Anatomy thorax and neck S1-8 Flashcards
What is the upper border of the thorax?
The clavicle
What are the articular surfaces of the clavicle?
the acromium process of the scapular and the sternum
What are the areas of the sternum?
The manubrium, body and xiphoid process
What is the name for the angle between the body and manubrium sternum?
Angle of louis
What is the marking of the angle of louis?
The 2nd costal cartilage
What way are intercostal spaces named?
the 2nd spaces is below the 2nd rib
What are the vertical ways to split the thorax?
The midline, mid-clavicular line anterior axillary, mid axillary line and posterior axillary line.
What is the insertion of the pectoralis major?
The humerus
What is the origin of the pectoralis major?
the medila 2 thirds of the clavicle and the sternum
What are the three compartments of the thorax?
The mediastinum and the left and right pleural cavities
What is the upper extend ot the pleural cavities?
Above the first rib
How many thoracic vertebrae are there?
12
How many cervical vertebrae are there?
7
How many ribs are there?
12
How many layers of intercostal muscle are there?
3
What is material connects the ribs to the strernum?
costal cartilage
How many articulations do the ribs have?
3
What are the articulations of the rib?
head articulates with body of vertebra and the one above the tip with the costal cartilage. some with the transverse process of the rib as well
Which ribs articulate with the costal cartilage to the sterunm?
1-7
Which ribs do not direcly articulate with the sternum?
8-10
what are floating ribs
Ribs 11 and 12 only articulate with the spine
Which structures pass through the superior thoracic aperture?
the subclavian artery also brachiocephalic trunk and veins internal jugular vein common carotid artery, oesophagus and trachea also phrenic and vagus nerves plus others
What is the superior thoracic aperture?
ring around superior aspect of the first rib and the T1 vertbral body and superior margin of the the manubrium sternum
What is the path of structures destined for the upper limb?
over the first rib
What passes through the inferior thoracic apeture?
oesophagus and vagus nerve and descending aorta
What is the inferior thoracic aperture?
body of the 12th vertebra rib 12 and distal end of 11 te cartilage of 10 to 8th ribs and ten and the xiphoid process
Which dome of the diaphragm is higher?
The right
How high can the right dome of the diaphragm get
To the 5th rib
What structures penetrate the diaphragm?
The oesophagus, inferior vena cava, the aorta passes posteriorly
What splits the mediastinum into inferior and superior areas?
the sternal angle
What defines the anterior middle and posterior areas of the mediastinum?
the pericardium
What passes through the root of the lung?
Lymphatics pulmonary veins and artery and the airways
What is the most clinically significant recess of the lungs?
the costodiapragmatic recess which is inferior between the thoracic wall and the diaphragm
Which is anterior the trachea or oesphagus?
The trachea
What is the axillary inlet?
they allow structurs from the superior thoracic inlet into the upper limb
What forms the axillary inlet?
the superior margin of the scapula the clavival and the lateral margin of the first rib
How does the IVCpass through the diaphram?
through the central tendo of the diaphram at the vertebral level of T8
How does the oesophagus pass though the diaphram?
It passes throug the muscular area of the diaphram to the left of the midline at the T10 level
How does the aorta pass the diaphragm?
posteriorly at the level of T12
What does the breast tissue consist of?
Secretory glands, superficial fasia, and overlying skin
Where do the lymphatics of the breast arise from?
for lateral parts it is the axillary region for the other it is tje thoracic ones
What level is te sternal plane?
T4/5
What happens at T4/5?
Sternal angle, 2nd rib anteriorly, separation of mediastinum, marks the aorta arch, passes the superior vena cava where it penetrates the pericardium the trachea bifurcates and the superior limit of the pulmonary trunk
What is the left right shunt in the thorax?
The left brachiocephalic vein crossing to join the right brachiocephalic forming the superior vena cava.
There are also the emiasagos and acessory(superior) veins which drain the thorax from the neurovasuclar bundles beneath the ribs. the flow into the azygous on the right and into the SVC
Which vessels supply the rib area?
