Anatomy Flashcards
Where is the isthmus of the thyroid gland?
Anterior to tracheal cartilages 2-4
What are the layers of the thorax from superficial to deep?
Skin, Superficial fascia, Deep fascia, External intercostal, Internal intercostal, Innermost intercostal, Ribs/joints, Parietal pleura
What are the 3 parts of the parietal pleura?
Cervical,
Mediastinal,
Costal,
Diaphragmatic
Where does the trachea split?
At the carina - T4/5
Where do the ribs attach to the vertebral column (3 points)?
T1-12
Are attached to rib above, below and transverse process (of inferior)
(T11+12 only attach to 1 vertebrae + transverse process)
Which part of the rib articulates with the vertebrae and the transverse process?
Head = vertebrae Tubercle = transverse process
What are the joints between the sternum and the clavicle, the sternum and the costal cartilage and the costal cartilage and costal cartilage called?
Sternoclavicular = sternum and clavicle Sternocostal = sternum and costal cartilage Costochondral = rib and costal cartilage Interchondral = costal margin
Where does the neurovascular bundle run?
In the costal groove inferior to the rib between the internal and innermost intercostals
What is the blood supply and drainage to the posterior and anterior intercostal spaces?
Posterior:
Thoracic aorta,
Azygous vein (is on right)
Anterior:
Internal thoracic artery (runs down from subclavian)
Internal thoracic vein (drains into brachiocephalic)
Where do the intercostal nerves arise from?
Anterior rami of spinal nerves T1-12
What order are the vessels of the intercostal neurovascular bundle?
From superior to inferior: (VAN) Vein Artery Nerve
Where are the attachments of the diaphragm?
L1-3,
Sternum,
Lower 6 ribs + costal cartilages
What passes through the diaphragm at T8, 10 and 12?
T8 = IVC T10 = oesophagus + vagus nerve T12 = aorta, thoracic duct + azygous vein
How many pulmonary arteries and veins supply each lung?
1 pulmonary artery
2 pulmonary veins
What is the purpose of the accessory/hemiazygos vein and where does it run?
Drains the left intercostal spaces into the azygous vein
The accessory hemiazygos drains the superior aspects and the hemiazygos drains the inferior aspects
It runs down the left side of the vertebral column and crosses it at roughly T9 into the azygos vein
What is the purpose of the bronchial arteries, where do they arise from and how many are there?
Supply the lungs and pleura
Arise from the thoracic aorta (anterior)
2 to the left lung and 1 to the right lung
Which structure does the vagus nerves follow down the thorax?
Oesophagus
What is contained within the carotid sheath and what structure protects this?
Vagus nerve,
Common carotid,
Internal jugular
Protected by sternocleidomastoid
Where do the bronchial veins drain into?
Partially the pulmonary veins (decreases the O2 content of these)
and the azygos/hemiazygos veins
Describe the course of the phrenic nerve?
Arises from the anterior rami of cervical spine nerves C3,4,5
Travels down anterior surface of scalene muscle and anterior to both lung roots
Sits on the lateral aspects off the fibrous pericardium
What does the phrenic nerve supply?
Somatic motor to the diaphragm Somatosensory to: mediastinal parietal pleura, fibrous pericardium, diaphragmatic parietal pleura, diaphragmatic parietal peritoneum
What muscle anchors the scapula to the ribs and what is its nervous supply, what occurs if this is paralysed?
Serratus anterior
Long thoracic nerve
Winged scapula
What muscles are connected to the clavicle?
Trapezius,
Deltoid,
Sternocleidomastoid,
Pectoralis major
What are the origins and insertion of the pectorals minor muscle?
Scapula and rib 3,4,5
What is the trapezius muscle?
Large muscle covering most of the back
Describe the latissimus dorsi
Largest muscle of the back,
Paired structure,
Wraps around the side of body
What are the parts of the mediastinum?
Superior,
Inferior (posterior, middle, anterior)
They are split at the sternal angle (transverse thoracic plane)
What is contained within the superior mediastinum?
The roots of the great vessels
What are the layers of heart tissue from external to internal?
Epicardium,
Myocardium,
Endothelium
Which great vessels are at the front and back of the heart?
Front = exit vessels (pulmonary trunk + aorta) Back = entrance vessels
Which is more anterior, the pulmonary trunk or the aorta?
Pulmonary trunk (use for rotation of the heart)
What is the transverse pericardial sinus?
