D1 anatomy test2 Flashcards
between what vertebrae separates the superior from inferior mediastinum?
T4-T5, inferior part has the heart
describe the development of lungs in relation to mediastinum
lungs grow out from mediastinum becoming surrounded by the pleura
pleural cavities are surrounded by what cells?
mesothelial cells
what is in the root of the lung?
pulmonary vessels, lymphatic tissue, nerves
parietal pleura vs visceral pleura
parietal is the outer layer. Visceral is directly on the lungs
what is a recess?
space of thoracic cavity the pleura doesn’t cover.
name the largest recess
costodiaphragmatic recess
how high does the pleura cavity extend in the neck?
2-3 cm above rib 1
what is a axillary inlet
gateway from thorax to superior limbs
what makes it?
superior margin of scapula, clavicle, lateral margin of rib 1. Brachial plexus passes through this.
what separates the abdomen from thorax?
diaphram
2 pathways structures enter the abdomen
pass through, pass posteriorly
pathway of inferior vena cavae
through central tendon near T8
esophagus pathway
through the muscular part near the mediastinum near T10
Aortic pathway
posteriorly to diaphragm midline at T12
breasts have 3 things
glands, superficial fascia, skin
lymphatic drainage of medial parts of breast
parasternal nodes
lymphatic drainage of lateral parts of breast
axillary region of upper limb
what nerves innervate breasts?
intercostal nerves 4-6
Explain why vertebral level 4-5 is important clinically
rib counting to find rib 2 (The clavicle covers rib 2), Also separates superior/inferior mediastinums, marks superior limit of pericardium, marks the aortic arch, Bifurcation of trachea
give some reasons why the venous system shunts left to right
Right atrium is on right side of body, superior & inferior vena cavae are on right side
what delivers the left side of the body (head, neck, upper limb, part of thorax) to superior vena cava?
left brachiocephalic vein
what drains everything else?
hemiazygos, accessory hemiazygos veins
why is the anterior part of the rib more inferior that the posterior part?
to allow expansion of the rib cage during respiration. The anterior thoracic wall moves
why is the middle part of the rib lower than both ends?
to allow it to elevate during inhalation
what causes the rib cage to change volume vertically?
the diaphragm pushing up
Pectoralis major m.
Largest and most superficial of pectoral region
Origination of pectoralis major m.
anterior surface of medial 1/2 of clavicle, sternum, costal cartilage
insertion of pectoralis minor
lateral lip of intertubercular groove
action of pectoralis major m
adducts, flexion, medially rotates humerus
origin of pectoralis minor m.
anterior surface of rib 3-5
insertion of pectoralis minor
coracoid process of scapula
action of pectoralis minor m.
pulls shoulder inferiorly
what is the clavipectoral fascia?
covers pectoralis minor and attaches to clavicle
what makes the Superior thoracic aperature
body of vertebra T1, medial margin of rib 1, manubrium
what makes the inferior thoracic aperature
body of T12, rib 12 & distal end of 11, distal cartilaginous ends of ribs 7-10, xiphoid process
Thoracic vert. with ribs
3 articulations,
what are demifacets?
where the ribs articulate with the vertebra ( superior & inferior demifacets)
what ribs only have one demifacet?
T1 and T10
which ribs don’t articulate with the transverse processes?
11,12 because the are floating ribs
name the true ribs and why theyre true
1-7, they articulate directly with the sternum
name the false ribs
8-12
what is the scalene tubercle and what rib is it found
rib 1, superior surface has 2 grooves. Anterior groove is for subclavian vein, posterior is for subclavian artery
what kind of joint is the costotransverse joint?
synovial, stabilized by 2 extracapsular ligaments. costotransverse lig. and lateral costotransverse lig.
costotransverse ligament
medial to joint, attaches neck of rib to transverse process
lateral costotransverse ligament
lateral to joint, attaches tip of transverse process to tubercle of rib
what kind of movement happens at these joints
gliding and sliding
joint of the head of the rib
synovial with 2 compartments and an intra-articular ligament that attaches crest to adjacent intervertebral disc. All this is surrounded by a joint capsule
sternocostal joints
between upper 7 costal cartilages and sternum. joint of rib 1 is fibrocartilagenous and the rest are synovial with sternocostal ligaments
interchondral joints
between ribs7-10
vessels organization in intercostal grooves
vein is most superior, then artery, then the nerve. ( the nerve is often not protected because its so low)
what is the endothoracic fascia?
