Anatomy Flashcards
Where would you auscultate to listen to the right middle lobe?
Between 4th and 6th ribs in mid-clavicular and mid-axillary lines
Where would to place your stethoscope to listen to lung bases
Vertebral level T 11
Where does the horizontal fissure lie in relation to surface anatomy?
Rib 4
Using surface landmarks describe where oblique fissures are
Both left and right are the level of rib 6 anterior and vertebral level T3 posterior
At which vertebral level does the larynx become the trachea and the pharynx become the oesophagus?
C6
Describe the venous drainage and arterial supply to the intercostal spaces
Anterior intercostal arteries – branch from internal thoracic artery.
Posterior intercostal arteries – branch from the thoracic aorta.
Anterior intercostal veins – drain into internal thoracic veins.
Posterior intercostal veins – drain into azygous vein.
Describe the intercostal neurovascular bundle from superior to inferior
VAN: vein, artery, nerve
At which vertebral level does the IVC penetrate the diaphragm?
T8
At which vertebral level does the oesophagus penetrate the diaphragm?
T10
At which vertebral level does the aorta penetrate the diaphragm?
T12
Which kind of muscle is the diaphragm made of?
Skeletal
Which anterior rami make up the phrenic nerve?
C3, C4 and C5
Paralysis of which nerve can cause winged scapula and why?
Severing of the long thoracic nerve can cause winged scapula as it supplies the serratus anterior muscle which allows rotation of the scapula
what are the 3 blood vessels found at either side of the sternum?
internal thoracic artery- intercostal artery branches from this and two veins
What is the most inferior part of the plural cavity
costodiaphragmatic recess with the most inferior part of this being the costophrenic angle
What sections make up the right lung?
Upper, lower and middle lobes
What sections make up the left lung?
Upper and lower lobes and the lingula.
Where is the cephalic vein located?
Delto-pectoral groove
What level does the trachea bifurcate at the carina?
T4-5 or the level of the sternal angle
Where do the inguinal ligaments attach?
Between the ASIS and pubic tubercle
What is the midpoint of the inguinal ligament?
The deep ring
What is a direct inguinal hernia?
bit of peritoneum is forced through the posterior wall of the inguinal canal and DIRECTLY out of the SUPERFICIAL ring.
What is an indirect hernia?
Bit of peritoneum is forced through the deep ring, into the inguinal canal and out the superficial ring
How would you distinguish between a direct and indirect hernia?
Reduce the hernia, occlude the ring with a finger-tip, ask the patient to cough. A direct hernia will reappear automatically as it does not need to pass through the deep ring to get into the scrotum.
Where is the vagus nerve located in respect to the phrenic nerve?
Medially
What is the order of the great vessels?
SAP- superior vena cava, aorta, pulmonary artery. Right to left.
Where is the tricuspid valve located?
deep to the coronary groove which contains the RCA.
What is the anterior interventricular groove?
It is the boundary which separates the ventricles and contains the LAD branch of the LCA.
What lies posterior to the posterior interventricular groove?
Posterior interventricular artery- it is a branch of the RCA.
What are the 2 main branches of the RCA?
Right marginal and posterior interventricular artery
Where is the LCA found?
Atrioventricular groove
What are the 4 branches of the LCA?
LAD, left marginal, left lateral/diagonal and left circumflex
What openings are there in the right atrium?
SVC, IVC and coronary sinus
What is the fossa ovalis/oval fossa?
It is a depression in the RA. A remnant of the foramen ovale.
What is the crista terminalis?
represents the boundary between smooth and rough parts of the RA.
Where is the Sinoatrial node?
inferior to the SVC opening within the RA.
How are cusps of the heart connected to the heart wall?
By tendinous cords which are anchored to papillary muscles.
Where would you auscultate the 4 heart valves?
Aortic- 2nd intercostal space right sternal edge
Pulmonary- 2nd intercostal space left sternal edge
Tricuspid- 4th intercostal space left sternal edge
Mitral- 6th intercostal space midclavicular line
What is the transverse thoracic plane?
It is the ‘line’ between the sternal angle and the T4/5 intervertebral disc. Differentiates superior and inferior mediastinum.
What vertebral level does the vagus nerve penetrate the diaphragm?
At T10 with the oesophagus.
Which vein drains in the SVC?
Azygous vein
What are the branches of the ascending aorta?
Right and left coronary artery.
What are the branches of the arch of the aorta?
Right to left- brachiocephalic trunk which has 2 branches- right common carotid and right subclavian.
Left common carotid and left subclavian.
What are the branches of the descending aorta?
inferior intercostal arteries.
Right bronchial artery. Superior and inferior left bronchial arteries
What is the venous angle?
Junction between the subclavian and internal jugular veins.
In terms of surface anatomy where is the left venous angle located?
at the left sternoclavicular joint
In relation to the lung root where do the vagus and phrenic nerves sit.
Vagus sits posteriorly and the phrenic sits anteriorly.
Which structure does the left recurrent laryngeal nerve hook underneath?
