BRS anatomy review Flashcards
locate apex of heart? blood supply?
left fifth intercostal
anterior intraventricular arter
expiration achieved by what muscle?
elastic tissue in lungs and thoracic wall
what kind of fibers do greater splanchnic nerves have
GVA and preganglionic sympathetic GVE
General visceral afferent and pre-gangl - sympthatic efferent
white rami communicantes severed at 6th thoracic - degen of what nerve bodies?
preganglionic sympathetic (which I undestand) from lateral grey horn -
and - don’t understand - dorsal root ganglion
Posterior anterior chest x ray - what part of heart do you see mostly?
right ventricle (sternocostal surface main structure)
Because looking at xray as if at front of patient
Posterior-Anterior (PA) projection
The standard chest radiograph is acquired with the patient standing up, and with the X-ray beam passing through the patient from Posterior to Anterior (PA). The chest X-ray image produced is viewed as if looking at the patient from the front, face-to-face.
atrial septum defect?
failure of foramen ovale to close
pacemaker of heart?
SA node
circumflex branch of left coronary artery supplies?
posterior left ventricle
laceration of phrenic (right)
loss of sensation of pericardium and mediastinal pleura - important for INHALATION - not for exhalation
drainage of cardiac veins into heart?
anterior cardiac drains to right atrium,
middle small oblique into coronary sinus,
right and left pulmonary into left atrium
lack of blood to left ventricle? - thrombosis in circumflex branch of left coronary artery
mitral valve insufficiency
cardiac notch?
near superior lobe of left lung
thoracentesis?
7 - 9 ribs - to aspirate pleural effusion
occlusion of descending thoracic aorta?
lower six intercostal arteries affected
which lung has a middle lobe?
right- it has a groove for the horizontal fissure, SVC, and larger capacity than left
which lung has a lingula?
LEFT - tongue shaped, left lung upper lobe
major muscles of expiration?
abdominal
posterior mediastium - what’s there?
descending aorta
hemiazyogos vein -
Posterior Mediastinum:
Organs: esophagus.
Arteries: descending thoracic aorta.
Veins and lymphatics: azygos hemiazygos veins, thoracic duct.
Nerves: vagus, splanchnic, sympathetic chain
what’s in superior mediastum?
bracheocephalic veins, trachea, arch of aorta,
Superior Mediastinum:
Organs: thymus, trachea, esophagus.
Arteries: aortic arch, brachiocephalic trunk, left common carotid artery, left subclavian artery.
Veins and lymphatics: superior vena cava, brachiocephalic veins, the arch of the azygos, thoracic duct.
middle mediastium
arch of azygos
heart, pericardium, great vessels, trachea, bronchi, esophagus, and lymph nodes. Esophageal tumors, tracheal tumors, and lymph nodes are typically located in this compartment. The posterior mediastinum contains autonomic nerves, vessels, and lymph nodes.
tumor superior to root of right lung?
arch of azygus vein
lacerate right vagus nerve near recurrent laryngeal?
parasymp nerve fibers will affect bronchial lumen, bronchial smooth muscles decrease heart rate etc - also affect pain, cough reflex and stretch of lung during inspiration
cystic fibrosis in child blocks which lung structures?
terminal brochioles (and alveolar ducts) viscose mucus - larger ducts not so affected
left primary bronchus is?
longer than right - right receives more foreign bodies, shorter, larger diameter
venous drainage of right third intercostal spaces ?
superior intercostal vein - to azygos on right, and brachiocephalic on left
Cardiac silhouette
right border is SVC
ascending aorta would be seen in middle of heart
refers to the outline of the heart as seen on frontal and lateral chest radiographs and forms part of the cardiomediastinal contour. The size and shape of the cardiac silhouette provide useful clues for underlying disease.
systole, dystole?
systole: contraction of the ventricles of the heart aortic and pulmonic valves open
dystole? mitral and tricuspid valves are OPEN to fill
sternal angle?
Bifurcation of the Trachea.
Boundary between the superior and inferior portion of the mediastinum. Passage of the thoracic duct from right to left behind esophagus Aortic Arch.
third rib articulates w?
body of sternum, body of second thoracic vertebra, transverse process of third thoracic vertebra
to aspirate pericardial fluid - insert needle?
left fifth intercostal space
first heart sound?
