Cardiorespiratory Anatomy Flashcards
1
Q
What is the Thoracic cavity continuous with?
A
The thoracic cavity is continuous with the neck via the superior thoracic aperture
2
Q
What is the thoracic cavity separate from
A
The thoracic cavity is separate from the abdominal cavity done via the diaphragm
3
Q
What is the diaphragm
A
The diaphragm is a sheet of skeletal muscle which is vital for breathing
4
Q
What do opening in the diaphragm allow
A
They allow structures to pass from the thoracic cavity to the abdomen
5
Q
What are the major organs found in the thoracic cavity
A
Heart
Lungs
6
Q
What does the thorax contain
A
Heart
Lungs
Trachea
Oesophagus
Arteries and veins
Nerves
Lymphatic vessels
7
Q
What is the rib cage also known as
A
Thoracic cage
8
Q
What is the thoracic cage
A
The thoracic cage is the bony skeleton of the thorax which is semi-rigid
9
Q
What does the thoracic cage do
A
-Protects the thoracic and some abdominal viscera
-Provides an attachment for the muscles used for breathing and upper limp movement
10
Q
What is the thoracic cage composed of
A
The sternum
12 pairs of ribs
Thoracic vertebrae
11
Q
Where is the sternum found
A
The sternum lies anteriorly in the midline of the thoracic cage
12
Q
How many part is the sternum made up of
A
3
13
Q
What are the 3 parts of the sternum
A
Manubrium- the superior part
Body- inferior to the manubrium
Xiphoid process- also known as the xiphsternum which is inferior to the body
14
Q
What is the notch on the manubrium called and where is it found
A
The notch is the suprasternal (jugular) notch
Found on the superior border of the manubrium
15
Q
What does the manubrium articulate with laterally
A
The clavicle
16
Q
At what joint does the clavicle and the manubrium articulate
A
At the sternoclavicular joint
17
Q
Where do the manubrium and the body articulate
A
They articulate at the manubriosternal joint
18
Q
What is the manubriosternal joint also known as
A
It can be known as the sternal angle or the angle of Louis
19
Q
What are the anterior parts of the ribs composed of
A
Costal cartilage
20
Q
What do the ribs articulate with
A
The ribs articulate with the costal cartilage
21
Q
At what joints do the ribs articulate with the costal cartilage
A
Costochondral joints
22
Q
What does the costal cartilage of the upper ribs articulate with
A
The sternum
23
Q
At what joint does the upper ribs and the sternum articulate
A
The sternocotal joint
24
Q
What do the ribs posteriorly articulate with
A
The thoracic vertebrae
25
At what joint do the ribs posteriorly articulate with the thoracic vertebrae
At the costovertebral joint
26
What do intercostal muscles do and where are they found
Intercostal muscles lie in the intercostal spaces and move the thorax for breathing
27
How many thoracic vertebrae do we have
12
28
Where can the thoracic vertebrae be found
They lie posteriorly in the midline of the thoracic cage
29
At what joints do thoracic vertebrae articulate with each other
They articulate at the intervertebral joints
30
What do the thoracic vertebrae articulate with
Intervertebral joints, and the posterior part of the ribs and costovertebral joints
31
Name the bones of the sternum from superior to inferior
Jugular notch
Clavicular notch
Manubrium
Sternal angle
Body
Xiphoid process
32
Name the bones in the skeleton of the thorax
Jugular notch
Clavicular notch
Clavicle
Scapula
Sternum-manubrium
Sternal angle
Sternum-body
Sternum-Xiphoid process
Costal cartilage
33
What is the heart
A sophisticated muscular pump
34
What is the heart composed of
Specialised smooth muscle
35
What do the specialised nerve cells and fibres do in the heart
They spontaneously generate and conduct electrical activity that stimulates the contraction of the myocardium.
36
Are the nerve cells and fibres under somatic or autonomic control
Automatic control, they are involuntary
37
What happens to the heart rate under sympathetic stimulation
Heart rate will increase
38
What happens to the heart rate under parasympathetic stimulation
The heart rate will decrease
39
What are the 4 chambers of the heart
Right and left atria
Right and left ventricles
40
What is the function of the ventricles
The ventricles are pumping chambers, the high pressure contracts cause blood to propel out of them
41
What are the walls of the ventricles like
They are muscular and thick
42
What are the valves in the heart for
The valves ensure that all blood flows in the on correct direction stopping back flow
43
What valve is found between the right atria and ventricle
The tricuspid valve- a type of atrioventricular valve
44
What valve is found between the left aria and ventricle
The mitral valve- a type of atrioventricular valve
45
What valve is found between the right ventricle and the pulmonary trunk
The pulmonary valve- a type of semilunar valve
46
What valve is found between the left ventricle and the entrance to the aorta
The aortic valve- a type of semilunar valve
47
How is the myocardium supplied with blood
The myocardium is supplied by the coronary arteries
48
What is the cardiopulmonary circulation
The cardiopulmonary circulation is the circulation of blood between the heart and lungs
49
In the cardiopulmonary circulation what do arteries Carry
Deoxygenated blood
50
In the cardiopulmonary circulation what do veins carry
Oxygenated blood
51
Describe the flow of blood in the cardiopulmonary circulation system
1-right aria receives deoxygenated blood from the superior and inferior vena cava
2-deoxygenated blood pumps through the tricuspid valve into the right ventricle
3-deoxygenated blood pumps from the left ventricle through the pulmonary valve
4- the deoxygenated bloody travels via the pulmonary artery to the lungs
5-gas exchange occurs in the lungs
6-oxygenated blood leaves the lungs and travels back to the heart via the pulmonary vein
7-the oxygenated blood arrives to the left atria from the pulmonary vein and pumps through the mitral valve
8-the oxygenated blood pumps from the left ventricle through the aortic valve
9-the oxygenated blood travels through the aorta and to the rest of the body
52
In relation the the circulatory system what do veins carry
The veins carry blood towards the heart
53
In relation to the circulatory system what do arteries carry
Arteries carry blood away from the heart
54
How many lobes is the right lung split into
The right lung is split into 3 lobes- a superior(upper), middle, inferior(lower)
55
How many lobes is the left lung split into
The left lung is split into 2 lobes- upper and lower
56
What seperates the lobes?
Fissures
57
What is each lung served by
One pulmonary artery
Two pulmonary veins
One main bronchus
58
What is the bronchial tree
The bronchial tree is the branching system of tubes that conducts air in and out of the lungs
59
How is the bronchial tree formed
The bronchial tree is formed when the trachea bifurcates into the left and right main bronchi, these enter the left and right lungs
60
Where does gas exchange occur in the lungs
Alveoli
61
What are the walls of the trachea and bronchi made of
Smooth muscle and cartilage
62
What is the role of cartilage in the trachea and bronchi
To act as a scaffold and keep the structures open
63
What are the walls of the bronchioles made of
Smooth muscle
64
What control of the smooth muscle in the bronchioles under
Autonomic control, involuntary
65
What happens to the bronchioles under sympathetic stimulation
Narrows of the bronchioles = bronchoconstriction
66
What happens to the bronchioles during parasympathetic stimulation
Opening of the bronchioles = bronchodilaton
67
What is surface anatomy
Surface anatomy is the study of anatomical structures by looking, feeling and listening
68
Describe the looking in relation to surface anatomy
Looking is observing the anatomical structures such as bones or parts of bones which can be clearly seen under the skin eg-clavicle. These can be used as visible landmarks to guide examination.
69
Describe feeling in relation to surface anatomy
Feeling or palpating is used during examination of a patient. You can palpate certain anatomical structures such as bones, blood vessels, muscle and some organs. During palpating we many palpate something which is abnormal which may cause harm to the patient
70
Describe listening in relation to surface anatomy
Listening or auscultation is used during an examination of a patient where the doctor will use a stethoscope the auscultate the heart, lungs and intestines. These sounds we auscultate can be normal or abnormal
71
What is the name of the line drawn straight down the centre of the sternum
This line is the midsternal (anterior median) line
72
What is the line drawn inferiorly from the midpoint of the clavicle
This line is the mid Clavicular line
73
What is the line drawn inferiorly from the anterior axilla(armpit)
This line is the anterior axillary line
74
What is the line drawn inferiorly from the middle of the axilla(armpit)
This line is the midaxillary line
75
What is the line drawn inferiorly from the posterior axilla(armpit)
This line is the posterior axillary line
76
What is the line drawn inferiorly through the scapula
This is the Scapula line
77
What is the line drawn straight down along the spinous process of the vertebrae
This line is the mid vertebral(posterior median) line
78
What does the manubrium articulate with laterally and inferiorly
The manubrium laterally articulates with the clavicle at the sternoclavicular joint and the first rib
The manubrium inferiorly articulates with the body of the sternum at the manubriosternal joint which can be known as the sternal angle/ angle of Louis’
79
What does the body articulate with at the sternum and inferiorly
The body articulates with the second rib at the sternal angle (inferior to the manubrium and superior to the body)
The body inferiorly articulates with the Xiphoid process
80
What shape is the xiphoid process
The xiphoid process is small and can vary in size
81
What does the xiphoid process articulate with
The xiphoid process articulates with the seventh rib on the superior part
82
What are the anterior of the ribs made of
Costal cartilage
83
What happens at the costochondral joints
The ribs articulate with the costal cartilage
84
What do the costal cartilage of ribs 1-7 articulate with
The costal cartilage of ribs 1-7 articulates with the sternum directly at the sternocostal joints
85
What are ribs 1-7 known as
True ribs
86
What are ribs 8-10 known as
False ribs
87
Why are ribs 8-10 known as false ribs
They are known as false ribs as the costal cartilage unites and merge to join the seventh costal cartilage
88
What are the 11th and 12th ribs known as
Floating ribs
89
Why are the 11th and 12th ribs known as floating ribs
They are floating ribs as they are short and so do not articulate with the sternum
90
What happens at the costovertebral joints
At the costovertebral joints the ribs articulate posteriorly with the thoracic vertebrae
91
What are adjacent ribs connected by
Intercostal muscles
92
Which ribs are known as typical and what makes them classified as typical ribs
Ribs 3-9 are typical ribs
Typical ribs look similar and share common anatomical features
93
Which ribs are know as atypical ribs and why are they classified as this
Ribs 1,2,10,11 and 12 are all atypical ribs
Atypical ribs look different to typical ribs and could lack some features of typical ribs. These are much shorter than typical ribs
94
Where are the thoracic vertebrae found
T1-T12 lie posteriorly to the midline of the thoracic cage
95
What does the head of the ribs articulate with
The head of the ribs typically articulates with the vertebral body
96
What does the tubercle of the rib articulate with
The tubercle of the rib articulates with the transverse process of the vertebrae
97
What is the superior thoracic aperture
It is where the manubrium, the first ribs and the thoracic vertebrae form a boundary, it is the passageway through which structures pass through between the head and neck
98
Where do Spinal nerves (T1-T12) innervate
The skin of the thoracic wall
99
What sensations from the skin reach our conscious perception
Touch
Pain
Temperature
100
How do sensations reach our conscious perception
Somatic sensory fibres
101
What nerves innervate the skeletal muscle of the thoracic wall
Somatic motor fibres
102
What spinal nerves innervate the sweat glands, the smooth blood vessels and the hair follicles
Sympathetic fibres
103
What is a dermatome
A dermatome is an area of skin innervated by a single spinal nerve
104
What does each spinal nerve innervate
Each spinal nerve innervate a specific strip around the chest wall
105
Describe the location of the breast/mammary glands
The mammary glands are superficial to the muscle of the chest wall.
