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Phase 1 flashcards > Cardiorespiratory anatomy > Flashcards

Cardiorespiratory anatomy Flashcards

1
Q

what are the three parts of the sternum?

A

manubrium, body and xiphoid process (xiphisternum)

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2
Q

superior border of the manubrium?

A

suprasternal (jugular) notch

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3
Q

what joint is between the clavicle and manubrium?

A

sternoclavicular joint

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4
Q

what joint is between the manubrium and body of the sternum?

A

manubriosternal joint/ sternal angle/ angle of Louis

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5
Q

which ribs does the body articulate with?

A

2-7

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6
Q

which rib articulates with the sternum at the sternal angle?

A

second

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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

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8
Q

what is the costal margin?

A

cartilaginous arch formed by the medial margins of the cartilages of ribs 7-10

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9
Q

which bone marks the upper border of the thorax?

A

clavicle

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10
Q

which bones does the clavicle articulate with?

A

sternum medially
acromium laterally

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11
Q

what is just below the lateral part of the clavicle?

A

coracoid process of the scapula

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12
Q

what is the xiphisternum made up of?

A

cartilage

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13
Q

why can’t the first rib be palpated?

A

lies deep to the clavicle and pec major

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14
Q

how many ribs do we have?

A

12

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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

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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

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17
Q

what is the midsternal line?

A

suprasternal notch through umbilicus

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18
Q

which three lines run on the side of the body?

A

midaxillary line
anterior axillary line
posterior axillary line

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19
Q

which joints are between ribs and their costal cartilages

A

costochondral

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20
Q

which joints are between the costal cartilages and the sternum

A

sternocostal

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21
Q

what happens to the costal cartilages of ribs 8-10

A

unite and join the seventh costal cartilage
false ribs

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22
Q

the costal cartilages of which ribs form the costal margin

A

7-10

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23
Q

which ribs do not articulate with the sternum?

A

11 and 12

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24
Q

which joints are between the ribs and thoracic vertebrae?

A

costovertebral

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25
Q

which ribs are typical or atypical and why?

A

3-9 are typical. have a head, neck, tubercle and body (shaft)
1,2, 10, 11, 12 are atypical for various reasons

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26
Q

how many thoracic vertebrae are there?

A

12

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27
Q

where do the head and tubercle of the ribs articulate on the vertebrae?

A

head - vertebral body
tubercle - transverse process

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28
Q

which structures form the superior thoracic aperture?

A

manubrium, first ribs, first thoracic vertebra

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29
Q

which spinal nerves innervate the skin of the thoracic wall?

A

T1-T12

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30
Q

how are skeletal muscles of the anterior chest wall innervated?

A

somatic motor fibres in spinal nerves T1-T12

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31
Q

how are sweat glands and smooth muscles of blood cells and hair follicles in the skin innervated?

A

sympathetic fibres

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32
Q

what is a dermatome?

A

area of skin innervated by a single spinal nerve

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33
Q

what does the breast contain?

A

variable amounts of fat
glandular/ secretory tissue arranged in lobules
ducts which converge on the nipple
connective tissue and ligaments
blood vessels
lymphatics

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34
Q

what is the area of pigmented skin surrounding the nipple?

A

areola

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35
Q

arterial supply of the breast

A

branches from the:
internal thoracic artery (from subclavian)
axillary artery

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36
Q

where does the internal thoracic artery lie?

A

deep to the lateral edge of the sternum - paired artery

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37
Q

venous drainage of the breast

A

axillary and internal thoracic veins

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38
Q

nerves suppling the breast

A

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

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39
Q

lymphatic drainage of the breast

A

axillary lymph nodes

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40
Q

name the 5 groups of lymph nodes in the axilla

A

central, pectoral, humeral, subscapular, apical

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41
Q

which regions do the axillary lymph nodes drain?

A

breast, upper limb, chest wall, scapular region, abdominal wall

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42
Q

which lymph nodes are involved in the spread of breast cancer and why? where are they located?

A

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

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43
Q

name the layers of intercostal muscles from superficial to deep

A

external, internal, innermost

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44
Q

name three accessory muscles of breathing

A

pectoralis major, pectoralis minor, serratus anterior

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45
Q

what is the primary function of the accessory muscles of breathing?

A

move the upper limb

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46
Q

what is the most superficial muscle of the anterior chest wall?

A

pec major

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47
Q

which muscle is lateral and superior to pec major?

A

deltoid

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48
Q

origin of pec major

A

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

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49
Q

insertion of pec major

A

crest of greater tubercle of humerus

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50
Q

location of pec minor in relation to pec major

A

deep to pec major

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51
Q

origin of pec minor

A

anterior surface, costal cartilages of ribs 3-5

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52
Q

insertion of pec minor

A

medial border and coracoid process of scapula

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53
Q

origin of serratus anterior

A

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))

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54
Q

insertion of serratus anterior

A

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)

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55
Q

action of pec major

A

adduction and internal rotation of the humerus at the shoulder joint

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56
Q

action of pec minor

A

protract the scapula

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57
Q

action of serratus anterior

A

protract the scapula

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58
Q

what is a sign of respiratory distress?

A

use of accessory muscles of breathing: pec major, pec minor, serratus anterior

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59
Q

what is shingles and how does it present?

A

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

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60
Q

what condition can be caused by the removal of lymph nodes, and how does it present?

A

lymphoedema
fluid accumulation and swelling in the affected upper limb

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61
Q

main vein that drains the superficial part of the upper limb

A

cephalic vein

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62
Q

which groove does the cephalic vein lie in?

A

delto-pectoral groove

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63
Q

components of the intercostal neurovascular bundle

A

intercostal nerve, intercostal artery, intercostal vein

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64
Q

what does pec major have on its deep surface?

A

neuromuscular bundle

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65
Q

which nerve supplies both pec major and pec minor?

A

medial pectoral nerve

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66
Q

which nerve only supplies pec major?

A

lateral pectoral nerve

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67
Q

name the intercostal muscles, superficial to deep

A

external intercostal, internal intercostal, innermost intercostal

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68
Q

orientation of external intercostal muscles

A

antero-inferiorly

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69
Q

action of external intercostal muscles

A

pull ribs superiorly

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70
Q

when are the external intercostal muscles most active?

A

inspiration

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71
Q

what happens to the external intercostal muscles anteriorly?

A

muscle becomes membranous and forms the external intercostal membrane

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72
Q

orientation of internal intercostal

A

postero-inferior

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73
Q

action of internal intercostal muscles

A

pull ribs inferiorly

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74
Q

when are the internal intercostal muscles most active?

A

expiration

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75
Q

what happens to the internal intercostal muscles posteriorly?

A

become membranous and forms the internal intercostal membrane

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76
Q

orientation of innermost intercostal muscles

A

postero-inferior

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77
Q

what lies deep to the innermost intercostal and superficial to the parietal pleura?

A

endothoracic fascia

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78
Q

name the layers from superficial to deep, from the skin to the lung

A

skin
superficial fascia
(serratus anterior)
external intercostal
internal intercostal
innermost intercostal
endothoracic fascia
parietal pleura
pleural cavity
visceral pleura
lung

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79
Q

where do the intercostal neuromuscular bundles lie relative to the intercostal muscles?

A

between the internal and innermost intercostal muscles

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80
Q

what does the intercostal neurovascular bundle supply?

A

intercostal muscles, overlying skin, underlying parietal pleura

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81
Q

where does each intercostal neurovascular bundle lie?

