Cardioresp Anatomy Flashcards
1
Q
Sternum location and its parts
A
Lies anterioly in the midline of the thoracic cage. Three pa-ts manubrium, body and xiphoid process
2
Q
Manubrium
A
Superior boarder has a notes - suprasternal (jugular notch). Articulates with clavicle at sternoclavicular joint nd first rib. Articulates with body at marubiosternal joint aka sternal angle /angle of Louis
3
Q
Body of sternum
A
Articulates with ribs 2-7 o (2nd rib with eternal angle)
4
Q
Xiphoid process
A
Inferior to one body. small and variable in shape. Seventh rib articulates with part of inferior body an superior part of xiphoid process.
5
Q
What are anterior parts of the ribs composed of?
A
Costal cartilage _ ribs articulate with them at costochondral joints
6
Q
True vs false Ribs and why
A
True ribs 1-7 I the costal cartilages articulate directly with sternum at stennocostal joints. False ribs 8-10 units and join 7th costal cartilage. Ribs 11-12 do not articulate with the sternum - “floating’
7
Q
Where do ribs articulate posteriorly
A
Articulate posteriorly with the toracic vertebrae at cast vertebral joints
8
Q
Typical us atypical ribs.
A
3-9 are typical ribs - have a head neck tubercle and body.
I-2 and 10-12 are atypical
9
Q
What nerves is the skin of the thoracic wall innovated by?
A
Spinal nerves T1 - T12 . Adermatatome is an area of skin innovated by a single spinal ne-ve.
10
Q
Spaces between ribs are inte-costal muscles, they contain:
A
Three lagers of inte-costal muscles (external, internal and inne-rmost)
And an intercostal neurovascular bundles comprising an intercostal nerve, artery and vein.
11
Q
External intercostal muscle fibre orientation
A
Antero-inferior. Contraction pulls its superior, hence most active in inspiration
12
Q
Internal intercostal fibre orientation
A
Perpendicular to external inte-costal, in postero-inferior direction. Contraction pulls ribs inferiorly so most active in expiration.
13
Q
Innermost intercostal fibre orientation.
A
Same direction as those of internal intercostal.
14
Q
Where is the endothoracic fascia?
A
Deep to innermost intercostal and superficial to parietal pleura
15
Q
where does intercostal neurovascular bundle lie
A
In the plane between internal and innermost intercostal muscles. Lies along inferior border of rib superior to the space. Lies in a shallow costal groove on deep surface of the RI’s
16
Q
What does intercostal neuromuscular bundle supply?
A
Intercostal muscles, overlying skins and underlying parietal pleura.
17
Q
Anterior and posterior intercostal arteries
A
Supply anterior and posterior parts of intercostal spaces respectively. Anterior arteries branches of internal thoracic artery (branch of subclavian artery). Posterior arteries are branches of descending aorta in the poste-ion tho-ax.
18
Q
intercostal veins.
A
Drain into internal thoracic vein and posterior intercostal veins drain into azygous
19
Q
What is the pleura?
A
Two layers of membranes covering lungs and structures passing into and out of them (blood vessels + main bronchi)
,parietal pleura lines inside of thorax
Visce-al pleura covers surface of lungs and extends into the fissures
A thin pleural cavity lies between parietal and visceral pleura.
20
Q
Parts of the parietal pleura
A
Cervical-covers apex of lung
Costal - lies adjacent
Mediastinal-lies adjacent to the heart
Diaphragmatic - lies adjacent to the Diaphragm
21
Q
What is the costodiaphragmatic recess
A
A ‘gutter’ around periphery of the diaphragms where costal pleura becomes continuous with diaphragmatic. A smaller costomediastinal recess lies in junction of costal and mediastinal pleura. These ape potential spaces that the lungs expand into during deep inspiration
22
Q
Innovation of the parietal pleura
A
Intercostal nerves that innovate one overlying skin of the chest wall. Somatic sensory fibres in these nerves carry sensation to our consciousness. Injury to parietal pleura is typically very painful
23
Q
Innovation of the visceral pleura
A
Autonomic sensory ne-ues (visceral afferents). Usually does not reach ou-conscious perception.
24
Q
Most superior part of the lung
A
Apex (projects into the roof of the neck above the clavicle
25
Lobes of the right lung
Three lobes - superior, middle and inferior
26
Lobes of the left lung.
Superior and inferior( anterior extension of superior lobe - the lingula - extends over the heart )
27
Fissures of the lungs
Both lungs have an oblique fissure. (Separates superior inferior in left lung. And the inferior in right lung.
Right lung has a horizontal fissure separating superior and middle.
28
Surfaces of lung
Costal - adjacent to ribs.
Mediastinal - adjacent to heart
Diaphragmatic - inferior surface of lung
29
Borders of the lung
Anterior - sharp and tapered
Posterior - thick and rounded
Inferior - sharp and tapered.
30
Hilum of the lung
Region of mediastinal surface of the lung where pulmonary artery, veins and main bronchus enter and exit the lung. (In right lungs pulmonary artery lies to ante-ion main bronchus (superior in left lung)
31
Bifurcation of the trachea
Level of sternal angle; internally this point is called carina. Right main bronchus is sho-ter wider descends more vertically (foreign body more likely to enter it)
32
Bronchial tree
Each main (primary) bronchi divides into lobar (secondary) bronchi, one for each lung lobe. These divide to give -ise to segmental (tertiary), bronchi (approx 10 in each lung) each supplies a functionally independent region of the lung called a bronchopulmonary segment 10 in each lung. Segmental bronchi within each segment divide into bronchioles that become smaller witheach division. Smallest bronchioles conduct air to and from alveoli.
33
What do walls of trachea and bronchi contain us walls of bronchioles
Trachea and bronchi - contain smooth muscle and cartilage, bronchioles - only contain smooth muscle. Contraction & relaxation of smooth muscle under autonomic control.
