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FBS2 > Anatomy of Systems > Flashcards

Anatomy of Systems Flashcards

1
Q

What are the primary and secondary curves of the spinal chord?

A

Primary: kyphotic
Secondary: cervical and lumbar regions (lordotic)

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2
Q

Name the parts of the vertebra

A

Spinous process, lamina, pedicle, vertebral foramen, superior articular facet (synovial joint), transverse processes, inferior articular facet, inferior notch, superior notch

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3
Q

What are the characteristics of cervical vertebrae?

A 
Body, foramen transversarium (vertebral artery), anterior and posterior tubercles
Atlas and axis: don't really have a body
Atlas: anterior arch has facet for dens
Axis: has dens
C7: first palpable spinous process
Articulation btw 1 and 2: flat
articulation btw 2 and 3: round
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4
Q

What are the characteristics of thoracic vertebrae?

A

Costal facets: one upper and one lower, 10, 11 and 12 only one
T1-2: spinous process not facing downwards
T11-12: spinous process facing backwards

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5
Q

What are the characteristics of lumbar vertebrae?

A

Vertebral foramen changes from round to pyramidal

Processes: spinous + mamillary, accessory, transverse

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6
Q

What type of joint is the sacroiliac joint?

A

Synovial joint anteriorly and interosseous ligament posteriorly

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7
Q

What are intervertebral discs composed of?

A
  1. Nucleus pulposus
  2. Annulus fibrosus (collagen type I)
  3. Vertebral end plate
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8
Q

What is the difference between primary and secondary cartilaginous joints?

A

Primary (synchondroses): hyaline cartilage only

Secondary (symphyses): fibrocartilage sandwiched between hyaline cartilage

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9
Q

What are the ligaments of the spinal cord?

A 
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum (attaches lamina)
Interspinous ligament
Supraspinous ligament
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10
Q

Which are the extrinsic superficial posterior trunk muscles?

A

Trapezius
Latissimus dorsi
Serratus posterior
Levator scapulae + rhomboids

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11
Q

Which are the intrinsic posterior trunk muscles?

A

Superficial layer: splenius muscles
Intermediate layer: erector spinae (Ilio-costalis, longissimus, spinalis)
Deep layer: transverso-spinalis (rotatores, multifidus, semispinalis)

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12
Q

Which are the lateral trunk muscles?

A

Quadratus lomborum

Psoas major

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13
Q

What does the intercostal neurovascular bundle supply?

A

Intrinsic muscles

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14
Q

What types of joints are the manubrio-sternal and the sterno-xiphoid joint?

A 
secondary cartilaginous (symphyses)
xiphisternum is cartilaginous
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15
Q

What type of joint is the 1st sternocostal joint?

A

primary cartilaginous (synchondrosis); only joint of this type

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16
Q

Which are the true, false and floating ribs and what type of joints do they have?

A 
True: 1-7
False: 8-12
Floating: 11-12
Joints:
2-7 --> sternocostal joints (synovial)
8-10 --> chondrocondral joints (synovial)
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17
Q

Which upper muscles are attached to the rib cage?

A

Sternocleidomastoid

Scalenes: anterior to 1st rib, posterior to 2nd rib, medius to both

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18
Q

What is the osteology of typical ribs?

A

Head: superior demi-facet, interarticular crest, inferior demi-facet
Neck
Tubercle: articular (facet), non articular (ligamentous)
Shaft
Subcostal groove on the bottom
Ligaments: costotransverse and lateral costotransverse

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19
Q

Which are the typical and atypical ribs?

A

Typical: 3-9 (10th usually is)
Atypical: 1-2, 11-12

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20
Q

What is the osteology of atypical ribs?

A

1st: short, strong, flat and very curved, has tubercle for scalenus anterior, grooves for subclavian vessels, single facet on head
2nd: tubercles for scalenus posterior and serratus anterior
11 and 12: do not have tubercles and do not attach to sternum

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21
Q

Which are the atypical vertebrae?

A

1st, 10th, 11th and 12th

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22
Q

What is the arterial supply to the chest wall?

