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OMS 1 > anatomy block 4 > Flashcards

anatomy block 4 Flashcards

1
Q

extrinsic muscles

A

innervated by anterior rami or CN XI

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2
Q

intrinsic muscles

A

innervated by posterior rami

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3
Q

superficial group

A

-trapezius - superior nuchal line/ligamentum nuchae/C7-T12 to clavicle/acromion/spine of scapula (superficial transverse scapular artery, acromial branch of subscapular artery, dorsal branches posterior intercostal arteries)
-latissimus dorsi - ribs 10-12/T12-L5 spinous process/iliac crest/sacrum to intertubercular sulcus of humerus (thoracodorsal artery, dorsal branches of posterior intercostal arteries, lumbar arteries, thoracodorsal nerve)
-levator scapulae - C1-4 TP to upper medial border of scapula (deep branch of transverse cervical artery, dorsal scapular nerve)
-rhomboid minor - C7-T1 SP to medial border of scapula and superior to spine (deep branch of transverse cervical artery, dorsal scapular nerve)
-rhomboid major - T2-5 SP to medial border of scapula inferior to spine(deep branch of transverse cervical artery, dorsal scapular nerve)

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4
Q

intermediate group

A

-serratus posterior superior - C7-T3 SP/supraspinous ligament to ribs 2-5 (anterior rami and intercostal arteries T2-5)
-serratus posterior inferior - T11-L2 SP/supraspinous ligament to ribs 9-12 (anterior rami and intercostal arteries T9-12)

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5
Q

deep group (intrinsic) - posterior rami spinal nerves

A

-splenius capitis - superior nuchal line/mastoid process to ligamentum nuchae/C7-T4 SP
-splenius vervicus - C1-3 TP to T3-11 SP
ERRECTOR SPINAE
-logissimus - capitis to mastoid process. //. cervicis to transverse process. //. thoracis to angle of rib/tubercle
-spinalis - thoracis to SP. //. cervicis hidden to SP. //. capitis hidden to occipital bone
-iliocaostalis - cervisis to TP. //. thoracis to angle of rib. //. lumborum to angle of rib
TRANSVERSIS SPINALIS
semispinalis - capitis C4-T6 TP to between superior and inferior nuchal line (pierced by greater occipital nerve). //. thoracis/cervicis thoracic TP to thoracic/cervical SP (span 4-6 vertebrae)
-multifidus - TP to base of SP (span 2-4 vertebrae)
-rotatores - SP to inferior TP (brevis connects adjacent vertebrae, longus skips a vertebrae)
SEGMENTAL
-levatores costarum - TP to inferior rib (brevis connect adjcent rib, longus skips a rib)
-interspinalis lumborum
-intertranversarius lateralis
SUBOCCIPITAL
-rectus capitus posterior major and minor, obliquus capitis superior and inferior, TP of atlas C1)

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6
Q

triangle of auscultation

A

rhomboid major, trapezius, latissimus dorsi
amplified thoracic sounds

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7
Q

lumbar triangle

A

latissimus dorsi, external oblique, iliac crest
herniation of abdominal structures

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8
Q

anterior wall of axilla

A

subclavius, pectoralis minor, clavipectoral fascia, pectoralis major

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9
Q

medial wall of axilla

A

upper thoracic wall, serratus anterior

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10
Q

apex (inlet) of axilla

A

clavicle, superior margin of scapula, coracoid process, rib 1

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11
Q

posterior wall of axilla

A

subscapularis, teres major, long head of triceps, latissimus dorsi

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12
Q

lateral wall of axilla

A

intertubercular sulcus

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13
Q

base of axilla

A

axillary fossa, anterior and posterior axillary fold

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14
Q

upper brachial plexus injury

A

ERB Duchenne Palsy/back packers
adducted and extended at elbow, medial rotated, lateral arm sensory deficit

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15
Q

lower brachial plexus injury

A

Klumpke paralysis
intrinsic muscles of hand paralyzed (claw hand), hand and forearm sensory deficit

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16
Q

posterior cord injury

A

Saturday night palsy/crutch
posterior arm and forearm paralyzed, elbow flexion and wrist drop

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17
Q

axillary artery

A

between clavicles and inferior border of teres major
1. superior thoracic artery
2. thoracoacromial artery, lateral thoracic artery (pectoral branch)
3. anterior circumflex artery, posterior circumflex artery, subscapular artery (circumflex scapular and thoracodorsal artery)

