1. Circulatory and Respiratory Organ Systems, Thoracic Cavity

Question 1

Red bone marrow - Histology

Answer 1

• reticular network, primary lymphoid tissue
• located in medullary canals of long bones
  
  • produce RBCs, platelets
  • destruct old RBCs
  • store iron

4 important structures:

1. Stroma
   
   • meshwork of reticular cells and fibres
   • contains:
     
     • haematopoietic cells
     • macrophages
     • collagen types I + II
     • enzymes
2. Haematopoietic cords
3. ​​Sinusoidal capillaries

Haematopoietic stem cells

• ​​differentiate into RBCs and other cells
• progenitors to:
  
  1. Lymphoid cells
     
     • T-, B-lymphocytes
  2. Myleoid cells
     
     • granulocytes, monocytes, erythrocytes, megalocytes

Question 2

Embryonic haematopoiesis

Answer 2

→ develop from pluripotential haematopoetic stem cells

1. 2 weeks after fertilization:
   
   • from yolk sac mesoderm
2. until 5th month:
   
   • Mesenchyme of spleen and liver become haematopoietic
3. red bone marrow (after birth)

Regulated by hormone Erythropoietin

Question 3

Erythrocytes - Development

Answer 3

• → from (hematopoietic-) stem cells
  
  • → myeloid stem cells

1. Pronormoblasts
2. early normoblast
3. intermediate normoblast
4. late normoblast (nucleus gets ejected)
5. Reticulocyte
6. RBC is released

Question 4

Thrombocytes - Development

Answer 4

1. Megakaryoblasts
2. Promegakaryocyte
3. Megakaryocyte
4. Thrombocytes

Question 5

Granulocytes - Development

Answer 5

→ from myeloblasts to white blood cells

Process:

1. Myeloblasts
2. Promyelocytes
3. Myelocytes
4. Metamyelocytes
5. Granulocyte
   
   • Neutrophils
     • 12-14 micrometer
     • 5000/microliter
     • for phagocytosis
   • Esosinophils
     
     • 14-16 micrometer
     • 150/microliter
     • for allergic reaction
   • Basophils
     
     • 13-15 micrometer
     • 30/microliter
     • release histamine

Question 6

Monocytes

Answer 6

• 15-20 micrometer (largest WBC)
• function: phagocytosis
• oval nucleus, kidney shaped
• azurophilic granules in the cytoplasm

Mononuclear phagocyte system:

• part of immune system
• in reticular CT, mainly:
  
  • monocytes
  • macrophages
• accumulate in lymph nodes + spleen

Question 7

Monocytes - Development

Answer 7

• in bone marrow from precursors called monoblasts
• can give rise to:
  
  • macrophages
  • dendritic cells
    
    • antigen presenting cells

Question 8

Lymphocytes

Answer 8

​Structure

• WBC
  
  • large nucleus
  • almost no cytoplasm
  • carry many ribosomes for protein synthesis
    
    • immunoglobulins

3 Types

• ​natural killer cells
  
  • cell-mediated response
• T-cells
  
  • cell-mediated response
• B-cells
  
  • antibody mediated response

Question 9

Lymphocyte - Development

Answer 9

Lymphopoiesis

1. common lymphoid progenitor
2. lymphoblast
3. prolymphocyte
4. natural killer cell
5. small lymphocyte
   
   • B-Cell
   • T-Cell

Question 10

Lymph nodes - Histology

Answer 10

• organized collection of lymphoid tissue:
  
  • cortex
    
    • B-+ T-cells
  • medulla
    
    • medullary cord
      
      • B-Cells
      • macrophages
• lymph passes through it
• afferent- and efferent lymph vessels are connected
• contains lymphoid follicles
  
  • dense collection of lymphocytes

Question 11

Thoracic Cavity - Topography

Answer 11

• enclosed by thoracic wall and diaphragm
• divided into 3 mayor parts: right and left pleural cavity + mediastinum​

Mediastinum

• heart
• esophagus
• trachea
• major nerves + blood vessels

Pleural cavities:

• right and left lung, enclosed by 2 pleural layers: parietal and visceral

Question 12

Mediastinum - Borders

Answer 12

Definition: visceral department in the middle of the thoracic cavity, between right and left pleural cavity

