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Anatomy Topnotch > 1. Anatomy > Flashcards

1. Anatomy Flashcards

1
Q

investing layer that encircles the neck

A

Superficial cervical fascia

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2
Q

superficial cervical fascia splits splits to enclose the

A

trapezius and sternocleidomastoid muscles

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3
Q

thin layer that is attached above the laryngeal cartilages

A

pretracheal layer

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4
Q

forms a false capsule of the thyroid gland

A

pretracheal layer

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5
Q

surrounds the thyroid and parathyroid glands forming a sheath that encloses the infrahyoid m.

A

pretracheal layer

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6
Q

thick layer that passes like a septum across the neck behind the pharynx and esophagus and in front of prevertebral mscles and vertebral column

A

prevertebral layer

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7
Q

froms the fascial floor of the POSTERIOR TRIANGLE

A

Prevertebral layer

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8
Q

forms the fascial floor of the posterior triangle

A

prevertebral layer

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9
Q

extends laterally over the first rub into the axilla to form the axillary sheath

A

prevertebral layer

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10
Q

local condensation of the prevertebral, pretracheal and investing layers of he deep cervical fascia

A

carotid sheath

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11
Q

lateral part of carotid sheath

A

internaj jugular vein

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12
Q

posterior

carotid sheath

A

vasgus nerve

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13
Q

medial

carotid sheath

A

common and internal carotid artery

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14
Q

sheath is thinnest over the

A

vein

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15
Q

carotid sheath fuses with _____ under the sternocleidomastod

A

pretracheal fascia

investing fascia

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16
Q

escaping from the upper carotid sheath are

A

glossopharyngeal (IX)
superior laryngeal branch of vagus (X)
spinal root of accessory(XI)
hypoglossal nerves (XII)

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17
Q

between the layers of the deep fascia is loose connective tissue that forms potential spaces

A

visceral
retropharyngeal
submandibular
masticatory spaces

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18
Q

it is possible for blood, pus, or air in this space to spread downward into the superior mediastinum

A

retropharyngeal space

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19
Q

potential space bounded by deep cervical fascia

lies between the vertebral and visceral compartments and contains loose connective tissue

A

retropharyngeal space

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20
Q

lateral to retropharyngeal space

A

carotid sheaths

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21
Q

posterior to retropharyngeal space

A

prevertebral fascia

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22
Q

anterior to retropharyngeal space

A

visceral part of pretracheal fascia

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23
Q

in ludwig’s angina, this space is the primary site of infection

A

submandibular space

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24
Q

this structure is in the carotid sheath over the internal jugular vein

A

ansa cervicalis

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25
Q

broad, thin sheath of muscle in the subcutaenous tissue of the enck

A

Platysma

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26
Q

is platysma considered a muscle of facial expression

A

Yes because it is supplied by cervical branch of facial nerve

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27
Q

hyoid bone is at what level of cervical vertebra

A

C3

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28
Q

Hyoid muscles includes

A 
suprahyoid muscles
1. digastric
2. mylohyoid
3. stylohyoid 
4. geniohyoid 
infrahyoid muscles 
A. deep group
1. thyrohyoid
2. sternohyoid
B. superficial grop
1. omohyoid
2. sternohyoid
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29
Q

nerve supply

digastric - anterior belly

A

nerve to mylohyoid

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30
Q

nerve supply

digastric posterior belly

A

facial

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31
Q

nerve supply

stylohyoid

A

facial

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32
Q

nerve supply

mylohydroid

A

nerve to mylohyoid

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33
Q

nerve supply

genihyoid m.

A

first cervical

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34
Q

elevates hydroi bone

A

suprahyoid

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35
Q

nerve supply

omohyoid

A

Ansa cervicalis

C1, C2, C3

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36
Q

nerve supply

sternohyoid

A

Ansa cervicalis

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37
Q

nerve supply

sternothyroid

A

Ansa cervicalis

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38
Q

nerve supply

thyrohyoid

A

first cervical

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39
Q

depresses hyoid

A 
all infrahyoid m. (omohyoid, sternohyoid, thyrohyoid)
except sternothyoid (depresses larynx)
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40
Q

depresses hyoid

elevates larynx

A

thyrohyoid

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41
Q

the only bone that does not articulate with another bone

A

hyoid bone

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42
Q

serves as a moveable base of the tongue

A

hyoid bone

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43
Q

triangles of the neck

A

anterior triangle

posterior triangle

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44
Q

anterior triangle is divided into 4 smaller triangles by 2 bellies of the digastric muscle superiorly and superior belly of the omohyoid muscle inferiorly

A

submandibular/ digastric
carotid
muscular / omotracheal
submental

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45
Q

posterior triangle includes

A

subclavian

occipital triangle

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46
Q

boundaries of submental triangle

A

apex: symphysis menti
base: body of the hyoid bone
on each side: anterior belly of the digastric muscle
floor: 2 mylohyoid muscles with their median raphe