106
In males are breasts well develop or rudimentary
Rudimentary
107
In females are breast well developed or rudimentary
Well developed
108
Where can breast tissue be found
Breast tissue is found on the chest wall
Breast tissue extends towards the anterior axilla this is the axillary tail
109
What does the breast contain
Fat- various amounts
Glandular and secretory tissues arranged in lobules
Ducts which converge on the nipple
Connective tissues
Ligaments
Blood vessels
Lymphatics
110
What is the breast primarily supplied by
The breast is primarily supplied by branches of the internal thoracic artery arising from the subclavian artery and the axillary artery
111
Describe the location of the internal thoracic artery
The internal thoracic artery goes deep to the lateral edge of the sternum, giving rise to the anterior intercostal arteries which supply the breast and intercostal space
112
How does venous bloody return from the breasts
The venous bloody returns by the axillary and internal thoracic veins
113
What nerves is the breast supplied with
The breast is supplied with somatic nerves and sympathetic fibres by the intercostal nerves
114
How does lymph drain from the breast
Lymph from the breast drains to the lymph nodes in the axilla
115
How many groups of lymph nodes are there in the axilla
5 groups
116
What are the 5 groups of lymph nodes in the axilla
Central
Pectoral
Humeral
Subscapular
Apical
117
What areas do the axilla lymph groups drain
Breast
Upper limb
Chest wall
Scapula region
Abdominal wall
118
Where are the apical nodes found
In the apex of the axilla
119
Why are the apical nodes so important
The apical nodes received lymph from all other lymph nodes in the axilla
120
What is the clinical relevance of the apical nodes
They drain the most lymph from the breasts so are often the ones involved in the spread of breast cancer
121
How many layers of muscle are there in the intercostal space
3 layers
122
What are the 3 layers of muscle found in the intercostal space
External intercostal
Internal intercostal
Inner most intercostal
123
What are the intercostal muscles for
Collectively they move the ribs and alter the dimensions of the thoracic cavity with inspiration and expiration
124
Where is the pectoralis major found
This is the most superficial muscle of the anterior chest wall
125
What does the pectoralis major attach to
The pectoralis major attaches to the upper humerus, the clavicle and the upper 6 ribs
126
Where is the pectoralis minor found
This muscle lies deep to the pectoralis major
127
What does the pectoralis minor attach to
The pectoralis minor attaches to the scapula and ribs 3,4 and 5
128
Where is the serratus anterior found
The serratus anterior is a superficial muscle that sweeps around the lateral aspect of the thoracic cage
129
What does the serratus anterior attach to
The serratus anterior attaches to the scapula and the upper 8 ribs
130
What is the major function of the pectoralis major, pectoralis minor and the serratus anterior
There main function is to move the upper limb
131
What is the function of the pectoralis major
Addicts the humerus
132
What is the function of the pectoralis minor and the serratus anterior
The pectoralis minor and the serratus anterior protract the scapula
133
What can the pectoralis major, pectoralis minor and the serratus anterior also aid with
They can be accessory muscles for breathing because they attach to the ribs, hence they can move the ribs if needed
134
What is the clinical relevance of using the pectoralis major, pectoralis minor and serratus anterior for breathing
If you are using these muscles to aid breathing, when the humerus and scapula are fixed the patient could be in respiratory distress
135
What are rib fractures a result of
Blunt trauma to the chest wall
Eg- falls, RTC or assault.
136
When do rib fractures cause the most pain
Inspiration
137
How are isolated rib fractures treated
Isolated rib fractures are treated conservatively and so are left to heal on there own with adequate pain management
138
How are multiple rib fractures treated
Multiple rib fractures are more serious and complex to manage as irregular healing of the ribs may lead to dysfunctional movements of the chest wall and inadequate ventilation
139
What is shingles
Shingles is a common skin condition which presents with a red, painful and itchy rash normally over the chest and abdomen on only one side of the body
140
What part of the body does shingles affect
Shingles affects the dermatomes
141
What cause shingles
Shingles is caused but the reactivation of the herpes zoster virus in people who have previously had chicken pox. The virus will lay dominant in the dorsal root ganglion until reactivated
142
Why does shingles only cause a rah in one area
Shingles rash will only be present in the dermatome which is innervate by the single spinal nerve affected
143
Where does breast cancer spread to first
Breast cancer will typically spread to the axillary lymph nodes first because most lymph from the breast is drained to these nodes
144
How could you know if the breast cancer has spread to the axillary node
You would know as they could be a palpable lump which would be the inflamed node, this could be visible before the mass in the breast is noticed
145
What could occur if the axillary lymph nodes are removed due to the spread of the malignancy
If the axillary lymph nodes are removed it could lead to fluid accumulation and swelling due to the lymph from the upper limbs not been drained properly, this is known as lymphoedema
146
What are the spaces between the ribs known as
Intercostal spaces
147
What do the intercostal spaces contain
Three layers of intercostal muscles and their associated membranes
Intercostal neurovascular bundle made up of an intercostal nerve, artery and vein
148
Where do the muscles found in the intercostal spaces make attachments
The intercostal muscles make attachments to the rib which lies superiorly and inferiorly
149
What are the 3 layers of intercostal muscles
External intercostal
Internal intercostal
Inner most intercostal
150
Where is the external intercostal muscle found
The external intercostal is the most superficial of the intercostal layers
151
How are the fibres in the external intercostal layer arranged
The fibres are oriented antero-inferiorly
152
What is the function of the external intercostal layer
This muscle layer contracts pulls the ribs superiorly meaning it in most active during inspiration
153
What happens at the anterior of the intercostal space
At the anterior of the intercostal space the muscle becomes membranous and forms the external intercostal muscle
154
Where is the internal Intercostal found
The internal intercostal lies deep to the external intercostal
155
How do the fibres run in the internal intercostal
The fibres in the internal intercostal run perpendicular to the external intercostal and so run posterior-inferior direction
156
What is the function of the internal intercostal
The internal intercostal contracts and pulls the ribs inferiorly and so is most active during expiration
157
When does the internal intercostal become membranous
The internal intercostal becomes membranous in the posterior part of the intercostal space and forms the internal intercostal membrane
158
Where is the innermost intercostal found
The innermost intercostal is found in the posterior part of the intercostal space deep to the internal intercostal
159
How are the fibres in the innermost intercostal orientated
The fibres are orientated the same direction as the internal intercostal which is posterio-inferior
160
What lies deep to the innermost intercostal
The endothoracic fascia lies deep to the innermost intercostal
161
What does the endothoracic fascia lie superior to
The endothoracic fascia lies superior to the parietal pleura
162
Where is the parietal pleura found
The parietal pleura is found surrounding the lungs
163
Where is the neurovascular bundle found
The neurovascular bundle is found in each intercostal space which lies in the plane between the internal and innermost intercostal muscle
164
What does the neurovascular bundle supply
The neurovascular bundle supplies the intercostal muscle, overlying skin and the underlying parietal pleura
165
Where can the neurovascular bundle be found in the intercostal space
The neurovascular bundle lies in the inferior border of the rib which is superior to the intercostal space. It lies in the costal groove on the deep surface of the rib
166
Why is the location of the neurovascular bundle clinical important
It is clinically important because during the medical procedure such as placing a chest drain this involves piercing the intercostal space, the incision need to be made at the middle to lower part of the space to avoid the intercostal vessels and nerves
167
Where can the collateral branches be found
Collateral branches run in the same tissue plane but are located in the lower part of the intercostal space
168
What do the anterior and posterior intercostal arteries supply
The anterior and posterior intercostal arteries supply the anterior and posterior parts of the intercostal space
169
Where does the anterior intercostal arteries come from
The anterior intercostal branches from the internal thoracic artery, which is a branch of the subclavian artery
170
Where does the posterior intercostal arteries come from
The posterior intercostal arteries branch from the descending aorta in the posterior thorax
171
Where do the anterior intercostal veins drain to
The anterior intercostal vein drain to the internal thoracic vein
172
Where does the posterior intercostal vein drain to
The posterior intercostal vein drains to the anyhow system of veins
173
What type of nerves are the intercostal nerves
The intercostal nerves are somatic nerves
174
What do intercostal nerves composed of
Intercostal nerves contain motor and sensory fibres
175
What do the intercostal nerves innervate
The intercostal nerves innervate the intercostal muscles, skin of the chest wall and the parietal pleura
176
Do intercostal nerves contain sympathetic fibres….. yes or no
Yes
177
What is the pleurae
The pleurae is the two layers of membrane that cover the lungs and the structures passing into and out of the lungs including the pulmonary blood vessels and main bronchi
178
Where is the parietal pleura found
The parietal pleura is found lining the inside of the thorax
179
Where is the visceral pleura found
The visceral pleura is found on the surface of the lungs and extends in the fissures
180
What is found between the parietal and visceral pleura
The pleural cavity
181
Are the two layers of the pleura continuous?
