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Phase 1 > Anatomy - CVR COPY > Flashcards

Anatomy - CVR COPY Flashcards

1
Q

What allows optimal positioning of the head?

A

-Cervical spine is flexible
-Neck is slender

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2
Q

Why is the neck prone to injury?

A

The flexibility of the cervical spine

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3
Q

Why is the neck an extremely vulnerable area for injury?

A

Many vital structures packed into the small region with little protection

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4
Q

What 6 things does the neck contain?

A

-Respiratory tract structures
-GI tract structures
-Glands
-Arteries and veins
-Nerves
-Several groups of muscles

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5
Q

What structures of the respiratory tract are in the neck?

A

-Pharynx
-Larynx
-Trachea

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6
Q

What structures of the GI tract are in the neck?

A

-Pharynx
-Oesophagus

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7
Q

What glands are in the neck?

A

-Thyroid
-Parathyroid

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8
Q

What do nerves in the neck innervate?

A

-Serve head and neck
-Upper limbs
-Thoraco-abdominal viscera (via vagus)
-Diaphragm (phrenic)

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9
Q

What muscle groups are in the neck?

A

-Move head and neck
-Move larynx in speech
-Swallowing that form floor of mouth
-Platysma - very thin subcutaneous muscle deep to the skin of the neck

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10
Q

What muscle does this show?

A

-Platysma
-Very thin subcutaneous muscle deep to skin of the neck

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11
Q

How many cervical vertebrae are there?
Describe them:

A

-7 cervical vertebrae
-Small
-Articulate with each other at facet joints that are oriented obliquely

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12
Q

Describe the types of joints between cervical vertebrae:

A

-Facet joints
-Oblique (at an angle)
-Good range of flexion and extension of the cervical spine - in comparison to thoracic

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13
Q

What bone is situated anteriorly in the upper neck, inferior to mandible?

A

-Hyoid bone
-Helps to keep pharynx open
-Provides attachment point for several muscles in neck and tongue

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14
Q

Label this diagram:
What is it?

A

Hyoid bone

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15
Q

What bones and cartilage are in the neck?

A

-7 cervical vertebrae
-Hyoid bone
-Larynx

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16
Q

What composes the larynx and what is its function?

A

-Skeleton of small cartilages connected by membranes and small joints
-Protects airway
-Muscles attach to laryngeal cartilages to move them and move vocal chords (phonation)

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17
Q

In what terms is the neck described?

A

Anterior and posterior triangles

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18
Q

What separates the anterior and posterior triangles of the neck?

A

Sternocleidomastoid muscles

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19
Q

What does the sternocleidomastoid connect?
How does it act?

A

-Attached to:
-Sternum
-Clavicle
-Mastoid process (part of temporal bone)
-Can act:
-Bilaterally
-Unilaterally

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20
Q

What nerve innervates the sternocleidomastoid muscle?

A

The accessory nerve (CN XI)

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21
Q

What are the 3 boundaries of the anterior triangle of the neck?

A

-Anteriorly: Midline of neck
-Posteriorly: Anterior border of sternocleidomastoid
-Superiorly: Lower border of mandible

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22
Q

What bones and cartilaginous structures are in the anterior triangle of the neck?

A

-Trachea
-Larynx

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23
Q

What glands are in the anterior triangle of the neck?

A

-Thyroid
-Parathyroid
-Submandibular thyroid gland

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24
Q

What is this?
Where is it?

A

-Submandibular salivary gland
-Anterior triangle of the neck

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25
Q

What muscles are in the anterior triangle of the neck?

A

-Suprahyoid muscles:
-Connect hyoid to skull
-Form floor of mouth
-Move hyoid and larynx in speech and swallowing
-Infrahyoid muscles:
-Strap muscles
-Connect hyoid to sternum and scapula
-Move hyoid and larynx in speech and swallowing

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26
Q

What blood vessels are in the anterior triangle of the neck?

A

-Common carotid artery and its terminal branches - external and internal carotid arteries
-External carotid artery to the head and neck
-Internal jugular vein

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27
Q

What nerves are in the anterior triangle of the neck?

A

-Branches of facial nerve (CN VII)
-Glossopharyngeal nerve (CN IX)
-Vagus nerve (CN X)
-Accessory nerve (CN XI)
-Hypoglossal nerve (CN XII)
-Ansa cervicalis - fibres from C1-C3 which innervate infrahyoid muscles

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28
Q

What are the boundaries of the posterior triangle of the neck?

A

-Anteriorly: Posterior border sternocleidomastoid
-Posteriorly: Anterior border of trapezius
-Inferiorly: Clavicle
-Superiorly, apex is formed by sternocleidomastoid and trapezius

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29
Q

What muscles and vessels are in the posterior neck of the triangle?

A

-Muscles that move the head
-Part of subclavian artery and subclavian vein
-External jugular vein which drains scalp and face

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30
Q

What nerves are in the posterior triangle of the neck?

A

-Accessory nerve (CN XI)
-Roots of brachial plexus (spinal nerves supplying upper limb)
-Cervical plexus (fibres from C1-4)
-Phrenic nerve

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31
Q

Describe the suprahyoid muscles:

A

-4 paired muscles:
-Mylohyoid
-Geniohyoid
-Stylohyoid
-Digastric
-Superior to hyoid bone and form floor of the mouth
-When they contract, raise hyoid bone and larynx during speech and swallowing

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32
Q

Describe the infrahyoid muscles:

A

-4 paired ‘strap’ muscles:
-Sternohyoid
-Omohyoid
-Sternothyroid
-Thryohoid
-Inferior to hyoid bone and just lateral to the anterior midline of the neck
-Draw hyoid bone and larynx inferiorly during speech and swallowing

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33
Q

What do the sternohyoid and omohyoid connect and where do they lie?

A

-Lie superficially
-Attach hyoid to sternum
-Attach hyoid to scapula

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34
Q

What do the sternothyroid and thyrohyoid connect and where do they lie?

A

-Lie deep
-Attach sternum to thyroid cartilage
-Attach thyroid cartilage to hyoid

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35
Q

Where does the thyroid gland lie and what is it composed of?

A

-Right and left lobes
-Lie just lateral to the lower larynx and upper trachea
-Each lobe deep to sternothyroid muscle

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36
Q

What joins the right and left lobes of the thyroid gland?

A

-The isthmus
-Lies anterior to the trachea

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37
Q

What is the function of the thyroid gland and what regulates its function?

A

-Produces hormones which play important role in regulation of metabolic processes
-Pituitary gland regulates hormone secretion from the thyroid gland

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38
Q

What supplies blood to the thyroid gland?

A

Thyroid ima artery is an additional artery present in some people

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39
Q

What veins drain the thyroid gland?

A
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40
Q

What are the parathyroid glands?

A

-Four glands
-Right and left superior and inferior
-Located in posterior of thyroid gland
-Produce parathyroid hormone which plays a role in calcium regulation
-Supplied by inferior thyroid arteries

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41
Q

Where does the internal carotid artery branch in the neck?

A

-It doesn’t give off any branches in the neck
-Enters cranium and supplies brain

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42
Q

Where do the common carotid arteries run?

A

-Ascend in the right and left sides of the neck
-Bifurcate into external and internal carotid arteries

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43
Q

Where does the external carotid artery branch?

A

-Several branches in that supply head and neck
-Including:
-Pharynx
-Scalp
-Thyroid gland
-Tongue
-Face

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44
Q

Label this diagram:

A
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45
Q

What is at the bifurcation of the common carotid artery?
What is its significance?

A

-Carotid sinus - small swelling
-Baroreceptors constantly monitor arterial blood pressure
-Visceral sensory info relayed to CNS via glossopharyngeal nerve
-Results in reflex response that regulate blood pressure

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46
Q

What does the subclavian artery give rise to and what does it supply?

A

-Supplies upper limb
-Large branch, thyrocervical trunk
-This gives rise to inferior thyroid artery

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47
Q

What major vessels form the superior vena cava?

A

-Internal jugular vein is major vein in neck which drains blood from brain and part of face
-This unites with subclavian vein which returns blood from upper limb
-This forms braciocephalic vein
-Right and left brachiocephalic unite to form SVC

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48
Q

What smaller vessel runs in the neck and joins the subclavian vein?

