1. Anatomy Flashcards
1
Q
investing layer that encircles the neck
A
Superficial cervical fascia
2
Q
superficial cervical fascia splits splits to enclose the
A
trapezius and sternocleidomastoid muscles
3
Q
thin layer that is attached above the laryngeal cartilages
A
pretracheal layer
4
Q
forms a false capsule of the thyroid gland
A
pretracheal layer
5
Q
surrounds the thyroid and parathyroid glands forming a sheath that encloses the infrahyoid m.
A
pretracheal layer
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
7
Q
froms the fascial floor of the POSTERIOR TRIANGLE
A
Prevertebral layer
8
Q
forms the fascial floor of the posterior triangle
A
prevertebral layer
9
Q
extends laterally over the first rub into the axilla to form the axillary sheath
A
prevertebral layer
10
Q
local condensation of the prevertebral, pretracheal and investing layers of he deep cervical fascia
A
carotid sheath
11
Q
lateral part of carotid sheath
A
internaj jugular vein
12
Q
posterior
carotid sheath
A
vasgus nerve
13
Q
medial
carotid sheath
A
common and internal carotid artery
14
Q
sheath is thinnest over the
A
vein
15
Q
carotid sheath fuses with _____ under the sternocleidomastod
A
pretracheal fascia
investing fascia
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)
17
Q
between the layers of the deep fascia is loose connective tissue that forms potential spaces
A
visceral
retropharyngeal
submandibular
masticatory spaces
18
Q
it is possible for blood, pus, or air in this space to spread downward into the superior mediastinum
A
retropharyngeal space
19
Q
potential space bounded by deep cervical fascia
lies between the vertebral and visceral compartments and contains loose connective tissue
A
retropharyngeal space
20
Q
lateral to retropharyngeal space
A
carotid sheaths
21
Q
posterior to retropharyngeal space
A
prevertebral fascia
22
Q
anterior to retropharyngeal space
A
visceral part of pretracheal fascia
23
Q
in ludwig’s angina, this space is the primary site of infection
A
submandibular space
24
Q
this structure is in the carotid sheath over the internal jugular vein
A
ansa cervicalis
25
broad, thin sheath of muscle in the subcutaenous tissue of the enck
Platysma
26
is platysma considered a muscle of facial expression
Yes because it is supplied by cervical branch of facial nerve
27
hyoid bone is at what level of cervical vertebra
C3
28
Hyoid muscles includes
```
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
```
29
nerve supply
| digastric - anterior belly
nerve to mylohyoid
30
nerve supply
| digastric posterior belly
facial
31
nerve supply
| stylohyoid
facial
32
nerve supply
| mylohydroid
nerve to mylohyoid
33
nerve supply
| genihyoid m.
first cervical
34
elevates hydroi bone
suprahyoid
35
nerve supply
| omohyoid
Ansa cervicalis
| C1, C2, C3
36
nerve supply
| sternohyoid
Ansa cervicalis
37
nerve supply
| sternothyroid
Ansa cervicalis
38
nerve supply
| thyrohyoid
first cervical
39
depresses hyoid
```
all infrahyoid m. (omohyoid, sternohyoid, thyrohyoid)
except sternothyoid (depresses larynx)
```
40
depresses hyoid
| elevates larynx
thyrohyoid
41
the only bone that does not articulate with another bone
hyoid bone
42
serves as a moveable base of the tongue
hyoid bone
43
triangles of the neck
anterior triangle
| posterior triangle
44
anterior triangle is divided into 4 smaller triangles by 2 bellies of the digastric muscle superiorly and superior belly of the omohyoid muscle inferiorly
submandibular/ digastric
carotid
muscular / omotracheal
submental
45
posterior triangle includes
subclavian
| occipital triangle
46
boundaries of submental triangle
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
47
contents of submental triangle
submental lymph nodes
| submental vessels
48
digastric triangle is also known as
submandibular triangle
49
digastric/ submandibular triangle
| boundaries
anterior and posterior bellies of digastric m.
inferior border of mandible
floor: mylohyoid
50
what is the muscle that separates the submandibular and sublingual space
mylohyoid
51
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
carotid triangle
52
this triangle of the neck is bounded by midline hyoid bone, superior belly of omohyoid muscle and sternocleidomastoid muscle
Muscular or omotracheal triangle
53
latin term cervical means
of the neck
54
the midline in the front of the neck has a prominence of the thyroid cartilage termed
laryngeal prominence
55
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.
quadrangular area
56
the cervical; portion of the spine has this curve
gentle forward curve / cervical lordosis
57
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
anterior cervical triangle
| posterior cervical triangle
58
boundaries of anterior cervical triangle
The anterior cervical triangle is bounded by the midline anteriorly, mandible superiorly, and sternocleidomastoid muscle inferolaterally.