34
What are the walls of the pharynx composed of ?
Oute- layer circular muscle and an o inner layer of longitudinal muscle.
35
The external circular muscle layer of the pharynx wall is composed of.
Three constrictor muscles the superior, middle and inferior constrictors that overlap. They contract superior to inferior so that swallowed food moves down pla-yax towards the oesophagus.
36
How does food move during swallowing
Food in oral cavity pushed into the oropharynx by the tongue. Soft palate rises and closes off nasopharynx from the oropharnx. Food enters laryogopharynx and constriction of the muscles of pla-nyeal wall move good into oesophagus. The epiglottis closes off the laryngeal inlet + prevents foodfliquids entering the larynx
37
What parts make up the pharynx?
Nasopharynx - posterior to the nasal cavity
Orophargnx - posterior to the oral cavity
Laryngopharynx - posterior to larynx
38
What type of tissue make up the tonsils ?
Collections of lymphoid tissue
39
Where are the pharyngeal and tubal tonsils ?
Found in nasopharynx. Pharyngeal fossil (adenoid) lies in the root of the nasopharynx. The tubal tonsil surrounds the opening of tube the auditory ( which connects the nasopharynx to the middle ear )
40
Palatine and lingual tonsils.
The palatine tonsil lies next to the pharyngeal wall in oropharynx. Lingual tonsil is a collection of lymphoid tissue on the posterior aspect of the tongue
41
Nerve innovation of the pharynx
Sensory fibres from the glossopharyngeal nerve and motor fibres from the vagus nerve
42
Nerves that lie dose to the posterior pharyngeal wall.
Cervical part of the sympathetic trunk and superior cervical ganglion. Superior laryngeal nerve - this branch of the vagus ne-ve descends over the posterior aspect of the internal carotid artery. Passes between the inferior and middle constrictors of the pharynx to the larynx.
Hypoglossal ne-ve. This lies close to the vagus nerve
Glossopharangeal nerve. From the posterior aspect, deep it lies to the internal carotid artery.
43
Gag reflex
Protects the airway. Mediated by glossopharyngeal and vagus nerves. Stimulation carried to CNS and muscles contract
44
Normal nerve innovation in swallowing
Vagus nerve coordinates contraction of the pharyngeal muscles and soft palate and conveys sensation from large , waist glossophangeal nerve provides sensory innovation to pharynx.
45
Cartilages of the larynx
Nine- thee unpaired and three paired.
46
Larynx unpaired cartilages
Epiglottis, thyroid and cricoid cartilage.
47
Larynx three paid cartilages.
Much smaller than unpaired. Aryteroids, the cuneiforms and corniculate cartilages
48
Thyroid cartilage
Two flat cartilages (laminae) meet in anterior midline to form laryngeal prominence
49
Superior and inferior Norns
Extensions formed from laminate that project superiorly and inferiorly
Superior norms attach to the hyoid bone.
Inferior horns articulate with cricoid cartilage below.
50
Cricothyroid membrane
Connects inferior border of thyroid and superior border of the cricoid. This is pierced to create an emergency airway.
51
Epiglottis
Attached to superior aspect of thyroid cartilage, where the two thyroid Latina e meet. During swallowing, it covers entrance to larynx and protects from entry of foods or liquid.
.
52
Aryteroids-
Sit on superior surface of cricoid cartilage. They articulate with cricoid cartilage at small joints. Vital fo-pronation, as vocal cords attach to them. Movements of them move the vocal cords.
53
Vocal folds
Two pairs of folds that project into the cavity. Vestibular folds ( false vocal cords) superio-ly and the vocal folds (tree vocal cords) inferiorly
54
Vocal ligaments
Attached anteriorly to the internal aspect of one laryngeal prominence and posteriorly to the aryteroid cartilages.
55
Vocal cords
Space between the few vocal cords is the rima glottidis. Addiction Closes this abduction opens it.
56
Two groups of muscles that act on the larynx
Extrinsic muscles-suprahyoid and infrahgoid muscles. Do not move individual cartilages, but rather move the larynx as one with speech + swallowing
Intrinsic muscles - move the laryngeal cartilages which in turn move the vocal cords. Injury to the nerves that innovate the intrinsic laryngeal muscles therefore affect speech.
57
Intrinsic muscles that move the vocal co-ds
- Left and right cricothyroid muscles-tension on vocal cords.
Left and right posterior cricoanyteroids _ each attached to inns lateral arteroid. These muscles abduct the vocal cords and open rima glottidis.
Transve-se arytenoid - unpaired muscle. adducts vocal folds and close rima glottidis.
58
Superior laryngeal ne-ve
Innovates cricothyroid muscle and is senso-y to langue above vocal folds
59
Recurrent laryngeal nerve
Innervotes all intrinsic muscles except cricothyroid and is sensory to larynx below Vocal folds
60
Blood supply of the lungs
Bronchial arteries from the descending aorta. Bronchial veins return blood to azygos
61
Autonomic nerves that innovate the lungs:
Parasympathetic fibres stimulate constriction of bronchial smooth muscle (broncoconstriction)and secretion from the glands of the bronchial tree.
Sympathetic fibres stimulate relaxation if the bronchial smooth muscle (bronchodilation) and inhibit secretion from the glands
62
Visceral afferents
(Visceral sensory fibres) accompany sympathetic and parasympathetic nerves and relay sensory information from lungs and visceral pleura to the CNS (not usually conscious perception).