A

External jugular vein

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49
Q

What nerve supplies the platysma in the neck?

A

Facial nerve (CN VII)

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50
Q

What does the glossopharyngeal nerve (CN IX) supply?

A

-Pharynx (sensory info)
-Carotid sinus (visceral sensory fibres that return to the CNS via CN IX)

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51
Q

What does the vagus nerve innervate in the neck?

A

-Vital for normal speech and swallowing
-Muscles of the pharynx (motor innervation)
-Larynx (motor and sensory info)

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52
Q

Where does the vagus nerve run in the neck?

A

-Between internal jugular vein and internal carotid artery (above bifurcation)
-Between internal jugular vein and common carotid artery (below its bifurcation)
-Three structures run together in fascial sleeve called carotid sheath

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53
Q

What does this show?

A

-Carotid sheath containing:
-Common carotid artery
-Internal jugular vein
-CN X - vagus
-Fascial sleeve

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54
Q

What does the accessory nerve (CN XI) innervate?

A

-Sternocleidomastoid
-Trapezius

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55
Q

What does the hypoglossal (CN XII) innervate?

A

-Motor to muscles of tongue
-Not supply any neck structures but travels through it
-Lateral to internal carotid artery and deep to external jugular vein

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56
Q

Where does the phrenic nerve form and what does it innervate?

A

-C3, 4, 5 nerve fibres
-Descends through neck to enter the thorax
-Innervates diaphragm

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57
Q

What is the head and neck richly innervated with?

A

-Sympathetic fibres nerves
-Sympathetic trunk extends as far as the base of the skull

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58
Q

What are the names of the associated sympathetic ganglia in the neck and what do they innervate?

A

-Superior cervical ganglia
-Middle cervical ganglia
-Inferior cervical ganglia
-Postganglionic fibres from these ganglia innervate the head and neck

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59
Q

What is the pharynx?

A

-Muscular tube which lies in the neck
-Forms part of the respiratory and GI systems
-One continuous passageway composed of 3 parts

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60
Q

What are the 3 parts of the pharynx and where are they located?

A

-Nasopharynx - posterior to nasal cavity
-Oropharynx - posterior to oral cavity
-Laryngopharynx - posterior to larynx

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61
Q

Label this diagram:

A
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62
Q

Describe the muscles of the pharynx:

A

-Outer layer of circular muscle
-Inner layer of longitudinal muscle

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63
Q

Label this diagram:
What does it show?

A

-External circular muscle layer is composed of three constrictor muscles
-Superior, middle and inferior constrictors that overlap each other

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64
Q

What is the action of the external circular muscles of the pharynx?

A

-Contract superior to inferior
-Swallowed food moves down the pharynx towards the oesophagus

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65
Q

Describe what happens during swallowing:

A

-Food in oral cavity pushed into oropharynx by tongue
-Soft palate rises and closes off nasopharynx from oropharynx
-Food enters laryngopharynx and constriction of pharyngeal wall move food into oesophagus
-Epiglottis closes off laryngeal inlet and prevents food or liquids from entering larynx

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66
Q

What is the innervation to the pharynx?

A

-Sensory fibres from glossopharyngeal nerve
-Motor fibres from vagus nerve

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67
Q

What nerves lie close to the posterior pharyngeal wall?

A

-Cervical part of sympathetic trunk and superior ganglion
-Superior laryngeal nerve
-Hypoglossal nerve - close to vagus
-Glossopharyngeal nerve - deep to carotid artery

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68
Q

Where does the superior laryngeal nerve run in proximity to the posterior pharyngeal wall?

A

-Branch of vagus
-Descends over posterior aspect of internal carotid artery
-Between inferior and middle constrictors of pharynx and larynx

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69
Q

What composes the larynx and what is its function?

A

-Several cartilages
-Membranes
-Small muscles
-Protects airway and contributes to phonation/speech

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70
Q

What are the 3 unpaired cartilages of the larynx?

A

-Epiglottis
-Thyroid
-Cricoid

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71
Q

Label the 3 unpaired cartilages of the larynx:

A
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72
Q

What are the 3 paired cartilages of the larynx?

A

-Arytenoid
-Cuneiform (very small)
-Corniculate (very small)

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73
Q

Label the 3 paired cartilages of the larynx:

A
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74
Q

How many cartilages compose the laryngeal skeleton:

A

-Nine
-Three unpaired
-Three pairs

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75
Q

Describe the structure of the thyroid cartilage:

A

-Composed of 2 flat cartilages (laminae) that meet in anterior midline
-This forms laryngeal prominence (Adam’s apple)
-Posterior laminae form superior and inferior projections called horns

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76
Q

What do the superior and inferior horns of the thyroid cartilage articulate with?

A

-Superior horns - attach to hyoid bone
-Inferior horns - articulate with cricoid below

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77
Q

Label this diagram:
What does it show?

A

Thyroid cartilage

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78
Q

What is this?

A

-Cricothyroid membrane
-Connects inferior border of thyroid and superior border of cricoid
-Pierced in an emergency airway

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79
Q

Describe the structure in green:
where is it attached?

A

-Epiglottis
-Attached to superior aspect of thyroid cartilage where two laminae meet
-During swallowing, epiglottis covers entrance to larynx (laryngeal inlet) and protects airway from entry of liquid or food

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80
Q

Describe the structures in blue:

A

-Arytenoid cartilages
-Sit on superior surface of cricoid cartilage
-Articulate with cricoid cartilage at small joint
-Small but vital for phonation
-Vocal cords attach to them and movements move the vocal cords

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81
Q

Label this diagram:

A
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82
Q

Label this diagram:

A
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83
Q

What two groups of muscles enact on the larynx?

A

Extrinsic and intrinsic

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84
Q

What are the extrinsic muscles of the larynx?

A

-Suprahyoid and infrahyoid muscles
-Do not move individual cartilages
-Move larynx as one (elevate and depress)

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85
Q

What are the intrinsic muscles of the larynx?

A

-Small muscles that move the individual cartilages of larynx relative to each other
-By moving cartilages, they move vocal cords
-This alters quality of speech

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86
Q

What are tonsils?

A

Collection of lymphoid tissue in the upper parts of the pharynx

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87
Q

What tonsils are found in the nasopharynx?

A

-Pharyngeal (adenoid) - lies in roof of nasopharynx
-Tubal - surrounds opening of audital tube)

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88
Q

Label this diagram:
What does it show?

A

Tonsils

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89
Q

What are the two tonsils not found in the nasopharynx?

A

-Palatine tonsil - lies next to pharyngeal wall in oropharynx
-Lingual tonsil - collection of lymphoid tissue on posterior aspect of tongue

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90
Q

How is the internal larynx modified for its function?

A

-Function is phonation
-Intrinsic muscles of larynx move laryngeal cartilages
-Laryngeal cartilages move vocal cords that lie inside larynx

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91
Q

What can injury to nerves innervating intrinsic laryngeal muscles cause?

A

Affect speech

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92
Q

What folds are within the larynx and project into the cavity?

A

-Two pairs
-Vestibular folds (superiorly) - false vocal cords
-Vocal folds (inferiorly) - true vocal cords

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93
Q

Label this diagram:
What does it show?

A

Folds within the larynx

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94
Q

What are the vestibular and vocal folds?

A

-Vestibular - folds of mucous membrane that lie superior to vocal folds
-Narrow space separates vestibular and vocal folds
-Vocal - folds of mucous membrane that cover and protect vocal ligaments

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95
Q

What forms the true vocal cords?

A

The vocal folds and vocal ligaments

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96
Q

Where is the vocal ligaments attached?

A

-Anteriorly - internal aspect of laryngeal prominence
-Posteriorly - arytenoid cartilages

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97
Q

What is this?

A

-Rima glottidis
-Space between the true vocal cords

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98
Q

Describe the changes of the rima glottidis:

A

-Adduction of true vocal cords closes rima glottidis
-Abduction of folds opens it
-Phonation requires adduction of the cords and closure of the rima glottidis

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99
Q

Describe the different abductions of the rima glottidis:

A

-Opens rima glottidis
-Small degree = whispering
-Partially = normal breathing
-Fully = forced breathing

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100
Q

What opens and closes the rima glottidis?

