anatomy of the cardiorespiratory system Flashcards
1
Q
where does the sternum lie anatomically?
A
anteriorly in the midline of the thoracic cage
2
Q
what are the three parts to the sternum?
A
manubrium, body and xiphoid process
3
Q
where in the sternum is the manubrium found
A
the most superior part
4
Q
what is the name of the notch in the superior part of the sternum?
A
suprasternal (jugular) notch
5
Q
what does the manubrium articulate with laterally?
A
the clavicle and the first rib
6
Q
what is the name of the joint where the clavicle and the manubrium ariculate?
A
sternoclavicular joint
7
Q
what does the sternum articulate with inferiorly?
A
body of the sternum
8
Q
what is the joint where the manubrium and the sternum articulate called?
A
manubriosternal joint
9
Q
what is the angle where the manubrium and the body articulate?
A
the sternal angle (angle of Louis)
10
Q
what does the body articulate with?
A
- the manubrium superiorly
- xiphoid process inferiorly
- ribs 2-7
11
Q
what does the second rib articulate with?
A
the sternum at the sternal angle
12
Q
where is the xiphoid process?
A
inferior to the body
13
Q
where does the seventh rib articulate?
A
inferior part of the body of the sternum and
the superior part of the xiphoid process
14
Q
identify these on a skeleton
A
- clavicle (collarbone)
- manubrium, body, and xiphoid process of the sternum
- sternoclavicular joints
- suprasternal notch
- manubriosternal joint (the sternal angle) and the second rib
- costal margin.
15
Q
what is the name of the cartilage found on the anterior part of the ribs?
A
costal cartilage
16
Q
what is the name of the joint where the ribs articulate with their costal cartilages?
A
costochondral
17
Q
what costal cartilage articulate directly with the sternum and what is the joint called?
A
ribs 1-7
sternocostal
joints
18
Q
what costal cartilage join with the seventh costal cartilage?
A
8-10
19
Q
what do the costal cartilage of ribs 7-10 form?
A
costal margin which is palpable
20
Q
what is significant about ribs 11 and 12?
A
short and do not articulate with the sternum – they are ‘floating’ ribs
21
Q
what do the ribs articulate with posteriorly and what is the name of the joint in which they articulate at?
A
thoracic vertebrae
costovertebral joint
22
Q
how are adjacent ribs connected to eachother?
A
intercostal muscles
23
Q
what are the two classification of ribs?
A
typical and atypical ribs
24
Q
what are typical ribs?
A
look similar and share common
anatomical features
25
what are atypical ribs?
look different to typical ribs and / or lack some of the
features of typical ribs
26
what are the typical ribs? and what makes rhemtypical?
ribs 3 - 9 are typical ribs. they have a head, neck, tubercle, and body (shaft).
27
what are the atypical ribs? and what makes them atypical?
ribs 1 - 2 and 10 - 12 are atypical.
ribs 1, 11 and 12
are much shorter than typical ribs
28
what does the head of the rib articulate with?
vertebral body
29
what does the tubercle of the rib articulate with?
transverse process
30
what is the name of the space created by the manubrium, the first ribs and the first thoracic vertebra?
superior thoracic aperture
31
what is a dermatome?
an area of skin innervated by a single spinal nerve
32
what does each pair of thoracic spinal nerves supply?
a ‘strip’ of skin around the chest wall
33
what do the somatic thoracic spinal fibres innervate?
the skeletal muscles of the
thoracic wall
34
what do the sympathetic thoracic spinal nerves innervate?
sweat glands and the smooth muscle of
blood vessels and hair follicles in the skin (arrector pili)
35
what is the anatomical term for armpit?
anterior axilla
36
what is the part of the breast that is towards the armpit called?
axillary tail
37
what are some components of the breast?
● fat - variable amounts.
● glandular / secretory tissue arranged in lobules.
● ducts which converge on the nipple. the areola is the region of pigmented skin
that surrounds the nipple.
● connective tissue and ligaments.
● blood vessels and lymphatics.
38
what arteries supply the breast?
1. internal thoracic artery (which arises from the subclavian artery)
2. axillary artery.
39
where does the internal thoracic arterty go to?
the lateral edge of the sternum
40
what does the internal thoracic cavity give rise to and what does this supply?
anterior intercostal arteries
breast and the intercostal spaces
41
where does venous blood from the anterior intercostal arteries return to?
axillary and
internal thoracic veins
42
what type of nerves and fibres innervate the breasts?
somatic nerves and sympathetic fibres via the intercostal nerves
43
what do somatic sensory fibres innervate in the breast?
skin of the breast
44
what do sympathetic fibres innervate in the breast?
smooth muscle in the blood vessel walls and nipple
45
where does the lymph from the breast drain to?
lymph nodes in the axilla
46
what are the groups of lymph nodes in the axilla?
central, pectoral, humeral, subscapular, and apical
47
what regions fo the lymph nodes in the axilla drain?
breast, upper limb, chest wall, scapular region, and the abdominal wall
47
what is the function of the apical nodes?
receive lymph from all other lymph nodes in
the axilla
48
why are apical nodes often involved in the spread of breast cancer?
because they drain most of the lymph from the breast
49
how many layers of intercostal muscle are there and what are the names?
3
1. external intercostal is most superficial.
2. internal intercostal lies deep to the external intercostal.
3. innermost intercostal lies deep to the internal intercostal
50
what is the pectoralis major and what does it attach to?
