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Nadim Phase 1 > Cardioresp Anatomy > Flashcards

Cardioresp Anatomy Flashcards

1
Q

origins (3) of pectoralis major

A
  1. Medial third of clavicle.
  2. Sternum.
  3. Costal cartilages.
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2
Q

insertion of pectoralis major

A

intertubercular sulcus of humerus

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3
Q

the innervation of pectoralis major

A

Medial and lateral pectoral nerves

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4
Q

action of pectoralis major

A

Adduction and medial rotation of the humerus at the shoulder.

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5
Q

origin of pectoralis minor

A

Ribs 3-5.

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6
Q

insertion of pectoralis minor

A

coracoid process of the scapula

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7
Q

innervation of pectoralis minor

A

Medial pectoral nerve

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8
Q

action of pectoralis minor

A

Protraction of the shoulder

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9
Q

origin of serratus anterior

A

Upper 8 ribs

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10
Q

insertion of serratus anterior

A

Costal surface of the scapula

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11
Q

innervation of serratus anterior

A

Long thoracic nerve

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12
Q

action of serratus anterior

A

Protraction of the scapula

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13
Q

Describe the course of the internal thoracic artery

A

It is a branch of the subclavian. It travels downward on the inside of the ribcage, approximately a centimeter from the sides of the sternum, and thus medial to the nipple.

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14
Q

What does the internal thoracic artery branch into?

A
  1. Musculophrenic - supplies the diaphragm.

2. Superior epigastric arteries - supplies the front of the abdomen.

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15
Q

What is the innervation of the intercostal muscles?

A

The intercostal nerves.

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16
Q

What is the function of the lungs?

A

Oxygenates blood by bringing inspired air into contact with O2 poor blood in the pulmonary capillaries.

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17
Q

What is the pleural cavity?

A

A potential space between the visceral and parietal pleura.

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18
Q

Name 2 functions of the serous fluid within the pleural cavity?

A
  1. Lubricates the pleurae.

2. Creates a surface tension helping the lungs to expand on inspiration

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19
Q

Name the 4 main structures that are found at the hilum of the lung.

A
  1. Pulmonary artery x1.
  2. Bronchus x1.
  3. Pulmonary vein x2.
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20
Q

What branch does the right main bronchus give off outside of the right lung?

A

Superior lobar bronchus.

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21
Q

What other smaller vessels are found at the hilum of the lung?

A
  1. Bronchial arteries.
  2. Pulmonary plexus of autonomic nerves.
  3. Lymph nodes.
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22
Q

Which lung are inhaled foreign bodies most likely to be found in and why?

A

The right lung. The right main bronchus is shorter and more vertical.

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23
Q

How many lobes does the right lung have and what are they called?

A

3 lobes.

Superior, middle and inferior.

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24
Q

How many lobes does the left lung have and what are they called?

A

2 lobes.

Superior and Inferior.

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25
Q

What is the fissure in the left lung called?

A

Oblique (lies along 6th rib).

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26
Q

What are the fissures in the right lung called?

A

Horizontal (extends from mid-axillary line anteriorly along the 4th rib) and Oblique (lies along 6th rib).

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27
Q

Describe the innervation of the lungs?

A
  1. Parasympathetic innervation derived from vagus nerve.
  2. Sympathetic innervation derived from sympathetic trunks.
  3. Visceral afferent - conducts pain impulses to sensory ganglion.
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28
Q

What is the action of parasympathetic innervation in the lung?

A

Bronchoconstriction and vasodilation of pulmonary vessels

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29
Q

What is the surface marking for the apex of the lung?

A

2 finger breadths (3cm) above the medial clavicle in the neck.

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30
Q

What are the surface markings for the lower border of the lung?

A

6th rib anteriorly, 8th rib in the mid-axillary line and 10th rib posteriorly.

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31
Q

What are the surface markings for the lower border or the pleural cavity?