A

Instrinsic muscles of larynx move laryngeal skeleton which moves vocal cords and opens and closes the rima glottidis

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101
Q

What are the 3 intrinsic muscles of the larynx required to know?

A

-Cricothyroid muscle
-Posterior cricoarytenoids
-Transverse arytenoids

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102
Q

What is this and its function?

A

-Cricothyroid muscle
-Anterior
-Muscle tips thyroid cartilage anteriorly and inferiorly
-Places tension on vocal cords

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103
Q

What is this and its function?

A

-Posterior cricoarytenoid muscles
-Posterior surface of cricoid
-Attach to arytenoids
-Abduct vocal cords and open rima glottidis

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104
Q

What is this and its function?

A

-Transverse arytenoid muscles
-Posterior aspect of larynx
-Connect two arytenoids
-Adduct vocal folds and close rima glottidis

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105
Q

Label:

A
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106
Q

What nerve innervates the cricothyroid muscle?

A

-Superior laryngeal nerve
-From vagus
-Sensory to the larynx above the vocal folds

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107
Q

What does the recurrent laryngeal nerve innervate?

A

-All intrinsic muscles except cricothyroid muscle
-Sensory to larynx below vocal folds

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108
Q

Label:

A
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109
Q

How many salivary glands are there and their names?

A

-3 pairs of salivary glands secrete saliva into the oral cavity
-Parotid
-Submandibular
-Sublingual

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110
Q

Label the pink:

A
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111
Q

What is glandular secretion stimulated by?

A

Parasympathetic fibres

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112
Q

Describe the parotid gland:

A

-Largest of 3 paired salivary glands
-Overlies posterior part of mandible
-Saliva empties into mouth via parotid duct - opens adjacent to upper second molar tooth

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113
Q

What is the structure in yellow?

A

Parotid gland

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114
Q

What is the parotid gland closely associated to?

A

-Facial nerve
-After exiting skull, nerve enters deep surface of parotid gland
-Within gland, facial nerve divides into 5 branches
-They emerge to innervate muscles of facial expression
-Also closely related to external carotid artery

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115
Q

What nerve stimulates secretion from the parotid gland?

A

Parasympathetic fibres from glossopharyngeal nerve

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116
Q

Describe the submandibular glands:

A

-Smaller than parotid
-Part lies within mouth, part lies outside
-Submandibular duct opens into floor of mouth under tongue

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117
Q

What nerve stimulates secretion from the submandibular gland?

A

Parasympathetic fibres from facial nerve

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118
Q

Describe sublingual glands:

A

-Small
-Lie on floor of mouth
-Open via several ducts into floor

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119
Q

What nerve stimulates secretion from sublingual glands?

A

Parasympathetic fibres in the facial nerve

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120
Q

Where doe the right and left coronary arteries arise from and what do they give rise to?

A

-Ascending aorta
-Several branches
-Each artery and their branches typically supply specific heart regions but variation exists

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121
Q

What does this show?

A

Coronary arteries arising from ascending aorta

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122
Q

What do cardiac veins return venous blood to?

A

Coronary sinus which enters right atrium

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123
Q

What is this?

A
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124
Q

What does the right coronary artery and its branches supply (5)?

A

-Parts of conducting system
-Right atrium
-Right ventricle
-Part of left ventricle
-Part of interventricular septum

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125
Q

What are the major branches of the right coronary artery?

A

-Branches to SAN and AVN - supply major components of conducting system
-Right marginal artery - inferior heart border
-Posterior Interventricular Artery - continuation of RCA on inferior heart surface, runs in posterior interventricular sulcus and supplies both ventricles

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126
Q

Where does the posterior interventricular artery run?

A

Posterior interventricular sulcus

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127
Q

Label this diagram:
What does it show?

A

RCA and its branches

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128
Q

What does the left coronary artery and its branches supply?

A

-Parts of conducting system
-Left atrium
-Most of left ventricle
-Part of right ventricle
-Part of interventricular septum

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129
Q

What happens to the LCA after running a short distance?

A

-Divides into two large terminal brannches
-Short segment is called the left main stem

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130
Q

What are the two terminal branches of the left main stem?

A

-Circumflex (Cx)
-Anterior interventricular artery

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131
Q

What are the main branches of the left coronary artery and what do they supply?

A

-Anterior interventricular artery (LAD) - runs in anterior interventricular sulcus towards apex and supplies both ventricles
-1 or 2 diagonal branches
-Circumflex artery - runs around heart to inferior/diaphragmatic surface - supplies left atrium, part of right ventricle and left ventricle
-Left marginal artery - arises from circumflex and supplies left ventricle

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132
Q

Label this diagram:
What does it show?

A

Left coronary artery and its branches

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133
Q

Where does the posterior interventricular artery arise from and what does it supply?

A

-May arise from right or left coronary artery
-Origin of posterior interventricular artery determines if someone is left or right dominant

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134
Q

Describe right-dominant circulation:

A

-Most people
-PIA arises from right coronary artery
-Both right and left coronary arteries supply left ventricle

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135
Q

Describe left-dominant circulation:

A

-PIV arises from circumflex artery
-Left coronary artery supplies entire left ventricle

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136
Q

Why is the dominance of circulation of the heart important in clinical practice?

A

-In right-dominant circulation, left stem occlusion would impair blood flow to part of left ventricle
-In left-dominant, blockage of left main stem would occlude blood flow to entire left ventricle

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137
Q

Are all the chambers of the heart anatomically the same?
Why?

A

-No
-Anatomical differences exist because of different function of different chambers
-Arise from different tissues/ structures during embryonic development

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138
Q

What inside the heart ensures uniderectional flow of blood through the chambers?

A

Valves

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139
Q

What does the right atrium receive blood from?

A

-Superior vena cava
-Inferior vena cava
-Coronary sinus

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140
Q

What are the 3 main features of the right atrium?

A

-Interatrial septum
-Fossa ovalis
-Crista terminalis

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141
Q

Label this diagram:

A
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142
Q

What is this?
Describe it:

A

-Fossa ovalis
-Depression in interatrial septum
-Remnant of foetal foramen ovale
-Shunted oxygenated blood from right to left atrium to bypass lungs

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143
Q

What does this show?
Describe it:

A

-Crista terminalis
-Muscular ridge
-Separates smooth-walled posterior part of atrium from anterior ridged, muscular wall
-Parts on either side of crista have different embryological origins

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144
Q

What are the ridges?

A

-Pectinate muscles
-Extend into right auricle

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145
Q

Where does the right ventricle pump blood into and what does this bifurcate into?

A

-Pumps deoxygenated blood into pulmonary trunk
-Bifurcates into right and left pulmonary artery

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146
Q

What prevents the back flow of blood into the right ventricle?

A

Pulmonary valve

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147
Q

What is the wall of the right ventricle thicker than?

A

Wall of right atrium

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148
Q

What are the 5 main features of the right ventricle?

A

-Interventricular septum
-Trabeculae carnae
-Papillary muscles
-Chordae tendinae
-Moderator band

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149
Q

What are these?
Describe them:

A

-Trabeculae carnae
-Muscular ridges on internal wall of right ventricle

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150
Q

What are these?
Describe them:

A

-Trabeculae carnae
-Muscular ridges on internal wall of right ventricle

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151
Q

What are these?
Describe them:

A

-Papillary muscles
-Modified regions of trabeculae carnae
-Project into lumen on ventricle

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152
Q

What are these?
Describe them:

A

-Chordae tendinae
-Fibrous cords
-Connect tips of papillary muscles to tricuspid valve

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153
Q

What does this show?
Describe it:

A

-Moderator band
-Modified region of trabeculae carnae
-Connects interventricular septum to one of the papillary muscles

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154
Q

What does the left atrium receive blood from?

A

-Pulmonary veins
-Two from each lung

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155
Q

Describe the interior wall of the left atrium:

A

-Smooth-walled posterior
-Anterior part bearing pectinate muscles
-Reflects development from two different embryological structures

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156
Q

What does blood flow through from left atrium to left ventricle?

A

-Left atrioventicular valve
-Called mitral valve
-Mostly passive but left atrium contracts to further force blood into the ventricle

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157
Q

What are the first branches of the aorta?

