Anatomy Flashcards
Describe the lung hilum
R: svc, azygous vein, trachea, oesophagus, broncus, pulmonary artery, pulmonary vein
L: left brachiocephalic vein, left subclavian artery, arch of aorta, bronchus, pulmonary artery, pulmonary vein
Laryngeal cartilages superior to inferior
Thyroid (large), cricoid (continuous ring), carina (division between bronchi)
What is the function of surfactant and where is it produced?
It prevents alveoli from collapsing, it is produced by the alveolar type 2 cells.
Difference between right and left bronchus
right bronchus is shorter, wider, and more vertical
Where is the pulmonary ligament and what is its function?
It is at the bottom of the hilum and stabilizes the lung
What are the four regions of mediastinum called?
Superior, anterior inferior, middle inferior, posterior inferior.
What is the border and contents of the superior mediastinum?
Border: first rib to T4. Contents: thymus, trachea, esophagus, thoracic duct, aortic arch, veins (superior vena cava, brachiocephalic, left superior intercostal), nerves (vagus, phrenic, left recurrent laryngeal), lymphatics, other small arteries and veins
Mnemonic: Try To Eat Toast And Vitamins Now Little Oliver
What are the borders and contents of the anterior inferior mediastinum?
Borders: T4 (superior) - T9 (inferior); sternum (anterior) - pericardium (posterior)
Content: remnants of the thymus, lymph nodes
What are the borders and contents of the middle inferior mediastinum?
Borders: T4 (superior) - T9 (inferior); anterior aspect of pericardium (anterior) - posterior aspect of pericardium
Content: phrenic nerve, heart, pericardium, ascending aorta, pulmonary trunk, superior vena cava, pericardiacophrenic artery
What are the borders and contents of the posterior
inferior mediastinum?
Borders: T4 (superior) - T12 (inferior); posterior aspect of pericardium (anterior) - spine (posterior)
Content: descending thoracic aorta, azygos veins, hemiazygos veins, accessory hemiazygos veins, thoracic duct, cisterna chyli, esophagus, esophageal plexus, vagus nerve, greater, lesser and least splanchnic nerves, lymphatics
Mnemonic: on the DATE Vivian Slapped Larry`
What nerve innervates the costal parietal pleura?
The intercostal nerves. (Lower portion of each rib.)
What nerve innervates the mediastinal pleura and diaphragm?
Phrenic nerve. ( Runs most laterally down the neck, around the heart, and attaches on the diaphragm.)
What does the vagus nerve do?
Provides parasympathetic innervation to the lungs and heart. (It passes posterior to the root of the lung.)
Describe the ribs.
1-7 = true ribs, articulate directly with the sternum via costal cartilage
8-10 = false ribs, articulate indirectly with the sternum via costal cartilage
11 & 12 = floating ribs, don’t articulate with the sternum
Scalene Muscles
3 muscles ( anterior, middle, posterior scalene) Origin: transverse processes of C3-7, insertion: ribs 1 &2, function: flexion, lateral flexion, rotation of the neck
Features of rib 1
Scalene tubercle for attachment of scalene muscles, groove for subclavian artery and vein. Manubrium where the jugular notch sits superiorly. Attaches to T1
T1
Sternoclavicular joint, highest point of lung apex
T2
Superior border of scapula
T3/T4
Top of arch of aorta
T4/T5
Sternal angle, bifurcation of trachea, start and end of arch of aorta, azygos vein enters SVC
T8
Vena cava (caval opening of diaphragm), phrenic nerve also passes diaphragm
T9
Xiphoid
T9 - L3
Costal Margin ( n)
T10
Oesophageal opening in diaphragm
T12
Aortic opening of diaphragm, origin of ceoliac
L1/2
Spinal cord ends
L4
Bifurcation of the abdominal aorta
Costal cartilage
Between sternum and rib
Costochondral joint
Between costal cartilage and rib
What does the bucket handle motion of the ribs do?
increases transverse dimension
What does the pump handle motion of the sternum do?
Increases anteroposterior diameter
Where is the internal thoracic artery?
Posterior and lateral of sternum, supplies anterior thoracic muscles. The musculophrenic branch runs from ribs 6- 12. Pericardiophrenic branch runs lateral to heart.
Where is the neurovasculature bundle found?