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47
Q

contents of submental triangle

A

submental lymph nodes

submental vessels

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48
Q

digastric triangle is also known as

A

submandibular triangle

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49
Q

digastric/ submandibular triangle

boundaries

A

anterior and posterior bellies of digastric m.
inferior border of mandible
floor: mylohyoid

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50
Q

what is the muscle that separates the submandibular and sublingual space

A

mylohyoid

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51
Q

what triangle of the neck is bounded by posterior belly of the digastric muscle, superior belly of omohyoid muscle and anterior border of sternocleidomastoid muscle

A

carotid triangle

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52
Q

this triangle of the neck is bounded by midline hyoid bone, superior belly of omohyoid muscle and sternocleidomastoid muscle

A

Muscular or omotracheal triangle

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53
Q

latin term cervical means

A

of the neck

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54
Q

the midline in the front of the neck has a prominence of the thyroid cartilage termed

A

laryngeal prominence

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55
Q

is on the side of the neck and is bounded superiorly by the lower border of the body of the mandible and the mastoid process, inferiorly by the clavicle, anteriorly by a midline in front of the neck, and posteriorly by the trapezius muscle.

A

quadrangular area

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56
Q

the cervical; portion of the spine has this curve

A

gentle forward curve / cervical lordosis

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57
Q

A quadrangular area can be delineated on the side of the neck. This quadrangular area is subdivided by an obliquely prominent sternocleidomastoid muscle into an

A

anterior cervical triangle

posterior cervical triangle

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58
Q

boundaries of anterior cervical triangle

A

The anterior cervical triangle is bounded by the midline anteriorly, mandible superiorly, and sternocleidomastoid muscle inferolaterally.

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59
Q

bounded by the mandible and 2 bellies of the digastric muscle.

A

submandibular triangle

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60
Q

submandibular triangle contains

A

submandibular salivary gland, hypoglossal nerve, mylohyoid muscle, and facial artery.

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61
Q

bounded by the sternocleidomastoid muscle, posterior belly of the digastric muscle, and superior belly of the omohyoid muscle.

A

carotid triangle

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62
Q

carotid triangle contains

A

carotid arteries and branches, internal jugular vein and vagus nerve

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63
Q

carotid triangle contains

A

carotid arteries and branches, internal jugular vein, and vagus nerve.

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64
Q

this triangle is bounded by the midline, hyoid bone, superior belly of the omohyoid muscle, and sternocleidomastoid muscle.

A

muscular or omotracheal triangle

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65
Q

muscular or omotracheal triangle

A

It includes the infrahyoid musculature and thyroid glands with the parathyroid glands.

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66
Q

located beneath the chin, bounded by the mandible, hyoid, and anterior belly of the digastric muscle.

A

submental triangle

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67
Q

bounded by the clavicle inferiorly, sternocleidomastoid muscle anterosuperiorly, and trapezius muscle posteriorly.

A

posterior cervical triangle

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68
Q

The posterior cervical triangle is divided into upper occipital triangle and lower subclavian triange by this structure

A

inferior belly of the omohyoid

anterior triangle: 2 bellies of the digastric muscle + superior belly of the omohyoid muscle inferiorly

posterior triangle: inferior belly of the omohyoid

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69
Q

structure that divides the anterior cervical triangle and posterior cervical triangle

A

anterior triangle: 2 bellies of the digastric muscle + superior belly of the omohyoid muscle inferiorly

posterior triangle: inferior belly of the omohyoid

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70
Q

bounded anteriorly by the sternocleidomastoid muscle, posteriorly by the trapezius, and inferiorly by the omohyoid muscle

A

occipital triangle

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71
Q

occipital triangle contains

A

contents include the accessory nerve, supraclavicular nerves, and upper brachial plexus.

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72
Q

bounded superiorly by the inferior belly of the omohyoid muscle, inferiorly by the clavicle, and anteriorly by the sternocleidomastoid muscle

A

subclavian triangle

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73
Q

subclavian triangle contains

A

supraclavicular nerves, subclavian vessels, brachial plexus, suprascapular vessels, transverse cervical vessels, external jugular vein, and nerve to the subclavius muscle.

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74
Q

this cervical vertebrae has 2 concave superior facets that articulate with the occipital condyles of the skull.
It has has no vertebral body and no spinous process.

A

C1 / atlas

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75
Q

the globe

A

C1/ atlas

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76
Q

axis

A

C2

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77
Q

has a conelike projection from the vertebral body that articulates within the atlas.

A

C2/ axis

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78
Q

has a nonbifid and a prominent posterior spinous process that can be felt distinctly at the base of the neck.

A

C7

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79
Q

these vertebrae have foramina in each of the transverse processes and bifid spinous processes

A

C2-C6

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80
Q

travels in the foramina of the transverse processes.