1. the most superficial muscle of the anterior chest wall
2. attaches
to the upper humerus, the clavicle and the upper six ribs
51
what is the pectoralis minor and what does it attach to?
smaller muscle that lies deep to pectoralis major
attaches to
the scapula (shoulder blade) and ribs 3-5
52
what is the serratus anterior minor and what does it attach to?
superficial muscle that sweeps around the lateral aspect of the
thoracic cage
attaches to the scapula and the upper eight ribs
53
why is the usage of the prior three muscles a sign of respiratory distress?
their main function is to move the upper limb, but they can also move the ribs as they are attached to them and the muscles that are meant to move the ribs are fixed
54
what is shingles?
red, painful, and itchy rash, typically over the chest
or abdomen on one side of the body only
55
what do shingles affect that explains their stripy appearance?
dermatomes
56
what type of people does shingles affect and how does the infection work?
people who have had chickenpox
after an infection with chickenpox, the virus lays dormant in the dorsal root
ganglion. when reactivated, it causes a rash and pain in the dermatome associated with the affected spinal nerve
57
what is metastatis?
spreading (of cancer)
58
what condition can removing axillary nodes lead to and why?
axillary nodes drain lymph from the upper limb, their removal can
lead to fluid accumulation and swelling in the affected upper limb, a condition called
lymphoedema
59
what are intercostal spaces?
the spaces in between the ribs
60
what do the intercostal spaces contain?
1. three layers of intercostal muscles
2. the membranes associated with the intercostal muscle
3. intercostal neurovascular bundle; an intercostal nerve, intercostal artery and an intercostal vein
61
what are the three types of intercostal muscle?
1. external
2. internal
3. innermost
62
how do the external intercostal muscles run and how is this related to their function?
obliquely towards the armpits, where they attach to the rib below them pulling it up and out for inspiration
63
how do the inner intercostal muscles run and how is this related to their function?
obliquely towards the medial line, where they attach to the rib below them pull it down, and in for expiration
64
how do the innermost intercostal muscles run?
same as the inner intercostal muscles
65
where does the endothoracic facia lie?
deep to the innermost intercostal and superficial to the parietal pleura, which surrounds the lung
66
where do the neurovascular bundles lie within each intercostal space?
in the plane between the internal and innermost intercostal muscle.
they lie along the inferior border of the rib superior to the space
67
what do the neurovascular bundles of the intercostal spaces supply?
intercostal muscles, the overlying skin, and the underlying parietal pleura
68
how can where the neurovascular bundles on the ribs lie be told?
on the inferior border of the rib, there is a shallow costal groove
69
what do the anterior and posterior intercostal arteries supply?
the anterior and posterior parts of the intercostal space
70
where do the anterior intercostal arteries branch from?
internal thoracic artery (a
branch of the subclavian artery)
71
where do the posterior intercostal arteries branch from?
descending aorta in the
posterior thorax
72
where do the anterior intercostal veins drain into?
internal thoracic vein
73
where do the posterior intercostal veins drain into?
azygos system of veins
74
are intercostal nerves somatic or autonomic?
somatic, with sympathetic fibers
75
do intercostal nerves contain motor or sensory fibers or both?
both
76
what do the intercostal nerves innervate?
intercostal muscles, the skin of the chest wall and the parietal pleura
77
what are the two types of pleural membranes and where do they lie?
1. the parietal pleura lines the inside of the thorax.
2. the visceral pleura covers the surface of the lungs and extends into the fissures.
78
what is the pleural cavity?
the space that lies between the parietal and visceral pleura
79
which of the parietal or visceral pleura can be seen by naked eye?
parietal
80
what lies within the pleural cavity?
pleural fluid made by pleural cells
81
what are the four parts of the parietal pleura and where do they lie?
1. the cervical pleura covers the apex of the lung.
2. the costal pleura lies adjacent to the ribs.
3. the mediastinal pleura lies adjacent to the heart.
4. the diaphragmatic pleura lies adjacent to the diaphragm
82
what is the costodiaphragmatic recess?
a ‘gutter’ around the periphery of the diaphragm,
where the costal pleura becomes continuous with the diaphragmatic pleura
83
what is the name of the recess that lies at the junction of the costal and mediastinal pleura?
costomediastinal recess
84
what is the importance of the two recesses?
potential spaces that the lungs expand into during deep inspiration
85
what innervates the parietal pleura, and can injury to it be felt and why?
1. the intercostal nerves that innervate the
overlying skin of the chest wall
2. pain can be felt as somatic sensory fibers there carry sensation to the consciousness
86
what innervates the visceral pleura, and can injury to it be felt and why?
1. autonomic sensory nerves (visceral afferents)
2. no pain as sensation from visceral afferents do not reach our conscious perception
87
where does the superior (apex) part of the lung lie?
projects into the root of the neck, above the clavicle
88
where does the base of the lung lie?
‘sits’ on the diaphragm
89
how many lobes are there in the right lung and what are their names?
3
a superior (upper), middle, and inferior (lower)
lobe
90
how many lobes are there in the left lung and what are their names?
superior and inferior lobe
91
which part of the lung extends over the heart?
an anterior extension of the superior lobe called the lingula
92
what is the costal surface of the lungs?
adjacent to the ribs
93
what is the mediastinal surface of the lungs?
adjacent to the heart
94
what is the diaphragmatic surface of the lungs?
inferior surface of the lung
95
what is the anterior border of the lungs in appearance?
sharp and tapered
96
what is the posterior border of the lungs in appearance?
thick and rounded
97
what is the inferior border of the lungs in appearance?
sharp and tapered
98
what is the hilum?
region on the mediastinal surface of the lung where the pulmonary artery, pulmonary veins and main bronchus enter and exit the lung
99
where does the root of each lung lie and what does it consist of?
1. between the heart and the lung
2. comprises the pulmonary
artery, pulmonary veins, and main bronchus
100
what encloses the root of each lung?
pleura
101
where are the positions of the pulmonary artery and the main bronchus at the right lung?
at the hilum of the right lung, the pulmonary artery lies anterior to the main bronchus
102
where are the positions of the pulmonary artery and the main bronchus at the left lung?
at the hilum of the left lung, the pulmonary artery lies superior to the main bronchus
103
where do the pulmonary veins lie in the left and right hila?
the two pulmonary veins are usually the most anterior and
inferior vessels
104
where does the trachea turn into the left and right main bronchi?
at the level of the sternal
angle
105
what is the bifurcation of the trachea marked by?
a ridge of cartilage called the
carina
106
why are foreign bodies more likely to enter the right main bronchus than the left?
the right main bronchus is shorter, wider and descends more vertically
107
what do the main (primary) bronchi divide into and how many are there at each lung?