The intercostal vessels from the aorta that run under the ribs. there are also the internal thoracic arteries which come from the subclavian arteries.
which dermatmes are in the thorax?
C4 C5 above clavicle, the T2 to T9 which roughly follow the levesl of the ribs
What are some dermotome landmarks?
T4 nipples, T10 umbilicus
Where are the sympathetic chain roots?
T1-L2 anterior rami
What is the innervation of the diaphragm?
C345 the phrenic nerve
What are the some muscles that attach to the ribs?
levator costarum serratus posterior superior and serratus posterior inferior. also internal innermost and external intercostal muscles
Which intercostal muscles are most active during inspiration?
external
Which intercostal muscles are most active during expiration?
internal and innermost
Which direction do the internal intercostal muscles go?
up and out
Which direction do the external intercostal muscles run?
down and in
What is the drainage of the breast lymphatics?
most of the tissue which is in the upper outer quadrant of the breast drains to axilliary lymph nodes
Which costal cartilage is next to the angle of louis?
second costal cartilage
What forms the anterior axillary fold?
The lower edge of the pectoralis major muscle
What is the origin of sarratus anterior?
upper 8 ribs
What is the insertion of the scapula?
medial border of the scapular
What is the clinical importance of the left cephalic vein?
It is used for passing wires into the heart and for pacemakers
What is the internal mammary artery/ internal thoracic?
A vertical artery that supplies the ribs and the diaphragm
Where is the lung connected to the mediastinum?
At the of the lung
Which nerves carry sensation from the parietal and visceral pleura?
The parietal pleaura is supplied by the same nerves as the thoracic tissue, spinal nerves t1-t12 the visceral is innervated by the vagus and sympathetic
What is a bronchopulmonary segment?
it has a feeding artery broncus and run tot he centre of the segment and branch to supply an area there are ten segments or each side they are anatomically separate
What are the structures at the hilum of the lung?
Main bronchus pulmonary artery two pulmonary veins bronchial artery lymphatic vessels braches of the vagus and sympathetic nerves
how do the lungs help with the return of blood?
During inspiration the pressure in the thorax drops and this aids with blood return to the heart
What is the sensory supply to the diaphragm?
The phrenic nerve C345 roots
What are the surface markings of the lungs?
Lowest from midclavicular th rib tip, mid axillary 8th tip, posteriorly 10th rib
What are the margins of the pleura?
They are 2 ribs lower than the lungs, midclavicular 8th, midaxillary 10th posterior 12th rib.
What is intercostal recession?
when a patient is having difficulty taking a breath and have to create a very negative pressure in the thorax and the intercostal muscles get sucked in
What are the surfaced of the lung?
Costal diaphragmatic and mediatinal
Where is the best to listen to left upper lobe?
Most places on the front on the left
Where is the best place to listen to the left lower lobe?
The axillary line lower down or anywhere on the lower posterior thorax
Where is the best place to listen to the right upper lobe?
The top anterior thorax
where is the best place to listen to the right middle/ linguillar lobe?
The lower anterior medial area
Where is the best place to listen to the right lower lobe?
Most places other than superiorly on the posterior thorax
where is the origin of the phrenic nerve?
Anterior Rami of C3-C5 nerve roots
Where does the coracoid process of the scapula project?
Anteriorly
Where does the acromium of the scapula project?
Laterally
What happens when you move medially to the intercostal muscles?
They become a membrane especially external intercostal
Where do the nerurovasular bundles go?
They go under the rib above it and very close
Which is above the pulomnary artery or vein?
the veins are lower
Where does the phrenic nerve go with respect to the hilum?
deep to pleura and anterior to the hilum of the lung.
Where does the phrenic nerve pass through the diaphragm?
