Anatomy Flashcards
1
Q
What makes up the upper respiratory tract?
A
Right & left nasal cavities
Oral cavity
Naso-/Oro-/Laryngo- pharynx
Larynx
2
Q
What makes up the lower respiratory tract?
A
Trachea Right & left main bronchi Lobar bronchi Segmental bronchi Bronchioles Alveoli
3
Q
What is the division between the URT and LRT?
A
The trachea
4
Q
At which level does the larynx (URT) become the trachea (LRT)?
A
C6 vertebrae
5
Q
The trachea can be palpated at the ________
A
Jugular notch of the manubrium
6
Q
The isthmus of the thyroid gland is anterior to the tracheal cartilages ___
A
2-4
7
Q
What connects the right and left side of the thyroid gland (forms an H shape)
A
Isthmus
8
Q
Where is the thorax?
A
Between the neck and the abdomen
9
Q
What are the components of the thorax?
A
Chest walls
Chest cavity
10
Q
What is the function of the chest wall?
A
Protection of the heart and lungs
Making the movements of tissue
Breast tissue –> lactation
11
Q
Where is the chest cavity located?
A
Within the chest walls
12
Q
What does the chest cavity contain?
A
Vital organs (Viscera) + major vessels and nerves
13
Q
What does the chest cavity consist of?
A
Mediastinum & right and left plural cavities
14
Q
What are the layers of the chest wall (superficial to deep)?
A
Skin
Fascia (Superficial then deep)
Bone / Joints
Parietal pleura
15
Q
The chest cavity is divided into which 3 areas?
A
Left pleural cavityRight pleural cavityMediastinum (in between)
16
Q
The pleura in contact with the chest wall is called ____ pleura
A
Parietal
17
Q
The pleura in contact with the lungs is called ___ pleura
A
Visceral
18
Q
What does the pleural cavity contain?
A
Pleural fluid
19
Q
What is the function of pleural fluid?
A
Cause surface tension between parietal and visceral pleura
Acts as a lubricant
20
Q
Each lung has __ Brunchopulmonary segments
A
10
21
Q
How many lobes does the right lung contain?
A
3
22
Q
Which lung contains 2 lobes?
A
Left lung
23
Q
Does each bronchopulmonary segment have its own blood supply?
A
Yes
24
Q
What defines a true rib?
A
Attach via their costal cartilage to the sternum via a single bar or cartilage
25
What defines a false rib?
Attach via costal cartilage above to the sternum (via common costal cartilage = costal margin)
26
What defines floating ribs?
No attachment to the sternum
27
Which are the true ribs?
1-7
28
Which are the false ribs?
8-10
29
Which are the floating ribs?
11-12
30
How many intercostal spaces are there?
11
31
What makes up the sternum?
Manubrium
Body
Xiphoid
Sternal angle
32
What are the joints of breathing and where are they found?
COSTOVERTEBRAL: Between ribs and vertebrae
COSTOCHONDRAL: Between ribs and costal cartilage
STERNOCOSTAL: Between the sternum and the costal cartilage
33
Which layers of skeletal muscle are located between the ribs & within the intercostal spaces (superficial to deep)?
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
34
Where do the layers of intercostal muscles attach?
Between adjacent ribs
35
How do the intercostal muscles make the chest wall expand during breathing?
By pulling adjacent ribs upwards and outwards
36
What is the main skeletal muscle of breathing?
The diaphragm
37
What does each intercostal space carry? Where is this located?
A neuro-vascular bundle between internal and innermost intercostal muscle layers
38
What constitutes a neuro-vascular bundle?
Nerve, Artery &Vein
39
What is the nerve supply to the intercostal spaces?
Anterior rams of spinal nerve (aka intercostal nerve)
40
What is the posterior arterial supply to the intercostal spaces?
Thoracic aorta
41
What is the anterior arterial supply to the intercostal spaces?
Internal thoracic artery
42
What is the posterior venous drainage of the intercostal spaces?
Azygous vein
43
What is the anterior venous drainage of the intercostal spaces
Internal thoracic vein
44
The intercostal spaces have ___ arterial and venous supply
Dual
45
Which arteries supply the chest wall?