1. lobar (secondary bronchi)
2. three in the
right lung and two in the left lung (one lobar bronchus for each lobe)
108
what do the lobar (secondary) bronchi divide into and how man are there in each lung?
1. segmental (tertiary) bronchi
2. approximately ten segmental bronchi in each lung
109
what is the name of the region that each segmental bronchus suppplies?
bronchopulmonary segments
110
what is the advantage to bronchopulmonary segments?
a segment may
be resected (surgically removed) without affecting the rest of the lung as they are supplied by their own segmental bronchus and blood vessels
111
what do the segmental bronchi divide into?
bronchioles, that become smaller with each division
112
where is the site of gas exchange?
alveoli
113
what do the walls of the trachea and bronchi contain?
smooth muscle and cartilage
114
what do the walls of the bronchioles contain?
smooth muscle
115
what supplies the lungs and where do they come from?
1. bronchial arteries
2. descending aorta
116
what do bronchial veins do?
return blood to the azygos system of veins
117
do somatic or autonomic nerves innervate the lungs?
autonomic
118
what do parasympathetic fibers in the lungs do?
stimulate:
1. constriction of bronchial smooth muscle (bronchoconstriction)
2. secretion from the glands of the bronchial tree.
119
what do sympathetic fibers in the lungs do?
1. stimulate relaxation of bronchial smooth muscle (bronchodilation)
2. inhibit secretion from the glands.
120
where does lymph from the lungs drain?
into the venous system via the thoracic duct or right lymphatic duct
121
where does the inferior border of the lungs lie?
1. 6th rib anteriorly (midclavicular line)
2. 8th rib laterally (midaxillary line)
3.10th rib posteriorly (at the vertebral column).
122
where does the patietal pleura extend to?
1. 8th rib anteriorly (midclavicular line)
2. 10th rib laterally (midaxillary line)
3. 12th rib posteriorly (at the vertebral column).
123
where do oblique fissures extend to in terms of ribs in the left and right lungs?
from the 4th rib posteriorly to the 6th costal cartilage anteriorly; the fissure runs deep to the 5th rib
124
where does the horiaontal fissure extend to in terms of ribs in the right lung?
extends anteriorly from the 4th costal cartilage and
intersects the oblique fissure
125
what type of muscle is the diaphragm?
skeletal muscle
126
what is the superior (thoracic) surface of the diaphragm adjacent to?
parietal pleura
127
what travels through the apertures of the diaphragm?
aorta, inferior vena cava, and oesophagus (structures that pass through the thorax and abdomen)
128
what is the diaphragm attached to?
the xiphoid process, costal margin (and to the tips of the 11th
and 12th ribs) and the lumbar vertebrae
129
what is special about the central part of the diaphragm?
is not muscular, but fibrous - the central tendon
130
what happens to the diaphragm during inspiration?
contracts during inspiration, the muscle fibres of the right and left domes are pulled towards their peripheral attachments, and the domes flatten. this increases the intrathoracic volume for the lungs to expand
131
what happens to the diaphragm during expiration?
diaphragm relaxes and domes superiorly. this decreases the
intrathoracic volume and drives the expiration of air from the lungs
132
what innervates the diaphragm?
right and left phrenic nerves innervate the right and left sides of the diaphragm,
respectively
133
what type of nerves are phrenic nerves and where are they formed from?
somatic nerves, formed in the neck by fibres from the C3, C4 and C5 spinal nerves, and hence contain motor and sensory fibres
134
what are the three planes in which the thoracic cavity can move during ventilation?
1. vertically - due to the contraction and relaxation of the diaphragm.
2. laterally - due to contraction of the intercostal muscles which move the ribs.
3. antero-posteriorly (AP) – due to movement of the sternum secondary to movement of the ribs.
135
what is the purpose of pleura and pleural fluid?
the fluid creates surface
tension between the parietal pleura and the visceral pleura, keeping the lung and thoracic wall ‘together’, so
when the thoracic cavity changes volume, the lung changes volume with it
136
describe the process of inspiration
1.the diaphragm and external intercostal muscles contract, increasing the intrathoracic volume (the external intercostals pull the ribs superiorly and laterally, and the ribs pull the sternum superiorly and anteriorly, increasing the AP and lateral dimensions of the thoracic cavity).
2. the lungs expand (increase in volume) with the thoracic wall (due to surface tension).
3. the pressure in the lungs decreases below atmospheric pressure and air is drawn into the lungs.
137
describe the process of expiration
1. the diaphragm and external intercostal muscles relax, and the internal intercostals contract, decreasing the intrathoracic volume (the internal intercostals pull the ribs
inferiorly, and the ribs pull the sternum inferiorly and posteriorly, decreasing the AP and lateral dimensions of the thoracic cavity).
2. the lungs recoil (decrease in volume).
3. the pressure in the lungs increases above atmospheric pressure and air is expelled
from the lungs.
138
what muscles are involved with normal breathing and which parts are active/passive?
inspiration is active and is mainly driven by movement of the diaphragm, but expiration is passive
139
what muscles are involved with vigorous breathing and is it active/passive?
active expiration uses the internal intercostal muscles
140
what muscles are involved with very vigorous breathing and is it active/passive?
active
the accessory muscles of breathing (sternocleidomastoid,
pectoralis major and minor, serratus anterior) contribute to the movement of the ribs and aid ventilation. the anterior abdominal wall muscles contribute to forced expiration
141
what is pleuritic chest pain and what does it feel like?
pain felt from the parietal pleura only, when it becomes inflamed or injured
feels typically sharp, well localised and worse on inspiration
142
what is pneumothorax?
the presence of air in the pleural cavity
143
what happens when pneumothorax occurs?
rapidly increasing volume of air progressively
compresses the lung, heart, great vessels and the opposite lung over to the contralateral side of the thorax, which can be fatal
144
what is haemothorax?
collection of blood in the pleural cavity and occurs secondary to trauma when blood vessels are torn or cut
145
what is pleural effusion and how is it treated?