With the IVC on the right, on the left
Where does the azygous vein enter the main vein?
in th vena cava above the heart
What is the path of the phrenic nerve on the left?
it passes anterior to the hilum of the lung
Where does the vagus nerve pass with respect to the hilum?
posterior to the hilum of the lung gives off recurrent laryngeal nerve under the arch of the aorta on the left
What is the ligumentum arteriousis?
It is a remnant of the ductus arteriousis a shunt from the pulmonary artery to the aorta the redcurrant goes under this
Where is the definition of the superior mediastinum?
first rib and T4
Where is the inferior mediastium?
T4 to T9
what is the bulge that marks the Sulcus terminalis crastae terminalis?
Where vagus and sympathetic nerves contact the SAN
Where should you listen to the apex beat of the heart?
5th intercostal space in the left midclavicular
Where should you listen to the aorta?
2nd intercostal space just to edge of sternum
What are subcostales?
Muscles running vertically between ribs
where do the upper thoracic arteries come froem?
The subclavian artery
Where do most intercostal arteries come from?
the thoracic aorta
Where are the main lymph nodes in the thorax?
Axillary, subcapsular, pectoral, parasternal, intercostal and diaphragmatic lymph nodes
At what level does the IVC pass through the diaphragm?
At TVIII
At what level does the oesophagus pass through the diaphragm?
At TX
What does the vagus nerve pass through the diaphragm wiht?
The oesophagus
What level does the aorta pass the diaphragm?
At TXII
What is the musculophrenic artery?
It is a continuation of the internal thoracic which comes from the subclavian
What are pleural recesses?
areas withing the pleura that are not filled with lung
What are the fissures of the right lung?
oblique and horizontal fissure
What are the fissures of the left lung?
The oblique fissure
Where do the bronchial arteries come from?
The throacic aorta or a tributary
What is the mediastinum?
Central area of te chest between the pleural cavities
What divides the superior and inferior mediastium?
TIV/TV vertebra
What are the layers of pericardium?
The visceral pericardium and then parietal which is conneced to the fibrous pericardium
What is the innervation to the pericardium?
Vagus nerve sympathetic and phrenic. pain in the phrenic so refered pain is in the neck
What areas of the heart are facing anteriorly?
mostly the right ventricle and some of the right atrium
What is on the diphragmatic surface of the heart?
left ventricle and a small portion of the right ventricle
What is on the left pulmonary surface of the heart?
Broad ad convex with the left ventrile and some of the left atrium
What is on the right polmonary surface of the heart?
Right atrium
What is the coronary sulcus?
A groove between the atria and the vetriclse where the coronary sinus drains
What are the openings of the right atrium?
SVC and IVC and coronary sinus
What is the name of the valve between the right atrium and ventricle?
the tricuspid valve
Which direction does the tricuspid valve point in?
Anterior and medially
What are the two areas of the right atrium?
The sinus of Venae cavae and the right auricle or atrium propper
What is the sulcus terminalis?
The sulcus that marks the division between the areas of the atrium
What is the cristae terminalis?
The internal ridge made of muscle beginning at SVC down to IVC
What are the walls of the right auricle like?
Muscular pectinati which fan out from the cristae terminalis to give a rough surface
What is the surface of the sinus of venae cavae?
It is a smooth area
What other feature lies in the right atrium?
the fossa ovalis
What is the corridor out of the right atrium called?
conus arteriosis
What is the name for the rough area of the ventricle?
Trabeculae carnae
What structures do the trabeculae carnae produce?
Ridges and bridges
How many papillary muscles are there in the right ventricle?
3
What is the septomarginal trabecula?
The moderator band which is part of the right bundle
What is the function of the papillary muscles?
They stop eversion of the valves
What is the interior of the left atrium like?
It has a smooth and rough area.
What is special about the aortic valve?
It is a semilunar valve and the coronary arteries exit from just by the valve
What are the functions of the fibrous skeleton of the heart?
It supports the valves, separates the atrial and ventricular musculature.
