Anatomy Flashcards
Scalpel system used to put on dissection blades
Swann Morton system
Can the first rib be felt in the living?
No because it is behind the clavicle and the pectoralis major muscle
Where is the sternal angle and what structures can we gauge from it
The sternal angle (also called the Angle of Louis) is between the manubrium of the sternum and the body of the sternum
It is connected to the second costal cartilage of the ribs
Where is the lower coastal margin and what does it seperate
The lower coastal margin seperates the thorax and the abdomen, it is the bony ridge of the bottom of the ribs
Where would the midclavicular line pass through (think of in a male)
It would be half way between the acriomioclaviocular joint and the sternoclavicular joint, going down (through the nipple for men), and passing in between the superior iliac spine and the pubic tubercle
Give 5 lines (running from head to toe) used to describe the body
Midline
Mid-clavicular line
Anterior axillary line (from the anterior axillary fold)
Mid-axillary line
Posterior axillary line (from the posterior axillary fold)
Give the origin, insertion, innervation and function of pectoralis major
Origin = medial half of the clavicle, sternum and 7 costal cartilages Insertion = intertubercular sulcus of the humerus Innervation = medial and lateral pectoral nerves Function = adduction, medial rotation and flexion of the humerus at the shoulder joint
Give the origin, insertion, innervation and function of pectoralis minor
Origin = 3rd, 4th and 5th rib anterior surface Insertion = coracoid process of the scapula Innervation = medial pectoral nerves Function = depresses the tip of the shoulder and protracts the scapula
Give the origin, insertion, innervation and function of serratus anterior muscle
Origin = Ribs 1 to 8 (or 9) Insertion = medial border of the scapula Innervation = long thoracic nerve (C5, C6 and C7) Function = pulls the scapula forwards on the thoracic wall, protraction and rotation of the scapula
Give the origin, insertion, innervation and function of external oblique muscle
Origin = lower surface of ribs 5 to 12 Insertion = aponeurosis ending in midline (linea alba) and lateral ip of iliac crest Innervation = anterior rami to T7 to T12 Function = compresses abdominal contents, turns anterior part of the abdomen to opposite side
Give the origin, insertion, innervation and function of deltoid muscle
Origin = anterior border of the lateral 1/3 of the clavicle, inferior edge of the crest of the spine of the scapula
Insertion = deltoid tuberosity of the humerus
Innervation = axillary nerve (C5, C6)
Function =abductor of the arm (beyond 15 degrees done by supraspinatus)
Where does the cephalic vein lie and what is its clinical significance
In the groove between the deltoid muscle and the pectoralis major muscle, this is the delto-pectoral groove (it is lateral to the pectoralis major muscle)
It is used clinically for vascular access and is the main vein that drains the superficial part of the upper limb
It is also important for inserting wires and catheters into the heart
Give the origin, insertion, innervation and function of the external intercoastal muscle
Origin = inferior margin of rib above Insertion = superior margin of rib below Innervation = intercoastal nerves T1-T11 Function = moves ribs superiorly, most active during inspiration
It becomes the anterior intercoastal membrane when it covers the coastal cartilages, so we can directly see the internal intercoastal muscles
Give the origin, insertion, innervation and function of internal intercoastal muscle
Origin = lateral edge of costal groove of rib above Insertion = superior margin of the rib below deep to insertion of external intercoastal muscle Innervation = intercostal nerves T1 - T11 Function = active during expiration, moves the ribs inferiorly
Where does the neurovascular bundle supplying the chest wall lie
Below each rib, deep to the internal intercoastal muscle
Give the origin, insertion, innervation and function of innermost intercostal muscle
Origin = medial edge of costal groove of rib above Insertion = superior margin of rib below Innervation = intercoastal nerves T1 - T11 Function = acts with the internal intercoastal muscles
How far down does the lungs and the pleura extends (give the rib markings)
Anteriorly = lungs 6th rib, pleura 8th rib
Mid-axillary line = lungs 8th rib, pleura 10th rib
Posteriorly = lungs 10th rib, pleura 12th rib
Explain where the oblique and horizontal fissures are on the lungs
Anteriorly = oblique 4th costal, horizontal 4th costal cartilage Laterally = oblique , horizontal Posteriorly = oblique , horizontal
Where is the only place the lung is connected to the body
The hilium of the lungs
Where are the internal thoracic vessels located? And what is their use and clinical significance
The internal thoracic arteries are located on the deep surface of the anterior wall of the thorax, they come of the subclavian artery and connect to the external iliac artery in the groin
They supply the medial part of the breast
Their clinical significance is that they are not prone to atherosclerosis and lie close to the left anterior descending artery. The left internal thoracic artery (also called the left internal mammary artery LIMA) is used in cardiac bypass
The internal thoracic vessels supply the abdomen wall and the diaphragm as a well
What structures can be found in the hilium of the lungs
2 pulmonary veins
1 pulmonary artery
1 bronchus (has cartilaginous rings)
Bronchial arteries (which supply the trachea, bronchus and bronchial tree)
Lymphatics
Branches of the vagus nerve and sympathetic chain
Give the differences between the right and left lung
The right lung
Has a horizontal fissure and an oblique fissure
Has a little cardiac impression
The left lung Has only an oblique fissure It has an aortic impression It has a big cardiac impression It has a lingula
Describe the lymph drainage of the breast and how this is relevant to breast cancer
Lymph drainage of the breast medial to the nipple passes through the intercostal space and drains into the internal thoracic (mammary) lymph nodes in the thorax
Lymph drainage of the breast lateral to the nipple drain into the lymph nodes in the axilla
How would you find where to listen to the heart valves using a stethoscope
Start at the suprasternal notch (also called sternal notch) and feel down to the sternal angle (also called the Angle of Louis). The sternal angle is connected to the second costal cartilage, from there feel the space under which is the second intercostal space
The pulmonary valve = left sternal margin at 2nd intercostal space
The aortic valve = right sternal margin at 2nd intercostal space
The mitral valve = left midclavicular line at 5th intercostal space
The tricuspid valve = right sternal margin at the 5th intercostal space
How does contraction of the pectoralis major assist with breathing
Pectoralis major, pectoralis minor and the scapula muscles form a ring around the thoracic cavity. When this ring contracts, it reduces thoracic volume and increases thoracic pressure to assist exhalation.