A

Coronary arteries

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158
Q

What prevents the backflow of blood from the aorta into the left ventricle?

A

Aortic valve

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159
Q

Describe the wall of the left ventricle:

A

-Thicker than the right ventricle
-Propels blood into the systemic circulation

160
Q

What are 3 features of the left ventricle?

A

-Trabeculae carnae
-Papillary muscles
-Chordae tendinae

161
Q

What valves close during ventricular contraction and what is their function?

A

-Tricuspid
-Mitral
-Prevent regurgitation of blood back into atria, ensuring the blood can only flow out the ventricles via the great vessels (pulmonary trunk and aorta)

162
Q

What 2 structures are essential for function of the atrioventricular valves and how do they work?

A

-Chordae tendinae
-Papillary muscles
-Do NOT close valves
-Allow closed valves to resist pressure generated inside ventricles during contraction and prevent them being forced open

163
Q

Describe how atrioventricular valves work:

A

-As ventricular pressure rises, valve cusps projecting into ventricle start to close passively
-When ventricles contract, papillary muscles also contract
-Papillary muscles tense chordae tendinae
-Pull on valve and prevent them inverting into atria

164
Q

What are the aortic and pulmonary valves called and their function?

A

-Semi-lunar valves
-Cusps are semi-circular (half-moon)
-Prevent backflow of blood from aorta and pulmonary trunk into the ventricles at the end of ventricular contraction

165
Q

Describe the semi-lunar valves:

A

-Each valve has 3 cusps
-Each cusp is attached to inner wall of vessel with a free edge projecting into vessel lumen
-Each cusp forms a pocket called a sinus between its free edge and vessel wall

166
Q

Label this diagram:

A
167
Q

Label this diagram:

A
168
Q

Describe the action of the semi-lunar valves:

A

-During ventricular systole, blood is forcefully propelled from ventricles
-Valves cusps flattened onto vessel walls so blood flows through the vessel unimpended
-End of systole so ventricular pressure drops
-When ventricular pressure is lower than vessel, blood flows back and is caught in the valve cusps
-Sinuses fill with blood and cusps balloon into lumen
-Free edges of cusps contact in lumen and close orifice

169
Q

When do the coronary arteries fill and why?

A

-Left and right coronary arteries from 2 of 3 aortic sinuses
-Fill during ventricular relaxation (diastole)

170
Q

What is the sound you hear when auscultating heart sounds with a stethoscope?

A

-Closing of valve
-As blood flows through each valve, sounds of valve closing is transmitted in the direction of the blood flow

171
Q

What different heart sounds can you hear?

A

-Healthy heart valves have a ‘lub-dub’
-Abnormal or dysfunctional valves produce abnormal sounds called murmers

172
Q

Where do we listen for heart sounds (general)?

A

-Listen to heart sounds where sound is transmitted
-Not directly over the valve
-These areas are called auscultatory areas

173
Q

What are the auscultatory areas for each valve?

A

-Aortic valve = 2nd intercostal space, just to right of sternum
-Pulmonary valve = 2nd intercostal space, just to left of sternum
-Tricuspid valve = 5th intercostal space, just to right of sternum
-Mitral valve = left 5th intercostal space, midclavicular line

174
Q

What stimulates myocardial contraction?

A

Specialised cells in the heart generate and conduct the electrical impulses that stimulate myocardial contraction

175
Q

What cells generate electrical impulses in the heart?
Location?

A

-Cells in sinoatrial node (SAN) spontaneously generate electrical impulses
-‘pacemaker’ of the heart
-Located at superior end of crista terminalis

176
Q

At what rate does the SA node generate impulses?

A

70 per minute

177
Q

What do impulses from the SA node stimulate?

A

Contraction of atria

178
Q

Where are impulses from the SAN conducted to?
-Location?

A

-Atrioventricular node (AVN)
-Inferior end of interatrial septum

179
Q

Where do impulses flow from the AVN?

A

-Conducting fibres from atrioventricular bundle (Bundle of His)
-Bundle divides into two groups of fibres - right and left bundle branch

180
Q

Where do impulses flow from bundle branches?

A

-Left and right bundle branches give rise to purkinje fibres
-Enter myocardium of left and right ventricles and stimulate contraction

181
Q

What is the SA node supplied by?
BLOOD

A

-RCA - 60% of people
-LCA - 40% of people

182
Q

What is the AV node supplied by?

A

-Usually by posterior interventricular artery
-In most people this arises from RCA

183
Q

What is the bundle of His supplied by?

A

Most people - LCA

184
Q

What can result in conduction abnormalities?

A

Occlusion of either coronary artery

185
Q

What external conduction acts on the SA node?

A

-Heart innervated by parasympathetic and sympathetic fibres
-Act upon the SA node
-Change force and rate of myocardial contraction
-ALSO innervated by visceral afferent fibres

186
Q

Describe sympathetic innervation to the heart:

A

-Increases heart rate
-Increases force of contraction

187
Q

Describe parasympathetic innervation to the heart:

A

-Slows heart rate
-Slows force of contraction

188
Q

What do visceral afferent fibres do in terms of the heart?

A

-Convey sensory information from heart back to CNS
-Usually, sensory info doesn’t reach conscious perception
-If myocardium is ischaemic, visceral sensory info is relayed back to conscious perception
-Can be perceived as pain, burning, tightness or pressure in chest
-Typically not pinpointed, felt generally in chest - referred pain

189
Q

What are the space in between ribs and what do they contain?

A

-Intercostal spaces
-Three layers of intercostal muscle and their associated membrane
-Intercostal neurovascular bundle comprising:
-Intercostal nerve
-Intercostal artery
-Intercostal vein

190
Q

Label this diagram:
What does it show?

A

Intercostal space and its structures

191
Q

What are the three intercostal muscles and what do they connect to?

A

-External
-Internal
-Innermost
-Rib above and belox
-Fibres run in different directions to each other and act on ribs differently

192
Q

Describe the external intercostal muscles:

A

-Most superficial
-Antero-inferiorly running fibres
-Contraction pulls ribs superiorly
-In anterior part of intercostal space, muscle becomes membranous and forms external intercostal membrane

193
Q

Describe internal intercostal muscles:
What does it form posteriorly?

A

-Deep to external
-Perpendicular to external - postero-inferior
-Contraction pulls ribs inferiorly
-Becomes membranous in posterior part of intercostal space and forms internal intercostal membrane

194
Q

Describe innermost intercostal muscle:
What are deep to them?

A

-Posterior part of intercostal space deep to internal
-Fibres orientated in same direction as internal
-Endothoracic fascia deep to innermost intercostal muscle and superficial to parietal pleura

195
Q

Label this diagram:

A
196
Q

Label the diagram:

A
197
Q

Where does the intercostal neurovascular bundle lie (plane) and what does it supply?

A

-In plane between internal and innermost intercostal muscles
-Supplies intercostal muscles, overlying skin and underlying parietal pleura

198
Q

Where does the neurovascular bundle run? (ribs)

A

-Along inferior border of the rib superior to the space
-Lies in a shallow costal groove on the deep surface of rib
-In procedures, incision is made to middle/lower part to avoid vessels and nerve
-Smaller collaterla branches run in same tissue plane but in lower

199
Q

What supplies blood to the anterior and posterior parts of the intercostal space?

A

Anterior and posterior intercostal arteries

200
Q

Label this diagram:

A
201
Q

What are anterior and posterior intercostal arteries branches of?

A

-Anterior - branches of internal thoracic artery which is branch of subclavian
-Posterior - branches of descending aorta in posterior thorax

202
Q

Label this diagram:

A
203
Q

What do anterior and posterior intercostal veins drain into?

A

-Anterior - internal thoracic vein
-Posterior - azygos system of veins

204
Q

Describe the intercostal nerves:

A

-Somatic
-Contain motor and sensory fibres
-Innervate intercostal muscles, skin of chest wall and parietal pleura
-Also carry sympathetic fibres

205
Q

What two layers of membranes cover the lungs and structures passing in and out of them?