Borders:

• Anterior: Sternum
• Posterior: Vertebral Column
• Lateral: Mediastinal pleura (Lungs)
• Superior: Thoracic inlet (to neck)
• Inferior: Diaphragm

Question 13

Mediastinum - Divisions

Answer 13

Divisions:

• superior mediastinum → 6 layers
• inferior mediastinum (anterior, middle and posterior)

→ dividing plane: “transthorscal plane”, from sternal angle to T4 and T5 vertebral discs

Question 14

Projection of Thoracic Organs onto Thoracic Wall

Answer 14

• Superior Thoracic Aperture → Root of Neck
  
  • Cervical pleura + apices of lungs
    *

Question 15

Female Breast - Anatomy

Answer 15

consist of:

• mammary glands (modified sweat glands)
  
  • in superficial fascia
  • secretory lobules
  • 15-20 lactiferous ducts → open on nipple
• associated skin
• connective tissue
• fatty tissue

lies on:

• deep fascia, but seperated from it by retromammary space

Question 16

Female Breast - Blood supply

Answer 16

laterally:

• axillary artery
  
  • superior thoracic a.
  • thoracoacromial a.
  • lateral thoracic a.
  • subscapular a.

medially:

• internal thoracic artery

intercostal:

• 2. • 4. intercostal arteries → perforate thoracic wall

Question 17

Female Breast - Lymphatic drainage

Answer 17

• 75% laterally or superiorly into axillary nodes, from there into subclavian trunks
• remaining: parasternal nodes, which drain into the broncomediastinal trunks

Question 18

Mammary gland - Histology

Answer 18

• 15 - 20 lobes with each an own lactiferous duct
• consist of:
  
  • small tubules
    
    • lined with simple cuboidal epithelium
    • produce milk
  • interlobar stroma (dense CT)
  • fat cells (contained in milk)

Question 19

Layers of the superior mediastinum (6x)

Answer 19

**Definition: **

lies superior to the horizontal plane between the sternal angle and approximately the T4-T5 intervertebral disc

Layer 1:

• Thymus (retrosternal adipose body)

Layer 2:

• Superior vena cava
• brachiocephalic veins

between: Phrenic + Vagus nerves

**Layer 3: **

• Aortic arch
• brachiocephalic trunk
• left common carotid- + left subclavian artery
• recurrent Laryngeal nerves

**Layer 4: **

• Trachea

between: Esophageotracheal groove: recurrent laryngeal nerves

**Layer 5: **

• Esophagus: Thoracic duct

**Layer 6: **

• Posterior Thoracic wall: veins, sympathetic trunk

Question 20

Thymus - Anatomy

Answer 20

→ situated in upper part of thorax, behind sternum, in the anterior + superior mediastina

• primary lymphoid organ
  
  • matures and differentiates T-lymphocytes
• right + left lobes, encapsuled
  
  • connected via CT
• early life: large
• degenerates to fat in adult

Question 21

Thymus - Histology

Answer 21

1. Cortex
   
   • many T-lymphocytes
   • macrophages
   • epithelial reticulum cells
   • reticular fibres
2. Medulla
   
   • ​​many epithelial reticulum cells
     
     • blood-thymus barrier!
   • Hassal’s corpuscules
     
     • Eosinophiles, concentrally arranged
   • Neuroendocrine cells
   • Myoid cells

Question 22

Layers of the posterior mediastinum

PDF 1: slide 16

Answer 22

Definition:

lies between the **pericardium anteriorly **and the vertebral column posteriorly and below the transthoracal plane

• Esophagus (C4-T11)
• vagus nerves
• thoracic aorta + parietal and viceral branches
• azygous + hemiazygous vein w/ tributaries
• thoracic duct
• symphathetic trunk
• thoracic splanchnic nerves

Question 23

Layers of the anterior mediastinum

Answer 23

• sternopericardiac ligaments
• internal thoracic vessels
• parasternal lymph nodes