This is only present in disease as exhalation is usually passive
Which bony structures lie subcutaneously in the anterior chest wall
The clavicle and sternum (manubrium, body and xiphisternum) only
The ribs are deep structures
What are the articulations of the clavicle
The sternoclavicular joint - sternum
The acromioclavicular joint - clavicle
What forms the anterior axillary fold
The lower edge of pectoralis major
What lies deep to pectoralis minor muscle
The axilla
The majority of beast tissue is in the upper outer quadrant of the breast. Where does the lymph from this part drain into
The lymph nodes in the axilla
Which costal cartilage connects to the sternum at the sternal angle
The second costal cartilage
Give the boundaries of the axillary fold
Tbc
Which nerves supply the surface of the visceral pleura and which nerves supply the surface of the (pareital) pleura linning the thoracic cavity
Visceral pleura = autonomic nerves
Parietal pleura = somatic nerves
Give the origin, insertion, innervation and function of the diaphragm
Origin = costal margin and the inner surfaces of the lower ribs
Insertion =
Innervation = phrenic nerve arising from C3, C4 and C5 (3rd, 4th and 5th cervical spinal nerves)
Function = contracts to decrease intra-thoracic pressure
Identify the cervical, mediastinal, diaphragmatic and costal parietal pleurae
Identify the costo-mediastinal and costo-diaphragmatic recesses
Tbc
Describe the contracting and non contracting muscles of the daphragm
The diaphragm has a non-contracting central tendon and peripheral muscle fibres
Give the two effects caused by the decrease in pressure in the thoracic cavity caused by the diaphragm cause
If the glottis is open, then air is drawn into the lungs
Blood is drawn from the inferior vena cava into the right atrium
It is the main mechanism of breathing in adults
How is a V/Q scan done and what is it used for
V stands for ventilation
Q sands for perfusion
A ventilation scan and a perfusion scan are done seperately. For the ventilation scan, a radioactive gas is inhaled by the patient and a gamma camera is used to measure the position of radioactivity in the lungs. For a perfusion scan, radioactive technetium is attached to albumen which is injected into the patient, a gamma camera is used to measure the position of radioactivity
The V/Q scan is used to check for blockages in the pulmonary arteries without affecting the bronchi
What is a sign of advanced respiratory distress and why
Intercostal recession, which is the visible sucking in of intercostal muscles during inspiration. It is a particularly important sign in the first six months of life.
It shows that the pressures needed to support breathing overcome the intercostal muscles - they need to create very negative intra-thoracic pressure to breath in so the intercostal muscles get sucked in.
Which nerves carry sensation from the parietal and visceral pleura
Autonomic nerves carry sensation for the visceral pleura (on lung surface so has same nerves as lungs) - the vagus and sympathetic nerves
Somatic nerves carry sensation for the parietal pleura (on chest wall so same nerves as tissue of chest wall) - the spinal nerves, T1 to T12
What is a bronchopulmunary segment
A bronchopulmonary segment has an artery and nerve which run through the center of the segment branching to feed all of it, the vein usually runs on the surface of the the segment.
The ten bronchopulmonary segments in each lung, each segment functions seperately anatomically and functionally which can influence how disease is spread through the lungs
Which structures pass through the hilum of the lung
2 pulmonary veins
1 pulmonary atery
1 bronchus (cartilageous rings inside)
Bronchial arteries (supply trachea, bronchus and bronchial tree)
Lymphatics
Vagus nerve branches and sympathetic chain branches
How does contraction of the diaphragm assist in returning blood to the heart
Contraction of the diaphragm increases thoracic volume and decreases intra-thoracic pressure. It increases intra-abdominal pressure so the net effect is the flow of blood from the abdomen into the chest
What is the sensory and motor nerve supply to the diaphragm
Sensory and motor are both from the phrenic nerve arising from the C3, C4 and C5 (the 3rd, 4th and 5th cervical spinal nerves)
What is a joint
A connection between two or more bones, irrespective of if movement can occur
Examples of a fibrous joints
The sutures of the cranium
The interosseous membrane between the radius and ulna of the forearm
Examples of a cartilaginous joint
Primary cartilaginous joints are joined solely by hyaline cartilage e.g attachments of the ribs to the sternum
Secondary cartilaginous joints are covered with a layer of hyaline cartilage but joined by fibrocartilage e.g the vertebral bodies
Example of a plane joint and movements allowed in this joint
Acromioclavicular joint
Articular surfaces are flat
Joint capsules are tight
Sliding movements in planes of articular surfaces
Example of a hinge joints and movements it allows
Elbow joint
It permits flexion and extension only
Example of a saddle joint and movements it allows
Carpometacarpal joint of the thumb
Articular surface are concave and convex
Permits flexion, extension, abduction, adduction and circumduction
Examples of condyloid joint and movement it allows
Metacarpophalangeal joints of the fingers
Similar to saddle joint in that movement in two axes but one is usually restricted
Permits flexion, extension, abduction, adduction and circumduction
Example of a ball and socket joint and the movement it allows
Hip joint
Spherical and concave articular surfaces
Multiple axes of movement
Permits flexion, extension, abduction, adduction, circumduction and rotation