A

-Pleurae
-Parietal - lies inside thorax
-Visceral - covers surface of lungs and extends into fissures
-Thin pleural cavity lies in between parietal and visceral pleura

206
Q

Label this diagram:
What does it show?

A

Different surface of pleura

207
Q

What do the pleural cells produce?

A

-Small amount of pleural fluid which fills pleural cavity
-Pleura and pleural fluid integral to mechanics of breathing
-Two layers continuous with each other

208
Q

Label this diagram:

A
209
Q

What are the recesses of the pleurae?

A

-Costodiaphragmatic recess
-Costomedial recess
-‘gutter’ around periphery of diaphragm where pleurae meet each other
-Potential spaces for lungs to expand into during deep inspiration

210
Q

What innervates the parietal pleura?

A

-Intercostal nerves that innervate overlying skin of chest wall
-Somatic sensory fibres in these nerves carry sensation to consciousness
-Injury is very painful

211
Q

What innervates the visceral pleura?

A

-Autonomic sensory nerves (visceral afferents)
-Usually do not reach conscious perception

212
Q

What is the apex and base of the lung?

A

-Apex - most superior part of lung, projects into root of the neck, above clavicle
-Base - sits on the diaphragm

213
Q

How many lobes does the right lung have?

A

-3 lobes
-Superior (upper)
-Middle
-Inferior (lower)

214
Q

How many lobes does the left lung have?

A

-2 lobes
-Superior
-Inferior
-Anterior extension of superior lobe - lingula extends over heart

215
Q

Describe the fissures of the lungs:

A

-Both have an oblique fissure:
-Left lung - separates superior and inferior lobes
-Right lung - separates superior and middle lobes from inferior lobe
-Right lung has horizontal fissure - separates superior lobe from middle lobe

216
Q

Label this diagram:

A
217
Q

What are the surfaces of the lung?

A

-Costal - adjacent to ribs
-Mediastinal - adjacent to heart
-Diaphragmatic - inferior surface

218
Q

Label and describe the borders of the lungs:

A

-Anterior - sharp and tapered
-Posterior - thick and rounded
-Inferior - sharp and tapered

219
Q

What are seen on the lung surfaces?

A

-Indentations created by adjacent structures
-Costal - rib markings
-Mediastinal of left - descending aorta and left ventricle
-Mediastinal of right - superior vena cava and azygous vein

220
Q

What lies in between the heart and lung?

A

-Root of each lung
-Comprises:
-Pulmonary artery
-Pulmonary veins
-Main bronchus
-Pleura encloses root of lung like a sleeve

221
Q

What is the hilum?

A

-Region on mediastinal surface of lung where pulmonary artery, pulmonary veins and main bronchus enter and exit lung
-Positions of pulmonary artery and main bronchus relative to each other different between lungs

222
Q

What is the difference in positions of structures in the hilums of right and left lungs?

A

-Right lung - main bronchus is posterior to pulmonary artery
-Left lung - main bronchus lies inferior to pulmonary artery
-Two pulmonary veins usually most anterior and inferior vessels

223
Q

Where does the trachea bifurcate and what into?

A

-Level of sternal angle
-Left and right main bronchus
-Right is more vertical, wider and shorter than left so foreign body is more likely to enter right main bronchus than left

224
Q

What does each main bronchus divide into and how many?

A

-Lobar bronchi
-3 in right lung
-2 in left lung

225
Q

What does each lobar bronchi give rise to and how many?

A

-Segmental bronchi
-10 in each lung

226
Q

What does each segmental bronchus supply and how many?

A

-Functionally independent region of lung called bronchopulmonary segment
-10 segments in each lung
-Supplies by own segmental bronchus and blood vessels
-Segement may be resected without affecting rest of lung

227
Q

What do segmental bronchi divide into?

A

-Within each bronchopulmonary segment, divide into bronchioles
-Become smaller with each division
-Very smallest conduct air to alveoli

228
Q

What do the walls of the trachea, bronchi and bronchioles contain?
Under what control are they?

A

-Trachea and bronchi contain smooth muscle and cartilage
-Bronchioles only contain smooth muscle
-Contraction and relaxation of smooth muscle is under autonomic control

229
Q

What is the blood supply to lung tissue?

A

-Bronchial arteries from descending aorta
-Bronchial veins return blood to azygos system of veins

230
Q

What nerves innervate the lungs?

A

-Autonomic nerves:
-Parasympathetic fibres:
-Stimulate constriction of bronchial smooth muscle
-Stimulate secretion from glands of the bronchial tree
-Sympathetic fibres:
-Stimulate relaxation of bronchial smooth muscle
-Inhibit secretion of glands

231
Q

What accompany the sympathetic and parasympathetic nerve fibres of the lungs?

A

-Visceral afferents (visceral sensory fibres)
-Relay sensory information from lungs and visceral pleura to CNS
-Do not usually reach conscious perception
-

232
Q

What does lymph from the lungs drain into?

A

Venous system via thoracic duct or right lymphatic duct

233
Q

What two things are different in terms of surface markings of the inferior lung?

A

-Inferior borders of the lungs
-Inferior extent of parietal pleura
-Pleura extends more inferiorly
-Space is costodiaphragmatic recess

234
Q

Where does the apex of the lung project?

A

-Lower neck
-Just superior to the medial end of the clavicle

235
Q

Where does the inferior border of the lungs lie?

A

-Anteriorly: - 6th rib (midclavicular line)
-Laterally - 8th rib (midaxillary line)
-Posteriorly - 10th rib (vertebral column)

236
Q

Where does the parietal pleura extend to?

A

-Anteriorly: - 8th rib (midclavicular line)
-Laterally: - 10th rib (midaxillary line)
-Posteriorly: - 12th rib (vertebral column)

237
Q

What is the surface anatomy of the oblique fissure?

A

-Extends from 4th rib posteriorly to 6th costal cartilage anteriorly
-Runs deep to 5th rib

238
Q

What is the surface anatomy of the horizontal fissure?

A

Extends anteriorly from 4th intercostal cartilage and intersects with oblique fissure

239
Q

What is the diaphragm?

A

Broad, thin, domed sheet of skeletal muscle

240
Q

Describe diaphragm (4):

A

-Separates thoracic and abdominal cavities
-Superior (thoracic) surface is adjacent to parietal pleural
-Openings (aperatures) allow passage of structures between thorax and abdomen (aorta, IVC and oesophagus)
-Function integral to mechanics of breathing

241
Q

What 3 things is the diaphragm attached to?

A

-Xiphoid process
-Costal margin (and tips of 11th and 12th ribs)
-Lumbar vertebrae

242
Q

What is the central part of the diaphragm?

A

-Not muscular - fibrous
-Central tendon

243
Q

What happens to the diaphragm during inspiration?

A

-Contracts
-Muscle fibres of right and left domes are pulled towards peripheral attachments
-Domes flatten
-Increases intrathoracic volume for lungs to expand

244
Q

What happens to the diaphragm during expiration?

A

-Relaxes and domes superiorly
-Decrease in intrathoracic volume
-Drives air from lungs

245
Q

What innervates the diaphragm?

A

-Right and left phrenic nerves
-Innervate right and left sides of diaphragm
-Somatic nerves
-Formed in neck from fibres of C3, C4, C5 spinal nerves
-Contain motor and sensory fibres

246
Q

In what planes does the dimensions of the thoracic cavity change during ventilation?

A

-Vertically - diaphragm contraction and relaxation
-Laterally - contraction of intercostal muscles
-Antero-posteriorly - movement of sternum secondary to rib movement

247
Q

What membranes are essential to ventilation?

A

-Pleurae and pleural fluid
-Pleural fluid creates surface tension between parietal pleura lining thoracic cavity and visceral pleura on surface of lung
-Keeps lung and thoracic wall together so when thoracic cavity changes volume, lung also changes volume
-Keeps them in contact and prevents lung from collapsing away from thoracic wall
-If surface tension is broken, ventilation may become dysfunctional

248
Q

What muscles are involved in normal quiet breathing?

A

-Inspiration is active
-Mainly driven by diaphragm movement
-Expiration is passive

249
Q

What muscles are involved in vigorous breathing?

A

-Intercostal muscles become important
-Active expiration uses internal intercostal muscles

250
Q

What muscles are involved in very vigorous or forced breathing?