59
bounded by the mandible and 2 bellies of the digastric muscle.
submandibular triangle
60
submandibular triangle contains
submandibular salivary gland, hypoglossal nerve, mylohyoid muscle, and facial artery.
61
bounded by the sternocleidomastoid muscle, posterior belly of the digastric muscle, and superior belly of the omohyoid muscle.
carotid triangle
62
carotid triangle contains
carotid arteries and branches, internal jugular vein and vagus nerve
63
carotid triangle contains
carotid arteries and branches, internal jugular vein, and vagus nerve.
64
this triangle is bounded by the midline, hyoid bone, superior belly of the omohyoid muscle, and sternocleidomastoid muscle.
muscular or omotracheal triangle
65
muscular or omotracheal triangle
It includes the infrahyoid musculature and thyroid glands with the parathyroid glands.
66
located beneath the chin, bounded by the mandible, hyoid, and anterior belly of the digastric muscle.
submental triangle
67
bounded by the clavicle inferiorly, sternocleidomastoid muscle anterosuperiorly, and trapezius muscle posteriorly.
posterior cervical triangle
68
The posterior cervical triangle is divided into upper occipital triangle and lower subclavian triange by this structure
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
69
structure that divides the anterior cervical triangle and posterior cervical triangle
anterior triangle: 2 bellies of the digastric muscle + superior belly of the omohyoid muscle inferiorly
posterior triangle: inferior belly of the omohyoid
70
bounded anteriorly by the sternocleidomastoid muscle, posteriorly by the trapezius, and inferiorly by the omohyoid muscle
occipital triangle
71
occipital triangle contains
contents include the accessory nerve, supraclavicular nerves, and upper brachial plexus.
72
bounded superiorly by the inferior belly of the omohyoid muscle, inferiorly by the clavicle, and anteriorly by the sternocleidomastoid muscle
subclavian triangle
73
subclavian triangle contains
supraclavicular nerves, subclavian vessels, brachial plexus, suprascapular vessels, transverse cervical vessels, external jugular vein, and nerve to the subclavius muscle.
74
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.
C1 / atlas
75
the globe
C1/ atlas
76
axis
C2
77
has a conelike projection from the vertebral body that articulates within the atlas.
C2/ axis
78
has a nonbifid and a prominent posterior spinous process that can be felt distinctly at the base of the neck.
C7
79
these vertebrae have foramina in each of the transverse processes and bifid spinous processes
C2-C6
80
travels in the foramina of the transverse processes.