Question 24

Layers of the middle mediastinum

Answer 24

• heart + pericardium
• initial parts of great vessels: ascending aorta, pulmonary trunk
• last parts of great vessels: superior + inferior vena cava, pulmonary + azygos veins
• phrenic nerves
• pericardiophrenic vessels
• root of lung
• bronchopericardiac membrane

Question 25

Trachea - Anatomy

Answer 25

• beginning: inferior border of cricoid cartilage (C6)
• 16-20 incomplete hyaline cartilage
  
  • prevent trachea from collapsing
  • open posteriorly towards esophagus
• bifurcates at sternal angle → right and left bronchi
• last cartilage: carina

Question 26

Bronchial tree - Anatomy

Answer 26

• thrachea → bronchi → 1°, 2°, 3° bronchi → bronchioles → terminal bronchioles

1. right bronchus
   
   • shorter, wider, steeper than left one
   • runs under azygous vein
     
     • divides into: 3 secondary (lobar) bronchi (superior, middle, inferior)
       
       • each divide into 10 segmental bronchi
2. left bronchus​
   
   • ​​inferior through aortic arch (to left side)
     
     • divides into: 2 secondary (lobar) bronchi (superior, inferior)
       
       • each divide into 8-10 segmental bronchi

Question 27

Trachea - Histology

Answer 27

• divided into 4 different layers:

1. Tunica mucosa
   
   • ​​​​Mucous epithelium
     
     • pseudostratified columnar ciliated epithelium
     • Goblet cells (secretion)
     • Endocrine cells
   • Lamina propria
     
     • Loose connective tissue
     • Lymphocytes
     • Plasma cells
2. Tunica submucosa​​
   
   • ​loose connective tissue
   • mucous glands
3. Tunica fibro•musculo•cartilaginea
   
   • ​​hyaline cartilage
   • annular ligaments
4. Tunica adventitia
   
   • connective fibres
   • blood vessels
   • nerves

Question 28

Bronchi - Histology

Answer 28

→ can be devided into 4 layers

• glands and supporting cartilage can be found

1. Tunica mucosa​​​​
   
   • ​​​​​pseudostratified columnar ciliated epithelium
   • height decreases towards terminal bronchioles
2. Tunica muscularis
   
   • larger bronchi: smooth muscle layer
   • smaller bronchi: smooth muscle cells
3. **Cartilage plates **
   
   • decrease in number and size towards terminal bronchioles
4. Adventitia
   
   • external layer of bronchi
   • collagen fibres

Question 29

Bronchioles - Histology

Answer 29

• NO cartilage, NO glands
• ciliated pseudostratified columnar
  
  • becomes less ciliated in direction to terminal bronchioles
• terminal bronchioles also contain “clara cells”
  
  • have secretory granules which secrete proteins protecting bronchiolar lining against pollution

Question 30

Lungs - General anatomy

Answer 30

• right lung: 3 lobes
• left lung: 2 lobes
• enclosed by pleura
  
  • visceral + parietal layer → pleural cavity
• hilum: root of lungs (medial side)
  
  • contains vessels and nerves

Borders:

• medial: heart in mediastinum
• inferior: bases rest on diaphragm
• superior: thoracic aperture
• lateral: thoracic wall (enclosed by pleura)

Question 31

Right lung - Anatomy

Answer 31

• ​​​​larger, heavier
• usually only 1 bronchial artery
• 3 lobes (superior, middle, inferior)
  
  • 3 secondary (lobar) bronchi
  • 10 tertiary (segmental) bronchi
• devided by
  
  • oblique fissure: starts at head of 5th rib, runs along 6th rib
  • horizontal fissure​: from upper quarter of oblique fissure to medial side

Question 32

Left lung - Anatomy

Answer 32

• upper and lower lobes devided by oblique fissure (along 6th rib)
• usually 2 bronchial arteries
• cardiac notch: impression on antero-inferior corner of superior lobe
• 2 secondary (lobar) bronchi
• 8-10 tertiary (segmental) bronchi

Question 33

Pleura - Anatomy

Answer 33

• → pleura constist of
  
  • mesothelium (single layer of flat cells)
  • supporting connective tissue layer​​

1. parietal pleura
   
   • outermost layer, lines thoracic wall
   • innervated by intercostal and phrenic nerves
   • sensitive to pain
2. visceral pleura
   
