Anatomy 3 & 4 Flashcards
1
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root of neck boundaries
A
- anterior: top of manubrium and superior border of clavicle
- posterior: body of T1 & superior margin of scapula
- inferior: thoracic inlet and axillary inlets
- lateral: first pair of ribs and costal cartilages
2
Q
where does subclavian artery pass through to become axillary artery
A
- cervicoaxillary canal
- occurs at lateral border of first rib
3
Q
brachial plexus divisions
A
- 5 anterior rami C5-T1
- 3 main trunks
- 3 anterior divisions from trunk
- 3 posterior divisions from trunk
- 5 main terminal branches
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Q
cervical pleura and injury susceptibility
A
- superior continuation of the costal and mediastinal parts of parietal pleura
- superiorly the pleura form a dome called the cupola
- more susceptible to injury in children and infants as it extends higher due to shorter neck length
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Q
injuries at root/base of neck can compromise
A
- lungs
- pleural sacs
- pneumothorax: air infiltration in lungd/pleural spaces
- haemothorax: blood infiltration
- chylothorax: chyle from lymphatic system
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Q
lungs are covered in
A
- visceral pleura innermost layer
- cervical pleura superiorly.. continuation of parietal pleura
- cervical pleura reinforced with suprapleural membrane
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Q
suprapleural membrane function
A
barrier to prevent changes in intrathoracic pressure
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Q
3 branches of aortic arch
A
- brachiocephalic trunk (R)
- subclavian artery (L)
- common carotid artery (L)
9
Q
subclavian artery general function
A
- supply upper limbs
- send branches to neck and to brain
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3 parts of subclavian
A
- 1st part medial to anterior scalene muscle
- 2nd part posterior to anterior scalene
- 3rd part lateral to anterior scalene, anterior to trunks of brachial plexus
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Q
pulsation of subclavian
A
apply deep pressure to omoclavicular triangle
12
Q
subclavian artery branches
A
- VIT CD
- vertebral, internal thoracic, thyrocervical trunk (1st part)
- costocervical trunk (2nd part)
- dorsal scapular (3rd part although highly variable)
13
Q
vertebral artery travels to/supplies
A
- branches off first part of subclavian srtery
- ascends in neck and enters foramen transversium of C6 to travel up neck
- exits at C1 to foramen magnum where it becomes basilar artery by joining vertebral artery from opposite side
- contributes to circle of willis
- supplies structures in brain, spinal cord and post cranial fossa
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Q
thyrocervical trunk gives off/supplies
A
- branch of 1st part of subclavian
- gives off inferior thyroid artery, transverse cervical and suprascapular
- supplies larynx, trachea, oesophagus, thyroid and parathyroid
- supplies prevertebral muscles, anterior scalene, trapezius
15
Q
what is venous angle
A
where thoracic duct (left side) and lymphatic trunk (right side) drain lymph into venous circulation
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Q
prevertebral muscles
anterior
A
- longus colli
- longus capitus
- rectus capitus anterior
- anterior scalene
17
Q
prevertebral muscles
lateral
A
- rectus capitus lateralis
- splenius capitus
- levator scapulae
- middle scalene
- posterior scalene
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Q
thoracic duct
A
- lymph drainage channel
- enters the venous system between left IJV and left SCV
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Q
anterior vertebral muscles actions
A
- longus colli
- flexes neck so rotation to opposite side
- longus capitus, RC, anterior scalene: flex head
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Q
middle and post scalene actions
A
- flex neck laterally
- middle elevates 1st rib and post 2nd during forced inspiration
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levator scapulae actions
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elevates scapula and rotates it
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Q
sole tributary of subclavian vein
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- external jugular vein
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Q
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afferent
periphery to CNS
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efferent
CNS to periphery
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sympathetic division sends motor innervation to
* viscera (body core)
* periphery (BV and sweat glands etc)
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parasympathetic division sends motor innervation to
* viscera (body core)
* not periphery
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ENS
* enteric division of autonomic nervous system
* independant nervous system
* works in conjunction with ANS and CNS to regulate the digestive system...control of motor function, blood flow, immune response, endocrine functions
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main function of sympathetic NS