Example of a pivot joint and the movement it allows
Atlanto-axial joint of cervical spine (the C1 atlas on the C2 axis)
Rotation around a central axis
Describe the knee joint, include the type of joint it is and the bones and ligaments involved
The knee joint is a synovial hinge joint, it is made up of the femur, patella and tibia
The tibia is flat while the femur is condular so they have a meniscus between them
The 4 ligaments in the knee are the;
Lateral collateral ligament - attaches the lateral epicondyle of the femur to the fibula
Medial collateral ligament - attaches the medial epicondyle of the femur to tibial plateau
Both the medial and lateral collateral ligaments lie in the capsule so will bleed into it when torn
Anterior cruciate ligaments - going from the anterior part of the tibial plateau to the posterior aspect of the lateral condyle of the femur (prevents forward movement of the tibia in relation to the femur)
Posterior cruciate ligaments - going from the posterior part of the tibial plateau to the anterior aspect of the medial condyle of the femur (prevents excessive movement of the femur anteriorly
The patella is attached is to the front of the quadriceps tendons to stop them rubbing on the femur and tibia during motion
Give an example of a fusiform type of skeletal muscle
Biceps brachii
Give an example of a parallel type of skeletal muscle
Rectus abdominis
Give an example of a convergent type of skeletal muscle
Pectoralis major
Describe as a fan muscle -parallel fibres but flat
Give an example of a unipennate type of skeletal muscle
Palmar interosseous
Give an example of a bipennate type of skeletal muscle
Rectus femoris
Give an example of a multipennate type of skeletal muscle
Deltoid muscle
Give an example of a circular type of skeletal muscle
Orbicularis oculi
Eye, mouth and anus
Allows closing of aperture
Give the origin, insertion, innervation and function of the sternocleidomastoid muscle
Origin = the manubrium of the sternum, medial 1/3 of the clavicle Insertion = mastoid process Innervation = accessory nerve (cranial nerve 11) supplies motor innervation and branches from anterior rami of C2, C3 and C4 Function = draw head forward, tilt head towards shoulder on the same side, rotating head to face opposite side
Give the origin, insertion, innervation and function of sterno-hyoid muscle
Origin = sternum Insertion = hyoid bone Innervation = anterior rami C1, C2 and C3 through the ansa cervicalis function = depresses hyoid bone after swallowing
Give the origin, insertion, innervation and function of platysma
Origin = skin of the face and mandible
Insertion = skin overlying the cavicle
Innervation =
Function =
What structures border the anterior triangle of the neck
The left sternocleidomastoid muscle, the lower border of the mandible and the midline
The right sternocleidomastoid muscle, the lower border of the mandible and the midline
Give the origin, insertion, innervation and function of geniohyoid
Origin = mental spine on the mandible Insertion = hyoid bone Innervation = branch of anterior ramus of C1 Function = fixed mandible pulls hyoid bone forward while fixed hyoid bone pulls mandible down and in
Give the origin, insertion, innervation and function of omohyoid bone
Origin = superior border of scapula (omo) Insertion = hyoid bone lateral to sternohyoid attachment Innervation = anterior rami of C1, C2 and C3 through the ansa cerviclis Function = depresses and fixes hyoid bone
Lies lateral to the sternohyoid bone
Has two bellies joined by a tendonous part
Give the origin, insertion, innervation and function of sternothyroid
Origin = sternum Insertion = lamina of thyroid cartilage Innervation = anterior rami of C1, C2 and C3 through ansa cervicalis Function = draws larynx (thyroid cartilage) downwards
Give the origin, insertion, innervation and function of thyrohyoid
Origin = lamina of thyroid cartilage Insertion = body of hyoid bone Innervation = anterior rami of C1 Function = depresses hyoid bone, when hyoid bone is fixed it raises the larynx
Give the origin, insertion, innervation and function of the anterior belly of the diagastric muscle
Origin = diagastric fossa on mandible Insertion = attachment of tendon between the two belly of diagastric muscle Innervation = mylohyoid nerve from inferior alveolar branch of mandibular nerve Function = opens mouth by lowering mandible, raises hyoid bone
Give the origin, insertion, innervation and function of posterior belly of diagastric muscle
Origin = mastoid notch on mastoid process on temporal bone
Insertion =
Innervation = facial nerve
Function = pulls hyoid bone up and back
Give the origin, insertion, innervation and function of cricothyroid muscle
Origin = cricoid cartilage Insertion = thyroid cartilage Innervation = external superior laryngeal nerve from the vagus nerve Function = forward and downwards rotation of the thyroid cartilage, stretches and tenses vocal ligament creating forceful speech and tone of voice (it is called the singer's muscle)
What arteries supply the thyroid gland
superior thyroid artery (branch of the external carotid artery)
inferior thyroid artery (branch of the thyrocervical trunk from the subclavian artery)
superior thyroid vein
medial (or middle) thyroid vein
inferior thyroid vein (all veins drain into the internal jugular vein, the external jugular and the brachiocephalic veins)
What does the carotid sheath contain
carotid artery
(Internal) jugular vein
Vagus nerve
Sympathetic chain
Which nerve is close to the inferior thyroid artery and so is at risk of damage during thyroid surgery
The right recurrent laryngeal nerve
Which tracheal rings are crossed by the isthmus of the thyroid
The second and third ring of the trachea
