Anatomy - Theory Flashcards
1
Q
At which point does the upper respiratory tract become the lower?
A
The beginning of the trachea
2
Q
At what vertebral level does the upper respiratory tract become the lower?
A
C6
3
Q
Where can the trachea be palpated?
A
Jugular notch of the manubrium
4
Q
What are the two types of pleura?
A
- Visceral
- Parietal
5
Q
What is the space between the visceral and parietal pleura called?
A
Intrapleural space
6
Q
How many lobes make up each lung?
A
Left - 2, right - 3
7
Q
How many bronchopulmonary segments does each lung lobe have?
A
10
8
Q
Why can small sections of lung easily be removed through surgery?
A
Each bronchopulonary segment has its own innervation, lymphatic and blood supplies
Little damage is done to surrounding bronchopulmonary segments when one is operated on
9
Q
How many pairs of ribs are there in the thoracic skeleton?
A
12
10
Q
What are the 3 type of ribs and what rib numbers does each type represent?
A
- True - ribs 1-7
- False - ribs -8-10
- Floating - ribs 11 and 12
11
Q
What are the three components of the sternum?
A
- Manubrium
- Body
- Xiphoid process
12
Q
What happens at the sternal angle?
A
Bronchi bifurcate
13
Q
Which parts of a rib articulate with the vertebrae?
A
Head and tubercle
14
Q
The head of the rib articulates with the vertebra of the ______ ________ and also the vertebra _______.
The tubercle associates with the __________ ________ of the vertabra of the ______ _________.
A
Same number
Above
Transverse process
Same number
15
Q
What is a costal groove?
A
This is a groove on the ribs in which a neurovascular bundle is located
16
Q
What is a costochondral joint?
A
A joint from rib to sternum
17
Q
What are sternocostal joints?
A
Synovial joints from sterum to ribs
18
Q
Where do costalvertebral joints occur?
A
Where ribs articulate with the sternum
19
Q
What are the three layers of intercostal muscles?
A
- External
- Internal
- Innermost
20
Q
How many intercostal spaces are there?
A
11
21
Q
Each intercostal space contains what?
A
A neurovascular bundle (nerve, artery and vein)
22
Q
A neurovascular bundle is found between which layers of muscle?
A
Internal and innermost intercostal muscle layers
23
Q
In a neurovascular bundle, where does the nerve supply originate?
A
Anterior ramus of the spinal nerve
24
Q
Blood supply to the intercoastal spaces is both posterior and anterior, which vessels are utilised in each situation?
A
Anterior - internal thoracic artery, internal thoracic vein
Posterior - thoracic aorta, azygous vein
25
Why is the right "dome" of the diaphragm larger than the left?
Due to the liver
26
Which type of muscle composes the diaphragm?
Skeletal
27
The phrenic nerve is composed of which spinal nerves?
C3, 4 and 5
28
The diaphragm is innervated by which nerve?
Phrenic
C3, 4 and 5 keep the diaphragm alive
29
Where in the neck is the phrenic nerve found?
Anterior surface of the scalenus anterior muscle
30
Where in the thorax is the phrenic nerve found?
It decends over the anterior surface of the external pericardium of the heart
31
What does the phrenic nerve supply to the diaphragm?
Somatic sensory and sympathetic axons (to diaphragm and fibrous pericardium)
Motor neurones (to diaphragm)
32
What is the root of breast tissue called?
Axillary tail
33
What is the name of the surrounding tissue close to the nipple?
Areola
34
Lymph drainage from breast tissue is split into which two main areas?
1. Axillary nodes - lateral quadrants (unilateral)
2. Parasternal nodes - medial quadrants (bilateral)
35
Where are sensory nerves located?
Within superficial fascia
36
The deltoid muscle and pectoralis major do not join completely so betweent them is a groove. What is the name of this groove?
Delto-pectoral groove
37
Which vein runs within the delto-pectoral groove?
Cephalic vein
38
The long thoracic nerve innervates which muscles
Serratus anterior muscles
39
The function of the serratus anterior muscles is to?
Anchor the scapular to the body
40
What are 4 different names of parietal pleura (based on location)?
1. Cervical - above ribs
2. Costal
3. Diaphragmatic
4. Medistinal
41
What is the most inferior part of the intrapleural cavity?
Costodiaphragmatic recess
(costophrenic angle - most inferior point)
42
What is the term given to the most superior part of the lungs?