A

inferior border of the rib superior to the intercostal space
in the shallow costal groove on the deep surface of the rib

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82
Q

in medical procedures that involve piercing the intercostal space (e.g chest drain), where is the incision made and why?

A

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

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83
Q

origin of anterior intercostal arteries

A

internal thoracic artery (which is a branch of the subclavian)

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84
Q

origin of posterior intercostal arteries

A

descending aorta

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85
Q

where do anterior intercostal veins drain into?

A

internal thoracic vein

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86
Q

where do posterior intercostal veins drain into?

A

azygos system of veins

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87
Q

what type of nerves are the internal intercostal nerves?

A

somatic - contain motor and sensory fibres
also carry sympathetic fibres

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88
Q

what do the intercostal nerves innervate?

A

intercostal muscles, skin of the chest wall, parietal pleura

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89
Q

what do the pleurae cover?

A

lungs and structures passing into and out of the lungs (pulmonary blood vessels and the main bronchi)

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90
Q

what does the parietal pleura line?

A

inside of the thorax

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91
Q

what does the visceral pleura line?

A

surface of the lungs
extends into fissures

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92
Q

what lies between the pleurae?

A

pleural cavity

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93
Q

name the different regions of the parietal pleura

A

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

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94
Q

are the parietal and/ or visceral pleura visible with the naked eye?

A

the parietal pleura is visible but the visceral pleura is not

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95
Q

what do pleural cells produce?

A

pleural fluid

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96
Q

what is the gutter around the periphery of the diaphragm where the costal pleura becomes continuous with the diaphragmatic pleura?

A

costodiaphragmatic recess

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97
Q

which recess lies at the junction of the costal and mediastinal pleura?

A

costomediastinal recess

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98
Q

innervation of parietal pleura

A

intercostal nerves that innervate the overlying skin of the chest wall
somatic sensory fibres

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99
Q

does injury to the parietal pleura reach our consciousness?

A

yes

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100
Q

innervation of visceral pleura

A

autonomic sensory nerves (visceral afferents)

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101
Q

does injury to the visceral pleura reach our consciousness?

A

no

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102
Q

which arteries are found on the deep surface of the anterior thoracic wall?

A

internal thoracic arteries (also called internal mammary arteries)

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103
Q

origin of the internal thoracic arteries

A

subclavian artery

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104
Q

function of the internal thoracic arteries

A

supply the breast and anterior chest wall

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105
Q

course of the internal thoracic artery

A

runs down the inside of the thorax and abdomen to connect with the external iliac artery just above the groin

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106
Q

what is the name for the most superior part of the lung?

A

apex

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107
Q

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

A

three
superior, middle and inferior

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108
Q

how many lobs does the left lung have?
name them

A

two
superior and inferior

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109
Q

what is the name of the anterior extension of the superior lobe of the left lung that extends over the heart?

A

lingula (latin for small tongue)

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110
Q

which fissure(s) do the left and right lung have?

A

both have oblique
right has horizontal too

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111
Q

surface markings of the horizontal fissure

A

below the 4th costal cartilage

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112
Q

surface markings of the oblique fissure

A

starts posteriorly at the 4th rib, runs along the 5th rib and ends at the tip of the 6th rib anteriorly

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113
Q

what does the oblique fissure separate in the left and right lungs?

A

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)

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114
Q

what does the horizontal fissure separate?

A

superior and middle lobe

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115
Q

where is the costal surface of the lung?

A

adjacent to the ribs

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116
Q

where is the mediastinal surface of the lungs?

A

adjacent to the heart

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117
Q

where is the diaphragmatic surface of the lungs?

A

inferior surface of the lung

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118
Q

name the borders of the lung

A

anterior, posterior and inferior

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119
Q

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

a) 6th rib
b) 8th rib
c) 10th rib

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120
Q

lower limit of the pleural space
a) mid clavicular line - anteriorly
b) mid-axillary line - laterally
c) vertebral column - posteriorly

A

a) 8th rib
b) 10th rib
c) 12th rib

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121
Q

what is the continuing potential space between the ribs and diaphragm called, and where does it extend to?

A

costo-phrenic space
two ribs lower than the lower limit of the lung

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122
Q

which structures leave indentations on the lung surface?
on the left and right lung

A

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

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123
Q

what is the root of the lung and what does it contain?

A

lies between the heart and lung
comprises of
- pulmonary artery
- pulmonary veins
- main bronchus

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124
Q

what encloses the root of the lung?

A

pleura

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125
Q

where is the one place where the lung has all its connections with the body?

A

hilum

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126
Q

what are the lung hila?

A

region on the mediastinal surface of the lung where the pulmonary artery, pulmonary veins and main bronchus enter and exit the lungs

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127
Q

how can the bronchi be distinguished in the lung hilum?

A

cartilage, which is not present in the blood vessels

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128
Q

what is the relation between the the main bronchus and pulmonary artery at the hilum of the right lung?

A

main bronchus lies anterior to the pulmonary artery

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129
Q

what is the relation between the main bronchus and the pulmonary artery at the hilum of the left lung?

A

main bronchus lies inferior to the pulmonary artery

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130
Q

how many pulmonary veins so we have in each hilum, and how many altogether?

A

2 in each hilum
4 altogether

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131
Q

where are the pulmonary veins usually located in both hila?

A

most anteriorly and inferiorly

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132
Q

other structures present in the lung hilum?

A

bronchial artery
lymphatics
branches of the vagus, parasympathetic nerve and the sympathetic chains

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133
Q

at which level does the trachea bifurcate? what joint can be found here?

A

T4
sternal angle

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134
Q

in which main bronchus is a foreign body more likely to become lodged, and why?

A

right main bronchus
it is shorter, wider and descends more vertically than the left main bronchus

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135
Q

what is the bronchial tree?

A

branching system of tubes that conduct air into and out of the lungs

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136
Q

describe the bronchial tree

A

trachea - right and left main bronchi - lobar bronchi - segmental bronchi - terminal bronchioles - respiratory bronchioles - alveoli

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137
Q

how many lobar bronchi are in each lung, and what is the naming based on?

A

the number of lobes in each lung
right - 3
left - 2

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138
Q

what does each segmental bronchus supply?

A

a functionally independent region of the lung called a bronchopulmonary segment

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139
Q

how many bronchopulmonary segments are there in each lung?

A

10 in the right
8 in the left

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140
Q

can a lung segment be resected without affecting the rest of the lung? why

A

yes
they are supplied by their own segmental bronchus and blood vessels

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141
Q

state whether bronchioles, trachea and bronchi have smooth muscle and/ or cartilage

A

trachea have smooth muscle and cartilage
bronchioles only have smooth muscle

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142
Q

is the contraction and relaxation of smooth muscle under somatic or autonomic control?

A

autonomic

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143
Q

where do the bronchial arteries arise from?

A

descending aorta

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144
Q

function of the bronchial arteries

A

supply oxygenated blood to trachea, bronchi and bronchial tree

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145
Q

where do the bronchial veins drain into?

A

azygos system of veins

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146
Q

action of parasympathetic fibres on the lungs

A

bronchoconstriction
secretion from the glands of the bronchial tree

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147
Q

action of sympathetic fibres of the lungs

A

bronchodilation
inhibit secretion from the glands of the bronchial tree

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148
Q

what relays sensory information from the lungs and visceral pleura to the CNS? do these sensations reach our consciousness?

A

visceral afferents (visceral sensory fibres)
no

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149
Q

how does lymph from the lungs eventually drain into the venous system?

A

thoracic duct or right lymphatic duct

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150
Q

is the diaphragm skeletal or smooth muscle?