A

Posterior intercostal artery –> lateral cutaneous branch

Internal thoracic artery (branch of subclavian) –> anterior intercostal artery

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23
Q

What is the azygos venous system?

A

Posterior intercostal veins (except first couple –> brachiocephalic directly)
Upper left chest –> accessory hemiazygos vein
Lower left chest –> azygos vein
Cross midline at T7-8
Drain into SVC

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24
Q

What does the internal thoracic artery give rise to?

A

Superior epigastric artery + musculo-phrenic artery

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25
Q

What are the lymphatics of the chest wall?

A

Superficial: axillary, supraclavicular and parasternal
Deep:
1. Anteriorly: internal thoracic, brachiocephalic, tracheobronchial –> bronchomediastinal trunk
2. Posteriorly: posterior mediastinal + posterior intercostal –> thoracic duct –> left lymphovenous portal

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26
Q

What is the nerve supply to the chest wall?

A

Anterior rami of thoracic spinal nerves –> intercostal muscles (supply chest wall intrinsic muscles), runs between internal and innermost intercostal muscles
Below the level of the sternal angle: start with T2
Nipple: T4
Xiphoid sternum: T6-7

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27
Q

Which are the layers of the heart?

A

Fibrous pericardium, parietal (serous) pericardium, visceral serous epicardium, myocardium, endocardium

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28
Q

What are the positions of the heart?

A

Sits on central tendon of the diaphragm –> pericardium is fused here

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29
Q

What is a cardiac tamponade?

A

excess fluid build up in pericardial cavity –> pressure on fibrous pericardium –> no expansion –> inward pressure on the heart muscle

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30
Q

What is the origin of the phrenic nerve?

A

C3,4,5

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31
Q

Which are the AV valves?

A

Tricuspid: right
Mitral: left

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32
Q

How do you check for abnormal heart size?

A

Transverse diameter of heart should be smaller or equal to diameter of hemi thorax

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33
Q

What are the layers of blood vessels?

A

Epithelium
Tunica intima: internal elastic lamina + fibrocollagenous tissue
Tunica media: smooth muscle
Tunica externa/adventitia: fibrocollagenous tissue with external elastic lamina + fibrocollagenous tissue

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34
Q

Where does the thoracic duct drain into?

A

Junction between internal jugular and subclavian vein (lympho-venous portal)

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35
Q

What are the structures of the right atrium?

A 
Right auricle
Sinus venarum
Fossa ovalis
Opening of coronary sinus
Musculi pectinati
Crista terminalis: embryological remnant, junction between true atrium and smooth sinus venosus
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36
Q

What are the structures of the right ventricle?

A

Membranous portion of the interventricular septum
Trabeculae carneae
Infundibulum
Cordae tendinae + papillary muscles (ant, pos and additional ones)

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37
Q

What are the structures of the left ventricle and atrium?

A

Atrium: entirely smooth apart from auricle, fossa ovalis is less pronounced, opening of four pulmonary veins
Ventricle: less pronounced infundibulum

38
Q

What are the characteristics of fetal circulation?

A

80% through foramen ovale + 20% into pulmonary chunk (19% through ductus arteriosus + 1% pulmonary circulation)

39
Q

What are the components of the conducting system of the heart?

A

SA node –> AV node –> bundle of his (right and left bundle branches) –> moderator band (septomarginal bundle) –> purkinje fibers

40
Q

Where is the cardiac pacemaker implanted?

A

Right atrium, coronary sinus and right ventricle

41
Q

What is the nerve supply to the heart?

A

Sympathetics: T1-T5 (cardiac nerve from cardiac plexus)
Superior cervical ganglion –> superior cardiac nerves
Middle cervical ganglion –> middle cardiac nerves
Inferior cervical ganglion –> inferior cardiac nerves
Parasympathetics: vagal nerve

42
Q

What are the coronary arteries of the heart?

A 
Right coronary artery from right ostium:
1. SA nodal branch
2. Right marginal
3. Posterior interventricular (descending)
Left coronary artery from left ostium:
1. Circumflex
2. Anterior interventricular (descending)
3. Left marginal
43
Q

What is the most common coronary artery to be occluded?