1. the presence of excess fluid in the pleural cavity
2. chest drain is used to remove air and/or fluid from the pleural space
146
what is primary lung cancer?
cancer of the lung tissue or bronchi
147
what is secondary lung cancer?
cancer from
elsewhere that has metastasized to the lungs
148
what is malignancy of the pleura called?
mesothelioma
149
what is a pulmonary embolism?
a blood clot in the pulmonary circulation
150
how do pulmonary embolisms form?
forms in the deep veins in one of the legs and is carried in the venous circulation back to the right side of the heart and into the pulmonary trunk
151
what is dyspnoea? how does this affect the muscles of ventilation?
breathlessness or shortness of breath
accessory muscles of respiration are used
152
what is the mediastinum? what dos it contain?
part of the thoracic cavity that lies between the lungs that contains all the thoracic viscera apart from the lungs
153
where does the mediastinum extend from?
1. superior thoracic aperture superiorly to the diaphragm inferiorly
2. sternum anteriorly to the thoracic vertebrae posteriorly
154
specify the organs and structures within the mediastinum
1. the heart and pericardium (the fibrous sac around the heart)
2. the great vessels that enter and leave the heart
3. the veins that drain the chest wall
4. the trachea and main bronchi
5. the oesophagus
6. nerves (somatic and autonomic)
7. lymphatics
8. the thymus gland
155
where is the division for superior and inferior mediastinum?
from the sternal angle
anteriorly to the T4/T5 junction posteriorly
156
where does the inferior anterior mediastinum lie and what does it contain?
1. lies between the posterior aspect of the sternum and the anterior aspect of the pericardial sac
2. contains the thymus
gland in children and its remnant in adults
157
where does the inferior middle mediastinum contain?
heart inside the pericardial sac, the pulmonary
trunk, and the ascending aorta
158
where does the inferior posterior mediastinum lie?
between the posterior aspect of the pericardial sac
and the vertebrae
159
what are the main contents of the superior mediastinum?
1. arch of the aorta and its three branches
2. superior vena cava and its tributaries - the left and right brachiocephalic veins
3. trachea
4. oesophagus
5. phrenic nerves (left and right) and vagus nerves (left and right)
6. thoracic duct
7. thymus gland
160
what parts of the aorta are in the thorax?
1. ascending aorta
2. arch
3. descending aorta
161
what does the ascending aorta give rise to?
coronary arteries that supply the myocardium
162
where does the arch of the arota lie?
in the superior mediastinum
163
where does the descending aorta go?
through the posterior mediastinum into the abdomen posterior to the diaphragm
164
what branches from the aortic arch?
1. brachiocephalic trunk
2. left common carotid
3. left subclavian
165
what does the braciocephalic trunk split into?
1. right common carotid artery
2. right subclavian artery
166
what does the right common carotid artery supply blood to?
right side of the head neck and the brain
167
what does the right subclavian artery supply blood to?
right upper limb
168
what does the left common carotid artery supply blood to?
left side of the head,
neck, and brain
169
what does the left subclavian artery supply blood to?
the left upper limb
170
where are the chemoreceptors within the aorta located?
within the aortic bodies of the aortic arch
171
what do the aortic chemoreceptors do?
monitor arterial oxygen and carbon dioxide
172
what is the ligamentum arteriosum?
a fibrous, cord-like connection between the pulmonary trunk and the arch of the aorta
173
what is the ligamentum arteriosum remnant of?
the ductus arteriosus, a foetal circulatory shunt
174
what does the ductus arteriosus
diverts most of the blood entering the pulmonary trunk directly to the aortic arch (only a small amount of blood circulates through the foetal lungs; enough for
them to develop)
175
what are the names of the veins that carry deoxygenated blood into the right atrium?
superior and inferior vena cava
176
where does the superior vena cava return blood from?
from the head, neck and upper limb
177
where does the superior tributaries cava and its tributaries lie?
in the superior mediatstinum
178
what is the superior vena cava formed by the union of?
the internal jugular vein (which drains the head and neck) and the subclavian vein (which drains the upper limb)
179
where does the inferior vena cava return blood from?
all regions inferior to the
diaphragm (abdomen, pelvis, and lower limbs)
180
where does the inferior vena cava enter the right atrium?
as soon as it enters the thorax through the diaphragm
181
what does the trachea do?
conducts air to and from the left and right main bronchi
182
why is the trachea semi rigid?
due to C-shaped, incomplete rings of cartilage in its walls
183
where does the trachea extend from and to?
from the larynx in the midline of the neck into the superior mediastinum and terminated at the level of the sternal angle by bifurcating into the left and right main bronchi
184
where does the oesophagus extend from?
the pharynx in the midline of the neck to the stomach in the posterior mediastinum
185
where does the oesophagus lie within the superior mediastinum?
the midline of the thorax
186
where does the oesophagus lie compared to the trachea?
posterior to the trachea
187
what nerves innervate the diaphragm?
left and right phrenic nerves
188
where are phrenic nerves formed from?
by fibres from the C3, C4 and C5 spinal nerves
189
what type of nerves are phrenic nerves and what do they contain?
somatic nerves and contain motor and sensory fibres
190
where do phrenic nerves pass through to enter the thorax?
superior thoracic aperture
191
what do vagus nerves innervate?
structures of the thorax and abdomen, in addition to the head and neck
192
where do the vagus nerves arise from?
the brainstem
193
what type of nerves do vagus nerves contain?
somatic sensory, somatic motor and parasympathetic fibres
194
what do vagus nerves descend through the neck alongside?