A

skeletal

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151
Q

function of the diaphragm

A

ventilation

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152
Q

attachments of the diaphragm

A

xiphoid process
costal margin
lumbar vertebrae

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153
Q

what is the central tendon?

A

central, fibrous part of the diaphragm

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154
Q

what happens to the diaphragm during inspiration?

A

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

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155
Q

what happens to the diaphragm during expiration?

A

relaxes
domes superiorly
intrathoracic volume decreases
air is expired from the lungs

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156
Q

what are the names of the two phrenic nerves?

A

right and left

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157
Q

are the phrenic nerves somatic and autonomic?

A

somatic (contain both motor and sensory fibres)

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158
Q

which spinal nerve segments form the phrenic nerve?

A

C3, C4 and C5 (keep the diaphragm alive!)

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159
Q

in which directions do the dimensions of the thoracic cavity change during ventilation, and why?

A

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

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160
Q

how is the pleural fluid integral to ventilation?

A

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

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161
Q

what happens if surface tension between the pleurae is broken e.g by puncture wound?

A

pneumothorax
ventilation becomes dysfunctional

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162
Q

describe the process of inspiration

A

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

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163
Q

describe the process of expiration

A

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

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164
Q

in normal quiet breathing, are inspiration and expiration active or passive?

A

inspiration is active (result of muscle contraction)
expiration is passive (due to elastic recoil of the lungs)

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165
Q

which muscle is the main driver of normal quiet breathing?

A

diaphragm

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166
Q

which muscle does active expiration use?

A

internal intercostal

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167
Q

which muscles are involved in very vigorous or forced breathing? e.g exacerbations of asthma or COPD

A

accessory muscles of breathing

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168
Q

which are the accessory muscles of breathing?

A

sternocleidomastoid
pec major
pec minor
serratus anterior

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169
Q

presentation of pleuritic chest pain

A

sharp and well localised
worse on inspiration

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170
Q

what is a pneumothorax? when does a tension pneumothorax develop?

A

presence of air in the pleural cavity
when air keeps entering the pleural cavity but cannot escape
compresses heart, great vessels and lungs

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171
Q

presentation of a pneumothorax

A

severe respiratory distress

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172
Q

what is a haemothorax?

A

collection of blood in the pleural cavity
occurs secondary to trauma when blood vessels are torn or cut

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173
Q

what is pleural effusion?

A

presence of excess fluid in the pleural cavity

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174
Q

how is a pleural effusion treated?

A

chest drain

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175
Q

what is malignancy of the pleura called?

A

mesothelioma

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176
Q

what is a pulmonary embolism, and how does it develop?

A

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

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177
Q

symptoms of dyspnoea

A

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

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178
Q

injury to which spinal segments causes paralysis of the diaphragm? is the paralysis ipsilateral or contralateral?

A

C3, 4 or 5
ipsilateral

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179
Q

how does contraction of the diaphragm assist in returning blood to the heart

A

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

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180
Q

which part of the thoracic cavity lies between the lungs and contains all the thoracic viscera apart from the lungs?

A

mediastinum

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181
Q

superior border of the mediastinum

A

thoracic aperture

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182
Q

inferior border of the mediastinum

A

diaphragm

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183
Q

anterior border of thee mediastinum

A

sternum

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184
Q

posterior border of the mediastinum

A

thoracic vertebrae

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185
Q

structures in the mediastinum

A

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

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186
Q

which two compartments is the mediastinum initially divided into?

A

superior and inferior

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187
Q

where does the line between the superior and inferior mediastinum run anteriorly and posteriorly

A

sternal angle anteriorly to T4/ T5 junction posteriorly

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188
Q

what are the divisions of the inferior mediastinum?

A

anterior, middle and posterior

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189
Q

boundaries of the anterior mediastinum

A

posterior aspect of the sternum
anterior aspect of the pericardial sac

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190
Q

name something contained in the anterior mediastinum

A

thymus gland in children and its remnant in adults
not many interesting things are contained here!

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191
Q

contents of the middle mediastinum

A

heart inside the pericardial sac, pulmonary trunk, ascending aorta

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192
Q

boundaries of the posterior mediastinum

A

posterior aspect of the pericardial sac and the vertebrae

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193
Q

contents of the superior mediastinum

A

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

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194
Q

names of the three parts of the aorta in the thorax

A

ascending, arch, descending

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195
Q

which part of the aorta gives rise to the coronary arteries?

A

ascending

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196
Q

in which direction does the arch of the aorta curve?

A

posteriorly

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197
Q

in which region of the mediastinum does the descending aorta travel through?

A

posterior

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198
Q

branches of the arch of the aorta

A

brachiocephalic trunk, left common carotid, left subclavian

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199
Q

what does the brachiocephalic trunk divide into?

A

right common carotid and right subclavian

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200
Q

what does the right common carotid supply?

A

right side of the head, neck and brain

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201
Q

what does the right subclavian supply?

A

right upper limb

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202
Q

what does the left common carotid supply?

A

left side of the head, neck and brain

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203
Q

what does the left subclavian artery supply?

A

left upper limb

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204
Q

order of branches of the aortic arch from the body’s left to right

A

left subclavian, left common carotid, right common carotid, right subclavian (last two from brachiocephalic trunk)

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205
Q

what are aortic bodies and where are they found?

A

peripheral chemoreceptors in the arch of the aorta

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206
Q

what do aortic bodies monitor?

A

arterial oxygen and carbon dioxide

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207
Q

which nerve carries visceral sensory information from the aorta to the CNS? what is the result

A

vagus
reflex responses that regulate ventilation

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208
Q

what is the ligamentum arteriosum?

A

fibrous, cord-like connection between the pulmonary trunk and the arch of the aorta

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209
Q

what is the ligamentum arteriosum a remnant of?

A

ductus arteriosus, a foetal circulatory shunt

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210
Q

function of the embryological ductus arteriosus?

A

diverts most of the blood entering the pulmonary trunk directly to the aortic arch

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211
Q

when does the ductus arteriosus close?

A

when a baby starts to use their lungs at birth

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212
Q

where does the superior vena cava drain?

A

head, neck and upper limbs

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213
Q

where do the SVC and its tributaries lie?

A

superior mediastinum

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214
Q

the union of which veins forms the SVC?

A

left and right brachiocephalic veins

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215
Q

the union of which veins forms each brachiocephalic vein?

A

internal jugular vein and subclavian vein

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216
Q

what does the internal jugular vein drain?

A

head and neck

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217
Q

how can we remember what the brachiocephalic vein drains?

A

brachium = arm
cephalic = head

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218
Q

where does the IVC drain?

A

all regions inferior to the diaphragm (abdomen, pelvis and lower limbs)

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219
Q

main branches of the left subclavian artery

A

vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk, and the dorsal scapular artery

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220
Q

main branches of the left common carotid

A

external carotid artery
internal carotid artery

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221
Q

what gives the trachea its semi-rigid structure?

A

C-shaped, incomplete rings of cartilage in its walls

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222
Q

where does the trachea extend from?

A

larynx in the midline of the neck to the superior mediastinum

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223
Q

where does the trachea terminate?

A

T4/ T5

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224
Q

what is the oesophagus and where does it extend from?

A

muscular tube that extends from the pharynx in the midline of the neck to the stomach

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225
Q

function of the oesophagus

A

move bolus distally by waves of contractions of smooth muscle

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226
Q

does the oesophagus lie anterior or posterior to the trachea?

A

posterior

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227
Q

path of the phrenic nerves

A

descend through the neck and enter the thorax through the superior thoracic aperture
course over the pericardium and pierce the diaphragm

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228
Q

what type of nerves are the phrenic nerves?