What are the extrinsic laryngeal muscles
They act to move the larynx superiorly and inferiorly and aid swallowing
Comprised of the suprahyoid, infrahyoid muscles and stylopharyngeus muscle
Suprahyoid muscles and the stylopharyngeus muscle elevate the larynx, they are;
- geniohyoid
- diagastric (anterior and posterior)
- mylohyoid
- stylohyoid
The infrahyoid muscle depress the larynx, they are;
- sternohyoid
- omohyoid (superior and inferior belly)
- sternothyroid
- thyrohyoid
What are the intrinsic laryngeal muscles
They act on individual components of the larynx aiding breathing and phonation
They act to change the shape of the rima glottidis and length and tension of the vocal folds
All of them except the cricothyroid muscle are innervated by the inferior laryngeal nerve (from the recurrent laryngeal nerve)
Cricothyroid Thyroarytenoid Posterior cricoarytenoid Lateral cricoarytenoid Transverse and oblique arytenoids
Give the origin, insertion, innervation and function of thyroarytenoid
Origin = thyroid cartilage Insertion = arytenoid cartilage Innervation = inferior laryngeal nerve (from the recurrent laryngeal nerve) Function = relaxes vocal ligament, allowing softer voice
Give the origin, insertion, innervation and function of posterior cricoarytenoid muscle
Origin = posterior surface of the cricoid cartilage Insertion = muscular process of the arytenoid cartilage Innervation = inferior laryngeal nerve from the recurrent laryngeal nerve Function = abducts vocal folds, widen rima glottidis
Give the origin, insertion, innervation and function of lateral cricoarytenoid
Origin = arch of cricoid cartilage Insertion = muscular process of the arytenoid cartilage Innervation = inferior laryngeal nerve from the recurrent laryngeal nerve Function = adducts the vocal folds
Give the origin, insertion, innervation and function of transverse and oblique arytenoids
Origin = one arytenoid cartilage Insertion = the other arytenoid cartilage Innervation = inferior laryngeal nerve from the recurrent laryngeal nerve Function = adducts the arytenoid cartilages, closes the posterior part of the rima glottidis narrowing the laryngeal inlet
A patient may develop hypocalcaemia after thyroid surgery why?
The parathyroid glands may be accidentally or deliberately removed during the thyroid surgery which can cause acute (sudden) hypoparathyroidism
Give the origin, insertion, innervation and function of stylopharyngeus muscle
Origin = styloid process Insertion = pharyngeal wall Innervation = glossopharyngeal nerve Function = elevation of the pharynx
Why does the thyroid gland have such a good blood supply
Iodine is present in low concentration in the blood so the gland needs a high flow of blood to ensure adequate supply of iodine
Give the origin, insertion, innervation and function of the superior constrictor muscle
Origin = medial pterigold plate and the pterygomandibular raphe extends to mandible Insertion = pharyngeal raphe Innervation = vagus nerve Function = constriction of the pharynx
Give the origin, insertion, innervation and function of the middle constrictor muscle
Origin = hyoid bone Insertion = pharyngeal raphe Innervation = vagus nerve Function = constriction of pharynx
Give the origin, insertion, innervation and function of the inferior constrictor muscle
Origin = thyroid cartilage (the thyropharyngeus), the cricoid cartilage (cricopharyngeus) Insertion = pharyngeal raphe Innervation = vagus nerve Function = constriction of pharynx
Which fascia lines the inner aspect of the constrictors and what is this fascia attached to
The fascia is called the pharyngobasilar fascia and it is attached to the pharyngeal tubercle, the auditory (Eustachian) tube and the medial pterygoid plate
Which fascia bridges the gap between the superior constrictor and the base of the skull
The pharyngobasilar fascia
Which cranial nerves form the pharyngeal plexus on the back of the pharynx
Vagus (10) and glossopharyngeal (9) nerve
What is the weakest part of the pharyngeal wall
Killian’s dehiscence - it is basically the line between the diverging fibres of the thyro-pharyngeal part of the inferior constrictor
Where can the stellate ganglion be found
Between the first rib and the transverse process of the seventh cervical vertebrae
What does the internal superior laryngeal nerve do
Give sensory innervation to the larynx above the vocal cords
Where does the superior laryngeal nerve enter the constrictor muscles
Between the middle and inferior constrictor muscles
What does the external superior laryngeal nerve do
Supply motor innervation to the cricothyroid muscle and the crico-pharyngeal part of the inferior constrictor
Which nerve innervates the carotid sinus
The glossopharyngeal nerve
Which nerve gives taste and sensation to the posterior 1/3 of the tongue
The glossopharyngeal nerve
Which nerve gives general sensation to the oropharynx
The glossopharyngeal nerve
Which nerve supplies the middle ear and the eustachian tube
The tympanic branch of the glossopharyngeal muscle
Which nerve supplies the stylopharyngeus muscle
The glossopharyngeal nerve
What does the glossopharyngeal nerve supply
Give sensory and taste to the posterior 1/3 of the tongue
Sensory to the oropharynx
The tympanic branch of the glossopharyngeal nerve supplies the middle ear and the eustachian tube
It supplies the stylopharyngeus muscle
Give the origin, insertion, innervation and function of the stylopharyngeus muscle
Origin = styloid process Insertion = pharyngeal wall Innervation = glossopharyngeal nerve Function = elevation of the pharynx
What is the significance of Killian’s dehiscence
During swallowing the high pressure can cause the mucosa of the pharynx to bulge out through Killian’s dehiscence and create a pouch.