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18
Q

veins in axilla

A

brachial vein joins basilic vein forming axillary vein
cephalic vein joins axillary vein forming subclavian vein

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19
Q

lymph nodes

A

humeral nodes, subscapular nodes, pectoral nodes join to form central nodes
central nodes to apical nodes
apical nodes to supraclavicular nodes
supraclavicular nodes to subclavian lymphatic trunk
subclavian lymphatic trunk to R or L venous angle

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20
Q

glenohumeral joint

A

joint capsule (synovial membrane and fibrous capsule), glenoid cavity, glenoid labrum
tendon sheath of long head biceps
coracohumeral ligament, transverse humeral ligament, glenohumeral ligaments (superior, middle, inferior)

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21
Q

acromioclavicular joint/suprascapular ligaments

A

acromioclavicular joint supported by AC ligament
coracoclavicular ligament (trapezoid ligament and conoid ligament)
superior trnasverse scapular ligament
coracoacromial ligament

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22
Q

extrinsic muscles of shoulder

A

superficial - trapezius, latissimus dorsi
deep - levator scapulae, rhomboid major and minor

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23
Q

intrinsic muscles of shoulder

A

SUBSCAPULAR NERVE
-supraspinatus - supraspinous fossa to greater tubercle
-infraspinatus - infraspinous fossa to greater tubercle
AXILLARY NERVE
-teres minor - lateral border to greater tubercle
-deltoid - spine/acromion/clavicle to deltoid tuberosity
LOWER SCAPULAR NERVE
-teres major - inferior angle to medial lip of intertubercular sulcus
UPPER AND LOWER SUBSCAPULAR NERVES
-subscapualris - subscapular fossa to lesser tubercle

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24
Q

rotator cuff

A

S - supraspinatus
I - infraspinatus
T - teres minor
S - subscapularis

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25
Q

shoulder bursa

A

subdeltoid, subacromial, subtendinous, bursa of subscapularis

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26
Q

ARMY over NAVY

A

suprascapular artery over superior transverse ligament, suprascapular nerve under superior transverse ligament

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27
Q

shoulder anastamosis

A

suprascapular artery, circumflex scapular artery, deep transverse cervical artery

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28
Q

quadrangular space

A

humerus, long head of triceps, teres major, teres minor
posterior humeral circumflex artery and nerve within

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29
Q

triangular space

A

teres major, teres minor, triceps long head
circumflex scapular artery within

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30
Q

triangular interval (hiatus)

A

humerus, teres major, triceps long head
deep brachial artery and radial nerve within

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31
Q

pectoral girdle includes

A

clavicles, scapulae, sternoclavicular joint

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32
Q

pectoral region

A

external to anterior thoracic wall, connects upper limb to axial skeleton, anterior wall for axilla, 2 layers
-superficial - skin, superficial fascia, breasts
-deep - muscles and relateed structures

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33
Q

breasts

A

2nd - 6th rib from lateral sternum to mid axillary line
-between breast and fascia is loose subcutaneous tissue (retromammary space)
-lactiferous duct/sinus, lobules, suspensory ligament
-branches of lateral thoracic artery, terminal branches or 2-4 posterior intercostal arteries
-lateral thoracic vein to axillary vein, internal thoracic vein to subclavian vein, posterior intercostal vein to azygous vein
-75% to axillary nodes, most remaining to parasternal nodes, inferior quadrants drain to abdominal nodes
-anterior and lateral cutaneous branches of 4th-6th intercostal nerves and subclavicular nerves (C3&4)

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34
Q

clavicopectoral fascia

A

encompasses subclavisus and pectoralis minor (between is costocorocoid membrane), inferior part attached to axillary fascia by suspensory ligament of axilla

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35
Q

structures piercing clavipectoral fascia

A

C - cephalic vein
A - acromiothoracic artery
L - laterla pectoral nerve
L - lymphatics

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36
Q

deltopectoral triangle contents

A

deltopectoral fascia, cephalic vein, deltoid branch thoracoacromial artery

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37
Q

pectoralis major

A

medial 1/2 clavicle/anterior sternum/1st-7th costalcartilages/aponeurosis of external oblique to lateral lip of bicipital groove
lateral and medial pectoral nerves
thoracoacromial and perforating branches of internal thoracic artery

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38
Q

pectoralis minor

A

ribs 3-5 to coracoid process
medial pectoral nerve
thoracoacromial and perforating branches of internal thoracic artery

