiorly

Question 21

Where is a safe zone for injection in the gluteal region?

Answer 21

-Upper outer quadrant.
-Well clear of the sciatic nerve.

Question 22

where is carotid pulse taken

Answer 22

-palpated in carotid triangle
-opposite the upper border of the thyroid cartilage (corresponds to level of the C4 vertebrae)

Question 23

If palpation is not gentle and unilateral, what could happen?

Answer 23

-Excessive stimulation of the carotid sinus.
- This could trigger vagal bradycardia.

Question 24

Where is the carotid sinus located?

Answer 24

The point where the common carotid bifurcates -into an external carotid and -an internal carotid artery.

Question 25

Internal jugular vein provides a visible indicator for what?

Answer 25

Central venous pressure.

Question 26

A raised jugular column signifies what?

Answer 26

-Right atrial hypertension (right-sided heart failure ) -pericardial tamponade

Question 27

JVD- jugular venous distension How was it carried out?

Answer 27

- Patient is reclined with head and torso angled upward at 45 degrees. - Head turned gently left and then right. - Internal jugular vein pulsation is observed. - Normal individual: <3 cm above the sternal angle.

Question 28

how to identify nail clubbing

Answer 28

-loss of normal nail angle: the lovibond angle (~160-> >180) -Schamroth's sign: loss of diamond-shaped window when opposing nails are placed together -spongy nail base -bulbous fingertip

Question 29

Examples of underlying conditions associated with nail clubbing.

Answer 29

-pulmonary (75-80% of cases): lung caner, interstitial lung disease, chronic lung infections -cvs( 10-15%): congenital heart disease with right-to-left shunts, infective endocarditis -GI (5-10%): inflammatory bowel disease, cirrhosis, celiac disease

Question 30

Mechanism of nail clubbing.

Answer 30

-result of platlelet clumping and megakaryocytes in peripheral vasculature (normally filtered by the lungs) - These will use platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) - Causing increased vascularity and connective tissue changes in the fingertips.

Question 31

Beau's lines.

Answer 31

- Transverse depressions across the nail plate. - Representing temporary interruption of nail matrix growth.

Question 32

causes of Beau's lines

Answer 32

Weeks of systemic stress events. - High fever -chemotherapy -myocardial infarction -severe infection.

Question 33

Frank's sign.

Answer 33

- Diagonal crease extending obliquely across the earlobe. - Correlation with coronary heart disease and atherosclerosis.

Question 34

Medial part of the nasolabial fold is raised by what muscle?

Answer 34

levator labii superioris alaque nasi

Question 35

Assessment of nasolabial folds can.

Answer 35

Be useful for distinguishing from central and peripheral facial nerve liaisons. - In central liaisons, forehead wrinkling is preserved, and the nasolabial fold is effaced on the side opposite to the side of the stroke( involved in strokes involving the middle cerebral artery) - In a peripheral liaison, the fold is effaced on the affected side of the forehead and is not spread, leading to loss of forehead wrinkling.