Food can enter this pouch decompose causing bad breath
The food in the pouch can also cause swelling and difficulty swallowing too
What is the relevance of the carotid sinus and its nervous supply
Sensory receptors in the carotid sinus measure blood pressure
High blood pressure presses on the carotid sinus and sends signals to the brain via the glossopharyngeal nerve
The brain sends signals to the heart via the vagus nerve to slow the heart rate
Pressure can be applied to this area in patients with fast heart rates
Why is a stroke in the area of the brain with the glossopharyngeal nerve dangerous
This can lead to damage of the nerve so when the person swallows they can no longer have sensation of fluid passing down into the larynx so fluid enters the lungs and causes infection
Which nerve gives sensory and taste innervation to the anterior 2/3 of the tongue
The lingular nerve from the mandibular branch of the trigeminal nerve gives sensory innervation
The chorda tympani branch of the facial nerve gives taste sensation
What gives motor innervation to the intrinsic muscles of the tongue
The intrinsic muscles of the tongue are those within the tongue itself
The hypoglossal nerve gives motor innervation to the tongue
Which nerve give motor innervation to the extrinsic muscles of the tongue
The extrinsic muscles of the tongue are those outisde the tongue that support it
palatoglossus - vagus nerve
styloglossus - hypoglossal nerve
genioglossus - hypoglossal nerve
hypoglossus - hypoglossal nerve
Which part of the pharynx lie below the lower border of the mandible
The hypopharynx (also called the laryngopharynx)
Which structures lie immediately behind the pharyngeal wall
Loose areolar tissue and the cervical vertebral bodies
Give the borders of the posterior triangle of the neck
Sternocleidomastoid muscle anteriorly
Trapezius posteriorly
Middle 1/3 of the clavicle inferiorly
What muscles are contained in the posterior triangle of the neck
Muscles Levator scapulae Anterior scalene Middle scalene Splenius capitis
What blood vessels cross the posterior triangle
Blood vessels
External jugular vein
Transverse cervical vein
Suprascapular vein
Distal part of the subclavian artery
Which nerves cross the posterior triangle
Nerves Spinal accessory nerve (11) Cutaneous branches of the cervical plexus Trunks of the brachial plexus Supraclavicular nerve Phrenic nerve
Which nerve enters the thyroid between the middle and inferior constrictor muscles
The superior laryngeal nerve
Which muscles comes from the styloid process and enters he gap between the superior and middle constrictor muscles
The stylopharyngeus muscles, it runs alongside the glossopharyngeal nerve
Which ganglion is fused with the first thoracic nerve in the thorax
The inferior cervical sympathetic ganglion, it is called the stellate ganglion
Give the muscles that run in the anterior triangle of the neck
Infrahyoid muscles Sternohyoid omohyoid Thyrohyoid sternothyroid cricothyroid (actually lies under the thyroid gland)
Suprahyoid muscles Geniohyoid Mylohyoid Stylohyoid Digastric (the anterior belly)
Give the main blood vessels run in the anterior triangle of the neck
The common carotid artery
The internal jugular vein
Give the nerves that run in the anterior triangle of the neck
Facial nerve Glossopharyngeal Vagus Accessory Hypoglossal
Give the four different subdivisions of the anterior triangle of the neck and the main structures that run in them
Carotid triangle
- common carotid artery bifurcates
- internal jugular vein
- hypoglossal nerve
- vagus nerve
Submental triangle
-submental lymph nodes draining lymph from the tongue and mouth
Submandibular triangle
- submandibular gland
- facial artery and vein
Muscular triangle
- infrahyoid muscles
- the pharynx
- thyroid gland
- parathyroid gland
Give the function, connection to brain, skull foramen and test for olfactory nerve
Smell
Cerebrum
Cribiform plate
cover each nostril and ask to smell different smells
Give the function, connection to brain, skull foramen and test for the optic nerve
Sight
Cerebrum
Optic Canal
use snellen chart for visual acuity, Ishihara plates for colour vision test, opthalmoscope to see head of optic nerve
Give the function, connection to brain, skull foramen and test for the occulomotor nerve
Eye movements, eyelid opening, pupil constriction (Parasym), accomodation midbrain
Superior Orbital Fissure
deficit in this nerve can cause diplopia (double vision), down and out facing eye as other nerves are unopposed, ptosis (eyelid drooping) and mydriasis (dilated pupils
To test draw an H shape with your finger and ask patient to follow the shape without moving their eye muscles
Give the function, connection to brain, skull foramen and test for the trochlear nerve
Eye movement through the superior Oblique muscle
Midbrain
Superior Orbital fissure
defect in nerve means cannot depress an adducted eye
Give the function, connection to brain, skull foramen and test for the trigeminal nerve
V1 sensation to anterior head face (superior 1/3) including scalp, forehead, cornea and tip of nose
pons
superior orbital fissure
V2 sensation to the face (middle 1/3) including cheek, nose, upper lip, upper teeth and palate
pons
foramen rotundum
V3 (sensation to face (lower 1/3) including lower lip, lower teeth, chin, jaw and anterior 2/3 of the tongue. Motor to muscles of mastication and the tensor tympani muscles in the middle ear
pons
foramen ovale
test motor by placing hands on muscles that contract when we clench the jaw
tests for sensation by putting cotton bud on each area
Give the function, connection to brain, skull foramen and test for the abducens nerve
Eye movement through the lateral Rectus muscle
Midbrain
Superior Orbital Fissure
defect in nerve means cannot abduct the eye
Give the function, connection to brain, skull foramen and test for the facial nerve
Facial movements, salivation (parasym), lacrimation (producing tears, parasym) and sensation from the external ear canal and taste from the anterior 2/3 of the tongue