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39
Q

subclavius

A

1st costochondrojunction to inferior surface clavicle
nerve to subclavius
clavicular branch of thoracoacromial artery

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40
Q

serratus anterior

A

lateral surface of ribs 1-12 and intercostal spaces to costal surface of medial border of scapula
long thoracic nerve
lateral thoracic artery

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41
Q

scapula

A

acromion, coracoid process, supraglenoid tubercle, infraglenoid tubercle

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42
Q

proximal humerus

A

head, anitomical neck, surgical neck, greater tubercle, lesser tubercle, intertubercular sulcus, deltoid tuberosity

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43
Q

mid diaphysis

A

radial groove

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44
Q

distal humerus

A

medial epicondyle, medial supracondylar ridge, lateral epicondyle, lateral supracondylar ridge, capitulum, trochlea, olecranon fossa, coronoid fossa, radial fossa

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45
Q

ulna

A

tuberosity of ulna, olecranon process

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46
Q

radius

A

radial tuberosity

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47
Q

what are the arm compartments separated by

A

medial and lateral intermuscular septa

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48
Q

flexor/anterior compartment

A

biceps, brachialis, coracobrachialis
musculocutaneous nerve
brachial artery

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49
Q

biceps brachi

A

musculocutaneous nerve (C5,6)
brachial artery
LONG HEAD - supraglenoid tubercle to radial tuberosity
SHORT HEAD - coracoid process to radial tuberosity
shoulder flexion, elbow flexion, supination of forearm
glenoid labrum (proximal long head attachment provides stability)
SLAP tear - superior labrum anterior to posterior

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50
Q

brachialis

A

musculocutaneous nerve (C5,6)
brachial artery
distal hald of anterolateral humerus to tuberosity of ulna
elbow flexion

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51
Q

coracobrachialis

A

musculocutaneous nerve (C5,6,7)
brachial artery
coracoid process to medial side of midshaft of humerus
shoulder flexion

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52
Q

extensor/posterior compartment

A

radial nerve
produndus brachii (deep brachial) artery
triceps brachii

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53
Q

triceps brachii

A

LONG HEAD - infraglenoid tubercle to olecranon process
LATERAL HEAD - posterior humerus above radial groove to olecraon process
MEDIAL HEAD - posterior humerus below radial groove to olecranon process
elbow extension

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54
Q

brachial artery

A

after teres major, under short head of biceps, starts medial and moves lateral to lie between epicondyles when crossing elbow, terminates below elbow and divides into radial and ulnar arteries
branches - profunda brachii, branches to adjacent muscles, humeral nutrient artery, superior ulnar collateral artery, inferior ulnar collateral artery

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55
Q

profuda brachii

A

posterior arm, runs in radial groove, anastamose with posterior circumflex and terminates into 2 collateral arteries which are radial and medial

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56
Q

veins in arm

A

deep - paired brachial veins run with brachial artery
superficial - basilic runs medial and becomes axillary, cephalic runs lateral and empties into axillary

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57
Q

lymphatics

A

to cubital nodes then to axillary nodes

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58
Q

nerves

A

-musculocutaneous pierces coracobrachialis and innervates anterior compartment
-median and ulnar nerves run with brachial artery proximally
-distal radial nerve continues lateral with radial artery, ulnar runs posterior to medial epicondyle to enter forearm
-posterior - radial nerve enters posterior compartment via triangular interval and gives branch to biceps and enters radial groove to give cutaneous and triceps branches

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59
Q

cubital fossa borders

A

lateral - brachioradialis and forearm extensors
medial - pronator teres and forearm flexors
superior - line between epicondyles
floor - brachialis and supinator
roof - bicipital aponeurosis, fascia, fal, skin

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60
Q

contents of cubital fossa (lateral to medial)

A

tnedon of biceps brachii, brachial artery, median nerve
superficial - median cubital vein crosses bicipital aponeurosis and runs superomedial to connect cephalic with basilic vein
venipuncture done here
biceps reflex (strike biceps tendon here) test C5 and 6

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61
Q

ligaments of elbow

A

radial collateral, ulnar collateral
radius pulled from anular ligament results in nursemaids elbow

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62
Q

supination muscle

A

supinator

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63
Q

pronator muscle

A

pronator teres, pronator quadratus

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64
Q

anterior compartment

A

mainly median nerve, a few ulnar

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65
Q

superficial anterior compartment

A

pronator teres, palmaris longus (inconcsistent), flexor carpi radialis (attached to lat wrist), flexor carpi ulnaris (ulnar nerve, attached to medial wrist)