A

vertebral artery

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81
Q

the contents of the upper portion of the carotid sheath are crossed obliquely and anteriorly by the

A

posterior belly of the digastric

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82
Q

the bifurcation of the common carotid artery into the internal and externl carotid arteries can easily be palpated

A

just beneath the anterior border of SCM at the level of the superior border of the thyroid cartilage

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83
Q

what artery is found in occipital triangle

A

occipital artery

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84
Q

what nerve crosses occipital triangle

A

accessory nerve

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85
Q

accessory nerve lesion will present with

A

weakness of the trapezius muscle
difficulty in elevating the scapula/ shrugging the shoulder
difficulty in laterally rotating the scapula during abduction of the arm

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86
Q

main contents of the posterior triangle

A

nerves

a. 3 trunks of the brachial plexus
b. 4 cutaneoius branches of the cervical plexus
1. lesser occipital
2. greatr auricular
3. transverse cervical
4. supraclavicular nervs
c. spinal accessory

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87
Q

arteries of the posterior triangle

A
  1. 3/4 part of the subclavian artery
  2. suprascapular artery
  3. transverse cervical artery
  4. occipital artery
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88
Q

veins of posterior triangle

A

subclavian vein

external jugular vein

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89
Q

the superficial landmark of supraclavicular triangle/ subclavian triangle/ omoclavicular
is the

A

supraclavicular fossa

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90
Q

this triangle is crossed by the external jugular vein and subclavian artery

A

supraclavicular triangle

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91
Q

isthmus is at the level of ___ tracheal rings

A

second, third, and fourth

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92
Q

base of thyroid at level of

A

4th-5th tracheal rings

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93
Q

thyroid gland is surrounded by this fascia

A

pretracheal layer of deep fascia

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94
Q

thyroid gland weighs

A

20 grams

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95
Q

pyramidal lobe is often present, projects upward from the isthmus, usually to the

A

left of the midline

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96
Q

fibrous of muscular band frequently connect the pyramidal lobe to the hyoid bone

A

levator glandulae thyroidea

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97
Q

blood supply of the thyroid gland

A

superior thyroid artery- from external carotid

inferior thyroid artery- from thyrocervical trunk

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98
Q

venous drainage of thyroid gland

A

superior thyroid - IJV
Middle thyroid - IJV
Inferior thyroid - brachiocephalic trunk

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99
Q

A 45 y/o woman is undergoing thyroid surgery for suspected thyroid cancer
The surgeon has taken a midline approach and encounters significant bleeding below the isthmus of the thyroid gland
What is the source of bleeding

A

Thyroidea Ima artery

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100
Q

thyroidea ima artery is present in

A

12% of individuals

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101
Q

thyroidea ima artery arises fro

A

aortic arch or brachiocephalic trunk and reaches the thyroid ishtmus inferiorly

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102
Q

first endocrine gland to develop

A

thyroid gland

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103
Q

thyroid gland develops

A

24 days after fertilization

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104
Q

where does the thyroid diverticulum arise from

A

median endodermal thickening in the floor of the PRIMORDIAL PHARYNX

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105
Q

the develoing thyroid gland is connected to the tongue by this narrow tube

A

thyroglossal duct

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106
Q

ectopic thyroid most common location

A

lingual

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107
Q

shallow depression in the posterior dorsal midline of the tongue that is the remnant of the more cranial part of the embryonic duct from which the thyroid gland developed.

A

foramen cecum

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108
Q

normaly thyroglossal duct atrophies and disappears but a remnant may persist forming

A

thyroglossal duct cyst

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109
Q

what will form following infection of the thyroglossal duct

A

perforation of the skin that opens in the median plane of the neck -> thyroglossal duct SINUS

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110
Q

Cervical Lymphnodes

A 
I- submental and submandibular
II- upper jugular 
III- middle jugular 
IV- lower jugular 
V - posterior triangle 
VI - anterior compartment 
VII - paratracheal
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111
Q

primary tumors within the oral cavity and lip metastasize nodes in levels

A

I, II, III

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112
Q

primary tumors within oropharynx, hypopharynx, and larynx

metastasize to nodes in levels

A

levels III, III, IV

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113
Q

primary tumors within nasopharynx and thyroid

metastasize to nodes in level/s

A

Level V

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114
Q

cancer cells in thyroid malignancy will metastasized first to this group of cervical lymph nodes

A

cervical LN V

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115
Q

also known as throat

A

pharynx

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116
Q

common passageway of respiratory and digestive systems

A

pharynx

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117
Q

3 divisible portions of pharynx

A

nasopharynx
oropharynx
laryngopharynx

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118
Q

contains the opening of the auditory tube and pharyngeal tonsils

A

nasopharynx

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119
Q

contains the palatine and lingual tonsils

A

oropharynx

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120
Q

open into larynx and esophagus

A

laryngopharynx

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121
Q

pharynx has a musculomembranous wall which is deficient

A

anteriorly

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122
Q

present openings of pharynx

A

auditory tubes
2 posterior nares
larynx
esophagus

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123
Q

muscles of the pharynx / deglutition

A 
superior constrictor
middle constrictor
inferior constrictor
cricopharyngeus 
stylopharyngeus 
salphingopharyngeus 
palatopharyngeus
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124
Q

gag reflex is also known as

A

pharyngeal reflex

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125
Q

afferent fibers that innervate the pharyngeal mucosa are branches of which of the following nerves

A

glossopharyngeal n.

