Cardiorespiratory anatomy Flashcards
1
Q
what are the three parts of the sternum?
A
manubrium, body and xiphoid process (xiphisternum)
2
Q
superior border of the manubrium?
A
suprasternal (jugular) notch
3
Q
what joint is between the clavicle and manubrium?
A
sternoclavicular joint
4
Q
what joint is between the manubrium and body of the sternum?
A
manubriosternal joint/ sternal angle/ angle of Louis
5
Q
which ribs does the body articulate with?
A
2-7
6
Q
which rib articulates with the sternum at the sternal angle?
A
second
7
Q
which rib articulates with the inferior part of the body of the sternum and the superior part of the xiphoid process?
A
7
8
Q
what is the costal margin?
A
cartilaginous arch formed by the medial margins of the cartilages of ribs 7-10
9
Q
which bone marks the upper border of the thorax?
A
clavicle
10
Q
which bones does the clavicle articulate with?
A
sternum medially
acromium laterally
11
Q
what is just below the lateral part of the clavicle?
A
coracoid process of the scapula
12
Q
what is the xiphisternum made up of?
A
cartilage
13
Q
why can’t the first rib be palpated?
A
lies deep to the clavicle and pec major
14
Q
how many ribs do we have?
A
12
15
Q
how many true, false and floating ribs do we have?
which ribs fall in each category?
A
7 true ribs, 1-7 as directly articulate with sternum
3 false ribs, 8-10 as they do not directly articulate with sternum
2 floating ribs, 11 and 12, do not connect with sternum at all, only vertebral column
16
Q
what is the midclavicular line?
A
vertically down, halfway between the sternoclavicular joint and acromioclavicular joint
continues to halfway between the ASIS and pubic tubercle
passes through the nipple in a male
17
Q
what is the midsternal line?
A
suprasternal notch through umbilicus
18
Q
which three lines run on the side of the body?
A
midaxillary line
anterior axillary line
posterior axillary line
19
Q
which joints are between ribs and their costal cartilages
A
costochondral
20
Q
which joints are between the costal cartilages and the sternum
A
sternocostal
21
Q
what happens to the costal cartilages of ribs 8-10
A
unite and join the seventh costal cartilage
false ribs
22
Q
the costal cartilages of which ribs form the costal margin
A
7-10
23
Q
which ribs do not articulate with the sternum?
A
11 and 12
24
Q
which joints are between the ribs and thoracic vertebrae?
A
costovertebral
25
which ribs are typical or atypical and why?
3-9 are typical. have a head, neck, tubercle and body (shaft)
1,2, 10, 11, 12 are atypical for various reasons
26
how many thoracic vertebrae are there?
12
27
where do the head and tubercle of the ribs articulate on the vertebrae?
head - vertebral body
tubercle - transverse process
28
which structures form the superior thoracic aperture?
manubrium, first ribs, first thoracic vertebra
29
which spinal nerves innervate the skin of the thoracic wall?
T1-T12
30
how are skeletal muscles of the anterior chest wall innervated?
somatic motor fibres in spinal nerves T1-T12
31
how are sweat glands and smooth muscles of blood cells and hair follicles in the skin innervated?
sympathetic fibres
32
what is a dermatome?
area of skin innervated by a single spinal nerve
33
what does the breast contain?
variable amounts of fat
glandular/ secretory tissue arranged in lobules
ducts which converge on the nipple
connective tissue and ligaments
blood vessels
lymphatics
34
what is the area of pigmented skin surrounding the nipple?
areola
35
arterial supply of the breast
branches from the:
internal thoracic artery (from subclavian)
axillary artery
36
where does the internal thoracic artery lie?
deep to the lateral edge of the sternum - paired artery
37
venous drainage of the breast
axillary and internal thoracic veins
38
nerves suppling the breast
somatic nerves and sympathetic fibres via the intercostal nerves
somatic sensory fibres innervate the skin of the breast
sympathetic fibres innervate smooth muscle in the blood vessel walls and nipple
39
lymphatic drainage of the breast
axillary lymph nodes
40
name the 5 groups of lymph nodes in the axilla
central, pectoral, humeral, subscapular, apical
41
which regions do the axillary lymph nodes drain?
breast, upper limb, chest wall, scapular region, abdominal wall
42
which lymph nodes are involved in the spread of breast cancer and why? where are they located?
apical nodes in the apex of the axilla
receive lymph from all other lymph nodes in the axilla
they drain most of the lymph from the breast
43
name the layers of intercostal muscles from superficial to deep
external, internal, innermost
44
name three accessory muscles of breathing
pectoralis major, pectoralis minor, serratus anterior
45
what is the primary function of the accessory muscles of breathing?
move the upper limb
46
what is the most superficial muscle of the anterior chest wall?
pec major
47
which muscle is lateral and superior to pec major?
deltoid
48
origin of pec major
clavicular part: anterior surface of medial half of clavicle
sternocostal part: anterior surface of sternum, costal cartilages of ribs 1-6
abdominal part: anterior layer of rectus sheath
49
insertion of pec major
crest of greater tubercle of humerus
50
location of pec minor in relation to pec major
deep to pec major
51
origin of pec minor
anterior surface, costal cartilages of ribs 3-5
52
insertion of pec minor
medial border and coracoid process of scapula
53
origin of serratus anterior
superior part: ribs 1-2, Intercostal fascia
middle part: ribs-3-6
inferior part: ribs 7-8/9 (variably extends to rib 10 (+ external oblique muscle))
54
insertion of serratus anterior
scapula
(superior part: anterior surface of superior angle
middle part: anterior surface of medial border
inferior part: anterior surface of inferior angle and medial border)
55
action of pec major
adduction and internal rotation of the humerus at the shoulder joint
56
action of pec minor
protract the scapula
57
action of serratus anterior
protract the scapula
58
what is a sign of respiratory distress?
use of accessory muscles of breathing: pec major, pec minor, serratus anterior
59
what is shingles and how does it present?
red, painful and itchy rash
typically over chest or abdomen on one side of the body only
strip like distribution - affects dermatomes
caused by a reactivation of the herpes zoster virus in people who have previously had chicken pox
virus lies dormant in the dorsal root ganglion and when reactivated, it causes a rash and pain in the dermatome associated with the affected spinal nerve
60
what condition can be caused by the removal of lymph nodes, and how does it present?
lymphoedema
fluid accumulation and swelling in the affected upper limb
61
main vein that drains the superficial part of the upper limb
cephalic vein
62
which groove does the cephalic vein lie in?
delto-pectoral groove
63
components of the intercostal neurovascular bundle
intercostal nerve, intercostal artery, intercostal vein
64
what does pec major have on its deep surface?
neuromuscular bundle
65
which nerve supplies both pec major and pec minor?
medial pectoral nerve
66
which nerve only supplies pec major?
lateral pectoral nerve
67
name the intercostal muscles, superficial to deep
external intercostal, internal intercostal, innermost intercostal
68
orientation of external intercostal muscles
antero-inferiorly
69
action of external intercostal muscles
pull ribs superiorly
70
when are the external intercostal muscles most active?
inspiration
71
what happens to the external intercostal muscles anteriorly?
muscle becomes membranous and forms the external intercostal membrane
72
orientation of internal intercostal
postero-inferior
73
action of internal intercostal muscles
pull ribs inferiorly
74
when are the internal intercostal muscles most active?
expiration
75
what happens to the internal intercostal muscles posteriorly?
become membranous and forms the internal intercostal membrane
76
orientation of innermost intercostal muscles
postero-inferior
77
what lies deep to the innermost intercostal and superficial to the parietal pleura?
endothoracic fascia
78
name the layers from superficial to deep, from the skin to the lung
skin
superficial fascia
(serratus anterior)
external intercostal
internal intercostal
innermost intercostal
endothoracic fascia
parietal pleura
pleural cavity
visceral pleura
lung
79
where do the intercostal neuromuscular bundles lie relative to the intercostal muscles?
