Anatomy Flashcards
1
Q
At which point does the upper respiratory tract become the lower?
A
The beginning of the trachea
2
Q
At which vertebral level does the upper respiratory tract become the lower?
A
C6
3
Q
Where can the trachea be palpated?
A
Jugular notch of the manubrium
4
Q
What are the two types of pleura?
A
- Visceral
2. Parietal
5
Q
What is the space between the visceral and the parietal pleura called?
A
Intrapleural space
6
Q
How many lobes make up each lung?
A
Left-2
Right- 3
7
Q
How many bronchopulmonary segments does each lung lobe have?
A
10
8
Q
Why can small sections of lung easily be removed through surgery?
A
Each bronchopulmonary segment has its own innervation, lymphatic and blood supplies
Little damage is done to surrounding bronchopulmonary segments when one is operated on
9
Q
How many pairs of ribs are there in the thoracic skeleton?
A
12
10
Q
What are the three type of ribs and what rib number does each type represent?
A
- true 1-7
- False 8-10
- Floating 11-12
11
Q
What are the three components of the sternum?
A
- Manubrium
- Body
- Xiphoid process
12
Q
What happens at the sternal angle?
A
Bronchi bifurcate
13
Q
Which parts of the rib articulate with the vertebrae?
A
head and the tubercle
14
Q
What is a costal groove?
A
This is a groove on the ribs in which a neurovascular bundle is located
15
Q
What is a costochondral joint?
A
A joint from rib to sternum
16
Q
What are sternocostal joints?
A
Synovical joints from sternum to ribs
17
Q
Where do costalvertebral joints occur?
A
Where the ribs articulate with the sternum
18
Q
What are the three layers of intercostal muscles?
A
- External
- Internal
- Innermost
19
Q
How many intercostal spaces are there?
A
11
20
Q
Each intercostal spaces contains what?
A
A neurovascular bundle (nerve, artery and vein)
21
Q
A neurovascular bundle is found between which layers of muscle?
A
Internal and innermost intercostal muscle layers
22
Q
In a neurovascular bundle, where does the nerve supply originate?
A
Anterior rams of the spinal nerves
23
Q
Blood supply to the intercostal spaces is both posterior and anterior, which vessels are utilised in each situation?
A
Anterior- internal thoracic artery, internal thoracic vein
Posterior- thoracic aorta, azygous vein
24
Q
Why is the right “dome” of the diaphragm larger than the left?
A
Due to the liver
25
Which type of muscle composes the diaphragm?
Skeletal
26
The phrenic nerve is composed of which spinal nerves?
C3,4,5
27
The diaphragm is innervated by which nerve?
Phrenic (C3,4,5 keep the diaphragm alive)
28
Where in the neck is the phrenic nerve found?
Anterior surface of the scalenus anterior muscle
29
Where in the thorax is the phrenic nerve found?
It depends over the anterior surface of the external pericardium of the heart
30
What does the phrenic nerve supply to the diaphragm?
```
Somatic sensory and sympathetic axons (to diaphragm and fibrous pericardium)
Motor neurones (to diaphragm)
```
31
What is the root of the breast tissue called?
Axillary tail
32
What is the name of the surrounding tissue close to the nipple?
Areola
33
Lymph drainage from breast tissue is split into which two main areas?
1. Axillary nodes- lateral quadrants (unilateral)
| 2. Parasternal nodes- medial quadrants (bilateral)
34
Where are sensory nerves located?
Within superficial fascia
35
The deltoid muscle and the pectoralis major do not join completely so between them is a groove. What is the name of this groove?
Delto-pectoral groove
36
Which vein runs within the delta-pectoral groove?
Cephalic vein
37
The long thoracic nerve innervates which muscle?
Serratus anterior muscles
38
The function of the serrates anterior muscles is too?
Anchor the scapular to the body
39
What are the 4 different names of the parietal pleura (based on location)?
1. Cervical- above the ribs
2. Costal
3. Diaphragmatic
4. Medistinal
40
What is the most inferior part of the intrapleural cavity?
```
Costodiaphragmstitic recess
(costophrenic angle- most inferior point)
```
41
What is the term given to the most superior part of the lungs?
Apex
42
What is the name of the middle projection of the left lobe?
Lingula
43
How are the lung lobes separated ?
Fissues
| oblique- superior and inferior, and horizontal- middle and superior - only in right lung
44
What are hila and what are they composed of?
Lung roots
They are made up of pulmonary arteries, veins and lymph nodes
Main bronchi
45
Why must all 5 lobes be listened to when auscultating?
They are all supplied by different lobar bronchi
46
What is an example of a high pitched and low pitched sound heard during auscultation?
High- wheezing
| Low- - rhonchi (rattling/snoring)
47
Coughing involves stimulation of sensory receptors in the mucosa. Which may such receptors be located?
- Oropharynx
- Larynopharynx
- Larynx
- Respiratory tree
48
Describe how a cough is produced
- Sensory (afferent) nerves stimulated
- Deep inspiration by CNS using diaphragm (phrenic nerves) and intercostal muscles (intercostal nerves)
- Adduction of vocal cord occurs- closes rima glottidis (vagus nerves)
- Contraction of anterolateral abdominal wall muscles stimulated by intercostal nerves
- Increased into-abdominal pressure
- Vocal cord abduct abruptly opening rima glottidis
49
What is the name of the space between the vocal cords?