Between internal and innermost intercostal muscles, it runs inferior on the subcostal groove, hence needles are inserted superior to the rib. (VAN superior to inferior)
What is the function of the phrenic nerve?
Provides motor information to the diaphragm, originating from C3,4,5 (keeps the diaphragm alive!)
Blood supply to posterior thorax
The 1st to 6th anterior intercostal arteries arise directly from the lateral aspect of the internal thoracic artery. The 7th to 9th arise from the musculophrenic artery, a branch of the internal thoracic artery.
Spinal cord injury at C6
Loss of some sensory innervation, but preservation of motor function due to intact phrenic nerve
What comprises the nasal septum?
ethmoid, vomer, cartilage
Describe the conchae?
Inferior nasal conchae + ethmoid, warm and humidify air due to high vascularisation and mucus.
Describe the olfactory bulb?
Small tube like structure on inferior anterior surface of brain, has small nerves that project through the ethmoid bone into the nasal cavity.
Where are the pharyngeal tonsils?
They are located on the posterior wall of the nasopharynx and comprised of lymphoid tissue
What is the boundary between the naso and oropharynx?
The soft palate
What is the boundary between the oro and laryngopharynx?
The upper margin of the epiglottis
What is the anterior boundary of the nasopharynx?
Posterior nares of nasal cavity, eustachian tube (into ear) opens on lateral wall of nasopharynx
What nerves provide motor information to the pharynx?
The pharyngeal branches of vagus and glossopharyngeal nerves
What movement happens between the atlas and occipital condyles?
Flexion/extension of neck (nodding)
What movement happens between the atlas and axis?
Rotation of head (shaking)
What are the superficial back muscles and what are their function?
(Extrinsic) Trapezius, Latissimus dorsi, Levator scapulae, Rhomboid major and rhomboid minor. Function: movement of upper limb.
What are the intermediate back muscles and what are their function?
(Extrinsic) Serratus posterior superior, Serratus posterior inferior.
Function: respiration.
Dorsal rami of spinal nerve innervation
What are the deep back muscles and what are their function?
(Intrinsic) Superficial group: Splenius capitis, Splenius cervicis
(Intrinsic) Intermediate group: Iliocostalis (lumborum, thoracis, cervicis), Longissimus (thoracis, cervicis, capitis), Spinalis (thoracis, cervicis, capitis)
(Intrinsic) Deep group: Semispinalis (thoracis, cervicis, capitis), Multifidus, Rotatores, Interspinales, interansversarii, levatores costarum
Function: Extends vertebral column.
Dorsal rami of spinal nerve innervation
Meninges
Surround brain and spinal cord, lateral to medial = dura matter, arachnoid, pia.
End of spinal cord
Conus medullaris which becomes cauda equina, the filum terminale attaches conus medullaris to coccyx.
Complete transaction of spinal cord
Loss of sensory and motor ability
Kyphosis
Abnormally rounded spine laterally
Blood supply to thorax
Thoracic aorta gives rise posteriorly to posterior intercostal arteries. Internal thoracic artery which descends from subclavian artery gives rise to anterior intercostal arteries.
Azygous
Empties in SVC, upper branch = accesory hemiazygous, lower = hemiazygous.
The posterior intercostal veins drain into the azygous, but the anterior intercostal veins drain into the internal thoracic vein.
Thoracic duct
Lymphatic duct, begins at the upper lumbar vertebrae into the cisterni chyli, up the thoracic cavity, through the aortic hiatus, right of midline between thoracic aorta and azygous vein, moves to the left and drains into the left internal jugular vein.
Breast vs Testicular cancer metastasis
Breast lymph will drain to axillary node so cancer will metastasize there, whilst testicular lymph will drain to lumbar lymph nodes so cancer will metastasise there.
Right lymphatic
Drains into right internal jugular
Branches of abdominal aorta
Superior to inferior. A :Celiac trunk (r: gastric, m: common hepatic, l: Splenic ~) L: r+l = inferior phrenic. A: superior mesenteric. r+l = renal, r+l = lumbar, r+l = gonadal, r+l= lumbar. A: inferior mesenteric. middle sacral
Blood supply of the gut
Foregut = celiac trunk, midgut= superior mesenteric, hindgut = inferior mesenteric
Where do the gonadal veins drain?