A

somatic
diaphragm is skeletal muscle so makes sense

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229
Q

motor innervation by phrenic nerves

A

diaphragm

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230
Q

sensory innervation by the phrenic nerves

A

pleura, peritoneum and pericardium (three P’s)

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231
Q

where do the left and right vagus nerves arise from?

A

brainstem

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232
Q

which fibres do the vagus nerves contain?

A

somatic sensory, somatic motor, parasympathetic

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233
Q

functions of the vagus nerves

A

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.

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234
Q

path of the vagus nerve?

A

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

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235
Q

what is the major channel for lymphatic drainage from most regions of the body?

A

thoracic duct

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236
Q

where does the thoracic duct empty into the venous system?

A

union of the left internal jugular vein and left subclavian vein (to form left brachiocephalic vein)

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237
Q

where does the thymus gland lie? can we see it in the cadaver

A

anteriorly in the superior mediastinum
no

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238
Q

what is the pericardium?

A

tough, fibrous sac that encloses the heart

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239
Q

why is the pericardium loose?

A

allow for the movement of the heart within it

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240
Q

layers of the pericardium

A

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)

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241
Q

potential space between the two layers of serous pericardium

A

pericardial cavity

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242
Q

what does the pericardial cavity contain, and what is the function of it?

A

pericardial fluid
lubricates the serous membranes and allows them to slide over each other with movements of the heart

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243
Q

innervation of the fibrous pericardium

A

left and right phrenic nerves give rise to sensory branches

244
Q

where do the phrenic nerves pass in relation to the lung hila on both sides?

A

in front

245
Q

where do the vagus nerves pass in relation to the lung hila on both sides?

A

behind

246
Q

in which direction does the base of the heart face?

A

posteriorly
the base is the posterior surface of the heart

247
Q

where does the inferior surface of the heart lie, and what is it also called?

A

central tendon of the diaphragm
diaphragmatic surface

248
Q

where does the anterior surface of the heart face, and what is it also called?

A

sternum and ribs
sternocostal surface

249
Q

where do the left and right sides of the heart face, and what are the names of these surfaces?

A

the lungs
pulmonary surfaces

250
Q

which chambers of the heart corresponds to the base/ posterior surface?

A

left atrium
part of the right atrium

251
Q

which chambers of the heart corresponds to the inferior/ diaphragmatic surface?

A

left ventricle, part of the right ventricle

252
Q

which chamber of the heart corresponds to the anterior/ sternocostal surface

A

right ventricle

253
Q

which chamber of the heart corresponds to the left pulmonary surface?

A

left ventricle

254
Q

which chamber of the heart corresponds to the right pulmonary surface?

A

right atrium

255
Q

which chamber forms the apex of the heart?

A

left ventricle

256
Q

where is the apex beat palpable?

A

left 5th intercostal space, midclavicular line

257
Q

which structures correspond to the right border of the heart?

A

right atrium, superior vena cava, inferior vena cava

258
Q

which structures correspond to the left border of the heart?

A

left ventricle, left pulmonary artery, left auricular appendage

259
Q

which chambers correspond to the inferior border of the heart?

A

right ventricle and part of the left ventricle

260
Q

surface landmarks of the right border of the heart

A

lies lateral to the right sternal edge, from the right 3rd costal cartilage to the right 6th costal cartilage

261
Q

surface landmarks of the left border of the heart

A

left 2nd intercostal space to the left 5th intercostal space in the midclavicular line

262
Q

surface landmarks of the superior border of the heart

A

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
Q

surface landmarks of the inferior border of the heart

A

lies along the line connecting the inferior end of the right border with the apex

mostly formed by the right ventricle

264
Q

what are the auricles/ auricular appendages?

A

outpouchings from the walls of the right and left atria
named because of their ear-like appearance

265
Q

what is patent ductus arteriosus?

A

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
Q

why does hoarseness result from cancer at the apex of the lung?

A

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
Q

what is pericardial effusion, and what can cause it?

A

increase in fluid volume in the pericardial space
inflammation of the pericardium (pericarditis)
accumulation of blood (due to trauma)

268
Q

what is cardiac tamponade?

A

pericardial effusion means heart is compressed and unable to fill properly

269
Q

where do the left and right coronary arteries arise from?

A

ascending aorta

270
Q

where do cardiac veins return venous blood to?

A

coronary sinus, which enters the right atrium

271
Q

what does the right coronary artery supply?

A

parts of the conducting system of the heart, right atrium, right ventricle, part of left ventricle, part of interventricular septum

272
Q

which valve lies deep to the atrioventricular groove?

A

tricuspid

the AV groove is between the right atrium and ventricle

273
Q

where does the right coronary artery lie?

A

atrioventricular groove

274
Q

which artery supplies the inferior border of the heart?

A

right marginal artery

275
Q

which artery is a continuation of the right coronary artery?

A

posterior inter ventricular artery

276
Q

where does the PIV run?

A

inferior surface of the heart
in the posterior intrventricular sulcus

277
Q

what does the PIV supply?

A

both ventricles

278
Q

name two main branches of the RCA

A

right marginal artery
posterior interventricular artery

279
Q

what does the left coronary artery supply?

A

parts of the conducting system, left atrium, most of the left ventricle, part of the right ventricle, part of the interventricular septum

280
Q

name three main branches of the left coronary artery

A

anterior interventricular artery (LAD)
circumflex
left marginal artery

281
Q

name the two terminal branches of the left coronary artery

A

anterior interventricular artery (also called the left anterior descending - LAD)
circumflex

282
Q

what is the short segment of the LCA called before it divides?

A

left main stem

283
Q

where does the anterior interventricular artery/ LAD run?

A

anterior interventricular sulcus towards the apex

284
Q

what does the LAD supply?

A

both ventricles

285
Q

where does the circumflex run?

A

around the heart onto the inferior/ diaphragmatic surface

286
Q

what does the circumflex supply?

A

left atrium, part of the right ventricle and left ventricle

287
Q

where does the left marginal artery arise from?

A

circumflex

288
Q

what does the left marginal artery supply?

A

left ventricle

289
Q

what is right dominant circulation, and is it rarer or more common?

A

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
Q

what is left dominant circulation, and is it rarer or more common?

A

PIV arises from the circumflex artery
therefore, the left ventricle is only supplied by the left coronary artery
rarer (30% of hearts)

291
Q

in what percentage of hearts are there two, parallel branches of the PIV?

A

20%

292
Q

function of heart valves?

A

unidirectional flow of blood through the chambers inside the heart

293
Q

name three vessels from which the right atrium receives blood from

A

SVC
IVC
coronary sinus

294
Q

what separates the atria?

A

interatrial septum

295
Q

name some features of the right atrium

A

interatrial septum
fossa ovalis
crista terminalis

296
Q

what is the fossa ovalis?

A

depression in the interatrial septum
remnant of the foetal foramen ovale

297
Q

function of the foramen ovale in a foetus

A

shunts oxygenated blood from the right atrium to the left atrium, bypassing the lungs

298
Q

what is the difference between the auricular appendages of the atria and the atria?

A

different embryological origins

299
Q

what is the crista terminals?

A

muscular ridge separating the smooth walled posterior part of the right atrium from the anterior part, which has a ridged, muscular wall

300
Q

what are the ridges on the right atrial wall, and where do they extend into?

A

pectinate muscles
right auricle

301
Q

significance of the crista terminalis

A

separates two parts of the right atrium with different embryological origins

302
Q

what does the pulmonary trunk divide into?