   • ​innermost layer, surrounds the lungs
   • innervated by vagal nerve endings
   • sensitive to stretch

• ​→ in between: pleural cavity with serous fluid
• pleural recess:
  
  • space which is not covered by lungs
  • fluids can collect there
  • costomediastinal vs. costodiaphragmatic recess

Question 34

Pleura - Innervation

Answer 34

Parietal pleura

• intercostal nerves

Visceral pleura

• autonomic NS

Question 35

Lungs - Blood supply

Answer 35

• Lungs contain non respiratory tissues:
  
  • bronchial veins (→ (hemi-)azygous- and pulmonary vein)
  • ​bronchial arteries (→ thoracic aorta)

Question 36

Lungs - Innervation

Answer 36

1. Pulmonary Plexus
   
   • ​​vagus nerve

Question 37

Lungs - Lymphatic drainage

Answer 37

1. Peribronchial network:
   
   • drains lymph from bronchi & most of lungs
2. Subpleural network(smaller):
   
   • borders lungs
   • drains lymph from peripheral lung areas + visceral pleura

⇒ Trachiobroncheal lymph nodes → paratracheal ln → subclavian + internal jugular veins

• Parietal pleura : drained by intercostal + parasternal l.n

Question 38

Lungs - Histology

Answer 38

Inside lungs: Alveoli

• outpouchings in the wall of bronchioles
• side of gas exchange:
  
  • epithelial walls of alveoli are extremely thin
    
    • Type 1 pneumocytes: gas exchage, flattened
    • Type 2 pneumocytes: surfactant/film production
  • a. might be connected by small pores
  • surrounded by dense CT, which contains anastomosing pulmonary capillary network
• blood-air barrier:
  
  • alveolar epithelium + capillary endothelium

Question 39

Pulmonary trunk - Branches

Answer 39

• from right ventricle
• divides into right + left pulmonary artery
• carry DEoxygenated blood

Question 40

Heart - Surfaces

Answer 40

Apex

• formed by left ventricle
• “tip” of the heart

Base of the heart

• formed by:
• left atrium, posterior right atrium
• origin of large vessels​
  
  • opposite to apex

Terminal sulcus (groove)

• ​​groove on right atrium
• extends from front of SVC to front of IVC
• internal: crista terminalis
  
  • margin between pectinate muscle and endocardium

Coronary sulcus (groove)

• division between atria and ventricles on sternal surface

​Interventricular sulcus (groove)

• separates 2 ventricles

Conus anteriosus

• pouch on anterior surface of right ventricle
• continuation: pulmonary trunk

Question 41

Heart - Form

Answer 41

• situated in the middle of the mediastinum
• pinecone-shape: broad at the base, thin at the apex
• typically size of the fist
• mass: 250-300g

Question 42

Heart - Topography

Answer 42

Superior view

• base of the heart
• large vessels: ant. to post.
  
  • pulmonary trunk (→ arteries)
  • aorta
  • SVC
  • pulmonary veins (2x each side)

Inferior view

• apex of the heart
• inferior margin
• rests on diaphragm

Lateral view

• right side:
  
  • right atrium
  • superior + inferior VC
  • right coronary artery
  • terminal sulcus
• left side:
  
  • left ventricle

Anterior view

• interior interventricular groove
• great cardiac vein
• right ventricle

Posterior view

• right ventricle
• left atrium
• “openings” of great vessels
• coronary sinus (veins)

Question 43

Pericardium - Anatomy

Answer 43

→ fibrous sac enclosing the heart and the roots of great vessels

→ oblique + transverse (between aorta and SVC) sinus

**3 layers + wall of heart: **

1. fibrous pericardium
   
   • dense CT
2. serous percardium
   
   • ​1. + 2. make up parietal layer
3. pericardiac cavity
   
   • filled with few drops serous fluid (lubrication)
4. epicardium (visceral layer)
5. myocardium
6. endocardium

Question 44

Pericardium - Blood supply

Answer 44

• perichardiophrenic artery
• bronchial artery
• esophageal artery

Question 45

Pericardium - Innervation

Answer 45

• vasomotor and sensory nerve fibres from phrenic- and **vagus nerves **and the symphathetic trunks