Left gonadal vein drains to the left renal vein. Right gonadal vein drains into the IVC.
Common iliac artery
Bifurcates into internal and external. Internal anterior branch supplies the pelvic viscera and perineum, internal posterior branch supplies the gluteal region. External branch supplies the lower limb as it becomes the femoral artery after it passes under the inguinal ligament.
What veins comprise the hepatic portal system?
Superior mesenteric (r), hepatic portal vein (75% of blood to liver), inferior mesenteric (l), splenic. NO VALVES
What organs drain via the hepatic portal system?
The gut tube, gall bladder, pancreas, spleen
What organs drain via the caval system?
kidneys and suprarenal glands
Consequences of excess blood going through hepatic system
(portal hypertension) Caput medusae, oesophageal and rectal varices. Often causes by liver cirrhosis due to alcoholism or hepatitis
Transverse pericardial sinus
Behind pulmonary trunk and ascending aorta, anterior to SVC
Right atrium
Crista terminalis = smooth muscle ring above musculi pectinati, SAN at base of SVC in sulcus terminalis, coronary sinus near IVC, fossa ovalis on left wall, AVN
Right ventricle
tricuspid valve, chordae tendineae, papillary muscles, trabecular carnae, pulmonary valve
Left atrium
Fossa ovalis on right wall, left auricular appendage, pectinate muscles, pulmonary veins
Left ventricle
Bicuspid valve, chordae tendinae, papillary muscles, trabeculae carnae, aortic valve, interventricular septum
Coronary arteries
Right coronary artery, at bottom is the right marginal branch, left coronary artery, anterior interventricular, left marginal, circumflex (posterior to auracle)
Aortic sinus
Bulge on bottom of ascending aorta
Neurovasculature of upper limb
Subclavian artery to the lateral margin of 1st rib, axillary artery to the lateral margin of teres major, brachial artery to cubital fossa (median nerve passes through). Laterally radial artery to deep palmar arch, medially ulnar artery to superficial palmar arch.
Innervation of upper limb
Axillary (C5,6) - deltoid, teres minor
Musculocutaneous (C5,6,7) - Arm anterior flexors
Median (C5,6,7,8,T1) - Forearm anterior flexors, and intrinsic hand muscles
Ulnar (C8,T1) - Forearm anterior flexors, and intrinsic hand muscles except thenar and lumbricles 1 &2
Radial (C5,6,7,8,T1) - Arm and forearm posterior extensors
Brachial plexus overview
Roots: C5,6,7,8,T1 Trunks: Superior, middle, inferior Divisions: Anterior, posterior Cords: Lateral, posterior, medial Branches musculocutaneous, lateral root of median, medial branch of median, median, axillary, radial, ulnar, thoracodorsal, lower subscapular, upper subscapular, median pectoral, medial antebrachial cutaneous, medial brachial cutaneous (Rugby teams don't cover bruises)
Cord branches
Lateral: Lateral pectoral, lateral root of median nerve, musculocutaneous nerve. rugby players are Long Legged Movers
Medial: medial cutaneous brachial nerve, medial cutaneous antebrachial nerve, medial pectoral nerve, ulnar nerve, median root of median nerve. rugby players Make Many Moves Using Muscles
Posterior: upper subscapular, lower subscapular, thoracodorsal, radial, axillary. rugby players are ULTRA competitive
Upper line of brachial plexus
roots C5,6 - superior trunk - anterior cord straight and that joins to the middle trunk - lateral cord- musculocutaneous, lateral root of median, lateral pectoral
Middle line of brachial plexus
root c7 - middle trunk -posterior cord straight and joins upwards to superior trunk and downwards to inferior trunk - posterior cord - axillary, radial, lower subscapular, thoracodorsal, upper subscapular
Lower line of brachial plexus
roots c8, T1 - inferior trunk, anterior division straight on - medial cord - medial brachial cutaneous, medial antebrachial cutaneous, medial pectoral, medial branch of median
Blood supply of lower limb
Abdominal aorta to common iliac at L4, external iliac to femoral under inguinal ligament,popliteal to anterior tibia to medial plantar arch.