* increase in activity in time of stress, fear, anxiety
* increase BP, blood sugar levels, blood flow to skeletal muscles
* decrease from visceral and cutaneous circulation
* dilation of pupils
* decreased salivation
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main function of parasympathetic NS
* increase in activity when sedentary
* targets viscera of the thorax, abdomen and pelvis
* decrease cardiac output, BP
* increase peristalsis in GIT, increased salivation
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describe ANS neurons
* consists of 2 neurons which synapse in a ganglion: preganglionic and postganglionic
* preganglionic are myelinated...postganglionic are non-myelinated
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what is a ganglion
* collection of nerve cell bodies within the PNS
* in CNS called nucleus
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2 neurotransmitters used in ANS
* acetylcholine (from cholinergic fibres)
* noradrenaline/norepinephrine (from adrenergic fibres)
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location of preganglionic neurons of parasympathetic NS
* nuclei in the brainstem and CNIII, CNVII, CNIX and CNX
* sacral spinal cord and spinal ganglia of S2-S4
* nerves then travel to ganglia typically close to target organ
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sympathetic NS neurons originate/travel to
* originate from lateral horn of spinal cord segments T1-L2
* thoracolumbar
* travel to prevertebral and paravertebral ganglia close to CNS
* paravertebral ganglia form sympathetic chain
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paravertebral ganglia form
* sympathetic chain
* extends from base of skull to the coccyx
* left and right chains join at coccyx to form ganglion impar
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sympathetic chain how the nerves enter
* preganglionic sympathetic neurons leave the spinal cord through ventral root
* form part of a spinal nerve
* enter the ganglia of the sympathetic chain via white ramus communicans
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preganglionic sympathetic chain neurons can either do one of three
1. synapse in the ganglia at the same level with a postganglionic neuron that exits through grey ramus communicans
2. travel up or down the chain to synapse in a ganglion at a different level with a postganglionic neuron that exits through grey ramus communicans
3. exit the ganglia via splanchnic nerve to a prevertebral ganglion to synapse with postganglionic neurons headed to abdominal and pelvic viscera
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sympathetic preganglionic fibres destined for the head region will
* ascend in the sympathetic trunk and synapse in superior cervical ganglion
* postganglionic fibres will travel to head region along the surface of ICA and carotid plexus
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sympathetic supply to head and neck begin in
* thoracolumbar region
* so must ascend to head and neck
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cervical ganglia
* where symp neurons headed for head and neck synapse
* superior cervical ganglion C1/2
* middle cervical ganglion C6
* inferior cervical ganglion C7
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cervicothoracic ganglion/stellate ganglion
* inferior cervical ganglion fuse with 1st thoracic ganglion
* in 80% of people
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no white rami communicans where
* in neck
* only in T1-L2
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horners syndrome and signs
* damage to sympathetic trunk
* results in absence of sympathetic functions on ipsilateral side of head
* constriction of pupil
* drooping of eyelid (ptosis) resulting from paralysis of smooth muscle component of levator palpebrae superiosis
* vasodilation and absence of sweating on face/necl (flushed face) caused by lack of sympathetic nerve supply to BV and sweat glands
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sympathetic nerves which exit symp chain as splanchnic nerves
* celiac
* superior mesenteric
* inferior mesenteric ganglia
* synapse in prevertebral ganglia
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adrenal medulla nerve supply and effect
* supplied by sympathetic pre-ganglionic neurones
* preganglionic neurons release acetylcholine whilst synapsing with chromaffin cells
* acH causes secretion of noradrenaline frrom chromaffin cells which enter bloodstream and cause a widespread response
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PNS CNIII
* preganglionic neurons travel from edinger-westphal nucleus in brainstem to ciliary ganglion
* postganglionic neurons travel to innervate ciliary muscle and sphincter pupillae
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PNS CNVII
* sup salvatory nucleus in brainstem to pterygopalatine and submandibular ganglia
* pterygopalatine ganglion to lacrimal gland and nasal mucosa
* submandibular ganglion to submandibular gland via chorda tympani
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PNS CNIX
* inferior salvatory nucleus to otic ganglion
* otic ganglion to parotid gland via auriculotemporal nerve
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PNS CNX