vertebral artery
81
the contents of the upper portion of the carotid sheath are crossed obliquely and anteriorly by the
posterior belly of the digastric
82
the bifurcation of the common carotid artery into the internal and externl carotid arteries can easily be palpated
just beneath the anterior border of SCM at the level of the superior border of the thyroid cartilage
83
what artery is found in occipital triangle
occipital artery
84
what nerve crosses occipital triangle
accessory nerve
85
accessory nerve lesion will present with
weakness of the trapezius muscle
difficulty in elevating the scapula/ shrugging the shoulder
difficulty in laterally rotating the scapula during abduction of the arm
86
main contents of the posterior triangle
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
87
arteries of the posterior triangle
1. 3/4 part of the subclavian artery
2. suprascapular artery
3. transverse cervical artery
4. occipital artery
88
veins of posterior triangle
subclavian vein
| external jugular vein
89
the superficial landmark of supraclavicular triangle/ subclavian triangle/ omoclavicular
is the
supraclavicular fossa
90
this triangle is crossed by the external jugular vein and subclavian artery
supraclavicular triangle
91
isthmus is at the level of ___ tracheal rings
second, third, and fourth
92
base of thyroid at level of
4th-5th tracheal rings
93
thyroid gland is surrounded by this fascia
pretracheal layer of deep fascia
94
thyroid gland weighs
20 grams
95
pyramidal lobe is often present, projects upward from the isthmus, usually to the
left of the midline
96
fibrous of muscular band frequently connect the pyramidal lobe to the hyoid bone
levator glandulae thyroidea
97
blood supply of the thyroid gland
superior thyroid artery- from external carotid
| inferior thyroid artery- from thyrocervical trunk
98
venous drainage of thyroid gland
superior thyroid - IJV
Middle thyroid - IJV
Inferior thyroid - brachiocephalic trunk
99
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
Thyroidea Ima artery
100
thyroidea ima artery is present in
12% of individuals
101
thyroidea ima artery arises fro
aortic arch or brachiocephalic trunk and reaches the thyroid ishtmus inferiorly
102
first endocrine gland to develop
thyroid gland
103
thyroid gland develops
24 days after fertilization
104
where does the thyroid diverticulum arise from
median endodermal thickening in the floor of the PRIMORDIAL PHARYNX
105
the develoing thyroid gland is connected to the tongue by this narrow tube
thyroglossal duct
106
ectopic thyroid most common location
lingual
107
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.
foramen cecum
108
normaly thyroglossal duct atrophies and disappears but a remnant may persist forming
thyroglossal duct cyst
109
what will form following infection of the thyroglossal duct
perforation of the skin that opens in the median plane of the neck -> thyroglossal duct SINUS
110
Cervical Lymphnodes
```
I- submental and submandibular
II- upper jugular
III- middle jugular
IV- lower jugular
V - posterior triangle
VI - anterior compartment
VII - paratracheal
```
111
primary tumors within the oral cavity and lip metastasize nodes in levels
I, II, III
112
primary tumors within oropharynx, hypopharynx, and larynx
| metastasize to nodes in levels
levels III, III, IV
113
primary tumors within nasopharynx and thyroid
| metastasize to nodes in level/s
Level V
114
cancer cells in thyroid malignancy will metastasized first to this group of cervical lymph nodes
cervical LN V
115
also known as throat
pharynx
116
common passageway of respiratory and digestive systems
pharynx
117
3 divisible portions of pharynx
nasopharynx
oropharynx
laryngopharynx
118
contains the opening of the auditory tube and pharyngeal tonsils
nasopharynx
119
contains the palatine and lingual tonsils
oropharynx
120
open into larynx and esophagus
laryngopharynx
121
pharynx has a musculomembranous wall which is deficient
anteriorly
122
present openings of pharynx
auditory tubes
2 posterior nares
larynx
esophagus
123
muscles of the pharynx / deglutition
```
superior constrictor
middle constrictor
inferior constrictor
cricopharyngeus
stylopharyngeus
salphingopharyngeus
palatopharyngeus
```
124
gag reflex is also known as
pharyngeal reflex
125
afferent fibers that innervate the pharyngeal mucosa are branches of which of the following nerves
glossopharyngeal n.
126
gag reflex afferent limb
pharyngeal branch of the glossopharyngeal nerve (supplies sensory innervation to the mucosa of the upper pharynx), vagus nerve (lower pharynx and larynx)
127
efferent limb gag reflex
pharyngeal branch of vagus nerve
128
nerve supply of pharynx
nasal pharynx - Maxillary nerve (V2)
Oral pharynx - glossopharyngeal nerve
Laryngeal pharynx - internal laryngeal nerve of the vagus
129
blood suply of the pharynx
ascending pharyngeal, tonsillar branches of the FACIAL ARTERY; branches of MAXILLARY and LINGUAL ARTERIES
130
lymph drainage of pharynx
deep cervical lymph nodes
131
lymphoid tissue that surrounds the opening into the respiratory and digestive systems
forming a ring
waldeyer ring of lymphoid tissue
132
lateral component of waldeyer ring
palatine and tubal tonsils
133
upper component of waldeyer ring
pharyngeal tonsil
134
lower component of waldeyer ring
lingual
135
organ that provides a protective sphincter at the inlet of air passages
larynx
136
responsible for voice production
larynx
137
situated below the tongue and hyoid bone
larynx
138
Larynx lies at the level of
4th, 5th, 6th cervical vertebrae
139
what cartilage forms the laryngeal prominence in the neck
thyroid cartilage
formed by the angle of the thyroid cartilage surrounding the larynx seen especially in males.