A

8th rib anteriorly, 10th rib in the mid-axillary line and 12th rib posteriorly.

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32
Q

What are the 3 branches of the arch of the aorta?

A
  1. Brachiocephalic trunk.
  2. Left common carotid artery.
  3. Left subclavian artery.
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33
Q

What are the branches of the brachiocephalic trunk?

A 
Right common carotid (LHS).
Right subclavian (RHS).
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34
Q

What is the ligamentum arteriosum a remnant of and what was its function in the foetus?

A

Remnant of the ductus arteriosum.

It’s function was to shunt blood between the pulmonary trunk and the aorta in order to bypass the non-functioning lungs.

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35
Q

What branch does the left vagus nerve give off as it crosses the arch of the aorta?

A

The left recurrent laryngeal nerve.

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36
Q

Briefly describe the anatomical course of the right phrenic nerve

A

Lies on large veins (brachiocephalic, SVC etc) and along the right side of the heart. Crosses in front of root of the lung.

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37
Q

Briefly describe the anatomical course of the left phrenic nerve.

A

Crosses the arch of the aorta and descends in front of the root of the lung.

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38
Q

What spinal roots is the phrenic nerve derived?

A

C3, 4 and 5 (cervical plexus).

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39
Q

What does the phrenic nerve supply?

A

Motor innervation to the diaphragm.

Sensory innervation to the pleura, peritoneum and pericardium.

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40
Q

Briefly describe the anatomical course of the left vagus nerve.

A

Crosses the aorta and behind the root of the lung. Breaks up into branches on the oesophagus (oesophageal plexus) and leaves the thorax as the anterior gastric nerve.

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41
Q

Briefly describe the anatomical course of the right vagus nerve.

A

Lies on the trachea and crosses behind the root of the lung. Breaks up into branches on the oesophagus and leaves the thorax as the posterior gastric nerve.

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42
Q

Where does the phrenic nerve enter the diaphragm?

A

It pierces the central tendon of the diaphragm alongside the IVC on the right (T8).

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43
Q

Where does the vagus nerve enter the diaphragm?

A

Through the oesophageal hiatus (T10).

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44
Q

What are the layers of the pericardium?

A
  1. Outer fibrous layer.
  2. Parietal serous layer.
  3. Visceral serous layer.
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45
Q

What structures form the left border of the heart?

A
  1. Left pulmonary artery.
  2. Left auricular appendage.
  3. Left ventricle.
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46
Q

What is the surface marking for the apex of the heart?

A

5th intercostal space in the mid-clavicular line.

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47
Q

What forms the right border of the heart?

A

The right sternal edge.

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48
Q

On what aspect of the heart would you find the left atrium?

A

The posterior aspect. It is closely related to the oesophagus.

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49
Q

Where is the RCA found?

A

In the atrio-ventricular sulcus.

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50
Q

Name the 3 main branches of the RCA.

A
  1. Sino-atrial nodal branch.
  2. Right marginal branch.
  3. Posterior inter-ventricular branch.
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51
Q

In 90% of hearts where does the posterior inter-ventricular artery arise from?

A

RCA

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52
Q

In 30% of hearts where does the posterior inter-ventricular artery arise from?

A

The circumflex artery.

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53
Q

In 20% of hearts where does the posterior inter-ventricular artery arise from?

A

The RCA and the circumflex artery.

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54
Q

Name the 2 main branches of the LCA.

A
  1. Circumflex.

2. Left anterior descending (LAD).

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55
Q

In what sulcus does the circumflex artery lie? What other large vessel can be found here?

A

Left atrio-ventricular sulcus.

The coronary sinus can also be found here. IT passes posteriorly and drains into the RA.

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56
Q

Where is the SAN located?

A

The upper aspect of the crista terminalis in the RA.

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57
Q

Where is the AVN located?

A

Inter-atrial septum.