between the internal and innermost intercostal muscles
80
what does the intercostal neurovascular bundle supply?
intercostal muscles, overlying skin, underlying parietal pleura
81
where does each intercostal neurovascular bundle lie?
inferior border of the rib superior to the intercostal space
in the shallow costal groove on the deep surface of the rib
82
in medical procedures that involve piercing the intercostal space (e.g chest drain), where is the incision made and why?
middle to lower part of the intercostal space
avoid the intercostal vessels and nerve
smaller collateral branches run in the same tissue plane, but in the lower part of the intercostal space
83
origin of anterior intercostal arteries
internal thoracic artery (which is a branch of the subclavian)
84
origin of posterior intercostal arteries
descending aorta
85
where do anterior intercostal veins drain into?
internal thoracic vein
86
where do posterior intercostal veins drain into?
azygos system of veins
87
what type of nerves are the internal intercostal nerves?
somatic - contain motor and sensory fibres
also carry sympathetic fibres
88
what do the intercostal nerves innervate?
intercostal muscles, skin of the chest wall, parietal pleura
89
what do the pleurae cover?
lungs and structures passing into and out of the lungs (pulmonary blood vessels and the main bronchi)
90
what does the parietal pleura line?
inside of the thorax
91
what does the visceral pleura line?
surface of the lungs
extends into fissures
92
what lies between the pleurae?
pleural cavity
93
name the different regions of the parietal pleura
cervical parietal pleura - covers apex of the lung
costal parietal pleura - lies adjacent to the ribs
mediastinal parietal pleura - lies adjacent to the heart
diaphragmatic parietal pleura - adjacent to the diaphragm
94
are the parietal and/ or visceral pleura visible with the naked eye?
the parietal pleura is visible but the visceral pleura is not
95
what do pleural cells produce?
pleural fluid
96
what is the gutter around the periphery of the diaphragm where the costal pleura becomes continuous with the diaphragmatic pleura?
costodiaphragmatic recess
97
which recess lies at the junction of the costal and mediastinal pleura?
costomediastinal recess
98
innervation of parietal pleura
intercostal nerves that innervate the overlying skin of the chest wall
somatic sensory fibres
99
does injury to the parietal pleura reach our consciousness?
yes
100
innervation of visceral pleura
autonomic sensory nerves (visceral afferents)
101
does injury to the visceral pleura reach our consciousness?
no
102
which arteries are found on the deep surface of the anterior thoracic wall?
internal thoracic arteries (also called internal mammary arteries)
103
origin of the internal thoracic arteries
subclavian artery
104
function of the internal thoracic arteries
supply the breast and anterior chest wall
105
course of the internal thoracic artery
runs down the inside of the thorax and abdomen to connect with the external iliac artery just above the groin
106
what is the name for the most superior part of the lung?
apex
107
how many lobes does the right lung have? what are they called?
three
superior, middle and inferior
108
how many lobs does the left lung have?
name them
two
superior and inferior
109
what is the name of the anterior extension of the superior lobe of the left lung that extends over the heart?
lingula (latin for small tongue)
110
which fissure(s) do the left and right lung have?
both have oblique
right has horizontal too
111
surface markings of the horizontal fissure
below the 4th costal cartilage
112
surface markings of the oblique fissure
starts posteriorly at the 4th rib, runs along the 5th rib and ends at the tip of the 6th rib anteriorly
113
what does the oblique fissure separate in the left and right lungs?
left - superior and inferior lobes
right - separates the superior and middle lobes from the inferior lobe (so is located between the middle and inferior lobe)
114
what does the horizontal fissure separate?
superior and middle lobe
115
where is the costal surface of the lung?
adjacent to the ribs
116
where is the mediastinal surface of the lungs?
adjacent to the heart
117
where is the diaphragmatic surface of the lungs?
inferior surface of the lung
118
name the borders of the lung
anterior, posterior and inferior
119
lower limit of the lung at the
a) mid clavicular line - anteriorly
b) mid-axillary line - laterally
c) vertebral column - posteriorly
with regards to the ribs
a) 6th rib
b) 8th rib
c) 10th rib
120
lower limit of the pleural space
a) mid clavicular line - anteriorly
b) mid-axillary line - laterally
c) vertebral column - posteriorly
a) 8th rib
b) 10th rib
c) 12th rib
121
what is the continuing potential space between the ribs and diaphragm called, and where does it extend to?
costo-phrenic space
two ribs lower than the lower limit of the lung
122
which structures leave indentations on the lung surface?
on the left and right lung
rib markings on the costal surfaces
left ventricle and descending aorta on the mediastinal surface of the left lung
superior vena cava and azygos vein on the mediastinal surface of the right lung
123
what is the root of the lung and what does it contain?
lies between the heart and lung
comprises of
- pulmonary artery
- pulmonary veins
- main bronchus
124
what encloses the root of the lung?
pleura
125
where is the one place where the lung has all its connections with the body?
hilum
126
what are the lung hila?
region on the mediastinal surface of the lung where the pulmonary artery, pulmonary veins and main bronchus enter and exit the lungs
127
how can the bronchi be distinguished in the lung hilum?
cartilage, which is not present in the blood vessels
128
what is the relation between the the main bronchus and pulmonary artery at the hilum of the right lung?
main bronchus lies anterior to the pulmonary artery
129
what is the relation between the main bronchus and the pulmonary artery at the hilum of the left lung?
main bronchus lies inferior to the pulmonary artery
130
how many pulmonary veins so we have in each hilum, and how many altogether?
2 in each hilum
4 altogether
131
where are the pulmonary veins usually located in both hila?
most anteriorly and inferiorly
132
other structures present in the lung hilum?
bronchial artery
lymphatics
branches of the vagus, parasympathetic nerve and the sympathetic chains
133
at which level does the trachea bifurcate? what joint can be found here?
T4
sternal angle
134
in which main bronchus is a foreign body more likely to become lodged, and why?
right main bronchus
it is shorter, wider and descends more vertically than the left main bronchus
135
what is the bronchial tree?
branching system of tubes that conduct air into and out of the lungs
136
describe the bronchial tree
trachea - right and left main bronchi - lobar bronchi - segmental bronchi - terminal bronchioles - respiratory bronchioles - alveoli
137
how many lobar bronchi are in each lung, and what is the naming based on?
the number of lobes in each lung
right - 3
left - 2
138
what does each segmental bronchus supply?
a functionally independent region of the lung called a bronchopulmonary segment
139
how many bronchopulmonary segments are there in each lung?
10 in the right
8 in the left
140
can a lung segment be resected without affecting the rest of the lung? why
yes
they are supplied by their own segmental bronchus and blood vessels
141
state whether bronchioles, trachea and bronchi have smooth muscle and/ or cartilage
trachea have smooth muscle and cartilage
bronchioles only have smooth muscle
142
is the contraction and relaxation of smooth muscle under somatic or autonomic control?
autonomic
143
where do the bronchial arteries arise from?
descending aorta
144
function of the bronchial arteries
supply oxygenated blood to trachea, bronchi and bronchial tree
145
where do the bronchial veins drain into?
azygos system of veins
146
action of parasympathetic fibres on the lungs
bronchoconstriction
secretion from the glands of the bronchial tree
147
action of sympathetic fibres of the lungs
bronchodilation
inhibit secretion from the glands of the bronchial tree
148
what relays sensory information from the lungs and visceral pleura to the CNS? do these sensations reach our consciousness?
visceral afferents (visceral sensory fibres)
no
149
how does lymph from the lungs eventually drain into the venous system?
thoracic duct or right lymphatic duct
150
is the diaphragm skeletal or smooth muscle?
skeletal
151
function of the diaphragm
ventilation
152
attachments of the diaphragm
xiphoid process
costal margin
lumbar vertebrae
153
what is the central tendon?
central, fibrous part of the diaphragm
154
what happens to the diaphragm during inspiration?
contracts
muscle fibres of the right and left domes are pulled towards their peripheral attachments, and the domes flatten
increases the intrathoracic volume for the lungs to expand
155
what happens to the diaphragm during expiration?
relaxes
domes superiorly
intrathoracic volume decreases
air is expired from the lungs
156
what are the names of the two phrenic nerves?
right and left
157
are the phrenic nerves somatic and autonomic?
somatic (contain both motor and sensory fibres)
158
which spinal nerve segments form the phrenic nerve?