140
laryngeal cartilages
unpaired cartilages:
epiglottis
thyroid
cricoid
paired cartilages:
arytenoid
corniculate
cuneiform
141
largest laryngeal cartilage
thyroid cartilage
142
laryngeal cartilage
| shaped like a signet ring; hyaline carilage
cricoid
143
laryngeal cartilage
leaf shaped lamina of lastic cartilage behind the root of the tongue
epiglottis
144
laryngeal cartilage
pryamid shapred
located at the back of the larynx
arytenoid
145
laryngeal cartilage
| small rod shaped
cuneiform
146
laryngeal cartilage
| small conical shaped
corniculate
147
connects the upper margin of the thyroid cartilage to the hyoid bone
thyrohyoid membrane
148
thyrohyoid membrane is pierced on each side by the
superior laryngeal vessels and internal laryngeal nerve
149
midline of thyrohyoid membrane is thickened to form the
thyrohyoid ligament
150
membranes/ ligaments of larynx
thyrohyoid membrane
cricotracheal ligament
quadrangular membrane
151
connects the cricoid cartilage to the first ring of trachea
cricothracheal membrane
152
extends between the epiglottis and the arytenoid cartilages
quadrangular area
153
quadrangular area
| thickened inferior margin forms the ___
vestibular ligament
154
lower margin of the cricothyroid ligament is attached to the
upper border of cricoid cartilage
155
superior margin of the cricothyroid ligament is attached to the
medial surface of the thyroid cartilage
156
forms the vocal ligament on each side (forms interior of vocal folds/ cords)
cricothyroid ligament
157
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
immediately INFERIOR TO THYROID CARTILAGE
INFERIOR TO true vocal cords
SUPERIOR to CRICOID CARTILAGE
158
cricoid cartilage lies at level
C6
159
cricothyroidomy
| vertical incision is made through the following structures
```
skin
superficial fascia
investing layer of deep cervical fascia
pretracheal fascia
larynx
```
160
complications of cricothyroidomy
esophageal perforation
161
fixed
| laryngeal fold
vestibular fold
162
mobile
voice production
laryngeal fold
vocal fold/ cord
163
formed by mucous membrane covering the vestibular ligament
vestibular fold
164
formed by mucous membrane the vocal ligament
vocal fold
165
vascular
laryngeal fold
pink in color
vestibular fold
166
avascular; white in color
| laryngeal fold
vocal fold
167
in thyroidectomy, what nerve maybe injured during ligation of superior thyroid artery
superior laryngeal nerve
168
superior laryngeal nerve
| 2 branches
internal laryngeal nerve
| external laryngeal nerve
169
sensory above the vocal area
internal laryngeal nerve
170
supplies cricothyroid
external laryngeal nerve
171
motor to muscles of phonation except cricothyroid
recurrent laryngeal nerve (inferior LN)
172
sensory below vocal cord area
recurrent laryngeal nerve
173
ligation of superior thyroid artery
| will injure
external laryngeal nerve
174
in a parial surgical resection of the thyroid gland, the paralysis of the circothyroid muscle maybe a result of
severing the superior laryngeal nerve
175
what laryngeal muscle acts as a chief tensor of vocal cords
cricothyroid
176
inability to abduct the vocal cords during quiet breathing which muscle is paralyzed
posterior cricoarytenoid
177
adductor of vocal cords
lateral cricoarytenoid
178
relaxor of vocal cords
thyroarytenoid
179
Which of the following muscles is most important to allow air movement through the larynx?
The posterior cricoarytenoid muscles are the only muscles that abduct the vocal folds and are necessary to widen the rima glottidis for breathing.
180
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?
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
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?
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
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?