the internal carotid artery and internal jugular vein and enter the thorax via the superior thoracic aperture
195
what does each vagus nerve give rise to and what does this nerve innervate?
recurrent laryngeal nerve (RLN), which ascend back up into the neck to innervate the muscles of the larynx
196
how does the left recurrent laryngeal nerve travel?
loops under the arch of the aorta before ascending
back up the left side of the neck (alongside the trachea) to the larynx
197
how does the right recurrent laryngeal nerve travel?
descends anterior to the right subclavian artery
and then loops under the inferior border of the artery before ascending back up the
right side of the neck (between the trachea and oesophagus) to the larynx
198
what is the purpose of the thoracic duct?
to be a major channel for lymphatic drainage from most regions of the body
199
where does the thoracic duct ascend from?
the posterior mediastinum and into the superior mediastinum
200
where does the thoracic duct empty into?
the venous system at the union of the left internal jugular vein and left subclavian vein
201
where is the thymus gland?
lies anteriorly in the superior mediastinum
202
why is the thymus gland not found within adults?
it atrophies with age and eventually becomes fatty
203
what is the pericardium?
tough, fibrous sac that encloses the heart like a loose-fitting bag
204
what are the two layers of the pericardium?
1. tough outer fibrous layer that is continous with the great vessels
2. inner thin serous layer made from a visceral and parietal layer that covers the surface of the heart and the outer layer and are continuous with eachother
205
what is in between the two layers of serous layer of pericardium?
a pericardial cavity that contains small amounts of pericardial fluid and low the membranes to slide over each other with the movements of the heart
206
what innervates the fibrous
sensory branches that stem from the left and right phrenic nerves
207
what is the 'base' surface of the heart?
the posterior surface
208
what is the 'inferior' surface of the heart?
the diaphragmatic surface
209
what is the anterior surface of the heart?
faces the ribs and the sternum (also called the sternocostal surface)
210
what is the pulmonary surface of the heart?
the left and right sides of the heart that face the lungs
211
what parts of the heart make up the base/posterior surface?
left atrium and part of the right atrium
212
what parts of the heart make up the inferior/diaphragmatic surface?
left ventricle with part of the right ventricle
213
what parts of the heart make up the anterior/sternocostal surface?
right ventricle
214
what parts of the heart make up the left pulmonary surface?
left ventricle
215
what parts of the heart make up the right pulmonary surface?
right atrium
216
where does the apex of the heart lie?
at the 5th intercostal space in the midclavicular line
217
which part of the heart corresponds to the right border?
right artium
218
which part of the heart corresponds to the left border?
left ventricle
219
which part of the heart corresponds to the inferior border?
right ventricle and part of the left ventricle
220
where does the right border of the heart correspond to on the ribs?
lies lateral to the right sternal edge, from the right 3rd costal cartilage to
the right 6th costal cartilage
221
where does the left border of the heart correspond to on the ribs?
extends from the left 2nd intercostal space to the left 5th intercostal space
in the midclavicular line (i.e. the apex)
222
where does the superior border of the heart correspond to on the ribs?
lies along the line connecting the superior extents of the right and left borders (i.e. from the right 3rd costal cartilage to the left 2nd intercostal space)
223
where does the inferior border of the heart correspond to on the ribs?
lies along the line connecting the inferior end of the right border with the apex (mostly formed by the right ventricle)
224
what are the auricles?
outpouchings from the walls of the right and left atria (look like an ear)
225
what is patent ductus arteriosus (PDA)?
the congenital ductus arteriosus does not close, which means blood flows from the aorta through the ductus arteriosus into the pulmonary trunk increasing its pressure (pulmonary hypertension) straining the right side of the heart
226
what is pericardial effusion?
an increase in fluid volume in the pericardial space
227
what may cause pericardial effusion?
1. inflammation of the pericardium (pericarditis)
2. accumulation of blood (due to trauma)
228
why can pericardial efusion be harmful?
the fibrous pericardium cannot stretch and so the heart is compressed and unable to fill
properly (called cardiac tamponade)
229
where do arteries lie within the heart?
within the grooves onthe eternal surface
230
what are the grooves on the external surface of the heart called?
sulci
231
where do the left and right coronary arteries arise from?
ascending aorta
232
where do cardiac veins return blood to?
the coronary sinus, that enters the right atrium
233
hat supplies blood to the sinatrial and the atrioventricular nodes?
branches from the right coronary artery
234
what supplies blood to the inferior border of the heart?
right marginal artery
235
what supplies blood to both ventricles of the heart? what is this blood vessel a continuation of?
posterior intraventricular arter, which is a continuation of the right coronary artery
236
what does the left coronary artery branch into?
1. anterior interventricular artery (or the left anterior descending; ‘LAD’)
2. circumflex artery
237
what is the part of the left coronary artery called before it branches off?
left main stem
238
where does the anterior interventricular artery run and supply?
runs in the anterior interventricular
sulcus towards the apex and supplies both ventricles
239
where does the circumflex artery run and supply?
runs around the heart onto the inferior/diaphragmatic left atrium, part of the right ventricle and the left ventricle
240
where does the left marginal artery run and supply?
arises from the circumflex and supplies the left ventricle
241
how can a right/left dominant circulation be determined?
if the posterior interventricular artery arises from the right coronary, the person has a right dominant circulation
if the posterior interventricular artery arises from the circumflex artery, the person has a left dominant circulation
242
why is left/right dominant circulation important?
in someone with a right-dominant circulation,
occlusion of the left main stem would impair blood flow to part of, but not the entire left ventricle. in someone with left-dominant coronary circulation, blockage of the
left main stem occludes blood flow to the entire left ventricle
243
what is the interatrial spetum?
separatedthe left anr right atrium
244
what is the fossa ovalis and where is it found?
a depression in the right interatrial septumthat is remnant of the foetal foramen ovale
245
what is the foetal foramen ovale?
shunts oxygenates blood from the right atrium to the left atrium allowing it to bypassthe lungs
246
what is the crista terminalis?
a muscular ridge that separates the smooth-walled posterior part
of the atrium from the anterior part, which has a ridged, muscular wall
247
what is the trabeculae carneae?
muscular ridges on the internal wall of the right ventricle
248
what is the papillary muscles?
modified regions of trabeculae carneae, which project into the
lumen of the ventricle
249
what is the chordae tendineae?
fibrous cords which connect the tips of the papillary muscles to
the tricuspid valve
250
what is the moderator band?
a modified region of the trabeculae carneae which connects the
interventricular septum to one of the papillary muscles
250
what does the left ventricle contain?