Deep femoral to popliteal to posterior tibial to lateral palmar arch
Innervation of lower limb
Obturator (L2,3,4) - Thigh medial adductors
Femoral (L2,3,4) - Thigh anterior extensors
Sciatic (L4,5,S1,2,3) - Thigh posterior flexors
Tibial (L4,5,S1,2,3) - Leg posterior flexors
Deep peroneal (L4,5,S1,2) - Leg anterior extensors
Superficial peroneal (L4,5,S1,2) - Leg lateral
Muscles of arm
Anterior: Biceps brachii, Coracobrachialis, Brachialis
Posterior: Triceps brachii
Muscles of anterior forearm
The superficial layer contains 4 muscles: flexor carpi ulnaris, palmaris longus, flexor carpi radialis, and pronator teres.
The intermediate layer contains just one muscle, flexor digitorum superficialis.
The deep layer contains three muscles:Flexor pollicis longus, Flexor digitorum profundus, Pronator quadratus
Muscles of posterior forearm
The superficial layer of the posterior compartment contains seven muscles that have a common origin of the supracondylar ridge and lateral epicondyle of the humerus (the common extensor tendon): Brachioradialis, Extensor carpi radialis longus, Extensor carpi radialis brevis, Extensor digitorum
Extensor digiti minimi, Extensor carpi ulnaris
The deep layer of the posterior compartment contains five muscles, all of which are innervated by the posterior interosseous nerve: Supinator, Abductor pollicus longus, Extensor pollicus longus, Extensor pollicus brevis, Extensor indicis
Muscles of thigh
The muscles that make up the anterior compartment of the thigh are sartorius and the quadriceps femoris muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius). Psoas major and iliacus muscles also pass into the upper aspect of the anterior compartment.
The muscles of the posterior compartment of the thigh are the biceps femoris, semitendinosus and semimembranosus
Medial: Adductor magnus, adductor longus, adductor brevis, obturator externus, gracilis
Muscles of posterior leg
The muscles in the posterior compartment are arranged into two groups: the superficial group and the deep group. These two groups are divided by a layer of deep fascia called the transverse intermuscular septum. As a group these muscles act to plantarflex and invert the foot, as well as flexing the toes. All muscles within the posterior compartment are innervated by the tibial nerve.
Superficial: The three muscles of the superficial group are gastrocnemius, soleus and plantaris.
Deep: There are four muscles which make up the deep group of the posterior compartment: popliteus, flexor digitorum longus, flexor hallucis longus and posterior tibialis. Popliteus is the only muscle to act on the knee whereas the others act on the foot and toes. Popliteus
Myotomes
Shoulder joint - Arm flexion (C5), extension (C6,7,8)
Elbow joint - forearm flexion (C5,6), extension (C7,8)
Wrist joint - supination (C6), pronation (C7,8), flexion (C6,7), extension (C6,7)
Finger adduction and abduction (T1), finger flexion and extension (C7,8)
What forms the pelvic inlet
sacrum, ilium, pubis, pubic symphysis
What forms the pelvic outlet
coccyx, sacrum, sacrotuberous ligament, ischium, pubic, pubic symphysis
What forms the pelvic diaphragm
levator ani, coccygeous, supports pelvic viscera, urinary and fecal continence
Perineal muscles
Superficial: superficial transverse perineal, ischiocavernosus (ishial tuberosity to pubis), bulbospongiosus ( superficial to urethrovaginalis place)
Deep: external urethral sphincter, deep transverse perineal, +f sphincter urethrovaginalis, compresor urethrea
Female reproductive organ
uterus (endometrium,myometrium,perimetrium, serosa), isthmus, ampulla, infubdibulum, fimbrae. Supplied by vaginal artery which arises from uterine artery which arises from internal iliac
Pubic cavity
rectum, rectouterine pouch, uterus, vesicouterine pouch, bladder
What does the pudendal nerve do?