Hypocalcemia - due to excision of the parathyroid glands
183
superior laryngeal nerve lesion will present as
asymptomatic - because the fibers are mainly sensory
| if external branch lesion- mild hoarseness/ monotonous speech
184
recurrent laryngeal nerve lesions result in
fixed vocal cord and transient hoarseness
185
Recurrent LN injured more commonly
left
186
LN that hooks around the arch of aorta
left recurrent LN
187
LN that hooks around right subclavian artery
right recurrent LN
188
unilateral injury to recurrent LN results in
ipsilateral paralysis of all intrinsic muscles of larynx except cricothyroid
median or paramedian position and does not move laterally on deep inspiration
189
tx for unilateral recurrent LN
no tx required
190
blood supply of larynx
upper half- superior laryngeal branch of the superior thyroid artery
lower half - inferior laryngeal branch of inferior thyroid artery
191
lymph drainage of larynx
deep cervical group of lymph nodes
192
dimensions of trachea
5 inches long
| 1 inch diameter
193
level of trachea
below the cricoid (C6) - lower border of sternal angle (T4)
194
blood supply of trachea
upper 2/3 - inferior thyroid arteries
| lower 1/3 - bronchial arteries
195
lymph drainage of trachea
pretracheal and para tracheal lymph nodes and deep cervical nodes
196
nerve supply of trachea
vagus
| recurrent laryngeal nerve
197
what is tracheostomy
opening is made in the trachea between 1st and 2nd or 2nd through 4th tracheal rings and tube is inserted into the trachea
198
abnormal communication between the trachea and esophagus
tracheoesophageal fistula
199
tracheoesophageal fistula results from
improper division of the foregut by the tracheoesophageal septum
200
most common type of esophageal atresia
esophageal atreasia with tracheoesophageal fistula at the distand end (85-90%)
201
dimension of parathyroid glands
6 mm long in diameter
202
blood supply of the Parathyrod gland
superior and inferior thyroid arteries
203
venous drainage of parathyroid glands
superior, middle and inferior thyroid veins
204
lymph drainage of thyroid gland
deep cervical nodes
| paratracheal lymph node
205
the activity of osteoclast in releasing calcium orm bones is result of
PTH
206
what cells produces parathyroid hormone
chief cells
207
controls the production of PTH
calcium levels in blood
208
cells of parathyroid gland
chief cell oxyphil cell
209
thyroid gland cells
follicular cell
| parafollicular cell
210
this hormone stimulates absorption of calcium from small intestine and reabsorption of calcium in the PCT of kidney
PTH
211
inferior parathyroid arise from
3rd pharyngeal pouch
212
superior parathyroid arise from
4th pharyngeal pouch
213
cervical plexus is formed by the
anterior rami of the first four cervical nerves
214
cervical plexus lie in front of
origins of levator scapulae
| scalenus medius muscle
215
cervical plexus is covered
in front by prevertebral player of deep cervical fascia
| related to the internal jugular vein
216
cervical plexus is anatomically close to this vein
internal jugular vei
217
cutaneous branches of cervical plexus
```
lesser occipital (C2)
greater auricular (C2 and C3)
Transverse cutaneous (C2 and C3)
Supraclavicular (C3 and C4)
```
218
nerve supply of
| lateral part of the occipital region and medial surface of the auricle
lesser occipital (C2)
219
nerve supply of
angle of the mandible
parotid gland
auricle
greater auricular (C2 and C3)
220
nerve supply of
| transverse cutaneous
anterior and lateral surfaces of the necl
221
nerve supply of
| chest wall, shoulder, and upper half of the deltoid region
supraclavicular (C3 and C4)
222
Muscular branches of the neck muscles
C2 and C3
C2 and C4
ansa cervicalis
223
motor nerve supply of
| prevertebral m.; sternocleidomastoid (proprioceptive)
C2 and C3
224
motor nerve supply of
| levator scapulae; trapezius (proprioceptive)
C2 and C4
225
motor nerve supply of omohyoid, sternohyoid, sternothyroid
ansa cervicalis
226
formed by fibers from the union of hypoglossal and C1 nerves (descending branch) unites with descending cervical (C2 and C3)
ansa cervicalis
227
only motor nerve supply to the diaphragm
phrenic nerve
228
phrenic nerve arises from
C3, C4, C5
229
phrenic nerve location
posterior to subclavian vein
anterior to subclavian artery
lateral to common carotid
230
pain detected by the phrenic nerve from the diaphragmatic peritoneum from an inflammed gallbladder is referred to