What is the course of the right coronary artery?
starts at the right of the aorta passes anteriorly between right auricle and pulmonary trunk and then vertically in the coronary sulcuse between the right atrium and ventricle when it meets the inferior margin of the right ventricle it goes posteriorly and down the posterior interventricular septum
What are the branches of the right coronary artery?
Atrial branch that does sinu-atrial branch which passes to the posteriorly, there is the right marginal branch thatc]ontinues alon the lateral border of the heart and the posterior intervendicular sometiems
What does the right coronary artery supply?
The right atrium and ventricle the sinuatrial node ineratrual septum
What is the path of the left coronary artery?
Exits the left of the aorta, between the pulmonary trunk and and runs between the left auricle and left ventricle there are the anterior inerventricular branch and the cifcumflex branch
What does the LAD supply?
The interventricular septum, gives of diagonal branches to the heart.
What is the circumflex artery?
Goes round the back of the heart and gives the left marginal and sometimes the posterior descending artery
What does the left coronary artery supply?
left atrium, left ventricle and interventricular septum including the bundle and branches of the conducting system
What is the most important idea in the venous system of the heart?
The coronary sinus drains into the right atrium. this lies in the sulcus between the atria and the ventricles
What are the main feins of the heart?
Great middle small and posterior
Where is the great cardiac vein?
apex of heart and ascends to anterior interventricular artery and reaches the coronary sulcus, and travels around the left of the heart to the right atrium
where is the middle cardiac vein?
it travels from the apex alond the posterior interventricular sulcus towards the coronary sinus
Where is the small cardiac vein?
It begins at the anterior section of the coronary sinus betwee right and left ventricle and into the right atrium
Where is the posterior cardiac vein?
It travels from the posterior surface on the left of middle cardiac vein into the coronary sinus
Where is the sinu atrial node?
superior end of crista terminalis of the right atrium.
Where is the Atrio ventricular node?
It is near the openning of the coronart sinus it extends the impulse conduction time
What is the atrioventricular bundle?
A group of conduction fibres that run from the AVN along the lower border of the membranous part of the interventricular septum before spilting into the right and left bundle branches
What does the parasympathetic innervation of the heart do and what is it?
It slows heart rate reduces force of contraction and constricts coronary arteries which is done by the vagus nerve
What is in the superior mediastinum?
Thymus, right and left brachiocephalic veins, left superior intercostal vein, arch of the aorta, superior vena cava, trachea oesophagus,
What are the borders of the superior mediastinum?
Jugular notch, to TI vertebra, sternal angle to TV vertebra inferiorly and the pleura laterally
explain the right main arteries?
The brachicephalic trunk splits into the right subclavian and the right common carotid
Describe the left arteries around the heart?
There is the left common carotid after the brachiocephalic trunk, then also the left subclavian artery
What is the left superior intercostal vein?
It is the vein that drains directly into the left brachiocephalic vein and drains the left intercostal areas of the superior throacic vertebra
what forms the superior vena cava?
The joining of the right and left brachiocephalic veins at the level of the third costal cartilage
What vein joins the superior vena cava?
The azygous vein
What is the ligamentum arteriosis?
The remenant of the ductus arteriosis which was a foetal shunt of blood from the pulmonary artery to the aorta
What is the path of the right vagus nerve?
It passes between the brachiocephalic trunk and the brachiocephalic vein and passes posteriorly to the root of the lung and it is crossed y the azygous vein it givesthe right recurrant larengeal which goes up under the brachiocephalic trunk
What is the path of the left vagus nerve?
It passes posterior to the left brachiosephalic vein and anterior to the subclavian artery it is passing posterior to the hilum of the lung. it gives the left recurrant laryngeal nerveinder the arch of the aorta
What is the path of the right phrenic nerve?
Lateral to the vagus, passes alongside the pericardial sac and witin the fibrous oericardium and anterior to the hilum of the lung
What is the path of the left phrenic nerve?
It passes lateral to the vagus and along side the pericardial sac in the fibrous pericardium and anterior to the hilum of the lung.