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66
Q

intermediate anterior compartment

A

flexor digitorum superficialis (proximal medial phalanges)

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67
Q

deep anterior compartment

A

flexor digitorum profundus (1/2 median 1/2 ulnar nerves), flexor pollicis longus

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68
Q

posterior compartment

A

radial nerve (brachioradialis is anterior compartment ut also radial nerve)

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69
Q

superficial posterior compartment

A

extensor carpi ulnaris, aconeus, extensor digiti minimi, extensor digitorum

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70
Q

deep posterior compartment

A

supinator, extensor indicis
3 longus - extensor carpi radialis, extensor pollicis (snuff box), abductor pollicis
2 bravis - extensor carpi radialis, extensor pollicis

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71
Q

deep flexor compartment arteries

A

ulnar medially, radial laterally, anterior interosseous a/n

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72
Q

deep extensor artery and nerve

A

posterior interosseous

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73
Q

hand bones

A

2 rows of 4 starting at bottom thumb
So - scaphoid
Long - lunate
The - triquetrum
Pinky - pisiform
Here - hamate
Comes - capitate
The - trapezoid
Thumb - trapezium

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74
Q

carpal tunnel

A

made of carpal arch and flexor retinaculum
includes 9 tendons (flexor digitorum profundus, flexor digitorum superficialis) and the median n

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75
Q

wrist joints

A

midcarpal and radiocarpal
can flex more than extend

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76
Q

palmar aponeurosis

A

palmaris longus tendon proximally
palmaris brevis tightens aponeurosis

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77
Q

thenar muscles : median nerve

A

(superficial to deep)
abductor pollicis brevis
flexor pollicis brevis
opponens pollcis brevid
adductor pollicis brevis (ulnar n)

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78
Q

hypothenar muscles : ulnar n

A

(superficial to deep)
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi

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79
Q

hand interossei

A

PADS - palmar, adduct, ulnar n (4)
DABS - dorsal, abduct, ulnar n (4)

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80
Q

lumbricals

A

attach to extensor hoods, 4 of them
medial 2 ulnar n
lateral 2 median n

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81
Q

palm blood supply

A

ulnar and radial nerves give superficial and deep palmar arches, dorsally they give the deep dorsal arch
deep palmar arch gives off palmar metacarpal aa
superficial gives off common pamar digital aa which end in proper digital aa
deep dorsal arch also gives dorsal maetacarpal aa and proper digital aa

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82
Q

palm innervation

A

ulnar n : medial 1/2 digit 4 and all digit 5
median n : palmar branch before carpal tunnel, the rest goes through tunnel and innervates lateral 1/2 digit 4, and digit 3,2,1

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83
Q

posterior hand innervation

A

ulnar n : medial side to medial 1/2 digit 4
radian n : thumb to lateral 1/2 digit 4 (not fingertips)
median n : fingertips of thumb to lateral 1/2 digit 4

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84
Q

cavities lined by mesothelium

A

pleura, pericardial, peritoneal

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85
Q

thorax

A

between neck and abdomen
contains thoracic cavity and contents, thoracic wall surrounds it

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86
Q

framework of thorax

A

12 ribs
costal cartilages
12 thoracic vertebrae
intervertebral discs
manubrium/body of sternum
xiphoid process

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87
Q

superior thoracic aperture/inlet

A

open, narrow, continues with root of neck

88
Q

inferior aperture of thorax

A

wide, closed by diaphram

89
Q

true ribs

A

1-7 articulate directly with sternum

90
Q

false ribs

A

8-10 articulate with costal cartilage of ribs above

91
Q

floating ribs

A

11-12 no anterior attachment

92
Q

rib features

A

head - has 2 facets, separated by crest, which articulate with vertebra superior with the same number and inferior 1 number above
neck
tubercle connects to corresponding TP
body - has costal groove for intercostal arteries and nerves

93
Q

sternum

A
  1. manubrium - articulates with clavicles (sternoclavicular joint) and manubriosternal symphysis (2nd costal cartilage attaches here)
  2. body - T5-9
  3. xiphoid provess at T10
94
Q

3 muscle layers in thoracic wall

A
  1. external intercostals - elevate ribs, anterior external intercostal membrane (attach inferolateral)
  2. internal intercostals - depress ribs, posterior internal intercostal membrane (attach inferomedial)
  3. innermost intercostal muscles - seperated from internal intercostals by intercostal (Vein, Artery, Nerve)
95
Q

subcostal muscles

A

in lower thoracic wall
internal surface of angle of rib to internal surface of 2-3 ribs inferior
run in the same direction and blend with the internal intercostals (depress ribs)