The ligament arteriosum on the arch of the aorta and does not enter the chest
which nerve is the recurrent laryngeal nerve a branch of?
The vagus nerve
Name the nerves of the superior mediastinum from lateral to medial
Phrenic, vagus and recurrent laryngeal
What structure does the right recurrent laryngeal nerve hook underneath?
Hooks under the right subclavian artery and doesn’t enter the chest.
Where does lymph from the left inferior lung lobe drain?
Right lymphatic duct
From anterior to posterior what are the structures of the posterior mediastinum?
Brachiocephalic veins and SVC, arch of the aorta, trachea, oesophagus and thoracic duct
Which cranial nerve innervates the tongue muscles?
CNXII- hypoglossal innervates all tongue muscles except the palatoglossus which is innervated by CNX- vagus.
Which CN innervates the constrictor muscles of the pharynx and the external layer of the pharyngeal muscles?
CNX- vagus
What nerves innervate the inner longitudinal muscles of the pharynx?
glossopharyngeal CNIX innervates stylopharyngeus muscle only.
Vagus CNX
Which cranial nerves control the gag reflex?
Sensory limb- CNIX glossopharyngeal
Motor limb- CNIX and CNX
Which nerves supply the anterior 2/3rds of the tongue?
General sensory: trigeminal Special sensory (taste): facial
Which nerve innervates the posterior 1/3rd of the tongue?
The glossopharyngeal nerve
What are the muscles of jaw closing?
Masseter, temporalis, medial pterygoid
What are the muscles of jaw opening?
Lateral pterigoid
which CN innervates jaw opening and closing muscles?
trigemianl nerve
Which bone are pterygoid plates a part of?
Sphenoid bone
Explain what pain there is and why it changes in appendicitis
Begins as dull and achy around the umbilicus then becomes localised and sharp in the RIF due to inflammation and irritation of the parietal peritoneum
What is the parasympathetic innervation to the GIT?
Vagus nerves- up to distal end of transverse colon.
Pelvic splanchnic nerves (S2,3&4) from descending colon to anal canal.
Is the liver a reteroperitoneal structure?
No, it is intraperitoneal.
which nerves synapse directly onto the adrenal gland?
sympathetic
Which afferent nerve fibres innervate the foregut, midgut and hindgut?
Foregut- T6-T9
Midgut- T8-T12
Hindgut- T10-L2
What is the function of the gall bladder?
stores and concentrates bile
What vertebral level does the coeliac trunk branch from the aorta?
T12 and supplies the foregut.
What artery runs superior to the pancreas?
Splenic
Where is bilirubin made?
In the spleen by the breakdown of RBCs
Which ribs protect the spleen?
9-11
What is the blood supply to the stomach?
Right from hepatic artery and left from coeliac trunk and gastric arteries.
Right from gastro-duodenal branch of hepatic artery and left from splenic artery- gastro-omental arteries
Which arteries supply foregut, midgut, hindgut?
Coeliac artery, superior mesenteric artery and inferior mesenteric artery.
Which ribs protect the liver?
right ribs 7-11
Name the 4 lobes of the liver
Right, left, caudate and quadrate
which artery supplies the gall bladder?
cystic artery
What makes up the portal triad?
Portal vein, hepatic artery and common bile duct
What two ducts join together to form the ampulla of vater?
common bile duct and pancreatic duct
What sphincter lies in the ampulla of vater?
Sphincter of oddi
What causes jaundice?
Increased circulating levels of bilirubin
Describe the blood supply to the pancreas
Mainly from pancreatic branches of splenic artery. And superior (from gastroduodenal branch of hepatic artery) + inferior (from SMA) pancreaticoduodenal arteries.
What kind of peritoneal structure is the duodenum?
Part 1 is intraperitoneal and parts 2-4 are reteroperitoneal.
What are paracolic gutters?
Part of the greater sac of the peritoneal cavity.
Where is McBurney’s point/appendiceal orifice?
1/3rd of the way between right ASIS and the umbilicus
At which vertebral level does the abdominal aorta bifurcate into the common iliac arteries?
T4
What is the marginal artery of Drummond?
Main anastomosis in the large intestine
What is the blood supply to rectum and anal canal?
Hindgut part – superior rectal artery from IMA. Somatic part (below the pectinate line) – middle and inferior rectal arteries from the internal iliac artery.
What are the 3 main sites of systemic portal anastamoses?
Distal end of oesophagus.
Skin around the umbilicus.
Rectum/anal canal.
What muscle makes up the pelvic floor?
Levator ani
At which vertebral levels does the sigmoid become the rectum and rectum become the anus?
Recto-sigmoid junction S3.
Rectum-anus anterior to tip of the coccyx
What are the 3 muscles associated with the levator ani?
iliococcygeus, puboccygeus and puborectalis
What is the nerve supply to levator ani?
Branch of sacral plexus, S3, S4.
Pudendal nerve S2, 3 and 4.
What nerve stimulates the internal and external anal sphincters?
Pudendal nerve
What route does the pudendal nerve take?
Exits the pelvis via greater sciatic foramen and reenters the perineum through lesser sciatic foramen
