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CARDIO-RESPIRATORY > CR Anatomy > Flashcards

CR Anatomy Flashcards

1
Q

Compare the position of the pulmonary valve to it’s auscultation point

A

Position - behind sternum opposite the 3rd intercostal space
Ausculation - Left side of sternum at 2nd intercostal junction

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2
Q

Compare the position of the aortic valve to it’s auscultation point

A

Position - left side of sternum opposite left 3rd intercostal junction
Auscultation - 2nd intercostal space to right of sternal body

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3
Q

Compare the position of the bicuspid/mitral valve to it’s auscultation point

A

Position - left of 4th intercostal junction

Auscultation - 5th intercostal space in mid-clavicular line

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4
Q

Compare the position of the tricuspid valve to it’s auscultation point

A

Position - behind sternum opposite 4-5th intercostal junction
Auscultation - lower left quadrant of the body of the sternum

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5
Q

What structure divides the mediastinum into superior and inferior?

A

Transverse thoracic plane (found at sternal angle T4-T5)

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6
Q

Describe the contents of the superior mediastinum

A

Manubrium, sternal angle, great vessels from aorta

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7
Q

Describe the contents of the inferior mediastinum

A

Sternum, heart, diaphragm, descending aorta, xiphoid process

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8
Q

Where is the thymus located?

A

Anterior mediastinum

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9
Q

What are the recurrent laryngeal nerves motor to?

A

Vocal cords

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10
Q

Describe the passage of the right vagus nerve in the mediastinum

A

Enters mediastinum lateral to RCCA –> descends in carotid sheath –> anterior to SCA and posterior to SVC –> gives off R recurrent laryngeal branch as it crosses the SCA –> travels in posterior mediastinum

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11
Q

Describe the passage of the left vagus nerve in the mediastinum

A

Enters mediastinum lateral to LCCA –> descends in carotid sheath –> anterior to SCA and posterior to left brachiocephalic vein –> at lateral side of aortic arch gives off L recurrent laryngeal nerve which hooks under aorta next to ligamentum arteriosum

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12
Q

What nerve plexi does the left vagus nerve supply?

A

Cardiac and pulmonary plexi

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13
Q

What nerve plexi does the right vagus nerve supply?

A

Combines with the left vagus supply to form the oesophageal plexus

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14
Q

Where do phrenic nerves enter the mediastinum?

A

Between the subclavian artery and the origin of the subclavian vein

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15
Q

Describe the passage of the right phrenic nerve

A

Descends lateral to right brachiocephalic vein and SVC –> over pericardium of right atria –> diaphragm

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16
Q

Describe the passage of the left phrenic nerve

A

Descends between left SCA and left CCA –> crosses lateral surface of aortic arch anterior to vagus nerve –> superficial to left atrium and ventricles –> diaphragm

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17
Q

When does the trachea bifurcate?

A

Level of sternal angle (transthoracic plane) at T4-T5

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18
Q

At which spinal level does the trachea begin?

A

C6

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19
Q

What is the first ganglion of the sympathetic trunk usually fused with?

A

Inferior cervical (stellate) ganglion

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20
Q

What does the gray rami of the thoracic sympathetic trunk innervate?

A

Goes to all of the thoracic spinal nerves and post-ganglionic fibres with spinal nerve –> blood vessels, sweat glands, erector pili muscles (skin)

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21
Q

What do the first 5 ganglia of the thoracic sympathetic trunk do?

A

Give post-ganglionic fibres to heart, aorta, lungs and oesophagus

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22
Q

What do the lower 8 ganglia of the thoracic sympathetic trunk do?

A

Give pre-ganglionic fibres which are grouped to form splanchnic nerves

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23
Q

What is the role of the greater splanchnic nerve?

A

Formed from sympathetic ganglia 5-9 and supplies the foregut

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24
Q

What is the role of the lesser splanchnic nerve?

A

Ganglia 10-11 go to midgut

Ganglia 12 goes to hindgut

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25
Q

How many ganglia are there in the thoracic portion of the sympathetic trunk?

A

12

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26
Q

What is the outer layer of pericardium bound to?

A

Central tendon of diaphragm

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27
Q

What is the nerve supply to the fibrous and parietal pericardium?