Question 46

Left atrium - Anatomy

Answer 46

• receives oxygenated blood from 4 pulmonary veins
• smaller than right atrium
• most posterior of all 4 chambers
• smooth walls, except for pectinate muscles in auricle

Question 47

Left ventricle - Anatomy

Answer 47

• on back of the heart
• pumps oxygenated blood into the aorta
• inferior ventricle + superior aortic vestibule
• 2 papillary muscles + chordae tendinae
  
  • hold back the flaps of bicuspid valve​
• walls with muscular ridges → trabeculae carnae cordis
• 2-3 thicker than right ventricle (higher pressure)

Question 48

Right atrium - Anatomy

Answer 48

• receives deoxigentated blood from:
  
  • SVC, IVC
  • Coronary sinus (collection of coronary veins)
  • posterior wall is smooth, anterior wall rough (pectinate muscle ridges)
    
    • → in between: crista terminalis
• fossa ovaries, former opening which closed after birth

Question 49

Right ventricle - Anatomy

Answer 49

• on anterior side of heart
• pumps deoxygenated blood into pulmonary trunk
• 3 papillary muscles + chordae tendinae
  • hold back the flaps of tricuspid valve
• walls with muscular ridges → trabeculae carnae cordis

*

Question 50

Heart valves

Answer 50

→ 4 valves in total, 2 types

caspital valves

• prevent backflow from ventricles into atria during systole
• anchored by chordae tendineae:
  
  • Tricuspid valve: right AV valve
    
    • anterior, posterior + septal
  • Bicuspid valve: left AV valve
    
    • anterior + posterior

semilunar valves

• 3 half-moon shaped cusps
• aortic valve
  
  • left + right + posterior
• pulmonary valve
  
  • left + right + anterior

Question 51

Interventricular/-atrial septa - Anatomy

Answer 51

Atria:

• forms during 1st-2nd month of fetal development

1. septum primum
   
   • opens when pressure is high in RA
2. septum secundum
   
   • has foramen ovale

Ventricles:

• muscular ventricular septum
• upper part: membranous VS
  
  • separates aortic vestibule from
    
    • upper part of right ventricle
    • lower part of right atrium

Question 52

Blood supply of heart

Answer 52

→ coronary arteries, arise from ascending aorta

Right coronary artery

• SA nodal artery
• Right marginal artery
• Posterior interventricular artery
• AV nodal artery

​Left coronary artery

• Anterior interventricular artery

Circumflex artery

• Left marginal artery

Veins into coronary sinus → right atrium

• small cardiac vein
  
  • runs with right coronary art.
• middle cardiac vein
  
  • posterior surface of heart
• great cardiac vein
  
  • runs with interventricular branch of left coronary art.

Question 53

Extrinsic innervation of the heart

Answer 53

→ innervate SA- and AV node and coronary vessels of the heart

• Vagus nerve (right and left)
  
  • Sensory
  • Parasymphathetic ( - heartbeat)
• Sympathetic nerve (from symp. ganglion)
  
  • Sensory
  • Sympathetic ( + heartbeat)

Question 54

Intrinsic pathway of the heart

Answer 54

1. SA node ⇒ cardiac muscle fibers ⇒ atria contract
2. Myogenic conduction ⇒ to AV node
3. AV node ⇒ bundle of His ⇒ AV branches
4. rightandleft branches: in interventricular septum
5. at apex: Purkinje fibres innervate ventricle muscle right and left

Question 55

Histology of the Heart

Answer 55

Cardiomyocytes:

• one central nucles
• cross striations: quick signal transduction
• innervated by autonomic NS → “involuntary striated muscle”
• between cells: intercalated discs w/ gap junctions
• at the end of fibres:
  
  • Fascia adherens
  • Desmosomes

Question 56

Aorta - Topography

Answer 56

• Ascending aorta
  
  • lies in middle mediastinum

1. Aortic arch
   
   • lies in superior mediastinum
   • arches over right pulmonary art.
   • passes downward on left side T4 vertebra
2. Thoracic aorta
   
   • runs on left side of the vertebral column
   • passes through aortic hiatus
3. Abdominal aorta
   
   • ​bifurcates on L4 level into left + right common iliac art.