1. trabeculae carneae
2. papillary muscles; two in the left ventricle
3. chordae tendineae that connect the tips of the papillary muscles to the mitral valve
251
what do the papillary muscles and chordae tendineae do?
allow the closed valves to resist the pressure generated inside the ventricles during contraction and prevent them from being forced open
252
what are abnormal heart sounds called?
murmurs
253
where are the auscultory areas for the heart for each valve?
1. aortic = 2nd intercostal space, just to the right of the sternum.
2. pulmonary space, just to the left of the sternum.
3. tricuspid = 5th intercostal space, just to the left of the sternum.
4. mitral = 5th intercostal space, left midclavicular line.
254
at wutehat rate does the sinoatrial node generate electrical impluses?
70 per min
255
what do visceral afferennt fibers do in the heart?
convey sensory information from the heart back to the CNS
256
does information from visceral afferent fibers reach conscious perception?
no usually, but if the myocardium is ischaemic, it can be relayed to ur conscious perception as pain, burning or tightness
257
what is referred pain?
pain that can not be pinpointed
258
what is myocardial infarction?
death of a region of myocardium secondary to occlusion (blockage) of the
coronary vessel that supplies it.
259
what is patient foramen ovale and the consequences?
when the foramen ovale fails to close after birth, allowing the movement of blood from the right to the left atrium. severity depends on the size
260
what is ventricular septal defects?
blood flow from the left to the right ventricle
261
what is cardiomyopathies?
diseases of myocardium, and most are inheriteds – some cause the myocardium to thin, whereas others result in the myocardium becoming thick and stiff which reduces the effect of the heart pumping leading to heart failure
262
where is the posterior mediastinum?
behind the heart and pericardium
263
where does the aorta descend through?
the posterior mediastinum
264
what do the posterior intercostal arteries supply?
the intercostal spaces
265
what does the bronchial arteries supply?
the lungs
266
what do the oesophageal branches supply?
the oesophagus
267
what do the pericardial branches supply?
the pericardium
268
what do the phrenic nerves supply?
the diaphragm
269
at what level does the aorta pass through the diaphragm?
t12
270
what does the aorta branch into?
1. posterior intercostal arteries
2. bronchial arteries
3. oesophageal arteries
4. pericardial arteries
5. phrenic branches
271
what is the function of azygos veins?
drains blood from the posterior thoracic wall and returns it to the superior vena cava
272
how do the azygous veins travel and where do they travel from?
arises in the abdomen at the level of L1 / L2 and traverses the diaphragm to enter the posterior mediastinum
273
where do azygos veins lie and what is the system?
lies on the bodies of thoracic vertebrae
consists of:
1. azygos vein on the right side of vertebral bodies
2. hemiazygos veins (shorter) on the left side of vertebral bodies
3. one or more veins connecting the veins to eachother
274
where do the sympathetic trunks lie?
posterior thoracic wall, either side of the vertebral column and posterior to the parietal pleura
275
what are the sympathetic trunks appearance wise?
thin, longitudinal fibre tracts regularly interspersed with ganglia (singular = ganglion)
276
what are ganglia in the sympathetic trunks also called?
paravertebral ganglia
277
what does the posterior intercostal space contain?
* intercostal muscles
* a posterior intercostal artery (a branch of the thoracic aorta)
* a posterior intercostal vein (which drains to the azygos system)
* a posterior intercostal nerve
278
what nerves convey sympathetic fibers to thoracic viscera?
cardiopulmonary splanchnic nerves
279
what nerves convey parasympathetic fibers to thoracic viscera?
vagus nerves
280
what do sympathetic and parasympathetic fibres form?
autonomic plexuses
281
what does the cardiac plexus innervate?
the sinoatrial node of the heart
282
what does the pulmonary plexus innervate?
the bronchi
283
what does the oesophageal plexus innervate?
the anterior surface of the oesophagus
284
what does the oesophageal plexus innervate?
the anterior surface of the oesophagus
285
what do visceral afferents do?
relay sensory information from the thoracic viscera back to the CNS
286
what is referred pain?
where pain from one part of the body is felt in another region
287
where is cardiac pain typically felt?
central chest, left side of the neck and left arm
288
why does the brain interpret cardiac pain as coming from the chest,neck and arm?
somatic sensory information and visceral sensory information (only when the heart is ischaemic) enters the spine at T1-T5
289
what is the hyoid bone?
slender bone situated anteriorly in the upper neck, inferior to the
mandible, that keeps the pharynx open
290
what are anterior and posterior triangles?
divisions of the neck separated by sternocleidomastoid muscle
291
what are suprahyoid muscles?
four paired muscles that lie superior to the hyoid bone and form the floor of the mouth; when they contract, they raise the
hyoid bone and larynx during speech and swallowing
292
what are infrahyoid muscles?
lateral to the anterior
midline of the neck that draw the hyoid bone and larynx inferiorly during speech and swallowing
293
what is the function of the thyroid gland?
produces hormones which play an important role in the regulation of metabolic processes
294
what regulates hormone secretion from the thyroid
gland?
pituitary gland
295
what blood vessles supply the thyroid gland?
left and right superior and inferior thyroid arteries
296
what are parathyroid glands?
glands that produce parathyroid hormone that plays a role in calcium regulation
297
what are parathyroid glands made from and where are they found?