96
Q

transverse thoracis muscles

A

posterior xiphoid process/inferior sternum/adjacent costal cartilages of true ribs to insert the inferior margines of costal cartilages 3-6
depress ribs

97
Q

arteries of thoracic wall

A
  1. 1st and 2nd intercostals from supreme intercostal (costocervical trunk of subclavian a)
  2. from aorta - posterior intercostal arteries for rib 3-11
  3. from subclavian a - internal thoracic aa which gives anterior intercostal arteries, (at 6th intercostal space) musculophrenic and superior epigastric aa
98
Q

veins of anterior thoracic wall

A

posterior intercostal veins drain into brachiocephalic on same side (1st) and the rest into azygos on R or hemiazygos/accessory hemiazygos on L
superior intercostal vv - L into brachiocephalic, R into azygos
azygos v - made from lumbar vv and R subcostal vv, connects superiorly to SVC, drains R intercostals, perichardial veins, bronchial veins, vertebral venous plexuses
hemiaxygos v - receives 9th-11th intercostals and subcostal v
accessory hemiazygos v - drain 4th-8th intercostals
hemiazygos/accessory hemiaxygos join azygos at T7-8

99
Q

nerves of anterior thoracic wall

A

T7-11 give intercostal nervers
T12 gives subcostal nerve

100
Q

lymph of anterior thoracic wall

A

parasternal nodes drain into bronchomediastinal nodes
intercostal nodes
diaphragmatic nodes posterior to xiphoid

101
Q

carpal tunnel syndrome

A

compression median n in carpal tunnel
phalens test (wrist flexion cause pain or tingling)
treat with splint, OMT, NSAIDs, steroids, sx

102
Q

cubital tunnel syndrome

A

compression ulnar nerve in cubital tunnel
impaire flexion of elbow and wrist
Tinels test
treat with extension, NSAIDs, OMT sx

103
Q

cervical radiculopathy

A

compression of a nerve root (arthritis, herniated disc)
Spurlings test, abduction relief sign
treat with rest, antiinflammatories, OMT, sx

104
Q

malingering

A

feigned signs and symptoms
more men with antisocial personality disorder, substance abuse, symptoms are vague

105
Q

angina pectoralis

A

coronary artery disease
women lower before menopause
chest pain with exertion
relieved by nitrate and resting
shortness of breath
EKG, stress test, CT
treat with meds, stent, bypass

106
Q

barrett esophagus

A

stomach is source of acid leading to barretts esophagus
squamous cells transform into glandular epithelium

107
Q

metaplasia

A

reversible change in which differentiated cell type is replaced by another

108
Q

dysplasia

A

atypical epithelium

109
Q

adenocarcinoma of esophagus

A

esophageal carcinoma

110
Q

great vessels

A

aorta, SVC, IVC, pulmonary arteries and veins

111
Q

pericardium

A

fibrous membrane with 2 layers
fibrous (superficial)
serous (deep)
boundaries of middle mediastinum, encloses roots of great vessels (blends with tunica adventitia)

112
Q

coelomic sacs

A

pleura, pericardium, peritoneum

113
Q

serous pericardium

A

parietal and visceral layers

114
Q

heart position

A

R ventricle anterior usually left to midline

115
Q

apex

A

inferolateral L ventricle

116
Q

heart base

A

posterior, mainly L atrium

117
Q

surfactes

A

anterior (sternocostal) - R ventricle
inferior (diaphragmatic) - L ventricle
R pulmonary - R atrium
L pulmonary - L ventricle

118
Q

borders

A

right - R atrium
inferior - right ventricle and some L ventricle
left - L ventricle and some auricle
superior - R and L atria and auricles

119
Q

surface projections

A

apex - 5th intercostal space at midclavicular line
superior border - 2nd L intercostal space to 3rd right intercostal space
right border - 3rd R intercostal space to 6th R intercostal space
inferior border - 6th R intercostal space to apex
left border - apex to 2nd L costal cartilage

120
Q

coronary sulcus

A

division between atria and ventricles
trunk of coronary vessels
encircles heart

121
Q

interatrial sulcus

A

separate atria, hidden by pulmonary trunk and aorta

122
Q

2 interventricular sulci

A

anterior - anterior interventricular artery and great cardiac vein
posterior - posterior interventricular artery and middle cardiac vein