deep to costal groove and full of fat.
name the 3 intercostal muscles and their organization
external ( superficial), internal ( between), innermost ( deep)
external intercostal muscles
11 pairs, most active in inspiration
external intercostal membrane
the external intercostal muscles turn into this as they reach the costal cartilage
internal intercostal muscles
11 pairs, inferior lateral edge of costal grooves to superior margins. Mostly active during expiration
internal intercostal membrane
end of muscle near the vertebral column
innermost intercostal muscles
same orientation as the internal
supreme intercostal arteries
forms the upper 2. The supreme intercostal arteries are a branch of the costocervical trunk
what is the costocervical trunk derived from?
it is a posterior branch of the subclavian artery
Where are the remaining 9 pairs derived from?
branches off of the aorta
where do anterior intercostal arteries derive from?
directly or indirectly from internal thoracic arteries
internal thoracic artery is derived from and turns into what?
derived from the subclavian artery in neck. As it descends it turns into the superior superior epigastric artery &musculphrenic arteries
where does the superior epigastric artery go?
into the anterior abdomen wall
where does the musculophrenic artery go?
through the diaphragm and ends at the last intercostal space
which one supplies the upper 6 ribs? Lower6?
internal thoracic artery, musculophrenic artery
parasternal nodes
thoracic wall drains here. Then drains to bronchomediastinal trunks
where do intercostal nodes in lower thorax drain?
thoracic duct
where do superficial regions drain?
axillary lymph nodes
innervation of thorax
mainly by intercostal nerves which are anterior rami of spinal nerves
Trachea starting and ending point
C6-T4/T5 plane
what is the name of the lowest tracheal cartilage around the bifurcation?
carina
which main bronchus is wider with a vertical course?
right. This is why inhaled stuff get stuck here more often
name the bifurcations of the trachea
trachea, main bronchus, lobar bronchus, segmental bronchus
describe a bronchopulmonary segment
kind of like a dermatome for lungs. It is an area of the lung supplied by a segmental bronchus. It is the smallest functionally independent region of a lung that can be removed. There are a total of 10 of these.
which pulmonary artery is longer and why
right, because the heart is laid on its side.
where do physicians listen to each lobe?( right lung)
superior lobe- anterolateral thoracic wall
middle lobe-lower anterior and lateral wall
inferior lobe- posterior and inferior walls
pulmonary arteries carry what
deoxygenated blood to the lungs
where does the right bronchial artery originate?
3rd posterior intercostal atery
where do the 2 left bronchial arteries arise from?
anterior surface of aorta
where do bronchial veins drain ?
either pulmonary veins or left atrium, into azygos vein on right or hemiazygos vein on left
name the 2 plexuses that innervate the lungs and where they are
anterior, posterior pulmonary plexuses. They are behind or in front of the tracheal bifurcation
visceral efferents from the vagus nerve…………
constrict the bronchioles
visceral efferents from the sympathetic system …..
dilate the bronchioles
lymph nodes of lungs
drain in tracheobronchial nodes which are around lobar and main lobes .
lymphatic drain pathway of lungs
tracheobronchial nodes->parasternal nodes & bronchomediastinal nodes-> bronchomediastinal trunks-> drain into base of neck
3 blood entrances into the right atrium
superior, inferior vena cava, coronary sinus
what is the sinus of venae cavae?
smooth thin walls that both venae cavae empty into
foramen ovale function
shunts blood away from the RA to the LA to by pass the lungs
what is the foramen ovale called as an adult?
fossa ovalis
conus arteriosus
out flow from the right ventricle to the lungs
what is trabeculae carneae?
This is a muscle layer in ventricles
Right ventricle papillary muscles
anterior, posterior, septal
what is the septomarginal trabecular( moderator band)
carries part of conduction system .
where is the tricuspid valve found?
right atrioventricular valve. Cusps are held together by commissures at base
name the 3 cusps of the tricuspid valve
anterior, posterior, septal
pulmonary valve
3 semilunar valves. Left, right, and anterior semilunar cusps
2 papillary muscles of the left ventricle
anterior, and posterior papillary muscles
Parts of the interventricular septum
upper membranous, and lower muscular.
mitral valve
left atrioventricular valve, Anterior, and posterior cusps joined by commissures.