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126
Q

gag reflex afferent limb

A

pharyngeal branch of the glossopharyngeal nerve (supplies sensory innervation to the mucosa of the upper pharynx), vagus nerve (lower pharynx and larynx)

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127
Q

efferent limb gag reflex

A

pharyngeal branch of vagus nerve

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128
Q

nerve supply of pharynx

A

nasal pharynx - Maxillary nerve (V2)
Oral pharynx - glossopharyngeal nerve
Laryngeal pharynx - internal laryngeal nerve of the vagus

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129
Q

blood suply of the pharynx

A

ascending pharyngeal, tonsillar branches of the FACIAL ARTERY; branches of MAXILLARY and LINGUAL ARTERIES

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130
Q

lymph drainage of pharynx

A

deep cervical lymph nodes

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131
Q

lymphoid tissue that surrounds the opening into the respiratory and digestive systems
forming a ring

A

waldeyer ring of lymphoid tissue

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132
Q

lateral component of waldeyer ring

A

palatine and tubal tonsils

133
Q

upper component of waldeyer ring

A

pharyngeal tonsil

134
Q

lower component of waldeyer ring

135
Q

organ that provides a protective sphincter at the inlet of air passages

136
Q

responsible for voice production

137
Q

situated below the tongue and hyoid bone

138
Q

Larynx lies at the level of

A

4th, 5th, 6th cervical vertebrae

139
Q

what cartilage forms the laryngeal prominence in the neck

A

thyroid cartilage

formed by the angle of the thyroid cartilage surrounding the larynx seen especially in males.

140
Q

laryngeal cartilages

A

unpaired cartilages:
epiglottis
thyroid
cricoid

paired cartilages:
arytenoid
corniculate
cuneiform

141
Q

largest laryngeal cartilage

A

thyroid cartilage

142
Q

laryngeal cartilage

shaped like a signet ring; hyaline carilage

143
Q

laryngeal cartilage

leaf shaped lamina of lastic cartilage behind the root of the tongue

A

epiglottis

144
Q

laryngeal cartilage
pryamid shapred
located at the back of the larynx

145
Q

laryngeal cartilage

small rod shaped

146
Q

laryngeal cartilage

small conical shaped

A

corniculate

147
Q

connects the upper margin of the thyroid cartilage to the hyoid bone

A

thyrohyoid membrane

148
Q

thyrohyoid membrane is pierced on each side by the

A

superior laryngeal vessels and internal laryngeal nerve

149
Q

midline of thyrohyoid membrane is thickened to form the

A

thyrohyoid ligament

150
Q

membranes/ ligaments of larynx

A

thyrohyoid membrane
cricotracheal ligament
quadrangular membrane

151
Q

connects the cricoid cartilage to the first ring of trachea

A

cricothracheal membrane

152
Q

extends between the epiglottis and the arytenoid cartilages

A

quadrangular area

153
Q

quadrangular area

thickened inferior margin forms the ___

A

vestibular ligament

154
Q

lower margin of the cricothyroid ligament is attached to the

A

upper border of cricoid cartilage

155
Q

superior margin of the cricothyroid ligament is attached to the

A

medial surface of the thyroid cartilage

156
Q

forms the vocal ligament on each side (forms interior of vocal folds/ cords)

A

cricothyroid ligament

157
Q

an emergency critothyroidotomy is done due to airway collapse and severe laryngoedema
Which of the following is the most accurate description of the location of the cricothroid membrane

A

immediately INFERIOR TO THYROID CARTILAGE
INFERIOR TO true vocal cords
SUPERIOR to CRICOID CARTILAGE

158
Q

cricoid cartilage lies at level

159
Q

cricothyroidomy

vertical incision is made through the following structures

A 
skin
superficial fascia 
investing layer of deep cervical fascia 
pretracheal fascia 
larynx
160
Q

complications of cricothyroidomy

A

esophageal perforation

161
Q

fixed

laryngeal fold

A

vestibular fold

162
Q

mobile
voice production

laryngeal fold

A

vocal fold/ cord

163
Q

formed by mucous membrane covering the vestibular ligament

A

vestibular fold

164
Q

formed by mucous membrane the vocal ligament

A

vocal fold

165
Q

vascular
laryngeal fold
pink in color

A

vestibular fold

166
Q

avascular; white in color

laryngeal fold

A

vocal fold

167
Q

in thyroidectomy, what nerve maybe injured during ligation of superior thyroid artery