Bilateral posterior intercostal arteries
46
The bronchial arteries are branches from the anterior surface of the ______
Thoracic aorta
47
The thoracic duct accompanies the ____ through the diaphragm
Aorta
48
What forms the floor of the chest cavity?
Diaphragm
49
What forms the roof of the abdominal cavity?
Diaphragm
50
The diaphragm has _____ to allow structures to pass
opening
51
What type of muscle is the diaphragm?
Skeletal muscle with central tendon
52
Why is the right dome of the diaphragm normally more superior than the left?
Because of the presence of the liver inferiorly
53
The muscular part of the diaphragm attaches peripherally to (anterior to posterior)?
1. Sternum
2. Lower 6 ribs & costal cartilage
3. L1-L3 vertebral bodies
54
What is the nerve supply of the diaphragm?
Phrenic nerve
55
Where does the phrenic nerve originate from?
C3,4 & 5 anterior rami
| keep the diaphragm alive
56
The phrenic nerve is found on the anterior aspect of the ______ muscle and descends over the _____ aspects of the heart
Scalenus anterior
| Lateral
57
The phrenic nerves supply the _____ and ______ axons to the diaphragm & ______
Somatic sensory
Sympathetic
Fibrous pericardium
58
The phrenic nerve supplies somatic _____ axons to the diaphragm
Motor
59
What are the 3 steps of inspiration mechanics?
Diaphragm contracts and descends
Intercostal muscles contract and elevate ribs
Chest walls pull the lungs outwards with them (parietal pleura)
60
What does the diaphragm contracting do to the vertical chest dimension?
Increases it
61
Which chest dimensions are increased by the intercostal muscles contracting?
A-P and lateral
62
What effect does the chest wall pulling the lungs outwards have?
CREATES NEGATIVE PRESSURE
| Air flows into the lungs
63
What are the 3 steps of expiration mechanics?
Diaphragm relaxes and rises
Intercostal muscles relax lowering ribs
Elastic tissue of lungs recoils
64
The lateral quadrants to axillary nodes in the breast show _____ drainage
Unilateral
65
The medial quadrants to parasternal nodes show _____ drainage
Bilateral
66
Where does blood supply to the breast come from?
Internal thoracic artery which comes from the subclavian vein
67
What is the groove in between the pectorals major and deltoid called?
Deltopectoral groove
68
Which vein drains the upper limb and drains into deeper veins in the neck?
Cephalic vein
69
Where is the costodiaphragmatic recess located?
Between the diaphragmatic parietal pleura and the costal parietal pleura
70
What is the most inferior region of the costodiaphragmatic recess, laterally?
The costophrenic angle
71
Abnormal fluid in the pleural cavity drains into the _______
Costodiaphragmatic recess
72
What is auscultation
Listening to the sound of air moving through the larynx
73
Which parts of the lung need to be auscultated during an exam?
All 5 lung lobes
Apices
Bases
74
Describe the dual blood supply to the lungs
OXYGENATED BLOOD
Pulmonary veins x 4
Bronchial arteries
DEOXYGENATED BLOOD
Pulmonary arteries x 2
Bronchial veins
75
What are the two types of bronchi?
LOBAR - provide lung lobes with air
| SEGMENTAL - provide bronchopulmonary segments with air
76
The sternal angle is at what rib level?
Level of rib 2
77
Which area on the ribs carriers the intercostal NVB?
Costal groove
78
Which nerve innervates serratus anterior? Injury to this nerve causes what?
Long thoracic nerve
| Winged scapula
79
What are the structures of the lung root?
```
Main bronchus
Pulmonary veins x 2
Pulmonary artery
Lymphatics
Sensory visceral afferents
Sympathetic and parasympathetic nerves
```
80
Coughing occurs in response to the stimulation of receptors in _______ (3)
Oropharyngeal mucosa
Laryngopharyngeal mucosa
Laryngeal mucosa
81
From which cranial nerve will the nasopharynx and oropharynx relay action potentials from?
CN IX (Glossopharyngeal nerve)
82
From which cranial nerve does the laryngopharynx relay action potentials from?
CN X (Vagus nerve)
83
What are carotid sheaths?