* does not supply parasympathetic supply tp head and neck but to thorax and abdomen
* travel within carotid sheath
* synapse in ganglia close to or within target organ
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scalp boundaries
* from superior nuchal line of the occipital bone
* to supraorbital margins of frontal bone
* laterally the scalp extends over temporal fascia to zygomatic arch
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face boundaries
* anterior aspect of the head
* from forehead to chin
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layers of the scalp
* skin
* (dense) connective tissue
* aponeurotic layer
* loose connective tissue
* pericranium
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skin of scalp layer
* outermost layer
* contains hair follicles, sweat and sebaceous glands
* thickest over occipital bone
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dense connective tissue scalp layer
* subcutaneous layer
* richly vascularised
* cutaneous nerves
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aponeurotic layer of scalp
* broad tendon and the intermediate section of occipitofrontalis muscle
* layer prevents superficial wounds from gaping open
* when layer is compromised it requires sutures to close
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loose connective tissue layer of scalp
* separates scalp proper (1st three layers) from underlying pericranium and calvaria
* loose aereolar tissue allows free movement of outer layers
* contains spaces susceptible to distension with fluid or infection spread
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where is there potential for infection spread in the scalp
* in loose connective tissue layer between aponeurosis and pericranium
* potential spaces for accumulation of fluid eg blood or spread of infection
* can spread to eyelids/root of nose
* due to the frontal belly of occipitofrontalis inserting into skin and subcutaneous tissue NOT bone
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scalp infections can spread to intracranial structures via
* emissary veins
* vessels that connect the extracranial vessels of the scalp to intracranial dural venous sinuses
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scalp innervation
* spinal nerves C2 and C3
* greater occipital nerve C2
* third occipital nerve C3
* greater auricular and lesser occipital C2 and C3
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greater auricular nerve innervates
* inferior aspect of auricle (external ear)
* skin over angle of mandible
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scalp blood supply and drainage
* arterial supply from both internal and external carotid arteries
* from ICA: supraorbital and supratrochlear arteries
* supraorbital and supratrochlear veins
* from ECA: superficial temporal, posterior auricular and occipital
* superficial temporal, posterior auricular and occipital veins
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scalp lymphatic drainage
* posterior: mastoid and occipital nodes drain to deep cervical nodes
* anterior: pre-auricular and parotid nodes
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what can present with CSF rhinorrhoea
cribiform plate fractures
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anterior cranial fossa
* frontal, ethmoid and sphenoid bones
* shallowest part of cranial fossa
* occupied by frontal lobes
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how do olfactory bulbs recieve nerves fibres from nasal cavity
via foramina of cribiform plate
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pituitary gland lies in/surrounded by
* lis in hypophyseal fossa
* surrounded by 4 clinoid processes and 2 superior projections
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what are buttresses
* thicker portions of cranial bone
* transmit forces around weaker regions of the cranium (bypassing orbits and nasal cavity)
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cranial meninges
* dura mater
* arachnoid mater
* pia mater
* membranous layers that help in protection of the brain
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dura mater
* outermost meninge
* two layers
* periosteal layer attached to bone
* meningeal layer in contact with arachnoid mater
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two layers of dura mater separate at
* dural folds
* venous sinuses
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arachnoid mater
* lines the dura mater
* trabeculae present which project from surface --> across the subarachnoid space --> and attach to pia mater
* subarachnoid space is fluid filled space
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subarachnoid space
* contains CSF and blood vessels
* arachnoid granulations reabsorb CSF into venous system
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arachnoid granulations can be found
* saggital sinus
* lateral lacunae
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dura mater folds
* limit the movement of the brain within the cavity
* falx cerebri
* tentorium cerebelli
* falx cerebelli
* diaphragma sellae
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blood supply of dura mater
* by meningeal arteries in the periosteal layer
* anterior meningeal arteries
* middle meningeal arteries