Aortic valve
3 semilunar cusps. Right, Left, Posterior aortic sinuses
which semilunar cusps do the coronary sinuses arise from?
right and left cusps. This is why the posterior cusp is reffered to as noncoronary sinus and cusp
name the 2 types of valve diseases
incompetence- poorly functioning valves, stenosis- a narrowing of the orifice caused by the inability of the valve to open all the way
what can heart diseases cause?
left ventricular hypertrophy, increased pulmonary venous pressure, pulmonary edema, hypertrophy of left atrium
pulmonary valve disease is most likely caused by……
a sort of disease
most common heart abnormality
atrial/ ventricular defects during development.
What is ASD/ VSD?
Atrialseptal defect, ventriculoseptal defect
which one is more common?
VSD ( happen in the membranous part of the septum)
Purpose of ductus arterioses
blood that slips into the pulmonary artery goes through this shunt into the aorta to the body. This is another by pass of the lungs
PDA?
Persistent ductus arteriosus, When the ductus arterioses fails to close
name the cardiac conduction pathway
SA node, AV node, AV bundle, left and right branches, purkinje fibers
the autonomic division of the PNS is responsible for 3 things
heart rate, cardiac output, force of each contraction
where are the cardiac plexuses located?
Superficial & deep, ( anterior to aorta and posterior to aorta)
Parasympathetic innervation of cardiac sys.
decrease heart rate, reduces force of contraction, constricts the coronary arteries
sympathetic innervation of cardiac sys.
increases heart rate, increases the force of contraction.
visceral afferents in cardiac sys.
sense alterations of blood pressure and chemistry
what layer of the pericardium covers the ascending aorta & pulmonary trunk?
visceral layer of the pericardial sac
at what level does the pulmonary trunk divide into right & left pulmonary arteries?
T5-T6
where is the superior mediastiunum?
posterior to manubrium and sternum and anterior to bodies of first 4 cervical vert.
what are the superior and inferior boundaries of the superior mediastinum?
oblique plane from manubrium to T1, T4/T5 plane
what borders it laterally?
parietal pleura from the lungs
major structures found in superior mediastinum….
Thymus, R/L Brachicephalic veins, superior vena cava, trachea, esohpagus, phrenic nerves, vagus nerves……….
left superior intercostal vein receives what posterior intercostal veins?
2-3
inferiorly the left superior intercostal vein sometimes connects to what?
accessory hemiazygos vein
how much of the inferior vena cava in contained in the pericardial sac?
the lower half. Remember the pericardial sac is the middle mediastinum.
the Brachiocephalic trunk divides into what two arteries?
right subclavian, right common carotid arteries
what do these two arteries supply?
right side of head and neck , upper right limb
name the small branch that occasionally is on the brachiocephalic trunk
thyroid ima artery- vascular supply to thyroid
second branch of the aortic arch
left common carotid artery ( supplies left side of head and neck)
third branch of aortic arch
right subclavian artery ( sullies left upper limb)
what lies on the left and right sides of the trachea and esophagus in the thorax area?
left - aorta, right- azygos vein
vagus nerves
as they pass through the thorax they provide parasympathetic innervation to the thoracic viscera and carry afferents from the thoracic viscera
special characteristic of the Visceral Afferents of Vagus nerve
relay info to CNS about normal physiological processes and reflex activities, not pain
where do the phrenic nerves arise?
cervical region mainly from 4th but also 3rd and 5th cervical spinal cord segments
what do phrenic nerves do?
motor and sensory innervation to diaphragm and its membrane
At what level does the thoracic duct shift to the left side? Where does it empty?
T5, Junction between the internal jugular vein and left subclavian vein
where does the right bronchomediastinal trunk drain?
the right sublcavian vein
where does the thoracic duck start and end?
L2-lower neck
how does it leave the thorax?
aortic hiatis
Where do the internal thoracic arteries branch from and what do they turn into
from the subclavian arteries, they turn into the musculophrenic arteries and superior epigastric arteries
where does the right supreme intercostal artery come from?
costocervical trunks witch are on the subclavian arteries.
Where does the azygos vein dump?
superior vena cava
which side does the azygos vein cover?
right side of thorax
where does the left superior intercostal artery come from
left brachiocephalic vein, it gives of the first 3-4 posterior intercostal veins
what level does the accessory hemiazygos vein start?
T8, T4-T8 posterior intercostal veins.
where does the accessory hemiazygos vein start and end? what veins does it supply?
starts ~T9, ends at right ascending lumbar vein/ left subcoastal vein junction , lower T4-T5 posterior intercostal veins
