Anatomy Flashcards
sternoclavicular joints
saddle joints where the clavicles articulate with the manubrium at its superolateral angles
vertebral level of the sternomanubrial joint
T4
vertebral level of the xiphoid process
T9
the 2nd costal cartilage articulates with
the manubrium and the sternal body
the 7th rib articulates with
the sternal body and the xiphoid process
costochondral joint
synchrondosis between the rib and the costal cartilage
sternocostal joint
synovial plane joint between the costal cartilage and the sternum
1st = primary cartilagenous (synchrondosis)
true ribs
ribs 1-7 (vertebrosternal)
false ribs
ribs 8-10 (vertebrochondral)
floating ribs
ribs 11-12 (vertebral)
subclavian vein and artery function
supply the upper limb
costovertebral joint
synovial plane joint between the head of the rib and the vertebral body of the same number and the one above it
function of the tubercle of the rib
articulates with the articular facet on the tip of the transverse process of the vertebra with the same number
The costotransverse joint
dermatome of the sternal angle
T2
dermatome of the nipples
T4
inferior border of the deflated lung at the midclavicular line
rib 6
inferior border of the deflated lung at the midaxillary line
rib 8
inferior border of the deflated lung at the midscapular line
rib 10
inferior border of the parietal pleura at the midclavicular line
rib 8
inferior border of the parietal pleura at the midaxillary line
rib 10
inferior border of the parietal pleura at the midscapular line
rib 12
rib level of the cardiac notch
ribs 4-6
Here a needle can enter the heart without penetrating the lungs or pleura
the oblique fissure follows…
rib 6
the horizontal fissure follows…
rib 4
vertebral level of the superior point of the lung
C7
when inflated, the posterior border of the lung extends to…
rib 12
muscle fibre orientation of the external intercostal muscles
infero-anteriorly (\//)
muscle fibre orientation of the internal intercostal muscles
infero-postereorly (//\)
muscle fibre orientation of the innermost intercostal muscles
infero-posteriorly (//\)
external intercostal muscles fill the intercostal space…
from the vertebrae to the costochondral junction.
the front is filled by external intercostal membrane
internal intercostal muscles fill the intercostal space…
from the sternum to the costal angle.
the back is filled by internal intercostal membrane
intercostal membrane
a thin aponeurosis
innermost intercostal muscles fill…
only the central half of the intercostal space.
the front is filled by the transvursus thoracis muscles.
the back is filled by the subcostalis muscles
contents of the neurovascular bundle (superior to inferior)
intercostal Vein
intercostal Artery
intercostal Nerve
location of the neurovascular bundle
in the costal groove/ sulcus below each rib, between the internal and innermost intercostal muscles
collateral branch of the neurovascular bundle
a small branch given off by each structure in the neurovascular bundle, located just above each rib
shape of the thoracic diaphragm
consists of a left dome and a (higher up due to the liver) right dome.
a clover shaped central tendon in the middle
attachments of the thoracic diaphragm
the xiphisternum
costal cartilages 7-12
vertebra T12
The central tendon is attached to the fibrous pericardium
The left and right crura (singular = crus)
tendons which bind the diaphragm to vertebral bodies L1-2
major openings (hiatuses) in the thoracic diaphragm, and their vertebral levels
inferior vena cava - T8 (through the central tendon*)
oesophagus - T10
aorta - T12
*so it cannot be compressed by contracting muscle
Due to the dome shape, more anterior structures are more superior
minor openings in the thoracic diaphragm are for…
azygous vein thoracic duct sympathetic trunks phrenic nerves vagus nerves
Phrenic nerves
motor and sensory nerves supplying the diaphragm (left and right domes, inferior and superior surfaces)
spinal level of origin of phrenic nerves
+ results of injury
C3-5
injury to the spinal cord above these levels will result in paralysis of the diaphragm (+ need for artificial ventilation)
Injury below these levels may result in quadriplegia (inability to move all limbs)
anterior and posterior axillary folds
the ridges of skin covered muscle on either sides of the arm pit
muscles for forced inspiration
accessory muscles, e.g.