C3, C4 and C5 (keep the diaphragm alive!)
159
in which directions do the dimensions of the thoracic cavity change during ventilation, and why?
vertically - contraction and relaxation of the diaphragm
laterally - contraction of the intercostal muscles which move the ribs
antero-posteriorly - movement of the sternum secondary to movement of the ribs
160
how is the pleural fluid integral to ventilation?
creates surface tension between the parietal and visceral pleurae
keeps the lung and thoracic wall together
therefore, when the thoracic cavity changes volume, the lung changes volume with it
prevents lung collapsing
161
what happens if surface tension between the pleurae is broken e.g by puncture wound?
pneumothorax
ventilation becomes dysfunctional
162
describe the process of inspiration
diaphragm and external intercostal muscles contract
intrathoracic volume increases
- external intercostals pull the ribs superiorly and laterally
- ribs pull the sternum superiorly and anteriorly
lungs increase in volume with the thoracic wall due to surface tension
pressure in the lungs decreases below atmospheric pressure
air is drawn into the lungs
163
describe the process of expiration
diaphragm and external intercostal muscles relax
internal intercostals contract
intrathoracic volume decreases
- internal intercostals pull the ribs inferiorly
- ribs pull the sternum inferiorly and posteriorly
lungs decrease in volume
pressure in the lungs increases above atmospheric pressure
air is expelled from the lungs
164
in normal quiet breathing, are inspiration and expiration active or passive?
inspiration is active (result of muscle contraction)
expiration is passive (due to elastic recoil of the lungs)
165
which muscle is the main driver of normal quiet breathing?
diaphragm
166
which muscle does active expiration use?
internal intercostal
167
which muscles are involved in very vigorous or forced breathing? e.g exacerbations of asthma or COPD
accessory muscles of breathing
168
which are the accessory muscles of breathing?
sternocleidomastoid
pec major
pec minor
serratus anterior
169
presentation of pleuritic chest pain
sharp and well localised
worse on inspiration
170
what is a pneumothorax? when does a tension pneumothorax develop?
presence of air in the pleural cavity
when air keeps entering the pleural cavity but cannot escape
compresses heart, great vessels and lungs
171
presentation of a pneumothorax
severe respiratory distress
172
what is a haemothorax?
collection of blood in the pleural cavity
occurs secondary to trauma when blood vessels are torn or cut
173
what is pleural effusion?
presence of excess fluid in the pleural cavity
174
how is a pleural effusion treated?
chest drain
175
what is malignancy of the pleura called?
mesothelioma
176
what is a pulmonary embolism, and how does it develop?
clot in the pulmonary circulation
clot usually forms in the deep veins in one of the legs and is carried in the venous circulation back to the right side of the heart and into the pulmonary trunk
177
symptoms of dyspnoea
shortness of breath
use of accessory muscles - fixing of upper limbs steady e.g by holding onto chair
allows the upper limb muscles that attach to the chest wall to move the ribs and aid ventilation
178
injury to which spinal segments causes paralysis of the diaphragm? is the paralysis ipsilateral or contralateral?
C3, 4 or 5
ipsilateral
179
how does contraction of the diaphragm assist in returning blood to the heart
when people breathe in, the diaphragm descends, which decreases the intrathoracic pressure and improves the intra-abdominal pressure
this compresses the blood in the inferior vena cava (IVC) and forces it upward into the right atrium and helps to fill the heart
180
which part of the thoracic cavity lies between the lungs and contains all the thoracic viscera apart from the lungs?
mediastinum
181
superior border of the mediastinum
thoracic aperture
182
inferior border of the mediastinum
diaphragm
183
anterior border of thee mediastinum
sternum
184
posterior border of the mediastinum
thoracic vertebrae
185
structures in the mediastinum
heart and pericardium
great vessels that enter and leave the heart
veins that drain the chest wall
trachea and main bronchi
oesophagus
somatic and autonomic nerves
lymphatics
thymus gland
186
which two compartments is the mediastinum initially divided into?
superior and inferior
187
where does the line between the superior and inferior mediastinum run anteriorly and posteriorly
sternal angle anteriorly to T4/ T5 junction posteriorly
188
what are the divisions of the inferior mediastinum?
anterior, middle and posterior
189
boundaries of the anterior mediastinum
posterior aspect of the sternum
anterior aspect of the pericardial sac
190
name something contained in the anterior mediastinum
thymus gland in children and its remnant in adults
not many interesting things are contained here!
191
contents of the middle mediastinum
heart inside the pericardial sac, pulmonary trunk, ascending aorta
192
boundaries of the posterior mediastinum
posterior aspect of the pericardial sac and the vertebrae
193
contents of the superior mediastinum
arch of the aorta and its three branches
superior vena cava and its tributaries - the left and right brachiocephalic veins
trachea
oesophagus
phrenic nerves (left and right)
vagus nerves (left and right)
thoracic duct
thymus gland
194
names of the three parts of the aorta in the thorax
ascending, arch, descending
195
which part of the aorta gives rise to the coronary arteries?
ascending
196
in which direction does the arch of the aorta curve?
posteriorly
197
in which region of the mediastinum does the descending aorta travel through?
posterior
198
branches of the arch of the aorta
brachiocephalic trunk, left common carotid, left subclavian
199
what does the brachiocephalic trunk divide into?
right common carotid and right subclavian
200
what does the right common carotid supply?
right side of the head, neck and brain
201
what does the right subclavian supply?
right upper limb
202
what does the left common carotid supply?
left side of the head, neck and brain
203
what does the left subclavian artery supply?
left upper limb
204
order of branches of the aortic arch from the body's left to right
left subclavian, left common carotid, right common carotid, right subclavian (last two from brachiocephalic trunk)
205
what are aortic bodies and where are they found?
peripheral chemoreceptors in the arch of the aorta
206
what do aortic bodies monitor?
arterial oxygen and carbon dioxide
207
which nerve carries visceral sensory information from the aorta to the CNS? what is the result
vagus
reflex responses that regulate ventilation
208
what is the ligamentum arteriosum?
fibrous, cord-like connection between the pulmonary trunk and the arch of the aorta
209
what is the ligamentum arteriosum a remnant of?
ductus arteriosus, a foetal circulatory shunt
210
function of the embryological ductus arteriosus?
diverts most of the blood entering the pulmonary trunk directly to the aortic arch
211
when does the ductus arteriosus close?
when a baby starts to use their lungs at birth
212
where does the superior vena cava drain?
head, neck and upper limbs
213
where do the SVC and its tributaries lie?
superior mediastinum
214
the union of which veins forms the SVC?
left and right brachiocephalic veins
215
the union of which veins forms each brachiocephalic vein?
internal jugular vein and subclavian vein
216
what does the internal jugular vein drain?
head and neck
217
how can we remember what the brachiocephalic vein drains?
brachium = arm
cephalic = head
218
where does the IVC drain?
all regions inferior to the diaphragm (abdomen, pelvis and lower limbs)
219
main branches of the left subclavian artery
vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk, and the dorsal scapular artery
220
main branches of the left common carotid
external carotid artery
internal carotid artery
221
what gives the trachea its semi-rigid structure?
C-shaped, incomplete rings of cartilage in its walls
222
where does the trachea extend from?
larynx in the midline of the neck to the superior mediastinum
223
where does the trachea terminate?