A

-Accessory muscles of breathing contribute to movement of ribs and aid ventilation
-Accessory muscles:
-Sternocleidomastoid
-Pectoralis major
-Pectoralis minor
-Serratus anterior

251
Q

Label this diagram:

A
252
Q

What separates the superior and inferior mediastinum?

A

-Line that connects sternal angle anteriorly with T4/T5 junction posteriorly
-Point where trachea bifurcates and start and end of aortic arch

253
Q

What is the inferior mediastinum divided into?

A

-Anterior
-Middle
-Posterior

254
Q

Where does the posterior mediastinum lie and what does it contain?

A

-Behind the heart and pericardium
-Descending aorta
-Azygos vein
-Oesophagus
-Thoracic duct
-Sympathetic trunk and splanchnic nerves
-Posterior intercostal vessels and nerves

255
Q

What branches from the aorta in the posterior mediastinum?

A

-Posterior intercostal arteries
-Bronchial arteries
-Oesophageal branches
-Periciardial branches
-Phrenic branches

256
Q

At what level does the aorta pass through the diaphragm?

A

T12

257
Q

Where do the azygos system of veins arise and where do they enter?

A

-L1/L2
-Traverses diaphragm to enter posterior mediastinum
-Lie on the bodies of the thoracic vertebrae

258
Q

What does the azygos system of veins drain?

A

-Drains blood from posterior thoracic wall
-Returns it into the superior vena cava

259
Q

What is the typical composition of the azygous system of veins?

A

-Azygos vein on right side of vertebral column
-Small (shorter) hemiazygos vein of left side of vertebral bodies
-One or more veins connecting the two

260
Q

Label this diagram:

A
261
Q

Where does the oesophagus lie in the posterior mediastinum?

A

To the right of the aorta

262
Q

What is the blood supply of the oesophagus in the posterior mediastinum?

A

-Supplied by oesophageal arteries from descending aorta
-Oesophageal veins return venous blood to the azygos system

263
Q

Under what nervous control is the oesophagus under?

A

Autonomic control

264
Q

How does the oesophagus pass from the posterior mediastinum to the abdomen?

A

-Passes through oesophageal hiatus
-Level of T10
-Most distal part of oesophagus lies inferior to diaphragm

265
Q

What does the thoracic duct do and where is it?

A

-Returns most of the body’s lymph to venous system
-Lies between azygos vein and aorta

266
Q

Label this diagram:

A
267
Q

What are these?
What do they do?

A

-Cisterna chyli
-Lymph from lower limbs, pelvis and abdomen flows towards them
-Sac-like swelling that gives rise to the thoracic duct which ascends into the thorax

268
Q

What is this?
What does it do?

A

-Thoracic duct
-In thorax, receives lymph from intercostal spaces and lymph nodes
-Ascends into neck and receives lymph from left side of head and neck and upper limb
-Terminates by opening into venous system at junction between left internal jugular vein and left subclavian vein

269
Q

Label this diagram:
What does it show?

A

Termination on thoracic duct

270
Q

What drains lymph from the right side of the head and neck?

A

Drained by lymphatic ducts that enter venous system at junction of right internal jugular and subclavian veins

271
Q

Where does the sympathetic trunk lie?

A

-Posterior to thoracic wall
-Either side of vertebral column
-Posterior to parietal pleura

272
Q

What are the sympathetic trunks?

A

-Thin, longitudinal fibre tracts
-Regularly interspersed with ganglia (collection of cell bodies within the CNS)

273
Q

What are the ganglia of the sympathetic trunk also known as?

A

-Paravertebral ganglia
-Lie alongside the vertebral column

274
Q

Where does the sympathetic trunk run to and from?

A

From the skull base to the coccyx

275
Q

Where do cell bodies of preganglionic sympathetic neurons lie?

A

-Thoracic and upper lumbar spinal cord segments
-T1-L2/L3

276
Q

What type of fibres are sympathetic fibres and what does this mean?

A

-Visceral motor fibres
-Leave spinal cord from its ventral aspect and enter spinal nerves T1-L2/L3 along with somatic motor nerves whose bodies lie in ventral grey horn

277
Q

How do sympathetic fibres reach all of the body?

A

Sympathetic trunk allows the sympathetic fibres arising from T1-L2/L3 to be distributed to all parts of the body

278
Q

What is the path of preganglionic sympathetic fibres?

A

-Exit spinal cord in spinal nerves T1 -L2/L3
-Immediately separate from spinal nerves and enter sympathetic trunk via short communicating/connecting branch (white ramus communicans)
-Once in sympathetic trunk, does one of three things

279
Q

What do preganglionic sympathetic fibres do once in the sympathetic trunk (3)?

A

-Synapse in the ganglion at its level of entry
-Ascend or descend in the trunk before synapsing in a ganglion
-Travel through a ganglion (and trunk) without synapsing

280
Q

What does this show?

A
281
Q

What does this show?

A
282
Q

What does this show?

A
283
Q

In scenarios 1 and 2, what happens next?

A

-Enter spinal nerves via a communicating branch (grey ramus communicans) (sympathetic fibres enter all 31 pairs of spinal nerves)
-Form visceral nerves that convey sympathetic fibres to head
-Form visceral nerves that convey sympathetic fibres to the thoracic viscera (cardiopulmonary splanchnic nerves)

284
Q

What are the 4 abdominopelvic splanchnic nerves?

A

-Greater splanchnic nerve (sympathetic preganglionic fibres from T5-T9)
-Lesser splanchnic nerve (from T10-T11)
-Least splanchnic nerve (from T12)
-Lumbar splanchnic nerves (from L1-L2)

285
Q

Where do the greater, lesser and least splanchnic nerves form and traverse?

A

-Formed in posterior mediastinum
-Traverse diaphragm to enter abdomen
-Preganglionic sympathetic fibres ultimately synapse with second neurons in prevertebral ganglia that lie close to blood vessels in abdomen
-After synapsing, postganglionic fibres innervate abdominal viscera

286
Q

What can you see in the posterior intercostal spaces?

A

-Intercostal muscles
-Posterior intercostal artery (branch of thoracic aorta)
-Posterior intercostal vein (drains into azygos)
-Posterior intercostal nerve

287
Q

What are thoracic viscera innervated by?

A

Both sympathetic and parasympathetic fibres that have coordinated, but generally opposing actions

288
Q

What main nerves innervate the thoracic viscera?

A

-Cardiopulmonary splanchnic nerves - convey postganglionic sympathetic fibres
-Vagus nerves convey parasympathetic fibres

289
Q

What do sympathetic and parasympathetic fibres form around thoracic viscera?

A

-Autonomic plexuses
-Braid/plait = plexus
-Look like delicate, fine meshes or webs

290
Q

What nerve plexuses do you find in the thorax?

A

-Cardiac plexus
-Pulmonary plexus
-Oesophageal plexus

291
Q

What does the cardiac plexus do?

A

-Innervates SAN of heart
-Sympathetic fibres increase heart rate and force of contraction
-Parasympathetic fibres decrease heart rate and force of contraction

292
Q

What does the pulmonary plexus do?

A

-Innervates bronchi
-Sympathetic relaxes bronchi
-Parasympathetic constricts them

293
Q

What does the oesophageal plexus do?

A

-Overlies anterior surface of oesophagus
-Sympathetic fibers inhibit peristalsis
-Parasympathetic stimulate peristalsis

294
Q

What relay sensory info from thoracic viscera back to CNS?

A

-Visceral afferents
-Along paths of vagus and thoracic splanchnic nerves

295
Q

Where do patients with myocardial infarction or angina usually feel pain and why?

A

-Central chest
-Left side of neck and arm
-Referred pain

296
Q

What innervates the heart?

A

-Cardiac plexus
-Composed of sympathetic and parasympathetic fibres
-Sympathetic fibres travel to cardiac plexus and heart from spinal cord segments T1-T5 via cardiopulmonary splanchnic nerves

297
Q

What other nerves also innervate the heart?