Pons
internal acoustic meatus and stylomastoid foramen
testing motor ask the patient to make facial expressions against resistance, facial nerve pulsy is one half of the face is rigid
Give the function, connection to brain, skull foramen and test for the vestibulocochlear nerve
balance and hearing
pons
interior acoustic meatus
to test cover one of patients ears and whisper a number into the ear and see if they can hear it or audiometry or tuning fork for sensory neural or conductive hearing loss
Give the function, connection to brain, skull foramen and test for the glossoharyngeal nerve
taste and sensation from posterior 1/3 of the tongue, sensation from pharynx, salivation, parasympathetics from the carotid vessels , Motor to stylopharyngeus muscle in the pharynx
medulla
jugular foramen
Give the function, connection to brain, skull foramen and test for the vagus nerve
parasympathetic to thoracic (heart) and abdominal (bowel) organs and motor to soft palate, motor to pharyngeal laryngeal muscles
medulla
jugular foramen
allows people to swallow, cough and generate voice from larynx so ask them to cough or if their voice has changed
Give the function, connection to brain, skull foramen and test for the accessory nerve
motor to trapezium and sternocleidomastoid muscle C1 to C5
in through foramen magnum and out through jugular foramen
to test ask patient to shrug into your hand while pushing on their shoulders to check even muscle bulk or ask patient to turn their head into your hand to see protrusion of sternocleidomastoid muscle
Give the function, connection to brain, skull foramen and test for the hypoglossal nerve
movements of the tongue
medulla
hypoglossal canal
ask patient to push tongue into their cheek, defective nerve would have a protrusion of the tongue towards the side of the lesion
Where can a subarachnoid haemorrage be found and what are the signs on an xray
bleeding under arachnoid layer of arteries into the brain - on xray it is widespread and fills spaces in brain - bleed on both side and no midline shift - usually caused by aneurysm
Where can a Subdural haematoma/ haemorrage be found and what are the signs on an xray
Space between the dura and the arachnoid is the subdural space - an actual space containing veins (bridging veins) running from arachnoid to dura
Subdural haematoma/ haemorrage is bleeding between the dura and arachnoid - on xray - bleeding is more wide spread - more concave in shape - midline shift to the contralateral side
Where can a extradural haematoma/ haemorrage be found and what are the signs on an xray
Space between the skull and dura is the extradural or epidural space - potential space and does not exist in healthy individuals - contains bloods vessels which can bleed if there is fracture of the skull
Extradural haematoma/ haemorrage is bleeding between the skull and dura - an xray image would show a contained bleed in a lens shape - a midline shift of the brain to the contralateral side
What are the meninges of the brain
Dura mater, arachnoid and pia mater are the meninges
Meninges protect the brain, provide frame work for blood supply, fluid filled space (subarachnoid space)
Dura mater is made up of the periosteal layer (attached to the skull) and meningeal layer (lower down) - gap between these layers is the venous sinuses
Explain the how the intrinsic back muscles are divided
The intrinsic back muscles are divided into the;
- superficial (spinotransversales)
- intermediate (erector spinae)
- deep (transversospinales)
Explain how the superficial (spinotransversales) intrinsic muscle of the back are divided
- splenuis capitis muscle
- splenuis cervicis muscle
Explain how the intermediate (erector spinae) intrinsic muscle of the back are divided
- iliocostalis
- longissimus
- spinalis
Explain how the deep (transversospinales) intrinsic muscle of the back are divided
- semispinalis
- multifidus
- rotatores
What nerve supplies the dorsal surface of the epiglottis for taste
The vagus nerve (ask if it would be the internal superior laryngeal nerve)
Which nerve supplies the parotid gland
The glossopharyngeal nerve
Where does the duct of the parotid gland enter the mouth
Passes over the masseter muscle into the cheek and enter the mouth adjacent to the 2nd upper molar
Give some blood vessels to be aware of close to the submandibular gland
Retromandibular vein
Facial vein
Facial artery
Which part of the submandibular gland contains it’s duct (the deep or superficial aspect) and where does the duct drain into
The deep part contains the duct
The duct empties under the tongue into the floor of the mouth
Which nerve supplies the submandibular nerve
The facial nerve
Where does the facial nerve exit the skull
The stylomastoid foramina
The facial nerve enters the parotid gland and divides into 5 parts, state those 5 parts
Temporal Zygomatic Buccal Mandibular Cervical
Why is the passage of the facial nerve through the parotid gland clinically significant
Diseases f the parotid gland especially maligancies can invade and damage the nerve leading to paralysis of the facial muscles
Damage to this nerve can also lead to corneal abrasions because the nerve cannot blink the eyes to wash out the front of the cornea and prevent it drying out
Damage to this nerve can lead to food leaking out of the corners of the mouth when eating and drinking because it can no longer close the mouth fully when eating and drinking
What type of joint is formed between the inferior horn of the thyroid cartilage and the cricoid cartilage
Synovial joint
What is the clinical significance of the piriform recess (also called piriform fossa) lateral to the posterior margins of the thyroid and cricoid cartilage
Malignant tumours arising in this piriform recess can remain “silent” (no symptoms) until it is locally advanced and this is because it grows to fill the fossa before the symptoms develop
Another name for the false vocal folds is
The superior vestibular fold