A

superior laryngeal nerve

168
Q

superior laryngeal nerve

2 branches

A

internal laryngeal nerve

external laryngeal nerve

169
Q

sensory above the vocal area

A

internal laryngeal nerve

170
Q

supplies cricothyroid

A

external laryngeal nerve

171
Q

motor to muscles of phonation except cricothyroid

A

recurrent laryngeal nerve (inferior LN)

172
Q

sensory below vocal cord area

A

recurrent laryngeal nerve

173
Q

ligation of superior thyroid artery

will injure

A

external laryngeal nerve

174
Q

in a parial surgical resection of the thyroid gland, the paralysis of the circothyroid muscle maybe a result of

A

severing the superior laryngeal nerve

175
Q

what laryngeal muscle acts as a chief tensor of vocal cords

A

cricothyroid

176
Q

inability to abduct the vocal cords during quiet breathing which muscle is paralyzed

A

posterior cricoarytenoid

177
Q

adductor of vocal cords

A

lateral cricoarytenoid

178
Q

relaxor of vocal cords

A

thyroarytenoid

179
Q

Which of the following muscles is most important to allow air movement through the larynx?

A

The posterior cricoarytenoid muscles are the only muscles that abduct the vocal folds and are necessary to widen the rima glottidis for breathing.

180
Q

A 33-year-old woman underwent partial thyroidectomy for hyperthyroidism in which the thyroid failed to take up radioactive iodine. She is noted to have some hoarseness of voice 1 month later. Which of the following is the most likely explanation?

A

D. Injury to the recurrent laryngeal nerve is common during thyroid surgery and may lead to the inability to tightly adduct the two vocal folds, resulting in hoarseness. In addition, the protective function of the rima glottidis may be lost, and food or liquid that does not go down the esophagus may flow into the trachea and cause a choking response.

181
Q

A 15-year-old boy is eating a fish dinner and inadvertently has a bone “caught in his throat.” He complains of significant pain above the vocal cords. Which of the following nerves is responsible for carrying the sensation for this pain?

A

Superior laryngeal nerve

[ The laryngeal mucosa above the vocal cords is innervated by the superior laryngeal nerve, whereas it is innervated below the vocal cords by the recurrent laryngeal nerve.

182
Q

A 25-year-old woman underwent thyroid surgery for a thyroid nodule. Two months later, she complains of dryness of skin and muscle spasms. Which of the following is the most likely explanation?

A

Hypocalcemia - due to excision of the parathyroid glands

183
Q

superior laryngeal nerve lesion will present as

A

asymptomatic - because the fibers are mainly sensory

if external branch lesion- mild hoarseness/ monotonous speech

184
Q

recurrent laryngeal nerve lesions result in

A

fixed vocal cord and transient hoarseness

185
Q

Recurrent LN injured more commonly

186
Q

LN that hooks around the arch of aorta

A

left recurrent LN

187
Q

LN that hooks around right subclavian artery

A

right recurrent LN

188
Q

unilateral injury to recurrent LN results in

A

ipsilateral paralysis of all intrinsic muscles of larynx except cricothyroid

median or paramedian position and does not move laterally on deep inspiration

189
Q

tx for unilateral recurrent LN

A

no tx required

190
Q

blood supply of larynx

A

upper half- superior laryngeal branch of the superior thyroid artery
lower half - inferior laryngeal branch of inferior thyroid artery

191
Q

lymph drainage of larynx

A

deep cervical group of lymph nodes

192
Q

dimensions of trachea

A

5 inches long

1 inch diameter

193
Q

level of trachea

A

below the cricoid (C6) - lower border of sternal angle (T4)

194
Q

blood supply of trachea

A

upper 2/3 - inferior thyroid arteries

lower 1/3 - bronchial arteries

195
Q

lymph drainage of trachea

A

pretracheal and para tracheal lymph nodes and deep cervical nodes

196
Q

nerve supply of trachea

A

vagus

recurrent laryngeal nerve

197
Q

what is tracheostomy

A

opening is made in the trachea between 1st and 2nd or 2nd through 4th tracheal rings and tube is inserted into the trachea

198
Q

abnormal communication between the trachea and esophagus

A

tracheoesophageal fistula

199
Q

tracheoesophageal fistula results from

A

improper division of the foregut by the tracheoesophageal septum

200
Q

most common type of esophageal atresia

A

esophageal atreasia with tracheoesophageal fistula at the distand end (85-90%)