A

Phrenic nerves (C3,4,5)

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28
Q

Describe the contents of the posterior mediastinum

A

Oesophagus, oesophageal plexus, thoracic aorta, azygos and hemi-azygos veins, sympathetic trunks and splanchnic nerves

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29
Q

What is the role of the azygos veins?

A

Drain blood from the posterior intercostal spaces, posterior abdominal wall, pericardium diaphragm and bronchii

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30
Q

Where does the azygos vein drain to?

A

Drains up through R side of thorax –> posterior portion of SVC –> RA

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31
Q

When are the coronary arteries perfused?

A

During diastole when the valves of the aortic sinus are shut

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32
Q

Describe the passage of the left coronary artery

A

Passes between auricle of left atrium and pulmonary trunk –> atrioventricular sulcus –> divides into left anterior descending and circumflex branches

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33
Q

Describe the passage of the right coronary artery

A

Leaves right side of the ascending aorta –> right of AV sulcus –> posterior surface of heart –> down posterior interventricular sulcus and gives off the posterior descending branch

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34
Q

Describe the passage of the left anterior descending artery

A

Runs within anterior interventricular sulcus towards heart apex (supplies anterior wall of left ventricle and anterior 2/3 of interventricular septum)

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35
Q

Describe the passage of the circumflex branch of the left coronary artery

A

Continues in the atrioventricular sulcus to the posterior surface of the heart giving off the marginal branch on the way

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36
Q

Describe the passage of the left marginal branch

A

Branch of circumflex artery (from left coronary artery) which follows the left margin of the heart and supplies most of the left ventricle

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37
Q

What structures does the right coronary artery supply?

A

Right atrium, SAN, AVN and posterior IV septum

38
Q

What structures does the marginal branch of the right coronary artery supply?

A

Much of the right ventricle

39
Q

How does angiogram appearance differ between left and right coronary arteries?

A

Right coronary arteries appear as C, left coronary arteries appear as M

40
Q

What is the main vein of the heart and where is it?

A

Coronary sinus, within the posterior AV sulcus

41
Q

Describe the passage of the 3 cardiac veins

A

Great cardiac vein - in anterior interventricular sulcus
Middle cardiac vein - runs in posterior interventricular sulcus
Small cardiac vein - parallel to right marginal artery

42
Q

Which 3 veins drain into the right atrium?

A

Superior and inferior vena cava and coronary sinus

43
Q

What is pectinate muscle?

A

Rough wall of the atria

44
Q

What is cristae terminalis?

A

Smooth-surfaced, thick portion of heart muscle in a crescent shape at the opening into the right atria

45
Q

What is trabeculae carnae?

A

Rounded/irregular muscular columns which project from the inner surface of the right and left ventricles

46
Q

What is the moderator band?

A

Muscular band of heart tissue found in the right ventricle of the heart

47
Q

What is the function of the fibrous framework of the heart?

A

Separates atria and ventricles, provides attachment for muscle, prevents valve overstretching and forms basis of electrical discontinuity between atria and ventricles

48
Q

What level is the diaphragm in relation to the ribs anteriorly?

A

7th rib

49
Q

What is a costophrenic recess?

A

The recess between the ribs and the lateral-most portion of the diaphragm

50
Q

What is a cardiophrenic recess?

A

Angle between the heart and the diaphragm at either the right or left side of the cardiac projection

51
Q

Where can the apex beat be located?

A

5th intercostal space in the mid-clavicular line

52
Q

What are true ribs?

A

First 7 ribs: connected directly to the sternum

53
Q

What are false ribs?

A

Bottom 5 ribs: don’t directly connect to the sternum, but do so via the ribs above them

54
Q

What are floating ribs?

A

Bottom 2 ribs which are not attached to the sternum at all

55
Q

Where do the intercostal veins drain to?

A

ANTERIORLY: internal thoracic vein
POSTERIORLY: azygos (right), hemizygos (left)

56
Q

Where is the internal thoracic artery located?

A

Passes just behind the costal cartilages either side of the sternum

57
Q

Describe the three layers of muscle between the ribs

A

External intercostals - hands into front pockets direction
Internal intercostals - hands into back pockets direction
Innermost intercostal muscles - hands into back pockets direction

58
Q

Describe the attachments of the diaphragm to the bony skeleton

A

Attached to posterior aspect of xiphoid process, internal surfaces of the lower 6 ribs and costal cartilages and to the L1-L3 posteriorly

59
Q

Name the 3 structures that pass through the diaphragm and at what spinal level

A

Vena cava - T8
Oesophagus - T10
Aorta - T12

60
Q

What is the sensory innervation of the mediastinal pleura, pericardium and some parietal pleura covering diaphragm?

