Anatomy Flashcards
What are the parts of the upper respiratory tract?
R+L nasal cavities, oral cavity, naso-, oro- and laringe- pharynx and the larynx
What are the parts of the lower respiratory tract?
R+L main bronchi, lobar bronchi, segmental bronchi, bronchioles and the alveoli
Where is the separation between the upper and lower respiratory tract?
C6 vertebrae
What is the chest wall?
the chest wall protects the heart and the lungs and makes the movements of breathing
What is the chest cavity?
the chest cavity is within the chest walls and contains the vital organs and the major blood vessels and nerves, it consists of the mediastinum and the right and left pleural cavities
What is the visceral pleura?
visceral pleura is the pleura that touches the lungs
What is the parietal pleura?
parietal pleura is the pleura that touches the walls of the body
What ribs make up the first set and how many are there?
ribs 1-7 are the true ribs
What ribs make up the second set and how many are there?
ribs 8-10 are the false ribs
What ribs make up the last set and how many are there?
ribs 11 and 12 are the floating ribs
What are the three joints in the ribcage and what type of joints are they?
- sternocostal joints are synovial
- costochondral joints are not real joints
- costovertebral joints are synovial
What three main structures can be palpated in the mediastinum?
- sternal angle at costal cartilage 2
- costal margin
- xiphoid process at the end of the sternum
What is the nerve supply to the diaphragm?
C3, 4 and 5 (keeps the diaphragm alive)
What are the three layers of intercostal muscles and what nerves are they supplied by?
- external
- internal
- innermost
the nerve supply is the anterior rami of the spinal nerve
What is the posterior blood supply to the intercostal muscles?
arterial is thoracic aorta
venous is the azygous vein
What is the anterior blood supply to the intercostal muscles?
arterial is internal thoracic artery
venous is the internal thoracic vein
Describe the two blood supplies to the lungs?
pulmonary arteries and branches for oxygenation of blood for the systemic circulation
bronchial arteries which provide oxygenated blood to the lung tissue
What muscles perform which movements to facilitate inspiration?
the diaphragm contracts as do the intercostal muscles which pull the chest wall and the lungs out so that air flows in
What muscles perform which movements to facilitate expiration?
diaphragm relaxes and rises, intercostal muscles relax and the elastic tissue recoils to increase the pressure in the lungs so air flows outwards
Which rib is the sternal angle at the level of?
the sternal angle is at the level of rib 2
What are the three palpable features on the human chest?
the sternal angle, the diploid process and the costal margin
Describe the anatomy of the breast with the quadrants and where the axillary tail moves from?
there are four quadrants with the axillary tail moving out from the superolateral quadrant
Where is the drainage for the lateral quadrants in the breast and is it unilateral or bilateral?
there is unilateral drainage from lateral quadrants to axillary nodes
Where is the drainage from the medial quadrants and is it unilateral or bilateral?
there is bilateral drainage from medial quadrants to parasternal nodes
What is the order of depth of the breast, pectoral fascia and the pectoralis major?
the pectoral fascia is deep to the breast and the pectoralis major is deep to the pectoral fascia
Where does the cephalic vein sit?
the cephalic vein sits in the delta-pectoral gross where the pectoralis major meets the deltoid
What does the serratus anterior do?
the serrates anterior anchors the scapula to the ribs
What does the long thoracic nerve supply do?
the long thoracic nerve supplies the serrates anterior
Where does the latissimus dorsi run?
the latissimus dorsi runs from the humerus round the back
What is the clinical explanation for what happens in the condition ‘winged scapula’?
this is paralysis of the serratus anterior usually by injury to the long thoracic nerve
What is the anatomical relationship between the subclavian vein and the muscle?
the subclavian vein runs anterior to the muscle
What is the anatomical relationship between the subclavian artery and the subclavian vein?
the subclavian artery runs superiorly to the vein
What is the anatomical relationship between the brachial plexus and the artery?
the brachial plexus runs posteriorly to the artery
Where are the subclavian vessels within the axilla so become the axillary artery and vein?
lateral to the lateral border of rib 1 is where the subclavian vessels are within the axilla
Where does the scalenus anterior run from and to?
the scalenus anterior runs form the cervical vertebrae to the first rib
What is the little corner between the diaphragm and the base of the lung called?
costodiaphragmatic recess
What clinical sign is seen on a CXR if there is fluid in the pleural space?
there will be blunting of the costophrenic angle
Explain the anatomy of the mediastinal parietal pleura?
the mediastinal parietal pleura is reflected onto the lung as visceral pleura at the lung root
What is in the root of the lungs at the right?
the main bronchi with the pulmonary arteries next to it, the black pulmonary lymph nodes and pulmonary veins are below
What is in the root of the lungs at the left?
the main bronchus with the pulmonary artery above and the black pulmonary lymph nodes below and the veins are to the side and below the bronchus
Where are the main places that the lung should be auscultated?
- superior to the medial 1/3rd of the clavicle to listen to the apex
- between ribs 4 and 6 in the mid-clavicular and mid-axillary lines to heat the middles lobe
- in the scapular line at T11
- at the left costodiaphragmatic cavity
Give a detailed summary of the first step of a cough
stimulation of sensory receptors in the mucosa of oropharynx, laryngopharynx, larynx and respiratory tree from trachea to bronchioles
Give a detailed summary of the second step of a cough
- deep inspiration using diaphragm, intercostals and accessory muscles
- adduction of the vocal cords to close the rim glottidis
- contraction of the anterolateral abdominal wall muscles so diaphragm moves superiorly to build up pressure
- vocal cords abduct to open rima glottides
- CN 5 tenses soft palate and is elevated by vagus nerve to close off entrance to nasopharynx and direct air through oral cavity
Where does the upper respiratory tract end?
up to the portion of the larynx above the vocal cords
What is the sensory nerve supply to the mucosa lining the nasal cavity?