201
Q

dimension of parathyroid glands

A

6 mm long in diameter

202
Q

blood supply of the Parathyrod gland

A

superior and inferior thyroid arteries

203
Q

venous drainage of parathyroid glands

A

superior, middle and inferior thyroid veins

204
Q

lymph drainage of thyroid gland

A

deep cervical nodes

paratracheal lymph node

205
Q

the activity of osteoclast in releasing calcium orm bones is result of

206
Q

what cells produces parathyroid hormone

A

chief cells

207
Q

controls the production of PTH

A

calcium levels in blood

208
Q

cells of parathyroid gland

A

chief cell oxyphil cell

209
Q

thyroid gland cells

A

follicular cell

parafollicular cell

210
Q

this hormone stimulates absorption of calcium from small intestine and reabsorption of calcium in the PCT of kidney

211
Q

inferior parathyroid arise from

A

3rd pharyngeal pouch

212
Q

superior parathyroid arise from

A

4th pharyngeal pouch

213
Q

cervical plexus is formed by the

A

anterior rami of the first four cervical nerves

214
Q

cervical plexus lie in front of

A

origins of levator scapulae

scalenus medius muscle

215
Q

cervical plexus is covered

A

in front by prevertebral player of deep cervical fascia

related to the internal jugular vein

216
Q

cervical plexus is anatomically close to this vein

A

internal jugular vei

217
Q

cutaneous branches of cervical plexus

A 
lesser occipital (C2)
greater auricular  (C2 and C3)
Transverse cutaneous (C2 and C3)
Supraclavicular (C3 and C4)
218
Q

nerve supply of

lateral part of the occipital region and medial surface of the auricle

A

lesser occipital (C2)

219
Q

nerve supply of
angle of the mandible
parotid gland
auricle

A

greater auricular (C2 and C3)

220
Q

nerve supply of

transverse cutaneous

A

anterior and lateral surfaces of the necl

221
Q

nerve supply of

chest wall, shoulder, and upper half of the deltoid region

A

supraclavicular (C3 and C4)

222
Q

Muscular branches of the neck muscles

A

C2 and C3
C2 and C4
ansa cervicalis

223
Q

motor nerve supply of

prevertebral m.; sternocleidomastoid (proprioceptive)

224
Q

motor nerve supply of

levator scapulae; trapezius (proprioceptive)

225
Q

motor nerve supply of omohyoid, sternohyoid, sternothyroid

A

ansa cervicalis

226
Q

formed by fibers from the union of hypoglossal and C1 nerves (descending branch) unites with descending cervical (C2 and C3)

A

ansa cervicalis

227
Q

only motor nerve supply to the diaphragm

A

phrenic nerve

228
Q

phrenic nerve arises from

A

C3, C4, C5

229
Q

phrenic nerve location

A

posterior to subclavian vein
anterior to subclavian artery
lateral to common carotid

230
Q

pain detected by the phrenic nerve from the diaphragmatic peritoneum from an inflammed gallbladder is referred to

A

C4 nerve distribution to the right shoulder tip via the SUPRACLAVICULAR NERVES

231
Q

each phrenic nerve supplies

A

corresponding half of diaphragm

232
Q

what can cause phrenic nerve injury

A

penetrating wounds in the neck

233
Q

effect of phrenic nerve injury

A

paralyzed half of the diaphragm relaxes and is pushed up into the thorax - LOWER LOBE of AFFECTED SIDE will collapse

234
Q

area of the neck immediately above the inlet into the thorax

A

root of the neck

235
Q

key muscle; deeply placed and descends almost vertically from the vertebral column to first rib

A

scalenus anterior

236
Q

scalenus anterior

important anatomic relations

A

anterior to carotid arteries, vagus nerve, IJV, deep cervical LN
Posterior to pleura, origin of the brachial plexus, 2nd part of the subclavian artery
Medial to vertebral artery and vein
lateral to- branches of the cervical plexus ; 3rd part of subclavian artery

237
Q

Zone I of neck

A

includes the root of the neck

extends from the clavicles and manubriumto the level of the inferior border of CRICOID cartilage

238
Q

zone II

A

extends from the cricoid cartilage to the level fo the angle of mandible

239
Q

zone III

A

above thelevel of the angle of mandible

240
Q

structures at risk Zone I

A

cervical pleurae, apices of the lungs
thyroid and parathyroid glands, trachea, esophagus , common carotid arteries, jugular veins and cervical region of the vertebral column

241
Q

structures at risk zone II

A

superior poles of thyroid gland
thyroid and cricoid cartilages
larynx, laryngopharynx, carotid arteries , jugular veins, esophagus,
cervical region of vertebral column

242
Q

structures at risk zone III

A

salivary glands, oral and nasal cavities, oropharynx and nasopharynx

243
Q

these neck zones obstruct the airway and have the greatest risk for morbidity and mortality

A

Zone I and III

244
Q

injury to this neck zone are most common

245
Q

why injuries to neck zone II have lower morbidity and mortality

A

because vascular damage may be controlled by direct pressure and structures involved are easily visualized and treated