Yes
182
What can be found in the pleural cavity
Within the pleural cavity houses cells which produce small amounts of pleural fluid
183
Why are the pleura and the pleural fluid important
They are integral mechanics of breathing
184
What are the parts of the parietal pleura
Cervical pleura
Costal pleura
Mediastinal pleura
Diaphragmatic pleura
185
What does the cervical pleura cover
The cervical pleura covers the apex of the lung
186
Where is the costal pleura found
Adjacent to the ribs
187
Where is the mediastinal pleura found
The mediastinal pleura is found lying adjacent to the heart
188
Where can you find the diaphragmatic pleura found
The diaphragmatic pleura is found lying adjacent to the diaphragm
189
What is the costodiaphragmatic recess
The costodiaphragmatic recess is a gutter around the periphery of the diaphragm where the costal pleura becomes continuous with the diaphragmatic pleura
190
What is found at the junction of the costal and mediastinal pleura
A smaller costomediastinal recess
191
What are the costodiaphragmatic and costomediastinal recesses there for
The recesses are potential spaces that the lungs expand into during deep inspiration
192
What is the parietal pleura innervated by
The parietal pleura is innervated by the intercostal nerves which innervate the overlying skin of the chest wall
193
What do nerve fibres in the parietal pleura carry
The somatic sensory fibres carry sensations to our consciousness, so injury to the parietal pleura can be painful which can occur by fractured ribs
194
What is the visceral pleura innervated by
The visceral pleura is innervated by autonomic sensory nerves known as visceral afferents
195
What are the lungs essential for
Lungs are the organs of gas exchange
196
What is the most superior of the lungs known as
The apex
197
Where does the apex rise to
The apex projects into the root of the neck above the clavicle
198
Where does the base of the lungs sit
The base of the lungs sit on the diaphragm
199
What are the oblique fissures
The oblique fissures are found in both the left and right lung, in the left lung it separates the superior and inferior lobes and in the right lung it separates the superior and middle lobes from the inferior lobe
200
What is the extra fissure that the right lung has
The right lung has a horizontal fissure which separates the superior lobe and the middle lobe
201
Where is the costal surface found
The costal surface is adjacent to the ribs
202
Where is the mediastinal surface found
The mediastinal surface is found adjacent to the heart
203
Where is the diaphragmatic surface found
The diaphragmatic surface is found on the inferior surface of the lung
204
What is the anterior border of the lung like
The anterior border of the lung is sharp and tapered
205
What is the posterior of the lung like
The posterior of the lung is thick and rounded
206
What is the inferior border of the lung like
The inferior border of the lung is sharp and tapered
207
Where can the rib markings be found
The rib markings can be found on the costal surface of both lungs
208
Where can indentations of the left ventricle be found
Indentations of the left ventricle can be found on the mediastinal surface of the left lung
209
Where can the indentations of the superior vena cava and azygos vein seen
The indentations of the superior vena cava and the azygos vein are seen on the mediastinal surface of the right lung
210
What does the root of each lung containing
The root of each lung contains the pulmonary artery, the pulmonary veins and the main bronchus
211
What is the hilum of the lung
The hilum of the lung is the region on the mediastinal surface where the pulmonary artery, pulmonary veins and the main bronchus enter and exit the lung
212
Are the positions of the pulmonary artery and the main bronchus the same in the left and right lung
No they are slightly different
213
What is the composition of the hilum in the right lung
The hilum of the right lung contains the main bronchus which lies anterior to the pulmonary artery the two pulmonary veins lie to the most anterior and inferior vessels
214
What is the composition of the hilum of the left lung
The hilum of the left lung contains the main bronchus lies inferior to the pulmonary artery and the two pulmonary veins are the most anterior and inferior vessels
215
How is the bronchial tree formed
The bronchial tree is formed by the bifurcation of the trachea at the level of the sternal angle
216
Describe the path of the right main bronchus
The right main bronchus is shorter wider and descends more vertically to that of the left main bronchus
217
What is the bronchial tree
The bronchial tree is the branching system of tubes that conducts air into and out of the lungs
218
What does each main bronchus divide into
Each main bronchus divides into lobar bronchi
219
How many lobar bronchi does the right lung have
The right lung divides into 3 lobar bronchi
220
How many lobar bronchi does the left lung have
The left lung is divided into two lobar bronchi
221
What does the lobar bronchus divide into
The lobar bronchus divides into segmental bronchi
222
How many segmental bronchi in each lung are there
There are 10 segmental bronchi in each lung
223
What is the function of each segmental bronchi
Each segmental bronchi supplies a functionally independent region of the lung called the bronchopulmonary segment
224
What do the bronchopulmonary segment divide into
The bronchopulmonary segment divides into the bronchioles
225
What is the function of the bronchioles
The bronchioles are small tubes that with each division become smaller, they conduct air to and from the alveoli
226
What is the function of the alveoli
Alveoli is the site of gas exchange within the lung
227
What is the wall of the trachea and bronchioles made from
The walls of the trachea contain smooth muscle and cartilage whereas the walls of the bronchioles contain just smooth muscle
228
What do the pulmonary arteries carry
The pulmonary arteries carry deoxygenated blood to the lungs
229
What supplies the lungs
The lungs are supplied by the bronchial arteries from the descending aorta
230
What do the pulmonary veins carry
The pulmonary vein carry’s oxygenated blood
231
How is venous blood returned from the lungs
The venous blood return bloody from the bronchial veins to the azygos system
232
What type of nerves innervate the lungs
Autonomic nerves innervate the lungs
233
What do parasympathetic fibres stimulate in the lungs
The parasympathetic fibres stimulates the constriction of the bronchial smooth muscle which is known as bronchioconstriction and they also stimulate the secretion from the glands in the bronchial tree
234
What do sympathetic fibres in the lungs stimulate
The sympathetic fibres in the lungs stimulate the relaxation of the bronchial smooth muscle known as bronchodilation and also inhibits the secretion from the glands in the bronchial tree
235
What fibres accompany the sympathetic and parasympathetic nerves of the lungs
The visceral afferents accompany the sympathetic and parasympathetic nerves
236
What is the function of the visceral afferents in the lung
The visceral afferents relay sensory information from the lungs and visceral pleura to the CNS but they do not reach our conscious perception
237
Where does lymph from the lungs drain into
The lymph drains into the venous system via the thoracic duct or right lymphatic duct
238
Where does the apex of each lung sit
The apex of each lung sits in the lowe neck superior to the medial end of the clavicle
239
Where is the inferior border of the lungs lies at
The 6th rib anteriorly
The 8th rib laterally
The 10th rib posteriorly
240
Where does the parietal pleura extent to
The parietal pleura extends to the
8th rib anteriorly
10th rib laterally
12th rib posteriorly
241
Where are the oblique fissures of both lungs found
The oblique fissures extend from the 4th rib posteriorly to the 6th costal cartilage anteriorly and the fissure runs deep to the 5th rib
242
Where can the horizontal fissure be found
The horizontal fissure extends anteriorly from the 4th costal cartilage and then intersects the oblique fissure
243
Where do you place a stethoscope to listen to the superior lobe of the lung
The stethoscope should be placed on the posterior of the chest wall to the markings of the oblique fissure
244
Where should we place the stethoscope to listen to the middle lobe
The stethoscope should be placed anteriorly or laterally
245
What are apertures
Apertures are openings in the diaphragm allowing the passage of structures between the thorax and abdomen
246
What are the structures that pass through the apatures
The structures include the aorta, the inferior vena cava, and the oesophagus
247
What attachments does the diaphragm make
The diaphragm is attached to the xiphoid process, costal margin, the top of the 11th and 12th rib and the lumbar vertebrae
248
What is the central part of the diaphragm known as
The central tendon
249
What happens to the diaphragm during inspiration
During inspiration the diaphragm contracts so the muscle fibres of the right and left domes are pulled towards the peripheral attachments causing the domes to flatten, this increases the intrathoracic volume from the lungs to expand
250
What happens to the diaphragm during expiration
During expiration the diaphragm relaxes and domes superiorly, this decreases the intrathoracic volume as such driving expiration of air from the lungs
251
What do the right and left phrenic nerves innervate
The right and left phrenic nerve innervate the right and left side of the diaphragm
252
What type of the nerves are the phrenic nerves
The phrenic nerves are the somatic nerves formed in the neck by fibres coming from the C3, C4 and C5 spinal nerves containing both motor and sensory fibres
253
What are the basic principles of ventilation
The muscles move the thoracic cage and change the dimensions
Changes in the intrathoracic cavity determine the intrathoracic volume
Changes in the intrathoracic volume alter intrathoracic volume
Pressure changes inside the thorax drive the processes of inspiration and expiration
Different muscles are used when the breathing is normal, vigorous or forced
254
Which dimensions change in the thoracic cavity during ventilation
Vertically- due to contraction and relaxation of the diaphragm
Laterally- due to contraction of the intercostal muscles which move the ribs
Anterior-posteriorly- due to the movement of the sternum secondary to the movement of the ribs
255
Why is the pleural fluid important in ventilation
The pleural fluid creates surface tension between the parietal pleura lining the thoracic cavity and the visceral pleura on the surface of the lungs
256
Why is surface tension important in the lungs
Surface tension keeps the lungs and thoracic wall together so when the thoracic cavity changes volume the lungs volume changes 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.
257
What happens if the surface tension is broken
If surface tension is broken, which can happen by a penetrating injury of the chest that punctures the parietal pleura and introduces air into the pleural cavity, known as a pneumothorax, ventilation may become dysfunctional.
258
Describe 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 dimensions of the thoracic cavity.
The lungs expand increasing the volume with the thoracic wall due to the surface tension
The pressure in the lungs decreases below atmospheric pressure and air becomes drawn into the lungs
259
Describe expiration
The diaphragm and external intercostal muscles relax and the internal intercostala contract which decreases the intrathoracic volume (the internal intercostals pull the ribs inferiorly and the ribs pull the sternum inferiorly and posteriorly, decreasing the dimensions of the thoracic cavity.
The lungs recoil and decrease in volume
The pressure inside the lungs increase above atmospheric pressure forcing air out of the lungs to be expelled
260
What muscles are involved during normal breathing
Normal breathing or quiet breathing- inspiration is active and driven by the diaphragm and expiration is passive
261
What muscles are used during vigorous breathing
Vigorous breathing or breathing during exercise- the intercostal muscles become important. Active expiration uses the internal intercostal muscles
262
What muscles are used during very vigorous breathing
Very vigorous breathing or forced breathing can be caused by an exacerbation of asthma or COPD- the accessory muscles of breathing will contribute to the movement of the ribs and aid ventilation
The accessory muscles are sternocleidomastoid, pectoralis major and minor and serratus anterior
263
What is pleuritic Chest pain
Pleuritic chest pain is when the pleura can become inflamed or injured which could occur by been torn by a fractured rib. The chest pain caused by this injury is typically vey sharp and localised, as will be worse on inspiration.
264
What is a pneumothorax or haemothorax
A pneumothorax is the presence of air in the pleura cavity, usually caused by trauma eg-torn by a fractured rib but can also occur spontaneously when a tear occurs in the visceral pleura. If air keeps entering the pleural cavity but cannot escape- this is known as a tension pneumothorax. The volume of air rapidly increases compressing the lung, heart and great vessels. Patients will present with severe respiratory distress.
A Haemothorax is a collection of blood in the pleural cavity occurring to secondary trauma when the blood vessels are torn or cut.
265
What is pleural effusion
Pleural effusion is the presence of excess fluid in the pleural cavity however this is not a diagnosis, the fluid could be pus from infection, blood or fluid related to malignancy.
A chest drain is used to remove air and or fluid from the pleural space. An incision is made in the lower part of the chosen intercostal space to avoid the neurovascular bundle which lies in the costal groove
266
What is mesothelioma
Mesothelioma is a malignancy of the pleura
267
Describe the primary and secondary lung cancer
Lung cancer can be primary which is cancer of the lung tissue or bronchi or it can be secondary which means that cancer from elsewhere in the body has metastasized to the lungs
268
What is a pulmonary embolism
Pulmonary embolism is a blood clot in the pulmonary circulation. The clot will form in deep veins in one of the lower limbs and is carried via venous circulation to the right side of the heart and so into the pulmonary trunk. The clot will either get lodged in either the pulmonary trunk or one of the pulmonary arteries which will cause severe respiratory distress and can become rapidly fatal. Small clots that form could occluded smaller pulmonary vessels which can cause infarction of the part of the lung they supply
269
What is dyspnoea
Dyspnoea is breathlessness or shortness of breath. When patients present with this respiratory distress by using the accessory muscles.