The “ lub” is the first heart sound, commonly termed S1, and is caused by turbulence caused by the closure of mitral and tricuspid valves at the start of systole. The second sound,” dub” or S2, is caused by the closure of aortic and pulmonic valves, marking the end of systole.
tricuspid and mitral valves close
Valves of the Heart
Toilet Paper My Ass
tricuspid
pulmonary
mitral
atrial
The right atrioventricular valve is the tricuspid valve. The left atrioventricular valve is the bicuspid, or mitral, valve. The valve between the right ventricle and pulmonary trunk is the pulmonary semilunar valve. The valve between the left ventricle and the aorta is the aortic semilunar valve.
chordae tendinae?
colloquially known as the heart strings, are tendon-resembling fibrous cords of connective tissue that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart.
Patent ductus arteriosus
(PDA) is a persistent opening between the two major blood vessels leading from the heart. The opening, called the ductus arteriosus, is a normal part of a baby’s circulatory system before birth that usually closes shortly after birth.
Tracheoesophageal fistula
what structure in fetus closes these two structure correctly
Tracheoesophageal septum formed by fusion of Tracheoesophageal folds in midline
is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs).
what structures branches into the bronchial arteries?
descending thoracic aorta
hirschsprung disease - megacolon - what nerve?
parasympathetic postganglionic - absense of enteric ganglia - NC
round ligament of liver?
left umbilical vein
excruciating peritonial pain from lesser sac - what nerve carries?
lower intercostal nerves
intercostal nerves?
run from spine - ventral rami become the intercostal nerve - running between innermost and intercostal muscles -
under rib in groove w/ artery
branch two
Lateral cutaneous branch and Anterior cutaneous branch
intercostal arteries?
internal thoracic arteries also called internal mammmary arteries (supply breasts of men and women)
posterior intercostal also supply some branches to back
2 sets - one from aorta - posterior intercostal - - branching to lateral cutaneous
posterior anastamoses with anterior intercostal artery that comes from internal thoracic artery decending down -from subclavian in intercostal muscles - betwe transversus thoracis mus and?
cremasterie muscle?
genitofemoral nerve
shunt around portal system?
splenic vein to left renal to IVC
supra renal gland arteries?
aorta, inferior phrenic, renal
gastrosplenic ligament (ligamentum gastrosplenicum or gastrolienal ligament)
is part of the greater omentum. Embryonically the gastrosplenic ligament is derived from the dorsal mesogastrium. The gastrosplenic ligament is made of peritoneum that connects the greater curvature of stomach with the hilum of the spleen.
inferior pancreaticoduodenal artery?
SMA - anastamose with celiac artery branches
during apendectomy at mcburney’s point - what structure is most likely to be injured?
iliohypogastric nerve
jejuenum vs ilium?
jejeunum - fewer mesenteric arterial arcade - more and taller plicae circulares - less fat (more digestion occurs here)
right colic vein?
part of portal system - SMA
retriperitoneal infection?
could be the dorsal pancreatic artery - (it is retroperitoneal
remnant of fetal ARTERY?
medial umbilical fold -
mediAN umbilical fold - urachus remnant
lateral umbilical fold (ligament) inferioror epigastic artery and vein which are adult vessels
ligamentum venosum - fibrous remnant of umbilical VEIN
scrotal lymph? “S” scrotum, skin penis, shit (anal cavity lower) - all go to SUPERFICIAL
superficial inguinal - from scrotum, penis, buttocks and lower part of anal canal
deep inguinal lymph?
upper part of vagina, anal canal to external iliac nodes
The lymphatic drainage of the prostate primarily
drains to the obturator and the internal iliac lymphatic channels. There is also lymphatic communication with the external iliac, presacral, and the para-aortic lymph nodes.
ovarian lymph?
The para-aortic nodes, also known as the lumbar aortic nodes, drain lymph from the kidneys, suprarenal glands, testes, ovaries, uterus, and uterine tubes.
appendectomy - ligate what artery?
iliocolic artery - be careful of…iliohypogastric nerve!!
severe pain from stomach - what nerve carries this terrible message?
greater splanchnic -
vagus only reflex = no pain
lower intercostal carries pain but not from stomach but from diaphragm, abdom wall and peritneum
processes vaginalis persists?
hydrocele
porta hepatis? doorway into liver
doorway- contains hepatic ducts, arteries, and branches of portal vein
The porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures (except hepatic veins) and hepatic ducts enter or leave the liver
The epiploic foramen (also called the foramen of Winslow)
is a passage between the greater sac (peritoneal cavity proper) and the lesser sac (omental bursa), allowing communication between these two spaces.
What is contained in the Hepatoduodenal ligament?