63
What is innervated by somatic sensory fibres carried in the intercostal nerves
Parietal pleura
64
Where does lymph from the lungs drain
Into the venous system via the thoracic duct or right lymphatic duct
65
What is the space between the parietal pleura and the inferior boarder of the lung
Costodiaphragmatic process
66
Apex of the lung
Projects into lower neck, superior to the medial end of the clavicle
67
Inferior boarder of the lung
6th rib anteriorly (midclavicular line)
8th rib laterally (midaxillary line)
10th rib posteriorly (at vertebral column)
68
Parietal pleura extends to the
8th rib (modclavicular line)
10th rib anteriorly (midaxillary line)
12th rib posteriorly (at vertebral column)
69
Oblique fissure location
Extends from 4th rib posteriorly to 6th intercostal cartilage anteriorly - runs deep to the 5th rib
70
Horizontal fissure of the right lung location
Extends anteriorly from the 4th costal cartilage and intersects oblique fissure
71
Diaphragm
Broad thin domed sheet of skeletal muscle. Separates thoracic and abdominal cavities. Superior surface adjacent to parietal pleura. Openings in it allow passage of structures between thorax and abdomen. Function is intergalactic to mechanics of breathing.
72
Attachments of the diaphragm
Xiphoid process, costal margin ( and to the tips of the 11th and 12th ribs) and the lumbar vertebrae. Central part of the diaphragm is not muscular but fibrous -the central tendon.
73
Movements of the diaphragm in breathing
Contracts during inspiration, muscle fibres of left and right domes pulled towards peripheral attachments and domes flatten. Increases thoracic volume for lungs to expand.
Relaxed during expiration, domes superiorly, decreasing thoracic volume and drives air from the lungs.
74
Nerve innervation of the diaphragm
Right and left phrenic nerves innervate right and left sides. They are somatic nerves formed in the neck by fibres from the c3, c4 and c5 spinal nerves so contain motor and sensory fibres.
75
Role of the pleural fluid in ventilation
Creates surface tension between parietal pleura lining the thoracic cavity and the visceral pleura on the surface of the lung. Keeps the pleura in contact with each other and prevents lung from collapsing away from thoracic wall when it changes volume.
76
How does contraction of the intercostal muscles help increase thoracic volume
External intercostals pull ribs superiorly and laterally and the ribs pull sternum superiorly and anteriorly, increasing the AP and lateral dimensions of the thoracic cavity.
77
Extra muscles in use in forced breathing
Sternocleidomastoid, pectoralis major and minor, serrated anterior
78
Where does the mediastinum extend from
Superior thoracic aperture superiorly to the diaphragm inferiorly. Sternum anteriorly to the thoracic vertebrae posteriorly
79
What does the mediastinum contain
Heart and pericardium.
Great vessels that enter and leave the heart
Veins that drain the chest wall
Trachea and the main bronchi
The oesophagus
Nerves (somatic and autonomic)
Lymphatics
The thymus gland
80
Two parts of the mediastinum
Superior and inferior , line between these ribs from sterns lang,e anterirly to the t4/t5 junction posteriorly.
81
Divisions of the inferior mediastinum
Anterior middle ( obtains heart inside the pericardial sac, the pulmonary trunk and the ascending aorta) and posterior compartments.
82
Contents of the superior mediastinum
Arch of the aorta and its three branches
Superior vena cava and it’s tributaries- left and right brachiocephalic veins
Trachea
Oesophagus
Phrenic nerves
Thoracic duct
Thymus gland
83
Three ‘parts’ of the aorta
Ascending, arch and descending
84
Ascending aorta
Short, first part , gives rise to the coronary arteries which supply myocardium
85
Descending (thoracic) aorta
Descends through posterior mediastinum and into the abdomen posterior to the diaphragm.
86
Three major branches of the aortic arch that supply the upper body
Brachiocephalic trunk -bifurcates into the right common carotid artery ( supplies right side of head and neck ) and the right subclavian artery which supplies the right upper limb.
The left common carotid artery (supplies left side of head and neck)
Left subclavian artery supplies the left upper limb
87
Receptors in the arch of the aorta
Aortic bodies contain chemoreceptors. These monitor arterial oxygen and co2. Visceral sensory information travels back to the CNS along the path of the vagus nerve and results in reflex responses that regulate ventilation.
88
Ligamentum arteriosum
A fibrous, cordlike connection between pulmonary trunk and arch of the aorta. Remnant of the duct is afteriosus, a foetal circulatory shunt. ( it diverts most blood entering pulmonary trunk directly to the aortic arch. This closes when baby starts to use their lungs at birth. And blood in the pulmonary trunk enters the lungs)
89
Two veins carrying deoxygenated blood to the right atrium
Superior and inferior vena cava
90
Superior vena cava (SVC)
Returns blood to the heart from the head
91
Superior vena cava (SVC)
Returns blood to the heart from the head, neck and upper limbs , lies in the superior mediastinum. Formed by union of left and right brachiocephalic veins.
Each brachiocephalic vein is formed by the union of the internal jugular vein (which drains head and neck) and the subclavian vein (which drains the upper limb)
92
Inferior vena cava (IVC)
Returns blood to the heart from all regions inferior to the diaphragm. Thoracic part of the IVC is very short ( enters the right atrium as soon as it enters the thorax through the diaphragm. )
93
Trachea
Conducts air to and from the left and right main bronchi. Semi-ridged due to c shaped incomplete cartilage in its walls.
Extends from the larynx in the midline of the neck into the superior mediastinum and is palpable superior to thr surasternal notch.
It terminates at the level of the sterns angle by bifurcation into the left and right main bronchi.
94
Oesophagus
Muscular tube extending from pharynx in the midline of neck to stomach. Peristalsis moves food down it. In superior mediastinum, the oesophagus lies in the midline of the thorax, posterior to the trachea. It descends into the posterior mediastinum.
95
Where do the phrenic nerves enter the thorax
They descend through the neck and enter the thorax through the superior thoracic aperture. They course over the pericardium and pierce through the diaphragm.