left and right superior and inferior that are located posterior to the thyroid gland
298
where do the common carotid arteries descend?
in the left and right sides of the neck
299
what does the common carotid artery bifurcate into?
external and internal carotid arteries
300
what does the internal carotid artery do?
enters the cranium and supplies the brain
301
what does the external carotid artery do?
artery gives rise to several branches that supply the head and neck, including the pharynx, scalp, thyroid gland, tongue, and the face
302
what does the internal jugular vein do?
drains blood from the brain
and part of the face
303
what do the left and right brachiocephalic veins unite to form?
superior vena cava
304
what separates the triangles of the neck?
the sternocleidomastoid muscle
305
how do cervical vertebrae allow for good flexion and extension?
small and articulate with each other at facet joints that
are orientated obliquely
306
where do the inferior thyroid arteries come from?
right and left subclavian arteries
307
where do the superior thyroid arteries come from?
from the front of the external carotid artery
308
what drains the thyroid gland?
superior, middle, and inferior thyroid veins
309
what happens at the point of common carotid arteries?
a swell of the carotid sinus exists, where baroreceptors monitor arterial blood pressure and relay the information back to the CNS via the glossopharyngeal
nerve to regulate blood pressure
310
what are the walls of the pharynx composed of?
1. outer layer of circular muscle
2. inner layer of longitudinal muscle
311
what is the external muscle layer of the pharynx composed of?
superior, middle and inferior constrictors
312
how does food travel down into the oesophagus?
1. food in the oral cavity is pushed into the oropharynx by the tongue
2. soft palate rises and closes off the nasopharynx from the oropharynx
3. food moves down into the laryngopharynx and constriction of the pharyngeal wall moves food into the oesophagus. the epiglottis closes off the laryngeal inlet to prevent food moving into the larynx
313
where is the nasopharynx?
posterior to the nasal cavity
314
where is the oropharynx?
posterior to the oral cavity
315
what is the laryngopharynx?
posterior to the larynx
316
what are tonsils made from and where are they found?
lymphoid tissue in the upper parts of the pharynx
317
what tonsils are found in the nasopharynx?
pharyngeal and tubal tonsils
318
where is the pharyngeal tonsil?
lies in the roof of the nasopharynx
319
where is the tubal tonsil?
surrounds the opening of the auditory tube
320
what tonsil lies in the oropharynx?
palatine tonsil
321
where does the lingual tonsil lie?
on the posterior aspect of the tongue
322
what is the pharynx innervated by?
sensory fibres from the glossopharyngeal nerve and motor fibres from the vagus nerve
323
name some nerves that innervate the pharynx?
1. cervical part of the sympathetic trunk
2. superior laryngeal nerve
3. hypoglossal nerve
4. glossopharyngeal nerve
324
how many cartilages is the larynx composed of?
9: three unpaired and three paired
325
what are the three unpaired cartilages of the larynx?
epiglottis, thyroid cartilage, and the cricoid cartilage
326
what are the three paired cartilages of the pharynx and how do their size compared to the unpaired?
much smaller
arytenoids, the cuneiforms and the corniculate
327
what is the structure of the thyroid cartilage?
composed of two flat cartilages (laminae) that meet in the anterior midline to form the laryngeal prominence
328
what do the laminae of the thyroid cartilage form posteriorly and what do these articulate with?
extensions that project superiorly and inferiorly - the
superior and inferior horns
1. superior horns attach to the hyoid bone
2. inferior horns articulate with the cricoid cartilage below
329
what is the cricothyroid membrane and its significance?
connects the inferior border of the thyroid and superior
border of the cricoid that is pierced to create an emergency airway
330
what is the epiglottis attached to?
superior aspect of the thyroid cartilage
331
where do arytenoid cartilages lie and what are their importance?
sit on the superior surface of the cricoid cartilage
vital for
phonation, as the vocal cords attach to them. movements of the arytenoids move the
vocal cords.
332
what is the internal asoect of the larynx modified for?
phonation
333
what are the vestibular folds?
two pairs of folds that project superiorly into the cavity of the larynx
334
what are the vocal folds?
two pairs of folds that project inferiorly into the cavity of the larynx (true vocal chords)
335
what is the purpose of the vocal folds?
protect the vocal
ligaments
336
where do the vocal ligaments attach to?
attached anteriorly to the internal aspect of the laryngeal prominence and posteriorly to the arytenoid cartilages
337
what is the space between the true vocal cords called?
rima glottidis
338
what is adduction of the rima glottidis?
closes the rima glottidis
339
what is abduction of the rima glottidis?
opens it
340
what groups of muscles act on the larynx?
extrinsic and intrinsic
341
what are the extrinsic muscles of the larynx and their function?
suprahyoid and infrahyoid muscles. they do not move the individual cartilages, but rather move the larynx as one with speech and swallowing
342
what are the intrinsic muscles of the larynx and their function?
move the laryngeal cartilages which in turn move the vocal
cords
343
what are the intrinsic muscles of the larynx?
1. left and right cricothyroid muscles anteriorly
2. left and right posterior cricoarytenoids on the posterior surface of the cricoid
3. transverse arytenoid
344
what nerves inner
vate the larnx and what feaures?
345
what separates the left and right nasal cavity and what is this made from?
thin midline septum, formed of cartilage and bone
346
what separates the nasal cavity from the oral cavity?
the hard palate
347
what separates the nasal cavity from the brain
bone
348
what is posterior to the nasal cavity?
nasopharynx
349
what sinus is associated with the nasal cavity?
the paranasal sinus
350
what is the structure of the septum?
formed of cartilage anteriorly and two thin plates of bone
posteriorly
351
what is the structure of the lateral wall of the nasal cavity?
three projections of bone, the superior, middle,
and inferior conchae (Latin = shell), or turbinates
352
what is the name of the space that lies inferior to the tubinates?
meatuses (superior, middle and inferior which lie inferior to their respective turbinates)
353
what is the purpose of the turbinates and meatuses?
inspired air travels through the meatuses it is warmed, humidified, and filtered
354
what is the name of the bone that separates the brain from the nasal cavity, and what is its structure?
cribriform plate
delicate section of bone that is perforated with tiny holes (like a sieve)
355
what is significant about the perforations in the cribform plate?
olfactory (relating to the sense of smell) nerves of the travel through the perforations to the brain
356
what does the blood supply of the nasal cavity look like?
supplied by branches of the maxillary artery which is a terminal branch of the external carotid artery. the branches form networks which is often the site of a nosebleed.