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58
Q

Name the artery that supplies:

a) The SAN
b) The AVN

A

a) Sino-atrial nodal branch of RCA.

b) Posterior inter-ventricular branch, usually RCA.

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59
Q

At what phase of the cardiac cycle do the coronary arteries fill?

A

Diastole; when the ventricles are relaxed.

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60
Q

What 2 spaces does the crista terminalis divide in the RA?

A

It divides the smooth walled atrium from the trabeculated auricle - ridges = musculi pecanti.

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61
Q

What is the Fossa Ovalis a remnant of?

A

The Foramen Ovale. In the foetus the foramen ovale shunted blood from the RA to the LA so as to bypass the lungs.

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62
Q

In the ventricles, what are the chordae tendinae attached to?

A

The valves (mitral or tricuspid) and the papillary muscles.

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63
Q

How do the mitral and tricuspid valves work?

A

They open passively when the atria contract and then close afterwards to prevent backflow. The papillary muscles and chordae tendinae work to keep the valves closed during ventricular contraction.

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64
Q

How do the atrial and pulmonary valves work?

A

They open passively when the ventricles contract. Towards the end of systole they close to prevent the back flow of blood. The pressure of blood on the valves keeps them closed.

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65
Q

How would you know if the atrial and pulmonary valves were incompetent?

A

You would get regurgitation of blood into the ventricles. This could be heard as a diastolic murmur.

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66
Q

Where can you hear the pulmonary valve?

A

Left of the sternum, 2nd intercostal space.

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67
Q

Where can you hear the aortic valve?

A

Right of the sternum, 2nd intercostal space.

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68
Q

What is the midline connection called of the two lateral thyroid gland lobes?

A

Isthmus.

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69
Q

What tracheal rings does the isthmus of the thyroid gland lie in front of?

A

2nd, 3rd and 4th.

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70
Q

Where do the thyroid arteries arise from?

A
  1. Superior thyroid artery - External carotid artery.

2. Inferior thyroid artery - Thyrocervical trunk, a branch of the Subclavian artery.

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71
Q

What vessels are contained within the carotid sheath?

A
  1. Carotid artery.
  2. Jugular vein.
  3. Vagus nerve.
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72
Q

What is the origin of sternocleidomastoid?

A

The manubrium of the sternum and the clavicle.

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73
Q

What is the insertion of sternocleidomastoid?

A

Mastoid process.

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74
Q

What nerve(s) are related to the superior thyroid arteries?

A

The external laryngeal nerves.

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75
Q

What nerve(s) are related to the inferior thyroid arteries?

A

The recurrent laryngeal nerve crosses the inferior thyroid artery.

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76
Q

How many parathyroid glands are there?

A

4.

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77
Q

Where are the parathyroid glands located?

A

Posterior surface of thyroid glands.

78
Q

How are the parathyroid glands developed?

A

From the pharyngeal pouches.

79
Q

Name 3 functions of the larynx.

A
  1. Phonation.
  2. Cough reflex.
  3. Protection of the lower respiratory tract.
80
Q

What is the epithelium of the vocal folds? and why?

A

Stratified squamous epithelium. This is more robust and can withstand the vibrations and wear and tear.

81
Q

What is the blood supply to the larynx?

A

Superior and inferior laryngeal arteries (branches of the thyroid arteries).

82
Q

What does the recurrent laryngeal nerve supply?

A

Motor innervation to intrinsic muscles of the larynx (except cricothyroid).

83
Q

What does the internal branch of the superior laryngeal nerve supply?

A

Sensory innervation to laryngopharynx and larynx.

84
Q

What does the external branch of the superior laryngeal nerve supply?

A

Motor innervation to the cricothyroid muscle.

85
Q

Name the 3 unpaired cartilages in the larynx.

A
  1. Epiglottis (elastic cartilage).
  2. Thyroid (hyaline cartilage).
  3. Cricoid (hyaline cartilage).
86
Q

What do the two sheets of thyroid cartilage form in the midline?