* posterior meningeal arteries
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pia mater
* thin membrane attached to surface of brain
* as it adheres to brain surface it enters sulci of brain
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brain can be damaged by
* external trauma such as blow to the head
* intracranial pathological processes:
* compressed by tumour
* leak or clot of blood which decreases O2 supply
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what is usually the dominant hemisphere
left cerebral hemisphere
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what are gyri/sulci
* elevations are called gyri
* infoldings referred to as sulci
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grey/white matter of brain
* outer surface composed of 6 layers of neural cell bodies (grey matter)
* white matter is myelinated axons of neuronal cells more interiorly
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cerebrum separated into cerebral hemispheres by
* longitudinal fissure
* falx cerebri runs in this fissure
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insula
* sometimes described as 5th lobe of brain
* deep to 3 of the other lobes
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lobes of the cerebrum
* frontal lobe
* parietal lobe
* occipital lobe
* temporal lobe
* insula
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cerebellum function
controls balance in ipsilateral side
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cranial nerves associated with midbrain
* CNIII
CNIV
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cranial nerve associated with pons
CNV
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which CN emerge from junction of pons and medulla
* CNVI
* CNVII
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cranial nerves emerging from medulla
* CNIX
* CNX
* CNXII
* CNXI (spinal nerve)
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frontol lobe areas and function
* prefrontal cortex: problem solving, decision making and complex planning
* motor cortex and primary motor precentral gyri: planning, control and execution of voluntary movement
* brocas area: production of speech, usually found in left hemisphere
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damage to prefrontal cortex and brocas area
* damage to prefrontal cortex can drastically alter personality
* damage to brocas area results in inability to form words although sounds can be made
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parietal lobe areas and function
* processing of sensory information
* primary somatosensory cortex (postcentral gyri): tactile sensation, sensory homunculus, conscious perception of pain, pressure, taste, temp, touch and vibration
* posterior parietal cortex: integration of sensory information, spatial perception, cognitive functions example can recognise object placed in hand relating it to previous sensory experiences
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homonculus
* somatotopic localisation
* particular areas of body are mapped to a particular part of the brain
* knee hip etc closer to midline, face teeth lips etc laterally
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occipital lobe areas and function
* primary visual cortex: recieves visual info from thalamus
* visual association area: interprets image and relates to past visual experiences
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if visual associated area damaged
* person could still see printed letters
* but no meaning obtained from them
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temporal lobe areas and function
* auditory cortex: hearing, speech, pitch and tone
* wernicks area: language comprehension, understanding of written and spoken language
* other roles: long term memory formation, visual perception and recognition, processing of olfactory stumuli (sense of smell)
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areas commonly effected by altzheimers/results in
* posterior parietal cortex: difficulty with navigation, gets lost
* temporal lobe: issues related to memory
* can cause atrophy of areas
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insula function
* integrating information relating to touch, vision and hearing
* anterior insula involved in language
* processing pain
* maintenance of CV homeostasis
* emotional response and empathy
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wernicks aphasia
* being able to speak words easily
* often meaningless
* cant form sentace
* incomprehensible words which make no sense
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corpus callosum formed by/function
* links the two cerebral hemispheres and allows communication
* formed by mylinated axons (white matter)
* provides horizontal pathway for axons
* axons pass through internal capsule
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cerebrum internal anatomy
* thalamus on either side of 3rd ventricle
* internal capsule contains fibres running from thalamus to cortex and cortex to thalamus, brainstem and SC etc
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why is internal capsule vulnerable
* contains fibres running from thalamus to cortex and vice versa