Rima glottidis
50
The glossopharyngeal nerve (CN IX) carries afferent sensory signals from where?
Oro and nasopharynx
51
Information from the laryngopharynx and the larynx is relayed to the brain by which nerve?
Vagus nerve (CN X)
52
What nerve innervates the nasopharynx that when stimulated will cause a sneeze?
Trigeminal nerve (CN V)
53
What are carotid sheaths and what do they carry?
They are protective tubes of deep fascia
| They carry the vagus nerve, the internal carotid artery, the common carotid artery and the internal jugular vein
54
Where are the attachments for the carotid sheaths?
Superiorly- Bones at the base of the skull
| Inferiorly- blend with fascia of superior mediastinum
55
Where do pulmonary visceral afferent travel from?
Visceral pleural and lower respiratory tree to the pulmonary plexus
56
What is the pulmonary plexus?
A network of intertwines sympathetic axons, parasympathetic axons and visceral afferents (associated with the lungs)
The plexus is located at the bifurcation of the trachea
57
What changes in the lower respiratory tract can sympathetic and parasympathetic nerves initiate?
- Change level of mucous production
| - change dilation of airways
58
How is sensory information relayed from visceral afferent passed oat the pulmonary plexus and why is this significant?
Via the vagus nerve
This means the vagus nerves receives sensory information for both the upper and lower respiratory tracts meaning a cough can be initiated by either signal
59
Where can the phrenic nerve be found?
In the neck on the anterior scalenus muscle
| Lateral aspect of the pericardium
60
The phrenic nerve supplies which nerve where?
Sensory and sympathetic- diaphragm and fibrous pericardium
| Somatic motor to diaphragm
61
What are the three types of intercostal muscles?
1. External
2. Internal
3. Innermost
62
What are the four sets of accessory muscles of deep inspiration?
1. Pectoralis major
2. Pectoralis minor
3. Sternocleidomastoid
4. Scalenus anterior, medium and posterior
63
Where does the pectorals major attach?
Between the sternum and the ribs and also the humerus
64
The pectoralis major allows for which movements?
Adduction and rotation of the humerus
| Full ribs upwards and outwards when the upper limb position is fixed (facilitates deep inspiration)
65
Where is the pectorals minor located and where does it attach?
Deep to the pectorals major
| Attaches at the coracoid process of the scapula and ribs 3-5 that can be pulled superiorly upon contraction
66
Where dos the sternocleidomastoid muscle attach?
Between the sternum and clavicle
| Also as the mastoid process of the temporal bone
67
Where does the scalenus muscle group attach?
Between cervical vertebrae and ribs 1 and 2
68
What happens when intrinsic muscles in the larynx move the cartilage?
The vocal cords will close since they are attached
| The intrinsic muscles are innervated by motor components of the vagus nerve
69
Where does the vagus nerve arise from?
The medulla oblongata
70
Where does the vagus nerve exit the base of the skull?
Through the jugular foramen
71
In the chest the vagus nerve lies ______ to the lung root and supplies ______ axons to the chest organs and pulmonary plexus
Posteriorly
| Parasympathetic
72
The ____ ____ forms what on the oesophagus
Vagus nerve
| Plexus
73
What happens when the vagus nerve reaches the stomach ?
it forms another plexus where it supplies the foregut and the midgut
74
How is the action of the diaphragm different in passive breathing versus forces expiration with a cough?
Passive breathing - just relaxes
Forced expiration - right and left anterolateral abdominal wall muscles contract compressing abdominal organs and pushing the diaphragm upwards aiding forced expiration
75
What are three anterolateral muscles int he chest wall?
1. External oblique
2. Internal oblique
3. Transversus abdominus
76
In what direction do the muscle fibres in the external oblique muscle pass?
The same direction as the external intercostal muscles
77
Where does the external oblique muscle attach both superiorly and inferiorly ?
Superiorly- superficial aspect of the lower ribs
| Inferiorly- iliac breast and pubic tubercle
78
The external oblique muscles blends into what?
A flat tendon called aponeurosis
79
What is the point at which the muscle fibres end and aponeurosis begins called?
Linea semilunari
80
When two aponeuroses meet as with the right and left external oblique muscles, what is the point at which they (aponeuroses ) meet called?
Linea alba
81
The linea alba for the external oblique muscle is located on the _____ surface of the body?
Anterior
82
In which direction do the muscle fibres from the internal oblique muscles run?
In the same direction as the internal intercostal muscles
83
Where does the internal oblique muscle attach both superiorly and inferiorly?
Superiorly - lower border- inferior part - of the lower rib
| Inferiorly - iliac crest and thoracolumbar facia
84
Where do the aponeuroses for the internal oblique muscles come together?
The anterior side of the body at the lineament alba
85
In which direction do the muscle fibres in the transversus abdominus travel?
In the axil plane
86
Where are the attachments for the transverse abdominus?
