Anatomy Flashcards
What does adduction of the vocal cords do and what nerve does this?
closes the rima glottidis
vagus nerve
What nerves supply the intercostal muscles?
Intercostal nerves
What nerve controls contraction of the anterolateral abdominal wall muscles?
intercostal nerves
What nerve tenses the soft pallate?
CN V - trigeminal
What nerve elevate the soft pallate?
vagus nerve
When sneezing what sensory receptor nerves are stimulated?
CN V or CN IX (trigeminal or glossopharyngeal)
What sensory receptor nerves are stimulated in coughing?
CN IX or CN X (glossopharyngeal or vagus)
What does the vagus nerve descend down to the mediastinum in?
Carotid sheath
What 4 things does the right carotid sheath obtain?
the vagus nerve
the right internal carotid artery
the right common carotid artery
the right internal jugular vein
Where is the pulmonary plexus and what 3 things make it up?
At the bifurcation of the trachea
sympathetic axons, parasympathetic axons, visceral afferents
What nerve sensory receptors are present in the mucosa of the oropharynx?
CN IX
What nerve sensory receptors are present in the mucosa of the laryngopharynx?
CN X
What nerve sensory receptors are present in the mucosa of the larynx?
CN X
What are present in the sensory receptors of the mucosa in the respiratory tree?
Visceral afferents
What is the phrenic nerve composed of?
The combined anterior rami of cervical spinal nerves 3,4 and 5
Where in the neck can the phrenic nerve be found?
On the anterior surface of the scalenus anterior
Where in the chest can the phrenic nerve be found?
Descending over the lateral aspect of the fibrous pericardium anterior to the lung root
What 4 areas does the phrenic nerve supply somatic sensory and sympathetic axons to?
The fibrous pericardium
The mediastinal parietal pleura
The diaphragmatic parietal pleura
Th diaphragmatic parietal peritoneum
What does the phrenic nerves somatic motor axons supply?
The diaphragm
What are the intercostal nerves?
The anterior rami of spinal nerves T1 - T11
What 3 muscles are the accessory muscles of inspiration?
Pectoralis major
Pectoralis minor
Sternocleidomastoid
Scalenous anterior, medius and posterior
What are the muscle attachments of the pectoralis major?
sternum/ribs and the humerus
What are the muscle attachments of the pectoralis minor?
ribs 3,4 and 5 (3-5)
the coracoid process of the scapula
What are the attachments of the sternocleidomastoid muscle?
sternum/clavicle and mastoid process of the temporal bone
What are the attachments of the scalenous anterior, medius and posterior?
Cervical vertebrae and ribs 1 & 2
What type of muscles are the intrinsic muscles of the larynx?
Skeletal muscles
What are the intrinsic muscles of the larynx supplied by?
(somatic) motor branches of the vagus nerve (CN X)
Where do the right and left vagus nerve connect with the CNS?
At the medulla (oblongata) of the brainstem
Describe the 5 steps in the course of the vagus nerve.
- Leaves the base of skull through the jugular foramen
- Descends through the neck within the carotid sheath
- Descend posterior to the lung root (supply parasympathetic axons to the chest organs - lungs via pulmonary plexus)
- Pass through the diaphragm on the oesophagus
- On the surface of the stomach they divide into many parasympathetic branches for the foregut and midgut organs
What is the name of the 6 pack muscles?
Rectus abdominis muscles
What are the accessory muscles used in deep, forced expiration?
The 3 layers of skeletal muscles of th antolateral abdominal wall
what are the three layers of abdominal muscles from external to internal?
External oblique
Internal oblique
Transverse abdominus
What muscle is just lateral to the pectoralis major and superior to the external obliques?
Serratus anterior
What is an aponeurosis?
A flattened tendon
What is the linea alba?
the right external oblique blends with the aponeurosis of the left external oblique at the midline (linea alba)
What is the linea semilunaris?
Where the muscle fibres end and the aponeurosis begins
What are the right external obliques attachments?
superiorly - the superficial aspects of the lower ribs
inferiorly - the anterior part of the iliac crest and the pubic tubercle
What are the right internal obliques attachments?