246
Q

superior part of the trunk between the neck and abdomen

247
Q

formed by 12 pairs of ribs, sternum, costal cartilages, and 12 thoracic vertebra, together with skin, fascia and muscles form the thoracic wall

A

thoracic cage

248
Q

jugular notch is another name for

A

suprasternal notch

249
Q

thorax is made up of 3 parts

A

sternum
ribs
thoracic vertebrae

250
Q

breastbone also known as

251
Q

parts of the sternum

A

manubrium
sternal angle of Louie
body
xiphoid process

252
Q

clinical landmark when counting ribs

A

sternal angle of Louie

or manubriosternal joint

253
Q

sternal angle coresponds this level of spine

A

T4 vertebra level

254
Q

xiphoid process becomes bony by

A

40 years old

255
Q

xiphisternal joint is at this thoracic level

256
Q

what anatomic features occur at the level of sternal angle

A
  1. trachea bifurcates into right and left bronchi
  2. arch of the aorta arises from the ascending aorta
    and continues as the descending aorta (The start and end of aortic arch)
  3. azygous vein drains into the superior vena cava
257
Q

True ribs

A

1st to 7th ribs

vertebrosternal

258
Q

false ribs

A

8th to 12th ribs

vertebrochondral

259
Q

false ribs proepr

A

8,9,10th ribs

260
Q

floating ribs

A

11, 12th ribs

261
Q

parts of ribs

A

head, neck
tubercle
shaft

262
Q

where the rib curves and twists

A

angle of rib

263
Q

at the inferior border to protect IC nerve and blood vesels

A

costal groove

264
Q

typical ribs

A

3-9th ribs

265
Q

atypical ribs

A

1,2,10,11,12

266
Q

broadest and most curved rib

prominent scalene tubercle for attachment of scalenus anterior muscle

267
Q

clinically immportant because of its close relationship to the lower nerves of brachial plexus and subclavian artery/ vein

268
Q

muscles of thoracic wall that elevate the ribs

A 
serratus post sup
levator costarum 
ext intercostal
innermost intercostal
subcostal
269
Q

muscles of thoracic wall that depress the ribs

A

serratus post inf
int intercostal
transverse thoracis

270
Q

an imaginary plane passing from the sternal angle of Louise anteriorly to the lower border of T4 posteriorly (T4-T5)

A

Mediastinum

271
Q

divisions of mediastinum

A

superior

inferior (anterior, middle, posterior)

272
Q

inferior boundary of mediastinum

273
Q

superior boundary of mediastinum

A

root of the neck

thoracic inlet

274
Q

anterior boundary of mediastinum

A

sternum and costal cartilages

xiphisternal joint at level of t9 vertebra

275
Q

posterior boundary of mediastinum

A

bodies of 12 thoracic vertebra

276
Q

contents of superior mediastinum

A 
thymus gland
superior vena cava 
brachiocephalic artery/ vein
left common carotid artery
left subclavian artery 
arch of the aorta 
phrenic and vagus nerve 
trachea 
esophagus 
thoracic duct 
left recurrent laryngeal nerve 
lymhnodes 
sympathetic trunks
277
Q

contents of anterior mediastinum

A

thymus (in children)
sternopericardial ligament
internal thoracic artery and branches
lymphatics and lymph nodes

278
Q

contents of middle mediastinum

A

heart enclosed in pericardium

arteries: ascending aorta, pulmonary trunk with its right and left branches
veins: superior vena cava, termination of azygos, pulmonary veins

nerves: phrenic, deep cardiac plexus

bifurcation of trachea with 2 principal bronchi

tracheobronchial lymph nodes

279
Q

contents of posterior mediastinum

A

esophagus
arteries
descending aorta with its branches

veins: azygos, hemizygos, accessory hemizygos
nerves: vagus and splanchnic nerves

thoracic duct

lymph nodes: posterior mediastinal

280
Q

boundaries of anterior mediastinum

A

ant: body of sternum
post: pericardium
lateral: mediastinal pleura
inf: diaphragm

281
Q

improper development of third and fourth pharyngeal pouches

A

DiGeorge Syndrome

282
Q

what glands would be absent in DiGeorge syndrome

A

thymus and

parathroid glands

283
Q

double walled fibro-serous sac

A

pericardium

284
Q

pericardium location

A

anterior to T5-T6 vertebrae
posterior to body of sternum
2nd-6th costal cartilage

285
Q

layers of pericardium

A 
fibrous 
serous 
1. parietal
2. visceral 
-paricardial cavity with pericardial fluid 30 mL
286
Q

cardiac tamponade results from

A

results from accumulation of fluid in the pericardial cavity that compresses the chambers of the heart- decreased venous return and reduced cardiac output