C4 nerve distribution to the right shoulder tip via the SUPRACLAVICULAR NERVES
231
each phrenic nerve supplies
corresponding half of diaphragm
232
what can cause phrenic nerve injury
penetrating wounds in the neck
233
effect of phrenic nerve injury
paralyzed half of the diaphragm relaxes and is pushed up into the thorax - LOWER LOBE of AFFECTED SIDE will collapse
234
area of the neck immediately above the inlet into the thorax
root of the neck
235
key muscle; deeply placed and descends almost vertically from the vertebral column to first rib
scalenus anterior
236
scalenus anterior
| important anatomic relations
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
Zone I of neck
includes the root of the neck
| extends from the clavicles and manubriumto the level of the inferior border of CRICOID cartilage
238
zone II
extends from the cricoid cartilage to the level fo the angle of mandible
239
zone III
above thelevel of the angle of mandible
240
structures at risk Zone I
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
structures at risk zone II
superior poles of thyroid gland
thyroid and cricoid cartilages
larynx, laryngopharynx, carotid arteries , jugular veins, esophagus,
cervical region of vertebral column
242
structures at risk zone III
salivary glands, oral and nasal cavities, oropharynx and nasopharynx
243
these neck zones obstruct the airway and have the greatest risk for morbidity and mortality
Zone I and III
244
injury to this neck zone are most common
zone II
245
why injuries to neck zone II have lower morbidity and mortality
because vascular damage may be controlled by direct pressure and structures involved are easily visualized and treated
246
superior part of the trunk between the neck and abdomen
thorax
247
formed by 12 pairs of ribs, sternum, costal cartilages, and 12 thoracic vertebra, together with skin, fascia and muscles form the thoracic wall
thoracic cage
248
jugular notch is another name for
suprasternal notch
249
thorax is made up of 3 parts
sternum
ribs
thoracic vertebrae
250
breastbone also known as
sternum
251
parts of the sternum
manubrium
sternal angle of Louie
body
xiphoid process
252
clinical landmark when counting ribs
sternal angle of Louie
| or manubriosternal joint
253
sternal angle coresponds this level of spine
T4 vertebra level
254
xiphoid process becomes bony by
40 years old
255
xiphisternal joint is at this thoracic level
T9
256
what anatomic features occur at the level of sternal angle
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
True ribs
1st to 7th ribs
| vertebrosternal
258
false ribs
8th to 12th ribs
| vertebrochondral
259
false ribs proepr
8,9,10th ribs
260
floating ribs
11, 12th ribs
261
parts of ribs
head, neck
tubercle
shaft
262
where the rib curves and twists
angle of rib
263
at the inferior border to protect IC nerve and blood vesels
costal groove
264
typical ribs
3-9th ribs
265
atypical ribs
1,2,10,11,12
266
broadest and most curved rib
| prominent scalene tubercle for attachment of scalenus anterior muscle
rib 1
267
clinically immportant because of its close relationship to the lower nerves of brachial plexus and subclavian artery/ vein
first rib
268
muscles of thoracic wall that elevate the ribs
```
serratus post sup
levator costarum
ext intercostal
innermost intercostal
subcostal
```
269
muscles of thoracic wall that depress the ribs
serratus post inf
int intercostal
transverse thoracis
270
an imaginary plane passing from the sternal angle of Louise anteriorly to the lower border of T4 posteriorly (T4-T5)
Mediastinum
271
divisions of mediastinum
superior
| inferior (anterior, middle, posterior)
272
inferior boundary of mediastinum
diaphragm
273
superior boundary of mediastinum
root of the neck
| thoracic inlet
274
anterior boundary of mediastinum
sternum and costal cartilages
| xiphisternal joint at level of t9 vertebra
275
posterior boundary of mediastinum
bodies of 12 thoracic vertebra
276
contents of superior mediastinum
```
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
contents of anterior mediastinum
thymus (in children)
sternopericardial ligament
internal thoracic artery and branches
lymphatics and lymph nodes
278
contents of middle mediastinum
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
contents of posterior mediastinum
esophagus
arteries
descending aorta with its branches
veins: azygos, hemizygos, accessory hemizygos
nerves: vagus and splanchnic nerves
thoracic duct
lymph nodes: posterior mediastinal
280
boundaries of anterior mediastinum