CN 5
What is the sensory nerve supply to the mucosa lining the pharynx?
CN 9
What is the sensory nerve supply to the mucosa lining the larynx?
CN 10
What does the carotid sheath contain?
- vagus nerve
- internal carotid artery
- common carotid artery
- internal jugular vein
Where does the respiratory mucosa go down until?
the level of the terminal bronchioles or alveoli
What does the pulmonary plexus consist of?
- sympathetic axons
- parasympathetic axons
- visceral afferents
Where do motor axons travel and what do they supply?
from the tracheal bifurcation along the respiratory tree to supply all mucous glands and all bronchiolar smooth muscles
Where do the pulmonary visceral afferents travel?
from visceral pleura and respiratory tree to the plexus then follow the vagus nerve to the medullas of the brainstem
Where does the phrenic nerve travel and what does it supply?
found in the neck on the anterior surface of the scalenus anterior muscle and descends over the lateral aspect of the fibrous pericardium anterior to the lung root
it supplies somatic sensory and sympathetic axons to diaphragm and fibrous pericardium supplies somatic motor to the diaphragm
What are the accessory muscles of inspiration?
- external oblique (hands in pockets)
- internal oblique (cuddle)
- transverse abdominus
- rectus abdominus
What are the names of the three laryngeal cartilages?
thyroid, cricoid and arytenoid
What is the rima glottidis?
it is the narrowest part of the larynx and is located within the thyroid cartilage
What type of muscle are the intrinsic muscles the larynx, where do they attach and what are they supplied by?
- skeletal muscles
- attach between the cartilages of the larynx
- supplied by branches of the vagus nerves
Where does the vagus nerve run?
connects at the medulla, descends through the neck within the carotid sheath and descends posterior to the lung root to pass through the diaphragm on the oesophagus
What can simple and tension pneumothoraces occur secondary to?
- pulmonary disease
- chronic cough
In what type of person is primary spontaneous pneumothorax common?
tall, thin men who smoke and inhale drugs
What are secondary spontaneous pneumothoraces related to?
- underlying COPD
- cystic fibrosis
What is a tension pneumothorax?
air leaks into pleural space in inspiration but doesn’t;t escape during expiration so there is intra-pleural pressure build-up leading to mediastinal shift and impaired cardiac function
How is a pneumothorax diagnosed?
- CXR = absent lung markings peripherally, lung edge could be visible
- examination = reduced ipsilateral chest expansion and breath sounds, hyper-resonance on percussion
What is the treatment for a large pneumothorax?
- needle aspiration
- chest drain insertion via 4th or 5th intercostal space in the midaxilliary line
How is a tension pneumothorax treated?
insert a large cannula into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line
What is a hernia?
any structure passing through another and ending up in the wrong place
What are the two features required for a hernia to form?
- weakness of one structure commonly a part of the body wall
- increased pressure on one side of that part of the wall
What are the five type of hernia?
- diaphragmatic
- umbilical
- inguinal
- incisional
- femoral
What does chronic cough do to the pressure?
increased intra-abdominal pressure on the diaphragam and the anterolateral abdominal wall
Where are the areas of weakness in the diaphragm and where do hernias develop?
- attachments to the xiphoid
- posterior attachments
so hernia develop in the - caval opening
- aortic hiatus
What are the two types of hiatus hernia?
- paraoesophagheal hiatus hernia (part of stomach is parallel to oesophagus)
- sliding hiatus hernia (part of stomach moves with gastro-oesophageal junction)
What do the inguinal ligaments form?
the floors of the inguinal canals and the inferior borders of the external oblique aponeuroses
What layers do the testes go through in its descent?
- processus vaginalis
- internmal spermatic fascia
- cremasteric fascia
- V shaped defect in the medial end of the external oblique aponeurosis
- external spermatic fascia
What is contained in the right spermatic cord?
- vas deferens
- testicular artery
- pamipiniform plexus
What is a direct inguinal hernia?
finger of peritoneum forced through the inguinal canal’s posterior wall out of the superficial ring into the scrotum
What is an indirect hernia?
through the deep ring and into the inguinal canal then out of the superficial ring into the scrotum
How to test between an indirect and a direct inguinal hernia?
reduce the hernia, occlude the deep ring with finger, ask patient to cough, direct will reappear and the indirect will not
What direction do external intercostal muscles run?
hands in pockets
What direction do internal intercostal muscles run?
hugging
What are the layers of the skin from superficial to deep?
skin superficial fascia deep fascia pecs/serratus intercostal muscle parietal pleura
What is the order of the artery, vein and nerve bundle between ribs from superficial to deep?
V A N
Where does the phrenic nerve run?
in front of hilum
Where does the vagus nerve run?
behind hilum
Where is the separation of the trachea into the bronchi?
T4 at the carina
What does the hilum look like in the left lung?
posterior is straight and anterior is a bulge
What is the appearance difference between the right and left hila?
right is more rounded