Protective "tubes" of cervical deep fascia
84
Where do the carotid sheets attach?
Superiorly to the bones of the base of the skull
| Blend inferiorly with the fascia of the mediastinum
85
What do the carotid sheaths (right/left) contain? (4)
Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein
86
How do visceral pleura and respiratory tree visceral afferents connect with the CNS? (3)
Sympathetic trunk
Pulmonary plexus
Vagus nerve (in the carotid sheath)
87
What is meant by "visceral afferent"?
Sensory nerve (that arrives) from an organ
88
What does the pulmonary plexus contain? (3)
Sympathetic axons
Parasympathetic axons
Visceral afferents
89
What is a plexus?
An intertwining of nerves
90
The sympathetic and parasympathetic axons in the pulmonary plexus are _____ nerves that supply the _____
Motor
| Heart
91
The motor axons travel from the tracheal _____ along the branches of the _________ to supply all ____ and ______
Bifurcation
Respiratory tree
Mucous glands
Bronchiolar smooth muscles
92
Describe the route of the pulmonary visceral afferents from the visceral pleura to the medulla
From visceral pleura
| Respiratory tree to the plexus then follow the vagus nerve to the medulla to the brain
93
Once the sensory receptors have been stimulated the CNS responds by rapidly coordinating _____
Deep inspiration
94
Deep inspiration requires use of ___(4)
Diaphragm
Intercostal muscles
Accessory muscles of inspiration
95
Which nerves innervate the diaphragm?
Phrenic nerves
96
Which nerves innervate the intercostal muscles?
Intercostal nerves
97
What is the difference between quiet and forced inspiration in terms of action potentials via the phrenic nerves?
In deep/forced inspiration a greater outflow of action potentials with a longer duration cause the diaphragm to flatten and descend maximally
98
The intercostal nerves are the anterior rami of which spinal nerves?
T1-T11
99
What are the accessory muscles of forced / deep inspiration?
Pectoralis Major
Pectoralis minor
Sternocleidomastoid
Scalenus anterior, posterior
100
Where does the pectoralis major attach?
Between the sternum/ribs and humerus
101
What is the function of the pectoralis major?
Adduction and medial rotation of the humerus
102
What position must the upper limb be in so the pectoralis major can pull the ribcage upwards/outwards?
Upper limb position is "fixed" E.g. by holing on to the air of the chair or the thigh
103
What is the recruitment of accessory muscles a clinical sign of
Dyspnoea?
104
What is the function of the pectoralis minor in terms of deep inspiration?
Puling ribs 3-5 superiorly towards the coracoid process of the scapula
105
Where does the sternocleidomastoid attach?
Between the sternum/clavicle and mastoid process of the temporal bone
106
Where do the scalenus anterior, medius & posterior attach?
Between cervical vertebrae; ribs 1 and 2
107
Which nerve stimulates the adduction of the vocal cords to close the rims glottidis during the coughing reflex?
CN X - Vagus nerve
108
Where do the intrinsic muscles of the larynx attach?
Between the cartilages
109
What do the intrinsic muscles of the larynx move? What does this result?
The cartilages - movement of the vocal cords
110
What type of muscle are the intrinsic muscles of the larynx?
Skeletal (voluntary) muscle
111
What type of nerve is CN X?
Mixed (sensory and motor)
112
Where does the cranial nerve connect with the CNS?
At the medulla oblongata of the brainstem
113
Through which structure do the vagus nerves (left&right) pass through the neck?
Within the carotid sheath
114
What is the important function of CN X to coughing?
Supply somatic sensory and somatic motor axons to the larynx
115
To which part of the larynx do the sensory parts of CNX go?
Mucosa lining of the larynx
116
To which part of the larynx do the motor parts of CNX go?
Intrinsic muscles of the larynx
117
In the chest, the vagus nerves descend ______ to the chest organs (including the lungs via the pulmonary plexus
Posterior
118
The vagus nerves pass through the diaphragm on the _______
Oesophagus
119
Where do the vagus nerves divide into many parasympathetic braches?