ant: body of sternum
post: pericardium
lateral: mediastinal pleura
inf: diaphragm
281
improper development of third and fourth pharyngeal pouches
DiGeorge Syndrome
282
what glands would be absent in DiGeorge syndrome
thymus and
| parathroid glands
283
double walled fibro-serous sac
pericardium
284
pericardium location
anterior to T5-T6 vertebrae
posterior to body of sternum
2nd-6th costal cartilage
285
layers of pericardium
```
fibrous
serous
1. parietal
2. visceral
-paricardial cavity with pericardial fluid 30 mL
```
286
cardiac tamponade results from
results from accumulation of fluid in the pericardial cavity that compresses the chambers of the heart- decreased venous return and reduced cardiac output
287
distention of the veins of the neck on inspiration
kussmaul sign
288
kussmaul sign is seen in
pericardial effusion, cardiac tamponade
289
drainage of fluid
location
pericardiocentesis
left 5-6th ICS near sternum
290
pericardiocentesis
| site
left xiphocostal angle
291
tissue layer penetrated during pericardiocentesis from superficial to deep
```
skin
fascia
rectus sheath
rectus abdomins
fibrous layer
serous layer of parietal pericardium
```
292
normal weight of the heart
280-340 grams males
| 230-280 grams in females
293
the sternocostal surface of the heart is formed primarily by
right ventricle
294
the pulmonary surface of the heart is formed primarily by
left ventricle
295
the diaphragmatic surface of the heart is formed primarily by
both ventricles mainly left ventricle
296
3 surfaces of the heart
sternocostal surface / anterior
diaphragmatic / inferior surface
pulmonary or left surface
297
4 borders of the heart
right - right atrium
inferior - right ventricle
left - left ventricle
superior- right and left atrium
298
outline of the heart
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
auscultatory site for pulmonary valve
2nd left ICS
300
auscultatory site for tricuspid valve
lower end of the sternum
301
auscultatory site for aortic valve
2nd right ICS
302
auscultatory site for mitral valve
5th ICS LMCL
303
surface anatomy
| tricuspid
behind right half of sternum (4th ICS)
304
surface anatomy
| mitral
behind left half of sternum (4th ICS)
305
surface anatomy
| pulmonary surface of the heart
behind medial end of the 3rd left costal cartilage (T6-T7)
306
surface anatomy
| aortic
behind the left half of the sternum (3rd ICS)
307
2nd heart sound (S2) represents closure of what valves
semilunar valves
| aortic and pulmonary valves
308
S2 is normally split because
aortic valve (A2) closes before the pulmonary valve (P2).
309
arterial supply of the heart
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
venous drainage of the heart
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
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
middle cardiac vein
312
small tributaries running throughout the myocardium
thebesian veins
313
main vein of the heart
coronary sinus
314
coronary sinus location
posterior surface in the coronary sulcus
| which runs from left atrium and left ventricle
315
coronary sinus drains into
right atrium
316
within the right atrium, the opening of the coronary sinus is located between
right atrioventricular orifice
| and inferior vena cava orifice
317
There are five tributaries which drain into the coronary sinus:
Great cardiac vein
small cardiac vein
middle cardiac vein
posterior surface:
left marginal vein
left posterior ventricular vein
318
main tributary of the coronary sinus
great cardiac vein
319
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.
great cardiac vein
320
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.
small cardiac vein
321
Another vein which drains the right side of the heart is the__________. It is located on the posterior surface of the heart.
middle cardiac vein
322
cardiac vein
which runs along the posterior interventricular sulcus to join the coronary sinus.
left posterior ventricular vein
323
a cardiac vein on the left posterior side
left marginal vein
324
supplies the left atrium and left ventricle
left circumflex artery
325
supplies the right atrium and right ventricle
right coronary artery
326
supplies the right ventricle and left ventricle and interventricular septum
left anterior descending artery (left anterior interventricular artery)
posterior interventricular artery
327
supplies the left ventricle
left marginal artery
328
supplies the right ventricle and the apex
right marginal artery
