CardioResp Anatomy Flashcards
label the parts of the thoracic cage
laterally, the manubrium articulates with the?
clavicle (collarbone) at the sternoclavicular joint, and with the first rib.
the body of the sternum articulates with which ribs?
2 - 7
the sternal angle articulates with which rib?
2
● How many pairs of ribs are there?
12
- The anterior parts of the ribs are composed of?
costal cartilage
- The ribs articulate with their costal cartilages at [a] joints.
costochondral
● Which ribs are ‘true’ ribs, ‘false’ ribs, and ‘floating’ ribs? Why are they called true, false and floating ribs?
1-7 = true (articulate with sternum directly)
8 -10 = false (unite and join at seventh costal cartilage)
11 - 12 = floating (do not articulate with sternum)
● Posteriorly, what do the ribs articulate with? what are the joints called
thoracic vertebrae at costovertebral joints
what are the typical ribs? describe them
- Ribs 3 - 9 are typical ribs. They have a head, neck, tubercle, and body (shaft).
- Ribs 1 - 2 and 10 - 12 are atypical
how many thoracic vertebrae are there?
12
what kind of vertebrae is this? HOw can you tell?
Cervical (C1-C7): have bifid (‘two-pronged’) spinous process, holes in the transverse processes (transverse foramen) and oval-shaped bodies. The vertebral foramen is triangular. The first two (C1 and C2) are uniquely modified for rotation of the head.
what kind of vertebrae is this and how can you tell?
Thoracic (T1-T12): have long, sharp, downward-sloping spinous processes that overlap the vertebra below, additional articular facets for the attachment of ribs and heart-shaped bodies. The vertebral foramen is round.
what kind of vertebrae is this? how can you tell?
Lumbar (L1-L5): have short, blunt spinous processes and extra-large, oval-shaped bodies to support the weight of the body. The vertebral foramen is triangular.
what vertebrae are these
Sacral (S1-S5): fused into the sacrum, a triangular-shaped bone that sits in the posterior midline. It articulates with the left and right hip bones to form the bony pelvis.
Coccygeal (Co1-Co4): fused to form the coccyx, which is a vestigial remnant of what used to be a tail.
● What are the joints between the vertebrae and ribs called?
costvertebral joiny
at which dermatone is the umbilicus?
t10
label the diagram of a breast
what vessels supply the breast?
● internal thoracic artery (which arises from the subclavian artery)
● axillary artery.
Venous blood returns to the axillary and internal thoracic veins.
The breast is supplied with somatic nerves and sympathetic fibres via the intercostal nerves.
Somatic sensory fibres innervate the [a] of the breast. Sympathetic fibres innervate [b] in the blood vessel walls and nipple.
skin
smooth muscle
what are the five groups of lymph nodes in the axilla?
central, pectoral, humeral, subscapular, and apical.
● They drain the breast, upper limb, chest wall, scapular region, and the abdominal wall.
● The apical nodes (in the apex of the axilla) receive lymph from all other lymph nodes in the axilla. Because they drain most of the lymph from the breast, the axillary lymph nodes are often involved in the spread of breast cancer.
what are the three layers of intercoastal muscle?
- External intercostal is most superficial.
- Internal intercostal lies deep to the external intercostal.
- Innermost intercostal lies deep to the internal intercostal.
label these muscles
- sternocleidmastoid
- deltoid
- pectoralis major
- sternum
- biceps brachii
- -
- clavical
- subscapularis
- Pectoralis minor
- Serratus anterior
- humerus
what are the intercostal muscles, what are their orientions and when are they used?
External intercostal
- antero-inferiorly, pulls ribs superiorly = inspirarion
Internal Intercostal
- postero-inferiorly, pulls ribs inferiorly = expiration
Innermost
- also postero-inferiorly
Where is the intercostal nerve bundle located?
between internal and innermost intercostal muscles
In medical procedures that involve piercing the intercostal space (such as placing a chest drain), the incision is made where? why?
middle to lower part of the intercostal space, to avoid the intercostal vessels and nerve.
blood supply to the intercostal muscles?
Anterior and posterior intercostal arteries
-anterior = from internal thoracic = subclavian
- posterior = descening aorta
- Anterior intercostal veins drain into the internal thoracic vein and posterior intercostal veins drain into the azygos system of veins – we will learn more about these later.
are the intercostal nerves somatic/autonomic?