Apex
43
What is the name of the medial projection of the left lobe?
Lingula
44
How are lung lobes separated?
Fissues
(oblique - superior and inferior, and horizontal - middle and superior - only in right lung)
45
What are hila and what are they composed of?
Lung roots
Pulmonary arteries, veins and lymph nodes
Main bronchi
46
Why must all 5 lung lobes be listened to when auscultating?
They are all supplied by different lobar bronchi
47
What is an example of a high pitched and low pitched sound heard during auscultation?
High - wheezing
Low - rhonchi (rattling/snoring)
48
Coughing involves stimulation of sensory receptors in the mucosa. Where may such receptors be located?
* Oropharynx
* Laryngopharynx
* Larynx
* Respiratory tree
49
Describe how a cough is produced
* Sensory (afferent) nerves stimulated
* Deep inspiration inititiated by CNS using diaphragm (phrenic nerve) and intercostal muscles (intercostal nerves)
* Adduction of vocal cord occurs - closes rim glottidis (vagus nerves)
* Contraction of anterolateral adbominal wall muscles stimulated by intercostal nerves
* Increased intra-abdominal pressure
* Vocal cord abduct abruptly opening rima glottidis (vagus nerves)
* Soft palate tenses (CN V) and elevates (vagus nerves) closing entrace to nasopharynx directing stream of air outwards through the oral cavity
50
What is the name of the space between vocal cords?
Rima glottidis
51
The glosspharyngeal nerve (CN IX) carries afferent sensory signals from where?
Oro and nasopharynx
52
Information from the laryngopharynx and larynx is relayed to the brain by which nerve?
Vagus nerve
| (CN X)
53
What nerve innervates the nasopharynx that when stimulated will cause a sneeze?
Trigeminal nerve
| (CN V)
54
What are carotid sheaths and what do they carry?
They are protective tubes of deep fascia
They carry the vagus nerve, the internal carotid artery, the common carotid artery and the internal jugular vein
55
Where are the attachments for carotid sheaths?
Superiorly - Bones at base of skull
Inferiorly - blend with fascia of superior mediastinum
56
Where do pulmonary visceral afferents travel from?
Visceral pleural and lower respiratory tree to the pulmonary plexus
57
What is the pulmonary plexus?
A network of intertwined sypathetic axons, parasympathetic axons and visceral afferents (associated with lungs)
The plexus is located at the bifurcation of the trachea
58
What changes in the lower respiratory tract can sympathetic and parasympathetic nerves initiate?
* Change level of mucous production
* Change dilatation of airways
59
How is sensory information relayed from visceral afferent passed on at the pulmonary plexus and why is this significant?
Via the vagus nerve
This means the vagus nerve receives sensory information for both the upper and lower respiratory tracts meaning a cough can be initiated by either signal
60
Where can the phrenic nerve be found?
In the neck on the anterior scalenus muscle
Lateral aspect of the pericardium
61
The phrenic nerve supplies which nerves where?
Sensory and sympathetic - diaphragm and fibrous pericardium
Somatic motor to diaphragm
62
What are the three types of intercostal muscles?
1. External
2. Internal
3. Innermost
63
What are the four sets of accessory muscles of deep inspiration?
1. Pectoralis major
2. Pectoralis minor
3. Sternocleidomastoid
4. Scalenus anterior, medius and posterior
64
Where does the pectoralis major attach?
Between the sternum and the ribs and also at the humerus
65
The pectoralis major allows for which movements?
Adduction and rotation of the humerus
Pull ribs upwards and outwards when the upper limp position is fixed (facilitates deep inspiration)
66
Where is the pectoralis minor located and where does it attach?
Deep to the pectoralis major
Attaches at the coracoid process of the scapula and ribs 3-5 that can be puled superiorly upon contraction
67
Where does the sternocleidomastoid muscle attach?
Between sternum and clavicle
Also at the mastoid process of the temporal bone
68
Where does the scalenus muscle group attach?
Between cervical vertebrae and ribs 1 and 2
69
What happens when intrinsic muscles in the larynx move the cartilage?
The vocal cords will close since they are attached
The intrinsic muscles are innervated by motor components of the vagus nerve
70
Where does the vagus nerve arise from?
The medulla oblongata
71
Where does the vagus nerve exit the base of the skull?