270
What happens during paralysis of the diaphragm
Injury to the phrenic nerve, the spinal nerves c3, c4 and c5 or c3, c4 and c5 spinal cord segments on one side may cause paralysis of the ipsilateral side of the diaphragm, but in a healthy person may cause no symptoms. If this happens over both sides of the diaphragm known as bilateral paralysis of the diaphragm the patient will require ventilation support
271
Where is the mediastinum located
The mediastinum is part of the thoracic cavity and lies between the lungs
272
What does the mediastinum contain
The mediastinum contains all the thoracic vescera apart from the lungs
273
Where does the mediastinum start and finish
The mediastinum extends from the superior thoracic apertures superior to the diaphragm inferiorly and the sternum anteriorly to the thoracic vertebrae posteriorly
274
What does the mediastinum contain
The mediastinum contains the
Heart and pericardium
The great vessels
The veins that drain the chest wall
The trachea
Main bronchi
The oesophagus
The nerves both somatic and autonomic
The lymphatics
The thymus gland
275
Describe the division in the mediastinum
The mediastinum is divided into superior and inferior compartments. The line between the two compartments runs from the sternal angle anteriorly to the t4/5 junction posteriorly
276
What is the inferior mediastinum divided into
The inferior mediastinum is further divided into a anterior, middle and posterior compartment
277
Where is the anterior mediastinum found
The anterior mediastinum lies between the posterior aspect of the sternum and the anterior aspect of the pericardial sac. This contains the thymus gland in children and the remnant of that gland in adults
278
Where is the middle mediastinum located
The middle mediastinum contains the heart inside the pericardial sac, the pulmonary trunk and the ascending aorta
279
Where is the posterior mediastinum located
The posterior mediastinum lies between the posterior aspect of the pericardial sac and the vertebrae
280
What are the main contents of the superior mediastinum
The main contents are
The arch of the aorta and its 3 branches
The superior vena cava and it tributaries the left and right brachiocephalic veins
Trachea
Oesophagus
Phrenic nerves left and right
Vagus nerves
Thoracic duct
Thymus gland
281
Where is the aorta found
The aorta is found leaving the left ventricle carrying oxygenated blood to the systematic circulation
282
What are the 3 parts of the aorta found in the thorax
The ascending aorta
The arch of the aorta
The descending aorta
283
What is the ascending aorta
The ascending aorta is the short first part of the aorta, this part gives rise to the coronary arteries which supplies the myocardium
284
What is the arch of the aorta
The arch of the aorta curves posteriorly which lies superior to the mediastinum
285
What is the descending aorta
The descending aorta also known as the thoracic aorta descends through the posterior mediastinum and into the abdomen posterior to the diaphragm
286
What does the arch of the aorta give rise to
The arch of the aorta gives rise to the 3 major branches that supply the upper body
287
What are the 3 major vessels that supply the upper body
The brachiocephalic trunk this bifurcates into the right common carotid artery
The left common carotid artery
The left subclavian artery
288
What does the brachiocephalic trunk serve
The brachiocephalic trunk bifurcates into the right common carotid artery which supplies the right side of the head and neck and the right subclavian artery which supplies the right upper limb
289
What does the left common carotid artery serve
The left common carotid artery supplies he left side of the head and neck
290
What does the left subclavian artery serve
The left subclavian artery supplies the left upper limb
291
What is found in the aortic bodies in the arch of the aorta
In the arch of the aorta the aortic bodies houses the chemoreceptors
292
What is the function of the chemoreceptors
The chemoreceptors constantly monitor the arterial oxygen and carbon dioxide, the information from the visceral sensory fibres travel back to the CNS along the vagus nerve resulting in a reflex response that regulates ventilation
293
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
294
What is the ductus arteriosus
The ductus arteriousus is found in foetus and is the site of gas exchange. The ductus arteriousus diverts most of the blood entering the pulmonary trunk directly to the aortic arch and is so a circulatory shunt. Once the baby begins to use there lungs at birth the ductus arteriousus closes and so the pulmonary trunk enters the lungs
295
What are the 2 main veins that enter the heart
The 2 main veins entering the heart are the superior and inferior vena cava
296
What is the function of the superior vena cava
The superior vena cava returns blood to the heart from the head neck and upper limbs
297
Where is the superior vena cava found
The superior vena cava and its tributaries lie in the superior mediastinum
298
How is the superior vena cava formed
The superior vena cava i formed by the Union of the left and right brachiocephalic veins (veins in the arm and head)
299
How is the brachiocephalic vein formed
The brachiocephalic vein is formed by the union of the internal jugular vein and subclavian vein
300
What is the function of the inferior vena cava
The inferior vena cava returns blood to the heart from all regions inferior to the diaphragm
301
Where does the inferior vena cava come from
The inferior vena cava is very short and as soon as it enters the thorax via the inferior mediastinum through the diaphragm and it enters the right atrium
302
What is the function of the trachea
The trachea conducts air to and from the left and right bronchi
303
What is the trachea made up of
The trachea contain c-ring shaped cartilage which are incomplete
304
Where is the trachea found
The trachea extends from the larynx in the midline of the neck into the superior mediastinum and it palpable just superior to the suprasternal notch. The trachea ends at the level of the sternal angle and the junction of T4 and T5 and bifurcates into the left and right bronchi
305
What is the oesophagus composed of
The oesophagus is made of smooth muscle
306
Where is the oesophagus located
The oesophagus extends from the pharynx in the midline of the neck to the stomach
307
How does the oesophagus move food
Food and fluid move distal due to waves of contractions of the smooth muscles of the oesophageal wall this is known as peristalsis
308
How are the left and right phrenic nerves formed
The left and right phrenic nerves are formed from the C3, C4 and C5 spinal nerves which innervate the diaphragm
309
What nerve fibres make up the phrenic nerves
The phrenic nerves are somatic nerves, containing motor and sensory fibres
310
Describe the course of the phrenic nerves
The phrenic nerves descend through the neck and enter the thorax through the superior thoracic aperture. They course over the pericardium and pierce the diaphragm
311
Where do the left and right vagus nerves arise from
The left and right vagus nerves arise from the brainstem
312
What nerve fibres do the vagus nerves contain
The vagus nerves contain somatic sensory, somatic motor and parasympathetic fibres
313
What do the nerve fibres of the vagus nerves innervate
They innervate the thorax and abdomen as well as the head and neck.
314
Describe the course of the vagus nerves
The vagus nerves descend through the neck alongside the internal carotid artery and internal jugular vein and then enter the thorax through the superior thoracic aperture. Each nerve gives rise to the recurrent laryngeal nerve, which ascends back up into the neck to innervate muscles of the larynx. The 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. 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. The vagus nerves descend in the thorax posterior to the root of the lung. These nerves contribute to the parasympathetic fibres to the heart, lungs and oesophagus. They traverse the diaphragm and convey parasympathetic fibres to most of the abdominal viscera.
315
What is the thoracic duct
The thoracic duct is a major channel for lymphatic drainage from most region of the body
316
Describe the course of the thoracic duct
The thoracic duct 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
317
What is the thymus gland
The thymus gland is a lymphoid organ
318
Where is the thymus gland found
The thymus gland is found lying anteriorly in the superior mediastinum.
The thymus gland will only be found in children as with age it becomes fatty
319
What is the pericardium
The pericardium is a tough fibrous sac that encloses the heart like a loose fitting bag
320
Why is the pericardium loose
The pericardium is loose around the heart to allow for movement of the heart within it
321
How many layers does the pericardium have
The pericardium has 2 layers
322
What is the outer layer of the pericardium
The outer layer of the pericardium is made up of a tough outer fibrous layer that attaches superiorly to the great vessels and inferiorly to the central tendon of the diaphragm
323
What is the inner layer of the pericardium
The inner of the pericardium is a thin inner serous layer which has 2 parts, the parietal layer that lines the inner aspects of the fibrous pericardium and the visceral layer that covers the surface of the heart, these two layers are continuous with each other
324
What is the pericardial cavity
The pericardial cavity is the narrow space between the two layers of the serous pericardium
325
What is the pericardial fluid
The pericardial fluid is found in the pericardial cavity that lubricates the serous membranes and allows them to slide over each other with movements of the heart
326
What nerve fibres innervate the fibrous pericardium
The left and right phrenic nerves give rise to branches that innervate the fibrous pericardium
327
What is the point of the heart called
The point of the heart is the apex
328
Where is the apex of the heart located
The apex of the heart is found to the left of the sternum towards the left lung
329
What is the base of the heart
The base of the heart is the posterior surface as it faces posteriorly
330
What is the inferior surface of the heart
The inferior surface of the heart is also known as the diaphragmatic surface as it lies on the central tendon of the diaphragm
331
What is the anterior surface of the heart
The anterior of the hear also known as the sternocostal surface as it faces the sternum and ribs
332
What are the left and right sides of the borders
The left and right borders also known as the pulmonary surfaces as they face the lungs
333
What does the posterior surface of the heart correspond to
The left atrium and part of the right atrium
334
What does the diaphragmatic surface of the heart correspond to
The left ventricle and part of the right ventricle
335
What does Sternocostal surface of the heart correspond to
The right ventricle
336
What does the left pulmonary surface correspond to
The left ventricle
337
What does the right pulmonary surface of the heart correspond to
The right atrium
338
How is the apex of the heart formed
The apex of the heart is formed by the left ventricle in the 5th intercostal space in the mid Clavicular line which is where the apex beat can be palpable
339
What is the right border of the heart
The right border is the right atrium
340
What is the left border of the heart
The left border is the left ventricle
341
What is the inferior border of the heart
The inferior border is the right ventricle and part of the left ventricle
342
Where is the right border found
The right border lies lateral to the right sternal edge from the right 3rd costal cartilage to the right costal cartilage
343
Where is the left border found
The left border is found extending from the left 2nd intercostal space to the 5th intercostal space in the mid Clavicular line, the apex
344
Where is the superior border found
The superior border lies along the line connecting the superior extents of the right and left borders, from the right 3rd costal cartilage to the left 2nd intercostal space
345
Where is the inferior border found
The inferior border of the heart lies along the line connecting the inferior end of the right border with the he apex mostly formed by the right ventricle
346
What are the auricles
The auricles or auricular appendages are the outpouchings from the walls of the right and left atria. They are named because of the ear-like appearance
347
Where do you find the major arteries that supply the heart
They lie in the grooves or sulci on the external surface of the heart
348
What is patent ductus arteriosus
The ductus arteriosus usually closes immediately after birth but in some cases it doesn’t close and will remain open or patent. After birth the pressure in the aorta exceeds the pressure in the pulmonary trunk and so the blood flows through the patent ductus arteriosus from the aorta into the pulmonary trunk. Over time the high pressure in the vessels of the lungs which strains the right side of the heart
349
What courses hoarseness of the voice
Cancer at the apex of the lung may involve recurrent laryngeal nerve, which supplies most of the muscles of the larynx. The nerve injury results in weakness or paralysis of the ipsilateral intrinsic laryngeal muscles which move the larynx and vocal cords . The hoarseness results due to the patient can no longer fully adduct their vocal cords
350
What is pericardial effusion
Pericardial effusion is an increase of fluid in the pericardial space, which can result from inflammation of the pericardium known as pericarditis, or an accumulation of blood due to trauma, this can also be fatal because the pericardium cannot stretch and so the heart is compressed and unable to fill properly and is known as cardiac tamponade
351
Where do the left and right coronary arteries arise from
The left and right coronary arteries arise from the ascending aorta and give rise to several branches
352
What does the cardiac veins do
The cardiac veins return venous blood to the coronary sinus which enters the right atrium
353
What does the right coronary artery and its branches supply
The RCA supplies part of the conducting system of the heart, the right atrium, the right ventricle, part of the left ventricle and part of the interventricular septum
354
What are the main territories that the right coronary artery supply
The RCA branches to the sinoatrial node and the atrioventricular node
The right marginal artery supplies the inferior border of the heart
The posterior inter ventricular artery is the continuation of the right coronary artery on the diaphragmatic surface of the heart, it runs in the posterior interventricular sulcus and supplies both ventricles
355
What does the left coronary artery and its branches supply
The LCA and its branches 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 septum
356
What is the short segment of the left coronary artery
The short segment of the left coronary artery is the left main stem
357
What are the two terminal branches of the left coronary artery
The two terminal branches of the left coronary artery are the anterior interventricular artery or the left anterior descending and the circumflex artery
358
What are the territories the left coronary artery supplies
The left coronary artery and its branches supply
The anterior interventricular artery runs in the anterior interventricular sulcus towards the apex which supplies both ventricles
One or two branches arise from the anterior interventricular artery
The circumflex artery runs around the heart onto the diaphragmatic surface, it supplies the left atrium, part of the right ventricle and the left ventricle
The left marginal artery arises from the circumflex and supplies the left ventricle
359
What is the posterior interventricular artery
The posterior interventricular artery supplies a significant portion of the left ventricle and will arise from either the left or right coronary artery.