The intercostal nerves are somatic and contain motor and sensory fibres. They innervate the intercostal muscles, the skin of the chest wall and the parietal pleura. Intercostal nerves also carry sympathetic fibres.
what are the two pleura of the lungs?
- The parietal pleura lines the inside of the thorax.
- The visceral pleura covers the surface of the lungs and extends into the fissures.
A very thin pleural cavity (or space) lies between the parietal and visceral pleura.
The parietal pleura is visible with the naked eye, but the visceral pleura is not. The two layers of pleura are continuous with each other. The pleural cells produce a small amount of pleural fluid, which fills the pleural cavity. The pleura and pleural fluid are integral to the mechanics of breathing.
Describe the innervation of the pleura of the lungs and how pain is felt
Parietal = Somatic sensory nerves (intercostal nerves) Very painful
Visceral = Autonomic sensory nerves - no conscious
how many lobes does the left and right lung have?
● The right lung has three lobes – a superior (upper), middle, and inferior (lower) lobe.
● The left lung has two lobes – a superior and inferior lobe. An anterior extension of the superior lobe – the lingula (Latin for ‘small tongue’) – extends over the heart.
label the lobes and fissures of the lung
- Costal surface
- Mediastinal surface -
- Diaphragmatic surface -
- Costal surface - adjacent to the ribs.
- Mediastinal surface - adjacent to the heart.
- Diaphragmatic surface - the inferior surface of the lung.
What structures enter and exit the lungs on the mediastinal surface?
Hilum: pulmonary artery, pulmonary veins and main bronchus enter and exit the lung.
The positions of the pulmonary artery and main bronchus relative to each other at the hilum is slightly different between the right and left lungs.
right =
left = ?
- At the hilum of the right lung, the pulmonary artery lies anterior to the main bronchus.
- At the hilum of the left lung, the pulmonary artery lies superior to the main bronchus.
At both the right and left hila, the two pulmonary veins are usually the most anterior and inferior vessels.
where does the trachea bifurcate?
Sternal Angle
T4 T5
=Carina
Which bromchus are foreign bodies more likely to enter? why?
Right Main Bronchus = lies more vertically
How many lobar (secondary) bronchi in each lung?
How many segmental (tertiary) bronchi in each lung?
Lobar = three in Right, two in Left
Segmental = 10 in each lung
how is it that a segment of the lung may be removed surgically without affecting the rest of the lung?
- Each segmental bronchus supplies a functionally independent region of the lung called a bronchopulmonary segment; there are ten segments in each lung. Because they are supplied by their own segmental bronchus and blood vessels, a segment may be resected (surgically removed) without affecting the rest of the lung.
walls of th trachea and bronchi vs walls of bronchioles?
The walls of the trachea and bronchi contain smooth muscle and cartilage, but the walls of bronchioles only contain smooth muscle
. Contraction and relaxation of the smooth muscle is under autonomic control.
blood supply of the lungs?
The pulmonary arteries carry deoxygenated blood to the lungs. Bronchial arteries from the descending aorta also supply the lungs.
The pulmonary veins return oxygenated blood to the heart from the lungs. Bronchial veins return blood to the azygos system of veins - we will learn more about these veins later.
Autonomic nerves innervate the lungs.
* Parasympathetic fibres stimulate: ?
- Sympathetic fibres: ?
Parasympathetic fibres stimulate:
* constriction of bronchial smooth muscle (bronchoconstriction)
* secretion from the glands of the bronchial tree.
Sympathetic fibres:
* stimulate relaxation of bronchial smooth muscle (bronchodilation)
* inhibit secretion from the glands.
● How many pulmonary arteries and veins enter / exit at the hilum?
One pulmonary artery
two pulmonary veins
what are the main apertures of the diaphram, at what level are they?
what happens to the diaphram during inspiration?
Contracts.
the muscle fibres of the right and left domes are pulled towards their peripheral attachments, and the domes flatten. This increases the intrathoracic volume for the lungs to expand.
what happens to the diaphram during expirarion?
relaxes and domes superiorly
This decreases the intrathoracic volume and drives expiration of air from the lungs.
innervation of the diaphram?