Another name for the true vocal folds is
The inferior vestibular folds
What lies between the false and true vocal folds
The laryngeal sinus
What is the sagittal space between the true vocal folds called
The rima glottidis
What muscle forms the vocal folds (ask if it forms both)
The vocalis muscles
Give the origin, insertion, innervation and function of rectus abdominis muscle
Origin = pubic tubercle, pubic symphysis and pubic crest Insertion = xiphoid process, costal cartilages or ribs 5 to 7 Innervation = anterior rami of T7 to T12 (thoracic spinal nerves) Function = compress abdominal contents and tense abdominal wall
Where is the highest point of the diaphragm (also the abdomen)
The 5th intercostal space on both sides
Where is the subcostal plane
The lowest point of the ribs and costal cartilages
Where is the intertubercular plane
Superior to the anterior superior iliac spine at the lateral tubercle halfway up the iliac crest
-it marks the position of the bifurcation of the abdominal aorta
What are the two horizontal lines of the abdomen
- the subcostal plane
- the intertubercular plane
Give the 9 regions the abdomen can be divided into
Centrally - the epigastrium, umbilicus and suprapubic (also called hypogastrium)
Right side - right hypochondrium, right flank and right iliac fossa
Left side - left hypochondrium, left flank and left iliac fossa
Going from back to front - lumbar (back), loin (side) and flank (front)
Give a posterior horizontal line used for abdominal examination
Intercristal plane - between highest point of iliac crest posteriorly, it runs between 4th and 5th lumbar vertebra and is useful in anaesthetic when giving epidurals
Give an additional horizontal line used for abdominal examinations
Transpyloric plane (transpyloric plane of Addissons) - runs from the tip of the 9th costal cartilage, lateral most part of where rectus abdominis muscle attaches to the costal cartilage
How does the position of the umbilicus move when the patient is lying down
Moves laterally
How does the position of the umbilicus change when the patient is stood up
Moves inferiorly
Where is McBurneys point
It is 2/3 way on the line from the umbilicus to the anterior superior iliac spine and lies over the iliac fossa
What lies on McBurney’s point
- where the appendix usually lies
- gives a guide to the position of the caecum during clinical examination of the abdomen
What is the significance of the line between the pubic tubercle and the anterior superior iliac spine
Below this line is the thigh and above it is the abdomen
How many millimeters does the diaphragm have to move to achieve a tidal volume of 500mls
5 or 6 millimeters
How does the midclavicular line relate to the rectus abdominis muscle
It will run almost on the outer edge of the rectus abdominis muscle
What are the aponeurosis of the abdominal muscles made of
Tendon
Give the origin, insertion, innervation and function of the rectus abdominis muscle
Origin = pubic tubercle, pubic symphysis and pubic crest Insertion = xiphoid process, costal cartilages or ribs 5 to 7 Innervation = anterior rami of T7 to T12 (thoracic spinal nerves) Function = compress abdominal contents and tense abdominal wall
Give the 3 abdominal muscles that form aponeurosis and directions they run
- external oblique muscles - downwards and inwards
- internal oblique muscles - 90 degrees to the external oblique muscles - upwards and inwards
- transverse abdominis muscles - horizontally
Which muscles cross the midline of the linea alba
No muscles does
Name the 3 aponeurosis of the abdomen
- external oblique aponeurosis
- internal oblique aponeurosis
- transversus abdominisis aponeurosis
What structure does the aponeurosis surround as a rectus sheath
The rectus abdominis
Where does the external oblique muscle become the external oblique aponeurosis
At the midclavicular line
Describe the structure of the internal oblique aponeurosis in the upper 2/3 of the abdomen and the lower 1/3 of the abdomen
- in the upper 2/3 of the abdomen, the internal oblique aponeurosis splits in two
- half of the internal oblique aponeurosis travels in front of the rectus abdominis
- half of the internal oblique aponeurosis travels behind the rectus abdominis muscle
-in the lower 1/3 of the abdomen, the internal oblique aponeurosis passes totally in front of the rectus abdominis muscle
Describe the structure of the transverse abominis aponeurosis in the upper 2/3 of the abdomen and the lower 1/3 of the abdomen
- in the upper 2/3, it passes totally behind the rectus abdominis muscle to form the rectus sheath
- in the lower 1/3, it passes totally in front of the rectus abdominis
Which thoracic spinal nerve supplies the dermatone of the umbilicus
Thoracic 10 (T10)
Which nerve supplies the dermatone of the non-hair bearing area of the lower abdomen
Thoracic 12 (T12)
Which nerve supplies the dermatones of the hair bearing area over the pubis
Lumbar 1 spinal nerve (L1)
Where do the pain fibres from the bowel take the sensation to
The thalamus
Give the nervous supply to the 3 parts of the gut and where pain can be felt
Foregut - greater splanchnic nerve - T5 to T9 - pain can be felt in the epigastrium
Midgut - lesser splanchnic nerve - T10 to T11 - pain can be felt in the periumbilical area
Hindgut - least splanchnic nerve - T12 - pain can be felt in the suprapubic area
How is a six pack formed
- rectus abdominis has tendonous intersections
- when the muscle is exercised, it hypertrophies and will bulge
- the tendon will not bulge giving the appearance of a six pack
Which parts of the rectus abdominis is connected to the rectus sheath
The muscle is not connected to the sheath but the tendon is firmly attached to the rectus sheath
What is the artery running on the deep surface of the rectus abdominis muscle
- the lower end of the artery is called the inferior epigastric artery and joins the external iliac artery
- the upper end of the artery is called the superior epigastric artery and it connected to the internal mammary arteries