Question 57

Vessels - artery types

Answer 57

1. Aorta: large elastic artery
   
   1. Tunica intima
   2. Subendothelial layer
   3. Tunica media
      
      • smooth muscle!
      • collagen fibres
      • elastic laminae
   4. Tunica adventitia
      
      • collagen fibres
      • blood vessels + nerves
2. Muscular arteries
   
   1. Tunica intima
   2. internal elastic membrane
   3. Tunica media
   4. External elastic membrane
   5. Tunica adventitia

Question 58

Vessels - Vein types

Answer 58

→ venules, small and large veins

1. ​Tunica intima
2. Tunica media
   
   • thin
3. Tunica adventitia
   
   • widest layer

Question 59

Subclavian Artery - Topography

Answer 59

• right: from brachiocephalic trunk, inferiorly to clavicle → axillary artery
• left: from descending aorta, inferiorly to clavicle → axillary artery

Question 60

Subclavian Artery - Branches

Viny Is Too Cute To Do Anatomy

Answer 60

• Vertebral artery
• Internal thoracic artery
• Thyrocervical trunk
• Costocervial trunk
• Transverse cervical artery
• Dorsal Scapular artery
• Axillary artery

Question 61

Thoracic aorta - Topography

PDF 1: slide 17

Answer 61

→ continuation of descending aorta, becomes abdominal aorta after diaphragm

• begins at lower border of T4 vertebra
• runs along left side of vertebral column
• ends at lower border of T12 vertebra (aortic hiatus)
• posteriorly:
  
  • azygos vein
• anteriorly:
  
  • root of left lung
  • pericardium
  • esophagus
  • diaphragm
• laterally:
  
  • right: hemiazygos vein + thoracic duct
  • left: pleura + lung

Question 62

Aorta - Branches

Answer 62

1. Ascending aorta
   
   • right and left coronary arteries
2. Aortic arch
   
   • brachiocephalic trunk
   • left common carotid artery
   • left subclavian artery
3. Thoracic aorta
   
   • posterior intercostal arteries
   • pericardial artery
   • bronchial arteries
4. Abdominal aorta
   
   • visceral + parietal branches

Question 63

The Tributaries of the SVC

PDF 1: slide 18

Answer 63

• receives blood from all structures superior to diaphragm (exc. heart + lungs)
• formed by left and right brachiocephalic vein
• receives:
  
  • right: azygous vein
  • left: hemiazygous vein
• enters right atrium

Question 64

The lymphatic drainage of the thoracic cavity

Answer 64

• Lumphatic ducts run on right and left side anterior to vertebral column
• left lymphatic duct (→ Thoracic duct) drains 75% of body lymph
• Lymph nodes and vessels from thoracic cavity drain into right and left bronchomediastinal trunk
• right bronchomediastinal trunk drains directly into right venous angle
• left bronchomediastinal trunk drains into left thoracic duct

Question 65

Symphathetic trunk in thoracic cavity

Answer 65

• part of the autonomic division of the PNS in posterior mediastinum
• two parallel cords, 11 - 12 ganglia, connected to thoracic spinal nerves
• Esophagus:
  
  • T2-T5→post synaptic axon→esophageal plexus
• Trachea & bronchial tree:
  
  • post synaptic thoracic branches→pulmonary plexus (bronchial dilation)
• Heart:
  
  1. Cervical ganglion: superior,middle,inferior cervical cardiac nerves
  2. Thoracic ganglia: thoracic cardiac nerves
     
     • make cardiac plexus together

Question 66

Vagus nerve - Branches

PDF 1: slide 14, 15

Answer 66

Recurrent Branches:

• right recurrent laryngeal nerve
• left recurrent larnygeal nerve

Branches to the heart:

• superior + inferior cervical cardiac branches
• thoracic cardiac branches

Branches to the airways:

• tracheal branches
• bronchial branches

Branches to the esophagus:

• esophageal branches
• esophageal plexus (ant.+post. vagal trunk)