The hepatoduodenal ligament is the distal portion of the lesser omentum, that connects the liver to the cranial part of duodenum. It forms the free right border of the lesser omentum and the ventral boundary of the epiploic foramen. It contains the portal vein, hepatic artery and bile duct.
meckle’s diverticulum is remnant of ? vitalline
yolk stalk - rule of 2s
2 feet proximal to iliocecal junction
growing tumor of uncinate process compresses?
SMA
direct hernia?
develops after birth
pituitary?
near cavernous sinus - behind and above it sphenoid sinus
number of sinuses? four pairs
There are four paired sinuses – named according to the bone in which they are located – maxillary, frontal, sphenoid and ethmoid.
The mucus from the sinuses drains into your nasal passages and then down the back of your throat to be swallowed.
number of dural venous sinuses?
11 -
Anterior
Sphenoparietal sinuses
Cavernous sinuses
Superior and inferior petrosal sinuses
Midline
Superior sagittal sinus Typically becomes right transverse sinus or confluence of sinuses
Inferior sagittal sinus Straight sinus
Typically becomes left transverse sinus or confluence of sinuses
Posterior
Occipital sinus
Confluence of Sinus
Right and Left transverse sinuses
Lateral Superior petrosal sinus Transverse sinuses Sigmoid sinus Inferior petrosal sinus Internal jugular vein Sigmoid sinuses
lesion of optic nerve?
blindness
if pituitary tumor large enough?
bitemporal hemianopia
partial blindness where vision is missing in the outer half of both the right and left visual field. It is usually associated with lesions of the optic chiasm, the area where the optic nerves from the right and left eyes CROSS near the pituitary gland.
binasal hemianopia - vision is missing in the inner half of both the right and left visual field.
bilateral atherosclerosis or aneurysms of the internal carotid arteries simultaneously compressing the adjacent NON‐CROSS fibres of both optic nerves.
abduct vocal cords
posterior cricoarytenoid - only muscle that does this - all other ADDUCT
The posterior cricoarytenoid muscles are the only muscles to open the vocal cords. By rotating the arytenoid cartilages laterally, these muscles abduct the vocal cords and thereby open the rima glottidis. Their action opposes the lateral cricoarytenoid muscles.
Intrinsic and extrinsic muscle of larynx?
Cricothyroid muscle lengthen and tense the vocal folds.
The intrinsic laryngeal muscles are responsible for controlling sound production.
Cricothyroid muscle lengthen and tense the vocal folds.
Posterior cricoarytenoid muscles abduct and externally rotate the arytenoid cartilages, resulting in abducted vocal folds.
Extrinsic The extrinsic muscles act to move the larynx superiorly and inferiorly. They are comprised of the suprahyoid and infrahyoid groups, and the stylopharyngeus (a muscle of the pharynx). The supra- and infrahyoid muscle groups attach to the hyoid bone.
What is the main function of the pharynx?
It is commonly referred to as the throat. The pharynx is part of both the digestive and respiratory systems. For the digestive system, its muscular walls function in the process of swallowing, and it serves as a pathway for the movement of food from the mouth to the esophagus.
cricopharygeaus act as a sphincter - preventing air from entering esophogus
is a semi-circular muscle located in the neck about three inches below the Adam’s apple. To prevent the reflux of foods from the esophagus into the throat, the cricopharyngeus remains contracted and tight at most times.
The oblique arytenoid muscle and aryepiglottic muscle?
prevent food from entering larynx
Great cerebral vein of galen is direct tributary of?
dural venous sinus
parasymptethic to eye?
pupil constricts, ciliary m contracts = accommodation THICKER LENS – enhanced vision for near objects
tympanic nerve branch of?
continues to lesser petrosal - with symphatheitc = to OTIC ganglion for synapse
glosspharyngeal -
Jacobson’s nerve is a tympanic branch of the glossopharyngeal nerve, arising from its inferior ganglion. It enters the middle ear cavity through the inferior tympanic canaliculus, runs in a canal on the cochlear promontory and provides the main sensory innervation to the mucosa of the mesotympanum and Eustachian tube.
otic ganglion?
glossopharyngeal nerve and innervates the parotid gland for salivation.
Parotid POTIC/D
The otic ganglion below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. It is functionally associated with the glossopharyngeal nerve and innervates the parotid gland for salivation.
Four parasympathetic ganglia located within the head –
the ciliary, otic, pterygopalatine and submandibular. They receive fibres from the oculomotor, facial and glossopharyngeal nerves (the vagus nerve only innervates structures in the thorax and abdomen).