A

Anterior descending artery

44
Q

What are the structures that form cardiac valves?

A

Lunule + nodule

45
Q

Which imaging would you use to see blood vessels?

A

CT or MRI

46
Q

Which intercostal space would you puncture to get access to the pleural space?

A

9th or 10th intercostal space during expiration

47
Q

Where does the vagus nerve pass?

A

Between internal jugular and carotid

48
Q

In expiration, at what intercostal spaces are the right and left domes of the diaphragm?

A

Right: 4th
Left: 5th

49
Q

What are the levels of the costodiaphragmatic recess?

A

8-11th intercostals; also known as phrenic angle

50
Q

What are the innervations of the costoparietal, diaphragmatic and mediastinal pleura?

A

Costoparietal: intercostal nerves
Diaphragmatic: phrenic nerve (C3,4,5)
Mediastinal: phrenic nerve

51
Q

What are the openings of the diaphragm?

A

Median arcuate ligament: aortic hiatus (opening for abdominal aorta)
Caval opening: in central tendon (aponeurosis), opening for IVC
Oesophageal opening: wrapped around right crura, situated in the left hemidiaphragm

52
Q

What is the neurovasculature of the diaphragm?

A

Motor supply: phrenic nerve (mainly C4)

Blood supply: superior and inferior phrenic arteries + musculophrenic arteries + intercostal arteries

53
Q

Which muscles are active in the inspiratory phase of quiet breathing?

A
  1. Diaphragm
  2. Scalenes: stabilise 1st rib
  3. Intercostals: stiffen to prevent bellowing
54
Q

Which are the inspiratory muscles?

A

External ics + parasternal intercostal muscles

55
Q

What are the functions of the subcostal muscles and transversus thoracis?

A

Subcostal muscles: inspiration

Transversus thoracis: expiration

56
Q

What are the functions of the sternocleidomastoid muscle and what is its innervation?

A
  1. extends head, flexes neck
  2. turns head
  3. inspiratory muscle
    Innervation: CN XI
57
Q

What are the functions of the scalene muscles and what is its innervation?

A
  1. lateral flexion of the head
  2. flexion of the neck
  3. inspiratory muscle
    Innervation: cervical plexus
58
Q

What are the accessory muscles of respiration?

A

Inspiration:
1. Pectoralis major: stabilising upper limb –> muscle of respiration, attaches to costal margins 6,7,8 up to sternum and humerus
2. Serratus anterior: attaches to scapula
3. Pectoralis minor: elevates ribs 2,3,4 or 3,4,5
Expiration:
1. Abdominal muscles: rectus abdominis, external oblique, IO, TA

59
Q

Which muscles are active in the inspiratory phase of forced breathing?

A
  1. Scalenes and sternocleidomastoid
  2. Intercostals
  3. Pec major and serratus anterior
  4. erector spinae
  5. lower limb stabilisation (quadratus lomborum)
60
Q

Which muscles are active in the expiratory phase of quiet breathing?

A
  1. Elastic recoil of lungs and gravity
  2. Intercostals
  3. Elevation of relaxed diaphragm
61
Q

Which muscles are active in the expiratory phase of forced breathing?

A
  1. Abdominal muscles
  2. Intercostals
  3. Elevated diaphragm
  4. Latissimus dorsi and serratus posterior superior and inferior
62
Q

How many divisions of the airway through the bronchi are there?

A

At least 23

63
Q

What is the blood supply to the bronchi?

A

Pulmonary arteries and veins

Bronchial arteries: 2 or 3, supply O2 to non-exchanging parts of the pulmonary system

64
Q

What connects the oral and nasal cavities?

A

The nasal pharynx

65
Q

How many nasal sinuses are there and what type of epithelium is present?

A

4 sets, connected to the nasal cavity; pseudostratified ciliated columnar cells

66
Q

How does the cough reflex work?

A

Laryngeal and tracheobronchial rapidly adapting irritant receptors, non-myelinated c-fibers:

  1. bronchial submucosal glands
  2. Ipsilateral vagus nerve –> cough centre in medulla –> efferents through phrenic and other somatic nerves, recurrent laryngeal, vagal efferents:
    a. expiratory muscles, larynx, trachealis, bronchial SM
67
Q

What is the outside structure of the ring of the larynx?