T4/ T5
224
what is the oesophagus and where does it extend from?
muscular tube that extends from the pharynx in the midline of the neck to the stomach
225
function of the oesophagus
move bolus distally by waves of contractions of smooth muscle
226
does the oesophagus lie anterior or posterior to the trachea?
posterior
227
path of the phrenic nerves
descend through the neck and enter the thorax through the superior thoracic aperture
course over the pericardium and pierce the diaphragm
228
what type of nerves are the phrenic nerves?
somatic
diaphragm is skeletal muscle so makes sense
229
motor innervation by phrenic nerves
diaphragm
230
sensory innervation by the phrenic nerves
pleura, peritoneum and pericardium (three P's)
231
where do the left and right vagus nerves arise from?
brainstem
232
which fibres do the vagus nerves contain?
somatic sensory, somatic motor, parasympathetic
233
functions of the vagus nerves
sensory: innervates the skin of the external acoustic meatus and the internal surfaces of the laryngopharynx and larynx. provides visceral sensation to the heart and abdominal viscera.
special sensory: provides taste sensation to the epiglottis and root of the tongue.
motor: provides motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
parasympathetic: innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract and regulates heart rhythm.
234
path of the vagus nerve?
descend through the neck alongside the internal carotid artery and internal jugular vein
enter the thorax via the superior thoracic aperture
each gives rise to a recurrent laryngeal nerve which ascend back up into the neck to innervate the muscles of the larynx
the left RLN loops under the arch of the aorta before ascending back up the left side of the neck (alongside the trachea) to the larynx
the right RLN 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
they contribute parasympathetic fibres to the heart, lungs and oesophagus
they traverse the diaphragm and convey parasympathetic fibres to most of the abdominal viscera
235
what is the major channel for lymphatic drainage from most regions of the body?
thoracic duct
236
where does the thoracic duct empty into the venous system?
union of the left internal jugular vein and left subclavian vein (to form left brachiocephalic vein)
237
where does the thymus gland lie? can we see it in the cadaver
anteriorly in the superior mediastinum
no
238
what is the pericardium?
tough, fibrous sac that encloses the heart
239
why is the pericardium loose?
allow for the movement of the heart within it
240
layers of the pericardium
tough, outer fibrous layer
thin inner serous layer with two parts that are continuous with each other
- parietal layer
- visceral layer (on the surface of the heart)
241
potential space between the two layers of serous pericardium
pericardial cavity
242
what does the pericardial cavity contain, and what is the function of it?
pericardial fluid
lubricates the serous membranes and allows them to slide over each other with movements of the heart
243
innervation of the fibrous pericardium
left and right phrenic nerves give rise to sensory branches
244
where do the phrenic nerves pass in relation to the lung hila on both sides?
in front
245
where do the vagus nerves pass in relation to the lung hila on both sides?
behind
246
in which direction does the base of the heart face?
posteriorly
the base is the posterior surface of the heart
247
where does the inferior surface of the heart lie, and what is it also called?
central tendon of the diaphragm
diaphragmatic surface
248
where does the anterior surface of the heart face, and what is it also called?
sternum and ribs
sternocostal surface
249
where do the left and right sides of the heart face, and what are the names of these surfaces?
the lungs
pulmonary surfaces
250
which chambers of the heart corresponds to the base/ posterior surface?
left atrium
part of the right atrium
251
which chambers of the heart corresponds to the inferior/ diaphragmatic surface?
left ventricle, part of the right ventricle
252
which chamber of the heart corresponds to the anterior/ sternocostal surface
right ventricle
253
which chamber of the heart corresponds to the left pulmonary surface?
left ventricle
254
which chamber of the heart corresponds to the right pulmonary surface?
right atrium
255
which chamber forms the apex of the heart?
left ventricle
256
where is the apex beat palpable?
left 5th intercostal space, midclavicular line
257
which structures correspond to the right border of the heart?
right atrium, superior vena cava, inferior vena cava
258
which structures correspond to the left border of the heart?
left ventricle, left pulmonary artery, left auricular appendage
259
which chambers correspond to the inferior border of the heart?
right ventricle and part of the left ventricle
260
surface landmarks of the right border of the heart
lies lateral to the right sternal edge, from the right 3rd costal cartilage to the right 6th costal cartilage
261
surface landmarks of the left border of the heart
left 2nd intercostal space to the left 5th intercostal space in the midclavicular line
262
surface landmarks of the superior border of the heart
lies along the line connecting the superior extents of the right and left borders
i.e from the right 3rd costal cartilage to the left 2nd intercostal space
263
surface landmarks of the inferior border of the heart
lies along the line connecting the inferior end of the right border with the apex
mostly formed by the right ventricle
264
what are the auricles/ auricular appendages?
outpouchings from the walls of the right and left atria
named because of their ear-like appearance
265
what is patent ductus arteriosus?
the ductus arteriosus remains open after birth
pressure in the aorta exceeds pressure in the pulmonary trunk
blood flows through a patent ductus arteriosus from the aorta into the pulmonary trunk
over time, increased flow through the pulmonary vessels can lead to pulmonary hypertension
266
why does hoarseness result from cancer at the apex of the lung?
involves the recurrent laryngeal nerve, which supplies most of the muscles of the larynx
nerve injury results in weakness or paralysis of the ipsilateral intrinsic laryngeal muscles, which move the larynx and the vocal cords
hoarseness results as the patient can no longer fully adduct their vocal cords
267
what is pericardial effusion, and what can cause it?
increase in fluid volume in the pericardial space
inflammation of the pericardium (pericarditis)
accumulation of blood (due to trauma)
268
what is cardiac tamponade?
pericardial effusion means heart is compressed and unable to fill properly
269
where do the left and right coronary arteries arise from?
ascending aorta
270
where do cardiac veins return venous blood to?
coronary sinus, which enters the right atrium
271
what does the right coronary artery supply?
parts of the conducting system of the heart, right atrium, right ventricle, part of left ventricle, part of interventricular septum
272
which valve lies deep to the atrioventricular groove?
tricuspid
the AV groove is between the right atrium and ventricle
273
where does the right coronary artery lie?
atrioventricular groove
274
which artery supplies the inferior border of the heart?
right marginal artery
275
which artery is a continuation of the right coronary artery?
posterior inter ventricular artery
276
where does the PIV run?
inferior surface of the heart
in the posterior intrventricular sulcus
277
what does the PIV supply?
both ventricles
278
name two main branches of the RCA
right marginal artery
posterior interventricular artery
279
what does the left coronary artery supply?
parts of the conducting system, left atrium, most of the left ventricle, part of the right ventricle, part of the interventricular septum
280
name three main branches of the left coronary artery
anterior interventricular artery (LAD)
circumflex
left marginal artery
281
name the two terminal branches of the left coronary artery
anterior interventricular artery (also called the left anterior descending - LAD)
circumflex
282
what is the short segment of the LCA called before it divides?
left main stem
283
where does the anterior interventricular artery/ LAD run?
anterior interventricular sulcus towards the apex
284
what does the LAD supply?
both ventricles
285
where does the circumflex run?
around the heart onto the inferior/ diaphragmatic surface
286
what does the circumflex supply?
left atrium, part of the right ventricle and left ventricle
287
where does the left marginal artery arise from?
circumflex
288
what does the left marginal artery supply?
left ventricle
289
what is right dominant circulation, and is it rarer or more common?
PIV arises from the right coronary artery
therefore, the left ventricle is supplied by both the left and right coronary arteries
more common (90% of hearts)
290
what is left dominant circulation, and is it rarer or more common?
PIV arises from the circumflex artery
therefore, the left ventricle is only supplied by the left coronary artery
rarer (30% of hearts)
291
in what percentage of hearts are there two, parallel branches of the PIV?