360
What determines whether you have a right or left dominant circulation
The origin of the posterior interventricular artery will determine if you have a right or left dominated circulation
361
What is the right dominant circulation
If a person has a right dominant circulation the posterior interventricular artery arises from the right coronary artery. In these people both the right and left coronary arteries supply the left ventricle
362
What is a left dominant circulation
If a person as a left dominant circulation it means the posterior interventricular artery arises from the circumflex artery which means the left coronary artery supplies the whole left ventricle
363
Why is if a person has a left or right dominant circulation clinically important
It is important as if someone with a right dominated circulation has occlusions of the left coronary artery would impair blood flow to part of but not all of the left ventricle, however if someone has occlusions in the left main stem, and has a left dominant circulation the entire left ventricle would have no blood flow
364
Why are the 4 chambers of the heart different
The 4 chambers of the heart are anatomically different due to the functions been different and them arising from different tissues and structures during embryonic development
365
What are the function of heart valves
The function is the heart valves is to ensure unidirectional flow of blood through the chambers of the heart
366
What does the right atrium do within the heart
The right atrium receives deoxygenated blood from the body via the superior and inferior vena cava and from the heart via the coronary sinus
367
What are the main features of the right atrium
The internal features are
The internal septum- seperates the right and left atrium
Fossa ovalis - a depression in the inreratrial septum, remnant of the foetal foramen ovale which shunted oxygenated blood from the right atrium to the left atrium bypassing the lungs
Crista terminalis- are muscular ridges that seperates the smooth walled posterior part of the atrium from the anterior part which has ridged muscular walls. The ridges are pectinate muscles and extend to the right auricle. The parts of the right atrium on either side of the crista have different embryological origins
368
Where does the blood flow after the right atrium
After the right atrium blood flows into the right ventricle via the tricuspid valve which is a atrioventricular valve. The blood flow is mostly passive but it does contract to empty fully
369
What is the function of the right ventricle
The right ventricle pumps deoxygenated blood from the right atrium into the pulmonary trunk.
370
Where does the blood flow from the pulmonary trunk
The blood flows from the pulmonary trunk to the lungs via the pulmonary artery
371
What are the internal features of the right ventricle
The right ventricle has
Interventricular septum- separates the left and right ventricle
Trabeculae Carneae- muscular ridges on the internal wall
Papillary muscles- modified regions of trabeculae carneae whcih projects into the lumen of the ventricle
Chordae tendineae- fibrous cord which connects the tip of the papillary muscles to the tricuspid valve
Moderator band- a modified region of the trabeculae carneae which connects the interventricular septum to one of the papillary muscles
372
What is the function of the left atrium
The left atrium receives oxygenated blood from the lungs via the pulmonary veins
373
What characteristics does the left atrium have
The left atrium has a thinner wall to what the ventricles have and has a smooth walled posterior, the anterior wall having pectinate muscles
374
Where does the blood flow to from the left atrium
From the left atrium the blood flows through the mitral valve which is another atrioventricular valve, into the left ventricle. The left atrium pumping blood into the left ventricle is passive but does contract to fully empty
375
What is the function of the left ventricle
The left ventricle receives oxygenated blood from the left atrium and pumps this through the aortic valve into the aorta to travel to the rest of the body
376
What does the aorta bifurcate into to
The first bifurcation is that of the aorta and the coronary arteries
377
What characteristics does the left ventricle have
The left ventricle has a thicker wall due to it propelling the pump to the rest of the body
378
What internal features does the left ventricle have
The left ventricle internally contains
Trabeculae carneae
Papillary muscles- 2 in the left ventricle
Chordae tendineae- that connects the tips of the papillary muscles to the mitral valve
379
What is it known as when the ventricles contract
When the ventricles contract this is known as ventricular systole
380
What happens to the tricuspid and mitral valve when the ventricles contract
When the ventricles contract the pressure rises inside them which does have the potential to cause the blood to flow back into the atrium, however both valves close when the ventricle contract which prevents the regurgitation of blood back into the atria which ensures that all the blood will flow into the great vessels
381
What is the important function of the papillary muscles and the Chordae tendineae
The papillary muscles and the chordae tendineae are important for the functioning of the atrioventricular valves. They do not close the valves but they allow the valves to stay closed while the ventricles contract, aiding the valves to withstand the pressure increase in the ventricles and stop them been forced back open.
382
When do the atrioventricular valves begin to close
The atrioventricular valves begin to close passively when the pressure rise in the ventricles. When the ventricles contact the papillary muscles also contract, they tense the cords which in turn pull on the valve cusps and prevent them entering the atria
383
What valves are the semilunar valves
The aortic valve and the pulmonary valve
384
What is the role of the semilunar valves
The role of the semilunar valves prevents the back flow of blood into the ventricles from the pulmonary trunk and the aorta
385
How many cusps does a semilunar valve have
A semilunar valve has 3 cusps each attached to the inner wall of the vessel with a free edge that projects into the vessel lumen, each cusp forms a pocket or sinus between the free edge and the vessel wall
386
What happens to the semilunar valve cusps during ventricular systole
When the ventricles contract during ventricular systole the valve cusps are flattened onto the vessel wall and the blood flows through into the great vessels. At the end of ventricular systole the pressure drops the blood in the vessel will begin to flow back to the heart but is caught in the valve cusps. The sinuses will quickly fill and so balloon into the lumen. The free edges of the cusps contract and close the valve orifice
387
Where do the right and left coronary arteries arise from
The right and left coronary arteries arise from 2 of the aortic sinuses, which is why the coronary arteries fill during ventricular diastole
388
What are abnormal heart sounds known as
Abnormal heart sounds are known as murmurs
389
What is the sound we hear through a stethoscope
What we hear through the stethoscope is the sound of the valve closing transmitted in the direction of blood flow
390
What is the aortic valve auscultatory area
The 2nd intercostal space just right of the sternum
391
What is the pulmonary valves auscultatory area
The 2nd intercostal space just left of the sternum
392
What is the tricuspid valves auscultatory area
The 5th intercostal space just left of the sternum
393
What is the mitral valve auscultatory area
The 5th intercostal space mid Clavicular line
394
Where does the conducting system of the heart begin
The conducting system of the heart begins at the sinatrial node
395
What is the function of the sinoatrial node
The sinoatrial spontaneously generates electrical impulses
It is known as the pacemaker of the heart
396
Where is the sinoatrial node located
The sinoatrial node is located at the superior end of the crista terminalis
397
How many impulses does the sinoatrial node generate per minute on average
70 per minute
398
Where do the impulses generated by the sinoatrial node travel to
The impulses travel to the atrioventricular node
399
What does the impulse generated by the sinoatrial node stimulate
The impulse generated by the sinoatrial node stimulates the contraction of the atria
400
Where is the atrioventricular node located
The atrioventricular node is located at the inferior of the interatrial septum
401
From the atrioventricular node what is formed
Conducting fibres form the atrioventricular bundle or the bundle of His
402
What happens to the atrioventricular bundle
The atrioventricular bundle divides into 2 groups the right and left bundle branches
403
What do the left and right bundle branches give rise to
They give rise to the purkinje fibres
404
Where do the purkinje fibres go
The purkinje fibres enter the myocardium on the left and right ventricles
405
What is the role of the purkinje fibres
They stimulate contraction of the ventricles
406
What is the sinoatrial node supplied by
In 60% of people the sinoatrial node is supplied by the right coronary artery
But
In 40% of people the sinoatrial node is supplies by the left coronary artery
407
What is the atrioventricular node supplied by
The atrioventricular node is supplied by the posterior interventricular artery which arises from the right coronary artery
408
What supplies the bundles of His
The bundle of His is usually supplied by the left coronary artery
409
What can occlusions of the coronary arteries cause
Occlusions of either coronary arteries can result in conduction abnormalities and myocardial ischaemia
410
What nerve fibres innervate the heart
Both sympathetic and parasympathetic fibres innervate the heart
411
What do the sympathetic and parasympathetic fibres act on
They act on the sinoatrial node to change the rate of the myocardial contraction
412
How does sympathetic fibres act on the sinoatrial node
The sympathetic stimulation increase the heart rate and force of contraction
413
How does parasympathetic fibres act on the sinoatrial node
They will act upon the sinoatrial node by slowing the heart rate and the force of the contraction
414
What do visceral afferents do in the heart
The visceral afferents within the heart transmits sensory information from the heart to the CNS which usually doesn’t reach our conscious perception, but if the myocardium is ischaemic the information will reach or conscious perception in the term of pain, burning, tightness or pressure in the chest
415
What is a myocardial infarction
Myocardial infarction is the death of a region of the myocardium due to a occlusion of one of the coronary vessels. Most commonly it is caused by atherosclerosis within them. A fatty plaque in the artery may grow until it narrows the lumen and restricts the blood flow.