Superiorly - the inferior border of the lower ribs
Inferiorly - the iliac crest and the thoracolumnar fascia of the lower back
What are the attachments of the transversus abdominus superiorly and inferiorly?
Superiorly - deep aspects of the lower ribs
Inferiorly - the iliac crest and the thoracolumnar fascia of the lower back
What are the rectus sheaths composed of?
The aponeuroses of the other 3 muscles:
Transversus abdominis aponeurosis
Internal oblique aponeurosis
External oblique aponeurosis
What do tendinous intersections do?
They divide each of the 2 long flat muscles into 3 or 4 smaller quadrate muscles: the 6 pack or 8 pack - this gives improved mechanical efficiency
Describe the course of the thoracoabdominal nerves?
The 7th to the 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces, in the plane between the internal oblique and the transversus abdominus as the thoracoabdominal nerves
The subcostal nerve?
T12 anterior ramus
The iliohypogastric nerve?
Half of L1 anterior ramus
The ilioinguinal nerve?
The other half of L1 anterior ramus
In an upright patient where will foreign bodies tend to be inhaled to?
The inferior lobe of the right lung
What is the carina?
The internal aspect of the tracheal bifurcation
Examination of a patient with a pneumothorax will show?
Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper-resonance on percussion
On a CXR what will you notice in the case of a pneumothorax?
Absent lung markings peripherally
Lung edges visible
What is a tension pneumothorax?
The torn pleura can create a one-way valve that permits air to enter the pleural cavity on each inspiration but prevents air escaping again on expiration. With each inspiration more air enters the pleural cavity. The pneumothorax exapnds and the lung collapses towards its root. Eventually the build up of air in the pleural cavity applies tension to the mediastinal structures.
What will you notice on a CXR of a tension pneumothorax?
No lung markings
Increased lung markings on other side
What level of the axial section is the superior medastinum at?
T4
What level of the axial section is the posterior mediastinum at?
T7
How will you know if there has been a mediastinal shift due to a tension pneumothorax?
Tracheal deviation away from the side of a unilateral pneumothorax, is palpable in the jugular notch.
What 2 steps are involved in the management of a large pneumothorax? Where would the needle/chest drain be inserted?
- Needle aspiration (thoracentesis)
- The siting of a chest drain
4th or 5th intercostal space in the midaxillary line.
Where are intercostal nerve bundles found (VAN)?
In the costal groove of ribs
In relation to the management of a large pneumothorax, what borders make up the safe triangle?
The anterior border of latissimus dorsi
The posterior border of pectoralis major
The axial line superior to the nipple
What is the emergency management of a tension pneumothorax?
Insert a large gauge cannula (grey/orange) into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax.
What is a pleurectomy?
Removal of visceral pleura (can be done by thoracoscopy)
What is chemical pleurodesis?
Magnesium silicate (talc) slurry introduced into the pleural cavity to produce adhesion between the parietal and visceral pleura.
What are the most likely consequences of a chronic cough?
Herniae
Name the 4 parts of the body wall that have normal anatomical weakness?
Diaphragm - diaphragmatic hernia
Umbilicus - umbilical hernia
Inguinal canal - inguinal hernia
Femoral canal - femoral hernia
Where are the weak points for herniae to develop in relation to the diaphragm?
Normal anatomical weakness at the attachments to the xiphoid
Normal anatomical weakness at posterior attachments
(hiatus hernia are common - oesophageal hiatus, aortic hiatus, caval opening - IVC)
What happens in a paraoesophageal hiatus hernia?
The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus and in the chest.
What happens in a sliding hiatus hernia?
The herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastro-oesophageal junction/
How is the inguinal canal formed embryologically?
During the passage of the testes or the round ligament of the uterus into the perinuem
(In the adult the canal contains the spermatic cord or the round ligament of the uterus)
What is the inguinal region from?
The anterior superior iliac spine and the pubic tubercle
What are the inguinal ligaments formed from and where are their attachments?
The inguinal ligaments are the inferior borders of the external oblique aponeuroses. They attach between the ASIS and pubic tubercle. (Their medial halves form the floors of the inguinal canals)
What is the deep ring of the inguinal canal?