What is a hernia
Weakness of the muscle wall that has allowed bowel (or other organs) to protrude out of the abdomen
What is the relationship between the external oblique muscle and the inguinal ligament
The lower part of the external oblique muscle is totally aponeurotic and is attached laterally to the anterior superior iliac spine and medially to the pubic tubercle and that is the inguinal ligament
What lies above the inguinal ligament
The inguinal canal which in males transmits all structures to and from the testis
What forms the spermatic cord
Rule of 3s
3 coverings - external spermatic fascia, cremesteric muscle and internal spermatic fascia
3 arteries - testicular artery, cremesteric artery and the artery of the vas
3 veins - testicular veins, cresmesteric vein and the vein from the vas
3 nerves - genital branch of the genitofemoral nerve (nerve to the cremester muscle), inguinal branch of the ileoinguinal nerve (supplies sensation to the anterior 1/3 of the scrotum) and sympathetic nerves to the vas and testis
3 structures - vas deferens, lymphatics and processus vaginalis (connects peritoneal sac around testis to the peritoneal sac in abdomen)
What is a symptom
What the patient tells you is happening to them
What is a sign
What the doctor finds by doing an examination
What is the mid-inguinal point
-midway between the pubic symphysis and anterior superior iliac spine
What structure lies on the transpyloric plane
- the gall bladder
- pancreas
- pylorus of the stomach
- duodeno-jejunal flexure
In thin recumbent patients (basically the people with least variation) where would the umbilicus lie
L3 vertebra
What does the intertubercular plane mark
-the position of the bifurcation of the abdominal aorta
When skin is damaged, where would the pain be felt
Exactly where the damage is occuring
Where would pain arising from internal organs be felt
- poor localised
- diffuse sensation can be felt different from where the organ is
The peritoneum covering the inside of the abdominal walls has the same sensory nerve supply as the skin overlying the same area of abdominal wall. If a diseased process involves the abdominal wall such as an inflamed appendix, where would the pain be felt?
Precisely directly over the appendix
Which diseases can irritate the diaphragm and cause pain
- cholecystitis (inflammation if the gall bladder)
- pain can be felt in the shoulder through C3,4 and 5
What is the sensory innervation of the kidney
- via the sympathetic plexus which accompanies the renal artery(T10, 11 and 12)
- the same sympathetic plexus supplies the gonads
Where can kidney pain be felt
- reffered along the cutaneous nerves of T10, 11 and 12 most commonly T12
- often described as pain radiating from loin to groin
- can also be felt in the gonadal area
Where can gonadal pain be felt
- sensory innervation via sympathetic plexus which accompanies the renal artery (T10, 11 and 12)
- most commonly T12
- can be felt in the loin
What does the iliohypogastric nerve do and where is it
- close to the pubic symphysis
- it originates from the anterior ramus of the L1 nerve root of the Lumbar plexus
- it gives sensory innervation to the posterolateral gluteal skin in the pubic region
- it gives motor innervation to the internal oblique muscle and the transverse abdominis
Describe the typical history of pain for appendicitis (inflammation of the appendix)
- a vague central pain at first but after a few hours or days it becomes a sharp pain in the right iliac fossa
- pain from appendix is relayed through the lesser splanchnic nerve via the sympathetic nervous system so dull pain in the umbilicus area
- inflammation soon extends to the surface of appendix and rubs the inside of the abdominal wall so pain is now relayed by cutaneous nerves so sharp pain is felt directly over the appendix
What is aortic aneurysm and where can it be felt
- an abnormal swelling of aorta which can burst and lead to sudden death
- it can be felt only from the epigastrium to the umbilicus because the intertubercular plane is where the abdominal aorta bifurcates
What is shingles and what is it activated
- an infection of the sensory nerve cell bodies by the Herpes Zoster virus
- it lays dormant in the sensory dorsal root ganglia and can activate when the patient is ill
What are the symptoms of the Herpes Zoster Virus
- the virus reproduces and travels down the sensory nerve fibres to the skin
- it produces an itchy rash with small fluid filled blisters (vesicles)
- these fluid blisters are full of viruses and when a patient scratches, the virus is released to infect others
- if the virus is in the T10 spinal nerve, the rash will form a ribbon from the T10 vertebra at the back to the umbilicus at the front (T10 dermatomes)
What is the afferent nerve of the cough reflex
The internal superior laryngeal nerve
Damage to the glossopharyngeal nerve causes
Loss of sensation to the back of the pharynx affects sensory control of swallowing so larynx remains partially open during swallowing so fluid may enter the lungs and cause infections
-it is common in patients with brain stem stroke
Damage of the vagus nerve
- loss of sensation to the inside of the larynx and affects sensory control of swallowing so the larynx remains open during swallowing so fluid may pass into the lungs causing infection
- it is common in patients with brain stem stroke
Which structure stops liquid refluxing into the back of the nose during swallowing
The soft palate
Which nerve carries sensation from below the vocal cords
The recurrent laryngeal nerve
Describe the histology of the mucus of the trachea
Psuedostratified ciliated columnar epithelium with goblet cells
Which nerve travels through the parotid gland
The facial nerve
Where do the parotid and submandibular gland ducts enter the mouth
Parotid - passes over the masseter muscle enter the cheek adjacent to the second upper premolar
Submandibular -under the tongue into the floor of the mouth