416
What is valve dysfunction
The valves in the heart can also become narrowed or incompetent. This would allow regurgitation of blood back into the atrium or ventricles. This turbulent blood flow would cause murmurs. Some valve dysfunction is congenital and so the person was born with it or it could be acquired.
417
What is cardiomyopathies
Cardiomyopathies is a disease of the myocardium and mostly are inherited, some cause the myocardium to become thin some cause it to become thick and stiff. This effects the hearts ability to pump efficiently which can lead to heart failure. There are no obvious symptoms but can cause sudden cardiac death
418
What are conducting system abnormalities
Myocardial infarction can cause conduction disturbances if the vessels that supply the conducting system are affected. Some have no symptoms. Some can be fatal but can be managed by fitting a pacemaker
419
What is heart failure
Heart failure is when the heart is unable to pump properly, which could be due to dysfunctional heart valves or the ability of the pericardium to contract properly. Symptoms can include shortness of breath and leg swelling
420
What is a cardiac arrest
Cardiac arrest is the cease of cardiac contraction, and the heart does not contract
421
What is the mediastinum made up of
The mediastinum is made up of the superior and inferior mediastinum
422
Where does the superior and inferior mediastinum seperate
The superior and inferior separate at the junction of T4/T5 posteriorly
423
When does the trachea bifurcate
The trachea bifurcates at the same level the mediastinum splits into the superior and inferior, this is at the T4/T5 junction
424
How many subdivisions does the inferior mediastinum divide into
3
425
What are the subdivisions of the inferior mediastinum
Anterior, middle and posterior
426
Where is the location of the posterior mediastinum
The posterior mediastinum is located behind the heart and pericardium
427
What does the posterior mediastinum contain
The posterior mediastinum contains the descending thoracic aorta, azygos veins, oesophagus, thoracic duct, sympathetic trunk and splanchnic nerves and the posterior intercostal vessels and nerves
428
What is the descending thoracic aorta
The descending thoracic aorta is the part of the aorta which descends through the posterior mediastinum
429
What are the branches of the descending aorta
The branches of the descending aorta are
The 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
430
At what level does the descending aorta pass through the diaphragm
The descending aorta pass through the diaphragm at the level of T12 of the thoracic vertebrae
431
At what level do the azygos system arise out the abdomen through the diaphragm
The azygos system of veins arise out the abdomen through the diaphragm at the level of L1/L2 into the posterior mediastinum
432
What is the function of the azygos system of veins
The azygos system of veins drain blood from the posterior thoracic wall and return it to the superior vena cava
433
Where is the azygos veins located
The azygos veins are located on the bodies of the thoracic vertebrae
434
What does the azygos system of veins comprise of
The system typically comprises of a azygos vein on the right side of the vertebral bodies, a smaller and shorter hemiazygous vein on the left side of the body and one or more veins connecting the veins to each other
435
Where does the azygos system receive blood from
The azygos system receives blood from the posterior intercostal veins, oesophageal veins and the bronchial veins
436
Where is the oesophagus located
The oesophagus is located in the posterior mediastinum at the right of the aorta
437
What is the oesophagus supplied by
The oesophagus is supplied by the oesophageal arteries which arise from the descending aorta
438
What control is the smooth muscle under in the oesophagus
Autonomic control
439
At what level does the oesophagus pass through the diaphragm
The oesophagus passes through the diaphragm at the level of T10
440
What is the location called where the oesophagus passes through the diaphragm
The oesophageal hiatus is where the oesophagus passes through the diaphragm
441
What is the function of the thoracic duct
The thoracic duct returns most of the body’s lymph to the venous system
442
What is the location of the thoracic duct
The thoracic duct lies between the azygos vein and the aorta
443
Where does lymph from the lower limbs, pelvis and abdomen flow towards
All lymph from the lower limbs, pelvis and abdomen flows towards the cisterns Chyli
444
What is the cisterna chyli
The cisterna chyli is a sac like swelling that gives rise to the thoracic duct which ascends into the thorax
445
When the cisterna chyli rises into the thoracic cavity what does the duct receive
When the cisterna chyli rises into the thoracic cavity and becomes the thoracic duct it receives lymph from the intercostal spaces and the lymph nodes
446
Where does the thoracic duct arise to after receiving lymph from the intercostal spaces and lymph nodes
The duct arises into the neck
447
When the thoracic duct enters the neck what does it receive
When the thoracic duct enters the neck it receives the lymph from the left side of the head neck and left upper limb
448
Where does the thoracic duct terminate
The thoracic duct terminates by opening into the venous system
449
Where does the opening of the venous system lie with the thoracic duct
The opening into the venous system and the thoracic duct lies at the junction between the left jugular vein and the left subclavian vein
450
Where does the right side lymph drain to
The right side lymph drains from the head, neck and right upper limb into the venous system by the lymphatic ducts
451
Where do the lymphatic ducts join the venous system
The lymphatic ducts join the venous system at the junction of the right internal jugular and the right subclavian vein
452
Where do the sympathetic trunks lie
The sympathetic trunks lie on the posterior thoracic wall either side of the vertebral column and posterior to the parietal pleura
453
What are the sympathetic trunks
The sympathetic trunks are thin, longitudinal fibres which. Are interspersed with ganglia
454
What is a ganglion
A ganglion is a collection of cell bodies outside the CNS
455
What are the ganglia within the sympathetic trunks referred to
The ganglia within the sympathetic trunks are sometimes referred to as paravertebral ganglia
456
Why are the ganglia in the sympathetic trunk known as the paravertebral ganglia
They are known as the paravertebral ganglia as they lie alongside the vertebral column
457
Where do the sympathetic trunks run from and to
They run from the base of the skull to the coccyx
458
Where can you find the cell bodies of the preganglionic sympathetic neurons
They lie in the thoracic and upper lumbar spinal segments from T1-L2/L3
459
Where do the visceral motor fibres leave the spinal cord
They leave the spinal cord from the ventral aspect
460
Where do the visceral motor fibres enter the spinal nerves
The visceral motor fibres enter the spinal nerves at T1-L2/L3 along with somatic motor nerves
461
How do the sympathetic fibres reach all parts of the body
The sympathetic fibres reach all parts of the body by the sympathetic trunks
462
How to the sympathetic trunks aid the sympathetic fibres in reaching all parts of the body
The preganglionic sympathetic fibres exit the spinal cord in spinal nerves via T1-L2/L3 and will almost immediately separate from the spinal nerves which then enter the sympathetic trunk via short connect branches known as white ramus communicants. From there the preganglionic axon the fibre will either
1- synapses in the ganglion at the level of entry
2- ascends/descends in the trunk before synapsing in a ganglion
3- travel through a ganglion and the trunk without synapsing
If the route follows 1 or 2 the postganglionic axon leaves the ganglia and enters the spinal nerves via the communicating branches known as the grey ramus communicans. Through this the sympathetic fibres enter all 31 pairs of the spinal nerves.
From this they form visceral nerves that convey the sympathetic fibres to the head and to the thoracic viscera which are cardiopulmonary splanchnic nerves
463
What are the abdominopelvic splanchnic nerves
They are the
-greater splanchnic nerve- which are sympathetic preganglionic fibres which originate from T5-T9 segments of the spinal cord
-lesser splanchnic nerve which originates from T10-T11 segments of the spinal cord
-least splanchnic nerve which originates from the T12 segment of the spinal cord
-lumbar splanchnic nerves which originates from the L1-L2 segment of the spinal cord
464
Where are the greater, lesser and least splanchnic nerves formed
They are formed in the posterior mediastinum and go down through the diaphragm into the abdomen
465
What does the posterior intercostal space contain
The posterior intercostal space contains an intercostal muscle, posterior intercostal artery which comes from a branch of the thoracic aorta, a posterior intercostal vein which drains into the azygos system and a posterior intercostal nerve
466
What is the thoracic viscera innervated by
It is innervated by both sympathetic and parasympathetic fibres
467
What do the cardiopulmonary splanchnic nerves convey
Cardiopulmonary splanchnic nerves covey postganglionic sympathetic fibres to the thoracic viscera
468
What does the vagus nerve convey
The vagus nerve conveys parasympathetic fibres to the thoracic viscera
469
What do the sympathetic and parasympathetic fibres form around the throacic viscera
The sympathetic and parasympathetic fibres form autonomic plexuses around the throacic viscera
470
What does the word plexus mean
Plexus comes from the Latin for the braid or plait and is not specific to nerves but also describes the network of veins and arteries
471
What are the plexus found in the thorax
Cardiac plexus
Pulmonary plexus
Oesophageal plexus
472
What does the cardiac plexus innervate
The cardiac plexus innervates the sinoatrial node of the heart , the sympathetic fibres innervate the heart rate and force contraction whilst the parasympathetic fibres decrease the heart rate and force the contraction
473
What does the pulmonary plexus innervate
The pulmonary plexus innervates the bronchi, the sympathetic fibres stimulate the relax of the bronchi known as bronchidialation and the parasympathetic fibres stimulate the constriction of the bronchi known as bronchiconstriction
474
What does the oesophageal plexus innervate
The oesophageal plexus innervates the anterior surface of the oesophagus the sympathetic fibres stimulate the inhibition of peristalsis and the parasympathetic fibres stimulate peristalsis
475
What do visceral afferents do in the thoracic viscera
Visceral afferents relay the sensory information from the viscera to the CNS along the paths of the vagus nerve and the thoracic splanchnic nerves
476
What type of pain do patients have who are having angina or a myocardial infarction
The cardiac pain felt during these episodes is not felt coming from the heart instead it is normally felt in the central chest left side of the neck and left arm which is known as referred pain
477
What is referred pain
Referred pain is pain from one part of the body but is felt in another region
478
What is the heart innervated by
The heart is innervated by the cardiac plexus
479
What is the cardiac plexus composed of
The cardiac plexus is composed of both sympathetic and parasympathetic fibres, the sympathetic fibres travel to the cardiac plexus and heart from the spinal cord segments T1-T5 via the cardiopulmonary splanchnic nerves
480
What do viscera sensory nerves do within the heart
The visceral sensory nerves innervate the heart and convey sensory information from the heart back to the CNS which doesn’t reach our conscious perception
481
When would the sensation that the visceral sensory nerves convey reach our conscious perception
The sensation would reach our conscious perception is the myocardium was ischaemic and would be interpreted as pain, tightness, crushing pressure or burning
482
Where do the visceral sensory nerves travel back to the CNS and enter the spinal cord where?