287
Q

distention of the veins of the neck on inspiration

A

kussmaul sign

288
Q

kussmaul sign is seen in

A

pericardial effusion, cardiac tamponade

289
Q

drainage of fluid
location
pericardiocentesis

A

left 5-6th ICS near sternum

290
Q

pericardiocentesis

site

A

left xiphocostal angle

291
Q

tissue layer penetrated during pericardiocentesis from superficial to deep

A 
skin
fascia
rectus sheath
rectus abdomins
fibrous layer 
serous layer of parietal pericardium
292
Q

normal weight of the heart

A

280-340 grams males

230-280 grams in females

293
Q

the sternocostal surface of the heart is formed primarily by

A

right ventricle

294
Q

the pulmonary surface of the heart is formed primarily by

A

left ventricle

295
Q

the diaphragmatic surface of the heart is formed primarily by

A

both ventricles mainly left ventricle

296
Q

3 surfaces of the heart

A

sternocostal surface / anterior
diaphragmatic / inferior surface
pulmonary or left surface

297
Q

4 borders of the heart

A

right - right atrium
inferior - right ventricle
left - left ventricle
superior- right and left atrium

298
Q

outline of the heart

A

superior border - inferior border of the 2nd left costal cartilage to the superior border of the 3rd right costal cartilage
right border- 3rd right costal cartlage to the 6th right costal cartilage
inferior border- inferior end of the right border to the apex beat (5th ICS LMCL)
left border- line connecting the left ends of the superior and inferior borders

299
Q

auscultatory site for pulmonary valve

A

2nd left ICS

300
Q

auscultatory site for tricuspid valve

A

lower end of the sternum

301
Q

auscultatory site for aortic valve

A

2nd right ICS

302
Q

auscultatory site for mitral valve

A

5th ICS LMCL

303
Q

surface anatomy

tricuspid

A

behind right half of sternum (4th ICS)

304
Q

surface anatomy

mitral

A

behind left half of sternum (4th ICS)

305
Q

surface anatomy

pulmonary surface of the heart

A

behind medial end of the 3rd left costal cartilage (T6-T7)

306
Q

surface anatomy

aortic

A

behind the left half of the sternum (3rd ICS)

307
Q

2nd heart sound (S2) represents closure of what valves

A

semilunar valves

aortic and pulmonary valves

308
Q

S2 is normally split because

A

aortic valve (A2) closes before the pulmonary valve (P2).

309
Q

arterial supply of the heart

A

right and left coronaries from ASCENDING AORTA

  1. right coronary artery
    a. marginal
    b. posterior interventricular
  2. left coronary
    a. anterior interventricular
    b. circumflex
310
Q

venous drainage of the heart

A

coronary sinus which drains into Right Atrium
Tributaries: GSM
Great cardiac vein
small cardiac vein
middle cardiac vein
-Anterior cardiac vein
-venae cordis minimae - opens directly to RA

311
Q

A 19 year old came to the ER and his angiogram exhibited that he was bleeding from the vein that is accompanied by the posterior interventricular artery.
Which of the following veins is most likely ruptured

A

middle cardiac vein

312
Q

small tributaries running throughout the myocardium

A

thebesian veins

313
Q

main vein of the heart

A

coronary sinus

314
Q

coronary sinus location

A

posterior surface in the coronary sulcus

which runs from left atrium and left ventricle

315
Q

coronary sinus drains into

A

right atrium

316
Q

within the right atrium, the opening of the coronary sinus is located between

A

right atrioventricular orifice

and inferior vena cava orifice

317
Q

There are five tributaries which drain into the coronary sinus:

A

Great cardiac vein
small cardiac vein
middle cardiac vein

posterior surface:
left marginal vein
left posterior ventricular vein

318
Q

main tributary of the coronary sinus

A

great cardiac vein

319
Q

a cardiac vein

It originates at the apex of the heart and follows the anterior interventricular groove into the coronary sulcus and around the left side of the heart to join the coronary sinus.

A

great cardiac vein

320
Q

cardiac vein

is also located on the anterior surface of the heart. This passes around the right side of the heart to join the coronary sinus.

A

small cardiac vein

321
Q

Another vein which drains the right side of the heart is the__________. It is located on the posterior surface of the heart.

A

middle cardiac vein

322
Q

cardiac vein

which runs along the posterior interventricular sulcus to join the coronary sinus.

A

left posterior ventricular vein

323
Q

a cardiac vein on the left posterior side

A

left marginal vein

324
Q

supplies the left atrium and left ventricle

A

left circumflex artery

325
Q

supplies the right atrium and right ventricle

A

right coronary artery

326
Q

supplies the right ventricle and left ventricle and interventricular septum

A

left anterior descending artery (left anterior interventricular artery)
posterior interventricular artery

327
Q

supplies the left ventricle

A

left marginal artery

328
Q

supplies the right ventricle and the apex

A

right marginal artery

Anatomy Topnotch (26 decks)

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