What structures are in the posterior mediastinum?
oesphagus, throacic aorta and branches, azygous veins thoracic duct and lymph nodes, sympathetic trunks and throacic splanchnic nerves
Which part of the heart does the oesophagus pass?
The right atrium
What innervates the oesophagus?
Mainly the vagus nerve
What is the azygous system of veins?
It is an important anastomosis for the drainage of the throax and abdomen
Where is the azygous vein?
On the right side of the body next to the lumbar
What is the hemiazygous vein?
It is the lower vein on the left of the vertebral bodies,
what is the acessory hemiazygous vein?
The accessory hemiaxygous is superior left vein and it startes around TVIII
What is the thoracic duct?
The lymphatic drainage of the body it is into the junction of the left subclavian vessels
Which nerves arise form the thorax from the sympathetic chain?
Greater, Lesser Least splanchnic nerves
Which nerves innervate the visceral and parietal pleura?
The parietal pleura lines the inside of the thoracic wall and is supplied by the same nerves as the tissue of the thoracic wall; the spinal nerves, thoracic 1 to thoracic 12. The visceral pleura covers the surface of the lung and is supplied by the same nerves as the lung; the vagus and sympathetic nerves.
What does the external caroted do?
Supplies the side of the face and head
What does the internal carotid do?
Supplies the brain
What does the left subclavian supply?
the vertebral arteries for parts fo the brain, axillary rhe upper limb thyro-cervical for the thyroid
What does the vagus innervate?
The pharynx larynx, heart, lungs foregut and midgut
Where is the apex beat of the heart?
The 5th intercostal space on the left midclavicular line
How can the fibrous pericardium contributes to a reduction in ventricular filling?
it resists stretching, and some extra fluid can resist the filling of the heart
What happens if heart valves are incompetent?
It would allow backflow of blood in the heart
What forms the main bulk of the electrical insulation in the heart?
The fibrous rings that the heart valves are attached to
How many bundle branches are there?
2 for left 1 for right
Where does the lesser splanchnic nerve originate
T10-11
Where does the greater splanchnic nerve originate?
T5-9
What roots does the Least splancnic nerve have?
T12
Where in the body does the azygous vein drain blood?
lateral and posterior cest wall and lateral and posterior abdominal wall
How far does the sympathetic chain cover?
It covers the T1-12 and L1+2 spinal segmental nerves
What is the function of the extrisic laryngeal muscles?
They move the larynx up and down the neck and support its central posistion very important in swallowing
Where can you create an airway?
In the cricothyroid membrane
Why does the thyroid have a very good blood supply?
Iodine is present in very low concentrations in the blood so needs a high flow to collect enough
What can be compressed by the thyroid gland?
The trachea
Where are the parathyroid glands?
Ther are 4 and the are on posterior surface of the thyroid gland
why might a patient develop hypocalcaemia after thyroid surgery, why?
They could have removed the parathryroid
What is a ganglion?
The cell bodies of nerve cells
What is the name of the fused first thoracic and lower cervical sympathetic ganglia?
The stellate ganglion
What structures are supplied by the superior laryngeal nerve?
Sensation to the inside of larynx to vocal chords and the cricothyroid muscle
Which special sensation is carried in the glossopharyngeal nerve?
taste to posterior 1/3 of tongue
What is the location of the carotid sinus and what does it detect?
It is the origin of the internal carotid artery and it senses blood pressure
which structures are immediately behind the pharyngeal wall?
A thin layer of areola tissue then the cervicle bodies
Which parts of the pharynx lie below the border of the mandible?
The hypopharynx
Which structure stops liquid refluing into the back of the nose during swallowing?
The soft palate
Which nerve carries sensation for the larynx below the vocal cords?
The recurrent laryngeal nerve
Which nerve travels through the parotid gland?
The facial nerve
Where do the parotid glands secretions enter the mouth?
from the cheek adjacent to te second upper premolar
Where do the secretions of the sub mandibular gland enter the mouth?
under the tongue
Which nerve supplies the muscles of the tongue?