C3 C4 C5 phrenic nerves (somatic)
keep the diaphram alive
basic mechanical principles of expiration
The diaphragm and external intercostal muscles relax, and the internal intercostals contract, decreasing the intrathoracic volume (the internal intercostals pull the ribs inferiorly, and the ribs pull the sternum inferiorly and posteriorly, decreasing the AP and lateral dimensions of the thoracic cavity).
* The lungs recoil (decrease in volume).
* The pressure in the lungs increases above atmospheric pressure and air is expelled from the lungs.
explain what happens during inspiration
- The diaphragm and external intercostal muscles contract, increasing the intrathoracic volume (the external intercostals pull the ribs superiorly and laterally, and the ribs pull the sternum superiorly and anteriorly, increasing the AP and lateral dimensions of the thoracic cavity).
- The lungs expand (increase in volume) with the thoracic wall (due to surface tension).
- The pressure in the lungs decreases below atmospheric pressure and air is drawn into the lungs.
During ventilation, the dimensions of the thoracic cavity change in three planes:
- Vertically - due to the contraction and relaxation of the diaphragm.
- Laterally - due to contraction of the intercostal muscles which move the ribs.
- Antero-posteriorly (AP) – due to movement of the sternum secondary to movement of the ribs.
how does the pleural fluid assist ventilation?
The pleural fluid creates ** surface tension** between the parietal pleura lining the thoracic cavity and the visceral pleura on the surface of the lung.
Surface tension keeps the lung and thoracic wall ‘together’, so when the thoracic cavity changes volume, the lung changes volume with it. Surface tension between the two pleural membranes keeps them in contact with each other and prevents the lung from ‘collapsing’ away from the thoracic wall. If the surface tension is ‘broken’ (e.g. by a penetrating injury of the chest that punctures the parietal pleura and introduces air into the pleural cavity - pneumothorax) then ventilation may become dysfunctional.
what muscles are involved in normal, quiet breathing?
inspiration = mainly diaphram
expiration = elastic recoil
what muscles are involved in vigorous breathing? (exercise)
the intercostal muscles become important. Active expiration uses the internal intercostal muscles.
what muscles are important in forced breathing? (asthma COPD)
accessory muscles of breathing (sternocleidomastoid, pectoralis major and minor, serratus anterior) contribute to movement of the ribs and aid ventilation. The anterior abdominal wall muscles contribute to forced expiration.
label what you can on this normal chest xray
uh oh whats this?
complete pneumothorax
● What imaginary line separates the superior mediastinum from the inferior mediastinum?
The ‘line’ between these compartments runs from the sternal angle anteriorly to the T4/T5 junction posteriorly.
ABCS
what is the Ligamentum arteriosum
The ligamentum arteriosum is a fibrous, cord-like connection between the pulmonary trunk and the arch of the aorta. It is the remnant of the ductus arteriosus, a foetal circulatory shunt.
- The SVC is formed by the union of?
- The SVC is formed by the union of the left and right brachiocephalic veins (brachium = arm; cephalic = head).
describe the course of the left and right recurrent laryngeal nerve
- The left recurrent laryngeal nerve loops under the arch of the aorta before ascending back up the left side of the neck (alongside the trachea) to the larynx.
- The 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 the right side of the neck (between the trachea and oesophagus) to the larynx.
cricothyroid = superior laryngeal nerve
all other intrinsic larynx = recurrent laryngeal nerve
what is the thoracic duct?
The thoracic duct is a major channel for lymphatic drainage from most regions of the body. 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.
name the layer of the pericardium from in to out
- Right border = right atrium
- Left border = left ventricle
- Inferior border = right ventricle and part of the left ventricle.
RMA supplies?
inferior border
R ventricle, Apex
PIV (/PDA supply)
Both ventricles
LAD (Anterior IV) supplies?
both ventricle
Cx supplies?
L Atrium, part of R Ventricle, L Ventricle
LMA supplies?
left ventricle
label the anatomy of the right atrium
- interatrial septum which separates it from the left atrium
- 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 atrium to the left atrium, hence bypassing the lungs.
- 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 and extend into the right auricle. The parts of the right atrium on either side of the crista have different embryological origins.
*
label the chambers of the heart and its valves
label the features of the Left ventricle
- trabeculae carneae – muscular ridges on the internal wall
- papillary muscles – modified regions of trabeculae carneae, which project into the lumen of the ventricle
- chordae tendineae – fibrous cords which connect the tips of the papillary muscles to the tricuspid valve
where can heart sounds be ausculated?