- muscles of the neck attaching to the sternum and upper ribs
- muscles of the abdomen that attach to the lower ribs
- upper limb and back muscles with rib attachments
Larynx
the “voice box”
a set of cartilages, membranes and ligaments which produce sound from expired air
attachments of the larynx
superiorly - to the hyoid bone
inferiorly - to the trachea at C6
function of the epiglottus
prevents solids and liquids entering the pharyngeal outlet
laryngeal prominence
the “adam’s apple”
in the middle of the thyroid cartilage
cricoid cartilage
a ring of cartilage below the thyroid cartilage and above the tracheal cartilages
motor innervation of the lower respiratory tract
sympathetic + parasympathetic
- sympathetic fibres from upper thoracic spinal levels via the pulmonary plexuses (located at the termination of the primary bronchi)
- parasympathetic fibres from the vagus nerve
* Sensory fibres travel in both
blood supply (+drainage) of the lower respiratory tract
- The bronchial arteries arising from the thoracic aorta
- intercostal ateries
the bronchial vein drains into the azygous venous system
spinal levels of the trachea
C6 - T4 (where it bifurcates)
cartilage rings of the trachea
15-20 C shaped hyaline cartilage rings, completed at the back by the trachealis muscle
Carina
the cartilage ring at the bifurcation of the trachea
right bronchi
the right main bronchus bifurcates just before entering the lung.
the superior branch is the superior lobar (eparterial) bronchus
the main bronchus then becomes the hypartrial bronchus
tracheobronchial lymph nodes
exist around the bifurcation of the trachea and alongside the two main bronchi
Hilum of the lungs
the area on the mediastinal surface of the lungs where the lung root enters and exits
root of the lung
consists of... the bronchus/ bronchi (posteriorly) the pulmonary artery (superiorly) the superior pulmonary vein the inferior pulmonary vein
bronchopulmonary/bronchomediastinal lymph nodes
surround the pulmonary veins at the hilum of the lung
parts of the parietal pluera
mediastinal pleura
diaphragmatic/phrenic pleura
costal pleura
apical/cervical/cupola pleura
pleural reflections
where the pleura changes direction to be on another surface
e.g.
costomediastinal
costophrenic
sternal pleural reflection (btw mediastinal and phrenic)
pleural angles/ recesses
spaces that occur between the pleura at pleural reflections
e.g.
costomediastinal
costophrenic
the thoracic inlet is surrounded by
1st ribs + their costal cartilages
superior border of the manubrium
T1 vertebra
the thoracic outlet is surrounded by
11th and 12th ribs
costal cartilages of ribs 7-10
vertebta T12
xiphisternal joint
intercostal space numbering
each space has the same number as the rib above it
normal location for a chest drain
5th intercostal space
in the midaxillary line
between the neurovascular bundle and the collateral branch
the fascial membrane covering the apex of the lung
suprapleural membrane
nerve supply to the parietal pleura
mediastinal and diaphragmatic parietal pleura is supplyed by the phrenic nerve
the rest is supplied by the intercostal nerves
only the parietal pleura is sensitive to pain
vagus nerve function
parasympathetic control of the heart, lungs and digestive tract.
sympathetic function (vasoconstriction) via peripheral chemoreceptors in response to hypoxaemia.