A

left and right pulmonary arteries

303
Q

where is the pulmonary valve located?

A

entrance of the pulmonary trunk

304
Q

what separates the ventricles?

A

interventricular septum

305
Q

name some features of the right ventricle

A

trabeculae carneae, papillary muscles, chordae tendineae, moderator band

306
Q

what are trabeculae carneae?

A

muscular ridges on the internal wall of the right ventricle

307
Q

what are papillary muscles?

A

modified regions of trabeculae carneae, which project into the lumen of the ventricle

308
Q

what are chordae tendineae?

A

fibrous cords which connect the tips of the papillary muscles to the tricuspid valve

309
Q

what is the moderator band?

A

modified region of the trabeculae carneae which connects the interventricular septum to one of the papillary muscles

310
Q

how many pulmonary veins does each lung give off, and how many do we have in total?

A

2, so then 4

311
Q

describe the internal wall of the left atrium

A

smooth-walled posterior part
anterior part bearing pectinate muscles

312
Q

what are the first branches from the aorta?

A

coronary arteries (NOT brachiocephalic trunk)

313
Q

aortic valve function

A

prevents back flow of blood into the left ventricle from the aorta

314
Q

features of the left ventricle

A

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
Q

function of papillary muscles and chordae tendineae

A

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
Q

why are the aortic and pulmonary valves called semilunar valves?

A

their cusps are semi-circular (half-moon) shaped

317
Q

how many cusps does each semilunar valve have?

A

three

318
Q

do coronary arteries fill during ventricular systole or diastole?

A

diastole

319
Q

where do we auscultate the aortic valve?

A

2nd intercostal space, just right of the sternum

320
Q

where do we auscultate the pulmonary valve?

A

2nd intercostal space, just left of the sternum

321
Q

where do we auscultate the tricuspid valve?

A

4th intercostal space, just left of the sternum

322
Q

where do we auscultate the mitral valve?

A

left 5th intercostal space, midclavicular line

323
Q

what is the heart’s pacemaker?

A

SAN

324
Q

where is the pacemaker of the heart located?

A

superior end of the crista terminalis

325
Q

rate of generation of impulses of the SAN

A

70 per minute

326
Q

what do impulses from the SAN stimulate?

A

atrial contraction

327
Q

where are impulses conducted after the SAN?

A

AVN

328
Q

where is the AVN?

A

inferior end of the interatrial septum

329
Q

from the AVN, what do the conducting fibres form?

A

atrioventricular bundle (Bundle of His)

330
Q

what does the Bundle of His divide into?

A

left and right bundle branches

331
Q

what do the bundle branches give rise to

A

Purkinje fibres

332
Q

function of Purkinje fibres

A

stimulate contraction of the left and right ventricles

333
Q

in what percentage of people is the SAN supplied by the right coronary artery? and left coronary artery?

A

60%
so then 40%

334
Q

which artery is the AVN usually supplied by?

A

PIV
(which usually arises from the RCA)

335
Q

which artery usually supplies the Bundle of His?

A

LCA

336
Q

effect of sympathetic stimulation of the heart

A

increases heart rate and force of contraction

337
Q

effect of parasympathetic stimulation of the heart

A

decreases heart rate and force of contraction

338
Q

what is a myocardial infarction

A

death of a region of myocardium secondary to occlusion of the coronary vessel that supplies it

339
Q

what usually causes an MI?

A

atherosclerosis within the coronary arteries

340
Q

what is stenosis of the vessels of the heart?

A

narrowing of the lumen

341
Q

what are cardiomyopathies?

A

diseases of myocardium

342
Q

what is heart failure?

A

the heart does not pump efficiently

343
Q

symptoms of heart failure

A

tiredness, shortness of breath, leg swelling

344
Q

what is cardiac arrest?

A

cessation of cardiac contraction

345
Q

name two causes of cardiac arrest

A

MI
conduction system abnormalities

346
Q

what happens at T4?

A

separates the superior and inferior mediastinum
trachea bifurcates
end of the aortic arch

347
Q

name contents of the posterior mediastinum

A

descending (thoracic) aorta
azygos veins
oesophagus
thoracic duct
sympathetic trunk and splanchnic nerves
posterior intercostal vessels and nerves

348
Q

name branches of the descending aorta as it passes through the posterior mediastinum

A

posterior intercostal arteries which supply the intercostal spaces
bronchial arteries - lungs
oesophageal branches - oesophagus
pericardial branches - pericardium
phrenic branches - diaphragm

349
Q

at which level does the aorta pass through the diaphragm?

A

T12

350
Q

at which level does the azygos system arise?

A

L1/ L2

351
Q

where do the azygos veins return blood to?

A

superior vena cava

352
Q

describe the azygos system of veins with regards to the vertebral bodies

A

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
Q

which vessel drains the posterior chest wall?

A

azygos system of veins

354
Q

from which vessels does the azygos system receive blood from?

A

posterior intercostal veins, oesophageal veins, bronchial veins

355
Q

in the posterior mediastinum, where does the oesophagus lie in relation to the aorta?

A

to the right

356
Q

arterial supply of the oesophagus

A

oesophageal arteries from the descending aorta

357
Q

how is blood from the oesophagus returned to the azygos system?

A

oesophageal veins

358
Q

at which level is the oesophageal hiatus?

A

T10 (oesophagus has 10 letters)

359
Q

main vessel of the lymphatic system

A

thoracic duct

360
Q

what forms the right edge of the heart?

A

right atrium, superior vena cava, right brachiocephalic vein

361
Q

what forms the left edge of the heart?

A

left ventricle, left auricular appendage, left pulmonary artery, arch of the aorta, left subclavian artery

362
Q

which sinus separates the areas where the arteries leave the pericardial sac and the veins enter the pericardial sac?

A

transverse sinus
lies between the pulmonary artery and aorta anteriorly and pulmonary veins and superior vena cava posteriorly

363
Q

describe the oblique sinus

A

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
Q

what is the sulcus terminalis?

A

groove between the right atrium and auricular appendage

corresponds to the crista terminalis internally

365
Q

what is immediately deep to the sulcus terminalis?

A

crista terminalis

366
Q

in which chamber is the moderator band?

A

right ventricle

367
Q

where does the thoracic duct lie?

A

between the azygos vein and the aorta

368
Q

where does the phrenic nerve run in relation to the hilum of the lung?

A

anterior

369
Q

where does the vagus nerve run in relation to the hilum of the lung?

A

posterior

370
Q

where does lymph from the lower limbs, pelvis and abdomen flow towards?

A

cisterna chyli (sac like swelling that gives rise to the thoracic duct)

371
Q

where does the thoracic duct drain lymph from?

A

lower limbs, pelvis, abdomen, intercostal spaces, lymph nodes, left side of the head and neck, left upper limb

372
Q

where does the thoracic duct terminate?

A

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
Q

how is lymph drained from the right side of the head and right upper limb?

A

lymphatic ducts that enter the venous system at the junction of the right internal jugular and right subclavian veins

374
Q

which nerve is immediately distal to the ligamentum arteriosus?

A

left recurrent laryngeal nerve

375
Q

path of the left recurrent laryngeal nerve

A

runs under the arch of the aorta and ascends to innervate most of the muscles of the larynx

376
Q

which structures lie posterior to the oesophagus?

A

azygos vein
vertebral column
descending aorta
thoracic duct

377
Q

where does the azygos vein drain into?

A

posterior aspect of the superior vena cava

378
Q

where do the trunks of the sympathetic chain lie?

A

posterior thoracic wall, either side of the vertebral column and posterior to the parietal pleura

379
Q

what is a ganglion?