Question 67

Vagus nerve - Topography

PDF 1: slide 13

Answer 67

**Origin: **CN #10, 2x (left + right)

**Thoracic inlet: **

• right: between right brachiocephalic vein + trunk
• left: between left brachiocephalic vein + left sublavian artery

(Recurrent laryngeal branches: )

• right: below right subclavian artery
• left: below aortic arch

Posterior Mediastinum:

• behind root of lung → Esophageal plexus

Esophageal hiatus of Diaphragm:

• anterior + posterior vagal trunk

Question 68

Vagus nerve heart branches

Answer 68

• Superior + Inferior cervical cardiac branches
  
  • Thoracic cardiac branches
    
    • cardiac branches → cardiac plexus

Question 69

Phrenic nerve - Topography

PDF 1: slide 11

Answer 69

Origin: Cervical plexus, C3-C5, 2x (left + right)

Cervical part:

• anterior to: anterior scalene muscle

Thoracic inlet:

• between: subclavian artery and vein
• anterior to: vagus nerve

Thoracic cavity:

• anterior to: root of lung
• between: mediastinal pleura and fibrous pericardium
• w/ pericardiacophrenic vessels

Sensory terminal branch:

• right phrenicoabdominal branch: Caval opening
• left phrenicoabdominal branch: Esophagus hiatus

Question 70

Phrenic nerve - Function

PDF 1: slide 12

Answer 70

sensory:

• fibrous pericardium
• mediastinal and diaphragmatic pleura
• diaphragm
• parietal peritoneum

motor:

• Diaphragm

Question 71

Nose - Anatomy

Answer 71

• external part of nasal cavity
• extends nasal c. ventrally, nostrils pointing downwards
• vestibule: aperture of each nostril
  • covered with hairy skin, sebaceous glands, sweat glands → air “filtering”
• pyramidal shape, apex in front

→ consist of cartilage:

• lateral processes of septal cartilage (superiorly)
• major alar cartilage (antero-inferiorly)
• septal cartilage (midline)
• 3 - 4 minor alar cartilage (posterio-inferiorly)

Question 72

Nasal cavity - Anatomy

Answer 72

• divided in the middle by nasal septum
• opens
  
  • anteriorly through nostrils → nose
  • posteriorly through choanae → nasopharynx
• surrounded by facial bones:
  
  • nasal- + frontal bone
  • ethmoid bone w/ perpendicular plate
  • maxilla w/ palatine processes
  • palatine bone
  • body of sphenoid bone

Question 73

Nasal cavity - Conchae + Meati

Answer 73

→ 3 conchae:

Formed by ethmoid bone:

• superior concha
• middle concha

Formed by maxilla:

• inferior concha

→ form 4 air channels:

• spheno-ethmoidal recess
• superior meatus
• middle meatus
• inferior meatus

Question 74

Paranasal sinuses + Openings

Answer 74

1. Ethmoidal sinus (w/ air cells!)
   
   • ​​posterior-: → superior nasal meatus
   • middle-: → middle nasal meatus
   • anterior-: → middle nasal meatus
2. Frontal sinus
   
   • → middle nasal meatus
3. Maxillary sinus
   
   • → middle nasal meatus
4. Sphenoid sinus
   
   • → sphenoethmoid recess
5. Nasolacrimal duct
   
   • → inferior nasal meatus

Question 75

Nasal Cavity - Histology

Answer 75

• lined by stratified squamous epithelium
• composed of:
  
  • olfactory cells
  • ciliated cells → filtering
  • goblet cells → mucus secretion
  • transient immune cells → produce lymphocytes and mast cells
• tight junctions between cells prevent materials from entering the tissue!