A

-Visceral sensory nerves
-Travel back to CNS alongside sympathetic fibres innervating heart and enters T1-T5
-Convey sensory info from heart back to CNS
-normally not reach conscious perception
-If myocardium is ischaemic, can be interpreted as pain, tightness and crushing in conscious perception

298
Q

Explain cardiac referred pain:

A

-Somatic sensory info from skin of chest wall, neck and arm also return to T1-T5
-Same segments as visceral sensory nerves of heart
-Brain interprets cardiac pain as coming from chest, neck and arm

299
Q

What is another example (other than cardiac) of referred pain?

A

-Diaphragm referred pain
-C3-C5 contribute spinal nerve fibres to phrenic nerve
-These segments also contribute to nerves that innervate skin of neck and shoulder
-Brain interprets diaphragm pain as coming from shoulder region

300
Q

Where is the mediastinum?

A

-Part of thoracic cavity
-Lies between the lungs
-Contains all thoracic viscera apart from lungs
-Extends from:
-Superior thoracic aperature superiorly to diaphragm inferiorly
-Sternum anteriorly to thoracic vertebrae posteriorly

301
Q

What viscera does the mediastinum contain?

A

-Heart and pericardium
-Great vessels that enter and leave heart
-Veins that drain chest wall
-Trachea and main bronchi
-Oesophagus
-Nerves
-Lymphatics
-Thymus gland

302
Q

What line separates the superior and inferior mediastinum?

A

Sternal angle to T4/T5 junction

303
Q

What does the inferior mediastnum separate into?

A

-Anterior
-Middle
-Posterior

304
Q

Where does the anterior mediastinum lie and what does it contain?

A

-Between posterior aspect of sternum and anterior aspect of pericardial sac
-Narrow space
-Contains thymus gland in children and its remnant in adults

305
Q

What does the middle mediastinum contain?

A

-Heart inside pericardial sac
-Pulmonary trunk and ascending aorta

306
Q

Where does the posterior mediastinum lie?

A

Posterior aspect of pericardial sac and the vertebrae

307
Q

What are the main contents of the superior mediastinum?

A

-Arch of aorta and its three branches
-Superior vena cava and its tributaries (brachiocephalic veins)
-Trachea
-Oesophagus
-Phrenic nerves and vagus nerves
-Thoracic duct
-Thymus gland

308
Q

Label this diagram:
What does it show?

A

Contents of superior mediastinum

309
Q

What are the 3 parts of the aorta in the thorax?

A

-Ascending aorta - short, first part:
-Gives rise to coronary arteries
-Arch of aorta:
-Curves posteriorly
-Lies in superior mediastinum
-Descending (thoracic) aorta:
-Descends through posterior mediastinum
-Into abdomen posterior to diaphragm

310
Q

What 3 main branches does the arch of the aorta give in the superior mediastinum?

A

-Brachiocephalic trunk:
-Bifurcates into right common carotid - supplies right side of head and neck and right subclavian - supplies right upper limb
-Left common carotid - supplies left side of head and neck
-Left subclavian - supplies left upper limb

311
Q

Label this diagram:

A
312
Q

Where are aortic bodies and what do they do?

A

-Arch of the aorta
-Chemoreceptor location
-Constantly monitor arterial oxygen and carbon dioxide

313
Q

How is info from aortic bodies carried?

A

-Visceral sensory information
-Travels back to CNS along path of vagus nerve
-Results in reflex responses that regulate ventilation

314
Q

What is this?
Describe:

A

-Ligamentum arteriosum
-Fibrous cord-like connection between pulmonary trunk and arch of aorta
-Remnant of ductus arteriosus - foetal circulatory shunt

315
Q

What is the ductus arteriosus?
Describe what happens to it:

A

-In foetus, gas exchange occurs at placenta not lung
-Diverts most blood entering pulmonary trunk directly into aortic arch
-When a baby starts to use thier lungs at birth, ductus arteriosus closes and blood into pulmonary trunk enters lungs

316
Q

What two veins return blood to the right atrium?

A

-Superior vena cava
-Inferior vena cava

317
Q

What does the SVC return blood from?

A

-Head
-Neck
-Upper limbs
LIES IN SUPERIOR MEDIASTINUM

318
Q

What forms the SVC?

A

Union of left and right brachiocephalic veins

319
Q

What forms each brachiocephalic vein?

A

Union of internal jugular vein and subclavian vein

320
Q

Label this diagram:
What does it show?

A

Formation of left and right brachiocephalic veins

321
Q

Where does the IVC return blood to the heart from?

A

-All regions inferior to the diaphragm
-Thoracic part is very short - as soon as it enters thorax through diaphragm, it enters heart

322
Q

Where does the trachea start and end?

A

-Extends from larynx in midline of neck to superior mediastinum - palpable just superior to suprasternal notch
-Terminates at level of sternal angle (junction of T4/T5) by bifurcating into left and right main bronchi

323
Q

Where does the oesophagus run in the mediastinum?

A

-Midline of the thorax
-Posterior to trachea
-Descends into posterior mediastinum

324
Q

Where do the left and right phrenic nerves form and what do they innervate?

A

-Formed from fibres from C3,4 and 5 spinal nerves
-Innervate diaphragm

325
Q

What is the path of the phrenic nerves?

A

-Descend through neck
-Into thorax through superior thoracic aperture
-Course over the pericardium and pierce the diaphragm

326
Q

What nerves are these?

A
327
Q

Where do the left and right vagus nerves arise?
What fibres do they contain?
What do they innervate?

A

-CNX
-Arise from brainstem
-Contain somatic sensory, somatic motor and parasympathetic fibres
-Innervate structures of the thorax, abdomen and head and neck

328
Q

Describe the path of the vagus nerve in the neck:

A

-Descends alongside the internal carotid artery and internal jugular vein
-Enter thorax via superior thoracic aperture

329
Q

What do each of the vagus nerves give rise to in the superior mediastinum?

A

-Recurrent laryngeal nerves
-Ascends back up into the neck to innervate muscles of larynx

330
Q

Label the diagram:

A
331
Q

What do the right and left recurrent laryngeal nerves loop around?

A

-Left :
-Under arch of aorta
-Ascends back up to left side of neck
-Along trachea
-Right:
-Descends to anterior to right subclavian artery
-Loops under inferior border of right subclavian artery
-Ascends up right side of neck
-Between trachea and oesophagus

332
Q

Where do the vagus nerves descend and what do they contribute?

A

-Descend into thorax posterior to root of lung
-Contribute parasympathetic fibres to heart, lungs and oesophagus
-Traverse diaphragm and convey parasympathetic fibres to most of abdominal viscera

333
Q

Where does the thoracic duct run in the mediastinum?

A

-Ascends through posterior mediastinum and into superior mediastinum
-Empties into venous system at union of internal jugular vein and subclavian vein

334
Q

What is the thymus and where does it lie?

A

-Lymphoid organ
-Lies anteriorly in the superior mediastinum
-Important in children but atrophies with age becoming fatty

335
Q

What is the pericardium?

A

-Tough, fibrous sac
-Encloses the heart like a loose-fitting bag to allow movement of the heart

336
Q

What two layers is the pericardium composed of and what do they connect to?

A

-Tough outer fibrous layer:
-Attached superiorly to the great vessels
-Attached inferiorly to central tendon of diaphragm
-Thin inner serous layer:
-Has 2 part (parietal and pleural)

337
Q

Describe the two layers of the serous pericardium:

A

-Parietal layer - lines inner aspect of fibrous pericardium
-Visceral layer - covers surface of heart
CONTINUOUS

338
Q

Label this diagram:

A
339
Q

What is the narrow space in between the two layers of serous pericardium?

A

-Pericardial cavity
-Small amount of pericardial fluid
-Lubricates serous membranes and allows them to slide over each other with movements of the heart

340
Q

What innervates the fibrous pericardium?

A

-Phrenic nerves
-Sensory branches

341
Q

What is the point of the heart called?

A

Apex

342
Q

What are the surfaces of the heart?

A

-Base - faces posteriorly so is called the posterior surface
-Inferior surface - lies on central tendon of the diaphragm, also called diaphragmatic surface
-Anterior surface - faces sternum and ribs so is called sternocostal surface
-Left and right sides face lungs so called pulmonary surfaces

343
Q

Label this diagram:
What does it show?

A

Surfaces of heart

344
Q

What parts of the heart do each surface correspond to?