A
  1. epiglottis

2. arytenoids: cartilage opposite to epiglottis

68
Q

Which structures control the diameter of the ring in the larynx?

A

aryepiglottic folds and aryepiglottic muscles (contraction –> closing)

69
Q

What is the function of the piriform recesses?

A

Channeling of fluid and food into the oesophagus

70
Q

Which structures are contained inside the ring of the larynx?

A

Vestibular folds, vocal folds and glottis

71
Q

What is the structure of the larynx?

A

Hyoid bone, thyrohyoid membrane, thyroid cartilage, cricothyroid membrane, cricoid cartilage

72
Q

What is the innervation of the larynx?

A

Inferior vagal ganglion:

  1. Superior laryngeal: internal (mucosa –> cough reflex above vocal cords), external
  2. Left recurrent laryngeal: goes down to mediastinum, loops around aorta and goes back up for motor and sensory supply to trachea and larynx below vocal cords
  3. Right recurrent laryngeal: loops around subclavian artery and goes back up
73
Q

What are the levels of the cricoid and carina?

A

Cricoid: C6
Carina: T4/5

74
Q

Where is the trachealis muscle situated and what is its nerve supply?

A

Fills space between cartilage and oesophagus, smooth muscle supplied by recurrent laryngeal

75
Q

What are the levels of the pulmonary fissures?

A

Transverse fissure: 5th rib laterally and 4th costal cartilage anteriorly
Oblique fissure: spine of T3 posteriorly to 6th costal cartilage

76
Q

What is the characteristic of the LUL?

A

Lingula: anchored around bottom bit of the heart

77
Q

What is the structure of the bronchopulmonary tree?

A

2 bronchi —> secondary bronchi (lobar bronchi: 2 on the left and 3 on the right) —> tertiary bronchus (supplies bronchopulmonary segments —> 10 in each lung (right: 3,2,5), vary on the left (5,5; might fuse))

78
Q

What is the relationship of the lung hila to the other structures in the chest wall?

A

Posteriorly: oesophagus + descending aorta behind
Anteriorly: heart right atrium
On top: aortic arch and azygos vein

79
Q

What is the lymphatic drainage of the lungs?

A

Intrapulmonary lymph nodes –> hilar lymph nodes –> inferior + superior tracheo-bronchial lymph nodes –> paratracheal lymph nodes –> bronchomediastinal lymph trunk
LLL: both ipsi and contralateral

80
Q

What is the innervation to the lungs?

A

Sympathetics: T1-T4
Parasymp: vagus: bronchoconstriction
Anterior and posterior bronchial plexus around bronchial tree
Bronchodilation: controlled by NO release from endothelial cells

81
Q

How is the mediastinum divided?

A

Superior mediastinum: T4 up, sternal angle

Inferior mediastinum: anterior, middle and posterior

82
Q

What are the first three branches of the aorta?

A

Brachiocephalic trunk, left common carotid artery, left subclavian artery

83
Q

At what position does the aortic arch begin and end?

A

Level of sternal angle

84
Q

Which structure is purely in the superior mediastinum?

A

Trachea

85
Q

At what level does the oesophagus begin?

A

C6 –> cricoid cartilage

86
Q

Where do the oesophageal plexuses sit?

A

Left in front, right in the back

87
Q

How does the muscle in the oesophagus change?

A

Upper oesophagus: skeletal muscle

Lower oesophagus: smooth muscle

88
Q

What are the constrictions of the oesophagus?

A
  1. Cricoid (C6)
  2. Arch of aorta (T4)
  3. Left main bronchus (T5)
  4. Left atrium (T6-10)
  5. Oesophageal hiatus (T10)
89
Q

What is the pathway of the phrenic nerve?

A

In between the subclavian artery and vein, anterior to the root of the lung

90
Q

Which are the autonomic nerves of the chest?

A 
Pulmonary plexus (T1-5)
Cardiac plexus (T1-4)
Oesophageal plexus (T2-6)

FBS2 (3 decks)

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