Through the jugular foramen
72
In the chest the vagus nerve lies __________ to the lung root and supplies _______________ axons to the chest organs and pulmonary plexus
Posteriorly
Parasympthetic
73
The _______ \_\_\_\_\_\_\_ forms what on te oesophagus?
Vagus nerve
Plexus
74
What happens when the vagus nerve reaches the stomach?
It forms another plexus where it supplies the foregut and midgut
75
How is the action of the diaphragm different in passive breathing versus forced expiration as with a cough?
Passive breathing - just relaxes
Forced expiration - right and left anterolateral abdominal wall muscles contract compressing abdominal organs and pushing the diaphragm upwards aiding forced expiration
76
What are the three anterolateral muscles in the chest wall?
1. External oblique
2. Internal oblique
3. Transversus abdominus
77
In what direction do the muscle fibres in the external oblique muscle pass?
The same direction as the external intercostal muscles
78
Where does the external oblique muscle attach both superiorly and inferiorly?
Superiorly - superficial aspect of the lower ribs
Inferiorly - iliac creast and public tubercle
79
The external oblique muscles blend into what?
A flat tendon called an aponeurosis
80
What is the point at which the muscle fibres end and the aponeurosis begins called?
Linea semilunaris
81
When two aponeuroses meet as with the right and left external oblique muscles, what is the point at which they (aponeuroses) meet called?
Linea alba
82
The linea alba for the external oblique muscles is located on the _________ surface of the body
Anterior
83
In which direction do the muscle fibres from the internal oblique muscles run?
In the same direction as the internal intercostal muscles
84
Where does the internal oblique muscle attach both superiorly and inferiorly?
Superiorly - lower border - inferior part - of lower ribs
Inferiorly - iliac crest and thoracolumbar facia
85
Where do the aponeuroses for the internal oblique muscles come together?
The anterior side of the body at the linea alba
86
In which direction do the muscle fibres in the transversus abdominus travel?
In the axial plane
87
Where are the attachments for the transversus abdominus?
Superiorly - Distal aspects of lower ribs
Inferiorly - Iliac crest and thoracolumbar fascia
88
What is the rectus sheath?
An encapsulation of the rectus abdomus muscles formed from the aponeuroses of the external and internal oblique muscles and the transversus abdominus
89
What is unique about the internal oblique aponeurosis in relationto the rectus abdominus?
The aponeurosis splits in half, with one half going posterior to the rectus abdominus and one half going anterior to it
90
Thoracoabdominal nerves are extensions of what nerves?
Intercostal nerves
91
Why do the 7th to 11th intercostal nerves terminate early?
Their associated ribs do not join in the midline
92
The intercostal nerves (7-11) terminate early since the ribs associated do not join in the midline - but what happens to the intercostal nerves from there?
They become thoracoabdominal nerves and remain between the internal oblique and transversus abdominus
93
After leaving the intercostal space, what does the T12 intercostal nerve become?
The subcostal nerve
Supplies the lower abdomen
94
Which nerve(s) originate from the L1 anterior ramus?
Iliohypogastric nerve
Ilioinguinal nerve
95
The anterolateral abdominal wall muscles have many functions including what?
* Maintaining posture
* Supporting vertebral column
* Help flex the vertebral column for movement
* Guarding - protect organs
* Contract to increase intraabdominal pressure for defecation, micturition, labour and forced expiration
96
Build up of air trapped in alveoli due to a chronic cough can cause what?
Rupture of the pleura leading to pneumothorax
97
During a pneumothorax, why does the lung collapse?
The vacuum of the pleural space is lost and this can no longer hold the lung in position due to the surface tension
The lung tissue recoils due to its elastic nature
98
What is the classification of a large pneumothorax?
A gap of greater than 2cm results between the lung and the parietal pleura.
(A small pneumothorax is when this gap is less than 2cm)
99
On examination, what signs may lead to a diagnosis of pneumothorax?
* Reduced ipsilateral chest expansion
* Reduced ipsilateral breath sounds due to absence of lung tissue
* Hyper-resonance - due to absence of lung tissue and increased air space
* Deviated trachea
100
On a chest X-Ray, how may a pnemothorax present?
* Absent lung marking around the peripheries
* The lung edge is visible
101
What four sections is the mediastinum split into?
1. Anterior
2. Posterior
3. Superior
4. Middle - houses the heart
102
Which section of the mediastinum houses the heart?