96
Left and right vagus nerves
Arise from the brain stem and contain somatic sensory, somatic motor and parasympathetic fibres. They innervate structures of the thorax and abdomen in addition to the head and neck.
They descend through the neck alongside the internal carotid artery and internal jugular vein and enter the thorax via the superior thoracic aperture.
They each give rise to a recurrent laryngeal nerve which ascend back up into the neck to innervate the muscles of the larynx.
97
Left recurrent laryngeal nerve
Loops under the arch of the aorta before ascending back up the left side of the neck (along the trachea) to the larynx.
98
Right recurrent laryngeal nerve
Descends anterior to the right subclavian artery and then loops under the inferior border of the artery before ascending back up to the right side of the neck ( between trachea and oesophagus) to the larynx.
99
Vagus nerves
Contribute parasympathetic fibres to the heart, lungs and oesophagus
They transverse the diaphragm and convey parasympathetic fibres to most of the abdominal viscera.
100
Thoracic duct
Major channel for lymphatic drainage. It ascends through the posterior mediastinum and into the superior mediastinum where it empties into the venous system at the union of the left internal jugular vein and left subclavian vein.
101
Thymus gland
A lymphoid organ. It lies anteriorly in the superior mediastinum. It is important in children but atrophied with age, eventually becoming fatty.
102
Pericardium and it’s two layers
A tough fibrous sac that encloses the heart like a loose fitting bag. It is loose to allow for the movement of the heart within it.
Outer fibrous layer attached superiorly to the great vessels and inferiorly to the central tendon of the diaphragm.
A thin inner serous layer which has two parts : the parietal layer lines the inner aspect of the fibrous pericardium, and the visceral layer covers the surface of the heart. The two layers are continuous with each other.
103
Space between the two layers of serous pericardium
The pericardial cavity. Contains a small amount of pericardial fluid that lubricates the serous membranes and allows them to slide over each other with movement of the heart. Left and right phrenic nerves give rise ti sensory branches that innervate the fibrous pericardium
104
Apex of the heart
Projects to the left of the sternum towards the left lung. Formed by the left ventricle. It lies at the 5th intercostal space in the midclavicular line.
105
Base of the heart
Faces posteriorly . Left atrium and part of right atrium
106
Inferior surface if the heart
Lies on the central tendon of the diaphragm also called diaphragmatic surface
. Left ventricle and part of right ventricle
107
Anterior surface of the heart
Faces the sternum and ribs also called sternocostal surface. Right ventricle
108
Right boarder of the heart
Lateral to right sterns edge from the right 3rd costal cartilage to the right 6th costal cartilage. Right atrium
109
Left boarder of the heart
Extends from left 2nd intercostal space to the left 5th intercostal space in the midclavicular line. Left ventricle
110
Superior boarder of the heart
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 )
111
Inferior border of the heart
Lies along the line connecting the inferior end of the right border with the apex. Right ventricle and part of the left ventricle
112
The auricles
Outpouchings from the walls of the right and left atria.
113
Saul I
External grooves on the heart containing Major arteries of the heart
114
Right coronary artery (RCA) and it’s branches
Supply parts of the conducting system of the heart, right atrium, right ventricle, pert of the left ventricle and part of the intraventricular septum.
Branches to the sinoatrial node and atrioventricular node supply these major components of the electrical conducting system of the hear
The right marginal artery supplies the inferior border of the heart.
Posterior interventricular artery (PIV) is the continuation of the right coronary artery on the inferior surface if the heart. It runs in the posterior interventricular sulcus and supplies both ventricles
115
Left coronary artery
Supply parts of the conducting system of the heart, the left atrium, most of the left ventricle, part of the right ventricle, and part of the interventricular system.
Only runs a short course before it divides into two large terminal branches. This is the left main stem. Two terminal branches of the LCA :
Anterior interventricular artery or left anterior descending
Circumflex artery
116
Main branches of the left coronary artery
Anterior interventricular artery (LAD) - runs in anterior interventricular sulcus towards the apex it supplies both ventricles.
One or two diagonal branches Arise from the LAD.
The circumflex artery runs around the heart onto the inferior/ diaphragmatic surface. It supplies the left atrium, part of the right ventricle and left ventricle .
Left marginal artery arises from the circumflex and supplies the left ventricle.
117
Right-dominant and left-dominant circulation
The posterior interventricular artery may arise from the right or left coronary artery. This determines if an individual has a right or left dominant coronary circulation.
Most have right - the PIV arises from the right coronay and both the right and left coronary arteries supply the left ventricle ( occlusion of the left main stem would impair blood flow to part of mut not the entire left ventricle.
Left dominant - the PIV arises from the circumflex artery - the left coronary artery supplies the entire left ventricle - a blockage of left main stem occludes blood flow to entire left ventricle
118
Interstitial septum
Separates right atrium from the left atrium
119
Fossa ovalis
A depression in the interatrial septum. It is the remnant of the foetal foramen ovale. In the foetus, the foramen ovale shunts oxygenated blood from the right to left atrium, hence bypassing the lungs.
120
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. The ridges are pectinate muscles are extend into the right auricle. The parts if the right atrium on either side if the crista have different embryological origins.
121
Trabeculae carneae
Muscular ridges on the internal wall
122
Papillary muscles
Modified regions of trabeculae carneae, which project into the lumen of the ventricle
123
Chordate tendineae
Fibrous cords which connect the tips of the papillary muscles to the tricuspid valve
124
Moderator band
A modified region of the trabeculae carneae which connects the interventricluar septum to one of the papillary muscles.
125
What blood does the left atrium receive
Oxygenated blood from the pulmonary veins ( two from each lung)
126
wall of left atrium
Thinner than ventricles - internally has a smooth walled posterior part and an anterior part bearing pectinate muscles. ( this reflects left atriums development from two different embryological structures.