On the surface of the stomach
120
Which structures do the parasympathetic branches of the vagus nerve supply? (2)
Foregut and Midgut organs
121
Does the vagus or the phrenic nerve pass anterior to the root of the lung?
The phrenic nerve
122
What is the purpose of anterolateral abdominal wall muscle contraction in terms of the cough reflex?
Raise intra-abdominal pressure
123
Which muscles forcefully increase the the intra-abdominal pressure during deep expiration?
Right left anterolateral abdominal wall and the diaphragm
124
Which muscles are involved in deep expiration? (4 - right and left of each)
Rectus abdominis
External oblique
Internal oblique
Transverses abdominus
125
What is an aponeurosis?
Flattened tendon
126
The aponeurosis of the right external oblique blends with the aponeurosis of the left external oblique the the midline ________
Linea alba
127
Where does the external oblique attach superiorly?
Superficial aspects of the lower ribs
128
Where does the eternal oblique attach inferiorly?
Anterior part of the iliac crest and the pubic tubercle
129
The fibre direction of the external oblique is the _____ as the external intercostal muscle
Same
130
Where is the lines semilunaris?
Where the muscle fibres end and the aponeurosis begins
131
_____ of the right internal oblique bless with the aponeurosis of the _______ at the midline linea alba
Aponeurosis
| Left internal oblique
132
Where does the right internal oblique attach superiorly?
The inferior border of the lower ribs
133
Where does the internal oblique attach inferiorly?
Iliac crest and thoracolumbar fascia of the lower back
134
Does the internal oblique have the same/opposite fibre direction as the internal intercostal muscles?
Same
135
Where does aponeurosis of the right transverses abdomens blend with the aponeurosis of the left transversus abdomens?
Linea alba
136
Where does the transversus abdominus attach superiorly?
Deep aspects of the lower ribs
137
Where does the transversus abdominus attach inferiorly?
Iliac crest and thoracolumbar fascia of the lower back
138
What encapsulates the rectus abdominus?
Internal oblique
External oblique
Skin
Transversus abdominis
139
Where does the the rectus abdominis attach superiorly?
Xiphoid process
| Costal margin
140
Where does the rectus abdominis attach inferiorly?
Pubis bone
| Pubic symphysis
141
The somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal part of the body wall (soma) are convey within the _____
Thoracoabdominal nerves
142
The 7th-11th intercostal nerves travel ______ then their terminal branches leave the _________ in which plane?
Anteriorly
Intercostal spaces
In the plane between the internal oblique and transversus abdominus
143
What is the name of the nerves in the plane between the internal oblique and transversus abdominus?
Thoracoabdominal nerves
144
What innervates the upper part of the abdominal wall?
Thoracoabdominal nerves
145
What innervates the area below T12?
Subcostal nerve
146
What does the iliohypogastric nerve innervate?
Half of L1 anterior ramus
147
What does the ilioinguinal nerve innervate?
Half of L1 anterior ramus
148
What are the functions of tonic (continuous low level) contractions of anterolateral abdominal muscles?
Maintain posture
| Support the vertebral column
149
What are the function of contractions of the anterolateral abdominal muscles?
Movements of the vertebral column (flexion; lateral flexion; rotations)
Guarding - protect the abdominal viscera
Increase intra-abdominal pressure (to assist defecation; micturition; labour)
Aid forced expiration
150
What is a pneumothorax?
Alveolar air in the pleural cavity
151
How can dynamic airway compression in asthma lead to a pneumothorax?
Expiration is difficult and the build-up of air trapped in alveoli can lead to rupture of lung and visceral pleura
152
By which mechanism is a pneumothorax developed?
Penetrating injury to parietal pleura or rupture of visceral pleura; loss of vacuum; elastic recoil of lungs towards lung root
153
What classifies a small pneumothorax?
2 cm between lungs and parietal pleura
154
What classifies a large pneumothorax?
> 2 cm between lungs and parietal pleura
155
How is a pneumothorax diagnosed by examination?
Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper-resonance on percussion
156
How can a pneumothorax be diagnosed by investigation via a CXR?
Absent lung markings peripherally
| Visible lung edge
157
How does a tension pneumothorax develop?