A

collection of cell bodies outside the CNS

380
Q

which veins drain into the azygos veins?

A

intercostal veins for the lower part of the thoracic wall

381
Q

describe the sympathetic trunks

A

thin, longitudinal fibre tracts regularly interspersed with ganglia
ganglia are connected by axons and dendrites

382
Q

where do the sympathetic trunks run from?

A

skull base to coccyx

383
Q

where do the cell bodies of preganglionic sympathetic neurones lie?

A

T1-L2/3

384
Q

where do sympathetic fibres leave the spinal cord?

A

from its ventral aspect (anterior)
enter spinal nerves T1-L2/3

385
Q

name the abdominopelvic splanchnic nerves and give their spinal levels?

A

greater: T5-T9
lesser: T10-11
least: T12
lumbar: L1-L2

386
Q

where are the greater, lesser and least splanchnic nerves formed in the mediastinum?

A

posterior mediastinum

387
Q

what structures does the posterior intercostal spaces contain behind the parietal pleura?

A

intercostal muscles
a posterior intercostal artery
a posterior intercostal vein
a posterior intercostal nerve

388
Q

orientation of the structures in the posterior intercostal space from superior to inferior

A

vein, artery, nerve
(VAN down)

389
Q

which nerves convey postganglionic sympathetic fibres to the thoracic viscera?

A

cardiopulmonary splanchnic nerves

390
Q

which nerve conveys parasympathetic fibres to the thoracic viscera?

A

vagus

391
Q

name three thoracic autonomic plexuses

A

cardiac, pulmonary, oesophageal

392
Q

where does the cardiac plexus innervate?
function?

A

SAN
sympathetic - increase heart rate and force of contraction
parasympathetic - decrease heart rate and force of contraction

393
Q

where does the pulmonary plexus innervate?
function?

A

bronchi
sympathetic - relaxes bronchi
parasympathetic - constricts bronchi

394
Q

where does the oesophageal plexus innervate?
function?

A

oesophagus
sympathetic - inhibit peristalsis
parasympathetic - stimulate peristalsis

395
Q

function of visceral afferents

A

relay sensory information from the thoracic viscera back to the CNS along the paths of the vagus and thoracic splanchnic nerves

396
Q

where is cardiac pain referred to?

A

central chest, left side of neck, left arm

397
Q

why is cardiac pain referred to the central chest, left side of neck and left arm?

A

these skin dermatomes are also innervated by T1-T5

398
Q

where is diaphragm pathology referred to and why?

A

shoulder, also innervated by C3-5

399
Q

what is an aortic dissection?

A

longitudinal tear in the aortic wall that allows blood to collect between the intima and media

400
Q

symptoms of Horner’s syndrome?

A

three signs
- ptosis: drooping upper eyelid
- miosis: small pupil
- anhidrosis: lack of sweating on one side of the face

401
Q

cause of Horner’s sydrome

A

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
Q

what is hiatus hernia?

A

abdominal segment of the oesophagus moves proximally through the oesophageal opening in the diaphragm and into the chest

403
Q

hiatus hernia symptoms

A

heartburn, acid reflux

404
Q

name some structures in the neck

A

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
Q

in which direction does platysma run from super to inferior?

A

outwards

406
Q

which muscle is thin and deep to the skin of the neck

A

platysma

407
Q

which muscle lies deep to platysma?

A

sternocleidomastoid

408
Q

how many cervical vertebrae are there

A

seven

409
Q

which joints join cervical vertebrae?

A

facet joints

410
Q

where is the hyoid bone located?

A

anteriorly in the upper neck
inferior to the mandible

411
Q

function of the hyoid bone

A

keep the pharynx open
provides an attachment point for several muscles in the neck and tongue

412
Q

what is the larynx composed of?

A

skeleton of small cartilages connected by membranes and small joints

413
Q

function of the larynx

A

protect the airway
voice box - phonation

414
Q

which muscle separates the anterior and posterior triangles?

A

sternocleidomastioid

415
Q

where is sternocleidomastioid attached to?

A

sternum, clavicle, mastoid process of the temporal bone

416
Q

does sternocleidomastioid act unilaterally, bilaterally or both?

A

both

417
Q

innervation of sternocleidomastoid

A

accessory nerve (CN XI)

418
Q

boundaries of the anterior triangle of the neck

A

anterior - midline of the neck
posterior - anterior border of sternocleidomastoid
superior - lower border of the mandible

419
Q

name structures inside the anterior triangle of the neck

A

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
Q

in which triangle of the neck can you see the thyroid prominence?

A

anterior

421
Q

function of the suprahyoid muscles

A

form the floor of the mouth
connect the hyoid to the mandible
move the hyoid and larynx in speech and swallowing

422
Q

function of the infrahyoid muscles

A

connect the hyoid to the sternum and scapula
move the hyoid and larynx in speech and swallowing
‘strap’ muscles

423
Q

which muscle is the most anterior of the strap muscles

A

sternohyoid

424
Q

which muscle lies just lateral to sternohyoid?

A

omohyoid

425
Q

which infrahyoid muscle connects the hyoid and sternum?

A

sternohyoid
origin - sternum
insertion - hyoid

426
Q

what is the ansa cervicalis?

A

fibres from C1-C3 which innervate the infrahyoid muscles

427
Q

boundaries of the posterior triangle of the neck

A

anterior - posterior border of sternocleidomastoid
posterior - anterior border of trapezius
inferior - clavicle

428
Q

which muscles form the apex of the posterior triangle?

A

sternocleidomastoid and trapezius

429
Q

name structures in the posterior triangle of the neck

A

muscles that move the head
subclavian artery and vein
external jugular vein
accessory nerve
roots of the brachial plexus
cervical plexus
phrenic nerve

430
Q

function of the external jugular vein

A

drain the scalp and face

431
Q

function of the brachial plexus

A

spinal nerves that supply the upper limb

432
Q

which nerve fibres form the cervical plexus?

A

C1-C4

433
Q

name the four suprahyoid muscles

A

mylohyoid
geniohyoid
stylohyoid
digastric

434
Q

where do the suprahyoid muscles lie?

A

superior to the hyoid bone and form the floor of the mouth

435
Q

are the hyoid muscles paired or unpaired?

A

paired

436
Q

what happens when the suprahyoid muscles contract?

A

raise the hyoid bone and larynx during speech and swallowing

437
Q

where do the infrahyoid muscles lie?

A

inferior to the hyoid bone just lateral to the anterior midline of the neck

438
Q

function of infrahyoid bones

A

draw the hyoid bone and larynx inferiorly during speech and swallowing

439
Q

name the infrahyoid muscles

A

sternohyoid, omohyoid, sternothyroid, thyrohyoid

440
Q

which infrahyoid muscles lie superficially?

A

sternohyoid and omohyoid

441
Q

function of sternohyoid

A

attach the hyoid to the sternum

442
Q

function of omohyoid

A

attach the hyoid to the scapula

443
Q

which infrahyoid muscles lie deep?

A

sternothyroid and thyrohyoid

444
Q

function of sternothyroid

A

attach the sternum to the thyroid cartilage

445
Q

function of thyrohyoid

A

attach the thyroid cartilage to the hyoid

446
Q

where do the right and left lobes of the thyroid gland lie?

A

just lateral to the lower larynx and upper trachea

447
Q

what structure joins the lobes of the thyroid gland?

A

isthmus

448
Q

which muscle does the thyroid gland lie deep to?

A

sternothyroid

449
Q

role of thyroid gland

A

produces hormones which play an important role in the regulation of metabolic processes

450
Q

which gland regulates hormone secretion from the thyroid?