A

The laryngeal prominence (Adam’s apple).

87
Q

What vertebral level is the inferior border of the larynx at?

A

C6.

88
Q

Name the 3 paired cartilages in the larynx.

A
  1. Arytenoid.
  2. Cuneiform.
  3. Corniculate.
89
Q

Where are cuneiform cartilages located?

A

Within the ary-epiglottic folds. They strengthen the folds.

90
Q

What is the space between the vocal cords called?

A

Rima glottidis.

91
Q

What is the superior vestibular folds also known as?

A

False vocal folds.

92
Q

What are the extrinsic muscles of the pharynx?

A

The suprahyoids, infrahyoids and stylopharyngeus.

93
Q

What is the function of the extrinsic muscles of the larynx?

A

They move the larynx superiorly and inferiorly during swallowing.

94
Q

Name the 4 infrahyoid muscles.

A
  1. Omohyoid (scapula to hyoid).
  2. Sternohyoid (sternum to hyoid).
  3. Sternothyroid (sternum to thyroid).
  4. Thyrohyoid (thyroid to hyoid).
95
Q

What is the function of the intrinsic muscles of the larynx?

A

They control the shape of the rima glottidis, and the length and tension of the vocal folds.

96
Q

What is the innervation of the intrinsic laryngeal muscles?

A

Recurrent laryngeal nerve.

97
Q

What intrinsic laryngeal muscle is not innervated by the recurrent laryngeal nerve?

A

Cricothyroid.

98
Q

What is the innervation of the cricothyroid muscle?

A

External branch of the superior laryngeal nerve.

99
Q

What is the function of the cricothyroid muscles?

A

Stretches and tenses the vocal cords. Important for the creation of speech.

100
Q

What is the function of the thyroarytenoid muscles?

A

Relaxes the vocal ligament, allowing for a softer voice.

101
Q

What nerve passes through the parotid gland?

A

The facial nerve - Cn 7.

102
Q

What are the 5 branches of Cn 7.

A
  1. Temporal.
  2. Zygomatic.
  3. Buccal.
  4. Mandibular.
  5. Cervical.
103
Q

Where does the pharynx extend from and to?

A

The base of the skull to the cricoid cartilage (C6).

104
Q

What are the 3 sections of the pharynx called?

A
  1. Nasopharynx.
  2. Oropharynx.
  3. Laryngopharynx.
105
Q

What is the function of the pharyngeal constrictor muscles?

A

They contract sequentially to propel food into the oesophagus.

106
Q

What is the origin of the superior constrictor?

A

Pterigoid plate and pterygomandibular raphe.

107
Q

What is the origin of the middle constrictor?

A

Hyoid bone.

108
Q

What is the origin of the inferior constrictor?

A

Thyroid and cricoid cartilages.

109
Q

What is the innervation of the pharyngeal constrictors?

A

The pharyngeal branch of the Vagus nerve.

110
Q

What vessels are found in the carotid sheath?

A
  1. Common carotid artery.
  2. Vagus nerve.
  3. Internal jugular vein.
111
Q

Where is the carotid sinus located?

A

At the bifurcation of the common carotid artery.

112
Q

Where does the glossopharyngeal nerve exit the cranial cavity?

A

Through the jugular foramen.

113
Q

What nerve supplies sensory and taste innervation to the posterior 1/3 of the tongue.

A

The glossopharyngeal nerve.

114
Q

What nerve supplies sensory sensation to the anterior 2/3 of the tongue?

A

The trigeminal nerve, Cn 5.

115
Q

What nerve supplies taste sensation to the anterior 2/3 of the tongue?

A

The facial nerve, Cn 7.

116
Q

What is the function of the tonsils?

A

The tonsils are a consolidation of lymphoid tissue. They prevent infection by stopping germs entering the mouth and nose.

117
Q

Give 4 functions of the nasal cavity.