Where the testis are pusehd into the transversalis fascia
What is the superficial ring of the inguinal canal?
The defect in the external oblique aponeurosis where the testis is passed into the superficial fascia of the scrotum.
What is the conjoint tendon and what does it do?
The medial end of the combined aponeuroses of internal oblique and transversus abdominis: anchors these muscles inferiorly to the pubic bone.
What is the spermatic cord made up of?
The three layers of “coverings” gained as the testis passes through the inguinal canal: internal spermatic fascia, cremasteric fascia, external spermatic fascia. It also contains structures within.
What does the right spermatic cord contain?
The vas deferens, testicular artery and pampiniform plexus
Name the contents of the spermatic cord from posterior to anterior
Vas deferens, testicular artery, testicular vein
What nerve emerges from the inguinal canal via the superficial ring?
The ileoinginal nerve
The complete contents of the spermatic cord contains 6 things - what are they?
Vas deferens, testicular artery, pampiniform plexus of veins, autonomic nerves supplying the smooth muscle of the vas deferens and arterioles, the genitofemoral artery, lymphatics draining lymph from the testis
Explain what a direct inguinal hernia is?
A “finger” of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum.
Explain what an indirect inguinla hernia is?
A “finger” of peritoneum is forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum.
How do you clinically differentiate between direct and indirect herniae?
- reduce the hernia
- occlude the deep ring with the fingertip pressure
- ask the patient to cough
If it is a direct hernia the lump will reappear, if indirect the lump will not reappear.
Where can you palpate the trachea?
In the jugular notch of the manubrim
At what level of the vertebra does the larynx become the trachea and the pharynx become the oesophagus?
C6
What is the parietal pleura adherent to?
- The structures of the mediastinum
2. The internal aspect of the chest walls
How many lobes does the right lung have?
3
How many lobes does the left lung have?
2
Which lung contains the horizontal fissure?
Right lung
How many bronchopulmnonary segments are there?
10
What lies in the costal groove?
Neurovascular bundle (VAN)
What supplies the anterior parts of the intercostal spaces and course vertically either side of the deep surface of the sternum?
The internal thoracic artery and veins (2)
What drains the posterior parts of the intercostal spaces
The azygous vein
What supplies the 11 pairs of intercostal spaces?
(bilateral) posterior intercostal arteries - supply the chest wall
branches from the thoracic aortas anterior surface (arterial blood for the lung tissue)
What nerve and its branches supply all the layers/structures of the right 4th intercostal spaces?
The right T4 anterior ramus also called the right 4th intercostal nerve and its branches
Whaat are the three attachments of the diaphragm?
- the sternum
- the lower 6 ribs and costal cartilages
- L1-L3 vertebral bodies
What are the phrenic nerves composed up?
Cervical spinal nerves 3,4 & 5 anterior rami
Where in the neck are the phrenic nerves found?
Anterior surface of the scalenus anterior
Where in the chest are the phrenic nerves found?
Descending over the lateral aspect of the fibrous pericardium
What does the phrenic nerve supply to the diaphragm and fibrous pericardium?
Somatic sensory and symnpathetic axons
What does the phrenic nerve supply to the diaphragm alone?
Supplies somatic motor axons
What is the arterial and venous supply of the breasts?
Subclavian and internal thoracic artery and vein
What is the lymph drainage for the breasts?
Unilateral drainage from lateral quadrants to axillary nodes
Bilateral draiange from medial quadrants to parasternal nodes
Where is the left cephalic vein found?
In the left delto-pectoral groove
What are the 2 heads of the pectoralis major?
Clavicular head
Sternocostal head
What is paralysis of serratus anterior a result of and what does it cause?
Usually through injury to the long thoracic nerve results in a “winged scapula”
What does the serratus anterior anchor?
The medial border of the scapula to ribs 1 and 8
Where does the long thoracic nerve come from?
It is a named branch of the brachial plexus and supplies the serratus anterior via its superficial surface
Where does the pectoralis minor attach between?
the coracoid process of the scapula and ribs 3-5
Where does the anterior intercostal vein drain into?
The internal thoracic vein
What is the anterior intercostal artery a branch of?
Internal thoracic artery
Which lung has a lingula?
Left lung