127
When in the cardiac cycle do the ventricles contract
Ventricular systole
128
Which structures allow the closed valves to resist pressure
Papillary muscles and chordae tendineae.
129
What are the aortic and pulmonary valves called
Semilunar valves
130
Semilunar valves structure and location
Cusps are semi-circular- each one has three cusps attached to the inner wall of the vessel, with a free edge that projects into the vessel lumen.
131
What part of the cardiac cycle are the coronary arteries filled
Ventricular relaxation (diastole)- as right and left coronary arteries arise from two of the three aortic sinuses
132
Aortic sinuses
Formed from each cusp of the aortic valve between its free edge and the vessel wall
133
What are the areas where heart sounds are heard called
Auscultatory areas
( aortic, pulmonary, tricuspid and mitral)
134
Aortic auscultatory area
2nd intercostal space, just to the right of the sternum
135
Pulmonary auscultatory area
2nd intercostal space, just to the left of the sternum
136
Tricuspid
5th intercostal space , just to the left of the sternum
137
Mitral auscultatory area
5th intercostal space, left midclavicular line
138
Sinoatrial node
Cells in the SAN spontaneously generate electrical impulses. Located at the superior end of the crista terminalis.
Generates impulses at a rate of approx. 70 per minute.
Impulses from the SAN stimulate contraction of the atria
Impulses conducted to the AV node, located at the inferior end of the interatrial septum.
139
Atrioventricular node
Located at the inferior end of the interatrial septum. Conducting fibres form the atrioventricular bundle (bundle of his). This divides into two groups of fibres, the right and left bundle branches.
140
Left and right bundle branches of the bundle of his
These give rise to purkinje fibres that enter the myocardium of the left and right ventricles respectively and stimulate contraction.
141
Blood supply to the SAN
Supplied by the RCA in approx 60% of people and by the LCA in around 40% of people.
142
Blood supply of the AVN
Usually supplied by the posterior interventricular artery. In most people, the PIV arises from the RCA
143
Blood supply of the bundle of his
In most people supplied by the LCA
144
Occlusion of coronary arteries can result in
Conduction abnormalities in addition to myocardial is ischaemia
145
Sympathetic and parasympathetic innervation of the heart.
These fibres act on the SAN and can change the rate and force of myocardial contraction.
Sympathetic stimulation increases the heart rate and force of contraction.
Parasympathetic stimulation slows the heart rate and force of contraction
146
Visceral afferent fibres innervation of the heart
Convey sensory information from the heart back to the CNS. Is myocardium is ischaemic, this information is relayed back to conscious perception and may be perceived as pain, burning or tightness, and can not usually be pinpointed - referred pain
147
The suprasternal notch is a feature of which bone ?
Manubrium
148
The umbilicus lies at which deratomal level
T10
149
Which group of lymph nodes receives the majority of lymph drainage from the breast?
Axillary
150
Between which two layers of tissue is the intercostal neurovascuar bundle located?
Internal intercostal and innermost intercostal muscle
151
The internal thoracic artery branches from which larger artery
Subclavian
152
Which nerves supplies the parietal pleura of the lateral chest wall
Intercostal
153
Which of the following structures is located in the hilum of the lung
Pulmonary vein
154
The inferior boarder of the lung is located at the level of which rib posteriorly
10 th
155
Which spinal nerves contribute to the phrenic nerve
C3 - c5
156
In quiet breathing, inspiration Is primarily driven by which muscles ?
Diaphragm
157
Which vessel is the second to branch from the arch of the aorta ?
Left common carotid
158
In fetal life, which structure shunts blood from the aorta to the pulmonary trunk
Ductus arteriosus
159
The right recurrent laryngeal nerve loops under which structure, before ascending back into the neck?
Right subclavian artery
160
Inferior boarder of the heart is formed mostly by which structure ?
Right ventricle
161
Into which structure does the coronary sinus drain
Right atrium
162
The diagonal artery typically arises from which larger coronary artery
Left anterior descending ( anterior
163
Where is the crista terminalis located
Right atrium
164
If the aortic valve is incompetent, blood regurgitates back into which structure ?
Left ventricle
165
Over which region of the chest wall would you place a stethoscope to best hear the tricuspid valve ?
5th intercostal space, left sternum margin
166
Posterior mediastinum contains
Descending (thoracic ) aorta
Azygous veins
Oesophagus
Thoracic duct
Sympathetic trunk and splanchnic nerves
Posterior intercostal vessels and nerves
167
Branches of the descending (thoracic ) aorta
Posterior intercostal arteries which supply the intercostal spaces
Bronchial arteries which supply the lungs
Oesophageal branches which supply the oesophagus
Pericardial branches which supply the pericardium
Phrenic branches which supply the diaphragm
168
At which level does the aorta pass through the diaphragm
T12
169
At what level does the azygous system of veins arise in the abdomen
L1/L2
170
Azygous veins
Drains blood from the posterior thoracic wall and returns it to the superior vena cava. Lie on the bodies of the thoracic vertebrae system comprises of :
An Azygous vein on the right side of the vertebral bodies
A smaller ( shorter) hemiazygous vein on the left side of the vertebral bodies
One or more veins connecting the above veins to each other
The Azygous system receives blood from the posterior intercostal veins, oesophageal veins and bronchial veins
171
Location of the oesophagus
In the posterior mediastinum lies to the right of the aorta
172
Blood supply of the oesophagus
Oesophageal arteries from the descending aorta. Oesophageal veins return venous blood to the Azygous system
173
At what level does the oesophagus pass through the oesophageal hiatus in the diaphragm
T10
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Thoracic duct
Returns most of the bodies lymph to the venous system.miles between the Azygous vein and the aorta.