Superiorly- distal aspects of lower ribs
| Inferiorly- iliac crest and thoracolumbar fascia
87
What is the rectus sheath?
An encapsulation of the rectus abdomen muscles formed from the aponeuroses of the external and internal oblique muscles and the transversus abdominus
88
What is the unique about the internal oblique aponeuroses in relation to the rectus abdominus?
The aponeuroses splits in half, with one half going posterior to the rectus abdominus and one half going anterior to it
89
Thoracoabdominal nerves are extensions of what nerves?
Intercostal nerves
90
Why do the 7th to 11th intercostal nerves terminate early?
Their associated ribs do not join in the midline
91
The intercostal nerves (7-11) terminate early since the ribs associated do not join in the midline- but what happens to the intercostal nerves from there?
They become thoracoabdomina nerves and remains between the internal oblique and transversus abddonminus
92
After leaving the intercostal space, what does the T12 intercostal nerve become?
The subcostal nerve
| Supplies the lower abdomen
93
Which nerve(s) originates from the L1 anterior ramus?
iliohypogastric nerve
| ilioinguinal nerve
94
The anterolateral abdominal wall muscles have many functions including what?
- maintaining posture
- supporting cerebral column
- help flex the vertebral column for movement
- guarding - protect organs
- contract to increase intraabdominal pressure for defecation, micturition labour and forced expiration
95
Build up of air trapped in alveoli due to a chronic cough can cause what?
Rupture of the pleura leading to a pneumothorax
96
During a pneumothorax, why does the lung collapse?
The vacuum of the pleural space is lost and this can no longer hold the lung in position due to the surface tension
The lung tissue recoils due to its elastic nature
97
What is the classification of a large pneumothorax ?
A gap of greater than 2cm results between the lung and the parietal pleura
(a small pneumothorax is when this gap is less than 2cm)
98
On examination, what signs may lead to a diagnosis of pneumothorax?
- reduced ipsilateral chest expansion
- reduced ipsilateral breath sounds due to absence of lung tissue
- hyper-resonance- due to absence of lung tissue and increased air space
- deviated trachea
99
On a chest X-Ray, how may a pneumothorax present?
- absent lung markings around the peripheries
| - the lung edge is visible
100
What is the four sections is the mediastinum split into?
1. Anterior
2. Posterior
3. Superior
4. Middle- houses the heart
101
What section of the mediastinum houses the heart?
middle
102
At which anatomical landmark does the middle mediastinum become the superior mediastinum?
At the level of the sternal angle
103
What can cause mediastininal shift and what are some of the consequences?
Tension pneumothorax
- tacheal deviation
- SVC compression
- Hypotension- reduced venous return
104
What can be done to allow excess air out of the pleural cavity (during a pneumothorax for example)
needle aspiration
| thoracentesis(pleural tap)
105
Where may be an appropriate location for a chest drain in pneumothorax management?
the middle of the 4th and 5th intercostal space in the midaxillary
106
Why is a chest drain inserted in the middle of an intercostal space?
To avoid the neurovascular bundles superiorly and inferiorly
107
What is the "safety triangle" in relation to pneumothorax management?
AN area where a chest drain can be inserted, or needle aspiration can occur
There are no organs to puncture in this area
It is composed of three points:
1. Anterior border of the latissimus dorsi
2. Posterior border of the pectorals major
3. Axial line superior to the nipple
108
To realise air in an emergency during a tension pneumothorax, where is a large gage cannula inserted?
The pleural cavity at the 2nd/3rd intercostal space in the mid- clavicular line
This is the level of rib 2 at the sternal angle
109
What is a hernia?
When any body structure passes through another to end up inane incorrect location, a hernia is formed
110
To develop a hernia, two factors must be present, what are these?
1. Weakness of one structure
| 2. Increased pressure on one side of the weak body wall
111
What are the two main types of oesophageal hernia?
1. Paraoesophageal hiatus hernia
| 2. Sliding hiatus hernia
112
What is the point at which the oesophagus becomes the stomach?
The gastro oesophageal junction
113
How do sliding hiatus herniae differ from paraoesophageal hiatus herniae?
- Sliding- whole stomach moves, gastro oesophageal junction moves
- Paraoesophageal- portion of the stomach herniates out, gastro oesophageal junction remains in the correct location
114
Where is the inguinal region?
The region found between the anterior superior iliac spines and the pubic tubercles
115
What are the inguinal ligaments formed from?
The inferior border of the external oblique aponeuroses
116
The medial halves of the inguinal ligaments form what in the inguinal canals?
The floor
117
Inguinal canals form channels between _____ and ______ ______.
Deep
| Superficial structure
118
What and where are the two openings in the inguinal canals?
1. The deep ring- intra-abdominal- midpoint of the inguinal ligament
2. The superficial ring- superficial- V-shaped part of the external oblique apononeurosis lying superolateral to the pubic tubercle
119
In relation to herniation, what does the inguinal canal allow for?
Abdominal structures can herniate through the canal and move to more superficial areas
120
How is the inguinal canal formed?
During embryonic development
| Descent of either the testes or round ligament of the uterus