They enter the spinal cord at segments T1-T5
483
Where do the somatic sensory nerves innervate
They innervate the chest wall, neck and arm
484
Where do the somatic sensory nerves enter the spinal cord
They enter the spinal cord segments T1-T5
485
Why is cardiac pain felt in the chest, neck and arm
Cardiac pain is felt in the chest, neck and arm due to both the visceral sensory nerves and the somatic sensory nerves enter the same spinal segments
486
Apart from cardiac pain what is another example of referred pain
Another example of referred pain is pain from the diaphragm. The cervical spinal cord segments C3-C5 contribute spinal nerves to the phrenic nerve. The spinal cord segments C3-C5 also contribute nerves to the skin of the neck and shoulders, so the brain interprets pain coming from the diaphragm as pain coming from the neck and shoulders
487
What is aortic dissection
Aortic dissection is a longitudinal tear in the wall of the aorta that allows blood to collect between the intima and media, this can happen to either the ascending, arch or descending. It’s onset is typically rapid severe chest pain as instead of the blood flowing through the true lumen, the blood will flow through the false lumen created from the tear
488
What is horners syndrome
Horners syndrome is the presentation of 3 different signs- small pupil(mitosis), a drooping eyelid(ptosis) and lack of sweating(anhidrosis) on one side of the face. This is caused by interruptions to the sympathetic nerves that innervate the head. A cancer in the apex of the lung that invades the sympathetic chain can cause this on the ipsilateral side of the body.
489
What is a hiatus hernia
A hiatus hernia the abdominal segment of the oesophagus which is inferior to the diaphragm and part of the stomach moves proximally through the oesophageal opening in the diaphragm into the chest. Symptoms could be heartburn and acid reflux
490
Why is the neck prone to injury and very vulnerable
The neck is prone to injury due to the cervical spine been flexible and the neck slender to allow optimal positioning of the head. Due to the neck been a small region all the structures are packed into a small space with very little protection making it extremely vulnerable
491
What does the neck contain
The neck contains
-The 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 neck and brain
-nerves- that serve the head, neck , upper limbs, thorax-abdominal viscera and the diaphragm
- Several groups of muscles- these help to move the head and neck, the larynx in speech and swallowing and the floor of the mouth
492
How many cervical vertebrae do we have
7
493
What do the cervical vertebrae articulate with
The cervical vertebrae articulate with each other
494
What joints do the cervical vertebrae articulate with each other at
They articulate at facet joints
495
How are the facet joints orientated
They are orientated obliquely
496
Why does the orientation of the facet joints in the cervical spine matter
It matter as this way they have a good range of flexion and extension in comparison to that of the thoracic spine
497
What is the hyoid bone
The hyoid bone is a slender bone which helps to keep the pharynx open and provides attachments for several muscles in the head and tongue
498
Where is the hyoid bone found
The hyoid bone is found in the anterior of the upper neck and inferior to the mandible
499
What is the larynx
The larynx is your voice box
500
What is the larynx composed of
The larynx is composed of a Shelton of small cartilages connected by membranes and small joints
501
What is the function of the larynx
The larynx protects the airway
502
How do the vocal cords move
The vocal cords move due to muscles attaching to the laryngeal cartilages and moving them in turn moving the vocal cords and allowing phonation
503
What is the anterior and posterior triangles of the neck seperated by
They are seperated by the sternocleidomastoid
504
What does the sternocleidomastoid muscle attach to
The sternocleidomastoid muscle attaches to the sternum, clavicle and the mastoid process which is part of the temporal Bone
505
What is the sternocleidomastoid muscle innervated by
The sternocleidomastoid muscle is innervated by the accessory nerve or the cranial nerve XI
506
What are the boundaries of the anterior triangle
The boundaries of the anterior triangle are
Anteriorly- the midline of the line
Posteriorly- the anterior boarder of the sternocleidomastoid
Superiorly- the lower border of the mandible
507
What does the anterior triangle contain
The trachea and larynx
The thyroid gland, parathyroid glands and the submandibular salivary gland
The suprahyoid muscles whcih connect the hyoid to the skull
The infrahyoid muscles also known as strap muscles which connect the hyoid to the sternum and scapula
The common carotid artery and its terminal branches
The branches of the external carotid artery
The internal jugular vein
Branches of the facial vein CN VII
Glossopharyngeal nerve CN IX
Vagus nerve CNX
The accessory nerve CN XI
Hypo gloss all nerve CN XII
Anna cervicalis
508
What are the boundaries of the posterior triangle
The boundaries of the posterior triangle are
Anteriorly- the posterior border of the sternocleidomastoid
Posteriorly- the anterior border of the trapezius
Inferiorly- the clavicle
509
What is the apex of the triangle
Formed by the sternocleidomastoid and the trapezius
510
What does the posterior triangle contain
The posterior triangle contains
The muscles that move the head
Part of the subclavian artery and subclavian vein
The external jugular vein
The accessory nerve CN XI
The roots of the brachial plexus
The cervical plexus
The phrenic nerve
511
What are the suprahyoid muscles
Four paired muscles (mylohyoid, geniohyoid, stylohyoid, digastric)
They lie to the superior to the hyoid bone and form the floor of the mouth. When they contract they raise the hyoid bone and larynx during speech and swallowing
512
What are the infrahyoid muscles
Four paired strap muscles
Lie inferior to the hyoid bone just lateral to the anterior midline of the neck
They draw the hyoid bone and larynx inferiorly during speech and swallowing
The sternohyoid and omohyoid lie superficial and attach to the hyoid to the sternum and scapula
The sternothyroid and thyrohyoid lie deep and attach the sternum to the thyroid cartilage and the thyroid cartilage to the hyoid
513
What is the thyroid gland composed of
The thyroid gland is made up of the left and right lobes
514
Where is the thyroid gland located
The thyroid glad lies just lateral to the lower larynx and upper of the trachea
515
How are the 2 lobes of the thyroid glands attached
The 2 lobes are joined by the isthmus
516
Where is the isthmus located
The isthmus is located anteriorly to the trachea
517
What is the function of the thyroid gland
The thyroid gland produces hormones which play a role in the regulation of metabolic processes
518
What regulates the hormones secreted by the thyroid gland
The pituitary gland
519
What supplies the thyroid gland
The thyroid gland has a good bloody supply which includes
- the left and right superior thyroid arteries which are branches of the external carotid arteries
- the left and right inferior thyroid arteries which are branches of the thyrocervical trunks which come from branches of the subclavian artery
Some have an additional thyroid ima artery
520
What veins drain the thyroid
Superior, middle and inferior thyroid veins
521
How many parathyroid glands are there
4
522
What are the 4 parathyroid glands
Right and left superior and right and left inferior
523
Where are the 4 parathyroid glands located
Posterior to the thyroid
524
What is the function of the parathyroid gland
They produce parathyroid hormone
525
What is parathyroid hormone used to regulate
Calcium
526
What are the parathyroid glands supplied by
They are usually supplied by the inferior thyroid arteries
527
Where do the common carotid arteries rise to
They ascend through each side of the head and neck
528
Where can the pulsation of the internal carotid artery felt
The pulsation can be felt laterally to the larynx
529
What does the common carotid artery bifurcate into
The common carotid artery bifurcates into the external and internal carotid arteries
530
Do the internal carotid arteries branch
No
531
Where does the internal carotid arteries arise to
They rise to brain ascending through the cranium
532
What does the internal carotid artery supply
The brain
533
Does the external carotid artery branch
Yes
534
What does the external carotid branches supply
The branches of the external carotid armies supply the head and neck regions including the pharynx, scalp, thyroid, tongue and the face
535
When the common carotid artery bifurcates what is found
At the point of bifurcation of the common carotid arteries there will be a small swelling known as a carotid sinus
536
What is found at the carotid sinus
Baroreceptors
537
What is the function of baroreceptors
Baroreceptors constantly monitor the arterial blood pressure
538
How does the information from the baroreceptors get back to the CNS
The visceral sensory information is relayed back to the CNS via the glossopharyngeal nerve and will result in a reflex response that will regulate the blood pressure
539
What does the subclavian artery supply
The upper limbs
540
Where does the thyrocervical trunk branch from
It branches from the subclavian artery
541
What is the function of the internal jugular vein
The internal jugular vein drains blood from the brain and part of the face
542
What does the internal jugular vein unite with and what does it become
The internal jugular vein unites with the subclavian vein which becomes the brachicephalic vein
543
When to left and right brachiocephalic vein unite what doe they become
The left and right brachiocephalic vein Join to become the superior vena cava
544
What is the function of the external jugular vein
The external jugular vein drains blood from the scalp and face
545
Where does the external jugular vein drain into
The external jugular vein drains into and joins the subclavian vein
546
What what does the facial nerve supply
The facial nerve or CN VII supplies the platysma in the neck
547
What does the glossopharyngeal nerve supply
The glossopharyngeal or CN IX nerve supples the pharynx via sensory innervation and the carotid sinus via visceral sensory fibres
548
What is the vagus nerve vital for
The vagus nerve is vital for normal speech and swallowing
549
What does the the vagus nerve supply
The vagus nerve of CN X nerve supplies the muscles of the pharynx by motor innervation and the larynx via motor and sensory innervation
550
Where does the vagus nerve run in the neck
The vagus nerve runs between the internal jugular and the common carotid artery before its branches
551
What do the vagus nerve, internal jugular vein and the common carotid artery form
They form the carotid sheath
552
What does the accessory nerve supply
The accessory nerve or the CN XI nerve supplies the sternocleidomastoid and trapezius muscles
553
What is the hypoglossal nerve
The hypoglossal nerve or the CN XII nerve is the motor to the muscle of the tongue
554
Where is the hypoglossal nerve located
The hypoglossal nerve is located lateral to the internal carotid artery and deep to the external jugular vein
555
What makes up the phrenic nerve
The phrenic nerve is made up of nerve fibres from C3, C4 and C5
556
What does the phrenic nerve innervate
The diaphragm
557
Where are the superior, middle and inferior cervical ganglia found
They are found in the sympathetic ganglia in the neck
558
Where do postganglionic fibres from the ganglia innervate
They innervate the head and neck
559
What is a thyroidectomy
A thyroidectomy is the removal of the thyroid gland for a specific reason such as thyroid cancer
560
What risks are associated with a thyroidectomy
When the thyroid is removed it risks injury to the recurrent laryngeal nerve which lies close to the inferior thyroid arteries, which may become cut along with the artery
561
What could injury to the recurrent laryngeal result in
Injury to the recurrent laryngeal nerve causes the inability to move the ipsilateral vocal cord and will affect the quality of the voice
562
What is another risk of a thyroidectomy
You have risk that the parathyroid gland will have to be removed
563
What issues does having the parathyroid gland removed
Disrupts the calcium homeostasis
564
What is carotid artery stenosis
Carotid artery stenosis is when the carotid artery narrows with atheroma or a fatty plaque and becomes stenosed
565
What is the result of carotid artery stenosis
It would restrict the blood flow to the brain
566
What would happen if the fatty plaque in a carotid artery breaks up
The fragments would travel up through the carotid arteries up into the cerebral arteries which would cause a stroke
567
How would you prevent a stroke from carotid artery stenosis
The fatty plaque would be surgically removed from the artery in a carotid endarterectomy