Where a finger can be inserted posterior to aorta and pulmonary trunk, anterior to SVC
What chambers are on the anterior, inferior and base of the heart?
Anterior: right ventricle
Base: left ventricle
Posterior: right and left atrium
What are the types of heart valve?
Tricuspid and mitral = leaflet
Pulmonary and aortic = semilunar
What supports the cusps of the valves?
Chordae tendineae connected to papillary muscles
What is the ligament arteriosum?
A remnant of the ductus arteriosus that connects the arch of the aorta to the left pulmonary artery
What artery supplies the SA node?
SA nodal branch of right coronary artery
What is the line that separates the smooth and rough parts of the interior of the right atrium?
Cristae terminalis
What type of joints are costochrondral?
Synovial
On imaging how is the difference between the internal thoracic artery and vein detected?
Thoracic artery branches off the subclavian vein distal to the splitting of the brachiocephalic trunk
Thoracic vein drains proximal to the venous angle
What chain of lymph nodes runs parallel and deep to the sternum and what drains into them?
Parasternal lymph nodes
Drains breast tissue
At which point do the subclavian vessels change their name to axillary?
Lateral border of the first rib
What is the most posterior, most superior and most inferior structure passing through the hilum?
Posterior = airway Superior = artery Inferior = vein
Where does the azygos vein drain into the SVC?
Superior to the hilum - passes from posterior and loops over it
Which vagus nerve does the recurrent laryngeal nerve branch off?
Right only
What are the attachment points of the external oblique?
Superiorly = superficial aspects of lower ribs Inferiorly = anterior part of iliac crest and pubic tubercle
What are the attachment points of the internal oblique?
Superiorly = inferior border of the lower ribs Inferiorly = thoracolumbar fascia of the lower back and iliac crest
Where are the attachment points of the transversus abdominus?
Superiorly = deep aspects of the lower ribs Inferiorly = thoracolumbar fascia of the lower back and the iliac crest
What nerves supply the abdominal muscles?
The thoracoabdominal nerves - continuation of 7-11th intercostal nerves
Where is the split between the superior and inferior mediastinum?
From the sternal angle to T4
Where is the safe triangle for drainage of a pneumothorax?
Anterior border of the latissimus dorsi,
Posterior border of the pectorals major,
What are the 2 types of hiatus hernia?
Paraoesophageal hiatus hernia = loop of stomach slides through hiatus
Sliding hiatus hernia = bulge of stomach through hiatus
What are the inguinal ligaments made from?
The inferior border of the external oblique aponeuroses
What are the entrance and exit of the inguinal canal and where are these?
Entrance = deep ring (midpoint of the inguinal canal) Exit = superficial ring (pubic tubercle)
What is contained within the spermatic cord?
Pampiniform venous plexus, Testicular artery, Vas deferens, Autonomic nerves, Lymphatic drainage
What is contained within the inguinal canal in males and females?
Males: Spermatic cord
Females: round ligament of the uterus
What is the difference in route of a direct and indirect hernia?
Direct: a finger of peritoneum forces directly through the wall of the inguinal canal and out the superficial ring
Indirect: a finger of peritoneum travels though the deep ring and out of the superficial ring of the inguinal canal
What are the sensory nerves of the nasal cavity, the larynx and the pharynx?
Nasal cavity: trigeminal (CNV)
Pharynx: glossopharyngeal (CNIX)
Larynx: vagus (CNX)
What are the sympathetic nerves to the heart and lungs called and what level do they leave the vertebral column?
Cardiopulmonary splanchnic nerves
T1-5
Where does the parasympathetic innervation fo the heart come from?
Vagus nerve (CNX)
Which cranial nerves are parasympathetic?
CN III, VII, IX, X (oculomotor, facial, glossopharyngeal and vagus)
What type of autonomic nerves are pelvic splanchnic nerves?
Parasympathetic
Pelvic = Parasympathetic
Where is the baroreceptor found and what nerve do they travel in?
Aortic arch
Vagus nerve
What nerve increases cardiac rate and force and what decreases the rate?
Sympathetic (cardiopulmonary splanchnic nerves) increase rate + force
Parasympathetic (vagus) decrease rate
Which side of the central sulcus is somatomotor and which is somatosensory?
Somatomotor = anterior (parietal lobe) Somatosensory = posterior (frontal lobe)
What type of pain is bony pain (broken bone, slipped spinal disk) or pleural pain felt as?
Somatic pain
What type of pain is tracheal, aortic and oesophageal?
Visceral
Where does the thoracic duct run?