A

pituitary

451
Q

blood supply of the thyroid gland

A

left and right superior thyroid arteries
left and right inferior thyroid arteries

452
Q

origin of the superior thyroid arteries

A

branches of the external carotid arteries

453
Q

origin of the inferior thyroid arteries

A

branches of the thyrocervical trunks (from the subclavians)

454
Q

venous drainage of the thyroid gland

A

superior, middle and inferior thyroid veins

455
Q

which glands are located posterior to the thyroid gland?

A

parathyroid glands

456
Q

how many parathyroid glands are there usually?

A

4

457
Q

which muscle lies deep to platysma?

A

sternocleidomastoid

458
Q

names of the parathyroid glands

A

right and left superior and inferior glands

459
Q

function of parathyroid glands

A

produce parathyroid hormone which plays a role in calcium regulation

460
Q

blood supply of the parathyroid glands

A

inferior thyroid arteries

461
Q

which additional thyroid arteryis present in some people?

A

thyroid ima artery

462
Q

what do the common carotid arteries bifurcate into?

A

external and internal carotid arteries

463
Q

where can pulsation of the internal carotid arteries be palpated?

A

immediately lateral to the larynx

464
Q

what blood vessels can be found in the neck

A

common carotid arteries (bifurcate)
subclavian artery and branches
- e.g thyrocervical trunk
internal jugular vein
external jugular vein

465
Q

what do the common carotid arteries bifurcate into?

A

external and internal carotid arteries

466
Q

path of the internal carotid

A

does not give rise to any branches in the neck
enters the cranium and supplies the brain

467
Q

path of the external carotid

A

gives rise to several branches that supply the head and neck, including the pharynx, scalp, thyroid gland, tongue and face

468
Q

what structure can be found at the bifurcation of the common carotid artery

A

carotid sinus

469
Q

function of the carotid sinus?

A

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
Q

how is visceral sensory information conveyed from the carotid sinus to the CNS?

A

glossopharyngeal nerve

471
Q

origin of the thyrocervical trunk

A

subclavian artery

472
Q

origin of the inferior thyroid artery

A

thyrocervical trunk

473
Q

function of the subclavian artery

A

supply the upper limb

474
Q

function of the internal jugular vein

A

drains blood from the brain and part of the face

475
Q

which veins form the brachiocephalic veins?

A

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
Q

which vessels form the superior vena cava?

A

left and right brachiocephalic veins

477
Q

function of the external jugular vein

A

drains blood from the scalp and face

478
Q

where does the external jugular vein join the venous system?

A

joins the subclavian vein

479
Q

name the nerves in the neck

A

facial (CN VII)
glossopharyngeal (CN IX)
vagus (CN X)
accessory (CN XI)
hypoglossal (CN XII)
phrenic (cervical 3-5)

480
Q

innervation of platysma

A

facial nerve

481
Q

sensory innervation of pharynx

A

glossopharyngeal

482
Q

visceral sensory innervation of the carotid sinus

A

glossopharyngeal

483
Q

motor innervation of the muscles of the pharynx

A

vagus

484
Q

motor and sensory innervation of the larynx

A

vagus

485
Q

in the neck, describe the path of the vagus nerve above AND below the bifurcation of the internal carotid

A

above
runs between the internal jugular vein and the internal carotid artery

below
runs between the internal jugular vein and common carotid artery

486
Q

which structures are enclosed in the carotid sheath?

A

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
Q

innervation of sternocleidomastoid

A

accessory nerve

488
Q

innervation of trapezius muscles

A

accessory nerve

489
Q

motor innervation of the tongue

A

hypoglossal

490
Q

does the hypoglossal supply any structures in the neck?

A

no, just travels through

491
Q

where does the hypoglossal nerve lie in the neck?

A

lateral to the internal carotid artery and deep to the

492
Q

sympathetic innervation of the head and neck

A

postganglionic fibres from the superior, middle and inferior cervical ganglia

493
Q

risks of thyroidectomy

A

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
Q

what is carotid artery stenosis?

A

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
Q

what is carotid endarterectomy?

A

procedure to remove atheroma from the wall of the carotid artery

496
Q

which vein is preferentially used for central line insertion?

A

internal jugular vein

497
Q

what is the pharynx?

A

muscular tube that lies in the neck
forms part of the respiratory and gastrointestinal systems

498
Q

name the parts of the pharynx

A

nasopharynx
oropharynx
laryngopharynx (hypopharynx)

499
Q

where is the nasopharynx?

A

posterior to the nasal cavity

500
Q

where is the oropharynx?

A

posterior to the oral cavity

501
Q

where is the laryngopharynx?

A

posterior to the larynx

502
Q

describe the anatomy of the walls of the pharynx

A

outer layer of circular muscle
inner layer of longitudinal muscle

503
Q

describe the external circular muscle layer of the pharynx

A

three constrictor muscles that overlap each other
- superior
- middle
- inferior

504
Q

which constrictor forms the posterior wall of the nasopharynx

A

superior

505
Q

which constrictor forms the posterior wall of the oropharynx

A

middle

506
Q

which constrictor forms the posterior wall of the laryngopharynx

A

inferior

507
Q

in which direction do the constrictor muscles contract?

A

superior to inferior

508
Q

what pushes food from the oral cavity to the oropharynx during swallowing?

A

tongue

509
Q

what rises to close off the nasopharynx from the oropharynx?

A

soft palate

510
Q

what closes off the laryngeal inlet and prevents food or liquids from entering the larynx?

A

epiglottis (one of the cartilages of the larynx)

511
Q

sensory innervation of the pharynx

A

gloossopharyngeal nerve

512
Q

motor innervation of the pharynx

A

vagus nerve

513
Q

which nerves lie close to the posterior pharyngeal wall?

A

cervical part of the sympathetic trunk and superior cervical ganglion
superior laryngeal nerve
hypoglossal nerve
glossopharyngeal nerve

514
Q

which nerve is the superior laryngeal nerve a part of?

A

vagus

515
Q

path of the superior laryngeal nerve

A

descends over the posterior aspect of the internal carotid artery
passes between the inferior and middle constrictors of the pharynx to the larynx

516
Q

function of the larynx

A

protect the airway
contributes to phonation/ speech

517
Q

how many cartilages comprise the larynx?

A

9

518
Q

how many unpaired cartilages are there?

A

3

519
Q

how many paired cartilages are there?

A

3 (or rather, 6 due to 2 x 3)

520
Q

how are the laryngeal cartilages joined?

A

membranes and very small joints

521
Q

name the three unpaired cartilages of the larynx

A

epiglottis, thyroid cartilage, cricoid cartilage

522
Q

are the paired cartilages larger or smaller than the unpaired cartilages?

A

smaller

523
Q

name the paired cartilages

A

arytenoids, cuneiforms, corniculate cartilages

524
Q

describe the anatomy of the thyroid cartilage

A

two flat cartilages (laminae) that meet in the anterior midline to form the laryngeal prominence

525
Q

alternative name for the laryngeal prominence

A

Adam’s apple

526
Q

what are the names of the posterior laminal extensions projecting superiorly and inferiorly from the thyroid cartilage?

A

superior and inferior horns

527
Q

which bone does the superior horn of the thyroid cartilage attach to?

A

hyoid bone

528
Q

what do the inferior horns of the thyroid cartilage articulate with below?

A

cricoid cartilage

529
Q

what connects the inferior border of the thyroid and the superior border of the cricoid cartilage?