- Aortic = 2nd intercostal space, just to the right of the sternum.
- Pulmonary = 2nd intercostal space, just to the left of the sternum.
- Tricuspid = 5th intercostal space, just to the left of the sternum.
- Mitral = 5th intercostal space, left midclavicular line.
(all patients take medicine)
describe the course of the conducting system
explain the nervous system
do the sympathetic ganglia lie closer to the CNS than target organs or further?
where (preganglionic) sympatheetic fibres arise from?
how are they then distributed to all parts of the body?
T1-L2/3
Distributed to all parts of the body via they sympathetic trunk
https://www.youtube.com/watch?v=SVm4YSH9Sns
what do pregangliomnic sympathetic fibres do after leaving the spinal chord at t1-L3 upon entering the sympathetic trunk?
- synapses in the ganglion at its level of entry (see Figure 1)
- ascends or descends in the trunk before synapsing in a ganglion sacral or cerviacl spine (no sympathetic fibres) ((see Figure 2)
- travels through a ganglion (and the trunk) without synapsing (splanchnic nerve) (see Figure 3).
What structures can be found in the anterior triange?
- the trachea and larynx
- the thyroid gland, parathyroid glands, and the submandibular salivary gland
-
the suprahyoid muscles which connect the hyoid to the skull. They form the floor of the mouth and move the hyoid and larynx in speech and swallowing.
* the infrahyoid muscles. Also called the ‘strap’ muscles, they connect the hyoid to the sternum and scapula. They move the hyoid and larynx in speech and swallowing. - the common carotid artery and its terminal branches (the external and internal carotid arteries)
- branches of the** external carotid** artery to the head and neck
- the** internal jugular vein**
- branches of the facial nerve (CN VII), glossopharyngeal (IX) , the vagus nerve (CN X), and the hypoglossal nerve (CN XII).
- the ansa cervicalis (fibres from C1-C3 which innervate the infrahyoid muscles).
ten toads sing in chours, excellent indeed
what do the Suprahyoid and Infrahyoid muscles do?
Suprahyoid: raise the hyoid and larynx during speech and swallowing
Infrahyoid: draw hyoid and larynx inferiorly during speech and swallowing
label the parts of abd blood supply to the thyroid gland
- 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).
Superior, middle, and inferior thyroid veins drain the thyroid gland.
The [a] is a major vein in the neck, which drains blood from the brain and part of the face.
* It unites with the [b] vein, which returns blood from the upper limb, to form the [c] vein.
* The right and left brachiocephalic veins unite to form the [d].
The [d] vein drains blood from the scalp and face. It joins the subclavian vein.
internal jugular
subclavian
brachiosephalic
superior vena cava
external jugular vein
label the parts of the pharynx
lable the different tonsils
label the cartilages of the larynx (pink)
three unpaired, three paired
Label the parts of the vocal chords:
1. vestibular folds ( false vocal chords)
2. vocal folds (mucus membrane)
+
3. vocal ligament = true vocal chords
4. Rima glottis (space between tru vocal chords)
what does the recurrent laryngeal nerve innervate?
all the intrinsic muscles except for the cricothyroid and is sensory to the larynx below the vocal folds.
what does the superior laryngeal nerve innervate?
cricothyroid muscle and is sensory to the larynx above the vocal folds
label the paranasal sinuses
The paranasal sinuses communicate with the nasal cavity via small ducts / channels.
● The frontal sinus drains into the [a]
● The sphenoid sinus drains into the [b]
● The ethmoid air cells drain into [c]
● The maxillary sinus drains into the [d] – the opening into the of which lies superomedially, therefore it cannot drain feely when the head is upright.
The paranasal sinuses communicate with the nasal cavity via small ducts / channels.
● The frontal sinus drains into the middle meatus.
● The sphenoid sinus drains into the spheno-ethmoidal recess.
● The ethmoid air cells drain into the superior and middle meatuses.
● The maxillary sinus drains into the middle meatus – the opening into the middle meatus lies superomedially, therefore it cannot drain feely when the head is upright.
The nasal cavity also receives the nasolacrimal duct which drains the fluid (‘tears’) that lubricate the anterior surface of the eye. The duct opens into the inferior meatus. When we cry, we get a runny nose because excess fluid runs down the nasolacrimal duct.
label the three slavivary glands (corrisponding ducts circled)