PA chest x-ray
posterior –> anterior
patient stands with front against film and holds a deep inspiration
patient close to x-ray film so more accurate picture
AP chest X-ray
used if a patient can’t stand
patient sits with back to x-ray film
bigger distance btw patient and film so less accurate. cannot be used to determine heart size
supine x-ray
patient lies down
position clavicles on CXR
should be equidistant from the spinous processes of the thoracic spine
appearance of ribs on CXR
posterior rib is more horizontal than anterior
with proper inspiration, 9-10 posterior ribs / 5-7 anterior ribs should be visible
heart shadow on CXR
occupies up to 50% of maximum internal thoracic diameter
remember to check the lung hidden behind the heart
mediastinum on CXR
hiliar vascular structures should be clearly defined
should be no widening
trachea on CXR
should be central
diaphragm on CXR
costophrenic and cardiophrenic angles should be sharp
The ectoderm forms the…
epidermis of skin
neural tube
The neural tube forms the…
brain and spinal cord
the paraxial mesoderm forms…
somites which each form a…
dermatome –> dermis of skin
myotome –> muscle
sclerotome –> bones
the intermediate plate mesoderm forms the…
urogenital system
the somatic lateral plate mesoderm forms the…
parietal pleura
the splanchnic lateral plate mesoderm forms the…
visceral pleura
the intra-embryonic coelom forms the…
pericardioperitoneal cannals –> intrapleural cavity
the endoderm forms the…
gut and respiratory system
the notochord forms the…
nucleus pulposus
the laryngotracheal groove forms the…
trachea and lung buds
the foregut forms the…
oesophagus
the septum transversum forms the…
central tendon of the diaphragm
migrates from C3-5
the pleuroperitoneal membranes form the…
primitive diaphragm
the dorsal mesentery of the oesophagus forms the…
median portion and the crura of the diaphragm
the peripheral parts of the diaphragm are formed by…
muscular in-growth from lateral body walls
Function of the thoracic wall
To protect the contents of the pleural and pericardial sacs, yet permit movements for respiration
The thoracic wall comprises of
The sternum
Vertebrae T1 - T12
Ribs 1 - 12
Location of the jugular notch
Superior border of the manubrium
Clinical use of the sternal angle
To locate positions from which to auscultate the heart + define pleural/ lung boundaries
Typical rib shape
Rounded superior border
Sharp inferior border
The fist rib articulates with…
T1 (only one vertebra)
Scalene tubercle
Tubercle on the 1st rib
Attaches to the anterior scalene muscle of the neck (an accessory respiratory muscle)
arrangement of grooves and scalene tubercle on the 1st rib
ANTERIOR Groove for subclavian vein Scalene tubercle Groove for subclavian artery POSTERIOR
Path of the subclavian vessels
Subclavian artery and vein pass from the neck to the axilla, sandwiched between the clavicle and 1st rib
The costal margin/ subcostal angle is formed by…
ribs/ costal cartilages 7-10
Orientation of the ribs in an adult
Anteroinferior
Function of the intercostal muscles
- respiratory movement
2. prevent the lungs and pleura from ballooning out between the ribs during respiratory movements
Layers of the chest wall (superficial to deep)
Skin Superficial fascia endothoracic/ deep fascia external intercostal muscle internal intercostal muscle innermost intercostal muscle parietal pleura pleural cavity visceral pleura
Dermatome
An area of skin supplied by a single spinal nerve
Major groups of lymph nodes (+ location)
Axillary - root of upper limb
Superficial + deep inguinal - root of lower limb
Pectoral - around the pectoralis major muscle
Tracheobronchial - bifurcation of trachea
Lumbar/ pelvic - around the root of arteries in the abdomen + pelvis
Superficial + deep cervical - superficial and deep groups in head and neck
The axillary lymph nodes lie around…
The axillary vein and its branches in the axilla
Lymph channels (function)
connect groups of lymph nodes
Location of the base (glandular part) of the breast
between ribs 2 - 6
between the lateral border of the sternum and the
anterior axillary line
Structure of the breast
The glandular part is divided into 16-20 lobes and smaller lobules and is surrounded by extensive adipose tissue
the axillary tail (of spence) of the breast, extends superolaterally into the floor of the axilla where it lies close to the axillary lymph nodes.