A

cricothyroid membrane

530
Q

which membrane of the larynx is pierced to create an emergency airway?

A

cricothyroid

531
Q

which cartilage is attached to the superior aspect of the thyroid cartilage, where the two laminae meet?

A

epiglottis

532
Q

function of the epiglottis during swallowing

A

covers the entrance to the larynx (laryngeal inlet) and protects the airway from the entry of liquid or food

533
Q

where are the arytenoids located?

A

superior surface of the cricoid cartilage

534
Q

function of the arytenoids

A

phonation
movement of the arytenoids move the vocal cords

535
Q

what are the names of the groups of muscles acting on the larynx?

A

extrinsic and intrinsic

536
Q

what is the difference between extrinsic and intrinsic muscles of the larynx?

A

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
Q

which nerves are responsible for the gag reflex?

A

glossopharyngeal and vagus

538
Q

describe the gag reflex

A

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
Q

why may there be swallowing difficulties following a stroke?

A

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
Q

what is the dangly part at the back of the throat?

A

uvula

541
Q

how can an emergency airway be created if the airway is obstructed above the level of the cricoid cartilage?

A

pierce the cricothyroid membrane

542
Q

name some structures that are palpable on examination of the neck

A

hyoid bone
thyroid cartilage
cricoid cartilage
first tracheal cartilage
cricothyroid membrane
lobes of the thyroid gland
carotid pulse

543
Q

what are tonsils?

A

collections of lymphoid tissue in the upper parts of the pharynx

544
Q

what are the two types of tonsils found in the nasopharynx

A

pharyngal (adenoid) and tubal

545
Q

where are the pharyngeal tonsils located?

A

roof of the nasopharynx

546
Q

where are the tubal tonsils located?

A

surround the opening of the auditory tube

547
Q

what is the auditory tube?

A

connects the nasopharynx to the middle ear

548
Q

where does the palantine tonsil lie?

A

next to the pharyngeal wall in the oropharynx

549
Q

where is the lingual tonsil?

A

posterior aspect of the tongue

550
Q

what protects the larynx and airway from the entry of fluid or food?

A

epiglottis

551
Q

what are the vocal folds?

A

folds of mucous membrane that project into the cavity of the larynx

552
Q

name the two pairs of folds that project into the cavity of the larynx

A

vestibular folds
vocal folds

553
Q

which of the folds are the true vocal cords, and which are the false vocal cords?

A

vestibular - false vocal cords
vocal - true vocal cords

554
Q

which folds are superior and which are inferior?

A

vestibular folds are superior
vocal folds are inferior

555
Q

what are the vestibular folds?

A

folds of mucous membrane that lie superior superior to the vocal folds

556
Q

what are the vocal folds?

A

folds of mucous membrane that cover and protect the vocal ligaments - together they form the true vocal cords

557
Q

what are the vocal ligaments attached to anteriorly?

A

internal aspect of the laryngeal prominence

558
Q

what are the vocal ligaments attached to posteriorly?

A

arytenoid cartilages

559
Q

What happens to the rima glottis when the true vocal cords are adducted?

A

Close

560
Q

What happens to the rima glottis when the true vocal cords are abducted?

A

Opens

561
Q

Does phonation require adduction or abduction of the true vocal cords?

A

Adduction
And closure of the rima glottis

562
Q

To what extent is the rima glottis opened in whispering?

A

Small degree

563
Q

To what extent is the rima glottis opened in normal breathing?

A

Partially

564
Q

To what extent is the rima glottis opened in forced breathing?

A

Fully

565
Q

Function of the intrinsic muscles of the larynx

A

Move the laryngeal cartilages and hence the vocal cords

566
Q

Which recess can be found either side if the laryngeal inlet?

A

Pyriform fossa

567
Q

Which nerve is responsible for general sensation and taste of the posterior third of the tongue?

A

Glossopharyngeal

568
Q

Location of the cricothyroid muscle

A

Between the thyroid and the cricoid cartilage

569
Q

Function of the cricothyroid muscle

A

Tips the thyroid cartilage anteriorly and inferiorly, placing tension on the vocal cords

570
Q

Location of the posterior cricoarytenoids

A

Posterior surface of the cricoid

571
Q

Function of the posterior cricoarytenoids

A

Abduct vocal cords and open rima glottis

572
Q

Location of the transverse arytenoids

A

Posterior aspect of the larynx, connecting the two arytenoid cartilages

573
Q

Function of the transverse arytenoids

A

Adduct the vocal folds and close the rima glottis

574
Q

Where does the superior laryngeal nerve innervate?

A

Cricothyroid muscle
Sensory to the larynx above the vocal folds

575
Q

Where does the recurrent laryngeal nerve innervate?

A

All of the intrinsic muscles except the cricothyroid
Sensory to the larynx below the vocal folds

576
Q

Name the salivary glands that secret saliva into the oral cavity

A

Parotid, submandibular, sublingual

577
Q

What type of fibres stimulate glandular secretion?

A

Parasympathetic

578
Q

What is the carina?

A

Where trachea bifurcates

579
Q

Which is the largest of the three paired salivary glands?

A

Parotid

580
Q

Where does the parotid lie?

A

Posterior part of the mandible

581
Q

Where is the parotid duct opening?

A

Adjacent to the upper second molar tooth

582
Q

What epithelium are vocal folds covered with?

A

Stratified, squamous non-keratinising epithelium

583
Q

What epithelium is most of the airway lined with?

A

Respiratory epithelium
Pseudostratified columnar ciliates with goblet cells

584
Q

What is the aryepiglottic fold?

A

Folds of soft tissues that extend from the epiglottis anterosuperiorly to the arytenoid cartilage posteroinferiorly

585
Q

Which nerve is the parotid gland closely related to?

A

Facial

586
Q

What happens to the facial nerve in the parotid gland?

A

Divided into five branches with emerge to innervate the muscles of facial expression

587
Q

Which blood vessel is the parotid gland associated with?

A

External carotid artery

588
Q

Which nerve stimulates secretion from the parotid gland?

A

Glossopharyngeal parasympathetic fibres

589
Q

Where does the submandibular duct open?

A

Floor of the mouth, under the tongue

590
Q

Which nerve stimulates secretion from the submandibular gland?

A

Parasympathetic fibres from the facial nerve

591
Q

Which nerve stimulates secretion from the sublingual glands?

A

Parasympathetic fibres in the facial nerve

592
Q

Where are sublingual glands?

A

Floor of the mouth

593
Q

Where do sublingual glands open?

A

Floor of the mouth

594
Q

Path of the recurrent laryngeal nerve

A

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
Q

Where does the facial nerve exit the skull?

A

Stylomastioid foramina

596
Q

Name the branches of the facial nerve

A

Mandibular, buccal, zygomatic, temporal, cervical

597
Q

Why can vocal cord palsy result from thyroidectomy?

A

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
Q

Name for visualisation of the larynx

A

Laryngoscopy

599
Q

Usual presentation of malignancy of the larynx

A

Hoarseness of the voice

600
Q

What is endotracheal intubation?

A

The passage of a semi-rigid tube into the trachea for ventilation

601
Q

Which condition causes painful inflammation and swelling of the parotid gland?

A

Mumps

602
Q

Which nerve is at risk by pathology of the parotid gland?

A

Facial (and its branches)

603
Q

Which cranial nerve is the only one to have a contralateral effect?

A

CN 4
CN IV
Trochlear

604
Q

Effect of pathology of the parotid gland

A

IPSILATERAL paralysis of facial muscles

605
Q

Describe endotracheal intubation

A

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

Phase 1 flashcards (27 decks)

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