The hypoglossal nerve
What does the hyoid bone connect to?
The floor of the oral cavity the larynx inferiorly and the pharynx posteriorly
What are the boundaries of the anterior triangle?
anterior border of sternocleidomastoid, inferior border of the mandible, the midline of the neck
What are the borders of the posterior triangle?
Posterior border of the sternocleido mastoid, anterior border of the trapezius and the middle third of the clavicle
What are the compartments of the neck?
Carotid sheath, pretracheal, prevertebral and investing (around the others)
What lies within the carotid sheath?
Common carotid artery, internal jucular vein, vagus nerve
What are the groups of muscles in the anterior triangle of the neck?
Suprahyoid and infrahyoid
What are the suprahyoid muscles?
stylohyoid, digastric, Mylohyoid and geniohyoid
What are the infrahyoid muscles?
omohyoid, sternohyoid, thyrohyoid and sternothyroid
What is the innervation of the suprahyoids?
Most facial some trigeminal or hypoglosal
what doe the suprahyoids do?
Move the hyoid bone and aid in mouth movements
Which infrahyoid muscles have a tendinous cenral region?
Digastric and omohyoid
What is the blood supply of the thyroid?
The external carotid gives superior thyroid artery, inferior theyroid artery, from thyrocervical trunk from the first part of the subclavian artery
What branches does the external thyroid artery give off?
Superior thyroid, ascending pharyngeal artery, lingual artery, occipital, posterior auricualr artery, superficual temporal artery, maxillary artery and facial artery
What does the accessory nerve inervate?
The sternocleidomastioid and trapeziums
How many pharengeal constrictors are there?
3 superior middle and inferior
What does the superior constrictor do?
aids in swallowing and closure of nasopharynx
What does middle constrictor do?
constricts lower pharynx
What are the longditudinal muscles of the pharynx?
Stylopharengeus, salpingopharengeus, palatopharengeus
What are the lingual tonsils?
The lymphoid tissue on the tongue
What are the palatine tonisls?
They are between the palatoglossal and palatopharengeal folds,
What are the pharyngeal tonsils?q
They are adempods amd are in midline roof of nasopharynx
What are the unpaired cartilages of the larynx?
epiglottis and the cricoid and thyroid cartilage.
What are the arytenoid cartilages?
They sit on the top of the thyroid cartilage
Where are the corniculate cartilages?
They sit on the top of aretynoid
What are the cuneiform cartilages?
They are suspended
What does the vocalis muscle do?
It adjusts tension in vocal cords
What does the transverse aretenoid do horisontal inter aretenoid?
Adduction of arytenoid
What does the lateral crico arytenoid do?
Abduction of arytenoid
What is the most superficual muscle of the neck?
The platisma
What is anser cervicallis?
C1 motor nerve rout that joins hypoglosa supplies strap muscles of the neck
What is the stellate ganglion?
sympathetic ganglion in the thoracic cavity
What is the superior cervical ganglia?
the sympathetic chain for the cervivle
What are larengeal voleculae?
the small area in behind the eppiglotis forming a dint
What gives anterior 2/3 of tongue touch sensation?
Mandibular branch of trigeminal
What gives taste to anterior 2/3 tongue?
fascial nerve
Which bones produce the nasal septum?
sphenoid and ethmoid the voma posteriorly
What is access to pituitary gland?
trans sphenoidal sinus
What nerves serve the sinuses?
Upper opthalmic and lower maxillary branch of trigeminal
What makes anterior part of nose?
elastic cartilage
What is the most posterior hole into nasal sinus?
Eustatian tube that is the middle ear muscles lift the flaps
What communicates with the nasal cavity inferior to inferior conchae?
there is the tear duct at the anterior of it
What communicates with he nasal cavity inferior to the middle conchae?
Openings of frontal sinus, maxillary and the ethmoid sinus anterior to posterior
What communicates with the nasal cavity inferior to superior conchae?
ethmoid and sphenoid sinus