357
what does the nerve supply of the nasal cavity look like?
sensory innervation of the nose is via branches of the trigeminal nerve (CN V)
358
what are the four types of paranasal sinuses and where do they lie?
1. frontal sinuses lie within the anterior part of the frontal bone.
2. ethmoid air cells lie within the ethmoid bone (superior to the nasal cavity and
medial to the orbits).
3. sphenoid sinuses lie within the sphenoid bone.
4. maxillary sinuses lie within the maxillae of the facial skeleton
359
where does the frontal sinus drain into?
middle meatus
360
where does the sphenoid sinus drain into?
spheno-ethmoidal recess
361
where does the ethmoid air cells drain into?
superior and middle meatuses
362
where does the maxillary sinus drain into?
middle meatus
363
what does the nasolacrimal duct drain?
fluid (‘tears’) that lubricate the anterior surface of the eye
364
what does the nasolacrimal duct drain into?
inferior meatus
365
where is the auditory tube?
connects the middle ear to the nasopharynx
366
what is the function of the auditory tube?
allows air to pass into the middle ear so that the pressure on either
side of the tympanic membrane (eardrum), which lies between the middle and
external ear, is equal. this is important for optimal conduction of soundwaves
367
what is the structure of the palate?
anteriorly of bone – the hard palate – and posteriorly of muscle – the soft palate
368
what is the hard palate composed of?
palatine processes of the maxillae and the
horizontal plates of the palatine bones
369
what is the function of the hard palate?
● it prevents food or fluid entering the nasal cavity.
● we push our tongue up against the hard palate during the first phase of swallowing,
which forces food and fluid backwards into the oropharynx.
● we push our tongue up against the hard palate to articulate certain sounds.
370
what projects from the soft palate?
the uvula -‘hangs’ from the posterior border of the soft palate and can be seen at the back of the mouth
371
what is the soft palate innervated by?
vagus nerve
372
what is the purpose of the soft palate?
the muscles of the soft palate contract during swallowing which elevates the soft palate. the nasopharynx is closed off from the oral cavity, preventing reflux of food and fluid into the
nasal cavity
373
what is the superior surface of the oral cavity?
soft tissues and muscles (the floor of the mouth)
374
what is the lateral surface of the oral cavity?
the cheeks
375
how many teeth do adults have?
32, 16 embedded in the maxilla (upper jaw) and 16 embedded in
the mandible (lower jaw).
376
what type and number of teeth are there?
in the upper and lower jaws there are four incisors, two canines, four premolars and six molars
377
what are teeth composed of?
● an inner pulp which contains blood vessels and nerves
● dentin which surrounds the pulp
● an outer, hard coating of enamel.
378
what are some functions of the tongue?
chewing, swallowing and speech
379
what is found on the surface of the tongue and its function?
s papillae on its
superior surface, some of which detect taste (‘taste buds’)
380
what is the space between the posterior tongue and the anterior aspect of the epiglottis called?
vallecula
381
what innervates the muscles of the tongue?
hypoglossal nerve (CN XII)
382
what types of muscle is found in the tongue, and what is its function?
1. intrinsic muscles lie entirely within the tongue. They are paired bilaterally and fuse in
the midline. They change the shape of the tongue.
2. extrinsic muscles are attached to the tongue but originate from outside it (from the
mandible and hyoid bone). They move the tongue.
383
what innervates the taste found in the anterior two thirds of the tongue?
facial nerve (CN VII)
384
what innervates the touch, pain, temperature found in the anterior two thirds of the tongue?
trigeminal nerve (CN V)
385
what innervates the touch, pain, temperature and taste found in the posterior third of the tongue?
glossopharyngeal nerve (CN IX)
386
what vessels supply the oral cavity and where do they branch from?
the lingual, maxillary, and facial arteries, which are
branches of the external carotid artery
387
what innervates the oral cavity?
the muscles of the soft palate are innervated by the vagus nerve. the tongue is innervated by four cranial nerves (CNs V, VII, IX and
XII)
388
what and where are the different tonsils?
● the pharyngeal tonsil lies in the roof and posterior wall of the nasopharynx
(sometimes called the ‘adenoid’).
● the tubal tonsil surrounds the opening of the auditory tube on the lateral wall of the
nasopharynx.
● the palatine tonsil lies on the lateral wall of the oropharynx. Usually referred to as ‘the tonsils’, they are visible on either side of the oropharynx when the mouth is open.
● the lingual tonsil is a collection of lymphoid tissue in the posterior tongue.
389
what is the name of the three pairs of salivary glands secrete saliva into the oral cavity?
the parotid, submandibular and sublingual salivary glands
390
is glandular stimulation sympathetic or parasympathetic?
parasympathetic
391
which is the largest of the three paired salivary glands and where does it lie?
parotid, overlies the
posterior part of the mandible
392
how does saliva empty into the mouth ?
through the parotid duct
393
what stimulates secretion from the parotid gland?
glossopharyngeal nerve
394
where are submandibular glands found?
lie inferior to the body of the mandible, just anterior to the angle. opens into the
floor of the mouth, under the tongue
395
what stimulates the secretion of saliva in submandibular glands?
parasympathetic
fibres in the facial nerve
396
where do sublingual glands lie?
in the floor of the mouth
397
what stimulates the secretion of saliva in sublingual glands?
parasympathetic fibres in the facial nerve