Which cranial nerve carries parasympathetic fibers?
oculomotor, facial, glossopharyngeal, and vagus nerves. 5 Special somatic afferent (SSA).
Special somatic afferent fibers (SSA) 2,8 SSA
are the afferent nerve fibers that carry information from the special senses of vision, hearing and balance. The cranial nerves containing SSA fibers are the optic nerve (II) and the vestibulocochlear nerve (VIII).
special visceral efferents.
Acronym: SVE. The term special visceral efferents (SVE) refers to nerve fibers that innervate the voluntary striated muscles of the larynx and pharynx and the muscles of facial expression and mastication.
dura in cranium - which CN innervate?
V (mid brain) - v2 and v3
v1 - anterior
X and XII (via C1) - posterior
carotid sinus? S = Stretch
stretch - at internal carotid IX
fracture optic canal ? enter orbit thru SOF
can
opthalamic artery and optic nerve
ENTER orbit thru SOF
The superior orbital fissure is the largest opening that connects the orbit with the middle cranial fossa. [1] The optic canal connects the orbit to the middle cranial fossa and transmits the optic nerve, ophthalmic artery, meningeal sheaths, and sympathetic nerve fibers
digastric posterior belly? VII
elevates hyoid bone
anterior? V
these can affect speech
The stylopharyngeus muscle - innervation - (CN IX)
act as a significant dilating muscle of the nasopharynx. During breathing, the contraction of this muscle pulls the nasopharyngeal wall dorsally. This action prevents the dynamic collapse of the dorsal wall of the nasopharynx by supporting the wall during inspiration
What do the pharyngeal muscles do? V Vagus - except sylophyngeus
Pharyngeal muscles. The pharyngeal muscles are a group of muscles that form the pharynx, which is posterior to the oral cavity, determining the shape of its lumen, and affecting its sound properties as the primary resonating cavity. The pharyngeal muscles (involuntary skeletal) pushing the food into the esophagus.
tensor tympani muscle V
connects to the malleus bone. Its role is to dampen loud sounds, such as those produced from chewing, shouting, or thunder.
stapideus? VII
The stapedius is the smallest skeletal muscle in the human body. At just over one millimeter in length, its purpose is to stabilize the smallest bone in the body, the stapes.
pupil doesn’t get larger even when light dims?
superior cervical ganglion damage SYMPATHETIC problem
The pupillary light reflex
neural pathway on each side has an afferent limb and two efferent limbs. The afferent limb has nerve fibers running within the optic nerve (CN II). Each efferent limb has nerve fibers running along the oculomotor nerve (CN III). The afferent limb carries sensory input.
common tendinous ring?
The tendinous ring, also known as the annulus of Zinn, is the common origin of the four rectus muscles (extraocular muscles). The tendinous ring straddles the superior orbital fissure and through it (from superior to inferior) pass: superior division of the oculomotor nerve (CN III)
The annulus of Zinn, also known as the annular tendon or common tendinous ring, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit. It is the common origin of the four rectus muscles (extraocular muscles). … Superior division of the oculomotor nerve (CNIII)
Which structure passes through the tendinous ring of the orbit?
The optic canal and adjacent part of the fissure are surrounded by the common tendinous ring, from which the four recti arise. The lacrimal, frontal, and trochlear nerves enter the orbit above the ring. The superior and inferior ophthalmic veins leave the orbit usually above and below the ring, respectively.
part of v1? lacrimal, frontal and nasociliary
lacrimal, frontal and nasociliary branches of ophthalmic (V1).
After leaving the cavernous sinus, the ophthalmic nerve goes through the superior orbital fissure, where it is usually already divided into its three terminal branches:
Lacrimal nerve.
Frontal nerve.
Nasociliary nerve.
cranial nerves near styloid process
VII, IX, XII
Significant vessels and nerves surround the styloid process. The internal jugular vein, internal carotid artery, and glossopharyngeal nerve (CN IX), vagus nerve (CN X), and accessory nerve (CN XI) lie medial to the styloid process. The occipital artery and hypoglossal nerve (CN XII) run along its lateral side
lesion of vagus causes deviation to uvula?
hoarseness?
on opposite side
damage to recurrent laryngeal of vagus
front and isthmus of thyroid gland associated with
inferior thyroid vein
numbness in anterior cervical triangle?
transverse cervical nerve
The transverse cervical nerve is also formed by fibres from C2 and C3. It curves around the posterior aspect of the sternocleidomastoid, and supplies sensation to the anterior neck.
phrenic nerve may be there too - but doesn’t have cutaneous fibers
The cervical plexus
is a plexus of the anterior rami of the first four cervical spinal nerves which arise from C1 to C4 cervical segment in the neck. They are located laterally to the transverse processes between prevertebral muscles from the medial side and vertebra
What are the branches of cervical plexus?