20%
292
function of heart valves?
unidirectional flow of blood through the chambers inside the heart
293
name three vessels from which the right atrium receives blood from
SVC
IVC
coronary sinus
294
what separates the atria?
interatrial septum
295
name some features of the right atrium
interatrial septum
fossa ovalis
crista terminalis
296
what is the fossa ovalis?
depression in the interatrial septum
remnant of the foetal foramen ovale
297
function of the foramen ovale in a foetus
shunts oxygenated blood from the right atrium to the left atrium, bypassing the lungs
298
what is the difference between the auricular appendages of the atria and the atria?
different embryological origins
299
what is the crista terminals?
muscular ridge separating the smooth walled posterior part of the right atrium from the anterior part, which has a ridged, muscular wall
300
what are the ridges on the right atrial wall, and where do they extend into?
pectinate muscles
right auricle
301
significance of the crista terminalis
separates two parts of the right atrium with different embryological origins
302
what does the pulmonary trunk divide into?
left and right pulmonary arteries
303
where is the pulmonary valve located?
entrance of the pulmonary trunk
304
what separates the ventricles?
interventricular septum
305
name some features of the right ventricle
trabeculae carneae, papillary muscles, chordae tendineae, moderator band
306
what are trabeculae carneae?
muscular ridges on the internal wall of the right ventricle
307
what are papillary muscles?
modified regions of trabeculae carneae, which project into the lumen of the ventricle
308
what are chordae tendineae?
fibrous cords which connect the tips of the papillary muscles to the tricuspid valve
309
what is the moderator band?
modified region of the trabeculae carneae which connects the interventricular septum to one of the papillary muscles
310
how many pulmonary veins does each lung give off, and how many do we have in total?
2, so then 4
311
describe the internal wall of the left atrium
smooth-walled posterior part
anterior part bearing pectinate muscles
312
what are the first branches from the aorta?
coronary arteries (NOT brachiocephalic trunk)
313
aortic valve function
prevents back flow of blood into the left ventricle from the aorta
314
features of the left ventricle
similar to right ventricle
- trabeculae carneae
- papillary muscles, two in the left ventricle
- chordae tendineae that connect the tips of the papillary muscles to the mitral valve
315
function of papillary muscles and chordae tendineae
normal functioning of the atrioventricular valves
they do not close the valves
allow the closed valves to resist the pressure generated inside the ventricles during contraction and prevent them from being forced open
when the ventricles contract, the papillary muscles also contract
the papillary muscles tense the cords, which pull on the valve cusps and prevent them everting into the atria
316
why are the aortic and pulmonary valves called semilunar valves?
their cusps are semi-circular (half-moon) shaped
317
how many cusps does each semilunar valve have?
three
318
do coronary arteries fill during ventricular systole or diastole?
diastole
319
where do we auscultate the aortic valve?
2nd intercostal space, just right of the sternum
320
where do we auscultate the pulmonary valve?
2nd intercostal space, just left of the sternum
321
where do we auscultate the tricuspid valve?
4th intercostal space, just left of the sternum
322
where do we auscultate the mitral valve?
left 5th intercostal space, midclavicular line
323
what is the heart's pacemaker?
SAN
324
where is the pacemaker of the heart located?
superior end of the crista terminalis
325
rate of generation of impulses of the SAN
70 per minute
326
what do impulses from the SAN stimulate?
atrial contraction
327
where are impulses conducted after the SAN?
AVN
328
where is the AVN?
inferior end of the interatrial septum
329
from the AVN, what do the conducting fibres form?
atrioventricular bundle (Bundle of His)
330
what does the Bundle of His divide into?
left and right bundle branches
331
what do the bundle branches give rise to
Purkinje fibres
332
function of Purkinje fibres
stimulate contraction of the left and right ventricles
333
in what percentage of people is the SAN supplied by the right coronary artery? and left coronary artery?
60%
so then 40%
334
which artery is the AVN usually supplied by?
PIV
(which usually arises from the RCA)
335
which artery usually supplies the Bundle of His?
LCA
336
effect of sympathetic stimulation of the heart
increases heart rate and force of contraction
337
effect of parasympathetic stimulation of the heart
decreases heart rate and force of contraction
338
what is a myocardial infarction
death of a region of myocardium secondary to occlusion of the coronary vessel that supplies it
339
what usually causes an MI?
atherosclerosis within the coronary arteries
340
what is stenosis of the vessels of the heart?
narrowing of the lumen
341
what are cardiomyopathies?
diseases of myocardium
342
what is heart failure?
the heart does not pump efficiently
343
symptoms of heart failure
tiredness, shortness of breath, leg swelling
344
what is cardiac arrest?
cessation of cardiac contraction
345
name two causes of cardiac arrest
MI
conduction system abnormalities
346
what happens at T4?
separates the superior and inferior mediastinum
trachea bifurcates
end of the aortic arch
347
name contents of the posterior mediastinum
descending (thoracic) aorta
azygos veins
oesophagus
thoracic duct
sympathetic trunk and splanchnic nerves
posterior intercostal vessels and nerves
348
name branches of the descending aorta as it passes through the posterior mediastinum
posterior intercostal arteries which supply the intercostal spaces
bronchial arteries - lungs
oesophageal branches - oesophagus
pericardial branches - pericardium
phrenic branches - diaphragm
349
at which level does the aorta pass through the diaphragm?
T12
350
at which level does the azygos system arise?
L1/ L2
351
where do the azygos veins return blood to?
superior vena cava
352
describe the azygos system of veins with regards to the vertebral bodies
an azygos vein on the right side of the vertebral bodies
a shorter hemiazygos vein on the left side of the vertebral bodies
one or more veins connecting the above veins to each other
353
which vessel drains the posterior chest wall?
azygos system of veins
354
from which vessels does the azygos system receive blood from?
posterior intercostal veins, oesophageal veins, bronchial veins
355
in the posterior mediastinum, where does the oesophagus lie in relation to the aorta?
to the right
356
arterial supply of the oesophagus
oesophageal arteries from the descending aorta
357
how is blood from the oesophagus returned to the azygos system?
oesophageal veins
358
at which level is the oesophageal hiatus?
T10 (oesophagus has 10 letters)
359
main vessel of the lymphatic system
thoracic duct
360
what forms the right edge of the heart?
right atrium, superior vena cava, right brachiocephalic vein
361
what forms the left edge of the heart?
left ventricle, left auricular appendage, left pulmonary artery, arch of the aorta, left subclavian artery
362
which sinus separates the areas where the arteries leave the pericardial sac and the veins enter the pericardial sac?
transverse sinus
lies between the pulmonary artery and aorta anteriorly and pulmonary veins and superior vena cava posteriorly
363
describe the oblique sinus
a cul-de-sac extending superiorly from the inferior vena cava between the two left pulmonary veins on one side and the two right pulmonary veins on the other. Its anterior wall is formed by the posterior wall of the left atrium, between the four pulmonary veins.
364
what is the sulcus terminalis?
groove between the right atrium and auricular appendage
corresponds to the crista terminalis internally
365
what is immediately deep to the sulcus terminalis?
crista terminalis
366
in which chamber is the moderator band?
right ventricle
367
where does the thoracic duct lie?
between the azygos vein and the aorta
368
where does the phrenic nerve run in relation to the hilum of the lung?
anterior
369
where does the vagus nerve run in relation to the hilum of the lung?
posterior
370
where does lymph from the lower limbs, pelvis and abdomen flow towards?
cisterna chyli (sac like swelling that gives rise to the thoracic duct)
371
where does the thoracic duct drain lymph from?
lower limbs, pelvis, abdomen, intercostal spaces, lymph nodes, left side of the head and neck, left upper limb
372
where does the thoracic duct terminate?
opens into the venous system at the junction between the left internal jugular vein and left subclavian vein to form the left brachiocephalic vein
373
how is lymph drained from the right side of the head and right upper limb?
lymphatic ducts that enter the venous system at the junction of the right internal jugular and right subclavian veins
374
which nerve is immediately distal to the ligamentum arteriosus?
left recurrent laryngeal nerve
375
path of the left recurrent laryngeal nerve
runs under the arch of the aorta and ascends to innervate most of the muscles of the larynx
376
which structures lie posterior to the oesophagus?
azygos vein
vertebral column
descending aorta
thoracic duct
377
where does the azygos vein drain into?
posterior aspect of the superior vena cava
378
where do the trunks of the sympathetic chain lie?
posterior thoracic wall, either side of the vertebral column and posterior to the parietal pleura
379
what is a ganglion?
collection of cell bodies outside the CNS
380
which veins drain into the azygos veins?
intercostal veins for the lower part of the thoracic wall
381
describe the sympathetic trunks
thin, longitudinal fibre tracts regularly interspersed with ganglia
ganglia are connected by axons and dendrites
382
where do the sympathetic trunks run from?
skull base to coccyx
383
where do the cell bodies of preganglionic sympathetic neurones lie?