123
Q

arteries of external heart

A

left coronary artery - mostly L atria and ventricle, some R atria and ventricle, anterior 2/3, interventricular septum, bundle of His
1. L anterior descending artery (R and L ventricles, apex, interventricular septum)
2. L circumflex artery (posterior lateral L ventricle, L atrium, L auricle)
R coronary artery - R atrium and ventricle, sinoatrial node, atrioventricular node, part of L ventricle, posterior 1/3 interventricular septum
1. R marginal artery (R ventrical and apex)
2. SA nodal branch (SA node)
3. posterior interventricular artery (R and L ventricle and inerventricular septum)
4. AV nodal branch (AV node)

124
Q

coronary dominance

A

determined by coronary artery that gives posterior interventricular artery
usually R

125
Q

venous drainage

A

all drain to coronary sinus (runs left to right in coronary sulcus on posterior, drains into R atrium)

126
Q

great cardiac vein

A

apex to anterior interventricular sulcus, follow left circumflex artery to become coronary sinus

127
Q

middle cardiac vein

A

apex to posterior interventricular sulcus

128
Q

small cardiac vein

A

inferior anterior coronary sulcus between R atrium and ventricle

129
Q

heart innervation

A

sympatethic T1-5 speed it up
parasympathetic vagus n slow it down

130
Q

superficial and deep cardiac plexuses

A

superficial - inferior to aortic arch between aortic arch and pulmonary trunk
deep - between aortic arch and brachial bifurcation

131
Q

layers of the heart

A

endocardium
myocardium
epicardium

132
Q

endocardium layers

A

endothelium
inner layer - CT and smooth muscle
outer layer - blood vessels

133
Q
A
134
Q

myocardium

A

myocytes

135
Q

epicardium

A

blood vessels and nerves
subepicardium
mesothelium

136
Q

valves

A

folds of endocardium
chordae tendinae attach AV valves
4 valves : bicuspid/tricuspid (AV), aortic and pulmocary (semilunar)

137
Q

conduction system

A

SA node (SVC and R atrium) - fastest to depolarize, pacemaker, follower cells connect with myocardium which connects AV node
AV node (septal wall near tricuspid) - slower
AV bundle - pass AP from AV node, becomes 2 bundles before purkinje fibers
purkinje fibers - ventricle conduction, functions like neurons

138
Q

blood vessel layers

A

tunica intima - endothelium simple squamous, maybe elastic membrane
tunica media - circumferentially oriented smooth muscle, maybe collagen or elastin
tunica adventitia - may be seperated by elastic lamina, CT, neurons

139
Q

artery types

A

large elastic - conducting arteries, media up to 60 layers, adventitia thin CT
medium muscular - distributing arteries, media 20-40 layers, adventitia thicker and inner part is external elastic membrane
arterioles - small, regulate BP, 1-2 layers, smooth muscle

140
Q

precapillary sphincters

A

ring of smooth muscle, influence BP and thermoregulation

141
Q

capillaries

A

continuous - tight junctions (muscle)
fenestrated - windows (intestinal vili)
sinusoid - large gaps (liver)

142
Q

veins small to large

A

venules - intima no subepithelium, media 0-2 layers of muscles, adventitia thick
medium veins - intima has internal elastic membrane, media 1-3 layers of smooth muscle, adventitia thick with some smooth muscle
large veins - intima subendothelium thicker, media smooth muscle decreased, adventitia thick bundles of longitudinal smooth muscle

143
Q

valves

A

in veins, allow 1 way flow

144
Q

vasa vasorum

A

in adventitia, vessels over 1 mm
branch into tunica media and provide metabolites to outer regions of vessels

145
Q

lymph vessles

A

capillaries - very thin walled, blind ending sacks (lacteals in GI)
vessels - all 3 layers but tunics thinner
often have valves
largest is thoracic duct (media 2 layers, poorly defined adventitia)

146
Q

cardiac skeleton

A

dense fibrous CT
4 rings connected by trigone (thickened CT)
maintain integrity of openings, attachment for valve susps, separate atria and ventricles

147
Q

stenosis

A

narrowing of valve
insufficiency and regurgitation is when the valves dont close completely

148
Q

diastole

A

relaxing

149
Q

systole

A

contracting

150
Q

first heart sound (S1)

A

closure of AV valves in systole

151
Q

second heart sound (S2)