* common site for stroke as small arteries supply coming from middle cerebral artery
* affects contralateral side
* pyrimidal tract (motor nerves) run through which stroke can cause motor weakness or paralysis
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basal nuclei function/diseases and damage
* arrange and coordinate movements (grey matter cell bodies)
* can decrease muscle tone and inhibit unwanted muscular activity
* diseases:
* parkinsons results in difficulty initiating movements, slowed movements
* huntingtons results in excessive and jerky involuntary movements
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hypothalamus location/function
* sits inferior and anerior to thalamus
* involved in maintaning homeostasis: consumption of fluids and food, temp control, sleep-wake cycle, growth and reproduction
* monitors internal environment and controls autonomic system
* controls release of hormones from pituitary gland through releasing hormones
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pituitary gland location/function
* sits in pituitary fossa connected to hypothalamus via pituitary stalk
* anteriorly is optic chiasm
* regulate hormone release
* hormones released include growth hormone, thyroid stimulating hormone, follicle stimulating hormone
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acromegaly cause/symptoms/dental signs
* caused by overproductin of growth hormone by pituitary gland
* most often by pituitary tumor which has slow growth so can be years for symptoms to arise
* symptoms: growth of hands and feeth, lip nose and tongue enlargements, deeper voice
* dental signs: spacing between teeth, increase in jaw size
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if acromegaly untreated can lead to
* high BP
* diabetes
* sleep apnoea
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what are ventricles/function
* fluid filled cavitis within the brain
* produce cerebral spinal fluid
* provide protection to the brain
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CSF produced by
* choroidal epithelial cells
* located in each ventricle
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lateral ventricles separated by/connected to 3rd by
* separated by septum pallucidum
* connected to 3rd ventricle by intraventricular foramen
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3 main functions of brainstem
* channel for tracks ascending and descending through CNS
* houses CN nuclei III to XII with exception CNXI (spinal nerve)
* location for refelx centres related to respiration, CV function and regulation of consciousness
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pyrimidal tract
* where nerve fibres cross to opposite side
* olive and pyramid give pyramidal tract its name
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spinal cord begins/ends at
* begins at foramen magnum of skull as continuation of medulla
* ends at L1/L2 vertebrae in adults
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spinal cord enlargements
* cervical enlargement C4-T1 which contributes to cervical plexus
* lumbosacral enlargements between T11-S11 which contributes to lumbosacral plexus
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spinal cord matter
* grey matter is deep to white matter
* opposite to brain
* H shape grey matter
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size of ventral horn reflects
* how much skeletal muscle is innervated at that level
* largest in cervical and lumbar regions and limb innervating
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where is lateral horn on SC present
* thoracic
* lumbar
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central canal of spinal cord
filled with CSF
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how spinal nerves formed
* rootlets converge to become roots both anteriorly (ventral) and posteriorly (dorsal)
* ventral and dorsal roots converge to become a spinal nerve (mixed)
* spinal nerves divide into anterior and posterior rami (mixed) after exiting from intervertebral foramen
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where spinal nerves emerge from
* all emerge between adjacent vertebrae except C1 which emerges between occipital bone and C1
* cervical spinal nerves emerge above corrisponding vertebrae except C8 which is above T1
* all other spinal nerves emerge below corresponding vertebrae
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spinal cord protection
* 3 meningeal layers
* dura mater
* arachnoid mater
* pia mater
* epidural fat
* subarachnoid space filled with CSF
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spinal cord protection
* 3 meningeal layers
* dura mater
* arachnoid mater
* pia mater
* epidural fat
* subarachnoid space filled with CSF
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myotome/dermatome
* unilateral mass of muscle supplied by a spinal nerve is called a myotome
* unilateral area of skin supplied by a spinal nerve is called a dermotome
* C1 has no dermatome
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blood supply of the brain summary
* vertebral artery from subclavian enters foramen magnum and both sides combine to form basilar artery
* anterior cerebral artery and middle cerebral artery originate from cerebral portion of ICA