T1-L2/3
384
where do sympathetic fibres leave the spinal cord?
from its ventral aspect (anterior)
enter spinal nerves T1-L2/3
385
name the abdominopelvic splanchnic nerves and give their spinal levels?
greater: T5-T9
lesser: T10-11
least: T12
lumbar: L1-L2
386
where are the greater, lesser and least splanchnic nerves formed in the mediastinum?
posterior mediastinum
387
what structures does the posterior intercostal spaces contain behind the parietal pleura?
intercostal muscles
a posterior intercostal artery
a posterior intercostal vein
a posterior intercostal nerve
388
orientation of the structures in the posterior intercostal space from superior to inferior
vein, artery, nerve
(VAN down)
389
which nerves convey postganglionic sympathetic fibres to the thoracic viscera?
cardiopulmonary splanchnic nerves
390
which nerve conveys parasympathetic fibres to the thoracic viscera?
vagus
391
name three thoracic autonomic plexuses
cardiac, pulmonary, oesophageal
392
where does the cardiac plexus innervate?
function?
SAN
sympathetic - increase heart rate and force of contraction
parasympathetic - decrease heart rate and force of contraction
393
where does the pulmonary plexus innervate?
function?
bronchi
sympathetic - relaxes bronchi
parasympathetic - constricts bronchi
394
where does the oesophageal plexus innervate?
function?
oesophagus
sympathetic - inhibit peristalsis
parasympathetic - stimulate peristalsis
395
function of visceral afferents
relay sensory information from the thoracic viscera back to the CNS along the paths of the vagus and thoracic splanchnic nerves
396
where is cardiac pain referred to?
central chest, left side of neck, left arm
397
why is cardiac pain referred to the central chest, left side of neck and left arm?
these skin dermatomes are also innervated by T1-T5
398
where is diaphragm pathology referred to and why?
shoulder, also innervated by C3-5
399
what is an aortic dissection?
longitudinal tear in the aortic wall that allows blood to collect between the intima and media
400
symptoms of Horner's syndrome?
three signs
- ptosis: drooping upper eyelid
- miosis: small pupil
- anhidrosis: lack of sweating on one side of the face
401
cause of Horner's sydrome
interruption to the sympathetic nerves that innervate the head
a cancer in the apex of the lung that invades the sympathetic chain can cause Horner's syndrome on the ipsilateral side of the head
402
what is hiatus hernia?
abdominal segment of the oesophagus moves proximally through the oesophageal opening in the diaphragm and into the chest
403
hiatus hernia symptoms
heartburn, acid reflux
404
name some structures in the neck
structures of the respiratory tract - pharynx, larynx, trachea
structures of the GI tract - pharynx, oesophagus
glands - thyroid and parathyroid
arteries and veins serving the neck and head, including the brain
nerves serving the head and neck, upper limbs, thoraco-abdominal viscera (via vagus) and diaphragm (via phrenic)
muscle groups - muscles moving the head and neck, moving the larynx in speech and swallowing, and that form the floor of the mouth
platysma muscle - thin, subcutaneous muscle deep to the skin of the neck
405
in which direction does platysma run from super to inferior?
outwards
406
which muscle is thin and deep to the skin of the neck
platysma
407
which muscle lies deep to platysma?
sternocleidomastoid
408
how many cervical vertebrae are there
seven
409
which joints join cervical vertebrae?
facet joints
410
where is the hyoid bone located?
anteriorly in the upper neck
inferior to the mandible
411
function of the hyoid bone
keep the pharynx open
provides an attachment point for several muscles in the neck and tongue
412
what is the larynx composed of?
skeleton of small cartilages connected by membranes and small joints
413
function of the larynx
protect the airway
voice box - phonation
414
which muscle separates the anterior and posterior triangles?
sternocleidomastioid
415
where is sternocleidomastioid attached to?
sternum, clavicle, mastoid process of the temporal bone
416
does sternocleidomastioid act unilaterally, bilaterally or both?
both
417
innervation of sternocleidomastoid
accessory nerve (CN XI)
418
boundaries of the anterior triangle of the neck
anterior - midline of the neck
posterior - anterior border of sternocleidomastoid
superior - lower border of the mandible
419
name structures inside the anterior triangle of the neck
trachea and larynx
thyroid gland, parathyroid glands and submandibular salivary gland
hyoid bone
suprahyoid muscles
infrahyoid muscles
common carotid artery and its terminal branches (external and internal carotid arteries)
branches of the external carotid artery to the head and neck
internal jugular vein
branches of the facial nerve (CN VII), glossopharyngeal (CN IIX), vagus (CN X), accessory nerve (CN XI), hypoglossal nerve (CN XII)
ansa cervicalis
420
in which triangle of the neck can you see the thyroid prominence?
anterior
421
function of the suprahyoid muscles
form the floor of the mouth
connect the hyoid to the mandible
move the hyoid and larynx in speech and swallowing
422
function of the infrahyoid muscles
connect the hyoid to the sternum and scapula
move the hyoid and larynx in speech and swallowing
'strap' muscles
423
which muscle is the most anterior of the strap muscles
sternohyoid
424
which muscle lies just lateral to sternohyoid?
omohyoid
425
which infrahyoid muscle connects the hyoid and sternum?
sternohyoid
origin - sternum
insertion - hyoid
426
what is the ansa cervicalis?
fibres from C1-C3 which innervate the infrahyoid muscles
427
boundaries of the posterior triangle of the neck
anterior - posterior border of sternocleidomastoid
posterior - anterior border of trapezius
inferior - clavicle
428
which muscles form the apex of the posterior triangle?
sternocleidomastoid and trapezius
429
name structures in the posterior triangle of the neck
muscles that move the head
subclavian artery and vein
external jugular vein
accessory nerve
roots of the brachial plexus
cervical plexus
phrenic nerve
430
function of the external jugular vein
drain the scalp and face
431
function of the brachial plexus
spinal nerves that supply the upper limb
432
which nerve fibres form the cervical plexus?
C1-C4
433
name the four suprahyoid muscles
mylohyoid
geniohyoid
stylohyoid
digastric
434
where do the suprahyoid muscles lie?
superior to the hyoid bone and form the floor of the mouth
435
are the hyoid muscles paired or unpaired?
paired
436
what happens when the suprahyoid muscles contract?
raise the hyoid bone and larynx during speech and swallowing
437
where do the infrahyoid muscles lie?
inferior to the hyoid bone just lateral to the anterior midline of the neck
438
function of infrahyoid bones
draw the hyoid bone and larynx inferiorly during speech and swallowing
439
name the infrahyoid muscles
sternohyoid, omohyoid, sternothyroid, thyrohyoid
440
which infrahyoid muscles lie superficially?
sternohyoid and omohyoid
441
function of sternohyoid
attach the hyoid to the sternum
442
function of omohyoid
attach the hyoid to the scapula
443
which infrahyoid muscles lie deep?
sternothyroid and thyrohyoid
444
function of sternothyroid
attach the sternum to the thyroid cartilage
445
function of thyrohyoid
attach the thyroid cartilage to the hyoid
446
where do the right and left lobes of the thyroid gland lie?
just lateral to the lower larynx and upper trachea
447
what structure joins the lobes of the thyroid gland?
isthmus
448
which muscle does the thyroid gland lie deep to?
sternothyroid
449
role of thyroid gland
produces hormones which play an important role in the regulation of metabolic processes
450
which gland regulates hormone secretion from the thyroid?
pituitary
451
blood supply of the thyroid gland
left and right superior thyroid arteries
left and right inferior thyroid arteries
452
origin of the superior thyroid arteries
branches of the external carotid arteries
453
origin of the inferior thyroid arteries
branches of the thyrocervical trunks (from the subclavians)
454
venous drainage of the thyroid gland
superior, middle and inferior thyroid veins
455
which glands are located posterior to the thyroid gland?
parathyroid glands
456
how many parathyroid glands are there usually?