Through the diaphragm at the aortic hiatus,
Up the thorax between the thoracic aorta and the azygous vein in the posterior mediastinum,
Above the arch of the aorta follows the oesophagus to the left venous angle
Which side of the thorax is mainly arterial and which is mainly venous?
Right = venous Left = arterial
What structures are in the posterior mediastinum?
Thoracic duct, Thoracic aorta, Oesophagus, Trachea and 2 main bronchi (ish), Azygous vein
What is the difference between radiating and referred pain?
Radiating: felt at the site of injury and a site distal to it
Referred: felt at just a site distal to that of the cause of the pain
Which is usually the most dominant coronary artery?
Right coronary artery
Which artery is most commonly occluded in an MI?
LAD
What vessels are most commonly used in CABG?
Radial artery,
Internal thoracic artery,
Great saphenous vein (from leg)
What artery supplies the SA and AV nodes?
Right coronary artery
What drains into the left atrium of the heart?
Left and right superior and inferior pulmonary veins (4 total)
What 2 vessels form the SVC?
Right and left brachiocephalic veins
What 2 vessels form the brachiocephalic trunk?
Internal jugular vein and subclavian vein (anterior to scalenus)
What groove do the right coronary artery, coronary sinus and the left anterior descending (LAD) artery travel in?
RCA = coronary groove
LAD = anterior interventricular groove
Coronary sinus = atrioventricular groove
Where does the vagus nerve pass through the diaphragm?
At T10 (with oesophagus)
What are the first anterior branches of the descending (thoracic aorta)?
Bronchial arteries
What drains into the right and left venous angles?
Right venous angle: Right lymphatic duct
Left venous angle: Thoracic duct
What lymph nodes are at the bifurcation of the trachea and what are at the hilum?
Bifurcation = tracheobronchial Hilum = Bronchopulmonary
What is the swelling of lymph under the diaphragm?
The cisterna chyli
Where does the right phrenic nerve pass through the diaphragm?
At T8 (with the IVC) - to supply diaphragm from the inferior aspect
What is the order of vessels in the superior mediastinum from anterior to posterior?
Brachiocephalic veins + SVC Arch of the aorta Trachea Oesophagus thoracic duct
Where do the vagus nerves supply somatosensory, somatomotor and parasympathetic to?
Somatosensory: palate, larynx, laryngopharynx
Somatomotor: pharynx and larynx
Parasympathetic: thoracic and abdominal organs
After the recurrent laryngeal nerves have branched off what kind of fibres are contained within the vagus nerves?
Parasympathetic
Describe the dentition from anterior to posterior
On each side; have maxillary and a mandibular (top/bottom); 2 incisors, 1 canine, 2 pre-molars 3 molars
(8 total - 8th = wisdom tooth)
Where are the muscles of mastication found and which ones open and close the jaw?
Close:
Masseter (at bottom on angle of the mandible)
Temporalis (temporal bone)
Medial pterygoid (runs vertically between temporalis and masseter)
Open: Lateral pterygoid (runs laterally under temporalis)
What nerve innervates the muscles of mastication and which foramen does it pass through?
Trigeminal (CNV) - sensory and motor
Formaen ovale
What type of tissues are tonsils and what are the visible tonsils that are usually removed?
Lymphoid tissue
Paletine tonsils
What type of taste buds have taste function and what have sensory function?
Taste:
Circumvallate,
Foliate,
Fungiform
Sensory:
Filiform (FEELiform)
What nerves supply taste and sensation to the posterior and anterior parts of the tongue?
Posterior: all glossopharyngeal
Anterior:
Taste = facial (CNVII)
Sensory = trigeminal (CNV)
What provides the sensory and motor innervation of the gag reflex?
Sensory = glossopharyngeal Motor = vagus
Which branches of the trigeminal nerve supply the superior and inferior gingiva?
Superior: V2
Inferior: V3
What nerve supplies the salivary glands?
Parotid: Glossopharyngeal (CNIX)
Submandibular + sublingual: facial (CNVII)
What are the 3 salivary glands and where are they?
Parotid (by ear - drains to upper 2nd molar)
Submandibular (under angle of mandible)
Sublingual (under tongue)
What are the 4 pairs of extrinsic muscles in the tongue and what nerves supply them?
Hypoglassal (CNXII):
Genioglossus,
Hyoglassus,
Styloglossus
Vagus (CNX):
Palatoglossus
What is the upper oesophageal sphincter called and what vertebral level is it at?