568
What are the risks of a endarterectomy have
Stroke and serve bleeding
569
Why is a central line inserted into the internal jugular vein
The internal jugular vein is chosen because it is easy to access and found on ultrasound
570
What is the pharynx
The pharynx is a muscular tube within the neck
571
What is the pharynx part of
The respiratory and gastrointestinal systems
572
How many parts is the pharynx divided into
3
573
What are the 3 parts of the pharynx
Nasopharynx
Oropharynx
Laryngopharynx
574
What is the location of the nasopharynx
The nasopharynx is found posterior to the nasal cavity
575
What is the location of the oropharynx
The oropharynx is posterior to the oral cavity
576
What is the location of the laryngopharynx
The laryngopharynx is located posterior to the larynx
577
What is the walls of the pharynx composed of
The walls of the pharynx are composed of an outer layer of circular muscle and inner layer of longitudinal muscle
578
How many muscles make up the external circular muscle layer
3 muscles
579
What are the 3 muscles that make up the external circular muscle layer
3 constrictor muscles
580
What are the 3 constrictor muscles
The superior, middle and inferior constrictors
581
How do the constrictor muscles contract
They overlap and contract superior to inferior to help move food down towards the oesophagus
582
During swallowing what happens to the tongue
During swallowing food is pushed into the oral cavity and into the oropharynx by the tongue, which rises and closes off the nasopharynx
583
What is the epiglottis
The epiglottis is one of the cartilages of the larynx
584
What is the function of the epiglottis
The function of the epiglottis is to close of the laryngeal inlet to prevent food and liquids entering the larynx
585
What nerves innervate the pharynx
Sensory fibres from the glossopharyngeal nerve
Motor fibres from the vagus nerve
586
What nerves lie close to the posterior pharyngeal wall
Cervical sympathetic trunk and superior cervical ganglion
Superior laryngeal nerve(branch of vagus nerve)
Hypoglossal nerve
Glossopharyngeal nerve
587
What is the larynx composed of
The larynx is composed of several cartilages, membranes and small muscles
588
What is the function of the larynx
The function of the larynx is to protect the airways and contributes to speech and phonation
589
How many cartilages is the larynx made up of
9 cartilages
590
How many cartilages within the larynx and paired or unpaired
3 are paired
3 are unpaired
591
What are the 3 unpaired cartilages
The epiglottis, thyroid cartilage and cricoid cartilage
592
What are the 3 paired cartilages in the larynx
The aryenoids, the cuneiforms and the corniculate cartilages
593
What is the thyroid cartilage composed of
Two flat cartilages, that meet in the anterior midline which form the laryngeal prominence
594
What is the laryngeal prominence also known as
The Adam’s apple
595
What does the posterior laminae for projections to
The superior and inferior horns
596
What does the superior horn attach to
The hyoid bone
597
What do the inferior horns articulate with
They articulate with the cricoid cartilage
598
What does the cricothyroid membrane connect
The membrane connects the inferior border of the thyroid and the superior border of the cricoid
599
What is the clinical relevance of the cricothyroid membrane
This is where an emergency airway can be made
600
Where is the epiglottis found
The epiglottis is found attached to the superior aspect of the thyroid cartilage where the 2 thyroid laminae meet
601
What does the epiglottis cover
The epiglottis covers the entrance to the larynx known as the laryngeal inlet
602
What is the function of the epiglottis
The function of the epiglottis is to cover the laryngeal inlet and protect the airway from liquid or food entering
603
Where is the arytenoids found
The arytenoids sit on the superior surface of the cricoid cartilage
604
What is the arytenoids vital for
They are vital for phonation as the vocal cords are attached to them, meaning movement of the arytenoids cause movement of the vocal cords
605
What are the two groups of muscles found in the larynx
Extrinsic and intrinsic
606
What are extrinsic muscles that act on the larynx
The suprahyoid and infrahyoid muscles
607
How do the extrinsic muscles act upon the larynx
The extrinsic muscles move the larynx as one not the individual cartilages
608
How doe the intrinsic muscles act upon the larynx
The intrinsic muscles move individual cartilages in relation to the larynx, which moves the vocal cords and so alters the quality of speech
609
Where is the hyoid bone palpable on the neck
Inferior to the mandible
610
Where is the thyroid cartilage palpable
In the midline of the neck
611
Where is the cricoid cartilage palpable
In the midline of the neck inferior to the thyroid cartilage
612
Where is the first tracheal cartilage palatable
Inferior to the cricoid cartilage
613
Where is the cricothyroid membrane palpable
Between the thyroid cartilage and the cricoid cartilage
614
Where are the thyroid gland lobes palpable
Either side of the upper trachea and inferior to the larynx
615
Where is the carotid pulse palpable
Anterior to the sternocleidomastoid at the same level as the thyroid cartilage
616
What is the function of the gag reflex
The gag reflex is there to protect the airway
617
What mediates the gag reflex
It is mediated by the glossopharyngeal and vagus nerves
618
How does the gag reflex work
The gag reflex works the the posterior wall of the pharynx or the tonsils become stimulated, the sensation from this travels to the CNS by the glossopharyngeal nerve which causes the muscles of the soft muscle and pharynx to immediately contract via the motor fibres in the vagus nerve.
619
Why could someone have swallowing difficulties after having a stroke
If the stroke has occurred in the part of the brain that controls swallowing then after this could become difficult. As the pathways of the vagus nerve and the glossopharyngeal nerve become interrupted the contraction of the pharynx and soft muscle wont be able to contract and the sensation from the larynx wont be conveyed properly the swallowing will be dysfunctional and the cough reflex will become impaired so patients would be at risk of aspiration
620
What is meant by the term aspiration
Aspiration is when swallowed food or liquids may pass into the lungs which would cause infection
621
Why would an emergency airway be performed
A foreign body maybe stuck close to the vocal cords or the vocal cords may become swollen
622
What is the function of an emergency airway
An emergency airway allows for the patient to breathe while the upper airway is blocked as this is bypassed while a more secure airway is established
623
What are the tonsils
A collection of lymphoid tissue
624
Where are the tonsils located
In the upper part of the pharynx
625
What are the 2types of tonsils
Pharyngeal,tubal, palatine and lingual tonsils
626
Where are the pharyngeal and tubal tonsils found
They are found in the nasopharynx
627
Within the nasopharynx where are the pharyngeal tonsils found
In the roof of the nasopharynx
628
Within the nasopharynx where are the tubal tonsils located
They surround the opening of the auditory tube
629
What is the function of the auditory tube
This tube connects the nasopharynx and the middle ear
630
Where are the palatine tonsils located
They are located next to the pharyngeal wall in the oropharynx
631
Where are the lingual tonsils located
They are located on the posterior aspect of the tongue
632
What is the internal aspect of the larynx modified for
Phonation
633
What are the 2 pairs of folds what project into the larynx
The vestibular folds and the vocal folds
634
What are the vestibular folds
They are false vocal cords
635
What are vocal folds
They are true vocal cords
636
What are the vestibular folds composed of
They are folds of mucous membrane that lie superior to the vocal folds
637
What are the vocal folds made up of
They are folds of mucous membrane that cover and protect vocal ligaments which form the vocal cords
638
Where are the vocal ligaments found
The vocal ligaments are attached anteriorly to the internal aspect of the laryngeal prominence and posterior to the arytenoids cartilages
639
What is the space between the true vocal cords known as
The rima glottidis
640
What does adduction of the true vocal cords cause
Adduction causes the rima glottidis to close
641
What does abduction of the vocal cords
Abduction causes the rima glottidis to open, to a small degree when whispering, partially open when normal breathing occurs and fully when breathing is forced
642
How do the intrinsic muscles aid phonation
The intrinsic muscles of the larynx move the laryngeal skeleton which moves the vocal cords and open and closes the rima glottidis
643
What is the cricothyroid muscle
This is an intrinsic muscle found in the larynx which aid to move laryngeal cartilages
644
Where Is the cricothyroid muscle found
It is found anteriorly between the thyroid and cricoid cartilages
645
How does the cricothyroid muscle put tension of the vocal cords
The muscle tips the thyroid cartilage anteriorly and inferiorly
646
What is the posterior cricoarytenoids
They are intrinsic muscles found in the larynx to move the laryngeal cartilages
647
Where is the cricoarytenoids located
They are located on the posterior surface of the cricoid and attach to the arytenoids
648
What is the role of the posterior cricoarytenoids
There role is to abduct the vocal cords and close the rima glottidis
649
What is the transverse arytenoids
They are intrinsic muscles within the larynx which move the laryngeal skeleton
650
Where is the transverse arytenoids located
They are located on the posterior aspect of the larynx which connect 2 arytenoid cartilages
651
What is the role of the transverse arytenoids
They adduct the vocal folds and close the rima glottidis
652
What does the superior laryngeal nerve innervate
They innervate the cricothyroid muscle and provides sensory fibres to the larynx above the vocal folds
653
Where does the superior laryngeal nerve branch from
The vagus nerve
654
Where does the recurrent laryngeal nerve branch from
The vagus nerve
655
What does the recurrent laryngeal nerve innervate
All intrinsic muscles apart from the cricothyroid muscle
Provides sensory fibres to the Larynx below the vocal folds
656
How many pairs of salivary glands secrete into the oral cavity
3 pairs
657
What are the 3 pairs of salivary glands
The parotid
The submandibular
The sublingual
658
What is glandular secretion stimulated by
Parasympathetic fibres
659
Which is the largest pair of salivary glands
The parotid glands
660
Where ate the parotid salivary glands located
They are located over the posterior part of the mandible
661
Where does the parotid salivary glands empty into the mouth
They empty via the parotid duct which opens adjacent to the upper second molar tooth
662
What nerve innervated the parotid salivary gland
The facial nerve enters deep to the surface of the parotid gland after exiting the skull
663
What happens to the facial nerve once it has enter the parotid gland
The nerve branches into 5 branches which all exit the gland and innervate the muscles needed for facial expression
664
How is secretion from the parotid gland stimulated
It is stimulated by parasympathetic fibres within the glossopharyngeal nerve
665
Where are the submandibular salivary glands located
They are located part in and part outside the mouth
666
Where does the submandibular gland empty into the mouth
They empty through the submandibular duct in the floor of the mouth under the tongue
667
What controls the secretion of the submandibular glands
Parasympathetic fibres of the facial nerve
668
Where are the sublingual salivary glands located
They are located in the floor of the mouth
669
Where do the sublingual glands open into the mouth
The sublingual glands open via small ducts in the floor of the mouth
670
What controls the stimulation of the sublingual glands
Parasympathetic fibres in the facial nerve
671
How does vocal cord palsy occur
Vocal cord palsy could occur when the patient goes through a thyroidectomy to remove there thyroid, during this the inferior thyroid artery is cut which could also cut/injury the recurrent laryngeal nerve. If this nerve is injured the intrinsic muscles of the ipsilateral side will not function and cause the vocal cords to be immobilised and results in hoarse voice
672
What is an endotracheal intubation
Endotracheal intubation is the means of passing a semi-rigid tube down into the trachea through the vocal cords either during surgery or sedation in Intensive care
673
What is the clinical relevance of disease, trauma or surgery of the parotid gland
Disease, trauma or surgery of the parotid gland could cause injury to the facial nerve and branches which can lead to paralysis of some of the ipsilateral facial muscles. This could be caused by the viral infection mumps