A
  1. Warms and humidifies air.
  2. Olfaction.
  3. Removes and traps pathogens.
  4. Drains and clears para-nasal sinuses.
118
Q

What is the function of the nasal conchae?

A

They increase the SA of the nose and they disrupt the fast flow of air. This means the air spends more time in the nasal cavity so it can be humidified.

119
Q

What opens into the inferior meatus?

A

Nasolacrimal duct.

120
Q

What opens into the inferior meatus?

A

Nasolacrimal duct.

121
Q

What opens into the middle meatus?

A

The frontal, maxillary and anterior ethmoid sinuses open at the hiatus semilunaris. The middle ethmoid sinus opens onto the ethmoidal bulla.

122
Q

What opens into the superior meatus?

A

The posterior ethmoid sinus.

123
Q

Where does the sphenoid sinuses open into the nasal cavity?

A

At the spheno-ethmoidal recess.

124
Q

Why does the nose have a rich vascular supply?

A

This means it can change the humidity and temperature of inspired air.

125
Q

What nerve supplies general sensation to the nose?

A

Branches of the trigeminal nerve.

126
Q

What vertebral level is the tracheal bifurcation?

A

T4.

127
Q

What is the function of the thoracic duct?

A

drains all the lymph from the lower half of the body and bowel back into the blood stream.

128
Q

Where does the thoracic duct drain into?

A

The confluence between the left jugular vein and left subclavian vein.

129
Q

Where does the azygous vein drain into?

A

The superior vena cava

130
Q

Describe the azygous vein

A

Azygous vein runs up the side of the thoracic vertebral column, draning towards the superior vena cava. It connects the superior vena cava and inferior vena cava. It transports deoxygenated blood from the posterior walls of the thorax and abdmen into the SVC.

131
Q

How does contraction of pectoralis major assist in breathing?

A

The two pectoralis muscles form part of a ring of muscles which encircle the thoracic
cage; the other muscles forming the ring are the scapula muscles. When the ring contracts
the thoracic pressure rises to assist exhalation. This only occurs in disease and during
exercise; normal exhalation is a passive process.

132
Q

Which bony structures lie subcutaneously in the anterior chest wall?

A

The clavicles and sternum (made up of the manubrium, body and xiphi-sternum). The
ribs are deep to muscles so are not subcutaneous

133
Q

What are the articulations of the clavicle?

A

At the medial end to the manubrium of the sternum; the sternoclavicular joint and at
the lateral end to the acromion of the scapula; the acromioclavicular joint.

134
Q

What forms the anterior axillary fold?

A

The lower edge of the pectoralis major muscle.

135
Q

What lies deep to pectoralis minor muscle?

A

The axilla.

136
Q

The majority of breast tissue is in the upper outer quadrant of the breast. Where does
lymph from this part of the breast drain?

A

To the axillary lymph nodes.

137
Q

Which costal cartilage connects to the sternum at the sternal angle (angle of Louis)?

A

The second costal cartilage

138
Q

Which nerves carry sensation from the parietal and visceral pleura?

A

The parietal pleura lines the inside of the thoracic wall and is supplied by the same
nerves as the tissue of the thoracic wall; the spinal nerves, thoracic 1 to thoracic 12. The
visceral pleura covers the surface of the lung and is supplied by the same nerves as the
lung; the vagus and sympathetic nerves.

139
Q

What is a bronchopulmonary segment?

A

A bronchopulmonary segment has a feeding artery and bronchus which run together
through the centre of the segment and repeatedly branch to reach all parts of the segment.
The veins which drain the segment run on the surface of the segment rather than through
the centre. The ten segments on each side are separated by layers of connective tissue and
the fissures. Each segment is anatomically and functionally separate and this influences how
diseases may spread through the lungs.

140
Q

What structures pass through the hilum of the lung?

A

Main bronchus, pulmonary artery, two pulmonary veins, bronchial artery, lymphatic
vessels, branches of the vagus and sympathetic nerves.