4
457
which muscle lies deep to platysma?
sternocleidomastoid
458
names of the parathyroid glands
right and left superior and inferior glands
459
function of parathyroid glands
produce parathyroid hormone which plays a role in calcium regulation
460
blood supply of the parathyroid glands
inferior thyroid arteries
461
which additional thyroid arteryis present in some people?
thyroid ima artery
462
what do the common carotid arteries bifurcate into?
external and internal carotid arteries
463
where can pulsation of the internal carotid arteries be palpated?
immediately lateral to the larynx
464
what blood vessels can be found in the neck
common carotid arteries (bifurcate)
subclavian artery and branches
- e.g thyrocervical trunk
internal jugular vein
external jugular vein
465
what do the common carotid arteries bifurcate into?
external and internal carotid arteries
466
path of the internal carotid
does not give rise to any branches in the neck
enters the cranium and supplies the brain
467
path of the external carotid
gives rise to several branches that supply the head and neck, including the pharynx, scalp, thyroid gland, tongue and face
468
what structure can be found at the bifurcation of the common carotid artery
carotid sinus
469
function of the carotid sinus?
baroreceptors here monitor arterial blood pressure
this visceral sensory information is relayed back to the CNS via the glossopharyngeal nerve, rsulting in reflex responses that regulate blood pressure
470
how is visceral sensory information conveyed from the carotid sinus to the CNS?
glossopharyngeal nerve
471
origin of the thyrocervical trunk
subclavian artery
472
origin of the inferior thyroid artery
thyrocervical trunk
473
function of the subclavian artery
supply the upper limb
474
function of the internal jugular vein
drains blood from the brain and part of the face
475
which veins form the brachiocephalic veins?
internal jugular vein and subclavian vein
there are 2 brachiocephalic veins - left and right
e.g left internal jugular + left subclavian = left brachiocephalic vein
476
which vessels form the superior vena cava?
left and right brachiocephalic veins
477
function of the external jugular vein
drains blood from the scalp and face
478
where does the external jugular vein join the venous system?
joins the subclavian vein
479
name the nerves in the neck
facial (CN VII)
glossopharyngeal (CN IX)
vagus (CN X)
accessory (CN XI)
hypoglossal (CN XII)
phrenic (cervical 3-5)
480
innervation of platysma
facial nerve
481
sensory innervation of pharynx
glossopharyngeal
482
visceral sensory innervation of the carotid sinus
glossopharyngeal
483
motor innervation of the muscles of the pharynx
vagus
484
motor and sensory innervation of the larynx
vagus
485
in the neck, describe the path of the vagus nerve above AND below the bifurcation of the internal carotid
above
runs between the internal jugular vein and the internal carotid artery
below
runs between the internal jugular vein and common carotid artery
486
which structures are enclosed in the carotid sheath?
common carotid artery (CC)
internal carotid artery (I see = IC)
internal jugular vein (IV)
vagus nerve (10th cranial nerve)
mnemonic - I see 10CCs in the IV
487
innervation of sternocleidomastoid
accessory nerve
488
innervation of trapezius muscles
accessory nerve
489
motor innervation of the tongue
hypoglossal
490
does the hypoglossal supply any structures in the neck?
no, just travels through
491
where does the hypoglossal nerve lie in the neck?
lateral to the internal carotid artery and deep to the
492
sympathetic innervation of the head and neck
postganglionic fibres from the superior, middle and inferior cervical ganglia
493
risks of thyroidectomy
injury to the recurrent laryngeal nerves - inability to move the ipsilateral vocal cord which affects the quality of the voice
these nerves are close to the inferior thyroid arteries, which are ligated during this procedure
removal of the parathyroid glands - disturbs calcium homeostasis
494
what is carotid artery stenosis?
atheroma (fatty plaque) in carotid artery narrows the lumen (stenosis) and impedes blood flow to the brain
if the plaque breaks up, fragments of the plaque and thrombus will be carried up into the cerebral arteries, causing a stroke
495
what is carotid endarterectomy?
procedure to remove atheroma from the wall of the carotid artery
496
which vein is preferentially used for central line insertion?
internal jugular vein
497
what is the pharynx?
muscular tube that lies in the neck
forms part of the respiratory and gastrointestinal systems
498
name the parts of the pharynx
nasopharynx
oropharynx
laryngopharynx (hypopharynx)
499
where is the nasopharynx?
posterior to the nasal cavity
500
where is the oropharynx?
posterior to the oral cavity
501
where is the laryngopharynx?
posterior to the larynx
502
describe the anatomy of the walls of the pharynx
outer layer of circular muscle
inner layer of longitudinal muscle
503
describe the external circular muscle layer of the pharynx
three constrictor muscles that overlap each other
- superior
- middle
- inferior
504
which constrictor forms the posterior wall of the nasopharynx
superior
505
which constrictor forms the posterior wall of the oropharynx
middle
506
which constrictor forms the posterior wall of the laryngopharynx
inferior
507
in which direction do the constrictor muscles contract?
superior to inferior
508
what pushes food from the oral cavity to the oropharynx during swallowing?
tongue
509
what rises to close off the nasopharynx from the oropharynx?
soft palate
510
what closes off the laryngeal inlet and prevents food or liquids from entering the larynx?
epiglottis (one of the cartilages of the larynx)
511
sensory innervation of the pharynx
gloossopharyngeal nerve
512
motor innervation of the pharynx
vagus nerve
513
which nerves lie close to the posterior pharyngeal wall?
cervical part of the sympathetic trunk and superior cervical ganglion
superior laryngeal nerve
hypoglossal nerve
glossopharyngeal nerve
514
which nerve is the superior laryngeal nerve a part of?
vagus
515
path of the superior laryngeal nerve
descends over the posterior aspect of the internal carotid artery
passes between the inferior and middle constrictors of the pharynx to the larynx
516
function of the larynx
protect the airway
contributes to phonation/ speech
517
how many cartilages comprise the larynx?
9
518
how many unpaired cartilages are there?
3
519
how many paired cartilages are there?
3 (or rather, 6 due to 2 x 3)
520
how are the laryngeal cartilages joined?
membranes and very small joints
521
name the three unpaired cartilages of the larynx
epiglottis, thyroid cartilage, cricoid cartilage
522
are the paired cartilages larger or smaller than the unpaired cartilages?
smaller
523
name the paired cartilages
arytenoids, cuneiforms, corniculate cartilages
524
describe the anatomy of the thyroid cartilage
two flat cartilages (laminae) that meet in the anterior midline to form the laryngeal prominence
525
alternative name for the laryngeal prominence
Adam's apple
526
what are the names of the posterior laminal extensions projecting superiorly and inferiorly from the thyroid cartilage?
superior and inferior horns
527
which bone does the superior horn of the thyroid cartilage attach to?
hyoid bone
528
what do the inferior horns of the thyroid cartilage articulate with below?
cricoid cartilage
529
what connects the inferior border of the thyroid and the superior border of the cricoid cartilage?
cricothyroid membrane
530
which membrane of the larynx is pierced to create an emergency airway?
cricothyroid
531
which cartilage is attached to the superior aspect of the thyroid cartilage, where the two laminae meet?
epiglottis
532
function of the epiglottis during swallowing
covers the entrance to the larynx (laryngeal inlet) and protects the airway from the entry of liquid or food
533
where are the arytenoids located?