A

-Base/posterior = left atrium, part of right atrium
-Inferior/diaphragmatic = left ventricle, part of right ventricle
-Anterior/sternocostal = right ventricle
-Left pulmonary = left ventricle
-Right pulmonary = right atrium

345
Q

What forms the apex of the heart and where does it lie?

A

-Formed by left ventricle
-Left 5th intercostal space
-In midclavicular line
-Apex beat palpable here

346
Q

In what way do we describe the heart which is important in x-rays?

A

-Edges (borders)
-Correspond to specific parts of the heart

347
Q

Which borders of the heart correspond to specific parts of the heart?

A

-Right border = right atrium
-Left border = left ventricle
-Inferior border = right ventricle and part of left ventricle

348
Q

What is the position of the right border of the heart relative to?

A

-Lateral to sternal edge
-From right 3rd costal cartilage to right 6th costal cartilage

349
Q

What is the position of the left border of the heart relative to?

A

Extends from left 2nd intercostal space to left 5th intercostal space in midclavicular line (apex)

350
Q

What is the position of the superior border of the heart relative to?

A

-Lies along line connecting superior extents of right and left borders
-Right 3rd costal cartilage to the left 2nd intercostal space

351
Q

What is the position of the inferior border of the heart relative to?

A

-Lies along line connecting inferior end of right border with apex
-Mostly formed by right ventricle

352
Q

What are these?
Describe them:

A

-Auricles (auricular appendiges)
-Ear-like appearance
-Outpouchings from walls of left and right atria

353
Q

Where is the sternum?

A

Anteriorly in the midline of the thoracic cage

354
Q

Label this diagram:

A
355
Q

Describe the manubrium:

A

-Superior part of sternum
-Superior border has suprasternal (jugular) notch
-Laterally articulates with clavicle (sternoclavicular joint) and with first rib
-Inferiorly articulates with body of sternum (manubriosternal joint) also known as sternal angle or angle of louis

356
Q

Describe the body of the sternum:

A

-Articulates ribs 2-7
-Second rib articulates with sternum at sternal angle
-Inferiorly articulates with xiphoid process

357
Q

Describe the xiphoid process:

A

-Small and variable in shape
-Seventh rib articulates with inferior part of sternal body and superior part of xiphoid process

358
Q

What does the red line show?
What is it composed of?

A

-Costal margin
-Costal cartilages of ribs 7-10
-Palpable

359
Q

How many pairs of ribs are there and what do they form?

A

-12 pairs
-Anterior, lateral and posterior walls of thoracic cage

360
Q

What are the anterior parts of the ribs composed of?

A

Costal cartilage

361
Q

Label this diagram:

A
362
Q

What are these?

A

-Costochondral joints
-Where ribs articulate with their costal cartilages

363
Q

Label this diagram:
What does it show about the ribs?

A

-Ribs 1-7 = true (costal cartilages articulate directly with sternum)
-Ribs 8-10 = false (unite and join the seventh costal cartilage)
-Ribs 11-12 = floating (short and do not articulate with sternum)

364
Q

Where do the ribs articulate posteriorly?

A

-Articulate with thoracic vertebrae
-Costovertebral joints

365
Q

What are adjacent ribs joined by?

A

Intercostal muscle which lie in intercostal spaces

366
Q

What is the classification of ribs?

A

-Typical - look similar and share common anatomical features
-Atypical - look different to typical ribs / or lack some of the features of typical ribs

367
Q

Which ribs are typical and atypical?

A

-Typical = ribs 3-9 (head, neck, tubercle and body)
-Atypical = 1-2, 10-12 (1,11,12 much shorter)

368
Q

Label this diagram:

A
369
Q

What lies posterior to the midline of the thoracic cage?

A

-12 thoracic vertebrae (T1-T12)
-Spinous processes palpable in midline of back
-Articulate with posterior parts of ribs at costovertebral joints
-Head of rib articulates with vertebral body and tubercle of rib articulate with transverse process

370
Q

What does this show?

A

Superior thoracic aperture

371
Q

What is the superior thoracic aperture and what forms it?

A

-Passageway through which structures pass between neck and the thorax
-Manubrium, first ribs and first thoracic vertebrae form boundary

372
Q

What can be articulated at the sternal angle?

A

Second rib

373
Q

Label this diagram:

A
374
Q

What innervates the skin of the thoracic wall?

A

-Spinal nerves T1-T12
-Sensation from skin of thoracic wall (touch, pain, temperature) reaches conscious perception via somatic sensory fibres in spinal nerves

375
Q

Describe innervation of skeletal muscles, sweat glands and smooth muscle in thoracic wall:

A

-Somatic motor fibres in spinal nerves T1-T12 innervate skeletal muscles of thoracic wall
-Sympathetic fibres innervate sweat glands and smooth muscle of blood vessels and hair follicles in skin

376
Q

What are each of these segments?

A

-Dermatomes
-Area of skin innervated by a single spinal nerve
-Each pair of thoracic spinal nerves supply a strip around the chest wall

377
Q

What are the breasts?

A

-Mammary glands
-Superficial to muscles of chest wall
-Well developed in females
-Grow during puberty and pregnancy
-Breast tissue extends towards anterior axilla (armpit) - called axillary tail

378
Q

What happens to the breasts after menopause?

A

-Atrophy
-Difficult to study in female cadavers

379
Q

What 5 things do the breasts contain?

A

-Fat
-Glandular/secretory tissue
-Ducts which converge at nipple (areola is pigmented region of skin)
-Connective tissue and ligaments
-Blood vessels and lymphatics

380
Q

What is the main blood supply to the breast?

A

-Internal thoracic artery (arises from subclavian artery):
-Course deep to edge of sternum
-Gives rise to anterior intercostal arteries that supply breast and intercostal spaces
-Axillary artery
-Axillary vein
-Internal thoracic veins

381
Q

What innervates the breasts?

A

-Somatic nerves and sympathetic fibres via the intercostal nerves
-Somatic sensory fibres innervate the skin of the breast
-Sympathetic fibres inner ate smooth muscle in the blood vessel wall and nipple

382
Q

Where does most lymph from the breast drain from?

A

-Drains to lymph nodes in the axilla
-Patterns are complex as axillary nodes communicate with other groups of lymph nodes in the thorax

383
Q

Describe the lymph nodes of the axilla:

A

-5 groups
-Central, pectoral, humeral, subscapular, apical
-Drain breast, upper limb, chest wall, scapular region and abdominal wall
-Apical nodes receive lymph from all other types of lymph nodes in the axilla
-As they drain most of the lymph from the breast, they are most involved in the spread of breast cancer

384
Q

Label the 5 groups of axilla lymph nodes:

A
385
Q

Where do the intercostal muscles lie?

A
386
Q

What are the 3 layers of muscle in the intercostal spaces?

A

-External intercostal - most superficial
-Internal intercostal - deep to external
-Innermost intercostal - deep to internal

387
Q

Label this diagram:

A
388
Q

What do the intercostal muscles do?

A

-Collectively move the ribs and alter the dimensions of thoracic cavity
-During inspiration and expiration

389
Q

What are the three upper limb muscles of the thorax?

A

-Pectoralis major - most superior
-Pectoralis minor - smaller muscle deep to pectoralis major
-Serratus anterior

390
Q

What are the three upper limb muscles of the thorax?

A

-Pectoralis major - most superior
-Pectoralis minor - smaller muscle deep to pectoralis major
-Serratus anterior

391
Q

Where does the pectorals major connect?

A

-Upper humerus
-Clavicle
-Upper six ribs

392
Q

Where does the pectoralis minor connect?

A

-Scapula
-Ribs 3-5

393
Q

Where does serratus anterior connect?

A

-Sweeps around lateral aspect of thoracic cage
-Attaches scapula and upper 8 ribs

394
Q

What are the prime functions of the pectoralis muscles?

A

-Move upper limb
-Pectoralis major - adducts humerus
-Pectoralis minor + serratus anterior - protract scapula

395
Q

What are the other functions of the pectoralis muscles?

A

-Accessory muscles of breathing
-Attach to ribs and hence move ribs if humerus and scapula are fixed
-Sign of respiratory distress

Phase 1 (23 decks)

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