141
Q

How does contraction of the diaphragm assist in returning blood to the heart?

A

Contraction of the diaphragm decreases intra-thoracic pressure and increases intraabdominal pressure. The net effect is for blood to flow from the abdomen into the chest.

142
Q

What is the sensory and motor nerve supply to the diaphragm?

A

Sensory and motor supply are both from the phrenic nerve which arises from the
spinal cord at cervical 3, 4 and 5 segments.

143
Q

What is the surface markings of the lowest extent of the lungs?

A

At the midclavicular line to lowest part of the lung lies at the tip of the 6th rib, at the
mid-axillary line the 8th rib and posteriorly the 10th rib.

144
Q

What is intercostal recession?

A

When a patient is having difficulty taking a breath in and is having to create very
negative pressures in the thorax the intercostal muscles get ‘sucked in’.

145
Q

What is the developmental significance of the ligamentum arteriosum?

A

It is the remnant of a shunt between the pulmonary artery and the aorta. The
shunt carries all the blood from the pulmonary artery into the aorta before the lungs have
developed and most of the blood after the lungs have developed. At birth is closes so that all
right ventricular blood passes to the lungs.

146
Q

What are the main branches of the following arteries and what organs/tissues do
these vessels supply:
(a)Left common carotid artery
(b) Left subclavian artery

A

(a) Internal and external carotid arteries
External; Left side of the face and head
Internal; most of the cerebral hemispheres

(b)Vertebral, thyro-cervical, axillary
Vertebral; cerebellum, brain stem, occipital lobe and the interior temporal lobe
Thyro-cervical; Thyroid gland and neck
Axillary; upper limb

147
Q

What are the nerve roots of the phrenic nerve? Why is this clinically important?

A

Cervical 3, 4 and 5. Painful diseases affecting the diaphragm are felt by the
patient in the side of the neck and onto the shoulder tip which is the dermatome supplied by
the cervical 3, 4, 5 nerve roots

148
Q

What structures are supplied by the vagus nerve?

A

Pharynx, larynx, heart lungs, fore gut and mid gut.

149
Q

What are the eight vessels which connect the heart to other structures?

A

Aorta, pulmonary artery, four pulmonary veins, superior vena cava and
inferior vena cava.

150
Q

What is the surface marking for the apex of the heart?

A

5

th intercostal space, midclavicular line

151
Q

How may the fibrous pericardium contribute to a reduction in ventricular filling?

A

Fibrous tissue is resistant to stretching, and so restricts the maximum end
diastolic volume. Diseases which ‘take up volume’ in the pericardial sac (eg. fluid, muscle
hypertrophy etc.) will reduce diastolic filling and therefore reduce stroke volume. Cardiac
output can then only increase by increasing the heart rate. Diseases which progress very
slowly (over years rather than days) can stretch the pericardium.

152
Q

Describe the anatomy of the tricuspid and mitral valves. What happens if they are
incompetent?

A

Both of these valves have a similar structure with the tricuspid having three cusps
and the mitral two cusps. The cusps are made of fibrous tissue covered with endothelium
and are very flexible. They cusps are attached to a ring of fibrous tissue which forms the
orifice between the atrium and ventricle, the myocardium is also attached to this fibrous ring.
The free edge of the cusp has multiple tendinous cords attached, the cordi tendini; for each
cusp these cords attach to a cylinder of myocardium, the papillary muscle, which contracts
during systole to keep the cordi tendini taught.

153
Q

Describe the anatomy of the aortic and pulmonary valves. What happens if they are
incompetent?

A

Both of these valves have a similar structure with both having three cusps. The cusps
are made of fibrous tissue covered with endothelium and are very flexible. They cusps are
attached to a ring of fibrous tissue which forms the orifice between the ventricle and the
artery (pulmonary and aorta), the myocardium is also attached to this fibrous ring. The free
edge of the cusps have a thickening, like a baton in a sail, which helps to shape the valve
when it is closed.