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Lymph from the lower limbs, pelvis and abdomen
Flows towards the cisterns Chuli, a sac-like swelling that gives rise to the thoracic duct, which ascends into the thorax. In the thorax the thoracic duct receives lymph from the intercostal spaces and lymph nodes. Duct ascends into the neck, receiving lymph from the left side of the head and neck and the left upper limb.
It terminates by opening into the venous system at the junction between the left internal jugular vein and the left subclavian vein.
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Lymph drainage of the right side of the hear and neck and right upper limb
Lymphatic ducts that enter the venous system at the junction of the right internal jugular and right subclavian veins
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Sympathetic trunks
Lie on the posterior thoracic wall, either side of the vertebral column and posterior to the parietal pleura. Thin longitudinal fibre tracts regularly inter spread with ganglia. Sometimes called paravertebral ganglia,
Ie alongside the vertebral column.
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Where does the sympathetic trunk extend
From the skull base to the coccyx.
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What is a ganglion
Collection of cell bodies outside the CNS
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Cell bodies of preganglionic sympathetic neurons
Lie in the thoracic and upper lumbar spinal cord segments (T1-L2/3). Sympathetic fibres are visceral motor fibres so they leave the spinal cord from its vertebral aspect and enter spinal nerves T1-L2/3 along with somatic motor nerves, whose cell bodies lie in the ventral grey horn
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How do sympathetic fibres reach all parts of the body
Trunk allows fibres arising from T1-L2/3 to be distributed to all parts of the body.
Preganglionoc sympathetic fibres exit the spinal cord in spinal nerves T1-L2/3.
They then separate from the spinal nerves and enter the sympathetic trunk via a short communicating branch ( white ramus communicans)
Once in the sympathetic trunk, the preganglionic axon does one of the following: 1. Synapses in the ganglion at its level of entry
2. Ascends if descends in the trunk before synapsing in a ganglion
3. Travels through a ganglion (and the trunk) without synapsing
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Abdominal pelvic splanchnic nerves
Greater splanchnic nerves ( sympathetic preganglionic fibres originating from T5-T9 segments of the spinal cord)
Lesser splanchnic nerve (T10-11)
Least splanchnic nerve (T12)
Lumbar splanchnic nerves ( L1-2)
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Where are the greater lesser and least splanchnic nerves formed
Posterior mediastinum and transverse the diaphragm to enter the abdomen
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Contents of the posterior intercostal spaces
Intercostal muscles
A posterior intercostal artery (branch of the thoracic aorta )
A posterior intercostal vein (which drains into the azygous system)
A posterior intercostal nerve
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Innervation of the thoracic viscera
Sympathetic and parasympathetic fibres that have coordinated but opposing actions.
The cardiopulmonary splanchnic nerves convey postganglionic sympathetic fibres to the thoracic viscera
The vagus nerves convey parasympathetic fibres to the thoracic viscera
These form the autonomic plexuses around the thoracic viscera
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Autonomic nerves plexuses in the thorax
Cardiac, pulmonary, oesophageal
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The cardiac plexus
Innervate the SAN. Sympathetic fibres increase the heart rate and force of contraction, whist parasympathetic fibres decrease the heart rate and force of contraction.
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Pulmonary plexus
Innervate the bronchi. Sympathetic stimulation relaxes the bronchi and parasympathetic stimulation constricts them.
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Oesophageal plexus
Overlies the anterior surface of the oesophagus. Sympathetic fibres inhibit peristalsis and parasympathetic fibres stimulate peristalsis
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Referred pain
Pain from one part of the body is felt in another region.
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Innervation of the heart
Cardiac plexus. Sympathetic fibres travel to cardiac plexus and heart from spinal cord segments T1-T5. Is the cardiopulmonary splanchnic nerves
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Cardiac referred pain
Visceral sensory nerves convey sensory info from heart to CNS alongside sympathetic fibres that innervate the heart so visceral sensory information enters spinal cord at segments T1-5. Somatic sensory information from the skin of the chest wall, neck and arm also returns to spinal cord segments T1-5
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Diaphragm referred pain
C3-5 supply the diaphragm, they contribute spinal nerve fibres to the phrenic nerve. They also contribute to the nerves that innnervate the skin of the neck and shoulder. The brain interprets pain coming from the diaphragm as coming from the shoulder region.
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Aortic dissection
Longitudinal tear in the aortic wall that allows blood to collect between the intima and media. Typically sudden onset chest pain
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Structures of the neck
Structures of the respiratory tract - pharynx, larynx and trachea
Structures of the gastrointestinal tract - pharynx and oesophagus
Glands - thyroid and parathyroid
Arteries and veins that serve the head and neck
Nerves that serve the heart and neck, upper limbs, thoraco-abdominal viscea ( via vagus nerve) and the diaphragm ( via the phrenic nerves )
Muscles that move head and neck, I’ve larynx in speech and swallowing and that form floor of the mouth. Platysma ( a very thin subcutaneous muscle deep to the skin of the neck)
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How do the cervical vertebrae articulate with each other
At facet joints that are orientated obliquely. This allows for good range of flexion and extension of the cervical spine in comparison to the thoracic spine.
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Hyoid bone
Slender bone situated anteriorly in the upper neck, inferior to the mandible. Helps to keep the pharynx open and provides an attachment point for several muscles in the neck and of the tongue.
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The larynx
A ‘skeleton’ of small cartilages connected by membranes and small joints. Protects the airway. Muscles attach to the laryngeal cartilages and move them, in turn moving the vocal cords and allowing phonation.
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Triangles of the neck
Anterior and posterior triangles which are separated from each other by the sternocleidomastiod muscle.