superior surface of the cricoid cartilage
534
function of the arytenoids
phonation
movement of the arytenoids move the vocal cords
535
what are the names of the groups of muscles acting on the larynx?
extrinsic and intrinsic
536
what is the difference between extrinsic and intrinsic muscles of the larynx?
extrinsic muscles move the larynx as one
intrinsic muscles move the individual cartilages of the larynx relative to each other. by moving the cartilages, they move the vocal cords and this alters the quality of speech
537
which nerves are responsible for the gag reflex?
glossopharyngeal and vagus
538
describe the gag reflex
protects the airway
- back of the mouth, posterior wall of the pharynx or tonsils are stimulated
- this sensation is carried to the CNS via the glossopharyngeal nerve
- muscles of the soft palate and pharynx immediately contract via motor fibres in the vagus nerve
539
why may there be swallowing difficulties following a stroke?
stroke affects the regions of the brain involved in the control of swallowing
vagus disruption - dysfunctional swallowing
glossopharyngeal disruption - loss of sensation impairs the cough reflex
risk of aspiration of food
540
what is the dangly part at the back of the throat?
uvula
541
how can an emergency airway be created if the airway is obstructed above the level of the cricoid cartilage?
pierce the cricothyroid membrane
542
name some structures that are palpable on examination of the neck
hyoid bone
thyroid cartilage
cricoid cartilage
first tracheal cartilage
cricothyroid membrane
lobes of the thyroid gland
carotid pulse
543
what are tonsils?
collections of lymphoid tissue in the upper parts of the pharynx
544
what are the two types of tonsils found in the nasopharynx
pharyngal (adenoid) and tubal
545
where are the pharyngeal tonsils located?
roof of the nasopharynx
546
where are the tubal tonsils located?
surround the opening of the auditory tube
547
what is the auditory tube?
connects the nasopharynx to the middle ear
548
where does the palantine tonsil lie?
next to the pharyngeal wall in the oropharynx
549
where is the lingual tonsil?
posterior aspect of the tongue
550
what protects the larynx and airway from the entry of fluid or food?
epiglottis
551
what are the vocal folds?
folds of mucous membrane that project into the cavity of the larynx
552
name the two pairs of folds that project into the cavity of the larynx
vestibular folds
vocal folds
553
which of the folds are the true vocal cords, and which are the false vocal cords?
vestibular - false vocal cords
vocal - true vocal cords
554
which folds are superior and which are inferior?
vestibular folds are superior
vocal folds are inferior
555
what are the vestibular folds?
folds of mucous membrane that lie superior superior to the vocal folds
556
what are the vocal folds?
folds of mucous membrane that cover and protect the vocal ligaments - together they form the true vocal cords
557
what are the vocal ligaments attached to anteriorly?
internal aspect of the laryngeal prominence
558
what are the vocal ligaments attached to posteriorly?
arytenoid cartilages
559
What happens to the rima glottis when the true vocal cords are adducted?
Close
560
What happens to the rima glottis when the true vocal cords are abducted?
Opens
561
Does phonation require adduction or abduction of the true vocal cords?
Adduction
And closure of the rima glottis
562
To what extent is the rima glottis opened in whispering?
Small degree
563
To what extent is the rima glottis opened in normal breathing?
Partially
564
To what extent is the rima glottis opened in forced breathing?
Fully
565
Function of the intrinsic muscles of the larynx
Move the laryngeal cartilages and hence the vocal cords
566
Which recess can be found either side if the laryngeal inlet?
Pyriform fossa
567
Which nerve is responsible for general sensation and taste of the posterior third of the tongue?
Glossopharyngeal
568
Location of the cricothyroid muscle
Between the thyroid and the cricoid cartilage
569
Function of the cricothyroid muscle
Tips the thyroid cartilage anteriorly and inferiorly, placing tension on the vocal cords
570
Location of the posterior cricoarytenoids
Posterior surface of the cricoid
571
Function of the posterior cricoarytenoids
Abduct vocal cords and open rima glottis
572
Location of the transverse arytenoids
Posterior aspect of the larynx, connecting the two arytenoid cartilages
573
Function of the transverse arytenoids
Adduct the vocal folds and close the rima glottis
574
Where does the superior laryngeal nerve innervate?
Cricothyroid muscle
Sensory to the larynx above the vocal folds
575
Where does the recurrent laryngeal nerve innervate?
All of the intrinsic muscles except the cricothyroid
Sensory to the larynx below the vocal folds
576
Name the salivary glands that secret saliva into the oral cavity
Parotid, submandibular, sublingual
577
What type of fibres stimulate glandular secretion?
Parasympathetic
578
What is the carina?
Where trachea bifurcates
579
Which is the largest of the three paired salivary glands?
Parotid
580
Where does the parotid lie?
Posterior part of the mandible
581
Where is the parotid duct opening?
Adjacent to the upper second molar tooth
582
What epithelium are vocal folds covered with?
Stratified, squamous non-keratinising epithelium
583
What epithelium is most of the airway lined with?
Respiratory epithelium
Pseudostratified columnar ciliates with goblet cells
584
What is the aryepiglottic fold?
Folds of soft tissues that extend from the epiglottis anterosuperiorly to the arytenoid cartilage posteroinferiorly
585
Which nerve is the parotid gland closely related to?
Facial
586
What happens to the facial nerve in the parotid gland?
Divided into five branches with emerge to innervate the muscles of facial expression
587
Which blood vessel is the parotid gland associated with?
External carotid artery
588
Which nerve stimulates secretion from the parotid gland?
Glossopharyngeal parasympathetic fibres
589
Where does the submandibular duct open?
Floor of the mouth, under the tongue
590
Which nerve stimulates secretion from the submandibular gland?
Parasympathetic fibres from the facial nerve
591
Which nerve stimulates secretion from the sublingual glands?
Parasympathetic fibres in the facial nerve
592
Where are sublingual glands?
Floor of the mouth
593
Where do sublingual glands open?
Floor of the mouth
594
Path of the recurrent laryngeal nerve
Right side of the neck
- arises from vagus as it passes in front of the subclavian artery
- passes up in the groove between the trachea and oesophagus
Left side
- rln is much longer
- vagus passes over the arch of the aorta
- rln passes under the arch of the aorta, into the groove between the trachea and oesophagus
- enters the posterior aspect of the larynx
595
Where does the facial nerve exit the skull?
Stylomastioid foramina
596
Name the branches of the facial nerve
Mandibular, buccal, zygomatic, temporal, cervical
597
Why can vocal cord palsy result from thyroidectomy?
Recurrent laryngeal nerve lies close to the inferior thyroid artery, which is ligated during thyroidectomy
RLN innervates all but one of the intrinsic muscles of the larynx
If injured, intrinsic muscles of the ipsilateral side do not function
Vocal cords on the affected side cannot move
Hoarseness of the voice results
598
Name for visualisation of the larynx
Laryngoscopy
599
Usual presentation of malignancy of the larynx
Hoarseness of the voice
600
What is endotracheal intubation?
The passage of a semi-rigid tube into the trachea for ventilation
601
Which condition causes painful inflammation and swelling of the parotid gland?
Mumps
602
Which nerve is at risk by pathology of the parotid gland?
Facial (and its branches)
603
Which cranial nerve is the only one to have a contralateral effect?
CN 4
CN IV
Trochlear
604
Effect of pathology of the parotid gland
IPSILATERAL paralysis of facial muscles
605
Describe endotracheal intubation
Passage of a semi rigid tube into the trachea for ventilation
Commonly performed when patients have a general anaesthetic for surgery or when sedated in intensive care
Laryngoscope lifts th tongue and epiglottis to the vocal cords can be directly seen
Tube is passed between the vocal cords into the trachea
Correct placement into the trachea rather than oesophagus is confirmed by carbon dioxide reading on the anaesthetic machine and auscultation both lungs to ensure the tube is in the trachea and not one of the bronchi