A

closure of semilunar valves in diastole

152
Q

right atrium

A

cristae terminalis divides into smooth (ava) and rough (muscular) portions
foramen ovale is opening in fetal interatrial septum, becomes fossa ovalis

153
Q

right ventricle

A

3 papillary muscles - anterior, posterior, septal
trabeculae carnae - muscular elevations
septomarginal trabeculae - purkinje fibers (interventricular septa to anterior papillary muscle)
conus arteriosus - leads to pulmonary trunk and valve

154
Q

left atrium

A

smooth wall (posterior half) and rough wall (anterior half with pectinate muscles)

155
Q

left ventricle

A

walls thicker
trabeculae carne finer and more numerous
anterior and posterior papillary muscles longer

156
Q

interventricular septum

A

thick muscular part
thin membranous part (upper)

157
Q

conducting system

A

nodal tissue conducting fibers
SA node - spread signal across both atria
AV node - distribute signal to ventricles
AV bundle - pass through skeleton connecting atria and ventricles
Bundle branches - junction of muscular and membranous intraventricular septum
purkinje fibers - extend ventricles and stimulate papillary muscles

158
Q

primitive heart field

A

splanchnic lateral plate mesoderm

159
Q

primary heart field

A

induced by pharyngeal endoderm
right left symmetry established
secondary heart field in surrounding splanchnic mesoderm

160
Q

carnialcaudal folding

A

brings heart into thorax

161
Q

cardiogenic progenitors coalesce in endocardial tube

A

splanchnic mesoderm myocardial cells surround tube and secrete cardiac jelly, connect pericardium through dorsal mesocardium (degenerates about day 28)

162
Q

secondary heart fiels

A

cells migrate and are incorporated into outflow tract and venous pole

163
Q

fetal heart correlates to postnatal heart

A

aortic sac - connection to aortic arch
truncus arteriosus - ascending aorta and pulmonary trunk
conus arteriosus/cordis - infundibulum and aortic vestibule
primitive ventricle - left and right ventricles
primitive atrium - left and right atrium
sinus venosus - coronary sinus and sinus venarum
veins - vena cava

164
Q

heart tube lengthens and twists

A

mesoderm forms septum transversum

165
Q

heart septation

A

epithelial to mesenchyme transition
neural crest cells migrate into endocardial cushion
septum forms but with foramen primum
second septum forms with fossa ovalis

166
Q

ventricular septation

A

starts as myocytes forming muscular septum
fully formed around 7 weeks

167
Q

AV valves

A

cavitation occurs with developing ventricles creating trabeculae carne and cordae tendinae

168
Q

intussusception

A

pulmonary veins incorporated into wall of L atrium

169
Q

2 parts of pleura

A

visceral and parietal, become continuous at the base of the lung
simple squamous epithelium on thin layer of CT with collagen, elastin, blod vessels, and lymphatics

170
Q

development

A

4 weeks laryngeotracheal diverticulum develops from foregut
tracheoesophageal ridges separate lung buds from foregut, fuse to form a septum
during separation lung forms trachea and 2 primary bronchi
15th week develop R and L primary bronchi which seperates into lobar bronchi
bronchi develop and branch, lungs move more caudal and expand into body cavity in pericardioperitoneal canals

171
Q

innervation of pleura

A

parietal - intercostals
visceral - parietal plexus

172
Q

hilum

A

where airways, nerves, and vessels pass into lungs

173
Q

root

A

medial to hilum, sleeve like covering for structures

174
Q

ligament

A

pleura from root of lung inferior to stabilize inferior lobe

175
Q

within the root and hilum

A

pulmonary artery, 2 pulmonary veins, main bronchus, bronchial vessels, lymphatics

176
Q

parietal pleura

A

cervical
costal
mediastinal
diaphragmatic

177
Q

pleural cavities

A

superior - 2-4cm above rib 1 into neck
inferior - extends to level just above costal margin
medially - bound by mediastinum

178
Q

endothoracic fascia

A

connect parietal pleura to thoracic wall

179
Q

suprapleural membrane

A

covers cervical parietal plerua (rib 1 to C7)

180
Q

phrenicopleura fascia

A

attach diaphram to parietal pleura (diaphragmatic)

181
Q

pleural recesses

A

costodiaphragmatic
costomediatinal

182
Q

pleura blood supply

A

parietal - intercostal a/v
visceral - R/L bronchial arteries and veins

183
Q

breathing

A

inspiration - thorax pressure lower than atmospheric
exhalation - thorax pressure higher than atmospheric