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Sternocleidomastoid muscle
Attached to the sternum, clavicle and the mastoid process. It can act unilaterally or bilaterally. It is innervated by the accessory nerve ( cranial nerve xi )
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Boundaries of the anterior triangle of the neck
Anteriorly - midline of the neck
Posteriorly - anterior boarder of the Sternocleidomastoid
Superiorly - the lower boarder of the mandible
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Contents of the anterior triangle of the neck
Trachea and larynx
Thyroid, parathyroid glands, and submandibular salivary gland
Suprahyiod muscles
Infrahyiod muscles
Common carotid artery ( and it’s terminal branches )
Internal jugular vein
Branches of the facial nerve, glossopharyngeal, vagus, accessory and hypoglossal nerve
Anna cervicalis
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Suprahyoid muscles
Connect the hyoid to the skull. They form the floor of the mouth and move the hyoid and larynx in speech and swallowing. Four paired muscles ( mylohyoid, geniohyoid, stylohyiod, digastric) lie superiorly to the hyoid bone
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Infrahyoid muscles
Also called strap muscles, connect the hyoid to the sternum and scapula. They move the hyoid and larynx inferiorly in speech and swallowing. Four paired muscles lie inferior to the hyoid bone, lateral to the anterior midline of the neck.
Sternohyiod and omohyoid lie superficially and attach to the sternum and scapula respectively
Sternothyroid and thyrohyoid lie deep and attach the sternum to the thyroid cartilage and the thyroid cartilage to the hyoid, respectively.
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Ansa cervicalis
Fibres from the C1-3 which innervate the infrahyiod muscles
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Boarders of the posterior triangle of the neck
Anteriorly - posterior boarder of the Sternocleidomastoid
Posteriorly - anterior boarder of the trapezius
Inferiorly - the clavicle
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Contents of the posterior triangle of the neck
Muscles that move the head
Part of the subclavian artery and the subclavian vein
The external jugular vein which drains the scalp and face
The accessory nerve (CN xi)
The roots of the brachial plexus ( spinal nerves that supply the upper limb)
The cervical plexus (fibres C1-4)
The phrenic nerve
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The thyroid gland
Composed of right andd left lobes that lie just lateral to the lower larynx and upper trachea. Each lobe lies deep to the sternothyroid muscle. The two lobes are joined by the isthmus, which lies anterior to the trachea .
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What regulates hormone secretion from the thyroid
Pituitary gland
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Blood supply of the thyroid
Left and right superior thyroid arteries - branches of the external carotid arteries
Left and right inferior thyroid arteries - branches of the thyrocervical trunks (which in turn are branches of the subclavian artery)
Some people have an additional thyroid ima artery. Superior, middle and inferior thyroid veins drain the thyroid gland.
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Parathyroid glands
Usually four - right and left superior and inferior glands located posterior to the thyroid gland. They produce parathyroid hormone which plays a role in calcium regulation. They are typically supplied by the inferior thyroid arteries.
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Branches of the common carotid artery
Internal carotid - does not give rise to any branches in the neck, it enters the cranium and supplies the brain.
External carotid- gives rise to several branches that supply the head and neck including the pharynx, scalp, thyroid gland, tongue and the face.
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Carotid sinus
Small swelling at the bifurcation of the common carotid. Baroreceptors here monitor arterial blood pressure. This visceral sensory information is relayed back to the CNS via the glossopharyngeal nerve and results in reflex responses that regulate the blood pressure
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The subclavian artery branches
Gives rise to several vessels. A large branch, the thyrocervical trunk, gives rise to the inferior thyroid artery. Supplies the upper limb.
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Internal jugular vein
Major vein in the neck, drains blood from the vein and part of the face.
Unites with the subclavian vein , which returns blood from the upper limb to form the brachiocephalic vein.
The right and left brachiocephalic veins unite to form the superior vena cava.
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External jugular vein
Drains blood from the scalp and face. It joins the subclavian vein.
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The facial nerve
CN VII - supplies the platysma in the neck
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Glossopharyngeal nerve
CN IX - supplies the pharynx ( sensory innervation)
And the carotid sinus ( visceral sensory fibres that return to the CNS vis CN IX)
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The vagus nerve
CN X - is vital for normal speech and swallowing supplies the
Muscles of the pharynx ( motor innervation)
The larynx (motor and sensory innervation)
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Where does the vagus nerve run in the neck
Between the internal jugular vein and the internal carotid artery ( above its bifurcation) and between the internal jugular vein and common carotid artery (below its bifurcation). These three structures run together in a fasciae sleeve called the carotid sheath.
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The accessory nerve
CN XI supplies the Sternocleidomastoid and the trapezius muscles
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The hypoglossal nerve
(CN XII) is motor to the muscles of the tongue. Does not supply any structures in the neck but travels through it. It lies lateral to the internal carotid artery and deep to the external jugular vein
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The phrenic nerve
Formed by c3, c4, c5 nerve fibres. It descends through the neck to enter the thorax. It innervated the diaphragm
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Sympathetic ganglia in the head and neck
Superior middle and inferior cervical ganglia
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Injury to the recurrent laryngeal nerve
Inability to move the ilsilateral vocal cord and affects quality of voice
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What separates the nasal cavities from each other
A thin midline septum, formed of cartilage and bone. When the head is bisected, the septum is seen on one half only
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What separates the nasal cavities from the oral cavity
The hard palate ( inferiorly )
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What separates nasal cavities from the brain
The cribiform plate, a delicate section of bone that is perforated with tiny holes.
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Midline nasal septum
Formed of cartilage anteriorly and two thin plates of bone posteriorly. The perpendicular plate of the ethmoid bone forms the superior part if the posterior septum and the vomer forms the inferior part of the posterior septum
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Conchae/ turbinates
Superior middle and inferior projections of Bon on the lateral wall of the nasal cavity.