154
Q

At what phase of the cardiac cycle do the coronary arteries fill? Why?

A

Blood flows through the coronary arteries during ventricular diastole. Blood
flows from high pressure to low pressure. During ventricular systole the highest pressure is
in the ventricular lumen and in the myocardium surrounding the lumen. Pressure is lower in
the aorta so blood flows out of the ventricle into the aorta. Pressure in the coronary arteries
on the surface of the heart is initially lower so these will fill with blood. However, most of the
coronary arteries are inside the myocardium where the pressure is highest so these will be
squeezed so that they are empty. Blood cannot flow from the surface arteries into the
myocardium so there is no flow. During ventricular diastole pressure in the aorta is high,
pressure in the myocardium drops to zero; now the coronary arteries inside the muscle can
fill and blood flow occurs.

155
Q

Describe the conducting system of the heart and its function.

A

The four fibrous rings which support the four heart valves form a complete
electrical isolation of the ventricles from the atria. In order for the ventricles to contract there
has to be a system of carrying the electrical impulse across this barrier. Furthermore, the
ventricles need to contract from the apex towards the aortic and pulmonary valve for
maximum efficiency. The conducting system performs both of these functions. It starts at the
atrio-ventricular node, which is positioned in the atrial septum close to the fibrous rings.
From the atrio-ventricular node modified myocardium (purkinje fibres) extends into the
ventricular septum and travels down to the apex of the heart. In the ventricular septum it
divides twice to provide a right bundle to the right ventricle and two bundles (an anterior and
posterior) for the left ventricle. The right bundle crosses the lumen of the ventricle as the
moderator band. Diseases affecting each component of this pathway are regularly seen in
acute medicine

156
Q

What is the blood supply of the sinoatrial node and the atrioventricular node?

A

The sino-atrial node is supplied by the right coronary artery in 60% of hearts
and the left in 40%.
The atrioventricular node is supplied by the posterior interventricular artery in
all hearts. However, in 90% of hearts the posterior interventricular artery arises from the right
coronary artery and in 30% of hearts from the left coronary artery. Note that in 20% of hearts
there are two posterior interventricular arteries, one from the left and one from the right
coronary. This variation makes a huge difference to the risk of coronary artery disease in
patients and alters the urgency of patient management.

157
Q

What is the location of the sinoatrial node?

A

The sinoatrial node is located on the crista terminalis (a ridge of tissue on the
inside between the right atrium and right atrial appendage) just where the superior vena
cava enters the right atrium

158
Q

What is the thoracic duct and where does it join the vascular system?

A

The thoracic duct is the main lymphatic channel draining lymph from the lower half of
the body and the bowel back to the blood stream. The bowel component is important
because fat is absorbed into the lymphatics so this is the only route for fat absorption.
At the confluence of the left subclavian and left internal jugular vein.

159
Q

What structures are supplied by the three splanchnic nerves and where does a patient
appreciate pain felt by these nerves?

A

Greater splanchnic nerve; fore gut, epigastrium.
Lesser splanchnic nerve: midgut, round the umbilicus.
Least splanchnic nerve, hind gut, suprapubic area

160
Q

What structure lies immediately behind the trachea in the upper thorax and the left atria
in the lower thorax?

A

The oesophagus

161
Q

What structures drain blood into the azygous system?

A

The lateral and posterior chest wall and the lateral and posterior abdominal wall

162
Q

Why is the left recurrent laryngeal nerve at risk from thoracic disease but not the right?

A

The left recurrent laryngeal nerve passes into the thorax, round the aortic arch and
back into the neck. The right recurrent laryngeal does not pass through the thorax.

163
Q

Where do the sympathetic nerves attach to the central nervous system?

A

The thoracic 1-12 and lumber 1 and 2 spinal segmental nerves.