Cricopharyngeus
C6
What type of muscles are in the pharynx? Describe their action and nerve supply
3 circular muscles - overlap to give squeezing action (upper, middle and lower constrictors)
3 longitudinal muscles
All innervated by vagus nerve
Describe the process of swallowing and the nerve supply of this?
- Close lips to prevent drooling (orbicularis oris - CNVII)
- Tongue (CNXII) pushes food towards oropharynx
- Pharyngeal constrictor muscles (CNX) push food inferiorly towards oesophagus
- Longitundinal muscles of pharynx (CNX) contract to raise larynx
What type of autonomic nerve increases peristalsis and what decreases it?
Parasympathetic increases
Sympathetic decreases
What is the parasympathetic supply to the oesophagus?
Vagus nerve
What are the 3 constrictions of the oesophagus?
Cervical = cricopharyngeus muscle (UOS) Thoracic = arch of aorta + left main bronchus Diaphragmatic = passing through diaphragm (LOS)
What is the change in mucosal lining of the oesophagus at the lower oesophageal sphincter called?
Z line
What are the parts of the stomach?
Fundus = very top (gas and air collection) Cardia = at oesophageal entrance Body = middle Pyloric antrum = by pyloric sphincter Incisura angularis = in lesser curvature
What are the parts of the large intestine?
Caecum, Appendix, Ascending, Transverse, Descending
Name the foregut, midgut and handout organs
Foregut:
Stomach, Liver, 1/2 pancreas, 1/2 duodenum, gall bladder, spleen
Midgut:
1/2 duodenum, jejunum, ileum, ascending colon, 2/3 transverse colon, caecum, 1/2 pancreas
Hindgut:
1/3 transverse colon to proximal 1/2 anal canal
Name the intraperitoneal and the retroperitoneal organs
Retroperitoneal: SAD PUCKER
S-suprarenal
A-aorta/IVC
D-duodenum
P-pancreas U-ureters C-colon (ascending + descending) K-kidneys E-(o)esophagus R-rectum
What splits the peritoneal cavity into a greater and lesser sac?
Lesser omentum (between liver and duodenum/stomach)
What is the mesentery proper?
The part of the mesentery that attaches to the small intestine
What vasculature runs in the lesser omentum?
Portal triad
What is the only entrance to the lesser sac?
Omental foramen
What are the pouches found in the greater sac in males are females (where fluid from ascites would collect)?
Males: rectovesical pouch
Female: rectouterine (posterior) and vesicouterine (anterior) pouches
Where must the needle be placed for paracentesis?
Lateral to the rectus sheath
Where does the parasympathetic innervation of the abdomen come from?
Vagus nerve (until end of midgut) Pelvic splanchnic nerves (S2,3,4)
Where is foregut, midgut and handout pain felt?
Foregut = epigastric Midgut = umbilical Hindgut = pubic
What vasculature does each functional lobe of the liver have?
Branch of hepatic artery,
Branch of hepatic vein,
Bile drainage,
IVC drainage
What are the 2 ligaments in the lesser omentum?
Hepatoduodenal,
Hepatogastric
What are the arteries that supply the lesser and greater curvature of the stomach and what structures are they contained within?
Lesser curvature:
Left and right gastric arteries
Lesser omentum
Greater curvature:
Left and right gastro-omental
Greater omentum
Where does fluid drain into when lying supine?
Hepatorenal recess, greater sac
What 2 major veins form the hepatic vein?
Splenic vein and superior mesenteric vein
IMV drains into splenic
Where does the blood supply to the gall bladder come from?
Cystic artery - branch of right hepatic artery
What types of cells carry out the exocrine and endocrine functions of the pancreas?
Exocrine: acinar cells
Endocrine: islets of langerhans
Where does the bile duct drain into the duodenum?
The ampulla of Vater with the main pancreatic duct
What sphincter controls the release of bile into he duodenum?
Sphincter of Oddi
What is the blood supply to the pancreas?
Superior and inferior pancreaticoduodenal arteries (coeliac trunk and SMA)
Which quadrants are the jejunum and ileum found in?
All 4
What are the differences between the jejunum and the ileum?
Colour: jejunum darker Vasculature: jejunum more vascular Thickness: jejunum thicker Mesenteric fat: ileum has more fat Circular folds: jejunum has more and larger folds Peyers patches: only in ileum
What is the vascular supply and drainage of the jejunum and ileum?