Purpose of the diaphragm
The main muscle of respiration
Also assists in raising intra-abdominal pressure during coughing, vomiting and defecation
The diaphragm is made of
Skeletal muscle
Difference between the phrenic and vagus nerves on a specimen
Phrenic = thinner, looser, more anterior, more lateral + can be seen all the way to the diaphragm
The vagus nerve lies immediately lateral to the trachea on both sides and soon passes posteriorly out of sight to lie on the oesophagus
Hiatus hernia
The abnormal protrusion (herniation) of a structure
e.g. the upper part of the stomach protruding into the thorax due to a tear/ weakness in the diaphragm
Spinal level of pulmonary artery bifurcation
T4
Rib level of the top of the domes of the diaphragm in quiet expiration
Rib 5
Therefore penetrating woulds below the nipples may damage the diaphragm
The upper respiratory tract consists of…
Nasal cavity
Pharynx
Larynx
Nerve supply of the larynx
Branches of the vagus nerve
for motor and sensory innervation
The lower respiratory tract consists of…
Trachea
Main/principal/primary bronchi + their branches
Lungs
Pleurae
Tracheo-oesophageal grooves
Grooves lying between the trachea and the oesophagus on both sides
Difference between the left and right main bronchi
Right is shorter, wider and more vertical
The left pulmonary artery and the aorta arch over the left main bronchus
Change in airway histology from bronchi – > alveoli
Gradually lose their cartilage and increase their elastic fibre content
Name of the corner of the left lung, below the cardiac impression
Lingula
Division of the bronchi
Principal bronchi
Lobar bronchi (2 on the left. 3 on the right.)
Segmental bronchi
Bronchopulmonary segment
A segment of the lung supplied by a tertiary (segmental) bronchus
Separated by layers of connective tissue
Can be surgically removed
Bronchial circulation function
Supplies blood to the tissue of the larger airways of the lung
Mediastinal pleura
Lines the structures situated between the two pleural cavities (in the mediastinum)
Site for pleural aspiration
9th intercostal space, midaxillary line
as the lung and parietal pleura are not co-extensive inferiorly
Cartilage found in the respiratory tract
Hyaline cartilage
Main connective tissue fibre in the respiratory tract
Elastin
Respiratory epithelium
Pseudostratified ciliated collumnar epithelium with goblet cells
Cells comprising the respiratory epithelium
Cilia (protrude into lumen)
Goblet cells - large, pale
Basal cells - small, dark staining
Goblet cell function
Secrete mucous
all pale staining cells secrete mucous
Mucosa
Respiratory epithelium
Basement membrane - smooth
Lamina propria
Lamina propria
Loose connective tissue
extracellular substance > cells
Can contain blood vessels
Submucosa
Contains mixed serous mucous glands
(appears grainy at low magnification)
Pale staining = mucous secreting
Dark staining = serous
Function and composition of the trachealis
Allows the oesophagus to expand
Smooth muscle
Layers of the trachea
Respiratory epithelium \ Basement membrane l -> Mucosa Lamina propria / Submucosa Cartilage Adventitia
Adventitia function + composition
Anchors the airway to surrounding structures
Loose connective tissue
Arrangement in hyaline cartilage in airways
Continuous in trachea
Irregular plates in bronchi
Disappears completely in bronchioles
Size of bronchioles
1mm or less
Composition of bronchiole wall
Collumnar/ cuboidal epithelium
SMOOTH MUSCLE
NO: cartilage, glands, goblet cells
Cells found in alveolar walls
Type I pneumocytes - smaller
Type II pneumocytes - larger
Macrophages - huge!
Main connective tissue fibres in alveoli
Reticular fibres
Elastin
Histological changes from bronchioles to alveoli
Smooth muscle slowly disappears
Epithelial cells flatten to form simple squamous epithelium
typical ribs
3 - 9
Intercostal nerves
The anterior rami of spinal nerves T1 - T11
Lung borders
Anterior border: where costal and mediastinal surfaces meet anteriorly
Inferior border: surrounds the diaphragmatic surface
Posterior border: where costal and mediastinal surfaces meet posteriorly
Lymphatic drainage of the breast
1.
Subareolar plexus
2.
75% (esp from lateral quadrants) –> axillary lymph nodes
From medial quadrants –> parasternal lymph nodes/ opposite breast
From inferior quadrants –> abdominal lymph nodes