Middle
103
At which anatomical landmark does the middle mediastinum become the superior mediastinum?
At the level of the sternal angle
104
What can cause mediastinal shift and what are some of the consequences?
Tension pneumothorax
* Tracheal deviation
* SVC compression
* Hypotension - recduced venous return
105
What can be done to allow excess air out of the pleural cavity (during a pneumothorax for example)
Needle aspiration
Thoracentesis
106
Where may be an appropriate location for a chest drain in pneumothorax management?
The middle of the 4th or 5th intercostal space in the midaxillary line
107
Why is a chest drain inserted in the middle of an intercostal space?
To avoid the neurovascualr bundles superiorly and inferiorly
108
What is the "safety triangle" in releation to pneumothorax management?
An area where a chest drain can be inserted, or needle aspiration can occur
There are no organs to puncture in this area
It is composed of three points:
1. Anterior border of the latissimus dorsi
2. Posterior border of the pectoralis major
3. Axial line superior to the nipple
109
To release air in an emergency during a tension pneumothorax, where is a large gage cannula inserted?
The pleural cavity at the 2nd/3rd intercostal space in the mid-clavicular line
This is at the level of rb 2 at the sternal angle
110
What is a hernia?
When any body structure passes through another to end up in an incorrect location, a hernia is formed
111
To develop a hernia, two factors must be present, what are these?
1. Weakness of one structure
2. Increased pressure on one side of the weak body wall
112
What are the two main types of oesophageal hernia?
1. Paraoesophageal hiatus hernia
2. Sliding hiatus hernia
113
What is the point at which the oesophagus becomes the stomach?
The gastro oesophageal junction
114
How do sliding hiatus herniae differ from paraoesophageal hiatus herniae?
* Sliding - whole stomach moves, gastro oesophageal junction moves
* Paraoesophageal - portion of the stomach herniates out, gastro oesophageal junction remains in the correct location
115
Where is the inguinal region?
The region found between the anterior superior iliac spines and the pubic tubercles
116
What are the inguinal ligaments formed from?
The inferior boder of the external oblique aponeuroses
117
The medial halves of the inguinal ligaments form what in the inguinal canals?
The floor
118
Inguinal canals form channels between _____ and ____________ \_\_\_\_\_\_\_\_\_.
Deep
Superficial structures
119
What and where are the two openings in the inguinal canals?
1. The deep ring - intra-abdominal - midpoint of the inguinal ligament
2. The superficial ring - superficial - V-shaped part of the external oblique aponeurosis lying superolateral to the pubic tubercle
120
In relation to herniation, what does the inguinal canal allow for?
Abdominal structures can herniate through the canal and move to more superficial areas
121
How is the inguinal canal formed?
During embryonic development
Descent of either the testes or round ligament of the uterus
122
In an adult, what does the inguinal canal contain?
Spermatic cord or round ligament of the uterus
123
During the descent of the testis, which tissues are passed through/by?
(not necessarily brought with the testis during descent)
* Processus vaginalis (part of peritoneum)
* Transversalis fascia
* Transversus abdominus - passes lower border does NOT pass thorough
* Internal oblique
* External oblique aponeurosis
* Deep fascia
* Superficial fascia
**_P_**rofessor **_T_**este **_TIED_** his **_S_**crotum
124
During the descent of the testes which tissues are brought with the testis?
1. Transversalis fascia - becomes internal spermatic fascia
2. Internal oblique muscle - cremasteric fascia
3. External oblique aponeurosis - external spermatic fascia
4. Processus vaginalis - tunica vaginalis
125
How is the internal spermatic fascia formed?
When the testis passes through the transversalis fascia and brings a portion with it
126
How is the cremasteric fascia on the testes formed?
When the testes pass by the inferior border of the internal oblique muscle and drag a portion with them
127
How is the external spermatic fascia formed?
When the testis passes through the superficial ring of the external oblique aponeurosis and brings some of the fascia with it
128
What is the spermatic cord composed of?
1. Three layers of fascia (internal (transversalis fascia), cremasteric (internal oblique), external (external oblique aponeurosis))
2. Testicular artery
3. Testicular vein (pampiniform venous plexus)
4. Vas deferens
129
What is the function of the vas deferens?
To transport sperm
130
What is the tunica vaginalis?
This forms when the processus vaginalis loses direct contact with the testis
It still remains in the scrotum