Supply: SMA via jejunal and ileal arteries
Drainage: SMV via jejunal and ileal veins
What are the collections of lymph nodes in the abdomen?
Celiac (drains foregut organs) Superior mesenteric (drains midgut organs) Inferior mesenteric (drains hindgut organs) Lumbar (drains kidneys, lower limbs, posterior abdo wall and pelvis)
Where is fat absorbed into in the small intestine?
Lacteal vessels that drain into the lymphatic drainage
What is the course of lymph drainage in the abdomen?
Superficial lymph nodes,
Deep lymph nodes,
Thoracic duct
Where are the potential sites for pus collection on either side of the colon?
Paracolic gutters
What are teniae coli?
3 bands of longitudinal muscle that run the length of the large intestine
What are the order of branches off the SMA?
Inferior pancreaticoduodenal, Middle colic, Right colic, Iliocolic branches (jejunal and ileal arteries)
Where does the appendicular artery arise from?
The SMA (iliocolic branch)
What is the difference between the arcades and vasa rectae in the jejunal and ileal blood supply?
Jejunal: longer vasa rectae, larger and fewer arcades
Ilial: shorter vasa rectae, smaller and more arcades
What arteries branch off the IMA?
Left colic,
Sigmoid arteries,
Superior rectal artery
What is the blood supply to the rectum and anal canal?
Superior rectal (from IMA) Middle and inferior rectal from internal iliac (beyond pectinate line)
What is the venous drainage of the rectum?
Superior rectal vein to IMA (then to splenic and hepatic portal)
Middle and inferior rectal veins to internal iliac vein (and IVC)
What muscle forms the pelvic floor?
Levator ani
At what point does the rectum transition into the anal canal?
Tip of the coccyx
What is the anus?
The distal end orifice that faeces pass through
What is the most posterior organ?
Rectum
What lies anterior to the rectum in males and females?
Males: prostate
Females: vagina/cervix
What type of muscle is the levator ani and what is its nervous supply?
Skeletal Pudendal nerve (S2,3,4) - somatic
What forms the external anal sphincter?
A branch of the levator ani (puborectalis)
Increases rectal angle when contracted
What forms the internal anal sphincter?
A thickening of the walls of the GI tract
Where does the sympathetic and parasympathetic innervation of the rectum/anal canal come from?
Sympathetic: T12-L2
Parasympathetic: S2,3,4 (with pudendal nerve)
What does the pectinate line indicate?
The line between he parts of the GI tract formed from endoderm and ectoderm
Signifies the difference between visceral dn somatic structures
What are the changes in the nervous supply, the arterial supple, the venous drainage and the lymphatic drainage either side of the pectinate line?
Above pectinate line: Autonomic, IMA, Hepatic portal (via IMV), Inferior mesenteric nodes
Below pectinate line: Somatic/pudendal, Internal iliac artery, IVC (via internal iliac vein), Superficial inguinal nodes
What are the collections of lymph nodes draining pelvic organs?
Internal iliac (inferior pelvis) External iliac (lower limbs + superior pelvis) Common iliac (combines internal and external iliac)
What foramen do the trigeminal, facial, glossopharyngeal, vagus and hypoglossal nerves pass through?
V1; superior orbital fissure V2; foramen rotundum V3; foramen ovale VII; internal acoustic meatus IX; jugular foramen X; jugular foramen XII; hypoglossal canal
What are the types of synovial joint and give an example of each?
Pivot (atlanto-axial), Plane (carpals), Hinge (elbow/knee), Biaxial (carpal-metacarpal/metcarpal-phalangeal), Ball&socket (hip/shoulder)
What does the cervical spine have that the rest of the spine doesn’t?
Vertebral foramen
What are the different vertebrae in the cervical spine?
C1 = atlas; no spinous process
C2 = axis; odontoid process
C7; larger spinous process (first palpable)
What kind of joints connect vertebrae?
Facet joints (synovial)
Where do spinal nerves leave the vertebral column?
Intervertebral foramen (only point where a spinal nerve exists)
What is the sleeve that covers bones and what is its purpose?
Periosteum - innervates and vasculates the bone
What is the central and outer part of the skeleton?
Axial and appendicular
What connects the transverse process to the vertebral body and what connects it to the spinous process?
Vertebral body; pedicle
Spinous process; lamina
What are the bones of the hands and the feet?
Hands:
Carpals = wrist
Metacarpals = palm
Phalanges = fingers
Feet:
Tarsals = hind foot
Metatarsals = forefoot
Phalanges = toes