* posterior cerebral artery from anterior portion of basilar artery and connects to MCA via posterior communicating artery
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circle of willis
* brain blood supply
* anterior cerebral artery
* anterior communicating
* middle cerebral
* posterior communicating
* posterior cerebral
* basilar from vertebral
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stroke caused by anterior cerebral artery occlusion
* if proximal to anterior communicating artery then circulation usually preserved
* occlusion distal to communicating artery may produce these signs and symptoms:
* contralateral hemiparesis and hemisensory loss involving mainly leg and foot (paracentral lobule of cortex)
* inability to identify objects correctly, apathy and personality changes (frontal and parietal lobes)
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stroke caused by middle cerebral artery occlusion
* contralateral hemiparesis and hemisensory loss involving mainly the face and arm (precentral and postcentral gyri)
* contralateral visual field defecr (damage to optic radiation)
* aphasia if LEFT hemisphere affected
* anosognosia (lack of insight) and decreased ability to understand/percieve their illness if RIGHT hemisphere affected
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stroke caused by posterior cerebral artery occlusion
* contralateral visual field defect (damage to calcarine cortex)
* macular sparing (preserved vision in centre of visual field) due to occipital pole recieving blood from middle CA
* visual agnosia...inability to recognise objects (ischaemia of LEFT occipital pole)
* impairment of memory if damage to medial aspect of temporal lobe
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what is a dural venous sinus
* spaces betweenperiosteal and meningeal layers of dura
* endothelium lined
* venous drainage of brain
* absorbs CSF via arachnoid granulations
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arachnoid granulations venous drainage
* extend into venous sinuses
* allow CSF to exit subarachnoid space and enter venous sinus into bloodstream
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cavernous sinus thrombosis/thrombophebitis risk/symptoms
* blood supply to danger triangle of face low so increased risk of infection
* usually injury/infection of face/dental infection spreads to cavernous sinus
* blood clot develops to prevent infection spreading further which decreases blood flow
* symptoms: headache around eye, increased temp, eye pain, double vision
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types of cranial haemorrhages
* extradural/epidural haematoma (middle meningeal artery rupture)
* subdura/dural border hematoma
* subarachnoid hemorrhage
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which cranial nerves do not come from brainstem
* CNI
* CNII
* CNXI comes from spinal cord
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cranial nerves carry one or more of the 5 main functional components
1. motor fibres to voluntary striated muscle
2. motor fibres innervating involuntary smooth muscle or glands
3. fibres transmitting general sensation from skin and mucous membranes
4. fibres conveying sensation from the viscera
5. fibres transmitting unique sensations
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CNI function
* afferent sensory fibres
* oflaction (sense of smell)
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CNII, CNIII, CNIV, CNVI supply/function
* CNII sensory supply of eye
* CNIII motor supply to ciliary muscle, sphincter papillae, all external eye muscles except those below
* CNIV motor supply to superior oblique muscle
* CNVI motor supply to lateral rectus muscle
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CNV sensory function overview
* sensory supply to
* face
* sinuses
* teeth
* orbit
* oral cavities
* dura mater
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CNV motor function overview
* muscles of mastication
* tensor tympani
* tensor veli palatini
* mylohyoid
* anterior belly of digastric
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CNVII motor function overview
* muscles of face
* posterior belly of digastric
* stylohyoid
* occipitalis
* auricularis
* submandibular, sublingual and lacrimal glands
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CNVII sensory function overview
* taste anterior 2/3 tongue
* soft palate sensation
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CNVIII
* vestibulocochlear
* auditory sensation
* travels close proximity to facial nerve so ear infection could...?
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CNIX sensory and motor function
* sensory supply of tonsil, pharynx, middle ear
* taste to posterior 1/3 tongue
* motor supply of stylopharyngeus, parotid gland
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CNX sensory and motor supply overview
* motor to heart, lungs, palate, pharynx, larynx, trachea, GI tract
* sensory to heart, lungs, trachea, GI tract, external ear
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CNXI motor supply
* sternocleidomastoid
* trapezius
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CNXII motor supply
* tongue muscles
* infrahyoid muscles (C1,2,3 fibres)
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