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What spaces lie inferior to the turbinates
Meatuses. Superior meatus lies inferior to the superior concha, and so on. As inspired air travels through the meatuses, it is warmed, humidified and filtered
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Olfactory receptors in the nasal cavity
In the Mucosa in the upper part if the nasal cavity. The axons of these receptors form olfactory nerves which travel through these perforations to the brain.
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Vessels of the nasal cavity
Supplied by several arteries, including branches of the maxillary artery, which is a terminal branch of the external carotid artery. An anastomotic network formed supplies the nasal septum and is often the site of bleeding in a nosebleed (epistaxis)
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Sensory innervation of the nose
Via branches of the trigeminal nerve ( CN V)
235
Paranasal sinuses
Cavities within the skull bones and are named according to the bones within which they are located. Frontal ethmoid, sphenoid, and maxillary
236
Frontal paranasal sinus
Lie within the anterior part if the frontal bone. Drains into the middle meatus
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Ethmoid air cells
Lie within the ethmoid bone ( superior to the nasal cavity and medial to the orbits) . Drain into the superior and middle meatuses
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Sphenoid sinuses
Lie within the sphenoid bone. Drains into the spheno-ethmoidal recess
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Maxillary sinuses
Lie within the maxillae of the facial skeleton. Lie lateral to the lateral walls of the nasal cavity. Drains into the middle meatus - the opening into the middle meatus lies superomedially, therefore it cannot drain freely when the head is upright.
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Nasolacrimal duct
Drains the fluid that lubricate the anterior surface of the eye. The duct opens into the inferior meatus.
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The middle ear
A small cavity within the temporal bone that is modified for hearing ( it contains three small bones that transmit sound waves to the inner ear)
242
Eustachian tube
Connects middle ear to the nasopharynx. Opening can be seen on the lateral wall of the nasopharynx, surrounded by a slight bulge, which is formed of tonsillar tissue.
Allows air to pass into middle ear so that the pressure on either side of the tympanic membrane, which lies between the middle and external ear, is equal. This is important for optimal conduction of sound waves.
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The palate
Separates the nasal cavities from the oral cavity composed anteriorly of bone - the hard palate and posteriorly of muscle - the soft palate. Forms the roof of the oral cavity
244
Constituents of the hard palate
Palatine processes if the maxillae and the horizontal plates of the palatine bones.
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Function of the heard palate
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.
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the soft palate
Lies posterior to the hard palate. A midline conical projection - the uvula - hangs from the posterior border of the soft palate and can be seen at the back of the mouth.
Composed of several muscles
They contract during swallowing which elevates the soft palate. Nasopharynx is closed off from the oral cavity, preventing reflux of food and fluid into the nasal cavity. Innervated by the vagus nerve.
247
Boundaries of the oral cavity
The hard and soft palate superiorly
Soft tissues and muscles inferiorly
Cheeks laterally
248
How many teeth do adults have
32 - 16 embedded in the maxilla (upper jaw) and 16 in mandible ( lower jaw)
Upper and lower jaws have 4 incisors, two canines, four premolars and six molars
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What are the teeth composed of
Inner pulp which contains blood vessels and nerves
Dentin, which surrounds the pulp
An outer hard coating of enamel
250
Erosion of enamel and dentin
By bacteria and food. This can lead to decay, inflammation and infection of the pulp, which is painful. Infection may spread to bone, leading to access formation.
251
The tongue
Debars papillary on its superior surface , some of which detect taste. Anterior part of the tongue lies in the oral cavity, and posterior part ( the root ) extends into the oropharynx.
252
vallecula
The space between the posterior tongue and the anterior aspect of the epiglottis.
253
Innervation of the tongue muscles
By the hypoglossal nerve ( CN XII)
Intrinsic muscles lie entirely within the tongue. They are paired bilaterally and fuse in the midline. The change the shape of the tongue.
Extrinsic muscles are attached to the tongue but originate from outside it ( from the mandible and hyoid bone) they move the tongue.
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Sensory innervation of the tongue
Taste in the anterior two thirds of the tongue is the facial nerve
General sensation in the anterior two thirds is served by the trigeminal nerve
Taste and general sensation in the posterior third are served by the glossopharyngeal nerve
255
Vessels of the oral cavity
Supplied by lingual, maxillary and facial arteries which are branches of the alternating carotid artery
256
Innervation if the oral cavity
Muscles of the soft palate are innervated by the vagus nerve.
257
Tonsillar tissue found in
Pharyngeal tonsil lies in the roof and posterior wall of the nasopharynx ( sometimes called adenoid)
Tubal tonsil surrounds the opening of the auditory tune on the lateral wall of the nasopharyngeal
5e palatine tonsil lies on the lateral wall of the oropharynx ( the tonsils) visible on either side of the oropharynx when mouth is open.
Lingual tonsil is a collection of lymphoid tissue in the posterior tongue.
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Salivary glands
Parotid, submandibular and sublingual. Glandular secretion is stimulated by parasympathetic fibres.
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Parotid gland
Largest salivary gland overlies the posterior part of the mandible. Saliva empties into the mouth via the parotid duct which opens adjacent to the upper second molar tooth.
260
Innervation of the parotid gland
Closely related to the facial nerve. After nerve exits the skull, enters the deep surface of the parotid gland. Facial nerve divides into 5 branches which emerge to innervate the muscles of facial expression. Also related to carotid artery. Secretion stimulated by parasympathetic fibres in the glossopharyngeal nerve.
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Submandibular glands
Smaller than parotid. Lie inferior to the body of the mandible just anterior to the angle. Opens into the floor of the mouth, under the tongue. Stimulated by facial nerve
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Sublingual glands
Lie in the floor of the mouth. They open via several small ducts into the floor of the mouth. Secretion is stimulated by parasympathetic fibres in the facial nerve.