A

Phrenic nerve

61
Q

Which nerves provide sensory innervation to the peripheral diaphragmatic parietal pleura?

A

Intercostal nerves

62
Q

What type of pleura covers the thoracic wall?

A

Costal pleura

63
Q

What type of pleura covers the lateral surface of the mediastinum?

A

Mediastinal pleura

64
Q

What type of pleura covers the superior surface of the diaphragm on each side of the heart?

A

Diaphragmatic pleura

65
Q

What is the lower area of the pleural cavity, into which the lung expands, known as?

A

Costophrenic/costophragmatic recess

66
Q

Where does the nasolacrimal/tear duct drain?

A

Inferior meatus

67
Q

Where is the maxillary air sinus?

A

Air sinus just beneath the eyes either side of the nose

68
Q

Where are the nasal conchae?

A

Scroll-like bones in the sides of the nasal cavity –> superior, middle and inferior conchae

69
Q

Where are the meatuses?

A

Meatuses are present beneath the conchae in the nose (they are air spaces) –> superior, middle and inferior meatuses

70
Q

What 3 bones make up the nasal septum?

A

Ethmoid, cartilage and vomer

71
Q

Where does the maxillary air sinus drain?

A

Into nose through the ostia (hole)

72
Q

What forms the ‘Adam’s apple’ (Laryngeal prominence)?

A

Thyroid cartilage joined anteriorly

73
Q

Where is the ‘vocal fold’?

A

Fold between the arytenoid and thyroid cartilages

74
Q

Where is the false vocal cord/vestibular fold?

A

Lies above the vocal fold

75
Q

Describe the attachments of the epiglottis

A

Leaf-shaped cartilage attached in the midline to the inner surface of the thyroid cartilage and extends upwards and backwards behind the tongue

76
Q

Name the cartilage in the larynx from superior to inferior anatomically

A

Thyroid, (arytenoid behind thyroid), cricoid cartilage

77
Q

Which cranial nerve supplies the larynx?

A

CN X (Vagus)

78
Q

What is the function of the recurrent laryngeal nerve?

A

Motor to all intrinsic muscles of the larynx except for cricothyroid –> involved in phonation

79
Q

What are the two divisions of the superior laryngeal nerve?

A

Internal laryngeal nerve (sensory) and external laryngeal nerve (motor)

80
Q

What is the function of the internal laryngeal nerve?

A

Sensory to structures of larynx and laryngopharynx above the vocal folds

81
Q

What is the function of the external laryngeal nerve?

A

Motor to cricothyroid –> intonation

82
Q

What is the blood supply to the larynx?

A

Laryngeal branches of superior and inferior thyroid arteries

83
Q

Where is the thyroid gland located?

A

Anterior to trachea at C5-T1

84
Q

What are the progressive divisions in the bronchial tree?

A

Trachea –> two main bronchi –> lobar bronchi (3R, 2L) –> segmental bronchi –> bronchopulmonary segment –> bronchioles –> alveoli

85
Q

Which side of lung is a foreign body most likely to get lodged and why?

A

Right side as the right lower lobar bronchus is more vertical than any of it’s left-side counterparts

86
Q

What is the blood supply to the lungs?

A

Bronchial arteries (from descending aorta)

87
Q

Where do bronchial veins drain to?

A

Azygos and hemiazygos veins

88
Q

Where does lymph from the lungs drains?

A

Leaves hilum –> tracheobronchial nodes –> bronchomediastinal lymph trunks

89
Q

What is the nerve supply to the lungs and visceral pleura?

A

Vagus (parasympathetic) and sympathetic fibres (not sensory to pain)

90
Q

What is the nerve supply to the parietal pleura?

A

Intercostal nerves predominantly

91
Q

What is the afferent branch of the choking reflex?

A

Internal laryngeal nerve (branch off of superior laryngeal nerve)

92
Q

What is the venous drainage of the larynx?

A

Thyroid veins –> IJVs

CARDIO-RESPIRATORY (25 decks)

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