Torn pleura creating a one-way valve allowing air to enter pleural cavity on inspiration but not expiration
158
What consequence can follow a tension pneumothorax?
Mediastinal shift
159
How can mediastinal shift, and therefore a tension pneumothorax, be diagnosed?
Deviation of the trachea - palpable on jugular notch
160
What is the consequence of mediastinal shift?
SVC compression reduces venous return to the heart causing hypotension
161
How is a large pneumothorax managed (2)?
```
Needle aspiration (thoracentesis)
Sitting of chest drain
```
162
Where should the needle enter to relieve a large pneumothorax?
4th or 5th intercostal space in the mid-axilliary line
163
How would you emergency manage a tension pneumothorax?
Insert large gauge cannula into pleural cavity via 2nd or 3rd intercostal space in the mid-clavicular line on the side of the tension pneumothorax
164
What is a hernia?
Any structure passing through another (i.e. ending up in the wrong place)
165
What is required for a hernia to develop?
Weakness of one structure (normal/congenital/surgical scar) + increased pressure on one side of that part of the wall
166
Why can a chronic cough cause a hernia?
Regular increase in intra-abdominal pressure on diaphragm, anterolateral abdominal walls (including inguinal region + femoral triangle)
167
Where do diaphragmatic hernia tend to develop?
Xiphoid attachment
Posterior attachments
Oesophageal hiatus
168
What distinguishes a paraoesophagheal hiatus hernia?
Herniated pert of stomach passes through oesophageal hiatus to become parallel to the oesophagus in the chest - Gastro-oesophageal junction doesn't move
169
What distinguishes a sliding hiatus hernia?
Herniated part of the stomach slides through oesophageal hiatus into the chest with the gastro-oesophageal junction
170
Where do inguinal hernias occur?
Uni-/bilateral
| Medial halves of inguinal region
171
What weakness and which pressure cause inguinal hernias?
```
Weakness = presence of inguinal canal
Pressure = intra-abdominal
```
172
What can cause an inguinal hernia?
Chronic cough or constipation
Occupational heavy lifting
Athletic effort
173
Where is the inguinal canal?
Between deep ring and superficial ring
174
Where is the inguinal region?
Between anterior superior iliac spine and pubic tubercle
175
What guides the testicle from its origin point in the abdomen down through the abdominal wall into the scrotum?
The gubernaculum
176
How does the testicle descend from the abdomen to the scrotum?
Testicle starts to push into transversalis fascia (drags some with its)
Bypasses transverse abdominus
Crosses internal oblique (drags some with)
Passes through superficial ring of pubic tubercle
Passes through superficial fascia (drags some with)
177
What does the layer of transversals fascia become known as when covering the testis?
Internal spermatic fascia
178
What does superficial fascia become known as later on when it covers the testis?
External spermatic fascia (covering of external oblique aponeurosis)
179
What does the internal oblique become known as later on when it covers the testis?
Cremasteric fascia
180
The structures that the testes dragged with it become known as the ____
Spermatic cord
181
Small part of peritoneum remained in scrotum after descending of testis becomes known as the ______
Tunica vaginalis
182
The point between the deep and superficial ring is the _____
Inguinal canal
183
The deep ring is where the the testes pushed into the ________
Transversals fascia
184
The superficial rings is where the testes pushed into the _______ of the scrotum
Superficial fascia
185
What does the spermatic cord contain?
Vas deferens
Testicular artery
Pampiniform plexus of veins
186
What is the function of the vas deferens?
Transports sperm
187
What are the boundaries of the femoral canal?
```
Anterior = inguinal ligament
Medial = lacunar ligament
Lateral = femoral vein
Posterior = pectinate ligament
```
188
What is a direct inguinal hernia?
Finger of peritoneum is forced through posterior wall of inguinal canal and directly out of superficial ring into the scrotum
189
What is an indirect inguinal hernia?
Finger of peritoneum is forced through the deep ring into the inguinal canal, then out of the superficial ring into the scrotum
190
How do you clinically differentiate between direct and indirect inguinal hernias?
1. Reduce hernia
2. Occlude deep ring with fingertip pressure
3. Ask patient to cough
If direct, lump will reappear
If indirect, lump will not reappear