innervate the perineum
Female reproductive ligaments
broad ligament (really broad), suspensory ligament holds up ovary
Male urethra
preprostatic,prostatic,membranous,spongy
Male reproductive organs
scrotum, testes, epididymis, vas deferens (sperm duct) seminal vesicle, urethra
Skin
Epidermis (keratinised stratified squamous, dermis (dense irregular connective tissue), hypodermis (adipose tissue) Hair follicle - dark circle light in the middle
Where does the humerus join the scapula
glenoid fossa
greater tubrelces and trochanters
lateral aspect of bones
CT
Aorta = white dot, stomach looks black, liver large, gall bladder darkened part on liver, IVC right of aorta, duodenum anterior to IVC, large intestine looks black , small intestine looks white,
Histology - muscles
skeletal = lines, cardiac = meat , smooth = bumfly t
Anterior cranial fossa
crista gali = protrusion between the cribifrom plate, lesser wing of sphenoid,
Middle cranial fossa
optic canal = small hole in lesser wing of sphenoid, formaman rotundum = just under and to right of optic canal, foramen ovale = down and to right of foramen rotundum, superior orbital fissue = large hole near foramen rotundum, pituitary fossa = seat by cribiform plate
posterior cranial fossa
foramen spinosum, internal acoustic meatus, foramen lacerum, jugular foramen is under internal acoustic meatus, hypoglossal canal near foramen magnum, clivus upwards of foramen magnum,
Sutures of skull
Lamboid = parietal and occipital, coronal = between frontal and parietal, pterion = joining of 3 sutures
Facial nerve
Cranial nerve 7, innervates muscles of facial expression, passes through internal acoustic meatus. [temporal,zygomatic,buccal,marginal mandibular,cervical]
Innervates: oribicularis occuli, nasalis, buccinator, masseter, platysma, zygomaticus major, depressor labii inferior
Trigeminal nerve
Cranial nerve 5, passes through foramen ovale, innervates all muscles of mastication: temporalis, medial and lateral pteryoid, masseter
Accesory nerve 11
foramen magnum. innervates trapezius - elevates, retracts, depresses and rotates scapula, sternocleidomastoid - cervical rotation and flexion
Jugular vein
internal drains head and neck to brachiocephalic veins , external drains face, exits jugular foramen
common carotids
bifurcate at c3/4
Components of the carotid sheath
common carotid artery, internal jugular vein, vagus nerve
internal dural venous system
drains blood from brain and meninges to the internal jugular
extraocular muscles
4 x rectus (superior,inferior,medical,lateral) 2x oblique (superior, inferior)
what is weldeyr’s ring
ring of lymphoid tissue found in thyroid consisting of pharangeal tonisl, tubual tonsils, palatine tonsils, lingual tonsils
Pharangeal muscles
constrictors decrease diameter of pharynx, longitudinal widen and elevate
Emergency cricothyroidotomy
cut cricothyroid ligament between cricoid and thyroid cartilage
Vagus nerve
on the left : descends into thorax to give recurrent laryngeal after coursing around the aortic arch
on the right: it courses round the right subclavian before giving rise to the recurrent largyngeal
Scapula
anterior = subscapular fossa
humerus
anterior: lateral epicondyle, capitulum, coranoid fossa, medial epicondyle
posterior: olecranon fossa, trochlea
radius
distal end has the syloid process which articulates with scaphoid and lunate bone, also at distal end is the ulnar notch
ulna
olecranon process on posterior aspect, trochlear notch on anterior aspect with coranoid process at the end styloid process
tarsals
talus, calcaneus, navicular (m), cuboid, lateral intermediate medial cuneiform
What flexes the distal interphalangeal joint
flexor digitorum profundus
Lower limb muscle functions
anterior thigh- femoral nerve, hip flexion, knee extension
posterior thigh - sciatic nerve, hip extension, knee flexion
medial thigh - obturator nerve, hipp adduction
anterior leg - deep fibular nerve, ankle dorsiflexion
posterior leg - tibial nerve, ankle plantarflexion
lateral leg - superficial fibular nerve, foor eversion
upper limb muscle functions
anterior arm - musculocutaneous nerve, elbow flexion
posterior arm - radial nerve, elbow extension
anterior forearm - median nerve , wrist flexion
posterior forearm - radial nerve, wrist extension
Rotator cuff
supraspinatus (abduction), infraspinatus (lateral rotation), teres minor (lateral rotation), subscapularis (medial rotation)
Carpal tunnel
median nerve and 9 tendons (4 flexor digitorum superficialis, 4 flexor digitorum profundus, 1 flexor pollicis longus)
Where does sensory afferent information come from
dorsal root
What artery supplies all organs of the pelvis?
Anterior iliac artery