164
Q

What happens if the sympathetic nerves to the head and neck are damaged?

A

Horner’s Syndrome: almost always effects one side only.
There will be no sweating on the face (anhidrosis)
The eye lid will droop (ptosis)
The pupil will be constricted (miosis)
Slightly withdrawn eye ball (enopthalmos)

165
Q

Where may you create an emergency airway?

A

Between the thyroid and cricoid cartilage, through the cricothyroid membrane.

166
Q

Why does the thyroid gland have such a good blood supply?

A

Iodine is present in very low concentration in the blood so the gland needs a
high blood flow to ensure adequate delivery of iodine

167
Q

Which structure may be compressed by an enlarged thyroid gland?

A

The trachea

168
Q

What is the location of the parathyroid glands and how many are there?

A

They are positioned on the posterior surface of the thyroid gland, there are
four

169
Q

What is the only complete cartilage ring around the airway?

A

The cricoid cartilage.

170
Q

A patient may develop hypocalcaemia after thyroid surgery, why?

A

The parathyroid glands may be (accidentally or deliberately) removed during
thyroid surgery which will cause acute (sudden) hypoparathyroidism.

171
Q

What forms the ganglia on the sympathetic chains and vagus nerve?

A

A collection of neuron cell bodies

172
Q

What is the name of the fused first thoracic and lower cervical sympathetic ganglia?

A

The stellate gangion

173
Q

What structures are supplied by the superior laryngeal nerve?

A

Sensation to the inside of the larynx down to the vocal cords and the
cricothyroid muscle.

174
Q

What is the location of the carotid sinus and what sensation does it detect?

A

The origin of the internal carotid artery; blood pressure.

175
Q

Which structure stops liquid refluxing into the back of the nose during swallowing?

A

The soft palate.

176
Q

Which nerve carries sensation from the larynx below the vocal cords?

A

The recurrent laryngeal nerves.

177
Q

Describe the histology of the mucosa of the trachea?

A

Simple, columnar, pseudostatified, ciliated with goblet cells

178
Q

Where do the parotid and submandibular ducts enter the mouth?

A

Parotid; from the cheek adjacent to the second upper premolar
Submandibular; under the tongue.

179
Q

Which nerve supplies the muscles of the tongue?

A

The hypoglossal nerve (cranial nerve XII)

180
Q

Occlusion of which vessel is most likely to result in a fatal heart attack?

A

The left main coronary artery.

181
Q

Which artery provides the main blood supply to the left ventricle?

A

The left anterior descending artery.

182
Q

Which vessel is most likely to become occluded without producing any symptoms?

A

Right marginal artery.

183
Q

Which artery most frequently supplies the AVN?

A

The right main coronary artery.

184
Q

What is the function of the Eustachian tube?

A

To equalize the air pressure either side of the tympanic membrane

185
Q

Why is the maxillary sinus more prone to infection?

A

The opening into the nasal cavity is at the top of the sinus so it does not drain easily.

186
Q

What is the nerve supply to the anterior 2/3 of the tongue?

A

General sensation – Trigeminal nerve, mandibular branch (cranial nerve Vc)
Taste sensation, facial nerve, (cranial nerve VII)
Muscles, hypoglossal nerve, (cranial nerve XII)

187
Q

Where do the ducts for the submandibular salivary glands open into the mouth?

A

Below the tongue

188
Q

Why may disease in the maxillary sinus cause numbness of the cheek?

A

The nerve which gives sensation to the cheek passes in the roof of the maxillary
sinus

189
Q

What are the attachments of the muscles of the tongue?

A

The hyoid bone

190
Q

What structure stops reflux of liquid into the nose during swallowing?

A

The soft palate

191
Q

Give 4 functions of the paranasal sinuses.

A
  1. Lighten the head.
  2. Warm and humidify air.
  3. Speech resonance.
  4. Protection against facial trauma.

Nadim Phase 1 (27 decks)

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