184
Q

lung surfaces

A

mediastinal, costal, diaphragmatic

185
Q

lung borders

A

anterior, posterior, inferior

186
Q

right lung

A

2 fissure - horizontal and oblique
3 lobes - superior, middle, inferioe
impressions - IVC, SVC, heart, esophagus, azygos vein, R subvlavian a/v, main bronchus branches

187
Q

left lung

A

1 fissure - oblique
2 lobes - superior and inferior
landmarks - cardiac nothc and lingula, main bronchus branches in root, arch of aorta pass over root, L subclavian artery and brachiocephalic vein arches over superior lobe

188
Q

topography

A

apex - C7/T1
inferior border - posteriorly rib 6, midaxillary rib 8, posterior rib 10
oblique fissure -posterior T4, midaxillary 5th intercostal space, anteriorly contour of rib 6
horizontal fissure - midaxillary rib 5, anteriorly rib 4 contour

189
Q

trachea

A

extends C6 to T4/5
divides into L/R main bronchus at sternal angle
carina - hook shaped structure at bifurcation

190
Q

right bronchus

A

shorter and wider

191
Q

bronchiole order

A

terminal branches
respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

192
Q

alveoli

A

type 2 - excrete surfactant
type 11 - gas exchange
alveolar pores allow pressure to equilibriate and air to circulate

193
Q

pulmonary blood supply

A

pulmonary artery to lobar arteries to segmental arteries

194
Q

bronchial arteries

A

nutrition for lung, run with bronchi

195
Q

bronchial veins

A

R drains into azygos
L drains into accessory hemiazygos

196
Q

sympathetics

A

bronchodilation
T1-4/5

197
Q

parasympathetics

A

vagus nerve
bronchoconstriction

198
Q

lymphatics

A

superficial pleural plecus deep to visceral pleura to bronchopulmonary nodes
deep bronchopulmonary plexus in submucosa into intrinsic pulmonary nodes into bronchopulmonary nodes
bronchpulmonary nodes into superior and inferior tracheobronchial nodes into right and left bronchomediastinal trunks
R to other branches forming short R duct
L into thoracic duct
some to axillary
parietal pleura to nodes in thoracic wall

199
Q

esophagus

A

compressed by L main bronchus
moves anterior to aorta

200
Q

off aorta

A

right side - carotid a, subclavian a
left side - brachiocephalic trunk (coming off common carotid a, subclavian a)

201
Q

bovine arch

A

L common carotid originates from brachiocephalic trunk

202
Q

double aortic arch

A

encircles esophagus and trachea

203
Q

retroesophageal aortic arch

A

esophagus gets compressed

204
Q

mediastinum veins

A

inferior thyroid, internal jugular, subclavian, brachiocephalic, pericardiophrenic, superior intercostal, posterior intercostal, azygos, hemiazygos, accessory hemiazygos, ascending lumber, subcostal

205
Q

mediastinum arteries

A

supreme intercostal, posterior intercostal, bronchial, esophageal, subcostal, superior phrenic

206
Q

superior vena cava syndrome

A

compression by things close to SVC
azygos vein for venous collateral circulation

207
Q

pericardial sinuses

A

oblique and transverse

208
Q

nerves in mediastinum

A

cervical plexus, phrenic nerve, vagus nerve, recurent laryngeal nerve, esophageal plexus, anterior vagal trunk

209
Q

distention of aortic arch

A

aneurism or dissection

210
Q

lymphatics

A

thoracic duct crosses midline behind aorta around T4-6
left side - subclavian trunk joins jugular trunk and mediastinal trunk to drain into thoracic duct
right side - subclavian trunk joins jugular trunch forming bronchomediastinal trunk

211
Q

chylothorax

A

laceration of thoracic duct

212
Q

anterior mediastinum

A

thymus, sternopericardial ligament, fat, CT, lymph nodes

213
Q

thymus

A

procuce T cells, blood supply from internal thoracic arteries, venoud drainage into L brachiocephalic or internal thoracic veins, lymph nodes are parasternal/tracheobronchial/near root of neck

214
Q

T4/5 sternal angle

A

transverse thoracic plane - superior margin of pericardium, connection of azygos v to SVC, separation of aortic sections, carina

215
Q

T5/6 to 3rd intercostal cartilage

A

branch point of pulmonary trunk, superior limit of heart

OMS 1 (8 decks)

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