Its branches consist of a superficial and deep set. The superficial branches are the great auricular nerve, lesser occipital nerve, transverse cervical, suprasternal, and supraclavicular nerves. The deep branches are the phrenic, communicantes cervicales, communicating, and muscular.
Nerves formed from the cervical plexus innervate
the back of the head, as well as some neck muscles. The branches of the cervical plexus emerge from the posterior triangle at the nerve point, a point that lies midway on the posterior border of the sternocleidomastoid
.
What muscles does the cervical plexus innervate?
Located in the posterior triangle of the neck, halfway up the sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.
C1-C2: Rectus capitis anterior and lateralis. C1-C3: Longus capitis. C2-C3: Prevertebral muscles and sternocleidomastoid. C3-C4: Levator scapulae, trapezius and scalenus medius.
The cervical plexus is a network of nerve fibres that supplies innervation to some of the structures in the neck and trunk. It is located in the posterior triangle of the neck, halfway up the sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.
cervical fascia I PT2 PV
cervical plexus in PV
By this classification system, the deep cervical fascia of the neck can subdivide into the investing layer, pretracheal and prevertebral layers, also known as the external, middle and deep layers respectively. The pretracheal, or middle layer, can be further subdivided into the muscular and visceral divisions
superior nasal meatus drains?
posterior ethmoidal sinus
what drains into middle nasal meatus - a lot
The middle meatus is an air passage of the lateral nasal cavity located between the middle nasal concha and lateral nasal wall. The anterior ethmoid air cells, maxillary and frontal sinuses all drain into the middle meatus.
VI run thru what?
cavernous sinus
crichoid ligament at same level as?
inferior laryngeal nerves
severed III nerve?
paralysis of ciliary muscle - and sphincter pupillae
what carries sympathetic fibers to eye ? NOT on III
Many of the fibers destined for the eye form the sympathetic root of the ciliary ganglion, which runs along with the ophthalmic artery to enter the orbit. These fibers then traverse the ciliary ganglion to enter the eye via the short ciliary nerves
The pharyngeal arches (branchial arch,
are a series of externally visible anterior tissue bands lying under the early brain that give rise to the structures of the head and neck.
what innervates the stylopharngeus?
GLOSSOpharangeus XII
nose punch, nasal septum broken, what is damaged?
vomer and perpendicular plate of ethmoid
what goes thru internal auditory meatus?
VII and VIII
what goes thru foramen lacerum?
triangular hole in the base of skull located between the sphenoid, apex of petrous temporal and basilar part of occipital. It is the juncture of the petroclival, sphenopetrosal, and pterygosphenoidal sutures.
nothing = the greater petrosal nerve passes medially to enter the foramen lacerum and fuses there with the deep petrosal nerve, forming the Vidian nerve or pterygoid nerve, which passes from the pterygoid canal to the pterygopalatine fossa
carotid sheath?
internal jug, vagus, internal and common carotid NOT sympathetic (w/ superior and middle cervical ganglia)
costocervical trunk gives rise to
deep cervical and superior intercosta
eye reflex blink carried by? v and VII
nasociliary V1- afferent, efferent VII
what lies in wall of cavernous sinus?
The cavernous sinus is a blood space containing endothelium, trabeculae, and ligaments. Each cavernous sinus contains the internal carotid artery (and sympathetic plexus), oculomotor nerve, trochlear nerve, abducens nerve, and the V1 and V2 branches of the trigeminal nerve. NOT the MANDIBULAR
adenoid? aka pharangeal tonsil
a mass of enlarged lymphatic tissue between the back of the nose and the throat, often hindering speaking and breathing in young children.
Greater petrosal nerve
Lacrimal gland. Oral mucosa
The deep petrosal nerve innervates the blood vessels and secretomotor aspects of the. Lacrimal gland. Oral mucosa
lesser petrosal?
paratoid
needle cricothyrotomy - open into
infraglottic cavity
what nerves are involved in swallowing?
many - 5, 7, IX, X
what opens the eye? orbicularis oculi or leavator palpebrae superiororis
levator - oculi closes