Question 76

Larynx (Kehlkopf)

Answer 76

• organ of voice production
• part of respiratory tract between pharyx (Rachen) and trachea (Luftröhre)
• acts as sphincter: prevents swallowed material from entering trachea
• consists of cartilage, membranes and muslces:
  
  • 3 large unpaired cartilages
    
    • Cricoid, Thyroid, Epiglottis
  • 3 pairs of smaller cartilages
    
    • Artenoids, Corniculate, Cuneiform

Question 77

Larynx - Thyroid cartilage

Answer 77

• hyaline cartilage
• right and left lamina
• anterior part of larynx (great part)
• in men: laryngeal prominence (90°)
• superior horn
  
  • lateral thyroid ligament - sesamoid cartilage - hyoid bone
• inferior horn
  
  • cricoid cartilage attached

Question 78

Larynx - Epiglottis

Answer 78

• elastic cartilage
• spoon-shaped, on inferior side
• attached to back of thyroid cartilage by thyro•epiglottic ligament

Question 79

Larynx - Cricoid cartilage

Answer 79

• hyaline cartilage ring
• anterior: arch
• posterior: lamina
• lowest part of larynx

IMPORTANT: crico•thyroid ligament → Cricothyrotomy

Question 80

Larynx - Arytenoid cartilage

Answer 80

• elastic + hyaline cartilage
• pyramide shape:

1. Apex
   
   • cuneiform cartilage
   • corniculate cartilage
2. Vocal process - anterior
   
   • vocal ligament
   • vocalis muscle
3. Muscular process - posterior
   
   • thyro•arytenoid muscle
   • crico•artenoid muscles

Question 81

Larynx - Ligaments

Answer 81

→ attach larynx to the hyoid bone and trachea!

1. Thyro•hyoid membrane,
2. Thyro•hyoid ligament
3. Hyo•epiglottic ligament
4. Thyro•epiglottic ligament
5. Crico•tracheal ligament
6. Crico•thyroid ligament (!)
7. Crico•pharyngeal ligament

Question 82

Larynx - Cavity

frontal section for end semester exam!

P. 26 Thieme

Answer 82

→ Divided into 3 parts by vestibular- and vocal folds

1. Vestibule
   
   • laryngeal inlet to vestibular folds
2. Glottis/Rima Glottidis
   • vestibular folds to vocal fold
3. Infraglottic cavity
   
   • part inferior to the vocal fold

Question 83

Hyoid bone - Anatomy

Answer 83

• horseshoe-shaped bone
• lies in neck on height of C3 vertebrae
• consists of body and 2 pairs of greater + lesser horn
• attached to thyroid cartilage by thyro•hyoid membrane

Question 84

Laryngoscopic image

Answer 84

• indirect: using a mirror, looking down the pharynx
• direct: head tilted backwards, patient must lie down. Using laryngoscope

Question 85

Larynx - Muscles

inferior laryngeal nerve

Answer 85

1. Crico•thyroid muscle - superior laryngeal n.
   
   • tightens vocal folds
   • opens rima glottidis
2. Vocal muscle
   
   • tightens vocal folds
   • closes rima glottidis
3. Thyro•arytenoid muscle
   
   • adducts arytenoid cartilages
   • closes rima glottidis
4. posterior Crico•arytenoideus muscle
   • adducts vocal folds
   • opens rima glottidis
5. lateral Crico•arytenoideus muscle
   
   • adducts vocal folds
   • closes rima glottidis
6. oblique Arytenoideus muscle

Question 86

27.1 Larynx - Blood supply

Answer 86

1. from: Subclavian artery →
   
   • Thyrocervical trunk →
   • Inferior thyroid artery →
   • Inferior laryngeal artery
2. from: External carotid artery →
   
   • Superior thyroid artery →
   • Superior laryngeal artery

Question 87

Larynx - Blood drainage

Answer 87

1. from: superior laryngeal vein →
   
   • superior/middle thyroid vein →​
   • internal jugular vein
2. from: inferior laryngeal vein →​
   
   • inferior thyroid vein →​
   • left brachiocephalic vein

Question 88

Larynx - Innervation

Answer 88

• Nodose-ganglion → Superior laryngeal nerve
  
  • internal ramus
    
    • sensory function
  • external ramus
    
    • motor function - cricothyroid muscle
  • recurrent laryngeal nerves
    
    • sensory and motor - all muscles
      
      • left: under aortic arch
      • right: under right subclavian artery

Question 89

Larynx - Histology

Answer 89

• Hyaline cartilge vs. Elastic cartilage (check last semester)
• Covering epithilia:
  
  • stratified squamous epithelium without papillae